老年慢性心力衰竭患者血清可溶性尿激酶型纤溶酶原激活物受体水平变化及临床意义

目的:探讨可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平对老年慢性心力衰竭(CHF)患者的早期诊断及预后评估的价值。方法:筛选2016-01-2017-08本院收治的105例CHF患者(CHF组),心功能Ⅱ级28例,心功能Ⅲ级55例,心功能Ⅳ级22例。另设同期健康体检且结果为正常者50例为对照组。使用双抗体夹心酶联免疫吸附(Elisa)法检测2组研究对象血清suPAR水平。应用超声心动图测定心功能,并计算平均室壁应力(MWS)和左心室心肌质量指数(LVMI)。比较2组研究对象及不同心功能分级患者的血清suPAR水平及心功能LVMI、MWS水平。CHF老年患者血清suPAR水平经Pearson分析与LVMI、MWS呈明显相关性。出院后第12个月心脏彩超复查患者心功能,统计发生心脏事件的病例数,比较并发心脏事件与无心脏事件发生的患者入院时血清suPAR水平。多因素logistic回归分析血清suPAR水平与CHF患者心脏事件的相关性。结果:与对照组比较,CHF组患者血清suPAR水平及MWS、LVMI增高,且随心功能分级增大而显著增加,差异有统计学意义(P0.01)。CHF老年患者血清suPAR水平经Pearson分析与MWS和LVMI呈正相关(r=0.609和0.644,P=0.000和0.000)。出院后第12个月发现,随访并发心脏事件的CHF老年患者入院时血清suPAR水平显著高于无心脏事件患者。CHF老年患者血清suPAR水平经多因素Logistic回归分析确定为发生12个月心脏事件的危险因素之一。结论:血清suPAR水平可能是CHF老年患者早期诊断及其预后判断的有效指标之一。     

血清suPAR水平与慢性心力衰竭患者预后的关系研究

目的探讨血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)与慢性心力衰竭(CHF)患者预后的关系。方法选取2016年1月至2017年12月期间于解放军联勤保障部队第九0九医院心血管内科收治的120例CHF患者作为CHF组(n=120),另选取同期来院进行体检的120例健康体检者作为对照组(n=120)。分析对照组及CHF组血清suPAR的表达情况,探讨其与炎症因子如肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和心功能指标如左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的相关性,并随访两组研究对象12个月,分析血清suPAR对CHF患者预后的评估价值。结果CHF组的血清suPAR、TNF-α、IL-6、N末端脑钠肽前体(NT-proBNP)水平以及LVEDD均明显高于对照组(P<0.05),LVEF明显低于对照组(P<0.05)。CHF患者中,NYHA分级Ⅳ级、Ⅲ级、Ⅱ级患者的血清suPAR、TNF-α、IL-6、NT-proBNP水平以及LVEDD逐渐降低,LVEF逐渐升高,两两比较差异均有统计学意义(P<0.05)。CHF患者中,血清suPAR水平与TNF-ɑ、IL-6、LVEDD、NT-proBNP均呈正相关,与LVEF呈负相关(P<0.05)。随访12个月,共28例患者发生心脏事件。预后不良组患者的血清suPAR、TNF-α、IL-6、NT-proBNP水平以及LVEDD均明显高于预后良好组,LVEF明显低于预后良好组(P<0.05)。多因素Logistic回归分析显示:suPAR水平过高及LVEF过低均是CHF患者发生心脏事件的独立危险因素(P<0.05)。受试者操作特征曲线(ROC)分析显示:血清suPAR对CHF患者预后有较高的评估价值,曲线下面积为0.798,敏感度和特异性为75.00%和77.21%。结论血清suPAR在CHF患者中表达明显上升,且是CHF患者发生心脏事件的独立危险因素,对患者的预后评估具有较高的应用价值。     

肿瘤患者胸水可溶性尿激酶受体检测及其临床意义

目的　了解良、恶性胸水中可溶性尿激酶受体 (suPAR)的水平及其与肿瘤患者病情和预后的关系。方法　放射免疫分析法检测 2 6例恶性胸水及 10例炎性胸水患者suPAR水平 ,并与 2 1名正常人 (对照组 )对照。结果　恶性胸水、炎性胸水与正常血浆suPAR水平分别为 (4 .3 6±2 .12 ) μg/L、(2 .64± 1.0 5 ) μg/L和 (1.73± 0 .96) μg/L ,炎性胸水suPAR水平高于对照组 (P <0 .0 5 ) ,而恶性胸水suPAR水平又高于炎性胸水 (P <0 .0 5 )。恶性胸水suPAR水平还显示出与患者预后相关。结论　检测suPAR水平有助于鉴别胸水的良、恶性及判断恶性肿瘤患者的预后     

老年慢性心力衰竭病人血清suPAR、MSTN水平与心功能和预后的关系

目的探讨老年慢性心力衰竭(CHF)病人血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、肌肉生长抑制素(MSTN)水平及其与心功能和预后的关系。方法选取2017年1月至2019年6月我科收治的CHF病人120例为观察组,同期选取我院体检健康志愿者100例为对照组。采用酶联免疫吸附法检测2组血清suPAR、MSTN水平。出院后随访1年,根据CHF病人是否发生心血管不良事件分为预后不良组(n=32)及预后良好组(n=88)。绘制ROC曲线,分析血清suPAR、MSTN对CHF病人不良预后的预测价值。结果观察组血清suPAR、MSTN水平较对照组明显升高,差异有统计学意义(P<0.05)。不同心功能分级病人血清suPAR、MSTN、氨基末端脑钠肽原(NT-proBNP)、LVEF水平比较,差异有统计学意义(P<0.05)。Pearson相关性分析示血清suPAR、MSTN与NT-proBNP呈正相关,与LVEF呈负相关(均P<0.05)。预后不良组血清suPAR、MSTN、NT-proBNP、LVEF水平与预后良好组相比,差异有统计学意义(P<0.05)。ROC曲线示,血清suPAR、MSTN及两项联合检测预测病人不良预后的灵敏度分别为0.785、0.754、0.908,特异度分别为0.743、0.716、0.779,AUC分别为0.867、0.815、0.912。结论老年CHF病人血清suPAR、MSTN水平明显升高,其与病人的心功能分级及临床预后密切相关,联合检测血清suPAR、MSTN对老年CHF病人的预后判断有较高临床价值,可作为病情的监测指标。     

血清泛素耦联酶2C、缺氧诱导因子1α水平与脑胶质瘤患者临床病理参数及预后的关系

目的探讨血清泛素耦联酶(UBE)2C、缺氧诱导因子(HIF)-1α水平与脑胶质瘤患者临床病理参数及预后的关系。方法酶联免疫吸附试验测定86例脑胶质瘤患者(观察组)及80例同期健康体检者(对照组)血清UBE2C、HIF-1α水平,并分析两指标与脑胶质瘤临床病理参数的关系。随访1年,比较死亡患者与存活患者的血清UBE2C、HIF-1α水平。结果观察组血清UBE2C、HIF-1α水平显著高于对照组,差异有统计学意义(P0.05)。临床TNM分期为Ⅰ～Ⅱ期、Karonfsky功能状态(KPS)评分≥70分患者的血清UBE2C、HIF-1α水平均显著低于临床TNM分期为Ⅲ～Ⅳ期、KPS评分70分患者(P0.05)。存活患者血清UBE2C、HIF-1α水平显著低于死亡患者(P0.05)。结论血清UBE2C、HIF-1α水平与脑胶质瘤患者的恶性程度和预后密切相关,两者可能成为临床上评估脑胶质瘤恶性程度和预后的有效指标。     

血浆hs—CRP、vWF及其裂解酶含量与急性冠脉综合征

目的：检测不稳定型心绞痛（UAP）、急性心肌梗死（AMI）等急性冠脉综合征（ACS）患者血浆中高敏C反应蛋白（h—CRP）和血管性血友病因子（vWF）及其裂解酶（vWF-cp）水平，探讨它们在ACS发病机制中的作用和相互联系。方法：研究对象分UAP组和AMI组（入院即刻采血），稳定型心绞痛（SAP）组和正常对照组（于入院次日空腹采血），各组均17例；应用酶联免疫吸附试验（ELISA）测定血浆vWF浓度和hs-CRP含量，以残余胶原结合力试验测定血浆vWF-cp活性水平。所有入选对象均行冠状动脉造影证实。结果：①UAP组和AMI组血浆hs-CRP与vWF水平均高于SAP组和正常对照组（P〈0．01）；②UAP组和AMI组血浆vWF—cp活性水平均低于SAP组和正常对照组（P〈0．01）；③ACS患者血浆hs—CRP与vWF水平间呈显著正相关（r=0．67，P〈0．01），而血浆vWF-cp与vWF、hs—CRP无明显相关关系。结论：①血浆hs—CRP、vWF水平升高可能是预测ACS斑块破裂和血栓形成的指标；②血浆vWF—cp活性降低在ACS血栓形成中可能起重要作用。     

老年慢性心力衰竭患者血清suPAR、PAI-1表达与预后的相关性研究

目的 通过检测老年慢性心力衰竭（心衰）患者血清中可溶性尿激酶型纤溶酶原激活物受体（suPAR）、纤溶酶原激活物抑制因子（PAI-1）表达,解析其与老年慢性心衰病情及预后的关系。方法 选取2018年1月至2020年1月于辽宁中医药大学附属医院确诊的老年慢性心衰患者120例为心衰组,同时根据NYHA分级分为Ⅱ、Ⅲ、Ⅳ级三个亚组,另选取同期健康体检者70例为对照组。采用酶联免疫吸附实验（ELISA）测定并比较各组老年慢性心衰患者及对照组血清suPAR、PAI-1、N末端脑钠肽前体（NT-proBNP）表达水平。根据患者1年内主要不良心血管事件（MACE）发生情况分为预后良好组和预后不良组,比较两组间血清suPAR和PAI-1水平。受试者工作特征曲线（ROC）测定血清suPAR、PAI-1对患者不良预后的诊断价值,多因素Logistic回归分析影响老年慢性心衰患者MACE发生的危险因素。结果与对照组相比,心衰组患者NT-proBNP、左室射血分数（LVEF）、左心室舒张末内径（LVEDD）、血清suPAR、PAI-1水平显著升高（P<0.05）;随着NYHA分级的升高,老年慢性心衰患者血...     

老年肺炎支原体肺炎患者IL-10、TNF-α、TGF-β1的变化及其临床意义分析

目的探讨老年肺炎支原体肺炎患者血清白介素10(IL-10)、肿瘤坏死因子(TNF-α)、转化生长因子(TGF-β1)的变化及其临床意义。方法收集2010年10月至2013年10月入住我院的55例老年肺炎支原体肺炎患者(MPP)的临床资料,另外选择同期于我院进行体检的健康者25名患者的体检资料作为对照组。两组患者均采用了酶联免疫吸附法(ELISA法)对其血清IL-10、TNF-α及TGF-β1水平进行了分析,比较急性期及恢复期与对照组上述指标水平、重症组与轻症组急性期及恢复期上述指标水平。结果 1肺炎支原体肺炎患者急性期及恢复期血清上述指标水平均显著高于对照组(P0.05),且急性期患者血清TNF-α及TGF-β1水平均显著高于恢复期(P0.05),但急性期与恢复期血清IL-10水平差异无统计学意义(P0.05);2重症组急性期患者血清IL-10、TNF-α及TGF-β1水平均显著高于轻症组(P0.05);3重症组恢复期患者血清IL-10、TNF-α及TGF-β1水平均显著高于轻症组(P0.05)。结论老年肺炎支原体感染患者血清IL-10、TNF-α、TGF-β1水平高低反映了患者疾病严重程度及病情缓解情况,具有十分重要的临床意义与价值。     

系统性硬化症患者血清8-异前列腺素F2α水平与临床特征的相关性研究

目的 通过8-异前列腺素F2α(8-iso-PGF2α)血清浓度的测量来调查系统性硬化症(SSc)的氧化状态,并探讨8-iso-PGF2α与临床特征的相关性.方法 通过酶联免疫吸附法检测51例SSc患者及22名年龄与性别匹配的健康对照血清8-iso-PGF2α浓度,并对其中35例SSc患者进行临床评定及实验室检查,以了解各临床特征与8-iso-PGF2α的相关性.另外用循环酶法测定血清同型半胱氨酸(Hcy)浓度,免疫比浊法测定血浆血管性假血友病因子(vWF)活性及血清免疫球蛋白(Ig)浓度,间接免疫荧光法检测血清抗核抗体、抗内皮细胞抗体,免疫印迹法测血清抗Scl-70抗体等,以了解8-is0-PGF2α与上述指标的相关性.结果 SSc患者血清8-iso-PGF2α水平较健康对照升高,其与一氧化碳弥散功能负相关.与高分辨肺CT肺间质纤维化的发生及肾小球叶间动脉阻力指数正相关,而与皮肤、外周血管、心脏、食管受累,疾病活动性、分型及vWF、Hcy、Ig、自身抗体等无相关性.结论 升高的氧化应激标志物8-iso-PGF2α与SSc肺间质纤维化及肾血管损害程度相关,进一步说明氧化应激在SSc发病机制中起着重要作用.     

HBV相关慢加急性肝衰竭患者血清GP73、suPAR和AT-Ⅲ水平变化及其临床意义探讨

目的 探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清高尔基体蛋白73(GP73)、可溶性人尿激酶型纤溶酶原激活物受体(suPAR)和抗凝血酶-Ⅲ(AT-Ⅲ)水平变化及其临床意义。方法 2019年11月～2022年10月我院收治的HBV-ACLF患者81例(早期29例,中期28例,晚期24例)和慢性乙型肝炎(CHB)患者65例,采用ELISA法检测血清GP73、suPAR和AT-Ⅲ水平。应用受试者工作特征曲线(ROC)评估各指标评估疾病预后的价值。结果 HBV-ACLF患者血清GP73和suPAR水平分别为(227.4±48.4)ng/mL和(8.3±2.3)ng/mL,显著高于CHB患者【分别为(126.6±31.6)ng/mL和(5.1±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(48.2±12.9)%,显著低于CHB患者【(76.6±18.7)%,P<0.05】;晚期HBV-ACLF患者血清GP73和suPAR水平分别为(265.6±27.1)ng/mL和(9.4±1.2)ng/mL,显著高于中期患者【分别为(231.7±29.5)ng/...     

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.