高血糖与非肥胖糖尿病小鼠肝脏病变的关系

目的观察非肥胖糖尿病(NOD)小鼠的肝脏损伤,探讨高血糖与肝脏病变的关系。方法53只雌性NOD小鼠随机分为普通饲料组(NC组,n=23)和高脂饲料组(HF组,n=30)。所有小鼠均在确诊为糖尿病后2周或观察至9月龄时处死。检测各组的肝指数、生化指标及肝脏组织学改变。结果NC组小鼠均无肝细胞脂肪变性发生,但糖尿病组(NC-DM组)肝指数、血糖、TG及ALT、AST均高于非糖尿病组(NC-ND组)小鼠(P0.05)。HF组小鼠均出现不同程度的肝细胞脂肪变性,糖尿病组(HF-DM)重于非糖尿病组(HF-ND)(P0.01),所有小鼠均表现为肝脏轻度非特异性炎症。DM组小鼠肝细胞胞质有糖原蓄积。结论NOD小鼠肝细胞脂肪变性与高脂饮食有关,高血糖可引起胞质糖原蓄积及肝酶学异常,并加剧肝细胞脂肪变性的程度。     

实验性兔脂肪肝肝脂酶活性变化及茶多酚的作用

目的 观察肝组织中肝脂酶(HL)活性变化与肝细胞脂肪变性的关系,探讨茶多酚对HL活性变化的影响及机制。 方法 雄性新西兰白兔分为三组:脂肪肝组6只喂高脂饲料;茶多酚组7只喂高脂饲料,同时口服茶多酚200μg·g-1·d-1;正常对照组6只喂普通兔饲料。实验8周后测定血脂水平、血浆HL活性水平,肝组织做病理形态学检查同时用吐温法行HL活性染色,用硫代巴比妥酸比色法测定肝组织丙二醛(MDA)含量。 结果 脂肪肝组均产生重度混合型脂肪肝,血总胆固醇(TC)为(28.49±5.99)mmol/L,正常对照组为(1.11±0.82)mmol/L,t=21.654,P<0.05;血清低密度脂蛋白胆固醇(LDL-c)为(12.15±1.95)mmol/L,正常对照组为(0.71±1.14)mmol/L,t=12.400,P<0.05;肝组织MDA含量为(75.58±29.88)nmol/mg,正常对照组为(43.64±16.95)nmol/mg,t-2.278,P<0.05。每100μm2肝组织中HL活性点个数为1.76±0.10,正常对照组为4.14±0.05,t=3.306,P<0.05。茶多酚组:肝脏病理改变5只兔为中度混合型脂肪肝,2只兔为轻度混合型脂肪肝,明显轻于脂肪肝组。血TC为(16.87±6.58)mmol/L,明显低于脂肪肝组高于正常对照组(t值分别为5.786和3.968,P<0.05)。血LDL-c为(5.10±4.19)mmol/L,明显低于脂肪肝组(t=2.478,P<0.05)高于正常对照组(t=3.7634,P<0.05)。肝组织MDA含     

早期糖代谢异常对冠状动脉血流储备的影响

目的探讨早期糖代谢异常对冠状动脉(冠脉)血流储备的影响.方法包括25例糖耐量异常的胸痛但冠脉造影正常患者(糖耐量异常组)及25例血糖正常且年龄、性别及一般情况匹配、冠脉造影正常的患者(对照组).比较两组的血糖、胰岛素、糖化血红蛋白、纤维蛋白原、C-反应蛋白水平及冠脉血流储备功能.结果糖耐量异常组空腹及糖耐量试验餐后2h血糖显著高于对照组分别为(6.54±0.22)mmol/L与(5.18±0.66)mmol/L;(10.63±3.26)mmol/L与(9.09±1.89)mmol/L,P均＜0.001],前者糖化血红蛋白明显增高[(6.32±O.67)%与(5.54±1.23)%,P＜0.05].与对照组比较,糖耐量异常组基础冠脉血流平均峰值流速显著增高[(22.6±5.6)cm/s与(17.9±4.9)cm/s,P＜0.05],但腺苷激发后冠脉血流平均峰值流速[(47.1±13.8)cm/s与(60.7±15.3)cm/s,P＜0.05]和冠脉血流储备(2.09±0.31与3.42±0.55,P＜0.001)显著减低.结论早期糖代谢异常时,冠脉造影正常,但其冠脉血流储备常常减低.     

国产罗格列酮对实验性树鼩肝脂肪变性的保护作用

目的探讨国产罗格列酮对高糖高脂喂养诱导树鼩肝脂肪变性干预治疗的效果.方法36只树鼩分为对照组8只(A组),喂常规鼠饲料.另28只喂高糖高脂饲料,并于22周将血糖≥11.1mmol/L的19只动物再分为药物干预组8只(B组)和非干预组11只(C组).B组以国产罗格列酮按每天5 mg/kg的剂量清晨一次性给药,用药7周.实验前、后检测体重(Wt)、空腹血糖(FBG)、血脂4项[总胆固醇(TC),三酰甘油(TG),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C)]、空腹血清胰岛素(FINS)和血清转氨酶水平.实验结束时剖腹取肝标本,光镜下观察肝脏形态学改变,以免疫组化法检测肝脏解偶联蛋白3(UCP3)和胰岛素受体β(IR-β)的表达水平,以计算机图像分析系统对UCP3、IR-β表达作细胞阳性计数和面积密度及灰度分析.结果(1)血生化改变B、C两组动物FBG均明显增高,实验结束时C组的血糖仍居高不下,同时血TC、TG增加值、FINS和自身稳定模型评估法胰岛素抵抗指数(HOMA-IR)也明显增高,而B组的FBG则显著下降,其他生化参数也均与对照组相似.(2)肝脏形态学B、C两组动物均出现弥漫性肝脂肪变性,脂肪变性的面积密度和肝细胞脂变率均在30%左右,两组差异均无显著性.实验结束时,B组肝脂肪变性显著改善,C组则进一步加重.(3)免疫组化分析C组IR-β表达明显强于A组(P＜0.01);正常肝细胞不表达UCP3,C组肝细胞表达UCP3的面积密度和细胞阳性率均明显小于B组(P＜0.01);肝肪脂变性面积密度与UCP3面积密度(r=-0.86,P=0.001)和细胞阳性率(r=-0.79,P＜0.001)呈负相关.结论国产罗格列酮可能通过改善胰岛素抵抗、提高胰岛素敏感性、促进肝脏UCP3的表达,对实验性树鼩肝脂肪变性起防治作用.     

CA 199水平在2型糖尿病患者人群中对于血糖控制的评估价值

目的:分析2型糖尿病患者血清糖链抗原199(carbohydrate antigen 199,CA199)水平与血糖控制的相关性.方法:测定77例住院2型糖尿病患者血清CA199水平,分别根据糖化血红蛋白、空腹血糖、餐后2h血糖水平将糖尿病患者分为低糖化组、高糖化组、空腹血糖达标组、高空腹血糖组、餐后血糖达标组及餐后高血糖组.比较各组CA199水平;分别计算糖化血红蛋白、空腹血糖、餐后2 h时血糖、年龄、病程、体质量指数、总胆固醇、甘油三酯、高密度脂蛋白胆固醇,低密度脂蛋白胆固醇与CA199的相关性并进行多元Logistic回归分析,比较各变量与CA199的相关程度.结果:高Hb A1c患者的CA199水平为15.77U/m L(10.15-26.34 U/m L)显著高于低Hb A1c的10.23 U/m L(6.34-15.34 U/m L)(Z=-3.455,P0.05),高空腹血糖组血清CA199水平14.34U/m L(9.35-26.38 U/m L)也高于正常空腹血糖组的13.17 U/m L(9.38-24.58 U/m L)(Z=-2.348,P0.05).高餐后血糖组血清和正常餐后血糖组血清CA199水平比较无统计学差异(Z=-0.183,P0.05).Spearman相关分析显示,CA199与糖化血红蛋白(r=0.234,P=0.001)、空腹血糖(r=0.245,P0.001)呈正相关(r=0.534,P=0.001),与餐后2 h血糖、胰岛素抵抗及胰岛B细胞功能无相关性.结论:2型糖尿病患者血清CA199水平与糖化血红蛋白及空腹血糖成正相关,与餐后2小时血糖无明显相关性.     

老年2型糖尿病及并发症与糖化血红蛋白的相关性

目的探讨老年2型糖尿病及并发症与糖化血红蛋白的相关性。方法老年2型糖尿病患者74例为观察组,同期体检的老年健康受试者60例为对照组。对比两组糖化血红蛋白和空腹血糖的检测结果;通过Pearson相关性检验分析糖化血红蛋白和空腹血糖的相关性;对比观察组有糖尿病并发症和无糖尿病并发症、合并糖尿病慢性并发症和合并糖尿病急性并发症患者的糖化血红蛋白和空腹血糖检测结果。结果观察组糖化血红蛋白[(9. 35±2. 51)%],空腹血糖[(10. 17±4. 36)mmol/L]均显著高于对照组(均P0. 05)。观察组空腹血糖的水平随着糖化血红蛋白水平的升高而升高,两者呈显著正相关(r0. 8,P0. 05)。有糖尿病并发症患者的糖化血红蛋白[(12. 19±2. 21)%],空腹血糖[(11. 13±5. 06)mmol/L]均显著高于无糖尿病并发症的患者(均P0. 05)。结论糖化血红蛋白水平与老年2型糖尿病并发症的发生相关,定期监测和维持糖化血红蛋白达标有助于降低老年2型糖尿病并发症发病的风险。     

吡格列酮对非酒精性脂肪肝模型小鼠肝脂肪变的影响

目的观察吡格列酮对非酒精性脂肪肝(NAFLD)小鼠肝组织学、胰岛素抵抗、肝功能和血脂的影响。方法C57小鼠适应性喂养1周后,对照组8只和模型组18只,对照组饲喂对照饲料,模型组喂养60%高脂饲料诱导非酒精性脂肪肝模型,共计14周。第10周模型组随机抽取10只为吡格列酮组,按10 mL/kg灌胃吡格列酮,共计4周。实验结束观察各组小鼠体质量、肝组织学、胰岛素抵抗、肝功能和血脂的变化。结果与模型组相比,吡格列酮组肝重和肝脏指数显著升高(P=0.01,P0.001),肝脏病理提示脂肪变性、肝小叶炎症明显改善(P0.001,P0.001),TG、空腹血糖、胰岛素抵抗指数(HOMA-IR)下降明显(P=0.002,P=0.001,P=0.01),高密度脂蛋白胆固醇(HDL)上升显著(P0.001)。结论吡格列酮可改善NAFLD模型动物胰岛素抵抗,减轻肝脂肪变和调节血脂作用。     

糖化血红蛋白在糖尿病患者诊治和疗效评价中的应用价值

目的探讨糖化血红蛋白在糖尿病患者诊断、治疗和疗效评价中的临床价值。方法以2014年11—10月期间来该院就诊的具有可比性的60例糖尿病患者和60例健康体检者为研究对象,分别应用葡萄糖氧化酶法和酶比色法检测其空腹血糖和糖化血红蛋白,采用t检验比较分析两组研究对象和是否合并视网膜病变患者空腹血糖和糖化血红蛋白之间的差异有无统计学意义。结果糖尿病患者和健康体检者的空腹血糖检测值分别为(9.05±1.03)mmol/L和(4.34±0.98)mmol/L,糖化血红蛋白分别为(7.84±1.53)%和(3.99±1.46)%,两组之间的差异有统计学意义(空腹血糖t=25.66,糖化血红蛋白t=14.10,P0.01),糖尿病组均显著高于健康体检组。糖尿病患者中,是否合并视网膜病变的空腹血糖检测值分别为(11.14±2.17)和(8.25±1.99)mmol/L,糖化血红蛋白分别为(10.25±1.89)%和(6.81±1.93)%,两者之间的差异有统计学意义(空腹血糖t=5.12,糖化血红蛋白t=16.31,P均0.01),合并视网膜病变者均显著高于未合并视网膜病变者。结论糖化血红蛋白水平的检测在糖尿病的临床诊断、制定治疗方案和疗效评估等方面具有重要的临床价值,值得推广应用。     

两种调脂药物对高脂血症性脂肪肝治疗的实验性研究.

目的探讨不同作用机制的调脂药(非诺贝特和辛伐他汀)对高脂血症性脂肪肝的作用.方法高脂食饵性喂养诱导大鼠高脂血症性脂肪肝模型.分别给予非诺贝特、辛伐他汀治疗,观察肝指数、肝功能,血脂、肝脂、血清及肝组织过氧化脂质(MDA)含量及组织学的变化.结果非诺贝特显著降低血脂,分别为TC(mmol/L)1.80±0.20与2 10±0.33,TG(mmol/L)0.76±0.18与1.09±0.31、血清及肝组织MDA含量(nmol/ml)分别3.97±0.57与6.89±1.22和75.22±20.88与106.69±15.60,但ALT、ALP、肝脂、肝指数却显著升高,肝组织学呈重度脂肪变;辛伐他汀显著降低血脂、肝脂、血清及肝组织MDA含量,对肝功能无影响,肝组织学接近正常.结论非诺贝特虽可显著降低血脂,但却加重肝内脂质沉积,不宜用于高脂血症性脂肪肝的治疗.辛伐他汀显著降低血脂及肝脂,降低脂质过氧化,,对肝功能无影响,可较安全、有效地用于高脂血症脂肪肝的治疗.     

复方甘正对非酒精性脂肪肝的治疗作用

[目的]观察复方甘正对高脂饮食诱导的大鼠非酒精性脂肪肝(NASH)的治疗作用。[方法]将30只SD大鼠随机分为3组:正常组、模型组和复方甘正治疗组。测定各组空腹血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、三酰甘油(TG)及肝匀浆TG、TC的水平,同时检测肝匀浆丙二醛(MDA)水平及超氧化物歧化酶(SOD)活性。[结果]模型组体重(493.20±19.55)g比正常组(371.60±31.69)g显著增高(P<0.01),治疗组(421.80±15.51)g较模型组显著降低(P<0.05)。模型组肝指数(3.33±0.74)比正常组(2.89±0.14)显著增高,治疗组(2.97±0.10)较模型组显著降低(均P<0.05);正常组肝细胞无脂肪变性,模型组普遍发生脂肪变性,治疗组肝脂肪变性程度较模型组显著减轻,正常组无炎性细胞浸润,模型组肝小叶内出现汇管区炎症,炎症活动度明显高于正常组,治疗组较模型组明显减低(均P<0.01);模型组血清ALT、AST及TC较正常组均显著升高,治疗组较模型组显著下降,但仍高于正常组(P<0.01,<0.05)。模型组血清TG水平与正常组接近,治疗组与模型组比较下降不明显;模型组肝匀浆TG、MDA水平高于正常组,SOD活性低于正常组;治疗组TG、MDA较模型组显著下降(均P<0.01),TG已降至正常水平。治疗组SOD活性较模型组明显增加,但低于正常组(均P<0.01),3组间TC水平比较差异无统计学意义。[结论]复方甘正具有显著的抗炎、抗脂质过氧化和清除氧自由基的作用。     

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.     

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.     

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.     

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.