脑血管病患者血浆抵抗素水平与胰岛素抵抗的相关性研究

目的　探讨脑血管病患者血浆抵抗素水平与胰岛素抵抗(IR)之间的关系。方法　采用酶联免疫方法(ELISA)测定50例动脉粥样硬化性血栓性脑梗死(ACI)、36例腔隙性脑梗死(LI)、36例脑出血(ICH)患者及46名健康对照者的空腹血浆抵抗素、胰岛素(INS)水平,同时检测空腹血糖、血脂、血压、身高和体质量,计算体质量指数(BMI)和INS敏感指数(QUICKI)。结果　ACI和ICH组空腹INS水平均明显高于对照组(P<0 .05,P< 0 .01 ),QUICKI值均显著低于对照组(P< 0 .05,P< 0. 01 );ICH组血浆抵抗素水平[ (7. 47±4. 60)ng/ml]与对照组[ (5. 32±2. 15)ng/ml]相比明显升高(P<0 .05 );ACI、LI组血浆抵抗素水平与对照组差异均无显著性(均P>0. 05)。血浆抵抗素水平与QUICKI呈负相关(r=-0 188,P<0 .05)。结论　脑血管病患者存在IR,血浆抵抗素水平可能与IR密切相关。     

瘦素及瘦素受体与缺血性脑血管病的相关性研究

目的探讨血瘦素水平和瘦素受体(LR)基因多态性对胰岛素敏感性影响及与缺血性脑血管病发病的关联。方法对81例动脉粥样硬化性血栓性脑梗死(AC I)、75例腔隙性脑梗死(LI)和36例健康对照者(HC)以放射免疫法检测血胰岛素水平、以ELISA检测血瘦素水平、以PCR-RFLP分析LR基因第6、20外显子碱基变异状况,并根据受试者血糖和胰岛素水平判定其胰岛素敏感指数(ISI)。结果AC I患者血胰岛素水平(6.17±4.33)μIU/m l显著高于对照者(3.49±1.85)μIU/m l(t=4.225,P<0.05),相应其ISI值则明显减低(-3.22±0.79 vs.-2.75±0.54);LI患者血胰岛素水平及ISI值与对照者无明显差异。各组受试者间血瘦素水平无显著差异,但AC I患者中血瘦素水平高于正常均值者的比例(55.56%),也显著高于对照者的比例(38.89%)(x2=7.023,P<0.05)。血瘦素水平与ISI值呈显著负相关。LR基因第6、20外显子各等位基因和基因型分布在各受试组间无明显差别,且各基因型受试者间血瘦素水平也无明显差别。结论AC I发病可能与胰岛素敏感性降低有关,血瘦素水平对胰岛素敏感性有负性影响作用。     

急性脑梗死患者简易胰岛素抵抗指数水平的临床研究

目的观察急性脑梗死患者的甘油三酯血糖指数(简易胰岛素抵抗指数TyG)和稳态模型评估的胰岛素抵抗指数(HOMA-IR)特点,并分析两指数的相关性。方法采用放射免疫法测定46例急性脑梗死(ACI)及40例健康对照者的空腹血胰岛素、空腹血糖、TG水平,计算简易胰岛素抵抗指数(TyG)和稳态模型评估法胰岛素抵抗指数(HOMA-IR)。结果急性脑梗死组TyG和HOMA-IR均较对照组增高(P0.05);急性脑梗死组和对照组TyG和HOMA-IR具有良好的相关性(分别为r=0.34,P0.05;r=0.27,P0.05)。结论急性脑梗死患者存在胰岛素抵抗,TyG评价胰岛素抵抗是一种简单准确的方法。     

血清超敏C反应蛋白与急性脑梗死的相关性研究

目的探讨血清超敏C反应蛋白(hsCRP)水平与急性脑梗死病情严重程度及危险因素的关系。方法采用全自动生化分析仪测定186例动脉粥样硬化性血栓性脑梗死(ACI)及155例腔隙性脑梗死(LI)患者的血清hsCRP、血糖、血脂等指标,并与329名健康者进行对照。同时对急性脑梗死患者血清hsCRP水平与病情进行相关分析。结果ACI组和LI组的hsCRP水平显著高于正常对照组(均P<0.05);hsCRP水平与急性脑梗死患者神经功能缺损程度相关(P<0.05);hsCRP水平与ACI组年龄、舒张压、血糖、三酰甘油水平呈正相关(r=0.261、0.222、0.261、0.166,均P<0.05),与LI组患者的年龄、收缩压、血糖、总胆固醇水平呈正相关(r=0.294、0.456、0.245、0.402,均P<0.05),与高密度脂蛋白水平负相关(r=-0.371,P<0.05)。结论hsCRP水平与急性脑梗死的病情严重程度明显相关;并与其危险因素相关。     

脑梗死患者的胰岛素抵抗与血浆组织型纤溶酶原激活物抑制物-1活性相关性的研究

目的　探讨动脉硬化性脑梗死 (ACI)患者急性期和恢复期的胰岛素抵抗 (IR)与血浆组织型纤溶酶原激活物 (t PA)抑制物 1(PAI 1)活性的关系。方法　分别测定 91例ACI患者急性期和恢复期血糖、胰岛素水平和血浆t PA和PAI 1的活性。血糖与胰岛素乘积之倒数的自然对数作为胰岛素敏感性指数 (ISI) ,并与4 0名健康同龄人对照。结果　ACI患者急性期和恢复期的血糖、胰岛素水平及PAI 1活性显著高于对照组(P <0 0 1～ 0 0 5 ) ,ISI和t PA活性显著低于对照组 (P <0 0 1～ 0 0 5 ) ;PAI 1活性与胰岛素水平显著正相关(r=0 .6 7,r=0 .6 6 ,均P <0 0 1) ,与ISI显著负相关 (r=- 0 .85 ,r=- 0 .6 6 ,均P <0 0 1) ;t PA活性与这些参数不相关 ;脑梗死体积与ISI负相关 (r=- 0 .19,P <0 .0 5 ) ,与PAI 1活性正相关 (r=0 .5 6 ,P <0 .0 5 ) ;体重指数与ISI负相关 (r=- 0 .4 9,P <0 .0 5 ) ,与PAI 1活性正相关 (r=0 .5 3,P <0 .0 5 )。结论　IR提高ACI患者的血浆PAI 1活性 ,IR的个体处于脑血栓形成的危险之中     

青年缺血性脑卒中患者血清瘦素和胰岛素水平的测定

目的 研究青年缺血性卒中患者的血清胰岛素和瘦素水平.方法 选取89例健康查体者(对照组)及112例青年缺血性卒中患者(病例组),应用放射免疫技术检测其空腹胰岛素和瘦素水平并进行比较.结果 脑梗死组血清胰岛素水平高于对照组,尤其是女性患者(P<0.05).脑梗死组血清瘦素水平高于对照组(P<0.01).脑梗死组和对照组男性患者瘦素水平均低于女性患者(P<0.05).结论 青年卒中患者存在高瘦素、高胰岛素水平,这两者可能是导致青年缺血性卒中的危险因素之一.     

动脉粥样硬化性脑梗死与胰岛素抵抗的相关性研究

目的探讨胰岛素抵抗与动脉粥样硬化性脑梗死的关系。方法选取动脉粥样硬化性脑梗死患者76例,分为神经功能缺损轻型组和中重型组,健康对照者48例;各组分别检测空腹血糖、空腹血清胰岛素、血脂、尿酸,计算胰岛素敏感指数,采用SPSS软件进行统计学分析。结果动脉粥样硬化性脑梗死组空腹血糖、空腹血清胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、胰岛素敏感指数与对照组比较差异均有统计学意义(P<0.05);动脉粥样硬化性脑梗死神经功能缺损,中重型组空腹血糖、空腹血清胰岛素、胰岛素敏感指数与轻型组比较差异均有统计学意义(P<0.05)。结论动脉粥样硬化性脑梗死患者存在胰岛素抵抗,胰岛素抵抗可能是动脉粥样硬化性脑梗死的危险因素;胰岛素抵抗与神经功能缺损的严重程度有关。     

伴颈动脉粥样硬化的急性脑梗死患者胰岛素抵抗与TNF-α关系的临床研究

目的探讨肿瘤坏死因子α(TNF-α)与胰岛素抵抗(IR)在伴颈动脉粥样硬化(CAS)的急性脑梗死中的作用机制及二者之间的关系。方法比较44例伴CAS的急性脑梗死患者与80例健康对照组中空腹血糖(FPG)、空腹血清胰岛素(FINS)、胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)、TNF-α、体重指数(BMI)等6个因素之间有无差异,并了解IR与TNF-α的相关性。结果伴CAS的急性脑梗死组与对照组相比,FPG、FINS、HOMA-IR、TNF-α明显高于对照组,ISI明显低于对照组(P<0.01或P<0.05);脑梗死组中,ISI与TNF-α呈显著负相关(r=-0.494,P<0.01)。结论在伴有CAS的急性脑梗死中同时存在IR及TNF-α升高,IR程度与TNF-α呈正相关。     

急性脑梗死与胰岛素抵抗及胰岛素抗体水平相关性分析

目的 探讨急性脑梗死(ACI)与胰岛素抵抗(IR)及胰岛素抗体(IAb)水平之间的相关性.方法 采用放射免疫法测定34例ACI组,28例ACI恢复期组及30名健康对照者的空腹血胰岛素(INS)、IAb水平,同时检测空腹血糖(FBG)、血脂,计算胰岛素敏感指数(ISI).结果 ACI组INS、IAb显著高于恢复期组及对照组;ISI较对照组显著降低.结论 ACI患者存在明显IR,血IAb水平亦显著增高,IR及IAb可能参与了ACI的发病过程.     

脑梗死患者的亚临床炎症及胰岛素抵抗

目的观察脑梗死患者的亚临床炎症及胰岛素抵抗(IR)情况。方法检测114例脑梗死患者(脑梗死组)血清C-反应蛋白(CRP)、白介素-6(IL-6)及空腹胰岛素(Fins)、空腹血糖(FPG)、血脂、血压水平,分析胰岛素敏感指数(ISI)与炎症指标的关系,并与70例非脑梗死患者(对照组)进行比较。结果⑴脑梗死组血清CRP水平[(2.73±0.87)mg/L]、IL-6水平[(0.14±0.03)ng/ml]明显高于对照组[(1.63±0.93)mg/L、(0.12±0.03)ng/ml](均P<0.01),ISI(-4.31±0.53)明显低于对照组(-3.92±0.43)(P<0.01);⑵脑梗死组中,CRP>8.2mg/L患者的ISI(-4.63±0.71)明显低于CRP≤8.2mg/L患者的ISI(-4.18±0.54)(P<0.05)。结论脑梗死患者存在血清炎症的证据及IR;并且IR和亚临床炎症反应水平相一致。     

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.     

Antidepressants and cytokines--clinical and experimental studies

Clinical and experimental studies indicate that stress and depression are associated with the up-regulation of the immune system, including increased production of pro-inflammatory cytokines. When administered to patients or laboratory animals, some of these cytokines induce typical symptoms of depression. It is known that cytokines modulate brain neurotransmission and the activity of the hypothalamic-pituitary-adrenal axis, both of which are disturbed in depression. This review summarizes in vivo, ex vivo and in vitro clinical and experimental studies of the effect of antidepressants on cytokine production. In vitro culture and animal studies in particular suggest that antidepressants of several classes decrease the production of pro-inflammatory cytokines and shift the pro/anti-inflammatory cytokine balance towards the latter. Some studies suggest that immunological disturbances, including changes in cytokine levels, are not shared by all depressive patients, which means that only in certain groups of patients may the immunomodulatory action of antidepressants play a significant role in producing the therapeutic effect.     

Anger and depression--theoretical and clinical considerations

The Freudian idea of inhibited anger being central to the pathogenesis of depression has been one of the cornerstones of psychiatric thinking. The aim of this article is to review the literature on psychotherapy theory and the relevant research with regard to the association of anger and depression, and to discuss clinical implications in treating depressive patients. Choice of research articles was based on systematic search of databases. Psychotherapy theories are mostly found in books not included in databases. Literature on psychotherapy theory was selectively chosen. Over-control, under-control and mixtures of the two may be present in depression, indicating problems in anger regulation. The links between anger and depression form a complex network. When treating patients with depression, explicit or implicit dealing with anger often seems to be helpful. In clinical reality, the relative amounts of elicitation of anger experience and training in expressive control needed by depressive patients may vary between different types of patients, different phases of depressive disorder, and different phases of therapy.