正常高值血压患者血浆血管活性因子和抗氧化酶的变化及其意义

目的正常高值血压具有较高的发展成为高血压的危险性。本研究的目的是观察正常高值血压患者血浆中血管活性因子和抗氧化酶的变化,以探讨其在高血压治疗和预防方面的意义。方法根据JNC-7诊断标准筛选病例并分为三组：正常血压组（NT组）为74例正常血压健康人,男性38例,女性36例,平均年龄（47．15±7．77）岁;正常高值血压组（PH组）为51例正常高值血压患者,男性29例,女性22例,平均年龄（47．82±5．16）岁;高血压组（EH组）为71例原发性高血压患者,男性37例,女性34例,平均年龄（48．25±7．97）岁。抽取静脉血,离心后分别采用放免法和酶联免疫法测定血中的血管紧张素Ⅱ（AngⅡ）、内皮素（ET）、血管加压素（AVP）、降钙素基因相关肽（CGRP）、一氧化氮合成酶（NOS）、超氧化物岐化酶（SOD）和谷胱甘肽过氧化物酶（GPX）等含量。结果与NT组相比,EH组和PH组血中甘油三酯、总胆固醇和低密度脂蛋白胆固醇水平明显升高（P〈0．05）;高密度脂蛋白胆固醇在PH组中降低,EH组明显降低（P〈0．05）;AngⅡ、AVP和ET在EH组和PH组均增高（P〈0．05）;CGRP在PH组和EH组均下降（P〈0．05;P〉0．05）;NOS在三组之间无明显的差异;SOD在PH和EH组明显下降（P〈0．05;P〈0．01）而GPX明显增高（P〈0．05;P〈0．01）。结论PH患者血中脂类物质、血管活性物质、抗氧化酶出现了异常变化,这会增加患高血压的可能性。为尽可能减少和防止其进展为高血压,应该对PH患者进行相应的治疗和控制。     

Increased plasma levels of adrenomedullin in patients with systemic inflammatory response syndrome.

We measured the plasma levels of adrenomedullin (AM), a novel vasodilating peptide, in 89 patients with various forms of systemic inflammatory response syndrome (SIRS) and 13 healthy volunteers serving as controls. Plasma levels of AM in SIRS (burns: 20.5 +/- 3. 2 fmol/ml [mean +/- SEM]; pancreatitis: 13.8 +/- 3.8 fmol/ml; trauma: 14.9 +/- 2.5 fmol/ml; traumatic shock: 41.1 +/- 7.8 fmol/ml; severe sepsis: 59.9 +/- 11.2 fmol/ml; septic shock: 193.5 +/- 30.1 fmol/ml) were significantly increased over those of controls (5.1 +/- 0.2 fmol/ml). The patients with traumatic shock or septic shock especially had higher levels of plasma AM than those with trauma or severe sepsis, respectively. These data showed that in patients with SIRS, plasma AM levels increased in proportion to the severity of illness. Subsequently, we measured the plasma levels of mediators such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, plasminogen activator inhibitor (PAI)-1, and thrombomodulin (TM) in patients with traumatic shock and septic shock. A significant correlation was observed between plasma AM and TNF-alpha levels in patients with septic shock, suggesting an important role for AM as well as of TNF-alpha in the pathophysiology of inflammation. Plasma AM and IL-8 levels correlated positively with Acute Physiology and Chronic Health Evaluation (APACHE) II score, peak multiple organ failure (MOF) score during the first month and prognosis in patients with septic shock, as did plasma IL-6 levels in patients with traumatic shock. The plasma AM level might serve as a useful marker for evaluating the severity of disease and as an early predictor of subsequent organ failure and outcome in septic shock.     

Increased plasma endothelin-1 levels in fibromyalgia syndrome

SIR, The fibromyalgia syndrome (FMS) is defined by symptomsof widespread, chronic musculoskeletal pain, stiffness and pressurehyperalgesia at characteristic soft tissue sites, called softtissue tender points. FMS shows clinical overlap with otherstress-associated disorders, including chronic fatigue syndrome(CFS) and depression. The disease is more common in women thanin men, and occurs mostly in middle age. Despite intensive researchin this field, the aetiology of the disorder is     

Increased plasma levels of thioredoxin in patients with glucose intolerance

OBJECTIVE: The aim of the present study was to determine the effects of glucose intolerance on oxidative stress in patients with coronary artery disease (CAD). METHODS: The patients were divided into 3 groups, diabetes mellitus (DM), IGT or normal glucose tolerance (NGT) according to the criteria of the American Diabetes Association. PATIENTS: The present study consisted of 178 consecutive patients who underwent diagnostic coronary arteriography and a 75-g glucose tolerance test. RESULTS: The level of plasma thioredoxin, a marker of oxidative stress was measured in every patient during the fasting state. The levels of plasma thioredoxin were significantly higher in the DM and IGT groups than the NGT group. Furthermore, we found that there was a positive association between thioredoxin levels and glycosylated hemoglobin (sigma=0.225, p=0.018). In multivariate logistic regression analysis, glucose intolerance (DM or IGT) was only independently associated with the high levels of thioredoxin. The levels of plasma thioredoxin were significantly higher in the CAD group compared to the non-CAD group. In multivariate logistic regression analysis, high levels of thioredoxin, male, age and hypertension were independently associated with the presence of CAD. CONCLUSION: Glucose intolerance was associated with the high levels of thioredoxin. High levels of thioredoxin were related to the presence of CAD. The measurement of thioredoxin as the marker of oxidative stress may be useful for monitoring the development of the cardiovascular diseases.     

Increased plasma levels of neuropeptide Y in hepatorenal syndrome

BACKGROUND/AIMS: To investigate the relationship between neuropeptide Y (NPY), a potent renal vasoconstrictor peptide released upon marked stimulations of sympathetic nervous system (SNS), and renal and circulatory function in cirrhosis. METHODS: Plasma levels of NPY (radioimmunoassay) and norepinephrine and renal function parameters were determined in 17 healthy controls, nine patients with cirrhosis without ascites, and 37 patients with cirrhosis and ascites, of whom 12 had hepatorenal syndrome (HRS). RESULTS: Patients with ascites showed circulating levels of NPY similar to those of patients without ascites and controls (73+/-4, +/-4 and 68+/-4 pmol/l, respectively; NS). However, patients with HRS had significantly increased levels of NPY with respect to the other groups (110+/-6 pmol/l; P<0.001). NPY levels correlated inversely with renal plasma flow and glomerular filtration rate and directly with norepinephrine. In patients with HRS (n=6) treatment with terlipressin and albumin was associated with a marked improvement in circulatory and renal function and marked suppression of NPY and norepinephrine levels. CONCLUSIONS: Patients with HRS have increased levels of NPY which are related to circulatory dysfunction and SNS activation and may contribute to renal vasoconstriction.     

Increased fasting plasma ghrelin levels in patients with bulimia nervosa

OBJECTIVE: Fasting plasma ghrelin levels play an important role in the pathophysiology of the eating disorder anorexia nervosa. Bulimia nervosa (BN) also has been associated with abnormal neuroendocrine regulation. Thus, we examined the relationship between body mass index (BMI) and plasma ghrelin concentrations in patients with BN for the first time. METHODS: The subjects included 15 female BN patients and 11 female healthy volunteers (controls). Fasting blood samples were collected from all subjects. RESULTS: The plasma ghrelin concentrations in all subjects demonstrated a significantly negative correlation with BMI. Mean plasma ghrelin level in BN patients was significantly higher than that in the controls, though mean BMIs between the groups were not significantly different. CONCLUSION: These findings suggest that not only BMI but also abnormal eating behaviors with habitual binge eating and purging may have some influence on circulating ghrelin level in BN.     

Increased plasma levels of soluble selectins in patients with unstable angina

BACKGROUND: Inflammation plays an important role in the pathogenesis of unstable angina. Adhesion molecules, such as selectins, mediate the interactions between leukocytes, platelets and endothelial cells during inflammation and thrombogenesis. HYPOTHESIS: The purpose of this study was to determine whether soluble E-selectin, P-selectin and L-selectin levels are increased in patients with unstable angina (UA). METHODS: Soluble E-, P- and L-selectin levels were measured by enzyme-linked immunoassay in the peripheral blood of 23 patients with UA, 26 patients with stable angina (SA) and 15 control patients with angiographically normal coronary arteries. RESULTS: Soluble E-selectin levels were significantly higher in patients with UA (45+/-11 ng/ml) than in controls (30+/-8 ng/ml, P<0.001), or patients with SA (34+/-8 ng/ml, P=0.001). Similarly, plasma levels of P- and L-selectin were significantly higher in patients with UA (427+/-144 and 772+/-160 ng/ml, respectively) than in patients with SA (278+/-79 and 643+/-94 ng/ml, respectively, P<0.005 vs. UA for both), or control patients (189+/-43 and 601+/-126 ng/ml, respectively, P=0.001 vs. UA for both). CONCLUSIONS: Plasma levels of soluble selectins were increased in patients with UA compared with patients with SA or patients without angiographically visible coronary artery disease. Measurements of these adhesion molecules may be helpful as non-invasive markers of coronary plaque destabilization in UA.     

Increased plasma levels of endothelin in diabetic patients with hypertension.

In order to gain insight into the potential role of endothelin, a 21 amino acid peptide produced by endothelial cells, in the development of complications of diabetes mellitus, basal plasma endothelin levels were measured in 152 patients with diabetes mellitus (83 patients with type 1 diabetes mellitus, 69 patients with type 2 diabetes mellitus) and compared to those in 50 healthy controls. Blood was drawn at 8:00 AM under resting conditions and endothelin was measured after prior extraction by a sensitive radioimmunoassay specific for both endothelin 1 and 2. Endothelin levels were increased in patients with diabetes mellitus in comparison to controls. In type 1 diabetes mellitus a positive correlation between endothelin levels and age was found. We found that 60% of patients with type 1 diabetes mellitus and elevated endothelin levels higher than 2.5 pg/mL (highest value in a control person) had had diabetes for more than 20 years (P less than .05 v patients with normal endothelin levels). In type 2 diabetes mellitus the relation between elevated endothelin levels and diabetes duration was reversed. Glycosylated hemoglobin (HbA1) concentrations above 10% of total hemoglobin were measured in 62% of the patients. Arterial hypertension was present in 60% of the patients with type 1 diabetes mellitus and increased endothelin levels greater than 2.5 pg/mL (both P less than .05 v patients with normal endothelin levels).(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased levels of plasma 5-hydroxytryptamine in patients with coeliac disease

In 17 patients with coeliac disease the 5-hydroxytryptamine (5-HT) concentration was measured in platelet-poor plasma (PPP) and in whole blood and compared with that of a control group of 30 healthy persons. The 5-HT level was determined by high-pressure liquid chromatography and electrochemical detection. In patients with coeliac disease the concentration of 5-HT in whole blood was elevated compared with the control group (p less than 0.001). The 5-HT level in PPP was significantly increased in patients with coeliac disease in whom the disease was untreated or treated with gluten-free diet for less than a year (p less than 0.01) but also compared with the patients with coeliac disease treated with a gluten-free diet for more than a year (p less than 0.01). In some untreated patients with newly diagnosed disease the 5-HT levels in PPP were markedly elevated and exceeded the levels ordinarily found in PPP in patients with carcinoid tumours. In these patients with coeliac disease the 5-HT concentration in PPP was reduced when the enteropathy was healed. There was no significant correlation between the 5-HT concentration in PPP versus whole blood in the different groups.     

Increased plasma tissue-type plasminogen activator levels in patients with chronic thrombocytopenia

Plasma fibrinolytic factors were measured in 14 patients with chronic idiopathic thrombocytopenic purpura (ITP), in 5 patients with chronic central thrombocytopenia and in 16 healthy volunteers. The von Willebrand factor (vWF), tissue-type plasminogen activator (t-PA) and D-dimer (DD) antigens were found to be significantly higher in both patient groups than in the control group. No difference appeared in euglobulin fibrinolytic activity and plasminogen activator inhibitor activity. The increases in both t-PA and vWF suggest the occurrence of an endothelial cell stimulation, associated with the reduction of circulating platelet number. The correlation of increased DD and t-PA levels during ITP can be the proof of a fibrinolysis activation and suggest an antifibrinolytic role of platelets at physiological concentrations. These results can justify antifibrinolytic therapy in bleeding thrombocytopenic patients.     

Increased plasma catecholamine levels in patients with symptomatic mitral valve prolapse

Total plasma catecholamine levels, plasma norepinephrine levels, heart rate, and systolic and diastolic pressures were measured in 15 symptomatic patients with mitral valve prolapse and in 19 normal subjects in supine baseline conditions and in a standing position. In the 15 symptomatic patients, total plasma catecholamine levels and plasma norepinephrine levels were significantly elevated in both positions, and heart rate was lower than in normal subjects in the supine position but returned to normal in the upright position. Thus, symptomatic patients with mitral valve prolapse demonstrate increased resting sympathetic tone. In addition, the associated supine bradycardia suggested that increased vagal tone might also be present at rest. These observations support the hypothesis of a dual autonomic dysfunction in these patients and could account for some of the clinical manifestations of the mitral valve prolapse syndrome.     

Increased activity of lysosomal enzymes in the peritoneal fluid of patients with gynecologic cancers and pelvic inflammatory disease

Purpose To investigate whether the activity of lysosomal enzymes is increased in the peritoneal fluid of patients with gynecologic cancers compared to activity in the peritoneal fluid from normal subjects and those with pelvic inflammatory disease, and fluid from benign ovarian cysts.Patients and methods -glucuronidase, -galactosidase, and -mannosidase activity was measured in the peritoneal fluid from patients with gynecologic cancer, pelvic inflammatory disease, and normal subjects, and fluid from benign ovarian cysts.Results The mean±SD of -glucuronidase, -galactosidase, and -mannosidase activity in the gynecologic cancers was 120±50 nmol, 203±86 nmol, and 240±119 nmol 4-methylumbelliferone/ml/h, respectively; in the normal control subjects it was 22±9 nmol, 46±10 nmol, and 80±23 nmol, respectively (P=0.00003, 0.0001, and 0.0001, respectively). The activity was increased even in cases without malignant cells in the peritoneal fluid. In pelvic inflammatory disease it was 148±82 nmol, 278±112 nmol, and 291±140 nmol, respectively. The activity in the fluid of the ovarian cysts was similar to that of the normal peritoneal fluid. There was a significant positive correlation between enzyme activity and stage of cancer, that was stronger for -glucuronidase (r=0.889, P=0.003).Conclusion The increased lysosomal enzyme activity in gynecologic cancers, without overlapping between patients and normal subjects or benign ovarian cyst fluid, indicates that such measurements might be applied for diagnostic purposes.     

Elevated plasma levels of endothelin in patients with sepsis syndrome

The levels of the recently isolated endothelial-derived peptide, endothelin, which has potent vasoconstrictor properties, were analyzed by radioimmunoassay in plasma from six patients with sepsis syndrome. For comparison endothelin levels were also measured in plasma from ten healthy volunteers. In the septic group plasma endothelin-like immunoreactivity was five-fold higher (11.3 +/- 2.8 pmol/l) compared to the volunteers (2.4 +/- 0.07 pmol/l) (P less than 0.01). Three patients had anuria and were found to have the highest plasma endothelin levels, maximally 23.8 pmol/l. In the septic group plasma endogenous norepinephrine was increased to 8.3 +/- 2.2 nmol/l, as compared to 0.98 +/- 0.09 nmol/l in healthy volunteers (P less than 0.01). The results confirm that the sympathetic nervous system is activated in the septic patient. Plasma levels of endothelin, probably emanating from damaged endothelial cells by bacterial toxins, are also elevated indicating that this peptide may be involved in vasoconstrictor responses resulting in organ failure, which so often is encountered in septicemia.