钙拮抗剂降压治疗对心脑血管事件影响:随机临床试验汇总评估

目的 汇总分析抗高血压随机临床试验,评估钙拮抗剂(CCB)降压治疗对高血压或心血管病患者心脑血管事件及总死亡的影响.方法 入选试验的标准:以CCB为基础的降压治疗并以安慰剂或利尿剂/β阻滞剂为对照的前瞻性随机临床试验,且样本数在400人以上,研究终点包括脑卒中,冠心病及总死亡.汇总分析16个试验(包括113 035例患者),评估CCB长期治疗对高血压或心血管病患者心脑血管事件及总死亡的影响.结果 汇总分析表明: CCB与安慰剂比较(8个试验,29 545例多为老年高血压的患者),CCB明显减少了患者的脑卒中,冠心病,心力衰竭危险(31%,13%,34%)及总死亡(14%).CCB与利尿剂/β阻滞剂比较(8个试验,83 490例多为高血压伴高危因素的患者),CCB则轻度减少了脑卒中、冠心病危险(14%,9%)及总死亡(12%),但增加了心力衰竭危险(5%).结论 与安慰剂比较的试验汇总分析表明,CCB对心血管病或高血压患者长期降压治疗的有益证据是明确的;与利尿剂/β阻滞剂比较, 轻度降低脑卒中、冠心病及总死亡危险.     

ACE抑制剂降压治疗对心脑血管事件影响的随机临床试验的汇总评估

目的评估ACE抑制剂(ACEI)降压治疗对高血压或心血管病患者的心脑血管事件及总死亡的影响.方法计算机检索Medline数据库;逐个试验质量评价后用EasyMA软件处理.纳入试验的标准以ACEI为基础的降压治疗并以安慰剂或利尿剂/β阻滞剂为对照的前瞻性随机对照临床试验,且样本数400人以上,研究终点事件包括脑卒中,冠心病及总死亡.结果汇总分析12个试验(包括86 270例病人),评估ACEI长期治疗对高血压或心血管病患者心脑血管事件及总死亡的影响.汇总分析表明ACEI与安慰剂比较的试验(7个试验包括了39 737例,多为心脑血管病患者)显示ACEI显著降低脑卒中,冠心病,心力衰竭危险(25%,14%,22%)及总死亡(11%).ACEI与利尿剂/β阻滞剂比较的试验(5个试验,46 533例,多为高血压或糖尿病患者)提示ACEI轻度减少冠心病危险及总死亡(均为8%),对心力衰竭影响无明显差异,但相对增加脑卒中危险(10%).结论与安慰剂比较的试验汇总分析表明,ACEI对心脑血管病或高血压患者长期降压治疗的有益证据是明确的;与利尿剂/β阻滞剂比较则大同小异.     

ACE抑制剂降压治疗对心脑血管事件影响的随机临床试验的汇总评估

目的评估ACE抑制剂(ACEI)降压治疗对高血压或心血管病患者的心脑血管事件及总死亡的影响。方法计算机检索Medline数据库；逐个试验质量评价后用EasyMA软件处理。纳入试验的标准：以ACEI为基础的降压治疗并以安慰剂或利尿剂／β阻滞剂为对照的前瞻性随机对照临床试验，且样本数400人以上，研究终点事件包括脑卒中，冠心病及总死亡。结果汇总分析12个试验(包括86270例病人)，评估ACEI长期治疗对高血压或心血管病患者心脑血管事件及总死亡的影响。汇总分析表明：ACEI与安慰剂比较的试验(7个试验包括了39737例，多为心脑血管病患者)显示ACEI显著降低脑卒中，冠心病，心力衰竭危险(25％，14％，22％)及总死亡(11％)。ACEI与利尿剂／β阻滞剂比较的试验(5个试验，46533例，多为高血压或糖尿病患者)提示ACEI轻度减少冠心病危险及总死亡(均为8％)，对心力衰竭影响无明显差异，但相对增加脑卒中危险(10％)。结论与安慰剂比较的试验汇总分析表明，ACEI对心脑血管病或高血压患者长期降压治疗的有益证据是明确的；与利尿剂／β阻滞剂比较则大同小异。     

从ALLHAT研究结果评长效钙拮抗剂的安全性和有效性

大量随机对照的临床试验已经证实 :现在常用的几类一线降压药物 [利尿剂、β 受体阻滞剂、钙拮抗剂 (CCB)、血管紧张素转换酶抑制剂 (ACEI)及血管紧张素AⅡ受体阻滞剂(ARB)等 ]长期降压治疗可以显著减少高血压患者脑卒中、冠心病、心血管死亡及延缓肾功能衰竭的发生率。然而从1995年以来美国Furberg等[1] 对于CCB降压治疗提出非议 ,他们根据既往试验的荟萃分析、病例对照研究或一些小规模临床试验认为CCB尤其是短作用的CCB增加冠心病发病甚至死亡的危险 ,也增加癌症和消化道出血的危险 ,并且认为CCB对糖尿病患者和肾脏保护没有益…     

钙拮抗剂和ACEI预防脑中风的作用是否有区别？

2003年和2004年,降压治疗试验协作组(BPLTTC)和英国国家优秀临床研究所(NICE)分别荟萃分析了近期发表的几十项大型高血压临床试验,结果显示:与安慰剂比,钙拮抗剂(CCB)和血管紧张素转换酶抑制剂(ACEI)可使高血压患者发生脑卒中的风险分别降低38%和28%。二者的差异与各自的降低幅度不同有关:CCB与安慰剂的血压差异均值为-8/-4mmHg,ACEI的差异均值为-5/-2mmHg。综合CCB和ACEI两组,降压较多与降压较少的血压差异为-4/-3mmHg,降压较多的脑卒中相对风险比降压较少的降低了23%。与传统抗高血压药(利尿剂/β受体阻滞剂)比,ACEI在预…     

正确理解英国NICE指南定位β受体阻滞剂在高血压治疗中的作用

The Lancet的报道提示,心血管疾病的一级预防中,高血压患者在采用β受体阻滞剂长期治疗期间,与其他降压药物[利尿剂、血管紧张素转换酶抑制剂(ACEI)、钙拮抗剂(CCB)]的比较中并没有获得更大的利益,反而增加了脑卒中的风险16%。这可能与一些β受体阻滞剂对血糖、血脂的不良影响和对血管结构及功能改善较弱有关。重新审视β受体阻滞剂在心血管疾病的预防及一级预防地位十分重要。大型临床试验已证明,β受体阻滞剂可以肯定地用于稳定性心绞痛及心肌梗死的冠心病患者,同样可以治疗代偿及失代偿的稳定性心力衰竭患者;在国际及国内的心力衰竭…     

降压治疗对体位性低血压的影响及其与心血管病的关系

正体位性低血压(orthostatic hypotension,OH)是晕厥、脑卒中、心血管病和早期死亡的预测因子,也是中老年人患高血压的重要危险因素,与降压治疗和特定类别的抗高血压药有关,如α1受体阻滞剂、利尿剂和β受体阻滞剂。OH经常被认为是降压治疗的禁忌证,但缺乏证据。因此,研究者在一个2×3析因试验非     

高血压的降压药物治疗——从ALLHAT临床试验得到的启迪

高血压降压药物治疗已取得重要进展 ,传统的降压药物噻嗪类利尿剂和 β阻滞剂降压治疗的受益早已得到确认。近年来 ,一些新的降压药例如血管紧张素转换酶抑制剂 (ACEI)、钙拮抗剂 (CCB)、α受体阻滞剂及血管紧张素受体拮抗剂 (ARB)又相继应用于临床 ,ACEI和CCB与安慰剂的随机双盲对照试验已证实其在高血压患者可降低心血管事件 ,但这些新的药物是否比价格明显低廉的传统药物具有更多的优越性尚不明了。2 0 0 2年 12月在JAMA杂志发表的“降血压和降血脂预防心肌梗死临床试验 (anti hypertensiveandlipidloweringtopreventheartattac…     

ASCOT试验的启示

20 0 3年 4月ACC会议及Lancet杂志公布了ASCOT(Anglo Scandinaviancardiacoutcometrial)试验降脂分支(lipid loweringarm)的结果[1] 。ASCOT试验降脂分支是在比较二组降压药物控制血压的基础上对血脂“合适”或略高的患者加用阿托伐他汀。与安慰剂组相比 ,降脂治疗可使致死性冠心病及非致死性心肌梗死降低 36 % ,脑卒中降低2 7%。ASCOT试验是第一个评估高血压患者控制血压的同时 ,对于通常不认为是高血脂症的患者用他汀降脂对心血管病的一级预防效果的前瞻性临床试验。这个试验拓展了降低高血压患者的心血管病危险的思路 ,并提供了…     

高血压合并脑卒中二级预防降压药物的选择

目的探讨高血压合并脑卒中二级预防降压药物的合理选择。方法回顾性分析国内外有关脑卒中二级预防的临床研究及汇总分析等有关资料。结果高血压不但是脑卒中最重要危险因素,也是脑卒中复发的重要危险因素,有效地控制血压能显著减少脑卒中的复发,脑卒中的复发不但与血压下降幅度明显相关,也与脑卒中前的基础血压有关,不同种类的降压药对减少脑卒中的复发有一定的差别,这种降压药物的特性与脑卒中一级预防相似。结论脑卒中二级预防降压药物治疗的效果,利尿剂、钙离子拮抗剂(CCB)优于血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体阻滞剂(ARB)及β受体拮抗剂等。     

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.