摘要
为了探讨肥厚性心肌病发病过程及其心脏结构和功能的变化规律,本实验以犬为研究对象,复制肥厚性心肌病病例,并且对其进行超声心动及血液生化、心电图、心脏X光片等指标的监测。
本实验选取10只1～2岁,体重在5千克左右的本地母犬,采用自身前后对照方法,按5mg/kg的剂量皮下注射肾上腺素复制出6只犬肥厚性心肌病病例,得出以下监测结果:(1)6只实验犬的超声心动图中左室游离壁明显增厚,在第8天以后的数值与第0天的数值比较变化显著(P<0.05);室间隔的增厚不显著(P﹥0.05);左室内径在第8天以后明显变小,其数值与第0天的数值比较变化显著(P<0.05)。用多普勒测出25～100mmHg收度偏差,出现心力衰竭;连续多普勒测二尖瓣处血流的速度,E峰降低60cm/s。(2)X光检查显示实验犬随着实验时间推移心脏逐渐变大且伴有左心室肥厚,心脏呈中或高度增大,心脏外型钝圆,同时伴发肺水肿。在实验后期正位片中的心脏会超出胸腔锁骨最狭窄处与肺尖的连线,在侧位片中心脏的心基部到心尖部的垂直距离会大于胸腔胸椎到胸骨最大垂直距离的2/3,其脊椎心脏指数VHS(Vertebral Heart Size)增大1～2。(3)处理前后实验犬心电图变化较大,在第8天到第10天实验犬心率在180～210次/min之间,并且出现窦性心律不齐或窦性心动过速,P波时间≥0.14秒;在Ⅰ、Ⅱ、aVL导联明显。后期P波增宽,且呈M形双峰。在Ⅰ、Ⅱ、aVF导联P波电压大于0.25mV时,P波形态高尖。实验后期R波在aVF和aVR导联的电压大于1.2mV,电轴左偏,在Ⅰ、Ⅲ导联的R波和S波电压之和大于2.5 mV,QRS波群为0.106秒。QRS时限延长,S-T段压低以及T波倒置,U波倒置并且增大,大于同导联T波的1/2。(4)血液生化分析发现LDH、CK、AST均有明显变化。其中LDH在第4～8天的数值与第0天的数值比较显著升高(P<0.05)。CK在整个实验过程中一直缓慢升高,尤其是到后期出现肌肉抽搐时,升高幅度更大,升高到正常值的二十倍左右,从第6天以后的数值与第0天的数值比较差异极显著(P<0.01)。AST在实验过程中出现两次明显波动,分别是初期和末期,尤其是第2天和第13天的数值与第0天的数值相比显著升高(P<0.05)。(5)病理切片显示心肌细胞显著肥厚,核大而浓染,核周呈亮区包围,心肌细胞排列紊乱多呈旋涡状或缠绕呈簇状排列,细胞内肌原纤维不呈平行排列,而是向各个方向、互相交错排列,可见间质纤维化灶形成,尤其位于主动脉瓣下区的内膜纤维化突出。心肌细胞间距加宽,间质水肿,间质毛细血管偶见充血甚至破裂导致出血。
通过结果分析,得出以下结论:(1)证明肾上腺素导致心肌肥厚的可行性,复制出了犬肥厚性心肌病病例。(2)经B超、X光监测证实实验犬心肌肥厚,心电图证实心率加快、波形变化,同时LDH、CK、AST升高,死后心尖组织切片可见相应变化。由此证明实验犬在肾上腺素的作用下出现心肌肥厚,为犬肥厚性心肌病临床诊断提供了一定的科学依据和实验数据。
In order to evaluate the diagnostic application of ultrasound in myocarditis-type of HCM disease, echocardiography was used to study the changes of cardiac structure and function in dogs from 1 to 2 years old which were chronic infusion of norepinephrie. We measure the blood biochemistry,ECG,echocardiography in everyday.
We chose the 10 female dogs that is about 5 kg, we use the before-after study, we hypodermic injection the norepinephrie, so we got 6 dogs that there are the HCM.We get the reusult:(1) The images in myocarditis-type of HCM dissease showed the variation of LVW to be significant, ( P<0.05) at the 8th day;the variation of interventricular septum to be not significant, (P>0.05); the variation of LV to be significant, (P<0.05) at the 8th day. The reusult of Doppler showed that 25～100mmHg declination, to lead to cardia failure. The reusult of continuous-wave doppler which the bloodstream speed of the trioventricular valve, show that the E wave to depress 60cm/s. (2) The results of X-ay show that the heart change obtuse, and appearance edema of lung. At the later period of the experiment, the heart went beyond the S-BP line of the clavicle the and apex of lung in the orthotropia. The vertical dimension of heart base and Apex of heart goes beyond the 2/3 vertical dimension of dorsal vertebraand chest bone.The VHS are augmentation 1～2. (3)The variation of ECG is significant, from the 8th day to 10th day, the HR is 180～210per-minute, and to appear the sinus arrhythmia or sinus tachycardia. The time of P wave is exceed 0.14s in the lead ofⅠ、Ⅱ、aVL ;the P wave widen, to submit the shape of M; the voltage of P wave is exceed 0.25mV in the lead ofⅠ、Ⅱ、aVF; and the P wave shape was cusp.At the later period of the experiment,the the voltage of R wave was exceed 1.2mV in the lead ofaVF and aVR , the voltage ,s sum of R wave and S wave was exceed 2.5mV in the lead ofⅠ、Ⅲ, the time of QRS wave group is 0.106s. The time limited of QRS was extended; S-T is intrusioned and the T wave is inversion, the U wave was inversion and augmentation. (4)The LDH, CK and AST of blood biochemistry obviously advance. The variation of LDH to be significant,the P<0.05 from the 4th day to 8th day. The reusult of CK was constantly to advance in the experiment. Especially, at the later period of the experiment,when the muscle convulsion, the variation was more significant, the variation of CK to be significant,the P<0.01 from the 6th day ; The variation of AST to be significant, the P<0.05 at the 2th day and the 13th day. (5)The pathological section showed that the cardiac muscle cell is hypertrophy, the Karyomegaly and strong dye, the permutation of the cardiac muscle cell is disord,it showed that vortex or clump.There were interstitial fibrosis, especially, it was intimal fibrosis.We used the microscope that we could watch the interval of the cardiac muscle cell to be broaden, interstitial edema and engorge in the blood capillary.
All of our results demonstrated that (1)the norepinephrie can induce the HCM, we are successful in the making the model of HCM. (2) It used about 14 days that we make the model of HCM , we provided some science data and the new information which make the dog model of HCM .
引文
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