儿童阻塞性睡眠呼吸暂停综合征与高血压的关系

目的 探讨儿童阻塞性睡眠呼吸暂停综合征(OSAS)患者中高血压的患病情况.方法 选取90例有睡眠打鼾的儿童,实施多导睡眠监测并同步进行24 h动态血压监测.按呼吸暂停低通气指数(AHI)分为OSAS组(AHI≥5次/h)和对照组(AHI<5次/h),比较两组的临床血压指数值、高血压的发病率和"非杓型"血压的情况.结果 1)OSAS组的体质量指数(BMI)、氧减指数(ODI)和睡眠期间血氧饱和度<92%的时间(TST92%)均比对照组高(P<0.05),2)OSAS组夜间睡眠时的收缩压(SBP)和舒张压(DBP)指数,以及白昼的收缩压指数较对照组高(P<0.05);3)OSAS组的高血压发病率及"非杓型"血压情况比对照组多(P<0.01).结论 儿童OSAS与高血压密切相关,且是高血压发病的危险因素,血压多呈"非杓型"改变.     

老年患者阻塞性睡眠呼吸暂停综合征严重性与血压和血糖及周围动脉硬化的关系

目的探讨老年患者阻塞性睡眠呼吸暂停综合征(OSAS)的严重性与周围动脉硬化、高血压、糖尿病的关系。方法选择2010年1月~2014年10月北京大学人民医院老年科收治的113例经睡眠监测检查证实且尚未接受治疗的老年OSAS患者,按照睡眠呼吸暂停低通气指数(AHI)分为轻度OSAS组32例、中度OSAS组33例、重度OSAS组48例;选择年龄、性别、吸烟情况与OSAS患者匹配的40例为对照组。均行颈动脉及下肢股动脉超声检查,24h血压监测,检测糖化血红蛋白等指标。结果与对照组比较,轻度OSAS组、中度OSAS组和重度OSAS组2型糖尿病及高血压的发病率显著升高,差异有统计学意义(P<0.05,P<0.01);重度OSAS组2型糖尿病的发病率高于轻度OSAS组(50.0%vs 28.1%,P<0.05)。重度OSAS组体质量指数、高脂血症及脂肪肝发生率高于对照组[(27.7±3.1)kg/m2 vs(24.4±2.5)kg/m2、68.8%vs 40.0%及56.3%vs 27.5%,P<0.05]。中度OSAS组及重度OSAS组24h平均收缩压、白昼收缩压、夜间收缩压、醒后收缩压、醒后舒张压高于对照组,差异有统计学意义(P<0.05)。多元逐步回归分析显示,颈动脉及下肢动脉不稳定斑块发生率与AHI呈正相关(P<0.05)。结论严重的OSAS患者更易出现高血压、2型糖尿病、高脂血症,颈动脉及下肢动脉不稳定斑块。     

高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

目的 探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化.方法 入选高血压患者105例,根据多导睡眠仪监测结果 分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS) 36例和高血压合并中、重度OSAS组22例.CPAP或手术治疗前后行24 h动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系.结果 治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%.与单纯高血压组比较,差异有统计学意义(P<0.05).治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%.38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05).中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显.结论 高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与OSAS严重性相关,CPAP或手术治疗后非杓型明显减少.     

高血压合并阻塞性睡眠呼吸暂停综合征患者治疗前后的血压昼夜节律变化

目的探讨高血压合并阻塞性睡眠呼吸障碍患者持续气道内正压通气(CPAP)或手术治疗前后的血压昼夜节律变化。方法入选高血压患者105例,根据多导睡眠仪监测结果分为单纯高血压组47例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组36例和高血压合并中、重度 OSAS 组22例。CPAP 或手术治疗前后行24 h 动态血压监测,比较治疗前后睡眠呼吸参数与血压昼夜节律的关系。结果治疗前单纯高血压组昼夜血压呈非杓型占23.4%,高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压呈非杓型的分别占47.2%和59.1%。与单纯高血压组比较,差异有统计学意义(P<0.05)。治疗后各组昼夜血压呈非杓型的比例均有所下降,分别为19.1%,38.9%和45.5%,与治疗前各组间比较,差异有统计学意义(P<0.05)。中、重度阻塞性睡眠呼吸暂停综合征组非杓型血压下降最为明显。结论高血压患者昼夜血压呈非杓型时应考虑合并睡眠呼吸暂停综合征,且昼夜血压变化与 OSAS 严重性相关,CPAP 或手术治疗后非杓型明显减少。     

阻塞性睡眠呼吸暂停综合征儿童的动态血压监测

目的评价24h动态血压监测在阻塞性睡眠呼吸暂停综合征（OSAS）儿童血压异常诊断中的意义。方法以我院2004年10月～2008年12月收治的36例OSAS儿童为研究对象,在对其进行多导睡眠图（PSG）监测前7h行24h连续动态血压监测后,将患儿分为高通气不足指数（AHI）组（AHI〉5）及低AHI组（AHI〈5）。记录及分析平均睡眠时间、觉醒时间及次数、24h平均收缩压及舒张压。结果OSAS儿童中AHI与BMI、动脉血氧减饱和度指数、SpO2值〈90％的睡眠时间、清醒时收缩压指数、睡眠中收缩压负荷、睡眠中舒张压指数、睡眠中舒张压负荷相关。结论动态血压监测可作为一种OSAS儿童高血压的早期诊断和预后判定的检查方法。     

老年阻塞性睡眠呼吸暂停综合征与高血压及胰岛素抵抗的相关性研究

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)与高血压及胰岛素抵抗(IR)的关系。方法随机选择符合OSAS患者48例作为OSAS组,并分为高血压组(28例)和正常血压组(20例)2个亚组,同期选择无OSAS的高血压患者30例作为单纯高血压组,健康体检者26例作为正常对照组,均进行整夜睡眠呼吸监测(7 h),并记录睡眠呼吸暂停低通气指数(AHI)等;空腹血糖(FPG)及空腹胰岛素(FINS)测定,对患者进行24 h的动态血压监测并进行相关分析。结果与单纯高血压组比较,高血压组患者非杓形血压比例和脉压均明显升高,差异有统计学意义(P0.05,P0.01)。OSAS组患者的FPG、FINS水平及胰岛素抵抗指数(HOMA-IR)均明显高于正常对照组,差异有统计学意义(P0.05);OSAS患者的AHI与FINS和HOMA-IR均呈正相关。结论 OSAS与IR存在独立的相关性,可能通过IR导致并进一步加重心血管疾病的发生和发展。     

阻塞性睡眠呼吸障碍对老年高血压患者血压昼夜节律变化的影响

老年高血压患者103例根据多导睡眠仪监测分为单纯高血压组26例、高血压合并轻度阻塞性睡眠呼吸暂停综合征(OSAS)组29例、高血压合并中度0SAS组30例和高血压合并重度OSAS组18例.行24 h动态血压监测,比较睡眠呼吸参数对血压昼夜节律的影响.结果高血压合并轻度、中度和重度OSAS组昼夜血压曲线呈非杓型的发生率分别为64.29%、76.67%和88.89%,后二组与单纯高血压组(50.00%)比较差异有统计学意义(P＜0.05,＜0.01).认为老年高血压患者血压昼夜节律变化与OSAS严重程度相关,应重视对老年非杓型高血压患者睡眠障碍的监测治疗.     

伴及不伴OSA高血压患者的血压变异性和OSA相关性研究

目的研究伴或不伴睡眠呼吸暂停(obstructive sleep apnea,OSA)高血压患者的血压变异性和OSA的相关性。方法纳入阴虚阳亢型轻中度高血压患者90例,对患者行便携式睡眠仪监测、24h动态血压(ABPM)监测。观察患者血压的均值、变异性,及昼夜节律和OSA的关系;采用多元逐步回归法分析OSA和血压的关系。结果与不伴OSA的高血压患者相比,伴OSA患者的血压变异性和非杓型血压发生率明显增高,夜间血压下降率明显降低(P<0.05);其中夜间平均收缩压、24h收缩压血压标准差与睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)呈正相关,夜间收缩压下降率和AHI呈负相关(P<0.05)。结论伴OSA患者的血压变异性增高,昼夜节律紊乱。     

老年高血压合并阻塞性睡眠呼吸暂停综合征患者血压昼夜节律的特点

目的探讨老年高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者血压昼夜节律的特点。方法入选老年原发性高血压患者90例,根据多导睡眠监测结果,将受试者分为单纯高血压组(42例)、高血压合并轻度OSAS组(21例)、高血压合并中、重度OSAS组(27例),行24 h动态血压监测,观察睡眠呼吸状态对血压昼夜节律的影响。结果高血压合并轻度OSAS组、高血压合并中、重度OSAS组与单纯高血压组比较,夜间收缩压、舒张压差异有显著性意义(P<0.05);与单纯高血压组比较,高血压合并轻度OSAS组血压曲线非杓型所占比例差异有显著性意义(P<0.05),高血压合并中、重度OSAS组比例有显著性差异(P<0.01);高血压合并中、重度OSAS组与高血压合并轻度OSAS组比较血压非杓型所占比例差异有显著性意义(P<0.05)。结论老年高血压合并OSAS患者其血压变异高于单纯高血压患者,这在合并有中、重度OSAS的患者表现尤其明显,因此老年高血压患者要注意睡眠状态时血压的变化,早期诊断OSAS并积极有效地治疗。     

老年高血压合并阻塞性睡眠呼吸障碍患者血压昼夜节律变化

目的探讨阻塞性睡眠呼吸障碍对老年高血压患者血压昼夜变化的影响。方法人选老年高血压患者106例,根据多导睡眠仪监测分为单纯高血压组54例、高血压合并轻度阻塞性睡眠呼吸暂停综合征组(高血压加轻度OSAS组)25例和高血压合并中、重度阻塞性睡眠呼吸暂停综合征组27例。行24小时动态血压监测．比较睡眠呼吸参数对血压昼夜节律的影响。结果老年高血压合并轻度和中、重度阻塞性睡眠呼吸暂停综合征组昼夜血压曲线呈非杓型的分别占52．0％和74．1％。与单纯高血压组比较差异有统计学意义。结论应重视对老年非杓型血压患者睡眠障碍的监测。     

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.