腹型肥胖的研究进展

近年来腹型肥胖作为代谢综合征最重要的特征得到了广泛关注.脂质异位沉积学说提出腹部皮下脂肪与内脏脂肪一样,在促进胰岛素抵抗形成的过程中发挥关键作用,同时也是导致心血管代谢风险的重要因素,而并非仪表现为既往所认为的机体保护作用.提示无论腹部皮下脂肪还是内脏脂肪堆积引起的腰围增加都应当得到足够的重视,也进一步支持将腰围作为代谢综合征工作定义中肥胖的诊断标准.腹型肥胖的治疗基础仍是生活方式干预,而体液因子、胃肠道激素及棕色脂肪研究的开展为腹型肥胖提供了新的治疗方向.     

哮喘大鼠肺组织中Wnt5a/JNK信号通路相关分子表达增强

目的研究Wnt5a/JNK信号通路相关分子在哮喘大鼠肺组织中的表达。方法将实验大鼠随机分为正常组和哮喘组,成功复制哮喘模型后,通过HE染色观察气道病理改变,实时荧光定量PCR检测肺组织和血液中Wnt5a mRNA的表达,Western blot法检测肺组织中磷酸化的c-Jun(p-c-Jun),磷酸化的c-Jun N端激酶(JNK)蛋白的表达。结果与正常组相比,哮喘组支气管黏膜增厚,褶皱增多,管腔狭窄;气管和血管周围有炎细胞的浸润。气道壁与平滑肌层显著变厚。哮喘组大鼠肺组织和血液中Wnt5a mRNA与对照组比较表达上调,p-c-Jun,p-JNK蛋白表达增加。结论哮喘大鼠的Wnt5a、p-JNK、p-c-Jun表达增强。     

小泛素相关修饰物与1型糖尿病

小泛素相关修饰物作为一个表达于全身多个器官的蛋白质家族,可对胞内多种转录因子、酶、蛋白质进行翻译后修饰.生理状态下,小泛素相关修饰物与胰岛β细胞的发育、成熟以及胰岛素的分泌密切相关.同时,它通过抑制机体自身免疫反应,减少胰岛β细胞凋亡而减缓1型糖尿病的发生、发展.对此家族蛋白及其修饰过程的深入研究为治疗1型糖尿病提供新的思路.     

糖尿病未必增加重症监护病房患者的死亡率

近年来一些研究结果显示在发生急性高血糖的重症监护病房(ICU)患者中,糖尿病患者的死亡率低于非糖尿病患者,而且无糖尿病史的患者更能从强化胰岛素治疗中获益.这似提示糖尿病对危重疾病潜在的"保护"作用.可能的"保护"机制包括糖尿病对慢性氧化应激状态的适应性反应、糖尿病患者危重疾病并发症的发生率下降及一些非生物学保护因素.因此对于无糖尿病史高血糖ICU患者的血糖管理应当给予更多的关注.     

Clinical analysis of inpatients with hyperglycemia in the medical intensive care units——Data of Shanghai Renji Hospital from 2002 to 2009

Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.     

糖尿病未必增加重症监护病房患者的死亡率

近年来一些研究结果显示在发生急性高血糖的重症监护病房(ICU)患者中,糖尿病患者的死亡率低于非糖尿病患者,而且无糖尿病史的患者更能从强化胰岛素治疗中获益.这似提示糖尿病对危重疾病潜在的"保护"作用.可能的"保护"机制包括糖尿病对慢性氧化应激状态的适应性反应、糖尿病患者危重疾病并发症的发生率下降及一些非生物学保护因素.因此对于无糖尿病史高血糖ICU患者的血糖管理应当给予更多的关注.     

胰岛素抗炎机制研究进展

胰岛素是体内唯一降低血糖的激素,目前,临床上主要使用胰岛素治疗糖尿病.然而,胰岛素不仅是一个重要的代谢调节激素,而且是一个重要的抗炎因子.其发挥抗炎作用的具体机制可能为:直接调节炎性反应因子,抑制氧化应激,调节一氧化氮的表达,在血管水平发挥抗炎作用,促进辅助性T细胞(Th)-2的转化,抑制白细胞介素-6-信号转导与转录激活因子(IL-6-STAT)炎性反应通路,降低C反应蛋白水平,下调Toll样受体等.     

脂蛋白脂酶基因敲除小鼠糖脂代谢研究及其胰岛素抵抗的机制探索

目的 研究不同周龄脂蛋白脂酶(LPL)基因敲除小鼠糖脂代谢情况,并探究其胰岛素抵抗的可能机制。 方法 分别选取16周和40周LPL基因敲除杂合子小鼠(LPL＋/–)和野生型(WT)C57小鼠作为实验对象,将其分为4组：16周LPL＋/–组( n＝6)、16周WT组( n＝6)、40周LPL＋/–组( n＝6)和40周WT组( n＝6)。注射肝素后,分别测定LPL＋/–小鼠及WT小鼠血清LPL活性;检测4组小鼠血清甘油三酯和游离脂肪酸水平;行腹腔葡萄糖耐量试验(IPGTT)监测血糖变化,计算葡萄糖曲线下面积(AUCG)和稳态模型评估的胰岛素抵抗指数(HOMA-IR)、稳态模型评估的β细胞功能指数(HOMA-β),评价胰岛素敏感性及胰岛β细胞功能;采用比色法测定血清丙二醛和总抗氧化力水平;用二氢乙啶(DHE)荧光染色法检测肝脏和骨骼肌中活性氧簇(ROS)水平。 结果 16和40周龄LPL＋/–组小鼠LPL活性均明显低于同周龄WT组小鼠( P<0.05)。40周龄LPL＋/–组小鼠血清甘油三酯和游离脂肪酸水平显著高于同周龄WT组小鼠( P<0.05),也明显高于16周龄LPL＋/–组小鼠甘油三酯、游离脂肪酸水平( P<0.05)。与同周龄WT组比较,40周龄LPL＋/–组小鼠IPGTT 30、120 min血糖明显上升( P<0.05),空腹胰岛素、HOMA-IR显著升高( P<0.05)。40周龄LPL＋/–组小鼠血清丙二醛明显升高( P<0.05),总抗氧化力显著降低( P<0.05)。16周龄LPL＋/–组小鼠骨骼肌中ROS表达水平显著增加,而40周龄LPL＋/–小鼠中肝脏、骨骼肌ROS水平均明显高于同周龄WT组小鼠。 结论 LPL＋/–小鼠随着年龄增长,脂代谢紊乱加重,血糖升高且出现明显胰岛素抵抗。血脂异常的LPL＋/–小鼠产生的胰岛素抵抗可能与氧化应激有关。     

白及产业现状及可持续发展策略

近年来,白及产业发展迅速,在医药、保健、美容等领域广泛应用,但是仍存在制约产业可持续发展的问题。通过对白及市场和产业发展现状进行实地调查,查阅相关文献并结合课题组研究成果,发现其主要存在以下制约因素：野生资源短缺,品种参差不齐;作用机制不明确,综合利用程度低;质量标准不明确,品质难以控制;产业层次低,产业集群发展缓慢等。因此,应通过加强白及种质资源保护和优良品种选育,深化白及作用机制和综合开发利用研究,完善白及质量评价体系,实施品牌战略,拓展销售市场等方法促进白及产业健康及可持续发展。     

Clinical analysis of inpatients with hyperglycemia in the medical intensive care units——Data of Shanghai Renji Hospital from 2002 to 2009

Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.