钙剂加维生素D治疗对糖尿病患者钙代谢的影响

本文报道NIDDM患者在常规治疗的基础上加用钙剂和维生素D治疗后的钙代谢变化。糖尿病患者单纯用常规治疗控制血糖后,负钙平衡不能完全纠正,而加用钙剂和维生素D治疗后,负钙平衡能完全纠正,并且高于正常对照组平衡值(P<0.01)。说明钙剂加维生素D治疗对糖尿病性骨质疏松是有益的。     

缬沙坦对心力衰竭心肌细胞收缩功能和钙瞬变的影响

目的:探讨缬沙坦对心力衰竭(HF)大鼠心肌细胞收缩功能和钙瞬变的作用。方法:结扎大鼠冠状动脉左前降支8周后,复制充血性HF模型,随机分为2组,即缬沙坦治疗组与HF对照组,分别用缬沙坦和安慰剂治疗,另设假手术组。治疗12周后,用急性酶解法获得单个大鼠心室肌细胞,用共聚焦显微镜测定单个细胞的收缩功能和钙瞬变。结果:①HF对照组左室舒张末压(LVEDP)明显大于假手术组(P<0.01),左室最大收缩压(LVSP)血压和左室内压的最大上升/下降速率(±dp/dtmax)明显小于假手术组(P<0.05、P<0.05和P<0.01);而缬沙坦治疗组LVSP和±dp/dtmax明显高于HF对照组(P<0.05和P<0.01),LVEDP明显小于HF对照组(P<0.01)。②HF对照组的心肌细胞表面积和最大舒张长度均大于假手术组(P<0.01),缩短分数明显低于假手术组(P<0.05),经缬沙坦治疗后均有明显改善(P<0.01)。③HF对照组心肌细胞的钙瞬变明显低于假手术组(P<0.01),舒张末期钙浓度明显升高(P<0.05),钙浓度下降时间明显减慢(P<0.01),经缬沙坦治疗后均明显改善(P<0.01)。结论:缬沙坦治疗能明显改善充血性HF的心肌细胞收缩功能,可能与改善HF心肌细胞钙调控异常有关。     

低蛋白饮食合并肾灵治疗慢性肾衰的疗效评价

对6例慢性肾功能衰竭患者采用治疗前的低蛋白饮食(LPD)后及LPD合并肾灵(LPD+EAA+KA)后自身对照的研究。结果显示:LDP+EAA+KA治疗后,Scr下降(P<0.01),Ccr提高(P<0.05),血BUN未有变化,血浆总必需氨基酸与总非必需氨基酸比率、支链氨基酸浓度均升高,且机体由负氮转为正氮平衡(P<0.005);蛋白质合成与分解率明显提高(P<0.001)。整个实验过程中,血浆钙、磷、总蛋白与白蛋白无明显变化。     

醒脑开窍针刺法结合康复训练干预脑卒中病人步态及平衡功能障碍的临床研究

目的探讨针刺结合康复训练干预脑卒中病人步态及平衡功能障碍的临床效果。方法选取2017年5月—2018年5月郴州市第一人民医院收治的脑卒中病人64例,采用随机序列软件分为对照组和治疗组,每组32例。两组均给予常规内科基础治疗和康复训练;治疗组加用醒脑开窍针刺法治疗。两组病人的步态参数采用步态分析系统评价;平衡能力采用Berg平衡量表和Tinetti平衡与步态量表评价;跌倒风险采用起立行走计时测验(TUGT)和站起测验(CRT)评价。结果两组治疗后步长、步速、步频均较治疗后提高(P<0.05或P<0.01),其中步速提高程度更为明显;两组治疗后摆动相百分比、足廓清和足跟落地角度均较治疗后增加(P<0.05),而支撑相百分比、脚尖离地角度则均较治疗后缩小(P<0.05);与对照组治疗后相比,治疗组对步态参数的改善程度更为明显(P<0.05)。两组治疗后Berg和Tinetti量表评分均较治疗前升高(P<0.05),而TUGT和CRT时间均较治疗前缩短(P<0.05);与对照组治疗后相比,治疗组平衡能力及跌倒风险的改善程度更为明显(P<0.05)。结论醒脑开窍针刺法结合康复训练能改善脑卒中病人的偏态步态,并提高病人平衡能力,从而降低跌倒风险。     

补阳还五汤联合子午流注纳甲法治疗脑中风后遗症及对炎症因子的影响

目的探讨补阳还五汤联合子午流注纳甲法治疗脑中风后遗症病人的临床疗效以及对白细胞介素-10(interleukin-10,IL-10)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的影响。方法以2014年3月—2017年3月收入我院的96例脑中风后遗症病人为研究对象。随机分为对照组和研究组,每组48例。所有病人给予相同的基础治疗,对照组病人进行子午流注纳甲法针灸,研究组病人在对照组基础上服用补阳还五汤。治疗3个疗程。比较两组的临床疗效及治疗前后Fugl-Meyel评分、Bathel评分和美国国立卫生研究院卒中量表(NIHSS)评分,比较两组病人治疗前后IL-10、IL-6及TNF-α水平。结果研究组总有效率为95.83%,显著高于对照组的81.25%(P<0.05)。治疗前两组各指标差异无统计学意义(P>0.05)。治疗后,两组病人的Fugl-Meyel评分和Bathel评分均显著升高(P<0.01),NIHSS评分均显著降低(P<0.01),且研究组Fugl-Meyel评分和Bathel评分均显著高于对照组(P<0.01),NIHSS评分显著低于对照组(P<0.01)。治疗后,两组病人血清IL-10显著升高(P<0.01),IL-6及TNF-α水平均显著下降(P<0.05),且研究组IL-10高于对照组(P<0.05),IL-6及TNF-α显著低于对照组(P<0.05)。结论补阳还五汤联合子午流注纳甲法可以有效改善脑中风后遗症病人的临床症状,提高其运动功能和生活质量,改善神经功能缺损,同时降低血清IL-6和TNF-α水平,升高IL-10水平,减轻炎症反应,改善机体免疫平衡。     

甲亢患者骨质疏松原因分析

对21例甲亢患者进行钙磷代谢监测。结果为甲亢患者血清钙比正常对照组明显升高(P<0.01),主要与T_3有关,但其升高呈可逆性,可随甲亢症状控制而降低。降钙素的高低与血清钙水平呈明显正相关(P<0.05),是后者反馈刺激的结果。作者提出,抑制T_3、在积极控制甲亢的同时补充小剂量钙剂是防治甲亢骨病的重要措施。     

51例糖尿病患者治疗前后钙磷代谢平衡结果分析

本文报告51例糖尿病患者治疗前后和28名健康成人共353个钙磷平衡试验日的研究结果。在治疗前IDDM和NIDDM病人均为负平衡,前者重于后者;治疗后前者完全纠正,后者明显好转。钙磷平衡与血糖水平有关。比较了Hotelling T~2分析与t检验结果;讨论了钙磷负平衡的机制和防治方法。     

Thera-Band弹力带改善脑卒中偏瘫病人下肢运动功能的效果

目的 探讨Thera-Band弹力带抗阻力训练对脑卒中偏瘫病人下肢运动功能的影响。方法 选取2022年1月至2023年4月我院收治的脑卒中偏瘫住院病人60例为研究对象,按随机数表法分为观察组和对照组,每组各30例。对照组采取常规康复治疗,观察组在对照组基础上进行Thera-Band弹力带抗阻力训练。采用简化Fugl-Meyer下肢运动功能评定(FMA)、Berg平衡功能量表(BBS)、计时起立行走测试(TUGT)、改良Barthel指数(MBI)对2组病人的康复治疗效果进行评价。结果 治疗后,2组病人FMA、BBS、TUGT、MBI评分较治疗前均有明显改善(P<0.05或P<0.01),与对照组比较,观察组FMA、BBS、TUGT、MBI评分改善更为显著(P<0.05或P<0.01)。结论 脑卒中偏瘫病人采用Thera-Band弹力带治疗,能够提高病人下肢运动功能,改善病人的步行和平衡功能,提高病人生活自理能力,值得临床进一步推广。     

51例糖尿病患者治疗前后钙磷代谢平衡结果分析

本文用逐步回归、判别分析和Hotelling T~2检验等多因素统计方法分析了51例糖尿病患者治疗前后和28名健康成人共353个钙磷平衡试验日的研究结果。治疗前,IDDM和NIDDM病人均为钙、磷负平衡,前者平均每日丢失钙346mg,磷586mg;后者平均每日丢失钙195mg,磷372mg。用饮食治疗、口服降糖药或胰岛素控制糖代谢紊乱后,IDDM的负平衡完     

麝香保心丸治疗不宜进行血运重建的气滞血瘀型冠心病的随机双盲对照研究

目的:观察麝香保心丸治疗不宜进行血运重建的气滞血瘀型冠心病的临床疗效及安全性。方法:纳入2017年—2019年就诊于中国中医科学院广安门医院的门诊及住院符合纳入标准的病人80例。采用随机双盲、平行对照的试验研究方法将病人随机分为治疗组和对照组,每组40例。在西药基础治疗基础上,治疗组给予麝香保心丸治疗,对照组给予安慰剂治疗,两组疗程均为6个月。比较两组治疗前后病人的复合终点指标、替代终点指标、中医证候、安全性指标等。结果:治疗后,治疗组心电图各导联ST段下降值总和、B型钠尿肽(BNP)水平低于对照组(P<0.01),左室射血分数(LVEF)高于对照组(P<0.01);两组治疗后C反应蛋白(CRP)水平均低于治疗前(P<0.01),但两组治疗后比较差异无统计学意义(P>0.05)。两组治疗后西雅图心绞痛量表(SAQ)各项目(治疗满意度除外)评分比较差异均有统计学意义(P<0.05或P<0.01)。治疗组治疗后中医证候评分低于对照组(P<0.01),治疗组中医证候疗效总有效率为86.49%,高于对照组的27.78%(P<0.01)。治疗组复合...     

Changes in fluorine metabolism during the treatment with calcium-magnesium preparation in 60 cases of endemic fluorosis

Using the method of metabolic balance, we investigated the fluoride metabolism and its change during calcium-magnesium preparation treatment in 60 cases of endemic fluorosis. We found that in patients with fluorosis the intake of fluoride and the levels of urinary, fecal and serum fluoride were several times higher than those of normal controls (P less than 0.01), that the intestinal fluoride apparent absorption rate was 1.5 times higher than that of normal controls (P less than 0.01) and that at a given dietary level of fluoride, there existed a balance of fluoride metabolism. Fluoride intake was positively correlated with intestinal fluoride apparent absorption rate (r = 0.375, P less than 0.01). The combination of calcium and magnesium preparation with fluoride led to decrease of intestinal fluoride apparent rate (P less than 0.05) and increase of fecal fluoride output (P less than 0.05). It seems reasonable to treat fluorosis with calcium-magnesium preparation.     

Reversible impairment of glucose tolerance in patients with endemic fluorosis

Summary Endemic fluorosis is a condition resulting from prolonged ingestion of drinking water which contains excess fluoride. Studies on rats have suggested that fluoride toxicity may produce glucose intolerance and abnormalities in insulin secretion. We studied glucose and insulin profiles following an oral glucose load in patients with endemic fluorosis. Twenty-five young adults (age range, 15–30 years) with endemic fluorosis, and an equal number of matched healthy control subjects with normal fluoride intake were studied. Impaired glucose tolerance was demonstrated in 10 of 25 (40%) patients with endemic fluorosis. Patients with impaired glucose tolerance had significantly higher fasting serum immunoreactive insulin (p<0.05), higher fasting serum fluoride (p<0.001), and a significantly lower fasting glucose to insulin ratio than that in patients with normal glucose tolerance (p<0.001) or control subjects (p<0.05). The fasting serum fluoride levels correlated positively with the area under the glucose curve (r=0.80,p<0.01) in patients with impaired glucose tolerance. Interestingly these abnormalities could be reversed when the village was provided drinking water with fluoride levels within acceptable limits. The present study shows that chronic fluoride toxicity in humans could result in significant abnormalities in glucose tolerance which are reversible upon removal of the excess fluoride.     

ICU呼吸机相关性肺炎患者微量元素、维生素D水平含量及临床意义

目的探讨重症医学科ICU呼吸机相关性肺炎(VAP)患者的微量元素、维生素D水平含量及临床意义。方法选取2019年6月至2020年3月在我院ICU病房收治的200例行呼吸机辅助呼吸超过2d的患者作为研究对象。以是否发生VAP作为分组依据,将发生VAP的52例患者纳入发生组,根据患者发生VAP情况分为3个亚组,低危组19例、中危组17例、高危组16例;未发生VAP的148例患者纳入未发生组。比较各组的血清微量元素钙、铁、锌、铜、维生素D水平差异。结果VAP发生组的血清钙、铁、锌、铜、维生素D水平均低于未发生组,差异有统计学意义(P<0.05)。低危组、中危组、高危组VAP患者的血清钙、铁、锌、铜、维生素D水平依次降低,差异有统计学意义(P<0.05);且组间两两比较,差异有统计学意义(P<0.05)。VAP病情严重程度与血清钙、铁、锌、铜、维生素D均呈负相关(r值分别为:-0.405、-0.392、-0.373、-0.278、-0.537,P<0.05)。结论大部分ICU病房患者在行呼吸机辅助呼吸时发生VAP与自身的微量元素钙、铁、锌、铜、维生素D水平含量低下有关。纠正患者的微量元素、维生素D水平,有助于降低VAP发生率。     

Effects of calcium–vitamin D co-supplementation on glycaemic control,inflammation and oxidative stress in gestational diabetes: a randomised placebo-controlled trial

Aims/hypothesis

This study was designed to assess the effects of calcium and vitamin D supplementation on the metabolic status of pregnant women with gestational diabetes mellitus (GDM).

Methods

This randomised placebo-controlled trial was performed at maternity clinics affiliated to Kashan University of Medical Sciences, Kashan, Iran. Participants were 56 women with GDM at 24–28 weeks’ gestation (18 to 40 years of age). Subjects were randomly assigned to receive calcium plus vitamin D supplements or placebo. All study participants were blinded to group assignment. Individuals in the calcium–vitamin D group (n?=?28) received 1,000 mg calcium per day and a 50,000 U vitamin D₃ pearl twice during the study (at study baseline and on day 21 of the intervention), and those in the placebo group (n?=?28) received two placebos at the mentioned times. Fasting blood samples were taken at study baseline and after 6 weeks of intervention.

Results

The study was completed by 51 participants (calcium–vitamin D n?=?25, placebo n?=?26). However, as the analysis was based on an intention-to-treat approach, all 56 women with GDM (28 in each group) were included in the final analysis. After the administration of calcium plus vitamin D supplements, we observed a significant reduction in fasting plasma glucose (?0.89?±?0.69 vs +0.26?±?0.92 mmol/l, p?p?=?0.02) and HOMA-IR (?0.91?±?1.18 vs +0.63?±?2.01, p?=?0.001) and a significant increase in QUICKI (+0.02?±?0.03 vs ?0.002?±?0.02, p?=?0.003) compared with placebo. In addition, a significant reduction in serum LDL-cholesterol (?0.23?±?0.79 vs +0.26?±?0.74 mmol/l, p?=?0.02) and total cholesterol: HDL-cholesterol ratio (?0.49?±?1.09 vs +0.18?±?0.37, p?=?0.003) and a significant elevation in HDL-cholesterol levels (+0.15?±?0.25 vs ?0.02?±?0.24 mmol/l, p?=?0.01) was seen after intervention in the calcium–vitamin D group compared with placebo. In addition, calcium plus vitamin D supplementation resulted in a significant increase in GSH (+51.14?±?131.64 vs ?47.27?±?203.63 μmol/l, p?=?0.03) and prevented a rise in MDA levels (+0.06?±?0.66 vs +0.93?±?2.00 μmol/l, p?=?0.03) compared with placebo.

Conclusions/interpretation

Calcium plus vitamin D supplementation in women with GDM had beneficial effects on their metabolic profile.

Trial registration

www.irct.ir IRCT201311205623N11

Funding

The study was supported by a grant (no. 92110) from Kashan University of Medical Sciences.     

Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis

The aim of this study was to perform serological testing to screen for celiac disease (CD) among premenopausal women with idiopathic osteoporosis and to investigate the bone turnover in patients who are seropositive for CD. We studied 89 premenopausal women with idiopathic osteoporosis. The serological screening protocol was based on a two-level evaluation. The first level consisted of determining serum level of IgA antigliadin antibodies (AGA). Subjects who were negative for IgA AGA were classified as not having CD, while samples testing positive for IgA AGA underwent a second level of the screening process. For the second level of screening, the serum IgA endomysial antibody (EMA) test was performed. Bone metabolism was evaluated by serum calcium (Ca), phosphorus, alkaline phosphatase, parathyroid hormone (PTH), 25 (OH) vitamin D, osteocalcin (OC), urinary deoxypyridinoline (dPD), and 24-h urinary calcium levels. Of the 89 patients evaluated, 17 were found to have positive IgA AGA tests (19%) and 9 were found to be positive for EMA (10.11%). EMA-positive patients showed lower values of serum Ca (p<0.05) and 25 (OH) vitamin D (p<0.01) and significantly higher values of PTH (p<0.01) compared with the EMA-negative patients. The level of urinary dPD was found to be significantly higher in EMA-positive patients (p<0.05). The results of this study suggest that all patients with idiopathic osteoporosis should be screened for CD by measurement of EMA. Additionally, we believe that serological screening for CD and detection of such patients will allow determination of the most convenient treatment strategies for osteoporosis.     

Blood Pressure is Lowered by Vitamin D (Alphacalcidol) during Long-Term Treatment of Patients with Intermittent Hypercalcaemia

ABSTRACT. There is epidemiologic evidence of a relationship between calcium deficiency and hypertension. The present study evaluated the effects of alphacalcidol, a synthetic analogue of active vitamin D, given to 29 patients with marginal, intermittent hypercalcaemia. Before therapy there was aninverse relationship between serum calcium levels and diastolic blood pressure (p<0.02). Treatment with 1 μg alphacalcidol raised the serum calcium by 0.07 mmol/l during a 6-month, double-blind, placebo-controlled trial and caused a significant reduction of diastolic blood pressure by 9.2 mmHg compared with placebo (p<0.01). The study extends previous observations, in normocalcaemic subjects, of inverse relationships between serum calcium and blood pressure indicating a primary disturbance of calcium homeostasis in hypertension. The observation that a physiologic amount of active vitamin D has hypotensive effects agrees with such a concept and suggests a new principle for the treatment of hypertension.     

维生素D缺乏与脓毒症预后相关性研究

目的 探讨维生素D缺乏与重症监护病房(ICU)脓毒症患者预后的相关性。方法  检测2012年4月至2013年8月广西医科大学第一附属医院236例入住ICU脓毒症患者的血清25(OH)D质量浓度,比较25(OH)D充足组、25(OH)D不足组、25(OH)D缺乏组的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、主要生化指标、ICU留住时间以及28 d病死率。多因素Cox回归分析影响预后的危险因素。结果  (1)175例(74.1%)血25(OH)D减少,其中100例(42.3%)25(OH)D不足,75例(31.8%)25(OH)D缺乏。(2)25(OH)D缺乏组与其余两组相比,ICU留住时间更长,APACHEⅡ评分、血降钙素原(PCT)、全段甲状旁腺激素(iPTH)、血培养阳性率以及28 d病死率更高(P<0.01)。随着血清25(OH)D浓度的降低,APACHE Ⅱ评分增高(r=-0.716,P<0.01),28 d病死率上升(r=-0.376,P<0.01)。(3)25(OH)D充足组、25(OH)D不足组以及25(OH)D缺乏组中位生存时间分别为26.0 d、23.3 d和18.4 d(P<0.05)。(4)Cox分析显示,25(OH)D<20 μg/L(即维生素D缺乏)是影响预后的危险因素(OR 1.205,95%CI 1.154,1.257,P=0.006)。结论  脓毒症患者维生素D缺乏发生率高,维生素D缺乏是影响其预后的独立危险因素。补充维生素D或可作为脓毒症的一种辅助治疗手段。     

Effects of calcium–vitamin D co-supplementation on metabolic profiles in vitamin D insufficient people with type 2 diabetes: a randomised controlled clinical trial

Aims/hypothesis

This study was performed to assess the effects of vitamin D and calcium supplementation on the metabolic profiles of vitamin D insufficient persons with type 2 diabetes.

Methods

In a parallel designed randomised placebo-controlled clinical trial, a total of 118 non-smoker individuals with type 2 diabetes and insufficient 25-hydroxyvitamin D, aged >30 years, were recruited from the Isfahan Endocrine and Metabolism Research Centre. Participants were randomly assigned to four groups receiving: (1) 50,000 U/week vitamin D + calcium placebo; (2) 1,000 mg/day calcium + vitamin D placebo; (3) 50,000 U/week vitamin D + 1,000 mg/day calcium; or (4) vitamin D placebo + calcium placebo for 8 weeks. A study technician carried out the random allocations using a random numbers table. All investigators, participants and laboratory technicians were blinded to the random assignments. All participants provided 3 days of dietary records and 3 days of physical activity records throughout the intervention. Blood samples were taken to quantify glycaemic and lipid profiles at study baseline and after 8 weeks of intervention.

Results

30 participants were randomised in each group. During the intervention, one participant from the calcium group and one from the vitamin D group were excluded because of personal problems. Calcium–vitamin D co-supplementation resulted in reduced serum insulin (changes from baseline: ?14.8?±?3.9 pmol/l, p?=?0.01), HbA_1c [?0.70?±?0.19% (?8.0?±?0.4 mmol/mol), p?=?0.02], HOMA-IR (?0.46?±?0.20, p?=?0.001), LDL-cholesterol (?10.36?±?0.10 mmol/l, p?=?0.04) and total/HDL-cholesterol levels (?0.91?±?0.16, p?=?0.03) compared with other groups. We found a significant increase in QUICKI (0.025?±?0.01, p?=?0.004), HOMA of beta cell function (HOMA-B; 11.8?±?12.17, p?=?0.001) and HDL-cholesterol (0.46?±?0.05 mmol/l, p?=?0.03) in the calcium–vitamin D group compared with others.

Conclusions/interpretation

Joint calcium and vitamin D supplementation might improve the glycaemic status and lipid profiles of vitamin D insufficient people with type 2 diabetes. Trial registration: ClinicalTrials.gov NCT01662193 Funding: Clinical Research Council, Isfahan University of Medical Sciences, Isfahan, Iran     

Hypovitaminosis D in female patients with chronic low back pain

Chronic low back pain (LBP) is an extremely common problem in practice, where it is often labeled idiopathic. No sufficient studies have been conducted to analyze the contribution of hypovitaminosis D to the etiology of chronic LBP in populations wherein vitamin D deficiency is endemic. The present study was, therefore, carried out to examine hypovitaminosis D and its determinants in female patients with chronic LBP during the childbearing period. Sixty female patients complaining of LBP lasting more than 3 months were clinically studied rheumatologically and neurologically. Questionnaires and indices quantifying risk factors associated with vitamin D deficiency were utilized. Biochemical assays of serum calcium, phosphorus, alkaline phosphatase (ALP), parathormone (PTH), and 25-hydroxyvitamin D (25 OHD) were performed and compared to those of 20 matched healthy controls. The determinants of vitamin D levels in patients were examined by stepwise regression. Patients with LBP had significantly lower 25 OHD levels (p < 0.05) and significantly higher PTH (p < 0.05) and ALP (p < 0.001) than controls, although there were no significant group differences in calcium and phosphorus. Hypovitaminosis D (25 OHD < 40 ng/ml) was found in 49/60 patients (81%) and 12/20 (60%) of controls, with an odds ratio of 2.97. Although many risk factors related to sun exposure, clothing, diet, and pregnancy were significantly correlated with vitamin D levels in patients, only limited duration of sun exposure, contributing 55% to the variance of 25 OHD, limited areas of skin exposed (13%), and increased number of pregnancies (2%), were significant determinants of vitamin D levels in patients. Despite the sunny climate, hypovitaminosis D is prevalent among Egyptian women in the childbearing period, especially those presenting with chronic LBP, where it is associated with hyperphosphatasia and hyperparathyroidism, without alterations in serum calcium. The major determinant of hypovitaminosis D in our patients is limited sun exposure.