乌司他丁注射液对急性肺损伤循环内皮祖细胞血管生成能力的影响

目的观察乌司他丁注射液对急性肺损伤循环内皮祖细胞血管生成能力的影响。方法成年新西兰大耳白兔(2.5kg~3.0kg)共40只随机分为3组,正常对照组、急性肺损伤组、急性肺损伤组+乌司他丁治疗组分别采用免疫组化法观察肺毛细血管密度,病理评价肺泡炎症。检测体外内皮祖细胞成血管能力。结果 HE染色评估肺泡炎症发现急性肺损伤与乌司他丁治疗组差异有统计学意义(P0.05);免疫组化观察到乌司他丁治疗组肺毛细血管密度较正常对照组、急性肺损伤组增加(P0.05);在体外进行细胞培养同样发现乌司他丁治疗组内皮祖细胞的成血管能力较正常对照组、急性肺损伤组提高(P0.05)。结论乌司他丁注射液能提高急性肺损伤循环内皮祖细胞成血管能力。     

一氧化氮减轻亚致死量高张氧引起的大鼠肺内皮损伤

已有报道,一氧化氮(NO)可改善实验性急性肺损伤动物高张氧通气的血氧含量、降低增高的肺动脉压。而且,NO既有防止氧化剂诱导肺损伤的保护作用,本身又可衍生氧化剂参与介导肺损伤。吸入NO对高张氧通气时的肺屏障功能有何影响尚未明了。因此,作者制备了实验动物模型,观察SD大鼠吸入NO(20ppm)对高浓度氧(95％O_2所致肺泡上皮屏障功能损害的影响。     

冠心病患者血白细胞不同亚群内载脂蛋白(a)和载脂蛋白B100含量的变化

目的研究冠心病患者白细胞不同亚群内载脂蛋白(a)和载脂蛋白B100的变化,并分析其与冠状动脉狭窄病变的关系。方法对冠状动脉造影证实无冠状动脉病变者(n=18)和冠状动脉三支病变者(n=13)进行研究。通过逆转录聚合酶链反应和荧光共聚焦显微镜、流式细胞仪分别检测细胞内载脂蛋白(a)和载脂蛋白B100的基因表达和蛋白含量。结果通过逆转录聚合酶链反应发现白细胞不能合成载脂蛋白(a)和载脂蛋白B100,而荧光共聚焦显微镜和流式细胞仪均证实白细胞三亚群内存在载脂蛋白(a)和载脂蛋白B100。流式细胞仪定量分析发现,冠状动脉三支病变组与无冠状动脉病变组比较细胞内代表载脂蛋白B100含量的平均荧光强度粒细胞(417±250比183±88,P<0.05)、单核细胞(189±77比41±13,P<0.01)及淋巴细胞(102±65比16±6,P<0.01)都明显增加,分别增加了128%、364%和532%。经过与血浆载脂蛋白B100浓度校正后也存在明显差异(P<0.01)。结论白细胞各亚群均可携带载脂蛋白(a)和载脂蛋白B100,其中细胞内载脂蛋白B100含量增加与冠状动脉狭窄病变有关。     

急性肺损伤时血中可溶型选择素-P值升高

在发生ARDS或急性肺损伤(ALI)时,中性白细胞和肺毛细血管内皮细胞的许多粘连分子介导中性白细胞肺内聚积。已证明血管内皮细胞和血小板的选择素-P(P-selection)即为一种中性白细胞与内皮细胞的粘连分子。本次研究测定了ALI患者血中可溶型选择素-P(PPS)值,并与其他肺疾患或无ALI的败血症患者进行对比。     

盐酸戊乙奎醚预处理对大鼠肺损伤早期血管内皮生长因子的影响

目的 探讨盐酸戊乙奎醚预处理对大鼠肺损伤早期血管内皮生长因子(VEGF)的影响,以及VEGF在肺损伤早期诊断中的意义. 方法 SD大鼠随机分为正常对照组、模型组和盐酸戊乙奎醚高、中、低剂量组,尾静脉注射脂多糖,建立全身炎症反应综合征-急性肺损伤(SIRS-ALI)模型.以ELISA法观察肺组织和血清VEGF的表达,光镜观察肺组织的病理改变,测定肺组织髓过氧化物酶(MPO)及超氧化物歧化酶(SOD)活性、肺湿重/干重比值(W/D),并进行动脉血气分析. 结果 模型组大鼠肺脏组织和血清VEGF表达显著增多,MPO活性显著增高,SOD活性降低(P＜0.05);盐酸戊乙奎醚可以有效抑制上述改变. 结论 盐酸戊乙奎醚可抑制肺损伤早期VEGF的表达,发挥保护作用; VEGF可以提示早期肺损伤.     

血管生成素与急性肺损伤

急性肺损伤是由肺毛细血管通透性增高而致的肺水肿,表现为重力依赖性的不均匀实变性疾病,而近年来发现血管生成素家族在调节毛细血管通透性、抗炎及调节肺动脉高压方面具有重要作用,本文就近年来两者关系研究的最新进展加以综述.     

亚低温对急性肺损伤大鼠NF-κB、TNF-α影响的研究

目的探讨亚低温对内毒素（LPS）致急性肺损伤大鼠的保护作用及可能机制。方法雄性SD大鼠48只,按随机数字表法分为常温内毒素组（A组,n=12）、亚低温内毒素组（B组,n=12）、常温空白对照组（C组,n=12）、亚低温空白对照组（D组,n=12）。腹腔注射内毒素制备急性肺损伤大鼠模型,观察不同时间段各组大鼠血气变化、血清NF-κB、TNF-α含量变化以及处死后各组大鼠肺组织病理形态学变化和干湿重变化。结果与两组空白对照组相比,内毒素两组大鼠PCO2、肺含水量、肺血清NF-κB、TNF-α含量均明显升高（P〈0．05）,病理形态学显示肺组织中性粒细胞浸润、毛细血管充血、水肿及出血明显。与常温内毒素组相比,亚低温内毒素组大鼠肺组织病变明显减轻,各生物学指标及NF-κB、TNF-α水平也相应下降（P〈0．05）。结论亚低温能明显减少急性肺损伤大鼠血清中NF-κB、TNF-α含量,延缓了急性肺损伤的发展进程。     

肺泡上皮细胞钠水转运与急性肺损伤

急性肺损伤主要导致肺泡毛细血管膜(呼吸膜)破坏,呼吸膜通透性增加,导致肺内液体潴留;而肺泡上皮屏障是决定呼吸膜通透性的主要因素。     

有效肺毛细血管压

成人呼吸窘迫综合症(ARDS)常伴有肺水肿,其范围和程度与肺血管内皮滤过的液体及蛋白成比例。毛细血管压的改变对滤过量影响较大,故认为降低毛细血管压是治疗通透性肺水肿的基本原则之一。通透性变化难以测定,故通透性肺水肿的定义为,无流体静压升高的肺水肿。虽通透性与流体静压性肺水肿不同,但因通透性增加与流体静压升高多同时发生,故作者认为没有必要将二者加以区分。【Starlings 方程式】Qfc=Kfc(△P-(?)△π),此处Qfc 为毛细血管滤过率,Kfc 为毛细血管滤过系数,△P为血管内压与组织静水压差,。为毛细血管壁     

上调微小RNA-142-3p对心肌肥厚中线粒体功能的影响

目的观察微小RNA(microRNA,miR)-142-3p对血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)诱导的心肌肥厚中线粒体功能的影响。方法我们使用Sprague-Dawley(SD)大鼠的乳鼠心肌细胞,细胞培养后分成4组:空白组;AngⅡ组;miR nc+AngⅡ组;miR-142-3p mimic+AngⅡ组。分别往细胞中转染相同浓度的miR-142-3p和miR nc质粒6 h,实时定量聚合酶链反应(real-time polymerase chain reaction,rt-PCR)检测实验组miR-142-3p mRNA表达增多,提示细胞质粒转染成功,再用10-6mol/L浓度的AngⅡ诱导细胞48 h,使用线粒体MitoRed Tracker处理细胞30 min,共聚焦显微镜观察细胞中线粒体密度的变化;使用流式细胞仪检测线粒体膜电位变化。结果与空白组相比,AngⅡ组的线粒体膜电位减低(n=3,P0.01);与AngⅡ+miR nc组相比,AngⅡ+miR-142-3p组的线粒体膜电位增加(n=3,P0.01)。与空白组相比,AngⅡ组的线粒体荧光数量减低(n=3,P0.01);与AngⅡ+miR nc组相比,AngⅡ+miR-142-3p组的线粒体荧光数量增加(n=3,P0.01)。结论在AngⅡ诱导心肌肥大过程中miR-142-3p对心肌线粒体具有保护作用。     

间质性肺疾病与肺癌

间质性肺疾病(ILD)患者中肺癌的发病率增高,特别是特发性肺纤维化合并肺癌的报道最多.ILD合并肺癌的病理类型以鳞状细胞癌最多,好发于肺下叶和外周部位.ILD的一些肿瘤标记物增高,与疾病的活动程度、严重程度、肺纤维化程度和病情预后等有关,并且具有一定的诊断价值.ILD的肿瘤标记物增高可能是其合并肺癌的危险因素.本文对I...     

肺癌和癌旁正常肺组织中5种肿瘤标志物比较研究

目的 探讨肺癌组织及癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子的含量。方法 应用放射免疫法测定39例肺癌和癌旁正常肺组织中心钠素、分泌型IgA、铁蛋白、DNA聚合酶、血管内皮生长因子5种肿瘤标志物含量。结果 5种肿瘤标志物在肺癌组织中的含量均高于癌旁正常肺组织，差异有统计学意义（P均〈0．001）。结论 肺癌细胞具有产生物质的作用。     

Quantitative lung perfusion following single lung transplantation

BACKGROUND: Following successful lung transplantation, most of the lung perfusion, as well as ventilation, is shifted towards the transplanted lung. We investigated the changes in perfusion during exercise in lung transplant recipients. PATIENTS AND METHODS: Twelve patients were included in the study. Six patients had emphysema and 6 patients had idiopathic pulmonary fibrosis (IPF). Patients underwent two upright lung perfusion scans: the first at rest and the second during a maximal cardiopulmonary exercise test. Lung perfusion was assessed in each lung and regionally. RESULTS: At rest, patients with emphysema had 83.3 +/- 8 % of total perfusion to the transplanted side and 16.7 +/- 8 % to the native lung, while in the IPF patients, it was 68.7 +/- 12 and 32.7 +/- 10 %, respectively ( P = 0.028). At peak exercise, perfusion shifted from the transplanted lung to the native lung ( P = 0.0095) both in emphysema and IPF patients. CONCLUSIONS: Following successful lung transplantation, most of the perfusion is directed towards the transplanted lung. During exercise, there was a small but significant shift towards the native lung. These findings highlighted the important role of the native lung during maximal exercise.     

The effect of lung biopsy on lung function in diffuse lung disease.

The aim of this study was to investigate the effect on lung function of lung biopsy used in the diagnosis of diffuse lung disease carried out by an open procedure or by video-assisted thoracoscopy. One hundred and sixteen patients with diffuse lung disease who attended the Royal Brompton Hospital were studied retrospectively. Thirty five patients underwent open lung biopsy, and 33 video-assisted thoracoscopic biopsy and 48 had their diagnosis made without biopsy. All patients underwent lung function tests before and after surgery, or at an interval of 3-6 months in those who did not undergo biopsy. No significant differences were found in changes in lung function between those who had and had not undergone biopsy, and the proportions of patients whose lung function improved or deteriorated were similar. Lung biopsy by an open procedure or by video-assisted thoracoscopy did not differ in its effects on lung function. The results for older patients, those with severe disease and those with fibrosing alveolitis were the same as for the whole group. Open lung biopsy for the diagnosis of diffuse lung disease does not deleteriously affect lung function whether carried out by an open or a minimally invasive procedure.     

Successful lung transplantation following lung volume reduction surgery

BACKGROUND: Lung volume reduction surgery (LVRS) is an accepted treatment modality for patients with advanced emphysema. Recently, successful lung transplantation (LTX) has been reported following LVRS. We assess the pulmonary functions in lung transplant recipients after LVRS. METHODS: 8 patients - 5 males and 3 women--aged 53-66 years with advanced emphysema underwent LVRS. Following clinical deterioration and decline of pulmonary function, patients underwent single LTX. Post transplantation follow-up included pulmonary function, 6 minute walk distance (6 MWD) and recording perioperative complications. RESULTS: Median forced expiratory in one second (FEV 1) before and after LVRS were 24 % with 31 % predicted, respectively. All but one showed improvement in lung function and 6 MWD following LVRS. Median maximal 6 MWD before and after LVRS was 222 and 316 meters, respectively. Median time from LVRS to LTX was 46 months (range 10-83). All patients survived and were discharged after LTX. Median FEV1 before and after LTX was 23 % with 57 % predicted, respectively. Median 6MWD before and after LTX was 240 and 462 meters, respectively. NYHA classes improved from 3-4 to 1-2 in 7 surviving patients. At transplantation, bleeding due to pleural adhesions was observed in 4 patients; two required blood transfusions. One patient developed acute respiratory distress syndrome and one had unilateral vocal cord paralysis. At nine-month follow-up, 7 patients are doing remarkably well, while one patient died 6 months after LTX due to bronchiolitis obliterans syndrome (BOS). CONCLUSIONS: LVRS is a therapeutic option in patients with end-stage emphysema. When emphysema deteriorates, LTX can be successfully performed with significant improvement of quality of life without significant additional risk.