阿托伐他汀钙对动脉粥样硬化患者血浆hs-CRP、NO水平的影响

目的 研究阿托伐他汀钙对动脉粥样硬化(AS)患者血浆高敏C-反应蛋白(hs-CRP)和一氧化氮(NO)的影响.方法 选择40例正常人作为对照组,40例动脉粥样硬化患者作为试验组,对动脉粥样硬化患者给予阿托伐他汀钙1个月干预治疗,测定治疗前后hs-CRP和NO水平,并与正常对照组比较.结果 动脉粥样硬化组治疗前血浆hs-CRP明显(P＜0.01)高于正常对照组,NO明显(P＜0.01)低于正常对照组;给予阿托伐他汀钙治疗后血浆hs-CRP降低(P＜0.05);血浆NO升高(P＜0.05).结论 阿托伐他汀钙对动脉粥样硬化患者具有独立于降脂作用之外的抗炎作用.     

RP-HPLC法测定氨酚双氢可待因片中对乙酰氨基酚、酒石酸双氢可待因的含量

目的建立高效液相色谱法测定氨酚双氢可待因片中对乙酰氨基酚、酒石酸双氢可待因两组分的含量。方法采用双波长测定上述两种成分,采用Hypersil C185μ(4.6mm×250mm)(大连依利特公司)色谱柱;乙腈-磷酸盐缓冲液(1%磷酸二氢铵和0.01mol.L-1辛烷磺酸钠溶液,用磷酸调pH3.0)(15∶85)为流动相;检测波长为280nm(对乙酰氨基酚);209nm(酒石酸双氢可待因)。结果线性范围分别为对乙酰氨基酚40.192μg.mL-1~401.92μg.mL-1(r=0.9999)、酒石酸双氢可待因0.8359μg.mL-1~8.3592μg.mL-1;平均回收率分别为对乙酸氨基酚100.1%(RSD=0.65%);酒石酸双氢可待因99.4%(RSD=0.33%)。结论本方法精密度好,结果准确可靠,适用于该复方制剂的质量控制。     

HPLC法测定芩连片中芍药苷的含量

目的建立HPLC法对芩连片中芍药苷的含量进行测定。方法色谱柱为Hypersil C18(4.6mm×250mm,5μm),流动相为甲醇∶水(22∶78),流速为1.0mL.min-1,检测波长为230nm。结果此法线性范围为0.0482~2.408μg(r=0.9999),平均回收率为97.85,RSD=0.82%(n=6)。结论该方法简便、快速,重现性好,可用于芩连片的质量控制。     

阿托伐他汀钙预治疗在急性冠状动脉综合征患者PCI术中的应用价值

目的探讨阿托伐他汀钙预治疗在急性冠状动脉综合征(ACS)患者皮冠状动脉介入术(PCI)中的应用价值。方法随机选取拟行PCI术ACS患者80例,随机分为治疗组(n=40)与对照组(n=40)。其中对照组患者为首次进行PCI治疗且术前未应用他汀类药物,治疗组患者在术前连续口服阿托伐他汀钙片3个月以上,对两组患者术前、术后12h、24h心肌损伤标记物的变化以及炎性反应进行监测,同时观察患者术后20min靶血管前向血流的TIMI血流分级情况,两组患者术后均随访1个月记录心血管事件的发生情况。结果与对照组比较,治疗组血清总胆固醇、甘油三酯水平明显低于对照组,差异有统计学意义(均P0.05)。与对照组比较,治疗组PCI术前、术后12h及24h的超敏C反应蛋白、白细胞介素-6、肌酸激酶同工酶、心肌肌钙蛋白均低于对照组(均P0.05)。治疗组PCI术前及术后的TMPG及TIMI血流分级均优于对照组(P0.05)。治疗组术中无复流现象的发生率明显低于对照组(P0.05)。治疗组术后1个月内心血管事件发生率明显低于对照组(P0.05)。结论阿托伐他汀钙预治疗在ACS患者PCI术中的应用不仅可以减轻患者心肌的损伤,降低炎性反应,还能在一定程度上改善患者术后血流灌注并降低近期心血管事件的发生率。     

Thoracic Aortic Calcification: Diagnostic,Prognostic, and Management Considerations

Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.     

化疗方案加芩部丹片治疗复治涂阳肺结核患者的临床价值

目的 观察化疗方案加芩部丹片对复治肺结核患者改善临床症状及生存质量的影响。方法 收集上海中医药大学附属龙华医院于2011年4月至2013年3月牵头开展的芩部丹治疗复治肺结核多中心、随机、双盲、安慰剂对照临床试验(临床试验注册号:NCT02313610)的复治结核病患者,共181例,采用随机数字表法分为观察组(2H-R-Z-E-S/6H-R-E+芩部丹片,93例)和对照组(2H-R-Z-E-S/6H-R-E+安慰剂,88例)。观察治疗前及治疗后中医证候积分(包括咳嗽、咳痰、胸痛、潮热、颧红、盗汗、口渴、咽干共8个临床症状积分)和SF-36评分(包括生理机能、生理职能、躯体疼痛、精力、社会功能、情感职能、精神健康、一般健康状况、健康变化共9个维度的评分)的差异。结果 治疗结束时,观察组改善中医证候的有效率为91.4%(85/93),明显高于对照组的78.4%(69/88),差异有统计学意义(χ ²=6.010,P=0.012)。治疗结束时,观察组的潮热、颧红、盗汗、咳痰、口渴、咽干6项症状积分改善的有效率分别为83.9%(78/93)、71.0%(66/93)、86.0%(80/93)、84.9%(79/93)、80.6%(75/93)、87.1%(81/93),均高于对照组[68.2%(60/88)、53.4%(47/88)、73.9%(65/88)、70.5%(62/88)、54.5%(48/88)、65.9%(58/88)],差异均有统计学意义(χ ²=6.415,P=0.013;χ ²=5.943,P=0.015;χ ²=4.195,P=0.041;χ ²=5.516,P=0.019;χ ²=14.144,P<0.001;χ ²=11.391,P=0.001)。治疗结束时,观察组的健康变化、生理机能、精力、一般健康状况的4项SF-36评分的平均秩次分别为98.58、99.03、102.27、100.47,均高于对照组的平均秩次(82.99、82.51、78.69、82.99),差异有统计学意义(U=3387.000,P=0.027; U=3345.000,P=0.028; U=3009.000,P=0.002; U=3211.000,P=0.012)。结论 芩部丹片有助于改善复治肺结核患者的临床症状、提高生存质量。     

急性冠脉综合征患者血清D-二聚体及同型半胱胺酸水平的变化

目的 通过观察瑞舒伐他汀治疗急性冠脉综合征(ACS)患者血清D-二聚体(D-D)及同型半胱胺酸(Hcy)水平变化,探讨瑞舒伐他汀对凝血和纤溶的影响,以及检测血清D-D和Hcy的临床价值.方法 选择临床确诊的ACS患者85例,在常规治疗(溶栓、阿司匹林、氯吡格雷、低分子肝素、血管紧张素转换酶抑制剂、β2-受体阻滞剂等治疗,不予任何调脂药物)基础上采用瑞舒伐他汀治疗2周,观察血清D-D(检测采用ELISA法)和Hcy(检测采用EIA法)水平变化.结果 ACS患者存在血清D-D和Hcy水平异常升高,显著高于对照组(P＜0.01);瑞舒伐他汀治疗2周后,血清D-D和Hcy水平均显著降低(P＜0.01),但与对照组相比仍具有显著性(P＜0.01);血清D-D与Hcy呈正相关(r=0.419,P＜0.01).结论 瑞舒伐他汀可显著降低ACS患者血清D-D及Hcy水平,具有改善血液凝固、纤溶系统活性亢进、降低高Hcy血症及稳定斑块的作用,动态联合检测ACS患者血清D-D及Hcy水平有利于病情观察、指导治疗及预后判定.     

Dual-energy X-ray absorptiometry and biochemical markers of bone turnover after autologous stem cell transplantation in myeloma

Objectives: To evaluate the effect of high‐dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) on bone turnover and bone mineral density in a cohort of 39 consecutive patients with multiple myeloma (MM). Methods: Phosphorus and calcium parameters, bone turnover markers, and bone mineral density were studied. Timepoints were diagnosis (T1), just before ASCT (T2), 6 months (T3) after ASCT, and 1 yr (T4) after ASCT. Results: No bone mineral loss was shown on dual‐energy X‐ray absorptiometry (DXA) at T1 (lumbar Z‐score ?0.02, femoral neck Z‐score 0.77) or during follow‐up. Chronic vitamin D deficiency (25OHD3 11.7 ± 7.7 ng/mL at T1) and relative hyperparathyroidism from T2 to T4 were observed. In spite of this moderate hyperparathyroidism, serum C‐telopeptide of type I collagen (CTX) decreased significantly between T1 and T4. Bone alkaline phosphatase levels were low at diagnosis and showed no significant change after ASCT, unlike DKK1 levels that were high at diagnosis and decreased 6 months after ASCT in patients not previously treated with bisphosphonates. Conclusion: Bone demineralization is moderate in multiple myeloma. ASCT induces a decrease in bone resorption but no changes in bone formation, remaining low despite the decrease in DKK1. Bone mineral loss, evaluated by DXA, is moderate in multiple myeloma. High‐dose chemotherapy followed by ASCT leads to decreased bone resorption but osteoblastic bone formation remains low, in spite of reduced circulating DKK1.     

G-protein-mediated inhibition of the Trp channel TRPM1 requires the Gβγ dimer

ON bipolar cells are critical for the function of the ON pathway in the visual system. They express a metabotropic glutamate receptor (mGluR6) that, when activated, couples to the G(o) class of G protein. The channel that is primarily responsible for the synaptic response has been recently identified as the transient receptor potential cation channel subfamily M member 1 (TRPM1); TRPM1 is negatively coupled to the mGluR6/Go cascade such that activation of the cascade results in closure of the channel. Light indirectly opens TRPM1 by reducing transmitter release from presynaptic photoreceptors, resulting in a decrease in mGluR6 activation. Conversely, in the dark, binding of synaptic glutamate to mGluR6 inhibits TRPM1 current. Closure of TRPM1 by G-protein activation in the dark is a critical step in the process of ON bipolar cell signal transduction, but the precise pathway linking these two events is not understood. To address this question, we measured TRPM1 activity in retinal bipolar cells, in human ependymal melanocytes (HEMs) that endogenously express TRPM1, and in HEK293 cells transfected with TRPM1. Dialysis of the Gβγ subunit dimer, but not Gα(o), closed TRPM1 channels in every cell type that we tested. In addition, activation of an endogenous G-protein-coupled receptor pathway in HEK293 cells that releases Gβγ without activating Go protein also closed TRPM1 channels. These results suggest a model in which the Gβγ dimer that is released as a result of the dissociation from Gα(o) upon activation of mGluR6 closes the TRPM1 channel, perhaps via a direct interaction.     

右美托咪定对心室肌细胞L型钙通道电流的影响

目的观察右美托咪定(DEX)对大鼠心室肌细胞L型钙离子通道电流(ICa-L)的影响,探讨其对心脏电活动影响的机制。方法取SD大鼠,用酶解法分离获得单个心室肌细胞,采用全细胞膜片钳技术记录ICa-L,观察不同浓度的DEX(0.6,1.8,5.4,10,200 ng/ml)以及1μmol/L育亨宾(α2肾上腺素受体拮抗剂)单独使用及与10 ng/ml DEX联合使用对ICa-L的影响。结果 0.6,1.8,5.4,10,200 ng/ml的DEX对峰电流的抑制率分别为8.8%±2.4%、14.6%±3.6%、21.4%±8.4%、25.2%±6.4%和32.1%±6.6%,使I-V曲线上移。小剂量(0.6,1.8,5.4 ng/ml)的DEX对ICa-L激活曲线无明显影响(n=6,P>0.05);大剂量(10和200 ng/ml)的DEX可使ICa-L激活曲线右移。0.6,1.8,5.4,10,200 ng/ml的DEX可使ICa-L失活后恢复时间延长。10 ng/ml的DEX可使ICa-L的峰值抑制约25.2%±6.4%,再向电极外液中加入育亨宾后ICa-L平均增加约15%(n=6,P<0.05)。1μmol/L育亨宾灌流前后ICa-L的峰值无差异(n=6,P>0.05)。结论 DEX对心室肌细胞ICa-L具有浓度依赖性地抑制作用,可能是通过细胞膜上的α2肾上腺素受体介导的。