高血压病患者炎性因子、假性血管性血友病因子水平与代谢综合征

目的比较伴代谢综合征(MS)的原发性高血压(EH)患者与单纯EH患者的炎性因子及假性血管性血友病因子(vWF)水平的差异,检验MS与炎症密切相关的假说。方法连续住院的138例EH患者,根据2005年国际糖尿病联盟MS新定义分为EH MS组(A组)99例与单纯EH组(B组)39例。测定血生化、白细胞(WBC)计数、血清高敏C反应蛋白(hsCRP)及血浆vWF。应用统计学方法分析hsCRP、vWF及与MS的关系。结果伴MS患者较不伴MS的病人腰围、体质量指数、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)明显升高(P<0.05或<0.01),WBC计数及血清hsCRP浓度升高,血浆vWF含量增加(P均<0.05),高密度脂蛋白胆固醇(HDL-C)降低(P<0.01)。EH患者vWF与hsCRP之间显著相关(r=0.283,P<0.01)。多元回归分析显示,vWF仍与hsCRP显著相关,并与年龄、MS、舒张压(DBP)及吸烟显著相关(P均<0.01)。而hsCRP与vWF及白细胞计数显著相关(P均<0.01)。Logistic多元回归分析显示:HDL-C、TG、LDL-C及vWF可以预测EH患者MS的发生(P<0.05或<0.01)。结论代谢综合征患者体内炎性状态进一步活化,内皮损伤程度更重。vWF与hsCRP显著相关,并与EH患者MS相关。     

老年女性代谢综合征炎性因子表达与二甲双胍干预的研究

目的 探讨老年女性代谢综合征(MS)与炎症之间的关系,以及二甲双胍(DMBG)对其的干预作用和机制.方法 老年女性非MS组53例,MS组65例.采用病例对照研究的方法,DMBG干预12 w前后进行MS、性激素和炎性因子相关指标的检测并比较.结果 MS组DMBG干预前较非MS组的体重指数(BMI)、腰围、腰臀比(WHR)、收缩压(SBP)、舒张压(DBP)、脉压差(PP)、空腹血糖(FBG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、睾酮(TS)、白细胞(WBC)、高敏CRP(hs-CRP)和白介素(IL)-6均有升高(P＜0.05,P＜0.01),而高密度脂蛋白胆固醇(HDL-C)、雌二醇(E2)、E2/TS降低(P＜0.05,P＜0.01).MS组DMBG干预后较干预前BMI、腰围、WHR、FPG、TG、LDL-C、TS、WBC、hs-CRP和IL-6均有降低,而HDL-C、E2和E2/TS升高(P＜0.05,P＜0.01). 结论老年女性MS患者与炎症关系密切,hs-CRP和IL-6可能是预测其发生发展的炎性标志物;DMBG在改善糖脂代谢的同时,还具有明显的抗炎作用和激素调节作用.     

辛伐他汀干预对缺血性脑卒中患者颈动脉粥样硬化斑块的影响

目的 评价辛伐他汀对缺血性脑卒中患者血脂及颈动脉粥样硬化斑块的影响.方法 40例缺血性脑卒中伴颈动脉粥样硬化的患者口服辛伐他汀20mg,每晚1次,治疗12个月,分别测定其治疗前后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、颈动脉内中膜厚度(IMT)及颈动脉斑块最大长度和厚度.结果 辛伐他汀治疗12个月后,患者TC、TG、LDL-C显著低于治疗前水平(P＜0.01),HDL-C水平明显升高(P＜0.01).颈动脉IMT及颈动脉斑块大小明显下降,与治疗前比较差异有统计学意义(P＜0.01).结论 辛伐他汀通过调脂,减少颈动脉内中膜厚度,对改善缺血性脑卒中患者颈动脉粥样硬化及稳定斑块有重要作用.     

原发性高血压患者合并代谢综合征加重血管内皮功能损害

目的 观察代谢综合征对原发性高血压患者颈动脉内膜中膜厚度(IMT)、肱动脉的舒张功能和高敏C反应蛋白(hsCRP)的影响.方法 EH患者148例根据是否合并MS,分为EH 非MS组(79例)和EH MS组(69例),选择同期健康体检者30例为正常对照(对照组),超声测定颈动脉IMT、肱动脉内皮依赖性血管舒张功能(FMD)和非内皮依赖性血管舒张功能(NMD),激光散射比浊法测定hsCRP.结果 与EH 非MS组患者比较,EH MS组患者的IMT[(1.0±0.3)VS(0.8±0.2)mm,P<0.01]和hsCRP[(0.9±0.4)vs(0.7±0.3)mg/L,P<0.01]显著增高,FMD[(5.5±4.0)%VS(8.9±3.5)%.P<0.05]和NMD[(13.5±4.1)%vs(20.1±3.9)%vs(26.7±3.3)%,P<0.01]显著降低.多元回归分析研究显示,IMT与收缩压、低密度脂蛋白胆固醇、空腹血糖和hsCRP相关(P<0.05或P<0.01).结论 EH和MS可损害内皮细胞及动脉的舒张功能,促进颈动脉内膜增厚和动脉硬化的发生发展.     

钙拮抗剂与利尿剂联合应用对高血压人群脂质代谢的影响

目的:评价利尿剂(双氢克尿噻)及与钙拮抗剂(尼群地平)合用对原发性高血压(EH)患者血脂的影响.方法:针对社区EH患者,应用双氢克尿噻2周,根据血压达标情况加用尼群地平(A组,68例),或继续维持小剂量双氢克尿噻(B组,67例)治疗,随访3个月,观察2组用药前后血压、心率、血脂的变化.结果:2组患者经治疗后血压、心率均有所下降(P＜0.05～0.01);3个月末B组TC、TG、LDL-C、HDL-C无变化(P＞0.05),A组用药后TC降低(P＜0.01).2组间TC、TG、LDL-C、HDL-C变化差异无统计学意义(P＞0.05).结论:钙拮抗剂与利尿剂联合应用治疗EH患者对血脂无不利影响.     

高尿酸血症与冠状动脉粥样硬化性心脏病的相关性

目的 探讨血尿酸水平在冠状动脉粥样硬化性心脏病(CAD)患者中的临床意义及其与血糖、血脂水平的相关性.方法 选取250例CAD患者作为观察组,随机抽取同期体检患者200例作为对照组.使用全自动生化分析仪检测尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG).结果 观察组高UA、高血糖、LDL-C升高及HDL-C降低的检出率均高于对照组(P＜0.01);观察组UA、血糖、LDL-C水平均高于对照组(P＜0.01),HDL-C水平均低于对照组(P＜0.01);SAP组、UAP组、和NSTEMI组血UA、血糖、TC、TG、LDL-C水平依次升高;HDL-C水平依次降低.结论 高UA血症在CAD的发生发展中具有重要的临床价值.血UA水平与血脂、血糖水平具有一定相关性.     

瑞舒伐他汀对颈动脉粥样硬化患者颈动脉内中膜厚度及血清炎症因子的影响

目的:观察瑞舒伐他汀对颈动脉粥样硬化患者颈动脉内中膜厚度(IMT)及血清炎症因子的影响,并了解瑞舒伐他汀出现临床治疗效果的时间点.方法:同期随机入选颈动脉粥样硬化患者81例为治疗组(口服瑞舒伐他汀10 mg/d),颈动脉内膜正常者52例为对照组,所有入选者低脂肪饮食.治疗前和治疗后6个月每月末检测血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hsCRP)及基质金属蛋白酶-9(MMP-9)浓度,并经超声检测颈动脉IMT.结果:治疗前治疗组血清TC、TG、LDL-C、hsCRP和MMP-9浓度及颈动脉IMT均高于对照组(P＜0.05～0.01),HDL-C低于对照组(P＜0.05),差异均有统计学意义.与治疗前比较,治疗组各观察指标从开始出现显著差异的时间点:从治疗后1个月开始血清TC、LDL-C、hsCRP及MMP-9明显下降,从2个月开始TG明显下降,从6个月开始颈动脉IMT明显降低,至6个月末均明显下降(P＜0.05～0.01);从3个月开始HDL-C明显升高,至6个月末均明显升高(P＜0.05～0.01),差异均有统计学意义.结论:瑞舒伐他汀具有良好的调脂、抗炎和抗颈动脉粥样硬化作用,治疗6个月后颈动脉IMT明显降低.     

高血压患者静息心率与代谢综合征

目的 探讨原发性高血压患者静息心率(RHR)与代谢综合征(MS)的关系及临床意义.方法 对323例符合原发性高血压的患者进行调查.每位患者均测RHR、血压、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素浓度(FINS)、胰岛素抵抗指数(IR).按RHR频率分RHR 1组＜75次/min(76例),RHR 2组75～79次/min(131例),RHR 3组80～85次/min(91例),RHR 4组＞85次/min(25例).结果 高血压患者不同RHR与FBG、TC、TG、LDL-C、FINS、IR正相关(r分别为0.61,0.28,0.45,0.41,0.36,0.54,P＜0.01),并随着RHR逐渐增加而升高.HDL-C随着RHR增加而下降(呈负相关,r=-0.41,P＜0.01);RHR 2与RHR3组之间腰围、血压无统计学意义(P＞0.05),但与RHR 1、RHR 4组有统计学意义(P＜0.0D.相关因素分析,高血压患者不同RHR与MS所聚集危险因素有关.结论 RHR可能与原发性高血压患者代谢紊乱有关.     

血脂、纤维蛋白原与脑梗死患者颈动脉粥样硬化的相关性研究

目的 探讨脑梗死患者颈动脉粥样硬化程度与血脂、纤维蛋白原的关系.方法 将脑梗死患者按颈动脉硬化程度分为内膜增厚组、斑块形成组和管腔狭窄组,分别测定总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(apoA)、载脂蛋白B(apoB)、脂蛋白(a)[Lp(a)]、纤维蛋白原(FIB)浓度,分析颈动脉粥样硬化程度与血脂、FIB的关系.结果 斑块形成组和管腔狭窄组TG、LDL-C、apoB、FIB浓度显著高于内膜增厚组和对照组,内膜增厚组TG、LDL-C、apoB、FIB浓度显著高于对照组(P均＜0.05).Logistic多元回归分析显示,颈动脉粥样硬化程度与LDL-C、Lp(a)、FIB呈显著正相关(P＜0.05,0.01).结论 LDL-C、Lp(a)、FIB是颈动脉粥样硬化的独立危险因素,及时检测脑梗死患者的血脂、FIB和颈动脉粥样硬化情况,对疾病的早期防治具有重要价值.     

代谢综合征患者血压变异性和心率变异性的临床研究

目的 通过观察代谢综合征(MS)患者血压变异性(BPV)和心率变异性(HRV),探讨MS对心血管系统自主神经功能的影响.方法 入选MS患者(MS组)110例及对照组46例,分别进行24h动态血压和动态心电图监测,对比分析两组的BPV和HRV的指标.结果 (1)MS组的一般资料(性别比、年龄)及HDL-C与对照组比较,差异均无统计学意义(P＞0.05);MS组的体质指数(BMI)、腰围(WC)、腰臀比(WHR)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、体脂含量(FATc)及体脂比例(FATp)与对照组比较,差异均有统计学意义(P＜0.05).(2)MS组BPV中9项指标均较对照组显著性增高(P＜0.05);其余3项(dDBPSD、nSBPSD及nDBPSD)指标升高,但无统计学意义(P＞0.05).(3)MS组HRV各项指标与对照组比较,差异均有统计学意义(P＜0.05).(4)MS与性别、吸烟、心血管病早发家族史、高血压、糖尿病、TG、FBG及MBI具有相关性(P＜0.05);与饮酒、TC、HDL-C及LDL-C无相关性(P＞0.05).结论 MS患者存在心血管系统自主神经功能紊乱,表现为BPV的显著升高和HRV的显著降低,其与性别、吸烟、心血管病早发家族史、高血压病、糖尿病、TG、FBG及MBI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.     

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.     

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.     

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.