肥胖者外周血Obestatin、Ghrelin水平变化与胰岛素抵抗的关系

目的探讨肥胖患者外周血Obestatin、Ghrelin水平变化与胰岛素抵抗(IR)的关系。方法选取正常对照组24例,单纯肥胖组30例,肥胖-糖代谢异常组(包括初诊断2型糖尿病或糖耐量受损患者)36例。测定空腹Obestatin、Ghrelin水平和空腹胰岛素(FPI),并计算稳态模型评价HOMA-IR。比较不同IR程度下Obestatin、Ghrelin水平的变化。结果单纯肥胖组、肥胖-糖代谢异常组患者空腹外周血Obestatin、Ghrelin水平均明显低于正常对照组(P0.05,P0.01),HOMA-IR、FPI、三酰甘油(TG)均高于正常组。与单纯肥胖组相比,肥胖-糖代谢异常组血中Obestatin、Gh-relin水平明显降低(P0.01,P0.05),HOMA-IR、空腹血糖(FPG)、FPI、TG明显增高(P0.05)。线性相关分析表明Obestatin、Ghrelin均分别与BM I、HOMA-IR负相关(P0.05),Obestatin与Ghrelin正相关。多元逐步回归分析显示BM I、HOMA-IR是影响Obestatin、Ghrelin水平的独立相关因素。结论 Obestatin、Ghrelin水平的降低可能参与了肥胖、IR的发生,并可能具有防止肥胖和2型糖尿病继续发展的作用。     

T2DM患者血浆内脏脂肪素、瘦素与胰岛素抵抗的相关性研究

目的 探讨2型糖尿病(T2DM)患者血浆内脏脂肪素、瘦素水平与胰岛素抵抗(IR)的相关性.方法 102例T2DM患者和64例正常糖耐量(NGT)对照者,根据BMl分为肥胖组(Ob)和非肥胖(Non-Ob)组,均测定空腹血浆内脏脂肪素、瘦素和相关临床指标,计算胰岛素抵抗指数(HOMA-IR)和腰臀比(WHR).结果 T2DM组与NGT组比较空腹血浆内脏脂肪素和瘦素水平明显升高(t=3.922,P=0.00;t=2.128,P=0.038).相关分析显示T2DM患者空腹血浆内脏脂肪紊与HOMA-IR、WHR、瘦素、HbA<,1> c和TG正相关(r=0.543,P=0.001;r=0.442,P=0.008;r=0.385,P=0.013,r=0.345,P=0.025;r=0.427,P=0.005),瘦素与HOMA-IR、性别、BMI正相关(r=0.578,P<0.01;r=0.547,P<0.01;r=0.607,P<0.01).结论 T2DM患者空腹血浆内脏脂肪素和瘦素水平显著升高,且与IR关系密切.     

多器官功能不全综合征患者胰岛素抵抗及胰岛素受体密度和亲和力变化的研究

目的探讨多器官功能不全综合征(MODS)患者胰岛素抵抗(IR)与红细胞表面胰岛素受体密度和亲和力的变化。方法应用葡萄糖氧化酶法测定MODS患者空腹血糖(FBG),放射免疫法测定胰岛素,放射受体分析法测定受体密度及亲和力。结果MODS各组患者空腹血糖、胰岛素、胰岛素抵抗指数(HOMA-IR)均明显高于对照组(P<0.01),且MODS死亡组明显高于生存组(P<0.01);MODS各组胰岛素分泌指数(HOMA-β)明显低于对照组,且MODS死亡组明显低于生存组。MODS各组患者红细胞表面胰岛素受体密度及亲和常数较对照组显著减少(P<0.01),而MODS死亡组亲和常数较生存组显著减少(P<0.01),受体密度比较无显著性差异(P>0.05)。结论MODS患者存在IR且与预后相关,红细胞膜胰岛素高亲和力受体减少可能是MODS患者发生IR的机制之一。     

2型糖尿病胰岛素抵抗与颈动脉内膜厚度相关性分析

目的研究2型糖尿病胰岛素抵抗与颈动脉内膜中层厚度的关系。方法对该院2型糖尿病病人均做颈动脉彩超测定颈动脉内膜中层厚度(IMT),根据IMT分为正常组(IMT<0.9 mm)58例、IMT增厚组(IMT≥0.9 mm)63例,受试者均隔夜空腹8 h以上取静脉血检测空腹血糖、空腹胰岛素、低密度脂蛋白、高密度脂蛋白、总胆固醇、甘油三酯、糖化血红蛋白水平,测量身高、体重,计算BMI。同时计算稳态模型胰岛素抵抗(HOMA-IR)指数,分析2型糖尿病患者颈动脉IMT与胰岛素抵抗、血糖、血脂等因素之间的关系。结果 2型糖尿病患者颈动脉IMT主要与年龄、FINS、HOMA-IR有关,IMT增厚组FINS和HOMA-IR明显高于IMT正常组,说明胰岛素抵抗程度、代偿性高胰岛素血症与IMT增厚呈正相关。结论胰岛素抵抗可能与颈动脉内膜增厚有关。     

阿尔茨海默病与2型糖尿病患者胰岛素抵抗的相关性

目的探讨阿尔茨海默病(AD)与胰岛素抵抗的相关性。方法选取AD患者78例、2型糖尿病(T2DM)患者42例和同期体检健康者33例作为研究对象;按痴呆严重程度将AD组分为轻度痴呆组19例、中度痴呆组33例和重度痴呆组26例。测定各组受试者空腹血糖(FPG)、空腹胰岛素(FINS)及稳态胰岛素抵抗指数(HOMA-IR)。结果 HOMA-IR T2DM组(3.72±1.82)>AD组(2.05±1.40)>健康对照组(1.46±0.62),各组间均有统计学差异(均P<0.05)。重度痴呆患者HOMA-IR水平(2.67±1.93)明显高于轻度(1.48±0.73)、中度痴呆患者(1.90±0.98)(均P<0.05),轻度与中度患者之间无统计学差异(P>0.05)。结论胰岛素抵抗与AD有一定的相关性,减轻胰岛素抵抗有助于延缓AD病情进展。     

2型糖尿病患者血浆Apelin-12水平与高血压、胰岛素抵抗的相关性

目的探讨Apelin-12与高血压、肥胖、胰岛素抵抗、炎症等的相关性。方法测定31例单纯2型糖尿病、37例2型糖尿病合并高血压患者及25例健康对照者血浆Apelin-12、肿瘤坏死因子α(TNF-α)、血脂、糖化血红蛋白(HbA1c)、空腹血糖、空腹胰岛素(FINS)、胰岛素抵抗(IR)指数(HOMA-IR)、体重指数(BMI)、血压等水平并进行各参数之间的相关分析。结果①糖尿病合并高血压组血浆Apelin-12水平低于正常对照组和单纯糖尿病组(P0.05或P0.01),单纯糖尿病组血浆Apelin-12水平高于正常对照组(P0.05)。②糖尿病合并高血压组TNF-α水平高于糖尿病组和正常对照组(P0.05或P0.01),糖尿病组TNF-α水平高于正常对照组(P0.05)③直线相关分析显示,空腹血浆Apelin-12与腰臀比(WHR),FINS,HOMA-IR,甘油三酯(TG),收缩压(SBP),TNF-α呈负相关,与HDL-C呈正相关。结论血浆Apelin-12水平在糖尿病组升高,在糖尿病合并高血压组降低,且与肥胖、IR、炎症等相关。推测Apelin-12可能参与了IR、2型糖尿病、高血压等疾病的发生发展。     

原发性高血压患者脂肪餐负荷后甘油三酯代谢变化与胰岛素抵抗关系的评价

目的:探讨原发性高血压患者脂肪餐负荷后甘油三酯(TG)代谢变化与胰岛素抵抗(IR)的关系.方法:20例健康人(正常对照组)、32例超重/肥胖高血压患者(超重/肥胖高血压组)和33例正常体重高血压患者(正常体重高血压组)禁食12小时后,进行标准脂肪餐负荷试验,以TG8小时曲线下面积(TG-AUC)和TG峰反应(TGPR)作为标准脂肪餐负荷后TG反应水平的指标.用稳态模式评估法的胰岛素抵抗指数(HOMA-IR)作为评价胰岛素抵抗的指标.结果:①超重/肥胖高血压组和正常体重高血压组TG-AUC、TGPR均显著高于正常对照组(P<0.05),超重/肥胖高血压组TG-AUC、TGPR显著高于正常体重高血压组(P<0.05).②超重/肥胖高血压和正常体重高血压组HOMA-IR均显著高于正常对照组(P<0.05),超重/肥胖高血压组HOMA-IR显著高于正常体重高血压组(P<0.05).③超重/肥胖高血压组和正常体重高血压组中具有IR的患者TG-AUC、TGPR显著高于无IR的患者(P<0.01),而上述两组中无IR患者TG-AUC、TGPR与正常对照组比较,无显著差异(P>0.05).④TG-AUC、TGPR与HOMA-IR、空腹TG水平、舒张压、体重指数呈正相关.多因素回归分析显示HOMA-IR是TG-AUC、TGPR最重要的影响因素.结论:原发性高血压患者存在脂肪负荷后TG代谢异常,肥胖和高血压对脂肪负荷后TG代谢异常及IR有协同作用,IR是引起脂肪负荷后TG代谢异常的重要因素.     

初诊2型糖尿病患者血浆内脂素与超敏C反应蛋白及胰岛素抵抗指数的相关性

目的 研究初诊2型糖尿病(T2DM)患者血浆内脂素浓度的变化及其与超敏C反应蛋白(hs-CRP)及胰岛素抵抗指数(HOMA-IR)的关系.方法 选取初诊T2DM患者52例及46例相匹配健康体检者;将T2DM组分为超重组(28例)、正常体重组(24例).检测受试者腰围、臀围,测定空腹血浆内脂素、hs-CRP、血脂、血糖、葡萄糖耐量(OGTT)及胰岛素释放试验(IRT),计算HOMA-IR.比较各组内脂素水平的变化,并对内脂素与各指标的相关性进行统计学分析.结果 T2DM患者空腹血浆内脂素明显高于正常对照(P<0.01),超重组与正常体重组间血浆内脂素差异无显著性意义.糖尿病(DM)患者血浆内脂素浓度与空腹血糖(FPG)(r=0.348,P<0.01)、餐后2 h血糖(r=0.394,P<0.01)、hs-CRP(r=0.372,P<0.01)、HOMA-IR(r=0.270,P<0.01)呈正相关.结论 初诊T2DM患者血浆内脂素显著升高,与HOMA-IR、hs-CRP呈正相关.它可能是联系肥胖和DM之间的一个重要环节.     

2型糖尿病患者微量白蛋白尿与胰岛素抵抗关系

伴微量白蛋白尿的2型糖尿病患者(DM-MA)36例,不伴微量白蛋白尿的(DM-NA)29例,正常对照组(NC)20例.3组患者均行空腹血糖、胰岛素、血脂等测定,并计算HOMA-IR评估组织胰岛素抵抗,根据结果进行比较分析,将所有患者的尿白蛋白排泄率(UAER)与有关因素进行多元回归分析.结果DM-MA组与DM-NA组HOMA-IR均高于NC组,差异非常显著(P＜0.01),DM-MA组HOMA-IR示明显高于DM-NA组(P＜0.05),而且HOMA-IR与UAER呈独立相关(r=0.4875,P＜0.01).结论与DM-NA相比,DM-MA有更严重的IR,IR是MA尿的独立危险因素.     

糖代谢异常大鼠心肌超微结构改变及TNF-α的表达

目的观察糖代谢异常(糖调节受损和糖尿病)大鼠心肌的超微结构改变及肿瘤坏死因子-α(TNF-α)的表达,揭示糖尿病心肌病(diabetic cardiomyopathy,DC)发生发展的炎性机制。方法30只雄性Wistar大鼠随机分为:正常对照组、胰岛素抵抗组(IR组)和T2DM组。用免疫组化法检测心肌组织中TNF-α的表达,透射电镜观察心肌的超微结构,并测定空腹血糖(FPG)、空腹血清胰岛素(FINS)等生化指标及计算胰岛素敏感指数(ISI)。结果TNF-α在IR组、T2DM组大鼠心肌组织中的阳性表达平均积分光密度值(IDP)显著高于正常对照组(P<0.01);且T2DM组大鼠IDP值显著高于IR组(P<0.01)。IR、T2DM组ISI负值均显著高于正常对照组(P<0.01)。电镜下IR、T2DM组大鼠心肌超微结构发生不同程度的损害。相关分析表明:TNF-α的IDP值与FPG水平、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)呈明显正相关(r=0.905,0.602,0.493,0.430,均P<0.01),与ISI明显呈负相关(r=-0.896,P<0.01),多元逐步回归分析显示FBG、ISI是影响TNF-α水平的重要因素。结论TNF-α的表达与高血糖、胰岛素抵抗(IR)密切相关,且TNF-α作为一种重要的炎症因子可能参与了DC的发病机制。     

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.     

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.     

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.