冠状动脉介入诊断治疗时那屈肝素与普通肝素联合应用的安全性研究

目的评价在无ST段抬高的急性冠脉综合征(ACS)患者行冠状动脉(冠脉)介入治疗(PCI)前后接受那屈肝素皮下注射与PCI术中普通肝素联合应用的安全性。方法190例ACS患者接受抗血小板治疗和2—4天那屈肝素治疗后分成3组：A组未行介入诊断和治疗,继续那屈肝素治疗;B组行冠状动脉造影(CAG)而未行PCI治疗;C组CAG后立即接受PCI治疗。B组和C组分别在停用最后1次那屈肝素注射后8—12小时内行CAG及CAG和PCI,介入操作时给予普通肝素,术后继续那屈肝素治疗。那屈肝素总的治疗时间不超过7天,观察10天期间出血发生情况。结果3组总的出血发生率分别为8．33％、12．7％和14．5％,差异无显著性。结论对接受抗血小板治疗的ACS患者,行PCI术前、术后那屈肝素皮下注射和术中普通肝素联合应用是安全的。     

经皮冠状动脉介入治疗中静脉注射那屈肝素的抗血栓疗效及安全性评价

目的比较经皮冠状动脉介入治疗(PCI)中静脉注射那屈肝素或普通肝素的抗血栓疗效及安全性.方法采用前瞻性、随机、单盲、多中心研究的设计,共入选98例因患冠心病需行PCI的患者,随机分为那屈肝素组(0.075 ml/10 kg,手术时间超过1 h补充半量)及普通肝素组(100 U/kg,手术时间超过1 h补充2000 U).PCI前静脉注射那屈肝素或普通肝素.那屈肝素组前22例患者分别在注射前、注射后8 min、1 h、2 h和4 h,用发色底物法测定血浆抗Ⅹa因子活性.出血程度的判断根据TIMI研究的标准进行.结果 (1) 性别、年龄、体重、血压、血红蛋白含量、红细胞压积、合并糖尿病的例数、冠心病类型、进行冠状动脉介入治疗的部位、介入治疗的手术方式及术前血浆cTNI>2 ng/ ml的例数在二组之间分布均衡,差异均无统计学意义;(2) 那屈肝素组前22例患者血浆抗Ⅹa因子活性测定显示,用药前、用药后8 min、1 h、2 h及4 h血浆抗Ⅹa因子活性分别为(0.10±0.00) IU/ ml、(1.89±0.24)IU/ ml、(0.96±0.24) IU/ ml、(0.47±0.13)IU/ ml和(0.30±0.12) IU/ ml.注射那屈肝素后8 min及1 h,所有患者血浆抗Ⅹa因子活性均在治疗水平(>0.5 IU/ ml),注射后2 h及4 h分别仅有45%及9%的患者血浆抗Ⅹa因子活性维持在治疗水平.(3)那屈肝素组术后血红蛋白数量、红细胞压积及出血指数分别为(129.5±13.6) g/L、(39.0±3.9)%和(1.16±5.80) g/L,与普通肝素组相似[分别为(125.5±14.9) g/L、(37.9±4.6)%和(0.90±6.5) g/L,P值分别为0.175,0.205和0.858);(4) 二组均无显微镜下血尿、无黑便或大便隐血阳性的患者;均无按TIMI试验标准所诊断的大出血或轻度出血的患者,无需要输血的患者;无穿刺部位的血肿;(5) PCI术后30 天内二组均无死亡、心绞痛复发及需行血管再通术等临床事件发生,那屈肝素组有1例患者PCI术后发生急性心肌梗死,普通肝素组无发生心肌梗死的病例,二组之间差异无统计学意义.结论 PCI术前注射那屈肝素能达到理想的抗血栓疗效; 与普通肝素相比,那屈肝素不增加出血事件和心血管病事件的发生率.     

非ST段抬高型急性冠状动脉综合征患者在介入治疗围术期应用磺达肝癸钠与那屈肝素的安全性和疗效比较

目的:在经皮冠状动脉介入治疗(PCI)期间接受较高剂量普通肝素的非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者中比较磺达肝癸钠与那屈肝素的安全性和疗效。方法:298例NSTE-ACS患者在早期PCI的上游随机接受磺达肝癸钠(磺达肝癸钠组146例)或那屈肝素(那屈肝素组152例)。两组PCI期间接受普通肝素的剂量为7000~10000 U(120~140 U/kg),合用替罗非班时为5000~7000 U(85~100 U/kg)。主要安全性终点为住院期间严重和轻微出血以及PCI术后48 h内的严重穿刺部位并发症。主要疗效终点为住院期间死亡、新发心肌梗死和再次靶血管血运重建。结果:磺达肝癸钠组主要安全性终点发生率低于那屈肝素组(5.5%vs 7.2%,风险比:0.63,95%可信区间:0.30~1.30),但差异无统计学意义(P=0.67)。两组间严重出血发生率相似(2.7%vs 2.6%,P=0.96)。磺达肝癸钠组轻微出血发生率低于那屈肝素组(2.7%vs 4.6%),但差异无统计学意义(P=0.39)。磺达肝癸钠组主要疗效终点发生率低于那屈肝素组(2.7%vs 4.6%,风险比:0.68,95%可信区间:0.21~2.64),但差异无统计学意义(P=0.59)。结论:在PCI期间接受较高剂量普通肝素的NSTE-ACS患者,围术期应用磺达肝癸钠与那屈肝素的安全性和疗效相当。     

早期那屈肝素预防脑出血患者深静脉血栓形成的安全性

目的 评价自发性脑出血(spontaneous intracerebral hemorrhage,sICH)患者早期皮下注射小剂量低分子肝素(low molecular weight heparin,LMWH)那屈肝素预防深静脉血栓形成(deep vein thrombosis,DVT)的安全性.方法 纳入早期使用那屈肝素或下肢间歇式充气加压装置(intermittent pneumatic compression,IPC)预防DVT的急性sICH患者.那屈肝素组从入院后第4天开始连续10 d皮下注射那屈肝素0.4 ml/d,IPC组使用IPC治疗.入院后第3天、第5天和第14天复查头颅CT评估血肿体积变化,记录治疗过程中的出血事件,彩色多普勒超声检查下肢DVT.结果 共纳入早期使用那屈肝素或IPC预防DVT的急性sICH患者94例,那屈肝素组41例,IPC组53例.共有14例发生下肢DVT,其中那屈肝素组5例(12.2％),IPC组9例(17.0％),但2组DVT发生率差异无统计学意义(x2 =0.418,P=0.518).治疗期间所有患者均未出现颅内血肿增大和再出血.结论 sICH患者早期皮下注射小剂量那屈肝素预防DVT是安全的.     

急性冠状动脉综合征介入治疗中应用那屈肝素的临床研究

目的 研究急性冠状动脉综合征患者在经皮冠状动脉介入治疗前应用那屈肝素的合适剂量并评估其安全性.方法 236例急性冠状动脉综合征高危患者随机分为Ⅰ组(那屈肝素0.075ml/10 kg,120例)和Ⅱ组(那屈肝素0.1 ml/10 kg,116例).两组给予相应剂量那屈肝素,每12 h皮下注射1次,至少48 h,最后一次注射1 h后行经皮冠状动脉介入治疗,术中不再追加那屈肝素.分别在末次注射前、注射后1 h、2 h、4 h、6 h、8 h测定血浆抗Xa因子活性.观察记录患者30 d内的主要心脏不良事件(死亡、再梗死、血运重建)及出血事件.结果 两组的一般临床资料、30 d内随访主要心脏事件及出血发生率差异均无统计学意义(P>0.05).各时间点血浆抗Xa因子活性Ⅱ组高于Ⅰ组,差异有统计学意义(P<0.01).结论 在急性冠状动脉综合征介入治疗前应用两种剂量那屈肝素均能达到有效的抗凝效果.     

国产比伐卢定在老年急性冠脉综合征患者介入术中治疗效果

目的 研究老年（年龄>65岁）急性冠脉综合征（ACS）患者在经皮冠脉介入（PCI）治疗术中使用国产比伐卢定的安全和有效性。方法 本研究通过回顾性分析我院35例PCI术中应用比伐卢定的老年ACS患者的临床资料,按1∶1匹配选取同期35例PCI治疗过程中常规应用普通肝素的老年ACS患者作为对照组,分析术后30 d内的主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)及出血并发症的发生情况。结果 两组临床资料对比,差异无统计学意义。术后30 d内MACCE发生率分别为4例（11%）和5例（14%）,差异无统计学意义;出血并发症发生率分别为1例（3%）和6例（17%）,比伐卢定组优于普通肝素组（P<0.05）。结论 老年ACS患者PCI术中使用比伐卢定与普通肝素相比,可减少术后30d内的出血事件发生率,且不增加MACCE的风险。     

低分子肝素在经皮冠状动脉成形术中的应用

目的　探讨低分子肝素在经皮冠状动脉成形术 (PCI)中应用的有效性和安全性。方法　将北京安贞医院心肺血管疾病抢救中心 2 0 0 1年 1 0月至 2 0 0 3年 1 1月收治的共 6 0 7例行PCI术的患者分为两组。A组为PCI术中常规用普通肝素 ,B组为术中用体重校正低分子肝素 (enoxaparin ,商品名 :克赛 )。A组 31 1例 ,其中男 2 0 3例 ,女 1 0 8例 ,平均年龄 (6 5 6± 4 0 )岁。B组 2 96例 ,其中男 2 0 0例 ,女 96例 ,平均年龄 (6 7 1± 3 5 )岁。结果　两组的一般临床资料比较差异无显著性。A组与B组手术成功率 (98 4%与 98 0 %)、30d内再次血运重建 (3例与 2例 )、30d内主要心血管不良事件 (各 2例 )、急性血栓形成 (均为 0例 )和周围血管并发症 (8例与 4例 )比较差异均无显著性 (P >0 0 5 )。结论　低分子肝素在PCI术中的应用是有效的、安全的。     

依诺肝素和那屈肝素治疗非ST段抬高的急性冠脉综合征

目的比较依诺肝素（enoxaparin，商品名克赛）与那屈肝素（nadroparin，商品名速碧林）对非ST段抬高的急性冠脉综合征患者临床预后的影响以及两组患者血浆中的血管性血友病因子（vWF）、高敏C反应蛋白（hs-CRP）水平是否有区别。方法 70名NSTE-ACS患者，随机分入依诺肝素组与那屈肝素组，比较两组随机入选后30天内的终点事件、出血事件的发生率。两组均检测入选时，低分子量肝素应用后4小时、12小时及66小时内血浆vWF、hs-CRP水平。结果 ①那屈肝素组患者与依诺肝素组患者在30天时经历的临床事件为10比12，差异无统计学差意义（P＞0.05）。②两组均未发生严重出血事件，那屈肝素组观察到4例微小出血事件，依诺肝素组为2例。③两组各时间点对应的vWF、hs-CRP水平无统计学差异（P＞0.05）。结论 对于NSTE-ACS患者的治疗，两种低分子量肝素（LMWH）在临床治疗效果及对炎性因子方面的作用是基本一致的。     

依诺肝素和那屈肝素治疗非ST段抬高的急性冠状动脉综合征

目的比较依诺肝素（enoxaparin）与那屈肝素（nadroparin）对非sT段抬高的急性冠状动脉综合征患者临床预后的影响以及患者血浆中的血管性血友病因子（von Willebrand factor，vwF）、高敏C反应蛋白（high sensitivity C reactiveprotein，hs-CRP）水平。方法非ST段抬高的急性冠状动脉综合征患者70例，随机分人依诺肝素组与那屈肝素组，比较两组30d内的终点事件和出血事件的发生率。两组均检测入选时，用药后4，12及66h血浆vWF、hs—CRP水平。结果①30d临床事件：那屈肝素组为10，依诺肝素组为12，差异无统计学差意义（P〉0．05）；②两组均未发生严重出血事件，微小出血事件：那屈肝素组4例，依诺肝素组2例；③两组各时间点对应的vWF、hs—CRP水平差异无统计学意义（P〉0．05）。结论对于NSTE—ACS患者的治疗，两种低分子量肝素治疗非ST段抬高的急性冠状动脉综合征效果及对炎性因子作用基本一致。     

择期PCI术前应用那屈肝素和达肝素钠安全性有效性的对比研究

目的:评价经皮冠状动脉介入(PCI)术前皮下注射那屈肝素和达肝素钠抗凝的安全性和有效时间。探讨2种药物抗Ⅹa因子活性与活化部分凝血活酶时间(APTT)及活化凝血时间(ACT)的关系。方法:选择行PCI术的患者101例,随机分为那屈肝素组(50例,0.01mL/kg)和达肝素钠组(51例,120IU/kg)均皮下注射,2次/d,应用至少48h后行PCI。测定血浆抗Ⅹa因子活性、ACT及APTT。观察术后1个月内出血并发症、死亡、急性心肌梗死情况。结果:1.4h后2组抗Ⅹa因子活性>0.5IU/mL均为92.0%以上;8h、12h后,那屈肝素组比例为74.0%、36.0%;达肝素钠组比例为54.9%、23.5%,2者间差异无统计学意义;24h、48h后,2组均为96.0%以上。2.2组抗Ⅹa因子活性与APTT在给药后4h、24h和48h呈正相关(P<0.05);与ACT差异无统计学意义。3.2组30d内均未发生不良临床事件,出血事件发生率相同。结论:择期PCI术前应用那屈肝素和达肝素钠抗凝安全、有效,强度至少可以维持8h。APTT能反应2种药物的有效抗凝强度,ACT则不能。     

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.