血管钙化对血管组织内皮素表达的影响

通过观察血管钙化大鼠血管组织和钙化血管平滑肌细胞内皮素含量的变化 ,探讨血管钙化对血管组织内皮素表达的影响。用维生素D3加尼古丁诱导大鼠血管钙化模型 ,β 磷酸甘油制备钙化血管平滑肌细胞 ,采用VonKossa染色、钙含量测定、4 5Ca聚集及碱性磷酸酶活性测定判断钙化程度 ,放射免疫分析法测定血浆、血管和血管平滑肌细胞培养基中内皮素含量 ,用竞争性定量逆转录聚合酶链反应方法测定血管和血管平滑肌细胞中内皮素mRNA水平。结果发现 :钙化血管平滑肌细胞VonKossa染色见有大量黑色颗粒沉积 ,钙化细胞的钙含量、4 5Ca2 + 摄入及碱性磷酸酶活性分别较正常平滑肌细胞增加 1 1 8%、1 74 %和 7倍 (P均 <0 .0 1 ) ;钙化细胞培养基中内皮素含量较对照组增加 35 % (P <0 .0 5 ) ,内皮素mRNA水平较对照组高 1 2 0 % (P <0 .0 5 ) ;钙化组大鼠血管组织VonKossa染色见血管中层有大量黑色颗粒沉积 ,主动脉钙含量、4 5Ca2 + 沉积及碱性磷酸酶活性分别较对照组高 5 .0倍、1 .4倍和1 .4倍 (P均 <0 .0 1 ) ;钙化大鼠血浆和血管内皮素含量分别较对照组增加 1 0 2 %和 1 0 3% (P均 <0 .0 1 ) ;钙化血管内皮素mRNA水平较正常对照组高 2 2 % (P <0 .0 1 ) ;波生坦处理的大鼠血管钙含量、4 5Ca2 + 聚集及碱性磷酸酶活性较单     

姜黄素对维生素D3和尼古丁诱导血管钙化大鼠血管中组织蛋白酶D表达的影响

目的研究组织蛋白酶D(CTSD)在大鼠动脉钙化模型中的表达以及姜黄素对其表达的影响。方法将30只雄性SD大鼠随机分成3组,每组10只,即对照组、钙化组和干预组。对照组大鼠给予等量生理盐水处理,钙化组大鼠用维生素D3和尼古丁处理,干预组大鼠在钙化组处理的基础上加用姜黄素干预。用von Kossa染色检测血管钙化,试剂盒检测血管钙含量和碱性磷酸酶活性,Western blot检测骨形态发生蛋白2(BMP-2)、Runx2和CTSD的蛋白表达,用免疫组织化学染色观察CTSD在血管中的表达及分布。结果维生素D3和尼古丁能够诱导经典大鼠钙化模型,von Kossa染色结果显示钙化组大鼠胸主动脉有大量黑色颗粒沉积,血管钙含量和碱性磷酸酶活性升高,Western blot检测结果显示BMP-2和Runx2表达显著上调;使用姜黄素干预后,与钙化组相比,大鼠胸主动脉钙化程度明显减轻,血管钙含量和碱性磷酸酶活性下降,BMP-2和Runx2表达下调。免疫组织化学染色结果显示钙化组CTSD表达上调且大量分布在细胞外基质中,姜黄素能够显著下调CTSD的表达并减少其在细胞外基质中的分布。结论姜黄素具有抑制血管钙化的作用,可能与其能够减少CTSD在细胞外基质中的表达有关。     

钙调神经磷酸酶对钙化细胞Ⅰ型三磷酸肌醇受体表达的影响

目的探讨大鼠血管平滑肌细胞钙化过程中钙调神经磷酸酶对Ⅰ型三磷酸肌醇受体蛋白和mRNA表达的影响。方法大鼠胸主动脉血管平滑肌细胞经传代培养后随机分为对照组、钙化组和环孢素A组,采用磷酸二氢钠诱导大鼠动脉血管平滑肌细胞钙化。应用免疫印迹法及实时荧光定量RT-PCR法测定钙调神经磷酸酶B亚基、Ⅰ型三磷酸肌醇受体的表达变化,同时测定Ca2+浓度及碱性磷酸酶、钙调神经磷酸酶活性。结果与对照组比较,钙化组钙调神经磷酸酶B亚基、Ⅰ型三磷酸肌醇受体蛋白和mRNA表达显著增加(P<0.01);与钙化组比较,环孢素A组钙调神经磷酸酶B亚基、Ⅰ型三磷酸肌醇受体蛋白和mRNA表达显著降低(P<0.01)。钙化组Ca2+浓度、钙调神经磷酸酶活性、碱性磷酸酶活性较对照组显著增高(P<0.01);环孢素A组碱性磷酸酶活性、Ca2+浓度较钙化组显著增加(P<0.05或P<0.01),钙调神经磷酸酶活性较钙化组显著降低(P<0.01)。结论钙调神经磷酸酶能够增强钙化细胞中Ⅰ型三磷酸肌醇受体mRNA和蛋白的表达。     

血管生成素样蛋白2促进ApoE－/－小鼠动脉粥样硬化内膜钙化

目的探讨血管生成素样蛋白2(Angptl2)对ApoE-/-小鼠动脉粥样硬化内膜钙化的影响。方法 12只6周龄雄性ApoE-/-小鼠随机分为对照组与干预组,每组6只,对照组小鼠予以高脂饮食,干预组小鼠在高脂饮食的基础上在第8周予以静脉注射人重组Angptl2蛋白,每周一次,持续1个月。两组小鼠高脂饮食喂养至16周龄时处死,测定血清脂质水平,HE染色观察主动脉组织形态学变化;von Kossa染色观察主动脉钙化,测定血管钙含量和碱性磷酸酶活性判断血管钙化程度;分别用免疫组织化学法、Western Blot、实时定量PCR(qRT-PCR)检测血管Runx2(核心结合因子α1)蛋白和mRNA的表达。结果干预组小鼠血清甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDLC)水平显著高于对照组(P0.05);血管壁Runx2表达水平较对照组显著升高(P0.05);对照组小鼠主动脉可见粥样硬化斑块,von Kossa染色斑块内未见明显黑色钙盐沉积,而干预组小鼠主动脉HE染色可见内膜较对照组显著增厚,有典型的动脉粥样硬化斑块形成,且von Kossa染色斑块灶状黑色钙化团块较对照组显著增强;干预组小鼠主动脉血管壁钙含量和碱性磷酸酶活性均明显高于对照组(P0.05)。结论 Angptl2会使高脂饮食ApoE-/-小鼠主动脉血清TG、TC、LDLC水平及Runx2的表达水平增高,同时增加小鼠主动脉中钙含量及血清中碱性磷酸酶活性,促进小鼠主动脉粥样硬化内膜的钙化。Angptl2可促进动脉粥样硬化内膜的钙化,控制和降低血浆中Angptl2的水平似乎可以抑制动脉粥样硬化的钙化,从而为临床预防冠心病的发生发展及治疗提供了一种新的靶标。     

Salusin-β在血管钙化模型的表达变化及意义

目的在大鼠血管钙化模型上观察血浆和主动脉组织salusin-β表达。方法实验动物按电脑随机数字表法随机分为正常组和钙化组,每组8只。钙化组采用维生素D3(300 000 U/kg 1次,肌肉注射)和尼古丁(25 mg/kg溶于花生油中早、晚各灌胃1次)诱导大鼠血管钙化模型。常规饲养4周后取材,用Von Kossa染色检测血管钙化程度;用钙离子测试盒、碱性磷酸酶(ALP)试剂盒测定大鼠主动脉钙含量和碱性磷酸酶活性;用放射免疫法检测大鼠血浆和主动脉组织salusin-β含量。结果维生素D3和尼古丁能够诱导典型大鼠血管钙化模型,Von Kossa染色可见血管钙化模型大鼠主动脉有大量黑色颗粒沉淀。钙化组血管钙含量、碱性磷酸酶活性明显高于正常组,差异有统计学意义(P<0.05);同时,钙化组血浆和主动脉组织中salusin-β的表达明显上调。结论大鼠血管钙化模型中salusin-β的表达上调。     

吡格列酮对糖尿病大鼠血管钙化的影响及机制

目的研究吡格列酮对糖尿病大鼠血管钙化的影响及其可能机制。方法将36只SD雄性大鼠随机平均分为6组:对照组、糖尿病组、钙化组、糖尿病+钙化组、钙化+吡格列酮组、糖尿病+钙化+吡格列酮组;建立大鼠血管钙化模型(维生素D3+华法林)和糖尿病模型(链尿佐菌素);并对血管组织进行Von Kossa染色、钙含量和碱性磷酸酶活性检测,qRT-PCR检测mRNA表达,免疫组织化学法检测骨保护素蛋白表达。结果钙化组血管平滑肌细胞及其间质内有大量黑色颗粒沉积;糖尿病+钙化组较糖尿病组和钙化组血管组织钙含量、碱性磷酸酶活性分别升高3.63倍、1.35倍和3.69倍、1.30倍(P<0.05),骨保护素mRNA含量及其蛋白表达降低(P<0.05);糖尿病+钙化+吡格列酮组较糖尿病+钙化组钙含量、碱性磷酸酶活性分别下调13.70%、18.04%(P<0.05),骨保护素mRNA含量及其蛋白表达升高(P<0.05)。结论吡格列酮可以减轻血管钙化程度并上调骨保护素mRNA含量及蛋白表达,骨保护素可能是抑制血管钙化主要因素之一。     

糖尿病大鼠钙化血管中Msx2和Wnt3a的表达

目的 研究糖尿病对血管钙化的影响及Msx2和wnt3a基因在钙化血管中的表达变化.方法 将48只雄性wistar大鼠随机分为四组:维生素D3和尼古丁诱导的单纯血管钙化组(n=12)、链脲佐菌素诱导的单纯糖尿病组(n=12)、链脲佐菌素联合维生素D3和尼古丁诱导的糖尿病合并血管钙化组(n=12)和正常雄性Wistar大鼠为正常对照组(n=12).测定大鼠血糖、血清胰岛素、总胆固醇和甘油三酯水平,以血管von Kossa染色、血管钙含量和碱性磷酸酶活性作为判断血管钙化程度的指标,测定大鼠血管中Msx2和wnt3a mRNA 的表达.结果 与正常对照组相比,单纯血管钙化组大鼠血管中Msx2和wnt3a mRNA 相对表达量有所升高(P<0.05),但血管钙含量和碱性磷酸酶活性无明显变化.与正常对照组及单纯血管钙化组相比,糖尿病合并血管钙化组大鼠的血管中,可见沿中膜弹力层内广泛分布的钙盐沉积,大鼠血管中钙含量和碱性磷酸酶活性以及血管内Msx2和wnt3amRNA 相对表达量明显增高(P<0.05).结论 糖尿病可以明显加速血管钙化的发生和发展.在糖尿病大鼠钙化血管中,骨形成过程中的转录因子Msx2和Wnt3a表达增高,提示血管钙化是一个类似于骨形成的过程,Msx2和Wnt3a 参与血管钙化病变的发生.     

血管紧张素Ⅱ对血管平滑肌细胞钙化的影响及信号通路

目的在钙化大鼠主动脉血管平滑肌细胞上观察血管紧张素Ⅱ对钙化的影响及其信号通道。方法用β磷酸甘油制备钙化的大鼠血管平滑肌细胞,再以血管紧张素Ⅱ,血管紧张素Ⅱ1型受体阻断剂缬沙坦,选择性蛋白激酶A或蛋白激酶C抑制剂等干预,通过Von Kossa染色及检测钙含量、碱性磷酸酶活性、骨钙素浓度和核心结合因子a1 mRNA表达来探讨血管紧张素Ⅱ对钙化的影响及其信号通道。结果血管紧张素Ⅱ增加钙化大鼠血管平滑肌细胞的钙含量、碱性磷酸酶活性、骨钙素浓度和核心结合因子a1 mRNA表达(P<0.05);而血管紧张素Ⅱ1型受体阻断剂和选择性蛋白激酶C抑制剂可阻断血管紧张素Ⅱ对血管平滑肌细胞的钙含量、碱性磷酸酶活性、骨钙素浓度和核心结合因子a1 mRNA表达的影响(P<0.05)。结论血管紧张素Ⅱ可促进β磷酸甘油诱导的血管平滑肌细胞钙化,其途径是通过血管紧张素Ⅱ1型受体,胞内信号途径是蛋白激酶C核心结合因子a1途径。     

螺内酯对血管钙化大鼠IL-6和MCP-1表达的影响

目的:观察螺内酯对血管钙化大鼠白细胞介素(IL)-6和单核细胞趋化蛋白-1(MCP-1)表达的影响。方法:实验动物分正常组、钙化组及钙化+螺内酯组。采用维生素D3和尼古丁诱导大鼠血管钙化模型,用钙离子测试盒、碱性磷酸酶试剂盒测定钙含量和碱性磷酸酶活性,Von Kossa染色检测血管钙化程度,放射免疫法检测大鼠血浆IL-6和MCP-1含量,免疫组织化学法检测血管组织IL-6和MCP-1受体表达。结果:Von Kossa染色可见血管钙化大鼠主动脉有大量黑色颗粒沉淀,钙化组血管钙含量、碱性磷酸酶活性明显高于正常组。钙化组血清IL-6和MCP-1含量明显增多,其血管组织相应受体亦同步上调。与钙化组相比,螺内酯干预能够减轻血管钙含量、碱性磷酸酶活性,减少血清IL-6和MCP-1含量及下调相应受体的表达。结论:螺内酯下调IL-6和MCP-1的表达,可能是其减轻大鼠血管钙化的另一重要机制。     

糖基化终末产物促进大鼠血管平滑肌细胞钙化

目的 观察糖基化终末产物对体外培养的血管平滑肌细胞钙化的影响.方法 在含10 mmol/Lβ-甘油磷酸钠培养液中加入不同浓度(0、50、100、200 mg/L和400 mg/L)的糖基化终末产物与大鼠血管平滑肌细胞孵育不同时间.采用磷酸苯二钠法检测碱性磷酸酶活性,甲-酚酞络合酮方法测定钙含量,实时定量逆转录聚合酶链反应检测成骨细胞特异性核心结合因子、碱性磷酸酶以及骨桥蛋白基因表达,蛋白免疫印迹检测成骨细胞特异性核心结合因子及骨桥蛋白蛋白表达.结果 与对照组相比,糖基化终末产物随作用时间延长和浓度增加,细胞钙含量增加(P<0.05),升高碱性磷酸酶活性和基因表达(P<0.05),促进成骨细胞特异性核心结合因子及骨桥蛋白基因及蛋白表达(P<0.01).结论 糖基化终末产物可促进体外培养的大鼠血管平滑肌细胞钙化.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.