血管内皮功能与体脂含量、分布及胰岛素抵抗的关系

探讨体脂含量、分布和胰岛素抵抗 (IR)对血管内皮功能的影响。 5 2 7例年龄 35～ 5 5岁的石家庄市居民 ,经健康检查各项临床和实验室指标未见异常。用高分辨率超声仪测定肱动脉血流介导的内皮依赖性血管舒张 (EDD) ,并测定体重指数 (BMI)、腰围 (W)、腰臀比 (WHR)和IR指数 (HOMA IR)。结果显示 ,内皮功能异常者的BMI、W、WHR和HOMA IR均较内皮功能正常者显著增加 ,BMI的升高主要表现在女性肥胖者 ,而W和WHR的升高则仅在各组男性中有显著差异。HOMA IR在超重和肥胖组男性及各组女性中均有显著差异。相关分析表明 ,BMI、WHR和HOMA IR是影响EDD的主要因素 ,但存在性别差异。W和EDD在男女性中均是参与IR的因素。血管内皮功能与体脂含量和分布及IR密切相关     

肥胖者内皮功能障碍与胰岛素抵抗关系的研究

目的探讨内皮功能障碍与胰岛素抵抗(IR)的因果关系。方法260例无代谢性疾病和心血管病的中年肥胖患者,其中内皮功能异常者157例,内皮功能正常者103例,均随机分为减重干预组和未干预组。另选87例正常体重的健康人作为正常对照组。强化生化方式减重干预2年,随访前后测定体脂、血压、血脂、空腹血糖和胰岛素,计算IR指数(HOMAIR),并通过高分辨率超声评价血管内皮功能。结果肥胖伴内皮功能异常者减重干预后内皮功能明显改善(4.56±4.79vs15.17±5.80,P<0.01),IR减轻(0.91±0.18vs0.68±0.22,P<0.01),未减重者内皮功能无改善,IR加重(0.92±0.20vs1.13±0.25,P<0.05);肥胖伴内皮功能正常者减重干预后内皮功能及胰岛素敏感性维持不变,而未减重者内皮功能出现异常(16.29±4.59vs7.88±5.24,P<0.01),胰岛素敏感性降低(0.66±0.30vs0.81±0.25,P<0.01)。结论内皮功能障碍是导致和加重肥胖者IR的重要原因,减重干预可逆转异常的内皮功能。     

飞行人员冠心病危险因素聚集度与胰岛素抵抗的关系

目的研究飞行人员心血管病危险因素聚集情况及其与胰岛素抵抗（IR）的关系。方法对230名健康疗养飞行人员进行心血管病危险因素问卷调查，检查血糖、血脂和血胰岛素水平，计算胰岛素抵抗指数（HOMA—IR）及8细胞的分泌功能，比较心血管病危险因素聚集度与胰岛素抵抗的关系。结果230名飞行人员中完成全部设计项目的155名，体质指数（BMI）、收缩压（SBP）、舒张压（DBP）与HOMA—IR呈正性相关，分别为：r=0．236，P=0．003；r=0．221，P=0．012；r=0．200，P=0．023。年龄≥40岁者HOMA—IR高于年龄〈40岁者（P〈0．05）；BMI≥25kg／m^2者HOMA—IR大于BMI〈25kg／m^2者（P〈0.05）；具有1项、2项代谢危险因素者HOMA-IR大于无危险因素者（P〈0.05）；同时具有≥3项代谢危险因素和心血管病相关生活因子者HOMA—IR大于无危险因素者（P〈0.05）。结论飞行人员胰岛素抵抗与体质指数、收缩压、舒张压相关，与年龄、飞行时间、血脂等因素不相关；具多项危险因素者IR高于不具危险因素者；BMI≥25kg／m^2可作为初步筛查飞行人员IR的界值。     

原发性高血压患者血清胆红素与胰岛素抵抗水平的关系

目的　探讨原发性高血压患者血清总胆红素浓度与胰岛素抵抗、血糖、血脂、尿酸等的关系。方法 :测定 16 5例原发性高血压患者 (男 6 1例 ,女 10 4例 )的空腹血清总胆红素、血红蛋白 (Hb)、尿酸(UA)、总胆固醇、三酰甘油 (TG)、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的浓度 ,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)和胰岛素曲线下面积 (AUCIN) ,稳态模式评估法计算胰岛素抵抗指数 (HOMA IR)。分析血清总胆红素浓度与其他各项参数的相关性。结果 :以HOMA IR 5 0 %位点 ,作为判断胰岛素抵抗的切割点 ,把原发性高血压患者分为胰岛素抵抗组 (IR)与胰岛素敏感组 (IS)。血清总胆红素浓度 :IR组 (9.3± 3.3)mol L显著低于IS组(12 .0± 3.8)mol L ,与HOMA IR、腰围臀围比、收缩压、Hb、空腹胰岛素、TG、ACUG、ACUIN呈显著相关关系 ;逐步回归分析显示 ,HOMA IR、ACUG 与Hb为血清总胆红素浓度的独立预测因子 ,血脂和UA均非血清总胆红素浓度的独立预测因子。结论 :原发性高血压患者血清总胆红素浓度与胰岛素抵抗、血糖与Hb直接相关 ,与血脂、UA无直接相关。提示低胆红素水平可能是胰岛素抵抗作为心血管疾病发生发展重要危险因素的机理之一     

正常糖耐量患者胰岛素抵抗与冠状动脉病变的相关性分析

目的探讨正常糖耐量患者胰岛素抵抗(IR)与冠状动脉病变的相关性。方法纳入浙江医院2007年1月-2010年12月收治的正常糖耐量患者129例,根据新HOMA稳态模型按胰岛素敏感指数(ISI)分为胰岛素敏感(IS)组(n=68)和IR组(n=61),分别测定两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、同型半胱氨酸(HCY)、血尿酸(UA)水平,并进行选择性冠状动脉造影及Gensini评分,采用Spearman、偏相关和多元逐步回归对结果进行相关性分析。结果与IS组比较,IR组冠状动脉病变程度严重,0支病变(29.8%vs11.8%,P<0.05)和1支病变(26.3%vs11.8%,P<0.05)比例显著降低,而多支病变比例(14.1%vs49.0%,P<0.01)、Gensini评分(10.6±12.7vs32.2±34.3,P<0.01)显著增高。校正影响因素后,Gensini评分与ISI呈明显的负相关(r=-0.354,P<0.01);多元逐步线性回归分析显示,ISI、HCY是影响Gensini评分的独立因素。结论在正常糖耐量患者中,IR与冠状动脉病变显著相关,是其独立的危险因子。     

2型糖尿病并发脑血管意外的多因素分析

目的：讨论2型糖尿病并发脑血管意外的危险因素。方法：788例住院治疗2型糖尿病患者根据 CT 和 MRI 检查结果分为糖尿病并发脑血管意外组(DMCI)173例与糖尿病无并发脑血管意外组(DM)615例,并收集同期的无糖尿病脑血管意外组患者(CI)168例作为对照组。结果：(1)DMCI 意外组的高血压患病率明显增高,(2)DMCI 组与 DM 组比较,年龄、糖尿病病程、BMI、WHI、血糖、胰岛素水平、HOMA—IR、LDL、TC 均明显增加,而 HDL 显著减低。(3)DMCI 组与 CI 组比较,胰岛素水平、HOMA—IS 明显增加,而 HOMA— IR 降低。结论：对2型糖尿病患者除严格控制血糖外,降压,调整血脂异常,降低血黏度,改善胰岛素对抗,增加胰岛素敏感性,对防止糖尿病并发大血管疾患有着重要意义。     

血浆脂肪甘油三酯脂酶水平与肥胖、胰岛素抵抗相关因素的关系研究

目的 探讨初诊2型糖尿病(T2DM)伴肥胖患者血浆脂肪甘油三酯脂酶(ATGL)水平变化及其与体重指数(BMI)、腰臀比(WHR)、血脂、血糖、血浆胰岛素水平等的关系.方法 纳入T2DM患者及健康体检者共161例,分为4组:初诊T2DM患者(T2DM)组、初诊T2DM伴肥胖患者(T2DM-ob)组、正常糖耐量伴肥胖者(NGT-ob)组和正常对照(NGT)组.再根据胰岛素抵抗指数(HOMA-IR)中位数将上述161例患者分为胰岛素抵抗(IR)组及胰岛素敏感(IS)组.采用酶联免疫法(ELISA)测定上述受试者血浆ATGL水平,并分析其与BMI、WHR、血脂、血糖、血浆胰岛素、HOMA-IR等的关系.结果 4组间血浆ATGL水平差异均无统计学意义,但4组中T2DM-ob组、T2DM组ATGL浓度分别与NGT-ob组、NGT组比较有降低的趋势.IR组ATGL水平(61.7±21.6μg/L)明显低于IS组(75.3±22.9μg/L,P<0.01).血浆ATGL水平与高密度脂蛋白胆固醇(HDL-C)呈明显正相关(r=0.229,P<0.01),而与空腹胰岛素(FINS)、HOMA-IR呈明显负相关(r=-0.199,P<0.05;r＝-0.234,P<0.01).多元回归分析结果表明,HDL-C、BMI、体内脂肪百分比(FAT%)均为影响血浆ATGL水平的独立相关因素.结论 血浆ATGL水平的改变与肥胖相关因素和IR等有关,并可能参与了肥胖、IR和T2DM的发生和发展.     

飞行员中与胰岛素抵抗相关因素的调查

目的　查明飞行员中与胰岛素抵抗 (IR)相关的因素 ,从而为减少飞行员IR提供基础。　方法　以 2 0 0 0年 5月～ 2 0 0 2年 5月住本院的 80例现役飞行员作为调查对象 ,按胰岛素抵抗指数(用HOMAIR法表示 )的 5 0 %百分位法 ,将其分为二组 :胰岛素相对敏感组 (HOMAIR <1.10 )和胰岛素相对抵抗组 (HOMAIR≥ 1.10 ) ;并用年龄相当普通正常人 (n =4 0 )作对照组。测量各组可能与IR有关的指标。　结果　飞行员组HOMAIR明显高于对照组 ;飞行员年龄、体重指数 (BMI)、舒张血压 (DBP)、胆固醇 (TCH)、高密度脂蛋白 (HDL c)、红细胞聚集指标、HOMA胰岛 β细胞功能(HOMAβ cell)与对照组相比无明显差异 ,且两组飞行员之间也无差异 ;而飞行员人群腰 /臀比(WHR)、收缩血压 (SBP)、空腹血糖 (FBG)、空腹胰岛素 (FINS)、甘油三酯 (TG)、血浆粘度、全血低切相对粘度高于对照组 ,且两组飞行员之间也有差异 (还包括代谢紊乱家族史、飞行时间 )。经多线性回归分析后飞行员IR与他们的代谢紊乱家族史、飞行时间、WHR、SBP、TG和血浆粘度呈正相关 ,与空腹血糖、空腹胰岛素、全血低切相对粘度无相关性。　结论　飞行员较普通人群更易出现IR ,且WHR、SBP、TG和血浆控制与IR有关的代谢性因素将有助于减少IR在飞行员中的发生。     

罗格列酮治疗2型糖尿病疗效观察

目的:观察罗格列酮治疗2型糖尿病的疗效。方法:将2型糖尿病60例随机分为两组:对照组服用二甲双胍或磺脲类降糖药物;罗格列酮组在对照组方案基础上加服罗格列酮4mg,每天1次。观察体重、体重指数、空腹血糖(FPG)、血脂、血压、肝功能、空腹胰岛素、糖化血红蛋白和胰岛素抵抗指数12周。结果:罗格列酮组治疗前后FPG、FINS、HOMA-IR差异显著(P<0.05),而对照组差异不显著(P>0.05);罗格列酮组治疗前后体重、BMI、谷草转氨酶、总胆红素、总胆固醇均差异不显著,三酰甘油、高密度脂蛋白、低密度脂蛋白治疗后变化水平均明显高于对照组(P<0.05)。结论:罗格列酮有肯定的降糖效果,同时降低胰岛素抵抗指数,改善脂代谢。     

妊娠糖尿病/妊娠糖耐量低减患者孕晚期血脂特点及其与体重的关系

目的了解妊娠糖尿病/妊娠糖耐量低减(GDM/GIGT)患者妊娠晚期血脂变化及其与孕期体重变化的关系。方法100g葡萄糖口服糖耐量试验(OGTT)筛查,按照美国糖尿病学会(ADA)标准诊断为GDM/GIGT的孕晚期初产妇女(n=216,年龄32.08±3.85岁)。记录孕前、分娩前体重,测量身高,计算孕前体质指数(BMI)、孕期增重、孕期体重增幅。于孕29±1周采空腹静脉血测定血浆总胆固醇(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)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白a[Lipoprotein a,Lp(a)]。根据孕期体重增长将患者分为低于正常(<10.0kg)组、正常(10~12.5kg)组和高于正常(>12.5kg)组,分析各组间血脂指标的差异;根据孕前BMI将患者分为正常(18.5~23.0)组,消瘦(<18.5)组、超重(23.1~25.0)组和肥胖(>25)组,分析各组间血脂指标的差异;分析孕前BMI、孕期增重、孕期体重增幅与孕晚期血脂的相关性。结果除Lp(a)外,TC、TG、HDL-c、LDL-c、ApoA1、ApoB的均值高于正常上限。多数GDM/GIGT患者孕前BMI处于正常范围,而孕期增重过高。孕前BMI各组,孕期增重各组间各血脂指标的水平没有统计学差异,且孕前BMI、孕期增重、孕期体重增幅与各血脂指标没有明显相关性。结论初步证实GDM/GIGT患者存在与正常妊娠相似的孕晚期血脂升高现象,这种变化与孕前的BMI或孕期的体重变化无显著相关性。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.