高血压伴胸痛与心肌缺血的心肌核素显像分析

目的　探讨冠状动脉造影正常的高血压伴胸痛患者 SPECT心肌负荷显像特点及临床意义。方法　应用 99Tcm-甲氧基异丁基异腈 ( MIBI)门控心肌灌注断层显像定性与半定量记分法 ,比较了 2 0例冠状动脉造影 ( CAG)正常的高血压患者及正常对照组运动前后心肌显像特点。结果　 ( 1)心肌灌注断层分析 :高血压组心肌灌注显像阳性率为 65 % ,明显高于对照组 ( P<0 .0 5 ) ,其中 47( 75 .8% )个节段为可逆性缺损 ,8( 12 .9% )个节段为部分可逆性缺损 ,3 ( 4 .8% )个节段为固定性缺损 ,另有 4( 6.5 % )个节段存在反向分布 ;高血压组 7例心室壁肥厚患者 ,与 13例无心室壁肥厚患者心室壁节段灌注异常比较 ,两者之间差异显著 ( P<0 .0 5 )。 ( 2 )心功能参数分析 :高血压组运动负荷显像、静息显像左心室射血分数 ( L VEF )值测定未见明显差异。高血压组患者运动负荷显像左心室舒张末期心室容积 ( LVEDV)平均为 66.4± 12 .5 3 ,明显低于静息显像 L VEDV 73 .6± 14 .2 3 ( P<0 .0 0 1)。结论　 ( 1)心肌灌注显像异常可以发生在 CAG正常有 /或无心肌肥厚的高血压患者中 ,但随着心肌肥厚的加重 ,心肌缺血有加重趋势。 ( 2 ) CAG正常的高血压患者可能存在冠状动脉血流储备功能下降     

心肌灌注断层显像对急性心肌梗死再灌注的研究

目的　通过心肌灌注断层显像研究急性心肌梗死 (AMI)患者经尿激酶或冠状动脉介入治疗前后心肌梗死面积的变化。方法　用99m锝甲氧基异丁基异腈心肌灌注断层显像测定 12 0例AMI患者心肌再灌注前后的心肌梗死面积。结果　再灌注组 (n =81)和无再灌注组 (n =36 )首次心肌显像心肌缺损面积无显著性差异 (P >0 0 5 ) :再灌注组再次显像心肌缺损面积明显小于首次显像 (2 2 3± 3 1%和 31 9± 5 6 % ,P <0 0 5 ) ;无再灌注组再次显像心肌缺损面积与首次显像无明显差异 (2 9 6± 2 8%和 32 4± 5 l% ,P >0 0 5 ) ;预后不良组心肌缺损面积明显高于预后较好组 (35 8± 6 1% ,n =32和2 0 6± 4 0 % ,n =88,P <0 0 5 )。结论　心肌灌注断层显像可作为AMI再灌注疗效评价较准确的手段     

冠心病患者左室舒张功能与左室缺血面积的相关性研究

目的 采用门控心肌灌注显像评估冠状动脉粥样硬化性心脏病(冠心病)患者左室缺血面积与左室舒张功能相关性。方法 收集2018年1月至2020年9月于徐州医科大学附属医院接受心肌灌注显像和心血池显像的187例患者,根据心肌灌注显像结果分为冠心病组138例和对照组49例。比较两组患者的一般临床资料(包括年龄、性别、体质指数,合并症有无高血压、糖尿病)、E/A比值、超声心动图指标差异、心功能指标差异。分析冠心病组患者E/A比值与运动灌注缺陷总分(SSS)及心功能指标之间的相关性。结果 对照组和冠心病组患高血压比例和糖尿病比例、E/A比值、高峰充盈率(PFR)、前1/3充盈分数(1/3FF)、平均充盈率(MFR)、左室舒张末期容积(EDV)、左室收缩末期容积(ESV)比较差异有统计学意义(P<0.05)。经门控心肌灌注显像得到的冠心病组患者SSS、PFR、1/3FF、MFR、EDV、ESV与E/A比值有良好的相关性(SSS:r=0.262,P=0.002;PFR:r=0.414,P<0.001;1/3FF:r=0.339,P<0.001;MFR:r=0.243,P=0.004;E...     

正常冠脉的老年高血压病人99mTc-tetrofosmin 负荷心肌灌注断层显像异常的临床意义

目的研究心肌灌注显像异常对冠状动脉造影(CAG)正常的老年高血压病人的临床意义.方法应用99mTc-tetrofosmin负荷与静息心肌灌注断层显像(MPT)定性方法,以及侧壁/室间隔计数比值(L/S)和负荷L/S与静息L/S之再比值,比较了27例CAG正常的老年高血压病人与21例血压正常的对照者的结果.结果①老年高血压组MPT阳性率为63%,显著高于对照组的9.5%,P＜0.01,而且以可逆性缺损为主,伴有少数反向填充;其心绞痛和心律失常发生率明显高于对照组.②老年高血压组与对照组相比,负荷L/S与静息L/S之再比值明显降低,P＜0.05.③老年高血压组MPT阳性病人负荷L/S与静息L/S之再比值低于MPT阴性病人P＜0.01.④ MPT异常分布于各个节段,大多数无明显心肌肥厚表现.结论心肌灌注显像异常可以发生在CAG正常、有或无心肌肥厚的老年高血压病人中.     

老年冠心病合并高血压及2型糖尿病患者核素心肌显像与血清学指标研究

目的 应用99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像对比分析老年冠心病患者(CHD)与CHD合并2型糖尿病(T2DM)和/或原发性高血压(EH)患者心肌缺血、心功能差异,并比较各组间血清学指标差异.方法 对237例老年CHD患者行门控SPECT核素心肌灌注显像,按病情分为4组:单纯CHD组、合并T2DM组、合并EH组、合并T2DM及EH组.分别统计4组总负荷评分(SSS)、总静息评分(SRS)、和总差值(SDS)、左室射血分数(LVEF)及血清学各项指标,并对4组数据进行对比分析.结果 合并T2DM组、合并EH组、合并T2DM及EH组核素心肌灌注显像SSS、SDS及D-二聚体(D-D)、血管性假血友病因子(vWF)、超敏C-反应蛋白(hs-CRP)均高于单纯CHD组(P＜0.05),而LVEF明显小于单纯CHD组(P＜0.05);合并T2DM及EH组SSS、SDS及D-D、vWF、hs-CRP均高于单纯合并T2DM组或合并EH组,左室射血分数(LVEF)则明显降低(P＜0.05);合并T2DM组、合并EH组两组间无明显差异(P=0.34);4组间血脂无明显差异.多因素分析显示D-D、vWF、hs-CRP水平与SSS、SDS呈正相关.结论 核素心肌灌注显像可有效评价冠脉心肌血供情况;CHD合并T2DM或EH患者心肌缺血显著,心功能较差;合并T2DM及EH患者心肌缺血最严重,而且心功能最差;D-D、vWF、hs-CRP水平可反映心肌缺血程度.     

冠状动脉造影正常的高血压患者心肌供血分析

目的　为了解冠状动脉造影（ＣＡＧ）正常的高血压患者心肌供血情况。方法选择５２例高血压病Ｉ期或Ⅱ期患者,排除心肌梗塞,心肌病,心瓣膜病等,经ＣＡＧ证实冠状动脉无狭窄者,行心电图、超声心动图、负荷９９ＴＣ－ＭＩＢＩ心肌断层显像检查;３０例ＣＡＧ正常无上述疾病的非高血压患者做对照。结果（１）５２例高血压患者中有２５例（４８．１％）心肌断层显像显示有心肌缺血,对照组缺血者７例（２．３％）,两组差异有显著性;（２）高血压组的室间隔厚度、左房内径明显高于对照组,舒张功能明显低于对照组;（３）高血压病程、心绞痛症状、心电图ＳＴ－Ｔ改变、左室肥厚及舒张功能在高血压缺血组和非缺血组之间差异无显著性。结论高血压患者虽然ＣＡＧ正常,但核素心肌显像仍有心肌缺血存在,考虑为高血压并发微血管病变,导致冠状动脉血流储备能力（ＣＦＲ）下降所致。     

腺苷负荷心肌灌注显像对冠状动脉介入治疗的临床意义

目的:探讨腺苷负荷心肌灌注显像对冠状动脉(冠脉)介入治疗的临床意义。方法:66例冠心病患者,行腺苷负荷心肌灌注显像和冠脉造影,根据需要进行介入治疗,介入治疗后3～7天复查腺苷负荷心肌灌注显像。腺苷负荷心肌灌注显像采用单光子发射断层显像图像采集系统,腺苷注射液总量为840μg/kg,6分钟匀速静脉泵入,腺苷泵入3分钟时静脉推注99锝-2-甲氧基异丁基异腈核素(99mTc-MIBI);1.5h后进行心肌灌注断层显像。若异常,次日行静息心肌显像。核素显像左心室心肌分为9个节段,心肌灌注评分分4级。结果:66例患者的腺苷负荷心肌灌注显像与冠脉造影结果相比,双支病变腺苷负荷心肌灌注显像阳性率(87.5%,28/32)和三支病变腺苷负荷心肌灌注显像阳性率(100%),与冠脉造影阳性率(100%)比较差异均无统计学意义(P0.05);单支病变腺苷负荷心肌灌注显像阳性率为54.5%(12/22),与冠脉造影阳性率(100%)比较差异有统计学意义(P0.01)。双支病变和三支病变腺苷负荷心肌灌注显像阳性率分别与单支病变相比,差异均有统计学意义(P均0.05)。冠脉介入后心肌核素显像血流灌注改善率为94.1%(32/34),与冠状动脉介入前(0%,0/34)自身对照,差异有统计学意义(P=0.003)。结论:腺苷负荷心肌灌注显像对于冠心病患者冠脉介入前病变程度分析以及介入后疗效判断有一定的临床意义。     

高血压患者^99mTc—MIBI心肌灌注及硝酸甘油介入显像的初步探讨

目的对高血压病人的９９ｍＴｃ－ＭＩＢＩ心肌灌注断层显像的临床意义进行探讨。方法１０５例高血压患者进行９９ｍＴｃ－ＭＩＢＩ负荷（运动或ＡＴＰ介入）和／或静息心肌灌注断层显像，其中５２例与１０例心肌灌注显像出现放射性异常减低的病人于２４～４８ｈ后分别进行硝酸甘油介入心肌显像与卡托普利介入心肌显像。结果高血压患者心肌灌注显像异常发生率８０．０％。２２例冠脉造影有１０例（５５．６％）证实为高血压合并冠脉狭窄≥５０％。硝酸甘油介入心肌显像使放射性减低节段填充或部分填充（血流灌注改善）６４．４％，无填充３１．１％，与冠心病心肌缺血组比较，差异有非常显著意义（Ｐ＜０．０１）；卡托普利介入心肌显像能使减低节段填充或部分填充占５３．８％。结论高血压患者心肌灌注显像所表现的放射性异常减低，其原因可有合并冠心病。心内局部合成肾素－血管紧张素参与，而高血压性心肌病变也是重要的原因。硝酸甘油介入与卡托普利介入心肌显像是鉴别上述病因的有效方法。     

核素心肌灌注显像评价FH纯合子患者心肌血供异常临床意义初步研究

目的:利用核素心肌灌注显像(MPI)研究家族性高胆固醇血症(FH)纯合子患者病情进展对心肌血供的影响及临床意义。方法:以经染色体检测确诊并来我院检查的28例FH纯合子患者为研究对象,均行药物负荷/静息MPI,根据心肌血供异常与否,将患者分成两组,并对两组患者的基本资料、血脂水平及心肌血流灌注情况进行对比分析,其中8例患者随诊1~2年。结果:28例FH患者,男性17例,女性11例,平均年龄12.12岁,TC(16.00±2.92)mmol/L,LDLC(13.82±2.73)mmol/L;MPI示15例阴性(男/女=11/4例),13例阳性(男/女=6/7例)。负荷试验中6例出现心电图ST段下移性改变。MPI显示:13例MPI阳性患者共计221个心肌节段中,29个节段出现心肌缺血(13.1%);其中左前降支、回旋支、右冠状动脉供血区分别有21个节段(21/29,72.4%)、5个节段(5/29,17.2%)、3个节段(3/29,10.3%)。MPI阳性与阴性两组中,患者的年龄(P=0.621)、身高(P=0.219)、体质量(P=0.847)、体质量指数(P=0.155)、治疗时间(P=0.189)、性别(P=0.246)、心电图ST段有无下移(P=0.372)、TC(P=0.088)、LDL-C(P=0.082)、TG(P=0.062)、HDL-C(P=0.652)均差异无统计学意义。8例随诊患者复查MPI结果提示:4例原无心肌缺血现仍为阴性;4例原有心肌缺血者,3例心肌缺血范围和程度均无明显变化,1例因心肌缺血程度加重导致心力衰竭后死亡。结论:FH纯合子患者心肌缺血好发于左前降支供血区,且患者的年龄、身高、体质量、治疗时间、血脂等因素在MPI阳性组与阴性组中的差异无统计学意义;最好早期对FH纯合子患者行MPI以评估心血管病危险度分层、患者治疗效果和预后。     

99mTc-MIBI运动-静息心肌灌注显像对经皮冠状动脉腔内成形术术后患者的预后估价

目的　本研究旨在评估运动 静息心肌灌注显像对冠状动脉腔内成形术 (PTCA)后患者预后的预测价值。方法　对 16 0例PTCA术后行99mTc 甲氧异丁基异腈 (MIBI)运动 静息心肌灌注显像的患者 ,随访 (36± 2 8)个月。结果　随访期间 ,34例 (2 1.3% )患者发生心脏事件 ,其中心肌显像提示的心肌缺血组 (n =4 3)心脏事件发生率为 6 2 .8% ,明显高于心肌梗死组 (n =32 ,12 .5 % ,χ2 =19.3,P <0 .0 0 0 1) ,而且也明显高于心肌显像正常组(n =85 ,3.5 % ,χ2 =5 7.4 4 ,P <0 .0 0 0 1)。心肌缺血组的无心脏事件生存率在 1年 ,3年 ,5年和 10年分别为 5 6 % ,32 % ,2 6 %和 2 6 % ,而正常组在相同时间内的无心脏事件生存率为 99% ,97% ,94 %和 94 %。多元线性分析显示 ,可逆性心肌灌注缺损节段是预测PTCA术后发生心脏事件的最重要的独立危险因子 (RR =5 .13,P <0 .0 0 0 1)。结论　99mTc MIBI运动 静息心肌灌注显像对PTCA术后患者的预后有重要的预测价值     

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.