瘦素水平与冠状动脉Gensini积分及肥胖的关系

目的探讨冠心病患者血浆瘦素水平与冠状动脉病变程度及体质指数的关系。方法拟诊冠心病患者93例,根据冠状动脉造影结果分为对照组20例和冠状动脉粥样硬化组73例,计算各组患者的Gensini积分、体质指数,检测血浆瘦素水平,并分析瘦素水平与Gensini积分、体质指数之间的关系。结果血浆瘦素水平随Gensini积分增加而升高(P<0.05);根据Gensini积分分为1～30分组、31～90分组及>90分组,瘦素水平分别为0.61±0.15μg/L、0.77±0.13μg/L及0.93±0.13μg/L;冠状动脉粥样硬化患者血浆瘦素水平与Gensini积分呈正相关(r=0.643,P<0.01)。随体质指数的增加瘦素水平逐渐升高(P<0.05),体重正常组、超重组、肥胖组瘦素水平分别为0.59±0.17μg/L、0.75±0.16μg/L、0.89±0.11μg/L。结论冠心病患者血浆瘦素水平与冠状动脉病变程度以及肥胖显著相关,推测瘦素可能参与动脉粥样硬化的发生发展。     

血清同型半胱氨酸水平与糖尿病合并冠心病患者冠状动脉病变程度的相关性

目的:探讨血清同型半胱氨酸水平与糖尿病合并冠心病患者冠状动脉病变程度的相关性。方法 :选择2014年6月1日—12月31日糖尿病合并冠心病患者91例,记录其冠状动脉病变情况,根据不同血清同型半胱氨酸水平以及不同冠状动脉病变情况分别分组,分析血清同型半胱氨酸水平与冠状动脉病变程度的相关性。结果:高同型半胱氨酸血症组患者冠状动脉病变Gensini评分显著高于正常同型半胱氨酸水平组患者[(34.54±31.81)分比(18.37±19.38)分,P=0.006)]。根据冠状动脉病变情况分组,单支病变患者血清同型半胱氨酸水平为(13.68±2.99)μmol/L,双支病变患者为(16.75±4.41)μmol/L,多支病变患者为(27.40±10.78)μmol/L,不同冠状动脉病变支数患者血清同型半胱氨酸水平存在显著差异(P     

血清脂肪细胞型脂肪酸结合蛋白及脂联素水平与冠心病的相关性

目的 探讨脂肪细胞型脂肪酸结合蛋白(A-FABP)、脂联素和A-FABP/脂联素比值与冠心病及冠状动脉病变程度的相关性.方法 经冠状动脉造影入选340例患者,分为冠心病组(211例)和非冠心病对照组(129例),用ELISA法测定血清AFABP及脂联素水平,冠状动脉病变程度用病变血管支数和Gensini积分表示.并从上述患者中选取年龄、性别、体质指数相匹配的冠心病及非冠心病者各10例,分离外周血单核细胞,佛波酯刺激为巨噬细胞后取培养上清,用ELISA法测定培养上清液A-FABP及脂联素浓度.结果 (1)冠心病组血清A-FABP水平[18.3(13.2,22.8)μg/L]较非冠心病组[16.4(13.5,20.4)μg/L]高,但差异未达到统计学意义(P=0.088);冠心病组血清脂联素水平低于非冠心病组[13.9(9.8,17.1)mg/L比19.7(14.5,27.6)mg/L,P＜0.05].(2)随着冠状动脉病变支数的增加,血清A-FABP水平呈升高、脂联素水平呈递减趋势;Gensini积分与血清A-FABP呈正相关(r=0.120,P=0.043),与脂联素呈负相关(r=-0.405,P=0.007).(3)冠心病组血清A-FABP/脂联素比值明显高于非冠心病组[(1.51±0.79)μg/mg比(0.89±0.30)μg/mg,P＜0.01];血清A-FABP/脂联素比值与Gensini积分的相关性更明显(r=0.531,P=0.000).(4)冠心病者单核源性巨噬细胞A-FABP/脂联素比值高于非冠心病者[(0.51±0.19)μg/mg比(0.36±0.11)μg/mg,P＜0.05].结论 高A-FABP和低脂联素水平可能是反映严重冠状动脉狭窄的新的血清标记物.A-FABP/脂联素比值较单独A-FABP或脂联素与冠状动脉病变的相关性更好.     

老年人脂蛋白相关磷脂酶A2与冠心病冠状动脉病变程度及危险因素的关系

目的 观察老年人脂蛋白相关磷脂酶A2(Lp-PLA2)水平与冠心病冠状动脉造影病变程度及冠心病危险因素的关系. 方法 测定90例临床怀疑冠心病行冠状动脉造影老年患者Lp-PLA2、超敏C反应蛋白(hs-CRP),血脂等指标,根据冠状动脉造影结果以病变支数及Gensini积分评价冠状动脉病变程度,分析Lp-PLA2与冠心病的关系. 结果冠心病组Lp-PLA2水平较对照组明显升高[(352.7±129.0)μg/L与(204.0±59.7)μg/L,P<0.01].Lp-PLA2水平随着冠状动脉病变支数和Gensini积分的增加而升高.Lp-PLA2与年龄(r=0.25,P<0.05)、三酰甘油(r=0.33,P<0.01)、低密度脂蛋白胆固醇(r=0.27,P<0.05)、载脂蛋白B(r=0.36,P<0.01)呈正相关.在冠心病组,Lp-PLA2与年龄呈正相关(r=0.29,P<0.05).Stepwise回归分析结果显示Lp-PLA2与冠心病相关. 结论 冠心病患者Lp-PLA2水平升高,其水平的高低可能反映冠状动脉病变的严重程度.为冠心病的危险因素之一.     

冠心病患者血清总胆汁酸水平与冠状动脉病变严重程度的相关性研究

目的探讨冠状动脉粥样硬化性心脏病(冠心病)患者血清总胆汁酸水平与冠状动脉病变严重程度的相关性。方法选取2014年1月~2015年3月山西省汾阳医院心内科收治的经选择性冠状动脉造影术(CAG)检查确诊且有临床表现的冠心病患者和经CAG检查除外冠心病的患者130例,随机分为冠心病组80例和对照组50例。收集两组患者血清总胆汁酸(TBA)水平及冠心病组CAG结果。采用Gensini评分系统对冠心病患者CAG结果进行评分,采用Pearson相关分析检测冠心病患者血清TBA与Gensini评分的相关性。结果冠心病组血清TBA水平明显高于对照组[(4.99±2.30)μmol/LVS(3.02±1.53)μmol/L],差异有统计学意义(P0.05);Pearson相关分析显示冠心病患者血清TBA水平和Gensini评分有明显相关性,差异有统计学意义(r=0.58,P0.05)。结论冠心病患者血清TBA水平与冠状动脉病变严重程度密切相关,可作为预测冠状动脉病变严重程度的指标。     

血清脂联素水平与冠脉病变严重程度有关

目的: 了解血清脂联素水平与冠脉病变严重程度的关系。方法: 入选96例冠状动脉造影（CAG）的冠心病患者,根据临床病史和CAG结果分为2组:急性冠脉综合征(ACS)组60例,稳定型心绞痛(SAP)组36例;另收集非冠心病CAG阴性组40例为对照组。用Gensini评分系统对冠状动脉病变程度进行评分。根据Gensini评分系统将冠脉病变组分为Gensini积分≥30分组和<30分组,再根据冠脉病变支数分为单支,双支和3支组。采用双抗体夹心ELISA法测定血清脂联素水平。分析血清脂联素水平与冠脉病变严重程度及冠脉病变支数的相互关系。结果: ACS组和SAP组血清脂联素水平［(7.2±2.6)mg/L,(8.4±3.2)mg/L］明显低于非冠心病组［(19.5±2.5)mg/L,均P<0.01］,且ACS组和SAP组之间差异也具有统计学意义（P<0.05）。Gensini积分≥30分脂联素水平［(7.0±1.6）mg/L］明显低于<30分组,［(13.7±6.7)mg/L,P<0.01］。3支病变组血清脂联素水平［(7.5±2.8)mg/L］较单支组［(13.2±5.8)mg/L］显著降低（P<0.01）,较双支病变组［(10.7±4.8)mg/L］也显著降低（P<0.05）。双支病变组与单支病变组之间差异无统计学意义。血清脂联素水平与冠脉病变严重程度Gensini积分呈负相关(r=-0.713,P<0.01)。结论: 脂联素水平与冠脉病变严重程度及冠脉病变支数显著相关,低脂联素水平可以作为评价冠脉病变严重程度的一个指标。     

血清淀粉样肽1-40水平与冠心病患者冠状动脉病变的相关性及其临床意义

目的:探讨冠心病患者血清淀粉样肽1-40(Aβ1-40)浓度变化及其与冠状动脉(冠脉)病变的关系。方法:选取我院经造影确诊的冠心病患者300例及同期造影为非冠心病患者86例,采集基本临床资料及生化指标,以酶联免疫吸附法(ELISA法)检测Aβ1-40的浓度。Gensini评分判断冠脉病变的严重程度,分析Aβ1-40浓度与冠心病及其严重程度的相关性。结果:与对照组比较,冠心病组血清肌酐[(76.2±18.9)μmol/L∶(69.4±14.3)μmol/L,P0.001]和Aβ1-40[(63.9±20.14)ng/L∶(55.9±17.1)ng/L,P0.001]显著增高而高密度脂蛋白[(0.96±0.26)mmol/L∶(1.06±0.33)mmol/L,P0.003]显著降低。Gensini评分重度(40)的冠心病患者肌酐、葡萄糖、总胆固醇、低密度脂蛋白及Aβ1-40显著高于轻度(20)患者(P0.05)。相关分析显示血清Aβ1-40浓度与年龄、高血压、尿素、肌酐、高密度脂蛋白及Gensini分级等呈显著相关(P0.05),在校正性别、年龄、高血压、肌酐、尿素及高密度脂蛋白后,Aβ1-40浓度仍与冠心病Gensini分级显著正相关(r=0.113,P=0.027)。结论:冠心病患者血清Aβ1-40显著升高,升高的Aβ1-40与冠心病冠脉Gensini分级显著正相关,提示血清Aβ1-40测定有可能成为临床冠脉病变评估的有效指标。     

胱抑素C水平与冠心病的相关性研究

目的了解胱抑素C水平与冠状动脉病变严重程度的关系。方法选择疑诊冠心病且行选择性冠状动脉造影的冠心病患者114例(冠心病组).根据临床病史和冠状动脉造影结果分为2组:急性冠状动脉综合征(acute coronarysyndromes,ACS)组73例,稳定性心绞痛(stable angina pectoris,SAP)组41例;另选择非冠心病(冠状动脉造影阴性)患者38例作为对照组。采用Gensini评分系统对冠状动脉病变程度进行评分。应用免疫比浊法测定血清胱抑素C水平。分析血清胱抑素C水平与冠状动脉病变严重程度及病变支数的相互关系。结果 ACS组和SAP组血清胱抑素C水平明显高于对照组[(2.2±3.5)mg/L vs(1.6±4.1)mg/L vs(0.7±2.9)mg/L,P<0.01].且ACS组血清胱抑素C水平明显高于SAP组(P<0.05)。Gcnsini积分≥30分患者血清胱抑素C水平明显高于Gensini积分<30分患者[(2.6±2.7)mg/L vs(1.8±5.2)mg/L,P<0.01]。3支病变患者血清胱抑紊C水平和Gensini积分较单支病变和双支病变患者明显增高[(2.8±1.8)mg/L vs(1.9±3.4)mg/L vs(2.1±4.1)mg/L;(49±16)分v5(17±9)分vs(28±1 8)分,P<0.05,P<0.01];双支病变患者Gensin积分较单支病变患者明显增高(P<0.01);而单支病变与双支病变患者血清胱抑素C水平差异无统计学意义(P>0.05)。血清胱抑素C水平与冠状动脉病变严重程度Gensini积分呈正相关(r=0.673,P<0.01)。结论胱抑素C水平与冠状动脉病变严重程度及病变支数显著相关,胱抑素C水平可以作为评价冠状动脉病变严重程度的一个指标。     

急性冠状动脉综合征患者血清脂肪细胞因子的变化与冠状动脉病变程度的关系

目的观察急性冠状动脉综合征(acute coronary syndrome,ACS)患者血清脂肪细胞因子:脂联素、瘦素、抵抗素水平变化及其对冠状动脉病变程度的影响。方法选择2009年1月~2011年10月在我院经冠状动脉造影确诊为ACS的患者95例作为ACS组,另选择冠状动脉造影正常的95例作为对照组。ACS组根据病变支数分为单支组(43例)、双支组(33例)、三支组(19例)。所有患者检查脂联素、瘦素、抵抗素水平及生化检查。结果 ACS组抵抗素[(4.63±1.44)μg/L vs(2.42±0.93)μg/L,P=0.017]、瘦素[(9.60±1.39)μg/L vs(6.70±1.38)μg/L,P=0.009]水平明显高于对照组,脂联素[(8.99±1.66)μg/L vs(12.11±1.97)μg/L,P=0.006]水平明显低于对照组。随着病变支数增多,脂联素水平明显降低,瘦素、抵抗素水平明显升高,差异有统计学意义(P<0.05)。logistic回归分析,ACS患者的脂联素OR=0.078,95%CI:0.017~0.364,P=0.001;抵抗素OR=16.56,95%CI:2.298~119.280,P=0.005;瘦素OR=7.17,95%CI:1.594~32.261,P=0.010。结论脂联素、瘦素、抵抗素在诊疗ACS方面具有重要价值。     

冠心病合并代谢综合征患者血白细胞和尿酸的变化及意义

目的:分析冠心病合并代谢综合征(MS)患者血白细胞和血尿酸的变化及意义。方法:入选275例冠心病患者,其中不合并MS的患者102例(非MS组),合并MS的患者173例(MS组)。检测患者血尿酸和白细胞计数,运用Gensini评分法评估冠状动脉狭窄程度。结果:MS组患者血尿酸[(331.1±86.7)μmol/L对(357.1±84.3)μmol/L,P=0.015]、白细胞计数[(6.4±1.8)×109/L对(7.1±2.2)×109/L,P=0.007]以及Gensini评分[(29.7±30.3)对(39.8±38.1),P=0.022]均明显高于非MS组。MS组血尿酸、白细胞计数与Gensini评分均有显著相关性。Logistic回归分析显示,血尿酸和白细胞计数是Gensini评分50的危险因素(P0.05)。结论:冠心病合并MS患者血白细胞计数和尿酸水平明显升高,两者与冠状动脉病变严重程度相关。     

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.