冠心病患者血浆血栓调节蛋白水平的测定及其临床意义

目的　测定冠心病患者血浆血栓调节蛋白 ( throm bom odulin,TM)水平并探讨其临床意义。方法　急性心肌梗死、不稳定型心绞痛、稳定型心绞痛三组患者及正常对照组 ,抽取血浆并用酶联免疫吸附试验测量其血浆 TM水平。结果　急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组血浆 TM水平均高于正常对照组 ( P<0 .0 5 ) ;急性心肌梗死组与不稳定型心绞痛组间患者血浆 TM水平没有显著性差异 ( P>0 .0 5 ) ,但均高于稳定型心绞痛组和正常对照组 ( P<0 .0 5 )。结论　血浆可溶性 TM水平是反映冠心病患者内皮细胞损伤程度和范围的良好标志 ,对急性心肌梗死、不稳定型心绞痛、稳定型心绞痛的鉴别有一定的临床指导意义     

巨噬细胞炎症蛋白1α与冠状动脉粥样硬化斑块病变相关性

目的 研究血浆巨噬细胞炎症蛋白1α水平在冠状动脉粥样硬化性心脏病患者的变化及与冠状动脉粥样硬化斑块病变严重程度及宽块稳定性的关系.方法 选择正常对照组25例及冠心病组84例(稳定型心绞痛26例,不稳定型心绞痛30例,急性心肌梗死28例),均采血测血浆巨噬细胞炎症蛋白1α;冠心病组患者均行冠状动脉造影记录冠状动脉病变支数及Gensini冠状动脉病变积分,并与血浆巨噬细胞炎症蛋白1α水平进行相关分析.结果 冠心病组血浆巨噬细胞炎症蛋白1α水平明显高于正常对照组(P<0.05).血浆巨噬细胞炎症蛋白1α水平在稳定型心绞痛组、不稳定型心绞痛组和急性心肌梗死组间以及轻、中、重度冠状动脉病变组(按Gemini积分分组)间均逐级升高,差异有显著性(P<0.05),但冠心病不同冠状动脉病变支数组间血浆巨噬细胞炎症蛋白1α水平差异无显著性(P>0.05).血浆巨噬细胞炎症蛋白1α水平与Gemini冠状动脉病变积分存在正相关(r=0.28,P<0.05).结论 冠心病患者血浆巨噬细胞炎症蛋白1α升高,可能是评价冠状动脉粥样硬化斑块病变严重程度及斑块稳定性的有效指标.     

血清高敏感C反应蛋白和老年男性冠心病的关系

目的　探讨血清高敏感C反应蛋白 (hsCRP)与老年男性冠心病的关系及其可能机制。方法　经冠状动脉造影证实的 6 4例老年男性患者分为冠心病组 (36例 )和对照组 (2 8例 ) ,检测血浆hsCRP水平 ,以多项临床及生化指标为危险因素进行统计分析。结果　冠心病组的hsCRP水平 (4 .73± 3.16 )mg L与对照组 (1.6 7± 1.93)mg L比较 ,差异有显著性意义。单因素logistic回归分析 ,发现hsCRP是冠心病发生的一个独立危险因素 ;高hsCRP(≥ 1.5mg L)者发生冠心病的OR值为 7.4。若把hsCRP分为三等分 ,当其每升高一个等分 ,冠心病临床病情严重程度加重一个或一个以上等级的可能性增加 3.9倍。年龄、BMI、总胆固醇、HDL C以及临床病情严重程度与hsCRP显著相关 ,但校正年龄和BMI之后 ,只有临床病情严重程度与hsCRP仍保持显著相关。结论　老年男性冠心病患者的体内炎症反映水平是升高的 ,hsCRP是老年男性冠心病患者临床病情严重程度的一个敏感指标。     

急性冠状动脉综合征患者血清可溶性细胞间粘附分子1和妊娠相关血浆蛋白A的变化

目的观察急性冠状动脉综合征患者血清可溶性细胞间粘附分子1、妊娠相关血浆蛋白A水平的变化,结合冠状动脉造影结果探讨其临床意义。方法用酶联免疫吸附法检测46例急性冠状动脉综合征患者(其中急性心肌梗死20例,不稳定型心绞痛26例)、22例稳定型心绞痛患者和20例冠状动脉造影阴性对照者血清可溶性细胞间粘附分子1、妊娠相关血浆蛋白A水平,分析冠状动脉病变程度与可溶性细胞间粘附分子1、妊娠相关血浆蛋白A浓度的关系。结果急性冠状动脉综合征组血清可溶性细胞间粘附分子1和妊娠相关血浆蛋白A浓度较稳定型心绞痛组、对照组显著升高(P<0.05或P<0.01)。冠状动脉造影为单支、双支、三支病变者,其可溶性细胞间粘附分子1、妊娠相关血浆蛋白A浓度依次增高。相关分析发现,急性心肌梗死、不稳定型心绞痛患者血清可溶性细胞间粘附分子1浓度与妊娠相关血浆蛋白A浓度显著正相关(r=0.737和r=0.758,P<0.001)。结论急性冠状动脉综合征患者可溶性细胞间粘附分子1、妊娠相关血浆蛋白A升高,二者可能是动脉粥样斑块不稳定的标志。     

急性冠状动脉综合征患者血清可溶性细胞间粘附分子1和妊娠相关血浆蛋白A的变化

目的 观察急性冠状动脉综合征患者血清可溶性细胞问粘附分子1、妊娠相关血浆蛋白A水平的变化，结合冠状动脉造影结果探讨其临床意义。方法 用酶联免疫吸附法检测46例急性冠状动脉综合征患者（其中急性心肌梗死20例，不稳定型心绞痛26例）、22例稳定型心绞痛患者和20例冠状动脉造影阴性对照者血清可溶性细胞问粘附分子1、妊娠相关血浆蛋白A水平，分析冠状动脉病变程度与可溶性细胞间粘附分子1、妊娠相关血浆蛋白A浓度的关系。结果急性冠状动脉综合征组血清可溶性细胞间粘附分子1和妊娠相关血浆蛋白A浓度较稳定型心绞痛组、对照组显著升高（P〈0．05或P〈0．01）。冠状动脉造影为单支、双支、三支病变者，其可溶性细胞问粘附分子1、妊娠相关血浆蛋白A浓度依次增高。相关分析发现，急性心肌梗死、不稳定型心绞痛患者血清可溶性细胞间粘附分子1浓度与妊娠相关血浆蛋白A浓度显著正相关（r=0．737和r=0．758，P〈0．001）。结论 急性冠状动脉综合征患者可溶性细胞阃粘附分子1、妊娠相关血浆蛋白A升高，二者可能是动脉粥样斑块不稳定的标志。     

2型糖尿病患者血栓调节蛋白水平与冠心病的关系

目的探讨2型糖尿病患者血栓调节蛋白（thrombomodulin,TM）水平与合并冠心病的关系。方法选择本院住院的97例糖尿病患者,把合并冠心病患者77例分为稳定性心绞痛组、不稳定性心绞痛组和心肌梗死组,单纯2型糖尿病患者20例为对照组。应用酶联免疫吸附测定（ELISA）检测其血浆TM水平,并对血浆TM与冠状动脉病变作相关分析。结果稳定性心绞痛组和对照组血浆P-选择素、1M水平间差异无统计学意义（P〉0.05）。不稳定性心绞痛组血浆TM水平与稳定性心绞痛组、心肌梗死组间差异均有统计学意义（P〈0．05）。不稳定性心绞痛组P-选择素水平与稳定性心绞痛组、心肌梗死组间差异均有统计学意义（P〈0．05）。Pearson相关分析表明,血浆P-选择素和TM水平与心绞痛程度呈正相关（r=0．6952,P〈0．05）。结论2型糖尿病合并冠心病患者,随着冠状动脉粥样硬化病变程度加重,血浆TM水平可能相应升高。监测2型糖尿病患者血浆TM水平,对预测其冠状动脉粥样硬化病的严重程度可能有一定意义。     

血清同型半胱氨酸与冠心病的相关性研究

目的探讨冠心病患者血清同型半胱氨酸(homocysteine,Hcy)水平变化的临床意义。方法检测106例冠心病患者和50例健康对照组的血清Hcy的水平。结果冠心病患者血清Hcy水平较健康对照组明显升高(P0.01);稳定型心绞痛、不稳定型心绞痛及急性心肌梗死三组Hcy比较水平依次升高,差异有统计学意义(P0.05)。Hcy水平随着冠状动脉病变支数的增加依次升高,有显著性差异(P0.05)。结论血清Hcy水平变化与冠状动脉病变的严重程度相关,是冠状动脉病变程度的重要危险因素之一。     

冠心病患者血浆同型半胱氨酸及亚甲基四氢叶酸还原酶C677T基因多态性

目的比较不同冠心病类型及不同冠状动脉病变支数间血浆同型半胱氨酸水平差异,分析亚甲基四氢叶酸还原酶C677T基因突变对血浆同型半胱氨酸水平影响,及其与冠心病的关系.方法对经冠状动脉造影确诊的非冠心病74例、稳定型心绞痛32例、不稳定型心绞痛104例、急性心肌梗死25例采用改良高效液相色谱法测定同型半胱氨酸,聚合酶链反应-限制性内切酶法测定亚甲基四氢叶酸还原酶C677T基因型.结果血浆同型半胱氨酸水平冠心病组较非冠心病组显著增高,急性心肌梗死、不稳定型心绞痛组均较非冠心病组、稳定型心绞痛组显著增高,冠状动脉单支病变较正常、双支、三支病变组显著高.亚甲基四氢叶酸还原酶C677T基因纯合突变患者血浆同型半胱氨酸水平显著高于正常纯合子和杂合子患者.冠心病组亚甲基四氢叶酸还原酶C677T基因突变频率较对照组高,但无统计学意义.相关分析表明亚甲基四氢叶酸还原酶C677T基因突变与冠心病、同型半胱氨酸均无相关性.二元Logistic回归分析表明,高同型半胱氨酸血症致冠心病的OR值是1.138,亚甲基四氢叶酸还原酶C677T基因突变不是冠心病的独立危险因素.结论同型半胱氨酸可能是冠心病的独立危险因素,更可能是急性冠状动脉综合征的标志物.血浆同型半胱氨酸水平不与冠状动脉病变支数成正相关.亚甲基四氢叶酸还原酶C677T基因突变可能不是冠心病的独立危险因素及血浆同型半胱氨酸水平最关键的影响因素.     

C反应蛋白水平与冠心病的相关性研究

目的 探讨冠状动脉粥样硬化心脏病(CHD)与C反应蛋白(CRP)之间的关系.方法 测定50例正常对照人群和80例经冠状动脉造影证实为CHD患者血浆的CRP水平,其中单支病变30例、双支病变25例、三支病变25例;稳定型心绞痛31例、不稳定型心绞痛25例,急性心肌梗死24例.结果 CRP 水平在稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组依次增高;稳定型心绞痛组(F=1.826,P＜0.05)、不稳定型心绞痛组(F=4.232,P＜0.01)及急性心肌梗死组(F=6.745,P＜0.01)的CRP水平均明显高于对照组,在冠心病组中,双支病变组(F=7.925,P＜0.01)以及三支病变组(F=9.467,P＜0.01)中CRP 水平也明显高于对照组.结论 CRP水平与冠心病和冠脉病变程度相关.     

不同炎性标志物对冠状动脉病变的预测价值

目的 探讨可溶性CD40L、单核细胞趋化蛋白1、白细胞介素8和白细胞介素6等炎性标志物对冠状动脉病变严重程度和稳定性的预测价值.方法 应用流式细胞术检测129例冠心病患者血浆可溶性CD40L、单核细胞趋化蛋白1、白细胞介素8和白细胞介素6水平,计算各类型冠心病患者冠状动脉病变的Gensini积分,分析上述炎性标志物与Gensini积分的相关关系以及对急性冠状动脉综合征的预测价值.结果 四种炎性标志物血浆浓度在冠心病组均显著高于对照组(P均<0.01),其中可溶性CD40L、单核细胞趋化蛋白1和白细胞介素6的浓度在急性心肌梗死组高于稳定型心绞痛组(P=0.001、P=0.009和P=0.011).血浆单核细胞趋化蛋白1和白细胞介素6水平与冠状动脉Gensini积分呈正相关关系(r=0.322, P<0.00001;r=0.203,P=0.026);多因素Logistic回归分析显示白细胞介素6对急性冠状动脉综合征有预测价值(OR=1.275,P=0.037).结论 血浆可溶性CD40L、单核细胞趋化蛋白1、白细胞介素8和白细胞介素6等炎性标志物与冠状动脉粥样硬化病变有关;血浆单核细胞趋化蛋白1和白细胞介素6能反映冠状动脉病变的严重程度;白细胞介素6对预测冠状动脉病变不稳定的冠心病急性冠状动脉综合征有一定价值.     

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.