海水淹溺性肺损伤中肺水肿发生机制的研究进展

海水淹溺后,除少数因喉头、气管反射性痉挛引起急性窒息外,导致死亡的主要原因是海水淹溺性肺水肿.海水淹溺性肺水肿的发生机制有海水高渗性的损伤作用、肺泡中液体吸收障碍、炎症介质以及活性氧物质的影响、神经体液因素影响等.     

80岁以上老年男性患者103例胸腔积液临床分析

目的探讨80岁以上老年男性患者胸腔积液的病因、诊断、鉴别诊断及治疗特点。方法对我科收治的资料完整的103例胸腔积液患者的临床资料进行分析。结果103例患者中良性胸腔积液72例,其中主要因肺部感染引起的胸腔积液35例,由心功能衰竭引起的胸腔积液10例,肺部感染合并心衰或肾功能不全等原因导致的胸腔积液17例,肝硬化、慢性肾功能不全引起的胸腔积液6例,结核性胸腔积液4例;恶性胸腔积液的29例中,原发病为肺癌22例,其他肿瘤7例;此外,不能明确诊断者2例。结论在老年男性患者中,肺部感染、肺部肿瘤、心功能不全是导致胸腔积液的主要原因。     

丹参酮ⅡA磺酸钠对海水浸泡人肺上皮A549细胞水通道蛋白5的影响

目的 探讨水通道蛋白5(AQP5)在海水浸泡致细胞损伤中的变化,同时了解丹参酮Ⅱ A可能的作用机制.方法 体外传代培养肺腺癌细胞株A549细胞,接种于培养皿中,按不同海水含量分为空白对照组及15%、25%、50%、75%、100%海水组;以25%海水浸泡不同时间分为空白对照组及海水1、4、8 h组;按给予不同剂量丹参酮ⅡA干预分为空白对照组、25%海水组及25、50、75、100μg/ml丹参酮ⅡA干预4 h组.用蛋白质免疫印迹法(Western blotting)检测AQP5蛋白表达;用免疫组化法检测AQP5阳性表达.结果 Western blotting结果显示,25%与50%海水组8 h时A549细胞AQP5蛋白表达均较空白对照组明显增高(1.053±0.231、1.116±0.316比0.101±0.081,均P＜0.05);海水1 h组AQP5表达较空白对照组稍有增加(0.306±0.125比0.288±0.098,P＞0.05),4 h组(1.423±0.377)明显增加(P＜0.01),8 h组AQP5表达(1.507±0.461)较4 h组略有增加,但差异无统计学意义;25μg/ml与50 μg/ml丹参酮Ⅱ A组4 h时AQP5蛋白表达较25%海水组明显减少(0.580±0.186、0.499±0.172比1.013±0.287,均P＜0.05).免疫组化显示,25%海水4 h组AQP5阳性表达较空白对照组明显增多(7.21±0.78比0.41±0.07,P＜0.01),染色变深;25μg/ml丹参酮ⅡA干预4 h组AQP5阳性表达(3.02±0.23)较25%海水4 h组明显减少(P＜0.05).结论 丹参酮Ⅱ A在25μg/ml浓度时毒副作用最小,对海水浸泡A549细胞的保护作用最佳,其机制可能与抑制AQP5的过度表达有关.

Abstract：

Objective To explore the effects of tanshinone Ⅱ A on the activity of aquaporin-5 (AQP5)in human alveolar epithelial cells (A549) after seawater exposure and its possible mechanism. Methods Routinely cultured A549 cells were divided into different groups according to different content of seawater:blank control group, 15%, 25%, 50%, 75%, 100% seawater groups; they were divided into different groups according to the duration of exposure to 25 % seawater : blank control group, 1, 4, 8 hours groups ;they were also divided into different groups according to concentration of tanshinone ⅡA and exposed to seawater for 4 hours: blank control group, 25% seawater group, 25, 50, 75, 100 μg/ml tanshinone ⅡA intervention groups. The expressions of AQP5 were respectively assayed by Western blotting and immunohistochemistry. Results The results of Western blotting showed that the expressions of AQP5 were remarkably higher at 8 hours of exposure to seawater in 25% and 50% seawater groups than those in blank control group (1. 053±0. 231, 1. 116±0. 316 vs. 0. 101±0. 081, both P＜0. 05); the expression of AQP5 in 1-hour group showed a slight increase compared with blank control group (0. 306±0. 125 vs. 0. 288±0. 098,P＞0. 05), that in 4-hour group was increased significantly (1. 423±0. 377, P＜0. 01), and in 8-hour group (1. 507± 0. 461 ) it was slightly higher than that in 4-hour group without statistical significance. The AQP5 expression was significantly lower in tanshinone ⅡA 25 μg/ml and 50μg/ml intervention groups than that in 25% seawater group (0. 580 ± 0. 186, 0. 499 ± 0. 172 vs. 1.013 ± 0. 287, both P ＜ 0. 05). Immunohistochemistry showed that the expression of AQP5 was markedly up-regulated after A549 cells were stimulated with 25% seawater for 4 hours as compared with blank control group (7.21±0. 78 vs. 0. 41 ±0.07, P＜0.01), but intervention of tanshinone ⅡA significantly inhibited the up-regulation of AQP5 expression (3.02±0.23) induced by 25% seawater (P＜0.05). Conclusion The experimental results showed that tanshinone ⅡA is innocuous to A549 at a dosage of 25 μg/ml, and it can decrease the overexpression of AQP5 induced by seawater.     

腹腔镜胆囊切除术对胆囊结石合并急性胆囊炎患者肝功能及应激指标的影响

目的探讨腹腔镜胆囊切除术(LC)对胆囊结石合并急性胆囊炎患者肝功能及应激指标的影响。方法回顾性分析2017年3月至2019年12月本院收治的68例急性胆囊炎患者的临床资料,按照治疗方法的不同分为两组,各34例。对照组采用小切口胆囊切除术治疗,观察组采用LC治疗,比较两组肝功能及应激指标。结果术后,两组总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、直接胆红素(DBIL)、间接胆红素(IBIL)水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后,两组促肾上腺皮质激素(ACTH)、皮质醇、C反应蛋白(CRP)水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05)。结论 LC治疗胆囊结石合并急性胆囊炎对机体的创伤较小,可有效减轻机体的应激反应,并减少对肝功能的损伤。