甘油三酯/高密度脂蛋白胆固醇比值对冠心病的诊断价值的探讨

目的　探讨甘油三酯 /高密度脂蛋白胆固醇 (TG/HDL C)比值对冠心病 (CHD)的诊断价值。方法　分析 173例选择性冠状动脉造影 (冠脉造影 )确诊的CHD患者 (CHD组 )及 118例冠脉造影阴性者 (对照组 )的TG/HDL C比值水平与CHD之间的关系。结果　CHD组患者的TG/HDL C比值水平及异常率均明显高于对照组 (2 0 2± 1 19vs 1 4 0± 0 97,P <0 0 1,2 8 9%比 11 8% ,P <0 0 1)。经多元逐步回归分析显示 :与TG、HDL C相比 ,该比值与CHD之间显示了更有意义的回归关系 (β值 0 2 5 ,P值 =0 0 0 0 1,复相关系数为 0 4 5 )。结论　TG/HDL C比值对于CHD诊断是一有临床使用价值的指标。     

冠心病患者脂蛋白(a)及三酰甘油/高密度脂蛋白胆固醇比值变化的研究

目的　探讨冠心病 (CHD)病情程度与脂蛋白 (a) [L p(a) ]及三酰甘油 /高密度脂蛋白胆固醇 (TG/ HDL- C)比值的关系。方法　测定 138例 CHD患者血清 L p(a)及 TG/ HDL- C比值 ,并与对照组健康人 82例相比较 ,分析 L p(a)及 TG/ HDL - C比值的临床意义。结果　 L p(a)浓度及 TG/ HDL - C比值在稳定型心绞痛组及不稳定型心绞痛组明显高于对照组 (分别 P<0 .0 5 ,P<0 .0 1) ,CHD组中两指标在慢性充血性心力衰竭 I°组、 °组、 °组呈上升的趋势 ,同时 L p(a)与 TG呈正相关 (r=0 .30 8,P<0 .0 1)。结论　 L p(a)及 TG/ HDL - C比值联合监测有助于 CHD的早期发现 ,了解病情程度     

冠心病C反应蛋白及甘油三酯/高密度脂蛋白胆固醇比值变化的研究

目的 :探讨冠心病 （CHD）病情程度与 C反应蛋白 （CRP）及甘油三酯 /高密度脂蛋白胆固醇 （TG/ HDL- C）比值的关系。方法 :测定 12 8例 CHD患者的血浆 CRP浓度、TG浓度、HDL- C浓度及 TG/ HDL- C比值 ,并与对照组（健康者 12 0例 ）相比较 ,分析 CRP及 TG/ HDL - C比值的临床意义。结果 :CRP浓度及 TG/ HDL - C比值在对照组、稳定型心绞痛组、不稳定型心绞痛组分别为 :2 2 93± 10 8μg/ L ,1.87± 0 .41;5 2 16± 32 8μg/ L ,3.2 6± 0 .81;13811±86 1μg/ L,3.6 6± 1.0 2 ;稳定型心绞痛组及不稳定型心绞痛组明显高于对照组 （分别为 P<0 .0 5、P<0 .0 1）。CHD组中 ,两指标在慢性充血性心力衰竭 I°组、 °组、 °组中分别为 :5 981± 391μg/ L,2 .0 2± 0 .39;11912± 90 8μg/ L,3.6 1± 0 .99;132 13± 989μg/ L ,4.82± 1.0 9;心力衰竭 °组、 °组明显高于心力衰竭 I°组 （P<0 .0 1）。同时 ,CRP浓度与 TG浓度呈正相关 （r=0 .5 4,P<0 .0 5 ） ;CRP浓度与 HDL - C浓度呈负相关 （r=- 0 .15 ,P<0 .0 1）。结论 :CRP及TG/ HDL- C比值在临床评价 CHD病情程度及预后方面具有一定的指导意义。 CRP与血脂之间存在着相关性。     

胆红素与血脂的综合指数对冠心病诊断价值的探讨

目的 :探讨胆红素与血脂的综合指数对冠心病 (CHD)的诊断价值。方法 :将 15 4例行冠状动脉 (冠脉 )造影术者 ,按照冠脉造影结果分为 3组 :CHD高度狭窄组、中度狭窄组 ,冠脉正常组 ,分析组间血脂、胆红素及综合指数的差异及其对CHD的预测符合率。结果 :CHD组患者血清总胆红素 (TBil)明显低于冠脉正常组 (P <0 .0 1) ,血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C) ,LDL C [高密度脂蛋白胆固醇 (HDL C) +TBil]比值、TC (HDL C +TBil)比值水平明显高于冠脉正常组 (P <0 .0 5或P <0 .0 1)。进行判别分析 ,将LDL C (HDL C +TBil)与传统危险因素 (HDL C、LDL C、TC、年龄、收缩压、血糖 )同时引入模型 ,年龄与LDL C (HDL C +TBil)进入模型 ,显示出较其他各项指标与CHD更强的相关性 ,且对CHD的预测符合率为 5 8.6 % ,高于传统危险因素对CHD预测符合率 (P <0 .0 5 )。结论 :胆红素与血脂的综合指数是有临床使用价值的预测指标     

绝经后女性冠状动脉病变与血脂代谢的关系

目的 :研究绝经后女性冠心病 ( CHD)患者血脂特点 ,探讨血脂代谢与冠状动脉病变的关系。方法 :以酶法测定和观察 94例经冠状动脉造影证实有一支以上主要冠状动脉狭窄≥ 5 0 %的绝经后女性 CHD患者的总胆固醇 ( TG)、甘油三酯 ( TC)、高密度脂蛋白胆固醇 ( HDL- C)、低密度蛋白胆固醇 ( L DL- C)、载脂蛋白 A1 、B( apo A1 、apo B) ,并以同期同年龄范围的健康体检女性 10 0例为对照组。结果 :1CHD组的 TG和 L DL- C明显高于对照组 ,HDL- C和 apo A1 明显低于对照组 ,而 TC仅轻度高于对照组 ;2多元逐步回归分析的有价值的判别指标为 apo A1 和 L DL- C;3 CHD组高 TG者 5 4例 ( 5 3 .2 % ) ,高 TG者冠状动脉双支及三支病变 2 9例 ( 5 8% ) ,而TG正常者双支及三支病变 13例 ( 2 9.5 % )。结论 :女性绝经后 CHD患者高 TG,高 L DL - C,低 HDL - C和低 apo A1是 CHD的重要危险因素 ,apo A1 和 L DL - C在致 CHD方面意义更大 ,其中高 TG者冠状动脉病变的严重程度更为明显     

老年高血压患者的脂质状态分析

为观察老年高血病患者血脂水平变化特点,我们将合并CHD的老年高血压患者30例和有CHD、无高血压病的30例老年患者,配对分析总胆固醇(TC)、甘油三脂脂(TG)、低密度脂蛋白(LDL—C)、高密度脂蛋白(HDL—C)、载脂蛋白A及B(ApoA、ApoB)、及脂蛋白[a](Lp[a])的水平.结果显示对见察组比对照组,(总胆固醇)TC(222.5±40.0比181.2±40.0mg/dl)、(甘油三脂)TG(215.4±98.9比166.7±99.7mg/dl)、(低密度脂蛋白)LDL—C(152.8±31.6比112.6±34.6mg/dl)以及(载脂蛋白 B)ApoB(±1.060±0.266比0.833±0.263g/l)均明显为高(P<0.05—0.01).并且观察组的异常检出率在上述相应指标也多于对照组.结论:老年冠心病合并高血压患者容易出现脂质代谢紊乱.     

低密度脂蛋白胆固醇/高密度脂蛋白胆固醇及甘油三酯/高密度脂蛋白胆固醇比值与冠心病关系的探讨

目的 :探讨低密度脂蛋白胆固醇 (LDL C) /高密度脂蛋白胆固醇 (HDL C)及甘油三酯 /HDL C比值与冠心病的关系。　　方法 :检测 3 42例经冠状动脉造影确诊的冠心病患者 (冠心病组 )和 2 0 2例冠状动脉造影正常者 (对照组 )的血脂中总胆固醇、甘油三酯、LDL C及HDL C含量 ,计算LDL C /HDL C及甘油三酯 /HDL C的比值。　　结果 :与对照组相比 ,冠心病患者的总胆固醇、LDL C及LDL C/HDL C比值明显增高 ,HDL C显著降低 ,有显著性差异 (P <0 0 5～ 0 0 0 1) ,而甘油三酯及甘油三酯 /HDL C比值两组间无显著差别。多元回归分析显示 ,冠心病的危险性与LDL C/HDL C比值呈正比 ,与甘油三酯及甘油三酯 /HDL C比值无显著相关。　　结论 :LDL C/HDL C比值对冠心病有一定的预测价值 ,而甘油三酯 /HDL C比值的预测价值尚待研究。     

急性心肌梗死甘油三酯/高密度脂蛋白胆固醇比值变化及意义

目的　探讨急性心肌梗死血脂的变化。　方法　以临床确诊急性心肌梗死 38例作为观察组 ,32例健康体检者为对照组。以酶法测定其空腹血清TG ,TC ,HDL C ,并计算TG HDL C的比值。　结果　急性心肌梗死TG ,TG HDL C比值高于对照组 ( P <0 0 1) ,HDL C低于对照组 ( P<0 0 1) ,TC ,LDL C则无统计学意义 ( P >0 0 5 )。　结论　TG HDL C比值增高对急性心肌梗死的诊断价值较TC及LDL C增高更有意义     

甘油三酯/高密度脂蛋白胆固醇比值与冠状动脉病变程度关系探讨

目的分析甘油三酯(三酰甘油)/高密度脂蛋白胆固醇(TG/HDL-C)比值与冠状动脉病变的关系,探讨其在冠心病检测中的意义.方法分析148例选择性冠状动脉造影确诊的冠心病(CHD)患者(CHD组)及58例冠脉造影阴性者(对照组)的TG/HDL-C比值与CHD之间的关系.结果CHD组患者的TG/HDL-C比值水平明显高于对照组(2.08±0.963vs1.26±0.685,P＜0.001).随着病变支数的增加,血清TG/HDL-C比值水平也相应的增加.经多元Logistic回归分析显示TG/HDL-C比值水平与冠状动脉严重程度有密切关系(OR=2.1;95%的可信区间为1.4～3.2).结论TG/HDL-C比值水平越高,冠状动脉病变越严重.TG/HDL-C比值对CHD诊断有一定临床使用价值.     

阻塞性睡眠呼吸暂停综合征老年患者血管内皮功能变化及其与冠心病的关系

目的　探讨老年阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化与冠心病 (CHD)的内在联系。方法　随机选择 31例无OSAS、无心血管疾病的老年单纯鼾症者为对照组 ,4 5例老年中、重度OSAS患者为OSAS组 ,OSAS组内又分为有CHD(16例 )和无CHD(2 9例 )两个亚组。测定和比较组间的血浆一氧化氮 (NO)、内皮素 (ET)及其比值的动态变化及OSAS组内CHD有无的区别。结果　与对照组相比 ,OSAS组患者的NO水平明显降低〔(2 7.6 9± 9.17)vs(6 1.90± 13.4 7) μmol/L〕 ,ET水平明显增高〔(5 8.0 8± 14 .2 1)vs (34.77± 8.2 3)ng/L〕 ,NO/ET比值明显下降〔(0 .4 7± 0 .18)vs (1.72± 0 .97) ,均P <0 .0 1)〕。CHD的发生率在OSAS组达 35 .6 %。与对照组相比 ,OSAS组中不伴CHD者降低的NO水平 (35 .5 3± 9.39) μmol/L、升高的ET水平 (47.78± 11.13)ng/L和下降的NO/ET比值 (0 .75± 0 .13)已有显著性差异 (P <0 .0 5 ) ;伴有CHD者的NO水平 (2 2 .17± 8.76 )μmol/L、ET水平 (6 9.14± 12 .17)ng/L和NO/ET比值 (0 .32± 0 .14 )较对照组相差更为明显 (P <0 .0 1)。结论　OSAS老年患者存在明显的血管内皮功能障碍 ,尤以CHD者为甚 ,血管内皮功能损伤可能是OSAS患者并发CHD的原因     

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.