1.Effect of rapid point pressure on therapeutic efficacy and pulmonary function in patients with chronic persistent bronchial asthma
Miaoyan SHI ; Zitong SHU ; Wei ZHANG ; Jun TIAN
Journal of Acupuncture and Tuina Science 2015;(1):36-43
Objective:To observe the effect of rapid point pressure on clinical effect and pulmonary function of patients with chronic persistent bronchial asthma.
Methods:A total of 60 confirmed chronic persistent bronchial asthma cases were randomly allocated into two groups, 30 in each group. Cases in the treatment group were treated with rapid point pressure, 1 h for the initial treatment, and 40 min for the ensuing treatments. The treatment was done once a day for 40 d. Cases in the control group were treated with Compound Methoxyphenamine Hydrochloride Capsules, 2 capsules for each dose, 3 times a day. The treatment lasted for 7 consecutive days. A 1-year follow-up was made for both groups.
Results:After treatment, the scores of each symptom and total symptom scores for the traditional Chinese medicine (TCM) symptoms in the treatment group were significantly higher than those in the control group (P<0.05);the total effective rates in the treatment group were higher than those in the control group in each time frame; and there was a between-group statistical significance in total effective rate after 7 d of treatment (P<0.01). After 40-day treatments, there were statistical significances in the forced expiratory volume in 1 s percentage of predicted value (FEV 1%) and inspiratory capacity (IC%) in the treatment group (P<0.05); however, there were no statistical significances (P>0.05) in forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC), peak expiratory flow rate (PEF%) and maximum midexpiratory flow rate (MMEF%); and there were no statistical significances in pulmonary function parameters in the control group. In addition, as for pulmonary function parameters, there were no intra-group statistical significances in differences before and after treatment (P>0.05).
Conclusion:Rapid point pressure can alleviate patients’ TCM symptoms and improve their FEV%and IC%.
2.Thyroid peroxidase antibody in autoimmune thyroid diseases
Shu-Jun ZHAO ; En-Jiang TIAN ; Fu-Jun SUN ; Zu-Pei CHEN ;
Chinese Journal of Endocrinology and Metabolism 1986;0(03):-
In hyperthyroid,hypothyroid and subclinical hypothyroid patients,the positive rate and level of the thyroid autoantibodies were all remarkably higher than those in the control group.The positive rate of thyroid peroxidase antibody (TPOAb) was higher than those of thyroglobulin antibody and thyroid microsome antibody in each group.In the group with restored thyroid function,the average level of TPOAb was significantly decreased, suggesting that TPOAb could be taken as an important indicator in evaluating the treatment and prognosis of autoimmune thyroid diseases.
3.The impact of dietary iodine/sodium intake on blood lipid metabolism in mice
Shu-jun, ZHAO ; Fu-jun, SUN ; Yan, YE ; En-jiang, TIAN ; Zu-pei, CHEN
Chinese Journal of Endemiology 2010;29(6):621-626
Objective The present study has been designed to investigate the impact of dietary iodine/sodium intake on blood lipid metabolism in mice. Methods According to body weight and gender, two hundred and sixty Balb/c mice were randomly divided into 2 groups including normal sodium group(Na) and low sodium group(LNa), with 130 animals per group. Each group were then randomly further divided into 5 sub-groups according to the amount of iodine intake: ① severe iodine deficiency(SID); ② mild iodine deficiency(MID); (③normal iodine (NI); ④ 10-fold high iodine ( 10HI ); (⑤ 50-fold high iodine (50HI), 10 groups in total, 26 per group.Eight months later, the body weight and the levels of urinary iodine, thyroid hormones and total cholesterol (TC),Results In Na group, the levels of TG and TC in male mice of SID group[ (1.64 ± 0.35), (3.88 ± 0.35 )mmol/L]and MID group[ ( 1.67 ± 0.31 ), (3.41 ± 0.66)mmol/L] were significantly higher than that of NI group[ ( 1.49 ± 0.42), (3.25 ± 0.47)mmol/L] and the levels of TG in female mice of SID group[(1.52 ± 0.22)mmol/L] were significantly higher than that of NI group[ (1.23 ± 0.22)mmol/L]. In addition, the levels of TG in male mice of 10HI and 50HI groups [ ( 1.16 ± 0.23 ), ( 1.21 ± 0.27 ) mmol/L ] were significantly lower than that of NI group [ ( 1.49 ± 0.42)mmol/L, all P < 0.05], the levels of TC in female mice of 10HI and 50HI groups[(2.37 ± 0.49), (2.48 ± 0.37)mmol/L] were significantly lower than that of NI group[ (2.84 ± 0.37) mmol/L, all P < 0.05 ]. In LNa group,the levels of TG and TC in male mice of SID group[ (1.39 ± 0.40), (3.33 ± 0.46 )mmol/L] were significantly lower than that of NI group [(1.30 ± 0.28), (3.00 ± 0.53) mmol/L, all P < 0.05], the levels of TG, TC and LDL in female mice of SID group[ (1.48 ± 0.26), (2.76 ± 0.43), (0.62 ± 0.22)mmol/L], the levels of LDL in female mice of MID group[ (0.60 ± 0.17 )mmol/L] were significantly lower than that of NI group[(l.22 ± 0.36), (2.51 ± 0.38),(0.48 ± 0.08), (0.48 ± 0.08)mmol/L, all P < 0.05], the levels of TG in male mice of 10HI and 50HI group [ (1.12 ± 0.22), (0.90 ± 0.11 )mmol/L] were significantly lower than that of NI group (all P < 0.05 ), the levels of TC in female mice of 10HI and 50HI groups[ (2.35 ± 0.34), (2.37 ± 0.37)mmol/L], the levels of LDL in female mice of 50HI group[(0.65 ± 0.18)mmol/L], were significantly lower than that of NI group(all P < 0.05). In Na group, the levels of thyroid hormones were distinctively decreased in SID group[TT4(0.00 ± 0.00)nmol/L, FT4 (0.93 ± 0.42)pmol/L, TT3(0.49 ± 0.07)nmol/L, FT3(2.86 ± 0.37)pmol/L] and MID group [TT4 (17.15 ± 15.26)nmol/L, FT4( 18.46 ± 4.31 )pmol/L, TT3(0.67 ± 0. 10)nmol/L, FT3(3.18 ± 0.24)pmol/L] compared with that of the NI group [TT4 (37.15 ± 15.26)nmol/L, FT4(28.46 ± 4.31)pmol/L, TT3(0.85 ± 0.10)pmol/L, FT3(3.87 ± 0.24)pmol/L, all P < 0.05 ]. In LNa group, the levels of thyroid hormones were distinctively decreased in SID group [TT4 (0.00 ± 0.00) nmol/L,FT4(1.03 ± 0.78)pmol/L, TT3(0.51 ± 0.05)nmol/L, FT3(3.01 ± 0.17)pmol/L] and MID group[TT4(19.76 ± 12.22)nmol/L, FT4(21.46 ± 5.37)pmol/L, TT3(0.71 ± 0.21)nmol/L, FT3(3.56 ± 0.23)pmol/L] compared with that of the NI group[TT4(36.23 ± 14.72)nmol/L, FT4(30.96 ± 6.33)pmol/L, TT3(0.89 ± 0.20)nmol/L, FT3(4.05 ± 0.24)pmol/L, all P < 0.05]. Conclusions Dietary iodine intake plays an important role in the blood lipid metabolism. Iodine deficiency could increase while iodine excess could decrease the levels of serum TG, TC or LDL in mice. Monitoring the amount of iodine intake during sodium restriction should have an important role in effective prevention and treatment of cardiovascular disease.
4.The impact of dietary iodine intake on lipid metabolism in experimental hypothyroid mice
Shu-jun, ZHAO ; Fu-jun, SUN ; Yan, YE ; En-jiang, TIAN ; Zu-pei, CHEN
Chinese Journal of Endemiology 2011;30(2):127-129
Objective To observe the effects of iodine deficiency and iodine excess on the lipid metabolism in an experimental hypothyroid model of mice and to explore the roles of iodine independent of its role in thyroid hormones. Methods Female Balb/c mice were randomly divided into 6 groups: control, severe iodine deficiency (SID), mild iodine deficiency(MID), normal iodine (NI), 10-fold high iodine (10HI) and 50-fold high iodine(50HI), 10 in each group. The mice in control group were fed with low iodine forage, other mice were fed with low iodine forage containing 0.2% methylthiouracilum. All mice drank deionic water containing different concentrations of potassium iodide(KI). The iodine content in water was 326.79, 0, 196.08,326.79, 385621, 19 542.50 μg/L, respectively. After three months, thyroid hormones in the serum were determined by radioimmunoassay.Also, the blood samples were analyzed for total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesteiol (HDL-C) and low density lipoprotein cholesterol (LDL-C) and measured enzymatically by automatic analyzer. Results①The levels of Tr4 in SID[(21.27 ± 9.63)μg/L], MID[(23.41 ± 3.93)μg/L], NI[(22.57 ±4.66)μg/L], 10HI [(21.07 ± 5.03) μg/L] and 50HI groups [(21.46 ± 5.90) μg/L] were distinctively decreased compared with control group[(42.15 ± 8.26)μg/L, all P < 0.01]. There were no statistical significant differences of TT3 between different groups (F = 0.99, P > 0.05 ). ②The level of TG in 10HI group [ ( 1.17 ± 0.16)mmol/L ] was obviously decreased compared with control [(1.39 ± 0.22 )mmol/L] and NI groups[(151 ± 0.22)mmol/L, all P< 0.05].Both TG and TC in 50HI group[(1.18 ± 0.22), (1.78 ± 0.15)mmol/L] were significantly decreased compared with control [( 1.39 ± 0.22), (2.14 ± 0.37)mmol/L] and NI groups [(1.51 ± 0.22), (2.00 ± 0.15)mmol/L, all P < 0.05].The difference of serum HDL-C and LDL-C between the groups was not significant(F = 0.55,0.54, all P > 0.05 ).Conclusions Dietary iodine plays a role in the metabolism of serum lipids independent of thyroid hormones.Thus, monitoring the amount of iodine intake during sodium restriction should also be taken extremely important for effectively prevention and cure of cardiovascular disease.
5.Levels of serum leptin in the autoimmune thyroid diseases
Shu-jun, ZHAO ; En-jiang, TIAN ; Fu-jun, SUN ; Lan-ying, LI ; Zu-pei, CHEN
Chinese Journal of Endemiology 2008;27(3):335-337
Objective To observe the levels of serum leptin in Gaves disease(GD)and thyroiditis(HT)Datients and to discuss the immunological role of leptin in the pathogenesis of autoimmune thyroid disease(AITD).Methods 102 newly diagnosed female AITD patients were divided into 3 groups:GD hyperthyroid group,HT hypothyroid group and subclinical hypothyroid group.Age,sex and BMI-matched 27 euthyroid,healthy subjects served as controis.The levels of FT3,FT4 and sTSH were determined by immunofluorometrie assay.ELISA kit was aDplied to measure the levels of serum leptin.Results Serum FT3 and FT4[(19.74±15.39),(78.25±58.68)pmol/L]levels of GD hyperthyroid patients were obviously higher than those of the controls[(4.87±0.25),(15.96±3.15)pmol/L,P<0.01],but serum sTSH and leptin levels[(0.15±0.08)mU/L,(8.73±1.92)μg/L]were obviously lower than those of the controls[(3.81±0.19)mU/L,(12.38±3.51)μg/L,P<0.01or<0.05].Serum FT3 and FT4[(3.36±0.26),(6.95±3.29)pmol/L]levels of HT hypothyroid patients were obviously lower than those of the controls(P<0.05),but serum sTSH and leptin levels[(45.48±35.83)mU/L,(17.17±3.82)μg/L]were obviously higher than those of the controls(P<0.01 or<0.05).Serum FT3 and FT4[(4.67±0.60),(14.87±2.14)pmol/L]levels of subclinical hypothyroid patients had not statistical difference comparing with those of the controls(P>0.05),but serum sTSH and leptin levels[(13.67±8.66)mU/L,(16.25±3.67)μg/L]were obviously higher than those of the controls(P<0.01 or<0.05).Conclusions Leptin might have an immuoregulation role in the pathogenesis of AITD.In addition,serum levels of leptin in AITD is also influenced by many other related hormones.
6.Effects of trichlorfon exposure on serum paraoxonase activity of pregnant mice and development of embryos
yi-jun, ZHOU ; shu-fang, ZHOU ; rong, SHI ; yu, GAO ; yu, DING ; ying, TIAN
Journal of Shanghai Jiaotong University(Medical Science) 2006;0(03):-
Objective To investigate the effects of maternal long-term exposure to low-dose trichlorfon on the serum paraoxonase (PON) activity of pregnant mice and development of embryos. Methods Female ICR mice (n=120) were randomly divided into control group and trichlorfon groups of different doses,and were managed by intragastric injection with trichlorfon of 0,2,10 and 50mg/kg,respectively. All the mice were managed once a day for a consecutive of 27 days,and were subjected to mating. The pregnant mice were continued to be managed with trichlorfon for 3 days,and were sacrificed on day 3 of gestation. The serum PON and acetylcholinesterase (AchE) activities were detected,and the development of embryos was evaluated. Results The serum PON activity of 2,10 and 50mg/kg trichlorfon group were (14.15?1.22),(12.78?1.80) and (10.45?1.95)IU/mL,respectively,and that of 50mg/kg trichlorfon group was significantly lower than that of control group [(13.37?2.31)IU/mL] (P0.05),while the the percentage of abnormal embryos of 50mg/kg trichlorfon group had an increased tendency. Conclusion Long-term exposure to low-dose trichlorfon can inhibit serum PON and AchE activity in pregnant mice without obvious effect on the development of embryos.
7.Low back pain of cold-damp pattern treated with electric-thermal Bian-stone therapy and traditional moxibustion: a randomized controlled trial.
Tao HUANG ; Bin HAN ; Yu-Ying TIAN ; Guang-Jun WANG ; Shu-Yong JIA ; Wei-Bo ZHANG
Chinese Acupuncture & Moxibustion 2014;34(6):585-589
OBJECTIVETo compare the difference in the efficacy on low back pain of cold-damp pattern between electric-thermal Bian-stone therapy and moxibustion box therapy.
METHODSForty-one cases of low back pain of cold-damp pattern were randomized into an electric-thermal Bian-stone therapy group (group A, 26 cases) and a box moxibustion therapy group (group B, 15 cases). In the group A, the electric-thermal Bian-stone was placed over Shenshu (BL 23) and Weizhong (BL 40). The temperature of stone was adjusted in accordance with patient's comfort. In the group B, moxibustion box was used over Shenshu (BL 23) and Weizhong (BL 40). The treatment was given once every day or every two days. Ten treatments made one session. The symptom and physical signs score of low back pain and the score of cold-damp syndrome were observed before and after treatment in the patients.
RESULTSThe symptom and physical signs score of low back pain and the score of cold-damp syndrome were all improved in the two groups (all P < 0.01). The changing rate of symptom and physical signs and syndrome were (37.04 +/- 32.68)% and (22.85 +/- 29.95)% in the group A, and were (47.29 +/- 22.08)% and (23.89 +/- 22.53)% in the group B, respectively, without significant difference in comparison between the two groups (all P > 0.05).
CONCLUSIONThe efficacy on low back pain of cold-damp pattern treated with the electric-thermal Bian-stone therapy is similar to that of moxibustion box therapy. This therapy is characterized as more convenient, safer operation and less pollution.
Acupuncture Points ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Low Back Pain ; therapy ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Moxibustion
8.Experimental study on effects of iodine deficiency and excess on thyroid autoimmunity.
Shu-jun ZHAO ; Fu-jun SUN ; En-jiang TIAN ; Zu-pei CHEN
Chinese Journal of Preventive Medicine 2006;40(1):18-20
OBJECTIVETo observe the effects of iodine on the level of CD4/CD8 cells and the production of thyroglobulin autoantibody (TGAb) and thyroid peroxidase autoantibody (TPOAb) in Wistar rats and to investigate the role of iodine in thyroid autoimmunity.
METHODSRat models with different iodine intakes including low iodine (LI,), normal iodine (NI,), 5 times normal iodine (5HI), 10 times normal iodine (10HI), 50 times normal iodine (50HI) and 100 times normal iodine (100HI) were established. The amount of iodine intake per rat per day in every group was about < 1, 6.15, 30.75, 61.50, 307.50, 615.00 microg separately. The levels of CD4 and CD8 immune cells in peripheral blood were measured by using flow cytometry. Radioimmunoassay (RIA) was used to determine the titers of TGAb and TPOAb in the serum.
RESULTSIn peripheral blood, the level of CD4 cells in LI group was (57.9 +/- 4.3)%, being much higher than in NI group (51.2 +/- 4.9)%. When the level of CD8 cells in 100HI group was (18.4 +/- 3.1)% showing significantly lower than in NI group (26.5 +/- 4.1)%, thus making the ratio of CD4/CD8 cells in the above two groups (LI: 2.4 +/- 0.40 and 100 HI: 2.7 +/- 0.4) higher than in NI group (1.9 +/- 0.3). As comparing with NI group (2099 +/- 220) CPM, the level of TGAb in LI group (1510 +/- 221) CPM was significantly decreased; while in 50HI group (3986 +/- 286) and 100HI group (3550 +/- 378) CPM, the levels of TGAb were both increased, and the levels of TPOAb in 10HI group (2066 +/- 184) CPM and in 50HI group (2141 +/- 163) CPM were both distinctly lower than in NI group (2372 +/- 245) CPM.
CONCLUSIONSIodine might exert influence on the level of CD4/CD8, and thus the production of thyroid antibodies might directly or indirectly take part in the process of thyroid autoimmunity. Both low iodine and 100 times normal iodine intakes might activate the immune state on some degrees. The effects of iodine on immune responses of TG and TPO antigen in thyroid autoimmunity might not be completely the same.
Animals ; Autoantibodies ; immunology ; Autoimmunity ; drug effects ; CD4-CD8 Ratio ; Drug Overdose ; Iodine ; adverse effects ; deficiency ; Rats ; Rats, Wistar ; Thyroid Gland ; drug effects ; immunology
9.Effect of iodine on the pathogenesis of postpartum thyroiditis
Xiao-qin, GUO ; Shu-jun, ZHAO ; Fu-jun, SUN ; En-jiang, TIAN ; Lan-ying, LI ; Zu-pei, CHEN
Chinese Journal of Endemiology 2008;27(6):617-621
Objective To explore the effect of iodine on the pathogenesis of postpartum thymiditis.Methods Forty-four female C57BL/6J mice,8-week old,fed by low iodine dietary(the concentration of iodine≤35 μg/kg),were randomly divided into 4 groups:non-pregnancy experimental autoimmune thymiditis(non-pregnancy EAT)group with 8 mice,EAT of mice was induced by immunization with pig's thyroglobulin(Tg)in the presence of complete Freund's adjuvant.Six mice in non-pregnancy EAT group survived at the end of experiment;normal iodine-PPT(NI-PPT)group,10-fold high iodine-PPT(10HI-PPT)group and 50-fold high iodine-PPT(50HI-PPT)group with 12 mice in each group.The last 3 groups mice,who received the same immunization schedule as the above,were mated with adult male mice followed by induction of EAT.In the end,7,6 and 6 mice were noticed to be pregnant in each group.All animals were killed 4 weeks after postpartum.Histological severity of thyroid specimens was evaluated.The serum level of thyroglobulin antibody(Tg-Ab),thyroid pomxidase antibody(TPO-Ab),TT3 and TT4 were measured by radioimmunoassay(RIA).The expression level of IFN-γ/IL-4 mRNA in spleenwere assayed by RT-PCR.Results Pathological examination showed the infiltration of inflammatory cells.epithelial cell applanation,follicle atrophy or destruction.The severity of inflammation in non-pregnancy EAT bgroup.NI-PPT group and 10HI-PPT group was less serious than that in the 50HI-PPT group,the difference has bstatistical significance(P<0.05).The level of TPO-Ab in non-pregnancy EAT group,NI-PPI-group,10HI-PPTgroup and 50HI-PPT group wag(14.32±8.85)%,(64.45±10.52)%,(38.46±5.57)%and(90.09±9.98)%.respectively the difference being statistically significant between any two groups(P<0.05).There was no statisticaldifference(F=0.484,P>0.05)of Tg-Ab among non-pregnancy EAT group[(33.74±3.71)%],NI-PPT group [(29.65±2.06)%],10HI-PPT group[(37.21±3.87)%]and 50HI-PPT group[(33.87±4.17)%].There was no statistical difference(F=1.596,P>0.05)of TT3 among non-pregnancy EAT group (2.47±0.69)%,NI-PPT group(1.57±0.25)%,10HI-PPT group[(1.60±0.28)%]and 50HI-PPT group[(1.82±0.75)%].The level of TT4 in 50HI-PPT group[(66.68±5.47)%]was lower than that in non-pregnancy group,NI-PPT group and 10HI-PPTgroup[(99.87±5.97)%,(89.13±7.64)%and(91.05±5.82)%],the difference being statistically significant(P<0.05).The expression level of IFN-γ mRNA was increasing,being 1.02±0.10,1.37±0.10,1.39±0.12 and 1.68±0.06 in non-pregnancy EAT group,NI-PPT group,10HI-PPT group and 50HI-PPT group.The difference had a statistical significance between any two groups except for NI-PPT group and 10HI-PPT group(P<0.05).The expression level of IL-4 mRNA in 10HI-PPT group(0.49±0.04)and 50HI-PPT group(0.53±0.06)were all higher than non-pregnancy EAT group(0.24±0.05)and NI-PPT group(0.35±O.05),the differences being statistically significant (P<0.05).Conclusions Adequate iodine supplementation during pregnancy and postpartum period is necessary,but iodine excess could induce postpartum thyroiditis.So iodine supplementation during pregnancy and postpartum should be adequate and reasonable.
10.Effects of naoxintong capsule on the inflammation and prognosis in borderline lesion coronary heart disease patients.
Shu-Ren LI ; Tian-Hong WANG ; Bao-Jun ZHANG
Chinese Journal of Integrated Traditional and Western Medicine 2012;32(5):607-611
OBJECTIVETo study the effects of Naoxintong Capsule (NC) on the inflammation and long-term prognosis in the borderline lesion coronary heart disease patients.
METHODSA total of 240 coronary heart disease patients with angina symptoms and accompanied with borderline lesion coronary heart disease (with the diameter stenosis in critical 50% -70%) by means of coronary angiography or multislice computed tomography coronary angiography were recruited. These patients were randomly assigned to the conventional treatment group (including nitrate, beta blockers, anti-platelet, anticoagulation, angiotensin converting enzyme inhibitors, and so on) and the NC treatment group (treated the same way as those for the conventional treatment group and NC). All patients were treated for 12 months. The occurrence of cardiovascular events was observed after treatment. The inflammatory factors in serum [interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and high sensitive C reaction protein (hs-CRP)], matrix metalloproteinases-9 (MMP-9), blood lipids and blood sugar, liver and kidney functions were measured before and after treatment.
RESULTSAfter 12 months of treatment, the incidence of angina pectoris patients (6.67% vs 15.83%, P < 0.05) and hospitalization due to acute coronary syndrome (ACS) attacks (4.17% vs 10.83%) was significantly lower in the NC treatment group than in the conventional treatment group. There was no statistical difference in the serum levels of IL-6, TNF-alpha, hs-CRP, and MMP-9 between the two groups before treatment (P > 0.05). After 12 months of treatment, serum levels of IL-6, TNF-alpha, hs-CRP, and MMP-9 were significantly lower when compared with before treatment in the same group (P < 0.05). Besides, the serum levels of IL-6, TNF-alpha, hs-CRP, and MMP-9 were significantly lower in the NC group than in the conventional treatment group (P < 0.05). By means of Logistic regression analysis we found that the post-treatment MMP-9 level and IL-6 level were independent risk factors influencing the recurrence of angina pectoris.
CONCLUSIONSNC could alleviate the inflammation. Long-term administration of NC could reduce the recurrence of angina pectoris and decrease the incidence of ACS attack in borderline lesion coronary heart disease patients. The post-treatment MMP-9 level and IL-6 level were independent risk factors influencing the recurrence of angina pectoris.
Aged ; C-Reactive Protein ; analysis ; Coronary Artery Disease ; drug therapy ; metabolism ; pathology ; Coronary Disease ; drug therapy ; metabolism ; pathology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Inflammation ; Interleukin-6 ; blood ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Prognosis ; Prospective Studies ; Tumor Necrosis Factor-alpha ; blood