非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

Objective To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease (NAFLD) patients, and their relationship with insulin resistance. Methods A total of 120 cases were enrolled and divided into two groups: NAFLD group (n = 60) and normal control group (n = 60). The serum levels of leptin and adiponectin were measured by EL1SA. The body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol (Tchol), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting blood glucose (FBG) and HOMA-IR (homeostasis model assessment insulin resistance) were detected and analyzed. Results Compared with control group, the serum leptin level in NAFLD group was Significantly higher [(12.37 ± 1.99) μg/Lvs (5.20 ± 1.03)μg/L,P<0.01], while the serum adiponectin level was significantly lower [(12.69 ± 2.83) mg/L vs (22.83 ± 4.61) mg/L, P < 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[(4.86 ± 0.63) vs (1.91 ± 0.41), P < 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR ( P = 8.175, P < 0.01), HOMA-IR ( P = 0.974, P < 0.01 ), FBG ( β = 0.564, P < 0.01). In contrast, adiponectin inversely associated with HOMA-IR ( β = -0.495, P < 0.01 ) and BMI ( β = -0.314, P < 0.01) respectively. Conclusions The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.     

非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

Objective To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease (NAFLD) patients, and their relationship with insulin resistance. Methods A total of 120 cases were enrolled and divided into two groups: NAFLD group (n = 60) and normal control group (n = 60). The serum levels of leptin and adiponectin were measured by EL1SA. The body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol (Tchol), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting blood glucose (FBG) and HOMA-IR (homeostasis model assessment insulin resistance) were detected and analyzed. Results Compared with control group, the serum leptin level in NAFLD group was Significantly higher [(12.37 ± 1.99) μg/Lvs (5.20 ± 1.03)μg/L,P<0.01], while the serum adiponectin level was significantly lower [(12.69 ± 2.83) mg/L vs (22.83 ± 4.61) mg/L, P < 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[(4.86 ± 0.63) vs (1.91 ± 0.41), P < 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR ( P = 8.175, P < 0.01), HOMA-IR ( P = 0.974, P < 0.01 ), FBG ( β = 0.564, P < 0.01). In contrast, adiponectin inversely associated with HOMA-IR ( β = -0.495, P < 0.01 ) and BMI ( β = -0.314, P < 0.01) respectively. Conclusions The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.     

自体颗粒脂肪注射移植充填面部软组织凹陷

目的探讨自体颗粒脂肪注射移植充填矫治面部凹陷的临床应用。方法标记面部凹陷部位,估计需要填充的脂肪量,取臀部或大腿部为供区。在肿胀麻醉下,用20 m l注射器吸脂,吸管采用3.0 mm的钝头吸管,负压应控制在20 m l注射器内3～5 m l左右真空。抽取脂肪颗粒,无菌状况下将所获脂肪颗粒洗去血迹、破碎脂肪细胞和脂滴,反复漂洗,至漂洗液色清透明;静置、分层后取中层饱满的脂肪颗粒注射在面部凹陷部位。结果采用自体脂肪颗粒移植充填矫正面部凹陷26例,其中6例患者经过了3次注射充填;12例患者经过了2次注射充填;8例患者经过了1次注射充填,均获良好效果。结论利用自体脂肪移植充填矫治面部凹陷,创伤小、并发症低、手术效果明显,相对现有其他治疗方法,是一种较为理想的治疗方法。     

非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

目的 探讨非酒精性脂肪性肝病(NAFLD)患者血清瘦素、脂联素的变化及其与胰岛素抵抗的关系. 方法 选取NAFLD患者60例,同期门诊体检健康者60名为对照组,ELJSA法测定血清瘦素、脂联素水平,并检测体质量指数、腰臀比、甘油三酯、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、空腹血糖、ALT、AST、γ-谷氨酰转肽酶(GGT),稳态模型评估的胰岛素抵抗指数(HOMA-IR).采用SPSS10.0软件包进行统计学分析,计量资料差异性比较用方差分析和t检验,多因素相关性用Spearman分析和Logistic回归分析. 结果 血清瘦素、脂联素水平NAFLD组分别为(12.37±1.99)μg/L和(12.69±2.83)mg/L,对照组分别为(5.20±1.03)μg/L和(22.83±4.61)mg/L,t值分别为24.661和14.516,P值均<0.01;HOMA-IR,NAFLD组为4.86±0.63,对照组为1.91±0.41,t值为30.451,P<0.01.Logistic多因素回归分析显示瘦素与腰臀围之比、HOMA-IR、空腹血糖呈独立正相关,β值分别为8.175、0.974和0.564,P值均<0.01;脂联素与HOMA-IR、体质量指数呈独立负相关,β值分别为-0.495和-0.314,P值均<0.01.结论 NAFLD患者血清瘦素、脂联素的变化与胰岛素抵抗有关.     

178例肝硬化的并发症分析

肝硬化是大多数慢性肝病发展的终末期阶段，患者往往因其并发症的出现病情迅速恶化，甚至死亡。掌握各种常见并发症的特点，寻求有效的防治措施，对改善肝硬化患者的预后有着重要的意义。现对我院2007年1月～2007年10月住院的178例肝硬化患者的并发症进行分析：     

聚乳酸-聚羟乙酸／磷酸三钙薄膜预防屈肌腱粘连的实验

目的：探讨在屈肌腱损伤修复后应用和不应用聚乳酸-聚羟乙酸／磷酸三钙薄膜包裹两种情况下，术后不同时期屈肌腱的粘连情况和聚乳酸-聚羟乙酸／磷酸三钙薄膜在肌腱愈合过程中的作用。方法：实验于2004-03／10在东南大学修复重建外科研究所实验室进行。选取健康成熟的三黄鸡40只，以右足第2，3趾深屈肌腱横断后修复作为肌腱粘连的动物模型，取右足第2趾为实验趾、第3趾为对照趾。聚乳酸-聚羟乙酸／磷酸三钙薄膜包裹，术后3，4，8周分别取材。通过生物力学、大体观察、组织学及扫描电镜检查，观测肌腱愈合情况、与周围组织的粘连情况、屈趾功能及假鞘结构。结果：进入结果分析的实验鸡39只。①实验趾肌腱的屈趾功能明显优于对照趾[术后3周：（10．53&;#177;1．07），（7．78&;#177;0．37）mm，术后4周：（14．96&;#177;1.51），（9．37&;#177;1．35）mm，术后8周：（19．93&;#177;0．81），（11．47&;#177;0．15）mm，P〈0．05]。②大体观察实验趾在各时间段肌腱与腱周组织的粘连均较对照趾轻，肌腱为内源性愈合，并形成具有正常滑膜A、B型细胞的假鞘结构，与肌腱间有间隙。结论：聚乳酸-聚羟乙酸／磷酸三钙薄膜通过刺激周围组织形成假鞘，阻止来自腱周的粘连，且不影响肌腱正常愈合，是较理想的预防肌腱粘连材料。     

嗜酒与乙型肝炎病毒感染的临床特征

我国是HBV感染的高流行区，根据2002年全国HBV感染者血清流行病学调查，3岁以上人群HBsAg的阳性率为9．09％。慢性HBV感染者中，肝硬化失代偿的年发生率约3％，5年累计发生率约16％，其中6％-15％可发展为肝细胞癌，长期持续的高病毒负荷增加了肝硬化、肝癌患者死亡的危险性。随着我国经济的发展和人民生活水平的提高，饮食习惯的改变和社会交往的增多，酒精的消耗量和嗜酒者也逐年增加，     

肝硬化病因及临床特点分析178例

目的:探讨东北地区肝硬化患者病因及临床特点.方法:选择我院2007-01/2007-10住院确诊的肝硬化患者178例,回顾性分析患者的临床资料和实验室检查结果.结果:178例患者中单纯乙型肝炎病毒感染61例(34.3%),单纯丙型肝炎病毒感染11例(6.2%),乙型与丙型肝炎病毒重叠感染3例(1.7%),单纯饮酒所致肝硬化39例(21.9%),酒精合并肝炎病毒共同损伤所致肝硬化27例(15.2%),其他为原发性胆汁性肝硬化8例(4.5%),不明原因肝硬化29例(16.3%).肝炎病毒感染和酒精中毒所致肝硬化相比,除蜘蛛痣(x2=4.503,P=0.034)外,其他症状和体征的发生率无显著性差异.肝硬化并发症为上消化道出血(42.0%)、原发性肝癌(28.7%)、继发感染(16.1%)和肝性脑病(11.2%).结论:东北地区的肝硬化病因仍然以乙型肝炎病毒感染为主.单纯病毒感染所致肝硬化的临床表现以门脉压力增高为主,酒精中毒则以肝功能损伤为主,肝炎病毒重叠感染及嗜酒与病毒感染并存容易导致肝癌的发生.     

RICU高龄患者机械通气初期睡眠障碍原因分析

目的:了解呼吸重症监护病房(RICU)高龄患者机械通气初期睡眠情况及影响因素。方法:采用匹兹堡睡眠质量指数对2010.1～2011.6收治RICU的50例高龄患者机械通气初期睡眠情况进行评估,用自编调查表研究睡眠质量的影响因素。结果:50例患者PSQl评分7.86±4.28分,其中有睡眠问题的占64%;引起的原因有年龄、环境陌生、医源性干扰、生理和心理不适。结论:RICU高龄患者机械通气初期睡眠差,其影响因素多,护士可根据实际情况采取个体化护理对策,改善患者睡眠质量,促进患者康复。     

自体软骨移植联合鼻唇肌复位术矫治单侧唇裂术后继发鼻畸形

目的探讨自体鼻中隔软骨与耳软骨联合移植同时行鼻唇肌复位术在单侧唇裂术后鼻畸形矫正中的疗效。方法将松解移位的鼻翼软骨悬吊复位至正常解剖位置,切取自体鼻中隔软骨修整成形后植入鼻翼软骨两内侧脚间,耳软骨植入充填患侧鼻翼,同期行鼻唇肌复位术,重建鼻软骨肌肉环,修复鼻部畸形。结果 26例鼻畸形患者术后不同程度改善,随访2～9个月,鼻外形美观,效果满意。结论应用自体鼻中隔及耳软骨移植重建鼻软骨支架同时行鼻唇肌复位术能有效矫正单侧唇裂术后鼻畸形。