动脉硬度与高血压患者心血管危险分层的关系--一种新的、简便的测定动脉硬度的方法

目的研究动脉硬度指数(ASI)预测高血压患者心血管危险的价值.方法用我们研制的YF-1血管硬度测量仪测量248例高血压病人的ASI,并进行了危险因素调查.结果①高血压并发症组的ASI(162.2±53.3)比单纯性高血压组(136.0±50.7)高(P＜0.01).②低危组、中危组、高危组和极高危组的ASI逐渐增大,任意两组比较均具有显著性差异(P＜0.01).③177例无并发症的高血压患者的Framingham危险积分与ASI有较好的相关性(r=0.435,P＜0.01).结论ASI是一个较好的预测心血管病危险的指标.     

动脉硬化无创检测对冠心病的诊断价值

目的 探讨踝臂脉搏波传导速度(baPWV)和踝臂指数(ABI)对冠心病(CHD)的诊断价值.方法 根据冠状动脉造影结果将168例患者分为CHD组与非CHD组.测定两组患者的右侧踝臂PWV(R-baPWV)、左侧踝臂PWV(L-baPWV)、右侧ABI(R-ABI)和左侧ABI(L-ABI).比较分析两组的基本资料,对比两组ABI及baPWV异常程度.结果 CHD组的年龄、性别构成、吸烟、糖尿病、高胆固醇血症、高血压等与非CHD组相比差异有统计学意义(P＜0.05).与非CHD组相比,CHD组ABI明显降低,且与冠脉狭窄程度呈负相关,差异具有统计学意义(P＜0.05).结论 冠心病的发生受多种因素的影响,baPWV及ABI对冠心病有一定的预测价值,应积极开展高危人群baPWV及ABI检测,对于早干预、延缓或阻止冠心病的进一步发展、预防严重心血管事件发生具有重要的临床意义和社会价值.     

脉搏波传导速度对冠心病诊断及冠状动脉狭窄程度的预测价值

目的评价臂踝脉搏波传导速度（baPWV）在冠心病诊断中的预测价值及臂踝脉搏波传导速度改变（baPWV）与冠状动脉狭窄程度（SYNTAX积分）的相关性。方法选择行冠状动脉造影患者452例,根据冠状动脉造影结果,将入选患者分为冠心病组（251例）和非冠心病组（201例）,冠心病组再按冠状动脉狭窄程度（SYNTAX分级）,分为轻、中、重三个亚组,所有患者在冠状动脉造影前应用脉搏波速度测量baPWV、baP-WV;依据冠状动脉造影结果诊断冠心病,应用ROC曲线评价baPWV对冠心病预测价值,并对冠心病组的baPWV及SYNTAX积分进行相关分析。结果 baPWV及baPWV在冠心病组和非冠心病组之间差异有统计学意义（P〈0.01）;在冠心病病变亚组,baPWV在轻、中、重三个亚组之间差异具有统计学意义（P〈0.001）;baPWV对SYNTAX积分的ROC曲线,在截断点22.5时,曲线下面积最大,预测冠心病的特异性是75.2,敏感性是60.6;baPWV与SYNTAX积分呈中度正相关（rho=0.545,P〈0.01）。结论 baPWV、baPWV对冠心病诊断有中等预测价值,但其特异性和敏感性受限。     

无创臂踝脉搏波速度的特征及与心血管危险因素的关系

目的研究分析臂踝脉搏波传导速度(baPWV)的特征以及与心血管危险因素的相关性。方法入选2013年1月至2015年3月期间在同济医院综合科参加体检并采用OMRON动脉硬化检测仪VP-1000进行baPWV检测者共3781例(包括住院患者226例)。依据baPWV的检测结果分为两组:baPWV1400 cm/s组(n=2171)和baPWV≥1400 cm/s组(n=1610)。依据合并冠心病危险因素(高血压、血糖异常、血脂异常、肥胖和吸烟史)的个数将226例住院患者分为4组:0项组(n=75)、1项组(n=33)、2项组(n=49)和3~5项组(n=69)。采用OMRON动脉硬化检测仪VP-1000测定baPWV。结果年龄、性别、心率、收缩压(SBP)、体质量指数(BMI)和平均动脉压(MAP)是影响baPWV的独立危险因素。男性和女性的baPWV均随年龄呈增加趋势,同时,每个年龄阶段的女性baPWV均显著低于同年龄阶段的男性,差异均具有统计学意义(P0.05)。baPWV与年龄(r=0.66)、SBP(r=0.62)、舒张压(DBP,r=0.26)、MAP(r=0.59)、颈动脉内膜中层厚度(CIMT,r=0.37)、尿酸(UA,r=0.16)、血糖(Glu,r=0.17)和糖化血红蛋白(HbA1c,r=0.19)呈显著正相关(P0.05),与总胆固醇(TC,r=-0.24)和左心室射血分数(LVEF,r=-0.23)呈显著负相关(P0.05)。随着合并危险因素数量的增加,年龄和baPWV均呈显著增长趋势(P0.01)。baPWV对冠心病诊断具有中等预测价值(曲线下面积为0.718,P0.05)。结论 baPWV与心血管危险因素密切相关,传统的心血管危险因素数量越多,baPWV值越大,baPWV对冠心病的诊断具有中等预测价值。     

踝臂脉搏波速度及糖化血红蛋白与冠心病危险因素的关系

目的 探讨踝臂脉搏波速度(baPWV)、糖化血红蛋白(HbA1c)与冠心病(CHD)危险因素的关系.方法 选择CHD患者87例,其中无糖尿病46例(A组),合并糖尿病41例(B组),另选健康体检者80例作为对照组.收集3组的年龄、腰围、收缩压(SBP)、舒张压(DBP)、脉压差(PP)、血脂、空腹血糖(FPG)及HbA1c检测指标,并检测其baPWV,分析CHD的相关危险因素.结果 3组间年龄、腰围、血压、PP、HbA1c、LDL-C、baPWV比较,P＜0.01或＜ 0.05;A、B组腰围、FPG、HbA1c、TG、TC、LDL-C、baPWV比较,P＜0.01或＜0.05.Logistic回归分析显示,高龄、baPWV、DBP、PP、TC、LDL-C、HbA1c是CHD的危险因素,其危险程度从高到低依次为高龄、baPWV、DBP、PP、HbA1c、LDL-C、FPG(P ＜0.01或＜0.05).A组baPWV与年龄、SBP、DBP、PP、TC、LDL-C、HbA1c呈正相关,B组baPWV与年龄、SBP、DBP、PP、TC、LDL-C、HbA1c、FPG呈正相关,C组baPWV与年龄、SBP、PP呈正相关,P＜0.01或＜0.05.结论 baPWV与CHD的主要危险因素HbA1c有相关性,baPWV、HbA1c对CHD发病有预测价值.     

N末端脑钠肽前体对冠心病的预测价值

目的 探讨N末端脑钠肽前体(NT-proBNP)对冠心病(CHD)的预测价值.方法连续选择因胸痛疑诊冠心病或已明确冠心病为进一步介入治疗的患者658例,其中经冠脉造影确诊为冠心病者484例为冠心病组,冠脉造影除外冠心病174例为对照组.记录两组的临床资料,分析冠心病危险因素及NT-proBNP、左室射血分数(LVEF)等,探讨NT-proBNP对冠心病的预测价值,采用改良Gensini法评价冠脉病变的严重程度并分析其与冠心病危险因素及NT-proBNP的关系.结果两组的基线资料中,年龄、男性、吸烟史、糖尿病、高血压、血脂异常、家族史、LVEF、NT-proBNP差异均有统计学意义(P均＜0.01).单因素logistic回归分析,年龄、男性、吸烟史、糖尿病、高血压、血脂异常、家族史、NT-proBNP均为冠心病的危险因素(P均＜0.05).经ROC曲线分析,NT-proBNP界值为641.15.多因素logistic回归分析,除年龄、男性、糖尿病与冠心病独立相关外(P均＜0.01),NT-proBNP也是冠心病的独立预测因素(OR＝1.66,95%CI:1.06～2.61,P＜0.05),且年龄、血脂异常、NT-proBNP与冠脉病变严重程度相关(P均＜0.05).进一步的NT-proBNP与改良Gensini评分的相关性分析,NT-proBNP与改良Gensini评分呈正相关(r＝0.14,P＜0.01).多因素logistic回归分析,NT-proBNP不是改良Gensini评分的独立预测因素(P＞0.05).结论传统冠心病危险因素中年龄、男性、糖尿病与冠心病独立相关.NT-proBNP也是冠心病的独立预测因素,其水平的升高对冠心病及冠脉病变严重程度可能有一定临床预测价值.     

脉搏波速度与冠状动脉病变的相关性研究

目的:应用脉搏波速度(pulse wave velocity,PWV)评价血管僵硬度,观察PWV与冠心病危险因素的相关性,及其对冠状动脉病变严重程度的预测价值. 方法:入选132例因胸痛疑诊冠心病而行冠脉造影的患者,其中男性68例,女性64例,平均年龄(66.4±10.0)岁.根据冠脉造影的结果,将患者分为冠状动脉正常组(Ⅰ组,n=32),冠状动脉病变单支组(Ⅱ组,n=33)、2支组(Ⅲ组,n=27)和3支组(Ⅳ组,n=40);同时有创测量中心动脉收缩压(CSBP)、舒张压(CDBP)及脉压(CPP).用欧姆龙动脉硬化检测仪测量患者臂踝PWV(baPWV).检测体质指数、血脂、颈总动脉内膜中层厚度、血清肌酐、左室质量指数等冠心病危险因素. 结果:逐步多变量回归分析显示,年龄(β =0.46,P＜0.01)和CSBP(β=0.19,P=0.013)与baPWV明显相关.baPWV比较:Ⅰ组与Ⅱ组无统计学差异(P=0.83);Ⅲ组、Ⅳ组较Ⅰ组和Ⅱ组明显升高(P＜0.05);Ⅲ组与Ⅳ组无统计学差异(P=0.47). 结论:年龄和CSBP是影响baPWV的两个独立危险因素.baPWV与冠状动脉病变严重程度明显相关,可以作为无创、简便、可重复的预测冠状动脉病变程度的一个重要指标.     

踝臂脉搏波速对冠心病的预测及筛查价值

目的:通过对踝臂脉搏波速(baPWV)的检测分析,探究baPWV对冠心病的预测及临床筛查的价值。方法:从1 460例接受选择性冠状动脉(冠脉)造影或冠脉CTA检查的患者中,筛选出冠心病患者483例(CHD组),冠脉粥样硬化患者677例(AS组),冠脉血管正常者300例(NL组)。各组之间的baPWV比较采用t检验,相关性分析用Pearson检验;绘制baPWV预测及筛查冠心病的ROC特征曲线。结果:CHD组与AS、NL组之间的年龄、体质指数(BMI)、腰围、收缩压、脉压、餐后2h血糖、低密度脂蛋白胆固醇、超敏C反应蛋白、血尿酸、血肌酐等各项指标差异存在统计学意义(均P0.05);CHD组与AS组、NL组之间的baPWV值差异存在统计学意义(P0.05)。相关性分析显示,baPWV水平与冠心病患者危险因素呈正相关;ROC曲线显示,以baPWV对冠心病的发生进行预测,1 545cm/s为截断点,其中曲线下面积为0.703,标准误0.015(P0.001);其灵敏度、特异度分别为89.8%和63.6%,阴性预测值(+PV)83.9%,阳性预测值(-PV)50.5%。结论:baPWV水平与冠心病患者的发病有着密切相关性,其对冠心病的预测和筛查具有重要的临床应用价值,有可能为冠心病患者未来的早期预防及治疗寻求新靶点提供更早、更可靠的科学依据。     

超重和肥胖与动脉僵硬度的相关性研究

目的 分析超重和肥胖与动脉僵硬度的关系.方法 选取2007至2009年江苏省社区自然人群4585名为研究对象进行回顾性研究.以体质指数(BMI)评价超重和肥胖,肱踝脉搏波传导速度(baPWV)评价动脉僵硬度.将BMI分别作为连续变量(以l kg/m2递增)和等级变量(体重正常、体重过轻、超重和肥胖)进行logistic多因素逐步回归分析,评价高动脉僵硬度风险和人群归因危险度百分比,并通过受试者工作(ROC)曲线分析BMI对高动脉僵硬度的预测价值.结果 (1)控制年龄后,男性和女性的BMI与baPWV均呈正相关(r值分别为0.213和0.186,P均＜0.01).超重、肥胖人群baPWV和高动脉僵硬度发生率均高于正常组(P均＜0.01).(2)logistic回归模型校正年龄、性别、高血压因素后,连续变量BMI致高动脉僵硬度的OR值为1.146(95％CI:1.117～1.175,P＜0.01);当BMI为等级变量时,体重过轻OR值为0.369(95％ CI:0.141～0.962,P＜0.05),超重和肥胖OR值分别为1.576(95％CI:1.333～1.863,P＜0.01)和2.087(95％CI:1.615 ～2.698,P＜0.01).超重和肥胖者高动脉僵硬度的人群归因危险度百分比分别为19.1％和11.6％.(3) BMI评估高动脉僵硬度的ROC曲线下面积为0.661(95％ CI:0.645 ～0.678,P＜0.01),BMI预测高动脉僵硬度的最佳分割值为24.25 kg/m2.结论 超重和肥胖人群的动脉僵硬度高于体重正常人群.超重和肥胖是独立于年龄、性别、高血压之外的高动脉僵硬度危险因素.     

循环EPCs CD34^＋水平与高血压病患者心血管危险因素的关系

目的探讨能否将循环内皮祖细胞(EPCs)CD34 水平作为评价高血压病患者心血管危险度的标志。方法高血压病患者组62例,对照组20例。高血压病患者采用Framingham心血管危险因素积分分层心血管危险因素,分为低危组18例,中危组14例,高危组17例,极高危组13例。作外周血循环EPCs CD34 水平与Framingham心血管危险因素积分的相关性分析。结果各研究组高血压病患者外周循环EPCs CD34 水平随着其心血管危险程度的增加,逐步下降,各组间比较有统计学意义(P<0.05)。EPCs CD34 水平与Framingham心血管危险因素积分呈负相关关系(r=-0.875,P<0.01)。结论高血压病患者循环EPCs CD34 水平下降与心血管危险因素有显著的相关性。循环EPCs CD34 水平可以作为高血压病患者心血管危险度的标志。     

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.