儿童青少年血浆新型气体信号分子硫化氢的参考值

目的 测定儿童与青少年血浆硫化氢含量的参考值.方法 健康儿童青少年200名,按照其年龄与性别分组,7～14岁75名(男43名,女32名),15～19岁125名(男64名,女61名),应用敏感硫电极法测定血浆硫化氢(H2S)含量.结果 学龄期7～14岁男孩血浆H2S含量为(52.2181±17.9400)μmol/L,女孩H2S含量为(51.9441±16.5448)μmol/L;15～19岁男孩血浆H2 S含量为(52.8771±14.1444)μmol/L,女孩H2 S含量为(53.6551±14.5563)μmol/L.各年龄组间及性别间差异均无显著性(P＞0.05),合并统计后得出儿童青少年血浆H2S含量的浓度均值为(52.8234±15.4339)μmol/L.结论 儿童青少年血浆H2S含量参考值为(52.8234±15.4339)μmol/L.     

冠心病患者血浆中新型气体信号分子硫化氢的变化

目的 探讨新型气体信号分子硫化氢(H₂S)在冠心病患者血浆中含量的差异及其病理生理意义。方法 采用硫敏感电极法测定40例冠心病患者及17例造影正常者血浆H₂S含量,并在冠心病患者分析不同临床亚型及不同冠脉病变类型血浆H₂S含量的差异、血浆H₂S含量与冠心病危险因素的关系。结果 (1)冠心病患者血浆H₂S含量[(26.10±14.27)μmol/L]远低于冠脉造影正常对照组[(51.74±11.94)μmol/L,P<0.01];(2)在冠心病患者中,不稳定型心绞痛患者血浆H₂S含量[(23.60±14.41)μmol/L]和急性心肌梗死患者血浆H₂S含量[(19.98±7.516)μmol/L],明显低于稳定型心绞痛患者[(38.41±14.53)μmol/L,P<0.05]。(3)冠脉双支和多支病变组血浆H₂S含量分别为(16.91±7.98)μmol/L、(18.39±7.78)μmol/L,两组间无明显差异(P>0.05),但均明显低于单支病变组(33.04±15.01)μmol/L(P<0.05和P<0.01)。冠脉血管有闭塞的其血浆H₂S含量明显低于单纯狭窄组[(19.04±9.55)μmol/Lvs(28.24±14.85)μmol/L,P<0.05]。(4)在冠心病患者中,吸烟者血浆H₂S含量明显低于不吸烟者[(27.54±10.37)μmol/Lvs(32.24±15.77)μmol/LP<0.05],高血压病者含量明显低于无高血压病者[(20.36±8.69)μmol/Lvs(33.77±15.86)μmol/L P<0.01];血浆H₂S水平与血糖水平呈强负相关(r=-0.4936 P=0.0016),与性别、年龄、胆固醇、甘油三酯、极低密度脂蛋白、高密度脂蛋白、体质量指数等无明显相关性。结论 血浆中H₂S含量降低可能与冠心病临床病情严重性及冠脉血管病变程度相关;血浆H₂S含量的减少可能与冠心病危险因素吸烟、高血压、高血糖相关。     

冠心病患者血浆尾加压素Ⅱ的临床研究

OBJECTIVE: To investigate the changes in plasma urotensin II(U II) expression levels in patients with coronary heart disease (CHD). METHODS: Plasma U II levels in 50 CHD patients with coronary stenosis indicated by coronary angiography and 20 healthy subjects were determined by radio immunoassay. RESULTS: Venous plasma U II levels were significantly lowered in CHD patients in comparison with the healthy subjects (1.61+/-1.02 pg/ml vs 3.70+/-1.30 pg/ml, P=0.000). In the CHD patient group, significantly differences were noted in the U II levels between patients with stable angina (2.62+/-1.20 pg/ml), unstable angina (1.39+/-0.80 pg/ml) and acute myocardial infarction (AMI, 1.04+/-0.45 pg/ml, P=0.004). CHD patients with coronary artery occlusion and those with only coronary stenosis had comparable venous plasma U II levels (1.29+/-1.02 pg/ml vs 1.76+/-1.00 pg/ml, P=0.131), whereas the patients with restenosis after percutaneous transluminal coronary angioplasty (PTCA) had higher U II levels than the other subjects in the CHD patient group (2.28+/-0.94 pg/ml vs 1.40+/-0.96 pg/ml, P=0.008), and the femoral plasma U II levels were significantly elevated after PTCT, increasing from 1.18+/-1.14 pg/ml to a postoperative level of 2.22+/-1.77 pg/ml (P=0.001). CONCLUSION: U II might play a role in the pathophysiological process of CHD and can be involved in the restenosis after angioplasty.     

低剂量叶酸对高同型半胱氨酸血症患者血浆同型半胱氨酸及趋化因子水平的影响

目的观察低剂量叶酸治疗对高同型半胱氨酸血症(HHcy)患者血浆同型半胱氨酸及趋化因子水平的影响。方法给予40名HHcy患者叶酸0.8mg/d治疗6个月,在治疗前、后分别采集空腹静脉血,检测血浆Hcy、叶酸、单核细胞趋化蛋白-1(MCP-1)、白细胞介素-8(IL-8)、超氧化物歧化酶(SOD)和丙二醛(MDA)水平。结果叶酸治疗6个月后,HHcy患者的血浆Hcy水平为(25.8±12.0)μmol/L,明显低于治疗前的(57.1±18.0)μmol/L(P<0.05)。患者的MCP-1、IL-8、SOD和MDA水平则在治疗前、后差异均无显著性。结论低剂量叶酸治疗可降低HHcy患者的Hcy水平,但对趋化因子的水平无影响。     

血浆不对称二甲基精氨酸水平与冠状动脉硬化关系的研究

目的研究不对称二甲基精氨酸（ADMA）水平是否与冠状动脉粥样硬化的病变范围和严重程度有关。方法110例行冠状动脉造影术的患者根据造影结果分为冠状动脉造影正常的对照组22例,轻度动脉硬化组21例,造影显示冠状动脉内膜不光滑,但无明显的狭窄或狭窄小于50％;单支病变组22例,造影显示1支主要的冠状动脉分支出现明显狭窄（≥50％）;双支病变组22例,两支主要的冠状动脉分支出现明显狭窄;多支病变组23例,两支以上主要的冠状动脉分支出现明显狭窄或伴有左主干病变。血浆ADMA水平的检测采用酶联免疫法。结果除轻度动脉硬化组ADMA水平（1．21μmol／L±0．36μmol／L,P=0．288）偏低外,单支病变组、双支病变组和多支病变组患者的ADMA水平均高于对照组（1．52μmol／L±0．61μmol／L,1．67μmol／L±0．80μmol／L和2．60μmol／L±0．62μmol／L vs 0．79μmol／L±0．54μmol／L,P〈0．01）。经过多元相关与Logstic等级回归分析,ADMA水平与冠状动脉病变程度密切相关。结论血浆ADMA水平升高可以预测冠状动脉粥样硬化的发生,ADMA可能是一种新的冠心病危险因子。     

血浆脂联素与冠状动脉病变程度的相关性分析

目的:通过测定冠状动脉造影患者的血浆脂联素(adiponectin,APN)浓度,进一步探索其对冠状动脉病变的影响.方法:收集105例冠状动脉造影患者的术前血浆,采用酶联免疫法测定APN浓度,冠状动脉病变程度用病变血管支数和 Gensini积分表示.结果:正常组APN浓度显著高于单支、双支、三支病变组(P值分别为0.012、[0.004]、0.000 5),且随病变支数的增加, APN浓度有逐渐降低趋势.Gensini积分≥30分组APN浓度明显低于《30分组及0分组(P《0.05).急性冠状动脉综合征组(acute coronary syndrome,ACS) APN浓度明显低于非ACS组[(0.731±0.361)mg/L与(1.097±0.617) mg/L,P=0.03).Logistic回归分析证实,低水平APN浓度是冠状动脉狭窄及斑块不稳定的独立危险因素.冠心病危险因素相关分析显示,APN与高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)呈正相关,与甘油三脂(triglyceride,TG)、C反应蛋白呈负相关.结论:血浆APN水平与冠状动脉粥样硬化及其严重程度和斑块稳定性独立相关,同时与C反应蛋白、TG、HDL-C也存在明确关系.     

Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea hypopnea syndrome and coronary artery disease

Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels, NO/ET ratio, total ischemic burden (TIB) of the myocardium, apnea hypopnea index (AHI), and minimal and mean pulse oxygen saturation (SpO2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET ［(51.39±11.69) ng/L］ and NO ［(36.67±11.86) μmol/L］, NO/ET (0.71±0.14), AHI (32.4±7.9), minimal SpO2 ［(68.9±11.4)%］, and myocardial TIB ［(66.29±16.37) mm·min］ before treatment, there were significant decreases in ET ［(33.41±10.03) ng/L］ （P&lt;0.05）, increases in NO ［(59.89±10.26) μmol/L］ and NO/ET (1.79±0.38) （P&lt;0.01）, decreases in AHI (1.9±0.5), and increases in minimal SpO2 ［(90.6±1.8) %］ （all P&lt;0.01） and myocardial TIB ［(36.42±10.87) mm·min］ （P&lt;0.05） after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.     

冠心病患者血浆同型光胱氨酸的变化及其机制的探讨

OBJECTIVE: To identify hyperhomocysteinemia (HHe) as a new and independent risk factor for coronary heart disease (CHD). METHODS: The association of coronary heart disease (CHD) and lipid, homocysteine (HCY) and the factors related to its metabolisms were examined. The mutation of the 677C-->T transition of MTHFR was determined by PCR-based assay. Whole blood and plasma folate (FA) and plasma vitamin B12(B12), as cofactors of those enzymes, were determined by radioimmunologic assay. Plasma HCY was determined by HPLC. RESULTS: Patients with CHD confirmed by coronary angiography had increased plasma HCY concentrations (17.1 +/- 3.6 mumol/L, 7.6 +/- 1.2 mumol/L). In patients with MI, HPT and family history (FH) of CHD, plasma HCY increased significantly. Plasma HCY concentrations had significant non-linear inverse relation with plasma FA and B12 concentrations. Homozygous mutants showed higher plasma HCY concentrations. Patients with CHD had increased serum CHOL and VLDL levels, but plasma HCY concentrations were not correlated with serum lipid levels. CONCLUSION: Hyperhomocysteinemia is an independent risk factor for coronary heart disease.     

新型气体信号分子硫化氢对左向右分流大鼠一氧化氮/一氧化氮合酶体系的影响

目的探讨内源性硫化氢(H2S)对左向右分流大鼠一氧化氮(NO)/一氧化氮合酶(NOS)体系的影响。方法将雄性SD大鼠随机分为分流组,分流+炔丙基甘氨酸(PPG)组,假手术组和假手术组+PPG组,每组8只。分流组及分流+PPG组大鼠经腹主动脉-下腔静脉穿刺建立左向右分流动物模型。术后4周,测量大鼠平均肺动脉压(MPAP);测定血浆NO、肺组织H2S、NO含量及NOS活性;用Western印迹方法测定肺组织eNOS含量。结果分流术后4周,分流组与假手术组比较,大鼠MPAP无明显变化;分流组与假手术组比较血浆NO(23·2μmol/L±3·6μmol/Lvs17·9μmol/L±3·4μmol/L,P<0·05)、肺组织H2S(37·6μmol/mg±2·1μmol/mgvs14·4μmol/mg±1·8μmol/mg,P<0·05)、肺组织NO(38·5±6·5μmol/μgvs31·8±6·5μmol/μg,P<0·05)、肺组织NOS活性(15·1U/mg±2·4U/mgvs12·0U/mg±1·4U/mg,P<0·05)及肺组织eNOS含量(0·3±0·1vs0·2±0·1,P<0·05)均明显升高。分流+PPG组大鼠MPAP较分流组及假手术组分别升高了15·82%和20·55%(19·5mmHg±1·7mmHgvs16·4mmHg±1·7mmHg和19·5mmHg±1·7mmHgvs15·5mmHg±1·3mmHg,P<0·05),肺组织H2S含量降低(28·8μmol/mg±2·2μmol/mgvs37·6μmol/mg±2·1μmol/mg,P<0·05),而血浆NO(27·8μmol/L±4·8μmol/Lvs23·2μmol/L±3·6μmol/L,P<0·05)、肺组织NO(46·0μmol/μg±6·0μmol/μgvs38·5μmol/μg±6·5μmol/μg,P<0·05)、NOS活性(20·9U/mg±3·9U/mgvs15·1U/mg±2·4U/mg,P<0·05)及eNOS含量均明显升高(0·4±0·1vs0·3±0·1,P<0·05)。结论内源性H2S可能通过抑制NO/NOS体系调节左向右分流大鼠肺动脉压力。     

培哚普利对急性心肌梗死伴2型糖尿病患者内皮祖细胞动员及预后的影响

目的观察应用培哚普利治疗急性心肌梗死(AMI)伴2型糖尿病(T2DM)患者的预后,血浆血管内皮生长因子(VEGF)、基质细胞衍生因子(SDF-1α)水平,骨髓内皮祖细胞(EPC)动员情况。方法将20例AMI伴T2DM患者随机分为培哚普利组(10例,予口服培哚普利4mg/d)及对照组(10例,未予培哚普利)。采用密度梯度离心法分离外周血单个核细胞,应用流式细胞仪检测AMI不同时间点[急诊经皮冠状动脉介入治疗(PCI)前,PCI后1、3、5、7、14和28d]外周静脉血中CD45-/low+/CD34+/CD133+/KDR+早期EPC数量。采用酶联免疫吸附法检测血浆中VEGF、SDF-1α及超敏C反应蛋白(hs-CRP)水平。结果培哚普利组在PCI后7d的外周静脉血中EPC数量为(211±78)个/1×106,显著高于对照组的(147±57)个/1×106(P<0.05),且在PCI后5d较PCI前显著升高(P<0.05)。培哚普利组在PCI后5、7d的血浆中VEGF水平[(172±72)、(183±63)ng/L]均显著高于同时间点的对照组[分别为(105±63)、(77±37)ng/L,P值均<0.05]。培哚普利组在PCI后7d(高峰点)的SDF-1α水平为(3296±680)ng/L,显著高于同时间点的对照组[(2115±570)ng/L,P<0.05]。培哚普利组在PCI后3d(高峰点)的hs-CRP水平为(26.2±6.5)mg/L,显著低于同时间点的对照组[(33.8±10.6)mg/L,P<0.05]。随访6个月时培哚普利组的左心室射血分数(LVEF)为0.491±0.059,显著高于入院时的0.469±0.051(P<0.05);对照组LVEF分别为0.482±0.054、0.479±0.052,差异无统计学意义(P>0.05)。结论使用培哚普利治疗AMI伴T2DM患者,可改善其组织缺血后SDF-1α、VEGF-EPC动员通路障碍,并改善其预后。