Relationship between serum leptin levels and clinical outcomes of hypertensive intracerebral hemorrhage

Circulating leptin is associated with cardiovascular events but the relationship between leptin and the clinical outcomes of intracerebral hemorrhage (ICH) is unclear. This study was to investigate the relationship between circulating leptin and the short-term clinical outcomes of ICH. Fifty-seven patients with hypertensive ICH (stroke group), 50 patients with hypertension (hypertension group), and 41 healthy subjects (control group) were recruited to this study. Serum levels of leptin were measured by radioimmunoassay. The serum level of leptin in the stroke group (14.6 ± 3.3 ng/L) was significantly higher than in the hypertension (10.2 ± 2.9 ng/L, P < 0.05) and control group (4.7 ± 3.3 ng/L, P < 0.01). Nine patients (15.8%) in the stroke group died during hospitalization. The mean National Institute of Health Stroke Scale (NIHSS) score of the surviving patients at admission and before discharge was 16 ± 6 and 9 ± 5, respectively (P < 0.01). There was a significant correlation between the serum leptin level and predischarge NIHSS scores (r = 0.62, P < 0.01). After adjusting age, sex, ICH volume and location, fasting blood glucose, fasting insulin levels, and systolic blood pressure (SBP) multivariate analysis showed that a high leptin level (>10 ng/L) was an independent predictor for in hospital mortality (adjusted risk ratio (RR), 3.6; 95% confidence interval (CI): 1.22-17.62; P = 0.02). In conclusion, serum leptin levels were increased in patients with hypertensive ICH. High leptin levels were associated with a poor functional recovery following ICH.     

急性脑出血患者血清胶质纤维酸性蛋白含量及临床意义

目的研究急性脑出血患者血清中胶质纤维酸性蛋白(GFAP)含量及临床意义。方法采用ELISA法检测发病后1 d内脑出血患者(56例,脑出血组)及健康体检者(50例,对照组)血清GFAP含量,分析脑出血患者血清GFAP含量与美国国立卫生研究院脑卒中量表(NIHSS)、血肿体积、血肿周围水肿体积及预后之间的关系。结果脑出血组患者发病第1天血清GFAP含量明显高于对照组,差异有统计学意义[(9.41±2.17)ng/L vs (1.17±0.41)ng/L,P0.01];大量出血患者血清GFAP含量明显高于少量出血患者,差异有统计学意义[(16.08±3.61)ng/L vs (5.19±2.06)ng/L,P0.01];血清GFAP含量与NIHSS、血肿体积、血肿周围水肿体积及预后呈正相关(r=0.7912,0.4920,0.4870,0.8032,P0.01);ROC曲线分析,以血清GFAP含量4.5 ng/L为标准评估预后,敏感性为0.82,特异性为0.77。结论脑出血后血清GFAP含量增高,在一定程度上反映了患者的病情程度,有助于早期预后的评估。     

Serum leptin in systemic lupus erythematosus

Leptin, a peptide hormone, plays an essential role in the regulation of body weight, the endocrine function, reproduction, the immune response and inflammation. The immune system, in turn, modifies leptin’s production. Systemic lupus erythematosus (SLE) is an autoimmunological disease characterized by widespread inflammation with possible involvement of each body organ and system. In this study, we assessed serum leptin levels in SLE patients and the control group in search for correlations between leptin concentrations and other markers’ level, the activity of the disease, its duration, the age of the patients and their bone mineral density. Blood samples were collected from 30 SLE and 30 control group women. Each SLE patient was matched with one from the control for age (±1 year) and the body mass index (BMI; ±1). Serum leptin levels were determined using the DRG Leptin ELISA Kit. Serum leptin levels in SLE patients ranged from 1.8 to 66.3 ng/ml (median value 7.5), and in control group it was 8.8 ng/ml (0.7–39.2) (NS). In SLE, serum leptin levels (after the logarithmic transformation) correlated with BMI (r = 0.89, P < 0.0001), the age (r = 0.34, P < 0.01) and the patients’ disease duration (r = 0.59, P < 0.0005). Serum leptin levels in SLE patients with arthritis (P < 0.05) and central nervous system (CNS) involvement (P = 0.05) were significantly lower in comparison with serum leptin levels in SLE patients without arthritis and CNS involvement. No correlation was found between serum leptin levels and the T-score. In the control group, the logarithmic transformation of serum leptin levels positively correlated with BMI (r = 0.52, P < 0.05). No differences in serum leptin levels were shown between SLE patients and the control group. However, we found correlation between BMI and serum leptin levels in both groups. Furthermore, serum leptin levels in SLE patients with arthritis and CNS involvement were significantly lower in comparison with SLE patients without arthritis and CNS involvement, which suggests that active chronic inflammation may lower plasma leptin concentrations.     

高血压患者血浆Apelin与左心室肥厚及颈动脉粥样硬化的关系

目的观察高血压患者血浆Apelin水平变化,探讨其与左心室肥厚和颈动脉粥样硬化的关系。方法选择原发性高血压患者125例,根据超声结果分为心肌肥厚组、内膜中膜增厚组、颈动脉斑块组和单纯高血压组,另选31例经体检筛选的健康者为对照组。采用酶联免疫分析法测定血浆Apelin含量。结果心肌肥厚组血浆Ape-lin含量(616±112ng/L)明显低于对照组(757±176ng/L)和单纯高血压组(715±170ng/L,P<0.001或0.05);并且血浆Apelin含量在内膜中膜增厚组(613±133ng/L)和颈动脉斑块组(592±146ng/L)均显著低于单纯高血压组和对照组(P<0.001或0.05)。相关分析表明,血浆Apelin水平与左心室质量指数、内膜中膜厚度和斑块指数均呈明显负相关(r分别为-0.253、-0.255和-0.246,P均<0.05)。结论血浆Apelin水平可能参与高血压心室重构和动脉硬化的发生与发展过程。     

Measurement of the serum leptin level could assist disease activity monitoring in rheumatoid arthritis

We investigated whether serum leptin levels are elevated in patients with active rheumatoid arthritis (RA) and whether these levels correlate with disease activity. Fifty RA patients were enrolled in this study, and their disease activity was assessed using the disease activity score 28 (DAS28). The patients were divided into two groups according to this score: a high activity group with DAS28 > 3.2 (n = 26) and a low activity group with DAS28 ≤ 3.2 (n = 24). Serum leptin levels were determined using a primate antibody radioimmunoassay. RA patients with high disease activity had significantly higher mean serum leptin levels, compared to those with low activity (14.2 ± 10.9 vs. 7.0 ± 3.4 ng/ml, P < 0.05). Mean leptin levels adjusted according to BMI were 0.6 ± 0.5 ng m²/ml kg for the high activity group and 0.3 ± 0.2 ng m²/ml kg for the low activity group, respectively, which were also significantly different (P < 0.05). Both serum leptin levels and leptin levels adjusted according to BMI correlated well with the DAS28 (r = 0.363 and 0.368, P < 0.05) and CRP levels (r = 0.433 and 0.472, P < 0.05), respectively. Sixteen of the 26 RA patients with high disease activity at the initial assessment were re-evaluated, at which point their DAS28 had decreased to less than 3.2. Mean follow-up leptin level was significantly lower than mean initial leptin level (7.8 ± 3.7 vs. 16.1 ± 12.7 ng/ml, P < 0.05). In conclusion, serum leptin levels were higher in RA patients with high disease activity, correlated well with disease activity, and decreased significantly when disease was well controlled.     

Increased levels of the soluble adhesion molecule E-selectin in patients with chronic myeloproliferative disorders and thromboembolic complications

Patients with chronic myeloproliferative disorders (CMD) show a high frequency of thrombosis. For this reason we evaluated endothelial cell markers, soluble adhesion molecule E-selectin (sELAM), and thrombomodulin (TM) in 25 patients with CMD. Among them nine presented thromboses in their past history. Data were compared with those obtained in a group of healthy subjects and a group of patients with secondary thrombocytosis. The mean plasma concentrations of sELAM were elevated in patients with CMD, as compared with healthy subjects (81.27 ± 42.8 ng/ml vs. 41.75 ± 13; P < 0.02). Similarly, the mean plasma concentrations of sTM were increased in CMD patients in comparison with the control group (102.0 ± 73 ng/ml vs. 16.7 ± 9.6; P < 0.01). More markedly elevated sELAM levels were observed in CMD patients with thrombosis than in patients without thrombosis (113.16 ± 29.5 ng/ml vs. 55.11 ± 19.1 ng/ml; P < 0.001), while no significant difference was found between CMD patients without thrombosis and secondary thrombocytosis (50.72 ± 10.8 ng/ml). Plasma thrombomodulin values in CMD patients with thrombosis (131 ± 93.8 ng/ml) were higher than those without thrombosis (65.77 ± 43.9 ng/ml; P < 0.02). sTM values were also significantly increased in patients with secondary thrombocytosis (P < 0.01). It is speculated that the plasma, sELAM levels may reflect endothelium activation and that it is possibly useful in predicting the thrombotic risk in myeloproliferative disorders. Am. J. Hematol. 57:109–112, 1998. © 1998 Wiley-Liss, Inc.     

A non-invasive method for evaluating cirrhotic portal hypertension by administration of 99mTc-MIBI per rectum

Abstract A study was performed to evaluate radio-isotopic imaging using technetium-99m hexakis 2-meth-oxyisobutyl isonitrile administered per rectum to assess portal collateral circulation. The heart-liver ratios (H/L; mean ± standard deviation) in 15 controls, 13 cases of histologically confirmed viral hepatitis and 57 cirrhosis patients were 0.27 ± 0.11, 0.43 ± 0.14 and 1.00 ± 0.28, respectively (P < 0.001). Among the cirrhosis patients those with the Child-Pugh classification A, B and C had H/L of 0.56 ± 0.14, 1.00 ± 0.20 and 1.19 ± 0.26, respectively (P < 0.001). A high value of H/L was associated with a high risk of hepatic encephalopathy (1.25 ± 0.17, P < 0.01) and oesophageal varices (1.02 ± 0.20, P < 0.01). There were associations between H/L and serum bilirubin (P < 0.01), albumin (P < 0.05) and prothrombin time (P < 0.05). The results also showed a good correlation between H/L and portal vein pressure measured during operation in 13 patients (P < 0.001, r= 0.87). The regression equation: y= 6.77 + 32.5 H/L, allowed portal vein pressure to be estimated. The prognostic value of the test was supported by the fact that good correlations were observed between the H/L ratio and widely accepted prognostic classification (Child-Pugh). It is suggested that this new method could be a reliable non-invasive way to give an indication of the degree of portasystemic shunting to evaluate the prognosis and to follow up the effects of medications for reducing portal hypertension in patients with cirrhotic portal hypertension.     

Structural cardiac changes in relation to 24-h ambulatory blood pressure levels in borderline hypertension

Abstract. Objectives. To investigate left ventricular hypertrophy (LVH) in relation to 24-h ambulatory blood pressure (24-ABPM) and insulin levels in borderline hypertension. Design. A case-control study. Subjects. Borderline hypertensive men (diastolic blood pressure (DBP) 85–94 mmHg, n = 69) and age-matched normotensive controls (DBP ≤ 80 mmHg. n = 69) from a population screening programme. Main outcome measures. Echocardiography (M-mode). insulin (RIA) and 24-APBM (Del Mar P-IV) levels. Results. The borderline group showed a significant increase in septal thickness (10.4±1.5 vs. 9.7±1.5 mm. P < 0.01), peak systolic wall stress (218±38 vs. 202±38 10³ dynes cm^?2, P < 0.05) and a decrease in LV ejection time (28.4±2.5 vs. 29.5±2.1s, P < 0.01). The septum vs. posterior wall thickness ratio was significantly higher in the borderline group (1.13±0.14 vs. 1.06±0.14, P < 0.01). Casual BP levels did not correlate with LVH indices, while 24-ABPM systolic levels correlated strongly with LVH indices in the borderline group (r = 0.22–0.52, P < 0.05) but not in the normotensive group. Insulin levels correlates strongly with LVH indices in the normotensive group (r = 0.34–0.47, P < 0.01) but not the borderline, group. Conclusions. Signs of asymmetric LVH and altered ventricular function are already detectable in borderline hypertension. The data also suggest that early structural cardiac changes are related to ambulatory blood pressure profile, but not to casual blood pressure or trophic factors such as insulin.     

Short‐Term Effect of Atorvastatin on Endothelial Function in Healthy Offspring of Parents with Type 2 Diabetes Mellitus

Endothelial function is impaired in healthy subjects at risk of type 2 diabetes mellitus (DM). We investigated whether endothelial dysfunction can be normalized by statin therapy in this potentially predisposed population. Flow‐mediated dilation (FMD) was measured in 56 first‐degree relatives (FDRs) (normotensive, normal glucose tolerance) and 20 age‐, sex‐, and BMI‐matched controls with no family history of DM. Other measurements included insulin resistance index using the homeostasis model of insulin resistance (HOMA_IR), plasma lipids, and markers of inflammation. The FDRs were then randomized and treated with atorvastatin (80 mg) or placebo daily in a 4‐week double‐blind, placebo‐controlled trial. The FDRs had significantly impaired FMD (4.4 ± 8.1% vs. 13.0 ± 4.2%; P < 0.001), higher HOMA_IR (1.72 ± 1.45 vs. 1.25 ± 0.43; P= 0.002), and elevated levels of plasma markers of inflammation—highly sensitive C‐reactive protein (hsCRP) (2.6 ± 3.8 mg/L vs. 0.7 ± 1.0 mg/L; P= 0.06), interleukin (IL)‐6 (0.07 ± 0.13 ng/mL vs. 0.03 ± 0.01 ng/mL; P < 0.001), and soluble intercellular adhesion molecule (sICAM) (267.7 ± 30.7 ng/mL vs. 238.2 ± 20.4 ng/mL; P < 0.001). FMD improved in the atorvastatin‐treated subjects when compared with the placebo‐treated subjects (atorvastatin, from 3.7 ± 8.5% to 9.8 ± 7.3%; placebo, from 3.9 ± 5.6% to 4.7 ± 4.2%; P= 0.001). There were also reductions in the levels of IL‐6 (0.08 ± 0.02 ng/mL vs. 0.04 ± 0.01 ng/mL; P < 0.001) and hsCRP (3.0 ± 3.9 mg/L vs. 1.0 ± 1.3 mg/L; P= 0.006). Our study suggests that treatment with atorvastatin may improve endothelial function and decrease levels of inflammatory markers in FDRs of type 2 DM patients.     

小动脉闭塞性脑卒中与血清细胞间黏附分子1和内皮素1的相关性研究

目的探讨小动脉闭塞性脑卒中(small vessel disease,SAO)与血清细胞间黏附分子l(intercellular adhesionmolecule-1,ICAM-1))、内皮素1(endothelin-1,ET-1)的关系及临床意义。方法选择首次急性SAO患者160例(SAO组),根据影像学检查有无白质疏松分为单纯腔隙性脑梗死组(ILI组75例)和缺血性白质疏松组(ILA组85例)。另选择健康体检者80例作为对照组。比较SAO组与对照组血清ICAM-1、ET-1水平,并进一步比较ILI组与ILA组的差异。结果 SAO组血清ICAM-1、ET-1明显高于对照组,差异有统计学意义[(323.55±44.04)ng/Lvs(275.34±37.03)ng/L,(74.12±13.20)ng/L vs(59.94±14.69)ng/L,P<0.01]。与ILI组比较,ILA组年龄偏大,ICAM 1、ET-1水平及高血压发生率明显增高,高胆固醇血症发生率明显降低,差异有统计学意义(P<0.05,P<0.01)。结论 ICAM-1、ET-1与SAO显著相关,尤其与ILA关系更为密切。ILA及ILI代表了2种不同类型的SAO。     

Serum 7S domain of type IV collagen levels in essential hypertension and hypertensive type 2 diabetic patients

Metabolic alteration of Type IV collagen occurs in micro- or macrovascular basement membrane of diabetic patients. Hypertension, a risk factor for clinical progression of diabetic vascular disease, may influence this metabolic alteration. The object of this study was to evaluate the serum 7S domain of type IV collagen (7S-collagen) levels in patients with essential hypertension and in Type 2 diabetic patients with or without hypertension and to investigate the relationship between the type IV collagen metabolism and the arterial blood pressure. Serum 7S-collagen levels in 18 patients with essential hypertension were significantly higher than in 24 normal subjects (4.2 ± 0.5 vs 3.6 ± 0.4 ng ml⁻¹ p < 0.01). Serum 7S-collagen levels in 28 normotensive diabetic patients (4.2 ± 0.5 ng ml⁻¹) were significantly higher than in normal subjects (p < 0.01). The serum 7S-collagen levels were significantly higher in 22 diabetic patients with hypertension (4.8 ± 0.6 ng ml⁻¹) than in the other groups. There was a significant correlation between the serum 7S-collagen levels and the systolic blood pressure in cases with essential hypertension (r = 0.59, p < 0.001) and in all diabetic patients (r = 0.52, p < 0.001), suggesting that elevation of the systolic blood pressure may influence the type IV collagen metabolism of vascular basement membrane. We conclude that the metabolic alteration of basement membrane occurring in patients with diabetes mellitus may worsen in the presence of high systolic blood pressure. © 1997 by John Wiley & Sons, Ltd.     

重组人促红细胞生长素治疗老年急性大脑中动脉缺血性脑卒中的研究

目的研究重组人促红细胞生长素(recombinant human erythropoietin,rhEPO)治疗老年急性缺血性脑卒中患者的有效性及安全性。方法入选74例年龄≥75岁的老年急性缺血性脑卒中患者,经磁共振弥散加权成像检查证实在大脑中动脉的范围内,将患者随机分为治疗组36例和对照组38例,患者入院后前3 d每日分别给予rhEPO或生理盐水静脉注射治疗。观察第1、3、7、20和30天美国国立卫生研究院卒中量表(NIHSS)评分和脑梗死体积变化,ELISA法检测损伤标记物S100B水平。结果与对照组比较,治疗组第20、30天NIHSS评分明显下降(P<0.05);第20天脑梗死体积明显降低[(46.5±32.3)cm~3 vs(89.6±68.9)cm~3,P<0.01];第3、7和20天血清S100B水平明显下降[(1.45±0.25)μg/L vs(1.58±0.13)μg/L,(1.41±0.20)μg/L vs(1.69±0.15)μg/L,(0.38±0.14)μg/L vs(0.78±0.26)μg/L,P<0.01]。结论老年急性缺血性脑卒中患者对静脉注射高剂量rhEPO治疗耐受性良好,并且可改善患者30 d后的临床预后。     

Changes in serum amylase, lipase and leukocyte elastase during diabetic ketoacidosis and poorly controlled diabetes

Diabetic ketoacidosis (DKA) is frequently associated with pancreatic enzyme abnormalities. In order to determine the main factors that lead to this increase, serum total amylase (TA), pancreatic amylase (PA), lipase (L) and leukocyte elastase (LE), an early predictor of acute pancreatitis, were measured in four groups of patients on admission. Group 1 consisted of 52 patients with DKA (age: 41.9 ± 19.2 years; blood glucose (Glc): 27.4 ± 11.5 mmol/L; pH: 7.20 ± 0.16; plasma bicarbonate: 10.5 ± 6.2 mmol/L; blood urea nitrogen (BUN): 0.60 ± 0.44 g/L; HbA_1C: 12.5% ± 2.8%). Group 2 consisted of 90 patients with poorly controlled non-ketotic diabetes (age: 53.4 ± 16.0; Glc: 14.3 ± 0.6; HCO₃ ⁻: 26.6 ± 3.2; BUN: 0.38 ± 0.20; HbA_1C: 11.3 ± 2.1). Group 3 consisted of 22 patients with well-controlled diabetes (age: 53.7 ± 12.8; Glc: 10.1 ± 5.2; HCO₃ ⁻: 27.4 ± 3.8; BUN: 0.36 ± 0.19; HbA_1C: 6.8 ± 0.8). Group 4 (controls) comprised 27 non-diabetic patients (age: 46.0 ± 15.0; Glc: 4.9 ± 0.5; HCO₃ ⁻: 28.4 ± 2.5; BUN: 0.30 ± 0.16; HbA_1C: 5.2 ± 0.7) (means ± SD). Increased enzyme activities were more frequent in group 1 (TA: 30.7; PA: 27.0; L: 36.5; LE: 73%) than in groups 2 (TA: 8.9; PA: 7.1; L: 8.9; LE: 45.5%), 3 (TA: 13.6; PA: 9.0; L: 18.1; LE: 31.8%) and 4 (TA: 7.0; PA: 3.0; L: 0.0; LE: 29.6%). Mean serum enzyme activities were significantly different in the 4 groups (ANOVA, P < 0.01) and were higher in group 1 than in groups 2, 3 and 4 (Student's t-test; group 1 vs 2 or 3 or 4: P < 0.001). In groups 1 + 2 + 3 + 4 (all patients), the four enzymes correlated with one another and also with Glc, BUN and HCO₃ ⁻ (P < 0.001). In group 1, TA correlated negatively with HCO₃ ⁻ (P < 0.001) and pH (P < 0.05); PA and L correlated positively with Glc and BUN (P < 0.01) and negatively with HCO₃ ⁻ (respectively, p < 0.01 and 0.05). PA correlated positively with pH (P < 0.01); LE correlated with Glc (P < 0.05) and BUN (P < 0.01). In conclusion, this study suggests that the serum levels of pancreatic enzymes increase with the degree of diabetic disequilibrium, and mainly correlate with metabolic factors such as hyperglycaemia, dehydration and acidosis. Increased pancreatic enzyme activities in patients with DKA, even in combination with abdominal pain, should not be diagnosed as acute pancreatitis; this could be important, particularly for younger clinicians. Received: 18 September 1998 / Accepted in revised form: 24 February 1999     

Pain treatment of fibromyalgia by acupuncture

The lack of objective parameters makes the measurement of pain and the efficacy of pain treatment in patients with chronic pain very difficult. We performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. The parameters corresponded to patients' self-report. Twenty-nine fibromyalgia patients as defined by ACR-criteria (25 women, 4 men) with a mean age of 48.2±2.0 years and a mean disease duration of 6.1±1.0 years participated in the study. Pain levels and positive tender points were assessed using the visual analogue scale (VAS, i.e., range 0–100 mm) and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0±3.4 mm before therapy to 34.5±4.3 mm after therapy (P<0.001). Dolorimetry revealed a decreased number of tender points after therapy from 16.0±0.6 to 11.8±1.0, P<0.01. Serotonin levels decreased from 715.8±225.8 μg/10¹² platelets to 352.4±47.9 μg/10¹² platelets (P<0.01), whereas the serum concentration increased from 134.0±14.3 ng/ml to 171.2±14.6 ng/ml (P<0.01). Substance P levels in serum increased from 43.4±3.5 pg/ml to 66.9 ±8.8 pg/ml (P<0.01). Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS and dolorimetry. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia. Received: 15 May 1997     

极低碳水化合物饮食对肥胖症患者心血管危险因素的影响

 目的 观察极低碳水化合物饮食(VLCD)治疗对单纯性肥胖患者心血管危险因素的影响。 方法 观察35例肥胖患者经VLCD治疗8周后,体重、腰围及血压改善的同时,空腹血糖(FPG)、空腹胰岛素(FIns)、血脂谱、尿微量白蛋白/肌酐(UACR)、C反应蛋白(CRP)、TNFα、脂联素(adiponectin)等心血管危险因素的改变。另采集35例健康志愿者作为基线对照组。 结果 基线时肥胖组较正常对照组有更显著的心血管危险因素(P值均<0.05)。试验结束时肥胖患者的体重与腰围分别减少了(8.5±0.7)kg与(6.6±1.1)cm(P值均<0.01);收缩压、舒张压、FIns、TC、TG等指标均较前显著降低(P值均<0.05);FPG、LDL-C及HDL-C等的改变无统计学意义;UACR、CRP、TNFα分别减少了(1.86±0.86)μg/mg、(1.15±0.45)mg/L及(0.94±0.21)ng/L(P值均<0.05);脂联素水平增加了(2.12±0.59)mg/L(P<0.01)。结论 8周的VLCD治疗肥胖症可有效减重并显著改善多种心血管危险因素。     

急性脑梗死后白细胞介素6与神经功能缺损评分的相关性及β-七叶皂甙钠的治疗作用

目的观察急性脑梗死后血清白细胞介素6(IL-6)与神经功能缺损程度评分的动态变化,探讨IL-6对急性脑梗死后神经功能恢复的影响及β-七叶皂甙钠治疗急性脑梗死的作用机制。方法选择急性脑梗死患者63例,随机分为对照组30例和治疗组33例,对照组予以脑梗死常规治疗,治疗组在常规治疗基础上加用β-七叶皂甙钠,在脑梗死后1、5、14d进行血清IL-6测定和美国国立卫生研究院卒中量表(NIHSS)评分。另选取健康体检者30例为正常组,清晨测定血清IL-6。结果治疗组和对照组患者脑梗死后1、5、14dIL-6水平较正常组明显升高,差异有统计学意义(P<0.01);治疗组脑梗死后14d血清IL-6水平明显低于对照组[(13.33±2.82ng/L)vs(15.25±4.65)ng/L,P<0.05];对照组和治疗组脑梗死后14d神经功能缺损评分较1、5d明显改善,差异有统计学意义(P<0.01);治疗组脑梗死后14d神经功能缺损评分较对照组明显降低[(9.03±2.28)分vs(10.38±2.30)分,P<0.05];脑梗死患者血清IL-6水平与神经功能缺损评分呈正相关(r=0.888,P<0.01)。结论急性脑梗死后血清IL-6水平与神经功能缺损密切相关,β-七叶皂甙钠可能通过抑制血清IL-6的增高而改善神经功能。     

The Association of Salivary Biomarkers With the Severity of Obstructive Sleep Apnea and Concomitant Hypertension

BackgroundWe aimed to assess the association between salivary alpha-amylase and salivary cortisol, and obstructive sleep apnea (OSA) severity.MethodsFifty-eight adults with suspected OSA were divided into the following 4 groups based on the apnea hypopnea index (AHI): control (AHI <5 events/hour), mild OSA (5 events/hour < AHI ≤15 events/hour), moderate OSA (15 events/hour < AHI ≤30 events/hour) and severe OSA (AHI >30 events/hour) groups. Salivary samples were collected after overnight polysomnography. Correlations between the salivary biomarkers and polysomnography parameters were analyzed.ResultsSalivary alpha-amylase levels of the moderate and severe OSA groups were significantly higher than those of the control and mild OSA groups, and no association was found between salivary cortisol and OSA severity. The salivary alpha-amylase levels were positively correlated with the AHI (r = 0.538; P < 0.01) and microarousal index (r = 0.541, P < 0.01), and negatively correlated with the lowest pulse oxygen saturation (r = ?0.375, P < 0.01). Salivary cortisol levels were significantly higher in patients with hypertension than in those without hypertension (10.01 ± 2.77 ng/mL vs. 5.52 ± 1.90 ng/mL, P < 0.05), and the salivary alpha-amylase levels were highest in the OSA concomitant hypertension group (32.81 ± 11.85 U/mL). Areas under the receiver operator characteristic analysis revealed that the cutoff values of salivary alpha-amylase for identifying moderate-severe OSA and OSA concomitant hypertension were 17.64 U/mL (sensitivity 85%, specificity 91%) and 25.35 U/mL (sensitivity 70%, specificity 94%), respectively.ConclusionsSalivary alpha-amylase is positively associated with the severity of OSA and OSA concomitant hypertension.     

Activity of Angiotensin‐Converting Enzyme After Treatment with L‐Arginine in Renovascular Hypertension

The renin‐angiotensin system plays a role in the pathophysiology of renovascular hypertension. In addition, some studies have demonstrated a beneficial effect of L‐arginine (L‐Arg), the precursor of nitric oxide (NO), in this model of hypertension. This study was designed to investigate the effects of L‐Arg on cardiovascular parameters and on the activity of the angiotensin‐converting enzyme (ACE), after 14 days of renovascular hypertension. The experiments were performed on conscious male Wistar rats. Two‐kidney, one‐clip renovascular hypertension (2K1C) was initiated in rats by clipping the left renal artery during 14 days, while control rats were sham‐operated. One group was submitted to a similar procedure and treated with L‐Arg (10 mg/ml; average intake of 300mg/day) from the 7th to the 14th day after surgery, whereas the respective control group received water instead. At the end of the treatment period, the mean arterial pressure (MAP) was measured in conscious animals. The rats were sacrificed and the ACE activity was assayed in heart and kidneys, using Hip‐His‐Leu as substrate. In a separate group, the heart was removed, the left ventricle (LV) was weighed and the LV/body weight ratios (LV/BW) were determined. We observed significant differences in MAP between the L‐Arg‐treated and untreated groups (129 ± 7 vs. 168 ± 6 mmHg; P < 0.01). The cardiac hypertrophy described for this model of hypertension was attenuated in the 2K1C‐L‐Arg‐treated group (14th day, wet LV/BW: 2K1C‐L‐Arg = 1.88 ± 0.1; 2K1C = 2.20 ± 0.1 mg/g; P < 0.05). L‐Arg administration caused an important decrease in cardiac ACE activity (2K1C‐L‐Arg: 118 ± 15; 2K1C: 266 ± 34 µmol/min/mg; P < 0.01). L‐Arg also decreased the ACE activity in the clipped kidney by 47% (P < 0.01), but not in the nonclipped kidney. These data suggest that increased NO formation and reduced angiotensin II formation are involved in the anthihypertensive effect of orally administered L‐arginine.     

The impact of apelin and relaxin plasma levels in masked hypertension and white coat hypertension

Masked hypertension (HTN) and white coat hypertension represent two reverse forms of clinical HTN with questionable prognostic significance. Recent evidence supports that low apelin and relaxin plasma levels contribute to vascular damage accelerating atherogenesis and predisposing to HTN and cardiovascular (CV) events. The aim of this study was to compare apelin and relaxin plasma levels between patients with masked hypertension (MH) and those with white coat HTN (WCH). Overall, 130 patients not receiving antihypertensive therapy were studied. All patients underwent 24‐hour ambulatory BP monitoring (ABPM) and office BP measurements. Plasma apelin and relaxin levels were measured by ELISA method. According to BP recordings, 24 subjects had MH (group A) and 32 had WCH (group B). Apelin (200 ± 111 pg/mL vs 305 ± 127 pg/mL, P < 0.01) and relaxin (35.2 ± 6.7 pg/mL vs 46.8 ± 23.6 pg/mL, P < 0.01) plasma levels were significantly lower in patients with MH compared to those with WCH, respectively. In conclusion, our findings showed that patients with MH had significantly lower apelin and relaxin levels compared to those with WCH. This observation implies an additional prognostic role for adipokines supporting the concept that MH is closer to essential HTN whereas WCH is a more benign condition.     

Impact of anthropometric measures and serum leptin on severity of gastroesophageal reflux disease

The aim of this prospective study was to evaluate the impact of obesity, determined by different anthropometric measures, on clinical and endoscopic severity of GERD and the relation between serum leptin and clinical and endoscopic severity of GERD in Egyptian patients. The study was carried out at Ain Shams University Hospitals and Theodor Bilharz Research Institute, Cairo, Egypt. A total of 60 patients with clinically and endoscopically evident gastroesophageal reflux disease (GERD) were enrolled in this study as well as 20 healthy subjects matched for age and gender serving as the control group. Patients were divided according to their body mass index (BMI) into two groups: group 1 (n = 30): overweight and obese (BMI ≥25 and/or waist‐to‐height ratio [WHtR] ≥0.5) and group 2 (n = 30): normal weight (BMI ≥18 to <25 and/or WHtR ≥0.4 to <0.5). Upper gastrointestinal endoscopy, anthropometric measures, and symptom severity score questionnaire were done for all patients. Serum leptin hormone was assessed for patients and control groups.The evidence revealed statistically significant difference between the two groups in terms of different anthropometric measures (P < 0.00) except the height (P < 0.9), abdominal fat depot equations (P < 0.00), endoscopic findings according to Los Angeles classification (P < 0.001), symptom severity score (P < 0.00), and serum leptin hormone (43.96 ± 23.50 in group 1 vs. 7.5133 ± 8.18294 in group 2 and 6.98 ± 5.90 in the control group) (P = 0.00). Obesity in general and central (abdominal) obesity specifically has significant impact on clinical and endoscopic severity of GERD. Increased leptin hormone level is associated with clinical and endoscopic severity of GERD. Future trial on larger number of patients is emphasized.