血清同型半胱氨酸对心脏结构和功能影响的研究

目的探讨血清同型半胱氨酸水平对心脏结构与功能的影响。方法研究对象包括冠心病患者57例,平均年龄(58±8)岁和正常人组24例,平均年龄(55±9)岁,均经选择性冠状动脉造影证实。应用HPSonos5500型超声诊断仪测定并计算舒张末期室间隔厚度、左室后壁厚度、舒张末期左室内径、左室心肌重量、左室重量指数和左室射血分数等指标。血清同型半胱氨酸水平应用高效液相色谱法测定。结果冠心病患者组同型半胱氨酸水平明显高于正常对照组〔（17.06±4.54)μmol/LVS(7.89±3.21)μmol/L,P＜0.01〕。舒张末期室间隔厚度、左室后壁厚度、舒张末期左室内径和左室心肌重量在两组间无显著性差异,而射血分数冠心病患者则明显低于正常人。舒张末期室间隔厚度、左室心肌重量和左室重量指数与血清同型半胱氨酸水平也呈显著正相关(r分别为0.25,0.36,0.32,P均＜0.05),而射血分数则与血清同型半胱氨酸水平呈显著负相关(r＝－0.36,P＜0.01)。结论研究表明血清同型半胱氨酸水平与舒张末期室间隔厚度、左室心肌重量和左室重量指数呈显著正相关,是影响心血管结构和功能的一个重要危险因素。     

不同体重指数对小儿心脏结构和功能的影响

近年来我国大中城市儿童单纯性肥胖症的发生率显著增加,业已证实肥胖是心脑血管疾病的独立危险因素之一。本文通过超声心动图对56例单纯性肥胖儿童心脏结构和功能进行了研究,旨在探讨儿重肥胖程度不同对心脏影响的特征及其相关性．报告如下。1对象与方法1．1对象1998年4－6月我们对济南市区部分中小学生查体,筛选出56例单纯性肥胖儿童,设肥胖组其中男32例,女24例;平均年龄问．2岁。肥胖诊断标准“‘：①实测体重超过同身高标准体重的ZO％,②肽三头肌部和肩牌下角两处皮福厚度之和＞32nun（男）、34mm（女）;③体重指数山＊1,体重…     

在线血液透析滤过对维持性血液透析患者心脏结构和功能的影响

目的探讨规律性在线高通量血液透析滤过对维持性血液透析(maintain hemodialysis,MHD)患者左心室结构和功能的维护作用和机理。方法按一定的纳入标准选择湖北医药学院附属人民医院血液净化中心MHD患者53例,随机分为单纯透析组(HD组)和透析+透析滤过组(HD+HDF组),于治疗前及6个月后用超声心动图分别测定各患者心脏结构和功能指标(LVDd、LVVd、E/A、EF和LVMI);在以上两时间点进行体检并抽取患者血标本分别检测患者基础状态指标(MAP、Hb、BMI、SCr)和透析相关慢性损害指标(CRP、IL-1a、a2-MG、PTH)。结果入选时两组患者在基础状态指标、透析相关慢性损害指标和心功能指标方面无显著差异;经不同治疗模式治疗6个月后,HD组在基础状态指标方面变化不明显,但在CRP、IL-1a、a2-MG、PTH等指标上有轻度升高;HD+HDF组患者在基础指标的血压和血红蛋白上和透析相关慢性损害指标上较前均有好转;治疗6个月后,HD组和HD+HDF组在E/A、EF、LVMI等心功能指标上均有所减退,但HD+HDF组较HD组的减退幅度明显较小。结论在维持性血液透析患者中采用HD+HDF模式更有助于减轻患者心脏结构和功能损害。     

胎儿心脏定量分析技术对生长受限胎儿心脏结构及功能的评估价值

目的 探究胎儿心脏定量分析技术(Fetal HQ)评估生长受限胎儿(FGR)心脏结构及功能的价值。方法 以350例单胎孕妇为研究对象,其中FGR 42例(FGR组,早发型20例,晚发型22例),非FGR 308例(NFGR组),均接受常规超声及Fetal HQ检查。对比各组常规超声与Fetal HQ参数。结果 FGR组孕妇超声胎儿脐动脉(UA)-搏动指数(PI)、UA-阻力指数(RI)、Tei指数均显著大于NFGR组(P<0.05),大脑中动脉(MCA)-PI、MCA-RI均显著小于NFGR组(P<0.05)。FGR组四腔舒张末期长径、舒张末期室间隔厚度(IVSd)、左心室后壁厚度(LVPWd)、左心室/右心室面积变化分数(LV/RVFAC)、左心室/右心室纵向应变(LV/RVGLS)、心输出量(CO)及每搏输出量(SV)均显著低于NFGR组(P<0.05)。早发型组与晚发型组Fetal HQ各参数对比差异均无统计学意义(P>0.05)。结论 Fetal HQ能有效评估FGR胎儿心脏形态、结构及功能,或许有利于FGR胎儿心功能监测及治疗干预。     

2型糖尿病对老年高血压患者心脏结构和功能的影响

目的探讨2型糖尿病(T2DM)对老年高血压(EH)患者心脏结构和功能的影响。方法入选60岁以上单纯EH患者142例(EH组),T2DM与高血压共存患者122例(并存组),同期体检健康者60例作为对照组,对3组研究对象的相关临床资料及彩色多普勒超声心动图等检查结果进行对比分析。结果 (1)并存组和EH组的舒张末期左心室内径(LVDd)、舒张末期室间隔厚度(IVSTD)、舒张末期左室后壁厚度(LVPWTD)、左室质量(LVM)和左室质量指数(LVMI)均高于对照组(P<0.05或P<0.01);而并存组的IVSTD、LVPWTD、LVM、LVMI又高于EH组(P<0.05或P<0.01)。(2)EH组和并存组的左心室舒张早期二尖瓣最大血流速度(E)、E/A比值及射血分数(EF)值均低于对照组,而A值高于对照组,并存组E值和EF值又低于EH组。(3)EF值低于50%的发生率分别是对照组8.33%,EH组38.73%,并存组54.92%,3组间差异有统计学意义(P<0.01)。E/A值<0.8或>1.6者,对照组21.67%,EH组46.48%,并存组69.67%,3组间差异有统计学意义(P<0.01)。结论糖尿病对老年高血压患者心脏结构、收缩和舒张功能均有一定的影响,高血糖可加重老年高血压患者心脏结构和功能的异常。     

沙格列汀对2型糖尿病患者左心室收缩功能影响的研究

目的探讨沙格列汀对2型糖尿病患者左心室收缩功能的影响。方法纳入2016年1至12月在新疆医科大学第一附属医院明确诊断为2型糖尿病使用降糖药物治疗的423例患者,根据有无使用沙格列汀治疗分为沙格列汀组和非沙格列汀组,全部行心脏彩超检查,进行组间比较;然后依据左心室射血分数分为收缩功能正常和减退组,进行组间比较;采用Logistic回归分析沙格列汀与左心室收缩功能相关性。结果 (1)与非沙格列汀组患者相比,沙格列汀组患者左心室舒张末径较小[(49.3±6.1)mm vs(52.5±6.6)mm],左心室射血分数较高[(61.6±3.4)%vs(58.4±5.2)%],差异具有统计学意义(P<0.05)。(2)与收缩功能减退患者相比,收缩功能正常患者沙格列汀使用比例较高(51.9%vs 28.1%),同时,收缩功能正常患者左心室舒张末径较小且血压、血糖水平较低,差异具有统计学意义(P<0.05)。(3)采用Logistic回归分析提示,使用沙格列汀为左心室收缩功能的保护因素。结论沙格列汀对2型糖尿病患者左心室收缩功能具有保护作用。     

培哚普利对高血压患者心脏结构及功能的影响

培哚普利(Perindopril)作为长效血管紧张素转换酶抑制剂,对高血压患者有良好的临床疗效.目前已开始应用于临床.本文报道应用二维超声及脉冲多普勒,通过检测服用培哚普利前后超声指标的变化,以探讨培哚普利对高血压患者心脏结构及功能的影响.1 对象与方法1.1 对象 符合WHO高血压诊断标准,病史在5年以上的原发性高血压患者作为研究对象.经病史、体检、实验室检查及其它辅助检查排除继发性高血压,并剔除合并冠心病、糖尿病、心肌病患者.实验对象共36例,男27例,女9例.年龄55.8±6.5岁.     

心脏磁共振成像技术对OSAHS患者心脏的研究

目的利用心脏磁共振成像技术研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者左心功能及心肌的变化,并对心肌组织进行量化分析。材料与方法选择符合2011年修订版OSAHS诊断标准,且经多导睡眠图(polysomnography,PSG)监测后诊断为OSAHS的男性患者24例,年龄40~60岁,及正常成年男性健康志愿者25名,年龄40~60岁,进行心脏磁共振基于梯度回波的多时相电影序列扫描、look-locker反转恢复(modified look-locker inversion recovery,MOLLI)序列对比剂注射前T1mapping扫描、基于T2平衡稳态自由进动序列(steady-state free-precession,SSFP)的T2 mapping扫描、T1 scout序列扫描、MOLLI序列对比剂注射后T1mapping扫描。获得左心功能参数左心室射血分数(left ventricular ejection fractions,LVEF)、左室舒张末期容积(left ventricular end diastolic volume,LVEDV)、收缩末期容积(left ventricular end systolic volume,LVESV)、每搏量(stroke volume,SV)、心输出量(cardiac output,CO)、心脏指数(cardiac index,CI)、左室心肌质量(left ventricular mass,LVM)、左室心肌T1值、T2值及细胞外体积分数(extracellular volume fractio,ECV)值。结果(1)心功能相关参数:OSAHS组LVEF、LVEDV及LVSV低于正常对照组,LVESV及LVM高于正常对照组,差异有统计学意义(P<0.05);收缩末期容积、每搏量、心输出量OSAHS组与正常对照组差异无统计学意义(P>0.05);(2)组织学参数:中间段T2值、心尖段T2值及左室心肌平均T2值OSAHS组高于对照组,差异有统计学意义(P<0.05);各段心肌及左室平均增强前T1值及ECV值OSAHS组高于对照组,但差异无统计学意义(P>0.05)。结论(1)心脏磁共振成像技术可以有效评估OSAHS患者心脏结构功能及心肌的早期改变,具有重要临床应用价值;(2)OSAHS患者的左心收缩及舒张功能均有不同程度的减低,心肌质量增加;(3)OSAHS患者左室心肌存在不同程度的心肌水肿和炎性改变。     

不同透析模式对尿毒症患者心脏结构及功能影响

目的 观察不同透析模式对尿毒症透析患者心脏结构及功能的影响.方法 选择苏州高新区人民医院血透中心符合纳入标准的血透患者77例,分为血液透析串联血液灌流组(HD+HP组)23例、血液透析滤过组(HDF组)26例及血液透析组(HD组)28例.分别于入组前与透析6个月后用心脏超声仪检测心脏结构及功能的相关参数.结果 心脏超声...     

Impact of cardiac magnetic resonance imaging on cardiac device and surgical therapy: a prospective study

Cardiac magnetic resonance (CMR) imaging may allow more appropriate selection of patients for cardiac device implantation and/or cardiac surgery. In this prospective observational study we evaluated the impact of CMR imaging on cardiac device and surgical therapy. All CMR examinations performed in a single centre over a 2 year period were prospectively recorded in a dedicated database under 4 clinical pathways [cardiomyopathy, viability, tumour/mass and arrythmogenic right ventricular cardiomyopathy (ARVC)]. Baseline data entered included planned cardiac device implantation and/or cardiac surgical intervention. Patients were contacted 6 months following CMR to evaluate the impact of CMR on planned therapy. Cost savings due to CMR were calculated as the number of surgical or device procedures averted following CMR scanning multiplied by their respective cost weights. Of 732 CMR examinations performed, the clinical pathway was cardiomyopathy in 488 (67 %), ARVC in 118 (16 %), viability in 92 (12 %) and tumour/mass in 34 (5 %). Six month follow-up was available in 666/732 patients. Following CMR, 56/150 (37 %) of patients with an initial plan for device implantation or cardiac surgery, did not undergo the planned intervention (P < 0.001, one-sample exact binomial test). Of 516 patients without an initial device or surgical plan, 33 (6 %) CMR resulted in device implantation or cardiac surgery (P < 0.001, Chi squared). Overall, the estimated saving due to CMR-guided management changes was AUD$737,270. CMR has a significant impact on patient management and offers potential cost savings with respect to selection of device and surgical therapy for cardiac disease.     

Acupuncture effects on cardiac functions measured by cardiac magnetic resonance imaging in a feline model

The usefulness of acupuncture (AP) as a complementary and/or alternative therapy in animals is well established but more research is needed on its clinical efficacy relative to conventional therapy, and on the underlying mechanisms of the effects of AP. Cardiac magnetic resonance imaging (CMRI), an important tool in monitoring cardiovascular diseases, provides a reliable method to monitor the effects of AP on the cardiovascular system. This controlled experiment monitored the effect electro-acupuncture (EA) at bilateral acupoint Neiguan (PC6) on recovery time after ketamine/xylazine cocktail anesthesia in healthy cats. The CMRI data established the basic feline cardiac function index (CFI), including cardiac output and major vessel velocity. To evaluate the effect of EA on the functions of the autonomic nervous and cardiovascular systems, heart rate, respiration rate, electrocardiogram and pulse rate were also measured. Ketamine/xylazine cocktail anesthesia caused a transient hypertension in the cats; EA inhibited this anesthetic-induced hypertension and shortened the post-anesthesia recovery time. Our data support existing knowledge on the cardiovascular benefits of EA at PC6, and also provide strong evidence for the combination of anesthesia and EA to shorten post-anesthesia recovery time and counter the negative effects of anesthetics on cardiac physiology.     

自触发心脏磁共振成像

目的探讨和实现一种自触发磁共振心脏成像(CMRI)。方法将心电图(ECG)信号和呼吸信号从监测信号中提取出来,然后将K空间数据重新排列、重建,得到心脏图像。结果自触发CMRI克服了传统的导联法难以获得稳定ECG信号的缺点,可提高扫描效率,得到高品质的亮血和黑血小鼠心脏电影图像。结论采用自触发CMRI可以实现小鼠心脏电影成像以及黑血成像,并用于评价其心脏结构和功能。     

Quantification of global and regional ventricular function in cardiac magnetic resonance imaging

One of the strong assets of cardiac magnetic resonance (CMR) is its ability to assess myocardial anatomy, structure, function, flow, and perfusion within a single examination. Quantification of global and regional function from magnetic resonance imaging (MRI) studies was shown to be accurate and reproducible in experimental and clinical research studies. With the advent of high-performance MRI scanners and newly developed pulse sequences, image acquisition times have been reduced considerably in recent years. However, the clinical use of CMR remains limited for various reasons. Among these limitations is that the amount of images obtained in a typical cardiac examination is so large that visual and especially quantitative image analysis is tedious and time consuming. There is an urgent need for optimized dedicated software tools featuring highly automated contour detection and optimized display capabilities to present the quantitative results to the physician in an orderly fashion, thus facilitating clinical decision making. This article focuses on the state of the art in CMR postprocessing techniques for quantitative assessment of global and regional function.     

心脏磁共振评价心尖肥厚型心肌病患者左心房室结构、功能及其相关性研究

目的用心脏磁共振评估心尖肥厚型心肌病(apical hypertrophic cardiomyopathy,AHCM)患者心脏形态及左心室舒张功能变化,并评估左心室舒张功能与心尖部厚度及左房形态、功能之间的关系。材料与方法回顾性分析2015年9月至2018年7月于我院就诊并完成心脏磁共振、心电图及超声心动检查的患者,挑选出其中AHCM患者69例及健康对照组25例,比较两组之间左心室射血分数(left ventrical ejection fraction,LVEF)、左心室心肌质量、左心室心肌厚度、收缩末期左房容积(left atrial end systolicvolume,LAESV)、左房整体峰值纵向应变(left atrial peak global longitudinal strain,LAPGLS)、左房整体峰值周向应变(left atrial peak global circumferential strain,LAPGCS)及左房面积变化分数(fraction area change,FAC)的差异,以及LAPGLS和LAPGCS与其他左心房室结构及功能参数之间的相关性。结果心尖肥厚型心肌病组左心室心尖部厚度、左心室心肌质量、LVEF、LAESV均明显高于正常对照组,LAPGLS及FAC均明显低于正常对照组,两组之间的差异均有统计学意义(P<0.05),而两组之间的LAPGCS差异则没有统计学意义。结论心尖肥厚型心肌病患者左心室舒张功能下降,而左心房收缩功能未发生明显变化。左心房FAC可作为LAPGLS的替代指标来判断左心室舒张功能是否下降。     

肌萎缩侧索硬化症的磁共振成像及磁共振弥散张量成像研究

目的:研究肌萎缩侧索硬化症(ALS)患者皮质脊髓束磁共振成像(MRI)的常规序列图像和MRI弥散张量成像(DTI)特点。方法:对16例ALS患者(病例组)及16名健康志愿者(对照组)行MRI、DTI扫描,获取轴位、冠状位和矢状位图像,选取感兴趣区(ROI),测量部分各向异性分数(FA)和表观弥散系数(ADC)。使用ALS功能评定量表修订版(ALSFRS-R)评分与ALSAppel(AALSS)评分对其进行临床评估,分析影像学表现与年龄、病程及临床表现间的关系。结果:16例ALS患者中有11例(68.7%)T2加权成像(T2WI)、液体衰减反转回复序列(FLAIR)序列轴位及冠状位图像显示皮质脊髓束信号异常增高。与对照组比较,病例组中脑、内囊后肢3/4和半卵圆区ADC值升高(P<0.01)。各ROI的FA值和ADC值与受检者的年龄、病程、ALSFRS-R评分、AALSS评分均无相关性。结论:MRI常规序列图像和DTI均能显示ALS患者的皮质脊髓束损害,而MRI常规序列对临床诊断可能具更重要的意义。     

膝骨性关节炎患者脑结构和功能变化的多模态MRI

目的  联合基于体素的形态学测量（VBM）技术和静息态功能磁共振成像（rs-fMRI）技术探究膝骨性关节炎（KOA）患者静息状态下脑灰质体积、脑神经元活动强度及基于种子点的功能连接强度改变,综合分析KOA相关异常脑网络。方法  前瞻性收集30例KOA患者（KOA组）及30例健康人（HC组）的3D高分辨率T1WI像和rs-fMRI图像,采用VBM、低频振幅、功能连接3种方法分析两组间脑灰质结构和功能数据差异。结果  与HC组相比,KOA组双侧梭状回、右侧颞中回低频振幅值增高,右侧楔前叶、右侧内侧前额叶皮质、左侧额中回低频振幅值减低（体素水平P<0.005,团块水平P<0.05）;右侧楔前叶、右侧顶下小叶、右侧初级视觉皮层、左侧颞中回、左侧中央后回灰质体积减小（体素水平P<0.002,团块水平P<0.05）;以右侧楔前叶为种子点,与右侧颞中回的功能连接增强,与左侧前扣带回、左侧背外侧前额叶皮质的功能连接降低（体素水平P<0.005,团块水平P<0.05）。结论  KOA患者感知皮层系统及联合皮层系统阵营均存在血氧水平依赖信号及灰质微结构的改变且有重叠,主要涉及视觉网络、感觉运动网络、默认状态网络、执行控制网络内及默认状态网络、执行控制网络、突显网络的部分脑区间,这可能提示KOA患者不仅处于慢性疼痛的病理状态,还伴有信息整合、注意力控制、情绪反应、情感解读等功能活动的异常。     

Evaluation of acute coronary syndromes by cardiac magnetic resonance imaging

The use of cardiovascular magnetic resonance (CMR) imaging for the evaluation of patients with acute chest pain and acute coronary syndromes has great potential. The strength of CMR relies on its ability to provide information on anatomy, physiology, and function in a single scanning session in a noninvasive manner without the need for iodinated contrast, radiation, or the need to undergo invasive procedures. Specifically, with regard to imaging patients with acute chest pain and/or myocardial infarction (MI), CMR has the ability to qualitatively and quantitatively evaluate global and regional right and left ventricular systolic functions, myocardial edema, myocardial perfusion, and myocardial infarct size and transmurality/viability. This review will focus on CMR imaging for the following applications: (1) imaging for the evaluation of ventricular function and infarct size in patients with acute chest pain and/or acute MI, (2) for triage and prognosis of patients presenting to the emergency department with acute chest pain, (3) for evaluating patients after sustaining an acute MI, and (4) for stem cell research.