高血压患者血脂,脂蛋白,载脂蛋白及胰岛素分析

本文就４９例高血压患者血脂、脂蛋白、载脂蛋白及血胰岛素（Ｉｎ）水平与４０例正常人比较分析发现：高血压患者体重指数（ＢＭＩ）、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、低密度脂蛋白胆固醇／高密度脂蛋白胆固醇（ＬＤＬ－ｃ／ＨＤＬ－Ｃ）、载脂蛋白Ｂ（ａｐｏＢ）、血糠（Ｇ）及Ｉｎ均较对照组显著升高、ＨＤＬ－Ｃ、ＨＤＬ２－Ｃ、ａｐｏＡＩ、ａｐｏＡＩ／ａｐｏＢ及Ｇ／Ｉｎ较对照组显著降低。Ｉｎ水平随ＢＭＩ增加而升高。相关分析发现：ＨＢＰ患者Ｉｎ与ＢＭＩ和ａｐｏＢ呈正相关，与ＨＤＬ－Ｃ、ａｐｏＡＩ／ａｐｏＢ呈负相关。Ｇ／Ｉｎ与ＨＤＬ－Ｃ呈正相关。血浆ＴＧ与ＨＤＬ－Ｃ呈负相关。     

海口市少年血脂、载脂蛋白相关因素研究（附514例调查分析）

检测了海口市５１４例１２～１５岁少年的血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）及载脂蛋白ＡＩ（ａｐｏＡＩ）、载脂蛋白Ｂ１ｏｏ（ａｐｏＢ１００）水平，并对其影响因素分别与性别、年龄、身高、体重、体质格数（ＢＭＩ）、收缩压及舒张压作了多元逐步回归分析。结果表明，ＢＭＩ是影响少年血脂与脂蛋白最主要因素，而ａｐｏＡＩ、ａｐｏＢ１００的变化主要受血清ＴＣ、ＴＧ及ＨＤＬ－Ｃ的影响。     

高血压患者血浆氧化修饰低密度脂蛋白的测定

目的测定高血压患者血浆氧化修饰低密度脂蛋白（ＯＸＬＤＬ）水平并了解其临床意义。方法用ＥＬＩＳＡ法测定６０例高血压患者（其中单纯高血压者３２例，合并冠心病者２８例）和５０例正常对照组血浆ＯＸＬＤＬ，并同时测定其他血脂、脂蛋白和载脂蛋白。结果高血压患者血浆中ＯＸＬＤＬ较对照组明显升高，男女之间差别无显著性。Ⅰ，Ⅱ，Ⅲ期患者血浆中ＯＸＬＤＬ亦明显升高，且各期之间相差无显著性。单纯者和合并冠心病者ＯＸＬＤＬ均明显升高，但后者更高。无论ＬＤＬ－Ｃ是否升高，高血压患者血浆ＯＸＬＤＬ均升高，但ＬＤＬ－Ｃ升高者ＯＸＬＤＬ更高。ＯＸＬＤＬ升高者，高血压合并冠心病百分率较高。相关分析表明，血浆ＯＸＬＤＬ与ＴＣ、ＬＤＬ－Ｃ、ＡｐｏＢ１００呈正相关（ｒ＝０．２５，０．２２，０．２６，Ｐ＜０．０５，＜０．０５，＜０．０２５），与ＨＤＬ－Ｃ呈负相关（ｒ＝－０．２２，Ｐ＜０．０５），与血压、年龄、病程无关。结论高血压患者血浆中ＯＸＬＤＬ明显升高，ＯＸＬＤＬ升高可能参与高血压致动脉粥样硬化作用，因此治疗时除给予降压治疗之外，应加强抗氧化治疗。     

90例85岁以上老人血脂,脂蛋白和载脂蛋白的研究

对９０例８５岁以上高龄老人的血脂、脂蛋白和载脂蛋白进行测定，并与陈旧性心肌梗塞（ＯＭＩ）组对比。结果显示：与ＯＭＩ组比较，高龄老人血清ＴＣ、ＬＤＬ－Ｃ、ＡｐｏＡⅠ和ＡｐｏＢ_（１００）的明显低，而ＨＤＬ－Ｃ／ＴＣ、ＨＤＬ－Ｃ／ＬＤＬ－Ｃ和ＡｐｏＡⅠ／ＡｐｏＢ_（１００）明显高；ＴＧ、ＨＤＬ－Ｃ和ＶＬＤＬ－Ｃ在两组之间无统计学差异。单因素相关分析显示，ＨＤＬ－Ｃ／ＴＣ，ＨＤＬ－Ｃ／ＬＤＬ－Ｃ和ＡｐｏＡⅠ／ＡｐｏＢ_（１００）与长寿呈正相关，与ＯＭＩ呈负相关；而ＴＣ、ＬＤＬ－Ｃ、ＡｐｏＡⅠ和ＡｐｏＢ_（１００）则与长寿呈负相关，与ＯＭＩ呈正相关；ＨＤＬ－Ｃ、ＴＧ和ＶＬＤＬ－Ｃ与长寿和ＯＭＩ几乎无相关关系。对各检测指标进行多元逐步回归分析，ＡｐｏＢ_（１００）对长寿作用最大，其次为ＡｐｏＡⅠ／ＡｐｏＢ_（１００）和ＨＤＬ－Ｃ．因此认为血清ＡＰｏＢ_（１００）水平的低值、ＨＤＬ－Ｃ和ＡｐｏＡⅠ／ＡｐｏＢ_（１００）的高值，是高龄老人血脂、脂蛋白和载脂蛋白的特点，亦是长寿的指标。     

陈旧性心肌梗塞者胰岛素水平及临床意义探讨

本研究观测了５０例老年陈旧性心肌梗塞（ＯＭＩ）病人空腹血浆胰岛素（ＩＳ）水平变化，并探讨其临床意义。结果表明，老年ＯＭＩ病人空腹血浆ＩＳ、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白Ｂ（ＡｐｏＢ）及脂蛋白（ａ）水平明显高于正常老年人，高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平明显降低。ＯＭＩ病人中空腹ＩＳ水平与ＴＧ、ＡｐｏＢ水平呈显著的正相关性，与ＨＤＬ－Ｃ呈显著的岁相     

载脂蛋白E基因多态性与冠心病关系的研究

目的：探讨载脂蛋白Ｅ（ａｐｏＥ）基因多态性在冠心病（ＣＨＤ）发生发展中的作用及其对血脂质、脂蛋白水平的影响。方法：应用聚合酶链反应技术和遗传学方法,测定９３ 例ＣＨＤ患者和９４例正常对照者的ａｐｏＥ基因型;按常规方法测定血浆脂质、脂蛋白水平。结果：共发现５ 种ａｐｏＥ基因型,分别为Ｅ３／３、Ｅ３／２、Ｅ４／３、Ｅ４／２和Ｅ４／４。ＣＨＤ组ａｐｏＥ４／３ 基因型和ε４ 等位基因频率及总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）均显著高于对照组（均Ｐ＜ ０．０１）,ａｐｏＡＩ的水平高于对照组（Ｐ＜ ０．０５）,其他血脂指标无显著性差异（ Ｐ＞ ０．０５）。在ＣＨＤ组各亚型之间,ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平之间存在显著性差异（Ｐ＜ ０．０５）。结论：ａｐｏＥε４ 等位基因是ＣＨＤ重要的遗传易患因素,ａｐｏＥ基因多态性亦影响血ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平。     

急性白血病患者血浆脂蛋白及载脂蛋白的临床研究

目的：探讨急性白血病患者血脂及载脂蛋白改变的临床意义。方法：用全自动生化分析仪检测９４例急性白血病患者血浆中血脂及载脂蛋白的含量。结果;急性白血病组较正常对照组ＴＧ、ａｐｏＢ显著升高,而 ＬＤＬ－Ｃ、 ＨＤＬ－Ｃ、ａｐｏＡ　Ｉ、ａｐｏＡＩ／ａｐｏＢ显著下降; ＡＬ患者缓解后较治疗前ＴＧ、ａｐｏＢ显著下降,而ＬＤＬ－Ｃ、ＨＤＬ－Ｃ、ａｐｏＡ　Ｉ、ａｐｏＡ　Ｉ／ａｐｏＢ显著升高。结论：急性白血病患者血脂及载脂蛋白监测是一项对患者疗效判断、病情监测均有重要意义均敏感指标。     

高脂蛋白血症与冠心病患者血清载脂蛋白CⅡ含量的变化

目的观察血清载脂蛋白ＣⅡ（ａｐｏＣⅡ）在高脂蛋白血症及冠心病中的变化特点。方法应用酶联免疫法（ＥＬＩＳＡ）测定新生儿至老年人群及１１８例高脂蛋白血症患者、４６例冠心病（ＣＨＤ）、５４例急性心肌梗死（ＡＭＩ）与２５例陈旧性心肌梗死（ＯＭＩ）患者血清ａｐｏＣⅡ含量，并分析与甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）的关系。结果脐带血ａｐｏＣⅡ含量最低，随着年龄增长，ａｐｏＣⅡ含量逐渐增加。高脂蛋白血症组ａｐｏＣⅡ显著高于老年健康组（Ｐ＜０．００１），ａｐｏＣⅡ与ＴＧ含量呈正相关（ｒ＝０．５２，Ｐ＜０．００１），但有１０例患者ＴＧ很高，而ａｐｏＣⅡ较低。ＣＨＤ、ＡＭＩ和ＯＭＩ组的ａｐｏＣⅡ水平随着ＨＤＬ－Ｃ下降而显著低于老年健康组。结论血清ａｐｏＣⅡ的测定有助于阐明高脂蛋白血症的发病机理及ＣＨＤ、ＡＭＩ和ＯＭＩ患者的血脂紊乱、ａｐｏＣⅡ水平下降可能是某些病例ＴＧ升高的原因之一。     

氧化修饰低密度脂蛋白及抗氧化剂在糖尿病血管病变中的作用

为探讨氧化修饰低密度脂蛋白（ＯＸＬＤＬ）及抗氧化剂在糖尿病血管病变中的作用，采用酶联免疫吸附双抗体夹心法（ＥＬＡＳＡ法），测定了６０例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人及３０例正常对照者血浆ＯＸＬＤＬ水平。结果显示：（１）ＮＩＤＤＭ组与正常对照组比较，血浆ＯＸＬＤＬ水平显著增高（Ｐ＜０．０１）。ＮＩＤＤＭ有血管病变组与无血管病变组比较，血浆ＯＸＬＤＬ水平显著增高（Ｐ＜０．０５）。（２）２０例ＮＩＤＤＭ病人用维生素Ｃ及维生素Ｅ治疗后，血浆ＯＸＬＤＬ水平显著下降（Ｐ＜０．０５）。（３）血浆ＯＸＬＤＬ水平与ＬＤＬ－Ｃ、ＨＤＬ、ＴＧ、ＴＣ、ＡｐｏＡ１及ＡｐｏＢ均无显著相关性。提示ＯＸＬＤＬ可能与糖尿病血管病变的发生和发展有关。抗氧化治疗可能对预防血管病变的发生有一定的作用。     

甲状腺激素对脂蛋白（a）水平的影响

甲状腺激素对脂蛋白（ａ）水平的影响向光大何玉生已知甲状腺激素可影响脂蛋白代谢，包括血浆总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬＣ），高密度脂蛋白胆固醇（ＨＤＬＣ）、载脂蛋白Ｂ（ａｐｏＢ）及载脂蛋白Ａ１（ａｐｏＡ１）代谢的影响。最近，国外研究发...     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。