高渗与低渗造影剂对原有肾损害大鼠肾毒性的研究

研究高、低渗造影剂对甘油肾损害大鼠肾毒性及氨氯地平的保护作用。结果表明：高渗造影剂组血清尿素氮和血清肌酐、肾组织磷脂酶Ａ２，脂质过氧化物含量，肾小管损害积分均明显高于低渗造影剂组及甘油对照组。氨氯地平预防组肾损害明显轻于高渗造影剂组。提示低渗造影剂肾毒性较小，氨氯地平对泛影葡胺肾毒性有保护作用。     

高渗和低渗造影剂对大白鼠肾毒性的实验研究

目的 :研究高、低渗造影剂对甘油致肾损害大鼠和正常大鼠的肾毒性 ,观察山莨菪碱预防肾小管损害的作用。方法 :用 2 5 %甘油按 1ml/ 10 0 g制肾损害大鼠模型 ,然后从静脉注射高渗造影剂 (76 %复方泛影葡胺 ,1ml/ 10 0 g)或优维显 (1m l/ 10 0 g) ,2 4h后各组随机处死 10只大鼠 ,肾脏用 10 %福尔马林固定后做病理检查。结果 :在肾功能损害组 ,给高渗造影剂后 ,可使肾小管管型数和肾小管坏死数明显高于低渗造影剂组和甘油对照组 (P<0 .0 1) ,山莨菪碱可明显减轻肾小管损害 (P<0 .0 5 )。正常肾功能组高、低渗造影剂组之间肾小管损害无显著性差异。结论 :肾功能损害时用低渗造影剂对肾毒性较小 ,山莨菪碱对复方泛影葡胺的肾毒性有一定的预防作用。     

泛影葡胺加重肾毒性及其对肾组织骨形成蛋白7表达的影响

目的 探讨高渗造影剂对甘油所致肾损害的大鼠肾毒性作用及可能机制.方法 32只SD大鼠随机分为正常对照组(N组)、甘油对照组(G组)、泛影葡胺对照组(LM组)、甘油+泛影葡胺组(G+LM组),每组8只.G组和G+LM组给予50%的甘油,后腿深部肌肉注射;N组和LM组以同样的方法给予等体积的生理盐水.3天后,LM组和G+LM组再给76%泛影葡胺(10 ml/kg)尾静脉注射;N组和G组按同样方法给予等量的生理盐水.各组于5天后检测血清肌酐(SCr)水平,苏木精-伊红染色观察肾组织病理损害,免疫组织化学法检测肾组织骨形成蛋白7(BMP-7)的表达.结果 BMP-7在N组肾组织中有高度表达,G组表达减少,LM组有中度表达,而G+LM组表达明显减少.结论 泛影葡胺能加重SD大鼠原有的急性肾毒性,骨形成蛋白7表达的下调是肾损伤的加重的重要因素之一.     

氨氯地平对造影剂致人肾小管上皮细胞毒性的保护作用

目的:从细胞分子水平探讨氨氯地平对造影剂(泛影葡胺)致人肾小管上皮细胞毒性的保护作用及其机制.方法:选择人肾小管上皮细胞株(human kidney cell,HKC)为研究对象,实验分为4组,即模型组(泛影葡胺111 g/L)、预防组(泛影葡胺111 g/L 氨氯地平10-5 mol/L)、氨氯地平对照组(氨氯地平10-5 mol/L)和培养基对照组(单纯无血清DMEM-F12培养基),采用四甲基偶氮唑盐试验和细胞培养上清乳酸脱氢酶(lactate dehydrogenase,LDH)测定泛影葡胺对HKC细胞毒性,采用Hochest33258荧光染色和流式细胞仪DNA分析观察泛影葡胺诱导的肾小管上皮细胞凋亡.采用Western blot和免疫荧光法检测凋亡调控基因Bax的蛋白表达,采用荧光比色法检测半胱氨酸天冬氨酸蛋白酶-3(caspase-3)活性.结果:与模型组相比,预防组细胞活力明显增高,细胞培养上清中LDH浓度明显减低,细胞凋亡率显著降低,Bas蛋白表达下调,caspase-3活性降低.结论:氨氯地平可显著减轻泛影葡胺所致的肾小管上皮细胞损伤,对泛影葡胺诱导的肾小管上皮细胞凋亡有保护作用,其机制可能为通过Bas和caspase-3介导调控造影剂诱导的肾小管上皮细胞凋亡.     

高渗和低渗造影剂对大鼠肾动脉内皮功能的影响及意义

目的 探讨不同类型和剂量的造影剂对大鼠肾动脉内皮功能的影响和内皮细胞损伤情况,为造影剂肾病的发生及防治提供研究资料.方法 肾动脉血管环在含不同剂量高渗造影剂泛影葡胺和低渗造影剂碘佛醇的IMDM培养液中孵育1 h,Griess法和放免法分别检测培养液中一氧化氮(nitric oxide, NO)和内皮素(endothelin-1, ET-1)的含量,并用化学发光法检测血管内皮细胞乳酸脱氢酶(lactate dehydrogenase, LDH)的释放情况.结果 肾动脉血管环在含泛影葡胺和碘佛醇的培养液中孵育1 h后,NO分泌无明显变化,而ET-1分泌增加,且呈剂量依赖性.孵育4 h后,泛影葡胺90 μl/ml组肾动脉内皮LDH释放显著增加;碘佛醇各剂量组引起的LDH释放增加没有统计学意义.结论 高渗造影剂泛影葡胺和低渗造影剂碘佛醇都可以影响肾动脉内皮功能,这一作用可能主要与ET-1分泌增加有关,而NO的分泌没有明显改变.泛影葡胺对肾动脉内皮功能的影响比碘佛醇严重,大剂量的泛影葡胺在一定时间内还可以导致孵育的肾动脉内皮细胞损伤.     

高渗和低渗造影剂对鼠的肾毒性及福辛普利或替米沙坦的保护作用

目的:比较高渗造影剂和低渗造影剂的肾毒性,探讨福辛普利或替米沙坦对造影剂肾毒性是否有保护作用及其可能的作用机制.方法:健康纯系SD大鼠48只,雌雄各半,随机分为正常对照组、甘油对照组、高渗造影剂组(HOCM)、低渗造影剂组(LOCM)、福辛普利预防组及替米沙坦预防组.除正常对照组外,其余组以25%高渗甘油盐水10 mL/kg后腿肌肉注射,诱导甘油肾损害模型.福辛普利或替米沙坦预防组在注射造影剂前1 h分别予以福辛普利10 mg/kg或替米沙坦5 mg/kg灌胃.注射造影剂后48 h处死大鼠,采用自动生化分析仪检测血清肌酐(SCr)水平,采用放射免疫法测定血浆血管紧张素Ⅱ(AngⅡ)水平.取左肾下极肾脏组织匀浆,采用比色法测肾组织中caspase-3活性;另取右肾下极肾组织,采用HE染色观察肾组织病理损害;采用免疫组织化学法检测肾组织claudin-1蛋白的表达;采用TUNEL染色检测肾小管上皮细胞凋亡.结果:注射造影剂后48 h,高渗和低渗造影剂均可引起肾鲻小管上皮细胞凋亡,HOCM组凋亡率明显高于LOCM;与对照组和LOCM组比较,HOCM组血清SCr和血浆AngⅡ水平明显增高,肾组织claudin-1蛋白的表达和caspase-3酶活性上调;福辛普利或替米沙坦预防组SCr和AngⅡ水平明显降低,肾组织claudin-1蛋白的表达和caspase-3酶的活性明显下调,肾组织损害减轻,肾小管上皮细胞凋亡率明显降低.结论:HOCM及LOCM均可诱导肾小管上皮细胞凋亡,且HOCM的作用更强.其机制可能与高渗造影剂上调caspase-3活性和claudin-1蛋白表达及AngⅡ水平增高有关;福辛普利或替米沙坦对造影剂肾毒性有一定保护作用.     

碘海醇与复方泛影葡胺在静脉肾盂造影术中的应用比较

目的:比较碘海醇与复方泛影葡胺在静脉肾盂造影术中的应用.方法:收集我院2009年1月至2011年1月应用30％碘海醇造影45例为碘海醇组,采用76％复方泛影葡胺造影60例为复方泛影葡胺组.观察两组肾盂肾盏的影像质量、显影情况及不良反应并进行比较.结果:复方泛影葡胺组的影像质量高于碘海醇组,两组比较差异有统计学意义(P＜0.05),在不良反应方面,碘海醇组明显低于复方泛影葡胺组(P＜0.05),两组的显影情况比较差异无统计学意义(P＞0.05).结论:两种造影剂各有不同优点,可根据不同患者选择不同的类型的造影剂.     

X线造影剂影响肺阻力动脉张力的中介因子:内皮素和内皮来源舒张因子的研究

目的：观察Ｘ线造影剂引起肺阻力动脉（ＰＲＡ）张力改变是否由内皮素和内皮来源舒张因子（ＥＤＲＦ）介导。方法：（１）离体ＰＲＡ分别于内皮素Ａ／Ｂ受体拮抗剂ＳＢ－２０９６７０处理前后暴露于泛影葡胺或其等容甘露醇对照溶液，观察其收缩反应。（２）离体ＰＲＡ依次由前列腺素Ｆ２α（ＰＧＦ２α）和左旋－硝基精氨酸甲基酯（Ｌ－ＮＡＭＥ）＋ＰＧＦα诱发２次程度相似的收缩反应后分别暴露于低渗显影葡胺，观察其舒张反应。结果：（１）泛影葡胺及甘露醇对照组ＳＢ－２０９６７０处理前后的２次ＰＲＡ收缩反应均无显著差异；（２）ＰＧＦ２α或Ｌ－ＮＡＭＥ＋ＰＧＦ２α收缩ＰＲＡ后低渗显影葡胺引起的舒张反应间无显著差异。结论：内皮素不介导泛影葡胺或高渗溶液引起的离体ＰＲＡ收缩反应，ＥＤＲＦ不介导低渗显影葡胺引起的离体ＰＲＡ舒张反应。     

氨氯地平和培哚普利预防放射造影剂肾毒性前瞻性随机临床研究

目的　研究培哚普利和氨氯地平对放射造影剂肾毒性的保护作用 ,并探讨一氧化氮 (NO)在造影剂肾毒性发病机制中的作用。方法　 2 97例静脉肾盂造影患者被随机分为 3组 ,即氨氯地平组、培哚普利组和对照组。注射 76 %泛影葡胺前 1h ,双盲法随机分别给予氨氯地平 (5mg)、培哚普利 (4mg)或安慰剂 ,造影前 2 4h和造影后 4 8h测内生肌酐清除率 (CrCl) ,并检测造影前后 2 4h尿中NO、白蛋白、N -乙酰基 - β -氨基葡萄糖苷酶 (NAG)及视黄醇结合蛋白 (RBP)含量。造影后 4 8h血清肌酐较基础值增高 2 5 %或 0 .5ml/dl定义为造影剂肾毒性。结果　安慰剂组尿中白蛋白、RBP、NAG显著升高 (P <0 .0 5 ) ,NO显著降低 (P <0 .0 5 ) ;造影后 4 8hCcr下降 (P <0 .0 5 )。培哚普利组Ccr、尿中NO、白蛋白、NAG和RBP的含量均无明显变化 (P >0 .0 5 )。氨氯地平组Ccr ,尿NO和RBP的含量亦无明显变化 (P >0 .0 5 )。但尿NAG含量增高 (P <0 .0 5 )。氨氯地平和培哚普利组尿RBP水平和造影剂肾毒性发生率均较对照组低 (P <0 .0 5 )。结论　造影前口服单剂量氨氯地平或者培哚普利均能有效预防造影剂肾毒性 ,NO可能在造影剂肾毒性发病机制中起重要作用。     

CT增强扫描中造影剂不良反应的防治和护理

目的：比较非离子型造影剂碘海醇和离子型造影剂泛影葡胺在CT增强扫描中的不良反应。方法：共200例各种原因行CT增强扫描的患者,其中100例使用非离子型造影剂碘海醇,另100例使用离子型造影剂泛影葡胺,对两组扫描后的不良反应进行对比。结果：碘海醇组不良反应发生率明显低于泛影葡胺组。非离子型造影剂的不良反应明显少于离子型造影剂。结论：在CT增强扫描中尽量用非离子型造影剂。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.