糖尿病神经病变患者单核细胞TOLL样受体4的表达及其与血浆肿瘤坏死因子α、白介素6的相关性研究

目的研究T2DM伴糖尿病神经病变患者外周血单核细胞TOLL样受体4(TLR4)的表达及其与促炎因子TNF-α、IL-6的相关性。方法将研究对象分为正常组(NC,n=44),T2DM组(n=44),T2DM神经病变组(n=44)。分离和提取外周血单核细胞,流式细胞术和RT-PCR检测单核细胞表面TLR4蛋白和mRNA;ELISA检测血浆TNF-α和IL-6。结果 T2DM神经病变组HbA_1 c[(9.09±-1.62)%vs(8.36土1.10)%vs(5.30±0.89)%]、单核细胞TLR4蛋白[(42.02±9.69)%vs(31.27±6.87)%vs(11.96±5.54)%]和TLR4 mRNA[(2.98±1.06)vs(1.74±0.47)vs(1.12±0.52)]、血浆TNF-α[(8.75±3.14)vs(6.27土3.64)vs(3.19±1.17)Pg/m1]、IL-6[(3.63±1.81)vs(2.60±1.14)vs(1.54±0.58)pg/ml]水平均高于T2DM和NC组(P0.01);T2DM神经病变组TLR4蛋白与TNF-α、IL-6呈正相关(r=0.631,P0.0001;r=0.447,P=0.0023)。结论糖尿病神经病变患者单核细胞TLR4参与机体炎症反应,与糖尿病神经病变的发生发展密切相关。     

Meprin-α调控T细胞激活介导动脉粥样硬化形成的研究

目的探讨小鼠血浆中T细胞激活在Meprin-α介导动脉粥样硬化形成中的作用及其机制。方法选择6周龄载脂蛋白E-/-小鼠30只,随机分为模型组、L-MeplA组和对照组,每组10只,高脂喂食,并于第10周末分别给予PBS、L-MeplA病毒和对照病毒质粒。HE染色检测小鼠主动脉粥样硬化斑块生成情况,流式细胞术检测小鼠外周血T细胞亚群比例,酶联免疫吸附法检测小鼠血浆炎性因子的分泌。结果与模型组比较,L-MeplA组动脉粥样硬化斑块面积和CD3、CD4T细胞比例显著增高,白细胞介素(IL)-6、IFN-γ水平显著增高[(41.3±6.8)pg/ml vs(20.2±4.1)pg/ml,(30.3±4.2)pg/ml vs(11.3±2.1)pg/ml,P0.05]。而模型组与对照组动脉粥样硬化斑块面积,CD3、CD4T细胞比例,IL-4、IL-5、IL-10和转化生长因子β比较,差异无统计学意义(P0.05)。结论Meprin-α介导动脉粥样硬化形成的作用与免疫功能失调有关,Meprin-α可通过介导1型辅助性T细胞激活进而加速炎性反应,最终导致动脉粥样硬化形成。     

运动对糖尿病动脉粥样硬化大鼠Toll样受体促炎通路的影响

目的研究不同运动量对糖尿病动脉粥样硬化大鼠主动脉组织Toll样受体2(TLR2)、TLR4及白细胞介素6(IL-6)、核转录因子κB(NF-κB)表达的影响。方法将100只SD大鼠随机分为对照组(n=20)和糖尿病动脉粥样硬化组(n=80)。对照组予普通饲料喂养,糖尿病动脉粥样硬化组予高糖高脂喂养后腹腔注射STZ(30mg/kg)建立糖尿病动脉粥样硬化模型,后再随机分为模型亚组及小、中、大运动量亚组,对后3亚组进行游泳运动干预。干预后采用ELISA测定各组血浆IL-6、NF-κB的浓度及采用Western blott测定主动脉组织中TLR2、TLR4的表达。结果运动前,模型亚组血浆IL-6[(58.06±5.38)vs(14.21±4.04)ng/ml]、NF-κB[(154.24±9.24)vs(65.99±8.63)ng/ml]较对照组升高(P0.01);各运动亚组运动干预后血浆IL-6、NF-κB较运动前下降(P0.01)。模型亚组主动脉组织中TLR2[(1.19±0.04)vs(0.57±0.04)]、TLR4蛋白表达[(1.25±0.05)vs(0.68±0.06)]较对照组升高(P0.01);运动干预的各亚组运动后主动脉组织中TLR2、TLR4较模型亚组降低,以中、大运动量亚组下降明显(P0.01或P0.05)。结论糖尿病动脉粥样硬化大鼠动脉组织TLR2、TLR4蛋白表达及血浆IL-6、NF-κB增高,运动可以改善上述与促炎通路有关的因素。     

探讨帕金森病患者血液及脑脊液相关炎性因子的临床意义

目的探讨帕金森病(PD)患者血液及脑脊液中相关的炎性因子水平变化的临床意义。方法选取2011年3月~2014年3月神经内科收治的PD患者50例为PD组,同期选择50例健康人群为对照组,分别抽取血液和脑脊液,检测白细胞介素(IL)-6、IL-1β和TNF-α、IFN-γ水平变化。结果 PD组患者血清IL-1β[(19.35±7.91)mg/L vs(1.99±2.81)mg/L]、IL-6[(279.58±68.51)mg/L vs(25.43±18.29)mg/L]、TNF-α[(376.81±79.28)mg/L vs(159.53±121.57)mg/L]明显高于对照组,差异有统计学意义(P0.05)。2组脑脊液中上述炎性因子水平比较,差异无统计学意义(P0.05)。PD组不同病程和严重程度患者IL-1β比较,差异无统计学意义(P0.05)。结论PD患者血液中炎性因子可能参与了疾病的发生和进展,炎性因子水平与病情及病程并无明显的相关性。     

阿托伐他汀钙联合缬沙坦对原发性高血压血清炎性因子水平及血管内皮功能的影响

目的研究阿托伐他汀钙联合缬沙坦对原发性高血压血清炎性因子水平及血管内皮功能的影响。方法选取2014年3月—2015年3月我院接诊的90例原发性高血压病人为观察对象。对照组采用缬沙坦治疗,观察组采用阿托伐他汀钙联合缬沙坦治疗。观察两组治疗前后血清炎性因子白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(Hs-CRP),血管内皮功能内皮素-1(ET)、一氧化氮(NO)、血管扩张率(FMD),收缩压、舒张压等治疗疗效。结果治疗后,观察组IL-6、TNF-α、hs-CRP低于对照组[(4.90±0.92)ng/L vs(9.38±2.01)ng/L、(13.28±2.03)ng/mL vs(15.33±2.17)ng/mL、(2.66±0.68)mg/L vs(6.35±1.50)mg/L](P0.05);观察组ET低于对照组,NO、FMD高于对照组(56.27±7.10)ng/L vs(69.72±9.50)ng/L、(20.26±2.01)μmol/L vs(17.94±1.89)μmol/L、(13.37±0.62)%vs(10.16±0.92)%(P0.05);观察组收缩压、舒张压低于对照组[(81.39±5.86)mmHg vs(89.27±6.03)mmHg、(118.30±16.37)mmHg vs(132.03±18.52)mmHg](P0.05);观察组总有效率优于对照组95.55%(43/45)vs 77.77%(35/45,P0.05)。结论阿托伐他汀钙联合缬沙坦治疗原发性高血压疗效显著,能够有效降低炎性因子水平,调节血管内皮功能。     

生长素对载脂蛋白E基因敲除小鼠动脉粥样硬化斑块与炎症因子的影响

目的观察生长素对载脂蛋白E基因敲除(ApoE~(-/-))小鼠血浆白细胞介素8(IL-8)、单核细胞趋化因子1(MCP-1)、肿瘤坏死因子α(TNF-α)水平和血管壁核转录因子κBp65(NFκBp65)表达及动脉粥样斑块的影响。方法8周龄雄性ApoE~(-/-)小鼠12只饲以西方类型膳食12周建立动脉粥样硬化模型,遗传背景相同的6只8周龄雄性C57BL/6J小鼠饲以同类型膳食作对照。第8周时模型组分为腹腔内注射生长素(100μg/kg)组(n=6)和注射生理盐水(0.1mL)组(n=6),C57BL/6J小鼠亦给予生理盐水(0.1mL)腹腔内注射。第12周时眼眶取血,分离血浆,酶联免疫吸附试验(ELISA)法检测IL-8、MCP-1、TNF-α水平。取小鼠主动脉进行苏丹Ⅳ染色,观察主动脉粥样硬化病变面积占主动脉内膜面积的比例,行主动脉窦HE及油红O染色,观察主动脉窦动脉粥样斑块面积占管腔总面积的比例,行主动脉免疫组化染色,观察NFκBp65的表达。结果与C57BL/6J小鼠比较,ApoE~(-/-)小鼠和ApoE~(-/-)+生长素小鼠总胆固醇和低密度脂蛋白胆固醇高[(6.7±0.5),(7.6±2.0)比(5.5±0.2)mmol/L,(5.6±0.3),(6.0±0.5)比(2.2±0.1)mmol/L,均P0.05],ApoE~(-/-)+生长素小鼠高密度脂蛋白胆固醇比ApoE~(-/-)组高[(0.5±0.1)比(0.3±0.1)mmol/L,P0.05]。与C57BL/6J小鼠比较,ApoE~(-/-)小鼠主动脉粥样硬化病变面积占主动脉内膜面积比例增加[(15.1±1.7)%比0],ApoE~(-/-)+生长素小鼠主动脉粥样病变面积占主动脉内膜面积比例较ApoE~(-/-)小鼠降低[(10.1±0.5)%比(15.1±1.7)%,P0.05];C56BL/6J小鼠主动脉窦无动脉斑块形成(0%),ApoE~(-/-)组和ApoE~(-/-)+生长素组均有动脉斑块形成,但ApoE~(-/-)+生长素组小鼠主动脉窦斑块面积占管腔总面积的比例较ApoE~(-/-)组低[(22.6±2.2)%比(32.4±3.2)%,P0.01]。ApoE~(-/-)小鼠TNF-α、IL-8和MCP-1水平较C57BL/6J小鼠增高[分别为(24.5±1.7)比(10.1±0.5)ng/L,(33.5±16.7)比(16.8±8.8)ng/L,(78.0±5.6)比(13.5±1.8)ng/L;均P0.05],ApoE~(-/-)+生长素组TNF-α、IL-8和MCP-1水平较ApoE~(-/-)组降低[分别为(15.5±1.0)比(24.5±1.7)ng/L,(22.0±1.2)比(33.5±16.7)ng/L,(45.5±4.5)比(78.0±5.6)ng/L;均P0.05]。ApoE~(-/-)小鼠血管壁NF-κBp65表达较C57BL/6J增高,ApoE~(-/-)小鼠+生长素组血管壁NF-κBp65表达较ApoE~(-/-)小鼠组降低(P0.05)。结论生长素通过抑制炎症反应减少ApoE~(-/-)小鼠动脉粥样斑块形成。     

辛伐他汀减轻载脂蛋白E~(-/-)小鼠氧化应激及小窝蛋白1的表达

背景氧化应激损伤内皮是动脉粥样硬化的始动因素,他汀对于动脉粥样硬化的干预主要集中在粥样硬化斑块形成之后,而对于粥样硬化斑块形成之前的研究较少。目的观察辛伐他汀对载脂蛋白(apo)E~(-/-)小鼠氧化应激及主动脉内皮小窝蛋白l的影响,探讨辛伐他汀在动脉粥样硬化一级预防中保护内皮功能的机制。方法24只6周龄雄性 apoE~(-/-)小鼠,随机等分为两组:对照组、辛伐他汀[5 mg/(kg·d)]治疗组,4周后处死动物。常规生物化学法测定血总胆固醇(TC)、超氧化物歧化酶活性(SOD)、丙二醛(MDA)和血清一氧化氮(N0)含量。采用苏木素伊红(HE)染色法观察小鼠主动脉内皮组织,免疫组织化学法分析小鼠主动脉内皮的小窝蛋白1的表达。结果两组间血脂水平无显著性差异。辛伐他汀治疗组主动脉内皮组织的损伤减轻(损伤阳性率33.3%比对照组:75%,P<0.05)。治疗4周后,辛伐他汀治疗组 SOD[(135.3±5.5)U/L 比对照组:(97.2±7.6)U/L,P<0.01)和 NO[(28.4±4.1)μmol/L 比对照组:(12.3±2.1)μmol/L,P<0.01]均明显升高,MDA 显著减低[(10.5±...     

糖尿病周围神经病变与炎性因子的相关性分析

目的探讨糖尿病周围神经病变(DPN)与hsC-RP、TNF-α、IL-6、IL-10的相关性。方法选取2016年11月至2018年6月于武汉市中心医院内分泌科住院治疗的T2DM患者217例,分为合并DPN组(DPN,n=75)及单纯T2DM组(T2DM,n=142),比较两组各项临床指标及炎性因子水平,分析炎性因子和神经传导速度及波幅的相关性。将DPN组分为痛性DPN亚组(n=46)和非痛性DPN亚组(n=29),分析疼痛评分和炎性因子的相关性及痛性DPN发生的危险因素。结果 DPN组病程、HbA1c、FPG、TNF-α、hsC-RP及IL-6水平均高于T2DM组,IL-10低于T2DM组(P0. 05或P0. 01)。Pearson相关性分析显示,TNF-α、IL-6分别与胫神经运动传导速度(mNCV)及波幅(CMAP)、腓浅神经感觉传导速度(sNCV)及波幅(SNAP)呈负相关(r=-0. 599、-0. 624、-0. 483、-0. 555、-0. 570、-0. 493、-0. 495、-0. 491,P0. 05或P0. 01)。多元线性回归分析显示,胫神经mNCV的影响因素为IL-6、TNF-α及hsC-RP(β=-2. 261、-0. 324、-0. 696,P0. 05);胫神经CMAP的影响因素为IL-6、年龄(β=-1. 201、-0. 020,P0. 01);腓浅神经s NCV的影响因素为TNF-α、HbA1c(β=-0. 671、-0. 385,P0. 01);腓浅神经SNAP的影响因素为TNF-α、IL6、HbA1c及糖尿病病程(β=-0. 154、-0. 645、-0. 117、-0. 038,P0. 05)。痛性DPN亚组IL-6、TNF-α水平高于非痛性DPN亚组[(2. 26±0. 59)vs(1. 93±0. 53)pg/ml、TNF-α(11. 38±2. 95)vs(9. 53±1. 88)pg/ml,P0. 05]。Logistic回归分析显示,TNF-α及IL-6是痛性DPN的危险因素(OR=1. 368、5. 042,P0. 01)。结论炎性因子和DPN的发生密切相关,IL-6及TNF-α水平升高与痛性DPN的发生相关。     

糖尿病患者颈动脉粥样硬化斑块高分辨磁共振成像研究

目的探讨糖尿病患者与糖代谢正常者颈动脉粥样硬化斑块的差异。方法选取糖尿病患者30例作为糖尿病组,糖代谢正常者28例作为糖代谢正常组,进行颈动脉3.0T MR高分辨扫描,依据MR图像,比较2组间斑块成分和颈动脉形态学指标的差异。结果糖尿病组颈动脉形成动脉粥样硬化斑块49支,糖代谢正常组47支,糖尿病组斑块内钙化(83.67%vs 55.32%,P=0.002)及薄/破裂纤维帽(67.35%vs 42.55%,P=0.015)的发生率明显高于糖代谢正常组;糖尿病组与糖代谢正常组斑块内出血(36.73%vs 44.68%,P=0.428)和富含脂质坏死核(85.71%vs 80.85%,P=0.523)比较,差异无统计学意义。糖尿病组在斑块最厚层面的管壁厚度高于糖代谢正常组,差异有统计学意义[(4.31±1.59)mmvs(4.01±1.62)mm,P=0.017];糖尿病组与糖代谢正常组血管总面积[(72.55±30.17)mm2 vs(81.54±34.15)mm2,P=0.432]和管壁标准化指数[(0.72±0.13)vs(0.66±0.15),P=0.255]比较,差异无统计学意义。结论糖尿病患者颈动脉动脉粥样硬化斑块的稳定性较糖代谢正常者差。     

高通量血液透析对老年尿毒症患者营养、免疫及炎症状态的影响

目的探讨高通量血液透析(HFHD)对老年尿毒症患者营养状况、免疫指标及白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平的影响。方法选取2014年1月至2017年12月北京航天总医院肾内科行血液透析的老年尿毒症患者112例,随机分为对照组(n=56)和观察组(n=56)。对照组采取常规的血液透析治疗,而观察组采取HFHD,均治疗6个月。分别于治疗前和治疗后6个月检测2组患者的血红蛋白(Hb)、血浆总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、免疫球蛋白A(IgA)、IgM、IgG、C3、C4、血钙、血磷、甲状旁腺激素(PTH)、β_2-微球蛋白(β_2-MG)、IL-6、IL-8、TNF-α及CRP水平变化,分析2组患者治疗前后的营养状况、钙磷代谢、免疫指标及炎症状态。采用SPSS 22.0统计软件进行数据处理。根据数据类型,组间比较采用t检验或χ2检验。结果治疗后,观察组患者的Hb[(136.28±14.25)vs(98.53±12.26)g/L]、TP[(69.85±6.12)vs(62.37±5.50)g/L]、Alb[(37.92±3.80)vs(31.65±3.37)g/L]、PA[(312.70±63.28)vs(242.18±46.27)mg/L]、IgA[(1.97±0.43)vs(1.58±0.30)g/L]、IgM[(1.53±0.26)vs(1.16±0.18)g/L]、IgG[(10.92±2.17)vs(9.35±1.60)g/L]、C3[(1.26±0.18)vs(1.05±0.15)g/L]及C4[(0.82±0.11)vs(0.54±0.07)g/L]水平均显著高于对照组(P0.05),而血磷[(1.84±0.31)vs(3.20±0.56)mmol/L]、PTH[(60.54±3.38)vs(107.43±7.56)mmol/L]、β_2-MG[(9.13±2.28)vs(20.82±3.27)mg/L]、IL-6[(197.42±40.63)vs(324.73±52.14)ng/L]、IL-8[(194.25±20.83)vs(237.15±28.60)ng/L]、TNF-α[(385.20±63.57)vs(468.37±71.40)ng/L]及CRP[(5.12±1.38)vs(6.30±1.54)mg/L]水平均显著低于对照组(P0.05)。结论 HFHD可有效改善老年尿毒症患者的免疫功能及营养状态,且能降低血清炎性因子水平。     

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.