我国主要少数民族医药防治缺血性心脏病研究概述

我国缺血性心脏病发病率逐年增加，给家庭和社会造成了严重的负担，亟待寻找更好的治疗手段和医疗方案。基于象数思维、整体观等思维方式和临床经验，我国主要少数民族医药逐渐发展出独特的理论体系与治疗特色，在防治缺血性心脏病方面具有极大的应用潜力及研究价值。其中藏族医药（以下简称“藏医药”）、蒙古族医药（以下简称“蒙医药”）、傣族医药（以下简称“傣医药”）均可归属于以自然观与生命观为哲学基础的医学系统，各自发展出“三因”“三根”“四塔五蕴”理论，形成了对缺血性心脏病的独特认识并提出了相应的治法治则，产生了以三味檀香散、八味沉香散、肉蔻五味丸、雅叫哈顿散为代表的经典方剂，并具有以广枣、红景天、血竭为代表的特色民族药资源。笔者拟以藏医药、蒙医药为主，归纳民族医药防治缺血性心脏病的相关研究，并探讨开展该类研究所面临的机遇和挑战，以期为民族药防治缺血性心脏病的临床应用及新药开发研究提供参考。     

Relationship between liver attenuation coefficient measured with ultrasound and glucolipid metabolism

目的 探讨超声测定肝脏衰减系数与糖脂代谢的关系.方法 入选411例具备完整的体格检查、血压、糖脂代谢及肝脏超声检查结果的男性患者,年龄36～65岁.应用超声测定肝脏衰减系数作为肝脏脂肪含量的评价指标,以肝脏衰减系数三分位点(＜0.48,≥0.48且＜0.69,≥0.69)将研究对象分为3组,比较各组的临床及生化指标,并以年龄50岁为界进行亚组分析.结果 411例研究对象中,106例(25.8％)超声定性诊断为非酒精性脂肪性肝病(NAFLD).上1/3位点组的年龄、收缩压(SBP)、餐后2h血糖(2hPG)、餐后2h胰岛素(2hIns)以及高血糖患病率、NAFLD患病率均显著高于下1/3位点组(P值分别＜0.05、0.01),胰岛素敏感性(ISIc)指数显著低于下1/3位点组(P＜0.05).在≥50岁组中,上1/3位点亚组的稳态模型胰岛素抵抗指数(HOMA-IR)、2hIns、三酰甘油(TG)水平、高血糖患病率及超声定性诊断NAFLD患病率均显著高于下1/3位点亚组(P值分别＜0.05、0.01),而ISIc显著低于下1/3位点亚组(P＜0.05).≥50岁组超声定性诊断为非NAFLD人群中,上1/3位点亚组的2hIns及TG水平均显著高于下1/3位点亚组(P值均＜0.05),体质指数(BMI)显著低于下1/3位点亚组(P＜0.05).多元逐步回归分析显示,在总研究人群、≥50岁研究人群和≥50岁且超声定性诊断为非NAFLD人群中,肝脏衰减系数(标准化β值分别=0.154、0.151、0.170,P值分别=0.000、0.002、0.007)均是2hIns的独立危险因素.结论 在年龄≥50岁超声定性诊断为非NAFLD的男性人群中,超声测定肝脏衰减系数对估测脂代谢异常及胰岛B细胞对糖负荷后的反应具有一定的临床意义.     

Zephyr5826起搏器心房自动阈值管理的临床观察

目的动态观察Zephyr5826起搏器心房自动阈值管理(ACM)功能的开启情况、准确性及安全性。方法选取置入Zephyr5826起搏器患者68例,于置入术后第1,7天及1,2,3,6个月时随访程控,观察ACM功能的开启情况,手工测试心房起搏阈值并与ACM功能测定的值进行比较。结果 68例均完成随访。随访期内35例(51.50%)成功开启ACM功能,其中术后第1,7天及1,2,3个月时开启例数分别为14例(20.6%)、21例(30.9%)、26例(38.2%)、28例(41.2%)和32例(47.1%)。手工测试与ACM测试的心房阈值无差异。33例因起搏器自动测定心房刺激除极波(ER)过小不推荐开启ACM功能。随访期间心电图及动态心电图(Holter)均未见心房失夺获及感知不良。与普通电压和高电压起搏相比,自动阈值管理功能在心房输出方面分别节省50%,88%的能量消耗。结论 Zephyr5826起搏器ACM功能可以安全有效的应用低能量起搏心脏。部分患者术后因起搏器测定心房ER过小未能开启ACM功能,但在随访过程中ACM的开启比例逐渐升高。     

Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用

目的探讨Dyna CT与Embolization Guidance技术在前列腺动脉栓塞中的应用。方法收集我科使用SIEMENS Artis Zeego数字减影血管造影机检查和图像采集进行前列腺动脉栓塞的38例患者,用Dyna CT技术明确前列腺癌供血动脉与其他侧支的情况,Embolization Guidance技术指导进行安全性的前列腺癌供血动脉栓塞。结果 38例患者经两名高年资主任医师指导分别进行前列腺癌动脉栓塞术。Dyna CT联合DSA确认前列腺动脉65侧,比例达85.5%(65/76),其中24例患者显示双侧前列腺动脉,10例确认单侧前列腺动脉;前列腺动脉开口起源于髂内动脉38条,起源于闭孔动脉11条,起源于膀胱下动脉9条,起源于阴部内动脉5条,起源于直肠下动脉2条。利用Embolization Guidance技术完成前列腺动脉栓塞89.2%(58/65),其中24例患者完成双侧栓塞,10例完成单侧栓塞,4例因血管迂曲不能进行超选择栓塞。结论 Dyna CT联合Embolization Guidance技术能够准确地显示前列腺优势供血动脉,在前列腺动脉栓塞治疗中具有重要的应用价值。     

执行海外医疗任务期间CT室检查533例病例分析

目的 分析"和谐使命-2011"任务期间医院船CT工作情况,了解任务期间不同人群特别是加勒比三国民众CT检查完成情况.方法 回顾性分析整个任务期问866船官兵、华人华侨、牙买加、特立尼达和多巴哥、哥斯达黎加三国民众CT检查部位及疾病检出情况.结果 整个任务期间共完成CT检查533例,最多的检查部位依次是头颈部(177)、脊柱(130)、腹部(126)、胸部(43),疾病检出率最高的部位依次是脊柱(87.1%)、腹部(73.0%)、四肢关节(59.0%)胸部(53.5%)、头颈部(46.3%).结论 三国民众对CT检查的需求旺盛,不同人群和来源患者CT检查部位和阳性率有一定差异,今后对外医疗服务时应加强病例选择、与外方医疗机构的沟通、合理安排医疗资源配置.并加强业务知识学习.医院船CT室有许多需要改善的方面,总结了"和谐使命-2011"任务期间的CT工作经验,为今后对外医疗服务任务积累了宝贵经验.     

葫芦素抗肿瘤作用研究进展

癌症是全球主要的公共卫生问题，中国国家癌症中心的统计数据也表明癌症以逐年提升的发病率和死亡率成为威胁人类健康的重大疾病。癌症的发生发展机制复杂，涉及多阶段、多个基因及多条信号通路的异常，常规的放化疗及新兴的靶向治疗方法是肿瘤治疗的主要方式，但由于其毒副作用和耐药性的产生严重影响了患者的生活质量和持续有效的治疗效果，因此寻找安全有效的抗癌药物是全球关注的焦点。抗肿瘤植物药紫杉醇类、长春碱类、鬼臼素类、人参皂苷和多糖等的研发与应用给肿瘤治疗带来了新的希望。葫芦素是一种来源于中药葫芦科植物的高度氧化的四环三萜类化合物，药理作用广泛且机制复杂，在葫芦素家族中，目前针对葫芦素B，D，E，I抗肿瘤作用研究最多，已有大量研究证实，葫芦素B，D，E，I在治疗消化系统、呼吸系统、生殖系统、血液系统、泌尿系统等肿瘤疾病中发挥了重要作用，能够显著抑制肿瘤细胞增殖，而且在阻滞细胞周期、诱导细胞凋亡和自噬性死亡、抑制细胞迁移和侵袭、抑制肿瘤血管生成、调节活性氧的水平、调节免疫等方面作用显著，有望开发成为抗癌新药。基于当前国内外针对葫芦素抗多种肿瘤的作用及机制研究成果，笔者对葫芦素抗肿瘤作用研究进展进行了全方面综述，以期为葫芦素类抗肿瘤药物新药研发提供参考。     

Ketogenesis prevents diet-induced fatty liver injury and hyperglycemia

Nonalcoholic fatty liver disease (NAFLD) spectrum disorders affect approximately 1 billion individuals worldwide. However, the drivers of progressive steatohepatitis remain incompletely defined. Ketogenesis can dispose of much of the fat that enters the liver, and dysfunction in this pathway could promote the development of NAFLD. Here, we evaluated mice lacking mitochondrial 3-hydroxymethylglutaryl CoA synthase (HMGCS2) to determine the role of ketogenesis in preventing diet-induced steatohepatitis. Antisense oligonucleotide–induced loss of HMGCS2 in chow-fed adult mice caused mild hyperglycemia, increased hepatic gluconeogenesis from pyruvate, and augmented production of hundreds of hepatic metabolites, a suite of which indicated activation of the de novo lipogenesis pathway. High-fat diet feeding of mice with insufficient ketogenesis resulted in extensive hepatocyte injury and inflammation, decreased glycemia, deranged hepatic TCA cycle intermediate concentrations, and impaired hepatic gluconeogenesis due to sequestration of free coenzyme A (CoASH). Supplementation of the CoASH precursors pantothenic acid and cysteine normalized TCA intermediates and gluconeogenesis in the livers of ketogenesis-insufficient animals. Together, these findings indicate that ketogenesis is a critical regulator of hepatic acyl-CoA metabolism, glucose metabolism, and TCA cycle function in the absorptive state and suggest that ketogenesis may modulate fatty liver disease.     

Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.