老年心衰患者血清尿酸水平的探讨

目的探讨老年心力衰竭患者的血清尿酸水平的意义.方法采用日本7020日立全自动生化仪速力法测定58例老年心力衰竭患者的血清尿酸.结果按心功能级别分组的血尿酸水平Ⅰ～Ⅱ级组(10例)261.59±70.13μmol/L;Ⅲ级组(15例)334.88±92.06μmol/L;Ⅳ级组(33例)459.58±105.6μmol/L.3组血清尿酸水平差异非常显著(P<0.01),心功能越差,血清尿酸水平越高(P<0.01);男女两组血清尿酸值比较,差异有显著意义(P<0.05).结论检测血清尿酸水平,为判断老年心力衰竭患者病情及其预后,提供一个有意义的生化指标.     

老年2型糖尿病患者高尿酸血症的相关因素分析

目的探讨老年2型糖尿病患者高尿酸血症的临床特征。方法将256例2型糖尿病住院患者分为老年糖尿病组(老年组)168例和非老年糖尿病组(非老年组)88例并选择37例无糖尿病老年人作为对照(对照组)。分别记录年龄、性别、体重指数、糖尿病病程,检测血清尿酸及肌酐,尿尿酸及肌酐、尿pH,计算24h尿尿酸排泄总量、尿酸清除率、肌酐清除率、尿酸清除分数等,3组间进行比较。结果老年组血清尿酸水平显著高于非老年组和对照组(均为P<0.01);而肌酐清除率〔(52.8±28.5)ml/min〕低于非老年组〔(89.9±34.3)ml/min〕(P<0.01)和对照组〔(57.9±37.6)ml/min〕(P<0.05),尿pH值下降,24h尿量增加。非老年组尿酸清除率〔(7.63±4.80)ml/min〕显著高于老年组〔(4.47±3.60)ml/min〕和对照组〔(3.75±3.20)ml/min〕(P<0.01);24h尿酸排泄量显著高于老年组和对照组(均为P<0.01)。结论老年组血清尿酸水平与年龄、血清肌酐、尿酸清除率、24h尿尿酸排泄量相关,尿酸生成增多、尿酸清除能力减退及尿量减少、尿pH值减低等多种因素共同导致老年2型糖尿病患者高尿酸血症。     

对氧磷酯酶-1与老年人2型糖尿病视网膜病变的关系

目的探讨血清对氧磷酯酶1(PON1)活性与老年人2型糖尿病(T2DM)并发视网膜病变(DR)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(oxLDL)用ELISA法测定。结果老年单纯T2DM组PON1活性为(9608±3143)kU/L,比健康对照组显著降低〔(13028±1948)kU/L,P<001〕,T2DM并发DR组PON1活性(7453±1679)kU/L,比老年单纯T2DM组显著降低(P<001)。oxLDL浓度在老年单纯T2DM为(6996±841)μg/L,比健康对照组显著升高〔(4264±763)μg/L,P<001〕,老年人T2DM并发DR组oxLDL浓度为(8123±849)μg/L比老年单纯T2DM组显著升高(P<001)。PON1活性与oxLDL的浓度呈高度负相关(r=-084,P<001),Logistic回归分析表明PON1活性是T2DM并发DR的高度危险因素(P<001)。结论PON1活性在T2DM显著下降,且在并发T2DM患者下降更显著。PON1活性与oxLDL呈负相关。PON1活性降低是T2DM并发DR的高度危险因素。     

不同CRRT方法对减少冠心病合并肾病患者PCI术后造影剂肾病的疗效分析

目的 探讨不同连续肾脏替代疗法（CRRT）对经皮冠状动脉介入治疗（PCI）的冠心病合并慢性肾功能不全患者肾功能改善的临床疗效分析。方法 选取2016年1月（与内文不符）[]至2017年8月在我院进行PCI治疗的肾病患者56例作为研究对象,分为两组,普通组28例实行CRRT治疗时间为PCI术后的12小时,加强组CRRP治疗的时间为PCI术前24 h及PCI术后12 h内。将两组患者慢性健康情况、急性生理情况、造影剂肾病（CIN）发生率、血肌酐水平进行比较。结果 普通组与加强组患者一般资料无明显差异。加强组患者CIN发生率比普通组明显减少(7.14% 比39.28%,P< 0.01)。普通组患者PCI术后24 h血肌酐水平比PCI术前增加［(308.14±45.08)μmol/L比 (254.59±80.44)μmol/L, P=0.02］;PCI术后48 h、72 h血肌酐水平与PCI术前差别不大[(232.49±20.12)μmol/L 比 (247.52±54.81)μmol/L 比 (254.59±80.44)μmol/L, P>0.05]。加强组患者PCI术后24 h血肌酐水平与PCI术前无明显差异[(274.04±71.06)μmol/L比 (286.65±53.04)μmol/L,P>0.05];加强组患者PCI术后48 h、72 h血肌酐水平比PCI术前明显减少［(220.12±23.87)μmol/L比 (286.65±53.04)μmol/L,P=0.01］、［(250.17±44.20)μmol/L比 (286.65±53.00)μmol/L,P=0.02］。结论 实施PCI术前、术后均进行CRRT取得的效果比实施PCI术后进行CRRT的效果更好,能够减少造影剂肾病发生。     

替米沙坦对老年2型糖尿病肾病患者胰岛素抵抗和胰淀素分泌的影响

目的 探讨替米沙坦对老年2型糖尿病肾病患者胰岛素抵抗和胰淀素分泌的影响.方法 162例老年糖尿病肾病患者按尿蛋白排泄量(UAE)和血肌酐水平分为3组:早期肾病组、临床肾病组和肾功能减退组.每组再随机分为替米沙坦组(80 mg/d)和氯沙坦组(100 mg/d).测定治疗前后UAE、内生肌酐清除率、空腹血糖、空腹胰岛素和血胰淀素水平,计算胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI).结果 血胰淀素与UAE、空腹胰岛素、HOMA-IR呈正相关,与ISI呈负相关,与内生肌酐清除率和空腹血糖无关.替米沙坦能显著降低各期糖尿病肾病患者空腹胰岛素[(16.25±2.24)和(10.86±2.03)mIU/L,P＜0.01)]、HOMA-IR(4.16±0.42和3.07±0.28,P＜0.05)及血胰淀素水平[(27.76±4.34)和(18.21±3.03)pmol/L,P＜0.01],升高ISI.与氯沙坦各治疗组比较,差异均有统计学意义,且改善作用在早期肾病组更显著(P＜0.05).结论 替米沙坦能够改善不同分期老年2型糖尿病肾病患者胰岛素抵抗,降低血胰淀素水平,其作用优于对应剂量氯沙坦.     

血清胱蛋白酶抑制剂C诊断老年高血压早期肾损害

目的观察老年高血压患者血清胱蛋白酶抑制剂C(Cyst-c)浓度对检出早期肾损害的价值.方法对412例老年高血压患者同时测血Cyst-c和血肌酐(Cr)浓度,并与正常对照组对照.结果412例老年高血压患者中早期肾损害197例(占47.82%),肾功能不全24例(5.82%),肾功能正常191例(46.36%).在早期肾损害组血Cyst-c浓度明显高于对照组[(2.3土0.8 vs 0.9±0.2)mg/L,P＜0.01)],而血Cr浓度两组无显著性差异[(86.6±12.7 vs 81.0±10.5)μmol/L,P＞0.05].结论老年高血压患者中,早期肾损害占47.82%,很常见.血Cyst-c能检出血Cr不能检出的早期肾损害.     

血清胱蛋白酶抑制剂C诊断老年高血压早期肾损害

目的 观察老年高血压患者血清胱蛋白酶抑制剂C(Cyst-c)浓度对检出早期肾损害的价值。方法 对412例老年高血压患者同时测血Cyst-c和血肌酐(Cr)浓度，并与正常对照组对照。结果412例老年高血压患者中早期肾损害197例(占47.82％)，肾功能不全24例(5.82％)，肾功能正常191例(46.36％)。在早期肾损害组：血Cyst-c浓度明显高于对照组[(2.3±0.8 vs 0.9±0.2)mg／L，P＜0.01)]，而血Cr浓度两组无显著性差异[(86.6±12.7 vs 81.0±10.5)μmol／L，P＞0.05]。结论 老年高血压患者中，早期肾损害占47.82％，很常见。血Cyst-c能检出血Cr不能检出的早期肾损害。     

老年糖耐量受损人群异质性分析

目的评价老年糖耐量受损人群伴或不伴胰岛素抵抗的分布比例,以及代谢综合征和动脉粥样硬化在伴胰岛素抵抗人群和不伴胰岛素抵抗人群中的发生情况。方法测定156例老年糖耐量受损人群体重指数(BMI)、腰臀比(WHR)、胆固醇(TC),甘油三酯(TG),低密度脂蛋白胆固醇(LDLC),高密度脂蛋白胆固醇(HDLC)、血压、胰岛素、胰岛素曲线下面积(InsAUC)、胰岛素原(PI)、胰岛素原曲线下面积(PIAUC)、超敏C反应蛋白(hsCRP)、纤维蛋白原(Fg)等指标,并测量其颈动脉内膜中层厚度和动脉斑块的变化,根据HOMA胰岛素抵抗指数(HOMAIR)将糖耐量受损人群分为胰岛素抵抗组和非胰岛素抵抗组。结果(1)156例糖耐量受损患者中,胰岛素抵抗组118例(75.6%);非胰岛素抵抗组38例(24.4%);(2)胰岛素抵抗组BMI、WHR、TG、TC、LDLC、收缩压、舒张压、InsAUC、PIAUC、HOMAIRCRP及Fg分别为(26.8±2.1)kg/m2、0.96±0.23、(2.9±1.3)mmol/L、(5.4±1.8)mmol/L、(3.9±1.5)mmol/L、(154±12)mmHg、(96±7)mmHg、(239±71)mU/L、(170±42)pmol/L、(7.5±1.2)mg/L、(4.5±1.4)g/L,明显高于非胰岛素抵抗组(22.8±2.5)kg/m2、0.80±0.2、(1.7±1.2)mmol/L、(4.5±1.5)mmol/L、(3.0±0.8)mmol/L、、(133±10)mmHg、(83±1)mmHg、(180±66)mU/L、(109±25)pmol/L、(4.3±0.8)mg/L、(3.8±1.5)g/L(P<0.05或P<0.01);而HDLC明显低于非胰岛素抵抗组(1.0±0.4)mmol/L、(1.4±0.4)mmol/L(P<0.05);(3)与非胰岛素抵抗组比较,胰岛素抵抗组和非胰岛素抵抗组内膜中层厚度分别为〔(1.18±0.05)mm、(1.01±0.02)mm,P<0.01〕,动脉斑块的发生率在胰岛素抵抗组显著高于非胰岛素抵抗组,分别为17.8%和7.8%。结论老年糖耐量受损人群存在异质性,多数伴胰岛素抵抗,伴胰岛素抵抗者代谢综合征和动脉粥样硬化发生的危险性显著高于不伴胰岛素抵抗者。     

内源性硫化氢在慢性阻塞性肺疾病患者中的变化及意义

目的研究内源性硫化氢(H2S)在慢性阻塞性肺疾病(COPD)发病中的作用。方法COPD急性加重组(AECOPD组)27例、稳定期COPD组37例和健康对照组13名,在入选时测定血清H2S和一氧化氮(NO)水平、肺功能、诱导痰细胞分类计数,对AECOPD患者行超声心动图和血气分析。结果(1)血清H2S水平稳定期COPD组[(50·8±2·5)μmol/L]比健康对照组[(39·8±1·6)μmol/L]、AECOPD组[(33·5±2·2)μmol/L]均显著增加(P均<0·01)。(2)AECOPD组吸烟者血清H2S[(28·1±1·3)μmol/L]比非吸烟者[(39·4±3·9)μmol/L,P<0·05]和健康非吸烟者显著降低[(39·8±1·6)μmol/L,P<0·01]。(3)稳定期COPD组不同程度气流阻塞患者血清H2S水平呈线性下降趋势(P<0·05),COPD全球创议(GOLD)Ⅲ期[(45·1±4·1)μmol/L]较Ⅰ期患者[(70·2±6·2)μmol/L]血清H2S水平显著下降(P<0·05)。(4)AECOPD组伴有肺动脉高压患者血清H2S水平显著降低[(26·3±2·2)、(36·2±2·5)μmol/L,P<0·05]。(5)血清H2S与NO、第一秒用力呼气容积占预计值百分比(FEV1占预计值%)、诱导痰淋巴细胞计数、诱导痰巨噬细胞计数均呈正相关(r=0·278~0·533,P均<0·05或0·01),与肺动脉收缩压(PASP)、诱导痰中性粒细胞计数均呈负相关(r=-0·561、-0·422,P=0·011、0·001)。结论内源性H2S可能参与COPD气流阻塞的发病,作为一种无创指标监测疾病严重程度和活动度具有一定意义。     

血清25羟基维生素D-3与糖尿病肾病的相关性研究

目的探究血清25羟基维生素D-3与糖尿病肾病的相关性。方法选择该院2017年2月-2019年5月接收的70例糖尿病患者作为糖尿病组,根据尿白蛋白排泄率(UAER)分为单纯糖尿病亚组[(9.97±2.34)μg/min,A组,24例]、早期糖尿病肾病亚组[(164.32±42.59)μg/min,B组,21例]临床糖尿病肾病亚组[(297.68±80.53)μg/min,C组,25例];另外选择健康体检者22名作为参照组[尿白蛋白排泄率为(7.79±1.59)μg/min]。比较每组患者血清-25(OH)D3、肾功能的变化,并分析其相关性。结果糖尿病组患者的血清25羟基维生素D-3低于参照组(P<0.05)。糖尿病组血尿素氮、血清肌酐水平高于参照组(P<0.05)。A组、B组、C组血清25羟基维生素D-3、血尿素氮、尿白蛋白排泄率、血清肌酐水平比较差异有统计学意义(P<0.05)。结论糖尿病肾病患者血清25羟基维生素D-3水平低于正常人,与肾功能指标联合检测可有助于糖尿病肾病的早期诊断与病变防控。     

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.     

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.     

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.