1700638376
1．试述基因诊断的优越性及其应用前景。
1700638377
1700638378
2．试述RNAi在内科学研究中的应用价值。
1700638379
1700638380
参考文献
1700638381
1700638382
[1] Prusiner SB. Prion diseases and the BSE crisis. Science, 1997, 278
:245-251.
1700638383
1700638384
[2] Hannon GJ. RNA interference. Nature, 2002, 418
:244-251.
1700638385
1700638386
[3] Barajas M, Mazzolini G, Genove G, et al. Gene therapy of orthotopic hepatocellular carcinoma in rats using adenovirus coding for interleukin 12. Hepatology, 2001, 33(1)
:52-61.
1700638387
1700638388
[4] Lehmann TG, Wheeler MD, Schwabe RF, et al. Gene delivery of Cu/Zn-superoxide dismutase improves graft function after transplantation of fatty livers in the rat. Hepatology, 2000, 32(6)
:1255-1264.
1700638389
1700638390
[5] Tokunaga T, Abe Y, Tsuchida T, et al. Ribozyme mediated cleavage of cell-associated isoform of vascular endothelial growth factor inhibits liver metastasis of a pancreatic cancer cell line. Int J Oncol, 2002, 21(5)
:1027-1032.
1700638391
1700638392
[6] Liu YP, Haasnoot J, Brake O, et al. Inhibition of HIV-1 by multiple siRNAs expressed from a single microRNA polycistron. Nucleic Acids Res, 2008, 36(9)
:2811-2824.
1700638393
1700638394
[7] Csorba T, Bovi A, Dalmay T, et al. The p122 subunit of tobacco mosaic virus replicase is a potent silencing suppressor and compromises both small interfering RNA- and MicroRNA-mediated pathways. J Virol, 2007, 81(21)
:11768-11780.
1700638395
1700638396
（陈智 彭国平）
1700638397
1700638398
1700638399
1700638400
1700638402
内科学新进展 第十四章 核素功能分子影像技术 在内科疾病诊断中的应用
1700638403
1700638404
摘 要 核素显像是显示放射性核素标记的放射性药物在体内的分布图。放射性药物根据自己的代谢和生物学特性，能特异地分布于体内特定的器官或病变组织，标记在放射性药物分子上的放射性核素由于发出射线能在体外被探测，因而核素显像是显示器官及病变组织的解剖结构和代谢、功能相结合的显像，而有别于常规的影像学方法。随着放射性药物及显像设备的发展，特别是SPECT、正电子发射断层摄影（positron emission tomography, PET）或PET/CT的出现，核素显像在临床疾病的诊断和研究中发挥着重要的作用。现就部分应用与进展阐述如下。
1700638405
1700638406
Abstract Radionuclide imaging is about the profile of radio-pharmaceutical in vivo. Radio-pharmaceutical could be distributed to the specified organ or the tissue with pathological changes according to its characteristic of metabolism and biology. The rays emitted by radioisotope which is labeled on radioactive drug can be detected in vitro, so radionuclide imaging could provide not only anatomic structure but also information about metabolism and function of the organ or the tissue. Obviously it is different from conventional imageology. At present, radionuclide image is widely used in not only clinical procedures but also in scientific studies. For example, in cardiovascular system, radionuclide image is widely used in diagnosis, for instruction of clinical therapy and providing information about dangerous of disease and evaluating prognosis of cardiovascular disease; in oncology, it can offer information from point view of metabolism which made early diagnosis of tumor easy, monitor curative effect, differentiate recrudescence form scar which is different by CT technology and identify malignant or benign tumor; in nervous system, it is used in study of higher brain function in addition to diseases; in organ transplantation, the activity of transplanted organ could be monitored by radionuclide image; in the investigation of infection and inflammation, it is also useful. On the whole, with the development of radioactive drug and visualization equipment, particularly the SPECT and PET（positron emission tomography, PET）or PET/CT, radionuclide imaging plays more and more important role in diagnosis and research of clinical disease. Now we’ll present some application and development of radionuclide image as follows.
1700638407
1700638408
1700638409
1700638410
1700638412
内科学新进展 第一节 在心血管疾病中的应用
1700638413
1700638414
目前，核素显像不仅用于心血管疾病的诊断，更重要的是用于指导临床治疗和提供疾病危险程度及预后的评估。临床应用主要有三个方面：一是应用不同的心肌灌注显像剂评价冠状动脉的灌注；二是应用门控心血池显像或首次通过研究估计心室的泵功能；三是诊断和评价心肌梗死。现仅对心肌灌注显像、心肌细胞活力测定及粥样斑块显像三方面的进展作一介绍。
1700638415
1700638416
一、心肌灌注显像
1700638417
1700638418
心肌灌注显像（myocardial perfusion imaging）是心肌显像中最常用的一种。心肌灌注显像最有价值的临床应用是与负荷试验相结合评价缺血性心脏病，它可以获得比其他诊断方法更有价值的重要信息，特别是疾病预后的信息。目前用于心肌灌注显像的药物较多，常用的单光子发射显像的显像剂有201Tl和99mTc甲氧基异丁基异腈（99mTc-sestamibi, 简称99mTc-MIBI）等。近年来随着新的显像剂研究进展，一些新的99mTc标记药物如99mTc-tetrofosmin（P53, 1, 2双 [双（2乙氧乙基）膦] 乙烷）、99mTc-teboroxime已开始用于临床。此外，应用PET进行心肌灌注显像时，需用正电子发射的显像剂如82Rb、13N-NH3和15O-H2O等。不同的显像剂其生物学特性、显像方法及临床价值有一定差别。其主要应用于临床急、慢性冠心病的诊断、危险性分级、评价预后及疗效评估等。
1700638419
1700638420
（一）冠心病心肌缺血的评价
1700638421
1700638422
冠状动脉造影是了解冠状动脉有否狭窄等形态学改变的最好方法，但它不能反映心肌局部的血流灌注与心肌细胞的活性，而心肌灌注显像不仅可以诊断有无心肌缺血，而且还可帮助确定缺血是可逆性还是不可逆性以及冠状动脉的储备功能。因此，心肌灌注显像是诊断冠心病心肌缺血简便而且准确的方法，其灵敏度和特异性可达到90％以上。心肌缺血的典型表现是负荷试验心肌灌注显像出现显像剂分布稀疏或缺损，而静息或再分布显像呈正常或明显充填，提示为可逆性心肌缺血。负荷试验心肌灌注显像诊断冠状动脉狭窄的敏感性和特异性明显高于静息显像。而且其敏感性随着病变血管的数目增加而提高，但有时也可因为三支冠状动脉均病变而导致心肌的显像剂呈均匀性分布降低而出现假阴性结果。在冠心病患者，心肌灌注显像的主要临床价值还表现在以下几方面。
1700638423
1700638424
1．冠状动脉狭窄的血流动力学意义与侧支循环的评价
1700638425
[
上一页 ]
[ :1.700638376e+09 ]
[
下一页 ]