肺炎衣原体感染与原发性高血压的相关性研究

目的探讨肺炎衣原体(chlamydia pneumoniae,Cpn)感染与原发性高血压及其肾损害发生发展的关系.方法120例原发性高血压病患者(病例组),其中男性67例,女性53例,年龄39～75(59.81±9.67)岁,以同期我院健康体检筛选出的与病例组年龄及性别相匹配的30岁以上的健康人作为对照组,共118例,其中男64例,女54例.两组年龄、性别经检验分析无统计学差异.所有纳入对象排除脑出血、周围血管病、肺炎、肺结核、肿瘤及免疫性疾病.应用间接微量免疫荧光法测定血清肺炎衣原体特异性IgG、IgM抗体滴度,感染判断标准为急性感染单次IgM≥116或IgG≥1512;既往感染IgM＜116,164≤IgG＜1512.对病例组IgG抗体滴度高于164者用巢式PCR(nPCR)法测定其外周血单核细胞中肺炎衣原体DNA.同时测定所有病例组病例的尿微量白蛋白与尿肌酐的比值.结果对照组、病例组肺炎衣原体总感染数(率)分别为30、93(25.60%、77.5%),其中既往感染数(率)分别为30、80(25.60%、66.7%),急性感染数(率)分别为0、13(0%、10.8%).总感染率、既往感染率及急性感染率病例组明显增高(P＜0.001),相对危险度分别为9.98、5.8、0.48,95%可信区间分别为5.5～18、14、3.31～10.18、0.42～0.54);IgM抗体病例组仅3例阳性,对照组无一例阳性;与对照组比较病例组血清Cpn-IgG抗体平均几何滴度差异有非常显著性(P＜0.001);病例组Cpn感染93例中外周血单核细胞中肺炎衣原体DNA阳性数(率)为27(29%),尿微量白蛋白与尿肌酐的比值增高者视为有肾损害,占36例,Cpn-IgG抗体平均几何滴度与尿微量白蛋白与尿肌酐的比值无关系;Cpn-DNA阳性者尿微量白蛋白与尿肌酐的比值增高.结论肺炎衣原体感染与原发性高血压明显相关,血清中特异性抗体仅能反映患者曾经感染过肺炎衣原体,DNA的存在提示有肺炎衣原体的持续感染,并与原发性高血压伴早期肾损害密切相关.     

急性心肌梗死病人肺炎衣原体感染的研究

目的　探讨肺炎原体感染与急性心肌梗死之间的相关性。方法　应用间接微量免疫荧光法 ,测定 40例急性心机梗死病人 (AMI组 )和 60例非冠心病对照者 (对照组 )入院时的血清TWARIgG、IgM抗体滴度。 结果　AMI组TWAR既往感染阳怀率明显高于对照组 ( 75 %∶3 8 3 3 % ,P 0 0 1)。AMI组病人血清TWARIgG平均几何滴度 (GMT) ( 1∶5 4 76± 4 5 1)与对照组 ( 1∶19 93± 4 2 9)相比有显著性差异 ( P 0 0 1)。高TWARIgG抗体水平 (IgG≥ 1∶16)发生AMI风险相对增高 (OR4 83 ,95 %CI2 0 6～ 11 3 1)。结论　AMI与肺炎衣原体感染有关。肺炎衣原体感染可能是构成AMI发生发展的一个危险因子     

肺炎衣原体感染对冠心病发病影响的临床观察

目的 研究肺炎衣原体(Cpn)感染与冠心病(CHD)的关系.方法 应用酶联免疫吸附试验(ELISA)测定冠心病组(120例)和对照组(111例)血清Cpn特异性抗体IgM、IgG及IgA,同时应用免疫浊度法测定冠心病组(97例)和对照组(95例)血清C-反应蛋白(CRP)含量.结果 冠心病组血清Cpn抗体IgG和/或IgA阳性率及IgG和IgA滴度明显高于对照组(均P<0.05);急性心肌梗死(AMI)、不稳定型心绞痛(UAP)及慢性冠心病(CCHD)患者血清Cpn抗体IgG及IgA滴度均分别高于对照组(均P<0.05);冠心病组Cpn抗体IgM阳性率及滴度与对照组无明显差异;IgG和/或IgA及CRP均为阳性组的冠心病发生率明显增高;多元回归分析显示Cpn慢性感染与冠心病发病呈正相关(P=0.045),Cpn慢性感染与冠心病其他危险因素间无相关性.结论Cpn慢性感染可作为冠心病的独立危险因素,炎症反应的发生可能是Cpn慢性感染导致动脉粥样硬化的关键环节.     

急性心肌梗死与巨细胞病毒感染及血炎症介质的相关研究

目的揭示巨细胞病毒感染和急性心肌梗死之间的关系,并进一步探讨巨细胞病毒感染与冠心病有关的炎症介质之间的相关性. 方法用酶联免疫法(ELISA)对急性心肌梗死急性期组(AMIa)、急性心肌梗死恢复期组(AMIr)、陈旧性心肌梗死组(OMI)、正常对照组分别进行血清巨细胞病毒(CMV)特异性抗体IgG、IgM检测,并检测各组的血可溶性细胞间黏附分子-1(sICAM-1)、白介素-6(IL-6)、C反应蛋白(CRP).结果 (1)CMV IgG阳性率各组均高于正常对照组(P<0.05),AMIa高于AMIr、OMI组(P<0.05),后二者之间差异无显著性(P>0.05);IgG浓度在四组中依次为AMIa、AMIr、OMI、正常对照组(P<0.05).IgM阳性率AMIa高于其余3组(P<0.05),其余3组之间差异无显著性.(2)炎症介质sICAM-1、IL-6病例组均高于正常组(P<0.05),AMIa高于AMIr、OMI组(P<0.05);CRP则仅AMIa高于AMIr、OMI、正常对照组(P<0.05).AMIa组CMV感染组sICAM-1、IL-6、CRP显著高于非感染组(P<0.05);OMI和AMIr组CMV感染组sICAM-1、IL-6也高于非感染组(P<0.05).CMV IgG与CRP、sICAM-1、IL-6有很好的相关性. 结论 (1)急性CMV感染与急性心肌梗死的发生有关,可能是后者的促发因素;(2)CMV感染时炎症介质明显增高,可能是通过引起或加重局部冠状动脉炎症反应,导致冠心病和急性心肌梗死发生.     

急性冠脉综合征患者血清肺炎衣原体、 人巨细胞病毒感染的血清学研究

目的　探讨急性冠脉综合征与肺炎衣原体、人巨细胞病毒感染之间的关系。方法　对 42例急性心肌梗死(AMI)患者、43例不稳定心绞痛 (UAP)患者和 33例健康对照者采用微量免疫荧光法 (Micro IFA)检测血清中肺炎衣原体特异性抗体IgG、IgM及其滴度 ,用间接酶联免疫吸附测定法测定血清中人巨细胞病毒抗体IgG和IgM。结果　三组研究对象中均未检出急性肺炎衣原体感染者。急性心肌梗死、不稳定心绞痛组和正常对照组肺炎衣原体慢性感染率分别为6 6 7%、6 2 8%和 36 4% ,其中急性心肌梗死组、不稳定心绞痛组肺炎衣原体慢性感染率均较对照组升高 ,有统计学差异(P <0 0 5 )。上述三组平均肺炎衣原体特异性抗体滴度分别为 1 42、1 37和 0 88,急性心肌梗死组较正常对照组升高 ,有显著性差异 (P <0 0 1)。不稳定心绞痛组较正常对照组升高 ,有统计学差异 (P <0 0 5 )。此外 ,急性心肌梗死组与不稳定心绞痛组之间肺炎衣原体慢性感染率及平均IgG滴度无统计学差异 (P >0 0 5 )。三组研究对象中仅检出 1例抗人巨细胞病毒抗体IgM阳性者 ,IgG阳性率分别为 34 2 %、2 1 6 %和 41 9% ,无统计学差异。结论　肺炎衣原体慢性感染与急性冠脉综合征之间存在一定的联系 ,人巨细胞病毒感染与急性冠脉综合征之间的关系仍需进一步的     

冠心病与肺炎衣原体感染的临床研究

目的 测定冠心病患者阿奇霉素治疗前后血肺炎衣原体DNA及特异性免疫球蛋白G（immunoglobulinG,IgG）抗体滴度,探讨肺炎衣原体感染与冠心病的相关性。方法 选择150例冠心病患者（冠心病组）及同期临床可疑冠心病而进行冠状动脉造影正常的55例病例作为对照组,应用巢式聚合酶链反应测定外周血单核细胞中肺炎衣原体DNA,用间接微量免疫荧光法测定IgG抗体滴度。冠心病组采用随机、双盲和安慰剂对照的方法分别给予阿奇霉素及安慰剂治疗6个月,于治疗后1周,1,3,6,12个月复查免疫荧光抗体滴度,研究结束时对阳性病例复查肺炎衣原体DNA。结果 冠心病患者肺炎衣原体DNA阳性49例,阳性率33％,对照组仅1例阳性,阳性率为2％,冠心病组与对照组比较阳性率明显增高。冠心病组中55例无症状型冠心病组阳性16例,阳性率为29％,48例不稳定型心绞痛亚组阳性19例,阳性率为40％,47例急性心肌梗死亚组阳性14例,阳性率为30％,冠心病各亚组间阳性率无差异。治疗后DNA转阴率阿奇霉素组为87％,安慰剂组为59％,治疗组疗效明显优于对照组。治疗前IgG抗体滴度冠心病组较对照组明显增高,治疗后无明显变化。结论 冠心病患者肺炎衣原体DNA阳性率及肺炎衣原体特异性抗体增高,阿奇霉素治疗后DNA转阴,抗体滴度无变化,检测DNA临床价值更大。     

冠心病患者血清C反应蛋白和可溶性细胞间粘附分子1与肺炎衣原体感染的相关性

目的探讨冠心病患者血清炎症标志物C反应蛋白和可溶性细胞间粘附分子1水平的变化及其与肺炎衣原体感染的关系。方法采用酶联免疫吸附法检测60例急性心肌梗死、不稳定型心绞痛、陈旧性心肌梗死、稳定型心绞痛及40例对照者血清C反应蛋白、可溶性细胞间粘附分子1及肺炎衣原体抗体IgG、IgM。结果冠心病组肺炎衣原体IgG阳性率和浓度均高于对照组(P<0.01),冠心病各组之间肺炎衣原体IgG和IgM阳性率差异无显著性(P>0.05),急性心肌梗死组肺炎衣原体IgG浓度高于陈旧性心肌梗死组、不稳定型心绞痛组和稳定型心绞痛组(P<0.05);冠心病组C反应蛋白、可溶性细胞间粘附分子1水平高于对照组(P<0.01),急性心肌梗死组C反应蛋白、可溶性细胞间粘附分子1水平高于不稳定型心绞痛组、陈旧性心肌梗死组和稳定型心绞痛组(P<0.01),不稳定型心绞痛组C反应蛋白、可溶性细胞间粘附分子1水平高于稳定型心绞痛组(P<0.05);肺炎衣原体IgG浓度、C反应蛋白、可溶性细胞间粘附分子1之间有很好的相关性(P<0.05)。结论炎症标志物水平变化在一定程度上反映了冠心病患者病情变化,肺炎衣原体感染与冠心病有关,炎症、感染可能共同参与了冠心病的发生发展。     

冠心病与肺炎衣原体感染的相关性研究

目的了解冠心病患者肺炎衣原体(Chlamydiapneumoniae,Cpn)感染状况,探讨肺炎衣原体感染与冠心病的关系。方法采用聚合酶链式反应、双抗体夹心法和间接ELISA法对200例经冠状动脉造影证实的冠心病患者和非冠心病患者,进行CpnDNA、血清循环免疫复合物和IgG抗体检测。结果冠心病组CpnDNA、血清循环免疫复合物和IgG抗体阳性检出率依次为43.4%、64.2%、65.4%。对照组CpnDNA、免疫复合物、IgG抗体阳性检出率依次为7.3%、39.0%、31.7%。冠心病组CpnDNA、循环免疫复合物和IgG抗体阳性率均高于对照组(P<0.01)。结论Cpn感染与冠心病关系密切。     

心房颤动患者血清肺炎衣原体特异性抗体的检测

目的 调查心房颤动患者的肺炎衣原体感染。方法 应用间接微量免疫荧光法测定血清肺炎衣原体特异性IgG和IgM抗体滴度。结果 44例心房颤动患者肺炎衣原体感染率为70％;而45例健康对照者的感染率为42％,差异有统计学意义（P＜0.05）。既往感染率：心房颤动患者组和对照组分别为42％和87％;急性感染率：心房颤动患者和对照组分别为0％和18％。两组患者肺炎衣原体特异性IgM抗体均呈阴性。结论 心房颤动患者肺炎衣原体感染率显著高于正常健康对照者。     

肺炎衣原体慢性感染对血脂水平的影响

目的探讨肺炎衣原体慢性感染对人血脂水平的影响。方法横断面研究方法;采用微量免疫荧光法检测血浆中肺炎衣原体特异性抗体,以肺炎衣原体IgA升高(滴度≥1∶32)的125名健康体检者为研究组,以性别、年龄近似但IgA抗体效价不升高(滴度<1∶32)的64名同期体检者为对照组,比较2组血清总胆固醇、甘油三酯水平的差异。结果研究组血清总胆固醇水平(4.28±0.74mmol/ml)高于对照组(4.01±0.74mmol/l),差异具有统计学意义(P<0.05),甘油三酯水平差别无统计学意义。血清总胆固醇水平与肺炎衣原体特异性抗体(IgG、IgM)、性别、年龄、家族史、吸烟史等因素无关。结论:肺炎衣原体慢性感染与血清总胆固醇水平升高密切相关。     

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.     

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.     

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.     

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.