卒中后抑郁状态患者的血浆、脑脊液单胺类神经递质测定

为探讨卒中后抑郁状态与血浆、脑脊液单胺类递质水平的关系,采用高压液相色谱仪,测定32例卒中后抑郁状态患者、30例卒中后无抑郁状态患者及28名正常人的血浆、脑脊液单胺类递质水平,进行对照分析。结果,卒中后抑郁状态患者血浆、脑脊液中单胺类递质水平多巴胺(DA)=(2.6±0.4)μmol/L,(2.0±0.3)μmo/L;去甲肾上腺素(NE)=(0.19±0.06)μmol/L,(0.14±0.06)μmol/L;5-羟色胺(5-HT)=(1.09±0.30)μmol/L,(0.60±0.12)μmol/L]低于卒中后无抑郁组[DA=(3.2±0.5)μmol/L,(2.6±0.4)μmol/L;NE=(0.31±0.12)μmol/L,(0.28±0.08)μmol/L;5-HT=(1.31±0.40)μmol/L,(1.11±0.40)μmol/L]及正常对照组[DA=(2.9±0.5)μmol/L,(2.2±0.6)μmo/L;NE=(0.27±0.70)μmol/L,(0.23±0.08)μmol/L;5-HT=(1.19±0.30)μmol/L,(0.88±0.07)μmol/L],而大脑左侧及前部卒中患者的血浆、脑脊液中单胺类递质水平低于其它卒中部位患者(P<0.05),脑脊液单胺类递质水平与抑郁程度呈负相关(P<0.05)。提示:卒中后抑郁状态的发生与血浆、脑脊液中单胺类神经递质的降低有关。     

活血化瘀药对大鼠脑缺血再灌注血管源性脑水肿的影响

目的:探讨预防性应用活血化瘀药对大鼠脑缺血—再灌注所致血管源性脑水肿的作用。方法:大鼠138只单纯随机分为:对照组;假手术组;低剂量短时干预组;高剂量短时干预组;低剂量长时干预组和高剂量长时干预组,采用线栓法制备大鼠大脑中动脉阻塞模型。测定大鼠神经功能缺损程度,检测脑水含量、血清及脑匀浆一氧化氮含量及光镜、电镜的病理改变。结果:药物干预组鼠神经功能缺损程度较对照组轻(P<0.01),药物干预组血清一氧化氮含量:假手术组(106.5±7.5)μmol/L,低剂量短时干预组(94.6±7.9)μmol/L,高剂量短时干预组(104.7±6.1)μmol/L,低剂量长时干预组(104.6±5.6)μmol/L,高剂量长时干预组(112.6±9.3)μmol/L较对照组(85.7±6.1)μmol/L高,差异有显著性意义(t=-7.673～-2.832,P<0.05),脑匀浆一氧化氮含量:假手术组(46.9±7.8)μmol/L,低剂量短时干预组(85.9±5.2)μmol/L,高剂量短时干预组(86.7±5.3)μmol/L,低剂量长时干预组(81.6±3.9)μmol/L,高剂量长时干预组(65.5±7.2)μmol/L较对照组(99.8±2.6)μmol/L低(t=7.011～20.361,P<0.01),病理损害较对照组轻。结论:活血化瘀药能减少缺血再灌注大鼠脑的一氧化氮产生,降低血管源性脑水肿的程度,减轻神经细胞损伤,具有抗缺血再灌注损伤作用。     

缺铁大鼠耳蜗组织铁降低对耳蜗听功能的影响

目的检测缺铁大鼠耳蜗组织微量元素含量及听阈改变。方法复制缺铁大鼠模型，测大鼠客观听阈改变，用原子吸收光谱法测定大鼠血清微量元素及耳蜗组织微量元素含量。结果缺铁组和正常组大鼠血清铁分别为(14.93±9.72)μmol/L、(46.11±18.3)μmol/L缺铁组和正常组大鼠耳蜗组织铁含量分别为(179.80±24.70)pmol/L，(410.18±111.96)pmol/L；缺铁组大鼠听阈提高＞15dB的发生率远高于对照组。结论缺铁大鼠不仅血清铁降低，耳蜗组织铁也降低，同时影响到耳蜗听功能。     

复方水蛭合剂对大鼠局灶性脑缺血细胞因子免疫损伤的保护作用

目的:探讨复方水蛭合剂对局灶性脑缺血细胞因子免疫损伤的保护作用。方法:Wistar大鼠正常组6只,空白对照组12只,复方水蛭合剂组36只。检测大鼠大脑中动脉缺血后6,24h脑组织匀浆白细胞介素1、肿瘤坏死因子、一氧化氮的变化及复方水蛭合剂对其影响。结果:大鼠大脑中动脉缺血后6,24h模型组脑组织匀浆肿瘤坏死因子、白细胞介素1、一氧化氮犤6h:(73.47±7.04)kIU/L,(0.87±0.05)μg/L,(89.07±6.69)μmol/L;24h:(90.75±7.63)kIU/L,(0.98±0.07)μg/L,(114.16±9.03)μmol/L犦明显比正常组犤(57.55±4.85)kIU/L,(0.70±0.09)μg/L,(51.43±5.49)μmol/L犦高(P<0.01),大、中剂量复方水蛭合剂组明显比空白对照组低(P<0.05～0.01,)。病理形态学检查:大、中剂量复方水蛭合剂组与空白对照组比较均较轻。结论:复方水蛭合剂对脑缺血所致的细胞因子的免疫损伤有保护作用。     

妊娠肝内胆汁淤积症胆汁酸水平与胎儿宫内缺氧的关系

目的探讨妊娠肝内胆汁淤积症(ICP)母儿胆汁酸水平与胎儿宫内缺氧的关系。方法采用循环酶法测定ICP孕妇117例(ICP组)及正常孕妇137例(正常对照组)的母血及脐血胆汁酸浓度。结果ICP组母血胆汁酸浓度(36.03±23.25)μmol/L,显著高于正常对照组(7.84±2.73)μmol/L(P<0.001);ICP组胎儿脐血总胆汁酸浓度(38.79±26.67)μmol/L,高于正常对照组(5.61±2.44)μmol/L(P<0.001),且与母血胆汁酸浓度呈正相关(r=0.841,P<0.001)。ICP组围生儿缺氧的发生率明显高于正常对照组(28.21%vs7.30%,P<0.05)。ICP组中缺氧组母血、脐血胆汁酸水平均高于无缺氧组,(分别为P<0.05、P<0.01)。结论ICP孕妇的胎儿胆汁酸浓度增高,与母血总胆汁酸浓度呈正相关。ICP时母儿均存在胆汁酸的淤积,过高的胆汁酸的细胞毒作用可能是ICP围生儿缺氧的机制之一。     

缺血后处理对异品系大鼠移植肝脏的保护作用

目的:观察缺血预处理和缺血后处理对异品系大鼠移植肝脏肝功能、抗氧化酶活力、脂质过氧化物产物、炎性细胞因子和病理组织学变化的影响,探讨在体条件下,缺血后处理对异品系大鼠移植肝脏是否具有保护作用。方法:实验于2003-12/2004-08在陕西西安第四军医大学唐都医院中心实验室完成。采用健康雄性SD大鼠和Wistar大鼠各36只,随机分为3组,每组SD大鼠和Wistar大鼠各12只,行SD大鼠至Wistar大鼠的原位肝移植。①对照组:供肝切除前及移植后无特殊处理。②预处理组:获取供肝前短暂肝脏缺血作为预处理。③后处理组:供肝植入后完全再灌注前,给予多次短暂复灌复停作为缺血后处理。接受肝移植后各组大鼠取6只于再灌注后2h留取血液及肝脏,检测血清肝功、炎性细胞因子、肝组织过氧化产物和抗氧化酶水平,另6只于再灌注后6h取肝脏制成切片进行病理学检测。结果:完成实验大鼠72只。①再灌注后2h的血清天冬氨酸转氨酶、丙氨酸转氨酶、乳酸脱氢酶含量:预处理组及后处理组明显低于对照组(P<0.05～0.01);而预处理和后处理组之间无明显差异(P>0.05)。②再灌注后2h肝组织的谷胱甘肽过氧化物酶、超氧化物歧化酶活力:预处理组明显高于对照组[(1.560±0.240)μkat/g,(15.981±2.113)kNU/g,(0.991±0.075)μkat/g,(11.945±1.146)kNU/g,P<0.01];后处理组亦明显高于对照组[(1.326±0.305)μkat/g,(15.596±2.361)kNU/g;(0.991±0.075)μkat/g,(11.945±1.146)kNU/g,P<0.01]。③再灌注后2h丙二醛和髓过氧化物酶含量:预处理组明显低于对照组[(0.539±0.008)μmol/g,(0.548±0.101)/(min·g);(0.816±0.105)μmol/g,(0.935±0.279)/(min·g),P<0.01];后处理组亦明显低于对照组[(0.554±0.116)μmol/g,(0.569±0.162)/(min·g),P<0.01,0.05];而预处理和后处理组间无明显差异(P>0.05)。④移植术后2h血清肿瘤坏死因子α、中性粒细胞弹性蛋白酶含量:预处理组、后处理组均明显低于对照组[(28.000±8.579),(20.000±3.578)ng/L;(32.500±6.058),(22.833±4.167)ng/L;(53.667±18.854),(35.000±6.033)ng/L,P<0.01,0.05];预处理和后处理组间无显著差异(P>0.05)。⑤移植术后6h组织病理切片改变:预处理组和后处理组也明显轻于对照组。结论:缺血后处理和缺血预处理对异品系大鼠移植肝脏具有相似的保护作用,能够改善移植后肝脏功能,提高组织的抗氧化能力,减轻移植后的缺血再灌注损伤。移植后炎性细胞因子水平的降低和单核细胞浸润的减轻可能是缺血后处理发挥其对异品系大鼠移植肝脏保护作用的机制之一。     

电针对癫痫大鼠脑组织及肝脏的一氧化氮和一氧化氮合酶含量的影响

目的:探讨电针对癫痫大鼠脑组织和肝组织中一氧化氮,一氧化氮合酶(nitricoxidesyntheses,NOS)的影响,以及电针治疗癫痫的可能机制。方法∶实验于2004-03/10在南京中医药大学第二临床医学院实验室完成。选择SD大鼠40只,随机分成为正常组、模型组、电针组、假针刺组,每组10只。采用比色法测定对癫痫造模大鼠的一氧化氮,NOS和一氧化氮/NOS比值进行随机对照分析性研究。结果∶模型组脑一氧化氮犤(19.76±2.66)μmol/L犦,NOS犤(498.8±94.7)nkat/g犦和一氧化氮/NOS比值(1.38±0.46)明显高于正常组(P<0.05),电针组脑一氧化氮犤(6.04±3.52)μmol/L犦,NOS犤(203.9±102.2)nkat/g犦和一氧化氮/NOS比值(1.00±0.57)明显低于模型组(P<0.05),假针刺组一氧化氮,NOS和一氧化氮/NOS含量不明显变化。肝组织中各项因子变化与脑组织中变化一致。结论∶电针对癫痫大鼠的一氧化氮,NOS和一氧化氮/NOS有显著的抑制调节作用。这可能是电针治疗癫痫临床取得疗效的重要机制之一。     

硒和/或维生素E对高脂血症大鼠心、肝、肾及血清脂质过氧化的作用

目的:研究硒和/或维生素E对抗高脂饲料所致实验性高脂血症大鼠心、肝、肾及血清脂质过氧化的作用,为临床应用硒和维生素E类产品防治由血脂代谢紊乱所致的脂质过氧化损伤相关性疾病提供理论依据和实验资料。方法:SD大鼠50只,雌、雄各半,以性别及体质量随机分为5组,采用高脂饲料致大鼠实验性高脂血症,然后分别分组给予经预试后的硒和/或维生素E,4周后行乙醚麻醉取血,同时取心、肝、肾组织作匀浆,采用硫代巴比妥(thiobarbituricacid,TBA)法测各组织或血清丙二醛(Malonaldehyde,MDA)含量以反映脂质过氧化水平。结果:高脂饲料可致实验性高脂血症,与对照组比较,其中三酰甘油、极低密度脂蛋白胆固醇(verylowdensitylipoproteincholesterol,VLDL-C)明显升高(P<0.05);总胆固醇、低密度脂蛋白胆固醇(lowdensitylipopro-teincholesterol,LDL-C)显著升高(P<0.01)。同时,高脂饲料可致部分组织或血清的脂质过氧化作用加强,对照组心、肝、肾及血浆中丙二醛含量分别为(0.775±0.346),(0.575±0.161),(0.576±0.414)μmol/g和(9.385±4.13)μmol/L;高脂饲料组分别为(0.958±0.416),(0.874±0.140),(0.926±0.388)μmol/g和(14.092±5.63)μmol/L。实验中,加用硒或维生素E或两者合用能使实验性高脂血症所致的丙二醛含量降     

不同剂量铁对高能饲料诱导肥胖大鼠体质量、体脂及血瘦素的干预效果

目的:探讨不同剂量铁对高能饲料诱导的肥胖大鼠体质量、体脂及胰岛素、瘦素、生长激素的影响。方法:实验在哈尔滨医科大学公共卫生学院完成。将高能、高脂饲料诱导的肥胖大鼠45只按体质量随机分为5组,每组9只,分别给予含缺铁、正常铁、5倍、10倍和20倍铁的高能、高脂饲料,喂养7周,记录给食量和摄食量,检测血脂、瘦素、胰岛素、生长激素及体质量、体脂。结果:45只实验大鼠均进入结果分析。补铁对肥胖大鼠体质量、三酰甘油、胆固醇、高密度脂蛋白、胰岛素和生长激素无显著性影响(P>0.05),但可使体脂含量降低犤正常铁组(4.82±1.28)%,5倍铁组(3.60±0.89)%,10倍铁组(3.72±0.81)%,20倍铁组(3.66±1.34)%,各组与正常铁组比较,P<0.01犦,血瘦素水平下降犤正常铁组(8.49±1.97)μg/L,5倍铁组(7.31±1.18)μg/L,10倍铁组(7.03±1.48)μg/L,20倍铁组(7.47±1.07)μg/L,P<0.05犦。结论:补铁可使肥胖大鼠脂肪分解,改善肥胖引起的高血瘦素水平。     

桑寄生对肾性高血压大鼠血浆β-内啡肽浓度影响的量效作用

目的:探讨降压作用明显的桑寄生对肾性高血压大鼠血浆β-内啡肽浓度的影响。方法:实验于2003-03/12在重庆医科大学动物实验中心完成。取Wistar大鼠60只,随机分5组,桑寄生细粉蒸馏水配制成浓度分别为200g/L和100g/L桑寄生组(100mL药液中分别含桑寄生药材细粉10g和20g)、卡托普利组(阳性对照组,蒸馏水配成10mL/L浓度)、蒸馏水组(模型组)和假手术组,每组12只。用“二肾一夹法”复制肾性高血压模型,术后分别以200g/L桑寄生、100g/L桑寄生、10mL/L卡托普利、蒸馏水20mL/kg灌胃,假手术组不进行肾动脉狭窄造模仅用蒸馏水灌胃。上述处理连续26d,于第27天测定血浆β-内啡肽浓度应用放射免疫法。结果:60只大鼠均进入结果分析。β-内啡肽浓度:①模型组明显高于假手术组犤(2.31±0.24,1.97±0.30)μg/L,(P<0.01)犦。②200g/L桑寄生组明显低于模型组犤(1.87±0.26,2.31±0.24)μg/L,(P<0.01)犦。③100g/L桑寄生组和卡托普利组低于模型组犤(2.09±0.28,2.31±0.24)μg/L,(2.08±0.22,2.31±0.24)μg/L,(P<0.05)犦。结论:桑寄生能降低模型大鼠血浆β-内啡肽浓度,该作用在200g/L时效果最好。     

幽门螺旋杆菌感染与肝硬化高氨血症及肝性脑病发病的相关性研究

目的 了解幽门螺旋杆菌(HP)感染与血氨水平及肝性脑病(HE)发病的相关性,探讨根除HP对血氨水平和HE发病的影响.方法 收集368例肝硬化患者,记录其性别、年龄、数字连接试验(NCT)结果、HP感染率、肝功能Child-Pugh分级、血氨水平和HE情况.HP阳性患者予以奥美拉唑+克拉霉素+阿莫西林1周根除治疗,1个月后复查13C尿素呼气试验,记录患者的神经、精神症状和血氨水平.结果 ①本组肝硬化患者的HP感染率为70.1%(258/368例);HE发生率为51.4%(189/368例);未发生HE的肝硬化患者中,179例进行了NCT,检出亚临床肝性脑病(SHE)患者85例(占47.5%).②HP阳性肝硬化患者血氨浓度[(79.3±61.8)μmol/L]显著高于HP阴性者[(52.7±49.8)μmol/L,P＜0.01];根除HP后血氨水平明显下降[(52.6±36.5)μmol/L,P＜0.01].HP阳性和HP阴性肝硬化患者HE发生率比较差异有显著性(59.6%比31.8%,P＜0.01);根除HP后HE发生率降至32.8%,与根除前比较差异有显著性(P＜0.01).③HE、SHE和肝硬化患者的HP感染率分别为81.5%、68.5%和53.9%(P均＜0.05),HE患者的血氨水平[(96.6±78.2)μmol/L]显著高于SHE患者[(60.5±50.4)μmol/L]和肝硬化患者[(46.8±36.4)μmol/L,P均＜0.01].结论 HP感染可加重肝硬化高氨血症,促成HE发作,根除HP有助于治疗和预防肝硬化HE发生.     

Evaluation of plasma ammonia levels in patients with acute liver failure and chronic liver disease and its correlation with the severity of hepatic encephalopathy and clinical features of raised intracranial tension

OBJECTIVES: The present study was designed to (a) evaluate and compare plasma ammonia levels (PAL) in patients with acute liver failure (ALF) and chronic liver disease (CLD) with or without hepatic encephalopathy (HE); (b) correlate the severity of HE with PAL; and (c) correlate PAL with clinical features of raised intracranial tension in ALF. DESIGN AND METHODS: A total of 40 patients, comprised of 20 patients with ALF (Group A) and 20 patients with CLD (Group B, which was comprised of 8 patients with HE (subgroup B1) and 12 patients without HE (subgroup B2)), were studied. PAL was estimated using an enzymatic UV-method (RANDOX). The clinical and biochemical profile of all the patients was recorded. Correlation between the grade of HE and PAL was derived using Pearson's correlation coefficient. The mean PAL of ALF patients with and without raised intracranial tension was compared using the standard error of difference between the two means. RESULTS: The mean PAL (micromol/L) +/- SD was as follows: Group A: 172.1 +/- 52.55, subgroup B1: 58.75 +/- 29.38, subgroup B2: 42.17 +/- 18.19 (normal levels = 10-47 micromol/L). All patients with ALF showed PAL more than the upper limit of the normal range, and there was good correlation between the severity of HE and PAL [r = 0.91 at P < 0.05]. In subgroup B1 (CLD with HE), 3/8 patients (37.5%), and in subgroup B2 (CLD with HE), 4/12 patients (33.3%) patients had PAL more than the upper limit of normal range. Within Group A, 14 patients had clinical features of raised intracranial tension/cerebral edema, and the mean PAL of these patients (188.21 +/- 49.15 micromol/L) was significantly higher than those who did not have features of raised intracranial tension (134.5 +/- 42.36 micromol/L) (SE of difference between two means). CONCLUSIONS: Raised PAL appears to be an important laboratory abnormality seen in patients with ALF, and there seems to be a significant correlation between the severity of encephalopathy and PAL in these patients. However, among patients with CLD, the proportion of patients with PAL more than the upper limit of normal range is not significantly different between those with or without HE. Our study also suggests that high PAL in ALF patients appears to correlate with clinical features of cerebral edema and raised intracranial tension.     

SARS患者的肝脏损害

目的　研究严重急性呼吸综合征 (SARS)患者肝脏功能和肝组织病理学的变化 ,探讨 SARS患者肝脏损害的可能机制及其临床意义。方法　依据中华人民共和国卫生部诊断标准 ,选择 2 0 0 3年 2— 6月收治的 SARS患者 110例检测肝脏功能 ,其中 8例死亡者行肝组织病理学检查 ;并与健康体检者 35例进行比较。结果　 SARS组患者血清丙氨酸转氨酶 (AL T)、天冬氨酸转氨酶 (AST)、总胆红素 (TBil)、乳酸脱氢酶(L DH)水平均显著高于对照组 ,分别为 (91.6 1± 5 0 .5 3) U/ L 比 (32 .91± 10 .5 6 ) U/ L,(78.6 8± 33.32 ) U/ L 比(2 9.4 3± 8.89) U/ L,(11.6 7± 4 .2 6 ) μmol/ L 比 (8.4 4± 3.86 ) μmol/ L,(42 9.95± 188.94 ) U/ L 比 (2 0 0 .83±4 4 .86 ) U / L ,P均 <0 .0 0 1;白蛋白 (AL B)和前白蛋白 (PAB)均明显低于对照组 ,分别为 (34.4 0± 5 .13) g/ L比(42 .0 9± 6 .79) g/ L和 (0 .2 0± 0 .0 6 ) g/ L比 (0 .34± 0 .0 5 ) g/ L ,P均 <0 .0 0 1;血清直接胆红素 (DBil)、总胆汁酸 (TBA)、γ谷氨酰转肽酶 (GGT )、碱性磷酸酶 (AL P)水平与对照组无差异 (P均 >0 .0 5 )。 AL T、AST、GGT、L DH变化范围较大 ,为正常范围 4～ 9倍 ,其余各项变化范围较小。AL T、AST和 PAB异常率达 80 .0 %以上 ,AL     

脑钠肽和内皮素在冠状动脉旁路移植术中的变化及意义

目的 观察氨基末端B型脑钠肽(Nt-proBNP)和大内皮素(bigET)在冠状动脉旁路移植术(CABG)前后的变化及其对术后近期并发症的预测价值.方法 分析47例常规体外循环冠状动脉旁路移植术(CCABG)和43例非体外循环冠状动脉旁路移植术(OPCAB)患者术前和术后24 h Nt-proBNP、bigET水平变化,及其对术后近期并发症的预测因子.结果 ①术后24 h CCABG和OPCAB两组Nt-pro BNP和bigET均明显升高,CCABG组Nt-proBNP由术前(1 083.5±717.9)pmol/L升到术后24 h(1 579.2±719.7)pmol/L(t=-4.30,P＜0.01),bigET由术前(1.10±1.82)pmol/L升到术后24 h(1.68±1.73)pmol/L(t=-5.35,P＜0.01);OPCAB组Nt-proBNP由术前(999.6±843.6)pmol/L升到术后24 h(1 460.8±830.0)pmol/L(t=-4.20,P＜0.01),bigET由术前(1.35±1.65)pmol/L升到术后24 h(1.73±1.50)pmol/L(t=-2.46,P=0.018).②术前Nt-proBNP水平与左室射血分数(LVEF)呈负相关(r=-0.43,P＜0.001).③经单变量和多变量Logistic回归分析,LVEF[相对比值比(OR)=1.045,95%可信区间(CI)为0.999～1.092,P=0.050]、术后24 h Nt-proBNP(OR=0.990,95%CI为0.999～1.000,P=0.014)水平是术后心力衰竭、低心排、围手术期心肌梗死、死亡、脑梗死的独立预测因子.经受试者工作特征曲线(ROC)分析术后24 hNt-proBNP＞1 174.41 pmol/L时,曲线下面积为0.698,95%CI为0.585～0.811,P＜0.003,敏感性为88.9%,特异性为57.1%,可预测近期并发症.结论 CABG术后Nt-proBNP、bigET明显升高;LVEF、术后24 h Nt-proBNP水平可预测术后近期并发症的发生.     

低分子肝素治疗脓毒症的前瞻性临床研究

目的 探讨低分子肝素对脓毒症的治疗作用。方法 40例脓毒症患者随机分为常规治疗组和 低分子肝素治疗组。观察两组患者治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、住重症监护治 疗病房(ICU)时间和28 d病死率差异,以及治疗前后白细胞介素-6(IL-6)、丙二醛(MDA)、超氧化物歧化酶 (SOD)、凝血功能和血小板计数(PLT)变化。结果 低分子肝素治疗组随治疗时间的延长,APACHEⅡ评分 和IL-6水平均下降,治疗后7 d与治疗前比较差异均有显著性(P均<0．05);而常规治疗组呈现先降后升 的趋势;治疗后7 d低分子肝素治疗组APACHE Ⅱ评分和IL-6水平均明显低于常规治疗组(P均<0．05)。 低分子肝素治疗组住ICU时间为(9．92±6．81)d,28 d病死率为40．9％,均低于常规治疗组(12．85±9．14)d 和50．0％,但差异无显著性。低分子肝素治疗组治疗后SOD明显升高[(159．13±99．31)kU／L比(318．38± 254．29)kU／L],MDA明显下降[(17．72±14．89)μmol／L比(6．62±5．53)μmol／L];常规治疗组则均呈相反 的变化趋势[SOD(180．99±169．40)kU／L比(135．16±107．73)kU／L;MDA(17．25±15．74)μmol／L比 (20．77±16．87)μmol／L];治疗后两组比较差异均有显著性(P均<0．05)。两组患者凝血酶原时间(PT)、白陶 土部分凝血酶原时间(KPTT)、纤维蛋白原(FIB)、PLT水平治疗前后差异均无显著性。结论 低分子肝素治 疗脓毒症可抑制炎性介质和氧自由基的释放,临床应用安全,无严重并发症。     

Caspase-cleaved cytokeratin 18 and 20 S proteasome in liver degeneration

Apoptosis of epithelial hepatocytes plays a pivotal role in acute as well as in chronic liver diseases. The cleavage of cytokeratin-18 (CK-18) by caspases is an early event in the apoptotic process. We therefore sought to investigate serum levels of CK-18 and 20S proteasome in patients with liver cirrhosis, primary graft dysfunction (PDF), and acute liver failure (ALF), and in healthy volunteers. Enzyme-linked immunosorbent assay (ELISA) was utilized to measure the concentration of M30, a fragment of CK-18 cleaved at Asp396 (M30 neoantigen), and the concentration of 20S proteasome. Serum levels of the CK-18 neoepitope M30 were significantly increased in ALF, primary graft dysfunction, and liver cirrhosis vs. healthy controls (1,993.6+/-124.7 U/L, 2,238.1+/-235.9 U/L, and 673.6+/-86.5 U/L vs. 66.8+/-29.1 U/L, respectively, P<0.001). Similar results were detected with the evaluation of 20S proteasome (124,014.5+/-13,235.6 ng/mL, 76,993.2+/-15,720.1 ng/mL, and 2,395.9+/-1,098.2 ng/mL vs. 1,074.5+/-259.4 ng/mL, respectively; P<0.001). Detection of CK-18 neoepitope M30 and 20S proteasome may represent a novel marker of tracing apoptotic epithelium, respectively mirroring degenerative liver processes in affected patient population.     

对机械通气患者呼出气冷凝液中过氧化氢的研究

目的 探讨呼吸重症加强治疗病房(RICU)机械通气患者呼出气冷凝液(EBC)中过氧化氢(H2O2)浓度与呼吸道炎症反应及预后的关系.方法 采用自行设计的EBC收集器,对36例机械通气患者在通气1、3、5和7 d收集呼气端的EBC,应用化学荧光法测定EBC中H2O2浓度,并进行统计学分析.结果 存活组机械通气3、5和7 d EBC中H2O2浓度较1 d明显降低,差异有统计学意义[(0.105±0.032)μmol/L、(0.072±0.034)μmol/L、(0.047±0.029)μmol/L比(O.192±0.135)μmol/L,P均O.05).死亡组机械通气7 d EBC中H2O2浓度较1、3和5 d明显升高,差异有统计学意义[(0.234±0.152)μmol/L比(0.055±0.029)μmol/L、(0.088±0.040)μmol/L、(0.150±0.134)μmol/L,P均0.05).与存活组比较,死亡组机械通气1 d EBC中H2O2浓度明显降低(PO.05);5 d和7 d时明显增高,差异有统计学意义(P均<0.05).存活组和死亡组机械通气患者EBC中H2O2浓度与APACHEⅡ、Ⅲ评分均无相关性(P均>O.05).结论 EBC中H2O2水平的高低与病情严重程度有关,故可作为机械通气患者气道炎症反应的重要监测指标,并可作为评估机械通气患者治疗和预后的重要监测指标.     

Plasma homocysteine levels in patients with beta-thalassaemia major

OBJECTIVE: We investigated the level of homocysteine (HCY) and its relation with vitamin B12, folate and oxidative stress in patients with beta-thalassaemia major. MATERIAL AND METHODS: Plasma HCY, methionine, advanced oxidation protein products (AOPP) and serum vitamin B12, folate, ferritin and total antioxidant capacity (TAC) were determined in 32 thalassaemic patients and 27 control subjects. RESULTS: HCY (6.44+/-0.44 versus 8.71+/-0.57 micromol/L), methionine (12.57+/-1.8 versus 22.2+/-3.8 micromol/L), folate (9.14+/-0.48 versus 15.38+/-0.71 nmol/L) and TAC (0.34+/-0.03 versus 0.56+/-0.03 mmol/L) significantly decreased in thalassaemic patients, whereas AOPP (20.26+/-1.8 versus 11.30+/-0.2 micromol/L) and ferritin (3481.0+/-512 versus 46.9+/-4.6 ng/mL) significantly increased. Vitamin B12 levels were similar in both groups (259.1+/-16.6 versus 228.9+/-7.4 pmol/L). CONCLUSIONS: These findings suggest that increased and uncompensated oxidative stress may lead to an increment in HCY catabolism in thalassaemic patients.     

Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: microdialysis in rest and during exercise

Local metabolic changes are suggested to be involved in muscle pain development in humans. Nineteen women with chronic work-related trapezius myalgia (TM) and 20 healthy female controls (CON) were studied during baseline rest, 20 min repetitive low-force exercise, and 120 min recovery. Interstitial serotonin (5-HT), glutamate, lactate, pyruvate, and blood flow were determined by microdialysis in the trapezius muscle. Baseline pressure pain threshold (PPT) was lower (143+/-18 (TM) vs. 269+/-17 (CON)kPa) (mean+/-SEM), pain intensity (visual analogue scale, VAS) higher (33+/-5 vs. 2+/-1mm), muscle 5-HT higher (22.9+/-6.7 vs. 3.8+/-1.3 nmol/l), and glutamate higher (47+/-3 vs. 36+/-4 micromol/l) in TM than in CON (all P<0.05), whereas muscle blood flow was similar in groups. Furthermore, muscle pyruvate was higher (180+/-15 vs. 135+/-12 micromol/l) and lactate higher (4.4+/-0.3 vs. 3.1+/-0.3 mmol/l) in TM than in CON (P<0.001). In response to exercise, VAS and glutamate increased in both TM and CON (all P<0.05). In TM only, lactate and pyruvate increased significantly (P<0.02), whereas blood flow increased to similar levels in both groups. During the initial 20 min recovery period, blood flow remained increased in TM (P<0.005) whereas it decreased to baseline levels in CON. In conclusion, patients with chronic work-related TM have increased levels of muscle 5-HT and glutamate that were correlated to pain intensity (r=0.55, P<0.001) and PPT (r=-0.47, P<0.001), respectively. In addition, TM was associated with increased anaerobic metabolism, whereas a normal rise in blood flow was seen with exercise. These findings indicate that peripheral nociceptive processes are active in work-related TM.     

异丙酚对急性呼吸窘迫综合征时肾Gq/11蛋白的干预作用

目的探讨异丙酚是否通过影响Gq/11蛋白的表达对肾脏起保护作用。方法采用尾静脉注射油酸(OA)法复制急性呼吸窘迫综合征(ARDS)大鼠模型。将健康雄性Wistar大鼠随机分为对照组(C组)、OA组和异丙酚预处理组(P组),并观察血压及相关酶的变化。用蛋白质免疫印迹法检测肾脏中Gq/11蛋白含量。结果P组Gq/11蛋白含量(124.68±19.38)%较C组(100.00±0)%增加了(24.68±19.38)%(P<0.01),但明显低于OA组(149.34±20.04)%(P<0.01)。P组肾组织血管紧张素转换酶(16.52±1.37)μmol·min-·g-1、乳酸脱氢酶(1.20±0.16)kU/g活性和丙二醛(1.51±0.35)μmol/g含量也均明显低于OA组分别为(17.56±1.02)μmol·min-1·g-1,(1.41±0.16)kU/g,(1.94±0.16)μmol/g,P均<0.01。结论预先注射异丙酚能降低Gq/11蛋白在肾脏中的含量,并减轻ARDS时肾损害的程度。