急性肾后性肾功能衰竭42例临床分析

急性肾后性肾功能衰竭是由于泌尿系急性梗阻引起的一种严重并发症，如不及时治疗会危及病人生命。本科1999年9月～2006年6月共收治结石引起的急性肾后性肾功能衰竭病人42例，现将其发病原因，诊断及治疗方法进行回顾总结，以提高对该病的认识。     

低钙透析液对维持性血液透析患者难治性高血压的影响

目的探讨低钙透析液对血液透析患者难治性高血压的影响。方法选取合并难治性高血压的维持性血液透析患者26例,采取自身对照的方法,先后应用钙浓度为1．75mmol／L（DCa2＋1．75）及1．25mmol／L（DCa2＋1．25）的透析液各连续进行20次透析,观察每次开始透析后0h、1h、2h、3h及透析结束时的血压,并分别与20次透析前后观察一般临床指标及血清总钙（Ca2＋）、磷（P3＋）、钙磷乘积及全段甲状旁腺激素（iPTH）的变化。结果与常规采用DCa2＋1．75比较,采用低钙透析液（DCa2＋1．25）进行透析,患者的血压降低,尤其在第3小时及透析结束后．差异有统计学意义（P〈0．05）;血钙、钙磷乘积降低（P〈0．05）,其他临床指标差异无统计学意义（P〉0．05）。结论低钙透析液对维持性血液透析患者难治性高血压的控制有利。     

Effect of schisandrin B on lung mRNA expression of transforming growth factor-β1 signal transduction molecule in rat lungs exposed to silica

Objective To investigate the effects of schisandrin B (Sch-B) on expression of transforming growth factor-β1 (TGF-β1) and signal transduction molecule mRNA in rat lungs exposed to SiO2,and explore the intervention mechanism of Sch-B on pulmonary fibrosis induced by SiO2. Methods Ninety six Wistar rats were randomly divided into control (normal saline) group, SiO2 group and SiO2 plus Sch-B group.The rats were exposed to SiO2 by direct tracheal instillation to establish the silicotic animal models. SiO2 group and SiO2 plus Sch-B group were treated with 1ml SiO2 (50 mg/ml) for each rat From the first day after model establishment, SiO2 plus Sch-B group were orally given Sch-B (80 mg/kg) a day, control group and silica group were orally given olive oil. On the 3rd, 7th,14th and 28th days after treatment, 8 rats in each group were sacrificed and samples were collected. The histo-pathological examination of lung was performed by HE staining. The expression levels of TGF-β1 、TGFβR Ⅱ and Smad4 mRNA in the lung tissues were detected by RT-PCR. Results The results of histo-pathological examination showed that in SiO2 group, lung tissues were injured obviously; the alveolar inflammation with alveolus interval edema and inflammation cell infiltration appeared on the 3rd and 7th days; the alveolus interval became thicker, became thicker, fibroblast and collagen matiix increased markedly on 14th day; the alveolar structure was damaged, alveolar wall thickened obviously,collagen aggradation and pulmonary fibrosis displayed on 28th day. The alveolar inflammation and pulmonary fibrosis in SiO2 plus Sch-B group were significantly less than those in SiO2 group. The expressions levels of TGF-β1、TGFβR Ⅱ and Smad4 mRNA (TGF-β1: 1.03±0.31 、1.33±0.39、1.08±0.26、0.82±0.16,TGF-βR Ⅱ:0.65 ±0.11、0.80 ±0.16、0.83 ±0.24、0.62 ±0.15, Smad4: 0.87 ±0. 15、0.68 ±0.11、0.78 ±0.19、0.30 ±0.08) in SiO2group were significantly higher than those in the control group (TGF-β1:0.59±0.22、0.55 ±0.25、0.56±0.20、0.55 ±0.12,TGR-βR Ⅱ:0.28 ±0.13、0.31 ±0. 15、0.34 ±0.15、0.27 ±0.09,Smad4:0.23 ±0.11、0.40 ±0. 12、0.39 ±0.12、0.18±0.06)(P＜0.01 or P＜0.05), but the expression level of TGF-β1 mRNA was the highest on the 7th day. The expression levels of TGF-β1 and Smad4 mRNA (TGF-β1: 0.68 ±0.28、0.88 ±0.25、0.75 ±0.11、0.61 ±0. 14,Smad4:0.25 ±0.12、0.45 ±0.09、0.44 ±0.07、0.21 ±0.04) in SiO2 plus Sch-B group were significantly lower than those in SiO2 group (P＜0.01 or P＜0.05),but there were no significant differences of the TGFβR Ⅱ mRNA expression levels between SiO2 group and SiO2 plus Sch-B group. Conclusion Sch-B can reduce the pulmonary fibrosis induced by SiO2 through inhibition of the mRNA express of TGF-β1 and Smad4 in the lung tissue, modulating the TGF-β1/Smad4 signal transduction pathway and inhibiting the target gene activation.     

两种桡动脉头静脉血管造瘘方法的临床探索

目的 探索采用钛轮钉进行动静脉血管吻合与显微外科进行动静脉血管缝合两种手术方法进行血管造瘘的临床效果。方法 将300例准备接受维持性血液透析的尿毒症患者随机分为两组，分别由内科医师采用钛轮钉进行桡动脉头静脉血管吻合（钛轮钉组）及显微外科医师进行桡动脉头静脉血管缝合（缝合组）造血管内瘘，通过观察手术切口长度、术中出血量、手术时间、血液透析时的血流量、手术费用及内瘘1年通畅率评价手术效果。结果 钛轮钉组在切口长度，术中出血量，手术时间及手术费用方面均优于缝合组（P〈0．01）。但是在透析过程中的血流量不及缝合组（P〈0．05）。术后1年血管内瘘通畅率两组之间无显著性差异（P〉0．05）。结论 采用钛轮钉进行动静酥血管吻合造癌具有手术切口小、出血少、时间短、速度快等优点。     

宫腔注射无水乙醇对小鼠动情周期的影响

目的探讨宫腔内注射无水乙醇对小鼠动情周期的影响。方法利用阴道脱落细胞染色法选择动情期规律的小鼠20只,宫腔注射无水乙醇,术后第一个动情周期内每日测定其动情周期,随机择10只在第二个动情周期每2 h测一次,观察动情周期的改变程度。结果实验小鼠宫腔注射无水乙醇后动情周期整体发生大幅度延长,且动情期、动情前期等各期时间均发生了不同程度的紊乱。结论本实验通过观测无水乙醇损伤子宫后小鼠动情周期发生紊乱的现象,为临床无水乙醇的使用提供一定的实验基础。     

五味子乙素对实验性矽肺大鼠肺组织MMP-2和TIMP-1蛋白含量的影响

目的:观察五味子乙素(Sch-B)对二氧化硅致大鼠矽肺中基质金属蛋白酶2(matrix metallopro-teinase,MMP-2)和其抑制物基质金属蛋白酶组织抑制因子1(tissue inhibitor of matrix metalloproteinase,TIMP-1)含量的影响。方法:96只大鼠随机分为对照组、染尘组和Sch-B干预组,每组32只,采用暴露式气管内注入SiO2混悬液法建立大鼠矽肺模型,造模后1 d灌胃给予Sch-B干预治疗,分别在药物干预3,7,14,28 d时处死大鼠,取其肺组织,HE染色检测肺组织病理改变;ELISA法测定大鼠肺组织中MMP-2和TIMP-1蛋白的含量。结果:与对照组相比,染尘组MMP-2和TIMP-1蛋白含量在3,7,14,28 d时明显增高(P<0.01);与染尘组相比,Sch-B干预组MMP-2和TIMP-1蛋白含量均明显降低(P<0.01),但仍显著高于对照组(P<0.01),差异有统计学意义。结论:Sch-B对二氧化硅致大鼠矽肺中不同时间点肺组织MMP-2和TIMP-1的表达均有一定程度的抑制作用,能在一定程度上调整MMP-2和TIMP-1的比值使其趋于平衡,具有减轻二氧化硅致矽肺大鼠肺纤维化的作用。     

艾司西酞普兰与帕罗西汀治疗抑郁症的临床对照研究

目的 比较艾司西酞普兰与帕罗西汀治疗抑郁症的有效性和安全性.方法 将在精神科治疗病例随机分为艾司西酞普兰组和帕罗西汀组,应用汗密顿抑郁量表(HAMD)(17项)评定治疗效果,应用副反应量表(TESS)评定不良反应,在入院时、1、2、4周分别进行对照,分别完成43、44例.结果 研究终点两组疗效显示:艾司西酞普兰组有效率为83.7%,帕罗西汀组有效率为86.4%,两组有效率无统计学差异(P>0.05),但艾司西酞普兰起效要快,2周时艾司西酞普兰组的HAMD减分率较帕罗西汀组明显(P<0.05);艾司西酞普兰副作用要少,但共有副作用两者发生率无显著性差异(P>0.05).结论 艾司西酞普兰治疗抑郁症疗效与帕罗西汀相当,但起效要快、不良反应要少,是治疗抑郁症的较好选择.     

氟对小鼠睾丸间质细胞凋亡与caspase-3表达的影响

目的观察氟化钠对体外培养小鼠睾丸间质细胞凋亡的影响,以及对间质细胞中半胱氨酸天冬氨酸蛋白酶3(caspase-3)表达的改变。方法将体外培养的小鼠睾丸间质细胞分成4组,加入不同浓度的氟化钠染毒(0,5,10,20 mg/L),染毒48 h后采用流式细胞仪AnnexinⅤ-PI双染法检测细胞凋亡率,并用免疫组织化学法检测氟化钠对小鼠睾丸间质细胞caspase-3的表达。结果所有染氟组均观察到间质细胞凋亡和caspase-3表达的变化。与其他组相比,20 mg/L氟化钠组细胞凋亡值均显著升高,caspase-3表达的平均灰度值则显著降低(P<0.01)。结论氟化钠可促进体外培养小鼠间质细胞凋亡及caspase-3表达,证实了氟化钠对小鼠间质细胞的发育有毒性作用。