不同糖耐量状态下空腹血浆肥胖抑制素水平及其与脂代谢的相关性

Objective To investigate whether fasting obestatin level is different in patients with impaired glucose tolerance or type 2 diabetes, and to explore the association between obestatin and lipid metabolism. Methods Eighty-four subjects without known diabetes were divided into three groups: normal glucose tolerance(NGT), impaired glucose tolerance (IGT) and type 2 diabetes (DM) Plasma obestatin levels were measured with a radioimmunoassay. The relationship between fasting obestatin levels and metabolic parameters was also analyzed. Results Fasting obestatin levels were lower in DM group [(2.82±0.78)ng/ml] and IGT group [(3.25±0.29)ng/ml] than in NGT group[(3.55±0.57) ng/ml, P＜0.01]. Triglycerides and low density lipoprotein cholesterol levels gradually increased among the three groups (P＜0.05). Multiple linear regression analysis revealed fasting obestatin level was independently associated with waist-to-hip ratio, triglyeride and low density lipoprotein cholesterol. The regression equation was obestatin=6.953-3.412×W/H-0.175×TG-0.123×LDL-C. Conclusions The decreased obestatin may be associated with IGR and T2DM, and obestatin level may be associated with lipid metabolism.     

老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

老年2型糖尿病和糖耐量受损患者血清铁蛋白与胰岛素抵抗和胰岛β细胞功能相关

目的 探讨60岁以上老年2型糖尿病和糖耐量受损(IGT)患者血清铁蛋白(SF)水平与胰岛素抵抗、胰岛β细胞功能之间的相关性.方法 入选2型糖尿病组患者1 143例,IGT组448例和正常糖耐量组(NGT)2 950名.测定身高、体重、血压、总胆固醇、甘油三酯(TG)、空腹血糖(FPG)、餐后2 h血糖(2hPG)、空腹胰岛素(FINS)和SF水平.采用稳态模型、QUICK来评估胰岛素抵抗,采用稳态模型和处置指数(DI)来评估胰岛β细胞功能.结果 2型糖尿病组SF水平高于NGT组(P<0.01);NGT、IGT和2型糖尿病组稳态模型评估的胰岛素抵抗指数(HOMA-IR)呈增高趋势(P<0.05),稳态模型评估的胰岛素β细胞功能指数(HOMA-β)、QUICK、DI呈递减趋势(均P<0.05).Spearman相关分析和偏相关分析显示,校正年龄和性别后,SF与FPG、2hPG、TG、FINS、HOMA-IR呈正相关,与HOMA-β、QUICK、DI呈负相关.多元逐步回归分析显示,QUICK、体重指数、TG是影响SF的独立危险因素.结论 老年2型糖尿病患者体内铁超负荷;随着SF的升高,胰岛素抵抗逐渐增加,而胰岛β细胞功能呈下降趋势.

Abstract：

Objective To investigate the relationship between serum ferritin and p-cell function,insulin resistance in elderly patients(age>60 years)with type 2 diabetes and impaired glucose tolerance.Methods Total 1143 patients with type 2 diabetes,448 patients with impaired glucose tolerance(IGT),and 2 950 subjects with normal glucose tolerance(NGT)were recruited for the measurments of height,weight,serum triglyceride(TG),total cholesterol,fasting plasma glucose(FPG),fasting insulin(FINS),postprandial 2 h plasma glucose(2hPG),and serum ferritin.Homeostasis model assessment of insulin resistance(HOMA-IR)and QUICK index were used to estimate insulin resistance,and homeostasis model assessment of β cell function(HOMA-p)and disposition index(DI)to evaluate p-cell function.Results The results showed that the level of serum ferritin was significantly higher in type2 diabetes mellitus group than NGT group(P<0.01).HOMA-IR was gradually increased,and HOMA-β,QUICK,and DI decreased from NGT to IGT,type 2 diabetes mellitus groups(all P < 0.05).Spearman and partial correlation analysis showed that partial adjustment for age and sex,serum ferritin was positively associated with FPG,2hPG,TG,FINS,and HOMA-IR,and negatively associated with HOMA-β,QUICK,and DI.Stepwise regression showed that serum ferritin was associated with QUICK,BMI,and TG.Conclusion The results suggest that iron overload exists in elderly patients with type 2 diabetes.With increasing serum ferritin level,insulin resistance increases and p-cell function decreases in the elderly patients with abnormal glucose metabolism.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

不同血糖状态人群血浆内脂素水平及其相关因素

Fasting plasma visfatin was determined in subjects with various types of glucose tolerance. Visfatin level was (17.64±1.37)μg/L in subjects with normal glucose tolerance,and rose to (27.42±1.34) μg/L(P<0.05) in those with impaired glucose tolerance or impaired fasting glucose, and to(26.55 ± 1.64) μg/L(P< 0.05)in diabetic patients. No difference was found between obese and non-obese subjects. Positive correlation existed between visfatin and HbA1c(r=0. 317,P<0.01). Multiple linear step-wise regression showed that HbA1c and fasting plasma glucose had independent relation with the visfatin level. The result suggests that plasma visfatin may be related to glueometabolism and may play a role in the development of type 2 diabetes.     

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.