脑血管肌纤维发育不良的临床和影像学特点(附4例报告)

目的 探讨脑血管肌纤维发育不良(FMD)的临床和影像学特点.方法 对4例经DSA及MR血管成像(MRA)检查确诊的脑血管FMD患者的临床资料进行回顾性分析.结果 4例患者中,3例为青年人(18～27岁),1例为中年女性(48岁),均无卒中史.所有患者均表现为缺血性脑血管病,3例为脑梗死,1例为短暂性脑缺血发作.影像学检查发现2例颈内动脉颅外段及2例右侧大脑后动脉(PCA)呈串珠样改变.1例颈动脉FMD患者合并大脑中动脉夹层及大脑前动脉微小动脉瘤,1例大脑后动脉FMD患者合并颈内动脉颅外段夹层.结论 脑血管FMD常导致无卒中史的中青年人出现缺血性脑血管病的发生,影像学特点为受累血管呈串珠样改变.     

体外循环相关脑损伤的监测

中枢神经系统损伤一直是心血管外科体外循环术后最突出的并发症及致死因素.有研究报道成人心血管低温体外循环术后早期神经系统功能异常如记忆力下降、注意力不能集中、思维反应迟钝及活动能力减低等,发生率在40％～70％[1-2].冠状动脉旁路移植术后恶性神经事件,如脑死亡、非致死性中风和短暂缺血发作的发生率在3％左右[3].神经系统并发症导致心血管术后病死率升高、住院周期延长和住院费用增加,是心脏外科领域亟待解决的严重问题.     

紫黄凝胶剂的提取工艺研究

目的研究紫黄凝胶剂的提取工艺,确定最佳提取工艺。方法以左旋紫草素含量为指标,采用HPLC法,通过正交试验,考察提取时间、提取温度、乙醇量对测量指标的影响。结果紫黄凝胶剂的最佳提取工艺为A2B2C1,即提取时间为40min,提取温度为40℃,乙醇量为6倍。结论经验证,该提取工艺重复性良好,切实可行,稳定可靠。     

老年阻塞性睡眠呼吸暂停低通气综合征患者血清同型半胱氨酸水平及其机制研究

目的 探讨老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清同型半胱氨酸(Hcy)水平及其与氧化应激的关系.方法 选择2007年1月至2010年6月在我院经多导睡眠仪(PSG)监测并确诊OSAHS的患者123例,依据年龄分为老年OSAHS组55例、非老年OSAHS组68例;另选同期经PSG监测排除OSAHS的正常对照100例,依据年龄分为老年对照组52例、非老年对照组48例.于睡眠呼吸监测次日晨起采取空腹肘静脉血4 ml,采用循环酶法测定Hcy,紫外分光光度比色法测定丙二醛(MDA)及谷胱甘肽(GSH),并记录睡眠呼吸监测相关指标.结果 血清Hcy在老年OSAHS组、老年对照组、非老年OSAHS组、非老年对照组中的水平差异具有统计学意义(F=28.26,P=0.000);组间两两比较结果显示,老年OSAHS组中的Hcy水平高于其余各组,老年对照组高于非老年对照组,非老年OSAHS组高于非老年对照组.各组MDA、GSH水平差异具有统计学意义(F=5.56,P=0.002、F=4.79,P=0.004);组间两两比较结果显示,MDA、GSH在老年OSAHS组中的水平均高于其余各组.多元线性回归分析显示,血清Hcy与年龄、MDA、GSH、睡眠呼吸紊乱指数(AHI)具有相关性(β值分别为0.07、0.50、0.23、2.00).结论 随增龄,Hcy水平增高并伴氧化应激的增强,以老年OSAHS患者表现尤为显著,氧化应激的存在可能是老年OSAHS患者血清Hcy水平增高的内在机制.

Abstract：

Objective To investigate the association between serum homocysteine (Hcy) level and oxidative stress in elderly patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods The 123 patients from January 2007 to June 2010 were recruited and divided into the elderly OSAHS group (n=55) and the non-elderly OSAHS group (n=68). One hundred healthy subjects were selected and divided into the elderly control group (n=52) and the non-elderly control group (n=48). The PSG variables were recorded and the levels of Hcy, malondialdehyde (MDA) and glutathione (GSH) were detected after sleep in all subjects. Serum Hcy level was measured by cyclophorase, MDA and GSH levels were measured by spectrophotometer. Results There were statistical differences in Hcy concentration between four groups (F=28.26, P=0.000). The Hcy concentration was higher in elderly OSAHS group than in other groups, and was higher in elderly control group than in non-elderly control group, and was higher in non-elderly OSAHS group than in non-elderly control group. There were statistical differences in MDA and GSH concentrations between the four groups (F=5.56, P=0.002;F=4.79, P=0.004). The concentrations of MDA and GSH were higher in elderly OSAHS group than in other groups. Multiple regression analysis indicated a statistically significant relationship of Hcy concentration with age, MDA, GSH and AHI (β=0.07, 0.50, 0.23 and 2.00). Conclusions The concentration of Hcy increases and oxidative stress enhances with aging, especially in the elderly patients with OSAHS. The mechanism of high level of serum Hcy in elderly patients with OSAHS may be the high oxidative stress.     

N5,N10-亚甲基四氢叶酸还原酶基因多态性与青年脑梗死的关系

目的 研究N5,N10 -亚甲基四氢叶酸还原酶(MTHFR)基因多态性与青年脑梗死的关系.方法 将67例青年脑梗死患者作为病例组,同期71例健康体检者作为对照组,用聚合酶链反应-限制性内切酶片段长度多态性分析(PCR-RFLP)的方法来观察MTHFR 677和1298位点基因型.结果 MTHFR 677位点基因型病例组中TT型为20例,占29.8％;CT型32例,占47.8％;CC型15例,占22.4％;T等位基因频率为53.7％.对照组中TT型30例,占42.2％;CT型34例,占47.9％;CC型7例,占9.9％;T等位基因频率为66.2％.对照组中TT型及T等位基因频率明显高于病例组,2组差异有统计学意义(P＜0.05).MTHFR1298位点基因型病例组中AC型29例,占43.3％;AA型38例,占56.7％;C等位基因频率为21.6％.对照组中AC型14例,占19.7％,AA型57例,占80.3％,C等位基因为9.9％,病例组中AC型及C等位基因频率明显高于对照组,2组差异有统计学意义(P＜0.05).结论 本组人群中MTHFR基因677及1298位点多态性与青年脑梗死都有相关性.     

全胸腹主动脉四分支血管置换术后早期结果:临床与CT表现

目的 全胸腹主动脉置换术后早期评价对并发症的早期干预及预后至关重要.本研究目的结合临床表现与主动脉CTA评价全胸腹主动脉四分支血管置换术后早期结果.方法 连续纳入2009年2月至2010年3月期间行全胸腹主动脉四分支血管置换术的CrawfordⅡ胸腹主动脉瘤患者29例,男24例,女5例,平均年龄41.4岁(27 ～58岁).所有患者在术后5-14d内随诊全主动脉CT血管造影(CTA).所有CTA均采用非心电门控螺旋扫描,层厚0.5 cm.注射对比剂后触发层面设在肺动脉分叉水平的降主动脉.图像后处理均采用容积再现、多平面重建、曲面重建等后处理技术,对人工血管的通畅性、吻合口及其他并发症进行综合评价,并结合临床表现对全降主动脉置换术后早期结果进行评价.结果 所有入选病例中24例术后临床病情比较稳定,CTA检查人工血管周围见不同程度低密度渗出、胸腔积液.5例出现并发症:1例术后3d出现尿少,化验检查提示肾功能不全,该例患者主动脉CTA显示左肾动脉分支血管闭塞;1例患者出现下肢轻瘫,CTA未见重建的肋间动脉显影,血管造影提示肋间动脉闭塞;1例出现呼吸功能不全;1例术后7d出现感染性休克,CT诊断为食管瘘;1例患者术后低血压,CTA见人工血管外对比剂外溢.所有有并发症的患者经过治疗后均好转出院.结论 主动脉CTA可以快速无创显示胸腹主动脉置换术后早期并发症的病因,为临床及时采取治疗措施提供依据.     

非特异性血管炎所致主动脉根部病变的外科治疗

目的探讨非特异性血管炎性病变所致主动脉根部扩张和主动脉瓣关闭不全的外科疗效及产生瓣周漏的机理。方法自1990年1月至2009年6月手术治疗了该类疾患36例（大动脉炎25例,白塞综合征11例）。21例行主动脉瓣机械瓣置换术（AVR）;15例行主动脉根部置换术（ARR）,包括Bentall’s术9例,改良Cabrol’s术4例和David’s术2例。结果手术死亡1例。术后发生瓣周漏或瓣撕脱14例（9例为外院手术）,全部行AVR术后再次手术12例,因再次瓣周漏第3次手术6例,包括2例心脏移植;3次术中死亡3例。远期死亡5例。首次行ARR无手术死亡及术后瓣周漏。结论恰当的手术时机、手术方法和系统抗炎治疗有助于提高非特异性血管炎性病变所致主动脉瓣关闭不全患者的外科疗效。     

急性脑梗死患者血清CXCL16水平与卒中亚型的关系

目的 探讨急性脑梗死患者血清CXCL16水平变化及其与脑梗死TOAST病因学分型之间的关系.方法 应用酶联免疫吸附法检测113例急性脑梗死患者血清CXCL16水平,按TOAST分型进行分组,将各亚组之间以及与32例健康对照者进行比较.结果 病例组血清CXCL16水平显著高于对照组[(2.29±0.21)ng/ml对(1.75±0.21)ng/ml,t=12.863,P=0.000];大动脉粥样硬化性卒中组血清CXCL16水平显著高于小动脉闭塞性卒中组[(2.38±0.23)ng/ml对(2.21±0.11)ng/ml,q=5.743,P=0.000],而且两者均显著高于对照组(q=20.501,P=0.000;q=13.527,P=0.000).在大动脉粥样硬化性卒中组中,≥2条动脉狭窄组血清CXCL16水平与仅有1条动脉狭窄组无显著差异[(2.34±0.24)ng/ml对(2.46±0.19)ng/ml,t=-1.969,P=0.054].多变量logistic回归分析显示,CXCL16(OR=0.972,95% CI 0.956～0.978,P=0.001)和高脂血症(OR=3.547,95% CI1.160～10.848,P=0.020)足脑梗死发生的独立危险因素.结论 血清CXCL16水平在脑梗死急性期升高,与脑梗死发生密切相关,且大动脉粥样硬化性卒中组显著高于小动脉闭塞性卒中组.     

脂蛋白相关磷脂酶A2基因A379V多态性与TOAST亚型的关系

目的探讨脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)血清水平及其基因A379V多态性与低分子肝素实验病因分型(the trial of Org 10172 in acute stroke treatment,TOAST)的关系。方法对急性期脑梗死患者(N=200)和对照组(体检中心健康体检者,N=172)应用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测血清Lp-PLA2水平,聚合酶链反应(polymerasechain reaction,PCR)及基因测序技术检测基因多态性。结果脑梗死组血清Lp-PLA2水平(24.39±6.63)ng/ml,高于对照组(15.78±4.32)ng/ml,差异有显著性(P<0.01);TOAST分型后比较,大动脉粥样硬化性梗死(large artery atherosclerotic stroke,LAA)组、小动脉闭塞性梗死(small artery occlusion stroke,SAO)组、对照组血清Lp-PLA2水平分别是(25.60±6.71)ng/ml、(21.43±5.47)ng/ml、(15.78±4.32)ng/ml,差异有显著性(P<0.01);脑梗死组惠者,Lp-PLA2基因A379V多态性位点CC基因型频率68%,C等位基因频率83%,与对照组的70.9%、84.3%比较,差异无显著性(P>0.05),但是TOAST分型后显示CC纯合子血清Lp-PLA2水平(26.27±6.25)ng/ml较T等位基因携带者(CT+TT)(20.39±5.64)ng/ml发生脑梗死的风险增加(P<0.01)。结论 Lp-PLA2血清水平在脑梗死组升高,LAA组升高最明显;A379V基因多态性CC基因型与脑梗死的发病可能相关。     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.