正五聚蛋白-3及血脂水平与急性冠状动脉综合征患者近期预后的关系

目的:探讨正五聚蛋白-3(pentraxin-3,PTX-3)、血脂水平与急性冠状动脉综合征(ACS)患者近期预后的关系。方法:分别测定123例ACS患者入院时的PTX-3和血脂水平,随访3个月,终点为冠状动脉事件(冠心病性死亡、因ACS引起的再住院、因心力衰竭引起的再住院)。结果:123例患者中发生冠心病猝死3例,ACS引起的再住院17例,心力衰竭引起的再住院5例,PTX-3异常组较PTX-3正常组冠状动脉事件发生率显著增高(OR=3.001,95%CI:1.023～8.801,P=0.045,RR=2.390);血脂异常组较正常组冠状动脉事件发生率显著增高(OR=2.714,95%CI:1.053～6.995,P=0.039,RR=2.160);血脂及PTX-3均异常组较均正常组冠状动脉事件发生率显著升高(OR=6.125,95%CI:1.245～30.130,P=0.026,RR=4.237)。结论:PTX-3或(和)血脂水平异常的ACS患者近期冠状动脉事件发生率显著升高,并以两者均异常者为著,因此联合检测可能有助于识别冠心病二级预防中的高危个体。     

阿托伐他汀在急性冠脉综合征血脂正常患者中的早期应用

目的:观察阿托伐他汀对血脂正常急性冠状动脉综合征(ACS)患者早期炎症因子和心脑血管事件的干预效果。方法:122例血脂正常的ACS患者随机分为阿托伐他汀治疗组和常规治疗对照组(各61例),另选择同期40例健康者作为健康对照组,分析比较组间及阿托伐他汀治疗(10mg/日×6月)前和治疗后2、4周血清白介素-6(IL-6)、高敏C反应蛋白(hs-CRP)和血脂水平的变化,同时观察ACS患者住院和半年随访期间主要心脑血管事件发生情况。结果:两组ACS患者血脂水平与健康对照组无显著差别,但其IL-6和hs-CRP水平显著高于健康对照组(P均<0.01);阿托伐他汀治疗2周后,仅IL-6、hs-CRP显著降低(P均<0.01),治疗4周后血胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)及IL-6、hs-CRP均显著降低(P均<0.01)且均低于常规治疗对照组(P均<0.05);阿托伐他汀治疗组住院期间复发性心绞痛、心力衰竭、心律失常及半年随访期间复发性心绞痛、非致死性心肌梗塞、心力衰竭、心律失常、需再住院治疗等均较常规治疗组显著降低(P均<0.05)。结论:血脂正常的ACS患者存在炎症反应,阿托伐他汀早期治疗能够抑制炎症因子,降低住院期间和半年随访期间主要心血管事件发生率。     

规范服用双联抗血小板药物对PCI术后冠心病患者预后的影响

目的:探讨规范服用双联抗血小板药物对经皮冠状动脉介入治疗术(PCI)后冠心病患者预后的影响。方法:选取2008-2012年在安徽医科大学第一附属医院被确诊为冠心病并行PCI的患者489例进行随访,通过COX回归方法分析规范服用双联抗血小板药物对初级终点事件(全因死亡,非致死性脑卒中及非致死性心肌梗死)及次级终点事件(Ⅳ级心功能及再血管化治疗)的影响。结果:规范服药组初级终点事件的发生率低于非规范服药组(5%∶17%,P0.001),两组间差异有统计学意义;而次级终点事件规范用药组发生率低于非规范用药组,但两组间无统计学差异。COX回归分析发现规范服用双联抗血小板药物可减少冠心病患者初级终点事件的发生率(RR=0.315,95%CI:0.150~0.666,P=0.002),但对次级终点事件无预测价值。进一步分析显示规范服用抗血小板药物仅对卒中发生的减少有统计学意义(RR=0.085,95%CI:0.020~0.366,P=0.001),对全因死亡及非致死性心肌梗死的发生无预测价值。结论:规范服用双联抗血小板药物可减少初级终点事件,特别是卒中的发生。     

超敏C-反应蛋白与冠心病严重程度相关性研究

目的研究血清超敏C-反应蛋白(hs-CRP)与老年冠心病严重程度的关系。方法选择2005年10月至2006年12月在汕头大学医学院第一附属医院心血管病房住院的患者共128例。测定经冠状动脉造影确诊的110例老年冠心病患者血清hs-CRP浓度,其中稳定型心绞痛患者40例,不稳定型心绞痛患者58例,急性心肌梗死患者12例。以经冠状动脉造影排除冠心病的18例患者为正常对照组,比较各组间hs-CRP的浓度。结果冠心病患者各亚组hs-CRP的浓度均较正常对照组(0.58±0.27)mg/L显著升高,P<0.01。冠心病患者各亚组中,不稳定型心绞痛组血清hs-CRP的浓度(7.78±5.93)mg/L显著高于稳定型心绞痛组(5.46±10.7)mg/L,P<0.01;急性心肌梗死组血清hs-CRP的浓度(32.75±22.12)mg/L,显著高于不稳定型心绞痛组及稳定型心绞痛组,P<0.01。结论血清hs-CRP的浓度与冠心病患者病情的严重程度有关,可作为临床冠心病患者病情严重程度的参考指标。     

活化T细胞核因子与急性冠状动脉综合征的相关性研究

目的:研究活化T细胞核因子(NFAT)在急性冠状动脉综合征(ACS)发病中的作用及价值。方法:选取冠心病患者360例,正常对照组60例。冠心病患者分ACS组180例[包括急性ST段抬高心肌梗死(STEMI)组、急性非ST段抬高心肌梗死(NSTEMI)组、不稳定性心绞痛(UA)组各60例]以及稳定稳定性心绞痛(SAP)组120例。所有患者行冠状动脉造影术(CAG)检查,冠状动脉狭窄程度采用Genisin评分,UA组病例同时行64排螺旋CT(CTA)造影检查证实为软斑块;酶联免疫法测定NFAT、高敏C反应蛋白(hs-CRP)浓度,分析NFAT在各组间的差异性以及对预测ACS的效果并与hs-CRP相     

急性冠状动脉综合征患者血小板CD40L表达及其临床意义

目的:探讨急性冠状动脉综合征(ACS)患者血小板CD40L表达的临床意义及其与血浆高敏C反应蛋白(hs-CRP)的关系。方法:收集稳定型心绞痛患者17例、ACS20例、正常对照15例,所有病例均行冠状动脉造影,采用流式细胞技术检测血小板CD40L的表达,采用免疫增强的透视比浊法检测血浆hs-CRP水平。结果:ACS组血小板CD40L的平均荧光强度(17.26±7.62)显著高于稳定型心绞痛组(10.81±2.94,P<0.01)和正常对照组(8.78±4.13,P<0.01)。ACS组血浆hs-CPR水平(8.11±6.67)mg/L显著高于稳定型心绞痛组[(2.79±1.24)mg/L,P<0.01]和正常对照组[(1.98±1.29)mg/L,P<0.01]。冠心病患者血小板CD40L及血浆hs-CRP与冠状动脉病变支数无相关性。冠心病患者血小板CD40L与血浆TC呈正相关(r=0.289,P<0.05)。与血浆hs-CPR、HDL、LDL、TG无相关性。结论:ACS患者血小板CD40L、血浆hs-CRP水平明显增高,血小板CD40L可能是反映斑块稳定性的指标之一。     

氟伐他汀治疗早期急性冠状动脉综合征的安全性评价

目的探讨氟伐他汀治疗早期急性冠状动脉综合征(ACS)的临床安全性。方法将64例ACS患者随机分成对照组和观察组各32例,对照组使用常规治疗方法 ,观察组在对照组治疗方法的基础上加用氟伐他汀。结果对照组32例中发生心血管死亡4例、复发性心绞痛15例、非致死性心肌梗死3例,共发生心血管事件22例,心血管事件发生率为69.7%(22/32);观察组32例中无心血管死亡病例、发生复发性心绞痛5例、非致死性心肌梗死2例,共发生心血管事件7例,心血管事件发生率为20.3%(7/32)。观察组心血管事件的发生率明显低于对照组(P0.05)。结论氟伐他汀早期治疗ACS安全、有效。     

血浆vaspin浓度与急性冠脉综合征的相关性

目的通过检测血浆丝氨酸蛋白酶抑制剂vaspin在不稳定型心绞痛(UAP)、急性非ST抬高心肌梗死(NSTEMI)和急性ST抬高心肌梗死(STEMI)患者中的浓度,探究vaspin与急性冠脉综合征(ACS)的相关性。方法选择ACS患者及对照组共200例,所有的入选患者均经冠状动脉造影检查。初次确诊的ACS患者共150例,其中不稳定型心绞痛(UAP)组50例、NSTEMI患者50例和STEMI患者50例;同期住院的对照组50例为经冠状动脉造影检查排除冠心病者。测定各组血浆中vaspin浓度、记录患者的一般情况并结合患者收缩压、舒张压、血常规、血糖、血脂、高敏C反应蛋白(hs-CRP)水平等临床资料进行统计学分析。结果 UAP组、NSTEMI组、STEMI组血浆vaspin浓度显著低于对照组(P0.05);NSTEMI组、STEMI组血浆vaspin浓度显著低于UAP组(P0.05);NSTEMI组、STEMI组血浆vaspin浓度无显著差异(P0.05)。在冠心病患者中血浆vaspin浓度随患者血管病变支数增多而降低,Logistic回归分析示冠状动脉病变支数与血浆vaspin浓度呈负相关(r=-0.351,P0.01)。结论 vaspin的血浆浓度越低,主要不良心脏事件发生率越高。血浆vaspin浓度可以成为ACS的一个新的指标。     

hs—CRP与冠状动脉病变程度及近期预后的相关性研究

目的 探讨血清高敏C反应蛋白(hs-CRP)与冠状动脉病变狭窄程度及近期预后的关系.方法 对135例不稳定型心绞痛(UA)和38例稳定型心绞痛(SA)患者入院时空腹进行hs-CRP测定,择期行选择性冠状动脉造影术计算冠状动脉病变程度积分,依据冠状动脉病变狭窄程度积分分为3组:A组≤4分为轻度、B组4分～8分为中度、C组＞8分为重度.分组比较相关因素.观察住院期间心血管事件(反复心绞痛发作、非致死性心肌梗死、心脏性死亡).结果 血清hs-CRP浓度与冠状动脉病变狭窄程度积分有相关性.3组之间hs-CRP水平两两比较均有统计学意义(P＜0.05).住院期间A组、B组和C组在反复心绞痛发作和非致死性心肌梗死两项之间比较有增高的趋势,但无统计学意义(P＞0.05).结论 心绞痛患者血清hs-CRP浓度与冠状动脉病变狭窄程度积分有相关性,hsCRP水平增高者心血管事件发生率较高.入院时血清hs-CRP水平增高的心绞痛患者有较高的危险性.     

Rho激酶对急性冠状动脉综合征患者复合心血管不良事件的影响

目的:探讨Rho激酶活性对急性冠状动脉综合征(ACS)患者长期预后的影响。方法:入选ACS患者280例为观察组,同期冠状动脉(冠脉)造影证实冠脉无异常的患者120例为对照组,观察组根据Rho激酶活性的高低分为高活性组和低活性组,记录观察组和对照组在Rho激酶、高敏C反应蛋白(hs-CRP)水平上的差异,记录观察组亚组间Rho激酶、hs-CRP水平和6个月复合心血管不良事件(非致命的心肌梗死、心力衰竭、心绞痛、再次血运重建和心源性死亡)发生率的差异,评价Rho激酶对ACS患者中长期预后的影响。结果:观察组Rho激酶和hs-CRP水平明显高于对照组(P0.05);观察组亚组间高活性组的hs-CRP水平明显高于低活性组(P0.05);随访1个月高活性组Rho激酶和hs-CRP水平仍显著高于低活性组(P0.05);随访6个月观察组亚组间Rho激酶和hs-CRP水平无显著差异,Rho激酶高活性组复合心血管事件的发生率高于低活性组,有显著差异(P0.05)。相关性分析显示,Rho激酶与hs-CRP呈正相关,Logistic回归分析显示Rho激酶活性是影响ACS患者6个月复合心血管事件发生率的独立预测因素(P=0.028)。结论:Rho激酶是一个与ACS患者相关的炎性因子,与hs-CRP呈正相关,可作为ACS患者中长期预后的独立预测因子。     

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.