三种实验性IgA肾病模型的比较

目的探讨建立一种理想的IgA肾病（IgAN）动物模型方法。方法分别采用葡聚糖G200、大肠杆菌外膜蛋白和金葡菌的细胞膜20肽抗原决定簇诱导小鼠IgA肾病模型。用分子生物学和病理学方法对3组IgAN模型小鼠进行鉴定和比较。结果（1）葡聚糖组尿蛋白增高，伴有血尿；免疫荧光显示部分肾小球大量IgA沉积；光镜下肾小球系膜细胞增多，肝和脾可见弥漫性的粉染物质沉积；电镜下肾小球系膜区少量低电子密度的致密沉积物，肝和脾可见淀粉丝样物质沉积。（2）大肠杆菌外膜蛋白组尿蛋白增高，伴有血尿；免疫荧光显示肾小球有少量IgA沉积；光镜下肾小球系膜细胞轻度增多，间质炎细胞浸润明显；电镜下肾小球系膜区无电子致密沉积物。（3）金葡菌细胞膜20肽抗原决定簇组尿蛋白增高，伴有血尿；免疫荧光显示多数肾小球均可见大量IgA沉积；光镜下肾小球系膜细胞增多，伴系膜基质轻度增生；电镜下肾小球系膜区和基底膜的内皮细胞下可见高电子密度的致密沉积物。结论金葡菌细胞膜20肽抗原决定簇组诱导的IgAN模型从临床表现和病理学变化与人IgAN极其相似，是3种IgAN模型中最理想的IgAN模型。     

低分子右旋糖酐、速尿与肝素钠配伍对儿童肾病综合征患者利尿作用与高凝状态的影响

目的:探讨低分子右旋糖酐、速尿与肝素钠配伍对儿童肾病综合征(NS)利尿作用与高凝状态的影响。方法:对45例新入院的住院NS患儿使用低分子右旋糖酐、速尿与肝素钠配伍治疗,观察其治疗前后的尿量、体重,并测定其治疗前后血流变学指标,血小板聚集功能、纤溶活性等指标并与25例采用潘生丁、激素治疗者进行对照观察。结果:观察组患儿治疗后较治疗前尿量明显增加,体重明显下降(P<0.01),治疗后观察组的尿量、体重与对照组比较也有显著性差异(P<0.05)。观察组血浆黏度、全血黏度(高切、低切)、血栓形成系数、血小板聚集治疗后较治疗前明显好转(P<0.01);对照组治疗前后这些指标无显著性差异(P>0.05);治疗后观察组与对照组比较有显著性差异(P<0.05)。组织纤溶酶原激活物(t-PA):纤溶酶原活化剂抑制物(PAI)、血浆α2抗纤溶酶(α2-AP)治疗前后无显著性差异,与对照组相比无显著性差异(P>0.05)。结论:采用低分子右旋糖酐和速尿、肝素钠联合治疗儿童NS水肿,既可达到利尿消肿的目的,又有抗凝、降低高凝状态的作用。     

淋巴显像评估妇科肿瘤治疗后下肢淋巴系统损伤

目的分析妇科肿瘤治疗后淋巴水肿患者淋巴显像的影像特点,建立评估下肢淋巴系统损伤的方法。方法166例连续陛病例（332个肢体）双足第1,2趾间皮下注射99Tcm-DX111—185MBq（0．1～0．15m1）后行淋巴显像。根据显像结果,以淋巴管完整程度和淋巴皮下返流状况为指标,将下肢淋巴系统损伤分为0,1,2和3级。根据国际淋巴学会淋巴水肿临床分期标准,将淋巴水肿分为0,I,Ⅱa,Ⅱb和Ⅲ期。列联表,检验比较2种分类方法间的相关关系。矿检验分析淋巴系统损伤分级的临床特征。结果妇科肿瘤治疗后患者淋巴显像表现包括：下肢、盆腔和腹腔区域的淋巴管中断、皮下淋巴返流、淋巴管和淋巴结不显影、淋巴囊肿和淋巴瘘等。332个肢体,水肿分期为0,I,Ⅱa,Ⅱb和Ⅲ期的分别为65（19．6％）,71（21．4％）,131（39．5％）,62（18．7％）和3（0．9％）个,淋巴显像损伤分级为0,1,2和3级的数量分别为36（10．8％）,79（23．8％）,116（34．9％）和101（30．4％）个。统计学分析表明,2者间有良好的相关性（x2=313．483,P〈0．001）。临床分析表明,2和3级损伤所占比例放疗组高于非放疗组,分别为70．5％（158／224）和54．6％（59／108）,x2=9．662,P=0．022;有丹毒病史者3级损伤比例也高于无丹毒者,分别为73．1％（38／52）和43．9％（50／144）,x2=12．238,P〈0．001。随着淋巴水肿病程进展,3级损伤肢体数所占百分比逐渐增高、病程〈1．5年者为36．6％（34／93）,病程1．5～5年者为72．3％（34／47）,病程〉5年者为76．9％（20／26）（x2=23．123,P〈0．001）。不同类型妇科肿瘤（x2=4．000,P=0．676）、是否化疗（x2=0．411,P=0．938）对淋巴系统损伤分级无明显影响。结论淋巴显像损伤分级方法有助于评估妇科肿瘤治疗后患者的淋巴系统损伤程度,可为治疗后淋巴水肿的临床诊断和预防提供客观依据。     

99Tcm-DX淋巴显像对淋巴系统疾病的应用

目的　探讨99Tcm 右旋糖酐 (DX)淋巴显像对乳糜症、淋巴管炎、肢体淋巴性水肿及淋巴瘤等疾病的诊断价值。方法　根据病种及病变部位合理选择99Tcm DX注射部位。根据病种及临床要求 ,选用动态显像、全身显像或局部平面显像。结果　①99Tcm DX显像对 2 4例乳糜症患者诊断特异性为 80 % ,灵敏度为 89 1%。②对 41例淋巴管炎诊断特异性为 83 3% ,灵敏度为 88 5 % ,淋巴管呈放射性管状浓聚。③对 116例四肢淋巴性水肿的诊断特异性为 85 7% ,灵敏度为 91 5 % ,其影像呈以下几种类型 :水肿肢体呈弥漫性放射性浓集 ;水肿肢体淋巴管及淋巴结放射性浓集 ;水肿肢体淋巴管不显影 ;水肿肢体见淋巴侧支形成。④淋巴瘤有以下几种异常图形表现 :淋巴结融合、淋巴链断裂、淋巴结肿大、淋巴交通支形成。结论　99Tcm DX淋巴显像对淋巴系统疾病的诊断具有方法简便 ,图像清晰 ,灵敏度、特异性高等优点 ,临床诊断价值高。     

用颈淋巴显像检测N0期口腔癌患者颈前哨淋巴结

目的评价颈淋巴显像检测口腔癌患者前哨淋巴结(SLN)的价值。方法21例临床N0期口腔癌患者术前行颈淋巴显像与术中蓝染法检测SLN，结果与组织学检查比较。结果①淋巴显像检测SLN的灵敏度为100％(21／21例)，蓝染法为85％(17／20例)。②SLN活组织检查和颈淋巴结清扫术均证实33．3％(7／21例)患者有颈淋巴结转移，准确性100％；活组织检查阴性者14例，颈淋巴结清扫术亦为阴性，特异性100％。结论淋巴显像能有效检测口腔癌患者的SLN，准确预测颈淋巴结转移情况。     

Studies on the kinetics and renal excretion of low and high molecular weight dextrans in preterm babies,newborns and young infants

Administration of low and high molecular weight dextrans in the initial phase of shock is no longer controversial. The special conditions in newborns, however, have been insufficiently considered in planning therapy. This investigation aimed at determining the biological half-lives of dextran 40 (Rheomacrodex^®) and dextran 60 (Macrodex^®) in this age group. The half-life of dextran 40 was found to be 60 min and that of dextran 60 3 h. Preterm babies and newborns excrete up to 25% less dextran 40 and 60 in 24 h than infants and adults. Normal adult values for excretion are only reached towards the end of the first year of life.     

低分子右旋糖酐对肾病综合征的利尿效果分析

目的 观察低分子右旋糖酐对原发性肾病综合征的利尿作用。方法 60例原发性肾病综合征的患者，分别采用：（1）速尿（1mg／kg）＋安慰剂；（2）速尿（1mg／kg）＋20％白蛋白50ml；（3）速尿（1mg／kg）＋250ml低分子右旋糖酐进行治疗．并测其24h尿量、尿肌酐、尿钠、心钠素（ANP）、血尿素氮、血肌酐及血压。结果单用速尿能增加尿量及尿钠（P〈0．05），但不增加血ANP。低分子右旋糖酐联用速尿或白蛋白联用速尿均能使尿量及尿钠、血ANP明显增加（P〈0．05），低分子右旋糖酐联用速尿不引起肾功能的损害。结论 低分子右旋糖酐能替代白蛋白起同等利钠利尿效果，且无白蛋白的副作用。     

Renal test dyes V.

Summary Fluorescence intensities on the renal cortex of Wistar-Furth rats were measured photometrically after an i.v. injection of FITC-dextrans with a molecular weight of 3400, 19000, 26000, 41000 or 153000. The kidney surface was illuminated by the 488 nm line of an ionized argon laser and the fluorescent patterns were recorded by a high sensitivity television camera connected with a tape recorder. Intensities of fluorescence were evaluated directly from the television record. Passages of FITC-dextrans through peritubular capillaries, early and late proximal as well as distal tubules correspond to those of lissamine green. Intensity of the dye during the tubular passage decreases with increasing molecular weight of dextran. Comparison of the tubular intensity of dextran 19000, 26000, 35000 and 41000 with that of dextran 3400 gave corresponding values of 45%, 33%, 19% and 13%, respectively. As could be expected from clearance results, dextran 153000 was only visible during its passage through the peritubular capillaries, but no tubular passage could be observed. This method permits, for the first time, the visualization and photometric quantification of glomerular filtration as a function of molecular size, i.e. glomerular permeability. Since several tubules are seen in each recorded field, it is often possible to make several analyses from the same videotaped record. The photometry of a dye bolus also allowed the measurement of local flow velocities in the proximal tubular loops. Supported by USPHS Grant HL08977 and Deutsche Forschungsgemeinschaft (SFB90)     

99 Tcm-DX直肠淋巴引流显像研究

目的 探讨^99Tc^m－右旋糖酐（DX）直肠淋巴引流显像术前诊断直肠癌淋巴结转移的临床价值。方法 直肠癌患者17例，正常对照者20例。肛镜引导下，分左右两侧直肠粘膜下注射^99Tc^m－DX，每点37MBq（0．5mL）。注射后不同时间行γ照相。结果 ①对照组直肠淋巴引流图：向头侧引流的淋巴链完整、对称，近似“八”字形、梯形。肠旁、肠外淋巴结向上引流至腹主动脉周围淋巴结；部分可以显示两侧髂内淋巴结；显影淋巴结数为7－16个。②直肠癌组术前直肠淋巴引流异常：向头侧引流的淋巴链不完整或不显影；淋巴结显影不清、缺损或增大，淋巴链呈“串珠”样。③直肠癌组术后行病理检查的207个淋巴结中，31个癌结节或癌转移。据Dukes分期法，直肠癌患者术前淋巴显像与术后病理检查结果对照，灵敏度为91．6％，准确性88．2％，特异性80．0％，假阳性率20．0％，假阴性率8．3％。结论 ^99Tc^m－DX直肠淋巴引流显像对直肠癌淋巴结转移的术前诊断有临床价值。     

Fluorescein labelled dextrans as tracers for vascular permeability studies in the nervous system

Summary Golden hamsters received i.v. injections of dextrans labelled with fluorescein isothiocyanate (FITC-Dextran). After 4 hrs samples from the cerebral hemispheres, Gasserian ganglia and sciatic nerves were fixed either by immersion in formalin or by cardiac perfusion with the same fixative. The distribution of the tracer was then studied by fluorescence microscopy of thin frozen sections. With this simple technique FITC-Dextrans could easily be detected in tissue sections. The tracers used (mol. w. 19000 and 154000) spread in the same way as fluorochrome-labelled albumin, remaining in the lumen of cerebral vessels but leaking extensively from vessels in the ganglia.FITC-Dextrans thus appear to be very useful tracers for vascular permeability studies of nervous tissue since dextrans can be obtained in a wide range of molecular weights. FITC-Dextrans can also be subjected to microscopic and quantitative studies.