CTLA-4Ig与ICAM-1单抗联合DCp诱导同种移植耐受

目的:利用细胞毒性T淋巴细胞相关抗原4 Ig融合蛋白(CTLA-4 Ig)和细胞间黏附分子1(ICAM-1)单克隆抗体联合治疗经供者树突状细胞前体(DCp)免疫的移植受者诱导移植耐受.方法:实验分4组:对照组、CTLA-4 Ig组、ICAM-1单抗组和联合组,每组8只BALB/c受鼠.每组均以2×106C57BL/6供者DCp经尾静脉输注受鼠.CTLA-4Ig组和ICAM-1单抗组分别自DCp输注之日起连续2周向受鼠腹腔内注射CTLA-4 Ig或ICAM-1单抗(0.1 mg/d);联合组以同样剂量两药注射2周;对照组则仅输注DCp.DCp输注1周后4组均行异位心脏移植并观察移植心存活时间,进一步作皮肤移植确认耐受状态.结果:对照组、ICAM-1单抗组和CTLA-4 Ig组的C57BL/6供心平均存活时间分别为(20.13±1.64)d、(45.00±2.62)d和(90.00±3.07)d,联合组8例中除1例存活98 d外,其他7例均超过100 d.前3组C57BL/6来源皮肤平均存活时间分别为(4.25±0.89)d、(9.00±0.76)d和(44.50±3.42)d,联合组8例中1例存活91 d,3例存活95 d,其他4例均超过100 d.结论:在供者DCp输注受者后以ICAM-1单抗和CTLA-4 Ig联合处理受者能够诱导针对供者的耐受状态.     

TGF-β1、IL-10在门静脉预输注供者凋亡脾脏细胞大鼠移植心脏模型中的表达

目的 输注供者凋亡细胞建立大鼠同种异体心脏移植模型,探讨凋亡细胞诱导免疫耐受的作用机制.方法 实验动物分为3组:A组为对照组;B组为实验组,心脏移植前经门静脉输注供者来源的凋亡脾脏细胞;C组为免疫抑制剂组,移植前后给予CsA.观察各组移植心脏存活时间,组织病理学改变,血清IL-2、IL-10及TGF-β1含量,并通过单向混合淋巴细胞培养判定耐受是否具有抗原特异性.结果 B组移植心脏存活时间较A组显著延长,排斥反应程度减轻,受者对供者产生抗原特异性耐受;C组移植心脏存活时间最长,但其免疫抑制作用缺乏抗原特异性.在心脏移植术后B组血清中IL-2水平较对照组显著降低,而IL-10及TGF-β1显著升高.结论 通过预输注供者凋亡细胞的方法可以诱导大鼠同种异体心脏移植的免疫耐受,并且此种耐受具有抗原特异性.IL-10及TGF-β1在此过程中可能起着重要作用.     

NBD多肽预处理的树突状细胞延长移植心存活时间的实验研究

目的 探讨NBD多肽预处理的供体源性树突状细胞(DC)在诱导心脏移植免疫耐受中的作用及可能机制.方法 体外培养供体源性BALB/c小鼠骨髓树突状细胞并以NBD多肽预处理(NBD多肽-DC,在小鼠心脏移植前7 d,将NBD多肽.DC输至受者C57BL/6小鼠体内.应用Cu-T建立小鼠颈部异位心脏移植模型,观察心脏移植物存活时间,病理分析检测排斥反应程度.混合淋巴细胞反应(MLR)测定受者脾脏T细胞对供者同种抗原的反应性,并用ELISA方法测定受者血清Thl型细胞因子(IFN-γ和IL-12)和Th2型细胞因子(IL-4和IL-10)水平的变化.结果 NBD多肽-DC可使移植心脏存活天数延长至(21.83±3.54)d,较PBS对照组的(6.66±1.21)d明显延长(P＜0.01),降低排斥反应病理分级(Stanford 1～2级),能诱导受者脾脏T细胞的抗原特异性低反应性,使受者小鼠血清INF-γ和IL-12水平显著降低(P＜0.01).而IL-4和IL-10水平明显升高(P＜0.01).结论 NBD多肽预处理的供体源性DC能够诱导针对移植供者产生的特异性免疫耐受现象,其机制可能与诱导受者T细胞的抗原特异性低反应性及Th1/Th2免疫偏移有关.     

CTLA-4 Ig融合蛋白抗小鼠同种心脏移植排斥的效果及其机制

目的：研究细胞毒性T淋巴细胞相关抗原4（CTLA－4,CD152）Ig融合蛋白（CTLA－4Ig)抗小鼠同种心脏移植排斥的效果及其体内作用的机制。方法：以C57BL／6小鼠为供,BALB／c小鼠为受行异位心脏移植术,分别腹腔注射CTLA4Ig[100μg/d,共15次]γ-球蛋白对照抗体及PBS,观察移植供心的存活时间;研究腹腔注射CTLA－4Ig后受体小鼠T细胞对同种抗原反应性的变化以及对T细胞亚群分化的影响。结果：同种心脏移植的小鼠腹腔注射CTLA－4Ig后,移植心脏存活时间较对照组显延长,40％移植心脏的存活时间长达2个月以上。CTLA－4Ig治疗后诱导受体小鼠T细胞对同种抗原低反应性,但对第三抗原的反应性无影响。受体血清中的Th1来源的IL－2、IFN－γ均明显低于PBS对照组,而Th2来源的IL－10的水平则明显高于对照组,IL－4未见明显的改变。结论：CTLA－4Ig治疗后可通过诱导受体小鼠T细胞对同种抗原低反应性以及受体T细胞由Th1向Th2分化,诱导供特异性免疫耐受的产生,显延长同种小鼠心脏移植存活期。     

负载供者抗原的第三方树突状细胞延长大鼠移植心脏存活

目的 观察负载供者抗原第三方未成熟DC对大鼠同种异体移植心脏存活期的影响.方法 培养骨髓来源第三方大鼠未成熟DC,负载供者抗原,CTLA-4 Ig致耐受处理.建立大鼠心脏腹部移植模型,A组:心脏移植;B组:心脏移植,术前输注供者源未成熟DC;C组:心脏移植,术前输注第三方未成熟DC;D组:心脏移植,术前输注负载供者抗原致耐受第三方未成熟DC.分别行移植心病理、IFNγmRNA表达和移植心存活时间观察.结果 D组的移植心病理改变轻,IFNγmRNA表达下调,移植心脏存活时间显著延长.结论 负载供者抗原第三方致耐受未成熟DC能够诱导供者特异性免疫耐受,明显延长大鼠移植心脏存活时间.     

前列腺素A1预处理供体大鼠对心脏移植受体T细胞功能的影响

目的 研究核转录因子-κB(NF-κB)抑制剂前列腺素A1(PGA1)预处理供体大鼠,在同种心脏移植中对供心的保护及对其受体T淋巴细胞功能影响.方法 使用大鼠同种心脏移植排斥模型,观察PGA1预处理供体对心脏存活时间影响,并进行受体大鼠混合淋巴细胞培养及测定血清白介素2、白介素4(IL-2,IL4)浓度.结果 PGA1组供心存活时间较生理盐水组延长(P＜0.05),混合淋巴细胞培养显示PGA1组受体大鼠T细胞对供体抗原刺激的增殖反应较生理盐水组受到抑制(P＜0.05),PGA1组血清IL-2浓度较生理盐水组降低(P＜0.05),而两组间血清IL-4浓度无显著差异(P＞0.05).结论 PGA1预处理供体能有效延长供心存活时间,抑制受体T淋巴细胞的免疫功能.     

胸腺基质淋巴细胞生成素受体剔降的未成熟树突状细胞调节哮喘小鼠Th1/Th2失衡的研究

目的树突细胞疫苗是治疗哮喘的新途径,文中探讨经鼻滴注基质淋巴细胞生成素（thymic stromal lymphopoetin,TSLP）受体剔降的未成熟树突状细胞（immature dendritic cell,imDC）对哮喘模型小鼠过敏性气道炎症及Th1/Th2免疫失衡的影响,为免疫调节治疗哮喘提供理论和实验基础。方法36只C57BL/6小鼠随机分为胸腺TSLP受体剔降的imDC治疗组（A组）、imDC治疗组（B组）和哮喘组（C组）。以卵蛋白（ovalbumin,OVA）、氢氧化铝免疫建立哮喘模型,A组和B组分别于激发前气道内滴注100μl的细胞悬液,分别含有1×106TSLPR剔降的imDC、imDC,C组气道内滴注100μl的PBS;各组激发后肺泡灌洗分析细胞组份,分离肺淋巴细胞测定细胞因子分泌水平,以流式细胞仪检测CD4＋干扰素-γ（interferonγ,IFN-γ）＋、CD4＋白细胞介素-4（interleukin-4,IL-4）＋百分比及IFN-γ＋/IL-4＋比值,比较各组肺组织学改变。结果TSLP受体剔降的imDC治疗组与其他组比较：①可明显抑制OVA抗原激发后气道内嗜酸性粒细胞的浸润（P〈0.01）;②明显抑制肺淋巴细胞产生IL-4、IL-5,增加了IFN-γ的产生;③肺淋巴细胞CD4＋IFN-γ＋百分比及IFN-γ＋/IL-4＋明显升高（P〈0.01）,而CD4＋IL-4＋百分比则明显下降（P〈0.01）;④明显抑制哮喘鼠气道内及肺泡内的过敏性炎症反应。结论激发前经鼻滴注TSLP受体剔降的imDC对哮喘小鼠过敏性气道炎症有明显的防治作用,其机制可能与抑制树突细胞TSLP-TSLP受体信号通路,调整Thl/Th2失衡有关。     

术前输注负载供者抗原的受者未成熟树突状细胞延长移植心存活时间的实验研究

目的:利用负载供者抗原的受者未成熟树突状细胞(imDC)干扰T细胞抗原间接识别途径,观察对同种异体移植心存活时间的影响。方法:用低剂量粒细胞-巨噬细胞集落刺激因子(GM-CSF)培养受者小鼠骨髓源性imDC,并在培养过程中加入供者可溶性抗原共同孵育,流式细胞术检测细胞表型,观察其在体外刺激自体T细胞增殖的能力,并于术前1周将约2.0×106个树突状细胞(DC)输入受者体内,观察其对同种异体移植心存活时间的影响。结果:受者DC可通过共同孵育的方式有效负载供者抗原,负载供者抗原的受者imDC在体外不能有效刺激自体T细胞活化增殖,将其于术前输入受者体内,移植心的存活时间由(7.2±1.7)天延长至(17.7±3.3)天。结论:术前输注负载供者抗原的受者imDC,可明显延长移植心的存活时间。     

转hCTLA4Ig树突状细胞诱导T细胞免疫耐受的实验研究

目的　通过逆转录病毒载体将人CTLA4Ig转染DCs ,探讨转人CTLA4Ig(hCTLA4Ig)树突状细胞 (DCsRev)诱导T细胞免疫耐受的可能性。方法　通过重组逆转录病毒将目的基因hCTLA4Ig转染到大鼠骨髓来源的DCs中 ,通过流式细胞检测目的基因hCTLA4Ig表达及DCs表面分子的改变 ;通过混合淋巴细胞反应 (MLR)检测DCsRev抑制T细胞免疫反应的能力。 结果　重组逆转录病毒转染DCs的最大效率为 91 2 5 % ;在功能上 ,DCsRev不但丧失了刺激MLR的能力 ,并且能够强烈抑制MLR中反应T细胞的增殖 ,而且抑制率与加入DCsRev的数量和DCsRev预处理反应T细胞的时间长短有关。具体来说 ,DCsRev数量在 10 3 ～ 10 4之间时 ,抑制率与剂量呈正相关 ,最高为 71 96%。而当DCsRev数量达到 5× 10 4抑制率下降为 5 9 2 %。在 12～ 48h之间 ,随着预处理时间的延长 ,抑制率却不断下降 ,预处理 12h抑制率最高 ,为 99 6%。但不做预处理 ,在反应开始时同时加入DCsRev ,则抑制率明显降低 ,仅为 5 9 2 %。对腹腔注射DCsRev大鼠脾T淋巴细胞体外分析表明 ,DCsRev也能在动物体内诱导耐受 ,但这种免疫耐受状态不能维持终身。结论　通过逆转录病毒载体将人CTLA4Ig转染DCs,不但DCs表面CD86分子被CTLA4Ig有效的封闭 ,并且能够诱导抗原特异性T细胞的免疫耐受     

Th1/Th2细胞因子对心脏移植大鼠NPC输注诱导免疫耐受的作用

目的探讨大鼠血清中Th1/Th2细胞因子表达与供肝非实质细胞(NPC)输注诱导心脏移植免疫耐受的关系。方法建立大鼠心脏移植模型,将40只大鼠随机分成排斥反应组、免疫耐受组,每组20只。观察移植心脏存活时间,并检测受者血清中Th1/Th2细胞因子白细胞介素2(IL-2)、干扰素γ(IFN-γ)、白细胞介素4(IL-4)、白细胞介素6(IL-6)、白细胞介素10(IL-10)的表达水平。结果免疫耐受组供心存活时间为(30.83±2.55)d,排斥反应组为(8.15±2.08)d,差异有显著性(t=24.46,P<0.01)。术后7、14 d排斥反应组血清Th1细胞因子IL-2、IFN-γ水平均高于免疫耐受组,Th2细胞因子IL-4、IL-10表达水平均低于免疫耐受组,术后7 d血清IL-6表达水平显著高于免疫耐受组(t=4.50~16.20,P<0.01)。结论免疫耐受的形成与Th1/Th2细胞因子相互作用有关。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.