内源性高甘油三酯血症存在胰岛素抵抗

为探讨内源性高甘油三酯血症是否存在胰岛素抵抗，本文对５３例内源性高甘油三酯血症患者及３３例年龄及性别相匹配的正常人的耐糖试验、胰岛素分泌试验、空腹血脂及血浆载脂蛋白进行了分析。结果发现，内源性高甘油三酯血症患者口服１００ｇ葡萄糖后血糖及血浆胰岛素水平明显增加，服糖后２ｈ血糖大于７．２２ｍｍｏｌ／Ｌ，服糖后３ｈ血浆胰岛素仍未恢复至空腹水平；且血浆胰岛素面积和葡萄糖面积、血浆胰岛素面积与葡萄糖面积的百分比及胰岛素抵抗指数均明显高于正常对照组，说明内源性高甘油三酯血症患者存在胰岛素抵抗，出现高胰岛素血症及葡萄糖耐量降低。     

老年冠心病患者血脂异常与胰岛素抵抗的关系

为研究老年冠心病患者血脂异常与胰岛素抵抗（ＩＲ）的关系，对３４例老年冠心病２以腔腹胰岛素／空腹血糖比值和口服葡萄糖负后胰岛素曲线下面积／葡萄糖曲线下面积比值作为胰岛素抵抗指标与空腹血脂水平进行直线相关分析，结果显示：无论是否合并高血压，老年冠心病患者存在血脂异常、高胰岛素血症及胰岛素抵抗，且ＩＲ指标与低密度脂蛋白胆固醇、甘油三酯呈明显正相关，与高密度脂蛋白胆固醇叶明显负相关，提示老年冠心病患者血脂     

心血管X综合征和胰岛素抵抗

目的 探讨Ｘ综合征患者是否存在胰岛素抵抗现象。方法 观察１１例Ｘ综合征患者（Ｘ综合征组）和１０例正常人（对照组）糖耐量试验时空腹和服糖后３０、６０、１２０和１８０分钟时血糖、血胰岛素水平和胰岛素敏感性指数的变化。结果 Ｘ综合征相对照组空腹血糖,服糖后１２０及１８０分钟时的血糖无变化;服糖后３０、６０分钟时的血糖Ｘ综合征组较对照级组高;Ｘ综合征且空腹胰岛素水平和胰岛素敏感性指数比正常对照组高;服糖后     

40岁以上中老年人糖耐量异常者血清脂质及载脂蛋白含量分析

为了探讨糖尿病脂蛋白异常血症的发生机理，研究了53例糖耐量异常者（糖耐量异常组）和27例糖耐量正常者（对照组）的血脂和血浆载脂蛋白水平，以及进行了葡萄糖耐量试验和胰岛素释放试验。结果发现，糖耐量异常组空腹及口服葡萄糖后60min血糖和血浆胰岛素水平与对照组无显著差异（P＞0．05），而口服葡萄糖后120min血糖（P＜0．05）、血浆胰岛素水平（P＜0．01）和口服葡萄糖后180min血糖（P＜0．01）、血浆胰岛素水平（P＜0．05）均比对照组显著升高。糖耐量异常组血浆甘油三酯和总胆固醇显著升高（P＜0．01和P＜0．05），同时伴有一定程度的低密度脂蛋白胆固醇升高和高密度脂蛋白胆固醇降低，以及载脂蛋白CⅡ、CⅢ及E显著增高（P＜0．01、P＜0．001和P＜0．005），这些血脂改变与糖尿病脂蛋白异常血症类似。此结果表明，胰岛素抵抗、高胰岛素血症在糖尿病脂蛋白异常血症的发生中起着重要的作用。同时也提示对一些空腹血糖正常，糖耐量异常，但还没有临床诊断为糖尿病患者，应进行常规血脂检查，筛选出脂蛋白异常者，并采取相应的措施予以纠正。     

培哚普利对高血压病患者血胰岛素水平的影响

对４０例高血压病（ＥＨ）患者和２０例健康对照者行口服葡萄糖耐量试验，测定其血糖（ＧＳ）和血胰岛素（ＩＳ）水平，计算其释放曲线下面积（ＡＵＣＧ、ＡＵＣＩ），发现两组空腹血糖无显著差别，ＥＨ组空腹ＩＳ和服糖后ＧＳ、ＩＳ及其ＡＵＣＧ、ＡＵＣＩ均显著高于对照组。提示高血压患者存在糖耐量降低、高胰岛素血症和胰岛素抵抗。３１例ＥＨ患者接受培哚普利降压治疗４周后，糖耐量试验显示糖负荷后１ｈ、２ｈ的ＧＳ和ＡＵＣＧ及空腹与糖负荷后各点的ＩＳ和ＡＵＣＩ均较治疗前显著降低。提示培哚普利能够降低ＥＨ患者血ＩＳ水平，具有改善其胰岛素抵抗的作用。     

甘油三酯对2型糖尿病患者胰岛素用量的影响

目的研究应用胰岛素降血糖治疗的2型糖尿病患者血甘油三酯对胰岛素用量影响。方法选取华北理工大学附属医院内分泌科2016年5月—2017年6月收治的140例院外应用胰岛素降血糖治疗且血糖控制差的2型糖尿病患者,其中78例为高甘油三酯水平患者,为高甘油三酯组,62例为甘油三酯水平正常患者为正常甘油三酯组,比较两组间血脂水平、空腹及餐后2 h血糖水平、C肽水平、胰岛素水平、出入院胰岛素用量及一般情况的差异。结果高甘油三酯组出院胰岛素用量,入院胰岛素用量、糖化血红蛋白、总胆固醇、空腹胰岛素水平、餐后2 h胰岛素水平、空腹血糖、餐后血糖高于正常甘油三酯水平组;高常甘油三酯组内经饮食运动控制人数低于正常甘油三酯组。结论 2型糖尿病合并高甘油三酯血症患者胰岛素用量、空腹及餐后2 h胰岛素、血糖水平明显高于2型糖尿病正常高甘油三酯水平患者。     

人血浆瘦素水平与肥胖及血糖、胰岛素的关系

目的　探讨人血浆瘦素水平与肥胖程度、血糖、胰岛素浓度的关系。方法　免疫放射法测定171例检查者(2型DM84例，IGT36例，NGT51例；男90例，女81例)的空腹血浆瘦素水平，并行口服葡萄糖耐量试验，测定血浆胰岛素和葡萄糖浓度，同时测量身高、体重，计算体重指数(BMI)。结果　空腹血浆瘦素水平与体重指数呈正相关(男r=0.6772,P＜0.01；女r=0.7191,P＜0.01)，但性别差异显著(P＜0.001)，女性是男性的2～3倍。采用多元逐步回归法分析，去除体重指数等因素的影响后，瘦素与胰岛素曲线下面积呈正相关，与血糖浓度无相关性。结论　肥胖者空腹血浆瘦素升高，血浆高瘦素水平与高胰岛素血症的相关性提示瘦素可能在2型糖尿病的发病中起一定作用。     

冠心病血清胰岛素浓度与心率变异性的变化及其关系

检测冠心病３４例，对照组３０例糖耐量前后血糖、胰岛素、Ｃ肽的变化，并测定２４小时动态心电图心率变异性（ＨＲＶ）。结果冠心病组空腹与服糖后胰岛素、Ｃ肽均明显升高，ＨＲＶ显著下降。进行血糖、胰岛素、Ｃ肽同ＨＲＶ相关分析，仅显示服糖后２小时胰岛素和胰岛素曲线下面积与ＨＲＶ呈负相关，ＨＲＶ≤１００ｍｓ的冠心病组显示更高的胰岛素水平，提示高胰岛素血症的交感神经兴奋作用可能是冠心病患者ＨＲＶ降低的原因之一。     

运动对老年高血压患者血压和糖,脂代谢的影响

目的探讨运动对老年高血压患者血压和糖、脂代谢的影响。方法将４３例老年高血压患者随机分为运动组和对照组，两组均接受尼群地平降压治疗，同时运动组进行为期３个月的体育运动。测量两组入组时和３个月后血压、血脂、空腹血糖、胰岛素及负荷后１ｈ和２ｈ血糖及血胰岛素。结果经过３个月规则运动，运动组空腹及糖负荷后１ｈ、２ｈ胰岛素水平、血胆固醇、甘油三酯及低密度脂蛋白较对照组降低（Ｐ值均＜０．０５），高密度脂蛋白较对照组增高（Ｐ＜０．０５）；试验后两组血压均较入组时降低，而运动组服药量较对照组减少（Ｐ＜０．０５）。结论规则的体育运动能降低老年高血压患者空腹及糖负荷后血胰岛素水平，并有利于血脂代谢紊乱的纠正和血压的控制     

高胰岛素血症与冠心病关系的研究

对40例冠心病患者及30例正常人进行糖耐量、胰岛素及C肽释放试验,并计算胰岛素敏感指数。发现冠心病患者血糖面积、空腹胰岛素水平及胰岛素面积、空腹C肽水平及C肽面积均高于正常人,而胰岛素敏感指数低于正常。提示冠心病患者存在高胰岛素血症及胰岛素抵抗。     

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.