目的:本文通過研究白介素23受體(IL-23R)基因多態性與擴張型心肌病(DCM)的相關性,探討DCM患者的免疫遺傳學發病機制. 方法:采用PCR-RFLP方法測定DCM患者和正常對照者IL-23R基因rs7517847位點的單核苷酸多態性. 用卡方檢驗比較病例組與對照組之間基因型頻率和等位基因頻率的統計學差異。結果:IL-23R基因rs7517847位點單核苷酸多態基因型和等位基因頻率在DCM組與正常對照組之間無差異。結論:本研究未發現IL-23R基因rs7517847位點多態性與DCM相關。
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. ResultsUltimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.
【摘要】 目的 觀察長期大量酒精攝入對大鼠心肌結構及心肌組織中丙二醛(MDA)、超氧化物歧化酶(SOD)和金屬硫蛋白(MT)含量的影響,探討氧化應激在酒精性心肌病大鼠中的作用。 方法 雄性健康SD大鼠45只,隨機分為2組,即對照組20只和模型組25只。模型組酒精濃度從5%、10%、20%和30%依次各自由飲1周,然后遞增至36%后以該濃度維持飼喂。對照組每日飲用與模型組酒精同等熱量的葡萄糖水。6個月后,觀察大鼠心肌組織的形態學改變及超微結構的變化,測定心肌組織中MDA、SOD及MT的含量。結果 模型組大鼠心肌細胞排列紊亂、間質充血、炎細胞浸潤、線粒體腫脹、空泡形成、肌絲溶解、核膜不規則和核仁裂解。心肌組織中MDA含量明顯升高(Plt;0.01),SOD活力含量明顯降低(Plt;0.01),MT含量明顯降低(Plt;0.01)。 結論 長期攝入大量酒精可使氧自由基代謝失衡,導致心肌損傷。氧化應激在酒精性心肌病發病機制中發揮著重要的作用。【Abstract】 Objective To observe the effect of longterm and large quantities of alcohol intake on myocardial structure of rats and the content of malondialdehyde (MDA), superoxide dismutase (SOD) and metallothionein (MT) in myocardium tissue. To study the effect of oxidative stress on the rats with alcoholic cardiomyopathy. Methods Fortyfive male and healthy SD rats were randomly divided into the control group (20 rats) and model group (25 rats).The alcoholic concentrate in model group was increased from 5%,10%,20% to 30% every week, and maintain free drinking mass concentration of 36% alcohol. The control group drink the same calories of glucose water. Six months later, the myocardial tissues were observed both in light microscope and electron microscope .The level of MDA、SOD and MT were tested in myocardium tissue. Results In the model rats, the cells of myocardial disarray, interstitial congestion, inflammatory cell infiltration, mitochondrial swelling, vacuole formation, melt filaments, irregular nuclear membrane and nucleolus cracking. The content of MDA incresed(Plt;0.01)and the activities of SOD decreased(Plt;001),levels of MT decreased (Plt;0.01) in the cardiac muscular tissues in the model group compared with the control group. Conclusion Longterm intake of large amounts of alcohol can break the balance of oxygen free radicals, which leading to the damage of myocardial. Oxidative stress plays an important role in the etiopathogenesis of alcoholic cardiomyopathy.
Dilated cardiomyopathy (DCM) is a highly prevalent disease which has multiple clinical manifestations and pathological features. With the characteristics of multi-sequence and multi-parameter, cardiac magnetic resonance imaging (MRI) can accurately assess the morphology, function and tissue characterization of heart, and provide comprehensive information for diagnosis of DCM. This review focuses on the sequences and clinical applications of MRI evaluation in DCM in order to provide additional information for clinical diagnosis, treatment and prognosis.
Objective To introduce a method of preoperative three-dimensional measurement by echocardiography to guide the surgical resection of hypertrophic obstructive cardiomyopathy (HOCM) and its long-term follow-up effect. MethodsBefore operation, each patient underwent transthoracic echocardiography to measure the length, width and thickness of diastolic ventricular septum hypertrophy on the long axis, short axis and four chamber sections, in order to establish three-dimensional measurement data of myocardial hypertrophy, and quantitatively estimate the location, depth and range of myocardium to be removed between 2014 and 2022 in our hospital. According to the quantitative data during operation, the hypertrophic myocardium of ventricular septum was resected to dredge the left ventricular outflow tract. ResultsForty-three patients were recruited, including 22 males and 21 females, aged 18-78 (49.2±5.1) years. Eighteen patietns underwent mitral valve surgery at the same time. All patients were satisfied with the relief of left ventricular outflow tract obstruction. Postoperative transesophageal echocardiography showed that the left ventricular outflow tract pressure gradient decreased significantly (94.2±28.1 mm Hg vs. 6.7±4.7 mm Hg, P<0.05). There was no ventricular septal perforation or complete atrioventricular block during the operation, and no one needed a secondary aorta-clamp for re-operation to remove hypertrophic myocardium again. Postoperative echocardiography showed that the mitral valve closed well or only had mild regurgitation, and the mitral systolic anterior motion sign basically disappeared. After 1.0-8.5 years of follow-up, the average pressure difference of left ventricular outflow tract remained below 10 mm Hg, and the clinical symptoms disappeared or improved significantly. Conclusion The quantitative prediction of the resection range of hypertrophic myocardium by three-dimensional measurement of preoperative echocardiography can accurately guide the surgical range of HOCM, avoid multiple blocking of aorta during operation, relieve left ventricular outflow tract obstruction to the greatest extent, and obtain better long-term results.