462例甲状腺结节临床分析

目的 探讨甲状腺结节的临床特点及实验室、超声检查特征在良、恶性鉴别诊断中的价值.方法 回顾性分析462例手术治疗甲状腺结节患者的临床资料.结果 女性患者结节恶性率高于男性(P＜0.05);年龄＞20～40岁者结节恶性概率较高;超声检查中良、恶性甲状腺结节在形态、边界、回声性质、内部钙化、结节内血流、周边缺乏声晕、颈部淋巴结肿大方面差异有统计学意义(P＜0.05).结论 患者一般状况、临床症状、超声检查有助于鉴别甲状腺结节的性质.     

运动对高脂喂养大鼠胰岛素抵抗的治疗作用

目的 观察运动对高脂饮食喂养大鼠胰岛素抵抗(IR)的影响,并初步探讨其机制.方法 将30只雄性Wistar大鼠分为对照组及高脂组,分别给予基础饲料和高脂饲料喂养;高脂组大鼠经喂养18周后制成IR模型,并进一步细分为静息组和运动组,继续给予高脂饲料喂养,运动组同时进行游泳训练,共持续6周.于实验进行24周后处死各组大鼠,检测各组大鼠血液中游离脂肪酸(FFA)水平及骨骼肌中甘油三酯(TG)含量,同时应用蛋白免疫印迹法检测各组大鼠骨骼肌中一磷酸腺苷活化蛋白激酶α(AMPKα)的磷酸化水平.结果 实验进行24周后,与对照组比较,发现静息组大鼠胰岛素敏感性显著降低,FFA水平及骨骼肌中TG含量明显增高,骨骼肌中AMPKα磷酸化水平降至对照组水平的48.7%;与静息组比较,运动组大鼠胰岛素敏感性及骨骼肌中AMPKα磷酸化水平均明显提高,FFA水平及骨骼肌中TG含量则显著降低;但与对照组比较,运动组大鼠FFA水平及骨骼肌中TG含量依然偏高,胰岛素敏感性及骨骼肌中AMPKα磷酸化水平仍然偏低.结论 运动干预可改善由高脂饮食诱导的IR,其治疗机制可能与降低血液中FFA水平及减轻骨骼肌中脂质异位沉积有关.

Abstract：

Objective To observe the effect of exercise on insulin resistance induced by a high fat diet and to explore the underlying mechanism.Methods Thirty healthy male Wistar rats were randomly divided into a normal control group (NC group) and a high-fat group (HF group),fed with normal chow and a high fat diet respectively.Eighteen weeks later,insulin resistance had appeared in the HF group.The HF group was then randomly subdivided into a high-fat diet control group (HC group,fed a high fat diet) and an exercise group (HE group,fed a high fat diet and subjected to swimming training for 6 weeks).After 24 weeks,an insulin sensitivity index was calculated.Serum free fatty acid (FFA) and skeletal muscle triglyceride (TG) were detected.Phosphorylation of adenosine monophosphate kinase-α (AMPKα) in skeletal muscle was detected by Western blotting.Results At twenty-four weeks the insulin sensitivity of the HC group had decreased significantly compared to the NC group.Serum FFA level and skeletal muscle TG content had both increased.Average phosphorylation of AMPKα in the HC group decreased to 48.7% of the NC group average.Compared to the HC group,insulin sensitivity and phosporylation of AMPK-α were elevated significantly in the HE group.Serum FFA level and skeletal muscle TG content were both lower.However,compared to the NC group,both serum FFA level and skeletal muscle TG content had increased in the HE group,while insulin sensitivity and phosphorylation of AMPKα had significantly decreased.Conclusions Exercise can significantly improve insulin resistance induced by a high-fat diet through decreasing serum FFA level and ectopic li-pid accumulation in skeletal muscle.     

白藜芦醇改善高脂喂养大鼠胰岛素抵抗的机制

目的:观察白藜芦醇(Res)对高脂喂养大鼠胰岛素抵抗的影响并初步探讨其机制。方法:将30只♂Wistar大鼠随机分为对照组(NC组)及高脂组(HF组),分别给予基础饲料和高脂饲料喂养;喂养6周后,对HF组大鼠进行胰岛素敏感性造模,再将造模成功的大鼠随机分为模型组(IR组)和Res干预组(RT组),继续给予高脂饲料喂养,RT组同时给予100 mg.kg-1.d-1Res灌胃,共持续10周。第16周末,处死各组大鼠,测量各组大鼠的体质量及肾周和附睾脂肪,脂肪组织石蜡切片HE染色观察脂肪细胞大小,并应用ELISA检测血清脂联素(APN)的水平。结果:第16周后I,R组大鼠与NC组相比,表现出内脏型肥胖,肾周脂肪细胞的面积明显增加,胰岛素敏感性及血清APN水平均显著下降;Res的干预可减轻RT组大鼠内脏型肥胖,降低肾周脂肪细胞的面积,改善胰岛素抵抗,并且明显上调血清APN水平;与NC组比较,RT组大鼠脂肪细胞面积仍然显著大于NC组;胰岛素敏感性及血清APN水平仍然显著低于NC组。结论:Res的干预可以改善高脂喂养大鼠的胰岛素抵抗;其机制可能与其在改善高脂喂养大鼠的内脏型肥胖的同时升高血清APN水平有关。     

镇脑宁胶囊联合氯沙坦钾治疗原发性高血压的临床研究

目的探讨镇脑宁胶囊联合氯沙坦钾片治疗原发性高血压的临床效果。方法选取2017年8月—2020年8月于平顶山市新华区人民医院诊疗的106例原发性高血压患者,根据入院顺序分成对照组和治疗组,每组分别53例。对照组口服氯沙坦钾片,50 mg/次,1次/d;治疗组患者在对照组基础上口服镇脑宁胶囊,1.2 g/次,3次/d。两组患者均连续治疗8周。观察两组患者临床疗效,比较治疗前后两组患者24 h平均收缩压和平均舒张压,及血清N-端脑利钠肽前体(NT-proBNP)、血管性血友病因子(vWF)水平和尿微量白蛋白水平。结果治疗后,治疗组总有效率为96.23%,明显高于对照组的84.91%(P0.05);治疗后,两组患者24 h平均收缩压和24 h平均舒张压均显著下降(P0.05),且治疗组明显低于对照组(P0.05);治疗后,两组患者血清NT-proBNP、v WF水平和尿微量白蛋白水平均显著下降(P0.05),且治疗组明显低于对照组(P0.05)。结论镇脑宁胶囊联合氯沙坦钾片治疗原发性高血压疗效显著,能够有效控制患者动态血压水平,降低血清学指标水平,安全性高,具有一定临床推广应用价值。     

合并桥本甲状腺炎的甲状腺乳头状癌临床病理特征分析

目的:探讨合并桥本甲状腺炎(hashimoto's thyroiditis,HT)是否影响甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特征。方法:回顾性分析514例于2015年06月至2016年12月在本院行甲状腺结节切除术、术后病理证实为PTC患者的临床资料,对比分析合并或不合并HT的PTC患者的年龄、性别、肿瘤直径、血清促甲状腺素（TSH）、有无包膜侵犯、中央淋巴结转移等临床病理特征差异。结果:514例PTC病例中合并HT者74例（14.40%）,不合并HT者440例（85.60%）,与不合并HT组相比,合并HT组女性比例更高（91.89% vs 74.09%,P<0.05）,年龄较小［（41.37±11.89）岁 vs （4４．３５±11.７９）岁,P<0.05］,肿瘤直径更小［（1.20±0.91)cm vs (1.53±1.18)cm,P<0.05］,发生包膜侵犯（18.92% vs 31.14%,P<0.05）、中央淋巴结转移（17.57% vs 30.45%,P<0.05）的比例较低,但肿瘤的多灶和多中心性方面未见显著性差异。结论:合并HT的PTC多集中于女性群体,病灶组织偏小,且PTC合并HT不会使疾病侵袭性加强。然而,合并HT患者TSH高,则可能会使PTC发生风险增加。     

何为脆性糖尿病

"脆性糖尿病"这个词会让人觉得新鲜,但在临床上,该病的患者并不少."脆性糖尿病"又称"不稳定性糖尿病",主要发生在1型糖尿病以及某些胰岛功能近乎衰竭的晚期2型糖尿病患者身上.这类患者对胰岛素异常敏感,使用微小剂量的胰岛素即可引起血糖剧烈波动.在规定了进食量、运动量和胰岛素用量下,患者的病情还是极不稳定,患者通常表现为低血糖、高血糖、酮症酸中毒、昏迷等状况的反复出现.     

桥本甲状腺炎甲状腺功能减退患者血清1,25-二羟维生素D_3及白细胞介素-8水平变化及意义

目的探讨桥本甲状腺炎(Hashimoto's thyroiditis,HT)甲状腺功能减退(甲减)患者应用左甲状腺素钠片治疗前及治疗5个月后血清1,25-二羟维生素D_3[l,25 2-hydroxyvitamin D_3,1,25(OH)_2D_3]、白细胞介素-8(interleukin-8,IL-8)水平变化及意义。方法 HT甲减患者58例为观察组,同期体检健康者58例为对照组。观察组给予左甲状腺素钠片150~200μg/d,连续口服5个月,对照组不作处理。对照组于入组时,观察组于治疗前及治疗5个月后采用光化学分析法检测血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free tetraiodothyron,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)水平,采用放射免疫分析法检测血清促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)水平,采用ELISA法检测血清IL-8、1,25(OH)_2D_3水平,并与对照组进行比较;Pearson法分析观察组血清IL-8、1,25(OH)_2D_3水平与FT_3、FT_4等指标的相关性。结果观察组治疗前血清FT_4[(9.55±5.27)pmol/L]、1,25(OH)_2D_3[(22.61±7.28)μg/L]均低于对照组[(19.70±6.20)pmol/L、(33.62±6.19)μg/L],血清TSH[(5.86±1.28)u/L]、TPOAb[(558.65±89.96)u/mL]、TgAb[(203.26±16.08)%]、IL-8[(114.62±16.78)ng/L]均高于对照组[(2.73±0.17)u/L、(45.12±0.85)u/mL、(38.23±12.39)%、(90.36±18.24)ng/L](P0.05),血清FT3[(5.26±1.57)pmol/L]、TRAb[(0.15±0.05)u/L]与对照组[(4.98±1.04)pmol/L、(0.12±0.07)u/L]比较差异均无统计学意义(P0.05);治疗5个月后,观察组血清FT_4[(17.14±3.22)pmol/L]、1,25(OH)_2D_3[(31.14±8.32)μg/L]均高于治疗前(P0.05),血清TSH[(3.18±1.04)u/L]、TPOAb[(61.24±13.29)u/mL]、TgAb[(42.98±11.84)%]、IL-8[(93.16±12.34)ng/L]均低于治疗前(P0.05),血清FT_3[(5.11±1.14)pmol/L]、TRAb[(0.13±0.08)u/L]与治疗前比较差异均无统计学意义(P0.05);Pearson相关性分析结果显示,观察组血清IL-8与TSH、TPOAb水平呈正相关(r=0.520,P=0.002;r=0.398,P=0.025),血清1,25(OH)_2D_3与TSH、TPOAb水平呈负相关(r=-0.408,P=0.021;r=-0.415,P=0.020)。结论HT甲减患者血清IL-8水平升高,1,25(OH)_2D_3水平降低,且与TSH和TPOAb水平相关。     

运动对高脂饮食诱导非酒精性脂肪肝的治疗作用

目的 观察运动对高脂饮食诱导非酒精性脂肪肝的治疗作用,并初步探讨其相关机制.方法 将30只Wistar大鼠分为对照组及高脂组,分别给予基础饲料和高脂饲料喂养;高脂组大鼠经喂养18周后制成胰岛素抵抗(IR)模型,并进一步细分为静息组和运动组,继续给予高脂饲料喂养,运动组同时进行游泳训练,共持续6周.于实验进行24周后处死各组大鼠,计算肝指数,观察肝脏病理学改变,检测各组大鼠肝脏甘油三酯(TG)含量,同时应用蛋白免疫印迹法检测肝脏组织一磷酸腺苷活化蛋白激酶(AMPK)磷酸化水平.结果 实验进行24周后,与对照组比较,静息组大鼠胰岛素敏感性显著降低,肝脏TG含量、肝指数明显增高,光镜下肝脏出现明显脂肪变性,肝脏内AMPK磷酸化水平降至对照组水平的50.8%;与静息组比较,运动组大鼠胰岛素敏感性明显提高,肝指数及肝脏TG含量均显著降低,光镜下可见肝脏脂肪变性程度明显改善,肝组织内AMPK磷酸化水平亦显著提高.结论 运动干预对高脂饮食诱导的非酒精性脂肪肝具有治疗作用,其机制可能与运动上调肝脏组织中AMPK磷酸化水平,从而改善IR及减少肝脏内TG含量有关.

Abstract：

Objective To observe the effect of exercise on nonalcoholic fatty liver disease (NAFLD) induced by high-fat diet and explore the mechanism.Methods Thirty healthy male rats were randomly divided into a normal control group( NC group) and a high-fat group( HF group), fed with normal chow and high-fat diet, respectively.Eighteen weeks later, the high-fat established as insulin resistance model and group was randomly divided into high-fat diet control group (HC group) and high-fat diet exercise group (HE group).HC group was continually given high-fat diet; HE group accepted swimming training for 6 weeks.After 24 weeks, the insulin sensitivity index (ISI) was calculated.After rats were sacrificed, weight of liver and body were measured to calculate liver mass index.Liver histology was detected by hematoxylin and eosin staining.Hepatic triglyceride content was detected.Phosphorylation of adenosine monophosphate-activated protein kinase (AMPK) level was detected by Western blot technique.Results At the 18th week, compared to NC group, ISI of HF group decreased obviously.It suggested that insulin resistance appeared in HF group.At the 24th week, compared to NC group, ISI of HC group decreased significantly.But hepatic triglycefide content and liver mass index both increased.Pathology observation under light microscope showed obvious liver steatosis in HC group.Phosphorylation of AMPK level in HC group decreased to 50.8% of NC group.Exercise greatly improved the liver mass index, hepatic triglyceride content and ISI as well as liver steatosis compared to HC group.Phosphorylation of AMPK was also elevated to 78.1% of NC group in HE group.However,compared to NC group, liver mass index and hepatic triglyceride content increased simultaneously, while ISI and phosphorylation of AMPK level obviously decreased in HE group.Conclusion Elevated level of phosphorylation of AMPK contributed to improve insulin resistance and decrease the hepatic triglyceride content.Exercise could markedly improve NAFLD induced by high-fat diet through elevating phosphorylation of AMPK in liver.     

孕26+6周，反复咳嗽伴双下肢及会阴水肿近2月

正1 病历摘要患者,34岁,因孕26~(+6)周,反复咳嗽伴双下肢及会阴水肿近2月,于2019年12月14日转入本院就诊。患者既往月经规则,15岁月经初潮,经期3～4天,周期30天。末次月经2019年6月9日,预产期2020年3月16日。G_3P_2,2009年、2010年各足月顺娩一活婴,分娩过程无异常。本次孕期不定期产前检查,行唐氏筛查、地中海贫血筛查、胎儿三维彩色超声、甲状腺功能等检查未见明显异常,未行葡萄糖耐量试验。     

运动对高脂饮食诱导非酒精性脂肪肝的治疗作用

目的 观察运动对高脂饮食诱导非酒精性脂肪肝的治疗作用,并初步探讨其相关机制.方法 将30只Wistar大鼠分为对照组及高脂组,分别给予基础饲料和高脂饲料喂养;高脂组大鼠经喂养18周后制成胰岛素抵抗(IR)模型,并进一步细分为静息组和运动组,继续给予高脂饲料喂养,运动组同时进行游泳训练,共持续6周.于实验进行24周后处死各组大鼠,计算肝指数,观察肝脏病理学改变,检测各组大鼠肝脏甘油三酯(TG)含量,同时应用蛋白免疫印迹法检测肝脏组织一磷酸腺苷活化蛋白激酶(AMPK)磷酸化水平.结果 实验进行24周后,与对照组比较,静息组大鼠胰岛素敏感性显著降低,肝脏TG含量、肝指数明显增高,光镜下肝脏出现明显脂肪变性,肝脏内AMPK磷酸化水平降至对照组水平的50.8%;与静息组比较,运动组大鼠胰岛素敏感性明显提高,肝指数及肝脏TG含量均显著降低,光镜下可见肝脏脂肪变性程度明显改善,肝组织内AMPK磷酸化水平亦显著提高.结论 运动干预对高脂饮食诱导的非酒精性脂肪肝具有治疗作用,其机制可能与运动上调肝脏组织中AMPK磷酸化水平,从而改善IR及减少肝脏内TG含量有关.