高血压病患者脉搏波速度与心血管疾病危险因素

目的 探讨高血压病患者脉搏波速度(PWV)与传统动脉粥样硬化危险因素的相关性.方法 应用脉搏波速度自动测量系统测量颈股动脉脉搏波速度(CFPWV)和颈桡动脉脉搏波速度(CRPWV)分别作为反映中央弹性大动脉和外周中等肌性动脉僵硬度的指标,对高血压患者664例[男353例,女311例,年龄18～82(52.1±12.8)岁]进行脉搏波速度检测,并检测空腹血糖、血脂、尿酸(UA)等血清生化指标.结果 高血压患者CFPWV和CRPWV随血压水平均呈升高趋势(P＜0.01),CFPWV由高到低依次为单纯收缩期高血压、收缩舒张期高血压、单纯舒张期高血压和正常血压.CRPWV由高到低依次为收缩舒张期高血压、单纯舒张期高血压、单纯收缩期高血压及正常血压.多元逐步回归分析显示年龄(标准化系数β=0.484,P＜0.01)、收缩压(β=0.277,P＜0.01)、心率(HR)(β=0.275,P＜0.01)、男性性别(β=0.142,P＜0.01)、UA(β=0.100,P=0.004)、空腹血糖(β=0.080,P=0.014)是影响CFPWV的独立因素(累积R2=0.404);男性性别(β=0.341,P＜0.01)、舒张压(β=0.149,P＜0.01)、HR(β=0.142,P＜0.01)是影响CRPWV的独立因素(累积R2=0.176).结论 PWV与心血管危险因素如年龄、血压、HR、男性性别、UA、空腹血糖呈独立正相关.     

老年单纯收缩期高血压患者动脉僵硬度的临床研究

目的探讨老年单纯收缩期高血压患者动脉僵硬度的改变。方法应用脉搏波速度自动分析仪测定颈动脉-股动脉脉搏波速度(CFPWV)和颈动脉-桡动脉脉搏波速度(CRPWV)分别作为评估中央弹性大动脉和外周中等肌性动脉僵硬度的指标,对43例健康老年人:男24例,女19例,年龄60～79岁,平均(68.2±4.6)岁和87例(单纯收缩期高血压患者40例,非单纯收缩期高血压患者47例)老年高血压患者:男41例,女46例,年龄60～78岁,平均(68.1±5.2)岁,进行脉搏波速度检测。结果老年单纯收缩期高血压患者CFPWV显著高于非单纯收缩期高血压及正常血压者(均P<0.01),CRPWV在3组间无显著差异(P>0.05);CFPWV与脉压(r=0.229,P=0.009)及年龄(r=0.203,P=0.020)呈显著正相关,CRPWV与脉压及年龄无显著相关性(均P>0.05)。多元逐步回归分析显示,脉压是CFPWV最主要的影响因素。结论老年单纯收缩期高血压患者大动脉僵硬度明显升高。     

血压正常高值人大动脉顺应性的变化

目的探讨血压正常高值人群大动脉顺应性的变化。方法选择年龄相似血压正常的健康者及没有任何靶器官损害的Ⅰ～Ⅱ级高血压患者191例,分为3组:正常血压组64人;正常高值组75人;高血压组52人。应用脉搏波速度(PWV)测定仪对所有入选者进行同时测定颈动脉桡动脉(CRPWV),颈动脉股动脉的脉搏波速度(CFPWV),及血压、身高、体重、体重指数(BMI)、腰围、臀围、腰臀围比值、心率(HR)等。结果CFPWV、CRPWV在正常组(8.9±1.6)m/s和(8.8±1.1)m/s、血压正常高值组(9.7±1.6)m/s和(9.7±1.4)m/s,高血压组3组中分别为(10.0±1.4)m/s和(10.3±1.5)m/s。方差分析示,3组间各因素比较除年龄、心率外均存在统计学差异。两组间的SNK检验示:血压正常高值组的身高、体重、BMI、腰臀围比值,CRPWV及CFPWV均大于正常组,P<0.05;而年龄、脉压(PP)、心率无统计学差异,P>0.05。正常高值组与高血压组的比较,CRPWV有明显的统计学差异,P<0.05。血压正常的健康人(血压正常高值组和理想血压组)的PWV与各因素的简单相关(Pearson)分析示:CRPWV与收缩压(SBP)、舒张压(DBP)、身高、HR相关;CFPWV与年龄、SBP、PP、BMI相关。CFPWV、CRPWV多因素逐步线性回归分析示:CFPWV与年龄、SBP、身高、体重关系密切;CRPWV与DBP、HR紧密相关。结论1、血压正常高值患者已经存在动脉顺应性的减退;2、血压正常人群的动脉顺应性随年龄、血压、HR的增高而减退。     

血压正常高值人群心血管危险因素和脉搏波传导速度

目的探讨血压正常高值人群血管脉搏波速度与心血管危险因素的关系。方法选择血压正常人群195例,分为两组:理想血压组90人(BP<120/80mmHg);正常高值组105人(BP:120～139/80～89mmHg)。应用脉搏波速度(PWV)测定仪对所有入选者同时测定颈桡动脉脉搏波速度(CRPWV),颈股动脉脉搏波速度(CFPWV),并测身高、体重、体重指数(BMI)、腰围等,同时抽取空腹肘部静脉血测定血糖(BG)、血脂、内皮素(ET)、一氧化氮(NO)和胰岛素(INS)的浓度。结果1)两组间各因素比较BMI、腰围、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、极低密度脂蛋白(VLDL)、BG、ET、NO、胰岛素抵抗指数(HOMAIR)、CRPWV、CFPWV存在统计学差异,P均<0.05。2)PWV与各因素的简单相关(Pearson)分析示:CFPWV与年龄、SBP、DBP、腰围、TG、胆固醇(CHO)、VLDL、BG、ET、NO、HOMAIR相关。CRPWV与年龄、腰围、SBP、DBP、TG、VLDL、BG、ET、NO、HOMAIR相关。3)多因素回归分析示:CFPWV=4.635 0.035SBP 0.047age 0.290TG-0.099BMI 0.010ET-0.009NO 0.076HOMAIR。R2=0.514。CRPWV=3.161 0.033DBP 0.034age 0.313BG 0.012ET-0.009NO。R2=0.274。结论1)血压正常高值者已经存在动脉弹性的减退。2)血压正常高值者动脉弹性的减退与内皮功能失调、血糖、血脂水平、胰岛素抵抗密切相关。     

高血压病和冠心病患者脉搏波传导速度分析

目的分析原发性高血压病和冠心病患者脉搏波传导速度(PWV)的临床意义及其影响因素,为高血压、冠心病等疾病的早期预防和干预治疗提供参考。方法选取164例行冠状动脉造影检查的患者作为研究对象,根据造影结果分为四组:正常对照组、高血压组、单纯冠心病组、冠心病合并高血压组。收集一般临床资料;空腹抽血检测生化指标;测定PWV。应用单因素方差分析及q检验分析PWV在研究对象中的分布特点,应用多元逐步线性回归分析研究影响PWV的因素。结果 (1)四组间的颈-股动脉脉搏波传导速度(CFPWV)和颈-足背动脉脉搏波传导速度(CDPWV)比较有统计学差异,高血压组、单纯冠心病组和冠心病合并高血压组的CFPWV及CDPWV较正常对照组显著升高,颈-桡动脉脉搏波传导速度(CRPWV)在四组间的比较无统计学差异;(2)CFPWV和CDPWV在高血压组和单纯冠心病组间的比较无统计学差异,冠心病合并高血压组的CFPWV高于高血压组和单纯冠心病组(P0.05);冠心病合并高血压组的CDPWV较单纯冠心病组明显升高(P0.05);(3)每组内部CFPWV、CDPWV和CRPWV三组数据间的比较有统计学差异;(4)多元逐步线性回归分析显示:心率、同型半胱氨酸(Hcy)、高密度脂蛋白胆固醇(HDLC)和脉压是影响CFPWV的主要因素;HDLC和平均压是影响CDPWV的主要因素。结论高血压病、冠心病患者的PWV明显高于正常人群,冠心病合并高血压患者的PWV升高更为显著,提示后者的动脉硬化程度更为严重;CFPWV具有更高的临床应用价值,心率、脉压、平均压、Hcy、HDLC等是影响PWV的因素;如果在早期检测PWV则能够为高血压病、冠心病等疾病的筛查诊断、早期预防及干预治疗提供可靠的判别指标。     

健康人1562名臂踝脉搏波速度及其影响因素初探

目的探讨健康人臂踝脉搏波速度(baPWV)及其影响因素的相关性。方法应用动脉硬化检测仪VP-1000(BP203RPE,Ⅱ型,PWV/ABI型)测量1562名健康人臂踝脉搏波速度,并检测空腹血糖、血脂等血清生化指标。结果多元逐步回归分析显示,年龄(β=0.367,P0.01)、收缩压(β=0.576,P0.01)、空腹血糖(β=0.08,P0.01)、男性(β=0.072,P0.01)、体质量指数(BMI)(β=-0.098,P0.01)是影响baPWV的独立危险因素(累积R~2=0.671)。结论 baPWV与年龄、男性性别、收缩压、空腹血糖存在正相关,与BMI成负相关。     

脉搏波传导速度与冠状动脉粥样硬化的相关性研究

目的研究脉搏波传导速度（PWV）与冠状动脉粥样硬化的相关性。方法对348例患者进行PWV测定,然后根据冠状动脉造影结果将患者分成正常对照组、单支病变组、双支病变组和多支病变组进行分析。结果①冠心病组与正常对照组比较,颈动脉一股动脉脉搏波传导速度（CFPWV）、颈动脉一桡动脉脉搏波传导速度（CRPWV）和颈动脉一远端动脉脉搏波传导速度（CDPWV）显著升高（P〈0．05）;②单支、双支和多支病变组间比较,CFPWV、CRPWV、CDPWV有统计学差异（P〈0．05）,且随病变支数的增加,CFPWV、CRPWV、CDPWV呈升高趋势;③每组内部的CFPWV、CRPWV、CDPWV三组数据中,CRPWV、CDPWV无统计学差异（P〉0．05）,但CRPWV、CDPWV均小于CFPWV（P〈0．05）。结论PWV与动脉粥样硬化明显相关,可反映冠状动脉粥样硬化病变程度;其中CFPWV较CRPWV、CDPWV在反映动脉粥样硬化方面更敏感。     

北京中老年自然人群颈-股动脉脉搏波速度的分布及相关因素

目的 了解我国中老年自然人群颈-股动脉脉搏波速度(CFPWV)的分布及相关因素.方法 对北京市石景山区1519名44～79岁居民进行心血管病危险因素调查及CFPWV测量.采用单因素方差分析、Pearson相关和偏相关、多元逐步回归分析CFPWV的相关因素.结果 (1)调整年龄后,男女CFPWV均值分别为11.4 m/s和11.1 m/s,男性显著高于女性(P<0.01).无论男女,随着年龄增长,CFPWV增加,趋势榆验有显著性(P<0.01).(2)调整年龄、件别后,高血压、糖尿病和心率较高组(≥70次/min)CFPWV显著高于非高血压、非糖尿病和心率较低组(<70次/min)(P均<0.01).(3)简单相关显示:不论男女,年龄、收缩压、舒张压、空腹血糖、心率均与CFPWV显著相关,相关系数为0.12～0.46(P均<0.01);女性CFPWV还与总胆固醇、甘油三酯显著相关,相关系数为0.11和0.13(P均<0.01);多元逐步同门显示年龄、性别、收缩压、舒张压、空腹血糖、心率是CFPWV的独市相关因素,年龄是CFPWV最大的相关因素.结论 我国中老年自然人群中,年龄、性别、收缩压、舒张压、空腹血糖、心率与CFPWV显著相关,高密度脂蛋白胆固醇、体质指数与CFPWV不相关.     

桡动脉增强指数与心血管病危险及动脉僵硬度相关分析

目的 探讨桡动脉增强指数(rAI)与心血管病危险及动脉僵硬度相关性。方法 北京地区4985例(男2417例,女2568例),年龄18 ～96(50.9±14.7)岁,测量左侧rAI;应用脉搏波传播速度(PWV)自动测量系统测定颈-股动脉PWV(CFPWV)和颈-桡动脉PWV(CRPWV)。并对其中没有心血管病的人群应用Framingham危险评分和中国缺血性心血管病危险评分分别计算个体心血管病风险。结果 女性的rAI显著高于男性[(83.18±12.36)％比(71.93±15.22)％,P＜0.01]。相关分析rAI无论与两种心血管评分还是与CFPWV、CRPWV均有显著相关性;当校正了年龄、舒张压、吸烟、心率、身高、腰围及空腹血糖后rAI仍与Framingham评分及中国心血管评分有相关性,其中男、女性相关系数r分别为0.17、0.09和0.12、0.08(P值均＜0.05),rAI仅与CFPWV有相关性(男女分别为r=0.14、0.10,P＜0.01),而与CRPWV无相关性。在相对年老的人群中(＞50岁)rAI与心血管病危险评分及PWV的相关性减弱。结论 rAI可能是一种预测心血管病风险及评估动脉僵硬度的有价值工具;作为危险分层的工具,rAI可能更适用于相对年轻的人群。     

高血压患者脉搏波传导速度与红细胞分布宽度性别差异的研究

目的:研究高血压患者脉搏波传导速度(PWV)和红细胞分布宽度(RDW)之间关系的性别差异。方法:选择2014年1月至2014年12月,在北京安贞医院体检中心体检的高血压患者285例(高血压组),并按照年龄、性别匹配无高血压人群519例(正常血压组)。记录入选患者的一般资料并检测RDW、空腹血糖、血脂水平以及血压、心率,肱踝动脉PWV(ba PWV)和颈股动脉PWV(cf PWV)。分析PWV和RDW之间的关系。结果:高血压组体质指数、空腹血糖、TC、TG-C、收缩压、舒张压、心率、ba PWV、cf PWV、RDW均明显高于正常血压组。高血压组男性的ba PWV、cf PWV均明显高于女性[(12.18±1.53)vs.(11.79±2.04)m/s,(8.00±1.28)vs.(7.76±1.83)m/s,P均0.01]。女性RDW显著高于男性[(13.98±0.87)vs.(13.05±0.71)%,P0.05]。Pearson相关分析,男性中ba PWV、cf PWV与RDW水平呈正相关。多元线性回归也显示男性中ba PWV、cf PWV与RDW水平显著相关。结论:高血压人群PWV和RDW水平显著高于正常血压组,男性中PWV与RDW水平明显相关。     

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.