2型糖尿病并阻塞性睡眠呼吸暂停综合征患者血糖波动与氧化应激的关系

目的：探讨2型糖尿病并阻塞性睡眠呼吸暂停综合征（ OSAS）患者血糖波动与氧化应激的关系。方法：选取2011-03～2013-07间经我院收治的2型糖尿病合并OSAS患者63例为观察组,并选取同期门诊健康体检者35例为对照组,检测两组受检者的空腹血糖（FPG）、糖化血红蛋白（HbA1c）、超氧化物歧化酶（SOD）、丙二醛（MDA）及8-异前列腺素F2α（8-iso-PGF2α）水平;另对观察组患者行动态血糖监测,计算出日内平均血糖波动幅度（ MAGE ）及日间血糖平均绝对值（ MODD）。结果：观察组患者FPG、HbA1c、MDA及8-iso-PGF2α水平均显著高于对照组,而SOD水平则显著低于对照组,差异均有统计学意义（P＜0.05或P＜0.01）。 Pearson相关分析显示,FPG、HbA1c与SOD呈显著负相关（r＝-0.527,r＝-0.503,P均小于0.05）,与MDA和8-iso-PGF2α则呈显著正相关（ r＝0.717、0.549和r＝0.515、0.520,P＜0.05或P＜0.01）;血糖波动指标MAGE、MODD与与SOD呈显著负相关（r＝-0.634,r＝-0.518,P均小于0.05）,与MDA和8-iso-PGF2α则呈显著正相关（r＝0.742、0.763和r＝0.735、0.774,P均小于0.01）。结论：2型糖尿病合并OSAS患者血糖波动指标均与氧化应激活化程度显著相关,因此,建议患者在注意控制血糖的同时,也要关注血糖波动。     

2型糖尿病下肢血管病变患者血糖波动与踝肱指数及8-异前列腺素F2α的相关性研究

目的 探讨糖尿病合并下肢血管病变（DLEAD）患者血糖波动与踝肱指数（ABI）及8-异前列腺素F2α（8-iso-PGF2α）的相关性.方法 选择2013年9月～2014年2月北京军区总医院内分泌科收治的60例2型糖尿病（T2DM）患者,依据超声检查结果分为单纯2型糖尿病组（DM组）,合并下肢血管病变组（DLEAD组）,另选取健康者20例做为对照组（NC组）.分别检测其血压、血脂、糖化血红蛋白（HbA1c）、8-iso-PGF2α、ABI等指标.应用动态血糖监测仪对各组行连续72 h血糖监测,采用全天血糖标准差（SDBG）、日内平均血糖波动幅度（MAGE）、全天有效血糖波动次数（FGE）、日间血糖平均绝对差（MODD）4个指标评价血糖波动,比较三组间ABI、8-iso-PGF2α及各血糖波动参数,并分析血糖波动参数及临床生化指标与ABI、8-iso-PGF2α的相关性.结果 ①DLEAD组患者的病程、MAGE、MODD、SDBG、FGE、8-iso-PGF2α较DM组均明显升高,差异均有统计学意义（P＜0.05）;DLEAD组ABI明显低于DM组,差异有统计学意义（P＜0.05）.②采用Pearson相关分析表明：MAGE、FGE、MODD与ABI呈负相关（r=-0.802、-0.147、-0.553,P＜ 0.05）;MAGE、MODD与8-iso-PGF2α呈正相关（r=0.825、0.504,P＜0.05）.多因素逐步回归分析发现：MAGE、FGE、MODD与ABI独立相关（Y=1.26-0.046MAGE-0.017 FGE-0.042 MODD）.结论 血糖波动与DLEAD密切相关,可能是通过诱发氧化应激水平引起及加重DLEAD.     

2型糖尿病患者8-异前列腺素F2α水平与颈动脉内中膜厚度的相关性研究

目的探讨2型糖尿病患者尿中8-异前列腺素F2α水平(8-iso-PGF2α)与颈动脉内中膜厚度(IMT)的相关性。方法选择2型糖尿病患者129例,健康对照者20例(对照组),分别检测其血脂、糖化血红蛋白(HbA1c)、尿8-iso-PGF2α等指标。并采用彩色高频多普勒超声诊断仪检测患者颈动脉IMT的水平,以IMT=0.9 mm为切点,将2型糖尿病患者分为颈动脉IMT正常组(IMT<0.9 mm)与IMT增厚组(IMT≥0.9 mm)。分析比较各组8-iso-PGF2α水平及各种生化指标的水平并将其与IMT值进行相关性分析。结果对照组、IMT正常组、IMT增厚组的8-iso-PGF2α水平分别为(356±137)、(507±167)、(1 342±323)pg/mmol肌酐,2型糖尿病患者尿中8-iso-PGF2α水平高于对照组,IMT增厚组的8-iso-PGF2α水平高于IMT正常组,差异均有统计学意义(P<0.05)。IMT水平与8-iso-PGF2α、HbA1c、LDL-C、TG及BMI呈正相关(P<0.05)。结论 2型糖尿病患者体内氧化应激水平明显增强,且与动脉粥样硬化密切相关。应尽早针对高氧化应激状态进行治疗,降低动脉粥样硬化风险,减少心脑血管并发症的发生。     

α-硫辛酸对2型糖尿病患者氧化应激及尿白蛋白排泄的影响

目的观察α-硫辛酸(ALA)对2型糖尿病患者氧化应激的影响及其肾脏保护作用。方法选择36例2型糖尿病患者为观察组,在糖尿病治疗的基础上加用ALA,并选择同期健康体检的30例作为对照组。6个月后,观察治疗前后空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血清丙二醛(MDA)、超氧化物歧化酶(SOD)及尿白蛋白(ALB)水平变化。结果①糖尿病组血清MDA、UACR(Ualb/Ucr)升高,血清SOD活性降低,与对照组比较差异有统计学意义(P<0.01)。②ALA治疗6个月后,观察组FBG和HbA1c无明显变化,血清MDA、UACR降低,血清SOD活性明显升高,与治疗前相比较差异有统计学意义(P<0.01)。③UACR与血清MDA水平显著正相关(r=0.867,P<0.01),与血清SOD水平明显负相关(r=-0.636,P<0.01)。结论α-硫辛酸可以减轻2型糖尿病患者尿白蛋白排泄,该作用可能与其减轻体内氧化应激作用有关。     

糖尿病肾病患者血清趋化因子与氧化应激水平的相关性及α-硫辛酸的治疗作用

目的:观察血清趋化因子及氧化应激指标在糖尿病肾病(DN)不同时期的差异及α-硫辛酸治疗后水平的变化,探讨趋化因子与氧化应激在DN中的相关性及抗氧化应激治疗对二者的影响?方法:选择2型糖尿病患者100例,根据24 h尿白蛋白定量(24h-UAL)水平分为肾功能正常组(24h-UAL< 30 mg/24 h)?早期DN组(24h-UAL 30~300 mg/24 h)和临床DN组(24h-UAL> 300 mg/24 h),3组患者均给予α-硫辛酸治疗4周,测定各组治疗前后血清趋化因子[fractalkine(FKN)?血清单核细胞趋化蛋白-1(MCP-1)]?氧化应激指标[谷胱甘肽过氧化物酶(GSH-PX)?超氧化物歧化酶(SOD)?血清丙二醛(MDA)]?空腹血糖(FPG)?餐后2 h血糖(2hPG)?糖化血红蛋白(HbA1c)水平及24h-UAL变化?另选30例健康体检者为健康对照组?结果:①糖尿病患者GSH-PX及SOD水平显著低于健康对照组,血清趋化因子与MDA水平则显著高于健康对照组;3组治疗后血清趋化因子与MDA水平均较治疗前显著下降,GSH-PX及SOD水平则显著升高;早期DN组及临床DN组治疗后24h-UAL较治疗前显著降低;治疗前后临床DN组血清FKN?MCP-1及MDA水平均明显高于肾功能正常组和早期DN组,GSH-PX及SOD水平则显著低于另两组(P < 0.05);②趋化因子与MDA?24h-UAL?FPG?2h PG及HbA1c呈正相关,与GSH-PX和SOD呈负相关;MDA与趋化因子?24h-UAL?FPG?2hPG及HbA1c呈正相关,GSH-PX和SOD与上述指标呈负相关?结论:DN患者血清趋化因子及氧化应激指标水平与24h-UAL及血糖水平显著相关,抗氧化应激治疗能降低血清趋化因子水平,减少尿蛋白排泄,从而延缓DN的进展?     

2型糖尿病血糖控制与氧化应激、NO、CRP相关性分析

目的:探讨2型糖尿病血糖控制和氧化应激、一氧化氮(NO)、C反应蛋白(CRP)的关系。方法:测定53例2型糖尿病患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、体重指数(BMI)、空腹血胰岛素(FINS)、丙二醛(MDA)、超氧化物岐化酶(SOD)、NO、CRP等指标。结果:MDA(4.60±1.62)ng/ml和HbA1c(7.39±2.88)%呈正相关(P<0.05),SOD(342.39±253.71)ng/ml和HbA1c呈显著负相关(P<0.05)。NO(79.37±40.37)μmol/L和HbA1c无相关性(P>0.05),但和糖尿病病程(5.79±5.26)年呈负相关(P<0.05);CRP(1.93±1.95)mg/L和HbA1c、BMI(23.78±3.83)kg/m2呈正相关(P<0.05,P=0.01),CRP和胰岛素敏感指数(ISI)(-3.84±0.73)呈显著负相关(P<0.01)。结论:2型糖尿病血糖控制水平和氧化应激及系统性炎症密切相关,NO和糖尿病病程有关。     

瑞格列奈治疗前后对2型糖尿病患者体内氧化应激水平的影响

目的通过分析瑞格列奈的降糖模式及作用特点,探讨瑞格列奈干预治疗对2型糖尿病患者体内血丙二醛(MDA)及血超敏C反应蛋白(hs-CRP)的影响。方法将35例2型糖尿病患者,加用瑞格列奈作为治疗对照组即A组,且同时选择性别、年龄、BMI等一般情况相匹配的健康体检者26例作为B组,即空白对照组。观察其治疗前后糖化血红蛋白(HbA1c)、体质指数(BMI)、血丙二醛(MDA)和血超敏C反应蛋白(hs-CRP)、空腹血糖(FBG)及餐后血糖(PBG)、甘油三酯(TG)、血糖波动等相关指标的变化。结果 (1)与治疗前相比,A组治疗后FBG、HbA1c、MDA、hs-CRP、TG明显下降,有统计学意义(P0.01)。(2)与B组相比,A组治疗后hs-CRP和MDA水平仍较高,差异有统计学意义(P0.05)。3相关性分析显示MDA水平与FBG、PBG、HbA1c、胰岛素用量呈正相关(r=0.229,P=0.019;r=0.371,P=0.002;r=0.265,P=0.028;r=0.405,P=0.021)。结论应用瑞格列奈能良好地控制血糖,可减轻2型糖尿病患者体内的氧化应激水平,且氧化应激水平主要取决于血糖水平及胰岛素用量。     

1,5-脱水葡萄糖醇与血糖相关性分析

目的1,5-脱水葡萄糖醇(1,5-AG)应用于2型糖尿病治疗监测的临床意义.方法对136例2型糖尿病和45例健康者测定1,5-AG、血糖、FMN、HbA1c.并以1,5-AG值为自变量、血糖、FMN、mA1c为因变量行多元回归分析.结果2型糖尿病组1,5-AG水平明显低于对照组(P＜0.01),且与血糖、FMN、HbA1c呈负相关(分别为r=-0.4952,r=-0.5819,r=-0.5635).结论1,5-AG能反映血糖状态,与近期(1～2周)血糖波动水平密切,说明1,5-AG可用于对糖尿病的诊断、筛查、监测.     

糖尿病肾病患者微炎症和氧化应激水平及其影响因素分析

目的:探讨糖尿病肾病患者微炎症状态和氧化应激的水平,并分析其影响因素?方法:选取129例2型糖尿病(T2DM)患者及144例糖尿病肾病(DKD)患者,分为T2DM组和DKD组,比较两组血清炎症标志物超敏C-反应蛋白(hs-CRP)和氧化应激指标丙二醛(MDA)水平?一般临床资料(病程?血压等)和生化指标[胆固醇?甘油三酯?糖化血红蛋白(HbA1c)等],将两组间存在统计学差异的相关性指标代入多元线性回归方程分析hs-CRP和MDA的影响因素?结果:①DKD患者血清hs-CRP和MDA较T2DM组显著增高,差异有统计学意义(P < 0.01);②直线相关分析显示hs-CRP及MDA均与DM病程?尿素氮(BUN)?肌酐(Cr)?尿酸(UA)?HbA1c?24 h尿蛋白定量?同型半胱氨酸(HCY)呈正相关,此外,MDA还与总胆红素?直接胆红素均呈负相关?③多元线性回归分析显示hs-CRP的影响因素是DM病程?UA?HbA1c?HCY,MDA的影响因素为DM病程?HbA1c?结论:DKD患者普遍存在微炎症和氧化应激水平的增高,DM病程?UA?HbA1c?HCY作为微炎症的影响因素,氧化应激的影响因素为DM病程?HbA1c,综合控制血糖?尿酸等可以更好地减轻DKD患者的微炎症和氧化应激状态?     

DM120方对糖尿病大鼠肾组织氧化应激水平的影响

目的:观察DM120方对糖尿病大鼠肾组织氧化应激水平的影响。方法:高脂饲料联合链脲佐菌素(STZ)诱导糖尿病模型。随机分为正常对照组、模型组和DM120方治疗组,干预8周,观察各组大鼠血糖、肾功能及肾组织丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、8-异前列腺素F2α(8-iso-PGF2α)的变化。结果:模型组大鼠血糖、肌酐、尿素氮、24 h尿微量白蛋白排泄量水平均较正常对照组明显升高;DM120方治疗组大鼠血糖、肌酐、尿素氮及24 h尿微量白蛋白排泄量水平均较模型组下降(P0.05,P0.01);DM120方治疗组大鼠MDA、8-iso-PGF2α水平均较模型组下降(P0.05),SOD水平较模型组上升(P0.05),各组GSH-PX差异无统计学意义。结论:DM120方对糖尿病大鼠肾组织具有一定的抗氧化作用,其作用环节可能与MDA、SOD、8-iso-PGF2α相关。     

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…