系统性红斑狼疮患者血清中B淋巴细胞刺激因子的检测

目的检测系统性红斑狼疮(SLE)患者血清B淋巴细胞刺激因子(BLyS)水平,并探讨其在SLE发病中的意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA)法检测血清BLyS水平。结果①SLE患者血清BLyS[(9.6±2.3)ng/ml]显著高于正常人对照组[(4.0±1.5)ng/ml]。②SLE患者中,血清BLyS水平活动组[(11.1±2.2)ng/ml]高于非活动组[(8.1±1.2)ng/ml],抗dsDNA抗体阳性组[(10.9±2.2)ng/ml]高于抗dsDNA抗体阴性组[(8.1±1.4)ng/ml],高IgG组[(10.8±2.4)ng/ml]高于非高IgG组[(8.3±1.3)ng/ml],低C3组[(10.2±2.5)ng/ml]高于非低C3组[(8.3±1.3)ng/ml],低C4组[(10.1±2.3)ng/ml]高于非低C4组[(7.6±0.7)ng/ml],低血小板计数组[(10.7±2.7)ng/ml]高于非低血小板计数组[(8.8±1.7)ng/ml]。③SLE患者血清BLyS水平与SLE疾病活动指数(SLEDAI)(r=0.56,t=15.89,P<0.01)、IgG(r=0.33,t=4.20,P<0.05)呈正相关;与C4(r=-0.47,t=10.04,P<0.01)、血小板计数(r=-0.53,t=13.85,P<0.01)呈负相关。结论BLyS可能参与SLE的发病。     

血浆转化生长因子β1水平与心房颤动导管消融后复发的关系研究

目的:探讨心房颤动(房颤)导管消融术前患者血浆转化生长因子β1(TGF-β1)水平与房颤消融术后复发的关系。方法:连续选取100例接受导管消融治疗的房颤患者,其中阵发性房颤60例,持续性房颤40例。阵发性及持续性房颤患者随访1年后根据房颤复发情况再分为复发组和无复发组。术前检测血浆TGF-β1水平,并行超声心动图等临床检查。结果:所有患者均随访12个月,房颤消融术后的复发率为30%(30/100),其中阵发性房颤术后复发率为21.6%(13/60),持续性房颤复发率为42.5%(17/40)。30例房颤术后复发患者术前血浆TGF-β1水平较70例术后无复发患者高[(35.49±8.47)ng/ml vs(27.00±8.61)ng/ml),P<0.05],其中阵发性房颤复发组术前血浆TGF-β1水平较无复发组高,差异有统计学意义[(28.90±8.44)ng/ml vs(22.47±6.64)ng/ml,P<0.05];持续性房颤复发组亦高于无复发组[(40.52±3.37)ng/ml vs(36.26±2.66)ng/ml,P<0.05]。对患者年龄、性别、房颤类型、体重指数、左心房内径、左心室射血分数、TGF-β1等多因素logistic回归分析得出术前血浆TGF-β1水平与房颤消融术后复发有关[OR=1.17,95%CI(1.05,1.31),P=0.004]。进一步分析显示,术前血浆TGF-β1水平与阵发性房颤的术后复发有关[OR=1.16,95%CI(1.05,1.52),P=0.01],与持续性房颤术后复发也有关[OR=1.71,95%CI(1.12,2.62),P=0.013]。结论:房颤消融术前血浆TGF-β1水平与房颤消融术后复发有关。     

慢性心力衰竭患者血浆cMyBP-C水平的变化

目的:探讨慢性心力衰竭(CHF)患者血浆中心脏型肌球蛋白结合蛋白-C(cMyBP-C)水平变化及其对近期预后的预测价值。方法:选取89例新入院确诊为CHF的患者为CHF组,30名健康体检者为对照组。收集所有受试者入院时及CHF组治疗1个月后的血浆样本,检测其cMyBP-C水平。彩色多普勒超声心动图仪检测左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)及E/A比值等。对cMyBP-C与心力衰竭指标进行相关性分析。对CHF组进行为期12个月的临床随访,记录主要不良心血管事件(MACE)的发生情况。用COX回归分析并绘制ROC曲线评价血浆cMyBP-C表达水平对CHF近期预后的预测价值。结果:CHF组患者入院时cMyBP-C血浆水平较对照组入院时明显升高[(137.07±44.44) ng/ml∶(29.29±10.37) ng/ml,P0.01];CHF组患者治疗1个月后与入院时相比较明显降低[(84.67±37.98) ng/ml∶(137.07±44.44) ng/ml,P0.01]。Pearson相关分析显示,CHF患者入院时血浆cMyBP-C水平与B型脑钠肽前体(proBNP)呈正相关性(r=0.711,P0.01),与LVEF、LVFS、E/A比值均呈负相关性(r=-0.659、-0.457、-0.478,均P0.01)。Spearman相关性分析显示,CHF患者入院时血浆cMyBP-C水平与NYHA分级呈正相关性(r=0.756,P0.01)。Cox回归分析结果显示,入院时血浆cMyBP-C水平是近期发生MACE的独立危险因素(HR=1.024,95%CI:1.001～1.048,P=0.044)。ROC结果显示,入院时血浆cMyBP-C水平预测CHF患者近期发生MACE的曲线下面积为0.805(95%CI:0.688～0.922),截点值为154.71 ng/ml,灵敏度为84.2%,特异度为74.1%。结论:cMyBP-C在CHF患者血浆中的表达水平可能发生改变,可为预测患者近期内MACE的发生风险提供参考。     

血清基质金属蛋白酶-9检测与系统性红斑狼疮活动性的关系

目的探讨血清基质金属蛋白酶-9(MMP-9)与系统性红斑狼疮(SLE)活动程度的关系和意义。方法采用双抗体夹心酶联免疫吸附测定法,检测30名健康人和36例SLE患者血清MMP-9水平,以分析其与SLE活动性变化关系。结果SLE患者血清MMP-9水平[(108±113)ng/ml]明显低于正常对照组[(352±115)ng/ml],P<0.001;糖皮质激素治疗后血清MMP-9水平[(246±196)ng/ml]与治疗前水平[(114±92)ng/ml]相比,差异有显著性意义(P<0.05);SLE患者活动期血清MMP-9水平[(72±66)ng/ml]低于非活动期[(166±146)ng/ml],P<0.05;SLEDAI>8分组[(80±72)ng/ml]低于SLEDAI≤8分组[(152±150)ng/ml],P<0.05;蛋白尿组[(82±20)ng/ml]低于非蛋白尿组[(152±43)ng/ml],P<0.05;关节炎组[(103±126)ng/ml]与非关节炎组[(117±89)ng/ml]之间差异无显著性,P>0.05。结论MMP-9可能与SLE的发病相关,血清MMP-9可作为反映SLE活动程度、肾脏损害及疾病进展或改善的一项指标。     

血浆基质金属蛋白酶2对心房颤动患者导管射频消融治疗术后复发的影响

目的:探讨血浆基质金属蛋白酶2(MMP-2)对心房颤动(房颤)患者导管射频消融术后房颤复发的影响。方法:102例行射频消融术治疗的阵发性房颤患者,根据术后6个月内房颤是否复发将患者分为维持窦律组(83例)和房颤复发组(19例),两组患者分别于术前和术后6个月检测血浆MMP-2及其抑制剂组织型基质金属蛋白酶抑制因子(TIMP-2)浓度。结果:与维持窦律组相比较,房颤复发组患者术前血浆MMP-2水平明显增高[(856.6±115.6)ng/ml:(748.0±109.3)ng/ml,P0.05],而TIMP-2的血浆水平两组之间差异无统计学意义。MMP-2与TIMP-2水平也无相关性(r=0.182,P=0.27)。多因素回归分析表明预测消融后房颤复发的独立危险因素是术前MMP-2浓度(OR=4.82,95%CI 1.1~18.0,P=0.002)、左房内径(OR=2.441,95%CI1.27~5.81,P=0.019)。结论:术前血浆MMP-2浓度对预测射频消融术后房颤复发具有一定的临床应用价值。     

血浆凝溶胶蛋白在急性ST段抬高型心肌梗死患者中的水平及意义

目的分析急性ST段抬高型心肌梗死(STEMI)患者血浆凝溶胶蛋白(p GSN)的水平,以及急诊经皮冠状动脉介入术(PCI)对其影响,探讨其能否作为心肌梗死和心肌缺血再灌注损伤的血清标志物,及其对短期预后的影响。方法连续收集126例首次发生STEMI并行急诊PCI的患者和60例稳定性心绞痛并行择期PCI的冠心病患者术前即刻及术后90 min血清标本,另抽取30名无心肌缺血证据的健康者血清标本作为对照,采用酶联免疫吸附试验(ELISA)检测p GSN浓度。p GSN在术前和术后的变化量记录为ΔG。STEMI组患者根据术后90 min心电图ST段回落程度分为ST段完全回落组(STR≥70%)和ST段不完全回落组(STR70%)。记录患者手术情况、实验室检查结果及3个月内所有心脏不良事件(MACE)。比较不同组间p GSN的水平差异,及其对预后的影响。结果 (1)p GSN基线水平在STEMI组明显低于稳定性心绞痛组和健康组[(104.51±35.91)ng/ml比(129.47±41.61)ng/ml和(138.17±43.43)ng/ml,F=9.641,P0.01],在稳定性心绞痛组和健康组之间差异无统计学意义(P0.05);(2)p GSN在STEMI组术后90 min较术前明显下降[(95.42±36.50)ng/ml比(104.51±35.91)ng/ml,t=4.959,P0.01],而在稳定性心绞痛组PCI术前后水平无明显变化(P0.05);(3)STEMI患者中ΔG在ST段完全回落组低于ST段不完全回落组[(1.92±4.46)ng/ml比(5.37±5.14)ng/ml,F=0.938,P=0.007];(4)基线p GSN诊断STEMI的ROC曲线下面积为0.742(95%CI:0.638~0.826,P0.01),选p GSN=96.13 ng/ml为诊断界点时,对诊断STEMI的敏感度为54.8%,特异度为80.6%;(5)STEMI组有22例患者出现MACE,基线p GSN在MACE组明显低于非MACE组[(82.28±23.56)ng/ml比(108.35±30.13)ng/ml,F=0.281,P=0.021],ΔG在MACE组明显高于非MACE组[(6.87±6.22)ng/ml比(3.25±4.14)ng/ml,F=3.276,P=0.008]。多因素Logistic回归分析显示,基线p GSN是独立预测3个月内MACE的主要因素之一。结论 p GSN术后的水平变化能较好反映急诊PCI术后的心肌灌注水平,对短期预后具有一定的预测价值。     

MMP-2在ST段抬高型心肌梗死患者中的表达及预后评估价值的研究

目的探索血浆基质金属蛋白酶-2(MMP-2)在ST段抬高性心肌梗死(STEMI)患者中的表达情况,及对近期主要不良心血管事件(MACE)的预测价值。方法连续入选2013年9月~2015年9月完全符合诊断标准的STEMI患者110例,另选取健康志愿者100例作为对照组。用酶联免疫吸附试验(ELISA)检测血浆MMP-2水平,计算患者出院GRACE评分。记录一般临床资料及出院后6个月内MACE事件发生情况。结果 STEMI患者MMP-2水平较对照组明显升高[(183.47±46.51)ng/ml vs.(66.26±26.73)ng/ml],差异具有统计学意义(P0.05);STEMI患者出院后6个月时间内,发生MACE事件者34人,MACE组MMP-2和GRACE评分均高于非MACE组,差异具有统计学意义(P均0.05);使用受试者工作特征曲线(ROC)分析GRACE评分、MMP-2水平预测STEMI患者6个月内发生MACE的AUC分别为0.711(95%CI:0.565~0.856,P=0.013)和0.737(95%CI:0.601~0.873,P=0.005)。结论 MMP-2对STEMI患者近期发生MACE事件有一定的预测价值。     

CTRP-3水平和高血压的相关性研究

目的:研究补体C1q肿瘤坏死因子相关蛋白3(CTRP-3)在高血压患者中的表达及其意义。方法:选择高血压患者562例作为高血压组,正常体检人员570例作为正常对照组。检测比较两组一般资料、血浆脂联素(APN)、瘦素和CTRP-3水平等。分析CTRP-3水平与高血压相关因素间的相关性,并进行高血压相关因素的多因素回归分析。结果:与正常对照组相比,高血压组血浆APN[(12.1±0.4)μg/ml比(7.3±0.5)μg/ml]、瘦素[(10.1±0.4)ng/ml比(6.2±0.8)ng/ml]和CTRP-3水平[(429±15)ng/ml比(314±13)ng/ml]显著降低,P均0.05。Spearman相关性分析显示,在校正年龄和性别后,血浆CTRP-3水平与高血压病患者人体质量指数、收缩压、舒张压、腰围、腰臀比、总胆固醇、低密度脂蛋白-胆固醇(LDL-C)、甘油三酯、空腹血糖、胰岛素、稳态模型胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白、高敏C反应蛋白(hsCRP)水平呈显著负相关(r=-0.852~-0.011,P0.05或0.01),与高密度脂蛋白-胆固醇(HDL-C)、APN和瘦素水平呈显著正相关(r=0.654~0.962,P均0.05)。多因素回归分析显示,与高三分位数CTRP-3组比较,低三分位数CTRP-3组OR=14.17(95%CI:3.62~28.34),P=0.001,说明低血浆CTRP-3水平是高血压的独立危险因素。结论:补体C1q肿瘤坏死因子相关蛋白3水平与高血压病显著相关,是高血压的独立危险因素。     

血清内脂素水平与药物洗脱支架内再狭窄的相关性研究

目的探讨血清内脏脂肪素(内脂素)水平与药物洗脱支架置入术后支架内再狭窄(ISR)之间的关系。方法选取于2015年1月~2017年6月于重庆市江津区中心医院心内科行药物洗脱支架置入术的冠状动脉粥样硬化性心脏病(冠心病)患者420例为研究对象,根据术后1年是否发生ISR将其分为ISR组(n=58)和非ISR组(n=362)。比较两组患者的临床资料,并采用ELISA法测定术前和术后4 h的血清内脂素水平。结果 ISR组和非ISR组患者术前的血清内脂素水平无明显差异[(13.1±6.4)ng/ml vs.(12.5±5.9)ng/ml;P=0.48]。ISR组和非ISR组患者术后的血清内脂素水平分别为(45.1±9.6)ng/ml、(34.7±7.5)ng/ml,差异有统计学意义(P0.01)。多因素Logistic回归分析结果表明,术后血清内脂素水平(OR=1.83,95%CI:1.21~2.75;P0.01)、糖尿病(OR=2.36,95%CI:1.16~4.80;P0.05)、支架长度(OR=1.43,95%CI:1.05~1.96;P0.05)和支架直径(OR=0.62,95%CI:0.47~0.81;P0.01)是药物洗脱支架置入术后ISR的独立预测因素。经ROC曲线获得的术后血清内脂素预测ISR的曲线下面积为0.82(95%CI:0.75~0.89)。最佳预测截点为36.8 ng/ml,其敏感性为74%,特异性为79%。结论药物洗脱支架置入术后的血清内脂素水平与ISR密切相关,是ISR的一项独立预测因素。     

急性和慢性束缚应激对大鼠内脏敏感性和神经内分泌的影响

目的了解急性和慢性部分束缚应激对大鼠内脏敏感性以及神经内分泌反应的影响特点和持续时间。方法成年SD大鼠分为对照组(无束缚应激)、急性组和慢性组,通过腹壁回撤反射(AWR)评分评估应激前后大鼠内脏对结直肠扩张(CRD)的敏感性;并通过放免法检测应激前后不同时间点大鼠血浆促肾上腺皮质激素(ACTH)以及皮质酮(CORT)水平。结果①20和40 mm Hg压力扩张时,急、慢性组的AWR评分均显著高于基础水平(0 d),P<0.05;但在应激后第7天AWR评分显著下降,P<0.05。②急性组血浆ACTH和CORT水平显著高于对照组[(25.35±6.03)ng/ml比(7.24±2.97)ng/ml,(312.47±50.76)pg/ml比(97.00±23.33)pg/ml],但束缚应激7 d后,激素浓度[(11.81±5.03)ng/ml和(113.73±24.58)pg/ml]下降至基础水平。③慢性组血浆ACTH和CORT水平[(20.84±2.19)ng/ml和(200.41±78.10)pg/ml]显著高于对照组,且激素水平在束缚7 d后[(19.95±5.31)ng/ml和(162.51±47.08)pg/ml)]仍维持在高水平。结论急性和慢性束缚应激都可导致大鼠内脏敏感性增高,但作用可能是短暂的。急性束缚应激短暂显著提高血浆ACTH和CORT水平,而慢性束缚应激可能长期提高激素水平。     

血浆瘦素浓度与老年患者全髋关节置换术后认知功能障碍的相关分析

目的探讨血浆瘦素浓度与老年全髋关节置换术后认知功能障碍的相关性。方法选取全身麻醉下的老年单侧全髋关节置换手术患者102例为病例组及同期102例健康体检的老年人为对照组,记录围手术期基础疾病、手术时间、术中失血量、阿托品用量及麻黄碱用量等资料,抽取对照组健康体检时和病例组拔除气管插管时的静脉血,采用ELISA法检测血浆瘦素浓度,在术前及术后第7天采用简易智力状态检查法评定认知功能。结果病例组血浆瘦素浓度（23．73±9．82）ng／ml较对照组（9．74±2．57）ng／ml显著升高,差异有统计学意义（P〈0．01）。病例组术后认知功能障碍24例（23．53％）。术后认知功能障碍患者血浆瘦素浓度（33．82±13．71）ng／m1较非术后认知功能障碍患者（20．63±5．18）ng／ml显著升高,差异有统计学意义（P〈0．01）。Logistic回归分析显示,血浆瘦素浓度是术后认知功能障碍的独立危险因素（OR=1．19,P〈0．01）。ROC曲线分析显示,血浆瘦素浓度大于22．14ng／ml,预测术后认知功能障碍的灵敏度为79．17％,特异度为78．21％。结论老年全髋关节置换术后患者血浆瘦素浓度显著升高,临床检测该指标有助于早期判断术后认知功能障碍的发生。     

Relationship between serum leptin levels and clinical outcomes of hypertensive intracerebral hemorrhage

Circulating leptin is associated with cardiovascular events but the relationship between leptin and the clinical outcomes of intracerebral hemorrhage (ICH) is unclear. This study was to investigate the relationship between circulating leptin and the short-term clinical outcomes of ICH. Fifty-seven patients with hypertensive ICH (stroke group), 50 patients with hypertension (hypertension group), and 41 healthy subjects (control group) were recruited to this study. Serum levels of leptin were measured by radioimmunoassay. The serum level of leptin in the stroke group (14.6 ± 3.3 ng/L) was significantly higher than in the hypertension (10.2 ± 2.9 ng/L, P < 0.05) and control group (4.7 ± 3.3 ng/L, P < 0.01). Nine patients (15.8%) in the stroke group died during hospitalization. The mean National Institute of Health Stroke Scale (NIHSS) score of the surviving patients at admission and before discharge was 16 ± 6 and 9 ± 5, respectively (P < 0.01). There was a significant correlation between the serum leptin level and predischarge NIHSS scores (r = 0.62, P < 0.01). After adjusting age, sex, ICH volume and location, fasting blood glucose, fasting insulin levels, and systolic blood pressure (SBP) multivariate analysis showed that a high leptin level (>10 ng/L) was an independent predictor for in hospital mortality (adjusted risk ratio (RR), 3.6; 95% confidence interval (CI): 1.22-17.62; P = 0.02). In conclusion, serum leptin levels were increased in patients with hypertensive ICH. High leptin levels were associated with a poor functional recovery following ICH.     

汉族急性脑血管病患者血浆血栓调节蛋白的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性研究

目的 探讨急性脑血管病患者血浆可溶性血栓调节蛋白(soluble thrombomodulin,sTM)含量的变化和血栓调节蛋白基因Ala455Val(C1418T)多态性的分布.方法 在79例汉族急性脑血管病患者(脑出血患者30例,脑梗死患者49例)和30名年龄和性别相匹配的健康对照者中,采用聚合酶链反应限制性酶切片段长度多态性分析技术检测TM Ala455Val(C1418T)多态性,酶联免疫吸附试验检测血浆sTM含量.结果 脑梗死组和脑出血组sIM含量分别为(32.08±6.98)ng/ml和(38.93±6.77)ng/ml,显著高于正常对照组的(9.90±3.09)ng/ml(P均<0.01),而且与高血压、糖尿病、心脏病等高危因素无关;脑出血组和脑梗死组TM 1418C/C基因型频率分别为53.3%和57.1%,高于对照组的40%,但无统计学差异.结论 无论足脑出血还是腑梗死患者,血浆sTM含量均显著高于正常人群;汉族人群中脑出血和脑梗死患者TM 1418C/C基因型频率虽然高于正常人群,但并非脑血管病的易感基因.     

抵抗素基因-420C>G位点多态性对脑出血患者血浆抵抗素水平的影响

目的探讨抵抗素基因-420C>G位点单核苷酸多态性对脑出血患者血浆抵抗素水平的影响。方法选取344例高血压性基底核出血患者,入院时抽取外周血提取DNA,采用聚合酶反应-限制性片断多态性分析基因型,同时采用ELISA法检测血浆抵抗素浓度,进行统计分析。结果酶切后可见抵抗素基因-420C>G位点有CC、CG和GG三种基因型,等位基因C和G的频率分别为71.08%和28.92%,基因型CC、CG和GG的频率依次为50.29%、41.57%和8.14%。经Hardy-Weinberg遗传平衡定律检验,各基因型频率符合遗传平衡。CC、CG和GG基因型患者血浆抵抗素浓度依次为(23.83±7.09)ng/mL、(26.54±7.32)ng/mL和(27.18±9.97)ng/mL。CC基因型患者血浆抵抗素均显著低于CG和GG基因型患者(P<0.01,P<0.05)。结论抵抗素基因-420C>G位点单核苷酸多态性显著影响脑出血患者血浆抵抗素水平,可能参与脑出血炎症反应。     

Leptin: a parameter for metabolic changes in heart failure

OBJECTIVE: Advanced chronic heart failure is a hypercatabolic state with an imbalance between anabolic and catabolic metabolism and finally progressive loss of both muscle mass and adipose tissue. Leptin, the product of the obesity gene, is a hormone secreted by adipocytes. Therefore, we tested the hypothesis that plasma leptin concentrations are reduced in advanced chronic heart failure. METHODS: In 20 patients with chronic congestive heart failure (LVEF 23 +/- 6%) and 20 healthy controls (LVEF 65 +/- 8%) matched for gender, age, and body mass index, fasting plasma leptin (ELISA) and TNF alpha (ELISA) were measured. Follow-up examination was performed after 1 year. RESULTS: The fasting plasma leptin concentrations of patients with NYHA grade III (8.4 +/- 3.8 ng/ml*) and NYHA grade IV (4.6 +/- 2.4 ng/ml dagger) were significantly lower as compared with the controls (11.2 +/- 3.1 ng/ml; *p < 0.05, dagger p < 0.01). In patients with NYHA grade II plasma leptin levels were significantly elevated as compared with the healthy controls (14.9 +/- 4.2 ng/ml). TNF alpha was higher in heart failure patients than in healthy controls (8.6 +/- 3.6 pg/ml; 5.9 +/- 2.1 pg/ml; respectively; p < 0.05), but did not correlate with the NYHA functional class. Mortality of the controls was 0%, whereas 15% (n = 3) in the congestive heart failure group; one patient (5%) needs an urgent heart transplantation. All of those patients had leptin concentrations below 5 ng/ml. CONCLUSIONS: Plasma leptin concentrations correlate with the NYHA functional class suggesting anabolic metabolism in NYHA class II and catabolic metabolism in advanced heart failure which might be of prognostic relevance.     

Relationship Between Serum Leptin Levels and Clinical Outcomes of Hypertensive Intracerebral Hemorrhage

Circulating leptin is associated with cardiovascular events but the relationship between leptin and the clinical outcomes of intracerebral hemorrhage (ICH) is unclear. This study was to investigate the relationship between circulating leptin and the short-term clinical outcomes of ICH. Fifty-seven patients with hypertensive ICH (stroke group), 50 patients with hypertension (hypertension group), and 41 healthy subjects (control group) were recruited to this study. Serum levels of leptin were measured by radioimmunoassay. The serum level of leptin in the stroke group (14.6 ± 3.3 ng/L) was significantly higher than in the hypertension (10.2 ± 2.9 ng/L, P < 0.05) and control group (4.7 ± 3.3 ng/L, P < 0.01). Nine patients (15.8%) in the stroke group died during hospitalization. The mean National Institute of Health Stroke Scale (NIHSS) score of the surviving patients at admission and before discharge was 16 ± 6 and 9 ± 5, respectively (P < 0.01). There was a significant correlation between the serum leptin level and predischarge NIHSS scores (r = 0.62, P < 0.01). After adjusting age, sex, ICH volume and location, fasting blood glucose, fasting insulin levels, and systolic blood pressure (SBP) multivariate analysis showed that a high leptin level (>10 ng/L) was an independent predictor for in hospital mortality (adjusted risk ratio (RR), 3.6; 95% confidence interval (CI): 1.22–17.62; P = 0.02). In conclusion, serum leptin levels were increased in patients with hypertensive ICH. High leptin levels were associated with a poor functional recovery following ICH.     

可溶性晚期RAGE水平与重型颅脑损伤继发急性肺损伤的相关分析

目的揭示血浆可溶性晚期糖基化终末产物受体(receptor for advanced glycation end products,RAGE)水平对重型颅脑损伤(severe traumatic brain injury,STBI)继发急性肺损伤(acute lung injury,ALI)的预测价值。方法收集102例STBI患者和50例健康体检者(对照组),采用ELISA法检测血浆可溶性RAGE水平,统计分析血浆可溶性RAGE水平的变化及对STBI继发ALI的预测价值。结果 STBI患者血浆可溶性RAGE水平[(1075.31±420.92)pg/ml]较对照组[(860.01±244.13)pg/ml]显著增高,差异有统计学意义(P0.01)。血浆可溶性RAGE水平1197.23pg/ml预测STBI继发ALI有72.41%的灵敏度和80.82%的特异度。同时,血浆可溶性RAGE水平1197.23pg/ml可独立预测STBI继发ALI(OR=11.40,95%CI=2.33~54.10,P0.05)。结论血浆可溶性RAGE水平可协助临床预测STBI并发ALI。     

Circulating obestatin concentration is lowered by insulin in rats

Circulating obestatin is lowered by food intake, but factors involved in obestatin regulation remain unclear. The aim of this study was to determine whether intravenous glucose or insulin infusion lowers obestatin. Rats were infused over 3?h with either A. saline (controls); B. dextrose to steady state blood glucose ~16.7?mM, or C. insulin 7.5?mU/kg.min, plus dextrose as needed to clamp to euglycemic basal concentrations. During 3?h of infusion, group B had significantly greater (P<0.01) glucose, 18.75±1.27?mM, than groups A (6.10±0.33?mM) or C (6.19±0.18?mM). Groups B and C had hyperinsulinemia at the end of the 3?h infusion (1.02±0.03?ng/ml, 1.07±0.02?ng/ml) compared with saline-infused (0.38±0.01?ng/ml, P<0.01). Obestatin concentrations were significantly reduced (P<0.01) in both hyperinsulinemic groups and (B=0.95±0.06?ng/ml; C=0.87±0.04?ng/ml) versus controls (1.56±0.13?ng/ml). These data suggest that insulin can decrease the plasma obestatin levels.     

慢性心衰患者血浆尾加压素Ⅱ与嗜铬粒蛋白A的相关性

目的：探讨血浆尾加压素Ⅱ（urotensinⅡ,UⅡ）和嗜铬粒蛋白A（CgA）浓度在不同心力衰竭分级患者中的变化及其两者之间的相关性。方法：各种病因导致的慢性心力衰竭（CHF）患者41例（心力衰竭组）,按NY-HA心功能分级标准,分为心功能Ⅱ级12例,Ⅲ级14例,IV级15例,并设健康对照组20例。采用放射免疫法测定血浆UⅡ含量,酶联免疫法测定血CgA含量,并对两组指标进行相关分析。结果：①CHF患者血浆UⅡ含量较健康对照组明显降低[心功能Ⅱ级组（2.99±0.16）pg/ml：III级组（2.57±0.12）pg/ml：IV级组（2.13±0.17）pg/ml：健康对照组（5.52±0.10）pg/ml,P〈0.01];②血浆CgA含量较健康对照组明显升高[心功能Ⅱ级组（147.00±1.41）ng/ml：III级组（276.75±2.00）ng/ml：IV级组（521.47±68.21）ng/ml：健康对照组（64.21±2.75）ng/ml,P〈0.01];③Pearson相关性分析显示,血浆UⅡ和CgA存在负相关（r值为-0.809,P〈0.01）。结论：（1）在充血性心衰患者中,随心功能级别的升高,尾加压素II含量降低,嗜铬粒蛋白A含量升高;（2）血浆尾加压素Ⅱ、嗜铬粒蛋白A共同参与了心衰的发生发展,其水平是判断心力衰竭及心室重构的可靠指标。     

高血压并糖耐量减低患者肿瘤坏死因子-α和白细胞介素-6的含量及意义

目的：观察原发性高血压（EH）合并糖耐量减低（IGT）患者血浆肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）水平的变化,探讨其与EH合并IGT的关系。方法：入选EH患者82例,分为EH合并IGT组（EH＋IGT组,42例）,EH糖耐量正常组（EH组,40例）,同时随机选择血压正常的健康人40例为健康对照组。检测各组TNF-α、IL-6、空腹血糖（FPG）、餐后2h血糖（2hPG）水平,计算胰岛素抵抗指数（HOMA-IR）。结果：与健康对照组、EH组比较,EH＋IGT组2hPG[（6.50±0.81）mmol/L、（6.59±0.79）mmol/L比（9.10±1.10）mmol/L]、HOMA-IR[（1.25±0.64）、（1.93±1.05）比（3.90±2.11）]明显升高（P均〈0.01）;与健康对照组比较,EH组、EH＋IGT组血浆TNF-α[（23.83±2.28）ng/ml比（27.80±4.73）ng/ml比（32.30±5.49）ng/ml]、IL-6[（76.76±12.81）ng/ml比（90.62±18.09）ng/ml比（112.97±24.88）ng/ml]水平明显升高（P〈0.05～0.01）,且EH＋IGT组明显高于EH组的（P均〈0.05）。多因素Logistic回归分析显示,EH合并IGT与TNF-α、IL-6、FPG、2hPG呈正相关（β为1.247,1.180,0.516,0.140;P〈0.05～0.01）。结论：原发性高血压合并糖耐量减低患者血浆肿瘤坏死因子α、白细胞介素6水平升高,提示其体内炎症反应增强。