扩张型心肌病心肌纤维化血清指标观察

目的 :观察原发性扩张型心肌病 (DCM )患者心肌纤维化血清学指标变化及血浆血管紧张素Ⅱ (AngⅡ )和醛固酮 (ALD)浓度 ,探讨心肌纤维化机制。方法 :采用放射免疫方法测定 35例原发性DCM和 2 4例正常对照者血清中Ⅲ型前胶原 (PCⅢ )、层粘连蛋白 (LN)、透明质酸 (HA)及血浆AngⅡ和ALD含量 ,将AngⅡ、ALD分别与PCⅢ、LN、HA进行相关分析。 结果 :原发性DCM血清PCⅢ、LN、HA及血浆AngⅡ、ALD浓度明显增高 ,AngⅡ、ALD分别与PCⅢ、LN、HA密切相关。结论 :原发性DCM存在不同程度心肌纤维化 ,血清中PCⅢ、LN、HA含量可间接反应心肌纤维化程度 ,AngⅡ、ALD在心肌纤维化过程中起着重要作用。     

血清透明质酸、Ⅲ型前胶原氨基端肽及层黏蛋白与老年慢性心力衰竭心肌纤维化相关性研究

目的 分析老年慢性心力衰竭(CHF)患者血清透明质酸(HA)Ⅲ型前胶原肽(PCⅢP)及层黏连蛋白(LN)与CHF及其心肌纤维化的关系.方法 采用放射免疫平衡法检测老年CHF组患者39例(心功能Ⅱ级14例,Ⅲ级21例,Ⅳ级4例,纽约心脏病学会分级法NYHA)及老年心功能Ⅰ级组(NYHA)46例血清HA,PCⅢP及LN浓度.结果 血清HA,PCⅢP及LN浓度分别为CHF组(359.75±84.59),(77.88±24.67),(86.73±23.90)μg/L;心功能Ⅰ级组(211.60±54.80),(64.82±23.99),(82.26±23.98)μg/L.与心功能Ⅰ级组比较,CHF组HA浓度显著增加(P＜0.05);两组间PCⅢP及LN浓度差异不显著(P＞0.05).结论 血清HA浓度升高可提示老年CHF及其心肌纤维化.     

老年陈旧性心肌梗死患者组织纤维化血清指标的观察

目的　通过对老年陈旧性心肌梗死 (MI)患者组织纤维化血清指标变化的观察 ,探讨将其作为反映MI患者心肌纤维化过程指标的临床应用价值。方法　测定MI患者 38例 ,心绞痛 (AP)患者 32例及健康老年人 (对照组 ) 34名的血清Ⅰ型前胶原 (PCⅠ )、Ⅲ型前胶原 (PCⅢ )、层粘连蛋白 (LN)和透明质酸 (HA)水平。结果　 (1)MI组的血清PCⅠ、PCⅢ、LN和HA水平较AP组和对照组显著升高 ;(2 )血清中PCⅠ、PCⅢ、LN和HA各值之间呈正相关 ;(3)MI组中的 2个以上部位的MI较单个部位MI的血清PCⅠ、PCⅢ和LN水平显著升高 ;(4 )多因素分析显示 ,MI组中PCⅠ、PCⅢ、LN、HA与左室舒张末期内径、MI部位及病程、<40 %左心室射血分数 (EF)值相关。结论　血清PCⅠ、PCⅢ和LN和HA均可作为MI患者心脏组织纤维化过程的监测指标 ,可为临床评估MI累及的范围、预后、心功能及了解MI的纤维化过程提供间接依据。     

血管紧张素转换酶抑制剂及螺内酯对扩张型心肌病心肌纤维化及心功能的影响

目的评价血管紧张素转换酶抑制剂培多普利(商品名:雅思达)及螺内酯逆转原发性扩张型心肌病(DCM)心肌纤维化及改善心功能的作用.方法采用放射免疫方法测定24例正常对照者及原发性DCM应用培多普利及螺内酯治疗前后心肌纤维化指标:血清Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸(HA),同时测定血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)浓度,采用超声方法测定左室射血分数(LVEF).结果原发生DCM PCⅢ、LN、HA明显升高,血浆AngⅡ、ALD活性增强,使用培多普利和螺内酯治疗6个月后PCⅢ、LN、HA显著下降,AngⅡ、ALD活性减低,心功能明显改善.结论原发性DCM存在不同程度心肌纤维化.血管紧张素换酶抑制剂及螺内脂通过抑制AngⅡ、ALD逆转心肌纤维化,明显改善心功能.     

扩张型心肌病中嗜铬粒蛋白A的表达及其与心肌纤维化的关系

目的 观察嗜铬粒蛋白A(chromogranin A,CGA)在扩张型心肌病(dilated cardiomyopathy,DCM)患者中的表达、心肌纤维化程度及二者间的关系,初步探讨CGA在心肌纤维化进程中的作用.方法 取DCM心脏移植患者的心肌组织标本作为研究对象,排除心脏疾病的脑外伤尸检心肌组织标本作为对照.利用实时荧光定量聚合酶链反应(real-time PCR)检测心肌中CGA及Ⅰ型胶原纤维(COL Ⅰ)、Ⅲ型胶原纤维(COL Ⅲ)、ADAMTS-1的mRNA表达,并分析其基因学相关性.免疫组织化学技术鉴定心肌中CGA的分布位置及其表达强弱变化.运用苦味酸天狼猩红特异染色和偏振光显微镜显像,并辅以图像分析软件计算心肌胶原容积积分(CVF).并对CGA与心肌纤维化的相关性进行形态学上的比较.结果 real-time PCR证实心肌中CGA-mRNA和COL Ⅰ-mRNA、COLⅢ-mRNA、ADAMTS-1-mRNA三者均具有相关性,相关系数分别为0.729、0.95、0.665.免疫组织化学结果表明,DCM患者心肌中CGA表达增加(P<0.05).DCM患者心肌CVF高于正常心肌(P<0.001).形态学上,CGA呈现阳性的部位及其分布密集区域的附近,心肌纤维化明显.结论 DCM心肌中CGA的表达与心肌纤维化具有相关性,推测DCM患者心肌组织中CGA的表达水平影响着心肌纤维化的发展.     

心力衰竭患者脑钠肽变化与间质胶原及心功能的关系

目的 探讨心力衰竭患者B型脑钠肽(BNP)的变化及其与间质胶原及心功能的关系.方法 选取心力衰竭患者47例(风湿性心脏病20例,扩张性心脏病7例,先天性心脏病20例)和5例正常心肌标本作对照,应用病理染色结合图像分析,RT-PCR测定心肌胶原容积分数(CVF)、BNP mRNA表达水平、超声心动图测量左室舒张末内径(LEVDD);免疫荧光法测定血浆BNP的含量,并和CVF及LEVDD作相关分析.结果 心力衰竭患者心肌间质CVF明显高于正常对照组(P<0.01);心力衰竭患者心肌BNP mRNA表达水平较正常心肌明显增高(P<0.01);心力衰竭患者血浆中BNP的含量明显增高,心功能分级越高其升高越显著(P<0.01).血浆BNP水平与CVF及LEVDD呈显著正相关(r分别为0.67、0.59,P<0.01).结论 心力衰竭患者血清BNP 含量增高并能反应心肌纤维化和心功能降低程度,快速检查血浆BNP可以用来评估病情并反映预后.     

老年高血压左心室肥厚患者心肌胶原纤维的病理改变特点

目的观察老年高血压左心室肥厚(LVH)患者心肌胶原纤维的病理改变特点。方法从解放军总医院1954年3月～2001年2月的3520例连续尸体解剖标本中,选取年龄≥65岁的126例的心脏标本,并依据诊断分为高血压组101例,其中LVH 0级15例,LVHⅠ级36例,LVHⅡ级28例,LVHⅢ级22例;对照组25例,对2组标本进行HE、苦味酸天狼星红和Ⅰ、Ⅲ型胶原纤维免疫组织化学染色,运用光镜和偏振光观察胶原纤维的分布特点,采用全自动图像分析计算心肌间质胶原容积分数(CVF)、Ⅰ型CVF和Ⅲ型CVF及Ⅰ型/Ⅲ型比值。结果与对照组比较,高血压组LVH 0级心肌胶原纤维无明显改变(P>0.05);与LVH 0级比较,高血压组LVHⅠ级患者心肌CVF、Ⅰ型CVF显著增高(P<0.01),而Ⅲ型CVF、Ⅰ型/Ⅲ型比值无明显改变(P>0.05);高血压组LVHⅡ级和LVHⅢ级患者心肌各项指标均显著增高(P<0.01)。结论随着高血压LVH程度的加重,Ⅰ型CVF明显升高,提示舒张功能受损愈重。     

慢性乙型肝炎患者血清中HA、LN、PCⅢ的含量与肝纤维化程度的关系探讨

目的 观察分析慢性乙型肝炎患者血清中的细胞外基质(ECM)HA、LN、PCⅢ的含量与肝纤维化程度的关系,以寻求肝纤维化的诊断指标。方法 采用放射免疫分析法(RIA)测定30例正常对照、45例慢性乙肝及10例肝硬化患者血清中HA、LN、PCⅢ的含量。同时进行肝活检。结果 慢性乙型肝炎轻、中、重度及肝硬化患者血清HA、LN、PCⅢ水平均不同程度高于对照组(P<0.01或P<0.05),并且随着肝损伤程度的加重逐渐升高,与肝纤维化程度呈正相关关系(P<0.01);结论 慢性乙型肝炎患者血清中HA、LN、PCⅢ水平与肝纤维化发生发展密切相关,对血清中HA、LN、PCⅢ水平同时测定,可作为诊断肝纤维化的血清学指标。     

沙坦类药物的降压外作用:抗纤维化与促肌细胞生成(待续)

问:在高血压病人左心室肥厚过程中,心肌纤维化起什么作用? 答:高血压病人左室肥厚过程中,可见左心室广泛的间质纤维增加,特别在血管周围纤维沉着.胶原占心肌细胞中视野的百分数,即胶原容积分数(CVF)增加.心肌中成纤维细胞与肌纤维母细胞合成Ⅰ、Ⅲ型胶原增多.基质金属蛋白酶分解的作用减少.     

冠状动脉支架置入术对老年冠心病患者心肌纤维化和左心功能的影响

目的 比较老年冠心病患者行冠状动脉支架置入术前、术后心肌纤维化的程度及左心功能的变化. 方法 经冠状动脉造影证实为单支血管病变的冠心病老年患者121例,在心肌梗死溶栓试验(TIMI)血流分级、症状及心肌流量储备分数(FFR)综合指导下行冠状动脉支架置入术,术后12个月复查冠状动脉造影,采用酶联免疫吸附法(ELISA)测定并比较患者术前、术后3个月、12个月血清Ⅰ型前胶原(PC I)、Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)、透明质酸(HA)以及醛固酮(ALD)水平的变化;左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、血浆N末端B型脑钠肽前体(NT-proBNP)水平及6 min步行试验(6 MWD)改善情况;并对FFR与PCⅢ、PCⅢ,NT-proBNP、ALD与PC I、PCⅢ、LN、HA进行相关性分析. 结果 患者支架置入术均成功,术后12个月复查冠状动脉造影,6例患者置入支架内或其他大血管存在不同程度狭窄,FFR为0.56～0.82;术后3个月血清PC Ⅰ、PCⅢ、LN、HA、ALD水平和LVEDD及NT-proBNP较术前降低(均P＜0.05),术后12个月更显著(P＜0.01);FFR与PCⅢ呈负相关(r=-0.67,P＜0.01);PCⅢ与NT-proBNP和ALD与PC Ⅰ、PCⅢ、LN、HA均呈正相关(r值分别为0.67、0.52、0.55、0.46、0.51,均P＜0.01).结论 老年冠心病患者在TIMI分级、症状及FFR综合指导下行单支冠状动脉支架置入术,能减轻心肌纤维化,改善心功能,提高生活质量.     

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.