冠心病合并糖尿病患者血清超敏C反应蛋白水平与冠脉病变特点关系分析

目的探讨冠心病合并2型糖尿病患者冠状动脉病变与血清超敏C反应蛋白（hs—CRP）的相关性。方法经冠状动脉造影确诊冠心病患者，并根据既往或入院后OGTT试验结果分为合并2型糖尿病组和非糖尿病组，检测其hs-CRP、血糖、血脂水平及平均动脉压，并对合并2型糖尿病组冠状动脉病变程度与hs—CRP、血糖、血脂水平、平均动脉压、性别及吸烟史等因素作Logistic回归分析。结果冠心病合并2型糖尿病组hs—CRP水平及冠脉病变程度明显高于非糖尿病组（均P〈0.05）。Spearman秩相关分析表明，冠心病合并2型糖尿病组及非糖尿病组hs-CRP水平与冠状动脉病变支数均呈正相关（无糖尿病组r=0．827，P〈0．01；合并糖尿病组r=0．897，P〈0．01）。Logistic回归分析表明，年龄、吸烟史、hs—CRP、血糖、低密度脂蛋白及总胆固醇等是冠心病合并2型糖尿病患者冠脉病变严重程度的危险因素（均P〈0．05），且hs—CRP是其中最重要的危险因素；而性别、甘油三酯、高密度脂蛋白及平均动脉压不是冠心病合并2型糖尿病患者冠脉病变严重程度的危险因素（均P〉0．05）。结论冠心病合并2型糖尿病组炎症反应水平明显强于非糖尿病组，且患者炎症反应水平与冠脉损伤正相关；糖尿病可能通过炎症反应促进冠心病的发生及发展。监测冠心病合并2型糖尿病患者血清hs—CRP水平，对预测其冠状动脉粥样硬化病变的严重程度有一定意义。     

血清抵抗素水平与动脉粥样硬化的相关性研究

目的探讨血清抵抗素与动脉粥样硬化的关系及其可能在糖尿病大血管并发症中所起的作用。方法病例选自2004年9月至2005年3月北京军区总医院的行冠状动脉造影的患者共88例,分为单纯冠心病组、糖尿病合并冠心病组、单纯糖尿病组以及正常对照组。受试者空腹采血,行生化检查及血清抵抗素、高敏C反应蛋白(hs-CRP)、可溶性肿瘤坏死因子受体2(sTNF-R2)的测定。结果各组患者血清抵抗素以及hs-CRP、sTNF-R2均高于正常对照组(P<0·05);抵抗素与sTNF-R2呈正相关(r=0·24,P=0·025),而与hs-CRP无显著相关性(P=0·613);多元回归分析显示,性别(b=0·194,P=0·029)及冠状动脉病变支数(b=0·155,P=0·001)是影响血清抵抗素水平的因素;随着冠脉病变支数的增加,血清抵抗素呈增高的趋势(P=0·004)。结论冠心病患者,特别是糖尿病合并冠心病患者,血清抵抗素水平增高;冠脉病变支数是影响血清抵抗素的重要因素;血清抵抗素水平与炎症标志呈正相关,提示抵抗素可能作为炎症因子在动脉粥样硬化以及糖尿病大血管并发症的发病机制中发挥作用。     

老年和中青年急性冠脉综合征血高敏C反应蛋白浓度的变化

目的：比较炎症标志物血高敏C反应蛋白（hs—CRP）浓度在老年和中青年急性冠脉综合征（ACS）患者中的变化。方法：对124例经冠状动脉造影明确冠心病的患者测定hs—CRP,并对其在老年和中青年ACS中的变化进行比较。结果：（1）老年和中青年ACS患者的hs—CRP浓度高于非ACS患者（P〈0．05）;（2）在老年组,hs—CRP水平在冠脉1、2、3支病变组的差异不显著;但在中青年组．冠脉2、3支病变组的hs-CRP水平显著高于单支病变组（P〈0．05）;（3）年龄与hs—CRP水平不相关（r=0．02,P〉0．05）。结论：急性冠脉综合征hs—CRP水平显著升高。中青年急性冠脉综合征患者的hs—CRP水平与冠脉病变支数有关。     

脂蛋白(a)及高敏C-反应蛋白与冠状动脉狭窄病变的相关研究

目的探讨脂蛋白（a）[Lp（a）]、高敏C-反应蛋白（hs—CRP）与冠状动脉（冠脉）狭窄的相关性。方法480例怀疑患有冠心病的患者在冠状动脉造影术前测定血清LD（a）和hs—CRP，冠脉病变的范围用冠脉病变的血管支数表示。结果①冠脉狭窄病变组351例，对照组129例。冠脉狭窄病变组患者的血清Lp（a）和hs—CRP水平分别为（129．18±2．21）mg／L和（1．68±3．40）mg／L，对照组分别为（50．18±1．84）mg／L和（0．81±2．86）mg／L，冠脉狭窄病变组患者的血清Lp（a）和hs—CRP水平均显著高于对照组（P〈0．01）。②单支病变组133例，双支病变组118例，三支病变组100例。单支病变组Lp（a）和hs—CRP水平分别为（116．90±2．15）mg／L和（1．54±3．24）mg／L，双支病变组分别为（128．77±2．16）mg／L和（1．89±3．14）mg／L，三支病变组分别为（148．15±2．31）mg／L和（1．99±3．95）mg／L。单支、双支及三支病变组LD（a）及hs—CRP均显著高于对照组（P〈0．01）。③Logistic回归分析结果显示，Lp（a）〉300mg／L者，发生冠心病的危险性增加（OR为1．025，95％CI：1．018～1．032，P〈0．001）；hs—CRP〉3．00mg／L者，发生冠心病的危险性增加（OR为1．281，95％CI：1．120～1．465，P〈0．001）。④Lp（a）与hs—CRP之间呈正相关（r=0．172，P〈0．01）。结论血清Lp（a）和hs—CRP水平与冠脉狭窄病变密切相关，均是冠心病的独立危险因素。     

初诊2型糖尿病颈动脉内膜中层厚度、胰岛素抵抗及高敏C反应蛋白之间的关系

新诊断2型糖尿病76例，按照有无颈动脉内膜中层厚度（IMT）增厚分成增厚组39例和无增厚组37例；另取正常健康者32例作对照组。分别测定三组IMT、高敏C反应蛋白（hs—CRP）、胰岛素抵抗指数（IRI）进行分析比较。结果IMT增厚组和无增厚组hs—CRP水平高于正常对照组（P均〈0．05）；IMT增厚组IRI高于无增厚组和对照组（P〈0．05）。初诊2型糖尿病颈动脉IMT与IR／、hs—CRP呈正相关（r=0．451，0．057；P均〈0．01）。认为颈动脉IMT的增厚提示糖尿病患者存在胰岛素抵抗；hs—CRP水平的升高是患者动脉粥样硬化程度加重的危险因素。     

老年血清β2微球蛋白及C反应蛋白与冠状动脉病变的相关性研究

目的 探讨老年冠心病患者血清β2微球蛋白（β2-MG）及C反应蛋白（CRP）水平与冠状动脉粥样硬化病变程度和范围的关系。方法 选择162例行冠状动脉造影检查的患者，将其分为4组，用放射免疫分析法和免疫散射比浊法检测血清β2-MG、CRP水平，老年冠心病组按冠状动脉病变支数及狭窄程度进一步分组，比较各组血清β2-MG、CRP水平的差异及与冠状动脉病变程度的相关性。结果 无论老年组或非老年组，冠心病患者血清β2-MG及CRP水平均明显高于健康对照组（P〈0．01）；在老年冠心病组中，冠状动脉病变支数越多，血清β2-MG、CRP水平越高，以3支病变组升高最明显，与1支病变组比较均有显著性差异（P〈0．05）；冠状动脉病变愈严重，血清β2-MG、CRP水平愈高，以3组升高最明显，与1组比较均有显著性差异（P〈0．05）；血清β2-MG、CRP水平与冠状动脉狭窄程度呈正相关，相关系数分别为0．512（P〈0．01）和0．416（P〈0、01）。结论 老年冠心痛患者血清β2-MG及CRP水平与冠状动脉硬化范围及严重程度均呈正相关关系，可能均是冠心病的独立危险因素。     

Slox-1、hs—CRP在急性冠脉综合征中的表达及意义

目的探讨Slox-1、hs—CRP在急性冠脉综合征（ACS）患者血清中的变化及Slox-1与斑块不稳定性的关系。方法将137例患者随机分为4组：急性心肌梗死（AMI）组30例,不稳定型心绞痛（uA）组52例,稳定型心绞痛（SAP）组25例,对照组30例。采用ELISA法检测患者血清中的Slox-1、hs—CRP、cTNI、CK—MB水平。结果AMI组和UA组外周血清Slox-1、hs—CRP水平明显高于SAP组和对照组（P〈0．01或〈0．05）。Slox-1与hs—CRP呈正相关（r=0．364,P〈0．01）。结论ACS患者中血清Slox-1水平明显升高,Slox-1与动脉粥样硬化斑块不稳定性有关,参与了ACS的发病。     

ACS患者血清高敏C反应蛋白水平变化及意义

目的观察急性冠脉综合征（ACS）患者高敏c反应蛋白（hs．CRP）水平变化,并探讨其意义。方法采用酶联免疫吸附法检测60例ACS患者[不稳定型心绞痛32例（UAP组）,急性心肌梗死患者（AMI组）28例]和36例健康人（对照组）血清中的hs—CRP、血脂和心肌酶。结果血清hs．CRP水平UAP组、AMI组均显著高于对照组（P〈0．01）,AMI组高于UAP组（P〈0．05）;ACS患者hs—CRP水平与LDL-C呈正相关（r=0．460）,与HDL-C水平呈负相关（r=-0．350,P〈0．05）,与CK、CK-MB呈正相关（r分别为0．0．53、0．51,P〈0．05）。结论ACS患者血清hs-CRP升高,可作为诊断ACS及判断病情的指标。     

冠心病患者血清脑钠肽、胆红素和高敏C反应蛋白水平及意义

目的探讨血清脑钠肽（BNP）、胆红素（BIL）和高敏C反应蛋白（hs—CRP）水平对冠心病（CAD）的诊断和评估病变严重程度的临床意义。方法将126例患者根据冠状动脉造影（CAG）结果分为CAD组与非CAD组（对照组）。CAD组再按照冠状动脉病变的范围分为单支病变、双支病变和多支病变三个亚组。根据CAG结果计算冠脉指数。同时测定每位患者的BNP、BIL和hs—CRP水平，并结合CAG结果进行统计学分析。结果与对照组比较，CAD组血清BNP、hs—CRP显著升高，总胆红素（TBIL）和间接胆红素（IBIL）显著降低，直接胆红素（DBIL）变化不明显。随冠脉病变支数增多，血清BNP、hs—CRP水平明显升高，血清BIL水平明显降低。多元线性相关分析显示血清BNP、hs—CRP水平与冠脉病变程度呈正相关，而血清TBIL、IBIL水平与冠脉病变程度呈负相关。结论血清BNP、hs-CRP水平升高和BIL水平降低对冠心病的诊断和冠脉病变严重程度的判定具有重要的临床意义。     

C-反应蛋白与冠心病关系的研究

目的：探讨高敏C-反应蛋白（hs—CRP）水平与冠状动脉疾病的关系。方法：对经冠状动脉造影确诊或有明确心肌梗塞的冠心病患者82例和同期经冠状动脉造影证实冠状动脉无狭窄的正常对照者43例进行对照研究。所有研究对象在入院初或病情稳定48h后采清晨空腹静脉血，应用微粒子增强透射免疫分析法测定血浆hs—CRP水平。结果：冠心病组的血浆hs—CRP水平显著高于对照组（P〈0．001）；在冠心病组中，急性冠脉综合征（ACS）组（42例）的hs—CRP水平显著高于稳定型心绞痛（SAP）组（40例）（P〈0．001），SAP组的hs—CRP水平也显著高于对照组（P〈0.01）。单支病变（19例）、双支病变（23例）、三支及左主干病变（30例）组的hs—CRP水平均显著高于对照组（P分别〈0.01，〈0.001和〈0.001）。以人群血浆hs—CRP水平的第90分位值3mg／L为截点，将冠心病组中行冠脉造影的对象分为低hs—CRP水平组和高hs—CRP水平组，可见后者多支病变（包括双支病变和三支及左主干病变）的例数（n=36）显著多于前者（n=17）（P〈0．05）。结论：高敏C-反应蛋白水平可反映冠状动脉疾病及其病变的严重程度。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.