系统性红斑狼疮患者血小板膜表面糖蛋白的变化

目的 探讨系统性红斑狼疮（SLE）患者血小板膜表面糖蛋白变化，研究血小板膜糖蛋白的变化在该病中的意义。方法 应用流式细胞仪（FCM）测定51例SLE患者血小板膜表面糖蛋白（GP）Ⅱb/Ⅲa和GMP－140的表达水平，并对GPⅡb-Ⅲa明显降低的SLE患者进行血小板聚集功能的测定。结果 SLE患者血小板膜表面GPⅡb-Ⅲa的阳性率明显低于正常对照组（P＜0．01），SLE患者血小板膜表面GMP－140表达水平高于正常对照组（P＜0．01），3例GPⅡb-Ⅲa明显降低的SLE患者存在血小板聚集不良或异常。结论 SLE患者体内产生抗血小板GPⅡb-Ⅲa特异性抗体，导致血小板表面GPⅡb-Ⅲa表达水平降低，并且可能与出血有关。SLE患者体内部分血小板活化，使血小板膜表面GMP－140表达水平增加，这些活化的分子标记物又参与炎症反应，加重原发病。     

心房颤动患者血小板活化与左心房血栓形成关系的研究

目的:探讨持续性心房颤动(房颤)患者血小板活化与左心房血栓形成的关系.方法:选择持续性房颤患者(房颤组)84例,窦性心律(窦律组)和正常对照组各20例,其中房颤组39例患者通过经食道超声心动图检查又分为血栓阳性者(22例)和血栓阴性者(17例).所有对象均用流式细胞仪检测全血中血小板膜活化糖蛋白(GP)Ⅱb/Ⅲa水平.结果:左心房内径和血中GPⅡb/Ⅲa水平比较:与正常对照组、窦律组比较,房颤组的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显增高,差异有统计学意义(P＜0.05).进一步分析结果发现,与正常对照组、窦律组比较,血栓阴性者和血栓阳性者的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显增高,差异有统计学意义(P＜0.05);且血栓阳性者的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显高于血栓阴性者,差异有统计学意义(P＜0.05).多元线性回归分析:发现GPⅡb/Ⅲa活化阳性血小板的百分率(t=4.07,P=0.000)是房颤患者左心房血栓形成的独立危险因素,而左心房内径无明确的预测价值(t=1.78,P=0.084).相关性分析:使用直线相关分析方法,分析房颤患者血中GPⅡb/Ⅲa水平同左心房内径的关系,发现GPⅡb/Ⅲa水平同左心房内径两者具有相关性(r=0.57,R2=0.33,P＜0.01).结论:持续性房颤患者存在血小板活化程度增加,且同左心房血栓形成有密切关系.     

氯吡格雷、阿司匹林对高血压患者血小板微粒CD62p、GPⅡ b/Ⅲa的影响

目的 探讨血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa与高血压的关系,以及抗血小板药物对其影响.方法 采用流式细胞术（FCM）和单克隆抗体标记法,检测60例高血压患者、20名健康对照者的血液标本,以20 μmol/L ADP为激活剂激活血小板,30例服用阿司匹林,30例服用氯吡格雷,检测高血压患者血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa水平,观察药物对其的作用.结果 高血压组CD62p、GPⅡb/Ⅲa的百分率（85.3%±11.2%、91.6±12.4%）比正常对照组高（69.8%±8.9%、72.5%±10.2%）,P＜0.01,服用阿司匹林组CD62p、GPⅡb/Ⅲa的百分率降至（64.2%±9.6%、69.2%±9.8%）,P＜0.05与服药前有显著性差异,服用波立维组CD62p、GPⅡb/Ⅲa的百分率降至（39.8%±10.2%、32.8%±11.6%）,P＜0.01与服药前比较有显著性差异.结论 高血压与血小板膜糖蛋白微粒CD62p、GPⅡb/Ⅲa 的表达存在一定的联系,阿司匹林、氯比格雷可降低血小板微粒CD62p、GPⅡb/Ⅲa水平.     

高血压病及其伴抑郁情绪障碍病人血小板活化的临床观察

目的观察单纯高血压病及高血压病伴抑郁症病人的血小板活化功能。方法应用流式细胞仪（FCM）对17例确诊为高血压病不伴抑郁症的病人（A组）、81例高血压病合并抑郁症的病人（B组）及49名无高血压及高血压病病史的健康体检者（C组）进行血小板活化功能的检测，测定血小板活化依赖性颗粒膜蛋白（CD62p），血小板质膜糖蛋白（CD42a／CD42b）、血小板糖蛋白GPⅡb／GPⅢa复合物的值。结果高血压病合并抑郁症分布为轻度抑郁为20.00％，中度抑郁为17.17％，重度抑郁为18．33％。高血压病合并抑郁症组病人CD62p的均值、GPⅡb／GPⅢa复合物的均值较单纯高血压病组升高，且差异有统计学意义（P〈0．05或P〈0．01）；高血压病合并抑郁症组CD42a／CD42b较单纯高血压病组下降（P〈0．05）。结论高血压病合并抑郁症病人在老年病房有较高的构成比。高血压病病人存在有血小板功能活化，而高血压病伴抑郁症病人血小板的活化较单纯高血压病病人。     

ITP血小板特异性抗体和T淋巴细胞亚群及NK细胞变化的意义探讨

目的：检测特发性血小板减少性紫癜（ITP）患者抗血小板膜糖蛋白（GPⅡb／Ⅲa、GPⅠb／Ⅸ）特异性抗体表达、T淋巴细胞亚群及NK细胞的变化,探讨相关因素在ITP发病机制中的作用。方法：应用改良血小板抗原单克隆抗体固相化检测技术（MAIPA）、流式细胞术分别检测52例ITP和24例正常对照组抗血小板膜糖蛋白（GPⅡb／Ⅲa、GPⅠb／Ⅸ）特异性抗体表达、T淋巴细胞亚群及NK细胞变化。结果：ITP组的血小板计数明显低于正常对照组（P〈0．05）;抗GPⅡb／Ⅲa及GPⅠb／Ⅸ抗体A值均高于正常对照组（P〈0．05）;相关分析表明ITP组血小板计数与两种特异性抗体水平均呈负相关关系;在T淋巴细胞亚群变化中,ITP组CD3^＋T淋巴细胞百分比、CD4^＋T淋巴细胞百分比及CD4^＋／CD8^＋的比值均明显低于正常对照组（P〈0．05）,CD8^＋T淋巴细胞百分比则显著高于正常对照组（P〈0．05）;NK细胞百分比明显低于正常对照组（P〈0．05）。结论：血小板特异性抗体及T淋巴细胞亚群的变化可较好地反映ITP这一病理过程,对提高诊断水平及指导临床有一定的实用价值。     

血栓抽吸联合GPⅡb／Ⅲa治疗血栓负荷过重心肌梗死患者的疗效

目的：探讨直接经皮冠状动脉介入治疗（PCI）中血栓抽吸导管（ZEEK导管）联合血小板Ⅱb／Ⅲa受体拮抗剂（GPⅡb／Ⅲa）治疗血栓负荷过重的急性ST段抬高型心肌梗死（STEMI）的效果。方法：人选STEMI患者136例,随机分为常规PCI组（44例）、GPⅡb／Ⅲa组（45例）和GP1Ib／Ⅲa±TA（血栓抽吸）组（47例）,分析三组PCI术后即刻梗死相关血管（IRA）的TIMI血流分级、梗死部位心肌灌注水平（TMP）分级、术后72h内出血、输血比例及术后30d、1年内主要心脏不良事件（MACE）等。结果：与常规PCI组比较,GPⅡb／Ⅲa组和GPⅡb／Ⅲa±TA组术后即刻IRA的TIMI血流分级[（2．31±0．50）比（2．52±0．48）比（2．69±0．47）]、TMP分级[（2．03±0．65）比（2．31±0．48）比（2．51±0．54）]明显提高,且GPⅡb／Ⅲa±TA组明显高于GPⅡb／Ⅲa组,P均d0．05;GPⅡb／Ⅲa组和GPⅡb／Ⅲa±TA组术后30d、1年MACE发生率均明显低于常规PCI组E30d：（9．6±28．4）％、（7．1±21．7）％比（16．2±37．4）％,1年：（16．3±35．5）％、（12．4±39．3）％比（29．7士46．3）％],P均d0．01。术后72h内出血、输血比例三组间差异无显著性。结论：冠状动脉血栓负荷过重的急性ST段抬高型心肌梗死患者急诊PCI中联合使用血栓抽吸导管和血小板Ⅱb／Ⅲa受体拮抗剂安全、有效,即刻获得的TIMI血流和心肌灌注优于常规PCI组及单用血小板Ⅱb／Ⅲa受体拮抗剂组。     

P2X_1受体介导的血小板活化与急性冠脉综合征的相关性研究

目的探讨P2X1受体介导的血小板活化与急性冠脉综合征（ACS）的关系及临床意义。方法选取70例ACS患者,其中急性心肌梗死（AMI）患者30例,不稳定型心绞痛（UA）患者40例,同期入院的健康受试者20例作为对照组。受试者均给予口服阿司匹林150 mg和氯吡格雷75 mg治疗,在服药前及服药后24 h抽取静脉血进行血小板检测。分别以α,β-me ATP（3μM）、低浓度胶原（1μg/mL）激活血小板,以Fluo-3,AMester为标记物在荧光分光光度计下观察血小板钙离子水平变化及应用酶联免疫吸附法（ELISA）测定血小板P-选择素、血小板膜糖蛋白Ⅱb/Ⅲa（GPⅡb/Ⅲa）水平的变化。结果 ACS组患者血小板钙离子、P-选择素及GPⅡb/Ⅲa基线水平均高于对照组（P〈0.05）,抗血小板治疗后ACS组及对照组患者血小板钙离子、P-选择素及GPⅡb/Ⅲa水平均较治疗前水平降低（P〈0.05）,但ACS组患者血小板钙离子、P-选择素及GPⅡb/Ⅲa水平下降幅度低于对照组（P〈0.05）。AMI组血小板钙离子基线水平高于UA组（P〈0.05）,抗血小板治疗后AMI组与UA组的血小板钙离子浓度下降幅度有统计学差异（P〈0.05）。结论 ACS患者血小板膜P2X1受体处于高活化状态,抗血小板治疗可以抑制血小板膜P2X1受体的激活。     

络泰注射液对冠心病病人活化血小板的影响

目的 观察络泰注射液对冠心病病人活化血小板的影响。方法 将60例冠心病病人随机分为两组，治疗组30例，予络泰注射液静脉输注，对照组30例子常规治疗。对两组病人进行血小板α颗粒膜糖蛋白GMP-140、GPⅡb／Ⅲa的检测。结果 治疗后治疗组血小板GMP-140水平与对照组比较有统计学意义（P〈0．05）。结论 络泰注射液治疗后老年冠心病病人活化血小板功能受到抑制。     

老年原发性高血压患者伴下肢动脉硬化闭塞症与血小板功能的相关性研究

目的　探讨老年原发性高血压 (EH)患者伴下肢动脉硬化闭塞症 (LEAO)与血小板功能的关系及其临床意义。方法　采用病例对照设计 ,老年EH患者伴LEAO组 (32例 )及老年EH患者组 (30例 )、健康老年组 (30例 ) ,用流式细胞术观察 3组的血小板膜糖蛋白 (GP)Ⅱb Ⅲa的活化水平、血小板聚集率 (PAgT)、纤维蛋白原 (Fg)等指标的变化。结果　GPⅡb Ⅲa的活化水平及PAgT在老年EH患者伴LEAO组明显高于老年EH患者组及健康老年组(P <0 .0 1) ,老年EH患者组与健康老年组的GPⅡb Ⅲa的活化水平及PAgT比较有明显增高 (P <0 .0 1) ,老年EH患者伴LEAO组的Fg与健康老年组比较有显著差异 (P <0 .0 1) ,老年EH患者伴LEAO组GPⅡb Ⅲa的活化水平与PAgT呈正相关 (r=0 .870 1、P <0 .0 1)。结论　GPⅡb Ⅲa及PAgT与老年EH患者伴LEAO密切相关 ,并对判断其血小板活化以及血管病变有重要的临床价值。     

老年非瓣膜心脏病心房颤动患者血小板功能及血管性血友病因子的改变

结果:老年非瓣膜心脏病房颤患者(A组,22例)血小板膜上活化糖蛋白Ⅱb/Ⅲa复合物(GPⅡb/Ⅲa)荧光阳性率为9.23％,显著高于无房颤患者(B组,18例)的2.61％及健康老年组(C组,16例)1.71％(均为P<0.01)。而A组患者的糖蛋白Ⅰb(GPⅠb)     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.