胰岛素抵抗和血管内皮功能障碍对代谢综合征的预测价值

目的 探讨胰岛素抵抗(IR)和血管内皮功能与代谢综合征(MS)发生的关系.方法 选择2000年石家庄市社区健康检查筛查出的583例单纯肥胖者[体质指数(BMI)≥25 kg/m2]为研究对象,其中男376例,女207例.测定单纯肥胖者的体质量、血压、血脂、血糖,计算胰岛素抵抗指数(HOMA-IR),观察血管内皮功能[以内皮依赖性血管舒张(EDD)表示].7年后对单纯肥胖者进行随访并复查上述指标.结果 2007年随访到524例,发生MS者194例,MS累计发生率为37.03%,年发生率为5.29%.男性(356例)和女性(168例)MS累计发生率(45.22%和19.64%)间差异有统计学意义(P＜0.01).发生MS者基线时腰围、腰臀比、三酰甘油(TG)、空腹血糖(FPG)、空腹胰岛素(Fins)、HOMA-IR、EDD与未发生MS者比较,差异均有统计学意义(P＜0.05).根据基线时的检测结果将单纯肥胖者分为4组:EDD异常组、IR组、EDD异常合并IR组、无EDD异常及IR组.EDD异常组和EDD异常合并IR组的MS累积发生率分别为41.53%和46.22%,与IR组的29.35%及无EDD异常及IR组的15.73%比较,差异均有统计学意义(P＜0.05);且IR组的MS累计发生率与无EDD异常及IR组比较,差异亦有统计学意义(P＜0.05).结论 IR和血管内皮功能障碍的发生均早于MS,可能为导致MS的基本原因,并可能成为MS发病的早期预测因子.     

β3肾上腺素能受体基因Trp64Arg突变与单纯肥胖者早期动脉粥样硬化的相关研究

目的探讨 β3 肾上腺素能受体 (β3 adrenergicreceptor,β3 AR)基因Trp6 4Arg突变与单纯肥胖者早期动脉粥样硬化形成的关系。方法 2 95例无心血管疾病和代谢性疾病的单纯超重 /肥胖者 ,按照腰臀比分为周围性肥胖和中心性肥胖组 ,172例正常体质量的健康人作为对照。检测各组 β3 AR基因Trp6 4Arg突变频率和血管内皮依赖性舒张功能 (endothelium dependentdilation ,EDD) ,并测定空腹时血糖 (fastingbloodglucose,FBG)、胰岛素(fastinginsulin ,FINS)、内皮素 (endothelin ,ET)和一氧化氮 (nitricoxide,NO) ,按稳态模式评估法公式计算胰岛素敏感性 (hemeostasismodelassessmentforinsulinresistance ,HOMA IR)。结果周围性肥胖组和中心性肥胖组的EDD均较正常体质量组显著降低 (P <0 .0 5 ,P <0 .0 1) ,前 2组比较 ,中心性肥胖组EDD降低更明显 ,且NO水平也显著下降 (P均 <0 .0 5 ) ;周围性肥胖组 ,中心性肥胖组和正常体质量组Trp6 4Arg突变频率分别为 17.17% ,2 5 .2 6 %和 18.89% ,虽无显著性差异 ,但中心性肥胖组与其他 2组比较 ,有明显升高趋势 ;周围性肥胖组EDD降低在β3 AR基因突变与无突变者之间无显著性差异 ,而中心性肥胖组的EDD在基因突变者较无突变者降低更显著 (P <0 .0 5 )。结论单纯肥胖者早     

胰岛素强化治疗对初诊2型糖尿病血管内皮功能的影响

目的探讨胰岛素强化治疗对初诊2型糖尿病患者血管内皮功能的影响。方法选择初诊2型糖尿病患者43例,应用胰岛素泵短期强化治疗,观察治疗前后血管内皮功能及体脂、血压、血脂、血糖、胰岛素抵抗指数(HOMA-IR)的变化。结果初诊2型糖尿病患者已存在血管内皮依赖性舒张(EDD)功能受损,并伴有各项代谢指标异常。经胰岛素强化治疗使血糖控制达标后,EDD由5.48±2.24增加为10.36±3.73(P<0.01),血脂及HOMA-IR显著降低(分别为P<0.05和P<0.01)。结论初诊2型糖尿病早期胰岛素强化治疗不仅可有效治疗糖脂代谢紊乱,并可显著改善血管内皮依赖性舒张功能。     

糖尿病伴高血压患者的β细胞功能变化

目的：探讨2型糖尿病伴高血压和血压正常时胰岛素作用和分泌的变化,方法：298例2型糖尿病分为高血压组95例和血压正常组203例,比较两组口服葡萄糖耐量试验（OGTT）和胰岛素释放试验中血糖及胰岛素,并以稳态模型（Homa model)评估公式胰岛素抵抗指数（IR）,β细胞功能指数（HBCI）及胰岛素敏感指数（IAI）评价胰岛素抵抗和β细胞功能。结果：高血压组患者空腹血糖,空腹胰岛素显著高于血压正常组（P＜0．01或P＜0．05）,与IR呈显著正相关（P＜0．01）,与IAI和HBCI呈负相关（P＜0．05）。各组内肥胖者亦显示与IR明显正相关而与IAI负相关,P＜0．01,说明高血压组患者胰岛素抵抗显著,β细胞分泌功能下降,伴有肥胖者胰岛素抵抗更加显著。结论：2型糖尿病伴高血压患者存在显著的胰岛素抵抗及β细胞分泌的功能紊乱,肥胖加重了胰岛素抵抗。     

单纯性肥胖成人神经内分泌功能与心理健康状况关系的追踪研究

目的：研究单纯性肥胖成人神经内分泌功能与心理健康状况的关系及其变化特点。方法：对82例超重肥胖者和73名适宜体重者进行了为期一年的前瞻性对照追踪，采用症状自评量表（SCL－90）评定心理健康状况，放射免疫法测定肾上腺皮质激素（ACTH）、皮质醇（COR）、胰高血糖素（GLU)和胰岛素。有胰岛素抵抗（IR）、胰岛素敏感指数（IAI）、Homeβ细胞功能指数（HBCI）评定胰岛素敏感性和胰岛β细胞内分泌功能。结果：超重肥胖组ACTH、GLU、HBCI、IR明显高于适宜体重组，也存在较多的心理症状，其IR、IAI与精神病性症状均有关。但追踪期间超重肥胖组心理状态有明显改善。结论：单纯性肥胖成人的神经内分泌功能与心理状态可能有关。     

单纯糖耐量受损者的内皮功能改变及危险因素分析

目的 探讨单纯糖耐量受损（I-IGT）者的内皮功能改变和危险因素的特点.方法 按2005年国际糖尿病联盟肥胖标准分肥胖和非肥胖组,选择I-IGT 83例（肥胖即D2亚组42例;非肥胖即D1亚组41例）,与糖耐量正常者142例（肥胖即N2亚组67例;非肥胖即N1亚组75例）作比较,做口服葡萄糖耐量试验及胰岛素释放试验,检测0nmin 、10 min、20 min、30 min、60 min、120 min血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸、脂联素、超敏C反应蛋白（hs-CRP）、血清内皮素（SET）,留取晨尿测定尿内皮素（UET）与尿微量白蛋白（U-MA）,记录糖尿病家族史并观察血压、身高和体重,测定肱动脉休息时、加压及服用硝酸甘油后的内径变化.结果 校正性别、年龄后I-IGT与糖耐量正常者、D2亚组与N2亚组以及D1亚组与N1亚组比较,U-MA、hs-CRP、UET和SET均有上升而内皮依赖性血管舒张功能和内皮非依赖性血管舒张功能下降有明显改变（P＜0.05或P＜0.01）,D2亚组与D1亚组比较hs-CRP有显著改变（P＜0.01）;多元回归分析显示,以内皮指标为因变量能进入方程的有糖尿病家族史、肥胖、血压、脂代谢、血糖及胰岛分泌功能等指标.结论 I-IGT非肥胖者和肥胖者主要表现为大血管混合微血管内皮改变,肥胖者大血管内皮改变较为严重;内皮功能改变的危险因素与糖尿病家族史外,还与肥胖、血压增高、脂代谢紊乱、血糖增高及胰岛功能的改变等代谢性因素密切相关.     

胰岛素抵抗对2型糖尿病患者血管内皮舒张功能的影响

目的 评价2型糖尿病患者的血管内皮舒张功能,探讨胰岛素抵抗(IR)对血管内皮功能的影响.方法 2型糖尿病患者分为IR组(24例)和非IR组(21例),另设正常对照组(30例).采用高分辨率超声检测肱动脉内皮依赖性和非依赖性舒张反应(EDD,EID).测定空腹血糖(FBG)、空腹胰岛素(FINS)及一氧化氮(NO),并采用稳态模式法计算胰岛素抵抗指数(HOMA-IR).结果 IR组和非IR组糖尿病患者的EDD、EID、NO均明显低于对照组(P＜0.01),IR组的EDD、EID、NO明显低于非IR组(P＜0.01).结论 2型糖尿病患者的内皮依赖性和非依赖性舒张功能均有受损,胰岛素抵抗是导致损害加重的高度危险因素.     

有糖尿病家族史儿童胰岛功能状态研究

目的：研究有糖尿病家族史儿童胰岛素敏感性、胰岛素抵抗及G细胞功能状态。方法：随机抽取新疆乌鲁木齐市天山区6所中小学10b15岁的在校学生,随机选取有糖尿病家族史的正常体重儿童37例（A组）、无糖尿病家族史的正常体重儿童39例（B组）、有糖尿病家族史的超重肥胖儿童32例（C组）、无糖尿病家族史的超重肥胖儿童37例（D组）,并进行体格检查和实验室生化检测。采用HOMA—IR、HOMA—B及胰岛素敏感指数（insulin sensitive index,ISI）评价。结果：在正常体重组：有糖尿病家族史儿童与无糖尿病家族史儿童比较存在胰岛素敏感性的下降,随着体重的增加渐出现血糖、血脂、血压方面代谢异常;在超重肥胖组：有糖尿病家族史儿童B细胞功能指数（β-cell function index,HBCI）、ISI、胰岛素抵抗指数（insulin resist index,IR）均异常;ISI、IR、HBCI除了与血糖（BG）、胰岛素（INS）密切相关,都与体重指数（BMI）、腰臀比（WHR）、甘油三酯（TG）密切相关;ISI与BMI显著相关,IR、HBCI与BMI呈正相关,IR与WHR呈正相关,ISI、HBCI与WHR呈负相关。结论：有糖尿病家族史儿童存在胰岛素敏感性降低、胰岛素抵抗及B细胞功能异常。     

肥胖和高血压病患者胰岛素敏感性的变化

探讨高血压病与肥胖患者胰岛素抵抗现象。方法用正常血糖胰岛素钳夹技术测定３６例正常血压者，２３例单纯肥胖患者，５１例高血压非肥胖患者及５４例高血压合并肥胖患者的葡萄糖代谢率（Ｍ值），同时做口服葡萄糖耐量试验和胰岛素释放试验。结果发现（１）肥胖、高血压非肥胖和高血压合并肥胖患者口服葡萄糖７５ｇ后，６０和１２０分钟血糖及不同时间点胰岛素值均比正常血压者高（Ｐ＜０．０１）；（２）Ｍ值：正常人、高血压非肥胖患者、单纯肥胖者、高血压合并肥胖患者分别为９．２±１．０、７．６±２．０、６．７±１．５、５．２±１．８ｍｇ·ｋｇ－１·ｍｉｎ－１，差异均有显著意义（Ｐ＜０．０５）；胰岛素敏感性降低在高血压病合并肥胖组为８７．０％，单纯肥胖为６９．６％，高血压非肥胖为４１．１％，正常人为２．８％，差异有显著意义（Ｐ＜０．０５）；（３）多因素回归分析，发现性别、年龄、舒张压对Ｍ值无明显影响，而体重指数每增加１ｋｇ／ｍ２，Ｍ值减少０．４２ｍｇ·ｋｇ－１·ｍｉｎ－１，收缩压每增加１０ｍｍＨｇ，Ｍ值减少０．２０ｍｇ·ｋｇ－１·ｍｉｎ－１。结论胰岛素敏感性降低可能是肥胖与高血压病的发病因素。肥胖对胰岛素敏感性的影响比血压的影响更明显。     

针灸结合行为疗法对老年肥胖者生活质量的影响

目的观察针灸结合行为疗法对老年单纯性肥胖者肥胖指数及生活质量的影响。方法将205例军队老年肥胖者随机分为单纯针灸组（A组）、针灸结合行为治疗组（A＋B组）和单纯行为疗法组（B组）。治疗前后测定三组体重、腰臀围比、体成分等肥胖指标，并采用生存质量评定量表简表（WHOQOL-BREF）中文版对肥胖患者生活质量进行评定。结果三组患者减重后的腰围、臀围、腰臀围比、体脂含量及百分比等指标以及生活质量评分较减重前有明显改善，均有显著性差异（P〈0．05），且针灸结合行为治疗组的上述指标改善显著优于单纯针灸组和单纯行为疗法组（P〈0．05）。结论针灸结合行为疗法的综合减肥方案能更有效地改善军队老年肥胖者的肥胖指标和生活质量，两者合用具有协同作用。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.