活动性狼疮肾炎患者外周血单个核细胞钙调神经磷酸酶活性的检测及白细胞介素-4表达变化

目的：检测活动性狼疮肾炎（LN）患者外周血单个核细胞（PBMC）白细胞介素-4（IL-4）表达及其与钙调神经磷酸酶（Calcineurin，CaN）活性的关系。方法：体外培养活动性LN患者PBMC，应用发色底物法检测胞浆CaN活性，逆转录PCR检测IL-4mRNA表达。结果：（1）在单纯培养情况下，正常对照组和LN组PBMC均出现一定量CaN活化，活动性LN组显著高于正常对照组[（46．08±5．58）mmol／mg．pr vs（8．81±3．61）mmol／mg．pr，P〈0．01]；在PMA＋Ionomyci刺激下，各组CaN活性均升高，活动性LN组CaN活性明显高于正常对照组[（69．34±12．59）mmol／mg．pr vs（37．12±11．57）mmol／mg．pr，P〈0．01]；（2）LN患者PBMC在单纯培养和PMA＋Ionomycin刺激时IL-4蛋白和mRNA表达均显著高于相应的对照组（P〈0．05）；（3）在单纯培养和PMA＋Ionomycin刺激时，FK506对LNPBMC表达IL-4蛋白和mRNA均有显著抑制作用（P〈0．01）。结论：LN患者PBMC存在CaN过度活化；LN患者PBMC高效表达IL-4与其CaN过度活化密切相关，通过阻断CaN活性可调控IL-4表达。     

细菌性腹膜炎诱导大鼠多器官功能不全综合征后结肠运动的变化和机理

目的探讨细菌性腹膜炎致多器官功能不全综合征（MODS）大鼠结肠运动的变化和细胞因子白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）及诱生性一氧化氮合成酶（iNOs）对结肠运动的影响。方法将Wistar大鼠随机分成正常对照组和MODS组；分别观测2组大鼠排便的粪点数、结肠肌条的振幅、结肠平滑肌细胞长度以及血清一氧化氮（NO）的变化；利用免疫组化和逆转录-聚合酶链反应（RT-PCR）方法检测结肠平滑肌IL-6、TNF-α和iNOS表达的变化。结果MODS组排便的粪点数和肌条的振幅均明显低于正常对照组（P〈0．05）；IL-6、TNF-α和iNOS蛋白表达在正常对照组为阴性表达，在MODS组为阳性表达；在正常对照组未检出IL-6 mRNA、TNF-α mRNA和iNOS mRNA的表达，而在MODS组，IL-6 mRNA、TNF-α mRNA和iNOS mRNA均呈阳性表达；MODS组平滑肌细胞的长度和血清NO水平均较正常对照组明显增高（P〈0．01）。结论MODS后结肠运动功能障碍与iNOS、IL-6和TNF-α密切相关。     

单双侧肺减容术后早期肺功能及肺血流动力学的变化

目的探讨单、双侧肺减容（LVRS）术后早期肺功能及肺血流动力学的不同变化。方法86例重度慢性阻塞性肺气肿患者（COPD）行LVRS手术,单侧61例、双侧25例,术前、术后3、6个月分别测量肺功能[第1秒用力呼气量（FEV1）、残气量（RV）、肺总量（TLC）]、动脉血气[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）]、心脏超声多普勒检查[心输出量（CO）、心脏指数（CI）、射血分数（EF）并计算肺动脉压（PAP）],并对其结果进行比较分析。结果80例患者痊愈出院,6例死亡;单侧LVRS术后3、6个月的FEV,较术前有明显提高（P〈0．05）,双侧LVRS术后各项指标改善较单侧更好（P=0．015）,RV、TLC较术前有明显降低（P〈0．05）;术后PaO2比术前提高（P〈0．05）,PaCO2较术前显著减低（P〈0．05）;肺血流动力学（CO、CI、EF、PAP）无明显变化（P〉0．05）。结论单、双侧LVRS治疗重度COPD患者是安全有效的,术后早期均可明显改善患者的肺功能,但双侧手术效果优于单侧;单、双侧LVRS对肺血流动力学无明显负影响,术前术后无明显改变。     

肺减容手术对肺血流动力学影响的实验研究

目的通过对犬肺气肿模型施行不同体积的肺减容（LVRS）手术观察其对肺血流动力学的影响，并探讨肺减容术肺组织的最佳切除体积。方法健康杂种犬24只，随机分成4组，Ⅰ组为正常对照组，Ⅱ-Ⅳ组经气管注入牛胰蛋白酶后饲养6周制成犬实验肺气肿模型，其中Ⅱ组用来验证模型的制备结果，Ⅲ组和Ⅳ组行肺减容手术，分别予以切除肺组织重量占平均全肺总重量的20％～30％和30％-40％。术后饲养4周处死。手术前、手术后1h、手术后4周分别查动脉血气，测量平均肺动脉压（MPAP）、肺毛细血管嵌顿压（PCWP）及心排出量（CO），由以上结果计算出肺血管阻力（PVR）。结果Ⅲ组手术4周后PaO2和PaCO2均明显改善（P〈0．05），Ⅳ组无显著变化（P〉0．05）。Ⅲ组手术后1h的MPAP显著升高（P〈0．05），4周后降至术前水平（P〉0．05）；Ⅳ组术后始终高于手术前（P〈0．05）。Ⅲ组手术后1h的PVR保持手术前水平（P〉0．05），4周后有所下降（P〈0．05）；Ⅳ组则始终高于术前（P〈0．05）。结论LVRS手术切除双肺总量的20％～30％是安全、有效的，适当的肺减容能够在有效地改善肺功能同时促进心脏功能的恢复。     

肝细胞癌中SFRP1和APC基因启动子甲基化与其mRNA的表达

目的探讨肝细胞癌（HCC）中SFRP1和APC基因启动子甲基化状态及其mRNA表达的关系。方法应用甲基化特异性聚合酶链反应（MSP）和逆转录-聚合酶链反应（RT—PCR）技术，检测30例肝细胞癌（HCC组）及相应的癌旁组织（癌旁组）和10例正常肝组织（正常对照组）中SFRP1及APC基因启动子甲基化状态和mRNA的表达水平，分析甲基化与某些临床参数与mRNA表达的关系。结果HCC组、癌旁组及正常对照组中的SFRP1和APC基因启动子甲基化率分别是11／30，4／30，0／10和14／30，5／30，0／10；HCC组明显高于其余两组（P〈0．05）。SFRP1基因启动子甲基化与临床资料无关（P〉0．05）；APC基因启动子甲基化与年龄（〈60）岁和癌肿无假包膜有关（P〈0．05）。HCC组SFRP1基因mRNA表达明显低于其余两组（P〈0．05），各组APC基因mRNA表达差异无显著性。两基因甲基化之间无相关性。结论SFRP1和APC基因启动子甲基化与HCC的形成和进展有关，但HCC组织中基因甲基化与mRNA表达的关系尚不明确。     

高糖对大鼠肾成纤维细胞VEGF和PEDF表达的影响

目的探讨高糖对体外培养的大鼠肾成纤维细胞（NRK）血管内皮生长因子（vascular endothelial growth factor，VEGF）和色素上皮衍生因子（pigment epithelium derived factor，PEDF）表达的影响。方法采用RT-PCR分析方法，测定在不同浓度高糖、不同时间点NRK细胞VEGF与PEDF mRNA的表达。设5．6mmol／L葡萄糖组为正常对照组。结果与正常组相比，加入不同浓度高糖的各组NRK细胞VEGF mRNA的表达明显升高（P〈0．05），PEDF mRNA的表达明显下降（P〈0．05），呈剂量依赖性改变；随着各组作用时间的延长，VEGF mRNA的表达呈上升趋势（P〈0．05），PEDF mRNA的表达呈下降趋势（P〈0．05），呈时间依赖性改变；VEGF与PEDF之间呈明显负相关（r=-0．811，P〈0．05）。结论在高糖环境中，体外培养的NRK细胞VEGF和PEDF表达失衡，PEDF表达下降的同时VEGF表达增加，两者的表达失衡可能在糖尿病肾病（DN）的发生发展中起一定的作用。     

凋亡相关基因Bax和bcl-2在骨关节炎软骨中的作用

目的探讨原发性骨关节炎与继发性骨关节炎发病机制的异同。方法收集原发性骨关节炎、继发性骨关节炎的关节软骨各8例，并以9例正常关节软骨作对照，采用RT—PCR和免疫组化方法分别检测Bax和bcl-2的mRNA和蛋白的表达，应用细胞核荧光染色的方法进行软骨细胞凋亡的检测。结果1．原发性骨关节炎组BaxmRNA表达明显升高，与继发组、对照组差异均有统计学意义（P〈0．01，P〈0．01），而继发性骨关节炎组Bax mRNA的表达与对照组之间的差异没有统计学意义（P〉0．05）；bcl-2mRNA在两类骨关节炎中的表达较对照组均升高（P〈0．01，P〈0．05），而两组间差异没有统计学意义（P〉0．05）。2．免疫组化发现两类骨关节炎中Bax、bcl-2蛋白表达水平与其mRNA表达相一致。3．原发性骨关节炎组、继发性骨关节炎组和正常对照组细胞凋亡率分别为10％～20％，8％～13％，2％～5％。原发性骨关节炎组细胞凋亡比例最高。结论软骨细胞凋亡是骨关节炎发病的重要原因，受Bax和bcl-2的共同调节；Bax表达水平的升高可能是原发性骨关节炎发病的重要原因。     

西沙必利联合腹膜氧合对油酸致急性肺损伤兔肺组织CC16 mRNA表达的影响

目的评价西沙必利联合腹膜氧合对油酸致急性肺损伤兔肺组织CC16 mRNA表达的影响。方法家兔24只，雌雄不拘，体重2．0～2．5kg，用油酸诱导急性肺损伤模型成功后，随机分为4组（n=6）：急性肺损伤组（A组）、西沙必利组（B组）、腹膜氧合组（C组）和西沙必利联合腹膜氧合组（D组）。急性肺损伤模型制备成功后4h取右下肺叶组织，采用半定量RT-PCR法测定CC16 mRNA的表达。结果与A组和B组比较，C组和D组CC16 mRNA表达增加（P〈0．01）。与C组比较，D组CC16 mRNA表达增加（P〈0．05）。病理结果显示D组肺组织损伤程度最轻。结论西沙必利联合腹膜氧合可上调油酸致急性肺损伤兔肺组织CC16 mRNA的表达，有利于急性肺损伤的治疗。     

Roux-en-Y胃旁路术对GK大鼠骨骼肌组织胰岛素抵抗影响的机制研究

目的探讨Roux-en-Y胃旁路术（RYGB）改善2型糖尿病大鼠（Goto-Kakizaki大鼠,GK大鼠）骨骼肌胰岛素抵抗的可能机制。方法30只GK大鼠随机分为GK-RYGB组、GK-假手术组、GK．对照组,另取10只Wistar大鼠作为正常对照组。术后28d时处死实验动物。ELISA法检测血浆ghrelin浓度,免疫印迹法检测骨骼肌组织的磷酸化（p）-／总（t）。P13Kp85ct、p-／t．Akt／PKB及细胞膜（m）-／t．GLUT4蛋白的相对表达量,实时荧光定量PCR法检测骨骼肌组织中P13Kp85a、Akt／PKB及GLUT4mRNA的表达。结果①血浆ghrelin浓度在正常对照组明显高于GK。对照组（P〈0．01）和GK-假手术组（P〈O．01）;GK-RYGB组也明显高于GK．对照组∽〈0．01）及GK．假手术组（尸〈0．01）,但与正常对照组相比差异无统计学意义（尸〉0．05）。②p-／t．P13Kp85tt、p-／t．Akt／PKB及m-／t-GLUT4蛋白相对表达量在正常对照组均较GK-对照组（分别P〈0．01、P〈0．05、P〈0．01）和GK．假手术组（分别P〈0．01、P〈0．05、P〈0．01）明显上升;GK-RYGB组亦较GK-对照组（分别P〈0．01、P〈0．05、JP〈0．01）和GK．假手术组（分别尸〈0．01、P〈0．05、P〈0．01）均分别明显上升。③骨骼肌组织中P13Kp85ct、Akt／PKB及GLUT4mRNA的表达在正常对照组均较GK．对照组（分别P〈0．01、P〈0．05、P〈0．05）和GK．假手术组（分别P〈0．01、P〈0．05、P〈0．05）明显上升;GK．RYGB组较GK．对照组（分别P〈0．01、P〈0．05、P〈0．05）和GK-假手术组（分别P〈0．0l、P〈0．05、P〈0．05）也均分别明显上升。结论①RYGB术后GK大鼠血浆ghrelin水平显著升高。②RYGB术能够上调GK大鼠骨骼肌组织中P13Kp85a、Akt／PKBmRNA和磷酸化蛋白的表达,并上调GLUT4的转录和翻译,促使更多的GLUT4在细胞膜表达,增加骨骼肌组织对葡萄糖的摄取,从而改善骨骼肌组织的胰岛素抵抗。     

阿霉素肾病大鼠肾组织中血管生成素样蛋白3基因表达

目的动态观察阿霉素肾病大鼠在发生蛋白尿的过程中肾组织血管生成素样蛋白3（ANGPTL3）mRNA表达水平的变化，探讨ANGPTL3在大鼠肾组织中表达与蛋白尿的关系。方法通过激光微分离技术分离阿霉素肾病大鼠肾小球和肾小管，采用实时荧光定量RT-PCR方法分析阿霉素注射后7、14、21和28d肾组织中ANGPTL3 mRNA表达水平的变化。结果（1）阿霉素注射后第14天开始出现大量蛋白尿（P〈0.01），血清白蛋白明显减少（P〈0．01），胆固醇（P〈0．01）和甘油三酯（P〈0．05）明显增高，以上各项指标均在第28天达高峰。（2）通过激光微分离系统成功地分离了大鼠肾组织中的肾小球和肾小管。（3）阿霉素注射后7及14d后，大鼠肾皮质中总ANGFTL3 mRNA表达水平与同一时间点正常对照组比较无明显变化；到第21天时为正常对照组的9．03倍（P〈0．01）；第28天时为正常对照组的3．95倍（P〈0．05），与第21天时相比已呈现下降趋势。（4）阿霉素注射后不同时间点肾小球中ANGPTL3 mRNA表达水平的变化趋势与肾组织总ANGPTL 3mRNA表达水平的变化一致，第7、14天时，肾小球中ANGPTL 3mRNA表达水平与同一时间点正常对照组比较无明显变化；到第21天时为同一时间点正常对照组的2．18倍（P〈0．05）；第28天时为正常对照组的1．90倍（P〈0．05）。（5）阿霉素注射后不同时间点肾小管中ANGPTL3 mRNA表达水平无明显改变，与同一时间点的正常对照组相比均无显著性差异。结论正常大鼠和阿霉索肾病大鼠的肾组织中均有ANGPTL3 mRNA表达。肾组织可以自身合成ANGPTL3；肾病的大鼠肾组织自身合成ANGPTL3增多，且这种改变是发生在肾小球。ANGPTL3可能通过影响肾小球的功能参与肾病蛋白尿的进展过程。     

肺气肿兔单侧肺减容术后的肺功能及组织结构变化

目的　评价阻塞性肺气肿兔单侧肺减容术 (LVRS)后的肺功能和组织结构变化 ,并与肺叶切除术比较。方法　 4 0只新西兰大白兔采用烟熏和气管内滴注弹性蛋白酶制成阻塞性肺气肿模型 ,随机分为肺气肿组 (A组 )、单侧LVRS组 (B组 )、肺叶切除组 (C组 )和假手术组 (D组 ) ,每组 10只。 8周后进行肺功能和肺组织学检查。结果　与A组比较 ,B组和C组的潮气量、0 3秒用力呼气容积 (FEV0 3)、FEV0 3 FVC(用力肺活量 )、PaO2 、平均肺泡数和肺泡隔面密度增加 ,功能残气量、PaCO2 、肺总容积和肺泡直径降低 (P <0 0 5 ) ,而D组变化不明显 (P >0 0 5 )。B组和C组肉眼及光镜下可见肺气肿改善 ,而D组无明显变化。B组和C组之间上述各指标差异无显著性 (P >0 0 5 )。结论　单侧LVRS和肺叶切除术均可有效改善阻塞性肺气肿兔的肺功能和组织结构     

Lung volume reduction surgery restores the normal diaphragmatic length-tension relationship in emphysematous rats

OBJECTIVE: Improved respiratory muscle function is a major effect of a lung volume reduction surgery. We studied length adaptation in rat diaphragmatic muscle in an attempt to elucidate the mechanism by which diaphragmatic function improves after this controversial operation. METHODS: We developed a model of elastase-induced emphysema and bilateral volume reduction through median sternotomy in rats. Five months after emphysema induction, maximum exchangeable lung volume was determined in intubated and anesthetized control animals and animals with emphysema. Costal diaphragmatic length was measured in vivo, and the length at which maximal twitch force is generated was determined on muscle strips in vitro. Also 5 months after elastase administration, another cohort underwent volume reduction or sham sternotomy. Five months after the operation, these animals were similarly studied. RESULTS: Lung volume was increased in emphysematous rats versus control rats (50.9 +/- 1.7 vs 45.4 +/- 1.3 mL, P =.001). Lung volume was decreased in emphysematous animals that had undergone volume reduction versus sham sternotomy (44.7 +/- 0.60 vs 49.4 +/- 1.0 mL, P =.001). In situ diaphragm length (1.99 +/- 0.04 vs 2.24 +/- 0.07 cm, P =.001) and the length at which maximal twitch force is generated (2.25 +/- 0.06 vs 2.48 +/- 0.09 cm, P =.038) were shorter in emphysematous than control animals. After volume reduction, in situ diaphragm length (2.13 +/- 0.06 vs 1.83 +/- 0.02 cm, P <.001) and the length at which maximal twitch force is generated (2.50 +/- 0.08 vs 2.27 +/- 0.06 cm, P =.013) were longer than in animals undergoing sham sternotomy. CONCLUSIONS: In this experimental model of emphysema and lung volume reduction surgery, emphysema shortens the length at which maximal twitch force is generated and shifts the diaphragmatic length-tension curve to lower lengths; volume reduction returns the length at which maximal twitch force is generated toward normal and shifts the diaphragmatic length-tension curve back to longer lengths. This restoration toward normal physiology may enable the improvement in diaphragmatic function seen after lung volume reduction surgery. The mechanism by which these length adaptations occur merits further investigation.     

单侧、双侧肺减容术后肺气肿兔动脉血气与肺通气功能的变化

目的 比较单侧、双侧肺减容术后肺气肿家兔动脉血气与肺通气功能的变化.方法 60只家兔随机分为正常对照(A组)、肺气肿(B组)、单侧假手术(C组)、单侧肺减容术(D组)、双侧假手术(E组)和双侧肺减容术(F组).除A组外,其余均采用吸烟加气管内滴注木瓜蛋白酶的方法制作成肺气肿模型.术后8周进行动脉血气分析和肺功能检查.结果 与B组比较,D组pH、氧分压(PaO2)和氧饱和度(SaO2)显著升高(P＜0.05),PaCO2显著降低(P＜0.05);F组pH、PaO2和SaO2显著升高(P ＜0.01),PaCO2显著降低(P＜0.01).与D组比较,F组pH、PaO2和SaO2显著升高(P＜0.05),PaCO2 显著降低(P＜0.05).与B组比较,C组和E组肺功能无显著性差异(P＞0.05);D组0.5s用力呼气容积( FEV0.5)和FEV0.5/FVC(用力肺活量)显著升高(P＜0.05),功能残气量(FRC )/TLC(肺总容积)、动态顺应性(Cld)和呼气相气道阻力(Re)显著降低(P＜0.05);F组FEV0.5和FEV0.5/FVC显著升高(P＜0.01),FRC/TLC、Cld和Re显著降低(P＜0.01).与D组比较,F组FEV0.5和FEV0.5/FVC显著升高(P＜0.05),FRC/TLC 、Cld和Re显著降低(P＜0.05).观察期内双侧肺减容术组兔死亡2只,其余各组兔均存活.结论 双侧肺减容术较单侧肺减容术更能改善动脉血气和肺通气功能.     

肺减容术治疗慢性阻塞性肺气肿

目的　为了提高肺气肿患者生存质量 ,探讨肺减容手术治疗慢性阻塞性肺气肿的可行性。　方法　本组肺减容手术 16例 ,其中同期双侧肺减容手术 9例 ,胸腔镜辅助小切口肺减容术 4例 ,标准后外侧切口单侧肺减容术 3例。术前根据计算机体层摄影术 (CT)和同位素肺通气肺灌注扫描选择肺气肿手术“靶区”,术中使用带牛心包垫的直线型切割缝合器切除病变 ,防止肺泡漏。　结果　手术时间 90～ 2 5 0分钟 ,平均 146分钟 ;主要并发症有肺泡漏≥ 7天 6例 ,心房颤动 2例 ,呼吸衰竭 1例 ,术后胸腔内出血 1例。 13例手术结束即拔出气管内插管 ,3例带管回病房需要机械通气。随访2～ 40个月 ,14例健在 ,术后患者呼吸困难指数上升为 级 1例 , 级 10例 , 级 3例。　结论　慢性阻塞性肺气肿选择性手术能改善患者肺功能 ,长期效果尚需要观察     

Compliance and functional residual capacity after staple versus combined staple/holmium laser lung volume reduction surgery in a rabbit emphysema model.

BACKGROUND: There is some evidence to suggest that laser exposure, when added to standard staple reduction techniques, may result in improved physiologic response to lung volume reduction surgery (LVRS). In this study, we compared physiologic responses of staple LVRS with combined staple/laser in a rabbit emphysema model. METHODS: Ninety-three New Zealand White rabbits underwent emphysema induction with aerosolized elastase 4 weeks before surgery and were killed 1 week after surgery. Treatment groups were bilateral moderate volume staple LVRS (< or =3 g, n = 39), combined moderate volume staple (< or =3 g)/holmium laser LVRS (n = 18), large-volume staple LVRS (> or =3 g, n = 27), or sham surgery (n = 9). RESULTS: Decrease in postoperative static respiratory system compliance by combined moderate-volume staple/laser treatment (1.22 cc/cm H2O) was similar to large-volume staple resection (1.40 cc/cm H2O, p = 0.39), and superior to moderate staple resection (0.82 cc/cm H2O, p = 0.01) or sham surgery (0.09 cc/cm H2O, p = 0.0001). Functional residual capacity decrease was greater after combined moderate staple/laser resection (6.46 cc) than large-volume staple resection (4.52 cc, p = 0.33), moderate-volume staple resection (4.59 cc, p = 0.43), or sham surgery (4.10 cc, p = 0.29). Perioperative mortality was highest after laser/staple LVRS (22%, 4/18). CONCLUSIONS: In this rabbit model, combined staple/ holmium laser reduction for emphysema results in significant improvement in compliance and trends toward improvement in functional residual capacity above staple reduction alone, but with higher mortality.     

Pulmonary vascular pressures increase after lung volume reduction surgery in rabbits with more severe emphysema

BACKGROUND: Emphysema is a chronic disease of the lungs with destruction of terminal alveoli and airway obstruction. Lung volume reduction surgery (LVRS) is being investigated for the treatment of emphysema. Increasing resection volumes with LVRS may lead to worsening of carbon monoxide diffusing capacity (Dlco) despite improvement in compliance and flow. We hypothesized that the pulmonary circulation-related parameters, pulmonary artery pressure (PAP) and diffusing capacity (Dlco), may be used as indicators of the maximally tolerated LVRS resection volume. METHODS: Emphysema was induced in 55 rabbits by endotracheal nebulization, with either single 15,000-unit (mild emphysema) or three 11,000-unit (moderate emphysema) doses of elastase. At Week 6, bilateral LVRS was performed via median sternotomy with an endoscopic stapler. Single-breath Dlco, static compliance, and PAP were measured prior to emphysema induction, preoperatively, and 1 week following LVRS. Animals were divided into the following groups: Group I (mild emphysema, <3 g resected), group II (mild emphysema, >3 g resected), group III (moderate emphysema, <3 g resected), group IV (moderate emphysema, >3 g resected). RESULTS: All animals having LVRS had immediate postoperative increase in pulmonary vascular resistance (PVR) following lung resection. Mean PAP, however, remained elevated when measured 1 week after LVRS (sacrifice) in animals with moderate emphysema. This is in contrast to animals with mild emphysema, in which follow-up PAPs approached preoperative baseline. CONCLUSION: These finding suggests that sustained increased PVR, denoted by elevated PAP, is more likely to occur after LVRS in animals with more severe emphysema and larger volume resection. The spirometric and compliance benefits of greater resection volumes have to be weighed against the compromise in pulmonary vasculature in the effort to determine the ideal resection volume for various degrees of emphysema.     

低分子肝素区域动脉灌注治疗重症急性胰腺炎的实验研究

目的:观察低分子肝素(LMWH)区域动脉灌注(LAI)对家兔重症急性胰腺炎(SAP)的疗效及对血浆TNF-α,IL-6,IL-10的影响。方法:24只健康成年家兔随机均分为假手术组,SAP组,SAP+LMWH静脉输注组(IV组),SAP+LMWH LAI组(LAI组)。以5%牛磺胆酸钠胰腺被膜下注射诱导SAP模型,造模30 min后,2个治疗组分别以静脉输注和LAI的方式给予LMWH(300 IU/kg),分别在术后0.5,3,6,12 h检测各组家兔静脉血浆TNF-α,IL-6和IL-10水平,并观察胰腺病理学改变。结果:假手术组术后血浆TNF-α和IL-6水平呈缓慢升高,其余各组血浆TNF-α和IL-6水平均在术后0.5~6 h内明显升高,与假手术组比较差异均有统计学意义(P<0.05或P<0.01),随后逐渐降低,其中IV组和LAI组血浆TNF-α和IL-6水平在各时点均低于SAP组(P<0.05或P<0.01),且LAI组两者降低程度大于IV组(P<0.05或P<0.01);假手术组术后IL-10水平在各时点无明显变化,SAP组IL-10水平在术后6 h各时点明显降低,与假手术组比较差异有统计学意义(均P<0.01),IV组和LAI组IL-10水平明显升高,与SAP组比较差异均有统计学意义(P<0.05或P<0.01),且LAI组升高程度明显大于IV组(P<0.01);除假手术组外,其余各组均为轻重不同的SAP特征性病理表现,以SAP组最重,IV组次之,LAI组最轻。结论:LMWH能降低SAP家兔TNF-α和IL-6的水平,提高IL-10的水平,对SAP具有治疗作用,且LAI优于静脉给药。     

Propofol attenuates diaphragmatic dysfunction induced by septic peritonitis in hamsters

BACKGROUND: Sepsis or peritonitis impairs diaphragmatic contractility and endurance capacity. Peroxynitrite, a powerful oxidant formed by superoxide and nitric oxide, has been implicated in the pathogenesis. Propofol scavenges this reactive molecule. The authors conducted the current study to evaluate whether propofol prevents diaphragmatic dysfunction induced by septic peritonitis. METHODS: Forty male Golden-Syrian hamsters (120-140 g) were randomly classified into five groups. Groups sham and sham-propofol 50 underwent sham laparotomy alone, whereas groups sepsis, sepsis-propofol 25, and sepsis-propofol 50 underwent cecal ligation with puncture. Groups sham and sepsis received infusion of intralipid, whereas groups sham-propofol 50, sepsis-propofol 25, and sepsis-propofol 50 received propofol at rates of 50, 25, and 50 mg.kg(-1).h(-1), respectively. Intralipid or propofol was subcutaneously infused from 3 h before surgery until 24 h after operation, when all hamsters were killed. Diaphragmatic contractility and fatigability were assessed in vitro using diaphragm muscle strips. Peroxynitrite formation in the diaphragm was assessed by nitrotyrosine immunostaining. Plasma nitrite-nitrate concentrations and diaphragmatic concentrations of malondialdehyde were determined. Using another set of animals, diaphragmatic inducible nitric oxide synthase activity was also measured. RESULTS: Twitch, tetanic tensions, and tensions during fatigue trials were reduced in group sepsis compared with group sham. In group SEPSIS, diaphragm malondialdehyde and inducible nitric oxide synthase activity, and plasma nitrite-nitrate concentrations increased, and positive immunostaining for nitrotyrosine residues was found. Propofol attenuated these changes. CONCLUSIONS: Pretreatment with propofol attenuated diaphragmatic dysfunction induced by septic peritonitis in hamsters assessed by contractile profiles and endurance capacity. This beneficial effect of propofol may be caused, in part, by inhibition of lipid peroxidation in the diaphragm caused by the powerful oxidant.     

Propofol Attenuates Diaphragmatic Dysfunction Induced by Septic Peritonitis in Hamsters

Background: Sepsis or peritonitis impairs diaphragmatic contractility and endurance capacity. Peroxynitrite, a powerful oxidant formed by superoxide and nitric oxide, has been implicated in the pathogenesis. Propofol scavenges this reactive molecule. The authors conducted the current study to evaluate whether propofol prevents diaphragmatic dysfunction induced by septic peritonitis.

Methods: Forty male Golden-Syrian hamsters (120-140 g) were randomly classified into five groups. Groups sham and sham-propofol 50 underwent sham laparotomy alone, whereas groups sepsis, sepsis-propofol 25, and sepsis-propofol 50 underwent cecal ligation with puncture. Groups sham and sepsis received infusion of intralipid, whereas groups sham-propofol 50, sepsis-propofol 25, and sepsis-propofol 50 received propofol at rates of 50, 25, and 50 mg [middle dot] kg-1 [middle dot] h-1, respectively. Intralipid or propofol was subcutaneously infused from 3 h before surgery until 24 h after operation, when all hamsters were killed. Diaphragmatic contractility and fatigability were assessed in vitro using diaphragm muscle strips. Peroxynitrite formation in the diaphragm was assessed by nitrotyrosine immunostaining. Plasma nitrite-nitrate concentrations and diaphragmatic concentrations of malondialdehyde were determined. Using another set of animals, diaphragmatic inducible nitric oxide synthase activity was also measured.

Results: Twitch, tetanic tensions, and tensions during fatigue trials were reduced in group sepsis compared with group sham. In group SEPSIS, diaphragm malondialdehyde and inducible nitric oxide synthase activity, and plasma nitrite-nitrate concentrations increased, and positive immunostaining for nitrotyrosine residues was found. Propofol attenuated these changes.