血清25-羟维生素D水平与初诊原发性高血压患者动态动脉硬化指数的相关性研究

目的探讨血清25-羟维生素D水平与初诊原发性高血压患者动态动脉硬化指数(AASI)的相关性。方法选取2015年1月—2016年5月在保定市第一中心医院就诊的初诊原发性高血压患者158例,根据血清25-羟维生素D水平分为维生素D缺乏组98例和非维生素D缺乏组60例。采用24 h动态血压监测仪监测两组患者动态血压,并计算AASI。比较两组患者一般资料、实验室检查指标及AASI。血清25-羟维生素D水平与初诊原发性高血压患者AASI的相关性分析采用Pearson相关性分析;AASI的相关因素分析采用单因素线性回归分析及多因素线性回归分析。结果两组患者性别、年龄、收缩压、舒张压、平均动脉压、血小板计数及血红蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平比较,差异无统计学意义(P0.05);维生素D缺乏组患者AASI高于非维生素D缺乏组(P0.05)。Pearson相关性分析结果显示,血清25-羟维生素D水平与初诊原发性高血压患者AASI呈负相关(r=-0.343,P0.01)。多因素线性回归分析结果显示,血清25-羟维生素D水平与初诊原发性高血压患者AASI独立相关(β=-0.355,P0.05)。结论血清25-羟维生素D水平与初诊原发性高血压患者AASI呈负相关,血清25-羟维生素D降低时AASI升高,且二者独立相关。     

高血压患者动态动脉僵硬指数与血压变异性的关系

目的探讨高血压患者动态动脉僵硬指数(AASI)与血压变异性(BPV)的关系。方法入选2009-03-2011-10中国医科大学附属第一医院就诊的高血压患者119例,所有患者均行24h动态血压监测。AASI定义为1减去24h舒张压和收缩压的回归系数。依据AASI水平,分为4组:AASI<0.30、0.30～<0.41、0.41～<0.52、≥0.52。结果相关性分析显示,AASI分别与年龄(r=0.301,P<0.01)、24h收缩压(r=0.276,P=0.001)、白昼收缩压(r=0.225,P=0.008)、夜间收缩压(r=0.366,P<0.01)、24h脉压(r=0.510,P<0.01)、24h收缩压标准差(r=0.297,P=0.001)呈正相关,而与24h舒张压标准差(r=-0.256,P=0.002)、24h平均心率标准差(r=-0.205,P=0.017)及24h平均动脉压标准差(r=-0.202,P=0.017)呈负相关。多元线性逐步回归分析显示,AASI与24h脉压和24h收缩压标准差呈正相关(β=0.321,β=0.725,均P<0.01),与24h舒张压标准差和24h平均动脉压标准差呈负相关(β=-0.428,β=-0.346,均P<0.01)。结论 AASI与BPV密切相关。     

高血压患者血清尿酸水平与血压变异性的关系

目的探讨高血压患者血清尿酸水平与血压变异性(BPV)的关系。方法收集2015年6月至2016年12月在福建医科大学附属泉州第一医院住院临床诊断为高血压的患者160例为研究对象,其中男性87例、女性73例,年龄36~82(63.4±10.3)岁。所有患者均行24h动态血压监测以及血脂、空腹血糖、肌酐、血清尿酸等生化指标检测。根据血清尿酸水平分为尿酸正常组(血清尿酸420μmol/L,n=96)、尿酸升高组(血清尿酸≥420μmol/L,n=64),比较两组基础资料及动态血压参数的差异。采用Pearson相关性分析尿酸与BPV的关系;应用多元线性回归分析BPV的影响因素。结果尿酸正常与升高组24h平均舒张压(24hDBP)、日间平均舒张压(dDBP)、夜间平均舒张压(nDBP)比较,差异无统计学意义(均P0.05);而24h平均收缩压(24hSBP)、日间平均收缩压(dSBP)、夜间平均收缩压(nSBP)、24h收缩压标准差(24hSBPSD)、24h舒张压标准差(24hDBPSD)、日间收缩压标准差(dSBPSD)、日间舒张压标准差(dDBPSD)、夜间收缩压标准差(nSBPSD)、夜间舒张压标准差(nDBPSD)比较,差异有统计学意义(均P0.05)。Pearson相关性分析结果显示,尿酸与24hSBPSD(r=0.620)、24hDBPSD(r=0.254)、dSBPSD(r=0.646)、dDBPSD(r=0.212)、nSBPSD(r=0.606)、nDBPSD(r=0.385)呈正相关(均P0.05)。多元线性回归分析结果显示,尿酸是24hSBPSD、24hDBPSD、dSBPSD、dDBPSD、nSBPSD、nDBPSD的影响因素(均P0.05)。结论尿酸可能是高血压患者BPV的影响因素。     

高血压患者和健康人动态动脉硬化指数与脉搏波传导速度比较

目的:比较不同年龄、血压水平的健康人和高血压患者动态动脉硬化指数(AASI)与脉搏波传导速度(PWV)的差异,分析其相关性,探讨AASI作为评价动脉弹性指标的可行性。方法:选取健康体检者167例和高血压患者148例,分别按年龄和血压分级标准分组,进行PWV测量及24h动态血压监测,根据24h动态舒张压与动态收缩压之间的关系,计算出回归斜率,AASI定义为1减去该斜率,对AASI与PWV进行比较研究。结果:随着年龄不断增长,两组的PWV和AASI值逐渐升高(P0.05～0.01),两组女性AASI明显高于男性[健康对照组(0.55±0.18)∶(0.48±0.15),高血压组(0.61±0.16)∶(0.55±0.17),P均0.01]。PWV在性别上无显著差异(P0.05);校正年龄因素影响后,高血压组PWV、AASI明显比健康对照组高,并随着血压水平的升高,PWV、AASI逐渐升高(P0.05～0.01);Pearson相关性分析表明:AASI与年龄、体重指数、24h平均收缩压、24h脉压、PWV呈正相关(r=0.106～0.573,P0.05～0.001),与24h平均舒张压呈负相关,其中以PWV相关性最显著(r=0.573,P0.001)。结论:年龄、血压、脉压和PWV都与AASI呈正相关;AASI作为评价动脉弹性指标,可能比测量血压更能准确反映血管功能状态,有助于筛选出处于亚临床状态的心血管病人。     

原发性高血压患者动态动脉硬化指数与血压昼夜节律及微量白蛋白尿的相关性

目的探讨原发性高血压(高血压)患者动态动脉硬化指数(ambulatory arterial stiffness index,AASI)与微量白蛋白尿(microalbuminuria,MAU)及血压昼夜节律的相关性,为预防高血压患者发生心血管事件提供依据。方法入选215例高血压患者,监测其24 h动态血压并检测生化指标、MAU等指标,采用Pearson相关分析、多因素Logistic回归进行分析。结果 AASI≥中位数(0.57)组患者的年龄、尿肌配、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、AASI、内膜中层厚度(intima-media thickness,IMT)、颈动脉指数、MAU、踝动脉收缩压(ankle systolic blood pressures,ASBP)、踝动脉舒张压(ankle diastolic blood pressures,ADBP)等指标明显高于AASI中位数(0.57)组(P0.05)。MAU阳性组AASI水平明显高于MAU阴性组,非构型血压组AASI水平明显高于构型血压组,差异有统计学意义(P0.05)。AASI、颈动脉指数均与尿白蛋白/尿肌酐比值呈正相关关系(r=0.5400,r=0.4254;P0.0001)。年龄、MAU阳性、AASI中位数(0.57)、饮酒史是血压昼夜节律的独立危险因素,引起非构型血压的危险度分别升高3.226、2.202、1.998、1.785倍。结论对于高血压患者应进行AASI评估,有助于了解其血压昼夜节律现象和肾功能损伤情况,一定程度上可以尽早了解其心血管事件的发生危险,预防病情恶化。     

高血压患者动态动脉硬化指数与左心室舒张功能的相关性

目的探讨高血压患者动态动脉硬化指数(AASI)与左心室舒张功能的相关性。方法选择安徽医科大学合肥第三临床学院心内科住院,且初次诊断为原发性高血压患者143例,按是否存在左心室舒张功能不全分为两组,并选择血压正常的患者为对照组(60例)。所有患者入院后在服药前均检测血尿酸、空腹血糖、总胆固醇等水平。心脏多普勒超声评价左心室舒张功能。并采用常规24 h动态血压监测数据计算高血压病患者AASI。分析比较三组间患者AASI与左心室舒张功能的相关性。结果三组患者性别、年龄、体质指数、空腹血糖、总胆固醇及高密度脂蛋白比较差异均无统计学意义(P0.05);左心室舒张功能不全组患者AASI、血尿酸、同型半胱氨酸、高敏C反应蛋白及低密度脂蛋白水平等明显高于左心室舒张功能正常组(P0.05)。Logistic多因素回归分析表明,AASI是高血压患者左心室舒张功能的影响因素。Pearson相关性分析显示AASI与E/A呈明显负相关(r=-0.697,P0.05),AASI与E/Ea呈明显正相关(r=0.614,P0.05)。结论 AASI可能是原发性高血压患者出现左心室舒张功能不全的一个标志。     

平均血小板体积/血小板计数、载脂蛋白B/A1与高血压患者动态动脉硬化指数的相关性

目的探讨平均血小板体积/血小板计数(MPV/PLT)、载脂蛋白B/A1(ApoB/A1)与高血压患者动态动脉硬化指数(AASI)的相关性。方法选取2015年5月至2018年6月期间收治的高血压患者228例为研究对象,根据AASI中位数的大小分为A组(24 h AASI0.53,n=111)和B组(24 h AASI≥0.53,n=117)。比较各组间基本资料及MPV/PLT、ApoB/A1水平,并进行Pearson相关分析与Logistic回归分析。结果 A组的年龄、病程、收缩压、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、AASI、MPV/PLT、ApoB/A1低于B组,舒张压高于B组(均P0.05)。高MPV/PLT高血压患者AASI高于低MPV/PLT者(0.65±0.06比0.48±0.04,P0.05)。高ApoB/A1高血压患者AASI高于低ApoB/A1者(0.62±0.07比0.50±0.06,P0.05)。Pearson相关性分析显示,高血压患者年龄、病程、收缩压、总胆固醇、LDL-C、MPV/PLT、ApoB/A1与AASI相关(r=0.621、0.704、0.725、0.675、0.653、0.677、0.716,均P0.05)。Logistic多元逐步回归分析显示,年龄、病程、收缩压、总胆固醇、LDL-C、MPV/PLT、ApoB/A1是高血压患者AASI的独立危险因素。结论 MPV/PLT、ApoB/A1与高血压患者AASI升高有关。     

高血压患者动态脉压相关指数与早期肾脏损害

目的探讨中老年原发性高血压(EH)患者动态脉压相关指数即24 h平均脉压(24 h PP)、动态脉压指数(PPI)和动态动脉硬化指数(AASI)预测早期肾脏损害的意义。方法对104例中老年EH患者进行血压测量和24 h动态血压监测,观察不同24hPP、PPI、AASI、肾小球滤过率(GFR)、微量白蛋白尿(MAU)及血清胱抑素C(Cys-C)的变化;采用受试者工作特征曲线(ROC)判断24hPP、PPI和AASI在预测肾脏功能早期受损的意义;采用多元线性逐步回归分析肾脏功能早期受损相关因素。结果以24hPP≥55 mm Hg、PPI≥0.36及AASI≥0.30为切点,高血压患者的GFR水平明显低(P<0.01);24hPP、PPI和AASI的ROC下面积从大到小依次为AASI、PPI和24hPP;多元线性逐步回归结果显示年龄(P=0.009)和高血压病程(P=0.008)与GFR的变化密切相关,且随着年龄的增长和高血压病程的延长,GFR有逐渐下降的趋势;相关和多因素回归分析结果显示GFR与年龄(r=-0.367,P=0.001)、高血压病程(r=-0.371,P=0.001)、24hPP(-0.254,P=...     

动态血压与老老年高血压脑白质疏松患者认知功能的关系

目的比较老老年高血压患者不同程度脑白质疏松(leukoaraiosis,LA)的动态血压参数与认知功能的相关性。方法对80例老老年高血压患者行24h动态血压监测,观察24h收缩压变异性(systolic blood pressure variability,SBPV)、24h舒张压变异性(diastolic blood pressure variability,DBPV)、动态动脉硬化指数(ambulatory arterial stiffness index,AASI)、动态脉压指数(ambulatory pulse pressure index,APPI)等;并对患者行简易智能状态检查量表(MMSE)评估。结果与LA 0级比较,1级、2级、3级的24hSBPV、24hDBPV、AASI、APPI增大(P0.05);与LA 1级比较,2级、3级24h-SBPV、24h-DBPV、AASI、APPI增大(P0.05);LA 3级的24h-SBPV、AASI和APPI显著高于2级,差异有统计学意义(P0.05)。与LA 0级、1级比较,2级、3级的记忆力、注意力和计算力、回忆能力、语言能力和总分显著降低,差异有统计学意义(P0.05)。24hSBPV(r=-0.8697,P=0.000)、24hDBPV(r=-0.6709,P=0.002)、AASI(r=-0.8373,P=0.000)、APPI(r=-0.5991,P=0.007)与MMSE呈显著负相关。结论 LA程度越重,24hSBPV、AASI、APPI越大;24hSBPV、AASI可能作为LA、认知功能下降的预测指标。     

高血压患者脉搏波流速与血压及血压变异性指标的相关性分析

目的评估高血压患者脉搏波流速(PWV)与血压变异性指标的相关性。方法自2015年1月~2015年7月连续入组京西医院心内科门诊的高血压患者50例,均进行24 h动态血压监测(ABPM)和PWV检查,计算患者的血压变异性指标,包括24 h、日间、夜间收缩压及舒张压的标准差(SD)、变异系数(CV)和血压变异时率(每分钟血压的变化)。结果 50例高血压患者平均年龄(61.16±8.99)岁,男性19例(38.0%),其中糖尿病患者占30.0%,血脂异常患者占72.0%。24 h平均血压为125.25/76.15 mmHg(1 mmHg=0.133k Pa),PWV为7.86 m/s。血压变异性指标分析可知收缩压的标准差、血压变异时率高于舒张压;而舒张压的血压变异系数高于收缩压。Pearson相关性分析结果表明:调整性别、年龄、糖尿病、血脂异常及服用药物情况后,PWV与24 h平均SBP(r=0.326,P=0.045)、24 h平均DBP(r=0.486,P=0.002)、日间平均SBP(r=0.324,P=0.047)、日间平均DBP(r=0.496,P=0.002)和夜间平均DBP(r=0.400,P=0.013)呈明显正相关。而并没有发现PWV与血压变异指标的相关性(P均0.05)。结论基于本研究结果发现高血压患者PWV与动态血压绝对值相关,而并没有发现其与血压变异性指标的相关性。     

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.