社区老年男性衰弱及其影响因素分析

目的 分析慢病、躯体功能、骨骼肌质量、脂肪等因素对老年男性衰弱患者的影响。方法 横断面分析在2021年4月-6月期间纳入的北京市社区658例≥60岁老年男性,用Fried衰弱表型（FP）诊断衰弱。采用 Charlson共病指数（CCI）评估患慢病状况。测试躯体功能并采用人体成分分析仪（Inbody770）骨骼肌、脂肪等体成分。采用SPSS26.0统计学软件进行数据分析,组间比较采用两独立样本t检验、Mann-Whitney U检验以及卡方检验,运用二元logistic进行单因素及多因素回归分析。结果 单因素分析显示衰弱组与非衰弱组不仅在年龄、身高、体重,而且在骨骼肌质量指数、体脂肪量、内脏脂肪面积、基础代谢率、蛋白质、骨矿物质含量以及握力、步速、5次起坐时间上,差异均有统计学意义（P＜0.05）。衰弱组CCI较非衰弱组明显增高,其中高血压、冠心病、糖尿病、低骨量、慢性支气管炎、慢性肾病患者比例较高（P＜0.05）。校正年龄、身高、体重后,多因素logistic回归分析发现 CCI（OR=1.256,95%CI 1.012～1.558,P =0.039）、低骨量（OR=2.312,95%CI 1.308～4.088,P=0.004）和5次起坐时间（OR=1.110,95%CI 1.022～1.250,P =0.013）是衰弱的独立影响因素。结论 CCI增高,低骨量和5次起坐时间延长与衰弱的发生密切相关。     

住院共病老年人认知衰弱现状及其影响因素

目的明确住院共病老年人认知衰弱分布特点,进一步探讨其影响因素。方法回顾性分析2015年11月至2018年1月在成都市第五人民医院老年病科住院的老年共病患者(年龄≥60岁)692例。采用老年综合评估衰弱指数(CGA-FI)量表评估衰弱状态,简易精神状态检查量表(MMSE)评估老年人认知情况;同时存在衰弱和认知障碍(CI)者定义为认知衰弱。采用Charlson合并症指数(CCI)进行共病严重程度评估。根据是否存在衰弱或CI将患者分为认知衰弱组(176例)、单纯衰弱组(176例)、单纯CI组(74例)和非认知衰弱组(266例)。收集并比较4组患者临床资料,分析共病老年患者认知衰弱分布特点。采用SPSS 23.0软件对数据进行统计分析。多因素logistic回归法分析发生认知衰弱的独立影响因素。结果纳入患者总体存在2～12种慢性疾病,CCI指数为5.5±1.9。25.4%(176例)的共病患者存在认知衰弱。趋势性检验显示,认知衰弱患病率随年龄、CCI级别的增高和Barthel日常生活能力的下降呈趋势性增加(P0.001)。与其他3组比较,认知衰弱组患者年龄、CCI,以及入院情况(病危/病重)、急性心力衰竭、慢性骨关节炎、老年综合征(营养不良、平衡功能障碍、抑郁情绪、睡眠障碍、跌倒史)比例均显著升高,体质量指数及Barthel日常生活能力(ADL)评分较低,差异有统计学意义(P0.05)。多因素logistic回归分析显示,营养不良(OR=5.022,95%CI 2.484～10.157;P0.001)、营养不良高风险(OR=2.272,95%CI 1.179～4.377;P=0.014)、平衡功能障碍(OR=4.803,95%CI 2.898～7.960;P0.001)、抑郁(OR=4.227,95%CI 2.271～7.866;P0.001)、骨关节炎(OR=2.707,95%CI 1.332～5.501;P=0.006)是住院共病老年人发生认知衰弱的独立影响因素。结论住院共病老年人普遍存在认知衰弱,年龄越大、共病程度和ADL障碍越严重,认知衰弱越明显。临床上应注意营养缺失、平衡力差并存在骨关节炎和抑郁的共病老年人群。     

住院共病老年人衰弱状态分布及其影响因素

目的明确住院共病老年人衰弱状态分布特点,进一步探讨其影响因素。方法横断面调查选取2015年11月至2017年7月成都市第五人民医院老年科收治的≥60岁住院共病患者440例。根据衰弱状态将患者分为衰弱组150例及非衰弱组290例,比较2组患者一般人口学资料、共病、衰弱状态及老年综合征情况。采用SPSS 23.0进行统计分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验或χ~2检验。采用Mantel-Haenszel χ~2检验分析衰弱分布趋势。危险因素分析采用向后逐步法二元logistic回归。结果 440例患者总体存在5(4,7)种慢性疾病,Charlson合并症指数(CCI)为(5.59±1.82)分。入选患者衰弱患病率为34.1%(150/440),衰弱前期占60.0%(264/440)。趋势性检验结果显示,随年龄和CCI评分升高,衰弱患病率显著增加,差异有统计学意义(P0.05);衰弱五要素中,体质量下降发生率随年龄和CCI评分增加而增加,握力下降和疲乏发生率随年龄增加而增加,差异亦有统计学意义(P0.05)。与非衰弱患者比较,衰弱组患者年龄增大,学历较低,合并慢性心力衰竭、慢性阻塞性肺疾病、抑郁、认知功能障碍、尿失禁、高跌倒风险、功能依赖的比例显著升高,但多重用药比例显著降低,差异有统计学意义(P0.05)。经校正混杂因素后,二元logistic回归分析表明,抑郁(OR=2.178,95%CI 1.252～3.790)和功能依赖(OR=1.942,95%CI 1.029～3.668)是衰弱的独立危险因素。结论住院共病老人中普遍存在衰弱,且衰弱的患病率与年龄和共病严重程度呈趋势性增加,抑郁和功能依赖与衰弱状态密切相关。     

衰弱离退休老干部跌倒发生现状及影响因素

目的 探讨衰弱离退休老干部跌倒发生现状,明确跌倒发生的影响因素。方法 选取2019年2月至10月于中国人民解放军总医院第一医学中心住院的离退休老干部442名作为研究对象,根据过去12个月内是否发生跌倒将衰弱前期或衰弱老干部分为2组。比较2组老干部一般资料,身体功能情况。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ²检验。采用Fried衰弱量表进行衰弱筛查,采用logistic回归分析衰弱老干部跌倒发生的危险因素。结果 最终共纳入322例(72.0%)衰弱前期及衰弱离退休老干部为研究对象,年龄63～98(76.91±9.23)岁。跌倒组患者60例,未跌倒组262例。单因素方差分析结果显示:衰弱评分、年龄、体质量指数、情绪状态、简易身体功能测试得分、串联站立测试得分、起坐测试得分对老干部是否发生跌倒有显著影响(P<0.05);logistic回归分析结果显示:年龄(OR=1.043,95%CI 1.003~1.085)、体质量指数＜18.5kg/m²(OR=3.704,95%CI 1.024~13.391)为衰弱老干部跌倒发生的主要影响因素(P<0.05)。结论 衰弱离退休老干部跌倒发生率较高,应加强该类人群跌倒风险的评估与筛查,针对跌倒高风险人群,制定有效预防措施。     

衰弱对老年男性慢性肾脏病患者发生肌少症的影响

目的探讨衰弱对老年男性慢性肾病(CKD)患者发生肌少症的影响。方法选择2018年10月1日~2019年1月30日解放军总医院第二医学中心门诊就诊的老年男性CKD患者105例,根据肌少症诊断分为正常组72例和肌少症组33例。多因素回归分析衰弱与老年CKD患者发生肌少症的相关性。结果105例患者中,衰弱期31例,患病率29.5%。肌少症组年龄、衰弱比例明显高于正常组,体质量指数、肌肉质量、脂肪量、TC和估算的肾小球滤过率(e GFR)水平明显低于正常组,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,衰弱是老年男性CKD患者发生肌少症的危险因素(OR=3.575,95%CI:1.030~12.410,P=0.045),年龄与肌少症呈正相关(OR=1.160,95%CI:1.001~1.343,P=0.048),体质量指数和eGFR与肌少症呈负相关(OR=0.469,95%CI:0.273~0.803,P=0.006;OR=0.962,95%CI:0.928~0.997,P=0.033)。肌少症组步速减慢、握力下降、疲惫感、低体力活动比例明显高于正常组,差异有统计学意义(P<0.01)。结论老年男性CKD患者肌少症的发生主要与年龄、体质量指数及衰弱有关。     

少肌症与老年高血压的相关性临床研究

目的探讨少肌症与老年高血压的相关性。方法选择年龄≥65岁老年人197例,其中125例原发性高血压患者为高血压组,72例健康体检者为对照组,分别测定2组入选者身高、体质量、四肢骨骼肌质量、血糖、血脂水平,并进行比较分析。结果高血压组四肢骨骼肌质量、相对骨骼肌质量指数低于对照组,差异有统计学意义[(14.62±3.25)kg vs(19.25±1.41)kg,P=0.000;(5.52±1.37)kg/m~2 vs(7.10±0.85)kg/m~2,P=0.000]。高血压组少肌症患病率高于对照组,差异有统计学意义(72.0%vs 47.2%,P=0.001)。男性少肌症患病率高于女性,差异有统计学意义(91.30%vs 38.10%,P=0.000)。多因素logistic回归分析显示,少肌症、女性、年龄为老年高血压的危险因素(OR=23.32,95%CI:5.349~101.632,P=0.000;OR=19.40,95%CI:4.438~84.794,P=0.000;OR=1.38,95%CI:1.034~1.837,P=0.029)。结论老年高血压与四肢骨骼肌质量密切相关,老年男性更易患少肌症,少肌症是引起高血压的1个危险因素。     

老年2型糖尿病住院患者合并肌少症影响因素研究

目的探讨老年2型糖尿病(T2DM)住院患者合并肌少症的临床特征及其影响因素。方法选取老年T2DM患者190例,根据肌少症诊断标准分为肌少症组43例和非肌少症组147例,进行握力、步速和人体成分分析等测定,采用Spearman相关分析骨骼肌质量指数(ASMI)相关影响因素,采用多因素logistic回归分析老年T2DM住院患者合并肌少症影响因素。结果肌少症组年龄和HDL水平明显高于非肌少症组,体质量指数(BMI)、基础代谢率、体蛋白、体脂肪、骨矿物质含量、内脏脂肪面积、上臂无脂肪周长及ASMI明显低于非肌少症组(P0.05,P0.01)。老年T2DM患者ASMI与性别、BMI、上臂无脂肪周长、骨矿物质含量、空腹胰岛素、血红蛋白呈正相关(P0.05,P0.01),与体脂百分比呈负相关(P0.01)。logistic回归分析显示,性别、BMI、内脏脂肪面积、骨矿物质含量是老年T2DM患者合并肌少症的危险因素(95%CI:1.254～64.334,P=0.029;95%CI:0.213～0.702,P=0.002;95%CI:1.002～1.081,P=0.040;95%CI:0.001～0.371,P=0.009)。结论肌少症是老年T2DM患者常见共患疾病,肌少症的发生与性别、BMI、内脏脂肪面积及骨矿物质含量密切相关。     

老年高血压患者发生衰弱对预后的影响

目的探讨衰弱对老年高血压患者不良预后的影响。方法随机选取2015年3月至2016年10月在解放军总医院门诊就诊或常规查体的老年高血压患者314例为研究对象,对患者的一般人口学特征、既往病史等进行问卷调查,应用Charlson合并症指数(CCI)对老年患者的共病状态进行评估,微型营养评估简表(MNA-SF)进行营养评估,Barthel指数进行日常生活能力评估。依据衰弱状态分为3组:正常组(n=65)、衰弱前期组(n=208)和衰弱组(n=41)。进行18个月的随访,依据是否发生跌倒分为2组:跌倒组(n=41)和非跌倒组(n=273);依据是否发生全因住院分为2组:住院组(n=133)和非住院组(n=181)。采用SPSS 19.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。对单因素分析有统计学意义的指标进行多因素logistic回归分析,筛选出独立的危险因素。结果 314例老年高血压患者应用Fried标准共检出衰弱者41例,检出率为13.1%,且衰弱的检出率随年龄的增加而增加。经校正的回归模型显示,步速减低与跌倒具有显著相关性(OR=2.88,95%CI 1.26~6.56,P0.05),步速减低与全因住院的相关性差异无统计学意义(OR=1.13,95%CI0.57~2.22,P=0.726)。结论老年高血压患者衰弱的检出率随年龄的增加而增加,步速减低是老年高血压患者发生跌倒的独立危险因素。     

老年人代谢综合征与骨质疏松的相关性研究

目的探讨老年人代谢综合征(MS)与骨质疏松的相关性。方法选择我院老年综合科诊治的老年患者258例,根据骨密度水平分为骨质疏松组93例和非骨质疏松组165例。又根据MS诊断分为MS组96例,非MS组162例。比较2组一般情况、体质量指数(BMI)、糖脂代谢、炎性因子等指标,并行多因素logistic回归分析。结果骨质疏松组年龄、女性、LDL-C、高敏C反应蛋白及白细胞介素6水平明显高于非骨质疏松组,BMI、腰围、臀围、四肢骨骼肌质量、四肢骨骼肌质量指数、HDL-C、维生素D、骨钙素水平明显低于非骨质疏松组(P0.05,P0.01)。MS组骨密度及T值(腰椎、左股骨颈、右股骨颈)、骨钙素和维生素D水平明显低于非MS组(P0.05,P0.01)。logistic回归分析显示,校正混杂因素后,MS、女性、LDL-C为老年患者骨质疏松的危险因素(OR=2.36,95%CI:1.08～4.13,P=0.000;OR=2.82,95%CI:1.64～5.07,P=0.000;OR=1.97,95%CI:1.19～3.12,P=0.000),BMI、HDL-C为老年患者骨质疏松的保护因素(OR=0.89,95%CI:0.79～0.96,P=0.001;OR=0.93,95%CI:0.82～0.98,P=0.001)。结论 MS、女性、LDL-C、BMI、HDL-C是老年人骨质疏松的影响因素。     

老年认知衰弱的现况及影响因素

目的 调查住院老年患者认知衰弱的现状并探讨其影响因素。方法 选择2018年1月至2021年5月于首都医科大学附属北京友谊医院老年医学科住院、年龄≥60岁且进行老年综合评估的158例患者为研究对象,根据简易精神状态量表(MMSE)及Fried衰弱表型将患者分为认知衰弱组(34例)和非认知衰弱组(124例),比较2组患者一般资料、化验检查及老年综合评估量表得分情况。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ²检验进行组间比较。应用二元logistic回归分析影响住院患者认知衰弱的因素。结果 与非认知衰弱组比较,认知衰弱组年龄更大,营养状况更差,生活能力依赖程度更严重,差异均有统计学意义(均P<0.05)。二元logistic回归分析显示,高龄(OR=0.921,95%CI 0.847～0.981)、IADL受损(OR=4.611,95%CI 1.725～12.328)及低白蛋白血症(OR=1.127,95%CI 1.007～1.262)是住院老年患者认知衰弱的影响因素。结论 住院老年患者认知衰弱发生率高,医务人员应重视...     

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.