Expression of ghrelin and insulin-like growth factor-1 in immature piglet model of chronic cyanotic congenital heart defects with decreased pulmonary blood flow

Background  Cyanotic patients have potential growth retardation and malnutrition due to hypoxemia and other reasons. Ghrelin is a novel endogenous growth hormone secretagogue that has effects on growth and cardiovascular activities. The aim of this study was to evaluate the plasma level and myocardial expression of ghrelin and insulin-like growth factor-1 (IGF-1) using an immature piglet model of chronic cyanotic congenital heart defects with decreased pulmonary blood flow.

Methods  Twelve weanling Chinese piglets underwent procedures of main pulmonary artery-left atrium shunt with pulmonary artery banding or sham operation as control. Four weeks later, hemodynamic parameters were measured. Enzyme-linked immunosorbent assay for plasma ghrelin and IGF-1 level measurement were performed. Ventricular ghrelin and IGF-1 mRNA expressions were measured by quantitative real-time polymerase chain reaction.

Results  Four weeks after surgical procedure, the cyanotic model produced lower arterial oxygen tension ((68.73 ± 15.09) mmHg), arterial oxygen saturation ((82.35 ± 8.63)%), and higher arterial carbon dioxide tension ((51.83 ± 6.12) mmHg), hematocrit ((42.67 ± 3.83)%) and hemoglobin concentration ((138.17 ± 16.73) g/L) than the control piglets ((194.08 ± 98.79) mmHg, (96.43 ± 7.91)%, (36.9 ± 4.73) mmHg, (31.17 ± 3.71)%, (109.83 ± 13.75) g/L) (all P <0.05). Plasma ghrelin level was significantly higher in the cyanotic model group in comparison to the control (P=0.004), and the plasma IGF-1 level was significantly lower than control (P=0.030). Compared with control animals, the expression of ghrelin mRNAs in the ventricular myocardium was significantly decreased in the cyanotic model group (P=0.000), and the expression of IGF-1 mRNAs was elevated (P=0.001).

Conclusions  Chronic cyanotic congenital heart defects model was successfully established. Plasma ghrelin level and myocardial IGF-1 mRNA expression were significantly up-regulated, while plasma IGF-1 level and myocardial ghrelin mRNA expression were down-regulated in the chronic cyanotic immature piglets. The ghrelin system may be an important part of the network regulating cardiac performance.

     

Partial liquid ventilation decreases tissue and serum tumor necrosis factor-α concentrations in acute lung injury model of immature piglet induced by oleic acid

Background  Pediatric patients are susceptible to lung injury. Acute lung injury in children often results in high mortality. Partial liquid ventilation (PLV) has been shown to markedly improve oxygenation and reduce histologic evidence of injury in a number of lung injury models. This study was designed to examine the hypothesis that PLV would attenuate the production of local and systemic tumor necrosis factor (TNF)-α in an immature piglet model of acute lung injury induced by oleic acid (OA).

Methods  Twelve Chinese immature piglets were induced acute lung injury by OA. The animals were randomly assigned to two groups of six animals, (1) conventional mechanical ventilation (MV) group and (2) PLV with 10 ml/kg FC-77 group.

Results  Compared with MV group, the PLV group had better cardiopulmonary variables (P <0.05). These variables included heart rate, mean blood pressure, blood pH, partial pressure of arterial oxygen (PaO₂), PaO₂/inspired O₂ fraction (FiO₂) and partial pressure of arterial carbon dioxide (PaCO₂). PLV reduced TNF-α levels both in plasma and tissue compared with MV group (P <0.05).

Conclusion  PLV provides protective effects against TNF-α response in OA-induced acute lung injury in immature piglets.

     

Effect of partial liquid ventilation on oleic acid-induced inflammatory responses in piglets

Background Pediatric patients are susceptible to lung injury.Acute lung injury （ALI） in children often results in a high mortality.Partial liquid ventilation （PLV） has been shown to markedly improve oxygenation and reduce histologic evidence of injury in a number of lung injury models.This study aimed to examine the hypothesis that PLV would attenuate the production of local and systemic cytokines in an immature piglet model of ALI induced by oleic acid （OA）.Methods Twelve Chinese immature piglets were induced to develop ALI by oleic acid.The animals were randomly assigned to two groups （n=6）： （1） conventional mechanical ventilation （MV） group and （2） PLV with FC-77 （10 ml/kg） group.Results Compared with MV group, PLV group got better cardiopulmonary variables （P 〈0.05）.These variables included heart rate, mean blood pressure, blood pH, partial pressure of arterial oxygen （PaO2）, PaO2/FiO2 and partial pressure of arterial carbon dioxide （PaCO2）.Partial liquid ventilation reduced IL-1β, IL-6, IL-10 and TN F-α both in plasma and tissue concentrations compared with MV group （P 〈0.05）.Conclusions Partial liquid ventilation provides protective effects against inflammatory responses in the lungs of oleic acid-induced immature piglets.     

乌司他丁对复杂先天性心脏病患儿体外循环围术期肺保护作用的研究

目的 观察乌司他丁对复杂紫绀型先天性心脏病小儿体外循环围术期肺功能的保护作用.方法 采用前瞻性随机对照研究方法,对行心脏畸形根治手术的复杂紫绀型先天性心脏病66例患儿,年龄60 d～4岁,随机分配于乌司他丁组和对照组.两组给药方案:乌司他丁组,注射用乌司他丁30 000 U/kg加入体外循环预充液,术后4h静脉注射乌司他丁10000 U/kg;对照组,给予等量生理盐水.采集并对比两组术前(T0)、术后即时(T1)和术后12 h(T2)呼吸功能参数、动脉血气指标和炎症因子浓度.结果 乌司他丁组入选32例,对照组30例.乌司他丁组T1时点动脉血氧分压(PaO2)(305.80±77.49 vs 250.43±61.21)、氧合指数(OI)(432.77±118.40 vs 342.33±84.10)、肺泡-动脉血氧分压差[P(A-a)O2](154.67±89.69 vs 220.13±66.04)、吸气平台压(Pplat)(24.17±3.91 vs 27.13±5.02)、肺静态顺应性(Cst)(5.91±1.94 vs 4.83±1.53)均优于对照组(P＜0.05),血清肿瘤坏死因子[(117.26±66.05) pg/mL vs(168.05±104.05) pg/mL]、白细胞介素-6[(129.74±88.97)pg/mL vs (185.61±107.49) pg/mL]浓度低于对照组(P＜0.05);T2时点OI(372.24±122.35 vs 308.78±105.29)、Cst(6.68±2.63 vs 5.63±1.86),乌司他丁组优于对照组(P＜0.05);两组机械通气延长率比较,乌司他丁组显著低于对照组(16.13％ vs 43.33％,P＜0.05).结论 围术期应用乌司他丁对复杂紫绀型先天性心脏病小儿肺功能有保护作用.     

Effects of low potassium dextran glucose solution on oleic acid-induced acute lung injury in juvenile piglets

Background  Epithelial dysfunction in lungs plays a key role in the pathogenesis of acute lung injury. The beneficial effects of low potassium dextran glucose solution (LPD) have been reported in lung preservation, and LPD enables injured alveolar pneumocytes to recover. So we hypothesized that systemic administration of LPD may have benefits in treating acute lung injury. We investigated the effects of LPD on arterial blood gas and levels of some cytokines in oleic acid-induced acute lung injury in juvenile piglets.

Methods  Oleic acid (0.1 ml/kg) was intrapulmonarily administered to healthy anesthetized juvenile piglets. Ten animals were randomly assigned to two groups (n=5 each): oleic acid-induced group (control group) with intravenous infusion of 12.5 ml/kg of lactated Ringer’s solution 30 minutes before administration of oleic acid and LPD group with systemic administration of LPD (12.5 ml/kg) 30 minutes before injecting oleic acid. Blood gas variables and concentrations of tumor necrosis factor alpha, endothelin 1 and interleukin 10 were measured before and every 1 hour for 6 hours after initial lung injury.

Results  Compared with control group, blood pH, partial pressure of arterial oxygen to fraction of inspired oxygen ratio, partial pressure of arterial carbon dioxide, and mean pulmonary arterial pressure in LPD group were improved (P <0.05 or 0.01). Six hours after lung injury, concentration of tumor necrosis factor alpha in lung tissue was lower in LPD group than control group (P <0.05). Plasmic concentration of endothelin 1 showed lower in LPD group while plasmic concentration of interleukin 10 showed higher in LPD group (P <0.05).

Conclusions  Before lung injury, systemic administration of LPD can improve gas exchange, attenuate pulmonary hypertension, decrease plasmic levels of endothelin 1, increase interleukin 10 and decrease concentration of tumor necrosis factor alpha in lung tissue in oleic acid-induced acute lung injury in juvenile piglets.

     

COPD中MicRNA-320c-5p调节SERPINA1基因表达的研究

目的 通过双荧光素酶报告系统验证miR-320c-5p对SERPINA1基因的靶向调控关系。方法 从人正常肺上皮细胞基因组库中获取SERPINA1基因的3′UTR序列,并通过序列匹配拟定候选miRNA。利用3%香烟烟雾提取物(cigarette smoke extract, CSE)诱导人支气管上皮细胞(BEAS-2b细胞)建立慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)细胞模型作为实验组,正常培养的BEAS-2b细胞作为对照组,使用实时荧光定量聚合酶链反应(real time flurocent qualitative polymerase chain reaction, RT-qPCR)法检测两组SERPINA1和候选miRNA的表达水平。构建野生型及突变型双荧光素酶报告基因载体,分别将双荧光素酶报告质粒(psiCHECK-2-SERPINA1-3′UTR和psiCHECK-2-SERPINA1-3′UTR mut)和miRNA质粒(miR-320-5p mimic)共转染到293T细胞,进行荧光活性测定。结果 通过序列...     

一种兔紫绀型心脏病动物模型的建立

目的　探讨建立兔紫绀型心脏病动物模型的方法。方法　将新西兰大白兔主肺动脉与左心耳侧侧吻合 ,形成右向左分流的紫绀型心脏病动物模型 ,紫绀组、对照组均于术后第 1周、第 4周抽取外周动脉血进行血气分析和血常规检查。结果　紫绀组与对照组比较 ,术后第 1周pH值、二氧化碳分压 (PCO2 )、血红蛋白 (Hb)、血细胞比容 (Hct)无显著差异 (P >0 .0 5) ,而氧分压 (PO2 )及氧饱合度 (SaO2 )明显低于对照组 (P <0 .0 1) ;术后第 4周紫绀组Hb、Hct、PO2 及SaO2 与对照组比较有显著差异 (P <0 .0 1) ,pH值与PCO2 2组比较无显著差异 (P >0 .0 5)。结论　将新西兰大白兔的主肺动脉与左心耳吻合 ,能产生持久而稳定的低氧状态 ,与临床上紫绀型心脏病的病理生理相接近 ,是一种稳定、可靠且经济的动物模型     

左向右分流型肺动脉高压大鼠肺组织中microRNA的表达谱及初步分析

目的检测晚期肺动脉高压(pulmonary hypertension,PH)大鼠肺组织中microRNA(miRNA)的表达,初步预测差异表达的microRNA调控的靶基因。方法 4～5周龄健康雄性SPF级SD大鼠20只,体质量90～110 g,按完全随机分组法分成分流组(n=10)和对照组(n=10)。分流组采用套管法行右侧颈总动脉-颈外静脉分流术以建立左向右分流型肺动脉高压模型,对照组行假手术,建立左向右分流型肺动脉高压大鼠模型。12周后,取大鼠外周肺组织,运用microRNA表达谱芯片检测分流组和对照组大鼠肺组织microRNA的差异性表达。运用Miranda、TargetScan、PicTar软件预测可能调控的靶基因,实时定量PCR验证miR-98、miR-130b和miR-127等的表达。结果平均肺动脉压(mPAP)、肺动脉中膜厚度百分比(MT%)及右心室肥厚指数(RVHI)均明显高于对照组(P<0.01),microRNA芯片结果提示:与对照组相比,在分流组大鼠肺组织中表达明显上调的miRNA有30个(miR-122、miR-130b、miR-146b等),明显下的miRNA有7个(miR-382、miR-192、miR-29c等),RT-PCR结果与芯片结果一致。结论 microRNA在左向右分流型肺动脉高压大鼠中表达存在差异,microRNA可能参与肺动脉高压大鼠肺血管的重构。     

Clinical results of combined palliative procedures for cyanotic congenital heart defects with intractable hypoplasia of pulmonary arteries

Background Congenital heart defects with intractable hypoplasia of the pulmonary arteries without intercourse or with intercourse stenosis is unsuitable for surgical correction or regular palliative procedures.We reported our experience with combined palliative procedures for congenital heart defects with intractable hypoplasia pulmonary arteries.Methods From 2001 to 2012,a total of 41 patients with cyanotic congenital heart defects and intractable hypoplasia of the pulmonary arteries underwent surgical procedures.From among them,31 patients had pulmonary atresia with ventricular septal defect (VSD) and the other 10 cases had complicated congenital heart defects with pulmonary stenosis.Different kinds of palliative procedures were performed according to the morphology of the right and left pulmonary arteries in every patient.If the pulmonary artery was well developed,a Glenn procedure was performed.A modified Blalock-Taussi9 shunt or modified Waterston shunt was performed if pulmonary arteries were hypoplastic.If the pulmonary arteries were severely hypoplastic,a Melbourne shunt was performed.Systemic pulmonary artery shunts were performed bilaterally in 25 cases.A systemic-pulmonary shunt was performed on one side and a Glenn procedure was performed contralaterally in 16 cases.Major aortopulmonary collateral arteries were unifocalized in six cases,ligated in two cases and interventionally embolized in two cases.There was one early death because of cardiac arrest and the hospital mortality was 2.4％.Results Five patients suffered from postoperative low cardiac output syndrome,three had perfusion of the lungs,and two pulmonary infections.Systemic pulmonary shunts were repeated after the original operation in three cases due to the occlusion of conduits.The mean follow-up time was 25 months.The pre-and the post-operation left pulmonary indices were (8.13±3.68) vs.(14.9±6.21) mm2/m2.The pre-and post-operation right pulmonary indices were (12.7±8.13) vs.(17.7±7.78) mm2/m2.The pre-and post-operational pulmonary indices were (20.87±9.43) vs.(32.6±11.7) mm2/m2.They were all significantly increased (P ＜0.001).The diameter of the pulmonary artery increased after the modified Blalock-Taussig shunt ((5.51±0.94) mm2/m2 pre-operation vs.(7.01±1.97) mm2/m2 post-operation),the modified Waterston shunt ((5.70±3.96) mm2/m2 pre-operation vs.(9.17±3.62) mm2/m2 post-operation) and the Melbourne shunt ((2.17±0.41) mm2/m2 pre-operation vs.(7.35±2.49) mm2/m2 post-operation) (all P ＜0.05).Bilateral pulmonary arteries developed well as compared to their pro-operation development.Hemoglobin decreased from (194±27) to (174±24) g/L (P ＜0.05) and peripheral oxygen saturation increased from (65±11)％ to (84±6)％ (P ＜0.001).During the follow-up of 27 to 49 months,ultimate complete repair was performed in four cases and one patient underwent a Glenn procedure.Conclusions The procedures should be considered on a case to case basis in patients having hypoplasia of the pulmonary arteries with cyanotic congenital heart defects.Combined palliative operations could be an adequate strategic treatment.     

新生儿先天性心脏病的彩色多普勒超声诊断及分析

目的：研究新生儿先天性心脏病的类型及临床特点。方法：对1995－2001年61例新生儿先天性心脏病的彩色多普勒超声波特点进行分析，并随访4例紫绀型先心病，12例非青紫型先心病患儿3个月至7年。结果：非青紫型先心病40例（65．6％）最常见类型为室间隔缺损（31．1％），动脉导管未闭（18．0％），房间隔缺损（6．6％），肺动脉瓣狭窄（1．6％）；青紫型21例（34．4％）中大动脉转位位居第一（11．5％），第二位为法乐氏四联征（8．2％），单心室（6．6％），居第三位。经胎儿超声心动图产前诊断先心病2例，1例为室间隔缺损，1例为单心室，新生儿先心病的临床表现主要为心脏杂音（82．0％），气促（62．3％）,持续性青紫（34．4％）。随访紫绀型先心4例，均手术治疗，2例术后死亡；非青紫型患儿12例，自愈7例，3例手术矫正，2例未愈无并发症。结论：为控制先心病胎儿的出生，降低婴幼儿的死亡率，应重视先心病的产前诊断并对重症患者终止妊娠，先后宜尽早行彩色多普勒超声检查以确诊。     

Effect of partial liquid ventilation on lung function in oleic acid-induced lung injury model of piglets

Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies.Partial liquid ventilation （PLV） has been developed as an alternative ventilatory strategy for treating severe lung injury.The aim of this study is to investigate the effect of PLV on lung function in immature piglets.Methods Acute lung injury was induced in 12 Chinese immature piglets by oleic acid （OA）.The animals were randomly assigned to two groups （n=6 each group）：（1） conventional mechanical ventilation （MV） group and （2） PLV with FC-77 （10 ml/kg） group.Mean arterial blood pressure （MAP）,mean pulmonary arterial pressure （MPAP）,central venous pressure （CVP）,left atrial pressure （LAP）,systemic vascular resistance （SVR）,pulmonary vascular resistance （PVR）,cardiac output （CO）,mean pressure of airway （Paw）,dynamic lung compliance （Cydn）,and arterial blood gases were measured during the observation period.Results No piglet died in either group with severe lung injury.After four hours of ventilation,pH in the MV group gradually decreased to lower than 7.20,while in the PLV group,pH also gradually decreased but remained higher than 7.20 （P ＜0.05）.Partial pressure of oxygen in artery （PaO2） decreased in both groups,but with a significant difference between the PLV group and MV group （P ＜0.05）.Partial pressure of carbon dioxide in artery （PaCO2） increased in both groups,but with a significant difference between the PLV group and MV group （P ＜0.05）.Paw increased in both groups,but was not significantly different （P ＞0.05）.Cydn decreased in both groups,but without a significant difference （P ＞0.05）.At four hours,heart rate （HR） and MAP in both groups decreased.MPAP in both groups increased,and there was a significant difference between the two groups （P ＜0.05）.CVP was stable in both groups.At four hours,PVR and LAP were increased in both groups.CO was decreased in both groups （P ＜0.05）.SVR was stable during the observation time.Conclusion PLV did not improve outcome in changes of lung function.     

复合姑息手术治疗肺动脉发育不良型先天性心脏病

目的 探讨复合姑息手术治疗合并难治性肺动脉发育不良的肺血减少型复杂先天性心脏病(先心病)临床经验.方法 对自2001年8月至2009年9月我院外科治疗的31例合并难治性肺动脉发育不良的肺血减少型复杂先心病患儿进行回顾性分析,其中合并室间隔缺损的肺动脉闭锁26例,其他合并肺动脉狭窄的复杂先心病5例.根据两侧肺动脉发育情况选择2种或2种以上的姑息手术:一侧肺动脉发育良好者行格林(Glenn)术;肺动脉发育较差者常规行改良Blalock-Taussig分流或改良Waterston分流术;肺动脉极度发育不良者采用改良Melbourne分流.对合并的粗大体肺侧支血管者行肺动脉融合或侧支血管结扎及封堵术.两侧均行体肺分流23例;一侧行体肺分流,另一侧行Glenn者8例.结果 术后早期1例死于心跳骤停,早期死亡率为3.2%,术后并发症包括低心排综合征5例,灌注肺3例,肺部感染3例.3例因分流管道堵塞而再次行分流手术.平均随访(25±16)(6～72)个月,与术前比较,左肺动脉指数(14.9±6.2比8.1±3.7)、右肺动脉指数(17.7±7.8比12.7±8.1)和肺动脉指数(32.6±11.7比20.9±9.4)均显著提高,差异均有统计学意义(均P＜0.001),与术前比较,Blalock-Taussig分流术(7.0±2.0比5.5±1.0)、改良Waterston分流术(9.2±3.6比5.7±4.0)和Melbourne分流术(7.4±2.5比2.2±0.4)术后肺动脉直径均增加,差异均有统计学意义(均P＜0.05),两侧肺动脉均明显发育,血红蛋白浓度和末梢血氧饱和度分布由术前的(194±27)g/L和(65±11)%改善至(174±24)g/L(P＜0.05)和(84±6)%(P＜0.001).4例肺动脉发育良好,已行二期矫治手术,另1例术后2年完成了二期Glenn手术.结论 对合并难治性肺动脉发育不良的肺血减少型复杂先心病,外科治疗应遵循个性化原则,不管是作为根治手术前的过渡治疗,还是最终治疗,复合姑息手术都是值得推荐的一种术式选择.     

胸膜剥脱术对结核性脓胸患者肺功能的影响

目的: 探讨胸膜剥脱术对结核性脓胸患者肺功能的影响。方法: 对89例单纯结核性脓胸进行胸膜剥脱术,在患者术前、术后9个月进行血气分析检测,选取动脉血氧分压、动脉血二氧化碳分压、动脉血氧饱和度、pH 4项指标进行评价,并测定术前、术后3、6、9个月的肺功能指标,对第1秒用力呼气容积、用力肺活量及二者比值和最大通气量进行监测,了解肺功能变化情况。结果: 所有患者手术顺利,术后恢复良好,术后9个月动脉血氧分压较术前改善明显(P<0.01),动脉血二氧化碳分压、动脉血氧饱和度和pH均无明显变化(P>0.05)。术后3、6、9个月肺功能监测指标均较术前明显改善(P<0.01),术后6个月和9个月各项肺功能指标亦均较术后3个月显著改善(P<0.01),而术后6个月和9个月差异均无统计学意义(P>0.05)。结论: 胸膜剥脱术能够有效改善结核性脓胸的肺功能,6个月后基本恢复到最大限度,对于有手术指征的患者应尽早实施胸膜剥脱术,阻止胸廓进一步变形,达到最好的治疗效果。     

A case of pulmonary embolism after abdominal angiography

The patient was a 72-year-old woman who had been diagnosed with cholecystolithiasis and had undergone laparoscopic cholecystectomy. Since the postoperative pathologic diagnosis was a gallbladder cancer with a depth of wall penetration of subserosa, she was admitted to Kurume University Hospital for a second-look operation. After admission, abdominal angiography was performed with a right femoral arterial puncture. After the release of inguinal compression with a belt, chest pain and difficulty in breathing appeared. Despite her normal blood pressure, arterial blood gas analysis showed a PO2 of 74.7 mmHg and a PCO2 of 41.5 mmHg, representing a slight decrease in PO2. Chest X-rays showed an increased cardiothoracic ratio and decreased lucency in the left upper lung field. The electrocardiogram revealed atrial premature contraction. Cardiac ultrasound did not show expansion of the right heart and blood vessels or abnormal structures in the main pulmonary artery. Since lung perfusion scintigraphy revealed perfusion defects in the left upper to middle and right upper lung fields, acute pulmonary embolism was diagnosed, and oxygen inhalation, thrombolytic, and anticoagulant therapy were instituted immediately. The symptoms improved the following day, but 240,000 u/day of urokinase was administered for 5 days, and 1,500 u/day of heparin for 10 days. On lung perfusion scintigrams 6 days later, the defects had disappeared. Moreover, no definite abnormal shadows were noted on chest X-rays. Radical surgery for gallbladder cancer was performed 3 weeks later. Considering the possible development of pulmonary embolism, we felt the need for careful management if the patient is released from bed rest after abdominal angiography.     

The Acid-Base Status in Cyanotic Congenital Heart Disease

The relation between oxygen consumption, metabolic status and prognosis was studied in two infants with identically low arterial oxygen tensions (20 mm. Hg) due to cyanotic congenital heart disease. The first patient had low oxygen consumption, arterial blood acidosis and increased arterial lactate, and died at the age of 36 hours. The second had normal oxygen consumption, arterial acid-base balance, lactate and pyruvate, and survived. Since arterial oxygen tensions were similar in both, it was concluded that compensatory factors, such as cardiac output, pulmonary and systemic blood flow and increased oxygen saturation at normal pH levels (Bohr effect), are important in maintaining tissue oxidation and preventing anaerobiosis and lactate production. The importance of a knowledge of acid-base status in the immediate prognosis of cyanotic congenital heart disease is stressed. The treatment of acidosis by buffer therapy may be an important palliative, improving cardiac output and tissue oxidation, and should be undertaken as soon as possible before irreversible cellular damage has occurred.     

小儿先天性心脏病合并重度肺动脉高压的病理学研究

目的　以定量肺病理学的方法 ,研究小儿左向右分流型先天性心脏病合并重度肺动脉高压 (PH)的肺小动脉病变。方法　先天性心脏病合并重度PH左向右分流型患儿 38例为PH组 ,于术前右心导管检查 2 1例 ,手术中取肺活检 ;另取非心血管病死亡婴幼儿尸检肺组织 6例为无PH组。光镜观察肺内病变 ,并以显微 -微机彩色图像分析仪测量计算肺细小动脉平均中膜厚度百分比 (%MT)、肺细小动脉平均中膜面积百分比 (%MS)及肺小动脉密度 (APSC)。结果　PH组 %MS、%MT及APSC均较无PH组明显升高 ,吸氧后的肺动脉收缩压 (SPAPO2 )与 %MT和 %MS均呈直线相关 ,回归方程分别为 :%MS =0 0 690 9SPAPO2 + 4 5 95 64,(P <0 0 5 ) ,r =0 4 4 14;%MT =0 12 67SPAPO2 + 2 5 4 10 7,(P <0 0 5 ) ,r =0 4 4 74。结论　定量测量肺小动脉中膜厚度、面积及密度 ,可以判定左向右分流先天性心脏病PH的严重程度 ,适用于婴幼儿未发育成熟的肺小动脉病变严重程度的判定     

体外循环早期氧浓度对紫绀型未成熟心肌线粒体结构的影响

目的探讨体外循环(ECC)早期不同氧浓度对紫绀型未成熟心肌细胞的超微结构的影响,以证实再氧合损伤的存在。方法将紫绀型先天性心脏病患儿20例随机分为两组,一组为高氧组,ECC预充液采用FO2100%预循环;另一组为低氧组,ECC预充液采用FO221%预循环,至ECC 10 min后均改为FO230%～40%。分别在ECC前、ECC后10 min取右心耳处心肌1 mm×1 mm×3 mm,用4%戊二醛固定。经切片、电子染色,采用日立H-7500透镜电子显微镜观察。将两组ECC前、ECC后线粒体损伤程度从0～Ⅲ级分布情况分别进行比较,采用X2检验中两样本多个构成比的比较进行数据分析,P0.05有统计学意义。结果高氧组ECC前、后线粒体损伤程度有明显改变,X2检验P0.05。低氧组ECC前、后多数线粒体损伤程度无明显改变。X2检验P0.05。结论 ECC早期高浓度氧可导致心肌再氧合损伤,采用FO221%可减少其损伤。     

Hyperoxygenated solution for improved oxygen supply in patients undergoing lung lavage for pulmonary alveolar proteinosis

Background At present, the most effective treatment for pulmonary alveolar proteinosis （PAP） remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated. Methods Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated （HO） and normal saline solution （plain lactated Ringer＇s solution, NO） randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution （HO group, n=-109）; if the number was even, normal saline solution was used （NO group, n=-115）. Data of saturation of peripheral oxygen （SPO2）, mean arterial pressure （MAP）, central venous pressure （CVP）, heart rate （HR） and end-tidal carbon dioxide tension （PETCO2） were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the leR and the right lung lavage was 1 week. Results No patient was withdrawn from the study due to low SPO2 or leakage. Oxygen pressure was （730.21±7.43） mmHg in the hyperoxygenated solution against （175.73±5.92） mmHg in the normal saline solution （P 〈0.01）. Compared with baseline, 8PO2 increased significantly as the instillation of solution began （P〈0.01）, leveled for about 30 seconds （P 〉0.05）, and then decreased significantly to the lowest at the time of drainage （compared with 120 seconds or peak, P 〈0.01）. SPO2 was higher in HO group than in NO group （P 〈0.01）. There were no significant differences in MAP, HR, CVP and PETCO2 between HO group and NO group （P 〉0.05） and also among different time points （P 〉0.05）. Conclusion During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.     

具有不同前向肺血流的肺血少型先天性心脏病患者在双向Glenn术后肺血管的发育

目的比较不同前向肺血流对肺血少型先天性心脏病患者在双向腔静脉-肺动脉吻合术(双向Glenn术)后肺血管发育的影响。方法选择2000年10月～2006年12月接受双向Glenn术的肺血少型先天性心脏病患儿132例,术中肺活检18例。将患儿按肺血来源不同分为两组:动脉性前向血流组(n=33)和静脉性前向血流组(n=99)。近红外线探头测量经皮血氧饱和度(SpO2)。测定红细胞压积(Hct)和血红蛋白(Hb)浓度。采用超声心动图测量左、右肺动脉直径(LPA和RPA)并计算肺动脉指数(PAI)。对术中取得的右肺下叶组织进行病理学形态半定量分析,测量肺小动脉平均中膜厚度百分比(MT%)、平均中膜面积百分比(MS%)、单位面积肺小血管数量(VPSC)和平均肺泡数(MAN)。结果术前两组患儿缺氧紫绀明显,但两组的SpO2、Hct、Hb差异无显著性(P>0.05);两组间的LPA、RPA及PAI差异无显著性(P>0.05);动脉性前向血流组的MT%和MS%显著高于静脉性前向血流组(P<0.05),两组VPSC和MAN差异无显著性(P>0.05)。双向Glenn术后两组患儿紫绀缺氧明显改善,SpO2显著升高(P<0.01),而Hct和Hb显著下降(P<0.01);SpO2与Hct(r=-0.49,P<0.01)和Hb(r=-0.196,P<0.01)均呈显著负相关,Hct和Hb呈显著正相关(r=2.4997,P<0.01);动脉性前向血流组和静脉性前向血流组的PAI较术前分别增加22%和44%,且两组间PAI差异具有显著性(P<0.05);术后动脉性前向血流组的RPA与术前相比差异无显著性(P>0.05),术后静脉性前向血流组的LPA、RPA显著大于动脉性前向血流组(P<0.05)。结论不同的前向肺血流对肺血少型先天性心脏病患儿在Glenn术后肺血管生长发育的影响不同,肺动脉狭窄者Glenn术后肺血管生长发育更明显,有利于尽早完成Fontan手术。     

软骨细胞SHOX基因过/低表达的差异miRNA筛选与验证

目的 建立软骨细胞(HC-α)SHOX基因过/低表达模型,筛选与未处理组差异表达miRNA,并予以验证.方法 通过慢病毒过/低表达SHOX基因,用miRNA芯片筛选差异表达的miRNA.结果 SHOX过表达组与对照组有425条差异表达的miRNA;SHOX低表达组与对照组有379条差异表达的miRNA;按照表达水平差异相反的标准筛选差异miRNA,其中6条miRNA在处理组中表达水平差异相反.实时荧光定量PCR对6条miRNA(miR-126、miR-192、miR-370、miR-432、miR-3162、miR-4745)进行验证,miR-126在过表达组明显上调(P＜0.05),在低表达组明显下调(P＜0.05).结论 miR-126参与SHOX介导的软骨细胞凋亡过程.