脑梗死患者外周血CD34+细胞水平和预后价值

Objective To detect the alteration of circulating CD34 + cell level in patients with the In'st-ever nonlacunar stroke and to investigate the prognostic value of CD34 +cell level. Methods 1he level of the circulating CD34+ cells were examined using flow eytometry in 119 patients with nonlacunar infarction. 1he patients were divided into group A (higher than average) and group B (lower than average) according to the detected values, The National Institutes of Health Stroke Scale (NIHSS) scores on admission and the modified Rankin Scale (mRS) scores at 3 months after the onset in the two groups wre compared. Results The level of CD34 + cells in group A was significantly higher than that in group B (0. 048 ± 0. 001 versus 0. 032 ± 0. 002, P < 0. 05 ), however, there was no significantly difference in NIHSS sores between the two groups. One week after admission, the increased level of CD34 + cells in group A was significantly higher than that in group B (0. 001 ±0. 003 versus - 0. 005 ± 0. 000, P < 0. 05 ). Three months after the onset of symptoms, the average mRS score in group A was significantly superior to that in group B (2. 98 ± 1.14 versus 3.25 ± 1.39, P <0. 05). 1he level of circulating CD34 + cells at the initial onset of symptom was negatively correlated with the mRS score at 3 months after stroke (r = -0. 48, P <0. 05). Conclusions The higher level of circulating CD34+ cells had better prognosis in patients with cerebral infarction. The level of circulating CD34+ ceils may be used as a prognostic indicator in patients with cerebral infarction.     

脑梗死患者外周血CD34+细胞水平和预后价值

Objective To detect the alteration of circulating CD34 + cell level in patients with the In'st-ever nonlacunar stroke and to investigate the prognostic value of CD34 +cell level. Methods 1he level of the circulating CD34+ cells were examined using flow eytometry in 119 patients with nonlacunar infarction. 1he patients were divided into group A (higher than average) and group B (lower than average) according to the detected values, The National Institutes of Health Stroke Scale (NIHSS) scores on admission and the modified Rankin Scale (mRS) scores at 3 months after the onset in the two groups wre compared. Results The level of CD34 + cells in group A was significantly higher than that in group B (0. 048 ± 0. 001 versus 0. 032 ± 0. 002, P < 0. 05 ), however, there was no significantly difference in NIHSS sores between the two groups. One week after admission, the increased level of CD34 + cells in group A was significantly higher than that in group B (0. 001 ±0. 003 versus - 0. 005 ± 0. 000, P < 0. 05 ). Three months after the onset of symptoms, the average mRS score in group A was significantly superior to that in group B (2. 98 ± 1.14 versus 3.25 ± 1.39, P <0. 05). 1he level of circulating CD34 + cells at the initial onset of symptom was negatively correlated with the mRS score at 3 months after stroke (r = -0. 48, P <0. 05). Conclusions The higher level of circulating CD34+ cells had better prognosis in patients with cerebral infarction. The level of circulating CD34+ ceils may be used as a prognostic indicator in patients with cerebral infarction.     

内皮祖细胞移植治疗缺血性脑血管病

一些实验研究表明，内皮祖细胞（EPC）在脑梗死后血管新生中起重要作用。EPC移植有可能为缺血性脑血管病的治疗提供一种全新的治疗策略。文章阐述了新血管形成和EPC与脑缺血的关系，并探讨了EPC移植治疗脑缺血的影响因素和应用前景。     

中国人群脂联素＋45位点基因单核苷酸多态性与缺血性脑卒中易感性的Meta分析

目的 通过Meta分析评估中国人脂联素基因＋45T＞G单核苷酸多态性（SNP）与缺血性脑卒中易感性的关系.方法 计算机检索Pubmed、Cochrane、中国期刊全文数据库（CNKI）及万方数据库中关于中国人群脂联素基因＋ 45T＞G SNP与缺血性脑卒中的相关性研究,对符合纳入标准的文献采用Rev Man5.2软件进行分析.结果 共纳入6篇文献,1604例患者.分析显示如下遗传模型中的差异明显,即等位基因模型（G VS.T）：OR=1.34,95％CI（1.04,2.72）;共显性模型（GG VS.TT）：OR=1.71,95％CI （1.27,2.30）;隐性模型（GG VS.F＋ TT）：OR=1.82,95％ CI（1.18,2.82）;显性模型（TG＋ GGVS.TT）：OR=1.22,95％CI （1.05,1.42）.结论 中国人群脂联素基因＋45T＞G SNP与缺血性脑卒中易感性相关,G等位基因可能为缺血性脑卒中的危险因素.     

PAI-1、u-PA、VEGF、CD34在动脉粥样硬化鼠急性脑缺血中的表达及意义

目的:探讨PAI-1、u-PA、VEGF、CD34在动脉粥样硬化大鼠急性脑缺血中的表达及意义。方法:将大鼠随机分成正常饮食组(A组)和高脂饮食组(B组),分别制备大鼠局灶性大脑中动脉栓塞/再灌注(MCAO/R)模型;观察大鼠神经病学评分,HE染色法检测脑缺血区病理改变,免疫组化法检测缺血区PAI-1、u-PA、VEGF、CD34表达,并应用流式细胞仪计数外周血CD34+血管内皮祖细胞(EPC)。结果:脑缺血后再灌注24h,PAI-1、u-PA、VEGF的表达增高,B组PAI-1、VEGF表达较A组明显,u-PA相反;再灌注48h后,外周血CD34+EPC计数B组(0.89%)较A组(1.11%)降低(P<0.05),脑缺血区CD34+细胞B组也少于A组。结论:PAI-1、u-PA及VEGF高表达促进了动脉粥样硬化的形成并加重急性脑缺血/再灌注损伤,CD34+低表达及EPC减少使血管再生能力降低。     

化瘀导滞汤防治庆大霉素所致大鼠肾损伤的实验研究

目的:探讨化瘀导滞汤防治庆大霉素所致肾毒性损伤的作用和部分机理。方法:18只健康雄性W ister大鼠随机分为3组,每组6只:正常组、模型组、治疗组。给予庆大霉素造成肾毒性损伤,于造模后5天取材,光镜和电镜下观察肾组织形态学改变,计算肾系数、检测血肌酐、血尿素氮、24h尿蛋白总量,氧化应激相关指标SOD、MDA、NOS的变化,检测NF-кB蛋白表达水平。结果:模型组大鼠与正常组比较:光镜下可见肾小管上皮细胞以变性为主,部分坏死;有较多的蛋白管型和少量的细胞管型、颗粒管型。电镜下可见肾小管上皮细胞胞浆中有大量脂滴存在,细胞的线粒体肿胀、内质网明显扩张,治疗组病变轻于模型组。模型组肾系数、血肌酐、血尿素氮、24h尿蛋白总量、NF-кB蛋白表达水平以及MDA、NOS明显高于正常组,SOD明显低于正常组(P<0.01),治疗组除24h尿蛋白总量外,其余指标与模型组相比有明显改善(P<0.01)。结论:化瘀导滞汤有良好的防治庆大霉素所致肾毒性损伤的作用,并提示与早期抗脂质过氧化损伤有关。     

胆红素对脑缺血再灌注大鼠半暗带区神经保护作用实验研究

目的探讨胆红素对脑缺血再灌注大鼠半暗带区神经保护作用及其潜在机制。方法 48只SD大鼠随机分为假手术组、胆红素干预组和生理盐水对照组各16只。假手术组大鼠仅分离血管,不结扎不插入线栓;胆红素干预组和对照组采用线栓法制作大鼠大脑中动脉缺血再灌注模型,再灌注2h后,胆红素干预组经腹腔注入2 mmol/L胆红素2.5mL,对照组经腹腔注入2.5mL生理盐水。再灌注24h后,各组采用TNUEL检测缺血半暗带区域细胞凋亡率,采用Western blot检测缺血半暗带区组织凋亡相关蛋白Bcl-2、Bax和caspase-3含量,采用ELISA法检测缺血半暗带区域氧化应激分子超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、谷胱甘肽(glutathione,GSH)和8-羟脱氧鸟苷(8-hydroxydeoxyguanosine,8-OHdG)含量。结果再灌注24h后,胆红素干预组和对照组半暗带区细胞凋亡率[(27.8±2.6)%、(47.8±7.0)%]、半暗带组织Bcl-2相对灰度值(1.9±0.3、1.4±0.3)、Bax相对灰度值(2.0±0.1、2.8±0.2)、caspase-3相对灰度值(1.9±0.2、3.0±0.1)、MDA[(4.9±0.3)、(11.3±0.2)μmol/g]和8-OHdG[(3.5±0.1)、(5.3±0.2)μg/L]水平明显高于假手术组[(4.7±2.5)%、0.8±0.3、1.2±0.1、1.2±0.1、(2.7±0.2)μmol/g、(2.1±0.1)μg/L](P0.05),SOD和GSH水平明显低于假手术组;胆红素干预组细胞凋亡率、Bax、caspase-3、MDA和8-OHdG水平明显低于对照组,Bcl-2、SOD和GSH水平明显高于对照组(P0.05)。结论胆红素可降低缺血半暗带区域细胞凋亡率,其机制可能与上调Bcl-2、下调Bax和caspase-3表达,并提高脑组织抗氧化应激能力相关。     

西酞普兰促进血管发生对脑缺血再灌注大鼠的神经保护作用

目的 探讨西酞普兰对局灶性脑缺血再灌注大鼠的神经保护作用及其可能机制.方法 75只雄性Sprague-Dawley大鼠随机分为假手术组、生理盐水对照组和西酞普兰干预组,每组25只.线栓法制作大鼠局灶性脑缺血再灌注模型.改良神经功能缺损量表评价大鼠神经功能缺损(每组5只).激光共聚焦技术观察缺血区微血管直径、密度和总面积(每组5只).酶联免疫吸附法检测血浆血管内皮生长因子(vascular endothelial growth factor,VEGF)浓度(每组5只).免疫组织化学染色法(每组5只)和蛋白质印迹法(每组5只)检测缺血脑组织VEGF表达.结果 模型制作后14 d时,西酞普兰干预组神经功能缺损较生理盐水对照组显著改善[(4.39±0.92)分对(6.57±1.13)分,P=0.015].三维共聚焦血管成像显示,西酞普兰干预组毛细血管直径显著性小于生理盐水对照组[(2.93±0.19)μm对(3.56±0.22)μm; P=0.000];血管密度显著性高于生理盐水对照组[(232.68±12.54)个/0.002 mm3对(176.26±10.87)个/0.002 mm3;P=0.000];微血管总面积显著性大于生理盐水对照组[(89 154±3 298) μm2/0.002 mm3对(75 368.14±3 519) μm2/0.002 mm3;P=0.000].酶联免疫吸附法显示,西酞普兰干预组血浆VEGF浓度显著性高于生理盐水对照组[(50.35±5.44) pg/ml对(13.75±4.12) pg/ml;P=0.000].免疫组织化学分析显示,西酞普兰干预组缺血区VEGF表达显著性高于生理盐水对照组(P =0.000).蛋白质印迹法显示,西酞普兰干预组缺血脑组织VEGF表达显著性高于生理盐水对照组[(0.94±0.18)对(0.62±0.22);P=0.006].结论 西酞普兰可显著减轻脑缺血再灌注大鼠的神经功能缺损,其机制可能与VEGF介导的血管发生有关.     

α-平滑肌肌动蛋白和E-钙依赖性黏附素在肾间质纤维化大鼠肾组织中的表达

目的： 检测单侧输尿管梗阻(UUO)所致大鼠肾间质纤维化模型肾组织中α-平滑肌肌动蛋白(α-SMA)和E-钙依赖性黏附素(E-Cad)表达的动态变化,并观察比较在肾小管间质纤维化不同阶段的病理变化。方法:采用 54只雄性健康SD大鼠随机分为正常组、假手术组和模型组,模型组行左侧输尿管结扎术,正常组21 d处死6 只动物,假手术组和UUO组分别于术后 3、7、14、21 d 各处死6只动物,共48只,取肾组织常规行HE染色、六胺银染色光镜下观察,取肾皮质电镜下观察病变情况。采用蛋白印迹法检测肾组织α-SMA、E-Cad 蛋白表达。结果: (1)随着造模时间的延长,肾小管间质纤维化逐渐加重,UUO术后21 d的肾小管扩张与萎缩均明显,肾间质有大量的纤维化组织出现。(2)与假手术组相比,模型组肾组织α-SMA于术后第3 d 即表达增加,并随梗阻时间延长表达逐渐增加,至UUO术后21 d达高峰。21 d模型组与假手术组比较,有显著差异(P<0.01)。(3)而E-Cad 蛋白于术后第3 d 即表达降低,并随梗阻时间延长逐渐降低。 结论: 在UUO阻塞性肾病中,α-SMA蛋白表达呈时间依赖性上调,而E-Cad 蛋白表达呈时间依赖性下调,提示在阻塞性肾病中,肌纤维母细胞的活化是一个动态的过程,可能与肾小管上皮细胞转分化有关。     

严重脑白质疏松症相关因素的病例对照研究

目的探讨严重脑白质疏松症的相关因素。方法按照筛选标准连续收集2015年4月-2016年2月武汉大学中南医院神经内科住院患者,通过头部核磁共振评估脑白质疏松症Fazekas评分并收集相关临床资料,并应用非条件Logistic回归来分析严重脑白质疏松症的相关因素。结果共纳入608例患者,包括Fazekas评分为0的对照组415例和Fazekas评分为3~6的病例组193例。多因素Logistic回归结果提示:高龄(G3 vs G1:OR10.81,95%CI 2.76~42.38,P=0.001;G4 vs G1:OR 28.40,95%CI 7.02~114.95,P0.05;G5 vs G1:OR 68.79,95%CI 14.22~332.92,P0.05)、脑动脉粥样硬化(OR 1.98,95%CI 1.07~3.65,P=0.029)和高血压病(OR=4.84,95%CI=2.65~8.85,P0.05)与严重脑白质疏松症之间呈显著正相关。结论高龄、脑动脉粥样硬化和高血压病可能是严重脑白质疏松症的独立危险因素。