精神分裂症与社会心理应激因素

本文应用ＣＣＭＤ－Ⅱ对精神分裂症病人在发病前一年内的应激事件进行分析，结果发现，精神分裂症病人应事件显著比正常人多，首次发病前遇到的生活事件较为严重，只有负性应激事件才与精神分裂症有关，且患者中以内向性格者居多。     

应激对室性心律失常患者血液流变学的影响

对２０例功能性室性心律失常患者和２０例与之在人口学特征方面相匹配的健康人进行了生活事件的评定和血液流变学指标的测定。结果发现：病例组高切变率血液粘度［ηｂ（Ｈ）］、血浆粘度［ηＰ］、红细胞压积（ＨＣＴ）和红细胞聚集性（ＲＣＡ）与对照组相比差异有显著性（Ｐ＜０．００１）；生活事件紧张总值与上述血液流变学指标呈正性显著相关（Ｐ＜０．００１）。提示应激性生活事件影响血液流变学特性，为应激与室性心律失常关系的研究提供了依据。     

军队医务人员生活事件、焦虑水平及与工作满意度的关系

目的:了解军队医务人员群体的应激现状和主要来源及其与工作满意度的关系。方法:对驻某地区的3家军队中心医院的300名医务人员(现役军人)进行调查,采用生活事件量表、军人心理应激自评问卷等为测量工具。结果:军队医务人员应激的主要来源为工作学习事件,焦虑水平和生活事件对工作满意度有显著的预测力。结论:减少军队医务人员生活事件,降低其焦虑水平,能有效提高其工作满意度。     

应激性生活事件对室性心律失常患者血液流变性的影响

目的 :探讨应激性生活事件对室性心律失常患者血液流变性的影响。方法 :采用应激性生活事件量表对 2 0例功能性室性心律失常患者和 2 0例与之在人口统计学方面相匹配的健康人进行了评定并测定血液流变学指标。结果 :病例组高切变率血液粘度 [ηb(H) ]、血浆粘度 ( ηP)、红细胞压积 (HCT)和红细胞聚集性 (AI)与对照组相比差异有非常显著性意义 (P <0 .0 1) ;生活事件紧张总值与上述血液流变学指标呈正性显著相关 (P <0 .0 1)。结论 :应激性生活事件影响血液流变学特性 ,并为应激与室性心律失常关系的研究提供了依据     

重大公共卫生事件下急性应激与护士工作退缩的关系：有调节的中介模型

目的:探讨在重大突发公共卫生事件下的急性应激事件与护士工作退缩行为的关系,并考察抑郁和正念在其中的作用机制。方法:采用斯坦福急性应激反应问卷、抑郁焦虑压力量表、正念注意觉知量表、工作退缩行为量表对533名临床护士进行问卷调查。结果:(1)急性应激显著正向预测护士工作退缩行为,且抑郁在其中起中介作用;(2)正念能够调节急性应激与抑郁的关系:相比于高正念水平,低正念水平个体其急性应激对抑郁的预测作用更强。结论:急性应激通过抑郁影响护士的工作退缩行为,并且正念调节了前半段路径。     

生活应激事件与希望感对农村留守儿童抑郁的影响

目的:探讨生活应激事件与希望感对农村留守儿童抑郁的影响。方法:采用流调中心抑郁自评量表(CES-D)、青少年自评生活事件量表(ASLEC)、儿童希望感量表(CHS)对1313名留守儿童进行调查。结果:1农村留守儿童在抑郁、希望感的动力因子、生活事件的受惩罚因子和其它因子得分上存在显著性别差异(t=1.99,4.82,6.11;P0.05);2生活应激事件、抑郁和希望感之间两两显著相关(P0.01);3希望感对抑郁水平的变化有显著的负向预测作用(β=-0.097,P0.01);生活应激事件中各因子对抑郁水平的变化具有显著的正向预测作用(P0.05);生活应激事件中的学习压力因子与希望感的交互作用对抑郁水平的变化具有显著的负向预测作用(β=-0.828,P0.001)。结论:希望感能够缓解学习压力给农村留守儿童抑郁带来的不良影响。     

功能失调性态度对大学生抑郁症状的预测作用

目的:探讨功能失调性态度对大学生抑郁症状发生的预测作用。方法:采用方便取样,选取湖南省长沙市某两所高校大一至大三的学生644名。用功能失调性态度问卷(DAS-A)、流调中心用抑郁量表(CES-D)、学生日常社会和学业事件量表(GASHSS)进行基线评定,用CES-D和GASHSS进行每月1次共6次的追踪测查。采用多层线性模型对数据进行统计分析。结果:功能失调性态度水平对追踪过程中抑郁症状水平的主效应显著(b=1.24,P<0.001),功能失调性态度水平与应激性生活事件水平对追踪过程中抑郁症状水平的交互作用显著(b=0.02,P<0.01),随着生活事件应激强度的增加,其抑郁症状明显增加。结论:功能失调性态度可能是抑郁症状的一个预测因子,高水平功能失调性态度的个体在经历应激性生活事件后更易表现出抑郁症状。     

539名高原新兵心理弹性与影响因素

目的:分析高原新兵心理弹性与影响因素。方法:2012年高原某部新兵抵达驻地1周后,采用心理弹性量表(中文版)(CD-RISC)、症状自评量表(SCL-90)、军人心理应激自评问卷(PSET)、团体用心理应激调查表(PSSG)、简易应对方式问卷(SCSQ)、艾森克人格问卷(EPQ)问卷,集中进行现场测评。结果:1高原新兵心理弹性较好,总分为(61.87±12.96);2高原新兵不同水平心理弹性组的应激总标分、生活事件、社会支持、积极应对、外向性、情绪稳定性、SCL-90总分均存在显著差异(P=0.001);3高原新兵心理弹性与积极应对、外向性、社会支持呈正相关(r=0.560,0.432,0.421;P=0.001),与应激总标分、生活事件、消极应对、情绪稳定性、SCL-90总分呈负相关(r=-0.190,-0.186,-0.116.-0.209,-0.186;P0.01);4积极应对、外向性、社会支持、消极应对和生活事件对心理弹性的预测良好,解释率达到38.44%。结论:高原新兵心理弹性状况较好。其心理弹性与应对方式、外向性、社会支持和生活事件密切相关。     

应激事件与大学新生心理健康的关系—气质性乐观的调节作用

目的在大学新生中探讨应激事件、气质性乐观以及心理健康的关系。方法采用SCL-90以及自编的气质性乐观问卷、应激事件调查表对某高校的4736名新生进行调查。结果1应激事件对大学新生的心理健康水平有负向预测作用,应激事件越严重,学生的心理健康水平越低;2气质性乐观对应激事件与心理健康之间的关系具有调节作用,与乐观学生相比,悲观学生的心理健康水平和应激事件之间的关系更密切。结论学生的乐观减弱了应激事件与心理健康之间的负向联系。     

A Trace Research of the Effect of Stress-reactive Rumination on Depressive Symptoms in High School Students

目的 探讨应激性沉思反应在应激性生活事件和抑郁症状关系中的调节作用.方法 在第一次测评时,用抑郁量表、青少年生活事件问卷和应激反应问卷-沉思分量表等自评量表对527名高中生的抑郁症状、应激性生活事件和应激性沉思反应进行测评,随后每3个月测评1次抑郁症状和应激性生活事件,追踪调查1年,用多层线性模型分析数据.结果 相关分析表明,首次测评的抑郁症状、应激性生活事件和应激性沉思反应之间均两两正相关(r=0.21～0.54,P＜0.001).多层线性模型分析表明,应激性生活事件(β=0.13,P＜0.001)和应激性沉思反应(β=1.74,P＜0.001)对抑郁症状的预测作用显著,应激性沉思反应与应激性生活事件的交互作用也显著(β=0.03,P＜0.05).结论 应激性沉思反应在应激性生活事件和抑郁症状的关系中起调节作用.     

The natural history of impaired glucose tolerance in the Pima Indians

Among 384 Pima Indians with impaired glucose tolerance according to World Health Organization criteria who were followed for 1.6 to 11.5 years (median, 3.3), non-insulin-dependent diabetes mellitus (NIDDM) developed in 118 (31 percent), glucose tolerance remained impaired in 100 (26 percent), and glucose tolerance returned to normal in 166 (43 percent). The cumulative incidence of NIDDM was 25 and 61 percent at 5 and 10 years, respectively. The risk of development of diabetes was 6.3 times (95 percent confidence interval, 3.8 to 10.6) as high as in a normoglycemic control group (n = 752). Variables predicting deterioration to NIDDM were age up to the age of 40, after which increasing age had a beneficial effect; higher plasma glucose levels during fasting and after carbohydrate loading; and higher serum insulin levels after fasting and lower levels after carbohydrate loading, suggesting that insulin resistance and decreased beta-cell responsiveness are important determinants of the clinical outcome of impaired glucose tolerance. Obese subjects had 2.9 times (95 percent confidence interval, 2.0 to 10.9) the incidence of NIDDM as the nonobese. Obesity was not, however, predictive of progression to NIDDM after an adjustment for plasma glucose and serum insulin levels. We conclude that in this population approximately one fourth of subjects with impaired glucose tolerance have NIDDM at five years and two thirds at 10 years (approximately one third revert to normal) and that age and plasma glucose and insulin levels are the best predictors of clinical outcome.     

糖尿病患者血浆CGRP RIA

为探讨血浆降钙素基因相关肽含量与糖尿病及其与并发症之间的关系,采用放射免疫分析法测定２８例正常人和６７例非胰岛素依赖型糖尿病患者血浆降钙素基因相关肽水平的变化。结果显示：糖尿病无并发症２血浆降钙素基因相关肽含量较对照组略有些显著意义;伴有并发症各组明显低于对照组伴有并发症者较为无并发症者也显著降低。随着伴有的并发症的增;多,即糖尿病病情的加重,血浆降钙素基因相关肽水平也随之降低。但降钙素基因相关肽     

The investigation of glucose metabolism and insulin secretion in subjects of chronic hepatitis B with cirrhosis

Aims: To investigate the situations of abnormal glucose metabolism and dysfunction of pancreatic islet beta cells in subjects of chronic hepatitis B (CHB) with cirrhosis. Methods: 106 hepatitis B virus (HBV) positive subjects with liver cirrhosis as well as with different grade of Child-Pugh and 37 healthy subjects were included in this study. The oral glucose tolerance test (OGTT), C-peptide and insulin release test were detected. Plasma glucose and insulin levels were analyzed periodically for 2 h after oral glucose loading. Results: There was no significant difference in the level of fasting plasma glucose and C-peptide between cirrhosis group and control group (P>0.05). The levels of OGTT 2 h glucose, insulin and C peptide were significantly higher in cirrhosis group than control group (P<0.01). Peak plasma glucose levels were obtained at 60 min in normal group and cirrhosis group. The peak insulin and C-peptide response occurred at 60 min in normal group, whereas it was delayed to 120 min in cirrhosis group. There was a significant difference between two groups in the pattern of plasma glucose levels at corresponding time points (P<0.05). The OGTT 2 h glucose and insulin levels were positively correlated with Child-Pugh Score (r1 = 0.389, r2 = 0.508, P<0.01). Conclusion: These findings implied that there was a certain degree of insulin resistance and abnormal glucose metabolism in the patients with liver cirrhosis.     

Effect of chronic restraint stress on carbohydrate metabolism in rat

There is some evidence suggesting that stress may induce diabetes mellitus; the effects of restraint stress however need to be investigated. The present study investigates the role of chronic restraint stress on carbohydrate metabolism in male rats. The animals of the stressed group (n=8) were exposed to different restraint stressors (1 h twice daily) for 30 days. On days 1, 15 and 30, before stress exposure, the animals were weighed and fasting blood samples were obtained by tail snipping and subsequently oral glucose tolerance tests (OGTT) were carried out. Fasting plasma glucose levels on the 15th day and the plasma glucose concentrations, on the 15th and 30th days of the experiment at 15 and 60 min following OGTT, in the stressed group, were significantly higher as compared to the control group. In the stressed group, fasting plasma insulin levels on the 15th and 30th days of the experiment and the plasma insulin concentrations, on the 15th day at 15 and 60 min after performing OGTT, were significantly lower as compared to the control group. Fasting plasma corticosterone concentrations were significantly increased on the 15th day of the experiment in the stressed rats as compared to the control rats and to concentrations on the 1st day. The weights of the stressed rats on the 15th and 30th experimental days were significantly lower than the controls. In conclusion, chronic restraint stress for 30 days leads to low body weight gain in rats and impairs glucose metabolism perhaps by affecting corticosterone and insulin secretion and by inducing a degree of insulin resistance.     

Daily Activity Level Buffers Stress–Glycemia Associations in Older Sedentary NIDDM Patients

Examined glycemic associations with medical variables, activity, daily stress, and mood state in 72 older patients with non-insulin-dependent diabetes mellitus (NIDDM). On three occasions over a 2-week observation period, subjects provided measures of everyday life stress, negative mood state, and daily activities. At the end of this period, fructosamine was assayed to measure glycemic control throughout the assessment period. After controlling for medical variables (age, illness duration, body mass index, caloric intake, and activity) and the main effects of psychological factors (stress; anxious, angry, and depressed mood states), stress interacted with activity such that glycemic elevation was positively associated with stress for subjects below the activity median but not for those above the median. This was unattributable to any overall activity-related differences in fructosamine, stress, or mood. None of the mood states interacted with activity. The findings suggest that extremely low levels of activity may strengthen life stress–glycemia associations in NIDDM.     

Early metabolic defects in persons at increased risk for non-insulin-dependent diabetes mellitus

To identify early metabolic abnormalities in non-insulin-dependent diabetes mellitus (NIDDM), we measured sensitivity to insulin and insulin secretion in 26 first-degree relatives of patients with NIDDM and compared these subjects both with 14 healthy control subjects with no family history of NIDDM and with 19 patients with NIDDM. The euglycemic insulin-clamp technique, indirect calorimetry, and infusion of [3-3H]glucose were used to assess insulin sensitivity. Total-body glucose metabolism was impaired in the first-degree relatives as compared with the controls (P less than 0.01). The defect in glucose metabolism was almost completely accounted for by a defect in nonoxidative glucose metabolism (primarily the storage of glucose as glycogen). The relatives with normal rates of metabolism (mean +/- SEM, 1.81 +/- 0.27 mg per kilogram of body weight per minute) and impaired rates (1.40 +/- 0.22 mg per kilogram per minute) in oral glucose-tolerance tests had the same degree of impairment in glucose storage as compared with healthy control subjects (3.76 +/- 0.55 mg per kilogram per minute; P less than 0.01 for both comparisons). During hyperglycemic clamping, first-phase insulin secretion was lacking in patients with NIDDM (P less than 0.01) and severely impaired in their relatives with impaired glucose tolerance (P less than 0.05) as compared with control subjects; insulin secretion was normal in the relatives with normal glucose tolerance. We conclude that impaired glucose metabolism is common in the first-degree relatives of patients with NIDDM, despite their normal results on oral glucose-tolerance tests. Both insulin resistance and impaired insulin secretion are necessary for the development of impaired glucose tolerance in these subjects.     

Abnormal glucose tolerance in Chinese women with polycystic ovary syndrome

BACKGROUND: The aims of this study were to analyse the prevalence of impaired glucose tolerance (IGT) and diabetes mellitus (NIDDM) in Chinese polycystic ovary syndrome (PCOS) patients and to assess the ability of screening tests to predict these abnormalities within this population. METHODS: A total of 102 PCOS patients were evaluated. All patients underwent oral glucose tolerance tests (OGTTs) with blood samples taken at 0, 1 and 2 h. The 2-h plasma glucose level was used to categorize subjects as having IGT or NIDDM. RESULTS: The prevalence of IGT was 20.5% and that of NIDDM was 1.9%. There was no significant relationship between BMI and 2-h plasma glucose levels. The areas under the receiver operating characteristic (ROC) curve for glucose to insulin ratio (G:I), homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were 0.702, 0.734 and 0.733 respectively. ROC analysis suggested a threshold value of 10.7 in G:I ratio (73.9% sensitivity and 59.5% specificity), a value of 2.14 in HOMA (73.9% sensitivity and 73.4% specificity) and a value of 0.34 in QUICKI (73.9% sensitivity and 73.4% specificity) for the prediction of abnormal glucose tolerance (IGT and NIDDM). CONCLUSIONS: Chinese women with PCOS are at increased risk of IGT and NIDDM. Even though G:I, HOMA and QUICKI are easier than OGTT, they could not replace the role of 2-h post-challenge plasma glucose level in the screening of IGT and NIDDM in PCOS women.     

Hyperinsulinemia and acanthosis nigricans in African Americans.

Compared with the US white, non-Hispanic population, the African-American population has a nearly two-fold higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM). Obesity, which usually precedes NIDDM, is associated with the skin lesion acanthosis nigricans in African Americans. This study was undertaken to determine what the relationship of acanthosis nigricans was to hyperinsulinemia, a major risk factor for NIDDM. Eighty-nine African-American subjects with acanthosis nigricans and 25 others without the skin lesion were evaluated using oral glucose tolerance testing and responsiveness to insulin. Noninsulin-dependent diabetes mellitus was present in 19 of the subjects with acanthosis nigricans. The prevalence of NIDDM in this group increased with increasing age, reaching 50% among those in their 40s. Fasting plasma insulin concentration was in direct proportion to the severity of the acanthosis nigricans involvement of the neck. These data suggest that among African Americans, this skin lesion is a marker for hyperinsulinemia and insulin resistance. Furthermore, the presence of acanthosis nigricans identifies a subset with a much higher prevalence of NIDDM than is present in African Americans in the general population.     

Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus

We compared a high-carbohydrate diet with a high-fat diet (specifically, a diet high in monounsaturated fatty acids) for effects on glycemic control and plasma lipoproteins in 10 patients with non-insulin-dependent diabetes mellitus (NIDDM) receiving insulin therapy. The patients were randomly assigned to receive first one diet and then the other, each for 28 days, in a metabolic ward. In the high-carbohydrate diet, 25 percent of the energy was in the form of fat and 60 percent in the form of carbohydrates (47 percent of the total energy was in the form of complex carbohydrates); the high-monounsaturated-fat diet was 50 percent fat (33 percent of the total energy in the form of monounsaturated fatty acids) and 35 percent carbohydrates. The two diets had the same amounts of simple carbohydrates and fiber. As compared with the high-carbohydrate diet, the high-monounsaturated-fat diet resulted in lower mean plasma glucose levels and reduced insulin requirements, lower levels of plasma triglycerides and very-low-density lipoprotein cholesterol (lower by 25 and 35 percent, respectively; P less than 0.01), and higher levels of high-density lipoprotein (HDL) cholesterol (higher by 13 percent; P less than 0.005). Levels of total cholesterol and low-density lipoprotein (LDL) cholesterol did not differ significantly in patients on the two diets. These preliminary results suggest that partial replacement of complex carbohydrates with monounsaturated fatty acids in the diets of patients with NIDDM does not increase the level of LDL cholesterol and may improve glycemic control and the levels of plasma triglycerides and HDL cholesterol.     

一氧化氮在实验性NIDDM大鼠心肌病变中的变化

目的:用非胰岛素依赖型糖尿病(NIDDM)模型,研究一氧化氮(NO)、构建型一氧化氮合酶(cNOS)与NIDDM早期心肌病关系。方法:给大鼠尾静脉注射小剂量链尿佐菌素,使大鼠糖耐量异常,然后加喂高热量食物,引起大鼠肥胖,饲养8周,可形成类似NIDDM模型。观察实验性NIDDM大鼠心肌超微结构、心肌NO产物NO₂^-/NO₃^-、cNOS表达的变化。结果:①透射电镜观察发现,NIDDM大鼠心肌有超微结构改变,例如:线粒体肿胀、心肌闰盘间隙增宽。②NIDDM大鼠心肌组织NO₂^-/NO₃^-水平显著低于正常对照大鼠(P＜0.01),L-精氨酸组心肌组织NO₂^-/NO₃^-显著高于NIDDM组(P＜0.01)。③NIDDM大鼠心肌组织cNOSmRNA表达显著低于正常对照大鼠(P＜0.01)。结论:NIDDM早期存在心肌病变,NO与其发生机制有关,L-精氨酸对NIDDM大鼠心肌病有一定的防治作用。