CN1171920A - Body-surface heart action potential picture and its detecting equipment - Google Patents
Body-surface heart action potential picture and its detecting equipment Download PDFInfo
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- CN1171920A CN1171920A CN 97116742 CN97116742A CN1171920A CN 1171920 A CN1171920 A CN 1171920A CN 97116742 CN97116742 CN 97116742 CN 97116742 A CN97116742 A CN 97116742A CN 1171920 A CN1171920 A CN 1171920A
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Abstract
The body surface cardiac action potential diagram is a detection method in the field of cardiac electro-physiology. It is used for early diagnosis of coronary heart disease. As compared with electrocardiogram, it can more sensitively represent the metabolic condition of potassium-ion of cardiac musclecell. Said invention not only provides a new non-invasive examination measure for clinical diagnosis, but also can be used for expounding excitation-contraction coupling mechanism of cardiac muscle cell, cause of disease and pathogenesis of atheroscleorsis and mutual relationship of coronary heart disease with hypertension, hyperglycemia, hyperlipemia and obesity.
Description
The present invention relates to the manufacture method of a kind of cardiac electrophysiology detection technique and equipment thereof.
Adopt the intracellular electrode technology can obtain the action potential picture of single myocardial cell, it is playing important function aspect the cardiac electrophysiology basic research, and regrettably it can not directly apply to clinical.Electrocardiogram is the noninvasive cardiac electrophysiology detection technique of wide clinical application, and the vectorcardiogram that grows up on this basis, ventricular late potential figure, spectral electrocardiogram or the like all are the development of electrocardiogram technology and replenish.Yet these methods are the variation of reflecting myocardium cell actual act current potential definitely all, therefore is used to detect the inside and outside ion transport process aspect of myocardial cell clinically and also lacks effective method and equipment.
The objective of the invention is to create the situation that a kind of noninvasive method is used to detect the myocardial cell ion transport.
The action potential of cardiac muscle comprises depolarization and two processes of repolarization, phase when being divided into five artificially at present: 0 is depolarizing phase mutually, and 1 is the rapid repolarization initial stage mutually, and 2 is the slow multipole phase mutually, and 3 is rapid repolarization latter stage mutually, and 4 is quiescent stage mutually.Body-surface heart action potential picture is a figure that obtain by the electrocardiosignal of gathering body surface, the comprehensive variation of reflection ventricle wall multilamellar myocardial cell action potential.The principle of its generation is based on following several new discoveries:
1, sodium ion enters the unipolarity of myocardial cell:
Myocardial cell has two sides, and what face the chambers of the heart is medial surface, and what face pericardium is lateral surface, and ventricle wall is made up of multi-layer cellular.The depolarization of normal myocardium is from medial surface, the extracellular sodium ion of medial surface at first enters cell, make extracellular sodium ion gradient minimizing in the cell, cause the sodium ion of lateral surface to have no chance to enter the cell of chambers of the heart side, therefore sodium ion always enters cell from the inboard of myocardial cell in unpolarized process, this character is called the unipolarity that sodium ion enters myocardial cell, it is the basis that produces action potential 0 phase forward curve, and sodium ion is by directed laterally speed and the amount that moves in chambers of the heart inboard when utilizing it to measure the myocardial cell depolarization by external electrode.
2, after the depolarization potassium ion to the inhomogeneity of extracellular rapid release:
The interior potassium concentration of myocardial cell is about 35 times of EC, because cell medial surface elder generation depolarization, the interior potassium ion of cell at first discharges to the cell medial surface after the depolarization, treat just to discharge simultaneously after whole cell depolarization finishes to the cell both sides, make potassium ion to the burst size of cell medial surface more than lateral surface, the therefore of short duration negative sense signal of telecommunication that can discharge to the cell medial surface to action potential 1 phase potassium ion at body surface measurement.
3, calcium ion enters cell and enters the amphicheirality of endoplasmic reticulum and the amphicheirality that sodium ion pumps cell:
Though the extracellular Ca2 ion concentration is 20000 times of intracellular fluid, but myocardial cell shrink required calcium be action potential 1 by sarcoplasmic reticulum release, the release that enters with calcium ion of sodium ion has activated calcium pump and sodium pump, occurred calcium ion active transport, sodium ion in sarcoplasmic reticulum mutually at 2 of action potential and entered cell by the slow channel to extracellular active transport and extracellular small amount of calcium ion, ATP is consumed in a large number in the myocardial contraction meanwhile, cell.To the two-way discrepancy in cell both sides, its action potential curve is a platform at this interim calcium, sodium ion.
4, potassium ion is to intracellular passive transport:
Myocardial cell membrane is free penetrating to potassium ion, depolarization makes myocardial cell almost simultaneously discharge a large amount of potassium ions to narrow and small intercellular substance at short notice, the intercellular substance potassium concentration is increased suddenly, and in 2 phases of action potential, ATP a large amount of in the cell are consumed by the myocardial contraction acting, moreover there is not special potassium pump on the cell membrane, although whenever pumping 3 sodium ion, sodium pump can gain two potassium ions, but the sodium ion that enters cell during owing to depolarization is limited, the potassium ion that goes out cell is more relatively, and (the inside and outside concentration ratio of cell membrane sodium ion is about 1: 5, and the potassium concentration ratio is 1: 35), therefore potassium ion is mainly finished by passive transport to intracellular transport, and its transport process is as follows:
The calcium ion that sarcoplasmic reticulum discharges in 2 phase cells of action potential is pumped into rapidly in the sarcoplasmic reticulum, the sodium ion that enters cell is also pumped the extracellular rapidly, make cytoplasm super nagative potential occur, most of potassium ion is transferred in the cell under the effect of super nagative potential.A part of in addition potassium ion is to be combined as a whole by Insulin receptor INSR and glucose, because the concentration difference of the inside and outside glucose of cell greater than the concentration difference of potassium ion, is also transferred in the cell by contrary concentration difference so enter intracellular while potassium ion at glucose along concentration difference.Therefore, potassium ion is to the participation of intracellular transfer by the Concentraton gradient and the insulin of sodium pump, calcium pump and glucose, and it mainly occurs in 2,3 phases of action potential.
5, the directivity of myocardium repolarization:
Vertical in the arrangement of ventricle wall cardiac muscle fiber is broadly divided into, medium ring and outer oblique three layers.The contraction of cardiac muscle fiber from inside to outside the order finish, diastole then be ecto-entad in sequence.Total amount and speed that the repolarization speed of cardiac muscle fiber and intracellular ATP produce are proportionate.Because coronary artery blood supply characteristics, make that outer cardiac muscle is abundant than the internal layer blood supply, so outer cardiac muscle is repolarization at first, potassium ion at first is transferred in the cell, it is poor to cause extracellular fluid between the ventricle wall ectonexine potassium concentration to occur thus, internal layer extracellular fluid potassium ion is spread laterally, and this process occurs in 3 phases of action potential, occurs a forward curve on the action potential curve.
6, the time difference that potassium ion permeates to the extracellular in the ventricle wall ectonexine cell:
The formation of resting potential is that potassium ion causes along the export-oriented diffusion of its electrochemical gradient, it occurs in 4 phases of action potential, because ventricle wall okioplast elder generation repolarization, amount and speed that its potassium ion discharges are higher than interior confluent monolayer cells, it is poor to have formed the potassium concentration opposite with action potential 3 phase times, occurs a negative sense curve this moment on the action potential curve.
The present invention is based on above six new discoveries and propose a kind of new design, to obtain body-surface heart action potential picture, its step is as follows:
1, the ECG signal of utilizing conventional at present method to gather body surface is also amplified 1000 times;
2, change the surface electrocardiogram signal of gathering into digital quantity by analog quantity, inversion frequency is not less than 200 times/second;
3, utilize computer technology to look for down the intermediate value of one group of complete cardiac electrical cycle electrocardiosignal, and obtain one group of new data after each data and intermediate value subtracted each other;
One group of new data that 4, will obtain carries out integration, just produces the data of one group of body-surface heart action potential picture;
5, with time being abscissa, is that the vertical coordinate mapping just can obtain body-surface heart action potential picture with the data of body-surface heart action potential picture.
The body-surface heart action potential picture that obtains in order to last method is Electrocardiographic integrated form in essence.Complete electrocardiosignal comprises two kinds of compositions, i.e. common-mode signal and difference mode signal, and they all belong to physiological signal.The difference amplification process has filtered the physiological common-mode signal, so routine electrocardiogram is Electrocardiographic difference form in essence, and the electric current that produces in its reflecting myocardium motor process changes, and Electrocardiographic integrated form has reflected the variation of voltage (current potential).
Advantage of the present invention is the action potential picture that obtains myocardial cell by noninvasive method, is more suitable in clinical practice than the intracellular electrode technology; Compare reflecting myocardium cell plasma transhipment more sensitively and metabolic process with the electrocardiogram technology.
Body-surface heart action potential picture can not replace the routine electrocardiogram technology, and it is replenishing of electrocardiogram technology and development.Accompanying drawing A curve is the body-surface heart action potential picture that utilizes the normal human that the present invention obtains, and it comprises 0,1,2,3,4 phases totally five time, it is characterized in that 3 phase current potentials generally are greater than or equal to 0 mutually and 1 mutually, and its reflects the speed and the amount of kalium ion transport; The B curve is the body-surface heart action potential picture of a patients with coronary heart disease, its 3 phase current potential be starkly lower than 0 mutually with 1 mutually; The two comparing difference is very remarkable, shows that myocardial ischemia mainly influences action potential 3 phase potassium ions to intracellular transhipment.
Body-surface heart action potential picture is mainly used in the early diagnosis of coronary heart disease.
Since human society entered for 20th century, along with the development of big industry and transportation, country was with country, interpersonal contacts are frequent day by day.On this basis, influenza virus also along with aircraft, steamer, train and automobile in country with country, carrying out frequent propagation between men.But who does not expect the propagation that goes round and begins again along with influenza virus just, and coronary heart disease, hypertension, diabetes, hyperlipoproteinemia, obesity and spread in developed country simultaneously stealthily and almost together with their complication comes.Especially since nearly half a century, the sickness rate of these diseases is ascendant trend year by year, causes the whole world several ten million people's death or disabilities every year, is called " diseases in 20th century " by people.In the face of savage disease like this, it is at a loss what to do that people seem.Its basic reason is not find the pathogeny of these diseases.
Influenza virus is any relation with " diseases in 20th century " actually, does not also have the report of this respect at present.To the eye what direct relation the two does not have, and in fact influenza virus is the arch-criminal!
The mechanism that causes coronary heart disease, hypertension, diabetes, hyperlipoproteinemia, obesity that is widely current of influenza virus can be summarized as follows:
The antigenic component of influenza virus comprises cAg and surface antigen two parts, cAg does not enter blood circulation after infecting human body, only invade upper respiratory tract mucosa and in mucosa, breed, the ordinary circumstance lower body does not produce immunoreation to it, and the former blood vessel wall that can see through of its surface antigen neuraminidase and haemoglutinin enters blood circulation in a large number, impels body to produce corresponding antibodies.Because this antibody can not stop influenza virus to invade upper respiratory tract mucosa, so human body lacks the effective immunity to influenza virus, and can suffer the invasion and attack of influenza virus repeatedly.Influenza virus invasion and attack each time all can make the antigen antibody complex concentration relevant with influenza virus in the blood circulation increase considerably, these complex can not see through blood vessel wall and excrete, can only be deposited on blood vessel, in the course of time just formed atherosclerosis, coronary artery then is one of atherosis position of the easiest formation.Because the speed that atherosclerosis takes place and its order of severity are directly proportional with the frequency and the cumulative frequency of influenza virus invasion and attack, thereby the sickness rate of coronary heart disease, hypertension, diabetes, hyperlipemia and obesity (diseases in 20th century) often demonstrates, and the city is higher than the rural area on spatial distribution, the more developed country of recurrent population is higher than remote closed country; The old people is higher than adolescence on the time distributes, and 20th century were higher than for 19th century; The brain worker is higher than physical labourer on occupation distributes.Although it is relevant with heredity that their family's clustering phenomena Most scholars is thought, but in fact infectious disease also has family's clustering phenomena, be not be hereditary unique feature, moreover hereditary does not generally exist differentials between town and country, professional difference and tangible epochal character.
The hemodynamic blood that coronary atherosclerosis causes changes can cause hypertension, and its mechanism is as follows:
Coronary atherosclerosis causes coronary stricture and elasticity attenuation, because coronary artery has powerful compensation, does not occur myocardial ischemia in early days in disease.Compensation coronarius comprises two aspects, the function that vasodilation function and perfusion pressure increase.Coronary atherosclerosis descends the coronary artery the planning function, can only satisfy blood supply coronarius by improving perfusion pressure coronarius when myocardium oxygen demand increases.To be that diastolic pressure is progressive slowly increase this hypertensive characteristics, without increasing of plasma epinephrine and norepinephrine, also the constitutional without renin angiotensin aldosterone system changes, but special mechanism is arranged, this mechanism is called heart-spinal cord-vasoreflex.
The visceral sensory nerve tip that is distributing a large amount of between myocardial cell, its pericaryon are positioned at breast 1 to breast 5 sections posteriors horn of spinal cord, and they change the most responsive to potassium concentration in the myocardial cell interstitial fluid.When myocardial ischemia since potassium ion to the intracellular transport obstacle, cause relaxing period intercellular fluid potassium concentration to increase, the afferent impulse of heart sensory nerve ending increases, and then cause that the efferent impulse spread of spinal cord sympathetic nerve increases, relaxing period periphery small artery is shunk to be strengthened, diastolic hypertension occurs, this process is called heart-spinal cord-vasoreflex; This hypertension is called cardiac origin hypertension.
The metabolic change that coronary atherosclerosis causes can cause hyperglycemia, hyperlipidemia and obesity, and its mechanism is as follows:
The myocardial cell interstitial fluid potassium concentration that myocardial ischemia causes increases and the hypertension that produces can make brain stem vagus nerve central excitation by vagal centripetal fiber.Vagal excitation can make insulin discharge to be increased, and promotes potassium ion to transport in myocardial cell, also promotes to have produced hyperlipemia, obesity and hyperinsulinemia thus by lipogenesis simultaneously.This hyperinsulinemia can not cause hypoglycemia, this is because the orthosympathetic irritability of spinal cord also increases when vagal excitation increases, it can promote the release of glucagon, and these two kinds of hormones are confronted with each other and made blood glucose instability occur, and this state is called insulin resistant.Insulin resistant makes secretion of insulin be depletion state, causes impaired glucose tolerance; The excitement simultaneously of vagus nerve and sympathetic nerve increases gastro-intestinal digestion absorption function and general metabolic function greatly, causes honey stomach.The attenuating of carbohydrate tolerance causes hyperglycemia with the absorption of too much diet.This hyperglycemia is called the cardiac origin hyperglycemia.
In sum, the wide-scale distribution of influenza virus is the main cause that atherosclerosis produces, and coronary atherosclerosis is to cause hypertension, hyperglycemia, hyperlipidemia and fat major reason.Therefore, want fundamentally to conquer " diseases in 20th century " and just must prevent the propagation of influenza virus, this needs whole world people's common action and secular effort.Patients with coronary heart disease is accomplished early diagnosis, so that early treatment and prevent that the state of an illness from further developing and have the important clinical meaning
Though the existence of the possible early discovery coronary heart disease of selective coronary arteriography is not suitable for the large-scale crowd generaI investigation.Therefore, the early diagnosis problem of coronary heart disease is a difficult problem highly visible.The key that solves this difficult problem is not merely a technical problem, the more important thing is the method for thinking problem.
A problem that needs people to rethink is: increasing of the increasing of the increasing of blood pressure, blood glucose, blood fat or increasing etc. of body weight, and can the increase of these physical quantitys or chemistry amount be treated as a kind of independently disease? answer seemingly cannot.Perhaps people have made the mistake of a subjectivism on this problem, habitually coronary heart disease, hypertension, diabetes, hyperlipemia, obesity etc. are got up to treat side by side, study its cause of disease and pathogeny respectively, and many subdisciplines have been produced again, the result makes simple question complicated artificially, make their cause of disease and the pathogeny main threads is various can't understand fully, have to be attributed to reluctantly genetic unusual at last.In fact the hypertension of these unknown causes, hyperglycemia, hyperlipidemia and obesity all are the early stage clinical manifestations of coronary atherosclerosis! Just can make preliminary early diagnosis according to these clinical manifestations to coronary heart disease.
Body-surface heart action potential picture can react the situation of cardiac muscle cell potassium ion transhipment more sensitively, thereby helps the early diagnosis of coronary heart disease.Coronary heart disease is the main cause that causes sudden death, the ventricular premature contraction that takes place frequently also is the common electrocardiogram performance of coronary heart disease, its genesis mechanism be since myocardial ischemia cause potassium ion to the intracellular transport obstacle, cause the retention of intercellular substance potassium ion, the excited valve of myocardial cell reduces and causes that quiver in the chamber and ventricular arrhythmia.Therefore patients with coronary heart disease is carried out the body-surface heart action potential picture inspection has crucial clinical meaning.
The present invention is not only to clinical the contribution of modern medicine a kind of new noinvasive detection means is provided, the more important thing is the mechanism of having illustrated the myocardial cell excitation contraction coupling, the mutual relation of having illustrated the atherosclerotic cause of disease and pathogeny, having illustrated coronary heart disease and hypertension, hyperglycemia, hyperlipidemia and obesity, indicated direction for the mankind finally conquer coronary heart disease.
Claims (3)
1, a kind of method by collection body surface ECG signal acquisition heart action potential picture is characterized in that the data of surface electrocardiogram signal are carried out integration, obtains one group of new data, and its mode with figure is showed;
What 2, claim 1 was mentioned carries out the method for integration to the surface electrocardiogram signal data, it is characterized in that: the intermediate value that at first calculates these group data at a certain group of data, each data and the intermediate value of this group are subtracted each other, obtain one group of new data, the new data of this group are carried out integration, just can obtain the integration data of the body surface signal of telecommunication.
3, a kind of figure of mentioning of claim 1 is characterized in that: the figure of the inside and outside both sides of reflection ventricle wall change in voltage, it is similar with the myocardial cell action potential picture that employing intracellular electrode technology for detection arrives, phase when also being divided into 0,1,2,3,4 five.
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| CN104519792A (en) * | 2012-06-11 | 2015-04-15 | 佐尔医药公司 | Resuscitation enhancements |
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| CN104519792A (en) * | 2012-06-11 | 2015-04-15 | 佐尔医药公司 | Resuscitation enhancements |
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