肝素治疗不稳定性冠状动脉疾病

肝素因其最初得自肝脏，故名肝素，现多由猪、牛、羊肠粘膜或猪、牛肺中提得，是一种粘多糖的硫酸酯…，体内天然存在的肝素是一种糖蛋白，以共价键形式与核心蛋白的丝氨酸碱基结合，属多糖类家族，分子量差异较大，由于去乙酰化、硫酸化和葡萄糖醛酸多聚化的不同，具有明显的结构异质性。肝素的清除和分子量的大小有关，分子量越大，清除越快。因此，在注射肝素的后期，血中以低分子肝素组分为主，此时，测得的肝素浓度和部分凝血活酶时间（APTT）不一致，血浆中虽有抗因子Xa活性，但A阳已经恢复正常。     

血小板激活因子拮抗剂对急性重症胰腺炎肠粘膜损伤的影响

目的 :观察血小板激活因子拮抗剂对急性重症胰腺炎 (SAP)时肠粘膜损伤以及细菌和内毒素移位的影响。　方法 :采用胰管内注射牛磺胆酸钠 胰蛋白酶的方法诱导猪SAP ,对照组用等渗盐水代替牛磺胆酸钠 胰蛋白酶进行胰管内注射。为了解血小板激活因子 (PAF)的特异性拮抗剂BN5 0 739对SAP肠粘膜损伤的影响 ,在诱导SAP之前 30min静脉注射BN5 0 739。测定肠粘膜血流量、肠粘膜内髓过氧化酶 (MPO)和丙二醛 (MDA)含量 ,观察肠粘膜的病理改变 ,并测定门静脉血的内毒素含量和门静脉血、肠系膜淋巴结、胰腺的细菌数量。　结果 :诱导SAP以前给予BN5 0 739能够增加肠粘膜血流量 ,减少肠粘膜MPO和MDA含量 ,降低门静脉血的内毒素浓度和移位细菌数量。　结论 :SAP时合并有肠粘膜损伤 ,用BN5 0 739拮抗PAF能够增加肠粘膜血流量、改善肠粘膜微循环、减轻肠粘膜的炎性细胞浸润和降低MDA和MPO含量 ,减轻肠粘膜损伤的严重程度 ,减少内毒素和细菌移位的数量     

肝素保护肠黏膜屏障的实验研究

目的 探讨肝素对烫伤鼠肠黏膜屏障的影响.方法 雄性Wistar大鼠70只(体重200~250 g)随机分为无烫伤组10只,烫伤组及烫伤后使用肝素组(肝烫组)各30只.用沸水制成大鼠背部35%Ⅱ°烫伤,肝烫组于烫伤后立即、4 h、8 h皮下注射硫酸肝素100μ·kg-1,烫伤组和无烫伤组相同时相皮下注射等量生理盐水.烫伤组、肝烫组分别于烫伤后8 h、12 h、24 h处死动物,无烫伤组8 h全部处死.大鼠FITC-D灌胃测定肠粘膜通透性,穿刺腹主动脉测血浆IL-6、IL-8.结果 烫伤后大鼠门静脉FITC-D标记的葡聚糖及血浆IL-6、IL-8与正常组相比均显著升高(P<0.01).使用肝素后,门静脉FITC-D标记的葡聚糖及血浆IL-6、IL-8均明显下降,分别与烫伤组8 h、12 h、24 h相比有显著差别.结论 烫伤可导致大鼠肠粘膜损伤,肠粘膜通透性增加,血浆IL-6、IL-8升高;肝素可以保护应激状态下的肠粘膜屏障,抑制炎症因子IL-6、IL-8 的产生,减轻全身炎症反应,保护脏器功能.     

参芪注射液对大鼠失血性休克再灌注肠粘膜糖皮质激素受体的调节作用

目的 探讨参芪注射液对大鼠失血性休克-再灌注后肠粘膜组织糖皮质激素受体的影响.方法 雄性SD大鼠72只,随机分成:正常组、模型组、参芪低剂量组(参芪注射液10g/kg)和参芪高剂量组(参纸注射液20g/kg).对SD大鼠静脉使用肝素后缓慢放血,建立重度血失性休克及复苏的动物模型;参芪注射液于再灌注前静脉注入.造模完成后观察各组动物肠粘膜病理学变化,动态观察2,6、12 h肠粘膜、GR的结合活性和GRRNA的表达水平.结果 正常组肠粘膜无明显改变,模型组肠粘膜重度损伤,参芪高剂量组轻度损伤,低剂量组中度损伤;参芪高剂量组与低剂量组比较,肠粘膜损伤减轻程度更明显.模型组与正常组比较,2、6、12 h肠粘膜GR结合活性和GRmRNA表达明显降低(P<0.01);参芪注射液高低剂量组与模型组比较,2、6、12h肠粘膜GR结合活性和GRmRNA表达明显升高(P<0.01,P<0.05);参芪高剂量组与低剂量组比较,2、6、12h肠粘膜GR结合活性和GRmRNA表达升高更明显(P<0.05).结论 参芪注射液能有效地减轻大鼠失血性休克再灌注肠粘膜损伤,提高肠粘膜GR结合活性和GRmRNA的表达水平.     

肝素临床应用的现状

肝素作为抗疑剂已用于临床多年，目前仍是有效抗凝剂，肝素为酸性粘多糖，广泛存在于哺乳动物的肠、肺、肝、肌肉组织及毛细血管壁上的肥大细胞中，循环中肝素含量不恒定约0.0009mg／100ml。早年因自肝脏提取而得名肝素．70年代发现来源于核肠粘膜的肝素，不仅含量丰富，而且具有更强大的抗凝活性，放目前大多数商品肝素的均从猪肠粘膜提取。一、肝素的药理作用1．对疑血Ⅰ阶段的影响①抑制FXIa，②抗FXa治性，③减低FⅦ激活速度。2．对凝血Ⅱ阶段的影响肝素＋ATⅢ＋其它辅因子＋凝血酶→形成复合物，减低凝血酶活性。3．对凝血Ⅲ阶段的…     

急性坏死性胰腺炎肠通透性及病理改变实验观察

目的观察急性坏死性胰腺炎（ＡＮＰ）犬肠通透性变化及肠粘膜病理改变。方法１５只杂种犬,分为ＡＮＰ组（ｎ＝８）和对照组（ｎ＝７）,经主胰管注入牛磺胆酸钠和胰蛋白酶复制ＡＮＰ模型。用气相色谱法检测尿中乳果糖／甘露醇（Ｌ／Ｍ）比值,第７天剖杀,取回肠粘膜作病理观察。结果ＡＮＰ犬尿中Ｌ／Ｍ比值高出对照组２～１０倍。肠粘膜顶端上皮脱落,脱落处有大量细菌侵入,微绒毛部分脱落,面积减少。血浆内毒素水平高出对照组１～２倍,二胺氧化酶活性下降,细菌移位率１００％。结论ＡＮＰ时肠粘膜严重受损,监测尿中Ｌ／Ｍ比值变化可反映早期肠粘膜损伤。     

细胞凋亡在实验性急性胰腺炎大鼠肠粘膜屏障功能障碍中的作用

目的 :探讨细胞凋亡在大鼠急性重症胰腺炎 (ASP)肠道粘膜屏障功能障碍中的作用。方法 :用胰胆管内注射 5 %牛磺胆酸溶液复制大鼠ASP模型。分别对ASP大鼠假手术 (shumoperation ;SO)组和正常组 (normal;N)大鼠 (SO)于术后 3、6、12、2 4h取末端回肠粘膜进行光镜、电镜观察 ,并用分子生物学标记 (TUNEL)方法研究肠粘膜上皮细胞的凋亡。结果 :ASP组大鼠除制模 2 4h光镜下可见肠粘膜上皮细胞脱落外 ,其它时相点肠粘膜均保持完整 ,电镜观察制膜各相点均可见典型凋亡细胞 ,TUNEL法显示制膜 3、6、12、2 4hASP组肠粘膜上皮细胞凋亡指数较假手术组显著增加P均 <0 .0 1,且于术后 6h达峰值 ,凋亡细胞主要分布于肠粘膜隐窝部。结论 :ASP大鼠早期肠粘膜上皮细胞凋亡明显增加 ,上皮细胞凋亡增加可能也参与了ASP时肠道粘膜屏障功能障碍的病理生理过程     

肝素钠在儿科的应用

肝素纳为抗凝血制剂,最初来自肝脏,现多由牛、猪、羊肠粘膜或脑组织提取而得,为白色或类白色粉末,有引湿性,易溶于水。本文拟对肝素钠在儿科临床上的应用加以介绍。1支气管肺炎弥出性血管内因血（DIC的治疗在积极治疗肺炎,纠正缺氧酸中毒,改善微循环,补充液量的同时给予肝素钠50U／kg,每4～6’h时1次,静脉应用,将凝血时间控制在15～18分钟左右,直至血液恢复正常。其机理：1）减少凝血因子的消耗n1。2）灭活凝血酶。3）抑制纤维蛋白原转变为纤维蛋白Q4）减轻器官乏氧。5）利尿及抑制醛固酮生成,减轻心脏负荷,有利心衰纠正。2…     

思密达——保护消化道防止内生及外来侵袭的新药

思密达(Smecta)是一种能吸附病原体,加强肠道粘膜屏障的高效肠粘膜保护剂。理化特性思密达[Si_8Al_4O_(20)(OH)_4]是由双四面体氧化硅单八面体氧化铝组成的多层结构,具有相当大的表面积(约100m～2/g),使其对消化道粘膜具有极强的覆盖能力和吸附作用。作用机理 1 经临床研究表明,思密达对致病性大肠杆菌、霍乱弧菌、空肠弯曲菌、金黄色葡萄球菌和轮状病毒都有较强的吸附固定的作用,而后随肠蠕动排出体外,从而避免肠粘膜细胞被病原体损伤。 2 可恢复并维持肠粘膜细胞由分泌型向吸收型转变,     

FGFR3与小鼠小肠缺血再灌注损伤后肠上皮细胞凋亡的关系

目的探讨成纤维细胞因子受体3（fibroblast growth factor receptor 3,FGFR3）与小鼠小肠粘膜缺血再灌注损伤后肠上皮细胞凋亡的关系。方法应用小肠缺血再灌注模型,检测野生小鼠及FGFR3增强小鼠小肠缺血再灌注损伤后1、3、6 h和1、3天各时间点肠粘膜结构、粘膜隐窝上皮细胞增殖能力及粘膜上皮细胞凋亡的改变。结果肠缺血再灌注l、3、6 h,肠粘膜损害明显,粘膜上皮细胞凋亡增加,粘膜隐窝上皮细胞增殖增多;肠粘膜再生1、3天组肠粘膜上皮细胞凋亡明显减少,粘膜隐窝上皮细胞增殖活性逐渐降低,肠粘膜结构恢复至正常。FGFR3增强小鼠在各时间点增殖能力明显强于野生小鼠,凋亡程度及肠粘膜损害程度均轻于野生小鼠。结论FGFR3抑制肠上皮细胞凋亡,促进增殖,可能在肠缺血再灌注损伤及肠再生修复过程中起重要作用。     

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.     

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.