D_1类多巴胺受体对肾上腺素α受体介导的促动脉平滑肌细胞增殖作用的影响

目的观察D1类多巴胺受体对肾上腺素α受体介导的血管平滑肌(VSM)细胞增殖的影响。方法以去甲肾上腺素(NE)10-6~10-9mol/L刺激Sprague-Dawley(SD)大鼠主动脉分离的VSM细胞,观察在D1类多巴胺受体激动剂(Fenoldopam)10-5~10-8mol/L存在的情况下,NE促细胞增殖作用的变化,细胞增殖用3H-TdR掺入量表示。结果NE呈浓度依赖性的促进SD大鼠VSM细胞的增殖,该作用由肾上腺素α受体介导,酚妥拉明存在的情况下可消除NE的促增殖作用。Fenoldopam本身对VSM细胞增殖无影响,但Fenoldopam可通过D1类多巴胺受体减弱NE(10-6mol/L)介导的VSM细胞增殖;该实验结果得到了人VSM细胞实验结果的印证。结论D1类多巴胺受体对NE介导的促VSM细胞增殖具有抑制作用,该作用可能在高血压的发生、发展中发挥一定的作用。     

经桡动脉和股动脉途径行冠状动脉介入术的对比研究

目的 研究比较经桡动脉和股动脉两种途径行冠状动脉造影 (coronary angiography,CAG) 和介入治疗(percutaneous coronary intervention,PCI)的优缺点.方法 择期行CAG和PCI病人804例,按途径分为桡动脉组294例 (包括1例股动脉途径CAG失败而改为桡动脉途径),股动脉组530例(包括19例桡动脉途径CAG失败而改为股动脉途径).比较两组CAG和PCI的手术操作成功率和并发症.结果 CAG手术成功率:桡动脉组92.9%,股动脉组99.4%,差异有统计学意义.PCI手术成功率:桡动脉组92.6%,股动脉组96.5%,差异无统计学意义.但桡动脉组有6例病人改从股动脉途径完成PCI.外周血管并发症:桡动脉组2.7%,股动脉8.7%,差异有统计学意义.结论 桡动脉途径与传统的股动脉途径相比能减少外周血管并发症,但手术操作的难度有所增加.     

老年高血压患者血浆抵抗素水平与胰岛素抵抗的相关性

目的了解老年高血压患者血浆抵抗素水平与胰岛素抵抗的关系。方法选择41例中青年人(对照组)和43例老年人(老年组),分别分为高血压组和正常血压组,用竞争性酶联免疫吸附试验测定各组空腹血浆抵抗素水平,同时测定空腹血糖、空腹胰岛素、血脂和胰岛素敏感指数,测量受试对象腰围、臀围和腰臀比。结果老年组血浆抵抗素水平与对照组相比明显升高(P<0.05),老年组中高血压亚组血浆抵抗素与正常血压亚组相比差异无显著性。对照组高血压亚组抵抗素水平略高于正常血压亚组,但差异无统计学意义(P>0.05)。抵抗素与年龄呈正相关(r=0.31,P<0.01;r=0.28,P<0.05),与体质指数呈正相关(r=0.23,P<0.05),与胰岛素抵抗指数呈负相关(r=-0.31,P<0.05),但在各实验组中,抵抗素与体质指数无明显相关性。结论空腹血浆抵抗素水平与年龄和体质指数呈正相关,与胰岛素抵抗指数呈负相关。     

家兔动脉粥样硬化与血小板源内皮型氧化氮合酶表达的相关性

Objective To explore the correlation of atheroselerosis progression and the expression of platelet derived endothelial nitric oxide synthase (eNOS) in rabbits. Methods A total of 24 male New Zealand white rabbits were used in this study. Six of the animals were fed with normal food (control group). Eighteen rabbits were fed with cholesterol-rich food (1 g/d) for 12 weeks to establish the atherosclerosis model. Among 18 models, 6 rabbits were executed immediately and their aorta and platelet samples were collected for further analysis (model group), 6 rabbits were orally administered with pravastatin (10 rag/d) for additional 12 weeks (treated group), and the remaining 6 rabbits were left untreated until the end of the study (untreated group). The control, treated and untreated animals were then killed, and the aorta and platelet samples were collected for eNOS expression analysis (RT-PCR). Results The aorta samples in model and untreated group exhibited rough intima and a lot of longitudinal fatty streaks, which indicated that atherosclerosis models were established successfully. While in treated group, the degree of atherosclerosis was decreased. The average percent of thickness of fatty streaks or atheroselerotic plaques relative to the whole thickness of vessel walls was 0. 04±0. 02, 0. 82±0. 16, 0. 33±0. 18,0. 77±0. 14 in control, model, treated and untreated group, respectively. The thickness of fatty streaks or atherosclerotic plaques was significantly increased in the model and untreated groups and decreased in treated group compared with the control group (both P<0. 05). The expressions of platelet derived eNOS/mRNA were 1. 02± 0. 28, 0. 41± 0. 27, 1.00 ± 0. 77, 0. 40±0. 29 in control, model, treated and untreated group, respectively. The expression of eNOS/mRNA was markedly decreased in model group and untreated group compared with the control group, but was increased in treated group compared with untreated and model groups (F=3. 544, P = 0. 024). Conclusions There is a negative correlation between eNOS expression and atherosclerosis development, which suggests that the reversal effect of pravastatin on atheroselerosis progression and plaque formation may relate to the expression of platelet derived eNOS.     

心脏肌钙蛋白Ⅰ诊断急性心肌梗死的价值

目的：探讨血清心脏肌钙蛋白Ⅰ在急性心肌梗死（ＡＭＩ）中的诊断价值。方法：急性心肌梗死（ＡＭＩ）组患者２０例,不稳定型心绞痛（ＵＡ）组３１例,陈旧性心肌梗死（ＯＭＩ）组１１例,危重病患者８７例（非心血管疾病）。ＡＭＩ组患者系列采血测定血清ｃＴｎＩ和ＣＫ－ＭＢ,ＵＡ与ＯＭＩ组,危重患者组均入院后次日晨取血１次。     

慢性阻塞性肺疾病肺康复治疗进展及实践

已证实肺康复能有效地减轻慢性阻塞性肺疾病(COPD)患者的呼吸困难,提高运动耐力和健康相关生活质量。不同严重程度的COPD患者均可从肺康复中受益。其内容主要包括运动锻炼、吸气肌肉训练、营养疗法等,运动锻炼是肺康复的核心内容。近年来,提高肺康复效果的方法有了新发展,主要包括增加运动量、教育管理和心理支持。虽然肺康复传统地应用于稳定期COPD患者,但对于AECOPD患者,感染控制后就可开始早期肺康复。肺康复应当遵循运动量的最大化,并个体化和联合不同方法。     

药物洗脱支架植入后抗血小板治疗对预后的影响

目的观察冠心病患者药物洗脱支架植入后应用抗血小板药物的情况及其与预后的关系。方法调查150例冠心病患者药物洗脱支架植入后应用抗血小板药物的情况,并对主要心脏不良事件进行随访分析。结果平均随访时间(30.3±15.1)个月,术后98.7%患者应用阿司匹林,应用时间平均(19.3±7.2)月;术后99.3%患者应用氯吡格雷,应用时间平均(8.6±4.7)月;随访1年后,阿司匹林及氯吡咯雷应用率分别为88.7%及85.3%,随访2年后,阿司匹林及氯吡咯雷应用率为52.7%及3.3%,随访期间25.3%患者完全停用抗血小板治疗。完全停止抗血小板药物的患者主要心脏不良事件明显增加(18.4%vs4.5%,P0.05)。结论冠心病患者药物洗脱支架植入后长期有效的抗血小板治疗有助于降低主要心脏不良事件。     

葛根素通过PI3K/Akt途径对大鼠缺血再灌注心肌细胞凋亡的抑制

目的 观察葛根素预处理对缺血再灌注(I/R)大鼠心肌细胞凋亡的影响及其与PI3K/Akt信号通路的关系.方法 30只SD大鼠随机分为假手术组(SH组)、缺血再灌注组(I/R组)、葛根素预处理组(PU组)、葛根素预处理+LY294002组(PU+ LY组)及缺血再灌注+LY294002组(I/R+ LY组).除假手术组外,其他各组大鼠均行结扎冠状动脉前降支30 min,再灌注120 min,监测血流动力学,Western印迹法检测心肌组织p-Akt信号蛋白的表达;TUNEL法检测心肌细胞凋亡.结果 与I/R组比较,PU组能够明显改善心功能,抑制心肌细胞凋亡,并增加Akt的磷酸化水平(P<0.05,P<0.01).结论 葛根素预处理能够抑制缺血再灌注所致的心肌细胞凋亡,其作用机制与PI3K/Akt信号通路活化有关.     

体外诱导人羊膜间充质干细胞分化为胰岛素分泌细胞

目的 探讨体外诱导人羊膜间充质干细胞(hAD-MSCs)向胰岛素分泌细胞分化潜能.方法 采用胰蛋白酶-胶原酶消化法分离提取hAD-MSCs,流式细胞术分析和免疫细胞化学染色行表型鉴定.取第3代按2.5× 106个/ml或5×105个/ml细胞密度接种6孔培养板或预置盖玻片的24孔培养板,在含10mmol/L尼克酰胺和N2补充物的无血清HG-DMEM培养基培养,未诱导组为含10％胎牛血清的LG-DMEM基础培养基.分别于体外诱导第7、14、21天采用免疫细胞化学法检测胰岛素和β2微球蛋白的表达,采用放射免疫法检测上清液中胰岛素含量,采用RT-PCR检测胰岛素mRNA和胰十二指肠同源异型盒因子1(PDX-1)mRNA的表达.结果 (1)hAD-MSCs高表达间充质干细胞表面标志CD29、CD44、CD73、CD166及波形蛋白;(2) hAD-MSCs诱导第7、14、21天胰岛素阳性细胞百分率分别为74.67％±1.53％、75.00％±1.00％、74.33％±1.53％,培养物上清液中胰岛素含量分别为(331.62±1.76)、(330.50±1.22)和(331.65±0.48) μIU/ml,各时点间比较无显著性差异(均P＞0.05),而未诱导组仍未见胰岛素阳性细胞;培养上清也未检测到胰岛素;(3) hAD-MSCs诱导前后均有PDX-1 mRNA和蛋白表达,胰岛素基因mRNA表达仅见于诱导组;(4) hAD-MSCs诱导组和未诱导组各时点均有β2微球蛋白表达,其阳性细胞百分率组间差异无显著性(均P＞0.05).结论 hAD-MSCs具有向胰岛素分泌细胞分化的能力,可能成为1型糖尿病细胞移植治疗的新的细胞供源.     

家兔动脉粥样硬化与血小板源内皮型氧化氮合酶表达的相关性

Objective To explore the correlation of atheroselerosis progression and the expression of platelet derived endothelial nitric oxide synthase (eNOS) in rabbits. Methods A total of 24 male New Zealand white rabbits were used in this study. Six of the animals were fed with normal food (control group). Eighteen rabbits were fed with cholesterol-rich food (1 g/d) for 12 weeks to establish the atherosclerosis model. Among 18 models, 6 rabbits were executed immediately and their aorta and platelet samples were collected for further analysis (model group), 6 rabbits were orally administered with pravastatin (10 rag/d) for additional 12 weeks (treated group), and the remaining 6 rabbits were left untreated until the end of the study (untreated group). The control, treated and untreated animals were then killed, and the aorta and platelet samples were collected for eNOS expression analysis (RT-PCR). Results The aorta samples in model and untreated group exhibited rough intima and a lot of longitudinal fatty streaks, which indicated that atherosclerosis models were established successfully. While in treated group, the degree of atherosclerosis was decreased. The average percent of thickness of fatty streaks or atheroselerotic plaques relative to the whole thickness of vessel walls was 0. 04±0. 02, 0. 82±0. 16, 0. 33±0. 18,0. 77±0. 14 in control, model, treated and untreated group, respectively. The thickness of fatty streaks or atherosclerotic plaques was significantly increased in the model and untreated groups and decreased in treated group compared with the control group (both P<0. 05). The expressions of platelet derived eNOS/mRNA were 1. 02± 0. 28, 0. 41± 0. 27, 1.00 ± 0. 77, 0. 40±0. 29 in control, model, treated and untreated group, respectively. The expression of eNOS/mRNA was markedly decreased in model group and untreated group compared with the control group, but was increased in treated group compared with untreated and model groups (F=3. 544, P = 0. 024). Conclusions There is a negative correlation between eNOS expression and atherosclerosis development, which suggests that the reversal effect of pravastatin on atheroselerosis progression and plaque formation may relate to the expression of platelet derived eNOS.