基于计步器的运动管理对2型糖尿病患者糖脂代谢的影响

目的：探讨以电子计步器为基础的运动管理对2型糖尿病(T2DM)患者运动血糖以及血脂的影响。方法选择2012-2015年在本院接受体检、疗养和治疗的80例T2DM患者作为研究对象,采用随机数字表法将其随机分为干预组和对照组,每组40例。对照组采取常规糖尿病管理策略,干预组在常规治疗的基础上配发电子计步器,经过2周的适应后,要求患者晚餐后进行3000~4000步/30~40 min的运动,运动频率每周不少于5 d。12周后比较两组患者的糖脂代谢指标的变化并进行统计学分析。结果干预组中有3例患者未能完成试验,与对照组比较,其余37例患者空腹血糖[(7.5±0.7) mmol/L vs (7.1±0.6) mmol/L)]、空腹C肽[(2.5±1.0) ng/mL vs (1.9±1.1) ng/mL]、空腹胰岛素[(13.3±2.2) mU/L vs (11.1±2.6) mU/L]、糖化血红蛋白[(7.5±0.7)%vs (7.0±0.8)%]、2 h血糖[(10.5±2.2) mmol/L vs (7.0±0.8) mmol/L ]及胰岛素抵抗指数[(3.9±2.6) vs (2.3±2.1)]均有显著改善,差异均有统计学意义(P<0.05);干预组低密度脂蛋白胆固醇为(2.6±1.0) mmol/L,较对照组的(3.1±0.9) mmol/L明显降低,差异有统计学意义(P<0.05)。结论基于电子计步器的运动干预可以明显提高T2DM患者的运动主动性及依从性,且能够不同程度的改善糖脂代谢,值得进一步推广。     

幽门螺杆菌和胃泌素与胃食管反流病的关系

目的：研究幽门螺杆菌（Hp）和胃泌素与胃食管反流病（GERD）的关系,探讨Hp对GERD病人下食管括约肌压力（LESP）的影响以及胃泌素和GERD之间的关系。方法：20例病人入选,24h食管pH值监测确立GERD存在;胃镜检查将病人分为内镜阳性GERD和内镜阴性GERD,并取活检作快速尿素酶、组织银染以及细菌培养,以确定有无Hp感染,3者中至少有2项阳性诊断Hp阳性;测定下食管括约肌压力（LESP）;取病人空腹血清,采用放射免疫法测定胃泌素。结果：20例病人中13例完成了血清胃泌素检查,Hp阳性8例,Hp阴性12例;Hp阳性病人和阴性病人LESP、胃泌素浓度、24hDeMeester积分均无显著差异,胃泌素水平同LESP无相关性;但胃泌素水平同24hDeMeester积分相关。结论：Hp对LESP无直接影响;空腹血清胃泌素水平的测定可能有助于GERD的诊断。     

胃镜下腔内胃黏膜折叠缝合术治疗胃食管反流病

目的探讨胃镜下腔内胃黏膜折叠缝合术治疗胃食管反流病的效果.方法对14例确诊为胃食管反流病者施行胃镜下腔内胃黏膜折叠缝合术,并记录手术前后患者的症状评分、胃镜及24h食管pH监测的结果.结果术后反流症状改善总有效率为85.7%(完全缓解35.7%,部分缓解50.0%),无效14.3%,24h食管pH监测结果显示反流得到较好的控制.结论胃镜下腔内胃黏膜折叠缝合术治疗胃食管反流病是安全、可靠的,能较好地改善胃食管反流病的症状.     

抗阻运动对糖尿病前期伴轻度高血压人群血压的影响

目的 研究不同运动方式对社区糖尿病前期（IGR）人群血压的控制效果。方法 于2015 年6 ~ 8 月在桂林的3 个社区卫生服务中心长期管理的社区居民中筛选出符合标准的IGR 合并轻度高血压人群83 人，随机分为3 组，经过1 年的干预和随访，最终收集到67 人的完整数据：抗阻运动组22 人、有氧运动组23 人、对照组22 人。干预期间，对照组保持原有的生活方式，抗阻和有氧运动组分别进行相应的运动干预，约50 min/ 次，以集体形式隔天训练。对干预后3、6、12 个月抽血查空腹血糖、空腹胰岛素和糖化血红蛋白（HbA1c），测血压，计算胰岛素抵抗指数（HOMA-IR）。结果 ①不同时间点之间的HbA1c、HOMA-IR、收缩压（SBP）、舒张压（DBP）比较，差异有统计学意义（F =22.415、9.289、32.689 和6.713，均P =0.000）；3 组间的HbA1c、HOMA-IR、SBP、DBP 比较， 差异有统计学意义（F =16.525、4.241、26.436 和4.653，P =0.000、0.044、0.000 和0.013），干预后抗阻运动组和有氧运动组的HbA1c、HOMA-IR、SBP、DBP 低于对照组；3 组的HbA1c、HOMA-IR、SBP、DBP 变化趋势差异有统计学意义（F =19.134、4.782、22.520 和6.792，均P =0.000），干预期间，对照组各指标总体呈上升趋势，两运动组各指标总体呈下降趋势，虽然两运动组不同时段各指标比较差异无统计学意义（P >0.05），但抗阻运动组的HbA1c、HOMAIR的下降幅度大于有氧运动组，且SBP、DBP 下降幅度小于有氧运动组。②干预3 个月时，有氧和抗阻运动组的HbA1c、HOMA-IR、DBP 均低于干预前，有氧运动组SBP 低于干预前；干预6 个月时，有氧和抗阻运动组的HbA1c、SBP、DBP 均低于干预前，抗阻运动组HOMA-IR 低于干预前；干预12 个时，有氧和抗阻运动组的HbA1c、HOMA-IR、SBP、DBP 均低于干预前，对照组HbA1c、SBP 高于干预前，均差异有统计学意义（P <0.05）。结论 抗阻和有氧运动均能安全有效地改善社区IGR 合并轻度高血压人群的HbA1c、血压、HOMA-IR，值得推广。     

Discrepancy between presumptive and definite causes of chronic cough

Background  The current diagnostic algorithms for chronic cough require the establishment of the primary presumptive causes followed by the confirmation of diagnosis with the specific therapies. The aim of the study was to investigate the discrepancy between presumptive and definite causes and its clinical implication.

Methods  A total of 109 patients with chronic cough underwent laboratory investigations to identify the cause of cough; including sinus computerized tomography (if needed), histamine bronchial provocation, induced sputum cytology and 24-hour esophageal pH or multi-channel intraluminal impedance combined with pH monitoring. The presumptive causes were confirmed by treating them sequentially. The difference between presumptive and definite causes of chronic cough was compared.

Results  Single cause was more frequent in the definite diagnosis than in the presumptive diagnosis (78.9% vs. 54.1%, χ²=15.01, P=0.0001). In contrast, multiple causes were significantly fewer in definite diagnosis than in the presumptive diagnosis (15.6% vs. 37.6%, χ²=13.53, P=0.0002). There was a discrepancy between definite and presumptive causes in 30 patients (27.5%). Compared with the presumptive causes, definite upper airway cough syndrome (24.8% vs. 11.9%, χ²=6.0, P=0.01) and gastroesophageal reflux disease (6.4% vs. 0, χ²=7.23, P=0.007) was more frequent as a single cause of chronic cough while cough variant asthma plus gastroesophageal reflux disease (3.7% vs. 11.9%, χ²=5.17, P=0.02) and upper airway cough syndrome plus nonasthmatic eosinophilic bronchitis (0 vs. 9.2%, χ²=10.48, P=0.001) were fewer as multiple causes of chronic cough.

Conclusions  A discrepancy was common between presumptive and definite causes of chronic cough. To treat presumptive causes sequentially may be a suitable solution for avoidance of erroneous multiple causes and possible over-treatment.

     

不同强度有氧运动对2型糖尿病患者血糖血脂水平的影响

目的观察分析不同强度有氧运动对2型糖尿病患者血糖、血脂水平的影响。方法选取48例2型糖尿病患者随机分为三组,各16例。对照组采用常规社区护理,观察1组在对照组基础上进行低强度有氧运动锻炼,观察2组进行中等强度有氧运动锻炼。3个月后,观察各组患者血糖及血脂水平变化。结果观察1组、2组患者空腹血糖、甘油三酯、胆固醇、高密度脂蛋白等指标均较运动前明显改善（P〈0．05）;观察1组、2组生活质量各项评分运动前后差异显著（P〈0．05）,且运动后观察2组患者生理、心理、社会满意度评分均高于观察1组（P〈0．05）。结论2型糖尿病患者进行有氧运动有助于调节其血糖及血脂水平并改善生活质量,且中等强度的有氧运动效果更佳。     

内镜缝合术在反流性食管炎中的临床应用研究

目的:探讨内镜缝合术在反流性食管炎中的应用价值及该术的安全性。方法:对经内镜、食管ph鉴测、食管测压、临床症状等确诊并且有质子泵抑制剂依赖的11例胃食管反流病(其中贲门切除术后胃食管反流2例),应用美国BARD内镜缝合系统行内镜下贲门缝合术,观察术前术后胃食管反流的积分情况及该术的并发症等项目,对该术的短期疗效及安全性进行评价。结果:11例患者共缝合26针,13个结,其中纵行缝合4例次,环行缝合9例次。术后症状完全缓解的5例,部分缓解的4例,无效2例。除术中缝合处针孔少许渗血外,术中及术后患者均未出现明显并发症。结论:内镜缝合术近期疗效可靠,安全性好,远期疗效有待进一步研究。     

Clinical curative effect of electroacupuncture combined with Zhizhukuanzhong Capsules for treating gastroesophageal reflux disease

OBJECTIVE:To study the clinical curative effect,safety and mechanism of action of electroacupuncture combined with Zhizhukuanzhong capsules(ZZKZC) in treating gastroesophageal reflux disease(GERD).METHODS:A total of 480 patients with confirmed GERD were randomly divided into four groups:the electroacupuncture group,the ZZKZC group,the combined therapy group,and the control group,with 120 cases in each group.Each case in the electroacupuncture group was treated with electroacupuncture on Zusanli(ST36),Zhongwan(CV12),Neiguan(PC6),Taichong(LR3)and Gongsun(SP 4)once daily for 6 weeks.Each case in the ZZKZC group was treated with oral administration of 1.29 g ZZKZC three times daily.The combined therapy group had electroacupuncture and ZZKZC.The control group was given oral administration of 5 mg mosapride three times and 20 mg pantoprazole twice daily.The 24-hour intraesophageal total number of reflux episodes with pH <4(or bilirubin absorbance ≥ 0.14),the number of long-term(≥5 min) reflux episodes,the percentage of upright time,the percentage of supine time,the percentage of total time of pH <4(or bilirubin absorbance ≥0.14),endoscopic grading score,symptom score,quality of life score,and adverse reactions were observed before treatment,at the end of treatment and 54 weeks after treatment in the four groups.RESULTS:The 24-hour intraesophageal pH and bile reflux,endoscopic grading score and symptom score were all significantly decreased at the end of treatment in every group,while the scores of 8 dimensions of quality of life were all increased compared with those before treatment(P<0.01).All of these indices were better in the combined therapy group than those in the other groups(P<0.05).These indices did not significantly deteriorate in the combined therapy group and electroacupuncture group 54 weeks after treatment compared with the end of treatment(P>0.05);however,these indices all significantly deteriorated in the ZZKZC and control groups(P>0.05).The short and long-term total efficacy rates in the combined therapy group showed significant superiority to those in the other groups(P<0.05 or P<0.01).No serious adverse reactions were found in the four groups.CONCLUSION:Electroacupuncture and ZZKZC play an important role in inhibiting intraesophageal acid and bile reflux,decreasing the endoscopic grading score,and alleviating the symptoms of gastroesophageal reflux to improve the quality of life.However,the effect of combined treatment is more effective,with better security and long-term efficacy,and therefore,this combination treatment is appropriate for clinicaluse.     

胃肠超声造影诊断胃食管反流病的可行性研究

目的 探析胃肠超声造影用于胃食管反流病中的可行性,以提高对胃食管反流病进行诊断的准确性. 方法 随机选取该院2013年6月—2015年6月接收的胃食管反流病患者共60例作为研究组. 选取同期来该院接受胃肠超声造影检查的60例健康者,并将其作为对照组. 剖析两组的检查结果. 结果 以5 min为单位,对照组反流时间≤2 s的,共59例;余下的1例,反流时间>2 s.反流频数≤2次的,共59例;>2次的,仅1例.研究组中,反流时间≥3 s的,共52例;<3 s的,共8例. 反流频数≥3次的,共52例;<3次的,共8例. 两组对比,反流的时间与频数间差异有统计学意义(P<0.05). 结论 于胃食管反流病中行胃肠超声造影诊断,能清楚地观测到胃食管反流现象,可行性较高.     

连续性及高强度间歇运动对2型糖尿病血糖调控影响的研究进展

规律运动可以帮助预防和改善2型糖尿病患者血糖控制情况，降低心血管疾病发生风险。本文综述了有氧运动对2型糖尿病血糖的改善情况，尤其是连续性及高强度间歇运动对2型糖尿病对血糖调控的影响，得出高强度间歇运动可调节骨骼肌中葡萄糖代谢情况，降低空腹血糖及糖化血红蛋白；3次/周及每周总计150 min以上的中等强度有氧运动被认为是改善2型糖尿病的症状最佳方案，且训练频率越高及训练量越大对于2型糖尿病病情的改善越有效；抗阻训练同样能增强胰岛素的作用，但抗阻介入有氧运动及抗阻介入高强度间歇训练能否对2型糖尿病产生更大的改善效果尚需更多的试验去验证。     

慢性咳嗽68例临床分析

目的 分析慢性咳嗽患者的病因分布。方法 对68例慢性咳嗽患者进行前瞻性研究。常规行X线胸片、肺功能、食道内镜、痰检查及血液学检查。必要时查支气管激发试验、24h食道PH值监测、鼻窦CT、纤维支气管镜及纤维鼻咽镜。根据临床表现、检查结果及特异性治疗疗效作最后诊断。结果 病因依次为咳嗽变异型哮喘30例，44．1％、鼻后滴流综合征21例，30．9％；胃食管反流病13例，19．1％；支气管结核2例，2，9％；真菌感染1例，1．5％；嗜酸细胞性支气管炎1例，1．5％。结论 慢性咳嗽最常见的病因为咳嗽变异型哮喘、鼻后滴流综合征及胃食管反流病。     

有氧运动与平肥方对DIO大鼠脂代谢和胰岛素抵抗的影响

目的评价有氧运动与平肥方对高脂饮食所致肥胖大鼠(DIO)脂肪代谢和胰岛素抵抗的影响。方法 SD雄鼠10只予普饲喂养作为空白对照组,30只经高脂饮食诱导成功的DIO雄鼠随机分为肥胖对照组、二甲双胍组、有氧运动+平肥方干预组,每组10只。实验干预6周后,检测各组大鼠体质量(BW)、空腹血糖(FPG)、总胆固醇(TCH)、甘油三酯(TG)、极低密度脂蛋白(VLDL)、空腹胰岛素(FINS)、HOMA-指数(HOMA-index)等。结果与对照组比较,DIO大鼠体质量、脂代谢各指标、血糖、胰岛素等差异具有统计学意义(P<0.01);干预数周后,与肥胖对照组比较,二甲双胍组和综合组均可显著降低DIO大鼠体质量,并可显著改善脂代谢诸指标及血糖、胰岛素及HOMA-指数(P<0.05或P<0.01)。其中,综合组在改善DIO大鼠体质量、VLDL两指标更优于二甲双胍治疗组(P<0.05)。结论 DIO大鼠普遍存在体质量、脂代谢异常及胰岛素抵抗;有氧运动和中药平肥方结合干预DIO大鼠,相对二甲双胍,在改善胰岛素抵抗的同时,能更好地减轻体质量并改善脂质代谢。     

Gastroesophageal reflux disease in infants. Myths and misconceptions, where is the evidence?

Infantile gastroesophageal reflux (GER) is a common self-limited, physiological phenomenon. Infantile gastroesophageal reflux becomes pathological (gastroesophageal reflux disease [GERD]) when symptoms become more severe or are associated with complications such as failure to thrive or hematemesis. Though it is a very common condition, there are several misconceptions and myths on GER/GERD diagnosis and management. Inappropriate investigations are frequently requested and unnecessary medications are increasingly prescribed, particularly in infants with symptoms attributed to possible GER/GERD. Several therapeutic interventions are used widely in GERD management, although some evidence is either insufficient or controversial.     

Diurnal, Postural and Postprandial Variations of Hematocrit

The microhematocrit (HCT) values of 59 subjects increased significantly in the sitting position and after moderate exercise, in comparison with the values obtained during recumbency. The consumption of an 800-calorie meal decreased the HCT and this effect lasted for six hours. In order to obtain comparable results blood for HCT should be taken in a “standard basal condition” in the morning hours, in the fasting state or after a light breakfast, and the patient should sit for at least 30 minutes before the blood specimen is taken.     

有氧运动对1级原发性高血压患者血小板功能的影响

目的观察有氧运动对1级原发性高血压患者的疗效和血小板功能的影响。方法对36例1级原发性高血压患者进行3个月的低强度有氧运动疗法,记录并比较运动疗法前后的血压、心率、血小板最大聚集率（PAGTmax）、血浆血小板α-颗粒膜蛋白（GMP-140）含量及平均血小板容积（MPV）的变化,并与36例正常对照者比较。结果运动疗法前,原发性高血压患者PAGTmax为（0．88±0．08）％,血浆GMP-140含量为（57±23）μg/L,MPV为（9．14±0．9）fl,与对照组相比均明显增加（t值分别为15.221、10．916、16．401,均P〈0．01）。与运动疗法前比较,运动疗法后原发性高血压者24h平均血压降低,同时PAGTmax下降至（0．80±0．05）％（t=4．323,P〈0．05）,血浆GMP-140含量下降至（28±20）μg／L（t=15．049,P〈0．01）,MPV下降至（9．0±0．9）n（t=5．518,P〈0．05）,且与正常对照组治疗后相比差异有统计学意义（t值分别为14．368、4．908、6．239,均P〈0．01）。正常对照组治疗前后上述指标差异无统计学意义（P〉0．05）。结论原发性高血压患者存在血小板活性增强,有氧运动在有效降低血压的同时能抑制血小板活化。     

Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels

CONTEXT: Previous studies of testosterone supplementation in HIV-infected men failed to demonstrate improvement in muscle strength. The effects of resistance exercise combined with testosterone supplementation in HIV-infected men are unknown. OBJECTIVE: To determine the effects of testosterone replacement with and without resistance exercise on muscle strength and body composition in HIV-infected men with low testosterone levels and weight loss. DESIGN AND SETTING: Placebo-controlled, double-blind, randomized clinical trial conducted from September 1995 to July 1998 at a general clinical research center. PARTICIPANTS: Sixty-one HIV-infected men aged 18 to 50 years with serum testosterone levels of less than 12.1 nmol/L (349 ng/dL) and weight loss of 5% or more in the previous 6 months, 49 of whom completed the study. INTERVENTIONS: Participants were randomly assigned to 1 of 4 groups: placebo, no exercise (n = 14); testosterone enanthate (100 mg/wk intramuscularly), no exercise (n = 17); placebo and exercise (n = 15); or testosterone and exercise (n = 15). Treatment duration was 16 weeks. MAIN OUTCOME MEASURES: Changes in muscle strength, body weight, thigh muscle volume, and lean body mass compared among the 4 treatment groups. RESULTS: Body weight increased significantly by 2.6 kg (P<.001) in men receiving testosterone alone and by 2.2 kg (P = .02) in men who exercised alone but did not change in men receiving placebo alone (-0.5 kg; P = .55) or testosterone and exercise (0.7 kg; P = .08). Men treated with testosterone alone, exercise alone, or both experienced significant increases in maximum voluntary muscle strength in leg press (range, 22%-30%), leg curls (range, 18%-36%), bench press (range, 19%-33%), and latissimus pulls (range, 17%-33%). Gains in strength in all exercise categories were greater in men assigned to the testosterone-exercise group or to the exercise-alone group than in those assigned to the placebo-alone group. There was a greater increase in thigh muscle volume in men receiving testosterone alone (mean change, 40 cm3; P<.001 vs zero change) or exercise alone (62 cm3; P = .003) than in men receiving placebo alone (5 cm3; P = .70). Average lean body mass increased by 2.3 kg (P = .004) and 2.6 kg (P<.001), respectively, in men who received testosterone alone or testosterone and exercise but did not change in men receiving placebo alone (0.9 kg; P = .21).Hemoglobin levels increased in men receiving testosterone but not in those receiving placebo. CONCLUSION: Our data suggest that testosterone and resistance exercise promote gains in body weight, muscle mass, muscle strength, and lean body mass in HIV-infected men with weight loss and low testosterone levels. Testosterone and exercise together did not produce greater gains than either intervention alone.     

24 h食管pH及胆红素监测在胃食管反流诊治中的应用

目的:探讨酸、胆汁与反流症状、消化不良症状、消化道以外的症状间关系以及24h食管pH和/或胆红素监测在新型术式客观评价中的作用。方法:应用24h食管pH及胆红素监测方法对68例有典型反流症状者,50例有消化不良症状者,20例咽部不适及哮喘,32例食管贲门癌不同术式患者进行监测。结果:①68例有典型反流症状者发生反流占95.5%,而在50例有消化不良症状如有反胃、上腹饱胀、嗳气等而无典型反流症状者中发生反流占72%。②典型酸反流症状者中混合反流占51.4%,即发生反流者中有一半为酸和胆汁反流同时存在。③24h食管pH监测,结果提示保留贲门的食管癌根治间置结肠代食管术治疗的患者发生酸反流者明显少于经典式食管癌根治术治疗者(29.4%vs66.7%,P<0.05)。结论:24h食管pH及胆红素监测为临床诊断胃食管反流或十二指肠胃食管反流的存在提供了客观依据,为食管癌根治新术式的评价提供客观依据。     

胃食管反流源性哮喘发病机制的研究现状

胃食管反流病与哮喘都是十分常见的疾病。哮喘患者中有50％～80％与胃食管反流病相关。本文介绍胃食管反流病并从四个方面具体分析了反流促发哮喘的机制,其中包括反流物被吸进肺内引起哮喘、使用支气管扩张药引起反流加重进而促进哮喘的进一步发展、反流物引发神经反射造成肺支气管收缩从而引发哮喘和反流物浸入气道使其处于高反应状态。通过分析本病的具体机制可以在一定基础上指导临床医生在实际工作中对胃食管反流源性哮喘的治疗。     

健康管理对胃食管反流病患者生活质量的影响

目的 评价健康管理对胃食管反流病患者生活质量的影响.方法 选取解放军总医院健康管理研究院2016年6月至2017年6月收治的胃食管反流患者66例作为研究对象,随机分为观察组和对照组,对照组患者采用常规护理方法进行护理,观察组患者在常规护理的基础上进行护理健康管理,比较两组患者的一般情况、护理满意度和生活质量.结果 2组患者的年龄、性别、体重差异均无统计学意义(P＞0.05),具有可比性;护理满意度观察组为100％,对照组为90.9％,观察组高于对照组,差异有统计学意义(P＜0.05);生活质量评分,观察组患者在生理功能、社会功能、情感功能、精神健康等方面得分明显高于对照组,差异有统计学意义(P＜0.05).结论 护理健康管理可辅助改善患者的临床症状,提高护理满意度,改善患者的生活治疗,值得推广.     

埃索美拉唑治疗反流性咳嗽的疗效分析

目的观察食道反流与慢性咳嗽的关系以及埃索美拉唑对慢性反流性咳嗽的疗效。方法对200例慢性咳嗽患者进行24小时食管PH监测,其中82例被诊断为食道反流性咳嗽,观察这82例患者咳嗽症状与食道反流的关系,同时将这82例患者随机分为两组,其中41例患者作为实验组给予埃索美拉唑进行为期8周的抗反流治疗,另41例患者给予同样疗程的莫沙比利治疗,并对结果加以分析。24小时食管PH监测包括反流参数即反流次数、反流时间大于5分钟的次数、最长反流时间、phi4的时间占监测时间的百分比及Demeester总积分。结果无论实验组还是对照组24小时食道PH值均无显著性差异,但是进行抗酸治疗后两组的结果有显著性差异,实验组的24小时食道PH值与对照组相比有显著降低（P〈O．05）,实验组的咳嗽症状较对照组也有明显改善（P〈O．05）。结论24小时食道pH监测对于食道反流引起的慢性咳嗽具有重要的诊断意义,而且抗酸治疗对于食道反流性咳嗽的症状改善也具有作用。