高血压左心室肥厚与心肌肌浆网钙调节蛋白相关性的实验研究

目的 探讨血管紧张素Ⅱ及肌浆网钙调节蛋白在高血压左心室肥厚形成中的作用和机制。方法 以自发性高血压大鼠,培哚普利治疗组和对照组为模型;分别测定左心室心肌血管紧张素Ⅱ含量,肌浆网Ｒｙａｎｏｄｉｎｅ受体密度和Ｋ受体亲和力及钙ＡＴＰ酶活力。结果左心室在肥厚与心肌ＡｎｇⅡ含量,肌浆网钙调节蛋白及钙ＡＴＰ酶活性相关（１）左心室心肌ＡｎｇⅡ含量：ＳＨＲ组「（１６．７±５．２ｐｇ／ｍｇ」比ＷＫＹ组升高「（１２     

培多普利对高血压大鼠左心室肥厚的影响

目的:探讨培多普利对原发性高血压大鼠左心室肥厚重构及进程中血管紧张素II(Ang-II)和肌浆网钙ATP酶的影响。方法:原发性高血压大鼠分成模型组、培多普利治疗组[SHR-t1mg/(kg)·d],WKY大鼠为正常对照组(WKY)。电镜观察左心室肥厚的超微结构,并分别测定心肌指数(左室重/体质量,LV/WT),血、心肌Ang-II水平和肌浆网钙ATP酶的活性变化。结果:SHR-t组的血AngII水平无明显改变,SHR组的血压、LV/WT(3.98±0.32)mg/g、Ang-II(16.72±5.24)pg/mg水平显著升高(P<0.01),电镜下可见心肌相对缺氧及代偿性细胞功能活跃表现。SHR-t组血压、LV/WT(3.38±0.31)mg/g、Ang-II(12.94±1.63)pg/mg明显下降(P<0.05),且未见上述心肌超微结构改变;但SHR-t组的LV/BW与WKY组(2.29±0.49)mg/g相比仍有显著差异(P<0.01);SHR组肌浆网钙ATP酶活性明显下调[0.52±0.11μmol/(g·min),P<0.05],治疗后恢复[0.82±0.11μmol/(g·min),P<0.05],但仍未达正常。结论:ACE-I主要通过抑制局部肾素-血管紧张素系统通路,对高血压大鼠左心室肥厚重构起了很好的逆转作用,但不可能完全阻断左心室肥厚的进程。     

自发性高血压大鼠血小板胞浆游离钙和血小板功能的变化及其与心脏重塑的关系

目的　研究自发性高血压大鼠 (SHR)血小板胞浆游离钙和血小板功能的变化及其与心脏重塑的关系。方法　将 1 7只SHR分为 3组 :1月龄SHR组 (n =6 )、1 0月龄SHR组 (n =6 )和 1 8～ 2 0月龄SHR组 (n =5 )。每组均等数按鼠龄、体重及雌雄配对配予Wistar大鼠 (WKY)作对照。SHR和WKY的血小板胞浆游离钙、血小板聚集率、收缩压和左心室肥厚指数被测定。采用直线回归分析确定血小板胞浆游离钙、血小板聚集率与左心室肥厚指数的关系。结果　 (1 ) 1 0月龄SHR组和 1 8～ 2 0月龄SHR组血小板胞浆游离钙浓度和血小板聚集率均显著高于同龄WKY组和 1月龄SHR组 (P均 <0 .0 1 ) ,1 8～ 2 0月龄SHR组血小板胞浆游离钙浓度和血小板聚集率还显著高于 1 0月龄SHR组 (P <0 .0 1 )。 (2 ) 1 0月龄SHR组和 1 8～ 2 0月龄SHR组左心室肥厚指数均显著高于同龄WKY组和 1月龄SHR组 (P均 <0 .0 1 )。 (3)SHR血小板胞浆游离钙浓度和血小板聚集率与左心室肥厚指数呈显著正相关 (P均 <0 .0 1 )。结论　血小板内钙代谢异常和血小板功能改变可能在SHR心脏重塑中起重要作用     

黄连素对L-甲状腺素诱发大鼠心肌肥厚的保护作用

目的　研究黄连素对 L-甲状腺素 (L- Thy)诱发大鼠发生心肌肥厚的保护作用。方法　 SD大鼠腹腔注射 (ip) L-甲状腺素 0 .5 mg/(kg· d)× 10 d,造成心肌肥厚模型 ,同时用黄连素 30 mg/(kg· d)× 10 d灌胃 ,观察大鼠的心肌肥厚指数 ,心肌细胞膜 Na+ - K+ - ATP酶和肌浆网 Ca2 + - ATP酶活力 ,心肌 NO含量 ,心肌钙调神经磷酸酶 (Ca N)活力的变化。结果　与正常对照组相比 ,心肌肥厚组心肌肥厚指数、Ca N活力明显升高 (P<0 .0 1) ,而心肌NO含量、Na+ - K+ - ATP酶活力和 Ca2 + - ATP酶活力均显著降低 (P<0 .0 1)。黄连素治疗组心肌肥厚指数 ,Ca N活力显著低于肥厚组 (P<0 .0 1) ,心肌 NO含量、Na+ - K+ - ATP酶活力和 Ca2 + - ATP酶活力则显著高于肥厚组 (P<0 .0 1)。结论　黄连素对 L-甲状腺素诱导的大鼠心肌肥厚具有保护作用。     

乌拉地尔干预急性心肌缺血的细胞机制

目的新的α肾上腺素受体拮抗剂乌拉地尔(阻断α1受体为主),治疗高血压急症、急性心肌缺血和肺水肿有效.本研究试图阐述乌拉地尔对缺血心肌内能量代谢状态、SR钙泵活力和钙释放通道的作用,探讨其治疗急性心肌缺血的分子和细胞机制.方法制备急性心肌缺血家兔模型,给予乌拉地尔1.0mg@kg-1@d-1,3天后测定缺血和非缺血区心肌内ATP、ADP、AMP和乳酸量,计算能荷;测定SRCa2+ATP酶活力和钙释放通道[3H]Ryanodine结合的Bmax的与Kd值.测定心肌细胞缺氧培养及药物干预时的SR钙泵活力.结果缺血和梗死区心肌内ATP、ADP、AMP含量比非缺血区下降31%、40%和33%,乳酸含量急剧升高65%,差异显著(P＜0.05和0.01);SRCa2+ATP酶活力从(1.19±0.11)μmol/g降至0.94μmol/g(P＜0.05);钙释放通道数目下降,亲和力不变.治疗组缺血心肌内ATP、ADP、AMP含量明显回升、能荷升高,SRCa2+ATP酶活力及释放通道数目均恢复正常(P＜0.05和0.01).缺氧培养乳鼠心肌细胞钙泵活力下降53%,乌拉地尔和拉西地平药物干预时钙泵活力无明显变化.结论乌拉地尔通过α受体改善缺血心肌内能量代谢、减少乳酸堆积、调节SRCa2+泵和钙释放通道功能、减轻钙超载是治疗的分子和细胞机制之一.     

高血压病人伴左心室肥厚的QT离散度的变化

目的　测定高血压伴左心室肥厚的QT离散度 ,研究左心室肥厚病人QT离散度的变化及与左心室肥厚的关系。方法　选择高血压伴左心室肥厚者 45例 ,高血压不伴左心室肥厚者 40例 ,健康人 40例 ,测定QT离散度。结果　①高血压伴左心室肥厚患者的QT离散度高于高血压不伴左心室肥厚组和健康组 (6 0 .5 6± 13 .15 ,45 .2 4± 11.0 9,38.18± 9.2 8,P <0 .0 1)。②高血压不伴左心室肥厚组QT离散度高于健康者 (4 5 .2 4± 11.0 9,38.14± 9.2 8,P <0 .0 5 )。结论　高血压伴左心室肥厚者QT离散度明显增高。     

前胡丙素对自发性高血压大鼠心肌受磷蛋白表达及磷酸化水平的影响

目的:探讨前胡丙素对自发性高血压大鼠(SHR)心肌重构的影响及可能机制?方法:SHR 20只,完全随机分为药物组[前胡丙素20 mg/(kg·d)灌胃,n = 10],对照组(n = 10),另设SD大鼠10只为正常组,干预8周,计算心脏质量指数及左室质量指数,光镜观察左心室心肌细胞形态和结构的变化,透射电镜观察心肌细胞超微结构及线粒体损伤情况,然后取左心室心肌制备匀浆,提取RNA,用半定量RT-PCR法测定受磷蛋白的基因表达水平,用液体闪烁计数法测定受磷蛋白的磷酸化水平?结果:与对照组比较,药物组用前胡丙素治疗8周后,心脏及左室质量指数明显下降(P < 0.05),SHR心肌肥厚等病理改变明显改善,左心室心肌受磷蛋白mRNA表达上调 (P < 0.05),心肌受磷蛋白磷酸化水平增加(P < 0.05),差异具有统计学意义?结论:前胡丙素有改善心肌重构作用,可能是通过上调SHR心肌肌浆网受磷蛋白表达及磷酸化水平而实现的?     

TNF-α的心肌负性肌力作用机制研究

目的 :探讨肿瘤坏死因子α(TNF-α)对心肌的负性肌力作用机制。方法 :采用离体大鼠乳头肌张力测定 ,细胞内双波长钙荧光检测和 ATP酶分析方法。结果 :1TNF-α抑制大鼠右心室乳头肌的收缩力 ,2 0 U/ ml和 2 0 0U/ ml TNF-α灌流 10 min后 ,乳头肌收缩力分别减小到对照的 91%和 76 % (P均 <0 .0 1) ;2 TNF-α处理后对心肌细胞钙瞬态变化幅度无明显影响 (0 .97± 0 .0 5 vs0 .95± 0 .0 7,P>0 .0 5 ) ;3TNF- α明显抑制肌浆网 Ca2 + - ATPase活性 ,平均抑制率达到 2 0 % ;4 TNF- α拮抗肌浆网 Ca2 + - ATPase对底物中不同水平的 Ca2 +和 ATP的正反应性 ;5TNF- α对肌膜 Ca2 + - ATP酶和 Na+ / K+ - ATP酶活性无明显抑制作用。结论 :TNF- α抑制心肌收缩力的负性肌力作用机制可能部分与心室肌浆网 Ca2 + - ATP酶活性下降有关 ,而与膜上的 Ca2 + - ATP酶和 Na+ / K+ - ATP酶活性无关。     

牛磺酸对大鼠心肌肌浆网钙转运功能的影响

目的：观察牛磺酸对大鼠心肌肌浆网（SR）钙转运的影响。方法：动物分为假手术、休克和牛磺酸组；盲肠结扎穿孔法复制休克模型；蔗糖密度梯度离心法制备心肌SR，分别测定SR钙摄取、[3H]ryanodine受体结合。结果：与休克组比较，牛磷酸组的SR摄钙率和最大援钙量分别提高91．5％（P＜0.01）和32．2％（P＜0．01），[3H]ryanodine受体结合Bmax值增加54.2％（P＜0．01），Kd值无明显变化。0．25～5mmol／L牛磺酸对正常大鼠钙转运无直接影响。结论：牛磷酸可以显著改善败血症休克大鼠心肌SR钙转运功能；其效应可能不是通过直接作用于SR所致。     

阿托伐他汀钙对自发性高血压大鼠血压及左室功能的影响

目的:以原发性高血压大鼠(spontaneously hypertensive rats,SHR)为实验模型,观察单纯使用阿托伐他汀钙对SHR血压、左室功能的影响,并探讨其相关机制.方法:10周龄雄性大鼠共30只,其中实验对照组21只,正常对照组9只.按实验和对照的原则分为3组:正常对照组(WKY),实验对照组(SHR),阿托伐他汀钙组[SHR-A,SHR服阿托伐他汀钙50 mg/(kg·d)],饲养16周后观察鼠尾收缩压(SBP),有创心功能,左心室心肌肥厚指数(LVMI),血浆内皮素-1(ET-1),肌浆网Ca2 -ATP酶活性(SERCA).两组间资料的比较采用t检验和方差分析(ANOVA).结果:SHR-A组较SHR组SBP低17.11mmHg;左室等容舒张期室内压下降的时间常数(T)显著降低[(1.02±0.04)ms vs(2.38±0.59)ms,P＜0.05];LVMI有明显下降[(3.08±0.20)mg/g vs(3.31±0.23)mg/g,P＜0.05].ET-1有明显降低[(131.94±26,84)pg/mL vs(196.96±38.87)pg/mL,P＜0.001],SERCA活性稍有升高.结论:阿托伐他汀钙治疗对延缓SHR血压的上升产生一定影响,有助于改善SHR左心室舒张功能,有助于抑制SHR左室肥厚.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.