血脂及部分血脂比值对冠心病的诊断价值

目的 分析探讨血脂及部分血脂比值对冠心病的诊断价值.方法 对210例患者行冠状动脉造影,根据造影结果分为对照组(冠状动脉无狭窄者)和冠心病组,冠心病组再根据Gensini评分分为轻度、中度和重度组,测定血脂水平并对其单项血脂和部分血脂比值与冠脉狭窄程度进行比较分析.结果 冠心病组的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)高于正常对照组,载脂蛋白A1(ApoA1)和高密度脂蛋白胆固醇(HDL-C)低于正常对照组(P均＜0.05).冠心病组的TC/HDL-C、TG/HDL-C、LDL-C/HDL-C高于正常对照组,ApoA 1/ApoB低于正常对照组(P均＜0.05).随着冠脉病变程度增加,TG/HDL-C、TC/HDL-C、LDL-C/HDL-C值升高,ApoA1/ApoB值降低(P＜0.05).结论 血脂和血脂比值异常对冠心病的诊断及其严重程度的判断上具有一定意义,血脂比值较单项血脂有更好的临床价值.     

载脂蛋白B/载脂蛋白A1比值在糖尿病合并冠心病患者冠状动脉病变评估中的作用

目的通过分析明确载脂蛋白B/载脂蛋白A1(ApoB/ApoA1比值在评估糖尿病合并冠心病患者冠状动脉病变严重程度中的作用。方法选择行冠状动脉造影确诊的糖尿病合并冠心病的患者(n=261),依据ApoB/ApoA1比值的均值分为高比值组(n=125)和低比值组(n=136),比较两组间一般临床资料、生化、冠状动脉Syntax评分等指标,分析ApoB/ApoA1比值与冠状动脉病变严重程度的关系。结果 (1)两组患者基本特征差异无统计学意义,ApoB/ApoA1高比值组低密度脂蛋白胆固醇(LDL-C)和血清总胆固醇(TC)高于低比值组(P 0. 05),而ApoA1水平低于低比值组(P 0. 05),同时,中重度冠状动脉病变多于低比值组(P 0. 05)。(2)随着冠状动脉病变程度的加重,TC、LDL-C、ApoB、ApoB/ApoA1比值逐渐升高,ApoA1逐渐降低,P 0. 05。(3)糖尿病合并冠心病人群的血管病变Syntax评分与ApoA1水平呈负相关(r=-0. 42,P 0. 05),与TC、LDL-C、ApoB、ApoB/ApoA1比值呈正相关(r=0. 47,0. 51,0. 62,0. 66,P 0. 05)。结论糖尿病合并冠心病患者ApoB/ApoA1比值升高,与冠状动脉Syntax评分呈正相关,能较好地反映冠状动脉病变严重程度。     

2型糖尿病各期肾病病人载脂蛋白等变化分析

选择健康人40例及我院住院2型糖尿病病人110人,根据24小时尿白蛋白定量分为糖尿病无肾病组(A组)、早期肾病组(B组)及临床期肾病组(C组),全部病人测定血甘油三脂(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB),将各组指标分析比较.结果B组、C组病人血TG较A组病人升高更明显,TC较正常组升高(P＜0.05),A组、B组、C组HDL-C均有下降,而B组、C组下降更有意义(P＜0.01).B组、C组血LDL-C较A组升高,有统计学意义,B组、C组血ApoA1下降,ApoB升高,ApoB/ApoA1升高.结论糖尿病肾病病人血脂及载脂蛋白显著异常,对糖尿病合并早期及临床期肾病病人应严格控制血脂水平.     

老年糖尿病合并冠心病52例血脂代谢异常分析

目的探讨2型糖尿病(DM)患者中血脂异常与冠心病(CAD)之间的关系.方法将82例2DM患者分为并发CDA组(A组)52例;未并发CDA组(B组)30例.30例健康者为对照组(C组).测定所有对象的血脂、空腹血糖水平.结果A组甘油三酯(TG)、空腹血糖(FBG)和载脂蛋白B(Apo-B)明显高于B组和C组(P＜0.01),高密度脂蛋白(HDL)、载脂蛋白A1(ApoA1)明显低于B组和C组(P＜0.01),高密度脂蛋白(HDL)、载脂蛋白A1(ApoA1)明显低于B组和C组(P＜0.01).B组除TG、FBG明显高于C组外(P＜0.01),HDL、ApoA1、Apo-B与C组无显著性差异(P＞0.05).血胆固醇(CHO)A组与B组及C组相比无显著性差异(P＞0.05).结论高TG血症是2型糖尿病患者发生冠心病的独立风险因素.血HDL、ApoA1、APOB的代谢异常亦很重要.     

载脂蛋白A1/载脂蛋白B比值与冠状动脉严重程度相关性研究

目的 探讨载脂蛋白A1(qpolipoproteinA1,ApoA1)/载脂蛋白B(apoplipoprotein B,ApoB)比值与冠状动脉狭窄严重程度的关系.方法 应用冠脉造影技术将120例患者分2组冠心病组与对照组.测定ApoA1和ApoB,并计算出比值,探讨其与冠脉病变记分(CSS)的关系.结果 冠心病组ApoA1/ApoB比值明显低于对照组(P＜0.01),ApoA1/ApoB比值与CSS呈负相关(P＜0.05).结论 ApoA1/ApoB比值与冠状动脉狭窄严重程度呈负相关.     

血清ox-LDL、ApoB及ApoB/A1与早发冠脉三支病变发生的关系

目的 探讨早发冠脉三支病变患者血清氧化低密度脂蛋白(ox-LDL)、载脂蛋白B(ApoB)、载脂蛋白A1( ApoA1)及ApoB/A1的特点.方法 共选取冠心病(CHD)患者164例,根据冠脉造影结果分为早发冠脉三支病变组96例(观察组),冠脉正常组(对照组)68例,比较两组患者血脂水平、ox-LDL、及ApoA1、ApoB的水平,分析其与早发冠脉三支病变的关系.结果 观察组血清ox-LDL、ApoB、ApoB/A1水平高于对照组(P＜0.01);而观察组与对照组血清ApoA1水平比较无统计学差异.Logistic回归分析显示,ox-LDL在两组患者中存在统计学差异(P＜0.05).结论 血清ox-LDL、ApoB、ApoB/A1水平是早发冠脉三支病变发生的预测因素,其中ox-LDL是预测早发严重冠脉三支病变发生的独立危险因素.     

冠心病患者D-二聚体的变化及其与血脂异常的相关研究

目的:通过检测血浆D-二聚体(D-dimer,DD)水平以评估不同类型冠心病患者体内新鲜血栓形成的可能性,并研究此类改变与诸血脂指标的相关关系。方法:对124例不类型的冠心病患者与26例正常人分别采用ELISA法测定血浆DD水平和脂蛋白(a)[Lp(a)],酶法测定甘油三酯(TG)、胆固醇(TC)和高密度脂蛋白(HDL),免疫散射比浊法测定载脂蛋白A1(ApoA1)和载脂蛋白B(ApoB)水平。结果:(1)与对照组比较,稳定型心绞痛(SAP)、陈旧性心肌梗死(OMI)组患者DD水平未改变(P>0.05),急性心肌梗死(AMI)组患者DD水平升高非常显著(P<0.01),不稳定型心绞痛(UAP)组患者DD水平亦显著升高(P<0.05),AMI组DD水平显著高于UAP组(P<0.05);与SAP、OMI组比较,UAP、AMI组DD水平升高显著(P<0.05);(2)DD与TG、ApoB和[Lp(a)]呈明显正相关(r=0.393,0.650和0.579,P<0.001);与TC亦呈正相关关系(r=0.235、P=0.009);与ApoA1和HDL呈负相关(r=-0.496,-0.178,P<0.001,P<0.05);(3)多元逐步回归可见ApoB和Lp(a)为独立影响DD的血脂指标。结论:在AMI、UAP组患者中,有与新鲜血栓形成相关指标DD的增高,以AMI组更为严重;血脂异常对冠心病患者的DD水平有影响,其中ApoB和Lp(a)为独立影响DD的血脂指标。     

应用ROC曲线评价ApoB/ApoA1比值对冠脉狭窄 程度的诊断价值

【摘要】 目的 探讨血清ApoB/ApoA1比值与冠状动脉狭窄程度的关系,评价其在冠心病中的诊断价值。方法:选取我院首次行冠脉造影检查并符合入组条件的患者198例,分为冠心病组（130例）、非冠心病（68例）,再根据Gensini（GS）积分评估价病变程度,对各血脂常规指标行ROC曲线分析及相关分析。结果：①冠心病组患者较非冠心病组ApoB/ApoA水平增高（P＜0.01）。②多因素logistic回归分析ApoB/ApoA1为冠心病独立危险因素（P＜0.01）,ApoA1为冠心病保护因素（P＜0.01）。③线性相关分析显示：ApoB/ApoA1(r=0.742)与GS呈正相关（P＜0.01）,ApoA1(r=-0.773)与GS呈负相关（P＜0.01）。④ROC曲线分析ApoB/ApoA1（曲线下面积AUC 0.836;敏感性0.853;特异性0.574;P＜0.01）,最佳诊断截点（cutoff值）为0.678。结论：①ApoB/ApoA1为冠心病独立危险因素;ApoA1为冠心病保护因素。②ApoB/ApoA1能有效反应冠脉狭窄程度。     

妊娠期血脂变化及其特异性参考区间的建立

目的 建立妊娠特异性血脂正常参考区间,为临床监测妊娠期血脂异常提供参考.方法 选择中孕期妇女(妊娠16 ～21周,中孕期组)90例、晚孕期者(妊娠28～35周,晚孕期组)139例、产前1～3d者(妊娠37～41周,产前期组)119例,选择年龄匹配的非妊娠妇女107例作为正常非孕对照组(对照组).采用生化分析仪检测各组血清游离脂肪酸(NEFA)、总胆固醇(CHOL)、甘油三脂(TRIG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、载脂蛋白A(ApoA)和载脂蛋白B(ApoB),观察各血脂指标在妊娠期的动态变化.结果 中孕期组、晚孕期组、产前期组血清NEFA、CHOL、TRIG、HDL、LDL、ApoA、ApoB均高于对照组(P均＜0.01).随着妊娠时间的延长,晚孕期妇女NEFA、HDL、ApoA下降,均低于中孕期组(P均＜0.05).结论 妊娠期血脂高于非孕期.成功建立正常妊娠妇女不同孕周血脂各指标的参考区间.     

2型糖尿病合并冠心病患者脂质及ApoA1/B变化

目的探讨2型糖尿病合并冠心病患者脂质及载脂蛋白A1/B的变化和意义。方法回顾本院收治的2型糖尿病人192例,将其分成两组:合并冠心病者(A组,n=72)和无合并冠心病组(B组,n=120);另设健康对照组(C组,n=70)。每例病人于入院后第2天采集空腹静脉血,检测甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、ApoA1、ApoB,并计算ApoA1/B值。结果与C组相比,A、B两组HDL-C及ApoA1下降(P0.05),TG、LDL-C水平升高(P0.05);A、B两组相比,A组TG、LDL-C、ApoB较B组明显升高(P0.05),HDL-C和ApoA1/B比值较B组明显下降(P0.05)。结论2型糖尿病合并冠心病患者较单一糖尿病患者血脂代谢异常更加显著,ApoB升高和ApoA1/B比例下降可能促进糖尿病患者发生冠心病的进程,可望成为糖尿病合并冠心病的临床预测指标。     

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.