高血压合并高脂血症对血管早期病变的影响

目的探讨高血压合并高脂血症患者肱踝脉搏波传导速度和踝臂指数的变化及相关影响因素。方法随机入选高血压合并高脂血症患者和单纯高血压患者各400例。检测肱踝脉搏波传导速度、踝臂指数、血糖、甘油三酯、低密度脂蛋白、高密度脂蛋白、总胆固醇等指标,比较两组肱踝脉搏波传导速度和踝臂指数值的差异,对血脂异常进行临床分型,比较各血脂异常亚型之间肱踝脉搏波传导速度值的差异,并对肱踝脉搏波传导速度相关影响因素进行相关分析。结果高血压合并高脂血症组肱踝脉搏波传导速度值(1674.0±13.0 cm/s)较单纯高血压组(1594.0±11.2 cm/s)显著升高(P<0.001);两组间踝臂指数值差异无统计学意义(P=0.897)。高血压病患者中,高甘油三酯血症、高胆固醇血症、混合型血脂异常组肱踝脉搏波传导速度值均显著高于单纯高血压组(P<0.001)。单因素相关分析表明,总胆固醇、低密度脂蛋白、总胆固醇/高密度脂蛋白均与动脉硬度指标肱踝脉搏波传导速度显著相关(P<0.05)。多元线性逐步回归分析结果表明,高血压患者中收缩压、年龄、总胆固醇/高密度脂蛋白、体质指数和空腹血糖与反映动脉僵硬度的肱踝脉搏波传导速度关系密切(P<0.05),总胆固醇/高密度脂蛋白(β=0.104,P<0.001),是仅次于收缩压和年龄的影响因素。结论血脂与肱踝脉搏波传导速度相关,高脂血症加速了高血压病患者的动脉硬化,高甘油三酯血症对动脉硬度的影响与高胆固醇血症相当,应引起足够的重视。     

培哚普利与氨氯地平对轻中度高血压患者血管弹性作用的比较

目的 比较培哚普利、氨氯地平两种降压药在改善高血压患者动脉弹性功能方面的差异.方法 78例高血压患者被随机分成培哚普利组(38例)和氨氯地平组(40例),每组有36例纳入最终统计数据,在服药前和服药1个月、6个月后应用科林波形分析仪PWV/ABI型仪器测量患者的臂踝脉搏波传导速度.结果 降压治疗后两组的收缩压、舒张压和脉压差均较治疗前明显降低(P<0.01);心率则未见明显变化.臂踝脉搏波传导速度在培哚普利组和氨氯地平组治疗1个月后(分剐为1 572.92±230.08 cm/s和1 542.31±227.59 cm/s)及治疗6个月后(分别为1 484.92±226.59 cm/s和1 432.50±217.88 cm/s)与治疗前(分别为1 737.39±275.99 cm/s和1 765.50±294.57 cm/s)比较均有所下降(P<0.001);且治疗6个月比治疗1个月下降更显著(P<0.001).与培哚普利组比,氨氯地平组降压治疗1个月后臂踝脉搏波传导速度变化值(223.19±200.65 cm/s比164.47±104.18 cm/8)及降压治疗6个月后变化值(333.00±227.36 cm/s比252.47±141.26 cm/s)更显著(P<0.01);降压治疗6个月后与降压治疗1个月后比较,两组臂踝脉搏波传导速度均有进一步的下降(P<0.001).结论 培哚普利和氨氯地平均能改善高血压患者动脉弹性功能.降压治疗1个月及6个月时,氨氯地平改善动脉弹性的作用更为明显.     

300例高血压前期者脉搏波传导速度与颈动脉硬化改变及相关性

目的 探讨高血压前期人群大动脉顺应性和颈动脉硬化的情况及相关性.方法 分层随机抽取高血压前期、高血压、正常血压各300例作为研究对象.采用动脉硬化诊断装置VP-1000测定肱踝脉搏波传导速度和踝臂指数,多普勒彩色超声观察颈总动脉内膜-中膜厚度以及斑块形成情况,比较三组间差异.比较各血压组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉内膜-中膜厚度与脉搏波传导速度的相关性.结果 (1)随着血压从正常向高血压转变,肱踝脉搏波传导速度呈上升趋势,高血压前期组(1 390±171 cm/s)较正常血压组(1 293±151 cm/s)升高但低于高血压组(1 652±291 cm/s,P<0.01);踝臂指数高血压前期组(1.115±0.060)与正常血压组(1.114±0.061)相比差异无统计学意义(P>0.05),但在高血压组明显升高(1.132±0.067,P<0.01).(2)颈动脉内膜-中膜厚度增厚率及斑块发生率在高血压前期组与正常血压组相比差异均无统计学意义,但在高血压组显著升高(P<0.01);颈总动脉内膜-中膜厚度在高血压前期组(0.73±0.10mm)与正常血压组(0.72±0.12 mm)相比差异无统计学意义(P>0.05),但在高血压组显著增厚(0.78±0.16 mm,P<0.01).(3)有或无合并颈动脉斑块时,高血压前期组脉搏波传导速度均较正常血压组升高(P<0.01),但低于高血压组(P<0.01);各血压组合并颈动脉斑块时脉搏波传导速度较无颈动脉斑块时均升高(P<0.01).肱踝脉搏波传导速度与颈总动脉内膜-中膜厚度呈正相关(r=0.271,P<0.01),校正血压因素后相关性仍存在(r=0.156,P<0.01).结论 高血压前期肱踝脉搏波传导速度显著升高.提示存在早期动脉硬度改变.肱踝脉搏波传导速度与颈动脉内膜-中膜厚度呈正相关,肱踝脉搏波传导速度可作为评估高血压前期动脉硬度有效且简便易行的指标.     

降压降脂联合治疗对老年高血压患者动脉弹性的影响

目的探讨降压降脂联合治疗对老年高血压患者动脉弹性的影响。方法入选老年轻、中度高血压患者216例,给予氢氯噻嗪(双氢克尿噻)(25 mg/d)作为基础治疗,2 w后随机分为联合组、降压组及降脂组,每组72例。分别给予坎地沙坦(8 mg/d)和(或)瑞舒伐他汀(10 mg/d)降压、降脂治疗12个月。测量血压、血生化、颈桡脉搏波传导速度。结果治疗12个月后,三组桡动脉脉搏波传导速度均较治疗前降低(P<0.05),联合组下降幅度较降压组、降脂组显著(P<0.05)。结论降压联合降脂治疗能显著降低老年高血压患者的颈桡脉搏波传导速度,改善动脉弹性,强于单一的降压或降脂治疗。     

高血压合并2型糖尿病患者动脉弹性与氧化应激和血管内皮功能的相关性

目的 研究高血压合并糖尿病患者肱-踝脉搏波传导速度与血清中丙二醛、超氧化物歧化酶和一氧化氮的相关性,探讨氧化应激、血管内皮功能变化在动脉硬化过程中的作用.方法 研究对象168例分为正常对照组(n=40)、原发性高血压组(n=70)和高血压合并2型糖尿病组(n=58),各组分别用比色法检测血清丙二醛、超氧化物歧化酶和一氧化氮含量,应用动脉硬化自动检测仪测定肱-踝脉搏波传导速度.结果 与对照组比较,原发性高血压组和高血压合并2型糖尿病组中丙二醛水平和肱.踝脉搏波传导速度明显增高(P<0.01),超氧化物歧化酶和一氧化氮水平明显降低(P<0.01);与原发性高血压组比较,高血压合并2型糖尿病组丙二醛水平和肱-踝脉搏波传导速度明显增高(P<0.05),超氧化物歧化酶和一氧化氮水平降低(P<0.05).相关分析显示肱-踝脉搏波传导速度与年龄、收缩压、舒张压、胆固醇、空腹血糖、高敏C反应蛋白和丙二醛呈正相关(相关系数r分别为0.418、0.672、0.469、0.179、0.392、0.277和0.571,均P<0.05),与超氧化物歧化酶和一氧化氮呈负相关(r分别为-0.438和-0.571,均P<0.05).多元逐步回归分析显示收缩压、丙二醛、空腹血糖和年龄是肱-踝脉搏波传导速度的独立危险因素.结论 高血压合并糖尿病患者动脉弹性明显减弱,且与体内氧化应激增强和血管内皮功能损伤有关,提示氧化应激和血管内皮功能在动脉硬化过程中起重要作用.     

高血压合并肥胖患者脉搏波传导速度的变化及其相关影响因素分析

目的 探讨高血压合并肥胖患者脉搏波传导速度的变化及其相关影响因素.方法 随机入选高血压合并肥胖患者和单纯高血压患者各300例.应用日本科林VP-1000动脉硬化测定仪测定臂踝脉搏波传导速度,同时检测血糖、甘油三酯、肌酐、尿酸、高密度脂蛋白胆固醇、总胆固醇及腰围等指标,并以臂踝脉搏波传导速度为因变量,以年龄、收缩压、舒张压、脉压、体质指数、腰围、血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、肌酐、尿酸等为自变量,行臂踝脉搏波传导速度的多因素分析.结果 高血压合并肥胖患者臂踝脉搏波传导速度(1635±239cm/s)较单纯高血压患者(1583±288 cm/s)显著升高(P<0.05).Pearson相关分析表明,两组臂踝脉搏波传导速度均与收缩压、脉压显著正相关(P<0.05),与舒张压无相关性(P>0.05).多元逐步回归分析表明,600例高血压患者中年龄、收缩压和腰围与反映动脉僵硬度的臂踝脉搏波传导速度关系密切(P<0.05).结论 高血压合并肥胖患者与单纯高血压患者之间臂踝脉搏波传导速度存在显著性差异,年龄、收缩压及腰围与臂踝脉搏波传导速度相关.     

贝那普利和非洛地平及厄贝沙坦降血压对臂踝脉搏波传导速度的影响

目的探讨贝那普利、非洛地平、厄贝沙坦3类降压药对高血压患者臂踝脉搏波传导速度的影响。方法将112例原发性高血压患者随机分成3个治疗组:贝那普利组、非洛地平组、厄贝沙坦组,各34例,均为1级高血压。3组患者分别给予贝那普利、非洛地平、厄贝沙坦降压治疗,服药前和服药1、3个月后测量患者的血压和臂踝脉搏波传导速度(baPWV)。结果 (1)3组降压治疗1个月及3个月后收缩压(SBP)、舒张压(DBP)、脉压差(PP)与治疗前比较,差异均有统计学意义(P<0.05);3组降压治疗1个月后、3个月后SBP、DBP、PP比较,差异均无统计学意义(P>0.05)。(2)3组降压治疗1个月后baPWV与治疗前比较,差异均有统计学意义(P<0.05),降压3个月后baPWV与降压1个月后比较,差异均有统计学意义(P<0.05)。结论贝那普利、非洛地平、厄贝沙坦均能改善高血压患者动脉弹性功能,获益主要来自降压,血压平稳持续达标可持续改善大动脉弹性。     

高血压病患者循环内皮微颗粒水平与动脉弹性功能关系的研究

目的:研究高血压病患者循环内皮微颗粒水平和动脉弹性功能的关系。方法:采用流式细胞仪技术测定高血压病患者(n=60,高血压组)和健康志愿者(n=32,对照组)血浆中CD31+/CD42-内皮微颗粒的水平,袖带震荡技术无创检测肱动脉与胫后动脉之间的肱踝脉搏波传导速度,评估二者之间的相关性。结果:与对照组相比,高血压患者循环内皮微颗粒水平显著升高[(972.6±116.2)比(1920.3±152.0)个/μl,P<0.001];高血压组患者肱踝脉搏波传导速度增快[(1369.3±147.3)比(1793.0±328.3)cm/s,P<0.001]。循环内皮微颗粒水平与肱踝脉搏波传导速度呈正相关(r=0.42,P<0.001),以肱踝脉搏波传导速度为因变量的多因素回归分析显示,循环内皮微颗粒水平是其独立影响因素。结论:高血压病患者循环内皮微颗粒水平升高且肱踝脉搏波传导速度加快,循环内皮微颗粒是肱踝脉搏波传导速度的独立影响因素,提示高血压病患者体内较高水平的循环内皮微颗粒加速了大动脉弹性功能减退。     

沿海正常人群糖化血红蛋白与肱-踝脉搏波传导速度的关系

目的 评估正常人动脉顺应性与糖化血红蛋白之间的关联.方法 横断面调查福建沿海地区30岁以上健康人1175例,行肱-踝脉搏波传导速度和糖化血红蛋白等检测,采用单因素分析和Logistic多元回归分析评价糖化血红蛋白与肱-踝脉搏波传导速度相关情况.结果 (1)肱-踝脉搏波传导速度与糖化血红蛋白具有相关性(r=0.147,P＜0.05);(2)糖化血红蛋白四分法组间显示,肱-踝脉搏波传导速度在四组间差异有统计学意义(P＜0.001);随着糖化血红蛋白水平升高,脉搏波传导速度增快,异常肱-踝脉搏波传导速度的比例升高;异常肱-踝脉搏波传导速度组糖化血红蛋白大于正常肱-踝脉搏波传导速度组(P＜0.05);(3) Logistic回归分析显示,年龄、收缩压、舒张压、糖化血红蛋白、尿酸为正常人群肱-踝脉搏波传导速度独立危险因素(均P ＜0.05),其中糖化血红蛋白比值比最大(OR=2.692,P＜0.05).结论 糖化血红蛋白与肱-踝脉搏波传导速度独立相关,提示非糖尿病健康人群中中间高血糖水平参与了大动脉血管壁早期功能或结构性损伤.     

老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化相关性的临床研究

目的探讨老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化的关系。方法将136例老年观察对象分为老年高血压组（76例）和老年健康对照组（60例）。用欧姆龙动脉硬化检测仪检测肱踝脉搏波传导速度（brachialankle pulse wave velocity,baPWV）,彩色多普勒检测颈动脉内膜-中层厚度（carotid intimamediathickness,clMT）,对肱踝脉搏波传导速度与颈动脉粥样硬化进行相关性分析。结果老年高血压患者肱踝脉搏波传导速度、颈动脉内中膜厚度明显高于对照组,差异有统计学意义（P〈O．05o在控制了年龄、体重指数、高血脂等多种动脉粥样硬化危险因素后,肱踝脉搏波传导速度与颈动脉内中膜厚度仍然存在正相关性（r=0．452,P〈0．01）。结论老年高血压患者肱踝脉搏波传导速度与颈动脉粥样硬化关系密切;控制血压对于延缓老年患者动脉粥样硬化的进展,减少心脑血管事件的发生有着重要意义。     

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.     

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.     

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.     

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.