脉搏波传导速度与冠状动脉病变程度的相关性研究

目的:探讨脉搏波传导速度(PWV)与冠状动脉病变严重程度的相关性。方法:选择我院2009年8月~2010年3月疑似冠心病患者80例,入选患者均测定PWV,进行冠状动脉造影(CAG)明确冠心病以及评价冠脉病变严重程度。根据冠状动脉造影结果分为CAG阴性组(32例)和CAG阳性组(48例),CAG阳性组又分为单支病变组(16例)、双支病变组(20例)和多支病变组(12例),比较各组患者的PWV以及分析PWV与冠脉病变严重程度的相关性。结果:CAG阴性组PWV[(1354.47±56.6)cm/s]和单支病变组的[(1475.38±79.13)cm/s]、双支病变组的[(1495.25±65.33)cm/s]、多支病变组的[(1613.17±75.11)cm/s]比较差异有显著性(F=24.06,P0.001);多支病变组的显著高于单支病变组与双支病变组的(P0.001);单支病变组与双支病变组的PWV差异无显著性(P=0.419)。PWV与冠状动脉病变支数间呈正相关(r=0.547,P=0.000)。控制高血压、糖尿病等因素后,PWV与冠状动脉病变支数仍呈正相关(偏相关系数r=0.520,P=0.000)。结论:脉搏波传导速度与冠状动脉病变支数呈正相关,可作为冠状动脉病变严重程度的预测因子。     

脉搏波速度与冠状动脉粥样硬化的关系

目的 为探讨脉搏波速度与冠状动脉粥样硬化程度的关系.方法 本文选择行冠状动脉造影或介入治疗的患者104例,进行脉搏速度测量、血液生化检查、病史采集及冠状动脉造影.结果 年龄、脉搏速度、脉压是显著性影响冠脉病变的危险因素(P＜0.05);年龄、脉搏速度、高血压病史、收缩压、脉压、吸烟、胆固醇在冠状动脉病变程度组间差异有显著性(P＜0.05);年龄、脉搏速度、脉压、总胆固醇、吸烟在多支病变组与正常组之间差异有显著性(P＜0.05).按照冠状动脉病变最大狭窄程度分组,冠状动脉病变程度间脉搏速度有显著性差异(P＜0.05);狭窄1级、2级、3级、4级与0级,狭窄1级与2级脉搏速度比较差异有显著性(P＜0.05).按脉搏速度值≤14 m/s和＞14 m/s分组,两组患者冠状动脉病变严重程度差异有显著性(P＜0.05);脉搏速度＞14 m/s组的患者既往多数有高血压病史,3支血管病变在脉搏速度＞14 m/s组中显著增高;冠状动脉无病变者在脉搏速度≤14 m/s组中显著性增多.冠心病合并高血压组与未合并高血压组患者的脉搏速度间差异有显著性意义(P＜0.05).在年龄与体重指数无明显差异的条件下,冠心病组、冠心病合并糖尿病组、冠心病合并高血压组、冠心病合并高血压及糖尿病组脉搏速度值逐渐升高(P＜0.05);冠心病组患者随着病变支数的增多,脉搏速度值显著性升高(P＜0.05).结论 提示脉搏速度与冠状动脉病变严重程度呈显著相关性,脉搏速度可综合反映高血压、高血糖等危险因素对血管的损伤,更能精确地对患者进行心血管危险分层,它可作为对冠心病患者危险分层的评估和冠状动脉严重程度识别的独立因素.     

血清脂联素水平、动脉脉搏波传导速度与冠心病的相关性研究

目的 探讨血清脂联素(APN)水平、动脉脉搏波传导速度(PWV)与冠心病的相关性.方法 选取行冠状动脉造影的住院患者178例,其中确诊为急性冠状动脉综合征(ACS) 82例(ACS组),稳定性心绞痛者52例(SAP组),正常者44例(对照组),采用定量冠状动脉造影分析(QCA)法分析冠状动脉狭窄程度,酶联免疫吸附法测定APN水平,全自动动脉硬化测定仪测定PWV.结果 APN水平和PWV值在3组间比较差异均有统计学意义(P＜0.05);ACS组与SAP组患者PWV比较差异有统计学意义(P＜0.05).双支病变组和3支病变组的冠状动脉狭窄程度、APN水平及PWV值与对照组比较差异均有统计学意义(P＜0.05),冠状动脉狭窄程度、PWV值在单支病变组和双支病变组与3支病变组比较,差异均有统计学意义(P＜0.05).结论 冠心病患者APN水平随着病变程度加重而明显下降,而PWV明显升高.在冠心病患者中应用APN、PWV进行综合评估有助于预测疾病发展.     

脉搏波速度与冠状动脉病变的相关性研究

目的:应用脉搏波速度(pulse wave velocity,PWV)评价血管僵硬度,观察PWV与冠心病危险因素的相关性,及其对冠状动脉病变严重程度的预测价值. 方法:入选132例因胸痛疑诊冠心病而行冠脉造影的患者,其中男性68例,女性64例,平均年龄(66.4±10.0)岁.根据冠脉造影的结果,将患者分为冠状动脉正常组(Ⅰ组,n=32),冠状动脉病变单支组(Ⅱ组,n=33)、2支组(Ⅲ组,n=27)和3支组(Ⅳ组,n=40);同时有创测量中心动脉收缩压(CSBP)、舒张压(CDBP)及脉压(CPP).用欧姆龙动脉硬化检测仪测量患者臂踝PWV(baPWV).检测体质指数、血脂、颈总动脉内膜中层厚度、血清肌酐、左室质量指数等冠心病危险因素. 结果:逐步多变量回归分析显示,年龄(β =0.46,P＜0.01)和CSBP(β=0.19,P=0.013)与baPWV明显相关.baPWV比较:Ⅰ组与Ⅱ组无统计学差异(P=0.83);Ⅲ组、Ⅳ组较Ⅰ组和Ⅱ组明显升高(P＜0.05);Ⅲ组与Ⅳ组无统计学差异(P=0.47). 结论:年龄和CSBP是影响baPWV的两个独立危险因素.baPWV与冠状动脉病变严重程度明显相关,可以作为无创、简便、可重复的预测冠状动脉病变程度的一个重要指标.     

主动脉瓣硬化与臂踝脉搏波传导速度的相关性及其对冠状动脉病变的预测价值

目的研究臂踝脉搏波传导速度(ba PWV)与主动脉瓣硬化(AVS)及其严重程度之间的关系,同时探讨二者在冠心病及冠状动脉三支病变诊断中的预测价值。方法 485例住院行冠状动脉造影同时行超声心动图及ba PWV测定的患者,其中男性297例,女性188例,年龄为62.52±10.28岁。根据主动脉瓣的形态学特点分为AVS组和non-AVS组,同时根据主动脉瓣硬化受累瓣膜数、瓣膜硬化严重程度积分分别进行分组,比较各组间ba PWV值。根据冠状动脉造影结果分为以下5组:冠状动脉无异常、冠状动脉粥样硬化、一支血管受累、两支血管受累、三支血管受累±左主干病变。比较AVS、ba PWV及其组合对冠心病及冠状动脉三支病变预测的敏感度、特异度、阳性预测值及阴性预测值,探讨二者联合应用能否提高其预测价值。结果 AVS组305例,non-AVS组180例,AVS组ba PWV(1536.57±285.06 cm/s)显著高于non-AVS组(1484.92±241.75 cm/s,P0.05)。不同受累瓣膜数组ba PWV分别为:0瓣组1484.92±241.75 cm/s,1瓣组1499.61±259.57 cm/s,≥2瓣组1593.55±313.07cm/s,差异具有统计学意义(P0.05)。不同积分组ba PWV分别为:0分组1484.92±241.75 cm/s,1分组1500.23±271.70 cm/s,≥2分组1586.16±296.26 cm/s,差异具有统计学意义(P0.05)。无论是在冠心病还是在冠状动脉三支病变预测方面,AVS预测值均优于ba PWV,AVS预测冠心病的阳性预测值为91.1%。AVS和ba PWV均异常预测冠心病和冠状动脉三支病变的特异度较高,分别为85.5%和66.9%,优于二者单独使用时的预测值。AVS与ba PWV任一项异常预测冠心病及冠状动脉三支病变的敏感度较高,分别为90.4%和95.3%。AVS硬化积分≥2分预测冠心病的敏感度不高,仅为33.6%,但特异度和阳性预测值较高,分别为97.3%和97.7%。结论 AVS组ba PWV均值高于non-AVS组,AVS受累瓣膜数≥2瓣组ba PWV均值显著高于0瓣组和1瓣组,AVS积分≥2分组ba PWV均值显著高于0分组和1分组。AVS在冠心病和冠状动脉三支病变预测方面优于ba PWV。当ba PWV与AVS联合应用时,二者均异常时预测冠状动脉病变的特异度较高,任一项异常的敏感度较高。AVS硬化积分≥2分预测冠心病的敏感度不高,但其预测冠心病的准确度较高。     

大动脉僵硬度与冠心病相关性研究

目的探讨颈-股动脉脉搏传导速度(C-F PWV),分析大动脉僵硬度和冠心病的相关性。方法408例行冠状动脉造影的患者,男313例,女95例。均采用Complior SP测量系统测量C-F PWV。记录血流动力学指标和心血管危险因素。冠状动脉病变的严重程度用冠状动脉病变的血管支数表示,比较不同严重程度冠心病患者的C-F PWV值,同时对C-F PWV与冠脉复杂病变的相关性进行评估。结果冠心病组年龄明显大于对照组[分别为(65.6±9.5)岁与(59.8±10.2)岁,P<0.01]。C-F PWV在校正了年龄、性别、高血压、高血脂和糖尿病等因素后经Logistic回归分析后,仍与冠心病的存在显著相关,分别为(10.3±1.79)与(12.8±3.1)m/s,P<0.01。C-F PWV值的升高和冠脉病变的严重程度相关(P<0.01),同时伴有更多的复杂病变,如完全闭塞病变,弥漫性病变和钙化病变。结论C-F PWV是一个判断冠心病存在及其严重程度的独立预测指标。     

脉搏波传导速度与冠状动脉病变严重程度的相关性：324例老年病例分析

目的探讨脉搏波传导速度（PWV）与冠状动脉粥样硬化程度的相关性。方法2008年1月至2010年1月因胸痛入住解放军总医院老年心血管病研究所行冠状动脉造影检查的患者324例,其中男性213例,女性111例,年龄（61±12）岁。根据冠状动脉造影结果分为两组：冠心病组和正常组。冠心病组为冠状动脉造影显示至少有一支以上血管狭窄程度≥50％。同时根据冠状动脉血管病变的支数分为单支病变、双支病变、严重病变[三支病变或（和）左主干病变]组。采用全自动动脉硬化测定仪同步记录左右侧肱动脉一踝动脉脉搏波传导速度（baPWV）作为反映大动脉弹性的指标。结果对324例患者影响冠心病发生的多元logistic逐步回归分析表明,性别、吸烟、PWV是冠心病独立的危险因素。PWV与冠状动脉病变支数的Spearman等级相关分析显示,PWV与冠心病病变支数成正相关（r=0．307,P=0．005）,在校正多种危险因素后相关性消失。多元回归分析表明,PWV≥1600cm／s的患者发生严重病变的危险度是Pwv〈1600cm／s者的5．736倍。结论动脉弹性减退与冠心病有关,冠心病严重病变者较轻度病变者动脉弹性减退更为明显。     

肱-踝脉搏波传导速度对冠心病的诊断价值

目的探讨肱-踝脉搏波传导速度(ba PWV)对冠心病的诊断价值。方法选取190例受检者根据冠状动脉造影结果分为冠心病组106例和对照组84例,同时将冠心病组进一步分为单支病变组、双支病变组及严重病变组,比较冠心病各组与对照组的ba PWV水平。以冠状动脉造影为金标准,绘制ROC曲线评价ba PWV值对冠心病的筛选价值。结果冠心病组ba PWV显著高于对照组(P 0. 05)。冠心病组单支病变组、双支病变组、严重病变组ba PWV值分别为(1 620. 13±94. 47) cm/s、(1 732. 97±84. 26) cm/s和(1 913. 20±180. 75) cm/s,两两比较差异均有统计学意义(P 0. 05)。由ROC曲线特征发现,ba PWV的最佳截断点为1 535 cm/s,此时约登指数为0. 730,灵敏度为83. 4%,特异度为88. 3%。结论 ba PWV对筛选冠心病有一定的价值,并能够预测冠脉病变的严重程度。     

血压与冠状动脉造影病变的关系

目的研究血压与冠状动脉病变的关系。方法选择可疑冠心病患者540例,根据冠状动脉有无病变分为病变组和无病变组;根据冠状动脉病变的范围分为单支血管病变组、双支血管病变组和三支血管病变组。所有患者入院后测量血压,并对每一个患者进行高血压、吸烟和糖尿病病史的调查,测定血脂水平。采用Judkins法进行冠状动脉造影。结果病变组高血压病程(5.85±8.87年)、收缩压(133±29 mm Hg)、舒张压(83±13 mm Hg)、脉压(51±17 mm Hg)及平均压(100±14 mm Hg)均明显高于无病变组(分别为1.78±4.27年、125±21 mm Hg、80±13mm Hg4、8±15 mm Hg和97±15 mm Hg)(P<0.05)。三支血管病变组高血压病程、收缩压和脉压水平(分别为7.42±10.10年、137±21 mm Hg和54±17 mm Hg)均高于单支血管病变组(分别为4.51±7.21年、132±19 mm Hg和49±16 mm Hg)和双支血管病变组(分别为5.76±8.79年1、34±23 mm Hg和52±17 mm Hg)(P<0.05)。随着高血压病程增加、收缩压、脉压及平均压水平的增高,冠状动脉病变狭窄程度逐渐增大;经多因素回归分析高血压病程(OR值=0.139,P<0.05)、年龄(OR值=1.045,P<0.05)等因素是冠心病发生独立的危险因素。结论随着年龄增大和高血压病程增加,患冠心病的机会增加,并且收缩压和脉压的升高对冠状动脉的危害性较大。     

血清尿酸含量及PWV与冠心病的相关性

目的研究血清尿酸(SUA)水平及脉搏波速度(PWV)与冠脉病变严重程度的关系。方法选择该院心血管内科2011年1月至2012年7月收住院并行冠状动脉造影的患者121例,比较冠状动脉狭窄组和对照组患者的SUA、踝臂脉搏波速度(baPWV);再根据冠脉病变支数将狭窄组分为不同亚组,比较SUA浓度及PWV与冠脉病变程度的关系。结果 SUA水平随着冠脉病变血管支数的增加而逐渐增高,对照组、单支、双支、多支组SUA分别为(349.26±96,58),(400.37±70.96)、(517.57±85.26)、(602.60±77.03)μmol/L,两两比较均有统计学意义(均P<0.05)。BaPWV亦随着冠脉病变血管支数的增加而逐渐增高,对照组baPWV(1 499.04±193.82)cm/s,单支组(1 885.32±319.73)cm/s,双支组(2 036.00±406.40)cm/s,多支组(2 171.03±348.53)cm/s,单支组、双支组和多支组baPWV均高于对照组(P<0.05),双支组baPWV高于单支组(P<0.05)。结论 SUA及PWV随着冠脉病变血管支数的增加而逐渐增高。SUA水平以及PWV对预测冠心病及其严重程度有重要的临床应用价值,对冠心病高危患者筛查有重要意义。     

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.