ω-3多不饱和脂肪酸对急性肺损伤炎症反应及免疫功能影响的机制研究进展

烧(创)伤、吸入性损伤、严重感染以及休克等疾病过程中,机体内多种炎性介质的释放,引发炎性细胞向肺组织迁移,激活呈级联放大的炎症反应,常常可造成以肺毛细血管内皮细胞和肺泡上皮细胞损伤为主的急性肺损伤(ALI),严重者短时间内可迅速发展为急性呼吸窘迫综合征(ARDS),病死率极高。ω-3多不饱和脂肪酸(ω-3PUFA)作为药理性免疫营养素的重要组成部分,目前已经超越了以往单纯提供能量、恢复正氮平衡的范畴,发挥着调控机体炎症反应、免疫功能的全面作用,并逐渐演变为现代危重性肺损伤治疗的重要组成部分。因此,本文就ω-3PUFA对ALI炎症反应及免疫功能影响的机制作一综述,旨在为临床治疗ALI提供理论依据。     

烧伤及合并吸入性损伤病人的肺功能检测

目的：探讨烧伤病人肺功能变化。方法：采用肺量计测量中等面积烧伤、大面积烧伤和烧伤合并吸入性损伤病人的肺功能。结果：1．中等面积、大面积及体表烧伤合并吸入性损伤病人FVC、FEV1．0、FEF75％降低，伤后50h降至最低值。2．中等面积烧伤组烧后10天FVC、FEV1．0、FEF50％、FEF75％有所回升，伤后30天恢复正常。3、大面积烧伤和体表烧伤合并吸入性损伤组伤后50h和伤后10天，均明显降低，伤后30天有所升高，但仍未达正常范围。4．合并吸入性损伤组的各时点肺功能参数下降较大面积烧伤组更为明显。结论：三组病人肺功能均有降低，随烧伤面积增大，降低更明显，体表烧伤合并吸入性损伤降低最为严重，微量肺量计检测对监护烧伤病人，尤其是合并有吸入性损伤的病人具有一定临床意义。     

高频部分液体通气对吸入性损伤犬呼吸功的影响

目的　观察高频喷射通气结合小剂量氟碳 (3ml/kg)液体通气对吸入性损伤犬呼吸的功影响。方法　将 16条犬经蒸气吸入造成吸入性损伤模型 ,并随机分为两组 ,即对照组和治疗组。两组动物致伤后均行高频喷射通气 ,但治疗组动物同时经气管导管将氟碳液体 (3ml/kg)缓慢注入肺内 ,在 90min内测机械通气功 (WOBvent)。结果　治疗组在给予小剂量氟碳后的WOBvent与致伤后比较差异无显著意义 (P >0 0 5 ) ,对照组治疗后的WOBvent与致伤后比较差异亦无显著意义 (P >0 0 5 ) ,治疗组与对照组各时间点的WOBvent比较差异均无显著意义 (P >0 0 5 )。结论　高频喷射通气合并小剂量氟碳 (3ml/kg)部分液体通气并不增加动物的呼吸功。     

c-Met癌基因在胃癌中的角色探讨

胃癌是世界范围内高发的恶性肿瘤．正常胃黏膜在外源及内源性致病因素共同作用下发生恶变，而肿瘤的发生、发展、浸润、转移对人类身心健康造成严重影响。蛋白酪氨酸激酶（protein tyrosine kinase，PTK）是一类备受关注的效应蛋白，研究发现PTK参与了人类多种肿瘤的发生及发展过程，部分能作为肿瘤预后评估指标。c-Met癌基因编码的蛋白产物属于受体型蛋白酪氨酸激酶家族，我们尝试回顾其在人类胃腺癌中相关研究，分析Met蛋白酪氨酸激酶在胃癌发生、发展中所扮演的角色及对临床治疗的意义。     

人骨髓间充质干细胞的分离培养鉴定及BrdU标记的实验研究

背景：骨髓间充质干细胞具有多向分化能力,是目前极具潜力的细胞及基因治疗的靶细胞。 目的：拟在体外建立一种分离纯化、培养扩增、标记骨髓间充质干细胞的方法。 设计、时间和地点：开放性实验,于2008-03/05在南昌大学第一附属医院烧伤研究所完成。 材料：人骨髓间充质干细胞取自临床骨髓穿刺检查正常的住院患者,无血液系统疾病和家族遗传病史,由南昌大学第一附属医院提供。 方法：密度梯度离心和贴壁培养相结合,分离纯化骨髓间充质干细胞,并用BrdU标记。 主要观察指标：相差显微镜下观察人骨髓间充质干细胞的形态变化;流式细胞仪检测人骨髓间充质干细胞的表面标记以及细胞周期;绘制人骨髓间充质干细胞生长曲线;透射电镜观察人骨髓间充质干细胞的超微结构。 结果：密度梯度离心结合贴壁法能分离培养出纯度较高的人骨髓间充质干细胞。流式细胞仪检测人骨髓间充质干细胞CD90,CD29,CD44,CD34,CD45阳性细胞表达分别为98.48%,98.74%,97.41%,0.36%,0.64%。人骨髓间充质干细胞的生长曲线呈S形。透射电镜可见人骨髓间充质干细胞胞质丰富,粗面内质网发达,大量蛋白分泌物。免疫组织化学检测BrdU标记48 h后人骨髓间充质干细胞标记率> 80%。 结论：采用淋巴细胞分离液密度梯度离心和贴壁培养相结合,以获得纯度较高和活性骨髓间充质干细胞,是简便可行的方法;BrdU是一种简单、有效的标记骨髓间充质干细胞的方法。     

早期药膳饮食对烫伤大鼠肠黏膜Peyer’s结T淋巴细胞及亚群的影响

背景：肠相关淋巴组织的组成部分Peyer’s 结是肠黏膜免疫系统的重要诱导部位,含有参与免疫应答的各种免疫细胞,如CD4 +T 细胞、CD8 +T细胞、B细胞等。 目的：观察早期药膳饮食对烫伤大鼠肠道肠黏膜Peyer’s结T淋巴细胞及其亚群的影响。 设计、时间及地点：随机对照动物实验,于2006-04/2007-03在南昌大学一附属医院完成。 材料：Wistar大鼠100只,随机分成药膳喂养组(n=30)、肉汤喂养组(n=30)、常规喂养组(n=30)、正常对照组(n=10)。药膳成分：党参20 g、白术25 g、茯苓25 g、炙甘草15 g、黄芪20 g、薏苡仁20 g、瘦猪肉200 g。 方法：药膳喂养组、肉汤喂养组、常规喂养组实施背部30%体表面积Ⅲ度烫伤,伤后早期分别给予药膳、肉汤和生理盐水,2 mL/次,2次/d。正常对照组实施37 ℃假伤。 主要观察指标：伤后3,7,14 d检测大鼠肠黏膜Peyer’s结T淋巴细胞及亚群。 结果：伤后3,7 d,药膳喂养组、肉汤喂养组、常规喂养组Peyer’s结淋巴细胞总数、CD3+淋巴细胞的百分比及总数、CD4+百分比及总数、CD8+细胞的百分比及总数较正常对照组明显减少 (P < 0.05,P < 0.01),至14 d,药膳喂养组与正常对照组相比差异不显著。伤后3,7,14 d药膳喂养组CD3+淋巴细胞的百分比及总数、CD4+百分比及总数较肉汤喂养组、常规喂养组明显升高(P < 0.05)。伤后3,7 d药膳喂养组Peyer’s结CD8+细胞的百分比及总数较肉汤喂养组、常规喂养组明显下降(P < 0.05)。 结论：早期药膳饮食有利于肠道Peyer’s结淋巴细胞的增生,并改善Peyer’s结T淋巴细胞亚群的比例,从而改善烫伤大鼠肠道免疫功能。     

烧伤休克期患者尿量变化对血乳酸的影响

收治的大面积烧伤患者66例,按休克期平均每小时尿量进行分组,分成高尿量组及低尿量组,将两组烧伤休克期补液治疗后不同时间点的血乳酸值进行比较。大面积烧伤患者伤后均出现血乳酸值升高,高尿量组在液体复苏6、24、48h各时点的血乳酸值均低于低尿量组,有显著性差异(P0.05)。两组经抗休克治疗48h后,血乳酸值均低于入院时基础血乳酸值(P0.05)。烧伤休克期高尿量组血乳酸值低于低尿量组,补液后高尿量组更有利于血乳酸清除。     

人血管内皮生长因子165基因转染人骨髓间充质干细胞的实验研究

Objective To establish an effective method of transfecting human marrow mesenchymal stem cells (MSC) with human vascular endothelial growth factor 165 ( VEGF 165) gene. Methods MSCs isolated and cultured in vitro were divided into transfection group (pShuttle-CMV/VEGF 165 plasmid was transfected into MSCs through liposome-mediating method), empty plasmid group (pShuttle-CMV vehi-cle was transfected into MSCs as control), liposome group (liposome was transfected into MSCs as control) and control group(normal culture). Expressions of Mrna and protein of MSCs were determined by RT-PCR, enzyme-linked immunosorbent assay and Western Blot. Sensitivity to MSCs on VEGF plasmid transfec-tion was detected by MTT test. Results Expression level of VEGF 165 gene Mrna in transfection group, empty plasmid group, liposome group, and control group was respectively 0.89 ± 0.03, 0. 34 ± 0.04, 0.40 ± 0.03, and 0.30 ± 0.03, and the difference between transfection group and the other three groups was statistically significant ( P <0. 01 ). Content of VEGF protein in transfection group, empty plasmid group, liposome group, and control group was respectively (778 ± 35 ), (543 ± 24), (561 ± 28), (571 ± 23) pg/Ml, and the difference between transfection group and the other three groups was statistically significant ( P <0.01 ). In the transfection group, expression level of VEGF protein peaked on 7th day after transfec-tion, which was decreased gradually later. In transfection group, expression level of V EGF 165 protein was obviously higher than that of the other three groups ( P <0. 01 ), and no inhibitory effect of VEGF plasmid transfection on MSCs proliferation was found. Conclusions The method for transfecting human VEGF 165 gene into MSCs is established in this research, through which target gene and protein can express effectively.     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.