基质金属蛋白酶9和胱抑素C水平与急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系研究

目的分析基质金属蛋白酶9(MMP-9)和胱抑素C(Cys-C)水平与急性脑梗死(ACI)患者颈动脉粥样硬化斑块稳定性的关系。方法选取2016年1—9月新疆医科大学第五附属医院神经内科收治的ACI患者189例作为观察组,另选取同期于新疆医科大学第五附属医院体检健康者80例作为对照组。比较两组受试者一般资料和实验室检查指标,MMP-9、Cys-C与ACI患者颈动脉粥样硬化斑块稳定性的关系分析采用有序Logistic回归分析,绘制ROC曲线以评价MMP-9、Cys-C对ACI患者颈动脉粥样硬化斑块稳定性的预测价值。结果两组受试者性别、年龄、高血压病史、空腹血糖(FBG)比较,差异无统计学意义(P0.05);观察组患者MMP-9、Cys-C水平高于对照组(P0.05)。观察组患者中发现不稳定性颈动脉粥样硬化斑块较多者83例(占43.9%),稳定性颈动脉粥样硬化斑块较多者67例(占35.5%),无颈动脉粥样硬化斑块者39例(占20.6%)。有序Logistic回归分析结果显示,MMP-9、Cys-C水平较低的ACI患者颈动脉粥样硬化斑块稳定性优于MMP-9、Cys-C水平较高者(P0.05)。绘制ROC曲线发现,MMP-9预测ACI患者颈动脉粥样硬化斑块稳定性的曲线下面积为0.932[95%CI(0.896,0.968)],最佳截断值为7.96 mmol/L,灵敏度为1.000,特异度为0.750,约登指数为0.075;Cys-C预测ACI患者颈动脉粥样硬化斑块稳定性的曲线下面积为0.794[95%CI(0.732,0.857)],最佳截断值为0.75 mmol/L,灵敏度为0.756,特异度为0.701,约登指数为0.457。结论 MMP-9、Cys-C水平与ACI患者颈动脉粥样硬化斑块稳定性有关,二者对ACI患者颈动脉粥样硬化斑块稳定性的预测价值均较高。     

血清内脂素水平与颈动脉粥样硬化的关系

目的 探讨血清内脂素水平与颈动脉粥样硬化的关系。方法 根据颈动脉超声结果将受试者分为无斑块组(638例)和斑块组(205例),均检测血压、身高、体重、腰围、臀围、体质指数,采用酶联免疫吸附法检测血清内脂素水平,放射免疫法检测血清肿瘤坏死因子-α。结果 ①斑块组血清内脂素水平及肿瘤坏死因子-α均高于无斑块组 (P<0.0001);②Logistic回归分析显示,年龄、收缩压、低密度脂蛋白胆固醇、血清内脂素及肿瘤坏死因子-α均与颈动脉斑块形成独立相关 (P<0.05);③受试者工作特征曲线（ROC曲线）显示,血清内脂素对颈动脉斑块形成的诊断准确性为0.838 (P<0.0001)。 结论 血清内脂素水平升高与颈动脉粥样硬化密切相关,并可作为颈动脉斑块形成的可靠评价指标。     

颈动脉粥样硬化斑块与急性脑梗死患者血脂、血压的相关性研究

目的 探讨颈动脉粥样硬化斑块与急性脑梗死患者血脂、血压的关系.方法 将123例急性脑梗死患者分为脑梗死合并高血压组与脑梗死组,并将51例年龄、性别匹配的健康体检者设为对照组.测量所有患者的血压、血脂,采用彩色多普勒超声检查急性脑梗死患者的颈动脉内膜-中层厚度(IMT)、斑块数量、部位.结果 高血压组颈动脉粥样硬化斑块的发生率达94.9%,发生率和IMT均明显高于脑梗死组和对照组(P＜0.05);斑块最好发的部位为颈总动脉分叉处(BIF),有颈动脉粥样硬化斑块者的血压、胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)均明显高于无粥样硬化斑块者(P＜0.05).结论 颈动脉粥样硬化斑块是脑梗死的重要危险因素之一,而高血压与高血脂是粥样硬化斑块形成的高危因素.     

老年高血压患者脉压与颈动脉粥样斑块的关系

目的研究老年高血压患者血压水平与颈动脉粥样斑块形成的关系.方法选取84例老年原发性高血压患者,根据彩色多普勒超声检查颈动脉粥样斑块情况分为两组,斑块组54例,无斑块组30例,检测血脂和尿酸变化,监测24 h动态血压,比较两组间性别构成、年龄、血脂和尿酸水平、24 h平均收缩压、舒张压及脉压差水平有无统计学差异.结果两组之间年龄分布存在明显的统计学差异(P<0.001); 斑块组PP明显高于无斑块组(P=0.003);年龄与脉压之间呈正相关(r=0.301,P=0.005).结论脉压增大可能是导致颈动脉粥样斑块形成的危险因子,降低脉压对老年高血压患者靶器官的保护可能起重要的作用.     

凌晨血压增高与亚临床动脉粥样硬化密切相关

目的 探讨高血压患者凌晨血压增高(MBPS)及动态血压监测参数与颈动脉粥样硬化的关系.方法 高血压患者226例,分为MBPS组(51例)与非MBPS组(175例),并根据颈动脉内膜中膜厚度(IMT)分为IMT增厚组94例和非IMT增厚组132例,分别检查血脂、动态血压监测、颈动脉超声等,比较两组之间年龄、动态血压参数以及颈动脉IMT以及斑块Crouse积分的差别.结果 1)MBPS组MBPS值、凌晨平均动脉压、凌晨脉压、颈动脉IMT、斑块积分显著高于非MBPS组(P＜0.05);2)颈动脉IMT增厚组MBPS值、凌晨平均动脉压、凌晨脉压、24 h平均收缩压、24 h平均舒张压、白昼平均收缩压、白昼平均舒张压、夜间平均收缩压、夜间平均舒张压显著高于颈动脉非IMT增厚组(P＜0.05).结论 MBPS者颈动脉粥样硬化程度较高,MBPS可能促进颈动脉粥样硬化进程.     

凌晨血压增高与亚临床动脉粥样硬化密切相关

目的探讨高血压患者凌晨血压增高(MBPS)及动态血压监测参数与颈动脉粥样硬化的关系。方法高血压患者226例,分为MBPS组(51例)与非MBPS组(175例),并根据颈动脉内膜中膜厚度(IMT)分为IMT增厚组94例和非IMT增厚组132例,分别检查血脂、动态血压监测、颈动脉超声等,比较两组之间年龄、动态血压参数以及颈动脉IMT以及斑块Crouse积分的差别。结果1)MBPS组MBPS值、凌晨平均动脉压、凌晨脉压、颈动脉IMT、斑块积分显著高于非MBPS组(P<0.05);2)颈动脉IMT增厚组MBPS值、凌晨平均动脉压、凌晨脉压、24h平均收缩压、24h平均舒张压、白昼平均收缩压、白昼平均舒张压、夜间平均收缩压、夜间平均舒张压显著高于颈动脉非IMT增厚组(P<0.05)。结论MBPS者颈动脉粥样硬化程度较高,MBPS可能促进颈动脉粥样硬化进程。     

颈动脉粥样硬化斑块对非瓣膜性心房颤动病人缺血性脑卒中事件的预测价值

目的 探讨颈动脉粥样硬化斑块对老年非瓣膜性心房颤动(NVAF)病人缺血性脑卒中事件的预测价值。方法 纳入303例NVAF病人,根据是否合并缺血性脑卒中分为房颤伴脑卒中组(n=134)和房颤不伴脑卒中组(n=169)。采用单因素及多因素回归分析探讨NVAF病人缺血性脑卒中的预测因素,并进一步评估其预测价值。结果 房颤伴脑卒中组中75.4%的病人存在颈动脉粥样硬化斑块,而非脑卒中组伴有颈动脉粥样硬化斑块的病人比例为66.3%,差异有统计学意义(P<0.05)。Logistic回归分析结果表明,颈动脉粥样硬化斑块以及CHA₂DS₂-VASc评分是NVAF病人缺血性脑卒中事件的独立危险因素。ROC曲线分析结果表明,颈动脉粥样硬化斑块联合CHA₂DS₂-VASc评分预测缺血性脑卒中的价值优于CHA₂DS₂-VASc评分。结论 在老年NVAF病人中,颈动脉粥样硬化斑块与缺血性脑卒中事件密切相关。颈动脉粥样硬化斑块联合CHA₂DS_2...     

血清25羟维生素D、全段甲状旁腺素水平与2型糖尿病患者颈动脉粥样硬化的相关性

目的分析血清25羟维生素D〔25(OH)VD〕、全段甲状旁腺素(iPTH)与2型糖尿病患者颈动脉粥样硬化的相关性。方法选择300例2型糖尿病患者为研究对象,抽取空腹状态下外周静脉血,检测其血清25(OH)VD、iPTH、血脂、尿酸等水平;同时测量患者血压,行颈动脉彩超检查,将患者分为无斑块组、小斑块组与中大斑块组,对比3组患者一般情况及血清25(OH)VD、iPTH水平,分析检验血清25(OH)VD水平及iPTH与患者颈动脉粥样硬化的相关性。结果全部纳入的300例2型糖尿病患者经查,102例无斑块,79例小斑块,119例中大斑块。3组不同颈动脉粥样硬化斑块2型糖尿病患者性别、年龄、体重指数、收缩压、尿酸、血脂等一般情况比较差异均无统计学意义(P>0.05)。3组患者中,血清25(OH)VD水平无斑块组>小斑块组>中大斑块组,血清iPTH水平无斑块组<小斑块组<中大斑块组,组间各指标比较差异有统计学意义(P<0.05)。经等级资料Spearman相关性分析检验证实,血清25(OH)VD、iPTH与2型糖尿病患者颈动脉粥样硬化均明显相关,前者呈负相关(r=-0.471,P<0.05),后者呈正相关(r=0.551,P<0.05)。结论在2型糖尿病患者中血清25(OH)VD降低、iPTH水平升高的患者易发生颈动脉粥样硬化,且25(OH)VD水平越低、iPTH水平越高的患者,发生颈动脉粥样硬化的风险越大,情况越严重。     

颈动脉粥样硬化与心脑血管危险因素的相关性分析

目的探讨颈动脉粥样硬化与心脑血管危险因素之间的关系。方法以2013年在小汤山医院体检中心进行健康体检的941例为研究对象,全部受检者控制饮食后进行体检。根据颈动脉彩超将受检者分为正常组,内-中膜增厚组,软斑组,混合斑块组和硬斑组5组。对各组性别、年龄、体重指数(BMI)、踝臂脉搏波传导速度(baPWV)、血压、空腹血糖(FBG)、血脂、尿酸(UA)等检查结果进行统计分析。结果正常组在收缩压、baPWV、UA3个方面明显低于其他组,高密度脂蛋白(HDL)水平高于其他组(P0.05)。软斑组、混合斑块组、硬斑组在年龄、舒张压、FBG、三酰甘油(TG)、低密度脂蛋白(LDL)等方面明显高于正常组(P0.05)。软斑组和混合斑块组的BMI水平明显高于正常组(P0.05)。软斑组和硬斑组的胆固醇水平明显高于正常组(P0.05)。多因素Logistic回归分析显示,baPWV、性别、年龄、FBG与颈动脉血管病变的发生密切相关,其中baPWV是影响颈动脉粥样硬化的最主要危险因素。同时UA对颈动脉粥样硬化发病的影响亦不容忽视。结论年龄、性别、血压、FBG、血脂、UA、BMI、baPWV,同样也是颈动脉粥样硬化形成及发展的危险因素,其中baPWV是影响颈动脉粥样硬化的最主要危险因素。     

老年急性脑梗死患者颈动脉斑块与血清C反应蛋白、脂蛋白(a)和血糖水平的关系

目的 研究老年人急性脑梗死患者颈动脉斑块与血清C反应蛋白(CRP)、脂蛋白(a)和血糖水平的关系.方法 选择60岁以上老年人127例.根据颈动脉彩色超声检查有无颈动脉斑块分为颈动脉斑块组(观察组)和非颈动脉斑块组(对照组),并检测两组患者血清CRP、脂蛋白(a)和血糖水平,分析老年人急性脑梗死中影响颈动脉粥样硬化及斑块形成的相关因素.结果 127例老年人中发生急性脑梗死46例(36.22%),其中观察组32例(25.19%),对照组14例(11.02%),颈动脉斑块检出率为65.35%,观察组患者脑梗死发生率显著高于对照组(P<0.05),观察组患者血清CRP、脂蛋白(a)和血糖水平显著增高(P<0.05).结论 颈动脉粥样硬化与脑梗死密切相关,颈动脉斑块发生率越高,脑梗死发生率也随之增高.年龄是动脉粥样硬化加重的危险因素,CRP、脂蛋白(a)和血糖可作为老年急性脑梗死的危险因素,并可预测梗死面积和病情的严重程度.     

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.     

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.