ATP敏感性钾通道(KATP)开放剂对脑缺血/再灌注大鼠谷氨酸受体1a和谷氨酸转运体1的影响

目的 研究ATP敏感性钾通道(KATP)开放剂克罗卡林对大鼠脑缺血/再灌注后脑梗死体积、代谢型谷氨酸受体1α(mGluRlα)和谷氨酸转运体1(GLT-1或者EAAT-2)的影响.方法 雄性Wistar大鼠按序号随机分为假手术组(A组)、缺血/再灌注脑缺血对照组(middle cerebral artery occlusion MCAOB,B组)、MCAO+ATP敏感性钾通道(KATP)开放剂克罗卡林组(C组).应用线栓法建立大鼠大脑中动脉闭塞再灌注(middle cerebral artery occlusion,MCAO)模型,大鼠脑缺血/再灌注24 h后,Bederson法评价动物的神经行为功能,氯化三苯基四氮唑(TTC)染色观察脑梗死体积,免疫组化测定谷氨酸受体1α(mGluR1α)和GLT-1.结果 脑缺血/再灌注24 h后,动物均表现神经行为功能障碍,大鼠神经行为功能评分C组(2.23±0.11)较B组(2.61±0.19)明显改善,差异有统计学意义(P＜0.05);缺血侧出现脑梗塞病灶,脑梗死体积C组(138.3±29.9)较B组(182.5±34.5)显著减小,差异具有统计学意义(P＜0.05);B组mGluR1α吸光度(0.293±0.009)与A组mGluR1α吸光度(0.183±0.008)相比,吸光度明显增加,差异有统计学意义(P＜0.05)、B组GLT-吸光度(0.147±0.009)与A组GLT-吸光度(0.255±0.009)相比,吸光度明显减少,差异有统计学意义(P＜0.05);C组mGluR1α吸光度(0.227±0.009)与B组mGluR1α吸光度(0.293±0.009)相比,其吸光度明显减小,差异有统计学意义(P＜0.05)、C组GLT-1吸光度(0.212±0.008)与B组GLT-1吸光度(0.147±0.009)相比明显增大,差异有统计学意义(P＜0.05).结论 预防性应用克罗卡林可能通过减少mGluR1α表达,增强GLT-1表达,减少谷氨酸堆积,减小脑梗死体积,从而减轻脑组织缺血/再灌注损伤.     

Axillofemoral Bypass Graft in a Spinal Cord Injured Patient with Impending Gangrene

ABSTRACT

The axillofemoral bypass graft, an extra-anatomic graft, connects the axillary artery to the femoral artery and is used in the treatment of significant aortoiliac occlusive disease in poor-risk patients. A common indication for axillofemoral bypass is a “hostile abdomen” (postoperative adhesions, neoplasms or radiation). Less frequent indications are aortic mycotic aneurysm, infected aortobifemoral bypass graft, aortoduodenal fistula, inflammatory aneurysm and extensive retroperitoneal fibrosis.

Spinal cord injured patients with peripheral arterial disease have two problems: 1) lack of premonitory symptoms (absence of claudication, paresthesias or rest pain) and 2) difficulty preventing pressure sores in the already poorly perfused limb. Indications for arterial reconstructive surgery are more drastic in this set of patients (impending gangrene and/or ischemic ulcers). Many spinal cord injured patients have sources of possible contamination (cystostomy and/or colostomy) which make intra-abdominal clean surgery impossible.

We present a spinal cord injured patient with a permanent cystostomy and impending gangrene of the left foot. He underwent a left axillofemoral bypass graft and had a good postoperative course.

We conclude that axillofemoral bypass graft is a good alternative for limb salvage in the spinal cord injured patient, especially when there is a source of possible contamination (colostomy and/or cystostomy) that would interfere with more common bypass grafting. The role of the noninvasive vascular laboratory for early detection of vascular disease is emphasized. (J Am Paraplegia Soc: 17; 171–176)     

Ischemic preconditioning attenuates the lipid peroxidation and remote lung injury in the rat model of unilateral lower limb ischemia reperfusion

BACKGROUND: Ischemia and reperfusion of the skeletal muscle tissue may cause remote lung injury. We aimed to evaluate the protective effect of ischemic preconditioning (IP) on the lung during unilateral lower limb ischemia reperfusion (IR). METHODS: Four groups of rats were used in this study: (i) the sham group (sham, n = 6) served as time controls, they remained anesthetized for the whole duration of the study; (ii) the ischemia and reperfusion group (IR, n = 10) underwent 4 h of left lower limb ischemia followed by 2 h of reperfusion; (iii) the ischemic preconditioning group (IP, n = 10), the left lower limbs of rats were exposed to three cycles of IP (10 min of ischemia followed by 10 min of reperfusion); and (iv) the ischemic preconditioning plus ischemia reperfusion group (IP/IR, n = 10) underwent IP followed by IR as in the IP and IR groups. Plasma and tissue samples were taken at the end of the study period for determination of lung tissue myeloperoxidase activity (MPO) and polymorphonuclear leukocyte count (PMNL), histological lung injury score and plasma thiobarbituric acid reactive substances (TBARS) level. RESULTS: PMNL count and MPO activity in the lung tissue, and plasma TBARS level were higher in the IR group compared with other groups while there were no differences between the sham and the IP and between the sham and the IP/IR groups. Histological lung injury score was higher in the IR group than in the IP/IR and sham groups. The plasma TBARS level in the IP group was significantly lower than in the IP/IR group. CONCLUSION: IP pretreatment reduces lipid peroxidation and lung injury caused by lower limb IR.     

阿托伐他汀联合阿司匹林治疗短暂性脑缺血发作的有效性与安全性

目的：探讨短暂性脑缺血发作(TIA）应用阿托伐他汀(Ato）联合阿司匹林治疗的有效性与安全性。方法整群选取该院2015年1月一2016年1月收治的86例TIA患者,按随机数字表法均分为两组。对照组43例,给予常规综合治疗;观察组43例,在此基础上联合Ato治疗。记录比较两组治疗结束后临床疗效,治疗前后血清甘油三酯(TG）、低密度脂蛋白(LDL）及总胆固醇(TG）水平,治疗期间不良反应。结果观察组总有效率为93.02%较对照组的76.74%明显更高(P<0.05）;治疗后观察组血清TG、LDL及TC水平分别为(1.92±0.57）、(3.49±0.52）、(5.12±0.62）mmol/L,对照组依次为(2.58±0.61）、(4.25±0.57）、(5.47±0.59）mmol/L,均明显低于本组治疗前(P<0.05）,且观察组较对照组改善程度更为明显(P<0.05）;两组不良反应比较,差异无统计学意义(P>0.05）。结论TIA应用Ato联合阿司匹林治疗更能有效改善血脂水平,疗效显著且安全可靠,具有较高临床指导意义。     

依达拉奉合用奥扎格雷钠治疗进展性缺血性脑卒中的疗效分析

目的：研究依达拉奉合用奥扎格雷钠治疗进展性缺血性脑卒中的疗效。方法试验对象：方便选取该院2014年2月—2016年2月收治的200例进展性缺血性脑卒中患者。患者分组方法：随机数字表法。200例患者分为A组和B组两个组别。A组用奥扎格雷钠治疗;B组给予依达拉奉合用奥扎格雷钠治疗。观察指标：①总有效率;②治疗前和治疗后患者NIHSS评分、Barthel指数的差异。结果①B组相比于A组总有效率更高,A组为72.00%,B组90.00%,χ2检验差异有统计学意义,P﹤0.05。②治疗前两组NIHSS评分、Barthel指数相似,B组分别（23.37±5.72)分和（18.95±2.92)分,A组分别（23.95±5.16)分和（18.75±2.91)分,t检验统计学差异无统计学意义,P>0.05;治疗后B组相比于A组NIHSS评分、Barthel指数改善更显著,B组分别（6.18±4.71)分和（78.22±3.59)分,A组分别（13.43±4.29)分和（57.11±3.94)分,t检验差异有统计学意义,P﹤0.05。结论依达拉奉合用奥扎格雷钠治疗进展性缺血性脑卒中的疗效确切,可有效改善患者神经功能和日常生活能力,值得推广。     

红细胞膜磷脂水平与急性缺血性卒中的关系

目的：该文采用高效液相色谱技术,对急性缺血性卒中患者红细胞膜磷脂含量分析,探讨红细胞膜磷脂水平在急性缺血性卒中发生、发展中的作用机制。方法采用流行病学横断面调查方法,自2015年7＿10月筛选病例组人群22例,健康对照组人群24名,分离红细胞膜,用HPLC,XBP-Silica柱分离,测定两组人群红细胞膜磷脂含量,数据采用SPSS 20.0统计学软件分析。结果5种磷脂中脂酰胆碱(PC﹚、磷脂酰乙醇胺(PE﹚、磷脂酰丝氨酸(PS﹚3种磷脂病例组含量(0.3796±0.1387﹚、(0.4498±0.1786﹚、(0.3301±0.0327﹚与对照组(0.4897±0.0154﹚、(0.5523±0.0107﹚、(0.6351±0.0599﹚数值差异有统计学意义(P<0.05﹚,磷脂酰肌醇(PI﹚和神经鞘磷脂(SM﹚差异无统计学意义(P>0.05﹚。结论红细胞膜磷脂水平参与影响了急性缺血性卒中的发生发展过程,可能是急性缺血性卒中发生发展的一个诱导机制。     

解毒化瘀方对凝血酶合并缺氧诱导PC12细胞损伤ERK1/2信号通路表达的影响

目的：探讨急性缺血性中风（AIS）瘀毒病机的分子机制及解毒化瘀方对凝血酶合并缺氧损伤的保护作用。方法（1）用凝血酶合并缺氧损伤PC12细胞,模拟急性缺血性中风的体外细胞模型。（2）将细胞分为空白组,模型组,解毒化瘀方含药血浆组和PD98059组（MEK抑制剂组）,应用荧光定量实时RT-PCR方法检测MEK1、PAR-1及ERK1/2的mRNA表达,应用免疫荧光法检测ERK1/2、P-ERK1/2的蛋白表达。结果 PCR结果提示：模型组MEK1、PAR-1及ERK1/2的mRNA表达与空白对照组相比显著升高（P<0.01）,解毒化瘀方组和PD98059组MEK1、PAR-1及ERK1/2的mRNA表达较模型组显著降低（P<0.01）,免疫荧光结果提示：解毒化瘀方组和PD98059组ERK1/2、P-ERK1/2的蛋白表达较模型组显著降低（P<0.01）。结论解毒化瘀方以凝血酶为作用的分子靶点,能够显著降低ERK1/2信号通路在缺血性中风体外细胞模型中的表达。     

急性缺血性脑卒中患者尿微量清蛋白与尿肌酐比值对近期神经功能恢复的影响

目的:检测急性缺血性脑卒中患者尿微量清蛋白与尿肌酐比值(albumin and urinary creatinine ratio,ACR),分析其对患者近期神经功能恢复的影响,为患者的临床治疗及预后的评估提供依据。方法:选择本院2014年1月至2015年4月急性缺血性脑卒中患者69例(观察组),其中NIHSS≥10分者31例,NIHSS评分<10分者38例;正常体检人群69例(对照组)。检测实验组和对照组中不同NIHSS评分患者尿液ACR值。结果:对照组ACR值为(1.60±0.62)mg/mmol,低于观察组(5.81±0.74)mg/mmol,差异具有统计学意义(P<0.05)。NIHSS评分≥10分患者的ACR值为(5.72±0.73)mg/mmol,高于NIHSS评分<10分的患者(4.19±0.50)mg/mmol,随着治疗时间的延长,实验组和对照组患者ACR值均呈下降趋势。ACR≥3 mg/mmol患者的NIHSS评分为(12.46±0.68)分,高于ACR<3 mg/mmol的患者NIHSS评分为(9.37±0.82)分,随着治疗时间的延长,实验组和对照组患者NIHSS评分均呈下降趋势。结论:急性缺血性脑卒中患者ACR值显著升高,ACR可作为急性缺血性卒中神经功能恢复的指标之一。     

缺血性中风病证候生物样本库标准化建设与管理

标准化生物样本库是实现科研成果快速转化并应用到临床实践的桥梁,是实现转化医学的保证。建设标准化缺血性中风病证候生物样本库十分必要;缺血性中风病证候生物样本库的标准化建设将为中医药领域建设中医特色性生物样本库提供参考经验,并推进中医药领域生物样本库的建设进程。     

C 反应蛋白与缺血性卒中 NIHSS 评分相关性研究

目的：探讨缺血性脑卒中患者C反应蛋白与患者入院及发病3周时NIHSS评分的关系,为患者的病情评估与预后评估提供参考证据。方法收集脑梗死住院患者为研究对象。采用调查问卷的方法,收集研究对象的基本研究信息,入院24 h内完成超敏C反应蛋白的检测,并记录患者入院时及发病3周时的NIHSS评分。结果入院时,重症组患者的C反应蛋白水平要高于轻型组患者[（5.59±3.72）vs（4.30±2.34）];入院3周时,神经系统预后不良组的C反应蛋白水平也比预后良好组的浓度高[（7.20±4.01） vs（2.97±1.65）],差异均具有统计学意义。多元logistic回归结果显示,C反应蛋白水平升高,患者发生重型卒中的风险升高1.56倍,95％ C I为1.13～2.18;C反应蛋白水平升高,脑卒中患者预后不良的风险升高2.01倍,95％ C I为1.89～3.66。结论急性期脑梗死患者入院时的超敏C反应蛋白的水平与神经功能缺损严重程度相关,可能是患者出院时神经功能预后评估的相关预测指标。