牛磺熊去氧胆酸对胰蛋白酶活性的影响

通过测定胰蛋白酶活力的方法,观察了TUDCA对胰蛋白酶的作用,同时与胰蛋白酶抑制剂(简称TI)进行了对比试验,发现TUDCA与TI相似,对胰蛋白酶均呈抑制作用,且随其浓度的增加,抑制作用增强,当TUDCA浓度为5 mmol/L时,对胰蛋白酶活力的抑制率达到44%。动力学实验还发现,增加底物浓度并不能抵消TUDCA的抑制作用,K_m及V_m均减小,但其比值不变,呈现出反竞争性抑制作用。     

牛磺熊去氧胆酸的获取方法及药理研究进展

牛磺熊去氧胆酸(TUDCA)是熊胆中的主要药理活性成分,临床上主要用于治疗与胆汁酸代谢异常相关的疾病。目前,市场上提供熊胆制品的唯一渠道是通过引流取胆法,但是该法目前受到相关条例的限制,因此有必要找到新的获取熊胆制品的方法。综述TUDCA的药理研究进展及人工合成TUDCA的方法尤其是生物合成法的研究进展。     

牛磺熊去氧胆酸钠抑制小鼠间歇性低氧模型肺组织中内质网应激的激活

目的：探究牛磺熊去氧胆酸钠(tauroursodeoxycholic acid sodium,TUDCA)在间歇性低氧(intermittent hypoxia,IH)模型小鼠肺组织中抑制细胞凋亡的机制。方法：32只C57小鼠随机分为对照组、TUDCA组、IH组和IH+TUDCA组,每组8只。将C57小鼠放入低氧舱中进行IH处理4周 (氧气浓度从21%下降到10%,再从10%恢复到21%为一个循环,每个循环的时间为90s),每天持续8h。4周IH处理后,Western印迹检测caspase-12和cleaved caspase-3在肺组织中的表达。同时,Western印迹、免疫组织化学和实时定量PCR检测葡萄糖调节蛋白78(glucose regulated protein 78,GRP78) 和CCAAT/增强结合蛋白同源蛋白(CCAAT/enhancer-binding protein homologous protein,CHOP)的表达。结果：与对照组和TUDCA组相比,IH组小鼠肺组织中caspase-12,cleaved caspase-3,GRP78和CHOP表达明显升高(均P<0.01);而在IH+TUDCA组中,TUDCA能够显著地减少上述蛋白的表达(均P<0.05)。结论：慢性的IH能够导致肺组织中内质网应激介导的细胞凋亡,而TUDCA可以通过抑制内质网应激的激活来降低细胞的凋亡水平。     

牛磺熊去氧胆酸结构及性质的研究

本文对牛磺熊去氧胆酸(Tauroursodeoxycholic acid,简称TUDCA)结构及性质进行了研究,结果表明:游离TUDCA是易溶于水的酸性化合物,其1%水溶液pH 2～3;差热分析测得其含两分子结晶水,且mp为180.4℃;元素分析结果,其C、H、N平均含量分别为57.75%、8.77%及2.61%;红外光谱表明具有典型的酰胺基、羟基及磺基吸收;~(13)SCNMR表明酰基C_(24)δ为177.4 ppm,羟亚甲基C_及C_7 δ均为71.7 ppm,牛磺酸基团中C_(25)及C_(26)的δ分别为37.6 ppm及50.8 ppm;质谱分析测得其(MWNa) 为522,与计算值521.70完全相同;比旋光度测定结果,其[α]_D~(17.5)= 43.28°,与计算值相一致;薄层层析结果R_f值为0.3.～0.32;磺酸基试验及其水解产物薄层色谱结果确证其分子中含磺酸基及熊去氧胆酸(UDCA)基团;几种胆酸Gregory-Pascoe反应物吸收光谱还表明,TUDCA分子中牛磺酸基团对显色反应产生显著影响。     

红景天注射液中5-羟甲基糠醛HPLC含量检测方法的建立及分析

目的:建立红景天注射液中5-羟甲基糠醛高效液相色谱（HPLC）含量检测方法,进一步分析多批次红景天注射液中5-羟甲基糠醛的含量,评价其安全性。方法:采用Agilent XDB-C18（250 × 4.6 mm,5 μm）色谱柱,0.01%磷酸水溶液为流动相,流速为1.0 mL/min;检测波长为284 nm;柱温为30 ℃。结果:建立了HPLC检测红景天注射液中5-羟甲基糠醛含量的方法,经方法学考察,符合要求。进一步分析表明,34批次红景天注射液中5-羟甲基糠醛含量范围为1.321~6.927 μg/mL,均低于药典规定的葡萄糖注射液中的5-羟甲基糠醛限量标准。结论:多数批次的红景天注射液中均含有微量的5-羟甲基糠醛,但根据临床用量比较,远小于葡萄糖注射液中5-羟甲基糠醛的限量标准,其安全性具有足够的保障。     

Efficacy and safety of tauroursodeoxycholic acid in the treatment of liver cirrhosis: A double-blind randomized controlled trial

No direct comparison of tauroursodeoxycholic acid (TUDCA) and ursodeoxycholic acid (UDCA) has yet been carried out in the treatment of liver cirrhosis in China. We designed a double-blind randomized trial to evaluate the potential therapeutic efficacy of TUDCA in liver cirrhosis, using UDCA as parallel control. The enrolled 23 patients with liver cirrhosis were randomly divided into TUDCA group (n=12) and UDCA group (n=11), and given TUDCA and UDCA respectively at the daily dose of 750 mg, in a randomly assigned sequence for a 6-month period. Clinical, biochemical and histological features, and liver ultrasonographic findings were evaluated before and after the study. According to the inclusion criteria, 18 patients were included in the final analysis, including 9 cases in both two groups. Serum ALT, AST and ALP levels in TUDCA group and AST levels in UDCA group were significantly reduced as compared with baseline (P<0.05). Serum albumin levels were significantly increased in both TUDCA and UDCA groups (P<0.05). Serum markers for liver fibrosis were slightly decreased with the difference being not significant in either group. Only one patient in TUDCA group had significantly histological relief. Both treatments were well tolerated and no patient complained of side effects. It is suggested that TUDCA therapy is safe and appears to be more effective than UDCA in the treatment of liver cirrhosis, particularly in the improvement of the biochemical expression. However, both drugs exert no effect on the serum markers for liver fibrosis during 6-month treatment.     

口服熊胆粉到达房水能力的实验研究

目的　探讨口服中药熊胆粉后,其标志成份牛磺熊脱氧胆酸(TUDCA)能否通过血-房水屏障到达房水内。方法　将5 6只家兔随机分成2组,对照组8只,给药组4 8只。给药组4 8只,随机分成6组,每组8只。空腹12h后给予熊胆粉10 0mg/mL灌胃,分别在灌胃后0 5、1,2、4、6、8h取其双眼房水。应用高效液相色谱仪(HPLC)法测定玻璃体内熊胆粉标记物熊脱氧胆酸(TUDCA)的质量浓度。结果　家兔灌胃后0 5、1、2、4、6、8h ,房水中TUDCA的分别为(2 3 70±1 4 1) μg/mL ,(35 16±3 6 3) μg/mL ,(41 5 1±2 83) μg/mL ,(47 78±4 6 9) μg/mL ,(32 38±5 2 4 ) μg/mL ,(44 72±7 4 8) μg/mL ,对照组几乎测不到TUDCA ,各时间点玻璃体内TUDCA浓度与对照组相比较差异具有显著性(P均<0 0 1) ,4h达高峰。结论　利用高效液相色谱仪法(HPLC)可准确测得房水中TUDCA的质量浓度;中药熊胆粉中主要成份TUD CA可透过血-房水屏障到达房水内。     

Tauroursodeoxycholic acid blocks lipolysis induced by TNF-α in 3T3-L1 adipocytes

目的 探讨牛黄熊脱氧胆酸(tauroursodeoxycholic acid,TUDCA)对TNF-α刺激3T3 -L1细胞脂肪分解及其可能的机制.方法 以3T3-L1前脂肪细胞经1-甲基-3-异丁基-黄嘌呤、地塞米松、胰岛素诱导分化成3T3-L1脂肪细胞,设:①对照组;②TNF-α(50 ng/ml)组;③TUDCA(1 mmol/L) +TNF-α(50 ng/ml)组;④TUDCA组(1mmol/L).通过油红O染色观察脂滴形态变化并测定培养基中甘油含量作为评价脂肪分解的指标,同时用Western blot检测脂滴包被蛋白perilipin A蛋白表达.结果 TNF-α可以显著刺激3T3-L1细胞脂肪分解,包括功能学显示甘油释放量显著增加[(2.784±0.104) mmol/L,P＜0.01],形态学显示脂滴碎裂;TUDCA可以明显抑制TNF-α刺激的3T3-LI细胞脂肪分解,包括阻止脂滴形态的改变,逆转甘油的释放[(1.718±0.085)mmol/L,P＜0.01].通过Western blot检测结果显示TNF-α可以下调perilipin A蛋白表达[(0.227±0.004),P＜0.01],而TUDCA可以阻断TNF-α对perilipin A蛋白表达的下调作用[(0.705±0.066),P＜0.01].结论 TUDCA可能通过阻止perilipin A蛋白下调而抑制TNF-α诱发脂肪分解,通过减少游离脂肪酸FFA,从而对胰岛素抵抗、糖尿病等具有一定的改善作用.     

牛黄熊脱氧胆酸抑制TNF-α刺激3T3-L1细胞脂肪分解

目的探讨牛黄熊脱氧胆酸(tauroursodeoxycholic acid,TUDCA)对TNF-α刺激3T3-L1细胞脂肪分解及其可能的机制。方法以3T3-L1前脂肪细胞经1-甲基-3-异丁基-黄嘌呤、地塞米松、胰岛素诱导分化成3T3-L1脂肪细胞,设:①对照组;②TNF-α(50 ng/ml)组;③TUDCA(1 mmol/L)+TNF-α(50 ng/ml)组;④TUDCA组(1 mmol/L)。通过油红O染色观察脂滴形态变化并测定培养基中甘油含量作为评价脂肪分解的指标,同时用Western blot检测脂滴包被蛋白perilipinA蛋白表达。结果 TNF-α可以显著刺激3T3-L1细胞脂肪分解,包括功能学显示甘油释放量显著增加[(2.784±0.104)mmol/L,P<0.01],形态学显示脂滴碎裂;TUDCA可以明显抑制TNF-α刺激的3T3-L1细胞脂肪分解,包括阻止脂滴形态的改变,逆转甘油的释放[(1.718±0.085)mmol/L,P<0.01]。通过Western blot检测结果显示TNF-α可以下调perilipin A蛋白表达[(0.227±0.004),P<0.01],而TUDCA可以阻断TNF-α对perilipin A蛋白表达的下调作用[(0.705±0.066),P<0.01]。结论 TUDCA可能通过阻止perilipin A蛋白下调而抑制TNF-α诱发脂肪分解,通过减少游离脂肪酸FFA,从而对胰岛素抵抗、糖尿病等具有一定的改善作用。     

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.