氯沙坦和依那普利对原发性高血压患者肾功能的影响

目的探讨血管紧张素Ⅱ受体拮抗剂(AIRA)和血管紧张素转换酶抑制剂(ACEI)对原发性高血压(EH)患者肾功能的影响.方法采用随机、单盲和平行对照方法,经1周药物冲洗期及2周安慰剂导入期后,60例EH患者(EH组)进行16周治疗期,每日1次口服氯沙坦50 mg(n=30)或依那普利5 mg(n=30),4周后如舒张压(DBP)≥90 mmHg(1 mmHg=0.133 kPa)则剂量加倍.治疗后测量血压、心率(HR)并记录症状、体征;并行24 h 动态血压监测(ABPM)1次.治疗前后分别测定血清肌酐(Cr)、尿素氮(BUN)、内生肌酐清除率(Ccr)和24 h 尿蛋白(UTP)、白蛋白(Alb),尿α1及β2微球蛋白(α1-MG和β2-MG)的排泄率.20例健康体检者作为对照组.结果⑴两组药物均能明显降低血压(P＜0.001).⑵治疗前EH组患者Ccr显著低于对照组,尿α1-MG和β2-MG及UTP、Alb显著高于对照组,且上述指标改变程度与EH的病程相关.⑶治疗16周后,氯沙坦和依那普利均能显著降低尿UTP、Alb,尿α1-MG和β2-MG,其中病程较长者,下降幅度较大.⑷咳嗽发生率氯沙坦组(6.7 %)明显低于依那普利组(26.7 %)(P＜0.01).结论⑴EH患者早期即有肾功能损害,且随病程延长损害加重.⑵氯沙坦可减轻和延缓高血压引起的肾功能损害,且病程较长者获益较大,其效果可能与依那普利相似.     

氯沙坦和依娜普利对高血压患者肾功能的影响

目的探讨血管紧张素Ⅱ受体拮抗剂(AIR)和血管紧张素转换酶掏剂(ACEI)对原发性高血压(EH)患者肾功能的影响.方法采用随机、单盲和平行对照方法,经1周药物冲洗期及2周安慰剂导入期后,60例EH患者(EH组)进行16周治疗期,每日1次口服氯沙坦50mg(n=30)或依那普利5mg(n=30),4周后加舒张压(DBP)≥90mm Hg(1mm Hg=0.133 kPa)则剂量加倍.治疗后测量血压、心率(HR)并记录症状、、体征并行24h动态血压监测(ABPM)1次.治疗前后分别测定血清肌酐(Cr)、尿素氮(BUN)、内生肌酐清除率(Ccr)和24h尿蛋白(UTP)、白蛋白(Alb),血尿(α1)及β2微球蛋白(α1-MG和β2-MG)的排泄率.20例健康体检者作为对照组.结果(1)两组药物均能明显降低血压(P＜0.05).(2)治疗前EH组患者Ccr显著低于对照组,(P＜0.01)血尿α1-MG和β2-MG及UTP、AlbEH组显著高于对照组,且上述指标改变程度与EH的病程相关.(3)治疗16周后,氯沙坦和依那普利均能显著降低UTP、Alb,血尿α1-MG和β2-MG,其中病程较长者,下降幅度较大.(4)咳嗽发生率氯沙坦组(6.7%)明显低于依那普利组(26.7%)(P＜0.01).结论(1)EH患者早期即有肾功能损害,且随病程延长损害加重.(2)氯沙坦可减轻和延缓高血压引起的肾功能损害,且病程较长者获益较大,其效果可能与依那普利相似.     

地尔硫缓释剂对原发性高血压患者肾功能的影响

目的 :探讨地尔硫缓释剂对原发性高血压 (EH)患者肾功能的影响。方法 :6 2例 EH患者 (EH组 )随机分为两亚组 :A组 (地尔硫缓释剂组 )和 B组 (卡托普利组 ) ,疗程均为 10周。治疗前后观察肾功能指标变化。2 0例健康体检者作为对照组。结果 :1治疗前 EH组患者内生肌酐清除率 (Ccr)显著低于对照组 ,血尿 β2 -微球蛋白 (β2 - m)及尿白蛋白 (Alb)显著高于对照组 ,且上述指标改变程度与 EH的病程相关 ;2地尔硫缓释剂和卡托普利治疗 EH患者 ,可明显降低血压、血尿 β2 - m与尿 Alb,其中病程较长者下降幅度较大 ,B组尿 Alb降低程度 >A组 (P <0 .0 5 )。结论 :1EH患者早期即有肾功能损害 ,且随病程延长损害加重 ;2地尔硫缓释剂可保护 EH患者早期损害的肾功能 ,且病程较长者获益较大 ,其效果可能与卡托普利相似     

氯沙坦对老年高血压病患者肾功能的影响

目的　探讨氯沙坦治疗 1年后对老年高血压病患者肾功能的影响。方法　应用生化和放射免疫分析技术测定 2 0名健康者 (对照组 )和 3 4例老年高血压病患者 (服用氯沙坦前后 )的肾功能指标 ,并进行比较。结果　高血压病组治疗前BUN、Scr水平与对照组比较无明显变化 (P >0 .0 5 ) ,而尿Alb、IgG、β2 MG水平均显著性升高 ,差异有显著性 (P <0 .0 5 ) ;高血压病组尿Alb、IgG治疗后与治疗前比较显著降低 (P <0 .0 5 ) ,血浆BUN、Scr ,血、尿 β2 MG无明显变化 (P >0 .0 5 )。结论　提示氯沙坦能有效降低老年高血压病患者微量蛋白尿 ,具有肾脏保护作用     

100例高脂血症早期肾损害患者肾功能联检结果分析及治疗效果观察

目的　探讨肾功能联检对原发性高脂血症早期肾损害的诊断价值及辛伐他汀和非诺贝特对高脂血症早期肾损害的治疗效果。方法　将 10 0例原发性高脂血症患者随机分为辛伐他汀组和非诺贝特组各 5 0例。两组患者均在服药前及服药后 8、2 4周查血脂及血 β2 - MG,取随意尿查 β2 - MG、Alb、Ig G(下称肾功能联检 ) ;并与 5 0例血脂正常的健康人 (对照组 )比较。结果　原发性高脂血症患者血、尿β2 - MG、尿 AL b及尿 Ig G均高于对照组 ,各指标均有显著性差异 (P<0 .0 0 1) ;与非诺贝特组比较 ,辛伐他汀组血清 TC、L DL - C明显降低 (P<0 .0 5 )。治疗后 8、2 4周辛伐他汀组血 β2 - MG,尿 β2 - MG、Alb、Ig G降低 ,与非诺贝特组比较 ,P<0 .0 1。结论　肾功能联检有助于早期发现原发性高脂血症亚临床肾脏损害 ;辛伐他汀在降低血 TC、升高 HDL- C的同时亦能降低 TG、尿蛋白 ,且对肾脏有保护作用     

老年单纯收缩期高血压患者的肾功能改变

目的　探讨老年单纯收缩期高血压患者动态血压与肾功能的关系。方法　对 2 9例研究组 ,2 6例正常对照组 ,分别作ABPM检查 ,并测定尿 β2 MG、α1MG、THP、ALB、Cr、CCr。结果　研究组动态血压各参数及尿 β2 MG、α1MG、ALB、THP较对照组明显升高 (P <0 0 1) ,Cr、CCr两组间无明显差异。 2 4小时平均收缩压、白昼平均收缩压、2 4小时收缩压负荷值、白昼收缩压负荷值与 β2 MG、α1MG、ALB显著相关 (P <0 0 1) ,与THP也相关 (P <0 0 5 ) ;夜间平均收缩压与α1MG、ALB显著相关 (P <0 0 1) ,夜间收缩压负荷值与 β2 MG、α1MG、ALB有相关性 (P <0 0 5 ) ,动态血压各项参数与Cr、CCr无相关性 (P >0 0 5 )。结论　老年单纯收缩期高血压患者收缩压水平与肾功能损害关系密切 ,应控制收缩压以延缓和减少肾功能损害     

原发性高血压患者动态血压与血、尿α_1-微球蛋白浓度的关系

目的 :与偶测血压 ( CBP)比较 ,观察动态血压与肾损害的关系 ,同时与常规检查肾功能方法作比较 ,观察原发性高血压 ( EH)不同时期的肾损害。方法 :采用放免法测定血、尿α1-微球蛋白( α1- MG) ,结合 2 4h动态血压监测 ( ABP) ,以 2 4例正常血压者作对照 ,观察 60例 EH患者肾功能变化。结果 :2 4h平均动脉压 ( MAP)负荷与血、尿α1- MG明显相关 ( P <0 .0 1) ,日间 MAP与之相关性最好 ( P <0 .0 1) ,夜间 MAP负荷与之也有相关性 ( P <0 .0 5 ) ,而与 CBP无关。ABP昼夜节律消失者 ,肾功能损害明显。尿α1- MG在轻度 EH时即出现异常。结论 :ABP和尿α1- MG能更好地反映 EH与肾损害的关系 ,有利于早期肾损害的发现。     

氯沙坦对原发性高血压β2-微球蛋白影响

目的　探讨血管紧张素Ⅱ受体阻断剂氯沙坦对原发性高血压所致尿 β2 微球蛋白 ( β2 MG)异常的影响。　方法　原发性高血压病人 5 5例 ,随机分为两组 ,治疗组 30例 ,应用氯沙坦。对照组 2 5例 ,应用拜新同 (硝苯地平缓释片 )。分别于服药 4周、8周、12周后测定尿 β2 MG。　结果　氯沙坦明显降低尿 β2 微球蛋白含量 (P <0 0 1)。　结论　氯沙坦适用于原发性高血压 β2 微球蛋白升高的病人 ,对肾脏有保护作用。     

氯沙坦与依那普利对原发性高血压病人肾功能的影响

目的观察氯沙坦和依那普利对伴有微量白蛋白尿的原发性高血压病人早期肾病的治疗作用。方法80例原发性高血压病人随机分两组,其中氯沙坦组40例,剂量50～100mg·d-1,依那普利组40例,剂量10～20mg·d-1,治疗8周。治疗第0、4和8周末测血压、心率;第0、8周测血肌酐(Scr)、尿肌酐并计算内生肌酐清除率(Ccr)以及尿微量白蛋白(ALB)、β2微球蛋白(β2-MG)水平。结果血肌酐和内生肌酐清除率两组间比较无统计学意义(P>0.05),尿微量白蛋白、β2微球蛋白氯沙坦组较治疗前分别下降了34.7%和24.5%,治疗前后比较差异有显著性(P<0.01);依那普利组分别下降了38.2%和24.8%,治疗前后比较差异亦有统计学意义(P<0.01);而两组间差值比较差异无统计学意义(P>0.05)。结论氯沙坦不仅降低血压而且降低尿微量白蛋白及尿β2微球蛋白水平,与依那普利相比具有同样的保护肾功能作用。     

雷米普利与依那普利治疗2型糖尿病合并高血压的临床研究

目的探讨雷米普利与依那普利治疗2型糖尿病合并轻、中度高血压病病人,观察其降压疗效,对尿α1、β2-微球蛋白(α1、β2-MG)、尿白蛋白(Alb)的影响及其比较研究.方法选择2型糖尿病合并轻、中度原发性高血压病病人80例.采用随机对照的方法分为雷米普利和依那普利组各40例.雷米普利组予雷米普利2.5 mg,每日1次;依那普利组予依那普利10 mg,每日1次.治疗前及治疗后第2周、第4周、第6周、第8周随诊测血压,治疗前及治疗后行24 h动态血压监测及用放射免疫法(RIA)测定病人尿α1-MG、β2-MG及Alb.结果服药8周后雷米普利组和依那普利组总有效率分别为90.2%和91.2%,收缩压和舒张压分别为治疗前(152.8±14.3) mmHg、(154.5±12.3) mmHg和(102.4±10.2) mmHg、(103.2±9.5) mmHg,降压治疗后为(132.7±13.5) mmHg、(138.3±12.6) mmHg和(89.2±9.8) mmHg、(89.6±10.6) mmHg,两组比较无统计学意义,无严重不良反应.两组均有明显降低尿α1-MG、β2-MG及Alb的排出,且对α1-MG的降低作用更显著.结论雷米普利既可降低DM合并EH的血压,又能降低尿微量白蛋白的排泄量,从而起到肾脏保护作用.     

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.