阻塞性睡眠呼吸暂停综合征患者的心率变异性分析

目的:分析阻塞性睡眠呼吸暂停综合征(OSAS)患者的心率变异性(HRV),探讨阻塞性睡眠呼吸暂停对HRV的影响。 方法:对118例鼾症患者行多导睡眠图监测,根据呼吸紊乱指数(AHI)分为OSAS组(AHI≥5,n=56)与非OSAS组(AHI<5,n=62),分别观察两组患者觉醒期及睡眠期的心率变异性指标,包括:正常RR间期平均值及其标准差值(SDNN)、正常RR间期差值均方根(rMSSD)、低频峰(LF,0.04-0.10 Hz)、高频峰(HF,>0.15 Hz)、总频谱(TP,0-0.4 Hz)。 结果:OSAS组觉醒期与睡眠期各项指标均低于同期非OSAS组,均有显著差异(P<0.05-0.01),非OSAS组组内比较觉醒期与睡眠期的各指标差异有显著性(P<0.05-0.01)。 结论:OSAS对心率变异性有较大影响,且在睡眠的不同阶段有着不均衡的影响,这可能是OSAS患者发生恶性心律失常等严重心脏事件甚至猝死的重要原因,应予以积极防治及进一步研究。     

STOP-Bang问卷及Epworth嗜睡评分预测OSAHS及与睡眠相关性研究

目的探讨STOP-Bang问卷(SBQ)和Epworth嗜睡评分(ESS)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断和评估睡眠质量中的价值。方法以51名鼾症患者为研究对象,行整夜多导睡眠监测前接受SBQ和ESS评估。结果 (1)单纯鼾症组与OSAHS组SBQ、ESS,非快动眼睡眠(Ⅰ期、Ⅱ期、Ⅲ+Ⅳ期)及快动眼睡眠(REM)、觉醒次数和微觉醒指数比较差异显著(P0.05)。(2)SBQ≥3分筛查OSAHS灵敏度、特异度分别为89.50%、30.80%;ESS≥9分筛查OSAHS灵敏度、特异度分别为78.90%、69.20%;SBQ≥3与ESS≥9筛查OSAHS的差异有统计学意义(χ~2=7.513,P=0.006)。(3)SBQ与呼吸暂停/低通气指数(AHI)、Ⅱ期睡眠、觉醒次数、微觉醒指数正相关(P0.05),与Ⅲ+Ⅳ期睡眠(%)和REM睡眠(%)负相关(P0.05)。ESS与AHI、Ⅰ期睡眠、Ⅱ期睡眠、觉醒次数、微觉醒指数正相关(P0.05),与Ⅲ+Ⅳ期睡眠(%)和REM睡眠(%)负相关(P0.05)。结论 SBQ与ESS均能预测OSAHS、评估OSAHS睡眠质量,两者联合使用优于单一量表。     

阻塞性睡眠呼吸暂停综合征心率变异性变化

目的探讨阻塞性睡眠呼吸暂停综合征的患者HRV参数的变化及临床意义。方法将48名阻塞性睡眠呼吸暂停综合征患者与健康对照组进行比较分析。结果阻塞性睡眠呼吸暂停综合征患者的HRV的各项参数与正常对照组存在显著差异(P<0.05)。结论阻塞性睡眠呼吸暂停综合征患者表现的夜间交感神经功能亢进、迷走神经功能受抑制,可作为阻塞性睡眠呼吸暂停综合征的筛选工具。     

室性期前收缩频率在患有阻塞性睡眠呼吸暂停综合征的冠心病患者中的临床意义

目的:分析室性期前收缩(VPC)频率及交感活性在患有阻塞性睡眠呼吸暂停综合征(OSAS)的冠心病患者中的意义.方法:125例患有OSAS的冠心病患者,均行多导睡眠图检查,将患者按呼吸暂停低通气指数(AHI)进行分组,睡眠阶段分为清醒组、S1、S2、S34及快速眼球运动时相(REM).并对患者心率震荡参数进行测量对比.结...     

高血压合并阻塞性睡眠呼吸暂停综合征患者的代谢特点

目的 探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者的代谢特点.方法随机选择住院的原发性高血压(EH)患者550例,其中男418例,女132例,根据睡眠呼吸暂停及呼吸紊乱指数(AHI)分成4组:单纯EH组94例(Ⅰ组),轻度OSAS+EH组157例(Ⅱ组),中度OSAS+ EH组126例(Ⅲ组),重度OSAS+...     

糖耐量减低与阻塞性睡眠呼吸暂停综合征关系的分析

目的探讨糖耐量减低与阻塞性睡眠呼吸暂停综合征(OSAS)的关系。方法测定并分析82例OSAS患者中43例糖耐量减低(IGT)患者(IGT组)和39例非IGT患者(非IGT组)的睡眠呼吸监测指标和体重指数(BMI),探讨糖耐量减低与阻塞性睡眠呼吸暂停综合征的相关性。结果IGT组的睡眠呼吸暂停低通气指数(AHI)低于非IGT组;最低脉氧饱和度(Lspo2)低于非IGT组;IGT组的体重指数明显高于非IGT组。结论糖耐量减低与阻塞性睡眠呼吸暂停综合征关系密切。     

室性期前收缩频率在阻塞性睡眠呼吸暂停的冠心病者中的临床意义

目的 评价室性期前收缩(VPC)频率及交感活性在惠有阻塞性睡眠呼吸暂停综合征(OSAS)的冠心病患者中的意义.方法 125例中有OSAS的冠心病患者,均行多导睡眠图检查,将患者按AHI值进行分组.睡眠阶段分为清醒组、S1、S2、S34及REM.并对患者心率震荡(HRT)参数进行测量对比.结果 VPC频率受睡眠阶段(清醒期、S2及REM,F=5.8,P<0.005)及AHI(F=8.7,P<0.005)影响;在严重OSAS患者,REM期VPC频率较清醒期为高(P=0.011),相反,中等OSAS患者VPC频率较低,且没有睡眠阶段依赖性(P=0.19).氧失饱和持续间期与AHI成正相关(r2=0.71,P<0.001),且在REM期较非REM期为长(P<0.0001),在REM期HRT参数TS与氧失饱和持续间期成负相关(r2=0.06,P=0.014).结论 REM期高VPC频率可能是阻塞性睡眠呼吸暂停综合症患者夜间高死亡率的原因之一.     

OSAHS患者持续智能型气道正压通气的疗效评估

目的使用多导睡眠监测(Polysomnography,PSG)评估智能型气道正压通气(APAP)治疗阻塞性睡眠呼吸暂停综合征(OSAS)的综合疗效。方法分析60例重度OSAS患者使用APAP治疗前后的PSG资料。结果经APAP治疗后,呼吸睡眠暂停低通气指数(AHI),呼吸暂停指数(AI)、低通气指数(HI)、最长呼吸暂停/低通气时间以及平均呼吸暂停/低通气时间显著下降(P均0.01);最低指脉氧饱和度(SPO_2)显著升高(P0.01);睡眠效率显著改善,N3期占总睡眠时间比显著升高,睡中觉醒信号显著下降(P均0.01),睡眠结构趋于合理;ESS评分由16±3降低至4±4(P0.01),症状改善率达91%以上。结论 APAP是一种安全、有效治疗OSAS患者的措施,其不仅改善了OSAS患者的AHI,还改善了睡眠质量和症状。     

阻塞性睡眠呼吸暂停综合征患者的心率变异性

阻塞性睡眠呼吸暂停综合征(OSAS)对心率变异性(HRV)有较大影响,动态心电图的HRV时域、频域指标分析显示OSAS患者自主神经功能受损,具有潜在致死性危险。OSAS的HRV改变可能是OSAS患者血压、心功能甚至恶性心律失常及猝死的重要原因。     

高血压合并阻塞性睡眠呼吸暂停综合征患者昼夜血压的变化

目的研究轻中度高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者昼夜血压变化的特点。方法入选心功能(NHYA)Ⅰ级的轻中度高血压患者177例,经多导睡眠呼吸监测后,按睡眠呼吸暂停指数分为4组,单纯高血压组(A组)42例,高血压合并轻度OSAS组(B组)66例,高血压合并中度OSAS组(C组)25例和高血压合并重度OSAS组(D组)44例,进行24 h动态血压监测。结果 D组患者昼间和夜间血压水平明显高于A组(P<0.05,P<0.01),与A组比较,B、C和D组夜间舒张压显著升高(P<0.05,P<0.01)。夜间低血氧水平与醒时、醒后舒张压、昼间、夜间收缩压和舒张压呈负相关(P<0.05)。结论轻中度高血压合并OSAS患者的夜间舒张压更高,合并重度OSAS的高血压患者全天血压水平均明显高于单纯高血压患者,血压升高幅度与夜间低氧血症程度呈负相关。     

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.