五莲县部分35岁以上人群代谢综合征及其相关疾病患病调查

[目的]了解五莲县居民糖尿病、高血压、血脂紊乱和代谢综合征（MS）的流行状况及其伴发胰岛素抵抗（IR）的情况,为进一步制定防治措施提供依据.[方法]2002年,在五莲县的叩官、许孟和县直社区,对1 410名（男性654人、女性756人）35～64岁居民进行问卷调查、体格检查及生化检验.[结果]MS患病率为9.15%,超重、肥胖、糖尿病、高血压、血脂异常和IR的罹患率分别为40.85%、6.67%、3.69@.85%、34.11%和25.18%;糖尿病、高血压、血脂异常和MS患病率随着年龄增加而增高;各年龄组均有胰岛素抵抗患者.[结论]五莲县部分社区35～64岁人群MS及相关疾病的罹患率较高.     

黄芪和硫酸锌对肠缺血-再灌注致肺损伤的防治作用

目的：研究黄芪、硫酸锌对肠缺血-再灌注(I／R)过程中肺脂质过氧化变化的影响并探讨其机制。方法：采用夹闭兔肠系膜上动脉及松央再灌注，复制损伤模犁。将动物随机分成4组，观察黄芪、硫酸锌对人、出肺血及肺组织超氧化物歧化酶(SOD)、黄嘌呤氧化酶（XO)、丙二醛(MDA)及肺表面活性物质(PS)含量的影响。结果：肠I／R过程中伴有急性肺损伤，静脉给予黄芪及硫酸锌可使再灌注后XO及MDA含量降低，且可防止SOD和PS减少。结论：黄芪、硫酸锌通过抗脂质过氧化能减轻或住一定程度上防止急性肺损伤的发生和发展。     

中药汤剂治疗奥氮平药物副反应的临床经验

目的:分析总结中药汤剂治疗奥氮平药物副反应的临床经验。方法:调查服用奥氮平1月以上的精神病患者,统计服用药物后较常出现的中医证候及舌脉象,类推奥氮平的中医“药毒”特性;将60例受试者随机分为2组,其中奥氮平合并服用中药汤剂的为治疗组,中药汤剂根据辨证论治选用温胆汤、玉女煎、补中益气汤、补脾胃泻阴火升阳汤加减治疗,对照组服用奥氮平合并安慰剂,观察治疗前、治疗1月、2月后中医证候评分及糖脂代谢指标的前后变化及组间差异,对疗效进行评估。结果:服用奥氮平1月前后比较,受试者便秘、纳多、肥胖、口干、脉数、精神疲倦、苔厚腻、肢体乏力、舌红、舌淡、脉滑、舌边齿痕、舌胖大、苔白的中医证候评分较前显著升高,具有统计学差异(P<0.05或P<0.01)。中医辨证分型为痰湿内阻证、胃热伤津证、脾气亏虚证和兼有脾虚、痰湿、胃热证。运用传统中医分析中药药性及功效的方法,类推奥氮平的“药毒”性热,入脾胃经,具有胃热伤津、伤脾生湿的作用。经过2月中药汤剂治疗后,试验组中医证候总分较前显著降低,差异具有统计学意义(P<0.01);试验组与对照组比较治疗后中医证候总分差异有显著性(P<0.01)。治疗后试验组与对照组的空腹血糖、餐后2h血糖、血清胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、体重、腰围、腰臀比及BMI值差异有显著性(P<0.05)。结论:临床上依据奥氮平“药毒”特性来辨证论治,运用中药汤剂治疗可以显著减少奥氮平所致的药物副反应。     

糖尿病“代谢记忆”研究进展

近年来大量循证医学证据表明了血糖控制在早期强化的重要性,并且在一段时间内改善血糖控制后,仍有并发症发生,机体的这种早期高血糖存在记忆的状态称为“代谢记忆”。由于代谢记忆的存在,临床以控制血糖为重点的干预方式无法有效阻止糖尿病大血管病变的发生发展,如何正确认识并阻止代谢记忆,成为目前糖尿病大血管病变临床防治的重要核心之一。本文从分子生物学、表观遗传学、妊娠糖尿病影响、血液流变学等方面综述了近几年糖尿病“代谢记忆”研究进展,为今后的基础研究和临床防治提供参考依据。     

Tratamiento actual de la enfermedad por hígado graso no alcohólico

Non-alcoholic fatty liver disease is the most prevalent hepatopathy, estimated at 30% in the general population. In the coming years, it will likely be the most common indication for liver transplantation and the most frequent cause of hepatocellular carcinoma. Current treatment for non-alcoholic fatty liver disease is based on dietary and exercise interventions that have been shown to be efficacious, even for reverting fibrosis. Unfortunately, compliance with general measures involving lifestyle modifications is very poor, making pharmacologic strategies a necessary option. At present, there are no treatments for non-alcoholic fatty liver disease approved by regulatory agencies, and the only ones with sufficient evidence and recommended by international societies are treatments with pioglitazone and vitamin E, which are not exempt from adverse effects. We review herein the current management of non-alcoholic fatty liver disease, including dietary and physical activity interventions, available treatments, equivocal therapies, emerging treatments, and treatments presently in clinical trials.     

Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years

BackgroundNo studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm.ObjectivesTo assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS.SettingUniversity hospital.MethodsA total of 191 patients with a body mass index >40 kg/m² and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS).ResultsForty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5–103.5] mg/dL to 61.0 [range, 2.0–76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from −1.0 ± 1.0 to −1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years.ConclusionsMBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.     

Metabolic acidosis due to inhaled salbutamol toxicity: A hazardous side effect complicating management of suspected cases of acute severe asthma

Metabolic acidosis has seldom been reported during treatment of asthma with use of beta agonist but not with much clinical consequence. We report two cases of metabolic acidosis with hyperventilation as a direct effect of salbutamol that caused difficulty in assessment and management of their respiratory symptoms which resolved with appropriate tapering of beta agonist.     

Risk stratification for mortality in cardiovascular disease survivors: A survival conditional inference tree analysis

Background and aimsEfficient analysis strategies for complex network with cardiovascular disease (CVD) risk stratification remain lacking. We sought to identify an optimized model to study CVD prognosis using survival conditional inference tree (SCTREE), a machine-learning method.Methods and resultsWe identified 5379 new onset CVD from 2006 (baseline) to May, 2017 in the Kailuan I study including 101,510 participants (the training dataset). The second cohort composing 1,287 CVD survivors was used to validate the algorithm (the Kailuan II study, n = 57,511). All variables (e.g., age, sex, family history of CVD, metabolic risk factors, renal function indexes, heart rate, atrial fibrillation, and high sensitivity C-reactive protein) were measured at baseline and biennially during the follow-up period. Up to December 2017, we documented 1,104 deaths after CVD in the Kailuan I study and 170 deaths in the Kailuan II study. Older age, hyperglycemia and proteinuria were identified by the SCTREE as main predictors of post-CVD mortality. CVD survivors in the high risk group (presence of 2–3 of these top risk factors), had higher mortality risk in the training dataset (hazard ratio (HR): 5.41; 95% confidence Interval (CI): 4.49–6.52) and in the validation dataset (HR: 6.04; 95%CI: 3.59–10.2), than those in the lowest risk group (presence of 0–1 of these factors).ConclusionOlder age, hyperglycemia and proteinuria were the main predictors of post-CVD mortality.Trial registrationChiCTR-TNRC-11001489.