美最新胆固醇指南要求非常高危人群LDL-C应低于70 mg/dl

据《中国医学论坛报》30卷29期5版蒋鸿鑫报道本报讯　7月12日美国国家胆固醇教育计划(NCEP)成人治疗专家小组在对5项大型的降胆固醇药临床研究考查后,建议需将非常高危人群的低密度脂蛋白胆固醇(LDLC)水平降至70mg/dl以下,以前建议降至100mg/dl左右。(Circulation2004,110∶227     

国家胆固醇教育计划指南进展

1998年,国家胆固醇教育计划(NCEP)确认并强调了冠心病一级预防,主要针对低密度脂蛋白胆固醇(LDLC),要求治疗目标值<130mg/dl(3.4mmol/L,1mg/dl=0.0259mmol/L)。1993年,在此基础上提出新的治疗目标值,即LDLC<100mg/dl。2001年,依然强调LDLC是治疗的主要目标,然而该指南注入新的特征:注重多种危险因素,将糖尿病危险水平提高到与冠心病等同;确定LDLC<100mg/dl为理想水平,将低高密度脂蛋白胆固醇(HDLC)定义改为<40mg/dl;用Framingham评估10年冠     

冠心病的新发病因素

国家胆固醇教育计划 (NCEP)关于成人治疗指南已经支持男性和女性心血管疾病 (CVD)发病因素评定 ,基于目前发病因子总数存在显著个体化。除吸烟、高血压等可处理的发病因子外 ,NCEP指南集中高胆固醇血症的治疗 ,尤其把降低低密度脂蛋白 (L DL- C)作为冠心病的基本预防的主要目标。NCEP介绍的治疗目标是低于二个心血管疾病发病因子的非冠心病降至 <16 0 m g/ dl(<4.1mmol/ L)二个或更多的发病因子的非冠心病 [已确诊的冠心病或其他动脉硬化性疾病除外 ,若此类情况则降至≤ 10 0 mg/ dl(≤ 2 .6 mmol/ L) ]降至 <130 mg/ dl(<3.4mmol/…     

临床血脂测定的方法学与标准化进展

众多研究表明,血脂测定不仅对于高脂血症的诊断及冠心病的危险评估和防治具有重要意义,而且已经应用于其他诸多临床相关专业疾病的研究[1,2]。中华医学会检验分会针对临床血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密脂蛋白胆固醇(LDLC)、载脂蛋白AⅠ和B(apoAⅠ和apoB)和脂蛋白(a)[Lp(a)]的测定方法与临床应用等实际工作中出现的问题,制定发表了《关于临床血脂测定的建议》文件[3],对于进一步规范我国临床血脂测定工作,保证测定结果的准确性与合理应用有着重要意义。近年来,临床血脂测定的方法学与标准化是血脂…     

冠心病患者餐后血糖异常的研究进展

1999年,美国心脏病学会(AHA)提出糖尿病(DM)是一种心血管疾病,并正式将糖尿病与血脂异常、高血压、吸烟等列为冠心病(CHD)的主要危险因素.2001年,美国国家胆固醇教育计划(NCEP)成人治疗组第三次报告(ATPⅢ)[1]又将糖尿病从过去的危险因素提升为糖尿病是冠心病的等危症.……     

胆固醇吸收合成标志物与冠心病

冠心病是由多种危险因素引发的重大疾病,血脂异常是其重要的危险因素之一.目前,我国面临着严峻的血脂异常防治形势和严重的疾病防控挑战.2007年中国成人血脂异常防治指南的发表[1],标志着我国血脂异常防治工作进入一个新的历史阶段.胡大一教授最近指出,丰富的循证医学依据一再证实胆固醇的升高是引发冠心病的罪魁祸首,在当前繁重的血脂异常防治工作中,胆固醇是血脂干预的首要目标[2].20世纪90年代,北欧辛伐他汀生存研究(scandinavian simvastatin survival study,4S)等一系列采用他汀类药物调脂治疗的大规模临床试验已充分表明,通过大幅降低血清总胆固醇(TC)、特别是低密度脂蛋白胆固醇(LDL-C),可显著降低冠心病事件发生.     

胆固醇吸收合成标志物与冠心病

冠心病是由多种危险因素引发的重大疾病,血脂异常是其重要的危险因素之一.目前,我国面临着严峻的血脂异常防治形势和严重的疾病防控挑战.2007年中国成人血脂异常防治指南的发表[1],标志着我国血脂异常防治工作进入一个新的历史阶段.胡大一教授最近指出,丰富的循证医学依据一再证实胆固醇的升高是引发冠心病的罪魁祸首,在当前繁重的血脂异常防治工作中,胆固醇是血脂干预的首要目标[2].20世纪90年代,北欧辛伐他汀生存研究(scandinavian simvastatin survival study,4S)等一系列采用他汀类药物调脂治疗的大规模临床试验已充分表明,通过大幅降低血清总胆固醇(TC)、特别是低密度脂蛋白胆固醇(LDL-C),可显著降低冠心病事件发生.     

重视代谢综合征的非药物治疗

新近根据美国国家胆固醇教育计划成人治疗专家组第三次报告(NCEP—ATPIII)指出；代谢综合征是指主要危险因素、生活方式危险因素及新出现的突发危险因素相互影响所形成的一种复合性疾病。代谢综合征的提出及深入研究各异常代谢之间的关系将对其治疗观念、策略、药物与方案的更新、改进与完善有益。并     

综合评价基础上的规范化降脂治疗

血脂异常是心血管病的重要危险因素。2007年我国正式发布由多个学科联合制定的《中国成人血脂异常防治指南》,以降低低密度脂蛋白胆固醇是首要目标为主导思想,强调治疗的基础是评估心血管病的整体危险,其核心内容是根据心血管病的综合危险决定开始干预的切点和干预的强度,规范降脂治疗,为广大临床医生提供了切实可行的治疗指导,对加强我国心血管病的防治具有十分重要的指导意义。在此,对新指南作一简要解读。     

2型糖尿病血脂紊乱治疗指南

国家胆固醇教育计划成人治疗组Ⅲ(NCEP ATPⅢ)和美国糖尿病学会(ADA 2002)实用临床建议均强调,糖尿病是冠心病的等危症,降低低密度脂蛋白-胆固醇(LDL-C)是首要的治疗目标。来自动物实验、实验室研究、流行病研究的结果均表明LDL-C     

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.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.