门冬胰岛素30联合阿卡波糖治疗初诊2型糖尿病的临床观察

目的评估门冬胰岛素30联合阿卡波糖治疗初诊2型糖尿病的有效性与安全性。方法 60例初诊2型糖尿病患者随机分为两组,每组各30例。门冬胰岛素30联合阿卡波糖组(A组):门冬胰岛素30三餐前皮下注射联合阿卡波糖50mg每日三次口服。门冬胰岛素联合甘精胰岛素组(B组):门冬胰岛素三餐前皮下注射联合甘精胰岛素晚9时皮下注射。共治疗2周,观察血糖控制情况、血糖达标时间、胰岛素用量、低血糖发生情况及体重增加情况、副反应等。结果治疗后两组空腹血糖(FBG)和餐后2小时血糖(2hBG)、日平均血糖均较治疗前明显下降、低血糖反应少、安全性好。门冬胰岛素30联合阿卡波糖组达标时间短、胰岛素用量少、体重无明显增加。结论门冬胰岛素30联合阿卡波糖可以良好控制高血糖,达标时间短、胰岛素用量少、对体重影响小,是初诊2型糖尿病的理想选择。     

甘精胰岛素联合阿卡波糖治疗老年糖尿病的临床研究

选取2016年7月至2017年4月68例老年糖尿病患者,均分为,对照组采用阿卡波糖治疗,研究组甘精胰岛素联合阿卡波糖治疗。结果研究组空腹血糖(FBG)、餐后2h血糖(2hPG)以及糖化血红蛋白(HbAI_(1c))指标,不良反应发生率(5.88%)低于对照组(35.29%),(P0.05)。结论甘精胰岛素联合阿卡波糖治疗老年糖尿病有效控制血糖,降低不良反应发生率。     

门冬胰岛素50对2型糖尿病患者血糖控制效果的观察

目的观察甘精胰岛素联合阿卡波糖和门冬胰岛素50治疗2型糖尿病的临床疗效。方法选择69例经口服药治疗无效的2型糖尿病患者,随机分为2组,分别给予甘精胰岛素联合阿卡波糖与门冬胰岛素50,3次/日,餐前注射,治疗12周,观察2组患者空腹血糖(FPG)、餐后2小时血糖(2h PG)、糖化血红蛋白(Hb A1c)、胰岛素用量、血糖达标时间、体重指数(BMI)、低血糖发生情况等各项指标的变化,从而比较治疗效果。结果 2组患者空腹血糖控制水平相似,而门冬胰岛素50组餐后血糖控制优于甘精胰岛素联合阿卡波糖组,同时门冬胰岛素50组Hb A1c水平更低,胰岛素用量少,血糖达标时间短,差异均有统计学意义(P0.05)。两组低血糖发生率相似。结论门冬胰岛素50治疗2型糖尿病疗效肯定,对餐后血糖的控制存在优势,且安全性良好。     

甘精胰岛素联合阿卡波糖治疗非肥胖2型糖尿病临床观察

98例2型糖尿病患者,使用甘精胰岛素联合阿卡波糖治疗非肥胖2型糖尿病,入院时测体重、身高、体重指数、腰围、臀围、腰臀比、糖化血红蛋白、空腹血糖、餐后2小时血糖等。98例患者治疗后空腹血糖和餐后2小时血糖均下降,与治疗前比较有显著差异;甘精胰岛素用量与年龄、BMI、HbA1c、FPG、2hPG之间有相关性;低血糖发生率明显减少。结论甘精胰岛素联合阿卡波糖治疗非肥胖2型糖尿病患者效果满意低血糖发生率下降,体重增加不明显。     

甘精胰岛素联合阿卡波糖治疗老年糖尿病的临床疗效分析

目的评价甘精胰岛素、阿卡波糖联合应用治疗老年糖尿病的临床疗效。方法选择该院2017年1月—2019年3月收治的96例老年糖尿病患者,应抽签法随机分为对照组、联合组,对照组接受甘精胰岛素治疗,联合组接受甘精胰岛素+阿卡波糖治疗,比较两组治疗前、治疗后1个月的血糖状况及不良反应发生情况。结果两组治疗前的血糖指标(空腹血糖、餐后2 h血糖、糖化血红蛋白)检测结果比较均差异无统计学意义(P0.05),治疗后1个月,联合组的上述指标水平均较对照组低(P0.05)。两组不良反应发生率比较差异无统计学意义(P0.05)。结论甘精胰岛素、阿卡波糖联合应用治疗老年糖尿病,疗效可靠,安全性较高。     

甘精胰岛素联合阿卡波糖治疗2型老年糖尿病的效果评价

目的观察甘精胰岛素联合阿卡波糖治疗老年糖尿病的临床效果。方法选择该院100例70岁以上老年2型糖尿病患者实施该次研究选取时间2015年4月—2018年4月,根据抽签法分为观察组(50例)和对照组(50例)。观察组使用甘精胰岛素联合阿卡波糖,对照组在使用普通胰岛素基础上应用甘精胰岛素,比较两组患者临床效果。结果观察组2 h PG(餐后2 h血糖)、Hb A1c(糖化血红蛋白)、FC-p (空腹C肽)、FBG(空腹血糖)等糖代谢指标改善程度高于对照组(P0.05)。观察组低血糖反应发生率、血糖达标时间、胰岛素使用量低于对照组,观察组血糖控制率高于对照组(P0.05)。结论在老年2型糖尿病中应用阿卡波糖及甘精胰岛素联合治疗,可降低低血糖反应发生率及胰岛素使用量,改善患者糖代谢指标,缩短血糖达标时间,临床应用及推广价值极高。     

甘精胰岛素联合阿卡波糖治疗非肥胖2型糖尿病临床观察

目的 评价甘精胰岛素联合阿卡波糖对非肥胖2型糖尿病血糖控制及低血糖事件的影响.方法 非肥胖2型糖尿病患者49例,分为甘精胰岛素联合阿卡波糖组(24例)应用甘精胰岛素日一次皮下注射配合阿卡波糖片日三次口服;预混人胰岛素组(25例)应用预混型人胰岛素70/30早晚餐前30分钟皮下注射.12周后随访血糖控制和低血糖事件发生情况.结果 两组空腹血糖,餐后2小时血糖,糖化血红蛋白较治疗前明显下降(P＜0.01).甘精胰岛素联合阿卡波糖组空腹血糖控制优于B组[(6.63±0.73)mmol/ L 对(7.21±0.88)mmol/ L )](P＜0.05),甘精胰岛素联合阿卡波糖组2例,预混人胰岛素组8例出现低血糖,两组比较差异有显著性(P＜0.05).结论 甘精胰岛素与阿卡波糖联合应用更好地改善了血糖控制,减少了低血糖发生率,增加了患者依从性.     

甘精胰岛素联合阿卡波糖治疗早期2型糖尿病

60例早期2型糖尿病患者给予甘精胰岛素联合阿卡波糖治疗12周后对比HbA1c、FPG、2hPG、低血糖事件发生数。结果：甘精胰岛素联合阿卡波糖治疗12周后HbA1c、FPG和2hPG均显著降低。结论：对早期2型糖尿病患者给予甘精胰岛素联合阿卡波糖治疗可提供良好的血糖控制,患者依从性好,低血糖事件发生少,是有效简便的治疗方案。     

甘精胰岛素联合格列美脲及阿卡波糖治疗2型糖尿病的疗效分析

目的分析研究2型糖尿病采取甘精胰岛素联合格列美脲及阿卡波糖共同治疗的临床效果。方法选取2011年8月—2014年4月在该院接收的患有2型糖尿病的病人一共有114例,随机分为研究组、对照组,对照组对病人采取甘精胰岛素联合格列美脲治疗,研究组对病人采取甘精胰岛素联合阿卡波糖治疗,对研究组与对照组病人治疗效果给予分析研究。结果两组病人的空腹血糖、餐后2 h血糖、平均血糖、最高血糖以及Hb Alc水平都有明显降低,其中研究组餐后2 h血糖下降明显高于对照组(P0.05);治疗3个月以后,研究组病人空腹血糖、餐后2 h血糖以及Hb Alc水平达标率明显高于对照组;研究组低血糖发生率明显低于对照组(P0.05)。结论 2型糖尿病采取甘精胰岛素联合阿卡波糖共同治疗,可以使病人血糖控制在有效范围之内,以及低血糖发生率明显减少,具有临床推广价值。     

甘精胰岛素联合阿卡波糖治疗老年糖尿病的效果分析

目的探讨甘精胰岛素联合阿卡波糖治疗老年糖尿病的效果分析。方法回顾性分析2016年1月—2018年12月在该院确诊并治疗的老年糖尿病患者的临床资料,从中按治疗方案不同分为两组,对照组使用预混胰岛素(诺和灵30R)治疗,观察组使用甘精胰岛素联合阿卡波糖治疗,随机从两组中各抽取100例病例。比较两组患者的血糖各指标变化、临床疗效、胰岛素用量及血糖达标时间、低血糖及其他不良反应发生率。结果观察组治疗后FPG、2 h PG、Hb A1c、BMI水平均明显低于对照组(P0.05);观察组治疗有效率为97.00%,明显高于对照组的76.00%(P0.05);观察组血糖达标时间、胰岛素用量明显少于对照组(P0.05);观察组低血糖、胃肠道不适等不良反应发生率明显低于对照组(P0.05)。结论甘精胰岛素联合阿卡波糖治疗老年糖尿病的效果显著,能有效控制血糖和体重,加快血糖达标速度,减少胰岛素用量,且低血糖发生率低,具有较好的疗效及安全性。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。