氟伐他汀对高脂餐后血浆甘油三酯和P-选择素浓度的影响

目的研究高血压病患者高脂餐后血浆P-选择素浓度变化,探讨氟伐他汀、或联合应用缬沙坦对血浆P-选择素浓度的短期影响.方法 33例高血压病患者于禁食12 h后接受高脂餐负荷试验(总热量800 kcal,脂肪50 g),检测空腹和餐后4 h血浆甘油三酯(TG)、总胆固醇、低密度脂蛋白-胆固醇、高密度脂蛋白-胆固醇和P-选择素浓度.所有患者随机分为3组对照组、氟伐他汀组(40 mg/d)和联合用药组(氟伐他汀40 mg/d和缬沙坦80 mg/d),1周后重复高脂餐负荷试验.结果 3组患者具有相似的空腹血脂和P-选择素浓度.33例患者餐后血浆TG和P-选择素浓度较空腹水平明显升高(P<0.05),但3组间无明显差异.餐后血浆TG浓度与餐后血浆P-选择素浓度显著正相关(r=0.427,P<0.05).用药1周后,3组患者的空腹和餐后血浆TG浓度较基础状态无显著变化.对照组餐后血浆P-选择素浓度较空腹水平明显升高(P<0.05);氟伐他汀组与联合用药组能抑制餐后P-选择素升高;联合用药组更能明显地减少空腹血浆P-选择素浓度(P<0.05).血浆P-选择素浓度的变化与治疗前后血浆血脂浓度和血压的变化无明显相关.结论短期内联合应用氟伐他汀和缬沙坦有效降低高血压病患者血浆P-选择素浓度,提示两药联合应用具有良好的协同作用.     

氟伐他汀改善2型糖尿病患者餐后血管炎症反应和纤溶功能

目的探讨极短期氟伐他汀治疗对2型糖尿病患者餐后血浆可溶性P-选择素和纤溶酶原激活物抑制剂1(PAI-1)抗原浓度的影响.方法40例初诊2型糖尿病患者和20例健康人(健康对照组)在禁食12 h后接受高脂餐,检测空腹和餐后4 h血浆PAI-1抗原、可溶性P-选择素和血脂水平.2型糖尿病患者被随机分为两组,分别接受安慰剂(安慰剂组,n=20)和氟伐他汀40 mg/d(氟伐他汀组,n=20)治疗.1周后,再次进行高脂餐负荷试验.结果两组2型糖尿病患者治疗前及治疗1周后和健康对照组餐后4 h较本组同期空腹血浆甘油三酯(TG)浓度比均有显著升高(P＜0.05);两组2型糖尿病患者治疗前餐后4 h血浆TG浓度显著高于健康对照组(P＜0.05).两组2型糖尿病患者治疗前及安慰剂组治疗1周后餐后4 h血浆可溶性P-选择素、PAI-1抗原浓度均较本组同期空腹显著升高(P均＜0.05),均有显著性差异;而氟伐他汀组治疗1周后和健康对照组无显著变化.将治疗前的两组2型糖尿病患者和健康对照组作为一个整体(n=60)进行相关分析,结果显示餐后4 h血浆TG浓度分别与餐后血浆可溶性P-选择素、PAI-1抗原浓度显著正相关.治疗1周后,两组2型糖尿病患者的血脂、血糖水平较治疗前均无显著变化.结论一次性高脂餐导致2型糖尿病患者餐后纤溶功能异常和血管炎症.极短期的氟伐他汀治疗可减轻这种餐后改变.     

氟伐他汀和缬沙坦联合治疗改善原发性高血压患者高脂餐后纤溶功能

目的 观察氟伐他汀和缬沙坦联合治疗对原发性高血压患者高脂餐后血浆纤溶酶原激活物抑制剂1(PAI-1)和组织型纤溶酶原激活剂(t-PA)抗原浓度的即期影响.方法 原发性高血压患者53例随机分成对照组(安慰剂,n=13)、氟伐他汀组(40 mg/d,n=13)、缬沙坦组(80 mg/d,n=14)和联合组(氟伐他汀:40 mg/d 缬沙坦:80 mg/d,n=13)4组治疗1周,禁食12 h后测高脂餐前(空腹,F)、后(4 h,P)的血浆可溶性P选择素、PAI-1和t-PA抗原及血脂浓度.4组分别治疗1周后再重复以上实验1次,并测量4组治疗前、后的血压.结果 高脂餐后血浆三酰甘油(TG)[F:(1.94±0.91)比P:(3.15±1.48)mmol/L]、可溶性P选择素[F:(259.8±124.0)比P:(345.7±138.4)ng/mL]、PAI-1[F:(36.4±13.1)比P:(48.7±18.5)ng/mL]和t-PA抗原[F:(9.6±3.2)比P:(13.5±6.0)ng/mL]浓度升高,差异有非常显著意义.高脂餐后血浆TG浓度分别与高脂餐后可溶性P选择素(r=0.430)、PAI-1抗原(r=0.421)浓度显著相关(P＜0.01).治疗1周后,缬沙坦组和氟伐他汀组的高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较各自空腹水平差异无统计学意义.联合组的空腹和高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较治疗前基础水平显著降低(P＜0.05).联合治疗一周后也明显地抑制了高脂餐后可溶性P选择素、PAI-1与t-PA,虽然仍有轻度增加,但差异无统计学意义(P＞0.05).上述指标的变化发生在血脂变化之前.结论 与氟伐他汀或缬沙坦的单用相比,极短期两药联合应用有效地降低了原发性高血压患者空腹和高脂餐后的血浆PAI-1和t-PA抗原浓度.     

氟伐他汀和缬沙坦联合治疗改善原发性高血压患者高脂餐后纤溶功能

目的观察氟伐他汀和缬沙坦联合治疗对原发性高血压患者高脂餐后血浆纤溶酶原激活物抑制剂1（PAI-1）和组织型纤溶酶原激活剂（t-PA）抗原浓度的即期影响。方法原发性高血压患者53例随机分成对照组（安慰剂n=13）、氟伐他汀组（40mg／d，n=13）、缬沙坦组（80mg／d，n=14）和联合组（氟伐他汀：40mg／d＋缬沙坦：80mg／d，n=13）4组治疗1周，禁食12h后测高脂餐前（空腹，F）、后（4h，P）的血浆可溶性P选择素、PAI-1和t-PA抗原及血脂浓度。4组分别治疗1周后再重复以上实验1次，并测量4组治疗前、后的血压。结果高脂餐后血浆三酰甘油（TG）IF：（1．94&#177;0．91）比P：（3．15&#177;1．48）mmol／L]、可溶性P选择素IF：（259．8&#177;124．0）比P：（345．7&#177;138．4）ng／mL]、PAI-I[F：（36．4&#177;13．1）比P：（48．7&#177;18．5）ng／mL]和t-PA抗原[F：（9．6士3．2）比P：（13．5&#177;6．0）ng／mL]浓度升高，差异有非常显著意义。高脂餐后血浆TG浓度分别与高脂餐后可溶性P选择素（r=0．430）、PAI-1抗原（r=0．421）浓度显著相关（P〈0．01）。治疗1周后，缬沙坦组和氟伐他汀组的高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较各自空腹水平差异无统计学意义。联合组的空腹和高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较治疗前基础水平显著降低（P〈0．05）。联合治疗一周后也明显地抑制了高脂餐后可溶性P选择素、PAI-1与t-PA，虽然仍有轻度增加，但差异无统计学意义（P〉0．05）。上述指标的变化发生在血脂变化之前。结论与氟伐他汀或缬沙坦的单用相比，极短期两药联合应用有效地降低了原发性高血压患者空腹和高脂餐后的血浆PAI-1和t-PA抗原浓度。     

心血管事件高危患者餐后高敏C反应蛋白浓度变化及氟伐他汀干预的影响

目的 研究心血管事件高危患者高脂餐后血浆高敏C-反应蛋白(hsCRP)浓度的变化,探讨极短期氟伐他汀对血浆hsCRP浓度的影响。方法 43例冠心病及其等危症患者随机分为氟伐他汀组(22例)和常规治疗组(21例),分别在常规治疗的基础上加服氟伐他汀(40 mg/d)和安慰剂。治疗前和1周后接受高脂餐负荷试验,检测空腹和餐后4 h血浆hsCRP和血脂水平。结果 两组患者的餐后血浆甘油三酯和hsCRP浓度较空腹水平明显升高(P<0.05)。1周后,常规治疗组的空腹和餐后血浆hsCRP浓度与血脂水平无显著变化;氟伐他汀组的餐后血浆甘油三酯和hsCRP浓度较治疗前显著降低,但血浆hsCRP浓度降低与血脂的变化无显著相关。结论 极短期氟伐他汀治疗有效降低心血管事件高危患者餐后升高的血浆hsCRP浓度。     

高脂血症患者粘附分子水平及调脂干预的研究

目的　观察高脂血症患者可溶性 P-选择素 ( s P- sel)和可溶性细胞间粘附分子 - 1( s ICAM- 1)的表达及阿托伐他汀的调脂干预的作用。方法　用酶联免疫吸附法 ( EL ISA)及放免法检测 32例高脂血症患者 (男 19例 ,女 13例 )服用阿托伐他汀 ( 10 mg/ d,疗程 4～ 6周 )前后血浆 s ICAM- 1和 s P- sel的水平并与性别、年龄相匹配的 30例正常血脂组对照。结果　高脂血症患者血浆 s ICAM- 1和 s P- sel的水平明显高于对照组 ( P<0 .0 1) ;阿托伐他汀治疗 4～ 6周后总胆固醇 ( TC)、甘油三酯 ( TG)、低密度脂蛋白胆固醇 ( L DL - C)、s ICAM- 1和 s P- sel的水平显著下降 ( P<0 .0 1) ;s ICAM- 1和 s P- sel与 TC、L DL- C、TG呈正相关 ( P<0 .0 5 ) ,HDL- C升高不明显。结论　 1)血浆 s ICAM- 1和s P- sel的表达增加推测是高脂血症致动脉粥样硬化的一个重要环节 ;2 )阿托伐他汀降低 s ICAM- 1和 s P- sel水平可能主要是通过调节血脂而产生。     

餐后三酰甘油与炎症反应导致高血压患者高脂餐后纤溶功能紊乱

目的研究高血压患者高脂餐后血浆高敏C反应蛋白(hsCRP)、纤溶酶原激活物抑制剂1(PAI-1)和组织型纤溶酶原激活剂(t-PA)抗原的浓度变化。方法空腹胆固醇水平正常的高血压患者54例和健康对照者30例于禁食12h后接受高脂餐负荷试验,检测空腹(F)和餐后4h(P)血浆hsCRP、PAI-1、t-PA抗原以及三酰甘油(TG)、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇的浓度。结果餐后血浆TG浓度在两组受试者均高于空腹水平,但高血压患者餐后TG浓度较高[(高血压组:(3.4±1.5)比对照组:(1.7±0.8)mmol/L,P<0.01]。与空腹状态相比,高血压患者餐后log(hsCRP)升高[空腹:(0.32±0.21)比餐后:(0.56±0.31)、血浆PAI-1[空腹:(37.1±14.3)比餐后:(57.5±15.1)μg/L]和t-PA抗原[空腹:(9.0±6.1)比餐后:(15.9±10.0)μg/L]浓度升高(P均<0.01);而对照组无显著变化。将84例受试者作为一个整体,相关分析显示:餐后血浆TG浓度分别与餐后log(hsCRP)(r=0.565,P<0.01)、PAI-1抗原(r=0.332,P<0.05)浓度显著相关。回归分析显示:餐后血浆TG浓度的增长值(r=0.324,P<0.05)和log(hsCRP)的增长值(r=0.386,P<0.01)对餐后血浆PAI-1抗原浓度的增长值有独立和显著的预示价值。结论一次性高脂餐引起的餐后TG增高和炎症反应可促使高血压患者餐后纤溶功能异常。     

苯那普利与氟伐他汀单用及联用对阿霉素肾病大鼠血清脂联素的影响

目的探讨苯那普利与氟伐他汀单用及联用对阿霉素肾病大鼠脂联素的影响。方法雄性SD大鼠120只,适应性饲养2周后,随机抽取18只为正常对照组,另外102只制作阿霉素肾病模型。84只造模成功大鼠随机分为四组:模型组(等容积生理盐水,n=21)、苯那普利组[苯那普利3.5mg/(kg.d),n=21],氟伐他汀组[氟伐他汀10mg/(kg.d),n=21]和苯那普利与氟伐他汀联合治疗组[苯那普利3.5mg/(kg.d)+氟伐他汀10mg/(kg.d),n=21]。分别于2、6及10周末,遵循随机化原则,按n=6分层抽取各组样本,收集24h尿液、血液标本待测。结果与模型组相比,苯那普利组、氟伐他汀组及联合治疗组血清甘油三酯、总胆固醇、脂联素浓度均降低,24h尿蛋白减少;联合治疗组更为明显;相关分析表明,蛋白尿、甘油三酯和总胆固醇分别与血脂联素浓度呈明显正相关关系(P<0.01)。结论苯那普利与氟伐他汀可减轻阿霉素肾病大鼠蛋白尿、降低血清甘油三酯、总胆固醇及脂联素浓度,联用时疗效更明显。提示苯那普利与氟伐他汀至少部分通过降低脂联素水平而减轻肾脏损害。     

缬沙坦联合氟伐他汀治疗高血压并左室肥厚

目的观察缬沙坦联合氟伐他汀的降压效果以及对靶器官的保护作用。方法将86例原发性高血压病并左室肥厚病人随机分为治疗组和对照组,每组各43例。治疗组予缬沙坦加氟伐他汀治疗;对照组予氨氯地平加氟伐他汀治疗,疗程均为6个月,观察两组治疗前后血压、心脏彩超变化。结果治疗组治疗后血压、心脏彩超各指标较治疗前降低(P0.05或P0.01)。结论缬沙坦联用氟伐他汀对高血压病合并左室肥厚病人有明显降压效果,并且可在短期内逆转左室肥厚。     

氟伐他汀加用地尔硫卓对心脏X综合征患者的治疗效果

目的观察地尔硫卓治疗心脏X综合征患者的疗效。方法将47例心脏X综合征患者随机接受氟伐他汀（23例,氟伐他汀组）或氟伐他汀+地尔硫卓（24例,联合用药组）治疗,随访治疗3个月后的临床情况并复查平板运动试验及一氧化氮（NO）、血浆内皮素-1（ET-1）的含量。结果各组用药后平板运动试验到达终点时间均显著延长（氟伐他汀组P<0.05;联合用药组P<0.01）。两组临床胸痛发生率及平板运动试验阳性率均显著降低（均P<0.01）。NO、HDL-C水平明显升高,TC、TG、LDL-C、ET-1水平明显下降。与对照组相比联合用药组平板运动试验中到达运动终点时间显著延长（P<0.05）,临床胸痛发生率显著降低（P<0.05）。结论氟伐他汀能明显改善X综合征患者的内皮细胞功能,加用地尔硫卓更能提高患者的运动耐量及缓解临床症状。     

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.