摘要:目的:研究高血壓病患者過氧化物酶體增殖物激活受體(PPAR)γ2基因Pro12Ala多態性與血糖水平之間的關系。方法:納入177名原發性高血壓患者,其中空腹血糖(FBG)lt;5.6 mmol/L組65例, FBG≥5.6 mmol/L組112例,收集一般資料;分別測定空腹及餐后2小時血糖、胰島素;對PPARγ2 基因Pro12Ala多態性與各臨床變量的關系進行研究。結果:FBGlt;5.6 mmol/L組和FBG≥5.6 mmol/L組Pro和Ala等位基因頻率分別為0.333,0.034及0.602,0.031;PP和PA基因型頻率分別為0.299,0.068及0.571,0.062;無AA型純合子。以體重指數(BMI)分層后,BMIlt;25組內,FBG與PPARγ2基因型相關（P=0.029)。以基因型分組比較,PA組空腹血糖水平和胰島素抵抗指數都低于PP組(Plt;0.05)。結論:成都地區高血壓患者PPARγ2基因Pro12Ala多態性與空腹血糖水平相關,且攜帶Ala基因者空腹血糖水平較低,胰島素抵抗較輕,推測該突變可能有減輕高血壓病患者胰島素抵抗,改善糖代謝異常的作用。Abstract: Objective:To study the association between the Pro12Ala polymorphism in peroxisome proliferatorsactivated receptorγ2 ( PPARγ2 ) gene and blood glucose levels in patients with primary hypertension. Methods：The Pro12Ala polymorphism in PPARγ2 was determined by polymerase chain reactionrestriction fragment length polymorphism (PCRRELP) in 177 subjects with primary hypertension of the Han people in Chengdu of China, including 65 subjects with fasting blood glucose (FBG)lt;5.6 mmol/L and 112 subjects with FBG≥5.6 mmol/L; the clinical characteristics including height, weight, OGTT(0h and 2h) of the subjects were detected and the realationship between the Pro12Ala polymorphism and the clinical characteristics were analysed. Results: The allele frequencies in the group with FBGlt;5.6 mmol/L and FBG≥5.6 mmol/L were 0.333, 0.602 for Pro and 0.034, 0.031 for Ala. The genotype frequencies were 0.299, 0.571 for PP and 0.068, 0.062 for PA, and there was no AA. In the group with BMIlt;25, the Pro12Ala polymorphism was associated with FBG （P=0.029). the Ala allele had a negative relationship to the FPG and insulin resistance index (IRI) (Plt;0.05).Conclusion: The data showed that the Pro12Ala polymorphism was associated with FBG., and The allele Ala probably had benefits to glycometabolic disturbance in patients with primary hypertension by declining insulin resistance.
Objective This experiment is to compare the effect of two operations “disconnection” and “ligation” of separation of gastroesophageal peripharal blood vessel in portal hypertension and provide base of rational for selecting reasonable method of separation of gastroesophageal peripheral blood vessel in portal hypertension.MethodsFortyeight SD rats were induced to model of liver cirrhosis and portal hypertension by CCL4 . They were divided at random into 3 groups (16 rats each): disconnection group, ligation group and pseudooperation group. There was also a normal comparison group with 6 normal SD rats (laparotomy only). Thirty days and 100 days after the operation, 8 rats were killed respectively in every group except for the normal comparison group. Thirty days after the operation, the rats of normal comparison group were killed. The adhesion around gastric cardia and fundus with the building of new branch blood vessels, and the relative average blood vessel amounts and average vein caliber changes in submucosa layer and lamina propria layer of esophagus inferior segment were observed. ResultsIn the observation of adhesion around gastroesophageal and the building of new branch blood vessels after the operations, disconnection group was more marked than ligation group. In the observation of relative average blood vessel amounts and average vein calibers changes in submucosa layer and lamina propria layer of esophagus inferior segment, pseudooperation group was more marked than in normal comparison group in different time（P＜0.05）,and 30 days after the operations, disconnection and ligation groups were less serious than pseudooperation group（P＜0.05）. One hundred days after the operation, the two observation indexes of all the groups were more serious than before, and result of disconnection group was nearly close to pseudooperation group（Pgt;0.05）, but ligation group was still less serious than pseudooperation group(P＜0.05).Conclusion Both the “disconnection” and “ligation” operation have the same rank effect of separation of gastroesophageal peripharal blood vessel in short time. But the “ligation” operation makes less trauma, postoperative adhesion and vascularizition, then the separation effect of the “ligation” operation may sustain a relatively long time.
ObjectiveTo explore the role of increased preoperative ventricular-arterial stiffening in hypertensive infants with coarctation of the aorta (CoA).MethodsA retrospective study was conducted in 314 infants with CoA (CoA group, 193 males and 121 females, aged 5.4±2.2 months), and 314 infants receiving tumor chemotherapy with normal cardiovascular function and without pneumonia (control group, 189 males and 125 females, aged 4.4±3.8 months), who were admitted to our hospital from 2015 to 2017. The clinical data of the two groups were compared.ResultsThere were statistical differences in effective aortic elastance index (Eai), effective left ventricular end-systolic elasticity index (Eesi), ventricle-artery coupling index (VACi), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and ratios of left ventricular hypertrophy, dilation and systolic dysfunction between the two groups (P<0.05). Compared with non-hypertensive CoA infants, CoA infants with hypertension had higher Eai, Eesi, NT-ProBNP level and proportion of left ventricular hypertrophy (P<0.05). Compared with concomitant ventricular septal defect, infants with isolated CoA had higher Eai, Eesi, NT-proBNP level, incidence of hypertension and higher proportion of left ventricular hypertrophy, dilation and systolic dysfunction (P<0.05). Eai and Eesi were positively correlated with NT-proBNP level, left ventricular hypertrophy and fractional shortening of left ventricle (P<0.05), while Eai and Eesi were negatively correlated with left ventricular end diastolic volume index, left ventricular end systolic volume index and concomitant ventricular septal defect (P<0.05). Hypertension was related to preoperative left ventricular hypertrophy, Eai, Eesi and NT-ProBNP. Eai was an independent risk factor for hypertension.ConclusionPreoperative ventricular-arterial stiffening is increased in infants with aortic coarctation, which is related to the occurrence of hypertension. Isolated CoA shows more significant increase in ventricular-arterial stiffening, higher ventricular overload and incidence of hypertension.
【Abstract】Objective To explore the dynamic expression of TNF-α and VEGF in the development of esophageal varices in rats with portal hypertension. Methods Sixty male SD rats were randomly divided into the experimental group and the control group. In the experimental group, a two-stage ligation of portal vein plus ligation of the left adrenal vein was performed.After establishment of the model, the expression of TNF-α、VEGF and PCNA in the lower esophagus was detected with immunohistochemical SP technique on 7 d、14 d、21 d and comparision of these data with control group was performed respectively. In the control group, a sham-operation was performed, was also divided.Results The portal venous pressure in the experimental group was significantly higher than that of the control, so did the vessel number and the total vascular area of the submucosal veins in the lower esophagus. Compared with the control subgroups, the expression of TNF-α and VEGF on the 21 d subgroup was ber, while PCNA was ber on the 14 d and 21 d. Conclusion In the development of esophageal varices of portal hypertension, VEGF possibly plays a role in the varices developemt, and TNF-α may be responsible for the damage of esophageal mucosa.
Objective To investigate the effect of proanthocyanidins (PC) on retina of rats with acute ocular hypertension. Methods The SpraqueDawley (SD) rats were randomly divided into the normal group, the model group and PC high or lowdosage group. The PC high or low dose group received 300mg/kg.d or 100mg/kg.d of PC in suspension solution for 5 days respectively. The normal group and the model group fed with distilled water for 5 days. Then acute ocular hypertension was induced in the model group and all PC groups, and after 48h of ocular hypertension the eyeballs were analyzed by electron microscope and UV spectrophotometer to measure the levels of superoxide dismutase(SOD), malonaldehyde (MDA), nitrogen monoxidum (NO), glutamic acid (Glu) and calcium ion(Ca2+). Results PC could raise the activity of SOD and reduced the levels of MDA,NO,Glu and Ca2+ in retina tissue. Electron microscope examination revealed that PC reduced retinal edema and ganglion cell apoptosis. PC also enhanced the SOD activity and suppressed the levels of MDA, NO, Glu and Ca2+. Conclusions PC can protect retina from acute ocular hypertension. The main mechanism might relate to anti-free radical oxidation, antagonizing calcium overloading, reducing toxicity of NO and Glu on the retina.
Objective To investigate the effect of vitamin K1 in the function of blood coagulation state, intraopera-
tive blood loss, and hemoglobin content of liquid in postoperative drainage in patients with cirrhosis combined with portal
hypertension before and after splenectomy combined with the hydrodynamic vein cut-out surgery.
Methods In total of 143 cases of cirrhosis combined with portal hypertension who treated in our hospital from January 2010 to October 2015 were prospectively collected, and randomly divided into 3 group, including 51 cases of vitamin K1 group, 45 cases of carbazochrome sodium sulfonate group, and 47 cases of control group. Drug was used form 1 week before surgery to 5 days after surgery (vitamin K1 group: vitamin K1, 0.03 g, intravenous drip; card collaterals sodium sulfonic group: card collaterals sulfonic sodium, 80 mg, intravenous drip; control group: normal saline, 250 mL, intravenous drip). Prothrombin time of patients in 3 groups was detected at 1 week before surgery, 3 days before surgery, 1 day before surgery, 1 day after surgery, 3 days after surgery, and 5 days after surgery; hemoglobin content of liquid in postoperative drainage was detected on 1, 3, and 5 days after surgery.
Results In terms of prothrombin time, there was no significant difference at 1 week before surgery and 5 days after surgery (P>0.05); prothrombin time of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group on 3 days and 1 day before surgery (P>0.05); prothrombin time of vitamin K1 group and carbazochrome sodium sulfonate group was both lower than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and vitamin K1 group on 1 day and 3 days after surgery (P>0.05). In terms of intraoperative blood loss, intraoperative blood loss of vitamin K1 group was lower than those of carbazochrome sodium sulfonate group and control group (P＜0.05), but there was no significant difference between carbazochrome sodium sulfonate group and control group (P>0.05). In terms of hemoglobin content of liquid in postoperative drainage, it was lower in vitamin K1 group and carbazochrome sodium sulfonate group than that of control group on 1 day and 3 days after surgery (P＜0.05), but there was no significant difference among 3 groups on 5 days after surgery (P>0.05).
Conclusion Vitamin K1 is helpful to improve function state of blood coagulation before and after surgery in patients with cirrhosis combined with portal hypertension (from 1 week before surgery to 3 days after surgery), and reduce the intraoperative blood loss; carbazochrome sodium sulfonate can improve function status of postoperative blood coagulation to 3 days after surgery and postoperative blood loss, but has no obvious improvement in the function status of preoperative blood coagulation and introperative blood loss.
ObjectiveTo evaluate the effect of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in acute lung injury (ALI) with intra-abdominal hypertension (IAH).
MethodsSix pigs were anesthetized and received mechanical ventilation (MV). Volume controlled ventilation was set with tidal volumn(VT) of 8 mL/kg,respiratory rate(RR) of 16 bpm,inspired oxygen concentration (FiO2) of 0.40,and PEEP of 5 cm H2O. ALI was induced by repeated lung lavage with diluted hydrochloric acid (pH<2.5) until PaO2/FiO2 declined to 150 mm Hg or less to established ALI model. Intra-abdominal hypertension was induced by an nitrogen inflator to reach intra-abdominal pressure of 20 mm Hg. Respiratory parameters and hemodynamics were continuously recorded at different PEEP levels(5,10,15,and 20 cm H2O). Every level was maintained for one hour.
ResultsPaO2/FiO2 in PEEP5,10,15 and 20 were 90±11,102±10,172±23 and 200±34 mm Hg respectively. PaO2/FiO2 in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). Chest wall compliance (Ccw) in PEEP5,15 and 20 were 26±3,76±15 and 85±14 mL/cm H2O respectively. Ccw in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in lung compliance (CL) in different PEEP levels (P>0.05). Plateau pressure(Pplat) in PEEP5,10,15 and 20 were 30±3,31±2,36±2 and 38±4 cm H2O respectively. Pplat in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). There was no significant difference in Pplat between PEEP15 and 20 (P>0.05). Heart rate (HR) in PEEP5,15 and 20 were 113±17,147±30,and 160±30 beat/min respectively. HR in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in HR between PEEP15 and 20 (P>0.05).Cardiac index (CI) in PEEP5 and 20 were 4.5±0.6 and 3.5±0.6 L·min-1·m-2 respectively. CI in PEEP20 was significantly lower than that in PEEP5 (P<0.05). There was no significant difference in CI in PEEP5,10 or 15(P>0.05). Central venous pressure(CVP) in PEEP5,15 and 20 were 12±2,17±2,and 18±3 mm Hg respectively. CVP in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in CVP between PEEP15 and 20 (P>0.05). There were no significant differences in MAP,SVRI,ITBVI,GEDI,PVPI,or EVLWI between different PEEP levels.
ConclusionConcomitant ALI and IAH can induce great impairments in respiratory physiology. When PEEP is gradually increased,oxygenation and the respiratory function are improved without significant secondary hemodynamic disturbances.
Objective To explore the methods， clinical effects， and application value of laparoscopic splenectomy combined with pericardial devascularization. Methods The clinical data of 23 patients with liver cirrhosis and portal hypertension who performed laparoscopic splenectomy combined with pericardial devascularization between july 2009 and july 2012 in our hospital were analyzed retrospectivly. Results In 23 cases， 2 cases were converted laparotomy due to bleeding， 21 cases were successfully performed laparoscopic splenectomy combined with pericardial devascularization. The operative time was 230-380 minutes （average 290 minutes）. The intraoperative blood loss was 300-1 500 mL （average 620 mL）. The postoperative fasting time was 1-3 days （average 2 days）. The postoperative hospital stay was 8-14 days （average 10 days）. Conclusion Laparoscopic splenectomy combined with pericardial devascularization is a feasible， effective， and safe procedure as well as minimally invasive hence is applicable for patients with portal hypertension and hypersplenism．
We had performed transjugular intrahepatic portosystemic stent shunt (TIPSS) in one hundred and three patients with advanced liver cirrhosis and portal hypertension from July,1993 to January, 1995. TIPSS was carried out successfully in ninty-eight out of 103 cases and the technical success rate was 95.2%. Acute variceal bleeding was immediatly controlled and portal pressure reduced by an average of 1.36±0.02 kPa after TIPSS. The disappearance of gastric cornoary and esophageal varices, the shrinkage of spleen and the reduction of ascite were observed . Three patients died of acute liver failure and one died of variceal redbleeding within 30 days of treatment. Mild encephalohthy was obserbed in 10 cases with TIPSS. At follow-up of 1～22 months, variceal rebleeding and ascite were observed in 6 patients and stenosis of shunt was evident is 12.5% of cases by the subsequent doppler sonography. According to this result, TIPSS is an effective method for the treatment of portal hypertension.
Portal vein blood flow is very important for the normal function of transplanted liver. The author reviewed the management methods of different portal vein thrombosis classification in the liver transplantation (LT). The prognosis of LT in the patients with Yerdel 1–3 thrombosis is similar to that the patients without thrombosis. The portal vein reconstruction of the patients with Yerdel 4 thrombosis can be realized by varicose vein to portal anastomosis, renoportal anastomosis or cavoportal hemitransposition. When anastomosis is made at the proximal side of a spontaneous shunt between the portal and cava system, the blood shunted from portal system can be reintroduced into the donor liver, which is crucial for the management of Yerdel 4 thrombosis. The establishments of artificial shunt by distal splenic vein, mesenteric vein or “multiple to one” anastomosis are effective attempts to drain the blood from portal system to the donor liver. For more severe diffuse thrombosis of portal vein system, multivisceral transplantation, including liver and small intestine, should be considered. The cases of LT in the patients with complex portal vein thrombosis are increasing, however the prognosis remains to be determined after accumulation of the cases.
