心肌梗死延迟增强三维与二维MR成像对比研究

Objective To prospectively evaluate the correlation between a single breath-hold three-dimensional (3 D) and several breath-hold two-dimensional (2D) delayed enhancement MR imaging sequences in the assessment of myocardial infarction size and the differences on image quality. Methods Fifteen patients with myocardial infarction underwent MR scan by using a single breath-hold 3D inversion-recovery fast low-angle shot (FLASH) sequence and several breath-hold 2D turbo-FLASH as the reference standard. Paired-samples t test was used to compare the ratio of the infarction areas in two sequences. Two-way ANOVA was used to assess the contrast-to-noise ratio (CNR) on 3D,2D magnitude-reconstructed and 2D phase-sensitive (PS) images. P value less than 0.05 was considered to indicate a significant difference. Meanwhile subjective visual evaluation was also performed to compare the image quality. Results The infarction ratio determined by 3D MR imaging 31.28% was no significant difference with that of 2D MR imaging 30.91% and had a good correlation (t = -0.505,P =0.621,r =0.990). The CNR was significantly higher in 3D and 2D magnitude-reconstructed groups than in 2D-PS group (3D and 2D magnitude-reconstructed images, 2D P5 image, 43.43±20.67 and 34.10±14.29, 7.59±2.59, respectively) (F = 24.376, P < 0.01). However, the contrast between normal and infracted myocardium was the highest in 2D-PS group with subjective visual evaluation (scores of 3D, 2D magnitude-reconstructed and 2D-PS images, 2.33, 2.13 and 2.73, respectively). On the other hand, the background noise on 2D-PS images was the highest in 3 groups (scores of 3 D, 2 D magnitude-reconstructed and 2 D-PS images, 2.67, 2.53 and 1.20, respectively). Conclusion The myocardial infarction ratio obtained with 3D MR imaging sequence is accurate, and the image quality is good.     

单次屏气及自由呼吸TSENSE技术对心功能测量及图像质量的评价

目的:评价TSENSE技术在不同加速因子及自由呼吸状态下测量心功能的准确性及图像质量.方法:15例患者真实稳态自由进动(trueFISP)全心短轴位电影检查.检查序列包括多次屏气trueFISP结合GRAPPA,不同加速因子(2～4)单次屏气TSENSE和自由呼吸TSENSE(R=3).测量并比较各种序列所测心脏射血分数(EF)、舒张末期容积(EDV)和收缩末期容积(ESV).结合乳头肌水平图像的对比噪声比(CNR)对各序列图像质量进行评价.结果:与GRAPPA相比,TSENSE各序列所测心功能指标差异无显著性意义(P＞0.05),两者结果具有一致性.各序列图像均具有诊断性,以GRAPPA和R=2时TSENSE图像质量最佳.结论:单次屏气和自由呼吸TSENSE技术全心扫描能准确评价左心室容积大小,以R=3时TSENSE序列最适合临床运用.     

孤立性肺病变相关支气管的CT最小密度投影与多平面重组对照研究

目的 探讨64层CT的MinIP与MPR在显示孤立性肺病变(SPL)相关支气管中的临床应用价值.方法 回顾性分析64层CT可明确显示SPL相关支气管关系者75例,将0.625 mm薄层重建图像沿SPL相关支气管长轴分别重组为2个斜面的MinIP和MPR图像,重组层厚分为1、2、3和5 mm 4组,对显示支气管和屏蔽肺血管方面进行图像质量评估.采用方差分析及组内相关系数进行统计学分析.结果 (1)两斜面显示SPL相关支气管4组MinIP图像的平均积分(1 mm均为4.85分,2 mm分别为4.77和4.84分,3 mm分别为4.63和4.67分,5 mm分别为4.25和4.28分)和1、2 mm层厚组MPR图像(1 mm分别为4.77和4.76分,2 mm分别为4.04和4.27分)均优良.两斜面MPR图像1 mm层厚组的平均积分与MinIP图像1～3 mm层厚组差异无统计学意义(t值均为0.318,P值均>0.05),明显高于5 mm层厚组(t值分别为6.318和6.610,P值均<0.01);两斜面MPR图像2 mm层厚组的平均积分较MinIP图像1～3 mm层厚组低(t值5.003～8.958,P值均<0.01),与5 mm层厚组差异无统计学意义(t值分别为1.794和0.3181,P值均>0.05).(2)两斜面MinIP图像肺血管屏蔽随层厚增厚效果越好(F值分别为45.312和40.415,P值均<0.01),3、5 mm层厚组平均积分(3 mm分别为4.67和4.64分,5 mm分别为5.00和4.97分)均优良,而2 mm层厚组平均积分(2 mm分别为3.32和3.20分)一般.结论 3 mm层厚的MinIP可清晰显示孤立性肺病变相关支气管.

Abstract：

Objective To investigate the clinical value of 64-slice computed tomography with MinIP and MPR for imaging the bronchus related to a solitary pulmonary lesion (SPL). Methods Seventy-five subjects with solitary pulmonary lesions underwent chest 64-slice CT and their bronchi were analyzed retrospectively. All images of thin-section (0.625 mm) were reconstructed with MPR and MinIP into images of 1, 2, 3, and 5 mm thickness and 1 mm gap in two orthogonal planes along the long axis of bronchus related to the SPL. The image quality of four series of MinIP and MPR images was evaluated in the aspect of bronchus visibility and pulmonary vascular masking. One-way ANOVA with Bonferroni correction and interclass correlation coefficient were used in the statistical analysis. Results (1) The mean scores of display of the bronchi on MinIP images of four series (4.85, 4.77 and 4.84, 4.63 and 4.67, 4.25 and 4.28, in 1, 2, 3, and 5 mm thickness, respectively) and on MPR images of 1 or 2 mm thickness (4.77 and 4.76, 4.04 and 4.27, in 1 and 2 mm thickness, respectively) were good or excellent. MPR images of 1 mm thickness and MinIP images of 1-3 mm thickness showed no significant differences (t=0.318, P> 0.05 for all), but they were superior to MinIP images of 5 mm thickness (t=6.318 and 6.610, P＜0.01). MPR images of 2 mm thickness were inferior to MinIP images of 1-3 mm thickness (t=5.003-8.958, P＜0.01), but there was no significant difference between MPR images of 2 mm thickness and MinIP images of 5 mm thickness (t=1.794 and 0.3181, all P> 0.05). (2) The effect of suppression of pulmonary vascular markings on MinIP images was better with the increase of slice thickness (F=45.312 and 40.415, P＜0.01). The mean scores of MinIP images of 3 mm and 5 mm thickness (4.67 and 4.64, 5.00 and 4.97, for 3 and 5 mm thickness, respectively) were good or excellent, but MinIP images of 2 mm thickness were just acceptable. Conclusion MinIP images of 3 mm thickness may display the bronchus related to SPL more clearly.     

自噬在低氧诱导人肾小管上皮细胞凋亡中的作用

目的：探讨自噬在低氧诱导人肾小管上皮细胞株（HK-2）凋亡中的作用。方法：培养HK-2细胞,根据培养环境氧浓度不同分为对照组（21%O2）和低氧组（1%O2）;根据低氧培养时间不同,低氧处理细胞进一步分为：低氧6 h亚组、低氧12 h亚组、低氧18 h亚组和低氧24 h亚组。Western blot检测HK-2细胞自噬相关蛋白Beclin1、LC3Ⅱ/LC3Ⅰ、P62和凋亡相关蛋白活化的天冬氨酸特异性半胱氨酸蛋白酶（cleaved-caspase3）表达水平,流式细胞仪检测HK-2细胞凋亡情况;采用低氧诱导稳定表达GFP-LC3的HK-2细胞18 h,在荧光显微镜下观察GFP-LC3自噬小体的变化;进一步采用低氧联合自噬诱导剂雷帕霉素（ra－pamycin,RP）或自噬抑制剂巴弗洛霉素A1（bafilomycin A1,BAfA1）处理HK-2细胞,细胞分为常氧对照组、常氧+雷帕霉素/或巴弗洛霉素组、低氧对照组、低氧+雷帕霉素/或巴弗洛霉素组。Western blot检测Beclin1、LC3Ⅱ/LC3Ⅰ、P62和cleaved-caspase3表达水平,流式细胞仪检测细胞凋亡情况。结果：与对照组（0.161±0.043）相比较,低氧12 h[（0.315±0.060）,P=0.019]、18 h[（0.586±0.063）,P=0.000]、24 h[（0.698±0.085）,P=0.000]亚组HK-2细胞cleaved-caspase3蛋白表达明显增多;低氧12 h、18 h、24 h亚组HK-2细胞凋亡率分别为（23.633±5.346）%、（25.200±4.782）%、（38.567±8.046）%,较对照组（11.800±3.966）%明显增多（P=0.036,P=0.021,P=0.000）。同时,低氧18 h、24 h亚组HK-2细胞表达Beclin1蛋白[（0.557±0.071）,（0.897±0.074）[较对照组（0.249±0.040）明显上调（P=0.001,P=0.000）;低氧6 h、12 h、18 h、24 h亚组细胞表达LC3Ⅱ/LC3Ⅰ蛋白[（1.795±0.143）,（2.873±0.078）,（3.029±0.089）,（3.735±0.059）]较对照组（1.322±0.191）明显上调（P=0.036,P=0.000,P=0.000,P=0.000）;细胞表达自噬底物P62蛋白[（0.776±0.061）,（0.602±0.119）,（0.419±0.117）,（0.384±0.068）]较对照组（0.957±0.035）明显下调（P=0.028,P=0.001,P=0.000,P=0.000）;低氧组细胞GFP-LC3斑点计数相对值为（40.667±6.028）,较对照组（18.667±5.508）明显增加（P=0.010）。雷帕霉素增加自噬后,低氧诱导的HK-2细胞凋亡（26.433±3.402）及cleaved-caspase3蛋白表达（0.265±0.066）较低氧对照组[（36.133±5.856）,（0.358±0.060）]明显减少（P=0.012,P=0.000）;巴弗洛霉素A1抑制自噬后,低氧诱导的HK-2细胞凋亡增多（49.233±3.412）及cleaved-caspase3蛋白表达（1.242±0.110）较低氧对照组[（25.933±3.650）,（0.659 ± 0.060）]明显增加（P=0.000,P=0.000）。结论：自噬在低氧诱导的HK-2细胞凋亡中起保护作用。     

白细胞介素6通过抑制自噬促进人脐静脉内皮细胞凋亡

目的：探讨IL-6对血管内皮细胞自噬和凋亡的影响以及自噬与凋亡的相互作用关系。方法：采用不同浓度IL-6诱导体外培养的人脐静脉内皮细胞(human umbilical vein endothelial cells, HUVECs),Cell Counting Kit-8(CCK-8)法检测细胞增殖与活性,流式细胞术检测细胞凋亡变化,单丹(磺)酰戊二胺(MDC)染色观察细胞嗜酸性自噬泡情况,透射电镜观察细胞超微结构的变化,Western blot检测凋亡相关蛋白激活型天冬氨酸特异性半胱氨酸蛋白酶(Cleaved-caspase3)以及自噬相关蛋白微管相关蛋白轻链3(microtubule-associated protein 1 light chain 3,LC3)和(sequestosome 1, SQSTM1)/P62表达水平。进一步采用IL-6分别联合自噬诱导剂雷帕霉素(Rapamycin,RP)诱导自噬或3-甲基腺嘌呤(3-Methyladenine,3-MA)抑制自噬,观察自噬对IL-6诱导血管内皮细胞凋亡的影响。结果：1. 与对照组相比,IL-6可以呈浓度依赖性降低血管内皮细胞的活性(P＜0.05),增加血管内皮细胞的凋亡(P＜0.05)和Cleaved-caspase3的表达(P＜0.05);2. IL-6浓度依赖性降低血管内皮细胞内LC3-II/LC3-I的表达(P＜0.05)而增加P62的表达(P＜0.05),在IL-6刺激下,MDC 染色观察可见血管内皮细胞内自噬泡逐渐减少(P＜0.05),荧光强度明显减弱,透射电镜下表现为自噬小体明显减少;3. 采用自噬抑制剂3-MA刺激血管内皮细胞,发现3-MA可以进一步抑制IL-6刺激下的血管内皮细胞的自噬水平而增加凋亡水平,表现为LC3-II/LC3-I的表达进一步下降(P＜0.05)和P62的表达进一步增加(P＜0.05),血管内皮细胞内的自噬泡和自噬小体数量明显减少(P＜0.05),并且3-MA可以进一步增加IL-6刺激下血管内皮细胞的凋亡(P＜0.05)和Cleaved-caspase3的表达(P＜0.05);4. 进一步采用自噬促进剂RP刺激血管内皮细胞,发现RP可以改善IL-6刺激下的血管内皮细胞的自噬水平而降低凋亡水平,表现为LC3-II/LC3-I的表达升高(P＜0.05)和P62的表达下降(P＜0.05),血管内皮细胞内的自噬泡和自噬小体数量的增多(P＜0.05),并且RP可以明显减少IL-6刺激下血管内皮细胞的凋亡(P＜0.05)和Cleaved-caspase3的表达(P＜0.05)。结论：白介素-6可通过抑制自噬而增加血管内皮细胞凋亡。     

单次屏气TGRAPPA及TmSENSE技术对左右心功能测量的应用研究

【摘要】目的：对比评价单次屏气TGRAPPA、TmSENSE与多次屏气GRAPPA技术结合true FISP电影在评价左右心室功能中的价值。方法：对37例行心脏MRI检查的患者,进行真实稳态自由进动采集全心短轴位电影检查,检查序列包括多次屏气GRAPPA结合true FISP电影检查及单次屏气TGRAPPA及TmSENSE。测量并比较各种序列的扫描时间、左右心室射血分数（EF）、舒张末期容积指数（EDVI）、收缩末期容积指数（ESVI）及心搏量（SV）。选取乳头肌水平图像进行图像质量评价及CNR分析。结果：多次屏气GRAPPA、单次屏气TGRAPPA及TmSENSE的扫描时间（189±57;17±5;17±5s）具有显著统计学差异（P＜0.01）;测得的左室功能参数EF（53.6±17.1、53.8±17.2、53.7±17.4％）、EDVI（80.4±33.2、79.9±33.4、79.5±33.7mL/m2）、ESVI（41.7±35.8、41.6±36.3、41.1±35.9mL/m2）、SV（38.7±10.2、38.2±10.7、38.3±10.8mL/m2）;右心室功能参数EF（52.0±15.6、52.7±15.7、52.5±15.7％）、EDVI（69.8±23.9、69.1±23.9、69.1±23.5mL/m2）、ESVI（34.9±21.2、34.2±21.5、34.2±21.1mL/m2）、SV（34.9±12.7、34.9±12.6、34.9±12.9mL/m2）;经统计学分析,三种方法的结果差异均无显著性意义（P＞0.05）。从图像质量上评价,相较于传统的多次屏气方法,TGRAPPA、TmSENSE技术的CNR会下降（P＜0.05),但TGRAPPA的CNR及图像质量评分高于TmSENSE。结论：单次屏气TGRAPPA、TmSENSE技术能够完成左右心功能的评价,相较于传统GRAPPA技术,明显缩短了采集时间,达到快速扫描的目的,TGRAPPA图像质量优于TmSENSE。     

疏血通联合奥扎格霉钠治疗脑梗死50例临床疗效观察

目的:观察疏血通与奥扎格霉钠联合治疗脑梗死的疗效。方法:选择脑梗死病人100例,随机分成两组,治疗组给予疏血通注射液6ml加入生理盐水250ml中静脉滴注,每天1次,和奥扎格霉钠80mg每天1次,联合用药,共14天。对照组给予丹参注射液常规治疗。治疗前后比较两组病人神经功能缺损。结论:治疗组基本痊愈和显著好转患者明显高于对照组(P<0.05),疏血通和奥扎格霉钠联合应用治疗脑梗塞疗效满意。     

睡眠行为干预配合药物治疗老年顽固性失眠临床观察

目的探讨睡眠行为干预配合右佐匹克隆、盐酸曲唑酮对老年顽固性失眠的疗效和安全性。方法将80例老年失眠症患者分为对照组和观察组各40例,对照组按照传统方法常规服用地西泮;观察组采用睡眠行为干预配合口服盐酸曲唑酮50 mg/d晚饭后服用,右佐匹克隆3 mg/d,(老年人起始剂量为1 mg/d),睡前服用。4周为1个疗程,2组在治疗前后采用睡眠状况自评量表(SRSS)进行评分比较。结果治疗后观察组(SRSS)评分明显低于对照组,差异有统计学意义(P<0.01)。结论睡眠行为干预配合右佐匹克隆/盐酸曲唑酮对老年顽固性失眠的疗效肯定且安全。     

脑梗死与颈动脉狭窄的关系及相关危险因素分析

目的:探讨脑梗死与颈动脉狭窄的关系及相关危险因素的调查。方法:对634例患者(包括72例脑梗死患者及52例腔隙性脑梗死患者)分别进行彩色多普勒超声检测,并记录2组颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径。用水银柱式血压计、医用磅称、自动生化分析仪完成血压、身高、体重、血糖、血脂检测,统计吸烟指数。结果:脑梗死组颈动脉粥样硬化斑块检出率、左右颈总动脉内径[81.94%、(7.24±0.07)mm、(7.21±0.60)mm]与腔隙性脑梗死组[28.85%、(7.45±0.10)mm、(7.52±0.75)mm]比较差异均有显著性(均P<0.05)。颈动脉狭窄程度与血脂、血糖、高血压、肥胖、吸烟、脑梗死有明显相关性。结论:颈动脉粥样硬化斑块与脑梗死发生有密切关系,对颈动脉粥样硬化斑块和血脂、血糖、高血压、肥胖、吸烟等指标进行干预有重要临床意义。