肝细胞生长因子对急性心肌梗死后左室重构的预测作用

目的: 探讨血清肝细胞生成因子(HGF)对急性心肌梗死(AMI)后早期左室重构的预测价值。方法: 36例AMI患者入院时及发病7 d测定血清HGF水平;AMI其中的26例分别于发病后7~10 d及发病后3个月行超声心动图检查,3个月时左室舒张末期容积指数（LVEDVI）与7~10 d时比增加≥5 ml/m2定义为左室重构组(n=11),对两组血清HGF值进行比较。结果: AMI患者入院时血清HGF浓度较对照组明显升高［(809±288)ng/L vs.(620±162)ng/L,P<0.01］,7 d时升高更显著［(1 607±1 355)ng/L,P<0.01］。发病7 d时血清HGF浓度在左室重构组较非左室重构组升高［(2 216±1 522)ng/L vs.(1 176±593)ng/L,P<0.05］,而入院时两组浓度则无显著差异。结论: AMI时血清HGF浓度升高,AMI后7 d时增高的血清HGF可能预示心室重构。     

血清肝细胞生长因子测定对急性冠脉综合征患者的临床意义

目的探讨急性冠脉综合征(ACS)患者血清肝细胞生长因子(HGF)水平变化的临床意义。方法入选59例ACS患者(急性心肌梗死组n=36,发病12h以内;不稳定型心绞痛组n=23)于入院时肝素注射前取静脉血,通过酶联免疫法测定血清HGF浓度。同时对与之性别及年龄相匹配的27例正常人测定相同指标。结果血清HGF浓度在AMI组[(1572.9±229.0)pg/ml]、UAP组[(899.2±63.9)pg/ml]较正常对照组[(619.5±31.1)pg/ml]明显增高;AMI发病3h内血清HGF水平也比正常对照组增高[(893.2±61.6)pg/mlvs(619.5±31.1)pg/ml];A-MI组血清HGF浓度与入院时cTnI、CK-MB及CK-MB峰值均无相关性;ACS患者血清HGF浓度与入院时CRP呈显著相关性。结论ACS患者血清HGF浓度增高,且与疾病的严重性呈正比;HGF的产生可能与ACS的炎症反应有关;血清HGF有可能成为临床上诊断早期AMI的一个新指标。     

血清肝细胞生长因子测定对不稳定性心绞痛患者的临床意义

目的:探讨不稳定性心绞痛(UA)患者血清肝细胞生长因子(HGF)水平变化的临床意义.方法:用酶联免疫吸附法(ELISA)测定比较不稳定性心绞痛组(UA组,n=50)、稳定性心绞痛组(SA组,n=30)和对照组(n=30)心绞痛发作24小时内及治疗2周后血清HGF水平,其中UA组又根据冠状动脉(冠脉)造影时冠脉对硝酸甘油的反应分为有固定狭窄患者与无固定狭窄患者两部分.结果:UA组入院24小时内血清HGF水平比对照组和SA组均高[(1 674.54±1 450.03)pg/ml对(648.90±115.20)pg/ml和(728.53±288.14)pg/ml],有非常显著差异(P＜0.01),而且血清HGF水平与UA分型有关,UA组无固定狭窄患者血清HGF水平显著低于有固定狭窄患者[(848.44±146.49)对pg/ml(1 855.88±1 544.07)pg/m1,P＜0.01].UA组发病2周后血清HGF水平由(1 674.54±1 450.03)pg/ml下降至(880.71±201.75)pg/ml(P＜0.01);其中UA组在3个月内发生冠脉事件的5例患者2周后的血清HGF水平平均为(1 546.80±932.12)pg/ml,明显高于UA组患者的平均水平(880.71±201.75)pg/ml(P＜0.01).SA组经治疗后血清HGF水平变化不大(P＞0.05).结论:UA患者血清HGF动态升高;UA预后不良者血清HGF持续升高,血清HGF水平有可能成为临床上UA与SA鉴别以及对心绞痛危险分层的一个新的血清学指标.     

经皮冠状动脉介入治疗对急性心肌梗死患者血清血管内皮生长因子、高敏C反应蛋白及纤维蛋白原的影响

目的:探讨经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者血清血管内皮生长因子(VEGF)、高敏C反应蛋白(hs-CRP)及纤维蛋白原(Fg)的影响。方法:选择110例行PCI的AMI患者为AMI组,53例健康体检人员为对照组,比较AMI患者PCI术前及术后(术后30 min、24 h、72 h)血清VEGF、hs-CRP、Fg水平的变化,以及PCI术后AMI患者发生心脏不良事件(MACE)患者与无MACE发生患者24 h峰值血清VEGF、hs-CRP及Fg水平的变化。结果:(1)与对照组比较,AMI组术前、术后30 min、24 h、72 h血清VEGF(pg/ml,130.5±40.2、143.2±49.7、107.1±31.8、97.3±24.4 vs 84.7±21.4)、hs-CRP(mg/L,3.11±0.56、4.67±0.62、6.42±0.72、2.83±0.56 vs 1.03±0.34)、Fg(mg/L,4.79±0.52、5.02±0.54、5.54±0.67、4.11±0.44 vs 3.86±0.32)水平均升高,差异均有统计学意义(P均0.05);与AMI组术前比较,AMI组术后30 min、24 h、72 h血清VEGF先升高(峰值在术后30 min),后逐渐降低;而血清hs-CRP、Fg逐渐升高(峰值在术后24 h),后降低,差异均有统计学意义(P均0.05)。(2)AMI患者术后24 h出现MACE者38例,无MACE者72例。与无MACE者比较,MACE者术后24 h血清VEGF(pg/ml,155.5±42.8 vs131.7±36.5)、hs-CRP(mg/L,6.89±0.53 vs 5.68±0.62)及Fg(mg/L,5.66±0.55 vs 5.23±0.60)均升高,差异均有统计学意义(P均0.01)。结论:血清VEGF、hs-CRP及Fg水平的监测对PCI术后AMI患者有重要的临床应用价值。     

急性冠状动脉综合征患者载脂蛋白A5检测及其意义

目的 探讨血清载脂蛋白A5(APOA5)水平与急性冠状动脉综合征(ACS)患者血脂谱及高敏性C反应蛋白(hs-CRP)的关系.方法 入选587例受试对象,分为对照组(n=232)、稳定性心绞痛(SA)组(n=127)、不稳定性心绞痛(UA)组(n=116)和急性心肌梗死(AMI)组(n=112).抽血分离血清,分别采用ELISA法和免疫比浊法测定血清APOA5以及hs-CRP,并测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C).比较各组ApoA5、hs-CRP和血脂的血清浓度差异,分析三者之间的相互关系.结果 UA组[(340.6±63.5)μg/L]和AMI组[(373.2±73.8)μg/L]的ApoA5浓度明显高于对照组[(108.7±23.2)μg/L]和SA组[(78.3±20.2)μg/L](均P<0.05).UA组和AMI组的ApoA5与TG(r=0.63和0.67,P<0.05)和hs-CRP(r=0.57和0.55,P<0.05)呈正相关,而ApoA5与TC、HDL-c和LDL-C无明显相关(P>0.05).结论 ACS患者中血清ApoA5浓度显著升高,与血清TG或hs-CRP浓度显著正相关,提示ApoA5的代谢和生理功能在ACS期间均发生了变化,这可能与炎症反应增强有关.     

冠心病患者血清转化生长因子-β1与肝细胞生长因子的相关性

目的探讨血清转化生长因子(TGF)-β1和肝细胞生长因子(HGF)的水平变化对冠心病患者心功能的影响。方法采用酶联免疫吸附法(ELISA)测定急性心肌梗死(AMI)组(n=40)、不稳定型心绞痛(UAP)组(n=45)、稳定型心绞痛(SA)组(n=35)患者血清TGF-β1、HGF水平。结果对照组TGF-β1水平显著高于SA组、UAP组和AMI组(P0.05),且SA组TGF-β1水平显著高于UAP组和AMI组;SA组、UAP组和AMI组HGF水平显著高于对照组(P0.05);与SA组比较,AMI组、UAP组血清HGF显著高于SA组(P0.05),与UAP组相比,AMI组血清HGF浓度明显升高(P0.05)。冠心病患者血清TGF-β1水平与HGF呈负相关(r=-0.534)。结论血清TGF-β1和HGF可能参与冠状动脉粥样硬化的发生发展过程,TGF-β1和HGF在冠心病的发病机制中互为影响。     

尿液血管内皮生长因子作为早期糖尿病肾病诊断的生物学标志物

目的:评估尿液血管内皮生长因子(uVEGF)能否作为诊断早期糖尿病肾病(DN)生物学标志物。方法:选择2015年4月至10月于郑州大学第一附属医院就诊的2型糖尿病患者94例,分为正常白蛋白尿组(n=30),微量白蛋白尿组(n=33),大量白蛋白尿组(n=31),另选30例健康者作为对照组,用酶联免疫吸附法(ELISA)检测各组uVEGF水平。各组患者病程、血清肌酐、尿酸、空腹血糖、糖化血红蛋白等用Logistic回归分析DN相关临床指标,ROC曲线评估灵敏度及特异性。结果:与健康对照组uVEGF(18.44±0.73 pg/ml)相比,大量白蛋白尿组uVEGF(90.07±7.02 pg/ml,P0.001),微量白蛋白尿组uVEGF(75.88±9.60 pg/ml,P0.001)和正常白蛋白尿组uVEGF(33.11±5.20 pg/ml,P=0.02)均显著升高。uVEGF与尿白蛋白(r=0.748,P0.001)、病程(r=0.714,P0.001)、血清尿素氮(r=0.466,P=0.004)、估算的肾小球滤过率(r=0.437,P=0.005)、血清肌酐(r=0.412,P=0.013)和总胆固醇(r=0.377,P=0.023)成显著正相关。ROC曲线示:uVEGF早期诊断DN的cut-off值为42.573 pg/ml,敏感度为94.7%,特异度为96.4%。结论:uVEGF可作为早期DN诊断的生物学标志物。     

急性心肌梗死患者心肌损伤标志物检测在早期诊断中的应用价值分析

目的分析心肌损伤标志物在急性心肌梗死(AMI)早期诊断中的应用价值。方法选择2016年6月~2017年2月于重庆市开州区人民医院心血管内科重症监护病房(CCU)接诊的122例疑似AMI的胸痛患者为研究对象,其中86例确诊AMI患者作为观察组,36例非AMI患者作为对照组。检测两组患者发病早期包括发病3 h内、3~h、6~12 h血清中肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、肌红蛋白(Myo)、心脏脂肪酸结合蛋白(H-FABP)的浓度变化,探讨各指标在AMI发病早期诊断中的应用价值。结果与对照组相比,观察组患者血清中H-FABP、Myo在发病初期3 h内明显升高[(51.37±15.78)vs(0.31±0.12)]pg/ml、[(185.32±87.36)vs.(55.78±11.76)]ng/ml,差异具有统计学意义(P0.05),3~6h、6~12h内H-FABP、Myo含量仍然维持较高水平,差异具有统计学意义(P0.05)。与对照组相比,观察组CK-MB、cTnⅠ在发病初期3 h内差异无统计学意义(t=1.9415,P=0.0545)、(t=0.3961,P=0.6927),但在发病3~6 h、6~12 h含量增高,差异具有统计学意义(P0.05)。结论心肌损伤标志物H-FABP在AMI发病前3 h即明显升高,有利于早期发现AMI并及时治疗。Myo在AMI发病初期前3h也明显升高,但是由于特异性差,可以作为主要的辅助诊断指标。     

可溶性血栓调节蛋白和高敏C反应蛋白与冠心病的相关性研究

目的:探究可溶性血栓调节蛋白(sTM)、高敏C反应蛋白(hs-CRP)血浆浓度与冠心病(CHD)的相关性。方法:根据冠状动脉(冠脉)造影结果,收集兰州大学第一医院心内科对照组(108例)、稳定型心绞痛组(SAP组,67例)和急性冠脉综合征组(ACS组,222例),采用酶联免疫吸附法(ELISA)检测sTM和hs-CRP血浆浓度,分析sTM和hs-CRP血浆浓度与冠脉病变范围的相关性和对冠心病的诊断价值。结果:各组sTM血浆浓度差异均有统计学意义,其中ACS组SAP组对照组[(97.31±4.19)pg/ml(72.16±6.70)pg/ml(52.29±2.28)pg/ml,均P0.05];hs-CRP血浆浓度ACS组对照组,且差异有统计学意义[(2.91±0.08)μg/ml(2.55±0.09)μg/ml,P=0.012],对照组和SAP组、SAP组和ACS组差异均无统计学意义(均P0.05);病例组hs-CRP和sTM血浆浓度与冠脉病变范围无相关性(均P0.05);sTM和hs-CRP血浆浓度无相关性(r=-0.070,P=0.116);sTM和hs-CRP血浆浓度用于ACS的判断均有显著意义(P0.001,P=0.048)。结论:sTM和hs-CRP血浆浓度均可预测冠心病患者的斑块稳定性,且对ACS有一定的诊断价值,但均与冠脉病变范围不相关。     

急性冠脉综合征患者血清同型半胱氨酸和hs-CRP的相关性

目的:探讨急性冠脉综合征(ACS)患者血清同型半胱氨酸水平的变化,评价其与高敏C反应蛋白(hs-CRP)的关系。方法:用免疫比浊透视法测定60例ACS患者和30例对照组血清中hs-CRP水平,以循环酶法测定血清同型半胱氨酸(Hcy)水平。结果:ACS组Hcy水平[(16.75±6.40)mg/L]明显高于对照组[(13.70±6.60)mg/L],P<0.05,AMI组的hs-CRP和Hcy水平明显高于UAP组(P<0.05),且ACS组血清Hcy水平升高[(16.75±6.40)mg/L]时,患者血清hs-CRP水平[(4.475±16.09)mg/L]也相应升高,两者之间呈正相关(r=0.444,P<0.01)。结论:血清同型半胱氨酸水平升高与心肌损伤程度有关,且可能通过hs-CRP加重心肌损伤。     

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.