培哚普利对老年心力衰竭患者血中可溶性细胞间黏附分子-1和细胞凋亡抑制因子的影响

目的　观察培哚普利对老年慢性心力衰竭 (CHF)患者循环血中可溶性细胞间黏附分子 1(sICAM 1)和细胞凋亡抑制因子 (Fas Apo 1)水平的影响。方法　用酶联免疫方法检测 5 3例老年CHF患者治疗前后及 2 5例健康老年人血中sICAM 1和Fas Apo 1水平。结果　老年CHF患者sICAM 1和Fas Apo 1水平分别为 (6 0 2 .6 1± 14 8.5 8) μg Lvs(0 .2 7± 0 .0 8) μg L ,显著高于 2 5例健康老年人 (178.5 4± 31.0 1) μg Lvs (0 .12± 0 .0 4 ) μg L ,且随着心功能损害程度加重而升高 ,各组间比较差异有显著性意义。培哚普利组与治疗对照组治疗前后血中sICAM 1和Fas Apo 1浓度水平差异有显著性意义 ,培哚普利组较治疗对照组治疗后血中sICAM 1和Fas Apo 1下降明显。结论　外周血中sICAM 1和Fas Apo 1水平可反映老年CHF的程度 ;培哚普利可明显降低老年CHF患者血中sICAM 1和Fas Apo 1的水平 ,从而保护和改善心功能。     

培哚普利对血压正常的早期糖尿病肾病患者微量白蛋白尿的疗效观察

目的观察培哚普利对血压正常的早期糖尿病肾病患者的白蛋白尿的疗效和对肾功能的保护作用.方法糖尿病患者52例,其尿白蛋白排泄率(AER)均在20～200 μg/min之间,所有患者经控制饮食、口服降糖药物及(或)采用胰岛素治疗使血糖控制在可接受水平(尚可,即空腹血糖<7.0 mmol/L,餐后2 h血糖<10.0 mmol/L),随机分成两组,A组为对照组,25例,在控制血糖基础上加用安慰剂治疗;B组为治疗组,27例,在控制血糖基础上加用培哚普利治疗.培哚普利剂量为4 mg/d.两组患者在治疗前及治疗后3、6、12、18个月复查空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白A1C(HbA1C)和AER等.结果 A组在12、18个月时AER分别为(52.3±8.6) μg/min和(60.5±9.0) μg/min,二者与治疗前的(44.2±6.8)μg/min相比有显著升高(P＜0.05).B组用培哚普利治疗后3、6、12、18个月时AER分别为(20.3±5.6) μg/min、(22.1±6.1) μg/min、(21.3±5.9) μg/min和(20.8±5.7) μg/min,均明显低于同期A组水平(P值均<0.05),与治疗前的(45.3±7.6) μg/min相比,差异亦有显著性(P值均<0.05).结论培哚普利对血压正常的伴有微量白蛋白尿的早期糖尿病肾病患者减少尿蛋白和保护肾功能有良好效果.     

培哚普利对急性冠状动脉综合征患者白介素-6和肿瘤坏死因子-α水平的影响

目的　观察急性冠状动脉综合征患者使用培哚普利治疗后白介素 - 6( IL- 6)和肿瘤坏死因子 ( TNF- α)水平的变化。方法　选择 10 0例诊断为不稳定型心绞痛 ( 73例 )和急性心肌梗死 ( 2 7例 )的病人分为两组 ,A组 ( 5 0例 )接受培哚普利治疗 2周 ,B组 ( 5 0例 )未接受培哚普利治疗。入院时和治疗 2周后分别检测 IL- 6和 TNF- α浓度。结果　入院时 A组 IL- 6和 TNF- α水平与 B组相比无显著性差异 ( 60 8.4± 112 .3 pg/ ml vs5 83 .1± 10 6.4pg/ m l,46.0±10 .4pg/ ml vs 44 .1± 8.8pg/ ml,P>0 .0 5 ) ,治疗两周后两组 IL - 6和 TNF-α水平均有降低 ,而 A组病人两周后 IL -6和 TNF- α水平与 B组相比有显著降低 ( 2 40 .5± 5 0 .4pg/ ml vs414.3± 98.6pg/ m l,16.2± 3 .5 pg/ m l vs3 2 .7± 6.2 pg/ ml,P<0 .0 5 )。结论　急性冠状动脉综合征患者应用培哚普利治疗后 IL - 6和 TNF-α水平降低 ,提示培哚普利可能有直接抗炎作用     

培哚普利对慢性心力衰竭患者血浆t-PA和PAI-1水平的影响

目的评价培哚普利对慢性心力衰竭(CHF)患者血浆组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制物-1(PAI-1)水平的影响。方法采用酶联免疫吸附法测定60例CHF患者(CHF组)及20例健康人(正常对照组)血浆t-PA、PAI-1水平。CHF组患者又随机均分为常规治疗亚组和培哚普利亚组。培哚普利亚组在常规治疗基础上加用培哚普利2~4mg,每日1次。所有CHF患者治疗2周后复测血浆t-PA、PAI-1水平。结果CHF患者血浆t-PA、PAI-1水平比正常对照组明显增高(P<0.01)。治疗后,培哚普利亚组血浆PAI-1水平比常规治疗亚组明显降低(P<0.01),血浆t-PA水平比常规治疗亚组明显升高(P<0.01)。结论培哚普利不仅可降低PAI-1水平,而且可升高t-PA水平,改善内源性纤溶功能。     

缬沙坦和尼群地平对原发性高血压患者血清可溶性粘附分子影响的对比研究

目的　对比研究缬沙坦和尼群地平对原发性高血压 (EH )患者血压及血清可溶性粘附分子sICAM 1,sVCAM 1水平的影响。方法　随机对照方法设计 ,将 6 4例轻中度原发性高血压患者分为两组 ,分别予缬沙坦 (80mg/d)和尼群地平 (10～ 30mg/d)治疗 6周 ,治疗前后抽血 ,用酶联免疫方法 (ELISA)测定外周血清中可溶性粘附分子sICAM 1,sVCAM 1水平。另选择 2 5例健康人作为对照组。结果　治疗前与对照组比较 ,高血压患者血清中可溶性粘附分子sICAM 1,sVCAM 1水平升高 ,分别为 [(318 2± 2 7 5 ) μg/Lvs (2 71 5± 2 6 8) μg/L ,P <0 0 5 ]和 [(5 90 6± 4 0 1) μg/Lvs (4 17 9± 38 7) μg/L ,P <0 0 1]。治疗后两组的血压均明显下降 (P <0 0 5 ) ,两组间无差异。缬沙坦组可溶性粘附分子sICAM 1,sVCAM 1水平均较治疗前明显下降 ,分别为[(32 0 5± 2 3 6 ) μg/Lvs (2 80 2± 2 5 4 ) μg/L ,P <0 0 5 ]和[(5 86 2± 4 2 5 ) μg/Lvs (4 5 1 2± 38 9) μg/L ,P <0 0 1]。而尼群地平组可溶性粘附分子sICAM 1,sVCAM 1水平较治疗前无明显下降 (P >0 0 5 )。结论　与尼群地平比较 ,缬沙坦不仅能有效降低血压 ,还能抑制血管壁的炎症反应 ,有利于预防和延缓动脉粥样硬化的发生和发展。     

培哚普利对慢性心力衰竭患者血浆血管紧张素Ⅱ和纤溶酶原激活物抑制物-1水平的影响

目的:评价培哚普利对慢性心力衰竭(CHF)患者血浆血管紧张素Ⅱ(AngⅡ)和纤溶酶原激活物抑制物-1(PAI-1)水平的影响。方法:分别采用放射免疫法和酶联免疫吸附法测定60例CHF患者及20例健康人(正常对照组)血浆AngⅡ、PAI-1水平。60例CHF患者随机分为常规治疗组(30例)和培哚普利组(30例)。培哚普利组在常规治疗基础上加用培哚普利2~4mg,qd。治疗2周后复测血浆AngⅡ、PAI-1水平。结果:治疗前CHF患者血浆AngⅡ、PAI-1水平比正常对照组明显增高(P<0.01)。治疗2周后,培哚普利组血浆AngⅡ、PAI-1水平比常规治疗组明显降低(P<0.01)。结论:培哚普利不仅可抑制肾素-血管紧张素系统,而且可改善内源性纤溶功能。     

培哚普利对充血性心力衰竭患者血压的影响

目的 :探讨培哚普利对充血性心力衰竭 (CHF)患者血压的影响 ,并对治疗前后血生化指标进行对比研究。方法 :将 6 2例CHF患者随机分为 3组 ,分别口服卡托普利首剂 6 .2 5mg ,2 4h后12 .5mg ,每日 3次 ;培哚普利首剂 2mg ,2 4h后 4mg ,每日 1次 ;安慰剂 1粒 ,每日 3次 ,均连服 2周。 结果 :首剂卡托普利使平均动脉压(MAP)降低 (16 .8± 2 .0 )mmHg(1mmHg =0 .133kPa) ,培哚普利作用不明显 ;2周后 ,卡托普利使卧位MAP降低(13.0± 2 .0 )mmHg ,立位降低 (16 .0± 3.0 )mmHg ,培哚普利使卧位MAP降低 (4.0± 2 .0 )mmHg ,立位降低 (6 .0± 2 .0 )mmHg(P <0 .0 1)。表明卡托普利首剂降压明显 ,而培哚普利无首剂降压反应 ,出现平缓的舒张压降低作用。结论 :培哚普利降压作用平缓 ,可作为CHF降压作用较为理想的药物之一 ,亦适合老年患者     

培哚普利对老年高血压血浆sICAM-1及ET水平的影响

目的　探讨老年原发性高血压 (EH)患者血浆细胞间黏附分子 1(sICAM 1)、内皮素 (ET)浓度的变化及培哚普利对其的影响。　 方法　采用酶联免疫吸附法 (ELISA)、放射免疫分析法分别对 63例轻至中度老年EH患者应用培哚普利治疗前后和正常老年对照组血浆sICAM 1、ET水平进行检测。　 结果 　老年EH患者血浆sICAM 1和ET水平明显高于正常对照组 (P <0 0 1) ,经培哚普利治疗 8周后其浓度明显下降 (P <0 0 1)。　 结论　老年EH病人中的sICAM 1和ET水平较正常老年人明显升高。培哚普利在降压的同时能降低老年EH患者血sICAM 1和ET浓度 ,减少高血压并发症发生。     

培哚普利对充血性心力衰竭患者红细胞超氧化物歧化酶活力和血浆总抗氧化能力的影响

目的 :探讨血管紧张素转换酶抑制剂 (ACEI)对体内抗氧化状态的影响。方法 :采用分光光度计测定红细胞超氧化物歧化酶 (SOD)活力和血浆总抗氧化能力 (TAC)。观察了 6 7例充血性心力衰竭 (CHF)患者口服培哚普利后血浆TAC和SOD活力的改变 ,并与依那普利进行比较。结果 :两治疗组CHF患者基础红细胞SOD活力、血浆TAC水平低于健康对照组 (P <0 .0 1) ;服药后 4周 ,依那普利组和培哚普利组红细胞SOD活力、血浆TAC水平升高 (P <0 .0 5 ) ,8周后进一步升高 (P <0 .0 1)。结论 :CHF患者的抗氧化能力低下 ,依那普利和培哚普利均能提高CHF患者的抗氧化能力 ,对阻止CHF的进一步发展起到有益作用     

急性冠状动脉综合征患者血浆细胞粘附分子和转化生长因子的变化及其意义

目的 :探讨急性冠状动脉综合征 (ACS)患者外周血可溶性细胞粘附分子 1(sICAM 1)和转化生长因子 β(TGF β)浓度变化及其意义。方法 :符合ACS诊断的 4 5例于入院后 1h内抽取肘静脉血5ml,测定sICAM 1和TGF β ,同时测定肌酸激酶 (CK)、乳酸脱氢酶 (LDH)、肌酸激酶同工酶 (CK MB) ,并设健康对照组。结果 :血浆sICAM 1水平显著升高 ,其中不稳定型心绞痛 (UAP)为 35 9.0 8± 35 .12 μg/L,非Q波性急性心肌梗死 (NQAMI)为 4 95 .34± 4 9.16 μg/L、Q波性急性心肌梗死(AMI)为 5 83.5 1± 5 4 .2 7μg/L,与对照组 (2 5 3.5 1± 38.4 3μg/L)比较有显著差异 (P <0 .0 0 1) ;血浆TGF β浓度明显下降 ,其中UAP为4 6 .72± 10 .15 μg/L,NQAMI为 4 1.6 9± 9.0 8μg/L,AMI为36 .72± 8.79μg/L,与对照组 (6 2 .10± 14 .4 6 μg/L)比较有显著差异 (P <0 .0 0 1)。sICAM 1与TGF β呈显著负相关 ;sICAM 1和CK、CK MB、LDH呈显著正相关 (P <0 .0 1)。结论 :血清sICAM 1和TGF β浓度的变化反映了ACS患者炎症和免疫状态 ,抑制致炎因子的作用 ,适度增强抗炎因子的作用 ,必将成为有效防治ACS的一个新途径     

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.