快速测定血浆B型钠尿肽鉴别老年人呼吸困难病因的临床观察

目的　评估快速B型钠尿肽 (BNP)测定在老年人呼吸困难诊断及充血性心力衰竭(CHF)近期预后判断的意义。　方法　根据最后诊断将 2 92例老年呼吸困难患者分为 4组 :CHF组( 14 6例 )、肺病组 ( 75例 )、CHF 肺病组 ( 5 2例 )和非CHF 非肺病组 ( 19例 ) ,采用干式快速免疫荧光法定量测定全部患者的血浆BNP浓度。　结果　CHF组BNP水平为 ( 736± 381)ng/L ;肺病组为 ( 6 2± 37)ng/L ;CHF 肺病组为 ( 5 14± 32 7)ng/L ;非CHF 非肺病组为 ( 6 1± 2 9)ng/L。肺病组的BNP水平与非CHF 非肺病组差异无显著性 (P >0 0 5 ) ,其余各组间差异有显著性 (P <0 0 1)。心功能Ⅱ～Ⅳ级〔纽约心脏学会 (NYHA)分级〕的BNP水平分别为 ( 374± 2 2 1)ng/L、( 6 34± 336 )ng/L、( 96 4± 32 1)ng/L ,组间差异有显著性 (P <0 0 1)。BNP值等于 110ng/L为界值时预测CHF的准确性最强。经短期观察发现 ,CHF组 14 6例中有 2 1例发生心血管事件 ,其BNP水平显著高于无心血管事件患者〔( 110 9± 4 31)ng/L和 ( 6 73± 336 )ng/L ,P <0 0 1)〕。　 结论　快速测定血浆BNP有助于鉴别老年人呼吸困难病因 ,是一种判断CHF预后的客观性指标     

同心圆硬化的临床表现及影像特点分析

目的总结同心圆硬化（BCG）的临床表现及影像特点。方法对7例均为临床、影像和（或）病理证实的BCG进行分析，总结其临床、影像特点。结果中青年起病，性别差异不明显。多以淡漠、反应迟钝起病，病变多为多发，且病灶较大，但症状及体征相对少。磁共振成像（MRI）检查均可见同心圆改变。结论同心圆硬化是一种特殊类型的脱髓鞘病，发病机制不明，诊断主要依靠MRI检查，激素治疗有效，预后良好。     

激素敏感脂酶基因高度表达对泡沫细胞形成的作用

中国仓鼠卵细胞在给予β－ＶＬＤＬ后，细胞内蓄积胆固醇酯，形成泡沫样细胞。以腺病毒基因转移方法书激素敏感脂酶基因转染到中国仓鼠卵细胞中，得到了来自激素敏感脂酶的胆固醇酯水解活性高度表达，此时，β－ＶＬＤＬ导致的胆固醇酯蓄积作用被阻断，提示增加胆固醇酯水解可以防止泡沫细胞形成。     

呼吸机所致肺损伤的生物伤机制与易感性

呼吸机所致肺损伤（VILI）的生物伤机制颇受关注。机械牵拉能刺激肺泡上皮细胞和肺内皮细胞、活化多形核白细胞和肺泡巨噬细胞，激活系列信号转导通路，导致细胞因子的释放、黏附分子的表达、细胞外基质及其降解酶的改变、花生四烯酸通路的活化、氧化与抗氧化失衡、核苷酸谱改变、凝血与纤溶异常、凋亡与坏死的变化。VILI存在诸多易感因素，如局部缺血和再灌注、体温、年龄、血流速度、内毒素等。     

疟疾疫苗现场试验研究进展

安全有效的疟疾疫苗可能是预防、控制疟疾的有效途径。然而,迄今为止,仍无一个安全有效的疟疾疫苗应用于现场。疟疾疫苗主要分为红前期疫苗、红内期疫苗及传播阻断疫苗,本文对这3类疫苗临床试验的进展进行综述。     

青海省多房棘球绦虫分子种系发生研究

目的　对青海省多房棘球绦虫分离株Cox1、Nad1基因进行扩增和测序，并构建系统进化树及分子钟，为推测其进化关系及起源提供参考依据。方法　收集2017年青海省人民医院收治的22份肝多房棘球蚴病患者术后标本，对多房棘球蚴线粒体DNA Cox1、Nad1基因进行PCR扩增和测序，并与GenBank数据库中的棘球属绦虫Cox1基因和Nad1基因序列进行比对，观察种内变异情况并构建进化树和分子钟。结果　所有多房棘球绦虫标本与GenBank数据库中检索的多房棘球绦虫亚洲株Cox1、Nad1基因序列同源性均达99%以上，共获得6种不同基因型，其中有2个分离株在GenBank数据库中未找到同源性100%的基因序列。系统进化树显示，收集的多房棘球绦虫标本与多房棘球绦虫亚洲株聚类效果明显；分子钟推测青海地区多房棘球绦虫起源于9.4万年前。结论　本研究发现青海省多房棘球绦虫存在6种不同基因型，其中首次发现2种基因型。青海地区多房棘球绦虫优势株为亚洲株，起源时间约在9.4万年前。     

冠心病患者高密度脂蛋白胆固醇与冠脉病变的相关性研究

目的探讨血浆高密度脂蛋白胆固醇(HDL-C)水平与冠脉病变的关系。方法选取153例行冠脉造影确诊的冠心病患者,并对冠脉病变程度进行分型,观察其与各项冠心病危险因素相关指标的关系。结果冠心病患者HDL-C比对照组明显降低,而总胆固醇(TC)、体重指数(BMI)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)比对照组明显增加,急性冠脉综合征组(ACS)患者比稳定型心绞痛组(ACS)HDL-C明显降低,TC明显增加P<0.001。HDL-C与冠脉病变类型、病变支数成负相关,TC与之成正相关。结论HDL-C与冠脉病变程度具有负相关关系。血HDL-C水平有可能成为一项有价值的、能预测冠心病事件的检查方法。     

ABCA1基因多态性与冠心病易感性的关联研究

目的探讨三磷酸腺苷结合盒转运子A1（ATP binding cassette transporter1,ABCA1）基因R219K及M883I单核苷酸多态性（SNP）位点与脂代谢和冠心病（coronary heart disease,CHD）易感性的关系。方法以医院为基础的病例-对照研究。经冠状动脉造影确诊的冠心病病例224例,同一地区正常对照248例。分别以PCR-RFLP和PIRA-PCR对ABCA1第219密码子G→A（Arg219Lys）和第883G→A（Met883Ile）密码子多态进行检测,比较不同基因型与个体血脂水平和冠心病患病风险的关系。结果吸烟、高血压和高血糖是冠心病的独立危险因素。与携带219RR基因型者比较,携带至少1个219K等位基因者（即RK和KK基因型）冠心病患病风险显著降低59％（OR = 0．41,95％ CI = 0．27～0．61）。而在883位点,II基因型携带者患冠心病率较低（OR = 0．54,95％ CI = 0．26～1．11）。而两位点联合作用分析发现与携带219RR,883MM或883MI基因型者相比较,携带其他组合基因型的个体冠心病患病风险降低61％（OR = 0．39,95％ CI = 0．26～0．60）。另外,对照组中携带219K等位基因者血清HDL-C水平显著高于219K非携带者（P = 0．037）,提示Arg219Lys位点的多态改变主要通过改变HDL-C水平影响个体冠心病的患病风险。结论ABCA1 R219K可能与中国汉族人群冠心病遗传易感性有关,血清高密度脂蛋白可能是其作用靶点。     

An oncolytic adenoviral vector of Smac increases antitumor activity of TRAIL against HCC in human cells and in mice

Hepatocellular carcinoma (HCC) displays a high resistance to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-mediated cell death. To increase sensitivity of HCC cells to TRAIL, we have constructed an oncolytic adenoviral vector (ZD55) and used this vector to deliver second mitochondria-derived activator of caspases (Smac) and TRAIL genes (ZD55-Smac and ZD55-TRAIL, respectively) into HCC cells. Our data showed that human HCC cells express high levels of inhibitor of apoptosis proteins (IAPs). Transfected HCC cells expressing exogenous X-linked IAPs (XIAPs) displayed more resistance to TRAIL. The expression of Smac led to rapid and potent activation of apoptosis in HCC cells after infection with ZD55-Smac. The activation of caspases and induction of apoptosis could be enhanced further through coinfection with ZD55-TRAIL. The combined treatment of ZD55-Smac and ZD55-TRAIL resulted in significant reduction of XIAP expression levels. In addition, our in vivo data in mice showed only a partial response in the established tumor treated either by ZD55-Smac or ZD55-TRAIL alone. By contrast, complete tumor regression was observed by combination of ZD55-Smac and ZD55-TRAIL in all treated animals. This strong antitumoral activity achieved by this combination was due to a dramatic induction of tumor cell apoptosis in the treated tumors. In conclusion, our data indicate that Smac antagonizes the IAPs in HCC tumor cells and enhances tumor cell death induced by TRAIL in the oncolytic adenoviral vector. The combination of Smac and TRAIL delivered by way of the oncolytic adenoviral vector would provide a useful strategy for therapy of HCC and might also be applied to other IAPs abundant in cancers.     

大剂量阿托伐他汀预防对比剂肾病

Objective To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention. Methods All patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n =100) and high dose group received additional atorvastatin 80 nag at 12 to 24 hours before procedure (n =50). Scr, Ccr, blood β2-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups. Results Baseline demographic characteristics and nephropathy risk factors were similar between groups. Cer was significantly reduced while blood β2-M and uric NAG/Cr were significantly increased in low dose group (all P ＜ 0.05) . Blood β2-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35±0.52) mg/L vs. (2.67±0.64) mg/L, P =0.008], day 3[(2.49±0.55)mg/L vs. (2.80±0.64) mg/L,P =0.011] and day 5[(2.29±0.53) mg/L vs. (2.56±0.66) nag/L, P = 0.026] post-procedure respectively; urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19±0.30) U/mmol vs. (1.46±0.34) U/mmol, P ＜ 0.001], day 3 [(1.30±0.30) U/mmol vs. (1.59±0.33) U/mmol, P ＜ 0.001], and day 5 [(1.10±0.30) U/mmol vs. (1.34±0.35) U/mmol, P = 0.001] post-procedure respectively;Cer in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69±20.99) mL/min vs. (65.19±18.72) mL/min,P =0.035], day 3[(64.04±15.82) ml/min vs. (56.79±14.50)ml/min,P =0.019] post-procedure respectively. Conclusion High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.