恩度联合腹腔化疗治疗肝癌腹水的护理体会

恶性腹水是肝癌晚期严重的并发症之一.肿瘤浸润或转移至胸腹膜后肿瘤新生血管的生成、血管内皮生长因子（VEGF）水平的升高以及血管通透性的增高等是恶性腹水形成的重要机制之一[1,2].肿瘤动物模型研究表明：腹腔内给予表达血管内皮抑制素的转基因治疗或腹腔内直接给予重组血管内皮抑制素可以抑制腹腔内肿瘤的生长,并能有效防止恶性腹水的形成和再发,与化疗药物之间有协同作用.自2008年1月至今,我们采用腹腔内注射重组人血管内皮抑制素（恩度）联合化疗药物治疗恶性腹水,取得初步疗效,现将护理体会报告如下.     

人参皂甙Rg3对小鼠肝癌H22腹水瘤抗血管生成作用的研究

目的 研究人参皂甙Rg3治疗小鼠恶性腹腔积液的抗血管生成作用.方法 50只雌、雄各半昆明种小鼠随机分为5组:Ⅰ组生理盐水组(0.9%NS);Ⅱ组顺铂组(DDP 0.5 mg/kg);Ⅲ组低剂量人参皂甙Rg3组(LPD 0.3 mg/kg);Ⅳ组中剂量人参皂甙RS3组(MPD 1.0 mg/ks);Ⅴ组高剂量人参皂甙Rg3组(HPD 3.0ms/ks).所有小鼠肝癌H22腹水瘤模型建立后24 h开始分别腹腔注射0.2 ml/只治疗,1次/d,共14 d.治疗结束后24 h,处死各组小鼠,应用酶联免疫吸附法检测腹水及血清中血管内皮生长因子(VEGF),免疫组织化学法计数腹膜瘤结节微血管密度(MVD),电镜观察人参皂甙Rg3中刺量组与生理盐水组腹腔内肿瘤细胞及腹膜瘤结节新生血管的形态学变化.结果 人参皂甙Rg3各剂量组随着用药剂量的加大,小鼠腹水及血清中VEGF值、腹膜瘤结节MVD下降(P＜0.05),且均较生理盐水组、DDP组下降(P＜0.05).电镜观察人参皂甙Rg3中剂量组较生理盐水组腹水中凋亡和坏死瘤细胞居多;腹膜瘤结节微血管基底膜平滑完整.结论 人参皂甙Rg3通过下调荷瘤小鼠体内VEGF,降低微血管的通透性和抑制腹膜微血管形成,从而抑制恶性腹腔积液的形成.这为临床应用提供了实验依据.     

生长抑素类似物奥曲肽抑制肝癌细胞血管内皮生长因子表达的研究

目的 探讨生长抑素类似物奥曲肽对肝癌细胞血管内皮生长因子(VEGF)表达的影响.方法 将40只小鼠随机分为2组,每组各20只.每只小鼠于腋窝皮下注射小鼠肝癌细胞株细胞.A组为实验组,皮下接种肿瘤24 h后予生长抑索奥曲肽(100μg·kg1·d-1)腹腔注射,连用20 d,B组为对照组,予以相同容积的无菌生理盐水腹腔注射,连用14 d.20 d后处死小白鼠,检测肿瘤大小、血管内皮生长因子(VEGF).结果 皮下接种7 d及14 d后A组皮下肿瘤的体积均明显小于B组(P＜0.05,P＜0.01).A组VEGF表达明显低于B组,统计学有显著差异性(Ridit检验,P＜0.05);A组微血管密度MVD亦较B组为低,但统计学差异无显著性(P=0.075).结论 奥曲肽对小白鼠肝癌移植瘤具有抑制作用,其作用机制是抑制肝癌细胞、VEGF的表达,对肿瘤组织血管形成的抑制作用亦可能为其原因.     

重组人血管内皮抑制素对结肠癌生长及肝转移抑制作用的研究

目的探讨重组人血管内皮抑制素(恩度)对小鼠结肠癌生长及肝转移的抑制作用。方法 40只小鼠建立结肠癌肝脏转移模型,随机分为对照组,恩度低浓度组、中浓度组、高浓度组,每组10只。各组给药浓度分别为0 mg/kg、2 mg/kg、4 mg/kg、8 mg/kg,于术后第2天腹腔注射给药,1次/d,共10 d。停止给药后2 d观察各组小鼠原发灶的大小、肝转移瘤的数量,检测原发灶的凋亡指数(AI)、肿瘤微血管密度(MVD)和血清VEGF浓度。结果各组的原发灶的体积平均数分别为1.230 cm3、1.198 cm3、1.125 cm3、0.891 cm3。高浓度组与对照组比较,脾脏种植瘤的体积明显缩小(P<0.05)。高浓度组的转移瘤数量明显少于低浓度组和对照组(P<0.05),低浓度组和中浓度组之间差异无统计学意义(P>0.05)。高浓度组原发灶的AI高于对照组(P<0.05)。中、高浓度组转移瘤的MVD计数明显低于对照组(P<0.05)。血清VEGF的浓度各实验组均低于对照组(P均<0.05)。结论重组人血管内皮抑制素能明显抑制结肠癌的生长和肝转移。     

Inhibitory Effect of Recombinant Human Endostatin on Growth and Liver Metastasis of Colon Cancer

目的 探讨重组人血管内皮抑制素(恩度)对小鼠结肠癌生长及肝转移的抑制作用.方法 40只小鼠建立结肠癌肝脏转移模型,随机分为对照组,恩度低浓度组、中浓度组、高浓度组,每组10只.各组给药浓度分别为0 mg/kg、2 mg/kg、4 mg/kg、8 mg/kg,于术后第2天腹腔注射给药,1次/d,共10 d.停止给药后2 d观察各组小鼠原发灶的大小、肝转移瘤的数量,检测原发灶的凋亡指数(AI)、肿瘤微血管密度(MVD)和血清VEGF浓度.结果 各组的原发灶的体积平均数分别为1.230 cm3、1.198 cm3、1.125 cm3、0.891 cm3.高浓度组与对照组比较,脾脏种植瘤的体积明显缩小(P＜0.05).高浓度组的转移瘤数量明显少于低浓度组和对照组(P＜0.05),低浓度组和中浓度组之间差异无统计学意义(P＞0.05).高浓度组原发灶的AI高于对照组(P＜0.05).中、高浓度组转移瘤的MVD计数明显低于对照组(P＜0.05).血清VEGF的浓度各实验组均低于对照组(P均＜0.05).结论 重组人血管内皮抑制素能明显抑制结肠癌的生长和肝转移.     

重组人内皮抑素两种给药途径抑制角膜新生血管的实验研究

目的:研究重组人内皮抑素(recombinant human endostatin,rHES,恩度)两种给药途径对碱烧伤诱导大鼠角膜新生血管的抑制作用. 方法:48只Wistar大鼠随机分为4组:A组(12只眼),对照组,不做处理;B组(12只眼),角膜碱烧伤后球结膜下注射生理盐水0.05ml,隔日1次;C、D组(各12只眼),右眼角膜碱烧伤后分别应用100mg/ml重组人内皮抑素点眼,4次/日和球结膜下注射0.05ml,隔日1次治疗.观察各组角膜新生血管的生长情况,免疫组化检测VEGF蛋白的表达.结果:C组、D组在碱烧伤后各时间点新生血管面积均小于B组,C组、D组与B组新生血管面积的差异有统计学意义(P<0.05);D组较C组对新生血管的抑制作用略强,差异无统计学意义(P>0.05).碱烧伤后第16天免疫组织化学检查显示除C组与D组间,其余各两两比较VEGF蛋白量差异有统计学意义,C组与D组VEGF蛋白量差异无统计学意义(P>0.05).结论:点眼和球结膜下注射重组人内皮抑素(恩度)即均可有效抑制CNV.     

重组人血管内皮抑制素注射液联合DC化疗方案对晚期卵巢癌患者中位生存期的影响

目的:观察重组人血管内皮抑制素注射液联合DC化疗方案对晚期卵巢癌患者中位生存期的影响。方法:选取68例晚期卵巢癌患者作为研究对象,依据随机数字表法将其分为对照组和观察组各34例,对照组给予DC化疗方案,观察组在对照组基础上联合重组人血管内皮抑制素注射液治疗,比较两组缓解率、血清基质金属蛋白酶-2(MMP-2)及血管内皮生长因子(VEGF)水平、体力状况和生命质量;随访3～4年,统计两组中位生存期。结果:观察组缓解率为76.47%(26/34),明显高于对照组的47.06%(16/34),差异有统计学意义(P<0.05);治疗后观察组血清MMP-2、VEGF水平明显低于对照组,差异有统计学意义(P<0.05);治疗后观察组KPS与QOL评分明显高于对照组,差异有统计学意义(P<0.05);随访3～4年,观察组中位生存期为30个月,对照组中位生存期为22个月。结论:重组人血管内皮抑制素注射液联合DC化疗方案能抑制晚期卵巢癌患者肿瘤血管的生成,延缓疾病进展,提高中位生存期的效果优于单纯DC化疗效果。     

重组人血管内皮抑制素联合TACE治疗对肝癌血管的影响

目的 探讨重组人血管内皮抑制联合肝动脉化疗栓塞术(TACE)对原发性肝癌内皮生长因子(VEGF)表达和肿瘤微血管密度(MVD)的影响. 方法 46例中晚期原发性肝癌患者随机分为对照组(20例)和治疗组(26例),对照组单纯给予TACE治疗,治疗组给予重组人血管内皮抑制素联合TACE治疗.利用免疫组化法检测治疗前、后VEGF的表达变化和MVD.ELISA法检测治疗前后血清VEGF的表达水平,并进行比较. 结果 治疗组术后7d、30d血浆VEGF水平(292.34±70.74)pg/ml、(189.49±72.66)pg/ml与对照组(371.36±81.20)pg/ml、(319.24±70.54)pg/ml比较呈明显降低,差异有显著性(t=2.149,P＜0.05).术后30d治疗组和对照组的VEGF表达强度分别为(158.4±38.9)和(60.75±14.0),和MVD分别为(56.6±15.1)和(21.7±6.1),两组比较差异有显著性(t1=2.576、t2=2.328、P均＜ 0.05).结论 TACE联合重组人血管内皮抑制素治疗明显降低肝癌VEGF表达和MVD,对肿瘤再生血管有一定抑制的作用,巩固和加强了TACE的治疗.     

外源性血管内皮生长因子对大鼠肝缺血再灌注损伤的影响

目的:研究外源性血管内皮生长因子(vascular endothelial growth factor,VEGF)对大鼠肝缺血再灌注损伤的影响?方法:雄性SD大鼠30只,体重(300±20)g,随机分为A组(VEGF组)?B组(缺血再灌注组)?C组(手术对照组),其中A?B组建立70%肝缺血再灌注损伤模型?A组于缺血前30 min经腹腔注射VEGF(50 μg/300 g体重);B组于缺血前30 min 经腹腔注射等量生理盐水;C组仅麻醉?开腹,不阻断血流?术后6 h,分别采用全自动生化分析仪?HE染色?ELISA法?比色法分别测定血肝功能酶?肝组织病理改变?肝脏诱导型一氧化氮合成酶(induced nitric oxide synthase,iNOS)活性?肝组织髓过氧化物酶(myeloperoxidase,MPO)的含量?结果:A组应用重组VEGF后血肝功能酶以及肝组织MPO显著低于B组(P < 0.01),肝脏局部iNOS的活性降低,肝组织形态学无明显改变?结论:外源性VEGF能抑制肝脏iNOS的活性,缓解肝功能下降,保护大鼠肝脏缺血再灌注损伤?     

重组人血管内皮抑制素对兔耳增生性瘢痕VEGF和TIMP-1表达的影响

目的探讨重组人血管内皮抑制素作用于兔耳增生性瘢痕后对瘢痕中血管内皮生长因子(VEGF)和基质金属蛋白酶抑制剂1(TIMP-1)表达的影响。方法新西兰大白兔16只,建立兔耳增生性瘢痕动物模型。模型建立成功后,将其随机分为实验组和对照组,每组8只。实验组瘢痕局部注射0.1 mL 5 mg/mL的重组人血管内皮抑制素,隔日1次,共5次;对照组局部注射0.1 mL生理盐水,隔日1次,共5次。在药物干预30 d后观察瘢痕大体变化并留取标本,用RT-PCR方法检测VEGF和TIMP-1 mRNA表达水平的变化,用免疫组织化学方法检测瘢痕组织中TIMP-1蛋白表达水平的变化。结果药物干预30 d后实验组兔耳瘢痕中VEGF和TIMP-1 mRNA表达量分别为0.279 0±0.030 7、0.244 4±0.057 4,对照组分别为0.657 0±0.161 1、0.730 2±0.103 8,实验组表达水平均低于对照组(P<0.05)。实验组兔耳瘢痕中TIMP-1蛋白阳性表达水平低于对照组(P<0.05)。结论重组人血管内皮抑制素能抑制兔耳增生性瘢痕组织形成,其机制可能与抑制VEGF和TIMP-1表达有关。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.