乌鲁木齐市维吾尔族、汉族住院患者胰岛素抵抗状态下多种危险因素分析

目的探讨乌鲁木齐市住院患者维吾尔族和汉族胰岛素抵抗(IR)状态下多种危险因素分布特点。方法来自内科住院病人219例,均进行葡萄糖糖耐量试验和胰岛素释放试验,运用稳态模式法评价胰岛素抵抗对维吾尔族、汉族多种危险因素分布的影响。结果维吾尔族胰岛素抵抗组体重和腰臀比大于维吾尔族对照组,差异有统计学意义(P0.05);汉族胰岛素抵抗组总胆固醇(TC)和低密度脂蛋白(LDLC)高于汉族对照组,差异有统计学意义(P0.05)。维吾尔族胰岛素抵抗组体重、体质指数(BMI)和腰围大于汉族胰岛素抵抗组,差异有统计学意义(P0.05)。维吾尔族体质指数明显高于汉族人群,即非胰岛素抵抗组维吾尔族高于汉族(26.84±4.19 vs25.52±3.19)kg/m2,(P0.05),胰岛素抵抗组维吾尔族高于汉族(27.77±3.60 vs 26.09±3.68)kg/m2(P0.05)。多个危险因素(Logistic回归分析)分析发现糖尿病、高血压、总胆固醇和甘油三酯与胰岛素抵抗呈正相关(P0.01)。高密度脂蛋白(HDLC)与胰岛素抵抗呈负相关(P0.01)。结论在乌鲁木齐市住院患者胰岛素抵抗人群中,维吾尔族以肥胖为主,汉族以胆固醇升高为主。糖尿病、高血压和血脂异常与胰岛素抵抗密切相关。     

女性生殖细胞发育过程的分子遗传学研究进展

女性生殖细胞的发育主要经历胚胎发育期和青春期后的卵泡发育期,其中有丝分裂-减数分裂转换、减数分裂阻滞和再激活是发育过程中的关键阶段。各发育阶段独具特征性分子事件,其顺序发生亦需严密的基因调控及与性腺体细胞的交互作用。近年来,单细胞转录组学研究揭示了生殖细胞及性腺体细胞的阶段特异性表达基因、信号传导通路及表观遗传学变化,为深入理解生殖细胞发育过程、阐明相关疾病的发病机制以及促进生殖遗传研究成果的临床转化提供了科学依据和理论基础。     

采用磁共振示踪法探讨大鼠脑细胞间隙内物质转运清除规律

目的 采用磁共振示踪法探讨脑细胞间隙（ECS）内物质转运规律及外界刺激对其转运能力的影响。方法 将32只雄性SD大鼠随机分为尾状核-对照组、丘脑-对照组、尾状核-运动组和丘脑-疼痛组,通过立体定位技术将示踪剂Gd-DTPA导引至尾状核和丘脑区的ECS,在示踪剂注射前和注射后不同时间点进行MR扫描,直至Gd-DTPA所致的高信号消失,通过图像后处理和数学建模技术,计算示踪剂在ECS内的半衰期,采用独立样本t检验比较各组结果。结果 尾状核ECS内的Gd-DTPA可转运至邻近皮层区,丘脑ECS内Gd-DTPA的转运局限于原位,未观察到向邻近区域进行跨区域转运。尾状核-对照组、丘脑-对照组Gd-DTPA的半衰期分别为（104.30±54.12） min和（49.93±2.11） min （t=2.839,P<0.05）。尾状核-运动组Gd-DTPA的半衰期分别为（113.42±47.32） min,与尾状核-对照组比较差异无统计学意义（t=0.359,P>0.05）。丘脑-疼痛组的Gd-DTPA的半衰期为（109.40±10.33） min,较丘脑-对照组显著延长（t=15.954,P<0.05）。结论 磁共振示踪法是研究脑ECS内物质转运规律的有效手段,外界刺激可调控相关脑区ECS内物质的转运清除。     

Fetuin-A to adiponectin ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus

AimsThe purpose of this research was to explore the associations of fetuin-A, adiponectin, and fetuin-A/adiponectin ratio (F/A ratio) with subclinical atherosclerosis as evaluated by carotid intima-media thickness (CIMT) in cases with newly diagnosed type 2 diabetes mellitus (T2DM).MethodsA total of 283 newly diagnosed T2DM patients were enrolled in this study. Serum fetuin-A and adiponectin levels were determined with an ELISA method. Other clinical and biochemical parameters were also collected.ResultsSignificant linear increases in waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure, homoeostasis model assessment of insulin resistance, C-reactive protein (CRP) and F/A ratio, and a significant linear decrease in adiponectin with increasing tertiles of CIMT were observed (P for trends <0.05). However, no significant correlation between fetuin-A and CIMT was detected (P > 0.05). In multivariate logistic regression models, WHR, SBP and F/A ratio were independently correlated with higher CIMT. Receiver operating characteristic curve analysis indicated that F/A ratio had a better predictive power for higher CIMT than adiponectin and fetuin-A, with an area under the curve of 0.802, 0.713 and 0.646, respectively.ConclusionF/A ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed T2DM.     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

贝尼地平对高血压病患者血浆降钙素基因相关肽水平的影响

目的　探讨钙离子拮抗剂贝尼地平对高血压病患者血浆降钙素基因相关肽 (CGRP)水平的影响。方法　 5 8例门诊高血压病患者接受贝尼地平 4～ 8mg/d治疗 8周 ,以 38例相匹配的健康者为对照 ,测定高血压病患者治疗前后和对照者的血浆CGRP水平。结果　高血压病患者的血浆CGRP水平较对照者明显降低 (最小值 :1 2 8比 39 95ng/L ;最大值 :4 3 72比 15 5 5 9ng/L ;P <0 0 0 1) ;高血压病患者经贝尼地平治疗 2周收缩压和舒张压明显降低 (P <0 0 5 ) ;之后维持治疗 8周血压稳定 ,血浆CGRP水平则较治疗前显著升高 (最小值 :2 84比 1 2 8ng/L ;最大值 :12 3 99比 4 3 72ng/L ;P<0 0 0 1)。结论　钙拮抗剂贝尼地平在降低血压的同时可明显升高高血压病患者血浆CGRP水平。     

白细胞介素1基因多态性与北京地区胃癌的关系

目的　了解白细胞介素 (IL) 1β 31、IL 1β 5 11和IL 1受体拮抗因子基因 (IL 1RN)多态性在北京地区胃癌患者及慢性胃炎患者中的分布情况 ,探讨IL 1基因多态性与北京地区胃癌的关系。方法　收集北京地区 5 7例胃癌患者和 12 0例慢性胃炎患者的外周血标本 ,提取DNA ,用聚合酶链反应 限制性片段长度多态性法 (PCR RFLP)检测入选患者的IL 1基因多态性情况 ,并比较这些基因多态性在胃癌组和慢性胃炎组的分布差异。结果　IL 1β 31C等位基因在慢性胃炎组和胃癌组中的分布频率分别为 4 9.2 %和 6 1.4 % ,胃癌组明显高于慢性胃炎组 (P <0 .0 5 ) ,携带IL 1β 31C等位基因增加胃癌的风险性 ,IL 1β 31C/C纯合子型的胃癌风险OR值为 2 .4 (95 %CI =1.0～ 5 .9)。IL 1β 5 11T等位基因在慢性胃炎组和胃癌组中的分布频率分别为 4 7.9%和 6 5 .8% ,胃癌组明显高于慢性胃炎组 (P <0 .0 1) ,携带IL 1β 5 11T等位基因增加胃癌的风险性 ,IL 1β 5 11T/T纯合子型的胃癌风险OR值为 3.8(95 %CI =1.5～ 9.7)。IL 1RN 2等位基因在慢性胃炎组和胃癌组中的分布频率分别为 3.8%和 11.4 % ,胃癌组明显高于慢性胃炎组 (P <0 .0 1) ,携带IL 1RN 2等位基因增加胃癌的风险性 ,L/ 2杂合子型的胃癌风险OR值为 3.5 (95 %CI =1.4～ 8.9