下肢动脉硬化性闭塞症介入治疗围手术期并发症分析

目的 总结下肢动脉硬化性闭塞症介入治疗围手术期相关并发症的防治经验.方法 对207例下肢动脉硬化件闭塞症行介入治疗,统计围手术期各种并发症的发生情况,分析并发症的发生率与泛大西洋介入协会(transAtlantic inter-society consensus,TASC)分型分级之间的关系以及糖尿病和冠心病对重要脏器并发症发生率的影响.结果 本组207例,介入手术成功190例.17例失败,其中13例为介入操作失败、4例死于术后重要脏器并发症.围手术期并发症包括穿刺点出血12例、假性动脉瘤4例、消化道出血2例、动脉破裂6例、脑梗塞8例、急性心衰9例、呼衰13例、肾衰6例、支架内血栓形成5例和蓝趾综合征1例.在本组患者的TASC分型中,股腘动脉病变介入治疗并发症的发生率为39.84%(51/128),高于主髂型的18.99%(15/79)(P<0.05);患有糖尿病以及合并糖尿病和冠心病患者重要脏器并发症的发生率分别为27.66%(13/47)和24.49%(12/49),高于无合并症患者的5%(2/40)(P<0.05).结论 下肢动脉硬化性闭塞症介入治疗围手术期并发症发生率较高可能与术中操作不当、病变类型复杂及合并糖尿病和冠心病有关,术前注意合并症的处理及术中选择合理治疗方式、缩短手术时间等可减少并发症的发生.     

慢性肾脏病非透析患者脑钠素与动脉粥样硬化及心功能的关系

目的 研究脑钠素（BNP）与慢性肾脏病（CKD）非透析患者动脉粥样硬化及心功能不全的关系。 方法 采用双抗夹心免疫荧光法检测203例CKD非透析患者与16例高血压患者对照组全血BNP水平，分析其与颈动脉超声结果、心脏彩超结果及既往心血管疾病史的关系。 结果 CKD非透析患者BNP水平与对照组相比显著升高[M（范围）：54.40(15.10～ 173.00) ng/L比9.35(7.35～15.00) ng/L，P < 0.01]。Spearman相关分析显示CKD患者BNP与颈动脉内膜中层厚度（IMT）、左室心肌重量指数（LVMI）等呈正相关。存在颈动脉斑块、左室肥厚或既往发生过心血管事件的患者血BNP水平显著增高。多元回归分析显示LVMI、既往心血管事件均是影响BNP水平的独立因素。 结论 CKD非透析患者BNP水平和动脉粥样硬化性疾病、左室肥厚及心功能不全相关，提示BNP水平可作为一项评价CKD非透析患者心功能及动脉粥样硬化的敏感生物学指标。     

严重鼻衄行颌内动脉栓塞术并发脑梗塞死亡

报道１例严重鼻衄伴高血压、动脉硬化患者，经常规方法止血无效，行患侧颌内动脉超选择性栓塞术。术后鼻出血停止，但出现脑梗塞、昏迷，经抢救无效，于术后第９天死亡。认为对有动脉硬化的患者，应不用或慎用超选择性动脉栓塞术。     

猕猴实验性脑动脉硬化扫描电镜观察

本实验表明,猕猴高脂造型22—28个月,其大脑中动脉(Middle Cerebral Artery:MCA)内皮发生水肿、细胞间隙变宽,局部破裂等改变,中膜平滑肌细胞增生、迁移。老年高脂组病损程度较重,且中央支也表现出类似改变。结果提示,高血脂可以引起脑动脉硬化性改变,且病损程度与年龄因素密切相关。     

Intermediate filament expression in human vascular smooth muscle and in arteriosclerotic plaques

Summary Different regions of human aorta and of other human arteries obtained at autopsy were analyzed with regard to their topography and to the different stages of arteriosclerosis. Material was studied by immunocytochemical techniques with antibodies specific for either desmin (D) or for vimentin (V), the two types of intermediate filament proteins present in vascular smooth muscle cells. In normal arteries endothelial cells as well as the adjacent intimal cells were D–V+. In the media D+V+ as well as D–V+ cells were present, with the relative numbers of each cell type dependent on the particular blood vessel. When cells in arteriosclerotic plaques at different stages of development were examined an occasional plaque showed cells of the D+V+ type. In the majority of plaques however the cells were V– D+. In plaques where severe ulceration and necrotic material was present D–V+ cells were found at the border of the lesion: foam cells when they could be identified appeared to be D–V+.     

Non-invasive evaluation of abdominal aortic properties: lumped circuit model and estimation of its parameters

To non-invasively determine abdominal aortic properties, a five-element lumped circuit model was adopted. The model consists of resistance due to blood viscosity (R1), inertia of blood flow, compliances of the vessel (C1, C2), resistance of the peripheral arteries (R2) and the impedance of the femoral arteries (termination). Patterns of the central velocity of the upper abdominal aorta and the femoral artery are measured by pulsed Doppler echocardiography, and confours of flow volume rates are calculated. The pressure pattern of the lower limb is recorded by a pulse wave rransducer and corrected according to sphygmomanometer values. Contours are transformed into respective Fourier transform components. The current transfer function is described theoretically and calculated from the acquired Fourier components. Values of every element are evaluated by the nonlinear least squares method. In 94 subjects (17–92 years), the values of each element are estimated. R2 values are greater in the elderly group, than in the young group and r₁ (R1/cm) increased with age. This model demonstrates that vessel compliance (c₁+c₂ (C1+C2/cm)) decreases with age, and it is suggested that this may be a useful marker of arteriosclerosis.     

Morphological detection and quantification of lipoprotein(a) deposition in atheromatous lesions of human aorta and coronary arteries

Summary Lipoprotein(a), as an atherogenic particle, represents an independent risk factor for coronary heart disease. In the present study the morphological distribution of apoprotein (a) and apoprotein B within the arterial wall is described. Apoprotein B, a constituent of very low-density lipoprotein, low-density lipoprotein and lipoprotein(a) has previously been demonstrated in atheromatous lesions. Lipoprotein(a) possesses an additional protein, designated apoprotein (a). Autopsy material (n=74) from the left coronary artery and from the thoracic aorta has been examined by means of immunohistochemistry and both apoprotein (a) and apoprotein B were detected, primarily associated with the extracellular matrix and accumulating in lesions in the arterial wall. The staining pattern for both antigens was almost always found to be congruent, suggesting that the detection of (a)-antigen has to be attributed at least in part to the presence of lipoprotein(a). It is concluded that both low-density lipoprotein and lipoprotein(a) have an important role in the pathogenesis of atherosclerosis.     

非诺贝特上调血管内皮细胞一氧化氮合酶的表达

目的:观察PPARα激动剂非诺贝特对牛主动脉(BAECs)内皮细胞一氧化氮合酶(eNOS)活性和表达的影响。方法:制备5-9代BAECs,加入不同浓度的非诺贝特(0, 5, 10, 50, 100 μmol/L)后,用NOS Assay Kit测定eNOS活性,RT-PCR法检测eNOS mRNA表达,Western blot分析检测eNOS蛋白质表达。结果: 非诺贝特以浓度和时间依赖的方式增加eNOS活性,非诺贝特浓度10 μmol/L以上时,明显增加eNOS活性。50μmol/L非诺贝特处理48 h时eNOS活性最大(为对照组的2.32±0.47倍,P<0.01)。非诺贝特处理1 h和12 h不增加eNOS活性。RT-PCR分析表明,非诺贝特浓度大于5 μmol/L以上时,明显增加eNOS mRNA水平,在非诺贝特浓度为50 μmol/L时作用最大,为对照组的2.08±0.33倍(P<0.01)。此作用在6 h时出现,持续到48 h。Western blot显示,非诺贝特处理48 h,eNOS蛋白表达明显增加,在浓度为10,50 和100 μmol/L时,eNOS蛋白表达分别为对照组的1.80±0.45, 2.70±0.42 和 2.20±0.32 倍,均P<0.01。在非诺贝特处理12 h后出现,持续到48 h。结论:PPARα激动剂非诺贝特增加BAECs eNOS基因表达,提高eNOS活性及增加蛋白表达。     

贵州农村老年人腹型肥胖及血脂水平对动脉硬化的交互作用

目的 探讨农村老年人腹型肥胖及血脂水平对动脉硬化的交互影响,为动脉硬化的防治提供参考依据。方法 采用多阶段抽样方法选取贵州省2个县（区）内5个乡镇共1 035名60岁及以上老年人为研究对象,进行问卷调查、现场体格检查、实验室检测和动脉硬化检测,采用SPSS 24.0软件进行χ2检验和非条件logistic回归分析贵州农村老年人腹型肥胖、血脂水平及其交互作用对动脉硬化的影响。结果 1 035名老年人中检出动脉硬化对象942人,检出率为91.01%。腹型肥胖老年人动脉硬化检出率94.25%（606人）;TG异常老年人动脉硬化检出率97.53%（158人）。多因素logistic回归分析结果显示,控制年龄、性别、婚姻状况、是否高血压等因素后,腹型肥胖者（OR = 2.018,95%CI:1.188～3.428）,TG异常者（OR = 3.350,95%CI:1.148～9.774）与老年人动脉硬化患病高风险相关。交互作用分析结果显示TG×腹型肥胖对老年人发生动脉硬化存在相乘交互作用（P＜0.05）,（OR = 3.526,95%CI:1.053～11.810）。结论 腹型肥胖、TG异常是动脉硬化的独立影响因素,且腹型肥胖与血脂水平对老年人患动脉硬化具有相乘交互作用。     

树鼩胆固醇酯转运蛋白的cDNA和蛋白质结构分析

目的　获得不易感动脉粥样硬化动物树胆固醇酯转运蛋白 (CETP)的cDNA和蛋白质序列 ,分析其结构特点 ,寻找其可能的抗动脉粥样硬化分子机制。方法　以从树肝脏mRNA反转录获得的cDNA一链为模板 ,应用SMART RACE技术 ,获得了树CETP的cDNA序列 ,并推导出其蛋白质氨基酸序列 ,应用分子生物学软件对该蛋白的一级、二级结构进行分析和比较。结果　获得的树CETPcDNA(在GenBank中的注册号为AF334 0 33)长 16 36bp ,编码 485个氨基酸 ,其成熟蛋白由 477个氨基酸组成 ,比人多一个氨基酸 (Gly318) ,该蛋白与人、家兔的同源性分别为 88%和 82 %。序列中与CETP结合和转运中性脂质功能相关的区域均非常保守 ,但在Asn34 2位的N 糖基化位点缺失 ,可能使其转运胆固醇酯的活性增加 ,利于外周组织和血浆中的胆固醇及其酯的清除。通过对不同种属蛋白序列的比较 ,初步分析了树CETP蛋白与功能相关的结构特点。结论　树CETP糖基化的特点有可能是该动物对动脉粥样硬化具有不易感性的分子机理之一