西南地区人群尿脂联素水平与2型糖尿病合并冠心病的相关性

目的探讨西南地区人群尿脂联素水平与2型糖尿病(T2DM)合并冠心病(CHD)的相关性。方法采用酶联免疫吸附试验(ELISA)测定23例T2DM患者(T2DM组)和23例T2DM合并CHD患者(DC组)及38例健康对照(NC组)的血、尿脂联素水平,探讨各组脂联素与体重指数(BMI)、腰臀比(WHR)、血脂、血糖、颈动脉中层厚度(IMT)、尿白蛋白/肌酐(ACR)等的关系。结果 DC组尿脂联素水平较T2DM组及NC组均明显升高(分别为20.91±4.59 vs 17.75±1.90μg/ml,20.91±4.59 vs 13.61±5.74μg/ml,P<0.01),T2DM组较NC组明显升高;DC组血清脂联素水平也明显升高(分别为5.73±1.78 vs 8.43±3.55μg/ml,5.73±1.78 vs 14.46±4.18μg/ml,P<0.01)。线性相关分析表明T2DM组尿脂联素水平与血清脂联素相关,而DC组则还与糖化血红蛋白(Hb A1c)、总胆固醇(TC)、ACR相关,进一步行多元逐步回归分析表明,DC组影响尿脂联素水平的独立危险因素为ACR、Hb A1c及TC是(Y尿脂联素=0.004X ACR+2.83XHBA1C+4.055XTC-30.224)。结论尿脂联素水平改变与T2DM大血管病变有关,其参与了T2DM合并CHD的发生发展。     

2型糖尿病患者尿微量白蛋白与血清甲状腺激素的相关性研究

选取2型糖尿病患者105例,分为糖尿病微量蛋白尿组及糖尿病正常蛋白尿组,设对照组30例,检测血清游离T3(FT3)、游离T4(FT4)、促甲状腺素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、尿微量白蛋白等指标,分析2型糖尿病患者尿微量白蛋白与血清甲状腺激素之间的相关性。结果三组之间FT3、T3、尿微量白蛋、HbA1c的差异有统计学意义(P<0.05),进一步两两比较,DM微量白蛋白尿组的FT3、T3显著低于DM正常蛋白尿组及对照组,尿微量白蛋白、HbA1c显著高于DM正常蛋白尿组及对照组,差异有统计学意义(P<0.05);尿微量白蛋白、FT3与病程有关,随病程的延长,尿微量白蛋白逐渐升高,FT3则逐渐降低,尿微量白蛋白与FT3呈负相关,相关系数为-0.496(P<0.05)。结论糖尿病伴有微量白蛋白尿患者会出现FT3、T3降低,尿微量白蛋白与FT3呈负相关,检测这两项指标对诊断、治疗及评估预后有重要意义。     

老年2型糖尿病患者血清sCXCL16水平与糖尿病肾病进展及预后的关联性研究

目的 探讨老年2型糖尿病(T2DM)患者血清可溶性CXC趋化因子配体16(sCXCL16)水平与糖尿病肾病(DKD)进展及预后的关联性。方法 招募2017年4月至2020年1月清华大学附属垂杨柳医院收治的55例DKD患者(DKD组)和54例单纯T2DM患者(T2DM组)为研究对象,另选择55名体检健康者作为对照组。比较三组血清sCXCL16水平,并分析其与DKD进展及预后的关联性。结果 DKD组和T2DM组血清sCXCL16水平均高于对照组,且DKD组血清sCXCL16水平高于T2DM组,差异有统计学意义(P<0.05)。对于DKD患者,大量白蛋白尿亚组血清sCXCL16水平显著高于微量白蛋白尿亚组(P<0.05)。Spearman秩相关分析结果显示,血清sCXCL16水平与尿素氮(BUN)、肌酐(Cr)、尿白蛋白排泄(UAE)、评估稳态模型-胰岛素抵抗指数(HOMA-IR)、24 h蛋白尿、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)均呈正相关(P<0.05)。多因素logistic回归分析结果显示,血清sCXCL16>18.50 ng/ml...     

糖尿病神经性膀胱患者血浆同型半胱氨酸、血清叶酸、维生素B_(12)的水平及尿动力学变化分析

目的 探讨糖尿病神经性膀胱(DNB)患者血清叶酸(FA)、维生素B_(12)(VitB_(12))、血浆同型半胱氨酸(Hcy)及尿动力学指标的变化及其临床意义。方法 选取许昌市中心医院内分泌科收治的T2DM患者251例,其中合并DNB患者86例(DNB组)、单纯T2DM患者165例(T2DM组),比较两组FA、VitB_(12)、Hcy及尿动力学指标。结果 DNB组FPG、2hPG、HbA1c、尿微量白蛋白(UMA)、膀胱最大测压容量(VMBC)、Scr、BUN、Hcy高于T2DM组(P0.01);FIns、FA、VitB_(12)、最大尿流率(MFR)、最大尿流率时逼尿及压力(PQmax)、膀胱顺应性(BC)低于T2DM组(P0.01)。结论 DNB患者血清FA、VitB_(12)、Hcy及尿动力学指标均发生改变。     

新诊断2型糖尿病患者胰岛素强化治疗对肾上腺皮质及交感-肾上腺髓质功能的影响

目的探讨新诊断T2DM患者胰岛素强化治疗前后肾上腺皮质及交感—肾上腺髓质功能的变化及意义。方法纳入新诊断T2DM患者30例,予胰岛素强化治疗,测定治疗前后FPG、2 hPG、FC-P、2 hC-P,24 h尿游离皮质醇(UFC)、尿甲氧基去甲肾上腺素(UNM)、尿甲氧基肾上腺素(UMN)水平,计算胰岛β细胞功能指数(△C—P/△PG)。结果治疗后FPG、2 hPG、24 hUFC、NM下降;△C—P/△PG上升(P0.05)。结论新诊断T2DM患者胰岛素强化治疗后不仅能抑制高血糖状态下过兴奋的HPA轴,并可能通过降低去甲肾上腺素水平抑制交感机能的亢进。     

血清TNF水平与2型糖尿病患者骨质疏松关系的初探

目的探讨血清肿瘤坏死因子(TNF)水平与2型糖尿病(T2DM)患者骨质疏松的关系。方法测定74例T2DM患者及46例年龄、体质量指数(BMI)相匹配的健康对照者的骨矿物质密度(BMD)、血清骨钙素(BGP)、抗酒石酸磷酸酶(TRAP)、尿羟脯氨酸(HOP)及TNF水平,2组进行比较。结果T2DM患者较对照组的BMD显著降低,血清BGP水平明显低于对照组(P<0·01);TRAP、尿HOP、TNF显著高于对照组(P<0·05),TNF与BMD呈显著负相关。结论T2DM患者BMD降低,其原因与TNF水平升高有一定关系。     

核素肾动态显像在糖尿病肾病中的临床应用

目的 探讨99mTc-DTPA肾动态显像判断糖尿病肾病(DN)患者肾功能的临床价值,为临床诊治T2DM及预后判断提供相关依据.方法 选取39例T2DM患者,并根据尿微量清蛋白测定结果 分成正常清蛋白尿组(11例)和清蛋白尿组(28例),另选择同期健康者12例作为对照组.受试者均行核素肾动态显像获取肾小球滤过率(GFR)及肾功能曲线,同时测定尿清蛋白水平.结果 正常清蛋白尿组GFR值与对照组比较,差异有统计学意义(P＜0.05);清蛋白尿组GFR值与对照组比较,差异有统计学意义(P＜0.01);清蛋白尿组尿清蛋白水平与对照组比较,差异有统计学意义(P＜0.05).结论 核素肾动态显像可用于早期诊断T2DM,了解双肾功能的受损程度,为治疗方案的选择提供一定依据.     

老年2型糖尿病患者合并动脉粥样硬化的相关因素

2型糖尿病(T2DM)以中老年患者居多,而心血管病变是该病最重要的并发症。如何有效减少老年T2DM患者动脉粥样硬化,延缓疾病进展,改善预后一直是DM治疗中一大热点。本文拟探讨引起老年T2DM患者动脉粥样硬化发生的相关因素,为临床治疗提供指导依据。1资料与方法1.1一般资料2010年1月至2012年10月我院收治的     

老年2型糖尿病血浆同型半胱氨酸与糖尿病微血管病变关系研究

目的探讨同型半胱氨酸(Hcy)水平在老年2型糖尿病(T2DM)患者合并微血管病变时的变化及其与T2DM微血管病变的关系。方法74例老年T2DM患者按有无微血管病变分为T2DMⅠ组(无微血管病变)及T2DMⅡ组(合并微血管病变),用循环酶法测定2组患者的Hcy水平,并与28名健康对照者(对照组)进行比较。结果(1)T2DMⅡ组血Hcy水平明显高于对照组及T2DMⅠ组。T2DMⅡ组高Hcy血症(Hcy>15μmol/L)的发生率为50.0%,较对照组(10.1%)及T2DMⅠ组(23.8%)明显升高(P<0.01)。(2)Hcy升高的T2DM患者中尿微量白蛋白排泄率(UAER)、肌酐(Cr)及糖尿病肾病(DN)的发生率高于Hcy正常的T2DM患者(P<0.01)。(3)多因素回归分析提示血Hcy水平与T2DM微血管病变有关(P<0.01,OR=1.055)。结论Hcy与老年T2DM微血管病变有关,可能是T2DM微血管病变发生发展的危险因素之一。     

绝经后2型糖尿病患者尿白蛋白排泄率与骨密度的相关性

本研究观察了82例绝经后2型糖尿病(T2DM)患者骨密度(BMD)与尿白蛋白排泄率(UAER)的关系，以探讨T2DM肾脏损害与骨质疏松(OP)之间的关系。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.