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目的 探讨肾移植受者术前甘油三酯（TG）代谢对其移植肾早期功能（EGF）恢复的影响。方法 回顾性分析2011年1月-2014年12月170例在解放军309医院接受活体肾移植受者的临床资料,经排除标准筛选后最终纳入154例受者,其中男124例,女30例,年龄31.9±8.4岁。根据受者术前TG水平分为TG正常组（0.401.70mmol/L或需服用降脂药控制血脂者,n=47）,观察两组患者中移植肾功能恢复不佳（PEGF）、肾功能延迟恢复（DGF）和肾功能缓慢恢复（SGF）的发生率,进一步比较移植肾功能顺利恢复（IGF）的两组受者术后3、7及30d的肌酐（Scr）水平。绘制以TG为诊断指标的ROC曲线,以获得预测肾移植术后发生PEGF、SGF、DGF风险的最佳TG值。结果 与TG正常组相比,TG异常组的受者术后PEGF及DGF的发病率较高,差异有统计学意义（P〈0.05）。IGF的受者中,TG异常组术后7、30d的Scr值高于TG正常组,差异有统计学意义（P〈0.05）。术前TG预测PEGF、SGF及DGF的ROC曲线下面积（AUC）分别为0.774、0.704、0.818,均明显大于机会参考下面积（P〈0.05）,最佳临界值均为1.37mmol/L。结论 受者术前TG代谢异常对移植肾早期功能恢复可能具有负性影响。术前受者TG在正常高值时（〉1.37mmol/L）,其发生PEGF、SGF和DGF的风险便已增加。

背景与目的中链甘油三酯（medium chain triglyceride，MCT）饮食有助于外科手术患者快速康复，本研究将短期MCT食谱应用于肺癌患者术后早期饮食，探讨肺癌患者术后应用McT的临床效果。方法2015年12月．2016年3月四川大学华西胸外科单个医疗组肺癌切除术患者纳人研究患者117例，随机分为McT组（62例）和常规饮食组（routine diet group,RDG）（55例）。分析两组患者术后白蛋白、肛门排气时间、胸腔闭式引流量及胸腔闭式引流管留置时间、术后住院日、住院费用。结果McT组患者术后肛门排气时间[（27．87±14．38）h]短于RDG组[（45．18±8．62）h]（P〈0．001）；术后胸腔引流管留置时间在MCT组[（75．40±48．41）h]少于RDG组[（110．64±94．19）h]（P=0．02s）；术后胸腔引流量在MCT[395mL]组少于RDG组[590mL]（P=0．027）。术后住院日在MCT组[（5．26±2．96）d）]短于RDG组[（6．73±3．99）d]（P=0．030）。血浆白蛋白术后McT组[（37．26±2．70）g／L]高于RDG组[（35．92±3．12）g／L]（P=O．023）。结论肺癌患者术后短期应用MCT饮食有助于改善胃肠功能快速恢复，且缩短术后住院时间。

目的探讨血脂水平与颈椎间盘退行性病变之间的相关性。方法收集2012年1月-2013年5月入住北京天坛医院脊柱外科的颈椎间盘突出患者101例作为病例组,另收集同一时期因四肢外伤入院的102例患者作为对照组,记录每位研究对象的人口统计学资料、身高、体重、高血压史、糖尿病史、吸烟饮酒情况,检测其空腹血脂水平（总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白）,进行两组间的成组匹配病例对照研究,探讨血脂水平与颈椎间盘退行性病变之间的相关性。结果病例组与对照组匹配良好,两组基线特征差异无统计学意义（P〉0.05）。与对照组相比,病例组中吸烟者及饮酒者比例均明显升高（40.59%vs 19.61%,P=0.004;31.68%vs 5.88%,P〈0.001）。单因素分析显示,病例组总胆固醇水平与甘油三酯水平显著高于对照组,而两组低密度脂蛋白及高密度脂蛋白水平差异无统计学意义。多因素调整后显示甘油三酯水平升高可显著增加颈椎间盘突出的风险（OR=1.90,95%CI 1.25～2.90）。同时调整总胆固醇水平与甘油三酯水平后,甘油三酯水平仍是颈椎间盘突出的独立预测因子。结论甘油三酯升高可能增加颈椎间盘突出的风险,但因果关系的确证需进一步的研究证据支持。

目的研究过氧化物酶体增殖物激活受体α（PPARα）、载脂蛋白A5（ApoA5）在脂联素调控HepG2细胞内甘油三酯（TG）代谢中的作用,并初步探讨脂联素影响TG代谢的机制。方法采用以含10%胎牛血清DMEM培养的HepG2细胞,分为对照组、溶剂组（加入0.1%DMSO）、MK886组（5.0μmol/L MK886＋0.1%DMSO）、脂联素组（25μg/ml脂联素＋0.1%DMSO）、脂联素＋MK886组（25μg/ml脂联素＋5.0μmol/L MK886＋0.1%DMSO）,24h后检测各组细胞内PPARα、ApoA5 mRNA和蛋白的表达水平及TG含量。结果与对照组、溶剂组、脂联素＋MK886组比较,MK886组HepG2细胞中PPARα、ApoA5 mRNA及蛋白表达明显降低（P〈0.01）,TG含量明显升高（P〈0.01）,而脂联素组PPARα、ApoA5 mRNA及蛋白表达明显升高（P〈0.01）,TG含量明显降低（P〈0.05）。对照组、溶剂组、脂联素＋MK886组3组间比较,PPARα、ApoA5 mRNA和蛋白表达水平及TG含量差异均无统计学意义（P〉0.05）。结论 HepG2细胞中TG的代谢与PPARα、ApoA5密切相关。脂联素可能是通过促进PPARα及ApoA5的表达从而下调HepG2细胞内TG含量。

目的比较空腹血糖受损（IFG）与糖耐量减低（IGT）者的血浆载脂蛋白A5（apoA5）、甘油三酯（TG）、胰岛素抵抗（IR）及胰岛β细胞功能,初步探讨IFG与IGT发病机制中的差异。方法选取23例空腹血糖受损者（IFG组）、24例糖耐量减低者（IGT组）及30例正常糖耐量者（NGT组）,行静脉葡萄糖耐量试验（IVGTT）,测010min胰岛素水平,计算急性胰岛素反应0-10（AIR0-10）,并采用ELISA法测定空腹apoA5水平,比色法测定空腹游离脂肪酸（FFA）及糖负荷后120min FFA（2hFFA）水平,稳态模型评价胰岛素抵抗指数（HOMA-IR）及胰岛β细胞功能（HOMA-B）,探讨apoA5与AIR0-10、TG、HOMA-B、HOMA-IR、FFA、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、总胆固醇（TC）、FPG及2hPG的关系。结果 IFG组和IGT组apoA5、AIR0-10、HOMA-B显著低于NGT组（P〈0.05）,而TG、FFA、2hFFA、HOMA-IR、FINS明显高于NGT组（P〈0.05）;IFG组apoA5、AIR0-10、HOMA-B、FINS、2hPG显著低于IGT组（P〈0.05）,TG、FFA2、hFFA、HOMA-IR、FPG明显高于IGT组（P〈0.05）。相关分析显示,apoA5与AIR0-10、HOMA-B、HDL-C呈正相关,而与TG、FFA、2hFFA、LDL-C、FPG、2hPG、FINS、HOMA-IR、BMI、WHR呈负相关;多元逐步回归分析显示,AIR0-10、TG、FFA、HOMA-IR是apoA5的独立影响因素。结论 IFG人群的IR和胰岛β细胞分泌功能受损较IGT人群更严重,其机制可能与IFG人群血浆中apoA5水平更低有关,提示apoA5可能是预防及延缓IFG进展为糖尿病的新靶点之一。

Background The triglyceride glucose (TyG) index is closely associated with subclinical atherosclerosis. However, the association remains inconclusive among obese and nonobese individuals. Methods This prospective study was conducted in 5751 adults with normal carotid intima‐media thickness (CIMT) at baseline. We divided the population into four groups based on the TyG index, which was calculated by the following formula: Ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). Information on CIMT was acquired by ultrasonography. Incident elevated CIMT was defined as IMT values greater than 0.9 mm at follow‐up. Odds ratios (ORs) and 95% confidence intervals (CIs) of the associations between TyG index and elevated CIMT were estimated using multivariable logistic regression models. Results After a median follow‐up of 4.3 years, 722 (12.6%) individuals had progressed to elevated CIMT. Compared with the second quartile of the TyG index, the first and fourth quartile both conferred higher risks of elevated CIMT after adjusting for potential confounders. In the total population, the ORs for the first and fourth quartile were 1.29 (95% CI, 1.00‐1.66) and 1.42 (95% CI, 1.11‐1.83), respectively. Restricted cubic splines demonstrated an approximately U‐shaped association between TyG index and elevated CIMT among the total and nonobese adults (P for nonlinearity <.05), but not in those with general or abdominal obesity. Conclusions A U‐shaped association was observed between TyG index and elevated CIMT only among nonobese Chinese adults. 摘要 背景 甘油三酯血糖(TyG)指数与亚临床动脉粥样硬化密切相关。然而，肥胖者和非肥胖者之间的联系仍然没有定论。 方法 这项前瞻性研究在5751名基线颈动脉内膜中层厚度(CIMT)正常的成年人中进行。根据TyG指数将人群分为四组，计算公式为:Ln(空腹甘油三酯[mg/dL]×空腹血糖[mg/dL]/2)。超声检查获得CIMT的相关信息。升高的CIMT定义为随访时IMT值大于0.9 mm。用多变量Logistic回归模型估计TyG指数与CIMT升高之间关联的优势比(OR)和95%置信区间(CI)。 结果 经过平均4.3年 的随访，有722例(12.6%)患者进展为CIMT升高。与TyG指数的第二个四分位数相比，在校正了潜在的混杂因素后，第一和第四个四分位数都具有更高的CIMT升高风险。在总人口中，第一和第四个四分位数的OR值分别为1.29(95%CI，1.00~1.66)和1.42(95%CI，1.11~1.83)。限制立方样条法显示TyG指数与非肥胖者和非肥胖者的CIMT升高呈近似的U型相关(P<0.05)，但在一般肥胖者或腹型肥胖者中不存在。 结论 仅在非肥胖的中国成年人中，TyG指数与CIMT升高呈U型相关。 Highlights Many studies have reported that the triglyceride glucose (TyG) index is an inexpensive biochemical marker to assess metabolic and cardiovascular diseases. Our findings indicate that the TyG index is nonlinearly associated with the risk of new‐onset elevated carotid intima‐media thickness (CIMT) during a follow‐up of 4.3 years. We further evaluated such relationship in participants by body size phenotypes. A U‐shaped association between TyG index and elevated CIMT only existed among those without general or abdominal obesity.

摘要 背景 甘油三酯血糖(TyG)指数与亚临床动脉粥样硬化密切相关。然而，肥胖者和非肥胖者之间的联系仍然没有定论。 方法 这项前瞻性研究在5751名基线颈动脉内膜中层厚度(CIMT)正常的成年人中进行。根据TyG指数将人群分为四组，计算公式为:Ln(空腹甘油三酯[mg/dL]×空腹血糖[mg/dL]/2)。超声检查获得CIMT的相关信息。升高的CIMT定义为随访时IMT值大于0.9 mm。用多变量Logistic回归模型估计TyG指数与CIMT升高之间关联的优势比(OR)和95%置信区间(CI)。 结果 经过平均4.3年 的随访，有722例(12.6%)患者进展为CIMT升高。与TyG指数的第二个四分位数相比，在校正了潜在的混杂因素后，第一和第四个四分位数都具有更高的CIMT升高风险。在总人口中，第一和第四个四分位数的OR值分别为1.29(95%CI，1.00~1.66)和1.42(95%CI，1.11~1.83)。限制立方样条法显示TyG指数与非肥胖者和非肥胖者的CIMT升高呈近似的U型相关(P<0.05)，但在一般肥胖者或腹型肥胖者中不存在。 结论 仅在非肥胖的中国成年人中，TyG指数与CIMT升高呈U型相关。

Background Greater lipid variability may cause adverse health events among diabetic patients. We aimed to examine the effect of lipid variability on the risk of diabetic microvascular outcomes among type 2 diabetes mellitus patients. Methods We assessed the association between visit‐to‐visit variability (measured by variability independent of mean) in high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein‐cholesterol (LDL), triglyceride, and remnant cholesterol (RC) measurements among participants involved in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the risk of incident microvascular outcomes, including nephropathy, neuropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. Results There were 2400, 2470, and 2468 cases of nephropathy, neuropathy, and retinopathy during a follow‐up period of 22 600, 21 542, and 26 701 person‐years, respectively. Higher levels of HDL, triglyceride, and RC variability were associated with an increased risk of incident nephropathy and neuropathy. Compared with the lowest quartile, the fully adjusted HRs (95% CI) for the highest quartile of HDL, triglyceride, and RC variability for nephropathy risk were 1.57 (1.22, 2.01), 1.50 (1.18, 1.92), and 1.40 (1.09, 1.80), respectively; and for neuropathy, the corresponding risks were 1.36 (1.05, 1.75), 1.47 (1.14, 1.91), and 1.35 (1.04, 1.74), respectively. Null association was observed between LDL variability and all microvascular complications. Additionally, all associations of variability in the other lipids with retinopathy risk were null. Conclusion Among individuals with type 2 diabetes mellitus, HDL, triglyceride, and RC variability were associated with increased risks of nephropathy and neuropathy but not retinopathy. Trial registration: ClinicalTrials.gov., no. NCT00000620. 摘要 背景 较大的血脂变异性可能会导致糖尿病患者的不良健康事件。我们旨在2型糖尿病(T2DM)患者中研究血脂变异性对糖尿病微血管结果风险的影响。 方法 我们评估了ACCORD研究参与者在高密度脂蛋白胆固醇(HDL), 低密度脂蛋白胆固醇(LDL), 甘油三酯和残余胆固醇(RC)测量中的随访间变异性(通过独立于平均值的变异性来衡量)与发生微血管病变(包括神经病变, 肾病和视网膜病变)的风险之间的关系。使用COX比例风险模型估计危险比(HR)和95%可信区间(CI), 并对潜在混杂因素进行了校正。 结果 在22600人‐年, 21542人‐年和26701人‐年的随访期内, 分别有2400例肾病, 2470例神经病变和2468例视网膜病变。HDL, 甘油三酯和RC变异性越高, 发生肾病和神经病变的风险就越高。与最低四分位数相比, 高密度脂蛋白, 甘油三酯和RC变异性对肾病风险的完全校正后的HR(95%CI)分别为1.57(1.22, 2.01), 1.50(1.18, 1.92)和1.40(1.09, 1.80)；对于神经病变, 相应的风险分别为1.36(1.05, 1.75), 1.47(1.14, 1.91)和1.35(1.04, 1.74)。在LDL变异性和所有微血管并发症之间无明显关联。此外, 其他血脂的变异性与视网膜病变风险之间无明显关联。 结论 在T2DM患者中, HDL, 甘油三酯和RC变异性与肾病和神经病变的风险增加有关, 但与视网膜病变无关。 HighlightsAssociation of lipid variability with diabetic microvascular complications.

Background：Hypertriglyceridenia （HTG） is the most common etiology of acute pancreatitis （AP） after alcohol and gallstone-induced disease.Elevation of serum triglyceride （TG） levels to ≥ 1000 mg/dl in a patient with AP strongly indicates HTG as the cause.The absolute risk of pancreatitis based on serum TG ≤1000 mg/dl has not been clearly defined.The aims of this study were to address the role of elevated TG levels between 500 and 1000 mg/dl in the clinical course of HTG pancreatitis （HTGP）;and assess the relationship between the level of serum TG and disease severity.Methods：A total of 224 HTGP patients between 2007 and 2011 were divided into two subgroups.Totally,122 patients in Group A had serum TG 〉1000 mg/dl;102 patients in Group B had maximal TG levels between 500 and 1000 mg/dl accompanied by lactescent serum;100 patients with biliary AP and 99 patients with alcoholic AP hospitalized during the study period were enrolled as controls.The clinical and biochemical data were analyzed.Results：The clinical presentation ofHTG-induced pancreatitis was similar to other causes.Severe form of AP in Group A was higher than Group B （Х^2 =4.002,P =0.045）.The severity with HTGP was significantly higher as compared to biliaryAP （Х^2 =33.533,P =0.000） and alcoholic AP （Х^2 =7.179,P =0.007）.Systemic complications with HTGP were significantly higher than biliary AP （Х^2 =58.763,P =0.000）.Conclusions：The study demonstrated that TG level ≥500 mg/dl should raise a high degree of suspicion,especially if no other etiology of AP is apparent.The severity of HTGP seems to correlate directly with TG level.HTGP seems be more severe than other causes of AP.

摘要 背景 较大的血脂变异性可能会导致糖尿病患者的不良健康事件。我们旨在2型糖尿病(T2DM)患者中研究血脂变异性对糖尿病微血管结果风险的影响。 方法 我们评估了ACCORD研究参与者在高密度脂蛋白胆固醇(HDL), 低密度脂蛋白胆固醇(LDL), 甘油三酯和残余胆固醇(RC)测量中的随访间变异性(通过独立于平均值的变异性来衡量)与发生微血管病变(包括神经病变, 肾病和视网膜病变)的风险之间的关系。使用COX比例风险模型估计危险比(HR)和95%可信区间(CI), 并对潜在混杂因素进行了校正。 结果 在22600人‐年, 21542人‐年和26701人‐年的随访期内, 分别有2400例肾病, 2470例神经病变和2468例视网膜病变。HDL, 甘油三酯和RC变异性越高, 发生肾病和神经病变的风险就越高。与最低四分位数相比, 高密度脂蛋白, 甘油三酯和RC变异性对肾病风险的完全校正后的HR(95%CI)分别为1.57(1.22, 2.01), 1.50(1.18, 1.92)和1.40(1.09, 1.80)；对于神经病变, 相应的风险分别为1.36(1.05, 1.75), 1.47(1.14, 1.91)和1.35(1.04, 1.74)。在LDL变异性和所有微血管并发症之间无明显关联。此外, 其他血脂的变异性与视网膜病变风险之间无明显关联。 结论 在T2DM患者中, HDL, 甘油三酯和RC变异性与肾病和神经病变的风险增加有关, 但与视网膜病变无关。