江门市新会区脂肪肝的流行病学调查及危险因素分析

目的研究脂肪肝在江门市新会区成人中的流行趋势、现状与危险因素。方法对3483各类体检人员的健康咨询、体格检查、空腹血糖、肝功能、血脂等指标及肝脏B超检查结果进行回顾性分析。结果江门市新会区体检人员中检出脂肪肝769例（22．08％），经年龄和性别调整后，新会区成人脂肪肝患病率21．57％。酒精性脂肪肝、可疑酒精性脂肪肝、非酒精性脂肪肝患病率分别为0．86％、0．69％、20．02％。脂肪肝患病率均随年龄增长而增加，60岁之前男性脂肪肝患病率显著高于女性．而60岁以后男女脂肪肝患病率相当。单因素分析显示，脂肪肝组年龄、体重指数、腰围、舒张压、空腹血糖、甘油三酯、胆固醇、丙氨酸氨基转移酶均显著高于非脂肪肝组（P〈0．001）。多元回归分析显示：甘油三酯、腰围、空腹血糖、BMI、舒张压、丙氨酸氨基转移酶、年龄和性别（男性）等指标与脂肪肝密切相关。结论江门市新会区成人脂肪肝患病率高，主要为非酒精性脂肪肝。脂肪肝发病率男性明显高于女性。高脂血症、超重及肥胖、糖代谢紊乱、高血压、高丙氨酸氨基转移酶、年龄、男性等为脂肪肝危险因素。     

14112例脂肪肝相关因素分析

目的：探讨脂肪性肝病（脂肪肝）的相关影响因素。方法分析14112健康查体者的临床资料,分析脂肪肝的相关影响因素。结果14112名受检者中,检出脂肪肝2874例,脂肪肝患病率为20．29％。其中男性患病率明显高于女性（ P＜0．01）;随着年龄增长脂肪肝患病率显著增加,在21～60岁体检人员中,男性检出率高于女性,在＞60岁者中女性的检出率高于男性;脂肪肝检出率随着体重指数增加显著上升。脂肪肝患者转氨酶异常发生率显著高于非脂肪肝者（P＜0．01）。结论性别、年龄、体质量指数、转氨酶与脂肪肝发病率有关。重点干预30～60岁肥胖男性及脂肪肝并转氨酶异常者有助于预防脂肪肝。     

东北地区城市脂肪肝的患病率及其危险因素的流行病学调查

目的探讨东北地区成人脂肪肝的流行病学特征及其危险因素。方法选取2009年1月~2009年12月具有完整资料的某体检中心的健康体检者15 635例,其中男9 037例,女6 598例,男女之比为1.37：1,年龄16~95岁,平均年龄（47.85±13.21）岁。通过性别、年龄分层后比较脂肪肝的患病率,并将脂肪肝患者的体质量指数、血压、血脂、血糖、尿酸、血常规、肝功能等检测结果与非脂肪肝组进行对比分析。结果 B超共检出脂肪肝患者5 955例,总患病率为38.1%,男性患病率显著高于女性（48.8%vs23.4%,χ2=1039.853,P〈0.001）;30~69岁的男性脂肪肝的患病率超过50%,尤以40~49岁最高（55.2%）,女性在39岁之前脂肪肝的发生率不足10%,50岁后骤然上升至35%以上,60~69岁达到高峰并超过男性（43.4%vs40.5%）,70岁以后女性脂肪肝患病率仍显著高于同龄男性（35.5%vs28.3%,χ2=7.670,P〈0.006）。非脂肪肝人群超重者占35.6%,肥胖占7.5%,而脂肪肝人群两者分别为51.0%,36.8%。脂肪肝组的血压、血糖、甘油三酯（TG）等增高的检出率明显高于非脂肪肝组,高密度脂蛋白胆固醇（HDL-C）降低的检出率明显低于非脂肪肝组（P均〈0.001）。单因素分析显示,体质量指数（BMI）、收缩压、TG、空腹血糖（FBG）和血尿酸（UA）,以及γ谷氨酰基转移酶和丙氨酸氨基转移酶在脂肪肝组明显高于非脂肪肝组（P均〈0.001）;相反,HDL-C则显著低于非脂肪肝组（t=47.174,P〈0.001）。多因素Logistic回归分析提示,脂肪肝危险因素包括BMI、TG、UA、FBG、舒张压、胆固醇等,OR值分别为3.590、1.936、1.567、1.508、1.346和1.177。结论东北地区城市男女脂肪肝的发生率在各年龄段有明显差异,脂肪肝的发生与代谢综合征的组分明显相关,尿酸的增高也与脂肪肝的发生明显相关。     

1995至2002年上海宝钢职工队列人群脂肪肝患病率变化

目的探讨近10年上海宝钢职工脂肪肝患病率的动态变化.方法回顾性分析1995-2002年间宝钢职工隔年健康体检资料,根据B超检查结果诊断脂肪肝,规定血清丙氨酸转氨酶(ALT)大于40 U/L为转氨酶升高.结果研究期间59 131人次参加体检,其中参加4次者27.1%,3次者26.6%,2次者24.0%.肥胖和代谢紊乱患病率在基线水平时已较高,随时间进展更加明显.随访中无论是男性还是女性,脂肪肝患病率均不断增高,总体脂肪肝患病率从1995-1996年的3.87%上升至2001-2002年的14.04%,血清ALT升高者脂肪肝检出率从25.88%上升至51.39%.各个时点总体脂肪肝患病率均以50～60岁组最高,同一时点男性脂肪肝患病率高于女性.结论上海宝钢职工脂肪肝患病率增长迅速,并已成为血清转氨酶异常的主要原因,肥胖和代谢紊乱可能与其高发有关.     

中青年脂肪肝人群高危因素分析

目的研究中青年（18-60岁）脂肪肝人群高危因素。方法运用流行病学调查方法调查脂肪肝患者1 031例。结果青岛市脂肪肝患病率35.49%,平均年龄50.90岁,男女之比3.11∶1;中青年脂肪肝948例（91.95%）;男性41-50岁患病率达峰值（31.15%）,女性51-60岁达峰值（38.65%）;脂肪肝高危因素检出率中超体质量（85.45%）及高甘油三酯（60.72%）比例最高;多因素Logistic回归分析,脂肪肝与肥胖、高甘油三酯、超体质量、高胆固醇、空腹高血糖呈正相关（P〈0.05）。结论青岛市脂肪肝患病率高,脂肪肝患者以中青年多见,与肥胖、高甘油三酯、年龄、超体质量、高胆固醇、空腹高血糖呈正相关。     

北京地区体检人群脂肪肝患病率及危险因素分析

目的了解北京市体检人群脂肪肝的患病率,分析其危险因素。方法对我院健康体检的14018名人员中脂肪肝患者的体重指数、血压、血脂、血糖、肝功能等检测结果与非脂肪肝组进行对比分析。结果脂肪肝的检出率为35.64％,男性明显高于女性,约是女性的1.63倍。男性脂肪肝的高发年龄是41-60岁,女性是61-70岁。脂肪肝组的腰围、体重指数、舒张压、血脂（TG、LDL-C、HDL-C）、血糖、血红蛋白、γ-谷氨酰基转移酶及丙氨酸氨基转移酶水平与非脂肪肝组比较差异均有显著性。脂肪肝组中肥胖、血脂异常、高血压、糖尿病的检出率显著高于非脂肪肝组（P〈0.05）。两组间乙肝病毒感染的比例无差异。结论肥胖、糖尿病、血脂异常、高血压是脂肪肝发病的危险因素。减轻体重和维持正常的血糖、血脂、血压水平是防治脂肪肝的重要措施。     

2008和2012年上海市35岁以上人群脂肪肝患病率研究

目的：明确2008和2012年上海市35岁以上居民脂肪肝患病率变化。方法利用上海市嘉定区外冈镇35岁以上居民2008年和2012年健康体检结果,分析上海市脂肪肝患病率变化。结果2008年6129例完成体检,B超共检出脂肪肝1259人,患病率20.54%；2012年6298例完成体检,B 超共检出脂肪肝1410例,脂肪肝患病率为22.39%,2012年脂肪肝患病率高于2008年（χ2=6.28,P〈0.05）,2012年男性脂肪肝患病率明显高于2008年（χ2=15.96,P〈0.01）,女性脂肪肝患病率无明显差异（χ2=0.03,P〉0.05）。结论脂肪肝患病率呈上升趋势,主要是男性患病率上升,女性无明显变化。患病呈年轻化趋势,小于65岁居民患病率上升,大于65岁居民患病率降低。     

无锡地区农村老年人常见病的现状分析

目的调查无锡地区农村老年人的健康状况及常见病的发病率，为提高农村老年人卫生保健防病治病提供依据。方法检测农村体检老年人血常规、丙氨酸氨基转移酶、γ-谷氨酰转移酶、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白-胆固醇、总蛋白、白蛋白、乙肝表面抗原及血压等指标。体检异常者由相关临床医生按照有关疾病诊断标准确诊，并作相关统计分析。结果体检1200例，身体健康者190例，占15．83％，患有各类疾病者1010例，占84．17％；其中，高脂血症的患病率36．92％，高血压31．08％，肝脏病9．5％，糖尿病6．67％。男性高血压患病率最高，占30．49％（P〈0．01）；女性高脂血症患病率最高，占43．07％（P〈0．01）。高脂血症主要以高甘油三酯血症为主，占78．56％，高胆固醇血症者占12．42％，混合型高脂血症者占9．03％；60—69岁男性患高甘油三酯血症所占比例最高，达90．00％，女性患高胆固醇血症和混合型高脂血症的比例大于男性；70～79岁的男、女性所患各型高脂血症的比例无明显差异；80～88岁的女性患高甘油三酯血症所占比例最高，达72．22％，男性患高胆固醇血症和混合型高脂血症的比例大于女性。结论高脂血症、高血压、慢性肝病、糖尿病等已成为农村老年人的常见疾病，且呈年轻化趋势。     

沈阳市不同职业人群脂肪肝的流行现状分析

目的探讨不同职业人群脂肪肝的流行现状。方法纳入6992名健康体检者为研究对象,职业来源包括2家医院的医护人员、3家银行的职员、3个工厂的工人及机关干部,所有研究对象均接受彩超检查。结果 6992名研究对象中,其中男性3662例,女性3330例,男女之比为1.10∶1。年龄（18～92）岁,平均年龄（40.00±11.34）岁,男女之间年龄差异无统计学意义。超声检出脂肪肝1593例（22.8%）,经性别及年龄调整后沈阳市脂肪肝的患病率为21.2%,男性为18.4%,女性为4.4%,男女之间脂肪肝的患病率差异有统计学意义（χ2=667.88,P〈0.001）。不同职业脂肪肝的患病率经年龄及性别调整后相应为：医护人员为18.6%,银行职员为20.3%,机关干部为17.6%,工人为28.7%,工人组明显高于其他3组,差异有统计学意义。男性患者发病高峰在（30～49）岁（41.4%）,女性患者随着年龄的增长逐渐增长。多元回归分析显示：性别、年龄、体重指数BMI、腰围、收缩压、血脂异常、血尿酸、空腹血糖及职业与脂肪肝相关。结论沈阳市脂肪肝的发病率高于南方城市。工人脂肪肝的患病率显著高于医护人员、银行职员及机关干部。脂肪肝的发病率与性别、年龄、代谢综合征及职业相关。     

丹栀逍遥散加味对肥胖伴非酒精性脂肪性肝病及胰岛素抵抗的影响

目的：观察丹栀逍遥散加味对湿热内蕴型肥胖伴非酒精性脂肪性肝病的作用及胰岛素抵抗的影响。方法：将60例肥胖者（BMI≥28）辨证为湿热内蕴型肥胖伴非酒精性脂肪性肝病患者给予丹栀逍遥散加味口服，疗程24周，并与同期60例健康体检者比较。治疗结束后观察所有患者体重指数（BMI）、腰臀比（WHR）、丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素敏感性指数（ISI）、血清总胆固醇（TC）、甘油三酯（TG）及血压变化。结果：治疗前湿热内蕴型肥胖伴非酒精性脂肪性肝病患者与健康组比较ISI显著下降（P〈0．01），治疗后患者BIM、WHR、ALT、AST、TC、TG明显下降（P〈0．05），ISI明显上升（P〈0．05）。结论：丹栀逍遥散加味不仅能显著降低湿热内蕴型肥胖伴非酒精性脂肪性肝病患者BMI、WHR、血脂，保肝降酶，同时也能改善胰岛素抵抗，预防高血压病、糖尿病等相关疾病。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.