运脾活血法治疗2型糖尿病胰岛素抵抗初探

2型糖尿病胰岛素抵抗是以中虚脾弱为本，痰、瘀、湿困为标，病机为升降失司，治疗从脾从瘀着手，建立运脾活血之法，选择《脾胃论》之清暑益气汤加味为基础方治疗，可获得显著的疗效。     

胸骨后甲状腺瘤SPECT／CT显像1例

1病历简介 患者,女,印岁.发现右上肺病灶26年,明显增大1月入院.患者于1979年因"咳嗽、痰中带血丝"行胸片及甲状腺扫描,检查发现"胸内异位甲状腺",行手术切除.     

整合素αvβ3受体靶向肿瘤显像研究进展

整合素αvβ3高表达于肿瘤细胞和肿瘤新生血管内皮细胞表面,而在正常组织和成熟血管内皮细胞表面呈低水平表达或不表达,整合素αvβ3能够与体内外含精氨酸-甘氨酸-天冬氨酸（RGD）序列的物质发生特异性结合。通过对RGD肽进行结构修饰、多聚化等来构建体内理化性能稳定的RGD肽和RGD-蛙皮素等融合肽,再通过不同的偶联剂介导完成RGD肽的不同放射性核素（^18F、^111In、^64Cu、^68Ga、^125I、^99Tc^m、^123I、^86Y等）标记,成为近年来肿瘤靶向显像的研究热点,部分临床实验正在国内外进行有效开展。通过PET／CT、SPECT／CT和PET／MRI多模态显像定量检测肿瘤整合素αvβ3受体的表达水平,来完成抗肿瘤新生血管生成治疗患者的筛选、疗效预测和实时监测,已成为近年来研究的焦点和新的发展方向。     

成纤维细胞激活蛋白靶向药物及其用于疾病显像和治疗的研究进展

成纤维细胞激活蛋白（FAP）在90%以上的上皮性肿瘤的癌症相关成纤维细胞（CAFs）中高丰度表达,具有特异性和广谱性,是肿瘤微环境靶向显像和治疗的研究热点。FAP靶向抗体、小分子抑制剂和多肽作为配体,通过偶联核素以及荧光探针用于肿瘤靶向显像、治疗、精准手术导航,并通过二聚体化以及新剂型构建（如白蛋白、纳米递送系统等）优化FAP靶向药物的生物分布,进而增加其在肿瘤内的滞留时间和增强生物学作用,推动其用于肿瘤靶向内放射性治疗和光热治疗。除了肿瘤,FAP也可为炎性疾病的显像和治疗提供有价值的靶点。笔者就近年来FAP在肿瘤和非肿瘤性疾病中的显像和治疗的研究进展进行综述。     

原位脑胶质瘤99Tcm-Galacto-RGD2 microSPECT/CT靶向显像研究

目的 合成 ⁹⁹Tc^m-半乳糖化精氨酸-甘氨酸-天冬氨酸多肽(⁹⁹Tc^m-HYNIC-Galacto-RGD₂-tricine-TPPTS, ⁹⁹Tc^m-Galacto-RGD₂),探讨其用于原位胶质瘤靶向显像的价值。方法 一步法制备⁹⁹Tc^m-Galacto-RGD₂,考察其体内外稳定性及体内生物学分布;构建荷人原位脑胶质瘤(U87MG)动物模型,⁹⁹Tc^m-Galacto-RGD₂尾静脉注射后行microSPECT/CT显像,勾画肿瘤感兴趣区,定量肿瘤的放射性摄取,病理学检查肿瘤整合素α_Ⅴβ₃表达水平,与放射性摄取进行相关性分析。结果⁹⁹Tc^m-Galacto-RGD₂放射化学纯度为(97.7±0.8)%,体内外稳定性好,能与脑胶质瘤细胞特异性结合,IC₅₀为(18±3)nmol/L。裸鼠尾静脉注射后血液清除快,脑组织放射性摄取少。静脉注射60 min后,肿瘤放射性摄取明显高于30 min(t=7.13, P<0.05),1 h肿瘤/脑组织放射性摄取比为13.92±3.43。microSPECT-CT显像阻断2 min后,肿瘤放射性摄取显著低于非阻断组(t=11.36,P<0.05);基于microSPECT-CT显像勾画肿瘤感兴趣区获得的肿瘤体积与肿瘤参考体积具有较好的一致性(95%CI=-11.94%~11.92%)。肿瘤⁹⁹Tc^m-Galacto-RGD₂摄取与整合素α_Ⅴβ₃表达水平呈线性相关(R²=0.896)。结论 ⁹⁹Tc^m-Galacto-RGD₂易于合成,理化性质好,microSPECT-CT融合显像可用于脑胶质瘤病灶的感兴趣区勾画和评价肿瘤组织整合素α_Ⅴβ₃的表达水平。     

32P-磷酸铬-聚 L-乳酸缓释粒子的制备及其放射性释出和生物分布

Objective The aim of this study was to prepare the 32P-chromic phosphate-poly(L-lac-tide) (32P-CP-PLLA) particles with different ratio of the materials and further examine their performance in-dex in vivo and in vitro and their intracorporeal distribution. Methods The erosion, degrading rates, de-layed release velocity and radioactivity self-absorption coefficient (RSAC) of 32P-CP-PLLA particles made from different materials were investigated and compared. After the implantation of 32P-CP-PLLA particles and the injection of 32P-CP colloids in the muscular tissues, the weight loss rate and the radioactivity release rate (RRR) of the particles were calculated. The intracorporeal distribution, radioactive half-life and bio-logical effect of 32P in the targeting sites were further studied. Statistical analysis was performed with SPSS 12.0, and one-way analysis of variance and t-test were used. Results 32P-CP-PLLA particles were of green cylinder, with regular shape and radionuclide distribution. The RSAC of the particles was of little re-lation with molecular weight of PLLA and proportional to the ratio of PLLA to CP. The extracorporeal release rate increased with the reduction of molecular weight of PLLA and with the increase of the ratio of PLLA to CP. The RRR reached peak when PLLA was 3 times of CP. The 32P-CP, released with the degradation and corrosion of the particle distributed mainly in the surrounding muscles of the particle. And the peak of per-centage activity of injection dose per gram of tissue (% ID/g) in liver, spleen and bone were 1. 7887, 1. 6401 and 1. 9470 respectively, much lower than that in the 32P-CP group (4.7523, 3.9712 and 4.3174 ; all t > 2.7, all P < 0.05). The % ID/g in other organs was much less. The radioactivity effective half-life in the targeting sites increased to about 13 d. There was widespread necrosis around the particles with no ex-istence of normal tissues among them. And no abnormality in spleen and liver was found. Conclusion As a better dosage form of pure β-particle emitter, 32P-CP-PLLA, which can increase the targeting radioactive dosage and effective half-life in the implanting sites, can be served as an potential implanting agent for onco-therapy with a better perspective.     

131Ⅰ联合他巴唑治疗Graves甲状腺功能亢进并心房颤动疗效观察

目的观察131I联合他巴唑治疗Graves甲状腺功能亢进(甲亢)并心房颤动(房颤)的临床疗效。方法 76例Graves甲亢并房颤患者随机分为A组32例(病程≤1a者14例为A1组,病程>1a者18例为A2组),B组44例(病程≤1a者21例为B1组,病程>1a者23例为B2组),A组给予他巴唑口服,B组他巴唑用法、用量同A组,并给予131I治疗,1a后评定2组甲亢和房颤治疗有效率,并比较2组甲状腺功能减退发生率。结果 A组甲亢治愈率、总有效率和房颤缓解率分别为40.6%,75.0%和46.9%;B组分别为79.5%,95.5%和75.0%,2组比较差异均有统计学意义(P<0.01,或P<0.05),其中A1组房颤缓解率(31.2%)高于A2组(15.6%)(P<0.01),B1组房颤缓解率(43.2%)高于B2组(31.2%)(P<0.05);治疗过程中A组发生白细胞减少5例,肝功能损害7例,B组均未发生;2组不良反应发生率比较差异有统计学意义(P<0.05)。结论 131I联合他巴唑治疗Graves病甲亢并房颤疗效优于单纯他巴唑治疗。     

32P-磷酸铬-聚 L-乳酸缓释粒子的制备及其放射性释出和生物分布

Objective The aim of this study was to prepare the 32P-chromic phosphate-poly(L-lac-tide) (32P-CP-PLLA) particles with different ratio of the materials and further examine their performance in-dex in vivo and in vitro and their intracorporeal distribution. Methods The erosion, degrading rates, de-layed release velocity and radioactivity self-absorption coefficient (RSAC) of 32P-CP-PLLA particles made from different materials were investigated and compared. After the implantation of 32P-CP-PLLA particles and the injection of 32P-CP colloids in the muscular tissues, the weight loss rate and the radioactivity release rate (RRR) of the particles were calculated. The intracorporeal distribution, radioactive half-life and bio-logical effect of 32P in the targeting sites were further studied. Statistical analysis was performed with SPSS 12.0, and one-way analysis of variance and t-test were used. Results 32P-CP-PLLA particles were of green cylinder, with regular shape and radionuclide distribution. The RSAC of the particles was of little re-lation with molecular weight of PLLA and proportional to the ratio of PLLA to CP. The extracorporeal release rate increased with the reduction of molecular weight of PLLA and with the increase of the ratio of PLLA to CP. The RRR reached peak when PLLA was 3 times of CP. The 32P-CP, released with the degradation and corrosion of the particle distributed mainly in the surrounding muscles of the particle. And the peak of per-centage activity of injection dose per gram of tissue (% ID/g) in liver, spleen and bone were 1. 7887, 1. 6401 and 1. 9470 respectively, much lower than that in the 32P-CP group (4.7523, 3.9712 and 4.3174 ; all t > 2.7, all P < 0.05). The % ID/g in other organs was much less. The radioactivity effective half-life in the targeting sites increased to about 13 d. There was widespread necrosis around the particles with no ex-istence of normal tissues among them. And no abnormality in spleen and liver was found. Conclusion As a better dosage form of pure β-particle emitter, 32P-CP-PLLA, which can increase the targeting radioactive dosage and effective half-life in the implanting sites, can be served as an potential implanting agent for onco-therapy with a better perspective.     

下腔静脉阻塞综合征下肢^99Tc^m-MAA显像肝和椎体显影一例

患者男,59岁,半个月前无诱因出现双侧下肢酸胀不适,伴下腹痛及下肢浮肿,近3d加重。无咳嗽、咳痰、呼吸困难,既往身体健康。实验室检查示：乙型肝炎病毒标志物（HBsAg,HBsAb,HBeAg,HBeAb,HBcAb）阴性,肝肾功能无明显异常,D-二聚体强阳性（＋＋＋＋）。X线胸片无异常;心脏超声示左心室射血分数63％,右房内探及异常回声（22mm×19mm×25mm）,考虑血栓可能。核医学显像均采用美国GEDiscovery SPECT仪。先行肺通气显像,后行^99Tc^m-聚合白蛋白[MAA,森科（南京）医药技术有限公司]下肢放射性核素显像（图1a）和肺灌注显像,结果示左侧腹壁浅静脉扩张,     

补肾通髓方联合头针治疗老年缺血性脑梗死患者的疗效及对认知功能的影响

目的:观察补肾通髓方联合头针对老年缺血性脑梗死患者的疗效及认知功能的影响。方法:选取2018年5月～2019年5月我院中医科诊治的老年缺血性脑梗死患者88例进行研究,按照随机数字表法分为观察组(44例)与对照组(44例)。对照组采用基础治疗,观察组在对照组基础上加用补肾通髓方联合头针治疗。治疗后观察两组患者疗效、中医证候积分、认知功能、美国国立卫生研究院卒中量表(NIHSS评分)、血液流变学指标。结果:治疗28d后,与对照组总有效率56.8%比较,观察组更高为84.1%(P0.05)。治疗14d、28d后,与对照组比较,观察组中医证候积分较低(P0.05)。治疗14d、28d后,MMSE、MoCA评分均明显升高,且观察组高于对照组(P0.05)。治疗14d、28d后,与对照组比较,观察组NIHSS评分得分较低(P0.05)。治疗28d后,观察组血液流变学指标水平低于对照组(P0.05)。结论:补肾通髓方联合头针治疗老年缺血性脑梗死患者疗效显著,能有效改善认知功能。