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1.
目的 探讨蛛网膜下腔出血(SAH)后大鼠基底动脉中高迁移率族蛋白B1 (HMGB1)表达变化的p38丝裂原活化蛋白激酶(p38 MAPK)的调控机制.方法 通过枕大池二次注血方法制作大鼠SAH模型,注血前预先给予p38MAPK抑制剂SB203580,应用酶联免疫吸附试验(ELISA)、逆转录酶-多聚酶链反应(RT-PCR)分别从蛋白、基因水平分析抑制p38MAPK途径后发生SAH时基底动脉中HMGB1的表达情况.结果 SAH后大鼠基底动脉逐渐出现痉挛.抑制p38MAPK途径后基底动脉HMGB1蛋白、基因水平在SAH后升高,于5~7d达高峰,之后逐渐降低,14 d时仍维持较高水平.与枕大池二次注血组基底动脉HMGB1蛋白、基因水平相比,SB203580干预后基底动脉HMGB1浓度相比对照组每个时间点均降低.结论 SB203580能下调枕大池二次注血后基底动脉HMGB1蛋白和基因的表达,p38MAPK信号通路可能直接参与SAH后HMGB1的诱生机制.  相似文献   

2.
p38MAPK在蛛网膜下腔出血后脑血管痉挛中的作用   总被引:2,自引:1,他引:1  
目的探讨促分裂原活化蛋白激酶p38(p38MAPK)在蛛网膜下腔出血(SAH)后脑血管痉挛(CVS) 中的作用。方法采用枕大池二次注血的方法建立SAH模型。用酶联免疫吸附测定法(ELISA)、免疫组织化学、测量基底动脉横截面积的方法分别检测兔脑脊液肿瘤坏死因子-α(TNF—α)浓度变化及平滑肌细胞p38MAPK的表达与CVS程度变化的关系。结果 TNF—α浓度在注血后第3天达高峰,持续到第5天时,与注血前有明显差异(P< 0.01);平滑肌细胞p38MAPK表达增强;基底动脉横截面积则显著小于对照组(P<0.01)。应用p38MAPK特异性抑制剂SB203580干预后,TNF—α浓度显著降低到注血前水平,平滑肌细胞p38MAPK表达也明显减弱,基底动脉横截面积与对照组相比无明显差异(P>0.05)。结论 SAH后继发性的CVS可能是激活的p38MAPK通过对细胞因子增量调节机制作用的结果。  相似文献   

3.
目的探讨蛛网膜下腔出血(SAH)后基底动脉肿瘤坏死因子α(TNF-α)的表达变化以及与脑血管痉挛(CVS)的关系。方法通过枕大池二次注血方法制作大鼠SAH模型,HE染色观察基底动脉的血管形态学变化,免疫组化方法观察基底动脉TNF-α的表达情况,酶联免疫吸附试验和逆转录酶-多聚酶链反应,分别从蛋白、基因水平分析TNF-α在SAH后基底动脉中的表达变化情况。结果SAH后大鼠基底动脉逐渐出现痉挛,从1 d开始,5~7 d时最明显,炎性细胞浸润也最明显,以后逐渐减轻,14 d基本恢复正常。TNF-α阳性的内皮细胞数及TNF-α蛋白水平逐渐增高,术后7 d达高峰,之后逐渐降低,14 d时仍维持较高水平。TNF-αmRNA表达在注血后1 d明显增加,7 d时达高峰,持续到14 d,仍维持较高水平。结论①大鼠枕大池二次注血后基底动脉呈现痉挛状态;②基底动脉TNF-α表达变化与动脉痉挛程度呈正相关,表明TNF-α可能导致SAH后基底动脉痉挛。  相似文献   

4.
党宝齐  陈罡  王中 《卒中与神经疾病》2011,18(5):275-278,305
目的探讨大鼠蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后基质金属蛋白酶-9(MMP-9)在基底动脉壁中的表达变化及其与脑血管痉挛(Cerebral Vasospasm,CVS)的关系。方法健康成年雄性SD大鼠51只,并随机分为正常组、对照组和SAH组,应用枕大池一次注血法制成SAH动物模型,对照组和SAH组大鼠在SAH后1 d,3 d,5 d,7 d,14 d时间点通过HE染色光镜下观察基底动脉的病理学变化,测定血管壁厚度及血管腔内径,以此评价脑血管痉挛;应用免疫组化法评估大鼠基底动脉管壁中MMP-9在不同时间点的表达水平。结果 HE染色显示SAH组基底动脉管腔狭窄,管壁增厚,3 d时最明显,之后狭窄程度渐减轻,14 d时基本正常;SAH后基底动脉壁MMP-9表达增加,表达高峰为注血后3~5 d,随后开始下降,14 d恢复正常。结论大鼠SAH存在明确的CVS,SAH后MMP-9在基底动脉壁中的表达上调,并与CVS的时相一致,提示MMP-9可能参与了CVS的病理过程。  相似文献   

5.
目的探讨血小板源性生长因子(PDGF)在大鼠蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)血管壁的表达及关系。方法将30只大鼠按照枕大池二次注血的方法建立模型,然后分别于建立模型后的1 d、3 d、5 d、7 d、14 d将大鼠处死,取出基底动脉制作石蜡切片在光镜下观察。采用免疫组化法检测大鼠基底动脉血管壁PDGF的表达水平。结果模型组中PDGF在基底动脉血管壁上的表达,3 d和5 d组最明显,与脑血管痉挛程度的变化是一致的。结论通过枕大池二次注血能够成功的模拟SAH后CVS的发生。PDGF参与了SAH后CVS的过程,并可能起了重要的作用。  相似文献   

6.
目的探讨姜黄素(Cur)对大鼠蛛网膜下腔出血(SAH)脑血管痉挛(CVS)的作用及其机制。方法将60只SD大鼠分成假手术组、SAH组及姜黄素+SAH组,每组20只,采用枕大池二次注血法制作SAH大鼠模型,姜黄素组在造模后给予一次姜黄素注射液(100mg·kg~(-1))腹腔注射治疗评定大鼠的神经生物功能,每组在造模后3d和7d处死,灌注固定后取大鼠基底动脉,印度墨水灌注,测量基底动脉内径、血管壁厚度,用酶联免疫吸附法测定各组血浆中肿瘤坏死因子-α(TNF-α)、一氧化氮酶(i NOS)含量。结果与假手术组相比,SAH组大鼠在造模后3d和7d基底动脉内径均显著缩小,基底动脉血管壁厚度显著增加,神经生物功能评分明显升高,血浆i NOS水平显著增高,TNF-α水平显著升高。与SAH组相比,使用姜黄素治疗后3d和7d基底动脉内径均显著增加,基底动脉血管壁厚度显著减小,神经生物功能评分降低,血浆i NOS水平显著降低,TNF-α水平显著降低。结论姜黄素可以改善SAH大鼠CVS,其机制可能与姜黄素抑制TNF-α和i NOS的信号通路,降低大鼠基底动脉血管炎症反应有关。  相似文献   

7.
目的 探讨酪氨酸激酶(Src)在蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)中的作用和机制,以及应用Src抑制剂PP2对脑血管痉挛的治疗作用。方法 枕大池二次注血法制作大鼠SAH模型,造模后第1天至第5天腹腔注射10mmol/L Src抑制剂PP20.1ml,对照组注射等体积DMSO。第5天处死动物,H-E染色观察大鼠基底动脉血管直径。Westernblot检测基底动脉Src、Ras、MAPK蛋白表达,Real-timePCR检测基底动脉IL-1β、IL-6mRNA表达。结果 枕大池二次注血法成功制作SAH模型,基底动脉发生了明显血管痉挛。SAH组基底动脉Src、Ras、MAPK表达显著增高,IL-1β、IL-6细胞因子mRNA表达增加。应用PP2后血管痉挛减轻,基底动脉Src、Ras、MAPK表达下降,IL-1β、IL-6mRNA表达减少。结论 Src与SAH后脑血管痉挛发生有关。Src抑制剂PP2能够缓解脑血管痉挛,其机制一部分通过MAPK信号通路起作用,另外可能通过减少IL-1β、ILl6等细胞因子表达,抑制炎症反应起作用,针对该信号通路可能对脑血管痉挛的治疗有效。  相似文献   

8.
兔痉挛脑血管中JNK的表达及其抑制剂的影响   总被引:1,自引:0,他引:1  
目的 观察兔脑血管痉挛(CVS)后基底动脉p-jnk的表达及其抑制剂SP600125对其表达的影响,以探讨蛛网膜下腔出血(SAH)后CVS细胞信号转导通路机制。方法 ①采用二次枕大池注血建立家兔CVS模型。②采用HE染色、免疫组织化学技术动态观察兔基底动脉血管壁组织病理改变、p-jnk的表达及使用SP600125干预后对上述表达的影响。结果 ①SAH组基底动脉管腔狭窄、炎症细胞浸润等,以SAH后7d时为最重,10d时逐渐缓解;SAH+SP600125组与同时段的SAH组比较血管变化明显减轻。②SAH组p-jnk在SAH后7d时表达最为明显,10d表达稍减少,但仍明显高于正常组(P〈0.01);SAH+SP600125组与同时段的SAH组比较p-jnk表达明显减少(P〈0.05)。结论 ①原癌基因c-jun氨基末端激酶(JNK)信号转导通路调节免疫炎性反应,是参与形成CVS机制之一。②JNK抑制剂SP600125可以调控血管壁的炎症反应,有效缓解CVS。  相似文献   

9.
目的 观察兔蛛网膜下腔出血(SAH)后基底动脉细胞色素C(Cyt-C)的表达规律,以探讨其在细胞凋亡中的作用及与脑血管痉挛(CVS)的关系.方法 36只新西兰大白兔随机分为对照组(6只)和SAH组(30只).SAH组采用枕大池二次注血法建立兔CVS模型,对照组行枕大池二次注入生理盐水.应用苏木精-伊红染色观察基底动脉形态学变化,TUNEL法检测基底动脉上细胞凋亡情况,免疫组化检测基底动脉内皮细胞和平滑肌细胞的Cyt-C表达.结果 对照组基底动脉结构正常,偶见凋亡细胞和Cyt-C表达.SAH组基底动脉出现相应病理学改变,管腔狭窄呈双相期改变;基底动脉上细胞凋亡和Cyt-C表达均在SAH后增多,于第7天达高峰,第10天逐渐下降.与对照组比较,SAH组内各时间点基底动脉直径和Cyt-C表达差异均有统计学意义(P<0.05).结论 兔CVS模型的基底动脉中存在细胞凋亡,Cyt-C是启动细胞凋亡的重要因素,在CVS发生和发展过程中起重要作用.  相似文献   

10.
目的探讨大鼠SAH(subarachnoid hemorrhage,SAH)后血清血小板源性生长因子(platelet-derivedgrowth factor,PDGF)与脑血管痉挛的关系,为临床治疗SAH后CVS(脑血管痉挛cerebral vasospasm)提供实验依据。方法 55只Sprague-Dawley大鼠随机分为三组:正常组,对照组(即SOR组,假手术组,Shamoperated rats,枕大池注入等量生理盐水)和SAH模型组。采用ELISA法测定血液中PDGF的水平;同时保存对应标本,观测大鼠基底动脉的形态学改变,测定血管壁厚度及血管内径。比较血清PDGF含量的变化与脑血管痉挛之间的关系。结果模型组基底动脉痉挛于第1 d就出现,第3d表现最为明显,第5,7d以后明显减轻,但仍比SOR组明显,第14 d基本正常。大鼠SAH后血清PDGF浓度于第1 d就明显升高,至第3 d达到顶峰,至第7天时仍高于SOR组,第14 d时基本正常。SAH后血清PDGF水平的变化与脑血管痉挛的变化是一致的。结论二次枕大池注血后,基底动脉发生了明显的细胞形态改变、管壁的增厚以及管腔的狭窄,提示SAH后有CVS的存在。SAH后血清PDGF水平的变化与脑血管痉挛的变化是一致的,呈正相关。提示PDGF可能参与了CVS的病理过程。  相似文献   

11.
目的探讨p38丝裂原活化蛋白激酶(p38MAPK)在蛛网膜下腔出血(SAH)后早期脑损伤(EBI)中的作用。方法成年雄性SD大鼠随机分配至对照组、SAH组及p38MAPK干预组,每组18只。采用血管内穿刺法制作SAH模型,干预组于术前30 min经侧脑室注射p38MAPK特异性抑制剂SB203580,造模后24 h处死。观察各组大鼠脑含水量和神经功能评分,RT-PCR及免疫组化检测脑组织p38MAPK表达。结果与对照组相比,SAH组大鼠脑含水量(t=-196.35,P0.01)及p38 MAPK的mRNA水平(t=-24.75,P0.01)均明显升高,神经功能评分明显减低(t=201.08,P0.01)。与SAH组相比,干预组脑含水量(t=75.67,P0.01)及p38 MAPK的mRNA水平(t=9.43,P0.01)均明显下降,神经功能评分明显升高(t=-81.68,P0.01)。免疫组化示SAH组及干预组均有p38MAPK表达,但干预组较SAH组表达水平明显下降(t=-3.37,P0.01)。结论 p38 MAPK在EBI形成机制中起重要作用,有望成为防治EBI的药物作用新靶点。  相似文献   

12.
Aims: To investigate the mechanism behind cytotoxic edema formation following subarachnoid hemorrhage (SAH). Methods: We explored the role of aquaporin‐4 (AQP4), inwardly rectifying K+ 4.1 (Kir4.1) channels and their upstream orchestrators p53 and p38MAPK in this process. A p53 inhibitor, pifithrin‐α (PFT‐α) was administered intraperitoneally to rats undergoing SAH by endovascular perforation. Totally, 98 male SD rats were categorized into sham, SAH, SAH+ dimethyl sulfoxide (DMSO), SAH+ 0.2 or 2.0 mg/kg PFT‐α groups. At 24 h after SAH, MRI (diffusion‐weighted imaging [DWI]), immunohistochemistry, and Western blot were used. Results: MRI (DWI) showed a significant cytotoxic edema in the brain following SAH with PFT‐α therapy reducing it. Immunohistochemistry and Western blot showed an increased level of p53, phosphorylated‐p38MAPK and AQP4 and a reduced level of Kir4.1; all of which could be reversed following PFT‐α treatment. Treble labeling staining revealed colocalization of p53 with phosphorylated‐p38MAPK and unmatched expression of AQP4 and Kir4.1 within astrocyte cells. Conclusion: These results indicated p53 mediates the formation of cytotoxic edema in the brain following SAH; an uncoupling expression of AQP4 and Kir4.1 on astrocytic end feets orchestrated by p38MAPK was partly responsible.  相似文献   

13.
p38 mitogen-activated protein kinase (MAPK) is a major player in mitochondrial dysfunction after subarachnoid hemorrhage (SAH). Moreover, DJ-1, which responds to oxidative stress and translocates to mitochondria, maintains mitochondrial homeostasis. Although a few studies have demonstrated that DJ-1 indirectly regulates p38 activation, the relationship between DJ-1 and p38 in mitochondrial dysfunction after SAH has not been delineated. Using an in vitro SAH model, alterations in p38, p-p38, DJ-1, and autophagic-related protein expression were detected. As expected, p38 inhibitor significantly blocked excessive expression of p38 and p-p38 after SAH, whereas total DJ-1 expression and mitochondrial DJ-1 were up-regulated. Further analysis showed that p38 inhibitor significantly blocked oxyhemoglobin (OxyHb) induced mitochondrial dysfunction, including mitochondrial membrane potential depolarization and reactive oxygen species (ROS) release. In addition, p38 inhibitor restored OxyHb-induced abnormal autophagic flux at the initiation and formation stage by regulating Atg5, beclin-1, the ratio of LC3-II/LC3-I, and p62 expression. This study suggested that overexpression of p38 induced the accumulation of mitochondrial dysfunction partly due to abnormal activation of autophagy, which largely relied on DJ-1 mitochondrial translocation.  相似文献   

14.
Objectives: Cx43 phosphorylation is involved in the pathogenesis of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). However, the exact phosphorylation mechanism of Cx43 in CVS is not fully elucidated. Thus, we examined the role of P38MAPK in CVS and Cx43 phosphorylation, using a double hemorrhage rat model.

Methods: Sprague–Dawley rats weighing 300–350?g were grouped into sham, SAH, vehicle, and SAH?+?SB203580. SAH was induced by double injecting blood into the prechiasmatic cisterns. Neurological score was measured with the Garcia scoring system, and the diameters of basilar arteries and the expression of pCx43, pP38MAPK, and P38MAPK proteins were measured through pressure myograph measurement and Western blot analysis, respectively.

Results: The neurological scores remarkably decreased after SAH but remarkably improved after SB203580 was used. The results of pressure myograph analysis on the SAH and vehicle groups showed the considerable narrowing of the basilar arteries in comparison with that of the sham group. By contrast, the arterial diameters in the SAH?+?SB203580 group were much larger than those observed in the SAH and vehicle groups. Moreover, the P38MAPK expression in the sham group had no substantial change in contrast to the SAH and vehicle groups, and pCx43 and pP38MAPK increased in the SAH and vehicle groups. Meanwhile, the SAH?+?SB203580 group showed marked decrease in Cx43 and P38MAPK phosphorylation levels relative to the SAH and vehicle groups.

Conclusions: P38MAPK pathway facilitates the development of CVS through the upregulation of Cx43 phosphorylation.  相似文献   


15.
Tumor-necrosis factor-α (TNF-α) is critical to the development of cerebral vasospasm after subarachnoid hemorrhage (SAH). Hence, therapeutic strategies targeting TNF-α can attenuate cerebral vasospasm. This study investigated the effects of SB203580, a p38 mitogen-activated protein kinase (MAPK) inhibitor, on TNF-α concentration in the cerebral arteries and the cerebrospinal fluid (CSF) after SAH and on subsequent cerebral vasospasm. Twenty-three rabbits were divided into four groups: (i) control (without SAH), (ii) SAH (SAH only), (iii) dimethylsulfoxide (DMSO, vehicle), and (iv) SB203580. The severity of vasospasm and the immunoreactivities of TNF-α and phosphorylated p38 MAPK in the brain vessels were determined in all animals, and the concentrations of TNF-α in the CSF were also assessed. Severe vasospasm was observed in the rabbits from the SAH and DMSO groups. SB203580 reversed vasospasm after SAH. Lower immunoreactivities of TNF-α and phosphorylated p38 MAPK were found in the basilar artery in the SB203580 group than in the DMSO group. The concentration of TNF-α in the CSF increased after SAH, but treatment with SB203080 after SAH suppressed this increase. Our data show that SB203580 reversed cerebral vasospasm by inhibiting the phosphorylation of p38 MAPK in the basilar artery and by suppressing the increase in TNF-α in the basilar artery and CSF after SAH. SB203580 could therefore potentially be used for the treatment of cerebral vasospasm after SAH.  相似文献   

16.
Our previous studies indicate that apoptosis in endothelial cells of major cerebral arteries contributes to cerebral vasospasm after subarachnoid hemorrhage (SAH). This study examined the pathologic roles of tumor suppressor p-53 in cerebral vasospasm using an established dog double-hemorrhage model. Twenty mongrel dogs were divided into four groups: (1) control, (2) SAH, (3) SAH+DMSO (vehicle), and (4) SAH+pifithrin-alpha (PFT) (p53 inhibitor). The p53 inhibitor (200 nmol/L) was injected into the cisterna magna daily from Day 0 through Day 3. Angiogram was performed on Day 0 and Day 7. Western blot, cell proliferation assay, histology, and TUNEL staining were conducted on the basilar arteries collected on Day 7 after SAH. The arterial diameter on Day 7 was 42%+/-4%, 40%+/-5%, and 59%+/-4% for SAH, SAH+DMSO, and SAH+PFT, respectively. In addition, positive staining of TUNEL and increased protein expression of p53, Bax, and PCNA in the basilar artery were observed on Day 7. PFT suppressed apoptosis in endothelial cells and proliferation in smooth muscle cells, and attenuated angiographic vasospasm. In conclusion, p53 may be a key factor in endothelial apoptosis and smooth muscle proliferation after SAH. Inhibition of p53 may potentially reduce or even prevent cerebral vasospasm.  相似文献   

17.
目的 探讨免疫炎症反应在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)后脑血管痉挛(cerebral vasospasm,CVS)发病机制中的作用.方法 应用新西兰家兔经枕大池二次注血制成SAH动物模型.在各相应时间点运用数字减影血管造影(digital subtraction angiography,DSA)、HE染色和免疫组化等方法 ,观察兔基底动脉管壁形态以及核转录因子kappaB(nuclear factor-kappaB,NF-κB)、细胞间粘附因子-1(intercellular adhesion molecule,ICAM-1)在管壁上表达的动态变化.结果 在SAH后第3天基底动脉血管腔已开始狭窄,第7天达到高峰,之后狭窄渐减轻,14d时基本接近正常.SAH后3d NF-κB表达增加,5~7d表达持续在一个较高的水平,随后开始下降;ICAM-1表达变化趋势与NF-κB相似,但在表达高峰时相上稍迟于后者.结论 NF-κB、ICAM-1在血管壁上的表达变化与CVS的发生时相密切相关,提示由其参与介导的血管壁炎症反应可能在CVS的发生和发展过程中起了重要的作用.
Abstract:
Objective To evaluate the possible effect of inflammatory reaction in the pathogenesis of CVS after SAH.Methods The "double-hemorrhage" model of vasospasm Was performed by two injections of autologous aterial blood into the cisterna magna of Newzealand rabbits.We oberserved morphological changes and the rule of expression and activity of NF-κB and ICAM-1 in basilar artery(BA)walls by DSA,light microscope and immunohistochemistry.Results The "double-hemorrhage"model of vasospasm was succeeded to be made.The BA vasospasm Was obvious on 3d after autologous aterial blood wa8 first injected into the cisterna magna,and peaked on 7d,and then relieved.On 14d,there was almost no abnormality in the arterial wall.Upregulation of NF-κB expression started on 3d,became stronger on 5d to 7d,and then decreased.The upregulation of ICAM-1 expression in the BA walls Was similar with NF-κB,but was a bit later to tively correlated with the vasospasm.Inflammatory reaction in arterial walls mediated by NF-8κB may play a key mle in the process of CVS after SAH.  相似文献   

18.
Signaling pathways for early brain injury after subarachnoid hemorrhage.   总被引:7,自引:0,他引:7  
Few studies have examined the signaling pathways that contribute to early brain injury after subarachnoid hemorrhage (SAH). Using a rat SAH model, the authors explored the role of vascular endothelial growth factor (VEGF) and mitogen-activation protein kinase (MAPK) in early brain injury. Male Sprague-Dawley rats (n = 172) weighing 300 to 350 g were used for the experimental SAH model, which was induced by puncturing the bifurcation of the left anterior cerebral and middle cerebral arteries. The blood-brain barrier (BBB), brain edema, intracranial pressure, and mortality were evaluated at 24 hours after SAH. The phosphorylation of VEGF and different MAPK subgroups (ERK1/2, p38, and JNK) were examined in both the cortex and the major cerebral arteries. Experimental SAH increased intracranial pressure, BBB permeability, and brain edema and produced high mortality. SAH induced phosphorylation of VEGF and MAPKs in the cerebral arteries and, to a lesser degree, in the cortex. PP1, an Src-family kinase inhibitor, reduced BBB permeability, brain edema, and mortality and decreased the phosphorylation of VEGF and MAPKs. The authors conclude that VEGF contributes to early brain injury after SAH by enhancing the activation of the MAPK pathways, and that the inhibition of these pathways might offer new treatment strategies for SAH.  相似文献   

19.
目的 探讨缝隙连接抑制剂甘珀酸对实验性蛛网膜下腔出血后脑血管痉挛的治疗作用.方法 建立兔蛛网膜下腔二次出血模型,脑池及静脉分别给与缝隙连接抑制剂甘珀酸,脑血管造影及光镜观察分析基底动脉的直径及形态学变化,并应用Western blotting检测基底动脉Cx43蛋白的表达变化.结果 给与甘珀酸后,基底动脉狭窄程度及光镜下形态学变化显著减轻:单纯注血组(65.7±10.3)%,脑池处理组(91.2±6.4)%,静脉处理组(96.4±11.0)%,腑池预处理组(89.7±12.8)%;同时也显著抑制了痉孪后Cx43蛋白表达水平的升高:单纯注血组(57.2±2.8)%,脑池处理组(10.0±5.3)%,静脉处理组(15.2±1.7)%.结论 缝隙连接抑制剂甘珀酸可能对蛛网膜下腔出血后脑血管痉挛起到预防和治疗作用.  相似文献   

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