首发精神分裂症患者及其正常Ⅰ级亲属糖代谢的研究

目的 探讨在排除抗精神病药物影响下精神分裂症患者及其正常Ⅰ级亲属的糖代谢情况.方法 选择58例符合中国精神障碍分类与诊断标准第3版(CCMD-3)和精神障碍诊断统计手册第4版(DSM-Ⅳ)中分裂症诊断标准的、首发且未服药的精神分裂症患者(患者组),以及其22例正常Ⅰ级亲属(亲属组)、24例普通人群(正常对照组)为研究对象.检测空腹血糖、胰岛素、C-肽以及口服葡萄糖耐量试验(OGTY)后2h血浆中血糖、胰岛素和C-肽水平.结果 患者组OGTT后2h血糖[(8.51±2.05)mmol/L]和糖代谢异常发病率(48.3%)均显著高于与亲属组[(5.61±1.38)mmol/L,9.1%]、正常对照组[(5.88±1.21)mmol/L,4.2%](均P<0.01),且患者组的空腹胰岛素、C-肽、OGTT后2h胰岛素及胰岛素抵抗指数(IRI)也都明显高于正常对照组[分别为(19.18±7.92)mU/L,(14.51±6.87)mU/L;(76.83±36.65)mU/L,(55.05±26.91)mU/L;(472.44±167.69)pmol/L,(324.27±160.23)pmol/L;(4.56±2.05),(3.24±1.55)],差异有显著性(均P<0.05).结论 与普通人群相比,精神分裂症患者具有较高的糖代谢异常发病率,精神分裂症与糖代谢异常之间存在一定的相关性.     

成人隐匿性自身免疫糖尿病患者一级亲属的免疫特征及胰岛功能变化

目的 探讨成人隐匿性自身免疫糖尿病(LADA)患者一级亲属的免疫特征及胰岛β细胞功能变化.方法 LADA-级亲属209例,经典1型糖尿病(T1DM)一级亲属340例,行口服葡萄糖耐量试验,观察其临床特征;使用放射配体法检测谷氨酸脱羧酶抗体(GAD-Ab)、蛋白酪氨酸磷酸酶抗体(LA-2Ab),研究其免疫学标志物.对46例一级亲属和39名正常对照进行静脉葡萄糖耐量实验,放射免疫法检测胰岛素,评估其胰岛功能.结果 (1)IADA一级亲属GAD-Ab检出率为4.3%(9/209),与经典TIDM一级亲属类似(5.3%,18/340).(2)LADA一级亲属抗体阳件组第一时相胰岛素分泌及第一时相胰岛素峰值比正常对照组均降低(4.9比5.3,4.1比4.5,P<0.05);LADA一级亲属抗体阴性组胰岛素抵抗指数比正常对照组及抗体阳性组增高((1.41比0.72、0.33,P<0.05).(3)LADA一级亲属糖耐量异常(ICT)检出率为16.7%(35/209),糖尿病检出率为10.0%(21/209).(4)抗体阳性组IGT检出率高于抗体阴性组(37.5%比15.0%,P<0.05).结论 LADA患者的一级亲属存在一定程度的胰岛自身免疫、胰岛素抵抗及胰岛B细胞分泌功能减退,抗体阳性组糖耐量异常检出率较高.     

Periodontal status among relatives of aggressive periodontitis patients and reliability of family history report

OBJECTIVES: To assess the periodontal status of relatives of Aggressive Periodontitis (AgP) patients, and to evaluate the reliability of the family history report as provided by the proband. MATERIAL AND METHODS: Data from 54 AgP patients were gathered along with a family history report for each of their relatives. Only 27 patients (probands) had relatives willing to be examined. This yielded a total of 61 relatives from whom the periodontal status was obtained. The family history report for each examined relative was compared with the periodontal diagnosis made at examination to assess reliability. RESULTS: Eight percentage of the examined relatives, aged between 12-76, were diagnosed with AgP, while chronic periodontitis was present in 39%, gingivitis in 38% and 15% were healthy. If the report provided by the proband was positive, the likelihood of finding any type of periodontitis in that relative was 85.7%, whereas if the report was negative the likelihood of the absence of periodontitis was 70.6%. CONCLUSION: The percentage of examined relatives who were affected with AgP (8%), although lower than percentages reported in other AgP family studies, was still higher than the prevalence of the condition in random populations. Reliability of periodontal family history was considered good and more reliable when it was positive.     

Human T-lymphotropic virus type-1 (HTLV-1) in Israeli patients and their family relatives and its transmission to rats

We tested the possibility that lymphocytes, sera and saliva, obtained directly from healthy human T-lymphotropic virus type 1 (HTLV-1) carriers and patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) of Iranian Mashhadi origin, as well as lymphocytes from patients with mycosis fungoides (MF) and their family relatives (MFR), may be infective. Peripheral blood mononuclear cells (PBMC), sera, PBMC cultured with phytohaemagglutinin A and phorbol myristate acetate, cell-free supernatant from these cultures, saliva cells and cell-free saliva were injected into adult WKA (n=107) and F344 (n=47) female rats. The appearance of anti-HTLV-1 antibodies in the rat sera was tested by particle agglutination assay and ELISA, and positive results were confirmed by western blot assay. Higher titers (1:1024) of anti-HTLV-1 antibodies were found in the F344 rats as compared to the WKA rats (1:256). The PA agglutination test was the most sensitive for the detection of HTLV-1 antibody. The HTLV-1 provirus was detected in both strains of rats infected with body fluids and cells from the Iranian Mashhadi Jews, in various organs (PBMC, spleen, thymus, salivary glands, spinal cord, kidney and brain) by nested PCR. However, the HTLV-1 provirus was not detected in 100% of the rats. The negative rats were only immunized and not infected. The spleen, thymus, spinal cord and salivary glands of the seropositive rats were found to be infectious and to transmit the HTLV-1 to healthy rats. F344 rats infected with PBMC cultures obtained from HTLV-1 antibody positive MF patients and their MFR who were only 20% positive showed anti-HTLV-1 antibodies, but only in 20% of rats without showing the HTLV-1 provirus; these rats were probably not infected but only immunized. This is one of the few studies on the transmission of HTLV-1 to rats by inoculation with human infectious fluids or cells from HTLV-1 infected healthy carriers (42%), HAM/TSP patients of Iranian Mashhadi origin (58%) as well as lymphocyte cultures obtained from HTLV-1 antibody positive MF and MFR of nonIranian origin.     

心源性猝死患者家属行基础心肺复苏对抢救成功率的影响

目的: 多中心、前瞻性研究观察并分析家属行基础心肺复苏对心脏骤停患者救治成功率的影响。 方法: 连续入选2006年5月~2007年12月,在北京市3个医院就诊的患者共127例。分为家属行基础心肺复苏组（A组）和未行基础心肺复苏组（B组）。比较两组抢救成功率,并对患者家属（414人）进行心肺复苏技术现况与需求的问卷调查。结果: 127例患者中,A组27例(21.3%);B组100例(78.7%)。A组的心肺复苏成功率显著高于B组（22% vs. 7%,P<0.01）,影响心肺复苏成功的因素包括:家属是否参与心肺复苏、开始心肺复苏的时间、操作是否规范有效等。结论: 家属行心肺复苏的抢救成功率优于未行心肺复苏者;目前家属对心肺复苏技术的需求量大,掌握率低,急需普及,普及的关键是规范化培训。     

Neurocognitive endophenotypes for bipolar disorder

Objectives:  Neurocognitive deficits have been proposed as vulnerability markers or endophenotypes for the development of bipolar I disorder (BD I). However, few research studies have examined whether neurocognitive deficits also exist in first-degree relatives of individuals with BD I.
Methods:  This prospective study examined neurocognitive function in individuals with BD I, their first-degree relatives and a normal control group using a comprehensive battery of neurocognitive tests.
Results:  Results indicated that individuals with bipolar disorder and their unaffected relatives demonstrated neuropsychological deficits in comparison to the normal control group in the domains of visuospatial/constructional abilities, executive function, visual learning and memory, and motor speed. In general, the unaffected relatives demonstrated an intermediate level of performance in comparison to the normal control and bipolar group. After adjustment for mood symptoms, significant differences were present for the visuospatial/constructional, executive function, and motor domains. Individuals with bipolar disorder also demonstrated a differential right versus left hemisphere deficit with respect to neurocognitive tasks.
Conclusions:  Results suggest that deficits on specific neuropsychological tests, most notably Digit Symbol, Block Design and Judgment of Line Orientation, may be indicative of cognitive endophenotypes for bipolar disorder. Replication studies are needed to further identify these deficits as endophenotypes for BD I.     

Comparison of Fasting Glucose with Post-Load Glucose Values and Glycated Hemoglobin for Prediction of Type 2 Diabetes: The Isfahan Diabetes Prevention Study

OBJECTIVES: The aim of this study was to compare the ability of fasting plasma glucose (FPG), post-load plasma glucose values and glycated hemoglobin (HbA1c) to predict progression to diabetes in non-diabetic first-degree relatives (FDR) of patients with type 2 diabetes. METHODS: A total of 701 non-diabetic FDR of diabetic patients aged 20-70 years surveyed in 2003 to 2005 were followed until 2008 for the onset of type 2 diabetes mellitus. At baseline and at follow-ups, participants underwent a standard 75 g 2-hour oral glucose tolerance test (OGTT). Prediction of progression to type 2 diabetes was assessed by using area under the receiver-operating characteristic (ROC) curves based upon measurement of FPG, post-load glucose values and HbA1c. RESULTS: The incidence of type 2 diabetes was 33.9 per 1000 person-years in men and 48.6 in women. The incidence rates were 4.6, 50.7, and 99.7 per 1000 person-years in FDR with normal glucose tolerance, impaired fasting glucose and impaired glucose tolerance respectively. FPG value was a better predictor of progression to diabetes than any post-load glucose values or HbA1c. The areas under the ROC curves were 0.811 for fasting, 0.752 for 1/2-hour, 0.782 for 1-hour and 0.756 for 2-hour glucose vs. 0.634 for HbA1c (p < 0.001). CONCLUSIONS: FPG had more discriminatory power to distinguish between individuals at risk for diabetes and those who were not at risk than post-load glucose values during OGTT or HbA1c. Our findings support the American Diabetes Association recommendation of using FPG concentration to diagnose diabetes.     

2型糖尿病患者非糖尿病一级亲属的胰岛素抵抗出现先于β细胞功能缺陷

目的 研究2型糖尿病患者非糖尿病一级亲属的胰岛素抵抗和胰岛β细胞功能的变化.方法 选取2型糖尿病患者一级亲属23名,其中糖耐量正常者10名(NGT组),糖耐量受损者13名(IGT组).以无糖尿病家族史的糖耐量正常者9名(NC组)为对照.应用高胰岛素-正葡萄糖钳夹技术和静脉葡萄糖耐量试验评估胰岛素抵抗和胰岛β细胞功能.结果 NGT组和IGT组的葡萄糖输注率(mg·kg-1·min-1)分别为(7.04±0.62)和(6.16±0.73),与NC组(10.22±0.93)相比明显降低(均P＜0.05).NGT组的第一时相胰岛素分泌量(对数转换)高于IGT组(3.87±0.24 vs 3.03±0.28,P＜0.05),NC组为(3.37±0.30).NGT组(1.43±0.22)与NC组(1.18±0.41)的葡萄糖处置指数(对数转换)明显高于IGT组(0.32±0.20,P＜0.01或P＜0.05),NC组与NGT组之间差异无统计学意义.结论 2型糖尿病患者非糖尿病一级亲属已经存在胰岛素抵抗,当胰岛素分泌不能代偿抵抗时开始出现糖耐量减退.     

2型糖尿病一级亲属的心率变异性与颈动脉内中膜厚度的关系

目的检测2型糖尿病（T2DM）一级亲属（FDRs）颈动脉内中膜厚度（IMT）及心率变异性（HRV）,并分析它们之间的关系。方法随机选取46例健康者（NGT组）、57例FDRs及59例T2DM患者,分别测定其空腹胰岛素、空腹血糖、餐后2h血糖、TC、TG、HDL-C及LDL—C,同时计算胰岛素敏感性指数（IAI）。彩色多普勒超声测量受试者的颈总动脉（CCA）和颈内动脉（ICA）的IMT,动态心电监测分析HRV。结果CCA-IMT、ICA—IMT在NGT、FDRs及T2DM组依次升高,且FDRs组较NGT组升高（P〈0．05）;T2DM组的ICA—IMT较NGT和FDRs组升高（P均〈0．05）;HRV各项指标[时域指标：总体标准差（SDNN）、均值标准差（SDANN）、标准差平均值指数（SDNN）、差值均方平方根（rMSSD）;频域指标：低频（LF）、高频（HF）]在NGT、FDRs及T2DM组依次减低（P均〈0．05）,FPG、IAI及TG均与CCA．IMT-ICA-IMT相关（复相关系数r=0．562、0．492,P均〈0．05）。结论在糖耐量正常的T2DM患者FDRs中,已经存在IMT增厚及HRV异常,且二者密切相关。