抑郁情绪对老年冠心病患者血清白介素-1β水平的影响

目的研究抑郁对老年冠心病稳定性心绞痛患者白介素-1β(IL-1β)水平的影响。方法收集2007年7月至2007年12月住院治疗、年龄≥60岁的老年冠心病稳定性心绞痛患者172例。根据Zung抑郁自评量表(SDS)评定标准分为冠心病伴抑郁患者124例,冠心病不伴抑郁患者48例,对两组患者的临床特征、血脂、血糖及IL-1β检测结果进行对比分析。结果冠心病伴抑郁组IL-1β水平高于冠心病不伴抑郁组,差异有统计学意义(P<0.05)。SDS问卷积分与IL-1β呈正相关(r=0.3013,P<0.01)。IL-1β与抑郁的严重程度呈正相关(r=0.3547,P<0.01)。结论抑郁情绪使稳定性心绞痛患者血清IL-1β增高,提示抑郁通过免疫炎症因子影响冠心病的发生、发展、预后,是冠心病预后的预测因素之一。     

冠心病稳定型心绞痛患者抑郁与血清白介素-1β水平相关

目的:研究抑郁对冠心病稳定型心绞痛患者血清白介素-1β(IL-1β)水平的影响。方法:收集2007年7月～12月住院治疗年龄≥50岁的冠心病稳定型心绞痛患者86例。根据ZUNG抑郁自评量表(SDS)评定标准分组,即冠心病伴抑郁患者62例,冠心病不伴抑郁患者24例,对两组患者的临床特征,血脂、血糖及IL-1β检测结果进行对比分析。结果:两组患者在年龄、性别构成、吸烟、饮酒、受教育程度、并发高血压病、糖尿病等之间的差异无统计学意义。冠心病伴抑郁组IL-1β水平显著高于冠心病不伴抑郁组(P0.05)。SDS问卷积分与IL-1β呈正相关(r=0.30,P0.01)。同时按轻、中、重程度与IL-1β相关分析也呈正相关(r=0.35,P0.05)。两组患者血脂水平无显著性差异,且与IL-1β之间没有相关性。结论:冠心病稳定型心绞痛患者抑郁与血清IL-1β水平相关。     

心理因素与腹泻型肠易激综合征关系的研究

背景:近年来肠易激综合征(IBS)的发病率有逐渐上升的趋势,但其病因和发病机制尚不清楚。目的:研究心理因素在腹泻型IBS发病中的地位和作用。方法:分别统计腹泻型IBS患者、病程类似的慢性胃炎患者和正常对照者(各50例)的Zung’s抑郁自评量表(SDS)和焦虑自评量表(SAS)评分,分析腹泻型IBS患者的病程与SDS、SAS评分的相关性。结果:腹泻型IBS患者与慢性胃炎患者的SDS、SAS评分无显著差异(P>0.05),但均显著高于正常对照组(P<0.001)。腹泻型IBS患者的病程与SDS、SAS评分有显著相关性(P<0.001)。结论:腹泻型IBS患者表现出的抑郁、焦虑等心理障碍可能是IBS的结果,而不是其原因;IBS的真实原因尚有待进一步研究。     

2型糖尿病患者一级亲属脂联素及三种细胞因子与胰岛素抵抗的相关性

目的研究2型糖尿病(T2DM)患者非糖尿病一级亲属脂联素、TNF-α、IL-6及C-RP水平的变化及其与胰岛素抵抗(IR)的相关性。方法测定糖耐量正常的T2DM患者一级亲属36例,及无T2DM家族史的正常人对照组46例的血糖、血脂、胰岛素、脂联素、TNF-α、IL-6及hsC-RP。结果①T2DM患者一级亲属组脂联素水平显著低于正常人对照组(11·9±3·0mg/Lvs14·4±3·2mg/L,P<0·01),而TNF-α、IL-6及hsC-RP水平显著高于正常人对照组(分别是14·0±2·8pg/mlvs10·3±2·6pg/ml,P<0·01;13·8±2·7pg/mlvs8·1±2·2pg/ml,P<0·01;1·3±0·4mg/Lvs0·7±0·3mg/L,P<0·01);②T2DM患者一级亲属组IR指数与脂联素呈负相关(r=-0·666,P<0·01),与TNF-α、IL-6呈正相关(分别为r=0·731,P<0·01;r=0·640,P<0·01)。结论脂联素、TNF-α、IL-6及C-RP可能与T2DM患者一级亲属的IR相关。     

失眠及其相关精神因素对女性肠易激综合征患者的影响

目的:探讨失眠和失眠相关精神因素对女性肠易激综合征(irritable bowel syndrome,IBS)患者症状的影响.方法:收集2009-01/10就诊于南京医科大学第一附属医院消化科门诊的成年女性IBS患者245例,对其进行问卷调查:一般人口学资料、症状问卷、阿森斯失眠量表(athens insomnia scale,AIS)、焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(selfrating depression scale,SDS).根据AIS评分将IBS患者分为失眠组和非失眠组,分别分析失眠对IBS典型症状、躯体症状、精神症状的影响及相关精神因素与IBS典型症状的关系.结果:(1)女性IBS患者中,失眠组典型症状的严重程度及每次发作的持续时间均高于非失眠组(P<0.05),而两组间的发作频率则无差异;(2)女性IBS患者失眠组躯体症状的发生率显著高于非失眠组(P<0.01);(3)失眠组女性IBS患者的SAS、SDS以及剔除睡眠相关条目后的SAS’、SDS’评分均显著高于非失眠组(P<0.01);(4)女性IBS患者典型症状的严重程度、发作频率及每次发作的持续时间均与SAS、SDS评分呈正相关(P<0.05).结论:失眠和失眠相关的焦虑、抑郁精神因素可加重女性IBS患者症状.     

氟哌噻吨美利曲辛抗抑郁焦虑治疗对慢性胃炎患者促炎和抗炎因子水平影响的研究

目的探讨氟哌噻吨美利曲辛(黛力新)抗抑郁焦虑治疗对慢性胃炎(CG)患者体内促炎因子和抗炎因子水平的影响。方法连续性纳入96例CG合并焦虑抑郁患者,分为试验组和对照组。对照组给予CG常规治疗,试验组在CG常规治疗的基础上加用黛力新。观察比较治疗前后患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分,促炎因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和IL-6以及抗炎因子IL-10、转化生长因子-β(TGF-β)和IL-4水平改变。结果经过2周的治疗,可见对照组患者SAS评分Y值下降较为明显(P0.05),而试验组患者的SAS评分X值和Y值、SDS评分X值和Y值均明显下降(P0.05)。试验组患者治疗2周后血清TNF-α和IL-6水平明显低于对照组(P0.05),而血清IL-10和TGF-β水平明显高于对照组(P0.05)。结论 CG患者易出现焦虑抑郁精神状态,进而加重体内促炎/抗炎失衡,通过黛力新干预治疗有助于缓解焦虑抑郁状态,改善体内炎性因子TNF-α、IL-6、IL-10和TGF-β水平,提高临床疗效。     

炎性因素对A型行为高血压患者早期肾脏损害的影响

目的探讨炎症介质对A型行为高血压患者早期肾脏损害的影响。方法研究对象90例分为A型行为高血压组(A组,n=30)、非A型行为高血压组(B组,n=30)及健康对照组(C组,n=30),检测、比较各组间血CRP、IL-1β、IL-6、TNF-α水平及尿β2微球蛋白、微量白蛋白水平并作相关分析。结果A组血CRP、IL-1β、IL-6、TNF-α水平及尿β2微球蛋白、微量白蛋白水平明显高于B组(P均<0·05);B组血CRP、IL-1β、IL-6、TNF-α水平及尿微量白蛋白水平明显高于C组(P均<0·05)。经多元线性回归分析,尿β2微球蛋白与血CRP、IL-1β、IL-6、TNF-α水平直线相关(P<0·05~0·01);尿微量白蛋白与血IL-1β、IL-6水平直线相关(P<0·05~0·001)。而且血浆CRP、IL-1β、IL-6和TNF-α含量亦互相呈正相关(P均<0·001)。结论A型行为高血压患者早期肾脏损害较非A型行为高血压者严重,A型行为是高血压病肾脏损害的独立危险因素;炎症介质可能在A型行为高血压患者早期肾脏损害中起重要作用。     

冠心病患者PCI术治疗前后抑郁焦虑的特点及心理干预

目的探讨冠心病(CHD)患者经皮冠状动脉介入术(PCI)治疗前后抑郁焦虑情况及心理干预的效果。方法选取CHD患者226例,随机分组成干预组和对照组各113例,对照组不做任何处理,干预组给予心理干预,比较两组PCI术治疗后抑郁焦虑情况。结果两组治疗前后SAS与SDS评分均显著高于国内常模(均P<0. 05)。对照组治疗后焦虑、抑郁比例及SAS、SDS评分均显著高于治疗前(P<0. 05)。干预组治疗后焦虑、抑郁比例及SAS、SDS评分均显著低于对照组(P<0. 05)。Logistic回归分析结果显示:女性患者抑郁症患病率较男性高;高龄患者焦虑抑郁的患病率较低龄患者低;家庭人均年收入低的患者焦虑抑郁症的患病率较高;教育程度为小学及以下的患者焦虑症的患病率较其他患者高;社会支持情况差的患者焦虑抑郁患病率较高(均P<0. 05)。结论 CHD患者存在焦虑、抑郁状态;性别、年龄、家庭人均年收入、教育程度和社会支持情况是主要的影响因素;心理干预对缓解患者焦虑、抑郁状态有一定作用。     

中老年冠心病患者炎症因子、同型半胱氨酸与抑郁的相关性

目的观察中老年冠心病患者血清炎症因子、同型半胱氨酸(Hcy)与抑郁的相关性。方法采用贝克抑郁量表第2版(BDI-Ⅱ)对中老年冠心病患者进行测评,从中选择合并抑郁者75例(抑郁组),同期调查无抑郁者75例(对照组)采血检测血清高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α和Hcy。结果抑郁组血清TNF-α水平显著高于对照组(t=2. 070,P0. 05)。抑郁组TNF-α与BDI得分呈正相关(r=0. 222,P0. 05),IL-1β与总胆固醇(TC)呈负相关(r=-0. 309,P0. 05),Hcy与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0. 167,P0. 05)。结论中老年冠心病患者血清炎症因子TNF-α与抑郁有一定的相关性。     

抑郁情绪对肝硬化患者血清hs-CRP、IL-1β和IL-6的影响

目的探讨抑郁情绪对肝硬化患者血清高敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的影响,并分析抑郁情绪与疾病严重程度的相关性。方法纳入肝硬化患者84例,通过汉密尔顿抑郁量表(HAMD)评估患者抑郁的严重程度,并分为抑郁组(n=53)和无抑郁组(n=31),比较两组患者的血清hs-CRP、IL-1β、IL-6水平。根据Child-Pugh分级分为A级34例、B级26例和C级24例,比较三组患者的血清hs-CRP、IL-1β、IL-6水平,并分析HAMD评分与血清炎症因子和Child-Pugh分级的相关性。结果 84例肝硬化患者中,53例(63.1%)有抑郁情绪。Child-Pugh C级患者抑郁情绪发生率明显高于Child-Pugh B级和Child-Pugh A级(P0.05)。抑郁组患者的血清IL-6、hs-CRP水平均显著高于无抑郁组(P0.05)。不同Child-Pugh分级患者血清IL-6、IL-1β、hs-CRP水平之间相比,差异有统计学意义(P0.01);Child-Pugh A级患者IL-6、IL-1β、hs-CRP水平显著低于B级(P0.05)。相关性分析显示,血清IL-6、IL-1β、hs-CRP分别与HAMD评分呈正相关(P0.05)。HAMD评分与肝硬化疾病严重程度呈正相关(r=0.338,P=0.002)。结论抑郁情绪可能加重肝硬化患者体内的炎症反应,血清hs-CRP、IL-1β、IL-6水平升高,抑郁情绪与疾病严重程度密切相关。     

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.