再论妊娠期糖尿病与胎儿生长发育

目的 研究妊娠期糖尿病与胎儿生长发育中糖代谢特点的关系。方法 选择妊娠期糖尿病25例（GDM组），正常孕妇20例（对照组），分别测孕妇空腹血糖、糖耐量、C肽、IGF－I、新生儿出生2h内空腹血糖，并依据新生儿出生体重分为大于胎龄儿组（LGA组，≥4000g），适于胎龄儿组（AGA组，2500－3999g)。结果 C肽及新生儿出生2h内空腹血糖GDM组与对照组差异有显著性；糖耐量各时点血糖值餐后2h血糖值LGA和AGA组差异有显著性。结论 血糖始终是影响胎儿生长发育的重要因素，孕妇餐后2h血糖水平与巨大儿的发生呈正相关。     

葡萄糖筛选试验在妊娠期糖尿病诊断及治疗中的价值

目的　探讨 5 0 g葡萄糖筛选试验 (GCT)在妊娠期糖尿病 (GDM )诊断及治疗中的价值。 方法　选择 2 0 0 0年 1月～ 2 0 0 3年 6月在我院行产前检查并分娩的 5 0 gGCT异常的孕妇 36 8例 ,按血糖值分为 5组 :≥7.8～ <8.0mmol/L为Ⅰ组 ,≥ 8.0～ <9.0mmol/L为Ⅱ组 ,≥ 9.0～ <10 .0mmol/L为Ⅲ组 ,≥ 10 .0～ <11.0mmol/L为Ⅳ组 ,≥ 11.0mmol/L为Ⅴ组。比较 5组 75 g口服葡萄糖耐量试验 (OGTT)异常的比例及需用胰岛素治疗的病例数的差异。结果　 5组GDM的发生率分别为 6 .9%、8.5 %、2 1.3%、4 7.8%和 85 .0 % ,75 gOGTT异常的发生率分别为 19.0 %、2 4 .2 %、5 1.1%、87.0 %和 90 .0 % ,且用胰岛素治疗的病例数随 5 0 gGCT血糖值的上升而增加。结论　 5 0 gGCT在GDM的诊断及治疗方案的预测方面均有重要价值。     

The pitfalls of the dexamethasone suppression test: A biological marker of endogenous depression?

In the past few years there have been numerous publications which have stressed the value of the dexamethasone suppression test (DST) as a diagnostic marker of endogenous depression. Our own studies in 333 psychiatric inpatients and 121 healthy subjects did not reveal a differential diagnostic use for the DST. This result is in good agreement with other results in the literature. Our data demonstrate that intervening variables such as severity of illness, weight loss, sleep disturbances, situational stress, drug and alcohol withdrawal, and the pharmacokinetics of dexamethasone have an important influence on DST results, regardless of the diagnostic classification.     

血钙水平与肾癌肿瘤大小、分期的相关性分析

目的分析肾细胞癌患者血钙水平和肿瘤大小与分期的相关性，从而进一步发现与病情相关的规律和了解病情。方法按照血钙水平将肿瘤大小／分期相应地分3组，即降低、正常和升高各3组。利用SPSS10．0软件，对3组不同的肿瘤大小／分期病例进行差异性分析和相关性研究。结果3组不同的肿瘤大小差异性分析（Kruskal-wallisH）显示，X^2=4．768，df=2，P=0．092；Spearman相关分析显示相关系数为．0．166，P=0．029。3组不同的肿瘤分期差异性分析（Kruskal-Wallis H）显示，X^2=4、277，df=2，P=0．118；Spearman相关系数为．0．157，P=-0．039。结论3组不同的肿瘤大小之间差异性无统计学意义，血钙水平与肿瘤大小间存在负相关；3组不同的肿瘤分期之间差异性无统计学意义，血钙水平与肿瘤分期间存在负相关。     

INTRAOPERATIVE BLEEDING IN ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE STOMACH AND STRATEGY FOR PREVENTION AND TREATMENT

To control intraoperative bleeding is an important key to successful endoscopic submucosal dissection. The distribution of submucosal vessels encountered during the procedure differ in places in the stomach and are roughly categorized into three groups: those located in the antrum, those in the lesser curvature, and those on the anteroposterior corpus wall which consists of oblique muscle layers. Therefore, knowledge of a suitable setting of diathermy and adjusted depth of dissection in the submucosal layer for each site is imperative. The combination of utilizing the distal attachment forced or swift coagulation (trimming with coagulation mode) have enable the treatment with an insulation tipped knife safer.     

多器官功能衰竭患儿血糖血乳酸血渗透压的改变

对５０例ＭＯＦ患儿血糖血乳酸血渗透压进行了检测，并与３５名健康儿童进行比较。结果显示危重患儿血糖血乳酸明显高于对照组，血糖血乳酸呈正相关，提示高血糖是危重患儿应激状态下的主要代谢改变。当患儿血糖＞１５ｍｍｏｌ／Ｌ血乳酸）５ｍｍｏｌ／Ｌ时，其死亡率明显增加，因此血糖血乳酸的变化可作为ＰＩＣＵ的常规监测指标。     

模拟缺血再灌注后心肌细胞的胰岛素抵抗现象

目的准确评价缺血再灌注心肌的胰岛素敏感性及其时相规律，为临床干预提供依据。方法建立成年大鼠心肌细胞模拟缺血60min再灌注模型，应用同位素示踪技术观察不同浓度（0IU／L、0．01IU／L、20IU／L）胰岛素刺激大鼠心肌细胞的葡萄糖摄取效应。结果缺血60min后再灌注15min和60min，心肌细胞活性比率无明显降低（P〉0．05）。胰岛素能促进各组心肌细胞的葡萄糖摄取，并呈剂量依赖性。缺血再灌注15min组和再灌注60min组心肌细胞胰岛素刺激的葡萄糖摄取较对照组均明显降低（P〈0．05）。再灌注60min组心肌细胞胰岛素刺激的葡萄糖摄取较再灌注15min组明显增加（P〈0．05）。结论缺血60min后，再灌注心肌细胞保留了对胰岛素的反应性，同时，再灌注心肌细胞发生明显的急性胰岛素抵抗，再灌注初期尤为严重。急性胰岛素抵抗很可能是缺血再灌注心肌损伤的又一重要机制。     

Similarities in Skeletal Muscle Strength and Exercise Capacity Between Renal Transplant and Hemodialysis Patients

Exercise intolerance is common in hemodialysis (HD) and renal transplant (RTx) patients. Aim of the study was to assess to what extent exercise capacity and skeletal muscle strength of RTx patients differ from HD patients and healthy controls and to elucidate potential determinants of exercise capacity in RTx patients. Exercise capacity, muscle strength, lean body mass (LBM) and physical activity level (PAL) were measured by cycle-ergometry, isokinetic dynamometry, DEXA and Baecke Questionnaire, respectively, in 35 RTx, 16 HD and 21 controls. VO2peak and muscle strength of the RTx patients were significantly lower compared to controls (p<0.01), but not different compared to HD patients. In RTx patients, strength (p<0.001), PAL (p=0.001) and age (p=0.045) were significant predictors of VO2peak. Muscle strength was related to LBM (p=0.001) and age (p=0.001), whereas gender (p<0.001) and renal function (p=0.01) turned out to be significant predictors of LBM. No effects of corticosteroids were observed. Exercise capacity and muscle strength seem equally reduced in RTx and HD patients compared to controls. In RTx patients, muscle strength and PAL are highly related to exercise capacity. Renal function appears to be a significant predictor of LBM, and through the LBM, of muscle strength and exercise capacity.     

葡萄糖转运蛋白在丁酸钠诱导结肠癌细胞凋亡中的作用

目的观察丁酸钠对结肠肿瘤细胞HT-29葡萄糖转运蛋白(GLUT1～GLUT5)表达的影响以及丁酸钠和不同浓度葡萄糖对bax和bcl-x/l表达的影响,探讨丁酸钠诱导肿瘤细胞凋亡的可能机制。方法2005年4月至12月在武汉大学人民医院应用逆转录-聚合酶链反应(RT-PCR)检测GLUT1～GLUT5mRNA的表达情况。免疫细胞化学法检测bax和bcl-x/l的表达。原位切口末端标记法(Tunel)检测细胞凋亡。结果丁酸钠明显抑制GLUT1和bcl-x/l表达并诱导肿瘤细胞凋亡,但对GLUT2、GLUT3、GLUT5和bax表达影响不大,GLUT4则未被检测出。丁酸钠干预条件下,葡萄糖浓度增加可以明显增加bcl-x/l的表达并降低丁酸钠诱导的细胞凋亡。无丁酸钠干预条件下,葡萄糖浓度变化对细胞凋亡影响很小。结论在HT-29细胞中,丁酸钠能明显降低GLUT1的表达。降低GLUT1的表达与丁酸钠诱导细胞凋亡作用密切相关。     

胰岛素和睾酮对Ishikawa细胞葡萄糖转运蛋白4表达的影响

目的探讨胰岛素(INS)和睾酮(T)对多囊卵巢综合征(PCOS)子宫内膜腺上皮细胞生长的影响和葡萄糖转运蛋白4(GLUT4)表达的调节机制。方法体外培养Ishikawa细胞,予不同浓度INS(90、60、30、3、0.3 U/L)或T(10-3、10-4、10-5、10-6、10-7mmol/ml)刺激Ishikawa细胞48 h,MTT法检测INS、T对Ishikawa细胞生长的作用;免疫细胞化学检测GLUT4蛋白在Ishikawa细胞定位表达;分别以30 U/L INS和10-5mmol/ml T刺激Ishikawa细胞24和48 h,逆转录聚合酶链反应(RT-PCR)方法测定INS和T对Ishikawa细胞GLUT4 mRNA表达的影响。结果(1)不同浓度的INS均可促进Ishikawa细胞的生长,随着INS浓度的增加,INS促进Ishikawa细胞生长作用越强,INS浓度自0.3~30 U/L时,Ishikawa细胞生长依次加强,与对照组相比均有显著性差异(P<0.01)。INS浓度达60、90 U/L时,细胞生长状况与INS浓度为30 U/L相似。不同浓度的T均可抑制Ishikawa细胞的生长,随着T浓度的增加,T抑制Ishikawa细胞生长作用越明显。T浓度自10-7、10-6、10-5mmol/ml,Ishikawa细胞生长依次减弱,与对照组相比均有显著性差异(P<0.01,P<0.05),T浓度达10-4、10-3mmol/ml时,细胞生长抑制状况与T浓度10-5mg/ml相似。(2)GLUT4蛋白,定位表达于Ishikawa细胞的细胞浆内。(3)Ishikawa细胞中GLUT4 mRNA表达,在INS组和T组均较对照组减弱(P<0.01,P<0.05),INS组比T组减弱更明显(P<0.05),且INS和T作用24和48 h GLUT4 mRNA表达无显著性差异(P>0.05)。结论不同浓度INS和T均可影响Ishikawa细胞生长,并降低GLUT4 mRNA的表达,推测PCOS高胰岛素、高雄激素血症的病理生理特性有可能影响子宫内膜的代谢过程,与子宫内膜的病变相关。