血清尿酸与我国2型糖尿病患者视网膜病变的相关性研究

目的 探讨血清尿酸（SUA）与我国T2DM患者DR的关系. 方法 采用四分位法将T2DM患者SUA水平分为4组,眼底镜诊断有无DR.采用Logistic多元回归分析SUA与DR发病率的关系. 结果 SUA＞ 212 μmol/L后即为DR危险因素.随着SUA升高（212～288、289～335、≥366μmol/L）,影响程度增加,OR（95％CI）值分别为3.85（1.98～6.84）、5.12（2.25～8.10）、5.71（2.99～8.87）. 结论 SUA是DR的危险因素,降低SUA水平应为其治疗的重要环节.     

空腹血糖受损发生冠心病危险因素的Logistic回归分析

目的 本研究旨在明确空腹血糖受损(IFG)是否为冠心病(CHD)的危险因素;IFG切点下调后,其与CHD的关系.方法 回顾性分析2007年2月至2008年12月该院收治的392例患者临床资料,由介入专科医生统一阅读研究对象的冠脉造影光盘,并按Gensini评分系统,对冠状动脉进行定性和定量评价.按不同空腹血糖(FPG)分组,对CHD组和非CHD组9种危险因素进行Logistic多元回归分析.结果 IFG:OR值为2.625(95% CI 1.314～5.243,P=0.006);新增IFG:即5.6 mmol/L≤FPG<6.1 mmol/L OR值为1.066(95%CI 1.033～1.101,P<0.001).结论 IFG是CHD危险因素;新增IFG相对于FPG<5.6 mmol/L,是发生CHD的相对危险段,故将FPG控制在5.6 mmol/L以下更安全.     

血清可溶性CD40配体水平与缺血性卒中发病风险、严重程度和梗死体积的相关性

目的探讨血清可溶性CD40配体(soluble CD40 ligand,sCD40L)水平与缺血性卒中发病风险、严重程度和梗死体积的相关性.方法纳入连续住院的急性缺血性卒中患者作为病例组,健康体检者作为对照组.收集病例组和对照组人口统计学、血管危险因素和临床资料.采用酶联免疫吸附法测定血清sCD40L水平.缺血性卒中患者根据基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke scale,NIHSS)评分分为轻度卒中组(＜8分)和中重度卒中组(≥8分),根据梗死体积中位数分为大梗死组和小梗死组.结果 共纳入106例急性缺血性卒中患者,其中男性59例(55.7％),女性47例(44.3％),平均年龄(71.31±11.27)岁;对照组86例,其中男性45例(52.3％),女性41例(47.7％),平均年龄(73.56 ±9.32)岁;大梗死组(≥1.8 cm3)41例(38.7％),小梗死组(＜1.8 cm3)65例(61.3％);轻度卒中69例(65.1％),中重度卒中37例(34.9％).缺血性卒中组基线血清sCD40L水平显著高于对照组[(5.61±1.68) mg/L对(3.56±1.32)mg/L;扣9.236,P＜0.01],缺血性卒中组入院14 d时血清sCD40L水平[(4.19±1.45)mg/L]较基线水平显著降低(P＜0.01),但仍然显著高于对照组(P＜0.01).多变量logistic回归分析显示,低密度脂蛋白胆固醇[优势比(odds ratio,OR)3.358,95％可信区间(confidence interval,CI)2.681 ～4.056;P ＜0.001]和血清sCD40L(OR5.103,95％ CI2.317 ～8.903;P ＜0.001)水平较高是缺血性卒中的独立危险因素;血清sCD40L水平较高(第4四分位数对第1四分位数,OR4.017,95％ CI1.608 ～ 10.037;P=0.003)、大动脉粥样硬化性卒中(OR2.321,95％ CI1.014 ～ 5.314;P=0.046)、皮质-皮质下梗死(OR 2.679,95％ CI1.111 ～6.460;P=0.028)和梗死灶体积较大(OR 3.216,95％ CI1.398～7.395;P=0.006)为中重度卒中的独立危险因素;血清sCD40L水平较高(第4四分位数对第1四分位数,OR 3.142,95％ CI1.274 ～7.745;P =0.013)、大动脉粥样硬化性卒中(OR 2.965,95％CI1.299 ～6.767;P=0.010)、皮质-皮质下梗死(OR4.750,95％ CI 1.909～11.818;P＜0.001)和基线NIHSS评分≥8分(OR 8.509,95％ CI3.432 ～21.094;P ＜0.001)为大梗死的独立危险因素.结论血清sCD40L 水平与缺血性卒中发病、梗死体积和严重程度密切相关.     

健康体检者空腹血糖、胰岛素抵抗与血清谷氨酰转肽酶水平的相关性研究

目的 探讨健康体检者血清谷氨酰转肽酶（γ-GT）与FPG、IR间的关系. 方法 纳入793名健康体检者,根据FPG中位数5.42 mmol/L与胰岛素抵抗指数（HOMA-IR）中位数2.04,分为高FPG（HF）组和正常FPG（NF）组,IR组和IS组,比较各组γ-GT水平. 结果 HF、IR组γ-GT水平均高于NF、IS组（P＜0.01）.Spearman相关分析显示,γ-GT与FPG、FIns及HOMA-IR呈正相关.Logistic回归分析结果显示,FPG（OR=1.615,95％CI：1.208～2.158）、TG（OR=4.104,95％CI：2.650～6.357）、FIns（OR=2.866,95％CI：1.114～7.372）及饮酒情况（OR=3.068,95％CI：1.935～4.864）是γ-GT水平升高的危险因素. 结论 FPG、FIns与血清γ-GT水平相关,γ-GT可能成为T2DM发生风险的预测因素.     

血清胱抑素C水平与高血压性脑出血风险

目的：探讨血清胱抑素C（cystatinC,CysC）水平与高血压性脑出血（hypertensive intracerebral hemorrhage, HICH）的关系。方法纳入HICH患者和健康对照者,收集人口统计学和临床资料,采用免疫比浊法检测血清CysC水平。结果共纳入连续的94例HICH患者和131名健康对照者。 HICH组基线收缩压[（168.57±28.64）mmHg对（128.13±16.23）mmHg;t=－13.442,P<0.001;1 mmHg=0.133 kPa]、舒张压[（95.56±14.68）mmHg对（76.80±8.76）mmHg;t=－11.965, P<0.001]、空腹血糖[（6.24±1.83）mmol/L对（5.22±1.13）mmol/L;t=－5.169,P<0.001]和血清CysC水平[（1.02±0.26）mg/L对（0.91±0.13）mg/L;t=－4.234,P<0.001]显著高于对照组。多变量logistic回归分析显示,基线收缩压≥140 mmHg [优势比（odds ratio, OR）12.523,95％可信区间（confidence interval, CI）5.353~29.299;P<0.01]、舒张压≥90 mmHg（OR 3.968,95％CI 1.792~8.784;P<0.01）、血清CysC水平≥1.09 mg/L（OR 3.279,95％CI 1.336~8.050;P<0.05）是HICH的独立危险因素。在HICH患者中,出血量≥30 ml组血清CysC水平[（1.13±0.26）mg/L]高于出血量<30 ml组[（0.99±0.25）mg/L;P<0.001]和对照组[（0.91±0.13）mg/L;P<0.001],出血量<30 ml组血清CysC水平高于对照组（P=0.004）。血清CysC与年龄、肌酐、尿素、尿酸之间呈正相关（P均＜0.01）,与估算的肾小球滤过率之间呈负相关（P＜0.01）。多变量线性回归分析显示,年龄、肌酐、尿素和尿酸与血清CysC水平独立相关（P均＜0.05）。结论 HICH患者血清CysC水平升高与出血量有关,血清CysC水平增高是HICH的独立危险因素。     

女性冠状动脉性心脏病危险因素分析

目的 探讨女性冠状动脉性心脏病(冠心病)患者的危险因素,同时了解这些危险因素与冠状动脉血管病变支数的相关关系.方法 分析了景德镇市第一人民医院2005年9月～2008年1月接受冠状动脉造影共139例女性住院患者的临床资料,根据冠状动脉造影结果 分成两组:冠心病组(n=49)及对照组(n=90).分别收集下列参数:吸烟、月经状况、原发性高血压病、糖尿病的人数比例,血清三酰甘油、尿酸、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及脂蛋白a浓度,进行比较分析,并和血管病变支数进行logistic多元回归分析.结果 三酰甘油和脂蛋白A在冠心病组高于对照组,高密度脂蛋白浓度低于对照组,差异有统计学意义[(2.4±2.4)mmol/L vs.(1.7±0.7)mmol/L,P<0.05;(3438.0±4393.0)αmg/Lvs.(1436.0±1287.0)αmg/L,P<0.05; (1.1±0.31)mmol/L vs.(1.3±0.9)mmol/L,P<0.05].logistic多元回归分析显示,空腹血糖与冠状动脉的病变血管支数相关(β=1.579,P=0.015).结论 原发性高血压、糖尿病、三酰甘油、高密度脂蛋白、脂蛋白A是本组女性冠心病患者的危险因素,且糖尿病是惟一与女性冠状动脉病变支数相关的危险因子.     

原发性醛固酮增多症患者24 h血尿同步电解质特征分析

目的探讨原发性醛固酮增多症(PA)患者的24 h血尿同步电解质的特点。方法回顾性分析2009年1月至2014年1月就诊于新疆维吾尔自治区人民医院高血压中心,规范进行PA筛查并完善24 h血尿同步离子测定的高血压患者764例,其中PA患者135例,非PA患者629例。结果与非PA组比较,PA组血清钾离子[(3.66±0.41)比(3.86±0.37)mmol/L]、血清磷离子[(1.08±0.16)比(1.16±0.19)mmol/L]及钙磷乘积[(29.7±5.2)比(32.4±6.9)(mg/dL)~2]较低,而尿液钾离子[41.5(31.6～52.4)比35.9(27.7～46.3)mmol/L]、尿液钙离子[6.0(4.5～8.1)比5.2(3.9～6.9)mmol/L]、尿液镁离子[3.8(3.1～5.0)比3.5(2.7～4.6)mmol/L]、血钠与尿钠的比值除以血钾平方与尿钾比值[(血钠/尿钠)/(血钾~2/尿钾),SUSPPUP][2.48(1.71～3.95)比1.96(1.39～2.73)(mmol/L)~(-1)]较高(P0.01)。低钾血症、低钙血症、尿钾54.1 mmol/L、尿钙7.5 mmol/L及钙磷乘积35(mg/dL)~2在PA患者中的检出率明显升高(均P0.05)。结论除已知PA患者低钾血症、血钙降低及尿钾、尿钙高排的电解质特征外,PA患者血液电解质特点还表现为血磷水平降低及尿镁水平升高;此外,复合离子指标:高SUSPPUP及低钙磷乘积也是PA的电解质特征。     

入院血糖水平对糖尿病和非糖尿病ST段抬高急性心肌梗死患者预后的影响

目的 探讨人院时血糖水平与糖尿病和非糖尿病患者ST段抬高急性心肌梗死(STEMI)患者近期病死率的相关性.方法 观察性分析国际性随机对照临床试验中7446例出现症状12 h内STEMI的中国患者,以入院血糖不同水平将已知糖尿病和非糖尿病的患者分组:入院血糖水平<6.1 mmol/L组(2018例),6.1～7.7 mmol/L组(2170例),7.8～11.0 mmol/L组(1929例),11.1～13.0 mmol/L组(465例)和>13.0 mmol/L组(864例),后3组定义为入院高血糖组.分析各组患者30 d的病死率.结果 在人院高血糖患者中有相当比例无既往的糖尿病史;各血糖水平组内,非糖尿病的患者使用胰岛素的比例均明显低于糖尿病患者.随血糖水平升高,非糖尿病患者病死率呈逐渐增加趋势(血糖<6.1 mmol/L组6.8%,6.1～7.7 mmol/L组8.3%,>13.0 mmol/L组18.6%,P<0.001),而糖尿病患者的病死率呈先降低后升高的变化(血糖<6.1 mmol/L组16.7%,6.1～7.7 mmol/L组8.2%,>13.0 mmol/L组22.0%,P<0.001);除显著高血糖(血糖>13.0mmol/L)外,非糖尿病的高血糖患者病死率高于相同血糖水平的糖尿病患者(均P<0.05).多变量logistic回归分析显示,在非糖尿病患者中,随血糖升高死亡危险逐步增加(血糖7.8～11.0 mmol/L组:OR=1.85,95%CI:1.45～2.34,P<0.001;血糖>13.0 mmoL/L组:OR=2.69,95%CI:1.97～3.66,P<0.001);而糖尿病患者中,除显著高血糖组外(血糖>13.0 mmol/L组:OR=3.08,95%CI:1.16～8.17,P=0.024),其他组近期死亡危险均无明显增加(均P>0.05).结论 与糖尿病患者相比,无既往糖尿病史的STEMI患者入院血糖水平升高也很常见,但接受治疗的比例较低,并且是与近期预后不良更密切相关的危险因素.     

镁与慢性肾脏病矿物质-骨代谢异常关系的研究进展

<正>在健康人体内,镁离子的摄入和排出是一个平衡状态~(〔1〕),包括肠道吸收、骨骼的存储交换和肾脏的排泄。肾脏是调节镁平衡的重要器官,约95%的镁离子通过肾小管被重吸收,髓袢升支粗段可重吸收60%左右。正常成人血清镁水平在0.75~1.0 mmol/L,低镁血症定义为血清镁低于0.75 mmol/L,高镁血症即血镁含量高于1.0 mmol/L~(〔2〕)。人体内50%~60%的镁位     

436例糖尿病足截肢相关因素分析

目的 研究与糖尿病足溃疡截肢相关的重要因素.方法 回顾性分析436例糖尿病足溃疡患者的人口学资料、糖尿病及相关疾病治疗、足溃疡严重程度、溃疡大小、是否合并感染和血生化结果.根据是否截肢将436例患者分为未截肢组和截肢组.结果 436例患者中有97例患者被截肢,截肢率为22.2%.与未截肢组患者相比,截肢组患者的年龄、性别、足病病程和血糖水平差异无统计学意义.但截肢组的外周血管疾病发病率更高(94.8%vs 86.1%,P<0.05),血白细胞计数[(10.80±6.03 vs 8.09±3.59)×10~9/L,P<0.01]、超敏C反应蛋白[(10.2+6.2 vs 6.9+6.1)mmol/L,P<0.01]明显增高,血浆白蛋白[(35.0±5.1 vs 36.8±5.0)g/L,P<0.01]、血红蛋白[(104.3±18.9 vs 114.1±21.0)g/L,P<0.01]、血清总胆固醇[(4.2±0.9 vs 4.7±1.3)mmol/L,P<0.01]、甘油=三酯[(1.2±0.5 vs 1.6±1.3)mmol/L,P<0.01]、高密度脂蛋白胆固醇[(1.1±0.5 vs 1.2±0.3)mmo/L,P<0.01]、低密度脂蛋白胆固醇[(2.7±0.8 vs 3.0±1.0)mmol/L,P<0.05]明显降低.多因素逐步logistic回归分析显示,外周血管病变、血白细胞计数、血清总胆同醇、超敏C反应蛋白为截肢的独立危险因素.结论 足溃疡严重程度、外周血管病变、炎症因素和营养不良可能是截肢相关的重要因素.     

Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes

BACKGROUND: Hypokalemia is a well-known, consistent finding in thyrotoxic periodic paralysis (TPP). It is less well known that hypophosphatemia and mild hypomagnesemia are often present in TPP and that rebound hyperkalemia can occur as a result of potassium therapy. OBJECTIVE: To report the prevalence of these electrolyte abnormalities in 24 episodes of TPP in 19 patients admitted to a single university-affiliated public hospital during a 15-year period. METHODS: The medical records of all patients admitted to the Santa Clara Valley Medical Center in San Jose, Calif, between August 1, 1982, and June 1, 1997, with any type of hypokalemic periodic paralysis were reviewed. In patients with TPP, serum potassium, phosphorus, and magnesium levels were evaluated during and after episodes of paralysis. The administered dose of potassium chloride, recovery time from hypokalemia, and prevalence of rebound hyperkalemia after recovery were also ascertained. Data are presented as mean +/- SD. RESULTS: Hypokalemia was present in all 24 initial episodes of TPP, with serum potassium levels ranging from 1.1 to 3.4 mmol/L (mean, 1.9+/-0.5 mmol/L). After recovery from hypokalemia, the maximum serum potassium level significantly increased, ranging from 4.0 to 6.6 mmol/L (mean, 4.9+/-0.5 mmol/L; P<.001). In 10 (42%) of 24 episodes, rebound hyperkalemia (serum potassium level >5.0 mmol/L) was present. Recovery time did not correlate with the potassium chloride dose administered (r = 0.17). Initial serum phosphorus levels ranged from 0.36 to 0.97 mmol/L (mean, 0.61+/-0.23 mmol/L) (1.1-3.0 mg/dL [mean, 1.9+/-0.7 mg/dL]), with hypophosphatemia present in 12 (80%) of 15 episodes. Serum phosphorus levels significantly increased (P<.01), to 1.26 to 1.74 mmol/L (mean, 1.48+/-0.16 mmol/L) (3.9-5.4 mg/dL [mean, 4.6+/-0.5 mg/dL]), with or without phosphorus replacement therapy. A slight increase in serum magnesium levels after paralysis resolved was observed in all patients (P<.07). No further episodes of paralysis occurred in any patients after they became euthyroid. CONCLUSIONS: Hypokalemia, hypophosphatemia, and mild hypomagnesemia are characteristic features of TPP. Hypokalemia occurred in 100% and hypophosphatemia in 80% of the episodes in our study. Rebound hyperkalemia is a potential hazard of potassium administration and occurred in 42% of 24 episodes.     

急性心肌梗死合并心原性休克死亡危险因素分析

目的 探讨ST段抬高的急性心肌梗死合并心原性休克(cardiogenic shock,CS)患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄(68.5±10.3)岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%(322例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.46,95%GI:1.18～1.81)、前壁梗死(OR=2.01,95%CI:1.29～3.11)、入院基线血糖＞7.8 mmol/L(OR=2.17,95%CI:1.26～3.73)、血钠＜130 mmoL/L(OR=2.21,95%CI:1.21～4.04)、左心室射血分数(LVEF)＜40%或重度左心功能障碍(LVD)(OR=3.78,95%CI:2.28～6.27)、未紧急血运重建(OR=3.53,95%CI:1.20～10.41)和使用利尿剂(OR=1.90,95%CI:1.21～2.97)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81(95%CI:0.77～0.86)和0.80(95%CI:0.75～0.84).结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.     

冠状动脉血流缓慢患者临床及造影结果的特点分析

目的 探讨冠状动脉血流缓慢(SCF)的临床特点及实验室检查的相关性.方法 通过TIMI血流分级法和TIMI帧数法联合判断,入选2008年1月至2009年12月因胸痛等心肌缺血症状于复旦大学附属中山医院心内科行冠状动脉造影(CAG)示心外膜冠状动脉无明显病变但存在SCF的患者共140例,对照组为连续性入选同期行CAG证实心外膜冠状动脉完全正常且血流正常的患者共140例.入院时记录所有研究对象的临床资料,测量并记录糖代谢、脂代谢等实验室指标,并进行统计学分析.结果 (1)SCF组的年龄小于对照组[(57.8±10.7)岁比(59.8±8.2)岁,P<0.01],糖尿病病史(49.3% 比 30.7%)、目前吸烟率(59.3%比46.4%)均高于对照组(P均<0.05),空腹血糖(FBG)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)(2.76±1.19比2.37±1.14)、载脂蛋白B(apoB)/载脂蛋白A1(apoA1)(0.95±0.27比0.83±0.55)水平高于对照组(P均<0.05),HDL-C[(1.05±0.35)mmol/L比(1.42±0.74)mmol/L]和apoA1[(1.10±0.19)mmol/L比(1.31±0.31)mmol/L]水平低于对照组(P均<0.01).(2)140例SCF患者中,最常见的血管受累情况是三支血管同时存在SCF(92例),而最常见的受累血管为右冠状动脉(RCA)(119例).(3)多因素logistic回归分析显示在调整其他因素的影响后,吸烟(OR=1.92,95% CI:1.04～3.57,P<0.05)、糖尿病(OR=2.44,95% CI:1.32～4.76,P<0.01)、FBG异常(OR=2.13,95% CI:1.16～3.98,P<0.05)、TG(OR=1.47,95% CI:1.03～2.13,P<0.05)、HDL-C(OR=0.47,95% CI:0.24～0.85,P<0.05)及apoA1(OR=0.55,95% CI:0.40～0.75,P<0.01)是发生SCF的独立预测因子.结论 年轻的吸烟患者更容易发生SCF,SCF患者存在糖代谢和脂代谢异常,脂代谢异常表现为TG升高、HDL-C水平下降.

Abstract：

Objective To analyze the clinical and angiographic characteristics of patients with slow coronary flow (SCF). Methods In this retrospective study, 140 patients with SCF and 140 control subjects without SCF were included. SCF were diagnosed by the combination of TIMI flow grade method and TIMI frame count method. All subjects had angiographically normal coronary arteries. The clinical and laboratory data were obtained from medical records at admission. Results Compared to control group, patients with SCF were younger [(57.8±10.7)years vs. (59.8±8.2)years], rate of smokers (59.3% vs. 46.4%) and diabetes mellitus (49.3% vs. 30.7%), fasting blood glucose (FBG) level [(7.8±2.8) mmol/L vs. (6.2±2.0) mmol/L, P<0.05] and triglyceride (TG) level [(2.11±1.93) mmol/L vs. (1.67±1.01) mmol/L,P<0.05] were higher, while high density lipoprotein cholesterol (HDL-C) level [(1.05±0.35) mmol/L vs. (1.42±0.74) mmol/L, P<0.01] and apolipoprotein A1(apoA1) level [(1.10±0.19)mmol/L vs. (1.31±0.31)mmol/L, P<0.01] were lower. Among the 140 SCF patients, left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) were involved at the same time in 92 patients. Among the three vessels, RCA is the most frequent involved vessel (n=119). After adjusting for other risk factors, current smoking (OR=1.92,95% CI:1.04-3.57,P<0.05), DM history (OR=2.44,95% CI:1.32-4.76,P<0.01), FBG (OR=2.13,95% CI:1.16-3.98,P<0.05), TG (OR=1.47,95% CI:1.03-2.13,P<0.05), HDL-C (OR=0.47,95% CI:0.24-0.85,P<0.05) and apoA1 (OR=0.55,95% CI:0.40-0.75,P<0.01) were independent factors for SCF (all P<0.05). Conclusions Our results demonstrated that patients with SCF were prone to have a significant metabolic disorder compared to the control group. Patients with high levels of FBG, TG and low levels of HDL-C were more likely to suffer from SCF, which maybe explained by the development of coronary endothelium and microvascular dysfunction.     

Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality.

Forty-two consecutive patients with leptospirosis and acute lung injury who were mechanically ventilated were analyzed in a prospective cohort study. Nineteen patients (45%) survived, and 23 (55%) died. Multivariate analysis revealed that 3 variables were independently associated with mortality: hemodynamic disturbance (odds ratio [OR], 6.0; 95% confidence interval [CI], 0.9-38.8; P=. 047), serum creatinine level >265.2 micromol/L (OR, 10.6; 95% CI, 0. 9-123.7; P =.026), and serum potassium level >4.0 mmol/L (OR, 19.9; 95% CI, 1.2-342.8; P=.009). These observations can be used to identify factors associated with mortality early in the course of severe respiratory failure in leptospirosis.     

大样本冠状动脉慢血流的相关因素分析

目的 探讨冠状动脉慢血流(slow coronary flow，SCF)现象的相关因素。方法 回顾西京医院心内科2006年9月~2015年6月冠脉造影的患者85 668例，将冠脉血流仅为TIMI II级或以下的定义为SCF(SCF组，n=958)，选取同时期冠状动脉血流正常患者为对照组(n=507)，多因素分析采用Logistic回归分析。结果 SCF组男性比例、吸烟率、吸烟指数、白细胞计数、血红蛋白浓度、高密度脂蛋白胆固醇、血清载脂蛋白A1、血清载脂蛋白B、超敏C反应蛋白、胱抑素C均显著高于对照组，差异具有统计学意义（P<0.05或P<0.01）。多因素Logistic回归分析结果显示，性别（OR=15.119,95%CI 4.854-47.096,P<0.05）,年龄(OR=0.934,95%CI 0.879-0.974,P<0.05),心率(OR=1.045,95%CI 1.01-1.081，P<0.05),吸烟指数(OR=1.002,95%CI 1.0-1.003,P<0.01),血清载脂蛋白A1(OR=14.472,95%CI 5.446-38.455,P<0.05),为SCF的独立相关因素。结论 性别、年龄、心率，吸烟指数、血清载脂蛋白A1降低为本地区SCF的独立相关因素。     

Prevalence and associated factors of non‐alcoholic fatty liver disease in patients with type‐2 diabetes mellitus

Background/Aims: Diabetic patients have an increased prevalence and severity of non‐alcoholic fatty liver disease (NAFLD). We aimed to investigate the prevalence and the factors associated with the presence of ultrasonographic NAFLD in type‐2 diabetic individuals. Methods: In a cross‐sectional design study, 180 type‐2 diabetic patients were submitted to a complete clinical and laboratory evaluation and abdominal ultrasonography for NAFLD detection and grading. Statistical analysis included bivariate tests, analysis of variance (anova , for increasing severity of steatosis) and multivariate logistic regression. Results: The prevalence of ultrasonographic NAFLD was 69.4% [95% confidence interval (CI): 58.3–82.7%]. Patients with NAFLD were more obese, had a higher waist circumference and serum triglyceride and alanine aminotransferase (ALT) levels than those without steatosis. Neither diabetic degenerative complication, nor glycaemic control was associated with liver steatosis. On multivariate analysis, a high serum triglycerides level [>2.82 mmol/L, odds ratio (OR): 3.7–4.1, 95% CI: 1.2–13.3] and a high‐normal ALT level (≥40 U/L, OR: 2.5–2.7, 95% CI: 1.2–5.9) were independently associated with hepatic steatosis, together with either the presence of obesity (OR: 7.1, 95% CI: 3.0–17.0) or of increased waist circumference (OR: 4.8, 95% CI: 1.9–12.2). Conclusions: Type‐2 diabetic patients have a high prevalence of ultrasonographic NAFLD and its presence is associated with obesity, mainly abdominal, hypertriglyceridaemia and high‐normal ALT levels. Non‐alcoholic fatty liver disease in diabetic patients may develop and progress independent of the diabetes progression itself.     

Laboratory tests to determine the cause of hypokalemia and paralysis

BACKGROUND: Hypokalemia and paralysis may be due to a short-term shift of potassium into cells in hypokalemic periodic paralysis (HPP) or due to a large deficit of potassium in non-HPP. Failure to make a distinction between HPP and non-HPP may lead to improper management. Therefore, we evaluated the diagnostic value of spot urine tests in patients with hypokalemia and paralysis during 3 years. METHODS: Before therapy, the urine potassium concentration, potassium-creatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample. RESULTS: Forty-three patients with hypokalemia and paralysis were identified: 30 had HPP and 13 had non-HPP. There was no significant difference in the plasma potassium or bicarbonate concentrations and in the pH of arterial blood between the 2 groups. All but 2 patients in the non-HPP group had urine potassium concentration values less than 20 mmol/L. Although the potassium concentration was significantly lower in the HPP group, there was some overlap. In contrast, the transtubular potassium concentration gradient and potassium-creatinine ratio differentiated patients with HPP vs non-HPP. Although only a mean +/- SD of 63 +/- 36 mmol of potassium chloride was administered in the patients with HPP, rebound hyperkalemia (>5 mmol/L) occurred in 19 (63%) of these 30 patients. CONCLUSIONS: Calculating the transtubular potassium concentration gradient and potassium-creatinine ratio provided a simple and reliable test to distinguish HPP from non-HPP. Minimal potassium chloride supplementation should be given to avoid rebound hyperkalemia in patients with HPP.     

亚甲基四氢叶酸还原酶基因 C677 T多态性与中国山东地区汉族人群缺血性卒中、高尿酸血症的相关性

目的：探讨亚甲基四氢叶酸还原酶（methylenetetrahydrofolatereductase,MTHFR）基因C677 T 多态性与中国山东地区汉族人群缺血性卒中、高尿酸血症的相关性。方法纳入山东地区汉族急性缺血性卒中患者和年龄、性别相匹配的对照者。采用聚合酶链反应扩增和芯片杂交显色技术检测MTHFR基因C677T 多态性,并测定血清尿酸浓度。结果共纳入山东地区汉族急性缺血性卒中患者145例和年龄、性别相匹配的对照者145名。缺血性卒中组糖尿病构成比（26.90％对6.89％;χ2=20.653,P<0.001）以及空腹血糖[（5.56±1.57）mmol/L对（5.01±1.11）mmol/L;t=－3.390, P=0.001]、高半胱氨酸[中位数,四分位数间距：18.2（16.30~22.55）μmol/L对15.20（12.10~17.85）μmol/L;Z=－6.323,P<0.001]和尿酸[43.0（361.60~490.45）μmol/L对285.9（267.00~346.25）μm o l/L;Z=－10.360, P<0.001]水平均显著高于对照组;缺血性卒中组 T T 基因型（42.07％对15.17％;χ2=25.673, P<0.001）和 T 等位基因（58.28％对34.48％;χ2=33.008, P<0.001）分布频率均显著高于对照组。多变量logistic回归分析显示,尿酸[优势比（ odds ratio, OR）1.018,95％可信区间（confidence interval, CI）1.013~1.024;P<0.001]、TT 基因型（对CT 基因型, OR 6.774,95％CI 1.779~25.507;P=0.005）、高血压（ OR 1.919,95％CI 1.013~3.636;P=0.045）、高半胱氨酸（ OR 1.153,95％CI 1.059~1.258;P=0.001）为缺血性卒中的独立危险因素。将缺血性卒中组与对照组合并,共101例存在高尿酸血症,189例尿酸正常。高尿酸血症组糖尿病患者构成比（32.67％对11.64％;χ2=23.749, P<0.001）以及总胆固醇[（5.67±1.56）mmol/L对（5.10±1.33）mmol/L;t=－3.255,P<0.001]和高半胱氨酸[19.50（17.10~24.70）μmol/L对15.40（12.60~18.05）μmol/L;Z=－7.236,P<0.001]水平显著高于尿酸正常组,TT 基因型（55.45％对13.76％;χ2=56.409,P<0.001）和T等位基因（71.79％对32.54％;χ2=79.561,P<0.001）分布频率显著高于尿酸正常组。多变量logistic回归分析显示,TT 基因型（对CC 基因型,OR 6.434,95％CI 2.334~17.736;P<0.001）、CT 基因型（对CC基因型,OR 2.234,95％CI 1.019~4.898;P=0.045）、高半胱氨酸（OR 1.081,95％CI 1.010~1.157;P=0.024）、总胆固醇（OR 1.363,95％CI 1.123~1.653;P=0.002）为高尿酸血症的独立危险因素。结论 MTHFR基因C677T TT 基因型和血清尿酸水平是中国山东地区汉族人群缺血性卒中的独立危险因素,MTHFR基因C677T TT 基因型亦为该人群高尿酸血症的独立危险因素,调整饮食习惯可能对山东地区汉族人群缺血性卒中的预防具有积极意义。     

Electrocardiographic changes in thyrotoxic periodic paralysis.

The electrocardiograms (ECGs) of 30 patients with hypokalaemic thyrotoxic periodic paralysis during and after paralysis were studied. During paralysis, typical features of hypokalaemia were seen in all patients with serum potassium levels of 2.8 mmol/l or less; above this level, the ECGs varied from non-diagnostic to those showing typical features of hypokalaemia. It was not possible to accurately predict the serum potassium level from the ECG except when either sinus arrest or heart block was present. Although extrasystoles have been reported to be common in hypokalaemia, none of the patients in this study had extrasystoles. Sinus arrest occurred in two patients and second degree atrio-ventricular block occurred in three patients, a finding which has not been reported in hypokalaemia.