ApoE-/-小鼠肾动脉粥样硬化斑块破裂的肾损害

目的 探讨ApoE^-/-小鼠肾动脉粥样硬化斑块破裂对下游肾脏的损伤机制。 方法 采用ApoE^-/-小鼠建立粥样硬化性肾动脉狭窄(ARAS)动物模型。选择肾动脉狭窄程度 <50％的ApoE^-/-小鼠，按斑块分为破裂组和未破裂组；选择同条件喂养的C57BL/6J 野生型小鼠为对照组。常规检测Scr及尿 N-乙酰-β-氨基葡萄糖苷酶(NAG)活性；Western印迹检测细胞核中核转录因子κBp65（NF-κBp65）、细胞间黏附分子1（ICAM-1）及P-选择素（P-sel）表达； RT-PCR检测白细胞介素6 （IL-6）mRNA表达；免疫组化染色检测巨噬细胞浸润情况。 结果破裂组Scr和尿NAG活性明显升高（均P < 0.01）；肾组织出现病理改变，肾间质中巨噬细胞浸润增加（P < 0.05）；细胞核中NF-κBp65表达增加（P < 0.05）；ICAM-1、P-sel、IL-6 mRNA表达增加（P < 0.05）。未破裂组上述指标与对照组比较，差异无统计学意义（P > 0.05）；肾脏未见明显病理改变。 结论 肾动脉粥样硬化斑块破裂可引起肾脏病理改变和肾功能受损；在粥样硬化性肾动脉狭窄的肾损害机制中，炎性反应是重要因素之一。     

Human Herpesvirus 6 in Bronchalveolar Lavage Fluid after Lung Transplantation: A Risk Factor for Bronchiolitis Obliterans Syndrome?

Bronchiolitis obliterans syndrome (BOS) is the limiting factor to long-term survival after lung transplantation. Previous studies suggested respiratory viral tract infections are associated with the development of BOS. To identify the impact of virus detection in bronchoalveolar lavage (BAL) fluid, we analyzed BAL samples from 87 consecutive lung transplant recipients for human herpesvirus (HHV)-6, Epstein-Barr virus, Herpes simplex virus 1/2, Cytomegalovirus, respiratory syncytical virus and adenovirus by PCR. Acute rejection, BOS and death were recorded for a mean follow-up time of 3.27 +/- 0.47 years. Results of PCR analysis and other potential risk factors were entered into a Cox regression analysis of BOS predictors and death. Only acute rejection was a distinct risk factor for BOS of all stages, death and death from BOS. HHV-6 was detected in 20 patients. Univariate and multivariate analysis revealed that HHV-6 was associated with an increased risk to develop BOS > orb = stage 1 and death, separate from the risk attributable to acute rejection. Identification of HHV-6 DNA in BAL fluid is a potential risk factor for BOS. Our results warrant further studies to elucidate a possible causal link between HHV-6 and BOS.     

Minimal Acute Rejection after Lung Transplantation: A Risk for Bronchiolitis Obliterans Syndrome

Bronchiolitis obliterans syndrome (BOS) is a major cause of lung allograft dysfunction. Although previous studies have identified mild to severe rejection (grade>or=A2) as a risk factor for BOS, the role of minimal rejection (grade A1) remains unclear. To determine if A1 rejection by itself is a risk factor for BOS, we performed a retrospective cohort study on 228 adult lung transplant recipients over a 7-year period. Cohorts were defined by their most severe rejection episode (none, A1 only, and >or=A2) and analyzed for the subsequent development and progression of BOS using univariate and multivariate time-dependent Cox regression analysis. In the univariate model, the occurrence of isolated minimal rejection was a risk factor for all stages of BOS. Similarly, multivariate models that included HLA mismatch, cytomegalovirus pneumonitis, community acquired viral infection, underlying disease and type of transplant demonstrated that A1 rejection was a distinct risk factor for BOS. Furthermore, the associated risk with A1 rejection was slightly greater than the risk from >or=A2 and treatment of A1 rejection decreased the risk for subsequent BOS stage 1. We conclude that minimal rejection is associated with an increased risk for BOS development and progression that is comparable to A2 rejection.     

Parainfluenza Virus Infection in Adult Lung Transplant Recipients: An Emergent Clinical Syndrome with Implications on Allograft Function

Parainfluenza virus is a common cause of seasonal upper respiratory tract infections in children and adults. Studies indicate that parainfluenza virus may play an important role in the etiology of respiratory tract infections in lung transplant recipients with an estimated incidence of 5.3 per 100 patients. Parainfluenza virus type 3 is the most frequent serotype in lung transplant patients. The rate of lower respiratory tract infections with parainfluenza virus among lung transplant recipients is between 10 and 66% of cases. In addition, trans-bronchial biopsy at the time of parainfluenza infection shows signs of acute allograft rejection. Subsequently, 32% of patients have been found to have active bronchiolitis obliterans at a median time of 6 months (range 1-14) postviral infection. These findings indicate that parainfluenza virus infections may have long-term implications for lung transplant recipients. Further studies are required to identify the mechanisms of immunomodulation of parainfluenza virus among these patients. In addition, controlled studies are needed to evaluate the efficacy of aerosolized ribavarin in the treatment of parainfluenza virus infection and to determine whether vaccines may be effective in these high-risk patients.     

负压疗法治疗肢体缺血

目的：评价负压疗法对肢体缺血的治疗效果，方法：１９８５－０７￣１９９５－０３，我们应用自行研制的治疗机，对１６７例（２３１个肢体）肢体缺血患者进行了负压治疗，其中动脉硬化性闭塞症６２例（９１肢），血栓闭塞性脉管炎７５例（９３肢），雷诺综合征３０例（４７肢），治疗时将患肢置入密闭舱内，压力范围为－８．６６ｋＰａ￣－１７．３ｋＰａ，一般上肢为－１０．７ｋＰａ，下肢为－１３．３ｋＰａ。结果：显效１１７肢     

Intermediate filament expression in human vascular smooth muscle and in arteriosclerotic plaques

Summary Different regions of human aorta and of other human arteries obtained at autopsy were analyzed with regard to their topography and to the different stages of arteriosclerosis. Material was studied by immunocytochemical techniques with antibodies specific for either desmin (D) or for vimentin (V), the two types of intermediate filament proteins present in vascular smooth muscle cells. In normal arteries endothelial cells as well as the adjacent intimal cells were D–V+. In the media D+V+ as well as D–V+ cells were present, with the relative numbers of each cell type dependent on the particular blood vessel. When cells in arteriosclerotic plaques at different stages of development were examined an occasional plaque showed cells of the D+V+ type. In the majority of plaques however the cells were V– D+. In plaques where severe ulceration and necrotic material was present D–V+ cells were found at the border of the lesion: foam cells when they could be identified appeared to be D–V+.     

Isolation and radiation hybrid mapping of dinucleotide repeat polymorphism at the human matrix Gla protein (MGP) locus

Matrix Gla protein (MGP) is an 84-residue, vitamin K-dependent protein expressed by chondrocytes and vascular smooth muscle cells, and is a potent regulator of calcium deposition in cartilage and arterial wall. We isolated a polymorphic dinucleotide CA repeat marker from a genomic clone containing the human MGP gene. This polymorphism will be useful in genetic studies of arteriosclerosis and osteoporosis. Received: November 5, 1997 / Accepted November 27, 1997     

肺炎衣原体对血管内皮细胞的感染及其对ICAM-1表达的影响

目的:观察肺炎衣原体对人脐静脉内皮细胞(HUVECs)的感染及其对细胞分泌和表达细胞间粘附分子1(ICAM-1)的影响,探讨C.pneumoniae感染在动脉粥样硬化形成中的作用及其可能机制。方法:用人喉表皮癌(HEP-2)细胞培养C.pneumoniae,以C.pneumoniae感染HUVE细胞,经透射电镜及PCR检测有无感染。用流式细胞仪检测感染前后HUVE细胞表面ICAM-1蛋白的表达的变化,用荧光定量RT-PCR检测ICAM-1mRNA的变化。结果:C.pneumoniae能感染体外培养的HUVE细胞;感染后12h,细胞表面ICAM-1蛋白的表达即增加,其峰值约在感染后24h;荧光定量RT-PCR结果显示其增加在mRNA水平。结论:C.pneumoniae能感染体外培养的人脐静脉内皮细胞并增加ICAM-1的表达,提示C.pneumoniae感染可能是动脉粥样硬化的始动因子之一,其致动脉粥样硬化机制可能与感染后血管内皮细胞粘附分子表达的增加有关。     

氧化修饰低密度脂蛋白可诱导人单核细胞源树突状细胞形成泡沫细胞

目的： 探讨氧化修饰低密度脂蛋白（ox-LDL）对人单核细胞源树突状细胞（DC）功能的影响。 方法： 采用免疫磁珠法分离人外周血CD14+单核细胞，经含rhGM-CSF（100 μg/L）和rhIL-4（20 μg/L）的Cellgro培养，使其分化为DC。DC与100 mg/L天然的或氧化修饰的LDL孵育72 h后，采用透射电镜和尼罗红染色观察细胞内脂质沉积，流式细胞术检测DC表型（CD1a，CD40，CD86，HLA-DR），混合T淋巴细胞反应检测DC对淋巴细胞增殖的影响，FITC-dextran检测DC吞噬功能，ELISA检测细胞培养上清Th1/Th2 (IL-12/IL-2)细胞因子的浓度。 结果： ox-LDL可诱导DC形成泡沫细胞，而天然的LDL无此作用。经ox-LDL处理的DC吞噬作用明显弱于天然的LDL，而对T细胞增殖作用却明显强于天然的LDL；可明显上调CD80(72.4±9.6 vs 89.5±10.1, P<0.01), CD86(67.2±8.8 vs 80.2±11.6, P＜0.01), HLA-DR(80.6±9.8 vs 86.6±10.8, P<0.01) 和CD1a(40.2±10.3 vs 60.2±9.3, P<0.01)的表达，明显促进DC细胞因子IL-12［(44.3±8.9)ng/L vs (65.1±10.4)ng/L, P<0.05］的分泌，但却降低IL-2［(43.6±7.8）ng/L vs （10.0±4.5）ng/L, P<0.01］。 结论： DC可通过摄取ox-LDL形成泡沫细胞，而后者与成熟DC的功能相似，说明DC可能是泡沫细胞新的来源，在动脉粥样硬化免疫病理发生中具有重要的作用。     

苦瓜抗兔动脉粥样硬化实验研究

目的：在证实苦瓜蛋白有抗炎、抗氧化作用的基础上，在兔动脉粥样硬化AS模型上，研究苦瓜是否有抗动脉粥样硬化作用。方法：新西兰兔分为3组，即正常组（正常兔饲料），AS模型组（正常兔饲料中含2％的胆固醇），苦瓜组（正常兔饲料中含2％的胆固醇和1.5％的苦瓜果肉）。90 d后处死动物，测定血脂及动脉壁总胆固醇含量，观察脂肪肝、主动脉粥样病变，综合评价苦瓜的抗动脉粥样硬化作用。结果：苦瓜组血清总胆固醇、LDL-C、血管壁总胆固醇均显著低于AS模型组，但TG水平与AS模型组差异不明显；苦瓜组HDL-C水平显著低于正常组；苦瓜组粥样病变面积、内膜厚度、I/M比值及脂肪肝程度均显著低于AS模型组。结论：苦瓜果肉有一定抗动脉粥样硬化作用。