骨化三醇对单侧输尿管梗阻大鼠肾小管上皮细胞转分化影响的研究

目的观察幼年大鼠单侧输尿管梗阻(UUO)肾组织中α-肌动蛋白(α-SMA)、E-钙黏蛋白(E-Cad)、转化生长因子-β1(TGF-β1)、骨形态发生蛋白-7(BMP-7)mRNA的表达,探讨骨化三醇对肾小管上皮细胞转分化(EMT)干预效应及机制。方法 54只雄性SD大鼠随机分为3组:假手术组(A组)、UUO模型组(B组)及UUO模型干预组(C组)各18只,灌胃满3、7、14d取肾。实时荧光定量聚合酶链反应(RT-PCR)法检测各组α-SMA、E-Cad、TGF-β1、BMP-7mRNA表达水平。结果与A组相比,B组E-Cad、BMP-7mRNA表达明显下降(P<0.01),α-SMA、TGF-β1mRNA表达显著增高(P<0.01);C组与B组相比,E-Cad、BMP-7mRNA表达明显上调(P<0.01),α-SMA、TGF-β1mRNA表达明显下降(P<0.01)。结论骨化三醇对UUO模型大鼠肾小管上皮细胞转分化有抑制作用,这种抑制作用可能与下调TGF-β的表达及上调BMP-7的表达有关。     

探析从风论治结缔组织病相关间质性肺疾病

[目的]探析从风论治结缔组织病相关间质性肺疾病(connective tissue disease-associated interstitial lung disease,CTD-ILD)的辨证思路,以期提高临床疗效.[方法]基于风邪致病特点"风为百病之长,善行数变,有内外之分",结合古籍文献及现有文献资料,考究风邪...     

Exacerbation of Secondary Pulmonary Hypertension by Flat Chest after Lung Transplantation

A 40-year-old woman with idiopathic pleuroparenchymal fibroelastosis (IPPFE) and flat chest underwent left single lung transplantation (SLT). Although she had developed over-systemic pulmonary arterial pressure (PAP) at transplantation, it was alleviated. However, her PAP gradually increased again. Her transplanted lung was well-inflated, but progression of fibrosis in her right native lung appeared to have caused a mediastinal shift, and her flat chest caused obstruction of the outflow tract of the pulmonary vein. She died of heart failure and associated infection 1.5 years after transplantation. An autopsy confirmed irreversible pulmonary arterial and venous changes in the transplanted lung, suggestive of chronic pressure overload. The flat chest associated with IPPFE can affect pulmonary circulation after SLT.     

肾性高血压大鼠胰岛素抵抗与肾间质纤维化相关研究

目的 从肾素.血管紧张素系统(RAS)角度初步探讨胰岛素抵抗(IR)对肾性高血压大鼠肾间质纤维化的影响.方法 SD大鼠行"两肾一夹"手术后随机分为蔗糖喂养组和对照组,蔗糖喂养组蔗糖喂养,对照组正常饲养,18周后处理.于处理前1日测定24 h尿蛋白定量;处理日测定2组血浆空腹血糖、胰岛素、胰岛素敏感指数、肾素、血管紧张素Ⅱ、醛固酮、尿素氮和肌酐水平.结果 与时照组相比,蔗糖喂养组空腹胰岛素水平明显增高(P<0.01),胰岛素敏感指数水平明显降低(P<0.01),血浆肾素、血管紧张素Ⅱ、醛固酮、尿素氮和肌酐水平及24 h尿蛋白定量均明显高于对照组(P<0.01).相关分析显示,24 h尿蛋白定量与血浆空腹胰岛素、胰岛素敏感指数、醛固酮及尿素氮水平呈明显相关.结论 IR状态能够加速肾性高血压大鼠肾间质纤维化的损害,除与血压升高、胰岛素的直接促增殖作用有关外,还可能与HIS引起的肾组织局部RAS的激活有关.     

PET/CT显像在肺间质纤维化中的应用进展

肺间质纤维化(PIF)是一组病因各异, 病理过程相似, 主要累及肺间质、肺泡和细支气管的弥漫性疾病。由于该病病因多、机制复杂、治疗难, 其已成为研究热点。近年来, PET/CT不仅广泛应用于肿瘤、心血管疾病及神经性疾病等方面, 在PIF的早期诊断、活动判断、疗效监测和预后评价等方面也表现出独特的优势。笔者对国内外PET/CT在PIF的研究现状作一综述。     

高龄亲属活体供肾在青年受体内病理学改变的长期研究

目的  通过长期病理随访探讨青年受体接受高龄亲属活体供肾肾移植的安全性。方法  根据供体年龄不同,将28例青年受体分为观察组（14例,高龄供体）和对照组（14例,中青年供体）。分别比较两组移植肾术后7年的存活情况及术后各时间点的血清肌酐（Scr）水平;比较两组在零时、术后6个月、术后7年移植肾活组织检查（活检）的慢性病理损伤评分;比较两组受体术后6个月、术后7年移植肾间质纤维化相关指标结缔组织生长因子（CTGF）、转化生长因子（TGF）-β、层黏连蛋白（LN）、纤维连接蛋白（FN）及细胞衰老相关指标细胞间连接蛋白（Cx）43及哺乳动物雷帕霉素靶蛋白（mTOR）的表达量。结果  观察组和对照组移植肾术后7年存活率分别为78.5%和92.8%,差异无统计学意义（P > 0.05）。观察组、对照组术后7 d Scr水平分别为190、160 μmol/L,术后1个月Scr水平分别为170、125 μmol/L,观察组术后各时间点的Scr水平均高于对照组,差异均有统计学意义（均为P > 0.05）。观察组移植肾组织零时活检的慢性病理损伤总评分明显高于对照组（P > 0.05）,但两组术后7年的慢性病理损伤总评分无明显差异（P > 0.05）。观察组和对照组组内各时间点比较,术后7年活检的慢性病理损伤总评分均高于零时活检及术后6个月活检的慢性病理损伤总评分（均为P > 0.05）。两组术后7年移植肾组织中CTGF、TGF-β、LN、FN、mTOR、Cx43表达量的比较差异均无统计学意义（均为P > 0.05）。结论  长期随访结果显示青年受体接受高龄供肾与接受中青年供肾的病理学改变相似,从病理学角度考虑青年受体接受高龄供肾是安全可行的。     

Fulminant Respiratory Failure Caused by Anti-asparaginyl tRNA Synthetase (Anti-KS) Antibody Syndrome-related Interstitial Lung Disease

Anti-asparaginyl transfer RNA (tRNA) synthetase (KS) antibodies, detected in <5% patients with anti-aminoacyl-tRNA synthetase antibody syndrome, are strongly associated with interstitial pneumonia but not myositis and skin symptoms. A recent report suggested that most patients with interstitial pneumonia and anti-KS antibody (KS-ILD) may present with chronic disease. We herein report a rare case of severe acute respiratory failure in a KS-ILD patient requiring extracorporeal membrane oxygenation (ECMO). ECMO is useful for facilitating not only lung rest until recovery but also the definitive diagnosis and treatment of ILD. KS-ILD can develop acutely with fulminant respiratory failure, as observed in this case.     

Intravenous immunoglobulin for acute exacerbation of fibrotic idiopathic interstitial pneumonias

Background and aim:Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is a fatal condition with no established treatment. Intravenous immunoglobulin (IVIG) is a unique therapy with both anti-inflammatory and anti-infective effects. Therefore, we hypothesized that IVIG may have a positive effect on AE of interstitial pneumonia. This study aimed to determine the effect of IVIG in patients with AE of fibrotic idiopathic interstitial pneumonias (IIPs), including IPF.Methods:We retrospectively analyzed consecutive patients who were diagnosed with AE of fibrotic IIPs and treated with pulse corticosteroid therapy (methylprednisolone 500–1000 mg/day for 3 days) between April 2018 and May 2021 at Kagawa Rosai Hospital and KKR Takamatsu Hospital.Results:This study included 52 patients with AE of fibrotic IIPs (IPF,41; fibrotic IIPs other than IPF,11). Thirteen patients received IVIG (5 g/day for 3–5 days) concurrently with pulse corticosteroid therapy. The remaining 39 patients were assigned to the control group. The survival rate on day 90 was significantly higher in the IVIG group than that in the control group (76.9% vs. 38.5%, p = 0.02). IVIG administration (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.02–0.69; p = 0.02) and C- reactive protein (OR, 1.19; 95% CI, 1.06–1.33, p < 0.01) were independently associated with 90-day mortality.Conclusions:The results indicate that administration of IVIG may improve the survival of patients with AE of fibrotic IIPs. We are now conducting a prospective study to confirm the effect of IVIG on AE of IPF since May 2022 (jRCT1061220010).     

温阳活血方对大鼠肾间质TIMP-1、MMP-3、FN的影响

目的观察温阳活血方对实验大鼠肾间质纤维化的保护作用并探讨其作用机理.方法实验采用单侧输尿管梗阻(UUO)大鼠模型,将其随机分为温阳活血组、福辛普利组、模型组,并设假手术组.观察梗阻侧肾脏组织形态学改变,免疫组化半定量分析各组的基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶抑制剂-1(TIMP-1)、纤维连接蛋白(FN)的表达水平并与假手术组比较.结果模型组及各治疗组与假手术组相比均呈不同程度的病理损害.模型组的MMP-3、TIMP-1、FN表达水平均高于假手术组(P＜0.05),且TIMP-1的表达明显高于MMP-3的表达.两个治疗组与模型组相比,MMP-3的表达水平高于模型组(P＜0.05);但TIMP-1、FN的表达水平低于模型组(P＜0.05);MMP-3、TIMP-1、FN在两个治疗组间的表达差异均无统计学意义(P＞0.05).结论温阳活血方可能通过抑制TIMP-1的表达,恢复MMP-3表达,以此来调节MMP-3/TIMP-1的比例,从而保护肾小管功能,减轻间质纤维化的进展.     

载抗生素骨科内植入物的研究进展

临床上骨科内固定手术后,由于感染或者感染后形成的高抗药性生物膜,在全身应用大剂量抗生素的情况下,病灶局部组织仍难达到有效的抗生素浓度,使感染久治难愈,导致内固定失败,为了减少术后感染的发生,可以使用载抗生素内植入物来进行治疗,或者在感染后经过清创后再次使用载抗生素内植入物进行治疗.本文对载抗生素内植入物的研究进展作一综述.