耳穴贴压联合中医饮食调护对糖尿病肾病患者的影响

目的:观察耳穴贴压联合中医饮食调护对糖尿病肾病患者的影响。方法:将糖尿病肾病患者60例按随机数字表法分成2组,对照组30例患者采用耳穴贴压治疗,观察组30例患者采用耳穴贴压联合中医饮食调护治疗。对比2组患者治疗前后肾功能指标、血清糖化血红蛋白、尿微量白蛋白、24h尿蛋白定量变化和肾小管损伤情况。结果:2组治疗后,血尿素氮(BUN)、内生肌酐清除率(CCr)、24 h尿白蛋白排泄率(UAE)和血肌酐(SCr)水平均明显优于治疗前,差异有统计学意义(P<0.05);治疗后,观察组肾功能指标BUN、CCr、UAE低于对照组,SCr则有所提高,差异有统计学意义(P<0.05)。2组患者治疗后,尿蛋白定量、尿微量白蛋白和血清糖化血红蛋白水平均明显优于治疗前,差异有统计学意义(P<0.05);观察组治疗后尿蛋白、尿微量白蛋白、血清糖化血红蛋白指标低于对照组,差异有统计学意义(P<0.05)。2组患者治疗后,β2-微球蛋白(β2-MG)和N-乙酰-β-D-氨基葡萄糖苷酶(NAG)水平均明显优于治疗前,差异有统计学意义(P<0.05);观察组治疗后肾小管损伤指标β2-MG、NAG低于对照组,差异有统计学意义(P<0.05)。结论:耳穴贴压联合中医饮食调护在糖尿病肾病患者中疗效明确,可改善肾功能指标,减轻肾小管损伤,改善临床症状。     

梅花针叩刺治疗脾肾两虚夹瘀型糖尿病周围神经病变的临床观察

目的：探讨梅花针叩刺治疗脾肾两虚夹瘀型糖尿病周围神经病变(DPN)的临床效果。方法：选取2015年2月至2018年1月广州市番禺区中医院收治的脾肾两虚夹瘀型DPN患者110例作为研究对象，随机分为对照组(n＝50)与观察组(n＝60)。对照组给予硫辛酸+甲钴胺治疗，观察组在对照组治疗的基础上给予梅花针叩刺治疗，2组均治疗观察28 d，记录并观察2组的疗效和预后。结果：观察组的总有效率为98.3%，显著高于对照组的88.0%(P<0.05)。治疗后2组的神经电图潜伏期低于治疗前，且波幅高于治疗前，2组比较差异有统计学意义(P<0.05)。2组治疗后正中神经和腓总神经的MNCV、SNCV高于治疗前，且观察组高于对照组，差异均有统计学意义(P<0.05)。治疗后6个月随访，观察组的复发率为1.7%，显著低于对照组的14.0%，差异有统计学意义(P<0.05)。结论：梅花针叩刺治疗脾肾两虚夹瘀型DPN能改善神经功能指标，提高治疗效果，降低远期复发率。     

慢病管理模式结合中药分期辨证治疗糖尿病肾病的获益与思考

糖尿病肾病已成为导致慢性肾衰竭和新进入透析的重要原因,也是糖尿病致死的重要原因。而且目前尚缺少疗效满意的治疗药物。本文提出为减少糖尿病肾病的危害,对本病的防治策略应重心前移,防控长期化。通过回顾文献,结合笔者的临床研究,对本病的流行病学特点进行分析,提出了防治糖尿病肾病进展的几个途径,应提倡实施个体化的长期的慢病管理模式,早诊断,早治疗,运用中医药辨证论治,多管齐下控制蛋白尿进展。以期达到延缓糖尿病肾病进展,提高患者生存质量的目的。     

滋阴活血汤治疗早期糖尿病肾病临床研究

目的:观察滋阴活血汤治疗早期糖尿病肾病的临床疗效。方法:选取130例早期糖尿病肾病患者,随机分为对照组和观察组,各65例。对照组给予降糖等西医对症治疗,观察组在对照组基础上给予滋阴活血汤,两组疗程均为4周。观察两组治疗前后血液流变学变化,采用全自动生化分析仪进行检测;核因子(nuclear factor,NF)-κB变化,采用双抗体夹心酶联免疫吸附试验测定;24小时尿蛋白变化,采用放射免疫法测定;两组治疗前后症状总积分变化。结果:治疗后,观察组治疗后全血黏度、红细胞压积比、纤维蛋白原水平均明显低于对照组(P0.05);观察组治疗后NF-κB及24小时尿蛋白水平均低于对照组(P0.05);观察组治疗后症状总积分明显低于对照组(P0.01);对照组有效率为81.5%,观察组为93.8%,组间比较,差异有统计学意义(χ~2=4.561,P0.05)。两组治疗中未见严重不良反应。结论:滋阴活血汤治疗早期糖尿病肾病疗效确切,安全;能有效改善患者血液流变学,降低NF-κB及24小时尿蛋白水平。     

Non-invasive metabolic biomarkers for early diagnosis of diabetic nephropathy: Meta-analysis of profiling metabolomics studies

AimDiabetic nephropathy (DN) is one of the worst complications of diabetes. Despite a growing number of DN metabolite profiling studies, most studies are suffering from inconsistency in their findings. The main goal of this meta-analysis was to reach to a consensus panel of significantly dysregulated metabolites as potential biomarkers in DN.Data synthesisTo identify the significant dysregulated metabolites, meta-analysis was performed by “vote-counting rank” and “robust rank aggregation” strategies. Bioinformatics analyses were performed to identify the most affected genes and pathways. Among 44 selected studies consisting of 98 metabolite profiles, 17 metabolites (9 up-regulated and 8 down-regulated metabolites), were identified as significant ones by both the meta-analysis strategies (p-value<0.05 and OR>2 or <0.5) and selected as DN metabolite meta-signature. Furthermore, enrichment analyses confirmed the involvement of various effective biological pathways in DN pathogenesis, such as urea cycle, TCA cycle, glycolysis, and amino acid metabolisms. Finally, by performing a meta-analysis over existing time-course studies in DN, the results indicated that lactic acid, hippuric acid, allantoin (in urine), and glutamine (in blood), are the topmost non-invasive early diagnostic biomarkers.ConclusionThe identified metabolites are potentially involved in diabetic nephropathy pathogenesis and could be considered as biomarkers or drug targets in the disease.Prospero registration numberCRD42020197697.     

Diabetes foot screening: Challenges and future strategies

BackgroundHealthcare options for people with diabetes is still not uniform both within and between countries. This is particularly evident for diabetic foot disease. The number of existing documents/guidelines, together with discrepancies which exist between different organizations or countries can lead to confusion for both practicing health care professionals and new countries or organizations who are in the process of developing local clinical guidelines. This study was aimed at exploring different stakeholder perspectives with a view to develop and introduce culturally competent foot screening guidelines.MethodsA phenomenological study which incorporated non-structured interviews with eleven local stakeholders and experts related to the field were conducted to explore interviewees’ perspectives regarding foot screening guidelines in Malta.FindingsQualitative analysis identified 3 key themes from the data highlighting barriers to the implementation of diabetes foot screening guidelines. These focused on organizational factors, healthcare professional factors and patient factors.ConclusionCurrent procedures related to diabetes foot screening has shortcomings. The findings of this study clearly highlight the need for change in current practices if effective diabetic foot screening is to be offered. Recommendations from this study are relevant to other countries especially those who share same cultures and practices. Making changes today and implementing them in the appropriate manner could make a world of difference in diabetes foot care.     

综述三维斑点追踪技术在糖尿病心肌病心功能评价中的应用

糖尿病心肌病(Diabetic Cardiomyopathy,DC)的进展会导致左心室功能减低,因此,早期正确评估左心室功能对糖尿病心肌病患者的治疗和预后有着重要的意义。由于左心室解剖结构的复杂性,常规超声技术通常很难准确的评估左心室功能的变化,三维斑点追踪技术(three-dimensional speckle tracking imaging,3D-STI)是在实时3D超声和斑点追踪技术(STI)基础上发展起来的一项新技术,其对心脏功能的评估不受整个心脏运动方向和运动幅度的限制,能够直观的对心肌各个方向的运动进行追踪。本文首先论述3D-STI 在左心室功能评价中的可行性,再对其在DC左心室功能评价中的研究展开综述。     

Effect of Yinqi Ointment on Wound Morphology and Growth Factor in Treating Diabetic Foot Ulcer

Objective: To investigate the effect of Yinqi ointment on wound morphology and growth factor in treating diabetic foot ulcer(DFU).Methods: From December 2016 to December 2017, 92 cases of DFU with deficiency of both Qi and Yin syndrome were randomly divided into treatment group and control group(44 cases in each group). The treatment group was treated with Yinqi ointment, while the control group was treated with mupirocin ointment. After 4 weeks of treatment, the ulcer healing effect, ulcer area, granulation tissue, epithelial tissue coverage,pain score, and dynamic analysis of vascular endothelial growth factor(VEGF), epidermis growth factor(EGF), and basic fibroblast growth factor(bFGF) in local granulation tissue were statistically analyzed before and after treatment in both groups. Results: The total effective rate was 88.37% in the treatment group and 74.42% in the control group. The wound reduction rate, epithelial tissue coverage rate, granulation tissue growth rate, and local pain relief rate in the treatment group were significantly superior to those in the control group(P 0.05). Through the local granulation detection, the treatment group and the control group have increased VEGF, EGF, and bFGF, but the treatment group increased the role of growth factor than the control group. Conclusion: Yinqi ointment can promote the healing of DFU, and its mechanism may be related to the increase of the content of growth factor in granulation tissue.