2型糖尿病一级亲属血清脂联素、瘦素及其比值与胰岛素抵抗的相关性研究

目的 研究血清瘦素、脂联素与2型糖尿病(T2DM)一级亲属胰岛素抵抗(IR)相关性,探讨二者在T2DM发病中作用.方法 收集既往无糖耐量异常史的T2DM一级亲属, 分为糖耐量正常(NGT)组174例、空腹血糖受损(IFG)或糖耐量低减(IGT)组55例,及新发T2DM组71例;以其无糖尿病家族史的配偶或亲友中OGTT正常者114例作为正常对照组(NC).酶联免疫法测定上述人群的血清真胰岛素(TI)、瘦素和脂联素水平.用HOMA-IR评价胰岛素抵抗(IR)状态.结果 从NC至NGT、IGT/IFG到DM组,IR进行性加重(HOMA-IR分别为1.3±0.7、1.7±1.5、 2.2±1.4 和3.2±2.8,P＜0.01);血清瘦素水平进行性增高(P＜0.01),瘦素水平与HOMA-IR正相关(r=0.35, P＜0.01);血清脂联素水平进行性降低(分别为20±12、17±11、13±8和10±6mg/L,P＜0.01),与HOMA-IR负相关(r=-0.41,P＜0.01);脂联素/瘦素比值进性行降低,与HOMA-IR负相关(r=-0.53, P＜0.01). 结论 T2DM一级亲属在NGT时即存在瘦素水平升高和脂联素水平明显下降.脂联素/瘦素比值下降趋势与IR和糖调节受损的严重程度密切相关,推测该比值的变化可能是糖尿病一级亲属存在的固有遗传缺陷的一种表现,可能在IR和T2DM的发生发展中起重要作用,因而渴望作为预测T2DM发病的早期观察指标.     

2型糖尿病家系一级亲属同胞腰臀股围的变化

目的：研究2型糖尿病家系一级亲属同胞糖代谢异常及糖耐量正常者的腰、臀、股围变化及其意义。方法：在560个临床表现为2型糖尿病的家系中，去除1型糖尿病、线粒体糖尿病和收集标本数少的家系后，得406个2型糖尿病家系，将其家系一级亲属同胞成员分为正常糖耐量组（NGT组，425例）、糖耐量减退组（IGT组，79例）、糖尿病组（DM组，694例），并以同胞配偶中的无糖尿病家族史的正常糖耐量者作为对照组（C组，429例），比较各组间腰、臀、股围及其各个比值的6个参数的差异。结果：DM组腰围、腰臀比、腰股比、臀股比高于C组，臀围、股围低于C组（腰围P＝0．0059，余均＜0．001）。NGT组腰臀比，腰股比大于C组（P分别显0．0009，0．0045），股围小于C组（P＝0．0321），均有显著差异。腰围、腰臀比、腰股比在X组、NGT组、IGT组、DM组有逐渐增高趋势，臀围、股围在四组有逐渐减低趋势。去除用胰岛素治疗，或体重指数＜20kg/m^2或空腹血糖＞14mmol/L者比较6个参数在4组中的差异，显示上述变化趋势更显著。结论：糖代谢异常患者，随着糖代谢异常的加重，其体脂有重新分布，逐渐向中心性肥胖发展的趋势。即腹围渐大，臀围，尤其是股围有逐渐相对缩小的趋势。值得注意的是2型糖尿病家系同胞一级亲属中的糖耐量正常者已不同于群体中的糖代谢正常者，开始出现此种变化趋势，可能与遗传因素有关。     

2型糖尿病患者一级亲属脂联素及三种细胞因子与胰岛素抵抗的相关性

目的研究2型糖尿病(T2DM)患者非糖尿病一级亲属脂联素、TNF-α、IL-6及C-RP水平的变化及其与胰岛素抵抗(IR)的相关性。方法测定糖耐量正常的T2DM患者一级亲属36例,及无T2DM家族史的正常人对照组46例的血糖、血脂、胰岛素、脂联素、TNF-α、IL-6及hsC-RP。结果①T2DM患者一级亲属组脂联素水平显著低于正常人对照组(11·9±3·0mg/Lvs14·4±3·2mg/L,P<0·01),而TNF-α、IL-6及hsC-RP水平显著高于正常人对照组(分别是14·0±2·8pg/mlvs10·3±2·6pg/ml,P<0·01;13·8±2·7pg/mlvs8·1±2·2pg/ml,P<0·01;1·3±0·4mg/Lvs0·7±0·3mg/L,P<0·01);②T2DM患者一级亲属组IR指数与脂联素呈负相关(r=-0·666,P<0·01),与TNF-α、IL-6呈正相关(分别为r=0·731,P<0·01;r=0·640,P<0·01)。结论脂联素、TNF-α、IL-6及C-RP可能与T2DM患者一级亲属的IR相关。     

亲属肾移植中供者年龄对移植肾功能的影响

目的 研究接受亲属高龄供肾者肾移植的患者近期移植肾功能状态,探讨高龄供肾者是否可保证移植肾的长期存活.方法选择接受父母供肾的肾移植患者86例,于近期观测肾功能指标.供者43~64岁,受者19~40岁.肾功能指标由血肌酐和尿素氮确定,由检验科提供.结果 86例肾移植患者中42例患者肾功能正常,其中24例患者接受的供者年龄大于或等于55岁,18例患者接受的供者年龄小于55岁.44例患者肾功能不正常,其中34例患者接受的供者年龄大于或等于55岁,10例患者接受的供者年龄小于55岁.接受供者年龄大于或等于55岁的患者与小于55岁的患者肾功能比较差异有统计学意义(P<0.05).结论 高龄供肾者不适宜作为肾移植的最佳供者,但亲属移植的患者移植肾功能下降后仍可维持较长时间肾功能.     

Cytokine overproduction in healthy first degree relatives of patients with IDDM

Summary Healthy family members of patients with insulin-dependent diabetes mellitus (IDDM) are known to share a number of immunological abnormalities with their affected relatives. Since monocyte and type 1 T-cell-derived cytokines contribute to the pathogenesis of IDDM, we studied the production of these cytokines in the healthy first degree relatives of 29 children with IDDM. We report that circulating tumour necrosis factor-α (TNF-α) and soluble interleukin-2 (sIL-2) receptor were present in increased amounts in non-diabetic family members at levels similar to those found in the diabetic children (duration of disease 3 months–5 years). Furthermore, marked hypersecretion of IL-1α and TNF-α by mitogen-stimulated peripheral blood mononuclear cells was found in both diabetic and healthy family members. Abnormalities of cytokine production in healthy relatives did not correlate with the presence of islet cell antibodies or with HLA DR type. These data indicate that healthy family members of patients with IDDM exhibit overproduction of a number of cytokines that have been implicated in diabetogenesis. [Diabetologia (1998) 41: 343–349] Received: 26 August 1997 and in revised form: 24 October 1997     

低密度脂蛋白胆固醇异常在2型糖尿病家系中的家族聚集性及相关因素分析

目的探讨低密度脂蛋白胆固醇(LDL-C)异常在北京地区2型糖尿病(T2DM)家系一级亲属中是否存在遗传倾向以及相关因素。方法收集北京地区具有两个或以上T2DM患者的家系295个,共978例,将每一家系中先证者按LDL-C<2.6 mmol/L和≥2.6 mmol/L分为正常LDL-C组131例和高LDL-C组163例,比较两组患者T2DM和非T2DM一级亲属的LDL-C水平,用多因素逐步回归分析了解其相关因素。结果高LDL-C组的T2DM一级亲属的年龄、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TCHO)和LDL-C高于正常LDL-C组(P<0.05)。多因素逐步回归分析显示,T2DM一级亲属的LDL-C与先证者LDL-C、HbA1c及年龄独立相关。高LDL-C组的非T2DM一级亲属的TCHO和LDL-C高于正常LDL-C组(P<0.05)。多因素逐步回归分析显示,非T2DM一级亲属的LDL-C与先证者LDL-C、HbA1c及年龄独立相关。结论在中国北京地区T2DM家系中LDL-C异常存在家族聚集现象,且LDL-C与HbA1c和年龄独立相关。     

‘Serological biopsy’ in first‐degree relatives of patients with gastric cancer affected by Helicobacter pylori infection

Background: Relatives of patients with gastric cancer are at increased risk of developing this disease, especially if they are infected by Helicobacter pylori. Moreover, H. pylori‐related atrophic gastritis and hypochlorhydria are well‐documented risk factors for noncardia gastric cancer. Serum pepsinogen I (sPGI) and II (sPGII) levels are low in this condition. The aim of our study was to assess by means of a ‘Gastropanel’ blood test, including sPGI, sPGII, gastrin‐17 (G‐17) and antibodies anti‐H. pylori (IgG‐Hp), both functional and morphological features of gastric mucosa in Hp?+?ve subjects with a family history of gastric cancer. Materials and Methods: Twenty‐five Hp?+?ve subjects consecutively referred to our department for gastrointestinal complaints, selected as first‐degree relatives of patients suffering from gastric cancer, were enrolled in the study and then matched for sex and age with 25 dyspeptic and Hp?+?ve subjects with no family history of gastric neoplasia. Blood samples were taken for determination of gastropanel in all patients; in addition, antibodies against CagA were analysed. Results: No statistically significant differences were detected zbetween the two groups as regards alcohol consumption, coffee intake and smoking habits. Mean sPGI levels in Group A (83.4?±?58.4 μg/L) were significantly lower than those in Group B (sPGI 159.5?±?80.6 μg/L; P?P?Conclusion: First‐degree relatives of patients with noncardia gastric cancer affected by H. pylori infection present lower sPGI and sPGII levels, possibly due to the increased frequency of atrophic lesions in these patients.     

Tumour necrosis factor-alpha gene promoter polymorphism and decreased insulin resistance

Summary Insulin resistance is a feature of non-diabetic relatives of non-insulin-dependent diabetic (NIDDM) families. Tumour necrosis factor-alpha (TNFα) expression is linked with insulin resistance, and is under strong genetic control. We examined the relationship between insulin resistance and two polymorphisms of the TNFα promoter region (positions –238 and –-308). Non-diabetic relatives (n = 123) of NIDDM families and control subjects (n = 126) with no family history of diabetes were studied. Insulin resistance was determined by homeostasis model assessment (HOMA) and short insulin tolerance test (ITT), and genotyping was by restriction digest. The –238 polymorphism (TNFA-A allele) was carried by 14 relatives and 11 control subjects, and all were heterozygotes. To examine the relationship between the –238 polymorphism and insulin resistance independent of potentially confounding factors, the relatives with the TNFA-A allele were individually pair-matched for age, sex, waist-hip ratio, body mass index, and glucose tolerance with relatives homozygous for the wild-type allele. Relatives with the TNFA-A allele had decreased insulin resistance (HOMA index: 2.0, 3.6 ± 2.1 [means ± SD of differences], p = 0.03), and this was true for comparable pair-matched control subjects (HOMA index: 1.1, 1.9 ± 0.8, p = 0.01). Combining relative (n = 7) and control (n = 4) pairs that had undergone an ITT, subjects with the TNFA-A allele had an increased K_ITT (3.8, 3.0 ± 1.0 %/min, p = 0.04) similarly indicating decreased insulin resistance. There was no significant relationship between the –308 polymorphism and insulin resistance. We conclude that the TNFA-A allele is associated with decreased insulin resistance as assessed by two independent methods, and may protect against the future development of NIDDM in susceptible individuals. [Diabetologia (1998) 41: 430–434] Received: 8 September 1997 and in revised form: 13 November 1997     

原发性肝癌患者与其一级亲属的血糖水平分析

[目的]分析启东地区原发性肝癌患者与其一级亲属及对照者血糖水平。[方法]肝癌患者448例（肝癌组）、肝癌患者一级亲属1282例（亲属组）及健康体检人员1236例（对照组）,均作HBsAg、空腹血糖检测,以χ2检验进行统计学处理。[结果]肝癌组的高血糖检出率显著性高于亲属组和对照组（χ2=16．64、64．80,P均〈0．01）;亲属组显著性高于对照组（χ2=24．33,P〈0．01）。肝癌组HBsAg阳性检出率显著性高于亲属组和对照组（χ2=382．91、726．61,P均〈0．01）;亲属组显著性高于对照组（χ2=91．04,P〈0．01）。[结论]高血糖和HBsAg可能是原发性肝癌的独立或协同危险因素,肝癌患者的一级亲属也可能是原发性肝癌的易感人群,应予高度重视。     

护理干预对ICU患者亲属焦虑状态的影响

目的探讨护理干预对ICU患者亲属焦虑状态的影响。方法对干预组患者亲属进行健康教育及心理疏导,对照组采用常规宣教,在患者入住ICU后24～36h,采用状态焦虑量表对患者亲属进行调查。结果ICU患者亲属的状态焦虑问卷得分明显低于对照组,差异具有统计学意义（P〈0．01）。结论有针对性地进行健康教育和心理疏导可减轻ICU患者亲属的焦虑程度。