空腹血糖受损与糖耐量受损患者血管内皮功能的对比研究

目的:应用多普勒超声技术检测空腹血糖受损(IFG)与糖耐量受损(IGT)患者的血管内皮功能,探讨其对动脉粥样硬化的影响。方法:根据口服葡萄糖耐量试验(OGTT)结果,选择血糖正常(NGT)组25例,IFG组24例,IGT组22例,检测TC、TG、LDL-C、HDL-C、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、高敏C反应蛋白(hs-CRP)及血管性血友病因子(vWF),OGTT后2h血糖(2hPG)及2h胰岛素(2hINS),以及肱动脉内皮依赖性舒张功能(EDD)。结果:IGT组vWF较IFG组、NGT组明显升高[(170.25±21.76)%∶(155.16±17.19)%、(135.46±15.52)%,P<0.05～0.01],肱动脉EDD较IFG组、NGT组明显降低[(4.86±0.94)%∶(5.47±0.90)%、(6.24±0.97)%,P<0.05～0.01];IFG组vWF较NGT组明显升高[(155.16±17.19)%∶(135.46±15.52)%,P<0.05],肱动脉EDD较NGT组明显降低[(5.47±0.90)%∶(6.24±0.97)%,P<0.05]。多因素逐步回归分析显示,EDD与2hPG、LDL-C明显负相关(r分别为-0.73、-0.59,P<0.05)。结论:IGT较IFG对血管内皮功能危害更大,加强IGT防治对延缓动脉粥样硬化更为重要。     

糖代谢异常对肱动脉内皮舒张功能影响的研究

目的 探讨葡萄糖代谢异常对肱动脉血管内皮舒张功能的影响.方法 应用高分辨率超声测量39例糖耐量减低(IGT)、47例T2DM和44例糖耐量正常者(NGT)反应性充血前后及含服硝酸甘油后肱动脉内径的变化.结果 IGT、T2DM组肱动脉内皮舒张功能均受损,T2DM组、NGT组分别与IGT组比较,差异有统计学意义(P＜0.05),T2DM组较NGT组差异明显(P＜0.01).与NGT组比,IGT组、T2DM组FPG、 HbA1c、LDL-C升高,与内皮依赖性血管舒张功能(EDVR)负相关;HDL-C降低,与EDVR正相关(P均＜0.01).结论 葡萄糖代谢异常可对肱动脉内皮舒张功能造成损伤.     

波动性高血糖对血管内皮功能的影响

目的观察波动性高血糖对血管内皮功能的影响,探讨其致动脉粥样硬化的机制。方法选择新诊断的2型糖尿病患者72例,根据动态血糖监测结果分持续性高血糖组33例和波动性高血糖组39例,检测患者的肱动脉内皮依赖性舒张功能(EDD)及颈动脉内膜中层厚度(IMT)、血脂、空腹血糖、空腹胰岛素、餐后2 h血糖(2hPG)及餐后2 h胰岛素(2hINS)、高敏C反应蛋白(hs-CRP)、血管性假血友病因子(vWF)及尿微量白蛋白(MAU)。结果与持续性高血糖组比较,波动性高血糖组的2hPG、2hINS、hs-CRP、vWF、MAU及IMT明显升高(P<0.05,P<0.01),肱动脉EDD明显降低[(6.61±0.79)%vs(5.21±0.88)%,P<0.01]。结论波动性高血糖较持续性高血糖对血管内皮功能危害更大,可能与餐后高血糖、胰岛素抵抗和炎性因子增多有关。     

老年高血压合并糖尿病前期患者肱动脉内皮功能及颈动脉内膜中层厚度变化的研究

目的探讨老年糖尿病前期患者肱动脉内皮功能及颈动脉内膜中层厚度(IMT)的变化。方法选择老年高血压合并糖尿病前期患者143例,根据口服葡萄糖耐量试验(OGTT)结果,分为OGTT正常组(NGT组)32例、单纯空腹血糖受损组(IFG组)35例、单纯OGTT受损组(IGT组)40例和IFG合并IGT组(IGR组)36例。检测4组患者的血脂、空腹血糖、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、胱抑素C、OGTT 2h血糖(2hPG)、2h胰岛素(2hINS)以及肱动脉内皮功能和IMT。应用多元逐步回归分析内皮依赖性舒张功能(EDD)和IMT的影响因素。结果与NGT组比较,IFG组、IGT组及IGR组IMT升高[(0.98±0.15)mm、(0.99±0.14)mm、(0.99±0.16)mmvs(0.83±0.13)mm,P<0.05],EDD减低[(6.45±0.92)%、(5.60±0.95)%、(4.85±0.86)%vs(7.46±0.96)%,P<0.05,P<0.01]。IFG组、IGT组及IGR组EDD比较,差异有统计学意义(P<0.05)。结论老年糖尿病前期患者的肱动脉EDD减低,颈动脉IMT增加。     

阿卡波糖对餐后高血糖患者血管内皮功能的影响

目的研究阿卡波糖对餐后高血糖患者血管内皮功能的影响。方法选择新诊断为2型糖尿病、行口服葡萄糖耐量试验餐后高血糖患者58例,分为常规组26例和治疗组32例。检测患者治疗前后体重指数、TC、TG、LDL-C、HDL-C、空腹血糖、空腹胰岛素、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、葡萄糖耐量试验2 h血糖、2 h胰岛素及肱动脉内皮依赖性舒张功能(EDD)。结果与治疗前比较,治疗后2组患者体重指数、2 h血糖、2 h胰岛素、HbA1c、vWF明显降低,EDD明显增大(P0.05,P0.01);与常规组比较,治疗组患者2 h血糖、2 h胰岛素、HbA1c、hs CRP、vWF明显降低,EDD增大更明显(P0.05,P0.01)。多因素逐步回归分析显示,EDD与2 h血糖、2 h胰岛素、HbA1c、hs-CRP呈负相关。结论阿卡波糖可能通过降低餐后高血糖,改善机体胰岛素抵抗,使血管内皮功能得到改善,延缓动脉粥样硬化的发生、发展。     

糖耐量受损患者肱动脉内皮依赖性血管舒张功能变化的研究

采用高分辨血管外超声检测糖耐量受损(IGT)患者肱动脉血流介导的内皮依赖性血管舒张功能(EDD)和硝酸甘油介导的内皮非依赖性血管舒张功能(EID)。IGT组EDD明显低于对照组(P<0.05)。EID在两组间无明显差异(P>0.05)。     

糖代谢异常对肱动脉内皮功能及颈动脉内-中膜厚度影响的研究

目的探讨糖代谢异常对肱动脉内皮功能及颈动脉内-中膜厚度(CIMT)的影响。方法将128例新诊断轻、中度高血压患者根据75g OGTT结果分为糖耐量正常(NGT)组39例、IGR组42例和T2DM组47例,检测各组FPG、2hPG、FIns、2hIns、HbA1c、血脂、高敏C反应蛋白(hsC-RP)、胱抑素C(Cys-C)、肱动脉内皮功能和CIMT。结果 NGT、IGR、T2DM组肱动脉内皮依赖性舒张功能(EDD)两两比较差异有统计学意义[(7.64±0.96)%vs(5.85±0.92)%,(7.64±0.96)%vs(4.22±0.86)%,(5.85±0.92)%vs(4.22±0.86)%,P<0.05或P<0.01]。T2DM组CIMT与NGT、IGR组比较差异有统计学意义[(0.89±0.07)vs(1.20±0.09)mm,(0.96±0.12)vs(1.20±0.09)mm,P<0.05]。Logistic多元逐步回归分析结果显示,EDD与FPG、2hPG、2hIns、HbA1c和Cys-C呈负相关,CIMT与TC、TG和LDL-C呈正相关(P<0.05)。结论在NGT-IGR-T2DM发展过程中,肱动脉EDD逐渐减退,CIMT逐渐增加。     

他汀类药物对中老年糖耐量异常患者颈动脉内膜中层厚度的干预作用

目的 探讨影响糖耐量低减(IGT)患者颈动脉内-中膜厚度(IMT)的危险因素及阿托伐他汀对其干预的机制.方法 入选50例IGT患者及50例正常对照(NGT),分别为IGT组及NGT组.采用高分辨率多普勒超声检测两组IMT值及斑块形成情况、肱动脉血流介导的血管扩张功能(FMD),其指标用肱动脉舒张内径的变化率(D%)表示.所有入选者均测量身高、体重、血压,测定空腹(FPG)、糖负荷后2 h血浆血糖(2hPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP).并计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR).分析IGT组上述指标与颈动脉IMT的相关性;针对IGT组给予阿托伐他汀20 mg/d,服药6个月,观察服药前后上述指标的变化,分析颈动脉IMT的变化((IMT)与其余指标变化的相关性.结果 IGT组较NGT组BMI、2hPG、TC、TG、LDL-C、hs-CRP、FINS、HOMA-IR、IMT均明显增高,D%明显减低(P＜0.05,P＜0.01);IGT组颈动脉IMT与BMI、2hPG、TG、LDL-C、FINS、hs-CRP及HOMA-IR均呈正相关(P＜0.05,P＜0.01),与D%呈负相关(P＜0.01).服药后,IGT组指标2hPG、FINS 、TG、TC、LDL-C、hs-CRP、HOMA-IR及IMT均有显著下降,D%显著升高(P＜0.05,P＜0.01);IGT组服药前后(IMT与(hs-CRP呈正相关(P＜0.01),与(D%呈负相关(P＜0.05).结论 IGT患者已经存在明显的早期动脉硬化(AS)及与之相关的多种危险因素;他汀类药物可通过降脂、抗炎、改善内皮功能及可能的改善IR、胰岛β-细胞功能等多种机制,防治IGT患者早期AS的发生、发展.     

高血压合并糖耐量减低患者血浆脑利钠肽水平与动脉粥样硬化的相关性

目的探讨血浆脑利钠肽(BNP)水平与血管内皮功能、颈动脉内膜中层厚度(IMT)和胰岛素抵抗指数(HOMA-IR)等指标的相关性在高血压合并糖耐量减低(IGT)患者动脉粥样硬化过程中所起的作用及机制。方法将149例高血压患者根据糖耐量分为糖耐量正常(NGT)组、IGT组和糖尿病组。根据IMT将IGT组分为三个亚组:IMT正常亚组、内膜增厚亚组和斑块形成亚组。检测肱动脉血流介导的血管内皮依赖性舒张功能(EDD)、硝酸甘油介导的非内皮依赖性舒张功能(EID)、血浆BNP、空腹血清胰岛素(FINS)和血脂等指标。结果 IGT组患者血浆BNP、空腹血糖(FPG)、口服葡萄糖耐量试验2 h血糖(2 h PG)、脉压、FINS、HOMA-IR、甘油三酯(TG)和IMT均显著高于NGT组(P<0.05);EDD显著低于NGT组(P<0.05)。内膜增厚亚组血浆BNP、2 h PG、FINS、HOMA-IR和TG显著高于IMT正常亚组(P<0.05),EDD显著低于IMT正常组(P<0.05);斑块形成亚组血浆BNP水平显著高于内膜增厚组(P<0.05)。血浆BNP水平与IMT(r=0.582)、HOMA-IR(r=0.477)和脉压(r=0.422)呈显著正相关,与EDD(r=-0.489)呈显著负相关。结论血浆BNP水平可能成为预测高血压合并IGT患者动脉粥样硬化的一个早期指标。     

1,5-脱水葡萄糖醇对糖尿病的诊断价值

目的 探讨血清1,5-脱水葡萄糖醇(1,5-AG)在糖尿病诊断中的应用价值.方法 应用葡萄糖激酶吡喃糖氧化酶(GK-PROD)法测定50例2型糖尿病患者(T2DM组)、100例糖耐量减低患者(IGT组)及30名正常对照者(NGT组)的血清1,5-AG,同时测定FPG、2hPG及HbA_1c等指标,应用ROC曲线评价1,5-AG、FPG及HbA_1c对糖尿病的诊断性能.结果 T2DM组血清1,5-AG水平显著低于NGT组和IGT组(P均＜0.01),IGT组低于NGT组(P＜0.05).血清1,5-AG与FPG、2hPG、HbA_1c均呈显著负相关.1,5-AG、FPG和HbA_1c诊断糖尿病的受试者工作特性(ROC)曲线下面积分别为0.948、0.921、0.817.结论 血清1,5-AG与糖耐量下降相关,1,5-AG含量测定可作为糖尿病诊断、筛查和血糖控制监测的指标.     

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.