1,5-脱水葡萄糖醇测定在糖耐量减低及糖尿病患者中的应用价值及临床意义

目的 评价1,5-脱水葡萄糖醇(1,5-AG)作为一项新的指标在糖耐量减低(IGT)及糖尿病患者中的应用价值及临床意义.方法 所有受试者均经口服葡萄糖耐量试验(OGTT),用吡喃糖氧化酶(PROD)法测定糖耐量正常(NGT)、IGT、2型糖尿病(T2DM)受试者1.5-AG血清水平.结果 正常人(30例)为1,5-AG水平(26.76±5.28) mg/L;IGT者(100例)为(21.43±2.52) mg/L;糖尿病患者(50例)为(10.69±2.72) mg/L,糖尿病组1,5-AG水平显著低于正常对照和IGT组(P＜0.01),IGT组1,5-AG低于正常对照组(P＜0.05).血清1,5-AG与空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)均呈显著负相关.1,5-AG、FPG和HbA1c分别以14 mg/L、6.2 mmol/L和6.4 %作为诊断参考值,其敏感性分别为90.0%、88.0%、82.0%;特异性分别为93.3%、90.0%、76.7%.结论 血清1,5-AG与糖耐量下降相关,IGT及糖尿病患者1,5-AG水平显著降低,血清1,5-AG含量测定可作为糖尿病诊断、筛选和血糖控制监测的指标.     

应用受试者工作特征曲线分析糖化血红蛋白对于2型糖尿病的诊断价值

目的 探讨HbA1c对于T2DM的诊断价值. 方法 选取T2DM患者230例,IGR患者130例和糖耐量正常（NGT）者102名,行75 gOGTT,同时测定FPG、2 hPG、HbA1c等临床指标. 结果 T2DM组FPG、2 hPG高于IGR、NGT组,IGR组FPG与NGT组比较差异无统计学意义.IGR组2hPG高于NGT组.T2DM组HbA1c高于IGR、NGT组（P＜0.01）,IGR组与NGT组比较差异无统计学意义.Pearson相关性分析显示,HbA1c与FPG、2hPG呈正相关（r=0.698、0.652,P=0.000）.受试者工作特征（ROC）曲线显示,HbA1c≥6.4％为诊断切点的曲线下面积0.922（95％CI：0.899～0.946）,HbA1c≥6.4％时与FPG及与2 hPG诊断T2DM的曲线下面积比较差异无统计学意义（P＞0.05）. 结论 HbA1c可作为T2DM诊断标准之一,HbA1c≥6.4％为最佳诊断切点.     

糖代谢异常对肱动脉内皮舒张功能影响的研究

目的 探讨葡萄糖代谢异常对肱动脉血管内皮舒张功能的影响.方法 应用高分辨率超声测量39例糖耐量减低(IGT)、47例T2DM和44例糖耐量正常者(NGT)反应性充血前后及含服硝酸甘油后肱动脉内径的变化.结果 IGT、T2DM组肱动脉内皮舒张功能均受损,T2DM组、NGT组分别与IGT组比较,差异有统计学意义(P＜0.05),T2DM组较NGT组差异明显(P＜0.01).与NGT组比,IGT组、T2DM组FPG、 HbA1c、LDL-C升高,与内皮依赖性血管舒张功能(EDVR)负相关;HDL-C降低,与EDVR正相关(P均＜0.01).结论 葡萄糖代谢异常可对肱动脉内皮舒张功能造成损伤.     

糖化血红蛋白联合空腹血糖检测在甲状腺功能亢进伴糖代谢异常患者中的诊断价值

目的探讨甲状腺功能亢进(下称"甲亢")患者采用HbA_1c联合FPG筛查糖尿病及糖尿病前期的敏感性和特异性并确定相应的最佳切点。方法选取2013~2016年于我院内分泌科住院的甲亢患者508例,行OGTT,检测HbA_1c、FPG及2hPG,测定身高和体重,计算BMI,采用受试者工作特征曲线(ROC)获得HbA_1c诊断和筛查糖尿病及糖尿病前期的相关切点及阳性似然比(+LR)、阴性似然比(-LR)。结果糖耐量正常组(NGT)、糖尿病前期组(IGR)、糖尿病(DM)组HbA_1c水平依次升高[(5.3±0.2)%vs(5.5±0.3)%vs(6.0±0.4)%,P0.001]。依据ROC曲线判定,本组人群中HbA_1c筛查糖尿病前期的最佳临界点为5.4%,敏感性为55.9%,特异性为64.39%。HbA_1c诊断糖尿病的最佳临界点为5.5%,敏感性为79.71%,特异性为73.16%。结论 HbA_1c可准确反映甲亢患者不同阶段的糖代谢异常状态,在甲亢患者中诊断和筛查糖尿病前期及糖尿病的ROC切点分别为5.4%与5.5%。HbA_1c联合FPG筛查糖尿病与OGTT诊断结果的吻合度有统计学意义(P0.001),较单独HbA_1c诊断糖尿病吻合度高。     

不同糖耐量水平者的血管内皮功能的研究

目的 观察不同糖耐量水平者的血管内皮功能的变化.方法 86例受试者根据糖耐量分三组:正常糖耐量(NGT)组27例,糖耐量减退(IGT)组31例,糖尿病(DM)组28例.采集空腹静脉血测血脂(TC、TG、LDL-C、HDL-C)、血糖(FPG)及胰岛素(INS)、糖化血红蛋白(HbAlc)、高敏C.反应蛋白(hs.CRP)、血管性血友病因子(vWF)等,并行OGTT2小时后采静脉血测血糖(2hPG)及胰岛素(2 hINS);应用高分辨率超声检测肱动脉内皮依赖的舒张功能(EDD).结果 DM组的2 hPG、2 hINS、HbAlc、hs.CRP、vWF较NGT组及IGT组明显升高(P＜0.01),DM组的肱动脉EDD较NGT组及IGT组明显减低(P＜0.01);IGT组的2 hPG、2 bINS、hs-CRP、vWF较NGT组明显升高(P＜0.05-0.01),IGT组的肱动脉EDD较NGT组明显减低(P＜0.01).多因素逐步回归分析显示:EDD与2 hPG,HbAlc,2 MNS及hs-CRP明显负相关(r分别为-0.67、-0.56、-0.52、-0.49,均P＜0.01).结论 IGT存在血管内皮功能受损,DM血管内皮功能受损更严重.餐后血糖对血管内皮功能损害尤为明显.     

血清Irisin水平与脂肪细胞型脂肪酸结合蛋白的相关性研究

目的探讨T2DM患者血清Irisin水平与脂肪细胞型脂肪酸结合蛋白(FABP4)的相关性。方法招募上海市奉贤区志愿者460名,根据75 g OGTT结果确定新诊断T2DM患者(T2DM组)56例,糖耐量正常者112名作为对照组(NGT)。测定糖脂代谢参数、Irisin及FABP4水平。结果 T2DM组WC、BMI、体脂百分比、SBP、DBP、ALT、TG、FPG、2 hPG、HbA_1c、HOMA-IR、SUA、eGFR较NGT组升高,HOMA-β低于NGT组(P0.05或P0.01)。Pearson相关性分析显示,Irisin与eGFR呈正相关;T2DM组血清Irisin与HbA_1c呈正相关(r=0.292,P=0.029),与FABP4呈负相关(r=-0.285,P=0.033)。校正年龄、BMI、体脂百分比、SBP、TC、eGFR,行多元线性回归分析结果显示,T2DM组HbA_1c和FABP4是Irisin的独立影响因素(R~2=0.350,P=0.025)。结论本研究表明,Irisin水平与糖脂代谢及肾功能密切相关。新诊断T2DM患者血清Irisin与FABP4呈负相关,提示Irisin可能有拮抗FABP4的作用。     

新诊断2型糖尿病患者胰岛β细胞功能相关因素的研究

目的 观察新诊断T2DM患者胰岛β细胞功能的变化,并分析其相关因素,为T2DM的临床治疗提供参考. 方法 对414例新诊断T2DM患者及143名正常糖耐量(NGT)人群行75 g OGTT和胰岛素释放试验,分别按照FPG、2 hPG、HbA1c和BMI进行分组,稳态模型评估胰岛β细胞功能指数(HOMA-β)、糖负荷后30 min净增胰岛素/净增血糖的比值(△I30/△G30)和胰岛素曲线下面积(AUC1).结果 T2DM各亚组FIns随FPG、2 hPG、HbA1 c升高而升高,当FPG≤13.0 mmol/L、2 hPG≤20.0mmol/L、HbA1c≤12.0％时,FIns开始下降;BMI≥25.0 kg/m2亚组FIns[(11.29±4.83) μIU/ml]高于其他组(P＜0.05).T2DM各亚组随FPG、2 hPG、HbA1c升高,HOMA-β、△I30/△G30呈进行性下降趋势;BMI≥25 kg/m2亚组HOMA-β、△I30/△G30高于其他两亚组,但均低于NGT组.AUC1随FPG、2 hPG、HbA1 c升高渐升高,当FPG≤13.0 mmol/L、2 hPG≤24.0 mmol/L和HbA1c≤12.0％时开始下降,NGT组高于18.5 kg/m2≤BMI＜23.0 kg/m2亚组,低于BMI≥25 kg/m2亚组. 结论 新诊断T2DM患者胰岛p细胞功能与高血糖程度密切相关,血糖和HbA1c是简单反映胰岛β细胞功能的指标;非肥胖患者胰岛β细胞功能较肥胖者差.     

不同糖耐量人群血清nesfatin-1水平及相关因素分析

目的 研究不同糖耐量人群血清nesfatin-1水平变化,及其与体重指数(BMI)、血糖、胰岛素敏感性等的关系.方法 115例研究对象分为正常糖耐量组(NGT组,33例)、糖耐量减低组(IGT组,30例)和新诊2型糖尿病组(T2DM组,52例)3组.根据BMI将T2DM组分为糖尿病肥胖组(T2DM-OB组,22例)和糖尿病正常体重组(T2DM-NW组,30例).采用ELISA法检测血清nesfatin-1水平.同时测定空腹血糖(FPG)、餐后2h血糖(2 h PG)、白细胞介素-6(IL-6)、胰岛素、糖化血红蛋白A1c(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C).T2DM-OB组给予吡格列酮治疗,使仅BMI高于T2DM-NW组(P＜0.05)后再次检测血清nesfatin-1水平.计算稳态模型评估-胰岛素抵抗指数(HOMA-IR)、BMI、腰臀比(WHR)等.结果(1)T2DM组和IGT组血清nesfatin-1水平显著高于NGT组[(1 780±660) ng/L,(1 620±590) ng/Lvs.(1 390±610) ng/L,P＜0.05].(2)T2DM-OB组血清nesfatin-1水平显著高于T2DM-NW组[(1 897±670) ng/L vs.(1 690±650)ng/L,P＜0.05],经吡格列酮治疗后T2DM-OB组nesfatin-1水平仍高于T2DM-NW组[(1 791±634) ng/L vs.(1 690 ±650)ng/L,P＜0.05].(3)Nesfatin-1水平与TG、FPG、2hPG、HbA1c、IL-6、HOMA-IR、BMI呈正相关(r=0.582,0.568,0.587,0.552,0.546,0.523,0.562).多元逐步回归分析显示,HOMA-IR、FPG、BMI与血清nesfatin-1水平独立相关.结论 随着糖耐量受损程度的加重及肥胖的发生,nesfatin-1水平逐渐升高,nesfatin-1可能在肥胖及糖耐量受损中发挥重要作用.     

糖化血红蛋白早期筛查糖尿病的截点探讨

目的探讨HbA_1c早期筛查糖尿病的最佳截点。方法选取我院门诊和住院行OGTT和HbA_1c测定的对象613名。以1999年WHO诊断糖尿病的"金标准"2hPG≥11.1mmol/L分为糖尿病组(DM)和2hPG11.1mmol/L非糖尿病组(NDM)。利用相关分析、受试者工作特征曲线(ROC)和约登指数确定HbA_1c筛查糖尿病的最佳截点。结果 DM组19.4%的患者HbA_1c6.5%,NDM组80.6%的患者HbA_1c6.25%。相关分析显示,HbA_1c与2hPG有相关性。HbA_1c与2hPG拟合回归方程为HbA_1c=3.031+0.290×2hPG。ROC曲线显示,最佳HbA_1c截点为6.25%。HbA_1c为6.25%时,敏感性为87.85%,特异性为80.67%。HbA_1c为6.25%时,具有最大的约登指数。结论 HbA_1c≥6.25%筛查糖尿病的有效率为94.97%,可使漏诊率降低至12.15%,适合作为早期筛查糖尿病的截点。     

妊娠期糖尿病不同转归结局患者FPG、HbAlc指标水平差异性研究

目的 探究妊娠糖尿病不同转归结局患者FPG、HbAlc指标水平的差异性。方法 选取2019年1月—2021年12月厦门医学院附属第二医院收治的1 000例GDM产妇作为研究对象,根据妊娠期糖尿病转归结局分为正常糖耐量组（NGT组）879例、葡萄糖耐量异常组（IGT组）52例、空腹血糖调节受损组（IFG组）47例及2型糖尿病组（T2DM）22例。对比4组孕期6周到产后6周的FPG、HbA1c指标变化。结果 与NGT组相比,IGT组、IFG组、T2DM组FPG、HbA1c指标水平较高,差异有统计学意义（P<0.05）;与NGT组相比,IGT组、IFG组、T2DM组FPG、HbA1c指标异常状态持续时间较长,差异有统计学意义（P<0.05）;NGT组相比,IGT组、IFG组、T2DM组FPG、HbA1c指标异常状态时间占总妊娠时间比重较大,差异有统计学意义（P<0.05）。结论 妊娠糖尿病不同转归结局患者FPG、HbAlc指标水平存在显著差异性,为妊娠糖尿病不良转归结局的预测提供研究方向。     

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.