伴有颈动脉斑块的高血压患者尿酸检测的意义

目的探讨高血压患者颈动脉斑块与尿酸及肾功能改变的关系.方法回顾分析151例[男81例,女70例;平均年龄(72.28±9.45)岁]2003年住院高血压患者资料,根据颈动脉多普勒检查有无颈动脉斑块划分为颈动脉斑块组及正常组,分析两组同期住院24 h动态血压、心脏超声、血脂及尿酸、肌酐、尿素氮、血糖等结果.结果两组尿酸值分别为(374.6±122.8;317.5±93.0)μmol/L.颈动脉斑块组明显高于颈动脉正常组(P=0.002).斑块组尿素氮、肌酐明显高于正常组(P=0.005,P=0.017).24h动态血压平均舒张压及白昼舒张压亦有明显差别.直线相关分析显示,颈动脉斑块与尿酸水平呈正相关(r=0.225,P=0.005).Logistic逐步回归分析,结果显示自变量尿酸、年龄对颈动脉斑块有影响.结论高血压患者尿酸与颈动脉斑块呈正相关,尿酸水平及年龄影响颈动脉斑块形成.     

老年高血压患者脉压与颈动脉粥样斑块的关系

目的研究老年高血压患者血压水平与颈动脉粥样斑块形成的关系.方法选取84例老年原发性高血压患者,根据彩色多普勒超声检查颈动脉粥样斑块情况分为两组,斑块组54例,无斑块组30例,检测血脂和尿酸变化,监测24 h动态血压,比较两组间性别构成、年龄、血脂和尿酸水平、24 h平均收缩压、舒张压及脉压差水平有无统计学差异.结果两组之间年龄分布存在明显的统计学差异(P<0.001); 斑块组PP明显高于无斑块组(P=0.003);年龄与脉压之间呈正相关(r=0.301,P=0.005).结论脉压增大可能是导致颈动脉粥样斑块形成的危险因子,降低脉压对老年高血压患者靶器官的保护可能起重要的作用.     

原发性高血压患者动态血压和颈动脉斑块与认知功能相关性研究

目的探讨原发性高血压患者动态血压、颈动脉斑块对认知功能的影响。方法将594例高血压患者按24h血压节律及颈动脉斑块的有无分为4组,(1)杓型血压+无颈动脉斑块组(149例);(2)杓型血压+颈动脉斑块组(144例);(3)非杓型血压+无颈动脉斑块组(154例);(4)非杓型血压+颈动脉斑块组(147例)。所有患者进行24h动态血压检测。彩色电脑声像仪逐节段观察颈动脉管壁内膜情况及有无斑块形成。使用简易智能状态检查量表(MMSE)对所有患者进行认知功能调查。结果非杓型血压+颈动脉斑块组、杓型血压+颈动脉斑块组、非杓型血压+无颈动脉斑块组、杓型血压+无颈动脉斑块组MMSE分别为(26.2±1.2)分、(28.3±1.5)分、(28.2±1.5)分(、28.8±0.6)分,非杓型血压+颈动脉斑块组MMSE与其他3组比较,差异有统计学意义(P<0.05,P<0.01)。logMMSE与24 h平均收缩压、昼间平均收缩压、昼间平均脉压、夜间平均收缩压、夜间平均舒张压、夜间平均脉压及颈动脉斑块呈负相关,与收缩压夜间下降率及舒张压夜间下降率呈正相关。结论动态血压节律变化及颈动脉斑块的形成与原发性高血压患者的认知功能损害相关。     

老年高血压患者血尿酸水平与颈动脉内-中膜厚度及左室重构的相关性

目的探讨老年高血压患者血尿酸水平与颈动脉内-中膜厚度及左室重构的相关性。方法检测患者血尿酸、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、甘油三酯(TG)、胆固醇(TC)水平,测定颈动脉内-中膜厚度及左室质量指数,按颈动脉内-中膜厚度分正常组、增厚组、斑块组,按左室质量指数分正常组与增高组,比较各组尿酸水平及其他指标。结果颈动脉内-中膜厚度正常组、增厚组、斑块组患者TG、TC、HDL、LDL比较,组间差异无显著性(P>0.05);颈动脉内-中膜增厚组平均尿酸水平明显高于正常组(t=4.03,P<0.05);斑块组平均尿酸水平明显高于颈动脉内-中膜增厚组(t=2.98,P<0.05)。左室质量指数正常组与增高组TG、TC、HDL、LDL无明显差异(P>0.05);左室质量指数正常组血尿酸水平明显高于正常组(t=5.78,P<0.05)。结论老年高血压患者血尿酸水平与颈动脉内-中膜厚度及左室重构密切相关。     

原发性高血压患者血尿酸水平及其临床意义

目的:观察原发性高血压(EH)患者血尿酸浓度的变化及其与高血压分期的关系。方法:分别测定57例EH(EH组)患者与58例正常血压健康者(对照组)的血尿酸浓度,以血尿酸、高血压病程、TOD程度、性别进行多变量分析。结果:①EH组平均血尿酸水平较对照组明显增高[(324.7±100.61)∶(264.52±98.62)μmol/L,t=3.239,P<0.01];②EH组血尿酸增高者多于对照组(12/57,21.1%∶3/58,5.2%,χ2=6.671,P<0.01);③在EH组中伴TOD的Ⅱ、Ⅲ期EH患者血尿酸水平高于不伴TOD者[(334.19±86.15)、(384.64±94.03)∶(276.53±77.54)μmol/L];④相关分析显示血尿酸水平与高血压分期正相关(r=0.565),而与性别、年龄、血压水平及高血压病程无明显相关性。结论:血尿酸浓度增高多见于EH患者且与高血压分期相关。     

新疆哈萨克族原发性高血压患者血清尿酸水平的影响因素分析

目的：探讨新疆哈萨克族原发性高血压（EH）患者血清尿酸（UA）水平的影响因素。方法：纳入我院2009年1月至2012年12月所有首次诊断为EH并未行降压治疗的新疆哈萨克族住院患者696例,按入院血压水平分为轻度高血压组（336例）和中重度高血压组（360例）,检测所有患者的l临床相关指标,分析新疆哈萨克族EH患者血清uA水平影响因素。结果：（1）与轻度高血压组比较,中重度高血压组血清UA[（269．08±86．49）mmol／L比（311．53±97．66）mmol／L]、甘油三酯[（1．36±0．66）mmol／L比（1．72±1．05）mmol／L]水平明显升高（P〈0．05）;（2）Pearson相关性分析显示血清UA水平与BMI、收缩压、舒张压、血清尿素氮、血清肌酐、甘油三酯水平正相关（r=0．17～0．29,P均〈0．05）;（3）多元线性回归分析校正BMI,收缩压,血清尿素氮,血清肌酐,空腹血糖,总胆固醇等因素后,舒张压（B=1．66,P〈0．05）、甘油三酯水平（B=19．34,P〈0．05）均进入方程。结论：新疆哈萨克族原发性高血压患者的血压水平是血清尿酸水平的一个独立影响因素。     

原发性高血压及相关危险因素与颈动脉内-中膜厚度的相关性研究

目的探讨原发性高血压(高血压)及相关危险因素与颈动脉内-中膜厚度(intima-media thickness,IMT)的相关性。方法本文收集了2007年6月至2007年12月在贵阳医学院诊治且病历资料较完整的186例高血压患者,按血压水平由低至高分成3组:高血压1级组50例;高血压2级组56例;高血压3级组80例。另外,选择门诊健康体检者50名作为对照组。收集研究对象的一般情况、血生化指标及双侧颈总动脉IMT及斑块的超声测量结果。结果高血压各组的颈动脉IMT,颈动脉斑块发生率明显高于对照组,并随血压等级增加而增加,方差分析及q检验显示差异有统计学意义(P0.05)。Logistic回归分析显示,年龄、男性、吸烟、总胆固醇及低密度脂蛋白胆固醇是颈动脉IMT增加的独立危险因素(P0.05),而脂蛋白(a)、尿酸、肌酐与颈动脉IMT无明显相关性(P0.05)。结论高血压可使颈动脉IMT增加,其程度和颈动脉斑块发生率均随血压分级增高而增加;年龄、男性、吸烟、总胆固醇及低密度脂蛋白胆固醇是颈动脉IMT增加的独立危险因素;脂蛋白(a)、肌酐、尿酸与颈动脉IMT无明显相关性。     

急性冠状动脉综合征患者血尿酸水平升高的意义

经冠状动脉造影证实急性冠状动脉综合征(ACS)患者398例和相匹配的378名健康者进入本研究。两组血尿酸均呈正态分布,ACS组血尿酸(322±107)μmol/L明显高于正常对照组(302±77) VanoL/L(P＜0．01)。ACS组中男性高尿酸血症(HUA)患病率为27．0%、女性为25．2%。ACS组空腹血糖、甘油三酯、尿素氮、肌酐、血压均明显高于对照组(均P＜0．01)。调整性别和年龄后多元逐步回归分析显示血胆固醇、尿酸、空腹血糖、平均动脉压为ACS冠状动脉狭窄的危险因素(P＜0．05或P＜0．01),HUA在ACS发病中起一定的作用。     

老年高血压患者脉压与颈动脉粥样斑块的关系

目的 研究老年高血压患者血压水平与颈动脉粥样斑块形成的关系。方法选取84例老年原发性高血压患者，根据彩色多普勒超声检查颈动脉粥样斑块情况分为两组，斑块组54例，无斑块组30例，检测血脂和尿酸变化，监测24h动态血压，比较两组间性别构成、年龄、血脂和尿酸水平、24h平均收缩压、舒张压及脉压差水平有无统计学差异。结果两组之间年龄分布存在明显的统计学差异（P〈0．001）；斑块组PP明显高于无斑块组（P=0．003）；年龄与脉压之间呈正相关（r=0．301，P=0．005）。结论脉压增大可能是导致颈动脉粥样斑块形成的危险因子，降低脉压对老年高血压患者靶器官的保护可能起重要的作用。     

无症状高尿酸血症与颈动脉斑块数量的相关性研究

目的探讨无症状高尿酸血症患者血尿酸水平与颈动脉斑块数量的关系。方法选择2009年1月至2013年12月间在广东省惠州市惠阳三和医院进行健康查体人员72例,依据入选对象血尿酸水平分为高尿酸组(n=39)与正常尿酸组(n=33),随访5年血尿酸水平变化,并检测颈动脉斑块数量,对血尿酸水平与颈动脉斑块数量进行相关性分析。结果纳入患者5年随访期间,高尿酸组与正常尿酸组中男性人群血尿酸水平均高于女性人群,差异均有统计学意义(P0.05)。高尿酸组男性及女性血尿酸水平均高于正常尿酸组男性及女性尿酸水平,差异均有统计学意义(P0.05)。两组人群5年随访期间男性及女性血尿酸水平变化不明显,年度之间血尿酸水平无统计学差异(P0.05)。高尿酸组男性和女性颈动脉斑块数量平均为(1.9±0.5)个、(1.2±0.3)个,正常尿酸组男性和女性颈动脉斑块数量平均为(0.8±0.3)个、(0.4±0.2)个;高尿酸组男性和女性颈动脉斑块数量显著高于正常尿酸组,差异有统计学意义(P0.05)。颈动脉斑块数量与血尿酸水平呈正相关,男性r=0.768,女性r=0.721,均有统计学意义(P0.05)。结论血尿酸水平升高与颈动脉斑块增加明显正相关。     

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.     

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.     

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.     

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.