吉非罗齐、辛伐他汀对冠心病患者血脂调节的疗效观察

目的：观察吉非罗齐（gemfibrozil,诺衡）、辛伐他汀（舒降之）治疗老年冠心病患血脂的效果及安全性。方法：60例冠心病伴血脂增高的患随机被分为A、B两组,每组30例。A组口服吉非罗齐300mg,1次／日,B组口服辛伐他汀20mg,1次／日,4周为一疗程。结果：①两组降低胆固醇（TC）、甘油三酯（TG）、低密度脂胆固醇（LDL－C）有显疗效（P＜0．01）;②吉非罗齐降低TG优于辛伐他汀（P＜0．01）,辛伐他汀降低TC优于吉非罗齐（P＜0．01）;③两组用药无明显副作用。结论：吉非罗齐、辛伐他汀对降低冠心病伴高血脂症的血脂有显疗效;吉非罗齐降低TG优于辛伐他汀,辛伐他汀降低TC优于吉非罗齐,二均较为安全。     

不同剂量辛伐他汀调脂治疗冠心病的疗效及安全性研究

目的　观察冠心病 (CHD)患者中 ,辛伐他汀不同剂量调脂的有效性和安全性。方法　选择确诊为CHD的 114例患者 ,随机 (计算机数字表 )、开放分为辛伐他汀 2 0mg组 (n =5 8)和 10mg组 (n =5 6 ) ,年龄 40～ 86岁 ,平均年龄(6 0 .7± 9.7)岁。均为每晚服药 1次。分别于用药前、用药后第 6、12、2 4周空腹采静脉血清 ,以酶法测定总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、甘油三酯 (TG)以及肝、肾功能等。结果　 (1)用药第 6周始 ,两组TC和LDL C均比用药前明显下降 ,且一直保持到用药 2 4周末 (P均 <0 .0 5 )。 (2 )第 6、12、2 4周的TC、LDL C水平 ,在 2 0mg组比 10mg组明显低 (P <0 .0 5 )。 (3) 2 4周TC达标率 ,2 0mg组明显高于 10mg组(78.2 %比 5 2 .9% ,P <0 .0 5 )。 (4 )两组间谷丙转氨酶 (ALT)升高等副作用未见明显差异。结论　 2 0mg辛伐他汀能够安全而且更有效地降低TC和LDL C水平 ,使更多的CHD患者的血清胆固醇达到理想标准水平     

2型糖尿病患者脂代谢紊乱与冠心病关系的探讨

目的　探讨 2型糖尿病患者脂代谢紊乱与冠心病的关系。方法　对 66例 2型糖尿病患者 (其中经冠脉造影确诊为冠心病者 45例 ,非冠心病者 2 1例 )进行全套血脂指标的测定并与对照组进行比较、分析。结果　与对照组相比 ,2型糖尿病并发冠心病患者高密度脂蛋白胆固醇(HDL C)水平降低 (P <0 .0 1) ,总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)及载脂蛋白B(ApoB)水平升高 (P <0 .0 5～ 0 .0 1) ,单纯 2型糖尿病患者TG、LDL C水平升高 ,HDL C水平降低 (P <0 .0 5～ 0 .0 1)。结论　HDL C水平的降低、TG、LDL C及ApoB水平的升高是 2型糖尿病并发冠心病的重要危险因素。尽早进行合理、有效的调脂治疗     

大豆异黄酮对去卵巢兔动脉粥样硬化的影响及其机制探讨

目的　探讨大豆异黄酮对卵巢切除 (OVX)兔血脂、内皮素 - 1(ET - 1)、肿瘤坏死因子 -α(TNF -α)、白细胞介素 - 6 (IL - 6 )水平及动脉粥样硬化斑块面积的影响。方法　 4 0只 5月龄雌兔随机分 4组 ,各 10只。除A组行假手术 ,余各组均行OVX ,并饲以胆固醇饮食 ,C组予大豆异黄酮 ,D组予雌二醇 ,12周后测定血脂、ET - 1、TNF -α、IL - 6及动脉粥样硬化斑块面积。结果　与B组比较 ,C、D组总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL -C)均除低 ,C组高密度脂蛋白胆固醇 (HDL -C)增高 (P <0 0 1) ;C、D组血浆ET- 1、TNF -α、IL - 6均降低 (P <0 0 1) ,且动脉粥样硬化斑块面积占主动脉总面积的百分比明显降低 (P <0 0 1)。结论　大豆异黄酮能改善去势兔血脂 ,并降低ET - 1、TNF -α、IL -6水平 ,从而预防及减轻动脉粥样硬化。     

80岁以上冠心病高危患者强化降脂的疗效和安全性

目的用辛伐他汀对80岁以上冠心病高危患者进行强化降脂治疗,观察其疗效和安全性。方法 80岁以上确诊冠心病高危患者50例,予辛伐他汀40 mg每晚8时服用。治疗前检测血脂、肝肾功能及肌酸激酶等。治疗4及24 w后重复检查上述指标,比较治疗前后血脂水平的变化率、达标率及不良反应。结果辛伐他汀40mg/d能有效降低总胆固醇(TC)、低密度脂蛋白(LDL)、三酰甘油(TG)水平,与治疗前相比,差异有显著性(P0.01);治疗24 w TC、LDL、TG分别下降18.71%、24.22%、16.13%。高危患者LDL2.6mmol/L为达标,25例患者17例达标,达标率68%,极高危患者LDL1.81mmol/L为达标,25例患者8例达标,达标率32%。治疗中有1例出现肝酶升高,2例出现乏力伴肌酶升高而中止治疗。结论对于80岁以上冠心病高危患者,辛伐他汀能显著降低TC、TG、LDL水平,提高达标率,具有良好的安全性。     

不同剂量辛伐他汀对冠心病患者血脂及安全性的影响

目的　观察不同剂量辛伐他汀对冠心病患者血脂的临床疗效及安全性的影响。方法　 32例冠心病伴血脂增高的患者随机分为A、B两组 ,其中A组 19例 ,口服辛伐他汀 5mg/d ,B组 13例 ,口服辛伐他汀 2 0mg/d ,比较服药前及服药后 4、8周血脂变化 ,将A组没有控制到理想水平的患者 ,增加剂量 2 0mg/d ,继续口服 8周。结果　①两组对降低胆固醇 (TC)和低密度脂蛋白 (LDL -C)有显著性疗效 (P <0 0 5 ) ;B组对甘油三脂 (TG)可有效降低。②服药 8周后 ,B组有 76 9%患者TC、LDL -C下降到理想水平 ,比A组 36 8%有显著性疗效 (P =0 0 3)。③将A组未达到理想水平的 13例患者继续口服辛伐他汀 2 0mg/d ,8周后又有 5 3 8%的患者TC、LDL -C降到理想水平。④A组及B组用药前、后 8周查血糖、血尿素氮、血肌酐、ALT、AST和CK均无统计学差异。结论　对血脂增高的冠心病患者 ,口服辛伐他汀 5mg/d对TC和 (或 )LDL -C高的患者疗效好。对伴TG高的患者 2 0mg/d不仅显著性降低TC、LDL -C ,同时TG有显著性降低 ,HDL -C升高。辛伐他汀剂量的增加不会导致副作用的增加     

急性冠脉综合征早期辛伐他汀治疗对血脂和炎症反应标记物的影响

目的　观察急性冠脉综合征 (ACS)早期辛伐他汀治疗对血脂和炎症反应标记物的影响及差异 ,探讨他汀类药物在ACS早期治疗中的作用。　方法　ACS住院患者 12 3例 ,入院后测定血浆甘油三酯 (TG)、总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、白细胞介素 6 (IL 6 )和C反应蛋白 (CRP)水平 ,然后随机分为辛伐他汀治疗组和非辛伐他汀治疗组。出院时重复测定上述指标。同期测定 15例慢性稳定性心绞痛 (CAP)患者和 15名健康者作对照比较。　结果　 1 ACS患者血浆TC、LDL C、IL 6、CRP显著高于健康者 (P <0 0 1) ,血浆LDL C、IL 6显著高于CAP患者 (P <0 0 1)。 2 出院与入院时比较 ,辛伐他汀组和非辛伐他汀组血浆IL 6、CRP显著降低 (P <0 0 1) ,出院时辛伐他汀组血浆IL 6、CRP也显著低于非辛伐他汀组 (P <0 0 1)。 3 据入院时血浆IL 6、CRP水平 ,把ACS患者分别分为IL 6、CRP高值组和低值组 ,出院与入院时比较 ,高值组和低值组血浆IL 6、CRP均显著降低 (P<0 0 1,P<0 0 1) ,但只有高值组 ,出院时辛伐他汀治疗者血浆IL 6、CRP显著低于非辛伐他汀治疗者 (P <0 0 1,P <0 0 5 )。　结论　ACS患者早期辛伐他汀治疗有明显抗炎症作用。     

高脂血症与血清载脂蛋白含量关系的研究

目的　探讨高脂血症与载脂蛋白的关系。方法　对杭州市 6 6 9名高脂血症患者和 2 6 2名健康人 ,用全自动生化分析仪测定TC、TG、HDL -C、LDL -C、ApoAⅠ、AⅡ、B、CⅡ、CⅢ、E。结果　与健康对照组比较 (1)高胆固醇血症组 ,HDL -C、LDL -C明显升高 (P <0 0 1) ,各类载脂蛋白均升高 ,尤以ApoAⅠ升高最明显。 (2 )高甘油三酯血症组 ,HDL-C低于正常对照组 (P <0 0 1) ,LDL -C无显著性差异 (P >0 0 5 ) ,ApoAⅠ降低 (P <0 0 1) ,ApoB、ApoCⅡ、ApoCⅢ、ApoE均有明显升高 (P <0 0 1)。 (3)混合型高脂血症组 ,LDL -C升高 (P <0 0 1) ,ApoAⅡ、ApoB、ApoCⅡ、ApoCⅢ、ApoE升高最明显 (P <0 0 1)。结论　高脂血症ApoAⅡ、B、CⅡ、CⅢ、E水平均升高 ;高胆固醇血症ApoAⅠ、B和HDL -C、LDL -C可同时升高 ;ApoCⅢ是高甘油三酯的重要影响因素 ;混合型高脂血症高甘油三酯伴LDL -C/HDL -C比值升高 ,可视为CHD的高危人群     

冠心病患者外周血血脂与载脂蛋白A1和载脂蛋白B100水平关系的研究

目的探讨冠心病（CHD）患者外周血脂和载脂蛋白的表达水平及其临床意义。方法选择120例冠心病患者（CHD组）,检测其总胆固醇（TC）、三酰甘油（TC）、低密度脂蛋白胆回醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）和载脂蛋白A1（APOA1）、载脂蛋白B100（APOB100）的水平,并选择同期健康体检者60名作为健康对照组。结果与对照组相比,冠心病患者外周血TG、TC、LDL—C、APOB100升高,而HDL—C、ApoA1水平下降,差异均有统计学意义（P〈0．05）。CHD组患者HDL—C水平与APOA1水平呈正相关（P〈0．05）,LDL—C水平与APOB100水平亦呈正相关（P〉0．05）。结论冠心病患者外周血脂和载脂蛋白异常,血脂及脂蛋白可作为冠心病患者危险因素的重要指标．联合检测有助于冠心病的早期诊断．     

不同剂量辛伐他汀对冠心病患者的调脂疗效观察

目的　观察不同剂量辛伐他汀对冠心病患者的调脂疗效及副作用。方法　将 70例冠心病患者随机分成两组 ,A组给予辛伐他汀 2 0mg/d ,B组给予辛伐他汀 4 0mg/d ,并在治疗前及治疗后 4周、12周检测血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL -C) ,高密度脂蛋白脂固醇 (HDL -C)、甘油三酯 (TG)以及血清谷丙转氨酶 (ALT) ,肌酸磷酸激酶 (CK)。结果　两组均有明显的TC、LDL -C降低 (P <0. 0 1) ,辛伐他汀 4 0mg/d组LDL -C降低更加显著 (P <0 . 0 5 ) ,两组均有降低TG趋势及升高HDL -C作用 ,除辛伐他汀 4 0mg/d组在 12周时HDL -C升高达统计学意义外 ,其余未达显著性差别。两组病人对药物均有良好的耐受性 ,无因不良反应退出观察。结论　辛伐他汀 2 0mg/d与辛伐他汀 4 0mg均有良好的调脂作用 ,辛伐他汀 4 0mg/d降低LDL -C及升高HDL -C作用更强 ,辛伐他汀 4 0mg/d的安全性良好。     

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.