原发性醛固酮增多症患者术前术后胰岛B细胞功能变化的研究

目的探讨原发性醛固酮增多症(简称“原醛症”)患者肾上腺腺瘤手术前后胰岛B细胞功能的变化。方法北京协和医院内分泌科2004—2006年收治的17例原醛症患者,接受肾上腺腺瘤摘除术前后均进行标准的75g葡萄糖耐量试验,分析胰岛素抵抗指数,HOMA分泌功能指数、胰岛素曲线下面积(INSAUC)胰岛素和血糖增量之比(ΔI30/ΔG30)等指标的变化以及和血钾、血浆醛固酮的相关关系。结果ΔI30/ΔG30在术后明显升高(P=0.01),按体重指数(BMI)≥25分层后肥胖或超重组术后ΔI30/ΔG30增加不明显(P=0.08);术前低血钾的患者术后胰岛B细胞分泌功能明显改善,而术前血钾正常者改善不明显。手术前后INSAUC变化和空腹血钾正相关(r=0.71,P=0.01),和醛固酮水平的变化以及随访时间无明显相关。结论原醛症患者肾上腺腺瘤摘除术后低血钾纠正,胰岛B细胞的分泌功能改善,其改善程度受术前血钾和体重的影响。     

原发性醛固酮增多症的分型诊断

目的 探讨用于原发性醛固酮增多症(原醛症)分型诊断检查方法的价值.方法 收集本院近7年来57例临床确诊的原醛症患者[醛固酮瘤22例,特发性醛固酮增多症(特醛症)26例,原发性肾上腺增生9例],检测患者的血电解质、血浆肾素活性及血、尿醛固酮,将结果与19例原发性高血压患者对照.再通过肾上腺CT、体位激发试验及肾上腺静脉采血检查对原醛症患者分型并随访.结果 (1)醛固酮瘤患者血压及血、尿醛固酮较特醛症患者高,血钾及血浆肾素活性则低,而原发性肾上腺增生患者临床及生化改变介于两者之间.肾上腺CT检查在原醛症分型诊断中的符合率为醛固酮瘤86.4%,特醛症73.1%,原发性肾上腺增生22.2%;肾上腺静脉采血检查以两侧醛固酮之比作为判定标准时符合率为86.4%、80.8%和77.8%,以醛固酮与皮质醇之比为判定标准则符合率分别为95.5%、92.3%及100.0%.(2)醛固酮瘤及原发性肾上腺增生患者术后随访血醛固酮均下降,血压恢复正常者分别为22.7%及44.9%,血钾恢复正常者为83.3%及100.0%,而特醛症患者随访中各项测值无明显变化,另有33.3%诊断时血钾正常的患者随访中出现低血钾.结论 原醛症的分型诊断需依靠多种检查手段综合分析,单纯依赖影像学检查或体位激发试验并不可靠,肾上腺静脉采血检查可作为影像学检查的补充,用两侧醛固酮与皮质醇的比值分析较单纯比较两侧醛固酮之比更为可靠;醛固酮瘤及原发性肾上腺增生患者术后临床及生化测值均得以明显改善,而特醛症患者随访中无明显变化.     

单侧肾上腺皮质腺增生引起的原发性醛固酮增多症

原发性醛固酮增多症(以下简称原醛),通常是由于肾上腺皮质腺瘤或双侧皮质增生引起的醛固酮过度分泌所致。测定卧位和立位血浆醛固酮可以粗略地鉴别这两种类型,更可靠的是术前经肾上腺静脉取血检查,若腺瘤较大,肾上腺扫描或C-T检     

原发性醛固酮增多症左心室肥厚及相关影响因素分析

目的探讨原发性醛固酮增多症（原醛）患者的并发症情况,分析原醛患者左心室肥厚的相关因素。方法对93例原发性醛固酮增多症（原醛组）患者及同期住院的84例原发性高血压（原高组）患者的临床资料进行回顾性分析。结果（1）与原高组患者相比,原醛组患者血钙水平更低（P〈0．05）,但脂代谢异常程度较轻。（2）原醛组患者左心室肥厚较原高组患者严重,相关分析显示,原醛组患者的左心室质量与低血钾病程（r=0．983,P〈0．01）、立位醛固酮水平（r=0．993,P〈0．01）呈显著正相关,而与血钾（r=-0．993,P〈0．01）呈显著负相关。结论原醛组患者与原高组患者相比血钙水平更低,左心室肥厚更严重,但脂代谢异常程度较轻;原醛组患者的左心室质量与低血钾病程、立位醛固酮水平和血钾水平具有相关性。     

内分泌疾病急诊的诊断和处理(二)

七、原发性醛固酮增多症并发高血压低血钾危象(一)病因原发性醛固酮增多症(简称原醛),大多(90%)由于肾上腺皮质腺瘤、少数由于皮质增生或癌肿所引起。由于自主性分泌醛固酮等盐皮质激素过多,潴钠排钾,使血压升高和血钾减低,可出现高血压低血钾瘫痪危象。(二)临床表现原醛的特征是高血压伴有低血钾,以及由于低血钾所引起的肌肉软弱麻痹和失钾性肾病。1.高血压,是最早出现的主要症状,常阵发性加重,多在150～250/90～130mmHg。常伴     

胰岛素治疗对高脂喂养的糖尿病大鼠胰腺内脂质及葡萄糖刺激后胰岛素分泌的影响

目的 观察胰岛素治疗对高脂喂养的糖尿病（DM）大鼠胰腺内脂质及葡萄糖刺激后胰岛素分泌（GSIS）的影响。方法 Wistar大鼠随机分为正常对照组（NC），DM高脂饲养组（DH）及DM高脂饲养胰岛素治疗组（DHI）。测定血糖、胰岛素、FFA、TG、胰腺内TG和FFA、胰岛素蛋白表达和相对β细胞数量、计算△I30／△G30及β细胞胰岛素分泌指数（MBCI）。结果 与DH相比，DHI血TG和FFA下降虽无统计学意义，但胰腺内TG和FFA含量明显下降（P〈0．01），△I30／△G30、MBCI、胰岛素表达和相对β细胞数量得到明显改善（P〈0．05或P〈0．01）。结论 长期高脂喂养DM大鼠可导致脂质异位沉积于胰腺，并进一步损伤GSIS。GSIS受损可能与胰岛素合成降低，β细胞数量减少有关。胰岛素治疗对高脂所致的上述改变有一定的改善作用。     

瑞格列奈对2型糖尿病患者早时相胰岛β细胞功能影响的临床研究

目的探讨瑞格列奈联合口服葡萄糖耐量试验-胰岛素释放试验（OGTT～IRT）评价新诊断的2型糖尿病（T2DM）患者胰岛G细胞功能的价值。方法96例新诊断的T2DM患者在人组时行OGTT试验,其结果作为基线资料。将患者随机分为3组,A组服单次瑞格列奈行OGTT,B组服1周瑞格列奈行OGTT,C组服1周格列本脲行OGTT。测定各时刻真胰岛素（TI）和免疫反应性胰岛素（IRI）,并计算TI／IRI及早时相胰岛素分泌指数△I10／△G30.结果A组和B组服药后30min时TI和TI／IRI较基线明显增加（P〈0．05）,△I10／△G30均较基线显著升高（P〈0．01）;C组服药前后上述指标均无统计学差异。结论瑞格列奈改善早时相胰岛素分泌,其联合OGTT—IRT较常规OGTT—IRT能更真实反映新诊断的T2DM患者胰岛B细胞分泌和储备功能。     

山东沿海地区Graves病患者糖调节异常特点分析

目的 探讨山东沿海地区汉族Graves病（GD）患者糖调节状态变化,并比较抗甲状腺药物治疗不同阶段糖调节状态变化特点.方法 选取2010年8月至2012年6月山东大学齐鲁医院收治的来自山东沿海地区的Graves病患者106例,男性45例,女性61例,平均年龄（34 ±5）岁.按患者所处治疗阶段分为3组,即初治组（GD1组,35例）、治疗期组（GD2组,37例）和减量期组（GD3组,35例）,并选取年龄相当的30名健康体检者作为对照（NC组）.入选患者均继续接受正规抗甲状腺药物治疗6个月,分别于治疗前后作口服葡萄糖耐量试验（OGTT）、胰岛素释放试验（InsRT）,观察血糖、胰岛素、早相胰岛素分泌指数（△I30/△G30）,OGTT血糖曲线下面积（GAUC）和InsRT胰岛素曲线下面积（INSAUC）的变化.应用方差分析进行数据比较.结果 基线时,GD各组空腹血糖水平显著低于NC组（F =29.85,P ＜0.05）;OGTT后血糖、胰岛素水平显著高于NC组（F=22.54、87.96,均P＜0.05）;GD各组△I30/△G30显著低于NC组（F=17.22,P＜0.05）;GAUC、INSAUC均显著高于NC组（F=79.09、112.77,均P＜0.05）;GD各组间相比,GD1、GD2组血糖、胰岛素水平显著高于GD3组（F=17.19、48.88,均P＜0.05）;治疗6个月后,GD各组血糖、胰岛素均显著低于基线水平（F=13.06、55.72,均P＜0.05）;GAUC、INSAUC均显著低于基线水平（F=53.08、96.98,均P＜0.05）.结论 沿海地区GD患者存在糖调节异常,主要特点是胰岛素早期分泌时相受损,高胰岛素血症;甲状腺功能正常后糖调节改善,糖耐量异常减轻和高胰岛素血症改善,但胰岛素早期分泌时相并无明显改善.     

肾上腺静脉采血在原发性醛固酮增多症分型诊断中的应用

目的探讨肾上腺静脉采血（AVS）检查在原发性醛固酮增多症（原醛症）分型诊断中的应用价值。方法收集瑞金医院近4年来39例临床确诊的原醛症患者[23例特发性醛固酮增多症（特醛症），16例醛固酮瘤]，经肾上腺静脉插管检查，取双侧肾上腺静脉以及肾静脉水平下的下腔静脉血液，测各点醛固酮和皮质醇水平，并将结果与影像学检查、体位激发试验（PST）及术后病理结果进行比较。结果（1）23例特醛症患者体位激发后血醛固酮较基础值均升高；16例醛固酮瘤患者血醛固酮升高者占56．3％（9／16）；（2）特醛症患者肾上腺B超检查符合率为69．6％（16／23），醛固酮瘤患者为56．3％（9／16）；肾上腺CT检查特醛症患者符合率为73．9％（17／23），醛固酮瘤患者为81．3％（13／16）；（3）AVS检查以两侧醛固酮之比作为判定标准时符合率为71．8％，以醛固酮与皮质醇之比为判定标准则达到100％。醛固酮瘤患者生化异常程度较特醛症患者明显。PST在特醛症及醛固酮瘤中有部分重叠；体位激发后血醛固酮升高者不能排除醛固酮瘤，而血醛固酮下降者可诊断为醛固酮瘤。结论单纯依赖影像学检查对于原醛症患者进行分型诊断易发生误诊。AVS检查的准确性高，对于影像学检查未能发现明显占位性病变者须进行该检查以明确诊断；对于AVS结果，用两侧醛固酮与皮质醇的比值之比分析较单纯比较两侧醛固酮之比更为可靠。     

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。     

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.     

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.     

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.