糖化血红蛋白在高血压人群糖代谢异常诊断切点的探讨

目的探索高血压患者中,糖化血红蛋白(HbA1c)诊断糖代谢异常的切点。方法采用非随机整群抽样入选无糖代谢异常病史的高血压患者,进行横断面研究。各家医院HbA1c检测均执行卫生部临检中心质控标准。测定患者口服葡萄糖耐量试验(OGTT)空腹、OGTT 2h血糖和HbA1c水平。分别以OGTT空腹血糖≥5.6和≥7.0mmol/L作为空腹血糖受损和空腹糖尿病的标准,以OGTT 2h血糖7.8~11.1mmol/L和OGTT 2h血糖≥11.1mmol/L作为糖耐量受损和糖尿病的诊断标准。采用受试者工作特征(ROC)曲线评价HbA1c在国人高血压患者对糖尿病和糖尿病前期的诊断切点。结果本研究共入选患者687(男410、女277)例,平均年龄60.9岁。以OGTT空腹和(或)2h血糖确诊糖尿病的比例为39.0%。单纯测定空腹血糖,糖尿病的检出率仅为17.5%;将漏诊55.2%的糖尿病患者;在OGTT空腹血糖受损患者中,通过OGTT 2h血糖测定,可多检出44.6%的糖尿病患者。以HbA1c≥6.5%作为糖尿病的诊断切点时,糖尿病的检出率为32.9%。ROC曲线分析显示,HbA1c=5.8%时诊断糖尿病前期的敏感度和特异度最佳;HbA1c=6.2%时诊断糖尿病的敏感度和特异度之和最大。结论高血压患者糖代谢异常患病率高,且被大量漏诊,故对高血压患者应常规筛查糖代谢异常。建议在高血压患者HbA1c诊断糖尿病前期和糖尿病的切点分别采用5.8%和6.2%。     

糖尿病家族史与高血压对糖代谢异常的影响及交互作用

目的探讨糖尿病家族史与高血压对糖代谢异常患病的影响及交互作用。方法为病例对照研究。选取2011年8—12月间大连地区参加中国2型糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究的基线血糖正常人群为研究对象, 2014年7—12月间对研究对象进行随访。收集研究对象基线时糖尿病家族史及高血压情况, 所有研究对象均行口服葡萄糖耐量试验, 依据随访时研究对象糖代谢状态将其分为病例组和对照组。采用多因素logistic回归模型分析糖尿病家族史、高血压对糖代谢异常患病的影响及交互作用。计算交互作用的相对超额危险度(RERI)、交互作用归因比(AP)、交互作用指数(SI), 以评估加法量表上的相互作用效应。结果共纳入2 597例研究对象。其中, 病例组526例, 对照组2 071例。多因素logistic回归分析结果显示, 糖尿病家族史(OR=1.387, 95%CI 1.133～1.699, P=0.002)和高血压(OR=1.553, 95%CI 1.134～2.126, P=0.006)是糖代谢异常患病的独立影响因素。糖尿病家族史与高血压相乘对糖代谢异常患病风险的OR值为1.020...     

空腹血糖未达糖尿病诊断标准患者直接进行口服葡萄糖耐量试验的异常率及安全性

目的探讨既往1年内空腹血糖检查未达糖尿病诊断标准(7 mmol/L)患者直接进行口服葡萄糖耐量试验(OGTT)糖代谢异常发生率及安全性等。方法年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病症状的患者301例直接进行OGTT,收集患者一般情况及血糖、血脂等。根据OGTT结果分为:血糖正常、糖调节受损组、糖尿病3组。分析糖调节受损、糖尿病发生率,分析3组年龄、血压、血糖、血脂等差异。结果血糖正常比例为47.18%,糖调节受损比例为34.88%,糖尿病比例为17.94%。血糖正常组年龄最小,糖尿病组高血压比例最高,糖调节受损组总胆固醇及低密度脂蛋白显著比血糖正常组高(均P0.05)。空腹血糖、餐后2 h血糖、糖化血红蛋白3组比较:血糖正常组糖尿病前期组糖尿病组(均P0.05)。空腹血糖5.6 mmol/L患者OGTT筛查餐后2 h血糖204例,其中糖耐量异常21.57%,糖尿病6.37%。3组直接行OGTT均未出现糖尿病酮症、糖尿病高渗状态等需紧急降糖处理病例,也未发现恶心、反酸、胃灼痛等消化道症状。结论年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病三多一少症状的患者直接进行OGTT检查具有很强的必要性及良好的安全性。     

血糖控制不佳的2型糖尿病患者心血管病风险分析

目的评估比较血糖控制良好和控制不佳的2型糖尿病患者未来10年心血管病风险及相关危险因素。方法收集本院内分泌科住院的2型糖尿病患者549例,根据其入院次日空腹糖化血红蛋白(HbA1c)测定结果,分为血糖控制不佳组(HbA1c>7%)408例和血糖控制良好组(HbA1c≤7.0%)141例,监测两组年龄、性别、现居地、吸烟史、饮酒史、个人疾病史、体重指数、腰围、收缩压、舒张压、血糖、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和纤维蛋白原等指标,并应用Framingham风险评估模型和China-PAR模型预测患者未来10年的心血管病发病风险。结果血糖控制不佳组收缩压、舒张压、空腹血糖、总胆固醇和低密度脂蛋白胆固醇平均值差异有统计学意义(P<0.05)。Framingham风险评估模型和China-PAR模型结果提示:血糖控制良好的2型糖尿病患者大多属于心血管病低、中风险,血糖控制不佳的2型糖尿病患者大多属于心血管病高风险。结论血糖控制不佳的糖尿病患者应更加注意心血管病危险因素的监测与控制,以降低其心血管病风险。     

正常低浓度血镁与2型糖尿病的相关性研究

目的:探讨正常偏低浓度血镁与2型糖尿病的相关性。方法:2010年3月至7月对上海市嘉定区菊园新区2 515名40岁以上居民进行问卷调查,测量身高、体重、腰围、血压等,并进行口服葡萄糖耐量试验(OGTT),采血检测血清镁、胰岛素、肝功能、肾功能、空腹及OGTT 2 h血糖(2hPG)。分析人群血镁浓度与2型糖尿病患病风险的相关性。结果:①在血镁的参考范围内,2hPG、2 h胰岛素、总胆固醇、低密度脂蛋白胆固醇和三酰甘油在血镁四分位分组各组间差异有统计学意义(均趋势P<0.01);校正相关混杂因素后,3组2型糖尿病患病风险OR(95%CI)分别是1.11(0.75～1.66)、1.61(1.08～2.40)和3.22(2.23～4.64)(趋势P<0.01)。结论:上海郊区40岁以上人群中,正常的低血镁水平与2型糖尿病患病风险显著相关。     

全身振动训练对2型糖尿病患者血糖控制的影响

目的比较振动训练(VT)与力量训练及柔韧训练(对照组)对2型糖尿病患者血糖控制的影响。方法 40例2型糖尿病患者参与实验。评价基础状态下和每周3次训练,训练12 w后空腹血糖、口服糖耐量试验(OGTT)、糖化血红蛋白(HbA1c)、股四头肌等长最大转矩和耐力能力。结果训练后空腹血糖浓度不变。VT组和力量训练组OGTT曲线下面积和最大葡萄糖浓度下降。VT组的HbA1c低于基础值,但其他两个干预组升高。结论 VT可能是2糖尿病患者控制血糖有效和费时少的方法。     

糖代谢异常和糖尿病患者血浆纤维蛋白原的观察

目的探讨血浆纤维蛋白原在糖代谢异常和糖尿病患者中的变化。方法对155例糖尿病、糖代谢异常患者和正常对照者进行血浆纤维蛋白原、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿素氮和血肌酐检测。结果糖尿病、糖代谢异常和正常对照组之间纤维蛋白原和三酰甘油在各组之间比较差异有统计学意义(P<0.01或P<0.05);纤维蛋白原的多因素linear regression分析发现空腹血糖、三酰甘油是纤维蛋白原的相关因子(P<0.05)。结论糖尿病和糖代谢异常患者血浆纤维蛋白原升高,而且纤维蛋白原与空腹血糖水平相关。因此,血浆纤维蛋白原升高可能参与糖尿病患者心脑血管疾病的形成。     

急性冠脉综合征患者糖代谢异常的研究

目的:探讨急性冠脉综合征(ACS)患者血糖代谢情况以及糖代谢异常对ACS预后影响的可能机制。方法:检测110例ACS患者的空腹血糖(FBG)、餐后2h血糖(2hPG)、MDA、SOD水平,FBG或2hPG中任一项异常则择期行口服葡萄糖耐量试验(OGTT),根据OGTT结果分为:合并糖尿病组(DM组,36例)、合并糖耐量异常组(IGT组,34例)、40例糖代谢正常患者作为对照组(NGT组)。另入选110例病情稳定的冠心病患者行MDA和SOD的检测。结果:①入院时已确诊糖尿病17例,糖耐量异常3例;入院后经OGTT确诊糖尿病19例,糖耐量异常31例。②合并糖代谢异常的ACS患者MDA显著高于糖代谢正常的ACS患者(P<0.001),SOD水平则显著降低(P<0.001);餐后2h血糖与MDA呈显著正相关。③合并糖尿病和合并糖耐量异常的ACS患者组间MDA、SOD水平比较,差异无显著性意义。结论:在ACS患者中糖代谢异常的发生率高,大部分是入院后经OGTT诊断。同糖尿病患者一样,ACS合并糖耐量异常患者血浆脂质过氧化程度升高,抗氧化能力降低。     

冠心病患者的糖代谢异常分析

目的探讨冠心病患者血糖代谢异常的发生率以及糖代谢异常对心血管事件发生和影响预后的可能机制。方法选择病情稳定的冠心病(NACS)患者和急性冠脉综合征(ACS)患者各110例。抽取静脉血检查空腹血糖(FBG)和餐后2小时血糖(2hPG),若其中任何1项异常,则进行口服葡萄糖耐量试验(OGTT)。根据血糖结果分为糖代谢正常组和糖代谢异常组(包括糖耐量异常组和糖尿病组)。同时行丙二醛(MDA)和超氧化物歧化酶(SOD)测定。结果糖代谢异常发生率在NACS和ACS患者中分别占44.54%和63.64%。无论NACS患者或ACS患者,糖代谢异常组的MDA升高和SOD降低与糖代谢正常组比较差异均有显著性;合并糖尿病和合并糖耐量异常的患者组间MDA及SOD水平比较,差异无显著性。结论糖代谢异常在冠心病患者中发生率较高,其中新识别糖代谢异常需要行OGTT检查;合并糖代谢异常的冠心病患者脂质过氧化程度高;合并糖耐量异常与合并糖尿病一样,对冠心病患者有相等程度的氧化应激。     

糖尿病前期筛查的分歧与共识

目前将糖耐量减低(IGT)和空腹血糖受损(IFG)称为糖尿病前期,处于该阶段的个体发生糖尿病和心血管疾病的风险明显增高.美国糖尿病协会强烈主张单独应用空腹血糖(FBG)定义糖代谢状态,而世界卫生组织(WHO)则极力推荐对无症状高血糖人群应用标准化的口服75 g葡萄糖耐量试验(OGTT),联合空腹和负荷后2 h血糖来定义一个个体是否存在任何程度的糖代谢紊乱.关于这个问题的争论焦点主要是测定FBG或2 h血糖的可行性.由于OGTT整个过程至少需要2 h,因此不太适合群体研究.但是单独测定FBG以定义糖代谢状况往往存在假阴性风险,而且糖负荷后2 h血糖是诊断IGT的唯一方法.基于两方面的考虑,推荐在群体中进行糖尿病前期和未诊断糖尿病筛选时,首先应用费效比合理的筛查工具确定出高危人群,然后再进行OGTT以进一步确诊.     

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.     

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.     

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.     

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.