伤科熏洗方对类风湿性关节炎患者血清肿瘤坏死因子-α和白细胞介素-1β水平的影响

目的探讨伤科熏洗方对类风湿性关节炎(RA)的疗效及其对RA患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)水平的调节作用。方法选取110例RA活动期患者,随机分为治疗组和对照组,每组55例。治疗组采用伤科熏洗方联合西药治疗,对照组仅用西药治疗,共4周。观察2组的临床疗效以及治疗前后临床症状和实验室指标的变化,采用ELISA法检测患者血清TNF-α和IL-1β水平。结果治疗组和对照组总有效率分别为72.7%和49.1%,治疗组明显高于对照组(P0.05)。治疗组和对照组临床症状均明显改善(P0.05),但治疗组明显优于对照组(P0.05)。治疗组血沉、C反应蛋白、TNF-α和IL-1β水平均明显降低(P0.05),对照组无明显变化(P0.05)。结论伤科熏洗方下调TNF-α和IL-1β可能是其治疗RA的重要机制之一。     

加味青娥丸对模拟失重状态下小鼠骨显微结构和β-catenin及DKK-1表达水平的影响

目的观察加味青娥丸对尾吊小鼠发生废用性骨质疏松模型骨显微结构的影响和β-catenin及Diekkopf-1(DKK-1) m RNA表达水平的影响,探讨加味青娥丸防治模拟失重状态下快速骨丢失的部分机制。方法 96只8周龄SPF级C57BL/6小鼠随机分为对照组(control组)、尾吊组(HLS组)、尾吊+加味青娥丸组(HLS+Qing'E组)、尾吊+雌二醇组(HLS+estradiol组),每组24只。control组及HLS组小鼠每天灌服生理盐水0.5 ml,HLS+Qing'E组给予加味青娥丸配制成的0.5 ml混悬液,HLS+estradiol组每天灌服补佳乐溶液0.5 ml,具体实验给药剂量按人与动物体表面积换算法计算。各组小鼠统一条件喂养3个月后,以micro-CT检测并经三维重建获得骨组织微观结构,免疫组化及RT-PCR检测下肢股骨头内骨组织局部β-catenin和DKK-1及其m RNA的表达,ELISA法检测循环血中Ⅰ型原胶原氨基端肽(PINP)的水平。结果与HLS组比较,control组、HLS+Qing'E组及HLS+estradiol组小鼠骨体积分数(BV/TV)、骨小梁数目(Tb.N)、骨小梁厚度(Tb.Th)显著增高(P0.05),结构模型指数(SMI)、骨小梁间隙(Tb.Sp)、骨表面积体积比(BS/BV)明显降低(P0.05)。与HLS组比较,control组、HLS+Qing'E组及HLS+estradiol组小鼠骨组织局部β-catenin m RNA的表达水平明显增高(P0.05),而DKK-1 m RNA表达水平明显降低(P0.05)。与HLS组比较,其他三组循环血中PINP水平明显增高(P0.05)。结论加味青娥丸能够防治尾吊小鼠发生废用性骨质疏松,其部分疗效机制可能与其增强骨组织局部β-catenin m RNA表达,抑制DKK-1 m RNA水平有关。     

伤科熏洗方对佐剂性关节炎大鼠血清炎症因子的调节作用

目的:探讨伤科熏洗方对佐剂性关节炎(AA)大鼠血清肿瘤坏死因子-α(TNF-α)和白介素-1β(IL-1β)的调节作用。方法:30只Wistar大鼠随机分为对照组、模型组和治疗组,每组10只。模型组和治疗组采用完全弗氏佐剂构建佐剂性关节炎大鼠模型,治疗组采用伤科熏洗方外用熏洗治疗。观察AA大鼠足趾肿胀、关节炎指数、病理改变以及血清TNF-α和IL-1β的变化。结果:与对照组相比,AA大鼠足趾明显肿胀,炎症指数增高,病理改变明显,血清TNF-α和IL-1β水平显著升高;经伤科熏洗方治疗后,足趾肿胀明显消退,炎症指数降低,病理改变减轻,血清TNF-α和IL-1β水平明显下降(P<0.05)。结论:伤科熏洗方可能通过抑制炎症因子TNF-α和IL-1β的表达,达到治疗大鼠佐剂性关节炎的作用。     

消瘀止血片对慢性肾功能衰竭患者血小板膜糖蛋白Ib/IX/V复合物的影响

选取2006年2月-2007年6月在华中科技大学同济医学院附属协和医院中阿医结合科门诊及病房的51例早中期慢性肾功能衰竭（CRF）患者,均符合CRF诊断标准（王海燕主编．肾脏病学．第2版．北京：人民卫生出版社,1996：1385）。其中男28例,女23例;年龄21～67岁,平均（44．26±15．00）岁;病程1～7年,平均（3．19±1．66）年。其中代偿期15例,失代偿期23例,衰竭期13例,无尿毒症期。     

罗格列酮对阿霉素肾病大鼠肾脏保护作用的研究

目的探讨过氧化物酶体增殖激活受体-γ激动剂-罗格列酮（RSG）对阿霉素（ADR）肾病大鼠肾脏的保护作用。方法通过一次性静脉注射盐酸阿霉素6mg／kg，制备肾病综合征模型大鼠。30只SD雄性大鼠随机分为正常组、模型组和罗格列酮治疗组（治疗组）。实验周期4周。免疫组化方法检测肾皮质过氧化物酶体增殖激活受体-γ（PPARγ）、转化生长因子（TCF-β1）的表达；检测血清生化指标及24h尿蛋白定量。结果模型组出现高脂血症、低蛋白血症及大量蛋白尿；治疗组血清总蛋白（TP）、白蛋白（Alb）、总胆固醇（TC）、甘油三酯（TG）及24h尿蛋白水平与模型组相比，差异有统计学意义；肾组织病理损害明显减轻，PPARγ表达上调，TGF-β1表达下调。结论RSG对ADR肾病大鼠的肾脏有保护作用，其机制可能是通过上调PPARγ，下调TGF-β1发挥作用。     

血清脂联素水平在磺脲类药物继发性失效的2型糖尿病患者中的变化及临床意义

目的观察磺脲类降糖药（SU）继发性失效2型糖尿病患者血清脂联素水平与血糖控制良好2型糖尿病患者及正常人之间的差异。方法采用ELISA法检测所有受试者血清脂联素水平,同时检测血糖和血脂,计算体重指数,进行相关性分析。结果血糖控制良好的患者脂联素明显低于正常人（P〈0．05）,SU继发性失效的患者明显低于血糖控制良好的患者（P〈0．05）;两组2型糖尿病患者胰岛素抵抗水平均明显高于正常人（P均〈0．05）,而两组患者比较无明显差异（P〉0．05）。SU继发性失效患者脂联素水平与空腹血糖、餐后2小时血糖、糖化血红蛋白、体重指数、空腹胰岛素、胰岛素抵抗指数、胆固醇、总甘油三酯及低密度脂蛋白胆固醇呈明显负相关（P均〈0．05）,与高密度脂蛋白胆固醇呈明显正相关（P〈0．05）。结论脂联素水平下降和胰岛素抵抗相互影响,可能参与了2型糖尿病SU继发性失效的发生发展。     

葫芦巴总皂苷对链脲佐霉素诱导的糖尿病大鼠血小板活化的调节作用

目的:观察葫芦巴总皂苷(TFGs)对链脲佐霉素(STZ)诱导的糖尿病大鼠血小板活化的调控作用。方法:将正常大鼠和糖尿病大鼠随机分为未治疗对照组、治疗对照组、未治疗糖尿病组和治疗糖尿病组。两治疗组采用TFGs治疗4周。治疗结束后,分别检测大鼠体质量、血糖和胰岛素水平,采用流式细胞术检测各组大鼠血小板膜P选择素(CD62P)的表达,采用比浊法检测各组大鼠血小板最大聚集率。结果:与正常大鼠相比,糖尿病大鼠血糖明显升高,体质量和胰岛素水平显著下降,糖尿病大鼠经TFGs治疗后体质量明显增加,血糖下降,胰岛素水平升高;糖尿病大鼠血小板CD62P表达和血小板聚集率明显增高,经TFGs治疗后明显降低。结论:TFGs具有明显抑制STZ糖尿病大鼠血小板活化作用,是一种具有防治糖尿病血管病变作用的降糖药物。     

血小板膜糖蛋白Ⅰb/Ⅸ/Ⅴ复合物表达变化：健康者与2型糖尿病患者的样本分析☆

BACKGROUND: It has been proved that platelet activation is involved in the development of diabetic angiopathy. Glycoprotein (GP) Ib/IX/V complex is one of the main platelet membrane glycoproteins, and the receptor of both von Willebrand Factor and thrombin. It plays a key role in the process of platelet activation. OBJECTIVE: To observe the expression changes of GP Ib/IX/V complex and its component GP Ibα in patients with type 2 diabetes mellitus. DESIGN: Case-control study. SETTING: Department of Integrated Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS: A total of 51 type 2 diabetic outpatients who visited Union Hospital were enrolled from December 2005 to January 2007. The diagnosis was based on the independent criteria from WHO in 1999. Of all the 51 patients, there were 23 females and 28 males, with a peripheral platelet count of over 50×109 L－1. All the subjects had no history of administrating drugs two weeks before the examination, which would potentially influence platelet count. According to disease controlling condition, the patients were assigned to well controlled patient (WCP) group (n = 25) and poorly controlled patient (PCP) group (n =26); and according to whether angiopathy was accompanied, diabetic patients were divided into vascular disease (VD) group (n =27) and non-vascular disease (NVD) group (n =24). Meanwhile 23 healthy subjects were enrolled as normal control group. Informed consents were obtained from subjects and their relatives. The experiments were approved by the ethical committee of Union Hospital. METHODS: Fasting venous blood was harvested from all the subjects' elbow on the early morning of visit day.①Biochemical analysis: Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and fasting plasma insulin (FINS) was measured by the Clinical Chemistry Department in Union Hospital.② Measurement of platelet membrane GP Ib/IX/V complex and its component GP Ibα: First, 3 mL cubital fasting blood was drawn from each subject and was anti-coagulated with 38 g/L natrium citricum. After that, all samples were fixed with 10 g/L paraform for 45 minutes. Then 50 μL well-fixed blood was added into the polystyrene tube, meanwhile 20 μL monoclonal antibody, such as CD42a-b-c-d and PE-labeled CD42b, was respectively mixed gently with the blood sample and incubated at room temperature in dark for 30 minutes. Next, 20 μL FITC-labeled rat IgG was mixed with the sample containing CD42a-b-c-d and incubated equally. In the end all blood samples were analyzed by FACS420 flow cytometry and the results were expressed as mean fluorescence intensity (MFI). ③ Platelet maximun aggregation rate (MAR) was detected according to reference. MAIN OUTCOME MEASURES: ①Biochemical indicators;②The expressions of GP Ib/IX/V complex and GP Ibα;③Platelet MAR. RESULTS: Fifty-one patients with type 2 diabetes mellitus and twenty-three healthy subjects were all involved in the result analysis.①There were significant differences in FINS in WCP group and PCP group compared with normal controls (P < 0.01). FPG and HbA1c were significantly higher in PCP group compared with normal control group and WCP group (P < 0.01).②Expressions of GP Ib/IX/V complex and GP Ibα were significantly lower in WCP group and PCP group compared with normal control group (P < 0.01), significantly lower in PCP group than in WCP group (P < 0.05), and also significantly lower in VD group and NVD group compared with normal control group (P < 0.01). Moreover the expression of GP Ibα in VD group and NVD group was significantly lower than that of normal control group (P < 0.05), and it also significantly decreased in VD group compared with NVD group (P < 0.05). MFI of GP Ib/IX/V complex had an obvious negative correlation with FBG, HbA1c and FINS (r =-0.634, -0.573, -0.649, P < 0.05), and GP Ibα MFI was obviously negatively correlated with FBG and HbA1c (r =-0.602, -0.543, P < 0.05).③Platelet MAR of diabetic patients were remarkably higher than in healthy subjects (t =-3.852, P < 0.01). Platelet MAR in PCP and VD groups were respectively higher than those in WCP and NVD groups (P < 0.05). CONCLUSION: Platelet activation exists in the early stage of type 2 diabetes mellitus without diabetic angiopathy, and is more obvious after diabetic angiopathy. There is a positive correlation between platelet activation and blood glucose. As a receptor of thrombin and von Willebrand Factor, GP Ib/IX/V complex may be involved in the development of diabetic angiopathy.     

武汉地区老年人群骨质疏松性骨折发病率初步调查

目的：了解武汉地区老年人群骨质疏松性骨折发生率。方法：根据流行病学调查的要求，整体抽样选择常住武汉市区60岁以上的老年居民1764人，现场调查由骨科医生执行，统一质量控制和回收表格，进行统计分析。结果：60岁及以上老年人群各种骨质疏松性骨折总发生率为7．31％。结论：武汉地区老年骨质疏松性骨折发生率低于国内部分地区。     

Expression of Platelet Membrane Glycoprotein Ib/Ⅸ/Ⅴ Complex,a Receptor of Thrombin,in Patients with Hemorrhagic Thrombopathy

To investigate the role of platelet membrane glycoprotein （GP） Ib/Ⅸ/Ⅴ complex and its subunit GP Ibα in patients with hemorrhagic thrombopathy （HT）, the expressions of GP Ib/Ⅸ/Ⅴ complex and GP Ibα,defined as mean fluorescence intensity （MFI）, were assessed by flow cytometry. The maximum aggregation of platelet was determined by turbidity method. These indicators were compared among 68 HT patients with the presenting complaint of hemorrhage, 33 well-controlled HT patients and 32 normal healthy subjects. The results showed that the MFI of GP Ib/Ⅸ /Ⅴ complex and GP Ibα was markedly lower in HT patients with current hemorrhage than that in the healthy subjects, with difference being statistically significant （P〈0.05）. There was no significant difference in the expressions of GP Ib/ Ⅸ/ Ⅴ complex and GP Ibα between well-controlled HT patients and normal healthy subjects （P〉0.05）. It was concluded that the expression of GP Ib/Ⅸ /Ⅴ complex, the receptor of thrombin and von Willebrand factor, was down-regulated in HT patients with current hemorrhage, which might result in the dysfunction of platelet aggregation and recurrence of HT.