氯沙坦和阿替洛尔对高血压患者纤溶系统及血浆血管性血友病因子的作用比较

目的比较血管紧张素受体拮抗剂(ARB)氯沙坦和β受体阻滞剂阿替洛尔对原发性高血压患者纤溶系统及血浆血管性血友病因子(vWF)的影响。方法轻中度原发性高血压患者60例随机分成氯沙坦组和阿替洛尔组(每组30例),分别给予氯沙坦50mg/(次.d)或阿替洛尔50mg/(次.d),共治疗8周。每4周随访1次,4周时血压如不达标(BP<140/90mmHg)则加用双氢克尿噻12.5mg/(次.d)。治疗前后行血浆组织型纤溶酶原激活物(tPA)及纤溶酶原激活物抑制剂1(PAI-1)检测,并计算PAI-1/tPA作为纤溶参数,同时测定血浆vWF的含量。结果两组的基线血压等一般情况具有可比性。治疗4周及8周时两组血压均较治疗前显著下降,组间比较无差异。同治疗前相比,氯沙坦组治疗8周时血浆PAI-1和vWF水平下降(P值分别<0.05及<0.01),PAI-1/tPA也有显著下降(P<0.05),而tPA则无显著变化(P>0.05);阿替洛尔组治疗8周时血浆PAI-1和vWF水平及PAI-1/tPA均无显著变化,而tPA则有所上升(P<0.05)。治疗后血浆vWF两组间比较,差异有非常显著意义。结论氯沙坦治疗能改善原发性高血压患者的纤溶系统并降低血浆vWF,而阿替洛尔则未见有此作用。     

氯沙坦对高血压病人血压、凝血和纤溶活性的影响

目的观察高血压病人凝血和纤溶活性的改变,探讨血管紧张素Ⅱ受体拮抗剂氯沙坦对高血压病人血压以及凝血和纤溶系统的影响.方法将26例原发性高血压病人和30例正常对照组进行比较.所有入选对象1个月内未服任何降脂药物,停用降压药1周以上,禁食10h后,次晨抽取血样,测定各项指标.结果高血压病人胰岛素敏感性指数(ISI)和组织型纤溶酶原激活物(tPA)水平降低,而纤溶酶原激活物抑制剂-1(PAI-1)活性和血管性血友病因子(vWF)则升高.经多元逐步回归分析提示PAI-1与收缩压水平、总胆固醇和vWF呈显著正相关.高血压组给予氯沙坦50～100mg/d治疗,疗程6周,收缩压和舒张压明显下降;PAI-1活性较治疗前明显降低;而tPA活性较治疗前升高;ISI和vWF在治疗后无明显变化.结论高血压病人存在一定程度的胰岛素抵抗和凝血、纤溶功能紊乱.氯沙坦治疗能有效降低病人的血压,同时可以改善高血压病人的纤溶活性.     

氯沙坦对扩张型心肌病心力衰竭患者纤溶参数的影响

目的了解扩张型心肌病心力衰竭患者纤溶参数的变化,及氯沙坦对纤溶参数的影响.方法测定40名健康者和60例扩张型心肌痛心衰患者血浆纤溶酶原激活物(tPA)活性,纤溶酶原激活物抑制物-1(PAI-1)活性以及血管紧张素Ⅱ(AngⅡ)含量.将扩张型心肌病患者随机分成常规治疗组和氯沙坦组.治疗14天后复查tPA、PAI-1、AngⅡ. 结果与正常对照组相比,扩张型心肌病心衰患者tPA活性下降、PAI-1活性升高、AngⅡ含量上升(P＜0.01).治疗14天后,常规治疗组tPA与PAI-1的活性和AngⅡ含量无显著变化(P＞0.05);氯沙坦组tPA活性上升、PAI-1活性下降(P＜0.01),AngⅡ含量降低(P＜0.05).结论扩张型心肌痛心力衰竭患者纤溶参数明显异常,氯沙坦能改善纤溶参数活性.     

氯沙坦对高血压病人血压、凝血和纤溶活性的影响

目的：观察高血压病人凝血和纤溶活性的改变。探讨血管紧张素Ⅱ受体拮抗剂氯沙坦对高血压病人血压以及凝血和纤溶系统的影响。方法：将26例原发性高血压病人和30例正常对照组进行比较。所有入选对象1个月内未服任何降脂药物。停用降压药1周以上，禁食10h后，次晨抽取血样，测定各项指标。结果：高血压病人胰岛素敏感性指数（ISI）和组织型纤溶酶原激活物（tPA)水平降低，而纤溶酶原激活物抑制剂-1（PAI-1）活性和血管性血友病因子（vWF)则升高，经多元逐步回归分析提示PAI-1与收缩压水平，总胆固醇和vWF呈显著正相关。高血压组给予氯沙坦50-100mg/d治疗，疗程6周，收缩压和舒张压明显下降；PAI-1活性较治疗前明显降低；而tPA活性较治疗前升高；ISI和vWF在治疗后无明显变化。结论：高血压病人存在一窍不通程度的胰岛素抵抗和凝血、纤溶功能紊乱，氯沙坦治疗能有效降低病人的血压，同时可以改善高血压病人的纤溶活性。     

氯沙坦对原发性高血压患者纤溶功能的影响

目的观察氯沙坦对原发性高血压(EH)患者纤溶功能的影响。方法观察34例EH患者应用氯沙坦治疗4周后收缩压(SBP)、舒张压(DBP)、心率、血浆组织型纤溶酶原激活物(t-PA)、内皮细胞型纤溶酶原激活物抑制剂(PAI-1)水平的变化,并与30例健康人作比较。结果治疗前EH患者血浆t-PA水平明显低于对照组,而PAI-1水平明显高于对照组(均P<0.01)。氯沙坦治疗4周后,血压明显下降,心率无明显变化,血浆t-PA水平增加,但无统计学意义,而PAI-1水平明显降低,t-PA/PAI-1比值升高(均P<0.01)。结论EH患者存在着内源性纤溶功能紊乱,氯沙坦可以改善EH患者的纤溶功能。     

脑血管球囊成形支架置入术治疗急性脑梗死的疗效及其对患者纤溶系统的影响

目的 探讨脑血管球囊成形支架置入术治疗急性脑梗死（AI）的临床疗效及其对患者纤溶系统的影响.方法 将68例AI患者随机分为两组各34例,观察1组给予尿激酶100万U静脉溶栓治疗,观察2组行脑血管球囊成形支架置入术治疗,术后口服氯吡格雷和阿司匹林.观察两组血流再通疗效,并检测其治疗前及治疗后1、7d的血管性假血友病因子（vWF）、组织型纤溶酶原激活物（tPA）、纤溶酶原激活物特异性抑制物（PAI-1）变化.另选体检健康者30例作为对照组.结果 观察2组血流再通率高于观察l组,P＜0.05.与对照组比较,观察组治疗前vWF、PAI-1、tPA升高,tPA/PAI-1降低,P均＜0.05;观察l、2组比较P＞0.05.治疗后ld观察组tPA、tPA/PAI-1升高,PAI-1降低,P＜0.05;治疗后7d,观察1组tPA、tPA/PAI-1降低,观察2组vWF升高,P均＜0.05.结论 脑血管球囊成形支架置入术治疗AI可使梗死相关血管再通,其疗效优于静脉溶栓;术后联合抗凝及抗血小板治疗对患者的纤溶系统影响不大.     

氯沙坦和尼群地平对高血压病患者E选择素、冯维布兰德因子等活性的影响

目的对比研究氟沙坦和尼群地平对原发性高血压(EH)患者血浆可溶性E选择素(sE-sel)、冯维布兰德因子(vWF)、纤溶酶原激活抑制物-1(PAI-1)活性的影响.方法60例EH患者随机分为二组,分别予以氯沙坦(50mg/d)和尼群地平(30mg/d)治疗4周,治疗前后抽血用酶联免疫方法(ELISA)测定血浆sE-sel、vWF、PAI-1活性.另选择30例健康人作对照组.结果氯沙坦组和尼群地平组患者治疗前sE-selectin、vWF、PAI-1活性较对照组均明显升高(P＜0.01);EH患者治疗后血压均明显下降(P＜0.01),氯沙坦组血浆sE-selectin(P＜0.01)、vWF(P＜0.01)、PAI-1(P＜0.05)活性较治疗前均有明显降低,而尼群地平组治疗后上述指标较治疗前均无明显降低(P＞0.05).结论EH患者存在高血浆水平sE-sel、vWF、PAI-1,表明存在血管内皮细胞功能障碍;与尼群地平比较,氯沙坦在降血压同时还可改善EH患者的内皮细胞功能障碍.     

血管紧张素转换酶抑制剂对糖尿病大鼠血浆PAI-1和tPA活性的影响

目的 探讨血管紧张素转换酶抑制剂(ACEI)对糖尿病(DM)大鼠血浆纤溶酶原激活物抑制剂1(PAI-1)和组织型纤溶酶原激活物(tPA)活性的影响及其机制.方法 将链脲佐菌素诱导的DM大鼠分为正常对照组、培哚普利治疗组、培哚普利联合一氧化氮合酶(NOS)抑制剂治疗组.治疗4周后比较各组血浆PAI-1和tPA活性及PAI-1/tPA比值.结果 与正常对照组相比,DM大鼠血浆PAI-1活性和PAI-1/tPA比值显著升高,tPA活性降低.培哚普利治疗使PAI-1活性下降,tPA活性增加.联合NOS抑制剂在一定程度上抵消了培哚普利的这种作用.结论 DM状态下存在纤溶异常,ACEI能够通过内源性的NO改善纤溶平衡.     

老年高血压患者血浆纤溶水平与胰岛素抵抗的分析

目的了解老年高血压患者胰岛素抵抗(IR)、血浆纤溶水平改变及二者的关系.方法用放射免疫分析法检测42例老年高血压患者和32例老年健康对照者的空腹胰岛素(FINS),用酶联免疫法测定其血浆组织纤溶酶原激活物(tPA)及其抑制物-1(PAI-1).结果老年高血压患者的FINS、tPA和PAI-1水平较对照组明显升高(分别P＜0.001,0.01,0.001),其胰岛素敏感指数(ISI)相应降低(P＜0.05);FINS与tPA和PAI-1呈正相关(分别P＜0.01,0.001),ISI与上述二指标呈负相关(分别P＜0.05,0.01).结论老年高血压患者存在IR和血浆纤溶水平下降,其血浆纤溶水平的变化与该患者的IR有关.     

氯沙坦对扩张型心肌病心力衰竭患者纤溶参数的影响

目的：了解扩张型心肌病心力衰竭患者纤溶参数的变化，及氯沙坦对纤溶参数的影响。方法：测定40名健康者和60例扩张型心肌病心衰患者血浆纤溶酶原激活物（tPA)活性，纤溶酶原激活物抑制物－1（PAI－1）活性以及血管紧张素Ⅱ（AngⅡ）含量，将扩张型心肌病患者随机分成常规治疗组和氯沙坦组。治疗14天后复查tPA、PAI-1、AngⅡ。结果：L与正常对照组相比，扩张型心肌病心衰患者tPA活性下降、PAI－1活性升高、AngⅡ含量上升（P＜0．01）。治疗14天后，常规治疗组tPA与PAI－1的活性和AngⅡ含量无显著变化（P＞0．05）；氯沙坦组tPA活性上升、PAI－1活性下降（P＜0．01），AngⅡ含量降低（P＜0．05）。结论：扩张型心肌病心力衰竭患者纤溶参数明显异常，氯沙坦能改善纤溶参数活性。     

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.