尿葡胺聚糖对尿石形成的影响(摘要)

尿葡胺聚糖对尿石形成的影响（摘要）白铁男马腾骧韩玉植葡胺聚糖（ＧＡＧｓ）与尿石形成有密切关系。我们检测并分析了尿石病人尿中ＧＡＧｓ排泄及与尿石形成的关系。材料和方法尿石病人３０例，年龄２４～６５岁，平均３８岁。男性２２例，女性８例。含钙尿石病人２２例...     

早发型重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义

Objective To investigate the expression levels of serum soluble Endoglin (sEng), plasma endothelin-1 (ET-1) and coagulation function in patients suffering from early onset severe preeclampsia with organ dysfunction, and to analyze the clinical significance. Methods Forty-nine early onset severe preeclampsia patients were enrolled in the study group, including 26 cases without organ dysfunction (study group Ⅰ) and 23 cases with organ dysfunction (study group Ⅱ). The control group included 30 cases of health pregnant women during the same period of gestation. The serum levels of sEng and plasma ET-1　were analyzed with enzyme-linked immunosorbent assay (ELISA), coagulation function was determined at the same time, and the relationship between the change in levels of sEng, ET-1, coagulation function and organ function, and also outcome of perinatal infants. Results ① The levels of sEng, ET-1, fibrinogen (Fib) and mean platelet volume (MPV) of the study group Ⅰ and I were significantly higher compared with control group (sEng,μg/L:10.96±3.21, 14.17±4.02vs. 7.49±2.73; ET-1, μg/L: 41.54 ± 10. 37, 65.91± 12.46vs. 24.56±6.26; Fib, g/L:4.41±1.02,5.35±1.17vs. 3.69±0.82; MPV, fl:11. 71± 1.21, 13.89±1.76vs. 11.03±0.82, all P＜ 0.05), and prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet (PLT) were significantly lower compared with control group (PT, s:10.73±1.82, 8.37±1.51vs. 12.95±1.91; APTT, s:26.14±4.32, 22.69±3.77vs. 30.25±4.71; PLT,×109/L; 164.17±50.67, 136.43±51.21vs. 201.63±59.83, all P＜0.05). There were also statistical significances in all the values between study group Ⅰ and I (all P＜0.05). ②There was positive correlation between the sEng level and systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, serum creatinine (SCr); there was negative correlation between the sEng level and albumin (Alb) content, PT, estriol/creatinine (E/C) of 12-hour urine, fetal birth weight (all P＜0.01). There was positive correlation between the level of ET-1 and the systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, SCr, or alanine aminotransferase (ALT); there was negative correlation between the level of ET-1and Alb, PT, E/C of 12-hour urine, or fetal birth weight (P＜0.05 or P＜0.01). ③In the study group, the occurrence rate of the heart, kidney and lung dysfunction, placental abruption and perinatal death of infants increased (69.23％vs. 11.11％, 38.46％vs. 2.78％, 38.46％vs. 2.78％, 46.15％vs. 2.78％, 53.85％vs. 2.78％, all P＜0.01) when the content of sEng≥ 16μg/L compared with sEng＜16μg/L; the occurrence rate of heart, kidney, liver and lung dysfunction, placental abruption and perinatal death of infants increased (64.28％vs. 11.43％, 35.71％vs. 2.86％, 28.57％vs. 5.71％, 28.57％vs. 5.71％,35.71％vs. 5.71％, 42.86％vs. 5.71％, all P＜0.01) when the level of ET-1≥70μg/L compared with ET-1＜70μg/L; the occurrence rate of multiple organ dysfunction syndrome was 90％ (9/10) when PT＜7s, APTT＜20s and PLT＜100×109/L. Conclusion The elevation of levels of serum sEng, plasma ET-1 and coagulation abnomality may contribute to the pathogenesis of the organ dysfunction in early onset severe preeclampsia, and the detection of the above-mentioned indexes has important clinical value.     

变异链球菌LuxS基因缺陷株的建立及其耐酸能力的研究

目的 建立LuxS基因缺失的变异链球菌突变菌株,并对突变株的耐酸能力进行研究.方法 以变异链球菌UA159为材料,运用基因重组方法将红霉素抗性基因(Eymr)与LuxS基因上下游区域的2个基因片段按一定顺序重组到质粒载体PUC19的多克隆位点中,获得了具有红霉素抗性的重组质粒,将载体质粒转化到含完整LuxS基因的变异链球菌UA159中,利用红霉素抗性筛选出LuxS基因缺失的突变株.检测变异链球菌LuxS基因突变菌株在不同pH环境下生长情况,并以正常菌株为对照.结果 PCR基因扩增结果显示,突变株LuxS基因已被Eymr基因完全替换,不能再编码合成AI-2(autoinducer 2)信号分子,扩增产物经DNA测序证实筛选得到了LuxS基因缺失的突变株,并且突变株不能诱导V.harveyi BB170的生物发光.与变异链球菌标准菌株相比,LuxS基因突变株的生长情况随着pH的降低受到明显抑制.结论 本研究成功构建LuxS基因缺失的变异链球菌突变株,LuxS感应信号系统参与变异链球菌耐酸能力的调控,LuxS基因缺失菌株耐酸能力降低.     

血液透析器重复使用的临床研究

为了研究透析器重复使用对终末期慢性肾功能衰竭接受血液透析患者体能的作用，动态观察透析器膜材料首次使用和使用不同消毒剂透析器膜材料重复使用对血液白细胞、血小板、补体Ｃ３、过氧化物岐化酶影响。结果表明：透析器膜材料血液生物相容性的改变与透析器膜材料的种类有关，透析器膜材料重复使用后血液生物相容性与消毒剂的种类有关，而与复用的次数无关。过氧化物岐化酶在透析器重复使用１５ｍｉｎ时比透析器首次使用下降百分率更明显，Ｐ值＜０．０１。透析器复用是影响患者长期存活的重要因素之一。     

早发型重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义

Objective To investigate the expression levels of serum soluble Endoglin (sEng), plasma endothelin-1 (ET-1) and coagulation function in patients suffering from early onset severe preeclampsia with organ dysfunction, and to analyze the clinical significance. Methods Forty-nine early onset severe preeclampsia patients were enrolled in the study group, including 26 cases without organ dysfunction (study group Ⅰ) and 23 cases with organ dysfunction (study group Ⅱ). The control group included 30 cases of health pregnant women during the same period of gestation. The serum levels of sEng and plasma ET-1　were analyzed with enzyme-linked immunosorbent assay (ELISA), coagulation function was determined at the same time, and the relationship between the change in levels of sEng, ET-1, coagulation function and organ function, and also outcome of perinatal infants. Results ① The levels of sEng, ET-1, fibrinogen (Fib) and mean platelet volume (MPV) of the study group Ⅰ and I were significantly higher compared with control group (sEng,μg/L:10.96±3.21, 14.17±4.02vs. 7.49±2.73; ET-1, μg/L: 41.54 ± 10. 37, 65.91± 12.46vs. 24.56±6.26; Fib, g/L:4.41±1.02,5.35±1.17vs. 3.69±0.82; MPV, fl:11. 71± 1.21, 13.89±1.76vs. 11.03±0.82, all P＜ 0.05), and prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet (PLT) were significantly lower compared with control group (PT, s:10.73±1.82, 8.37±1.51vs. 12.95±1.91; APTT, s:26.14±4.32, 22.69±3.77vs. 30.25±4.71; PLT,×109/L; 164.17±50.67, 136.43±51.21vs. 201.63±59.83, all P＜0.05). There were also statistical significances in all the values between study group Ⅰ and I (all P＜0.05). ②There was positive correlation between the sEng level and systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, serum creatinine (SCr); there was negative correlation between the sEng level and albumin (Alb) content, PT, estriol/creatinine (E/C) of 12-hour urine, fetal birth weight (all P＜0.01). There was positive correlation between the level of ET-1 and the systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, SCr, or alanine aminotransferase (ALT); there was negative correlation between the level of ET-1and Alb, PT, E/C of 12-hour urine, or fetal birth weight (P＜0.05 or P＜0.01). ③In the study group, the occurrence rate of the heart, kidney and lung dysfunction, placental abruption and perinatal death of infants increased (69.23％vs. 11.11％, 38.46％vs. 2.78％, 38.46％vs. 2.78％, 46.15％vs. 2.78％, 53.85％vs. 2.78％, all P＜0.01) when the content of sEng≥ 16μg/L compared with sEng＜16μg/L; the occurrence rate of heart, kidney, liver and lung dysfunction, placental abruption and perinatal death of infants increased (64.28％vs. 11.43％, 35.71％vs. 2.86％, 28.57％vs. 5.71％, 28.57％vs. 5.71％,35.71％vs. 5.71％, 42.86％vs. 5.71％, all P＜0.01) when the level of ET-1≥70μg/L compared with ET-1＜70μg/L; the occurrence rate of multiple organ dysfunction syndrome was 90％ (9/10) when PT＜7s, APTT＜20s and PLT＜100×109/L. Conclusion The elevation of levels of serum sEng, plasma ET-1 and coagulation abnomality may contribute to the pathogenesis of the organ dysfunction in early onset severe preeclampsia, and the detection of the above-mentioned indexes has important clinical value.     

血液透析患者红细胞钠、钙水平及其表面形态学改变对血压的影响

目的:通过研究透析液钙浓度对血透患者红细胞钠、钙水平及其表面形态学变化,最终探讨透析性高血压的发病机制。方法:对89例患者在1160次血液透析中的9520个血压记录值进行调查,包括透析进行中1～4小时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP),并对其中40例透析性、药物抵抗性高血压及非高血压患者的血浆钙(Ca)、钠(Na)、S2细胞钙(RBCCa)、钠(RBCNa)、红细胞表面立体形态观察测定。通过对以上检测数据的分析研究从中发现显著性差异和相关性因素。结果:使用透析液Ca为1.25mmol/L(LdCa低钙)患者的血压透析中呈下降P<0.01;Ca为1.75mmol/L(HdCa高钙)血压呈上升P<0.01,在透析第3、4小时最明显。RBCCa测定显示高血压患者透析后明显高于非高血压患者,高血压患者RBCCa0.5797±0.2914mmol/L,非高血压患者RBCCa0.3569±0.1805mmol/L,P<0.05。而RBCNa无显著性差异,P>0.05。在RBC立体形态学扫描电子显微镜(SEM)观察中有意义的发现是,RBC“裙边样”改变在透析前Hd-Ca明显低于LdCa,分别是3.36±1.8047%,9.833±0.2490%,P<0.01,而透析后HdCa明显高于LdCa,分别是9.5233±1.9302%,3.7517±3.5257%,P<0.01。结论:高钙透析液是透析性高血压患者在透析中升压的重要因素之一,其相关因素是HdCa可使RBC表面立体形态改变,RBC“裙边样”变形率增加,RBC表面接触面积增加,在通过外周微血管时阻力增加,这些可能与RBCCa含量增加相关。     

妊娠期高血压疾病患者血清脂联素、内皮素-1和一氧化氮水平变化及意义

目的探讨妊娠期高血压疾病（hypertensivedisordercomplicatingpregnancy,HDCP）患者血清脂联素（adiponectin）、内皮素（endothelin,ET）1和一氧化氮（nitrogenmonoxide,NO）水平变化及其与该疾病发生的关系。方法将2007年6月至2008年5月在天津医科大学第二医院妇产科确诊为妊娠期高血压疾病,并住院治疗后手术分娩的82例孕妇中同意接受试验的62例孕妇纳入研究组（n=62）,包括HDCP组（n=20）,轻度PE组（n=20）,重度PE组（n=19）,子痫组（n=3）;同期住院手术分娩的正常足月妊娠孕妇纳入对照组（n=20）（本研究遵循的程序符合天津医科大学第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,取得受试对象的知情同意,并与其签署临床研究知情同意书）,采用酶联免疫吸附测定（enzymelinkedimmunosorbentassay,ELISA）法检测定上述各组血清脂联素、内皮素-1水平;用硝酸还原法测定一氧化氮水平。结果研究组中,轻、重度PE组和子痫组孕妇的血清脂联素水平及一氧化氮水平呈下降趋势,内皮素-1水平呈上升趋势。轻、重度PE组及子痫组与HDCP组及对照组脂联素水平、内皮素-1及一氧化氮水平比较,差异有显著意义（P〈O．05,P〈O．01,P〈O．01）;重度PE组与轻度PE组比较,差异有显著意义（P〈0．05）;子痫组与重度PE组比较,血清脂联素水平呈下降趋势,差异无显著意义（P〉0．05）;内皮素-1及一氧化氮水平比较,差异有显著意义（P〈0．05;P〈0．05）;HDCP组与对照组比较,差异无显著意义（P〉O．05）。PE组血清脂联素水平与一氧化氮呈正相关（r=0．619,P〈0．01）,与内皮素-1呈负相关（r=0．571,P〈0．01）;血清脂联素水平与血压呈显著负相关（r=0．516,P〈0．01;r=0．474,P〈0．01）。结论脂联素水平降低,可影响血管内皮功能,在妊娠期高血压疾病的发生发展过程中,起一定作用。     

LuxS基因缺失的变形链球菌突变株的构建及鉴定

目的 通过同源重组法构建LuxS基因缺失的变形链球菌(Streptococcus mutans)突变株.方法 运用基因同源重组方法将红霉素抗性基因(Eymr)连接到PCR扩增LuxS基因两端区域产生的2个基因片段之间,并共同插入到pUCl9载体的多克隆位点中,构建出带红霉素抗性标志的缺失突变载体pUCluxKO.将突变载体转化到含完整LuxS基因的突变受体变形链球菌标准株中,红霉素筛选出LuxS基因缺失的变形链球菌突变株,并经PCR、生物荧光检测及DNA测序鉴定.结果 构建的突变载体经限制性内切核酸酶酶切分析显示,产生的条带与设计结果完全一致.PCR方法扩增突变株LuxS和Eymr基因显示,LuxS基因已被完整敲除掉,经生物荧光检测,突变株不能诱导哈氏弧菌(Vibrio harveyi)BBl70的生物发光,说明不能产生信号分子AI-2(autoinducer-2).DNA测序证实筛选得到了LuxS基因缺失的变形链球菌突变株.连续传代培养后证实,变形链球菌LuxS基因突变株具有良好的稳定性.结论 成功构建出LuxS基因缺失的变形链球菌突变株,为研究LuxS基因对变形链球菌致龋毒力的影响奠定了基础.     

早发型重度子痫前期合并器官功能障碍患者可溶性内皮抑素、内皮素-1与凝血功能的变化及意义

目的 探讨可溶性内皮抑素(sEng)、内皮素-1(ET-1)和凝血功能的变化在早发型重度子痫前期合并器官功能障碍患者中的意义.方法 49例早发型重度子痫前期患者中无器官功能障碍(研究Ⅰ组)26例,合并器官功能障碍(研究Ⅱ组)23例;以同期30例健康孕妇为对照组.采用酶联免疫吸附法(ELISA)测定血中sEng、ET-1水平,常规测定凝血功能,比较3组间各指标的变化及其与器官功能、围生儿结局的关系.结果 ①研究Ⅰ组与研究Ⅱ组sEng、ET-1、纤维蛋白原(Fib)、血小板平均体积(MPV)均高于健康对照组[sEng (μg/L):10.96±3.21、14.17±4.02比7.49±2.73,ET-1(μg/L):41.54±10.37、65.91±12.46比24.56±6.26,Fib(g/L):4.41±1.02、5.35±1.17比3.69±0.82,MPV(fl):11.71±1.21、13.89±1.76比11.03±0.82,均P＜0.05],凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(PLT)均低于健康对照组[PT(s):10.73±1.82、8.37±1.51比12.95±1.91,APTT(s):26.14±4.32、22.69±3.77比30.25±4.71,PLT(×109/L):164.17±50.67、136.43±51.21比201.63±59.83,均P＜0.05],且研究Ⅰ、Ⅱ组相比差异亦有统计学意义(均P＜0.05).②研究组sEng与血压、Fib、24 h尿蛋白、血肌酐(SCr)均呈正相关,与血浆白蛋白(Alb)、PT、12h尿雌激素/肌酐比值(E/C)及胎儿出生体重均呈负相关(均P＜0.01);而ET-1与血压、Fib、24h尿蛋白、SCr、丙氨酸转氨酶(ALT)均呈正相关,与血浆Alb、PT、12h尿E/C、胎儿出生体重均呈负相关(P＜0.05或P＜0.01).③sEng≥16μg/L组伴发心、肾、肺功能障碍、胎盘早剥及围生儿死亡的发生率高于sEng＜16μg/L组(69.23%比11.11%,38.46%比2.78%,38.46%比2.78%,46.15%比2.78%,53.85%比2.78%,均P＜0.01);ET-1≥70μg/L组伴心、肾、肝、肺功能障碍、胎盘早剥及围生儿死亡的发生率均高于ET-1＜70μg/L组(64.28%比11.43%,35.71%比2.86%,28.57%比5.71%,28.51%比5.71%,35.71%比5.71%,42.86%比5.71%,均P＜0.0);PT＜7s、APTT＜20s及PLT＜100×109/L时,多器官功能障碍发生率达90%(9/10),其中1例孕妇死亡.结论 血中sEng、ET-1水平升高及凝血功能紊乱是早发型重度子痫前期合并器官功能障碍患者的明显特征,其水平与患者的病情程度明显相关.