高脂血症患者血尿酸、瘦素、脂联素水平的变化

目的观察不同临床类型的高脂血症患者血尿酸（uA）、瘦素、脂联素水平,探讨其在高脂血症发病中的作用。方法选择不同临床类型的高脂血症患者336例,分为高胆固醇血症组（高TC组）、高甘油三酯血症组（高TG组）、混合型高脂血症组（混合组）和低高密度脂蛋白血症组（低HDL—C组）组;另选择正常对照组204人。检测各组患者的血尿酸、血清瘦素和脂联素水平,并分析其在脂代谢中的作用。结果与正常对照组相比,高TG组、混合组及低HDL—C组UA水平有不同程度的升高（P〈0．05）,其中高TG组uA水平升高最明显。与正常对照组比较,除低HDL—C组脂联素水平明显升高外（P〈0．05）,其余各高脂血症组无论是血清瘦素水平,还是脂联素水平差异均无统计学意义（P〉0．05）。高脂血症各组之间两两比较,高TG组瘦素水平低于低HDL—C组（P〈0．05）,高TC组脂联素水平低于低HDL—C组（P〈0．05）。结论高脂血症患者存在尿酸代谢紊乱,可能与血清瘦素、脂联素共同参与有关。血清瘦素、脂联素将来有可能成为判定代谢综合征的严重程度及预后的指标。     

原花青素对高脂血症模型大鼠脂肪因子及免疫调节的影响

目的 观察原花青素对高脂血症模型大鼠血清瘦素(Leptin)、抵抗素、脂联素以及肿瘤坏死因子-α(TNF-α)、IL-6的影响.方法 SD大鼠随机分成对照组(C组)、高脂血症模型组(H组)、原花青素高剂量组(HD组)、原花青素低剂量组(LD组),各10例.除对照组饲普通饲料外,其余各组喂饲高脂饲料并进行干预实验比较.6 w后检测大鼠血脂,血清胰岛素、瘦素、抵抗素、脂联素及TNF-α、IL-6的变化.结果 与对照组相比,H组血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)水平升高(P＜0.01或P＜0.05);高密度脂蛋白(HDL-C)水平降低(P＜0.01);血清胰岛素、瘦素、抵抗素和TNF-α、IL-6含量明显升高(P＜0.01);脂联素水平明显降低(P＜0.01).原花青素干预组血脂水平明显降低(P＜0.01);血清胰岛素、瘦素、抵抗素和TNF-α、IL-6含量降低(P＜0.01或P＜0.05);脂联素水平升高(P＜0.01).结论 瘦素、抵抗素、脂联素和TNF-α、IL-6在高脂血症的病理和生理过程中起着重要作用.原花青素通过增加脂联素,降低血清胰岛素、瘦素、抵抗素、TNF-α和IL-6含量,控制炎症反应,对高脂饮食所致高脂血症相关性胰岛素抵抗的防治发挥重要作用.     

四种临床类型高脂血症患者血清瘦素、脂联素水平的变化

目的观察四种临床类型高脂血症患者血清瘦素、脂联素（adiponectin，ADN）水平，并探讨它们在脂代谢中的作用。方法入选540例体检人群，其中正常对照组204例。高脂血症患者336例，其中高胆固醇血症组（高TC组，80例）、高甘油三脂血症组（高TG组，105例）、混合型高脂血症组（混合组，85例）和低高密度脂蛋白血症组（低HDL组，66例）4组，分别检测每组患者血清瘦素、ADN水平，并分析其在脂代谢中的作用。结果与正常对照组比较，除低HDL组ADN水平明显升高外（P〈0．05），其余各高脂血症组无论是血清瘦素水平，还是ADN水平均未见统计学差异（P〉0．05）；高脂血症各组之间两两比较可见高TG组瘦素水平低于低HDL组（P〈0．05）；高TC组ADN水平低于低HDL组（P〈0．05）。无论正常对照组还是高脂血症组，血清瘦素与ADN均呈显著正相关（P〈0．05）。结论血清瘦素与ADN共同参与脂代谢的调节，它们之间的相互制约及动态平衡可能在高脂血症的发展进程中起着重要作用。     

慢性阻塞性肺疾病患者血脂水平与瘦素、脂联素的关系

目的探讨慢性阻塞性疾病(COPD)患者脂质代谢的特点。方法检测30例COPD稳定期患者和20例同年龄段健康体检者血脂总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,应用ELISA方法测定两组血清脂肪因子(瘦素、脂联素)水平,进行组间比较以及相关性分析。结果与对照组比较,COPD组血清TC、TG明显降低(P0.05),而HDL-C和LDL-C与对照组比较差异不明显(P0.05)。与对照组比较,COPD组血清瘦素水平明显降低(P0.05),血清脂联素水平明显升高(P0.05),并且COPD患者血脂水平与瘦素呈显著正相关(P0.05),与脂联素呈显著负相关(P0.05)。结论 COPD患者存在脂质代谢异常,脂肪因子瘦素、脂联素参与了脂质代谢的调节,但其具体机制有待进一步研究。     

刍议2型糖尿病肾病患者内脂素、脂联素和C反应蛋白变化及其临床意义

目的探究2型糖尿病肾病患者内脂素、脂联素以及C反应蛋白(CRP)变化水平与其临床意义。方法对94例2型糖尿病患者按照尿清蛋白排泄率(UAER)分3组:微量蛋白尿组29例,UAER为每分钟21~200μg;正常蛋白尿组34例,UAER为每分钟不足20μg;大量蛋白尿组34例,UAER为每分钟超过200μg;同时,健康体检34例正常人为对照组,选择氧化酶法对FPG检测,胶体滤过法对Hb A1c检测,全自动生化分析仪对BUN、TG、HDL-C、TC、LDL-C、SCr以及BUN检测;免疫比浊法对CRP检测,高效免疫比浊法对尿微量清蛋白检测。结果 3组血清内脂素与CRP水平比对照组高;正常蛋白尿组血清脂联素比对照组低,微量蛋白尿组与大量蛋白尿组血清脂联素比对照组高;病程、UAER、BUN、TC、LDL-C、SCr、TG、SBP、FPG、Hb Alc均与内脂素与CRP存在正相关;内脂素、CRP与HDL-C间存在负相关;病程、LDL-C、SCr、BUN、UAER、SBP均与脂联素存在正相关(P0.05)。结论 2型糖尿病肾病发生与发展中,血清内脂素、CRP、脂联素都可能参与,对三者水平共同检测,对早期糖尿病肾病进行评估。     

脂联素及糖脂代谢异常与乳腺癌发生、转移的关系

目的 研究血清脂联素、血糖及血脂水平与乳腺癌发病风险及转移的关系.方法测定80例乳腺癌患者和50例对照组受试者的血清脂联素、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,探讨其与乳腺癌的关系.结果乳腺癌组、淋巴结转移组血清脂联素及HDL-C水平分别低于正常对照组、无转移组(P＜0.01或 P＜0.05);乳腺癌组,淋巴结转移组FPG、TG分别高于对照组及无转移组(P＜0.01或 P＜0.05).Logistic回归分析发现,降低的脂联素(OR:0.805,P＜0.01)和HDL-C(OR:0.087,P＜0.05)增加乳腺癌的风险性,而升高的TG(OR:4.806,P＜0.05)增加乳腺癌的风险性;降低的脂联素(OR:0.725,P＜0.01),升高的FPG(OR:2.354,P＜0.05)增加乳腺癌转移的风险.结论低脂联素血症是乳腺癌发病和转移的独立危险因素;糖脂代谢异常也可能与乳腺癌的发病及转移有关.     

疏肝降脂颗粒对非酒精性脂肪性肝病患者血清瘦素及脂联素水平的影响

目的:观察疏肝降脂颗粒对非酒精性脂肪性肝病(NAFLD)患者血清瘦素及脂联素水平的影响。方法:60例NAFLD患者,随机分为治疗组和对照组,治疗组30例患者给予疏肝降脂颗粒治疗,对照组30例患者给予当飞利肝宁胶囊,比较两组患者治疗前后血脂(TC、TG)、肝功能(ALT、AST)、瘦素(LP)、脂联素(ADPN)及肝脏CT的变化。结果:与治疗前比较,治疗组患者ALT、AST、TC、TG检测结果显著下降,疗效优于对照组,差异有统计学意义(P0.05)。与治疗前比较,两组患者血清瘦素及脂联素水平均显著下降(P0.05)。与对照组比较,治疗组患者血清瘦素水平明显下降,脂联素水平显著升高(P0.05)。结论:疏肝降脂颗粒可降低血清瘦素水平、升高脂联素水平,改善肝功能、调节血脂代谢,临床疗效优于当飞利肝宁胶囊。     

血清瘦素和脂联素水平与非缺血性扩张型心肌病患者预后的关系研究

目的分析血清瘦素和脂联素水平与非缺血性扩张型心肌病(NIDCM)患者预后的关系。方法选取2012—2015年在西安市第五医院确诊的NIDCM患者68例作为试验组,其中纽约心脏病协会(NYHA)分级Ⅰ级15例,Ⅱ级24例,Ⅲ级17例,Ⅳ级12例;体质指数(BMI)正常22例,超重18例,肥胖28例。另选取同期体检健康者40例作为对照组。采用电话或入院就诊等方式对所有患者进行随访,随访截至患者死亡或2016-12-31。比较对照组与试验组受试者、不同BMI患者血脂指标、肌酐(Cr)水平及血清瘦素、脂联素水平,并比较不同NYHA分级患者血清瘦素、脂联素水平;血清瘦素、脂联素水平与NIDCM患者BMI的相关性分析采用Pearson相关性分析;绘制Kaplan-Meier生存曲线以评价不同血清瘦素、脂联素水平患者生存状况。结果对照组与试验组受试者总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Cr水平比较,差异无统计学意义(P0.05);试验组患者血清瘦素、脂联素水平高于对照组(P0.05)。不同BMI患者TC、TG、HDL-C、LDL-C、Cr水平比较,差异无统计学意义(P0.05);超重和肥胖患者血清瘦素和脂联素水平高于BMI正常患者,肥胖患者血清瘦素和脂联素水平高于超重患者(P0.05)。NYHA分级Ⅱ级、Ⅲ级及Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅰ级患者,NYHA分级Ⅲ级及Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅱ级患者,NYHA分级Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅲ级患者(P0.05)。Pearson相关性分析结果显示,血清瘦素、脂联素水平与NIDCM患者BMI呈正相关(r值分别为0.844、0.789,P0.05)。Kaplan-Meier生存曲线显示,血清瘦素水平≤5.74μg/L患者生存状况优于血清瘦素水平5.74μg/L患者(P0.05);血清脂联素水平≤12.45 mg/L患者生存状况优于血清脂联素水平12.45 mg/L患者(P0.05)。结论 NIDCM患者血清瘦素和脂联素水平明显升高,且其水平变化与患者心力衰竭严重程度及预后有关。     

电针对高脂血症新西兰兔脂肪组织脂联素mRNA表达的影响

目的探讨电针胃经穴位对高脂血症新西兰兔血脂及脂肪组织脂联素mRNA表达的影响。方法取24只雄性新西兰兔,随机数字法分为高脂血症组和正常对照组各12只。造模8 w以后,上述两组再各自随机分为电针组和对照组各6只。电针10 d后,7180型日立自动分析仪测定所有新西兰兔的血脂四项,Real Time PCR法检测新西兰兔腹腔脂肪组织脂联素mRNA表达。结果造模后高脂血症组的甘油三酯(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)明显高于正常对照组,高密度脂蛋白胆固醇(HDL-C)明显低于正常对照组(均P0.05),显示造模成功。电针后高脂电针组的血清TC水平明显低于高脂对照组(P0.05)。电针后高脂电针组脂肪组织脂联素mRNA表达量明显高于高脂对照组(P0.05)。结论电针新西兰兔胃经穴位可以有效降低血脂和增强脂肪组织脂联素基因表达,对改善高脂血症有一定作用。     

瑞舒伐他汀对高脂饲养大鼠心肌脂联素及其受体表达的影响

目的　探讨瑞舒伐他汀对高脂饲养大鼠心肌脂联素及其受体mRNA和蛋白表达的影响。方法　8周龄Wistar大鼠48只,随机分为对照组、高脂饲养组、高脂饲养＋瑞舒伐他汀组,20周后,全自动生化分析仪测定血清甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDLC）、高密度脂蛋白胆固醇（HDLC）、血糖,ELISA测定血清脂联素,RT-qPCR和　Western　blot测定心肌组织脂联素及其受体　mRNA和蛋白的表达。结果　与对照组相比,高脂饲养组大鼠血清TG、TC、LDLC、血糖、脂联素升高（P＜0.01）,HDLC降低（P＜0.01）。与高脂饲养组相比,高脂饲养＋瑞舒伐他汀组血清TG、TC、LDLC、脂联素降低（P＜0.05）,　HDLC升高（P＜0.01）,血糖无明显差异（P＞0.05）。与对照组相比,高脂饲养组心肌脂联素mRNA和蛋白表达升高（P＜0.01）,心肌脂联素受体mRNA和蛋白表达降低（P＜0.05）。与高脂饲养组相比,高脂饲养＋瑞舒伐他汀组心肌脂联素mRNA和蛋白表达降低（P＜0.05）,心肌脂联素受体1　mRNA和蛋白表达升高（P＜0.05）,心肌脂联素受体2　mRNA和蛋白表达无明显差异（P＞0.05）。结论　高脂饲养大鼠过程中,可出现血清脂联素升高,心肌脂联素mRNA和蛋白表达上调,心肌脂联素受体mRNA和蛋白表达下调,瑞舒伐他汀可以部分逆转这些作用。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.