原发性高血压心肌超声声学密度及部分血管活性肽水平变化的研究

目的:应用超声声学密度技术探讨原发性高血压患者心脏心肌组织密度的变化,分析原发性高血压部分血管活性肽心钠素、脑钠素、内皮素-1、降钙素基因相关肽、胰岛素样生长因子-1(IGF-1)水平的变化规律及其与心肌组织密度的关系.方法:将入选对象90例,分为对照组30例,无左心室肥厚组30例及左心室肥厚组30例,应用超声声学密度技术测量左心室心肌不同切面的平均声学密度值(AII%);测量心钠素、脑钠素、内皮素-1、降钙素基因相关肽、胰岛素样生长因子-1水平,分析其变化规律及与心肌声学密度的关系.结果:无左心室肥厚组各室壁AII%较对照组有增高趋势,但差异无显著性意义(P＞0.05);左心室肥厚组四腔心切面观室间隔AII%较对照组显著性升高(P＜0.05),胸骨旁左心室长轴切面观室间隔AII%较对照组显著性升高(P＜0.05),余室壁AII%较对照组均有增高趋势,但差异无显著性意义(P＞0.05);而无左心室肥厚组和左心室肥厚组各切面室壁的平均声学密度值之和较对照组有显著性升高(P＜0.05).心钠素、脑钠素、内皮素-1、胰岛素样生长因子-1在无左心室肥厚组有增高的趋势(P＞0.05),在左心室肥厚组显著性升高(P＜0.05).降钙素基因相关肽水平无左心室肥厚组与对照组比较显著性降低(P＜0.05),其中左心室肥厚组降低更显著(P＜0.01).原发性高血压心脏各切面室壁AII%之和与内皮素-1、心钠素、脑钠素、胰岛素样生长因子-1等各因子水平呈正相关,与降钙素基因相关肽水平呈负相关.结论:原发性高血压心肌平均超声声学密度增高,心钠素、脑钠素、内皮素-1、降钙素基因相关肽、胰岛素样生长因子-1等部分血管活性肽与原发性高血压平均超声声学密度有相关关系.     

脑钠肽与高血压左室肥厚的关系

目的 探讨血清脑钠肽(BNP)浓度变化及与原发性高血压患者左室肥厚的关系.方法 用酶联免疫吸附法(ELISA)测定30例高血压无左室肥厚患者(NLVH组)、28例高血压伴左室肥厚患者(LVH组)及30名血压正常的健康成人(对照组)血清BNP浓度.采用多普勒超声心动图检查计算左室重量指数(LVMI),观察BNP水平与左心室重量指数(LVMI)的相关性.结果 LVH组BNP水平明显高于NLVH组及对照组,差异有统计学意义(P＜0.01),NLVH组高于对照组(P＜0.01).BNP浓度与左室重量指数呈正相关(r=0.67,P＜0.01).结论 BNP水平可以反映高血压及左室肥厚的程度.     

培哚普利对高血压患者血清IGF—Ⅰ和左心室肥厚的影响

目的 研究培哚普利对原发性高血压患者血清胰岛素样生长因-Ⅰ(insulin.1ike growth factor-Ⅰ,IGF-Ⅰ)浓度和左心室肥厚程度的影响.方法 选择原发性高血压患者40例作为治疗组,每日予以口服培哚普利4 mg～8 mg.疗程为6个月,同时选择健康检查结果正常的40名成人作为对照组.检测治疗组治疗前后及对照组血清IGF-Ⅰ浓度和左心室肥厚程度,并进行统计分析.结果 治疗组治疗前血清IGF-Ⅰ浓度和左心室肥厚程度的各项指标均高于对照组.经培哚普利治疗后,治疗组血清IGF-Ⅰ浓度、血压及左心室肥厚程度的各项指标均比治疗前明显下降.结论 培哚普利可降低原发性高血压患者血清IGF-Ⅰ浓度,改善左心室肥厚程度.     

原发性高血压患者血浆脑钠尿肽改变的临床意义

探讨原发性高血压患者血浆脑钠尿肽浓度变化与左心室舒张功能和左心室肥厚的关系.采用多谱勒超声心电图和放射免疫分析方法,将54例原发性高血压患者分组和14例正常者进行脑钠尿肽水平、心脏结构、左心室舒张功能检测.结果发现,与正常对照组相比,高血压组血浆脑钠尿肽浓度明显增高;而且血浆脑钠尿肽浓度在1级、2级、3级高血压患者各组间有显著性差异,说明脑钠尿肽浓度与高血压的严重程度密切相关.将54例高血压患者分为单纯高血压组与左心室肥厚组,并两组间相比较在左心室射血分数、左心室短轴缩短率FS均无显著性差异(P＞0.05),而在血浆脑钠尿肽浓度、左心室肥厚(包括室间隔肥厚、左心室后壁肥厚)相比较具有显著性差异(P＜0.001).结论提示,血浆脑钠尿肽浓度与原发性高血压的发生、发展、左心室肥厚及左心室舒张功能受损有一定关系,并有望成临床医师判断高血压患者左心室肥厚和左心室舒张功能异常的一项较好生物化学指标.     

缬沙坦长期治疗对原发性高血压患者左心室肥厚及心功能影响的对比研究

目的探讨血管紧张素Ⅱ受体拮抗剂--缬沙坦对原发性高血压患者左心室肥厚及心功能的影响.方法入选经超声心动图检查证实为原发性高血压的左心室肥厚患者72例,随机分配到缬沙坦组(口服80～160mg/d)或阿替洛尔组(口服25～50 mg/d)(n均=36),治疗8个月,治疗前后各检查一次超声心动图及放射性核素心室显像,对比分析组内治疗前后左心室重量指数及左心功能参数变化和两组间的差异.结果①与治疗前比较,原发性高血压患者在缬沙坦或阿替洛尔治疗8个月后,两组收缩压与舒张压明显下降(159/101 mmHg至142/89 mmHg;161/103 mmHg至145/90mmHg,1 mmHg=0.133 kPa)(P均＜0.01).②原发性高血压患者在缬沙坦治疗8个月后,左心室后壁与室间隔厚度较治疗前显著下降(P均＜0.05),左心室重量及左心室重量指数下降更显著(P均＜0.01);而在阿替洛尔治疗8个月后左心室后壁与室间隔厚度无明显变化,左心室重量及左心室重量指数下降显著(P＜0.05).③原发性高血压患者在缬沙坦治疗8个月后左心室高峰充盈率明显增加(P＜0.05),而在阿替洛尔治疗8个月后左心室高峰充盈率无明显变化,两组间比较则有明显差别(P＜0.05).结论原发性高血压患者在缬沙坦治疗8个月后可使原发性高血压患者左心室肥厚显著逆转及左心室舒张功能显著改善,缬沙坦对左心室舒张功能的作用优于阿替洛尔.     

hsCRP与原发性高血压心肌纤维化相关性分析

目的 观察原发性高血压患者血清高教C反应蛋白(hsCRP)与心肌声学密度的变化情况,探讨hsCRP与高血压心肌纤维化的关系.方法 将入选对象84例,分为健康对照组30名,原发性高血压无左心室肥厚组(NLVH) 28例及原发性高血压左心室肥厚组(LVH)26例.应用超声心动图测量声学密度各项值,采用免疫胶乳比浊法测定hsCRP.结果 NLVH组hsCRP与对照组相比有增高趋势,但无统计学意义(P＞0.05),LVH组hsCRP与NLVH组相比显著性升高(P＜0.01).NLVH组与对照组相比,矫正的声学强度(CAI1、CAI2)背向散射积分周期变化值(CVIB1、CVIB2)无统计学意义(P＞0.05),LVH组与NLVH组相比,CAI1、CAI2值显著性升高(P＜0.01),CVIB1、CVIB2值显著性降低(P＜0.01).hsCRP与CAI1、CAI2呈直线正相关(P＜0,01),hsCRP与CVIB1、CVIB2呈直线负相关(P＜0.01).结论 hsCRP与原发性高血压心肌纤维化之间有明显相关性.     

原发性高血压患者左心室肥厚与室性心律失常及心率变异性的关系

为探讨原发性高血压患者左心室肥厚与室性心律失常及心率变异性的关系。将原发性高血压患者分为无左心室肥厚组和左心室肥厚组，通过心脏B超观察原发性高血压患者心脏的结构与功能，通过动态心电图观察其24h室性期前收缩情况及心率变异性各时域指标。结果发现，左心室肥厚组患者的24h室性期前收缩发生率及室性期前收缩级别明显高于无左心室肥厚组（P＜0．01）；两组患者心率变异性各指标差异无显著性（P＞0．05）；与室性期前收缩级别相关的独立危险因素依次为室间隔厚度、左心室舒张末期内径和患者的年龄（P＜0．05，P＜0．001，P＜0．05）。以上提示原发性高血压合并左心室肥厚患者严重室性心律失常的发生率明显增高，而左心室肥厚与心率变异性无相关性。室间隔厚度、左心室舒张末期内径与年龄是原发性高血压患者发生室性心律失常的独立危险因素。     

培哚普利对高血压患者血清IGF—Ⅰ和左心室肥厚的影响

目的研究培哚普利对原发性高血压患者血清胰岛素样生长因-Ⅰ（insulin-like growth factor-Ⅰ，IGF—Ⅰ）浓度和左心室肥厚程度的影响。方法选择原发性高血压患者40例作为治疗组，每日予以口服培哚普利4mg-8mg，疗程为6个月，同时选择健康检查结果正常的40名成人作为对照组。检测治疗组治疗前后及对照组血清IGF-Ⅰ浓度和左心室肥厚程度，并进行统计分析。结果治疗组治疗前血清IGF-Ⅰ浓度和左心室肥厚程度的各项指标均高于对照组。经培哚普利治疗后，治疗组血清IGF-Ⅰ浓度、血压及左心室肥厚程度的各项指标均比治疗前明显下降。结论培哚普利可降低原发性高血压患者血清IGF-Ⅰ浓度，改善左心室肥厚程度。     

氯沙坦钾片对高血压左心室肥厚患者的治疗效果及对血清中IGF-1的影响

目的 观察氯沙坦钾片对高血压左心室肥厚(LVH)患者的治疗作用及对血清中胰岛素样生长因子(IGF)-1的影响,探讨其临床意义.方法 选取180例高血压LVH患者,随机分为氯沙坦钾片组和硝苯地平组各90例,观察其治疗前、后舒张末期室间隔厚度(IVST)、舒张末期左室后壁厚度(LVPWT)和左心室重量指数(LVMI)改变,同时于治疗前、治疗后观察血清中IGF-1的变化.结果 两组治疗后IVST、LVPWT和LVMI均明显减小,但是氯沙坦钾片组减少值明显高于硝苯地平组(P＜0.05).两组治疗后血清中IGF-1明显低于治疗前,但氯沙坦钾片组治疗前、后IGF-1的减少值明显高于硝苯地平组(P＜0.05).结论 氯沙坦钾片对高血压LVH患者的治疗作用明显,且对血清中IGF-1的表达有重要的降低作用.     

原发性高血压患者同型半胱氨酸水平与左心室肥厚的关系

目的观察原发性高血压患者同型半胱氨酸(Hcy)水平与左心室肥厚的关系。方法收集原发性高血压患者136例,其中H型高血压患者97例,所有入选患者采用高效液相色谱-串联质谱检测方法测定血浆Hcy浓度,彩色多普勒超声诊断仪测定左心室形态结构,分析原发性高血压患者血Hcy与左心室重构的关系。结果 H型高血压患者左心室肥厚发生率明显高于Hcy正常组(27.8%比7.7%,P=0.010)。左心室肥厚组Hcy水平明显高于无左心室肥厚组[(20.3±12.3)比(14.4±7.5)μmol/L,P=0.001]。H型高血压组室间隔厚度、左心室后壁厚度、左心室质量指数均高于Hcy正常组[分别为(0.92±0.11)比(0.84±0.11)cm,(0.87±0.09)比(0.82±0.09)cm,(110.9±35.6)比(92.2±20.6)g/m2,均P<0.05]。单因素相关分析显示血浆Hcy与左心室质量、室间隔厚度、左心室后壁厚度呈正相关。Logistic回归分析提示Hcy(OR=5.602,P=0.014)、收缩压(OR=1.101,P<0.01)是影响左心室肥厚的危险因素。结论高Hcy血症是高血压左心室重构的独立危险因素。     

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.