目的 探讨细胞因子氨基末端脑钠肽前体(NT-proBNP)、可溶性ST2(sST2)及心电图QRS波时限在老年慢性心力衰竭(CHF)患者中的变化及其意义.方法 选取2014年1月～2017年12月无锡市第三人民医院心血管内科确诊的老年CHF患者200例作为CHF组;另选取年龄及性别相似的健康老年人100例作为健康对照组.对比分析两组的NT-proBNP、sST2及心电图QRS波时限、左室射血分数(LVEF％)、左室收缩末期内径(LVESD)及左室舒张末期内经(LVEDD).结果 CHF组的NT-proBNP、sST2及心电图QRS波时限均高于健康对照组,差异具有统计学意义(P＜0.05);随着纽约心脏病协会(NYHA)分级的升高,200例CHF患者的NT-proBNP、sST2及心电图QRS波时限呈逐渐升高的趋势,组间进行两两比较差异具有统计学意义(P＜0.05);CHF组的LVEF％值低于健康对照组,LVESD、LVEDD测定值均高于健康对照组,差异有统计学意义(P＜0.05).CHF患者的LVEF％值低与NT-proBNP、sST2、QRS波时限测定值均呈显著的负相关关系(r=-0.704、-0.556、-0.604,P＜0.05).结论 老年CHF患者NT-proBNP、sST2水平均升高,QRS波时限延长,并且与患者心功能受损情况相关.

Objective To investigate the effects of combined use of Xuebijing and CVVH on PLT,TBil and Cr in elderly patients with multiple organ dysfunction syndrome.Methods Ninety-four cases of elderly patients with multiple organ dysfunction syndrome were selected,which were treated in hospital ICU hospitalization from March 2013 to March 2017,and they were divided into the observation group (47 cases) and control group (47 cases).The patients of two groups were all treated with conventional comprehensive treatment.The patients of control group were treated with CVVH (blood flow rate 200 ml/min,ultrafiltration volume 150-300 ml/min,replacement fluid flow 3 000 ml/h,continuous treatment for 1-4d).Based on control group,the patients of observation group were treated with Xuebijing injection (intravenous infusion of 100 ml times,3 times / d,treatment for 7d).Compare the clinical efficacy,ventilator support time and ICU hospital stay and changes of the levels of SCr,BUN,IL-1β,IL-10,TNF-α,TBil,PLT,PaO2,PaO2/FiO2,APACHE Ⅱ scores of two groups.Results After the appropriate treatment,the total effective rate of the observation group was 91.5％,which was significantly higher than 74.5％ of the control group (x2 =4.821,P =0.028);In terms of ventilator support time,ICU hospitalization time,PLT and APACHEⅡscore,the performance of the observation group was significantly better than the control group (P ＜ 0.05);The TBil,PaO2,PaO2/FiO2 of the two groups were significantly improved than before,and the patients in the observation group improved more significantly (P ＜ 0.05);The SCr,BUN of the two groups were significantly decreased than before,and the patients in the observation group decreased more significantly (P ＜ 0.05);The IL-1β,IL-10,TNF-α of the two groups were significantly decreased than before,and the patients in the observation group decreased more significantly (P ＜ 0.05).Conclusion Combined use of Xuebijing and CVVH in the treatment of elderly patients with multiple organ dysfunction syndrome can get the exact effect,significantly improve the organ function and prognosis,which makes it worthy of clinical application.

AIM: To investigate the effects of caveolin-1 (Cav-1) scaffolding domain peptide, cavtratin, on lipopolysaccharide (LPS)-induced mouse acute lung injury and heme oxygenase-1 (HO-1) activity.METHODS: Adult male BALB/c mice were randomly divided into 6 groups (n=8 to 10): control, Antennapedia internalization sequence (AP), LPS, LPS+hemin, LPS+ hemin+cavtratin and LPS+hemin+cavtratin+zinc protoporphyrin IX (ZnPP) groups.After LPS administration for 24 h, the lung pathological changes, the wet/dry weight (W/D) ratio of lung tissues, total cell number in bronchoalveolar lavage fluid and serum lactate dehydrogenase activity were measured.The co-localization of HO-1 and Cav-1 was displayed by immunofluorescence, and the HO-1 activity were detected.The mRNA expression of pro-inflammatory cytokines IL-1β, IL-6, TNF-α, MCP-1 and iNOS was detected by real-time PCR.RESULTS: The mice in LPS+hemin+cavtratin group had the decreased interaction between HO-1 and Cav-1, and the increased HO-1 activity compare with LPS group (P<0.05).Compared with LPS group, the pulmonary damage was attenuated in LPS+hemin+cavtratin group, and the injury indexes, including W/D ratio, total cell number in bronchoalveolar lavage fluid and lactate dehydrogenase activity in the serum, and the mRNA expression of inflammatory cytokines all decreased (P<0.05).HO-1 activity inhibitor ZnPP abolished the above protective effect of cavtratin on the lung tissues with LPS-induced acute lung injury.CONCLUSION: Cavtratin has beneficial effects on the lung with LPS-induced acute injury by restoring the HO-1 activity.

OBJECTIVE To investigate the protective effect of heparin for kidney injury in mice challenged Taihu lake water drowning.METHODS 60 Male ICR mice were randomly divided into control group,model group,low-dose heparin group,high-dose heparin group.After 9 min,the level of superoxide dismutase(SOD),malondialdehyde(MDA) and myeloperoxidase (MPO) were measured by colorimetry method.Pathological biopsy of kidney tissue of each group were examined.RESULTS The pathological slice indicated that renal structure was significantly improved by reducing the hyperemia and swelling of glomerulus,reducing swelling of epithelial cell of proximal convoluted tubule in low and high-dose heparin groups.The level of MDA and MPO were decreased.The level of SOD was increased comparing with that in the model group (P ＜ 0.01).CONCLUSION Heparin can improve oxidative damage induced by Taihu lake water drowning;it may be related to the antioxidation ability.

Objective To investigate the effect of Reduning (RDN) injection on acute lung injury(ALI)and heme oxygenase-1(HO-1) in LPS-·induced mice. Methods 48 male ICR mice were randomly divided into six groups:control group, LPS group, RDN group, LPS+RDN group, LPS+DEX group and LPS+RDN+ZnPP group. Mice were intratracheal instillation with LPS(5mg/kg)to induce ALI.After LPS administration for 24 h,bronchoalveolar lavage fluid(BALF)and lung tissue were collected for the histopathological examinations.Lung wet/dry(W/D)ratio,total cell counts,the content of LDH,lung tissue HO-1activity and HO-1 protein expression were examined.Results Compared with LPS group,lung W/D ratio,total cell counts and content of LDH were significantly decreased(P<0.05)while lung tissueHO-1 activity and HO-1 protein expression were significantly increased (P<0.05) in LPS+RDN group. The pathological changes of the lung were also significantly attenuated in LPS+RDN group and LPS+DEX group as compared to LPS group. ZnPP abolished the protective effects of RDN on LPS-induced ALI. Conclusion RDN has protective effect on LPS-induced ALI, and its protective effect is related to the increase of HO-1 expression and activity.

目的 研究硫辛酸对百草枯中毒大鼠胸腺的保护作用.方法 选取♂SD大鼠40只,随机均分为正常组、模型组、硫辛酸组(低、高剂量),于72 h后用比色法测定各组胸腺组织中GSH-PX、MPO的活力、免疫组化试剂盒检测CD4+及CD8+阳性细胞的表达.结果 硫辛酸组的胸腺皮、髓质分界清楚,表明硫辛酸可以提高GSH-PX活力,降低MPO活力,提高抗氧化能力,提高CD4+阳性表达,增强机体的细胞免疫功能.结论 硫辛酸能够改善百草枯对胸腺细胞的氧化损伤,可能与提高机体的抗氧化能力、调节酶活力、抑制炎症因子的积聚,而增强机体的细胞免疫功能有关.

目的:研究α-硫辛酸(α-lipoic acid,LA)对百草枯(paraquat,PQ)中毒大鼠胸腺Bax、Bcl-2表达及SOD活力、MDA水平的影响.方法:SD雄性大鼠40只,随机分为4组,分为正常组、模型组、α-硫辛酸低剂量组和α-硫辛酸高剂量组.实验结束后,取大鼠胸腺组织进行HE染色,观察大鼠胸腺组织结构的变化.采用黄嘌呤氧化酶法(羟胺法)测定SOD活力、MDA水平,SABC免疫组化试剂盒检测胸腺组织Bcl-2相关X蛋白(Human Bcl-2 associated X protein,Bax)和重组人B细胞淋巴瘤因子2(B-Cell lymphoma-2,Bcl-2)的表达.结果:模型组胸腺皮质区淋巴细胞呈松散状分布,皮髓质分界较模糊.与正常组比较,模型组大鼠胸腺组织SOD活力显著下降(P＜0.01),MDA水平显著升高(P＜0.01);Bax和Bcl-2蛋白表达量有所增加(P＜0.01).与模型组比较,LA低剂量组和高剂量组大鼠胸腺组织SOD活力均明显升高(P＜0.01),MDA水平明显下降(P＜0.01);Bax和Bcl-2蛋白表达量明显减少,Bcl-2/Bax比值明显提高(P＜0.01).结论:LA可能通过增高Bcl-2/Bax比值而抑制胸腺淋巴细胞的凋亡,从而为LA抗氧化损伤治疗PQ中毒的实验方法提供依据.

1 资料与方法 病例1:男性,57岁,以不规则低热、咳嗽伴痰中带血起病,48 d后症状加重,胸部CT示右下肺感染.血肌酐258 μmol/L,双肾B超无异常.给予抗感染、止血等治疗无效.

目的探讨血红素加氧酶-1基因启动子区短串连重复序列的等位基因多态性与急性冠状动脉综合征(ACS)易感性之间的关系。方法采用PCR扩增技术和聚丙烯酰胺凝胶电泳方法分析64例ACS患者和56例对照者HO-1基因启动子区GT二核苷酸重复序列的分布。结果ACS患者组和对照组在年龄、性别等方面差异无统计学意义(P>0.05);ACS患者和对照组中HO-1基因启动子区L型等位基因频率分别为21.88%和10.72%,两者差异有统计学意义(P<0.05)。结论HO-1基因启动子区短串连重复序列多态性与ACS患者的易感性可能有关。