肥胖者的胰岛素水平与高血压关系初探

对50例单纯性肥胖者及48例正常体重者同时检测身高、体重、血压、血脂、空腹血糖及空腹血清胰岛素。结果肥胖组血压、甘油三酯、空腹血清胰岛素显著升高(P<0.01或P<0.05),而载脂蛋白A_l显著降低(P<0.01),且肥胖组空腹血清胰岛素及胰岛素敏感指数与血压有显著相关性(均P<0.01),而对照组则无关(均P<0.05)。提示在高胰岛素血症和胰岛索抵抗引起的高血压发病过程中,肥胖起重要促进作用。     

2型糖尿病胆囊结石的危险因素分析

目的初步探讨2型糖尿病合并胆囊结石的危险因素.方法采用病例对照方法,观察64例2型糖尿病伴胆囊结石(DG)与75例糖尿病不伴胆囊结石(NDG)患者,检测两组对象的身高、体重、腰围、臀围、血压、血脂、尿酸、血糖、空腹胰岛素,计算出体重指数、腰臀比、胰岛素抵抗指数、胰岛素敏感指数.结果两组比较,年龄、血压、甘油三酯、胆固醇、低密度脂蛋白、尿酸、空腹血糖差异无统计学意义(p>0.05);DG组比NDG组体重指数、腰臀比、空腹胰岛素、胰岛素抵抗指数明显升高(p<0.05),高密度脂蛋白、胰岛素敏感指数明显下降(p<0.05);多元逐步回归分析显示空腹胰岛素、高密度脂蛋白降低有增加胆囊结石发病危险的趋势.结论低高密度脂蛋白、高胰岛素血症和肥胖是2型糖尿病并发胆囊结石的危险因素.     

高血压病患者血糖异常及其危险因素的临床研究

目的 研究高血压病患者耱代谢异常情况,并探讨可能的危险因素.方法 收集363例无糖尿病病史的高血压患者一般临床资料,测量血压、身高、体重、腰围、臀围、测定空腹血糖、空腹胰岛素、总胆固醇、三酰甘油、OGTT2h和血糖等指标,用胰岛素抵抗指数作为胰岛素敏感性评价指标.结果 363例患者血糖调节异常的有218例,占60.06%,新诊断糖尿病有56例,占15.43%,单因素分析显示,年龄、腰围、腰臀比、腰围身高比、总胆固醇、三酰甘油、空腹胰岛素、胰岛素抵抗指数、糖尿病家族史及吸烟史在不同糖代谢状况的患者差异有显著性(P<0.05或P<0.01),经多分类多因素Logiscic回归分析显示:年龄,胰岛素抵抗指数与高血压合并血糖调节异常有关;年龄、胰岛素抵抗指数、腰围、腰围身高比、三酰甘油与高血压合并糖尿病有关(P<0.05).结论 高血压痛患者血糖代谢异常检出率高,对具有中心性肥胖、高血脂、胰岛素抵抗等危险因素的高血压病患者在降压的同时,更应关注糖代谢的情况.     

老年2型糖尿病合并脑梗塞危险因素分析

目的 探讨老年2型糖尿病合并脑梗塞的危险因素.方法 回顾性分析56例老年2型糖尿病合并脑梗塞患者的年龄、性别、身高、体重、糖尿病病程、血压、空腹血糖、餐后2 h血糖、空腹胰岛素、血清总胆固醇及甘油三脂,与随机选取的同期住院56例无脑梗塞的老年2型糖尿病患者（对照组）进行对比.结果 2型糖尿病合并脑梗塞组的餐后2 h血糖、收缩压、血清总胆固醇、甘油三脂、空腹胰岛素及胰岛素抵抗指数均明显高于对照组（P〈0.01）,空腹血糖及舒张压高于对照组（P〈0.05）.结论 高血压、高血糖、高血脂、高胰岛素血症是老年2型糖尿病合并脑梗塞的高危因素,应积极干预.适时监测血压、血糖、血脂及血胰岛素是防治该病的重要手段.     

二甲双胍对高胰岛素血症肥胖儿童糖代谢和血清脂源性激素的影响

目的:观察二甲双胍对高胰岛素血症肥胖患儿血清脂源性激素(脂联素、抵抗素、瘦素)水平的影响。方法:54例高胰岛素血症肥胖患儿分为轻、中度肥胖组(27例)及重度肥胖组(27例),以门诊健康体检非肥胖儿童45例为对照组,2个肥胖组用二甲双胍治疗12周,检测治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。结果:轻、中度肥胖组与重度肥胖组治疗前空腹血糖水平与对照组比较差异无统计学意义(P>0.05);血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA-IR)均高于对照组(P<0.01);脂联素水平明显低于对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01);体重指数(BMI)下降,但差异无统计学意义。结论:二甲双胍能显著改善肥胖患儿胰岛素抵抗。     

2型糖尿病合并非酒精性脂肪肝临床资料分析

目的 探讨2型糖尿病舍并非酒精性脂肪肝的危险因素.方法 2型糖尿病合并非酒精性脂肪肝(DFL)组93例,2型糖尿病无非酒精性脂肪肝(NDfL)组、90例,用空腹C肤代替胰岛素改良HOMA公式评价胰岛素抵抗.结果 DFL组体质量指数、腰围、空腹C-肽、餐后2小时c-肽、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰胺转移酶、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血尿酸和HOMA(CP)升高(均P＜0.05);Logistic回归分析表明体重指数、高甘油三酯血症、空腹C-肽是DFL形成的危险因素.结论 2型糖尿病合并非酒精性脂肪肝的危险因素是肥胖、高甘油三酯血症和胰岛素抵抗.     

上海市平凉社区人群出生体重与成年后代谢异常

目的　调查不同出生体重儿成年后代谢异常的现患率,探索两者的关系。方法　对上海市平凉社区糖尿病流行病学调查中15 ~74岁有确切出生体重记录的1 010名中国人(男性390例,女性620例)检测体重指数、腰围、臀围、腰臀比、血压、空腹血糖、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇。以单变量及多变量分析方法观察不同出生体重儿成年后代谢异常的差别及两者的关系。结果　低出生体重者( <2 5kg) 56人,高出生体重者(≥4kg) 53人、正常出生体重者901人。低出生体重组成年后BMI均高于正常出生体重组,其中女性体质指数和腰围、腰臀比两组差异有统计学意义(P<0. 01 )。男性高出生体重组成年后腰围和臀围均较正常出生体重组高,两组差异有统计学意义(P<0 .05);低出生体重组成年后肥胖、高胆固醇血症、糖尿病及糖尿病合并高血压的患病率均高于正常出生体重组(P<0 .05、P<0 .01、P<0 05、P<0. 01),高出生体重组成年后肥胖发生率和高血压患病率均高于正常出生体重组(P<0 .05);低出生体重与成年后超重肥胖、腹型肥胖、高胆固醇血症及糖尿病的发病呈显著性相关。结论　低出生体重与成年后肥胖、糖脂代谢异常相关,是成年后发生超重肥胖、高胆固醇血症和糖尿病的危险因素。     

老年人代谢综合征相关因素的临床分析

目的探讨老年人代谢综合征(MS)相关因素与疾病的关系。方法测定209例中、老年患者空腹血糖、血脂、血清胰岛素水平及胰岛素抗体,同时测量身高、体重,了解与某些病症的患病相关性。结果老年患者组中的高胰岛素血症的检出率明显高于中年期患者(P<0.05);高胰岛素血症组MS检出率明显高于胰岛素浓度正常组(P<0.01);肥胖组MS患病率明显高于体重正常组(P<0.01)。结论老年患者的胰岛素抵抗发生率明显高于中年期患者,MS与胰岛素抵抗、高胰岛素血症、肥胖有着密切的关系。     

高血压并脑梗死患者胰岛素抵抗及血脂异常的研究

目的研究高血压并脑梗死患者胰岛素抵抗(IR)、血脂异常的状况及IR与脑大小血管病变的关系。方法测定85例高血压并脑梗死患者(腔隙性脑梗死组40例,血栓形成性脑梗死组45例)的血脂、空腹血糖、空腹血胰岛素及胰岛素敏感指数(ISI),并与40名健康对照者进行比较。结果高血压并脑梗死患者血脂、血糖、胰岛素I、SI与对照组比较均有显著性差异(P<0.01或P<0.05),腔隙性脑梗死组胰岛素明显高于血栓形成性脑梗死组(P<0.05),而ISI较血栓形成性脑梗死组明显减低(P<0.05)。结论高血压并脑梗死存在IR,IR可能是其独立危险因素之一,腔隙性脑梗死可能与IR关系更为密切。     

糖尿病患者肥胖及胰岛素抵抗与血浆同型半胱氨酸的关系

目的 探讨2型糖尿病患者肥胖、胰岛素抵抗与血浆同型半胱氨酸的关系.方法 1)120例2型糖尿病分为肥胖组与非肥胖组,比较两组间的Hcy和胰岛素抵抗指数(HOMA-IR)的差别.2)2型糖尿病分为高Hcy和正常Hcy组,比较两组的血糖、血脂、血压、血肌酐、胰岛素和糖基化血红蛋白,体重指数(BMI)及HOMA-IR的差别.3)多元逐步回归分析Hcy的影响因素.结果 1)肥胖组的Hcy、HOMA-IR高于非肥胖组(P<0.01).2)高Hcy与正常Hcy的病程(P<0.01)、空腹血糖(P<0.05)、糖基化血红蛋白(P<0.05)、血肌酐(P<0.01)、总胆固醇(P<0.05)、高密度脂蛋白胆固醇(P<0.05)、BMI(P<0.01)、空腹胰岛素(P<0.01)及HOMA-IR(P<0.01)差别有统计学意义.3)血浆Hcy与HOMA-IR、BMI、病程、胰岛素、肌酐独立相关.结论 肥胖与胰岛素抵抗与2型糖尿病患者的Hcy'密切相关.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.