肥胖为急性胰腺炎患者早期独立的预后指标

目的研究基于亚洲人群肥胖诊断标准探讨肥胖在评估急性胰腺炎(AP)预后中的作用.方法分别采用Ranson标准、APACHE-Ⅱ评分和Balthazar CT分级系统对临床资料完整的42例AP患者入院时的病情严重程度作回顾性分析,若同时符合Ranson标准为≥3分,APACHEⅡ≥8分和Balthazar CT分级达到D级或E级者拟诊为重症急性胰腺炎(SAP).肥胖的诊断依据为体重指数(BMI)≥25 kg/m2.同时详细记录患者入院时的年龄、性别、病因及并发症情况.结果42例患者中SAP11例,轻型急性胰腺炎(MAP)31例.SAP患者平均BMI为(27.31±6.28)kg/m2,显著高于MAP患者平均BMI(22.41±4.72)kg/m2,AP时肥胖患者与非肥胖患者发展成SAP与年龄无相关性.AP时男性肥胖患者较男性非肥胖患者更易发展成SAP,且男性肥胖患者较女性肥胖患者SAP发生的危险度高.胆源性AP时肥胖患者SAP发病的危险度最高,且胆源性AP时肥胖患者较非肥胖患者更易发展成SAP.AP时肥胖与并发症无显著差异.结论肥胖可能是AP时早期独立的预后因素,尤其与一些相关因素如性别、病因联合应用时可能更具有评估性.     

肥胖、高脂血症与急性胰腺炎相关性研究

目的探讨肥胖、高脂血症在急性胰腺炎发病中的影响与作用.方法选择重症急性胰腺炎(SAP)患者98例,轻症急性胰腺炎(MAP)患者107例,测定体重指数(BMI)、血脂水平以及急性胰腺炎相关的实验室检查指标.结果肥胖组(BMI≥28 kg/m2)共有64例,超重组(24≤BMI＜28 kg/m2)和体重正常组(BMI＜24kg/m2)分别有66例和75例.肥胖组SAP比例高于超重组和体重正常组;SAP患者BMI和血三酰甘油高于超重组和体重正常组;对于肥胖的急性胰腺炎患者,血脂升高伴随着更为严重的胰腺和肝肾功能损害,在超重组和体重正常组未观察到同样的效应.结论肥胖影响急性胰腺炎的严重程度,并且肥胖者发生急性胰腺炎后,血脂水平可作为急性胰腺炎严重程度的预测指标.     

加强重症急性胰腺炎临床若干问题的研究

依据亚特兰大标准 (1992 ) ,急性胰腺炎 (AP)可分为轻症急性胰腺炎 (MAP)和重症急性胰腺炎(SAP)。SAP占AP发病总数的 10 %～ 2 0 % ,其死亡率约 2 0 %。显然 ,要显著降低SAP患者死亡率 ,尚需经历一段相当艰辛的历程 ,以解决临床中不断出现的问题。1.临床评估标准需要完善 :现阶段仍沿用 2 0世纪 70年代的Ranson标准、Balthazar标准 ,及 2 0世纪 80年代的APACHE Ⅱ标准。这些标准对于AP的临床工作起了较大的指导作用 ,但实践中发现 ,Ranson标准不能动态评估 ,且其是基于酒精和胆道疾病等病因建立的 ,未必适合肥胖和高脂血症等其他…     

内毒素及其诱生细胞因子与急性胰腺炎患者临床预后的关系

目的动态观察血浆内毒素及其诱生细胞因子TNF-α、IL-1β水平在急性胰腺炎(AP)患者中的变化,探讨其在AP发生、发展中的作用及其与AP患者临床预后的关系.方法联合应用Ranson标准、APACHEⅡ评分和Balthazar CT分级系统将17例确诊为AP的患者分为轻型急性胰腺炎(MAP)13例和重症急性胰腺炎(SAP)4例,并于入院后第1、2、3、4、5天连续监测患者血浆内毒素水平和血清TNF-α、IL-1β水平.结果 SAP组患者内毒素水平于入院后第2天起较MAP组显著升高,血清TNF-α和IL-1β水平于入院后第1天和入院后第5天较MAP组显著升高(P ＜ 0.05).AP患者血浆内毒素水平于入院后第4天起与血清TNF-α水平呈直线正相关,AP患者血浆内毒素水平自第2天起与IL-1β水平呈直线正相关.结论内毒素及其诱生细胞因子水平的高低与AP病情严重程度一致.因此这些指标在判断MAP和SAP以及衡量AP预后方面具有重要的参考价值.     

肥胖、高脂血症与急性胰腺炎相关性研究

目的　探讨肥胖、高脂血症在急性胰腺炎发病中的影响与作用。　方法　选择重症急性胰腺炎 (SAP)患者 98例 ,轻症急性胰腺炎 (MAP)患者 10 7例 ,测定体重指数 (BMI)、血脂水平以及急性胰腺炎相关的实验室检查指标。　结果　肥胖组 (BMI≥ 2 8kg/ m2 )共有 6 4例 ,超重组 (2 4 ≤ BMI<2 8kg/m2 )和体重正常组 (BMI<2 4 kg/ m2 )分别有 6 6例和 75例。肥胖组 SAP比例高于超重组和体重正常组 ;SAP患者 BMI和血三酰甘油高于超重组和体重正常组 ;对于肥胖的急性胰腺炎患者 ,血脂升高伴随着更为严重的胰腺和肝肾功能损害 ,在超重组和体重正常组未观察到同样的效应。　结论　肥胖影响急性胰腺炎的严重程度 ,并且肥胖者发生急性胰腺炎后 ,血脂水平可作为急性胰腺炎严重程度的预测指标。     

肝功能异常对急性胰腺炎病因和病情分级判定的临床意义

目的观察急性胰腺炎(AP)伴发肝损伤患者肝功能各项指标与病因及病情的关系,旨在探讨肝功能变化对明确AP病因及预测病情程度的临床意义。方法回顾性分析聊城市人民医院2011年1月-2016年3月住院的163例AP患者的临床资料,按病因分为胆源性(n=85)、非胆源性(n=78)2组;参照CT影像Balthazar分级标准将其分为轻型胰腺炎(MAP)和重型胰腺炎(SAP),其中MAP患者138例,SAP患者25例。胆源性SAP 18例,胆源性MAP 67例;非胆源性SAP 7例,非胆源性MAP 71例。比较患者肝功能指标ALT、AST、GGT、ALP水平,并观察胆源性、非胆源性AP患者入院时、入院48 h、入院96 h肝功能变化情况。计量资料2组间比较采用t检验;3组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料组间比较采用χ~2检验。结果对于MAP患者,胆源性与非胆源性组间ALT、AST、ALP、GGT水平差异均有统计学意义(P值均0.05);而SAP患者胆源性与非胆源性组间仅ALP和GGT水平差异有统计学意义(P值均0.05)。胆源性AP所引起的肝损伤,48~96 h的ALT、AST、ALP、GGT水平大幅下降,与入院时比较差异均有统计学意义(P值均0.05);而非胆源性AP患者不同入院时间肝功能指标比较,差异均无统计学意义(P值均0.05)。胆源性AP患者ALP、GGT及ALP+GGT水平异常的发生率均高于非胆源性AP组,差异均有统计学意义(P值均0.05)。对于同一病因引起的胰腺炎,肝功能在SAP与MAP患者之间差异均无统计学意义(P值均0.05)。结论AP患者尤其是胆源性AP多合并肝功能异常。对于MAP,肝功能异常越明显,应首先考虑胆源性;对于SAP,ALT、AST对病因的预测价值不大,ALP、GGT则更为敏感,ALP、GGT的升高,提示胆源性AP的可能。连续检测肝功能变化,对于肝功能明显下降,尤其是ALT、AST水平明显下降的患者,胆源性AP的可能性越大。肝功能损伤的程度尤其是转氨酶活性的高低与AP病情程度无关。     

重症胰腺炎RanSon标准与CT影象的相关性

目的探讨重症胰腺炎的Ranson标准与CT影象的相关性方法用BalthazarCT分级系统诊断的SAP31例,同时用Ranson标准再评价,并以50例BalthazarCT分级C级以下的轻症胰腺炎作为对照组.结果31例SAP患者Ranson标准的相对准确性仅为61.29%.当Ranson标准1～2项阳性时,SAP的可能性为32.25%,MAP的可能性为38%.结论单纯用Ranson标准评估急性胰腺炎的严重程度有漏误可能,CT检查快捷、准确、能及时发现局部并发症.临床上需CT与有关实验室检查结合才能全面估价病情.     

肥胖者重症急性胰腺炎发生率的多中心前瞻性对照研究

目的 观察肥胖的急性胰腺炎(AP)患者在基础内科治疗过程中发展为重症急性胰腺炎(SAP)的概率,探讨肥胖对AP病情发展的影响.方法 采用多中心、前瞻性研究,以APACHEⅡ评分评估AP严重程度,共纳入轻症急性胰腺炎(MAP)患者161例,以体重指数25 kg/m2为标准,分为肥胖组(79例)和非肥胖组(82例).在相同的基础内科治疗条件下观察两组患者血C-反应蛋白(CRP)和三酰甘油水平、并发症发生率、SAP的发生率及病死率.结果 肥胖组的CRP水平为(117±109)mg/L,显著高于非肥胖组的(35±36)mg/L(P＜0.01);肥胖组高三酰甘油血症患者的例数是非肥胖组的1倍,但无显著性差异.两组均无局部并发症,但肥胖组各系统并发症发生率(20.3%)显著高于非肥胖组(6.1%,P＜0.01).肥胖组有16例(20.3%)发展为SAP,显著高于非肥胖组(5例,6.1%,P＜0.01).肥胖组有1例(1.3%)病死,非肥胖组无病死.在APACHEⅡ4-7分的MAP患者中,肥胖组的SAP发生率(43.3%)明显高于非肥胖组(18.5%,P＜0.05).结论 肥胖且 APACHEⅡ评分为4-7分的MAP 患者更易进展为SAP,应给予更积极的临床干预措施.     

急性胰腺炎患者血清高迁移率族蛋白B1水平的变化及意义

目的 检测急性胰腺炎(AP)患者血清高迁移率族蛋白B1(high mobility group box-1protein,HMGB1)的水平变化,探讨HMGB1在AP发生发展中的作用.方法 以33例重症急性胰腺炎(SAP)、38例轻症急性胰腺炎(MAP)以及28例健康体检者为研究对象,在发病72 h内收集血标本,采用ELISA法检测血清HMGB1水平,分析其与患者性别,年龄,病因,发病时间,Ranson评分,Balthazar CT评分,血清C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、肌酐、总胆红素等指标,局部和(或)全身并发症的关系.结果 健康对照组、MAP组、SAP组血清HMGB1水平分别为(1.82±0.64)μg/L、(6.13±5.80)μg/L、(11.48±6.94)μg/L,SAP组显著高于MAP组,MAP组又显著高于健康对照组(P值均<0.05).在发病24 h内患者血清HMGB1水平开始增高,48 h内达峰值,后开始下降,至72 h仍维持在高于正常值水平.血清HMGB1水平与患者性别、年龄、病因无关;与Ranson评分、Balthazar CT评分、CRP、LDH、血肌酐值呈正相关关系.有局部和(或)全身并发症患者血清HMGB1水平高于无并发症者,但差异不显著.结论 HMGB1是一种晚期炎症介质,与AP病情的严重程度相关,并可能参与了SAP时肾功能不全的发生.     

肥胖、高脂血症与急性胰腺炎的相关性研究进展

急性胰腺炎(AP)临床上分为轻型急性胰腺炎(MAP)和重症急性胰腺炎(SAP),可发生于任何年龄。胆道疾病和酒精中毒是其主要病因。近年来由于肥胖和高脂血症的人群增多,与肥胖及高脂血症相关胰腺炎的发病率也逐年增高。肥胖是急性胰腺炎的独立危险因素之一,高脂血症也成为继胆源性和     

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.