肝细胞生长因子对肝纤维化的保护作用及其机制研究

目的 观察肝细胞生长因子(HGF)对实验性肝纤维化大鼠的保护作用及其可能的作用机制.方法 采用CCl4复合因素造模,HE染色观察肝组织形态学变化,赖氏法检测ALT、AST,TUNEL标记法检测肝细胞凋亡百分率,免疫组化方法观察增殖细胞核抗原(PCNA)、bcl-2、bax、Cyt C、caspase-3表达.结果 造模5～8周时,模型组可见肝小叶结构紊乱,纤维组织明显增生,并向肝小叶内延伸分割肝小叶,造模8周可形成假小叶.与模型组比较,HGF治疗组肝细胞变性坏死、炎性细胞浸润及纤维组织增生较轻(P<0.01),ALT、AST水平下降(P<0.05),肝细胞凋亡明显减少(P<0.05),PCNA阳性表达明显增高(P<0.05),bcl-2表达明显增多(P<0.01),同时bax、Cyt C、caspase-3表达显著减少(P<0.05).结论 HGF通过调节线粒体途径抑制肝细胞凋亡、促进肝细胞增殖而发挥对实验性肝纤维化大鼠的保护作用.     

硒及中药抗肝纤维化实验研究

目的 探讨硒及中药的抗肝纤维化作用。方法 用CCl4等复合因素制备大鼠肝纤维化的动物模型，对病理形态学、常规生化指标ALT、A／G及血清肝纤维化指标HA、PC Ⅲ的变化进行观察。结果 模型组与预防组各组之间均有显著性差异，而中药＋硒预防组与中药预防组之间亦有显著性差异。病理结果显示，模型组正常肝小叶结构被破坏，有假小叶形成，肝细胞肿胀，呈水样变性，部分细胞脂肪变性可见肝细胞的点状坏死；而预防给药各组肝细胞的脂肪变性和水样变性明显减轻，未见明显的假小叶形成，其中以中药＋硒组肝细胞脂肪性和水样变性程度最轻。结论 硒及中药单独应用均可提高A／G值、降低血清ALT及HA、PCⅢ的水平，减轻肝组织纤维化的形态；如果在中药中适量加硒，则会进一步增强抗肝纤维化的作用。     

双虎清肝颗粒对四氯化碳诱发肝纤维化大鼠血液TNF-α和肝脏组织学的影响

目的：探讨双虎清肝颗粒对四氯化碳诱发肝纤维化大鼠血液TNF-α和肝脏组织学的影响。方法：清洁级Sprague-Dawley大鼠60只,随机分成6组,A组（正常对照组）、B组（模型组）、C1组（双虎清肝颗粒小剂量组）、C2组（双虎清肝颗粒中剂量组）、C3组（双虎清肝颗粒大剂量组）、D组（水飞蓟素对照组）。除正常对照组外,均经皮下注射400mL/L四氯化碳8周,后各治疗组给予不同剂量双虎清肝颗粒干预8周,阳性对照组给予水飞蓟素干预8周,ELISA法检测肿瘤坏死因子（TNF-α）,常规HE及Masson染色,光镜观察肝组织的脂肪变、炎症及纤维化程度。结果：各组大鼠肝脏病理表现：A组肝细胞排列整齐,未见脂质空泡形成,汇管区未见炎症,肝小叶结构清晰可见,未见肝纤维化及假小叶形成;B组可见大量脂质空泡形成,汇管区可见大量炎性细胞浸润,成纤维细胞大量增生,肝细胞广泛变性呈片状坏死。汇管区可见大量假小叶形成,肝小叶间隔明显增宽和大量胶原纤维沉积;C1、C2、C3、D组：C1组同B组相比,未见明显差异,可见大量脂质空泡形成,汇管区见大量炎性细胞浸润、成纤维细胞增生,肝细胞广泛变性及点状、片状坏死及较多假多小叶形成。C2组同模型组相比,脂质空泡有所减少,肝细胞坏死程度有所减轻,假小叶形成较少,仍明显可见、较多胶原纤维沉积。C3、D组同B组相比,脂质空泡明显减少,肝细胞坏死程度明显减轻,假小叶形成、胶原纤维沉积明显减少（见图1）。各组大鼠肝纤维化病变半定量结果：A组大鼠纤维化程度为0,B组大鼠纤维化程度为16.1±5.5,C1组大鼠纤维化程度为12.6±4.6^a,C2组大鼠纤维化程度为10.7±3.9^a,C2组大鼠纤维化程度为6.4±3.4^a,D组大鼠纤维化程度为6.5±3.3^a,以上数据为半定量计数结果,计算公式：P＋L＋2×（PN＋BN）;与B组比较,^aP〈0.05。各组大鼠肝脏TNF-α表达结果：A组大鼠8.01±3.45^b,B组大鼠19.15±4.86,C1组大鼠11.28±3.43^a,C2组大鼠9.93±5.31^a,C3组大鼠9.37±5.02^a,D组大鼠10.86±5.28^a。与B组比较,^aP〈0.05,与B组比较,^bP〈0.01。结论：双虎清肝颗粒能够显著改善四氯化碳所诱发的肝纤维化大鼠肝脏组织学变化及TNF-α的表达,并且量效关系明显。     

益生菌制剂治疗肝硬化的形态学研究

观察口服益生菌制剂对大鼠肝硬化模型的治疗效果,以寻求利用微生态疗法治疗肝病的新途径。用ｗｉｓｔａｒ 大鼠５０ 只,分四组做实验,并进行组织学观察,结果显示：治疗组肝细胞变性坏死程度减轻,假小叶形成延缓。提示,益生菌对肝硬化有一定治疗作用,可作为肝病患者的辅助治疗。     

枳椇子对实验性肝纤维化Ⅰ、Ⅲ型胶原的影响

目的研究枳楔子提取物对CCl4诱导的实验性肝纤维化的保护作用。方法用CCl4制备大鼠肝纤维化模型,免疫组化观察Ⅰ、Ⅲ型胶原蛋白的表达。结果模型组肝细胞大量坏死,汇管区炎性细胞浸润,假小叶形成。预防组能减轻纤维化时肝细胞的变性坏死及炎性细胞浸润,纤维组织增生较模型组明显减少,呈局限性,假小叶部分消失。预防组Ⅰ、Ⅲ型胶原免疫组化着色减少且浅,呈丝状,与模型组相比程度明显减少。结论枳棋子能促进肝纤维化时Ⅰ、Ⅲ型胶原的降解。其机理可能与抑制肝星状细胞(hepatic stellate cell,HSC)活化有关。     

维拉帕米和尼群地平对大鼠肝硬化作用的实验研究

目的：观察维拉帕米和尼群地平对大鼠肝硬化模型的治疗效果，并探讨其作用机制，以寻求用钙拮抗剂治疗肝病的新途径。方法：80只Wistar大鼠分为正常对照组、肝硬化模型组、维拉帕米组、尼群地平组、联合用药组。第4周、第8周测血清谷丙转氨酶（ALT）、总胆红素（TBIL）、透明质酸（HA）、Ⅳ型胶原（Ⅳ-C），肝组织切片分析。结果：维拉帕米和尼群地平有降低ALT和TBIL的作用，对肝硬化的指标HA和Ⅳ-C也有改善，且联合用药效果更佳。病理证明两种药物能减轻肝细胞变性坏死程度，延缓假小叶形成。结论：维拉帕米和尼群地平联合使用，可以有效地预防CCl4/乙醇对大鼠肝功能的损伤，降低肝硬化程度。     

绿甘安对大鼠肝硬化的缓解作用

目的探讨在绿甘安干预下，大鼠肝硬化形成时的肝脏功能和肝脏组织病理学改变是否有缓解作用。方法雄性SD大鼠50只随机分为3组,绿甘安组20只采用绿甘安尾静脉注射，皮下注射四氯化碳（CC14），饮用乙醇；肝硬化组20只皮下注射CCI4，饮用乙醇；对照组10只正常饮水摄食。10周后检测各组大鼠的肝脏功能，并观察肝脏组织的病理学变化。结果3组大鼠肝脏功能有差异（P〈0．05），在总胆红素（TBIL）、丙氨酸转氨酶（ALT）、总蛋白（TP）、白蛋白（ALB）、球蛋白（GLOB）指标上，绿甘安组介于肝硬化组和正常对照组之间（P〈0．05）。在肝脏组织病理学检查中，绿甘安组大鼠存在肝细胞变性、坏死、纤维组织增生，但是假小叶形成不明显；肝硬化组大鼠纤维增生明显，并形成大小不一的假小叶。结论绿甘安对大鼠肝硬化形成有一定的缓解作用。     

肝硬化大鼠肝缺血再灌注损伤肝细胞死亡方式

目的研究肝硬化大鼠肝缺血再灌注(I/R)损伤时肝细胞死亡的主要方式。方法采用四氯化碳复合法制作肝硬化大鼠模型,将肝硬化大鼠随机分为假手术(SO)组和I/R组,I/R组建立70%肝I/R模型,并于再灌注后0、1、6、24、48 h取材。比较各组的血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平,肝细胞钠钾ATP酶、钙ATP酶活性,流式细胞仪检测肝细胞胀亡和凋亡百分比,电镜观察肝细胞形态学改变。结果与SO组相比,I/R组再灌注后血清ALT、AST水平显著升高(P<0.05),6 h达高峰,后逐渐下降;肝细胞钠钾ATP酶、钙ATP酶活性显著下降(P<0.05),于再灌注1 h达低谷,后逐渐恢复;再灌注早期(6 h内)肝细胞死亡方式以胀亡为主,后期(24 h后)凋亡细胞逐渐增多;电镜下可见典型胀亡和凋亡改变。结论胀亡是肝硬化大鼠肝脏I/R损伤肝细胞死亡的主要方式,肝功能损伤与胀亡密切相关。     

同型半胱氨酸对人血管平滑肌细胞凋亡及bax、bcl-2表达的影响

目的　观察同型半胱氨酸 (Hcy) 对人血管平滑肌细胞 (VSMCs) 凋亡以及bax、bcl-2表达的影响。方法　采用组织贴块法体外培养人VSMCs; 采用流式细胞仪检测细胞凋亡率; 逆转录 -聚合酶链反应法检测Bax、bcl-2mRNA的表达。结果　体外培养的人VSMCs在终浓度为 0 (对照组)、100、200、500、1 000μmol/LHcy的培养液中孵育 24h后的细胞凋亡率分别为 ( 2. 68±0. 23 )%、 ( 2. 79±0 .12 )%、( 8. 45±2. 41 )%、 ( 13. 37±4 .71 )%、(23. 75±5 .56)%, 表明Hcy诱导人VSMCs细胞凋亡呈浓度依赖性; baxmRNA相对表达量分别为 0 .86±0. 01、0 .92±0 .03、1. 51±0 .02、1. 82±0 .03、1 .91±0 .02, bcl-2mRNA相对表达量分别为 1. 38±0 .04、1. 32±0 .03、1. 28±0 .03、1 .21±0. 02、1 .09±0. 02, 表明Hcy呈浓度依赖性诱导人VSMCsbax基因表达显著上调, bcl-2基因表达轻度下调, bax/bcl-2比值升高。结论　Hcy诱导人VSMCs凋亡可能是通过上调bax基因表达来实现的, 诱导人VSMCs凋亡可能是Hcy致动脉粥样硬化作用的机制之一。     

益舒软肝丸抗脂质过氧化的实验研究

目的:研究益舒软肝丸逆转肝硬化的作用机理。方法:以CCL4复合因素法建立肝硬化模型,首先制备出肝硬化的实验动物模型,造模结束后,连续灌胃给药3个月。检查ALT、AST,A/G、CHE;HA、LN、PⅢNP、Hyp;SOD、MDA。结果:与模型对照组大鼠比,用药组组织切片显示汇管区有少量纤维组织增生,但未见假小叶结构;肝功能指标ALT、AST减少,A/G、CHE增加,肝功能有显著好转;HA、LN、PⅢNP、Hyp水平显著降低,肝纤维化程度降低;MDA水平降低。结论:说明益舒软肝丸有明显的抗肝硬化的作用,作用机制可能与抗脂质过氧化,保护肝细胞有关。     

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.     

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.     

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.