内源性硫化氢在大鼠早期高肺血流性肺动脉高压中的动态变化

目的:探讨大鼠早期高肺血流性肺动脉高压形成中内源性硫化氢体系的动态变化规律。方法:雄性SD大鼠80只,体重140~160 g,随机分为分流组(40只)和对照组(40只)。分流组大鼠经下腔静脉-腹主动脉穿刺术建立高肺血流动物模型。分别在术后1 d、3 d、1周、4周及8周各实验时间点测量肺动脉收缩压(SPAP)、肺组织匀浆中硫化氢(H2S)含量及CSE mRNA相对含量。结果:SPAP于分流后1周开始升高,8周明显升高;肺组织H2S及CSE mRNA含量于分流后3 d及4周显著升高;SPAP与肺组织H2S、CSEm RNA含量于分流后1周、4周及8周呈明显负相关。结论:大鼠高肺血流性动物模型可导致肺动脉高压,早期伴随内源性肺组织H2S及CSEmRNA含量的变化,提示内源性H2S体系可能与高肺血流性肺动脉高压形成有关,并在其中发挥保护性的调节作用。     

姜黄素改善慢性肺动脉高压肺血管重塑作用途径的研究

目的：探究姜黄素改善慢性低O2高CO2大鼠肺动脉高压肺血管重塑作用途径的研究。方法：建立慢低O2高CO2肺血管重塑模型,以24只雄性大鼠为受试对象,随机分为四组（n=6）：I组（常氧空白对照组）,Ⅱ（低O2高CO2模型组）,Ⅲ组（色甘酸钠对照组）,Ⅳ组（姜黄素实验组）。将后3组动物放入常压低O2高CO2舱中,吸入O2浓度8％～11％,CO2浓度3％～5％,每天8h,每周6d,连续4周,Ⅲ组给予色甘酸钠以20mg／kg体重腹注射处理,Ⅳ组给予姜黄素混悬液按150mg/kg体重灌胃处理。光镜下、透射电镜下观察肺动脉血管壁及其周围大细胞超微结构形态学改变,甲苯胺蓝染色法和免疫组织化学法对肺动脉周围的肥大细胞及其脱颗粒状态进行性定量测定。结果：①电镜下,Ⅱ组肺细小动脉中膜平滑肌增生,外膜胶原纤维密集,内弹力板扭曲,内皮细胞起,血管外肥大细胞内颗粒减少,胞膜不完整;光镜下,Ⅱ组相比1组肺细小动脉管腔／管总面积（WA／TA）明显升（P〈0．05）、管腔／管总面积（EA／TA）明显降低（P〈0．05）,甲苯胺蓝染色肥大细胞细胞数（NMC）、肥大细胞脱颗率（DR）及免疫组化检测类胰蛋白酶阳性细胞数（TBS）高于I组（P〈0．05）;②干预后,电镜下,Ⅲ组、Ⅳ组血管结基本正常,平滑肌增生及胶原增生较Ⅱ组轻,肥大细胞膜完整;光镜下,两干预组相比Ⅱ组WA／TA明显降低（P〈0．05）、ET／TA明显升高（P〈0．05）,甲苯胺蓝染色NMC、DR、TBS阳性细胞数分别低于Ⅱ组（P〈0．05）。结论：姜素可通过Mc途径抑制慢性低O2高CO2导致的大鼠肺血管重塑改变。     

Lung surfactant in subacute pulmonary disease

Pulmonary surfactant is a surface active material composed of both lipids and proteins that is produced by alveolar type II pneumocytes. Abnormalities of surfactant in the immature lung or in the acutely inflamed mature lung are well described. However, in a variety of subacute diseases of the mature lung, abnormalities of lung surfactant may also be of importance. These diseases include chronic obstructive pulmonary disease, asthma, cystic fibrosis, interstitial lung disease, pneumonia, and alveolar proteinosis. Understanding of the mechanisms that disturb the lung surfactant system may lead to novel rational therapies for these diseases.     

体外循环中急性肺水肿分析

目的：强调重视和加强体外循环中对肺功能的保护。方法：分析16例在体外循环中发生肺水肿患者术前的肺动脉高压,血红蛋白,肾功能和心功能情况,经PEEP＋利尿药＋激素和超滤器为主,辅以强心,扩血管药的协同治疗。结果：所有患者经治疗后气道阻力下降,均减小至术前水平,无酸中毒,尿量＞100ml/min。平均2．5天拔管停呼吸机,11例患者术后第一天均顺利脱离呼吸机。15例患者出院,1例死于MOF。结论：中度肺动脉高压、贫血和心肾功能功能不全可能是体外循环中急性肺水肿的诱发因素,体外循环时应采取措施预防预防和减轻肺功能损伤。     

Application of microarray technology in pulmonary diseases

Microarrays are a powerful tool that have multiple applications both in clinical and cell biology arenas of common lung diseases. To exemplify how this tool can be useful, in this review, we will provide an overview of the application of microarray technology in research relevant to common lung diseases and present some of the future perspectives.     

肺纤维化初期肺动脉高压大鼠肺动脉反应性的变化

目的：观察肺纤维化初期肺动脉高压大鼠肺动脉血管反应性的变化。方法：66只雄性SD大鼠,随机分为博莱霉素（BLM）组和手术对照（Sham）组。BLM组为气管内一次性滴注BLM（5 mg/kg）;Sham组为气管内滴注等容量的生理盐水（NS）。应用离体血管张力检测技术测定大鼠肺动脉血管反应性变化;用HE显示肺动脉壁病理形态学变化;Masson染色检测肺纤维化程度;右心漂浮导管技术测定大鼠平均肺动脉压。结果：①BLM组大鼠的肺动脉血管（保留内皮和去内皮）对苯肾上腺素（PE）的收缩反应均弱于Sham组（P均〈0.05）。②BLM组大鼠肺动脉血管（保留内皮）对氯化乙酰胆碱（Ach）的舒张反应明显弱于Sham组（P〈0.01）。③Sham组有内皮的肺动脉血管对L-NAME和PE联合作用的收缩反应明显强于PE单独作用（P〈0.01）,而BLM组有内皮肺动脉血管对L-NAME和PE联合作用的收缩反应与对PE单独作用比,其差异无统计学意义（P〉0.05）。④BLM组肺动脉内皮细胞脱落。⑤BLM组大鼠肺组织呈现纤维增生初期的病理特征,且大鼠的平均肺动脉压明显高于Sham组（P〈0.05）。结论：肺纤维化形成初期肺动脉高压大鼠肺动脉血管反应性出现异常。     

肺结节检测算法研究

探讨基于CT图像数据的肺结节自动检测算法。肺结节提取一般步骤为：CT图像预处理、肺实质分割、肺结节提取。     

Electrophysiological modelling of pulmonary artery smooth muscle cells in the rabbits--special consideration to the generation of hypoxic pulmonary vasoconstriction

In vascular smooth muscle cells, it has been suggested that membrane potential is an important component that initiates contraction. We developed a mathematical model to elucidate the quantitative contributions of major ion currents [a voltage-gated L-type Ca²⁺ current (I_CaL), a voltage-sensitive K⁺ current (I_KV), a Ca²⁺-activated K⁺ current (I_KCa) and a nonselective cation current (I_NSC)] to membrane potential. In order to typify the diverse nature of pulmonary artery smooth muscle cells (PASMCs), we introduced parameters that are not fixed (variable parameters). The population of cells with different parameters was constructed and the cells that have the electrophysiological properties of PASMCs were selected. The contributions of each membrane current were investigated by sensitivity analysis and modification of the current parameters. Consequently, I_KV and I_NSC were found to be the most important currents that affect the membrane potential. The occurrence of depolarisation in hypoxic pulmonary vasoconstriction (HPV) was also examined. In hypoxia, I_KV and I_KCa were reduced, but the consequent depolarisation in simulation was not enough to initiate contractions. If we add an increase of I_NSC (2.5-fold), the calculated membrane potential was enough to induce contraction. From the results, we conclude that the balance of various ion channel activities determines the resting membrane potential of PASMCs and our model was successful in explaining the depolarisation in HPV. Therefore, this model can be a powerful tool to investigate the various electrical properties of PASMCs in both normal and pathological conditions.     

SENP1在大鼠低氧性肺动脉高压形成中肺血管壁中表达及可能作用

目的:探讨大鼠低氧性肺动脉高压(HPH)形成过程中SENP1在肺小动脉的动态表达变化及作用。方法:40只成年雄性Wistar大鼠随机分为5组(n=8):对照组和缺氧3 d、7 d、14 d2、1 d组,常压间断低氧复制HPH大鼠模型。测各组大鼠平均肺动脉压(mPAP)、右心室肥大指数(RVHI)、血管形态学指标;原位杂交、逆转录-聚合酶链反应(RT-PCR)检测肺内SUMO特异性蛋白酶-1(SUMO-specific proteases-1,SENP1)mRNA表达,免疫组化、Westernblot检测其蛋白质水平。结果:①缺氧7 d后,肺小动脉出现血管重塑,且mPAP明显上升;低氧14 d后,肺小动脉重塑更明显,mPAP达高峰。RVHI在低氧14 d后明显增加。②原位杂交显示,SENP1 mRNA在对照组肺小动脉壁呈阳性表达,低氧后其相对量无明显变化。RT-PCR显示肺组织SENP1 mRNA表达与原位杂交所观察到的肺小动脉壁SENP1 mRNA变化趋势一致;SENP1蛋白在对照组呈阳性表达,低氧7 d后其表达量开始呈进行性下降。Western blot显示肺组织内SENP1蛋白表达与免疫组化观察到的肺小动脉壁SENP1蛋白变化趋势一致。③SENP1蛋白与mPAP、重塑指数、RVHI均呈负相关。结论:慢性低氧诱导肺小动脉壁SENP1蛋白降解,进而可能在HPH发病过程中发挥一定的作用。     

Autophagy in pulmonary hypertension: Emerging roles and therapeutic implications

Autophagy is an important mechanism for cellular self-digestion and basal homeostasis. This gene- and modulator-regulated pathway is conserved in cells. Recently, several studies have shown that autophagic dysfunction is associated with pulmonary hypertension (PH). However, the relationship between autophagy and PH remains controversial. In this review, we mainly introduce the effects of autophagy-related genes and some regulatory molecules on PH and the relationship between autophagy and PH under the conditions of hypoxia, monocrotaline injection, thromboembolic stress, oxidative stress, and other drugs and toxins. The effects of other autophagy-related drugs, such as chloroquine, 3-methyladenine, rapamycin, and other potential therapeutic drugs and targets, in PH are also described.     

辛伐他汀对大鼠肺纤维化及其内皮间质变过程的影响*

目的: 观察辛伐他汀对大鼠肺纤维化及其内皮间质变(EnMT )过程中VE-钙粘素(VE-cad)、波形蛋白(VIM)、α-平滑肌蛋白(α-SMA)表达的影响。方法: 健康雄性SD大鼠60只,随机分为对照组(A组)、造模组(B组)、辛伐他汀5 mg治疗组(C组)、辛伐他汀10 mg治疗组(D组),每组各15只。博来霉素(BLM)按5 mg/kg剂量一次性气管内灌注复制博莱霉素致大鼠肺纤维化模型,从造模第1日起C、D 组每天分别胃内灌注辛伐他汀混悬液5 mg /(kg·d)及辛伐他汀混悬液10 mg /(kg·d),A组和B 组每天胃内灌注等体积生理盐水10 ml /(kg·d)。于造模第7、14和28 日随机处死各组大鼠5只。Masson染色观察大鼠肺组织形态变化;碱性水解法检测肺组织中羟脯氨酸(HYP)含量;免疫组化法测定各组大鼠肺组织血管新生微血管密度(MVD);免疫组化和逆转录-聚合酶链反应法测定各组肺组织中VE-Cad、VIM及α-SMA蛋白和mRNA的表达水平。结果: ①与A组相比,B、C、D组各时间点肺组织HYP和MVD水平、VIM、α-SMA的mRNA和蛋白表达水平均明显升高(P均＜0.05),且以28 d达最高;而相应时间点VE-Cad 的mRNA和蛋白表达水平均明显降低(P均＜0.05),且以28 d达最低。②与B组相比,C、D组HYP和MVD水平、VIM、α-SMA的mRNA和蛋白表达水平均有降低(P均＜0.05),以D组28 d下降最明显;而相应时间点VE-Cad 的mRNA和蛋白表达水平均有升高(P均＜0.05),以D组28 d升高最明显。结论: 辛伐他汀可减轻大鼠肺纤维化,其机制可能与增强VE-cad表达,降低VIM及α-SMA表达,减少EnMT 发生有关。     

Effects of hypoxia on the pulmonary microvascular permeability in adult rabbit lung

Within the last 30 years, researchers have explored what role hypoxia might play in causing permeability changes in the pulmonary microvasculature. Since the data accumulated thus far are unclear, the effects of hypoxia on microvascular transport in the isolated, Ringer's perfused adult rabbit lung was observed and the following parameters were measured or computed for both oxygenated and hypoxic perfusates: pulmonary arterial (r_a) and pulmonary venous (r_v) resistances, pulmonary capillary filtration coefficients (K_f), and pulmonary capillary endothelial reflection coefficients () for NaCl and inulin. Separate reservoir bottles were used to create the desired oxygenated (aeration of solution with 95% O₂-5% CO₂) gas mixture or hypoxic (aeration of solution with 95% N₂-5% CO₂) gas mixture. A higher, but not significant, resistance value was found during the oxygenated state. A significant increase in the pulmonary capillary filtration coefficient during hypoxia (10.72 × 10^–4±0.446 × 10^–4 cm³/s cm H₂O for the hypoxic perfusate and 8.80 × 10^–4±0.384 × 10^–4 cm³/s cm H₂O for the oxygenated perfusate) was found and a significant difference between oxygenated and hypoxic pulmonary capillary reflection coefficients for inulin was computed (oxygenated solution revealed a finding of 0.120±0.003 and the hypoxic solution revealed 0.105±0.002). These findings imply a change in the microvascular permeability during hypoxia. According to the pore theory, a change in pore number, pore size, or both could have occurred. However, from the reflection coefficient data, a change in pore radius seems most likely.     

Tissue plasminogen activator and acute pulmonary embolism

We assessed the efficacy and safety of peripheral intravenous recombinant human tissue-type plasminogen activator (rt-PA) in 47 patients with angiographically documented pulmonary embolism (PE). We administered 50 mg/2 h and, if necessary, an additional 40 mg/4 h. By 6 hours, 94% of the patients had angiographic evidence of clot lysis that was slight in 5, moderate in 12, and marked in 27 patients. Among the 34 patients with pulmonary hypertension prior to treatment, average pulmonary artery pressure decreased from 43/17 (27) to 31/13 (19) mm Hg (P less than 0.0001). The average lung scan perfusion defect decreased from 37% before therapy to 16% (P less than 0.01) after therapy among the 19 patients who had pre- and post-treatment lung scans. Of 7 patients with pre- and post-treatment imaging and Doppler echocardiograms, hypokinetic right ventricular wall movement (mild in 1, moderate in 2, and severe in 4) normalized in 5 and improved to mild hypokinesis in 2. Right ventricular diameter decreased from 3.9 +/- 1.0 to 2.0 +/- 0.5 cm (P less than 0.005). Fibrinogen decreased 33% from baseline at 2 h and 42% from baseline at 6 h. However, patients with the greatest degree of angiographic clot lysis at 2 h had a preponderance of fibrinogenolysis over fibrinolysis, demonstrated by a lower ratio of cross-linked fibrin degradation products to fibrin(ogen) degradation products (0.14 +/- 0.09 vs. 0.54 +/- 0.82) (P less than 0.04). Among selected patients, peripheral intravenous rt-PA is associated with rapid lysis of PE, improved pulmonary perfusion, and improved right ventricular function.     

血浆N端脑钠肽前体与COPD合并慢性肺源性心脏病患者肺动脉压的相关性分析

目的探讨血浆N端脑钠肽前体与COPD合并慢性肺源性心脏病患者肺动脉压的相关性。方法将我院收治的94例COPD稳定期患者,根据心脏彩超检查明确合并慢性肺心病患者分为观察组46例,单纯COPD患者分为对照组48例,采用化学发光法测定两组患者血浆NT-proBNP水平,心脏彩超检查两组患者右心室前壁厚度、右心室舒张末期内径、左室射血分数、主肺动脉宽度、肺动脉压,并进行比较。结果与对照组比较,观察组血浆NT-proBNP水平明显升高(P0.05),右心室前壁厚度、右心室舒张末期内径、主肺动脉宽度、肺动脉压明显升高(P0.05)。血浆NT-proBNP水平与肺动脉压成明显正相关(r=-0.284,P0.01)。结论 COPD合并慢性肺心病患者血浆NT-proBNP水平升高,有助于评估肺动脉高压的严重程度。     

Experimental pulmonary candidiasis

The initial interaction of Candida albicans with pulmonary tissue of B6D2/F₁ mice was investigated. The LD₅₀ for mice challenged intravenously (IV) was approximately 3 × 10⁵ yeasts, whereas the LD₅₀ by the intratracheal (IT) route was in excess of 10⁸ yeasts. Mice challenged IV died of progressive yeast growth in the kidneys. In contrast, mice challenged IT rapidly eliminated the entire inoculum by the first day after challenge. Resident pulmonary alveolar macrophages (PAM) killed upwards of 70% of C. albicans in an in vitro killing assay. At effector: target ratios favoring the effector cell population resident PAM were able to restrict the formation of yeast germ tubes to only 30% of the yeasts, whereas at equivalent ratios virtually all of the intracellular yeasts produced germ tubes. Evaluation of the ability of PAM, harvested from genetically different strains of inbred mice, to kill C. albicans in vitro showed that killing ability was a property of resident PAM from mice with the black 6 background. It was discovered that during the initial stages of infection in vivo, the expression of the F4/80 surface molecule was down regulated, and the expression of the Mac 1 surface molecule upregulated. There were no quantitative changes in expression of either Mac 2, Mac 3, Ly 5 or the 5C6 surface epitopes. Taken together, the data show that pulmonary tissue is quantitatively very resistant to C. albicans infection, because of the ability of resident PAM to rapidly phagocytize and kill yeasts. Killing of C. albicans by resident PAM may be a property of a subset of this mononuclear phagocyte population and was accompanied by alterations in the expression of surface molecules.Presented as part of the Everett S. Beneke Symposium in Mycology, May 27, 1988.     

MMP-10 from M1 macrophages promotes pulmonary vascular remodeling and pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is characterized by muscularized pulmonary blood vessels, leading to right heart hypertrophy and cardiac failure. However, state-of-the-art therapeutics fail to target the ongoing remodeling process. Here, this study shows that matrix metalloproteinases (MMP)-1 and MMP-10 levels are increased in the medial layer of vessel wall, serum, and M1-polarized macrophages from patients with PAH and the lungs of monocrotaline- and hypoxia-induced PAH rodent models. MMP-10 regulates the malignant phenotype of pulmonary artery smooth muscle cells (PASMCs). The overexpression of active MMP-10 promotes PASMC proliferation and migration via upregulation of cyclin D1 and proliferating cell nuclear antigen, suggesting that MMP-10 produced by infiltrating macrophages contributes to vascular remodeling. Furthermore, inhibition of STAT1 inhibits hypoxia-induced MMP-10 but not MMP-1 expression in M1-polarized macrophages from patients with PAH. In conclusion, circulating MMP-10 could be used as a potential targeted therapy for PAH.     

非粒细胞减少患者肺曲霉病22例回顾性分析

目的提高对非粒细胞减少患者肺曲霉病的认识及诊疗水平。方法回顾性分析22例非粒细胞减少患者肺曲霉病的临床、影像学及实验室资料,随诊其转归。结果22例肺曲霉病（PA）患者,男性12例,女性10例,平均年龄（56．3±21．4）岁。确诊、临床诊断各8例,拟诊6例。侵袭性肺曲霉病（IPA）11例,单纯性曲霉球6例,慢性坏死性肺曲霉病（CNPA）5例。常见基础疾病为继发型肺结核（8／22）、糖尿病或类固醇性糖尿病（6／22）、高血压病（5／22）、慢性阻塞性肺疾病（5／22）,4例系原发社区感染。常见临床症状咳嗽咳痰（18／22）、咯血（11／22）、气促（7／22）。影像学表现为肺部渗出或实变病灶9例、空洞改变及典型曲霉球12例,结节或肿块1例。首选药物治疗依次为伏立康唑（10／22）、卡泊芬净（4／22）、伊曲康唑（3／22）。结论非粒细胞减少伴IPA好发于糖尿病、慢性阻塞性肺疾病,亦可发生在免疫功能正常患者。单纯曲霉球多继发或并发于肺结核。应注意鉴别CNPA与单纯曲霉球。IPA临床表现缺乏特征性。影像改变未见典型晕征及空气半月征,肺外播散少见,药物治疗首选伏立康唑。     

离子通道在肺动脉的分布及在低氧肺血管收缩反应中的作用

低氧性肺血管收缩反应（HPV）是指在急性低氧时,肺泡氧分压降到某一临界值,肺血管发生的快速、可逆的收缩反应,以纠正肺泡通气／灌流的不匹配。HPV的发生与肺动脉平滑肌细胞上K^＋、Ca^2＋、Cl^-通道的状态密切相关,而这些通道在不同部位的肺动脉上分布存在差异,因此不同部位的肺动脉在低氧中所表现的收缩反应程度也不同,本综述将对上述通道在肺动脉上的分布特点及其在HPV中的作用做一总结。     

Bosentan in pulmonary arterial hypertension: a comparison between congenital heart disease and chronic pulmonary embolism

Background. In patients with pulmonary hypertension, it is unknown whether the treatment effect of bosentan is dependent on the duration of pulmonary vessel changes. Therefore, we studied the response to bosentan in patients with life-long pulmonary vessel changes (pulmonary arterial hypertension (PAH) due to congenital heart disease (CHD)) and in patients with subacutely induced pulmonary vessel changes (chronic thromboembolic pulmonary hypertension (CTEPH)). Methods. In this open-label study, 18 patients with PAH due to CHD and 16 patients with CTEPH were treated with bosentan for at least one year. All patients were evaluated at baseline and during follow-up by means of the six-minute walk distance (6-MWD) and laboratory tests. Results. Improvement of 6-MWD was comparable in patients with PAH due to CHD (444±112 m to 471±100 m, p=0.02), and in CTEPH (376±152 m to 423±141 m, p=0.03) after three months of treatment. After this improvement, 6-MWD stabilised in both groups. Conclusion. Although duration of pulmonary vessel changes is strikingly different in patients with PAH due to CHD and CTEPH, the effect of one year of bosentan treatment was comparable. The main treatment effect appears to be disease stabilisation and decreasing the rate of deterioration. (Neth Heart J 2009;17:334–8.)     

Adenoviral gene transfer to the neonatal rat pulmonary circulation

BACKGROUND: Gene delivery to the pulmonary circulation has been studied in adult animals, but has not been extensively investigated in neonates. METHODS: We tested the ability of recombinant, replication-defective adenovirus to transduce the pulmonary circulation when delivered by percutaneous ventricular puncture. Five-day-old rat pups were injected with 10(7) to 10(10) particles (approximately 10(5) to 10(8) pfu) in 30 micro l total volume. RESULTS: Using RT-PCR, we detected transgene expression in both lung and liver at all dosages. However, whereas only 1/6 pups injected with 10(7) particles had detectable expression, 8/9 pups in the two highest dose groups had detectable expression. In the highest dose group expression was approximately 5-fold greater in lung than liver, though in the lower dose groups no difference between lung and liver was found. Expression decreased by only 25% from day 4 through the last time point at day 28 in lung, whereas liver expression was undetectable in 7 of 9 samples on day 28. Histopathological examination demonstrated expression both within the media of large arteries and in small, peripheral arteries and capillaries, with a concentration of expression in the most distal areas of both the lungs and liver. No evidence of inflammation was seen. CONCLUSIONS: We conclude that the neonatal pulmonary circulation can be effectively transduced using systemic adenoviral vector injection, has more sustained expression than liver, and may be a target for therapeutic gene delivery.