缬沙坦对自发性高血压大鼠血清PⅠCP、PⅢNP和MMP-1的影响

目的 探讨缬沙坦对自发性高血压大鼠(SHR)血清Ⅰ型前胶原羧基端肽(PⅠCP)、血清Ⅲ型前胶原氨基端肽(PⅢNP)和血清基质金属蛋白酶-1(MMP-1)的影响及意义.方法 16只12周龄雄性SHR随机分为2组,每组各8只,分别予以缬沙坦和生理盐水灌胃;同时选取8只同周龄的雄性Wistar-Kyoto大鼠(WKY)作为对照.给药8 w后采用ELISA法测定血清PⅠCP、PⅢNP和MMP-1浓度.结果 SHR对照组血清PⅠCP、PⅢNP浓度明显高于WKY组(P＜0.01);而SHR治疗组血清PⅠCP、PⅢNP浓度明显低于SHR对照组(P＜0.01);SHR治疗组血清PⅠCP、PⅢNP、MMP-1浓度与WKY组比较无显著性差异(P＞0.05).结论 缬沙坦可调控血清PⅠCP、PⅢNP及MMP-1的含量,恢复细胞外基质合成和降解的动态平衡,抑制心肌细胞外基质的增生,防止心室重构的发生.     

丹参酮ⅡA磺酸钠对高血压病病人血清Ⅰ型及Ⅲ型前胶原水平的影响

目的探讨丹参酮ⅡA磺酸钠注射液(诺新康)对高血压病病人血清Ⅰ型前胶原羧基端肽(PⅠCP)和Ⅲ型前胶原氨基端肽(PⅢNP)水平的影响。方法60例高血压病病人随机分为对照组和治疗组。对照组采用常规疗法,积极控制血压。治疗组在对照组治疗基础上予丹参酮ⅡA磺酸钠注射液治疗。采用放射免疫分析法测定两组病人治疗前后血清PⅠCP,PⅢNP浓度,彩色多普勒超声心动图测量左室质量指数(LVMI)。结果高血压病病人血清PⅠCP和PⅢNP水平与LVMI呈正相关(r=0.4286、0.5224,P<0.05),治疗后两组血清PⅠCP和PⅢNP水平较治疗前均有下降(P<0.05或P<0.01),但治疗组下降更明显(P<0.05)。结论PⅠCP,PⅢNP水平是反映高血压病病人心肌胶原合成活跃程度、左心室肥大的敏感指标。丹参酮ⅡA磺酸钠注射液能有效降低高血压病病人血清PⅠCP,PⅢNP水平,对逆转高血压病左室肥厚具有明确的作用。     

慢性缺氧大鼠心肌HSP47 mRNA的表达及其与PⅠCP和PⅢNP含量的相关性研究

目的探讨慢性缺氧大鼠心肌HSP47 mRNA表达与血清Ⅰ型前胶原C端原肽(PⅠCP)、Ⅲ型前胶原N端原肽(PⅢNP)含量及心肌纤维化的相关性。方法模拟缺氧环境,建立慢性缺氧大鼠模型。将40只SD大鼠随机分为5组,每组8只。对照组不给于缺氧处理(A组),各慢性缺氧组大鼠分别缺氧7 d(B组)、14 d(C组)、21 d(D组)、28 d(E组)。采用实时荧光定量PCR(q-PCR)检测心肌中热休克蛋白(HSP47)mRNA的表达量;运用酶联免疫吸附测定(ELISA)方法检测血清及心肌中PⅠCP、PⅢNP的浓度;采用HE和MASSON染色法对对照组和慢性缺氧组大鼠进行组织切片染色。结果与对照组比较,模型组的HSP47 mRNA表达量增多(P0.01),血清和心肌的PⅠCP、PⅢNP浓度升高(P0.01);心肌HSP417 mRNA的表达与血清和心肌的PⅠCP、PⅢNP含量呈正相关(P0.05);HE和MASSON染色显示慢性缺氧组心肌组织广泛纤维化。结论在慢性缺氧条件下HSP47 mRNA的表达量与PⅠCP、PⅢNP浓度正相关,提示HSP47作为心肌胶原分子伴侣在慢性缺氧所致心肌纤维化中起一定作用。     

替米沙坦对自发性高血压大鼠左心室重构的影响

目的 研究替米沙坦对自发性高血压大鼠(SHR)左心室重构的影响.方法 16只12周龄雄性SHR,随机分为替米沙坦组和SHR空白对照组,每组8只;另设同龄Wistar大鼠(WKY)8只为正常对照组.治疗组给予替米沙坦10 mg·kg-1·d-1灌胃给药,饲养8 w后处死动物,测量左心室重量及心肌厚度,计算左心室重量与体重比(LVW/BW);通过Van Gieson染色法观察左心室心肌胶原纤维变化,对左心室心肌胶原容积分数(CVF)和血管周围胶原面积(PVCA)进行分析;电镜和HE染色观察左室心肌超微结构.结果 与正常对照组WKY大鼠相比,SHR空白对照组的尾动脉收缩压(SBP)、LVW/BW、左室壁厚度、CVF、PVCA均显著增高(P＜0.01);与SHR空白对照组相比,替米沙坦组能有效降低SHR的SBP,改善左心室肥厚(P＜0.01),减少心肌间质及心肌小动脉周围的胶原(P＜0.01),组织病理及电镜显示,替米沙坦治疗能显著改善SHR左心室重构.结论 替米沙坦能有效降低SHR血压,改善左心室重构.     

缬沙坦和卡托普利干预高血压大鼠左室心肌纤维化及超微结构改变的比较研究

目的比较缬沙坦和卡托普利对心肌纤维化及超微结构改变的干预作用.方法14周龄自发性高血压大鼠(SHR)25只随机分为5组缬沙坦组(SHRv)、卡托普利组(SHRc)、卡托普利组+缬沙坦组(SHRc+v)、假治对照组(SHR20)和高血压基础对照组(SHR14).同周龄SD大鼠5只设为正常对照组(SD20).疗程为6周.处死后测算左室重量/体重比(LVM/BW)、光镜观察心肌胶原分布,测算胶原容积分数(CVF)、血管周围胶原面积/管腔面积比(PVCA/LA)和组织匀浆胶原浓度,电镜观察心肌超微结构改变.结果三个治疗组反映心肌纤维化的多项指标均较SHR20和SHR14组显著改善(P＜0.01&0.05).SHRv与SHRc+v组的改善相似,均优于SHRc组(P＜0.05),但仍差于SD20组(P＜0.05).心肌超微结构改变均较SHR20组显著好转.结论缬沙坦和卡托普利均能抑制高血压心肌纤维化及超微结构改变,但短期治疗不能恢复正常.缬沙坦的作用优于卡托普利,两者联用优于单用卡托普利,但并不显著优于单用缬沙坦.     

血清Ⅰ型前胶原羧基端肽和Ⅲ型前胶原氨基端肽预测充血性心力衰竭药物疗效的临床价值

目的 探讨充血性心力衰竭(CHF)患者应用血管紧张素转换酶抑制剂 (ACEI)/血管紧张素受体抑制剂(ARB)和(或)β受体阻滞剂等药物治疗后,血清Ⅰ型前胶原羧基端肽(PⅠCP)和Ⅲ型前胶原氨基端肽(PⅢNP)的变化及其临床意义.方法 86例CHF患者根据治疗药物的不同分三组:ACEI/ARB组,29例,倍他乐克组,24例;ACEI/ARB+倍它乐克组,33例;47例体检健康者为对照组.采用放射免疫法测定对照组、CHF患者入院时及规范治疗6 w后血清PⅠCP和PⅢNP浓度.应用多普勒超声测算:左室射血分数(LVEF)、E峰和A峰及两者比值(VE/VA)、左室内径(LVID).结果 各组CHF患者及对照组之间基本临床资料(性别、年龄等)差异不显著.各组CHF患者NYHA分级和LVEF也无显著差异.CHF患者血清PⅠCP和 PⅢNP均明显高于对照组(P＜0.01).3组CHF患者治疗6 w后,NYHA分级和LVEF较治疗前均明显改善(P＜0.01,P＜0.05),血清PⅠCP 和PⅢNP较治疗前也均明显降低(P＜0.01).相关分析显示,PⅠCP和 PⅢNP水平与LVID呈正相关,与LVEF、VE/VA呈负相关.结论 血清PⅠCP 和PⅢNP水平可预测CHF患者药物治疗反应效果.     

缬沙坦合用安体舒通对急性心肌梗死伴室壁瘤患者血运重建后的血清胶原水平和心功能的影响

目的:研究缬沙坦及合用安体舒通对经再灌注治疗的急性心肌梗死患者血清胶原水平和心功能的影响。方法:首次急性前壁心肌梗死伴室壁瘤患者70例,随机分为缬沙坦组、合用药组(缬沙坦合用安体舒通),在治疗后1周、2周、12周测定血清Ⅰ型前胶原羧基末端肽(PⅠCP)和Ⅲ型前胶原氨基末端肽(PⅢNP)浓度;并在治疗后2周、12周进行二维超声心动图检查。结果:12周时合用药组血清PⅢNP、血清PⅠCP较缬沙坦组明显降低(P0.05)。合用药组的舒张末期容积指数、收缩末期容积指数、局部室壁运动指数、左室射血分数及左室质量指数较缬沙坦组明显改善(P0.05)。结论:缬沙坦能够阻抑急性心肌梗死伴室壁瘤患者的胶原合成,改善心室收缩和舒张功能;合用药组的作用优于单用缬沙坦,显著改善心室收缩和舒张功能。     

缬沙坦和卡托普利干预高血压大鼠左室心肌纤维化及超微结构改变的比较研究

目的：比较缬沙坦和卡托普利对心肌纤维化及超微结构改变的干预作用。方法：14周龄自发性高血压大鼠(SHR)25只随机分为5组：缬沙坦组(SHRv)、卡托普利组(SHRc)、卡托普利组 缬沙坦组(SHRc v)、假治对照组(SHR20)和高血压基础对照组(SHR14)。同周龄SD大鼠5只设为正常对照组(SD20)。疗程为6周。处死后测算左室重量／体重比(LVM／BW)、光镜观察心肌胶原分布，测算胶原容积分数(CVF)、血管周围胶原面积／管腔面积比(PVCA／LA)和组织匀浆胶原浓度，电镜观察心肌超微结构改变。结果：三个治疗组反映心肌纤维化的多项指标均较SHR20和SHR14组显著改善(P＜0．0l＆0．05)。SHRv与SHRc v组的改善相似，均优于SHRc组(P＜0．05)，但仍差于SD20组(P＜0．05)。心肌超微结构改变均较SHR20组显著好转。结论：缬沙坦和卡托普利均能抑制高血压心肌纤维化及超微结构改变，但短期治疗不能恢复正常。缬沙坦的作用优于卡托普利，两者联用优于单用卡托普利，但并不显著优于单用缬沙坦。     

缬沙坦对糖尿病大鼠心肌血小板源生长因子-B的表达及心肌纤维化的影响

目的 探讨缬沙坦对糖尿病(DM)大鼠心肌血小板源生长因子-B(PDGF-B)表达及心肌纤维化的影响.方法 32只大鼠分为对照组、DM未治疗组、缬沙坦小剂量治疗组(10 mg·kg~(-1)·d~(-1))、缬沙坦大剂量治疗组(30 mg·kg~(-1)·d~(-1));12 w后放免法测定血浆和心肌血管紧张素Ⅱ(AngⅡ)浓度;称量体重及全心、左室重量,计算心体比(H/B)和左室重量指数(LVMI);天狼星红染色测量心肌间质的胶原容积分数(CVF). RT-PCR检测各组心肌PDGF-B、纤维连接蛋白(FN)、Ⅲ型胶原(ColⅢ)的mRNA表达情况.结果 DM未治疗组H/B、LVMI增高(P＜0.01);PDGF-B、FN和ColⅢ mRNA表达显著上调;缬沙坦干预12 w后,血浆和心肌 AngⅡ浓度升高;H/B、LVMI降低(P＜0.05或P＜0.01),DM心肌中FN、ColⅢ mRNA的表达减少,心肌间质CVF降低(均P<0.01);大小剂量治疗组可以减少DM心肌PDGF-B mRNA的表达(P<0.01).以上效应具有剂量依赖性.结论 DM大鼠心肌PDGF-B表达明显上调.缬沙坦能减少DM大鼠心肌细胞外基质(ECM)积聚,改善心肌结构,PDGF-B表达下调可能是缬沙坦抑制DM心肌纤维化的心脏保护作用机制之一.     

血清脂联素水平与高血压及心肌纤维化的关系

目的:研究血清脂联素与高血压的关系,探讨高血压患者血清脂联素水平对心肌纤维化的影响,阐明高血压患者血清脂联素水平与心肌纤维化的关系.方法:根据美国预防、检测、评估与治疗高血压全国联合委员会第七次报告(JNC-7)的血压标准,筛选出33例高血压患者(高血压组),并筛选出同期在我院体检中心观察的健康人33例(正常对照组).所有入选者清晨空腹抽取外周静脉血,用酶联免疫法测定血清脂联素、Ⅰ型前胶原羧基端肽(P Ⅰ CP)和Ⅲ型前胶原氨基端肽(P Ⅲ NP)水平.结果:与正常对照组相比,高血压组血清脂联素水平明显降低[(4.21±2.89)ng/ml比(2.69±1.00)ng/ml,P＜0.01];且1级高血压患者与2级高血压患者血清脂联素比较明显升高,差异有统计学意义(P＜0.05).与正常对照组相比,高血压组P Ⅰ CP和P Ⅲ NP水平显著增高,P Ⅰ CP分别为(13.10±6.56)ng/ml比(4.12±1.19)ng/ml,P Ⅲ NP分别为(128.94±56.37)ng/ml比(66.70±11.72)ng/ml,两组比较差异均有统计学意义(P均＜0.01).相关分析表明,血清脂联素水平与P Ⅰ CP及P Ⅲ NP水平呈明显负相关(r分别为-0.245和-0.275,P均＜0.05).结论:高血压患者血清脂联素水平明显降低,血压越高脂联素水平越低,血清脂联素水平与P Ⅰ CP及P Ⅲ NP水平呈明显负相关,推测低水平的脂联素血症在高血压心肌纤维化中可能起重要作用.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。