核因子-κB对血管紧张素Ⅱ诱导THP-1源性泡沫细胞ATP结合盒转运子A1表达的影响

目的:探讨核因子-κB(NF-κB)对血管紧张素Ⅱ(AngⅡ)诱导THP-1源性泡沫细胞ATP结合盒转运子A1(ABCA1)表达的影响及在胆固醇流出中的作用。方法:THP-1源性泡沫细胞分别给予10-5mol/LAngⅡ(AngⅡ组)、10μmol/LNF-κB特异性抑制剂TPCK预孵(TPCK组)。采用夹心酶联免疫分析法检测泡沫细胞内NF-κB的活化程度。通过透射电镜和荧光分光光度计、酶化学法,检测泡沫细胞内胆固醇含量的变化。利用闪烁计数法测量泡沫细胞内胆固醇流出率。用逆转录-聚合酶链反应法和免疫印迹法半定量分析泡沫细胞ABCA1的表达。结果:TPCK组NF-κB活化核易位则无明显高峰,维持在较低的水平。TPCK组泡沫细胞内胆固醇含量较AngⅡ组降低24.1%(P<0.05),胆固醇流出率较AngⅡ组显著升高41.1%(P<0.05),ABCA1mR-NA和蛋白表达较AngⅡ组升高30%和19%(P<0.05)。结论:AngⅡ可经NF-κB介导下调THP-1源性泡沫细胞ABCA1的表达,致泡沫细胞内胆固醇流出减少,增加泡沫细胞内胆固醇含量,加速动脉粥样硬化。     

黑龙江省县区级结核病定点医疗机构结核病诊断能力现况调查

目的:调查分析黑龙江省县区级结核病定点医疗机构结核病诊断服务能力情况,为全省结核病预防控制服务体系建设提供参考依据.方法:采用横断面调查方法,自拟调查问卷,于2020年8-10月对黑龙江省78家县区级结核病定点医疗机构进行调查,主要了解结核病临床诊疗、胸部影像检查、结核病实验室检测人力资源情况及结核病辅助检查开展情况....     

ST段抬高心肌梗死818例临床资料对比分析

目的：探究2006年与2014年我院收治ST段抬高心肌梗死患者一般资料、主要用药、住院期间不良心血管事件发生率的变化情况。方法：将我院2006年和2014年全部ST段抬高心肌梗死患者分为2006年组（n=96例）和2014年组（n =722例）,对2组临床资料进行回顾性分析并比较。结果：2014年组与2006年组相比,合并吸烟史、氯吡格雷、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂（ACEI/ARB）/螺内酯应用及急诊冠脉介入治疗比例升高,住院期间再发心绞痛、心源性死亡比率下降,阿司匹林、他汀类药物使用率及发病到就诊时间、住院天数无明显变化。结论：吸烟与急性心肌梗死发病率升高关系密切。患者对急性心肌梗死知识仍然缺乏,医生对RAAS抑制剂重视程度不够。     

急性心肌梗死并发心脏破裂的临床经验探讨

心脏破裂（cardiac rupture,CR）是急性心肌梗死（acute myocardial infarction,AMI）的一种并发症,病死率高。现将2008年10月～2011年2月在我院心脏监护病房住院期间发生心脏破裂的12例患者临床资料进行回顾性分析,为临床防治心脏破裂事件提供一定经验。     

肺炎衣原体通过上调酰基辅酶A:胆固醇酰基转移酶1诱导人单核细胞株THP-1源性泡沫细胞形成的实验研究

Objective To investigate the expression changes of acyl-coenzyme A: cholesterol acyhransferase 1 (ACAT1) on Chlamydia pneumoniae (C. pn) induced foam cell formation. Methods Human monocytic cell line (THP-1) was induced into macrophages by 160 nmol/L phorbol myristate acetate (PMA)for 48 h, and were randomly allocated into four groups: negative control group (50 μg/ml LDL for 48 h) ; positive control group (50 μg/ml ox-LDL for48 h) ; C. pn infection group (50 μg/ml LDL plus 1× 105,4×105,5×105and 1×106 IFU C.pn for 48 h or 1×106 IFU C.pn for 0,24,48 and 72h); ACAT inhibitor 58-035 plus C. pn infection group (1, 5, 10 μg/ml ACAT inhibitor 58-035 pretreatment for 1 h,50 μg/ml LDL and 1 × 106 IFU C. pn for 48 h). The mRNA and protein expressions of ACATI were determined by RT-PCR and Western blot, respectively. Lipid droplets in cytoplasm were observed by oil red 0 staining. The contents of intracellular cholesteryl esters were detected by enzyme-fluorescence. Results The mRNA and protein expressions of ACATI were significantly up-regulated in positive control cells compared those in negative control cells and further upregulated by C. pn infection in a time-dependent and concentration-dependent manner (all P ＜ 0.05). There were significantly increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol in positive control cells as compared with negative control cells and these were further aggravated by C. pn (at the concentrations of 5× 105 and 1×106IFU for 48 h) and C. pn infection induced increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol could he significantly attenuated by ACAT inhibitor 58-035 (all P ＜ 0.05). Conclusion Chlamydia pneumoniae induces THP-1-derived foam cell formation by up-regulating the expression of ACATI.     

颈动脉内中膜厚度结合血清MMP-9及APN预测冠状动脉斑块稳定性

目的 探讨颈动脉内-中膜厚度(CIMT)、血清脂联素(APN)、血清基质金属蛋白酶-9(MMP-9)诊断冠状动脉不稳定斑块的价值。方法 选取接受OCT检查的急性冠状动脉综合征(ACS)患者27例(ACS组),并选取同期来诊的急性胸闷、胸痛而冠状动脉造影阴性者30例为对照组。检测血清APN及MMP-9,并行颈动脉超声检查,并记录CIMT、APN、MMP-9和冠状动脉斑块纤维帽厚度;分析两组指标的差异及各指标之间的相关性,绘制ROC曲线评价各指标对薄纤维帽斑块的诊断价值。结果 ACS患者CIMT、MMP-9水平显著高于正常组(P<0.01),而APN水平显著低于正常组(P<0.01);冠状动脉斑块纤维帽厚度与CIMT及MMP-9呈负相关(r=-0.357,P<0.05;r=-0.477,P<0.01),与APN呈正相关(r=0.468,P<0.05);CIMT、MMP-9、APN联合检测诊断冠状动脉薄纤维帽斑块的ROC曲线下面积大于单个指标的曲线下面积(分别为:0.815、0.688、0.772、0.739)。结论 CIMT值及MMP-9水平升高、APN水平降低与冠状动脉斑块的稳定性密切相关,且三者联合对ACS更具诊断价值。     

2型糖尿病并冠心病患者vWF水平变化及其与冠脉病变程度、临床相关因素的关系

目的观察2型糖尿病合并冠心病患者中血管性血友病因子（vWF）的变化及其与冠脉病变程度、临床相关因素的关系。方法2型糖尿病患者582例,其中合并冠心病患者414例（DM-CHD组）、不合并冠心病患者168例（DM．NCHD组）,另选择100例非糖尿病非冠心病患者作为对照组。空腹取血测定3组血浆vWF、TC、LDL-C、HDL-C、TG、尿酸（uA）、糖化血红蛋白（HbA,C）、空腹血糖（FBG）、载脂蛋白A1（ApoAl）、载脂蛋白B（ApoB）;计算胰岛素抵抗指数（IRI）。记录DM．CHD组患者冠脉病变情况及Gensini积分;同时根据ACC／AHA冠脉病变分型建议,将患者冠脉病变分为A、B、C型并比较分析。结果DM．CHD组血浆vwF水平高于DM-NCHD组和对照组,P均〈0．05。DM-CHD组血浆vWF水平与冠脉病变支数、Gensini积分呈正相关（r值分别为0．611、0．635,P均〈0．05）;冠脉C型病变患者血浆vwF水平高于B型病变和A型病变（P均〈0．05）,且B型病变高于A型病变血浆vwF水平（P〈0．05）。DM-CHD组血浆vWF与糖尿病病程、FBG、HbA,c、IRI呈正相关（r值分别为0．541、0．508、0．616、0．796,P〈0．05）,其中与IRI的相关性最高（标准化回归系数0．976,P=0．023）。结论2型糖尿病合并冠心病患者vWF水平升高,且与冠状动脉病变程度、冠脉病变支数呈正相关,与糖尿病病程、FBG、HbA,c、IRI密切相关。vWF在2型糖尿病合并冠心病的发生和发展中具有重要作用,监测血浆vWF水平有助于糖尿病合并冠心病的诊断、判断病情及指导治疗。     

造影剂剂量与估计肾小球滤过率比值对高龄糖尿病患者造影剂肾病的诊断价值

目的探讨经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发病情况;评估造影剂剂量(CMV)与估计肾小球滤过率(eGFR)比值对高龄糖尿病患者造影剂肾病的诊断价值。 方法回顾性分析875例在济宁医学院附属医院心内科接受PCI患者的临床资料。采用SPSS19.0统计软件进行统计学分析,比较CIN组与非CIN组患者的各项资料,如性别、年龄、吸烟、是否低血压、左室射血分数(LVEF)、血红蛋白值、低密度脂蛋白(LDL-C)、空腹血糖、高血压和2型糖尿病病史;术前血肌酐(Scr)、eGFR;术后48hScr、eGFR。用Logistic回归分析CIN的危险因素。 结果入组患者CIN患病率4.80%(42例),男性、合并高血压病、2型糖尿病、高脂血症、吸烟、低血压、贫血、发病时心肌梗死合并休克的患病率分别为65.71%、54.86%、37.26%、22.51%、34.17%、16.80%、4.20%、8.91%。CIN与非CIN患者相比,在高龄患者(33.33%,19.33%,χ²＝4.902,P<0.05)、患有糖尿病(52.38%,36.49%,χ²＝4.317,P<0.05),吸烟(50.00%,33.37%,χ²＝4.914,P<0.05),发病时低血压(28.57%,16.21%,χ²＝4.374,P<0.05),心肌梗死伴休克(19.05%,8.40%,χ²＝5.579,P<0.05),低LVEF[(36.46±9.27)%,(43.62±3.46)%,t＝2.398,P<0.05]及造影剂用量大[(154.5±95.3)mL,(115.04±49.63)mL,t＝2.069,P<0.05]的患者更容易发生CIN;eGFR在CIN组明显降低[(72.50±15.06)mL/(min·1.73m²),(108.55±21.7)mL/(min·1.73m²),t＝7.220,P<0.05]。CMV/eGFR在CIN组与非CIN组间[(2.19±1.30),(1.01±0.40),t＝ －3.439,P<0.05]差异有统计学意义。多因素回归分析显示高龄(年龄≥70岁,RR＝5.27,P<0.05)、糖尿病(RR＝9.87,P<0.05)、LVEF(RR＝7.35,P<0.05)、术前eGFR(RR＝4.12,P<0.05)、心肌梗死合并休克(RR＝6.75,P<0.05)、CMV/eGFR(RR＝13.45,P<0.05)是CIN的危险因素。ROC工作曲线显示,CMV/eGFR>1.52对于高龄糖尿病患者是否发生CIN的敏感度为72.50%,特异度为84.00%。 结论PCI前评估患者的危险因素非常重要,高龄糖尿病更容易发生CIN;CMV/eGFR比值是一个独立的能够预测高龄糖尿病患者PCI后能否发生CIN的指标。     

肺炎衣原体通过上调酰基辅酶A:胆固醇酰基转移酶1诱导人单核细胞株THP-1源性泡沫细胞形成的实验研究

Objective To investigate the expression changes of acyl-coenzyme A: cholesterol acyhransferase 1 (ACAT1) on Chlamydia pneumoniae (C. pn) induced foam cell formation. Methods Human monocytic cell line (THP-1) was induced into macrophages by 160 nmol/L phorbol myristate acetate (PMA)for 48 h, and were randomly allocated into four groups: negative control group (50 μg/ml LDL for 48 h) ; positive control group (50 μg/ml ox-LDL for48 h) ; C. pn infection group (50 μg/ml LDL plus 1× 105,4×105,5×105and 1×106 IFU C.pn for 48 h or 1×106 IFU C.pn for 0,24,48 and 72h); ACAT inhibitor 58-035 plus C. pn infection group (1, 5, 10 μg/ml ACAT inhibitor 58-035 pretreatment for 1 h,50 μg/ml LDL and 1 × 106 IFU C. pn for 48 h). The mRNA and protein expressions of ACATI were determined by RT-PCR and Western blot, respectively. Lipid droplets in cytoplasm were observed by oil red 0 staining. The contents of intracellular cholesteryl esters were detected by enzyme-fluorescence. Results The mRNA and protein expressions of ACATI were significantly up-regulated in positive control cells compared those in negative control cells and further upregulated by C. pn infection in a time-dependent and concentration-dependent manner (all P ＜ 0.05). There were significantly increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol in positive control cells as compared with negative control cells and these were further aggravated by C. pn (at the concentrations of 5× 105 and 1×106IFU for 48 h) and C. pn infection induced increases in the accumulation of lipid droplets and the ratio of cholesteryl ester to total cholesterol could he significantly attenuated by ACAT inhibitor 58-035 (all P ＜ 0.05). Conclusion Chlamydia pneumoniae induces THP-1-derived foam cell formation by up-regulating the expression of ACATI.