妊娠相关血浆蛋白A对经皮冠状动脉介入治疗后心肌损伤预测价值

目的:探讨经皮冠状动脉介入治疗术(PCI)前血浆妊娠相关血浆蛋白A(PAPP-A)含量对术后心肌损伤的预测价值.方法:95例择期行PCI的不稳定型心绞痛患者,根据手术前24 h PAPP-A是否升高分为高PAPP-A组(30例,PAPP-A≥10 mU/L)和低PAPP组(65例,PAPP-A＜10 mU/L).检测术前高敏C反应蛋白(hs-CRP)水平及术后24 h内肌钙蛋白I(cTnI)阳性率,并进行2组间各观察指标的比较.结果:高PAPP-A组术前PAPP-A及hs-CRP水平,冠状动脉介入治疗后cTnI阳性率均明显高于低PAPP-A组,差异有统计学意义(P＜0.05).多变量逐步Logistic回归分析表明,PCI前血浆PAPP-A及hs-CRP水平是术后cTnI阳性的独立预测指标(P＜0.05).结论:PCI前血PAPP-A含量是术后心肌损伤的独立预测因素.     

尿微量白蛋白在冠状动脉介入治疗术后对心肌损伤的评估作用

目的 探讨冠状动脉介入治疗术后尿微量白蛋白的变化及其对心肌损伤的评估作用.方法 经皮冠状动脉介入治疗患者86例,手术方式全部为经皮腔内血管成形术及支架术.于手术前即刻及术后24 h,分别采集肘静脉血3 mL,采用电化学发光测定心肌型肌酸激酶同工酶、心肌肌钙蛋白I和肌红蛋白水平,分析与比较微量白蛋白尿阳性组和微量白蛋白尿阴性组上述心肌损伤标志物水平的变化.结果 微量白蛋白尿阳性组术后心肌肌钙蛋白I、心肌型肌酸激酶同工酶水平分别为1.68±0.74 μg/L、10.16±4.18 μg/L,明显高于术前微量白蛋白尿阳性组和术后微量白蛋白尿阴性组 (P<0.05);微量白蛋白尿阳性组术后肌红蛋白水平为40.16±15.82 μg/L,明显高于术前的16.68±6.45 μg/L (P<0.05),但与术后微量白蛋白尿阴性组比较差异无显著性(32.35±11.38 μg/L;P>0.05).结论 两组患者术后心肌肌钙蛋白I、心肌型肌酸激酶同工酶和肌红蛋白水平与术前相比升高,提示冠状动脉介入治疗可引起心肌损伤.微量白蛋白尿阳性组术后心肌肌钙蛋白I和心肌型肌酸激酶同工酶水平高于微量白蛋白尿阴性组,提示术前微量白蛋白尿阳性对冠状动脉介入治疗术后心肌损伤具有一定的预测价值.     

血浆D-二聚体与急性冠脉综合征的相关性

目的探讨急性冠脉综合征(ACS)患者血浆D-二聚体水平与其临床相关性。方法前瞻性研究2013年9月至2014年9月就诊于吉林大学第一医院心血管疾病诊治中心患者196例,其中ACS组133例,对照组63例,ACS组又分为不稳定型心绞痛组(UAP)41例、急性心肌梗死组(AMI)92例。各组均记录入院时血浆D-二聚体、肌酸激酶同工酶(CK-MB)、肌钙蛋白I水平,其中AMI组还分别记录心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMP)、血栓积分(TS)及住院期间主要心脏不良事件(MACE)发生情况,分析血浆D-二聚体与ACS相关性研究。结果与对照组比较,AMI组患者血浆D-二聚体、CK-MB与肌钙蛋白I水平均升高(P<0.05);与对照组比较,UAP组CK-MB与肌钙蛋白I水平升高,但差异不具有统计学意义(P>0.05),而血浆D-二聚体水平升高,差异具有统计学意义(P<0.05);AMI组中TMP 0~1级患者血浆D-二聚体水平明显高于TMP 2~3级(P<0.05),TS≥2分患者血浆D-二聚体水平明显高于TS<2分者(P<0.05),出现MACE患者血浆D-二聚体水平明显高于未发生者(P<0.05)。结论血浆D-二聚体可作为诊断早期ACS的参考指标;AMI患者血浆D-二聚体水平的升高高度提示血运重建后心肌组织灌注不佳及冠脉血管血栓高负荷,MACE发生可能性越大。     

肺部疾病的老年患者血浆D-二聚体水平测定及临床意义

目的 探讨血浆D-二聚体水平在老年常见肺部疾病中的表达和临床意义.方法 对310例住院治疗的肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发肺癌患者及转移性肺癌患者的血浆D-二聚体水平进行测定,分析比较血浆D-二聚体水平的差异性.结果 肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发性肺癌及转移性肺癌组的血浆D-二聚体水平与对照组比较差异有统计学意义(P＜0.05).肺炎组血浆D-二聚体水平低于肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌组,差异有统计学意义(P＜0.05).肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组间血浆D-二聚体水平差异无统计学意义(P＞0.05).急性肺栓塞患者血浆D-二聚体水平升高,与肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组血浆D-二聚体水平差异有统计学意义(P＜0.05).结论 肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌均可引起凝血机制的异常,导致血浆D-二聚体水平升高,在急性肺栓塞中最为明显.但血浆D-二聚体水平的升高不是诊断急性肺栓塞的特异性指标,也不是疾病严重程度的预测指标,其临床价值在于阴性排除结果.     

室间隔缺损封堵术前后心肌肌钙蛋白Ⅰ的变化

目的:探讨室间隔缺损(VSD)患者介入治疗前后心肌肌钙蛋白Ⅰ(cTnI)的变化规律。方法:42例VSD患者用酶联免疫吸附(ELISA)法检测介入治疗前后不同时间点血清cTnI水平。其中5例患者由于缺损口<1mm,仅行左心室造影未行封堵治疗,为诊断性导管介入组;另37例患者为VSD封堵组。结果:42例患者术前血清cTnI水平均处于正常值(<0.15 ng/ml)范围内。术后即刻、4h、24h及72h,诊断性导管介入组血清cTnI水平与术前比无显著性差异(P>0.05);VSD封堵组术后即刻、4h及24h血清cTnI水平均较术前升高(P均<0.01);两组间比较亦有显著性差异(P均<0.01)。术后72h较24 hVSD封堵组降低但仍高于术前水平,有显著性差异(P<0.05),而两组间比较有显著性差异(P<0.05)。结论:cTnI可以预测心肌微损伤,介入治疗(VSD封堵术)是一种安全、有效、创伤小的治疗方法。     

老年急性ST段抬高型心肌梗死病人血浆D-二聚体水平与冠状动脉高血栓负荷的关系

目的:探究血浆D-二聚体水平与老年急性ST段抬高型心肌梗死病人冠状动脉高血栓负荷的关系。方法:选取2020年2月—2021年2月我院收治的137例老年急性ST段抬高型心肌梗死病人作为研究对象,根据病人冠状动脉血栓负荷情况将病人分为低血栓负荷组(85例)和高血栓负荷组(52例)。比较两组病人的临床资料,采用多因素Logistic回归分析影响冠状动脉高血栓负荷的因素;采用Pearson检验分析高血栓负荷病人血浆D-二聚体水平与其他影响因素间的相关性;采用受试者工作特征曲线(ROC)评价各影响因素对病人冠状动脉高血栓负荷的预测价值;采用Kaplan-Meier法绘制生存曲线,比较不同D-二聚体水平病人的生存情况。结果:高血栓负荷组血红蛋白水平低于低血栓负荷组,红细胞分布宽度(RDW)、肌酐(Cr)、心肌肌钙蛋白I(cTnI)、C反应蛋白(CRP)、脂蛋白相关磷脂酶A2(Lp-PLA2)、D-二聚体水平高于低血栓负荷组(P<0.05);多因素分析结果显示,RDW增加及cTnI、CRP、Lp-PLA2、D-二聚体水平升高是病人冠状动脉高血栓负荷的独立危险因素(P<0.05);高血栓负...     

D-二聚体与老年急性心肌梗死冠状动脉介入术后无复流的相关性研究

目的探讨D-二聚体水平与老年急性ST段抬高型心肌梗死(ST-elevated myocardiol infarction,STEMI)患者直接PCI后无复流的关系。方法连续性入选老年急性STEMI接受直接PCI患者124例,根据术后即刻血流TIMI分级和心肌染色分级将患者分为正常血流组84例和无复流组40例。比较2组D-二聚体水平,并探讨D-二聚体水平与术后无复流发生的关系。结果无复流组患者D-二聚体水平明显高于正常血流组[0.91(0.55,1.41)mg/L vs 0.46(0.33,0.96)mg/L,P=0.00]。多元logistic回归分析显示,D-二聚体水平是介入术后无复流发生的独立危险因素(OR=4.18,95%CI:1.18~14.7,P=0.026)。ROC曲线分析显示,术前D-二聚体界值为0.74mg/L时,预测术后无复流发生的敏感性为70.0%,特异性为72.6%。血浆D-二聚体0.74mg/L患者的无复流发生率明显高于血浆D-二聚体≤0.74mg/L患者无复流发生率(54.0%vs 17.5%,P=0.00)。结论老年急性STEMI患者接受直接PCI后,冠状动脉无复流发生与D-二聚体水平相关。     

非ST段抬高急性冠状动脉综合征患者血浆D-二聚体与GRACE评分的相关研究

目的:探讨非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者血浆D-二聚体水平与全球急性冠状动脉事件注册(GRACE)评分的关系。方法:入选151例在我院住院的NSTE-ACS患者,其中不稳定性心绞痛(UA)40例,非ST段抬高心肌梗死(NSTEMI)111例。入院后测定血浆D-二聚体浓度,计算GRACE评分并进行危险分层,分析NSTE-ACS患者血浆D-二聚体水平与GRACE评分及危险分层的关系。结果:NSTEMI组D-二聚体含量的平方根及GRACE评分均高于UA组(P0.05和P0.01)。将所有NSTE-ACS患者作GRACE危险分层,高危组D-二聚体含量的平方根明显高于中危组及低危组(均P0.01),中危组与低危组D-二聚体含量的平方根差异无统计学意义(P0.05)。将所有NSTE-ACS患者按D-二聚体含量1.0μg/ml和≥1.0μg/ml分为低D-二聚体组和高D-二聚体组,高D-二聚体组GRACE评分明显高于低D-二聚体组(P0.01)。NSTE-ACS患者D-二聚体的平方根与GRACE评分呈正相关(r=0.335,P0.01)。结论:NSTE-ACS患者血浆D-二聚体水平与GRACE评分具有良好的相关性。D-二聚体水平对于NSTE-ACS患者的早期危险分层具有一定的价值。     

卵巢癌患者血浆D-二聚体水平变化及意义

目的 观察卵巢癌患者血浆D-二聚体水平变化,并探讨其临床意义.方法 采用免疫比浊法检测46例卵巢癌（癌症组）、50例卵巢良性肿瘤患者（良性组）及50例健康体检者（对照组）的空腹血浆D-二聚体.结果 癌症组血浆D-二聚体水平及阳性率分别为（2.13±1.58） μg/L、73.9％,良性组分别为（0.22±0.13）μg/L、26.0％,对照组分别为（0.17±0.05） μg/L、2.0％;三组间两两比较,P均＜0.05.随着卵巢癌分期的增加,血浆D-二聚体检测阳性率也呈逐渐上升（P均＜0.05）;随着术前血浆D-二聚体水平的升高,卵巢癌诊断的敏感性、特异性及准确性均逐渐上升（P均＜0.05）.结论 卵巢癌患者血浆D-二聚体水平升高,其水平检测有助卵巢肿瘤的良、恶性鉴别,可作为卵巢癌早期诊断、临床分期、预后判断指标之一.     

冠状动脉病变介入治疗后血浆B型利钠肽和肌钙蛋白I的变化

目的观察不同类型冠状动脉病变介入治疗前后血液B型利钠肽(BNP)及心肌肌钙蛋白I(cTnI)的变化。方法选取接受冠状动脉介入治疗的患者52例,根据冠状动脉病变血管累及范围分为单支病变组、双支病变组,分别测定两组患者术前、术后6、24、48h BNP,cTnI水平,并记录术中球囊扩张时间、扩张次数、造影剂用量。结果单支病变组球囊扩张时间、扩张次数及造影剂用量均小于双支病变组(P<0.05);两组术后6h BNP水平均高于术前(P<0.05),术后24h达峰值;两组术后24h cTnI水平显著升高(P<0.05),但单支病变组BNP、cTnI峰值水平低于双支病变组(P<0.05)。结论多支病变或复杂病变患者介入治疗后BNP、cTnI水平升高明显,提示应进行术前危险评估,术后应给予适当药物辅助治疗改善预后。     

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.