2型糖尿病患者血糖波动与颈动脉内膜中层厚度的关系

目的探讨2型糖尿病(T2DM)患者血糖波动与颈动脉内膜中层厚度(CIMT)的关系。方法连续纳入2009年7月至2012年3月在我院内分泌科住院的T2DM患者64例,所有患者均应用高分辨彩色多谱勒超声诊断仪测定CIMT以及动态血糖监测系统(CGMS)进行72h血糖监测,并检测糖化血红蛋白(HbA1c)、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)等。根据CIMT<0.9mm将患者分为CIMT正常组(A组,n=37)和CIMT增厚组(B组,n=27)。结果①A组患者年龄、收缩压、LN(LDL-c)、LN〔日间血糖平均绝对差(MODD)〕均小于B组,差异有统计学意义(P均<0.05);但两组患者性别、糖尿病病程、体质量指数(BMI)、糖尿病慢性并发症、糖尿病家族史、舒张压、TG、TC、HDL-c以及日内血糖波动指标平均血糖的标准差(SD)与平均血糖波动幅度(MAGE)无明显差异(P>0.05)。②Pearson相关分析显示:糖尿病患者CIMT与年龄、LN(LDL-c)、LN(MODD)、SD相关,r值分别为:0.370(P=0.005)、0.325(P=0.009)、0.346(P=0.005)、0.251(P=0.045)。③多重线性回归分析显示:患者年龄、吸烟、LN(LDL-c)、LN(MODD)是CIMT的重要危险因素。结论 T2DM患者血糖波动是导致动脉粥样硬化的重要危险因素,且独立于HbA1c之外。     

T2DM患者ABI、Cys C与糖尿病肾病的相关性

目的 探讨2型糖尿病(T2DM)患者踝肱指数(ABI)及胱抑素C(Cys C)与糖尿病肾病(DKD)的相关性.方法 回顾性分析2017年9月至2019年12月就诊于景德镇市第一人民医院内分泌科及肾内科住院的265例T2DM患者临床资料,根据尿清蛋白排泄率(UAER)将T2DM患者分为正常清蛋白尿组(n=107)、微量清蛋白尿组(n=111)和大量清蛋白尿组(n=47),比较各组一般资料及临床生化指标数据.结果 与正常清蛋白尿组比较,微量清蛋白尿组收缩压(SBP)、高密度脂蛋白-胆固醇(HDL-c)、低密度脂蛋白-胆固醇(LDL-c)、UAER、尿素氮(BUN)、肌酐(Cr)、肾小球滤过率估计值(eGFR)、ABI、Cys C指标差异有统计学意义(P<0.05).与正常清蛋白尿组比较,大量清蛋白尿组BMI、SBP、舒张压(DBP)、甘油三酯(TG)、HDL-c、LDL-c、UAER、BUN、Cr、eGFR、ABI、Cys C指标差异有统计学意义(P<0.05).与微量清蛋白尿组比较,大量清蛋白尿组SBP、DBP、空腹血糖(FPG)、TG、UAER、BUN、Cr、eGFR、ABI、Cys C指标差异有统计学意义(P<0.05).ABI与SBP、UAER、BUN和Cr呈负相关,与HDL-c和eGFR呈正相关(P<0.05);Cys C与SBP、DBP、UAER、BUN、Cr和TG呈正相关,与eGFR呈负相关(P<0.05).多因素logistic回归分析结果显示:T2DM病程、BMI、糖化血红蛋白(HbA1c)、SBP、总胆固醇(TC)、Cr、BUN、Cys C指标水平升高及DBP、HDL-c、ABI指标水平降低是DKD发生的独立危险因素(P<0.05).ABI联合Cys C判断尿蛋白异常的受试者工作特征(ROC)曲线下面积为0.824,灵敏度为88.4％,特异度为80.4％.结论 ABI、Cys C与DKD发生有相关性,二者联合检测可以增加DKD筛查的灵敏度与特异度.     

非高密度脂蛋白、同型半胱氨酸、尿酸水平与冠状动脉病变程度的相关性分析

目的:探讨冠心病患者非高密度脂蛋白(non-HDL-c)、血清同型半胱氨酸(HCY)、血浆尿酸(UA)水平与冠状动脉病变程度的关系及其临床意义。方法:选取中国武装警察部队后勤学院附属医院心脏医院以冠心病或可疑冠心病住院的患者(410例),根据冠状动脉造影检查(CAG)结果分为冠心病组(A组)和非冠心病组(B组),A组患者再根据病变血管Gensini评分分为A1组、A2组、A3组。A组、B组分别测定总胆固醇(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)、血清同型半胱氨酸(HCY)、血浆尿酸(UA)水平,并计算出非高密度脂蛋白(non-HDL-c)数值。分析A组与B组及A1、A2、A3组组间TC、TG、LDL-c、HDL-C、non-HDL-c、HCY、UA水平。进行冠心病组临床资料及血脂水平与Gensini积分的Pearson的相关分析及与Gensini积分的多因素Logistic回归分析。结果:A组较B组TC、LDL-c、non-HDL-c、HCY、UA水平明显升高,差异有统计学意义(P<0.01、P<0.05);A1、A2、A3组TC、LDL-c、non-HDL-c、HCY、UA水平呈升高趋势,差异有统计学意义(P<0.01、P<0.05);冠心病组TC、LDL-c、non-HDL-c、HCY、UA水平与Gensini积分呈正相关性,(r=0.505、0.457、0.448、0.219、0.371;P<0.01、P<0.05);冠心病组TC、non-HDL-c、HCY、UA水平与Gensini积分有独立相关性(P=0.015、0.006、0.000、0.000)。结论:non-HDL-c、HCY、UA水平升高是冠状动脉粥样硬化的独立危险因素,且对冠脉病变程度有较高的预测价值。     

急性脑梗死患者糖化血红蛋白与颈动脉斑块厚度的相关性研究

目的 探讨急性脑梗死患者糖化血红蛋白(HbA1c)与颈动脉粥样硬化斑块厚度的相关性.方法 选择住院的急性脑梗死患者200例,依据有无合并2型糖尿病将其分为糖尿病组(T2DM组)100例,非糖尿病组(NDM组)100例.所有患者均检测HbA1c、血脂、同型半胱氨酸(Hcy),并应用彩色多普勒超声仪测定颈动脉斑块的有无,测定其最大斑块厚度(MTCAP).探讨其相关性及危险因素.结果 ①T2DM组和NDM组MTCAP、收缩压(SBP)、HbA1c、血清总胆固醇(TC)比较差异有统计学意义(P＜0.05).②相关性分析:T2DM组中HbA1c、TC、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、Hcy与MTCAP呈正相关(r=0.243,0235,0395,0.278,0.215,P＜0.05),以MTCAP为因变量,以HbA1c、TC、TG、LDL-C、Hcy为自变量进行多元线性回归分析,TC、TG、Hcy 3个变量进入最终方程.结论 急性脑梗死合并2型糖尿病患者的HbA1c与MTCAP呈正相关,但并不是MTCAP的主要危险因素.     

急性冠脉综合征合并糖尿病患者住院期间血糖控制现状分析

目的揭示目前ACS合并DM患者住院期间血糖控制现状,为ACS合并DM的住院患者优化血糖管理策略进行有益的探索。方法回顾性调查我院2006年1月至2008年12月收治的ACS合并DM患者382例的一般资料,住院期间血压控制的理想值及生化指标控制的理想值,包括空腹血糖(FPG)、餐后2h血糖(2hPG)、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)、血肌酐、HbA1c、有无低血糖的发生及原因、死亡及原因。结果 FPG控制良好以上为49.22%,控制理想的仅为36.13%。餐后2hPG控制良好以上占45.55%。血压控制良好以上352例,占92.15%。TG控制良好以上299例,占78.27%。TC控制良好以上342例,占89.53%。HDL-c控制良好以上240例,占62.83%。LDL-c控制良好以上308例,占80.63%。结论无论FPG或2hPG与总体DM人群的达标率相差较远;血压、TG、TC、HDL-c、LDL-c与总体DM人群的达标率较为接近。ACS合并DM患者优化血糖管理策略势在必行。     

2型糖尿病患者抑郁情绪对血糖控制的影响

目的 探讨2型糖尿病(T2DM)患者抑郁情绪对血糖控制的影响.方法 应用Zung抑郁自评量表(SDS)评估抑郁情况,276例T2DM患者分为SDS≥53分(A组)、SDS＜53分(B组).比较两组糖化血红蛋白(HbA1c)、空腹血糖(FPG)及胰岛素抵抗指数(HOMA-IR)等,分析T2DM患者血糖控制的影响因素.结果 T2DM患者SDS标准分与HbA1c呈正相关(r=0.26,P＜0.05).多元回归分析显示T2DM患者SDS标准分与HbA1c仍相关(β=0.30,t=5.1,P＜0.05).A组HbA1c水平高于B组(t=3.685,P＜0.05);当校正性别、年龄、受教育程度等因素后,A组HbA1c仍高于B组(F=47.8,P＜0.05).结论 抑郁情绪不利于T2DM患者血糖控制.     

2型糖尿病患者ApoA1/ApoB之值与其血管并发症关系分析

目的:分析2型糖尿病(T2DM)患者载脂蛋白A1/载脂蛋白B之值(ApoA1/ApoB值)与其血管并发症的关系.方法:226例T2DM患者按照有无血管并发症分为无血管并发症(A组)、有大血管并发症组(B组)、有微血管并发症组(C组)、同时有大血管和微血管并发症组(D组)4组,测定并比较各组空腹血糖(FBG)、糖化血红蛋白(HbA1c)及血脂各项指标,并行多元逐步回归分析.结果:(1)A组收缩压(SBP)、HbA1c、FPG、甘油三酯(TG)、ApoB较B、C、D组明显偏低(P＜0.05);(2)A、C组总胆固醇(CH)、低密度脂蛋白(LDL)较B、D组明显降低(P＜0.05),而A、C组高密度脂蛋白(HDL)、ApoA1/ApoB值明显高于B、D组(P＜0.01),B、C、D组ApoB明显高于A组(P＜0.01).(3)多元逐步回归分析示ApoA1/ApoB值与HDL呈明显正相关(r =0.237,P＜0.01),与HbA1c、TG、LDL呈明显负相关(r=-0.393,-0.416,-0.545,P＜0.05).结论:ApoA1与DM微血管病变无相关性,ApoB为DM血管病变的共同致病因子,ApoA1/ApoB值在血管粥样硬化的诊断治疗上较ApoA1、ApoB单项更有价值.     

亚临床甲状腺机能减退症患者血脂异常结果临床分析

目的:观察亚临床甲状腺机能减退症(亚甲减)患者中血脂异常结果的临床意义。方法:测定并比较58例亚临床甲减患者和80例健康人群的血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)、三酰甘油(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)水平,对TSH与血脂水平进行相关性研究。结果:亚临床甲减组中的TC、LDL-c明显高于对照组(P<0.05),TG、HDL-c两组之间差异无统计学意义(P>0.05)。结论:亚临床甲减组TC、LDL-c明显高于健康对照组,亚临床甲减在促进动脉粥样硬化的过程中,血脂紊乱可能是重要的危险因素。     

无症状2型糖尿病周围神经病变患者监测血清NO和AGEs的临床意义

目的：研究一氧化氮（NO）、晚期糖基化产物（AGEs）监测对无症状2型糖尿病（T2DM）周围神经 病变（DPN）的临床意义。方法：选取2015年12月至2018年12月间浙江中医药大学附属第三医院的T2DM住 院患者80例,通过测定振动感觉阈值（VPT）联合神经传导速度（NCV）诊断为DPN的患者60例,其余20例为 单纯T2DM组。60例DPN患者再通过有无肢体麻木、烧灼感、疼痛等症状分为有症状DPN组29例和无症状DPN 组31例。比较3组患者的空腹血糖（FPG）、餐后2h血糖（PPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、总 胆固醇（TC）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、载脂蛋白a（APOa）、载脂蛋白b （APOb）水平;比较3组患者NO、AGEs水平差异。结果：有症状DPN组的FPG、PPG、HbA1c水平均明显高于无 症状DPN及单纯T2DM患者（ P ＜0.01）。无症状DPN组的FPG、PPG、HbA1c水平均高于单纯T2DM患者（ P ＜0.05）。 3组患者的TG、TC、LDL-c、HDL-c、APOa、APOb水平差异无统计学意义（ P＞ 0.05）。与单纯T2DM组比,DPN组 血清NO均明显下降,AGEs水平明显升高（ P ＜0.01）;2组DPN患者血清NO、AGEs水平差异有统计学意义（ P ＜ 0.01）。 结论：临床上早期无症状DPN发病率高,NO、AGEs是其重要的生物信号和效应分子,早期检测有助 于了解神经病变的程度。控制血糖对减少DPN的发生具有非常重要的临床意义。     

初诊2型糖尿病患者踝肱指数异常率临床分析

目的研究初诊2型糖尿病(T2DM)患者中踝肱指数(ABI)异常率及影响因素。方法检测初诊T2DMABI值320例,ABI<0.9或≥1.3为异常组(A组),0.9相似文献   

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.