上海市成人代谢综合征与脂肪肝关系分析

目的探讨代谢综合征与脂肪肝的关系,并评估脂肪肝预测代谢紊乱危险因素聚集的价值。方法采取随机多级分层整群抽样方法调查3175名上海市16岁以上居民,内容包括问卷调查、体检、葡萄糖耐量试验、血脂全套和肝脏实时超声。代谢综合征的诊断根据美国国家胆固醇教育计划成人治疗组第三次报告(NCEPATPⅢ)标准(中心性肥胖诊断参照世界卫生组织西太平洋区标准)。结果3175名成人中代谢综合征和脂肪肝检出率分别为22.9%和20.8%。无论男性还是女性,与肥胖、中心性肥胖相比,脂肪肝判定危险因素的聚集率、特异度、阳性预测值以及归因度百分比最高。中心性肥胖、糖尿病、血脂异常、高血压病等人群脂肪肝患病风险分别是对照人群的32.8倍(95%CI,14.9～72.4)、31.6倍(95%CI,14.2～70.4)、22.6倍(95%CI,10.3～50.0)、23.3倍(95%CI,10.5～51.3),而代谢综合征人群脂肪肝患病风险是对照人群的39.3倍(95%CI,17.8～87.1)。661例脂肪肝患者根据体重指数(BMI)分层后,仅腹型肥胖患病率随BMI增加而增加;即使是体重正常的脂肪肝患者,其代谢紊乱1项和5项指标检出率分别达86.1%、2.8%。结论上海市成人代谢综合征和脂肪肝同为常见病,两者关系密切;脂肪肝能较好预测代谢紊乱危险因素聚集。     

延安地区成人脂肪肝患病率及其危险因素的探讨

目的调查并探讨延安地区成人脂肪肝的患病率及其主要危险因素。方法收集延安大学附属医院2011年2月-2013年3月资料完整的健康体检者,均接受人体学测量(身高、体质量、血压)、生化及免疫学检查(肝功能、血糖、血脂、血尿酸、肾功能、病毒标志物)及超声检查。资料分析采用t检验、χ2检验及Logistic回归分析法。结果共6236例健康体检者参与调查研究,约占延安市人口的3.76‰。其中男3532例,女2704例,平均(49.27±12.93)岁。B超共检出脂肪肝1602例,占25.69%,其中酒精性、可疑酒精性、非酒精性脂肪肝分别占4.55%、7.08%及88.37%。脂肪肝组肥胖、高血压、高尿酸血症、空腹血糖过高、糖尿病、血脂异常患病率等均显著高于非脂肪肝组。多元回归分析显示:年龄、男性、饮酒、腰围、身体质量指数(BMI)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、尿酸(UA)、空腹血糖、糖尿病、高血压病是脂肪肝的危险因素,其中HDL-C是脂肪肝的保护因素。空腹血糖调节受损组及糖尿病组较血糖正常组相比脂肪肝患病风险分别增加了1.584、2.638倍(P值均0.001);超重、Ⅰ度肥胖、Ⅱ度肥胖组与正常体质量组相比脂肪肝患病风险分别增加了1.627、1.796、9.544倍(P值均0.001);适量饮酒、过量饮酒组与无饮酒组相比,脂肪肝患病风险分别增加1.638、3.648倍(P值均0.001);肥胖加饮酒组较无肥胖和饮酒组相比,脂肪肝患病风险增加了17.672倍(P0.001)。收缩压、舒张压、UA、TG、总胆固醇(TC)、LDL-C增高组及HDL-C降低组较正常组相比脂肪肝患病风险分别增加了1.835、1.768、1.821、4.524、1.569、1.824、2.724倍,差异具有统计学意义(P0.05)。其中以TG及HDL-C异常的危险性增加最为明显。结论延安地区成人脂肪肝患病率偏高,主要为非酒精性脂肪肝,性别、年龄、肥胖、饮酒、糖代谢紊乱、高尿酸血症、高血压及血脂异常为主要的危险因素。     

陕、甘两省酒精性与非酒精性脂肪肝流行病学分析

目的调查陕西省和甘肃省成人酒精性、非酒精性脂肪肝患病率并分析相关危险因素。方法采用横断面调查的方式，调查两省成人脂肪肝患病率，内容包括填写问卷，测量身高、体重、腰围，生化检查和B超检查。结果共调查1500人，其中男性1023名，女性477名。共检出脂肪肝247例，其中饮酒率、酒精性脂肪肝、非酒精性脂肪肝的检出率分别为56．53％、3．87％、12．60％。男性脂肪肝患病率无论是酒精性还是非酒精性均高于女性（P〈O．05）。脂肪肝的患病率随年龄的增加而上升。经Logistic多元回归分析，年龄、日酒精摄入量、饮酒年限、BMI与酒精性脂肪肝密切相关，其中以日酒精摄入量相对风险度最高（OR=9．941，95％CI4．803～20．577）；年龄、男性、高脂血症、BMI、腰围与非酒精性脂肪肝密切相关，其中以高脂血症相对风险度最高（OR=3．750，95％cI2．752～6．745）。结论两省成人脂肪肝患病率较高，以非酒精性脂肪肝为主。肥胖、饮酒是脂肪肝最重要的危险因素。     

2型糖尿病患者LEP-2548位点SNP与非酒精性脂肪肝的关系

目的:探讨2型糖尿病(type 2 diabetes.T2MD)患者瘦素基(1eptin gene promoter,LEP)启动子区-2548单核苷酸多态性(single nucleotidepolymorphisms,SNP)与其合并非酒精性脂肪肝的关联.方法:以208例T2MD患者为病例组,其中合并非酒精性脂肪肝患者98例,无脂肪肝者110例,同时选择在性别、年龄上与之匹配的100例健康体检者为正常对照组:采用基于连接酶(ligase detection reaction,LDR)的测序分型方法,检测LEP-2548G>A位点的SNP:同时测量受试者的身高、体质量、腰围、臀围,并检测空腹C肽水平、肝功能、血糖、血脂等临床指标.结果:LEP-2548G>A住点SNP的分布在正常对照组及合并非酒精性脂肪肝、无脂肪肝的T2MD组间差异有显著性(P<0.01);SNP的分布与中腹部肥胖相关,且LEP-2548AA基因型发生中腹部肥胖的风险高,为GG基因型的2.720倍(OR=2.720,95%CI:1.1 86-6.235,P<0.05);LEP-2548G>A位点的基因型作为独立变量与T2MD患者合并非酒精性脂肪肝患病相关,AA基因型是T2MD患者合并非酒精性脂肪肝的危险因素(95%CI:1.210-7.615,P<0.05).结论:LEP-2548AA基因可能通过调控机体脂肪分布,增加中腹部肥胖风险,促进T2MD合并非酒精性脂肪肝的发生.     

成人肥胖测量指标与高血压患病关系

目的探讨成人肥胖测量指标与高血压患病的关系。方法利用江苏省2010年成人慢性病及其危险因素监测数据,描述新发现高血压患者在不同人群中的分布差异;运用双变量相关和非条件Logistic回归方法,分析体质量指数(BMI)、腰围、腰身比和体脂百分比等肥胖测量指标与血压及高血压患病的关系。结果江苏省成人新发现高血压患病率为35.3%,男性高于女性,患病率随年龄增长呈上升趋势(P0.05)。双变量相关分析结果表明,BMI、腰围、腰身比和体脂百分比等肥胖测量指标与收缩压和舒张压均成正相关。多因素非条件Logistic回归分析结果显示,肥胖(χ2=129.67,P0.05)、中心型肥胖(χ2=157.05,P0.05)、BMI(χ2=176.21,P0.05)、腰围(χ2=187.73,P0.05)、腰身比(χ2=221.49,P0.05)和体脂百分比(χ2=155.22,P0.05)均与高血压患病显著相关;BMI、腰围、腰身比和体脂百分比每增加1个标准差(SD),高血压患病风险分别增加59%(OR=1.59,95%CI:1.50~1.70)、60%(OR=1.61,95%CI:1.50~1.71)、68%(OR=1.68,95%CI:1.57~1.79)和149%(OR=2.49,95%CI:2.21~2.80)。BMI、腰围、腰身比和体脂百分比等肥胖测量指标对高血压患病风险的影响依次升高。结论 BMI、腰围、腰身比和体脂百分比与高血压患病相关,高血压患病风险随肥胖程度的增加而升高。     

温州市成人体质量指数、腰围与高血压的关系

目的了解温州市成年人高血压患病率、超重率、肥胖率、中心性肥胖率,并探讨成人体质量指数(BMI)、腰围与高血压患病危险的关系。方法采用多阶段随机抽样方法,从温州市11个区县随机抽取年龄≥18岁的居民进行调查。调查方法包括问卷调查和身体测量。并采用Logistic回归分析探讨BMI、腰围与高血压的关联。率的标化采用2010年全国第6次人口普查数据。结果共调查42 747人,有效问卷41 054份,有效率96.04%。居民标化超重率、肥胖率、中心性肥胖率分别为25.9%、5.9%、42.3%,标化高血压患病率为25.2%。以无超重/肥胖/中心性肥胖人群为参照,超重+中心性肥胖、肥胖+中心性肥胖者患高血压的风险分别为2.475(95%CI 2.330~2.628)、4.140(95%CI3.751~4.570)倍,糖尿病+肥胖+中心性肥胖及血脂异常+肥胖+中心性肥胖者患高血压的风险分别是无糖尿病或血脂异常,无超重/肥胖/中心性肥胖者的6.298(95%CI 5.086~7.800)和4.159(95%CI3.633~4.763)倍。结论 BMI和腰围的增加均能增加高血压发病风险。超重、肥胖和中心性肥胖对高血压患病存在联合作用。     

肥胖通过不同机制导致脂肪性肝炎和肝细胞癌

<正>非酒精性脂肪性肝病(NAFLD)是肥胖和代谢综合征累及肝脏的病理表现,疾病谱包括单纯性脂肪肝(NAFL)、非酒精性脂肪性肝炎(NASH)及其相关肝纤维化、肝硬化和肝细胞癌(HCC)。随着肥胖在全球的流行,NAFLD已成为全球第一大慢性肝脏疾病,普通成人和肥胖患者NAFLD患病率分别高达25%和50%,肥胖症显著增加NAFLD患者肝硬化和HCC发病风险~([1-2])。临床上,90%以上的丙型肝炎相关HCC和酒精性肝病相关HCC发生在肝硬化的基     

吸烟和β2-肾上腺素能受体基因Gln27Glu变异与新疆哈萨克族肥胖性高血压的关系

目的:探讨新疆哈萨克族体质指数(BMI)增高、高血压及血脂异常与β2-肾上腺素能受体(ADRB2)基因变异及非遗传因素的关系。方法:选取新疆和丰县牧区30～70岁哈萨克牧民671例(男283例,女388例),检测血清TC,TG,HDL,LDL。用PCR-限制性酶切片段多态性技术确定ADRB2基因Gln27Glu和Thr164Ile位点基因型。结果:①ADRB2基因Thr164Ile位点仅检测到5例Thr/Ile杂合子,约占1%,Ile/Ile基因型未检测到。②校正性别和年龄后,Gln27Glu和Thr164Ile位点各自不同基因型间BMI、血压和血脂平均水平比较差异均无统计学意义。③多元Logistic回归分析提示:TG、舒张压(DBP)是BMI增高的风险因素,与(Glu27Glu+吸烟)相比,(Gln27Glu+不吸烟)引起BMI增高风险增加1.69倍(95%CI:0.99～2.88),而(Gln27Gln+不吸烟)增高2.71倍(95%CI:1.49～4.92)。④多元方差分析提示,年龄、吸烟和饮酒对BMI、血压和TG的影响差异有统计学意义,而Gln27Glu位点仅对BMI有影响。⑤与体重正常者相比,超重者DBP增高的风险增加1.47倍(95%CI:1.03～2.09),肥胖者增加2.64倍(95%CI:1.69～4.11)。超重和肥胖者高TG的风险分别增加2.05倍(95%CI:1.27～3.31)和3.49倍(95%CI:2.06～5.92)。结论:新疆哈萨克族人群BMI和DBP,TG互为风险因素,且可能受到年龄、ADRB基因Glu27Glu变异和吸烟交互作用以及饮酒的影响。     

四川省广元市城区行政企事业单位职员脂肪肝患病率及危险因素流行病学调查

目的 明确广元市企事业行政单位职员脂肪肝的患病率及相关危险因素。方法2005年1月～2006年12月在我院体检的企事业行政单位职员。体检内容涉及问卷调查、体格检查、血脂检测、空腹血糖、肝功能及肝脏实时超声检查。结果 有4504人完成调查，约占广元行政企事业单位职员人数的12．08％（4504／37267）（以2006年统计局人事年报为准），男2689人，平均（44．49±14．03）岁；女1815人，平均（39．52±11．93）岁。B超共检出脂肪肝194例，占4．31％，其中酒精性脂肪肝占4．22％，非酒精性脂肪肝占95．78％。无论是男性还是女性，脂肪肝患病率随年龄增长而增加，60岁前达到高峰，随后稍有下降；男性脂肪肝患病率显著高于女性（Х^2=65．648，P〈0．001），而60岁后男女间脂肪肝患病率无差异（Х^2=1．368，P=0．242）。脂肪肝组性别、年龄、超重、血压、血脂、血糖等因素均显著高于对照组（P〈0．05）。多元回归分析显示：体重指数（BMI）、超重、文化程度、性格特点、夜间加餐、甜食与脂肪肝密切相关，尤其超重可增加脂肪肝的患病风险。同时运动量少、不良饮食习惯、生活无规律也是脂肪肝患病的风险因素，而过量饮酒并不是脂肪肝患病风险的高危因素。结论 广元市行政企事业单位职员脂肪肝患病率较高，主要是非酒精性脂肪肝、超重及饮食行为习惯不良与脂肪肝发病相关。     

非酒精性脂肪肝治疗进展研究

<正>非酒精性脂肪肝(nonalcoholic fatty liver disease,NAFLD)是一种与胰岛素抵抗和遗传易感密切相关的代谢应激性肝脏损伤,其病理学改变与酒精性肝病相似,但患者无过量饮酒史,包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎、脂肪性肝硬化和肝癌[1,2]。随着社会压力增大、不正当的饮食频繁及运动量减少,我国肥胖和糖尿病的发生率增加,NAFLD已成为我国常见的慢性肝病之一。     

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.