鳖源胶原蛋白提取纯化及在生物材料中的应用

近年来,胶原蛋白因其良好的生物学性能在生物材料应用中得到越来越多的关注,为了建立一种快速高效的鳖源胶原蛋白纯化方法和探究其在生物材料中的应用价值,首先用Van Gieson染色法和苦味酸-天狼星红染色法观察裙边胶原纤维组织结构,发现裙边胶原纤维含量非常高且类型主要是Ⅰ型。采用不同截留分子量的透析袋对裙边胶原蛋白粗提液进行直接透析纯化,发现截留分子量为100 k Da的透析袋在透析48 h后对裙边胶原蛋白的纯化效果最好,SDS-PAGE检验显示几乎没有杂带。对裙边胶原蛋白生物学性能包括吸水性、体外降解性进行考察,其吸水力和持水力分别高达12.06 g/g和98.21%,且在72 h后被完全降解;对裙边胶原蛋白海绵的溶血性、皮肤致敏性、肝部创伤止血性、促创伤皮肤愈合性进行了研究,并和交联胶原进行比较,发现裙边胶原蛋白和交联胶原均不会造成SD大鼠溶血和皮肤过敏,二者均具有良好的止血效果,且裙边胶原蛋白能显著缩短创伤皮肤愈合时间,具有良好的促创伤皮肤愈合性,而交联胶原效果欠佳。本研究表明裙边胶原蛋白表现出了优良的生物学性能,在生物材料领域具有很大应用价值。     

瘦素促进皮肤创伤大鼠胶原合成的实验研究

目的：研究瘦素对创伤大鼠创面组织胶原合成的影响,探讨瘦素促进创伤愈合的作用机制。方法：雄性Wistar大鼠30只,体质量（180±20）g,按体重随机分为：正常组、创伤对照组和瘦素治疗组,用5%Na2S背部脱毛。瘦素治疗组和创伤对照组大鼠于背部制做缺损创面（2.0 cm×2.5 cm）,并分别用瘦素蛋白溶液0.1 ml（含瘦素2.0μg）和等体积生理盐水涂抹,每天一次,连续7 d。之后处死大鼠,取创面组织及正常组大鼠相应部位脱毛皮肤检测皮肤及创面胶原合成相关指标。结果：瘦素治疗组肉芽组织中羟脯氨酸含量（33.92±3.09）mg/g较创伤对照组（29.55±3.59）mg/g显著升高（P〈0.05）,I、Ⅲ型胶原mRNA的水平0.96±0.09、0.09±0.06分别较创伤对照组0.80±0.03、0.08±0.03显著增加（P〈0.05）,I、Ⅲ型胶原的蛋白表达也较创伤对照组显著增强。结论：瘦素通过促进创伤组织I、Ⅲ型胶原的基因表达和胶原蛋白的合成,从而加快肉芽组织的生长,促进创伤组织的修复和愈合。     

大血藤醇提物抗炎镇痛和止血活性研究初探

为观察大血藤醇提物抗炎、镇痛、止血活性,该文采用75%乙醇提取制备大血藤醇提物(AESC),利用HPLC法测定其绿原酸含量; KM鼠(或新西兰兔)在测定抗炎、镇痛、止血活性时随机分为空白对照组、阳性对照组(云南白药酊组)、AESC组,依次测定其抑制二甲苯致小鼠耳肿胀度作用、痛阈值和兔肝脏局部创面损伤出血的记分分值,分别考察其抗炎、镇痛、止血作用。结果表明:AESC中绿原酸含量为(0.294±0.013 5)%;与空白组比较,剂量为0.700 g·kg~(-1)的AESC组能显著减轻二甲苯所致的小鼠耳肿胀度(P0.01),抑制率达26.3%;与空白组及给药前比较,剂量为1.40 g·kg~(-1)的AESC组均能显著提高小鼠痛阈值(P0.01);与空白组相比,剂量为1.40 g·kg~(-1)的AESC组能显著提高兔肝脏局部创面损伤出血的记分分值(P0.001)。大血藤醇提取物具有显著的抗炎、镇痛、止血作用,有望将其开发为抗炎、镇痛、止血制剂。该结果也为大血藤的临床应用提供理论依据。     

VAC 技术治疗兔耳缺血性创面的实验研究

目的:观察间歇和持续负压下缺血创面不同处理与愈合的关系。方法:实验前1天,用脱毛剂(Nair,美国)对兔耳背脱毛。动物用1%戊巴比妥钠耳缘静脉注射麻醉(30 mg/kg体重),固定于手术台。75%乙醇消毒双侧耳背皮肤。距耳根3-3.5cm处分离、结扎兔耳中央神经血管束。在耳背中部形成直径2.5cm全层皮肤缺损创面(保留软骨膜)[1]。止血后置动物于特制木盒内。42只大白兔共84个创面,随机分为-50mmHg-75mmHg和-100mmHg 3大组,分别施以间歇负压(运行2分钟,停1分钟)和持续负压组。实验分别运用-50mmHg,-75mmHg,-100mmHg三个不同负压值进行连续、间歇治疗兔耳缺血性创面,观察伤后1,3,7,10,14,20d创面愈合情况,取伤后7d组织标本进行Western blot、HE染色,观察VEGF(vascular endothelial growth factor)的表达及创面上皮的再生和肉芽组织生长情况[1]。以及各时间点细胞凋亡的检测。结果:-50mmHg(纱布+海绵)间歇负压引流技术治疗兔耳缺血性创面的愈合最快,-75mmHg治疗组次之,-100mmHg治疗组创面愈合最慢。在同一时间点上,-50mmHg治疗组与-75mmHg,-100mmHg治疗组和空白对照组之间相比,能够更快地促进创面VEGF的表达和肉芽组织的再生,毛细血管增多。封闭负压治疗能够降低创面组织细胞的凋亡的发生。结论:(1)封闭负压治疗能够促进缺血创面的肉芽组织再生及VEGF的表达,减少创面组织细胞的凋亡的发生;(2)-50mmHg间歇封闭负压治疗效果最好。     

胶原蛋白/BMP复合材料的制备和成骨性能研究

以胶原膜(含87.5 mg I型胶原蛋白)为载体, 复合3.5 mg rhBMP-2(人基因重组骨形成蛋白-2), 制备胶原蛋白/BMP复合材料。复合材料首先在兔背阔肌中埋置, 预构新生骨组织, 并采用ALP染色、Von Kossa染色和HE染色等观察复合材料的成骨过程和组织形态。然后将形成的新骨组织游离移植修复自体下颌骨体部洞穿性缺损; 并设以胶原为载体的rhBMP-2复合骨修复材料直接修复为对照组, 骨缺损不修复组为空白组。采用X线、抗压强度、硬组织切片、四环素荧光染色、骨形态计量检查, 观察复合材料修复骨缺损的质量和效果。结果表明, 胶原蛋白/BMP复合材料在兔背阔肌中4～6周成骨, 胶原材料于3～5周降解; 成骨过程为是以软骨成骨为主的方式, 新骨形态为编织骨, 可见明显的微血管分布; 游离移植修复自体下颌骨缺损, 6周缺损区为骨性愈合, 与对照组在抗压强度(P = 0.041)、新骨量(P = 0.034)均有显著性差异。胶原蛋白/BMP复合材料在骨骼肌中形成的新生骨组织可作为供骨修复一定范围的骨缺损。     

胶原蛋白/BMP复合材料的制备和成骨性能研究

以胶原膜(含87.5 mg I型胶原蛋白)为载体, 复合3.5 mg rhBMP-2(人基因重组骨形成蛋白-2), 制备胶原蛋白/BMP复合材料。复合材料首先在兔背阔肌中埋置, 预构新生骨组织, 并采用ALP染色、Von Kossa染色和HE染色等观察复合材料的成骨过程和组织形态。然后将形成的新骨组织游离移植修复自体下颌骨体部洞穿性缺损; 并设以胶原为载体的rhBMP-2复合骨修复材料直接修复为对照组, 骨缺损不修复组为空白组。采用X线、抗压强度、硬组织切片、四环素荧光染色、骨形态计量检查, 观察复合材料修复骨缺损的质量和效果。结果表明, 胶原蛋白/BMP复合材料在兔背阔肌中4～6周成骨, 胶原材料于3～5周降解; 成骨过程为是以软骨成骨为主的方式, 新骨形态为编织骨, 可见明显的微血管分布; 游离移植修复自体下颌骨缺损, 6周缺损区为骨性愈合, 与对照组在抗压强度(P = 0.041)、新骨量(P = 0.034)均有显著性差异。胶原蛋白/BMP复合材料在骨骼肌中形成的新生骨组织可作为供骨修复一定范围的骨缺损。     

玉米微孔淀粉制备止血剂研究

为了制备玉米微孔淀粉止血剂,并对止血剂性能进行评价研究,采用酸酶序解法制备玉米微孔淀粉,测定其孔密度和吸水率,用动物创面出血模型检验其止血效果。研究结果显示,该方法所得微孔淀粉孔密度为3.4×10~4/mm~2,吸水率为156.98%,无病原微生物和内毒素;兔耳创面和兔肝脏创面完全止血时间分别在140 s和80 s之内,止血迅速、牢固,优于云南白药。研究结果表明,该微孔淀粉组织相容性良好,符合生物材料安全性的要求,可望开发为新型止血材料。     

霞水母胶原蛋白活性肽和寡肽胶原抗疲劳作用的实验研究

本文对霞水母胶原蛋白活性肽和寡肽胶原的抗疲劳作用进行了研究。试验中分别以25、50、100mg/kg剂量的霞水母胶原蛋白活性肽和寡肽胶原给小鼠连续灌胃30d,然后进行小鼠负重游泳试验、血清尿素氮、肝糖原及血乳酸含量测定。结果显示,两种受试物各剂量组小鼠的游泳时间明显长于对照组(P0.05或P0.01),各剂量组小鼠运动后血清尿素氮含量及乳酸曲线下面积均低于对照组(P0.01);各剂量组的小鼠游泳后肝糖原含量和空白对照组比较均有不同程度的提高。从而表明,霞水母胶原蛋白活性肽和寡肽胶原均具有抗疲劳作用。     

负压封闭引流对兔颅骨外露创面愈合效果的实验研究

目的:探讨负压封闭引流技术(VSD)对兔颅骨外露缺损创面愈合的治疗效果。方法:选取成年新西兰大白兔76只,平均分为四组并建立兔颅骨外露实验模型。其中,A组(19只):于兔颅骨上方制作直径为2.0cm的圆形创面,保留骨膜,采用-120mmHg负压引流和常规换药治疗;B组(19只):实验动物处理同A组,仅采用常规换药治疗;C组(19只):在兔颅骨上制作直径2.0cm的圆形创面,剔除骨膜,治疗方法同A组;D组(19只):实验动物处理同C组,治疗方法同B组。每组各抽取10只,观察创面愈合率和创面愈合时间;其余9只分别在第7天、10天、20天、30天进行取材检测,分析疗效机制。结果:A组创面愈合时间为19.40±1.65天,B组为24.00±2.31天;C组为25.40±4.43天,D组为30.00±5.50天。运用VSD治疗和常规治疗创面愈合时间比较有统计学意义(P0.05)。结论:VSD治疗兔骨外露缺损创面能有效缩短创面愈合时间,促进血管再生,胶原蛋白合成。     

蝇蛆油促进大鼠皮肤机械损伤愈合作用及机制研究

目的:本文拟研究蝇蛆油对皮肤机械损伤的治疗作用及作用机制。方法:SD大鼠随机分为正常组、模型组、蝇蛆油组和重组牛碱性成纤维细胞生长因子(rb-bFGF)凝胶组,制作大鼠皮肤机械性损伤模型,在不同时间点采集样本,检测创面愈合率、创面愈合时间、血管内皮生长因子(VEGF)含量、丙二醛(MDA)和超氧化物歧化酶(SOD)水平,并检测组织中胶原蛋白Ⅰ、胶原蛋白Ⅲ、血小板衍生因子(PDGF)和细胞角蛋白19(CK19)表达情况。结果:模型组大鼠创面愈合时间为29.5±2.6 d,而蝇蛆油创面愈合时间为22.4±2.8 d,存在显著差异(P0.01)。VEDF含量在模型组和给药组均随着创面愈合时间增加,给药组在第1 d即显著高于模型组(P0.01),并在第21 d达到最大值(2051.5±148.2 ng/L)。模型组大鼠创面组织中MDA含量为6.47±0.92 nmo L/mg,SOD含量为7.52±3.21 U/mg,而蝇蛆油给药组大鼠创面组织中MDA含量为3.42±0.83 nmo L/mg,SOD含量为21.32±2.94 U/mg,存在显著差异(P0.01)。进一步研究发现,与模型组比较,蝇蛆油给药组大鼠创面组织中胶原蛋白Ⅰ、胶原蛋白Ⅲ、PDGF和CK19含量均显著升高(P0.01)。结论:蝇蛆油能够促进机械性损伤皮肤创面愈合,其作用机制可能是通过促进血管生成,抗氧化损伤,促进胶原生成,诱导干细胞形成,从而促进创面愈合。     

槐角黄酮栓抗炎、止血、抗溃疡作用的实验研究

目的:研究槐角黄酮栓的抗炎、止血、抗溃疡作用。方法:从中药槐角中提取总黄酮,与脂肪酸甘油酯混合后用热融法制成栓剂。采用小鼠耳廓肿胀法、滤纸肉芽肿法、腹腔毛细血管通透性试验和角叉菜胶致大鼠足跖肿胀法观察槐角黄酮栓的抗炎作用;通过玻璃毛细管法和断尾法测定小鼠出、凝血时间,评价槐角黄酮栓的止血效果。复制大鼠直肠损伤模型,直肠给药治疗,观察伤口愈合情况并HE染色,评价槐角黄酮栓的促愈合作用。结果:槐角黄酮栓具有明显的抗炎、抗溃疡作用,并能缩短小鼠出、凝血时间,提高直肠创面愈合率。结论:槐角黄酮栓制备工艺简单,具有较好的抗炎、止血、抗溃疡作用。     

胶原／壳聚糖复合膜的制备及止血效果的研究

目的 以胶原和壳聚糖制备复合膜,检验其止血效果,并探讨其止血原因。材料与方法：以酸解法从牛腱中提取胶原,用甲壳素制得壳聚糖,以胶原和壳聚制成复合膜,通过动物实验测不同配比的复合膜对出血创面的止血时间,并与其它止血材料做对比。结果：各种配比的复合膜的止血效果均比明胶等一般止血材料好。结论：胶原/壳聚糖复合膜有良好的止血作用,可望在外科手术上得到广泛应用。     

内镜止血在急性非静脉曲张性上消化道出血治疗中的临床应用

目的:探讨内镜下金属钛夹止血在急性非静脉曲张性上消化道出血治疗中的应用价值。方法:按照随机数字表法将2014年1月-2014年12月我院收治的40例急性非静脉曲张性上消化道出血患者分为观察组(n=20)及对照组(n=20),观察组行内镜下金属钛夹止血治疗,对照组予以内镜下药物注射,比较两组治疗后的止血效果、临床疗效及并发症情况。结果:观察组患者治疗后的有效止血率、即时止血率为95.00%、100.00%,分别高于对照组的65.00%、75.00%,差异有统计学意义(P0.05)。治疗后观察组临床疗效优于对照组,差异有统计学意义(P0.05)。治疗后两组患者均未出现严重并发症。结论:内镜下金属钛夹止血用于急性非静脉曲张性上消化道出血具有止血效果好、并发症少等特点,临床有重要的参考价值。     

Evolution of Primary Hemostasis in Early Vertebrates

Hemostasis is a defense mechanism which protects the organism in the event of injury to stop bleeding. Recently, we established that all the known major mammalian hemostatic factors are conserved in early vertebrates. However, since their highly vascularized gills experience high blood pressure and are exposed to the environment, even very small injuries could be fatal to fish. Since trypsins are forerunners for coagulation proteases and are expressed by many extrapancreatic cells such as endothelial cells and epithelial cells, we hypothesized that trypsin or trypsin-like proteases from gill epithelial cells may protect these animals from gill bleeding following injuries. In this paper we identified the release of three different trypsins from fish gills into water under stress or injury, which have tenfold greater serine protease activity compared to bovine trypsin. We found that these trypsins activate the thrombocytes and protect the fish from gill bleeding. We found 27 protease-activated receptors (PARs) by analyzing zebrafish genome and classified them into five groups, based on tethering peptides, and two families, PAR1 and PAR2, based on homologies. We also found a canonical member of PAR2 family, PAR2-21A which is activated more readily by trypsin, and PAR2-21A tethering peptide stops gill bleeding just as trypsin. This finding provides evidence that trypsin cleaves a PAR2 member on thrombocyte surface. In conclusion, we believe that the gills are evolutionarily selected to produce trypsin to activate PAR2 on thrombocyte surface and protect the gills from bleeding. We also speculate that trypsin may also protect the fish from bleeding from other body injuries due to quick contact with the thrombocytes. Thus, this finding provides evidence for the role of trypsins in primary hemostasis in early vertebrates.     

Hemostasis During Urologic Surgery: Fibrin Sealant Compared With Absorbable Hemostat

In the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery, their effectiveness and safety have since been demonstrated to extend to a wide array of procedures. Fibrin sealants typically contain two components—fibrinogen and thrombin—that are combined and delivered simultaneously to a target bleeding site in order to achieve hemostasis. However, many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. This subanalysis compares the safety and effectiveness of a fibrin sealant versus an absorbable hemostat for achieving hemostasis during urologic procedures with mild to moderate bleeding.Key words: Hemostasis, Hemostatics, Fibrin tissue adhesive, Urologic surgical procedures, Surgical techniqueIn the United States, fibrin sealants have been used to achieve hemostasis for nearly two decades. Although their clinical utility was first demonstrated in cardiac surgery,¹ their effectiveness and safety have since been demonstrated to extend to a wide array of procedures, including cardiovascular, gastrointestinal, pneumothoracic, neurologic, urologic, otolaryngologic, dental, and reconstructive surgeries.^2,3 Within the field of urology, fibrin sealants have been used to manage bleeding from renal trauma,⁴ as well as to facilitate hemostasis during renal surgeries, including partial nephrectomies.^5–7Fibrin sealants typically contain two components—fibrinogen and thrombin—that are combined and delivered simultaneously to a target bleeding site (TBS) in order to achieve hemostasis.³ Many commercial formulations contain other additional components, such as antifibrinolytic agents, that have been associated with adverse outcomes. For example, in an observational study (N = 4374), the antifibrinolytic aprotinin was associated with an increased risk of long-term mortality within 5 years following coronary artery bypass graft surgery.⁸ Furthermore, repeated exposure to aprotinin may lead to allergic or potentially fatal anaphylactic reactions.^9–11 For this reason, the US Food and Drug Administration (FDA) issued an alert in 2006 indicating that caution should be used when using aprotinin in patients with a history of previous exposure to the product.¹² Tranexamic acid, another antifibrinolytic present in some commercial fibrin sealants, has been associated with alterations in neural tissue growth and adherence.¹³ Because of the risk of cerebral neurologic toxicity, fibrin sealants containing tranexamic acid are contraindicated for use in neurosurgery or in surgical procedures during which contact with cerebrospinal fluid or dura mater may occur.¹⁴In a phase III, randomized, single-blind, parallel-group, multicenter study,¹⁵ the fibrin sealant CROSSEAL™ (Ethicon, Inc., Somerville, NJ) significantly reduced the time to hemostasis during liver resection surgery compared with conventional hemostatic techniques. EVICEL® Fibrin Sealant (Human) (Ethicon, Inc.), the successor of CROSSEAL, requires no antifibrinolytic additive and is therefore both aprotinin and tranexamic acid free, and achieves hemostasis using exclusively human components.¹⁶ The effectiveness and safety of this fibrin sealant for hemostasis in soft tissue during elective retroperitoneal or intra-abdominal surgery were compared with an absorbable hemostat (SURGICEL® Absorbable Hemostat; Ethicon, Inc.) in a randomized, active-controlled, multicenter study.¹⁷ This article describes a subanalysis of data from the largest patient subgroup from that study, and evaluates the effectiveness and safety of a fibrin sealant versus an absorbable hemostat for patients who underwent urologic surgical procedures.     

明胶—几丁糖膜的制备及其止血性能的实验研究

目的制备几丁糖膜以及研究其止血性能。方法 在透析后的几丁糖与明胶混合液中加入戊二醛交联后置入冻干机冻干制得几丁糖膜。取新西兰兔4只,在背部两侧对称性剪开直径1cm渗血伤口,分别用纱布和几丁糖膜止血,观察与创面的粘附情况,记录出血时间,以膜或纱布中Hb光度吸收值表示出血量。结果 几丁糖膜与创面粘附良好,几丁糖膜组、纱布组的出血时间分别为78.25±6.42秒、119.05±11.39秒,Hb光度吸收值为0.76±0.51、1.63±0.72,明显优于纱布对照组(P<0.01)。结论 几丁糖膜具有一定的止血性能。     

多聚糖止血颗粒对兔股动脉出血的止血效果观察

目的：观察PerClot^TM多聚糖止血颗粒在兔股动脉局部止血效果。方法：分离并剪断兔股动脉,应用多聚糖止血颗粒止血,通过测定出血量与止血时间同阴性对照组对比了解活动患肢对止血稳定性的影响。结果：受试2组平均出血量如下：PerClot^TM组：（1．46±0．06）g;阴性对照组（2．48＞±0．10）g。统计分析后可知PerClot^TM组较阴性对照组出血量减少（P〈0．叭。平均止血时间如下：PerClot^TM组：（100±30．1）s;阴性对照组（200±36．33）g。统计分析后可知PerClot^TM组较阴性对照组止血时间减少（P〈0．01）．活动患肢对止血稳定性无影响。结论：多聚糖颗粒止血效果可靠,有临床应用前景,值得进行临床实验。     

Mechanism of action, development and clinical experience of recombinant FVIIa

Recombinant FVIIa has been developed for treatment of bleedings in hemophilia patients with inhibitors, and has been found to induce hemostasis even during major surgery such as major orthopedic surgery. Recombinant FVIIa is being produced in BHK cell cultures and has been shown to be very similar to plasma-derived FVIIa. The use of rFVIIa in hemophilia treatment is a new concept of treatment and is based on the low affinity binding of FVIIa to the surface of thrombin activated platelets demonstrated in a cell-based in vitro model. By the administration of pharmacological doses of exogenous rFVIIa the thrombin generation on the platelet surface at the site of injury is enhanced independently of the presence of FVIII/FIX. As a result of the increased and rapid thrombin formation, a tight fibrin hemostatic plug is being formed. A tight fibrin structure has been found to be more resistant to fibrinolytic degradation thereby helping to maintain hemostasis. The general mechanism of action of pharmacological doses of rFVIIa shown to induce hemostasis not only in hemophilia, but also in patients with platelet defects, and with profuse bleedings triggered by extensive surgery or trauma, may very well be the capacity of generating a tight fibrin hemostatic plug through the increased thrombin generation. Such a fibrin plug will help to resist the overwhelming mostly local release of fibrinolytic activity triggered by the vast tissue damage occurring in extensive trauma. A release of fibrinlytic activity locally has also been demonstrated to occur in the gastrointestinal tract as well as during profuse postpartum bleedings. Pharmacological doses of rFVIIa have in fact, also been shown to induce hemostasis in such cases.     

"U"字缝合止血法对前置胎盘剖宫产患者术中出血量的影响

目的:探讨"U"字缝合止血法对前置胎盘剖宫产患者术中出血量的影响。方法:将2015年9月至2017年9月在西北妇女院儿童医院行前置胎盘剖宫产术的产妇96例作为研究对象,将其随机分组为两组,每组各48例患者。两组均给予常规止血处理,对照组采用"8"字缝合止血法,观察组为"U"字缝合止血法,比较两组手术指标及止血效果。结果:观察组手术时间、止血时间、术中出血量均显著少(短)于对照组(P0.05),凝血酶时间(TT)、血浆凝血酶还原时间(PT)、D-二聚体(D-D)、血小板(PLT)以及活化部分凝血活化酶时间(APTT)水平均明显低于对照组(P0.05),血红蛋白(HGB)、纤维蛋白原(FIB)水平均显著高于对照组(P0.05);止血有效率[97.92%(47/48)]显著高于对照组[85.42%(41/48)](P0.05),患者下床活动时间、住院治疗时间均显著短于对照组(P0.05)。结论:在前置胎盘剖宫产术中,实施"U"字缝合止血法可快速止血,且操作简单,确保降低出血量,降低对患者的损害,保证产妇健康和安全。