血管紧张素转化酶基因多态性与高血压病人胰岛素抵抗相关性的研究

目的探讨血管紧张素转化酶(ACE)基因多态性,血管紧张素原(AGT)基因突变与高血压及胰岛素抵抗的关系.方法用聚合酶链反应(PCR)检测76例原发性高血压及28例正常血压者的ACE基因插入/缺失(I/D)多态性及AGT基因位点突变,同时进行口服葡萄糖耐量及胰岛素释放试验,以空腹血糖及空腹胰岛素乘积倒数的对数值(ISI),胰岛素曲线下面积IS-AUC作为胰岛素敏感性指标.结果 (1)ACE基因多态性在高血压和正常血压组无显著性差异,而AGT T235等位基因频率在高血压组高于正常对照组(0.43 vs 0.32, P<0.05).(2)无论是高血压还是正常血压者ACE基因DD型者的ISI均明显低于ID和II型,IS-AUC显著高于ID和II型[ISI-4.31±0.20 vs -3.63±0.22 和-3.27±0.24, P<0.01; IS(AUC)211.1±56.8 vs 135.7±54.7、126.8±51.7 mu*L-1, P<0.01],而AGT基因T235,T174基因突变与胰岛素抵抗无关(P>0.05).结论 ACE基因DD型而非AGT基因可能参与高血压病人及正常血压者胰岛素抵抗的基因调节,这可能是ACE基因DD型易发生心血管危险的机制之一.     

ACE基因多态性与原发性高血压及胰岛素抵抗关系的研究

目的　探讨 ACE基因多态性与原发性高血压及胰岛素抵抗间的关系。方法　原发性高血压 16 0例 ,正常对照 15 0例 ,用聚合酶链反应法 (PCR)扩增 ACE基因第 16内含子多态性位点的序列 ,测空腹血糖、胰岛素 ,并计算胰岛素敏感指数 (ISI) ,比较高血压组、对照组间 ACE基因型的频率及等位基因频率 ,用 χ2 检验 ;比较不同 ACE基因型间的 ISI,用方差分析。结果　高血压组 DD基因型频率显著高于对照组 ,而各基因型间 ISI无差别。结论　高血压组 DD基因型频率显著高于对照组 ,ACE基因多态性与胰岛素抵抗间无关系。     

原发性高血压代谢综合征与血管紧张素转换酶基因插入/缺失多态性关系的探讨

目的 :探讨原发性高血压 (EH)代谢综合征与血管紧张素转换酶 (ACE)基因插入 /缺失多态性的关系。方法 :选取EH患者 2 0 2例 ,其中男 116例 ,女 86例 ,年龄 30～ 72 (5 9.5 4± 9.2 6 )岁。符合代谢综合征者 10 6例 ,非代谢综合征 96例。应用聚合酶链反应 (PCR)测定两组ACE基因插入 /缺失多态性。结果 :EH代谢综合征组与非代谢综合征组ACE基因DD、ID、II基因型间无显著相关性 (χ2 =2 .5 4 5 ,P 0 .0 5 )。代谢综合征组ACE多态性基因型与腰围、高密度脂蛋白胆固醇 (HDL C)密切相关 (P <0 .0 1) ;与腰围 /臀围、三酰甘油 (TG)密切相关 (P <0 .0 5 ) ;与血压、血糖、胰岛素无关 (P 0 .0 5 )。代谢综合征组ACE基因DD、ID基因型腰围较II基因型显著增加 (P <0 .0 1,<0 .0 5 ) ;DD基因型腰围 /臀围、TG较II基因型显著增加 (P <0 .0 5 ) ;ACE基因DD基因型HDL C较II基因型显著降低 (P <0 .0 5 ) ;ACE基因DD、ID、II基因型间血压、血糖、胰岛素差异无统计学意义 (P 0 .0 5 )。结论 :EH代谢综合征与ACE基因多态性无显著相关性。但是代谢综合征患者肥胖、脂代谢紊乱与ACE基因多态性密切相关 ,而血压水平、胰岛素敏感性却与ACE基因多态性无关。     

肥胖和高血压患者餐后甘油三酯代谢异常与胰岛素抵抗的关系

目的　探讨高血压病与肥胖患者餐后甘油三酯 (TG)代谢异常与胰岛素抵抗的关系。方法　 19例健康人 ,19例单纯肥胖患者 ,2 1例高血压非肥胖患者 ,2 3例高血压合并肥胖患者禁食 12h后 ,进行标准脂肪负荷试验 ,以TG 8h曲线下面积 (TG AUC)和TG峰反应 (TGPR)作为标准脂肪负荷后TG反应水平的指标。以胰岛素敏感性指数 (ISI)及胰岛素曲线下面积 (IS AUC)作为胰岛素敏感性的判定指标。结果　 (1)高血压合并肥胖、高血压非肥胖、单纯肥胖组TG AUC ,TGPR均显著高于正常组 [TG AUC分别为 :(2 4 5 1± 10 6 8)mmol/L、(17 5 8± 7 6 8)mmol/L、(15 2 6± 4 93)比 (8 74± 2 34)mmol/L ,P <0 0 5 ;TGPR分别为 :(5 2 1± 2 2 7)mmol/L、(3 4 6± 1 82 )mmol/L、(3 0 2± 1 0 1)比 (1 5 4±0 5 6 )mmol/L ,P <0 0 5 ],高血压合并肥胖组TG AUC ,TGPR显著高于高血压非肥胖和单纯肥胖组 (P<0 0 1) ,高血压非肥胖组与单纯肥胖组之间无显著性差异。 (2 )高血压合并肥胖、高血压非肥胖、单纯肥胖组ISI(绝对值 ) ,IS AUC均显著高于正常组 ,高血压合并肥胖组IS AUC ,ISI显著高于高血压非肥胖和单纯肥胖组 (P <0 0 1) ,高血压非肥胖组与单纯肥胖组之间无显著性差异。 (3)高血压合并肥胖、高血压非肥胖和肥胖组中具     

血管紧张素原基因和血管紧张素转换酶基因多态性与高血压

目的　研究中国人群中血管紧张素原 (AGT)基因单核苷酸多态性 (SNP)及血管紧张素转换酶 (ACE)基因插入 /缺失多态与高血压病的关系。方法　在 3 4 5例高血压病患者与 2 0 6名血压正常人中采用PCR RFLP法检测AGT基因A 2 0C ,A 6G和M 2 3 5T的多态性 ,用PCR法检测ACE基因 16内含子Alu片段插入 /缺失多态 ,同时用EM算法进行两位点连锁不平衡分析。结果　在M 2 3 5T和A 2 0C ,M 2 3 5T和A 6G ,A 2 0C和A 6G位点观察到了连锁不平衡 (P <10 - 4)。病例 对照检验显示T2 3 5等位基因频率在高血压组中高于对照组 ,且高血压病患者中ACE (DD +ID) +AGT TT2 3 5基因型频率高于对照组。结论　受检人群中AGT基因各多态频率处于两两连锁不平衡 ,但AGT基因即T2 3 5位点以隐性作用方式与高血压关联 ,T2 3 5等位基因与ACE D等位基因在高血压病发生中具协同作用     

ACE基因多态性及MYBPC3突变与高血压左室肥厚的关系

目的探讨血管紧张素转换酶(ACE)基因多态性与肌球蛋白结合蛋白C(MYBPC3)基因突变联合作用和高血压左室肥厚(LVH)的关系。方法随机选取118例高血压LVH患者、238例高血压非LVH患者及104例血压正常对照者,行病例-对照研究。超声心动图测量和计算左室重量指数(LVMI);聚合酶链反应(PCR)、限制性片段长度多态性(RFLP)检测ACE/ID多态性;双脱氧末端测序方法检测MYBPC3基因突变。结果高血压LVH组ACE基因DD型频率显著高于高血压非LVH组和正常对照组(χ2=13.10,P<0.01);MYBPC3基因未发现突变。结论 ACE基因多态性与高血压LVH形成有关,DD基因型易发生LVH;MYBPC3基因突变与高血压LVH无明显关系;ACE基因DD型与MYBPC3基因间不存在联合作用。     

血管紧张素转换酶基因多态性与2型糖尿病并发高血压的相关性研究

目的 :研究血管紧张素转换酶 (ACE)基因多态性与 2型糖尿病并发高血压的关系。方法 :应用 PCR方法分析 149例 2型糖尿病患者及正常对照者的 ACE基因型。结果 :1ACE基因型及等位基因构成比 ,正常对照组与 2型糖尿病组无显著性差异 ;2并发高血压组 DD型及 D等位基因频率显著高于无高血压组 (P <0 .0 5 )。结论 :ACE基因 I/ D多态性与 2型糖尿病并发高血压有关。     

氯沙坦逆转高血压病人左心室肥厚与血管紧张素转化酶基因多态性的关系

目的 为了探讨血管紧张素转化酶(ACE)基因多态性与高血压左室肥厚(LVH)的关系。方法 利用外周血白细胞抽提基因组DNA、体外PCR基因扩增的方法检测68例高血压LVH患者ACE基因第16内含子、长度为287bp的片段插入／缺失(I／D)多态性，并将患者分为DD、ID、II三种基因型。观测给予口服氯沙坦(50mg～100mg／d、部分病例加用氢氯噻嗪12．5mg～25mg／d)20周前后患者坐位收缩压(SBP)、舒张压(DBP)、超声心动图左房内径(LAD)、舒张末期室间隔厚度(IVST)、左室后壁厚度(PWT)、左室舒张末期内径(LVDd)及左室重量指数(LVMI)的变化。结果 (1)68例高血压LVH患者中，ACE基因DD型17例(25％)、ID型22例(32％)、II型29例(43％)，D和I等位基因频率分别为0．41和0．59。(2)所有患者口服氯沙坦20周后，SBP、DBP明显下降；但其它观测指标却因基因型不同而呈现不同的变化。LVMI的下降幅度，DD型为7．4％，ID型为5．2％，II型为2．3％，DD型与ID型、II型相比，有显著性差异。结论 (1)ACE基因I／D多态性可能与高血压LVH有关，ACE基因DD型可能是高血压LVH的独立危险因子。(2)氯沙坦可以显著降低高血压LVH患者的血压、逆转LVH，且以ACE基因DD型效果较好(与ID型、II型相比)。     

血管紧张素转换酶基因多态性与非杓型高血压的关系

目的研究血管紧张素转换酶 ( ACE)基因插入 /缺失 ( I/ D)多态性与非杓型高血压 ( EH)的关系。方法　 1应用聚合酶链反应 ( PCR)方法扩增 5 0例正常人、99例高血压患者的 ACE基因上 2 87bp片段 ,根据插入 ( I)或 /缺失( D)来判断其多态性。 2高血压患者行 2 4h动态血压监测 ( ABPM) ,根据 ABPM结果分为杓型 EH组和非杓型 EH组。结果　 1非杓型组与健康对照组相比 ,其 D等位基因及 DD基因型显著升高。 2非杓型组与杓型组相比 ,其 D等位基因及 DD基因型显著升高。3杓型组与健康对照组相比 ,ACE基因型和等位基因频率无显著性差异。结论　ACE基因多态性与非杓型高血压有关联性 ,DD基因型提示可能与高血压昼夜节律改变有关     

缺失型血管紧张素转换酶基因与心肌梗死患者血浆载脂蛋白E水平的关系

目的 :探讨缺失型血管紧张素转换酶 (ACE)基因与心肌梗死患者血浆载脂蛋白 E(apo E)浓度间的关系。方法 :用免疫比浊法测定 5 5例陈旧性心肌梗死 (OMI)患者及 47例对照者血浆 apo E浓度。用 PCR法检测ACE基因缺失 (D) /插入 (I)多态性。结果 :OMI患者血浆 apo E浓度为 (5 2 .1± 14.6 ) m g/ L ,显著高于对照组(41.2± 17.2 ) mg/ L (P <0 .0 5 )。 OMI组 ACE DD(5 1.2± 14.7) m g/ L、DI(5 4.7± 12 .1) mg/ L、II(5 9.0± 2 6 .0 )m g/ L基因型间血浆 apo E水平无显著性差异 (P >0 .0 5 )。 ACE DD基因型频率及 D等位基因频率与对照组比较无显著性差异 (P>0 .0 5 )。结论 :缺失型 ACE基因可能与 OMI患者血浆 apo E水平无相关关系     

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.