激光心肌血运重建术在晚期缺血性心脏病中的应用

Percutaneous myocardial revascularization (PMR),building on the succeeds of transmyocardial laser revascularization (TMR),has developed that allows TMR-like channels to be cradated via a percutaneous approach. This catheter based approach avoids the morbidity associated with general anesthesia and thoractomy or thoracoscopy. It also avoids transmural treatment of the myocardium by the laser. Although its mechanism remains unclear, many patients with intractable angina and non-bypassable coronary artery disease have benefited from the new system. It is hoped that PMR will mimic the clinical benefit of TMR,and will gradually become a main method in treating end-staged coronary artery disease.

心脏干细胞的研究进展

传统观点认为心脏是终末分化器官，心脏细胞数目在出生后固定且终生不再增加，损伤后没有内源性再生能力，因此目前治疗手段局限于改善现有的心肌细胞功能。但日益增多的证据已对这一概念提出挑战，研究者分别在梗死后心肌、晚期缺血性心脏病及扩张型心肌病患者心脏中检测到心肌细胞有丝分裂表现。Hiedihy等于2002年首次发现心脏包含一群内源性干细胞，有自我更新及多向分化能力，负责维持心脏内环境稳态，这类细胞被称为心脏干细胞（cardiac stem cells，CSC）。此后很多实验室已经在人类或其他哺乳动物成熟心脏中分离出CSC，但其在何种程度上参与心脏的生理及病理过程，有何生物学特性，能否用于临床等更多问题随之而来，本文就此综述如下。