青少年高血压与代谢综合征的危险因素

目的 探讨青少年高血压与代谢综合征(MS)各组分之间的关系及其危险因素分析.方法 通过分层整群随机抽样,共抽取12～18岁青少年3953人,以12～15岁为青春前期(n=1698),16～18岁为青春期(n=2255),测量身高、体质量、腰围、臀围、血压、空腹血糖(FPG)、三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平.结果 1)总调查人群中高血压患病率为6.2%.2)13～18岁超重肥胖者血压高于体质量正常者(P＜0.05).3)男、女性青春期舒张压(DBP)异常检出率均高于青春期前(P＜0.05),青春期女性收缩压(SBP)异常检出率高于男性(P＜0.05).4)高血压组体质量、体质量指数(BMI)、腰臀比(WHR)、SBP、DBP、FPG、TG及LDL-C均高于正常对照组,HDL-C稍低于对照组(P＜0.05).5)高血压组超重肥胖、高TG、低HDL-C、MS及高血压家族史检出率高于正常对照组(P＜0.05),两组间高FPG、糖尿病家族史检出率差异无统计学意义.6)Logistic多因素回归分析显示,女性高SBP危险性是男性的2.10倍(95% CI为1.47～2.98);年龄每增加1岁,DBP升高的危险性增加1.22倍(95% CI为1.08～1.38);有高血压家族史青少年高SBP的危险性是无家族史的1.64倍(95% CI为1.17～2.30);BMI每增加1 kg/m2,SBP升高的危险性增加1.24倍(95% CI为1.20～1.28),DBP升高的危险性增加1.19倍,(95% CI是1.15～1.23)(P＜0.01).结论 青少年高血压与MS密切相关,家族史、超重肥胖是引发青少年高血压的主要危险因素,要重视青少年心血管疾病的一级预防.     

2型糖尿病家系青少年一级亲属心血管危险因素研究

目的探讨2型糖尿病（T2DM）家族史对青少年心血管危险因素的影响。方法秦皇岛地区12～18岁青少年4023人横断面调查。根据父母有无糖尿病分为糖尿病家族史阳性组（FH＋）和阴性组（FH-）。测量腰围（WC）、血压、FPG、血脂,计算BMI。结果（1）FH＋组腰围、FPG、TC和LDL-C均高于FH-组（P〈0.05）,超重/肥胖、高SBP、高FPG检出率高于FH-组（P〈0.05）。（2）校正年龄、性别后FH＋组SBP、FPG升高、超重/肥胖的危险性分别是FH-组的1.54、2.06、1.33倍,95%CI分别是（1.10～2.16）、（1.46～2.89）、（1.12～1.59）,具有2项以上心血管危险因素的危险性是FH-组的1.72倍。结论T2DM患者的青少年一级亲属已存在心血管危险因素增加和聚集。应重视对这一人群进行早期筛查和干预,以减少心血管病的发生。     

有高血压家族史血压正常的青少年心血管危险因素分析

目的 探讨高血压家族史对血压正常青少年心血管危险因素的影响.方法 通过分层整群随机抽样,共抽取13～18岁青少年3874人,血压正常青少年3724例,分为高血压家族史阳性组(FH )(n=1145)和高血压家族史阴性组(FH-)(n=2579).测量身高、体质量、腰围、臀围、血压、空腹血糖(FPG)、血三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平.结果 1)FH 组体质量指数(BMI)、腰围、腰臀比(WHR)、FPG、TC和LDL-C均高于FH-组(PO.05).3)校正年龄和性别后,logistic多因素回归分析显示:FH 青少年具有2项以上心血管危险因素的危险性是FH-青少年的1.7倍(95% CI:1.2～2.2),FH 组男性青少年具有2项以上心血管危险因素的危险性是女性青少年的3.0倍(95%CI:1.8～5.O).结论 原发性高血压患者的一级亲属青少年已存在心血管危险因素增加和聚集.重视对这一人群进行心血管疾病的一级预防,可有效减少心血管疾病及动脉粥样硬化的发生.     

谷氨酰-半胱氨酸连接酶催化亚基C-129T和修饰亚基G-23T多态性与冠心病的关系

目的 探讨谷氨酰-半胱氨酸连接酶催化亚基（GCLC）C-129T多态性和修饰亚基（GCLM）G-23T多态性与冠心病遗传易感性的关系。方法 采用聚合酶链反应-限制性片段长度多态方法,检测212例冠心病与218例对照的GCLCC-129T和GCLMG-23T基因型分布及差异。结果 冠心病组中GCLC-129T等位基因频率显著高于对照组（P〈0．01）,GCLC-129T的冠心病发病风险是-129C的2．38倍（95％CI：1．25～4．54）。与GCLC-129CC基因型相比,GCLC-129CT基因型的冠心病发病风险显著增加至2．14倍（95％CI：1．08～4．24,P〈0．05）,GCLC-129T等位基因携带者（CT、TT基因型）患冠心病的风险显著增加至2．28倍（95％CI：1．16～4．49,P〈0．05）。冠心病组中GCLM-23T等位基因频率显著低于对照组（P〈0．01）,GCLM-23T的冠心病发病风险是．23G的0．59倍（95％CI：0．42～0．82）。与GCLM-23GG基因型相比,GT、Tr基因型和-23T等位基因携带者（GT、Tr基因型）的冠心病发病风险分别为0．71倍（95％CI：0．47～1．08,P〉0．05）、0．18倍（95％CI：0．06～0．55,P〈0．01）和0．61倍（95％CI：0．42～0．92,P〈0．05）。结论 GCLCC-129T多态性可能是冠心病的一个遗传易感因素,而GCLMG-23T多态性可能是冠心病的一个遗传保护因素。     

有2型糖尿病家族史的非肥胖青少年血浆Ghrelin水平变化的影响因素

目的探讨有T2DM家族史且BMI正常的青少年空腹血浆中Ghrelin水平的变化及相关影响因素。方法80名13-15岁BMI正常青少年，根据有无糖尿病家族史分为糖尿病家族史阳性组（FHD＋）和糖尿病家族史阴性组（FHD-）。测量身高、体重及血压，检测FPG、血脂、空腹真胰岛素（FTI）及Ghrelin水平。结果FHD＋组BMI、FPG、FTI和胰岛素抵抗指数（HOMA-IR）高于FHD-组（P〈0．05），空腹Ghrelin水平低于FHD-组（P〈0．01）。Ghrelin与FPG（r=-0．456，P〈0．01），FTI（r=-0．183，P％0．05）和HOMA-IR（r=-0．237，P〈0．01）呈负相关。以Ghrelin为因变量，行多元线性回归显示，FPG（β=-354．435，P〈0．01）和FHD（β=-176．468，P〈0．01）为独立危险因素。结论有T2DM家族史的BMI正常的青少年已存在空腹Ghrelin水平的降低，FPG的升高和糖尿病家族史可能是Ghrelin水平降低的相关因素。     

老年高血压患者降压治疗对脑血液循环影响初探

目的探索老年高血压患者长期降压治疗对脑血液循环的影响。方法采用颈部血管超声测定全脑血流量（CBF）技术,前瞻性随访142例老年高血压患者降压治疗前、治疗后1／2年及1年时血压与血流动力学参数。结果老年高血压患者降压治疗后CBF增高（治疗前616．41±107．96mL／min,疗程1／2年时629．73±103．63mL／min,疗程1年时635．69±106．31mL／min,P〈0．05）,SBP降幅大者治疗后CBF高（疗程1／2年时β0．147,95％,CI0．022～0．272,P=0．021,疗程1年时B0．161,95％CI0．018～0．313,P=0．037）,基础DBP高者治疗后CBF下降风险大（疗程1／2年时0R1．117,95％CI1．001～1．247,P=0．048,疗程1年时0R1．213,95％CI1．028～1．473,P=0．024）。结论老年高血压患者积极降压治疗安全且益丁脑血液循环,但对基础DBP高者需加强监测。     

体质量指数,而不是腰围/身高,与青少年高血压关系最密切

目的 探讨青少年体质量指数(BMI)、腰围/身高(WHtR)与血压关系. 方法 通过分层整群随机抽样,共抽取13～18岁青少年3874人,以BMI及WHtR将人群分为:A组:BMI正常、WHtR＜0.46,(n=3024),B组:BMI正常、WHtR≥0.46,(n=103),C组:BMI达超重肥胖诊断标准、WHtR＜0.46,(n=189),D组:BMI达超重肥胖诊断标准、WHtR≥0.46,(n=558).测量身高、体质量、腰围、收缩压(SBP)、舒张压(DBP)水平. 结果 1)D组SBP和DBP水平明显高于其他3组(P＜0.01),C组SBP与DBP水平高于A组和B组(P＜0.01).A组与B组间比较,差异无统计学意义.2)校正年龄、性别后,与A组相比,logistic回归分析,C组和D组发生高SBP的危险性分别为A组的2.9,7.6倍(95%CI分别是1.49～5.55,5.32～10.81,P＜0.01),D组发生高DBP的危险性是A组的5.39倍(95%CI:3.63～8.01,P＜0.01),C组和D组发生高SBP的危险性分别为是A组的2.4,6.2倍(95%CI分别是1.35～4.17,4.64～8.39,P＜0.01).3)对超重肥胖青少年(C组和D组)行多元线性回归显示,仅BMI为SBP和DBP独立危险因素,而WHtR未被引入方程. 结论 超重肥胖是引发青少年高血压的重要危险因素,BMI,而非腰围/身高,可作为青少年高血压独立预测因素.     

颈动脉硬化及脑梗死与老年人认知功能障碍的相关性研究

目的探讨颈动脉粥样硬化斑块、脑梗死在老年人认知功能障碍发生中的作用。方法选取认知功能障碍患者258例（观察组）及非认知功能障碍患者708例（对照组）,采用头部CT检查脑梗死灶发生情况,采用ATLI-IDI-超9彩色多普勒超声仪确定颈动脉斑块形态、大小。结果观察组有颈动脉斑块及脑梗死者分别为173例（67．05％）和46例（17．83％）,对照组分别为399例（56．36％）和77例（10．88％）,两组比较P〈0．05;有颈动脉斑块者患认知功能障碍的危险性是无颈动脉斑块者的1．58倍（95％CI为1．17～2．13）,有脑梗死者患认知功能障碍的危险性是无脑梗死者的1．78倍（95％CI为1．19～2．64）,同时有颈动脉斑块、脑梗死者患认知功能障碍的危险性是两者均无的2．71倍（95％CI为0．84～3．98）。结论颈动脉粥样硬化斑块、脑梗死均为老年人认知功能障碍的独立危险因素,且两者密切相关。     

体重指数增加是高血压的危险因素

美国学者Gelber等对Physicians’Health Study的13563例无高血压健康人群随访14．5年发现，与体重指数（BMI）〈22．4kg／m^2者相比，BMI分别为22．4～23．6、23．7～24．7、24．8～26．4和〉26．4kg／m^2人群发生高血压的相对危险分别为1．20（95％CI 1．09～1．32）、1．31（95％CI1．19～1．44）、1．56（95％CI1．42～1．72）和1．85（95％CI1．69～2．03）。研究者认为，随着BMI的增加发生高血压的危险也增加，预防超重和肥胖可预防高血压。     

健康入、糖尿病及高血压患者24小时动态血压比较

155例研究对象，分为正常组，糖尿病组高血压组（轻中度）。采用TM-2421动态血压监测仪监测记录24小时ABP。结果：（1）三组ABP均呈勺型变化，糖尿病和高血压组SBP水平显著高于正常组（P〈0．01．P〈0．05）。高血压组DBP水平显著高于正常组和糖尿病组（P〈0．01，或P〈0．05）。余弦法证实三组ABP变化的显著昼夜节律性，糖尿病和高血压组的夜间血压（SBP、DBP）下降率明显低于正常组（P〈0．01，或P〈0．05）。（2）ABP参数：糖尿病和高血压组ABP均值和负荷明显高于正常组（P〈0．01，或P〈0．05）；ABP变异性三组之间无显著性差异；高血压组ABP曲线下面积显著性高于正常组（P〈0．01），与糖尿病组无显著性差别。结论：高血压和临床正常血压的糖尿病患者均出现ABP部分参数与正常对照组的显著性差异。提示：糖尿病患者在临床明确诊断高血压前已发生血压调节的明显改变。     

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.     

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.     

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.     

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.