血清总胆红素与2型糖尿病肾病的相关性研究

目的探寻血清总胆红素(TB)与2型糖尿病肾病的相关性。方法将126例住院2型糖尿病患者按尿白蛋白排泄率(UAER)将其分为正常蛋白尿组、早期糖尿病肾病组、临床糖尿病肾病组,比较三组血清TB水平及其他临床生化资料,探寻血清TB与UAER的相关性,并采用多因素Logistic回归分析探讨糖尿病肾病发病的影响因素。结果三组间年龄、体质量指数(BMI)、舒张压(DBP)、尿酸(UA)、总胆固醇(TCH)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(Hb A1c)比较差异均无统计学意义(P0.05),糖尿病病程、收缩压(SBP)、TB在不同组间差异有统计学意义(P0.05)。Spearman相关分析显示血清TB与UAER显著负相关(r=-0.32,P0.01)。Logistic多元回归分析显示BMI和TB是糖尿病肾病的独立影响因素(OR=1.189、0.850;P0.05、P0.01)。结论血清TB与2型糖尿病肾病呈负相关,其可能成为糖尿病肾病的一种新治疗靶点。     

2型糖尿病视网膜病变的相关因素分析

目的探讨糖尿病视网膜病变(DR)与全身因素的关系。方法对473例2型糖尿病患者根据眼底病变程度分为无DR组(NDR)、背景型DR组(BDR)、增殖型DR组(PDR)三组。比较三组在年龄、糖尿病病程、血压(BP)、体重指数(BMI)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿微量白蛋白排泄率(UAER)、甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、尿素氮(BUN)、肌酐(Cr)以及空腹和餐后2小时C肽(CP0和CP2)的不同。采用logistic回归分析DR与各因素的相关性。结果 BDR组与NDR组比较:年龄、病程、SBP、DBP、UAER、TC、LDL-C、BUN、CP0和CP2有显著差异(P0.05、0.001、0.001、0.05、0.001、0.001、0.001、0.05、0.001、0.001);PDR组与NDR组比较:病程、SBP、DBP、BMI、UAER、BUN、CP0和CP2有显著差异(P0.001、0.001、0.05、0.05、0.001、0.05、0.05、0.001);PDR与BDR组比较:年龄、SBP、DBP有显著差异(P均0.05)。经logistic回归分析显示,病程、UAER、TC是DR发生的危险因素(OR=1.090、1.002、1.361,P均0.05),CP2是DR发生的保护因素(OR=0.865,P=0.001)。结论 DR的发生及其严重程度与病程、UAER、TC及CP2密切相关,重视对DR相关因素的监测与评价有助于DR的预防和治疗。     

血清AAG和Hcy与2型糖尿病肾病的关系

目的探讨血清α1酸性糖蛋白(AAG)和同型半胱氨酸(Hcy)水平在2型糖尿病肾病不同肾损害期的应用价值。方法收集本院2013年1~12月住院的2型糖尿病患者128例,根据24h尿白蛋白排泄率(UAER)的不同分为单纯2型糖尿病组、早期糖尿病肾病组和临床糖尿病肾病组,并选择同期健康体检者80例作为健康对照组,分别检测血清肌酐(Cr)、尿素氮(BUN)和Hcy水平,并对检测结果进行统计分析。结果单纯2型糖尿病组、早期糖尿病肾病组、临床糖尿病肾病组血清AAG、Hcy水平有明显差异,差异有统计学意义(P0.05),UAER与血清AAG水平呈正相关(r=0.673,P0.05),与Hcy水平呈正相关(r=0.35,P0.05)。结论联合检测血清AAG、Hcy对早期糖尿病肾病的诊断、以及评估糖尿病肾损伤程度具有重要意义。     

2型糖尿病患者血清IL-6和TNF-α水平的检测对预后的意义

目的通过测定2型糖尿病(DM)患者血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平的变化,探讨其在糖尿病肾病(DN)中的发病学意义,了解其对DM预后的影响.方法采用放射免疫法检测85例2型DM患者血清IL-6和TNF-α水平.并根据24 h尿白蛋白排泄率(UAER)将DM患者分为单纯DM组(SDM,n=40),隐性糖尿病肾病组(IDN,n=28)和显性糖尿病肾病组(ODN,n=17),并与32例正常人对照.结果(1)SDM,IDN,ODN 3组患者及正常对照组血清IL-6水平分别为(99±16),(112±22),(128±24),(90±15)ng/L,TNF-α水平分别为(127±15),(130±16),(148±22),(112±22)ng/L,经方差分析,各组间差异具有非常显著意义(F=19.27,13.35,P均＜0.01),其中SDM,IDN,ODN 3组均明显高于正常对照组(P＜0.05或P＜0.01),ODN组又明显高于SDM组和IDN组(P＜0.01),IDN组血清IL-6水平亦较SDM组升高(P＜0.05).(2)糖尿病病程与患者血清IL-6,TNF-α水平呈明显正相关(r=0.396,P＜0 01和r=0.277,P＜0.05),UAER与患者血清IL-6,TNF-α水平变化亦呈正相关关系(r=0.630,0.426,P均＜0.01);空腹血糖与患者血清IL-6,TNF-α水平间均未见相关关系.结论IL-6和TNF-α可能参与了糖尿病及其肾病的发生与发展.血清IL-6,TNF-α水平检测可以作为临床观察DN病情及判断DM预后的参考指标.     

2型糖尿病合并早期糖尿病肾病的相关危险因素分析

目的 探讨2型糖尿病患者早期糖尿病肾病（EDN）的相关危险因素,为其防治提供临床依据。方法 将171例2型糖尿病患者按尿白蛋白排泄率（UAER）水平分为单纯糖尿病组（SDM,UAER〈20 μg/min）和早期糖尿病肾病组（EDN,UAER 20～200 μg/min）,观察两组年龄、病程、血压、体重指数（BMI）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹C肽（FCP）、甘油三酯（TG）、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）等指标的差异,并进行比较分析。结果 EDN组BMI、LDL-C均较SDM组升高,而HDL-C降低,差异有统计学意义（P〈0.05）,而年龄、病程、FPG、HbA1c、FCP、TG、TC等差异无统计学意义（P〉0.05）;在50例血脂正常的患者中,SDM组的年龄、病程、TC、LDL-C等指标均低于EDN组（P〈0.05）;应用χ2检验发现,EDN在血脂正常和异常组中的比例差异有统计学意义（P〈0.05）;Logistic回归分析显示糖尿病病程、高BMI和高LDL-C与EDN的发病密切相关。结论 在2型糖尿病肾病的防治过程中,要注意控制病程、肥胖、血脂等危险因素。     

血清分泌型卷曲相关蛋白5水平与2型糖尿病肾病的相关性

目的探讨2型糖尿病(T2DM)患者血清分泌型卷曲相关蛋白5(SFRP-5)水平与糖尿病肾病(DN)的相关性。方法选择T2DM住院患者137例,根据尿白蛋白排泄率(UAER)分为3组:正常白蛋白尿组(A组)47例;微量白蛋白尿组(B组)45例;大量白蛋白尿组(C组)45例。选择50例健康体检者作为对照组。ELISA法检测血清SFRP-5,同时测定空腹静脉血糖(FBG)、血脂、肝肾功能、UAER。比较各组间的指标差异。结果 4组SFRP-5比较差异均有统计学意义(P0.05)。T2DM患者血清SFRP-5的水平低于对照组,B组、C组血清SFRP-5水平高于A组,C组血清SFRP-5水平高于B组(均P0.05)。血清SFRP-5水平与舒张压(DBP)、总胆固醇(CHO)、甘油三酯(TG)、FBG、空腹血清胰岛素(Fins)、胰岛素抵抗指数(HOMA-IR)、尿素氮(BUN)、肌酐(CR)、UAER呈正相关,与高密度脂蛋白(HDL)、肾小球滤过率(GFR)、总胆红素呈负相关。多元线性回归分析显示,UAER、HOMA-IR、空腹血糖(FBG)、空腹血糖(FBG)、尿酸(UA)、收缩压(SBP)、TG是SFRP-5的独立影响因素。结论T2DM患者血清SFRP-5水平随着UAER的增加而升高,两者可能参与糖尿病肾病的发生,并可能成为糖尿病肾病发生及发展过程中的新的标记物。     

糖尿病肾病相关危险因素分析

目的：探讨糖尿病肾病相关危险因素，以指导临床治疗及早期防治。方法：对61例糖尿病患者（2例1型糖尿病，59例2型糖尿病）的空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）、收缩压（SBP）、尿酸分别检测及计算，按照尿白蛋白排泄率（UAER）分为糖尿病肾病组和非糖尿病肾病组（P〈0．01）。结论：早期控制血糖、血脂、血压、尿酸，缩短病程，是防止糖尿病肾病发生发展的关键。     

胱抑素C检测在早期糖尿病肾病诊断中的作用

目的探讨胱抑素C(CysC)检测在早期糖尿病肾病诊断中的作用。方法选择120例确诊为2型糖尿病的患者,根据24 h尿微量白蛋白排泄率(UAER)将其分为单纯糖尿病组(n=40)、糖尿病肾病早期组(n=40)和糖尿病肾病中晚期组(n=40),分别测定其肾小球滤过率、CysC、血肌酐(Cr)、尿素氮(BUN)等指标,并对其相关性进行分析。结果各组患者间的病程、UAER水平具有统计学差异(P<0.05);与单纯糖尿病组比较,糖尿病肾病早期组和中晚期组GFR水平均降低,CysC水平升高(P<0.05);与糖尿病肾病早期组比较,中晚期组GFR降低,CysC、Scr、BUN水平均升高,差异有统计学意义(P<0.05);Pearson相关分析显示,CysC与GFR、Scr、BUN呈现一定的相关性。结论 CysC可以作为糖尿病肾病早期的诊断指标,值得临床推广应用。     

血清内脂素、Vaspin与糖尿病肾病的相关性

目的 探讨2型糖尿病肾病患者血清内脂素、丝氨酸蛋白酶抑制剂（vaspin）水平与糖尿病肾病的相关性.方法 选择98例2型糖尿病患者,根据尿白蛋白排泄率分为3组：正常蛋白尿组（UAER＜ 20 μg/min）35例,微量蛋白尿组（UAER 20～200 μg/min）33例,大量蛋白尿组（UAER＞ 200 μg/min）30例;另选健康体检正常者35例为对照组.采用酶联免疫吸附法（ELISA）检测受检者血清内脂素、vaspin水平,同时测定空腹血糖（FPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、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）、空腹胰岛素（FIns）,并测量体质量指数（BMI）、收缩压（SBP）和舒张压（DBP）,比较各组间差异.结果 3组患者血清内脂素水平明显高于对照组,差异有统计学意义（P＜0.01）;血清vaspin在正常蛋白尿组明显高于对照组、微量蛋白尿组和大量蛋白尿组,差异有统计学意义（P＜0.01）.内脂素和vaspin分别与BMI、SBP、FPG、HbA1c、LDL-C和FIns呈正相关（P＜0.01）,与HDL-C呈负相关（P＜0.01）.结论 血清内脂素水平随着2型糖尿病肾病的发展而逐渐升高,可能参与了2型糖尿病肾病的发生、发展,而vaspin与肥胖、体脂分布以及脂代谢关系密切,可以作为早期2型糖尿病监测指标.     

血管内皮生长因子与糖尿病肾病关系探讨

目的 探讨血管内皮生长因子(VEGF)与2型糖尿病肾病的关系.方法 检测2型糖尿病患者122例和正常对照组40例血清VEGF水平,按尿微量白蛋白排泄率(UAER)水平分组比较检测结果.结果 糖尿病各组患者血清VEGF水平较正常对照组显著升高,与糖化血红蛋白(HbA1C)、病程、UAER呈显著正相关(P＜0.01).结论 血清VEGF与2型糖尿病肾病密切相关,其浓度的测定对判断2型糖尿病肾病的发生、发展有重要的临床意义.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.