糖尿病慢性并发症与血清同型半胱氨酸和超敏C反应蛋白的关系

目的探讨2型糖尿病(T2DM)慢性并发症患者血清同型半胱氨酸(Hcy)和超敏C反应蛋白(hs-CRP)水平的改变。方法 129例2型T2DM患者分为单纯糖尿病(DM)组,糖尿病肾病(DN)组和糖尿病合并冠心病(DM+CHD)组,50例体检健康者作为健康对照组,分别检测其血糖、血清Hcy、血清hs-CRP。结果 DN组和DM+CHD组Hcy显著高于DM组和对照组(P0.01),DM组与对照组之间差异无统计学意义(P0.05);所有糖尿病组hs-CRP高于对照组(P0.05),DN组和DM+CHD组升高更为明显(P0.01)。结论血清Hcy和hs-CRP对糖尿病并发症的早期诊断以及病情发展的分析和监测有一定的临床意义。     

冠状动脉粥样硬化心脏病患者血清同型半胱氨酸和超敏C反应蛋白表达特点及临床意义

目的探讨冠状动脉粥样硬化心脏病(CHD)患者血清同型半胱氨酸(Hcy)和超敏C反应蛋白(hs-CRP)的表达特点及临床意义。方法选取江西省鄱阳东湖医院心内科住院的105例CHD患者为CHD组。根据CHD不同类型分为稳定型心绞痛(SAP)组、不稳定型心绞痛(UAP)组和急性心肌梗死(AMI)组,分别为42、36和27例。根据CHD患者冠脉狭窄程度分为中度组和重度组,分别为67例和38例。另选取同期体检的30例健康人群为健康组。检测并比较健康组和CHD不同亚组血清Hcy、hs-CRP水平,采用Pearson法分析CHD患者血清Hcy、hs-CRP、冠脉狭窄程度间的相关性。结果 SAP组、UAP组和AMI组血清Hcy、hs-CRP水平均显著高于健康组(P 0. 05),SAP组、UAP组和AMI组血清Hcy水平依次升高(P 0. 05),AMI组血清hs-CRP水平显著高于SAP组和UAP组,差异均有统计学意义(P 0. 05);中度组和重度组CHD患者血清Hcy、hs-CRP水平均显著高于健康组(P 0. 05),且重度组血清Hcy、hs-CRP水平高于中度组,差异均有统计学意义(P 0. 05); Pearson相关分析显示,CHD患者血清Hcy与hs-CRP呈正相关(r=0. 547,P 0. 05),血清Hcy、hs-CRP与冠脉狭窄程度呈正相关(r=0. 705、0. 438,P 0. 05)。结论血清Hcy、hs-CRP水平与CHD发生有紧密关联,与冠脉狭窄程度呈正相关。因此,临床加强血清Hcy、hs-CRP水平检测对CHD评估和风险预测具有显著价值。     

2型糖尿病并下肢血管病变相关血清标志物水平分析

目的分析2型糖尿病并下肢血管病变患者中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinaseassociated lipocalin,NGAL）、同型半胱氨酸（homocysteine,Hcy）、高敏C反应蛋白（high sensitivity C-reactive protein,hs-CRP）水平变化,探讨其与2型糖尿病并下肢血管病变的关系。方法 83例2型糖尿病患者依据下肢动脉彩色多普勒检查结果评分分组,评分为0分者21例为下肢动脉无病变组,评分〈10分者21例为下肢动脉轻度病变组,评分为〉10-20分者21例为下肢动脉中度病变组,评分〉20分者20例为下肢动脉重度病变组,分别测定患者NGAL、Hcy、hs-CRP水平并进行组间比较。结果 NGAL、Hcy、hs-CRP水平有病变组均较无病变组增高,差异均有统计学意义（P〈0.05）,且随病变程度加重逐渐增高,组间两两比较差异均有统计学意义（P〈0.05或P〈0.01）;NGAL、Hcy、hs-CRP水平与下肢病变程度呈正相关（r=0.661,P=0.000;r=0.612,P=0.000;r=0.647,P=0.000）。结论 NGAL、Hcy、hs-CRP水平对2型糖尿病患者下肢血管病变程度的评估有重要价值。     

外周血指标联合检测对冠心病的诊断价值研究

目的分析血清超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、D-二聚体水平与冠心病(CHD)的相关性,并探讨联合检测对冠心病诊断的诊断价值。方法收集100例冠心病患者(研究组)及100例无CHD的健康体检者(对照组),并依据合并症分为单纯CHD组(32例)、合并高血压组(46例)、合并糖尿病组(9例),合并高血压+糖尿病组(13例)、检测各组血清hsCRP、Hcy、D-二聚体水平,并进行统计学分析。结果研究组hs-CRP、Hcy、D-二聚体水平均显著高于对照组(P0.05)。Logistic回归分显示,三项指标均为CHD的独立危险因素,对CHD诊治有一定的临床意义,以Hcy应用价值最高。两两联合检测中,hs-CRP和Hcy联合检测是较为理想的方案,三项联合检测不适于CHD的早期诊断。单纯CHD组、合并高血压组、合并高血压+糖尿病组hs-CRP、D-二聚体水平与合并糖尿病组比较差异有统计学意义(P0.05)。结论 hs-CRP、Hcy、D-二聚体是CHD的独立危险因素,其联合检测对CHD的诊断效能较佳。     

同型半胱氨酸与鼻咽癌相关性及其机制研究

目的探讨同型半胱氨酸(Hcy)和血清超敏C-反应蛋白(hs-CRP)水平的关系,明确Hcy和hs-CRP水平与鼻咽癌发生的关系,以明确Hcy是否为鼻咽癌的危险因素。方法收集2012年1月至2014年7月中山市中医院肿瘤科收治并确诊为鼻咽癌的患者72例,另选取同期体检的50例志愿者作为健康对照组,鼻咽癌患者分为鼻咽癌缓解组和鼻咽癌未缓解组。收集入选研究对象清晨空腹静脉血测定血浆Hcy和hs-CRP水平。结果与健康对照组比较,鼻咽癌缓解组、未缓解组治疗前血浆Hcy和hs-CRP水平显著升高,差异均有统计学意义(t=9.08,P=0.023;t=6.84,P=0.035);与鼻咽癌缓解组治疗前比较,鼻咽癌未缓解组治疗前血浆Hcy和hs-CRP水平显著升高,差异均有统计学意义(t=10.94,P=0.018;t=8.67,P=0.026);与鼻咽癌缓解组治疗前比较,鼻咽癌缓解组治疗后血浆Hcy和hs-CRP水平显著降低,差异有统计学意义(t=7.15,P=0.030;t=5.34,P=0.047);与鼻咽癌未缓解组治疗前比较,鼻咽癌未缓解组治疗后血浆Hcy和hs-CRP水平降低,但差异无统计学意义(t=1.05,P=0.072;t=1.84,P=0.064)。鼻咽癌患者血浆Hcy与hs-CRP水平之间有直线相关关系,呈正相关,相关系数为0.522。结论血浆Hcy和hs-CRP水平变化与鼻咽癌严重程度和治疗效果均有正相关性,为临床早期诊断和提高治疗效果提供了参考依据。     

超敏CRP、同型半胱氨酸的联合检测对2型糖尿病肾病早期诊断的意义

目的 探讨超敏C-反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)和血脂水平在2型糖尿病(T2DM)、糖尿病肾病(DN)中的诊断意义。方法 根据尿微量清蛋白排泄率(UAER)将61例T2DM患者分为单纯糖尿病组(SDM组)、糖尿病肾病组(DN组),30例健康者作为对照组,分别测定各组血清Hcy和血脂的水平并与对照组比较。结果 DN组血清hs-CRP、Hcy、血脂水平与SDM组均显著高于对照组,差异有统计学意义(P<0.05)。Hcy、Lp(a)和hs-CRP分别与UAER呈正相关(r分别为0.551、0.432、0.594,P<0.01)。结论 hs-CRP和Hcy随着UAER的增加而明显升高,可体现病情的加重,可作为糖尿病(DM)及DN患者病情监测指标。     

同型半胱氨酸、脂蛋白(a)、高敏C反应蛋白与颈动脉内膜中层厚度的关系

目的探讨同型半胱氨酸(Hcy)、脂蛋白(a)[Lp(a)]、高敏C反应蛋白(hs-CRP)与颈动脉内膜中层厚度(CIMT)的关系。方法将177名健康体检者根据Hcy测定结果分为高Hcy组(108名)和Hcy正常组(69名),分别测定2组Lp(a)、hs-CRP水平及CIMT,比较高Hcy组和Hcy正常组之间Lp(a)、hs-CRP及CIMT的差异;分析Hcy、Lp(a)、hs-CRP及CIMT之间的相关性。采用受试者工作特征(ROC)曲线分析Hcy、Lp(a)、hs-CRP诊断颈动脉内-中膜增厚的价值。结果高Hcy组hs-CRP及CIMT明显高于Hcy正常组(P=0.000),而Lp(a)两组之间无明显差异(P=0.217)。Hcy、hs-CRP与CIMT呈明显正相关(r值分别为0.660、0.624,P=0.000);Lp(a)与CIMT无相关性(r=0.122,P=0.316);Hcy与hs-CRP呈正相关(r=0.597,P=0.000);Lp(a)与Hcy、hs-CRP无相关性(r值分别为0.063、0.01,P值分别为0.65、0.994)。如以CIMT≥1.00 mm为颈动脉内-中膜增厚,Hcy和hs-CRP的ROC曲线下面积(AUC)分别为0.869(P=0.000)、0.872(P=0.000),而Lp(a)的AUC为0.512(P=0.857)。结论 Hcy、hs-CRP与CIMT明显相关,Hcy和hs-CRP可能在颈动脉内-中膜增厚过程中起重要作用。     

老年早期糖尿病肾病患者血清Hcy、β_2-MG及炎症因子的变化研究

目的探讨老年早期糖尿病肾病患者血清同型半胱氨酸(Hcy)、β2微球蛋白(β2-MG)及炎症因子的水平变化。方法选取2016年1-12月新疆军区总医院收治的70例老年2型糖尿病患者作为研究对象,其中单纯糖尿病患者36例(单纯DM组),早期糖尿病肾病患者34例(早期DN组),另选取同期于该院健康体检的35例健康老年人作为对照组,检测并比较各组血清Hcy、β2-MG、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)水平。结果单纯DM组与早期DN组的Hcy、β2-MG水平均高于对照组,早期DN组的Hcy、β2-MG水平高于单纯DM组,差异均有统计学意义(P0.05)。单纯DM组与早期DN组的hs-CRP、IL-6、IL-8、TNF-α水平均高于对照组,早期DN组的hs-CRP、IL-6、IL-8、TNF-α水平高于单纯DM组,差异有统计学意义(P0.05)。结论老年早期糖尿病肾病患者的血清Hcy、β2-MG及炎症因子异常升高,检测上述指标有助于早期判断病情。     

3项测定在老年糖尿病肾病早期诊断中的应用价值

目的评价血清胱抑素C(Cys C)、同型半胱氨酸(Hcy)和超敏C反应蛋白(hs-CRP)测定在老年糖尿病肾病早期诊断中的应用价值。方法检测31例尿蛋白正常组(A组)、32例微量蛋白尿组(B组)和30例大量蛋白尿组(C组)老年糖尿病肾病患者Cys C、Hcy和hs-CRP水平,同时选择33例健康老年人作为健康对照组,对检测数据进行t检验和相关分析。结果 A、B、C组与健康对照组比较,Cys C、Hcy和hs-CRP水平都明显升高,差异有统计学意义(P<0.05);且肾功能损伤程度越重,Cys C、Hcy水平越高,差异有统计学意义(P<0.05);而B组与A组比较hs-CRP水平变化不明显,差异无统计学意义(P>0.05);C组与A组和B组比较hs-CRP水平变化差异有统计学意义(P<0.05)。结论血清Cys C、Hcy和hs-CRP是老年糖尿病肾病早期诊断的重要指标,且病情程度越重,Cys C、Hcy和hs-CRP水平越高,三者变化呈正相关,并且Cys C、Hcy在检测老年糖尿病肾病肾脏损害程度方面敏感性优于hs-CRP。     

分析多项指标表达水平在糖尿病肾病早期诊断中的意义

目的探讨血清胱抑素C(Cys-C)、血清超敏C反应蛋白(hs-CRP)、尿转铁蛋白(TRF)、尿α1-微球蛋白(α1-MG)联合检测在糖尿病肾病(DN)早期诊断中的临床应用价值。方法选取宝鸡市第三人民医院内分泌、肾内科收治的47例单纯糖尿病患者(单纯DM组)、44例早期DN患者(早期DN组)和50例健康体检者(对照组)的血液和尿液标本,在日立7180全自动生化分析仪上检测Cys-C、hs-CRP、TRF和α1-MG水平,同时检测传统肾功能诊断指标血清肌酐(SCr)、尿素(SUrea)水平,并对检测结果进行统计学分析。结果单纯DN组和早期DN组CysC、hs-CRP、TRF和α1-MG水平显著高于对照组,差异有统计学意义(P0.05);早期DN组Cys-C、hs-CRP、TRF和α1-MG水平高于单纯DM组,差异也有统计学意义(P0.05);SCr和SUrea检测水平在3组间差异无统计学意义(P0.05);Cys-C、hs-CRP、TRF和α1-MG均与传统肾功能诊断指标呈正相关。4项指标联合检测的阳性检出率(90.91%)明显高于任意单一指标的阳性检出率,差异均有统计学意义(P0.05)。结论 Cys-C、hs-CRP、TRF和α1-MG可作为DN早期肾功能损伤的重要监测指标,联合检测有利于提高DN的早期检出率,为临床医生早期诊断DN提供有价值的实验室依据。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。     

罕见和未知基因型珠蛋白生成障碍性贫血的分析与鉴定

目的对珠蛋白生成障碍性贫血(简称地贫)血液学表型阳性但未检出常见地贫基因型的疑似个体做进一步分子水平检测,以明确诊断。方法收集2015年5月至2018年8月在清远市妇幼保健院就诊的地贫血液学表型阳性但常见地贫基因型检测为阴性的标本96例(包括疑似α-地贫88例和β-地贫8例),分别采用单管多重PCR、DNA测序法、荧光定量PCR和芯片捕获测序法检测罕见和未知缺失型地贫基因。结果从上述疑似α-地贫标本中共检出罕见α-地贫基因型17例,其中泰国缺失型(--^THAI/αα)5例,菲律宾缺失型(--^FIL/αα)2例,α^ΔCD303例,α珠蛋白基因拷贝数增加(ααα^anti3.7或ααα^anti4.2)5例,并且发现2例新的α-地贫突变,即α^ΔCD272-279delAGCTTCGG和CD167-169insT。在8例β-地贫特征个体中检出罕见β-地贫基因型Poly A(A>G)2例,-90(C>T)3例,CD37(TGG>TAG)1例,IVS-I-2(T>A)1例,另外还鉴定出1例新的缺失型β-地贫基因(缺失位置为ch11:5,246,000-5,250,500,缺失长度为4kb左右)。结论对未检出常见地贫突变但血液学表型阳性个体进行深度分析,既可提高地贫基因的检出率,有利于遗传咨询和产前诊断,又可能发现新的地贫突变,丰富了中国人群的地贫基因突变谱。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

头面部血管肉瘤3例报告并文献复习

目的:总结我们对头面部血管肉瘤手术联合放射治疗方法的经验认识。方法:报道3例头面部血管肉瘤病例,并复习相关文献。结果和结论:头面部血管肉瘤是一种少见的、多中心的血管肿瘤,预后差。头面部血管肉瘤的手术治疗常常需要切除较广的范围。放射治疗对头面部血管肉瘤是一种合理治疗,既能使受侵犯的真皮组织和周围皮肤得到进一步治疗,又能保护其下的正常组织。     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.