血清胰高血糖素样肽-1水平可预测新诊断2型糖尿病患者的颈动脉粥样硬化

目的：探讨新诊断2型糖尿病（T2DM）患者血清胰高血糖素样肽-1（GLP-1）水平与颈动脉粥样硬化（CAS）的相关性。 方法：选择T2DM患者180例，均接受颈动脉超声检查，分为单纯T2DM组（78例）和T2DM合并CAS组（DMCAS 组，102例），另选取本院同期健康体检者60例为对照组，比较3组临床检查指标；多因素 logistic 回归分析T2DM患者并发CAS的独立影响因素， 将DMCAS 组患者根据CAS分级分为1、2、3级，比较不同分级的空腹血糖（FPG）、低密度脂蛋白胆固醇(LDL)、GLP-1 和颈动脉内中膜厚度(IMT)水平。统计学分析GLP-1与CAS分级、FPG、LDL和IMT的相关性。受试者工作特征（ROC）曲线分析GLP-1对T2DM合并CAS发生的预测价值。 结果：FPG、LDL、GLP-1和IMT为T2DM患者合并CAS的独立危险因素（P均<0.05）。GLP-1与CAS分级、FPG、LDL和IMT呈显著负相关（P均<0.05）。预测T2DM患者CAS发生的最佳GLP-1水平为6.59 pmol/L（P<0.05）。 结论：T2DM合并CAS患者血清GLP-1水平明显降低，且与CAS严重程度相关；GLP-1水平能在一定程度上预测T2DM患者CAS的发生。     

血清IgG亚型与2型糖尿病患者冠状动脉粥样硬化相关性的研究

目的 探讨血清IgG亚型与T2DM患者冠状动脉粥样硬化（CAS）的相关性。方法选取2020年7月至2021年6月于南华大学附属第一医院内分泌代谢科就诊的T2DM患者41例，根据有无冠状动脉斑块分为单纯T2DM组（T2DM,n=12）和T2DM合并CAS组（CAS,n=29），比较两组血清IgG1、IgG2、IgG3及IgG4，受试者工作特征（ROC）曲线评估各指标对T2DM合并CAS的诊断价值。结果 与T2DM组比较，CAS组年龄升高，TC、淋巴细胞比例、血Ca2+降低（P<0.05）。CAS组IgG1、IgG3高于T2DM组（P<0.05）。ROC曲线分析显示，IgG1的ROC曲线下面积（AUC）为0.509(P=0.0805)，敏感度0.552，特异度0.626。IgG3的AUC为0.727(P=0.0236)，敏感度0.582，特异度0.656。组合7(IgG1、IgG3、年龄、淋巴细胞比例、血Ca2+、TC)的AUC为0.8519。结论IgG1和IgG3是T2DM患者CAS的危险因素，组合7是预测T2DM合并CAS的理想模型。     

2型糖尿病患者血清γ-谷氨酰转肽酶水平的变化及其与颈动脉粥样硬化的关系

目的观察T2DM患者血清γ-谷氨酰转肽酶(GGT)的变化,探讨GGT与T2DM患者颈动脉粥样硬化(CAS)的关系。方法选择T2DM(T2DM组)患者35例和正常对照者(NC组)40名,分析GGT和CAS的关系。结果T2DM组GGT高于NC组(P0.05);T2DM组发生CAS 15例,其中9例为双侧;NC组CAS者2例,其中1例为双侧。Logistic回归分析示,年龄、高血糖和GGT是颈动脉斑块的独立预测因素。结论 T2DM患者GGT水平高于正常人群,同时T2DM患者GGT水平升高与颈动脉粥样斑块形成相关。     

2型糖尿病合并颈动脉粥样硬化患者血清丝氨酸蛋白酶抑制剂B1水平变化的研究

目的探讨T2DM合并颈动脉粥样硬化(CAS)患者血清丝氨酸蛋白酶抑制剂B1(SerpinB1)水平变化。方法选取2018年2月至2019年3月于苏州大学附属第一医院内分泌科住院的T2DM患者119例,血压、血脂均正常。根据颈动脉超声结果分为T2DM合并CAS组(T2DM+CAS)62例,单纯T2DM组(T2DM)57例。另选取同期我院健康体检人群56名为正常对照(NC)组。收集各组一般资料及生化指标,ELISA法测定血清SerpinB1浓度。结果 NC、T2DM组SerpinB1水平差异无统计学意义(P0.05),但低于T2DM+CAS组(P0.01)。Pearson相关分析显示,血清SerpinB1水平与糖尿病病程、FPG、HbA_1c、胰岛素抵抗指数呈正相关(r=0.215、0.240、0.244、0.203,P0.05或P0.01)。Logistic回归分析显示,SerpinB1、年龄、LDL-C是T2DM合并CAS患者的独立危险因素(P0.05或P0.01)。结论 T2DM合并CAS患者血清SerpinB1水平升高,可能在CAS的发生发展中发挥作用。     

血清分泌型卷曲相关蛋白5与2型糖尿病及颈动脉粥样硬化的相关性研究

目的探讨血清分泌型卷曲相关蛋白5(SFRP5)与T2DM及颈动脉粥样硬化(CAS)的相关性。方法根据颈动脉彩色多普勒超声结果,将56例T2DM患者分成T2DM合并CAS组(CAS组)28例和单纯CAS组(NAS组)28例,同时选取同期正常对照组(NGT组)28名。ELISA测定血清SFRP5浓度。结果 CAS组和NAS组血清SFRP5浓度较NGT组低[(114.36±25.48)vs(48.19±11.82),(43.88±8.19)pg/ml,P0.01];CAS组与NAS组血清SFRP5比较,差异无统计学意义。Pearson相关分析表明,血清SFRP5与年龄、TG、高敏C反应蛋白(hsC-RP)、FPG、FIns、HOMA-IR、HbA_1c、LDL-C、BMI呈负相关(r=-0.614,-0.160,-0.331,-0.682,-0.467,-0.580,-0.706,-0.339,-0.322,P0.01),与HDL-C呈正相关(r=0.386,P0.01),与性别、TC、SBP、DBP无相关性(P0.05)。多元线性逐步回归结果示,在排除混素因素后,年龄、FIns、HbA_1c是血清SFRP5的影响因素。结论 T2DM患者血清SFRP5浓度较正常人低,SFRP5可能是T2DM的保护因素,或可改善IR,该蛋白的合成可能有助于延缓或逆转T2DM的发生与进展,为T2DM患者的防治提供了新思路。     

血清1-磷酸鞘氨醇水平对老年急性脑梗死患者颈动脉粥样硬化斑块形成有一定预测价值

摘要 目的：探讨血清1-磷酸鞘氨醇（S1P）水平对老年急性脑梗死（ACI）患者颈动脉粥样硬化（CAS）斑块形成的预测价值。方法： 采用横断面法选取入院24h内接受颈部血管超声检查的老年ACI患者223例,根据有无CAS斑块分为内膜增厚组（72例）和斑块组（151例）,另选取同期健康体检者70例作为对照组。检测3组受试者血清S1P水平,采用单因素和多因素Logistic回归分析S1P与老年ACI患者CAS斑块形成的相关性,采用受试者工作特征（ROC）曲线分析S1P对颈动脉不稳定斑块的预测价值。结果：单因素分析显示,患者年龄、胆固醇（TC）,甘油三酯（TG）、血清S1P水平与CAS斑块的形成有关（P均＜0.05）。斑块组S1P水平显著高于内膜增厚组 [(712.63±132.34) ng/mL vs. (656.86±130.58)ng/mL,P＜0.05]。多因素Logistic回归显示,S1P是影响CAS斑块形成的独立危险因素（OR>1,P<0.05）。ROC曲线显示,当S1P截断值为685ng/mL时,曲线下面积为0.97（95%CI：0.970~0.980,P=0.001）,敏感度为95.8%,特异性为89.4%。结论： 血清S1P水平是老年ACI患者CAS斑块形成的独立危险因素。     

对2型糖尿病合并颈动脉粥样硬化症患者白介素37表达的观察

目的观察T2DM合并颈动脉粥样硬化(CAS)患者白介素37(IL-37)的表达。方法选取2017年4月至2018年1月于滨海县人民医院内分泌科就诊的T2DM患者72例。分为T2DM组(n=38),T2DM合并CAS组(T2DM+CAS,n=34),另选取本院体检健康者35名作为对照组(NC)。体外分离培养PBMCs,分为空白组(Con)、脂多糖(LPS)刺激组和IL-37+LPS刺激组。检测各组血清IL-37、IL-1β,IL-6和TNF-α;LPS刺激后检测IL-1β、IL-6和TNF-α的mRNA表达。结果NC组、T2DM组、T2DM+CAS组血清IL-37浓度表达依次降低[6.72(5.34,7.63)vs 5.65(5.21,6.75)vs 5.18(4.61,5.73)pg/ml,P0.05],血清IL-1β、IL-6浓度表达依次升高[27.85(21.52,33.64)vs 32.46(29.31,44.72)vs 41.32(30.45,52.17)pg/ml,P0.05;5.44(4.21,11.56)vs 8.15(5.76,19.33)vs 11.73(7.52,21.64)pg/ml,P0.05]。与NC组比较,T2DM组、T2DM+CAS组血清TNF-α浓度表达升高[9.73(6.92,15.34)vs 14.56(8.71,22.35)vs 16.14(8.63,26.17)pg/ml,P0.05]。与LPS刺激组比较,IL-37+LPS刺激组IL-1β、IL-6和TNF-α的mRNA表达降低。结论 T2DM合并CAS患者血清IL-37浓度降低,体外研究证实IL-37可降低炎性细胞因子表达。     

新诊断2型糖尿病患者血清对氧磷酶3水平与颈动脉粥样硬化的相关性

目的探讨T2DM患者血清对氧磷酶3(pon3)水平与血糖、血脂、IR等代谢因素及T2DM早期颈动脉粥样硬化(CAS)的关系。方法选择新诊断T2DM患者108例,根据有无CAS分为合并CAS(A,53例)组和不合并颈动脉斑块(B,55例)组;另选择健康体检者为对照(C,54例)组。采用ELISA方法测定空腹血清pon3水平,检测血脂、同型半胱氨酸(Hcy)、纤维蛋白原(Fib)、HbA1c、FPG、hsC-RP、超氧化物歧化酶(SOD)等指标,采用稳态模型评估胰岛素抵抗指数(HOMA-IR)。结果 3组血清pon3水平依次为:C组(2.24±0.44)ng/mlB组(2.72±0.51)ng/mlA组(3.58±0.62)ng/ml(P0.05或P0.01);血清pon3水平与BMI、FIns、TC、HOMA-IR、hsC-RP、FPG、HbA1c、Hcy、Fib呈正相关(r分别为0.513、0.523、0.593、0.529、0.517、0.487,0.487、0.547,0.528,P0.05或P0.01),与HDL-C、SOD负相关(r=-0.497,-0.589)。多元逐步回归分析显示,BMI、hsC-RP、LDL-C、Fib是影响T2DM患者pon3的独立相关因素。Logistic回归分析显示,BMI、Fib、LDL-C、pon3是T2DM发生CAS的主要影响因素。结论血清pon3在新诊断T2DM合并颈动脉斑块人群中升高,在新诊断T2DM合并CAS的发生中起重要作用。     

丝氨酸蛋白酶抑制物在2型糖尿病合并颈动脉粥样硬化患者中的意义

目的分析血清丝氨酸蛋白酶抑制物(vaspin)在2型糖尿病(T2DM)合并颈动脉粥样硬化(CAS)患者中的意义。方法根据有无CAS,将197例T2DM患者分为CAS T2DM组(A组)和单纯T2DM组(B组)与正常对照组(NC组)比较血清vaspin水平。结果 T2DM患者vaspin高于NC组(P0.05);B组vaspin较A组高(P0.05)。结论 vaspin在T2DM合并CAS患者血管病变中有保护作用。     

2型糖尿病合并脑梗死病人血清趋化素、GDF-15表达及其临床意义

目的 观察2型糖尿病(T2DM)合并急性脑梗死(ACI)病人血清趋化素、生长分化因子-15(GDF-15)水平变化,并探讨其临床意义。方法 选取2019年7月—2021年4月华中科技大学同济医学院附属梨园医院收治的67例单纯T2DM病人为单纯T2DM组,56例T2DM合并ACI病人为T2DM合并ACI组,另选取同期58名体检健康者为对照组。比较对照组、单纯T2DM组、T2DM合并ACI组一般资料、血清趋化素、GDF-15水平;采用Pearson相关性分析法分析T2DM合并ACI病人血清趋化素、GDF-15水平与空腹胰岛素(FINS)、空腹血糖(FPG)的相关性;采用Logistic回归分析T2DM并发ACI的影响因素;绘制受试者工作特征曲线(ROC)评价血清趋化素、GDF-15预测T2DM并发ACI的价值。结果 单纯T2DM组、T2DM合并ACI组FPG、FINS及血清趋化素、GDF-15水平高于对照组(P<0.05),T2DM合并ACI组血清趋化素、GDF-15水平高于单纯T2DM组(P<0.05);T2DM合并ACI病人血清趋化素、GDF-15水平与FPG、FINS均呈...     

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.