高血压患者脂肪酸粘附蛋白2基因多态性与餐后甘油三酯代谢异常的关系

目的研究原发性高血压患者(EH)餐后甘油三酯代谢异常与脂肪酸粘附蛋白2基因(FABP2)变异的关系.方法 50例EH患者和30例健康人禁食10～12小时后,进行标准脂肪负荷试验,以甘油三酯(TG)8小时曲线下面积(TG-AUC)和TG峰反应(TGPR)作为标准脂肪负荷后TG反应水平的指标.用聚合酶链反应(PCR)对FABP2基因54密码子HhaI酶切位点限性片段长度多态性进行分析.结果 (1)EH组TG-AUC,TGPR均显著高于对照组(TG-AUC 20.02±6.25比9.61±2.27 mmol/L,P<0.05;TGPR 4.15±2.82比2.05±1.31 mmol/L,P<0.01).(2) EH组FABP2基因54密码子Thr型(Thr54)基因频率与正常组无显著差别(0.28比0.25, P>0.05).(3)EH组中Thr纯合型(Thr 54/Thr 54)和Thr杂合型(Ala 54 /Thr 54)患者TG-AUC、TGPR显著高于野生型(Ala 54 /Ala 54)者,纯合型患者TG-AUC、TGPR显著高于杂合型(TG-AUC28.2±6.11、21.9±6.16比13.9±6.07 mmol/L,P<0.05;TGPR 7.56±2.67、4.20±1.62比2.34±1.47 mmol/L,P<0.05).结论高血压病患者存在餐后TG代谢障碍和消除延迟,FABP2基因54密码子Thr改变是餐后甘油三酯代谢异常的影响因素之一.     

高血压患者氯沙坦治疗前后血管内皮功能与血管紧张素Ⅱ的变化

目的探讨氯沙坦治疗前后高血压患者血管内皮功能和血浆血管紧张素Ⅱ的变化.方法50例高血压患者氯沙坦治疗4～6周,根据达目标血压(以舒张压<90mmHg为标准调整降压药每天剂量50～100mg,部分患者加双氢氯噻嗪25mg),观察氯沙坦治疗前后肱动脉超声检测血管内皮功能和血浆血管紧张素Ⅱ浓度的变化.结果肱动脉内径基础值及含服硝酸甘油后肱动脉内径变化差异均无显著性[(3.78±0.57)mm对(3.82±0.63)mm,(18.7±4.5)%对(20.1±7.2)%,P>0.05],反应性血管充血引起肱动脉内径的变化治疗前后差异有显著性[(4.32±0.71)%对(9.38±4.1)%,P<0.01)].氯沙坦治疗前后血浆血管紧张素Ⅱ浓度变化显著[(38.6±6.8)pmol/L对(76.9±15.3)pmol/L,P<0.01].结论氯沙坦在有效降压的同时,能改善血管内皮舒张功能.     

阿托伐他汀钙对高血压病患者餐后甘油三酯代谢异常及血管内皮功能的影响

目的阿托伐他汀钙(立普妥)对高血压病患者餐后甘油三酯代谢异常及血管内皮功能的影响.方法30例高血压病(Ⅰ级)患者并经标准脂肪负荷试验确定为餐后高甘油三酯症,采用高分辨率血管外彩超检测脂餐后4 h肱动脉血流介导的内皮依赖性血管舒张功能(EDF),随后受试者随机分为立普妥治疗组和常规治疗组,常规治疗组服用双克25 mg qd,而立普妥组在常规药物的基础上加服立普妥20 mg qn.治疗4周后重复标准脂肪负荷试验和脂餐后4 h肱动脉血流介导的内皮依赖性血管舒张功能.结果治疗前两组脂肪餐后EDF均较空腹明显下降(立普妥治疗组13.89%±3.28%比9.88%±3.53%,P＜0.05;常规治疗组14.37%±3.51%比10.11%±3.62%,P＜0.05),但两组间TG-AUC,TGPR无显著性差别.治疗4周后两组血压均较治疗前有显著下降,立普妥组餐后TG-AUC,TGPR较治疗前显著下降[TG-AUC(18.84±6.81比10.12±5.38)mmol/L,P＜0.05;TGPR(3.96±1.78比2.16±1.06)mmol/L,P＜0.05],其餐前和餐后EDF较治疗前有明显改善(空腹13.89%±3.28%比17.96%±3.87%,P＜0.05,脂餐后4 h9.88%±3.53%比16.67%±3.35%,P＜0.05),且空腹EDF和餐后EDF无显著差异.常规治疗组餐后TG-AUC、TGPR、空腹EDF较治疗前无明显改善,餐后EDF虽有所改善,但仍较空腹受损(14.86%±2.75%比11.42%±2.65%,P＜0.05).相关分析显示餐后EDF下降值、SBP、DBP与餐后TG-AUC,TGPR呈正相关(TG-AUC相关系数r分别为0.35,0.32,0.25,P＜0.05;TGPR相关系数r分别为0.34,0.31,0.21,P＜0.05).结论立普妥降脂治疗能显著改善高血压病患者餐后甘油三酯代谢及血管内皮功能.     

超声评价扩张型心肌病患者肱动脉内皮舒张功能

目的应用高频超声评价扩张型心肌病(dilated cardiomyopathy,DCM)患者肱动脉内皮功能。方法应用高频超声测量32例DCM患者和40例健康对照者的基础状态时、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,计算反应性充血和含服硝酸甘油后肱动脉内径变化的百分率。结果DCM患者反应性充血所致的肱动脉内径百分变化率[(4.0±3.5)%]明显低于正常人[(13.2±3.9)%,P<0.05],DCM患者含服硝酸甘油所致的肱动脉内径变化的百分率[(27.8±9.2)%]和健康对照者[(28.5±8.9)%,P>0.05]差别无显著统计学意义。结论DCM患者肱动脉内皮舒张功能受损。     

老年糖尿病患者脂肪餐后甘油三酯的变化及其对血管内皮功能的影响

目的探讨老年糖尿病患者餐后甘油三酯(TG)的动态变化及其对血管内皮功能的影响。方法随机选取空腹血脂正常的老年2型糖尿病患者及非糖尿病患者各30例,进行6 h口服脂肪餐试验,应用高分辨超声检测空腹及餐后4 h的颈动脉内-中膜厚度(IMTc)与肱动脉血流介导的血管舒张功能(FMD)。结果两组脂肪餐后TG水平均较空腹时显著增高,但糖尿病组TG曲线下面积(TG-AUC)显著高于非糖尿病组[(10．46±2,34)mmol／L对(6．48±1．26)mmol／L,P< 0．05];两组餐后IMTc均无明显改变,但FMD明显受损,糖尿病组餐后FMD下降程度(△FMD)明显高于非糖尿病组[(53．02±25．50)％对(29．19±20．42)％,P<0．05]。相关分析显示,糖尿病组TG-AUC与餐后4 h TG增加值(△TG4)呈正相关(r=0．79,P<0．05);其△FMD与△TG2呈独立相关(r=0．74,P<0．05)。结论老年糖尿病患者存在餐后高TG血症,它可导致血管内皮功能受损,促进动脉粥样硬化的发生与发展。     

高血压病患者脂餐后血管内皮功能受损

目的探讨高血压病患者高脂餐后血管内皮功能变化.方法 20例高血压病患者和20名正常对照者在禁食12 h后接受高脂餐负荷试验.分别测定餐前及餐后2、4、5、7 h血清血脂浓度.采用高分辨血管外超声法检测餐前及餐后4 h肱动脉血流介导的内皮依赖性血管舒张功能.结果两组受试者的空腹血脂水平无显著差异;餐后2、4、5 h血清甘油三酯(TG)浓度较空腹状态有显著升高.但高血压病组具有较高的餐后4、5、7 h血清TG浓度及其净增加值.两组受试者餐后内皮依赖性血管舒张功能均较空腹时显著受损.高血压病组,(5.38±1.95)% vs(2.21±1.06)%;对照组,(9.38±2.42)% vs(6.25±2.23)%;P<0.001.高血压病组的空腹以及餐后内皮依赖性血管舒张功能较对照组均显著受损(P<0.001),且餐后内皮依赖性血管舒张功能的受损程度显著高于对照组[(58±14)% vs (33±17)%,P<0.001].相关分析显示餐后4 h 血清TG浓度净增加值与餐后内皮依赖性血管舒张功能的变化率显著正相关(r=0.373,P<0.05).结论高血压病患者餐后显著而持久的高甘油三酯血症可导致餐后内皮依赖性血管舒张功能严重损害.     

阻塞性睡眠呼吸暂停低通气综合征患者的血管内皮舒张功能

目的评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血管内皮功能。方法OSAHS患者30例(轻度组8例,中重度组22例)及对照组10例,分别用高分辨率超声检测基础状态、反应性充血时(内皮依赖性血管扩张)以及含服硝酸甘油后(非内皮依赖性血管扩张)的肱动脉内径,计算不同状态下肱动脉的扩张率以评估血管内皮功能。结果对照组、轻度和中重度OSAHS组患者反应性充血时肱动脉内径扩张率分别为(15.2±2.6)%、(14.3±3.2)%和(9.8±4.9)%,中重度OSAHS组患者血管内皮介导的舒张反应较对照组和轻度OSAHS组明显降低;含服硝酸甘油后肱动脉内径扩张率分别为(16.5±5.0)%、(15.7±4.1)%和(14.1±6.2)%,3组间无明显差别。结论中重度OSAHS患者存在血管内皮功能障碍,OSAHS本身可能是导致血管内皮损伤的重要因素。     

冠状动脉支架置入术后再狭窄与内皮功能关系的临床分析

目的 观察血管内皮功能失调与冠心病支架置入术后再狭窄的关系.方法 在支架术后6个月随访的患者中选择11例再狭窄及15例非狭窄病例,采用高分辨率超声检测两组患者肱动脉血流介导的内皮依赖性血管扩张百分比(FMD),比较两组患者的内皮功能.结果 两组基础肱动脉内径(D1)差异无统计学意义,再狭窄组的反应性充血时肱动脉内径(D2)小于非再狭窄组[(4.26±0.10)mm和(4.42±0.12)mm,t=-3.59,P=0.001],再狭窄组的肱动脉内径变化绝对值(ΔD)小于非再狭窄组[(0.23±0.09)mm和(0.34±0.11)mm,t=-2.83,P=0.009],再狭窄组FMD低于非再狭窄组(5.74±2.17和8.48±2.80,t=-2.70,P=0.013).FMD与再狭窄的偏相关系数为0.47(t=0.04).结论 冠状动脉支架置入术后再狭窄患者的内皮功能较非再狭窄患者明显减退,血管内皮功能异常与支架置入术后的再狭窄有相关性.     

高血压对血管内皮功能的影响

目的:探讨高血压的血管内皮功能变化。方法:应用高分辨率超声仪检测我院门诊及住院的高血压患者的肱动脉对反应性充血(血流介导的内皮依赖性血管扩张)的舒张反应.并与健康人进行对比。结果:基础血管内径:高血压组3.89±0.47 mm.健康组3.84±0.455 mm,P>0.05;反应性充血的肱动脉内径的变化百分率:高血压组为7.4±2.83%.健康组为12.40±3.79%.有非常显著差异.P<0.001;含服硝酸甘油后肱动脉内径的变化百分率:高血压组为14.20±2.90%.健康组为14.22±0.88%(P>0.05)。结论:高血压患者血管内皮功能受损。     

应用超声血管反应性充血法评价血管内皮功能

目的探讨应用超声血管反应性充血法评估血管内皮舒张功能的可行性和可靠性。方法 12名中青年健康体检者(健康对照组)和10例中青年心肌梗死患者(心肌梗死组)接受肱动脉超声检查,比较两组肱动脉反应性充血前后血管内径及血流量变化百分率。结果肱动脉基础内径及基础血流量两组间比较差异无统计学意义。反应性充血后血管内径变化百分率健康对照组显著高于心肌梗死组(13.6%±6.6%比7.2%±2.3%,P<0.05),反应性充血后血流量变化百分率健康对照组显著高于心肌梗死组(398.6%±150.4%比283.8%±146.3%,P<0.05)。结论肱动脉超声检查间接评价血管内皮功能,测定准确、操作简便、无创性、可重复检测且可提供动脉壁的解剖学图像。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.