Advanced gastric cancer of the antrum: Anatomic-functional correlation between chief cell mass and serum pepsinogen I

Chief cell mass and type I serum pepsinogen (PGI) were calculated in 19 advanced antral gastric cancer of intestinal type. Comparisons were also made with parietal cell mass and acid secretion. In gastric cancer of the antrum there is a significant decrease of the chief cell mass and of serum pepsinogen I. The patients were subdivided according to the histological findings of the fundic mucosa. In cases of antral gastric cancer with superficial fundic gastritis there is normozymogenism with hyperpepsinogenemy; with preatrophic fundic gastritis there is hypozymogenism with normopepsinogenemy; with atrophic fundic gastritis there is hypozymogenism with hypopepsinogenemy. Similar behavior of the chief cell mass between antral gastric cancer and fundic atrophic gastritis without cancer has become recognized and while the validity of PGI as a marker of fundic atrophic gastritis has emerged it does not allow discrimination between atrophic fundic gastritis and atrophic fundic gastritis associated with gastric cancer of the antrum.     

超重和肥胖人群血清脂联素水平与2型糖尿病的关系

目的研究血清脂联素水平与超重、肥胖及与血糖（PG）的关系。方法对深圳地区21～60岁人群共29799人进行BMI，腰围（WC），腰臀围比（WHR）及血糖检测，按BMI高低分成三大组：正常非肥胖（NC）组（BMI≤24）男10267人、女14268人；超重（OW）组（24〈BMI〈28）男2952人、女1800人；和肥胖（Ob）组（BMI≥28）男245人、女267人。Ob组按血糖水平又分为单纯肥胖（S-Ob）组（男190人，女216人）和2型糖尿病肥胖（T2DM-Ob）组（男55人，女51人）。调查三大组人群T2DM的患病率，分析BMI、WC、WHR与T2DM的关系，并测定各组人群的血清脂联素水平。结果T2DM的患病率在NC组男性和女性分别为32‰和35‰；在OW组的男性和女性分别为126‰和106‰；在肥胖组的男性和女性分别为225‰和191‰。T2DM的患病率在男性WC〉85cm者显著高于WC≤85cm者，在女性，WC〉80cm者显示高于WC≤80cm者（P均〈0．01）。血清脂联素浓度在Ow组、Ob组及T2DM—Ob组均显著低于NC组（P=0．000）。在T2DM—Ob患者中，脂联素浓度与BMI、WC、WHR、PG呈显著负相关。结论脂联素浓度变化可能与肥胖及糖尿病密切相关。保持BMI和WC在正常范围，是预防糖尿病发生的有效措施之一。     

Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States

BACKGROUND & AIMS: Based on experimental and epidemiologic studies, we investigated whether coffee and caffeine consumption reduced the risk of elevated alanine aminotransferase (ALT) activity in persons at high risk for liver injury in a national, population-based study. METHODS: Participants were 5944 adults in the Third US National Health and Nutrition Examination Survey, 1988-1994, with excessive alcohol consumption, viral hepatitis, iron overload, overweight, or impaired glucose metabolism. Liver injury was indicated by abnormal serum ALT activity (>43 U/L). RESULTS: Elevated ALT activity was found in 8.7% of this high-risk population. In unadjusted analysis, lower ALT activity was associated with increasing consumption of coffee ( P = .001) and caffeine ( P = .001). Multivariate logistic regression analyses showed that the risk of elevated ALT activity declined with increasing intake of coffee ( P for trend = .034) and caffeine ( P < .001). Comparing persons who drank more than 2 cups per day with noncoffee drinkers, the odds ratio was .56 (95% confidence interval, .31-1.0). Comparing persons in the highest caffeine quintile with the lowest, the odds ratio was .31 (95% confidence interval, .16-.61). These relationships were consistent across subgroups at risk for liver injury and were relatively unchanged when analyses included the entire population or when limited to persons without impaired liver function or right upper quadrant pain. Fasting insulin concentrations did not mediate the effects. CONCLUSIONS: In this large, national, population-based study, among persons at high risk for liver injury, consumption of coffee and especially caffeine was associated with lower risk of elevated ALT activity.     

Relationships between serum aminotransferase levels, liver histologies and virological status in patients with chronic hepatitis C in Taiwan

In patients with chronic hepatitis C, the relationships between serum alanine aminotransferase (ALT) levels, histological liver injury and serum hepatitis C virus (HCV) RNA titres remain controversial. To evaluate these relationships, 93 Chinese patients with histological diagnosis of chronic hepatitis C were enrolled for this study. Serum ALT levels, HCV-RNA titres and HCV genotypes were examined. The histology was evaluated according to a modified histological activity score based on the degree of periportal necro-inflammation, intralobular necro-inflammation, portal inflammation, total necro-inflammation and fibrosis. The mean serum ALT level was significantly higher in patients with severe intralobular necro-inflammation activity than in patients with mild or no activity (P= 0.013). However, scores of intralobular activity were only weakly correlated with serum ALT levels (r= 0.27) and could not be used to adequately predict ALT values. Serum ALT levels showed no significant correlation with the scores of portal inflammation, periportal necro-inflammation, total necro-inflammation and fibrosis. Also, there was no significant difference in the mean serum ALT level among different serum HCV-RNA levels and HCV genotypes. Serum HCV-RNA titres and genotypes showed no significant correlation with liver histology and serum HCV-RNA titres were only weakly correlated with the total necro-inflammatory score (r= 0.27). In conclusion, although serum ALT levels were higher in patients with more severe intralobular necro-inflammatory activity, the correlation was not strong enough to adequately predict ALT values. Serum HCV-RNA titres and genotypes also showed no significant correlation with serum ALT levels and liver histologies.     

Elevated fasting serum insulin level predicts future development of hypertension

Background

Studies have investigated clinical association between fasting insulin level and hypertension. However, it is still debatable whether elevated fasting insulin actually increases the risk of hypertension with the passage of time. Thus, this study was aimed at investigating the association between baseline fasting insulin level and the development of hypertension.

Methods

25,062 normotensive, non-diabetic Korean men participating in a medical health check-up program were followed up from 2005 until 2010. They were divided into 4 groups according to baseline fasting insulin levels (first quartile–fourth quartile). The incidence of hypertension was compared among 4 groups, and Cox proportional hazards model was used to determine if hypertension was associated with higher baseline fasting insulin level.

Results

The incidence of hypertension increased according to the baseline fasting insulin level (first quartile: 13.3%, second quartile: 15.4%, third quartile: 17.5%, fourth quartile: 23.2%, P < 0.001). Even after adjusting for multiple covariates, the HRs (95% CI) for hypertension were higher for the second (1.12; 0.96–1.31), third (1.39; 1.20–1.62) and fourth quartile group (1.75; 1.51–2.03), compared to the first quartile group, respectively (P for trend < 0.001).

Conclusion

The risk of hypertension was in proportion to the baseline fasting insulin level. In addition, hyperinsulinemia was an independent risk factor for the future development of hypertension. These findings suggest the value of fasting insulin level as an early predictor of hypertension.     

Association between fasting serum glucose levels and incidence of colorectal cancer in Korean men: The Korean Cancer Prevention Study-II

Introduction

The incidence of colorectal cancer (CRC) is steadily increasing worldwide. Numerous studies have demonstrated that diabetes mellitus is related to an increased risk of CRC; however, the association between impaired fasting glucose and CRC is unclear. Therefore, we evaluated the correlation between fasting serum glucose (FSG) levels and the incidence of CRC, which can be used to develop novel methods for preventing CRC.

Methods

A total of 175,677 individuals from the Korean Metabolic Syndrome Research Initiative study were enrolled between 2004 and 2011. The incidence of CRC was assessed during a mean follow-up of 4.7 years. Hazard ratios (HR) for CRC according to FSG levels were calculated with the Cox proportional hazard model adjusted for age, sex, body mass index, smoking status, alcohol consumption, and regular exercise.

Results

The risk of developing CRC in subjects with high FSG was significant (HR, 1.45; 95% confidence interval [CI], 1.10–1.90), and the risk was higher in men (HR, 1.51; 95% CI, 1.12–2.05). The HR of rectal cancer, but not colon cancer, was significantly higher both in the total population and in men in the high FSG group.

Conclusions

The incidence of CRC positively correlated with FSG levels in men. Rectal cancer incidence was especially correlated with high FSG in the site-specific analysis. Therefore, serum glucose levels maybe a potential marker of colorectal cancer. Early detection and intervention for controlling elevated glucose levels may be indicated as a way to prevent carcinogenesis.     

中国人血清瘦素水平与肥胖度的关系

目的研究１５～６８岁中国人血清瘦素（ｌｅｐｔｉｎ）水平与体脂、年龄、性别及睾酮的关系。方法用放射免疫分析法测定７７例正常非肥胖和２８例超重或肥胖个体〔体重指数（ＢＭＩ）≥２５〕的血清瘦素水平。结果中国人正常非肥胖者平均瘦素浓度男性为（２．１５±１．４６）μｇ／Ｌ,女性为（７．８６±３．６０）μｇ／Ｌ;超重或肥胖者平均瘦素浓度男性为（４．８７±３．４７）μｇ／Ｌ,女性为（１６．５９±６．９２）μｇ／Ｌ,女性均较男性高约２～３倍。血清瘦素水平与ＢＭＩ显著相关（男子ｒ＝０．６９,Ｐ＜０．００１;女子ｒ＝０．６３,Ｐ＜０．００１）,但２５％的肥胖个体仍存在有瘦素的相对性缺乏。结论血清瘦素水平与ＢＭＩ显著相关提示多数肥胖个体存在瘦素抵抗,部分瘦素相对性缺乏的肥胖者将有可能成为瘦素治疗的对象。     

聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎患者疗效及对血清细胞因子和肝纤维化指标的影响

目的观察聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阳性的慢性乙型肝炎（CHB）患者的疗效及其对血清T淋巴细胞因子和肝纤维化指标的影响。方法144例CHB患者依纳入顺序单双号被随机分为观察组和对照组,每组72例。给予对照组患者阿德福韦酯,观察组在对照组的基础上给予聚乙二醇干扰素α-2a,治疗24 w,观察两组抗病毒疗效以及血清T淋巴细胞因子白介素（IL）-2、IL-6、IL-10、γ-干扰素（INF-γ）以及血清肝纤维化指标Ⅲ型前胶原肽（PⅢP）、层粘连蛋白（LN）、透明质酸（HA）、Ⅳ型胶原(Ⅳ-C）的变化。结果在治疗24 w末,观察组患者血清HBV 转阴率、HBeAg转阴率、HBeAg血清转换率分别为72.22%、58.33%和41.67%,显著高于对照组(分别为55.56%、22.22%和20.83%,P<0.05）;观察组血清IL-2和INF-γ水平分别为（2.18±1.26） pg/ml和（99.65±11.03） pg/ml,较对照组显著升高【（1.71±1.05） pg/ml和（85.70±11.82） pg/ml,P<0.05】,而IL-6和IL-10分别为（4.53±2.15） pg/ml和（15.42±9.39） pg/ml,较对照组显著降低【（5.47±2.25） pg/ml和（20.07±13.08）pg/ml,P<0.05】;观察组HA、LN、Ⅳ-C、PⅢP分别为（127.28±59.60） μg/L、（110.52±37.39） μg/L、（116.56±28.61） μg/L和（163.65±64.38） μg/L,均较对照组显著降低【（261.35±81.46） μg/L、（162.32±38.82）μg/L、（174.13±43.05） μg/L和（212.43±64.25） μg/L,P<0.05】。结论聚乙二醇干扰素α-2a联合阿德福韦酯抗病毒疗效及改善HBeAg阳性CHB患者血清T淋巴细胞因子失衡,降低肝纤维化指标的作用优于单用阿德福韦酯者。     

脑积水患者行经颅多普勒检测的意义

目的明确脑积水患者经颅多普勒（TCD）监测结果与颅内压的关系。方法选择我院32例行脑室腹腔分流术的脑积水患者（观察组），分别于术前1d和术后5d行大脑中动脉（MCA）的TCD监测；另选择27名门诊体检健康个体为对照组，行大脑中动脉TCD监测，并与观察组作对照。结果观察组患者行分流手术前TCD监测显示MCA收缩期血流速度（Vs）、舒张期血流速度（Vd）以及平均血流速度（Vm）较对照组明显下降（P〈0．05）；而搏动指数H和阻抗指数砌却明显高于对照组（P〈0．01）。观察组患者治疗前、后MCA的PI、RI、Vd、Vm间差异有显著性意义（P〈0．05）。结论经颅多普勒中RI和PI值可作为评价脑积水患者颅内高压的有效手段。     

Clinical significance of serum hyaluronic acid as a fibrosis marker in chronic hepatitis C patients treated with interferon-α: Histological evaluation by a modified histological activity index scoring system

Abstract The aim of the present study was to investigate the histological changes effected by interferon (IFN) treatment and to evaluate the clinical significance of serum hyaluronic acid (HA) as a marker of fibrosis. Forty-nine patients with chronic hepatitis C treated with IFN-α were divided into three groups according to the existence of viraemia: sustained complete responders (CR), complete responders with relapse (PR) and non-responders (NR). Needle biopsy sections of the liver taken before and at the end of IFN treatment were assessed according to the modified histological activitindex (HAI) scoring system. Serum fibrosis markers, including HA, were measured at needle biopsies. Biopsies of CR at the end of treatment showed a significant improvement in fibrosis and necroinflammatory scores. More significant correlation was observed between fibrosis scores and serum levels of HA before IFN treatment (r= 0.607, P < 0.0001) than those between fibrosis scores, on the one hand, and pepride of type III procollagen (PIIIP; r= 0.531, P= 0.0004) or type IV collagen 7S domain (type IV-C; r= 0.241, P= 0.1062) on the other. Moreover, serum HA levels fell significantly in patients in whom fibrosis improved (P= 0.011). This is the first paper describing the advantages of the modified HAI scoring system over others in estimating the effect of IFN-α; the results also indicate that serum HA can be useful in monitoring liver fibrosis in chronic hepatitis C patients treated with IFN-α.     

Clinical significance of serum auto-antibodies in Chinese patients with chronic hepatitis C: Negative role of serum viral titre and genotype

Positive serum anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA) have been reported in 10–66% of patients with chronic hepatitis C virus (HCV) infection from Western countries. However, the mechanism involved in this immunological disorder is still unknown. This study was carried out to evaluate the prevalence and clinical significance of positive serum auto-antibodies in Chinese patients with chronic hepatitis C and to assess the role of serum HCV-RNA titre and HCV genotype in the presence of serum auto-antibodies. Serum ANA, SMA and anti-mitochondrial antibody (AMA) were measured in 122 patients with chronic hepatitis C. Clinical, biochemical and virological data (serum HCV-RNA titre and HCV genotype) were compared between patients with and without serum auto-antibodies. Fifty-eight (48%) patients were associated with positive serum autoantibodies: 42 (34%) positive for ANA, six (5%) positive for SMA, nine (7%) positive for both ANA and SMA and one (1%) positive for AMA. Clinical parameters (age, sex, blood transfusion history), liver biochemical tests, the presence of cryoglobulinaemia or cirrhosis, and the response to interferon treatment were not significantly different between patients with and without positive serum auto-antibodies. Serum HCV-RNA levels and HCV genotypes were also not significantly different between the two groups. Logistic regression analysis showed that none of the previously mentioned parameters were significant predictors to associate with serum auto-antibodies in chronic hepatitis C. We concluded that 48% of Chinese patients with chronic hepatitis C were associated with positive serum auto-antibodies. Hepatitis C virus genotypes and serum HCV-RNA levels were not correlated to the presence of serum auto-antibodies. The clinical significance and actual pathogenesis of this phenomenon remain to be clarified.     

血清脂联素水平与肥胖度的关系

目的 研究上海地区人群血清脂联素(adiponeetin)水平与年龄、性别、体脂及血清瘦素水平的关系。方法 用放射免疫分析法测定104例正常非肥胖和57例超重或肥胖个体[体重指数(BMI)≥25kg/m~2]的血清脂联素水平。结果 正常非肥胖者脂联素男性(10.15±6.33)mg/L,女性(13.82±6.09)mg/L;超重或肥胖者脂联素男性(5.78±3.55)mg/L,女性(8.13±4.32)mg/L。正常女性血清脂联素水平高于男性,肥胖及超重个体血清脂联素水平显著低于正常人。脂联素浓度与BMI、腰围和体脂％呈显著负相关,与血清瘦素呈负相关,但扣除体脂因素后两者并尤明显相关性。在本年龄段中,脂联素与年龄关系不大。结论 脂联素作为脂肪细胞分泌的一种激素蛋白,其浓度变化可能与肥胖及其相关疾病密切相关,表明脂联素的增加可能是有益的。     

Low serum bilirubin concentration is a novel risk factor for the development of albuminuria in patients with type 2 diabetes

Objective

Bilirubin has been recognized as an important endogeneous antioxidant. Previous studies reported that bilirubin could prevent atherosclerosis. The aim of this study was to investigate if serum bilirubin concentration could be a predictor for the development of albuminuria in patients with type 2 diabetes.

Materials and Methods

We measured serum bilirubin in 320 consecutive patients with normoalbuminuria. We performed follow-up study to assess the development of albuminuria, mean interval of which was 3.2 ± 0.9 years. Cox proportional hazards regression was used to examine the relationship between serum bilirubin concentration and the development of albuminuria.

Results

During follow-up duration, 43 patients have developed albuminuria. In multivariate analysis, after adjusting for comprehensive risk factors, the risk of developing albuminuria was higher in the lowest quartile of serum bilirubin concentrations than that in the highest quartile of serum bilirubin concentrations (Hazard ratio, 5.76; 95% CI, 1.65 to 24.93).

Conclusions

Low serum bilirubin concentration could be a novel risk factor for the development of albuminuria in patients with type 2 diabetes.     

Usefulness of serum lipid determination in diabetic practice

Summary In order to evaluate the importance of measuring serum lipids in the current care of diabetics, blood triglycerides were measured in 155 diabetics and 59 controls. Comparison with a chemical method confirmed the usefulness of the nephelometric method for the diagnosis and control of hyperlipemia in current practice. The importance of measuring serum lipids was confirmed by a close correlation between lipemia and cardiovascular complications such as coronary insufficiency, high blood pressure, and peripheral arterial insufficiency. It appeared also that glycemia and cholesterol are not sufficient to assess the biological pattern and prognosis of diabetes. Thus, lipemia is an essential parameter in the evaluation of any diabetic because of its value regarding prognosis and control of therapy.