老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

老年糖尿病患者大血管病变发生情况调查及危险因素分析

目的探讨老年糖尿病患者大血管病变发生情况及其危险因素。方法选择2013年1月至2014年12月明确诊断的老年2型糖尿病(T2DM)患者(年龄60岁)152例,调查患者大血管病变发生情况(如心绞痛、心肌梗死、脑梗死、脑出血、下肢血管狭窄或闭塞等)。全部患者根据有无大血管病变分为大血管病变组、非大血管病变组,比较两组患者一般资料(年龄、病程、身高、体重、血压等)及生化指标(血糖、血脂、血尿酸、肌酐等),并分析患者发生大血管病变的危险因素。结果大血管病变组患者年龄高于非大血管病变组,收缩压、有吸烟史患者比例明显高于非大血管病变组(P0.05)。大血管病变组甘油三酯、低密度脂蛋白水平明显高于非大血管病变组(P0.05)。多因素Logistic回归分析发现老年糖尿病患者发生大血管病变的独立危险因素为年龄(OR 1.108,95%CI 1.037~1.182,P=0.004)、收缩压(OR 1.315,95%CI 1.279~5.306,P=0.012)、吸烟史(OR 2.102,95%CI 1.038~6.280,P=0.036)。结论年龄、血压、吸烟史是老年T2DM患者发生大血管病变的独立危险因素,因此高龄、高血压、有吸烟史的老年糖尿病患者,要警惕大血管病变,并积极控制血压,戒除不良嗜好。     

2型糖尿病患者游离脂肪酸与大血管病变的相关性研究

目的　探讨 2型糖尿病 (T2DM )患者游离脂肪酸 (FFA)与大血管病变的相关性。　方法　 2 0 3例T2DM患者 ,根据是否合并大血管病变 ,分为非大血管病变组 (114例 )和大血管病变组(89例 ) ,与 73名正常对照组比较 ,采用酶比色法测血清FFA ,对大血管病变的相关危险因素行Logis tic回归分析。　结果　T2DM组较正常对照组血清FFA明显升高 [(0 5 3± 0 2 5mmol/L与 0 39±0 18mmol/L比 ,P <0 0 1) ],大血管病变组血清FFA[(0 5 6± 0 2 8)mmol/L]与非大血管病变组[(0 4 9± 0 2 1)mmol/L]、正常对照组 [(0 39± 0 18)mmol/L]比较 ,差异有显著意义 (F =12 2 6 ,P<0 0 1)。T2DM组为整体 ,有无大血管病变为因变量Y(有 =1,无 =0 ) ,以FFA及其他危险因素为自变量 ,进行Logstic回归分析。最后年龄、病程、收缩压和FFA进入回归方程。 　结论　FFA是T2DM大血管病变的一个重要的独立危险因素。     

2型糖尿病合并外周血管病变相关危险因素探讨

目的探讨2型糖尿病（T2DM）患者发生外周血管病变（PVD）的危险因素。方法选取180例T2型DM患者,其中合并PVD80例,无PVD100例,检测相关临床指标。结果T2DM合并PVD组糖尿病病程、血清肌酐、总胆固醇、高密度脂蛋白胆固醇、高血压、脑梗死史、高敏C反应蛋白（hsC-RP）和白细胞介素6（IL-6）水平显著高于无PVD组。多因素回归分析显示hsC-RP和糖尿病病程与T2DM并发PVD正相关。结论hsC-RP是促使T2DM并发PVD的独立危险因素。     

2型糖尿病合并血管疾病的风险因素分析

目的探讨2型糖尿病并发血管疾病的危险因素。方法对2005年1月—2008年12月在山西医科大学第二附属医院住院的2型糖尿病患者,检测血糖、血脂、血压等各项指标,探讨2型糖尿病并发血管疾病的危险因素。结果高收缩压和舒张压是冠心病(CHD)和脑血管病(CVD)的重要风险因素,但不是周围血管病(PVD)的主要易患因素。年龄和糖尿病病程与PVD和CHD有关,而与CVD关系不明显。结论 2型糖尿病合并血管并发症的最大风险因素是性别(男性)、年龄、糖尿病病程和高血压。     

2型糖尿病大血管病变相关因素多元回归分析——餐后甘油三酯水平增高可能为独立危险因素

目的　探讨影响 2型糖尿病大血管病变的危险因素。方法　初诊 2型糖尿病 2 6 8例按是否合并大血管病变分为病变组 (98例 )及对照组 (170例 ) ,对其进行混合餐负荷试验及其相关的临床观察 ,筛选相关因素进行多元逐步L ogistic回归分析。结果　病变组体重指数 (BMI) 2 5 .6 6± 1.78kg/ m2 较对照组 2 3.0 4± 1.6 8kg/ m2 增高 (P <0 .0 5 ) ;病变组餐后 4小时 TG水平 3.2 3± 0 .89mmol/ L 较对照组 1.99± 0 .79mmol/ L 增高 (P <0 .0 5 ) ;将 2 6 8例受试者作为整体 ,以大血管病变作为应变量 Y(有 =1;无 =0 ) ,以年龄、BMI、收缩压 (SBP)、舒张压 (DBP)、糖化血红蛋白 (Hb A1c)、空腹胰岛素 (FINS)、空腹 TG、TC、L DL- C、HDL- C及餐后 4小时甘油三酯 (TG4 h)共 11个因素为自变量 ,进行多元逐步L ogistic回归分析 ,入选的变量是 TG4 h和 BMI。结论　提示餐后甘油三酯水平增高与糖尿病大血管病变独立显著相关 ,应重视糖尿病患者的调脂治疗     

2型糖尿病下肢血管病变发生率及危险因素分析

目的了解2型糖尿病患者下肢血管病变(PVD)发生率,分析PVD的相关危险因素。方法对2000~2003年在浙江大学医学院附属第一医院内分泌科住院治疗297例2型糖尿病患者进行回顾性分析(单因素及Logistic回归分析)。结果64.98%(193/297)患者多普勒超声检查提示有下肢血管病变。年龄、病程、24h尿白蛋白(UAE)、血尿酸(UA)、血肌酐(Cr)、收缩压增高比例、周围神经病变(DPN)比例、冠心病(CHD)比例在有下肢血管病变者中均显著增高(P<0.01)。Logistic回归分析结果表明,年龄、总胆固醇(Tch)、DPN是PVD的独立危险因素(OR=1.087,1.353,2.201)。结论2型糖尿病患者下肢血管病变发生率高,与年龄、血脂、血压、血糖以及糖尿病其它慢性并发症多种因素相关。     

血清von Willebrand因子与糖尿病血管并发症关系的初步研究

目的　探讨 2型糖尿病患者血清 von Willebrand因子 (v WF)与微血管、大血管并发症之间的关系。　方法　将 4 0 8例年龄相近的 2型糖尿病患者 ,根据是否合并血管并发症分为 :无并发症组 (1 2 5例 )、大血管并发症组 (1 2 3例 )、大血管和微血管并发症组 (1 6 0例 )。观察不同组患者血清v WF水平 ,并与正常对照组 (1 0 5名 )比较。　结果　血清 v WF水平在正常对照组为 (0 .8± 0 .4 ) U/ml;无并发症组 (1 .2± 0 .5 ) U/ ml;大血管并发症组 (1 .4± 0 .6 ) U/ ml;大血管和微血管并发症组 (1 .6± 0 .6 ) U/ ml;血清 v WF水平随血管并发症增多而上升 ,各组间差异均有非常显著意义 (P<0 .0 1 )。L o-gistic分析表明 ,v WF既与是否合并大血管病变呈显著相关 (回归系数 β=0 .95 6 ,P=0 .0 0 1 ) ,也与是否合并微血管病变呈显著相关 (回归系数 β=1 .783,P=0 .0 1 2 )。多元逐步回归分析表明 ,尿微量白蛋白、年龄、糖尿病病程分别与 v WF呈正相关 (β=0 .32 4 ,P<0 .0 0 1 ;β=0 .2 31 ,P<0 .0 0 1 ;β=0 .1 4 5 ,P<0 .0 5 )。　结论　 2型糖尿病患者血清 v WF逐渐升高反映了微血管和大血管并发症的发生和发展     

2型糖尿病患者微量白蛋白尿与缺血性心脏病的关系

目的 :探讨 2型糖尿病患者微量白蛋白尿与缺血性心脏病 (IHD)的关系。方法 :6 1例 2型糖尿病患者 ,依有无并发 IHD分为糖尿病并 IHD组 (17例 )和糖尿病不并 IHD组 (44例 ) ,分析比较两组心血管疾病危险因素。再依微量白蛋白尿含量分为微量白蛋白尿组 (2 2例 )和非白蛋白尿组 (39例 ) ,比较两组 IHD的发生率。结果 :糖尿病并 IHD微量白蛋白尿含量明显高于不并 IHD组〔(98.5 1± 48.97) m g/L∶ (9.87± 5 .84) mg/L ,P <0 .0 1〕;微量白蛋白尿组并发 IHD的发生率显著高于非白蛋白尿组 (45 .45 %∶ 17.95 % ,P<0 .0 5 )。结论 :检测微量白蛋白尿是预测 2型糖尿病患者 IHD发病率的有意义的指标。     

高血压并存2型糖尿病老年患者的心脏结构与功能变化

高血压和糖尿病都是老年人常见的疾病 ,是导致老年人充血性心力衰竭、冠心病、脑卒中等发病率和死亡率增高的主要危险因素。我们以老年高血压 (高血压组 )为对照 ,分析高血压并存 2型糖尿病 (高血压 +糖尿病组 )的老年患者的心脏结构和功能变化特征 ,探讨其临床意义。　　一、资料与方法　　 1.临床资料 :1999年 6月至 2 0 0 2年 11月资料完整的高血压 +糖尿病组 76例 ,其中男 4 1例、女 35例 ,年龄 6 5～79岁 ,平均 (6 9 6± 7 3)岁 ;高血压组 5 3例 ,男 2 9例、女 2 4例 ,年龄 6 5～ 83岁 ,平均 (71 2± 8 5 )岁。 2型糖尿病按WHO 1998…     

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.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

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.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.