新诊断2型糖尿病患者血清高分子量脂联素水平及其影响因素分析

目的观察新诊断T2DM患者血清高分子量脂联素(HMW-APN)水平,探讨其与糖脂代谢、IR及胰岛β细胞功能的关系。方法 176例研究对象,根据75g OGTT结果分为新诊断T2DM组88例和NGT组88名,两组再以BMI 25kg/m2为切点分为正常体重(NW)亚组和肥胖(OB)亚组。检测各组HbA1c、血糖、胰岛素、血脂及HMW-APN水平。结果T2DM组血清HMW-APN水平低于NGT组[0.99(0.52~1.56)vs 2.53(1.69~5.44)ng/L](P<0.01)。T2DM组和NGT组的OB亚组HMW-APN水平均低于同组内NW亚组[0.74(0.35~1.39)vs 1.21(0.74~2.08)ng/L;2.11(1.47~4.01)vs 4.49(2.40~6.11)ng/L](P<0.05)。相关性分析提示,HMW-APN与BMI、WC、WHR、SBP、TG、FPG、2hPG、HbA1c、FIns、2hIns、胰岛素抵抗指数(HOMA-IR)、高敏C反应蛋白(hsC-RP)呈负相关(P<0.05或P<0.01),与HDL-C、胰岛β细胞功能指数(HOMA-β)呈正相关(P<0.01)。多元逐步回归分析提示,2hPG、hsC-RP及WHR是血清HMW-APN水平的独立影响因素。结论血清HMWAPN水平在新诊断T2DM患者中降低,其与肥胖、糖脂代谢、IR、胰岛β细胞功能及hsC-RP密切相关,提示血清HMW-APN下降可能参与了肥胖和T2DM的发生发展。     

不同空腹血糖水平糖尿病患者尿酸排泄分数的变化及其相关因素分析

目的观察不同FPG水平的糖尿病患者尿酸排泄分数(FEur)的变化,并分析其影响因素。方法根据75 g OGTT结果,将482例研究对象分为NGT组(FPG5.6 mmol/L)122名、IFG组(5.6mmol/I≤FPG7.0 mmol/I)144例及T2DM组(FPG≥7.0 mmol/L)216例,比较各组一般资料及生化指标。另根据FEur水平进行三分位分组,从低到高依次为低分位(3.14%~3.86%)组、中分位组(4.12%~7.73%)及高分位(7.84%~11.60%)组,比较各组参数的差异,并采用Pearson相关分析和Logistic回归分析FEur的影响因素。结果 (1)与其他两组比较,T2DM组年龄、BMI、WC、FPG、2 hPG、FIns、HOMA-IR、HbA在c、TG、eGFR及FEur升高,而2 hIns、HOMA-β及SUA降低(P0.05或P0.01)。与NGT组比较,IFG组FPG、2 hPG、FIns及HOMA—IR升高,2 hIns及HOMA-β降低(P0.05)。(2)经三分位分组后,随FEur水平逐渐升高,FPG水平亦逐渐升高(P0.05或P0.01)。(3)Pearson相关分析结果显示,FEur水平与FPG、2 hPG及HbA在c呈正相关(r=0.465、0.249、0.150,P0.05),与BMI、FIns、HOMA—IR及SUA呈负相关(r=—0.287、—0.090、—0.279、—0.225,P0.05)。Logistic回归分析结果显示,BMI、FPG、HbA在c、SUA为FEur水平的影响因素。结论 FPG水平与FEur相关,FEur可反映肾脏处理UA的状况,糖尿病患者监测其水平变化,对避免高尿酸带来的肾脏的损害具有一定帮助。     

二肽基肽酶-4抑制剂对2型糖尿病患者血糖和胰岛功能的影响

目的 探讨口服降糖药二肽基肽酶-4（DPP-4）抑制剂对T2DM患者的临床疗效及安全性.方法 对32例口服降糖药及胰岛素治疗血糖控制不佳的T2DM患者使用DPP-4抑制剂进行12周的治疗观察,测定治疗前后BMI、SBP、DBP、TC、TG、FPG、2 hPG、Scr、谷丙转氨酶（AST）、HbA1 c、FC-P及2 hC-P水平.同时计算胰岛素抵抗指数[HOMA-IR（C-P）]及胰岛β细胞功能指数[HOMA-β（C-P）].结果 12周后FPG[（7.94±0.52）mmol/L]、2 hPG[（12.29±1.07） mmol/L]、HbA1c[（8.44±0.50）％]均较治疗前下降（P＜0.01）,FC-P水平[（6.52±0.13） pmol/L]、2 hC-P水平[（7.83±0.17） pmol/L]及HOMA-β均增加（P＜0.01）.研究期间均无严重低血糖事件发生. 结论 DPP-4抑制剂可降低T2DM患者FPG、2 hPG、HbA1c水平,同时改善胰岛β细胞功能,且无明显不良反应,安全性较好.     

新疆维吾尔族2型糖尿病患者Fosl2蛋白表达及与胰岛素抵抗及胰岛β细胞功能的关系

目的探讨新疆维吾尔族T2DM患者Fosl2蛋白表达,及与IR和胰岛β细胞功能的关系。方法收集新疆喀什地区维吾尔族T2DM患者(T2DM组)及非糖尿病者(Non-DM组),各50例,测量身高、体重、WC、臀围、SBP、DBP,检测FPG、HbA1c、FIns、血脂及Fosl2蛋白水平,计算BMI、WHR、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)及胰岛素敏感指数(HOMA-IS)。结果 (1)T2DM组Fosl2蛋白水平[(18.09±19.48)vs(41.48±26.32)ng/ml]、ln HOMA-IS[(-4.93±0.73)vs(-3.90±0.80)]及ln HOMA-β[(3.63±0.97)vs(4.65±0.85)]低于Non-DM组(P0.01),而BMI、FPG、HbA1c、TC、TG、LDL-C、HDL-C、FIns及HOMA-IR均高于Non-DM组(P0.05);(2)相关性分析显示,在维吾尔族人群中,Fosl2水平与BMI、FPG、HbA1c、TC、HOMA-IR呈负相关(P0.05),与ln HOMA-IS呈正相关(P0.01);在维吾尔族T2DM人群中,Fosl2水平与TG呈正相关,与FIns、ln HOMA-β呈负相关(r=0.536、-0.465、-0.469,P0.05)。结论 Fosl2蛋白表达水平与新疆维吾尔族IR、胰岛β细胞功能密切相关,Fosl2蛋白表达水平下调可能参与了维吾尔族T2DM的发生发展。     

2型糖尿病HbA1c与胰岛β细胞功能及IR的关系

将196例新诊断为T2DM的患者按HbA1c水平分为1组(HbA1c≤7.5%)、2组(HbA1c9.0%)和3组(HbA1c≥9.0%)。采用HOMA-β,HOMA-IR评价基础胰岛素分泌功能和IR程度。采用ΔI130/ΔG30、INSAUC评价第一相胰岛素分泌功能。结果①校正性别、年龄、BMI后,随HbA1c的升高,HOMA-β及第一相胰岛素分泌下降,HbA1c≥9.0%组HOMA-IR较1组、2组升高。②HOMA-β、ΔI130/ΔG30、INSAUC与血糖、HbA1c、TG成负相关;HOMA-IR与血糖、BMI、TG正相关。③多元逐步回归分析显示,FPG、BMI和HbA1c是HOMA-β的独立影响因素;BMI、HbA1c和TG是ΔI130/ΔG30的独立影响因素;腰围、FPG、BMI是INSAUC的独立影响因素;BMI、TG、是HOMA-IR的独立影响因素。结论T2DM患者存在胰岛素分泌缺陷及IR,两种情况在HbA1c水平较高者中尤为显著。     

口服降糖药治疗血糖控制不佳的2型糖尿病患者联用艾塞那肽安全性和疗效观察

目的 观察口服降糖药(OADs)治疗血糖控制不佳T2DM患者联用艾塞那肽的临床疗效及安全性. 方法 对40例OADs治疗血糖控制不佳且BMI＞23 kg/m2的T2DM患者加用艾塞那肽治疗12周,测定治疗前后相关指标;稳态模型评估胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β). 结果 加用艾塞那肽治疗12周后,FPG、2 hPG、HbA1 c、HOMA-IR、BMI、TG较治疗后下降[FPG(8.77±1.92)vs (7.49±1.14) mmol/L;2 hPG(16.55±3.24)vs(14.69±1.50) mmol/L;HbA1 c(8.91±1.37)％vs(7.94±0.90)％;HOMA-IR (1.44±0.41)vs(1.24±0.25);BMI (30.34±2.91)vs(29.41±2.59) kg/m2;TG(2.21±1.34)vs(1.59±0.51)mmol/L] (P＜0.01);2 hIns及HO-MA-β较治疗前增加[(5.96±0.65)vs(6.10±0.46)pmol/L;(3.81±0.54)vs(4.01±0.32)](P＜0.05或P＜0.01).所有病例均无严重低血糖事件发生. 结论 使用OADs治疗血糖控制欠佳的T2DM患者加用艾塞那肽可降低血糖、BMI及TG,同时改善胰岛β细胞功能和IR,且安全性较好.     

胰岛素强化治疗对初诊2型糖尿病患者胰岛β细胞功能和胰岛素抵抗的影响

目的探讨阶梯式胰岛素强化治疗对初诊2型糖尿病（T2DM）患者胰岛β细胞功能和胰岛素抵抗（IR）的影响及机制。方法初诊T2DM患者61例,进行为期2周的胰岛素强化治疗和后续10周的预混胰岛素治疗,比较治疗前后FPG、2hPG、HbA1c、Fins、2hIns、FC-P、2hC-P、TC、TG、胰岛β细胞分泌指数（HOMA-β）和胰岛素抵抗指数（HOMA-IR）的变化。结果治疗后患者FPG、2hPG、HbA1 c和HOMA-IR显著下降,而Fins、2hIns、FC-P、2hC-P和HOMA-β显著上升。结论对血糖明显升高的初诊T2DM患者,短期胰岛素强化治疗及后续数周预混胰岛素皮下注射治疗可有效控制血糖,明显改善胰岛8细胞功能并减轻IR。     

血清甲状旁腺激素水平与新诊断2型糖尿病患者胰岛素抵抗和胰岛β细胞功能的相关性研究

目的分析新诊断T2DM患者血清甲状旁腺激素(PTH)水平与IR和胰岛β细胞功能的关系。方法选取2018年1~12月于我院内分泌科住院治疗的新诊断T2DM患者120例(T2DM组),另选取同期于我院健康体检者40名为正常对照(NC)组,检测两组血清PTH、FPG、HbA_1c和FIns等指标,并采集餐后30、60、120及180 min静脉血检测BG、Ins和C-P水平。稳态模型评估胰岛素抵抗指数(HOMA-IR);胰岛β细胞功能评估分别采用HOMA-β和早期Ins分泌指数(ΔI_(30)/ΔG_(30))。结果将T2DM组按照PTH水平分为T1亚组(25.16 ng/L)、T2亚组(25.16~38.35 ng/L)和T3亚组(≥38.35 ng/L)。随着PTH水平升高,HbA_1c水平逐渐降低,ΔI_(30)/ΔG_(30)呈增加趋势,2 hPG降低(P0.05)。Pearson相关性分析显示,PTH与HbA_1c呈负相关,与ΔI_(30)/ΔG_(30)呈正相关(P0.05),与HOMA-β和HOMA-IR不相关。结论 T2DM患者血清PTH水平与胰岛β细胞早时相Ins分泌相关,与基础Ins分泌不相关。     

不同糖耐量患者糖化血红蛋白与胰岛素抵抗的相关性研究

目的 探讨不同糖耐量患者HbA1 c与IR的相关性.方法 291名受试者行75 gOGTT,根据结果分为T2DM、IGR和正常糖耐量（NGT）组,分析各组HbA1c与IR相关指标的关系.结果 T2DM组FPG、2 hPG、HbA1c、LDL-C、FIns和胰岛素抵抗指数（HOMA-IR）高于IGR组,HDL-C、胰岛素分泌指数（HOMA-β）和ISI低于IGR组（P＜0.05或P＜0.01）.T2DM组HbA1c与TG、HOMA-IR呈正相关（r=0.17,P=0.03;r=0.19,P=0.02）,与HOMA-β、ISI呈负相关（r=-0.39,P=0.00;r=-0.28,P=0.00）.IGR组HbA c与HOMA-β、ISI呈负相关（r=-0.49,P=0.00;r=-0.32,P=0.02）.NGT组HbA1c与HOMA-IR、HOMA-β、ISI无相关性（P＞0.05）.结论 T2DM组HbA1 c、HOMA-IR高于IGR组,不同糖耐量组HbA1c与IR呈正相关.     

新诊断2型糖尿病患者血清pannexin-1水平与胰岛素抵抗关系的研究

目的探讨新诊断T2DM患者血清pannexin-1水平与IR的关系。方法选取2015年5月至2016年6月于我院就诊的新诊断T2DM患者62例(T2DM组)及同期体检健康者29名(NC组)。ELISA测定两组受检者空腹血清pannexin-1水平、FPG、FIns、血脂等水平,计算BMI、WC、IS和胰岛素抵抗指数(HOMA-IR)。结果 T2DM组血清pannexin-1水平高于NC组(P0.01)。相关分析显示,T2DM组血清pannexin-1与BMI、WC、FPG、HbA1c、TG、TC、FIns、HOMA-IR呈正相关,与胰岛β细胞功能指数(HOMA-β)、ISI呈负相关(P0.05或P0.01)。多元线性回归分析发现,HbA1c、WC是影响pannexin-1的独立危险因素(β=0.475、0.032,P0.05)。结论新诊断T2DM患者血清pannexin-1水平升高,参与了T2DM及IR的病理过程。     

Usefulness of procalcitonin for diagnosis of infective endocarditis

The aim of this study was to evaluate the accuracy of procalcitonin (PCT) in predicting infective endocarditis (IE). 23 adult patients with IE, 30 patients with sepsis and 30 with tick-borne encephalitis were included in this prospective study. The PCT serum level, C-reactive protein (CRP), total leukocyte, and immature polymorphonuclear (PMN) cell counts were determined on admission, prior to the institution of antibiotic therapy, and compared according to the diagnosis. The median PCT level in patients with IE endocarditis was 0.81 ng/ml, in patients with sepsis it was 43.74 ng/ml, and in the group with viral infection it was 0.25 ng/ml (P < 0.001). The highest PCT level was found in patients with Staphylococcus aureus endocarditis. The area under the receiver operating characteristic curve that used PCT to predict IE was 0.722 (95% CI 0.572–0.873), compared with 0.909 (95% CI 0.829–0.989) for CRP, 0.699 (95% CI 0.551–0.846) for immature PMN cell count, and 0.619 (95% CI 0.468–0.770) for leukocyte count. Our study fails to demonstrate superiority of PCT as a diagnostic laboratorial parameter in predicting IE compared to CRP.     

慢型、潜在型克山病患者的血管内皮功能观察

目的观察山东省慢型、潜在型克山病患者的临床特点和血管内皮功能,探讨机体内皮功能失调与克山病发生发展的关系。方法选择慢型、潜在型克山病患者57人、病区健康人34人,分别采集清晨空腹血检测ET、NO、NOS、iNOS及cNOS含量及活性。结果(1)克山病患者ET水平明显高于病区健康人(P<0.01);心功能越差,ET升高越明显(P<0.01);(2)NO和NOS含量,潜在型、慢型克山病均明显高于病区健康人(P<0.01);慢型高于潜在型(P<0.01);iN-OS含量克山病患者也高于病区健康人(P<0.05);慢型克山病高于潜在型克山病(P<0.05)。结论ET、NO水平的变化可能作为一种中间环节参与了克山病的发病机制;心功能不同,血浆ET、NO升高的程度也不同;ET、NO可作为克山病病情严重程度的预测指标。     

三七有效组分Rx对兔动脉粥样硬化的实验研究

目的：探讨三七有效组分R。对兔动脉粥样硬化的影响。方法：40只雄性新西兰大白兔随机分成正常对照组、高脂模型组、三七总皂甙组三七有效组分Rx高荆量组、三七总皂甙组三七有效组分Rx低刺量组，喂饲12周后同时处死．分别测定血一氧化氮(NO)、内皮素(ET)、PAI、t—PA、血浆脂质过氧化物、红细胞内超氧化物歧化酶(SOD)，并行主动脉壁形态学、主动脉壁光镜、透射电镜观察。结果：三七有效组分Rx高、低剂量组明显升高血NO、t—PA，降低血清ET、PAI水平，抗脂质过氧化，提高红细胞内SOD活性。大体形态、光镜、电镜显示，三七有效组分Rx高、低剂量组能减轻动脉粥样硬化病变程度，减少泡沫细胞层数。结论：三七有效组分Rx有干预动脉粥样硬化的作用。     

Papillomavirus Infectious Pathways: A Comparison of Systems

The HPV viral lifecycle is tightly linked to the host cell differentiation, causing difficulty in growing virions in culture. A system that bypasses the need for differentiating epithelium has allowed for generation of recombinant particles, such as virus-like particles (VLPs), pseudovirions (PsV), and quasivirions (QV). Much of the research looking at the HPV life cycle, infectivity, and structure has been generated utilizing recombinant particles. While recombinant particles have proven to be invaluable, allowing for a rapid progression of the HPV field, there are some significant differences between recombinant particles and native virions and very few comparative studies using native virions to confirm results are done. This review serves to address the conflicting data in the HPV field regarding native virions and recombinant particles.     

前列腺干细胞抗原在人前列腺癌组织中的表达及意义

目的 探讨前列腺干细胞抗原（PSCA）在人前列腺癌（PCa）和正常前列腺（NP）、良性前列腺增生（BPH）组织中的表达及其与临床分期、病理分级的关系。方法 采用免疫组织化学（IHC）链霉菌过氧化物酶法（SP法）检测26例人PCa石蜡包埋标本、10例BPH患者的前列腺切除标本及3例NP标本中PSCA的表达。结果 PSCA在PCa组织中表达阳性率为96．2％，其中强阳性率为88．5％。NP组织阳性率为66．7％（均为弱阳性）。BPH组织阳性率为70．0％（均为弱阳性）。PCa与NP、BPH组织表达水平差异有显著性意义（P〈0．01），BPH与NP组织表达水平无统计学意义（P〉0．05）。PSCA在PCa组织主要表达于癌细胞，细胞间质和肌肉组织均无表达；NP及BPH组织表达则定位于前列腺上皮的基底细胞层。PSCA表达水平与PCa临床分期、病理分级均无相关性（P〉0.05）。结论 PSCA是一个新的细胞表面抗原，可能在PCa的诊断、免疫治疗等方面具有广阔的应用前景。     

降钙素原在医院获得性肺炎和呼吸机相关性肺炎的诊断和抗感染管理中的应用价值

医院获得性肺炎(HAP)和呼吸机相关性肺炎(VAP)是我国现患率居第一位的医院感染性疾病。国内外相关指南相继进行了更新,旨在提高HAP/VAP诊断和治疗水平,改善患者的结局,但我们仍然面临诸多挑战。降钙素原(PCT)是较C反应蛋白(CRP)更特异的感染相关生物学标志物,对重症细菌感染和脓毒症具有反应快速、特异性高的优点,动态监测PCT可指导HAP/VAP的诊断及抗菌药物治疗的疗程。     

Palliative management of refractory dyspnea in COPD

COPD is a progressive illness with worldwide impact. Patients invariably reach a point at which they require palliative interventions. Dyspnea is the most distressing symptom experienced by these patients; when not relieved by traditional COPD management strategies it is termed “refractory dyspnea” and palliative approaches are required. The focus of care shifts from prolonging survival to reducing symptoms, increasing function, and improving quality of life. Numerous pharmacological and non-pharmacological interventions can achieve these goals, though evidence supporting their use is variable. This review provides a summary of the options for the management of refractory dyspnea in COPD, outlining currently available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled furosemide, Heliox, rehabilitation, nutrition, psychosocial support, breathing techniques, and breathlessness clinics.     

Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia

Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown. Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia. Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus. Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage. (J Cardiovasc Electrophysiol, Vol. 21, pp. 245–254, March 2010)     

Methemoglobin Forming Effect of Dimethyl Trisulfide in Mice

Abstract

Dimethyl trisulfide (DMTS) is a natural organic trisulfide that has been patented as a promising antidotal candidate against cyanide (CN). The primary mode of action of DMTS is as a sulfur donor that enables the conversion of CN to thiocyanate. Recently, it was discovered that DMTS is capable of oxidizing hemoglobin (Hb) to methemoglobin (MetHb) in vitro. The goal of these experiments was to measure the extent of DMTS-induced MetHb formation in vivo. In these experiments, intramuscular (IM) injections of formulated DMTS were administered to mice. Following the IM injection, blood was drawn and analyzed for MetHb using a rapid spectrophotometric method. Methemoglobin levels peaked in a dose-dependent manner between 20 and 30?min., and then began dropping. The highest MetHb levels measured for the 50, 100, 200 and 250?mg/kg doses of DMTS were respectively 3.28, 6.12, 9.69, and 10.76% MetHb. These experiments provide the first experimental evidence that IM administered DMTS generates MetHb in vivo and provide additional evidence for the presence of a secondary therapeutic pathway for DMTS - CN scavenging by DMTS-generated MetHb.     

Expression of membrane-type matrix metalloproteinases in synovial tissue from patients with rheumatoid arthritis or osteoarthritis

We investigated the expression of membrane-type matrix metalloproteinase (MT-MMP) and matrix metalloproteinase (MMP) mRNAs in synovial tissue from patients with rheumatoid arthritis (RA, n = 5) or osteoarthritis (OA, n = 5) by Northern blot analysis. Northern analysis demonstrated strong expression of MT1-MMP, MT3-MMP, MMP-1, and MMP-3 and weak expression of MT2-MMP and MMP-8 in synovial tissue from patients with RA or OA. MT4-MMP was not detected. No significant difference was shown in the expression of MT-MMP mRNAs between RA and OA. Synovial tissue of RA or OA patients expressed MT-MMPs as well as MMPs. These results indicate that, in addition to MMPs, MT1-MMP, MT3-MMP, and probably MT2-MMP may play a role in the degradation of bone and cartilage matrix in RA and OA. Such information may provide a clue to the development of a novel therapeutic approach targeted on the prevention of joint destruction. Received: April 30, 2000 / Accepted: September 19, 2000