正常糖调节人群中腹内脂肪积聚与糖脂代谢的早期变化

目的　研究中国糖调节正常者体脂分布与糖脂代谢和胰岛素敏感性的关系。方法　采用核磁共振测量 5 0 4名年龄≥ 4 0岁糖调节正常中国人 (男 2 15名、女 2 89名 )的腹腔内脂肪、腹部及股部皮下脂肪面积。按体重指数分为非超重 /肥胖 (NON OW /OB)组和超重 /肥胖 (OW /OB)组 ,再依据腹腔内脂肪面积 (VA)进一步分为腹内脂肪积聚 (VO ,VA≥ 10 0cm2 )和非腹内脂肪积聚 (NVO ,VA <10 0cm2 )亚组。分析各组间糖脂代谢、胰岛素敏感性参数的异同及变化。结果　NON OW /OB和OW /OB组分别有 10 .5 %和 5 5 .5 %为腹内型肥胖。VO亚组餐后 2h血糖、2h胰岛素、0～ 2h平均胰岛素水平、空腹C肽及胰岛素抵抗指数 (HOMA- IR)均显著高于NVO亚组 (P值均 <0 .0 5 )。VO亚组的空腹三酰甘油、空腹游离脂肪酸、0～ 2h平均游离脂肪酸水平均显著高于NVO亚组 (P值均 <0 .0 5 )。结论　腹内脂肪积聚者尚未出现糖代谢异常前已存在明显的胰岛素抵抗、代偿性高胰岛素血症及高游离脂肪酸状态 ,这些代谢的异常变化是腹内型肥胖者易患糖尿病的病理生理基础。     

调脂汤对冠心病稳定型心绞痛合并高脂血症患者的治疗疗效探讨

目的:探讨调脂汤对冠心病稳定型心绞痛合并高脂血症患者的治疗疗效.方法:选择2016年6月至2017年8月我院接收并治疗的78例冠心病稳定型心绞痛合并高脂血症患者,分为两组,对照组采用常规西药治疗,研究组采用调脂汤治疗,对比两组治疗的疗效.结果:研究组治疗后各项血脂水平及总有效率优于对照组,P<0.05.结论:调脂汤治疗冠心病稳定型心绞痛合并高脂血症的效果确切,可推广.     

脂联素基因多态性与肥胖、血清脂联素水平的相关性**☆

目的：研究发现，脂肪组织分泌的脂联素在体脂变化，糖、脂代谢以及抗动脉粥样硬化中发挥有益的作用。分析脂联素基因（apM1）多态性与肥胖、血清脂联素水平的相关性。 方法：⑴试验对象：选取2000-08/2003-07在上海市华阳社区肥胖流行病学调查所诊断的超重/肥胖人群以及上海市第六人民医院门诊就诊的390名患者。男171例，女219例，平均年龄(51±1)岁。纳入标准：①符合世界卫生组织（WHO）肥胖诊断标准。②所有纳入对象均为汉族人。③对试验目的知情同意。⑵试验方法及评估：根据世界卫生组织（WHO）肥胖诊断标准将受试对象分为正常体质量组(体质量指数< 25 kg/m2)182例和超重/肥胖组（≥25 kg/m2）208例。进一步根据腹腔内脂肪面积将超重/肥胖组分为腹内型肥胖（腹腔内脂肪面积≥100 cm2）114例和非腹内型肥胖（腹腔内脂肪面积<100 cm2）94例。采用多聚酶链反应-限制性片段长度多态性方法检测apM1基因第二外显子+45（Exon2+45）和第三外显子+331（Exon3+331）2个位点的基因多态性。应用核磁共振测定局部体脂，放射免疫分析法测定空腹血清脂联素水平。试验对数据先进行正态分布检验，如果符合正态分布，两组间计量资料的比较采用t检验，多组间比较用F检验。计算基因多态性的基因型频率，确认符合Hardy-Weinberg平衡，计算等位基因频率，基因型分布作Hardy-Weinberg吻合度检验。等位基因频率和基因型频率的比较采用χ2检验。 结果：正常对照组182例和超重/肥胖组208例均进入结果分析。①中国汉族人apM1基因Exon2+45位点存在基因多态性，有3种基因型，即TT，TG，GG；Exon3+331位点不存在基因多态性，均为TT基因型。②apM1基因Exon2+45位点基因型及等位基因频率在超重/肥胖者与正常体质量者之间无显著差异；在腹内型肥胖与非腹内型肥胖者间亦无显著差异。③apM1基因Exon2+45位点各基因型组间血清脂联素水平无显著差异。 结论：中国汉族人脂联素基因Exon2+45位点的多态性与肥胖以及肥胖类型、血清脂联素水平无相关性；Exon3+331位点不存在基因多态性。     

扩展高胰岛素-正葡萄糖钳夹技术的建立

目的建立扩展高胰岛素-正葡萄糖钳夹技术.方法应用扩展葡萄糖钳夹技术(即联合葡萄糖钳夹、3-3H标记葡萄糖示踪技术及间接测热技术)对9例正常体重、正常糖耐量者进行方法学研究.结果(1)在优势浓度胰岛素、血浆葡萄糖稳定在正常水平状态下肝糖产生完全被抑制,未见到升糖激素(皮质醇、生长激素、胰高血糖素)显著兴奋及内源性胰岛素释放.(2)扩展高胰岛素-正葡萄糖钳夹稳态期,胰岛素介导的机体葡萄糖利用率(葡萄糖消失率)较基础状态显著增加[(5.86±0.65)mg*kg-1*min-1比(2.45±0.15)mg*kg-1*min-1,P＜0.01],并以糖原合成为主;脂肪氧化被显著抑制,游离脂肪酸浓度显著下降.结论扩展高胰岛素-正葡萄糖钳夹技术已成功建立;在外源性胰岛素-葡萄糖代谢的稳定状态下,机体对葡萄糖利用显著增加,脂肪分解显著减少.     

急诊治疗严重哮喘呼吸衰竭的临床观察

目的：探讨急诊治疗严重哮喘呼吸衰竭的临床疗效。方法选取严重呼吸衰竭哮喘患者69例。对照组给予对症治疗,观察组接受对症治疗的同时配合使用无创正压机械通气治疗,比较2组抢救成功率、血气分析等指标变化情况。结果观察组抢救成功率（93.94%）明显优于对照组（80.56%）（P<0.05）;RR与HR指标变化明显,pH值与SaO 2等指标明显上升,2组死亡率及各项指标差异显著,差异均有统计学意义（P＜0.05）。结论无创正压机械通气应用于严重哮喘呼吸衰竭患者的急诊治疗中可以迅速、有效地改善患者症状,提高临床治愈率,安全有效,值得临床推广应用。     

自拟活血祛痰通络汤治疗中风恢复期偏瘫肩痛38例

目的:观察自拟活血祛痰通络汤治疗中风恢复期偏瘫肩痛的临床疗效。方法:将中风恢复期偏瘫肩痛患者69例随机分为观察组38例、对照组31例,两组常规活血化瘀,营养神经治疗,观察组另外给予自拟活血祛痰通络汤治疗,治疗3个疗程后分别观察患者疗效,肩痛程度、肩痛频度积分,血粘度水平的变化。结果:两组总疗效分别为89.47%、80.64%,两组有显著性差异,治疗组均优于对照组(P<0.05),治疗后肩痛程度、肩痛频度积分改善,血粘度水平下降,治疗组均优于对照组(P<0.05或P<0.01)。结论:自拟活血祛痰通络汤治疗中风恢复期偏瘫肩痛具有良好的疗效。     

上海社区糖尿病前期及糖尿病人群视网膜病变患病率及相关危险因素分析

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. Methods DR screening after the epidemiologic study of metabolic syndrome in Huayang and Canyang Community , Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbAlc, serum lipid and blood pressure were also assessed. 642 patients,312 males and 330 females, aged 65 ± 13, with complete data were enrolled into the analysis. Results The prevalence of DR was 19. 9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12. 0%, 5. 1%, 2. 3% and 0. 5%, respectively; the prevalence of DR in IGR reached 8. 0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. Conclusion The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.     

上海社区糖尿病前期及糖尿病人群视网膜病变患病率及相关危险因素分析

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. Methods DR screening after the epidemiologic study of metabolic syndrome in Huayang and Canyang Community , Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbAlc, serum lipid and blood pressure were also assessed. 642 patients,312 males and 330 females, aged 65 ± 13, with complete data were enrolled into the analysis. Results The prevalence of DR was 19. 9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12. 0%, 5. 1%, 2. 3% and 0. 5%, respectively; the prevalence of DR in IGR reached 8. 0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. Conclusion The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.     

上海社区糖尿病前期及糖尿病人群视网膜病变患病率及相关危险因素分析

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. Methods DR screening after the epidemiologic study of metabolic syndrome in Huayang and Canyang Community , Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbAlc, serum lipid and blood pressure were also assessed. 642 patients,312 males and 330 females, aged 65 ± 13, with complete data were enrolled into the analysis. Results The prevalence of DR was 19. 9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12. 0%, 5. 1%, 2. 3% and 0. 5%, respectively; the prevalence of DR in IGR reached 8. 0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. Conclusion The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.     

生脉活心汤治疗慢性充血性心力衰竭35例

近年来,我们以生脉活心汤治疗慢性充血性心力衰竭(以下简称慢性心衰)35例,报告如下. 1 一般资料 本组35例中,女26例,男9例;35～39岁3例,40～49岁5例,50～59岁10例,60～69岁12 例,＞70岁5例;以急性心力衰竭收入院4例,其余以冠心病、肺心病、高血压病、风心病等原发病收入 院,单一原发病者28例,2种或2种以上原发病者7例.入院前用药史:35例均曾服地高辛,服利尿剂19 例,服降压药8例,服扩血管药15例,服其他药5例.以文献[1]、[2]有关标准为诊断依据,心功能状 态可根据病人的临床表现分为4级.本组35例心功能均在三级以上.