女性冠心病临床特征研究进展

冠心病是影响女性身体健康和死亡的头号病因.由于性别、生理和社会环境的不同,与男性相比,女性冠心痛在危险因素、临床表现及其治疗预后上均有着不同程度的差异.当前女性冠心痛主要有如下特点:社会重视程度不足;危险因素较特殊;心肌缺血症状不典型;就医时危险因素多和病情重;治疗不够积极;病死率高.因此,当前有必要加强对女性冠心病的研究和诊治工作,以全面提高女性冠心病的防治水平.     

抑郁症与冠心病

抑郁症与冠心病之间存在密切联系,并被认为是心血管系统尤其是缺血性心脏病的另一种重要危险因素.产生抑郁的主要原因多涉及认知扭曲、生活中缺少令人愉快的事、人际间关系等问题,它从多方面影响冠心病发生、发展.抗抑郁药物治疗、心理社会干预以及运动疗法是冠心病合并抑郁症的主要治疗方法.SADHART和ENRICHD试验是目前针对冠心病合并抑郁患者进行药物及非药物治疗的最客观、权威的研究.     

非糖尿病更年期女性患者的心绞痛表现

目的分析未合并糖尿病的更年期女性患者的心绞痛特点，以及心绞痛对诊断冠心病的临床意义。方法回顾性分析1996年1月1日至2007年1月1日行冠状动脉造影的住院患者，完整记录胸痛的相关症状。以冠状动脉造影为金标准，比较在非糖尿病患者中，更年期女性组、对应年龄男性组及老年女性组的心绞痛特点，分析心绞痛不同表现类型对诊断冠状动脉明显狭窄的敏感性、特异性、准确性和患病率。结果2027例研究对象中，更年期女性组冠心病104例，表现为非心源性胸痛、不典型心绞痛和心源性心绞痛的患者分别为13例、26例和65例；对应年龄男性组冠心病662例，表现为非心源性胸痛、不典型心绞痛和心源性心绞痛的患者分别为92例、255例和315例；老年女性组冠心病414例，表现为非心源性胸痛、不典型心绞痛和心源性心绞痛的患者分别为64例、162例和188例。无论是胸痛一组症状（非心源性胸痛）、二组症状（不典型心绞痛）或三组症状（心源性心绞痛），对于冠状动脉明显狭窄的诊断均有一定意义。更年期女性组患者典型心绞痛诊断冠心病的敏感性及准确性均高于对应年龄男性组和老年女性组。结论在未合并糖尿病的更年期女性患者中，胸痛的国际临床分型对其冠心病诊断有意义，使用典型心绞痛症状的诊断准确性高。     

冠心病合并抑郁症的研究进展

冠心病的发病率和病死率较高,目前抑郁症已被研究证实是冠心病发生和不良预后的独立危险因素,两者共病可互为因果,相互影响,共同使患者病情恶化.冠心病合并抑郁症是双心医学中常见的疾病,现对冠心病合并抑郁症的发病特点、共病机制、早期筛查与评估治疗等方面的研究进展作一综述.     

冠心病合并抑郁症的治疗研究

目的总结冠心病合并抑郁症的治疗经验。方法收集2005年5月—2010年7月在我院住院治疗的56例冠心病合并抑郁症患者,除给予常规的冠心病治疗外,先给予心理治疗,对于心理治疗无效或疗效差者加用药物治疗。结果 46例患者症状好转出院,出院后继续接受冠心病及抗抑郁治疗,通过出院后定期随访,病情稳定,冠心病病情无加重,抑郁症亦逐渐好转,疗效较好。8例患者依从性差,拒绝服用抗抑郁药物,冠心病症状好转后转外院继续治疗,2例患者因冠心病病情危重死亡。结论心理治疗和药物治疗是提治疗高心病合并抑郁症疗效的有效措施。     

女性冠心病的特点

在许多国家,冠心痛都是发病率和死亡率居首位的疾病.在过去的20年,男性冠心病死亡率逐年下降,在女性却观察不到这种趋势.许多研究发现,女性冠心病在临床表现、发病机制、危险因素及诊断方面都和男性有所差异.现拟对女性冠心痛的特点作一综述.     

女性冠心病危险因素分析

目的通过对女性冠心病危险因素的分析．提高女性冠心病的防治水平。方法回顾性分析98例确诊为冠心病的女性住院患者,其中未绝经21例,已绝经77例,并从周围人群中抽取86例非冠心病女性作为对照组,进行对比分析。结果女性冠心病患者各项危险因素均高于对照人群,无论绝经与否均有统计学意义（P〈0．05）。两组人群中,未绝经女性和绝瘩．女性表现为各项危险因素的不同差异。结论女性冠心痛与多种危险因素相关,应综合检查和评定,大力推行冠心病一级和二级预防。     

疏肝解郁汤治疗冠心病合并抑郁症的临床研究

目的：观察疏肝解郁汤治疗冠心病合并抑郁症的临床疗效。方法将确诊为冠心病合并抑郁症的患者60例,随机分为治疗组和对照组,各30例,两组均给予冠心病常规药物治疗,治疗组在此基础上加用疏肝解郁汤口服,每次1袋（200 mL）,每日2次。治疗4周后对比两组临床疗效。结果治疗4周后,治疗组心绞痛疗效、心电图疗效、抑郁症疗效均优于对照组,差异有统计学意义（P〈0.05）;治疗组降低三酰甘油（TG）水平明显优于对照组,差异有统计学意义（P〈0.05）,而总胆固醇（TC）、低密度脂蛋白胆固醇（LDL C）、高密度脂蛋白胆固醇（HDL C）差异无统计学意义（P〉0.05）;治疗组降低 C反应蛋白（CRP）、血清同型半胱氨酸（HCY）水平优于对照组,差异有统计学意义（P〈0.05）。结论疏肝解郁汤对冠心病合并抑郁症有较好疗效,且可有效降低 TG、HCY、CRP水平。提示其对冠心病合并抑郁症的改善作用可能与增强机体抗氧化能力、减轻血管内皮损伤、抑制血管收缩、控制血管炎症反应有关。     

冠心病合并抑郁症研究的进展

冠心病和抑郁症严重影响患者健康，给家庭和社会带来沉重负担，且两种疾病之间具有密切的联系。抑郁可以预测冠心病的发生，冠心病可以引起抑郁的发生。本文就冠心病合并抑郁症的发病机制和治疗研究的进展作一综述。     

高血压病合并高尿酸血症与冠心病的关系

目的 探讨高血压病合并高尿酸血症在冠心病患病风险及冠状动脉病变程度评估中的价值.方法 选取临床疑诊冠心病的患者662例,根据高血压病与高尿酸血症的发病情况分为高血压病合并高尿酸血症组、单纯高血压痛组、单纯高尿酸血症组、无高血压病及高尿酸血症组.所有患者行冠状动脉造影并依据冠状动脉病变程度分为冠心病组和非冠心痛组,对冠状动脉病变程度的评估应用Gensini评分方法,观察高血压痛合并高尿酸血症与冠心病的关系.结果 冠心病组患者血尿酸水平(358.1±95.1 μmol/L)、高尿酸血症(30.8%)及高血压病(52.6%)患病率高于非冠心痛组(P＜0.05).高血压病、高尿酸血症是冠心病患病有意义的预测因子,二者存在交互作用,OR为1.17.高尿酸血症合并高血压病的冠心痛患者Gensini评分显著升高.高血压痛合并高尿酸血症的患病率与冠状动脉病变血管支数存在趋势性关系.结论 联合应用血尿酸与高血压痛对冠状动脉病变程度及患病风险评估可能有一定临床意义.     

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.