新诊NIDDM人群中血浆胰岛素水平与血压的相关性

作者观察了４０１例新诊ＮＩＤＤＭ血浆胰岛素与血压的关系。血浆胰岛素较高组（ＩＮＳ２ｈ≥８２ｍＵ／Ｌ）高血压患病率为４５．８％（３３／７２），明显高于较低组（ＩＮＳ２ｈ＜８２ｍＵ／Ｌ）的２７．４％（９０／３２９），血压水平也较高（８８Ｐ１８．８±０．４ｋＰａｖｓ１７．７±０．２ｋＰａ，ＤＢＰ１２．０±０．２ｋＰａｖｓ１１．４±０．１ｋＰａ，Ｐ＝０．０００１）。多因素回归分析在排除年龄、性别、ＢＭＩ、血糖等混杂因素影响后，口服葡萄糖耐量试验（ＯＧＴＴ）２小时血浆胰岛素水平与ＳＢＰ显著正相关（Ｐ＜０．０１），与ＤＢＰ边缘相关（Ｐ＝０．０５）。提示现行放射免疫测定的糖负荷后２小时胰岛素水平是致血压升高的独立危险因素。     

胰淀素对大鼠胰岛素分泌的影响及其机理的探讨

目的　为研究胰淀素（ Ａｍｙｌｉｎ） 对大鼠胰岛细胞分泌胰岛素的影响和机理。方法　用放免和荧光方法分别检测经不同浓度胰淀素温育的大鼠胰岛细胞的胰岛素分泌量、细胞内 Ｃａ 《及ｃ Ａ Ｍ Ｐ 含量。结果　在胰淀素１０μｍｏｌ／ Ｌ 组中高糖刺激下的胰岛素含量、细胞内 Ｃａ 《含量，细胞内ｃ Ａ Ｍ Ｐ 含量分别为０ ．８９ ±０ ．２１ｎｇ／ ｍｌ、６３ ±１０ｎｍｏｌ／ Ｌ、２９ ．３ ±３ ．３ｐｍｏｌ／１ ×１０６ 细胞与对照组（１ ．７５ ±０ ．４２ｎｇ／ｍｌ、１３５ ±１０ｎ ｍｏｌ／ Ｌ、３６ ．３ ±７ ．４ｐｍｏｌ／ Ｌ） 比较，其中胰岛素分泌量、细胞内 Ｃａ 《含量均明显降低， Ｐ＜ ０ ．０１ ，细胞内ｃ Ａ Ｍ Ｐ 含量有减少趋势。结论　高浓度的胰淀素抑制了胰岛细胞内 Ｃａ 《升高和／ 或细胞内ｃ Ａ Ｍ Ｐ 形成，可能是胰岛素分泌减少的原因之一。     

实验性非胰岛素依赖型糖尿病大鼠肝脏葡萄糖激酶活性的改变

目的研究实验性非胰岛素依赖型糖尿病（ＮＩＤＤＭ）大鼠肝脏葡萄糖激酶活性的改变。方法选用雄性Ｗｉｓｔａｒ大鼠１３只用半量链脲佐菌素（３０μｇ／ｇ体重）加高脂、高糖、高热量饲料喂养１８周，制成类非胰岛素依赖型糖尿病模型，另选用２０只作为对照组，观察两组血糖和胰岛素释放水平，同时测肝脏葡萄糖激酶活性。结果糖尿病组肝脏葡萄糖激酶活性（２．１７±０．２０Ｕ／ｇ肝组织）明显低于正常对照组（２．８７±０．１１Ｕ／ｇ肝组织，Ｐ＜０．０１）。结论肝脏葡萄糖激酶活性降低可能参与ＮＩＤＤＭ的发病机制     

糖尿病患者血清生长激素与肌酐清除率

测定了１６例胰岛素依赖型糖尿病（ＩＤＤＭ）患者，１９例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和２３例对照者的血清生长激素（ＧＨ）水平。在ＩＤＤＭ组，无论是肌酐清除率（Ｃｃｒ）正常或减低，其ＧＨ值均为２．５３±１．７３μｇ／Ｌ，均高于对照组的０．７１±０．５３μｇ／Ｌ（Ｐ＜０．０５），ＧＨ与Ｃｃｒ呈负相关（ｒ＝０．６３，Ｐ＜０．０１），ＮＩＤＤＭ组Ｃｃｒ＜５０ｍｌ／ｍｉｎ者ＧＨ值为１．８３±０．４７μｇ／Ｌ显著高于对照组（Ｐ＜０．０５）和Ｃｃｒ＞８０ｍｌ／ｍｉｎ组（ＧＨ０．８３±０．４９μｇ／Ｌ，Ｐ＜０．０５）。糖尿病（ＤＭ）伴微血管并发症者，ＧＨ值为２．９２±１．７０μｇ／Ｌ，高于无此并发症者ＧＨ１．２４±０．９７μｇ／Ｌ，（Ｐ＜０．０１），认为ＧＨ与ＤＭ微血管并发症有关。     

胰淀素对优降糖刺激大鼠胰岛素分泌作用的影响及其机制

目的研究胰淀素对磺脲类降糖药刺激大鼠胰岛细胞分泌胰岛素作用的影响和机制。方法用放免和荧光方法分别检测经不同浓度胰淀素温育后再行优降糖刺激试验的胰岛细胞胰岛素分泌量、细胞内Ｃａ２＋含量。结果在胰淀素５μｍｏｌ／Ｌ、１０μｍｏｌ／Ｌ组中,３ｎｍｏｌ／Ｌ优降糖刺激下的胰岛素分泌量分别为（３８±１０）μｇ／Ｌ、（２１±１０）μｇ／Ｌ,均比对照组（４９±０９）μｇ／Ｌ低（ｔ＝２３１３,Ｐ＜００５;ｔ＝５８８７,Ｐ＜００１）;细胞内Ｃａ２＋含量为（２７０±１５）ｎｍｏｌ／Ｌ、（１３０±１５）ｎｍｏｌ／Ｌ,均显著低于对照组（３３０±１８）ｎｍｏｌ／Ｌ,并呈剂量相关性（ｔ＝７２４３,Ｐ＜００１;ｔ＝２４１４３,Ｐ＜００１）。结论高浓度的胰淀素抑制优降糖刺激胰岛β细胞内Ｃａ２＋浓度增加可能是胰岛素分泌减少的机制之一。     

NIDDM病人红细胞变形能力与红细胞ATP酶活性和红细胞内离子浓度关系的研究

本文检测了４２例ＮＩＤＤＭ病人红细胞变形能力（ＥＤ）和红细胞ＡＴＰ酶活性、红细胞内离子浓度的变化。结果显示ＮＩＤＤＭ病人红细胞滤过指数（ＩＦ）较对照组明显增高（Ｐ＜０．００１）；红细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶和Ｃａ２＋－ＡＴＰ酶活性较对照组明显降低（Ｐ＜０．０１），Ｍｇ２＋－ＡＴＰ酶活性变化不明显；红细胞内Ｎａ＋、Ｃａ２＋浓度较对照组明显增高（Ｐ＜０．０１），而Ｍｇ２＋浓度较对照组明显降低（Ｐ＜０．０１）。有血管病变者这些变化较无血管病变者更明显。ＮＩＤＤＭ病人红细胞ＩＦ与Ｎａ＋－Ｋ＋－ＡＴＰ酶、Ｃａ２＋－ＡＴＰ酶活性呈负相关（ｒ＝－０．４６８，－０．４５８，Ｐ＜０．００１），与红细胞内Ｎａ＋、Ｃａ２＋浓度呈正相关（ｒ＝－０．４７３，０．４６６，Ｐ＜０．Ｄ０１），与Ｍｇ２＋浓度呈负相关（ｒ＝－０．４３６，Ｐ＜０．０１）。     

高血压和高胰岛素血症关系的初步探讨

对１０例体重指数（ＢＭＩ）正常的老年高血压患者和１１例体重指数正常、血压正常的老年对照者进行口服葡萄糖耐量试验（ＯＧＴＴ），检测血糖、血脂、胰岛素水平、红细胞膜钠钾泵活性。结果表明，体重指数正常的高血压患者与对照组比较，存在高胰岛素血症（餐后１２０分钟胰岛素分别为：７４．３±２．３μＵ／ｍｌ及３０．０±２．μＵ／ｍｌ，Ｐ＜０．０５）、高脂血症。多元相关分析进一步表明，去除年龄、体重的影响，收缩压（ＳＢＰ）和餐后１２０分钟胰岛素仍呈正相关（ｒ＝０．５０９９，Ｐ＜０．０５），说明胰岛素是致高血压的一个因素。本实验还发现ＳＢＰ、舒张压（ＤＢＰ）和钠钾泵呈负相关，且钠钾泵和胰岛素曲线下面积（ＡｒｅｎＵｎｄｅｒＣｕｒｖｅ，ＡＵＣ）呈负相关（ｒ＝－０．４５０５，Ｐ＜０．０５）。这证实胰岛素致高血压作用可能是胰岛素抵抗影响钠钾泵活性所致。     

预防食管静脉曲张破裂再出血的随机对照临床试验

目的比较预防食管静脉曲张再出血的两种药物方案（联用方案：５－单硝酸异山梨醇酯（ＩＳ－５－ＭＮ）联用螺内酯；单用方案：螺内酯）的疗效。方法所有经临床、实验室资料及内镜证实为食管静脉曲张出血的６３例连续的病便，在出血停止、生命体征平稳的两周后被随机分成两组，分别接受联用方案（ｎ＝３２，ＩＳ－５－ＭＮ４０ｍｇＱＮｐｏ，螺内酯２０～４０ｍｇＱＩＤｐｏ）和单用方案（螺内酯２０～４０ｍｇＱＩＤｐｏ）。全部病人随访至研究终点。结果联用方案组３２例患者的平均无出血时间（ＭＦＢＤ）比单用方案组长，但无统计学意义（３１０±５８ｖｓ１８０±４４天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０８６７）。ＣｈｉｌｄＡ和ＣｈｉｌｄＢ的两组患者的ＭＦＢＤ的差异有显著性（ＣｈｉｌｄＡ，３７２±４ｖｓ２５９±６４天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０４９８；ＣｈｉｌｄＢ，２８０±３２ｖｓ１６７±８７天，ＬｏｇＲａｎｋ检验，Ｐ＝０．０４９１），但ＣｈｉｌｄＣ的两组的ＭＦＢＤ无统计学上的差别（６５±２２ｖｓ５３±１２天，ＬｏｇＲａｎｋ检验Ｐ＝０．８３１５）。结论５－单硝酸异山梨醇酯联用螺内酯对预防ＣｈｉｌｄＡ和ＣｈｉｌｄＢ的食管静脉曲张再出血较单用螺内酯有效。     

GM—CSF及IL—4增强肝癌患者树突状细胞免疫功能

目的　探讨粒／ 巨噬细胞集落刺激因子（ ＧＭＣＳＦ） 及白介素４（ＩＬ４） 对正常成人及肝癌患者树突状细胞（ＤＣ） 表面人白细胞抗原（ＨＬＡ）ＤＲ 及Ｂ７２ 等免疫分子表达及其免疫功能的影响。方法　以ＧＭＣＳＦ 及ＩＬ４ 联合刺激正常成人（ｎ ＝ １０） 及肝癌患者（ｎ ＝ １０）ＤＣ,检测经ＧＭＣＳＦ 及ＩＬ４ 联合刺激前后ＤＣ 表面ＨＬＡＤＲ 及Ｂ７２ 表达水平及ＤＣ 免疫功能变化。结果　经ＧＭＣＳＦ 及ＩＬ４ 联合刺激后ＤＣ 表面ＨＬＡＤＲ 及Ｂ７２ 表达水平在肿瘤患者（６－７ ±１－６ 、６－１ ±１－１ 增至１３－１ ±２－３ 、１１－４ ±２－０ＶＯＦ,Ｐ＜ ０－０１） 及正常成人（１０－７ ±１－４ 、９－６ ±１－２ 增至１４ ±２－２ 、１１ ±１－７ＶＯＦ,Ｐ＜ ０－０５） 均有增高;该ＤＣ 免疫诱导能力亦相应增强（ 肝癌患者：由３１００ ±１２０ 增至６４００ ±１４０ｃｐｍ ,Ｐ＜ ０－０１ ;正常人：由６２００ ±９０ 增至７０００ ±１１０ｃｐｍ ,Ｐ＞ ０－０５） 。结论　ＧＭＣＳＦ 及ＩＬ４ 联合刺激能增强正常成人及肝癌患者ＤＣ 表面ＨＬＡＤＲ 及Ｂ７２ 表达水平并进一步增强ＤＣ 免疫功能。提示联合应     

小肠脂酸结合蛋白基因54号密码子变异与中国人糖尿病发病机制的关系

在２３１例中国人中观察小肠脂酸结合蛋白基因（ＦＡＢＰ２）５４号密码子变异与ＮＩＤＤＭ及其病理生理以及肥胖的关系。结果：ＦＡＢＰ２－Ｔｈｒ５４（＋）基因型个体呈糖耐量减退时的空腹Ｃ肽、糖负荷后２小时Ｃ肽、负荷后３小时内Ｃ肽总值及面积均显著低于Ｔｈｒ５４（－）基因型个体（Ｐ分别为０．０４、０．０３、０．０１及０．０１）。胰岛素有同样变化趋向。结果表明：中国人中的ＦＡＢＰ２－Ｔｈｒ５４（＋）个体胰岛β细胞的葡萄糖刺激胰岛素分泌功能储备不及Ｔｈｒ５４（－）者。ＦＡＢＰ２－５４号密码子变异可能参与糖尿病发病中胰岛素分泌不足的机制。     

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.