脂肪肝和血脂的关系

肝脏是脂肪代谢的重要场所。脂肪肝的定义：肝脏对脂肪合成能力增加和转运人血的能力下降时,脂类物质（三酰甘油）在肝脏内蓄积过多,超过肝脏重量5％或组织学上有50％以上的肝实质脂肪化时,即为脂肪肝。由于生活不断改善,我国脂肪肝的发病率逐年升高,已占平均人口的10％,脂肪肝已作为一种常见病进入我们的生活。肥胖、嗜酒和糖尿病的人群中脂肪肝可高达50％-60％,     

非酒精性脂肪肝患者血清游离脂肪酸与胰岛素抵抗的关系

目的研究非酒精性脂肪肝(NAFLD)患者血清游离脂肪酸(FFA)水平及其与胰岛素抵抗(IR)的关系。方法测定118例NAFLD患者(NAFLD组)及103名健康体检者(正常对照组)的血清FFA并计算胰岛素抵抗指数(HOMA-IR)。结果 NAFLD组血清FFA浓度为(752.50±101.42)μmol/L,HOMA-IR为1.48±0.42,均高于正常对照组[(441.75±95.64)μmol/L,0.67±0.33](P<0.01)。NAFLD组FFA与HOMA-IR呈正相关(r=0.325,P<0.05)。结论 FFA与NAFLD密切相关,FFA致NAFLD可能通过IR起作用。     

脂肪肝患者血清瘦素与胰岛素抵抗的关系

目的:探讨脂肪肝患者血清瘦素水平变化及其与胰岛素抵抗之间的关系,以期为治疗和预防脂肪肝提供参考依据。方法:观察组57例脂肪肝患者均为广东医学院附属医院消化内科住院及门诊患者,男36例,女21例。纳入标准:无嗜酒史,近2～4周内未使用过肝损害药物。排除标准:排除糖尿病、原发性高血压。对照组33例,为本院健康体检者,男21例,女12例。纳入标准:糖耐量、肝功能、血脂、体质量指数均在正常范围,无饮酒史,无任何肝脏疾病,肝炎病毒标志物阴性。排除标准:B超检查排除脂肪肝。用放免法测定观察组患者及对照组血清瘦素水平,同时测定体质量指数(bodymassindex,BMI)、空腹血糖、空腹胰岛素、血脂,采用稳态模式评价胰岛素抵抗(homeostasismodelassessmentinsulinresistance,HOMA-IR)。结果:①脂肪肝患者瘦素水平、BMI、空腹血糖、空腹胰岛素、HOMA-IR、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(low-densitylipoproteincholesterol,LDL-C)均高于对照组(t=3.920～10.060,P<0.05～0.01)。②脂肪肝组、对照组女性瘦素水平犤(11.84±2.07),(7.05±0.94)μg/L犦明显高于男性犤(5.50±1.32),(3.01±0.62)μg/L犦(t=6.356,7.890,P<0.01)。③同性别组内瘦素与BMI,HOMA-IR呈正相关(男性组r=0.7662,0.4883,P<0.01;女性组r=0.     

Relationship of pulse oximetry to arterial oxygen tension in infants

Pulse oximetry is a useful technique for noninvasive oxygen monitoring in sick infants. We simultaneously measured oxygen saturation by pulse oximetry and on arterial blood samples by co-oximetry as well as PaO2 and the relative content of fetal (F) and adult hemoglobin in order to evaluate the reliability of pulse oximetry. Comparisons were made in triplicate in ten infants with acute cardiorespiratory disease less than 7 days of age and in 11 infants with chronic lung disease greater than 28 days of age. Oxygen saturation pulse oximetry and arterial saturation were well correlated over a wide range of saturation values. In infants with chronic lung disease, PO2 derived from pulse oximetry was within 10 torr of measured PaO2 in 73% of comparisons. In contrast, calculated PaO2 was within 10 torr of measured PaO2 in only 50% of comparisons in patients with acute disorders. The chronic infants all had less than 10% hemoglobin F, but in the acute infants, hemoglobin F ranged from 26% to 83%. Nonetheless, correction of oxygen dissociation curves for type of hemoglobin in these acute infants failed to improve the correlation between calculated and measured PaO2. We conclude that pulse oximetry saturations and their derived PaO2 values correlated well with measured arterial saturation and PaO2 obtained from arterial blood samples in neonates with chronic lung disease and prolonged oxygen dependence. In infants with acute cardiorespiratory problems, pulse oximetry unreliably reflects PaO2, but may be useful in detecting clinical deterioration.     

Conjunctival oxygen tension and its relationship to arterial oxygen tension

Using a miniaturized Clark electrode embedded in a polymethylmethacrylate eyepiece, we measured transconjunctival oxygen tension (PcjO₂) in 5 healthy volunteer subjects at multiple levels of steady-state isocapnic hypoxia, normoxia, and hyperoxia. PcjO₂ was linearly related to arterial oxygen tension (PaO₂) as PaO₂ ranged from 28 to 205 mm Hg (PcjO₂=0.59 PaO₂+0.36 mm Hg;r=0.94; standard error of the estimate=7.09 mm Hg). However, the relationships between PcjO₂ and PaO₂ varied significantly among subjects. Whereas the overall mean ratio of PcjO₂ to PaO₂ was 0.59, the mean ratio for subjects ranged from 0.47 to 0.79 and was significantly different among subjects (P<0.0001). The time response of the electrode to a step change in oxygen tension in vitro was exponential, with a 90% response time of 38 seconds after a lag of 3.7 seconds. The time responses to in vivo changes in oxygen tension were also exponential. From hypoxia to normoxia, 90% response time was 45.0 seconds after a lag of 5.1 seconds; from room air to hypoxia, 90% response time was 72.4 seconds after a lag of 30.3 seconds; from room air to hyperoxia, 90% response time was 87.2 seconds after a lag of 6.8 seconds. We conclude that, although PcjO₂ measured by a miniaturized Clark electrode is linearly related to PaO₂ in healthy subjects, variation in the relationship of PcjO₂ to PaO₂ among individuals will prevent precise estimation of PaO₂ for any individual unless subject-specific calibration is performed.     

脂肪肝与高尿酸血症的相关性

为探讨脂肪肝与高尿酸血症的关系,本论文从2006年7月1日～12月31日来杭州疗养院海勤疗养区健康体检的人群中选取399名为本次研究对象,结果 发现脂肪肝组高尿酸血症的发生率明显高于对照组,现报告如下.     

Relationship between plasma pyridoxal-5''-phosphate concentration and the apoenzyme content of serum aminotransferases in patients with a renal allograft

We developed a rapid fluorometric assay for measurement of serum magnesium using the ligand, 8-hydroxy-quinoline-5-sulfonate and adapted the procedure to the Multistat Fluorescence Light Scattering Centrifugal Analyzer. The standard curve extends from 0.26 to 4.11 mmol/l. There was no interference from calcium or inorganic phosphorus at concentrations of 4.95 and 5.0 mmol/l, lead, iron, zinc or copper at twice the normal levels found in serum, bilirubin at concentrations of 10 mg/dl, or lipemic samples with triglyceride concentrations of 2400 mg/dl. Citrate and EDTA lowered magnesium concentrations in serum. Analytical recovery of magnesium added to four serum specimens averaged 97%. Between-run and within-run precision of the assay gave CVs which ranged from 2.9 to 7.6%. Magnesium concentrations, measured by our fluorometric procedure, were compared with those obtained by atomic absorption and colorimetric procedures. Correlation coefficients of 0.91 and 0.88 were obtained.     

Trauma in patients who are morbidly obese

Trauma is the fifth leading cause of death in the United States. There is an eight-fold increase in mortality rates among victims of blunt trauma who are morbidly obese. Airway, circulation, and breathing mechanisms are altered in patients who are morbidly obese, which makes assessment and treatment difficult. Normal diagnostic and treatment procedures performed in the field and hospital must be modified. Some treatments or diagnostic procedures cannot be performed in the average hospital setting on patients who are obese; therefore, perioperative nurses must modify OR routines to provide care. AORN J 76 (Oct 2002) 585-589.     

Plasma fibronectin concentrations in morbidly obese patients

Plasma fibronectin concentrations and liver morphology were investigated in 45 morbidly obese subjects (median overweight 88%) and in 42 normal weight controls, matched for sex and age. A significantly (P less than 0.01) raised plasma fibronectin concentration (median 464 mg/l, range 276-862 mg/l) was found in the obese subjects when compared with concentrations in the controls (median 348 mg/l, range 164-536 mg/l). Plasma fibronectin concentrations of the obese patients correlated significantly to their degree of overweight (r = 0.33, P less than 0.05) as well as to the degree of fatty change found in their liver biopsies (r = 0.33, P less than 0.05). Significantly (P less than 0.05) elevated plasma fibronectin concentrations even in obese subjects without hepatic fatty change indicate that liver fat accumulation is no prerequisite of the obesity-related elevation of plasma fibronectin. Raised plasma fibronectin concentration in obesity may more readily be explained by an increased fibronectin formation by lipocytes.     

Tobramycin pharmacokinetics in morbidly obese patients.

Tobramycin kinetics were examined in 9 morbidly obese women following a single intravenous (120 mg) bolus. After the injection, serum elimination conformed to a 2-compartment open model with alpha and beta t1/2s of 0.285 and 2.1 hr. The volume of distribution (Varea) was determined to be 0.44 1/kg ideal body weight (IBW) and 0.20 1/kg total body weight (TBW). To normalize Varea to 0.26 1/kg, 58% of the patients' adipose weight (TBW -- IBW) must also be taken into account.     

夜间间歇性低血氧与高血压患者脂肪肝的关系

目的 探讨高血压患者夜间间歇性低血氧与脂肪肝的关系.方法 选择行多导睡眠监测的原发性高血压患者168例,并根据肝脏超声影像学的诊断结果分组,比较两组间临床、实验室资料及多导睡眠监测指标中的睡眠呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）,分析脂肪肝形成的相关因素.结果 脂肪肝组（101例）较非脂肪肝组（67例）的体重指数、空腹血糖、甘油三酯、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、谷酰转肽酶明显增高（P＜0.05）,但LSaO2水平明显降低[（79.37±9.19）％ vs.（83.12±6.40）％,P＜0.05].Logistic回归分析表明空腹血糖、LSaO2可能是高血压患者脂肪肝的形成的危险因素,OR值分别为3.794（95％ CI：1.678 ～8.578）,3.378（95％ CI：1.464 ～7.796）.结论 高血压患者脂肪肝形成可能与夜间间歇性低血氧有关.     

Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion

Mean subcutaneous tissue PO2 (PsqO2) measurements were obtained in dogs with an unheated electrode placed in an implanted Silastic tonometer, while PaO2 was increased in increments from 40 to 600 torr during normal, increased, and reduced blood volume. These changes reflect that the mean PsqO2 is approximately 10 torr below the PO2 of venous blood draining that tissue. Since PaO2 was already known, the oxygen content of arterial and venous blood entering and leaving this tissue could be determined by reference to blood-oxygen dissociation curves. Therefore, relative changes in blood flow could be calculated using the Fick principle. After a 20% blood loss, the PsqO2 measured during breathing of room air fell to 20% of baseline, corresponding to an 80% fall in sc blood flow; it remained low until the shed blood was returned despite compensatory changes in cardiac output. Rapid infusion of electrolyte solutions in normovolemic animals produced a temporary increase in local blood flow. Subcutaneous oximetry seems capable of quantifying peripheral perfusion and may be clinically useful.     

Increased serum aminotransferases associated with anti-mitochondrial antibodies in systemic lupus erythematosus patients with autoimmune liver disease

BACKGROUND: Serum aminotransferase activities are increased in many liver diseases, but the causes for the elevation might be difficult to determine. Whether the elevation of aminotransferases correlates with anti-mitochondrial antibodies (AMA) in systemic lupus erythematosus (SLE) patients with autoimmune liver disease deserves further consideration. METHODS: A meticulous review was done in a large SLE cohort searching for laboratory features of the presence of AMA. Forty-eight hospitalized SLE patients with AMA and 60 randomly selected SLE patients without AMA as a matched case control were enrolled into the retrospective study. Laboratory data were collected, analyzed and compared in SLE patients with and without AMA. RESULTS: Serum activities of aminotransferases were significantly increased in the 48 SLE patients with AMA compared with the 60 subjects without AMA. Meanwhile, we found a positive correlation between serum AMA titers and serum aminotransferase activities. CONCLUSION: Although much remains to be learned about the pathogenesis of autoimmune liver disease associated with AMA, it is possible to suggest that AMA might contribute to the elevation of aminotransferases in SLE patients with the progressive disease.