cTnI定量检测对不稳定性心绞痛患者冠脉病变程度和预后的判断价值

目的探讨不稳定性心绞痛(UAP)患者cTnI定量检测同冠脉病变数量、程度和预后之间的关系.方法不稳定性心绞痛患者68例,采用美国DPC公司全自动化学发光免疫检测系统及试剂进行血清cTnI定量检测、CK-MB质量试验.并行冠脉造影术.随访观察30天后心脏事件的发生.结果 68例UAP患者中,A组26例(占38.2%),cTnI≥0.4 ng/ml.B组42例(占61.8%),cTnI＜0.4 ng/ml.同步测定CK-MB质量,二组间差异无显著性.A组中C型病变、三支病变、左主干受累和高度狭窄20例(占76.9%),明显高于B组9例(占21.4%,P＜0.05).A组Braunwald分级ⅢA或ⅢB者23例(占88.5%),B组仅3例(占7.1%),明显高于B组(P＜0.001).A组30天内发生心脏事件14例(占53.8%),明显高于B组4例(占9.5%,P＜0.01).结论化学发光免疫分析法cTnI定量检测同冠状动脉病变数量及严重程度、临床Braunwald分级有密切关系.并对判断不稳定性心绞痛患者预后有一定的预测价值.     

心肌肌钙蛋白I在不稳定型心绞痛患者中的应用价值

目的：探讨心肌肌钙蛋白I（cTnl)检测在不稳定型绞痛患中的临床应用价值。方法：对80例不稳定型心绞痛（UAP）患进行临床Braunwald分级,固相层析免疫法测定血清cTnI,酶学法测定肌酸磷酸激酶（CK）及其同功酶（CK－MB）,并观察住院期间心脏事件发生率。结果：80例UAP患中22例（27．5％）血清cTnI检测呈弱阳性或阳性,而CK－MB仅2例（2．5％）升高（P＝0．0001）。cTnI阳性组（22例）与阴性组（58例）之间临床除Braunwald分级存在差异（77．3％比48．3％,P＝0．02）外,其他均无差异。住院期间发生心脏事件率在cTnI阳性组较阴性组明显增高（40．9％比6．9％,P＝0．007）,多元logistic回归分析发现,cTnI是预测不稳定型心绞痛患住院期间心脏事件的最主要独立危险因素。结论：心肌肌钙蛋白I是反映心肌细胞损伤较灵敏、较特异的指标,是判断不稳定型心绞痛患近期预后的最主要独立预测因素。     

心脏肌钙蛋白I对老年不稳定型心绞痛患者危险分层的判断价值

血清心脏肌钙蛋白I（cTnI）增高的不稳定型心绞痛（UAP）患者比cTnI正常者更易发生心脏事件。以往多通过临床症状、体表静息心电图或超声心动图等无创方法对UAP进行危险分层，评价其预后，但老年UAP患者心绞痛症状及心电图常不典型，难以及时对其发生心脏事件的危险性作出正确判断，冠脉造影虽能准确判断冠脉病变的严重性，但属有创法，     

肌钙蛋白I对不稳定型心绞痛患者预后评价

目的观察不稳定型心绞痛（UAP）患者入院后血清肌钙蛋白I（cTnI）的变化,探讨其与ECG改变、心绞痛分级、冠状动脉病变的关系及对心脏事件的短期预报价值。方法34例UAP患者分别在入院时,入院后12h、24h、48h、10d各采血一次。用免疫发光法测定cTnI浓度,并分析其与临床状况、冠状动脉病变以及心脏事件的关系。结果在30d内,UAP患者中cTnI≥0.4μg/L者46.67%发生心脏事件;cTnI＜0.4μg/L者10.53%发生心脏事件（P＜0.05）。心绞痛Ⅲ级cTnI阳性率高,cTnI有否升高与心电图改变及冠状动脉造影、冠状动脉病变支数、狭窄部位无关（P>0.05）。cTnI对预测发生心脏事件的敏感性77.8%、特异性68%、阳性预测值46.7%、阴性预测值89.5%、准确性70.6%。结论cTnI定量测定对判断UAP患者短期内发生心脏事件有重要的预报价值。     

不稳定性心绞痛冠状动脉造影病变与临床的相关性

目的：分析不稳定性心绞痛（UA）临床表现,心电图与冠状动脉（冠脉）造影病变形态的关系。确定不稳定性病变及住心院心脏事件的临床预测因子,方法：选择冠脉造影异常（血管狭窄≥50％）的住院UA病人120例,观察不同Braunwald分级病人造影病变形态等的发生率,评估心电图ST段异常对复杂病变、住院心脏事件等的预测价值。结果：复杂病变的检出率Ⅲ级（20／33例）最高,较Ⅰ级（13／43例）差异有显著性（P＜0．05）,血栓的检出率Ⅲ级（6／33例）亦高于Ⅰ、Ⅱ级,与Ⅱ级（1／44例,2％）比较差异有显著性（P＜0．05）。住院心脏事件发生率Ⅲ级明显高于Ⅰ级（58％与195,P＜0．01）与Ⅱ级（58％与25％,P＜0．01）。Logistic回归分析示,心电图ST段异常及BraunwaldⅢ级均能预测复杂病变的存在（P＜0．01,OR为4．9;P＜0．01,OR为3．3）,心电图异常能预测三支病变（P＜0．01,OR为3．9）和心脏事件（P＜0．01,OR为4．8）。结论心电图ST段异常及48h内发作的静息心绞痛对复杂病变有预测价值。ST段异常的病人,三支血管病及发生心脏事件的危险性高。     

不同性别心绞痛患者肌钙蛋白Ⅰ和脑利钠肽检测的临床意义

目的 探讨不同性别心绞痛患者血浆心肌肌钙蛋白Ⅰ(cTnI)和脑利钠肽(BNP)水平检测的临床意义.方法 入选心绞痛患者283例,对照组64例.入院时测定血浆cTnI、BNP,并根据性别、冠状动脉造影结果、心绞痛类型及不稳定型心绞痛(UAP)Braunwald危险分级进行分组分析.结果 男性UAP组、BraunwaldⅡ级组、Braunwald Ⅲ级组cTnI[分别为(0.113±0.102)ng/L、(0.131±0.111)ng/L、(0.133±0.118)ng/L]明显高于女性对应各组[分别为(0.065±0.047)ng/L、(0.063±0.037)ng/L、(0.076±0.070)ng/L],而且在男性中,UAP组cTnl明显高于稳定型心绞痛(SAP)[(0.056±0.014)ng/L]组和对照组[(0.050±0.002)ng/L],BraunwaldⅢ级组和BraunwaldⅡ级组cTnI明显高于Braunwald Ⅰ级组[(0.072±0.055)ng/L];女性各组BNP均明显高于男性对应各组,而且在女性中,UAP组BNP[(92.00±32.72)ng/L]明显高于SAP组[(43.21±14.20)ng/L]和对照组[(37.86±9.27)ng/L],BraunwaldⅢ级组和BraunwaldⅡ级组BNP[(115.20±44.73)ng/L、(89.04±13.92)ng/L]明显高于Braunwald Ⅰ级组[(73.98±17.65)ng/L],BraunwaldⅢ级组BNP明显高于BraunwaldⅡ级组.结论 心绞痛患者BNP和cTnI的表达存在性别差异;男性患者cTnI水平与心绞痛的类型及其危险层次明显相关;女性患者BNP水平与心绞痛的类型及其危险层次明显相关.     

手足口病患儿心肌损害相关指标检测分析

对416例手足口病患儿进行临床血清学、心电图、心脏超声检查,并观察分析其心肌损害情况.结果 手足121病416例中,肌酸激酶同工酶(CK-MB)升高254例,心电图显著改变53例,肌钙蛋白(cTnI)阳性51例,心脏B超异常6例;59例诊断为心肌炎.认为手足口病易致心肌损伤,及时行血清心肌酶谱、cTnI、心电图、心脏超声检测有助于手足口病患儿心肌损害的早期诊断和治疗.     

联合应用肌酐清除率与心肌肌钙蛋白Ⅰ对非ST段抬高急性冠状动脉综合征预后价值的研究

目的探讨肌酐清除率(Ccr)以及联合应用Ccr与心肌肌钙蛋白Ⅰ(cTnI)对非ST段抬高急性冠状动脉综合征(ACS)患者住院期间和出院后1年内预后预测的价值.方法将166例非ST段抬高ACS患者进行分组,比较Ccr正常组(Ccr≥70ml/min)88例和降低组(Ccr＜70ml/min)78例;Ccr和cTnI均正常组(Ccr≥70 ml/min且cTnI＜0.04μg/L)46例,一项异常组(Ccr＜70 ml/min或cTnI≥0.04μg/L)71例和两项均异常组(Ccr＜70ml/min且cTnI≥0.04 μg/L)49例患者住院期间和出院后1年内急性心肌梗死、心力衰竭、难治性心肌缺血和心脏性死亡的发生率.结果单因素分析显示Ccr降低组住院期间和出院后1年内心力衰竭和复合心脏事件的发生率较Ccr正常组显著增高(P＜0.05).多因素分析显示校正心电图改变、Braunwald分级、高脂血症、高血压、糖尿病等危险因素后,Ccr降低是住院期间发生心力衰竭和复合心脏事件的独立预告因子,也是出院后1年内发生心力衰竭和心脏性死亡的独立预告因子.在Ccr降低组,Ccr＜50 mL/min患者住院期间心力衰竭和出院后1年内年心脏性死亡的发生率较70 ml/min＞Ccr≥50 ml/min患者显著增高(P＜0.05).多因素分析校正性别、年龄、心电图改变、Braunwald分级、高脂血症、高血压、糖尿病等危险因素后发现Ccr和cTnI均异常是住院期间和出院后1年内发生复合心脏事件的预告因子.结论Ccr能够作为评估非ST段抬高ACS近期和远期预后的指标之一;Ccr与cTnI联合应用对住院期间和出院后1年内发生心力衰竭和复合心脏事件有更好的预测价值.     

动态心电图缺血性ST段下移与血浆BNP、cTnI、hs-CRP水平变化的临床意义

目的 探讨动态心电图及血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）和高敏C反应蛋白（hs—cRP）水平与冠状动脉狭窄的关系。方法按Braunwald标准,120例心功能正常的不稳定型心绞痛（UAP）患者分为IB组（35例）、ⅡB组（42例）及ⅢB组（43例）,并取50例稳定型心绞痛（SAP）患者作为对照组。SAP组与UAP组于入院时及入院后24h抽肘前静脉血2次,分别行BNP、cTnI和hs—CRP检测,取两次结果的最高值。常规行动态心电图检查和择期行冠状动脉造影检查。结果①UAP组缺血性ST。（ST段延续至J点后80ms）段下移水平及BNP、cTnI、hs—CRP均显著高于对照组（P均〈0．05）;ⅢB组显著高于IB组和ⅡB组（P均〈0．05）。②冠脉三支与双支病变组BNP明显高于单支病变组,缺血性sT舶段下移敏感性高于单支病变组。三支病变组BNP、cTnI明显高于双支及单支病变组,组间比较差异有统计学意义（P均〈0．05）。③观察4周,UAP组心脏事件发生率明显高于SAP组（P＜0．05）。Logistic回归分析显示,BNP、cTnI和hs—CRP是30d主要心脏不良事件（MAcE）的独立预测因素。结论动态心电图检查及血浆BNP、cTnI、hs—CRP水平对临床评价UAP患者病情程度及近期预后有重要价值。     

肌钙蛋白Ⅰ对老年不稳定性心绞痛患者危险分层的判断价值

目的　探讨心脏肌钙蛋白I(cTnI)对老年不稳定性心绞痛 (UAP)患者危险分层的判断价值。　方法　对 6 8例老年UAP患者、17例稳定性心绞痛 (SAP)患者及 11例健康对照者分别进行血清cTnI测定 ,并观察住院 1个月内心脏事件发生情况。　结果　UAP组血清cTnI值为 (1 94± 0 6 3)μg/L ,明显高于SAP组的 (0 6 1± 0 11) μg/L及对照组的 (0 47± 0 0 8) μg/L(均为P <0 0 1)。UAP组内 ,随着Braunwald临床分级增高 ,Ⅰ～Ⅲ级血清cTnI值相应增高〔分别为 (1 35± 0 2 8)、(2 0 4± 0 31)及(3 17± 0 74) μg/L〕(P <0 0 5 )。对照组、SAP组及BraunwaldⅠ级UAP患者无 1例发生心脏事件 ;BraunwaldⅡ级 1例患者发生非致命性心肌梗死 ;BraunwaldⅢ级患者中 ,血清cTnI≥ 1 5 μg/L者心脏事件发生率为 42 1% ,高于血清cTnI <1 5 μg/L者的 13 3% (P <0 0 5 ) ,比数比 (OR) 3 15 ,95 %可信限为1 0 1～ 9 81。血清cTnI≥ 1 5 μg/L时判断心脏事件的阳性预测值为 42 1% ,阴性预测值为 86 7%。　结论　血清cTnI检测对老年UAP患者危险分层有较好的判断价值。     

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.