早发冠心病患者同胞及子女血脂与载脂蛋白E基因多态性研究

目的 :探讨早发冠心病患者同胞及子女与正常对照人群血脂分布特点、载脂蛋白E(apoE)基因型及其等位基因频率分布和对血脂的调节作用。方法 :检测早发冠心病患者的 72例同胞及子女 (病例组 )的血脂参数 ,应用聚合酶链反应及限制性片段长度多肽性分析各自的apoE基因型及其等位基因频率分布 ,并与 81例年龄相匹配并且父母和同胞无明显冠心病的对照者 (对照组 )进行比较。结果 :病例组血浆总胆固醇 (TC)和脂蛋白a[Lp(a) ]较对照组明显升高 [(4 .5 9± 1.6 1)mmol/L∶(4 .0 8± 1.0 2 )mmol/L ,P <0 .0 5 ;(2 41.88± 119.2 5 )mg/L∶(182 .2 4± 90 .2 0 )mg/L ,P <0 .0 1]。两组人群共有apoE基因型 6种 ,ε2 / 2 ,ε4/ 4和ε4/ 2为少见基因型。病例组ε4/ 3基因型和ε4等位基因频率明显高于对照组 (P <0 .0 5 )。病例组ε4/ 3基因型组血浆TC和低密度脂蛋白胆固醇 (LDL C)高于对应ε2 / 3组。病例组ε2 / 3基因型组血浆高密度脂蛋白胆固醇 (HDL C)高于对应ε4/ 3组。结论 :早发冠心病患者同胞及子女除了有早发冠心病家族史外 ,血浆TC、Lp(a)明显高于对照组 (P <0 .0 5～0 .0 1)。病例组ε4/ 3基因型和ε4等位基因频率明显高于对照组 (P <0 .0 5 ) ,并影响血浆TC、LDL C和HDL C的水平     

雌激素替代疗法对绝经后妇女血清血管 紧张素转化酶及血脂代谢的影响

目的　探讨雌激素替代疗法 (ERT)对绝经后妇女血清血管紧张素转化酶 (ACE)含量及血脂代谢的影响。方法　测定 30例健康绝经后妇女应用ERT(治疗组 )前及应用ERT 14周后血清ACE、雌二醇 (E2 )及血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、脂蛋白 (a) [Lp(a) ]含量 ,并与 30例健康绝经后妇女应用安慰剂 (对照组 )进行对照。结果　对照组应用安慰剂前后 ,ACE及血脂各项含量无变化 ;治疗组应用ERT后 ,ACE含量明显降低且与E2 呈负相关 ,血清TC、LDL C及Lp(a)含量降低 ,HDL C含量升高 ,TG无变化。结论　绝经后妇女补充雌激素 ,可通过降低血清ACE水平及改善血脂代谢共同发挥对心血管系统的保护作用。     

血脂和内皮功能异常在微血管性心绞痛发病学中的意义

目的　研究血脂紊乱和血管内皮功能失调在微血管性心绞痛患者发病学中的意义。方法　测定 2 1例微血管性心绞痛患者血脂水平并同时采用高分辨超声技术检测其血管内皮舒张功能 ,与 2 4例正常人 (对照组 )作比较。结果　 (1 )微血管性心绞痛组血脂异常主要表现为总胆固醇(TC)、低密度脂蛋白 胆固醇 (LDL C)、载脂蛋白B1 0 0 (ApoB1 0 0 )和脂蛋白 (a) [Lp(a) ]明显升高 (P值均 <0 0 5 ) ;(2 )微血管性心绞痛组肱动脉血流介导性内皮舒张功能较对照组明显减退 [(4 7± 1 9) %比(1 2 8± 3 7) %,P <0 0 0 1 ],而两组对硝酸甘油的反应差异无显著性意义 [(1 9 7± 8 1 ) %比 (2 1 2±6 6 ) %,P >0 0 5 ];(3 )微血管性心绞痛组肱动脉内皮依赖性舒张与血清LDL C和Lp(a)水平呈显著的负相关 (r=- 0 5 1 2 5和 - 0 42 71 ,P均 <0 0 0 1 )。按血流介导的肱动脉舒张程度将两组合并后分为A、B两组 (A组≤ 4 %,B组 >4 %) ,结果显示 :A组LDL C水平升高显著 [(4 0 9± 0 6 5 )mmol/L比 (2 5 9± 0 49)mmol/L ,P <0 0 5 ]。结论　 (1 )微血管性心绞痛患者血脂异常以TC、LDL C、ApoB1 0 0 和Lp(a)升高为主 ,同时存在明显的血管内皮依赖性舒张功能障碍 ,提示血脂紊乱和内皮功能异常在其发病中起重要作用 ;(2     

绝经后心肌梗死患者性激素与脂代谢关系的临床研究

目的:探讨绝经后心肌梗死（MI）患者性激素（SH）与脂代谢之间的关系。方法:利用放免法、免疫酶法、酶法分别检测绝经后妇女MI组（30例）和绝经后妇女对照组（30例）血中雌二醇（E2）、孕酮（P）、睾酮（T）、脂蛋白（a）[Lp（a）]、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平。结果:与绝经后妇女对照组相比,绝经后MI组E2、E2/P、E2/T、HDL-C水平显著降低（100.35±41.26pmol/L:148.38±46.44pmol/L,P<0.001,90.52±65·48:149.75±116.74,P<0.05,104.52±64.24:154.22±111.34,P<0.05,0.95±0.30mmol/L:1.12±0.43mmol/L,P<0.05）,Lp（a）、LDL-C、TG、TC水平明显升高（21.31±17.93 mg/dl:13.52±13.04mg/dl,P<0.05.2.98±1.04mmol/L:2.15±1.19mmol/L,P<0.05,1.63±1.44mmol/L:1.13±0.55mmol/L,P<0.05,4.23±0.94mmol/L:3.50±1.36mmol/L,P<0.05）,E2与Lp（a）、LDL-C均呈负相关（r=-0.373,P<0.05,r=-0.635,P<0.01）,与HDL-C呈正相关（r=0.378,P<0.05）.结论:绝经后MI患者存在明显的以E2。水平不足为主的性激素紊乱和脂代谢异常,脂代谢异常和E2水平不足密切相关;E2水平不足促进脂代谢异常,可能是绝经后妇女MI发生的重要原因之一。     

2型糖尿病患者血清脂蛋白(a)水平及其与冠心病的关系

目的　探讨 2型糖尿病患者血清脂蛋白 (a) [Lp(a) ]水平及其与冠心病的关系。方法　选择 90例 2型糖尿病及 6 8例健康对照者测定其血清Lp(a)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)水平 ;计算低密度脂蛋白胆固醇 (LDL C)水平及TC、TG、LDL C与HDL C比值。结果　 (1)糖尿病组血清Lp(a)水平与对照组比较差异无显著性意义 (P >0 .0 5 )。 (2 )将 2型糖尿病患者分为糖尿病伴冠心病和单纯糖尿病亚组后发现 :①糖尿病伴冠心病亚组血清Lp(a)水平明显高于单纯糖尿病亚组 [(2 3.78± 2 3.73)mg/dlvs (13.31± 10 .6 6 )mg/dl;P <0 .0 1]及对照组 [(2 3.78± 2 3.73)mg/dlvs (16 .2 8± 17.95 )mg/dl;P <0 .0 5 ];②糖尿病伴冠心病亚组血清Lp(a)水平与LDL C呈正相关关系 (r =0 .32 16 ,P <0 .0 5 )。结论　 2型糖尿病患者血清Lp(a)水平增高可能与冠心病发病有密切关系。     

小剂量尼尔雌醇对绝经后妇女脂蛋白(a)和血脂的调脂疗效

目的 :观察小剂量、长效尼尔雌醇对绝经后妇女脂蛋白 (a)〔 Lp(a)〕和血脂的影响。方法 :选择绝经 2年以上的妇女 54例 ,随机分为治疗组和对照组。治疗组每月服尼尔雌醇 1次 ,每次 2mg。结果 :治疗组 3个月后 HDL- C、apo- AI明显升高 ,LDL- C降低 ,Lp(a)治疗半年后开始下降 ,治疗 9个月后与对照组相比有显著性差异 ,1年后降低仍较显著 ,TC、TG无明显改变。对照组前后无明显改变。结论 :尼尔雌醇副作用轻 ,同时减轻绝经期妇女的更年期综合征症状。对高 Lp(a)、高LDL- C或者低 HDL- C水平的绝经妇女可作为最初单一预防冠心病的药物使用     

尼尔雌醇替代治疗对绝经后妇女血脂及血流变的影响

目的　观察尼尔雌醇替代治疗对绝经后妇女血脂及血液流变学的影响。　 方法 　对 36例绝经后妇女用尼尔雌醇进行替代治疗 ,剂量为每半月 2mg ,共 6月 ,最后 7d加用安宫黄体酮 8mg·d-1,于用药前和治疗 6月后分别测血脂及血液流变学指标。　 结果 　尼尔雌醇替代治疗 6月后血总胆固醇 (TC)、低密度脂蛋白胆固醇(LDL C)、TC/高密度脂蛋白胆固醇 (HDL C)、LDL C/HDL C均明显下降 (P <0 0 1) ,HDL C明显升高 (P <0 0 1) ,血纤维蛋白原 (PFC)、全血粘度 (ηb)、血浆粘度 (ηp)、细胞压积 (HCT)均显著下降 (P <0 0 1) ,血液还原粘度 (ηr)明显下降(P <0 0 5 )。　 结论 　用尼尔雌醇替代治疗能明显改善血脂紊乱 ,降低血粘度。     

高脂血症患者血脂蛋白a水平的研究

目的　研究高脂血症 (HLP)患者血脂蛋白a[Lp(a) ]水平的变化。方法　用免疫比浊法测定 30例HLP患者血Lp(a) ,同时测定研究对象血胆固醇 (TC)、甘油三酯(TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇(LDL C)、载脂蛋白AI(ApoA1)及载脂蛋白B(ApoB)。结果　HLP患者血Lp(a)显著高于对照组 (2 17 5± 14 5 3vs15 0 3± 14 9 8,P <0 0 5 )。HLP患者血Lp(a)与TC的相关系数为 0 6 4 3(P <0 0 1)。结论　HLP患者血Lp(a)明显升高 ,是冠心病 (CHD)、动脉粥样硬化 (AS)的危险因子。     

老年人冠心病确诊前血脂变化研究

目的　研究老年人冠心病确诊前血脂变化特点。方法　确诊冠心病当年及前 4年的总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (L DL )和高密度脂蛋白胆固醇 (HDL)水平并进行比较。结果　冠心病组与无冠心病组血脂比较 :TC5.1 5± 0 .91 mmol/ L与 5.0 2± 0 .98mmol/L,TG1 .55± 0 .86mmol/ L与 1 .53± 0 .96mmol/ L,HDL 1 .33± 0 .34mmol/ L与 1 .46± 0 .45mmol/ L,LDL3.1 2± 0 .94mmol/ L与 2 .73± 0 .79mmol/L ,LDL/ HDL2 .53± 1 .0 9与 1 .91± 0 .66。研究组确诊当年、前 1年、前 2年、前 3年和前 4年的血脂变化 :HDL1 .33± 0 .34、1 .30± 0 .37、1 .34± 0 .31、1 .32± 0 .35和 1 .43± 0 .44;LDL3.1 2± 0 .94、3.2 3± 0 .98、3.0 4± 0 .86、2 .33± 0 .99和 2 .89± 0 .96。结论　冠心病危险因子在确诊冠心病前的第1年最高 ,提示在进入老年期血脂仍旧在改变 ,冠心病危险因子不断升高 ,保护因子不断降低 ;老年人仍有必要采取干预血脂措施。     

中老年女性脂蛋白(a)含量测定及临床意义

目的　观察中老年女性血清脂蛋白 (a)〔LP(a)〕及血脂含量与心、脑血管疾病的发生、发展的关系。方法　采用电泳法和酶法检测30 5例中老年女性血清LP(a)及血脂含量。结果　中老年女性绝经后组 ,血清中LP(a)、LDL C、TC、TG含量高于绝经前组 (P <0 .0 1或P <0 .0 5) ;HDL C、和E2 低于绝经前组 (P <0 .0 1或P <0 .0 5)。心、脑血管疾病组LP(a)、LDL C、TC、TG均明显高于对照组 (P <0 .0 1或P <0 .0 5) ,HDL C低于对照组 (P <0 .0 5)。结论　中老年女性绝经后血清中LP(a)、LDL C、TC、TG含量升高 ,HDL C含量降低使中老年女性增加了患心脑血管疾病的危险。     

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.