腹部闭合性外伤性脾破裂诊治体会(附86例报告)

脾破裂是腹部外伤中最常见的腹腔内脏损伤,其发病率在开放性损伤中约6%,闭合性损伤时约25%[1]。我科自1995年6月~2005年10月共收治脾破裂86例,现报告如下。1资料与方法1.1一般资料本组86例,男68例,女18例,年龄16~70岁,平均43岁。车祸伤54例,坠落伤16例,殴打伤9例,挤压伤7例。伤     

活性氧介导醛固酮诱导的足细胞凋亡

目的 观察醛固酮（ALD）及其受体拮抗剂螺内酯（SPI）对足细胞活性氧（ROS）产生及凋亡的影响,并探讨其可能机制。 方法 体外培养条件的永生化小鼠足细胞系,分为空白对照组、ALD组、SPI组、ALD+SPI组;用荧光分光光度计检测足细胞内ROS水平;间接免疫荧光检测nephrin表达;流式细胞仪检测足细胞凋亡率;RT-PCR、Western 印迹法检测bax、bcl-2 mRNA及蛋白表达。同时观察抗氧化剂N-乙酰半胱氨酸（NAC）对上述效应的阻断作用。 结果 与对照组相比,ALD诱导足细胞ROS产生增多（P < 0.05）,该作用可被SPI阻断（P < 0.05）。ALD可诱导足细胞nephrin表达降低及足细胞凋亡（P < 0.05）,同时伴有bax mRNA、蛋白表达升高及bcl-2 mRNA、蛋白表达降低（P < 0.05）,SPI及NAC可阻断这一变化（P < 0.05）。 结论 ALD通过ROS途径作用于盐皮质激素受体上调促凋亡因子bax表达,下调抑凋亡因子bcl-2表达,进而诱导足细胞凋亡。     

来氟米特联合糖皮质激素治疗IgA肾病的研究

目的 观察来氟米特( leflunomide,LEF)与激素治疗IgA肾病患者的疗效及其对尿转化生长因子β1(TGFβ1)的影响.方法 选取符合条件的60例IgA肾病患者,将其分为LEF组和激素组各30例,LEF组给予口服LEF联合泼尼松治疗,激素组予口服泼尼松治疗,采用酶联免疫吸附试验(ELISA)检测尿TGF1,检测值均用尿肌酐(Cr)进行校正.用药期间检测尿TGFβ1/Cr的排泄水平、24 h尿蛋白定量、血清白蛋白、血常规、肝肾功能等指标,进行统计学分析.结果 LEF组治疗后尿TGFβ1/Cr水平、24 h尿蛋白定量均显著下降(P＜0.01),总有效率为85.7％.两组治疗后尿TGFβ1/Cr水平差异有统计学意义(P＜0.05).与激素组比较疗效存在显著差异(P＜0.01),不良反应轻微.结论 LEF联合中小剂量激素治疗IgA肾病比单纯应用激素的临床疗效好,抑制TGFβ1的表达可能是其治疗机制之一.     

大黄的临床应用与体会

大黄性寒味苦,归脾、胃、大肠、肝、心经,功能泻热通便、凉血解毒、逐瘀通经,在临床中应用得当,疗效显著,特别在各科急症中,更具其独特的疗效.     

微创术结合中医药治疗基底节区脑出血疗效观察

目的:观察微创术结合中医药治疗高血压性基底节区脑出血的临床疗效。方法:将48例出血量≥30ml的高血压性基底节区脑出血患者随机分为治疗组与对照组,两组均于西医常规治疗基础上进行早期微创术以清除颅内血肿,治疗组加用桃红四物汤加减内服,连续治疗4周。观察两组的临床疗效、并发症发生数并进行比较。结果:治疗组临床疗效明显优于对照组,恶化率和并发症发生率均低于对照组。结论:徽创术结合中医药治疗高血压性基底节区脑出血疗效满意。     

Protective effect of sulodexide on podocyte injury in adriamycin nephropathy rats

This study examined the effect of sulodexide on podocyte injury in rats with adriamycin nephropathy （AN）. A total of 36 healthy male SD rats were randomly assigned to three groups： control group, AN group and sulodexide treatment group. Rat models of AN were established by a single tail intravenous injection of adriamycin （6.5 mg/kg） in both AN group and sulodexide treatment group. Sulodexide （10 mg/kg） was administered the rats in the treatment group once daily by garage from the first day of model establishment until the 14th day or the 28th day. Samples of 24-h urine and renal cortex tissues were harvested at day 14, 28 after the model establishment. Excretion of 24-h urinary protein was measured by Coomassie brilliant blue method. The pathological changes in renal tissues were observed by light microscopy and electron microscopy respectively. Heparanase mRNA was detected by RT-PCR. Expressions of desmin, CD2AP and heparanase were determined by immunohistological staining. The results showed that the expressions of heparanase mRNA and protein were increased in the glomeruli of AN rats at day 14 and 28 after the model establishment, which was accompanied by the increased expression of desmin and CD2AP. The mRNA and protein expression of heparanase was decreased in the sulodexide-treated rats as compared with AN rats at day 14 and 28. And, the protein expression of desmin and CD2AP was reduced as with heparanase in the sulodexide-treated rats. Proteinuria and podocyte foot process effacement were alleviated in the AN rats after sulodexide treatment. There was a positive correlation between the expression of heparanase and the expression of desmin and CD2AP （as well as 24-h urinary protein excretion）. It was concluded that increased heparanase is involved in podocyte injury. Sulodexide can maintain and restore podocyte morphology by inhibiting the expression of heparanase in AN.     

选择性一期缝合胆总管加鼻胃管引流在胆总管切开术中的应用观察

我科2002年10月～2006年10月对15例肝外胆管结石患者行胆总管切开取石鼻胃管内引流后一期缝合胆总管切口，取得满意疗效。现报告如下：     

TRPC6高表达对血管紧张素Ⅱ诱导的小鼠足细胞凋亡的影响

目的 观察瞬间受体电位阳离子通道蛋白6(TRPC6)高表达对血管紧张素Ⅱ(AnglI)诱导的小鼠足细胞凋亡的影响并探讨其作用机制.方法 用脂质体将针对小鼠TRPC6的基闪真核表达载体pEGFP.N1.mTRPC6转染体外培养的永生化小鼠足细胞系.24 h后用荧光显微镜观察增强绿色荧光蛋白(EGFP)的表达.Western印迹法检测转染后TRPC6蛋白表达的变化.将足细胞分组,应用不同浓度AngⅡ处理足细胞,Fluo-3AM结合激光共聚焦显微镜检测各组足细胞胞质内钙离子的浓度.RT-PCR及Westem印迹法检测Bax、Bcl-2 mRNA及蛋白的水平.流式细胞仪及Hoeehst染色法榆测足细胞凋亡.结果 pEGFP-NI-mTRPC6转染足细胞后,约35%细胞出现绿色荧光;足细胞TRPC6蛋白表达明显上调(P<0.01).TRPC6高表达町以明显促进AngII诱导的足细胞钙离子内流(P<0.01),在蛋白及基因水平均上调Bax的表达而下调Bcl.2的表达(P<0.01,P<0.05).在低剂量Ang Ⅱ(10-10mol/L)作用下.足细胞凋亡率为(2.50±0.72)%,转染TRPC6以后凋亡率为(4.33±0.45)%,差异有统计学意义(P<0.05).在高剂量Ang Ⅱ(10-6mol/L)作用下,足细胞凋亡率为(15.46±1.40)%.转染TRPC6以后凋亡率为(18.33±0.87)%,差异有统计学意义(P<0.01).结论 TRPC6在AngⅡ诱导的足细胞凋亡中发挥重要作用.TRPC6可能通过增加钙离子内流,进而启动其下游的捌亡调节成分参与凋亡过程.     

Protective effects of eplerenone on podocyte injury in adriamycin nephropathy rats

To investigate the protective effects of eplerenone on adriamycin-induced renal injury and the possible mechanisms involved,36 male Sprague-Dawley rats were randomly divided into control group,adriamycin nephropathy(AN) group and eplerenone-treated group(100 mg.kg-1.d-1 eplerenone).Blood pressure,24-h urinary protein,serum potassium,sodium and creatinine were measured 28 days after adriamycin injection(a single tail intravenous injection of 6.5 mg/kg adriamycin).The morphological changes of renal tissues were observed by light and electron microscopy.Immunohistochemistry and Western blotting were performed to examine the expression of TGF-β1 and desmin in renal cortex.The results showed that 28 days after adriamycin injection,there were no significant changes in the level of serum potassium,sodium,creatinine concentrations and blood pressure values in the rats of the three groups.Meanwhile,the 24-h proteinuria excretion in the AN group was significantly higher than that in the control group(P<0.01),but that in the eplerenone-treated group was substantially reduced when compared with that in the AN group(P<0.05).Mild mesangial cell proliferation and matrix expansion,diffuse deformation and confluence of foot processes in podocytes were found in the AN group.By contrast,rats in the eplerenone-treated group exhibited obvious attenuation of these morphological lesions.The protein expression of TGF-β1 and desmin in the AN group was markedly up-regulated in contrast to that in the control group(P<0.01),whereas that in the eplerenone-treated group was much lower than in the AN group(P<0.05).It was concluded that eplerenone may ameliorate the proteinuria and the development of pathological alteration in adriamycin-induced nephropathy presumably via the inhibition of cytokine release,and restore the morphology of podocytes independent of its blood pressure-lowing effects.     

螺内酯对单侧输尿管梗阻后肾间质纤维化调节作用的实验研究

目的探讨螺内酯对大鼠单侧输尿管梗阻模型( U U O )肾间质纤维化的影响。方法 32 只大鼠随机分为假手术组、U U O 组、小剂量螺内酯组( 20 m g/kg·d)、大剂量螺内酯组( 50 m g/kg·d),术前 1 d 开始给予螺内酯或等量蒸馏水灌胃,观察第 14 天血清钾、钠、肌酐水平及血压的变化;以 M asson 染色定量分析方法判定肾间质纤维化程度;以免疫组织化学方法测定转化生长因子 -β1( TG F-β1) 和α- 平滑肌肌动蛋白( α-SM A)的表达并进行定量分析。结果与 U U O 组相比,小剂量螺内酯组、大剂量螺内酯组的血清钾、钠,肌酐,血压均无明显变化( P >0.05);肾小管间质纤维化程度及 TG F-β1 和α-SM A 的表达均明显低于 U U O组( P <0.05)。小剂量螺内酯组和大剂量螺内酯组肾间质纤维化程度、TG F-β1 和α-SM A 的表达差异均无显著性( P >0.05)。结论螺内酯可通过下调 TG F-β1 和α-SM A 减少细胞外基质堆积从而减轻肾间纤维化。