肥胖患者的瘦素抵抗

目的位于脉络丛上的瘦素受体是血液中瘦素进入脑脊液的通道.该文研究了肥胖患者和正常人脑脊液/血清瘦素浓度的比值,探讨肥胖患者瘦素受体功能的变化.方法采用RIA方法测定40例肥胖患者和50例正常人脑脊液和血清中的瘦素浓度.结果40例肥胖患者平均血清浓度为(40.2±8.6)ng/mL,50例正常人为(9.6±1.5)ng/mL,肥胖组脑脊液瘦素浓度为(0.337±0.040)ng/mL,正常组为(0.289±0.026)ng/mL,脑脊液/血清浓度比值,肥胖组与正常组相应为0.0084和0.0270,正常人是肥胖患者的3.2倍.结论血清瘦素通过其受体进入脑脊液,作用于弓状核引起体重下降,肥胖患者脑脊液/血清瘦素比值下降,反映肥胖患者的瘦素通过受体进入脑脊液的能力已经饱和,提示这可能是发生瘦素抵抗的原因.     

结核病人肾上腺皮质功能及利福平对其功能的影响

应用放射免疫分析法检测了34例正常人及200例结核病人的血清皮质醇含量,未经抗痨治疗的结核病人皮质醇含量(8AM:797.42±268.02nmol/L,4Pm:467.55±190.99nnmol/L)较正常组(8Am:597.63±183.22nmol/L,4Pm:276.55±58.24nmol/L)明显升高(P<0.01),且具有正常昼夜节律性,并探讨了利福平对结核病患者肾上腺皮质功能的影响。     

老年心力衰竭患者的皮质醇浓度变化

目的:探讨老年心力衰竭患者的血清皮质醇浓度变化。方法:选择67例老年心脏病患者,根据有无心力衰竭分为心衰组37例,对照组30例。未经激素类药物治疗前,应用放射免疫法分别测定0时、8.00时、16.00时血清皮质醇水平。结果:心衰组皮质醇分泌昼夜节律性异常,呈现分泌节律的"倒置"现象,与对照组相比差异显著(P<0.05)。而昼夜节律性正常者,皮质醇单项或多项升高,两组无显著性差异(P>0.05)。皮质醇水平变化还与疾病的程度有关。结论:老年心力衰竭患者可有皮质醇水平变化,表现为异常升高或"倒置"现象。皮质醇昼夜节律性正常至关重要。     

单纯性肥胖症的儿童的肾上腺皮质功能

我们测定了42例单纯性肥胖症小儿的肾上腺皮质功能,结果显示:①1/3的患儿血浆总皮质醇(PTC)昼夜节律正常,而其余2/3的患儿存在不同程度、不同类型的异常;②尿游离皮质醇(UFC)的含量在正常范围;③地塞米松抑制筛查试验正常。表明多数单纯性肥胖症患儿的肾上腺皮质功能活动水平较高;但对地塞米松的反馈抑制作用仍十分敏感,与正常小儿及柯兴综合征患者均有显著不同。     

血浆和脑脊液中白介素-6水平变化在新生儿颅内出血的意义

目的研究新生儿颅内出血中血浆和脑脊液白介素-6(IL-6)的水平变化与临床意义。方法采用ELISA法测定了新生儿血浆、脑脊液IL-6的含量(新生儿颅内出血22例为实验组,无窒息史、严重感染及神经系统疾病的入院新生儿13例为对照组)。结果实验组血浆、脑脊液中IL-6含量均显著高于对照组(P<0.01,P<0.001),以脑脊液升高更为显著;大出血组其IL-6含量较小出血组均显著升高(P值均为P<0.05);颅高压组其IL-6含量较正常颅压组均显著升高(P<0.05,P<0.01),以脑脊液升高明显。结论新生儿颅内出血患儿血浆和脑脊液中IL-6水平变化与脑损伤严重程度有关,是病情监测和判断预后的指标之一。     

脑脊液SOD变化对诊断肝性脑病脑损害的价值

为探讨肝性脑病是否存在脑器质性损害及脑脊液SOD含量测定对脑损害程度的估计价值,将对照组、单纯肝硬化、亚临床肝性脑病、肝性脑病及有脑器质性损害患者分5组作脑脊液SOD含量的测定。结果发现肝性脑病组脑脊液SOD含量为996.10±228.52μg/L,较对照组和单纯肝硬化组明显增高(P<0.01),并与脑器质性损害组(974.51±389.28μg/L)接近(P>0.05)。亚临床肝性脑病患者脑脊液SOD含量805.00±276.53μg/L,明显高于对照组(P<0.05),但低于肝性脑病患者(P<0.05)。表明肝性脑病存在脑器质性损害。脑脊液SOD含量的测定对评估脑损害严重程度有一定价值。     

脑脊液置换联合鞘内注药治疗结核性脑膜炎疗效观察

目的探讨脑脊液置换联合鞘内注药治疗结核性脑膜炎(TBM)的临床效果。方法 149例TBM患者分为对照组和观察组,对照组67例患者给予常规抗结核药物治疗,观察组82例患者在此基础上给予脑脊液置换和鞘内注药联合治疗,对2组患者的治疗效果、临床症状、脑脊液蛋白含量、脑脊液白细胞计数及脑脊液压力进行比较。结果观察组患者治疗有效率显著高于对照组(P<0.05);观察组患者发热和头痛消失时间、脑脊液压力及脑脊液蛋白含量和脑脊液白细胞计数恢复时间、住院时间均显著短于对照组(P<0.05);2组患者治疗后脑脊液蛋白含量、脑脊液白细胞计数和脑脊液压力均显著低于治疗前(P<0.05);治疗后观察组患者脑脊液蛋白含量、脑脊液白细胞计数和脑脊液压力均显著低于对照组(P<0.05)。结论脑脊液置换联合鞘内注药治疗TBM效果显著,可快速改善患者的临床症状及脑脊液生化指标。     

采用脑室冲洗进行脑脊液置换在脑脊液异常的脑积水患者脑室腹腔分流术中的应用效果

目的探讨采用脑室冲洗进行脑脊液置换在脑脊液异常的脑积水患者脑室腹腔分流术中的应用效果。方法将60例脑脊液异常的脑积水患者随机分成观察组和对照组,每组30例。观察组患者行脑室穿刺后,采用脑室冲洗进行脑脊液置换,对照组患者行脑室外引流或腰大池外引流,两组均待脑脊液蛋白浓度<500 mg/L后行脑室腹腔分流术。比较两组患者术前、术后7 d、术后14 d的脑脊液蛋白含量及等待分流手术时间,观察两组患者治疗及随访期间颅内感染发生率、分流管堵管发生率。结果两组患者的脑脊液蛋白含量差异无统计学意义(P>0.05)。观察组等待分流时间短于对照组(P<0.05),但颅内感染发生率、分流管堵管发生率差异均无统计学意义(均P>0.05)。结论采用脑室冲洗进行脑脊液置换是一种行之有效的缩短脑脊液异常的脑积水患者等待脑室腹腔分流手术时间的方法,且不会增加患者颅内感染及分流管堵管的发生率。     

44例神经梅毒患者的临床特征及诊治分析

目的:分析神经梅毒患者脑脊液检查、头颅核磁共振(MRI)、心脏彩超等在有无症状分组之间是否具有差异性。方法:回顾44例神经梅毒住院患者的临床表现、资料及诊治,使用SPSS 18.0软件进行统计学分析。结果:44例中无症状神经梅毒13例,有症状神经梅毒31例。无症状组脑脊液蛋白含量与有症状组差异有统计学意义(P=0.026)。两组患者梅毒血清滴度、脑脊液TRUST阳性率、脑脊液白细胞含量、头颅核磁共振检查异常率、心脏彩超检查异常率差异无统计学意义。结论:神经梅毒的诊断应结合临床表现、血清学、脑脊液及影像学检查综合分析。有症状组神经梅毒患者脑脊液检查蛋白含量较无症状组显著升高,脑脊液蛋白含量较高者出现神经症状的风险可能性较大。     

脑脊液Cystatin C在脑膜脑炎诊断中的价值探讨

目的:探讨脑脊液胱氨酸蛋白酶抑制剂C(Cystatin C)在脑膜脑炎诊断中的临床价值。方法:检测51例脑膜炎、30例脑膜脑炎、42例脑炎患者及21例正常对照组脑脊液Cystatin C、总蛋白(TP)、葡萄糖(Glu)及氯化物(Cl)水平,以评价脑脊液中Cystatin C在脑膜脑炎诊断中的价值。结果:脑膜脑炎组Cystatin C(3.68±1.19 mg/L)较正常对照组(5.40±1.15mg/L)及脑膜炎组(5.08±1.42 mg/L)显著降低(p<0.01),与脑炎组(3.61±1.48 mg/L)比较无显著差异(p>0.05)。结论:脑脊液中Cystatin C联合Glu、Cl及TP对脑膜脑炎的诊断有一定价值。     

脑血管病患者血浆和脑脊液P物质水平的研究

目的 探讨Ｐ物质与脑血管病的关系。方法 采用放射免疫分析法检测了６０例急性硬梗死患者，４０例急性脑出血患者，１５例急性蛛网膜下腔出血患者，１５例血管性痴呆患者和４０例对照者血浆及部分患者，对照者脑脊液ＳＰ的含量，同时动态观察血浆ＳＰ水平随病程的变化。结果 脑血管病患者血浆，脑脊液ＳＰ水平均低于对照组，其中急性脑梗死患者及急性蛛网膜下腔出血患者脑脊液中ＳＰ含量下降具统计学意义，余者差异无显著性，急性     

Hormone secretion in alcohol-induced pseudo-Cushing's syndrome. Differential diagnosis with Cushing disease.

We describe the clinical and biochemical characteristics of alcohol-induced pseudo-Cushing's syndrome in two patients with signs and symptoms of Cushing's syndrome and slight disturbances in liver function. An insufficient suppression of plasma cortisol to the overnight administration of 1 mg of dexamethasone was accompanied by an absent diurnal rhythm of plasma cortisol and an increased cortisol secretion rate. The plasma cortisol levels at 8 AM normalized during hospital admission (ie, alcohol withdrawal) at the same rate or parallel with the serum gamma-glutamyl transferase concentration. A normal increase of plasma cortisol, adrenocorticotropic hormone, and growth hormone in response to an insulin induced hypoglycemia was not compatible with the diagnosis Cushing's syndrome. However, the result of a differential diagnostic test with metyrapone was compatible with the presence of Cushing's disease. An erroneous diagnosis of Cushing's disease can be easily made in patients with alcohol-induced pseudo-Cushing's syndrome.     

Effect of the regimen of kidney-tonifying and qi-invigorating on aging changes of glucocorticoid receptor

The plasma cortisol concentration and the sites of glucocorticoid receptor (GCR) in the peripheral lymphocytes were measured in 32 healthy aged persons and 13 young adults. In animal experiment, GCR of spleen lymphocytic cell was also measured in 18 aged rats and 9 young rats. The results showed that GCR was significantly lower in the aged persons or rats than that in the young while the plasma cortisol level didn't change with aging. So we think that GCR is more sensitive than the plasma cortisol level to reflect the aging change of the adrenal cortex function. After the treatment with the regimen of Kidney-tonifying and Qi-invigorating, the GCR of the aged persons and rats was enhanced, and in this way, the function of the aged adrenal cortex was improved.     

垂体腺瘤患者胰岛素抵抗和皮质醇水平的相关性研究

目的 探讨垂体腺瘤(PA)患者胰岛素抵抗(IR)、血清皮质醇水平及昼夜分泌节律情况.方法 选取2016年10月至2017年4月该院收治的67例PA患者(垂体性Cushing综合征23例,生长激素腺瘤15例,泌乳素瘤16例,无功能性腺瘤13例)作为观察组,选取该院同期体检的49例健康体检者作为对照组.分别测定两组对象的空腹血糖(FPG)、空腹胰岛素(FINS)、血清皮质醇等生化指标,计算IR指数(HOMA-IR),并分析患者IR与血清皮质醇的相关性.结果 观察组皮质醇昼夜分泌节律紊乱的发生率为58.21％;皮质醇分泌节律异常的PA组患者空腹血清皮质醇水平明显高于相应的皮质醇分泌节律正常的PA组和对照组;垂体性Cushing综合征和生长激素腺瘤组的FINS水平和HOMA-IR均高于对照组,相关性分析显示,垂体性Cushing综合征和生长激素腺瘤患者的HOMA-IR与空腹血清皮质醇、FINS水平呈正相关(P＜0.05).结论 垂体性Cushing综合征和生长激素腺瘤存在IR的发生,这可能与血清皮质醇升高密切相关.     

脑出血和脑梗塞急性期血浆皮质醇变化及其与病情和预后的关系

本文对60例脑出血及25例脑梗塞病人急性期血浆皮质醇含量进行了测定并与31例正常人对照,结果表明脑梗塞病人与正常人无明显差异;脑出血组则明显高于脑梗塞组。脑出血病人病情越重含量越高,脑出血极重型血浆皮质醇含量高于1380nmol/L。11例含量在1987nmol/L以上者全部死亡。脑出血1周后随病情好转血浆皮质醇含量明显下降者均存活;含量持续增高者预后不良。可见血浆皮质醇测定有助于判定急性脑血管病患者(尤其是脑出血)的病情和预后。     

术后患者补给不同剂量维生素C的观察

目的 探讨手术后病人血清维生素C含量的变化并为补给适宜剂量的维生素C提供依据。方法 选择54例临床施行中等以上手术病人为观察对象，术前随机分为两组。补给维生素C 500mg／d为观察1组，补给维生素C 1000ng／d为观察2组。两组均为术后当天开始补给，并于术前及手术后3天、7天取清晨空腹血及留24h尿测定维生素C含量。另测94例正常供血者血清维生素C含量为正常值。结果 观察1组病人手术后3天血清维生素C含量恢复至正常水平，7天已超出正常水平高限，24h尿维生素C排出量3天、7天均迅速增加。观察2组病人血清维生素C含量3天、7天均较观察1组病人显著升高。24h尿维生素C排出量术后3天、7天均较观察1组病人明显增加。结论 施行中等以上手术病人补给维生素C 500mg／d是安全，可行的；补给维生素C 1000mg／d是过量的，血清维生素C含量饱和。24h尿排出量明显增加。     

Stress-induced cortisol release in hypothalamic hypoadrenalism.

A 52-year-old woman experienced hypoadrenalism (mean 8 AM plasma cortisol level, 3.7 microgram/dL) after hypothalamic surgery and radiotherapy for craniopharyngioma. Despite low plasma adrenocorticotropic hormone levels (less than 25 pg/mL), absent diurnal variation of the plasma cortisol level, and subnormal urinary 17-hydroxycorticosteroid response to metyrapone, she had normal plasma cortisol responses to insulin-induced hypoglycemia and to administration of vasopressin or synthetic adrenocorticotropic hormone. Stress-induced cortical release may be preserved despite notable abnormalities in regulation of cortisol secretion by diurnal and feedback-mediated mechanisms.     

白介素-6在慢性移植物抗宿主病中的作用研究

目的探讨血浆白介素-6(IL-6)水平在慢性移植物抗宿主病(cGVHD)中的作用。方法采用ELISA方法对27例异基因骨髓移植后发生cGVHD的患者治疗前、中、后及17例无并发症移植患者和18例健康者血浆IL-6水平进行测定并比较。结果cGVHD患者与未发生cGVHD患者和健康者血浆IL-6阳性率间差别有显著性意义(P<0.05);cGVHD患者治疗前、中、后血浆IL-6水平间差别有显著性意义(P<0.05)。结论血浆IL-6水平与cGVHD有关,血浆IL-6水平在患者发病开始时就升高,其水平反映cGVHD病情严重程度。     

Plasma cortisol concentration and blood leukocyte content of glucocorticoid receptors in patients with deficiency-cold vs deficiency-heat syndromes]

Plasma cortisol concentration and blood leukocyte content of glucocorticoid receptors (GCR) were assayed in 20 patients with deficiency syndromes, 10 cold in property (deficiency-cold), the other 10 hot in property (deficiency-heat), and also in 10 healthy individuals as normal control for the purpose of investigating the nature of cold and heat syndromes. As a result, the cases of deficiency-cold syndrome (DCS) had a normal concentration of plasma cortisol but a lowered content of GCR in leukocytes when compared with the normal control (P less than 0.05); the cases of deficiency-heat syndrome (DHS) had a higher concentration of plasma cortisol than the normal control (P less than 0.05) and a slightly higher content of GCR in leukocytes. It was concluded that the DCS is characterized by diminished biological effects of adrenocortical activity, while the DHS, by augmented biological effects of adrenocortical activity.