鼠胆管结扎性肝损伤时肾神经与钠潴留的关系

将动物分为４组：对照组；单纯肾肾神经去除组；单纯胆管结扎组；胆管结扎＋双肾神经去除组。术后１６天，观察各组血浆肾素活性及肾对钠的代谢作用，结果发现，与对照组相比，双肾神经去除组各指标间无显著变化，胆管结扎鼠血浆痛素活性显著升高，钠代谢呈显著正平衡，显著高于其它３组，而胆管结扎＋双管神经去除鼠钠平衡代谢无显著变化，提示：肾神经在胆管结扎鼠钠潴留中发挥重要作用。     

高血压与肾交感神经活性的关系再评价

<正>高血压是一种常见的慢性疾病,常并发多种疾病而严重影响患者的生活质量,且增加心血管疾病患者的死亡风险,顽固性高血压的治疗至今仍是一个难题[1]。我们就高血压与肾交感神经活性的关系及治疗新技术做一综述。1高血压与肾交感神经的关系交感神经过度兴奋常常导致血压上升,而高血压患者也往往合并交感神经活性增加,尤其是肾交感神经活性增加。     

B型脑钠肽与肾血管性高血压关系研究的进展

肾血管性高血压(renal vascular hypertension,RVH)是继发性高血压常见病因之一,其发病率约为0.2%~5.0%。目前RVH越来越多地引起人们的重视,然而它缺乏特征性临床表现,且实验室检查对区分RVH和原发性高血压(EH)尚缺乏特异性。有文献报道B型脑钠肽(B-type natriuretic peptide,B     

肾去交感神经对心肌梗死后室性心律失常的影响

目的 探讨肾去交感神经(RDN)对成年犬心肌梗死后室性心律失常的作用.方法 8只成年健康比格犬随机分为2组:肾去交感神经组(RDN组,n=4)结扎冠状动脉前降支构建心肌梗死模型,心肌梗死后1 h给予外科+肾去交感神经消融;假手术组(Sham组,n=4)结扎冠状动脉,仅开腹分离肾动脉不进行肾去交感神经消融.对比两组犬的室...     

盐敏感性高血压与钠代谢及盐负荷后的肾排钠反应

用口服盐水负荷及速尿缩容试验相结合确定盐敏感者（ＳＳ），对人群中血压偏高青少年及高血压病人（ＥＨ）与血压正常对照者（ＮＴ）进行了年龄及性别配对研究。ＳＳ检出率在ＥＨ及高血压家族史阳性者中显著高于ＮＴ及高血压家族史阴性。ＳＳ血压值，夜尿钠量，血胰岛素水平等均明显升高，尿血管舒缓素排泄量减低，红细胞Ｎａ＋／Ｌｉ＋反转运增速。盐负荷后红细胞钠进一步升高，肾排钠反应呈现增强及减低两种类型，且后者的血浆肾素活性不被抑制，血压升高幅度亦大。提示盐敏感者有钠代谢缺陷，肾脏对盐负荷呈现调节及非调节两种类型。     

肾交感神经消融治疗难治性高血压的疗效与思考

虽然有多类化学药物用于高血压的治疗,但目前高血压的控制率仍很低,在未控制的高血压患者中,约30.0%为难治性高血压,即应用包含利尿剂的≥3种降压药物仍不能达标者.虽然难治性高血压的原因有很多,如依从性差、继发性高血压、配伍不合理和药物的相互作用等,但即使剔出这些因素,仍有5.0%的高血压患者属真正的顽固性高血压[1-2],因此,寻找新的治疗高血压的方法十分必要.继高血压疫苗之后,肾交感神经消融治疗为高血压的治疗提供了新的途径.     

经皮肾神经射频消融术的降压疗效及安全性:附两例报告

交感神经过度兴奋一直被认为是高血压发病的基础环节,其中肾脏交感神经系统对于诱发和保持高血压起着决定性作用.抑制交感神经的过度激活被认为是治疗高血压及其并发症的一个重要靶点,肾交感神经射频消融术(renal sympathetic denervation,RSD)作为一种新型的降压技术,备受广大临床医生关注.RSD通过插入肾动脉的射频导管释放能量,透过肾动脉的内中膜选择性毁坏外膜的肾交感神经纤维,以达到微创治疗顽固性高血压的目的.我们报道两例术后随访超过6个月的高血压患者,以期初步探讨RSD的疗效及安全性.     

舒张性心力衰竭大鼠循环及组织交感活性与肾胺酶的相关性研究

目的研究舒张性心力衰竭大鼠模型血浆及心肌组织肾胺酶与交感神经递质多巴胺、肾上腺素、去甲肾上腺素的关系,探讨其在舒张性心力衰竭中的作用。方法采用腹主动脉和左侧肾动脉同时缩窄的方法建立大鼠舒张性心力衰竭模型,通过超声心动图监测和左心导管检查评价舒张性心力衰竭大鼠模型。研究血浆交感神经递质与肾胺酶之间的关系。结果术后12周成功建立舒张性心力衰竭大鼠模型。与假手术组比较,手术模型组大鼠血浆交感神经递质水平明显增高[其中多巴胺(15707.34±2 518.76)ng/ml比(7 731.34±1 162.59)ng/ml,P<0.01;肾上腺素(161.15±36.93)ng/ml比(61.72±13.84)ng/ml,P<0.01;去甲肾上腺素(141.06±50.98)pg/ml比(55.66±20.28)pg/ml,P<0.01],而肾胺酶水平明显降低[(9.33±5.46)pg/ml比(19.07±6.88)pg/ml,P<0.01]。相关分析表明循环肾胺酶与多巴胺、肾上腺素、去甲肾上腺素水平具有负相关关系(相关系数r分别为-0.640、-0.594、-0.528,均为P<0.05),而心肌组织肾胺酶与多巴胺、肾上腺素、去甲肾上腺素水平无明显相关性(相关系数r分别为0.584、0.474、0.194,均为P>0.05)。结论采用联合腹主动脉和左侧肾动脉同时缩窄的方法可以成功建立大鼠舒张性心力衰竭模型,此时肾胺酶在交感神经活性改变中发挥一定作用。     

下丘脑室旁核氧化应激反应对心力衰竭时肾交感神经活动的影响

目的 探索心力衰竭(HF)时下丘脑室旁核(PVN)氧化应激反应是否能够增强肾交感神经(RSNA)活动,进而促进HF的发生发展.方法 取SD大鼠行冠脉结扎术制作心衰模型,对照组(SHAM)大鼠不结扎冠脉,两天后通过侧脑室插管给予tempol(氧自由基清除剂)或人工脑脊液(VEH).正常饲养4周后,测量各组大鼠血流动力学、RSNA、PVN区域NADPH亚基gp91 phox的表达.结果 HF组大鼠心功能明显低于SHAM组大鼠,RSNA增强、PVN区域NADPH亚基gp91 phox的表达增加.HF大鼠给予tempol治疗后心功能各项指标有所改善,RSNA减弱,PVN区域gp91 phox的表达降低,但达不到SHAM组水平.结论 心衰时PVN区域氧化应激反应增强与RSNA增加有关,降低该区域氧自由基水平可能延缓HF的发生发展过程.     

经皮肾去交感神经导管射频消融术对神经体液的影响

研究提示经皮肾去交感神经(RSD)对多种疾病产生治疗作用的机制可能与其对自主神经和体液调节的影响有关。RSD可使自主神经重获平衡;降低肾素、血管紧张素、醛固酮、去甲肾上腺素、心钠肽的水平;增加肾胺酶、活性氧;降低血糖和胰岛素水平。     

A CASE OF CHOLESTEROSIS OF THE COMMON BILE DUCT DIAGNOSED BY PERORAL CHOLANGIOSCOPY

We experienced a case of cholesterosis of the common bile duct in which peroral cholangioscopy (POCS) was very useful for making a diagnosis. The patient was a 66‐year‐old man. He was admitted for examination of an asymptomatic mass in the pancreas. The mass was diagnosed as a serous cystic tumor of the pancreas. While examining the tumor, endoscopic retrograde cholangiopancreatography (ERCP) incidentally revealed a 7 mm irregular filling defect in the distal common bile duct. EST was then performed, followed by POCS, which revealed a clump of yellowish‐white Ip or Isp polyps in the distal bile duct. Histological examination of biopsy specimens taken under direct vision gave a diagnosis of cholesterol polyps containing foamy cells. POCS was useful for allowing direct observation of the characteristic color of cholesterol polyps, and for obtaining biopsy specimens under direct vision.     

磁共振胆胰管成像对老年性胆总管扩张患者诊断价值

目的老年性胆总管扩张患者磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP）的诊断和鉴别诊断价值评估。方法回顾性分析197例老年性胆总管扩张患者MRCP检查及临床诊断与治疗结果进行比较。结果MRCP诊断为胆总管下端结石68例，急性胆囊炎，胆囊结石伴胆总管扩张57例，胆囊切除术后改变38例，胆囊颈管结石22例，胆道系统肿瘤7例，胰腺占位性病变5例，诊断符合率99．5％结论MRCP在老年性胆总管扩张的病因诊断和鉴别诊断中有重要价值。     

老年肝门部胆管癌的诊治特点

目的探讨老年肝门部胆管癌的诊治特点。方法回顾性分析111例60岁以上肝门部胆管癌的临床资料及随访情况。结果43例行肿瘤根治性切除，10例行肿瘤姑息性切除，20例行手术胆道引流，38例行内镜置管或PTCD引流。行根治性或姑息性肿瘤切除的患者，减黄效果、生活质量改善及术后生存时间均明显优于其他方法。结论对老年肝门部胆管癌的手术治疗应持积极态度。     

INTRADUCTAL ULTRASONOGRAPHY BEFORE BILIARY DRAINAGE AND TRANSPAPILLARY BIOPSY IN ASSESSMENT OF THE LONGITUDINAL EXTENT OF BILE DUCT CANCER

Aim: We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS‐BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal extent of bile duct cancer. Methods: Between November 1999 and January 2005, we performed IDUS‐BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS‐BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS‐BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated. Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS‐BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS‐BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS‐BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS‐BD and TPB. Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS‐BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS‐BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.     

大鼠急性坏死性胰腺炎合并肾损害及前列环素的保护作用

制作大鼠急性坏死性胰腺炎（ＡＮＰ）模型，观察肾组织学、肾功能的变化及前列环素（ＰＧＩ２）的影响。结果发现，ＡＮＰ模型制作后４８小时，肾组织出现严重的损害，肾功能明显下降，肾静脉血６－酮－ｐＧＦ１α／ＴＸＢ２比值、肾血流量及肾组织灌流量均明显下降。给予外源性ｐＧＩ２能明显增加６－酮－ｐＧＦ１α／ＶＴＸＢ２比值，增加肾血流量及肾组织灌流量，减轻肾组织学改变，改善肾功能。