血清胆红素水平与冠心病严重程度的关系

目的:探讨血清胆红素水平与冠心病严重程度的关系。方法:回顾性随机选择2014-07至2016-03在我院心内科住院患者568例,经冠状动脉(冠脉)造影确诊为冠心病患者438例(冠心病组)和非冠心病患者130例(非冠心病组);冠心病组患者中单支病变者166例、双支病变者150例和三支病变者122例,以Gensini积分中位数34分为界分为低分者和高分者各219例。依据总胆红素(TBIL)水平是否大于17.1μmol/L分为TBIL正常组(n=426)和TBIL升高组(n=142)。收集所有患者的一般资料、生化指标(包括生化全套、血常规)、彩色多普勒及冠脉造影检查结果。比较各组之间TBIL、直接胆红素(DBIL)水平和间接胆红素(IBIL)水平的差异。结果:(1)与非冠心病组相比,冠心病组患者TBIL、DBIL和IBIL水平显著降低(P0.05),高胆红素血症(HBI)的检出率有下降趋势;TBIL升高组的冠心病检出率也有下降趋势,差异均无统计学意义(P0.05)。(2)冠心病组患者病变累及的冠脉支数越多、Gensini积分越高,TBIL、DBIL和IBIL水平越低(P0.05),且Pearson相关分析显示,TBIL、DBIL、IBIL水平均与冠心病患者的左心室射血分数(LVEF)呈正相关(r=0.390,r=0.283,r=0.426,P均0.05)。(3)多元线性回归分析结果显示,DBIL和IBIL水平为冠心病的独立危险因素,且呈负相关(B=-3.766,B=-2.705,P0.05)。(4)TBIL、DBIL、IBIL水平均与冠心病患者的超敏C反应蛋白(hs-CRP)呈负相关(r=-0.617,r=-0.473,r=-0.580,P均0.05)。结论:血清胆红素水平与冠脉狭窄程度呈负相关,且不依赖胆红素存在的形式,低胆红素水平可能是冠心病发生的一个独立危险因素。     

血清胆红素检测在冠心病诊断中的应用价值

目的探讨血清胆红素检测在冠心病诊断中的应用价值。方法选取我院收治的195例冠心病患者为冠心病组,194名健康志愿者为志愿者组,检测其直接胆红素(DBIL)、间接胆红素(IBIL)以及总胆红素(TBIL)的含量,并分析它们之间的关系。结果冠心病患者的DBIL、IBIL和TBIL与志愿者组相比均明显较低,差异具有统计学意义(P0.05);其中AMI患者的TBIL与SAP患者、UAP患者相比,有所增高,差异有统计学意义(P0.05),而冠心病患者之间的DBIL、IBIL检测则差异无统计学意义(P0.05)。结论对冠心病患者检测血清胆红素科预防或控制疾病的进展,同时还可指导疾病的临床治疗,调节患者体内调节体内胆红素水平对预防和诊断冠心病有一定的价值,值得临床推广应用。     

血清胆红素与老年冠心病的相关性探讨

目的探讨血清胆红素与老年冠心病的相关性。方法选取本院冠心病患者37例和体检健康老年者54例。记录所有研究对象基本资料,检测血清胆红素、血脂、肝功能,并进行相关分析。结果冠心病组的血清总胆红素(TBIL)和间接胆红素(IBIL)浓度显著低于非冠心病组(P0.05),而直接胆红素(DBIL)的水平在2组之间无统计学差异。结论在老年冠心病患者中血清胆红素(TBIL、IBIL)水平降低,在生理范围内轻度升高的胆红素是冠心病的一个保护因素。     

血清胆红素水平与冠心病发病及冠状动脉病变程度的相关性

目的探讨血清胆红素水平与冠心病(CAD)发病及冠状动脉病变程度的关系。方法收集9 847例行诊断性冠状动脉造影的疑诊CAD患者进行回顾性分析,以冠状动脉造影阳性(主要血管直径狭窄≥50%)作为诊断CAD的标准,将全部患者分为CAD和非CAD两组。冠状动脉造影病变程度采用Gensini积分评价,根据冠状动脉主要血管受累支数分为0支、单支、两支和三支病变组。分析血清胆红素水平与CAD发病及冠状动脉病变程度的关系。结果 9 847例患者中确诊CAD 6 419例(65.2%)。CAD组的总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)显著低于非CAD组(P<0.001),且TBIL、DBIL、IBIL水平越低,冠状动脉病变越严重。Logistic回归分析证实TBIL、DBIL是CAD的独立保护因素。结论血清胆红素水平降低患者的CAD发病率明显升高;血清胆红素水平越低,冠状动脉病变越严重;TBIL、DBIL是CAD的独立保护因素。     

血清胆红素水平与冠状动脉粥样硬化性心脏病的相关性研究

目的对患者血清胆红素含量与冠状动脉粥样硬化性心脏病(CHD)的严重程度、临床分型进行相关性分析。方法选取2016-01~2016-12该院住院的183例CHD患者作为CHD组,并选择同期住院其他疾病(呼吸疾病、心率失常、肺炎等)患者90例作为非CHD对照组。根据冠脉造影的结果将CHD组患者分为单支血管病变组62例,双支血管病变组77例和多支血管病变组44例。根据患者病史及临床表现分为ST段抬高型心肌梗死(STEMI)组41例,急性非ST段抬高型心肌梗死(NSTEMI)组43例,不稳定型心绞痛(UAP)组49例和稳定型心绞痛(SAP)组50例。结果 CHD组患者总胆红素(TBIL)值、间接胆红素(IBIL)值和直接胆红素(DBIL)值均显著低于对照组(P0.05);多支病变组患者血清中TBIL、IBIL和DBIL含量显著低于双支及单支病变组,且双支病变组显著低于单支病变组(P0.05)。将冠脉病变的支数与TBIL、IBIL、DBIL含量进行相关性分析,相关系数分别为r=-0.433,P0.05;r=-0.392,P0.05;r=-0.415,P0.05,血管病变的支数与TBIL、IBIL、DBIL水平呈负相关。STEMI组和NSTEMI组TBIL、DBIL和IBIL水平显著低于UAP组和SAP组,并且UAP组TBIL值显著低于SAP组(P0.05)。将冠心病的不同临床分型与TBIL、DBIL、IBIL值进行相关性分析,相关系数分别为r=-0.388,P0.05;r=-0.314,P0.05;r=-0.353,P0.05,TBIL、DBIL和IBIL值随冠心病严重程度增加而降低。结论血清胆红素水平与冠状动脉粥样硬化血管的病变支数、CHD严重程度有负相关性,其水平可以反映冠脉病变的严重程度及斑块稳定性。     

血清胆红素及炎症指标与冠心病关系的探讨

目的探索冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉狭窄程度与血清胆红素及炎性指标如超敏C反应蛋白(hs-CRP)的关系。方法回顾性分析2013年4月~2016年2月因胸痛于武汉大学中南医院住院并行冠状动脉造影的患者1055例,其中冠心病组741例,根据Gensini评分或SYNTAX评分中位数进一步分为两组,定义为轻度病变组及重度病变组。314例非冠心病患者作为对照组。结果与对照组相比,冠心病组患者血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素浓度(IBIL)更低,炎症标志物超敏C反应蛋白更高,差异均有统计学意义(P0.05)。轻度病变组与重度病变组相比,TBIL、DBIL及IBIL更高,hs-CRP更低,差异均具有统计学意义(P0.05)。相关分析显示血清胆红素与冠状动脉病变严重程度呈负相关,超敏C反应蛋白与冠状动脉病变严重程度呈正相关。多因素Logistic回归分析显示hs-CRP、LDL-C、高血压、糖尿病和吸烟是重度冠心病的独立危险因素,而TBIL、HDL-C是重度冠心病的独立保护因素。受试者工作特征曲线(ROC曲线)显示TBIL诊断冠心病的曲线下面积为0.758(95%CI:0.731~0.783)。当TBIL诊断临界值取14.7μmol/L时,其诊断效能最高,敏感性为72.0%,特异性为71.6%。结论血清胆红素与冠状动脉病变严重程度呈负相关。总胆红素是重度冠心病的独立保护因素,hs-CRP是重度冠心病的独立危险因素。血清总胆红素水平对冠心病有一定的预测价值。     

冠状动脉病变程度与胆红素血脂指数及纤维蛋白原水平的关系

目的:研究胆红素血脂综合指数和纤维蛋白原水平与冠状动脉病变程度的关系。方法:选取患者300例,均行冠状动脉造影,按照2种方法进行分组:①根据造影结果,无冠心病者为对照组(75例),冠心病者为观察组(225例);②根据冠状动脉病变程度将患者分为4组:A组无血管病变(75例),B组单支血管病变(119例),C组2支血管病变(54例),D组3支或主干血管病变(52例)。抽取所有患者空腹血,检测血浆总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及纤维蛋白原(FIB)水平,并计算出胆红素血脂综合指数。结果:①观察组患者TC、LDL-C、胆红素血脂综合指数[LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)]及纤维蛋白原较对照组均有所升高,差异有统计学意义(P0.05);观察组患者HDL-C、DBIL、IBIL及TBIL均低于对照组,差异有统计学意义(P0.05);②以冠状动脉病变程度分组的比较中,TBIL、IBIL、LDL-C、LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)及纤维蛋白原水平的差异均有统计学意义(P0.05);③Logistic危险因素分析显示,胆红素血脂综合指数LDL-C/(HDL-C+TBIL)、TC/(HDL-C+TBIL)及纤维蛋白原的优势比(OR)分别为1.75、1.65、2.01;可信区间分别为1.02～2.86、1.05～2.77、1.63～3.02,均是冠心病的危险因素;④相关性分析显示,胆红素血脂综合指数与冠心病患者Gensini积分呈正相关性(r=0.60,r=0.56,P0.05);纤维蛋白原与冠心病患者Gensini积分亦呈正相关性(r=0.32,P0.05)。结论:胆红素血脂综合指数和纤维蛋白原水平与冠状动脉病变程度呈正相关性,胆红素血脂综合指数与纤维蛋白原水平随着冠状动脉病变程度加重而升高。     

胆红素和C反应蛋白预测急性心肌梗死患者支架术后长期预后的意义

目的探讨胆红素和C反应蛋白(C-reactive protein,CRP)预测急性心肌梗死(acute myocardial infarction,AMI)患者支架术后长期预后的意义。方法选择2016年9月至2018年3月中山大学附属江门医院行经皮冠状动脉介入治疗的120例AMI患者为AMI组,120例健康体检者为对照组,测定两组患者血清中总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)、CRP的浓度。6个月内对AMI组患者进行心血管事件评定,发生心血管事件为事件组,其余患者为非事件组,对6个月内发生心血管事件患者的CRP、TBIL浓度进行直线回归分析。结果与对照组比较,AMI组患者TBIL、DBIL、IBIL浓度更低,CRP浓度更高,差异有统计学意义(P0.05)。与非事件组比较,事件组患者TBIL浓度较低,CRP浓度更高,差异有统计学意义(P0.05)。对6个月内发生主要不良心血管事件患者的CRP、TBIL浓度进行直线回归分析,其R-Square(确定系数)为0.851(P0.01)。结论 AMI患者TBIL、DBIL、IBIL浓度较健康体检者低,而CRP浓度更高;TBIL浓度越低,CRP浓度越高,AMI患者支架术后长期(6个月)预后越差。联合检测TBIL、CRP浓度可预测AMI患者支架术后长期主要不良心血管事件的发生率,能更准确预测其长期预后。     

原发性高血压患者胆红素及氧化应激水平与颈动脉粥样硬化的关系

目的探讨原发性高血压(EH)患者胆红素及氧化应激表达,及其与颈动脉粥样硬化的关系。方法连续入选2015年3月~2016年12月于琼海市人民医院心血管内科治疗的EH患者187例,根据彩色多普勒超声检查颈动脉内膜中层厚度(IMT)将患者分为EH患者(对照组,n=97)和EH合并动脉粥样硬化患者(研究组,n=90)。检测患者血清中胆红素水平,包括总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)水平,另外检测血清中氧化应激水平,包括同型半胱氨酸(HCY)、超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)及氧化型低密度脂蛋白(OX-LDL)水平。对比分析两组患者胆红素水平及氧化应激因子水平,同时分析不同动脉粥样硬化程度患者的各检测因子水平及相关性,另外分析各检测因素的相关性。结果两组患者年龄、性别构成比、体质指数(BMI)、病程等比较,差异均无统计学意义(P0.05)。与对照组相比,研究组患者TBIL、DBIL、IBIL、SOD和NO水平均明显下降,而HCY、MDA及OX-LDL水平均显著升高,且差异均具有统计学意义(P均0.05)。随着动脉粥样硬化程度的升高,各组患者检测因子水平之间的差异均具有统计学意义(P0.05),与内膜增厚组相比,内膜斑块形成组和内膜狭窄组患者的TBIL、DBIL、IBIL、SOD及NO水平明显下降,而HCY、MDA及OX-LDL水平显著升高;与内膜斑块形成组相比,内膜狭窄组患者的TBIL、DBIL、IBIL、SOD及NO水平明显下降,而HCY、MDA及OX-LDL水平显著升高,且差异均具有统计学意义(P均0.05)。相关性分析结果显示,IMT值与TBIL、DBIL、IBIL、SOD和NO水平呈负相关,而HCY、MDA及OX-LDL水平呈正相关(P0.05)。同时,各检测指标存在密切的相关性,TBIL、DBIL、IBIL、SOD和NO水平与HCY、MDA及OX-LDL水平之间呈负相关,TBIL、DBIL、IBIL、SOD和NO水平之间呈正相关,HCY、MDA及OX-LDL水平之间呈正相关(P均0.05)。结论原发性高血压患者合并动脉粥样硬化的发生和发展,与血清胆红素水平及氧化应激反应密切相关,血清胆红素水平与氧化应激因子水平显著相关。     

红细胞分布宽度及胆红素与胃癌临床特征的关系

目的探讨红细胞分布宽度(RDW)和胆红素,包括:总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)在胃癌患者中的预后价值。方法收集2015年1月至2018年12月于徐州医科大学附属医院就诊的395例胃癌患者作为胃癌组,以同期在医院体检的150名健康人群作为对照组。回顾性分析两组RDW及胆红素的差异,以及胃癌患者术前RDW和胆红素与临床病理资料的关系。结果胃癌组RDW明显高于对照组,胆红素则明显低于对照组,差异均有统计学意义(P0.05);随着淋巴结转移、浸润深度加深、肿瘤最大直径增加、TNM分期升高、CEA增加、CA19-9增加,胃癌组患者的RDW升高,而TBIL、IBIL降低,差异均有统计学意义(P0.05);同时,随着肿瘤最大直径增加、TNM分期升高、CEA增加、CA19-9增加,胃癌组患者DBIL降低,差异均有统计学意义(P0.05)。结论 RDW和胆红素可能是胃癌患者的潜在预后因素。     

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.