洛伐他汀对老年高血压病合并高胆固醇血症患者的降脂疗效观察(摘要)

从受体水平阻断肾素－ 血管紧张素系统的生物学效应来探讨血管紧张素Ⅱ和醛固酮对高血压大鼠心肌肥厚及纤维化的作用,将二肾一夹型高血压大鼠分为高血压治疗组和高血压对照组,高血压治疗组在术后第１６ 周通过饮水给予缬沙坦（１０ μｇｇ·ｄ）,高血压对照组和假手术组不给药。术后第１６ 周、２０ 周及２８ 周分别处死大鼠,测定血压、心脏和左心室重量、血浆和心肌血管紧张素Ⅱ及醛固酮浓度、左心室重量指数、心肌胶原含量及胶原容积分数。结果发现,高血压对照组大鼠血浆和心肌血管紧张素Ⅱ及醛固酮浓度、左心室重量指数、心肌胶原浓度及胶原容积分数均显著高于假手术组（ Ｐ＜０．０５ 或０．００５）;与高血压对照组比较,高血压治疗组血浆血管紧张素Ⅱ浓度明显增高,血压、左心室重量指数、血浆醛固酮浓度、心肌胶原浓度及胶原容积分数则显著降低（Ｐ＜０．０５） ,且主要是Ⅰ型胶原减少。结果提示,肾血管性高血压大鼠左心室重塑与心肌血管紧张素Ⅱ和醛固酮浓度密切相关,血管紧张素Ⅱ１ 型受体拮抗剂缬沙坦可以阻断血管紧张素Ⅱ的病理生理作用,抑制醛固酮的释放,逆转左心室重塑,心脏局部血管紧张素Ⅱ的生物学效应可能主要是血管紧张素Ⅱ１ 型受体所介导     

培哚普利对肾性高血压大鼠心肌纤维化及转化生长因子β1的影响

目的探讨培哚普利对肾性高血压大鼠心肌纤维化作用及对转化生长因子-β1表达影响。方法建立双肾一夹肾血管性高血压(2K1C)大鼠模型,将24只实验大鼠随机分为假手术组、高血压组、培哚普利组,术后4周末开始灌胃培哚普利片2mg/(kg.d),共8周。测量大鼠尾动脉收缩压、心脏重量/体重、心肌胶原容积分数(CVF)、血管周围胶原容积分数(PVCA)及转化生长因子-β1(TGF-β1)的表达。结果和假手术组相比,高血压组的收缩压、心脏重量/体重、CVF及PVCA显著增加(P<0.01),TGF-β1表达上调(P<0.01)。和高血压组相比,培哚普利组心脏重量/体重、CVF、PVCA及TGF-β1的表达降低(P<0.05)。结论培哚普利可以减轻肾性高血压大鼠心肌纤维化,其机制可能与下调TGF-β1有关。     

肾素—血管紧张素系统对大鼠心肌缺血和缺血再灌注后左心室功能的影响

目的　观察肾素 血管紧张素系统 (RAS)对大鼠心肌缺血和缺血再灌注后左心室功能的影响 ,以及给予氯沙坦和培哚普利干预的结果。方法　结扎大鼠左冠状动脉前降支造成心肌梗死 ,30min后松解结扎线再灌注心肌 6 0min ,假手术组只穿线不结扎 ,大鼠随机分为假手术组、生理盐水对照组、氯沙坦组、培哚普利组。监测大鼠心肌缺血 30min和缺血再灌注 6 0min时血流动力学和左心室功能、循环RAS组分、肌酸激酶 (CK)和去甲肾上腺素(NE)等指标。结果　①与假手术组比较 ,对照组的左室舒张末压在冠脉结扎和再灌注后均升高 ,而血压、左室收缩压和±dp/dt则显著降低 ;与对照组比较 ,两个用药组大鼠的心功能明显改善 ;②对照组血浆NE、CK水平明显高于假手术组和用药组 ;③对照组血浆各RAS组分水平比假手术组明显升高 ;用药组则明显抑制RAS活性。结论　①大鼠心肌缺血和再灌注后发生左心室功能障碍 ;②心肌缺血和缺血再灌注损伤后循环RAS被激活 ;③氯沙坦和培哚普利可以保护心肌细胞 ,改善左心室功能障碍     

滋肾活络方联合培哚普利对自发性高血压大鼠左室肥厚的影响

目的探讨滋肾活络方联合培哚普利对自发性高血压大鼠(SHR)血压及左心室肥厚的影响。方法以16周龄SHR为高血压左心室肥厚模型,随机分为模型组、培哚普利组、联合用药组。分别在0、4、8、12 w动态检测尾动脉平均动脉压(MBP)。干预12 w后,测量大鼠左心室质量(LVM),计算左心室质量指数(LVMI);左室心肌苏木素-伊红(HE)染色,观察形态变化;酶联免疫吸附(ELISA)法检测大鼠血清Ⅰ型前胶原羧基端前肽(PICP)及Ⅰ型胶原羧基末端交联肽(ICTP)浓度,计算PICP/ICTP比值。结果联合用药组可有效降低SHR的MBP;减轻SHR的心肌损伤,改善间质重构;降低LVMI及血清PICP浓度、PICP/ICTP比值。结论滋肾活络方联合培哚普利能够有效降低动脉压、减缓左室肥厚。     

血管紧张素Ⅱ1型受体拮抗剂与醛固酮受体拮抗剂对逆转高血压大鼠心肌重塑的作用

在受体水平阻断肾素—血管紧张素系统 ,比较血管紧张素Ⅱ 1型受体拮抗剂与醛固酮受体拮抗剂对逆转高血压心肌重塑的作用 ,来探讨高血压性心肌重塑的可能机理。为此 ,制作二肾一夹型高血压大鼠模型形成心肌肥厚及纤维化 ,然后分成高血压对照组、缬沙坦组 [10 μg (kg·d) ]和螺内酯组 [4 0mg (kg·d) ]。分别观察给药前、给药后 4周和 12周血浆及心肌血管紧张素Ⅱ和醛固酮含量、左心室重量指数、心肌胶原含量、心肌胶原容积分数及Ⅰ、Ⅲ型胶原的病理特征。结果发现 ,与高血压对照组比较 ,缬沙坦组左心室重量指数、心肌胶原含量和心肌胶原容积分数显著下降 (P <0 .0 5 ) ,以降低Ⅰ型胶原沉积为主 ;螺内酯组左心室重量指数、心肌胶原含量和心肌胶原容积分数亦有所下降 (P <0 .0 5 ) ,以降低Ⅲ型胶原沉积为主 ,但作用不如缬沙坦。结果提示 ,左心室肥厚发展过程与心肌纤维化存在异时性。血管紧张素Ⅱ和醛固酮在心肌重塑过程中起关键作用 ,血管紧张素Ⅱ 1型受体可能主要介导Ⅰ型胶原的沉积 ,而醛固酮受体可能主要介导Ⅲ型胶原的沉积。     

牛磺酸对肾性高血压大鼠血浆及心肌血管紧张素Ⅱ、醛固酮的影响

目的　观察牛磺酸 (Tau)对肾性高血压大鼠血浆及心肌血管紧张素 (Ang )、醛固酮 (Ald)的影响。方法　Wistar大鼠随机分为假手术组 (Sham组 )、二肾一夹肾性高血压模型组 (2 K1C组 )、Tau治疗组 (2 K1C+Tau组 ) ,每组 8只。测定并比较各组尾动脉收缩压 (SBP)、左心室重量指数 (L VWI)、心肌胶原含量、心肌纤维直径、血浆及心肌 Ang 、Ald含量。结果　 2 K1C组大鼠 SBP、L VWI、心肌胶原含量、心肌纤维直径、血浆及心肌 Ang 、Ald含量较 Sham组显著增加 (P<0 .0 1)。牛磺酸 (5 0 mg/ kg· d)治疗 8周显著降低 2 K1C大鼠 SBP、L VWI、心肌胶原含量、心肌纤维直径、血浆及心肌 Ang 和 Ald含量 (P<0 .0 1)。结论　牛磺酸可降低肾性高血压大鼠循环及心肌局部肾素血管紧张素醛固酮系统 (RAAS)活性 ,抑制心肌细胞肥大及胶原增生 ,有效防治左室肥厚     

ACEI联合小剂量安体舒通对原发性高血压胶原更新的临床实验研究

目的观察在同等控制血压前提下血管紧张素转换酶抑制剂(ACEI)加安体舒通对心脏胶原更新的影响.方法临床研究随机入选原发性高血压患者135人,随机分入A(ACEI+安体舒通)、B(ACEI)、C[非肾素血管紧张素醛固酮系统(RAAS)干预治疗]三组,观察一年,比较三种治疗方案对心肌胶原更新的影响.动物实验使用肾动脉上腹主动脉次全结扎高血压心肌肥厚模型SD大鼠48只,随机分为A(ACEI+安体舒通)、B(ACEI)、C(空白对照)、D(伪手术)四组,治疗2个月,从病理上验证ACEI加安体舒通对心脏胶原更新的影响.结果临床研究显示在同等控制血压的前提下,减低血清PⅢNP的疗效,ACEI联合抗醛固酮治疗优于单纯ACEI治疗,两者均优于非RAAS干预治疗.动物研究显示ACEI联合抗醛固酮治疗使心肌间质胶原沉积明显减低.结论 ACEI联合抗醛固酮治疗比单纯ACEI治疗更好的减低血清PⅢNP,并使心肌间质胶原沉积明显减低,而且该作用不依赖于血压下降.     

培哚普利对肾性高血压大鼠肾脏血管紧张素转换酶2的影响

目的采用两肾一夹(2K1C)高血压大鼠模型,了解培哚普利对高血压大鼠肾脏血管紧张素转换酶2(ACE2)表达的影响。方法40只雄性大鼠随机分为5组:正常对照组;2K1C高血压组;缬沙坦组;高剂量培哚普利组;低剂量培哚普利组。给药8周后,计算心重指数,放射免疫分析法测定血浆血管紧张素(Ang)Ⅱ水平,逆转录聚合酶链反应(RT-PCR)检测肾脏ACE2 mRNA表达,免疫组织化学法检测肾脏ACE2表达。结果培哚普利和缬沙坦治疗都明显降低高血压大鼠血压(P<0.01);RT-PCR和免疫组织化学染色结果显示2K1C高血压大鼠肾脏ACE2表达较正常大鼠降低(P<0.05);经培哚普利及缬沙坦治疗后大鼠ACE2表达明显高于2K1C高血压组(P<0.05)。高剂量培哚普利组血浆AngⅡ降低较缬沙坦组明显(P<0.01)。2K1C高血压大鼠心重指数明显高于各给药组(P<0.01)。结论2K1C高血压大鼠肾脏组织中ACE2表达降低,培哚普利及缬沙坦在降压的同时能增加肾脏组织ACE2的表达。     

ACEI联合小剂量安体舒通对原发性高血压胶原更新的临床实验研究

目的 观察在同等控制血压前提下血管紧张素转换酶抑制剂(ACEI)加安体舒通对心脏胶原更新的影响。方法 临床研究随机人选原发性高血压患者135人，随机分人A(ACEI 安体舒通)、B(ACEI)、C[非肾素血管紧张素醛固酮系统(RAAS)干预治疗]三组，观察一年，比较三种治疗方案对心肌胶原更新的影响。动物实验使用肾动脉上腹主动脉次全结扎高血压心肌肥厚模型SD大鼠48只，随机分为A(ACEI 安体舒通)、B(ACEI)、C(空白对照)、D(伪手术)四组，治疗2个月，从病理上验证ACEI加安体舒通对心脏胶原更新的影响。结果 临床研究显示在同等控制血压的前提下，减低血清PⅢNP的疗效，ACEI联合抗醛固酮治疗优于单纯ACEI治疗，两者均优于非RAAS干预治疗。动物研究显示ACEI联合抗醛固酮治疗使心肌间质胶原沉积明显减低。结论 ACEI联合抗醛固酮治疗比单纯ACEI治疗更好的减低血清PⅢNP，并使心肌间质胶原沉积明显减低，而且该作用不依赖于血压下降。     

缬沙坦对不同时期高血压大鼠血浆和心肌肾素-血管紧张素系统及左心室重塑的影响

从受体水平阻断肾素－血管紧张素系统的生物学效应来探讨血管紧张素Ⅱ和醛固酮对高血压大鼠心肌肥碍及纤维化的作用,将二肾一夹高血压大鼠分为高血压治疗组和高血压对照组,高血压组在术后第１６周通过饮水给予缬沙坦（１０μｇ／ｇ．ｄ）,高血压对照组和假手术组不给药。术后第１６周、２０周及２８周分别处死大鼠,测定血压、心脏和左心室重量、血浆和心肌血管紧张素Ⅱ及醛固酮浓度、左心室重量指数、心肌胶原含量及胶原容积分数     

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.