外源性磷酸肌酸对儿童围术期的心肌保护作用

目的探讨外源性磷酸肌酸（CP）对先天性心脏病患儿体外循环下（CPB）开胸术中心肌保护及术后心肌恢复的作用。方法将63例先天性心脏病患儿随机分为A、B和C组3组,每组21例,心肌灌注液均采用等量含血STH2液,B、C组术中心肌灌注液中加入外源性CP,术后均采用常规极化液治疗,C组术后静脉加用CP。监测术后即刻至术后5 d心肌酶的变化趋势。结果手术结束时血中心肌酶水平明显升高,B、C组间无差异,均明显低于A组（P〈0.05）;术后C组心肌酶水平恢复最快,A组最慢,各组间有统计学差异（P〈0.05）。结论先天性心脏病患者围术期应用CP具有保护心肌和加快损伤心肌修复的作用。     

磷酸肌酸对大鼠缺血再灌注后心肌损伤的影响

目的 观察磷酸肌酸对大鼠缺血再灌注后心肌损伤的影响.方法 60只雄性SD大鼠随机分为假手术组、模型组、磷酸肌酸组.结扎大鼠左前降支冠状动脉使心肌缺血,30 min后恢复血流并持续120 min,复制缺血再灌注损伤模型.磷酸肌酸组分别于缺血再灌注前30 min经右颈内静脉注射磷酸肌酸3 mg/kg,模型组及假手术组给予等量的生理盐水.测定血清乳酸脱氢酶(LDH)、磷酸肌酸激酶(CK)及心肌组织丙二醛(MDA)和超氧化物歧化酶(SOD)的含量并观察心肌超微结构的变化.结果 磷酸肌酸组与模型组比较,血清LDH、CK值降低,心肌组织MDA值减小,SOD值升高.光镜及电镜下心肌细胞变性坏死程度及心肌细胞超微结构形态改变显著减轻.结论 磷酸肌酸对大鼠心肌缺血再灌注损伤均有保护作用.     

冠心病介入治疗后的心肌损伤

介入治疗可能引起心肌损伤,表现为介入治疗后心肌损伤标记物心肌型肌酸激酶同工酶和心肌肌钙蛋白浓度升高.造成心肌的损伤的原因有:球囊扩张和(或)支架术后斑块的挤压移位可引起冠状动脉细小分支血管的闭塞,侧支血管分布区域的心肌细胞发生坏死;术后局部心肌微循环灌注仍存在不足等.冠状动脉介入治疗后心肌损伤标记物的升高与球囊扩张时间、球囊压力及扩张次数呈正相关;介入治疗前基础病变越重、越复杂、合并症越多,术后越容易出现心肌损伤标志物的增高.术前、术后常规检测特异性的心肌损伤标志物,有助于前瞻性观察,为采取治疗措施提供依据,减少再梗死和心脏猝死的发生率.     

PCI术后心肌损伤标志物增高的相关因素及临床意义

随着冠状动脉介入治疗的进展。冠状动脉介入治疗后心肌损伤标志物的增高已引起人们的重视，冠状动脉介入治疗术后心肌损伤标志物的增高预示晚期预后不良。积极探索其发生机制并采取相应措施至关重要。     

磷酸肌酸钠预处理对大鼠肺缺血再灌注损伤的保护作用

目的 研究磷酸肌酸钠预处理在急性肺缺血再灌注损伤(LIRI)中的作用,并探讨其作用机制。方法 32只雄性清洁级SD大鼠,随机均分成为Sham组、Sham+磷酸肌酸钠组、LIRI组、LIRI+磷酸肌酸钠预处理组各8只。观察各组肺功能、肺组织学病理检查、肺水肿、氧化应激、炎症反应和凋亡染色,探讨磷酸肌酸钠预处理对肺的保护作用。结果 磷酸肌酸钠预处理在大鼠肺缺血再灌注损伤中可显著降低肺组织病理学改变,明显改善肺功能,减轻肺水肿程度,肺组织中丙二醛(MDA)和髓过氧化物酶(MPO)含量下降表达,而超氧化物歧化酶(SOD)活性显著升高,降低支气管肺泡灌洗液的炎症介质表达,降低肺组织细胞凋亡率。结论 磷酸肌酸钠预处理能够减轻大鼠LIRI,其可能的肺保护机制即是通过抑制活性氧生成和减少肺组织凋亡和抑制炎症介质有关。     

磷酸肌酸对大鼠缺血再灌注损伤心肌线粒体MDA、SOD和Ca2+表达的影响

目的 探讨磷酸肌酸(PCr)对缺血再灌注(I/R)损伤心肌线粒体的影响.方法 采用大鼠左冠状动脉前降支结扎法建立大鼠I/R模型.60只雄性大鼠随机分为缺血再灌注(I/R)损伤组、假手术组、PCr组,假手术组只剖胸不结扎冠状动脉,余两组制作I/R模型,PCr组结扎前45 min经股静脉注射PCr 4 mg/kg,假手术组和I/R组分别静脉注射相应体积的生理盐水,在缺血45 min及2 h时测定I/R区心肌丙二醛(MDA)、超氧化物歧化物(SOD)及总Ca2+浓度.结果 与假手术组比较I/R损伤组MDA、总钙显著增高(P＜0.05),SOD显著降低(P＜0.01);与I/R损伤组比较,PCr组MDA含量及总钙水平显著降低(P<0.05),SOD显著增高(P＜0.01).结论 PCr对心肌I/R损伤有保护作用.     

磷酸肌酸钠对经皮冠状动脉介入术后心肌损伤的保护作用

目的探讨磷酸肌酸钠对经皮冠状动脉介入术后心肌损伤的影响。方法选取经皮冠状动脉介入术后心绞痛患者共100例,随机分为实验组和对照组各50例。两组血管病变情况、置入支架总长度、支架数目、最大压力差异均无统计学意义(P均>0.05)。患者于术前均进行常规体检、生化检查及药物治疗,实验组患者在常规治疗基础上术后静注磷酸肌酸钠。结果两组术后血清肌酸磷酸激酶同工酶(CK-MB)及肌钙蛋白I(TnI)均明显升高(P<0.05);对照组术后CK-MB及TnI均明显高于实验组(P<0.05);实验组总有效率明显高于对照组(P<0.05)。结论磷酸肌酸钠对经皮冠状动脉介入术后导致的心肌损伤具有保护作用。     

磷酸肌酸钠对重度窒息新生儿血清肌酸激酶同工酶和心肌肌钙蛋白I的影响

目的观察磷酸肌酸钠对重度窒息新生儿血清肌酸磷酸激酶同工酶（CK-MB）和心肌肌钙蛋白I（cTnI）的影响。方法入选重度窒息新生儿60例,按照入院顺序随机分为治疗组和对照组,每组30例患儿,均给予常规对症支持治疗,治疗组在常规对症支持治疗基础上加用磷酸肌酸钠,1g／d,静脉滴注,6～7d为一疗程。比较治疗前后两组患儿血清CK-MB和cTnI水平的变化。结果治疗前两组患儿血清CK-MB和cTnI水平均高于正常水平,但两组间差异无统计学意义[治疗组分别为（68．7±18．7）U／L、（2．73±0．22）斗g／L;对照组分别为（68．8±19．3）U／L、（2．85±0．20）μg／L]（P〉0．05）。治疗3d后,治疗组血清CK-MB和cTnI水平显著下降[（24．4-4-3．1）U／L、（0．36±0．03）μg/L]（P〈0．01）,接近正常水平;而对照组则在7d后恢复至正常水平[（27．8±2．5）U／L、（0．77±0．03）μg/L]。结论磷酸肌酸钠能够快速有效地降低重度窒息新生儿血清CK-MB和cTnl的水平。     

梗阻性黄疸兔与人血清心肌标志物的比较分析

目的探讨梗阻性黄疸兔血清心肌标志物含量变化与梗阻性黄疸患者血清心肌标志物含量变化的差别。方法用止血钳钳夹实验兔胆总管以造成可逆型梗阻性黄疸,以Beckman全自动免疫分析仪测定其血清心肌标志物;同批测定结石性梗阻性黄疸患者血清心肌标志物。对测定数据进行统计分析和比较。结果梗阻黄疸实验兔（梗阻30 d）TBil、DBil显著高于对照组（P〈0.01）;其血清肌酸激酯同工酶（CK-MB）、肌红蛋白（MYO）、肌钙蛋白Ⅰ（TROPI）分别为（8.76±2.36）、（88.4±24.9）、（0.35±0.11）μg/L比对照组（2.36±1.12）、（31.3±12.4）、（0.01±0.01）μg/L有显著增加（P〈0.01）。梗阻性黄疸患者治疗前血清CK-MB、MYO、TROPI分别为（23.93±5.11）、（188.8±36.5）、（0.34±0.08）μg/L,显著高于健康对照组（2.06±0.82）、（25.4±10.2）、（0.01±0.01）μg/L,P〈0.01）。结论实验性梗阻性黄疸兔血清心肌标志物含量与人类梗阻性黄疸患者一样显著增加,人或实验动物梗阻性黄疸都可造成心肌损害。     

糖尿病对离体大鼠缺血后适应心肌保护作用的影响

目的探讨糖尿病对离体大鼠缺血后适应心肌保护作用的影响。方法诱导2型糖尿病大鼠模型,采用Langendorff离体心脏灌流法,全心停灌30min,复灌60min,制成心肌缺血模型;全心停灌30min后,给予再灌注10s、停灌10s6次循环,然后再灌注至60min,制备缺血后适应模型。测定血流动力学指标和复灌20min冠状动脉流出液中乳酸脱氢酶(LDH)、肌酸激酶(CK)的含量。实验结束分离出左心室心肌并横切成5片,并测定心肌梗死面积。结果糖尿病大鼠缺血后适应血流动力学无明显改善,心肌酶释放量未减低,心肌梗死面积未显著减少(50.1%±3.7%比45.7%±4.8%,P0.05)。结论缺血后适应对糖尿病大鼠离体心脏无保护作用。     

Prompt detection of myocardial injury by assay of creatine kinase isoforms in initial plasma samples

To determine the sensitivity and specificity of assays of isoforms of the MM isoenzyme of creatine kinase (CK) and MB-CK for the diagnosis or exclusion of acute myocardial infarction in plasma samples obtained at the time of presentation to the emergency room of patients with suspected myocardial infarction, 50 patients in whom the diagnosis was ultimately established and 31 in whom infarction was ultimately excluded were evaluated. Of the 50 patients in whom infarction was ultimately established, 47 had an increased ratio of the MM3 to the MM1 isoform or elevated MB-CK in the plasma sample initially available. The specificity of the approach was 77%, sensitivity 94%. The availability of rapid assays for MM-CK isoforms and for MB-CK should facilitate determination of the presence or absence of acute myocardial injury sufficiently promptly so that decisions regarding treatment can be made optimally.     

The correlation between myocardial resilience after high-intensity exercise and markers of myocardial injury in swimmers

To investigate how high-intensity exercise influences an athlete''s myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.     

缺血后适应对急性心肌梗死患者临床及预后的影响

目的探讨急性心肌梗死(AMI)患者施行缺血后适应能否有效地降低缺血再灌注损伤,从而对心脏产生保护作用。方法选取AMI患者42例,随机分为对照组22例和缺血后适应组20例。监测2组患者PCI术前、术后2h、1、2、3d内肌酸激酶同工酶(CK-MB)值,并测定CK-MB峰值及各时间点下CK-MB平均值曲线下面积;监测PCI术前及术后2h血清C反应蛋白(CRP)、丙二醛和超氧化物歧化酶(SOD)水平;比较2组患者PCI术前及术后24h内心电图ST段回落情况。结果缺血后适应组CK-MB峰值明显低于对照组[(570.61±41.27)U/L vs(661.80±58.55)U/L,P<0.01];CK-MB平均值曲线下面积明显低于对照组[(5821.19±2912.07)%vs(9843.12±3578.02)%,P<0.01];缺血后适应组术后2hCRP下降幅度明显低于对照组(P<0.05);缺血后适应组术后丙二醛下降较对照组明显(P<0.05);缺血后适应组术后SOD升高较对照组明显(P<0.01);缺血后适应组ST段回落情况较对照组高(60.0%vs 45.5%,P<0.05),对照组中有2例患者因发生恶性心律失常死亡。结论AMI患者施行缺血后适应处理能够降低CK-MB的释放,降低氧自由基含量,减轻炎性反应,使冠状动脉恢复血流情况占有明显优势,能够明显降低再灌注损伤,发挥心脏保护作用。     

急诊冠状动脉介入治疗对ST段抬高心肌梗死患者跨室壁复极离散度的影响

目的探讨急诊PCI对急性ST段抬高心肌梗死(STEMI)患者跨室壁复极离散度的影响。方法选择STEMI患者341例,其中未能实现梗死相关冠状动脉再通者129例为非再通组,经急诊PCI再通者212例为再通组;另选择非冠心病者36例为对照组。以校正的T波顶点至终点时间(Tp e/c,Tp-e/RR~(1/2))作为跨室壁复极离散度量化指标。比较正常者与STEMI患者、再通组与非再通组的Tp-e/c值:以及影响急诊PCI术后Tp-e/c下降幅度的相关因素。结果非再通组Tp-e/c较对照组明显升高(P<0.01),且在入院即刻、第2、3天差异无统计学意义(P>0.05)。再通组不同梗死相关冠状动脉在术后即刻、第2、3天Tp-e/c下降幅度差异无统计学意义(P>0.05)。再通组Tp-e/c下降幅度与ST段回落程度、肌酸激酶同工酶、肌钙蛋白I、左心室舒张末内径呈独立正相关(r=0.381,r=0.238,r=0.201,r=0.147,P<0.01),与LVEF、Killip分级呈独立负相关(r=-0.1 98,P<0.01;r=-0.1 62,P<0.05)。结论急诊PCI能有效降低患者跨室壁复极离散度,该效果与不同梗死相关冠状动脉无关,而与ST回落程度、心肌标记物水平及左心室收缩功能有关。     

Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting.

AIMS: To establish the influence of perioperative myocardial injury on short- and long-term survival after coronary artery bypass grafting (CABG). METHODS AND RESULTS: The correlation of postoperative serum aspartate aminotransferase and creatine kinase MB to early cardiac-related death and to late survival was evaluated in 4911 patients who underwent CABG consecutively during a 6-year period. There were 93 early deaths (1.9%), 73 of them cardiac-related (1.5% of 4911). After a mean follow-up of 5 years, 409 additional deaths (8.5% of 4818) had occurred. Elevated enzyme levels on day 1 postoperatively highly increased the risk of early cardiac death (serum aspartate aminotransferase >or=2.35 microkat.l(-1): odds ratio 9.2; serum creatine kinase MB >or=61 microg.l(-1): odds ratio 6.0), and increased the risk of late death by approximately 50% (serum aspartate aminotransferase >or=2.35 microkat.l(-1): relative hazard 1.5; serum creatine kinase MB >or=61 microg.l(-1): relative hazard 1.4). This increased risk of death was independent of other risk factors and remained constant over time. CONCLUSIONS: Enzyme elevation after CABG implied an increased risk of both early and late death. The long-term effect persisted many years after surgery.     

Prognostic significance of myocardial enzyme release after coronary interventions

Mild to moderate periprocedural elevation in CK with concurrent CK MB elevation result in increased subsequent myocardial infarction and mortality. However the potential risks that percutaneous revascularization interventions pose must be evaluated in light the risks of alternative procedures and the risks of continued medical management. Prospective clinical trials examining the relationship of periprocedural enzyme elevations to long term prognosis will need to address this issue. Cathet. Cardiovasc. Intervent. 46:292–302, 1999. © 1999 Wiley-Liss, Inc.     

急性心肌梗死患者外周血中微小RNA-492表达水平及临床意义

目的 探究急性心肌梗死(acute myocardial infarction,AMI)患者外周血清微小RNA(miR)-492表达水平以及临床诊断意义.方法 选择2018年9月～2020年6月广东医科大学附属医院急诊科就诊的老年AMI患者248例为研究组,选择同期冠状动脉造影正常者248例为对照组.检测2组血清肌钙蛋...     

肌酸激酶-同工酶亚型的检测及其在心肌损伤中的应用

目的:探讨在5~18岁心肌炎患者诊断中肌酸激酶-同工酶(CK-MB)亚型的检测意义。方法:选择120例5~18岁心肌炎患者作为观察对象,以心肌肌钙蛋白I(cTnI)检测结果作为心肌损伤确诊标准,分为非心肌损伤组(非损伤组,70例)及心肌损伤组(损伤组,50例),对比两组CK-MB质量及CK-MB活性差异。同时对CK-MB质量及CK-MB活性在心肌炎心肌损伤诊断中的应用价值进行分析。结果:与非损伤组比较,损伤组CK-MB质量[(40.35±23.27)μg/L比(105.62±29.26)μg/L]及CK-MB活性[(62.31±16.19)U/L比(120.78±15.23)U/L]均显著升高,P均=0.001;CK-MB质量及CK-MB活性均对心肌炎心肌损伤具有较高的诊断灵敏度(84.00%,74.00%)、特异性(82.86%,72.86%)及准确性(82.50%,71.67%),且CK-MB质量检测的准确性显著高于CK-MB活性检测(P=0.046)。CK-MB质量曲线下面积(0.838)及CK-MB活性曲线下面积(0.733)均对心肌炎心肌损伤具有显著的诊断价值(P均=0.001)。结论:相对于CK-MB活性,CK-MB质量在5~18岁患者心肌炎心肌损伤中具有更高的诊断价值。