前言--重视老年高尿酸血症及痛风的防治(一)

原发性高尿酸血症和痛风是嘌呤代谢紊乱及(或)尿酸排泄减少所引起的一组代谢性疾病。其主要的临床特征为反复发作的关节炎、痛风石形成和痛风肾病等。痛风与高尿酸血症患者常伴有肥胖、高血压、糖代谢及脂代谢紊乱、凝血系统功能障碍等,这些疾病以胰岛素抵抗为其共同的病理生理     

高尿酸血症主要治疗路径

<正>高尿酸血症是遗传因素和环境因素相互作用所致。临床上高尿酸血症分为原发性和继发性两类。尿酸排泄减少和合成增加是导致高尿酸血症的两大病因,基础研究已证实,90%的高尿酸血症是由于尿酸排泄减少所致,只有10%与尿酸合成增加有关。高尿酸血症与糖尿病患者的肾功能、心血管事件、痛风、脂质代谢、胰岛素抵抗均有直接或间接的关系,糖尿病患者应该改善相关生活饮食行为,定期检查血尿酸浓度,必要时进行相关治疗。     

血清尿酸与高尿酸血症相关疾病

尿酸是人体嘌呤碱基分解代谢终产物,经肾脏排泄。体内尿酸生成超过肾脏排泄时血清尿酸会显著升高,造成高尿酸血症。高尿酸血症与痛风、心血管疾病、肿瘤裂解综合征及肾脏疾病的引发或加剧密切相关。本文对血清尿酸的临床意义进行综述。     

痛风了，怎么吃？

糖尿病和痛风都是代谢综合征的成员,不少“糖友”常合并痛风。什么是痛风？痛风是由于机体内一种叫嘌呤的物质代谢紊乱,使体内尿酸产生过多或肾脏排泄尿酸减少,从而引起血液中尿酸浓度过高,形成高尿酸血症。没有临床症状的,就称高尿酸血症;如果尿酸盐结晶沉积于关节腔内,引起关节囊滑膜急性炎症反应,造成滑膜充血、肿胀、关节液增加,导致关节尤其是足部关节剧痛,即是痛风。     

2型糖尿病伴高尿酸血症的病因与治疗新进展

高尿酸血症是嘌呤代谢障碍性疾病,也是与代谢异常综合征和糖尿病密切相关性疾病之一,其主要原因是尿酸生成过多或肾脏排泄减少.高尿酸血症与肥胖症、高脂血症、高血压病、糖尿病、动脉粥样硬化等疾病呈显著正相关.糖尿病肾病、高血压、高胰岛素血症均可因阻碍肾小管排泌钠与尿酸引起血尿酸增高.血钠增高与高血压相关,高胰岛素血症又与肥胖、脂质代谢异常特别是高甘油三酯血症、肥胖及糖代谢异常共现.高尿酸血症除了引起痛风、肾结石与肾病外,还使糖尿病患者大血管并发症及心脑血管终点事件发生率显著增高.     

高尿酸血症与代谢综合征

过去一直认为高尿酸血症对人体的影响主要是尿酸盐结晶沉积在关节及肾脏而引起相应的病变。近期许多研究表明 ,高尿酸血症与代谢综合征的许多成分如肥胖、高血压、血脂异常、高血糖症、冠心病及胰岛素抵抗等密切相关。并已成为代谢综合征的一部分 ,二者关系正引起人们的重视。本文将高尿酸血症与代谢综合征的关系作一综述 ,以评价高尿酸血症在代谢综合征中的作用。     

2型糖尿病与痛风

2型糖尿病患者往往同时存在高尿酸血症、高血压、肥胖、血脂紊乱、高胰岛素血症等一系列代谢变化，临床上将此称为“代谢综合征”。代谢综合征发病的中心环节是胰岛素抵抗，由此所导致的代谢紊乱可直接影响尿酸在体内的代谢而出现或加重高尿酸血症。     

高尿酸血症与代谢综合征

过去一直认为高尿酸血症对人体的影响主要是尿酸盐结晶沉积在关节及肾脏而引起相应的病变。近期许多研究表明，高尿酸血症与代谢综合征的许多成分如肥胖、高血压、血脂异常、高血糖症、冠心病及胰岛素抵抗等密切相关。并已成为代谢综合征的一部分，二者关系正引起人们的重视。本文将高尿酸血症与代谢综合征的关系作一综述，以评价高尿酸血症在代谢综合征中的作用。     

老年痛风

原发性痛风是一种嘌呤代谢失常或其代谢产物尿酸排泄不良的遗传性疾病.痛风在各种年龄均可发生,但发病率随年龄增长而升高。因此本病在老年多见。临床表现有急性关节炎、皮肤可扪到由尿酸钠沉积的痛风石、尿酸性肾结石以致肾衰。痛风的特点是高尿酸血症及高尿酸尿症,因而引起不少并发症。除原发性痛风外,还有若干不同疾病也可导致持续性的高尿酸血症,其所表现的特点类同原发性高尿酸血症。因此,痛风可分为原发性及继发性二类。继发性痛风大多由以下情况引起,如血液及     

甲状腺功能减退症的临床治疗

甲状腺功能减退症是由各种原因导致的低甲状腺激素血症或甲状腺激素抵抗而引起的全身性低代谢综合征，临床表现为黏液性水肿。笔者临床治疗48例，现报告如下。[第一段]     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.