老年阻塞性睡眠呼吸暂停综合征多导睡眠图与认知功能的相关性

目的探讨老年阻塞性睡眠呼吸暂停综合征(低通气综合征,OSAS)患者多导睡眠图与认知功能的相关性。方法以该院42例老年OSAS患者为观察对象,另以40例具有可比性的非OSAS患者为对照,比较两组PSG及认知功能,并对OSAS患者PSG和认知功能的相关性进行pearson相关性分析。结果 (1)OSAS组患者入睡后觉醒次数、呼吸暂停低通气指数(AHI)、Ⅲ+Ⅳ期、呼吸紊乱指数、氧减指数OSAS组高于对照组(P<0.05);最低血氧饱和度(SaO2)、平均SaO2OSAS组低于对照组(P<0.05);(2)OSAS组MMSE、MoCA、画钟实验、2 min后延迟记忆与对照组相比差异具有统计学意义(P<0.05);(3)相关性分析发现,MMSE与最低SaO2和平均SaO2具有相关性(P<0.05);MoCA与最低和呼吸紊乱指数具有相关性(P<0.05);画钟实验与平均SaO2具有相关性(P<0.05);符号数字测验与入睡后觉醒次数、最低SaO2具有相关性(P<0.05);2 min后延迟记忆与入睡后觉醒次数具有相关性(P<0.05)。结论老年OSAS患者存在认知功能障碍,其发生可能与低氧血症、呼吸紊乱有关。     

老年阻塞性睡眠呼吸暂停综合征并存脑卒中患者氧化应激指标观察及发病机制探讨

目的 观察老年阻塞性睡眠呼吸暂停综合征(OSAS)合并脑卒中患者血浆中血管内皮生长因子、一氧化氮、内皮素等指标的变化情况并初步探讨其发病机制.方法 经手握式脉搏血氧监测仪监测后,将患者分为OSAS并存脑卒中患者32例;单纯OSAS患者36例;单纯脑卒中患者31例;无脑卒中和OSAS患者33例为对照组.检测血浆中血管内皮生长因子(VEGF)、内皮素(ET)和一氧化氮(NO)浓度.结果 (1)血浆VEGF浓度从高到低分别为:OSAS并存脑卒中患者(195.3±56.7)ng/L、单纯OSAS患者(162.3±48.7)ng/L、单纯脑卒中患者(156.4±51.8)ng/L及正常对照组(114.1±54.Z)ng/L,差异有统计学意义(F=21.02,P<0.05);(2)血浆NO浓度从低到高分别为:OSAS并存脑卒中患者(62.3±4.9)mmol/L、单纯脑卒中患者(64.7±5.1)mmol/L、单纯OSAS患者(66.2±4.2)mmol/L及正常对照组(77.5±6.8)mmol/L,差异有统计学意义(F=17.35,P<0.05);(3)血浆ET浓度从高到低分别为:OSAS并存脑卒中患者(59.8±9.6)ng/L、单纯脑卒中患者(56.5±4.3)ng/L,单纯OSAS患者(54.7±7.9)ng/L、及正常对照组(37.2±8.5)ng/L,差异有统计学意义(F=4.27.P<0.05).结论 (1)OSAS患者血浆VEGF、ET浓度升高,血浆NO水平下降;(2)并存脑卒中的OSAS患者比无脑卒中的单纯OSAS患者血浆VEGF、ET浓度升高更显著,血浆NO水平下降更明显.提示:OSAS老年脑卒中患者存在明显血管内皮功能障碍,伴脑卒中者为甚,血管内皮功能损伤可能是OSAS患者并发脑卒中的原因之一.     

阻塞型睡眠呼吸暂停综合征患者血浆同型半胱氨酸的变化

背景 阻塞型睡眠呼吸暂停综合征(OSAS)与血浆高同型半胱氨酸血症(HHCY)是近年来心血管疾病研究领域中的两大热点问题.对于HHCY和OSAS之间相互关系的研究不多,得到的结论存在着差异.目的 探讨OSAS患者的同型半胱氨酸是否有改变?通过夜间持续正压(CPAP)治疗能否影响同型半胱氨酸血症(HCY)值.方法 根据美国邦德全数字睡眠监测系统的监测结果分为OSAS组81例和健康对照组120例.两组之间年龄、性别(均为男性)、吸烟、体质量指数、空腹血糖、内生肌酐清除率(CCr)比较,差异无统计学意义(P＞0.05).对两组实验对象分别检测晨起空腹同型半胱氨酸浓度、肌酐(Cr)、空腹血糖(FPG)、一氧化氮(NO),并对两组数据进行统计分析.对睡眠呼吸暂停组患者进行夜间持续正压通气治疗7天后再次检测晨起空腹HCY浓度,并对进行CPAP治疗前后的HCY浓度进行比较分析.结果 OSAS组HCY浓度较对照组HCY浓度明显增高[OSAS组(14.0±2.9)比对照组(11.5±2.3)μmol/L,P＜0.01].OSAS组NO浓度较对照组NO浓度明显降低[OSAS组(23.6±9.1)比对照组(51.9±13.4)μmol/L,P＜0.01].OSAS组经CPAP治疗后HCY浓度低于治疗前[(12.6±3.1)比治疗前(14.0±2.9)μmol/L,P＜0.05].结论 OSAS患者血浆HCY浓度较健康人群增高,经CPAP治疗后可降低HCY的浓度.     

阻塞型睡眠呼吸暂停综合征患者血浆同型半胱氨酸的变化

背景阻塞型睡眠呼吸暂停综合征(OSAS)与血浆高同型半胱氨酸血症(HHCY)是近年来心血管疾病研究领域中的两大热点问题。对于 HHCY 和 OSAS 之间相互关系的研究不多,得到的结论存在着差异。目的探讨 OSAS 患者的同型半胱氨酸是否有改变?通过夜间持续正压(CPAP)治疗能否影响同型半胱氨酸血症(HCY)值。方法根据美国邦德全数字睡眠监测系统的监测结果分为 OSAS 组81例和健康对照组120例。两组之间年龄、性别(均为男性)、吸烟、体质量指数、空腹血糖、内生肌酐清除率(CCr)比较,差异无统计学意义(P>0.05)。对两组实验对象分别检测晨起空腹同型半胱氨酸浓度、肌酐(Cr)、空腹血糖(FPG)、一氧化氮(NO),并对两组数据进行统计分析。对睡眠呼吸暂停组患者进行夜间持续正压通气治疗7天后再次检测晨起空腹 HCY 浓度,并对进行CPAP 治疗前后的 HCY 浓度进行比较分析。结果 OSAS 组 HCY 浓度较对照组 HCY 浓度明显增高[OSAS 组(14.0±2.9)比对照组(11.5±2.3)μmol/L,P<0.01]。OSAS 组 NO 浓度较对照组 NO 浓度明显降低[OSAS 组(23.6...     

阻塞性睡眠呼吸暂停对冠状动脉粥样硬化斑块的影响

目的 探讨阻塞性睡眠呼吸暂停(OSAS)对冠状动脉粥样硬化斑块的影响.方法 126例老年冠心病(CAD)患者根据多导睡眠仪监测结果,分为OSAS合并CAD组(62例)、无OSAS组(64例).所有患者常规清晨空腹卧位取静脉血测定测定胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血常规白细胞计数、中性粒细胞分类及血清(hs-CRP)水平.根据冠状动脉造影术、64层螺旋CT检查结果记录OSAS合并CAD组、无OSAS组冠状动脉病变、Gensini评分及粥样硬化斑块情况.结果 CAD合并OSAS组TC、TG、LDL-C分别为(5.76+0.85)mmol/L、(3.37±0.97)mmol/L、(3.65±0.58)mmol/L,HDL-C为(1.06±0.20)mmol/L,无OSAS组TC、TG、LDL-C分别为(4.26±0.78)mmol/L、(1.72±0.54)mmol/L、(2.91±0.58)mmol/L,HDL-C为(1.13±0.14)mmol/L,CAD合并OSAS组TC、TG、LDL-C均高于无OSAS组(t值分别为2.959、3.556、2.165,P<0.05),HDL-C低于无OSAS组(t=2.545,P<0.05);OSAS合并CAD组患者血白细胞数、中性粒细胞百分比及hs-CRP水平较无OSAS组明显增高(P<0.05);OSAS合并CAD组冠状动脉多支病变发生率为51%,Gensini积分为(23.6±20.7)分,冠状动脉软斑块为(67.6+9.7)个,无OSAS组分别为30%,(18.9±19.4)分,(39.3±9.4)个,两组比较差异有统计学意义(t值分别为5.39,2.048,19.001,P<0.05).结论 OSAS和冠状动脉粥样硬化性心脏病密切相关,促进冠状动脉粥样硬化斑块的形成.     

一氧化氮与高血压病的严重程度

目的 探讨高血压病与血清一氧化氮(NO)之间的关系。方法 硝酸还原酶法测定82例高血压病患者血清一氧化氮浓度并和31例健康成人对照。结果 健康成人血清一氧化氮浓度为78.35±27.41umol/L高血压病Ⅰ～Ⅱ期组为47.28±34.83umol/L,较正常对照组血清NO含量显著减低(P<0.01),高血压病Ⅲ期组血清NO浓度为37.7±18.59umol/L,又较高血压病Ⅰ～Ⅱ期组含量有非常显著减低(P<0.01)。结论 血清NO浓度随高血压病严重程度加重而减低,揭示NO是高血压病发生和发展的重要因素之一。     

老年阻塞性睡眠呼吸暂停综合征睡眠障碍特点与认知损害相关性分析

目的 分析老年阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的睡眠障碍特点与认知损害相关性. 方法 受检老年人36例,分为OSAS组(18例),对照组(18例),均进行多导睡眠图(polysomnography,PSG)家庭睡眠监测、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、爱泼沃斯思睡量表(Epworth sleepiness scale,ESS)测试,检测简易智力状态(mini-mental state examination,MMSE)、记忆商(MQ)并进行画钟测验、词表学习、符号数字测验等认知功能评估. 结果 (1)OSAS组Delta睡眠比例减少、最低和平均血氧饱和度明显减少、呼吸暂停及低通气指数(apnea and hypopnea index,AHI)及氧减指数明显增加(P＜0.05).(2)OSAS组MMSE、MQ、符号数字测验、画钟测验成绩较差(P＜0.05).(3)OSAS组MMSE评分与年龄呈负相关(r=-0.533,P＜0.05),与平均血氧水平呈正相关(r=0.409,P＜0.05).MQ与MMSE、入睡潜伏期、氧减指数相关(r分别为0.726,0.495,0.645,P均＜0.05). 结论 老年OSAS以深睡眠减少、血氧饱和度降低等为其睡眠障碍特点,可能是引起记忆、视空间、操作学习等认知功能损害的重要原因.     

血管性认知损害与S100β和髓鞘碱性蛋白的关系

目的探讨S100β和髓鞘碱性蛋白(MBP)与血管性认知损害(VCI)的关系。方法①分组:将67例VCI患者分为轻度VCI组,25例;中度VCI组,23例;重度VCI组,19例;对照组为正常健康者30名。②用酶联免疫吸附法(ELISA)检测各组对象血清的S100β蛋白和MBP含量。③认知功能评价:运用简易智能状态量表(MMSE)及临床记忆量表(CMS)评估认知功能。结果轻、中、重度VCI组的血清S100β浓度分别为(0.42±0.08)、(0.59±0.06)及(0.64±0.06)μg/L,对照组为(0.39±0.11)μg/L,差异均有统计学意义(P<0.05);相关性分析显示,中、重度VCI组血清S100β含量与MMSE总分及记忆商值皆呈显著性负相关(r=-0.55,r=-0.57;r=-0.63,r=-0.65,),而轻度VCI组血清S100β含量与MMSE总分及记忆商值无显著相关性。轻、中、重度VCI组的血清MBP浓度为(3.94±0.68)、(3.44±0.76)及(5.21±0.96)μg/L,对照组为(1.75±0.47)μg/L,差异有统计学意义(P<0.05)。相关性分析显示,重度VCI组血清MBP含量与MMSE总分及记忆商值均呈显著性负相关(r=-0.67,r=-0.61),轻、中度VCI组血清MBP含量与MMSE评分和记忆商值均呈显著性负相关(r=-0.62,r=-0.58;r=-0.63,r=-0.57)。结论血清S100β和MBP浓度有可能作为观察中、重度血管性认知(包括记忆和脱髓鞘变化)损害的生化指标。     

阻塞性睡眠呼吸暂停对高血压患者血管内皮影响研究

目的 回顾性分析高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者的预后及影响因素.方法 对2004年1月至2007年10月江苏省省级机关医院确诊的高血压病患者共168例,通过电话和门诊随访,随访时间中位数35个月.根据多导睡眠仪监测结果 分为:高血压合并OSAS(OSAS+)组和高血压不合并OSAS(OSAS-)组.所有患者均通过彩色多普勒超声测定肱动脉血流介导的舒张功能(FMD),并测定与高血压预后相关的血清生化指标.随访患者心血管死亡、心绞痛或心肌梗死、脑卒中等事件.结果 OSAS+组患者血清超敏C反应蛋白(hsCRP)水平高于OSAS-组,(2.49±2.65)mmol/Lvs(1.73±1.76)mmol/L(P<0.05),FMD值低于OSAS-组,(6.20±3.40)%vs(8.39±3.86)0A(P<0.05).OSAS+组患者总事件发生率高于OSAS-组(28.8%A vs 13.7%,P=0.016).Logistic多因素回归分析显示:FMD主要损伤因素排名首位是OSAS(OR=2.89,P=0.003),其次是血清hsCRP(OR=1.23,P=0.044);FMD、血清hsCRP及尿酸成为高血压患者预后的影响因子(OR=1.7,1.7,3.5,P=0.03,0.00,0.01).结论 OSAS影响高血压患者血管内皮功能,使总的事件(心脑血管原因导致的死亡、心绞痛或心肌梗死和脑卒中)发生率增加.OSAS可能主要通过损伤血管内皮功能间接影响高血压患者的预后.     

阻塞性睡眠呼吸暂停低通气综合征患者血清铁蛋白、铁调素的变化及其临床意义

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者血清铁蛋白(SF)、铁调素的变化及其临床意义.方法 选取经多导睡眠监测确诊为OSAS的男性患者51例,其中单纯OSAS组36例(轻度OSAS组13例,中重度OSAS组23例),OSAS合并糖尿病组15例；另选取单纯2型糖尿病(T2DM)患者14例作为T2DM组；设立单纯肥胖男性18例为对照组.分别检测各组受试者空腹血糖、HbA1c及空腹胰岛素水平,并用ELISA法检测SF、铁调素水平,观察OSAS患者SF、铁调素对糖代谢的影响.结果 (1)轻度OSAS组、中重度OSAS组、OSAS合并糖尿病组和T2DM组的SF水平升高,分别为(268.24±47.94),(316.45 ±49.36),(377.66±49.95),(286.01 ±45.53) μg/L,均高于对照组(203.28±32.83) μg/L,差异有统计学意义(F =39.38,P ＜0.01)；铁调素水平下降,分别为(66.41 ±12.00),(47.34 ±13.35),(34.52±8.49),(54.45±8.25) μg/L,均低于对照组(88.26±12.34)μg/L,差异有统计学意义(F=67.80,P＜0.01).(2)SF、铁调素与睡眠呼吸紊乱指数、最长呼吸暂停时间、夜间血氧饱和度低于90％的时间占总睡眠时间的百分比、最低血氧饱和度存在相关性(r=-0.65 ～0.34,P均＜0.01),且SF与铁调素之间存在线性相关(F=22.40,P＜0.01).结论 OSAS患者存在SF及铁调素水平的异常,可能在T2DM的发生中发挥一定的作用.     

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.