老年代谢综合征患者血胰岛素样生长因子1与代谢综合征的关系

目的了解代谢综合征(metabolic syndrome,MS)患者血胰岛素样生长因子1(IGF1)水平及其与MS的关系。方法按2005年国际糖尿病联盟(IDF)颁布的MS定义,将老年患者465例分为MS组255例和对照组210例。查空腹血糖、胰岛素、C肽、餐后2 h血糖、血脂全套、血IGF1并计算体质指数(BMI)。两组按是否并存糖尿病再分为糖尿病和非糖尿病两个亚组。结果(1) MS组除高密度脂蛋白胆固醇(HDL-C)低于对照组外,其他血液指标均高于对照组(P<0．01);两组IGF1水平与年龄、BMI均呈负相关(P<0．05)。(2)MS糖尿病组IGF1(163．5±128．1)μg／L、胰岛素(14．3±10．5)mU／L高于MS非糖尿病组(114．0±52．6)μg／L、(8．46±4．4)mU／L,C肽(1．1±0．4)μg／L低于MS非糖尿病组(2．5±0．4)μg／L,均为P<0．01;IGF1水平与胰岛素、C肽无相关性,与冠心病呈负相关(P<0．05)。(3)对照糖尿病组IGF1(129．2±49．1)μg／L低于对照非糖尿病组(136．6±80．5)μg／L,胰岛素(14．1±11．7)mU／L、C肽(3．28±2．23)μg／L高于对照非糖尿病组(10．3±6．1)mU／L、(2．9±1．7)μg／L,P<0．01或0．05。对照组IGF1与C肽负相关,与甘油三酯正相关;对照糖尿病组IGF1与胰岛素、C肽负相关(均为P<0．01或0．05)。结论MS患者存在高血IGF1现象,这与单纯糖尿病患者低IGF1不同;MS患者IGF1水平较低时发生冠心病的机率较高。     

蜂螫伤中毒患者血清肿瘤坏死因子与血浆内皮素的变化及意义

目的探讨肿瘤坏死因子α(TNFα)与内皮素(ET)在蜂螫伤中毒患者中的变化及临床意义。方法将97例蜂螫伤中毒患者分成轻度、中度、重度中毒3组,并根据预后分成死亡组、存活组。另选取35例健康人作为正常对照组,各组均采用放射免疫法检测血清TNFα与血浆ET水平,同时进行对比分析。结果蜂螫伤中毒患者轻度中毒组血清TNFα(1．36±0．37)μg／L与血浆ET (55．20±12．60)ng／L的含量仅轻度升高,与正常对照组[(1．09±0．25)μg／L、(50．90±8．80)ng／L]比较差异无统计学意义(P>0．05);中度、重度组患者血清TNFα(2．82±0．79)μg／L、(4．02±0．93)μg／L与血浆ET水平(139．30±58．80)ng／L、(210．50±86．30)ng／L较正常对照组明显升高(P值均<0．01),中度组患者血清TNFα与血浆ET水平较轻度组为高(P<0．01),重度组患者又较中度组高(P<0．01)。死亡组血清TNFα(4．53±0．89)μg／L与血浆ET(267．50±98．70)ng／L水平高于存活组(2．40±0．82)μg／L、(107．60±57．90)ng／L(P值均<0．01)。蜂螫伤中毒患者血清TNFα与血浆ET水平呈正相关(r=0．62,P<0．01)。结论TNFα与ET可能协同参与了蜂螫伤中毒患者的发病过程。血清TNFα与血浆ET升高越明显,蜂螫伤中毒患者病情越重,病死率就越高。血清TNFα与血浆ET的检测可作为判断病情轻重和预后的一个重要临床指标。应用TNFα与ET拮抗剂或抑制剂对防治蜂螫伤中毒的发生发展、改善预后可能有重要的临床意义。     

老年大肠癌患者血清胰岛素样生长因子Ⅱ的变化及临床意义

目的研究血清胰岛素样生长因子Ⅱ(IGF-Ⅱ)在老年人大肠癌发展过程中的变化及其临床意义。方法应用放射免疫及电化学发光分析法检测48例大肠癌、32例大肠腺瘤、20例健康者血清IGF-Ⅱ、血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)的含量。结果老年大肠癌、大肠腺瘤组血清IGF-Ⅱ水平分别为(1．05±0．45)μg／L和(0．79±0．24)μg／L,明显高于健康对照组(0．50±0．15)μg／L(P<0．01),大肠癌较大肠腺瘤增高更显著(P<0．05)。大肠癌患者中,Dukes分期A、B、C 3期IGF-Ⅱ水平分别为(0．87±0．26)μg／L、(0．95±0．35)μg／L和(1．21±0．45)μg／L,较对照组显著增高(P<0．01),D期为(0．51±0．25)μg／L,增高不明显(P>0.05),并较前3期显著下降(P< 0．01);大肠癌不同肿块大小、解剖部位及分化程度间差异无统计学意义(P>0.05)。联合检测IGF-Ⅱ、CEA、CA19-9较单项检测阳性率显著提高(P<0．05)．结论IGF-Ⅱ与老年人大肠癌的发生、发展有密切关系,与CEA、CA19-9联合检测,可显著提高大肠癌的诊断阳性率。     

男性冠心病患者雄激素与颈动脉内膜和中膜厚度及血管细胞黏附因子-1的关系

目的探讨男性冠状动脉粥样硬化性心脏病(冠心病)患者体内雄激素水平与反映内皮功能异常的指标颈动脉内膜、中膜厚度(IMT)、血管细胞黏附因子-1(VCAM-1)的关系,观察雄激素减轻动脉粥样硬化的程度。方法比较51例男性冠心病患者与55例对照者的年龄、体质量、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、吸烟、空腹血糖、血压、血清游离睾酮水平(FT)、VCAM-1及IMT,分析冠心病危险因素如年龄、体质量、TC、LDL-C、HDL-C、TG、吸烟、空腹血糖、血压及FT与VCAM-1、IMT的相关性。结果冠心病组的年龄、血压、吸烟史、空腹血糖、HDL-C与对照组比较,差异无统计学意义(P>0．05);体质量为(78．1±5．7)kg,大于对照组的(73．6±4．8)kg,P<0．01;TC高于对照组[(4．99±0．88)mmol／L和(4．52±0．65)mmol／L,P<0.01];LDL-C高于对照组[(3．35±0．63)mmol／L和(2．94±0．55)mmol／L,P<0．01];TG高于对照组[(2．35±0．92)mmol／L和(1．87±0．61)mmol／L,P<0．01];FT低于对照组[(13．2±3.6)×10-9g／L和(16．6±5．1)×10-9g／L,P<0．01];IMT高于对照组[(1．11±0．24) mm和(0．96±0．22)mm,P<0．01];VCAM-1含量高于对照组[(372．7±111．8)×10-6g／L和(208．2±72．5)×10-6g／L,P<0.01]。多元逐步回归分析显示FT与IMT、VCAM-1分别呈负相关(r=-0.358,r=-0.547,均为P<0．01)。结论男性冠心病患者FT水平与反映内皮功能异常的指标IMT、VCAM-1呈负相关。     

P-选择素基因单核苷酸多态性与IgA肾病的相关性

目的研究P-选择素基因变异与原发性IgA肾病的相关性。方法在用直接测序法广泛筛查P-选择素基因全部编码区、部分调控区和外显子-内含子连接区并发现16个单核苷酸多态性(SNP)的基础上,挑选9个中高频SNPs(频率>5％)。选上海瑞金医院肾科收治的汉族原发性IgA肾病患者210例及健康对照者103例,用PCR产物直接测序法进行基因分型,对IgA肾病进行病例-对照相关分析。结果(1)IgA肾病者AA基因型频率(78．1％)明显高于健康对照者(65．1％,P =0．0136),AG+GG基因型频率(21．9％)明显低于健康对照者(34．9％,P=0．0136);IgA肾病者等位基因A频率(88．6％)明显高于健康对照者(81．6％,P=0．0165),等位基因G频率(11．4％)明显低于健康对照者(18．4％,P=0．0165)。危险度相关分析,AG+GG基因型使IgA肾病发病危险性下降为52．2％(OR=0．522,95％CI为0．311～0．875)。(2)96例IgA肾病者外周血P-选择素水平为(26．8±9．1)μg／L,显著高于健康对照者[(19．6±4．5)μg／L,P<0．01],-825A／G多态性AA基因型者的P-选择素水平[(28．1±9．0)μg／L]显著高于AG+GG基因型[(23．4±8．5)μg／L,P<0．05]。结论P-选择素基因启动子区-825A／G与IgA肾病易感性及患者肾功能显著相关,揭示了P-选择素基因在IgA肾病中的致病作用。     

空腹高血糖的2型糖尿病患者加用甘精胰岛素或中性鱼精蛋白锌胰岛素的比较研究

单用口服降糖药血糖控制不佳的2型糖尿病患者分别加用甘精胰岛素或中性鱼精蛋白锌胰岛素(NPH)联合治疗3个月,然后停止胰岛素治疗,恢复原口服治疗方案,共观察6个月。结果甘精胰岛素组的HbAIC和餐后血糖低于NPH组[治疗3个月(6．1±0．5)％vs(6．9±0．8)％和(7．2±2．1)mmol／L vs(9．3±3．1)mmol／L,治疗6个月(6．6±0．7)％vs(7．4±1．1)％和(8．8±2．8)mmol／Lvs(10．3±3．1) mmoL／L,P<0．01或P<0．05],两指标的下降值甘精胰岛素组大于NPH组[治疗3个月(4．0±0．7)％vs (3．7±0．6)％和(7．1 4-2．0)mmol／Lvs(5．9±1．8)mmol／L,治疗6个月(3．5±0．5)％vs(3．2±0．3)％和(5．5±1．4)mmol／Lvs(4．9±1．3)mmol／L,P<0．01或P<0．05],提示使用甘精胰岛素可以在不增加不良反应的情况下比NPH更加全面而有效地控制血糖。     

阿托伐他汀钙抗apoE基因缺陷小鼠动脉粥样硬化病变的研究

目的观察阿托伐他汀钙对载脂蛋白E基因缺陷(apoE-／-)小鼠动脉粥样硬化病变的抑制作用。方法将apoE-／-小鼠随机分为模型组和阿托伐他汀钙治疗组,每组各8只。酶法检测血清脂质含量,比色法测氧化指标一氧化氮,总抗氧化能力及丙二醛含量,病理图像分析法测定主动脉粥样硬化斑块面积及管腔面积,免疫组织化学染色方法测定主动脉壁血管细胞黏附分子-1、细胞间黏附分子-1的表达。结果阿托伐他汀钙高剂量组(5．0 mg·kg-1·d-1)、低剂量组(2．5 mg·kg-1·d-1)血浆一氧化氮含量分别为(27．3±9．1)mmol／L和(19．7±8．7)mmol／L,总抗氧化能力分别为(211．8±43．6)mmol／L和(177．4±39．6)mmol／L,比模型组[(3．5±2．4)mmol／L和(73．7±38．3)mmol／L]明显增高(P<0．01);丙二醛含量分别为(11．6±3．3)mmol／L和(14．4±3．4)mmol／L,比模型组(45．5±5．3)mmol／L明显降低(P<0．01)。阿托伐他汀钙可下调血管细胞黏附分子-1及细胞间黏附分子-1的表达(P<0．01)。结论阿托伐他汀钙能明显增强apoE-／-小鼠抗氧化能力,降低主动脉壁血管细胞黏附分子-1及细胞间黏附分子-1的表达,抑制动脉粥样硬化病变的发展。     

肾综合征出血热患者血清可溶性细胞因子、粘附分子及肝肾功能的变化

目的探讨血清可溶性TNF-α、IL-1β、转化生长因子-β1（TGF-1β）、E-选择素（E-sel）和L-选择素（L-sel）在肾综合征出血热（HFRS）发病机制中的作用。方法41例HFRS患者（轻症组22例，重症组19例）纳入研究，按病期采血，分别采用放射免疫法检测TNF-α、IL-1β，ELISA法检测TGF-β1、E-sel和L-sel，自动生化仪检测肝、肾功能和PLT计数。结果从发热期至多尿期，血清IL-1β、TNF-α、E-sel和L-sel水平均升高，其峰值与对照组比较，分别为（0．56±0．10）μg／LH5（0．19±）．06）μg／L、（2．41±1．61）μg／L比（0．824-0．16）μg／L、（198．4±29．2）μg／L比（56．4±25．8）μg／L、（1372．5±137．3）μg／L比（1089．9±137．9）μg／L，差异有统计学意义（P值均〈0．01）。动态观察，上述细胞因子和粘附分子的变化曲线与ALT、BUN的变化趋势一致。血清TGF-1β、TGF-β1／IL-1β和TGF-β1／TNF-α比值在病程前三期均显著降低，与PLT的变化趋势相似。结论HFRS急性期血清IL-1β、E-sel、L-sel升高和TGF-β1水平下降是造成失控性全身炎性反应和肝、肾功能损害的重要因素，在HFRS发病机制中起重要作用；合理的对症治疗和适量使用免疫调节剂可改善预后。     

阻塞性睡眠呼吸暂停低通气综合征患者呼出气凝集液中过氧化氢浓度

目的测定阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼出气凝集液(EBC)中的过氧化氢(H2O2)浓度,观察其改变及与病情程度的相关性。方法收集EBC 42份,其中OSAHS患者32份(吸烟者18份,非吸烟者14份),非OSAHS对照组10份。荧光法测定睡前和晨起EBC中的H2O2浓度。结果OSAHS组患者睡前EBC中H2O2浓度与对照组比较差异无统计学意义(F= 0．01,P=0．99)。晨起EBC中H2O2浓度OSAHS不吸烟组和吸烟组分别为(1．82±1．12)、(1．65±0．89)μmol／L,较对照组(0．71±0．36)μmol／L明显增高(F=5．11,P=0．01)。其浓度亦分别较睡前[(0．87±0．45)、(0．88±0．36)μmol／L]升高(t分别为2．95、3．43,P均<0．01)。对照组睡前[(0．86±0．46)μmol／L]和晨起[(0．71±0．36)μmol／L]差异无统计学意义(t=0．81,P=0．43)。晨起EBC中H2O2浓度与夜间最低血氧饱和度(SpO2min)呈负相关(β=-0．36,P=0．02),晨起与睡前H2O2浓度变化的差值亦与SpO2min呈负相关(β=-0．38,P=0．01)。结论OSAHS患者由于夜间反复出现缺氧-再氧和,呼吸道局部氧应激反应在晨起增加。     

β-淀粉样蛋白致大鼠行为学改变及对海马核因子-κB和一氧化氮合酶表达的影响

目的研究β-淀粉样蛋白(amyloid-beta protein,Aβ)对大鼠学习记忆功能及海马区内核因子kB(NF-kB)、诱导型一氧化氮合酶(iNOS)蛋白表达的影响及其相互关系。探讨NF-kB在阿尔茨海默病(AD)发病中的可能作用。方法采用大鼠侧脑室立体定向注射Aβ25-35的方法建立AD的动物模型,通过Morris水迷宫检测大鼠学习、记忆能力,通过免疫组化的方法观察Aβ25-35对大鼠海马区内NF-kB及iNOS蛋白表达的影响,并分析NF-kB与iNOS表达的关系。结果大鼠经侧脑室立体定向注射10μmol／L Aβ25-35 5μl后,(1)模型组大鼠Morris水迷宫检测逃避潜伏期(3 d分别为42．19±12．29,31．28±20．59,23．91±8．05)较对照组(3 d分别为27．35±14．96,13．17±6．79,13．01±6．38)明显延长(P<0．05或P<0．01);(2)模型组大鼠海马区内NF-kB蛋白表达(29．40±4．01)及iNOS蛋白表达(34．42±5．99)较空白对照组(分别为23．36±2．31和11．56±4．09)均有明显升高(P<0．01),(3)NF-kB与iNOS阳性细胞密度具有显著相关性(r=0．453,P< 0．05)。结论Aβ能够明显降低大鼠短期学习记忆能力,并诱导大鼠海马区内NF-kB和iNOS的蛋白表达增强,同时NF-kB与iNOS的表达呈正相关关系。提示NF-kB和iNOS均参与了由Aβ诱导的炎性反应过程,NF-kB可能是iNOS表达的介导因子之一。     

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.     

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.     

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.     

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.