目的 探讨miR-221在急性心肌梗死(AMI)大鼠心肌损伤中的作用及相关机制.方法 通过冠状动脉左前降支结扎大鼠建立AMI模型,将构建成功的36只AMI大鼠模型随机分为AMI组、对照组及抑制组,另外设立假手术组采用冠状动脉左前降支穿线不结扎,每组各12只.抑制组和对照组分别采用心肌组织局部注射慢病毒转染的miR-221抑制剂及miR-221 NC,AMI组和假手术组每天给予等量生理盐水,隔日1次,连续2 w.实时定量-聚合酶链反应(PCR)检测miR-221表达,记录大鼠心脏功能,并采用原位末端凋亡法(Tunel)检测心肌凋亡指数(AI),紫外分光光度法检测含半胱氨酸的天冬氨酸蛋白水解酶(Caspase)3及Caspase-9活性,Western印迹检测Bcl-2、Bax,增殖细胞核抗原(PCNA),Ki67蛋白表达及细胞外蛋白调节激酶(ERK1/2)磷酸化水平.结果 与假手术组miR-211表达量相比,AMI组显著提高(P<0.01).与假手术组miR-211表达量相比,AMI组及对照组均显著提高(P<0.01);与AMI组及对照组相比,抑制组显著降低(P<0.01).与假手术组和抑制组比较AMI组及对照组左室射血分数(LVEF)、左室长轴缩短分数(FS)水平均显著降低,而左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)水平均显著升高(P<0.01).与假手术组心肌AI相比,AMI组及对照组均显著提高(P<0.01);与AMI组及对照组相比,抑制组显著降低(P<0.01).与假手术组相比,AMI组及对照组中心肌组织中Caspase-3及Caspase-9活性明显升高(P<0.01);与AMI组及对照组相比,抑制组中心肌组织中Caspase-3及Caspase-9活性显著降低(P<0.01).与假手术组比较,AMI组及对照组中Bcl-2、PCNA及Ki67表达量明显下调(P<0.01),Bax表达量明显上调(P<0.01);与AMI组及对照组比较,抑制组中Bcl-2、PCNA及Ki67表达量明显上调(P<0.01),Bax表达量明显下调(P<0.01).与假手术组p-ERK1/2表达量比较,AMI组及对照组明显下调(P<0.01);与AMI组及对照组比较,抑制组明显上调(P<0.01).结论 miR-221低表达能显著AMI大鼠心肌损伤,与上调EKR1/2磷酸化水平相关.

Objective: To explore the role and related mechanism of mammalian sterile 20-like kinase 1(Mst-1)in regulating hypoxia reoxygenation (HR) induced myocardial cell autophagy and apoptosis. Methods: Enzyme digestion method combined with differential adherent method was used to culture neonatal mouse myocardial cells. HR model was established by hypoxia for 24 hours and reoxygenation for 6 hours. The experimental groups including control group (normal cultured cardiomyocytes), Mst-1 empty virus group (cardiomyocytes transfected with recombinant lentiviral empty vector for 48 hours), Mst-1 knockdown group (recombinant lentivirus carrying Mst-1small interfering RNA (siRNA) was transfected into cardiomyocytes for 48 hours), Mst-1 overexpression group (cardiomyocytes were transfected with recombinant lentivirus carrying Mst-1 gene for 48 hours), HR group (cardiomyocytes exposed to HR), Mst-1 knockdown+HR group (HR model of cardiomyocyte was established 48 hours after transfection with recombinant lentivirus carrying Mst-1siRNA) and Mst-1 overexpression+HR group (HR model of cardiomyocyte was established 48 hours after transfection with recombinant lentivirus carrying Mst-1 gene). Real-time fluorescence quantitative RCR (qPCR) and Western blot were used to detect the relative expression of Mst-1 mRNA and protein in the cells, immunofluorescence staining was used to detect cardiomyocyte troponin T (cTnT), and autophagosomes and autophagy enzyme changes. TUNEL method was used to detect myocardial cell apoptosis, Western blot was adopted to detect autophagy-related protein microtubule-related protein 1 light chain 3 (LC3) Ⅱ/LC3 Ⅰ, P62 and apoptosis-related protein cleaved-caspase 9, pro-caspase 9, cleaved-caspase-3, pro-caspase-3, and myeloid leukemia 1 (MCL-1) expression. MCL-1 inhibitor A1210477 was used to validate the signaling pathway of Mst-1 on regulating cardiomyocyte apoptosis and autophagy. Results: Immunofluorescence detection revealed that the cultured cells expressed cardiomyocyte-specific marker cTnT. The expression of Mst-1 in cardiomyocytes increased in HR model. Lentiviral transfection could effectively inhibit or overexpress Mst-1 in treated cells. The levels of autophagosomes and autophagolysosomes in cardiomyocytes undergoing HR and in Mst-1 overexpression+HR group were lower than those of control group, while autophagosomes and autophagolysosomes in cardiomyocytes of Mst-1 knockdown+HR group was significantly higher than in the HR group (all P<0.05). The TUNEL results showed that the proportion of TUNEL positive cells was significantly increased in the HR group and Mst-1 overexpression+HR group than in the control group, while the proportion of TUNEL positive cells was significantly decreased in the Mst-1 knockdown group+HR group as compared to the HR group (all P<0.05). Western blot results showed that the LC3 Ⅱ/LC3 Ⅰ levels were significantly lower, while the expression levels of P62, cleaved-caspase-9 and cleaved-caspase-3 were significantly higher in the HR group and Mst-1 overexpression+HR group than in control group (all P<0.05). The LC3 Ⅱ/LC3 Ⅰ value was significantly higher, and the expression levels of P62, cleaved-caspase-9 and cleaved-caspase-3 were significantly lower in the Mst-1 knockdown+HR group than in the HR group (P both<0.05). The expression level of P-MCL-1 protein was significantly lower in cardiomyocytes of HR and Mst-1 overexpression+HR group than in control group, and the expression level of P-MCL-1 protein was higher in Mst-1 knockdown+HR group than in HR group (P both<0.05). The recovery experiment showed that inhibiting MCL-1 in cells can block the regulatory effect of Mst-1 siRNA on cell autophagy and apoptosis. Conclusion: Inhibiting Mst-1 expression in cardiomyocytes can promote the autophagy of cardiomyocytes induced by hypoxic reoxygenation and reduce the apoptosis of cardiomyocytes via activating McL-1.

目的 探讨参麦注射液对内毒素诱导心肌细胞凋亡的影响.方法 原代培养乳鼠心肌细胞,分为对照组,内毒素(LPS)处理组,参麦注射液(SMI)+内毒素(LPS)处理组.MTT法检测心肌细胞存活率;流式细胞仪检测心肌细胞凋亡;RT-PCR检测心肌细胞Wnt2、β-catenin mRNA的表达;Western blot检测心肌细胞内Wnt2、β-catenin蛋白表达.结果 0.8 g/L与1 g/L SMI组心肌细胞存活率高于LPS组;0.8 g/L与1 g/L SMI组心肌细胞凋亡率低于LPS组.SMI+ LPS组中Wnt2、β-cateninmRNA的表达随SMI剂量的增加而降低,0.8 g/L SMI组中β-cateninmRNA表达低于LPS组,1g/L SMI组中Wnt2、β-catenin mRNA表达低于LPS组;SMI+ LPS组中Wnt2、β-catenin蛋白的表达随SMI剂量的增加而降低,0.8 g/L SMI组中β-catenin蛋白表达低于LPS组,1g/L SMI组中Wnt2、β-catenin蛋白表达低于LPS组,差异有统计学意义(P＜0.05).结论 参麦注射液对内毒素诱导的乳鼠心肌细胞凋亡具有明显的抑制作用,其机制可能与抑制Wnt2、β-catenin的表达有关.

目的 探讨心外膜脂肪体积(EATV)及血清基质金属蛋白酶-2(MMP-2)与冠状动脉粥样硬化斑块稳定的相关性.方法 选择冠心病126例(冠心病组),根据疾病类型分为稳定型心绞痛(SA)46例、不稳定型心绞痛(UA)49例和急性心肌梗死(AMI)31例;按照斑块稳定类型分为稳定型46例和不稳定型80例;根据斑块成分分为软斑块40例、混合斑块39例和钙化斑块47例.另外选择同期性别、年龄匹配无器质性心脏病的室上性心动过速患者72例作为对照组.检测各类患者EATV和血清MMP-2水平,分析冠心病患者EATV和MMP-2的相关性.结果 与对照组比较,冠心病组EATV增大,血清MMP-2水平升高(P均<0.05).与稳定型斑块患者相比,不稳定型斑块患者EATV增大,血清MMP-2水平升高(P均<0.05).SA、UA、AMI患者EATV逐渐增大,血清MMP-2水平逐渐升高,软斑块,混合斑块、钙化斑块患者逐渐EATV增大,血清MMP-2水平逐渐升高,差异均有统计学意义(P均<0.05).Pearson相关性分析显示,冠心病患者EATV大小与血清MMP-2水平呈正相关(r=0.752,P=0.019).结论 冠心病患者EATV增大,血清MMP-2水平升高,且EATV增大及血清MMP-2水平升高程度与冠心病的类型、斑块稳定性及斑块成分密切相关.

目的:采用低分子肝素联合华法林法治疗器质性心脏病心房颤动,并对治疗效果进行详细探究.方法:随机选取遵义医学院附属医院2015年5月至2016年5月收治的40例重症心力衰竭患者作为研究对象,所有患者均于用药前行下肢血管多普勒检查,排除血栓.组织所有患者进行心电图或动态心电图检查,均确诊为器质性心脏病心房颤动.根据随机分配原则,分为对照组和观察组,每组各20例.在组织患者治疗前,对两组患者进行血糖血脂控制治疗.对于对照组患者,采用阿司匹林进行治疗;对于观察组患者,采用华法林+注射用低分子量肝素钠进行治疗.对两组患者治疗效果进行比较和分析.结果:治疗期结束后,对两组患者血栓栓塞情况进行统计和分析,对照组血栓发生率为70.0％,观察组血栓发生率为10.0％,观察组患者血栓发生几率明显低于对照组患者.结论:采用低分子肝素联合华法林法治疗患者器质性心脏痛心房颤动,治疗效果显著.

目的:在临床医学实践中,诊断学是医学专业中十分重要的一门课程,是联系基础和临床医学的桥梁.本文从临床见习角度,对诊断学教学中存在的问题及诊断学教学改革措施进行探究,以期促进诊断学教学质量的提升.

Objective:To investigate the clinical efficacy of warfarin combined with low molecular weight heparin in preventing thromboembolism.Methods:40 patients with surgical operation were selected.They were randomly divided into the two groups on average.The control group was treated with conventional treatment.After surgery for 1~ 3 days,on the basis of conventional treatment,the observation group used warfarin combined with low molecular weight heparin in thrombosis prevention.The thrombosis situations of the two groups were statistically counted and analyzed.Results:The incidence of thrombosis in observation group was lower than that in the control group (P<0.05).Conclusion:For patients after surgery,warfarin and low molecular weight heparin to prevent thrombosis can obtain good preventive effect.

目的 观察阿司匹林(ASP)与异钩藤碱(Iso)合用对家兔体外血小板聚集的影响.方法 通过体外血小板聚集实验,采用比浊法测定ASP与Iso合用对胶原(Col)、凝血酶(Thr)及二磷酸腺苷(ADP)诱发的家兔血小板聚集率的影响.结果 ASP与Iso合用可抑制由C01(50 mg·L-1)、Thr(3 U·mL-1)及ADP(15μmol·L-1)诱导的血小板聚集.结论 ASP与Iso合用能协同抑制家兔体外血小板聚集.

目的 评价心脏再同步治疗(CRT)心力衰竭的临床疗效,分析CRT无反应患者的可能原因.方法 收集接受CRT治疗的充血性心力衰竭患者28例,CRT后定期随访,比较CRT前、后患者心功能、左心室射血分数(LVEF)、左心室舒张末内径(LVEDD)的变化.结果平均随访(8.72±8.31)个月,20例接受CRT的患者心功能改善,LVEF增加(P<0.05),8例患者对CRT无反应.结论 CRT能改善慢性充血性心力衰竭患者的左心室收缩功能,CRT反应与患者是否合并基础心脏疾病、左心室电极植入位置以及是否存在心脏机械收缩不同步有关.

Objective To assess the clinical outcomes in chronic heart failure(CHF) patients after cardiac resynchronization therapy(CRT).Methods Twenty-nine CHF patients who underwent CRT were included in this study.The patients were regularly followed up,during which their heart function,left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter (LVEDD) were observed and their clinical outcomes after CRT were assessed.The clinical outcome was defined as effective when the heart function wasgrade 1 according to the NYHA classification or when the left ventricular end systolic volume was15%or the absolute LVEF value was0.05%according to the echocardiographic findings.Otherwise,it was defined as non-response to CRT.Results The patients were followed up for 6-24 months(8.7±8.3 months). The LVEDD was significantly shorter,the heart function grade was significantly lower,and the LVEF value was significantly higher in 21 patients after CRT than before CRT(73.9±8.0 mm vs 68.7±10.2 mm,3.1±0.1 vs 2.0±0.1,34±7%vs 42 + 6%,P0.05).Of the 29 patients,21 (72.4%) had response to CRT and 8(27.6%) had no response to CRT including 2 who died.Conclusion CRT can improve the systolic function of left ventricule and response to CRT is related with the non-synchronic heart mechanical contraction in CHF patients.

<正>目前射频消融治疗阵发性室上性心动过速(简称室上速)已成为一线治疗。射频消融行房室结折返性心动过速(atrioven-tricular nodal reentrant tachycardia,AVNRT)慢径改良中并发Ⅲ度房室传导阻滞发生率为0～3%,多发生于消融过程中[1]。本

目的总结CARTO-Merge技术指导心房颤动射频消融方法,观察其治疗的安全性和近期疗效。方法 6例房颤患者在Carto-Merge指导下进行环肺静脉消融术,观察其成功率、复发率及手术并发症。结果 5例患者手术即刻评估均成功消融,1例持续性房颤患者在消融后转为房性心动过速(标测示为窦房结旁房速),5例患者随访1～2年至今无复发。结论在CARTO-Merge技术指导心房颤动射频消融安全,能有效缩短学习曲线,提高手术成功率,减少并发症的发生。

目的分析射频消融治疗房室房道所致阵发性室上性心动过速不成功的原因以提出相应对策。方法回顾性分析1998年至2006年4月216例旁道消融情况,常规放置右房、右室及冠状窦电极,行心内电生理检查明确左侧或右侧旁道,经股动脉或股静脉进大头电极于二尖瓣环或三尖瓣环标测消融。结果216例房室旁道,成功消融201例,成功率93%,失败15例,占6.9%,其中右侧旁道13例,占5.9%,希氏束旁道1例占0.46%,左后间隔旁道1例,占80.46%。结论射频消融根治房室房道引起室上速有效并较安全,但部分病例未成功,初期消融失败主要为导管操作不熟练和旁道标测不精细,后期主要原因为右侧旁道解剖特点和靶点图识别不准确有关。

慢性心力衰竭(CHF)是心内科治疗上的难题,尽管药物治疗取得了突破性的进展,但仍是具有较高患病率和死亡率的严重疾病[1].近年来人们在尝试应用心脏再同步化治疗(Cardiac resynchronization therapy,CRT)慢性重度心力衰竭患者,取得了可喜的进展.CRT是在传统的右心房、右心室双心腔起搏基础上增加左心室起搏,以恢复房室、室间和室内运动的同步性.

目的观察介入方法治疗先天性心脏病的临床疗效。方法本组病例均采用国产封堵器经股动脉或股静脉途径修补房间隔缺损、室间隔缺损,采用进口二尖瓣球囊扩张肺动脉瓣狭窄2例,应用弹簧圈封堵动脉导管未闭1例,应用国产蘑菇伞封堵动脉导管未闭4例。结果完成介入治疗59例,房间隔缺损封堵19例,失败1例,室间隔缺损封堵34例,成功封堵5例动脉导管未闭。随访3～22mo无1例残余分流。结论经导管介入治疗简单先心病成功率及安全性均较高,是疗效可靠的治疗方法。

Objective:In order to analysis the clinical character of stenosis of right coronary artery(PCA).Methods:According to the results of coronary arteriography of the patient from 2002 to 2006,all patients were divided into two groups:single coronary artery stenosis group and multi-coronary artery stenosis group.Then the difference of prevalence rate of coronary artery stenosis between RCA and left coronary artery(LCA)was compared.Results:In the prevalence rate of coronary artery stenosis there was no significant difference(P<0.05)between RCA and LCA in multi-coronary artery stenotsis group.However,in the group of single coronary artery stenosis,the prevalence rate of coronary artery stenosis of RCA was less than that of LCA(P<0.001).Conclusion:The morbidity of RCA stenosis is less than that of left coronary artery.

近年来随着冠心病介入诊疗技术的发展,冠心病的治疗已由传统的单一内科药物治疗,发展到药物治疗基础上合用介入治疗,并且经皮冠状动脉介入治疗(PCI)已成为治疗冠心病的重要手段.现将我院2003年1月至2006年4月经皮冠状动脉介入治疗冠心病的临床资料报告如下.

显性房室旁道是预激综合征的常见类型,显性房室旁道可分布于除主动脉和二尖瓣环连接处之外任何瓣环部位[1],不同部位显性房室旁道在体表心电图上表现不同,因此,根据体表心电图可确定房室旁道在瓣环上的部位,为射频消融(RFCA)提供参考.

<正>阵发性心动过速是临床常见心律失常,最常见的两种类型为房室结折返性心动过速(atrioventric- ular nodal reentry tachycardia,AVNRT)和房室折返性心动过速(atrioentricular reentry tachycardia AVRT)。前者约占室上速总数的50％,后者约

冠心病(CAD)是最常见的严重威胁中老年身体健康的首要疾病之一,而选择性冠状动脉造影是目前诊断冠心病最成熟、可靠的方法.近年随着CAD介入诊疗技术的发展,CAD的治疗已由传统的单一药物治疗,发展到药物治疗基础上合用内科介入治疗及外科主动脉-冠状动脉旁路移植术(CABG).而冠状动脉造影(CAG)为其提供了准确的依据,是进行冠状动脉介入治疗的基础.我院自2003年1月份开展CAG至今,共完成400例冠状动脉造影,并对其中135例患者行冠状动脉介入治疗.现对其进行回顾性分析,以指导下一步的临床诊断与治疗.