2002年 · 第115卷第02期

Objectives To compare primary stenting in the infarct-related coronary artery with intravenous rt-PA therapy plus rescue intracoronary stenting. Methods Ninety-eight patients with a first acute myocardial infarction (AMI) were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stneting (thrombolysis plus stenting group). Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction,LVEF) was calculated by echocardiography before discharge between the two groups. Results There were 47 patients (97.91%) in primary stenting group and 50 patients (100%) in thrombolysis plus stenting group had achieved TIMI grade 2-3 flow after the procedure. But the former had more cases (93.8%) of TIMI 3 flow than that of latter (60.0%. P=0.0001). There was no difference between the two groups in cardiac events during hospitalizaton. But the patients in primary stenting group had better cardiac function (LVEF 0. 62± 0. 14 vs 0. 50 ±0. 12, respectively, P=0.0001) between the two groups. Conclusions Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting. Chin Med J 2002; 115(2): 163-165

Objective To determine the mid-term effects of cutting balloon angioplasty (CBA) on in-stent restenosis. Methods A total of 69 patients with in-stent restenosis were divided into 2 groups randomly: cutting balloon angioplasty and plain old balloon angioplasty. The mechanisms of restenosis and dialation results were determined by quantitative coronary angiography and intravascular ultrasound. Follow-up was performed. Results The procedural success rate was 100%without death and acute closure. One patient experienced dissection at the distal end of the stent and needed another stent. The mean follow-up period was 6.7 ±2.3 months. The final re-restenosis rate was 15%and 18%at 3 months and 6 months respectively, markedly lower than after plain old balloon angioplasty (38%and 43%) . Acute gain by intravascular ultrasound (IVUS) was 1.72 ±0.52 mm after cutting balloon angioplasty, higher than 1.15 ± 0.54 mm after plain old balloon angioplasty. The lumen diameter late loss in the cutting balloon group was 0.26 ±0.05 mm and 0.38 ± 0.06 mm at 3 months and 6 months respectively, significantly lower than for those in conventional balloon group (0.78 ± 0.19 mm and 0.89 ± 0.16 mm, respectivelly, P <0.001). As shown by IVUS, the main mechanism of cutting balloon angioplasty was marked reduction of plaque area without significant increase of vessel area (less vessel trauma). Conclusion Cutting balloon angioplasty is feasible and effective for the treatment of in-stent restenosis with less vessel trauma. Chin Med J 2002; 115(2): 166-169

Objective To investigate the importance of autoimmunity against β1-adrenoreceptor in the pathogenesis of dilated cardiomyopathy (DCM). Methods Fourteen rabbits were divided equally into two groups. Rabbits in the immunized group (n=7)were immunized monthly for one year with synthetic peptide corresponding to the second extracellular loop of the β1-adrenoreceptor and adjuvant. Control rabbits received the mixture with the same procedure as described except with a substitution of saline for the corresponding peptide. During the study period, all rabbits were bled to assay the titers of antipeptide antibody and left ventricular ejection fractions (LVEFs)were measured by emission computed tomography. At the end of experiment, invasive cardiac function was measured and morphologic examinations were done. Results High titers of antipeptide antibody were found in the sera from immunized rabbits throughout the study period in contrast to those from control rabbits. LVEFs were significantly higher in immunized rabbits than those of the control group at the 4th and 6th month. At the end of the experiment, the maximal rates of rise and decline of ventricular pressure of the immunized group were significantly lower than those of the control group. Morphological changes were found in immunized rabbits such as the enlargement of ventricles, myofibrillar lysis and necrosis, mitochondria swelling and condensation. No obvious alterations were noted in hearts of control rabbits. Conclusion Autoimmunity against the β1-adrenoreceptor may be involved in the pathogenesis of dilated cardiomyopathy and β1-adrenoreceptor antibody may play a role in the process. Chin Med J 2002; 115(2): 170-174

Objective To assess complement-mediated myocardial injury on isolated guinea pig working hearts and cardioprotective effects of CD59. Methods Using a modified Langendorff apparatus, isolated guinea-pig working hearts were perfused with a modified Krebs Henseleit buffer containing 3%heat-inactivated human plasma and zymosan (IPZ)(control) (n=10), 3%normal human plasma and zymosan (NPZ) (n=10), or 3%normal human plasma and zymosan and 1.5 μg/ml CD59 (NPZC) (n=10), respectively. Epicardial electrocardiogram(ECG), cardiac output (CO), coronary arterial flow (CF), maximum left ventricular developed pressure(LVPmax), maximum left ventricular developed pressure increase rate (+dp/dtmax), maximum left ventricular developed pressure decrease rate (- dp/dtmax) and heart rate (HR) were recorded at 0, 15,30, 45 and 60 min of treatment. After the experiment, immunohistochemical examination was performed to detect the presence of C3a or C5b-9 in the myocardium of the isolated hearts. Results Compared the IPZ group, hearts treated with NPZ showed a slight depression on ST segments of epicardial ECG at 15 min, a significant elevation between 30min to 60min, a decrease in CF, CO, LVPmax,+dp/dtmax and - dp/dtmax, and an increase in HR at 15 min. The observed alterations in CF, CO,LVPmax, +dp/dtmax and - dp/dtmax remained decreased, while the HR remained increased until the end of the protocol. The all above parameters of hearts treated with NPZC were similar to the control group (IPZ)at any given time. Immunohistochemical examination showed positive signals of C3a and C5b-9 in the myocardium of hearts treated with NPZ. C3a was positive in NPZC, and C3a and C5b-9 were negative in IPZ. Conclusions Activated human complements directly damage isolated guinea pig working hearts, and CD59 offers a significant protection against the injuries. Chin Med J 2002; 115(2): 175-178

Objective To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV). Methods Ten intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60%and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored. Results Tidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05) . With the level of assist increasing, peak inspiratory pressure was increasing significantly (P <0.05), while patients' work of breath had the tendency to decrease (P <0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50[1.50] vs 0.75[2.00], P <0.05) at the same degree of respiratory muscle unloading. PaCO2 was significantly higher on PAV (54[23] mm Hg) than on PSV (48[23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 ± 4 cm H2O vs 21 ± 3 cm H2O, respectively, P <0.05). Hemodynamics and oxygenation remained unchanged. Conclusions PAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand . Chin Med J 2002; 115(2): 179-183

Objective To study Chlamydia pneumoniae (C. pneumoniae) infection in 110 patients with respiratory tract infection admitted to our hospital from January to December 1995 in Nanjing. Methods Sputum and throat swab specimens were taken and C. pneumoniae DNA was detected by using polymerase chain reaction (PGR) with the HM-1-HR-1 primer pair. At the same time, serum samples were taken and immunoglobulin G and M (IgG and IgM) fractions of antibodies to C. pneumoniae were studied by microimmunofluorescence test. Results Prevalence of specific IgG was 70%in patients with respiratory tract infection. Seventeen patients (15.5 %) were serologically diagnosed as having recent C. pneumoniae infections and 12 patients(10.9%) had positive PGR in sputum and/or swab specimens. The total positive rate was 22.7%(25/110) detected by PGR combined with serological tests. Acute infection of C. pneumoniae was common in patients with asthma (57.1%), pneumonia (35.0%). COPD (25.9%) and bronchitis (25.0%). Clinical features between C. pneumoniae infection and non-C. pneumonia infection showed no significant differences. Conclusions Chlamydia pneumoniae is an important pathogen that causes infection of the human respiratory tract and attention should be drawn to this special illness. Chin Med J 2002; 115(2): 184-187

Objective To compare the influence of cardiac-pulmonary function on clinical acute respiratory failure patients using Proportional assist ventilation (PAV), Pressure support ventilation (PSV) and intermittent positive pressure ventilation (IPPV). Here, we also describe some our experience with the clinical use of PAV. Methods Using the IPPV mode in ten acute respiratory failure patients, calculate Elastance (Ers) and Resistance (Rrs), then change to PSV, set inspiratory positive airway pressure (I PAP) according to IPPV,so that tidal volume (VT) is the same as that of IPPV. We then changed the mode into PAV and set the assist ratio according to PSV, so that VT and Ppeak were the same as that of PSV. Then we observed the changes of respiratory mechanics, blood gas levels and hemodynamics during ventilation. Results Compared with PSV and IPPV, peak pressure (Ppeak) of PAV was markedly lower while VT was similar; work of breathing of patient (WOBp), and work of breathing of ventilation (WOBv) were also lower; center vein pressure (CVP) and pulmonary capillary wedge pressure (PCWP) of PAV were markedly lower than that of IPPV while VT were similar. Compared with PSV, VT, mean blood pressure(mBP) and cardiac output (CO) of PAV were higher. Mean pulmonary artery pressure (mPAP) and WOBp of PAV were lower while Ppeak was similar; the differences in WOBp were notable. Conclusions For clinical acute respiratory failure patients, compared with PSV and IPPV, PAV has lower airway pressure、less WOBp and less influence on hemodynamics. Chin Med J 2002; 115(2): 188-191

Objective To investigate the relationship between codon 54 gene polymorphism of the host defense moleculo mannose-binding protein (MBP), and the patterns of glomerular immune deposition in IgA nephropathy (IgAN) . Methods IgAN patients with different patterns of glomerular immune deposition were selected and divided into two groups. Group A consisted of 77 patients with glomerular IgA and C3 deposits, and Group AGM consisted of 70 patients with glomerular IgA, IgG, IgM, C3 and Clq deposits. Clinical features and laboratory relevant data of all patients were collected . One-hundred and forty healthy adults were recruited as normal controls. The MBP gene codon 54 GGC/GAC polymorphism was investigated by using polymerase chain reaction and restriction fragment length polymorphism. Results The genotype frequency of GGC/GAC heterozygotes was significantly higher in Group AGM as compared with that of Group A (41.4%vs 19.5%. P <0.01) or normal subjects (41.4%vs 26.4%, P <0.05), while no difference was found in the distribution of MBP genotypes between Group A and normal subjects. GAC allele frequency was also higher in Group AGM than that in Group A (0.24 vs 0. 14, P < 0.05) or normal subjects (0.24 vs 0.15, P <0.05). The variant allele (GAC) was markedly associated with Group AGM (OR=1 .95, 95%CI: 1 .06 -3.58). In both Group A and Group AGM, more patients carrying the variant allele had episodes of upper respiratory or gastrointestinal infections prior to the onset of IgAN than those with wild homozygotes (GGC/GGC). Conclusions Genetic variation of the host defense molecule, MBP, may be involved in the formation of the diverse patterns of glomerular immune deposition in IgAN. The variant allele of the MBP gene may partially account for abundant immune deposits in some IgAN patients. Chin Med J 2002; 115(2): 192-196

Objective To investigate the effect of L-arginine (L-arg) on early compensatory renal growth (CRG),tubulointerstitial accumulation of extracellular matrix (ECM), long term survival rate and renal scarring in rats with 5/6 nephrectomy (SNx). Methods The experiment included four groups of rats (n=5 each group): (1) Sham group, (2) SNx group, (3) SNx + L-arg group, and (4) Sham + L-arg group (L-arg 1% in drinking water). Parameters related with CRG and early tubulointerstitial expression of ECM and a smooth muscle actin (αSMA) were evaluated by immunohistochemistry at day 30. The survival rate and the extent of renal scarring in the rats were observed at day 120. Results L-arg significantly increased the early CRG of SNx rats as determined by the wet kidney weight(P <0.05), total protein (P <0.01), and DNA content (P <0.001) of the remnant kidney. The cell proliferation in the tubulointerstitium as determined by immunostaining for proliferative cell nuclear antigen(PCNA) also markedly increased (P <0.05). Furthermore, glomerular volume (Vg) in the SNx rats treated by L-arg increased 16%compared with that in the SNx group (P=0.06). More specifically, L-arg significantly increased the interstitial immunostaining for collagen Ⅲ, Ⅳ, and fibronectin (P<0.05, 0.01,respectively), which were positively correlated with the increased expression of α-SMA (P <0.001,respectively) . In the long term experiment, L-arg significantly reduced the survival rate (P <0.05) and increased the severity of renal scarring in the SNx rats (P <0.05). Conclusion This preliminary study suggested that early supplementation with L-arg might exacerbate the progression of renal scarring in rat remnant kidney. Chin Med J 2002; 115(2): 197-201

Objective To investigate the direct effects of the Flt3 ligand (FL) on hematopoiesis, such as the stimulation of the formation of hematopoietic colonies and the proliferation of dendritic cells, as well as the indirect stimulation of hematopoiesis, especially via the proliferation of endothelial cells. Methods Mononuclear cells from human cord blood were plated in methylcellulose medium containing different cytokines to induce hematopoietic colony formation. Dendritic cells (DCs) were induced from the mononuclear cells with a cytokine cocktail with or without recombinant human soluble FL (rhFL; 100 ng/ml). The Flt3 receptors on the surface of a human microvascular endothelial cell line (ECV) were analyzed by flow cytometry. The proliferation of ECV stimulated by rhFL was measured with the microculture tetrazolium assay. The levels of FL, IL-6, IL-8, G-CSF and GM-CSF in the supernatant of ECV cultures were measured by enzyme linked immunoabsorbent assay (ELISA). Results rhFL stimulates colony formation from cord blood when used as a sole stimulant. FL in combination with other cytokines increased colony formation significantly. The number of DCs was approximately 2.5 times higher when rhFL was used. rhFL stimulates the proliferation of ECV on which Flt3 receptors are expressed. Furthermore, ECV secretes FL, IL-6, IL-8, G-CSF and GM-CSF, which were augmented by tumor necrosis factor-α and rhFL. Conclusions rhFL enhances hematopoietic colony formation and DC proliferation from human cord blood cells. FL not only stimulates the proliferation of ECV, but is also secreted by ECV. FL may exert direct and indirect effects on hematopoiesis. Chin Med J 2002; 115(2): 202-205

Objective To investigate whether telomerase activity, human telomerase RNA (HTR) and human telomerase reverse transcriptase (HTERT) expression were associated with tumor development in lung cancer and whether telomerase is regulated at gene level or transcriptional level. Methods Expression of HTR and HTERT was detected by reverse transcription-polymerase chain reaction(RT-PCR) in 68 human lung cancer and in 68 adjacent-neoplatic lung tissues. And telomerase activity was examined by a quantitative telomeric repeat amplification protocol (TRAP). Results In 68 lung cancer tissues, telomerase activity, HTR and HTERT were expressed in 79%, 98.5%and 91.2%respectively, whereas all adjacent non-neoplastic lung tissues were telomerase negative. Most normal lung tissues expressed HTR (91.2%) and HTERT was detected in only 7 of 68 non-neoplastic tissues. Conclusions The relatively high frequency of telomerase activity in lung cancer whereas the detection of no telomerase activity in normal lung tissues suggested that telomerase may play an important role in tumorigenesis of lung cancer. Compared to HTR, HTERT expression was better associated with telomerase activity with a concordance of 88.9%. Telomerase activity may be regulated at transcription level or translation level. Chin Med J 2002; 115(2): 290-292

Objective To explore the effect of shenmai injection (SI) on expression of TNF-α mRNA in peritoneal macrophages (pMΦs) of scald mice. Methods BALB/c mice were inflicted with 11 %of body surface area Ⅲ degree scald and injected intraperitoneally (ip) with SI daily for 5 days, and expression of TNF-α mRNA in pMΦs was determined by semi-quantitative RT-PCR. Results In scald mice, the expression of TNF-α mRNA in pMΦs increased significantly, but it was reduced obviously (P <0.01) after SI administration, while the livability was increased markedly (P < 0.05). Conclusions For scald mice, the cause of death at early stage might be related to the high expression of TNF-α mRNA in pMΦs and the use of SI can decrease the death rate. Chin Med J 2002; 115(2): 293-295

Objective To make quantitative analysis of DNA content of breast concer with neuroendo- crine (NE) cells and its significance. Methods Using MIPS-Ⅲ image analyzer, DNA content and 9 parameter measurements of the tumor nuclei were made in both NE positive (17) and negative (64) breast carcinomas. Results Out of 81 breast carcinomas, 17 cases were NE positive while 64 cases were NE negative. In the NE (+) cases, the integral optic density, mean optic density, DNA index, DNA stemlines peak,> 5c aneuploidy cells and the rate of aneuploidy cells were all lower than those in the NE negative breast carcinoma cases (P <0.01) . The positive rates of NE cells were 32.5%and 7.9%in grade Ⅰ - Ⅱbreast carcinomas and in grade Ⅲ breast carcinomas respectively with significant difference between the two groups (P<0.01). Conclusion Our study shows that NE (+) breast carcinomas have lower DNA parameters than NE (-)breast carcinomas, suggesting that NE (+) breast carcinomas have lower malignancy. Chin Med J 2002; 115(2): 296-298