游离脂肪酸、胰岛素抵抗与代谢综合征相关因素的关系

目的了解代谢综合征(MS)患者血清游离脂肪酸(FFA)水平的变化,探讨血清FFA与MS各危险因素的关系。方法检测400例MS患者和100名健康体检者(正常对照组)空腹血清FFA、空腹胰岛素(FINS)、空腹血糖(FPG)及血脂[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)]浓度,按稳态模型公式计算各组胰岛素抵抗指数(HOMAIR);同时测量身高、体重、腰围、臀围及血压,计算体重指数(BMI)、腰臀比(WHR)。将400例MS患者按原发病分为单纯肥胖组(120例)、糖尿病组(110例)、高血压组(170例)。采用Spearman等级相关分析FFA与血脂、血压、FPG、BMI、WHR及胰岛素的相关性。结果 MS组FFA、FPG、FINS、TC、TG、LDL-C、HOMA-IR、收缩压(SBP)、舒张压(DBP)、BMI、WHR均明显高于正常对照组(P0.05),而HDL-C明显低于正常对照组(P0.05)。单纯肥胖组、糖尿病组、高血压组及正常对照组之间HOMA-IR、FFA差异均有统计学意义(P0.05)。血清FFA与BMI、WHR、HOMA-IR、SBP、DBP、FPG、FINS、TG、LDL-C呈正相关(r值分别为0.581、0.480、0.321、0.215、0.267、0.223、0.325、0.369、0.561,P0.05),与HDL-C呈负相关(r=-0.613,P0.05),与TC无相关关系(r=0.674,P0.05)。结论 MS患者空腹血清FFA水平较正常人明显升高,并与胰岛素敏感性相关。FFA与MS各组分之间均有关系,其中FBG、WHR、HDL-C、FINS与血清FFA及HOMA-IR有一定关系。     

孕妇血清妊娠相关蛋白、胰岛素抵抗指数与妊娠期糖尿病的关系

目的探讨孕妇血清妊娠相关蛋白(PAPP-A)、胰岛素抵抗指数(IR)与妊娠期糖尿病(GDM)的关系。方法选择89例GDM患者为研究组,60例正常孕妇为对照组,比较2组空腹血糖(FPG)、糖负荷后2 h血糖(2 h PG)、空腹胰岛素(FINS)、糖负荷后2 h胰岛素(PINS)、IR、胰岛素分泌(IS)指数及血清PAPP-A,分析血清PAPP-A、IR与血糖指标的关系。结果研究组孕妇FPG、IR高于对照组,FINS、PINS、PAPP-A、IS低于对照组,差异均有统计学意义(P0.05)。血清PAPP-A与IR呈负相关(r=-0.562,P0.05),与IS呈正相关(r=0.491,P0.05),与FPG呈负相关,与FINS呈正相关;IR与FPG呈正相关,与FINS呈负相关。结论 GDM孕妇血清PAPP-A、IR指数明显增高,其指数越高,GDM血糖水平越高,胰岛素分泌能力越低。     

2型糖尿病患者高血清游离脂肪酸水平与胰岛素抵抗的相关性研究

目的探讨2型糖尿病(T2DM)患者血清游离脂肪酸(FFA)水平与胰岛素抵抗的相关性。方法选取102例T2DM患者作为T2DM组,依据糖化血红蛋白(HbA1c)水平分为控制良好和控制不良组,选取62例健康体检者作为健康对照组,检测各组的HbA1c、三酰甘油(TG)、空腹血糖(FBS)、餐后2h血糖(PPBS)、空腹胰岛素(FINS)、空腹FFA及餐后2h游离脂肪酸(2hFFA)。以稳态模式评估胰岛素抵抗指数(HOMA-IR)。结果T2DM组HbA1c、TG、FBS、PPBS、FFA、2hFFA及HOMA-IR均较健康对照组明显升高(P0.05)。T2DM控制不良组各指标均高于控制良好组(P0.05)。FFA、2hFFA与其他指标均呈明显正相关(r0.5,P0.01)。结论T2DM患者体内FFA水平显著升高,与胰岛素抵抗存在明显相关性。     

2型糖尿病患者血清游离脂肪酸水平与胰岛素抵抗的关系

目的探讨2型糖尿病(T2DM)患者血清游离脂肪酸(FFA)水平与胰岛素抵抗(IR)的关系。方法选取106例T2DM患者为观察组,选择106例健康体检者为对照组,比较2组受检者体质量指数(BMI)、空腹血糖(FPG)、FFA、糖化血红蛋白(HbA1c)、总胆固醇(TG)、甘油三酯(TC)及胰岛素抵抗指数(HOMA-IR)水平。根据血糖控制水平将T2DM患者分为控制良好组(n=56)和控制不良组(n=50),比较2组患者FFA及HOMA-IR水平。分析T2DM患者血清FFA与HOMA-IR的相关性。结果观察组BMI、FPG、FFA、HbA1c、TC、TG、HOMA-IR均显著高于对照组(P0.05);血糖控制不良组患者FFA及HOMA-IR水平均显著高于控制良好组(P0.05);相关性分析显示,T2DM患者血清FFA与HOMA-IR水平呈正相关性(r=0.621,P0.05)。结论血清游离脂肪酸水平与2型糖尿病患者胰岛素抵抗程度关系密切,且可以反映患者血糖控制水平。     

高龄妊娠糖尿病患者铁代谢水平与胰岛素抵抗的相关性

目的探究高龄妊娠糖尿病患者铁代谢水平与胰岛素抵抗的相关性。方法回顾性选取2019年6月至2020年4月46例苏州大学附属太仓第一人民医院收治的高龄妊娠糖尿病患者46例作为观察组,同期选取糖耐量正常的孕妇46例作为对照组。检测两组孕妇的低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清铁、总胆固醇(TC)、转铁蛋白、血清铁蛋白、甘油三酯(TG)、空腹血糖(FBG),血红蛋白(Hb)、空腹胰岛素(FINS),比较贫血情况,分析铁代谢水平与胰岛素抵抗的关系。结果观察组孕妇的贫血发生率为2.17%,明显低于对照组的19.57%,差异具有统计学意义(P 0.05)。经过Pearson相关性分析,胰岛素分泌指数(HOMA-IS)与空腹胰岛素(FINS)呈正相关(r=0.362,P 0.05),与血清铁蛋白、甘油三酯(TG)、血红蛋白(Hb)、空腹血糖(FBG)、孕前体重指数(BMI)呈负相关(r=-0.552、-0.552、-0.317、-0.463、-0.339,P 0.05)。胰岛素抵抗指数(HOMA-IR)与FINS呈负相关(r=-0.386,P 0.05),与血清铁蛋白、TG、Hb、FBG、孕前BMI呈正相关(r=0.543、0.628、0.556、0.682、0.554,P 0.05)。多元线性回归分析显示,血清铁蛋白、TG、Hb、孕前BMI为高龄妊娠糖尿病患者的HOMA-IR的独立危险因素(P 0.05)。结论高龄妊娠糖尿病患者的铁储备增加,与胰岛素抵抗有明显的关系,胰岛素分泌指数与血清铁蛋白呈负相关,胰岛素抵抗指数与血清铁蛋白呈正相关,过度铁负荷可能参与患者的胰岛素抵抗,加重病情。     

2型糖尿病患者血脂水平与血清Apelin等细胞因子的关系研究

目的了解2型糖尿病患者不同的血脂水平与血清、Apelin、脂联素、抵抗素等脂肪细胞因子的关系。方法所有的门诊或病房的2型糖尿病患者均空腹12h以上,取肘静脉血,分离血清,当日送检血脂及空腹血糖、胰岛素,其余血清置-80℃冰箱保存以备测定血清Apelin,脂联素及抵抗素。记录入选对象的年龄、糖尿病病程、身高、体重,通过公式计算BMI（体质指数）=体重/身高2（kg/m^2）,FPG（空腹血糖）及FINS（空腹胰岛素）并计算胰岛素抵抗指数（HOMA-IR）=（FPG×FINS/22.5）。然后根据化验结果将患者分为2组。伴有高脂血症组,与血脂正常组。其中高脂血症组再分为：高甘油三酯组,高胆固醇组及混合组（2个指标均高于正常）,然后进行血脂与各组脂肪因子以及胰岛素抵抗指数的相关分析。结果两组患者,不同血脂水平之间的脂肪细胞因子差异有统计学意义。糖尿病患者血清Apelin水平与TG（甘油三酯）、FFA（游离脂肪酸）、BMI、FINS呈显著正相关（分别r=0.766;r=0.675;r=0.780;r=0.821）,P值均〈0.05,而与TC（胆固醇）、HDL-C（高密度脂蛋白）、LDL-C（低密度脂蛋白）无相关性。结论2型糖尿病患者中伴有脂代谢紊乱者,血清Apelin水平明显升高且与患者的甘油三酯,游离脂肪酸的浓度密切相关,呈明显正相关。升高的Apelin水平可能参与与胰岛素抵抗的发生,其具体机制尚不明确,需进一步研究。     

糖尿病肾损伤大鼠空腹血清脂肪细胞型脂肪酸结合蛋白、游离脂肪酸的动态观察及意义

目的：动态观察链脲佐菌素(STZ)诱发1型糖尿病肾损伤大鼠空腹血清脂肪细胞型脂肪酸结合蛋白(FABP4)、游离脂肪酸(FFA)的含量和血糖、血脂、血肌酐、尿素氮、尿白蛋白等指标的变化,探讨 FABP4及 FFA 与糖尿病肾损伤发病的关系。方法选择健康的无特定病原体(specific pathogen free,SPF)级雄性 Wistar 大鼠28只作为建模对象,随机分为两组：对照组 n =8、糖尿病组(DM 组)n =20。收集3天,1,2,4,8周24小时尿,用酶联免疫吸附实验(ELISA)法检测24小时尿白蛋白。1,2,4,8周取空腹末梢静脉血(眼内眦静脉),统一测定 FABP4、FFA、血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)和其他血生化指标。结果与对照组相比,DM 组血清 FABP4及 FFA 水平第1周即升高,2、4、8周血清 FABP4及 FFA 水平均高于对照组,差异有统计学意义(P <0.05);DM 组 FABP4、FFA 每个时间点差异均无统计学意义(P >0.05);Spearman 相关分析显示,空腹血清 FABP4水平与 FFA(r =0.512,P <0.01)、FBG(r =0.434,P <0.01)、TG(r =0.360,P <0.05)、24小时尿白蛋白(r =0.583,P <0.01)呈明显正相关,与血 ALB(r =-0.485,P <0.01)呈负相关,与 TC(r =0.13,P >0.05)无相关性,空腹血清 FFA 水平与 FBG (r =0.490,P <0.01)、TG (r =0.542,P <0.01)、TC(r =0.370,P <0.01)、24小时尿白蛋白(r =0.634,P <0.01)呈明显正相关,与血 ALB (r =-0.278,P <0.01)呈负相关。结论糖尿病肾损伤大鼠第1周即有空腹血清 FABP4、FFA 有意义增高,这种升高比空腹血糖的升高更敏感,代谢紊乱是糖尿病的早期事件,提示空腹血清 FABP4、FFA 测定可能作为糖尿病肾损伤早期诊断的指标。     

2型糖尿病患者的非糖尿病一级亲属血清铁蛋白的临床研究

目的探讨2型糖尿病(T2DM)患者及2型糖尿病患者非糖尿病一级亲属(NGT)血清铁蛋白(FRT)的变化及其影响因素.方法选择2型糖尿病组(T2DM)、2型糖尿病非糖尿病一级亲属组(NGT)、其他健康人群对照组(NC)三组,每组60例,性别、年龄、体重指数(BMI)、腰臀比(WHR)、血压、血脂等指标相近.分别测定其血清铁蛋白、糖化血红蛋白、空腹胰岛素、空腹血糖、餐后2小时血糖、胆固醇、甘油三酯.用稳态模型(HOMA)公式来评估胰岛抵抗(IR)和胰岛素分泌功能:HOMA IR=空腹血糖(FPG)×空腹胰岛素(FINS)/ 22 5;HOMA β=FINS×20/(FPG-3 5).对比分析不同组别的变化及关系.结果经年龄和体重指数校正后,血清铁蛋白水平在2型糖尿病组、2型糖尿病非糖尿病一级亲属组及正常健康对照组呈现出明显由高至低趋势,两两比较均具有统计学差异(P<0.05).结论血清铁蛋白水平在2型糖尿病组患者,尤其是新诊断患者中明显升高,且血清铁蛋白升高的个体具有明显升高的糖化血红蛋白及血糖水平,提示铁蛋白代谢异常与2型糖尿病明显相关.     

男性肝硬化患者空腹血清瘦素水平与胰岛素抵抗的关系

目的 探讨男性肝硬化患者空腹血清瘦素水平与胰岛素抵抗的关系.方法 随机选取我院男性肝硬化患者64例,其中肝源性糖尿病患者31例,肝硬化患者33例.我院同期健康体检12例为健康对照组.分别检测其空腹血糖(FPG)、空腹胰岛素(FINS)和空腹瘦素(FLEP),计算胰岛素抵抗指数(HOMA-IR);检测其TG、TC、HDL-C等.结果 ①肝源性糖尿病组、肝硬化组FLEP水平[ln(FLEP)分别为(1.15±0.30)和(0.78±0.31)μg/L]均明显高于健康对照组[(0.33±0.07)μg/L,P均<0.01];肝源性糖尿病组明显高于肝硬化组(P<0.01).②瘦素相关因素的Pearson相关分析:血清FLEP与FPG、FINS、HOMA-IR呈正相关(r分别为0.44、0.42、0.25、0.28,P<0.01或P<0.05),与胰岛素敏感指数呈负相关(r=-0.24,P<0.05).结论 FLEP参与胰岛素抵抗的发生和发展,从而参与肝源性糖尿病的发生、发展.     

肥胖人群抵抗素表达与血清游离脂肪酸、肿瘤坏死因子α、脂联素水平的研究

目的了解3种脂肪细胞因子(游离脂肪酸、肿瘤坏死因子α和脂联素)与肥胖人群抵抗素表达的关系。方法选取19例肥胖和29例非肥胖受试者,采用逆转录聚合酶链反应(RT-PCR)方法,检测腹部皮下与大网膜脂肪组织中抵抗素mRNA的表达,同时测定血清抵抗素、肿瘤坏死因子α(TNF-α)、游离脂肪酸(FFA)和脂联素等指标,计算胰岛素敏感性指数及胰岛素抵抗指数(HOMA-IR)。结果肥胖组的血清FFA、TNF-α和抵抗素水平高于非肥胖组(均P<0.05);而血清脂联素水平却低于非肥胖组(P<0.05);抵抗素在各组皮下及网膜脂肪组织中的表达差异均无统计学意义;以血清抵抗素为因变量进行多元逐步回归分析,显示脂联素、TNF-α、皮下脂肪组织中抵抗素表达、FFA进入回归方程;相关分析显示,血清抵抗素与体质量指数、FFA、TNF-α、HOMA-IR呈正相关(分别r=0.457,P=0.008;r=0.708,P=0.000;r=0.520,P=0.006;r=0.703,P=0.000),与血清脂联素水平呈负相关(r=-0.928,P=0.000);皮下脂肪中抵抗素表达与TNF-α呈负相关(r=-0.352,P=0.039),与网膜脂肪中抵抗素的表达呈正相关(r=0.285,P=0.05),与血清FFA和脂联素水平无相关性。结论提示TNF-α、皮下脂肪组织中抵抗素表达和FFA对血清抵抗素水平具有正性影响,而脂联素对抵抗素水平产生负性作用;TNF-α可能下调皮下脂肪中抵抗素的表达。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.