探究初发Graves病患者糖代谢紊乱与甲状腺功能的关系

目的探讨初发毒性弥漫性甲状腺肿(Graves'disease,GD)患者甲状腺功能对糖代谢的影响。方法收集2017年6月至2021年6月期间十堰市太和医院内分泌科收治的358例Graves病初发患者,根据口服葡萄糖耐量试验(OGTT)结果分为糖耐量正常组(A组)、糖耐量异常与空腹血糖受损组(B组)及糖尿病组(C组)。收集各组患者一般资料,完善OGTT、胰岛素释放试验(IRT)、C肽释放试验(CRT)、空腹血糖(FPG)、甲状腺功能等实验室检查,比较相关指标在各组间有无差异。结果GD患者随糖代谢异常程度的加重,平均患病年龄增加,血糖、胰岛素、C肽分泌水平逐步增高,β细胞功能指数(MBCI)降低,差异有统计学意义(P<0.05)。结论初发GD患者可存在胰岛β细胞功能受损与胰岛素抵抗现象,考虑是患者体内的高甲状腺功能状态导致。     

硒对大骨节病病区人体红细胞免疫功能的影响

目的 探讨硒及含硒的谷胶革肽过氧化物酶（GPX）对大骨节病（KBD）病区人体红细胞免疫功能的影响。方法 测定KBD病区人体血硒含量,GPX活性,红细胞C36R花环率和IC花环率及血清RCIA促进率和抑制率,以及补硒对上述指标的影响。结果 ①病区人体血硒含量、GPX活性和红细胞G3bR花环率明显低于非病区;血清RCIA抑制率明显高于非病区;②病区人体IC花环率,血清RCIA促进率与非病区人体无明显差异;③补硒12周后,血硒含量,GPX活性,C3bR花环率明显提高;血清RCIA抑制率明显降低。④病区人体普遍处于低硒状态,且红细胞免疫功能均低下。结论 KBD病区人体红细胞免疫功能低下和血清RCIA抑制因子增高是低硒所致的一种普遍效应,而不是KBD病区人体所特有。     

补硒对大骨节病患者红细胞免疫功能的影响

给１３－１６岁大骨节病患者每日口服２００μｇ亚硒酸钠硒或硒酵母硒１２周，测定红细胞硒含量和谷胱甘肽过氧化物酶（ＧＰＸ）活性、红细胞免疫粘附（ＲＣＩＡ）功能、血清ＲＣＩＡ调节功能和循环免疫复合物（ＣＩＣ）含量，以探讨补硒对大骨节病患者ＲＣＩＡ功能的影响。结果表明：补硒后患者的红细胞硒含量、ＧＰＸ活性和红细胞Ｃ３ｈ受体（ＲＣ３ｂＲ）花环率均明显提高，而血清ＲＣＩＡ抑制率明显降低，对红细胞免疫复合物ＩＣ     

老年糖代谢紊乱与β细胞功能及胰岛素抵抗的评价

目的探讨老年人糖代谢紊乱时胰岛素抵抗和胰岛β细胞的功能状态及相应指标。方法对12例NGT(对照组)、22例IGT、33例DM0及20例DM1-5进行OGTT试验,并测定0,1,2 h胰岛素、C肽水平。计算胰岛素及C肽敏感指数(ISI)、胰岛素及C肽抵抗数(IR)、胰岛素及C肽Homa-B细胞功能指数(HBCI)、胰岛素、C肽曲线下面积与血糖曲线下面积比。结果胰岛素、C肽水平仅餐后1 h差异有统计学意义。空腹状态下IGT组胰岛素及C肽水平最高,NGT组次之。IGT,DM0,DM1-5胰岛素、C肽的高峰均后移至餐后2 h。NGT,IGT,DM0,DM1-5随糖代谢紊乱的加重,胰岛素及C肽的水平递减,峰值减低;TC,TG,LDL及UR水平递增,但差异无统计学意义。胰岛素、C肽曲线下面积与血糖曲线下面积比,随糖代谢紊乱的加重而递减,且统计学检验差异有显著性(P<0.01)。胰岛肽、C肽β细胞功能指数(HBCI)、胰岛素、C肽敏感指数(ISI),也随糖代谢紊乱的加重而递减,但除胰岛素功能指数(HBCI,P=0.009)外,统计学检验差异无显著性。胰岛素、C肽抵抗指数(IR):在NGT组最低(2.74±1.78、0.78±1.22),DM0组最高,各组比较统计学检验差异无显著性。结论老年糖尿病患者同样显示:从NTG到IGT,DM0,DM1-5胰岛素分泌功能逐渐减低;在糖尿病的发生及发展过程中同时存在着胰岛素抵抗。在IGT时,胰岛素抵抗和胰岛β细胞功能异常就已存在。     

骨关节病与大骨节病关节软骨细胞凋亡的比较

目的比较成年人大骨节病与骨关节病关节软骨细胞凋亡及凋亡相关调控因子Fas和诱导型一氧化氮合酶(iNOS)的表达分布特点,探讨两种疾病发病机制的异同。方法收集15例大骨节病、15例正常对照以及15例骨关节病的关节软骨,分别采用脱氧核糖核酸末端转移酶介导的脱氧核糖核酸缺口标记(TUNEL)技术和免疫组化法,观察大骨节病、骨关节病和正常对照关节软骨的细胞凋亡率、Fas及iNOS蛋白表达及其分布特点。结果大骨节病及骨关节病关节软骨细胞凋亡率较正常对照高(P<0·01),且关节软骨剥蚀区的细胞凋亡率较未剥蚀区高(P<0·05),但大骨节病与骨关节病之间软骨细胞凋亡率差异无显著性。大骨节病与骨关节病关节软骨Fas及iNOS表达阳性细胞数较正常关节软骨增多(P<0·01),且关节软骨剥蚀区Fas及iNOS表达阳性细胞数较未剥蚀区增多(P<0·05),但大骨节病与骨关节病之间Fas及iNOS表达阳性细胞数差异无显著性。结论骨关节病和大骨节病均存在软骨细胞异常凋亡,Fas和iNOS可能参与了细胞凋亡过程。     

大骨节病关节软骨细胞凋亡及其相关调控因子的表达

OBJECTIVE: To investigate the characteristics of chondrocyte apoptosis and distribution of Bcl-2, Bax, Fas and iNos expressions in articular cartilage in Kashin-Beck disease (KBD). METHODS: Samples of articular cartilage were collected from 15 healthy children and 15 children with KBD diagnosed according to the Pathological Criteria of KBD Diagnosis in China. Chondrocyte apoptosis was detected by TUNEL method, and the articular chondrocytes positive for Bcl-2, Bax, Fas and iNos were stained by B-SA immunohistochemistry. RESULTS: The percentage of apoptotic chondrocytes positively stained by TUNEL in the middle layer of articular cartilage was significantly higher in KBD children than in the control group (33.60%+/-2.71% vs 1.33%+/-0.41%, t=11.59, P<0.01). Significant difference in Bcl-2, Bax, Fas and iNos expressions was observed between the upper, middle and deep layers of the articular cartilage of KBD children (F =73.49-114.42, P<0.01), and staining for Bcl-2, Bax, Fas and iNos in KBD children was prominent in the upper layer (41.93%+/-12.26%, 45.60%+/-15.78%, 53.60%+/-16.49%, and 45.47%+/-14.02%, respectively) and the middle layer (14.93%+/-3.50%, 13.87%+/-4.32%, 23.27%+/-4.83%, and 21.67%+/-6.82%, respectively) of the articular cartilage; the percentages of chondrocytes positively stained for Bcl-2, Bax, Fas and iNos were significantly higher than those of the control group (t=11.75-18.65, P<0.01). CONCLUSION: The percentages of apoptotic chondrocytes and chondrocytes positive for Bcl-2, Bax, Fas and iNos in the articular cartilage of children with KBD are significantly higher than those in healthy children.     

糖代谢紊乱中的细胞因子

从糖调节受损到糖尿病,从胰岛素抵抗至归细胞功能衰竭,从糖尿病初发到并发症出现,许多细胞因子在此过程中起到调节、促进、预示转归的作用。了解这些细胞因子的特点和作用机理,对预防及延迟糖尿病的发生发展会有一定帮助。     

大骨节病与骨关节病患者软骨细胞凋亡及其机制的比较研究

目的比较分析大骨节病与骨关节病关节软骨中细胞凋亡及相关调控因子Bcl-2、Bax、Fas及iNos的表达分布特点，探讨两病发病机制的异同。方法收集大骨节病和骨关节病的关节软骨各15例．并以15例正常人作对照。采用脱氧核糖核酸末端转移酶介导的脱氧核糖核酸缺口标记（TUNEL）技术和免疫组化抗生物素蛋白-生物素-碱性磷酸酶（B-SA）法染色，观察大骨节病、骨关节病和正常对照关节软骨的凋亡细胞和Bcl-2、Bax、Fas及iNOS蛋白阳性表达率及其分布特点。结果（1）大骨节病及骨关节病关节软骨凋亡阳性细胞数较正常关节软骨增多（F=20．90～53．16，df=42，P〈0．01），且关节软骨剥蚀区的凋亡阳性细胞数较未剥蚀关节软骨区增多（t=4，154-6.004，df=28，P〈0.01），但大骨节病与骨关节病之间软骨细胞凋亡阳性数无显著性差异（t=1.329～1.362，df=28，P〉0.05）。（2）大骨节病与骨关节病关节软骨Bcl-2、Bax、Fas及iNos表达阳性细胞数较正常关节软骨增多（F=25.46-215.31，df=42，P〈0．01），且关节软骨剥蚀区Bcl-2、Bax、Fas及iNos表达阳性细胞数较未剥蚀区增多忙2．278～7.77，df=28，P〈0．05），但大骨节病患者与骨关节病Bcl-2、Bax、Fas及iNos的表达阳性细胞数无显著性差异（t=0.284-1．590，df=28，P〉0．05）。结论大骨节病与骨关节病均有相似的细胞凋亡，而且凋亡机制相同，即Bcl-2、Bax、Fas及iNos途径。     

危重症患儿糖代谢紊乱的临床意义

危重症患儿在一些应激原的刺激下使机体处于应激状态 ,通过内分泌系统来调节维持机体内环境的平衡 ,而强烈的刺激可导致代谢紊乱 ,如糖代谢紊乱。可出现应激性高血糖症。如今应激性高血糖症已引起儿科临床医师的关注 ,本文对我科 1998年 7月～ 2 0 0 0年10月间收治的 40例危重症患儿的血糖值做一分析。1　资料和方法1 1　一般资料 :40例均为我科收治的危重症患儿。其中男 2 6例 ,女 14例。年龄 0～岁 18例 ,2～岁 14例 ,4～岁5例 ,8～ 12岁 3例。新生儿重度窒息12例 ,急性重症肺炎 8例 ,化脓性脑膜炎 4例 ,病毒性脑炎 2例 ,婴儿腹泻并脱水酸…     

乙肝患者糖代谢紊乱30例分析

自2001年以来，我院共收治慢性乙肝351例，其中合并血糖升高30例，本文对其有关因素做以探讨，以供同道参考。     

大骨节病发病机制的研究进展

大骨节病(KBD)的病因及发病机制未明,缺乏特异性的治疗手段,关于病因假说有4种:生物地球化学说、饮水中有机物中毒学说、粮食真菌毒素中毒说,以及病毒感染学说。近年来对KBD发病机制的分子生物学、基因组学及遗传病学的研究成为国内外研究的热点,目前已经达成共识的是:KBD是一种包括遗传因素及环境因素在内的多种复合因素导致的疾病。     

Serum Metabolomic Indicates Potential Biomarkers and Metabolic Pathways of Pediatric Kashin-Beck Disease

ObjectiveTo explore potential serum biomarkers of children with Kashin-Beck Disease (KBD) and the metabolic pathways to which the biomarkers belong.MethodsA two-stage metabolomic study was employed. The discovery cohort included 56 patients, 51 internal controls, and 50 external controls. The metabolites were determined by HPLC-(Q-TOF)-MS and confirmed by Human Metabolome Databases (HMDB) and Metlin databases. MetaboAnalyst 3.0 and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database were used to analyze the metabolic pathways of the candidate metabolites. The use of HPLC-(Q-TRAP)-MS enabled quantitative detection of the target metabolites which were chosen using the discovery study and verified in another independent verification cohort of 31 patients, 41 internal controls, and 50 external controls.ResultsEight candidate metabolites were identified out in the discovery study, namely kynurenic acid, N-α-acetylarginine, 6-hydroxymelatonin, sphinganine, ceramide, sphingosine-1P, spermidine, and glycine. These metabolites exist in sphingolipid, glutathione, and tryptophan metabolic pathways. In the second-stage study, five candidate metabolites were validated, including kynurenic acid, N-α-acetylarginine, sphinganine, spermidine, and sphingosine-1P. Except for spermidine, all substances exhibited low expression in the case group compared with the external control group, and the difference in levels of sphinganine, spermidine, and sphingosine-1P was statistically significant.ConclusionThe direction of change of levels of sphinganine, spermidine, and sphingosine-1P in the two-stage study cohorts was completely consistent, and the differences were statistically significant. Therefore, these substances can be used as potential biomarkers of KBD. Furthermore, these results raise the possibility that sphingolipid metabolic pathways may be closely related to KBD.     

Crosstalk between CpG Methylation and Polymorphisms (CpG-SNPs) in the Promotor Region of DIO2 in Kashin-Beck Disease

ObjectiveThis study was designed to determine the methylation profile of four CpGs and the genotypes of two CpG-SNPs located in promoter region of DIO2 in patients with Kashin-Beck disease (KBD). We also analyzed the interaction between the CpGs methylations and CpG-SNPs.MethodsWhole blood specimens were collected from 16 KBD patients and 16 healthy subjects. Four CpGs and two CpG-SNPs in the promoter regions of DIO2 were detected using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS). The CpGs methylation levels were compared between samples from KBD patients and healthy subjects. The methylation levels were also analyzed in KBD patients with different CpG-SNP genotypes.ResultsThe mRNA expression of DIO2 in whole blood of KBD patients was significnatly lower than in healthy controls (P “0.05). The methylation levels of DIO2-1_CpG_3 in KBD patients were significantly higher than those in healthy controls (P <0.05). The methylation levels of four CpGs were not significantly different between KBD patients and healthy controls. The methylation level of DIO2-1_CpG_3 in the promoter region of DIO2 in KBD patients with GA/AA genotype was significantly higher than that of KBD patients with GG genotype (P <0.05).ConclusionThe methylation level of DIO2 increases in KBD patients. Similar trends exist in KBD carriers of variant genotypes of CpG-SNPs DIO2 rs955849187.     

大骨节病5例报告并文献复习

目的 了解大骨节病的研究成果及进展;从发病机制、家族聚集性特点、临床表现、影像学检查、诊断与鉴别诊断、防治等方面对大骨节病进行总结,提高对本病的认识.方法 报告5例大骨节病的临床表现、流行病学背景及X线特点,并复习文献.结果 大骨节病的发病机制与环境密切相关,并具有家庭聚集性特点.诊断主要依靠病区接触史、临床表现以及X线检查,并应与骨关节炎、类风湿关节炎等疾病相鉴别.我国对本病的预防已取得可喜成绩,但药物治疗仍在继续探索之中.结论 国内外学者在大骨节病的研究方面已取得很多成果,但仍有很多未知领域,需要继续深入研究.     

我国大骨节病文献作者研究能力和团队特征现状分析

目的：对我国大骨节病文献作者的研究能力和合作关系进行分析,为我国大骨节病的研究合作提供依据。方法：检索4个常用中文期刊数据库,纳入大骨节病的中文期刊文献。采用BICOMS抽取和整理关键词信息生成共现矩阵,采用NetDraw绘制图谱,采用SPSS 17.0对数据进行描述性分析。结果：有3 454位作者在1957-2012年8月从事大骨节病研究,其中81位作者发表15篇及以上文献。聚类分析将81个作者分为西安交通大学医学院地方病研究所、中国地方病防治研究中心大骨节病研究所、吉林省地方病第二防治研究所,以及由中国科学院、河南省疾病预防控制中心、甘肃省疾病预防控制中心组成的第四研究团队。结论：大骨节病研究人员众多,各团队研究方向明确,特点突出,但机构间合作较弱,有待加强。     

葛根素对糖尿病大鼠糖、脂代谢和肾功能的影响

目的:观察葛根素对糖尿病大鼠糖、脂代谢和肾功能的影响.方法:选机取健康SD大鼠10只分到正常对照缀(A组),将链脲佐菌素造模成功的SD大鼠随机分到糖尿病组(B组)、葛根素低、中、高剂量组(C、D、E组),每组10只.C、D、E组分别给予葛根素注射液40、80、160mg/(kg·d)腹腔注射,A组和B组腹腔注射相应量的生理盐水,分别于实验第8w来检测血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、高密度胆固醇(HDL-C)、低密度胆固醇(LDL-C)、肌酐(sCr)、尿素氮(BUN),结果:葛根素治疗组FBG、TG、TC、LDL-C、sCr、BUN均商予A组(P＜0.01或P＜0.05),但明显低于B组(P＜0.01或P＜0.05).结论:葛根素可以改善糖尿病大鼠糖、脂代谢和肾功能.     

四川阿坝藏区成人大骨节病功能评分的信度和效度验证

目的 验证自制的藏区成人大骨节病功能评分（function score for adult Tibetans with Kashin-Beck disease,FSAT-KBD）量表用于评价阿坝地区藏族成人KBD患者的日常生活和劳动功能状态的信度和效度。方法 用FSAT-KBD量表于2010年9~10月对阿坝洲壤塘县352例成年KBD患者进行现场调查。用Cronbach α 系数检验FSAT-KBD的内部一致性信度,用主成分因子分析检验结构效度,用Spearman秩相关检验维度相关性效度。将患者分别按年龄、患病时间和受累关节数分组,通过比较各亚组之间量表得分是否存在差异来检验区分效度。用Spearman秩相关分析FSAT-KBD得分与美国医学结局研究简短健康调查量表（medical outcomes study short form health survey, SF-12）和疼痛视觉模拟量表（visual analogue scale,VAS）得分的相关性检验汇聚效度。用t检验比较KBD患者和当地正常居民的量表得分差异检验FSAT-KBD的区分效度。结果 该量表的应答率为96.0%,完成率为100%,平均完成时间为（3.2±1.6） min。Cronbach α 系数为0.945。提取了2个公因子,解释了量表总变异的72.8%,各条目在相应主因子上的载荷均>0.5,与理论假设一致。各条目与总分的相关性均大于0.6。量表得分具有年龄越大、患病时间越长、受累关节数越多的患者得分越低的趋势。FSAT-KBD得分与SF-12和VAS之间有较好的相关性。KBD患者量表得分低于年龄配伍的当地正常居民（ P<0.001）。结论 FSAT-KBD可用于评价阿坝藏区成人KBD患者的功能状况,具有较好的信度和效度。     

In vitro effects of sodium hyaluronate on the proliferation and the apoptosis in chondrocytes from patients with Kashin-Beck disease and osteoarthritis

Objective:To identify the in vitro effects of sodium hyaluronate(HA) on the proliferation and the apoptosis of chondrocytes from patients with Kashin-Beck disease(KBD) and osteoarthritis(OA). Methods:Samples of articular cartilages from KBD and OA patients, as well as healthy volunteers(6 subjects in each of the 3 groups) were dissected, digested with collagenase and the cells cultured in monolayers. Chondrocytes from each sample were assigned to an untreated group and two HA-treated groups: H0(no HA), H100(HA, 0.1 g/L) and H500(HA, 0.5 g/L). The first passage chondrocytes were used to observe proliferation using the MTT assay, and apoptosis by flow cytometry through Annexin V/PI staining. Results:HA promoted proliferation of chondrocytes in all the three groups, and in KBD and OA groups, for cells cultured for 4 and 6 days, H500 significantly promoted the cell proliferation. The apoptotic rates of both KBD and OA group chondrocytes were in the order H500 < HA100 < H0. Conclusion:Sodium hyaluronate administration has a dose-dependendent vitro effect to promote proliferation and inhibit apoptosis of chondrocytes from patients with KBD and OA.     

血清胆红素水平对新生儿神经功能及免疫功能的影响

目的 探讨新生儿血清胆红素水平对神经功能及免疫功能的影响.方法 将100例新生儿黄疸患儿按照其治疗前血清总胆红素(total serum bilirubin,TSB)水平的高低分为轻度组(n=33)、中度组(n=36)和重度组(n=31);另选30例健康新生儿作为正常对照组.比较各组血清T SB/白蛋白(B/A)比值、S-100B蛋白、神经元特异性烯醇化酶(NSE)、免疫球蛋白(IgG、IgA、IgM)水平及外周血T淋巴细胞亚群(CD4+、CD4+/CD8+)的差异,并分析T SB与其他各指标的相关性.结果 与正常对照组比较,轻、中、重度组患儿血清B/A比值、S-100B蛋白和NSE水平均显著升高,差异有统计学意义(P<0.05);血清IgG、IgA、IgM水平及外周血CD4+细胞百分比、CD4+/CD8+比值均显著降低,差异有统计学意义(P<0.05);随着血清T SB水平的升高,血清B/A比值、S-100B蛋白和NSE水平逐渐升高,血清IgG、IgA、IgM水平及外周血CD4+细胞百分比、CD4+/CD8+比值逐渐降低,且轻、中、重度组间比较,差异有统计学意义(P<0.05);新生儿血清TSB水平与B/A比值、S-100B蛋白及NSE水平呈正相关(P<0.05);与血清IgG、IgA、IgM水平及外周血CD4+细胞百分比、CD4+/CD8+比值呈负相关(P<0.05).结论新生儿血清胆红素升高可导致一定程度的神经毒性和免疫功能损害,且胆红素水平越高,神经功能和免疫功能损害越严重.     

复合超滤对小儿先天性心脏病术后肺功能的影响

目的探讨复合应用改良超滤和零平衡超滤对改善小儿先天性心脏病体外循环(extracorporeal circulation,ECC)术后肺功能的临床效果。方法60例行室间隔缺损修补术(VSD)的患儿随机分为四组:常规超滤组(CUF组,n=15)、改良超滤组(MUF组,n=15)、零平衡超滤组(ZUF组,n=15)和改良超滤 零平衡超滤组(M Z组,n=15)。分别检测各组围术期红细胞压积(Hct),呼吸功能氧合指数(OI),肺泡-动脉血氧分压差(P(A-a)O2),呼吸机辅助时间(MAT)及炎性介质肿瘤坏死因子α(TNF-α)和白细胞介素-6(IL-6)的浓度。结果术后各组Hct无显著性差异(P>0.05);M Z组、ZUF组和MUF组术后1 h,6 h,12 h,24 h OI高于CUF组(P<0.05),而M Z组术后1 h,6 h,12 h,24 h P(A-a)O2较ZUF组、MUF组和CUF组低(P<0.05);M Z组术后呼吸机支持时间较MUF组、ZUF组和CUF组短(P<0.05);M Z组和ZUF组停机及术后2 h,12 h,24 h TNF-α和IL-6浓度较MUF组和CUF组明显降低(P<0.05)。结论零平衡超滤加改良超滤较单一超滤方法能较好地改善小儿先天性心脏病患者术后肺功能,降低体内炎性介质浓度。