2型糖尿病合并非酒精性脂肪肝危险因素的临床分析

目的：探讨2型糖尿病（T 2DM）合并非酒精性脂肪肝（NAFLD）的危险因素。方法选取住院T 2DM患者104例,根据肝脏B超检查结果分为NAFLD组(n=56)和非NAFLD组(n=48),回顾性分析2组患者的各个相关临床指标,采用Logistic多元回归分析筛选危险因素。结果 NAFLD组的体重指数（BMI）、空腹血清葡萄糖（FPG）、血清胰岛素（FInS）、胰岛素抵抗指数（HOMA-IR）、血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL-C）、血尿酸水平（UA）均显著高于非NAFLD组,高密度脂蛋白（HDL-C）显著低于非NAFLD组,上述差异均有统计学意义（P<0.05）。多元回归分析表明,BMI、TG是预测糖尿病患者发生NAFLD的独立危险因素（P<0.05）。结论 T 2DM合并NAFLD与肥胖、脂代谢紊乱、胰岛素抵抗密切相关。     

2型糖尿病和高血压患者瘦素与胰岛素敏感性的关系

目的：研究2型糖尿病和原发性高血压血清瘦素水平以及与胰岛素敏感性的关系。方法：随机选取2型糖尿病合并高血压患者42例，原发性高血压患者35例，2型糖尿病33例，正常对照组30例，分别测定入选对象的体重指数（BMI）、腰臀比值（WHR）、血压、总胆同醇（CHOL）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、空腹胰岛素（FINS）和瘦素（Leptin），并计算胰岛素敏感指数（ISI）。结果：糖尿病合并高血压组、单纯高血压组和单纯糖尿病组血清瘦素水平均明显高于对照组，瘦素与性别、BMI、WHR、TG、SBP和FINS呈正相关（P〈0．03～0．001），与ISI呈负相关（P〈0．0011；性别、WHR、BMI和ISI在逐步回归分析中最后进入方程（r^2=0．596，P=0．000）。结论：高血压和糖尿病时血清瘦素水平增高，高瘦素血症与高胰岛素血症的相关性提示瘦素在2型糖尿病和高血压的发病中可能起一定的作用。     

老年人非酒精性脂肪肝与胰岛素抵抗的关系

目的探讨老年人非酒精性脂肪肝（NAFLD）与胰岛素抵抗（IR）的关系。方法2008-09-2012-10在我院内科住院的≥60岁的老年患者112例,分为2组：NAFLD组52例,非NAFLD组60例。比较两组间年龄、性别、BMI、WHR、TC、TG、CRP、HDL-C、LDL-C、ALT、Cr、FPG、FINS和HOMA—IR的差异,并进行Logistic回归分析。结果NAFLD组与非NAFLD组BMI、WHR、TG、ALT、FPG、FINS、HOMA—IR的差异有统计学意义。Logistic回归分析显示BMI、WHR、TG、HOMA—IR是NAFLD的独立影响因素。结论肥胖、高甘油三脂血症和胰岛素抵抗是NAFLD的独立危险因素。     

肥胖与胰岛素抵抗及Ⅱ型糖尿病的关系

目的 探讨肥胖（超重）和正常体质量者脂肪中心型分布与胰岛素抵抗及Ⅱ型糖尿病的关系。方法 测定肥胖者和正常体质量对照组的体重指数9BMI），腰臀比（WHR），血糖，胰岛素敏感指数，血脂等指标。探讨它们之间的相关性。结果 BMI，WHR与血胰岛素，三酯酰甘油，胆固醇呈正相关。结论 中心型肥胖与胰岛素抵抗之间存在内在联系。两者共同参与了Ⅱ型糖尿病发病过程。     

2型糖尿病合并非酒精性脂肪肝的相关因素及其它与胰岛素抵抗的关系

目的分析2型糖尿病合并非酒精性脂肪性肝病（NAFLD）的相关因素并研究其与胰岛素抵抗之间的关系,并探讨诱发NAFLD的相关危险因素。方法选取2型糖尿病患者180例,其中合并NAFLD者90例,未合并NAFLD者90例,回顾患者的一般临床资料、实验室检测结果,比较两组患者的一般临床资料、检测结果及胰岛素抵抗指数。结果NAFLD组在WHR、BMI、ALT、TG等指标上显著高于非NAFLD组（P〈0．05）,在HDL—C则相反;NAFLD组患者的HOMA—1R、HOMA—B显著高于较非NAFLD组（P〈0．05）;BMI、wHR、HOMA—IR、TG是NAFLD发生的独立危险因素（P〈0．05）。结论BMI、WHR、HOMA—IR、TG升高能提高2型糖尿病合并NAFLD的发病几率。     

非酒精性脂肪肝血清脂联素与肥胖和胰岛素抵抗关系的研究

目的研究非酒精性脂肪肝（NAFLD）患者血清脂联素与肥胖和胰岛素抵抗的关系。方法测定该院体检和住院人群中45例NAFLD患者和31例年龄、性别相匹配的正常对照者空腹血清脂联素，同时检测其身高、体重、腰围、臀围、血压、血脂、肝功能及胰岛素水平，并计算体重指数、腰臀比和采用稳态模型法计算IRI。结果血清脂联素浓度NAFLD组（7．07&#177;1．10）ng／mL比正常对照组（10．68&#177;1．45）ng／mL明显降低，P〈0．05。相关分析显示血清脂联素与HOMA—IR、ALT、GGT、腰臀比、体重指数、三酰甘油（GT）呈负相关，与高密度脂蛋白胆固醇呈正相关；而与性别、年龄、收缩压、舒张压、天冬氨酸转氨酶、总胆固醇、低密度脂蛋白胆固醇、血糖无相关性。结论NAFLD患者血清脂联素水平降低且伴有明显的IR,IR是NAFLD患者基本特征之一，中心型肥胖、低脂联素水平是NAFLD的危险因素；NAFLD患者脂联素水平降低和中心型肥胖可能共同参与了IR的发生、发展，进而影响NAFLD的发病。     

老年2型糖尿病合并非酒精性脂肪肝患者游离脂肪酸与胰岛素抵抗相关性研究

目的：探讨老年2型糖尿病合并非酒精性脂肪肝（NAFLD）患者游离脂肪酸与胰岛素抵抗（IR）的相关性。方法：入选老年2型糖尿病合并非酒精性脂肪肝患者（A组）38例,老年2型糖尿病无非酒精性脂肪肝（B组）32例,健康老年人（C组）40例为研究对象。测定所有对象空腹血糖（FPG）、空腹胰岛素（FINS）、空腹血甘油三酯（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）、糖化血红蛋白（HBAIc）、空腹游离脂肪酸（FFA）,并检查各组身高、体重、腰围、臀围,计算体重指数（BMI）、腰臀比（WHR）。用稳态模型评估胰岛素抵抗,Homa—IR=FBG×FINS／22．5。结果：老年2型糖尿病合并非酒精性脂肪肝组TG、TC、LDL—C、FFA、BMI、BWH、Homa—IR明显高于其他各组（P值均〈0．05）,将老年2型糖尿病并非酒精性脂肪肝组的FFA与Homa—IR、TC、TG、LDL—C、BMI、WHR作相关性分析。结果显示,FFA与Homa—IR、TC、TG、LDL—C、BMI、WHR呈正相关（分别为r=0．756,0．843,0．738,0．819,0．792、0．725．P均〈0．05）。结论：在老年2型糖尿病合并非酒精性脂肪肝组中。FFA水平升高与IR并存,二者存在明显相关性,二者在糖尿病合并非酒精性脂肪肝的发生发展过程中具有重要意义。     

抵抗素与非酒精性脂肪肝病相关性研究

目的：探讨抵抗素和非酒精性脂肪肝病（ non－alcoholic fatty liver disease,NAFLD）的相关性。方法：从我市市立医院选择2012－2013年 NAFLD 患者60例为观察组,从该院体检中心选择健康者60例为对照组,对其抵抗素与体质量指数（ body mass index, BMI）、腰臀比（waist－to－hip ratio,WHR）、血浆总胆固醇（total－cholesterol,TC）、三酰甘油（triglyceride,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）、糖化血红蛋白（glycosylated he－moglobin,HbAlc）、空腹血糖（ fasting blood glucose,FBG）、空腹胰岛素（ fasting insulin,FINS）、胰岛素抵抗指数（ homeostasis model of assess－ment for insulin resistence index,HOMA－IR）、谷丙转氨酶（their serum alanine aminotransferase,ALT）、谷草转氨酶（aspartate aminotrans－ferase,AST）、透明质酸（hyaluronic acid,HA）、Ⅳ型蛋白（Ⅳcollagen,Ⅳ－C）、白介素－18（interleukin－18,IL－18）进行分析。结果：观察组BMI、WHR、TC、TG、LDL－C、HbAlc、FPG、FINS、HOMA－IR、抵抗素、ALT、AST、HA、Ⅳ－C、IL－18均高于对照组,HDL－C低于对照组（ P ＜0．05）。结论：抵抗素与NAFLD呈正相关,是NAFLD的危险因素,开发和研制抵抗素拮抗剂是预防和治疗NAFLD的有效途径。     

腹型肥胖与血压、血糖、胰岛素及血脂关系的研究

目的：探讨腹型肥胖与血压,血糖,胰岛素,血脂的关系。方法：将730例被调查者根据体重指数（BMI）及腰臂比（WHR）分为3组,腹型肥胖组（A组）：280例,男性BMI≥,WHR≥0.9;女性BMI≥24,WHR≥0．8,非腹型肥胖组（B组）,42例,男性BMI≥25,WHR＜0．9,女性BMI≥24,WHR＜0．8。非肥胖组（C组）：408例,男性BMI＜25,女性BMI＜24,分析3组的血压,血糖,胰岛素,血脂的差异及与BMI,WHR的相关性。结果：血压,血糖,胰岛素,胆固醇,甘油三酯A组均明显高于C组,差异有显著性（P＜0．05）,A组与B组除空腹胰岛素外,余各项指标差异无显著性（P＞0．05）,B组与C组比较,各项指标差异无显著性（P＞0．05）。WHR,BMI与血压,血脂,血糖,胰岛素呈低度正相关,WHR与血压,血糖,胆固醇,甘油三酯的相关性大于BMI,与胰岛素,高密度脂蛋白的相关性小于BMI,结论：腹型肥胖比非腹型肥胖具有较高的心脑血管疾病的危险因素,腹部脂肪分布较BMI增加与血压,血糖,血脂增高关系较为密切。≥≥≥≥     

不同标准判定的肥胖患者脂肪细胞因子血清水平的临床意义比较

目的探讨3种代谢综合征（MS）诊断标准判定的肥胖患者脂联素（Adiponectin，APN）、抵抗素（Resistin，RST）、瘦素（Leptin，LPT）血浆水平临床意义的异同。方法采用2004中华医学会糖尿病学会（CDS）、2005国际糖尿病联盟（IDF）和2007中国成人血脂异常防治指南（CALIP）MS诊断标准中对肥胖的判定切点，将80名研究对象分为肥胖组和非肥胖组。测量体脂参数、血压，检测临床生化指标，测定空腹血浆胰岛素（FINS）、APN、RST、LPT、高敏C反应蛋白（hsCRP）、肿瘤坏死因子（TNF）α、白介素（IL）6、尿微量白蛋白（UAE）等。计算胰岛素抵抗指数（HOMA-IR）、分泌指数（HOMA-β）、敏感指数（ISI）。结果（1）3种不同标准的肥胖组血浆APN水平均显著低于非肥胖组（P均〈0．01）。（2）血浆RST水平在2004CDS肥胖组显著高于非肥胖组（P〈0．01），在2005IDF和2007CALIP肥胖组与非肥胖组间差异无统计学意义。（3）血浆LPT水平在2005IDF和2007CALIP肥胖组显著高于非肥胖组（P〈0．01，P〈0．05），在2004CDS肥胖组与非肥胖组间差异无统计学意义。（4）总体分析，血浆APN与性别呈显著正相关，与体重指数（BMI）、腰围（WC）、收缩压（SBP）、ln FINS、lnHOMAIR、总胆固醇（TC）、ln三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）、lnhsCRP呈显著负相关；血浆RST与lnhsCRP呈显著正相关，与腰臀比（WHR）呈显著负相关；血浆LPT与性别、年龄、BMI、In空腹血浆血糖（FPG）、lnFINS、lnHOMA—IR、Tc、高密度脂蛋白胆固醇（HDL—C）、LDL-C呈显著正相关，与WHR、ISI呈显著负相关；多元逐步回归分析，WC、lnhsCRP与血浆APN独立相关，WHR、lnhsCRP与血浆RST独立相关，性别、BMI、ISI、LDL-C与血浆LPT独立相关。（5）血浆APN在不同标准的各肥胖组均与性别呈显著正相关，在20051DF和2007CALIP时与WC、lnTG呈显著负相关     

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.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

<正>As culture is the soul of a nation,the three books,"History of Chinese Philosophy,""History of Chinese Culture"and"History of Chinese Science and Technology"have demonstrated the superiority of our great Chinese culture,and its significant impact in the field of international culture.Both core value and practical value of the Chinese culture are very clear,reflected in the views of universe,nature,life,health,disease,and therapy and related considerations,concepts,and technical methods.