前列腺癌患者性激素与促性腺激素的变化

目的 探讨性激素和促性腺激素对前列腺癌的影响。方法对1996-01-01-2005-12-31解放军总医院内分泌科测定53例确诊未治的前列腺癌患者性激素：睾酮（T）、雌二醇（E2）与促性腺激素，包括黄体生成素（LH）、卵泡刺激素（FSH），同时测定了253名正常对照者的性激素与促性腺激素。结果前列腺癌组总睾酮和反映游离睾酮的指标睾酮分泌指数（TSI）以及FSH均低于正常对照组，且均有统计学意义（P〈0．05）。E2、LH两组比较无统计学意义（P〉0．05）。结论（1）前列腺癌患者处于低雄激素水平。（2）当睾酮（正常为15nmol/L）或睾酮分泌指数（正常为4、0）低于诊断标准时，前列腺癌的发病率可能升高。     

阻塞性睡眠呼吸暂停低通气综合征患者性激素水平的变化与分析

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）男性患者性腺激素水平的变化及相互间的关系，为伴有性功能减退的OSAHS患者是否需要性激素替代治疗提供临床依据。方法 对男性OSAHS患者（OSAHS组）和对照组进行多导睡眠监测，应用美国强生全自动化学发光免疫分析系统测定血清促卵泡刺激素（follicular-sti mulating hormone，FSH）、黄体生成素（luteinizing hormone，LH）及睾酮（total testosterone，T）水平，分析其间的变化关系。结果 与对照组比较，OSAHS组患者FSH、LH[（4.10±1.61）U/L、（3.70±1.74）U/L]显著低于对照组[（11.68±3.33）U/L、（12.48±3.10）U/L；P均〈0.01]；T[（11.14±3.82）nmol/L]低于对照组[（13.15±1.36）nmol/L；P〈0.05]。血清LH水平与睡眠呼吸暂停低通气指数（AHI）呈显著负相关（r=-0.548，P〈0.01），与氧减〈90%的时间（min）和血氧饱和度〈90%时间占总监测数据的百分比（TS90%）呈负相关（r=-0.317，P〈0.05；r=-0.315，P〈0.05）；与LSpO2呈显著正相关（r=0.633，P〈0.01）。血清FSH水平与AHI呈显著负相关（r=-0.557，P〈0.01）；与LSpO2呈显著正相关（r=0.540，P〈0.01）。血清T与AHI和TS90%呈显著负相关（r=-0.468，P〈0.01；r=-0.442，P〈0.01）、与氧减〈90%的时间（min）呈负相关（r=-0.378，P〈0.05）；与LSpO2呈正相关（r=0.335，P〈0.05）。结论 OSAHS男性患者存在垂体-性腺轴激素分泌异常，反馈调节紊乱，并与AHI和夜间低氧相关。     

2型糖尿病一级亲属脂联素等与胰岛素抵抗的相关研究

测定糖耐量正常T2DM患者一级亲属35例，及对照组42例的脂联素、抵抗素、TNF-α。结果1．一级亲属组脂联素水平低于正常对照组（12．29±3．64mg／L vs 14．66±3．43mg／L，P〈0．05），而抵抗素、TNF-α水平显著高于正常组（分别是19．02±6．85Pg／ml vs 15．68±6．24pg／ml，P〈0．05；14．12±2．87pg／ml vs 10．43±2．58pg／ml，P〈0．05）；2．一级亲属组IR指数与脂联素呈负相关（r=-0．53，P〈0．05），与抵抗素、TNF-α呈正相关（分别为r=0．62，P〈0．05；r=0．48，P〈0．05）。结论脂联素、抵抗素、TNF-α可能与T2DM患者一级亲属的IR相关。     

男性特发性低促性腺激素型性腺功能减退症87例临床分析

目的探讨男性特发性低促性腺激素型性腺功能减退症(idiopathic hypogonadotropic hypogonadism,IHH)临床特点。方法回顾性分析1985年5月至2006年2月解放军总医院收治的87例男性IHH患者临床资料。结果87例IHH患者就诊年龄平均(18.8±4)岁,其中25例伴有嗅觉减退或消失。87例染色体核型为46,XY。检测甲状腺、肾上腺功能正常,黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)基础值低,促性腺激素释放激素[戈那瑞林(GnRH)或促黄体生成素释放激素(LHRH)]兴奋试验LH峰值较基础值升高。18例患者LH脉冲分泌呈现多种异常形式,86.2%(75/87)IHH患者骨龄落后于实际年龄,头颅CT或磁共振成像检查排除下丘脑-垂体区占位性器质性病变。结论根据性发育异常患者合并的各种先天异常、病史、体格检查、染色体核型分析、性激素水平、GnRH或LHRH兴奋试验,必要时行LH脉冲分析、骨龄测定、头颅CT或磁共振成像,可进行IHH的诊断与鉴别诊断。     

男性慢性心力衰竭患者雄激素水平与心功能和运动耐量的关系

目的探讨男性慢性心衰患者雄激素水平与心功能和运动耐量的关系。方法用酶联免疫吸附方法测定90例男性慢性心衰患者（心衰组）和80例健康对照组血清总睾酮（TT）、游离睾酮（FT）水平，心衰患者心功能按NYHA心功能分级，运动耐量以6min步行试验评价。结果与对照组相比，心衰组患者TT、FT明显降低（（9．63±3．22 vs 20．45±8．92，P〈0．01；0．054±0．036 vs 0．422±0．328，P〈0．01）；心衰组TT、FT水平与左室射血分数（LVEF）呈显著正相关（r=0．270，P〈0．01；r=0．257，P〈0．05）；心衰组TT、FT水平与6min步行试验距离成正相关（r=0．247，P〈0．05；r=0．330，P〈0.01）。结论男性慢性心衰患者雄激素水平降低，其雄激素水平的测定对心脏功能评估具有重要临床意义。     

非酒精性脂肪肝患者胰岛素抵抗与脂联素基因表达的关系

目的探讨NAFLD患者胰岛素抵抗（IR）与脂肪组织脂联素基因表达的关系。方法用SYBR GreenI实时定量RT-PCR方法检测脂肪组织脂联素mRNA的表达水平，用稳态模型法计算IR指数。结果肥胖和非肥胖NAFLD患者及对照组IR指数分别为：3．0±0．8、2．8±0．9和2．0±0．6、1．2±0．5，其脂肪组织脂联素基因表达和血浆脂联素浓度较对照各组显著降低（P〈0．05），IR与脂联素基因表达（r=0．5，P〈0．05）和血浆脂联素浓度负相关（，=0．4，P〈0．05），与血清甘油三酯正相关（r=0．3，P〈0．05）。结论NAFLD患者的IR与脂肪组织脂联素基因低表达有关，脂联素基因低表达在IR和NAFLD发病中起了一定作用。     

特发性低促性腺激素性性腺功能减退症诊治专家共识解读

特发性低促性腺激素性性腺功能减退症( 简称IHH),是下丘脑促性腺激素释放激素(GnRH) 分泌或作用障碍 导致的一种疾病,以青春不发育和配子生成障碍为主要临床表现。性激素替代治疗可促进第二性征发育。当患者 有生育需求时,促性腺激素或GnRH 泵治疗,有助于配子产生。2015 年中华内分泌学分会性腺学组专家,针对此病 制定了专家共识。文章针对共识中存在的一些争议问题进行探讨,这些问题包括疾病命名、基因诊断、儿童IHH 的 识别和治疗、生精治疗中的问题等,旨在增加内分泌医生对此疾病的认识,提高诊治水平。     

特发性低促性腺激素性性腺功能减退症的遗传学研究进展

特发性低促性腺激素性性腺功能减退症( idiopathic hypogoandotropic hypogonadism,IHH)是一种复杂的寡基因疾病.其中60％的患者伴嗅觉缺如或减退,又称Kallmann综合征.通过遗传学及分子生物学手段研究,目前已发现十余个IHH的致病基因.     

Kisspeptin/GPR54与特发性低促性腺激素性性腺功能减退症

特发性低促性腺激素性性腺功能减退症(IHH)主要表现为促性腺激素水平低下和性成熟障碍.迄今,对IHH的病因和发病机制了解甚少.近年来,在部分IHH家系中发现了G蛋白耦联受体54(GPR54)基因突变,进一步研究提示GPR54及其配体kisspeptin参与促性腺激素释放激素(GnRH)的分泌调节.Kisspeptin可以直接促进下丘脑GnRH分泌、介导性激素对GnRH的反馈调节,以及参与青春期肩动等.因此认为,Kisspeptin/GPR54的基因突变是导致IHH的病因之一,同时kisspeptin/GPR54对下丘脑-垂体-性腺轴的正常功能起到重要参与作用.     

男性特发性低促性腺激素性性功能减退症

男性特发性低促性腺激素性性功能减退症是由于基因异常引起下丘脑分泌促性腺激素释放激素（GnRH）功能障碍导致睾丸功能低下的遗传性疾病，主要临床表现为第二性征发育不全，性功能低下和不育。诊断主要根据临床表现和血卵泡刺激素、黄体生成素和睾酮水平均明显降低，且除外体质性青春发育延迟和后天获得性低促性腺激素性性腺功能减退症。目前尚无根治措施，仅限于替代治疗。雄激素替代治疗可以促进第二性征的发育和维持性功能，使用促性腺激素或GnRH脉冲治疗可诱导精子生成，使部分患者实现生育愿望。早期诊断和恰当的治疗策略是治疗成功的关键。     

Urinary angiotensinogen level is correlated with blood pressure level and proteinuria in patients with masked hypertension

Urinary <AQ: Please check whether all the edits made in this paper convey your intended meaning, and correct if necessary.>angiotensinogen (UAGT) level is an index of the intrarenal-renin angiotensin system status and is significantly correlated with blood pressure (BP) and proteinuria in patients with hypertension (HT). We aimed to investigate the possible relationship between UAGT levels and albuminuria in masked hypertensives. A total of 96 nondiabetic treated hypertensive patients were included in this study. The patients were divided into two groups: masked hypertensives (office BP <140/90 mmHg and ambulatory BP ≥130/80 mmHg) and controlled hypertensives (office BP <140/90 mmHg and ambulatory BP <130/80). The mean UAGT/UCre level and urinary albumin–creatinine ratio (UACR) of masked hypertensives were higher than those of controlled hypertensives (7.76 μg/g vs 4.02 μg/g, p < 0.001 and 174.21 mg/g vs 77.74 mg/g, p < 0.001, respectively). A significant positive correlation was found between UAGT/UCre levels and ambulatory systolic BP and diastolic BP levels in patients with masked HT, but this was not found with office SBP or DBP levels. Importantly, UAGT/UCre levels showed a significant positive correlation with UACR in both groups, but correlation of the UAGT levels with UACR was more pronounced in masked hypertensives (r = 0.854, p < 0.001 vsr = 0.512, p < 0.01). As a result, UAGT level was increased in patients with masked HT, which was associated with an elevation in albuminuria. Overproduction of the UAGT may play a pivotal role in development of proteinuria.     

急性冠脉综合征患者血清同型半胱氨酸和hs-CRP的相关性

目的:探讨急性冠脉综合征(ACS)患者血清同型半胱氨酸水平的变化,评价其与高敏C反应蛋白(hs-CRP)的关系。方法:用免疫比浊透视法测定60例ACS患者和30例对照组血清中hs-CRP水平,以循环酶法测定血清同型半胱氨酸(Hcy)水平。结果:ACS组Hcy水平[(16.75±6.40)mg/L]明显高于对照组[(13.70±6.60)mg/L],P<0.05,AMI组的hs-CRP和Hcy水平明显高于UAP组(P<0.05),且ACS组血清Hcy水平升高[(16.75±6.40)mg/L]时,患者血清hs-CRP水平[(4.475±16.09)mg/L]也相应升高,两者之间呈正相关(r=0.444,P<0.01)。结论:血清同型半胱氨酸水平升高与心肌损伤程度有关,且可能通过hs-CRP加重心肌损伤。     

不同糖耐量者血清丙二醛及超氧化物歧化酶水平的变化

目的　分析不同糖耐量时氧化应激的变化及其与胰岛素抵抗(IR)的关系。方法　2003-05 ~12哈尔滨医科大学附属第二医院测正常人、肥胖、糖耐量减低(IGT)和新诊断2型糖尿病(T2DM)患者血清丙二醛(MDA)及超氧化物歧化酶(SOD)水平,分析两指标与胰岛素敏感指数(ISI)的关系。结果　肥胖组和IGT组已存在氧化应激。MDA与ISI呈显著负相关,SOD与ISI呈显著正相关(均P<0.01)。结论　T2DM患者IR可能与氧化应激有关。     

Plasma nitrite/nitrate level is inversely correlated with plasma low-density lipoprotein cholesterol level

Background: Plasma nitrite/nitrate (NOx) is a stable end product of the vasodilator nitric oxide (NO). However, there are few reports about plasma NOx levels in humans. Hypothesis: The purpose of this study was to assess the availability of plasma NOx for evaluating basal endogenously-synthesized or endothelium-derived NO, and to examine whether NOx levels are lowered in patients with coronary artery disease (CAD) or its risk factors. Methods: Plasma NOx levels were measured using an automated system based on the Griess reaction. NOx levels for a 24-h period reproducibly became lowest at 6 A.M. in restricted healthy volunteers, and became stable in inpatient volunteers at 6 A.M. within 4 days after admission. Results: Based on these findings, NOx levels at 6 A.M. in inpatients can be considered as the basal levels. In 40 inpatients suspected of CAD (28 men, 12 women; mean age 60 ± 11 years), the basal levels of NOx were not related to CAD and its risk factors, except for hypercholesterolemia. The NOx level of patients with hypercholesterolemia was significantly lower than that of patients with normal cholesterol (n = 16, 34 ± 16 μmol/l vs. n = 24, 49 ± 23 μmol/l, p < 0.03). Furthermore, the NOx levels correlated negatively with the total cholesterol and low-density lipoprotein cholesterol levels (r= –0.40, p < 0.01; r = –0.47, p < 0.003, respectively), but not with other lipid fraction levels. Conclusion: The results suggest that the quantity of basal endothelium-derived NO synthesis may be decreased in the presence of hypercholesterolemia.     

Dubin-Johnson-like black liver with normal bilirubin level

Black liver is a common finding in Dubin-Johnson syndrome (DJS), which is caused by the lack of multidrug resistance-associated protein 2 (MRP2). Impaired excretion of epinephrine metabolites is believed to be a cause of black liver in DJS. Recently, we experienced a patient with black liver whose serum bilirubin level was normal. Coarse brown granules were observed in the hepatocytes, and this finding closely resembled that observed in DJS. However, the granules were negative for Schmorl staining. The MRP2 gene did not show any mutation. Immunostaining study demonstrated MRP2 protein expression in the liver, and it was localized in the canalicular membranes of hepatocytes. This case illustrates for the first time that DJS is not the only cause of black liver.     

Serum leptin level in patients with functional dyspepsia

BACKGROUND/GOAL: Previous studies have shown that leptin plays a major role in the amount of food consumption. Recently, leptin and its receptors have been found in the human gastric mucosa. The aim of this study was to seek any possible correlation between serum leptin level and subtypes and pathological findings in functional dyspepsia. MATERIALS AND METHODS: In a prospective study, we randomly select 44 patients as dysmotility-like and ulcer-like dyspepsia (according to ROME II criteria) in two equivalent groups and compared them with 22 healthy volunteers control group who matched the patients in relation to age, sex and body mass index. From each patient, a fasting blood sample for leptin level and two antral biopsies for evaluating the intensity of gastritis and Helicobacter pylori infection were provided and compared with the control group. RESULTS: Compared to the control group, serum leptin level was significantly higher in patients with dysmotility-like dyspepsia (P < 0.05). Leptin level were also significantly correlated with the presence of gastritis and H. pylori infection (P < 0.05). CONCLUSION: Leptin may have a role in the pathogenesis of the dysmotility variety of non-ulcer dyspepsia through mechanisms other than H. pylori infection. Further studies based on gastric leptin immunohistochemistry may need correlation between symptoms of functional dyspepsia and gastric leptin expression.     

血浆同型半胱氨酸水平与心肌梗死的相关性

目的探讨血浆同型半胱氨酸(Hcy)水平与心肌梗死的关系。方法我院2012年1月至2013年12月间收治的40例心肌梗死患者作为心肌梗死组,选取同期行健康体检的正常人40例作为非心肌梗死组,比较两组血浆Hcy水平及治疗后心肌梗死组患者Hcy水平,分析心肌梗死危险因素。结果心肌梗死组患者血浆Hcy水平明显高于非心肌梗死组,治疗后,心肌梗死组Hcy水平较治疗前有明显下降,差异均具有统计学意义(P0.05);血浆Hcy高表达为心肌梗死独立危险因素。结论血浆Hcy水平与心肌梗死有一定的相关性,高Hcy为心肌梗死的独立危险因素。