苯那普利对兔髂动脉球囊损伤后内膜增生的影响

为了探讨髂动脉内膜剥脱术后再狭窄的预防，将２８只兔随机分为苯那普利组和对照组，行右髂动脉内膜球囊剥脱术。术后３０天处死动物，作病理形态学检查及流式细胞术测定。结果表明，苯那普利组损伤血管内膜厚度小于对照组，而管腔面积大于对照组（Ｐ均＜０．００１）。治疗组血管壁细胞增殖期细胞数明显低于对照组（Ｐ均＜０．００１）。提示，苯那普利能抑制动脉球囊损伤后血管平滑肌细胞增殖，减轻内膜增生。     

人白细胞相关抗原B27及细菌多肽在脊柱关节病发病中的作用

目的了解细菌多肽应具备什么基本条件才能被人白细胞相关抗原（ＨＬＡ）Ｂ２７递呈而导致脊柱关节病。方法以来自衣原体热休克蛋白６０、能与Ｂ２７分子结合的９肽作为原型，用人工方法将９肽的每一个氨基酸残基均以另外１９种氨基酸替换，将合成的１８０种９肽分别与Ｂ２７Ｔ２细胞孵育，观察其与抗Ｂ２７单克隆抗体Ｂ２７Ｍ２的反应性。结果与Ｂ２７分子结合的９肽其第２位氨基酸残基应是精氨酸，以其它１９种氨基酸替换均使Ｂ２７Ｍ２的反应性明显降低；第６，８，９位氨基酸残基的选择性亦较高，仅有６～８种氨基酸能诱导与Ｂ２７Ｍ２的反应性；第３，５，７位氨基酸残基没有什么选择性，几乎任何一种氨基酸残基对Ｂ２７Ｍ２反应性的影响均不大。结论第２，９位氨基酸残基是９肽与Ｂ２７紧密结合所必需的，而第６，８位氨基酸可能与抗Ｂ２７单克隆抗体的识别有密切关系     

鞘膜瓣转移矫治尿道下裂术后阴茎段多发性尿瘘

目的 探讨修复尿道下裂术后多发性尿瘘的一种新技术.方法 采用睾丸鞘膜瓣转移结合尿道支架管和弹性包扎治疗尿道下裂术后多发性尿瘘8例,患者均有尿瘘修补失败病史,尿瘘数量最少3个、最多7个,平均5个,分别分布在阴茎头至阴茎根部之间.结果 8例患者尿瘘均一期愈合,术后排尿及外形均良好.5例患者术后电话随访8～10个月,无尿瘘复发现象、无排尿困难及阴茎弯曲等问题.结论 睾丸鞘膜瓣转移结合尿道支架管支撑和弹性敷料包扎是治疗尿道下裂术后多发性尿瘘的一种有效方法,手术简单、效果可靠、对外形影响较小.

Abstract：

Objective To discussed a new technique for multi-fistulas after urethraplasty in hypospadias. Methods 8 cases with postoperative multi-fistulas, which were not successfully repaired by previous treatment, were reoperated with tunica vaginalis flap combined with urethral stent and elastic dressing. The multi-fistulas were located between glan and scrotum. The number of fistulas was 3-7(median, 5 ). Results Primary healing was achieved in all the 8 cases. The micturition and esthetic result were satisfied. 5 cases were followed up for 8-10 months with no recurrence of fistula. There was also no dysuria and penile curvature. Conclusions Tunica vaginalis flap combined with urethral stent and elastic dressing is an effective technique for multi-fistulas after urethraplasty. It is easily performed with reliable result.     

瑞舒伐他汀对肾小球硬化症患者动脉粥样硬化的影响

目的探讨瑞舒伐他汀对肾小球硬化症患者炎性反应介质和抗动脉粥样硬化的作用。方法选择38例肾小球硬化症患者,随机分为2组,观察组22例予瑞舒伐他汀10 mg口服,每天1次,对照组16例未接受任何调脂治疗,仍维持其原有治疗不变。治疗12个月后观测血脂水平、估计的肾小球滤过率(eGFR)、高敏C反应蛋白(hs-CRP)、血管内膜中层厚度(IMT)等检测指标的变化。结果观察组患者血清总TC、LDL-C、TG、尿蛋白、hs-CRP降低,最大血管IMT显著降低[由(1.89±0.98)mm降至(1.75±0.87)mm,P<0.05]、eGFR增加[由(50.7±18.7)增至(53.3±20.1)ml·min~(-1)·1.73 m~(-2),P<0.05],对照组无明显变化(P>0.05)。观察组eGFR、尿蛋白改善均优于对照组(P<0.05)。结论瑞舒伐他汀不仅有显著的血脂调节作用,还能降低患者血管内膜中层厚度以及改善炎性反应的作用。     

白介素-1β诱导小型猪冠状动脉内膜增殖时Rho激酶表达与雷帕霉素干预的研究

目的通过小型猪模型观察白介素-1β(IL-1β)诱导冠状动脉内膜增殖时Rho激酶和p27mRNA表达的变化及雷帕霉素干预的作用,探讨Rho激酶表达对冠状动脉狭窄的作用及可能机制。方法通过开胸手术分离小型猪冠状动脉左前降支(LAD)及回旋支(LCX)近端,包裹IL-1β。2周后行冠状动脉造影,然后取标本做病理学检查,并用RT-PCR法测血管壁组织Rho激酶和p27mRNA表达。结果正常冠状动脉血管壁可见Rho激酶mRNA表达及较高水平的p27mRNA表达;用一定量IL-1β诱导冠状动脉内膜增殖,可迅速造成血管管腔狭窄。在此过程中Rho激酶mRNA表达增加3倍以上(30.80±4.10对128.20±15.89),而p27mRNA的表达则明显减弱。雷帕霉素抑制小型猪血管内膜增殖,减少炎细胞浸润,还能减少Rho激酶mRNA表达,并增强p27mRNA的表达。结论Rho激酶在炎症因子诱导的冠状动脉狭窄过程中表达明显增强,通过向下调节p27的活性调控血管内膜的增殖。雷帕霉素通过增强p27mRNA的表达,而减弱Rho激酶对p27的调节,这可能是雷帕霉素抑制血管内膜增殖的新机制。     

Increased mean carotid intima media thickness in type 2 diabetes mellitus patients with non-blood pressure component metabolic syndrome: A preliminary report

AIMS:

Patients with type-2 diabetes mellitus have greater carotid intima media thickness and they are at risk for generalized atherosclerosis. This study aimed to compare the thickness of carotid artery intima media in type-2 diabetes mellitus patients with and without nonblood pressure component metabolic syndrome.

SETTINGS AND DESIGN:

This was a comparative observational study conducted in the Departments of Pharmacology and Physiology in the College of Medicine, Al-Mustansiriyia University in cooperation with Baghdad Teaching Hospital.

MATERIALS AND METHODS:

Forty-six diabetic patients of both sexes with systolic blood pressure < 130 mm Hg and diastolic blood pressure < 85 mm Hg were subjected to high resolution B-mode ultrasonography of the common and internal carotid arteries. Patients were grouped into those without metabolic syndrome (Group I) and with nonblood pressure component metabolic syndrome (Group II).

STATISTICAL ANALYSIS:

The two-tailed unpaired Student''s t-test was used in this study.

RESULTS:

Significantly high mean thickness was observed in the common carotid intima media (0.824 ± 0.155 mm) but not in the internal carotid arteries in group II patients compared to group I patients (0.708 ± 0.113 mm). Group II also had a significant number of patients with increased lesion intima media thickness (≥ 1.1 mm).

Conclusion:

The greater carotid intima media thickness observed in type 2 diabetes mellitus patients is related to the metabolic syndrome even in the absence of the blood pressure component.     

负荷后1小时血糖与老年男性高血压患者颈动脉内中膜厚度的相关性

目的 探讨口服葡萄糖耐量试验(OGTT)1 h血糖(1 hPG)升高与老年男性原发性高血压患者动脉硬化的相关性.方法 将126例老年男性原发性高血压患者根据OGTT结果分为1hPG正常的正常糖耐量组、1 hPG升高组、糖耐量异常组和糖尿病组,比较不同组间各代谢指标及颈动脉内中膜厚度(IMT).结果 1 hPG升高组1 hPG(12.0±1.1)mmol/L与糖尿量异常组(11.1±1.8)mmol/l,相似,高于正常糖耐量组(9.1±1.4)mmol/L(P<0.01),低于糖尿病组(P<0.01);IMT值在4组内递增(P<0.05),1 hPG升高组IMT值为(1.02±0.12)mm;1 hPG为颈动脉IMT的独立相关因素(P<0.01).结论 男性高血压人群1 hPG升高较糖耐量异常更早出现,与动脉硬化相关.     

Does oxidized LDL contribute to atherosclerotic plaque formation and microvascular complications in patients with type 1 diabetes?

Objective

The aim of the study was to investigate whether changes in the level of oxidized LDL (oxLDL) over 2-years contribute to the development of subclinical macroangiopathy and/or microvascular complications in patients with DM1.

Design and methods

Basic clinical and biochemical parameters and oxLDL level were measured in 70 patients at baseline and after 2 years of the study. In addition, an ultrasonographic study was performed to assess the carotid intima media thickness (IMT).

Results

Patients did not differ according to basic clinical and biochemical parameters at the beginning and after 2 years of the study. IMT increased (p = 0.000001) whereas oxLDL level decreased (p = 0.00001) in DM1 patients during 2 years. Multivariate regression analysis showed that oxLDL independently influences IMT in DM1 patients (β = 0.454, R2 = 0.35). Further, positive correlations between oxLDL value and LDL-C concentration (r = 0.585, p < 0.05, n = 70) and between oxLDL level and apo-B concentration have been established (r = 0.610, p < 0.05, n = 70). Moreover, patients with chronic microvascular complications showed a higher value of IMT in comparison with patients without them (p = 0.003).

Conclusion

Our results provide the evidence that oxLDL accelerates atherosclerotic plaque formation and may contribute to the development of microvascular complications in DM1.     

Endothelial dysfunction and increased carotid intima-media thickness in the patients with slow coronary flow

Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 ± 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 ± 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.