肾小球疾病中转化生长因子-β_1与肌成纤维细胞的表达及意义

目的：探讨肾小球疾病中转化生长因子-β1（TGF-β1）与肌成纤维细胞的α-平滑肌肌动蛋白（α-SMA）表达及其对肾硬化的影响作用。方法：将原发性肾小球肾炎患者42例根据不同病理类型分为4组,利用肾活检组织免疫组织化学染色观察TGF-β1、α-SMA、胶原Ⅲ（Col-Ⅲ）表达与患者血肌酐（Scr）和内生肌酐清除率（Ccr）之间的相关性,根据镜下免疫组织化学染色在肾小球、肾小管间质中的着色深浅程度及分布,用MetuMorph图像处理系统,测出灰度按半定量方法,进行统计学分析。结果：不同病理类型的肾小球肾炎有不同的表达,随硬化程度的加重,其表达显著增加。TGF-β1表达主要分布于肾小球的系膜基质区、新月体中和小管间质的肾小管上皮细胞胞浆、间质成纤维细胞胞浆中、间质基质区和炎性细胞大量浸润区。α-SMA的表达在MsPGN组最高,而FSGS,SGN肾小球上几乎无α-SMA的表达,在肾间质中α-SMA的表达,随病变程度的加重,其表达显著增加。肾硬化中TGF-β1表达量与患者Scr和Ccr之间呈正相关,α-SMA、Col-Ⅲ在肾小管间质的表达量与患者Scr和Ccr之间呈正相关。结论：在肾硬化形成过程中,TGF-β1是重要的促发因素,肾硬化病变的初期,炎症反应使巨噬细胞和成纤维细胞等活化,分泌TGF-β1增加,TGF-β1进一步刺激（肾小管上皮细胞）TEC和成纤维细胞等,使表型转化为Myo-FB,Myo-FB合成和释放TGF-β1,进入恶性循环,最终导致肾硬化形成。     

TGF-β1及FN在狼疮样小鼠肾组织中的表达及霉酚酸酯的干预作用

目的：研究TGF-β1及FN在狼疮样小鼠肾组织中的表达及霉酚酸酯（MMF）的干预作用。方法：建立cGVHD狼疮样小鼠模型。按随机设计原则将模型动物分两组即模型组和MMF治疗组,另设正常对照组。检测各组小鼠血肌酐、尿素氮及尿蛋白的变化,用HE染色观察肾组织纤维化程度,以Real-time PCR检测各组小鼠肾组织中TGF-β1及FN的mRNA丰度,并用Western blotting方法检测各组小鼠肾组织中TGF-β1及FN的蛋白表达情况。结果：12周模型组的小鼠肾小球系膜节段、弥漫性增生,且血肌酐、尿素氮及尿蛋白较正常对照组均明显增加,Real-timePCR及Western blotting结果证实模型组小鼠的肾组织中TGF-β1及FN的mRNA和蛋白表达水平与正常组相比水平均明显增加,而MMF治疗组与模型组相比其TGF-β1及FN的mRNA和蛋白表达均降低,且血肌酐、尿素氮及尿蛋白水平也有所降低。结论：TGF-β1可能参与了狼疮肾炎的发病,MMF可能通过抑制肾组织TGF-β1的表达来改善狼疮肾炎的增生病变。     

姜黄素对TGF-β1诱导人肾小管上皮细胞转分化及分泌细胞外基质成分的影响

目的：通过研究姜黄素（curcumin,Cur）对转化生长因子-β1（TGF-β1）诱导人肾小管上皮细胞（HK-2）转分化及分泌细胞外基质（ECM）成分的影响,探讨姜黄素在防治肾小管-间质纤维化方面可能的作用机制。方法：应用不同浓度Cur处理经TGF-β1诱导活化的HK-2细胞,通过显微镜观察细胞形态改变,免疫组化技术检测α-平滑肌肌动蛋白（α-SMA）和E-钙黏蛋白（E-cadherin）的表达;应用酶联免疫吸附法（ELISA）检测细胞培养上清Ⅰ型胶原（ColⅠ）、Ⅲ型胶原（ColⅢ）和纤连蛋白（FN）的分泌。结果：（1）正常HK-2细胞表达E-cadherin,不表达α-SMA,经TGF-β1刺激后细胞表型发生转变,E-cadherin的表达明显减弱,α-SMA表达明显增强;（2）不同浓度Cur组与单纯TGF-β1刺激组相比α-SMA的表达有所减弱,而E-cadherin的表达增强;（3）不同浓度Cur抑制了ColⅠ、ColⅢ和FN的分泌,与单纯TGF-β1刺激组相比有统计学差异（P〈0.05）。结论：姜黄素能抑制TGF-β1诱导人肾小管上皮细胞转分化及细胞外基质成分ColⅠ、ColⅢ和FN的合成,在一定程度上具有防治肾小管-间质纤维化的作用。     

冬虫夏草在肾间质纤维化大鼠模型中的作用及其对TGF-β1、α-SMA的影响

目的：探讨冬虫夏草在肾小管间质纤维化大鼠模型中肾脏保护作用及其可能的作用机制。方法：采用单侧输尿管结扎术（UUO）致肾小管间质纤维化大鼠模型。将大鼠随机分为3组：假手术组、模型组、虫草治疗组。手术后第9d处死各组大鼠，用免疫组化半定量检测各组肾脏TGF-β1、α-SMA、Ⅳ型胶原的表达，Masson染色评定各组肾小管间质损害程度。结果：模型组TGF-β1、α-SMA、Ⅳ型胶原的表达及肾小管间质损伤指数明显高于假手术组（P〈0．01），而虫草治疗组明显低于模型组（P〈0．01）。结论：冬虫夏草可能通过下调TGF-β1，抑制肾小管上皮细胞、成纤维细胞转化为成肌纤维细胞防治。肾小管间质纤维化。     

小球性蛋白尿与肾小管间质损害的相关分析

目的 探讨不同肾小球疾病时蛋白尿程度与小管间质浸润细胞的类型之间相关性，分析其对间质浸润细胞类型的影响和作用。方法对57例原发性肾小球肾炎患者，检测患者24h尿蛋白定量，随即进行肾活检及免疫组织学检测。结果IgA免疫荧光染色阳性的系膜增生性肾炎间质浸润以T细胞为主；急性感染后肾小球肾炎(APGN)则以单核巨噬细胞为主；而在微小病变肾病(MCD)、膜性肾病(MGN)、局灶节段性肾小球硬化(FSGS)、膜增生性肾小球肾炎(MPGN)，淋巴细胞与单核巨噬细胞所占比例无显著性差异。MCD患者蛋白尿定量与间质浸润细胞总数相关，IgA免疫荧光染色阳性的MPGN患者，蛋白尿定量分别与T细胞总数、CD4^ 细胞亚群及单核细胞数量相关；APGN、MGN、FSGS、MPGN(IgA染色阴性)患者，蛋白尿定量与间质浸润细胞总数及细胞亚群无显著相关性。结论蛋白尿可能是引起在IgA免染色阳性的MPGN和MCD患者间质炎症细胞浸润的始动因素之一；在IgA染色阳性的MPGN，蛋白尿引起间质损害的机制主要通过CD4^ 细胞亚群及单核细胞的作用；但在其它原发性肾小球肾炎，蛋白尿不是引起间质炎症细胞浸润的主要因素。     

养阴固肾活血片对肾脏细胞外基质影响的实验研究

目的:探讨养阴固肾活血片(以下称肾炎康复片)治疗慢性肾炎,预防和延缓肾功能减退的作用机理。方法:用免疫组化方法观察肾炎康复片对单侧输尿管梗阻(UUO)模型大鼠CD_8~ T细胞、转化生长因子β(TGF-β)及细胞外基质(ECM)等方面的影响。结果:药物治疗组与模型对照组相比较,肾间质CD_8~ T细胞浸润及TGF-β表达明显减少,α平滑肌肌动蛋白(α-SMA),Ⅲ型胶原,Ⅳ型胶原,纤维连接蛋白(FN),层粘连蛋白(LN)等细胞外基质沉积均有显著改善(P<0.05)。结论:肾炎康复片通过影响CD_8~ T细胞在肾脏间质的浸润和减少ECM沉积,减轻了肾脏纤维化程度,这可能是其预防和延缓肾功能减退的主要机理。     

慢性肾小球肾炎患者肾脏BMP-7表达与肾间质纤维化程度的观察

目的观察慢性肾小球肾炎肾组织骨形态发生蛋白-7（BMP-7）、Ⅲ型胶原（Col-Ⅲ）、旷平滑肌肌动蛋白（α-SMA）的表达、肾间质纤维化程度及肾功能的关系和临床应用价值。方法采用免疫组化二步法（SP法）检测60例慢性肾小球肾炎及6例正常肾组织中BMP-7、Col-Ⅲ、α-SMA表达,并用计算机图像分析软件检测肾小管间质BMP-7、Col-Ⅲ、α-SMA阳性染色相对面积,同时检测慢性肾小球肾炎患者肌酐清除率、24小时尿蛋白、血清白蛋白、总蛋白改变;常规病理检查。结果①与正常对照组比较,慢性肾小球肾炎患者BMP-7表达明显下降（P〈0．01）;②BMP-7表达随着肾小管间质纤维化加重呈明显降低趋势,并同Col-Ⅲ、α-SMA的表达呈显著负相关。结论BMP-7表达与慢性肾小球肾炎肾间质纤维化程度密切相关,它可以作为慢性肾小球肾炎肾间质纤维化程度的标志。     

慢性马兜铃酸肾病患者肾小管上皮细胞转分化的研究

目的探讨慢性马兜铃酸肾病。肾小管上皮细胞转分化与肾间质纤维化的关系。方法以慢性马兜铃酸肾病患者的肾组织为标本,作常规Masson染色化病理检查;用天狼星红组织化学(组化)染色检查胶原Ⅰ、Ⅲ表达;用免疫组化染色检查角蛋白(CK)、α-平滑肌肌动蛋白(α-SMA)、波形蛋白(Vim)及转化生长因子-β1(TGF-β1)表达。对结果进行定量或半定量分析。结果 肾间质Masson染色纤维化面积及胶原Ⅰ、Ⅲ面积,与肾小管间质α-SMA及Vim阳性表达面积呈显著正相关(P<0.05),与肾小管CK阳性表达面积呈显著负相关(P<0.05);病变过程中健存肾小管TGF-β1表达明显增强。结论慢性马兜铃酸肾病患者的肾小管上皮细胞可转分化为肌成纤维细胞,参与肾间质纤维化,而这细胞转分化很可能与其自身高表达TGF-β1相关。     

黄芪通过c-met调控TGF-β1诱导的肾小管上皮细胞转分化

AB 目的：探讨黄芪对TGF-β1诱导的肾小管上皮细胞转分化及细胞外基质分泌的作用及机制。方法：体外培养正常大鼠肾小管上皮细胞（NRK52E）,应用倒置相差显微镜观察NRK52E细胞形态学变化;免疫组织化学染色法及实时荧光定量PCR法检测α-平滑肌肌动蛋白（α-SMA）,肝细胞生长因子HGF受体（c-met）的表达;ELISA法定量检测细胞上清液中胶原Ⅰ（Col-Ⅰ）,胶原Ⅲ（Col-Ⅲ）和纤维黏连蛋白（FN）的水平。结果：TGF-β1可诱导肾小管上皮细胞肌成纤维细胞转分化（TEMT）,TGF-β1诱导组细胞肥大、拉长,呈长梭形,α-SMA表达明显增强,Col-Ⅰ、Col-Ⅲ和FN分泌增加（P〈0.05）。加入不同浓度黄芪后,细胞形态接近正常肾小管上皮细胞形态,α-SMA表达、Col-Ⅰ、Col-Ⅲ和FN分泌均较TGF-β1诱导组明显抑制（P〈0.05）,c-met表达较TGF-β1诱导组增加（P〈0.05）且呈剂量依赖性。结论：TGF-β1可以诱导肾小管上皮细胞肌成纤维细胞转分化,增加细胞外基质成分Col-Ⅰ、Col-Ⅲ和FN的分泌;黄芪能够抑制TGF-β1诱导的NRK52E细胞转分化以及细胞外基质的分泌;黄芪抑制细胞转分化的机制可能与其增强c-met的表达有关。     

霉酚酸酯抑制大鼠肾间质纤维化的研究

目的：研究霉酚酸酯（MMF）在单侧输尿管梗阻（UUO）大鼠模型中，能否减少肾小管间质肌成纤维细胞（MyoF)的浸润、增殖及I、Ⅲ型胶原（Col I、ColⅢ）的沉积。方法：将54只大鼠中的36只行左输尿管结扎术，另外18只行假手术。结扎后的大鼠分为模型组和MMF组。术后第5、10及15天分别处死各组中的6只大鼠，用免疫组化方法测定增殖细胞核抗原（PCNA）、α－平滑肌肌动蛋白（α-SMA）及Col I、Col Ⅲ的表达情况。行HE和Masson染色，动态观察肾脏病理学变化。结果：MMF能显著减少肾组织处于增殖状态下的细胞数目和肾小管间质区MyoF的浸润，减轻了Col I、Col Ⅲ的沉积，并有效改善了肾脏的病理学改变。结论：MMF可减少输尿管梗阻后MyoF的浸润并抑制其增殖，从而改善UUO所致的肾脏损伤，提示MMF有潜在的延缓慢性肾功能衰竭进程的作用。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.