昆明地区原发性高血压患者464例血糖水平调查与分析

目的调查分析昆明地区原发性高血压住院患者血糖水平．为其合理治疗提供参考信息．亓法应用生物方法检测464例单纯原发性高血压及合并心功能不全住院患者的空腹血糖（FPG）、糖化血清蛋白（SFA）和糖化血红蛋白（HbAlc）．调查对象分3组：I组（单纯原发性高血压）、Ⅱ组（原发性高血压心功能I-Ⅱ级）和m组（原发性高血压心功能Ⅲ级以上）．结果调查对象FPG、SFA和HbAlc平均水平分别为（6．16±2．57）mmol／L、（2．70±0．49）mmo]fL和HbAlc平均水平为（6．17±1．38）％．i组间FPG和SFA平均水平差异无显著性意义．38．1％患者FPG水平〉5．6mmol／L,19．8％患者FPG水平〉7．0mmol／L,44．4％患者HbAlc水平〉6．0％,21．3％患者HbAlc水平〉6．5％．Ⅱ组、Ⅲ组患者的HbAIc平均水平高于I组,差异有统计学意义（P〈0．05）．结论昆明地区原发性高血压住院患者中,近半数患者存在不同程度血糖水平升高,这可能是引起心功能不全的因素之一     

Traditional couching is not an effective alternative procedure for cataract surgery in Mali

INTRODUCTION: In Mali, more cataract patients receive sight-restoring surgery using a traditional "couching" procedure (the lens inside the vitreous body) than by modern cataract surgery. In order to evaluate the relative effectiveness and other outcomes of the traditional procedure compared to the modern surgical intervention, we conducted a population-based survey in a rural district of Mali in 1996. METHOD: A total of 99,800 persons from 160 villages were eligible to be included in the sample. All individuals operated for cataract by a modern procedure were checked for visual acuity and questioned regarding their clinical history, the cost of the surgery and their satisfaction with the surgery immediately following the operation and presently. Each patient was paired with one person operated by a traditional cataract surgical procedure. RESULTS: From a total population of 99,800 we found 85 individuals (0.085%) who had been operated by intracapsular extraction (ICCE) without lens implantation and we paired these with 82 individuals operated by the traditional method and by a local healer. In both groups, males were predominant (74.4% in the modern group and 61.3% in the traditional) and the median age was 65 and 68 years, respectively. Men with a higher social status (defined as administrative or religious authority) were slightly more common among those operated by ICCE (18.9%) than among those operated by the traditional healer (4.4%). Nearly half (47.6%) of the patients operated by couching did not know that a modern alternative existed. The mean cost to the patient of the two procedures was similar; with traditional couching costing on average US$ 42.10 and modern surgery (including transport and drugs) costing US$ 52.40. The traditional healer was often paid partially in kind and the price paid varied according to the patient's ability to pay. The clinical results differed greatly between the two methods. After aphakic correction of eyes operated by ICCE, 5.3% had good vision (33/18), 76.8% had low vision (33/60 and <3/18) and 17.9% were still blind (<3/60). Of eyes operated by traditional couching, none had good vision, 29.1% had low vision and 70.9% were blind. The level of satisfaction was high (89.7%) among persons operated in an ophthalmic center by the modern method, and relatively low (22.6%) among persons operated traditionally. DISCUSSION: In Mali, two types of providers offer two different interventions to treat cataract-blind persons. This study suggests that the couching method used by traditional healers is relatively expensive and ineffective. It is also potentially dangerous although this study did not address this question specifically. It is important that health policy makers and medical authorities do what they can to prevent traditional healers from performing the couching procedure, as well as informing the population about the existence of a more-effective and safer alternative. However, while more effective and safer, the results obtained by ICCE are not excellent either. Further, it is important to improve the quality of ophthalmic services in order to provide cataract patients with the best, most accessible and least expensive services possible.     

不同血糖浓度2型糖尿病患者胃转流Roux-en-Y吻合术疗效的研究

目的：观察不同空腹血糖（FPG）水平2型糖尿病（T2DM）患者胃转流Roux-en-Y吻合术（RYGBP）术后血糖变化及转归情况。方法：前瞻性选取胃部疾病合并T2DM患者行胃部分或全胃切除,残胃食管近端空肠Roux-en-Y吻合术25例,根据入院时FPG水平分为3组：A组（7.0 mmol/L≤FPG〈11.1 mmol/L）、B组（11.1 mmol/L≤FPG〈15.0 mmol/L）、C组（FPG≥15.0 mmol/L）。检测各组术前（0周）、术后1、4、8、12、24周FPG水平,评估患者术后转归情况。结果：各组术后FPG较术前均有明显下降（P〈0.01）,术后24周A组与C组比较,B组与C组比较,差异均有统计学意义（P〈0.01）;A组与B组比较,差异无统计学意义（P〉0.05）。所有患者RYGBP术后T2DM均有不同程度的改善,治愈率为72%。结论：从血糖改善方面评估,RYGBP对所有T2DM患者均有不同程度的改善,但FPG水平过高时控制效果较差。     

糖化血红蛋白水平的不同切点在糖尿病诊断中的应用

目的 评估不同糖化血红蛋白(HbA1c)切点在糖尿病(DM)诊断中的应用价值.方法 研究对象来自2007年1月一2009年10月为明确DM诊断而就诊者和DM高危人群接受DM筛查者,共1 427名,男645名,女782名,平均年龄为(53±15)岁.研究对象空腹10 h行口服葡萄糖耐量试验(OGTT)并同时测定HbA1c、糖化血清白蛋白(GA).结果 ①按1999年世界卫生组织糖尿病诊断标准,糖耐量正常(NGT)、糖调节受损(IGR)和DM组分别有582例、378例、467例.NGT、IGR、DM组的HbA1 c水平呈递增趋势(P＜0.05).②Pearson相关分析显示,HbA1 c与GA及OGTT中的空腹血糖(FPG)、糖负荷后2 h血糖均呈正相关(r值分别=0.74、0.82、0.80,P值均＜0.01).③以OGTT为诊断DM的金标准绘制受试者特征工作曲线,以HbA1 c诊断DM的曲线下面积(AUC)为0.943(95%CI为0.931～0.955),与以FPG诊断DM的AUC[0.955(95%CI为0.944～0.965)]的差异无统计学意义(P＞0.05).以HbA1 c≥6.3%为切点诊断DM的敏感性度为79.7%,显著高于FPG≥7.0 mmol/L的51.4%和HbA1c≥6.5%的67.2%(P值均＜0.01).结论 在无法进行OGTT的情况下,HbA1c可用于DM的诊断,6.3%确是比较适合我国人群的诊断DM的HbA1c切点.     

糖化血红蛋白在血糖异常和糖尿病患者中的测定及意义

目的通过检测糖尿病患者和血糖异常糖化血红蛋白（HbAlc）和空腹血糖（FBG）,探讨糖尿病患者HbA1c检测的临床意义。方法选择确诊的糖尿病患者152例,血糖异常者28例,正常对照52例,分别测定HbAlc和FBG,并记录临床并发症。结果糖尿病组的HbAlc异常率明显高于对照组和血糖异常组,差异有统计学意义（χ2=46.194,P〈0.01）;糖尿病组的HbA1c和FBG均高于血糖异常组和对照组,差异有统计学意义（F=85.183和27.932,P〈0.01）;糖尿病合并并发症组的HbA1c水平显著高于单纯组,两者间差异有统计学意义（t=5.115,P〈0.01）,而两者间FBG值的差异无统计学意义（t=0.835,P〉0.05）。结论 HbAlc较FBG更能真实反映糖尿病患者的血糖水平,可以全面了解病情严重程度,指导临床治疗和初步判断并发症的发生和发展趋势。     

The impact of restricted diet on brain function using BOLD-fMRI

We investigated the effect of a restricted diet model on activity in the human motor cortex using functional magnetic resonance imaging (fMRI). Two series of blood oxygenation level-dependent (BOLD)-fMRI measurements were made in healthy subjects performing simple motor tasks using their right hands. The first series was done 5–10 days prior to the restricted diet schedule (controls), and the second series was performed after 25–28 days of restricted diet, in the form of a religious fast (Ramadan). The size and intensity of the activated area in the motor cortex increased during the time of restricted diet versus the controls. We conclude that restricted diet has a significant effect on cerebral activity, as shown by BOLD-fMRI, although the exact relationship between the images and neuronal activity due to the restricted diet is still to be determined.     

儿童异位性皮炎食物不耐受IgG抗体检测结果及禁食后疗效分析

目的探讨患儿童异位性皮炎与血清14种食物特异性IgG抗体的相关性及针对性对不耐受食物进行禁食后的疗效。方法ELISA法检测患者血清中的14种食物特异性IgG抗体,并进行等级判定食物不耐受的程度。并将阳性者随机分为两组,观察其未禁食组与禁食干预组第2、4周、3、6个月的疗效积分比较。结果43例中40例为阳性,食物不耐受总阳性率为93%,两种以上不耐受率为70%。其中前4位分别是蛋清/蛋黄(72.09%)、牛奶((58.14%)、鳕鱼(16.23%)、大豆(11.63%)。禁食组在第4周、3、6个月疗效积分比较有统计学意义(P<0.05),疗效优于未禁食组。结论食物不耐受与儿童异位性皮炎有密切的相关性,根据测定结果针对性的干预,可以改善患者的症状,提高患儿的生活质量。测定血清中特异性抗体对诊治是有意义的。     

Murine Glut-1 transporter haploinsufficiency: Postnatal deceleration of brain weight and reactive astrocytosis

Glucose transporter type 1 (Glut-1) facilitates glucose flux across the blood–brain-barrier. In humans, Glut-1 deficiency causes acquired microcephaly, seizures and ataxia, which are recapitulated in our Glut-1 haploinsufficient mouse model. Postnatal brain weight deceleration and development of reactive astrogliosis were significant by P21 in Glut-1^+/− mice. The brain weight differences remained constant after P21 whereas the reactive astrocytosis continued to increase and peaked at P90. Brain immunoblots showed increased phospho-mTOR and decreased phospho-GSK3-β by P14. After fasting, the mature Glut-1^+/− females showed a trend towards elevated phospho-GSK3-β, a possible neuroprotective response. Lithium chloride treatment of human skin fibroblasts from control and Glut-1 DS patients produced a 45% increase in glucose uptake. Brain imaging of mature Glut-1^+/− mice revealed a significantly decreased hippocampal volume. These subtle immunochemical changes reflect chronic nutrient deficiency during brain development and represent the experimental correlates to the human neurological phenotype associated with Glut-1 DS.     

成都地区中老年居民脉压及脉压指数分析

[目的]调查分析成都地区中老年居民脉压(PP)、脉压指数(PPI)的影响因素,寻找可能改善脉压异常的方法。[方法]利用2007代谢综合征研究调查资料(共1061人),把人群依据PP(PP≤60mmHg及PP﹥60mmHg)及PPI(PPI≤0.450及PPI﹥0.450)分为正常组及增高组,分析两组人群多代谢异常及心血管疾病危险因素分布特征,并采用Logistic回归分析寻找与PP/PPI相关的危险因素。[结果]①两个分组间年龄、收缩压、男性比重、高血压家族史、体重指数、腰围、臀围、空腹血糖、肾功能等指标PP、PPI增高组明显高于PP、PPI正常组,舒张压则是PP、PPI增高组明显低于PP、PPI正常组。②血脂各成分PP组间无统计学差异,总胆固醇、低密度脂蛋白水平PPI增高组高于正常组。③PP及PPI增高组其代谢综合征、高血压、糖尿病、肥胖、腹型肥胖、血脂异常等患病率皆高于PPI正常组,差异有统计学意义。④Logistic回归分析提示PP、PPI与女性性别、年龄、收缩压、BMI、腰围、臀围、空腹血糖、肌酐、尿酸、总胆固醇、低密度脂蛋白水平呈正相关,与男性性别及舒张压呈负相关。[结论]成都地区脉压及脉压指数与代谢性指标关系密切,可能可以通过改善血脂、空腹血糖、腰围、体重指数、肾功能等指标来减少脉压及脉压指数的异常。