血管紧张素Ⅱ和血小板衍生生长因子BB:引起系膜细胞内游离钙浓度变化的异同

目的：研究血管紧张素Ⅱ(AngⅡ)和血小板衍生生长因子BB(platelet-derived growth factor-BB，PDGF-BB)引起的肾小球系膜细胞(MC)内游离钙浓度变化的异同。方法：以体外培养的MC为研究对象，激光共聚焦显微术结合Fura-3染色法动态测定细胞内游离钙浓度。结果：AngⅡ和PDGF-BB均可浓度依赖性地引起MC内游离钙浓度的升高，但二者的动态变化曲线存在显著不同。无钙缓冲液和钙通道阻滞剂均可抑制AngⅡ和PDGF-BB引起的细胞内钙浓度变化，但其抑制的方式和程度均有所不同。结论：AngⅡ和PDGF-BB通过不同的激发途径引起MC内游离钙浓度的升高。     

Higher activation of the interferon-gamma signaling pathway in systemic lupus erythematosus patients with a high type I IFN score: relation to disease activity

Increased IFN-γ levels have been associated with systemic lupus erythematosus (SLE). However, the relationships among IFN-γ, type I interferons (IFNs) and clinical features have not been extensively studied. Peripheral blood samples from 44 SLE patients and 36 healthy donors (HDs) were collected. Quantitative real-time PCR was used to assess the mRNA expression of IFNG, type II IFN-inducible genes (IRF1, GBP1, CXCL9, CXCL10, and SERPING1, which are used for the type II IFN score), type I IFN-inducible genes (IRF7, MX1, ISG15, and ISG20, which are used for the type I IFN score), TBX21, and EOMES in peripheral blood mononuclear cells. Flow cytometry was used to measure the IFN-γ levels in lymphocytes. The mRNA levels of type II IFN-inducible genes, IFNG, TBX21, and EOMES were significantly higher in SLE patients than those in HDs. Similarly, the percentages of IFN-γ-producing cells in lymphocytes and their subsets in SLE patients were significantly increased. Linear regression indicated that IFNG expression levels and type II IFN scores were positively correlated with anti-double-stranded DNA autoantibody levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores. Compared with patients with low type I IFN scores, patients with high type I IFN scores showed increased type II IFN scores and SLEDAI scores. Type II IFN scores were positively associated with type I IFN scores. The IFN-γ signaling pathway is activated in SLE patients and may be considered an index of disease activity. IFN-γ, together with type I IFNs, promotes the pathogenesis of SLE.     

2型糖尿病并轻中度高血压患者早期肾损害与脉压、脉压指数的关系

目的：探讨2型糖尿病合并轻中度高血压患者早期肾损害与脉压、脉压指数的关系。方法：120例2型糖尿病合并轻中度高血压患者检测血、尿β2-MG及尿白蛋白同时计算脉压、脉压指数，根据有无肾损害分组检测脉压、脉压指数；根据脉压、脉压指数分组检测血、尿β2-MG及尿白蛋白。结果：脉压〉60mmHg的高血压患者血β2-MG、尿β2-MG、尿白蛋白高于脉压〈60mmHg的高血压患者；脉压指数〉0．6的高血压患者血β2-MG、尿β2-MG、尿白蛋白高于脉压指数〈0．6的高血压患者。结论：高血压患者随着脉压和脉压指数的增大而出现肾损害的加重。     

胰岛素治疗对2型糖尿病病人胰岛β细胞功能的影响

①目的探讨胰岛素治疗对2型糖尿病病人胰岛β细胞功能的影响.②方法将100例病程超过10年,血糖控制不良的2型糖尿病病人,随机分为两组,A组给予常规治疗,B组给予胰岛素强化治疗,治疗前后应用放免法测C肽.③结果B组病人治疗后血C肽基础值及高峰值均明显高于治疗前(t=2.34.2.38,P＜0.05),A组病人治疗后血C肽基础值及高峰值较治疗前虽有增加,但差异无统计学意义(t=1.73,1.84,P＞0.05).B组治疗前后C肽变化较A组明显(t=2.23,2.13,P＜0.05).④结论病程超过10年的2型糖尿病病人及时采用胰岛素治疗有利于保护胰岛β细胞功能,减轻高血糖毒性.     

成立教学查房示范团队对内科教学查房持续质量改进的意义

教学查房是临床教学实践的重要环节。成立教学查房示范团队,通过制定教学查房标准化操作程序、鼓励教学模式创新等措施,使团队在临床教学查房过程中起到示范作用。此举既弥补了教学查房中存在的不足,又提升了临床带教教师的教学水平和教学查房的质量。     

EFFECTS OF DIFFERENT AMOUNTS OF PROTEIN DIETS ON KIDNEY IN DIABETIC RATS

Sixty-three streptozotocin-induced diabetic rats were divided into 3 groups fed with different amounts of protein diets 7%, 20% and 40% protein in Group 1, 2 and 3 respectively for 2 months. The ratio of right kidney weight/body weight (RKW/BW), 24h urinary protein excretion (UPE), creatinine clearance (Ccr), mean glomerular diameter (MGD), and colloidal iron staining (CTS) on surface of processes of glomerular podocyte were obsrerved by the end of the experiment. The results showed that RKW/BW and UPE in Group Ⅰreduced as compared with those in Group 2 and 3. The MGD in Group 3 in creased as compared with those in Group 2 and 1. But Ccr in diabetic rats fed with different diets showed no significant difference. Finally, it was found that fusion of the glomerular epithelial cell foot processes and decreased CIS were intensified by increased dietary protein content. The present findings suggest that restriction of protein intake may be able to retard the progression of diabetic nephropathy.     

Expert consensus on the establishment and maintenance of native arteriovenous fistula

Vascular access is the lifeline of hemodialysis patients. There are great differences in the establishment and use of vascular access in different countries and regions around the world. We believe that on the basis of good evaluation and planning, it is recommended that hemodialysis patients choose native arteriovenous fistula first. In view of the new progress of vascular access views domestic and international at home and abroad in recent years, we organized experts to recommend the establishment and maintenance of arteriovenous fistula (AVF) for the Chinese population, including preoperative evaluation and planning of the establishment of AVF, AVF surgery, perioperative drug intervention measures and postoperative maintenance, and put forward suggestions for future research directions. The recommendations in this consensus are general and clinicians need to make treatment decisions based on the actual situation.     

N-乙酰半胱氨酸对多器官功能障碍综合征大鼠器官的保护作用及其机制

目的 通过观察N-乙酰半胱氨酸(NAC)对多器官功能障碍综合征(MODS)大鼠的器官功能、核因子(NF)-kB、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6的影响,探讨NAC对MODS的器官保护作用及其机制.方法 将35只Sprague-Dawley大鼠分为假手术对照(Sham)组(5只)、MODS组(15只)、MODS+NAC组(15只).用肠缺血/再灌注结合酵母多糖腹腔注射制作成MODS大鼠动物模型,动脉夹夹闭肠系膜上动脉45 min,然后松夹恢复灌注,在恢复灌注12 h后,腹腔注射酵母多糖与0.9%氯化钠溶液混悬液(250 mg/kg).MODS+NAC组在恢复再灌注时,注射NAC 150 mg/kg.于注射酵母多糖18 h后,测定大鼠的动脉血氧分压(PaO_2)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、尿素氮(BUN)、肌酐(Cr)、肌酸激酶(CK),取肝、肾组织,应用凝胶迁移率法检测NF-kB的活性,酶联免疫吸附试验检测大鼠的血清TNF-α、IL-6含量,留肺、肝脏、肾、小肠标本行病理组织学检查.结果 MODS组大鼠的PaO_2较Sham组大鼠显著降低(P<0.01),而MODS+NAC组大鼠的PaO_2较MODS组大鼠显著升高(P<0.01).MODS组大鼠的ALT、AST、TBIL、BUN、Cr、CK均较Sham组显著升高(P值均<0.01),而MODS+NAC组大鼠上述指标较MODS组大鼠显著降低(P值均<0.01).MODS组大鼠的血清TNF-α、IL-6含量较Sham组显著升高(P值均<0.01),而MODS+NAC组则较MODS组大鼠显著降低(P值均<0.01).MODS组大鼠的肝脏、肾脏NF-kB活性均较Sham组显著升高(P值均<0.01),而MODS+NAC组则较MODS组显著降低(P值均<0.01).Sham组大鼠肺、肝脏、肾脏及小肠的病理表现基本正常,MODS组大鼠各器官存在明显的病理损伤,而MODS+NAC组的病理损伤程度较MODS组有所好转.结论 应用NAC可以对MODS大鼠起到器官保护作用,其机制可能与抑制NF-kB活性从而减少炎性因子合成有关.     

电针预处理对脂多糖诱导的急性肺损伤大鼠炎性细胞因子及水通道蛋白5的影响

目的 探讨电针足三里穴预处理对脂多糖（LPS）诱导的急性肺损伤（ALI）大鼠的干预作用及可能机制。方法 将SD大鼠随机分为正常、ALI4h、ALI6h、针刺+ALI4h和针刺+ALI6h组，ALI4h、ALI6h组大鼠气管内用LPS（2mg/kg）分别滴注4h和6h以诱导ALI，后两组大鼠在针刺预处理双侧足三里穴1周后于气管内分别滴注LPS4h和6h。各组均取血、支气管肺泡灌洗液（BALF）及肺组织，计算BALF中白细胞总数及肺湿/干比（W/D），HE染色观察肺组织形态，ELISA方法检测血浆中AQP5、IL-1β、IL-6、IL-10、TNF-α和BALF中AQP5水平，免疫组化方法观察肺组织AQP5表达。结果 与正常组比较，ALI4h组白细胞计数、W/D增高（P<0.05）、肺泡总面积和肺组织面积之比（A/t）降低（P<0.05）以及IL-1β、IL-10、TNF-α含量显著增高（P<0.001）；ALI6h组IL-6和IL-10含量明显增高（P<0.01）；ALI4h、ALI6h组AQP5含量显著降低（P<0.001）、积分光密度（IOD）明显降低（P<0.01）。与ALI4h组比较，针刺+ALI4h组白细胞计数与W/D降低（P<0.05）、IL-1β与TNF-α含量降低（P<0.05）、血浆及BALF中AQP5含量均升高（P<0.05），针刺+ALI6h组血浆AQP5含量有升高（P<0.05）。结论 电针足三里穴预处理对LPS诱导的ALI大鼠具有抗炎、降低肺水肿的保护作用，且在诱导4h时的ALI中更佳，其机制可能与电针下调炎性细胞因子和上调AQP5的表达有关。