风湿病合并糖尿病患者顿服或分餐口服糖皮质激素的血糖变化特征

目的探讨风湿病合并糖尿病患者使用糖皮质激素前后的血糖变化特征。方法将42例风湿病合并糖尿病患者随机分为顿服组（21例）和分餐组（21例）。所有患者在口服糖皮质激素前后均每天监测8次血糖（测早、中、晚三餐前后＋睡前21：00＋次日凌晨3点）。然后分别给两组患者口服糖皮质激素7 d,顿服组在每日上午7：00口服,分餐组分三餐（7：00,11：00,18：00）口服。对患者在口服糖皮质激素前、顿服组、分餐组血糖变化的特征进行分析。结果风湿病合并糖尿病患者应用糖皮质激素前血糖以早餐后升高为主,顿服组血糖以下午和晚上升高为主,分餐组血糖以中餐后升高为主。结论分次使用糖皮质激素能使糖尿病患者血糖更容易控制且较平稳。     

糖尿病患者应用糖皮质激素后的动态血糖特征及降糖方案调整

目的 观察2型糖尿病患者实施不同类型糖皮质激素治疗后的血糖升高特点,探讨调整控制血糖时胰岛素的用法,为2型糖尿病患者出现的高血糖进行早期监测和干预措施提供依据.方法 选取2014年3月至2016年3月来我院内分泌科、血液病科、皮肤科、风湿免疫科就诊的糖尿病患者共60例,按随机分组原则将入选患者分为甲强龙治疗组(DM1组)、地塞米松治疗组(DM2组)和强的松治疗组(DM3组),每组各20例.所有入选患者均采用雷兰动态血糖监测系统(DGMS)进行连续血糖监测,第2天上午8:00开始给药,其中DM1组静滴甲强龙40 mg,DM2组静滴地塞米松10 mg,DM3组一次口服强的松30 mg.比较三组患者应用糖皮质激素治疗前后的血糖波动特点,即餐后3 h血糖水平、餐后血糖峰值及餐后曲线下面积(AUC)增值.结果 治疗前,三组患者的血糖水平比较差异无统计学意义(P>0.05);经治疗,三组患者餐后3 h的血糖水平均有不同程度的升高,且在治疗的第2 d升高程度更为显著,与治疗前比较差异均有统计学意义(P<0.05);经治疗,DM2组患者的血糖升高最为明显,其次为DM3组,最后为DM1组,且三组患者的血糖升高间比较差异有统计学意义(P<0.05);在应用糖皮质激素治疗后,三组患者中餐、晚餐的血糖峰值及餐后AUC增值均明显高于早餐,增高程度依次为DM2组>DM3组>DM1组,各组间比较差异均有统计学意义(P<0.05).结论 糖尿病患者在应用糖皮质激素治疗后其血糖变化有着自身的特点,大部分患者在中、晚餐后表现出高血糖,而甲强龙对血糖的影响最小,但仍需合理的给予降糖处理以控制血糖.     

SGLT-2抑制剂对2型糖尿病患者血糖波动的影响

目的 ：探讨SGLT-2抑制剂对于2型糖尿病患者血糖波动的影响。方法 ：选取2020年1月～2022年1月在湖南省某三级医院内分泌科治疗的116例2型糖尿病患者,随机分为观察组和对照组各58例,两组患者均予以二甲双胍和胰岛素降糖。在此基础上观察组使用SGLT-2抑制剂的代表药物达格列净,对照组使用西格列汀,各治疗12周。对两组患者接受治疗前后的血糖波动相关指标变化情况进行比较。结果 ：治疗后两组患者空腹血糖（FBG）、餐后2小时血糖（2h PG）、糖化血红蛋白（Hb A1c）、血糖变异系数（CV）、平均血糖、血糖水平标准差（SDBG）、餐后血糖的波动幅度（PPGE）、最大血糖波动幅度（LAGE）均低于治疗前,葡萄糖的目标范围内时间（TIR）高于治疗前;且治疗后观察组CV、平均血糖、SDBG、PPGE、LAGE、TIR与对照组比较,差异具有统计学意义;观察组患者△平均血糖、△SDBG、△PPGE、△LAGE、△CV、△TIR等指标明显大于对照组。结论 ：使用SGLT-2抑制剂可有效控制血糖波动。     

多途径诱导初发2型糖尿病患者血糖长期临床缓解的研究

目的了解胰岛素抵抗对血糖的影响和胰岛素抵抗在治疗前后,以及停药后的变化和长期临床缓解的可行性。方法通过测定治疗前后空腹血糖、空腹血浆胰岛素水平,肝、肾功能,甲状腺功能对治疗前后的结果进行分析。结果81例罗格列酮治疗组患者随访调查中,56例患者仅使用罗格列酮治疗,其胰岛素抵抗指数无明显增加（P〉0.05）;73例胰岛素治疗组患者随访调查中,41例（占56.2%）患者在使用胰岛素强化治疗12周后停药,其胰岛素抵抗指数无明显增加（P〉0.05）。结论在初发2型糖尿病患者中,尤其以餐后血糖升高为主、胰岛细胞功能较好的患者中,通过正规治疗,可以得到良好的血糖控制。     

拜糖平与二甲双胍治疗Ⅱ型糖尿病疗效及药物副作用分析

目的：探讨分析拜糖平与二甲双胍治疗Ⅱ型糖尿病的临床疗效及可能产生的药物副作用。方法：选择于2012年1月～2013年6月到我院进行治疗的120例Ⅱ型糖尿病患者最为研究对象,随机将其分为观察组及对照组,每组60例,观察组患者使用拜糖平进行治疗,对照组患者使用二甲双胍进行治疗,对治疗后2组患者的临床疗效及药物副作用进行对比分析。结果：经治疗后2组患者的空腹血糖及餐后2小时血糖均有明显下降,且差异有统计学意义（P＜0．05）,2组间下降水平相比较,餐后2小时血糖观察组更为明显,差异有统计学意义（P＜0．05）;但对照组空腹血糖下降更为明显,2组间差异有统计学意义（P＜0．05）;空腹胰岛素及餐后2小时胰岛素方面在治疗前后2组均没有出现明显的变化,差异无显著性意义（P＞0．05）,并发症轻微,患者可耐受。结论：拜糖平与二甲双胍对于Ⅱ型糖尿病的治疗均有显著疗效,且副作用轻微,值得在临床推广应用。     

福辛普利对高血压病患者胰岛素抵抗的影响

目的：探讨福辛普利对高血压病患者胰岛素抵抗的影响。方法：将200例高血压病患者随机分为福辛普利组100例,硝苯地平组100例,福辛普利组口服福辛普利（商品名蒙诺）5～10mg,每日1次,硝苯地平片10～20mg,每日3次．8周为一疗程。观察治疗前后空腹血糖、餐后2h血糖、空腹胰岛素、餐后2h胰岛素及胰岛素敏感性指数的变化。结果：两组患者治疗前后空腹血糖差异无统计学意义（P〉0．05）,福辛普利组治疗后餐后2h血糖、空腹胰岛素、餐后2h胰岛素和胰岛素敏感性指数与治疗前比较差异有统计学意义（P〈0．05）。硝苯地平组治疗前后各项指标差异无统计学意义（P〉0．05）。结论：福辛普利能显著降低高血压病患者餐后2h血糖、提高血胰岛素敏感性指标,从而改善胰岛素抵抗。     

恩格列净联合二甲双胍治疗2型糖尿病的效果及对血糖变异性、胰岛素抵抗的影响

目的：探讨恩格列净联合二甲双胍在2型糖尿病患者中的疗效及对血糖变异性、胰岛素抵抗的影响。方法：选取2018年1月—2022年1月佳木斯市传染病院诊治的100例2型糖尿病患者为研究对象,使用随机数字表法将其分为观察组（n=50）及对照组（n=50）。对照组行二甲双胍治疗,观察组在对照组的基础上加用恩格列净。对比两组的血糖指标、血糖变异性指标、胰岛功能指标及心脏功能指标。结果：治疗前,两组患者的空腹血糖（FBG）、餐后2 h血糖（2 h PG）及糖化血红蛋白（HbA1c）水平相较差异均无统计学意义（P>0.05）;治疗后,两组的三项指标均下降,且观察组均低于对照组,差异均有统计学意义（P<0.05）。治疗前,两组的血糖标准差（SDBG）、餐后血糖波动幅度（PPGE）、最大血糖波动幅度（LAGE）水平相较差异均无统计学意义（P>0.05）;治疗后,两组的三项指标均下降,且观察组均低于对照组,差异均有统计学意义（P<0.05）。治疗前,两组空腹胰岛素（FINS）、餐后2 h胰岛素（2 h PINS）、胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）水...     

BIAsp30与BI30胰岛素对老年2型糖尿病患者血糖控制能力的临床

日的对比观察BIAsp30与BHI30胰岛素对老年2型糖尿病患者血糖的控制能力．方法选择老年2型糖尿病患者80例,观测分别用BIAsp30与BHI30胰岛素药治疗前后早餐前后、午餐前后和晚餐前后的血糖动态变化及低血糖不良反应发生率．结果血糖控制效果：观察组患者与对照组治疗前后的各项观察指标差异无统计学意义（P〉O．05）;观察组患者经治疗后空腹血糖、餐后2h血糖和糖化血红蛋白水平均低于治疗前（P〈0．05）;对照组患者经治疗后空腹血糖、餐后2h血糖和糖化血红蛋白水平均低于治疗前（P〈O．05）．血糖动态监测：观察组患者早餐后峰值和晚餐后峰值均明显低于对照组患者水平（P〈O．05）．低血糖不良反应发生率：观察组患者不良反应发生率（5％）低于对照组患者（12．5％）．结论BIAsp30皮下注射给药对治疗老年2型糖尿病患者较BHI30具有更强的血糖控制能力．     

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。     

两种注射方式对妊娠糖尿病患者胰岛素治疗效果分析

目的 分析不同胰岛素注射方式对妊娠糖尿病患者的血糖的影响,为治疗妊娠糖尿病提供临床证据.方法 选取妊娠糖尿病患者86例,随机分为两组,其中观察组（n=43）：给予胰岛素泵持续皮下输注联合三餐前皮下注射干预血糖;对照组（n=43）：给予胰岛素多次皮下注射干预.观察两组患者血糖控制情况及并发症情况治疗.结果 两组患者治疗后血糖水平明显下降,且观察组患者下降程度明显优于对照组,比较具有统计学意义（P＜0.05）;观察组患者血糖达标时间及母婴并发症的发生率明显低于对照组,比较具有统计学意义（P＜0.05）.结论 胰岛素泵联合三餐前皮下注射干预妊娠糖尿病血糖,可以有效、快捷,且更加安全地控制血糖水平,有利于孕妇及胎儿的身体健康,值得临床推广.     

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.     

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.