非酒精性脂肪肝合并代谢综合征各组分及其聚集与心脑血管病的相关分析

目的分析非酒精性脂肪肝(NAFLD)合并代谢综合征(MS)各组分及其聚集情况与心脑血管病的关系。方法对门诊就诊和健康体检成年人2 478例按是否合并NAFLD分为对照组和NAFLD组。分析NAFLD合并MS各组分及其聚集情况,NAFLD并心脑血管病与MS组分、聚集数相关性。结果 NAFLD组体质量指数、腰围、血压、空腹血糖、胆固醇、三酰甘油、低密度脂蛋白、丙氨酸氨基转移酶均显著高于对照组,高密度脂蛋白则低于对照组。NAFLD组肥胖、高血压、高三酰甘油血症、低高密度脂蛋白血症、高血糖和代谢综合征分别为51.80%,32.76%,37.22%,39.28%,24.53%,45.97%,显著高于对照组。NAFLD组合并心脑血管病较无NAFLD组显著增高,NAFLD合并心脑血管病与MS组分、聚集数显著相关。结论 NAFLD患者有明显的代谢综合征组分集聚,合并心脑血管病显著增高;随着MS组分聚集数增多,有并发心脑血管病变危险性增大的趋势。     

非酒精性脂肪肝与冠心病危险因素的相关性分析

目的探讨非酒精性脂肪肝（NAFLD）与冠心病危险因素之间的关系。方法从我院2008年5月—2010年3月间门诊就诊和健康体检者中,抽取患及未患非酒精性脂肪肝患者各86例,分析其与年龄、腰围（WI）、体重指数（BMI）、血压、谷丙转氨酶（ALT）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（GLU）、尿酸（UA）之间的关系。结果 NAFLD组有较高的ALT、TG、LDL-C、GLU、UA水平,与非NAFLD组比较,差异有统计学意义（P〈0.01）;NAFLD组合并冠心病和高血压的患病率明显高于非NAFLD组,差异有统计学意义（P〈0.05）。WI、BMI、高血压、高三酰甘油血症、高低密度脂蛋白血症、高血糖与脂肪肝关系密切,OR分别为7.795（P〈0.01）、5.782（P〈0.01）、1.673（P〈0.05）、3.575（P〈0.01）、3.871（P〈0.01）、2.396（P〈0.01）。结论非酒精性脂肪肝与肥胖、高血压、高三酰甘油血症、高低密度脂蛋白血症、高血糖等冠心病的危险因素有相关性。     

非酒精性脂肪肝危险因素的相关分析

目的探讨非酒精性脂肪肝(NAFLD)患病危险因素的相关分析。方法对参加健康体检的743例某单位职工测量身高、体重,行血脂、血糖、肝肾功能等生化检查及腹部B超检查,进行NAFLD组和非脂肪肝组危险因素的组间比较以及合并代谢综合征的相关分析。结果 1NAFLD组的年龄、体重指数、血压、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、腰臀比、丙氨酸转氨酶(ALT)、空腹血糖(FPG)、餐后血糖明显高于非脂肪肝组,而高密度脂蛋白(HDL)明显低于非脂肪肝。2743例参加体检的职工中,检出NAFLD 221例。3NAFLD组合并高脂血症、高血压、糖尿病、肥胖症及代谢综合征者分别为:30.32%,34.39%,17.19%,18.55%,41.6%,非脂肪肝组分别为:14.18%,14.37%,4.59%,4.02%,9.8%,两组比较有统计学意义(P<0.01)。4NAFLD与非脂肪肝组合并代谢综合征者中以高血糖为多。结论 NAFLD患病危险因素高于非脂肪肝组;NAFLD的患病率高于一般人群;NAFLD合并代谢综合征者显著高于非脂肪肝者;肥胖、高脂血症、糖尿病、高血压与NAFLD合并代谢综合征的发病密切相关;NAFLD合并代谢综合征中以糖代谢紊乱更明显。     

不同年龄层次脂肪肝患者中代谢异常发生情况分析

目的调查上海宝钢集团股份公司职工各年龄层次的脂肪肝患者代谢异常的发生情况。方法回顾性分析该公司2001年1月至2002年12月参加体检的职工体检资料,根据年龄将患有脂肪肝的人群分为5组:18～30岁、～40岁、～50岁、～60岁和>60岁,比较各组脂肪肝人群中代谢异常的发生情况。统计学处理采用方差分析及χ~2检验。结果共纳入14 578份职工体检资料,年龄范围18～84岁。脂肪肝的患病率为14.08%,ALT异常占3.17%,ALT异常者脂肪肝患病率为51.9%。脂肪肝组代谢异常包括肥胖、高血压、血脂紊乱和空腹血糖增高的发生率明显高于非脂肪肝组(均P<0.01)。在各年龄层次的脂肪肝患者中,体质指数以～50岁年龄组最大,肥胖的发生率也最高(47.21%),～40岁年龄组肥胖的发生率(43.97%)较18～30岁年龄组的发生率(16.94%)增长了近两倍。收缩压和舒张压的变化基本表现为随年龄增长逐渐升高,高血压的患病率也逐渐上升;在18～30岁的脂肪肝患者中,高血压的患病率已经高达66.13%,随年龄增长,>60岁的患者中高达95.47%出现高血压。此外,各年龄层次中约55%以上的脂肪肝患者出现高三酰甘油血症,35%以上的患者出现高三酰甘油血症和空腹血糖增高,患病率与年龄的增长无关。结论各年龄层次的脂肪肝患者均出现了明显的代谢异常,年轻的患者也不例外。     

新诊断2型糖尿病患者合并非酒精性脂肪肝临床分析

目的 探讨新诊断2型糖尿病(T2DM)患者发生非酒精性脂肪性肝病(NAFLD)的危险因素、临床特点.方法 对山西医科大学第一附属医院139例新诊断T2DM的住院患者进行回顾性分析,其中舍并NAFLD者65例,不合并NAFLD者74例.结果 2型糖尿病合并脂肪肝组与无脂肪肝组比较,体重指数(BMI)、三酰甘油(TG),高密度脂蛋白胆固醇(HDL-C)、空腹C肽(FCP)、餐后2 h C肽(2 h CP)、空腹胰岛素(FINS)、丙氨酸转氨酶(ALT)、胰岛素抵抗指数(HOMA-IR)以及24 h尿白蛋白(24 hUALB)有统计学意义(P<0.05或P<0.01);肥胖症、脂代谢紊乱、代谢综合征以及糖尿病肾病的发生率也明显增高(P<0.05或P<0.01);经Logistic回归分析,BMI、FCP和FINS是2型糖尿病并发脂肪肝的危险因素.结论 肥胖、胰岛素抵抗及脂质代谢紊乱是2型糖尿病并发脂肪肝的主要危险因素.     

尿酸血症与代谢综合征相关性初步观察

目的 探讨高尿酸血症与代谢综合征之间的关系.方法 将健康体检诊断明确高尿酸血症患者设为男性和女性高尿酸血症组,血尿酸正常者设为男性和女性对照组.分别对男性和女性两组人群的代谢综合征成分进行比较.结果 男性和女性高尿酸血症组收缩压、舒张压及腰围、体重指数与对照组比较均有统计学意义,男性高尿酸血症组胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白及空腹胰岛素与对照组比较有统计学意义.女性高尿酸血症组胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、空腹血糖及空腹胰岛素与对照组比较均有统计学意义(P＜0.01).结论 高尿酸血症与肥胖、高血压、糖尿病、脂代谢紊乱等代谢综合征的因素关系密切,临床医生应予高度重视并予积极干预治疗.     

原发性肾病综合征患者发生类固醇糖尿病的危险因素分析

目的:探讨原发性肾病综合征患者类固醇糖尿病(SDM)的发病率及危险因素。方法:回顾分析2011年1月至2015年12月,南京总医院国家肾脏疾病临床医学研究中心糖皮质激素(GC)治疗后发生SDM的原发性肾病综合征患者的临床资料。根据糖代谢的变化分为SDM组,糖调节受损组和糖代谢正常组。比较各组间患者的基线临床特征及实验室指标,行Logistic回归分析SDM的危险因素。结果:2 281例原发性肾病综合征患者中671例出现糖代谢紊乱,其中142例为SDM。81.7%的SDM在GC治疗1年内诊断,中位时间为108d。年龄、局灶性节段性肾小球硬化症、肾小球滤过率及空腹血糖与糖代谢紊乱的发生具有相关性,三组间统计学差异显著。SDM组患者的体质量指数、高血压2级以上(含2级)所占比例、合并使用他克莫司的比例、高尿酸血症及三酰甘油水平与糖代谢正常组相比,统计学差异显著,而与糖调节受损组相比无统计学差异。多因素Logistic回归分析显示:女性、高龄、空腹血糖、高尿酸血症、三酰甘油、GC起始剂量以及合并使用他克莫司是使用GC治疗原发性肾病综合征患者发生SDM的独立危险因素。结论:原发性肾病综合征患者使用GC治疗后糖代谢紊乱的发病率高。女性、高龄、空腹血糖升高、高尿酸血症、高三酰甘油血症、GC起始剂量较大及合并使用他克莫司是SDM的独立危险因素。     

肥胖对2型糖尿病患者临床特征及心脏结构功能的影响

目的 探讨肥胖对2型糖尿病患者心脏结构和功能的影响. 方法 符合WHO1999年糖尿病诊断标准的住院2型糖尿病患者270例.根据2000年亚太地区肥胖诊断标准将所有患者分为非肥胖组和肥胖组.使用M型超声心动图检测升主动脉内径(AOD)、左房内径(LAD)、左室收缩期内径(LVDs)、左室舒张期内径(LVDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室短轴缩短率(FS)、射血分数(EF),采用多普勒超声检测二尖瓣E峰与A峰比值(E/A). 结果 (1)肥胖组体质量、体表面积、舒张压、空腹胰岛素、餐后胰岛素、空腹C肽、胰岛素抵抗指数(HOMA-IR)及三酰甘油高于非肥胖组,非肥胖组糖化血红蛋白及空腹血糖高于肥胖组;(2)肥胖组LAD.IVS、LVPW、左心室质量及E/A比值＜1的发生率高于非肥胖组;(3)多元逐步回归分析:非肥胖组EF与体质量指数呈负相关;肥胖组EF与收缩压呈正相关,与胆固醇、左心室质量(LVM)、空腹胰岛素呈负相关.结论 肥胖糖尿病患者存在明显左心肥大、左心舒张功能异常,与胰岛素抵抗、高三酰甘油血症并存.     

新疆维吾尔族男性高尿酸血症与代谢综合征相关性研究

目的 了解新疆维吾尔族男性高尿酸血症与代谢综合征的相关性.方法 对791例维吾尔族男性体检者的体重、身高、腰围、臀围、舒张压（DBP）、收缩压（SBP）进行测量,并检测相关血液生化指标,包括血尿酸（SUA）、空腹血糖（FBG）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）.结果 此次研究人群中代谢综合征的检出率为18.33％,高尿酸血症检出率为39.95％.高尿酸组患者体质指数（BMI）、腰臀比（WHR）、DBP、SBP、FBG、TC、TG、LDL-C与代谢综合征组的相关指标均高于尿酸正常组,并与血尿酸水平密切相关：高尿酸组与尿酸正常组比较,腹部脂肪堆积、肥胖、高血糖、高三酰甘油血症、高血压的检出率比较差异有统计学意义（P＜0.05）.高尿酸组出现腹部脂肪堆积、肥胖、高血糖、高三酰甘油血症、高血压的风险分别为尿酸正常组的2.126、3.002、2.413、2.903和2.101倍（P＜0.05）.结论 腹部脂肪堆积、肥胖、高血糖、高三酰甘油血症、高血压等代谢综合征相关危险因子是新疆维吾尔族男性发生高尿酸血症的危险因素,应加强对高尿酸血症及代谢综合症患者的健康教育.     

老年人脂肪肝与冠心病危险因素的相关性

目的探讨老年人脂肪肝与冠心病危险因素之间的关系。方法调查920例老年男性,分析其脂肪肝与年龄、体质指数(BMI)、平均血压、谷丙转氨酶、总胆固醇、甘油三酯、空腹血糖、吸烟和饮酒之间的关系,并对脂肪肝、肥胖与高血压、高胆固醇血症、高甘油三酯血症、糖尿病之间的关系进行多元回归分析。结果920例老年男性非肥胖(BMI<28kg/m2)与肥胖(BMI≥28kg/m2)者脂肪肝的患病率(分别为111%和409%)比较,差异有显著性(P<005)。脂肪肝的患病率与高甘油三酯血症呈显著正相关(OR=3491,P<001),与高胆固醇血症、糖尿病呈正相关(OR=1539、1585,均为P<005)。当将肥胖和脂肪肝分别与冠心病的危险因素进行相关分析,在脂肪肝组中冠心病危险因素除高血压外OR值均高于肥胖组。结论在男性老年人群中,脂肪肝与冠心病的危险因素有相关性。     

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.