缺血性糖尿病足病的流行病学调查和治疗方法研究

目的 初步了解本院缺血性糖尿病患者足病的发病比例,并评价以血管重建术为基础的综合治疗的疗效.方法 对本院收治的糖尿病足病患者,根据体格检查、踝肱指数测定和血管影像学检查结果 筛选出下肢缺血患者,并计算其所占比例.同时予血管重建术治疗为主,结合抗感染等综合疗法,并观察疗效.结果 本组糖尿病足病患者81例,确诊为缺血性糖尿病足病11例（13.58%）,其中接受外科血管重建术治疗者10例,手术成功率为90.9%;9例患者创面愈合,2例截肢,临床成功率为81.9%.结论 明确缺血性糖尿病足病患者的流行病学特点,并予针对性治疗,可大幅提高保肢率、改善疗效.     

骨痛-Fanconi综合征-M蛋白

Fanconi综合征(FS)导致的骨软化症是单克隆免疫球蛋白沉积性疾病(MIDD)的罕见合并症。本文报道1例23岁男性,临床表现为逐渐加重的多部位骨痛伴活动受限,辅助检查提示低磷血症、代偿性代谢性酸中毒、肾性糖尿、氨基酸尿及低尿酸血症等近端肾小管功能损害,免疫固定电泳提示IgAλ型M蛋白、血碱性磷酸酶水平升高,影像学检查显示骨软化,结合骨髓涂片等诊断为意义不明单克隆免疫球蛋白血症(MGUS)继发FS,并引起骨软化症。给予纠正酸中毒、补磷、补活性维生素D等治疗后骨痛症状有所改善。本文同时复习MIDD引起FS及继发骨软化症的相关文献。     

糖尿病肾病分期证候分布与聚类分析探索

目的:基于疾病分期,探索糖尿病肾病(DN)中医证候分布规律和研究方法,为进一步研究该病的病因病机及证候特点提供依据。方法:按照量表的制作方法,制定DN中医证候问卷,对180例患者进行了分层、横断面调查,对所得数据进行频数统计和聚类分析。结果:Ⅲ期以气虚、阴虚表现多见,兼有内热、血瘀、痰湿;Ⅳ期在Ⅲ期基础上出现了血虚、阳虚,还可兼有热结、湿浊表现。V期本虚更甚,还可兼有气滞、郁热等多种表现。对症状条目进行聚类分析,得到8种证候组合。结论:DN中医证候具有本虚标实的特点,血瘀证贯穿病程始终,证素组合多样,应用聚类分析方法具有可行性。     

Association of Chinese medicine constitution susceptibility to diabetic nephropathy and transforming growth factor-β1 (T869C) gene polymorphism

Objective  

To explore the association of Chinese medicine constitution susceptibility to diabetic nephropathy (DN) and transforming growth factor (TGF)-β1 (T869C) gene polymorphism.     

国内“互联网+”糖尿病管理方法的进展

随着互联网技术及互联网设备的飞速发展,我国用于糖尿病社区管理的“互联网+”管理方法不断被运用于实际管理中。笔者就国内社区现有“互联网+”糖尿病管理方法中各类管理方案的优势进行综述,以期为“互联网+”糖尿病管理方法的发展与推广提供参考。     

Genome-wide and size-based cell-free DNA indices as predictive biomarkers for locally advanced esophageal squamous cell carcinoma treated with preoperative or definitive chemoradiotherapy

For locally advanced esophageal cancer, concurrent chemoradiotherapy (CRT) followed by surgery has been a standard treatment, while clinical studies showed comparable survival outcomes between definitive CRT and neoadjuvant CRT followed by surgery in patients responding to CRT. Thus, biomarkers are required to predict treatment outcomes and benefit of adding surgery after CRT. This prospective biomarker study examined the role of cell-free DNA (cfDNA) fragmentation profiles and genomic copy number variations (CNVs) in predicting treatment outcomes in esophageal squamous cell carcinoma patients treated with neoadjuvant or definitive CRT. The clinical response was evaluated after induction chemotherapy and after CRT. Fragment Ratio (FR)-score and I-score were calculated from plasma cfDNA reflecting fragment lengths and CNV of cfDNA, respectively. The association between indices of cfDNA (cfDNA concentration, FR-score, and I-score) and treatment outcomes (clinical response, time to progression [TTP], and overall survival [OS]) were evaluated. Sixty-one patients were included. Thirty patients received neoadjuvant CRT followed by surgery, whereas 31 received definitive CRT. Low baseline, post-induction chemotherapy, and post-CRT FR-scores and low post-induction I-score were significantly associated with improved treatment response (P < 0.05). Additionally, patients with surgery after CRT showed significantly longer survival than patients without surgery in the FR-score-high group (median TTP, 12.7 vs 3.4 months; P = 0.011; OS, not reached vs 12.9 months; P = 0.02), while there was no survival benefit with surgery in the FR-score-low group. FR-score may be a new biomarker to predict treatment response, residual tumor burden after CRT, and consequently, survival benefit of adding morbid surgery after CRT. FR-score has strength in a relatively simple and inexpensive methodology compared to deep sequencing, resulting in high availability and accessibility, despite limited sensitivity.     

糖尿病肾病血清抗氧化能力及炎性指标的变化

目的探讨糖尿病肾病患者血清抗氧化能力指标及炎性指标的变化。方法选取2011年8月—2012年8月于杭州市红十字会医院进行诊断治疗的288例糖尿病肾病患者为观察组,同一时期的288名健康体检人员为对照组,然后将2组被检测人员的血清TAC、SOD、MDA及hs—CRP、IL-6指标进行比较,同时将观察组中不同疾病分期者的上述指标检测结果进行比较。结果观察组的血清TAC、SOD均低于对照组,MDA及hs—CRP、IL-6则高于对照组,并且观察组中V期者变化大于Ⅰ一Ⅳ期的患者,Ⅳ期患者大于Ⅰ～Ⅲ期患者,P均〈0．05,差异均有统计学意义。结论糖尿病肾病患者血清抗氧化能力指标及炎性指标均呈现明显的异常状态,并对疾病的分期有了解意义。     

血小板活化标志物与糖尿病肾病的关系

糖尿病患者所发生的一系列理化因素改变可导致血小板的活化,而另一方面,活化的血小板在糖尿病肾病的发生、发展中亦起着重要作用。现对血小板活化标志物的种类(主要为血小板颗粒膜糖蛋白和质膜糖蛋白)及其与糖尿病肾病的密切关系进行综述。以期为临床上对糖尿病肾病患者使用抗血小板活化药物提供理论依据。