螺内酯对急性心肌梗死患者胶原代谢标志物和左室重构的影响

目的:观察螺内酯对急性心肌梗死(AMI)患者胶原代谢标志物及左室重构的影响。方法:将60例AMI患者分为常规治疗组与螺内酯治疗组,应用放射免疫法测定血浆Ⅲ型前胶原氨基末端肽(PⅢNP)、血清透明质酸(HA)含量,用超声心动图测量左室结构及舒缩功能参数。结果:常规治疗组与螺内酯治疗组AMI后第2天血浆PⅢNP分别为(5.24±1.09)、(5.14±1.21)μg/L与正常组[(5.01±1.18)μg/L]相比差异无统计学意义(均P>0.01)。螺内酯治疗组第4周、第12周血浆PⅢNP含量分别为(7.25±1.97)、(6.82±1.98)μg/L较常规治疗组同时间点含量[(10.23±2.25)、(8.36±2.11)μg/L]均显著下降(均P<0.01)。第4周、第12周螺内酯治疗组血清HA含量[(136.4±28.7)、(109.2±30.5)ng/L]与常规治疗组[(167.5±31.5)、(134.5±36.1)ng/L]比较均显著下降(P<0.01)。螺内酯治疗组第12周左室舒张期末容积指数[(57.2±5.8)ml/m2]和收缩期末容积指数[(29.2±5.3)ml/m2]与常规治疗组[(65.9±6.3),(35.7±6.8)]相比均显著降低(P<0.01);二尖瓣血流舒张早期流速(VE)与心房收缩期流速(VA)比值(VE/VA)与常规治疗组相比均显著增加(P<0.01),射血分数虽有增加,但无明显变化(P>0.05)。结论:螺内酯可降低AMI患者血浆PⅢNP、HA含量,阻抑左室重构,改善左室功能。     

卡维地洛治疗扩张型心肌病心力衰竭的疗效及对血浆细胞凋亡抑制因子的影响

目的 :观察卡维地洛治疗国人扩张型心肌病 ( DCM)心力衰竭 ( HF)的临床疗效 ,以及对血浆细胞凋亡抑制因子 ( APO- 1/ Fas)的反应。方法 :2 4例 DCM HF患者在洋地黄、利尿剂、血管紧张素转换酶抑制剂和硝酸盐类扩血管药物治疗基础上 ,随机分为卡维地洛组和常规组 (加用安慰剂 )。治疗前与治疗 3个月后应用超声心动图测量左室短轴缩短分数 ( FS) ,射血分数 ( EF) ,左室舒张末内径 ( L VDD) ,室间隔厚度 ( IVS)和左室后壁厚度( L VPW) ;以 EL ISA法测定患者血浆 APO- 1/ Fas浓度。结果 :治疗 3个月后 ,两组心功能均有显著改善 ,但卡维地洛组 L VDD[( 60 .5± 6.7)∶ ( 66.3± 6.3 ) m m,P<0 .0 5 ],[EF( 4 9.4± 9.8) %∶ ( 4 1.3± 6.2 ) % ,P<0 .0 5 ],D/T( 3 .0 8± 0 .62∶ 3 .69± 0 .79,P <0 .0 5 )改善比常规组更明显。治疗前两组 CHF患者血浆 APO- 1/ Fas水平均显著高于正常水平 ,且与 EF负相关 ( r =- 0 .73 ,P <0 .0 0 1) ,治疗 3个月后卡维地洛组 APO- 1/ Fas显著低于常规组 [( 0 .94± 0 .2 6)∶ ( 1.18± 0 .3 2 ) μg/ L,P <0 .0 5 ]。结论 :卡维地洛对 CHF心肌的保护作用可能与抑制心肌细胞凋亡有关。     

充血性心力衰竭患者血清细胞因子与心功能的关系及阿托伐他汀的干预作用

目的:探讨充血性心力衰竭(CHF)患者血清肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6水平的变化与心功能的关系及阿托伐他汀对其水平的影响。方法:84例CHF患者被随机分为阿托伐他汀治疗组(42例)和常规治疗组(42例),另选30例健康人作为正常对照组,采用放射免疫方法检测各组治疗前后血清中TNF-α及IL-6的水平,并作心脏超声检查,评估心功能。结果:①84例心功能I~IV级CHF患者血清中TNF-α水平:[(0.52±0.16)μg/L∶(0.64±0.17)μg/L∶(0.79±0.17)μg/L∶(0.88±0.18)μg/L],IL-6[(96.67±17.79)μg/L∶(119.19±25.48)μg/L∶(143.51±26.63)μg/L∶(154.21±23.39)μg/L]随着心功能损害程度加重而显著升高(P0.05);②阿托伐他汀组与常规治疗组治疗后血清TNF-α,IL-6水平均较治疗前明显下降(P均0.05),且阿托伐他汀组较常规治疗组治疗后血清中TNF-α[(0.63±0.21)μg/L∶(0.74±0.19)μg/L],IL-6[(108.87±20.86)μg/L∶(113.92±15.37)μg/L]降低更明显(P0.05);③治疗后阿伐他汀治疗组左室射血分数[(40±6)%∶(36±5)%]、左室收缩末容积指数[(31±6)ml/m2∶(34±5)ml/m2]、左室舒张末容积指数[(47±12)ml/m2∶(51±11)ml/m2]较常规治疗组明显改善(P均0.05)。结论:①充血性心力衰竭患者TNF-,αIL-6水平与心功能状态密切相关;②阿托伐他汀能降低血浆细胞因子(肿瘤坏死因子、白细胞介素-6)水平,改善心脏功能,有益于慢性心力衰竭的治疗。     

卡维地洛对慢性心力衰竭患者血浆脑钠素水平的影响

目的:探讨慢性心力衰竭(CHF)患者卡维地洛治疗前后血浆脑钠素(BNP)浓度的变化。方法:用放射免疫法测定56例CHF患者(CHF组)治疗前、后及60例体检健康者(对照组)的血浆BNP浓度;用放射性核素99m锝心血池扫描测定CHF患者治疗前、后左心室射血分数(LVEF)。结果:CHF患者血浆BNP浓度(222.65±78.52)ng/L显著高于对照组(38.82±15.31)ng/L(P<0.01),且随着心功能分级的程度加重而增加。血浆BNP浓度与LVEF之间存在良好的负相关(r=-0.68,P<0.01)。卡维地洛治疗3个月后血浆BNP浓度由(222.65±78.52)ng/L降至(79.65±69.52)ng/L(P<0.01);LVEF由(34.41±4.54)%升至(46.51±5.38)%(P<0.01)。结论:CHF患者血浆BNP浓度升高,且随CHF严重程度的增加而显著升高;卡维地洛可使CHF患者血浆BNP浓度显著降低,且能改善左心室功能状态。     

雷米普利对老年心力衰竭患者血清细胞因子的影响

目的研究老年心力衰竭患者血清细胞因子水平与心功能的关系以及雷米普利对血清细胞因子的影响.方法将76例老年心力衰竭患者随机分为雷米普利治疗组(36例)和常规治疗组(40例),另设年龄、性别与之匹配的健康老年人作为对照组(30例).应用双抗夹心ELISA法检测各组受试者血清肿瘤坏死因子α(TNF-α)、可溶性肿瘤坏死因子受体(STNFRI)、白细胞介素6(IL-6)、白细胞介素10(IL-10)和转化生长因子β1(TGF-β1)水平.常规治疗组和雷米普利组在治疗2周后复查上述指标.结果(1)血清TNF-α、STNFRI、IL-6、IL-10和TGF-βI水平与老年心力衰竭患者的基础心脏病无关(P＜0.05);上述血清细胞因子水平随心功能的恶化而升高(P＜0.05或P＜0.01).(2)与治疗前比较,雷米普利治疗组治疗前后血清TNF-α[(20.9±8.2)μg/L比(13.2±8.4)μg/L]、sTNFRI[(2.7±0.9)μg/L比(1.9±0.4)μg/L]、IL-6[(29.2±6.8)ng/L比(20.5±6.0)ng/L]、IL-10[(22.1±6.4)ng/L比(13.8±5.7)ng/L]及TGF-β1[(2144.1±597.9)ng/L比(1348.8±342.4)ng/L]水平均下降(分别为P＜0.05或P＜0.01),雷米普利治疗组比常规治疗组下降明显(P＜0.01).结论老年心力衰竭患者血清细胞因子与心功能密切相关,能够反映心力衰竭的程度;雷米普利能明显改善老年心力衰竭患者细胞因子的异常.     

阿罗洛尔治疗慢性心衰的疗效及其对血浆脑钠肽的影响

目的:研究盐酸阿罗洛尔治疗慢性心衰(CHF)的疗效及其对血浆脑钠尿肽(BNP)的影响。方法:选择我院收治的CHF患者116例,依据随机数字表法均分为常规治疗组和阿罗洛尔组(常规治疗基础上联合阿罗洛尔治疗)。连续治疗6个月。观察两组治疗前后左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、心肌能量消耗(MEE);血清白介素8 (IL-8)、高敏C反应蛋白(hsCRP)等炎性因子水平;血浆BNP水平;Lee心衰积分及不良反应。结果:治疗后,与常规治疗组比较,阿罗洛尔组LVESV [(38.45±3.93)ml比(36.42±3.51)ml]、LVEDV [(49.23±4.89)ml比(47.43±4.37)ml]、MEE [(96.11±9.86)cal/min比(86.58±8.83)cal/min]明显减小,IL-8 [(32.18±3.17)ng/L比(28.92±2.79)ng/L]、hsCRP [(5.86±0.51)mg/L比(3.78±0.35)mg/L]、BNP [(275.75±27.64)ng/L比(196.75±20.04)ng/L]水平及Lee心衰积分[(4.77±0.73)分比(2.82±0.54)分]明显降低,LVEF [(45.69±4.76)%比(51.89±5.30)%]明显提高(P0.05或0.01)。阿罗洛尔组总有效率明显高于常规治疗组(94.83%比79.31%,P=0.027)。两组治疗期间均无明显不良反应。结论:阿罗洛尔可显著改善心力衰竭患者心功能,降低血浆脑钠肽及炎性因子水平,疗效显著,安全可靠。     

慢性充血性心力衰竭患者血浆白介素-15与NT-proBNP水平的相关性

目的:探讨慢性充血性心力衰竭(CHF)患者血浆白介素15(IL-15)与N末端B型利钠肽前体(NTproBNP)水平的相关性。方法:序贯纳入205例诊断为CHF的患者作为CHF组,同期行健康体检的52例健康成年人作为健康对照组。根据NYHA心功能分级,CHF组又被进一步分为II级组(55例),III级组(87例)和IV级组(63例)。测量比较各组间血浆IL-15水平,分析CHF患者血浆NT-proBNP、左室射血分数(LVEF)与血浆IL-15水平的相关性。结果:与健康对照组比较,CHF组血浆NT-proBNP水平[(71±33)pg/ml比(5884±1379)pg/ml]显著升高,LVEF[(57±7)%比(31±8)%]显著降低,P均=0.001。CHF组的血浆IL-15水平显著高于健康对照组[(18.35±6.42)ng/L比(7.78±3.11)ng/L],P=0.001;与II级组相比,III级、IV级血浆IL-15水平[(10.24±3.61)ng/L比(20.17±6.35)ng/L比(21.94±7.32)ng/L]显著升高(P均=0.001),而III级与IV级组间无显著差异(P=0.187)。Pearson相关分析显示,CHF患者血浆IL-15水平与血浆NT-proBNP水平显著正相关(r=0.172,P=0.038)。结论:CHF患者血浆IL-15水平与血浆NT-proBNP水平呈显著正相关,NT-proBNP可能成为预测CHF的一种新型标志物。     

老年人心力衰竭与C-反应蛋白肾上腺髓质素脑钠素和基质金属蛋白酶的关系

目的研究老年充血性心力衰竭(CHF)患者血浆中高敏C-反应蛋白(hs-CRP)、肾上腺髓质素(ADM)、脑钠素(BNP)和基质金属蛋白酶(MMPs)的水平,与心力衰竭的严重程度、左室射血分数(LVEF)的关系及各指标的相互关系。方法采取50例CHF患者和24例健康对照者空腹静脉血,测定hs-CRP、ADM、BNP、MMP-2、MMP-9水平,用彩色超声探测仪测定LVEF。CHF组按美国纽约心脏病学会(NYHA)心功能分级标准分为Ⅱ、Ⅲ、Ⅳ级组。结果CHF组hs-CRP、ADM、BNP、MMP-2、MMP-9和LVEF水平〔分别为(7.7±4.4)mg/L、(34.9±9.4)ng/L、(154.5±59.7)ng/L、(149.9±60.3)μg/L(、182.0±57.2)μg/L(、32.4±5.0)%〕与对照组〔分别为(0.9±0.7)mg/L、(16.3±2.7)ng/L(、38.8±11.4)ng/L、(149.9±60.3)μg/L、(70.1±6.8)μg/L、(58.4±3.1)%〕比较,差异有统计学意义(均为P<0.01);CHF组hs-CRP、ADM、BNP、MMP-2、MMP-9浓度与LVEF均呈显著负相关(均为P<0.01),且hs-CRP、MMP-2、MMP-9浓度与LVEF负相关更显著。CHF组hs-CRP、ADM、BNP、MMP-2、MMP-9相互间呈显著的正相关(P<0.01),且hs-CRP与MMP-2、MMP-9间的相关性(r为0.77、0.82)较hs-CRP与ADM、BNP间的相关性(r为0.49、0.51)更显著。结论hs-CRP、ADM、BNP、MMP-2、MMP-9共同参与老年人CHF的发生和发展过程;hs-CRP与MMP-2、MMP-9能更准确反映左室功能障碍程度;MMPS在老年人CHF心室的重塑中具有重要的作用。     

脑钠素测定对心力衰竭患者的诊断价值

目的　评价脑钠素 (BNP)测定对充血性心力衰竭 (心衰 ,CHF)诊断的价值。方法　呼吸困难住院患者 85例 ,根据病因分为心衰组和非心衰组 ,采用ELISA法测定两组血浆BNP水平。结果　心衰组血浆BNP浓度 [( 65 4.1± 3 0 2 .6)ng/L]显著高于非心衰组 [( 2 0 6.3± 5 3 .7)ng/L] ,两组比较差异有非常显著性 (P <0 .0 0 1) ;以正常对照组的血浆BNP浓度的 ( x±s1.96s)为标准 ,诊断CHF的敏感性为 96% ,特异性为 93 %。结论　血浆BNP是诊断CHF较好的血液指标 ,尤其对于鉴别呼吸困难患者是否为心源性心力衰竭具有重要意义     

癌症患者血浆和组织浸液凝血酶调节蛋白的检测及临床意义

用ELISA法检测188例癌症患者血浆TM和24例癌组织及其邻近正常组织浸液的TM浓度。结果:癌症患者血浆TM水平[(33.47±14.25)μg/L]明显高于对照组[(20.40±7.22)μg/L,P<0.01,癌症转移组(41.68±16.96)μg/L明显高于对照组(P<0.01),术后组患者TM(18.45±9.96)μg/L]比术前组TM[(28.29±11.74)μg/L]明显回落(P<0.01),     

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.     

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.     

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.     

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.