老年高血压合并2型糖尿病患者血尿酸、血清同型半胱氨酸水平及临床意义

目的 分析血尿酸(SUA)、血清同型半胱氨酸(Hcy)与老年高血压合并2型糖尿病(T2DM)的关系.方法 将该院收治的125例老年高血压患者分两组,对照组56例为单纯高血压组,实验组69例为高血压合并T2DM患者,血SUA及Hcy含量采用酶联免疫法以及全自动生化分析仪进行测定.结果 实验组血SUA水平为(360.50 ±65.54) mmol/L,对照组为(312.15±60.75)mol/L,两组间差别有统计学意义(P＜0.05).实验组血Hcy水平为(19.60±5.25) μmol/L,对照组为(16.25 ±4.80) μmol/L,两组间差别有统计学意义(P＜0.05).结论 高SUA、高Hcy血症在老年高血压合并T2DM患者中高发,是老年高血压合并T2DM的危险因素.     

同型半胱氨酸及血尿酸与2型糖尿病血管并发症的关系

目的探讨同型半胱氨酸(Hcy)及血尿酸(SUA)与2型糖尿病(T2DM)血管并发症的关系。方法根据有无血管并发症将93例T2DM患者分为T2DM合并血管病变者52例(Ⅰ组)和T2DM未合并血管病变者41例(Ⅱ组),另选取健康体检者45名作为对照组,分别测量三组受试者的Hcy、SUA水平。结果三组间Hcy和SUA水平比较差异具有统计学意义(P0.05),水平由高至低依次为Ⅰ组Ⅱ组对照组。高Hcy组和高SUA组合并血管并发症发生率均明显高于正常Hcy组和正常SUA组(P0.05)。结论 Hcy和SUA水平与T2DM血管并发症关系密切。     

2型糖尿病合并非酒精性脂肪性肝病与血脂代谢紊乱的关系

目的探讨2型糖尿病(T2MD)合并非酒精性脂肪性肝病(NAFLD)与血脂代谢紊乱之间的关系。方法选取184例T2DM合并NAFLD患者和150例单纯T2MD患者,检测两组患者身高、体重、血糖指标、血脂指标等并进行比较;运用Logistic回归分析对T2DM合并NAFLD影响因素进行分析。结果与T2DM组比较,T2DM+NAFLD组患者空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、空腹C肽、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白(Apo)B、天门冬氨酸氨基转移酶(AST)、谷氨酸氨基转移酶(ALT)、谷胺酰转肽酶(GGT)、血尿酸(SUA)水平均明显升高,高密度脂蛋白胆固醇(HDL-C)水平明显降低(均P0.05);经Logistic回归分析发现,体重指数(BMI)、TG、HOMA-IR、ALT、SUA是T2DM合并NAFLD的危险因素。结论 T2DM合并NAFLD患者存在明显血脂代谢紊乱,同时也与BMI、SUA、胰岛素抵抗密切相关。     

老年代谢综合征人群血尿酸水平及影响因素相关分析

目的探讨老年代谢综合征(MS)合并高尿酸血症的临床特征。方法将258例老年干部人群分为MS高尿酸血症组、MS正常血尿酸组和老年健康对照组,测定其腰围、体重指数(BMI)、血压(SBP,DBP)、血糖(FBG,PBG)、甘油三酯(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血清胰岛素(FINS)、血肌酐(Cr)、血尿酸(UA),游离脂肪酸(FFA),用最小稳态模型计算胰岛素抵抗指数(HOMA-IR)。结果与老年MS正常血尿酸组相比,老年MS高尿酸血症组的BMI、DBP、TG、FINS、HOMA-IR、FFA、Cr水平明显升高,而HDL-C水平降低。血尿酸与FINS、FFA、TG、HOMA-IR、BMI、FBG正相关,与HDL-C负相关。多元逐步回归分析显示:TG、HDL-C、HOMA-IR是老年MS合并高尿酸血症的独立危险因素,结论舒张压、血肌酐、甘油三酯、高密度脂蛋白、胰岛素抵抗与老年MS合并高尿酸血症密切相关,血尿酸水平的升高是代谢综合征的危险因素     

影响2型糖尿病患者血尿酸水平的相关因素分析

回顾性分析186例2型糖尿病患者血尿酸(SUA)水平,比较高尿酸血症组(HUA组)和正常血尿酸组(UA正常组)的性别、年龄、病程、体重指数(BMI)、平均动脉压(MAP)、血脂、糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、空腹血清胰岛素(FINS)、血尿酸(SUA)、胰岛素抵抗指数(HOMA-IR)、肌酐清除率(Ccr)等指标,并对血尿酸的影响因素进行多元逐步回归分析,比较病程为0-5年(A组)、5-10年(B组)、10-15年(C组)三组间的血尿酸水平。结果:HUA组的甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、FPG、FINS、SUA、HOMA-IR高于UA正常组(P0.05);多元逐步回归分析显示,病程、BMI、TG、Hb A1c、Ccr和HOMA-IR是影响血尿酸的独立相关因素,其中Ccr和SUA呈负相关;不同病程组间的血尿酸水平有统计学差异,病程越长血尿酸水平越高。结论:2型糖尿病合并高尿酸血症与糖尿病病程的延长、肥胖、高甘油三酯、高血糖、肌酐清除率的下降及胰岛素抵抗密切相关。     

新诊断2型糖尿病患者血清尿酸水平的影响因素分析

目的探讨新诊断T2DM患者血清尿酸(SUA)水平的影响因素。方法选取新诊断T2DM患者490例,根据SUA水平分为合并高尿酸血症(T2DM+HUA)组67例和单纯T2DM组(T2DM组)323例。测定临床及相关生化指标,分析SUA升高的影响因素。结果 (1)新诊断T2DM患者高尿酸血症的患病率为13.67%(67/490),男性高于女性[9.80%(48/490)vs 3.88%(19/490),P=0.012];(2)T2DM+HUA组BMI、WC、谷丙转氨酶(ALT)、谷草转氨酶(AST)、TG、C-P、胰岛素抵抗指数(HOMA-IR)均高于T2DM组,年龄、HbA1c、HDL-C、ISI低于T2DM组(P0.05);(3)多元线性回归分析显示,年龄、女性及HDL-C为SUA的保护性因素,2hC-P为SUA水平增高的危险因素。年龄是男性HUA的保护性因素,2hC-P为SUA水平增高的危险因素。HDL-C和ISI为女性HUA的保护性因素,脱酸脱氢酶(LDH)和2hC-P是女性HUA发生的危险因素。结论新诊断T2DM患者SUA水平受年龄、性别、肝功能、HDL-C及IS影响。     

血尿酸水平在非酒精性脂肪肝发病中的变化

目的研究血尿酸与非酒精性脂肪肝之间的关系。方法选取单纯非酒精性脂肪肝患者40例,非酒精性脂肪肝合并Ⅱ型糖尿病患者72例,健康体检者62例为研究对象。测定体质量指数(BMI),检测空腹血糖(FBG)、尿酸(SUA)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、胆固醇(TC)、甘油三酯(TG)、糖化血红蛋白(HbA1C)、尿微量白蛋白/尿肌酐(Ualb/UCr)等生化指标并行肝脏B超检查。放射免疫法测定空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA IR)。结果非酒精性脂肪肝合并Ⅱ型糖尿病组BMI、SUA、ALT、AST、TG、FBG、FINS、HOMA IR、HbA1C、Ualb/UCr均高于对照组;与单纯非酒精性脂肪肝比较,非酒精性脂肪肝合并Ⅱ型糖尿病组胰岛素抵抗及SUA水平更重;相关性研究表明,FBG、HOMA IR、HbA1C与SUA呈正相关。结论非酒精性脂肪肝患者存在明显的胰岛素抵抗及高血尿酸血症,且两者具有一定的相关性,但SUA是否是NAFLD发病的独立危险因素有待进一步研究证实。     

非酒精性脂肪肝血尿酸水平与胰岛素抵抗的相关性

目的:研究非酒精性脂肪肝(non-alcoholic fatty liver,NAFL)患者血尿酸水平及其与胰岛素抵抗程度的相关性.方法:选取单纯NAFL患者40例,NAFL合并2型糖尿病患者(type2diabetes mellitus,T2DM)72例,健康体检者62名为研究对象.测定体重指数(body mass index,BMI),检测空腹血糖(fasting blood glucose,FBG)、尿酸(serum uric acid,SUA)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、胆固醇(cholesterol,TC)、甘油三酯(triglyceride,TG)、糖化血红蛋白(glycated hemoglobin,HbA1C)、尿微量白蛋白/尿肌酐(Ualb/UCr)等生化指标并行肝脏B超检查.放射免疫法测定空腹胰岛素(fasting insulin,FINS),计算胰岛素抵抗指数(HOMA IR).结果:NAFL合并T2DM组BMI、SUA、ALT、AST、TG、FBG、FINS、HOMA IR、HbA1C、Ualb/UCr、SF均高于对照组;与单纯NAFL比较,NAFL合并T2DM组胰岛素抵抗及SUA水平更重;相关性研究表明FBG、HOMA IR、HbA1C与SUA呈正相关.结论:NAFL患者存在明显的胰岛素抵抗及高血尿酸血症,且两者具有一定的相关性.降低胰岛素抵抗联合纠正尿酸代谢紊乱对防止NAFL的发生发展具有重要的临床意义.     

2型糖尿病合并非酒精性脂肪肝的危险因素分析

目的探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的危险因素。方法选取住院T2DM患者139例,根据肝脏B超检查结果分为NAFLD组和无NAFLD组,回顾性分析了两组患者的各个相关临床指标,采用Logistic多元回归分析筛选危险因素。结果 139例2型糖尿病患者中,合并非酒精性脂肪肝组的体质量指数(BMI)、胰岛素抵抗指数(HOMA-IR)、空腹血清胰岛素(FIn S)、空腹血糖(FPG)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、血尿酸水平(UA)均显著增高;高密度脂蛋白(HDL-C)显著低于未合并非酒精性脂肪肝组。上述差异均有统计学意义(P0.05)。Logistic多元回归分析显示,BMI、TG是糖尿病发生NAFLD的独立危险因素(P0.05)。结论 T2DM合并NAFLD与肥胖、脂代谢紊乱、胰岛素抵抗密切相关。     

老年2型糖尿病合并高尿酸血症患者早期肾损害预测模型的构建与分析

目的 探讨老年2型糖尿病(T2DM)合并高尿酸血症患者早期肾损害发生情况及影响因素,并构建预测模型。方法 纳入老年T2DM合并高尿酸血症患者200例,根据是否发生早期肾损害将其分为早期肾损害组(96例)和非早期肾损害组(104例),收集其一般临床资料及实验室检查结果并进行组间比较。采用多因素logistic回归分析评估老年T2DM合并高尿酸血症患者发生早期肾损害的危险因素,并构建预测模型;采用受试者工作特征(ROC)曲线评价该模型的预测价值。结果 早期肾损害组患者年龄、糖尿病病程、糖化血红蛋白(HbA1c)、甘油三酯(TG)、血尿酸(SUA)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)及24 h尿微量白蛋白水平均高于非早期肾损害组(P<0.05)。多因素logistic回归分析结果显示,年龄、糖尿病病程、BMI、HbA1c、TG、SUA、CRP、Hcy及24 h尿微量白蛋白均是老年T2DM合并高尿酸血症患者发生早期肾损害的独立危险因素(P<0.05)。构建logistic回归预测模型,验证结果显示模型建立具有统计学意义、构建有效、拟合效果较好。ROC曲线分析结果显示,该l...     

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.     

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.     

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.