PPAR-γ在COPD所致的肺动脉高压患者中的表达变化

目的探讨COPD所致肺动脉高压患者PPAR-γ表达水平与肺动脉压力、胰岛素抵抗的关系。方法63例COPD患者中合并肺动脉高压（PAH组）30例,无肺动脉高压COPD组33例,20例体检者为对照组。采用实时荧光定量RT—PCR测定外周血单个核细胞PPAR-γmRNA表达水平,放免法检测空腹胰岛素（FIN）,葡萄糖氧化酶法测定空腹血糖（FPG）。结果COPD组及PAH组PPAR-γ表达水平下降,FPG、FIN及IRI升高;PAH组肺动脉压力增高,PPAR-γ表达下降及IRI升高更加明显;PPAR-γ表达水平与肺动脉压力、FPG、FIN及IRI均呈负相关（r=-0．683,-0．476,-0．553,-0．589,P〈0．05）,肺动脉压力与IRI呈正相关（r=0．505,P〈0．05）。结论PPAR-γ表达下调可能与空腹血糖异常、胰岛素抵抗、肺动脉高压形成有关。     

Effects of zoledronic acid on the expression of HIF-1α and VEGF in the osteosarcoma cell line LM8 under hypoxic condition

Objective To investigate the effects of zoledronic acid on the expression of HIF-1α and VEGF in osteosarcoma LM8 cell line under hypoxic condition. Methods The hypoxic culture model was established. After LM8 cells were treated with zoledronic acid, semi-quantitative PCR was used to assess the expression of HIF-1α and VEGF mRNA. The expression of HIF-lct and VEGF protein was de-tected by immunohistochemical staining and ELISA respectively. Results Compared with cells in normoxic conditions, cells in the hypoxic environment and cells treated with zoledronic acid in the hypoxic condition did not show a significant change in the mRNA level of HIF-1α(P >0. 05). However, the protein expression of HIF-1α was markedly decreased in the cells treated with zoledronic acid in the hypoxic envi-ronment. In contrast, both mRNA and protein expression levels of VEGF were down-regulated in the zoledronic acid treatment hypoxic group (P <0.05). Conclusion Under hypoxic conditions in vitro, zoledronic acid inhibited the expression of HIF-1α protein, which decreased VEGF mRNA level and protein expression in osteosarcorna LM8 cell line.     

Fascin在肺癌中的表达及临床探讨

Objective To investigate Fascin expression in human lung cancer tissues and its clinical significance.Methods Immunohistochemistry was performed in 62 patients with different histological types and clinical stages of lung cancer and 92 cases with other malignant tumors.Fascin positive rate in each group was calculated and the differences of pathological characters between the two groups were analyzed.Results Fascin expression in lung cancer tissues was significantly higher than that in normal lung tissues(P ＜ 0.05),its expression varied by different clinical stage of lung cancer tissue differentiation.As differentiation degree decreased,Fascin positive rate increased.Fascin expression was independent with age,sex,smoking history(P ＞ 0.05).Fascin expression had no significant difference between lung cancer group and other tumor group(P ＞ 0.05).Conclusions Fascin expression raising might be common in malignant tumors.Fascin expression in lung tissues indicated the possibility of lung cancer.In lung tissue,high expression of Fasein was a sign of poor differentiation and malignant status of lung cancer.     

The expression and meaning of TGF-β and TGIF in endometrosis

Objective To explore the role of TGF-βand TGIF in the pathogenesis of endometriosis. Methods The expression of TGF-β and TGIF was detected by immunohistochemistry method in the ectopic and eutopic endometrium of 30 cases with endometriosis (ec-topic endometrium group and eutopic endometrium group) and in the normal endometrium of 40 cases without endometriosis (control group). Result The expression of TGF -β in ectopic endometrium group was significantly higher than that in eutopic endometrium group and control group (P < 0.05). There was no significant difference in the expression of TGF- βbetween eutopic endometrium group and control group(P > 0.05). The expression of TGIF in ectopic endometrium group was significantly lower than that in eutopic endometrium group and control group( P <0.05). There was no significant difference in the expression of TGIF between eutopic endometrium group and control group(P > 0.05). There were negative correlation between the expressions of TGF - β and TGIF in ectopic endometrium group and eutopic endome-trium group(rs= - 0.769, - 0.549, P < 0.05). Conclusion The abnormal expression of TGF-β and TGIF in ectopic endometrium of pa-tients with endometriosis may be associated with the genesis and progression of endometriosis.     

原位肝移植合并重症脓毒症病人的临床研究

Objective To improve the treat effect of the orthotopic liver transplantation patients with severe sepsis. Methods Fif-ty-six post-surgery patients were enrolled in this study. Patients were divided into two groups. One was non-OLT group (A group) and the other was OLT group (B group). Besides general data, the surveillance of blood lactate, the number of failure organs, APACHE Ⅱand MODS were recorded. 28-days survival rate and follow-up were checked. Results The mortality of hospitalization in non-OLT group was 30% and 57.6% in OLT group. The level of blood lactate in OLT group at the 1 st day increased significantly, which was statistically differ-ent with that in non-OLT group (P <0.01). It decreased but kept higher than that in non-group in following seven days. The numbers of failure organs in OLT group were more than in non-OLT group (P <0.01). The continuous APACHE Ⅱ score had no significant difference between two groups. But the continuous MODS score in OLT group was higher than in non-OLT group (P <0.01). Conclusions The 28-days mortality of OLT with severe sepsis is almost two times as much as that of non-OLT. It should cause more attention. The OLT with se-vere sepsis is more likely suffered from failure organs and difficult to recovery. To assess the condition of failure organs in OLT patients with severe sepsis, MODS score is better than APACHE Ⅱ score in this study. It is suggested that the standard of score system could be improved or come up with new score for organ transplantation. It will be better if blood lactate score is included.     

兔颈动脉损伤后再狭窄与p53蛋白关系的研究

Objective To observe the effect of p53 protein on smooth muscle cell(VSMC)in rabbit artery balloon injury.Methods Restenosis model of carotid artery after balloon injury was established in rabbits.30 rabbits were divided into 2 groups,the sham group(n = 6)and the vascular injury group(n = 24).With H.E.staining and automatic image analysis system,we investigated artery morphology alteration and measured the area of arterial intima and media.The expressions of p53 protein were detected by immunohistochemical analysis.Results With H.E.staining and automatic image analysis and immunohistochemistry,the results showed that the expression of p53 was significantly reduced and the intima area was increased in model group compared with the sham group(P ＜0.01).But the expression of p53 in media was remarkably reduced compared with intima(P ＜ 0.01).Conclusions The possible mechanism of preventing arterial restenosis in the balloon injury might be related with p53,which may be through inhibiting neointimal proliferation in arterial restenosis .     

强直性脊柱炎合并骨质疏松的临床研究

Objective To investigate the incidence of osteoporosis (OP) in patients with ankylosing spondylitis and the relationship between OP and the clinical data. Methods Serum levels of bone alkaline phosphatase (BALP) and tartrate resistant acid phosphatase 5b (TRACP5b) were detected by enzyme linked immunosorbent assay ( ELISA ) in 60 cases with ankylosing spondylitis, and it was compared with normal controls. Bone mineral density (BMD) was measured through dual-energy X-ray absorptiometry ( DXA), including lumbar ( L2 - L4), bilateral femoral neck and greater trochanter. Some clinical data was collected and analyzed at the same time. Results The incidence of OP in AS patients was 35%, and the incidence of OP in the femoral proximal end was higher than that in lumbar. Compared with normal controls[ ( 1.06 ±0. 18 )U/L ], the levels of serum TRACP5b in AS[ (1.31 ± 0. 82 )U/L] patients was significantly higher ( P <0. 05 ). The levels of serum BLAP in OP combined AS group[ ( 21.65 ± 5.41 ) U/L]were significantly lower than non-OP group[ (32. 37 ± 16. 5 ) U/L] ( P <0. 05 ). The disease duration was negatively correlated with the BMD of femoral neck ( P < 0. 01 ). Conclusions There was higher incidence of OP in AS patients, which were related with the abnormality of bone metabolism and the disease duration.Multiple factors participated in the regulation of bone metabolism of AS.     

血清基质金属蛋白酶3与颈动脉粥样硬化斑块及缺血性脑卒中的关系

Objective To investigate the relationship between the matrix metalloproteinase-3(MMP-3)and the stability of carotid artery plaque,and explore MMP-3's prediction role on the attack and relapse of acute ischemic cerebrovascular events.Methods 100 patients with the first ever acute cerebral infarction,100 patients with chronic cerebral circulation insufficiency(CCCI)and 40 persons without cerebrovascular diseases were enrolled in this study.According to the carotid ultrasound examination,100 cerebral infarction patients were divided into three subgroup: unstable plaque group(45 patients,mixed plaque,soft plaque),stable plaque group(35 patients,plaque Group)and endometrial coarse group(25patients).Matrix metalloproteinase-3(MMP-3)levels of all the subjects were measured by enzyme-linked immunosorbent assay(as basal level).All the subjects were followed up for one year to observe cerebral infarction events.Serum MMP-3 levels of each group,and the basic serum MMP-3 levels were compared among patients who were attacked or relapsed cerebral ischemic with those who had not been attack cerebral ischemic during this period of time.Results 5 patients in the cerebral infarction group had relapse (5%),2 patients in the CCCI group were attacked by cerebral ischemic(2%),and no one in the normal control group was attacked by cerebral ischemic.Serum MMP-3 levels in the acute cerebral infarction group were significantly higher than CCCI group,and both groups were significantly higher than normal control group (P ＜0.05).The basic serum MMP-3 levels in all patients who were attacked by cerebral ischemic were significantly higher than those who had not been attack by cerebral ischemic during this period of time(P ＜0.05).The serum MMP-3 levels of the unstable plaque group were significantly higher than stable plaque group.And both groups were significantly higher than endometrial coarse group(P ＜0.05).Conclusions Elevated levels of matrix metalloproteinase-3(MMP-3)might have something with the stability of carotid atherosclerotic plaque,and participate the attack and the relapse of acute cerebral infarction.Determination of MMP-3 might be used to predict the attack and relapse of acute cerebral infarction.     

精氨酸刺激试验评估胰岛β细胞功能的临床价值

Objective To investigate the value of intravenous arginine stimulation test (AST) in evaluating function of pancreatic islet beta cell response in patients of diabetes mellitus. Methods Twentyone patients with type 1 diabetes mellitus (DM1, DM1 group) and 113 patients with type 2 diabetes mellitus (DM2, DM2 group) were recruited in this study. DM2 patients were divided into two sub-groups, DM2a group (duration of no more than 1 year, 58 patients) and DM2b group (more than 1 year, 55 patients). The serum levels of C-peptide (CP) were determined at fasting and 2,3,4,5 minutes after intravenous injection of 5 g arginine. Results In DM1 group, the level of CP after injection of arginine was. similar to the fasting level (P> 0.05 ). In DM2 group, the peak level of CP appeared at 3th minute (CP3) during AST, and was significantly higher than fasting CP level(P < 0.01 ). The level of fasting and arginine-stimulated CP in DM2a group was significantly higher than that in DM2b group, and the level of fasting and arginine-stimulated CP in DM2b group was significantly higher than that in DM1 group. The patients of DM1 group whose level of CP3 < 600 pmol/L all needed insulin injection to control hyperglycemia, and the coincident rate was 100.0%.In DM2 group, there were 91 patients whose CP3 ≥600 pmol/L, among which 85 patients could be well controlled with diet or oral hypoglycemic agents, and the coincidentrate was 93.4%; there were 22 patients whose CP3 < 600 pmol/L, among which 19 patients need insulin injection to control hyperglycemia, and the coincident rate was 86.4%. Conclusions AST is valuable in assessing the function of pancreatic islet beta cell in patients with diabetes mellitus. The level of CP3 ≥600 pmol/L can be considered as a reference in diagnosis and treatment of diabetes mellitus.     

精氨酸刺激试验评估胰岛β细胞功能的临床价值

Objective To investigate the value of intravenous arginine stimulation test (AST) in evaluating function of pancreatic islet beta cell response in patients of diabetes mellitus. Methods Twentyone patients with type 1 diabetes mellitus (DM1, DM1 group) and 113 patients with type 2 diabetes mellitus (DM2, DM2 group) were recruited in this study. DM2 patients were divided into two sub-groups, DM2a group (duration of no more than 1 year, 58 patients) and DM2b group (more than 1 year, 55 patients). The serum levels of C-peptide (CP) were determined at fasting and 2,3,4,5 minutes after intravenous injection of 5 g arginine. Results In DM1 group, the level of CP after injection of arginine was. similar to the fasting level (P> 0.05 ). In DM2 group, the peak level of CP appeared at 3th minute (CP3) during AST, and was significantly higher than fasting CP level(P < 0.01 ). The level of fasting and arginine-stimulated CP in DM2a group was significantly higher than that in DM2b group, and the level of fasting and arginine-stimulated CP in DM2b group was significantly higher than that in DM1 group. The patients of DM1 group whose level of CP3 < 600 pmol/L all needed insulin injection to control hyperglycemia, and the coincident rate was 100.0%.In DM2 group, there were 91 patients whose CP3 ≥600 pmol/L, among which 85 patients could be well controlled with diet or oral hypoglycemic agents, and the coincidentrate was 93.4%; there were 22 patients whose CP3 < 600 pmol/L, among which 19 patients need insulin injection to control hyperglycemia, and the coincident rate was 86.4%. Conclusions AST is valuable in assessing the function of pancreatic islet beta cell in patients with diabetes mellitus. The level of CP3 ≥600 pmol/L can be considered as a reference in diagnosis and treatment of diabetes mellitus.     

异丙酚对大鼠肺缺血/再灌注损伤的保护作用

Objective To study the protective effects of propofol against ischemia/reperfusion injury in rat lung. Methods Rat model of pulmonary ischemia/reperfusion injury was used in this study. Rats were randomly divided into three groups, including sham opera-tion group (group A), iachemia/reperfusion group (group B) and propofol group (group C), 15 rats in each group. The concentration of tumor necrosis factor -α and interleukin-6 in bronchoalveolar lavage fluid (BALF) were measured by enzyme linked immunosorbent assay (ELISA). Then blood gas analysis, lung wet/dry (W/D) weight ratio were detected in each group. Results Propofol could significantly improve PaO2, reduce the W/D value and the contents of TNF-α and IL-6 in BALF. Conclusion Propofol effectively suppressed the pro-duction and release of inflammatory cytokine, therefore it can protect the lung from isehemia/reperfusion injury.     

快速康复外科对非小细胞肺癌患者术后肺部并发症的影响

目的对比研究快速康复外科（fast track surgery,Frs）和传统手术外科（conservative treatment surgery,CTS）对非小细胞肺癌（nonsmall—cell lung cancer,NSCLC）患者术后肺部并发症的发生率影响。方法选取2008年01月至2010年05月在本科对40例非小细胞肺癌行肺叶切除术患者采用FTS治疗（FTS组）;和同期40例按CTS围手术期处理的同种患者（CTS组）作对照。比较两组患者术后肺部并发症（肺部感染、肺不张、持续漏气〉7d）的发生率;同时分析两组术后辅助通气时间、手术结束时体温、ICU停留时间以及住院时间等情况。结果FTS组较CTS组术后肺部并发症的发生率显著减少（34．21％VS8．33％,P〈0．05）;两组ICU停留时间的中位数相差1天;grs组住院天数较CTS组明显减少[（11．1±3．6）dvs（16．6±5．7）d,P〈0．01]。结论按照FTS原则对NSCLC患者进行手术治疗,选择合适的围手术期处理以减少术后肺部并发症的发生率,促进患者早期康复。     

血内皮祖细胞与一氧化氮在慢性阻塞性肺疾病并发肺动脉高压患者中的变化及意义

目的 观察慢性阻塞性肺疾病（COPD）并发肺动脉高压（PAH）病人外周血内皮祖细胞（EPCs）数量和功能及一氧化氮的变化,并探讨其在COPD并PAH发病中的作用.方法 选择本院住院的COPD病人60例,其中COPD并PAH（COPD＋PAH组）病人30例,COPD非PAH病人30例（COPD组）;正常对照20例（非COPD组）.用密度梯度离心法从外周血获取单个核细胞,将其接种在人纤维连接蛋白包被培养板,培养7d后对贴壁细胞进行细胞化学分析.通过集落形成试验、改良的Boyden小室和黏附能力测定实验计数EPC的数量、测定EPC的迁移和黏附能力.用硝酸还原酶法比色检测入选患者血浆一氧化氮（NO）水平.结果 和正常对照组[（24.9±4.1）克隆形成数]及COPD组[（21.9±3.9）克隆形成数]相比,COPD＋PAH组[（14.2±3.5）克隆形成数]外周血EPC数量明显减少,黏附和迁移能力显著降低（F≥9.15,q≥3.49,P〈0.05）,且EPC数量及黏附、迁移能力与肺动脉压力呈负相关（r=-0.79、-0.85、-0.89,P〈0.01）.COPD＋PAH组患者NO水平[（43.6±4.8）ng/ml]明显低于对照组[（67.17±4.9）ng/ml]（P〈0.01）,NO浓度与循环EPCs数量及迁移能力呈正相关（r=0.77、0.71,P〈0.01）,与循环EPCs黏附能力无关.结论 COPD病人PAH的发生可能与循环EPCs数量减少、迁移和黏附能力降低有关,这种变化可能与血浆NO水平减少有关.     

异丙酚对大鼠肺缺血／再灌注损伤的保护作用

目的研究异丙酚对肺缺血／再灌注损伤的保护作用。方法复制肺缺血再灌注损伤大鼠模型。将成年Wistar大鼠随机分为3组,A组为假手术组;B组为肺缺血一再灌注组,C组为畀丙酚组,每组15只。用酶联免疫吸附（ELISA）法检测支气管肺泡灌洗液（BALF）中TNF-α、IL-6的含量。同时对各纽动物血气和肺湿／干重比（W／D）进行检测。结果异丙酚能明显改善缺血再灌注动物的血氧分压,减少肺W／D值,降低BALF中TNF-α、IL-6含量。结论异丙酚抑制肺缺血再灌注时炎性细胞因子的表达,从而减轻细胞因子介导的炎性损伤,具有肺保护作用。     

前列地尔脂微球载体注射液治疗慢性肺心病的临床疗效观察

目的观察前列地尔脂微球载体注射液对慢性肺源性心脏病病人肺动脉高压、心功能及动脉氧分压的影响。方法将60例慢性肺源性心脏病肺动脉高压病人随机分为2组,对照组30例常规治疗,治疗组30例常规治疗基础上加用前列地尔脂微球载体注射液。结果与对照组相比较,治疗组临床症状、平均肺动脉压(mPAP)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)均有显著改善(P<0.01)。结论前列地尔脂微球载体注射液能显著降低平均肺动脉压,提高动脉血氧分压和动脉血氧饱和度,改善右心功能,提高临床疗效。     

布托啡诺对脂多糖诱导离体兔肺动脉反应性变化的影响

Objective To explore the regulatory roles of butorphanol on isolated rabbit pulmonary arteries by lipopolysaccharide(LPS)pre-incubation and assay the protective effect of ketamine on clinic sep tic shock patients.Methods Vascular ring tension detection technique was applied to observe the effect of butorphanol on the normal or lipopolysaccharide incubated pulmonaryvascular.Results In normal group, the final concentration of butorphanol(0.1 μmol,1μmol,10μmol,100μmol)were used to make pretreat ment- phenylephrine(PE)pulmonary artery relaxation.In LPS group,the effect of vasodilation of butor phanol was enhanced.Conclusions LPS can enhance the effect of butorphanol on pulmonary artery relaxa tion reaction.And the direct effect of butorphanol on pulmonary arteries was vasodilation.     

缬沙坦对博莱霉素所致大鼠肺纤维化的干预研究

目的观察AT1受体拮抗剂缬沙坦对博莱霉素A5（BLMA5）所致大鼠肺纤维化模型形成过程的影响。方法54只SD雄性大鼠随机分为正常对照组（C组）、模型对照组（B组）和缬沙坦治疗组（T组）3组，18只／组。T组于大鼠气管内滴注0．5％BLMA5生理盐水溶液（5mg／kg）以复制肺纤维化动物模型，并于造模当天每日给予缬沙坦（20mg／kg）灌胃；B组以生理盐水代替缬沙坦灌胃；C组则均用生理盐水代替BLMA5和缬沙坦。各组动物均于制模开始后的第7、第14、第28天分别随机处死6只动物，分取肺组织行病理切片HE染色和Masson染色于光镜下观察大鼠早期肺泡炎程度以及晚期肺纤维化程度、碱水解法检测肺组织羟脯氨酸（Hyp）浓度、免疫组化技术检测肺组织平滑肌肌动蛋白（α—SMA）和转化生长因子TGF—β1水平。结果（1）肺组织Hyp含量：制模第7天3组动物间比较差异均无统计学意义（P〉0．05）；第14天和第28天，B组肺组织Hyp含量较C组明显升高（P〈0．01），T组较B组Hyp含量明显下降（P〈0．01）。（2）早期肺泡炎程度：HE染色可见B组在第7天时急性肺损伤、肺泡炎程度最为明显，可见肺泡间隔和肺泡腔内有大量炎性细胞浸润，肺泡隔增宽，其后炎症渐有减轻，但第14天和第28天时炎症仍较C组明显（P〈0．01）；T组在第7、第14天和第28天肺泡炎程度均较B组明显减轻（P〈0．05）。（3）晚期肺纤维化程度：Masson染色在第7天3组动物间肺纤维化程度差异无统计学意义，第14、第28天时B组可见胸膜下、大气道及血管壁周围的基质胶原明显及纤维组织增多，较C组差异有统计学意义（P〈0．01），T组较B组肺纤维化程度明显减轻（P〈0.05）。（4）肺组织TGF—β1蛋白表达水平：B组第7天时肺组织内TGF-β1表达水平最强，以后逐渐减低，但与C组比较仍显著升高（P〈0．01）；T组TGF—     

三种抗纤维化药物对大鼠肺纤维化模型的疗效观察

目的筛选强有力的抗肺纤维化药物，为临床治疗提供理论依据。方法SD大鼠90只分为6组，正常对照组，模型组，姜黄素组，卡介茵多糖核酸组，地塞米松组，联合用药组。除正常对照组气管内灌注0．2ml生理盐水，其余各组一次性气管内灌注博来霉素生理盐水0．2ml（5mg／kg），术后当日给药，正常对照组，模型组1ml·kg^-1·d^-1生理盐水，姜黄素组：姜黄素50mg·kg^-1·d^-1卡介菌多糖核酸组：卡介菌多糖核酸2．5mg·kg^-1·d^-1地塞米松组：地塞米松2．5mg·kg^-1·d^-1。联合用药组：地塞米松2．5mg·kg^-1·d^-1加卡介菌多糖核酸2．5mg·kg^-1·d^-1腹腔注射。用药至处死动物的前一天。于造模后的7、21和28d各组处死5只大鼠，作HE和Masson染色观察肺泡炎和肺纤维化程度，并测肺组织羟脯氨酸含量。结果三种药物对肺泡炎和肺纤维化均有抑制作用，以联合用药组效果最佳（P〉0．05）。结论肺纤维化的发病机制复杂，联合用药可能取得最佳疗效。     

布托啡诺对脂多糖诱导离体兔肺动脉反应性变化的影响

目的 探讨阿片受体激动剂布托啡诺对正常及内毒素休克时肺动脉血管反应性的影响,从而指导临床用药.方法 应用血管环张力检测技术,观察布托啡诺对正常及脂多糖（lipopolysaccharide,LPS 4 μg/ml,4 h）孵育的肺动脉血管环反应性的影响.结果 在正常肺动脉组,布托啡诺终浓度（0.1 μmol/L,1 μmol/L,10μmol/L,100 μmol/L）使苯肾上腺素（Phenylephrine,PE）预收缩的肺动脉呈剂量依赖性舒张,在LPS孵育的肺动脉组,布托啡诺终浓度（0.1 μmol/L,1μmol/L,10μmol/L,100 μmol/L）也使PE预收缩的肺动脉呈剂量依赖性舒张反应,但其舒张作用与正常组比较明显加强.结论 布托啡诺对血管具有直接的舒张反应,并且LPS可以增强布托啡诺对肺动脉的最大舒张反应.