血管内皮生长因子与细胞黏附分子-1的表达及其对血管内皮功能的影响

目的 通过观察高脂血症大鼠NO、血管内皮生长因子(VEGF)与血管细胞黏附分子-1(VCAM-1)水平及调脂药物辛伐他汀对其表达的影响,探讨高脂血症在动脉粥样硬化早期对内皮功能的损伤机制.方法 将30只SD大鼠随机分为正常对照组、高脂血症组及辛伐他汀治疗组,分别检测3组大鼠血脂变化及NO、VEGF、VCAM-1水平.结果 与正常对照组比较,高脂血症组NO水平较低、VCAM-1表达较强且范围较广,黏附于内皮的白细胞数明显增多(P＜0.05);VEGF水平与对照组比较,差异无统计学意义;高脂血症组血NO2-/NO3-水平为(29.6±7.2)μmol/L,与正常对照组(38.0±9.9)μmol/L比较明显降低(P＜0.05);辛伐他汀组血NO2-/NO3-水平为(37.4±9.5)μmol/L,高于高脂血症组(P＜0.05),VEGF较高脂血症组明显增高(P＜0.05);血NO2-/NO3-与VEGF呈正相关(r=0.644,P＜0.05).血清NO浓度与VCAM-1表达强度及范围呈负相关(r分别为-0.676、-0.684,均为P＜0.05).结论 NO、VCAM-1参与高脂血症血管内皮的损害;辛伐他汀对内皮功能的改善,可能是通过提高NO水平、减少内皮细胞VCAM-1的表达及促进VEGF的分泌而实现的.     

老年高血压水平与血管内皮功能相关指标的关系研究

目的探讨老年高血压水平与和血管内皮功能的关系。方法收集2010年9月—2014年5月在我院心内科收治的老年高血压患者182例,根据血压水平将患者分为3组:轻度高血压组62例,中度高血压组63例,重度高血压组57例。收集同期健康体检志愿者55例为对照组。结果与对照组相比,3个高血压组血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1)和血管内皮生长因子(VEGF)水平较低(P0.05),一氧化氮(NO)水平较高(P0.05),随着高血压分级越高,AngⅡ、ET-1和VEGF水平越低(P0.05),NO水平越高(P0.05);相关性分析显示AngⅡ、ET-1、VEGF水平与血压水平呈正相关关系(r=-0.71、0.68和0.64,P0.05);NO与血压水平呈负相关关系(r=-0.62,P0.05)。结论老年高血压的发生发展与血管内皮功能不全密切相关,内皮功能不全的发生机制与AngⅡ、ET-1、NO和VEGF水平密切相关,可通过AngⅡ、ET-1、NO和VEGF直接或间接评估内皮功能的改善或受损状况。     

通心络胶囊对颈动脉狭窄病人血管内皮功能及颈动脉血流的影响

目的观察通心络胶囊对颈动脉狭窄病人血管内皮功能及颈动脉血流的影响。方法将65例颈动脉狭窄病人随机分为两组。对照组32例,给予阿司匹林肠溶片、硫酸氢氯吡格雷片、辛伐他汀等常规药物治疗。研究组33例,在对照组基础上加服通心络胶囊。分别检测两组治疗前及治疗12周后血清血管内皮生长因子(VEGF)、内皮素-1(ET-1)、一氧化氮(NO)水平及颈动脉血流的变化。结果治疗前,两组病人血清VEGF、ET-1、NO水平及颈动脉血流速度比较差异无统计学意义(P0.05)。与对照组治疗12周后比较,研究组病人ET-1水平明显降低(P0.05),血清VEGF、NO水平明显升高(P0.05),血流速度明显改善(P0.05)。结论通心络胶囊能明显改善颈动脉狭窄病人血液流变学、血管内皮功能、颈动脉血流,明显提高脑部供血。     

降脂灵片联合瑞舒伐他汀对高脂血症病人血清VEGF、NO、SOD的影响

目的观察降脂灵片联合瑞舒伐他汀对高脂血症病人血脂、血管内皮功能、超氧化物歧化酶(SOD)的影响。方法将100例高脂血症病人随机分为对照组和观察组,各50例,两组均给予高脂血症治疗指南推荐的低盐低脂饮食及瑞舒伐他汀钙片口服,观察组加服降脂灵片。观察治疗前、治疗12周后两组血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、血管内皮生长因子(VEGF)、一氧化氮(NO)、SOD的变化。结果治疗前,两组TC、TG、VEGF、HDL-C、LDL-C、VEGF、NO及SOD比较,差异均无统计学意义(P0.05)。治疗12周后,两组TG、TC、LDL-C均下降,HDL-C、VEGF、NO、SOD均升高,且观察组TG、TC、LDL-C较对照组明显下降(P 0.05),HDL-C、VEGF、NO、SOD较对照组均明显升高(P 0.05)。结论降脂灵片联合瑞舒伐他汀能明显降低高脂血症病人血脂和血管内皮功能。     

辛伐他汀对高脂血症患者内皮功能障碍的干预作用及其与碱性成纤维细胞生长因子的关系

目的 研究辛伐他汀对高脂血症患者血管内皮功能障碍的干预作用及其与血清碱性成纤维细胞生长因子的关系.方法 将54例高脂血症患者按血脂水平随机分为辛伐他汀组(28例,辛伐他汀20 mg/d,8周)和高.脂对照组(26例),另设正常对照组(29例,正常健康受试者).应用彩色多谱勒超声诊断仪测量受试者肱动脉血流介导的舒张功能,评价血管内皮功能的变化.应用酶联免疫吸附双抗体夹心法和硝酸酶还原法检测受试者血清碱性成纤维细胞生长因子和一氧化氮的含量,评价一氧化氮及碱性成纤维细胞生长因子与血管内皮功能障碍的关系.常规检测血清总胆固醇、甘油三酯、低密度脂蛋白及高密度脂蛋白的浓度.结果 8周后,辛伐他汀组与高脂对照组相比肱动脉血流介导的舒张功能明显改善(P<0.05),血清一氧化氮和血清碱性成纤维细胞生长因子含量升高(P<0.05),血清总胆固醇、甘油三酯和低密度脂蛋白浓度明显下降(P<0.01),而高密度脂蛋白浓度明显升高(P<0.01).结论 辛伐他汀可增加血清碱性成纤维细胞生长因子含量,提高一氧化氮含量,改善高脂血症患者血管内皮功能障碍,其作用机制与降低血清总胆固醇、甘油三酯和低密度脂蛋白的浓度有一定关系.     

瑞舒伐他汀钙对高脂血症患者颈动脉粥样硬化斑块及IL-1、TNF-α水平的影响

目的观察瑞舒伐他汀钙对高脂血症患者血脂、血管内皮生长因子(VEGF)、一氧化氮(NO)、颈动脉粥样硬化斑块面积、肿瘤坏死因子(TNF-α)、白细胞介素-1(IL-1)水平的影响,探讨瑞舒伐他汀钙对高脂血症患者血管内皮功能、颈动脉粥样硬化斑块治疗的作用机制。方法将115例高脂血症患者随机分为研究组(62例)与对照组(53例),研究组给予瑞舒伐他汀钙10mg,每日1次口服,肠溶阿司匹林100mg,每日1次口服。对照组仅给予肠溶阿司匹林100mg,每日1次口服。观察两组患者治疗前后血脂水平及血清VEGF、NO、TNF-α、IL-1、内膜中层厚度(IMT)、斑块面积的变化。结果治疗前,两组患者血脂、血管内皮功能、炎症因子及颈动脉斑块等方面比较,差异无统计学意义(P0.05)。治疗12周后,与对照组比较,研究组三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、TNF-α、IL-1、IMT、斑块面积明显降低(P0.05),高密度脂蛋白胆固醇(HDL-C)、VEGF、NO水平明显升高(P0.05)。结论瑞舒伐他汀钙能明显改善高脂血症患者血管内皮功能,升高VEGF、NO的表达,减小颈动脉粥样硬化斑块,抑制机体炎症反应。     

脂康颗粒联合瑞舒伐他汀对高脂血症患者血管内皮功能及TNF-α、IL-1的影响

目的探讨脂康颗粒联合瑞舒伐他汀钙对中老年高脂血症患者血管内皮功能及炎性因子的影响。方法 79例患者随机分为两组,观察组42例,给予脂康颗粒及瑞舒伐他汀钙口服;对照组37例,仅给予瑞舒伐他汀钙口服。治疗前、治疗12周后,分别测定两组患者胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血管内皮生长因子(VEGF)、一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)水平。结果治疗前,两组患者血脂、血管内皮功能及炎性因子差异均无统计学意义(P0.05)。治疗12周后,观察组TG、TC、LDL-C、TNF-α、IL-1水平明显降低(P0.05),VEGF、NO、HDLC水平明显升高(P0.05)。结论脂康颗粒联合瑞舒伐他汀钙能明显降低高脂血症患者血脂及炎性因子水平,降血脂的同时明显改善血管内皮功能。     

依那普利对肾性高血压大鼠RAS系统及NO影响的实验研究

目的:了解血压增高、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)分泌增强时对ET-1、NOS及NO生成的影响方法:制造肾性高血压大鼠模型,并灌喂依那普利液体,检测血或组织AngⅡ、ET-1、NOS及NO等水平.结果:肾动脉狭窄使PRA、AngⅡ、ET-1生成增高,NOS活性及NO生成下降,血压升高与AngⅡ及PRA水平有明显正相关,与NO呈负相关,8周后血AngⅡ水平逐渐恒定或减低,而组织匀浆AngⅡ升高,依那普利可改善上述状况.推论:ACEI作用部位不仅存在于循环系统中,也存在于不同的组织中,组织型肾素-血管紧张素系统作为ACEI的一个作用部位十分重要.     

瑞舒伐他汀联合硫酸氢氯吡格雷对冠心病患者的临床疗效

目的:探讨瑞舒伐他汀联合硫酸氢氯吡格雷对冠心病患者的临床疗效。方法:选择124例经冠状动脉造影确诊为冠心病的患者为研究对象。患者被随机均分为常规治疗组(常规治疗药物,包括硫酸氢氯吡格雷)和联合治疗组(在常规治疗组基础上加用瑞舒伐他汀),两组均治疗2个月。测定、比较两组治疗前后心功能及血清血管紧张素Ⅱ(AngⅡ)、血管内皮生长因子(VEGF)和一氧化氮(NO)水平,比较两组治疗效果。结果:联合治疗组总有效率显著高于常规治疗组(96.77%比83.87%,P=0.015)。与常规治疗组比较,联合治疗组治疗后左室射血分数[(61.89±7.02)%比(68.96±8.23)%]、NO[(75.25±9.45)μmol/L比(82.25±10.22)μmol/L]水平显著升高,而室壁运动评分指数[(1.35±0.39)%比(1.11±0.29)%]、AngⅡ[(102.25±6.93)ng/L比(52.99±5.36)ng/L]、VEGF[(328.25±23.41)ng/L比(228.69±22.69)ng/L]水平显著降低(P均0.01)。结论:瑞舒伐他汀联合硫酸氢氯吡格雷能有效改善冠心病患者心功能,降低血管紧张素、血管内皮生长因子水平,升高一氧化氮水平,效果显著,值得推广。     

缺氧预处理间充质干细胞对兔颈动脉球囊损伤后血管内皮生长因子水平及再内皮化的影响

目的探讨外周血间充质干细胞(MSCs)移植对动脉粥样硬化模型兔颈动脉球囊损伤后外周血血管内皮生长因子(VEGF)水平及再内皮化的影响。方法新西兰雄性大白兔72只,随机分为缺氧预处理MSCs移植组(处理组)、非处理MSCs移植组(非处理组)及对照组,每组24只。术后1、2、4周采集外周血检测VEGF水平;术后1、4周留取血管标本免疫组织化学染色,进行归巢MSCs分析、再内皮化程度分析。结果与对照组比较,处理组和非处理组兔1、2、4周VEGF水平明显升高;与非处理组比较,处理组兔1、2周VEGF水平明显升高。与移植后1周时比较,处理组和非处理组兔2周时VEGF水平明显降低。移植后4周时内皮化程度分析显示,处理组和非处理组均明显优于对照组,其中处理组又明显优于非处理组(P<0.05)。结论 MSCs移植能够显著提高兔外周血VEGF水平,加速损伤血管再内皮化;移植经缺氧预处理的MSCs可增强上述作用,可能与缺氧应激诱导MSCs分泌VEGF等细胞因子功能增强有关。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.