老年高血压病患者高脉压与靶器官损害

目的观察在药物规则治疗下的老年高血压病患者脉压(PP)与心脏、血管和肾脏等靶器官损害的关系,为临床更好地控制血压,防治靶器官损害提供依据.方法用24小时动态血压仪监测263例老年高血压病患者全天平均脉压(ABPP),多普勒超声检查颈动脉粥样斑块发生率(CAPR)、颈总动脉分叉处内膜-中膜厚度(IMT)及内径(CAD)、左室重量指数(LVMI)、左室舒张早期充盈峰值流速与心房收缩期充盈峰值流速比值(E/A值)、射血分数(EF),生化测定内生肌酐清除率(Ccr)及24小时尿微量白蛋白排泄量(MAU).评价不同ABPP值对心脏、颈动脉、肾脏结构或功能的影响.结果老年高血压病患者PP≥60 mmHg与P\%P\%<60 mmHg比较,E/A值、EF和Ccr均下降(P<0.05),而LVMI、CAD、CAPR、IMT、MAU升高(P<0.05).结论老年高血压病患者脉压增大,可促进心脏、血管及肾脏等靶器官损害,提示在老年高血压病患者中脉压也是预测心脏、血管及肾脏损害有价值的指标,控制脉压可以减轻老年高血压病患者靶器官损害.     

老年高血压病患者高脉压与靶器官损害

目的　观察在药物规则治疗下的老年高血压病患者脉压 (PP)与心脏、血管和肾脏等靶器官损害的关系 ,为临床更好地控制血压 ,防治靶器官损害提供依据。方法　用 2 4小时动态血压仪监测 2 63例老年高血压病患者全天平均脉压(ABPP) ,多普勒超声检查颈动脉粥样斑块发生率 (CAPR)、颈总动脉分叉处内膜 -中膜厚度 (IMT)及内径 (CAD)、左室重量指数 (LVMI)、左室舒张早期充盈峰值流速与心房收缩期充盈峰值流速比值 (E/A值 )、射血分数 (EF) ,生化测定内生肌酐清除率 (Ccr)及 2 4小时尿微量白蛋白排泄量 (MAU)。评价不同ABPP值对心脏、颈动脉、肾脏结构或功能的影响。结果　老年高血压病患者PP≥ 60mmHg与PP <60mmHg比较 ,E/A值、EF和Ccr均下降 (P <0 0 5) ,而LVMI、CAD、CAPR、IMT、MAU升高 (P <0 0 5)。结论　老年高血压病患者脉压增大 ,可促进心脏、血管及肾脏等靶器官损害 ,提示在老年高血压病患者中脉压也是预测心脏、血管及肾脏损害有价值的指标 ,控制脉压可以减轻老年高血压病患者靶器官损害     

老年原发性高血压患者脉压与靶器官损害的相关性研究

目的探讨老年原发性高血压患者脉压与靶器官损害的严重程度及其相关性.方法将98例老年原发性高血压患者分为脉压＜60mm Hg和脉压≥60mmHg两组,均做心电图、超声心动图、头颅CT、颈动脉超声,血尿素氮（BUN）、血肌酐（Cr）、尿肌酐和尿白蛋白检查.结果脉压≥60 mm Hg组与脉压＜60 mm Hg组比较,其左心室重量指数（LVMI）、左心室舒张末期内径（LVDd）、颈动脉内膜厚度（IMT）、颈动脉斑块发生率（CAPR）、BUN、Cr、尿白蛋白定量等指标均高于脉压＜60 mm Hg组（P＜0.05）,靶器官损害发生率高于脉压＜60 mm Hg组（P均＜0.05）.结论老年原发性高血压患者靶器官损害与增大的脉压有关,控制脉压可以减轻靶器官损害程度.     

脉压变异性与高血压靶器官损害的相关性分析

目的探讨脉压变异性与高血压靶器官损害的关系。方法搜集近5年住我院未曾治疗的高血压病患者192例(男101例,女91例),以脉压变异性(PPV)<10mmHg、10≤PPV<15mmHg、PPV≥15mmHg分为3个组。分析各组的PPV与尿素氮(BUN)、血清肌酐(Cr)、血清尿素(UA)、内生肌酐清除率(Ccr)、左室质量指数(LVMI)、室间隔厚度(IVSd)、后壁厚度(PWd)、主动脉起始段内径(AoD)、冠状动脉左前降支(LAD)、左室舒张期内径(LVDd)、左室射血分数(LVEF)、左室短轴缩短率(FS)及心脑并发症发生率的相关性。结果①PPV与年龄、BUN、Cr、UA、收缩压(SBP)、舒张压(DBP)、脉压(PP)、LVMI呈正相关(P均<0.05),而与Ccr、FS、LVEF呈负相关(P均<0.05)。②左室肥厚、心功能不全、心电图异常及脑并发症的发生率与患者年龄、SBP、DBP、PP、PPV有关(P均<0.05),差异有统计学意义。结论高血压病患者PPV增大,可促进心脏、脑及肾脏等靶器官损害。提示高血压病患者中PPV也是预测心脏、脑及肾脏损害有价值的指标。控制PPV可以减轻高血压病患者靶器官的损害。     

动态脉压对老年高血压患者靶器官损害的影响

目的探讨动态脉压对老年高血压患者靶器官损害的影响。方法选择原发性高血压患者146例,按24 h平均脉压(MPP)分为2组:24 h MPP≥60 mm Hg(1 mm Hg=0.133 kPa)为A组(60例),24 h MPP<60 mm Hg为B组(86例);另选健康体检者为对照组(C组,30例)。所有患者均行血清肌酐、动态血压、超声心动图、颈动脉超声检查;计算肌酐清除率(Ccr)、24 h平均收缩压(MSBP)、24 h平均舒张压、24 h MPP、左心室重量指数(LVMI)、LVEF、颈动脉内膜中层厚度(IMT)。结果与C组比较,A组和B组患者24 h MSBP、24 h MPP、LVMI、IMT、左心室肥厚、左心室功能受损、脑损害、肾功能受损、颈动脉斑块发生率明显升高,Ccr、LVEF水平明显降低(P<0.05,P<0.01);与B组比较,A组患者Ccr、LVEF水平明显降低,24 h MSBP、24 h MPP、LVMI、IMT、靶器官损害发生率均明显升高(P<0.05,P<0.01)。24 h MPP与心脑肾和颈动脉损害相关(P<0.05)。结论动态脉压增大与老年高血压患者靶器官结构和功能的损害相关;动态脉压越大,靶器官损害越严重。     

高血压病患者脉压与靶器官损害的关系

目的探讨脉压与高血压病靶器官损害的关系.方法回顾性调查近5年住我院未治疗高血压病患者696例(男387例,女309 例),按平均压<107 mmHg和≥107 mmHg分为二组,再分别以脉压≤60 mmHg, 60<PP≤80 mmHg, 80<PP≤100 mmHg,>100 mmHg分为4个亚组.分析各亚组的脉压与体重指数(BMI)、血糖、血脂、BUN、Cr、UA、CCr、LVMI、EF、FS及心脑并发症发生率的相关性.结果 (1)各亚组的高血压病史、吸烟者、饮酒者、BMI、血糖、甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白(HDL)及低密度脂蛋白(LDL)无明显差别(P>0.05);(2)脉压与BUN、Cr、UA、年龄、SBP、LVMI呈正相关(r分别为0.75,0.60,0.70,0.48,0.59, 0.56,P均<0.05),而与CCr、DBP、FS、EF呈负相关(r分别为-0.68,-0.52,-0.49,-0.51,P均<0.05).(3)左室肥厚、冠心病、心功能不全及脑并发症的发生率与患者年龄、收缩压、舒张压和脉压有关(P均<0.05),统计学分析脉压起着更重要的作用.结论高血压病患者的靶器官损害与年龄、收缩压、舒张压和脉压等因素有关,但脉压起着更重要的作用.     

动态脉压对老年高血压病患者左心室肥厚及主动脉根部扩张的影响

目的研究老年高血压病患者动态脉压(24 h PP)与左心室肥厚(LVH)及主动脉根部(AOD)扩张的相关关系。方法对60例老年高血压病患者进行动态血压(ABP)和超声心动图等检查,分别测量ABP和超声心动图的各种参数。将24 h PP≥60 mm Hg(1 mm Hg=0.133 kPa)的患者30例作为A组,24 h PP<60 mm Hg的患者30例作为B组。结果A、B两组LVH和AOD扩张的发生率差异有显著性意义(P<0.01)。左心室重量指数与24 h PP2、4 h平均收缩压(24 h SBP)密切相关(P<0.01),与脉压和收缩压呈正相关(P<0.05)。AOD与24 h PP、24 h SBP、年龄和病程密切相关(P<0.01)。结论老年高血压病患者的24 h PP与LVH及AOD扩张密切相关,24 h PP可作为评价抗高血压药物能否更好地减少高血压病患者靶器官损害的重要指标之一。     

老年高血压病患者动态脉压与左心室肥厚及主动脉根部扩张的相关研究

目的　研究老年高血压病患者动态脉压 ( 2 4hPP)与左心室肥厚 (LVH)及主动脉根部 (AOD)扩张的相关关系。方法　对 118例老年高血压病患者进行动态血压 (ABP)和超声心动图等检查 ,分别测量ABP和超声心动图的各种参数。将 2 4hPP≥ 60mmHg( 1mmHg =0 13 3kPa)的患者 5 8例列为A组 ,2 4hPP <60mmHg的患者 60例列为B组。结果　A、B两组LVH和AOD扩张的发生率有非常显著的差异 (P <0 0 1)。左心室重量指数 (LVMI)与 2 4hPP、2 4h平均收缩压 ( 2 4hSBP)呈密切正相关 (r分别为 0 47、0 42 ,P均 <0 0 1) ,与脉压 (PP)和收缩压 (SBP)呈弱相关 (r分别为 0 2 5和 0 2 1,P均 <0 0 5 )。AOD与 2 4hPP、2 4hSBP、PP、SBP、年龄和病程密切正相关 (r分别为 0 5 9、0 49、0 45、0 3 7、0 2 9和 0 3 4,P均 <0 0 1)。结论　老年高血压病患者的 2 4hPP与LVH及AOD扩张密切相关 ,2 4hPP可作为评价抗高血压药物能否更好地减少高血压患者靶器官损害的重要指标之一     

药物干预下高血压患者脉压和靶器官损害的相关性研究

目的探讨药物规则治疗下脉压与高血压病靶器官损害的关系,为临床更好地控制血压防治靶器官损害提供依据。方法将我院近2年来药物规则治疗下的高血压患者324例(男184例,女140例),按脉压<60mmHg、60mmHg≤PP<80mmHg、PP≥80mmHg分为三组,分析各组脉压与体重指数(BMI)、血糖、血脂、Bun、Cr、CCr、MAU、LVMI、EF及心脑肾并发症发生率的相关性。结果①各组的性别分布、病程、BMI、血糖、血脂水平差异无统计学意义(P>0.05);②脉压与年龄、SBP、Bun、Cr、MAU、LVMI成正相关(P<0.05),而与DBP、Ccr、EF成负相关(P<0.05);③冠心病、左室肥厚、心功能不全、脑并发症及肾功能不全的发生率与患者年龄、收缩压、舒张压和脉压有关(P均<0.05);统计学分析脉压起着重要的作用。结论即使药物规则治疗下,高血压患者的靶器官损害与年龄、收缩压、舒张压、脉压等因素有关,并且脉压的影响更重要,因此在高血压病的治疗过程中应重视缩小脉压。     

高血压病患者脉压与靶器官损害的关系

目的　探讨脉压与高血压病靶器官损害的关系。方法　回顾性调查近 5年住我院未治疗高血压病患者 696例(男 3 87例 ,女 3 0 9例 ) ,按平均压 <10 7mmHg和≥ 10 7mmHg分为二组 ,再分别以脉压≤ 60mmHg ,60 10 0mmHg分为 4个亚组。分析各亚组的脉压与体重指数 (BMI)、血糖、血脂、BUN、Cr、UA、CCr、LVMI、EF、FS及心脑并发症发生率的相关性。结果　 ( 1)各亚组的高血压病史、吸烟者、饮酒者、BMI、血糖、甘油三酯 (TG)、胆固醇 (TC)、高密度脂蛋白 (HDL)及低密度脂蛋白 (LDL)无明显差别 (P >0 0 5) ;( 2 )脉压与BUN、Cr、UA、年龄、SBP、LVMI呈正相关 (r分别为 0 75,0 60 ,0 70 ,0 48,0 59,0 56,P均 <0 0 5) ,而与CCr、DBP、FS、EF呈负相关 (r分别为 -0 68,-0 52 ,-0 49,-0 51,P均 <0 0 5)。 ( 3 )左室肥厚、冠心病、心功能不全及脑并发症的发生率与患者年龄、收缩压、舒张压和脉压有关 (P均 <0 0 5) ,统计学分析脉压起着更重要的作用。结论　高血压病患者的靶器官损害与年龄、收缩压、舒张压和脉压等因素有关 ,但脉压起着更重要的作用     

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.     

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.