高血压患者胰岛素抵抗与血清脂联素及炎症标志物水平

目的 探讨高血压患者胰岛素抵抗与血清脂联素水平及炎症标志物变化的关系.方法 入选非糖尿病的新发高血压患者108例,同时入选64例血压正常者作为对照.常规检测受试者的血压、血糖、血脂和胰岛素,计算稳态模型胰岛素抵抗指数(HOMA-IR),同时检测血清脂联素、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)及可溶性E选择素(sE-s).根据血压水平对患者进行分组,比较各组血清脂联素及炎症标志物水平的差异;用logistic回归筛选平均动脉压的影响因素.结果 1)HOMA-IR随着血压的升高而升高,2级和3级高血压患者与对照组比较差异有统计学意义(P＜0.05);2)总体高血压患者血清脂联素水平(4.5±2.0)mg/L低于对照组(7.1±1.9)mg/L,炎症标志物hs-CRP、TNF-α、IL-6和sE-s水平高于对照组,(P均＜0.01);3)相关分析显示脂联素与收缩压、舒张压、HOMA-IR、hs-CRP、TNF-α、IL-6和sE-s呈负相关,相关系数分别为-0.533、-0.364、-0.375、-0.234、-0.509、-0.416和-0.297(P＜0.05);4)Logistic回归显示HOMA-IR、hs-CRP、脂联素和BMI是平均动脉压独立的影响因素(P＜0.05).结论 高血压患者血清脂联素水平低,炎症标志物水平高,存在胰岛素抵抗;随着血压水平的升高,血清脂联素水平逐渐降低,炎症标志物水平逐渐升高,胰岛素抵抗程度加重;HOMA-IR、hs-CRP、脂联素和BMI是平均动脉压独立的影响因素.     

冠心病合并糖尿病病人脂联素水平监测分析

目的探讨冠心病合并糖尿病病人的血清脂联素水平及其影响因素。方法从该院选择2013年1月—2013年12月期间收治的100例冠心病合并糖尿病的患者作为观察组,另外选择50例健康体检者作为对照组,测试两组患者的血清脂联素水平、高敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDLC）、空腹血糖（FPG）、空腹胰岛素（FINS）水平,并分析其相互之间的关系。结果观察组患者的血清脂联素水平显著低于对照组（P〈0.05）;血清脂联素水平和hs-CRP、TNF-α、TG、胰岛素抵抗指数（HOMA-IR）呈负相关,与HDL-C呈正相关。结论低脂联素水平是冠状动脉粥样硬化发生及病变程度的重要危险因子;糖尿病患者血清脂联素水平的明显下降可作为冠心病的危险因素。     

平均动脉压水平与血清脂联素浓度相关性研究

目的探讨不同平均动脉压水平与血清脂联素浓度的相关性。方法入选187例受试者,按不同血压水平以及治疗情况分为正常血压组、正常高值血压组、高血压未治疗组以及高血压正规药物治疗组。用放射免疫法检测血清脂联素浓度与尿微量白蛋白含量;计算胰岛素抵抗指数HOMA—IR和尿微量白蛋白与肌酐比（ACR）。结果（1）比较正常血压组和正常高值血压组发现,两组间平均动脉血压水平[（89±6）mmHg比（102±7）mmHg,1mmHg=0.133kPa]和脂联素浓度（中位数值：15．58μg／ml比9．06μg/ml）均有统计学意义（P〈0．01）;高血压治疗组的脂联素浓度明显高于未治疗组（11．89μg/ml比5．37μg/ml,P〈0．01）。（2）Pearson相关分析也发现脂联素浓度与平均动脉血压呈负相关（r=-0.479,P〈0．001）;按性别分层分析也得到类似的结果（r=-0．441,P〈0．001）。（3）多元线性逐步回归分析发现平均动脉血压和胰岛素抵抗指数是血清脂联素的独立影响因素,两者解释了57％的血清脂联素浓度的变异。结论平均动脉血压对脂联素浓度的影响独立于胰岛素抵抗状态和肾脏排泄功能;平均动脉血压水平高的患者,其血清脂联素浓度相对偏低。     

高血压前期与胰岛素抵抗、血清脂联素水平的相关研究

目的探讨人群胰岛素抵抗及血清脂联素水平与高血压前期的关系。方法入选160例体检人群,分为理想血压组（43例）、高血压前期组（79例）、1级高血压组（38例）,分别检测受检者血清脂联素、空腹血清胰岛素水平,采用HOMA-IR法计算胰岛素抵抗指数。对理想血压是否进展为高血压前期进行二分类Lo-gistic回归分析。结果理想血压组、高血压前期组、1级高血压组胰岛素抵抗指数分别为（1.39±0.06）、（1.78±0.06）、（2.49±0.15）,三组间差异有显著统计学意义（P〈0.01）。高血压前期组、1级高血压组血清脂联素水平分别为（17.76±0.99）mg/L、（18.59±1.32）mg/L,两组差异无统计学意义;两组血清联素水平与理想血压组[（22.89±1.25）mg/L]比较,差异均有显著统计学意义（P均〈0.01）。Logistic回归分析表明体质指数、胰岛素抵抗指数为理想血压进展为高血压前期的危险因素而脂联素为保护因素。结论高血压前期人群胰岛素抵抗水平已经升高,并伴随脂联素水平下降。     

DR患者血清同型半胱氨酸、脂联素及TNF-α的水平变化及意义

目的观察糖尿病视网膜病变（DR）患者血清同型半胱氨酸（Hcy）、脂联素和肿瘤坏死因子α（TNF-α）的水平变化,探讨其临床意义。方法对60例DR患者（DR组）、40例糖尿病无视网膜病变患者（NDR组）采用ELISA法检测血清Hcy、脂联素和TNF-α水平。另选健康体检者20例为对照（对照组）。结果血清Hcy和TNF-α水平DR组〉NDR组〉对照组（P均〈0．05）,血清脂联素水平DR组〈NDR组〈对照组（P均〈0．05）;血清脂联素与TNF-α、Hcy呈负相关（r=-0．532、-0．586,P均〈0．05）。结论DR患者血清Hcy、TNF-α水平升高,脂联素水平降低;三者可能在DR的发生发展中发挥重要作用。     

冠心病患者血清脂联素水平及其影响因素分析

目的探讨冠心病血清脂联素（APN）水平及其影响因素。方法选择冠心病患者50例（冠心病组）、健康体检者40例（对照组）,分别采用酶联免疫法检测APN、TNF-α水平,同时检测各组患者血压、BMI、空腹血糖、胰岛素及血脂等相关指标。结果冠心病组血糖、胰岛素、胰岛素抵抗指数、TNF-α、LDL、TG和TC均明显高于对照组（P均〈0.01）,HDL和APN水平明显低于对照组（P均〈0.01）。Pearson相关分析显示,冠心病患者血清APN水平与胰岛素、胰岛素抵抗指数、TNF-α和TG均呈负相关（r分别为-0.48、-7.23、-0.69、-5.12,P均〈0.05）。Logistic回归分析显示,胰岛素抵抗指数、TNF-α和TG是冠心病患者血清APN水平的独立影响因素（r分别为8.864、3.398、4.067,P均〈0.01）。结论 APN与冠心病的危险因素（胰岛素抵抗和炎症、血脂紊乱）相关,三者相互联系并在冠心病发病中起到重要作用。     

超重和肥胖人群脂联素受体mRNA的水平与脂肪细胞因子的相关性

目的 了解两种脂联素受体（AdpR1和AdpR2）在人脂肪组织中的表达水平及其与血清脂肪细胞因子的关系。方法 选取19例超重或肥胖（OW＋Ob）和29例正常体重者（NC），用RT-PCR技术检测腹部皮下脂肪组织（AAT）与大网膜脂肪组织（0AT）中脂联素受体的表达水平，并测FIns、血脂和血清脂联素、TNF-α、FFA等指标。结果 （1）两种脂联素受体mRNA的表达水平在OW＋Ob组和NC组、AAT和OAT之间均无差异；但OW＋Ob患者的血浆TG、VLDL-C、FIns、TNF-α、FFA均高于NC组（P＜0．05～P＜0．01），而血清脂联素低于NC组（P＜0．05）。（2）总体观察对象中，AAT的脂联素受体mRNA表达水平与血清脂联素、FFA、FIns、HOMA-IR水平呈负相关（P＜0．05～P＜0．01）；与ISI呈正相关（P分别＜0．05和＜0．01）。（3）OW＋Ob组中脂联素与BMI、FFA、FIns、HOMA-IR呈负相关（P＜0．05～P＜0．01），与ISI呈正相关（P＜0．01）；FFA与血浆TG、LDL-C、FIns呈正相关（P均＜0．05）。结论 OW＋Ob人群的血清TNF-α、FFA水平高于NC人群，脂联素水平低于NC人群，而脂联素受体mRNA的表达水平在两组间没有差异。脂联素受体、FIns、脂联素、FFA是一组很好的评估胰岛素敏感性的指标。     

2型糖尿病患者非糖尿病一级亲属血清游离脂肪酸脂联素与胰岛素抵抗的关系

目的测定2型糖尿病（T2DM）患者及其非糖尿病一级亲属（FDRs）血清游离脂肪酸（FFA）、脂联素水平，评估其胰岛素敏感性，分析FFA、脂联素与胰岛素抵抗（IR）之间的关系。方法测定健康对照组（46例）、FDRs组（43例）和T2DM组（30例）的血清FFA及脂联素，用IR指数（HOMA-IR）评估胰岛素敏感性，分析各指标在3组之间的差异及相关性。结果FFA在对照组（0．36±0．14）mmol／L、FDRs组（0．52±0．17）mmol／L和T2DM组（0．68±0．23）mmol／L，呈依次增高趋势，差异有统计学意义（P〈0．05）。脂联素在对照组和FDRs组分别为（10．25±2．34）mg／L和（6．03±1．91）mg／L，差异有统计学意义（P〈0．01）；而T2DM组为（4．75±1．27）mg／L，低于FDRs组，差异有统计学意义（P〈0．01）；HOMA-IR在对照组、FDRs组和T2DM组呈依次增高趋势，差异有统计学意义（P〈0．05）。FFA与HOMA-IR呈正相关，与脂联素呈负相关；脂联素与体质指数、HOMA-IR呈负相关。结论FDRs组已经存在IR，并且血清FFA水平升高，脂联素水平降低；FFA、脂联素与IR密切相关，可作为评估IR的较好指标。     

替米沙坦对原发性高血压患者血清脂联素和颈动脉粥样硬化的影响

目的:观察替米沙坦治疗前后原发性高血压(EH)患者血清脂联素和颈动脉内膜中层厚度(IMT)的变化。方法:选取52例高血压患者(高血压组)和50例健康体检者(对照组)为研究对象。高血压组接受替米沙坦治疗6个月后,观察对照组及高血压组治疗前后的血压、脂联素、胰岛素、颈动脉IMT等指标的变化情况。结果:与对照组比较,高血压组的血压、颈动脉IMT升高,脂联素水平降低,差异有统计学意义(P0.05)。与治疗前比较,高血压组治疗6个月后血压显著降低(P0.01),高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、颈动脉IMT显著下降(P0.05),脂联素水平显著升高(P0.05),胰岛素、胰岛素抵抗得到显著改善(P0.01)。血清脂联素水平与胰岛素抵抗程度、颈动脉IMT均呈负相关。结论:替米沙坦显著增高原发性高血压患者血清脂联素水平,改善胰岛素抵抗,抑制颈动脉粥样硬化的进展。     

糖耐量减低患者血清脂联素与HsCRP、TNF-α、IL-6相关性研究

应用ELISA法测定26例健康查体者（对照组）和26例糖耐量减低（IGT）患者（IGT组）的血清脂联素水平,RIA法测定高敏C反应蛋白（HsCRP）、TNF-α、IL-6水平。结果对照组脂联素显著高于IGT组,HsCRP、TNF-α及IL-6显著低于IGT组;多元逐步回归分析显示,腰臀比（WHR）和胰岛素抵抗（IR）是脂联素的独立危险因素;脂联素与HsCRP、IL-6呈负相关（r=-0.416,-0.366;P〈0.05）;控制性别、体质量指数等因素后,不存在相关性。表明脂联素、HsCRP、TNF-α、IL-6可预测2型糖尿病发生,肥胖、IR是联系脂联素与炎症因子的纽带。     

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.