利拉鲁肽治疗超重和肥胖2型糖尿病的临床疗效观察

目的观察利拉鲁肽治疗超重和肥胖2型糖尿病患者的临床疗效和安全性.方法对68例接受口服降糖药后不能有效控制血糖的2型糖尿病(T2DM)患者利拉鲁肽治疗前后临床和实验资料进行对比和统计分析.结果利拉鲁肽治疗后与治疗前比较空腹血糖(FPG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、体重差异有统计学意义(P<0.05).结论利拉鲁肽能降低T2DM 患者的FPG、2hPBG、HbA1c和体质量;并且改善胰岛β细胞功能,但胃肠道反应较常见.     

利拉鲁肽对超重、肥胖2型糖尿病患者内脏脂肪的影响

［摘要］ 目的观察利拉鲁肽对胰岛素联合二甲双胍治疗血糖控制不佳的超重、肥胖2型糖尿病（type 2 dabetes mellitus,T2DM）患者胰岛素抵抗及内脏脂肪的影响。 方法筛选超重、肥胖T2DM患者80例,糖化血红蛋白（glycated hemoglobin,HbA1c）符合(7%≤HbA1c≤11％),随机分成2组,胰岛素联合二甲双胍组（对照组）、胰岛素联合二甲双胍的基础上加用利拉鲁肽（利拉鲁肽组）,治疗24周,观察治疗前后体重（body weight,WT）、腰围（waist circumference,WC）、体重指数（body mass index,BMI）、空腹血糖（fasting plasma glucose,FPG）、总胆固醇（total lesterol,TC）、三酰甘油（triglyceride,TG）、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）、HbA1c、空腹胰岛素（fasting insulin,FINS）、胰岛素抵抗指数（insulin resistance index,HOMA-IR）及内脏脂肪面积（visceral fat area,VFA）的变化。 结果治疗后,对照组FPG、TC、TG、LDL-C、HbA1c、FINS、HOMA-IR较治疗前均降低,HDL-C升高,差异有统计学意义（P＜0.05）;利拉鲁肽组WT、WC、BMI、 FPG、HbA1c、TC、TG、LDL-C、FINS、HOMA-IR、VFA较治疗前均降低,HDL-C升高,差异有统计学意义（P＜0.05）。治疗后,利拉鲁肽组WT、WC、BMI、VFA较对照组均降低（P＜0.05）。利拉鲁肽组与每日应用胰岛素剂量比对照组减少（P＜0.05）。VFA降低与WT、WC、BMI降低呈正相关（P＜0.05）。 结论利拉鲁肽应用于超重、肥胖2型糖尿病患者不仅可以降低血糖还可以减轻体重,改善胰岛素抵抗,减少内脏脂肪,具有临床获益。     

利拉鲁肽对二甲双胍联合胰岛素治疗后血糖控制不佳T2DM合并肥胖患者糖脂代谢和BMI的影响

目的探讨利拉鲁肽对二甲双胍联合胰岛素治疗后血糖控制不佳2型糖尿病(T2DM)合并肥胖患者糖脂代谢和体质量指数(BMI)的影响。方法选取2019年12月至2021年1月在河南科技大学第一附属医院收治的156例血糖控制不佳T2DM合并肥胖患者,采用简单随机分组将患者分为观察组和对照组,每组各78例。对照组患者采用二甲双胍联合门冬胰岛素治疗,观察组在对照组治疗基础上加用利拉鲁肽进行治疗,均持续治疗12周。分别于治疗前后,检测血糖、血脂和BMI。记录两组治疗期间的不良反应发生情况。结果治疗后,两组患者空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、BMI、胰岛素抵抗指数(HOMA-IR)均低于治疗前,且观察组治疗后FPG、2hPG、HbA1c、TC、TG、BMI、HOMA-IR均低于对照组(P<0.05);观察组低血糖发生率为1.28%,低于对照组10.26%(P<0.05)。结论利拉鲁肽可以改善二甲双胍联合胰岛素治疗后血糖控制不佳T2DM合并肥胖患者的糖脂代谢,降低BMI和低血糖发生率。     

利拉鲁肽治疗106例老年2型糖尿病的疗效观察

目的:观察利拉鲁肽治疗老年2型糖尿病的临床疗效。方法:选取106例2型糖尿病老年患者,给予利拉鲁肽0.6 mg皮下注射,1次/d,1周后增加至1.2 mg,治疗前和治疗16周后,检测患者空腹血糖(FPG)、2 h餐后血糖(2hPG)、糖化血红蛋白(HbA1c)、体重指数(BMI)和胰岛素功能,治疗期间观察患者低血糖反应情况及肝功能、肾功能、淀粉酶、血常规、血脂水平。结果:16周治疗后患者FPG、2hPG、HbA1c、BMI和胰岛素抵抗指数均明显下降,胰岛β细胞功能指数明显升高(P均<0.05),低血糖等不良反应轻微。结论:利拉鲁肽治疗2型糖尿病能显著改善患者血糖谱,改善胰岛细胞功能,有良好的效果和安全性,是老年2型糖尿病患者有效而安全的治疗方案。     

利拉鲁肽对2型糖尿病合并代谢综合征患者的疗效研究

目的:观察利拉鲁肽对2型糖尿病合并代谢综合征患者的临床疗效。方法:选取2型糖尿病合并代谢综合征患者128例为研究对象,给予患者利拉鲁肽治疗,并随访30周。治疗前后,观察患者的体重、体重指数(BMI)、腰围、血压、空腹胰岛素(FINS)、空腹C肽(FCP)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1C)、总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白胆固醇(LDL-C)等化验指标,并计算胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)。结果:接受利拉鲁肽治疗后,患者的体重、BMI、腰围值较治疗前下降,差异有统计学意义(P<0.05);与治疗前相比,患者的FBG、2 hPG、HBA1C明显降低,有显著性差异(P<0.01),TG水平下降,差异有统计学意义(P<0.05);血压及TC、LDL-C变化无统计学意义(P>0.05);FINS、FCP、HOMA-β明显提升,HOMA-IR明显降低,差异有统计学意义(P<0.05)。结论:给予2型糖尿病合并代谢综合征患者利拉鲁肽治疗,可显著降低其血糖水平、减少体重、降低血脂,并且改善其胰岛β细胞分泌功能。     

艾塞那肽联合二甲双胍治疗口服降糖药控制不佳的2型糖尿病疗效观察

目的 观察艾塞那肽联合二甲双胍治疗对口服降糖药(OAD)控制不佳的2型糖尿病(T2DM)患者的临床疗效.方法 31例既往使用OAD控制不佳的T2DM患者,改用艾塞那肽联合二甲双胍治疗3个月,观察治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、体重、体质指数(BMI)、C-肽(空腹及餐后2h)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的变化.结果 治疗后FPG、2hPG、HbA1c、体重、BMI、TC、TG、LDL-C均有明显下降(P均＜0.01).C-肽(空腹及餐后2h)未发现明显变化(P＞0.05).低血糖发生率为3.23％.结论 艾塞那肽联合二甲双胍能有效地控制T2DM患者的血糖,减轻体重,且发生低血糖的风险低.     

利拉鲁肽对超重和肥胖2型糖尿病患者血糖和体重控制的疗效分析

目的：观察利拉鲁肽对超重和肥胖2型糖尿病患者血糖和体重控制的疗效。方法：选取本院住院治疗的体重指数≥26 kg/m^2的2型糖尿病患者20例,既往使用多种口服降糖药血糖控制不佳者,应用利拉鲁肽注射液治疗16周,比较治疗前后患者的空腹血糖、餐后2 h血糖、体重指数、HbA1c的控制情况。结果：与治疗前比较,患者应用利拉鲁肽治疗后的空腹血糖、餐后2 h血糖、糖化血红蛋白、体重均明显降低（P〈0.05）。结论：利拉鲁肽能够有效控制超重和肥胖2型糖尿病患者的血糖升高和体重增加。     

利拉鲁肽治疗初发2型糖尿病的疗效及其对患者血糖及胰岛功能的影响

目的：观察利拉鲁肽治疗初发2型糖尿病的临床效果,并探讨其对患者血糖及胰岛功能的影响。方法选取2013年11月至2015年10月期间在我院内分泌科住院治疗的患者60例,按照随机、对照研究设计方案分为观察组(利拉鲁肽组)及对照组(预混胰岛素组),每组30例。利拉鲁肽组每日1次皮下注射,起始剂量0.6 mg/d,1周后根据血糖情况调整剂量至1.2 mg/d,根据患者耐受情况,最大1.8 mg/d。预混胰岛素组给予精蛋白生物合成人胰岛素(30R)。比较两组患者入组后及治疗12周后的空腹血糖（FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、体质量指数(BMI)、空腹C肽(FC-P)、餐后2 h C肽水平(2 h C-P)、胆固醇(TC)、甘油三酯(TG)及胰岛细胞功能指数(HOMA-β)。给予动态血糖监测,计算血糖波动系数、低血糖时间比例、血糖漂移幅度(MAGE),并进行比较分析。结果治疗前两组患者FPG、2 hPG、HbA1c、BMI、FC-P、2 h C-P、TC、TG、HOMA-β、MAGE、血糖波动系数及低血糖时间比例等各项指标比较差异均无统计学意义(P>0.05),治疗后两组患者的FPG、2 hPG、HbA1c指标均较治疗前降低(P<0.05),但组间治疗后比较差异均无统计学意义(P<0.05);观察组治疗后BMI、血糖波动系数、MAGE、低血糖时间比例、TC、TG均较治疗前减少(P<0.05),FC-P、2 h C-P、HOMA-β均较治疗前升高(P<0.05),且与对照组比较差异均有统计学意义(P<0.05);对照组患者的血糖波动系数、MAGE、低血糖时间比例、FC-P、2 h C-P、HOMA-β、TC、TG治疗前后比较差异均无统计学意义（P>0.05);相关性分析显示,利拉鲁肽组患者的MAGE与2 h C-P呈负相关(r=-0.587,P<0.05),预混胰岛素组患者的MAGE与2 h C-P无相关性(r=-0.099,P>0.05)。结论利拉鲁肽更有效、安全降糖,减轻体重,降低血脂,改善胰岛功能。     

利拉鲁肽对新诊断2型糖尿病合并肥胖/超重男性病人的血睾酮水平的影响

目的:探讨皮下注射利拉鲁肽注射液治疗新诊断2型糖尿病(T2DM)合并肥胖/超重男性病人对血浆睾酮水平的影响.方法:入组新诊断肥胖/超重T2DM男性病人40例,随机分为在原治疗方案的基础上加用利拉鲁肽20例(观察组)和不加用利拉鲁肽20例(对照组),治疗6个月,观察利拉鲁肽注射液的临床疗效和对血浆睾酮的水平变化的影响.结果:治疗前2组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)差异均无统计学意义(P>0.05).治疗后,对照组FPG和HbA1c较治疗前明显改善(P<0.01),观察组各项指标均较治疗前明显改善(P<0.01);且与对照组比较,观察组FPG和HbA1c均降低(P<0.05和P<0.01),HOMA-β明显升高(P<0.01).治疗后观察组睾酮水平明显高于治疗前(P<0.01),而对照组治疗前后睾酮水平差异无统计学意义(P>0.05);治疗前后,2组睾丸酮水平间差异均无统计学意义(P>0.05).结论:利拉鲁肽能有效降低新诊断T2DM合并肥胖/超重病人血糖,改善胰岛β细胞功能,可提高血浆睾酮水平.     

门冬胰岛素30联合二甲双胍及利拉鲁肽治疗肥胖2型糖尿病

目的 观察门冬胰岛素30联合二甲双胍及利拉鲁肽治疗血糖控制不佳肥胖2型糖尿病（T2DM）疗效及对患者胰岛素功能和性激素的影响。方法 选取2018年1月~12月本院收治的70例血糖控制不佳的肥胖T2DM患者,按随机数表法分为观察组和对照组各35例。对照组接受门冬胰岛素30及二甲双胍治疗,观察组在对照组基础加用利拉鲁肽治疗,持续治疗12周。分别于治疗前后测定两组患者空腹血糖（FPG）、餐后两小时血糖（2hPG）、糖化血红蛋白（HbA1c）、身高、体重、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）;测定男性患者睾酮（T）、雌二醇（E2）、性激素结合球蛋白(SHBG)含量;女性患者于经期结束后一周测定雌二醇（E2）、促卵泡刺激素（FSH）、促黄体生成素（LH）水平;统计两组患者低血糖事件发生情况。结果 治疗后,观察组患者FPG、2hPG、HbA1c显著低于对照组和治疗前（P＜0.05）;观察组患者体重与BMI显著低于对照组和治疗前（P＜0.05）;观察组患者TC、TG、LDL显著低于对照组和治疗前（P＜0.05）,治疗后两组HDL水平有所下降但无显著差异（P＞0.05）;观察组男性患者T、SHBG水平显著高于对照组和治疗前（P＜0.05）,观察组女性患者E2显著高于对照组和治疗前（P＜0.05）。结论门冬胰岛素30联合二甲双胍及利拉鲁肽治疗血糖控制不佳肥胖2型糖尿病能有效降低患者血糖水平,纠正脂质代谢紊乱,上调性激素水平,具有一定的临床应用价值。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.