经皮腔内冠状动脉成形术和支架术后心肌微损伤对近期临床预后的影响

目的 :通过观察血清肌钙蛋白I(cTnI)和肌酸激酶 同工酶 (CK MB)的变化 ,了解经皮腔内冠状动脉成形术 (PTCA)和支架术后心肌微损伤情况及其对近期预后的影响。方法 :选择 83例经造影证实为单支血管病变的稳定型心绞痛行PTCA和支架术后无严重并发症者。测定术前 ,术后 6、12、2 4及 4 8h血清cTnI、CK MB的水平 ,并随访观察术后 4～ 5周内心血管事件的发生情况 ,以及通过超声心动图检查术前和术后随访期间左室射血分数的变化。结果 :术后 2 3例出现cTnI或 (和 )CK MB阳性者 ,其中支架组 2 1例 ,球囊组 2例。cTnI阳性检出率 (2 4 .1% )明显高于CK MB阳性检出率 (6 .0 % ) (P <0 .0 1)。cTnI和 (或 )CK MB阳性 (损伤组 )术中球囊扩张的总时间、单次扩张最长时间以及分支血管阻塞的发生率均明显高于cTnI和 (或 )CK MB阴性 (未损伤组 ) (分别为P <0 .0 5、P <0 .0 1、P <0 .0 1) ,而球囊扩张次数和扩张的最大压力两组相比无明显差别 (P >0 .0 5 ) ,随访术后近期心血管事件的发生率和左室功能的变化两组无明显差异。结论 :PTCA及支架术后心肌微损伤并不少见 ,尤以支架术后发生率高。这种微损伤对近期预后的影响不大。检测这种微损伤的指标以cTnI明显优于CK MB。     

超声心动图评价抗心肌肌球蛋白抗体对急性心肌梗死病人左室重构及心功能的影响

目的探讨抗心肌肌球蛋白抗体（AMA）与急性心肌梗死（AMI）病人左室重构及心功能的关系。方法选择AMI病人42例，其中10例AMA阳性及32例AMA阴性的病人。分别于发病7d和6个月后进行超声心动图检查，比较两组心功能参数的变化。结果6个月后观察左室短长轴比值（D／L）、左室质量（LVM）；左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、每搏量（SV）、心排血量（CO）、左室射血分数（LVEF）、左室内径缩短率（FS）以及舒张早期心室充盈速度最大值E峰、舒张晚期心室充盈速度最大值A峰、E／A比值、E峰流速时间积分（E—VTI）、A峰流速时间积分（A—VTI）、E—VTI／A—VTI等指标，AMA阴性组均有显著改善（P〈0．05），而阳性组无明显改变。结论AMA可能参与心肌损伤和心室重构，影响AMI病人的心功能和预后。     

血清肌钙蛋白T及I对急性心肌梗死早期诊断的临床价值

目的 :观察急性心肌梗死 (AMI)患者入院前后血清肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)的变化 ,探讨cTnT、cTnI对早期诊断AMI的价值。方法 :对 10 0例患者 (AMI 5 0例、不稳定型心绞痛 5 0例 )和 2 0例健康人进行了血清cTnT、cTnI、肌酸激酶 (CK)和肌酸激酶同工酶 (CK MB)检测。结果 :①血清cTnT、cTnI、CK和CK MB检测AMI的敏感度和特异度分别为 80 %和 90 %、85 %和 92 %、92 %和 6 1%、75 %和 75 %。②AMI患者血清cTnT、cTnI浓度平均升高 (17.5± 5 .7)和 (16 .2± 4 .8)倍 ,显著高于CK(7.6± 3.1)倍、CK MB (6 .5± 2 .9)倍 (P <0 .0 1) ;③AMI后 3h内cTnT、cTnI阳性检出率为 5 0 .0 %、4 0 .0 % ,明显高于CK MB(2 4 .0 % )和CK(2 0 .0 % ) ;AMI 5d后cTnT、cTnI阳性检出率为 70 .0 %、6 6 .0 % ,而CK MB和CK仅为 4 .0 %和 8.0 %。结论 :血清cTnT、cTnI能早期确切诊断AMI ,具有较宽的时间诊断窗口 ,是心肌梗死早期诊断较敏感和特异的血清标志物     

系统性红斑狼疮患者抗心肌抗体与心脏病变的相关性研究

目的了解抗心肌抗体(AMA)与系统性红斑狼疮(SLE)患者出现心脏病变的相关性。方法随机选取2004年8月至2006年12月山东大学山东省立医院风湿免疫科收治的女性SLE患者160例,所有患者均未应用免疫抑制剂及大剂量激素治疗,并排除原发性心脏病、肺源性心脏病和先天性心脏病。采用酶联免疫吸附试验(ELISA)法检测其血清AMA,并按其检测结果分为AMA阳性组56例和AMA阴性组104例。同时记录患者发病年龄、心脏病变情况及抗核抗体(ANA)等自身抗体的测定结果。结果AMA阳性组中24例出现心脏病变,占42.9%。而AMA阴性组中17例出现心脏病变,发生率为16.3%,明显低于阳性组(P<0.05)。AMA阳性组抗双链脱氧核糖核酸(dsDNA)抗体及抗核小体抗体(AnuA)的阳性率明显高于AMA阴性组(P<0.05)。AMA阳性组中,外周血白细胞、C3、C4均有不同程度下降,但2组间差异无显著性意义。结论AMA阳性组患者心脏病变的发生率远高于AMA阴性组,提示SLE患者心脏病变的发生与AMA可能存在相关关系。     

抗线粒体抗体阴性原发性胆汁性肝硬化的临床特征

目的　原发性胆汁性肝硬化 (PBC )的最重要特征为血清抗线粒体抗体 (AMA )阳性 ,但少数PBC病例AMA阴性。本文分析AMA阴性PBC患者的临床、生化和免疫学特性。方法　对 1991年 1月～ 2 0 0 2年 7月期间临床 /病理诊断PBC的 70例患者进行回顾性研究 ,分析比较AMA阴性和AMA阳性患者的一般资料、病程、临床表现、生物化学、免疫学及病理学等特征。结果　确诊PBC时 ,11例患者血清AMA/AMA M2 阴性 ,AMA阴性患者的血清免疫球蛋白M显著低于AMA阳性患者 ,分别为 (2 85 1± 14 18)mg/L和 (63 61± 492 8)mg/L ,P =0 .0 3 3 ,血清抗核抗体和 (或 )抗平滑肌抗体阳性率高于AMA阳性患者 (分别为 81.8%和 40 .7% ,P =0 .0 3 1) ,在年龄、性别比例、临床表现、肝功能试验、组织学表现和病理分期等各方面和AMA阳性患者无显著性差异。结论　AMA阴性PBC患者除血清免疫球蛋白M较低及抗核抗体和 (或 )抗平滑肌抗体阳性率较高外 ,其他临床特征和AMA阳性者相似     

冠状动脉侧支循环与前驱心绞痛对急性心肌梗死的影响

目的 :探讨侧支循环 (CR)和前驱心绞痛对急性心肌梗死 (AMI)患者梗死范围和心功能的影响及其可能的机制。方法 :119例首次AMI患者行选择性冠状动脉造影和左心室造影 ,分析冠状动脉CR及前驱心绞痛与AMI时肌酸激酶 (CK)峰值浓度和左室功能改变等的关系。结果 :①全组共 119例患者 ,兼有CR和前驱心绞痛者 (A组 ) 5 3例 ;有CR无前驱心绞痛者 (B组 ) 2 1例 ;仅有前驱心绞痛者 (C组 ) 2 6例 ;既无CR又无前驱心绞痛者 (D组 ) 19例。②心肌酶学改变 :A组CK峰值浓度显著低于D组 (P <0 .0 5 ) ,其CK同工酶 (CK MB)的峰值浓度显著低于D组和B组 (分别P <0 .0 1和 <0 .0 5 ) ;而且B组和C组的CK MB峰值浓度均低于D组 (均P <0 .0 5 )。③各组患者的心肌梗死部位、病变血管支数无统计学差异 ,但非Q波心肌梗死的比例A组显著高于D组(36 %对 2 1% ,P <0 .0 5 )。④心功能情况 :A组左室射血分数 (LVEF)显著高于其他各组 ,而且B组和C组的LVEF均高于D组 (P <0 .0 5 )。而室壁运动Cortina计分则A组明显低于其他各组 ,B组和C组均显著低于D组 (P <0 .0 5 )。结论 :冠状动脉CR和前驱心绞痛所致的缺血预适应对AMI患者的心肌均有重要的保护作用 ,而且二者可协同发挥作用     

急性心肌梗死伴先前性心绞痛患者临床分析

目的 :探讨急性心肌梗死 (AMI)伴先前性心绞痛 (AP)患者的冠状动脉 (冠脉 )病变特点及临床预后。方法 :在连续急诊冠脉造影的 385例AMI患者中分析伴有AP(AP组 ,2 0 2例 )及无AP者 (Non AP组 ,183例 )的临床资料与冠脉病变特征 ,并平均随访 (2 8.7± 8.2 )个月主要心血管事件 (包括反复心绞痛发作、非致命性心肌梗死、非致命性心力衰竭、靶血管血运重建及心脏性死亡 )和复合终点事件的发生率。结果 :与Non AP组比较 ,AP组肌酸激酶 (CK)及其同工酶 (CK MB)峰值均显著降低 [(196 5± 14 2 2 )∶(312 6± 2 10 8) ;(81± 4 6 )∶(118± 5 6 )IU/L ,均P <0 .0 1],但其三支病变及伴左主干病变者较多 (33.2 %∶16 .9% ;8.9%∶3.6 % ,均P <0 .0 5 ) ,随访期间AMI后反复心绞痛发作与心脏性死亡率较高 (36 .2 %∶2 3.6 % ,P <0 .0 1;10 .2 %∶3.6 % ,P <0 .0 5 ) ,复合终点事件明显增加 (4 8.0 %∶30 .0 % ,P <0 .0 1)。多元Logistic回归分析示AP与AMI患者死亡危险 (OR值 :3.96 ,95 %CI :2 .2 5～ 7.34,P <0 .0 5 )及复合终点事件 (OR值 :3.2 2 ,95 %CI:1.82～ 8.74 ,P <0 .0 1)增加独立相关。结论 :AMI有AP者 ,其冠脉病变多较重 ,且临床预后较差     

前壁及广泛前壁心肌梗死患者溶栓前后心脏储备功能观察

目的 :通过容量负荷试验评价急性心肌梗死 (AMI)溶栓再通与溶栓未通或未溶栓者早期的基础心功能及心脏储备功能的动态演变。方法 :选择 30例前壁及广泛前壁AMI患者分为溶栓再通组与溶栓未通或未溶栓组 ,在溶栓前后 2 4h内行漂浮导管连续监测及容量负荷试验 ,进行溶栓前后及组间的比较。结果 :①溶栓再通组溶栓后 4h心功能出现明显改善 ,平均肺动脉压、肺嵌压明显下降 (P <0 .0 5 ,<0 .0 1) ,心脏指数明显升高(P <0 .0 5 )。②溶栓后 6h溶栓再通组负荷试验阴性率为 72 .2 % ,至 2 4h负荷试验阴性率为 10 0 %。③基础心功能处于正常低限者 ,负荷试验后表现为负荷试验阳性。结论 :溶栓再通后 ,随着基础心功能的改善 ,心脏储备功能也逐渐得以恢复 ,心脏储备功能的恢复要晚于基础心功能的改善。     

抗线粒体抗体阳性和阴性PBC患者临床表现、血清学和免疫学指标及病理特征比较

目的:探讨抗线粒体抗体(AMA)阳性和阴性的原发性胆汁性肝硬化(PBC)患者的临床表现、血清学和免疫学指标及病理特征。方法:选取98例PBC患者,采用间接免疫荧光法测定AMA和AMA-M2,两者均为阳性者即为AMA阳性组,均阴性者为AMA阴性组。观察比较2组患者的临床表现、血清学和免疫学指标、病理特征。结果:98例PBC患者中,AMA阳性组有81例(82.7%),AMA阴性组有17例(17.3%)。2组患者的临床表现、血清学指标、病理特征和分期间的差异均无统计学意义(均P0.05)。AMA阳性组患者IgM水平均明显高于AMA阴性组,AMA阳性组患者ANA、SMA阳性率均明显低于AMA阴性组,差异有统计学意义(P0.05)。结论:AMA阳性与阴性PBC患者的临床表现、血清学指标、病理特征和分期相似,但AMA阳性PBC患者的血清IgM水平升高,ANA、SMA阳性率降低。     

再灌注治疗后心肌灌注状态对心电图QT离散度的影响

目的　探讨急性心肌梗死 (AMI)再灌注治疗后心肌微循环灌注状态与心电图QT离散度 (QTd)和临床预后的关系。方法　经静脉溶栓和经皮冠状动脉腔内球囊成形术 (PTCA)再灌注治疗成功的AMI患者 30 8例 ,再灌注治疗后 1h按照 12导联心电图ST段的下移幅度分为A和B两组。A组为ST段迅速下降组 (下降≥ 5 0 % ) ,共 2 2 1例 ;B组为ST段持续抬高组 (下降 <5 0 % ) ,共 87例。分别计算两组患者入院即刻、再灌注治疗后 1h和 2 4h心电图的QTd ,并进行比较。结果　A组患者CK、CK MB峰值均明显小于B组 (P <0 0 5 ) ,分别为 (315 5± 2 0 4 6 )vs(4 2 5 3± 2 76 2 ) ;(12 9± 80 )vs(181± 94 )。A组左心室射血分数明显高于B组 (5 7%vs 4 7% ,P <0 0 5 ) ,左心功能不全、梗死后心绞痛发生率均明显低于B组 (P <0 0 5 ,7 5 %vs10 4 % ;4 6 %vs 8 3% )。A组再灌注治疗后 1h、2 4h心电图QTd均明显低于B组 (P <0 0 5 ) ,分别为 (4 0± 14 )vs(4 6± 12 ) ;(37± 13)vs(4 5± 15 )。结论　AMI再灌注治疗后 ,心肌组织水平灌注状态与临床预后及QTd有相关性 ,QTd和心电图ST段回落速度是判断心肌微循环灌注状态的简易实用指标。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

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.