非糖尿病人群空腹血糖与脑梗死的队列研究

目的研究非糖尿病人群中空腹血糖水平对新发脑梗死的影响。方法选择2006-2010年符合纳入排除标准的开滦集团职工为随访对象,分析不同空腹血糖水平下脑梗死事件的发生情况。结果本研究纳入样本84 002例,年龄为30~70(51.1±13.0)岁,男性66 464例。随访时间为(47.8±3.2)个月。随访期间有887例观察对象发生脑梗死,累积发病率为1.06%。按性别分层后,男性空腹血糖4.6、4.6~5.6及≥5.6mmol/L组的累积发病率分别为1.42%、1.02%、1.41%;女性空腹血糖4.6、4.6~5.6及≥5.6mmol/L组的累积发病率分别为0.35%、0.53%、0.67%。应用Cox回归模型校正收缩压、舒张压、总胆固醇、吸烟和饮酒等指标后,在男性人群中,与4.6~5.6mmol/L组相比,空腹血糖≥5.6mmol/L组发生脑梗死事件的相对风险为1.29(95%CI 1.08~1.55)。女性人群中未发现此相关性。结论在非糖尿病人群中,空腹血糖水平≥5.6mmol/L增加男性脑梗死的发生风险。     

基线收缩压水平对糖尿病人群新发心脑血管事件的影响

目的 探讨基线收缩压水平对糖尿病人群新发心脑血管事件的影响.方法 本研究以参加2006-07-2007-10健康查体的101 510名开滦集团职工中的8306例空腹血糖≥7.0或＜7.0 mmol/L但已确诊为糖尿病,正在使用降糖药物的人群作为观察对象,随访38～53(48.1±3.1)月,随访期间每半年收集一次新发...     

糖尿病人群中高敏C反应蛋白与新发心脑血管事件关系的前瞻性研究

目的 探讨基线血清高敏C反应蛋白(hsCRP)水平对糖尿病人群新发心脑血管事件的预测价值.方法 本研究采用前瞻性队列研究方法,以参加2006年7月至2007年10月健康查体的101 510名开滦集团职工中空腹血糖≥7.0 mmoL/L或＜7.0 mmol/L但已确诊为糖尿病,正在使用降糖药物的7865例糖尿病者作为观察队列,随访38～53(48.02±3.14)个月,随访期间每半年收集1次新发心脑血管事件情况.分析基线血清hsCRP水平对糖尿病人群新发心脑血管事件的预测价值.结果 (1)随着基线hsCRP水平的增高,发生总心脑血管事件、脑梗死和心肌梗死事件率均逐渐增高,差异有统计学意义(P＜0.01);多变量Cox比例风险回归分析表明校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体质指数及吸烟因素后,基线hsCRP最高四分位数组(hsCRP≥2.50 mg/L)发生总心脑血管事件、脑梗死和心肌梗死的相对危险(RR)分别为最低四分位数组(hsCRP＜0.41 mg/L)的1.64倍(95% CI:1.20～2.24,P=0.002),1.52倍(95% CI:1.03～2.24,P=0.034)和2.57倍(95% CI:1.34～4.91,P=0.004).(2)随着基线hsCRP水平的增高,研究对象的平均年龄逐渐增高;女性在人群中比例逐渐增多;体质指数、收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平增高,差异均有统计学意义(P＜0.05);高密度脂蛋白胆固醇水平降低,差异有统计学意义(P＜0.05).结论 基线hsCRP可预测糖尿病人群发生心脑血管事件,hsCRP水平较高者发生临床心脑血管事件的危险增加,尤其是脑梗死和心肌梗死的危险.

Abstract：

Objective To evaluate the predictive value of baseline serum high sensitivity C-reactive protein for the first cardio-cerebral vascular event in the population with diabetes. Method In this prospective cohort study, a total of 101 510 employees of Kai Luan Group, who received healthy examination from July 2006 to October 2007, were screened and 7865 subjects with fasting plasma glucose ≥ 7. 0 mmol/L or known diabetes mellitus and under insulin or hypoglycemic drugs therapy were followed up for 38 - 53 (48. 02 ± 3. 14) months. Results ( 1 ) Incidence rates of total cardio-cerebral vascular events, cerebral infarction and myocardial infarction increased in proportion to increased levels of baseline hsCRP ( P ＜ 0. 01 ). After adjusting for age, gender, body mass index ( BMI), systolic blood pressure( SBP), diastolic blood pressure (DBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and cigarette smoking, multivariate Cox's proportional hazards regression analysis indicated that the individuals in the highest quartile of hsCRP levels group (hsCRP≥2. 50 mg/L) had an increased risk of total cardio-cerebral vascular events (RR: 1.64, 95% CI:1.20-2.24), cerebral infarction (RR: 1.52, 95% CI: 1.03-2.24), myocardial infarction (RR: 2.57,95% CI: 1.34 -4. 91 ) compared with those in the lowest quartile group( hsCRP ＜ 0. 41 mg/L). (2) Higher baseline hsCRP levels were associated with aging, female gender, higher BMI, SBP, DBP, fasting blood glucose, TC, TG, LDL-C levels and lower HDL-C levels ( all P ＜ 0. 05 ). Conclusion Baseline hsCRP level is associated with increased first cardio-cerebral vascular event in the population with diabetes.     

糖尿病患者空腹血糖水平与新发脑梗死的相关性研究

目的探讨糖尿病患者空腹血糖水平与新发脑梗死事件的相关性。方法选取苏州大学附属第二医院住院的糖尿病患者512例,进行定期随访,记录新发脑梗死事件情况并进行统计分析。结果入院时各组生化检查空腹血糖水平越高,LDL-C、总胆固醇和甘油三酯就越高;随访结束统计,空腹血糖水平越高新发脑梗死发生率则越高;高危组脑梗死发生率14.9%,正常组发生率5%,差异有统计学意义(P0.05)。结论糖尿病患者空腹血糖水平与新发脑梗死事件关系密切,空腹血糖水平越高出现脑梗死事件率则越高。     

空腹血糖增高对老年非糖尿病急性心肌梗死患者预后的影响

目的 探讨空腹血糖对老年非糖尿病急性心肌梗死患者预后的影响.方法 入选我院2004年1月至2012年1月接受尿激酶溶栓或经皮冠脉介入治疗并再通非糖尿病急性心肌梗死患者182例,均于入院第二天检测静脉空腹血糖(FPG).按照FPG＜ 5.6 mmol/L(n=72)、5.6 mmol/L≤FPG ＜7.0 mmol/L(n=52)、FPG ≥7.0 mmol/L(n=58)分为三组,多因素分析三组患者住院期间心律失常、左心功能不全发生率的差异.结果 随着FPG水平增高,心律失常、左心功能不全发生率均增加,多因素回归分析表明FPG是心血管事件发生的独立危险因素.结论 FPG增高是非糖尿病老年心肌梗死患者预后的独立危险因素.随着FPG增高,住院患者心血管事件的发生率增高,应将FPG控制在正常范围.     

甘油三酯增高与高血压检出率的关系

目的探讨甘油三酯增高与高血压检出率的关系。方法在20～69岁人群,筛选出其中体重指数、总胆固醇和空腹血糖正常,无糖尿病、肾病病史,无高血压家族史的健康体检者73214名,分别按年龄每10岁分组,再按甘油三酯水平分正常组(等于或小于1.69mmol/L)、临界组(1.70～2.25mmol/L)和增高组(2.25mmol/L),统计血压正常与高血压的人数,统计按甘油三酯水平分组的高血压年龄标准化检出率。结果甘油三酯正常组,临界组和升高组的高血压年龄标准化检出率在男性分别为7.0%,11.5%,14.2%,在女性分别为2.4%,7.6%和13.4%。结论排除胆固醇、血糖空腹、体重和年龄因素后,无论男女,高血压检出率随甘油三酯水平升高而增加。     

低血糖生成指数控制饮食对老年糖尿病血脂异常患者血脂水平的影响

目的 探讨低血糖生成指数控制饮食对老年糖尿病合并血脂异常患者血脂水平的影响.方法 22例老年糖尿病合并血脂异常患者,未用任何降脂降糖药物,在营养治疗中给予低血糖生成指数控制饮食,比较患者控制饮食前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)等的变化.结果 经过6 w的低血糖生成指数控制饮食,FPG由(7.92±1.21) mmol/L降至(6.23±0.66) mmoL/L(P ＜0.01),2hPG由(13.73±3.35)mmol/L降至(8.54±0.85) mmol/L(P＜0.01),TG由(1.82±0.64) mmol/L降至(1.13±0.43) mmol/L (P＜ 0.01),TC由(5.44±0.29) mmol/L降至(5.05±0.77) mmol/L(P＜0.01),LDL-C由(3.72±0.48)mmol/L降至(3.21±0.67) mmol/L(P＜0.0l),HDL-C由(1.41±0.25) mmol/L升至(1.61±0.29) mmol/L(P ＜0.01),其差异均具有统计学意义.结论 低血糖生成指数控制饮食可以明显改善老年糖尿病合并血脂异常患者的血脂水平.     

2型糖尿病患者高密度脂蛋白亚型分子组分的变化

目的 研究2型糖尿病患者高密度脂蛋白亚型分子构成成分含量、代谢关键酶活性变化及与血糖等指标的相关关系.方法 26例新发2型糖尿病患者与25例健康对照者留取血浆检测血糖、胰岛素和血脂谱.以改良一步沉淀法分离高密度脂蛋白3并检测其组分含量,并计算高密度脂蛋白2的主要组分含量.以荧光酶法测定胆固醇酯转运蛋白和磷脂转运蛋白活性.结果 (1)2型糖尿病组血高密度脂蛋白胆固醇与对照组无显著差异(P=0.579).(2)2型糖尿病组与对照组的胆固醇酯转运蛋白和磷脂转运蛋白活性均无明显差异.(3)2型糖尿病组高密度脂蛋白3以下组分含量较对照组明显减少(均P＜0.01):胆固醇为0.60±0.17 mmol/L比0.75±0.22mmol/L,磷脂为1.14±0.19 mmol/L比1.29±0.22 mmol/L,游离胆固醇为0.021±0.012 mmol/L比0.033±0.012mmoL/L,胆固醇酯为0.97±0.28 mmol/L比1.19±0.36 mmol/L.其中游离胆固醇和胆固醇酯含量与餐后血糖、糖化血红蛋白、胰岛素抵抗指数呈显著负相关(P＜0.05).(4)2型糖尿病组高密度脂蛋白2的载脂蛋白AI含量较对照组显著降低(604.8±233.3 mg/L比755.4±198.0 mg/L,P＜0.05),并与胰岛素抵抗指数、餐后血糖、血甘油三酯呈显著负相关(P＜0.05).结论 2型糖尿病患者高密度脂蛋白3和高密度脂蛋白2颗粒主要组分含量明显减少,并与血糖水平及胰岛素抵抗程度相关.     

血液生化检验在糖尿病诊疗中的临床应用分析

目的讨论血液生化检验在糖尿病诊疗中的临床应用。方法将2018年9月—2020年8月期间就诊于该院内分泌科的122例糖尿病患者作为该次研究对象,并将其设定为实验组,选取同期来该院体检中心的健康人群122名作为对照组,对两组人群均采用血液生化检验(血清甘油三酯水平、空腹血糖、糖耐受测定),并对其血液生化检验情况进行对比和分析。结果实验组空腹血糖为(8.95±1.62)mmol/L,对照组空腹血糖为(5.11±0.15)mmol/L;实验组糖耐受平均值为(13.4±3.30)mmol/L,对照组糖耐受平均值为(5.13±1.01)mmol/L;实验组血清甘油三酯为(2.38±1.06)mmol/L,对照组血清甘油三酯为(1.34±0.61)mmol/L,实验组患者的空腹血糖、糖耐受平均值以及血清甘油三酯水平与对照组相比明显较高,差异有统计学意义(t=26.070、27.651、9.392、P<0.001)。结论血液生化检验在糖尿病的诊疗中可靠性较高。     

中药养阴降浊汤联合耳穴贴压治疗糖尿病合并高脂血症的价值评价

目的分析评价中药养阴降浊汤+耳穴贴压在糖尿病合并高脂血症中的治疗价值。方法用"双盲法"将2016年3月—2018年2月在该院诊治的68例糖尿病合并高脂血症患者分为34例/组。一组实施常规西药治疗(对照组),另一组在此基础上增加中药养阴降浊汤、耳穴贴压治疗(观察组)。比较血糖与血脂指标以及血糖达标率、低血糖事件发生率。结果治疗后,观察组患者糖化血红蛋白(6.05±0.24)%、空腹血糖(7.06±1.14)mmol/L、饭后2 h血糖(8.36±1.14)mmol/L均低于对照组,高密度脂蛋白胆固醇(1.41±0.22)mmol/L比对照组高,低密度脂蛋白胆固醇(3.15±0.50)mmol/L、甘油三酯(1.52±0.29)mmol/L、总胆固醇(6.01±0.24)mmol/L同样低于对照组,观察组的血糖达标率更高,为73.53%(P0.05),两组低血糖事件发生率都较低(P0.05)。结论在糖尿病合并高脂血症中,选择中药养阴降浊汤、耳穴贴压治疗效果确切。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.