肺炎支原体感染对川崎病的影响及机制探讨

目的 分析肺炎支原体感染对川崎病的影响及其机制,以期指导临床诊疗。 方法 回顾性分析2013年8月至2018年8月我科住院的496例川崎病患儿临床资料,其中合并肺炎支原体感染组193例,未合并肺炎支原体感染组303例。应用倾向评分匹配法1∶1校正2组的年龄、性别、是否为不完全型川崎病、是否使用糖皮质激素、丙种球蛋白使用时间、丙种球蛋白使用方法和阿司匹林初始剂量,比较2组患儿的总发热天数、冠状动脉直径、冠状动脉扩张发生率、冠状动脉瘤发生率和丙种球蛋白无反应发生率。 结果 川崎病合并肺炎支原体感染组男性患儿多,更易发生颈部淋巴结肿大,年龄、中性粒细胞百分比、血沉和低密度脂蛋白高于川崎病未合并肺炎支原体感染组,血钾、血钙、高密度脂蛋白和白蛋白低于川崎病未合并肺炎支原体感染组,差异有统计学意义(均P2=5.516,P结论 肺炎支原体感染可能引起川崎病患儿脂质代谢及电解质的紊乱,其炎症反应更强,持续时间更长,对冠状动脉损伤更大。     

经皮介入封堵冠状动脉-肺动脉瘘治疗分析

目的:分析冠状动脉-肺动脉瘘(coronary artery-to-pulmonary artery fistula,CPAF)行经皮介入封堵治疗的可行性、安全性及疗效。方法:回顾性分析长海医院心内科于2009年7月至2016年2月之间接受经皮介入封堵术的58例CPAF患者的临床资料,排除合并其他复杂心脏病变而需要外科手术治疗的患者。结果:58名CPAF患者经介入封堵均获成功,平均植入封堵材料(2.35±0.87)枚。24名(41.38%)患者成功封堵后残余分流立即消失,34名(58.62%)患者仍有少量分流。未出现手术相关并发症。术后随访2~61个月,无出血、缺血等并发症。随访造影显示,其中3名(5.17%)患者出现了大量再通,后者随后均接受了再次封堵术并成功封堵。结论:经皮介入封堵CPAF切实可行,但应选择适宜患者,且需要经验丰富的术者操作。经治疗后冠状动脉瘘可能出现再通,因此对这些患者应进行随访造影或其他影像学检查。     

Renal function and plasma arginine vasotocin during an acute salt load in feral chickens

Summary Renal clearance experiments were conducted on feral chickens descended from birds collected from a coral island off the coast of Queensland, Australia. Following a control period when 0.13 M NaCl was used as a vehicle for the renal function markers, a salt load was imposed by infusion of 1 M NaCl. The hypertonic NaCl infusion resulted in increases in glomerular filtration rate (GFR), effective renal blood flow (ERBF), and urine flow rate (V), whereas filtration fraction decreased. Haematocrit was reduced and plasma osmolality, sodium, chloride and potassium concentrations increased. Plasma arginine vasotocin (P_AVT) levels increased from 31.4±2.3 pg·ml^-1 during the control infusion to 56.0±1.7 pg·ml^-1 following a salt load of 12 mmol Nacl·kg^-1 The sensitivity of release of AVT was 0.69±0.11 pg·ml^-1 per mosmol·kg^-1. The concentrations of Na and Cl in urine increased, whereas urine osmolality and potassium concentration decreased. The expansion of the extracellular fluid volume induced by the salt loading would tend to suppress the release of AVT, whereas the osmotic stimulus would provide a stimulus for the release of AVT. In this study, GFR, ERBF and ERPF increased at the same time as P_AVT increased.Abbreviations AVP arginine vasopressin - AVT arginine vasotocin - ERBF effective renal blood flow - ERPF effective renal plasma flow - GFR glomerular filtration rate - P_avt plasma arginine vasotocin concentration - PAH paraaminohippuric acid - SEM standard error of mean - SNGER single nephron glomerular filtration rate - U/P urine to plasma ratio - V urine flow rate     

l-Arginine Effects on Na+ Transport in M-1 Mouse Cortical Collecting Duct Cells—A Cationic Amino Acid Absorbing Epithelium

The effect of l-arginine on transepithelial ion transport was examined in cultured M-1 mouse renal cortical collecting duct (CCD) cells using continuous short circuit current (I _SC ) measurements in HCO₃ ⁻/CO₂ buffered solution. Steady state I _SC averaged 73.8 ± 3.2 μA/cm² (n= 126) and was reduced by 94 ± 0.6% (n= 16) by the apical addition of 100 μm amiloride. This confirms that the predominant electrogenic ion transport in M-1 cells is Na⁺ absorption via the epithelial sodium channel (ENaC). Experiments using the cationic amino acid l-lysine (radiolabeled) as a stable arginine analogue show that the combined activity of an apical system y⁺ and a basal amino acid transport system y⁺L are responsible for most cationic amino acid transport across M-1 cells. Together they generate net absorptive cationic amino acid flux. Application of l-arginine (10 mm) either apically or basolaterally induced a transient peak increase in I _SC averaging 36.6 ± 5.4 μA/cm² (n= 19) and 32.0 ± 7.2 μA/cm² (n= 8), respectively. The response was preserved in the absence of bath Cl⁻ (n= 4), but was abolished either in the absence of apical Na⁺ (n= 4) or by apical addition of 100 μm amiloride (n= 6). l-lysine, which cannot serve as a precursor of NO, caused a response similar to that of l-arginine (n= 4); neither L-NMMA (100 μm; n= 3) nor L-NAME (1 mm; n= 4) (both NO-synthase inhibitors) affected the I _SC response to l-arginine. The effects of arginine or lysine were replicated by alkalinization that mimicked the transient alkalinization of the bath solution upon addition of these amino acids. We conclude that in M-1 cells l-arginine stimulates Na⁺ absorption via a pH-dependent, but NO-independent mechanism. The observed net cationic amino acid absorption will counteract passive cationic amino acid leak into the CCD in the presence of electrogenic Na⁺ transport, consistent with reports of stimulated expression of Na⁺ and cationic amino acid transporters by aldosterone. Received: 11 September 2000/Revised: 6 December 2000     

The bone and the kidney

Renal tubular diseases may present with osteopenia, osteoporosis or osteomalacia, as a result of significant derangements in body electrolytes. In case of insufficient synthesis of calcitriol, as in renal failure, the more complex picture of renal osteodystrophy may develop. Hypothetically, also disturbed renal production of BMP-7 and Klotho could cause bone disease. However, the acknowledgment that osteocytes are capable of producing FGF23, a phosphaturic hormone at the same time modulating renal synthesis of calcitriol, indicates that it is also bone that can influence renal function. Importantly, a feed-back mechanism exists between FGF23 and calcitriol synthesis, while Klotho, produced by the kidney, determines activity and selectivity of FGF23. Identification of human diseases linked to disturbed production of FGF23 and Klotho underlines the importance of this new bone-kidney axis. Kidney and bone communicate reciprocally to regulate the sophisticated machinery responsible for divalent ions homeostasis and for osseous or extraosseous mineralisation processes.     

Polymorphisms of the uridine-diphosphoglucuronosyltransferase 1A1 gene and coronary artery disease

Bilirubin, an antioxidant in the blood, plays a role in protection from atherosclerosis. The level of bilirubin is highly correlated to the incidence of coronary artery disease (CAD). Unconjugated bilirubin is conjugated with glucuronic acid through the reaction of uridine 5′-diphosphate-glucuronosyl transferase 1A1 (UGT1A1). The interactions of CAD and the variations in the coding regions of the UGT1A1 gene have never been evaluated. The purpose of this study was to analyze the influence of the UGT1A1 variant on the incidence of CAD. There were 135 participants in this study: 61 in the experimental group, who had CAD, and 74 in the control group, who did not have CAD. The blood samples from all 135 participants were collected and assayed to clarify the relationship between bilirubin and CAD. The assay of the polymerase chain reaction and the sequence of the UGT1A1 gene were examined to find the gene’s polymorphisms. The bilirubin levels for the participants in the control group were significantly higher than for the patients in the CAD group. Although the concentration of bilirubin in the UGT1A1 variant was higher than the wild type for the patients in the CAD group, there was no significant difference in the polymorphism of UGT1A1 between the patients in the CAD group and the participants in the control group.     

结扎兔冠状动脉前降支与左室支的急性心肌梗塞比较

本文比较了结扎兔冠状动脉前降支（ＬＡＤ组）和左室支（ＬＶＡ组）两种方法建立的急性心肌梗塞模型。结果发现１：ＥＣＧ标测,三天内不同时间ＬＶＡ组∑△ＳＴ升高毫伏数均高于ＬＡＤ组（Ｐ＜０．０１或Ｐ＜０．０５）;２：Ｎ－ＢＴ染色,ＬＶＡ组心肌梗塞占心室重的百分率为１７．３％±０．５６％,而ＬＡＤ组为８．２％±２．４２％,两者相差非常显著（Ｐ＜０．０１）,证实了ＬＶＡ组心梗面积较ＬＡＤ组大且相对稳定。采用增强（Ｇｄ－ＤＴＰＡ）磁共振成像（ＭＲＩ）扫描发现ＬＶＡ组急性心梗范围在三天内基本稳定。作者认为,兔急性心梗模型采用结扎ＬＶＡ优于结扎ＬＡＤ。     

缺氧促进热休克蛋白70在肺动脉平滑肌细胞中的表达

缺氧性肺动脉高压中肺动脉结构重组,中膜平滑肌细胞增殖并迁移,但机制不明。本研究观察缺氧对肺动脉平滑肌细胞（ＰＡＳＭＣ）细胞周期、ＤＮＡ合成及细胞增殖的影响,并通过观察缺氧对ＰＡＳＭＣ热休克蛋白７０（ＨＳＰ７０）表达的影响,初步探讨缺氧的作用是如何介导的。结果表明缺氧可直接或协同内皮质－１促进ＰＡＳＭＣ ＤＮＡ合成及细胞增殖,并可增加ＨＳＰ７０在ＰＡＳＭＣ中的表达。     

Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI in STEMI patients with multivessel disease: a meta-analysis

Background

There are controversial data regarding infarct-related artery only (IRA-PCI) revascularisation versus multivessel revascularisation (MV-PCI) in ST-elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary percutaneous coronary intervention (PCI). We performed a meta-analysis comparing outcome in same stage MV-PCI versus IRA-PCI in STEMI patients with multivessel disease.

Methods

Systematic searches of studies comparing MV-PCI with IRA-PCI in the MEDLINE and the Cochrane Database of systematic reviews were conducted. A meta-analysis was performed of all available studies. Primary outcome was all-cause mortality. Secondary endpoints were re-infarction, revascularisation, bleeding and major adverse cardiac events (MACE).

Results

A total of 15 studies were identified with a total number of 35,975 patients. Mortality rate was significantly higher in the MV-PCI group compared with the IRA-PCI group, odds ratio (OR): 1.64 (1.46–1.85). Both the incidence of re-infarction and re-PCI were significantly lower in the MV-PCI group compared with the IRA-PCI group: OR 0.54 (0.34–0.88) and OR 0.67 (0.48–0.93), respectively. Bleeding complications occurred more often in the MV-PCI group as compared with the IRA-PCI group: OR 1.24 (1.08–1.42). Rates of MACE were comparable between the two groups.

Conclusions

MV-PCI during the index of primary PCI in STEMI patients is associated with a higher mortality rate, a higher risk of bleeding complications, but lower risk of re-intervention and re-infarction and comparable rates of MACE.