抗氧化低密度脂蛋白抗体的检测桨临床意义

目的 :探讨血清抗氧化低密度脂蛋白 (ox LDL)抗体的检测方法 ,并观察分析血清抗ox LDL抗体水平对冠状动脉粥样硬化斑块稳定性的评估价值。方法 :用酶联免疫吸附法 (ELISA法 )检测 10 0例冠心病患者 [17例急性心肌梗死 (AMI) ,41例不稳定型心绞痛 (UAP) ,42例稳定型心绞痛 (SAP) ]及 31例正常健康对照者 (对照组 )血清抗ox LDL抗体水平 ;并对 10 0例患者进行了 1年随访。结果 :血清抗ox LDL抗体水平在AMI组 (1.39± 0 .6 8)和UAP组 (1.35± 0 .6 2 )明显高于对照组 (0 .81± 0 .31,P <0 .0 1)和SAP组 (0 .94± 0 .36 ,P <0 .0 1) ;随访 1年后 ,有 2 2例患者发生心脏事件。血清抗ox LDL抗体水平在发病组 (1.6 7± 0 .6 9)明显高于病变稳定组(1.0 3± 0 .44 ,P <0 .0 1)。Logistic回归分析结果 :血清抗ox LDL抗体水平与患者预后关系密切 (P <0 .0 1)。结论 :血清抗ox LDL抗体水平与冠心病患者预后密切相关 ,可以作为冠状动脉粥样硬化斑块易损性的评估指标     

胆红素与血脂的综合指数对冠心病诊断价值的探讨

目的 :探讨胆红素与血脂的综合指数对冠心病 (CHD)的诊断价值。方法 :将 15 4例行冠状动脉 (冠脉 )造影术者 ,按照冠脉造影结果分为 3组 :CHD高度狭窄组、中度狭窄组 ,冠脉正常组 ,分析组间血脂、胆红素及综合指数的差异及其对CHD的预测符合率。结果 :CHD组患者血清总胆红素 (TBil)明显低于冠脉正常组 (P <0 .0 1) ,血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C) ,LDL C [高密度脂蛋白胆固醇 (HDL C) +TBil]比值、TC (HDL C +TBil)比值水平明显高于冠脉正常组 (P <0 .0 5或P <0 .0 1)。进行判别分析 ,将LDL C (HDL C +TBil)与传统危险因素 (HDL C、LDL C、TC、年龄、收缩压、血糖 )同时引入模型 ,年龄与LDL C (HDL C +TBil)进入模型 ,显示出较其他各项指标与CHD更强的相关性 ,且对CHD的预测符合率为 5 8.6 % ,高于传统危险因素对CHD预测符合率 (P <0 .0 5 )。结论 :胆红素与血脂的综合指数是有临床使用价值的预测指标     

抗氧化低密度脂蛋白抗体与冠心病的关系

目的 :探讨氧化修饰低密度脂蛋白 (ox LDL)引发的免疫反应在动脉粥样硬化 (AS)发生发展中的作用 ,揭示ox LDL致AS的免疫学机制。方法 :90例冠心病 (CHD)患者 (分为 3组 :稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组 ) ,采用ELISA法检测其血液中ox LDL、ox LDL Ab及ox LDL IC水平。并入选 4 0例健康人群作为对照组。结果 :CHD各组血液中ox LDL、ox LDL Ab及ox LDL IC水平明显高于对照组 ,以急性心肌梗死组为最高。 3项指标的阳性率以ox LDL IC为最高。ox LDL Ab与血清脂蛋白无关 ,与ox LDL呈负相关 ,与ox LDL IC正相关。结论 :ox LDL的免疫反应参与AS的发生发展 ,这是细胞和分子的一系列复杂的免疫炎症反应过程     

急性冠状动脉综合征患者巨噬细胞集落刺激因子变化及其与氧化低密度脂蛋白关系

目的 :观察冠心病不同类型患者中巨噬细胞集落刺激因子 (MCSF)水平的变化及其与氧化低密度脂蛋白 (ox LDL)之间的关系 ,进一步探讨急性冠状动脉综合征预测的炎症指标。　　方法 :采用酶联免疫法检测急性冠状动脉综合征组 (n =46)、稳定性心绞痛组 (n =45)和正常对照组 (n =40 )血浆MCSF及ox LDL水平。　　结果 :3组血清MCSF、ox LDL的水平。血清MCSF和ox LDL水平在急性冠状动脉综合征组均显著高于稳定性心绞痛组和正常对照组 (P均 <0 0 0 1) ;稳定性心绞痛组血清MCSF和ox LDL水平均显著高于正常对照组 (P <0 0 5和 <0 0 0 1)。急性冠状动脉综合征组MCSF水平与ox LDL呈显著正相关 (r=0 571,P <0 0 0 1)。　　结论 :急性冠状动脉综合征患者血清MCSF和ox LDL水平均明显升高 ,且两者呈显著正相关。从临床角度提示MCSF和ox LDL可能相互作用 ,促进了急性冠状动脉综合征的发生。     

CD40配体高表达与不稳定型心绞痛之间的关系

为了探讨不稳定型心绞痛患者外周血单核细胞表达CD40配体及血清可溶性CD40配体变化的临床意义。应用间接免疫荧光流式细胞术和双抗夹心酶联免疫测定法分别对正常对照组 16例、稳定型心绞痛 2 0例、不稳定型心绞痛 2 0例患者血单核细胞表达CD40配体及血清可溶性CD40配体水平进行检测。并观察血清可溶性CD40配体与冠状动脉病变程度的关系。结果发现 ,(1)不稳定型心绞痛组血单核细胞表达CD40配体明显较稳定型心绞痛组和对照组高 (P <0 .0 1) ,稳定型心绞痛组与对照组相比无差异 (P >0 .0 5 )。 (2 )不稳定型心绞痛组血清可溶性CD40配体水平明显较稳定型心绞痛组和对照组高 (P <0 .0 1) ,而稳定型心绞痛组与对照组相比亦有明显差异 (P <0 .0 5 )。 (3)经皮冠状动脉腔内成形术后血清可溶性CD40配体明显高于术前 (P <0 .0 1) ,但血单核细胞表达CD40配体无差异 (P >0 .0 5 )。 (4 )血清可溶性CD40配体水平与冠状动脉病变的复杂狭窄数相关 (r=0 .5 4,P <0 .0 1) ,而与狭窄的程度和范围无关。此结果提示 ,血清可溶性CD40配体升高对冠状动脉斑块的不稳定或破裂起重要作用 ,且可能是冠状动脉病变的活动性标志物。     

冠心病患者血浆组织因子和组织因子途径抑制物的变化

目的 :通过检测不同类型冠心病 (CHD)患者血浆组织因子 (TF)和组织因子途径抑制物 (TFPI)水平变化 ,探讨其在CHD发病过程中的作用。方法 :以酶联免疫吸附测定法测定CHD患者血浆中TF和TFPI抗原水平。结果 :不稳定型心绞痛 (UAP)和急性心肌梗死 (AMI)患者的血浆TF和TFPI水平与正常对照者和稳定型心绞痛 (SAP)患者相比均有显著性增高 (P <0 .0 5 ) ,以AMI患者尤为明显 (P <0 .0 1) ;UAP和AMI患者的TF PI/TF比值显著降低 (P <0 .0 5 ) ,而SAP患者的上述指标与正常对照者相比 ,其差异均无显著性意义 (P >0 .0 5 )。结论 :UAP和AMI患者TFPI/TF系统失衡 ,标志高凝状态的存在 ;TF和TFPI在这两种类型CHD的发病机制中可能起着重要的作用     

C反应蛋白水平与冠心病的相关性研究

目的 探讨冠状动脉粥样硬化心脏病(CHD)与C反应蛋白(CRP)之间的关系.方法 测定50例正常对照人群和80例经冠状动脉造影证实为CHD患者血浆的CRP水平,其中单支病变30例、双支病变25例、三支病变25例;稳定型心绞痛31例、不稳定型心绞痛25例,急性心肌梗死24例.结果 CRP 水平在稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组依次增高;稳定型心绞痛组(F=1.826,P＜0.05)、不稳定型心绞痛组(F=4.232,P＜0.01)及急性心肌梗死组(F=6.745,P＜0.01)的CRP水平均明显高于对照组,在冠心病组中,双支病变组(F=7.925,P＜0.01)以及三支病变组(F=9.467,P＜0.01)中CRP 水平也明显高于对照组.结论 CRP水平与冠心病和冠脉病变程度相关.     

对氧磷酯酶1与2型糖尿病肾病的关系

目的　探讨血清对氧磷酯酶 1(PON1)活性与 2型糖尿病 (DM)并发肾病 (DN)的关系。方法　血清PON1活性用酚乙酸酯为底物测定 ,血浆氧化型低密度脂蛋白 (ox LDL)用ELISA法测定 ,尿 2 4小时微量白蛋白用放免法测定。结果　 91例 2型DM患者的PON1活性比 5 4例正常对照显著降低〔(138.2± 31.4 )kU/Lvs (184 .1± 2 9.5 )kU/L ,P <0 .0 0 1〕 ,且 2型DM的Ⅰ组 (UAER <30mg/ 2 4h)、Ⅱ组 (UAER 30～ 30 0mg/ 2 4h)和Ⅲ组 (UAER >30 0mg/ 2 4h)相比 ,PON1活性依次显著下降〔(15 1.8± 2 4 .5 )kU/L ,(12 4 .5± 32 .8)kU/L ,(10 1.1± 36 .6 )kU/L ,P <0 .0 1〕 ,而ox LDL的浓度却依次显著升高〔(6 16 .2± 135 .7) μg/L ,(75 3.9± 132 .5 ) μg/L ,(875 .1± 15 3.2 ) μg/L ,P <0 .0 1〕。PON1活性与ox LDL的浓度呈高度负相关 (r =- 0 .83,P <0 .0 0 1) ,也与UAER呈负相关 (r =- 0 .2 8,P<0 .0 5 ) ,多元回归分析表明PON1活性是 2型DM并发DN的高度危险因素 (P <0 .0 1)。结论　PON1活性在 2型DM显著下降 ,且在并发DN的 2型DM患者下降更显著。PON1活性与ox LDL呈负相关。PON1活性降低是 2型DM并发DN的高度危险因素     

内皮素与冠心病患者冠状动脉病变的相关性研究

目的 :观察不同类型心绞痛患者血浆内皮素 （ET）的变化 ,探讨它与冠脉病史和射血分数的关系。方法 :30例心绞痛患者 ,按照临床表现和冠脉狭窄程度分为 :稳定型心绞痛 （SAP）和不稳定型心绞痛 （U AP）组 ;轻度狭窄、中度狭窄和重度狭窄组。结果 :UAP血浆 ET显著高于 SAP和正常对照组 （P<0 .0 1） ,而 SAP与正常对照组无差异（P>0 .0 5 ） ;随着冠脉狭窄程度加重 ,血浆 ET有增高趋势。重度狭窄组显著高于轻度和中度狭窄组 （P<0 .0 5或 P<0 .0 1）。结论 :血浆 ET水平与冠脉病变积分呈正相关 （r=0 .5 2 4,P<0 .0 1） ,而与左室射血分数呈负相关 （r=-0 .496 ,P<0 .0 1）。     

冠心病患者血清胆红素水平与氧化低密度脂蛋白的关系

目的　观察冠心病不同类型患者血清胆红素水平及其与氧化脂蛋白 (OX -LDL)之间关系 ,探讨急性冠状动脉综合征预测指标。方法　分别检测急性冠状动脉综合征组 (N =76 ) ,稳定型心绞痛组 (N =4 2 )和正常对照组 (N =4 5 )血清胆红素及OX -LDL水平并进行比较。结果　急性冠状动脉综合征组血清胆红素水平显著低于稳定型心绞痛组和正常对照组 (P <0 0 1) ;血清OX LDL水平显著高于稳定型心绞痛组和正常对照组 (P <0 0 1) ;稳定型心绞痛组血清胆红素显著低于正常对照组 (P <0 0 1) ;血清OX LDL水平显著高于正常对照组 (P <0 0 1)。急性冠性动脉综合征组胆红素水平与OX -LDL呈显著负相关 (r =- 0 84 3,P <0 0 1)。结论　急性冠状动脉综合征患者血清胆红素水平明显降低 ,OX -LDL水平明显升高 ,两者呈负相关。提示胆红素和OX -LDL可作为判断冠状动脉病变程度及稳定性的临床指标。     

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.     

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.     

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.     

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.