动脉弹性降低的影响因素及动脉弹性的测量方法

血管内皮弹性改变的病理变化主要表现为血管内皮的变性、增生、钙化,及时准确的发现导致血管弹性下降的病因或诱因,并检测到上述病理改变,对于延缓及治疗心血管疾病的进展具有重要的临床意义。一、导致动脉弹性降低的因素 1.遗传因素：遗传因素在高血压病的发生发展中起着至关重要的作用。     

神经内窥镜下经鼻蝶窦入路切除垂体腺瘤的手术配合

目的探讨神经内窥镜下经鼻蝶窦入路切除垂体腺瘤的手术配合要点。方法对经CT或MRI诊断为垂体腺瘤的67例患者采用在神经内窥镜下经鼻蝶窦入路手术，切除垂体腺瘤。术中护士予以积极配合。结果67例垂体腺瘤中，肿瘤全切61例，次全切5例，大部分切除1例；无死亡病例，无视神经损伤。随访5个月至3年，所有患者的症状均有所改善。结论手术室护士全面了解手术过程，做好患者的心理护理和物品准备，熟练正确使用显微器械和腔镜器械，术中严格无菌操作，与医生默契配合，是手术成功的重要保证。     

经气管注射骨髓间充质干细胞治疗早期血管炎性作用所致肺动脉高压的实验研究

目的探讨气管注射骨髓间充质干细胞(MSCs)治疗肺动脉高压(PAH)的作用机制,观察MSCs治疗PAH对肺血管结构的影响。方法将SD大鼠分为空白对照组(Con组)、PAH组、MSCs气管注射治疗组(TMSCs组),MSCs静脉注射治疗组(VMSCs组)。VMSCs、TMSCs、PAH组大鼠皮下注射野百合碱(MCT)造PAH动物模型,Con组皮下注射生理盐水。VMSCs组及TMSCs组大鼠于MCT注射7 d后分别经股静脉、气管注射MSCs悬液,Con组及PAH组注射等量的低糖DMEM培养基。MCT注射10、21 d时,检测荧光在TMSCs组及VMSCs组肺组织的分布。MCT注射21 d,检测肺血流动力学指标及Smad2、磷酸化Smad2(p-Smad2)的表达情况,取肺组织做病理切片观察肺血管结构的变化。结果MCT注射21 d时,肺动脉收缩压(SPAP)、肺动脉平均压(MPAP)在VMSCs、TMSCs组较PAH组明显下降(P<0.05),但高于Con组(P<0.05);VMSCs、TMSCs组血管壁厚度较PAH组明显变薄(P<0.05);PAH、TMSCs、VMSCs组Smad2的水平无明显差别,略高于Con组;PAH组p-Smad2水平高于TMSCs、VMSCs和Con组;上述指标在VMSCs和TMSCs组间差异无统计学意义。结论 MSCs治疗可以降低肺动脉压力,减轻肺血管的重构作用,这可能与MSCs降低Smad2蛋白及其活性形式p-Smad2蛋白的表达有关,气管注射MSCs可能是治疗PAH的有效途径。     

臂踝指数和颈动脉内膜中层厚度对绝经后女性冠心病的评价价值

目的探讨臂踝指数(ABI)和颈动脉内膜中层厚度(IMT)对绝经后女性冠心病的评价价值及绝经后女性发生冠心病的相关危险因素。方法选择疑诊冠心病的绝经后女性患者187例,根据冠状动脉造影结果分为非冠心病组66例和冠心病组121例;冠心病组又分为单支病变组40例、双支病变组40例、多支病变组41例。通过Gensini积分系统评价冠状动脉病变程度。检测各组患者ABI、IMT及相关指标,并进行比较。结果与非冠心病组比较,冠心病组IMT明显增厚,ABI明显降低,差异有统计学意义(P<0.05)。随着冠状动脉病变程度加重,ABI明显降低,IMT及斑块检出率也明显增高。logistic回归分析显示,ABI降低(≤0.9)、IMT增厚(≥0.9 mm)是绝经后女性冠状动脉病变的独立预测因素,便秘为独立危险因素。其他危险因素:年龄、糖尿病、高血压、高胆固醇血症、高尿酸、高敏C反应蛋白升高等可以增加绝经后女性患冠心病的风险。结论 ABI及IMT可以作为绝经后女性冠状动脉病变的无创性预测指标。便秘可作为绝经后女性冠心病的独立危险因素。     

血红素加氧酶1在肺动脉高压中拮抗转化生长因子β血管重构的研究进展

<正>随着血红素加氧酶1和转化生长因子β研究的不断深入,这两种活性物质的特性逐渐被了解,血红素加氧酶1能通过抗炎、抗免疫、抗增殖等作用参与体内器官及组织的保护作用;而转化生长因子β可由多种免疫细胞产生,在肺动脉高压血管重构方面起着重要作用。我们就血红素加氧酶1基因及其转化生长因子β的生物学特性,以及血红素加氧酶1拮抗转化生长因子β在肺动脉高压血管重构作用的主     

Mesenchymal stem cells attenuate vascular remodeling in monocrotaline-induced pulmonary hypertension rats

Intravenous and intratracheal implantation of mesenchymal stem cells (MSCs) may offer ameliorating effects on pulmonary hypertension (PH) induced by monocrotaline (MCT) in rats. The aim of this study was to examine the anti-remodeling effect of intravenous MSCs (VMSCs) and intratracheal MSCs (TMSCs) in rats with PH, and the underlying mechanisms. MSCs were isolated from rat bone marrow and cultured. PH was induced in rats by intraperitoneal injection of MCT. One week after MCT administration, the rats were divided into 3 groups in terms of different treatments: VMSCs group (intravenous injection of MSCs), TMSCs group (intratracheal injection of MSCs), PH group (no treatment given). Those receiving saline instead of MCT served as negative control (control group). Pulmonary arterial structure was pathologically observed, pulmonary arterial dynamics measured, and remodeling-associated cytokines Smad2 and Smad3 detected in the lungs, three weeks after MCT injection. The results showed that PH group versus control group had higher pulmonary arterial pressure (PAP) and wall thickness index (WTI) 21 days after MCT treatment. The expression of phosphorylated (p)-Smad2 and the ratio of p-Smad2/Smad2 were much higher in PH group than in control group. Fluorescence-labeled MSCs were extensively distributed in rats’ lungs in VMSCs and TMSCs groups 3 and 14 days after transplantation, but not found in the media of the pulmonary artery. WTI and PAP were significantly lower in both VMSCs and TMSCs groups than in PH group three weeks after MCT injection. The p-Smad2 expression and the ratio of p-Smad2/Smad2 were obviously reduced in VMSCs and TMSCs groups as compared with those in PH group. In conclusion, both intravenous and intratracheal transplantation of MSCs can attenuate PAP and pulmonary artery remodeling in MCT-induced PH rats, which may be associated with the early suppression of Smad2 phosphorylation via paracrine pathways.     

冠心病患者血B型钠尿肽和纤维蛋白原水平临床意义的研究

目的研究冠心病与B型钠尿肽(BNP)、纤维蛋白原(FIB)的临床关系。方法经冠状动脉造影明确诊断冠心病患者164例,按临床类型分为稳定性心绞痛(SAP)20例,不稳定性心绞痛(UAP)64例,急性心肌梗死(AMI)80例,另选取同期健康对照组20例。于发病6～24 h内抽取清晨空腹静息状态下静脉血检测BNP、FIB,并进行比较。采用Judkins法评定冠状动脉病变程度,采用Gensini积分系统衡量冠状动脉病变程度,并与BNP、FIB进行相关分析。结果在冠心病临床分型中AMI组、UAP组、SAP组BNP、FIB明显高于对照组,差异有统计学意义(P<0.05)。病变血管支数分组中三组FIB比较差异有统计学意义(P<0.05)。合并疾病分组BNP水平比较差异有统计学意义(P<0.05)。冠心病临床分型各组Gensini评分与BNP、FIB无相关性(P>0.05)。结论 BNP与FIB水平与冠心病临床分型相关,BNP与病变血管支数无明显相关性。