目的 研究β2-肾上腺素能受体对心肌炎大鼠炎症因子的影响和调节机制.方法 通过Freund's adjuvant(CFA)及猪心肌肌球蛋白(PCM)感染易致敏的Lewis大鼠,构建EAM大鼠模型,并随机分为对照组、自身免疫性心肌炎组(EAM组)和β-肾上腺素能受体拮抗剂处理的自身免疫性心肌炎组(EAM+PRO组).采用Trizol法提取总RNA;RT-PCR法检测β2-AR的mRNA表达;HE染色检测大鼠的心肌组织炎症浸润情况;ELISA法检测IL-1β、IL-6、TNF-α、MCP-1和ICAM-1水平;RIPA法提取总蛋白;蛋白质免疫印迹法检测NLRP3、IL-18和Caspase-1蛋白的表达量.结果 与对照组相比,EAM组大鼠的心率、LVIDd和LVIDs指标显著增加,EF和FS指标则显著降低,差异有统计学意义(P<0.05);EAM组大鼠中β2-AR的mRNA表达量显著上调(P<0.05);与EAM组相比,拮抗剂组(EAM+PRO)β2-AR的mRNA表达量显著下调,差异有统计学意义(P<0.05);EAM组大鼠心肌组织的炎症浸润程度明显高于对照组,EAM+PRO组炎症浸润程度显著低于EAM组,差异有统计学意义(P<0.05).与对照组相比,EAM组的NLRP3、Caspase-1和IL-18的蛋白表达量均显著上调(P<0.05),EAM组大鼠中IL-1β、IL-6和TNF-α的含量均显著升高(P<0.05),EAM组大鼠中MCP-1和ICAM-1的含量均显著升高(P<0.05).与EAM组相比,EAM+PRO组大鼠NLRP3、Caspase-1和IL-18蛋白的表达量均显著下调(P<0.05).结论 EAM可能促进大鼠心肌细胞中β2-AR的表达,并促进NLRP3的表达从而上调Caspase-1的表达;Caspase-1又会导致IL-18的激活并释放到细胞外,引起细胞趋化因子MCP-1和粘附分子ICAM-1等分泌增加,这可能会引起心脏炎症及心功能的改变.

目的:研究急性ST段抬高型心肌梗死(ASTEMI)患者血清乙酰肝素酶(HPSE)、信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE1)水平与血栓负荷的关系.方法:纳入我院于2019年11月-2020年12月期间收治的118例ASTEMI患者作为研究对象,将其按照冠状动脉造影明确的血栓负荷程度差异分作低血栓负荷组(72例)以及高血栓负荷组(46例).检测并比较两组血清HPSE以及SCUBE1水平,通过单因素及多因素Logistic回归分析ASTEMI患者高血栓负荷的相关影响因素.此外,采用受试者工作特征(ROC)曲线分析血清HPSE以及SCUBE1预测ASTEMI患者高血栓负荷的效能.结果:高血栓负荷组血清HPSE以及SCUBE1水平均高于低血栓负荷组(P＜0.05).经多因素Logistic回归分析发现:血清HPSE、SCUBE1、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平均是ASTEMI患者高血栓负荷的危险因素,而术后冠脉心肌梗死溶栓试验(TIMI)分级为Ⅲ级是保护性因素(均P＜0.05).经ROC曲线结果显示:血清HPSE以及SCUBE1联合检测预测ASTEMI患者高血栓负荷的曲线下面积、敏感度、特异度及约登指数均明显高于上述指标单独预测.结论:ASTEMI患者血清HPSE以及SCUBE1均和血栓负荷密切相关,联合检测具有预测ASTEMI患者高血栓负荷的价值.

目的 研究黄芪多糖(APS)对缺氧/复氧(H/R)所致乳鼠心肌细胞损伤的保护作用及其机制.?方法 分离并体外培养乳鼠心肌细胞3 d后随机分为五组,正常组、H/R组、APS低、中、高剂量(20、40、80μmol/mL)组;给药干预30 min后,H/R组和APS各剂量组给予缺氧2.5 h后复氧处理.复氧2 h后,CCK-8法检测细胞增殖抑制率,Annexin V-FITC/PI染色法检测细胞凋亡水平,生化分析法检测培养液中乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)水平,酶联免疫吸附(ELISA)法检测培养液中N末端脑钠肽前体(NT-proBNP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平,Western blot法检测糖调节蛋白78(GRP78)、CCAAT/增强子结合蛋白同源蛋白(CHOP)、激活型半胱氨酸蛋白酶-12(cleved caspase-12)、B细胞淋巴瘤基因-2(bcl-2)、bcl-2相关X蛋白(Bax)、核因子-κB(NF-κB)蛋白表达. 结果与正常组比较,H/R组细胞增殖抑制率和凋亡率升高(P<0.01),培养液中LDH、CK、CK-MB水平和NT-proBNP、TNF-α、IL-1β 水平升高(P<0.01);GRP78、CHOP、Cleved Caspase-12、Bax、NF-κB蛋白表达上调而bcl-2表达下调(P<0.01),bcl-2/Bax比值降低(P<0.01).与H/R组比较,APS中、高剂量细胞增殖抑制率和凋亡率降低(P<0.01),培养液中LDH、CK、CK-MB水平和NT-proBNP、TNF-α、IL-1β水平降低(P<0.05);GRP78、CHOP、Cleved Caspase-12、Bax、NF-κB蛋白表达下调而bcl-2表达上调(P<0.01),bcl-2/Bax比值升高(P<0.01).?结论 APS可以减轻H/R诱导的乳鼠心肌细胞损伤,可能与APS抑制内质网应激通路介导的细胞凋亡和炎症反应有关.

目的:探讨黄芪多糖(APS)对缺氧/复氧(H/R)所致乳鼠心肌细胞凋亡与自噬抑制作用的相关机制.方法:分离并体外培养乳鼠心肌细胞3 d后制备H/R损伤细胞模型,设正常对照组、H/R组、APS低、中、高剂量(20、40、80μmol/ml)组,各组于造模前30 min给药处理.复氧2 h后,CCK-8法检测细胞增殖抑制率,Annexin V-FITC/PI染色法检测细胞凋亡水平,Western blot法检测p-Akt、Cleaved Caspase-3、Bcl-2、Bax、p-mTOR、Beclin1、LC3、P62蛋白表达.结果:与H/R组比较,APS中、高剂量细胞增殖抑制率和凋亡率显著降低(P<0.01),p-Akt、p-mTOR、Bcl-2表达量显著升高而Cleaved Caspase-3、Bax、Beclin1、LC3-Ⅰ、LC3-Ⅱ、P62表达量显著降低(P<0.05),Bcl-2/Bax比值显著升高、LC3-Ⅱ/LC3-Ⅰ比值显著降低(P<0.01).结论:APS可能通过激活Akt/mTOR通路调控凋亡和自噬相关蛋白表达,对H/R所致乳鼠心肌细胞凋亡与自噬起到抑制作用.

目的 探讨血小板功能和基因检测指导下抗血小板作用的关系.方法 收集2018年12月～2019年12月我院治疗的200例冠心病患者,通过基因芯片检测试剂盒鉴定血小板功能基因型,根据血小板功能基因多态性检测结果将患者分为野生型组和突变型组.通过光比浊法测定两组患者的血小板抑制率,并比较两组患者的氯吡格雷抵抗情况.结果 200例患者中共有47例(23.5％)发生氯吡格雷抵抗现象,其中野生型组18例(9.00％),突变型组46例(44.00％),差异具有统计学意义(P<0.05).结论 血小板功能基因多态性、糖尿病、体质指数是氯吡格雷抵抗的重要影响因素,检测血小板功能基因多态性、是否患有糖尿病、体质指数有助于指导患者的抗血小板治疗.

早老综合症也被称作是早老病,起属于一种比较罕见的和早发同时相对严重的一种过早老化性的疾病,其核心的临床特征提现为身材矮小和体重低,以及早期脱发与脂肪营养障碍和硬皮病,以及关节可动性减弱等.早老病最初出现在一岁,两岁后可以对其进行确诊,患者存活的平均年龄未13.4岁,通常患者的存活年龄是在7岁至27岁,很少有怀有早老病的患者仍然可以活到45岁,心脑血管疾病是导致早老病产生的核心因素.早老病患者大部分是儿童,研究报道在当前世界范围中发病率达到了1/4000000到1/8000000.并且男性犯病率要比女性发病率高,起比例达到了1.5:1.当前,国内对于早老病发病率进行研究的相关报道极少.

目的 研究黄芪多糖对H2O2所致乳鼠心肌细胞氧化应激损伤的影响,并探讨其可能作用机制.方法 分离并培养乳鼠心肌细胞72h后分为空白对照组、H2O2组、黄芪多糖20μmol/L+ H2O2组、黄芪多糖40μmol/L+ H2O2组、黄芪多糖80μmol/L+ H2O2组,每组设10个复孔.每组给予相应干预24h后,采用MTT法检测细胞存活率,采用紫外-可见分光光度计检测细胞中抗氧化酶[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)]活性,采用氧敏感荧光探针DCFH-DA检测氧自由基(ROS)含量,采用全自动生化分析仪检测培养液中心肌酶[谷草转氨酶(AST)、磷酸肌酸激酶(CPK)、乳酸脱氢酶(LDH)]和丙二醛(MDA)含量,通过流式细胞仪检测细胞凋亡状况并计算凋亡率,采用免疫印迹法检测细胞核因子-κB(NF-κB)蛋白表达情况并进行半定量分析.结果 与H2O2组比较,黄芪多糖40μmol/L+H2O2组和黄芪多糖80μmol/L+ H2 O2组细胞存活率及细胞中SOD、GSH-Px、CAT活性显著升高(P均＜0.05),ROS含量显著降低(P＜0.05),培养液中AST、CPK、LDH和MDA含量及细胞凋亡率、NF-kB蛋白表达量均显著降低(P均＜0.05);黄芪多糖80μmol/L+ H2O2组细胞存活率及细胞中SOD、GSH-Px活性均显著高于黄芪多糖40μmol/L+H2O2组(P均＜0.05),CPK、MDA含量及细胞凋亡率、细胞中NF-κB蛋白表达量均显著低于黄芪多糖40 μmol/L+H2O2组(P均＜0.05).结论 黄芪多糖可能通过提高心肌细胞存活率、改善抗氧化酶活性、提高ROS清除能力、降低心肌酶含量、抑制细胞凋亡、下调NF-kB蛋白表达而对H2O2诱导乳鼠心肌细胞氧化应激损伤起保护作用,且高剂量效果更好.

目的 观察黄芪多糖(APS)对H2O2所致乳鼠心肌细胞损伤的保护作用机制.方法 无菌条件下分离并培养乳鼠心肌细胞72 h后分为空白对照组、H2O2组、APS(20、40和80 μmol/L) +H2O2组,每组设10个复孔.给药干预24 h后,观察比较各组细胞形态、细胞存活率、细胞中抗氧化酶(SOD、GSH-Px、CAT)活性和丙二醛(MDA)含量、培养液中心肌酶(AST、CPK、LDH)活性、细胞凋亡状况及细胞凋亡率情况.结果 倒置光学显微镜下,空白对照组呈单层簇状生长,且伪足多而饱满,搏动明显,节律一致;H2O2组细胞胞浆空泡、伪足少,细胞脱落、悬浮、溶解坏死,搏动弱且频率低、节律不齐等;APS各治疗组与H2O2组比较,心肌细胞形态不同程度好转,且以APS(80 μmol/L)+H2O2组改善效果最明显.H2O2组心肌细胞存活率与空白对照组比较降低(P＜0.01);APS (40、80 μmol/L)+H2O2组细胞存活率与H2O2组比较升高(P＜0.01).H2O2组乳鼠心肌细胞SOD、GSH-Px、CAT活性与空白对照组比较降低,MDA含量则升高(P＜0.01);APS (40、80μmol/L)+H2O2组SOD、GSH-Px、CAT活性与H2O2组比较均升高(P＜0.05或P＜0.01),MDA含量则降低(P＜0.01).H202组乳鼠心肌细胞培养液中AST、CPK、LDH活性与空白对照组比较均升高(均P＜0.01).APS (40、80μmol/L)+H2O2组AST、CPK、LDH活性与H2O2组比较均降低(均P＜ 0.05或P＜0.01).Flow Cytometry检测空白对照组仅存在少量凋亡细胞,H2O2组凋亡细胞数量较空白对照组增多;与H2O2干预组比较,APS干预24 h可明显改善H2O2诱导损伤乳鼠心肌细胞凋亡状况,其以APS(80 μmol/L)+H2O2组效果最明显.H2O2组乳鼠心肌细胞凋亡率与空白对照组比较升高(P＜ 0.01);APS (40、80μmol/L) +H2O2组细胞凋亡率与H2O2组比较则降低(P＜0.01).结论 APS可通过有效改善细胞生存状态、提高细胞存活率、降低氧化应激损伤、抑制细胞凋亡而发挥对H2O2乳鼠心肌细胞损伤的保护作用.

Objective To investigate the effects of astraglus polysaccharides (APS)on the cadiocytes apoptosis induced by H2 O2 in neonatal rat. Methods Cadiocytes of neonate rat was cultivated for 72 hours and divided into six groups:normal control group,H2 O2 group,APS (20,40,80μmol/L)plus H2 O2 groups(n=10). Twelve hours after the drugs were given,the survival rate was detected by MTT assay.The cardiomyocytes apoptosis was observed by flow cytometry and the apoptosis rate was calculated.The activity of superoxide dismutate(SOD),catalase (CAT)and the content of malondialdehyde (MDA)in cardiomyocytes were determinted.The content of aspartate aminotransferase(AST),creatine phosphokinase(CPK),lactate dehydrogenase (LDH)in culture medium were detected.The expression of nuclear factor kappa B(NF κB),caspase 3 protein was detected by western blot and Semi quantita-tive analysized.The expression of AKT mRNA,bcl 2 mRNA,Bax mRNA were detected by reverse transcription polymerase chain re-action (RT PCR)and the ratio of bcl 2/Bax was calculated. Results Compared with the H2 O2 group,the survival rate in APS(40, 80μmol/L)plus H2 O2 groups was significantly increased.The cardiomyocytes apoptosis was improved and the apoptosis rate was significantly decreased.The activities of SOD,CAT in cardiomyocytes were significantly increased and the content of MDA was signifi-cantly decreased.The contents of AST,CPK,LDH in culture medium were significantly decreased.The expression of AKT mRNA,bcl 2 mR-NA were significantly up regulated,while the expression of Bax mRNA was significantly down regulated,the ratio of bcl 2/Bax was sig-nificantly increased.The expression of NF κB,caspase 3 protein were significantly down regulated.Al of the difference above were significant (P<0.05 or P<0.01). Conclusion APS had inhibitive effects on neonatal rat cadiocytes apoptosis induced by H2 O2 ,which perhaps related to its effects of improving the activity of antioxidase,depressing oxidative stress,down regulating the expression of NF κB,caspase 3 protein,up regulating the expression of anti apoptotic genes and down regulating the expres-sion of pro apoptotic genes,raising the ratio of bcl 2/Bax.

目的 探讨急诊冠状动脉介入治疗经桡动脉入路与经行血管闭合装置股动脉入路的有效性和安全性.方法 选取2010年1月至2012年12月在我院连续行急诊冠脉介入治疗的192例急性ST段抬高心肌梗死(STEMI)患者,依据血管入路途径将患者分为桡动脉组82例和行血管闭合装置股动脉组110例,观察疗效、并发症及住院期间主要心血管不良事件(MACE).结果 两组临床基线资料比较差异均无统计学意义(P值均＞0.05);两组住院期间病死率、PCI操作成功率差异均无统计学意义(P值均＞0.05);桡动脉组PCI操作时间和Needle-to-Balloon时间较行血管闭合装置的股动脉组延长(P值均＜0.05);桡动脉组非主要血管并发症的发生率低于行血管闭合装置的股动脉组(P=-0.016).结论 行急诊PCI经桡动脉入路与经行血管闭合装置的股动脉入路途径相比,具有相同的MACE和住院期间病死率,因此可将其作为急诊PCI血管入路途径的选择.

毗虫啉是一种新型的硝基亚甲基类的内吸杀虫剂,具有胃毒和触杀作用.其杀虫机制主要是选择性抑制昆虫神经系统烟碱型乙酰胆碱受体,阻断昆虫神经系统的正常传导,导致昆虫麻痹进而死亡.吡虫啉对人畜均有一定毒害.急性重度吡虫啉中毒病情凶险,死亡率高.彻底清除体内吡虫啉可明显提高重度中毒患者的抢救成功率.序贯消化道净化联合血液灌流治疗急性重度吡虫啉中毒疗效显著.

目的评估急性ST段抬高型急性心肌梗死(ST-elevation myocardial infarction,STEMI)行急诊冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后使用血管闭合装置的安全性和有效性。方法对因STEMI经股动脉入路行急诊PCI的278例患者进行院内预后研究。主要终点为由致命性血管入路出血、需要外科干预的血管入路并发症、血红蛋白下降≥3 g/dl或需输血的血管入路出血组成的主要血管并发症。结果 231例(83.1%)患者使用了血管闭合装置;47例(16.9%)患者给予了手工压迫。血管闭合装置组的主要血管并发症发生率明显低于手工压迫组,分别为3.5%和10.6%(P=0.031)。多变量回归分析表明使用血管闭合装置是降低主要血管并发症发生率的独立预测因素(比值比0.38;95%CI,0.17~0.91)。结论急性STEMI患者行急诊PCI时使用血管闭合装置是安全的,与手工压迫组比较可明显降低主要血管并发症发生率。

Objective To investigate the short-term prognosis of mild coronary stenosis(25%-50%)diagnosed by coronary computerized tomography(CT) in the patients with acute chest pain, and determine if they need further diagnostic examinations.MethodsThe patients(n=215) with lower risk TIMI scores and mild coronary stenosis diagnosed by coronary CT were chosen from Handan Central Hospital from Mar. 2008 to Feb.2012. The necessity of further diagnostic examinations was determined through observing the incidence of major adverse cardiovascular events(MACE) within 30 days including myocardial infarction, unstable angina, coronary revascularization and cardiovascular death.ResultsDuring 30-dya follow-up period, there was only one patients(0.5%) with MACE(95%CI: 0%~2.6%), who had positive results of cardiac troponin T reexamined for three times during hospitalization. No patients experienced cardiovascular death or required coronary revascularization.ConclusionThe possibility of short-term onset of MACE is very low in the patients with mild coronary stenosis diagnosed by coronary CT. Although the examination of serial biomarkers will be beneficial for these patients,further diagnostic tests are not necessary.

Objectives We hypothesised that primary percutaneous coronary intervention (PCI) and contemporary medical treatment will result in a lower incidence of malignant ventricular arrhythmias (VA) and shorten the time frame of their occurrence. Thus, an electrocardiographic monitoring period of 24 hours should be sufficient to detect more than 95% of all malignant VA. Methods We continuously monitored all patients with ST-segment elevation myocardial infarction (STEMI) for 48 hours. Results Of the 255 patients who underwent PCI for STEMI, 12 (4.7%) developed malignant VA. Sixty percent of malignant VA occurred during the first 24 hours; and 92%, during the first 48 hours. In univariate analysis, heart rate greater than 100 beats per minute, Thrombolysis in Myocardial Infarction flow grade less than 3, elevated creatinine, elevated C-reactive protein, higher white blood cell count, use of diuretics, and lower hematocrit were associated with an increased risk of VA. Symptom-onset-to-balloon time of 4 hours or more in patients with postprocedural Thrombolysis in Myocardial Infarction 3 flow, treatment with β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins were associated with a reduced risk of VA. After multivariate adjustment, independent predictors of sustained VA included total white blood cell count of 12 × 1012/L or more, hematocrit of 39% or less, and lack of β-blocker medication. Conclusions In this study, we could demonstrate that primary PCI results in a lower incidence of VA compared with data from the literature but did not shorten the time frame of VA occurrence. Thus, an electrocardiographic monitoring period for VA of 48 hours should be performed in patients with STEMI.

Objectives The aim of this study was to determine if patients presenting with symptoms of acute coronary syndrome and foud to have mild (25% to 50%) diameter reduction with computed tomographic angiography (CCTA) are likely to benefit from further diagnostic testing. Methods A registry study of 215 subjects with symptoms concerning for possible acute coronary syndrome with low-risk features found to have mild maximal diameter stenosis on CCTA was performed at our hospital. The potential contribution of additional testing was determined by measuring the major adverse cardiac events (MACE) from presentation through 30 days. The MACE included myocardial infarction, coronary revascularisation, unstable angina, and cardiovascular death. Results The MACE occurred in 1 (0.5%) of 215 subjects (95% confidence interval, 0%-2.6%) and was identified by an elevation of serial cardiac markers during the index hospitalisation. No patients experienced cardiovascular death or required revascularisation. Conclusions In patients with emergent low-risk chest pain and 25% to 50% diameter coronary stenosis by CCTA, the rate of near-term MACE is very low. Serial cardiac markers may be beneficial in this subgroup. Routine provocative testing is unlikely to be beneficial during the index visit.