恶性心包积液的内科治疗进展

恶性心包积液是晚期癌症患者常见并发症之一,已严重影响病人的生活质量和生存期,近年来许多临床医师对恶性心包积液的内科治疗做了大量研究,如腔内化疗、生物反应调节剂、博莱霉素、热疗等,其近期疗效均较好,不良反应轻。     

丹参对博莱霉素所致大鼠肺纤维化保护作用的实验研究

目的:探讨丹参对博莱霉素所致大鼠肺纤维化的保护作用及其作用机理.方法:通过气管内注射博莱霉素复制大鼠肺纤维化模型,在造模后的d 1和d 7开始给予丹参注射液治疗,分别在d 7、d 28处死大鼠,对肺组织匀浆中的脂质过氧化物(MDA)、谷胱甘肽(GSH)、羟脯氨酸(HYP)和肺组织病理学变化测量.结果:在造模后d 1给予丹参注射液治疗能抑制实验性肺纤维化大鼠的肺组织匀浆中的MDA、HYP异常升高和GSH的下降,减轻其肺部的病理损害;在造模后d 7给予丹参注射液治疗,丹参治疗组与模型组上述观察指标比较无统计学差异.结论:丹参注射液可预防大鼠肺纤维化,对已形成的肺纤维化无逆转作用.     

Enhanced antitumor effect of targeted nanoliposomal bleomycin

Folate receptor (FR)‐mediated drug delivery is a promising approach for active targeting of drugs to the FR‐positive tumor cells. Bleomycin (BLM) is an antitumor antibiotic with poor therapeutic activity as a result of its limited diffusion into tumor cells. The aim of this study was to investigate whether FR‐targeted PEGylated nanoliposomes (FPNL) can effectively deliver BLM to tumor cells and enhance its in vitro and in vivo efficacy. FPNL and PNL (non‐targeted) were prepared by thin film hydration method, and their physiochemical properties, cellular uptake, tissue distribution and tumor inhibitory effects were investigated. In Lewis lung cancer (LLC1) cells, FPNL containing BLM showed 2.38‐fold and 3.26‐fold higher cytotoxicity compared to PNL‐BLM and free BLM, respectively. Moreover, the uptake of FPNL by these cells was increased as compared to the PNL. Furthermore, FPNL showed significantly higher tumor distribution of BLM in the LLC1 cells and more tumor inhibition efficacy compared to free BLM and PNL. Both formulations of nanoliposomes had longer plasma half‐life than that of free BLM. Therefore, FPNL may be suitable carriers for targeted drug delivery to FR‐positive tumor cells.     

Quantitative image analysis of drug-induced lung fibrosis using laser scanning confocal microscopy.

Pulmonary fibrosis is a serious lung disorder that in certain cases may be difficult to quantify. It was our objective to evaluate the use of laser scanning confocal microscopy (LSCM) in quantifying fibrosis after exposure to amiodarone (AD) and bleomycin (BLM), two commonly used therapeutic drugs known to cause debilitating lung fibrosis in humans. Male F344 rats were intratracheally dosed with AD (6.25 mg/kg on days 0 and 2), BLM (0.25 and 1.0 mg/kg on day 0), or their respective vehicle controls. The right lung was assayed for hydroxyproline, a biochemical measure of collagen, at day 21 for the BLM groups and day 28 for the AD groups. The left lung was fixed, sectioned into blocks, dehydrated, stained with Lucifer yellow (LY, 0.1 mg/ml), and embedded in Spurr resin. The area of lung tissue stained by LY was quantified by LSCM. A fibrotic response in the AD and BLM groups was confirmed by histopathological assessment and a significant increase (p < 0.05) in total right lung hydroxyproline above control values. The area of connective tissue stained by LY of the two drug-treated groups appeared as bright linear bands in the alveolar septae and was significantly increased (p < 0.05) as measured by image analysis when compared with their respective controls. LSCM, with its advanced image analysis system, is an alternate method to quantify fibrotic lung disease. LSCM could be particularly useful when tissue quantity is limited, such as when tissue has been archived from previous studies, or when analyzing human lung biopsy samples for disease diagnosis, where biochemical analysis is difficult.     

气管插管快速灌注博莱霉素复制大鼠肺间质纤维化模型

目的：研究大鼠肺闻质纤维化的造模方法。方法：模型组大鼠气管插管灌注不同剂量（7、6、5、3．4、2、1mg／kg体质量）的博莱霉素A5-生理盐水，对照组给予等体积生理盐水，观察大鼠生存情况、肺组织病理，并深入研究博莱霉素1mg／kg体质量组，观察大鼠体质量变化，肺组织病理，检测第14天、28天、45天时大鼠肺系数以及血清中转化生长因子β1（transfor—minggrowthfactorfjl，TGF—β1）和血小板衍生生长因子（platelet—derivedgrowthfactor，PDGF）的含量。结果：经多个剂量的研究发现，较大剂量博莱霉素气管插管快速灌注法复制大鼠肺问质纤维化模型死亡率高，1mg／kg体质量气管内灌注博莱霉素A5-生理盐水可以造成大鼠肺组织纤维化改变。深入研究发现，与假手术组比较，1mg／kg体质量组大鼠肺组织病理14d已出现明显的纤维化改变，28d已形成弥漫性纤维化，45d时纤维化程度进一步加重。与假手术组比较，模型组3、7、14d体质量降低（P〈0．01），21d体质量虽有所下降，但差异无统计学意义（P〉0．05）；14、28、45d时肺系数升高（P〈0．01），血清TGF-β1水平从28d时开始升高（P〈0．05，P〈0．01），血清PDGF水平45d时升高（P〈O．05）。1mg／kg体质量组造模死亡率较低。结论：博莱霉素1mg／kg体质量气管插管快速灌注法可以成功复制大鼠肺间质纤维化模型。     

柴胡皂甙d干预肺纤维化VEGF/PEDF表达的实验研究

摘要 目的 观察柴胡皂甙d（saikosaponin-d SSd）对博来霉素（BLM）致肺纤维化小鼠肺组织血管内皮生长因子（VEGF）/色素上皮衍生因子（PEDF）在不同时间表达变化的调节作用,并探讨其与抗肺纤维化作用的关系。 方法 将80只小鼠随机分为4组,正常对照组,模型组,SSd大、小剂量治疗组。治疗组分别每天腹腔注射不同剂量SSd, MASSON染色观察纤维化程度,样本碱水解法检测肺组织中羟脯氨酸（HYP）含量,免疫荧光观察PEDF、VEGF蛋白在肺内表达的规律,RT-PCR观察各时间点PEDF、VEGF mRNA表达的强度。 结果 MASSON染色示模型组、治疗组均纤维化逐渐进展的动态变化;HYP含量随时间逐渐增加;造模组VEGF表达从第三天开始升高,第7天达高峰,之后逐渐下降,28天到最低,PEDF表达总体呈现逐渐增高趋势;治疗组VEGF表达总体比单纯造模组降低,并呈剂量依赖关系;PEDF表达比造模组升高,呈剂量依赖关系;结论 SSd能够抑制肺纤维化进展,机制可能与下调VEGF的表达,上调PEDF的表达有关。     

常山酮对口腔黏膜下纤维性变SD大鼠模型抗纤维化作用研究

目的　探讨常山酮对博来霉素致口腔黏膜下纤维性变（oral submucous fibrosis,OSF）大鼠的药理作用。方法　将40只SD大鼠随机分为实验组和对照组,每组20只。实验组大鼠在麻醉状态下,于双侧颊黏膜下局部注射1 mg/mL 博来霉素稀释液100 μL,每天1次,共持续给药8周;对照组大鼠注射等量的生理盐水。分别于实验前和给药2、4、6、8周时用游标卡尺对每只大鼠进行张口度测量,每次每只大鼠测量3次,求平均值。建模过程中实验组大鼠有3只死亡。8周后分别处死建模成功的实验组大鼠5只和全部对照组大鼠,取其双侧颊黏膜组织置于多聚甲醛中固定。另建模成功的实验组12只大鼠随机分为常山酮治疗组和常山酮对照组各6只。常山酮治疗组大鼠给予1 μg/mL常山酮稀释液 200 μL,给药方式同建模时博来霉素的注射,每天1次,持续6周;常山酮对照组大鼠给予相同剂量的生理盐水。分别于2、4、6周时对每只大鼠进行张口度测量,测量方法同上。6周后处死全部大鼠,取其双侧颊黏膜组织置于多聚甲醛中固定。采用HE染色观察各组大鼠颊黏膜组织病理变化情况。结果　（1）20只SD大鼠局部注射博来霉素 8周诱导出了17只临床和病理上与人OSF相似改变的SD大鼠模型;（2）局部给药常山酮6周缓解了OSF模型鼠的纤维化情况。结论　常山酮可改善博来霉素致OSF大鼠的纤维化情况,阻止纤维化的进一步发展。     

抑制PARP1活性对博来霉素诱导的肺纤维化的改善作用

目的:探讨抑制聚ADP核糖多聚酶1(PARP1)活性对于博莱霉素导致的肺纤维化的改善作用,阐明抑制PARP1活化改善肺纤维化的作用机制。方法:48只雌性ICR小鼠随机分为对照组(腹腔注射生理盐水)和5、10、15 mg·kg^-1博莱霉素组(模型组)。3个模型组分别在第1、4、8、11、15、18、22和25天腹腔注射相应浓度的博莱霉素。60只雌性ICR小鼠随机分成对照组、10 mg·kg^-1博莱霉素模型组及不同剂量PARP1抑制剂PJ34治疗组(腹腔注射博来霉素20min前尾静脉注射1、5和10 mg·kg^-1 PJ34)。上述实验中,分别于第14、21和28天每组选取3只小鼠,处死后取肺。HE染色观察肺泡结构,Masson染色分析纤维化程度。肺上皮源性细胞A549用于博莱霉素刺激后,Real-time PCR法分析PJ34对上皮间充质转化(EMT)标志基因表达的影响。结果:与博莱霉素模型组比较,PJ34治疗组小鼠肺泡结构的破坏及胶原在肺间质中的沉积明显减轻;Real-time PCR法分析,与博莱霉素模型组比较,PJ34治疗组肺上皮细胞A549中E-cadherinmRNA表达水平升高(P<0.05),α-SMA和TGF-βmRNA表达水平下降(P<0.05或P<0.01)。结论:抑制PARP1活性可以影响EMT标志基因的表达及肺纤维化的产生,PARP1抑制剂可用于预防博来霉素治疗肿瘤过程中产生的肺纤维化。