体重指数在老年代谢综合征人群中诊断价值的初步探讨

目的了解老年人群中体重指数（BMI）与代谢综合征患病及相关代谢异常之间的关系。方法683例65岁以上（平均71．2岁）的老年男性,以中华医学会糖尿病学分会制订的代谢综合征工作定义作为标准,按照BMI进行分层,分析不同BMI人群代谢综合征的患病率及各项代谢指标的异常情况。结果（1）当BMI≥123kg／m^2时,代谢综合征的患病率随BMI的增加显著上升,BMI和代谢异常数量之间呈现一种正相关趋势（r=0．557）;（2）BMI增加与收缩压（SBP）、舒张压（DBP）、血甘油三酯之间正相关（r值分别为0．189、0．198和0．201）,与血高密度脂蛋白胆固醇之间负相关（r=-0．157）;（3）在血压正常人群和在非糖尿病人群,BMI与SBP、DBP、空腹血糖及餐后2h血糖之间显著正相关;（4）冠心病和肾脏损害患者的BMI显著高于无相关疾病人群（P〈0．05）;（5）冠心病、肾脏损害和脑血管病变患者中的代谢综合征患病率显著高于没有这些疾病的人群（P〈0．05）。结论随着BMI的增加,代谢指标异常的数量逐渐增加,代谢综合征的患病率也逐渐升高。BMI的增加与冠心病、肾脏损害和脑血管病变的发病相关。     

老年糖尿病合并冠心病52例血脂代谢异常分析

现对我院 1998～ 2 0 0 2年住院的老年 2型糖尿病 (T2 - DM)合并冠心病 5 2例患者血脂代谢情况进行分析 ,探讨 T2 - DM患者血脂异常与冠心病的关系。1　对象和方法1.1　 对象　老年糖尿病合并冠心病组 :5 2例 ,男 4 7例 ,女 5例 ,平均 70 .0± 7.6 0岁。冠心病诊断按 WHO标准。老年糖尿病为 6 0岁以上及 6 0岁以前发病进入该年龄组的糖尿病患者。老年糖尿病不合并冠心病组 :30例 ,男 2 4例 ,女 6例。平均6 9.4± 6 .82岁。为我院住院的老年糖尿病病人并且无冠心病者 ,除外甲状腺功能低下、酒精中毒、肝肾功能异常。正常老年组 :30例 ,男…     

老年代谢综合征患病情况及特点

目的　 调查老年干部代谢综合征的患病情况及特点。　 方法　通过体检的方法 ,测定血糖、血脂、血压、心电图、身高、体重、腰围、臀围、眼底等 ,并详细对受检人员询问病史。　 结果 　 1615名老年干部中发现代谢综合征 198例 ,发生率为 12 2 6% ;10 0 4名中年干部中发现 65例 ,发生率仅为 6 47% (P <0 0 1)。老年干部糖尿病、高血压的发生率分别为 2 1 67%、5 7 71% ,较中年干部的发生率 13 5 5 %、2 9 5 8%有明显增高 (P <0 0 1)。老年代谢综合征者冠心病、腹型肥胖、眼底动脉硬化的发生率分别为 5 4 0 4%、63 64%和 40 91% ;而非老年代谢综合征者为 2 6 15 %、44 61%和 2 9 2 3% ,明显低于老年代谢综合征者 (P <0 0 1)。　 结论　老年代谢综合征发病率较高 ,其主要原因是糖尿病和高血压的高发病率。老年代谢综合征伴有高冠心病、动脉硬化发病率 ,是威胁老年人身体健康的主要疾病     

乌鲁木齐市汉族老年人糖代谢异常的流行病学调查

目的 调查乌鲁木齐市60岁以上老年汉族居民糖尿病和糖尿病前期的患病率以及分布特点.方法 对乌鲁木齐市2个社区的居民进行查体及75 g葡萄糖耐量试验,共调查2210例,其中60岁以上老年人(老年组)为1231例,40～59岁中年人(中年组)951例.糖尿病诊断标准采用1999年WHO标准.结果 老年组糖尿病和糖尿病前期的患病率分别为32.2%、29.0%,标化后分别为25.6%、23.1%;较中年组患病率高(分别为12.3%、20.9%),差异有统计学意义(x2=192.62,P＜0.05);老年组糖耐量受损(IGT)患病率(21.6%)高于中年组(13.9%),差异有统计学意义(x2=20.97,P＜0.05);单IFG患病率在老年组与中年组间差异无统计学意义;老年组代谢综合征患病率为52.2%,高于中年组(33.7%),差异有统计学意义(x2=73.77,P＜0.05).回归分析结果显示,糖尿病家族史、高血压、高甘油三酯血症是老年人糖尿病发生的危险因素(x2=44.34,P＜0.05).结论 老年汉族人群糖尿病、IGT及代谢综合征的患病率均高于中年人群,必须重点采取干预措施.     

高血压合并糖尿病的治疗

高血压和糖尿病在临床上非常常见 ,二者的发病率都在逐年增高。流行病学研究显示 ,高血压与糖尿病有一定的关联[1～ 3 ] 。目前我国高血压患者近 1亿 ,糖尿病患者近 30 0 0万 ,其中 90 %为 2型糖尿病 ,高血压合并糖尿病的患者约 1 5 0 0万。在高血压患者中 ,糖尿病的患病率约为 1 0 %～ 2 0 % ,糖尿病患者中约 5 0 %合并高血压。WHO1 997年报告 1 996年全世界糖尿病患者 1 .32亿 ,预测到 2 0 1 0年将增至 2 .4亿 ,2 0 2 5年达到近 3亿 ,成为世界第五大死亡原因。新增加的病人将约 2 /3～ 3/4在中国、印支亚大陆及非洲等发展中国家 ,在糖尿…     

中国12个地区中老年人糖尿病患病率调查

目的　调查中国 4 0～ 99岁一般人群中糖尿病和糖耐量低减 (IGT)的患病现状。方法采用分级整群抽样方法 ,在 1997年 8月～ 1998年 8月期间横断面调查中国 12个地区的 4 0～ 99岁居民2 9 5 5 8人。结果　中国 4 0～ 99岁一般人群中糖尿病的标化患病率为 5 .89% (95 %CI:5 .6 2 %～ 6 .16 % ) ,IGT标化患病率为 5 .90 % (95 %CI:5 .6 3～ 6 .17% ) ,12个地区之间的糖尿病标化患病率和IGT标化患病率有显著性区别 (χ2 =84 .5 ,P <1× 10 -5) ,城乡之间的糖尿病患病率 (城 :6 .8% ,乡 :3.8% ,χ2 =12 4 .2 ,P <1× 10 -5)和IGT患病率 (城 :6 .1% ,乡 :5 .3% ,χ2 =11.6 ,P =0 .0 0 0 7)有显著性区别 ,总体上各年龄组之间的糖尿病患病率 (χ2 =12 4 .2 ,P <1× 10 -5)和IGT患病率 (χ2 =11.6 ,P =0 .0 0 0 7)也有显著性区别 ,并呈现增龄性上升的趋势。结论　中老年人糖尿病患病率有地区和城乡差别 ,总体上有随年龄增长而增加的现象     

老年男性糖耐量低减的血管病变及相关因素

目的：观察老年男性糖耐量低减（IGT）患的血管病变及相关因素。方法：查体新发现的老年男性IGT患，共141例，与同一人群中糖耐量正常73例（NGT组）及新诊断的2型糖尿病患79例（DM组）作比较，观察冠心病、高血压、脑血管病、肥胖、尿白蛋白排出率（UAE）的患病率，并分析发生血管病变的相关因素。结果：IGT组与NGT组相比，合并高血压、脑血管病显增高，伴高甘油三酯（TG）血症、UAE增高显多于NGT组，但低于DM组。多元回归分析显示，UAE≥10μg/min、高TG血症是老年男性发生IGT的危险因素。结论：（1）老年男性IGT患合并高血压、脑血管病明显高于NGT人群，高TG血症和尿白蛋白排出增加的发生率高；（2）UAE增高、高TG血症是老年男性发生IGT的危险因素；（3）UAE，TG增高和血压升高是发生糖尿病的危险因素。     

驻湘部队老年男性干部代谢综合征的发病率调查

目的：调查驻湘部队老年男性干部人群代谢综合征的患病率。方法：于2006年3月1日～2006年11月30日，选择来我院门诊体检的年龄≥60岁驻湘老年男性干部，采用整群随机抽样方法进行横断面研究，以中国糖尿病协会的建议为诊断标准，对老年男性干部人群代谢综合征的患病率进行了分析。结果：驻湘部队老年男性干部人群的代谢综合征（MS）患病率为20．5％，肥胖患病率44．8％，高血压为47．1％，高血糖为26．8％，高血脂为22．5％。高龄老年组的各项患病率均高于老年组。结论：驻湘部队老年男性干部人群具有较高的代谢综合征患病率，代谢综合征和各组分的患病率在不同的年龄段有所不同。进一步的流行病学调查和对人群进行干预的研究十分必要。     

从心血管危险因素看空腹血糖受损切点下调

目的在不同空腹血糖水平下分析心血管危险因素的聚集情况,探讨我国成人空腹血糖受损(IFG)切点下调的合理性.方法对1994年全国25岁以上22.4万人群糖尿病普查中15 564例经口服75克葡萄糖耐量试验检查的人群资料进行分析.结果 (1)将人群按空腹血糖(FPG)0.56 mmol/L间隔分组,BMI≥25 kg/m2、高甘油三酯、高血压及代谢综合征的比率随FPG逐渐上升,FPG 5.0～5.6 mmol/L组超重比率出现明显升高(P=0.001),FPG 5.6～6.1 mmol/L组其余各组分及代谢综合征比率均有明显升高(P＜0.001).(2) 餐后2 h血糖＜7.8 mmol/L时,FPG 5.6～6.1 mmol/L组与FPG＜5.6 mmol/L组比较,BMI≥25 kg/m2、高血压、代谢综合征患病率分别升高25%,15%,46%;糖尿病家族史阳性率增高.(3) 按照1999年WHO诊断分型标准及2003年ADA专家委员会建议将非糖尿病人群分为正常糖耐量(NGT),单纯IFG,单纯糖耐量受损(IGT)及IFG合并IGT(IFG+IGT)组.IFG诊断切点下调至5.6 mmol/L后,糖调节受损各组仍具有FPG 6.1 mmol/L为切点时临床特点.IFG+IGT组代谢异常较单纯IFG及单纯IGT为重.单纯IFG与单纯IGT组比较IFG组年轻、糖尿病家族史阳性多,相对肥胖,总代谢综合征比率高;IGT组收缩压、甘油三酯、餐后胰岛素水平高,女性比例高.结论 (1)糖尿病前心血管危险因素已开始随空腹血糖水平增高而增加,自FPG 5.6 mmol/L组以上代谢综合征及单组分比率均有显著升高.(2)以FPG≥5.6mmol/L为切点划分的新IFG人群表现为年轻,糖尿病家族史阳性率高,代谢综合征比率高于NGT及单纯IGT人群.FPG可能对年轻者更有诊断价值.     

不同性别老年高血压人群代谢综合征患病特点

目的分析不同性别老年高血压人群代谢综合征患病率及特点。方法采用分层整群抽样的方法对辽宁省阜新农村地区年龄≥65岁高血压患者1 637例,按不同年龄、体重指数(BMI)、血脂水平、血糖水平及高血压分级分为不同组分,进行流行病学调查和实验室检查。根据中华医学会糖尿病学分会关于代谢综合征诊断标准,分析不同性别老年人在代谢综合征各组分中患病率及特点。结果 (1)代谢综合征患病率随年龄的增长而降低,女性患病率明显高于男性。(2)代谢综合征患病率随BMl的升高而升高。(3)高TG患病率最高.其次为高LDL-C、低HDL-C和高TC。(4)在高血压各分级中女性患病率均高于男性。(5)代谢综合征患病率随血糖的升高而升高,女性患病率均高于男性。结论 (1)老年代谢综合征患病率随年龄的增长而降低,随BMI及血糖的升高而升高。(2)女性代谢综合征患病率明显高于男性,在高血压及血糖分层中女性患病率均高于男性。     

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.     

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.     

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.