代谢正常肥胖疾病与非酒精性脂肪性肝病的相关性研究

【目的】探讨代谢正常肥胖（metabolically healthy obese ,M HO ）与非酒精性脂肪性肝病（nonalco-holic fatty liver disease ,NAFLD）的相关性。【方法】收集本院2006年4月至2010年1月体检者资料,记录体检个体的各项临床指标、相关生化指标及腹部B超结果,排除资料不全者,共2830例。根据肥胖的诊断标准,共有613例纳入本研究,包括M HO 261例,肥胖伴代谢综合征（metabolic syndrome ,MS）352例。对其中M HO合并NAFLD者（ n＝134）、未合并NAFLD者（ n＝127）及MS（ n＝352）者的一般资料、血压、血糖、血脂、尿酸、外周血白细胞计数（WBCC）进行分析,并对109例MHO（其中MHO合并NAFLD者62例）随访1～3年。观察 M HO 合并 NAFLD 者发生 MS 的情况。【结果】① M HO 中,未合并 NAFLD 组体质指数（BMI）、年龄、收缩压（SBP）均较合并NAFLD组低,且差异有显著性（ P＜0．05）。合并NAFLD组BMI、年龄与肥胖伴MS组相比无统计学差异,SBP较肥胖伴MS组低,较未合并NAFLD组高,且差异有显著性（ P ＜0．05）。②M HO中合并NAFLD组代谢异常性疾病的发病率较未合并NAFLD组高（59．68％ vs 29．79％,P＜0．05）。【结论】①M HO合并NAFLD者临床及生化特征与肥胖伴MS者更相近。② NAFLD是M HO向代谢异常性疾病进展的危险因素。     

肥胖与非肥胖者腹部皮下及内脏脂肪组织蛋白质组差异的四例研究

目的：采用二维电泳和质谱分析体系研究肥胖与非肥胖者腹部皮下及内脏脂肪组织的蛋白质组的差异，探讨胰岛素抵抗的机制。方法：采用固相pH梯度二维电泳分离肥胖与非肥胖者腹部皮下及内脏脂肪组织的总蛋白质，采用凝胶银染显色，通过扫描仪获取凝胶图像，Pdquest软件分析图像找出差异蛋白质点，对部分差异点用基质辅助激光解析电离飞行时间质谱仪（MALDI-TOF-MS）测定其胶内酶解后的肽质量指纹图谱，并查询Mascot蛋白质数据库。结果：8个差异蛋白质点被初步鉴定为能参与细胞信号传导、代谢过程以及生长分化的蛋白质，分别为：奎亭羧基末端水解酶-L1、AnnexinⅡ、组织相容性抗原ⅠA链、单酰甘油脂肪酶、血清反应元件的锌指结构域结合蛋白、AlloalbuminVenezia、PRO2044和未知蛋白。结果：差异表达的蛋白质在一定程度上提示腹部皮下内脏脂肪组织之间可能存在功能差异，以及中心型肥胖者腹部皮下及内脏脂肪组织与胰岛素抵抗的可能关系。     

山楂治疗氯氮平所致肥胖高脂血症疗效观察

目的：观察山楂治疗氯氮平所致肥胖高脂血症的临床疗效及安全性。方法采用随机数字表法将2013年1月至2014年12月我院精神科收治的86例精神分裂症患者分为观察组与对照组各43例,观察组应用氯氮平以及山楂丸治疗,疗程3个月,对照组仅应用氯氮平治疗,两组均每日辅助0.5 h心理行为干预治疗。分别于治疗的第0、1、2、3个月测查两组总胆固醇(TC)和甘油三酯(TG)、体质量和不良反应。结果观察组痊愈5例,显著进步15例,进步19例,无效4例,显效率为46.5%,有效率为90.7%;对照组痊愈2例,显著进步8例,进步12例,无效21例,显效率为23.3%,有效率为51.2%,观察组显效率、有效率均明显高于对照组,差异均有统计学意义(P<0.05);观察组的血脂[TC、TG治疗前vs治疗后第2个月：(9.37±0.13) mmol/L vs (5.21±0.11) mmol/L、(2.92±0.12) mmol/L vs (2.21±0.13) mmol/L]、体重指数[治疗前vs治疗后第3个月：(32.28±1.53) vs (24.21±1.73)]治疗后均降低,与治疗前比较差异均有统计学意义(P<0.05),对照组的血脂、体重指数治疗前后比较,差异均无统计学意义(P>0.05);两组治疗过程中不良反应TESS分值差异无统计学意义(P>0.05)。结论山楂治疗氯氮平所致肥胖高脂血症安全有效,服用方便依从性好。     

Yoga Training Improves Metabolic Parameters in Obese Boys

Yoga has been known to have stimulatory or inhibitory effects on the metabolic parameters and to be uncomplicated therapy for obesity. The purpose of the present study was to test the effect of an 8-week of yoga-asana training on body composition, lipid profile, and insulin resistance (IR) in obese adolescent boys. Twenty volunteers with body mass index (BMI) greater than the 95th percentile were randomly assigned to yoga (age 14.7±0.5 years, n=10) and control groups (age 14.6±1.0 years, n=10). The yoga group performed exercises three times per week at 40~60% of heart-rate reserve (HRR) for 8 weeks. IR was determined with the homeostasis model assessment of insulin resistance (HOMA-IR). After yoga training, body weight, BMI, fat mass (FM), and body fat % (BF %) were significantly decreased, and fat-free mass and basal metabolic rate were significantly increased than baseline values. FM and BF % were significantly improved in the yoga group compared with the control group (p<0.05). Total cholesterol (TC) was significantly decreased in the yoga group (p<0.01). HDL-cholesterol was decreased in both groups (p<0.05). No significant changes were observed between or within groups for triglycerides, LDL-cholesterol, glucose, insulin, and HOMA-IR. Our findings show that an 8-week of yoga training improves body composition and TC levels in obese adolescent boys, suggesting that yoga training may be effective in controlling some metabolic syndrome factors in obese adolescent boys.     

中药内服外薰配合电针治疗单纯性肥胖96例临床观察

目的 观察中药内服外薰配合电针治疗单纯性肥胖的临床疗效.方法 192例单纯性肥胖患者随机分成治疗组和对照组各96例,治疗组采取中药内服及中药薰蒸配合电针治疗;对照组采取普通针刺治疗,均为每周3次,隔天1次,4周为1个疗程,共治疗两个疗程,观察两组治疗前后体质量指数(BMI)及腰臀比值(WHR)及治疗效果.结果 经过2个疗程治疗后,治疗组痊愈48例、显效34例、有效10例、无效4例、总有效率95.8％,对照组分别为18例、32例、34例、12例、87.5％,经Ridit分析,治疗组平均Ridit值=0.6080,对照组平均Ridit值=0.3920,U=5.889(P＜0.01).两组治疗后BMI、WHR较治疗前均有明显改善(=2.44、2.03、2.44、2.03,均P＜0.01),两组治疗后差异均无统计学意义.结论 中药内服外薰配合电针治疗,能有效提高单纯性肥胖的临床疗效,是一种效果理想的临床减肥疗法.     

肥胖与多囊卵巢综合征的相关分析

多囊卵巢综合征(PCOS)是育龄妇女最常见的临床表现高度异质性的内分泌、代谢疾病,是无排卵性不孕的主要原因之一,发病率占育龄妇女的5％～10％.肥胖与PCOS存在紧密联系.PCOS患者中,约50％存在超重或肥胖,其中大部分表现为腹型肥胖.肥胖与一系列代谢紊乱有关,特别是伴胰岛索抵抗的高胰岛素血症和高雄激素血症,两者在PCOS的病理生理过程中发挥关键作用.肥胖易加重PCOS患者的胰岛素抵抗和高雄激素血症,导致肥胖型PCOS患者更易并发2型糖尿病、心血管疾病等远期并发症,同时因此而产生的多毛、痤疮及不孕等典型表现易导致PCOS患者焦虑、抑郁等心理疾病的发生率升高.     

Managing Occupational Therapy Burnout

Burnout has been conceptualized as an ineffective coping response to stress experienced on the job. This article will explore the construct of burnout as reported in the literature of the helping professions. An emphasis will be placed on prevention and remediation strategies, particularly those aimed at organizational causes of burnout for occupational therapists.     

Caloric Intake and Hypothalamic Neurotransmitters in Zucker Rats made Acutely Diabetic with Streptozocin

Abstract

Zucker rats, lean and obese, treated with low dose intraperitoneal injections of streptozocin become hyperglycemic within 24 h. Insulin levels fall, although the obese animal remains hyperinsulinemic. Associated with these changes in glucose and insulin there are transient decreases in caloric intake. Macronutrient selection studies show that protein consumption decreases. There is a trend for fat intake to decrease. The levels of hypothalamic neurotransmitters in the lean animals are not altered by streptozocin. The levels of 5-hydroxyindoleacetic acid increases in the streptozocin-treated obese animal in the paraventricular region, ventromedial region and the raphe. Serotonin is also significantly increased in the paraventricular region of the obese rat. These results suggest that acutely, treatment with streptozocin injures pancreatic islets, causing, in turn, decreases in insulin levels so that hyperglycemia ensues in both phenotypes. Associated with these perturbations are decreases in caloric intake. The magnitude of change in insulin levels is much greater in the obese rat. It is hypothesized that in the obese Zucker rat decrements in food intake are mediated by increase in serotonin turnover in the hypothalamus and these changes are related to changes of insulin levels. These data support the concept that circulating insulin affects hypothalamic neurotransmitters.     

Using quadratic inference functions to determine the factors associated with obesity: findings from the STEPS Survey in Iran

PurposeThe last study that had a representative sample of the Iranian population and examined the association between sociodemographic and lifestyle factors with obesity used data from the 1999 to 2000 National Health Survey in Iran. Concern about the increased prevalence of obesity has heightened interest in the association between varieties of these factors with obesity among Iranian households.MethodsData (20,917 adults) were taken from the 2009 STEPwise approach to Surveillance survey in Iran that was conducted under the supervision of World Health Organization. Using quadratic inference function, we evaluated the relation of age, sex, physical activity, serving of fruit and vegetable, employment status, smoking, and place of residence with obesity.ResultsUsing 20–30 years as the reference group, the obesity odds ratios (ORs) were 2.48, 3.79, 3.52, and 3.15 for ages 30–40, 40–50, 50–60, and 60+ years, respectively. Obesity OR for female was 2.63, compared with male. Obesity ORs for smokers and ex-smokers were 0.64 and 1.18, respectively, compared with nonsmokers. Among Iranian adult, obesity ORs for the moderate and vigorous physical activity were 0.99 and 0.90, respectively, compared with low level. The estimated odds of obesity were 46% higher for rural adults. Obesity ORs for public and private employed were 0.79 and 0.76, respectively, compared with unemployed.ConclusionsOur results may provide better insights of the factors associated with obesity and can be used as a basis to reinforce health programs to prevent obesity in Iran.