抑郁症和糖尿病共病患者的临床特征对照研究

目的探讨抑郁症和糖尿病共病患者的临床特征。方法使用自制调查表,收集30例抑郁症和糖尿病共病患者和30冽单纯抑郁症患者的社会人口学资料和病情资料。结果抑郁症和糖尿病共病患者的平均病程、平均发病次数和平均住院日均显著高于单纯抑郁症患者;抑郁症和糖尿病共病患者的临床症状显著重于单纯抑郁症患者;抑郁症和糖尿病共病患者的出院疗效显著差于单纯抑郁症患者。结论抑郁症和糖尿病共病患者的临床症状重、治疗难度大。     

抑郁症与抑郁焦虑障碍共病临床特征对照研究

目的探讨抑郁症与抑郁焦虑障碍共病患者的临床特征。方法对34例抑郁焦虑障碍共病患者（研究组）和44例抑郁症患者（对照组）采用自拟一般人口学资料问卷统计一般资料,采用汉密顿抑郁量表及汉密顿焦虑量表评定两组患者的抑郁和焦虑状况,对评定结果进行对比分析。结果两组患者一般人口学资料均无显著性差异;研究组汉密顿抑郁量表总分、焦虑／躯体化、认知障碍、阻滞因子分以及自杀条目分均显著高于对照组（P〈0．01～0．05）;汉密顿焦虑量表总分、躯体性焦虑、精神性焦虑因子分,以及焦虑心境、紧张、抑郁心境、肌肉系统症状、感觉系统症状、心血管系统症状、胃肠道症状、植物神经症状及会诊时行为表现单项条目分均显著高于对照组（P均〈0．01）;其他因子或条目分均无显著性差异（P〉0．05）。结论抑郁焦虑障碍共病患者较单纯抑郁症患者的抑郁和焦虑症状更严重、自杀风险大。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的:探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法:选取2003-06/2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表(问卷共90项,每个项目按5级评分,参照全国成人常模标准:因子分<1.8分为正常;1.8～2.0分为轻度异常;2.1～3.0分为中度异常;>3.0分为重度异常),对3组患者分别进行测评,记录总分和9个因子分(包括:躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性),比较各组间评分的差异。结果:有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较:焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者(2.60±0.52,1.86±0.41和1.16±0.35;t=5.76,7.91,P<0.01)。②3组患者症状自评量表各因子分评定结果比较:焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组(P<0.01);焦虑和抑郁障碍共病患者除敌对外,躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组(P<0.01)。结论:焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

抑郁症伴发高血压糖尿病冠心病患者临床特征分析

目的探讨抑郁症伴发高血压、糖尿病、冠心病患者的临床特征,为临床干预提供依据。方法将50例伴有高血压、糖尿病、冠心病的抑郁症患者设为共病组,抽取同期住院的50例单纯抑郁症患者设为对照组,两组均口服舍曲林治疗,观察12周。于治疗前及治疗12周末采用汉密顿焦虑量表、汉密顿抑郁量表评定焦虑抑郁状况,采用社会功能缺陷筛选量表评定社会功能状况。结果治疗前共病组汉密顿焦虑量表,汉密顿抑郁量表及社会功能缺陷筛选量表总分均显著高于对照组（P〈0．01）;治疗12周末,各量表评分均较治疗前显著下降,但共病组仍显著高于对照组（P〈0．05或0．01）。结论抑郁症伴发高血压、糖尿病、冠心病患者较单纯抑郁症患者的焦虑、抑郁症状严重,社会功能缺陷明显,治疗效果较差。     

焦虑和抑郁障碍共病患者与抑郁症及焦虑症患者心理健康状况对比

目的：探讨焦虑和抑郁障碍共病患者与抑郁症和焦虑症患者心理健康状况下降的差异性。方法：选取2003-06／2004-08广州市脑科医院精神科门诊首次就诊的焦虑和抑郁障碍共病患者27例、抑郁症24例和焦虑症患者29例。采用症状自评量表（问卷共90项，每个项目按5级评分，参照全国成人常模标准：因子分〈1．8分为正常；1．8-2．0分为轻度异常；2．1-3．0分为中度异常；〉3．0分为重度异常），对3组患者分别进行测评，记录总分和9个因子分（包括：躯体化、强迫状态、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性），比较各组间评分的差异。结果：有24例抑郁症患者、29例焦虑症患者和27例焦虑和抑郁障碍共病患者的测评结果纳入分析。①3组患者症状自评量表总分评定结果比较：焦虑和抑郁障碍共病患者明显高于单纯抑郁症患者和焦虑症患者（2.60&;#177;0.52，1.86&;#177;0.41和1.16&;#177;0.35；t=5.76，7．91，P〈0．01）。②3组患者症状自评量表各因子分评定结果比较：焦虑和抑郁障碍共病患者躯体化、强迫、人际、抑郁、焦虑、敌对、恐怖、偏执、精神病性等因子得分均显著高于焦虑组（P〈0．01）；焦虑和抑郁障碍共病患者除敌对外，躯体化、强迫、人际、抑郁、焦虑、恐怖、偏执、精神病性等因子得分和总分均显著高于抑郁组（P〈0．01）。结论：焦虑和抑郁障碍共病患者心理健康水平较单纯抑郁症和焦虑症患者下降程度更明显。     

老年期抑郁焦虑患者生命质量的研究

目的调查老年抑郁症和焦虑障碍共病患者与老年单纯抑郁症患者的生命质量差异。方法根据美国精神障碍诊断手册第四版(DSM-IV)的诊断标准,连续入组108例老年抑郁症患者,其中58例单纯抑郁症(抑郁症组),50例抑郁症和焦虑障碍共病(共病组)。选用健康状况调查问卷(SF-36)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)量表对其生命质量进行评定。结果抑郁症组患者的躯体功能(PF)和社会功能(SF)因子分均高于共病组,差异均有统计学意义(t分别=3.95、3.69,P均<0.05)。抑郁症组HAMD和HAMA总分均低于共病组,差异均有统计学意义(t分别=-2.69、-6.16,P均<0.05)。PF与SF呈正相关(r=0.52,P<0.05),与HAMD、HAMA呈负相关(r分别=-0.47、-0.47,P均<0.05);SF与HAMD、HAMA均呈负相关(r分别=-0.45、-0.45,P均<0.05)。结论老年抑郁和焦虑障碍共病患者的生命质量下降,较单纯抑郁患者的抑郁和焦虑症状更重,共病患者的生命质量与其抑郁焦虑症状程度相关。     

抑郁症与2型糖尿病共病患者临床特征分析

精神障碍与糖尿病的关系是当前精神病学研究的重点之一,抑郁症与糖尿病是严重影响人类心身健康的两种疾病,当两者共病时增加了治疗和护理的难度,致残率明显升高[1].为此,作者对抑郁症合并2型糖尿病患者与单纯抑郁症患者的临床资料进行对照分析,现将结果报告如下.     

老年抑郁症和焦虑障碍共病患者的临床特征

目的:研究分析老年抑郁症与焦虑障碍共病患者的临床特点。方法:选取本院2016年7月至2017年7月接收的88例抑郁症老年患者。依据患者的疾病类型将其分为单纯抑郁症组(抑郁症组,n=49)与抑郁症和焦虑障碍共病组(共病组,n=39)。通过抑郁量表、汉密顿抑郁量表、汉密顿焦虑量表以及简易智能状态评定量表、健康状况调查问卷对比两组患者之间的差异。结果:统计分析抑郁症组患者与共病组患者的基本资料、发病诱因等并无明显差异,不符合统计学意义(P>0.05);而对比两组患者GDS评分、HAMD评分、HAMA评分,共病组患者明显要高于抑郁症组患者,差异符合统计学意义(P<0.05);且郁症组患者的SF-36躯体功能与社会功能评分均低于共病组患者,差异符合统计学意义(P<0.05)。结论:与单纯的抑郁症老年患者相比较,抑郁症和焦虑障碍共病老年患者病情更严重,自杀风险更大,生活质量更差。     

中老年患者抑郁症康复治疗观察

目的观察抗抑郁药联合心理治疗与单纯心理治疗对中老年患者抑郁症状的,临床疗效。方法63例合并抑郁症的中老年患者分两组，单纯心理治疗组30例，抗抑郁药联合心理治疗组33例，两组均在治疗原发症基础上进行心理治疗，综合组同时应用抗抑郁药物治疗，治疗前后两组均进行Zung抑郁量表评分，并对主要症状改善情况进行统计。结果综合治疗组显著优于心理治疗组（P〈0.05）：结论中老年患者合并抑郁症应在心理治疗基础上适时积极应用抗抑郁药物可显著改善抑郁症状，提高生活质量，值得临床推广。     

糖尿病合并社区获得性肺炎临床分析

目的：探讨糖尿病合并社区获得性肺炎的临床特点。方法：回顾性分析42例住院糖尿病合并社区获得性肺炎患者的临床资料,与同期住院的60例单纯社区获得性肺炎患者的临床资料进行对比,从临床表现、实验室检查、治疗与转归等方面进行对比分析。结果：糖尿病合并CAP患者低蛋白血症发生率、尿蛋白阳性率、电解质紊乱的发生率高于单纯CAP组;胸部X线片双侧病变发生率较单纯CAP患者高;持续发热时间、平均住院时间较单纯CAP组长;差异均有统计学意义。结论：糖尿病合并CAP较单纯CAP患者病情严重,临床医师应予以充分重视,严格控制血糖及合理选用抗生素是治疗成功的关键。     

老年糖尿病合并肺部感染的临床与淋巴细胞免疫学分析

目的：分析老年糖尿病合并肺部感染的临床特点与免疫学变化。方法：将297例老年肺部感染者，按有无糖尿病分为糖尿病组及非糖尿病组，对照分析其临床表现、实验室检查、合并症、并发症、治疗与转归及T细胞亚群CD4／CD8的比值差异。结果：糖尿病组以发热、纳差、神志不清、大小便失禁为首发症状、低氧血症、低蛋白血症、贫血、电解质紊乱的比例数明显高于非糖尿病组，其合并症、并发症、平均住院天数及死亡率均高于非糖尿病组。糖尿病组T细胞亚群CD4／CD8的比值明显低于非糖尿病组。结论：老年糖尿病患者比一般老年患者免疫力低，更易发生肺部感染，且临床表现不典型，病情危重的多，死亡率高。     

Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.

OBJECTIVES: To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes. METHODS: Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalizedfor acute myocardial infarction in Connecticut were reviewed by trained abstractors. RESULTS: One year after myocardial infarction, elderly patients with non-insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function. CONCLUSIONS: Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non-insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.     

急性冠状动脉综合征合并糖尿病临床特点分析与护理

目的探讨急性冠脉综合征（ACS）合并糖尿病患者的危险因素及并发严重并发症时的临床特点,提出相应的护理措施。方法回顾2008年6月—2009年6月我院收治ACS患者126例,针对有无糖尿病史,分析临床特点。结果①36.5%的ACS患者伴有糖尿病;②ACS合并糖尿病患者中有空腹血糖、血胆固醇和血甘油三酯水平高于非合并糖尿病组（P〈0.05）;③ACS合并糖尿病患者住院期间严重并发症的发生率及病死率明显高于非合并糖尿病组（P〈0.05）。结论 ACS合并糖尿病的患者其临床表现不典型,致死性并发症多,预后不良。积极治疗高危因素,采取正确的防治措施,能减少并发症,降低病死率。     

Metabolic syndrome and a course of osteoarthrosis

AIM: To compare osteoarthritis (OA) course in patients with metabolic syndrome (MS) and those free of MS. MATERIAL AND METHODS: The presence and completeness of MS according to 2005 criteria were studied in 1350 OA patients (mean age 52.65 +/- 11.31 years). Most of the patients were women (74%) and persons over 45 years of age (80%). RESULTS: MS was detected in 82.3% examinees with OA. MS was complete in 62.56%. MS-free OA was separately comorbid with arterial hypertension, obesity and diabetes mellitus. OA patients with MS had earlier clinical symptoms of OA, its longer duration, prevalence of generalized disease, more frequent development of knee joint synovitis and periarthritis, more intensive pain in the joints. OA patients with MS were more frequently affected with cardiovascular, gastrointestinal, renal and thyroid diseases, diabetes mellitus and complications of these diseases. This resulted in 2.5 times greater nosological load on the patients. 20% patients with OA were declared invalid, most of them (266, 90.17%) had MS. CONCLUSION: Relationship of OA symptoms with metabolic factors may point to participation of the latter in the development and progression of OA.     

初诊2型糖尿病短期强化治疗后应用甘精胰岛素临床观察

目的 观察甘精胰岛素在初诊2型糖尿病短期强化治疗后的临床应用.方法 选择68例强化治疗后血糖控制不理想的新诊断2型糖尿病患者,将其随机分成两组,甘精胰岛素组(35例)每日1次皮下注射,预混胰岛素(诺和灵30R)组(33例)每日2次皮下注射.观察两组患者的血糖控制情况,12周后观察两组患者糖化血红蛋白及C肽水平变化.结果 两组患者血糖均明显下降,甘精胰岛素组空腹血糖下降幅度明显大于预混组(P<0.05);两组的胰岛功能均得到明显恢复,但差异无统计学意义(P＞0.05).甘精胰岛素组低血糖发生率明显低于对照组(P＜0.05),甘精胰岛素组的胰岛素用量及体质量增加值低于预混组(P＜0.05).结论 对短期强化治疗后新诊断2型糖尿病血糖控制不理想患者,应用甘精胰岛素或预混胰岛素进行治疗,均能达到明显的降糖效果,使胰岛功能得到明显恢复.其中甘精胰岛素降低空腹血糖效果更好,胰岛素用量较少,夜间低血糖发生率低,应用方便、安全、有效,患者依从性好,是值得临床应用推广.     

Increased risk of myocardial infarction in depressed patients with type 2 diabetes

OBJECTIVE

To investigate major depressive disorder (MDD), which complicates the course of type 2 diabetes and is associated with an increased risk of cardiovascular disease and death. This risk may be due to a greater susceptibility for myocardial infarction (MI) in depressed patients with type 2 diabetes compared with nondepressed patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Veterans Administration electronic medical records were analyzed to identify a cohort free of cardiovascular disease in fiscal years 1999 and 2000, aged 25 to 80 years. ICD-9-CM codes were used to create a four-level risk group indicating 1) neither diabetes nor MDD (n = 214,749), 2) MDD alone (n = 77,568), 3) type 2 diabetes alone (n = 40,953), and 4) comorbid MDD and type 2 diabetes (n = 12,679). Age-adjusted Cox proportional hazards models were computed before and after adjusting for baseline sociodemographic and time-dependent covariates.

RESULTS

After adjusting for covariates, patients with type 2 diabetes alone and patients with MDD alone were at ∼30% increased risk for MI, and patients with type 2 diabetes and MDD were at 82% increased risk for MI (hazard ratio 1.82 [95% CI 1.69–1.97]) compared with patients without either condition.

CONCLUSIONS

Compared with patients with only diabetes or only MDD, individuals with type 2 diabetes and MDD are at increased risk for new-onset MI. Monitoring cardiovascular health in depressed patients with type 2 diabetes may reduce the risk of MI in this especially high-risk group.Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI). People with type 2 diabetes have at least a twofold increased risk of MI compared with those without type 2 diabetes (1,2), and people with MDD have a similarly increased risk of MI compared with people without MDD (3). Managing type 2 diabetes is a challenge in uncomplicated patients but is more difficult in those with comorbid MDD. MDD interferes with type 2 diabetes self-care and imposes an additional risk of hyperglycemia (4). Noncompliance with medication, poor health behaviors, inflammation, and other physiologic pathways may all contribute to poor cardiovascular outcomes in patients with MDD and type 2 diabetes (5–8).Katon et al. (9) reported that compared with nondepressed patients with type 2 diabetes, patients with type 2 diabetes and MDD were approximately twice as likely to have cardiovascular risk factors, including smoking, obesity, sedentary lifestyle, and glycosylated hemoglobin >8.0. These risk factors are associated with poor cardiovascular outcomes, and after adjustment for clinical characteristics and self-care, depressed patients with type 2 diabetes were at a 24% increased risk of macrovascular complications (7). In this same cohort, all-cause death and cardiovascular death were both significantly elevated in patients with MDD and type 2 diabetes than in patients without MDD. However, the risk of cardiovascular death was attenuated and no longer significant after adjustment for demographics, diabetes severity, comorbidity, health behaviors, and other clinical characteristics at baseline (6). These results from insurance enrollees in Washington state are supported by similar findings from the National Health and Nutrition Examination Survey, in which depression in type 2 diabetes was associated with greater all-cause mortality and with coronary heart disease (10).Although evidence indicates that depression worsens cardiovascular outcomes in type 2 diabetes, extant studies have been limited to just two cohorts. In addition these studies have examined the effects of depression on composite cardiovascular outcomes but have not reported specific cardiovascular end points such as MI. To fill this gap in the literature, we analyzed data from the national Veterans Administration (VA) medical records system to determine if depressed patients with type 2 diabetes are at increased risk of MI compared with patients with neither MDD nor diabetes, with patients with diabetes alone, and with patients with MDD alone.     

伴精神病性症状的重性抑郁障碍患者听觉事件相关电位P300研究

目的探讨伴精神病性症状的重性抑郁障碍患者听觉事件相关电位P300变化。方法将52例重性抑郁障碍患者设为研究组,将研究组中18例伴有精神病性症状者设为A组,34例无精神病性症状者设为B组;随机抽取52例正常健康体检者设为对照组。对所有对象进行听觉事件相关电位P300检测,并进行对比分析。结果研究组听觉事件相关电位P300的P3波潜伏期较对照组明显延长（P〈0．05）;A组P3波潜伏期较B组明显延长,P3波幅较B组显著降低（P〈0.05）。结论伴精神病性症状的重性抑郁障碍患者听觉事件相关电位P300有显著改变,听觉事件相关电位P300检测有助于其临床诊断。     

糖尿病患者血小板参数、血液流变学和凝血功能指标检测的临床意义

目的:探讨糖尿病患者血小板参数、血液流变学和凝血功能指标的临床价值.方法:对46例糖尿病有微血管病变患者、46例糖尿病无微血管病变患者和90例正常对照组的血浆凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原进行检测,测定三组人群血流变参数及血小板参数.结果:糖尿病有微血管病变组凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均低于糖尿病无微血管病变组,而纤维蛋白原高于糖尿病无微血管病变组,两者之间差异有统计学意义(P＜0.05);血小板参数中平均血小板体积高于糖尿病无微血管病变组(P＜0.05),而血小板分布宽度、血小板计数和血小板压积差异均无统计学意义(P＞0.05);血流变参数中全血黏度、血浆黏度、红细胞压积均高于糖尿病无微血管病变组.结论:常规检测血小板参数、血液流变学和凝血功能指标,对糖尿病微血管病变患者的病情预测和早期诊治有重要意义.     

糖尿病患者血清同型半胱氨酸、脂蛋白a、超敏C反应蛋白联合检测的临床意义

目的：探讨联合检测糖尿病患者血清同型半胱氨酸（Hcy）、脂蛋白 a[Lp（a）]、超敏 C反应蛋白（hsCRP）水平的临床意义。方法检测30例糖尿病并发微血管病变患者、30例单纯糖尿病患者、44例健康体检者的血清 Hcy,Lp（a）和hsCRP水平,用 SPSS13.0统计学软件处理数据。结果糖尿病并发微血管病变组血清 Hcy,Lp（a）和 hsCRP水平均显著高于单纯糖尿病组和健康对照组（P＜0.05）,单独检测时,Lp（a）的阳性率高于 Hcy和 hsCRP 的阳性率,Hcy,Lp（a）和hsCRP联合检测时,阳性率高于各个项目单独检测的阳性率。结论 Hcy,Lp（a）和 hsCRP与糖尿病微血管病变的发生、发展关系密切,三者联合检测对监测糖尿病微血管病变的发生、发展具有一定的临床应用价值。