血清脂联素水平与2型糖尿病患者颈动脉内中膜厚度变化关系的研究

目的 探讨血清脂联素水平与2型糖尿病(T2DM)患者颈动脉内中膜厚度(IMT)变化之间的关系.方法 应用酶联免疫法测定140例IMT≤1 mm的T2DM患者及80例正常对照者的血清脂联素水平,糖尿病组在生活方式干预的基础上,给予抗血小板聚集、强化血糖、血压、血脂治疗,随访12个月后重新测定IMT,按IMT分为两组(DM1组IMT≤1 mm,DM2组IMT＞1 mm),分析血清脂联素水平与IMT变化之间的关系.结果 (1)T2DM组血清脂联素水平低于对照组(6±3 vs 13±7 mg/L, P＜0.01).(2)DM1组与DM2组相比较,腰臀比(0.90±0.07 vs 0.93±0.05,P=0.024)、HDL-C(1.28±0.36 vs 1.11±0.22 mmol/L, P=0.013)、血清脂联素水平(6.07±3.31 vs 4.06±2.71mg/L, P=0.003),差异均有统计学意义.(3)Logistic回归分析显示,血清脂联素含量降低、年龄增长、HDL-C降低是T2DM患者IMT增厚的危险因素.结论 低血清脂联素水平是T2DM患者动脉粥样硬化的独立危险因素.     

2型糖尿病一级亲属血清脂联素、瘦素及其比值与胰岛素抵抗的相关性研究

目的 研究血清瘦素、脂联素与2型糖尿病(T2DM)一级亲属胰岛素抵抗(IR)相关性,探讨二者在T2DM发病中作用.方法 收集既往无糖耐量异常史的T2DM一级亲属, 分为糖耐量正常(NGT)组174例、空腹血糖受损(IFG)或糖耐量低减(IGT)组55例,及新发T2DM组71例;以其无糖尿病家族史的配偶或亲友中OGTT正常者114例作为正常对照组(NC).酶联免疫法测定上述人群的血清真胰岛素(TI)、瘦素和脂联素水平.用HOMA-IR评价胰岛素抵抗(IR)状态.结果 从NC至NGT、IGT/IFG到DM组,IR进行性加重(HOMA-IR分别为1.3±0.7、1.7±1.5、 2.2±1.4 和3.2±2.8,P＜0.01);血清瘦素水平进行性增高(P＜0.01),瘦素水平与HOMA-IR正相关(r=0.35, P＜0.01);血清脂联素水平进行性降低(分别为20±12、17±11、13±8和10±6mg/L,P＜0.01),与HOMA-IR负相关(r=-0.41,P＜0.01);脂联素/瘦素比值进性行降低,与HOMA-IR负相关(r=-0.53, P＜0.01). 结论 T2DM一级亲属在NGT时即存在瘦素水平升高和脂联素水平明显下降.脂联素/瘦素比值下降趋势与IR和糖调节受损的严重程度密切相关,推测该比值的变化可能是糖尿病一级亲属存在的固有遗传缺陷的一种表现,可能在IR和T2DM的发生发展中起重要作用,因而渴望作为预测T2DM发病的早期观察指标.     

瘦素与脂联素比值和8-羟基脱氧鸟苷与高血压患者心踝血管指数的相关性

目的探讨瘦素与脂联素比值(L/A)和8-羟基脱氧鸟苷(8-OHdG)与原发性高血压(EH)患者心踝血管指数(CAVI)的相关性。方法选取2015年5月至2018年5月期间福州大学医院和福建医科大学附属泉州第一医院收治的EH患者238例作为研究对象。根据CAVI是否正常,分为CAVI正常组156例,CAVI增高组82例。选取同期体检健康者100人作为对照组。比较3组间的基本资料、L/A、8-OHdG、CAVI、颈动脉内膜中层厚度(IMT),并进行Pearson相关分析与多元Logistic回归分析。结果 CAVI增高组和CAVI正常组CAVI、IMT高于对照组,CAVI增高组又高于CAVI正常组(均P0.05)。CAVI增高组和CAVI正常组血清瘦素、L/A、8-OHdG高于对照组,脂联素低于对照组(均P0.05);CAVI增高组血清瘦素、L/A、8-OHdG也高于CAVI正常组,脂联素低于CAVI正常组(均P0.05)。Pearson相关分析显示,瘦素、L/A、8-OHdG与EH患者CAVI、IMT呈正相关(r=0.574、0.581;0.672、0.621;0.574、0.563;均P0.05),脂联素与EH患者CAVI、IMT呈负相关(r=-0.604、-0.613,均P0.05)。多元Logistic逐步回归分析显示,瘦素、脂联素、L/A、8-OHdG是EH患者CAVI增高的独立影响因素[OR(95%CI) 1.060(1.011～1.111),0.509(0.291～0.890),2.948(2.031～4.516),1.124(1.071～1.193)]。结论 L/A、8-OHdG与EH患者CAVI及IMT密切相关。     

中老年2型糖尿病合并非酒精性脂肪肝患者脂肪细胞因子与下肢动脉粥样硬化的相关性

目的探讨血清脂肪细胞因子与2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者下肢动脉粥样硬化的相关性。方法记录176例T2DM合并NAFLD患者入院后的一般临床资料,检测入院时血清脂联素、瘦素、白细胞介素(IL)-6且均接受彩色多普勒超声检测下肢动脉,按照动脉内-中膜厚度(IMT)及踝臂指数(ABI)分为Ⅰ组(IMT1 mm,n=42)、Ⅱ组(1 mm≤IMT≤1.2 mm,n=55)、Ⅲ组(IMT1.2 mm,n=79);ABI1.3组(n=64)、0.9~1.3组(n=76)及0.9组(n=36);同期另选50例体检健康者为对照组。结果Ⅰ组、Ⅱ组、Ⅲ组、对照组体质指数(BMI)、舒张压(DBP)、空腹血糖(FPG)、2 h餐后血糖(2 h PG)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)存在统计学差异(P0.05),Ⅲ组BMI、DBP高于对照组;Ⅲ组FPG、2 h PG、Hb A1c、LDL-C高于Ⅱ组、Ⅰ组及对照组(P0.05);Ⅲ组TG、TC亦高于Ⅰ组及对照组(P0.05);四组血清脂联素、瘦素、IL-6亦存在显著差异(P0.05),血清瘦素、IL-6水平从对照组到Ⅲ组逐渐增高(P0.05),而血清脂联素则逐渐降低(P0.05);ABI1.3组、ABI 0.9~1.3组及ABI0.9组血清瘦素、IL-6水平逐渐增高(P0.05),血清脂联素则逐渐降低(P0.05);IMT及ABI分别与瘦素、IL-6呈现正相关,而与脂联素呈负相关;多元逐步回归分析提示:血清瘦素、IL-6与IMT呈独立正相关(P0.05),而脂联素则与其呈独立负相关(P0.05);多因素非条件Logistic回归分析提示:血清瘦素、IL-6是发生ABI0.9的高危因素,而脂联素则是其保护因素。结论血清高水平瘦素、IL-6与T2DM合并NAFLD患者下肢动脉粥样硬化的形成及发展密切相关,脂联素则可能抗炎抑制粥样硬化形成,从而延缓下肢动脉粥样硬化性疾病的发生。     

2型糖尿病患者颈动脉内膜中层厚度与血清白介素18、C反应蛋白、脂联素水平的关系

目的探讨2型糖尿病(T2DM)患者血清白介素18(IL-18)、超敏C反应蛋白(hs-CRP)和脂联素水平与颈动脉内膜-中层厚度(CIMT)的关系。方法选择新诊断T2DM组136例,年龄、性别和体重指数(BMI)相匹配的正常对照组(NC组)60例。用ELISA法测定空腹血清IL-18、脂联素、hs-CRP,超声测定CIMT。根据CIMT将T2DM组分为增厚组(CIMT≥0.9 cm)和正常组(CIMT<0.9 cm)。结果 (1)与NC组比较,T2DM组血清IL-18、hs-CRP水平升高(P<0.05),脂联素水平下降(P<0.05),CIMT增厚(P<0.05);(2)T2DM患者CIMT增厚组血清IL-18、hs-CRP水平高于CIMT正常组(P<0.05),脂联素水平下降(P<0.05);(3)T2DM患者血清IL-18、hs-CRP与CIMT呈正相关,脂联素水平与CIMT呈负相关;(4)多元逐步回归分析显示,IL-18升高和脂联素下降是T2DM患者CIMT增厚主要影响因素。结论 AS与慢性炎症反应有关,高hs-CRP、IL-18水平和低脂联素水平是反映T2DM患者AS程度的指标。     

2型糖尿病患者血清脂联素/瘦素比值与冠状动脉病变的关系

目的 探讨2型糖尿病患者血清脂联素、瘦素及二者比值与冠状动脉病变的关系.方法 对行冠状动脉造影的180例2型糖尿病患者的大血管病变危险因素进行采集,分为冠心病组和对照组,冠心病组又分为单支病变组、双支病变组和多支病变组,测量脂联素和瘦素的变化,分析脂联素/瘦素比值与冠状动脉病变的关系.结果 与对照组比较,冠心病组总胆固醇、纤维蛋白原定量和空腹血C反应蛋白升高,高密度脂蛋白胆固醇、脂联素和脂联素/瘦素比值(2.78比1.16)降低.相关分析表明,冠心病组中冠状动脉狭窄程度与年龄、纤维蛋白原定量和C反应蛋白呈正相关,与脂联素和脂联素/瘦素比值(r=-0.314)呈负相关.在校正体质指数后,冠状动脉狭窄程度与脂联素/瘦素比值仍呈负相关(r=-0.541).多因素Logistic回归分析显示,脂联素/瘦素比值降低是冠状动脉病变的危险因素.脂联素/瘦素比值随冠状动脉病变支数增加而变小(2.10比1.37比 0.72 ),组间差异有统计学意义.分层结果显示,当冠状动脉病变支数逐渐升高时,脂联素/瘦素比值与冠状动脉危险因素仍然相关,而稳态胰岛素评估模型胰岛素抵抗与冠状动脉危险因素不再相关.结论 2型糖尿病患者中,脂联素/瘦素比值降低与动脉粥样硬化的形成有关.脂联素/瘦素比值可望作为评估动脉粥样硬化程度的血清学标志.脂联素/瘦素比值相对于稳态胰岛素评估模型胰岛素抵抗是一个较好评估胰岛素抵抗致冠状动脉病变的指标.     

社区中老年人群脂联素水平及其影响因素

目的 调查社区中老年人群的血清脂联素水平,分析其影响因素.方法 对仪征地区2个社区50岁以上退休人群,进行流行病学调查并应用ELISA法检测血清脂联素水平.结果 587人的平均血清脂联素水平为(8.15±3.00) mg/L.2型糖尿病(T2DM)组、高脂血症组的低脂联素水平(四分位分级)的比例分别高于无T2DM组、无高脂血症组,差异有统计学意义(P<0.01).多因素Logistic回归分析结果显示,血清低脂联素水平(低于中位数水平)与T2DM(OR=2.659,95%CI=1.667,4.238)、腹型肥胖(OR=1.528,95%CI =1.002,2.328)之间的关系有统计学意义.未发现年龄、性别、吸烟及饮酒等因素与血清脂联素水平间的联系.结论 低血清脂联素水平可能与T2DM、腹型肥胖存在相关性.     

2型糖尿病患者一级亲属脂联素及三种细胞因子与胰岛素抵抗的相关性

目的研究2型糖尿病(T2DM)患者非糖尿病一级亲属脂联素、TNF-α、IL-6及C-RP水平的变化及其与胰岛素抵抗(IR)的相关性。方法测定糖耐量正常的T2DM患者一级亲属36例,及无T2DM家族史的正常人对照组46例的血糖、血脂、胰岛素、脂联素、TNF-α、IL-6及hsC-RP。结果①T2DM患者一级亲属组脂联素水平显著低于正常人对照组(11·9±3·0mg/Lvs14·4±3·2mg/L,P<0·01),而TNF-α、IL-6及hsC-RP水平显著高于正常人对照组(分别是14·0±2·8pg/mlvs10·3±2·6pg/ml,P<0·01;13·8±2·7pg/mlvs8·1±2·2pg/ml,P<0·01;1·3±0·4mg/Lvs0·7±0·3mg/L,P<0·01);②T2DM患者一级亲属组IR指数与脂联素呈负相关(r=-0·666,P<0·01),与TNF-α、IL-6呈正相关(分别为r=0·731,P<0·01;r=0·640,P<0·01)。结论脂联素、TNF-α、IL-6及C-RP可能与T2DM患者一级亲属的IR相关。     

2型糖尿病家系非糖尿病正常体重一级亲属脂联素水平5年随访

目的探讨2型糖尿病患者非糖尿病正常体重一级亲属脂联素水平变化及脂联素与胰岛素敏感性和颈动脉内膜中层厚度(IMT)之间的关系.方法入选2型糖尿病非糖尿病正常体重一级亲属53名和对照组37名,入组时检测了脂联素、血脂、血糖、血压及空腹胰岛素水平.用高频B超检测IMT及内皮依赖性血管舒张功能(EDVD).采用稳态模式(HOMA)评价胰岛素抵抗(HOMA-IR)和评价胰岛β细胞功能(HOMA-β).一级亲属组29名和对照组20名完成了5年随访.结果基线时一级亲属组血浆脂联素水平明显低于对照组[(10.06±5.79)对(14.43±7.91)mg/L,P<0.05].5年后一级亲属组脂联素水平降低24.0%(P<0.05),对照组脂联素水平降低36.7%(P<0.05).一级亲属组脂联素与腰臀比(r=-0.397)、空腹血糖(r=-0.373)、IMT(r=-0.372)和HOMA-IR(r=-0.40)负相关(均P<0.05).校正相关因素后,多元逐步回归分析显示一级亲属组脂联素与年龄,高密度脂蛋白胆固醇(HDL-C),IMT独立相关.对照组脂联素与低密度脂蛋白胆周醇(LDL-C)和IMT独立相关.结论 5年后一级亲属组和对照组脂联素水平均明显降低,脂联素降低可能与IMT增加相关.     

血清脂肪细胞型脂肪酸结合蛋白及脂联素水平与冠心病的相关性

目的 探讨脂肪细胞型脂肪酸结合蛋白(A-FABP)、脂联素和A-FABP/脂联素比值与冠心病及冠状动脉病变程度的相关性.方法 经冠状动脉造影入选340例患者,分为冠心病组(211例)和非冠心病对照组(129例),用ELISA法测定血清AFABP及脂联素水平,冠状动脉病变程度用病变血管支数和Gensini积分表示.并从上述患者中选取年龄、性别、体质指数相匹配的冠心病及非冠心病者各10例,分离外周血单核细胞,佛波酯刺激为巨噬细胞后取培养上清,用ELISA法测定培养上清液A-FABP及脂联素浓度.结果 (1)冠心病组血清A-FABP水平[18.3(13.2,22.8)μg/L]较非冠心病组[16.4(13.5,20.4)μg/L]高,但差异未达到统计学意义(P=0.088);冠心病组血清脂联素水平低于非冠心病组[13.9(9.8,17.1)mg/L比19.7(14.5,27.6)mg/L,P＜0.05].(2)随着冠状动脉病变支数的增加,血清A-FABP水平呈升高、脂联素水平呈递减趋势;Gensini积分与血清A-FABP呈正相关(r=0.120,P=0.043),与脂联素呈负相关(r=-0.405,P=0.007).(3)冠心病组血清A-FABP/脂联素比值明显高于非冠心病组[(1.51±0.79)μg/mg比(0.89±0.30)μg/mg,P＜0.01];血清A-FABP/脂联素比值与Gensini积分的相关性更明显(r=0.531,P=0.000).(4)冠心病者单核源性巨噬细胞A-FABP/脂联素比值高于非冠心病者[(0.51±0.19)μg/mg比(0.36±0.11)μg/mg,P＜0.05].结论 高A-FABP和低脂联素水平可能是反映严重冠状动脉狭窄的新的血清标记物.A-FABP/脂联素比值较单独A-FABP或脂联素与冠状动脉病变的相关性更好.     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

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.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.