2型糖尿病合并非酒精性脂肪肝与血清尿酸的关系

目的:研究2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFL)的患者的临床特点及其与血清尿酸(SUA)的关系。方法:将113例住院T2DM患者根据有无合并非酒精性脂肪肝分为合并脂肪肝组和非脂肪肝组,记录患者身高、体重、腰围、臀围,进行空腹血糖(FBG)、血总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、血清尿酸(SUA)、空腹胰岛素(FINS)测定,计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)。对两组的一般临床资料进行统计学分析。结果:2型糖尿病合并脂肪肝组BMI、WHR、FINS、HOMA-IR、LDL-C、TG、SUA较非脂肪肝组升高(P<0.05),而FBG、TC、HDL-C两组差别无显著性(P>0.05)。脂肪肝患者中高尿酸血症患者比例较高,男性脂肪肝患者的尿酸高于女性脂肪肝患者。结论:2型糖尿病合并脂肪肝组血脂异常、胰岛素抵抗更明显,SUA的水平显著升高。     

外周血单核细胞表达PEDF在2型糖尿病视网膜病变中的意义

[目的]色素上皮衍生因子(PEDF)通过抗血管增生、抗炎、抗氧化应激等影响糖尿病视网膜病变(DR)发生发展,而单核/巨噬细胞(CD14+)与慢性炎症关系密切.本研究拟通过观察外周血CD14+细胞中PEDF的表达水平,为进一步探讨DR发病机制提供线索.[方法]选取2011年10月至2013年4月在我院内分泌科住院确诊为2型糖尿病患者(DM组)108例,分为无糖尿病视网膜病变组(NDR组)52例和糖尿病视网膜病变组(DR组)56例,同期健康体检者作为对照组(NC组)52例.收集患者外周血白细胞及其分类细胞计数相关指标;密度梯度离心法收集患者PBMC,免疫磁珠分离法提取CD14+细胞;剩余PBMC提取总蛋白,westem blot比较总PBMC (tPBMC)与分离掉CD14+细胞的PBMC[PBMC (exCD 14+)]中PEDF蛋白表达水平.[结果]DR组和NDR组单核细胞绝对值较NC组升高(P＜0.05),但DR组和NDR组间单核细胞绝对值的差异无统计学意义(P＞ 0.05);DR组淋巴细胞绝对值较NDR组明显减低(P＜0.05);与tPBMC相比,PBMC(exCD 14+)中PEDF蛋白表达水平明显下降(P＜0.05).[结论]DR患者外周血单核细胞数量增加.单核细胞是PBMC中表达PEDF的主要细胞.     

胰岛素非注射不可吗

作为第一个真正有效的抗糖尿病药物,胰岛素已经走过了八十多年的历程.在这历程中,虽然不断有新的口服降糖药问世,但没有一个可以撼动或挑战胰岛素的王者之位.     

糖尿病患者降压治疗预防心血管并发症(摘要)

糖尿病患者的降压问题一直是学术界关注和争论的话题。学术界在这一方面达成的共识只是降压治疗对伴有高血压的糖尿病患者有肯定的益处,但这种益处范围多大,仅仅是心血管方面,还是包括脑血管、肾脏病、眼等各个系统以及总病死率等终点事件,则存有争议;同时这种益处是否可以外推到对非高血压的糖尿病患者,也一直悬而未决。《Cochrane图书馆》的这篇文章对在糖尿病患者身上所进行的降压试验进行系统的评估,特予摘译,以供广大的临床医生参考。     

持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

两种带教方式在内科见习教学的比较和体会

医学见习是医学教育中一个重要的阶段,既往采用全职老师带教形式,2004年后改为专科医生兼职带教.前者优势在于师生关系比较融洽,能够较好地实现因材施教和教学相长;后者能够使学生更多地了解专科进展,增加学习兴趣.在研究期间两种带教形式学生考试成绩无明显差异.     

头孢哌酮钠/舒巴坦钠致凝血功能障碍1例报告

目的通过报告1例头孢哌酮钠/舒巴坦钠致乙肝肝硬化患者凝血功能障碍,以强调乙肝肝硬化患者应谨慎使用该药。方法对患者的病史、用药情况和住院期间的检查结果和治疗情况进行分析。结果患者出现凝血功能障碍和头孢哌酮钠/舒巴坦钠很可能相关。结论对肝硬化患者,使用头孢哌酮钠/舒巴坦钠时应警惕可能出现凝血功能障碍,应定期监测凝血功能以便及时发现,必要时适当补充维生素K以防止出现严重后果。     

持续皮下胰岛素输注和胰岛素每日多点注射治疗2型糖尿病的成本效果分析

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.     

冠状动脉病变与2型糖尿病患者UAER的关系

目的采用320排动态容积CT（DVCT）评价冠状动脉病变范围与2型糖尿病患者24h尿白蛋白排泄率（UAER）之间的关系。方法采用320-DVCT对64例住院2型糖尿病患者进行冠状动脉成像检查,同时检测患者的UAER,根据UAER水平,将患者分为正常对照组,微量蛋白尿组和大量蛋白尿组。观察各组冠状动脉病变范围并加以比较。结果蛋白尿组冠状动脉病变范围比对照组明显增加（P〈0.05）。随着蛋白尿组UAER水平的增加,患者的冠状动脉病变范围明显增加（P〈0.05）。结论 2型糖尿病患者的UAER水平与冠状动脉病变范围有关,UAER水平越高者,其冠状动脉病变越严重。