肺血管内皮细胞激活在先天性心脏病肺高压肺血管重构中的作用

目的探讨肺血管内皮细胞激活在左向右分流型先天性心脏病(先心病)肺动脉高压(肺高压)发生、发展及肺血管重构中的作用。方法将先心病室间隔缺损(室缺)合并轻、中、重度肺高压患者30例作为研究对象;10例单纯室缺患者作为对照组。所有患者于体外循环建立前抽取肘正中静脉血,同时取右肺中叶小块肺组织,放射免疫法或比色法测定血浆白介素-1(IL-1)、内皮素(ET-1)和一氧化氮(NO)含量,以反映肺血管内皮细胞激活、损伤程度;QTM970图像分析仪测定肺组织肺小动脉外径、管壁厚度、血管总面积;计算出管壁厚度占外径的百分比(WT/D),管壁面积占血管总面积的百分比(WA/A),以反映肺小血管的形态学改变。结果先心病患者伴随肺动脉压力的增高,血浆IL-1β和ET-1/NO水平呈上升趋势(P<0.05);WT/D、WA/A逐渐增高(P<0.05);二者呈显著正相关(P<0.05)。结论左向右分流所致肺血管内皮细胞激活与内皮衍生因子分泌失衡密切相关;其在肺高压发生及肺血管重构中起重要作用。     

Correlation between endothelia cells activation and imbalance of cytokines in pulmonary hypertension of congenital heart disease

Objective To explore the correlation between endothelia cells activation and cytokines （ET-1, NO） levels in patients with pulmonary hypertension （PH）, and to discuss their roles in the development of PH. Methods Twenty patients with simple ventricular septal defect （VSD） were chosen as controls, and 30 patients with PH were studied. Plasma levels of ET-1 and NO were measured by radioimmunoassay or colorimetric method. Before cardiopulmonary bypass was established, the specimens from right lung were fixed with formaldehyde solution, embedded with paraffin and stained by SP immunohlstochemistry. Intercellular adhesion molecule-1 （ICAM-1） expression was measured through the determination of the light density with computer imaging technology. Results Compared with that of the patients with simple VSD, the light density of ICAM-1 and plasma level of ET-1 increased in patients with PH; but plasma level of NO decreased （P〈0.05）. Positive correlation was observed between ICAM-1 and ET-1/NO （P〈0.05）. Conclusion Endothelia cells activation and imbalance of ET-1/NO might play an important role in the development of PH.     

先天性心脏病肺动脉高压患者肺组织内皮型一氧化氮合成酶的表达及肺血管重建

目的　探讨内皮型一氧化氮合成酶 (eNOS)在肺动脉高压的发生、发展及肺血管重建中的作用。方法　经心动超声及多普勒检查 ,确定为单纯室间隔缺损患者 10例为对照组 ;室间隔缺损合并肺动脉高压患者共 3 0例 ,为实验组。体外循环建立前取右肺中叶少许肺组织 ,福尔马林固定 ,石蜡包埋 ,SP法免疫组织化学染色 ,并进行灰度扫描。以管壁厚度占血管外径的百分比 (WT % )、管壁面积占血管总面积的百分比 (WA % )反映肺血管壁的增厚程度。方差分析进行组间差异比较。结果　先心病患者随肺动脉压力的增高 ,肺组织eNOS表达呈下降趋势 ,而肺小血管形态发生明显改变 ,WT %、WA %明显增高 (P <0 .0 1)。eNOS的表达与肺高压程度、肺血管形态学改变之间存在负相关性 (P <0 .0 1)。结论　先心病肺高压的eNOS含量低下 ,造成内源性一氧化氮(NO)生成减少 ,在肺动脉高压的发生、发展及肺血管重建中起一定作用     

Von Willebrand因子在先天性心脏病肺动脉高压中的表达及意义

目的　探讨VonWillebrand因子 (VWF)在先天性心脏病 (简称先心病 )室间隔缺损 (简称室缺 )伴肺动脉高压 (简称肺高压 )中的表达及其临床意义。方法　应用酶联免疫吸附双抗体夹心法检测 1 5例先心病室缺伴肺高压患者血浆中VWF的表达 ,并与先心病室缺无肺高压的患者作对照。结果　伴肺高压的先心病患者血浆中的VWF水平显著高于无肺高压的先心病患者(P <0 .0 5 )。结论　VWF与先心病室缺伴肺高压的发生、发展有着密切关系。     

内皮素-1诱导大鼠血管平滑肌细胞产生C-反应蛋白的作用

目的观察内皮素-1(ET-1)诱导血管平滑肌细胞(VSMCs)产生C-反应蛋白(CRP)的作用及其机制。方法培养大鼠VSMCs,以不同浓度ET-1刺激VSMCs,并用ETA拮抗剂BQ123、抗氧化剂PDTC、p38MAPK抑制剂SB203580及ETB阻断剂BQ788进行干预,免疫细胞化学法及半定量逆转录聚合酶链反应(RT-PCR)法分别测定不同浓度及不同干预因素下VSMCs中CRP蛋白及mRNA的表达。结果 ET-1能刺激VSMCs CRP蛋白及mRNA的表达增强,其效应呈浓度依赖性;BQ123、PDTC及SB203580能明显减少ET-1诱导的大鼠VSMCs CRP蛋白及mRNA的表达,而BQ788对此作用无明显影响。结论 ET-1通过ETA、活性氧(ROS)、p38MAPK诱导大鼠VSMCs产生CRP。     

BLOOD FLOW PATTERN AND QUANTITATIVE STUDY IN SOLITARY PULMONARY NODULES WITH DYNAMIC CONTRAST-ENHANCED MRI

Objective To evaluate the efficacy of contrast enhanced dynamic MRI in differentiating solitary pulmonary nodules(SPNs). Methods Eighty-three patients with SPNs undertaken contrast enhanced dynamic MRI. Time-signal intensity curve (T-SI Curve) was made. Peak height (PH), steepest slope (SS), maximum enhancement (Emax) and the enhancement rates of signal intensity were recorded at the first ( E1 ), second ( E2 ),third (E3) , fourth ( E4), fifth (E5) , and sixth (E6) minute after injection. Results Malignant nodules and inflammatory nodules enhanced significantly higher than benign nodules, and malignant nodules and inflammatory nodules showed obviously higher PH, SS, Emax, E1-E6 values than benign nodules( P ＜ 0. 01 ). There were no significant differences in PH, SS, E E1-E6 values between malignant nodules and inflammatory nodules( P ＞ 0. 05 ).Conclusion Contrast enhanced dynamic MR imaging can provide SPNs' hemodynamic information and is helpful in differentiating SPNs.     

EFFECT OF QUERCETIN ON CULTURED HUMAN VASCULARENDOTHELIAL CELLS

Quercetinisakindofflavonoidcompound.ItisdemonstratedthatQuelowersbloodpressure,b1oodlipidandcapillarypermeabilityanddilatescoronaryartery"'-Ouealsopossessesantioxida-tion,antineoplasticactivity,antiplatelet,aggrega-tioninducedbyadenosinediphosphate(ADP),thrombin,arachidonicacid,andtheinhibitionofproductionandreleaseofthromboxaneB2and5-hydroxytryptaminebyplatelet">-ItraisescAMPlevel,inhibitscGMP-dependentphosphodiesterasetoelevatecGMPlevelincellsc4i.Especially,thereisagreatprogressinanti…     

容量超负荷型及容量合并压力超负荷型心脏心肌胶原的变化

为研究容量超负荷型心脏病心肌胶原含量的改变，我们应用羟脯氨酸法，观察了19例先天性心脏病房／室间隔缺损患者右心耳心肌胶原含量的变化，并与5例健康意外死亡者作对照，结果表明：容量超负荷型心脏患者，无论是房间隔缺损还是空间隔缺损，心肌胶原含量与正常人相比显著降低，但当房／室间隔缺损合并肺动脉高压后，心肌胶原含量则增多，与正常人相比有显著性差异。     

尿酸水平对冠脉病变的预测

目的探讨尿酸水平在冠心病发病中的作用及其与冠脉病变的相关性。方法根据冠状动脉造影结果分为冠心病(CHD)组(164例)和正常对照组(51例),比较两组间尿酸水平的差别及与CHD之间的关系。结果CHD组患者的尿酸水平明显高于正常对照组[(316.67±97.35)μmol/Lvs.(286.16±98.33)μmol/L,P<0.01]。随后进行多元Logistic回归分析,显示在调整了糖尿病、性别和纤维蛋白原(FIB)等因素的作用后,尿酸对回归方程的影响达不到统计学意义。亚组分析显示有高尿酸血症的糖尿病患者冠心病发病风险明显提高。结论高尿酸血症作为独立的冠心病危险因素尚缺乏充分证据,应用尿酸与血糖综合评估冠心病的发生风险可能有一定意义。     

室间隔缺损并肺动脉高压102例外科治疗

先天性心脏病室间隔缺损（ＶＳＤ）是一常见多发病，由于存在左向右分流，常导致肺动脉高压（ＰＨ），使围手术期死亡率增加，预后不佳，故早期发现、早期手术治疗己被重视。本文对１０２例ＶＳＤ·ＰＨ患者外科手术治疗进行分析，并对手术适应症、手术径路、并发症预防及术后处理进行讨论。     

C反应蛋白与高血压病、冠心病关系的临床研究

目的分析高血压病、冠心病患者血清C反应蛋白(CRP)的变化及其与相关临床指标的关系。方法测定143例高血压病、108例冠心病患者和120例健康体检者的血清CRP、空腹血糖(FBG)、血脂及体积指数(BMI)并做相关分析。结果高血压和冠心病组CRP水平显著高于正常对照组(P<0.01);高血压1级与3级间CRP差异有显著性(P<0.05);急性心肌梗死(AMI)组与不稳定型心绞痛(UAP)组CRP高于稳定型心绞痛(SAP)组,差异有显著性(P<0.05);CRP与年龄、TG、FBG呈显著正相关,与HDL-C呈显著负相关(P<0.05)。结论①CRP是炎症标志物,高血压与冠心病患者血清CRP显著升高,提示患者体内存在炎症反应;②CRP水平反映了高血压和冠心病患者的病变程度。     

室间隔缺损并肺动脉高压心肌超微结构改变的观察

通过对10例空间隔缺损(VSD)并中、重度肺动脉高压(PH)患者右心房肌超微结构的观察,发现心肌微丝不同程度溶解消失,且在溶消区内可见粗面内质网池扩张,脂褐素增多及脂质小滴的出现;线粒体增生,其大小不等,分布不均,部分线粒体嵴消失,发生退行性变及基质电子密度降低;部分闰盘双膜间隙扩张,心肌纤维结缔组织增生。这些改变,可能与心肌慢性缺血缺氧有关。     

Effect of ABCA1-V771M polymorphism on plasma lipid levels and its relationship with coronary atherosclerotic heart disease

Objective To explore the risk association of ABCA1-V771M polymorphism with coronary heart disease (CHD) in Hart nationality in Northwest of China. Methods With case-control study, ABCA1-V771M polymorphism was detected in 204 unrelated Hart nationality people in Northwest of China, and all the subjects by coronary angiography were grouped into 106 cases and 98 controls. The genotypes and alleles frequency distribution of ABCA1-V771M polymorphisms were analyzed by PCR-RFLP analysis, and the clinical statistics of serum lipids were compared and its effects of ABCA1-V771M polymorphism on the plasma lipid levels and coronary atherosclerotic heart disease were analyzed. Results The genotypic frequencies of ABCA1-V771M polymorphism matched well under Hardy-Weinberg equilibrium (P>0.05), V and M allelic frequencies were 33.3% and 66.7%. In comparison with VV VM genotype carriers, MM genotypes carriers had much lower plasma levels of HDL-C (P<0. 001) and much higher plasma levels of TG (P<0. 05). M allelic frequency in CHD group was significantly higher than V allelic frequency (P<0. 05). M allele was related with more severity of atherosclerosis in the coronary artery than V allele (P<0.05). However, there was no obvious difference in the incidence of AMI among carriers with three genotypes of ABCA1-V771M polymorphism (P>0.05). Conclusion ABCA1-V771M polymorphism was not only associated with the plasma levels of HDL-C and TG, but also related to the susceptibility and severity of coronary atheroselerotic heart disease. Moreover, M771 allele appeared to be atherogenie among Han population in Northwest of China.     

对氧磷-酶1192位Gln-Arg基因多态性与冠心病的相关性

目的确定对氧磷酶1(PON1)基因192位Gln-Arg多态性与陕西地区汉族冠心病(CHD)患者发病之间的关系。方法对动脉造影确诊的222例冠心病患者和164例非冠心病患者,采用PCR-酶切法检测PON1基因192位Gln-Arg多态性并进行对比分析。结果陕西地区汉族人群等位基因R和Q频率分别为60.23%和39.77%,其中CHD组RR、QR、QQ基因型分别占41.44%、39.64%、18.92%,对照组RR、QR、QQ基因型分别占35.98%、45.73%、18.29%;CHD组等位基因R频率占61.26%,Q频率占38.74%,对照组的等位基因R频率占58.84%,Q频率占41.56%,组间比较无显著性差异(P>0.05);心肌梗死和非心肌梗死、冠状动脉病变不同程度间等位基因R和Q频率及RR、QR、QQ基因型之间无显著性差异(P>0.05)。结论陕西汉族人群PON1192位Gln-Arg基因多态性与CHD发病之间无相关性。     

比索洛尔对冠心病心率变异性和代谢的影响

为探讨比索洛尔对冠心病患者心率变异性（Ｈｅａｒｔｒａｔｅ ｖａｒｉａｂｉｌｉｔｙ,ＨＲＶ）和代谢的影响,将６０ 例冠心病（ＣＨＤ）患者随机分为对照组和比索洛尔组,对ＨＲＶ各时域指标及血脂、血糖、胰岛素等代谢指标进行检测。结果表明,比索洛尔组反映交感神经张力的ＨＲＶ指标明显提高;比索洛尔对血糖、血脂及尿酸等代谢指标无明显影响。表明比索洛尔能改善ＣＨＤ患者ＨＲＶ情况,同时对代谢无影响     

碱性成纤维细胞因子在博莱霉素致肺纤维化肺血管损伤中的作用

目的探讨碱性成纤维细胞因子(bFGF)在博莱霉素(BLM)致大鼠肺纤维化肺组织中的表达及其在肺血管损伤中的作用。方法于大鼠气管内注射BLM以复制其肺纤维化模型,应用bFGF多克隆抗体按SABC法行免疫组织化学染色,定量图像分析。结果BLM组动物支气管上皮细胞胞浆内、支气管和肺小动脉肌层以及肺泡巨噬细胞胞浆内可见较多棕黄色细颗粒状bFGF阳性表达产物,显著高于对照组(P<0.05)。结论在BLM致大鼠肺纤维化过程中bFGF表达上调,提示bFGF可能参与肺间质纤维化的发病过程。     

氧化修饰的低密度脂蛋白对内皮细胞功能的影响

目的　观察OX LDL对内皮细胞NO、ET 1合成及细胞表面细胞间粘附分子 1(ICAM 1)表达的影响。方法　采用培养的人脐静脉内皮细胞 (HUVEC) ,在分别加入不同浓度OX LDL(5 0、10 0、15 0mg·L-1)孵育 2 4h ,或浓度为 10 0mg·L-1于不同时间 (12、2 4、36h)孵育后观察培养液中NO及ET 1水平及细胞表面ICAM 1的表达。结果　OX LDL可显著抑制NO的合成 (P <0 .0 5 ) ,但各时间段培养液中NO含量无显著性差异 (P >0 .0 5 ) ;OX LDL还可明显增加ET 1的分泌及诱导细胞表面ICAM 1的表达。结论　OX LDL对内皮细胞具有明显的细胞毒作用 ,它对NO、ET 1释放及ICAM 1表达的影响可能是其致动脉粥样硬化发生的重要机制。     

绝经对女性冠心病患者临床特征及危险因素的影响

目的探讨绝经对女性冠心病患者临床特征及危险因素的影响。方法选择2009年2月至2011年1月在我院经冠脉造影确诊的未绝经冠心病患者(29例);年龄相匹配的男性患者(31例);绝经后女性冠心病患者(67例),其中绝经时间≤5年者30例,绝经时间>5年者37例;健康绝经者(60例),其中绝经时间≤5年者30例,绝经时间>5年者30例进行对比分析。结果与男性比较,未绝经组糖代谢异常及有冠心病家族史明显高于男性组(P<0.05),且多数具有典型的心绞痛。绝经各组与未绝经组比较随着绝经时间的延长合并高血压者显著升高(P<0.01)。而合并糖代谢异常及有冠心病家族史者下降,同时表现为典型心绞痛者也明显下降(P<0.05)。冠状动脉病变女性以单支病变为主(P<0.05)。绝经后冠心病者较绝经≤5年健康组,雌二醇及孕酮水平均下降明显(P<0.05),随着绝经时间的延长雌二醇下降尤为明显,而绝经后的冠心病组间无差异。结论心血管危险因素、临床特征两性存在差异,绝经对女性冠心病患者心血管危险因素及冠状动脉病变有影响,雌孕激素水平下降可能是其原因之一。     

THE STUDY OF PRODUCTION AND MECHANISM OF ANTIPHOSPHOLIPID ANTIBODIES IN PATIENTS WITH CORONARY HEART DISEASE

Ａｎｔｉｐｈｏｓｐｈｏｌｉｐｉｄａｎｔｉｂｏｄｉｅｓ(ＡＰＡ)ａｒｅｉｍｍｕｎｏｇｌｏｂ ｕｌｉｎｓｏｆｔｈｅＩｇＧ ,ＩｇＭａｎｄＩｇＡｃｌａｓｓｅｓｗｉｔｈｓｐｅｃｉｆｉｃｉｔｙｆｏｒｎｅｇａｔｉｖｅｌｙｃｈａｒｇｅｄｐｈｏｓｐｈｏｌｉｐｉｄａｎｄｉｎｃｌｕｄｅａｎｔｉｃａｒｄｉｏｌｉｐｉｎａｎｔｉｂｏｄｉｅｓ(ＡＣＡ) ,ｌｕｐｕｓａｎｔｉｃｏａｇｕｌａｎｔｓ(ＬＡ )ａｎｄａｎ ｔｉｐｈｏｓｐｈａｔｉｄｙｌｓｅｒｉｎｅａｎｔｉｂｏｄｉｅｓ[1] .Ｕｓｕａｌｌｙ ,ｄｅｔｅｒｍｉｎａｔｉｏｎｏｆＡＣＡ Ｉｇ…     

人心房室隔内新的兴奋传导通路

根据对35例国人正常心脏标本、2例房室隔水平连续切片和2例房室交点区矢状连续切片的观察，发现从右房经界嵴至房室隔内的居室结有三条传导兴奋的通路：①从冠状窦下壁至房室结后缘；②从冠状窦口周围沿右房心内膜下至房室结浅层；③经冠状窦口下方，沿三尖瓣隔侧瓣上方右房心内膜下至房室结下缘。