颈动脉粥样硬化斑块稳定性评估正电子发射断层扫描/磁共振研究进展

颈动脉粥样硬化斑块破裂是导致脑梗死的主要原因,探索斑块进展的病理生理机制,尽早发现易损斑块是国际研究热点。研究显示炎性反应与斑块发生、发展、破裂密切相关,但炎性反应过程及其与预后关系的病理生理机制尚不清楚。高分辨磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)和正电子发射断层扫描(positron emission tomography,PET)是评价颈动脉粥样硬化斑块的有力手段,HR-MRI能提供斑块形态学信息,PET能提供斑块内炎性反应的巨噬细胞代谢信息。本文重点对HR-MRI、PET及一体化PET/MR成像在颈动脉粥样硬化斑块稳定性评估的研究进展进行综述,阐明颈动脉斑块易损性的病理生理机制,以期进行早期影像学预警,有效预防脑梗死。     

血管再生：中医药治疗中风的新方向

Based on the pathophysiology of the brain, advance in angiogenesis induced by stroke, and evidences of Chinese-medicine-mediated angiogenesis, the possibility to study the stroke-treating mechanism of Chinese medicine in angiogenesis was discussed. And regarding our previous work on angiogenesis modulated by qi-tonifying and stasis-eliminating therapy following intracerebral hemorrhage, we proposed some questions, which should be taken into account in the further work.     

动脉粥样硬化发病机制和药物干预的研究现状

动脉粥样硬化是心脑血管事件发生的共同基础,是造成心脑血管疾病和死亡的重要因素。炎症、氧化应激被认为是动脉粥样硬化发生和发展的核心机制。动脉粥样硬化不稳定性斑块的破损是缺血性卒中和心肌梗死的主要发病机制。研究动脉粥样硬化的发病机制及斑块的稳定性,采用有效治疗手段,真正达到有效预防和治疗动脉粥样硬化有着重要的意义,也是目前研究热点。     

Angiogenesis and Hepatic Fibrosis: Western and Chinese Medicine Therapies on the Road

Hepatic fibrosis is a common feature of almost all chronic liver diseases. Formation of new vessels (angiogenesis) is a process strictly related to the progressive fibrogenesis which leads to cirrhosis and liver cancer. This review mainly concerns the relationship between angiogenesis and hepatic fibrosis, by considering the mechanism of angiogenesis, cells in angiogenesis, anti-angiogenic and Chinese medicine therapies.     

彩色多普勒超声在中医药治疗颈动脉粥样硬化斑块中的应用

目的:探讨彩色多普勒超声在中药治疗颈动脉粥样硬化斑块前后对比中的应用。方法:采用彩色多普勒超声,对58例颈动脉粥样硬化斑块患者进行检查,观测其应用中药(益气活血汤)治疗前后斑块回声性质、大小、内-中膜厚度、管腔狭窄程度及彩色多普勒血流频谱参数变化情况。结果:治疗组颈动脉粥样硬化斑块患者中斑块均有不同程度的缩小,管腔内径扩大,内-中膜厚度变薄(P<0.01)。结论:彩色多普勒超声能准确监测颈动脉粥样硬化斑块的大小,评估血管狭窄的程度,为临床心脑血管疾病的早期诊疗提供客观依据,减少脑梗死的发生。     

Inhibition of Pathological Angiogenesis of Chinese Medicine against Liver Fibrosis

Pathological angiogenesis of liver which includes liver sinusoidal capillarization due to lose of fenestraes of liver sinusoidal endothelial cells (LSECs) and formation of new vascular, is a crucial mechanism responsible for origination and development of liver fifibrosis and closely involves in the development of cirrhosis and hepatic cancer. Anti-neovascularization medicine such as sorafenib can decrease portosystemic shunts, improve splanchnic hyperdynamic circulation, lower portal hypertension, while it can not be applied in clinic due to its serious toxic and side reactions. Chinese herbal formula can effectively inhibit pathological angiogenesis of liver, improve microcirculation of liver, and decrease the probability of gastrointestinal hemorrhage in cirrhotic patients. Different Chinese herbal formula are of different characteristics on inhibiting pathological angiogenesis in liver fifibrosis, which partly explains synergistic effect of different compatibility of Chinese materia medica and opens up good vista for Chinese medicine against liver fifibrosis through inhibiting angiogenesis.     

颅内动脉粥样硬化病理分型及影像学研究进展

目前对于动脉粥样硬化的发生发展机制尚不清楚,有多种理论学说互相补充,但均不能完全解释动脉粥样硬化的病理改变过程。颅内动脉粥样硬化是动脉粥样硬化的好发部位之一,由于其解剖学位置深、管径小、走形迂曲,活体明确颅内动脉粥样硬化斑块成分及稳定性受到了限制。越来越多研究表明准确判断颅内动脉粥样硬化斑块成分及其稳定性,对于临床治疗和鉴别诊断有重要价值。传统颅内血管影像学检查均不能满足定量、定性分析颅内动脉粥样硬化斑块,而三维高分辨磁共振成像（3D-HRMR]）作为一项新兴技术,近几年其颅内动脉管壁成像的研究备受关注,是目前唯一合适活体内分析颅内动脉粥样硬化斑块成分及斑块稳定性的检查方法。本文对目前颅内动脉粥样硬化病理分型及影像学研究进展做一综述。     

中药预防乳腺癌实验研究进展

中药具有不良反应少、多靶点和辨证施治的特点,在乳腺癌的预防方面正受到越来越多的重视。近年来的实验研究结果表明,中药对乳腺癌的预防疗效显著,其作用机制包括抑制肿瘤细胞增殖和促进凋亡、抑制血管生成、调节性激素水平、调节免疫和调节代谢等。     

Opposite effects of WEB2086 on angiogenesis in atheromas and ischemic hindlimb of apoE gene deficient mice

Background  Our previous research has suggested that platelet activating factor receptor was related to atherosclerosis. The present study investigated the effect of a platelet activating factor receptor antagonist- WEB2086 on angiogenesis in aortal plaque and ischemic hindlimb of apolipoprotein E-deficient mice.
Methods  Eight-week-old apolipoprotein E-deficient mice were fed with a 0.15% cholesterol diet to develop advanced lesions. At age 32 weeks unilateral hindlimb ischemia was surgically induced and the mice were divided into two groups: with or without WEB2086 mixed with their drinking water (4.3 mg in 100 ml). At age 40 weeks blood was collected from the orbit for measurement of serum lipids and an enzyme linked immunosorbent assay was used to determine platelet activating factor and oxidized low density lipoprotein in the gastrocnemius and aorta. Whole-Mount CD31 stain and plaque-associated sprouting have been used to estimate angiogenesis in plaque from the aorta and laser Doppler perfusion imaging and immunohistochemical expression of von Willebrand factor have been used to estimate angiogenesis in ischemic hindlimb.
Results  The lipid composition of serum was not different between the groups. However, the amount of platelet activating factor and oxidized low density lipoprotein detected in the aorta was significantly higher than that in the gastrocnemius of ischemic hindlimb. The ratio of lesion to aorta levels was significantly reduced by administration of WEB2086, (31.52±6.18)% vs (55.58±8.34)%, P<0.01. The mean density of intimal capillaries in atherosclerotic plaque, (31.13±9.20)% vs (57.74±11.28)%, P<0.01, and the mean number of sprouts per aorta were significantly reduced, 183.92±34.17 vs 392.54±76.79, P<0.01, in the WEB2086 group. Blood flow (0.85±0.12 vs 0.45±0.06, P<0.01) and capillary density of ischemic hindlimb (1.18±0.17 vs 0.53±0.09, P<0.01) were markedly increased in apolipoprotein E-deficient mice treated with WEB2086 versus controls.
Conclusion  The study provides evidence that WEB2086 can inhibit angiogenesis in atherosclerotic plaque but promote it in ischemic hindlimb.

     

中药有效成分治疗肺癌的作用机理研究进展

肺癌是我国恶性肿瘤死亡的首要原因,中药有效成分以中医理论为基础,发挥多环节、多靶点、多层面的抗肿瘤作用。目前中药有效成分治疗肺癌的作用机理研究主要集中在调节机体免疫功能、抑制肺癌细胞生长、影响细胞周期、诱导细胞凋亡、抑制新生血管生成、抑制转移等方面。     

氟伐他汀对动脉粥样硬化斑块中巨噬细胞凋亡的影响

目的通过研究他汀类药物稳定斑块作用中对巨噬细胞凋亡的影响以探讨在急性冠脉综合征中稳定斑块的分子机制。方法复制兔动脉粥样硬化及高脂血症模型，以氟伐他汀及安慰剂治疗，取腹主动脉，观察其斑块变化，计数斑块中巨噬细胞数量，TUNEL染色计算巨噬细胞凋亡率及SP法测巨噬细胞中Bcl-2阳性表达率。结果给药4周后，治疗组与安慰剂组比较，斑块厚度无明显变化。治疗组斑块中巨噬细胞总数低于对照组，且巨噬细胞凋亡率低于对照组。治疗组斑块中巨噬细胞Bcl-2阳性表达率，高于对照组。结论氟伐他汀可以抑制兔动脉粥样硬化斑块中巨噬细胞的凋亡，减轻炎症反应，稳定斑块。其作用途径可能是通过了增加抗凋亡基因Bcl-2的表达。     

瑞舒伐他汀对载脂蛋白E基因敲除小鼠动脉粥样硬化的治疗作用及其机制

目的: 探讨瑞舒伐他汀对载脂蛋白E基因敲除(ApoE^-/-)小鼠动脉粥样硬化模型血脂水平、动脉粥样硬化斑块及斑块内细胞凋亡的影响,阐明瑞舒伐他汀抑制动脉粥样斑块进展及斑块内细胞凋亡的机制。方法: 选取健康6周龄雄性ApoE^-/-小鼠30只,随机分为高脂饮食组、高脂+他汀组和普通饮食对照组,每组10只。前2组小鼠给予高脂饮食,普通饮食对照组小鼠给予普通饲料,喂养4周后,3组小鼠分别给予0.9%生理盐水、瑞舒伐他汀(10mg·kg^-1·d^-1)和0.9%生理盐水灌胃8周,ELISA法检测各组小鼠血清血脂水平,HE染色观察小鼠动脉粥样硬化斑块大小,TUNEL法检测斑块内细胞凋亡,免疫组织化学染色法检测凋亡相关基因Bax蛋白表达。结果: 高脂+他汀组小鼠血清总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平明显低于高脂饮食组(P<0.05或P<0.01),高脂+他汀组高密度脂蛋白胆固醇(HDL-C)水平明显高于高脂饮食组(P<0.01)。高脂饮食组小鼠主动脉粥样斑块呈巨块型,斑块内可见大量泡沫细胞、胆固醇结晶、坏死细胞及炎性细胞;高脂+他汀组小鼠主动脉粥样斑块较小,泡沫细胞、坏死细胞和炎性细胞均较少;高脂+他汀组小鼠主动脉粥样斑块面积明显小于高脂饮食组(P<0.01);高脂+他汀组小鼠主动脉粥样斑块内细胞凋亡指数明显低于高脂饮食组(P<0.01)。与高脂饮食组比较,高脂+他汀组小鼠Bax蛋白表达明显降低。结论: 瑞舒伐他汀可以抑制动脉粥样斑块进展,抑制斑块内细胞凋亡,其作用机制可能与线粒体途径有关。     

《中国实验动物学报》稿约

目的建立新西兰兔股动脉粥样硬化改良模型,探讨其可行性并与传统造模方法进行比较。方法西兰兔通过高脂饲料饲养后,在X线透视下经颈动脉行股动脉球囊损伤,建立改良动脉粥样硬化模型。与传统造模方法相比,评判造模前后的冠状动脉造影血流分级(Thrombolysis in Myocardial Infarction,TIMI)评分、管腔内径,血管内膜厚度和泡沫细胞阳性面积的变化,以及血凝血酶原时间(Prothrombin Time,PT)值的变化。结果与对照组比较,改良模型组的股动脉管腔内径显著狭窄(P<0.001),其狭窄程度与动脉内膜增厚程度存在相关性(r=-0.753)。同时,血管内膜泡沫细胞阳性面积率显著增多(P=0.018)。该变化与传统造模组相比,更为显著。结论改良法建立粥样斑块模型不但具有可行性,而且可控程度高、易重复。这种造模方法可以通过微创技术TIMI评分与血液生化学进行评价;与传统模型相比,更有助于进一步阐明不稳定斑块的机制。     

高血压病颈动脉粥样硬化斑块发生情况及其干预研究

目的运用高频超声了解高血压患者颈动脉粥样硬化的发生情况并对其进行干预研究。方法对196例原发性高血压患者行颈动脉超声检查,将有斑块者随机分成降压、降压 降脂两组,6个月后复查颈部血管超声。结果(1)高血压合并症越多,斑块检出率越高,斑块严重程度分级越高;(2)6个月后降压 降脂组较单纯降压组颈动脉斑块有明显回退(P<0.05)。结论(1)颈动脉可作为一个良好的体表窗口,反映高血压患者动脉粥样硬化的病变程度。(2)他汀类降脂药对稳定、缩小颈动脉粥样斑块有显著疗效。     

脑梗死患者颈动脉粥样硬化斑块及相关因素分析

目的探讨脑梗死患者颈动脉粥样硬化斑块的发生与相关因素的关系。方法分别对80例脑梗死患者（脑梗死组）和78例非脑梗死患者（对照组）的颈动脉进行检测,观察颈动脉粥样硬化斑块的发生及与血压、血糖、血脂的关系。结果脑梗死组患者颈动脉粥样硬化斑块发生率为76.25%,对照组为25.60%,两组差异有统计学意义（P〈0.01）。脑梗死组颈动脉粥样硬化斑块好发于颈总动脉分叉处。高血压、血脂异常、糖尿病、TG升高是脑梗死颈动脉粥样硬化斑块形成的危险因素。结论颈动脉粥样硬化斑块与脑梗死发生有密切关系,对脑梗死患者进行颈动脉超声检查,及早发现颈动脉粥样硬化斑块并积极控制危险因素,对预防和治疗脑梗死具有重要意义。     

颈动脉粥样斑块与冠状动脉病变

目的 研究颈动脉粥样斑与冠状动脉病变的关系。方法 将82例冠心病待排和冠心病患者按冠状动脉造影结果分成正常组和冠脉粥样病变组,同期超声检测颈动脉粥样硬化程度。结果 颈动脉粥样斑块与冠脉弱粥样硬化之间有较密切的关系。颈动脉粥样斑块对狭窄性冠状动脉病变预测的敏感性为71.7%,特异性为91.9%,阳性和阴性预测值分别为91.7%和73.9%,其准确性为81.7%。结论 颈动脉超声检测可作为预测冠状动脉粥样硬化有价值的指标。     

3.0 T高分辨率磁共振成像评估动脉粥样硬化性大脑中动脉狭窄

目的：1、分析大脑中动脉M1段粥样硬化斑块的位置分布、厚度分布及其可能原因。2、评估大脑中动脉粥样硬化斑块所在管腔的重塑性。方法：3.0T MRI检查64例大脑中动脉M1段管壁成像（TOF-MRA 管壁断面成像）,统计斑块所在位置及斑块的厚度。定义斑块面积比率=斑块面积/斑块所在层面管腔的截面积;重塑率=斑块所在层面血管的截面积/近远端正常血管截面积的平均;残腔率=剩余管腔面积/近远端正常管腔面积的平均。结果：大脑中动脉M1段粥样硬化斑块最易形成环形及沉积在管腔的前下壁,斑块的厚度以0.5mm-1.5mm为主,占72.5%。大脑中动脉粥样硬化斑块所在管腔呈正性重构。结论：1、大脑中动脉M1段粥样硬化斑块最易发生环壁及前下壁。斑块厚度以0.5mm-1.5mm为主。2、斑块面积比率与残腔率之间为负相关,管腔重塑率与残腔率无关。     

组织因子途径抑制物-2 (TFPI-2)在动脉粥样硬化斑块稳定性中的作用

 【摘要】组织因子途径抑制物 2 (tissue factor pathway inhibitor 2,TFPI 2)是一种含Kunitz型结构域的丝氨酸蛋白酶抑制剂,其生理功能和病理作用尚不清楚。由于TFPI 2在抑制恶性肿瘤侵袭转移中的重要作用及肿瘤侵袭转移与动脉粥样硬化斑块不稳定破裂的原因相似,研究者的目光开始转向TFPI 2对斑块稳定性的作用。本文就TFPI 2在动脉粥样硬化斑块稳定性中的作用作一综述。     

动脉粥样硬化性脑梗死患者颈动脉内膜中层厚度及斑块的检测及意义

目的研究颈动脉粥样硬化斑块及颈动脉内膜中层厚度（IMT）与脑梗死的关系。方法用彩色多普勒超声检测58例脑梗死患者颈动脉内膜中层厚度（IMT）,颈总动脉内径,斑块数,性质及部位,并与正常对照组比较。结果与正常对照组比较,脑梗死组IMT明显增厚（P〈0.01）,颈总动脉内径明显增大（P〈0.05）,斑块检出率增高（P〈0.01）。结论颈动脉粥样硬化是脑梗死的重要危险因素,脑梗死患者颈动脉内膜中层厚度增厚,颈总动脉内径增大,颈动脉粥样化斑块发生率高。