高血压合并2型糖尿病患者动脉弹性与氧化应激和血管内皮功能的相关性

目的 研究高血压合并糖尿病患者肱-踝脉搏波传导速度与血清中丙二醛、超氧化物歧化酶和一氧化氮的相关性,探讨氧化应激、血管内皮功能变化在动脉硬化过程中的作用.方法 研究对象168例分为正常对照组(n=40)、原发性高血压组(n=70)和高血压合并2型糖尿病组(n=58),各组分别用比色法检测血清丙二醛、超氧化物歧化酶和一氧化氮含量,应用动脉硬化自动检测仪测定肱-踝脉搏波传导速度.结果 与对照组比较,原发性高血压组和高血压合并2型糖尿病组中丙二醛水平和肱.踝脉搏波传导速度明显增高(P<0.01),超氧化物歧化酶和一氧化氮水平明显降低(P<0.01);与原发性高血压组比较,高血压合并2型糖尿病组丙二醛水平和肱-踝脉搏波传导速度明显增高(P<0.05),超氧化物歧化酶和一氧化氮水平降低(P<0.05).相关分析显示肱-踝脉搏波传导速度与年龄、收缩压、舒张压、胆固醇、空腹血糖、高敏C反应蛋白和丙二醛呈正相关(相关系数r分别为0.418、0.672、0.469、0.179、0.392、0.277和0.571,均P<0.05),与超氧化物歧化酶和一氧化氮呈负相关(r分别为-0.438和-0.571,均P<0.05).多元逐步回归分析显示收缩压、丙二醛、空腹血糖和年龄是肱-踝脉搏波传导速度的独立危险因素.结论 高血压合并糖尿病患者动脉弹性明显减弱,且与体内氧化应激增强和血管内皮功能损伤有关,提示氧化应激和血管内皮功能在动脉硬化过程中起重要作用.     

2型糖尿病患者血清抵抗素水平与高血压相关性研究

目的 评价2型糖尿病患者血清抵抗素( Resistin)水平与高血压发生及其血压水平严重程度的相关性,探讨Resistin与心血管病危险因素的关系.方法 选取正常对照组72例,2型糖尿病组85例,2型糖尿病合并高血压组125例;其中将2型糖尿病合发高血压组根据血压水平再分为3个研究亚组.采用竞争性酶联免疫吸附试验测定Resistin水平,比较血清Resistin浓度在各组的变化.结果 血清Resistin水平在2型糖尿病合并高血压组高于2型糖尿病组,2型糖尿病组高于正常对照组,P均＜0.05.多因素Logistic回归分析表明,Resistin水平是影响血压水平的独立危险因素(R2=0.086,P＜0.05).血清Resistin水平于不同高血压病变严重程度组间差异有统计学意义(P =0.032),控制其他高血压危险因素(如年龄、体质量指数、血糖)后,Resistin水平仍与高血压病变程度正相关.结论 血清Resistin水平与2型糖尿病合并高血压发生及其血压水平严重程度具有相关性.     

2型糖尿病合并不同分级高血压患者血清瘦素和α-黑色素细胞刺激素水平的变化

目的:探讨2型糖尿病合并不同分级高血压患者血清瘦素和α-黑色素细胞刺激素(α-MSH)水平的变化。方法:选取我院197例2型糖尿病患者作为研究对象,依据2010年中国高血压防治指南推荐的测量要求及高血压诊断和分级标准将197例患者进行分组:单纯2型糖尿病组[DM组,收缩压140 mm Hg(1 mm Hg=0.133 k Pa)和舒张压90 mm Hg] 45例;2型糖尿病合并1级高血压组[DH1组,收缩压140~159 mm Hg和(或)舒张压90~99 mm Hg]47例;2型糖尿病合并2级高血压组[DH2组,收缩压160~179 mm Hg和(或)舒张压100~109 mm Hg]51例;2型糖尿病合并3级高血压组[DH3组,收缩压≥180 mm Hg和(或)舒张压≥110 mm Hg]54例。另选取40名健康体检者作为正常对照组。应用酶联免疫吸附法测定血清瘦素和α-MSH水平。应用多元逐步回归法分析二者与各影响因素的相关性。结果:(1)血清瘦素水平:与正常对照组比较,其他各组明显升高,且随血压分级的增加,DH1组、DH2组和DH3组血清瘦素水平逐渐升高,以DH3组最高(P均0.05);(2)血清α-MSH水平:与正常对照组比较,其他各组明显降低,且DH2组和DH3组血清α-MSH水平均明显低于DM组,以DH3组最低(P均0.05);(3)相关分析结果显示:收缩压和稳态模型评估-胰岛素抵抗指数(HOMA-IR)与血清瘦素呈正相关(r=0.58,P=0.00; r=0.59,P=0.00),而与血清α-MSH呈负相关(r=-0.61,P=0.00; r=-0.59,P=0.00);进一步多元回归分析提示,HOMA-IR和收缩压均是血清瘦素和α-MSH的独立影响因素。结论:2型糖尿病合并不同分级高血压时,随着高血压分级升高,血清瘦素水平逐渐升高,血清α-MSH水平逐渐下降,表明二者可能共同对2型糖尿病合并高血压的发生有一定的影响。     

2型糖尿病患者血瘦素水平与高血压的相关性研究

选择122例2型糖尿病患者,分为合并高血压组和血压正常组,各组又分别分为肥胖和非肥胖亚组.测定其体重指数(BMI)、空腹血糖(FBG)和胰岛素、糖化血红蛋白(HbA1c)及血清瘦素水平,并作相关性分析.结果显示,2型糖尿病患者高血压组与非高血压组间血清瘦素水平无差异(P＞0.05);血清瘦素水平与BMI、空腹胰岛素呈正相关关系(P＜0.01),与血压无明显相关性(P＞0.05);但在合并高血压组,血清瘦素水平与HbA1c呈负相关关系(P＜0.05).提示2型糖尿病患者的血清瘦素水平与血压无明显相关性,但合并高血压患者长时间血糖控制不良可能会导致血清瘦素水平的下降.     

脑梗死患者颈动脉斑块特征与危险因素的相关性

目的探讨脑梗死患者颈动脉斑块特征与危险因素的相关性。方法纳入150例脑梗死患者,其中无并发症者12例,合并糖尿病者30例,合并高血压者76例,合并糖尿病和高血压者32例;血脂异常者77例,血脂正常者73例。将150例患者按照是否合并糖尿病、高血压以及高血脂进行分组。比较各组之间颈动脉斑块检出率、斑块稳定性、内-中膜厚度(IMT)、平均斑块数和斑块积分的差异,再依据是否检出颈动脉斑块分为两个亚组,比较血压、血糖和血脂水平的差异。结果与其余三组比较,无并发症组颈动脉斑块检出率显著降低,稳定斑块率显著升高(P<0.05或P<0.01),而其余三组之间差异无统计学意义(P>0.05)。血脂正常组颈动脉斑块检出率显著低于血脂异常组,而稳定斑块率显著高于血脂异常组(P<0.01)。无并发症组IMT、平均斑块数和斑块积分均显著小于其余三组,合并高血压组以及合并糖尿病组上述指标均显著小于合并高血压和糖尿病组(P<0.01)。血脂正常组IMT、平均斑块数和斑块积分均显著低于血脂异常组(P<0.01)。未检出斑块组血压、空腹血糖(FBG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平均显著低于检出斑块组(P<0.01)。结论血压、糖尿病和高脂血症是导致动脉粥样硬化斑块形成以及加重其程度和不稳定性的重要危险因素,对于合并相关危险因素的患者,应加强颈动脉超声的检查,以及时监测颈动脉斑块的形成和变化,良好地控制脑梗死的发生与进展,提高生活质量。     

厄贝沙坦联合氨氯地平对老年原发性高血压合并2型糖尿病患者血清同型半胱氨酸及脑钠肽水平的影响

目的探讨厄贝沙坦联合氨氯地平治疗老年原发性高血压并2型糖尿病患者后血清同型半胱氨酸(Hcy)及脑钠肽(BNP)水平的影响。方法将216例老年原发性高血压合并糖尿病患者(年龄≥60岁)随机分成A、B、C三组,A组(86例)给予厄贝沙坦+氨氯地平治疗,B组(65例)给予厄贝沙坦治疗,C组(65例)给予氨氯地平治疗,观察90 d。分别测定治疗前后三组患者血清Hcy及BNP水平。结果治疗前三组一般临床资料无显著差异(P>0.05);治疗后,A组患者血清Hcy与BNP水平较治疗前明显降低(P<0.05),与B、C两组治疗后比较差异显著(P<0.05)。Logistic回归分析示Hcy(OR=1.629,P=0.023)和BNP(OR=2.216,P=0.016)是老年高血压合并2型糖尿病发生心脑血管疾病的独立危险因素且两者呈正相关(r=0.52,P<0.05)。结论厄贝沙坦联合氨氯地平可显著降低老年原发性高血压并2型糖尿病患者Hcy和BNP水平,从而减少心肾靶器官损害。     

罗格列酮对糖尿病合并高血压大鼠血压的影响及其机制

目的探索罗格列酮对糖尿病合并高血压大鼠血压的影响及其可能的机制。方法选择自发性高血压大鼠24只,采用链脲佐菌素腹腔注射的方法建立糖尿病合并高血压模型,造模后,随机分为对照组12只,治疗组12只(罗格列酮灌胃),治疗4周,观察血压变化,检测血清NO和一氧化氮合成酶(NOS)含量,用免疫组织化学染色检测血管内皮素受体A(ETRA)和内皮素受体B(ETRB)表达变化。结果与对照组比较,治疗组大鼠血压明显降低(P<0.05);血清NO和NOS含量均明显增高[(29.98±4.86)μmol/L vs(38.68±4.57)μmol/L,P<0.01;(15.53±1.19)U/ml vs(17.51±1.48)U/ml,P<0.01];心肌ETRA水平无明显变化(P>0.05),而ETRB表达水平显著升高(P<0.01)。结论罗格列酮能明显降低糖尿病合并高血压大鼠的血压,产生降压现象的机制可能是通过选择性的上调ETRB表达,提高NOS活性,进而增加NO合成,促进血管舒张实现的。     

阿卡波糖对老年冠心病患者餐后生理参数的影响

目的 探讨阿卡波糖对冠心病餐后生理参数波动的影响及餐后心肌缺血发作的相关影响因素.方法 选择110例冠心病出现餐后胸闷、心绞痛发作的患者,观察其餐前餐后血压、心率、血糖及血脂变化情况,根据其合并症情况分为单纯冠心病组、合并高血压组、合并糖尿病组,均采用阿卡波糖治疗和常规治疗相结合,分析阿卡波糖对冠心病患者餐后心肌缺血与这些生理参数波动的关系.结果 单纯冠心病组和合并高血压组餐后血压、心率、血糖、血脂明显升高,合并糖尿病组餐后血糖、血脂明显升高,血压、心率明显降低;阿卡波糖治疗后,三组心率、血糖、血压波动幅度明显降低(P<0.05,P<0.01),血脂波动幅度无明显变化(P>0.05).结论 阿卡波糖可有效缓解在单纯冠心病及其合并高血压或糖尿病的患者中,餐后可出现血糖、血脂、血压及心率不同程度的波动,并预防老年冠心病患者心血病事件的发生与发展.     

男性性激素水平与糖尿病合并冠心病的关系

目的探讨2型糖尿病男性患者性激素水平与冠心病发病之间的关系。方法2型糖尿病男性患者102例,分为冠心病合并组(n=58)和无冠心病合并组(n=44),测定两组血清睾酮、性激素结合球蛋白、血压、血脂及血糖,计算体质指数。结果冠心病合并组血清睾酮和性激素结合球蛋白水平与无冠心病合并组相比明显降低,两组血压、血脂和体质指数差异有显著性(P<0.05),但血糖差异无显著性。结论合并冠心病的2型糖尿病患者男性激素水平比无冠心病合并患者明显降低,认为男性糖尿病患者男性激素水平降低是发生冠心病的重要危险因素。     

糖尿病合并冠心病患者血清C1q肿瘤坏死因子相关蛋白3的水平及意义

目的探讨糖尿病合并冠心病患者血清新型脂肪因子C1q肿瘤坏死因子相关蛋白(CTRP)3水平及其临床意义。方法选择南通市第二人民医院内分泌科2016年1～12月老年单纯2型糖尿病患者100例作为2型糖尿病组(B组)、老年2型糖尿病合并冠心病患者100例作为2型糖尿病合并冠心病组(C组)及同期健康体检老年者100例作为对照组(A组)。收集受试者性别、年龄、收缩压(SBP)、舒张压(DBP)等临床资料,收集总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)等实验室检查指标。采用酶联免疫吸附试验(ELISA)测定血清CTRP3水平。采用Gensini评分评估冠状动脉狭窄程度。结果三组受试者性别、年龄、SBP、DBP、TC、LDL-C比较差异无统计学意义(均P>0.05);三组BMI、TG、HDL-C、FBG、HbA1c比较差异有统计学意义(均P<0.05),其中与A组比较,B组和C组BMI、TG、FBG、HbA1c明显升高(均P<0.05),HDL-C明显降低(P<0.05),B组和C组BMI、TG、HDL-C、FBG、HbA1c比较差异无统计学意义(均P>0.05)。与A组比较,B组和C组血清CTRP3水平明显降低(P<0.05),与B组比较,C组血清CTRP3水平明显降低(P<0.05);与A组和B组比较,C组Gensini评分明显升高(P<0.05),A组和B组Gensini评分比较差异无统计学意义(P>0.05)。糖尿病合并冠心病患者血清CTRP3水平与BMI、TG、FBG、HbA1c、Gensini评分呈负相关(均P<0.05),与HDL-C呈正相关(P<0.05),与年龄、SBP、DBP、TC、LDL-C无相关性(均P>0.05)。血清CTRP3水平诊断糖尿病合并冠心病的ROC曲线下面积为0.857,95%CI为0.854～0.890,P=0.000。结论糖尿病合并冠心病患者血清新型脂肪因子CTRP3水平降低,CTRP3可能参与糖尿病合并冠心病患者的糖脂代谢过程,在疾病诊断和冠状动脉狭窄程度评估方面具有潜在价值。     

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.     

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.     

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.