2型糖尿病肾病患者血清细胞粘附分子变化与氧化应激的关系

目的　探讨 2型糖尿病肾病患者 (DN)血清细胞粘附分子变化及其与氧化应激的关系。　方法　检测DN患者血清可溶性细胞间粘附分子 1(sICAM 1)、可溶性血管细胞粘附分子 1(sVCAM 1)、血清丙二醛 (MDA)含量和超氧化物歧化酶 (SOD)活性。　结果　早期DN及DN患者血清sVCAM 1水平〔分别为 (1 75± 0 48)、(1 91± 0 2 7)mg/L〕明显高于对照组〔(1 6 7± 0 72 )mg/L ,P <0 0 5和0 0 1〕 ,DN组明显高于单纯糖尿病 (DM)组〔(1 5 8± 0 39)mg/L ,P <0 0 5〕 ;DM组、早期DN组和DN组患者血清sICAM 1〔分别为 (75 6 0 0± 12 5 47)、(80 2 2 1± 12 4 81)、(897 6 0± 10 5 80 ) μg/L〕明显高于对照组〔(5 82 6 4± 10 2 73) μg/L ,P <0 0 0 1〕 ,其中DN组明显高于单纯DM组和早期DN组 (分别P <0 0 1和<0 0 5 ) ;单纯DM组、早期DN组和DN组患者血清SOD活性〔分别为 (86 5 9± 13 85 )、(85 6 9±11 32 )、(71 73± 16 35 )NU/L〕显著性低于对照组〔(92 73± 11 2 5 )NU/ml,P <0 0 1〕 ,MDA含量〔分别为(3 99± 1 36 )、(4 2 6± 1 95 )、(6 5 0± 2 98)nmol/ml〕显著性高于对照组〔(3 72± 0 5 7)nmol/ml,P <0 0 1〕。DM患者血清sVCAM 1与sICAM 1、收缩压、尿素氮 (BUN)和肌酐 (Cr)呈正相     

对氧磷酯酶1与2型糖尿病肾病的关系

目的　探讨血清对氧磷酯酶 1(PON1)活性与 2型糖尿病 (DM)并发肾病 (DN)的关系。方法　血清PON1活性用酚乙酸酯为底物测定 ,血浆氧化型低密度脂蛋白 (ox LDL)用ELISA法测定 ,尿 2 4小时微量白蛋白用放免法测定。结果　 91例 2型DM患者的PON1活性比 5 4例正常对照显著降低〔(138.2± 31.4 )kU/Lvs (184 .1± 2 9.5 )kU/L ,P <0 .0 0 1〕 ,且 2型DM的Ⅰ组 (UAER <30mg/ 2 4h)、Ⅱ组 (UAER 30～ 30 0mg/ 2 4h)和Ⅲ组 (UAER >30 0mg/ 2 4h)相比 ,PON1活性依次显著下降〔(15 1.8± 2 4 .5 )kU/L ,(12 4 .5± 32 .8)kU/L ,(10 1.1± 36 .6 )kU/L ,P <0 .0 1〕 ,而ox LDL的浓度却依次显著升高〔(6 16 .2± 135 .7) μg/L ,(75 3.9± 132 .5 ) μg/L ,(875 .1± 15 3.2 ) μg/L ,P <0 .0 1〕。PON1活性与ox LDL的浓度呈高度负相关 (r =- 0 .83,P <0 .0 0 1) ,也与UAER呈负相关 (r =- 0 .2 8,P<0 .0 5 ) ,多元回归分析表明PON1活性是 2型DM并发DN的高度危险因素 (P <0 .0 1)。结论　PON1活性在 2型DM显著下降 ,且在并发DN的 2型DM患者下降更显著。PON1活性与ox LDL呈负相关。PON1活性降低是 2型DM并发DN的高度危险因素     

急性淋巴细胞白血病患儿血清sTNFRs水平测定的临床价值

目的 :探讨急性淋巴细胞白血病患儿血清 TNFa、s TNFR- 和 s TNFR- 水平及其临床意义。方法 :采用 EL ISA法测定血清 TNFa、s TNFR- 和 s TNFR- 水平。结果 :2 4例 AL L患儿血清 TNFα〔(173.2 2±74.5 1) ng/L〕明显高于 2 0例正常对照儿童〔(78.5 9± 18.45 ) ng/L〕,初发与复发患儿血清 s TNFR- 〔(2 .76±1.0 5 )、(2 .44± 1.37) μg/L〕、s TNFR- 〔(2 .33± 1.18)、(2 .0 9± 1.2 2 ) μg/L〕明显高于正常儿童〔(0 .75± 0 .2 6 )、(0 .71± 0 .14) μg/L〕,均为 P <0 .0 1;血清 TNFα与 s TNFR- 呈显著性正相关 (r =0 .6 31,P <0 .0 1) ;8例患儿经有效治疗完全缓解后血清 s TNFRs均降至正常水平〔(0 .83± 0 .2 5 )、(0 .92± 0 .17) μg/L〕;血清 s TNFRs在WBC≥ 10 0× 10 9/L患儿的阳性率明显高于 WBC<10 0× 10 9/L者 (P <0 .0 1) ,其与外周血幼稚细胞数呈显著正相关 (R =0 .72 4 ,R =0 .582 ,P <0 .0 5)。结论 :AL L患儿血清 s TNFRs异常升高与白血病细胞有关 ,血清 s TNFRs水平可作为估计肿瘤负荷及治疗效果的一项指标。     

阻塞性睡眠呼吸暂停综合征老年患者血管内皮功能变化及其与冠心病的关系

目的　探讨老年阻塞性睡眠呼吸暂停综合征 (OSAS)患者血管内皮功能变化与冠心病 (CHD)的内在联系。方法　随机选择 31例无OSAS、无心血管疾病的老年单纯鼾症者为对照组 ,4 5例老年中、重度OSAS患者为OSAS组 ,OSAS组内又分为有CHD(16例 )和无CHD(2 9例 )两个亚组。测定和比较组间的血浆一氧化氮 (NO)、内皮素 (ET)及其比值的动态变化及OSAS组内CHD有无的区别。结果　与对照组相比 ,OSAS组患者的NO水平明显降低〔(2 7.6 9± 9.17)vs(6 1.90± 13.4 7) μmol/L〕 ,ET水平明显增高〔(5 8.0 8± 14 .2 1)vs (34.77± 8.2 3)ng/L〕 ,NO/ET比值明显下降〔(0 .4 7± 0 .18)vs (1.72± 0 .97) ,均P <0 .0 1)〕。CHD的发生率在OSAS组达 35 .6 %。与对照组相比 ,OSAS组中不伴CHD者降低的NO水平 (35 .5 3± 9.39) μmol/L、升高的ET水平 (47.78± 11.13)ng/L和下降的NO/ET比值 (0 .75± 0 .13)已有显著性差异 (P <0 .0 5 ) ;伴有CHD者的NO水平 (2 2 .17± 8.76 )μmol/L、ET水平 (6 9.14± 12 .17)ng/L和NO/ET比值 (0 .32± 0 .14 )较对照组相差更为明显 (P <0 .0 1)。结论　OSAS老年患者存在明显的血管内皮功能障碍 ,尤以CHD者为甚 ,血管内皮功能损伤可能是OSAS患者并发CHD的原因     

2型糖尿病患者血清残粒样微粒胆固醇水平及其临床意义

目的　探讨血清残粒样微粒胆固醇(RLP C)在糖尿病(DM)患者中的变化及其与糖尿病肾病(DN)的关系。方法　血清RLP C浓度用免疫分离法测定,同时测定血浆α 颗粒膜蛋白 (GMP140)和血清一氧化氮(NO)。尿 24h微量白蛋白用放免法测定,根据尿白蛋白排泄率 (UAER)将其分为 3组。结果96例 2型DM患者RLP C与 44例正常对照 (NC)比较显著升高〔(0. 281±0. 162)mmol/Lvs(0. 193±0. 125)mmol/L,P<0. 01〕,且 2型DM患者D1 组 (UAER<20μg/min)、D2 组 (UAER20 ~200μg/min)和D3 组(UAER>200μg/min)相比,RLP C浓度依次显著增加〔( 0. 225±0. 145 )mmol/L, ( 0. 292±0. 181 )mmol/L, (0. 363±0. 192)mmol/L〕。D2 和D3 组GMP140浓度显著高于D1 和NC组(均P<0. 01),NC组和D1 组NO均显著高于D2 和D3 组 (均P<0. 01)。RLP C与NO呈高度负相关 (r=-0. 75,P<0. 01 ),与UAER和GMP140呈高度正相关(r=0. 78和r=0. 81,均P<0. 01),NO与GMP140浓度呈高度负相关 (r=-0. 78,P<0. 01)。结论　RLP C浓度在 2型DM患者中显著增加,且在并发DN的 2型DM患者增加更显著,RLP C在DN的发生发展中具有致病作用,其机制可能是通过损伤血管内皮和活化血小板所致。     

游泳运动对高脂饮食老年大鼠胰岛素抵抗和血清瘦素的影响

目的　研究单纯高脂饮食及不同强度运动对大鼠胰岛素敏感性和血清瘦素的影响。　方法　 4 8只 15月龄雄性SD大鼠随机分为对照组、高脂组、高脂加 90min运动组及高脂加 4 5min运动组 ,两运动组大鼠在高脂饮食同时均进行 15周不同强度的游泳运动。实验结束测定大鼠血糖、胰岛素、胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)和瘦素 ,计算胰岛素敏感指数 (ISI)和肥胖评定 (Lee)指数。　结果　高脂组ISI〔 - (6 6 3± 0 39)〕较对照组〔 - (5 5 7± 0 31)〕明显低 (P <0 0 1) ;而运动组ISI分别为〔 - (5 5 2± 0 2 8)和 - (5 36±0 2 9)〕 ,均较高脂组明显升高 (均P <0 0 1)。两运动组间ISI差异无显著性 (P >0 0 5 )。运动后两组血清瘦素分别为 (2 2 3± 0 84 )ng/ml和 (3 0 2± 1 39)ng/ml,较高脂组 (7 94± 3 6 7)ng/ml明显下降 (P <0 0 1)。血清瘦素与胰岛素呈正相关 (r =0 2 82 ,P <0 0 5 ) ;与ISI负相关 (r =- 0 4 2 3,P <0 0 1)。　结论　单纯高脂饮食可致大鼠胰岛素抵抗 ,适当运动可增加高脂饮食大鼠的胰岛素敏感性 ;血清瘦素水平与胰岛素、胰岛素抵抗相关。     

糖尿病大鼠血管醛固酮及其合成酶CYP11B2 mRNA的变化

目的　探讨糖尿病大鼠血管醛固酮及其合成酶CYP11B2mRNA的变化。方法　建立STZ糖尿病大鼠肠系膜血管体外灌流模型 ,以高效液相 (HPLC)分离、纯化血管生成的醛固酮后作放免检测 ,采用逆转录聚合酶链反应 (RT PCR)法检测醛固酮合成酶CYP11B2mRNA。结果　 (1)肾上腺切除大鼠肠系膜血管醛固酮生成量与正常对照组比较无显著差异〔(0 .82± 0 .19)ng/ 2 0min(n =8)vs (0 .88± 0 .19)ng/ 2 0min (n =8) ,P >0 .0 5〕。 (2 )糖尿病大鼠肠系膜血管醛固酮生成量较正常对照组显著减少〔(0 .5 3± 0 .2 2 )ng/ 2 0min (n =8)vs (0 .88± 0 .19)ng/ 2 0min (n =8) ,P <0 .0 1〕。 (3)肾上腺切除大鼠和其他各组肠系膜血管均可检测到醛固酮合成关键酶—CYP11B2mRNA ,糖尿病组肠系膜血管CYP11B2表达则较正常对照组减弱。结论　SD大鼠肠系膜血管能分泌醛固酮 ,糖尿病大鼠CYP11B2受抑制 ,血管醛固酮生成量减少     

不同糖耐量状态的原发性高血压患者血清抵抗素水平

目的　了解不同糖耐量状态原发性高血压患者血清抵抗素浓度 ,探讨肥胖与糖尿病(DM)的关系。方法　酶免疫测定法检测 71例原发性高血压患者〔2型DM 18例 ,糖耐量低减 (IGT)2 6例 ,正常糖耐量 (NGT) 2 7例 ;男 33例 ,女 38例〕的空腹血清抵抗素水平 ,口服葡萄糖耐量试验和胰岛素释放试验 ,测定血浆葡萄糖浓度和血清胰岛素浓度 ,计算葡萄糖曲线下面积 (AUCG) ,根据Cederholm公式计算胰岛素敏感指数 (ISI) ;测量收缩压 (SBP)、舒张压 (DBP)、身高、体重、腰围、臀围 ,计算体重指数 (BMI)、体内脂肪百分比 (BF % )及腰围 /臀围比 (WHR)。结果　空腹血清抵抗素浓度(μg/L) :DM组 (2 9.8± 12 .1)显著高于NGT组 (2 2 .0± 8.4 ) (P <0 .0 5 ) ,略高于IGT组 (2 5 .1± 10 .4 )(P >0 .0 5 )。空腹血清抵抗素浓度与AUCG(r =0 .38,P <0 .0 0 1)及BF % (r=0 .35 ,P <0 .0 1)呈显著正相关 ,与ISI呈显著负相关 (r =- 0 .2 4 ,P <0 .0 5 ) ,与SBP、DBP、BMI及WHR无相关。结论　 2型DM患者空腹血清抵抗素水平升高 ,血清抵抗素浓度与血糖浓度及BF %的相关性提示人体抵抗素可能是肥胖与糖尿病连系所在     

HBVDNA的表达与肝纤维化形成的相关性研究

探讨HBVDNA的表达与肝纤维化形成的相关性。应用荧光定量PCR技术测定 2 0 0例乙肝患者和 4 9名健康对照组的血清HBVDNA ,同时用放免法检测层粘连蛋白 (LN)、透明质酸 (HA)、Ⅲ型前胶原 (PⅢ )、Ⅳ型胶原 (Ⅳ .C)水平。HBVDNA表达阳性组LN、HA、PⅢ、Ⅳ .C的含量〔(16 4 8± 5 6 1)、(16 6 1± 78 0 )、(15 3 5± 6 0 7)、(92 1±2 9 9) μg/L〕显著高于HBVDNA阴性组〔(110 9± 2 9 8)、(82 1± 2 4 7)、(91 9± 2 9 2 )、(5 9 5± 14 3) μg/L〕(P <0 0 0 1)和健康对照组〔(10 4 9± 16 3)、(6 8 0± 2 7 6 )、(76 3± 2 1 3)、(5 4 3± 7 8) μg/L〕(P <0 0 0 1)。HBVDNA阳性组中 ,上述四项指标随着HBVDNA含量升高而递增。动态观察 2 8例乙肝患者随着治疗过程HBVDNA浓度下降 ,LN、HA、PⅢ、Ⅳ .C的含量明显递减。HBVDNA的阳性表达与肝纤维化形成的相关性十分密切     

对氧磷酯酶-1与老年人2型糖尿病视网膜病变的关系

目的探讨血清对氧磷酯酶1(PON1)活性与老年人2型糖尿病(T2DM)并发视网膜病变(DR)的关系。方法血清PON1活性用酚乙酸酯为底物测定。血浆氧化型低密度脂蛋白(oxLDL)用ELISA法测定。结果老年单纯T2DM组PON1活性为(9608±3143)kU/L,比健康对照组显著降低〔(13028±1948)kU/L,P<001〕,T2DM并发DR组PON1活性(7453±1679)kU/L,比老年单纯T2DM组显著降低(P<001)。oxLDL浓度在老年单纯T2DM为(6996±841)μg/L,比健康对照组显著升高〔(4264±763)μg/L,P<001〕,老年人T2DM并发DR组oxLDL浓度为(8123±849)μg/L比老年单纯T2DM组显著升高(P<001)。PON1活性与oxLDL的浓度呈高度负相关(r=-084,P<001),Logistic回归分析表明PON1活性是T2DM并发DR的高度危险因素(P<001)。结论PON1活性在T2DM显著下降,且在并发T2DM患者下降更显著。PON1活性与oxLDL呈负相关。PON1活性降低是T2DM并发DR的高度危险因素。     

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.