目的 通过大鼠缺血性心力衰竭心脏减负荷模型,探讨心室减负荷对缺血性心力衰竭心脏MMPs-TIMPs表达的影响.方法 通过结扎冠状动脉前降支的方法,形成缺血性心力衰竭模型,随机分为两组,即减负荷组(n=14)与心力衰竭组(n=10),前者通过异位心脏移植的方法形成左心室减负荷模型;后者不进行心脏移植,另外8只大鼠作为空白对照组.2周后,测量左心室收缩压(LVSP)、左心室舒张末压(LVEDP)及最大压力上升及下降速度(±dP/dtmax).用Western blot法、RT-PCR检测MMP-1、MMP-2、MMP-7、MMP-9、TIMP-1、TIMP-2、TIMP-3,以及TIMP-1/MMP-1的比值和TIMP-3/MMP-9、TIMP-2/MMP-2比值和TIMP-3/MMP-9比值.结果 与对照组比较,心力衰竭组中的MMP-1、MMP-2和MMP-9基因表达明显增加;与心力衰竭组比较,在减负荷后,减负荷组的MMP-2和MMP-9基因表达水平下降明显,差异有统计学意义(P<0.05),TIMP-2和TIMP-3的基因表达明显升高,差异有统计学意义(P<0.05).与心力衰竭组比较,TIMP-1/MMP-1的比值和TIMP-3/MMP-9均有明显升高(P<0.05);TIMP-2/MMP-2的比值升高更为明显(P<0.01).与心力衰竭组比较,减负荷组的MMP-9和MMP-2的蛋白表达水平下降(P<0.05),TIMP-1和TIMP-3蛋白表达水平上升(P<0.05).结论 MMPs-TIMPs轴在心脏减负荷后心室重塑过程中发挥重要作用.对大鼠缺血性心肌病进行减负荷可以下调MMP-1、MMP-2和MMP-9,上调TIMP-1和TIMP-3,从而提高TIMPs与MMPs之比;在检测心脏细胞外基质方面,TIMPs/MMPs的比值较单个MMP或TIMP更加敏感.

Objective To discuss the application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis.Methods The modified Nikaidoh procedure was employed to exchange and transplant the aortic and pulmonary roots and rebuild the left and right ventricular outflow tracts.The changes in structure of heart tissues,the post-operative recovery and growth and development of the patients were observed.Results After the modified Nikaidoh procedure,the relationship between the ventricle and artery was recovered to be normal,without the serious progressive aortic valve insufficiency,and medium or above pulmonic valve regurgitation,and left and right ventricular outflow tract obstruction.5 cases survived after the operation and 1 case died of serious heart failure and multiple organ dysfunction syndrome.According to the follow-up of 4 months to 7 years,the growth and development of patients were improved,with the significant increase in the oxygen saturation and the disappearance of cyanosis.Conclusion The application of modified Nikaidoh in Taussig-Bing anomaly with pulmonary stenosis can achieve the anatomical radical cure and obtain the good surgical effect.

临床资料:患者女性,38 岁,主因右侧肢体无力 1 年余,加重伴言语不清 1 周来院,1 年前患者无明显诱因出现右侧肢体无力,呈加重趋势,无头晕、头痛,无恶心、呕吐,无发热、乏力、盗汗,无腹痛、腹泻,未行特殊治疗.

目的 探讨心肌梗死患者自体外周血干细胞(autologous peripheral blood stem cell,APBSC)动员、采集的效率,以及自体外周血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)治疗心肌梗死的安全性和可行性.方法 46例心肌梗死患者在常规药物治疗基础上,冠状动脉旁路移植术(coronary artery bypass grafting,CABG)前5d,根据患者体质量,给予重组人粒细胞集落刺激因子(recombinant human granulocyte colony stimulating factor,rhG-CSF)450 μg/d(≤65 kg)或600 μg/d(＞65 kg)皮下注射,进行APBSC动员及扩增.CABG前24 h进行APBSC采集.46例患者均在非体外循环下行CABG,在完成血管桥吻合后,经桥血管及心外膜下注入采集的APBSC.在APBSC动员、采集前后检测外周血和采集产品中单个核细胞(mononuclear cells, MNC)及CD34+细胞数量.检测APBSC采集前后血压、心率、呼吸、白细胞(white blood cell,WBC)、红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、血细胞比容(hematocrit,Hct)、血小板(platelet,Plt)和血清Ca2+的变化.观察APBSC动员、采集、移植过程中有无不良反应.结果 APBSC动员后外周血中WBC、MNC、CD34+细胞数量较动员前显著升高(P＜0.01).APBSC采集后外周血中MNC、CD34+细胞数量较采集前显著升高(P＜0.01),APBSC采集前后血压、心率、呼吸、WBC、RBC、Hb、Hct及血清Ca2+变化差异无统计学意义(P＞0.05),Plt计数采集后较采集前明显降低(P＜0.01).APBSC动员、采集、移植过程中发生不良反应20例,其中APBSC动员过程中的不良反应占17.4％(8/46),APBSC采集过程中的不良反应占10.9％(5/46),APBSC移植过程中的不良反应占15.2％(7/46).结论 心肌梗死患者APBSC经过动员、采集后可获得较高的MNC和CD34+细胞产量;APBSCH治疗心肌梗死安全可行.

目的:通过单光子发射型电子计算机断层显像术(SPECT)评价自体外周血干细胞移植(APBSCT)治疗心肌梗死的临床疗效.方法:自2012年1月～2015年2月就诊于河北省胸科医院心肌梗死患者76例,根据是否行APBSCT分为移植组46例、对照组30例.入选患者常规药物治疗,移植组冠状动脉旁路移植术(CABG)前5天,进行自体外周血干细胞(APBSC)的动员及扩增,CABG前1天进行APBSC采集.入选患者采取非体外循环下CABG,移植组经心外膜下及冠状动脉桥血管注入采集的APBSC.两组均在术前及术后6个月运用SPECT评价心肌灌注情况;运用超声心动图评价左心室形态、室壁节段运动指数(WMSI)及心功能指标.结果:术后6个月时两组与术前相比心肌灌注缺损面积减小,左心室舒张末期内径(LVDd)较术前明显减小,左心室射血分数(LVEF)较术前明显增高,WMSI较术前明显降低,差异有统计学意义(P＜0.05).移植组术后指标更优于对照组,差异有统计学意义(P＜0.05).结论:CABG同期APBSCT治疗心肌梗死能改善心肌血流灌注,SPECT对APBSCT治疗心肌梗死有较高的临床价值.

Objective To study the clinical efficacy of autologous peripheral blood stem cell transplantation for the treatment myocardial infarction,in the same period of coronary artery bypass grafting (CABG).Methods From January 2012 to January 2015,76 patients with myocardial infarction were selected.Patients were divided into transplantation group (n =46) and control group (n =30) on the basis of whether being treated by autologous peripheral blood stem cell transplantation.After myocardial infarction patients were taken to the hospital with the therapy of conventional drug,5 days before CABG,transplantation group was given the autologous peripheral blood stem cell mobilization and expansion,24 hours before CABG,taking autologous peripheral blood stem cell collection.76 patients took CABG with non-cardiopulmonary by pass,transplantation group was given autologous peripheral blood stem cell via transplantation vessels and subepicardial,while the control group was not given the injection of autologous peripheral blood stem cell.The LV morphology,wall motion score index (WMSI) and index of cardiac function before and after the operation in both groups were evaluated by echocardiography.Results Six months after CABG,there was a significant decrease in Left ventricular end-diastolic diameter and wall motion score index,Left ventricular ejection fraction was increased.The indexes of cardiac function in the transplantation group were better than the control group.Conclusion Autologous peripheral blood stem cell transplantation for the treatment myocardial infarction can improve the heart function,and has obvious recent clinical curative effect in the same period of CABG.

Objective To investigate the curative effect and value of the minimally invasive ligation in patent ductus arteriosus.Methods 48 cases patients with simple ductus arteriosus were randomly divided into minimally invasive group and control group,each of 24 cases.Minimally invasive group were treated with left auscultation triangle small incision extrapleural ligation of patent ductus arteriosus,control group were given traditional treatment.Observed the ventilation time,blood transfusion,intensive care unit(ICU) residence time,postoperative hospital stay,postoperative drainage situation and hospitalization costs of two groups.Results The ventilation time,ICU residence time and postoperative hospital stay of minimally invasive group were shorter than those of control group;blood transfusion,postoperative drainage situation and hospitalization costs of minimally invasive group were less than those of control group,the differences were statistically significant(P < 0.05 or P < 0.01).Conclusion Small incision extrapleural ligation of patent ductus arteriosus with less trauma,fewer complications and quick recovery,it's a safe,economical and effective surgical method,and worthy of clinical application.

目的 评价不同年龄患儿行非体外循环双向Glenn分流术后肺血管的发育.方法 回顾性分析2007年3月- 2010年11月25例接受非体外循环下双向Glenn分流术的复杂先天性心脏病患儿临床资料.结果 全组无死亡病例.低年龄组患儿术后随访McGoon比率、Nakata指数升高均好于高年龄组(P均＜0.0S).结论 低年龄患儿行非体外循环下双向Glenn分流术后肺血管的发育要好于高年龄组,提倡对复杂的、难以一期根治的先天性心脏病患儿行早期干预.

目的 研究左心室重建术对非手术区心肌组织血管紧张素Ⅱ受体表达的影响.方法 对50只杂种犬建立左心室壁瘤动物模型,并根据超声心动图检查结果 分为实验组和对照组,前者采用左室重建术(Dor手术)切除室壁瘤,后者只开胸不行左室重建术,通过实时荧光定量逆转录-聚合酶链反应方法 检测各组非手术区心肌组织中的血管紧张素Ⅱ1型受体(angisotensin Ⅱ type 1 receptor,AT1R)mRNA、血管紧张素Ⅱ 2型受体(angistotensin Ⅱ 2 receptor,AT2R)mRNA的含量.结果 与正常组相比,实验组和对照组非手术区心肌组织AT2RmRNA表达明显增多(P﹤0.05),AT1RmRNA明显减少(P﹤0.05),AT2RmRNA/AT1RmRNA的比值明显升高(P﹤0.05),提示实验组和对照组的非手术区心肌都发生了心室重构;与对照组相比,实验组的非手术区心肌AT2RmRNA表达明显减少(P﹤0.05),AT1RmRNA表达增多(P﹤0.05),AT2RmRNA/AT1RmRNA比值降低(P﹤0.05),提示实验组的非手术区心肌心室重构小于对照组.结论 左心室重建术从一定程度上延缓了左心室重构的发生,有助于改善心功能.

目的研究左心室重建术对非手术区心肌组织超微结构的影响。方法对50只杂种犬建立左心室壁瘤动物模型,并根据室壁瘤的大小、部位分为实验组和对照组,实验组采用左心室重建术(Dor手术)切除室壁瘤,对照组只开胸不行左心室重建术,通过电镜观察2组非手术区心肌组织超微结构的变化。结果与正常组相比,实验组和对照组非手术区心肌组织超微结构均有心室重构和心肌损害;与对照组相比,实验组非手术区心肌组织心室重构和心肌损害程度小于对照组。结论 左心室重建术从一定程度上延缓了左心室重构的发生,有助于改善心功能。