TNF-α与肥胖相关胰岛素抵抗的研究进展

肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）是一种在肿瘤细胞中发挥细胞毒性作用的肽类物质,曾经被认为在体内可使体重减轻而在体外又可促进脂肪生成。1993年,首次在啮齿类动物的脂肪组织中发现了TNF-α,它在肥胖动物模型中的表达量呈显著增加,并且在肥胖人的脂肪组织中也过量表达,而缺乏TNF-α或其受体的肥胖小鼠胰岛素抵抗（insulin resistance,IR）改善。因而初步确定TNF-α也是由脂肪细胞分泌的一种促炎症因子,不仅发挥介导免疫反应、细胞凋亡和存活、细胞毒性以及其他细胞因子的产生的作用,而且与肥胖相关IR的发生密切关联。现将TNF-α与肥胖相关IR的研究进展综述如下。     

机采血小板采集效果评价

目的 评价机采血小板采集效果.方法 选择54名机采血小板捐献者,对采集前后外周血检测指标、采集过程参数及成品质量进行检测分析.结果 54名机采血小板献血者献血前后外周血主要指标：WBC、RBC、HGB、HCT、PLT、MPV、PDW、P-LCR比较,差异具有统计学意义（P＜0.05）,献血后外周血PLT计数、成品PLT计数与血细胞分离机设定值（估算值）差异无统计学意义（P＞0.05）.结论 捐献血小板对献血者红细胞、白细胞影响不大.献血者及血小板成品实际采集后计数与机器提供参数存在个体差异,为保证产品质量需适当提高机器设定值,谨慎使用机器采后计数下限.选择技术先进、采集效率高、应用范围广的血细胞分离机可以保证采集产品质量,满足临床用血需求,同时保障献血者身体健康,从而招募、保留更多的献血者.     

磺脲类降糖药继发性失效2型糖尿病患者血清瘦素水平的变化

目的 观察磺脲类(SU)降糖药继发性失效2型糖尿病(T2DM)患者血清瘦素水平,探讨瘦素水平与其他代谢指标的相关性.方法 选择60例磺脲类降糖药继发性失效T2DM患者(SFS组)、30例血糖控制良好的T2DM患者(WCP组)和20例健康志愿者(NC组).采用酶联免疫吸附法(ELISA法)检测3组受检者的瘦素水平,同时检测生化指标、胰岛素水平等,并进行相关性分析.结果 WCP组患者血清瘦素水平[(10.2±3.6)ng/ml]与NC组[(6.6±2.3)ng/ml]比较,SFS组患者血清瘦素水平[(14.8±3.9)ng/ml]与WCP组比较,差异均有统计学意义(P＜0.05);WCP组及SFS组患者的空腹胰岛素水平[分别为(16.5±7.2)μU/L和(17.5±7.5)μU/L]、胰岛素抵抗指数(HOMA-IR)[分别为(4.1±2.9)和(4.3±2.9)]与NC组[分别为(13.9±6.8)μU/L和(2.7±1.6)]比较,差异均有统计学意义(P＜0.05).相关性分析显示,SFS组患者血清瘦素水平与空腹血糖、餐后2 h血糖、糖化血红蛋白、体质指数、空腹胰岛素、HOMA-IR、三酰甘油及低密度脂蛋白胆固醇水平呈正相关(P＜0.05),与高密度脂蛋白胆固醇水平呈负相关(P＜0.05).结论 瘦素和胰岛素抵抗相互作用,可能在磺脲类降糖药继发性失效发病中起重要作用.     

超声弹性成像在表浅软组织良恶性肿块鉴别诊断中的价值

目的探讨超声弹性成像对于表浅软组织良恶性肿块患者的临床诊断价值。方法对96例表浅软组织良恶性肿块患者进行弹性成像检测,并将诊断结果与病理检查结果进行对比分析。结果 96例患者共有肿块134个,病理检查确诊为良性肿块92个,恶性肿块42个。弹性图分级0级有6个肿块,均为良性肿块;1级有21个肿块,也均为良性肿块;2级有59个肿块,良性肿块53个,恶性肿块6个;3级有37个肿块,良性肿块9个,恶性肿块28个;4级有11个肿块,良性肿块3个,恶性肿块8个。2种检查结果比较可以发现,良性肿块多集中于0²级,而恶性肿块多集中于32级,而恶性肿块多集中于3⁴级,良性肿块和恶性肿块的弹性分级比较差异有统计学意义(P<0.05)。按照弹性成像分级3级为恶性肿块与良性肿块的分界点,采用超声弹性成像技术对浅表软组织肿块患者的恶性与良性肿块诊断的准确率为86.6%(116/134)。结论弹性成像作为一项新兴检测技术,其对表浅软组织良恶性肿块的检出率较高。     

葫芦巴总皂苷联合磺脲类降糖药治疗2型糖尿病36例临床观察

目的:观察葫芦巴总皂苷(TFGs)与磺脲类降糖药(SU)合用对继发性失效2型糖尿病(T2DM)的临床疗效。方法:72例单纯使用SU血糖控制不良的T2DM患者,按就诊顺序随机分为对照组(36例)和治疗组(36例),在服用SU的基础上,分别加服安慰剂和TFGs,观察其疗效。结果:治疗组总有效率明显高于对照组(P<0.01);与治疗前相比,治疗组空腹血糖、餐后2 h血糖、糖化血红蛋白、临床症状积分显著下降(P均<0.01),体重指数和肝肾功能无明显变化。结论:TFGs联合SU治疗T2DM,显示了较好的降糖效果,同时能改善临床症状,且有较好的安全性。     

血清脂联素水平在磺脲类药物继发性失效的2型糖尿病患者中的变化及临床意义

目的观察磺脲类降糖药（SU）继发性失效2型糖尿病患者血清脂联素水平与血糖控制良好2型糖尿病患者及正常人之间的差异。方法采用ELISA法检测所有受试者血清脂联素水平,同时检测血糖和血脂,计算体重指数,进行相关性分析。结果血糖控制良好的患者脂联素明显低于正常人（P〈0．05）,SU继发性失效的患者明显低于血糖控制良好的患者（P〈0．05）;两组2型糖尿病患者胰岛素抵抗水平均明显高于正常人（P均〈0．05）,而两组患者比较无明显差异（P〉0．05）。SU继发性失效患者脂联素水平与空腹血糖、餐后2小时血糖、糖化血红蛋白、体重指数、空腹胰岛素、胰岛素抵抗指数、胆固醇、总甘油三酯及低密度脂蛋白胆固醇呈明显负相关（P均〈0．05）,与高密度脂蛋白胆固醇呈明显正相关（P〈0．05）。结论脂联素水平下降和胰岛素抵抗相互影响,可能参与了2型糖尿病SU继发性失效的发生发展。     

葫芦巴总皂苷对链脲佐霉素诱导的糖尿病大鼠血小板活化的调节作用

目的:观察葫芦巴总皂苷(TFGs)对链脲佐霉素(STZ)诱导的糖尿病大鼠血小板活化的调控作用。方法:将正常大鼠和糖尿病大鼠随机分为未治疗对照组、治疗对照组、未治疗糖尿病组和治疗糖尿病组。两治疗组采用TFGs治疗4周。治疗结束后,分别检测大鼠体质量、血糖和胰岛素水平,采用流式细胞术检测各组大鼠血小板膜P选择素(CD62P)的表达,采用比浊法检测各组大鼠血小板最大聚集率。结果:与正常大鼠相比,糖尿病大鼠血糖明显升高,体质量和胰岛素水平显著下降,糖尿病大鼠经TFGs治疗后体质量明显增加,血糖下降,胰岛素水平升高;糖尿病大鼠血小板CD62P表达和血小板聚集率明显增高,经TFGs治疗后明显降低。结论:TFGs具有明显抑制STZ糖尿病大鼠血小板活化作用,是一种具有防治糖尿病血管病变作用的降糖药物。     

武汉地区老年人群骨质疏松性骨折发病率初步调查

目的：了解武汉地区老年人群骨质疏松性骨折发生率。方法：根据流行病学调查的要求，整体抽样选择常住武汉市区60岁以上的老年居民1764人，现场调查由骨科医生执行，统一质量控制和回收表格，进行统计分析。结果：60岁及以上老年人群各种骨质疏松性骨折总发生率为7．31％。结论：武汉地区老年骨质疏松性骨折发生率低于国内部分地区。     

血小板膜糖蛋白Ⅰb/Ⅸ/Ⅴ复合物表达变化：健康者与2型糖尿病患者的样本分析☆

BACKGROUND: It has been proved that platelet activation is involved in the development of diabetic angiopathy. Glycoprotein (GP) Ib/IX/V complex is one of the main platelet membrane glycoproteins, and the receptor of both von Willebrand Factor and thrombin. It plays a key role in the process of platelet activation. OBJECTIVE: To observe the expression changes of GP Ib/IX/V complex and its component GP Ibα in patients with type 2 diabetes mellitus. DESIGN: Case-control study. SETTING: Department of Integrated Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS: A total of 51 type 2 diabetic outpatients who visited Union Hospital were enrolled from December 2005 to January 2007. The diagnosis was based on the independent criteria from WHO in 1999. Of all the 51 patients, there were 23 females and 28 males, with a peripheral platelet count of over 50×109 L－1. All the subjects had no history of administrating drugs two weeks before the examination, which would potentially influence platelet count. According to disease controlling condition, the patients were assigned to well controlled patient (WCP) group (n = 25) and poorly controlled patient (PCP) group (n =26); and according to whether angiopathy was accompanied, diabetic patients were divided into vascular disease (VD) group (n =27) and non-vascular disease (NVD) group (n =24). Meanwhile 23 healthy subjects were enrolled as normal control group. Informed consents were obtained from subjects and their relatives. The experiments were approved by the ethical committee of Union Hospital. METHODS: Fasting venous blood was harvested from all the subjects' elbow on the early morning of visit day.①Biochemical analysis: Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and fasting plasma insulin (FINS) was measured by the Clinical Chemistry Department in Union Hospital.② Measurement of platelet membrane GP Ib/IX/V complex and its component GP Ibα: First, 3 mL cubital fasting blood was drawn from each subject and was anti-coagulated with 38 g/L natrium citricum. After that, all samples were fixed with 10 g/L paraform for 45 minutes. Then 50 μL well-fixed blood was added into the polystyrene tube, meanwhile 20 μL monoclonal antibody, such as CD42a-b-c-d and PE-labeled CD42b, was respectively mixed gently with the blood sample and incubated at room temperature in dark for 30 minutes. Next, 20 μL FITC-labeled rat IgG was mixed with the sample containing CD42a-b-c-d and incubated equally. In the end all blood samples were analyzed by FACS420 flow cytometry and the results were expressed as mean fluorescence intensity (MFI). ③ Platelet maximun aggregation rate (MAR) was detected according to reference. MAIN OUTCOME MEASURES: ①Biochemical indicators;②The expressions of GP Ib/IX/V complex and GP Ibα;③Platelet MAR. RESULTS: Fifty-one patients with type 2 diabetes mellitus and twenty-three healthy subjects were all involved in the result analysis.①There were significant differences in FINS in WCP group and PCP group compared with normal controls (P < 0.01). FPG and HbA1c were significantly higher in PCP group compared with normal control group and WCP group (P < 0.01).②Expressions of GP Ib/IX/V complex and GP Ibα were significantly lower in WCP group and PCP group compared with normal control group (P < 0.01), significantly lower in PCP group than in WCP group (P < 0.05), and also significantly lower in VD group and NVD group compared with normal control group (P < 0.01). Moreover the expression of GP Ibα in VD group and NVD group was significantly lower than that of normal control group (P < 0.05), and it also significantly decreased in VD group compared with NVD group (P < 0.05). MFI of GP Ib/IX/V complex had an obvious negative correlation with FBG, HbA1c and FINS (r =-0.634, -0.573, -0.649, P < 0.05), and GP Ibα MFI was obviously negatively correlated with FBG and HbA1c (r =-0.602, -0.543, P < 0.05).③Platelet MAR of diabetic patients were remarkably higher than in healthy subjects (t =-3.852, P < 0.01). Platelet MAR in PCP and VD groups were respectively higher than those in WCP and NVD groups (P < 0.05). CONCLUSION: Platelet activation exists in the early stage of type 2 diabetes mellitus without diabetic angiopathy, and is more obvious after diabetic angiopathy. There is a positive correlation between platelet activation and blood glucose. As a receptor of thrombin and von Willebrand Factor, GP Ib/IX/V complex may be involved in the development of diabetic angiopathy.     

威海血站血型初筛错误原因分析及措施

目的了解血型初筛错误的原因,提高血型初筛的准确率。方法统计我站2008～2010年无偿献血标本中初筛错型比例,分析错型原因,提出改进措施,提高血型初筛的准确率。结果错型中以该凝集而不凝集为主,占50.68%,判读错误居第二位,占25.68%,操作错误占12.16%,标记错误占11.49%。结论针对错型原因,通过加强人员培训,提高人员素质;强化操作规程,任何情况下不允许简化流程;加强各环节的核对;合理选择ABO血型初检试剂,并按规定的要求贮存;持续改进流动采血车的工作条件,大量外采时合理安排工作人员等措施来提高血型初筛的准确率。