氯沙坦降低糖尿病大鼠肾脏肾上腺髓质素和内皮素的表达

目的探讨应用血管紧张素Ⅱ(AngⅡ)受体1拮抗剂对糖尿病大鼠肾脏肾上腺髓质素(ADM)、内皮素-1(ET-1)及其各自受体表达的影响。方法单侧切除大鼠肾,在其腹腔内注射STZ,诱发实验性糖尿病模型。随机将大鼠分为:右肾切除对照组(A组)、糖尿病组(B组)和氯沙坦治疗组(C组)。采用免疫组化检测ADM和ET-1的表达,W estern b lot检测ADMR和EDNR-A蛋白的表达,原位杂交检测ADM mRNA和RT-PCR检测ET-1 mRNA的表达。结果B组较A组各表达指标均显著增强,C组较B组各表达指标均减低。结论氯沙坦可能通过影响ADM、ET-1及其各自受体的表达,发挥对肾脏的保护作用。     

肾上腺髓质素和内皮素-1在妊娠高血压疾病患者胎盘绒毛组织中表达的研究

目的研究胎盘绒毛组织肾上腺髓质素(ADM)和内皮素-1(ET-1)在妊娠高血压疾病发病中的作用。方法用免疫组化法检测ADM和ET-1在正常晚孕妇女(20例)和妊娠高血压疾病患者(60例)胎盘绒毛膜组织中的表达情况,结果用计算机软件分析处理。结果ADM和ET-1在胎盘绒毛组织合体滋养细胞和毛细血管内皮细胞中均有表达,位于胞浆和胞膜。与正常晚孕期胎盘组织相比,妊高征患者组织中ADM平均灰度值增高,而ET-1平均灰度值降低(113.45±3.24vers 131.55±5.68,135.48±3.21 vers 119.05±5.41,P<0.05);随着妊高征病情加重,ADM增高和ET-1降低的幅度更加显著,轻、重度子痫前期组患者胎盘组织中ADM平均灰度值高于妊娠高血压组,而ET-1平均灰度值低于妊娠高血压组(135.48±4.96,141.52±5.37 vers 117.64±5.36;116.64±6.75,109.27±4.98 vers 131.24±4.39,P<0.05),而轻、重度子痫前期组之间比较无显著性差异(P>0.05)。结论胎盘绒毛组织ADM表达减弱,ET-1表达增强可能在妊娠期高血压疾病发病中起重要作用。     

高血压患者肾上腺髓质素、内皮素测定及其临床意义

肾上腺髓质素 (ＡＤＭ)、内皮素 (ＥＴ)是体内两个作用相反舒缩血管作用的生物活性物质。有研究表明 ,ＡＤＭ与ＥＴ相互作用 ,参与内皮源细胞旁分泌、自分泌调节体系的构成 ,共同协调血管张力 ,在原发性高血压的动态发生发展过程中起重要作用[1] 。因此本文选择ＡＤＭ、ＥＴ这两个机能上具有相互拮抗作用的血管活性肽作为研究对象 ,分析两者在高血压中的作用。对象和方法一、对象 :选择 2 0 0 2年 4月～ 2 0 0 2年 11月我院内科门诊确诊为高血压患者 4 3例 (男 2 4 ,女 19)。年龄 3 2～ 64岁 ,平均 4 7± 13岁。诊断及分级依据 1999年ＷＨＯ…     

γ射线辐射对大鼠胸主动脉平滑肌细胞肾上腺髓质素和内皮素生成的影响

为观察^60COγ射线辐射对培养的大鼠血管平滑肌细胞（VSMC）肾上腺髓质素（Adm)内皮素（ET）生成的影响，以探讨辐射防治再狭窄的机制，采用逆转录－竞争性聚合酶链反应观察经0,1,,24,25Gy辐射的培养大鼠血管平滑肌细胞Adm和ET mRNA水平；用放免方法测定相应的Adm和ET的生成。发现1Gy辐射对VSMC Adm和ET的生成及基因表达均无显著影响。14Gy辐射后VSMC生成的Adm较对照组增加270％（P＜0．05），ET的生成较对照组降低27．3％（P＜0．01）；25Gy辐射使VSMC生成的Adm和ET含量分别增加233％（P＜0．05）和降低58．0％（P＜0．01）。14和25Gy辐射分别使细胞Adm mRNA水平较对照组增加82．4％（P＜0．01）和101％（P＜0．01），使ET mRNA水平较对照组降低47．1％（P＜0．01）及40．2％（P＜0．01）。表明^60Coγ射线辐射可以促进Adm的蛋白及基因表达，而抑制ET的蛋白及基因表达，增加了Adm/ET比值。     

休克过程中肾上腺髓质素变化的研究进展

Adrenomedullin (AM) is a new peptidergic regulator of vascular function. AM serves as a hormone, which has many biological properties, plays an important role in the many pathophysiological processes, especially shock. This review will highlight the structure, biological properties of AM and the relationship between AM and shock.     

肾上腺髓质素

肾上腺髓质素（ＡＭ）是近年发现的一种在体内广泛分布的内源性血管活性肽。人ＡＭ前体含有１８５个氨基酸残基，成熟ＡＭ由５２个氨基酸残基组成。ＡＭ具有舒张动脉、降低血压、排钠利尿等生物作用，在人、鼠体内分布广泛     

肾上腺髓质素研究进展

肾上腺髓质素是一种新发现的降压肽，广泛分布于体内多种脏器、神经组织和某些神经细胞瘤中。具有调节动脉血压、呼吸系统、肾脏、细胞增殖和迁移等作用。它在高血压的降压、呼吸系统疾病的发生及治疗方面有重要意义。     

肾上腺髓质素与脑血管病

肾上腺髓质素 (Adrenomedullin ,AM )是一种新发现的生物活性肽 ,在人体多种组织中都有AMmRNA的表达。AM具有扩张血管、降低血压、排尿利钠、抑制内皮细胞凋亡、影响内分泌的功能。在脑血管病的发生发展中起重要的保护作用。     

老年男性高血压患者血浆ADM和ET-1含量变化的意义

目的:探讨老年男性高血压患者血浆肾上腺髓质素(ADM)、内皮素-1(ET-1)含量变化的临床意义.方法:用放射免疫分析测定62例老年男性高血压患者血浆ADM、ET-1含量,并与35例年龄、性别匹配的健康老年人对照.结果:高血压组血浆ADM、ET-1含量显著高于正常对照组(P＜0.01),两者均随高血压分级1、2、3级组逐渐递增(P＜0.01,＜0.05);血压控制不良者明显高于血压控制良好者(P＜0.01),病情重组显著高于病情轻组(P＜0.01);伴肾功能受损者也显著高于肾功能正常者(P＜0.01);血浆ET-1含量平均增幅明显高于血浆ADM(P＜0.01);高血压组血浆ADM与ET-1含量呈正相关(r=0.394,P＜0.01);正常对照组两者含量不相关(r=0.172,P＞0.05).结论:老年男性高血压患者血浆舒血管活性肽ADM含量显著增高,可能是机体的一种代偿性自身调节机制,以此抑制ET-1等缩血管活性肽增高对血压调节产生不良的影响,对机体起到自身代偿性保护作用.     

肾上腺髓质素对内皮素促家兔气道平滑肌细胞增殖的抑制作用

在体外培养的家兔气道平滑肌细胞（ＡＳＭＣ）上，观察肾上腺髓质素（ＡＭ）对内皮素（ＥＴ）促ＡＳＭＣ增殖的影响及丝裂素活化蛋白激酶（ＭＡＰＫ）活性的变化。以探讨ＡＭ对ＡＳＭＣ增殖的调控。结果显示１０－８ｍｏｌ／ＬＥＴ－１显著刺激ＡＳＭＣ３Ｈ－ＴｄＲ参入及ＭＡＰＫ激活（Ｐ＜０．０１）。ＡＭ（１３－５２）呈剂量依赖地抑制ＥＴ－１的上述作用（Ｐ＜０．０５，Ｐ＜０．０１）。单独应用ＡＭ（１３－５２）对ＡＳＭＣ３Ｈ－ＴｄＲ参入及ＭＡＰＫ活性无明显影响。表明ＡＭ（１３－５２）可抑制ＡＳＭＣ对ＥＴ－１的增殖反应，其机理可能涉及ＭＡＰＫ活性的抑制。     

The long-term results of coronary artery bypass grafting in patients with type II diabetes

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.     

Blood volume after coronary artery bypass grafting

Patients with stable angina pectoris are reported to have a markedly reduced blood volume (BV). In the present study, average BV was still 19% less than that predicted in 77 men examined 5 years after coronary artery bypass grafting. Beneficial effects of the operation such as relieved angina, absence of medication, complete revascularization status at repeat angiography, and restored physical fitness were not found to be associated with a normalization of the BV. No significant correlation was found between BV and body weight, heart volume, exercise capacity, ejection fraction or left ventricular end-diastolic pressure. The reduced BV in patients with angina pectoris after successful revascularization and the absence of correlation with physiological variables indicate a persisting disturbed regulation mechanism.     

冠状动脉搭桥术患者围术期血浆神经元特异性烯醇化酶浓度与术后认知功能

目的研究冠状动脉搭桥术患者围术期血浆神经元特异性烯醇化酶（NSE）浓度及术后认知功能。方法40例接受冠状动脉搭桥术的男性患者，分为体外循环组和非体外循环组，每组20例。在术前、术后6、12、18和24h采血，用放射免疫方法测定血浆NSE浓度。在术前1天和术后7～10天进行神经心理测试。结果体外循环组患者术后6h血浆NSE浓度比术前显著升高，同时高于非体外循环组；非体外循环组患者各时点无差别。非体外循环组患者在数字广度测验（逆向）、斯特鲁字色干扰测验改正反应和阻塞反应的结果显著优于体外循环组患者。体外循环组患者术后6hNSE水平与连线测验A型相关，术后12hNSE浓度与数字广度测验（顺向）、连线测验A型、斯特鲁字色干扰测验时间分项相关。结论心脏手术后血浆NSE浓度的升高可在某种程度上反映术后认知功能障碍，但在具体应用时应考虑NSE的组织多源性及体外循环因素的影响。     

Off-pump coronary artery bypass grafting in moyamoya disease

Moyamoya disease is an occlusive intracranial arteriopathy owing to intimal hyperplasia with formation of abnormal cerebrovascular collateral networks; however, the etiology remains unclear. Although this disease is known to be associated with renovascular hypertension, it is extremely rare for it to be associated with stenoses of the coronary arteries. We herein described a case of a 56-year-old female with angina and asymptomatic moyamoya disease. We performed off-pump coronary artery bypass grafting (OPCAB) to avoid cardiopulmonary bypass and the risk of intraoperative hypotension. Conventional coronary artery bypass grafting has a potential risk of brain ischemia in moyamoya patients, but OPCAB may avoid this perioperative cerebral ischemic complication.     

Clinical outcome of urgent coronary artery bypass grafting

Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. The purpose of this study was to evaluate the clinical outcome of urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent CABG. All patients required an urgent surgical revascularization within 24 hr of diagnostic coronary angiography. In-hospital mortality after urgent CABG was 17.3% (18/104). We compared preoperative characteristics and postoperative clinical outcomes between the survival group (n=86) and the mortality group (n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of mortality was low cardiac output. The independent preoperative risk factors of mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492, p=0.034). Other risk factors of mortality included prolonged cardiopulmonary bypass time, prolonged ventilator use, and extended intensive care unit stay. The 10-yr actuarial survival rate was 61%. Although the operative mortality rate was high after urgent CABG, a favorable long-term clinical outcome can be expected if the patients survive.     

Perioperative cytokine release during coronary artery bypass grafting in patients of different ages

Surgical interventions and cardiopulmonary bypass (CPB) induce a systemic inflammatory response with cytokine release. Ageing is perceived as a process of impaired immune functions: IL-1β, IL-6 and tumour necrosis factor-alpha (TNF-α) secretion are increased while IL-2 release is reduced in advanced age. At present, little information is available about perioperative immune reactions at different stages of ageing. The aim of the present study was to compare IL-6, IL-1β, TNF-α, IL-10 and soluble IL-2 receptor (sIL-2R) in younger and older patients undergoing cardiac surgery. Male patients (n = 14) undergoing elective coronary artery bypass grafting (CABG) surgery employing CPB with moderate hypothermia were divided into two groups according to their age: group 1 included seven patients < 50 years old, group 2 included seven patients > 65 years old. All patients received general anaesthesia using a balanced technique with sufentanil, isoflurane and midazolam. Blood samples were collected pre-operatively (T1); intra-operatively during CPB (T2); post-operatively on the day of surgery (T3); on the first post-operative day (T4). Blood concentrations of IL-6, IL-1β, IL-10, TNF-α and sIL-2R were measured using commercially available ELISA kits and corrected for plasma cell volume. Statistical analysis was performed by non-parametric analysis of variance and Mann–Whitney U-test. Significance level was set to P < 0.05. There were no statistically significant differences in the perioperative release of TNF-α, IL-6, IL-1β, IL-10 and sIL-2R among the two groups. We conclude that the perioperative course of cytokine release in patients undergoing CABG surgery with CPB and comparable perioperative management does not significantly differ in the two age groups.     

冠状动脉搭桥术病人围术期皮质醇分泌的昼夜节律性

观察冠状动脉搭桥术病人围术期皮质醇昼夜分泌节律性的变化。选择在低温体外循环或非体外循环下行冠脉搭桥术的男性病人40例，分为体外循环组和非体外循环组，每组20例。所有病人均在麻醉诱导前(基础值)、气管插管后。10min、肝素化后10min、转机后30min(或切皮后2h)、中和肝素前和术终各时点及术后每3h抽血1次持续到术后24h。采用放射免疫方法检测血浆皮质醇的浓度。两组病人术中各时点血浆皮质醇浓度显著低于麻醉诱导前，而在术后24h明显升高；非体外循环组病人在诱导后和术终时点皮质醇水平高于体外循环组。在术后24h体外循环组与非体外循环组分别有3例和7例病人的皮质醇分泌表现为昼夜节律性，其余病人则无昼夜节律性分泌。体外循环与非体外循环冠状动脉搭桥术后多数病人皮质醇昼夜节律性分泌紊乱，但非体外循环冠脉搭桥术病人术后早期有皮质醇昼夜分泌节律性的病例数多于体外循环组，提示体外循环有可能干扰了围术期皮质醇的分泌节律。     

Comparison of coronary artery bypass grafting with percutaneous coronary intervention for unprotected left main coronary artery disease

Purpose

Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs).

Materials and Methods

The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS).

Results

Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49±4.09 vs. 4.81±2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016).

Conclusion

Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI.