门脉高压患者降钙素基因相关肽、神经肽y与醛固酮检测及意义

目的研究降钙素基因相关肽(CGRP)、神经肽y(NPY)与醛固酮(ALD)在门脉高压症发病中的作用.方法应用放射免疫学方法对30例门脉高压症患者、30名正常对照者的血浆以及20例门脉高压症患者的腹水进行CGRP、NPY与ALD的检测.结果门脉高压症组患者血浆CGRP、NPY与ALD水平分别为125.95±35.43pg/ml、88.49±52.51pg/ml及868.5±459.6pg/ml,正常对照组分别为69.14±23.29pg/ml、151.54±38.51pg/ml及306.4±124.3pg/ml,两组差别有显著意义(P＜0.05),腹水组分别为81.83±38.55pg/ml、61.47±28.35pg/ml及216.7±186.1pg/ml.腹水CGRP与正常对照组相比差异无显著意义,腹水NPY与ALD含量低于正常对照组(P＜0.05).其中有腹水者NPY低于无腹水者,而CGRP与ALD水平高于无腹水者(P＜0.05).结论血浆CGRP、NPY与ALD均在肝硬变门脉高压发病的病理生理机制中起作用.     

血浆N末端B型利钠肽原水平评估肝硬化患者心功能改变及其与肝功能的关系

目的 心脏彩色多普勒超声监测肝硬化患者心脏结构和功能改变,检测肝硬化患者血浆N末端B型利钠肽原(NT-proBNP)水平,探讨NT-proBNP水平在评估心脏结构和功能改变及其与肝功能的关系. 方法 检测40例肝硬化患者及25例健康对照者的血浆NT-proBNP水平.肝硬化患者肝功能Child-Pugh分级,A级10例(A组),B级15例(B组),C级15例(C组),患者用心脏超声评估其心脏结构和功能改变.肝硬化组与对照组间比较用t检验,组间比较用单因素方差分析,相关性分析用Spearman相关检验.结果 肝硬化组NT-proBNP水平为(240.15±80.87)pg/ml,较对照组的(55.86±20.13)pg/ml明显增高,P＜0.05,差异有统计学意义;肝硬化患者不同肝功能分级组间NT-proBNP水平比较:A组和B组分别为(189.20±20.25) pg/ml、(202.34±31.20) pg/ml,与C组的(300.13±34.96) pg/ml比较明显降低,P＜0.05,差异有统计学意义;A组与B组比较差异无统计学意义(P＞ 0.05).肝硬化患者不同肝功能分级A、B、C组间,左室直径、右室直径、室间隔厚度、左室后壁厚度、主动脉瓣环直径、左室射血分数、E峰、A峰、E/A比较,差异无统计学意义(P＞0.05);不同肝功能分级各组间LAs比较:A组和B组分别为(29.83±3.76) mm、(31.78±4.05) mm,均低于C组的(35.08±3.68) mm,P＜0.05,差异有统计学意义;A组与B组比较差异无统计学意义(P＞ 0.05).相关性分析发现NT-proBNP与LAs呈正相关(r=0.535,P＜0.05),与LVPW亦呈正相关(r=0.312,P＜0.05),而与LVd、IVS、EF和E/A无相关性. 结论 肝硬化患者血浆NT-proBNP水平增高,可反映肝硬化患者潜在的心功能不全,且可反映患者的肝功能状况.     

肝硬化门脉高压患者血浆SS、VIP及MTL变化的临床意义

目的　研究生长抑素(SS)、血管活性肠肽(VIP)、胃动素(MTL)在门脉高压症中的水平及其作用。方法　应用放射免疫学方法对 62例肝硬化门脉高压症患者、51例正常对照者血浆及 43份门脉高压性腹水进行SS、VIP与MTL的检测。结果　门脉高压症组血浆SS、VIP与MTL水平分别为 58 23±13 5pg/ml, 18 68±4 22pg/ml及 362 95±32 82pg/ml;正常对照组分别为 81 23±31 89pg/ml, 11 96±3 27pg/ml及 202 95±26 42pg/ml,二者差异有显著性(P<0 05)。腹水组分别为 148 03±28 41pg/ml, 14 12±3 64pg/ml及 267 43±29 04pg/ml。腹水SS、MTL高于对照组血浆含量(P<0 05)。腹水VIP与对照组血浆含量差异无显著性。肝硬化腹水患者血浆SS低于无腹水者,而VIP与MTL水平高于无腹水者(P<0 05)。VIP、MTL随着肝功能分级的发展而逐步增加。结论　血浆SS、VIP与MTL在肝硬化门脉高压症的病理生理机制中起着重要作用。     

加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响

目的:观察加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响.方法:选择符合2000年9月西安全国传染病与寄生虫病学术会议<肝硬化诊断标准>同时符合中医血瘀阻络证型肝硬化门脉高压症患者40例,随机分治疗组和对照组.两组患者均常规接受护肝、降酶等对症治疗,治疗组患者加服加味瓜蒌散,对照组患者加服心得安(通用名普萘洛尔).治疗前后清晨空腹取血放射免疫法测胃肠激素胃动素(MTL)、胃泌素(GAS)、胰高血糖素(GLU)、脑肠肽(SS),肝纤维化指标透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)、层粘连蛋白(LN),并进行血流动力学检查.结果:治疗组治疗后GAS、MTL水平明显下降(P＜0.01或P＜0.05),HA、PCⅢ、C-Ⅳ、LN下降(P＜0.01或P＜0.05),门静脉内径、血流量与用药前比较差异有显著性意义(P＜0.05),血流速度治疗前后与对照组比较差异无显著性意义(P＞0.05).结论:加味瓜蒌散能够有效调节肝硬化门静脉高压症患者胃肠激素、血流动力学,降低纤维化指标,延缓门脉高压的形成,减轻门脉高压性胃病的程度,减少食管胃底静脉曲张破裂出血的机会及风险,疗效优于心得安,是防治肝硬化门脉高压症的有效方剂.     

门脉高压肝脏小叶间动脉与小叶间静脉血管内皮生长因子受体的分布

目的:明确肝硬化门脉高压前后VEGFR-1、2在肝脏血管的分布变化.方法:SD♂大鼠30只,体质量180-220g.动物随机分为肝硬化门脉高压模型组(n=20)和随正常对照组(n=10).正常对照组正常饮水饮食,实验组采用硫代乙酰胺皮下注射法制作肝硬化门脉高压模型.12wk后经组织病理学检查证实肝脏有假小叶形成和门静脉压力大于1.57kPa的大鼠共12只纳入本研究.采用免疫组织化学染色法,分别观察VEGFR-1和VEGFR-2的变化特点.结果:VEGFR-2在肝硬化门静脉高压组大鼠的小叶间动脉和静脉中的表达均显著高于正常对照组(t=24.306,54.776,均P<0.05).VEGFR-1在肝硬化门静脉高压组大鼠的小叶间动脉和静脉中的表达也显著高于正常对照组(t=20.669,33.210,均P<0.05).VEGFR-2在肝硬化门脉高压组大鼠的小叶间静脉的表达显著高于小叶间动脉(t=23.424,P<0.05);而VEGFR-1在门脉高压组大鼠的小叶间动脉和小叶间静脉的表达几乎无明显差异(t=1.434,P>0.05).结论:VEGFR-2可能通过促进肝内小叶间静脉的新生血管生成代偿性降低门静脉高压.     

肝硬化门脉高压症患者的十二指肠损害

目的探讨肝硬化门脉高压症患者十二指肠损害的发生率及其与肝硬化病程、门脉高压性胃病、肝功能分级的关系。方法对72例肝硬化门脉高压症患者进行胃镜检查,观察十二指肠粘膜病变,同时检测14C呼气试验。另选72例接受胃镜检查的非肝硬化门脉高压患者为对照组。结果肝硬化门脉高压症患者十二指肠糜烂发生率为41.7%,随肝硬化病程延长和肝功能分级差而增高,而幽门螺杆菌感染率与对照组无显著性相差(P>0.05)。糜烂主要发生于十二指肠降部,糜烂轻重程度与肝功能分级无关(P>0.05)。结论肝硬化门脉高压症患者十二指肠糜烂与非特异性十二指肠炎不同,是门脉高压导致十二指肠的一种病变。     

门脉高压性胃病与肠道菌群失调及内毒素相关性研究

目的　探讨肝炎后门脉高压性胃病 (PHG)发病机制、门脉高压时肠道菌群的分布以及与内毒素之间的关系、药物治疗对肠道菌群和内毒素的影响。方法　选择 2 0 0 2 - 0 2～ 2 0 0 3- 12大连市第六人民医院住院的肝炎后肝硬化及门脉高压性胃病患者 ,均做电子胃镜、治疗前后大便菌群分析、鲎实验检测血浆内毒素 (LPS)。结果　门脉高压胃病组与肝炎后肝硬化组和对照组相比较 ,拟杆菌、双歧杆菌显著减少 ;而肠杆菌科细菌、酵母菌显著增加。门脉高压胃病组与肝炎后肝硬化组血内毒素较对照组均显著增加 (P <0 0 1)。结论　内毒素与肠道菌群产生异常变化可能对门脉高压性胃病的发病有直接或间接的影响。     

肝硬化门脉高压性胃病与幽门螺杆菌关系的探讨

目的探讨肝硬化门脉高压性胃病(PHG)与幽门螺杆菌(Hp)感染的关系及临床意义。方法对72例PHG和50例慢性胃炎患者进行了胃镜、病理检查和Hp检测,并进行对比分析。结果伴有PHG 的肝硬化门脉高压患者的Hp感染率为23.07%,不伴有PHG者为25.0%,两者差异无显著性(P>0.05), 轻度PHG患者Hp感染率为23.80%,重度为20.0%,差异无显著性(P>0.05)。门脉高压患者的Hp感染率显著低于慢性胃炎组(23.60%比72.0%,P<0.01),但门脉高压患者慢性活动性胃炎的发生与Hp的感染密切相关,活动性胃炎的Hp感染率(53.84%)比非活动性胃炎Hp感染率(16.94%)显著升高(P< 0.01)。结论肝硬化门脉高压性胃病的Hp感染率降低,可能与肝硬化患者胃内环境不适合Hp的生存有关。门脉高压患者胃黏膜的活动性炎症,可能是由Hp感染引起,与肝硬化门脉高压关系不大。     

双介入治疗肝硬化门脉高压和脾功能亢进症

目的 探讨经颈内静脉肝内门体分流术(Transjugular intrahepatic portosystemic shunt,TIPS)和部分脾栓塞术(Partial splenic embolization,PSE)联合治疗肝硬化门脉高压及脾功能亢进症的疗效.方法 30例均为肝硬化门脉高压及脾功能亢进症患者,行TIPS术后再行PSE术.用超声检测门、脾静脉内径、门脉主干血流速度、脾脏长径和厚度;血细胞分析仪检测血象.结果 30例患者TIPS术后的门脉压力较术前降低(P＜0.01).门、脾静脉内径较术前缩小(P＜0.01),门脉主干血流速度较术前增快(P＜0.01);术后3～6月的脾脏长径及厚度、白细胞、血小板及血红蛋白较术前均无明显变化(P＞0.05).30例患者PSE术后的门、脾静脉内径、门脉主干血流速度与TIPS术后的比较无明显变化(P＞0,05);而白细胞、血小板及血红蛋白较TIPS术后明显升高(P＜0.01),脾脏长径和厚度较TIPS术后缩小(P＜0.05).结论 联合TIPS和PSE术治疗,能有效降低肝硬化患者的门脉压力,同时又能缓解脾功能亢进.     

肝硬化及伴门脉高压性胃病患者血浆胃泌素变化的临床研究

采用放免法测定３２例肝硬化和２８例正常人的血浆胃泌素，以探讨胃泌素与肝硬化肝功能损害程度及合并门脉高压性胃病的关系。结果：肝硬化患者血浆胃泌素水平（１５２．５６±３０．２）明显高于正常人（９３．７４±２５．６３），Ｐ＜０．０５；且随肝功能损害程度的加重而增高。其中伴门脉高压性胃病患者血浆胃泌素水平高于无伴发症者。结论：胃泌素是判定肝硬化肝功能损害程度的一项有效指标，可指导临床用药减少门脉高压性胃病的发生，预防上消化道出血。     

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.     

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.     

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.     

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.