怡开治疗2型糖尿病早期肾病的疗效观察

目的 :观察怡开 (胰激肽原酶肠溶片 )对 2型糖尿病 (T2DM)早期肾病的疗效。方法 :5 8例T2DM早期肾病患者 ,随机分成对照组和治疗组 ,在常规降糖药物治疗同时 ,治疗组口服怡开 ,3个月后比较治疗前后尿微量白蛋白 (UAER)的变化。结果 :怡开组治疗后可显著减少尿微量白蛋白的排出量 (P <0 .0 1 ) ,对照组治疗前后UAER无明显差异 (P >0 .0 5 )。结论 :怡开可降低糖尿病尿微量白蛋白的排泄 ,对T2DM早期肾病有良好的疗效     

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.     

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.     

2型糖尿病患者血清胆红素水平与糖尿病肾病的关系

目的 探讨2型糖尿病(T2DM)患者血清胆红素水平与糖尿病肾病(DN)的关系.方法 收集461例T2DM患者(T2DM组)的临床资料,记录空腹血糖、肝肾功能和血脂谱等生化指标,根据尿白蛋白/肌酐比值(ACR)将T2DM组患者再分为正常蛋白尿组(NA组,n=221)、微量白蛋白尿组(MA组,n=191)和大量白蛋白尿组(OA组,n=49),以301名健康体检者作为正常对照组.结果 T2DM患者血清总胆红素(TBIL)和直接胆红素(DBIL)水平显著低于正常对照组,这种差异在校正其他影响因素后仍然存在(P＜0.01,P＜0.05).T2DM患者的血清TBIL和DBIL水平,NA组＞MA组＞OA组,组间比较差异均有统计学意义(P＜0.01).按照血清TBIL水平的三分位点将T2DM患者分为三组进行分析的结果显示:随着血清TBIL水平的升高,ACR逐渐降低(P＜0.01),肾小球滤过率则逐渐升高(P＜0.05);多元逐步回归分析提示TBIL是ACR的独立影响因素(β=-0.15,P＜0.01).结论 在T2DM患者中,血清高胆红素水平对DN的发生和发展起保护作用.     

2型糖尿病不同尿白蛋白排泄率患者血清血管性血友病因子水平及其临床意义

目的探讨2型糖尿病(T2DM)不同尿白蛋白排泄量患者血清血管性血友病因子(v Wf)的表达水平,及其在糖尿病肾病(DN)发生中的可能作用。方法正常对照组49例和T2DM组144例进入该研究,根据尿白蛋白排泄水平,将糖尿病患者分为正常蛋白尿组(49例),微量蛋白尿组(50例),临床蛋白尿组(45例)。采用ELISA法测定受试者血清v Wf的浓度。结果正常蛋白尿组、微量蛋白尿组、临床蛋白尿组,年龄、病程、BMI、Hb A1C、FPG、FINS、HOMA-IR、ACR和v Wf水平显著高于正常对照组(P<0.01);T2DM患者血清v Wf水平与T2DM病程、BMI、HOMA-IR、Hb A1C、ACR和Fg呈显著正相关。结论血管内皮细胞损伤及功能紊乱是DN发病机制之一,血清v Wf水平可以成为DN早期的预测指标。     

糖尿病肾病与骨质疏松的相关性研究

目的探讨2型糖尿病(T2DM)患者尿微量白蛋白与骨密度的关系及其相关性.方法随机选取我院T2DM患者203例,测定研究组腰椎(L1-L4)、股骨颈的骨密度,并根据尿微量白蛋白定量设:T2DM正常白蛋白尿组(<30mg/24h)(1组)、T2DM微量白蛋白尿组(30-300mg/24h)(2组)、T2DM大量白蛋白尿组(≥300mg/24h)(3组),比较不同白蛋白尿组骨密度的差异,将T2DM患者尿白蛋白定量与骨密度作相关性分析.结果 T2DM患者微量白蛋白尿组和大量白蛋白尿组股骨颈的骨密度较正常白蛋白尿组显著降低(p<0.05),腰椎的骨密度也呈下降趋势(p>0.05).结论糖尿病肾病患者骨密度降低.     

血清胱抑素C与糖尿病肾病的相关性研究

目的:研究2型糖尿病(T2DM)患者血清胱抑素C(CysC)对于诊断早期糖尿病肾病(DN)的临床意义;晨尿微量白蛋白(mALB)/肌酐(Cr)比值(ACR)与24h尿mALB的相关性。方法:测定259例T2DM患者及40例健康对照者血清Cys-C、Cr、尿酸(UA)、血脂进行比较;收集259例T2DM患者24h尿和晨尿,测定24h尿mALB、晨尿mALB、Cr,进行晨尿ACR与24h尿mALB相关性分析。结果:血清Cys-C各组间比较差异显著;晨尿ACR与24h尿mALB呈高度相关。结论:血清CysC对于DN的诊断较Cr更为准确;晨尿ACR可替代24h尿mALB作为观察评价尿微量白蛋白排泄量的指标。     

2型糖尿病多因素干预治疗对微血管病变的影响

目的 通过与常规治疗相比，检测针对2型糖尿病（T2DM）微量白蛋白尿患者多项可改变的危险因素进行的多因素强化干预治疗的效果，评价在3年的强化干预治疗期间微血管并发症的终点事件。方法 60例T2DM微量白蛋白尿患者随机分为常规治疗组及强化治疗组，比较两组的微血管并发症的发生情况。结果 经过3年的多因素强化治疗，糖尿病肾病、视网膜病变及神经病变的危险因素下降了50％～70％。结论 为期3年的包括行为改变和多种药物治疗的多因素干预治疗能够延缓T2DM微量白蛋白尿患者的肾脏病变、视网膜病变和神经病变的进展。     

尿微量白蛋白检测对2型糖尿病早期肾损伤的诊断价值

①目的探讨尿微量白蛋白检测对2型糖尿病早期肾损伤的诊断价值。②方法根据尿蛋白检查结果将98例2型糖尿病患者分为两组,尿蛋白阴性组(60例)和尿蛋白阳性组(38例);另设40例健康对照组。检测分析各组尿微量白蛋白(MA)的含量变化。③结果98例2型糖尿病患者中,MA阳性结果分析显示,尿MA与病程密切相关,病程越长,尿MA阳性率越高(P<0.05);尿MA与性别无关(P>0.05)。④结论尿MA检测对预测2型糖尿病患者早期肾损伤的发生、发展具有重要意义。     

2型糖尿病患者血清可溶性IL-2受体水平与糖尿病肾病相关性分析

目的探讨2型糖尿病(T2DM)患者外周血可溶性白介素-2(sIL-2R)水平与糖尿病肾病(DN)的相关性。方法选取2018年9月至2019年7月在我院内分泌科收治的T2DM患者327例,其中正常蛋白尿(NA)组190例、微量白蛋白尿(MA)组87例、大量白蛋白尿(OA)组50例。检测并比较三组患者年龄、性别、体质量指数(BMI)、糖化血红蛋白(HbA1c)、病程、外周血sIL-2R、血肌酐、肾小球滤过率(e GFR)、尿白蛋白/肌酐比值(UACR)水平差异。对比三组患者外周血可溶性白介素-2(sIL-2R)的水平差异,研究外周血可溶性白介素-2(sIL-2R)对糖尿病肾病的影响。结果血清sIL-2R在NA组、MA组及OA组中水平依次升高,组间比较及组内两两比较,差异均有统计学意义(P0.05或PO.01);多元逐步回归分析显示,病程、sIL-2R是ACR的独立影响因素(P0.01)。结论外周血sIL-2R水平是DN的独立影响因素,进一步证实细胞免疫可能参与DN的发生和发展。     

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…