复方丹参注射液对冠心病患者血管内皮功能及内皮素和一氧化氮合酶基因表达的影响

为探讨复方丹参注射液对冠心病患者血管内皮功能的影响及其作用机制 ,将 84例冠心病患者随机分为对照组、复方丹参注射液治疗组和维生素C治疗组 ,分别于治疗前、后用彩色多普勒检测血管内皮依赖性舒张功能 ,并采血检测内皮素 1和一氧化氮水平及内皮素 1和内皮型一氧化氮合酶mRNA表达。结果发现 ,治疗前 3组间血管内皮依赖性舒张功能、内皮素 1及一氧化氮水平及其mRNA表达比较差异无显著性 ,治疗后复方丹参注射液和维生素C两治疗组血管内皮依赖性舒张功能明显改善 (16 .7%± 5 .0 %和 13.8%± 5 .1%比 9.4 %± 4 .5 %和 9.7%± 4 .1% ,P <0 .0 5 ) ,高于对照组 (11.2 0 %± 3.90 % ,P <0 .0 5 ) ,前者又优于后者 (P <0 .0 5 ) ;复方丹参注射液治疗组内皮素 1水平及其mRNA表达下降 ,内皮型一氧化氮合酶水平及其mRNA表达升高 ,与对照组及治疗前比较差异有显著性 ;维生素C治疗组一氧化氮水平及内皮型一氧化氮合酶mRNA表达也升高 ,但低于复方丹参注射液治疗组 (P <0 .0 5 )。以上提示复方丹参注射液能改善冠心病患者血管内皮功能 ,其机制之一为调节内皮型一氧化氮合酶和内皮素 1mRNA表达     

龙津降纤酶治疗急性脑梗死临床疗效观察

目的 :观察龙津降纤酶治疗急性脑梗死临床疗效及对血小板、纤维蛋白原及全血黏度、血浆黏度的影响。方法 :前瞻性、完全随机化设计 ,将 74例诊断明确的急性脑梗死病人随机分为降纤酶组 (治疗组 ) 3 7例与丹参组(对照组 ) 3 7例。降纤酶总量为 2 0U ,5d内分 3次给予。结果 :治疗组总有效率86.49% ,显效率 64 .85 % ;对照组分别为 62 .16%与18.92 %。两组疗效比较有统计学意义 (P <0 .0 1) ,且血液流变学指标的改善 ,治疗组明显优于对照组 (P <0 .0 1)。结论 :降纤酶治疗急性脑梗死疗效显著、疗程短 ,无明显副作用。     

缝隙连接蛋白43在去卵巢大鼠骨细胞中的表达及其与骨质疏松的关系

目的　探讨去卵巢致骨质疏松大鼠骨细胞中缝隙连接蛋白 4 3(Cx4 3)的表达及意义。　方法　采用 10月龄未孕产Wistar雌性大鼠 30只 ,随机分为去卵巢组、假手术组和尼尔雌醇治疗组。于术后 8周末测量 3组大鼠全身及腰椎骨密度 (BMD) ,采用放免法测定血清雌二醇水平 ,采用SABC免疫组化法观察Cx4 3在成骨细胞和破骨细胞中的表达情况 ,采用 3’ OH末端DNA原位标记技术观察凋亡细胞变化。　结果　术后 8周末去卵巢组全身及腰椎BMD和血清雌二醇水平明显低于假手术组和尼尔雌醇治疗组 (P <0 0 1)。去卵巢组成骨细胞内Cx4 3阳性表达率 (13 80 %±1 14 % )低于假手术组 (6 3 6 0 %± 2 4 6 % )和尼尔雌醇治疗组 (6 3 6 0 %± 2 12 % ) (P <0 0 1) ,而破骨细胞内去卵巢组Cx4 3阳性表达率 (6 6 10 %± 1 37% )高于假手术组 (42 2 0 %± 1 93% )和尼尔雌醇治疗组 (41 80 %± 1 81% ) (P <0 0 1)。去卵巢组成骨细胞的凋亡变化 (49 30 %± 3 86 % )高于假手术组 (2 4 2 0 %± 2 78% )和尼尔雌醇治疗组 (2 5 5 0 %± 3 0 3% ) (P <0 0 1) ,破骨细胞凋亡变化(5 80 %± 1 14 % )低于假手术组 (19 2 0 %± 1 75 % )和尼尔雌醇治疗组 (19 70 %± 1 6 9% ) (P <0 0 1)。而上述观察指标中假手术组和尼尔雌醇治疗     

OSAHS患者血小板聚集率和纤维蛋白原的测定

目的　探讨阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者血小板聚集率和纤维蛋白原的变化和意义。方法　对 30例OSAHS患者和 32例正常对照者用血小板聚集仪测定血小板的最大聚集率 ,并用双缩脲法测定纤维蛋白原。结果　OSAHS患者的血小板聚集率 (ADP0. 5 μmol/L :32 5 4± 2 3 5 9% ;ADP2 0 μmol/L :5 3 89± 2 1. 14 % )明显高于正常对照者 (ADP0 5 μmol/L :2 1. 0 0± 14 . 85 % ;ADP2 .0 μmol/L :4 0 .2 0± 17. 31% ) (P <0 .0 5 )。OSAHS患者的纤维蛋白原 (388± 74mg/dl)与正常对照者 (36 3± 91mg/dl)无明显差异 (P >0 . 0 5 )。结论　OSAHS患者高血小板聚集率是引起心脑血管疾病增多的重要内在机制之一。     

血府逐瘀汤在自发性高血压大鼠颈动脉血管胶原重构及逆转中的意义

为探讨血府逐瘀汤在自发性高血压大鼠颈动脉血管间质胶原重构及逆转中的意义 ,选择 16周龄雄性自发性高血压大鼠 36只 ,分为自发性高血压大鼠组、伊贝沙坦组 [30mg (kg·d) ]和伊贝沙坦联合血府逐瘀汤 (联合用药 )组 3组 ;另选同龄雄性Wistar大鼠 12只作为对照 ;取颈总动脉切片行HE和苦味酸一天狼星红染色 ,分别检测血管壁厚 腔径比和胶原面积 ;应用放射免疫法测定血清中Ⅰ型和Ⅲ型前胶原的浓度。结果发现 ,自发性高血压大鼠组颈动脉壁厚 腔径百分比较对照组高 (14 .7%± 0 .5 %比 5 .9%± 0 .3% ,P <0 .0 5 ) ,伊贝沙坦组 (8.4 %± 0 .4 % )以及联合用药组 (7.6 %± 0 .5 % )较自发性高血压大鼠组下降 ;自发性高血压大鼠组胶原面积百分比较对照组高 (9.6 %± 0 .4 %比 4 .8%± 0 .3% ,P <0 .0 5 ) ,伊贝沙坦组 (8.2 %± 0 .4 % )较自发性高血压大鼠组下降 ,联合用药组 (6 .17%± 0 .38% )下降更明显 ;自发性高血压大鼠血清Ⅰ型前胶原、Ⅲ型前胶原和Ⅰ型前胶原与Ⅲ型前胶原比值均较对照组明显增高 (16 7.4± 18.7、6 4 .6± 7.6和 2 .6± 0 .3比 83.6± 10 .1、4 5 .3± 5 .6和 1.82± 0 .2 1,P <0 .0 5 ) ,伊贝沙坦组Ⅲ型前胶原下降明显 ,与对照组无统计学差异 ;Ⅰ型前胶原和Ⅰ型前胶原与Ⅲ型前胶原比     

国产降纤酶治疗脑梗死研究

目的　为进一步研究国产降纤酶对脑梗死的疗效。方法　采取随机双盲对照临床研究。在应用降纤酶治疗前及用药后第 14d分别进行神经功能缺损评分 (NDF) ,并进行日常生活能力评估 (Barthel指数 )。同时检测血浆中纤维蛋白原含量、肝功和肾功。结果　降纤酶治疗组血浆纤维蛋白原含量在用药后极显著降低 (P <0 0 1)对肝功、肾功、凝血功能无影响 ,也未发生过敏反应。近期疗效降纤酶治疗组显著优于对照组。神经功能缺损评分及Barthel指数有显著进步 (P <0 0 5 )。结论　国产降纤酶为安全有效地降低血浆纤维蛋白原含量及治疗急性脑梗死有较好疗效的药物     

银杏叶提取物对高脂饮食所致血管内皮功能损伤的保护及与对氧磷酶活性的关系

为探讨银杏叶提取物对高脂血症所致血管内皮功能损伤的保护作用及其机制 ,在大鼠高脂血症模型对比观察了银杏叶提取物和维生素E的作用。结果发现 ,大鼠高脂血症导致血管内皮依赖性舒张反应和非内皮依赖性舒张反应、血清一氧化氮浓度和对氧磷酶活性显著降低、血清丙二醛浓度显著升高。银杏叶提取物 [2 5mg (kg·d) ]或维生素E[10 0mg (kg·d) ]对高脂血症无明显抑制作用 (P >0 .0 5 ) ,但显著保护血管舒张功能和一氧化氮的血清浓度及对氧磷酶的活性 ,阻止了丙二醛的升高。在对照组、高脂组、银杏叶提取物和维生素E组 ,一氧化氮浓度(mmol L)分别为 5 .16± 1.3、3.35± 1.0 7、5 .0 5± 1.4 1和 4 .91± 1.6 5 (高脂组比对照组 ,P <0 .0 5 ;高脂组比银杏叶提取物和维生素E组 ,P <0 .0 5 ) ;内皮依赖性舒张反应分别为 95 .1%± 19.8%、4 7.1%± 15 .0 %、81.8%± 9.3%和 76 .2 %± 11.3% (高脂组比对照组 ,P <0 .0 1;高脂组比银杏叶提取物和维生素E组 ,P <0 .0 1) ;非内皮依赖性舒张反应分别为 98.2 %± 3.6 %、5 6 .7%± 7.9%、85 .8%± 7.2 %和 83.6 %± 4 .9% (高脂组比对照组 ,P <0 .0 1;高脂比银杏叶提取物和维生素E组 ,P <0 .0 1) ;对氧磷酶活性 (kU L)分别为 :18.0 %± 7.2 %、7.9%± 3.7%、16 .5 %     

奥扎格雷钠与阿斯匹林合用对不稳定型心绞痛患者血液流变学影响

目的　观察奥扎格雷钠与阿斯匹林合用对不稳定型心绞痛 (UAP)患者血液流变学影响。方法　随机将收治的 4 2例UAP患者分为对照组 2 1例和治疗组 2 1例 ,对照组给予口服阿斯匹林片等常规治疗 ;治疗组则在常规治疗基础上 ,每天用奥扎格雷钠 16 0mg溶于 5 0 0ml生理盐水中静滴 ,连用 2周 ,监测治疗前后血液流变学参数、心电图和心绞痛症状等。结果　治疗组在心绞痛缓解和消失时间等方面优于对照组 (P均 <0 0 1)。治疗组治疗后纤维蛋白原含量、血细胞比容、血小板聚集率均较治疗前显著降低 (P <0 0 1～ 0 0 5 ) ,全血比黏度较治疗前有所降低 ,但无统计学意义 (P >0 0 5 ) ;对照组治疗后血小板聚集率较治疗前显著降低 (P<0 0 5 ) ,其余各指标差异无统计学意义 (P <0 0 5 ) ;两组用药过程中均无出血并发症。结论　在常规治疗基础上加用奥扎格雷钠能显著降低血小板聚集率等血液流变学参数 ,更有效治疗UAP。     

复方丹参治疗过敏性紫癜的疗效与血小板聚集功能观察

我们应用复方丹参注射液治疗过敏性紫癜 (HSP) ,并观察其对血小板聚集功能的影响。临床资料 :5 0例 HSP皆为本院住院及门诊患儿 ,均符合HSP的诊断标准。治疗组及对照组各 2 5例 ,两组患儿在年龄、症状和并发症等方面经统计学处理无差异。治疗方法 :两组患儿均应用抗生素、肾上腺皮质激素、抗过敏等常规治疗。治疗组加用复方丹参注射液 ,按 0 .2～ 0 .5 ml/ (kg· d)加入 10 %葡萄糖液中静滴 ,每日 1次 ,连用 1周。治疗前及治疗 1周后分别检测血小板聚集功能 ,并观察皮肤紫癜消退天数、住院 (或治疗 )天数。数据以 x± s表示 ,两组资料差…     

降纤酶治疗不稳定型心绞痛36例报道

目的探讨降纤酶治疗不稳定型心绞痛的临床疗效.方法对照组38例,用阿司匹林、β受体阻滞剂、加硝酸盐类、钙拮抗剂治疗.降纤酶组36例,在对照组治疗基础上给降纤酶10 IU,连用3 d,继而5 IU,连用7 d,均加于生理盐水250 mL中静脉输注,每天1次,两组均以10d为1个疗程.结果1个疗程结束后进行疗效评价,降纤酶组临床症状改善总有效率91.67%,对照组为71.05%(P＜0.05);心电图(∑ST)改善降纤酶组优于对照组(P＜0.05);血浆纤维蛋白原定量比较,亦有统计学意义(P＜0.001).结论降纤酶治疗不稳定型心绞痛安全、有效,疗效优于对照组.     

Large Lipomatous Hypertrophy of the Interventricular Septum

We present the case of a 58-year-old woman who had large lipomatous hypertrophy of the interventricular septum, a condition that is reported very infrequently. Preoperative cardiac magnetic resonance images revealed an inhomogeneous, infiltrating mass that was suppressed in fat-suppression mode. The extensive mass was causing right ventricular dysfunction, so we excised it through a right ventricular approach. The findings on histologic analysis of the mass were consistent with lipomatous hypertrophy. The patient died of septic shock on the 28th postoperative day. In addition to the patient''s case, we discuss the characteristics and diagnosis of this rare entity.     

Resolution of Right-Sided Heart Failure Symptoms after Resection of a Primary Ovarian Carcinoid Tumor

Carcinoid tumors are rare neuroendocrine malignancies that typically originate from the gastrointestinal tract. Patients who are diagnosed with carcinoid heart disease generally have poor prognoses because of advanced metastases during staging and few therapeutic options. We present the case of a 61-year-old woman with right-sided heart failure, secondary to carcinoid heart disease caused by a primary ovarian carcinoid tumor. After undergoing surgical resection of the left ovary and fallopian tube, the patient experienced complete resolution of her heart failure symptoms. In addition to the patient''s case, we discuss the diagnosis, nature, and treatment of this rare condition.     

Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment.     

Conservative Management of Cardiac Hemangioma for 11 Years

Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients.We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.     

Effects of hypoxia, hyperoxia on the regulation of expression and activity of matrix metalloproteinase-2 in hepatic stellate cells

AIM To study the effects of hypoxia,hyperoxia on theregulation of expression and activity of matrixmetalloproteinase-2 (MMP-2) in hepatic stellate cells(HSC).METHODS The expressions of MMP-2,tissue inhibitor ofmatrix metalloproteinass-2 (TIMP-2) and membrane typematrix matalloproteinass-1 (MT1-MMP) in cultured rat HSCwere detected by immunocytochemistry (ICC) and in situhybridization (ISH).The contents of MMP-2 and TIMP-2 inculture supernatant were detected with ELISA and theactivity of MMP-2 in supernatant was revealed byzymography.RESULTS In the situation of hypoxia for 12h,theexpression of MMP-2 protein was enhanced (hypoxiagroup positive indexes:5.7±2.0,n=10;control:3.2±1.0,n=7;P<0.05),while TIMP-2 protein was decreasedin HSC (hypoxla group positive indexes:2.5±0.7,n=10;control:3.6±1.0,n=7;P<0.05),and the activity(total A) of MMP-2 in suparnatant declined obviously(hypoxla group:7.334±1.922,n=9;control:17.277±7.424,n=11;P<0.01).Compared the varied duration ofhypoxia,the changes of expressions Including mRNA andprotein level as well as activity of MMP-2 were mostnotable in 6 h group.The highest value (Ahypoxla~-Acontrol) ofthe protein and the most intense signal of mRNA were inthe period of hypoxia for 6 h,along with the lowestactivity of MMP-2.In the situation of hyparoxia for 12 h,the contents (A_(450)) of MMP-2 and TIMP-2 in supernatantwere both higher than those in the control,especially theTIMP-2 (hyperoxla group:0.0499±0.0144,n=16;control:0.0219±0.0098,n=14;P<0.01),and so wasthe activity of MMP-2 (hyperoxia group:5.252±0.771,n=14;control:4.304±1.083,n=12;P<0.05),and the expression of MT1-MMP was increased.CONCLUSION HSC is sensitive to the oxygen,hypoxiaenhances the expression of MMP-2 and the effect is moremarked at the early stage;hyperoxia mainly raises theactivity of MMP-2.     

Unusual Presentation of Listerial Myocarditis and the Diagnostic Value of Cardiac Magnetic Resonance

Listeria monocytogenes is an infrequent cause of bacterial myocarditis. Myocarditis without evidence of endocarditis is even rarer. Management in such cases involves early diagnosis, antibiotic therapy, and emergency treatment of arrhythmias.We report the case of a 47-year-old man who presented with features of acute ST-segment-elevation myocardial infarction complicated by ventricular tachycardia that necessitated urgent electrical cardioversion. Contrast-enhanced cardiac magnetic resonance images revealed hypertrophy, necrosis, and a mass that was determined to be an abscess caused by L. monocytogenes. Antibiotic treatment led to resolution of the listerial myocarditis.In addition to reporting our patient''s case, we discuss the comparative advantages of cardiac magnetic resonance versus transthoracic echocardiography in characterizing myocarditis, upon presentation and in follow-up evaluation.     

Importance of Absent Ductus Arteriosus in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

Tetralogy of Fallot without pulmonary valve syndrome is almost always associated with an absent ductus arteriosus. Patients with right aortic arch and retroesophageal left subclavian artery have a vascular ring if the left ductus arteriosus or its remnant and the Kommerell diverticulum are present. We report the cases of 2 infants in whom the role of an absent ductus arteriosus or its remnant is noteworthy. Both patients had a combination of tetralogy of Fallot with absent pulmonary valve syndrome and right aortic arch with retroesophageal left subclavian artery without a vascular ring. The absence of the ductus arteriosus has a role in the pathogenesis of tetralogy of Fallot with absent pulmonary valve syndrome. The absence of a ductus arteriosus in the right aortic arch with retroesophageal left subclavian artery precludes a vascular ring.     

胆囊息肉样病变612例临床分析

目的分析总结胆囊息肉样病变的临床、病理、诊断等特征．方法我院及中华医学会第七届全国胆道外科学术会议资料共报道胆囊息肉样病变６１２例进行分析和总结．结果胆囊息肉样病变６１２例占同期胆囊切除术的４２％；３０岁～５０岁占７８５％；结石合并率２８５％；病理类型中以胆固醇息肉最多，占５３７％；腺瘤性息肉恶变率极高，达２８５％；临床表现无特异性，Ｂ超的诊断率最高，达９２５％．结论胆囊息肉样病变患者相对年轻；病理类型以胆固醇类多见，腺瘤性息肉易恶变，特别是合并结石的息肉；临床诊断以Ｂ超为首选