他汀类药物抗炎护肾作用机制的实验研究

目的 在UUO模型上观察氟伐他汀对肾间质巨噬细胞细胞浸润、单核细胞趋化蛋白-1(MCP-1)表达及肾间质纤维化程度的影响,探讨他汀类药物的抗炎护肾作用机制.方法 72只SD雌性大鼠随机分成对照组(n=24)、UUO模型组(单侧输尿管梗阻术,n=24)和氟伐他汀治疗组[UUO FVT组,单侧输尿管梗阻术 氟伐他汀20 mg/(kg·d),n=24].于术后第3,7,10,14天分别处死各组大鼠.用HE及Masson染色动态观察肾脏病理变化,免疫组织化学法测定MCP-1的表达和巨噬细胞浸润.结果 UUO模型组大鼠肾小管-间质MCP-1与单核巨噬细胞抗原ED-1的表达及肾间质胶原相对面积较对照组显著增加(P＜0.05);而术后各时间点,治疗组大鼠肾小管-间质MCP-1、ED-1的表达及肾间质胶原相对面积较UUO模型组显著减少(P＜0.05).结论 氟伐他汀可降低MCP-1表达、抑制巨噬细胞浸润,减轻肾间质纤维化,提示他汀类药物具有抗炎护肾的作用.     

黄芪对UUO模型大鼠肾脏肝细胞生长因子表达的影响

目的 动态观察黄苠(AM)对单侧输尿管梗阻(UUO)所致大鼠肾小管间质纤维化的拈抗作用和肝细胞生长因子(HGF)表达的影响.方法 SD大鼠随机分为假手术组(SOR组)、UUO组和UUO+AM治疗组(AM组).在造模后3、7、14 d处死动物,观察肾脏病理改变.采用免疫组化方法检测肾组织中α-平滑肌肌动蛋白(α-SMA)、HGF表达.实时荧光定量RT-PCR检测大鼠.HGF mRNA和α-SMA mRNA表达量.Western blot检测大鼠HGF及其受体C-met蛋白表达量.结果 与SOR组相比,各时间点UUO大鼠肾脏病理损害进行性加重,AM治疗后可明显减轻UUO大鼠肾小管损伤及肾间质纤维化程度(P<0.05).随着梗阻时间的延长,UUO大鼠肾组织α-SMA表达逐渐增加;HGF及其受体C-met呈现先升高后下降的表达规律,在UUO术后第7 d达高峰,此后大幅回落;与UUO组各对应时间点比较,AM治疗后可使肾组织中的HGF及其受体C-met表达显著增高,α-SMA表达明显降低(P<0.05).结论 AM可能通过诱导HGF及其受体C-met的表达,负性调控肾小管上皮细胞转分化,减轻肾间质纤维化.     

UUO模型大鼠肾间质纤维化动态进展及α-SMA、TGF-β1和VDR表达变化

目的 观察单侧输尿管梗阻(UUO)模型大鼠肾小管间质纤维化动态进展,研究该病理过程中肾脏纤维化相关蛋白表达的变化.方法 32只清洁级SD大鼠随机分为假手术组(n=16)和UUO模型组(模型组,n=16).两组大鼠分别于术后(模型组建模后)第2、5、9、14天分批(n=4)处死,留取手术侧(模型组梗阻侧)肾脏组织.分别采用HE和Masson染色、免疫组织化学染色及Western blotting等方法,评价肾小管间质纤维化损伤程度并检测肾脏组织α平滑肌肌动蛋白(α-SMA)、纤维连接蛋白(FN)、维生素D受体(VDR)及转化生长因子β1(TGF-β1)等相关蛋白的表达.结果 肾脏组织形态学观察显示,随着输尿管梗阻时间的延长,肾小管间质纤维化程度逐步加重.免疫组织化学染色显示,模型组大鼠建模后各时间点肾间质α-SMA和FN阳性面积百分比均显著高于假手术组(P＜0.05),且随着梗阻时间的延长逐渐升高,至建模后第14天时达到高峰.Western blotting分析表明,模型组大鼠建模后各时间点α-SMA和TGF-β1相对表达量均显著高于假手术组(P＜0.05),而VDR相对表达量显著低于假手术组(P＜0.05);建模后第2天,模型组大鼠肾脏组织α-SMA相对表达量已显著增加;建模后第14天,模型组α-SMA和TGF-β1相对表达量分别增高至假手术组的12.7倍和8.8倍,而VDR相对表达量下降至假手术组的3%.结论 UUO模型大鼠建模后第14天可出现显著的肾间质纤维化;建模早期肾间质中α-SMA表达增加提示肾间质成纤维细胞的活化;VDR表达的进行性减少提示其与肾间质纤维化有关.     

吡非尼酮对单侧输尿管梗阻大鼠肾脏间质纤维化的影响

目的 探讨吡非尼酮(pirfenidone,PDF)对单侧输尿管梗阻(UUO)大鼠肾间质纤维化的作用.方法 雌性SD大鼠42只,随机分为3组:假手术组、模型组及治疗组[PDF 500 mg/(kg*d)].UUO术后7 d和14 d分别处死各组大鼠,光镜观察梗阻肾组织病理变化;免疫组化和RT-PCR方法检测各组肾组织α-平滑肌肌动蛋白(α-SMA)的表达水平;RT-PCR方法检测各组肾组织结缔组织生长因子(CTGF)的表达水平.结果 模型组肾脏间质纤维化病变最明显,治疗组病变显著减轻(P＜0.01).与假手术组相比,模型组α-SMA蛋白和基因表达及CTGF的基因表达均明显增加(均 P＜0.01);治疗组上述物质表达则较模型组明显减少(均 P＜0.01).结论 吡非尼酮可能通过抑制α-SMA和CTGF的表达进而减少细胞外基质的沉积,发挥肾脏保护作用.     

益气活血法对肾间质纤维化影响的实验研究

目的 观察益气活血中药拮抗肾间质纤维化的作用及对转化生长因子β1mRNA表达的影响.方法 将30只大鼠随机分假手术组(对照组)、模型组和治疗组(中药组),采用单侧输尿管梗阻(UUO)模型,术后第14天观察梗阻肾组织病理改变,应用免疫组织化学方法检测转化生长因子β1(TGF-β1)、α-平滑肌肌动蛋白(α-SMA)和Ⅰ型胶原的表达.结果 模型组TGF-β1、α-SMA、Ⅰ型胶原的表达增加,肾间质病变加重,与对照组相比有显著差异(P＜0.05);治疗组与模型组相比,TGF-β1、α-SMA、Ⅰ型胶原的表达下调,肾间质病变面积明显缩小,差异有显著性(P＜0.05).结论 益气活血中药可能通过下调TGF-β1、α-SMA、Ⅰ型胶原的表达,从而阻抑肾间质纤维化的进展.     

氯沙坦及霉酚酸酯对单侧输尿管梗阻大鼠肾脏的保护作用

目的:观察氯沙坦及霉酚酸酯对单侧输尿管梗阻(UUO)大鼠肾脏转化生长因子(TGF)β1、Ⅲ型胶原、α平滑肌肌动蛋白(α-SMA)表达介导的肾间质纤维化的作用. 方法:雌性SD大鼠30只,随机分为假手术组(Sham、UUO组、氯沙坦组(LSRT、霉酚酸酯组(MMF和联合用药组(L M).制备UUO大鼠模型后,LSRT组给予氯沙坦(50 mg·kg-1·d-1)灌胃、MMF组给予霉酚酸酯(25 mg·kg-1·d-1灌胃、L M组给予氯沙坦霉和霉酚酸酯(剂量同前)灌胃,用免疫组织化学方法检测术后14 d肾组织α-SMA、TGF-β1、Ⅲ型胶原表达量,并进行Masson染色评分.同时测定收缩压、尿蛋白及肌酐清除率. 结果:各组大鼠收缩压、尿蛋白及肌酐清除率均无差异(P＞0.05).与Sham组比较,UUO组及治疗组α-SMA 、TGF-β1、Ⅲ型胶原表达及Masson染色评分均增高,且UUO组高于各治疗组(P＜0.05),而联合治疗组低于单用药组(P＜0.05).结论:氯沙坦及霉酚酸酯可通过下调α-SMA、TGF-β1、Ⅲ型胶原表达减轻UUO术后肾组织间质纤维化,联合用药作用优于单独用药.     

UUO模型大鼠肾间质纤维化动态进展及α-SMA、TGF-β1和VDR表达变化

目的 观察单侧输尿管梗阻（UUO）模型大鼠肾小管间质纤维化动态进展,研究该病理过程中肾脏纤维化相关蛋白表达的变化.方法 32只清洁级SD大鼠随机分为假手术组（n=16）和UUO模型组（模型组,n=16）.两组大鼠分别于术后（模型组建模后）第2、5、9、14天分批（n=4）处死,留取手术侧（模型组梗阻侧）肾脏组织.分别采用HE和Masson染色、免疫组织化学染色及Western blotting等方法,评价肾小管间质纤维化损伤程度并检测肾脏组织α平滑肌肌动蛋白（α-SMA）、纤维连接蛋白（FN）、维生素D受体（VDR）及转化生长因子β1（TGF-β1）等相关蛋白的表达.结果 肾脏组织形态学观察显示,随着输尿管梗阻时间的延长,肾小管间质纤维化程度逐步加重.免疫组织化学染色显示,模型组大鼠建模后各时间点肾间质α-SMA和FN阳性面积百分比均显著高于假手术组（P＜0.05）,且随着梗阻时间的延长逐渐升高,至建模后第14天时达到高峰.Western blotting分析表明,模型组大鼠建模后各时间点α-SMA和TGF-β1相对表达量均显著高于假手术组（P＜0.05）,而VDR相对表达量显著低于假手术组（P＜0.05）;建模后第2天,模型组大鼠肾脏组织α-SMA相对表达量已显著增加;建模后第14天,模型组α-SMA和TGF-β1相对表达量分别增高至假手术组的12.7倍和8.8倍,而VDR相对表达量下降至假手术组的3%.结论 UUO模型大鼠建模后第14天可出现显著的肾间质纤维化;建模早期肾间质中α-SMA表达增加提示肾间质成纤维细胞的活化;VDR表达的进行性减少提示其与肾间质纤维化有关.     

西红花酸对单侧输尿管大鼠肾组织结缔组织生长因子表达的影响

目的：研究西红花酸对单侧输尿管结扎（UUO）大鼠肾组织结缔组织生长因子（CTGF）表达及肾间质纤维化的影响。方法：采用UUO大鼠模型，将大鼠随机分为3组：假手术组（SHAM组）、模型组（UUO组）、西红花酸组（C组）。SHAM组和UUO组给予标准资料30g／d，C组于术前3d至术后9d每天分别给予西红花酸50rag／kg.d灌胃，第9天处死各组大鼠。免疫组化法检测各组肾组织CTGF；HE、Masson染色评定各组肾小管间质损害程度。结果：UUO组CTGF的表达及肾小管间质损伤指数明显高于SHAM组（P〈0.05），而C组上述指标明显低于UUO组（P〈0.05）。结论：西红花酸可以一直肾纤维化CTGF表达，从而遏制肾纤维化的进展。     

安体舒通和缬沙坦对UUO大鼠肾脏的抗氧化保护作用

目的 探讨醛固酮受体拮抗剂安体舒通和血管紧张素Ⅱ-1型受体拮抗剂(AT1Ra)缬沙坦对单侧输尿管梗阻(UUO)模型肾间质纤维化的抗氧化保护作用.方法 Wistar大鼠行左侧输尿管结扎术,分为UUO模型组(n=11),安体舒通治疗组(US,n=12),缬沙坦治疗组(UV,n=11)和安体舒通+缬沙坦治疗组(USV,n=10),同时设假手术对照组(n=7).术后第14天处死各组大鼠,进行HE和Masson染色,观察肾脏病理变化;比色法测定肾组织羟脯氨酸(HYP),丙二醛(MDA)和超氧化物歧化酶(SOD)含量;免疫组织化学方法测定α-平滑肌肌动蛋白(α-SMA)的表达.结果 UUO组与其它组大鼠比较,肾组织HYP和MDA含量明显升高,SOD含量显著下降,肾脏病理改变加重,肾组织α-SMA的表达显著增加(P<0.05);各用药组与UUO组大鼠比较,肾组织HYP和MDA含量明显降低,SOD含量升高,肾间质纤维化显著减轻,肾组织α-SMA的表达显著减少(P<0.05).结论 安体舒通联合缬沙坦能减少单侧输尿管梗阻肾组织脂质过氧化物的产生,增加抗氧化酶的含量,从而显著改善UUO大鼠氧化应激所致的肾间质纤维化.     

血清和糖皮质激素诱导蛋白激酶1在梗阻性肾病肾间质中的表达和血竭素高氯酸盐对其的干预作用

目的 探讨在单侧输尿管梗阻(UUO)性肾病肾间质中血清和糖皮质激素诱导蛋白激酶1(serum and glucocorticoid induced kinase 1,SGK1)的表达及血竭素高氯酸盐(Dracohodin Perchlorate,DP)对其的干预作用.方法 用单侧输尿管梗阻的方法致大鼠肾间质纤维化,60只SD大鼠随机分为假手术组、模型组、低剂量和高剂量DP治疗组,分别在造模第3、7、14天后处死各组大鼠,采集静脉血检测肾功能(BUN、SCr)变化,肾组织标本用碘酸-席夫(PAS)染色确证发生纤维化病变,免疫组化技术检测肾组织SGK1蛋白的表达及DP干预后的变化.结果 与假手术组比较,模型组大鼠第7、14天血清BUN、SCr水平显著升高(P＜0.05),肾间质纤维化形成;与模型组比较,仅有DP高剂量治疗组大鼠血清肾功能指标好转(P＜0.05),肾间质纤维化好转.模型组大鼠肾间质SGK1蛋白的表达明显高于假手术组(P＜0.05),且随着梗阻时间延长其表达呈增强趋势;仅DP高剂量治疗组大鼠的肾间质SGK1蛋白显著低于模型组(P＜0.05).结论 在梗阻性肾病肾间质纤维化进程中,SGK1蛋白表达明显上调,而DP对SGK1蛋白的表达有显著的抑制作用,可能对肾间质纤维化病变起到一定延缓作用.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.