肾脏异位脂质沉积与糖尿病肾脏病脂毒性机制的研究进展

糖尿病肾脏病是常见的糖尿病微血管并发症之一。研究发现早期糖尿病肾脏病患者肾内就已发现有异位脂质沉积,其可引起肾内细胞发生脂毒性损伤。异位脂质沉积主要与脂肪酸摄取、氧化利用失衡及脂代谢紊乱有关。本文从异位脂质沉积导致肾脏结构改变、肾内异位脂质沉积形成以及其形成后导致肾脏受损诱发糖尿病肾脏病最新机制进行了详细阐述,同时就基...     

他汀类药物在慢性肾脏病患者中的应用

目前,慢性肾脏病(CKD)已经成为威胁全球人类健康的重大疾病之一,中国CKD的患病率约10.8％.既往研究显示,CKD患者心血管疾病的发病率和死亡率很高,而血脂异常作为CKD患者心血管疾病的一个独立危险因素,与肾脏疾病密切相关.脂代谢紊乱既是CKD的一种伴随的生化改变,也是CKD发生发展的始动因素.     

慢性肾脏病患者调脂治疗的思考

脂质代谢紊乱在慢性肾脏病(CKD)患者中普遍存在,不仅能导致CKD的进展,而且增加了心血管事件发生的概率.然而,临床医师对CKD患者的调脂治疗并不十分积极,既考虑CKD的不同发展阶段调脂治疗是否获益,也担忧药物的安全性和耐受性.因此,本文主要从目前的试验证据出发阐明CKD不同发展阶段的患者是否需要接受调脂治疗,如何应用、何时开始及能否从中获益等问题.     

慢性肾脏病患者的血脂管理

<正>慢性肾脏病(CKD)患者常合并血脂代谢异常,通常表现为三酰甘油升高、高密度脂蛋白降低,低密度脂蛋白和总胆固醇的变化个体差异较大。合并脂代谢紊乱可增加CKD患者动脉粥样硬化和心血管事件的发生风险。2013年改善全球肾脏病预后组织(KDIGO)发布了《CKD患者血脂管理临床实践指南》,对CKD患者的血脂管理给出了初步建议,但随着对CKD合并脂代谢紊乱认识的不断加深,我们发现,CKD患者的血脂管理领域仍有很多问题有待进一步探索。     

脂代谢紊乱在糖尿病肾脏疾病发病机制中的研究进展

DKD患者常伴血脂紊乱,脂质调控与DKD发生发展密切相关.脂质通过沉积、脂质修饰、促发炎症反应、诱导IR、促进细胞凋亡等多种途径,参与DKD发生发展.本文对脂代谢紊乱在DKD发病机制中的研究进展进行综述,旨在为临床治疗DKD提供依据.     

脂代谢紊乱与肾损害及其临床处理

早在1982年,Moorhead[1]就提出脂类聚集可以导致慢性的肾损伤,近30年来多项的动物试验和临床研究都证明脂代谢紊乱还能促发肾小球硬化和肾小管间质损伤,与慢性肾脏疾病(CKD)的进展有关,而降脂治疗可以减少肾损伤,保护残余肾功能.     

脂蛋白肾小球病--由载脂蛋白E变异诱导的肾脏脂质沉积症

许多研究证实,继发于肾病综合征、高血压及饮食失衡的高脂血症可以引起肾小球硬化,其病变性质与被氧化的低密度脂蛋白(ＬＤＬ)所致的动脉性硬化性病变相似,一些遗传性脂质代谢异常引起的全身性疾病如Ｆａｂｒｙ病(卵磷脂酰基转移酶缺乏)和ＶｏｎＧｉｅｒｋｅ病也可引起特殊的肾脏脂质沉积[1～3];与上述肾脏脂质沉积症相比,脂蛋白肾小球病(ＬｉｐｏｐｒｏｔｅｉｎＧｌｏｍｅｒｕｌｏｐａｔｈｙ,ＬＰＧ)是近十年来发现的一种新的独立的肾小球疾病,它以毛细血管袢高度扩张,袢内充满脂蛋白栓塞为特征。Ｓａｉｔｏ的研究强调ＬＰＧ的发生与载脂蛋…     

脂蛋白脂肪酶与糖尿病

脂蛋白脂肪酶(LPL)是甘油三酯(TC)水解的限速酶,其基因缺失和基因多态性与糖、脂代谢紊乱的发生、发展密切相关.LPL功能紊乱可引起胰岛素抵抗甚至糖尿病,其可能机制包括:脂质异位沉积与胰岛素信号转导通路受损、内质网应激、氧化应激、炎性反应.明确LPL在糖尿病发生、发展中的作用,为防治糖尿病提供了新的思路.     

脂代谢紊乱与肾损害及其临床处理

早在1982年，Moorhead就提出脂类聚集可以导致慢性的肾损伤，近30年来多项的动物试验和临床研究都证明脂代谢紊乱还能促发肾小球硬化和肾小管间质损伤，与慢性肾脏疾病（CKD）的进展有关，而降脂治疗可以减少肾损伤，保护残余肾功能。[第一段]     

他汀类药物与肾脏损害

他汀是一类目前最强效的调脂药物,可用于患有肾脏疾病合并高脂血症的患者.有临床观察提示,他汀类药物通过纠正血脂代谢紊乱,可降低肾脏疾病患者发生缺血性心血管疾病如冠心病和缺血性脑卒中等危险;此外还有可能通过改变肾脏血液动力学或抑制炎症反应等作用,改善肾功能或延缓肾功能的恶化.     

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.