高血压患者胰岛素抵抗与血压昼夜模式改变的关系

目的 探讨原发性高血压时胰岛素抵抗(IR)与血压昼夜模式改变的关系.方法 对41例原发性高血压(EH组)、42例原发性高血压伴IR(EH+IR组)和30例健康志愿者(对照组)分别检测空腹血糖和胰岛素水平,计算胰岛素敏感指数(ISI),并行24小时动态血压监测,计算夜间血压下降率.结果 与EH组比较,EH+IR组血糖、胰岛素明显升高,ISI降低,收缩压及舒张压夜间下降率减少(P均<0.01).ISI与收缩压及舒张压夜间下降率呈负相关(r=0.645和-0.712,P<0.01).结论 IR与血压昼夜模式改变有关.     

替米沙坦改善高血压患者的胰岛素抵抗

目的观察替米沙坦对高血压患者胰岛素抵抗的影响。方法入选初诊为原发性高血压患者110例为研究对象,同期年龄和性别相匹配的健康体检者100例为对照组。高血压患者给予替米沙坦40～80mg/d,治疗12周。观察高血压患者治疗前后血压、空腹血糖和胰岛素(FINS)、胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR)水平的变化。结果治疗前高血压患者血压、FINS和HOMA-IR水平明显高于对照组,ISI水平明显低于对照组(均P<0.05)。替米沙坦治疗12周后,高血压患者的血压明显下降,空腹血糖、FINS和HOMA-IR水平降低,ISI水平升高(均P<0.05)。结论替米沙坦可改善高血压患者的胰岛素抵抗。     

原发性高血压患者微量白蛋白尿与胰岛素抵抗关系的探讨

目的研究原发性高血压(EH)患者微量蛋白尿与胰岛素抵抗的关系.方法对388例EH患者根据其尿白蛋白排泄率EH患者合为两组微量白蛋白阳性组(139例)和微量白蛋白阴性组(249例),所有患者均检测空腹血糖(FBG)、空腹胰岛素(FIN)胰岛素敏感指数(ISI),血脂及肾功按HOMA模型计算胰岛素抵抗指数(HOMA-IR),HOMA-IR=FBG×FIN)/22.5,再取其自然对数.两组进行比较.结果两组间年龄、高血压病程、血脂水平、FBG、FIN及ISI均无显著性意义(P＜0.05),但收缩压与舒张压在两组间有着统计学差异(P＜0.001),血尿酸亦存在显著性差别(P＜0.05).结论EH患者尿微量白蛋白的排泄与胰岛素抵抗无直接相关性,与血压水平及血尿酸有关.     

雷米普利对原发性高血压病患者血浆胰岛素水平的影响

目的观察雷米普利对原发性高血压病(EH)患者胰岛素敏感的影响.方法 37例EH患者根据血压高低给予雷米普利2.5～5 mg, 每日晨起一次口服,治疗前及治疗8周后,分别测空腹血糖(FPG)及空腹血浆胰岛素(FPI),计算胰岛素敏感指数(ISI)并与20例性别、年龄、体重指数相同的健康者比较.结果两组FPG正常,无显著差异,EH组FPI显著升高( P<0.01),ISI显著下降( P<0.01).雷米普利治疗8周后,FPI明显下降(P<0.05),ISI明显增高(P<0.05).结论高血压患者存在高胰岛素血症,雷米普利稳定降压的同时程度不同程度的改善高胰岛素血症.     

胰岛素抵抗与高血压及其血压严重程度的相关性研究

目的探讨胰岛素抵抗与高血压及其血压严重程度的关系。方法选择177例正常人和166例高血压病非糖尿病患者。所有患者均抽血查胰岛素、糖耐量试验(OGTT),以胰岛素敏感指数(ISI)及胰岛素曲线下面积(IS-AUC)作为胰岛素敏感性的判定指标。并据SBP≥160mmHg和(或)DBP≥100mmHg将高血压病组分为两组。用多元相关分析及多因素逐步回归分析胰岛素抵抗与高血压的相关性。结果高血压病组的年龄、体重指数、ISI、IS-AUC与对照组比较有显著差异(P<0.05)。高血压病两组间比较ISI、IS-AUC有显著差异(P<0.05)。经相关分析显示ISI、IS-AUC与血压升高有显著相关性,ISI与血压升高呈显著负相关,IS-AUC与血压升高呈显著正相关。多因素逐步回归分析显示ISI、IS-AUC是血压升高的最显著危险因子。结论胰岛素抵抗与高血压及其血压严重程度相关,胰岛素抵抗是血压升高的最重要的影响因素,胰岛素敏感性越低,血压越高。     

高血压患者高胰岛素血症与血压的关系及卡托普利对其的影响

对36例原发性高血压患者(EH)、28例正常人分别测定了空腹血糖(BG)、血浆胰岛素(IS)及胰岛素敏感指数(BG/IS)。结果发现EH组血浆IS较正常对照组显著增高(P<0.001);BG/IS显著降低(P<0.001);空腹BG两组间无显著差异;且EH组平均动脉压与血浆IS水平呈显著正相关(r=0.637,P<0.01);与BG/IS呈显著负相关(r=-0.512,P<0.05)。EH组单纯接受卡托普利治疗4周后,血浆IS较治疗前显著降低(P<0.01);BG/IS较治疗前则显著升高(P<0.01)。结果提示:胰岛素抵抗(IR)及高IS血症是致血压升高的重要病生理因素;卡托普利可以改善EH患者的IR及高IS血症。     

有家族史的原发性高血压患者冠状动脉病变与胰岛素抵抗的相关性

目的　研究高血压家族史对原发性高血压患者的冠状动脉病变有无影响及冠状动脉病变与胰岛素抵抗的相关性。方法 对160例预行冠状动脉造影检查且符合原发性高血压的患者进行问卷调查,按有无家族史分为:(1)有家族史的高血压病组 72 例;(2)无家族史的高血压病组 88 例。每位患者均测量空腹胰岛素浓度及做冠状动脉造影检查。结果 有家族史的高血压病组的空腹胰岛素浓度、胰岛素抵抗指数、甘油三酯浓度明显的大于无家族史的高血压组(P<0 .01);有家族史的高血压病组有冠状动脉病变的比例达73. 7%,而无家族史组为58. 0%,两组比较有显著性差异,并且有家族史的高血压病组冠状动脉病变的平均累积积分明显大于无家族史的高血压病组(P<0 .01);有家族史的高血压病组的年龄、腰围、收缩压(SBP)、空腹胰岛素浓度(FINS)、胰岛素抵抗指数(IR)、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)的 OR值有统计学意义,而无家族史的高血压病组在年龄、SBP、TC、HDL- C、LDL -C的 OR值上有统计学意义。结论　高血压家族史是原发性高血压患者冠状动脉病变的重要预测因子,可能与有高血压家族史的原发性高血压患者代谢紊乱更严重,以及高胰岛素血症或胰岛素抵抗更明显有关。     

脉压与胰岛素抵抗的关系

目的评价高血压及正常血压人群脉压与胰岛素抵抗(IR)及其相关危险因素的关系。方法入选原发性高血压病人391例,正常血压者98例,收集如下资料:血压(收缩压、舒张压、脉压)、腹围、体重指数、空腹血糖、空腹胰岛素、HOMA-IR、血脂(甘油三脂、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇),观察两组不同脉压亚组胰岛素抵抗及其相关危险因素的变化,并分别对两组进行脉压与空腹胰岛素、HOMA-IR、腹围等多因素相关性分析。结果两组随脉压增宽,空腹胰岛素及HOMA-IR显著增高,但高血压组脉压与胰岛素抵抗无独立相关性,脉压与胰岛素抵抗的关系主要依赖于收缩压的变化;正常血压组脉压与胰岛素抵抗独立正相关(r=0.20,P<0.05)。结论脉压可能是反映胰岛素抵抗的较好指标,但在高血压人群的这种作用不如收缩压和腹围。     

原发性高血压分级与胰岛素抵抗、血浆内皮素-1的关系

目的探讨血浆内皮素-1(endothelin-1,ET-1)、胰岛素抵抗(insulin resistance,IR)和原发性高血压(高血压)分级之间的关系。方法入选150例门诊及体检科新发现的高血压患者,按照2010年《中国高血压防治指南》诊断标准和血压分级原则,分为高血压1级组(52例)、高血压2级组(50例)、高血压3级组(48例),分别检测患者的血浆ET-1、空腹血糖(fasting blood glucose,FBG)、空腹血清胰岛素(fasting serum insulin,FINS)浓度。IR检测采用HOMA法,计算胰岛素敏感指数(insulin sensitivity index,ISI)。结果高血压3级组ISI明显小于高血压2级组和高血压1级组,差异有统计学意义(0.31±0.07 vs.0.43±0.06 vs.0.52±0.03,P<0.05);高血压2级组ISI明显小于高血压1级组,差异有统计学意义(P<0.05)。高血压3级组血浆ET-1浓度明显高于高血压2级组和高血压1级组,差异有统计学意义[(166.27±10.58)ng.L-1vs.(156.74±12.11)ng.L-1vs.(148.62±11.45)ng.L-1,P<0.05];高血压2级组血浆ET-1浓度明显高于高血压1级组,差异有统计学意义(P<0.05)。相关分析结果显示,ISI与收缩压呈负相关(r=-0.58,P<0.05),与舒张压也呈负相关(r=-0.56,P<0.05);ET-1与收缩压呈正相关(r=0.60,P<0.05),与舒张压也呈正相关(r=0.59,P<0.05)。结论 IR及血浆ET-1浓度升高与高血压血压分级有密切关系。     

高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。     

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.