VEGF基因转染血管内皮祖细胞的实验研究

目的:探讨血管内皮生长因子（VEGF）基因转染血管内皮祖细胞（EPCs）的方法及效果。方法:取生长活跃的EPCs，分别转染不同浓度的携带VEGF-165基因的腺病毒质粒（Adv-GFP-VEGF165）（转染组）及空质粒（Adv-GFP）（空质粒组），并设空白对照组。荧光显微镜下观察转染效果，MTT法检测不同病毒滴度时细胞增殖情况；ABC-ELISA法检测上清液中VEGF蛋白表达情况。结果:转染组镜下观察到大部分细胞呈现绿色荧光。病毒滴度为1∶100的转染会导致细胞生长停滞，并造成细胞损害； 1∶50的转染后对细胞增殖无明显影响。ELISA检测证实转染组上清液中VEGF蛋白浓度明显高于空质粒组及空白对照组（P<0.01）。结论:以腺病毒为载体的VEGF基因转染EPCs是可行的，1∶0是合适的转染比率，转染后上清液中VEGF蛋白表达明显增加。     

大动脉炎手术与腔内治疗的效果及其影响因素

目的研究中国人种族中,大动脉炎腔内治疗及转流手术疗效的比较,以及影响因素的分析,为国人大动脉炎治疗方式的选择及术后合并症的预防提供数据参考。方法研究对象选取从2002年1月至2014年7月,在首都医科大学附属北京安贞医院血管科诊断为大动脉炎并进行外科治疗的患者,诊断标准采用1990年美国风湿病学会制定标准,对患者随访后进行数据分析。结果共行手术49例次,女性44例,占89.8%,平均发病年龄(27.20±10.35)岁,手术27例,腔内治疗22例(支架置入7例、球囊扩张15例),共处理病变血管61根。随访时间3~148个月,平均(50.43±42.708)个月,无死亡病例。通畅率方面,3个月通畅率97.8%,6个月通畅率95.6%,1年通畅率88.3%,3年通畅率79.6%,5年通畅率76.1%,10年通畅率57.1%。单纯球囊扩张成形术与球囊扩张+支架置入术,1年通畅率分别为91.7%和68.6%(P=0.045)。合并症方面,早期合并症仅有2例出血,晚期合并症共出现13例,其中脑梗死1例,血栓栓塞6例,再狭窄5例(支架内再狭窄2例,球囊扩张后再狭窄3例),人工血管排异反应1例,其中腔内治疗5例,转流手术8例(P=0.002)。累计无合并症比率1年为88.1%,3年为79.0%,5年为75.4%,10年为51.9%。Logistic回归分析提示,随访期间免疫指标异常是术后合并症独立危险因素(OR=7.596,CI:1.091-52.884,P=0.041)。结论转流手术与腔内治疗在3年和5年远期通畅率上,转流手术要明显优于腔内治疗;随访期间免疫指标的异常是术后出现合并症的独立危险因素,因此术后免疫调节显得尤为重要;球囊扩张成形术较球囊扩张加支架置入术有更好的一期通畅率。     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

主髂动脉破裂外科治疗23例体会

目的探讨外科手术在主髂动脉破裂治疗中的地位。方法分析1984年4月至2003 年12月手术治疗的23例主髂动脉破裂患者的临床资料,主髂动脉瘤破裂18例,外伤性破裂5例。其中破损修补2例,人工血管置换21例。结果 23例患者中,手术抢救成功19例,死亡4例,其中术后48 h内死于急性肾功能衰竭2例,死于应激性溃疡并发消化道大出血1例,术后72 h内死于呼吸功能衰竭1例。结论对于主髂动脉破裂患者须积极纠正低血容量休克,同时迅速有效控制主髂动脉血流后尽快修补血管或行人工血管置换。     

旁路移植人工血管闭塞原因分析及再手术的术式选择

目的 分析旁路移植人工血管闭塞的原因，探讨再手术术式的选择。方法 回顾性分析自1993年1月至2002年5月治疗的旁路移植人工血管闭塞患者47例。均给予再手术治疗，其中单纯人工血管切开取栓9例；人工血管取栓 吻合口成形16例；人工血管或自体大隐静脉再移植22例。结果 单纯人工血管切开取栓术及人工血管取栓 吻合口成形术的2年再闭塞率分别为67％、56％，明显高于人工血管或自体大隐静脉再移植手术术式的9％。结论 人工血管或自体大隐静脉再移植手术的效果明显优于单纯人工血管切开取栓术及人工血管取栓 吻合口成形术。     

医源性股动脉假性动脉瘤的治疗方法

Objective To evaluate the effect on ultrasound-guided locsl comprression and surgical to treat iatrogenic fem- oral artery pseudoanerurysms. Methods 197 patients were diagnosed as iatrogenic femoral artery pseudoaneurysms from Apri 1199 to April 2008.There were 122 male and 75 female, aged 59.7 years (rimed 40- 81 years). One. Hundrel and severty-one stahle cases were managed by ultrasound-guided local compression initially and 26 patients were directly treated with surgical repair because d the rupture of femoral artery pesudoaneurysms or the pseudoaneurysms≥40mm in diameter. Results 171 patients received llocal com- pression therapy, 137 cases were cured directly (the effective rate was 80%), but the last failed 34 cases were required conversion to surgical reparr. The nymber of the surgical repaired patients was 60 (incluing 26 cases with direct operation and 34 cases with required conversion to surgical repair). Forty-seven patients received direct excision of femoral artery pseudoaneurysm, six patients underwent angioplasty with autogenously saphenous vein patch, and seven patients got bypass operation with artificial vascular graft. During the perioperative period, no serious complications including bleeding, neuralgia, and lymphatic fistula even arterio venous fis- tula and so on, no death occurred. All patients were followed up for 1 month to5 years after the procedures, no local FAP recurred, no limb ischemia developed and no deaths occurred. Conclusion Uitrasound-guided compression, surgical repair, and ultrasound- guided percutaneous thrombin injection are the three main modalities of treating iatrogenic FAP, while ultrasound-guided compresson and magical therapy get popularized domestically. Ultrasound-guided comperession seems a safe, inexpensive, and effective method for the managerment of iatrogenic femoral artery pseudoaneurysms. It may be used as a lust-line therapetic modality for mint of the un-complicated patients. However, surgical repair can be reserved for those who failed comperssion therapy or unsuitable as mentioned above.     

急性肠系膜动脉缺血性疾病的诊治分析——附27例报道

目的:探讨急性肠系膜动脉缺血的诊断和治疗方法。方法:回顾性分析自2002年5月至2008年12月我院共收治肠系膜动脉缺血性疾病患者27例。急诊行手术治疗21例,其中单纯行肠系膜上动脉取栓术9例,肠系膜上动脉切开取栓加肠切除吻合术8例,单纯肠切除吻合术3例,肠切除加肠造瘘术1例。保守治疗6例。结果:手术治疗21例,1例于死于感染性休克,5例出现短肠综合征,经胃肠外营养等对症治疗后症愈出院,6例行保守治疗者均症状减轻,好转出院。结论:彩超是早期诊断肠系膜动脉缺血的重要手段,及时手术和加强术后监护是提高疗效的关键。     

主髂动脉硬化闭塞症的腔内治疗

主髂动脉硬化闭塞症是血管外科的常见疾病,腔内技术治疗主髂动脉病变有良好的近远期疗效,已成为主髂动脉硬化闭塞症的首选方法。我科自2002年1月至2010年6月共行主髂动脉硬化闭塞症腔内治疗161例,报道如下。     

不同时期大动脉炎患者血浆差异表达蛋白的变化

目的 在血浆中筛选与大动脉炎疾病和时期相关的血浆差异表达蛋白.方法 提取各20例大动脉炎急、慢性期患者和20例健康者的血浆进行蛋白双向凝胶电泳,计算机图像软件分析筛选差异性表达的蛋白点,基质辅助激光解析电离飞行时间(MALDI-TOF)质谱鉴定差异表达蛋白.并对部分蛋白采用酶联免疫吸附法(ELISA)检测血浆中的含量.结果 筛选鉴定出疾病差异表达蛋白14种,包括血清淀粉样蛋白A,血清淀粉样P物质,纤维蛋白原,C3c,C4a,C7,C4结合蛋白,补体因子H-相关蛋白1,α-1酸性糖蛋白,重组激活基因蛋白1(RAG1),载脂蛋白A-Ⅰ、Ⅳ,α1-微球蛋白,转甲状腺素蛋白,结合珠蛋白;其中与大动脉炎不同时期相关的蛋白有血清淀粉样蛋白A、纤维蛋白原、转甲状腺素蛋白、结合珠蛋白.在ELJSA检测中,急性期患者血清中血清淀粉样蛋白A水平(中位数95.9 mg/L)和显著高于慢性期(中位数49.2 mg/L,P=0.009)和健康对照组(中位数23.9 mg/L,P=0.001).急性期补体C4结合蛋白C4BP(中位数88.5 mg/L)显著高于慢性期(中位数61.7mg/L,P=0.023)和正常对照(中位数32.6 mg/L,P=0.001).结论 大动脉患者血浆有多种免疫有关蛋白和急性时相蛋白的表达,有可能用于疾病不同时期的判定;补体激活,补体调节蛋白和自身抗体的产生均参与大动脉炎的免疫病理机制,对这些蛋白的进一步研究有助于阐明大动脉炎的病理机制.     

腔内修复治疗破裂性腹主动脉瘤合理性、有效性、安全性研究

目的 探讨腹主动脉腔内修复（EVAR）治疗破裂性腹主动脉瘤（RAAA）的合理性、有效性和安全性。方法 回顾性分析2005年8月至2020年1月首都医科大学附属北京安贞医院收治的112例RAAA病人资料，对EVAR组和开放手术（OSR）组围手术期结果进行比较分析。结果 EVAR组和OSR组30 d病死率分别为12.3%（8/65）和12.8%（6/47），两组差异无统计学意义（P=0.942），围手术期各种并发症发生率及二次手术干预率两组差异均无统计学意义。EVAR组和OSR组手术时间分别为（3.5±1.7）h和（7.2±3.1）h，差异有统计学意义（P＜0.01）；EVAR组和OSR组术中出血量分别为（267.7±433.9）mL和（2721.3±2112.1）mL，差异有统计学意义（P＜0.01）；EVAR组和OSR组术中输红细胞量分别为（2.2±4.2）U和（7.2±3.1）U，差异有统计学意义（P＜0.01）；EVAR组和OSR组术中输血浆量分别为（147.7±324.6）mL和（1121.3±754.1）mL，差异有统计学意义（P＜0.01）。EVAR组ICU时间为（6.9±8.0） d，低于OSR组（8.6±8.4） d，但差异无统计学意义（P=0.285）；EVAR组住院时间为（13.3±10.4） d，低于OSR组（21.8±11.1） d，差异有统计学意义（P＜0.01）。结论 EVAR治疗RAAA有与OSR相似的30 d病死率和并发症发生率，而EVAR有更短的手术时间，更少的术中出血量和输血量、更短的住院时间。EVAR治疗RAAA是合理、有效、安全的。