黄连素对灌流心脏发生心衰的保护作用

目的　探讨黄连素对心脏衰竭的发生有无保护作用。方法　采用 L angendorff法灌流离体心脏 ,用维那帕米造成急性心衰 ;比较用黄连素和不用黄连素的心脏心衰程度的差异。结果　用黄连素 (10 - 6 mol/ L)灌流心脏后再用维那帕米致衰 ,此时心衰发生的程度明显轻于未用黄连素组 (P<0 .0 0 1)。结论　黄连素对心力衰竭的发生具有保护作用     

Evaluation of sE-Selectin and sICAM-1 as Parameters for Renal Function

Introduction. In order to monitor acute renal failure, intensive care patients were examined, and routine as well as specialized parameters were compared. Materials and Methods. Thirty-three patients at the Surgical Intensive Care Unit (ICU) were examined daily over the entire period for which they stayed in the ICU. The patients were retrospectively classified as being either with or without acute renal failure. Group 1 consisted of 22 patients who resided in the ICU for 11–15 (median 14) days without ARF. Group 2 consisted of 11 patients who developed an ARF during their stay of 13–18 (median 16) days in the ICU. In addition to the routine parameters of diuresis, serum creatinine/urea, and clearance of creatinine, specialized parameters for kidney function, including the excretion rates of α1-microglobulin, N-acetyl-β-D-glucosaminidase, and total protein, were compared with the excretion rate of soluble ICAM-1 and sE-Selectin. Results. Diuresis, serum creatinine, urea, and enzyme elimination were pathological among patients with ARF. Already on the day of admission, raised elimination rates of sICAM-1 were found in the urine of patients who had developed an ARF. While high values were still shown upon discharge, levels kept falling among patients without ARF. Clearly raised values were also shown for sE-Selectin compared to patients without ARF. Conclusions. sICAM-1 and sE-Selectin as supplementary parameters indicating renal function revealed early signs of kidney damage. These parameters may play a major role in the development of novel therapeutic approaches for ARF (antibodies against ICAM-1 or sE-Selectin).     

体外生物人工肝系统对暴发性肝衰竭兔的支持作用

目的探讨培养肝细胞用于生物人工肝及其作为肝移植辅助支持手段的可能性。方法以培养人肝细胞和中空纤维反应器为主要材料构成体外生物人工肝系统,对Ｄ-氨基半乳糖诱导的暴发性肝衰竭（ＦＨＦ）免进行人工肝支持实验。结果尽管两组实验动物的存活时间没有明显差异,但支持治疗组兔的血清转氨酶、总胆红素和肌酐水平均低于对照组,肝组织病理检查见肝细胞坏死程度明显轻于对照组,实验所用肝细胞保持较好的活力和贴壁能力。结论所用体外生物人工肝支持系统已发挥出培养肝细胞的生物作用,能够部分代偿ＦＨＦ兔的肝脏功能。【关键词】##4人工肝;;支持;;暴发性肝衰竭;;兔     

盐酸戊乙奎醚预先给药对脓毒症小鼠急性肺损伤时β-抑制蛋白-1表达的影响

目的 探讨盐酸戊乙奎醚预先给药对脓毒症小鼠急性肺损伤时β-抑制蛋白-1表达的影响.方法 健康雌性昆明小鼠30只,体重18～20 g,采用随机数字表法,将其分为3组(n=10):假手术组(S组)、脓毒症组(CLP组)和盐酸戊乙奎醚组(PHCD组).采用盲肠结扎穿孔法制备脓毒症模型.PHCD组于造模前1h腹腔注射盐酸戊乙奎醚0.45 mg/kg,S组和CLP组给予等容量生理盐水.造模后12 h,收集肺泡灌洗液(BALF),测定总蛋白浓度;取肺组织,行肺损伤评分,测定肺湿/干重(W/D)比和肌球蛋白轻链激酶(MLCK)、血管内皮钙黏蛋白(VE-cadherin)、β-抑制蛋白-1的表达.结果 与S组比较,CLP组和PHCD组肺损伤评分、肺W/D比和BALF总蛋白浓度、肺组织MLCK表达升高,VE-cadherin表达降低,CLP组β-抑制蛋白-1表达降低,PHCD组β-抑制蛋白-1表达升高(P＜ 0.05或0.01);与CLP组比较,PHCD组肺损伤评分、肺W/D比和BALF总蛋白浓度、肺组织MLCK表达降低,VE-cadherin和β-抑制蛋白-1表达升高(P＜0.05或0.01).结论 盐酸戊乙奎醚预先给药可通过上调β-抑制蛋白-1的表达,降低肺微血管通透性,从而减轻脓毒症小鼠急性肺损伤.     

应用分子吸附循环系统治疗急性肝功能衰竭的经验

目的 探讨急性肝功能衰竭患者等待肝移植期间应用分子吸附循环系统的治疗效果.方法 本组共有16例急性肝功能衰竭患者在等待肝移植期间接受了分子吸附循环系统治疗.结果 16例患者经治疗临床症状及体征明显改善:凝血酶原时间、总胆汁酸、丙氨酸转氨酶、天冬氨酸转氰酶、肌酐和血氨水平明显降低(P＜0.05);肿瘤坏死因子α、一氧化氮和白细胞介素10等细胞因子水平有所下降,但无统计学意义(P＞0.05);序贯性脏器衰竭评估的计分由9.91±1.09降至6.64±1.76,Glascow昏迷评分由7.29±2.06升至13.26±2.14.16例患者中14例成功过渡到肝移植治疗,13例痊愈出院.治疗成功率为81.25%.结论 分子吸附循环系统是治疗肝功能衰竭安全而有效的辅助方法,帮助急性肝功能衰竭患者顺利渡过肝移植等待期.     

Serum oxidized low-density lipoprotein is inversely correlated to telomerase activity in peripheral blood mononuclear cells of haemodialysis patients

BACKGROUND: Telomerase preserves telomeres' function and structure preventing cellular senescence. Its activity is reduced in peripheral blood mononuclear cells (PBMC) of haemodialysis (HD) patients. The purpose of this study is to investigate the potential correlation between increased oxidative stress/inflammation and telomerase activity in PBMC of HD patients. METHODS: Telomerase activity was measured by PCR-ELISA in PBMC isolated from a group of 42 HD patients and 39 subjects with estimated glomerular filtration rate >or=80 mL/min (control group). Serum oxidized low-density lipoprotein (ox-LDL), tumour necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) were also measured in both groups by ELISA. RESULTS: Ox-LDL was negatively correlated to percentage telomerase activity in PBMC (r = -0.506, P = 0.000 in the whole group of 81 HD and normal subjects and r = -0.559, P < 0.001 in HD patients). TNF was also inversely associated with percentage telomerase activity in the whole group studied (r = -0.492, P = 0.000) while IL-10 was not. In stepwise multiple linear regression, taking into consideration the most important characteristics of the HD patients and control group, the only significant predictors for percentage telomerase activity in PBMC were ox-LDL and TNF (beta = -0.421, t = -4.083, P = 0.000 and beta = -0.381, t = -3.691, P = 0.000, respectively) while examining separately HD patients, the predictors for the same parameter were ox-LDL and HD duration (beta = -0.671, t = -4.709, P = 0.000 and beta = -0.349, t = -2.447, P = 0.023, respectively). CONCLUSION: Ox-LDL serum level is inversely correlated to telomerase activity in PBMC of HD patients. Our study proposes a new consequence of increased oxidative stress in HD patients: the premature cellular senescence potentially related to atherosclerosis through LDL oxidation.     

甲状腺激素治疗老年充血性心力衰竭的临床观察

目的:观察老年充血性心力衰竭(CHF)患者甲状腺激素水平及甲状腺激素治疗的效果.方法:将86例老年CHF患者随机分为两组,在常规治疗的基础上,治疗组加用甲状腺片10～20 mg/d,2周为一疗程.结果:治疗组治疗后三碘甲状腺原氨酸(T3)明显上升(P＜0.05);治疗组总有效率高于对照组(χ2=9.53,P＜0.01);心功能显著改善相关,心功能Ⅳ级患者改善更明显(P＜0.05).结论:CHF患者大多数体内甲状腺激素水平降低,适当地补充甲状腺激素对老年 CHF治疗有益.     

利奈唑胺治疗慢性肾功能衰竭伴重症肺部感染二例

病例1 患者女,67岁,因＂反复气喘4年,加重3周＂于2008年10月24日入院.患者2004年无明显诱因出现反复气喘,当时步行上3楼感气短,夜间可平卧,伴心悸、乏力,经治疗后好转,平时未规则服用药物.     

Metabolic Risk Factors Are Associated with the Disease Severity and Prognosis of Hepatitis B Virus-Related Acute on Chronic Liver Failure

Background/AimsMetabolic risk factors could accelerate hepatitis B virus (HBV)-related mortality; however, their impacts on disease severity in HBV-related acute on chronic liver failure (HBV-ACLF) patients remain unexplored. In this study, we assessed the effects of metabolic risk factors on the outcome of HBV-ACLF patients.MethodsThis study retrospectively enrolled antiviral therapy naïve HBV-ACLF patients from a single center in China. Patients were evaluated according to Child-Turcotte-Pugh score, Model for End-Stage Liver Disease (MELD) score, 30-day, 90-day mortality and survival rate to estimate the prognosis of HBV-ACLF. The impacts of different metabolic risk factors were further analyzed.ResultsA total of 233 patients, including 158 (67.8%) with metabolic risk factors and 75 (32.2%) without metabolic risk factors, were finally analyzed. Patients with metabolic risk factors had significantly higher MELD score (22.6±6.1 vs 19.8±3.8, p<0.001), 90-day mortality rate (56.3% vs 38.7%, p=0.017), and shorter median survival time (58 days vs 75 days hazard ratio, 1.553; 95% confidence interval, 1.061 to 2.274; p=0.036) than patients without them. Moreover, metabolic risk factors were independently associated with patients’ 90-day mortality (hazard ratio, 1.621; 95% confidence interval, 1.016 to 2.585; p=0.043). Prediabetes/diabetes and hypertension were related to higher rates of infection and worse renal function in HBV-ACLF patients.ConclusionsHBV-ACLF patients with metabolic risk factors, especially prediabetes/diabetes or hypertension, could have more severe disease and lower survival rates. In addition, the existence of metabolic disorder is an independent risk factor for HBV-ACLF patients’ 90-day mortality.     

乌司他丁对原位肝移植时的急性肺损伤的保护作用

目的探讨乌司他丁对原位肝移植时的急性肺损伤（ALI）的保护作用。方法将20例肝移植患者随机分为2组：（1）乌司他丁组（n=10）于皮肤切开后静脉持续滴注乌司他丁30×10^4IU,以后每隔4h重复使用;（2）对照组（n=10）于相应时间滴注等体积生理盐水。所有患者均在非静脉转流下行经典原位肝移植术,分别于麻醉后手术开始前（T41）、无肝前期120min（T1）、无肝期30min（T2）、新肝期5min（T3）、新肝期60min（T4）和手术完毕（T5）时抽取静脉血,应用放射免疫分析法测定血浆白细胞介素6（IL-6）、白细胞介素8（IL-8）及肿瘤坏死因子α（TNF-α）的浓度,应用硫代巴比妥酸比色法测定血浆丙二醛（MDA）浓度,应用黄嘌呤氧化酶法测定超氧化物歧化酶（SOD）活性。除T1外,其余时间点取动脉血作血气分析,计算呼吸指数（RI）。结果对照组T3、T4、T5时的RI值均较R时升高（P〈0．01）,乌司他丁组仅T3时的RI值高于T0时（P〈0．05）。乌司他丁组T4、T5时的RI值明显低于对照组（P〈0．05）。两组T2、T3、T4、T5时的IL-6和IL-8浓度均较T0时升高（P〈0．01,P〈0．05）,但乌司他丁组的升高幅度明显低于对照组（P〈0．01,P〈0．05）;两组T1、T2、T3、T4、T5时的TNF-α浓度均较T0时升高（P〈0．01,P〈0．05）,但乌司他丁组T3、T4、T5时的TNF-α浓度明显低于对照组（P〈0．01,P〈0．05）;两组T3、T4、T5时的MDA浓度均较T0时升高（P〈0．01,P〈0．05）,但乌司他丁组的升高幅度明显低于对照组（P〈0．01,P〈0．05）。对照组T3、T4、T5时的SOD活性均较T0时下降（P〈0．01）;乌司他丁组仅T3时的SOD活性低于T0时（P〈0．05）,而T3、T4、T5时的SOD活性明显高于对照组（P〈0．05）。结论乌司他丁可减轻肝移植所致的炎症反应,减少氧自由基的产生,从而减轻ALI。