纤维蛋白原/白蛋白比值与急性心肌梗死患者介入治疗术后支架内再狭窄的关系

目的:探讨纤维蛋白原/白蛋白比值(FAR)与急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后发生支架内再狭窄(ISR)的关系。方法:选取2015-12-2016-12于我院心内科就诊的STEMI患者162例,根据术后复查造影结果分为ISR组和非ISR组,比较两组患者临床资料、实验室检查结果、心脏超声指标、冠状动脉病变情况、既往支架置入情况、服药情况等。采用多因素Logistic回归分析发生ISR的相关因素,受试者工作曲线(ROC)用于评价FAR对ISR的预测价值。结果:与非ISR组比较,ISR组患者血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)与三酰甘油(TG)水平明显增高(均P0.05),高密度脂蛋白胆固醇(HDL-C)、白蛋白水平与左心室射血分数(LVEF)明显降低(均P0.05)。两组患者年龄、性别、吸烟、高血压、糖尿病、术后服用β受体拮抗剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)、他汀类药物、抗血小板药物、病变血管及置入支架类型、数目和直径比较均差异无统计学意义,但ISR组置入支架的长度显著高于非ISR组(P0.05)。多因素Logistic回归分析显示,FAR(P=0.028,OR=19.092)、置入支架的长度(P=0.008,OR=1.214)、TC(P=0.012,OR=1.873)是ISR发生的独立危险因素,而LVEF(P=0.013,OR=0.915)、支架直径(P=0.047,OR=0.203)可能是ISR发生的保护因素。ROC曲线下面积为0.658(95%CI:0.579～0.731,P=0.0013),FAR的诊断临界值为1.19,此时敏感性为64.29%,特异性为70.15%。结论:FAR升高可独立预测冠状动脉支架置入术后ISR的发生,是ISR发生的危险因素。此外,TC与置入支架的长度也是ISR发生的危险因素。     

血清CTRP5水平与冠状动脉药物洗脱支架术后再狭窄的关系

目的:探讨血清补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)表达水平与冠状动脉(冠脉)药物洗脱支架置入术后支架内再狭窄(ISR)的相关性。方法:入选152例雷帕霉素支架置入术后至少1年且冠脉造影复查确诊为ISR患者(ISR组),并选择同期154例年龄和性别匹配但未发生ISR的患者为对照组。记录两组的临床特征、生化指标、冠脉病变和介入治疗情况。采用酶联免疫吸附法(ELISA)检测血清CTRP5水平。应用多因素Logistic回归分析,分析与ISR相关的因素。结果:与对照组相比,ISR组既往心肌梗死史、糖尿病和吸烟较多,血清CTRP5、超敏C反应蛋白(hs-CRP)、糖化血红蛋白和低密度脂蛋白胆固醇(LDL-C)水平显著增高,但左室射血分数减低(P均0.05)。尽管两组的冠脉病变支数和支架置入部位无显著差异,但ISR组支架直径较小、长度较长,分叉病变多见(P0.05)。Logistic回归分析显示,CTRP5、既往心肌梗死史、糖尿病、hs-CRP、支架长度是ISR的独立危险因素,而支架直径、左室射血分数与ISR呈负相关。结论:血清CTRP5水平升高可能与冠脉药物洗脱支架术后再狭窄发生有关。     

影响冠心病患者支架植入后支架内再狭窄的Logistic多因素回归分析

目的探讨影响冠心病患者支架植入后支架内再狭窄(ISR)发生的相关因素。方法回顾性分析2016年1月—2018年1月在四川省攀枝花市中西医结合医院接受经皮冠状动脉介入(PCI)治疗的387例冠心病患者的临床资料,根据PCI术后复查冠状动脉造影(CAG)结果将患者分为ISR组(n=41)和非ISR组(n=346)。比较两组患者临床资料,对影响PCI术后ISR发生的相关因素进行Logistic多因素回归分析。结果 Logistic多因素回归分析结果显示,糖尿病、支架直径、支架长度、支架数量、高hs-CRP浓度、疤痕体质引起的内皮过度增生是冠心病患者PCI术后发生ISR的独立危险因素(P0.05)。结论冠心病患者PCI术后发生ISR与合并糖尿病、支架直径、支架长度、支架数量、血清hs-CRP水平密切相关,临床应予以相应干预以降低ISR发生率。     

冠心病PCI术后支架内再狭窄的相关因素分析

目的分析冠心病患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的影响因素。方法选取2007年1月至2016年1月在遵义医学院附属医院心内科成功行支架植入术的冠心病患者1342例,依据复查造影结果分为ISR组(89例)和非ISR组(1253例)。回顾性分析两组患者病史资料、血液生物化学指标、心脏超声指标、冠状动脉病变、支架情况、服药情况及主要不良心血管事件(MACE)等,采用多因素Logistic回归分析其与冠状动脉支架术后ISR的关系。结果入选患者ISR发生率为6.6%。ISR组糖尿病患病率、术后吸烟率、停用阿司匹林、1年内停用氯吡格雷患者比例明显高于非ISR组(P0.05);ISR组服用大剂量他汀患者比例低于非ISR组(P0.05)。ISR组复杂病变、串联支架数高于非ISR组(P0.05);ISR组植入支架长度较非ISR组长(28.43±6.58 mm比26.27±7.08 mm,P=0.001);ISR组植入支架直径(2.92±0.41 mm比3.04±0.43 mm,P=0.003)、术后最小管腔内径(MLD)(2.44±0.34 mm比2.57±0.35 mm,P0.001)较非ISR组偏小;ISR组术后直径狭窄率高于非ISR组(8.46%比7.60%,P=0.018);ISR组早期获得低于非ISR组(1.77±0.43 mm比1.87±0.43 mm,P=0.043)。多因素Logistic回归分析显示,糖尿病、术后吸烟、停用阿司匹林、支架长度、支架直径、串联支架、术后MLD、术后直径狭窄率为冠状动脉支架术后ISR的独立危险因素。随访至8个月发现,ISR组复发心绞痛、靶病变再次血运重建(TLR)、复合MACE发生率明显高于非ISR组(P0.001);随访至1年发现,ISR组复发心绞痛、TLR、心肌梗死(MI)、复合MACE发生率明显高于非ISR组(P0.05)。ISR组支架血栓发生率明显高于非ISR组(P0.001)。结论糖尿病、吸烟、停用阿司匹林、支架直径、支架长度、串联支架、术后MLD、术后直径狭窄率是PCI术后ISR的危险因素,PCI术后ISR可能增加MACE发生率。     

支架植入术糖尿病患者支架内再狭窄COX风险分析

目的探讨糖尿病患者支架植入术后支架内再狭窄(ISR)的危险因素及其相关性。方法 120例接受冠状动脉支架植入术的糖尿病患者,按术后是否存在ISR分为:狭窄组36例,术后存在ISR;对照组84例,术后证实无ISR。回顾性分析比较两组性别、年龄、吸烟史、血脂水平、血糖水平、凝血常规、狭窄程度、支架部位、支架类型、支架数量、支架直径、支架长度、抗血小板治疗等因素的差异。通过计算机COX比例风险模型,对术后发生ISR可能的特征性影响因素进行多因素分析。结果与对照组相比,狭窄组性别、吸烟史、血清低密度脂蛋白水平、糖化血红蛋白(Hb A1c)水平、纤维蛋白原、支架类型、支架数量、支架直径、支架长度、接受双重抗凝治疗的比例存在显著差异(P0. 05)。Cox回归分析显示吸烟史、Hb A1c水平、支架类型、支架直径及支架长度是术后ISR发生的危险因素(P0. 05)。结论吸烟、长期血糖控制不良、使用非药物涂层支架、应用小直径及长支架的糖尿病患者支架植入术后ISR的可能性较高。     

氯吡格雷正常代谢型患者药物支架术后再狭窄的相关因素分析

目的:分析氯吡格雷正常代谢型冠心病患者冠状动脉介入术(PCI)后支架内再狭窄(ISR)发生的相关因素。方法:选择2014-01-2017-12于贵州省人民医院心内科住院的冠心病PCI术后复查造影的患者1 210例,行CYP2C19基因多态性检测,其中1 050例(86.8%)为正常代谢型,根据有无ISR将其分为再狭窄组(ISR组,115例)和无ISR组(NSR组,935例)。比较两组患者的临床资料、并发症、血脂及术后用药等指标。结果:ISR组与NSR组年龄、性别、BMI、合并高血压、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)等指标均无显著差异。Logistic回归分析显示,ISR组糖尿病、慢性肾脏病(CKD)、吸烟、低密度脂蛋白胆固醇(LDL-C)水平高、长支架(≥29 mm)、小血管内径(≤2.5 mm)及分叉病变的患者比例明显高于NSR组(均P0.05),高密度脂蛋白胆固醇(HDL-C)水平高、单支架、规律运动、服用钙拮抗剂明显低于NSR组(均P0.05)。结论:对于氯吡格雷正常代谢型冠心病患者,糖尿病、CKD、吸烟、LDL-C、长支架、细支架、分叉病变是ISR的独立危险因素,而HDL-C、单支架、规律运动及同时服用钙拮抗剂是ISR的保护因素。     

骨保护素与冠心病合并糖尿病患者冠状动脉支架内再狭窄的关系

目的探讨血清骨保护素(OPG)与冠心病合并糖尿病患者冠状动脉介入术后支架内再狭窄(ISR)的关系。方法在行经皮冠状动脉介入治疗并于约1年后行冠状动脉造影复查的1 652例糖尿病患者中,135例为ISR患者(ISR组),从其余患者中随机选取85例无ISR的冠心病合并糖尿病患者作为对照(无ISR组)。检测血清OPG水平及生物化学指标,并收集患者的临床资料。通过多变量Logistic回归分析发生ISR的独立危险因素。结果 ISR组血清OPG水平显著高于无ISR组(P<0.001)。与无ISR组相比,ISR组患者的吸烟发生率更高,血清肌酐、总胆固醇、高敏C反应蛋白、低密度脂蛋白胆固醇水平更高,冠状动脉病变更严重,累及的血管更多,肾小球滤过率更低,使用降糖药物治疗患者更少,支架直径更小(P均<0.05)。将血清OPG水平按三分位数分组,在校正了可能的混杂因素后,多变量Logistic回归分析显示血清OPG高水平组发生ISR的风险是低水平组的5.349倍(OR=5.349,95%CI为2.049～13.967,P=0.001),中水平组发生ISR的风险是低水平组的2.711倍(OR=2...     

纤维蛋白原/白蛋白比值对STEMI患者PCI术后发生支架内再狭窄的诊断价值

目的：分析纤维蛋白原/白蛋白比值（FAR）对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后发生支架内再狭窄(ISR)的诊断价值。方法：对2016年1月至2017年12月我院收治的39例PCI术后发生ISR的STEMI患者（研究组）以及同期行PCI术后未发生ISR的75例STEMI患者（对照组）进行回顾性分析。记录并比较两组患者入院后、进行干预前的生化指标、心脏超声指标以及相关手术资料。采用多因素Logistic回归法分析ISR发生的危险因素,应用ROC曲线分析FAR对PCI术后ISR的诊断价值。结果：两组空腹血糖、糖化血红蛋白、餐后2h血糖、总胆固醇、低密度脂蛋白、纤维蛋白原以及白蛋白比较,差异无统计学意义（P>0.05）;与对照组比较,研究组左心射血分数明显降低,而FAR值明显升高,差异有统计学意义（P<0.05）。两组靶病变血管、置入支架的类型、支架个数、支架直径以及PCI术后所服药物比较,差异无统计学意义（P>0.05）;与对照组比较,研究组患者支架长度明显较长,差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,较大的FAR和支架长度是ISR发生的独立危险因素,而较大的左心射血分数是ISR发生的保护因素（P<0.05）。ROC曲线分析结果显示,FAR预测PCI术后ISR发生的曲线下面积为0.702（95%CI：0.642~0.787）,最佳诊断临界值为1.17,此时FAR对ISR发生的敏感性为69.72%,特异性为71.34%。结论：FAR和支架长度是ISR发生的独立危险因素,而左心射血分数是ISR发生的保护因素。FAR升高可独立预测PCI术后ISR的发生。     

冠状动脉慢性完全闭塞病变PCI后支架内再狭窄的预测因素分析

目的:探讨冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的预测因素。方法:选择241例成功行PCI的CTO患者,分为ISR组(43例)和非ISR组(198例),分析导致ISR的可能性因素。结果:ISR组和非ISR组在糖尿病、既往行PCI术、既往心肌梗死、慢性肾功能不全、冠状动脉完全闭塞长度≥20mm、支架总数、支架总长度、平均支架直径、血管内超声(IVUS)引导、成功逆向介入方面,差异均有统计学意义(均P0.05)。多因素logistic回归分析显示,糖尿病、慢性肾功能不全、既往PCI术、既往心肌梗死、成功逆向介入、支架总数、平均支架直径是CTO病变ISR的独立预测因子。结论:CTO病变PCI后ISR发生率较高,糖尿病、慢性肾功能不全、既往PCI术、既往心肌梗死、成功逆向介入、支架总数、平均支架直径是其独立预测因素。     

血浆中基质交感分子1水平与经皮冠状动脉介入术后支架再狭窄的相关性研究

目的探讨血浆中基质交感分子1(STIM1)水平与经皮冠状动脉介入治疗(PCI术后支架内再狭窄(ISR)的相关性。方法选取营口市中心医院2016年6月至2018年6月收治的100例成功接受PCI的冠心病(CHD)患者作为研究对象,术后8个月患者均行冠状动脉造影,对PCI术前和术后STIM1水平进行检测。根据是否发生ISR,将患者分为ISR组和无ISR组(NISR组)。采用Pearson相关分析STIM1水平与PCI术后ISR的相关性,多元线性Logistic回归分析STIM1对PCI患者发生ISR的影响。结果中位随访时间18.2个月,发生ISR患者共36例,NISR组64例。两组患者吸烟史、合并高血压、糖尿病、高血脂、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、植入支架数、支架长度、病变血管数及术前STIM1比较差异无统计学意义(P 0.05)。ISR组和NISR组C反应蛋白(CRP)、术后STIM1、支架直径和术后最小管腔内径比较差异有统计学意义(χ2/t=9.343、8.278、5.991、5.966,P 0.05)。多因素Logistic回归示,术后STIM1、支架直径和术后最小管腔内径是PCI术后ISR的独立危险因素(OR=1.811、2.344、3.515,P 0.05)。STIM1水平与PCI术后ISR呈正相关(r=0.675,P 0.05)。结论 STIM1水平与PCI术后ISR密切关联,是PCI术后ISR的独立危险因素。     

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.