2型糖尿病肾病患者血清C反应蛋白与脂代谢异常的相关性研究

目的：了解血清超敏C反应蛋白（hsCRP）在2型糖尿病肾病中的变化与脂代谢异常的关系。方法：根据尿白蛋白排泄率（UAER）将2型糖尿病患者分为正常蛋白组（DM）40例、糖尿病肾病组（DN）33例及健康对照者（NC）30例。测定血清超敏CRP,同时测定血总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）及载脂蛋白B（Apo-B）等指标,测定空腹血糖（FBG）、HbA1C。观察各组间hsCRP变化与血脂作相关性分析。结果：DM组、DN组较NC组HbA1C、TC、TG、LDL-C、CRP水平升高,有统计学差异（P〈0.05或P〈0.01）;DN组较DM组CRP、TG、APO-B水平升高,有统计学差异（P〈0.05或P〈0.01）。DN组CRP与TG、TC、LDL-C呈正相关（P〈0.05或P〈0.01）。结论：2型糖尿病肾病中血清炎症因子CRP水平升高与脂代谢异常密切相关。     

绝经后女性骨密度与脂代谢相关性研究

目的 分析绝经后女性骨密度（BMD)与脂代谢相关性,探讨血脂紊乱对BMD的影响。方法 选择509名自然绝经后女性,未患有影响骨代谢疾病,无长期服用影响骨代谢的药物史,未使用过调脂药物。根据年龄段不同,分为<60岁、60~69 岁、70 ~79岁、>80岁4组,分别测量身高、体重、总胆固醇（TC)、甘油三酯（TG)、低密度脂蛋白胆固醇（LDL-C)和高密度脂蛋白胆固醇（HDL-C),并采用双能X线吸收测定仪测量正位腰椎,左侧股骨颈（Neck)处BMD,采用直线相关分析法分析 BMD和血脂之间的相关性,并控制年龄、体重指数因素后进行偏相关分析。结果 不同年龄组BMD、TC、LDL-C有显著差异。 各年龄组BMD与TC及LDL-C呈负相关,与HDL-C呈正相关,与TG无相关性。校正年龄、体重指数后的偏相关显示BMD仍与TC及LDL-C呈负相关,与HDL-C呈正相关。结论 绝经后女性TC和LDL-C升高与BMD下降密切相关,是骨质疏松的重要影响因素。     

脂肪乳剂建立大鼠高脂血症模型的研究

目的 用两种不同浓度脂肪乳剂按灌胃法建立大鼠高脂血症模型,并对其血脂水平进行评价,为建立合适的高脂血症动物模型提供依据.方法 将30只150～180 g健康雄性SD大鼠随机分为正常对照组、低浓度脂肪乳剂组及高浓度脂肪乳剂组,每组10只.分别饲以基础饲料、低浓度配方脂肪乳剂(20％猪油、6％胆固醇、0.2％丙基硫氧嘧啶、2％胆酸钠及10％吐温-80)及高浓度配方脂肪乳剂(30％猪油、10％胆固醇、1％丙基硫氧嘧啶、5％胆酸钠及20％吐温-80).2周后处死大鼠,测定血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平.结果 高浓度脂肪乳剂组血清TC、TG、HDL-C及LDL-C水平与正常对照组及低浓度脂肪乳剂组比较均升高(P＜0.05),低浓度脂肪乳剂组血清TC、TG及HDL-C水平与正常对照组比较差异无统计学意义(P＞0.05).结论 高浓度脂肪乳剂可以成功建立SD大鼠高脂血症模型,低浓度脂肪乳剂不适合用于建立SD大鼠高脂血症模型.     

绝经后2型糖尿病妇女血脂水平和骨密度的关系

目的探讨绝经后2型糖尿病妇女血脂和骨密度改变的相关性。方法将290例绝经后2型糖尿病妇女按T值分成骨质疏松组和非骨质疏松组;检测各组患者血清总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇LDL-C)以及腰椎骨密度(BMD),然后分析血脂和骨密度的关系;对骨密度和血脂、年龄、绝经年龄等变量之间的关系进行多元逐步回归分析。结果(1)绝经后2型糖尿病妇女的HDL-C与腰椎BMD存在负相关(r=-0.305,P=0.001),LDL-C、TG、TC与腰椎BMD无相关;(2)在校正体重指数、年龄和绝经年限影响因素后,绝经后2型糖尿病妇女的HDL-C与腰椎BMD仍存在负相关(r=-0.160,P=0.018),而LDL-C、TG、TC与腰椎BMD仍无相关。(3)在多元逐步回归分析中,HDL-C(β1=-0.199,P=0.005)仍与骨密度独立相关。结论绝经后2型糖尿病妇女的HDL-C与腰椎BMD存在负相关而TC、TG、LDL-C与腰椎BMD无相关。     

中青年2型糖尿病患者血脂与骨密度关系

目的 探讨中青年2型糖尿病患者血脂与骨密度的相关性。方法 将230例中青年2型糖尿病患者按骨密度测定分成骨质疏松组和非骨质疏松组;检测两组患者血清总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及骨密度和常见生化指标,如血糖和糖化血红蛋白、钙磷和肝肾功能,分析血脂各成分与骨密度之间的关系。 结果 (1) 中青年2型糖尿病患者体重指数与骨密度存在显著正相关(r= 0.256,P<0.01),而年龄、HDL-C与骨密度存在显著负相关（r1= -0.298,P1<0.01;r2= -0.237,P2<0.01）;TC、TG、LDL-C与骨密度均无相关性。(2) 在校正年龄、BMI等因素后,HDL-C仍与骨密度呈负相关(r=-0.152,P<0.05）。 结论 中青年糖尿病患者HDL-C增加可能与骨密度降低有一定的关系,而年龄增大可导致骨质疏松发生的增加,体重指数增加可减少骨质疏松发生的增加。     

乳腺癌患者化疗前后血脂血糖及体质量指数的变化

目的:探讨乳腺癌患者化疗前后血脂、血糖及体质量指数(BMI)水平的变化。方法:选取收治的141例乳腺癌患者,记录化疗前后的血脂水平,包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),同时收集化疗前后的血糖及BMI,分析以上指标化疗前后的变化。结果:全组患者(不论绝经状态)化疗后TG、TC、LDL-C、血糖水平均明显升高,而HDL-C、BMI水平明显降低(均P0.05)。在绝经前患者中,化疗后TG、TC、LDL-C水平升高,HDL-C水平降低(均P0.05),血糖水平和BMI变化不明显(均P0.05);在绝经后患者中,化疗后TG、血糖水平明显升高(均P0.05),但TC、HDL-C、LDL-C水平无明显变化(均P0.05)。结论:乳腺癌患者总体上表现为化疗后血脂、血糖水平升高,BMI下降,但绝经前与绝经后患者表现有所不同,应针对患者具体情况考虑进行适当的干预。     

肾移植后血他克莫司浓度与血脂和空腹血糖水平的相关性分析

目的 探讨肾移植后血他克莫司(Tac)浓度对受者血脂、空腹血糖(FBG)水平的影响.方法 选取肾移植后规律应用Tac+吗替麦考酚酯+泼尼松抗排斥反应治疗,且术前血脂、血糖水平正常的受者为研究对象.术后不同时点根据受者血Tac浓度与正常范围比较,将受者分为高浓度组、正常组和低浓度组,监测血Tac浓度谷值、血脂及FBG等生化指标的变化情况及相关性,并比较术后不同时段3组间血脂、FBG水平的差异.结果 术后1个月高浓度组三酰甘油(TG)水平显著高于正常组和低浓度组(P＜0.05),高密度脂蛋白胆固醇(HDL-C)水平显著低于正常组和低浓度组(P＜0.05)；术后3个月高浓度组TG、FBG水平显著高于正常组和低浓度组(P＜0.05和P＜0.01)；术后6个月高浓度组总胆固醇(TC)、TG、FBG水平显著高于正常组和低浓度组(P＜0.05,P＜0.01和P＜0.05).各时点正常组与低浓度组间各生化指标的差异均无统计学意义(P＞0.05).结论 肾移植后血Tac浓度超过正常范围,且时间越长,越容易引起药物性高脂血症及糖尿病.     

绝经后骨质疏松症患者血清ICTP、PINP与血脂相关性的研究

目的探讨绝经后骨质疏松症患者骨代谢指标(ICTP、PINP)与血脂水平的相关性及可能的机制。方法测定122例绝经后骨质疏松症患者(骨质疏松症组)和122例绝经后健康正常妇女(正常对照组)的血清ICTP、PINP、TG、TC、LDL-C、HDLC等指标,并分析其相关性。结果两组相比较,骨质疏松症组TG、TC、LDL-C高于正常对照组(P0.05),骨质疏松症组HDL-C低于正常对照组(P0.05),骨质疏松症组PINP低于正常对照组(P0.05),骨质疏松症组ICTP高于正常对照组(P0.05);PINP与TG、TC、LDL-C呈负相关,而与HDL-C呈正相关;ICTP与TG、TC、LDL-C呈正相关,而与HDL-C呈负相关。结论骨质疏松症患者成骨因子PINP水平下降、破骨因子ICTP水平升高与TG、TC、LDL-C升高及HDL-C降低密切相关,高脂血症引起的代谢紊乱与骨质疏松症的发生存在一定的关联性。     

骨性关节炎与类风湿性关节炎患者常见血脂含量的比较

目的比较骨性关节炎(OA)与类风湿性关节炎(RA)患者血清中常见血脂的含量,为OA患者中心血管疾病(CVD)的防治提供新的理论依据。方法随机选取自2012-08—2013-03因膝关节OA或RA在本院骨科进行的139例全膝关节置换术(TKA),OA组117例,RA组22例。所有患者入院后第1天早晨抽取空腹静脉血5 ml并立即送查血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),计算LDL-C/HDL-C比值。结果 OA组年龄及BMI均大于RA组,差异有统计学意义(P0.05)。OA组血清中TC及LDL-C水平显著高于RA组,差异有统计学意义(P0.05);但2组TG、HDL-C及LDL-C/HDL-C比值差异无统计学意义(P0.05)。多因素Logistic回归分析显示,通过校正年龄和BMI 2个混杂因素后,与RA组相比,OA组更易合并高TC水平(OR=2.815,P=0.003),而2组TG、HDL-C、LDL-C及LDL-C/HDL-C差异无统计学意义(P0.05)。结论在OA患者中,及时检测血清TC含量将有利于对远期CVD的综合防治。     

血脂异常与狼疮性肾炎病情活动的相关性

目的探讨血脂异常与狼疮肾炎(lupus nephritis, LN)病情活动的相关性。方法回顾性分析2016年1月至2019年1月于武汉大学人民医院肾内科诊断为LN的患者472例,其中行肾穿刺活检术的患者212例,按照2∶1比例抽取健康体检者236例。根据LN患者狼疮活动度评分(systemic lupus erythematosus disease activity index, SLEDAI)、狼疮性肾炎病理类型、血脂水平[总胆固醇(total cholesterol, TC)、总三酰甘油(total glyceride, TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)]进行分组,收集患者实验室检查指标,采用方差分析及相关性分析,探究LN患者血脂异常与LN病情活动度的相关性。结果 (1)LN患者血脂平均水平(TC、TG、HDL-C、LDL-C)均高于健康体检者,其中TC、TG、HDL-C水平比较差异具有统计学意义(P0.01);(2)LN血脂异常组患者TC、TG、LDL-C、SLEDAI、24 h尿总蛋白(24-hour urine total protein, 24hUTP)、尿素氮(urea nitrogen, BUN)、尿酸(uric acid, UA)、D二聚体(D-Dimmer)、血沉水平高于血脂正常组,估算肾小球滤过率(estimated glomerular filtration rate, eGFR)、HDL-C、血清白蛋白低于血脂正常组,差异具有统计学意义(P0.05);(3)Ⅳ型、Ⅴ型、Ⅳ+Ⅴ型LN患者血脂异常发病率最高,各组之间TC(F=3.119,P=0.006)、LDL-C(F=2.237,P=0.041)水平比较,差异有统计学意义(P0.05);(4)不同SLEDAI分组间LN患者TC(F=4.839,P=0.008)、TG(F=3.105,P=0.046)、LDL-C(F=4.605,P=0.010)水平差异有统计学意义(P0.05),其中重度活动组LN患者TC、TG、LDL-C水平显著升高;(5)Logistics回归分析显示TC、TG升高,HDL-C降低是LN发生的危险因素;(6)Pearson相关分析显示LN患者体内TC、TG、HDL-C水平与SLEDAI呈正相关关系(r0,P0.05),HDL-C水平与SLEDAI呈负相关关系(r0,P0.05)。结论 LN患者体内血脂水平与SLEDAI呈明显相关关系,早期监测LN患者血脂水平,对了解LN患者病情活动具有重要意义。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.