应激性心肌病的亚型及发病机制新认识.中华老年心脑血管病杂志.2016; 18(3):317-320.房加雄,齐跃,于慧春,田泽君,刘子泉,吕琪,胡远兵,王杰思,李贺应激性心肌病是较常见的急性心血管病事件,心理、躯体应激、疾病、药物等多种病因均可诱发。早在古时圣经时代(biblical times)、古罗马时期,上世纪40及60年代,学者就已用伤心综合征(Broken heart syndrome)、“悲伤心脏”(broken heart)描述心理应激与死亡关系,到80年代初Cebelin等报道了无冠心病突然死亡的应激性心肌病(stress cardiomyopathy)病例。本病发病时左心室收缩常呈现特征性章鱼瓶(Takotsubo)形态,90年代日本学者Sato等首先用章鱼瓶心肌病描述本病典型特征。由于本病常以强烈心理应激刺激为诱因,2006 年美国心脏病学会称之为应激性心肌病(stress-induce cardiomyopathy,SIC)。近10余年来世界各地本病临床病例报告逐年增加,观察到多种不同心室累及特征的亚型,诊断标准也不断完善。越来越多的证据表明,急性中枢神经损伤导致心脏功能异常,年龄相关的心脏交感神经功能变化与本病关系密切。应激性心肌病主要发生于老年人,在全球,特别是我国人口老龄化进程的日益加速的大形势下,深入研究本病有重要意义。 应激性心肌病可由多种强烈应激诱发,主要发生于老年人,临床表现与ACS相近,根据心室形态特征性改变可分为多种亚型。本病大多预后良好,部分患者可出现严重并发症,急性期住院死亡率4.2%,少数患者可复发。由于病理生理机制还不完全清楚,目前尚无共识有效的治疗对策,加上诱因众多,个体化治疗是总原则。积累的证据表明,中枢神经和外周心脏交感神经功能异常在本病中可能发挥重要作用,即中枢神经损伤导致交感神经活性变化和心脏损伤、对心脏局部去甲肾上腺素浓度发挥重要调控作用的交感神经再摄取功能异常。深入研究阐明这些异常的机制可能成为本病研究的新重点。
AnextensiveDeBakeytypeIIIbaorticdissectionwith massive right pleural effusion presenting as abdominal pain and acute anemia: particular case reportHui-Chun Yu, Zhen-Qing Wang, Yuan-Yuan Hao, Feng-Ping An, Yu-Chuan Hu, Rui-Bing Deng, Peng Yu, Guang-Bin Cui, He LiJ Geriatr Cardiol.2015 May;12(3): 319–322.doi:10.11909/j.issn.1671-5411.2015.03.010PMCID:PMC4460177Article PubReader PDF–1.6M CitationAbstractWe describe the case of a 79-year-old male presented with sudden onset of abdominal pain and mild breathlessness, and complicated acute progressive anemia with haemoglobin which declined from 120 g/L to 70 g/L within five days. An urgent computed tomography angiography showed acute thoracic aortic dissection, DeBakey type IIIb, a dissecting aneurysm in the proximal descending thoracic aorta starting immediately after the origin of the left subclavian artery and extending distally below the renal arteries with evidence of rupture into the right pleural cavity for massive pleural effusion. Plasma D-dimer, brain natriuretic peptide and C reactive protein level were elevated. Our case showed that D-dimer can be used as a ‘rule-out’ test in patients with suspected aortic dissection. A raised BNP may exert a protective role through anti-inflammatory endothelial actions in the systemic circulation.Keywords:Acute aortic dissection, Anemia, D-dimer, The elderly
长期压力超负荷大鼠心脏交感神经NET、NGF及其受体表达变化第三军医大学学报.2015;37(1)叶帆,张晶,房加雄,齐跃,杨学永,李贺 [摘要]目的:检测长期心脏压力超负荷(pressure overload,POL)大鼠心脏交感神经去甲肾上腺素转运蛋白(norepinephrine transporter NET)、心肌神经生长因子(nerve growth factor NGF)及受体TrkA表达变化,探讨心脏压力负荷导致交感神经重塑的机制。方法: 40只雄性Wistar大鼠随机分为:假手术对照组(n=10)和POL组(n=30)二组,建立腹主动脉缩窄大鼠心脏POL模型。手术后8周,用超声心电图评价大鼠心脏功能,用免疫组化荧光方法检测左心室心肌NGF蛋白表达。用实时荧光定量PCR检测心脏交感神经节NET mRNA表达及左室心肌GAP43(growth associated factor GAP43)、TrkA mRNA表达变化。结果:与对照组比较,POL大鼠IVSs、 IVSd 、LVPWd显著增加;LVMI升高33.23%(p<0.05< span="">);心功能(EF、FS%)增强(p<0.05< span="">),表明大鼠心功能代偿。POL组心肌NGF蛋白表达增加(p<0.05< span="">),但心肌GAP43、心脏NET mRNA水平未见显著变化(p>0.05),Trk A mRNA表达显著下降(p<0.05< span="">)。结论:POL后心功能代偿阶段,心肌NGF蛋白表达增高,不伴交感神经生长增加,可能与Trk A mRNA低表达有关;推测心脏NET mRNA转录后异常或内化可能是POL后NET功能异常原因。
老年人跌倒与心血管病及防治中华老年心脑血管病杂志.2012;15(10):1117-1120.杜海科,胡远兵,李振洲,杨溢,曾建,张继英,晁爱军,李文军(Wenjun Li),李贺武警部队老年医学专业委员会(杜海科,胡远兵,李振洲,杨溢,曾建,张继英,李贺) 武警后勤学院附属医院(李贺,杜海科) 天津市天津医院(晁爱军) Worcester MA 01655,USA,University of Massachusetts Medical School, Department of Medicine, Division of Preventive and Behavioral Medicine (Wenjun LI) 跌倒(fall)是老年人最常见的严重病症之一,原因复杂,我国人口老龄化日趋严重,老年人健康、事故预防和疾病防治将成为重要国策问题。美国流行病学研究显示,30%~40% 65岁以上家居(community-dwelling)老年人每年至少跌倒一次,其中严重跌伤需要治疗者(髋部及其他骨折、硬膜下血肿、外伤性脑损伤等)约占10%。急诊老年患者中10%与跌倒有关,约6%需住院治疗。跌倒是65岁以上老年人外伤、致残和死亡的主要原因。 85岁以上男、女性家居老年人跌倒发生率分别为33%和60%。同时,跌倒也影响老年人生活质量、心理健康、独立生活能力,并增加医疗费用、经济负担和对家庭成员的严重依赖。老年人跌倒与并存疾病有关,心血管病是老年人群多发、重要疾病,心血管病及治疗与跌倒之间关系密切。我们简要综述近年来国外对二者关系的相关研究进展,为亟待开展的中国老年人跌倒研究提供借鉴。
巨噬细胞移植对心肌梗死大鼠细胞外基质修复的影响第三军医大学学报.2012;34(17):1727-1732.任宁,周欣,李贺,黄体钢,叶帆,陈树涛,丛洪良目的 探讨移植巨噬细胞对大鼠缺血再灌注引起的心肌梗死后细胞外基质修复和心室重塑的影响。方法贴壁法培养Wistar大鼠腹腔巨噬细胞,建立Wistar大鼠心肌缺血?再灌注模型,随机分为对照组(AMI组,n=23),巨噬细胞移植组(MΦ组,n=20),假手术组(n=12)。术后第7天和第28天,取大鼠左室心肌组织进行组织病理学分析,分别测定膨展指数、梗死面积、非梗死区心肌细胞横截面积(CSA)、梗死区及非梗死区胶原容积分数(CVF)、梗死区胶原成熟程度。结果 与AMI组比较,MΦ组术后第7天膨展指数[(0.27±0.13)vs(0.41±0.19),P<0.05]、非梗死区CSA[(330.65±57.30)μm2vs(408.00±99.98)μm2,P<0.01]均显著减少,MΦ组术后第28天膨展指数[(0.30±0.11)vs(0?48±0.12,P<0.01]、非梗死区CSA[(335.80±92.52)μm2vs(515.41±93.13)μm2,P<0.01]也均显著减少;术后第7天和第28天MΦ组梗死区CVF显著大于AMI组[(53.51±5.82)% vs(45.05±3.66)%,(79.17±5.58)% vs(73.17±5.94)%,P<0.01],非梗死区CVF显著小于AMI组[(2.37±0.65)% vs(4.84±1.81)%,(2.64±0.63)% vs(6.01±1.34)%,P<0.01],梗死区胶原成熟程度显著大于AMI组[(0.566±0.009)vs(0.509±0.011),(2.162±0.047)vs(1.454±0.020),P<0.01]。结论 巨噬细胞心肌内移植促进梗死区胶原沉积和成熟度增加,减少梗死范围,减轻非梗死区纤维化程度和心肌肥厚程度,从而改善心肌梗死后左室重塑。
He B, Ye F, Zhou X, Li H*, Xun X, Ma X, Liu X, Wang Z, Xu P, Li Y.Exogenous nerve growth factor supplementation elevates myocardial immunoreactivity and attenuates cardiac remodeling in pressure-overload rats. ABBS. 2012;44(11):931-8.Acta Biochim Biophys Sin (Shanghai).2012 Nov;44(11):931-8. doi: 10.1093/abbs/gms082. Epub 2012 Sep 30.Exogenous nerve growth factor supplementation elevates myocardial immunoreactivity and attenuates cardiac remodeling in pressure-overload rats.He B1,Ye F,Zhou X,Li H,Xun X,Ma X,Liu X,Wang Z,Xu P,Li Y.Author informationAbstract It is postulated that supplementation of exogenous nerve growth factor (NGF) might mediate improvement of the cardiac sympathetic nerve function in heart failure (HF). Local intramuscular injection of NGF near the cardiac sympathetic ganglia could influence the innervation pattern, norepinephrine transporter (NET) gene expression, and improve the cardiac remodeling in experimental HF animals. In this study, we injected NGF into the scalenus medius muscles of Sprague-Dawley rats with abdominal aortic constriction (AC). The nerve innervated pattern, left ventricular morphology, and function following injection in rats with AC were investigated respectively by immunohistochemistry and echocardiography. Levels of mRNA expression of NET, growth associated protein 43 (GAP 43), NGF and its receptors TrkA and p75(NTR), and brain natriuretic peptide (BNP) were measured by real-time polymerase chain reaction. The results showed that myocardial NGF mRNA levels were comparable in rats with AC. Short-term supplementation of exogenous NGF raised the myocardial NGF immunoreactivity, but did not cause hyperinnervation and NET mRNA upregulation in the AC rats. Furthermore, myocardial TrkA mRNA was found to be remarkably decreased and p75(NTR) mRNA was increased. Myocardial TrkA downregulation may play a beneficial effect for avoiding the hyperinnervation, and it is reasonable to postulate that p75(NTR) can function as an NGF receptor in the absence of TrkA. Interestingly, local NGF administration into the neck muscles near the ganglia could attenuate cardiac remodeling and downregulate BNP mRNA. These results suggest that exogenous NGF can reach the target tissue along the axons anterogradely, and improve the cardiac remodeling.PMID:23027377 [PubMed - indexed for MEDLINE]
(中华老年心脑血管病杂志.2012;14(5):546-548)何冰,周欣,郝倩,王得顺,李贺 AS相关CVD和骨质疏松在老年人群中最常见,两者预防和治疗是我们面对的严峻问题。目前研究显示,骨质疏松与AS发生、发展存在许多共同的机制和危险因素。许多新研究结果进一步加深了对两者关系的认识,但两者之间确切关系、Vit D的多效性作用对AS相关心血管疾病的影响,目前尚未完全明了。骨质疏松是否可成为AS危险因素或促进因素?或从另一方面看,AS的进展是否促进骨质疏松发生?现有证据表明,有效的预防、治疗骨质疏松对AS相关疾病也发挥有益的作用,说明两者之间存在共同的发生或进展途径,有效的治疗骨质疏松有可能成为AS防治的新途径。加强相关研究对老年人群健康和相关疾病防治,具有十分重要的意义。
何冰 周欣 郝倩 杨震 李贺 动脉硬化、骨质疏松有共同的危险因素和发病机理,二者治疗药物相互有益,说明可能存在相互促进关系[4-6]。同时延缓动脉硬化、增加BMD双重作用药物可能成为新的研究方向。抑制12/15 LO、降低降钙素表达、调节低密度脂蛋白受体相关蛋白-5、Wnt 缺失拮抗剂、重组骨保护素及对严重骨质疏松有促合成,并限制主动脉瓣钙化作用的甲状旁腺素 1-34 N-端片段是目前关注的几方面[9,10]。新研究证据表明,心血管系统中不同细胞系间可互相转化,如平滑肌细胞与破骨细胞、微血管外膜细胞与成骨细胞间转化,这种转化可能为骨质疏松、动脉血管钙化/动脉硬化预防和治疗提供新思路[12]。面对世界人口老龄化日趋显著,重视对动脉硬化和骨质疏松机制研究,对老年人群健康及相关疾病防治意义重要。
神经递质转运蛋白在应激性心肌病发病中的潜在作用李贺,周欣,彭朋,何冰,王得顺,胡冰,郑淑芳摘 要:应激性心肌病是强烈应激诱发的心血管急症,自20世纪90年代初 Dote首次报告后,世界各地临床报告病例逐年攀升。发病机制迄今尚不完全清楚,但交感神经过度激活,大量释放去甲肾上腺素在本病发生中起重要作用。根据相关研究进展,主要综述神经递质转运蛋白调控神经递质及交感神经活性在这一神经源性心脏病中可能发挥的重要作用。关键词:应激性心肌病;神经递质转运蛋白;去甲肾上腺素;γ-氨基丁酸;交感神经Potential role of neurotransmitter transporters on stress cardiomyopathyLI He1*, ZHOU Xin1, PENG Peng2, HE Bing2, WANG De-Shun1, HU Bing1, ZHENG Shu-Fang1(1 Hospital Affiliated Logistical College of CAPF, Institute of Cardiovascular Diseases of CAPF, Tianjin 300162, China; Abstracts: Stress cardiomyopathy is an acute severe cardiovascular syndrome triggered by an emotionally or physically stressful event, also known as takotsubo cardiomyopathy has aroused interest in the cardiology community since it was first described by Dote in Japan in 1990. An increasing number of cases of the cardiomyopathy, mainly occurring in elderly women recently, have been documented in many parts of the world. Although the exact mechanism of stress cardiomyopathy remains not fully understood, it appears that the activation of the sympathetic nervous system, resulting in a surge of catecholamines due to severe emotional or acute physical disease, probably plays a central role in the pathology of this condition. This review primarily addresses the potential role of neurotransmitter transporters involved with pathogenesis of the neurogenic heart disease.Key words: stress cardiomyopathy; neurotransmitter transporter; norepinephrine; γ-aminobutyric acid; sympathetic nerve
心-踝血管指数—— 动脉粥样硬化无创检测指标: 845例分析Cardio-ankle vascular index— a marker of atherosclerosis: analysis of 845 cases 张继英1, 郇志华1, 庞志刚1, 张懿芳1, 杜海科2, 李 贺2中文摘要: 目的 用无创方法检测青年和老年人心-踝血管指数(CAVI), 分析动脉粥样硬化(AS)和血管硬度的影响因素。方法 845例住院、门诊及正常体检者(男594例、女251例, 年龄35~85岁)测定CAVI, 并进行诊室血压、血脂、血糖、肾功能、心电图及胸部X线检查, 记录既往史。结果 845例中54.2% CAVI异常(458例); CAVI增加与年龄、血压、脉压差等因素密切相关; 随年龄增长, 并存疾病如高血压、糖尿病、冠心病、脑卒中及血脂异常, 特别是冠心病、高血脂检出率升高; 吸烟对CAVI影响显著, 吸烟并存疾病可使CAVI进一步升高。结论 CAVI是新的AS评估指标, 与多种因素有关, 吸烟及吸烟并存疾病对CAVI均有明显影响。结果提示, AS应根据患者各自不同的影响因素进行个性化综合防治。英文摘要:Objective To determine the risk factors of atherosclerosis(AS) and arterial stiffness assessed non-invasively by the cardio-ankle vascular index(CAVI). Methods A total of 845 subjects aged from 35 to 85 years were subjected to CAVI measurement. Blood pressure(BP), lipids, glucose, renal function, chest X-ray radiographs, previous medical records were also obtained for all subjects. CAVI was measured using a VaSera VS-1000 and calculated by heart to ankle pulse wave velocity(haPWV, m/s). Results CAVI was high in 458 subjects(54.2%). CAVI was significantly positively correlated with age, BP, and pulse pressure. Detection rates of hypertension, diabetes, coronary artery disease(CHD), stroke and dyslipidemias, especially CHD and hyperlipidemias, increased with aging. Smoking was significantly correlated with CAVI. The smokers with other comorbidities displayed further higher CAVI. Conclusions CAVI, as a new parameter of arterial stiffness, is influenced by various cardiovascular risk factors. Smoking and the comorbidities are all involved in elevation of CAVI. A personalized comprehensive prevention and treatment strategy should be recommended for patients with AS.