西南地区各族人群血清同型半胱氨酸水平分析及参考范围的建立

目的 分析西南地区各族人群血清同型半胱氨酸(HCY)水平,建立基于循环酶法的西南主要民族血清HCY参考区间,并初步探讨海拔对血清HCY水平影响.方法 用循环酶法试剂检测体检健康的汉族人群4021名(包括平原汉族3581名、高原汉族440名)、藏族人群680名、彝族人群369名血清HCY水平,根据性别、年龄、种族、生活海拔进行分层分组统计分析.结果 藏族人群血清HCY水平均高于彝族及汉族同性别同年龄阶段组(P＜0.01),而彝族人群均高于汉族同性别同年龄阶段组(P＜0.01);汉、彝族各年龄阶段男性血清HCY水平均显著高于女性(P＜0.05);藏族人群性别间血清HCY水平差异无统计学意义(P＞0.05);彝族、藏族所有年龄组间血清HCY水平差异均无统计学意义(P＞0.05),而汉族男性和女性各年龄组间血清HCY水平不完全一致(P =0.001,0.005),两两分别比较发现,汉族男性和女性在＞70岁组、61 ～ 70岁组与其他各组差异均有统计学意义(P＜0.01),而＜60岁各组间差异无统计学意义(P＞0.05).民族年龄性别分层分析可将所有受试者分为汉族男性21～ 60岁、61～70岁、＞70岁、女性21 ～ 60岁、61～ 70岁、＞70岁、彝族男性、女性、藏族人群九个小组,血清HCY水平参考区间分别为6.87～22.18μmol/L、7.33～27.69μmol/L、9.81～31.03μmol/L、4.39 ～ 17.36μmol/L、5.68 ～ 20.90μmol/L、7.11 ～ 26.33μmol/L、8.65～27.11μmol/L、6.92 ～ 25.37μmol/L、10.26～ 36.66μmol/L.根据生活海拔分层分析,高原汉族组血清HCY水平显著高于平原汉族组(P ＜0.001).结论 健康人群血清HCY水平与性别、年龄、种族、生活海拔密切相关,我们基于循环酶法根据不同因素分别建立的西南地区各组人群血清HCY参考区间,对本地区临床实验室有重要借鉴意义.     

尿中乳酸水平与新生儿窒息后早期肾损伤的关系

目的 探讨尿中乳酸的变化在新生儿窒息后肾损伤中的意义。方法 对38例足月窒息新生儿(轻度窒息13例,重度窒息25例)和15例正常新生儿的尿中乳酸及反映早期肾损伤指标-β2-MG水平进行了检测。结果 与正常组(24.44±15.90)μmol/L、(0.10±0.01)mg/L]相比,轻度窒息组尿中乳酸、N-、β2-MG水平[(30.11±18.58)μmol/L、(2.80±1.95)mg/L]显著升高(P<0.05或0.01);与轻度窒息组和正常对照组,重度窒息组尿中上述指标的水平[(54.75±15.59)μmol/L、(5.05±2.19)mg/L]也显著升高(P<0.01)。在窒息组内,乳酸水平与Apgar评分呈显著负相关关系(r为-0.68,P<0.01),与β2-MG水平之间均呈显著正相关关系(r为0.85,P<0.01)。结论 窒息新生儿尿中乳酸水平有望成为反映新生儿窒息程度和窒息后肾损伤的早期指标。     

老年性痴呆患者血浆同型半胱氨酸、镁离子水平变化及与年龄的相关性分析

目的:检测分析两类老年性痴呆患者血浆同型半胱氨酸(Hcy)和镁离子(Mg2+)水平变化及与年龄的关系。方法:老年性痴呆患者共99例,其中阿尔茨海默病46例(AD组)、血管性痴呆53例(VD组)、另选65例健康人群作对照组。以循环酶法测定各组血浆Hcy水平,以亚甲蓝显色法测定各组血浆Mg2+水平,并进行组间比较和相关性分析。结果:血浆Hcy浓度,与对照组(11.91±3.77μmol/L)比较,AD组(17.69±3.93μmol/L)和VD组(19.91±4.23μmol/L)均明显升高(P<0.01);血浆Mg2+浓度,与对照组(1.03±0.15mmol/L)比较,AD组(0.69±0.17mmol/L)和VD组(0.71±0.17mmol/L)均明显降低(P<0.01);AD组、VD组血浆Hcy浓度均随着年龄的增长而升高,相关系数r分别为0.551、0.479(P均<0.05)。结论:针对高危人群定期测定血浆Hcy、Mg2+水平,对AD和VD的诊断与预后有积极意义。     

SLE患者血清可溶性肿瘤坏死因子受体水平及意义

目的探讨系统性红斑狼疮 (SLE)与可溶性肿瘤坏死因子受体 (sTNF R)的关系。方法利用双抗体夹心ELISA法检测了活动期SLE患者35例,稳定期患者25例及健康对照40例血清中sTNF RI和sTNF RII的水平。结果患者血清sTNF RI和sTNF RII的水平分别为(2.34±0.76)μg/L和(4.33±1.15)μg/L ;健康对照组分别为(1.09±0.11)μg/L和(2.05±0.29)μg/L ,患者明显高于健康对照组(P<0.01)。活动期SLE患者血清sTNF RI和sTNF RII水平分别为(2.93±0.32)μg/L和(5.19±0.53)μg/L ,明显高于稳定期SLE组分别为(1.46±0.15)μg/L和(3.04±0.28)μg/L(P∨0.01)。稳定期也明显高于健康对照组(P<0.01)。在SLE患者组中 ,血清sTNF RI和sTNF RII的水平与疾病活动积分呈显著的正相关(相关系数分别为0.76和0.69)(P<0.01) ;与抗ds DNA抗体水平亦呈显著的正相关(相关系数分别为0.67和0.58)(P<0.01) ;与补体C3的水平呈显著的负相关(相关系数分别为 -0.62和 -0.84)(P<0.01)。结论SLE患者血清sTNF RI和sTNFRII的水平明显增高 ,且与疾病的活动度呈显著正相关 ,这对于SLE的诊断及监测疾病的活动性 ,以及患者的判断预后可能是一种有用的实验室指标。     

西藏山南地区藏族人群血清同型半胱氨酸和瘦素水平

目的 研究西藏山南地区藏族人群血清同型半胱氨酸(HCY)和瘦素(leptin)水平。方方法 本研究以2018年2月至2021年1月在西藏山南地区进行常规体检的藏族人群880例作为研究对象,分别采用化学发光法对不同年龄、不同性别、不同季节受试者的HCY、leptin水平进行比较,研究西藏山南地区藏族的血清HCY、leptin水平分布。结果 随着年龄的升高,其血清HCY、leptin水平显著升高;男性组的血清HCY、leptin水平显著高于女性组(P<0.05);季节对血清HCY、leptin水平影响无统计学意义(P>0.05),西藏山南地区藏族的男性血清HCY、leptin水平的上限分别为22.18μmol/L、7.85μg/L;女性血清HCY、leptin水平的上限分别为18.01μmol/L、7.01μg/L。结论 西藏山南地区藏族人群血清HCY、leptin水平显著升高,未来关于对高危人群的健康教育方面,建议针对居民的危险因素展开健康教育。     

血清瘦素及胰岛素和血糖测定在妊娠期糖代谢中的临床意义

目的:探讨血清瘦素及胰岛素和血糖水平与妊娠期糖代谢异常孕妇的关系。方法:采用放射免疫分析测定36例妊娠期糖代谢异常孕妇(糖代谢异常组)和34例正常孕妇(正常妊娠组)的空腹及口服50g葡萄糖后3h的血清瘦素水平;采用电化学发光法测定两组孕妇的空腹血清胰岛素水平;采用葡萄糖氧化酶法测定两组孕妇的口服50g葡萄糖后1h的血糖水平。结果:1.糖代谢异常组孕妇血清瘦素水平为(14.9±4.3)μg/L,正常妊娠组为(9.8±1.7)μg/L,两组比较差异有显著性(P<0.01);2.糖代谢异常组孕妇空腹血清胰岛素、服糖后1h血糖水平分别为(12.9±4.3)mU/L、(11.0±1.4)mmol/L;正常妊娠组孕妇分别为(8.45±3.0)mU/L、(7.84±1.3)mmol/L。糖代谢异常组孕妇血清瘦素水平与空腹血清胰岛素、服糖后1h的血糖水平呈明显的正相关关系。相关系数(r)分别为0.835、0.758。结论:空腹血清瘦素水平升高见于妊娠期糖代谢异常孕妇,其瘦素水平的高低与空腹胰岛素及血糖水平相关。     

胰岛素样生长因子-1及内皮素-1水平与胎儿宫内发育受限发病的关系

目的 探讨胰岛素样生长因子-1(IGF-1)及内皮素-1 (ET-1)与胎儿宫内发育受限(FGR)发病的关系.方法 应用放射免疫分析法和酶联免疫吸附试验,分别测定21例FGR患儿脐血、孕妇(FGR组)血清及羊水中IGF-1和ET-1水平,同期住院的正常晚期妊娠妇女34例(正常妊娠组)作为对照.结果 (1)FGR组孕妇血清IGF-1为112.16±7.02μg/L,低于正常妊娠组的207.07±8.25μg/L,两者比较,差异有显著性(P＜0.01);FGR组脐血清IGF-1为16.27±7.38μg/L,低于正常妊娠组的44.89±6.44μg/L,两者比较, 差异有极显著性(P＜0.001);FGR组羊水中IGF-1 与正常妊娠组无明显差异(P＞0.05);(2)FGR组脐血清ET-1为79.34±3.67μg/L,高于正常妊娠组的43.96±4.16μg/L,两者比较,差异有显著性(P＜0.01);FGR组羊水中ET-1水平(21.96±1.89μg/L)明显高于正常妊娠组(10.41±2.13μg/L),两组相比有显著差异(P＜0.01);而FGR组孕妇血清ET-1与正常妊娠组相比无明显差异(P＞0.05).结论 IGF-1及ET-1在FGR的发病中可能起到重要作用有关.     

人血清中甘露聚糖结合凝集素的检测及意义

建立检测甘露聚糖结合凝集素 (MBL )的酶联免疫法 ,检测 2 2 6例不同性别、年龄正常人和 115例病人血清中的MBL水平。结果发现儿童组显著低于成人组。术后、烧 (烫 )伤和支原体肺炎患者的血清MBL水平 ( x±s)分别为 (6 73± 3 2 9)mg/L、 (5 86± 3 37)mg/L和 (5 18± 3 4 3)mg/L ,较正常对照组 (2 6 5± 1 5 6 )mg/L显著增高 ,而慢性肾脏病患者的血清MBL水平 (1 0 4± 0 4 8)mg/L显著降低。结果提示血清MBL水平可作为监测个体天然免疫功能的一项指标     

健康人与代谢性骨病患者血清骨钙素水平及其意义

目的 :研究正常与病理状态下血清骨钙素 (S -BGP)变化及其临床意义。方法 :采用放射免疫分析法观察了 2 70例不同年龄段 (每隔 1 0岁为一年龄段 )健康人 ,60例脑血管疾病以及 85例代谢性骨病患者的S -BGP水平。结果 :(1 ) 89例新生儿脐血S -BGP浓度为 1 9 3± 1 6 8μg/L ,2 2例出生 3天婴儿S -BGP浓度为 7 4± 2 3μg/L ,1 0 0例正常人 (1 1～ 60岁 ,平均年龄 39岁 )S -BGP浓度为 5 2± 1 35μg/L ,其中 :男性 5 3±1 4μg/L(n =47) ,女性 5 1± 1 34μg/L(n=53)。 30例老年健康人S -BGP浓度为 3 9± 1 48μg/L。S -BGP与年龄呈明显负相关 (r=- 0 383 ,P <0 0 0 1 )。 (2 ) 85例代谢性骨病患者S -BGP浓度 :甲亢患者 2 1 7± 2 0 46μg/L ,与正常组比较差异非常显著 (P <0 0 1 ) ;老年糖尿病 (NIDDM)患者 2 6± 0 99μg/L ,与正常老年健康组比较差异非常显著 (P <0 0 1 )。 (3) 60例老年脑血管疾病患者S -BGP水平 :脑梗塞 2 2± 1 1 μg/L ,脑出血 2 5± 1 2 μg/L ,与正常老年健康组比较差异非常显著 (P <0 0 1 )。结论 :本文结果表明 ,S -BGP的放射免疫分析是研究正常与病理状态下骨代谢变化的重要检测手段     

酚妥拉明治疗妊娠期肝内胆汁淤积症临床研究

目的探讨酚妥拉明治疗妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的疗效。方法将60例妊娠32~36周,无其他妊娠并发症或合并症的ICP单胎初产妇随机分为研究组和对照组,各30例。对照组应用地塞米松+鲁米那+中药治疗,研究组在对照组基础上加用酚妥拉明治疗。观察两组治疗前后皮肤瘙痒的缓解程度、血清肝功能指标的变化;比较两组羊水粪染(Ⅱ°、Ⅲ°)、新生儿窒息、脐动脉血气分析结果;监测酚妥拉明治疗期间的血压与心率变化。结果(1)研究组治疗前后皮肤瘙痒评分、血清总胆红素(TBIL)、间接胆红素(DBIL)、总胆汁酸(TBA)、甘胆酸(CG)的差值分别为1.48±0.71、8.65±5.32μmol/L、5.33±2.56μmol/L、27.65±13.45μmol/L、51.56±25.78μg/L;对照组分别为0.71±0.60、5.37±3.70μmol/L、2.99±2.00μmol/L、19.98±10.34μmol/L、35.25±20.35μg/L,两组比较,差异均有显著性(P<0.05)。两组治疗前后血清谷丙转氨酶(ALT)及谷草转氨酶(AST)的差值比较,差异无显著性(P>0.05)。(2)研究组羊水粪染率、新生儿窒息率、脐动脉血pH值、PO2、PCO2分别为7.14%、3.57%、7.26±0.07、24.86±11.20mmHg、43.34±10.41mmHg;对照组分别为32.14%、28.57%、7.22±0.04、19.25±6.90mmHg、49.92±6.83mmHg,两组比较,差异均有显著性(P<0.05)。研究组和对照组脐动脉血pH值<7.2分别为2例(7.14%)、8例(28.57%),两组比较,差异有显著性(P<0.05)。(3)研究组酚妥拉明治疗前、中、后的血压和心率比较,差异均无显著性(P>0.05)。结论酚妥拉明治疗ICP安全有效,且无明显不良反应。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.