肝硬化患者凝血系统常规指标和胰岛素样生长因子改变及意义

目的探讨凝血系统常规指标和胰岛素样生长因子在肝硬化病情预后中的作用,为临床诊断和治疗提供依据。方法按Child-Pugh分级标准将120例肝硬化患者分为A、B、C3级组,选择40例健康体检者作为正常对照组。测定凝血系统常规指标和胰岛素生长因子。结果（1）肝硬化组凝血因子PT、APTT水平与对照组比较均显著增高,且随着Child-Pugh积分的增高而逐渐升高（P〈0.05）;FIB水平与对照组比较显著降低（P〈0.05）,且随着Child-Pugh积分的增高而逐渐下降,A、B、C3级组间相比较也有显著性差异（P〈0.05）。（2）肝硬化组胰岛素样生长因子3项指标显著低于对照组,相比较有显著性差异（P〈0.05）;A、B、C三组IGF-Ⅰ、GIF-Ⅱ、IGFBP-3水平随Child-Pugh积分增加而呈递减趋势,显著低于对照组（P〈0.05）,A、B、C3级组间比较也有显著性差异（P〈0.05）。结论凝血系统常规指标和胰岛素样生长因子能及时准确地反映肝损害情况,可作为临床上进一步评价肝硬化分级的指标,对估测肝硬化的严重程度及预后有十分重要的临床价值。     

不同浓度铅接触者血铅水平对铅中毒诊断分级的价值

探讨铅接触工人血铅浓度与慢性铅中毒程度的关系。 [方法 ]对 12 7人 (男 112人 ,女 15人 )蓄电池厂工人的血铅及空气中铅浓度的剂量 反应关系进行研究。 [结果 ]血铅在不同铅接触浓度下呈明显的剂量 反应关系。进一步对血铅值分组分析 ,发现高浓度接触组血铅与铅中毒的诊断分级相一致 ,而低浓度接触组铅吸收病例血铅为 (2 2 5 5± 0 0 6 9) μmol/L ,轻度铅中毒病例血铅为 (2 16 0± 0 0 76 ) μmol/L ,两组比较无显著性差异。[结论 ]仅以血铅值来划分中毒程度欠妥 ,还应以现行国家慢性铅中毒诊断标准综合分析进行中毒分级。     

Lead Levels in Blood Bank Blood

Although blood bank blood is usually screened for dangerous pathogens, the presence of toxic metals in blood has received little attention. Population blood lead levels have been declining in the United States, but occasional high outliers in blood lead concentration can be found–even when mean levels of blood lead are low. We sampled 999 consecutive blood bank bags from the King/Drew Medical Center, used between December 1999 and February 2000. The geometric mean blood lead level was 1.0 μg/dl (0.048 μmol/l), but 0.5% of the samples had lead levels that exceeded 10 μg/d1, and 2 samples had lead levels that exceeded 30 μg/dl. The 2 samples with the highest lead levels could have presented an additional risk to infants if they were used for blood replacement. Therefore, even in countries with generally low population blood lead levels, blood bank blood should be screened for lead concentration prior to use with infants.     

某蓄电池厂铅作业男工血铅、尿铅及血清中性激素水平的调查

目的评价铅作业男性工人的血铅、尿铅水平及其影响因素,研究铅作业男性工人的血清中性激素水平的改变并探讨其机制。方法 2011年1月,选取深圳市某蓄电池厂铅作业男工120名作为接触组,按工作场所空气中铅含量的水平分成高、中、低3个接触浓度组;并选取来自同一家工厂未接触铅作业的40名男工作为对照组,测定4个组人群的血铅、尿铅、血清睾酮、FSH（促卵泡刺激素）及LH（促黄体生成素）的水平并进行统计分析。结果工作场所空气中铅浓度平均为0.29mg/m3,样品超标率为90%;3个接触组血铅、尿铅含量、尿铅异常率均明显高于对照组,差异均有统计学意义,且各接触组间血铅水平及异常率比较,差异也均有统计学意义（均P〈0.01）;随着工龄的增长,工人血铅、尿铅水平和异常率均有升高的趋势;中、高浓度接触组工人的血清睾酮水平均低于对照组和低浓度接触组,而血清FSH水平均高于对照组和低浓度接触组,差异均有统计学意义（均P〈0.01）。结论在该次研究的条件下,工龄增加、工作场所中铅浓度超标是导致血铅、尿铅水平升高的主要危险因素;铅暴露可能对下丘脑—垂体—睾丸轴的性激素分泌功能造成影响,从而对男性工人的生殖系统产生内分泌干扰作用。     

Blood Lead Concentrations and Pregnancy Outcomes

In this study, the authors related blood lead concentrations to Apgar scores, birth weight, gestational age, small-for-gestational age, and hypertension in pregnancy (HIP)/toxemia. Data and blood were collected 4 times during pregnancy from 705 women, aged 12–34 yr. Blood lead concentrations, measured by atomic absorption spectrophotometry, were related to reproductive outcomes, abstracted from medical records. Average blood lead concentrations were 1.2 μg/dl (standard error = ± 0.03). Maternal blood lead concentrations were related significantly to HIP/toxemia—before and after adjusting for age, calcium intake, and race/ethnicity (p < .03). Longitudinal regression analyses revealed that blood lead concentrations in women with HIP/toxemia changed by 0.02 μg/dl for every 0.01 μg/dl change in women without HIP/toxemia. Maternal blood lead concentration and its change were not significantly associated with other reproductive outcomes. Low levels of maternal blood lead concentrations were significantly associated with HIP/toxemia.     

性早熟女童血清IGF-1、瘦素检测及其临床价值探讨

【目的】 探讨特发性中枢性性早熟(idiopathic central precocious puberty, ICPP)女童、单纯性乳房早发育(simple premature thelarche, SPT)患儿血清胰岛素样生长因子-1(IGF-1)、瘦素(leptin)、体质指数(body mass index, BMI)的变化及临床意义。 【方法】 测定28例ICPP及32例SPT女童BMI、血清IGF-1和leptin的水平,并以26名正常青春发育期女童及30名未发育女童作为对照,观察BMI及血清IGF-1、leptin水平的相互关系;以IGF-1及leptin为诊断指标,对ICPP进行诊断试验评价。 【结果】 ICPP组女童血清IGF-1及leptin水平均明显高于SPT及未发育女童,差异有统计学意义(P<0.01),而与正常青春发育女童差异无统计学意义(P>0.05)。ICPP组女童IGF-1及leptin水平均与BMI呈正相关(r=0.67,0.71,P<0.01);正常青春发育组女童IGF-1及leptin水平均与BMI亦呈正相关(r=0.63、0.68,P<0.01);SPT组、未发育组女童IGF-1及leptin水平均与BMI无相关关系(P>0.05)。IGF-1>319.47 ng/mL对诊断ICPP的灵敏度、特异度、阳性预测值分别为95.4％、96.3％、95.6％;leptin>6.32 ng/mL对诊断ICPP的灵敏度、特异度、阳性预测值分别为96.5％,95.7％,94.8％。 【结论】 IGF-1和leptin水平的测定可作为ICPP诊断的参考指标,对鉴别ICPP与SPT具有重要临床意义;同时,IGF-1和Leptin可能是激活GnRH脉冲分泌的相关代谢因子。     

宫内生长迟缓儿血清GH、IGF-1、IGFBP-3和瘦素水平及临床意义

【目的】探讨宫内生长迟缓(intrauterine growth retarded,I UGR)新生儿血清生长激素(growth hormone,GH)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)、胰岛素样生长因子结合蛋白-3(insulin-like growth factorbinding protein-3,IGFBP-3)、瘦素的浓度水平及临床意义。【方法】选择出生48-72 h的I UGR新生儿62例和足月适于胎龄儿(appropriate for gestional age,AGA)37例与早产AGA36例,其中I UGR分为重度I UGR组(29例),轻度I U-GR组(33例)和足月小于胎龄儿(small for gestional age,SGA)32例与早产SGA30例;分别于上午9时抽取静脉血,分离血清。采用放射免疫法测定GH、IGF-1、IGFBP-3和瘦素。【结果】①足月SGA和足月AGA组血清GH、IGF-1、IGFBP-3、瘦素浓度(μg/L)分别为6.58±1.42和24.32±3.59,11.89±3.01和37.12±6.4,82.3±19.66和256.55±33.62,2.75±0.66和7.58±1.26;早产SGA和早产AGA组血清GH、IGF-1、IGFBP-3、瘦素浓度(μg/L)分别为8.18±2.55和13.83±3.98,13.59±4.83和21.05±3.44,93.48±16.44和157.33±39.34,3.21±0.61和4.9±0.83,各组比较有显著差异(P<0.05或P<0.01)。②轻度和重度I UGR组血清GH、IGF-1、IGFBP-3、瘦素浓度(μg/L)分别为5.82±1.02和8.67±2.07,9.96±2.19和14.56±3.87,77.48±20.51和99.13±7.16,2.61±0.63和3.31±0.51,两组比较差异均有显著性(P<0.01)。【结论】新生儿血清GH、IGF-1、IGFBP-3、瘦素浓度水平与胎儿生长发育有密切关系,是调节胎儿宫内生长发育的重要因素。     

Low-Level Lead Exposure and Blood Lead Levels in Children: A Cross-Sectional Survey

The authors studied 53 girls (44.5%) and 66 (55.5%) boys in Karachi, Pakistan, to determine their blood lead levels. The association between blood lead levels/water lead levels and the possible risk factors and symptoms associated with lead toxicity was explored. The mean lead level for the entire group was 7.9 μg/dl (standard deviation = 4.5 μg/dl). Thirty (25.2%) of the children had lead levels that exceeded 10 μg/dl; 12 (10.0%) of these had lead levels that exceeded 15 μg/dl. Thirteen (20.9%) of the children under the age of 6 yr (n = 62) had lead levels greater than 10 μg/dl, and 6 (9.6%) had levels in excess of 15 μg/dl. The authors found no association (p > .05) between high lead levels in water and blood lead levels in children. Mean blood lead levels were highest in the group of children exposed to various risk factors for lead absorption (e.g., exposure to paint, remodeling, and renovation; use of lead utensils; pica). There was a significant association between a history of exposure to paint/renovation activities and a history of pica. High blood lead levels in the children in Karachi stress the urgency for actions that control lead pollution. Screening programs should be instituted by the state. Individuals must become aware of lead's toxicity, and they must avoid substances that contain lead.     

司坦唑醇对促性腺激素释放激素拟似物处理后的青春期大鼠生长板软骨细胞IGF-1 mRNA表达及其蛋白合成、分泌的影响

目的研究司坦唑醇（stanozolol,ST）对促性腺激素释放激素拟似物（gonadotropin releasing hormone agonist,GnRHa）处理后的离体青春期大鼠生长板软骨细胞胰岛素样生长因子-1（insulin-like growth factor-1,IGF-1）mRNA表达及其蛋白合成、分泌的影响。方法将6只雌鼠的原代软骨细胞,分为时效组、量效组。根据是否用司坦唑醇干预,将时效组和量效组分为时效干预组,时效对照组;量效于预组,量效对照组,分别观察司坦唑醇的干预时限和剂量对促性腺激素释放激素拟似物处理后离体青春期大鼠生长板软骨细胞增殖的影响。采用软骨细胞增殖能力测定法（MTT）和免疫组化法检测不同剂量、不同时间点司坦唑醇处理的离体的青春期大鼠生长板软骨细胞的增殖细胞核抗原（proliferating cell nuclear antigen,PCNA）表达,荧光实时定量RT—PCR检测软骨细胞的IGF-1 mRNA表达。酶联免疫吸附法（enzyme—linked immunosorbent assay,ELISA）测定胰岛素样生长因子-1的合成。结果司坦唑醇以时效和量效作用方式,对雌激素受抑的离体青春期大鼠生长板软骨细胞增殖呈双相型影响。在合适的剂量和疗程时,软骨细胞增殖效应可达最好效果。①司坦唑醇作用2h后,软骨细胞IGF-1 mRNA表达显著增加,与时效对照组基础值相比,差异有显著意义（P〈0．05）,并存在较强的时间依赖性;作用8h时,达最高峰（为时效对照组基础值的3．8倍）。司坦唑醇的作用在（10^-10～10^-5）mol／L时,与软骨细胞的细胞核抗原增殖效应存在明显的剂量依赖性（组间比较,差异有显著意义,P〈0．05）;在10^-7mol／L时,软骨细胞的增殖细胞核抗原表达达最高峰（为基础值的5．75倍）。②司坦唑醇作用自5h起,软骨细胞胰岛素样生长因子-1蛋白合成与时间点为0组比较,差异有显著意义（P=0．042）;5h-20h时,作用存在显著时间依赖性（P〈0．05）;作用20h时,达峰值（为量效对照组基础值的3．3倍）。与量效对照组比较,司坦唑醇自10^-10mol／L组,胰岛素样生长因子-1蛋白含量开始增加,并在10^-7mol／L组达峰值（P=0．000）。结论司坦唑醇可以量效、时效的作用方式,影响和增加对促性腺激素释放激素拟似物处理后的体外培养雌激素水平,促进青春期大鼠生长板软骨细胞IGF-1 mRNA的表达和胰岛素样生长因子-1的合成、分泌,推测司坦唑醇促进生长效应机制与生长板局部胰岛素样生长因子-1的自分泌、旁分泌增加有关。     

Childhood Exposure to Phthalates: Associations with Thyroid Function,Insulin-like Growth Factor I,and Growth

Background

Phthalates are widely used chemicals, and human exposure is extensive. Recent studies have indicated that phthalates may have thyroid-disrupting properties.

Objective

We aimed to assess concentrations of phthalate metabolites in urine samples from Danish children and to investigate the associations with thyroid function, insulin-like growth factor I (IGF-I), and growth.

Methods

In 845 children 4–9 years of age, we determined urinary concentrations of 12 phthalate metabolites and serum levels of thyroid-stimulating hormone, thyroid hormones, and IGF-I.

Results

Phthalate metabolites were detected in all urine samples, of which monobutyl phthalate was present in highest concentration. Phthalate metabolites were negatively associated with serum levels of free and total triiodothyronine, although statistically significant primarily in girls. Metabolites of di(2-ethylhexyl) phthalate and diisononyl phthalate were negatively associated with IGF-I in boys. Most phthalate metabolites were negatively associated with height, weight, body surface, and height gain in both sexes.

Conclusions

Our study showed negative associations between urinary phthalate concentrations and thyroid hormones, IGF-I, and growth in children. Although our study was not designed to reveal the mechanism of action, the overall coherent negative associations between urine phthalate and thyroid and growth parameters may suggest causative negative roles of phthalate exposures for child health.     

Recent Trends in Childhood Blood Lead Levels

Blood lead levels in children in the United States have declined through 1994, the date of the most recent National Health and Nutrition Examination Survey. In this investigation, the authors analyzed whether blood lead levels have changed since 1994 and quantified the magnitude of any change. The authors evaluated blood lead levels from 12 longitudinal data sets from 11 states and 1 city. Geometric mean blood lead levels declined between 4%/year and 14%/year in 8 of the data sets. No differences in decline rates were observed between data sets from states that had universal screening as a goal or that included repeat measures for an individual child and those data sets that did not. The authors' best estimate for these populations was a decline rate of 4–7%/year, which was comparable to the decline rate prior to 1994.     

铅作业工人神经肌电图改变与血铅水平关系的研究

本文对140名铅作业工人进行了神经肌电图检查和血铅测定,发现正中神经感觉传导速度随血铅升高而减慢,呈显著负相关;正中神经、尺神经的传导速度和末端潜伏期改变与血铅水平有关,呈接触水平-反应关系。末端潜伏期的异常率在血铅超过1.93～2.41μmol/L时显著增高。拇展短肌、小指展肌和伸指总肌的肌电图改变主要表现为小力收缩时运动单位电位多相电位数显著增多和大力收缩时显示的运动单位电位数目显著减少。     

兰州市小儿血铅水平调查及相关因素分析

目的 了解兰州市０～７岁小儿血铅水平及影响因素。方法 采用随机抽样的方法对在甘肃省人民医院产科出生的１０３名新生儿,来该院进行计划免疫的１月至３３月龄的１４６名婴幼儿以及采用分层整群抽样法对本市９所幼儿园的８０８名３～７岁儿童进行了毛细血管对血铅测定。对所有小儿的个人情况及家庭生活环境均进行了问卷调查。结果 新生儿血铅均值为８３．５μｇ／Ｌ,≥１００μｇ／Ｌ者２５例,占２４．２７％。１４６例婴幼儿     

胰岛素样生长因子-1对脓毒症大鼠血浆应激激素和胰岛素样生长因子-1受体表达的影响

目的探讨胰岛素样生长因子-1（IGF-1）对脓毒症大鼠血浆应激激素及骨骼肌IGF-1受体（IGF-1R）蛋白质和mRNA表达的影响。方法选择71只SD大鼠采用盲肠结扎穿孔法建立腹腔感染及颈静脉置管肠外营养（PN）模型后，将存活的30只大鼠随机分为脓毒症组（n=10）、PN组（n=10）及IGF-1组（n=10），另设正常组（n=10）。正常组和脓毒症组给予生理盐水，PN组给予营养支持，IGF-1组为PN＋IGF-1静脉注射，连续5天。第6天行颈动脉置管，开腹取门静脉血测定胰岛素、胰高血糖素、肾上腺素、皮质醇和IGF-1水平；免疫组织化学法及实时定量PCR法测定肝脏和骨骼肌IGF-1R蛋白质和mRNA的表达。结果与对照组相比，脓毒症组大鼠血浆胰岛素、胰高血糖素、肾上腺素、皮质醇水平显著升高，IGF-1显著下降（P〈0．01）；IGF-1组前5项指标较脓毒症组和PN组显著降低，IGF-1则显著升高（P〈0．05，P〈0．01）。脓毒症组肝脏和骨骼肌IGF-1R蛋白质及mRNA表达较对照组显著增强（P〈0．05，P〈0．01）；IGF-1组的IGF-1R蛋白质及mRNA表达较脓毒症组和PN组显著降低（P〈0．01）。结论IGF-1可改善应激激素之间的平衡，降低脓毒血症大鼠IGF-1R在蛋白质和mRNA水平的表达，从而有利于血糖的控制。     

1982～1998年西安市非职业接触女性血铅和血镉水平的调查研究

探讨非职业接触人群血铅和血镉水平及其变化趋势，为评估分析环境铅和镉污染程度和污染来源提供科学依据。「方法」按ＷＨＯ生物监测方法和程序于１９８２－１９９８年对西安市非职业接触女性连续进行了血铅和血镉监测，并对相关人群做了一性摸底对照监测。「结果」１７年间女性血铅由０．２８０μｍｏｌ／Ｌ升至０．４３８μｍｏｌ／Ｌ，血镉由４．４５ｎｍｏｌ／Ｌ升至６．３２ｎｍｏｌ／Ｌ，上升幅度分别是５６．４％和４２．０％     

平顶山市3~6岁儿童铅中毒调查及影响因素分析

目的:了解该市学前儿童血铅水平和铅中毒流行情况及影响因素。方法:对铅防门诊和部分幼儿园的市区3~6岁学前儿童抽样检测血铅,并进行问卷调查与统计分析。结果:共检测1018例儿童,其中门诊病例220例,幼儿园798例。血铅均值81.3±30.1μg/L,铅中毒率31.0%,门诊铅中毒(47.3%)流行率高于幼儿园(26.6%),P<0.05。影响因素中,儿童挑食、家中使用燃煤灶具和学校及家庭周围高铅环境污染对铅中毒流行率有明显影响,P<0.05。结论:该市学前儿童铅中毒的流行率处中等水平,低于河南省的郑州、新乡、洛阳等地。环境污染是引起儿童铅中毒的主要因素,偏食对铅中毒也有影响。     

血清胰岛素样生长因子-1和一氧化氮水平与原发性高血压关系的临床研究

目的探讨血清胰岛素样生长因子-1（IGF-1）及一氧化氮（NO）水平与原发性高血压（EH）及左心室肥厚（LVH）的关系。方法入选EH患者100例,为初次尚未服药治疗或服药后但血压控制不满意者,分为1、2、3级,计算左心室重量指数（LVMI）,LVMI〉125 g/m2（男）或〉120 g/m2（女）,为LVH。分为LVH（46例）组和无LVH（54例）组。另40例健康体检者作为对照组。分别用放射免疫法测定血清IGF-1及硝酸还原酶法测定血清NO水平。100例EH患者降压治疗3月后再次测定血压与血清IGF-1水平。结果 EH患者血清IGF-1水平（358.6±52.6）ng/ml高于正常对照组（142.5±41.3）ng/ml,血清NO水平（41.5±23.7）μmol/L低于对照组（82.1±20.8）μmol/L。EH组血压1-3级间血清IGF-1的水平（分别为257.6±45.3、329.4±32.8、412.3±41.5 ng/ml）随着EH级数的增加而增加且不同级数之间差异有统计学意义,NO的水平（分别为63.4±15.2、48.5±19.8、32.5±21.6μmol/L）随着EH级数的增加而降低且不同级数之间差异有统计学意义。EH伴LVH者血清IGF-1水平（387.4±35.8）ng/ml高于无LVH者（296.6±40.2）ng/ml,血清NO水平（34.3±18.2）μmol/L低于无LVH者（57.9±22.2）μmol/L。EH组经药物治疗3月后血压达标者的血清IGF-1水平（259.2±42.6）ng/ml低于血压未达标者（324.6±37.2）ng/ml,血清NO水平（75.6±12.9）μmol/L高于血压未达标者（46.2±15.3）μmol/L。结论 EH患者IGF-1升高,NO降低,可能参与高血压LVH的调节。其水平可以较好地反映LVH的程度。     

Relationship Between Blood Lead Levels and Hematological Indices in Pregnant Women

Several studies have revealed a negative association between blood lead levels and hematological impairment. In this cross-sectional study, we examined the relationship between blood lead levels and hematological indices in 292 pregnant women from Durango, Mexico. Apparently healthy pregnant women, aged 14–41 years and at 3–41 weeks of gestation, were recruited between June 2007 and May 2008. Blood lead and hematological indices were measured. The mean blood lead was 2.79 ± 2.16 μg/dL, and lead levels ≥5 μg/dL were detected in 25 women (8.6%). Hemoglobin, hematocrit, and red blood cells count were significantly higher in pregnant women with a blood lead concentration of ≥5 μg/dL than the group with lower blood lead levels (p < .05). Mean corpuscular volume and mean corpuscular hemoglobin were not significantly related to lead levels. Hemoglobin and hematocrit showed a non-significant positive correlation with blood lead, but the correlation between red blood cell count and blood lead levels was statistically significant (r = 0.185, p = .002). The findings suggest that a positive association between blood lead and some hematological indices may occur at relatively low blood lead concentration (mean < 5 μg/dL).     

Gender Differences in Blood Lead and Hemoglobin Levels in Andean Adults with Chronic Lead Exposure

Abstract

A field study of the prevalence of lead (Pb) intoxication was conducted in 158 adults (67 men and 91 women) living at 2,500-2,800 meters in Ecuadorian Andean villages with high Pb contamination from local small-scale Pb-glazing cottage industries. Venous blood samples showed mean blood lead (PbB) levels of 34.5 μg/dL (SD 22.2) for men and 27.0 μg/dL (SD 18.4) for women; this difference was significant (t-test, p = 0.022; Mann-Whitney U, p = 0.044). An ANOVA showed no significant main effect for gender (F = 0.118, p = 0.782) or age (F = 2.479, p = 0.117), and no significant gender-by-age interaction (F = 0.273, p = 0.602). In the Pb-glazing study group, 39% of the men had PbB levels ≥40 μg/dL, while 41 % of the women had PbB levels ≥ 30 μg/elL (the WHO health-based biological limits). A reference group of 39 adults (24 men and 15 women) had a mean PbB level of 5.9 μg/dL (SD 2.8; range: 1.8–16.8), significantly different from that of the 158 subjects in the study group (t-test, p < 0.0001). The difference in mean PbB levels of men (6.8 μg/dL) and women (4.7 μg/dL) in the reference group was significant (t-test, p = 0.026; Mann-Whitney U, p = 0.019). The mean altitude-corrected hemoglobin levels in the study group were lower than normal, 11.3 g/dL for men and 10.9 g/dL for women.