肝移植术后相关高血糖症的调查分析

有研究表明,糖代谢异常可增加肝移植术后患者发生心血管疾病、感染以及神经系统病变等的危险性,是肝移植术后患者病死率的独立预测因素[1].因此,如何预防和控制肝移植术后糖代谢异常在移植术后患者的随访中显得日益重要.现就我院肝移植术后1年发生血糖代谢异常的患者进行回顾性分析,报道如下.     

应用IL-2Ra对肝移植术后糖代谢异常患者预后的影响

目的探讨白介素2受体拮抗剂(IL-2Ra)对肝移植术后糖代谢异常患者预后的影响。方法选取儋州市人民医院与中山大学附属第一医院2015年6月—2018年6月收治的肝移植术后糖代谢异常患者80例,根据随机数字表法分成对照组(n=40)与观察组(n=40)。对照组于肝移植术后给予常规治疗,观察组在此基础上加用IL-2Ra。分别在两组肝移植术后24 h、术后6个月检测糖代谢指标与胰岛素水平,包括空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2 h INS)、胰岛素抵抗指数(HOMA-IR)。比较两组肝移植术后6个月的新发糖尿病发生率,并记录治疗期间不良反应情况。结果两组术后6个月的FPG、HbA1c、2 h PG低于术后24 h,且观察组显著低于对照组(P0.05)。两组术后6个月的FINS、2 h INS、HOMA-IR显著低于术后24 h,且观察组FINS、HOMA-IR显著低于对照组(P0.05)。观察组新发糖尿病率为12.50%,显著低于对照组的32.50%(P0.05)。观察组不良反应率为2.50%,对照组无不良反应病例,组间比较无显著差异(P0.05)。结论 IL-2Ra的应用能进一步纠正肝移植术后的糖代谢紊乱与胰岛素水平,降低新发糖尿病发生率,且未见严重不良反应。     

颅咽管瘤术后垂体功能减退患者糖代谢异常危险因素研究

目的研究颅咽管瘤术后垂体功能减退患者糖代谢异常的危险因素。方法收集2008年3月至2020年7月天津医科大学总医院住院的49例颅咽管瘤术后垂体功能减退患者首次入院资料, 根据1999年世界卫生组织(WHO)公布的糖尿病诊断标准, 将49例患者分为糖代谢异常组(糖尿病患者和糖耐量减低患者)和糖代谢正常组。收集患者的一般资料、术后并发症、实验室检验结果等进行病例回顾性分析。结果 (1)糖代谢异常组18例, 其中11例为糖尿病, 7例为糖耐量异常。(2)糖代谢异常组体重指数(BMI)、合并脂肪肝比例及甘油三酯水平显著高于糖代谢正常组。(3)二元logistic回归分析发现, 超重、肥胖是颅咽管瘤术后垂体功能减退患者糖代谢异常的独立危险因素, BMI截断值为27.25 kg/m2。结论颅咽管瘤术后患者糖代谢异常比例较高, 超重肥胖是其独立危险因素。     

冠心病合并糖代谢异常患者的临床研究

目的分析冠心病合并糖代谢异常患者的冠状动脉病变特点和糖代谢异常对经皮冠状动脉介入治疗(PCI)操作及住院期不良事件的影响。方法对184例糖代谢异常及147例糖代谢正常的冠心病患者进行回顾性分析。分析患者的冠状动脉病变特点,计算血管造影成功率、操作成功率以及临床成功率,分析糖代谢异常对住院期临床事件的影响。结果糖代谢异常组患者多支病变检出率明显高于糖代谢正常组患者,冠状动脉病变范围更广泛、程度更重、病变更复杂,更易累及小血管(P<0.05)。糖代谢异常组与糖代谢正常组之间的血管造影成功率、操作成功率和临床成功率差异无统计学意义(分别为91.8%vs.93.9%,88.0%vs.91.8%及85.3%vs.90.5%,P均>0.05)。Logistic多元回归分析显示糖代谢异常不是PCI术住院期发生不良事件的独立危险因素(OR=0.999,95%IC:0.242~9.172,P>0.05)。结论糖代谢异常患者冠状动脉病变比糖代谢正常患者更复杂、严重;糖代谢异常不是PCI术住院期发生不良事件的独立危险因素。     

临床常见肝脏疾病合并糖代谢异常的临床特点及处理

临床常见的肝脏疾病与糖代谢异常密切相关,其病理机制涉及胰岛素抵抗和胰岛功能损伤。病毒性肝炎、代谢相关脂肪性肝病、肝移植术后等合并糖代谢异常具有其特定的临床特点,晚期及终末期肝病患者更易于发生低血糖。选择降糖药物时需要考虑肝病类型及肝功能情况。常用的降糖药物除具有降糖作用外,部分药物还具有改善肝脏病变的潜在益处。     

肝移植围术期输血对术后并发症发生的影响

目的:探讨围术期输血对肝移植患者术后并发症发生的影响.方法:回顾性研究分析2005-01/2012-12中国人民解放军第302医院收治的418例肝移植患者病例的一般资料和输血资料,分析输血对肝移植患者术后并发症发生的影响.结果:386例肝移植患者中,术后并发症发生着为235例(60.88%),未发生者151例(39.12%).早期并发症以肺部感染、电解质紊乱和再灌注损伤为主.随着围术期输血次数和剂量的增多,并发症的发生机会显著增多.结论:肝移植围术期输血次数及剂量越多,越容易并发感染、水电紊乱、再灌注损伤等并发症,应尽量减少输血.     

成人肝移植术后新生未分化性肝肉瘤1例

未分化性肝肉瘤(undifferentiated sarcomaoftheliver,UESL)多发生于6～10岁的儿童,误诊率高,成人少见,肝移植术后发生更为罕见[1].我院收治了1例肝移植术后新生UESL成年患者,现报道如下.     

糖代谢异常对肝硬化并发症的影响

目的 探讨糖代谢异常对肝硬化并发症的影响.方法 以2005年1月1日至2007年12月31日上海市第一人民医院消化内科494例肝硬化住院病例为研究对象,其中男293例,女201例,年龄(62±14)岁,回顾性分析糖代谢异常对肝硬化并发症的影响.计量资料比较采用t检验,计数资料采用卡方(X~2)检验,并计算比值比(OR值),P＜0.05为差异有统计学意义.结果 494例肝硬化中191例糖代谢异常,303例糖代谢正常.糖代谢异常者发生上消化道出血104/191例,脾功能亢进141/191例,高于糖代谢正常者的97/303例和194/303例,OR值分别是2.539和1.584,均P＜0.05.根据病毒性肝炎、嗜酒因素进行分层后,在无病毒性肝炎、不嗜酒的病例中,糖代谢异常发生上消化道出血和脾功能亢进的OR值分别是2.653和2.640,均P＜0.05.年龄分为＜50岁、50～70岁、＞70岁三组后,糖代谢异常均可增加肝硬化患者并发上消化道出血的发病危险性(OR值分别为3.314、2.233、2.425,均P＜0.01).结论 糖代谢异常是肝硬化患者发生上消化道出血和脾功能亢进的危险因素,且独立于病毒性肝炎和嗜酒.年龄分层后,糖代谢异常仍是肝硬化患者并发上消化道出血的危险因素.     

肝移植术后胆道并发症分析与预防

目的 探讨肝移植术后胆道并发症的相关因素.方法 回顾性研究100例原位肝移植患者的临床资料,采用单因素分析及Logistic多因素回归模型分析各危险因素的分布.结果 9例患者确诊为肝移植术后胆道并发症,7例治愈,2例因感染死亡.胆道并发症发生率为9%,单因素分析及非条件Logistic多元回归分析表明胆道血供和胆道吻合口直径与肝移植后胆道并发症的发生密切相关.结论 胆道并发症是肝移植术后常见并发症之一,缺血性损伤和吻合口大小是肝移植术后胆道并发症的重要原因,及时预防、诊断、处理胆道并发症将明显地提高肝移植患者的生活质量和生存期.     

熊去氧胆酸对肝移植术后受肝者肝功能异常的治疗作用

熊去氧胆酸(UDCA)在肝移植后主要拮抗疏水性胆汁酸的细胞毒性,但其对肝移植患者的保护作用尚存争议[1].本研究观察了华西医院127例肝移植术后患者使用UDCA的临床资料,现报道如下.一、资料与方法1.研究对象:收集我院2002年1月-2009年3月712例肝移植患者.术后平均随访35个月,随访方案采用移植术后3月内每半月随访1次,术后3～6个月患者每月随访1次,术后6～ 12个月患者每2个月随访1次,术后1年以上患者每3个月随访1次.符合本实验入组条件者127例(1例患者因不良反应退出研究).     

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.     

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.     

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.     

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.