冠心病稳定性心绞痛患者冠状动脉造影术后血浆内皮素-1水平升高意义

目的观察稳定性心绞痛患者冠状动脉造影时血浆内皮素-1水平变化及其临床意义.方法根据冠状动脉造影结果将64例患者分为两组,冠心病稳定性心绞痛组(SA组)与冠脉正常组(正常对照组).冠状动脉造影前及冠状动脉造影后即刻抽取血液标本测定血浆内皮素-1水平并记录动脉收缩压与舒张压.结果两组冠状动脉造影所耗时间无明显差异(P>0.05),冠状动脉造影前及冠状动脉造影后即刻平均动脉压在SA组分别为137/86 mmHg和141/90 mmHg(P<0.05),正常对照组分别为136/85 mmHg和138/87 mmHg(P>0.05);冠状动脉造影前及冠状动脉造影后即刻血浆内皮素-1水平在SA组分别为5.51±1.28 ng/L和 6.94±1.37 ng/L(P<0.01),正常对照组分别为5.10±1.13 ng/L和5.14±1.16 ng/L(P<0.05).结论冠状动脉造影可激发冠心病稳定性心绞痛患者的内皮细胞反应,导致血浆内皮素-1水平升高.     

冠心病心绞痛患者血浆IL-8水平和中性粒细胞CD11 b/CD18 表达与冠状动脉狭窄程度及病变稳定性的相关性

目的 :探讨冠心病心绞痛患者血浆白细胞介素 8(IL 8)水平和中性粒细胞CD11b/CD18表达与冠状动脉狭窄程度和病变稳定性的关系。方法 :选择 6 8例不稳定型心绞痛患者 (UA组 )和 5 2例稳定型劳累性心绞痛患者 (SA组 ) ,用夹心ELISA法测定IL 8水平 ;用流式细胞仪检测其CD11b/CD18受体表达。同期测定 2 0例正常人以作对照。依据冠状动脉造影结果 ,按直径法和ABC分型综合评定心绞痛患者冠状动脉病变程度。结果 :UA组患者血浆IL 8为 (10 0 .11± 31.89)ng/L ,显著高于SA组患者〔(5 9.0 8± 19.2 9)ng/L ,P <0 .0 1〕和正常对照组〔(47.6± 2 0 .8)ng/L ,P <0 .0 1)〕 ;CD11b/CD18表达UA组患者 (433± 6 1)也显著高于SA组患者 (2 4 0± 5 3,P <0 .0 1)和对照组 (2 2 5± 37,P <0 .0 1)。UA组患者血浆IL 8和CD11b/CD18表达在A型、B型及C型病变组依次增加 ,并与冠状动脉狭窄直径呈正相关 (r =0 .6 72 3,P <0 .0 0 1和r =0 .5 5 94 ,P <0 .0 0 1)。SA组上述参数与正常对照组比较以及在A、B、C 3种病变组之间比较均无统计学差异。结论 :心绞痛患者血浆IL 8和CD11b/CD18表达增加与冠状动脉狭窄程度和病变稳定性有关。     

冠心病患者血浆纤维蛋白原水平变化

目的　观察冠心病患者血浆纤维蛋白原水平变化特点。方法　选择 10 2例有典型心绞痛或不典型胸痛患者行冠状动脉造影、同时测定其血浆纤维蛋白原 ( fg)水平 ,观察冠状动脉造影阳性与阴性患者血浆 fg的关系 ,同时观察不同的冠状动脉狭窄支数与 fg水平变化的关系。结果　 1)、5 3例心绞痛患者的 fg水平明显高于 37例冠状动脉造影正常组 ( 3.86± 0 .70 g/L,3.37± 0 .62 g/L ,P<0 .0 1) ;12例急性心肌梗死之 fg明显高于心绞痛 B组与正常组 A组 ( 5 .83± 1.85 g/L ;3.37± 0 .62 g/L ;P<0 .0 1) ;2 )、在不同的狭窄支数亚组中 ,Fg水平与病变支数无显著差异性。结论　冠心病患者血浆 fg水平明显升高 ,说明 fg在动脉粥样硬化及血栓形成中起重要作用     

冠心病不同类型间斑块稳定性相关指标的比较研究

目的　比较血清抗氧化低密度脂蛋白 (oxLDL)抗体、细胞间黏附分子 1(ICAM 1)、血管细胞黏附分子 1(VCAM 1)和E 选择素水平对不同类型冠心病斑块稳定性的评价意义。方法　用酶联免疫吸附法 (ELISA)检测了 10 0例冠心病患者 (17例急性心肌梗死 ,4 1例不稳定性心绞痛 ,4 2例稳定性心绞痛 )及 31例正常健康对照者血清ICAM 1、VCAM 1、E 选择素和血清抗oxLDL抗体水平 ,并比较上述各指标水平与不同类型冠心病斑块稳定性之间的关系。结果　血清ICAM 1水平在急性心肌梗死组 (76 4± 111)ng/ml和不稳定性心绞痛组 (70 9± 10 0 )ng/ml明显高于稳定性心绞痛组 (6 0 7± 83)ng/ml,和正常对照组 (6 0 3± 90 )ng/ml,P <0 0 1;血清VCAM 1水平在急性心肌梗死组 (185 5± 6 6 6 )ng/ml和不稳定性心绞痛组 (172 4± 5 5 5 )ng/ml明显高于稳定性心绞痛组 (136 0± 36 0 )ng/ml,和正常对照组 (10 39± 319)ng/ml,P <0 0 1;血清E 选择素水平在急性心肌梗死组 (5 4± 19)ng/ml和不稳定性心绞痛组 (5 3± 2 2 )ng/ml明显高于稳定性心绞痛组 (39± 19)ng/ml,和正常对照组 (38± 14 )ng/ml,P <0 0 5 ;血清抗oxLDL抗体水平在急性心肌梗死组 (1 39± 0 6 8)和不稳定性心绞痛组 (1 35± 0 6 2 )明显高于稳定性心绞痛组 (0     

D-二聚体与冠心病病情及冠状动脉病变稳定性的相关研究

目的 :探讨血浆D 二聚体 (D dimer,DD)与冠心病(CHD)病情及冠状动脉病变稳定性的关系。方法 :对 1 1 0例观察对象按照冠状动脉造影病变形态学特征分为 :简单病变组 3 2例 ,复杂病变组 5 6例 ,正常对照组 2 2例。同时 ,根据临床CHD病情分为 :急性心肌梗死 (AMI)组 1 1例、不稳定型心绞痛 (UAP)组 49例 ,稳定型心绞痛(SAP)组 2 8例 ,正常对照组 2 2例。用酶免法 (ELASA)检测血浆DD含量 ,比较不同组间DD含量。结果 :血浆DD含量复杂病变组 [( 0 .499± 0 .2 1 4)mg/L]高于简单病变组 [( 0 .3 2 9± 0 .1 73 )mg/L]及正常对照组 [( 0 .3 1 9± 0 .1 2 6)mg/L],差异均有统计学意义 (P <0 .0 1 )。AMI组 [( 0 .5 93± 0 .3 44 )mg/L]和UAP组 [( 0 .471± 0 .2 1 4)mg/L]明显高于SAP组 [( 0 .2 92±0 .1 0 1 )mg/L]及正常对照组 [( 0 .3 1 9± 0 .1 2 6)mg/L],差异均有统计学意义 (P <0 .0 1 )。结论 :血浆DD含量与冠状动脉病变稳定性及CHD病情严重性相关 ,DD是冠状动脉病变活动性的血液标志物。     

冠状动脉粥样硬化性心脏病患者QT离散度与血浆内皮素和胰岛素敏感性的关系

为探讨冠状动脉粥样硬化性心脏病患者QT离散度与血浆内皮素水平、胰岛素敏感性及严重室性心律失常的关系 ,对 47例冠状动脉粥样硬化性心脏病患者和 2 0例健康对照者进行口服葡萄糖耐量试验、胰岛素和C肽释放试验 ,并测定血浆内皮素水平。急性心肌梗死患者糖耐量试验在梗死后第四周进行 ,第一天血样本也检测内皮素水平。所有对象在抽血当天同步记录常规 12导联心电图测算QT离散度。以QT离散度为因变量 ,以 9个胰岛素敏感性指标和血浆内皮素水平为自变量 ,进行逐步回归和 /或简单相关分析。结果发现 ,冠状动脉粥样硬化性心脏病各亚组内皮素被有效选入回归方程 ,QT离散度与内皮素呈显著正相关 ;急性心肌梗死组空腹血糖也被有效选入回归方程 ,但QT离散度与空腹血糖呈负相关 ;其它自变量均未被选入方程。急性心肌梗死早期发生严重室性心律失常者第一天内皮素水平 (16 0 .5± 2 3.0ng/L)和QT离散度 (86± 19ms)高于未发生严重室性心律失常者 (119.7± 15 .2ng/L ,6± 13ms) ,也高于正常对照组 (45 .0± 14.7ng/L ,P <0 .0 5 ) ;此两组QT离散度与内皮素呈正相关 (r分别为 0 .94和 0 .84,P均 <0 .0 1)。提示冠状动脉粥样硬化性心脏病患者尤其是急性心肌梗死患者血浆内皮素水平增高是QT离散度增大的独立相关因素     

冠心病患者血浆氧化低密度脂蛋白和同型半胱氨酸与循环内皮细胞和内皮素相关性研究

目的　通过对 58例冠心病患者血浆中循环内皮细胞、内皮素、氧化低密度脂蛋白和同型半胱氨酸水平的观察 ,探讨它们与动脉粥样硬化发生过程中的关系 ,以及氧化低密度脂蛋白和同型半胱氨酸与循环内皮细胞和内皮素之间的相关性。方法　分别用酶联免疫吸附法和高效液相色谱分析法测定血浆中氧化低密度脂蛋白和同型半胱氨酸水平 ,同时测定血浆中循环内皮细胞和内皮素水平 ,进行对比和直线相关性分析。结果　冠心病组循环内皮细胞 :(7 78± 3 31 )cells/ 0 9μl,内皮素(98 1 4± 35 0 8)ng/L ,氧化低密度脂蛋白 (80 9 2 5± 31 1 89) μg/L ,同型半胱氨酸 (1 9 40± 7 0 3) μmol/L。对照组上述指标分别为 :(4 1 0± 1 60 )cells/ 0 9μl,(52 61± 1 5 71 )ng/L ,(438 2 4± 2 0 0 54) μg/L和(1 1 1 9± 2 94) μmol/L。两组比较P均小于 0 0 0 1。冠心病组氧化低密度脂蛋白与血浆循环内皮细胞、内皮素均呈正相关 ,相关系数分别为 0 92 6(P <0 0 0 1 )、0 979(P <0 0 0 1 ) ,同型半胱氨酸同样与循环内皮细胞、内皮素呈正相关 ,相关系数分别为 0 947(P <0 0 0 1 )、0 90 0 (P <0 0 0 1 ) ,且冠心病组血浆循环内皮细胞和内皮素呈正相关 ,相关系数为 0 939(P <0 0 0 1 )。结论　氧化低密度脂     

急性有机磷农药中毒患者血浆内皮素的变化及临床意义

目的　探讨急性有机磷农药中毒 (AOPP)患者血浆内皮素 (ET)的变化及其临床意义。方法　将 6 9例AOPP患者分成轻度、中度、重度中毒组 3组 ,另选取 2 5例健康人为正常对照组 ,各组均采用放射免疫法检测血浆ET含量。同时进行对比分析。结果　AOPP轻度中毒组患者血浆ET的含量 (5 6 18± 12 80 )ng/L仅轻度升高 ,与正常对照 (5 0 85± 8 93)ng/L比较 ,差异无显著性 (P >0 0 5 ) ;中度、重度中毒组患者血浆ET含量分别为 :(72 6 1± 14 2 1)ng/L ,(110 32± 17 38)ng/L较正常对照组明显升高 (P均 <0 0 1) ,中度中毒组患者血浆ET含量较轻度中毒组明显升高 (P <0 0 1) ;重度中毒组患者血浆ET含量较中度中毒组明显升高 (P <0 0 1)。结论　随着AOPP中毒程度的加重 ,血浆ET含量逐渐上升 ,血浆ET的检测可作为判断AOPP患者病情轻重、治疗效果及预后的参考指标     

高血压病患者血浆内皮素-1浓度的变化及氯沙坦干预的效果

目的:探讨内皮素—1在EH发生中的作用以及氯沙坦干预前、后EH患者内皮素—1水平的变化。方法:76例高血压患者眼用氯沙坦6周(剂量50～100mg/d),部分患者加用双氢氯噻嗪(12.5mg,2次/d),观察氯沙坦治疗前、后血压和血浆内皮素—1的变化。结果:EH组与对照组血浆内皮素—1水平分别为89.13±29.17ng/L、60.13±10.23ng/L,前者显著升高(P<0.05),高血压Ⅲ级者的ET-1水平显著高于高血压Ⅱ级的(P<0.05)。氯沙坦治疗前、后内皮素—1水平分别为89.13±29.17ng/L、65.32±7.19ng/L,治疗后的显著降低(P<0.01)。氯沙坦治疗前收缩压和舒张庄分别为168.34±12.92、112.46±6.09mmHg,治疗后分别为125.71±20.05、80.15±5.11mmHg,均较治疗前明显降低(P<0.01)。结论:内皮素—1在高血压的形成和维持中起者重要的作用,氯沙坦在有效降压时,可以降低血浆内皮素—1水平。     

冠状动脉斑块形态与血浆血管性血友病因子及α-颗粒膜蛋白水平的关系

目的 :通过测定冠状动脉造影显示不同粥样硬化斑块形态患者血浆血管性血友病因子 (vWF)及α 颗粒膜蛋白(GMP 14 0 )水平 ,探讨其临床意义。　　方法 :74例接受选择性冠状动脉造影的患者根据冠状动脉粥样硬化斑块形态分为光滑斑块组 (n =15 )、复杂病变斑块组 (n =3 7)和正常对照组 (n =2 2 )。所有患者于冠状动脉造影前采血测定血浆vWF、GMP 14 0水平。　　结果 :复杂病变斑块组血浆vWF水平显著高于光滑斑块组 [(2 0 1 10± 2 0 92 ) %对 (14 9 40± 10 2 1) % ,P <0 0 1] ,复杂病变斑块组血浆GMP 14 0水平显著高于光滑斑块组 [(2 9 3 8± 3 17)ng/ml对 (17 5 4± 2 0 9)ng/ml ,P <0 0 1] ,均有极显著性差异。　　结论 :冠状动脉造影表现为复杂形态病变者 ,血浆vWF、GMP 14 0水平高于光滑斑块病变者 ,可作为判断冠状动脉是否存在不稳定病变的间接参考。     

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.