糖尿病肾病血尿酸与血脂、体重指数及肌酐清除率的关系

目的：通过检测2型糖尿病（T2DM）患者血尿酸（SUA）、血脂、体重指数、血肌酐（SCr）等水平,探讨高尿酸血症与相关影响因素及糖尿病肾病发生、发展的关系。方法：根据尿微量白蛋白（mAlb）/肌酐（Cr）水平将110例T2DM患者分为3个亚组,正常白蛋白尿组40例（尿mAlb/Cr〈30μg/mg）、微量白蛋白尿组39例（30μg/mg≤尿mAlb/Cr〈300μg/mg﹚及临床白蛋白尿组31例﹙尿mAlb/Cr≥300μg/mg）,测定SUA、SCr、糖化血红蛋白﹙HbA1c﹚、空腹胰岛素（FINS）、三酰甘油（TG）等指标,计算肌酐清除率（CCr）和体重指数,并与30例对照者（对照组）比较。结果：临床白蛋白尿组SUA水平为（375.6±179.5）μmol/L,显著高于对照组、正常白蛋白尿组、微量白蛋白尿组的（247.9±111.1）、（229.7±104.3）、（235.9±122.8）μmol/L（P〈0.01或P〈0.05﹚,且SUA随mAlb/Cr的增加而增加。SUA与SCr、TG、BMI呈正相关（P〈0.01）,与CCr呈负相关（P〈0.01）;多元线性逐步回归分析显示TG、BMI与SUA呈正相关（P〈0.05）,CCr与SUA呈负相关（P〈0.05）,SCr与SUA无相关性。结论：TG、BMI、CCr是SUA的独立相关因素,CCr与SUA相关性较SCr好,高尿酸血症可能参与了T2DM患者糖尿病肾病的发生、发展过程,应尽早干预治疗。     

高血压微量白蛋白尿与血肌酐和血尿酸的相关性分析

目的：探讨非糖尿病高血压患者微量白蛋白尿与肾功能状况相关性。方法：原发性高血压患者99例,尿常规检查尿蛋白阴性,用微量白蛋白尿试纸条（Micral-testⅡ）测定微量白蛋白尿,0 mg/L和20mg/L为A组,50 mg/L和100 mg/L为B组;分别比较两组之间的年龄、性别、BMI、收缩压、舒张压、血糖、胆固醇、血肌酐、血尿酸等相关因素进行对比分析;对以上变量与尿微量蛋白水平进行Logistic回归分析。结果：两组之间的血肌酐水平分别是（78.98±18.09）μmol/L和（94.84±15.80）μmol/L（P=0.006）;血尿酸水平分别是（308.29±76.87）μmol/L和（378.07±85.01）μmol/L（P=0.006）;回归分析结果微量白蛋白尿水平与血肌酐正相关（P=0.041）,与血尿酸正相关（P=0.001）。结论：在非糖尿病高血压患者中微量白蛋白尿与血肌酐、血尿酸水平正相关;尿的微量白蛋白尿增多预示早期肾脏损害。     

无症状脑梗死与2型糖尿病肾病发生发展的相关性研究

目的 探讨无症状脑梗死(SCI)与2型糖尿病肾病发生发展的相关性.方法 选取2006年1月～2011年1月住院且随访资料完成的2型糖尿病(T2DM)患者327例.根据患者尿白蛋白/肌酐比值(ACR)分为正常蛋白尿组(ACR＜30 mg/g,184例)、微量白蛋白尿组(ACR=30～299 mg/g,143例).经头颅CT或MRI诊断SCI.以正常蛋白尿组患者出现微量白蛋白尿,微量白蛋白尿组患者出现大量白蛋白尿(ACR≥300mg/g)为一级终点.应用Kaplan-Meier法计算一级终点累计发生情况.Cox风险模型分析一级终点发生的独立危险因素 结果 平均随访39个月后,32例正常蛋白尿组患者和39例微量白蛋白尿组患者达到一级终点.并发SCI患者一级终点达到率明显高于未并发SCI患者(P＜0.05).多因素Cox模型分析显示,并发SCI患者到达一级终点的风险比为2.19(P ＜0.05).结论 2型糖尿病患者并发SCI与糖尿病肾病的发生发展关系密切.     

氯沙坦降压疗效及对尿酸和蛋白尿的影响

目的探讨高血压治疗中氯沙坦对血压、蛋白尿和尿酸的影响.方法观察30例高血压患者服用氯沙坦(50mg/d)治疗8周后血压、尿蛋白、血尿酸及肌酐的变化.结果氯沙坦治疗8周后,血压明显下降,从161.66±17.52/97.42±6.70mmHg降至137.33±14.81/87.30±8.53mmHg(1mmHg=0.133kPa,P＜0.001);尿酸从457.76±108.77μmol/L降至405.91±90.11μmol/L(P＜0.001);蛋白尿从2210.26±1969.8mg/24h降至1895±2447.97mg/24h(P＜0.001);血肌酐变化不显著(P＞0.05).结论氯沙坦对高血压患者具有良好的降压作用,同时兼有降尿酸、降尿蛋白的作用.     

血清NGAL对早期诊断2型糖尿病肾病的临床价值

目的评价血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)早期诊断2型糖尿病肾病(DKD)的临床价值。方法实验纳入2型糖尿病(T2DM)病人316例,根据尿白蛋白/肌酐比值(ACR)将病人分为正常白蛋白尿组(ACR30 mg/g)149例、微量白蛋白尿组(30 mg/g≤ACR≤300 mg/g)99例、大量白蛋白尿组(ACR300 mg/g)68例。以270例健康体检者为对照组。测定实验对象的血清NGAL(sNGAL)、血清胱抑素C(CysC)、血清葡萄糖(Glu)、糖化血红蛋白(HbA1c)和尿液白蛋白/肌酐比值(ACR)。使用SPSS 19.0和Med Cal 12.7统计软件进行统计学分析。用受试者工作特征曲线(ROC)的曲线下面积(AUC)、灵敏度和特异性表示诊断性能,以最佳优登指数获取判断值。结果正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组sNGAL水平高于对照组,差异有统计学意义(P0.05);且随着ACR的升高,sNGAL逐渐升高;微量白蛋白尿组、大量白蛋白尿组CysC水平高于对照组,eGFR水平低于对照组,差异均有统计学意义(P0.05);正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组HbA1c、Glu水平均高于对照组,差异有统计学意义(P0.05),但在三组间差异无统计学意义(P0.05)。sNGAL与CysC(r=0.639,P0.001)、ACR(r=0.445,P0.001)和HbA1c(r=0.160,P=0.004)呈正相关,与eGFR(r=-0.639,P0.001)呈负相关。以150.1μg/L为判断值,sNGAL诊断DKD的灵敏度和特异性分别为65.3%和86.6%,AUC=0.792。结论 sNGAL是一个早期诊断DKD的生物标记物。     

前列地尔联合黄葵胶囊治疗糖尿病肾病22例效果观察

目的:观察前列地尔联合黄葵胶囊治疗糖尿病肾病的效果。方法:选择糖尿病肾病40例患者,随机分为观察组与对照组,两组均给予基础治疗。观察组在基础治疗基础上再予前列地尔联合黄葵胶囊治疗,10天为1个疗程,连续2个疗程。两组治疗前后均检测尿素氮(BUN)、血肌酐(Scr)、尿微量白蛋白/肌酐(ACR)、肾小球滤过率(GFR)。结果:(1)经治疗后BUN、Scr、ACR两组比较:观察组为7.5±2.8 mmol/L,72.5±11.6μmol/L,132.6±22.4μg/mg;对照组为9.1±3.5 mmol/L,80.6±14.7μmol/L,169.3±20.3μg/mg观察组均低于对照组,两组比较差异有统计学意义(P<0.05)。(2)经治疗后观察组GFR为108.4±9.6 mL.min-1.1.73m-2,对照组为98.3±11.5 mL.min-1.1.73m-2,两组比较差异有统计学意义(P<0.05)。结论:前列地尔联合黄葵胶囊治疗糖尿病肾病疗效显著,值得临床推广应用。     

银杏叶提取物对糖尿病病人尿微量白蛋白及血小板功能的影响

目的观察银杏叶提取物(Ginkgp Bo;pba Extract,GbE)对2型糖尿病病人血小板聚集功能及微量白蛋白尿的影响.方法对52例2型糖尿病合并微量白蛋白尿病人,26例在常规治疗糖尿病(格列奇特或合用二甲双胍口服)基础上加用GbE70 mg加入生理盐水250ml中静脉滴注14 d;另26例病人单用常规治疗14 d为对照组.2组均于治疗前后检测血小板聚集率、血浆α颗粒膜蛋白-140(GMP-140)、血栓素β2(TXB2)、尿白蛋白的变化.结果GbE组血小板粘附率下降(38±15)%,GMP-140水平下降(8±16)μg/L,TXB2水平下降(124±88)ng/L,尿白蛋白和肌酐的比值下降(8.1±3.9)mg/mmol;而常规治疗组依次为(4±21)%,(0.9±10)μg/L,(1±66)n/L及(14±3.6)mg/mmol;2组组间比较,差别均有非常显著意义(P＜0.01).结论GbE有改善血小板功能、减少糖尿病微量白蛋白尿的作用.     

2型糖尿病肾病患者尿白蛋白/肌酐、血尿酸及C反应蛋白的变化及意义

目的 探讨2型糖尿病肾病患者尿白蛋白/肌酐比值、血尿酸及血清C反应蛋白(CRP)水平的变化及意义.方法 对本院已确诊的120例2型糖尿病患者同时检测尿白蛋白/肌酐比值、血尿酸及血清C反应蛋白(CRP),并同时收集24h尿液进行尿微量白蛋白(MA)测定,按尿白蛋白排泄率(UAER)将糖尿病组分三组:B组为正常蛋白尿组(UAER<20μg/min);C组为微量蛋白尿组(UAER 20～200g/min);D组为临床蛋白尿组(UAER>200μg/min).另选我院体检健康者40例作为A组正常对照组.结果 在B组和C组及D组中血尿酸、血清CRP含量高于A组,与A组比较,差异有统计学意义(P<0.05),B组尿中mALB/Cr虽高于A组,但差异无统计学意义(P>0.05),而C组及D组尿中mALB/Cr高于A组差异有统计学意义(P>0.05).结论 尿中mALB/Cr水平在糖尿病肾功能早期损伤中变化较明显.血尿酸水平对于糖尿病肾病的发展很重要;CRP参与炎症过程与糖尿病肾病的致病,发展过程有关.     

微量白蛋白尿与糖尿病视网膜病变的相关性研究

目的 了解尿微量白蛋白测定在预防糖尿病视网膜病变(DR)中的意义.方法 对150例住院的Ⅱ型糖尿病患者(T2DM),根据眼底情况分为正常眼底组(NR),背景型糖尿病视网膜病变组(BDR)和增殖性糖尿病视网膜病变组(PDR);对所有患者均检测尿白蛋白/肌酐比(ACR);根据ACR的值分为正常白蛋白尿组(NA),微量白蛋白尿组(MAU),大量白蛋白尿组(CAU).结果 150例Ⅱ型糖尿病患者中有125倒(83.3％)合并不同程度的DR,且其严重程度与病程呈正相关;ACR在30～300mg/g之间,有90.2％患者发生DR,ACR＞ 300mg/g,DR的发生率为100％.结论 Ⅱ型糖尿病患者DR发生与蛋白尿水平和病程密切相关,尿微量白蛋白可成为预测DR严重程度的指标之一.     

硫辛酸联合胰激肽原酶治疗2型糖尿病早期肾病临床效果分析

目的：观察硫辛酸注射液联合胰激肽原酶治疗2型糖尿病早期肾病的临床效果。方法：80例早期2型糖尿病肾病患者,随机分为对照组和观察组各40例。对照组采取常规治疗,观察组常规治疗基础上加用硫辛酸和胰激肽原酶治疗,疗程2周。比较治疗前后两组患者空腹血糖、尿微量白蛋白、尿白蛋白肌酐比值和胱抑素-C水平。结果：治疗后两组患者空腹血糖、尿微量白蛋白、尿蛋白肌酐比值和胱抑素-C水平均低于治疗前,差异均有统计学意义（P＜0.05）;治疗后观察组尿微量白蛋白为96.17±20.97 mg/L,尿蛋白肌酐比值为79.10±15.92 mg/mmol,胱抑素-C为1.03±0.25 mg/L,分别低于对照组的205.28±36.38 mg/L,175.60±32.78 mg/mmol和1.85±0.24 mg/L,差异均具有统计学意义（P＜0.05）。结论：硫辛酸联合胰激肽原酶治疗早期2型糖尿病肾病安全有效,值得临床应用。     

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…     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…