罗格列酮治疗非糖尿病患者不稳定型心绞痛的疗效及其对血浆内皮素的影响

目的 探讨罗格列酮治疗非糖尿病患者不稳定型心绞痛(UAP)的临床疗效及其对患者血浆内皮素的影响.方法 将90例UAP患者随机分成两组,观察罗格列酮治疗前后临床症状、心电图及血浆内皮素(ET)水平的变化,同时观察罗格列酮对UAP患者复发率、心肌梗死(心梗)的发生率和死亡率的影响.结果 用药14天后,治疗组和对照组的临床疗效和心电图疗效总有效率间比较差异无显著性(P>0.05).应用罗格列酮14天、30天和180天后TNF-α和ET水平均较治疗前明显降低(P<0.05),对照组TNF-α和ET水平变化比较差异无显著性(P>0.05);用药14天,治疗组UAP的复发率、心梗的发生率和死亡率与对照组比较差异无显著性(P>0.05),但30天和180天后两组比较差异有显著性(P<0.05).结论 罗格列酮可降低UAP患者的血浆内皮素水平,对UAP患者具有较好的保护作用,并有助于改善UAP患者恢复期的病情.     

3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂对老年原发性高血压患者血管内皮功能的影响

目的探讨3-羟基-3-甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂对老年原发性高血压患者血管内皮功能的影响.方法采用随机对照方法,观察66例老年原发性高血压患者(治疗组)经普伐他汀(pravastatin)10mg每日1次治疗12周后血浆内皮素(ET)、一氧化氮(NO)水平的变化,并与40例安慰剂组和15例正常血压组对照.结果治疗组和安慰剂组患者血浆ET水平明显高于正常血压组,血浆NO水平则较正常血压组显著降低.治疗组血浆ET水平治疗后较治疗前平均降低26.7%,有显著性差异(P＜0.05),而NO水平比治疗前平均上升248.3%,有非常显著性差异(P＜0.001);不同低密度脂蛋白胆固醇(LDL-C)水平的原发性高血压患者治疗后血浆ET和NO水平的变化无显著性差异(P＞0.05).结论提示普伐他汀可能具有改善老年原发性高血压患者血浆ET和NO异常,保护血管内皮功能的作用,且其对ET和NO的影响与LDL-C水平无关.     

盐酸苯那普利对充血性心力衰竭患者内皮素、血管紧张素Ⅱ及一氧化氮的影响

目的　探讨充血性心力衰竭患者内皮素 (ET -1)、血管紧张素Ⅱ (AngⅡ )及一氧化氮 (NO)的变化及盐酸苯那普利对其影响。方法　采用随机双盲法对 6 0例心力衰竭患者口服盐酸苯那普利 (苯那普利组 30例 )和安慰剂组 (安慰剂组 30例 )治疗 12周。观察治疗前、后的血浆ET - 1、AngⅡ、NO水平及心功能的变化。结果　充血性心力衰竭患者血浆ET - 1、AngⅡ及NO水平较对照组显著升高 (P <0 0 1) ,经盐酸苯那普利治疗后血浆ET - 1、AngⅡ及NO水平明显降低 (P <0 0 1) ,而安慰剂组无明显变化 ,左室射血分数 (LVEF)显著增加 (P <0 0 1)。结论　血浆ET - 1、AngⅡ及NO水平升高是充血性心力衰竭患者重要的病理特征之一。经盐酸苯那普利治疗后 ,充血性心力衰竭患者心功能明显改善 ,其机制可能与保护内皮细胞功能有关     

高血压合并糖耐量减低患者C反应蛋白、内皮素、一氧化氮水平的变化及意义

目的观察原发性高血压(EH)合并糖耐量减低(IGT)患者C反应蛋白(CRP)、内皮素(ET)、一氧化氮(NO)水平变化,探讨EH合并IGT与CRP、ET、NO的关系。方法纳入EH患者82例,其中合并IGT 42例,糖耐量正常(NGT)者40例;非EH者80例,其中IGT 40例,NGT 40例。CRP测定采用免疫比浊法,ET测定用放射免疫法,NO测定用硝酸还原法。结果 EH组CRP和ET水平高于非EH组(均P<0.05);EH组NO水平低于非EH组(P<0.05)。高血压或非高血压者中,IGT人群血浆CRP和ET水平均高于NGT人群,NO水平均低于NGT人群。多因素Logistic回归分析,EH合并IGT与CRP、空腹血糖、ET、餐后2 h血糖、胆固醇、胰岛素抵抗指数、收缩压、舒张压呈正相关;与NO呈负相关(均P<0.05)。结论 EH合并IGT患者CRP、ET水平增高,NO水平降低。提示EH合并IGT患者体内炎症水平、血管内皮细胞功能的损伤进一步增高。     

磺酰脲类药物合用马来酸罗格列酮治疗2型糖尿病的有效性和安全性观察--随机、双盲、对照、平行、多中心临床试验

背景 本试验是中国患者在服用磺酰脲类药物的基础上,加服马来酸罗格列酮治疗2型糖尿病的首次大型临床试验。方法 患者在服用磺酰脲类药物基础上,随机接受马来酸罗格列酮4mg(2mgbid)或8mg(4 mg bid)或安慰剂对照治疗24周。其中,34％患者合并使用格列苯脲,25％的患者合并使用格列吡嗪。治疗24周后,观察患者HbA_(1c)、空腹血浆血糖(FPC)和血浆胰岛素浓度的变化情况。结果530例患者随机进入治疗(平均年龄为59岁,其中45％患者为男性,55％患者为女性),105人进入磺酰脲类药物合用安慰剂组(安慰剂组),215人进入罗格列酮4mg合用磺酰脲类药物组(R4+su组),210人进入罗格列酮8mg合用磺酰脲类药物治疗组(R8+SU组)。与安慰剂组对照相比,R4+SU组和R8+SU组平均HbA_(1c)值分别下降1.04％和1.44％(均P<0.001),FPG分别下降1.2mmol/L和2.0mmol/L(均P<0.001)。R4+SU组和R8+SU组治疗24周后,血中胰岛素水平较基线值分别下降23.3pmol/L和30.4pmol/L(均P<0.001)。尽管本试验入选人群中56％患者基线时的肝炎血清学检查结果为阳性,但试验中无明显肝毒性反应。血常规、血生化及心电图各项观察指标均无明显改变。结论 罗格列酮合用磺酰脲类药物能明显改善中国2型糖尿病患者的血糖控制水平。乙型和丙型肝炎血清学阳性的患者,对罗格列酮     

非洛地平对原发性高血压患者血浆一氧化氮和内皮素含量的影响

目的探讨原发性高血压(EH)患者血浆一氧化氮(NO)和内皮素(ET)含量的变化及非洛地平对其的影响。方法观察72例EH患者(EH组)非洛地平治疗前后血浆NO和ET水平的变化,并与30例正常人(对照组)进行对比分析。结果非洛地平治疗前EH组血浆NO明显低于对照组(P<0.01),血浆ET明显高于对照组(P<0.01)。非洛地平治疗6周后,EH组血压和血浆ET水平明显降低,NO水平明显增高(P<0.01)。结论非洛地平在有效降血压的同时,能使EH患者血浆NO水平升高,ET水平降低,因此对血管内皮功能具有保护作用。     

针刺、穴注对偏头痛大鼠血浆ET、6-K-PGF1α、TXB2和脑组织NO含量的影响

目的 通过观察针刺、针刺+穴位注射对偏头痛模型大鼠血浆内皮素(ET)、6-酮-前列环素F1α(6K-PGF1α)、血栓素B2(TXB2)和脑组织一氧化氮(NO)含量的影响,探讨针刺、针刺+穴位注射治疗偏头痛的可能作用机制.方法 以皮下注射硝酸甘油的方法复制的偏头痛大鼠模型为研究对象,观察针刺、针刺+穴位注射治疗前后大鼠的行为学变化及大鼠血浆ET、6-K-PGF1α和TXB2及脑组织NO含量的变化.结果 与正常组相比,模型组大鼠血浆ET、TXB2含量明显降低,6-K-PGF1α、NO水平明显升高(P＜0.05);与模型组相比,各治疗组大鼠血浆ET、TXB2水平明显升高(P＜0.05),6-K-PGF1α、NO水平明显降低(P＜0.05).结论 针刺、穴注能明显改善偏头痛大鼠的行为学特征,缓解偏头痛发作,其可能机制是通过调节ET、6-K-PGF1α、TXB2和NO的释放,有效改善脑血管舒缩功能障碍,从而使偏头痛得以缓解;针刺配合穴位注射有一定的协同作用,提示临床应用时联合应用效果可能更佳.     

阿卡波糖对糖耐量减低患者血浆内皮素、一氧化氮、C反应蛋白的影响

目的观察糖耐量减低患者应用阿卡波糖治疗前后血浆内皮素、一氧化氮、C反应蛋白水平变化。方法口服75g葡萄糖耐量试验筛查出糖耐量减低患者61例，随机分为阿卡波糖组（n=34）和安慰剂组（n=27），并对其进行为期15周的随机、双盲、安慰剂对照、阿卡波糖干预治疗试验。试验前后观察两组血浆内皮素、一氧化氮、C反应蛋白变化情况。结果糖耐量减低患者应用阿卡波糖治疗15周后。血浆内皮素、C反应蛋白显著下降，一氧化氮上升，而安慰剂组三者均无显著性改变。结论糖耐量减低患者应用阿卡波糖治疗后其血浆内皮素、一氧化氮、C反应蛋白水平可显著改善。     

益智醒脑丸对中风先兆病人血浆内皮素和一氧化氮的影响

目的观察益智醒脑丸对中风先兆病人的血浆内皮素(ET)、一氧化氮(NO)的影响.方法240例中风先兆病人随机分为益智醒脑丸组(治疗组)和阿司匹林组(对照组),观察治疗前后两组病人血浆ET、NO的变化,并观察其临床疗效.结果治疗组有效率(97.30%)明显优于对照组(72.57%),两组比较有统计学意义(P＜0.01).益智醒脑丸与阿司匹林比较可明显改善中风先兆病人血浆ET、NO水平(P＜0.01).结论益智醒脑丸能够改善中风先兆病人血浆ET、NO水平,可用于防治中风先兆.     

胰岛素联合罗格列酮治疗对糖尿病患者血浆醛固酮的作用

目的 通过比较糖尿病患者胰岛素联合罗格列酮治疗前后血浆醛固酮水平的变化,探讨罗格列酮导致水肿的机制.方法 2型糖尿病患者单独使用胰岛素治疗半年以上的患者随机分为两组,罗格列酮联合胰岛素治疗组在目前胰岛素治疗基础上加用罗格列酮4mg/日(n=10),胰岛素组继续胰岛素治疗(n=10).分别于治疗前、治疗后2、4、6个月测定立位血浆醛固酮水平,监测患者水肿情况及体重.结果 罗格列酮可以导致水肿、体重增加.罗格列酮联合胰岛素治疗组血浆醛固酮水平2个月时较对照组有升高的趋势(P＞0.05);治疗4个月时显著高于对照组(P＜0.05);至6个月时罗格列酮联合胰岛素治疗组血浆醛固酮水平较前下降,与胰岛素组无统计学差异(P＞0.05).结论 罗格列酮治疗早期出现的水肿可能与血浆醛固酮水平升高有关.     

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.