慢性充血性心力衰竭患者胰岛素抵抗的临床观察

观察38例慢性充血性心力衰竭（CHF）患者和25例正常人血胰岛素水平及胰岛素敏感性指数（IAI）的变化，以探讨胰岛素抵抗（IR）在CHF的作用。结果显示：CHF患者的空腹血糖、空腹血胰岛素（FIS）、IAI明显高于对照组（均P＜0．01），不同心功能分级组间IAI差异显著（P＜0．05～0．01）。提示：①CHF患者存在IR和高胰岛素血症（HIS）已与心衰程度有关；②IR和HIS可能是CHF继发性病理生理变化，并可能对CHF发展演变及临床处理产生一定影响。     

福辛普利与伊贝沙坦对高血压患者胰岛素抵抗的影响

目的观察血管紧张素转换酶抑制剂(ACEI)福辛普利和血管紧张素Ⅱ受体拮抗剂(AngⅡA)伊贝沙坦对原发性高血压患者胰岛素抵抗的影响。方法选择192例原发性高血压患者，随机分为福辛普利组和伊贝沙坦组各96例，用福辛普利和伊贝沙坦治疗24周，测定实验组和正常对照组的空腹胰岛素(FINS)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及尿酸(UA)，并留尿测定2h尿微量白蛋白(UAER)。比较福辛普利和伊贝沙坦治疗前后胰岛素敏感指数(IAI)、UAER等变化。结果福辛普利和伊贝沙坦治疗后血压较治疗前显著下降；福辛普利和伊贝沙坦治疗后IAI有显著改善。福辛普利和伊贝沙坦治疗后UAER显著降低，伊贝沙坦治疗后UA明显下降。而血脂无明显变化。结论福辛普利和伊贝沙坦在稳定降低血压的同时，具有改善胰岛素抵抗和对人肾脏功能的保护作用。     

甘精胰岛素治疗新发糖尿病的疗效观察

26例新发2型糖尿病（T2DM）患者给予2周甘精胰岛素强化治疗（三餐配合使用速效胰岛素）;治疗前后测定空腹血糖（FPG）、空腹胰岛素（FINS）,并计算IAI、胰岛素抵抗指数（HOMA—IR）。结果IAI明显增加,HOMA—IR显著改善。结论对新发T2DM,胰岛素强化治疗可以快速、稳定控制血糖,改善胰岛B细胞功能和IAI。     

化工地区健康人群的血脂、血糖、胰岛素水平的探讨

目的 探讨化工地区健康人群血糖代谢情况及其特点。方法 使用现代技术，长期观察该环境下人体空腹血脂、血甘油三酯（TG）、胆固醇（CHOL）、高密度脂蛋白-胆固酵（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）、载脂蛋白-A1（Apo-A1）、载脂蛋白-B（Apo-B）、空腹血浆血糖（FPG）及空腹血浆胰岛素（FINS）的变化，以及胰岛素的敏感性。结果 IAI指数计算极不敏感者，占高FINS的66．94％。结论 客观指标虽然只有高胰岛素血症存在，但部分病例提示高胰岛素血症先于多种疾病存在，提示今后即将发生上述各种疾病的可能。     

100例老年慢性心力衰竭患者胰岛素抵抗状况分析

目的探讨老年慢性心力衰竭(CHF)患者胰岛素抵抗(IR)状况,为临床治疗CHF提供新思路。方法将符合标准的入选人群分为:对照组(38例)、CHF并非高胰岛素组(52例)、CHF并高胰岛素组(48例),共3组,入选年龄均≥60岁。进行以上3组人群年龄、性别、体重指数等因素的可比性研究。入选人群均进行空腹血糖(FPG)、葡萄糖耐量测定(OGTT)空腹胰岛素水平(FIS)、胰岛素敏感性指数(IAI)等的测定,同时行心脏彩超检查收集左室射血分数(LVEF)指标。将三组以上各指标再进行统计学分析,观察CHF患者是否存在IR。按基础病因分组分为冠心病组、高心病组、退行性心瓣膜病组、扩张性心肌病组等,再进行各组以上各指标的对比分析,观察以上指标在不同基础病因组是否存在差异。结果与对照组相比,CHF并非高胰岛素组及CHF并高胰岛素FIS升高,IAI值降低(P<0.05)。CHF患者按不同基础病因分组后,各组间FIS,IAI指标均无显著性差异(P>0.05)。与CHF并非高胰岛素组比较,CHF并高胰岛素组FIS水平升高,IAI值降低(P<0.05)。与NYHAⅢ级组比较,NYHAⅣ级组FIS指标升高,IAI值降低(P<0.05)。结论 CHF患者存在IR,且在出现高胰岛素血症之前就可能已经存在IR现象。IR水平可能与CHF的基础病因无关,是CHF患者普遍存在的一种病理生理状态。IR水平可能与心功能分级有关,心功能越差,IR越明显。     

福辛普利联合二甲双胍治疗高血压伴胰岛素抵抗的临床疗效观察:附43例报告

该文观察福辛普利联合二甲双胍治疗高血压伴胰岛素抵抗(insulin resistance,IR)患者的降压疗效和对胰岛素抵抗的影响。方法:将高血压伴IR的患者86例分为治疗组和对照组(各43例),前者给予福辛普利和二甲双胍治疗,后者单予福辛普利治疗,疗程均为3月。观察2组治疗前后血糖、胰岛素敏感指数、血压的变化及不良反应。结果:治疗组服药后空腹血糖、空腹胰岛素及餐后2h血糖均下降,胰岛素敏感指数升高,与对照组比较差异均有统计学意义(P<0.05~P<0.01)。2组服药后收缩压与舒张压均下降,但治疗组收缩压降压幅度较对照组大(P<0.01)。2组在治疗期间均…     

贝那普利对高血压合并糖耐量低减患者血管舒张功能的影响

目的探讨贝那普利对高血压合并糖耐量低减（1GT）患者血管内皮依赖性舒张功能的影响。方法贝那普利10～20mg／d治疗高血压合并IGT患者40例,共6个月,分析治疗前后血压、空腹血糖（FPG）、糖负荷后2h血糖（2hPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA—IR）、血浆一氧化氮（NO）的变化,利用高频超声血管技术检测贝那普利治疗前后肱动脉内皮依赖性舒张功能（EDD）,计算其舒张内径的变化率（D）。结果与治疗前比较,治疗后患者的收缩压下降（P〈0．01）,舒张压、FINS、HOMA—IR下降（P〈0．05）,血浆NO水平、D升高（P〈0．05）。治疗前后D变化值（AD）分别与FINS、HOMA—IR、NO及它们的变化值AFINS、AHOMA—IR、ANO相关。结论贝那普利对高血压合并IGT患者在有效降压的同时,能明显改善内皮依赖性舒张功能。     

老年患者脂代谢变化与评价胰岛素敏感性的方法的相关性研究

目的　筛选出适合评价临床表现分布不同的老年患者脂代谢变化与胰岛素敏感性关系的参数。方法　测定 45例临床表现分布不同老年患者的空腹状态下的血糖 (FPG) ,胰岛素 (FINS)及血脂各项指标。计算胰岛素敏感指数 (IAI) ,空腹 β细胞功能指数 (FBCI) ,Homa β细胞功能指数 (HBCI) ,胰岛素抵抗指数 (IR)。并通过直线相关及多元逐步回归分析 ,了解上述评价胰岛素敏感性的各项参数与血脂各项指标的关系。结果　IAI与FBCI、IR、FPG、FINS、甘油三酯 (TG)呈明显的负相关 (r =- 0 52 7、- 0 91 3、- 0 658、 - 0 91 2、- 0 545、- 0 637,P =0 0 0 8、0 0 0 0、0 0 0 0、0 0 0 0、0 0 0 6) ,IAI与高密度脂蛋白 (HDL C)呈明显的正相关 (r=0 637,P =0 0 0 1 )。IR与FPG、FINS、TG呈明显的正相关 (r =0 80 3、0 790、0 680 ,P =0 0 0 0、0 0 0 0、0 0 0 0 ) ,IR与HDL C、载脂蛋白 (Apo)A1呈明显的负相关 (r =- 0 750、- 0 41 6 ,P =0 0 0 0、0 0 4 3)。IAI与IR呈明显负相关 (r=- 0 91 3,P =0 0 0 0 )。多元逐步回归分析 ,回归方程 :IAI=1 41 7HDL C - 6 82 8,IR =2 5 0 74- 1 7 1 2 7HDL C 2 745TG。结论　IAI和IR可以作为临床表现分布不同的老年患者这一小样本人群的脂代谢变化与胰岛     

福辛普利对原发性高血压并糖耐量减低患者脉搏波速度的影响

目的观察福辛普利对原发性高血压（EH）并糖耐量减低（IGT）患者臂—踝脉搏波速度（baPWV）的影响。方法选择EH并IGT患者51例,给予福辛普利5～10 mg/d治疗6个月,观察治疗前后血压、血糖、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、NO、内皮素（ET）及baPWV的变化。结果与治疗前相比,治疗后患者的血压、2小时血糖（2hPG）、FINS、HOMA-IR、ET水平及baPWV较治疗前下降（P均〈0.05）,NO水平上升（P〈0.05）。治疗前baPWV及治疗后其变化值分别与脉压（PP）、2hPG、FINS、HOMR-IR、NO、ET及它们的变化值相关（P均〈0.05）。结论福辛普利对EH并IGT患者降压的同时,还可减轻胰岛素抵抗,改善血管内皮功能,降低脉搏波传导速度,从而改善大动脉的弹性及顺应性。     

非酒精性脂肪肝患者血浆抵抗素水平测定及与胰岛素抵抗的相关性

目的 探讨血浆抵抗素水平变化在非酒精性脂肪肝（NAFLD）发病中的作用及与胰岛素抵抗（IR）的关系。方法选择32例单纯NAFLD患者（F组）、29例NAFLD并2型糖尿病患者（FD组）和30例体检正常者（对照组）,分别测定空腹血浆抵抗素、空腹血糖（FPG）及胰岛素（FINS）水平,计算胰岛素敏感指数（ISI）,并分析其相关性。结果F组和FD组血浆抵抗素水平、FINS及ISI均明显高于对照组,尤以FD组为著;且血浆抵抗素水平与FINS、FPG呈正相关,与ISI呈负相关。结论NAFLD患者血浆抵抗素水平升高（尤以并2型糖尿病者为著）,并与ISI呈负相关;此可能在NAFLD等IR相关性疾病的发生、发展中具有一定作用。     

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.     

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.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.