阻塞性睡眠呼吸暂停低通气综合征患者心律失常的发生及相关因素的研究

目的通过了解阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间心律失常发生的类型及相关因素;探讨OSAHS相关心律失常的可能机制。方法对100例睡眠打鼾者进行动态心电图及多导睡眠监测(PSG),根据监测结果分为对照组及OSAHS组,再将OSAHS组分为轻、中、重三组,分析各项数据资料。结果 OSAHS组各项睡眠呼吸监测参数与对照组比较均有显著性差异(P0.05),且随着OSAHS的程度加重,各亚组间比较存在显著差异(P0.05);对照组心律失常的发生率为28.57%,OSAHS组心律失常的发生率为58.3%,两组比较有显著性差异(Χ~2=7.589,P0.05),且随着程度的加重,心律失常的发生率逐渐增大(轻度组40.91%、中度组55.56%、重度组71.88%);OSAHS组中室上性早搏(29.2%)与室性早搏(27.8%)最多见;23.6%的OSAHS患者出现联合性心律失常,且有65%患者出现在重度组,缓慢性心律失常也多见于重度OSAHS患者;OSAHS患者心率变异较对照组大(P0.05)。结论 OSAHS患者易发生心律失常,OSAHS患者夜间周期性呼吸暂停以及低通气引起低氧血症与自主神经功能紊乱可能是夜间心律失常的诱发因素。     

nCPAP 对中重度阻塞性睡眠呼吸暂停低通气综合征患者心肌供血的影响

目的 观察中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心肌供血的关系,探讨经鼻持续气道内正压通气(nCPAP)治疗对中重度OSAHS患者心肌供血的影响.方法 将明确诊断为中重度OSAHS患者中随机分为持续nCPAP治疗1年以上的长期治疗组(n=32 例),短期治疗组(n=30 例)及对照组(n=31 例).治疗前三组的临床基本特征差异无统计学意义(P＞0.05).分别对治疗后的三组患者进行24h动态心电图和睡眠呼吸监测,观察呼吸睡眠暂停-低通气事件、心肌缺血负荷,同时实时观察呼吸暂停-低通气事件和血氧饱和度下降与心肌缺血的关系.结果 对照组中13 例(41.94%)夜间出现心肌缺血发作,心肌缺血负荷为(59.12±7.18)mm·min / h.其与呼吸暂停- 低通气累计持续时间及累计次数呈正相关(r=0.816、0.749,P＜0.01).随着血氧饱和度下降幅度增加,心肌缺血发作次数也增多,差异有显著统计学意义(P＜0.01).长期治疗组患者经1年的nCPAP 治疗后夜间心肌缺血发生例数(6.25%、41.94%)及心肌缺血负荷[(1.32±0.78)mm·min / h、(59.12±17.18)mm·min / h],与对照组相比均明显减少,差异有显著统计学意义(P＜0.01),与短期治疗组比较差异无明显统计学意义(P＞0.05).在短期组中,仅3 例(10.00%)夜间出现心肌缺血发作,心肌缺血负荷为(2.42±1.43)mm·min / h,与对照组比较,心肌缺血程度减少,差异有显著统计学意义(P＜0.01).结论 夜间心肌缺血在中重度OSAHS患者中较多见,且与呼吸暂停- 低通气持续时间、发生次数及血氧饱和度下降幅度有关.无论长期还是短期的nCPAP 治疗都能明显减少中重度OSAHS 患者夜间心肌缺血的发生例数.     

阻塞性睡眠呼吸暂停低通气综合征对血压及心律失常的影响

目的观察阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep Apnea-hypopnea Syndrome,OSAHS)对血压及心律失常的影响。方法 117例OSAHS患者按照按其睡眠呼吸暂停低通气指数(AHI)及经皮血氧饱和度(SPO2)的变化情况分为轻度、中度、重度组,随机选取35例无OSAHS患者作为对照组。所有入选对象均行多导睡眠图(Polysomnogram,PSG)检查,监测睡前及醒后血压,同时行动态心电图监测。结果睡前及醒后血压水平在OSAHS患者中明显高于对照组(P0.01),并且各组间相比差异均有统计学意义(P0.05)。睡前及醒后血压相比:对照组无显著差异(P0.05),轻度OSAHS组收缩压无显著差异(P0.05),舒张压有显著差异(P0.05),中度及重度OSAHS组收缩压及舒张压水平均有显著差异(P0.05)。中重度OSAHS组心律失常发生率明显高于对照组和轻度OSAHS组,差异有统计学意义(P0.05)。结论 OSAHS本身可以引起夜间血压的升高,且血压的变化随着OSAHS程度的加重而加大。OSAHS在睡眠时有较大的心率变异性,夜间可见明显的高频峰,心率变异夜间大于白天。     

阻塞性睡眠呼吸暂停低通气综合征与心律失常相关性及持续正压通气疗效探讨

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心律失常的关系及经鼻持续正压通气(nCPAP)治疗OSAS所致心律失常的疗效。方法:对82例睡眠打鼾者同步进行夜间7h以上多导睡眠图(PSG)及24h动态心电图监测,根据PSG结果分为OSAS组64例和对照组(单纯鼾症组)18例,比较组间最长呼吸暂停时间(LAT)、平均呼吸暂停时间(MAT)、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(mSaO2)、心律失常发生率及发生类型;对18例中重度OSAS伴心律失常患者行nCPAP治疗,比较治疗前后监测资料。结果:OSAS组LAT、MAT长于对照组,AHI高于对照组,mSaO2低于对照组(均P<0.01),OSAS组心律失常发生率显著高于对照组(P<0.01);并且随着病情加重而升高(P<0.05)。nCPAP治疗后,AHI下降,mSaO2上升,平均每小时心律失常发生次数较治疗前显著减少(均P<0.01)。结论:OSAS与心律失常之间存在显著相关性,OS-AS患者夜间心律失常与低氧血症密切相关,nCPAP可有效减少心律失常的发生。     

阻塞性睡眠呼吸暂停低通气综合征与心律失常及高血压的相关性研究

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心律失常及高血压的相关性。方法:应用多导睡眠图监测系统(PSG)行至少7h睡眠呼吸监测,长程心电图(Holter)同步记录心电动态变化,动态血压监测仪监测24h血压波动。结果:OSAHS组心律失常及高血压的发生率明显高于对照组(P0.05),病情分度越重者,其心律失常及高血压的发生率也越高(P0.05);重度OSAHS伴高血压与单纯高血压组比较,日间平均收缩压(DABPS)、日间平均舒张压(DABPD)、夜间平均收缩压(NABPS)、夜间平均舒张压(NABPD)、血压变异率水平均具有统计学差异。结论:心律失常及高血压的发生与OSAHS的严重程度相关,是导致心血管疾病及增加心血管意外的危险因素之一。     

阻塞性睡眠呼吸暂停低通气综合征与心肌缺血及心律失常的关系

目的：分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与心肌缺血及心律失常的关系。方法：应用多导睡眠图监测系统（PSG）行至少7h睡眠呼吸监测，长程心电图（Holter）同步记录心电动态变化。结果：0SAHS组心肌缺血及心律失常的发生率明显高于对照组（P〈0．05），病情分度越重者，其心肌缺血及心律失常的发生率也越高。结论：OSAHS与心肌缺血及心律失常关系密切，是导致心血管疾病及增加心血管意外的重要危险因素。     

冠心病合并OSAHS患者夜间心律失常情况分析

目的 进一步分析冠心病合并阻塞性睡眠呼吸暂停综合征(OSAHS)患者夜间心律失常情况,并探讨其形成机制.方法 120例冠心病患者按睡眠呼吸监测结果合并OSAHS者90例(OSAHS组),不合并OSAHS者30例(非OSAHS组).对两组临床资料及夜间心律情况进行比较.结果 两组夜间最慢心率和平均心率变化有明显异常(P＜0.05);OSAHS组夜间窦性心动过速、室性心律失常以及传导阻滞的发生率明显高于非OSAHS组(P＜0.05);窦性心动过缓和心房颤动的发生率亦明显高于非OSAHS组(P＜0.01).结论 冠心病合并OSAHS患者夜间心律失常发生率明显增高,尤其是窦性心动过缓和心房颤动发生率显著升高.     

阻塞型睡眠呼吸暂停低通气综合征夜间不同时段呼吸暂停低通气次数与心律失常发生规律相关性研究

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者夜间不同时段发生呼吸暂停、低通气次数与心律失常次数及规律相关性.方法 选择2006年5～12月在兰州大学第一医院就诊经多导睡眠图监测确诊的69例OSAHS男性患者,根据呼吸紊乱指数(AHI)分为轻度(16例)、中重度(52例)2组.收集其夜间不同时段发生呼吸暂停、低通气次数及心律失常次数和AHI、平均血氧饱和度(MSpO2)、最低血氧饱和度(LSpO2).比较上述指标之间的差异并分析相互间的关系.结果 OSAHS患者夜间不同时段发生呼吸暂停、低通气和心律失常次数有着明显的不同;中重度OSAHS患者在凌晨>3时至4时发生的呼吸暂停、低通气和心律失常次数明显高于其他时段(P<0.05),并与MSpO2和LSpO2呈负相关(P均<0.05);心律失常总次数与凌晨>3时至4时和>4时至5时发生的呼吸暂停、低通气次数呈线性回归关系(F=27.1,P=0.001).结论 中重度OSAHS患者夜间不同时段发生呼吸暂停、低通气次数和心律失常次数有着明显的规律性,尤其以凌晨>3时至4时为其高峰时段.     

阻塞性睡眠呼吸暂停低通气综合征与心律失常及高血压的相关性

目的观察阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与心律失常及原发性高血压(高血压)的相关性。方法以2014年3月至2015年6月在南京市第一医院经多导睡眠监测(polysomnography,PSG)最终确诊为OSAHS的患者108例,按照有无高血压将其分为观察组(高血压组)及对照组(无高血压组),各54例。经体格检查及PSG记录患者的睡眠呼吸暂停低通气指数(apnea hypopneaindex,AHI)、心律失常次数及高血压分级,比较两组上述指标之间的差异并分析相互间的关系。结果 OSAHS与高血压分级(Ⅰ、Ⅱ、Ⅲ级)及心律失常发生率呈正相关(r=0.412、0.385、0.376和0.413,P0.05)。两组的最慢心率及平均心率变化有明显异常,且高血压并发OSAHS患者的变化更大,差异具有统计学意义(P0.05)。观察组窦性心动过速[27.78%(15/54)vs.9.26%(5/54),P0.05]、室性心律失常[46.30%(25/54)vs.22.22%(12/54),P0.05]、传导阻滞[74.07%(40/54)vs.55.56%(30/54),P0.05]、窦性心动过缓[96.30%(52/54)vs.59.26%(32/54),P0.05]、心房颤动[18.52%(10/54)vs.7.41%(4/54),P0.05]的发生率明显高于对照组,差异具有统计学意义。结论高血压并发OSAHS患者的心律失常发生率明显增高,尤其是窦性心动过缓及心房颤动的发生率显著升高。     

阻塞性睡眠呼吸暂停低通气综合征患者心律失常的相关因素分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者心律失常的相关因素。方法对69例睡眠打鼾者行多导睡眠仪（PSG）及24 h动态心电图（Holter）监测,分为观察组（OSAHS患者）49例和对照组（单纯打鼾者）20例。比较两组间呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、心律失常发生率及发生类型。结果 OSAHS组AHI明显高于对照组,LSaO2明显低于对照组（P均〈0.01）;OSAS组心律失常发生率显著高于对照组,并且随OSAHS病情加重,心律失常发生率增高。结论 OSAHS患者心律失常的发生与低氧血症密切相关。     

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.