预行动静脉内瘘手术患者自身血管保护行为影响因素的结构方程模型

目的基于结构方程模型分析预行动静脉内瘘手术患者自身血管保护行为的影响因素。方法于2020年3月至2022年3月选择某院预行动静脉内瘘手术患者166例作为研究对象,采用一般资料调查表、中文版预行动静脉内瘘术自我护理行为评估量表(scale of self-care behaviours anticipatory to creation of arteriovenous fistula,ASBAC-AVF)、社会支持评定量表进行调查,随后采用单因素、多元线性回归以及结构方程模型对预行动静脉内瘘手术患者自身血管保护行为的影响因素进行分析。结果166例预行动静脉内瘘手术患者中文版ASBAC-AVF量表为(11.94±2.73)分,社会支持评定量表总分为(43.45±11.21)分;单因素分析和多元线性回归分析结果显示,文化水平、自身血管保护相关健康宣教、居住地区、输液频次以及社会支持均是预行动静脉内瘘手术患者自身血管保护行为的影响因素,可解释其58.6%的变异(P<0.05);结构方程模型分析结果显示,自身血管保护相关健康宣教、输液频次以及社会支持直接影响预行动静脉内瘘手术患者自身血管保护行为(路径系数分别为0.312、0.226、0.402);文化水平和居住地区不但可以直接影响预行动静脉内瘘手术患者自身血管保护行为(路径系数分别为0.256、0.194),还可以通过社会支持的中介效应间接影响预行动静脉内瘘手术患者自身血管保护行为(路径系数分别为0.087、0.073)。结论预行动静脉内瘘手术患者自身血管保护行为受多种因素的影响,医务人员应对未参加自身血管保护相关健康宣教、输液频次低以及社会支持度低的预行动静脉内瘘手术患者进行干预,以提升其自身血管的保护能力。

冠状动脉旁路移植术后2型糖尿病患者接受自身血管或静脉桥介入治疗预后的比较

目的:比较冠状动脉旁路移植术(coronary artery bypass graft,CABG)后的2型糖尿病(type 2 diabetes mellitus,T2DM)患者选择自身血管或静脉桥行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)对患者预后的影响,并探讨该类患者发生主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)的预测因素。方法:筛选了CABG术后需再次行PCI治疗的T2DM患者559例,其中488例患者接受自身血管PCI,71例患者接受静脉桥PCI。比较不同靶血管的选择对预后的影响,并采用多因素Cox回归分析发生MACCE的预测因素。主要研究终点为MACCE。结果:与自身血管PCI组相比,静脉桥PCI组患者慢血流/无复流的发生风险更高(2.8%vs.零,P=0.008)。中位随访40个月发现自身血管PCI组与静脉桥PCI组患者发生MACCE的风险相似(35.2%vs.33.8%,P=0.916),并且两组患者发生其他终点事件,差异无统计学意义。多因素Cox回归分析发现,性别(男性)(HR=0.678,95%CI:0.487~0.970,P=0.033)是既往CABG合并T2DM患者PCI后发生MACCE的保护性因素,而慢性肾脏病(chronic kidney disease,CKD)(HR=1.822,95%CI:1.010~3.282,P=0.046)和主动脉内球囊反搏治疗(HR=6.117,95%CI:2.390~15.660,P<0.001)是该部分患者术后发生MACCE的危险因素。结论:在CABG术后的T2DM患者中,不论选择自身血管或静脉桥PCI,术后长期不良心血管事件发生风险相似,但自身血管PCI患者慢血流/无复流现象发生率低。此外,男性患者长期预后较好,而合并CKD及主动脉内球囊反搏治疗后的患者长期预后较差。

低分子肝素协同aFGF促“自身血管搭桥”

目的 探讨低分子肝素 (LMWH)协同酸性成纤维细胞生长因子 (aFGF)促“自身血管搭桥”的可行性。方法 建立兔下肢缺血模型 (2 8只兔 ) ,平均分成 4组 :(1)盐水组 ;(2 )LMWH组 ;(3)aFGF组 ;(4)aFGF +LMWH组。术后第 2 8天 ,通过动脉造影数字减影、血管免疫组化等技术比较各组小血管数量及平滑肌厚度。结果 静脉给予低剂量的aFGF(2 0 0 μg)未见明显的促血管生成作用 ,当相同剂量的aFGF与LMWH(10 0 0ICU)合用时显示出明显的促血管生成作用 ,各组间血管平滑肌厚度差异无明显性。结论 LMWH在体内能够协同aFGF促“自身血管搭桥”

Autoimmune liver serology:Current diagnostic and clinical challenges

Liver-related autoantibodies are crucial for the correct diagnosis and classification of autoimmune liver diseas-es(AiLD),namely autoimmune hepatitis types 1 and 2(AIH-1 and 2),primary biliary cirrhosis(PBC),and the sclerosing cholangitis variants in adults and children.AIH-1 is specified by anti-nuclear antibody(ANA) and smooth muscle antibody(SMA).AIH-2 is specified by antibody to liver kidney microsomal antigen type-1(anti-LKM1) and anti-liver cytosol type 1(anti-LC1).SMA,ANA and anti-LKM antibodies can be present in de-novo AIH following liver transplantation.PBC is specified by antimitochondrial antibodies(AMA) react-ing with enzymes of the 2-oxo-acid dehydrogenase complexes(chiefly pyruvate dehydrogenase complex E2 subunit) and disease-specific ANA mainly react-ing with nuclear pore gp210 and nuclear body sp100.Sclerosing cholangitis presents as at least two variants,first the classical primary sclerosing cholangitis(PSC) mostly affecting adult men wherein the only(and non-specific) reactivity is an atypical perinuclear antineutro-phil cytoplasmic antibody(p-ANCA),also termed peri-nuclear anti-neutrophil nuclear antibodies(p-ANNA) and second the childhood disease called autoimmune sclerosing cholangitis(ASC) with serological features resembling those of type 1 AIH.Liver diagnostic serol-ogy is a fast-expanding area of investigation as new purified and recombinant autoantigens,and automatedtechnologies such as ELISAs and bead assays,become available to complement(or even compete with) tradi-tional immunofluorescence procedures.We survey for the first time global trends in quality assurance impact-ing as it does on(1) manufacturers/purveyors of kits and reagents,(2) diagnostic service laboratories that fulfill clinicians' requirements,and(3) the end-user,the physician providing patient care,who must properly interpret test results in the overall clinical context.

Enhanced vasoconstriction to α_1 adrenoceptor autoantibody in spontaneously hypertensive rats

Autoimmune activities have been implicated in the pathogenesis of hypertension.High levels of autoantibodies against the second extracellular loop of α1-adrenoceptor(α1-AR autoantibody,α1-AA) are found in patients with hypertension,and α1-AA could exert a α1-AR agonist-like vasoconstrictive effect.However,whether the vasoconstrictive effect of α1-AA is enhanced in hypertension is unknown.Using aortic rings of spontaneously hypertensive rats(SHR) and normotensive Wistar-Kyoto(WKY) rats,we observed the vasoconstrictive responses to α1-AA with phenylephrine(α1-AR agonist) as a positive control drug.Aortic nitrotyrosine levels were also measured by ELISA and immunohistochemistry.The results showed that the aortic constrictive responses to α1-AA and phenylephrine(both 1 nmol L-1-10 μmol L-1) were greater in SHR than in WKY rats.Endothelial denudation or L-NAME(a non-selective NOS inhibitor)(100 μmol L-1) increased α1-AA- or phenylephrine-induced vasoconstrictions both in SHR and WKY.However,selective iNOS inhibitor 1400W(10 μmol L-1) enhanced the α1-AA-induced aortic constriction in WKY,but not in SHR.The aortic nitrotyrosine level was significantly higher in SHR than WKY,as shown by both ELISA and immunohistochemistry.These results indicate that the vasoconstrictive response to α1-AA is enhanced in SHR,and this altered responsiveness is due to endothelial dysfunction and decreased NO bioavailability.The study suggests an important role of α1-AR autoimmunity in the pathogenesis and management of hypertension especially in those harboring high α1-AA levels.