高血糖对脑血管病急性期患者预后的影响

目的观察高血糖对脑血管病急性期患者预后的影响。方法对入院的脑血管患者进行常规血糖测定,分为高血糖组与正常血糖组,对其病情、预后进行观察。结果伴高血糖的急性脑血管患者较正常血糖患者病情重,预后差,死亡率高。结论脑血管病急性期血糖升高对患者的预后有不利影响。     

高血糖对脑血管病急性期患者预后的影响

目的 观察高血糖对脑血管病急性期患者预后的影响。方法 对所有发病72h内人院的脑血管病患者进行常规血糖值测定，分为高血糖组和正常血糖组，对其病情、预后进行观察。结果 伴高血糖的脑血管病患者较正常血糖患者病情重，预后差，死亡率、致残率高（P〈0.05）。结论 脑血管病急性期血糖增高，对患者的预后有不利影响。     

脑血管病急性期应激状态的临床观察

目的观察脑血管病急性期应激性心脏、血压、血糖的变化。方法观察203例急性脑血管病人的心电图、心肌酶、血压和血糖。结果缺血性脑血管病和出血性脑血管病在心电图心肌酶、血压和血糖改变方面无统计学意义,但与疾病的严重程度有关。结论应激反应的轻重可反映病情的严重程度和预后。     

血清低钠低氯对病毒性脑炎的诊断价值

目的观察病毒性脑炎急性期血清钠、氟浓度的改变及其临床意义。方法选择我院收治的病毒性脑炎患者120例,另选同期健康人120例,对两组观察对象血清钾、钠、氯浓度进行动态监测。结果病毒性脑炎组血清钾正常,88例（73％）患者血清钠、氯水平明显下降,32例（27％）患者血清电解质正常。病毒性脑炎重症组与轻症组钠、氯水平间差异有统计学意义（P〈0．05）。结论成人病毒性脑炎急性期大部分存在低钠、低氯血症,低钠、低氯与患者病情轻重相关,动态监测血清钾钠氯有助于病毒性脑炎的诊断和鉴别诊断以及病情轻重和预后估计。     

262例急性出血性脑血管病临床与心电图关系分析

目的：研究急性出血性脑血管病临床与心电图关系。方法：262例急性出血性脑血管病病人均在急性期做心电图(ECG)检查，部分病例测定血糖及血钾，对心电图改变发生机制及临床关系进行分析。结果：262例中58例ECG正常，204例不正常，异常率为77．86％。ECG正常者死亡5例(8．26％)，ECG异常者死亡及恶化出院44例(21.57％)。两组比较预后有统计学意义(P＜0．01)。结论：脑源性ECG改变与出血有直接关系，义与脑部病变部位、严重程度及预后密切相关。特别是ECG改变明显，复查无改善或恶化，同时伴血糖增高、血钾低者，预后更差，提示ECG改变可作为急性出血性脑血管病判定预后的主要指标之一。     

急性脑卒中并发高钠血症38例临床分析

目的 探讨急性脑卒中时高血钠与卒中性质、部位、病情轻重和预后的关系。方法 采用日立7170型钾钠氯全自动分析仪，用进口试剂。测定入院后第1天开始连续测定7天空腹血钠。结果 180例患者中出现高钠血症38例。高血钠与病情轻重、卒中部位、预后有关，与卒中性质无关。结论 血钠可作为判断急性脑卒中病情轻重、预后的指标之一。     

应激性高血糖与新发急性脑出血患者预后的相关性研究

目的探讨应激性高血糖与新发急性脑出血患者预后的相关性。方法选取2014年3月—2015年9月连云港市第二人民医院收治的新发急性脑出血患者116例,根据入院时空腹血糖分为正常血糖组56例和应激性高血糖组60例,两组患者均给予保守治疗或对症治疗,比较两组患者预后并分析新发急性脑出血的影响因素。结果应激性高血糖组患者预后劣于正常血糖组(P=0.000)。多因素logistic回归分析结果显示,出血量≥30 ml〔OR=8.21,95% CI(2.20,25.39)〕、有并发症〔OR=6.67,95% CI(1.35,18.60)〕及应激性高血糖〔OR=4.41,95% CI(2.07,8.61)〕是新发急性脑出血患者预后不良的危险因素(P0.05)。结论应激性高血糖与新发急性脑出血患者预后有关,是导致患者预后不良的危险因素之一,应积极控制血糖以改善患者预后。     

短期胰岛素强化治疗急性脑血管病并发应激性高血糖的临床疗效

目的探讨短期胰岛素强化治疗对急性脑血管病并发应激性高血糖的临床疗效。方法将216例急性脑血管病并发应激性高血糖患者随机分为常规治疗组和胰岛素强化治疗组,每组108例。常规治疗组对应激性高血糖不作治疗,胰岛素强化治疗组采用短期胰岛素强化治疗,严格控制血糖在4.0~6.1 mmol/L,治疗观测期为7 d,期满后对比分析两组的临床疗效。结果胰岛素强化治疗组神经功能缺损程度较常规治疗组显著降低,胰岛素强化治疗组治疗后基本痊愈率和显著好转率明显高于常规治疗组,不良转归率显著低于常规治疗组(P<0.05)。结论急性脑血管病并发应激性高血糖时采用短期胰岛素强化治疗能提高患者的治愈率,减轻伤残程度,提高患者的生活质量,降低死亡率,对改善急性脑血管病预后有重要临床意义。     

离子紊乱与单纯疱疹病毒性脑炎患者预后的关系

目的探讨单纯疱疹病毒性脑炎（HSE）急性期血清钠、钾、氯离子浓度的改变对患者预后的影响。方法对HSE患者血清钠、氯离子浓度进行动态监测，分析其变化与患者预后的关系。结果入院时重症患者电解质紊乱发生率高于轻症组（P〈0．05）；高钠血症、低钠血症、低氯血症的病死率高于电解质正常组（P〈0．01）。结论重症HSE患者大部分存在血清钠、氯水平的紊乱，血清钠、氯离子紊乱的出现提示预后不良；HSE电解质紊乱的类型可作为评估患者预后的指标之一。     

胰岛素强化治疗急性脑血管病应激性高血糖疗效观察

目的 探讨短期胰岛素强化治疗对急性脑血管病并发应激性高血糖的临床疗效.方法 将52例急性脑血管病合并应激性高血糖患者随机分为胰岛素强化治疗组(治疗组)和常规组(对照组).观察并比较两组患者的临床疗效.结果 治疗组治疗后神经功能缺损程度较对照组显著降低(P<0.05),治疗组治疗后显著好转率明显高于对照组(P<0.05).结论 急性脑血管病并发应激性高血糖时采用短期胰岛素强化治疗能提高患者的治愈率,减轻伤残程度,对改善急性脑血管病预后有重要临床意义.     

The serum concentration of insulin, C-peptide, and proinsulin in patients with acute pancreatitis

Summary In 14 patients with acute pancreatitis during 16 episodes of the disease the concentrations of blood glucose, serum insulin (IRI), C-peptide (CP), and proinsulin (Pro) were determined in the fasting state on d 1, 2, 3, 5, and 10 after the attack. The peptides were measured using RIAs, and for determination fo CP two antibodies: Byk-Mallinckrodt’s and more specific M-1221 Novo antibodies were used. Apart from sporadic rises in the initial period of the disease, the blood glucose level did not change significantly and had a decreasing trend. On d 1 the mean serum IRI level was 0.17±0.04 (SD) nM, and it decreased on d 5 to 0.06±0.04 nM, rising again to 0.11±0.15 nM on d 10. The serum Pro concentration was on the same days: 11.1±12.6, 4.2±2.4 and 7.5±10.8 pM, whereas the serum CP values determined with M-1221 antibodies were 0.48±0.50, 0.34±0.19, and 0.52±0.25 nM, respectively. However, when serum CP was determined using Byk-Mallinckrodt kits, the concentration on d 1 was 1.90±1.12 nM and over the following days it decreased to 1.08±0.98 nM on d 5 and on d 10 it was 1.11±0.46 nM. In one patient (not included in the calculation of the mean values), in whom the second attack of acute pancreatitis had a fatal outcome, the serum levels of all three peptides were very high, with a particularly evident difference of CP-values, dependent on the antibodies used: 2.47 nM with M-1221 antibodies and 9.90 mM with Byk-Mallinckrodt kits on d 5. We hypothesize that the transient decrease of the serum peptides released into the blood in the process of insulin biosynthesis observed in the early period of acute pancreatitis is owing to their breakdown by the activated pancreatic proteases. Our observation suggests also that in acute pancreatitis in blood appeared an unidentified protein reacting with less specific antibodies to C-peptide.     

Prospective study of serum uric acid levels and stroke in a Chinese hypertensive cohort

Our aim was to investigate the association between serum uric acid (SUA) levels and the risk of first stroke in a Chinese population of hypertensive patients. This prospective study enrolled 20,577 hypertensive participants who without a history of stroke, and was conducted from May 2008 to August 2013 in Anqing and Lianyungang (China). A total of 632 (3.1%) first stroke events (510 ischemic events, 120 hemorrhagic events and 2 unspecified stroke events) were identified during a mean 4.5-year follow-up period. The risk of first stroke was not significantly associated with the increased SUA levels; this conclusion was also found after adjustment for gender and age. However, a statistically significant decreased risk of hemorrhagic stroke for the second SUA quartile (Q2) compared to the first quartile (Q1) (HR 0.56, 95%CI: 0.32–0.97, P = 0.037) was found. In addition, when grouped by tertiles of diastolic blood pressure (DBP), the results showed that high SUA lowered the risk of total stroke in participants in the third SUA quartile (Q3) (HR 0.69, 95%CI: 0.49–0.96, P = 0.028) and fourth SUA quartile (Q4) (HR 0.70, 95%CI: 0.50–0.99, P = 0.043) as compared with that in the first quartile (Q1). To sum up, no significant evidence in present study indicates that increased SUA levels are predictive of first stroke in a Chinese population of hypertensive patients.     

Low serum creatinine predicts risk for type 2 diabetes

Aims

As an insulin target tissue, skeletal muscle is inversely related to type 2 diabetes mellitus (T2DM). Serum creatinine originates mainly from creatine in muscle and is considered as a reliable surrogate marker for muscle mass in apparently healthy subjects. It is therefore hypothesized that low serum creatinine could effectively predict increased risk of T2DM. Yet information is scarce regarding the longitudinal relationship between serum creatinine and T2DM. This study aims to investigate this relation in a large general population of both men and women.

Methods

A prospective cohort study (n = 57 587; follow‐up range: 1‐9 years, mean: 3.57 years, 95% confidence interval: 3.55‐3.58 years) was conducted in a general population sample from Tianjin, China. Multivariable Cox proportional hazards regression models were used to assess the relationship between baseline serum creatinine and the risk of developing T2DM (as defined by the American Diabetes Association criteria).

Results

During the follow‐up period, 2017 subjects developed T2DM. The multivariate‐adjusted hazard ratios (95% confidence interval) for T2DM incidence across quintiles of serum creatinine were 1.00 (reference), 0.86 (0.75, 0.99), 0.82 (0.72, 0.94), 0.85 (0.74, 0.97), and 0.77 (0.67, 0.89; P for trend <.01). Similar results were observed in both sexes (interaction P = .56).

Conclusions

These findings indicate that serum creatinine concentration is inversely related to incident T2DM in both men and women. Measuring serum creatinine may assist in the early detection of individuals at high risk of developing T2DM.     

免疫球蛋白类型不同的多发性骨髓瘤患者血脂变化的意义

目的：探讨不同免疫球蛋白（Ig）类型的多发性骨髓瘤（MM）患者血脂变化的临床意义。方法：检测MM患者60例,其中IgG型30例,IgA型12例,IgD型5例,轻链型13例。对照组为健康体检者30例的胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和总胆汁酸（TBA）水平,并进行统计学分析。结果：MM患者与对照组相比TC、LDL-C、HDL-C和TBA水平均差异有统计学意义（均P〈0.01）,而TG水平比较差异无统计学意义（P〉0.05）。IgG和IgA型MM患者的TC、TBA、HDL-C和LDL-C水平和轻链型患者比较均差异有统计学意义（均P〈0.05）;TG水平和轻链型患者比较差异无统计学意义（P〉0.05）。IgD型MM患者和轻链型患者比较差异无统计学意义（P〉0.05）。结论：检测血脂变化可作为MM患者免疫球蛋白分型的一个辅助实验室诊断手段。     

The serum glucose response to glucagon suppression with somatostatin,insulin or antiglucagon serum in depancreatized rats

Summary Total immunoreactive glucagon (IRG) and immunoreactive glucagon of A cell origin (IRG_a) were measured in the serum of normal, sham-operated and depancreatized rats, after the administration of three glucagon antagonists: insulin (5–200 mU/rat/h), somatostatin (SRIF; 100 g/kg/h) and antiglucagon serum (AGS, enough to bind three times the calculated total amount of circulating IRG). Since no differences were noted between the responses of normal and sham-operated animals, the values were pooled and used as controls. Pancreatectomy caused a significant increase in serum glucose, IRG_a and total IRG and a significant decrease in serum insulin. AGS and SRIF significantly decreased serum glucose in control, but not in depancreatized rats, even though SRIF caused a significant decrease of IRG_a in all animals. SRIF significantly decreased plasma insulin in control rats, but did not modify total IRG secretion in either group. In control rats the minimum effective hypoglycaemic dose of insulin (5 mU/rat/h) may have decreased serum IRG_a, but not total IRG. At higher doses (20 mU/rat/h) insulin stimulated glucagon secretion. In depancreatized animals, higher doses of insulin (200 mU/rat/h) were needed to lower serum glucose. On the other hand, a dose of 100 U/rat/h was sufficient to lower the serum IRG. We conclude that although hyperglucagonaemia may contribute to the hyperglycaemia of the untreated depancreatized rats, the excessive secretion of glucagon is secondary to insulin insufficiency and that, at least in this animal model, the hypoglycaemic action of insulin is only minimally dependent upon its ability to suppress glucagon secretion.     

Association of resistin polymorphism,its serum levels and prevalence of stroke in Japanese type 2 diabetic patients

Aims/Introduction: Resistin, an inflammatory cytokine, might be involved in the development of atherosclerosis. In a recent paper, we showed that resistin polymorphism might be a risk marker for stroke susceptibility in Japanese type 2 diabetic patients. We tested whether the serum resistin levels might be also a risk marker of stroke independently from RETN polymorphism. Materials and Methods: Type 2 diabetic outpatients from our hospitals were enrolled. Patients (n = 89) with a history of coronary heart disease and stroke, and randomly selected controls (n = 178) matched for sex and age, but without a history of coronary heart disease and stroke, were examined for polymorphism ‐420 (C>G) and cytokines levels. Results: Serum resistin levels were significantly higher in patients with cardiovascular diseases (CVD) than in those without CVD (P = 0.024), and were highest in patients with stroke among the CVD. In multiple logistic regression analysis, serum resistin levels was an independent risk marker of stroke even after adjusted by RETN polymorphism, age, sex, body mass index, HbA_1c, systolic and diastolic blood pressure, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, creatinine, history of coronary heart disease, treatment of insulin, sulfonylurea and aspirin (odds ratio 1.33, 95% confidence interval [CI] 1.02–1.73, P = 0.039). The enrolled patients were divided by their serum resistin levels (high or low group) and their genotypes (CC, CG, GG at ‐420) into six groups. Patients with the GG genotype and high resistin levels showed the highest odds ratio, 5.69 (95% CI 1.24–26.1), compared with the group with CC and low levels. Conclusions: The results suggest that serum resistin levels might be a good marker of susceptibility to stroke as well as RETN polymorphism. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.00040.x, 2010)     

老年2型糖尿病患者血清胆红素水平与颈动脉粥样硬化程度、糖化血红蛋白的关系

目的探讨老年2型糖尿病（T2DM）患者血清胆红素水平与颈动脉粥样硬化程度、糖化血红蛋白（HbA1c）的关系。方法T2DM患者98例，按照颈动脉粥样硬化斑块程度分为0级组、1级组、2级组、3级组；按照HbA1c控制水平分为糖尿病A组，糖尿病B组，糖尿病C组，均测定其血清胆红素水平，再进行比较。结果T2DM患者不同程度的斑块分组之间血清胆红素水平存在显著性差异（P〈0．05），斑块3级组〈2级组〈1级组〈0级组，不同水平的HbA1c分组之间血清胆红素水平无显著性差异（P〉0．05）。结论老年T2DM患者颈动脉粥样硬化斑块形成可能与低血清胆红素有关，血清胆红素可作为老年T2DM患者颈动脉粥样硬化形成的新的实验室诊断指标，而血清胆红素与HbA1c无明显相关。     

扩张型心肌病血清Ⅰ型、Ⅲ型前胶原水平与左室结构及收缩功能的关系

目的研究扩张型心肌病（IDCM）血清Ⅰ型、Ⅲ型前胶原（PCⅠ、PCⅢ）水平与左室结构及收缩功能的关系。方法IDCM患者53例,健康人32例为对照组,应用放射免疫法测定血清PCⅠ、PCⅢ,应用超声心动仪测量左室结构指标及左室射血分数（LVEF）。分析IDCM血清PCⅠ、PCⅢ与左室结构指标、LVEF关系。结果IDCM组血清PCⅠ、PCⅢ高于对照组（P<0.01）。简单线性相关分析揭示IDCM血清PCⅠ、PCⅢ分别与舒张末期左室内径、左室质量指数（LVMI）正相关（P<0.05）,与LVEF负相关（P<0.01）。多元逐步回归分析显示血清PCⅠ、PCⅢ分别与LVEF负相关,与左室结构指标无相关性（P>0.05）。结论IDCM血清PCⅠ、PCⅢ升高;反映左室收缩功能降低。     

Diurnal patterns of blood glucose,serum free fatty acids,insulin, glucagon and growth hormone in normals and juvenile diabetics

Summary Blood glucose, serum free fatty acids,-insulin, -glucagon and -growth hormone have been measured half-hourly in five newly diagnosed, untreated, male patients with classic juvenile diabetes and in five healthy male subjects during a 24-h period of daily life. —Blood glucose, serum insulin and -free fatty acids followed, on the whole, the expected pattern. Serum gluoagon showed a fairly constant level during day and night in both groups. — In the non-diabetic subjects, serum growth hormone was low during most of the day. Only two peaks were observed before 10 p.m. Four of the subjects showed peaks at precisely the same time, namely at 10.30 p.m. and 1.30 a.m. Two showed peaks at 5.00–5.30 p.m. The mean serum growth hormone concentration during the 24-h period was 1.98 ng/ml. — In the juvenile diabetics, the growth hormone was higher and the level fluctuated much more, showing more frequent and higher peaks than in the non-diabetics. The mean serum growth hormone concentration during the 24-h period was 7.26 ng/ml, i.e. three to four times higher than in the non-diabetics.

---

Tagesrhythmen des Blutzuckers und der Serumspiegel der freien Fettsäuren, des Insulins, des Glucagons und des Wachstumshormons bei Normalpersonen und jugendlichen Diabetikern

Zusammenfassung Bei gesunden Männern und 5 männlichen Patienten mit dem klassischen Bild eines frisch entdeckten, unbehandelten, jugendlichen Diabetes wurden in halbstündigen Abständen der Blutzucker und die Spiegel der freien Fettsäuren, des Insulins, des Glucagons und des Wachstumshormons im Serum während einer 24 Std-Periode des Tagesablaufs bestimmt. —Die Tageskurven für Blutzucker, freie Fettsäuren und Seruminsulin zeigten dabei im ganzen den erwarteten Verlauf. Das Serumglucagon wies in beiden Gruppen bei Tag und Nacht recht konstante Werte auf. — Bei den Normalpersonen fanden sich den größten Teil des Tages niedrige Wachstumshormon-Spiegel. Nur 2 Gipfel wurden vor 22 Uhr beobachtet. 4% der Kontrollpersonen zeigten solche Maxima genau gleichzeitig, nämlich um 22.30 und um 1.30 Uhr. Bei 2 ließen sich Gipfel um 17 Uhr und 17.30 nachweisen. Die durchschnittliche Wachstumshormon-Konzentration während der 24 Std-Periode betrug 1.9. — Bei den jugendlichen Diabetikern lagen die Werte für das Wachstumshormon höher, schwankten stärker und zeigten mehr und höhere Gipfel als bei den nichtdiabetischen Vergleichspersonen. Der mittlere Wachstumshormon-Spiegel betrug während der 24 Std-Periode 7.26 ng/ml, lag also 3–4 × höher als beim Kontrollkollektiv.

---

Schéma d'évolution de la glycémie, des acides gras libres, de l'insuline, du glucagon et de l'hormone de croissance dans le, sérum, chez des sujets normaux et des diabétiques juvéniles

Résumé La glycémie, les acides gras libres, l'insuline, le glucagon et l'hormone de croissance sériques ont été mesurés toutes les demi-heures chez cinq patients de sexe masculin, atteints de diabète juvénile classique, récemment diagnostiqué et non traité, et chez cinq sujets de sexe masculin en bonne santé pendant une période de 24 h. — La glycémie, l'insuline et les acides gras libres du sérum suivaient dans l'ensemble le schéma attendu. Le taux de glucagon sérique était assez constant pendant le jour et la nuit dans les deux groupes. -Chez les sujets nondiabétiques, l'hormone de croissance du sérum était basse pendant la plus grande partie du jour. Deux pics seulement ont été observés avant 10 h du soir. Quatre des sujets ont eu des valeurs élevées exactement au même moment, c'est-à-dire à 10.30 h du soir et à 1.30 h du matin. Deux ont eu des valeurs élevées à 5 h – 5.30 h de l'après-midi. La concentration moyenne d'hormone de croissance du sérum pendant la période de 24 h était de 1.98 ng/ml. — Chez les diabétiques juvéniles, l'hormone de croissance était plus élevée et le taux variait beaucoup plus, monttrant des pics plus fréquents et plus élevés que chez les non-diabétiques. La concentration moyenne d'hormone de croissance du sérum pendant la période de 24 h était de 7.26 ng/ml, c'est-à-dire une concentration trois sà quatre fois plus élevée que chez les non-diabétiques.