氯沙坦和苯那普利联合治疗肾性高血压的临床研究

目的观察氯沙坦和苯那普利联合治疗肾性高血压的疗效。方法将55例伴有高血压和稳定肾功能不全的慢性肾炎患者随机分三组，分别用氯沙坦(50mg／d)、苯那普利(10mg／d)和氯沙坦(50mg／d)加苯那普利(10mg／d)共治疗24周。单独用药组治疗12周后，若血压≤130／80mmHg(1mmHg=0．133kPa)，继续单独用药治疗12周;若血压＞130／80mmHg，改为联合用药治疗12周。观察血压、尿蛋白、血肌酐、血尿酸的变化及药物的不良反应。结果联合用药组血压控制率比单独用药组高(P＜0．01)。三种药物均有降尿蛋白作用。与治疗前比较，联合用药组第12周后血肌酐有明显下降(P＜0．05)。联合用药及单用氯沙坦均有降尿酸作用。单独用药血压未达标病例再联合用药后，血压、尿蛋白、血肌酐和血尿酸均有明显下降(P＜0．05，P＜0．01)，且尿蛋白和血肌酐的下降幅度比血压达标病例继续单独用药更显著(P＜0．05，P＜0．01)。联合用药的不良反应与单独用药相比没有明显增加。结论氯沙坦和苯那普利联合治疗伴有高血压和稳定肾功能不全的慢性肾炎，较单独用药更有效地控制血压、减少蛋白尿、降低血肌酐和血尿酸，具有良好的安全性和耐受性。     

左旋氨氯地平联合氢氯噻嗪与海捷亚治疗老年单纯收缩期高血压的疗效观察

目的 对比观察左旋氨氯地平联合氢氯噻嗪和海捷亚治疗老年单纯收缩期高血压的临床疗效及安全性。方法 将96例老年单纯收缩期高血压患者随机分成两组，A组50例，给予左旋氨氯地平2．5mg加氢氯噻嗪12．5mg，1次／d，晨服；B组46例，给予海捷亚1片，1次／d，晨服，均治疗12周。第4周A组根据血压情况调整剂量为左旋氨氯地平5mg加氢氯噻嗪25mg，1次／d；B组海捷亚调整为2片，1次／d，治疗9周。分别检测治疗前后血压、心率、空腹血糖、血脂、血尿酸、血钾、血肌酐，并记录不良反应。结果 两组患者治疗前后SBP、PP间差异均有显著统计学意义（P〈0．01），A组有效率为88．0％，B组有效率为87．0％，两组有效率差异无统计学意义（P〉0．05）。两组治疗前后心率、生化指标无明显变化，A组不良反应发生率为6．0％，B组为4．3％。结论 A、B组降压效果显著，且疗效相似，不良反应少，耐受性好，对心率与血生化指标无明显影响。     

海捷亚治疗原发性高血压的临床观察

目的观察海捷亚(氯沙坦钾／氢氯噻嗪片)对原发性高血压患者的降压疗效及不良反应。方法为自身对照方式的多中心研究。选择490例Ⅰ、Ⅱ级原发性高血压病例，服海捷亚(每天晨服一次)共4周，观察用该药期间血压、心率及不良反应情况。结果服海捷亚1周起，收缩压、舒张压、平均动脉压均显著下降(P＜0．01)，至第4周降压幅度最显著(P＜0．001)。海捷亚对老年高血压与较年轻高血压患者同样有效。结论海捷亚能有效控制血压，不良反应少。     

乐卡地平治疗原发性高血压的疗效观察

目的：通过临床和动态血压监测评估每日一次乐卡地平的降压效果。方法：选择轻～中度原发性高血压患者为研究对象，口服乐卡地平10mg，每日1次，效果不明显时改为每日20mg，观察八周。用药前、后分别以常规血压和动态血压观察24h平均收缩压和舒张压，白昼平均收缩压和舒张压，夜间平均收缩压和舒张压及心率的变化，并观察血糖、血脂、血尿酸及血肌酐的变化，同时观察药物副作用。结果：偶测血压及动态血压均较前下降显著（P〈0．05）。心率较前无变化（P〉0．05）、血糖、血脂较前无变化（P〉0．05），血尿酸及血肌酐下降明显（P〈0．05）。结论：乐卡地平每日服用一次能有效控制轻～中度原发性高血压患者24h血压，并具有很好的耐受性。     

培哚普利、卡托普利和硝苯地平对老年轻中度高血压患者肾功能的影响

目的：观察培哚普利、卡托普利和硝苯地平对老年轻中度高血压患者肾功能的影响。方法：９４例老年轻中度高血压心室肥厚患者随机分为培哚普利、卡托普利和硝苯地平３组，服用２周安慰剂后用药３个月，剂量逐月递增。用药前后测定血压、尿微白蛋白分泌率（ＭＡＥＲ）、尿素氮、肌酐、肌酐清除率和血钾、血钠。结果：３组用药后血压均明显下降达正常范围；尿ＭＡＥＲ在培哚普利组显著下降（Ｐ＜０．０１），另两组下降不显著；尿素氮、肌酐、肌酐清除率３组治疗前后无明显变化；血钾在卡托普利组和培哚普利组均有上升（Ｐ＜０．００５和Ｐ＜０．０５），血钠水平３组间均无变化。结论：培哚普利、卡托普利和硝苯地平均可有效控制血压，培哚普利同时可降低尿ＭＡＥＲ，改善肾功能，但培哚普利与卡托普利均可引起血钾升高，应引起注意。     

氯沙坦及苯那普利治疗慢性肾功能不全合并高血压疗效比较

目的 探讨治疗慢性肾功能不全合并高血压的最佳药物。方法 将78例慢性肾功能不全患者随机分为氯沙坦组43例和苯那普利组35例,分别13服氯沙坦50mg／d和苯那普利10mg／d连续8周,观察用药前及用药后4、8周血压、尿蛋白、血尿素氮（BUN）、肌酐（Scr）、尿酸（uA）和钾的变化及咳嗽反应。结果 用药后两组血压、尿蛋白定量均明显下降,P〈0．01;治疗8周氯沙坦组BUN、Scr有所下降,苯那普利组Scr下降有显著意义（P〈0．05）,而仅氯沙坦组血尿酸减低（4周时P〈0．05;8周时P〈0．01）,苯那普利组发生咳嗽反应4例。结论 氯沙坦及苯那普利在控制血压、降低尿蛋白、改善肾功能等方面疗效相近;氯沙坦尚有可减低血尿酸水平、无咳嗽反应及用药耐受性更好等特点。     

氯沙坦联合吲达帕胺治疗高血压合并高尿酸血症的疗效观察

目的探讨氯沙坦联合吲达帕胺治疗高血压合并高尿酸血症的疗效。方法选取78例高血压合并高尿酸血症患者,随机分为两组,对照组39例,给予口服氯沙坦50mg,1次/d,治疗组39例,在对照组的基础上加服吲达帕胺2.5mg,1次/d;治疗12周,观察血压、血尿酸、血肌酐和血钾的变化。结果治疗组降压效果明显优于对照组（P〈0.01）,且两组降血尿酸效果比较无显著差异（P〉0.05）。结论氯沙坦联合吲达帕胺具有良好的降压、降血尿酸作用。     

海藻酸钾散剂与寿比山降压疗效及安全性的临床对比研究

目的比较海藻酸钾散剂与寿比山治疗原发性高血压的疗效及安全性。方法采用随机、双盲、配对、组间平行对照的方法，海藻酸钾散剂组和寿比山组各76例。海藻酸钾散剂组给药3g，每日2次，逐渐增量，最大剂量为每日8g。寿比山组给予寿比山每次2．5mg，每日1次，两组疗程均为8周。结果两组治疗后第1周、第4周、第8周收缩压及舒张压均较用药前显著降低（P〈0．01）。海藻酸钾组降压幅度收缩压为21．59mmHg，舒张压为10．15mmHg寿比山组降压幅度收缩压为25．27mmHg．舒张压为11．15mmHg．两组收缩压及舒张压下降幅度比较均无统计学意义、海藻酸钾散剂降压的总有效率为750％，寿比山组为67．1％（P〉0．05）。海藻酸钾散剂组无明显不良反应，且对各生化指标、心率及心电图均无影响：结论海藻酸钾散剂与寿比山具有相似的降压疗效，是一种安全、有效的降压药．     

阿利沙坦酯与贝尼地平对轻中度高血压患者降压效果、肾功能及血尿酸影响的对比研究

背景近年研究发现,钙通道阻滞剂(CCB)贝尼地平具有降低尿蛋白的作用。血管紧张素Ⅱ受体拮抗剂(ARB)阿利沙坦酯是我国首个自主研发的1.1类抗高血压药。但目前有关贝尼地平与阿利沙坦酯治疗高血压的研究报道少见。目的比较阿利沙坦酯和贝尼地平对轻中度高血压患者降压效果、肾功能及血尿酸的影响。方法选取2020年1月至2021年6月深圳大学总医院心血管内科、肾内科门诊及住院部收治的新发高血压患者92例,采用随机数字表法分为阿利沙坦酯组(n=45)和贝尼地平组(n=47)。贝尼地平组患者给予贝尼地平治疗,阿利沙坦酯组患者给予阿利沙坦酯治疗。比较两组患者治疗前及治疗12周后24 h平均血压(包括24 h平均收缩压和24 h平均舒张压)、肾功能指标(包括血肌酐、血β₂-微量蛋白、尿微量白蛋白/尿肌酐比值、尿总蛋白/尿肌酐比值)及血尿酸,并观察两组患者治疗期间不良反应发生情况。结果两组患者治疗前及治疗12周后24 h平均收缩压、24 h平均舒张压比较,差异无统计学意义(P>0.05);治疗12周后,两组患者24 h平均收缩压和24 h平均舒张压分别低于本组治疗前(P<0.05)。两组患者治疗前及治疗12周后血肌酐、血β₂-微量蛋白、尿微量白蛋白/尿肌酐比值、尿总蛋白/尿肌酐比值、血尿酸比较,差异无统计学意义(P>0.05);治疗12周后,两组患者血肌酐、血β₂-微量蛋白、尿微量白蛋白/尿肌酐比值、尿总蛋白/尿肌酐比值、血尿酸分别低于本组治疗前(P<0.05)。两组患者治疗期间均未出现明显不良反应。结论阿利沙坦酯与贝尼地平对轻中度高血压患者的降压效果及肾功能的改善效果相似,但对于轻中度高血压合并高尿酸血症患者推荐使用阿利沙坦酯。     

吲达帕胺治疗老年单纯收缩期高血压疗效观察

目的探讨吲达帕胺对老年单纯收缩期高血压（ISH）的疗效观察。方法以108例老年ISH患者随机分为吲达帕胺治疗组（n=54，吲达帕胺1．25mg／d）和氨氯地平治疗组（n=54，氨氯地平5mg／d）。每周测量坐位血压2次。治疗前和治疗后3个月后分别检测空腹血糖、血脂、血尿酸、血钾、血钠。结果两组治疗前后降压疗效差异均有统计学意义（P〈0．01），但组间相比差异无统计学意义（P〉0．05）。两组治疗前后空腹血糖、血脂、血尿酸、血钾、血钠亦无统计学差异。结论吲达帕胺治疗老年ISH安全、有效。     

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.