氨甲环酸对全膝关节置换术中及术后失血量的影响

目的探讨氨甲环酸对全膝关节置换术术中及术后失血量的影响。方法全膝关节置换术的患者78例,随机分为观察组和对照组各39例,观察组患者于术后使用氨甲环酸,对照组患者术后不用氨甲环酸。比较两组的术中失血量、术后可见失血量、输血量、输血人数、术后血红蛋白和术后凝血3项。结果两组患者的术中失血量比较差异无统计学意义（P〉0．05）,但术后可见失血量、输血量、输血人数、术后血红蛋白比较,差异均有统计学意义（P〈0．05）,观察组的指标明显优于对照组。术中松开止血带时与术后3小时,两组患者的凝血3项比较差异无统计学意义（P〉0．05）。结论全膝关节置换术中及术后短期使用氨甲环酸能明显降低患者术后失血量及输血量,此药物安全有效,值得临床推广应用。     

幽门螺杆菌感染与糖化血红蛋白水平的关系探讨

分析2011年于本院体检中心进行健康体检者中体检数据完整、进行了^13C-尿素呼气试验检测幽门螺杆菌（Hp）及糖化血红蛋白检测的11514名受试者的体检数据。结果显示,女性Hp阳性检出率（31．77％）高于男性（29．36％）,X^2=7,355,P〈0．05。35～60岁受试者Hp阳性检出率最高,为31．17％。体重指数≥28kg／m^2者及有中心型肥胖者Hp阳性检出率相对较高,分别为31．55％及30．44％,但与正常体重及无中心型肥胖者比较,差异无统计学意义。总人群中,Hp阳性患者糖化血红蛋白水平高于Hp阴性者（t=-2．276,P=0．01）。亚组分析显示,体重指数≥24kg／m。及有中心型肥胖的受试者中,Hp阳性患者的糖化血红蛋白水平高于Hp阴性者（P〈0．05）。Hp阳性与糖尿病患病率呈正相关（OR=1．282;95％CI：0．941～1．799）,在肥胖患者中相关性更明显（OR=1．459;95％C1：1．070～2．071）。提示,Hp阳性患者糖化血红蛋白水平较高。Hp可能参与血糖调节受损的发生,且可能与高体重指数相关。     

慢性肾脏病患者血红蛋白变异度与肾功能进展关系的临床研究

目的评价在肾内科门诊规律随访的慢性肾脏疾病(CKD)患者的肾脏功能进展情况,及与血红蛋白变异度的相关情况。方法采用前瞻性队列研究设计,收集慢性肾脏病患者规律随访,定期抽取血样标本检测血红蛋白、肾功能等指标,建立数据库并应用统计软件对观察结果进行分析。结果共纳入197例患者,其中CKD 2期11例,3期125例,4期54例,5期7例。进入队列时基线年龄为62.3±10.6岁,基线肾小球滤过率(eGFR)为33.3±10.2 ml/(min·1.73 m2),随访18个月,72例(36.5%)患者的肾功能发生进展,与肾功能稳定组相比,肾功能进展组的血红蛋白变异度指标较高,差异有统计学意义(P<0.05)。结论慢性肾脏病患者的血红蛋白的变异度水平与肾功能进展有关,应对患者的血红蛋白波动增加关注。     

剖宫产前后血红蛋白释放试验的连续观察

目的观察剖宫产手术前后红细胞释放血红蛋白情况。方法 1例剖宫产孕妇,分别于剖宫产术前、术后1、5、13 d采血,对这4份血液标本进行双向多层电泳,对其中术后5天的血液标本进行等低渗全程电泳,再对术后1天和5天的标本的血浆进行单向电泳试验。结果剖宫产术后5 d标本血红蛋白释放的变化较大。即在血红蛋白A1前方出现快泳联苯胺阳性成分,血浆中也有此联苯胺阳性成分,在白蛋白前出现丽春红阳性物质,涉及急性期反应蛋白。结论剖宫产手术前后血红蛋白释放结果有差异。     

521名流动学龄前儿童贫血患病率调查

目的了解深圳市流动学龄前儿童贫血患病状况,为制定保护流动儿童健康措施提供参考依据。方法对深圳市部分幼儿园和社区的521名流动学龄前儿童进行营养健康调查,另选500名非流动学龄前儿童作为对照,检测两组儿童血红蛋白（Hb）含量,并作对比分析。结果521名流动学龄前儿童中贫血者89人,贫血患病率为17.08%,且贫血患病有随年龄增长而显著增加的趋势;以3～5岁年龄组贫血患病率最高,为29.53%。男女童贫血患病率基本一致。而非流动学龄前儿童贫血患病率为6.2%,与流动学龄前儿童比较,差异有统计学意义（χ2=32.23,P〈0.01）.结论流动学龄前儿童贫血患病率高于非流动儿童。应采取相应干预措施,降低流动学龄前儿童的贫血患病率。     

糖尿病肾病患者糖化血红蛋白、超敏C-反应蛋白和尿微量白蛋白检测的临床意义

摘要：目的探讨糖尿病肾病（DN）患者血糖化血红蛋白（HbAlc）、超敏C反应蛋白（hs—CRP）和尿微量白蛋白（Um1Alb）检测的临床价值。方法选择186例2型糖尿病（T2DM）患者,根据其24hUmAlb水平将患者分为三组：正常蛋白尿组（A组）79例,尿微量白蛋白组（B组）64例及临床蛋白尿组（c组）43例。男选取同期在我院做健康体检者60例作为对照组。分别采血及24h尿液检测HbAlC、hsCRP及UmAlb水平并进行比较。结果A、B、C三组患者HbAlc、hsCRP及UmAlb水平均显著高于对照组（P〈0．01）;A、B、C三组间HbAlc、hs—CRP和U1TIAlb水平比较,差异均有统计学意义（A组〈B组〈C组,P〈O．01）。结论HbAlC、hsCRP及UmAlb联合检测有助于DN的早期诊断,对评价患者病情及指导治疗有重要价值。     

剖宫产术同时行子宫肌瘤剔除术的临床研究

目的评估剖宫产同时行子宫肌瘤剔除术的安全性和有效性。方法选择2009年1月至2012年6月深圳市龙华人民医院收治的妊娠合并子宫肌瘤孕妇108例为观察组,选择同期行单纯剖宫产术的孕妇69例为对照组,对两组手术及产后情况进行分析。结果观察组手术时间长于对照组,差异有统计学意义（P〈0．05）,两组术中出血量、术后48h阴道出血量、血红蛋白下降值、术后肠蠕动恢复时间、手术切口愈合时间、手术后并发症、恶露干净时间的比较,差异无统计学意义（P〉0．05）;5cm≤直径≤8cm组产妇术中平均出血量、术后48h阴道出血量和血红蛋白下降值虽然稍高于直径〈5cm组,但两组比较差异无统计学意义（P〉0．05）。结论剖宫产同时行子宫肌瘤剔除术,不会增加产后出血、产褥感染等风险,是安全可靠的。     

Improved diabetes care by primary care physicians: results of a group-randomized evaluation of the Medicare Health Care Quality Improvement Program (HCQIP)

BACKGROUND/OBJECTIVES: Glycosylated hemoglobin (HbA1C) measurements in patients with diabetes mellitus contribute to glycemic control, and, therefore to lower diabetic complication rates. Determine if an intervention that includes claims-based feedback about patterns of HbA1C measurement results in more frequent monitoring of HbA1C in diabetic Medicare beneficiaries. SUBJECTS: Primary care physicians in a single Southern state treating Medicare beneficiaries with diabetes mellitus. METHODS: A group-randomized evaluation of an intervention that included claims-based feedback about patterns of HbA1C measurement, educational materials, and practice aids. RESULTS: Rates for each quality indicator increased from 1996 to 1998 for both the intervention and comparison groups, although increases were larger for intervention counties. HbA1C testing rates increased in intervention counties 16.8% compared to 13.0% in the comparison counties, an absolute difference of 4.0% (95% CI, 0.7 to 7.3). Differences for other indicators were small, although positive and favoring the intervention, and lacked statistical significance. CONCLUSIONS: Physician interventions that included practice-level feedback about monitoring of glycemic control successfully led to improved care of diabetic Medicare beneficiaries.     

孕妇血红蛋白浓度与早产关联强度剂量反应关系

目的 探讨孕妇血红蛋白浓度与早产关联强度的剂量反应关系。方法 选取广西壮族自治区武鸣、平果、靖西、德保、隆安、田东等县级医院2015年1月至2017年12月入院的12 780例壮族孕妇及其分娩的新生儿作为研究对象，回顾性地收集研究对象的一般人口学资料、孕期产检资料以及出生结局资料。采用非条件logistic回归方法初步分析孕期贫血对早产的影响，采用限制性立方样条模型分析孕期血红蛋白浓度与早产关联强度剂量反应关系。结果 排除2 053例高血压或年龄≥ 35岁的孕妇，非条件logistic回归分析显示，孕早期贫血组发生早产的风险是非贫血组的1.29倍（OR=1.29，95% CI：1.04~1.59，P=0.019）；限制性立方样条模型显示，孕早期血红蛋白浓度与早产的关联呈非线性"L"形剂量反应关系（非线性检验：P<0.001），孕晚期血红蛋白浓度与早产的关联呈非线性"U"形剂量反应关系（非线性检验：P<0.001）。结论 孕妇孕早期和孕晚期血红蛋白浓度与早产的关联呈非线性剂量反应关系。     

Glucagon-like peptide 1 receptor agonists in end-staged kidney disease and kidney transplantation: A narrative review

AimsGlucagon-like peptide 1 receptor agonists (GLP-1RA) improve glycemic control and promote weight loss in type 2 diabetes (DM2) and obesity. We identified studies describing the metabolic benefits of GLP-1RA in end-staged kidney disease (ESKD) and kidney transplantation.Data synthesisWe searched for randomized controlled trials (RCTs) and observational studies that investigated the metabolic benefits of GLP-1RA in ESKD and kidney transplantation. We summarized the effect of GLP-1RA on measures of obesity and glycemic control, examined adverse events, and explored adherence with therapy. In small RCTs of patients with DM2 on dialysis, liraglutide for up to 12 weeks lowered HbA1c by 0.8%, reduced time in hyperglycemia by ∼2%, lowered blood glucose by 2 mmol/L and reduced weight by 1–2 kg, compared with placebo. In prospective studies inclusive of ESKD, 12 months of semaglutide reduced HbA1c by 0.8%, and contributed to weight losses of 8 kg. In retrospective cohort studies in DM2 and kidney transplantation, 12 months of GLP-1RA lowered HbA1c by 2%, and fasting glucose by ∼3 mmol/L compared with non-use, and in some reports, weight losses of up to 4 kg were described. Gastrointestinal (GI) side effects were most commonly reported, with hypoglycemia described with GLP-1RA in hemodialysis, particularly in those using insulin.ConclusionsGLP-1RA are growing in popularity in those with DM2 and obesity. In small RCTs and observational cohort studies modest glycemic and weight benefits have been described in ESKD and transplantation, but GI side effects may limit adherence. Larger and longer term studies of GLP-1RA remain important.