肾小球肾炎系膜增殖和基底膜组成变化的相关研究

应用免疫组织化学方法检测了随机选择的９５例肾小球肾炎的Ⅳ型胶原和纤维连接蛋白。结果表明，两种抗原的表达和定位可分为单纯基底膜型和系膜，基底膜复合型，墓产殖明显的肾小球肾炎的Ⅳ型胶原和纤维连接蛋白阳性表达明显多于系统膜无增殖和轻微增殖的肾小球肾炎。     

MsPG肾小球Ⅳ－Col及LN的免疫组化和定量分析

取１１例系膜增生性肾炎（ＭｓＰＧ），活检新鲜标本，用ＡＢＣ免疫组化方法显示Ⅳ型胶原（Ⅳ－Ｃｏｌ）和层粘连蛋白（Ｌａｍｉｎｉｎ，ＬＮ）在肾小球中的分布，并经计算机图像分析系统进行定量分析。结果表明，实验组基膜的ＬＮ灰度明显高于对照组（Ｐ＜０．０１），而ＬＮ在系膜区的密度以及Ⅳ型胶原在系膜区和基膜的密度与对照组比较无显著性差异。提示ＭｓＰＧ肾小球毛细血管基底膜的ＬＮ含量增多。     

MsPG肾小球IV—Col及LN的免疫组化和定量分析

取１１例系膜增生性肾炎（ＭｓＰＧ）活检新鲜标本，用ＡＢＣ免疫组化方法显示Ⅳ型胶原（Ⅳ－Ｃｏｌ）和层粘连蛋白（Ｌａｍｉｎｉｎ，ＬＮ）在肾小球中的分布，并经计算机图像分析系统进行定量分析。结果表明，实验组基膜的ＬＮ灰度明显高于对照组（Ｐ〈０．０１），而ＬＮ在系膜区的密度以及Ⅳ型胶原在系膜区和基膜的密度与对照组比较无显著性差异。提示ＭｓＰＧ肾小球毛细血管基底膜的ＬＮ含量增多。     

肾炎大鼠肾小球α—SMA表达与基质增生的关系

为了进一步了解肾小球α平滑肌肌动蛋白（αｓｍｏｔｈｍｕｓｃｌｅａｃｔｉｎ，αＳＭＡ）的表达与肾炎发病时肾小球基质增生的关系，我们观察了大鼠肾毒血清肾炎（ｎｅｐｈｒｏｔｏｘｉｃｎｅｐｈｒｉｔｉｓ，ＮＴＮ）发病１～１４ｄ肾脏组织形态、肾功能、肾小球αＳＭＡ和血小板衍生的生长因子（ｐｌａｔｅｌｅｔｄｅｒｉｖｅｄｇｒｏｗｔｈｆａｃｔｏｒ，ＰＤＧＦ）以及基质成分纤维连接蛋白（Ｆｉｂｒｏｎｅｃｔｉｎ，ＦＮ）、胶原Ⅲ和Ⅳ型的表达，并对αＳＭＡ、ＰＤＧＦ及基质成分间进行相关性分析。研究显示，ＮＴＮ第３天大鼠肾小球表达αＳＭＡ和ＰＤＧＦ，先于ＦＮ的表达和胶原Ⅳ型的增多。在ＮＴＮ第７和１４天，αＳＭＡ和ＰＤＧＦ表达增加，并且两者间及与ＦＮ和胶原Ⅳ型之间呈显著正相关。在ＮＴＮ各时间点均未能在肾小球中检测出胶原Ⅲ型的存在。研究表明，注射抗血清引起的肾小球免疫损伤刺激肾小球系膜细胞表达αＳＭＡ是系膜细胞被激活后大量分泌基质的标志。系膜区ＰＤＧＦ的分泌进一步加强了系膜细胞αＳＭＡ的表达及基质增生。     

早期糖尿病大鼠肾小球中纤维连接蛋白和碱性成纤维细胞生长因子的表达

采用链脲佐菌素建立大鼠糖尿病（ＤＭ）模型，观察ＤＭ形成后１、２、４周肾小球中纤维连接蛋白（ＦＮ）和碱性成纤维细胞生长因子（ｂＦＧＦ）的表达。结果：ＦＮ在ＤＭ１周和２周鼠肾小球内的表达无明显变化；在第４周，ＦＮ除了系膜区染色明显加深外（Ｐ〈０．０５），还出现了肾小球基底膜的强染。在第１周，模型鼠肾小球系膜区ｂＥＧＦ染色较正常加强（Ｐ〈０．０５），第２周恢复到基础水平，第４周在系膜区又出现了较１周时更强的表达（Ｐ〈０．０５）。上述结果提示，ＤＭ早期肾小球内即有细胞外基质的堆积，ＦＮ为一般感指标；ｂＦＧＦ后期表达上调与ＦＮ沉积有关。     

图像分析技术在肾小球肾炎病理学研究中的应用

将临床确诊为系膜增生性肾小球肾炎（ＭｓＰＧＮ）的病例分为轻、中、重三组，从每组中随机抽取１０例作为实验组１、２、３，取３例正常肾组织作为对照组。然后对所选取的３３例分别进行光镜图像分析，间接免疫荧光检查。结果显示：在Ｍａｓｓｏｎ染色的绿染部分分析结果中，中、重度ＭｓＰＧＮ与正常比较有显著性差异（Ｐ＜０．０５），ＰＡＳＭ黑染中，重度与正常比较有显著性差异（Ｐ＜０．０５）。间接免疫荧光见：对照组肾小球内未见Ⅲ型胶原，有少量Ⅳ型胶原分布于毛细血管基膜及系膜区，Ⅲ型胶原在中、重度ＭｓＰＧＮ中出现，Ⅳ型胶原随着病变进展明显增加。以上结果表明：Ⅲ、Ⅳ型胶原的出现及增加在肾小球肾炎的病变过程中起着重要作用。图像分析技术对肾小球肾炎的诊断具有一定的临床价值     

糖基化终末产物对肾小球系膜细胞表达纤溶酶原激活物抑制物1的影响

探讨非酶促糖基化终末产物是否影响肾小球系膜细胞降解肾小球细胞外基质的丝氨酸蛋白酶－纤溶酶原激活物抑制物１（ＰＡＩ－１）基因表达和生物学活性。方法用体外制备的非酶促糖基化牛血清白蛋白（ＡＧＥ－ＢＳＡ）作用人肾小球系膜细胞２４小时和４８小时，观察对细胞增殖、纤维连接蛋白分泌、ＰＡＩ－１基因表达和生物学活性的作用。结果ＡＧＥ－ＢＳＡ抑制肾小球系膜细胞增殖，促进纤维连接蛋白分泌，上调ＰＡＩ－１生物学活性。ＡＧＥ－ＢＳＡ作用系膜细胞２４小时后，ＰＡＩ－１基因表达显著增加（０．６５％±０．０８％，对照０．４５％±０．０６％，Ｐ＜０．０５）；４８小时后ＰＡＩ－１基因表达增加更趋显著（０．９２％±０．１０％，对照０．５１±０．０８，Ｐ＜０．０１）。结论非酶促糖基化终末产物增加肾小球系膜细胞ＰＡＩ－１基因表达和生物学活性，参与了肾小球细胞外基质积聚和肾小球硬化的病理生理过程。     

洛伐他汀对人肾小球系膜细胞胰岛素样生长因子-1表达的影响

目的：观察HMG-CoA还原酶抑制剂洛伐他汀对人肾小球系膜细胞胰岛素样生长因子-1(IGF-1)表达及纤维连接蛋白、层连蛋白和Ⅳ型胶原分泌的影响。方法：分别于体外低糖(5．6mmol／L)和高糖(30mmol／L)环境中培养人胎肾小球系膜细胞．用RT-PCR法检测系膜细胞IGF-1 mRNA表达水平,用酶免和放免法测定细胞上清液中纤维连接蛋白、层黏连蛋白和Ⅳ型胶原含量。分别在培养液中加入洛伐他汀或／和西拉普利,观察不同刺激时间和药物浓度对上述基质蛋白指标的影响。选择刺激时间48h和刺激浓度10μmol／L,观察单用或联用洛伐他汀和西拉普利对系膜细胞IGF-1 mRNA表达的影响。结果：高糖环境下肾小球系膜细胞过度增殖,细胞上清液中纤维连接蛋白、层黏连蛋白和Ⅳ型胶原含量增加,IGF-1 mRNA表达明显增加。洛伐他汀和西拉普利均可明显抑制系膜细胞增殖,降低细胞上清液中基质蛋白浓度,IGF-1 mRNA表达亦显著下降。洛伐他汀对IGF-1 mRNA表达的抑制作用略强于西拉普利,但两者联用未显示更强的抑制效果。结论：高糖可刺激人肾小球系膜细胞IGF-1高表达,并增加基质蛋白的分泌,洛伐他汀与西拉普利类似,均可一定程度逆转上述现象,提示他汀类药物可能有益于早期糖尿病肾病的防治。     

系膜增生性肾小球肾炎中的Ⅲ,Ⅳ型胶原和层粘连蛋白变化探讨

系膜增生性肾小球肾炎中的Ⅲ、Ⅳ型胶原和层粘连蛋白变化探讨第二军医大学长征医院病理科叶廷军，陈泳莲，刘会敏系膜增生性肾小球肾炎（ｍｅｓａｎｇｉａｌｐｒｏ－ｌｉｆｅｒａｔｉｖｅｇｌｏｍｅｒｕｌｏｎｅｐｈｒｉｔｉｓ，ＭｓＰＧＮ）是以系膜区细胞外基质的进行性...     

苯那普利对抗Thy1.1大鼠系膜基质积聚的影响

目的 观察血管紧张素转换酶抑制剂苯那普利对系膜增殖性肾炎（MsPGN）大鼠系膜基质的影响。方法 用抗胸腺细胞血清（ATS）诱导SD大鼠产生MsPGN后，用苯那普利治疗24d，处死大鼠并用ELISA方法测定大鼠肾小球系膜中胶原Ⅳ（ColⅣ）、胶原Ⅲ（ColⅢ）、层粘连蛋白（LN）、纤维连接蛋白（FN）的含量。结果 治疗组大鼠系膜中ColⅣ、ColⅢ、LN、FN的含量明显低于对照组大鼠系膜中各相应成分的含量，各对应成分之间两两比较差异均有统计学意义（P〈0．01）。结论 苯那普利对MsPGN大鼠系膜基质的积聚有明显的抑制作用。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.