低蛋白饮食治疗早期慢性肾功能不全的临床观察

目的:观察分别以低蛋白面粉(含蛋白质0·9%,热卡344Kcal/100g)为主食和普通大米、面粉为主食的不同低蛋白饮食治疗早期慢性肾功能不全的疗效。方法:病情稳定的慢性肾功能不全患者60例,均符合以下条件:(1)原发病为原发性肾小球疾病,血清肌酐(SCr)1·3~3·0mg/dl;(2)年龄18~70岁,性别不限;(3)原发疾病无明显活动迹象,双肾缩小;(4)尿蛋白<1·5g/24h,尿红细胞<50万/ml;(5)血压控制低于140/90mmHg。原发疾病仍有活动或伴有严重贫血、营养不良、感染、出血、肝功能不全、心功能不全及糖尿病患者不入选。患者随机分为低蛋白面粉饮食组(n=30)和普通低蛋白饮食组(n=30),观察6个月。两组蛋白质摄入量0·6g/(kg·d),以鸡蛋、牛奶、瘦肉等优质蛋白质,补充主食以外摄入不足的蛋白质部分,保证热卡摄入量30~35Kcal/(kg·d)(按理想体重计算)。由专人个体化制订每周食谱,定期饮食指导,并通过每月连续3日饮食记录表,调查和计算患者的实际营养素摄入量。观察两组治疗前后人体测量参数、血生化、尿蛋白定量等指标,计算饮食蛋白质摄入量(DPI)和肾小球滤过率(GFR)。结果:(1)病例退出原因:两组各有5例患者退出研究,其中治疗组2例不耐受长期服用面食、要求改用大米,2例常不能在家中就餐、无条件按要求烹调低蛋白面粉,另1例外地患者因面粉携带不便、拒用;对照组4例未能按制订的食谱控制饮食,蛋白质摄入过多,另1例未按要求随访;(2)两组各有25例完成研究,治疗组和对照组DPI分别为(0·61±0·02)g/(kg·d)和(0·63±0·04)g/(kg·d),两组无差异;(3)两组患者治疗前后体重、体重指数、臂中肌周径和上臂围均无显著变化;(4)对照组总蛋白、白蛋白和前白蛋白轻度下降(P>0·05),治疗组保持稳定;(5)治疗组BUN下降明显(P<0·01),对照组无下降。治疗组SCr显著下降,对照组在2个月和4个月时SCr上升(P<0·05),但至6个月时与基础值无差异;治疗组GFR上升(P<0·05),而对照组在2个月和4个月时GFR下降(P<0·05),但在6个月时与基础值无差异;两组GFR下降的速率分别为-0·31(ml/min·1·73m2)/月和0·28(ml/min·1·73m2)/月。(6)治疗组尿蛋白定量下降,对照组无明显变化,治疗前尿蛋白定量升高的患者中治疗组和对照组分别有7/13(53·8%)和4/15例(26·7%)降至正常范围(P>0·05)。结论:6个月的初步研究表明,以低蛋白面粉为主食的优质低蛋白饮食对肾功能和尿蛋白的疗效优于普通低蛋白饮食,营养状况稳定,患者的顺应性和耐受性好。     

不同剂量多巴酚丁胺对短期冬眠心肌室壁运动的影响及其与血流动力学关系

目的:观察不同剂量多巴酚丁胺对短期冬眠心肌室壁运动及心肌氧耗量的影响。方法:选择10条犬为研究对象,通过缩窄冠状动脉左前降支建立短期冬眠心肌模型。在缺血90分种后分别以不同剂量的多巴酚丁胺(2.5、5、10、15μg·kg~(-1)·min~(-1))持续静脉输入,用二维超声和彩色室壁运动分析(CK)观察室壁运动的变化,同时经左心导管监测心肌耗氧量的变化。结果:9条犬成功建立短期冬眠心肌模型。多巴酚丁胺剂量达5μg·kg~(-1)·min~(-1)时,心肌耗氧量的增加,剂量增大到10～15μg·kg~(-1)·min~(-1)时,心肌耗氧量进一步增加。多巴酚丁胺剂量为2.5μg·kg~(-1)·min~(-1)、5μg·kg~(-1)·min~(-1)时,前壁增厚率逐渐恢复、CK色带增宽(P<0.01)。而当剂量增大到10μg·kg~(-1)·min~(-1)、15μg·kg~(-1)·min~(-1)时,可见原已恢复的室壁运动减弱(P<0.01)。收缩期CK色带宽度和室壁增厚率呈高度相关性(r=0.957,P<0.01)。结论:短期冬眠心肌对多巴酚丁胺负荷呈双向反应。剂量为2.5～5μg·kg~(-1)·min~(-1)时,室壁运动明显增强,而10～15μg·kg~(-1)·min~(-1)时,室壁运动恶化,结果可能与心肌耗氧量增加有关。收缩末期CK色带宽度与二维超声测量的室壁增厚率有很高的相关性,可准确反映收缩期室壁运动。     

联合应用氨力农和多巴胺治疗感染性休克患者的临床体会

目的:评价联合应用氨力农和多巴胺治疗感染性休克患者右心室功能不全的临床疗效。方法:40例感染性休克患者,随机分为两组,A组18例患者给予多巴胺2～5μg·kg~(-1)·min~(-1)持续静脉滴注,B组22例患者行氨力农10μg·kg~(-1)·min~(-1)联合多巴胺2～5μg·kg~(-1)·min~(-1)持续静脉滴注,运用REF-1~(TM)右心功能监测仪,观测治疗前及72h后患者右心室射血分数(RVEF)、肺血管阻力指数(PVRI)、中心静脉压(CVP)、右心室舒张末容积指数(RVEDVI)、心排指数(CI)、肺动脉嵌压(PAWP)和右心室作功指数(RCWI)的变化;运用Seldinger技术,结合HP监护仪,观测治疗前后收缩期动脉血压(SBP)的变化。结果:与治疗前相比,B组患者RVEF和RCWI显著增加,PVRI和RVEDVI明显下降,CI下降,SBP升高,CVP和PAWP无显著性改变;A组患者除收缩压明显升高外,其余指标均无显著性变化。两组患者死亡率分别为33.33％(6/18)对13.64％(3/22),P<0.05。结论:联合应用氨力农和多巴胺可迅速纠正患者的休克状态,改善右心室功能不全,降低患者死亡率。     

多巴酚丁胺负荷超声心动图试验在心肌梗死冠脉重建术前后判定存活心肌的对比研究

目的:采用多巴酚丁胺负荷超声心动图(DSE)试验评价心肌梗死(MI)病人冠脉重建术(CRV)后心室运动功能恢复的临床意义。方法:选择30例急性心肌梗死病人,在冠脉重建术前、术后6个月,以不同剂量多巴酚丁胺(5、10、15、20、25、30μg·kg~(-1)·min~(-1))连续静注5min后,用二维超声心动图观察患者室壁运动异常(WMA)节段的变化。结果:在不同剂量多巴酚丁胺下,CRV前后患者的心率、收缩压均呈升高反应(P<0.05),WMA均有不同程度上的改变(P<0.05)。结论:DSE试验是识别MI区域存活心肌有价值的方法之一。多巴酚丁胺从5μg·kg~(-1)·min~(-1)开始有效,10～15μg·kg~(-1)·min~(-1)达高峰,≥20μg·kg~(-1)·min~(-1)则在术前对部分病人有诱发心肌缺血,使收缩功能恶化及频发室早出现。     

恶性肿瘤化疗后粒细胞集落刺激因子应用时间的临床探讨

40例患者分治疗组及对照组各20例,治疗组化疗结束24 h后即开始皮下注射粒细胞集落刺激因子(G-CSF)2～3μg·kg~(-1)·d~(-1)(一般100～150μg/d),连续3d;对照组在化疗结束后第1～5天复查血象,白细胞低于4.0×10~9/L,即每日皮下注射G-CSF2～3μg·kg~(-1)·d~(-1),连续3d或至白细胞≥4.1×10~9 L。结果:G-CSF可有效防止白细胞过度下降,并可使其     

PGE_1对ARDS肺动脉高压症的疗效和肺气体交换的作用

最近输注前列腺素E_1(PGE_1)0.03mg·kg~(-1)·min~(-1) 7天,可改善ARDS 患者的存活,但此肺血管扩张作用很少证明对气体交换有作用,故作者对6例继发于ARDS 肺动脉高压症患者给PGE_I,测定血气、血液动力学和通气/灌注比((?)A/(?)),以评价其血管扩张作用。患者6例(男4,女2)年龄31～79岁,临床和放射学符合ARDS 诊断标准,全部患者平均肺动脉压>20mmHg,皆以呼气末正压(PEEP)通气.用自动血气分析器测量动脉和混合的静脉血气,多惰性气体排除法测定(?)A/(?)分布,5例患者用PGE_1 0.04μg·kg~(-1)·min~(-1)输注,1例用0.02μg·kg~(-1)·min~(-1).     

低蛋白饮食合并肾灵治疗慢性肾衰的疗效评价

对6例慢性肾功能衰竭患者采用治疗前的低蛋白饮食(LPD)后及LPD合并肾灵(LPD+EAA+KA)后自身对照的研究。结果显示:LDP+EAA+KA治疗后,Scr下降(P<0.01),Ccr提高(P<0.05),血BUN未有变化,血浆总必需氨基酸与总非必需氨基酸比率、支链氨基酸浓度均升高,且机体由负氮转为正氮平衡(P<0.005);蛋白质合成与分解率明显提高(P<0.001)。整个实验过程中,血浆钙、磷、总蛋白与白蛋白无明显变化。     

硝酸甘油介入小剂量多巴酚丁胺心电图试验识别冬眠心肌的临床研究

目的 观察小剂量多巴酚丁胺(Dobu)合用硝酸甘油心电图负荷试验识别冬眠心肌的准确性和安全性。方法 陈旧性心肌梗死患者30例,行小剂量Dobu(5～10μg·kg~(-1)·min~(-1))及其合用硝酸甘油心电图负荷试验。在试验前、低剂量期(5μg·kg~(-1)·min~(-1))和峰值剂量期(10μg·kg~(-1)·min~(-1))行超声心动图及心电图检查,计算心电图识别冬眠心肌的准确性。结果 30例中检出冬眠心肌19例。ST段偏移识别冬眠心肌的敏感性、特异性和准确性分别为47.4％、90.9％和63.3％,若与T波假正常化相结合则可达84.2％、81.8％和83.3％,且无诱发心绞痛。结论硝酸甘油介入小剂量Dobu心电图负荷试验是识别冬眠心肌简便、安全、特异、中度敏感的指标。     

低蛋白合并α-酮酸饮食对被动型Heymann肾炎大鼠肾小球足细胞Nephrin表达的影响

目的 观察低蛋白合并α-酮酸饮食对被动型Heymann肾炎大鼠肾小球足细胞Nephrin表达的影响.方法 将40只SD大鼠分为对照组、模型组(PHN组)、低蛋白饮食组(LPD组)和低蛋白合并α-酮酸饮食组(LK组),对照组经尾静脉注射1 mL/100 g生理盐水,其他三组经尾静脉注射1 mL/100 g新西兰大耳兔抗FX1A血清.对照组、PHN组饮食蛋白占饲料质量的10％,LPD组饮食蛋白占饲料质量的5％,LK组饮食蛋白占饲料质量的5％(其中α-酮酸提供1％的蛋白).4周后检测各组24 h尿蛋白定量、血清肌酐、TG、TC及血清白蛋白,激光共聚焦显微镜免疫荧光检查大鼠肾小球足细胞Nephrin表达情况.结果 激光共聚焦显微镜显示,PHN组、LPD组肾小球内Nephrin荧光强度较对照组明显减弱,且部分节段有缺失;LK组肾小球内Nephrin荧光强度较对照组减弱.结论 低蛋白合并α-酮酸饮食对被动型Heymann肾炎大鼠具有肾脏保护作用.     

PGE_1对ARDS患者释氧量和耗氧量的影响—PGE_1多中心研究结果

为了观察PGE_1连续输注对氧运输的远期效果,作者回顾性分析了美国13个医学中心的PGE_1双盲随机对照实验的临床资料。实验组受试者50例,均为创伤、手术或败血症所致的ARDS 患者.用PGE_12.5mg 溶于5ml 无水乙醇中,以0.9%生理盐水或5%葡萄糖水稀释至1000ml;安慰剂组亦50例,采用5ml 无水乙醇加以稀释,其稀释度相同.经中心静脉导管或肺动脉插管输入,初始浓度为5ng·kg~(-1)·min~(-1),每隔半小时增加5ng·kg~(-1)·min~(-1),最终浓度30ng·kg~(-1)·min~(-1),连续7天,欲结束输注时,需     

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.