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国家自然科学基金(30500656)

作品数:10 被引量:19H指数:3
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37例心脏移植的体外循环管理经验被引量:3
2012年
目的:总结37例原位心脏移植体外循环管理经验。方法:37名患者进行了同种异体心脏移植手术,术前心脏超声检查EF值平均(24.52±4.79)%;采用中度低温、轻中度血液稀释、中高流量体外循环灌注。术中监测血气和电解质,常规使用超滤技术和白蛋白。供心保护采用HTK心肌保护液,经主动脉根部灌注冷HTK心脏停搏液,快速取下心脏,并放置于冷HTK液中低温保存。结果:供心热缺血时间(7.7±1.7)min,冷缺血时间(194.52±121.57)min,体外循环时间(110.87±29.83)min。主动脉阻断时间为(47.83±8.91)min,平均动脉压55~85mmHg。37例患者均顺利脱离体外循环机。结论:良好的供心保护,体外循环过程中保持平均动脉压在60~80mmHg及晶胶比在0.45~0.60,血气和电解质的动态监测以及超滤和白蛋白的应用是心脏移植体外循环管理的关键。
李平董念国孙宗全肖诗亮张凯伦陈剑锋张菁
关键词:体外循环心脏移植
大鼠颈总动脉移植模型的建立
2008年
随着新型免疫抑制剂的应用和个体化治疗方案的实施,器官移植术后急性排斥反应得到了有效控制,慢性排斥反应及由此导致的移植物慢性功能丧失已成为限制移植器官及受者长期存活的主要因素。探寻移植物慢性排斥反应的机制已成为当代免疫学家亟待解决的重大课题。目前,研究慢性排斥反应常用的动物实验是大鼠胸主动脉腹腔移植模型,但其存在创伤大、易截瘫、腹腔感染和粘连等缺点,死亡率高。我们在成功建立大鼠胸主动脉腹腔移植模型的基础上,
高思海敖启林王现国尹辉赵金平潘铁成
关键词:颈总动脉慢性排斥反应个体化治疗方案新型免疫抑制剂急性排斥反应
A New Carotid Artery Transplantation Model of Rats
2009年
To establish a murine carotid artery transplantation model for the study of the chronic re-jection, 80 rats were divided into two groups, an allotransplant (ACI-Lewis) group and an isotrans-plant (Lewis-Lewis) group (control group). The donor carotid artery and the recipient carotid artery were anastomosed by using a polyethylene cuff (internal diameter: 0.7 mm, length: 3 mm).The pathological changes of carotid artery transplant were observed 14, 28 and 56 days after the trans-plantation. The results showed that the model was successfully established in 95% of the animals. The chronic rejection-associated arteriosclerosis was induced 28 days after the transplantation. The new chronic rejection model of carotid artery by using cuff technique caused fewer traumas and was easy to make. The pathological changes of the transplant mimicked the chronic rejection-associated arteriosclerosis found in human transplant.
高思海李平赵金平张韵凤孙愉
关键词:颈动脉慢性排斥反应颈内动脉颈总动脉
The Inhibitory Effect of Astilbin on the Arteriosclerosis of Murine Thoracic Aorta Transplant被引量:4
2009年
The inhibitory effect of astilbin on transplant arteriosclerosis in murine model of thoracic aorta transplantation was examined. Model of rat thoracic aorta transplantation was established. Ninety rats were divided into three groups. In isograft group, the thoracic aorta of Brown Norway (BN) rat was anastomosed with the abdominal aorta of another BN rat. In allograft group, the thoracic aorta of BN rat was anastomosed with the abdominal aorta of Lewis rat. In astilbin group, the rats receiving allo-transplantation were given astilbin 5 mg/kg per day for a time of 28 days. The donor thoracic aorta and the recipient abdominal aorta were anastomosed by means of a polyethylene cannula (inner diameter: 1.5 mm, length: 3 mm length). The grafts were histologically examined for structural changes. The areas of arterial lumen and endatrium were calculated. Our results showed that, in the allograft group, 28 days after allografting, conspicuous proliferation of smooth muscles and infiltration with a great number of inflammatory cells were found in the tunica intima and tunica media. Astilbin significantly inhibited the proliferation of smooth muscles and ameliorated the infiltration of inflammatory cells thereyby prevent against the development of transplant arteriosclerosis. It is concluded that asltilbin can effectively prevent the development of arteriosclerosis in allotrans-plant by inhibiting the proliferation of smooth muscles and inhibit the proliferation of smooth muscles in tunica of intima and media and reducing infiltration of the inflammatory cells.
赵金平李平张韵凤王现国敖启林高思海
关键词:平滑肌细胞增殖移植动脉硬化LEWIS大鼠
转化生长因子β1对心脏移植排斥反应中穿孔素和颗粒酶B表达的影响
2008年
目的探讨转化生长因子β1(TGF-β1)对大鼠心脏移植排斥反应中穿孔素和颗粒酶B表达的影响。方法采用大鼠颈部心脏移植模型,实验动物随机分为3组:同系移植组、异系移植组和TGF-β1组。于术后第5d取移植心脏,用逆转录聚合酶链式反应(RT-PCR)法观察穿孔素和颗粒酶B的表达情况。结果异系移植组穿孔素和颗粒酶B表达明显升高(与同系移植组相比,P<0.01)。TGF-β1组穿孔素和颗粒酶B表达明显降低(与异系移植组相比,P<0.01)。结论TGF-β1对心脏移植排斥反应的免疫抑制作用可能与其抑制穿孔素和颗粒酶B的表达有关。
赵金平张韵凤李平高思海
关键词:心脏移植排斥反应穿孔素颗粒酶B
Astilbin Inhibits Proliferation of Rat Aortic Smooth Muscle Cells Induced by Angiotensin Ⅱ and Down-regulates Expression of Protooncogene被引量:1
2012年
This study examined the effect of astilbin on the proliferation of rat aortic smooth muscle cells (RASMCs) induced by angiotensin Ⅱ (AngⅡ) and explored the possible mechanisms. Cell proliferation model of RASMCs was induced by treatmente with AngⅡ. Cells were randomly di-vided to 8 groups. Normally cultured VSMCs serves as blank control group; in AngⅡ model group, cells were treated with AngⅡ at 10-7 mol/L; in three astilbin groups, cells were treated with 10, 15, 30 mg/L of astilbin; in three AngⅡ+astilbin groups, cells were treated with AngⅡ (at 10-7 mol/L) and astilbin at 10, 15, 30 mg/L. Cell proliferation ability was detected by MTT method and the cell cycles and proliferation index were flow cytometrically determined. The expression of c-myc mRNA was assessed by using reverse transcription polymerase chain reaction (RT-PCR), and the expression of NF-κB in RASMCs was immunocytochemically observed. Our results showed that MTT metabo-lism in RASMCs in the basic and AngII stimulated situation was inhibited by astilbin, and the cells numbers of G0/G1 phase were increased and that of G2/S phase were decreased markedly. Not only highly expression of c-myc gene stimulated by AngⅡ could be inhibited by Astilbin significantly, but also the expression of NF-κB protein can be down regulated by Astilbin. We are led to conclude that astilbin astilbin can inhibit the AngⅡ-mediated proliferation of RASMCs by blocking the tran-sition of RASMCs from G0/G1 phase to S phase and by down-regulating the expression of NF-κB, c-myc gene.
李平高思海揭伟敖启林黄亚非
关键词:ASTILBINSMOOTHPROLIFERATIONANGIOTENSINPROTOONCOGENE
全腔肺动脉连接术的体外循环管理被引量:3
2012年
目的总结全腔肺动脉连接术体外循环转流的方法与经验。方法全组26例均在全麻体外循环下行全腔肺动脉连接术,麻醉诱导后放血,使红细胞压积稀释到术前的50%~60%。预充液中加入血浆和白蛋白等胶体液使晶胶比值维持在0.5~0.6,胶渗压16~18mmHg;实施浅低温体外循环,灌注流量2.4~2.8L/(m2.min),维持平均动脉压40~60mmHg。心脏复温时,启动常规超滤并再次加入血浆和白蛋白,提高红细胞压积(HCT)和胶体渗透压,通过增加血容量和提高血浆胶体渗透压来适应新的血流动力学变化。停机时"置换性"的超滤使得血红蛋白浓缩至35%~45%,血浆胶体渗透压至18~21mmHg。结果该组4例患者死于术后低心排血量,余22例患者均存活痊愈出院,体外循环期间血流动力学基本稳定,血气电解质维持在正常范围,术后SaO2≥92%,中心静脉压(CVP)15~17cmH2O。结论停机前加入大量的血浆和白蛋白以增加血容量、提高并长时间维持胶体渗透压以适应新的血流动力学变化,保持机体内环境稳定是全腔肺动脉连接术中体外循环管理的关键。
李平董念国高思海孙宗全
关键词:先天性心脏病体外循环
转化生长因子β1对心脏移植排斥反应中细胞黏附分子表达的影响被引量:1
2008年
目的探讨转化生长因子β1(TGFβ-1)对大鼠心脏移植排斥反应中CD44、选择素E、淋巴细胞功能相关抗原-1(LFA-1)、血管细胞黏附分子-1(VCAM-1)表达的影响。方法采用大鼠颈部心脏移植模型,随机分为3组:对照组、移植组、TGF-β1组。于移植术后第5天取移植心脏,用逆转录聚合酶链式反应(RT-PCR)法观察CD44、选择素E、VCAM-1、LFA-1的表达情况。结果移植组CD44、选择素E、LFA-1、VCAM-1表达明显升高,与对照组相比,均P<0.01。与移植组相比,TGFβ-1组CD44、选择素E、LFA-1、VCAM-1表达明显降低,均P<0.01。结论TGF-β1对心脏移植排斥反应的免疫抑制作用可能与其抑制CD44、选择素E、LFA-1、VCAM-1等黏附分子的表达有关。
赵金平李平张韵凤王现国杨辰垣高思海
关键词:心脏移植转化生长因子Β1移植物排斥黏附分子
落新妇苷对心脏移植排斥反应中活化T细胞p38丝裂原激活蛋白激酶信号传导通路的影响被引量:5
2007年
目的:用小鼠心脏移植急性排斥反应体外模型,探讨落新妇苷对心脏移植排斥反应中活化T细胞p38丝裂原激活蛋白激酶(p38MAPK)信号传导通路的影响。方法:分离BALB/C小鼠心肌细胞(2×105个.mL-1)和C57BL/6小鼠的脾细胞(1×106个.mL-1),前者做刺激细胞,后者做反应细胞,进行混合细胞培养,建立小鼠心脏移植急性排斥反应体外模型。实验分3组:对照组,心肌细胞与脾细胞混合培养;落新妇苷组,在对照组基础上加入落新妇苷(15mg.L-1);落新妇苷加p38MAPK抑制剂组,在对照组基础上加入落新妇苷(15mg.L-1)和p38MAPK抑制剂SB203580(5μmol.L-1)。TUNEL法检测T淋巴细胞凋亡情况。RT-PCR和Western blot法检测T细胞p38MAPK表达情况。结果:落新妇苷组T细胞凋亡指数和p38MAPK表达均明显高于对照组(P<0.01)。落新妇苷加p38MAPK抑制剂组T细胞凋亡指数和p38MAPK表达均明显低于落新妇苷组(P<0.01),而与对照组相比差异无显著性(P>0.05)。结论:落新妇苷诱导心脏移植排斥反应中活化T细胞凋亡与其激活p38MAPK信号传导通路有关。
高思海李平陈涛赵金平徐沁孜潘铁成刘力刚宋定伟
关键词:心脏移植落新妇苷P38丝裂原激活蛋白激酶
大鼠胸主动脉腹腔移植模型的建立及改进被引量:2
2007年
目的:移植物慢性排斥反应最重要的特征是移植体动脉硬化,大鼠大动脉移植模型的血管改变非常类似于人类的移植体动脉硬化,但此模型的制作多采用显微外科血管缝合方法,既费时又需精巧的显微外科技术。采用套管技术建立大鼠胸主动脉腹腔移植模型,验证其作为慢性排斥反应简化动物模型的可行性。方法:实验于2005-03/2006-03在卫生部器官移植重点实验室完成,动物实验方法符合动物伦理学要求。①实验材料:选用纯系Wistar大鼠120只和SD大鼠40只,按随机数字表法分为两组:异系移植组(SD→Wistar)40对次,同系移植组(Wistar→Wistar)40对次。②实验方法:采用自制聚乙烯套管(内径1.5mm,长度3mm)将供体胸主动脉与受体腹主动脉连接,建立胸主动脉腹腔移植模型。③实验评估:分别于移植术后14,28,42,56d取移植动脉标本,采用病理图像定量分析及电镜等检测手段,观察移植动脉病理变化。结果:同、异系胸主动脉移植模型共成功72只,成功率为90%。①手术时间40~45min,其中移植胸主动脉冷缺血时间10~15min,腹主动脉阻断时间4~7min。②异系移植组动脉硬化具有血管中层细胞坏死迁移、内膜增生及炎性细胞浸润的特点,与人类慢性排斥反应动脉硬化的改变类似,最早出现在术后28d。③同系移植组无明显内膜增生,与受者自身的正常动脉差异不明显;异系移植组术后14d内膜出现细胞增生层,术后28d内膜出现半月形增生,增生程度直到术后56d仍呈上升趋势。结论:采用套管技术建立大鼠胸主动脉腹腔移植模型简单易行,避免了显微血管缝合,明显缩短了腹主动脉阻断时间和移植胸主动脉的冷缺血时间,成功率高,移植后的血管改变类似于人类慢性排斥反应移植体动脉硬化,可作为分析慢性移植排斥反应的简化模型。
李平高思海赵金平尹辉王现国孙瑜潘铁成
关键词:移植物排斥动脉硬化
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