2型糖尿病病人的非糖尿病一级亲属胰岛β细胞功能和胰岛素抵抗的研究

目的　研究 2型糖尿病 (T2DM )及 2型糖尿病病人的非糖尿病一级亲属胰岛 β细胞功能、胰岛素抵抗 (IR)及早期胰岛素分泌功能 ,探讨其在糖尿病发生发展中的作用。方法　选取 59例正常对照组、58例T2DM病人糖耐量正常的T2DM病人一级亲属及 38例T2DM ,他们的体重指数 (BMI)均 <2 5kg/m2 ,计算并比较三组的血清胰岛素、血糖及稳态模型胰岛素抵抗指数 (HOMA IR)、β细胞功能指数 (HOMA β)及胰岛早期分泌指数 (△I30 /△G30 )。结果　非肥胖的糖耐量正常的一级亲属组的HOMA IR均高于正常对照 (P <0 0 5) ,但低于T2DM组 ;而HOMA βTI一级亲属组低于对照组 (P <0 0 5) ,但高于T2DM组 (P <0 0 1 ) ;△I30 /△G30 显示一级亲属组低于对照组 (P <0 0 5)。结论　非肥胖 2型糖尿病一级亲属在糖耐量正常时就已经存在胰岛β细胞功能的受损、胰岛素抵抗及胰岛素早期分泌指数减低 ;IR并非继发于肥胖和高血糖症。     

2型糖尿病患者一级亲属正常糖耐量人群胰岛素抵抗与胰岛β细胞功能的研究

探讨2型糖尿病（T2DM）患者一级亲属糖耐量正常人群胰岛素抵抗（IR）与胰岛β细胞功能状态。结果发现，母亲或双亲糖尿病组一级亲属糖耐量正常人群，空腹胰岛素水平和HOMA—IR明显升高，而糖刺激后30min胰岛素与血糖比值（△I30／△G30）明显降低，因此，T2DM患者一级亲属在糖耐量正常阶段已存在IR和早期胰岛素分泌功能受损。     

2型糖尿病患者非糖尿病一级亲属血清高敏C反应蛋白与胰岛素抵抗的相关性

目的探讨血清高敏C反应蛋白（hsC-RP）在2型糖尿病（T2DM）发病中的作用。方法利用ELISA方法检测72例T2DM患者非糖尿病一级亲属（FDR）和68例健康对照者（NC）血清hsC-RP、Fins、FPG等，并用HOMA—IR公式计算胰岛素抵抗指数。结果（1）FDR组血清hsC—RP水平较NC组升高（P〈0.01），HOMA—IR高于NC组（P〈0.01）；（2）血清hsC-RP水平与HOMA-IR（r=0．307，P〈0．01）、Fins（r=0．286，P〈0．05）、BMI（r=0．250，P〈0．05）、LDL—C（r=0．302，P〈0．05）、TC（r=0．267，P〈0．05）相关。结论慢性炎症与胰岛素抵抗密切相关，hsC-RP升高是2型糖尿病发生的一个预测因子。     

蛋白酪氨酸磷酸酶抗体对成人隐匿性自身免疫性糖尿病的诊断价值

目的探讨蛋白酪氨酸磷酸酶抗体（IA-2A）对成人隐匿性自身免疫性糖尿病（LADA）的诊断价值。方法采用放射配体法检测2027例初诊2型糖尿病（T2DM）患者的IA．2A和谷氨酸脱羧酶抗体（GAD-Ab）,分析IA-2A在初诊T2DM患者中的分布及其与临床特征的关系。结果初诊T2DM患者中IA-2A阳性检出率低于GAD-Ab阳性检出率（2．2％7）S10．6％,P〈0．01）。联合GAD-Ab和IA-2A检测,可使LADA阳性检出率达11．5％。IAm2A在低体重、低c肽水平患者中阳性检出率高;随着起病年龄增大,IA-2A阳性检出率下降（P〈0．05）。与T2DM组比较,单独IA-2A阳性患者使用胰岛素治疗的比例高（P〈0．05）。高滴度IA-2A阳性LADA患者具有起病年龄小（P〈0．01）、体重轻、高血压比例低、空腹C肽低、合并GAD-Ab阳性和使用胰岛素比例高（P〈0．05）等特点。结论IA-2A检测对LA—DA具有辅助诊断价值,与GAnAb联合检测可提高LADA诊断的敏感性。     

非糖尿病高胰岛素血症人群的胰岛b细胞功能分析

目的 分析正常血糖及糖调节受损合并高胰岛素血症（HINS）人群的胰岛β细胞功能状态。方法对北京某高校年度查体人员中无糖尿病史者行口服75g葡萄糖耐量试验（75gOGTT）,资料完整的非糖尿病人群共634例,其中HINS者94例,分析正常血糖及糖调节受损HINS人群的胰岛功能的差异。结果正常血糖及糖调节受损人群中高胰岛素组胰岛素抵抗指数HOMA—IR、△I120／△G120、第一时相及第二时相胰岛素分泌指数显著高于对照组（P〈0．05）;胰岛素敏感指数（ISI～Stumvoll）、HOMA—IR校正后β细胞功能指数（HBCI／IR）显著低于对照组（P〈0．05）;β细胞功能指数（HBCI）高于对照组,但差异无统计学意义（P〉0．05）;△I120/△G120／IR两组间无统计学差异（P〉0．05）。糖调节受损HINS组年龄、服糖后2h血糖、总胆固醇、低密度脂蛋白胆固醇、收缩压、2h胰岛素水平显著高于正常血糖HINS组（P〈0．05）;HBCI、HBCI／IR、第一时相及第二时相胰岛素分泌指数显著低于正常血糖HINS组（P〈0．05）;HOMA—IR和ISI—Stumvoll两组间无统计学差异（P〉0．05）。结论正常血糖及糖调节受损HINS人群虽然胰岛素分泌绝对值增加,但实际的胰岛6细胞功能在逐渐减退。正常血糖-HINS和糖调节受损-HINS是2型糖尿病发生发展的中间过渡状态,应该尽早检出、早期干预。     

成人隐匿性自身免疫性糖尿病患者T细胞亚群变化与胰岛β细胞功能相关性研究

目的观察成人隐匿性自身免疫性糖尿病（LADA）患者T细胞亚群的变化,及其与胰岛β细胞功能的相关性。方法LADA组24例,经典1型糖尿病（T1DM）18例,健康对照（NC）组20例,应用流式细胞技术测定三组入选者T细胞表面分子CD4、CD8,以百分比表示各表面分子阳性T细胞占外周血淋巴细胞的比例。测空腹C肽（FC-P）和糖负荷后2h C肽（2hC-P）。测空腹血糖、空腹胰岛素、应用HOMA公式计算胰岛素敏感指数（HOMA-IS）。结果LADA与T1DM组CD4^＋T细胞、CD4^＋／CD8^＋比值明显高于NC组（P〈0．01）,LADA与TIDM对比无统计学差异。CD4^＋T细胞与反映胰岛功能2hC-P呈明显的负相关。结论T淋巴细胞亚群失衡参与并介导了胰岛β细胞的损伤和LADA的发生。     

不同糖耐量人群血浆前列腺素E2水平及与胰岛素抵抗的关系

目的比较不同糖耐量人群血浆前列腺素E2（PGE2）水平的差异及与胰岛素抵抗（IR）的关系。方法糖耐量异常组（IGT组）100例,2型糖尿病组（T2DM组）1。0例,对照组（NC组）60名。比较各组血浆PGE2水平的差异,计算胰岛素抵抗指数（HOMA—IR）。结果T2DM组空腹血浆PGE2水平比IGT组及NC组明显升高（P〈0．05）,IGT组也高于NC组（P〈0．05）。多元逐步回归分析结果表明PGE2是HOMA—IR的危险因素。结论PGE2可能在IR发生发展中起重要作用。     

2型糖尿病患者外源性给予胰升血糖素对肥胖与血浆Ghrelin的影响

目的探讨肥胖及非肥胖2型糖尿病（T2DM）患者胰岛素抵抗（IR）与生长激素释放肽Gh—relin分泌的关系。方法肥胖T2DM患者26例（Ob＋T2DM组）及非肥胖T2DM患者32例（NOb＋T2DM组）,正常对照30名（NC组）行胰升血糖素－C-P释放试验,同步取血测定血浆Ghrelin和C-P。结果（1）Ob4-T2DM组空腹Ghrelin水平低于NC组和NOb＋T2DM组（P〈0．05或P〈0．01）;Ob＋T2DM组FC-P及胰岛素抵抗指数（HOMA2-IR）高于NC组和NOb＋T2DM组（P〈0．01或P〈0．05）。静脉推注胰升血糖素后,NC组Ghrdin水平显著下降（P〈0．01）,肥胖及非肥胖T2DM组Ghrelin水平无显著性改变。（2）Pearson相关分析显示空腹血浆Ghrelin水平分别与WC、BMI、体脂百分比、体脂重量呈负相关;多元回归分析显示腰围（WC）是Ghrelin水平的负性预测因子（回归方程Y=4．814—0．0265X）。（3）Ob＋T2DM组中,空腹血浆Ghrelin水平分别与WC、BMI、体脂百分比、体脂重量、HOMA2-IR呈负相关。结论外源性给予胰升血糖素对T2DM患者Ghrelin抑制效应减弱;肥胖T2DM患者血浆Ghrelin水平较非肥胖患者明显降低,且与WC、BMI、体脂百分比、体脂重量、HOMA2-IR负相关;中心性肥胖T2DM患者血浆Ghrelin水平下降与IR有关。     

应用高胰岛素正葡萄糖钳夹技术评价我国LADA患者的胰岛素抵抗

目的应用高胰岛素正葡萄糖钳夹技术评估我国成人隐匿性自身免疫性糖尿病（LADA）患者的胰岛素抵抗。方法研究对象分为LADA组、2型糖尿病（T2DM）组、正常对照（NC）组。糖尿病患者均为初诊未治,经2周胰岛素强化治疗血糖控制达标后进行研究。对全部研究对象空腹测定临床参数及生化指标,应用高胰岛素正葡萄糖钳夹技术测定胰岛素敏感性指数（ISI）。结果LADA组FC-P及Fins显著低于NC组（P〈0．05）,年龄、BMI、wHR、SBP、DBP、TC、TG、LDL—C、HDL-C与NC组比较,均无统计学差异。LADA组BMI、WHR、SBP、Fins、FC-P、TC、TG、LDL-C均显著低于T2DM组（P均〈0．05）。NC组、LADA组、T2DM组ISI分别为12．83±1．09、6．70±0．71、3．80±0．20,三组间比较有统计学差异（P〈0．05）。结论与NC组相比,LADA患者存在胰岛素抵抗,其程度较T2DM组轻。     

成人隐匿性自身免疫性糖尿病胰岛素抵抗与β细胞功能的研究

目的 探讨成人隐匿性自身免疫性糖尿病（LADA）患者的胰岛素抵抗（IR）与胰岛β细胞功能的关系。方法 对40例LADA、40例速发性1型糖尿病（T1DM）、50例2型糖尿病（T2DM）患者和30例正常健康者（对照组）进行了身高、体重、空腹和餐后2h血糖、空腹胰岛素、糖化血红蛋白（HbA1c）、血脂、24h尿蛋白检测,并做眼科检查、周围神经电生理检查、下肢血管彩超,计算体重指数（BMI）、腰臀围比（WHR）、胰岛素抵抗指数（HOMA-IR）和胰岛素释放指数（HOMA-IS）。结果 LADA患者HOMA-IR和HOMA-IS高于T1DM,低于T2DM（P均〈0．01）。LADA患者病程5a内下肢血管病变及其病变危险因素低于T2DM（P〈0．05）,与T1DM相似;微血管病变三组问比较无差异。结论 LADA患者既存在IR,又有胰岛β细胞分泌功能不足。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.