ApoE基因多态性与中国人2型糖尿病及其心血管并发症的关系

目的为研究载脂蛋白Ｅ（ＡｐｏＥ）基因多态性与２型糖尿病及其心血管并发症的关系。方法以载脂蛋白Ｅ（ＡｐｏＥ）基因为候选基因，运用聚合酶链反应限制性片段长度多态性（ＰＣＲＲＦＬＰ）方法检测了１１２例２型糖尿病患者及６０例正常对照者的ＡｐｏＥ基因型。结果两组研究对象其ε３、ε２和ε４等位基因的分布频率分别为０．８４４，０．０９３，０．０６３和０．８６７，０．０８３，０．０５０（Ｐ＞０．０５），说明ＡｐｏＥ基因多态性与中国人２型糖尿病发病无相关性，通过比较２型糖尿病患者不同ＡｐｏＥ基因型与其血脂指标的关系发现：ＡｐｏＥ基因多态性与血总胆固醇水平（Ｐ＝０．００２９）及血低密度脂蛋白（ＬＤＬ）Ｃ水平（Ｐ＝０．００２１）相关，携带ε４等位基因的个体具有较高的ＴＣ及ＬＤＬＣ水平，而携带ε２等位基因的个体具有较低的ＴＣ及ＬＤＬＣ水平。ＡｐｏＥ基因多态性与２型糖尿病伴高血压无相关（Ｐ＝０．１１１）。携带ε４等位基因的患者冠心病发病率明显较携带其他等位基因患者为高（Ｐ＝０．００８）。结论ε４等位基因可能是２型糖尿病合并冠心病的一个危险因子     

载脂蛋白E基因多态性与冠心病关系的研究

目的：探讨载脂蛋白Ｅ（ａｐｏＥ）基因多态性在冠心病（ＣＨＤ）发生发展中的作用及其对血脂质、脂蛋白水平的影响。方法：应用聚合酶链反应技术和遗传学方法,测定９３ 例ＣＨＤ患者和９４例正常对照者的ａｐｏＥ基因型;按常规方法测定血浆脂质、脂蛋白水平。结果：共发现５ 种ａｐｏＥ基因型,分别为Ｅ３／３、Ｅ３／２、Ｅ４／３、Ｅ４／２和Ｅ４／４。ＣＨＤ组ａｐｏＥ４／３ 基因型和ε４ 等位基因频率及总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）均显著高于对照组（均Ｐ＜ ０．０１）,ａｐｏＡＩ的水平高于对照组（Ｐ＜ ０．０５）,其他血脂指标无显著性差异（ Ｐ＞ ０．０５）。在ＣＨＤ组各亚型之间,ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平之间存在显著性差异（Ｐ＜ ０．０５）。结论：ａｐｏＥε４ 等位基因是ＣＨＤ重要的遗传易患因素,ａｐｏＥ基因多态性亦影响血ＴＣ、ＬＤＬ－Ｃ和ａｐｏＡＩ水平。     

武汉地区Ⅱ型糖尿病患者冠心病与载脂蛋白E基因型的关系

应用聚合酶链反应（ＰＣＲ）技术，对随机选择的１２５例ＮＩＤＤＭ患者和５０例非ＤＭ患者进行ＡｐｏＥ基因型检测，以研究ＮＩＤＤＭ患者ＣＨＤ与ＡｐｏＥ基因型间的关系。结果表明，ＮＩＤＤＭ患者心肌梗塞和缺血性心电图改变在Ａｐｏε４／４和ε４／３型组中发生率分别为２１％和４１％，但不同基因型组间差异无显著性。心绞痛在Ａｐｏε４／４和ε４／３型组中为５２％，显著高于ε３／３型组（３１％，Ｐ＜０．０５）。Ａｐｏε４／４和ε４／３型ＮＩＤＤＭ患者，任何证据的ＣＨＤ发生率为７２％，显著高于ε３／３型组（３７％）及ε２／２、ε３／２型组（３３％，Ｐ＜０．０１）。ＮＩＤＤＭ患者中ＣＨＤ组Ａｐｏε３／３和ε４／３基因型频率分别为５２％和３４％，分别低于（ε３／３）、高于（ε４／３）非ＣＨＤ组（７１％，Ｐ＜０．０５；１０％，Ｐ＜０．０１）；ＣＨＤ组ε４等位基因频率为２１％，明显高于非ＣＨＤ组（７％，Ｐ＜０．０１）。提示Ａｐｏε４／４和ε４／３为ＮＩＤＤＭ患者ＣＨＤ的重要危险指标。     

老年冠心病载脂蛋白E基因多态性相关性分析及其对血脂的影响

目的 研究载脂蛋白Ｅ（ＡｐｏＥ）基因多态性与老年冠心病（ＣＨＤ）的相关关系及其对血脂水平的影响。方法 应用聚合酶链反应－限制性片段长度多态性（ＰＣＲ－ＲＦＬＰ）基因分析方法，测定１６１例老年ＣＨＤ患者和８６例同年龄对照者的ＡｐｏＥ基因型；血脂水平按常规方法测定。结果 本共发现５种ＡｐｏＥ基因型，分别为Ｅ３／３、Ｅ４／４、Ｅ４／３及Ｅ４／２。老年ＣＨＤ组ＡｐｏＥ４／３基因型和ε４等位基因频率均高于对     

老年痴呆患者apoE基因型分布

目的观察中国老年痴呆患者ａｐｏＥ基因型的分布，初步探讨ａｐｏＥ在老年痴呆发病中的作用。方法应用聚合酶链式反应（ＰＣＲ）对３５例健康人、２３例多梗塞性痴呆（ＭＩＤ）及１７例老年性痴呆（ＡＤ）患者进行ａｐｏＥ基因多态性分析，测定血清胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白ＡⅠ（ａｐｏＡⅠ）、载脂蛋白Ｂ（ａｐｏＢ）和载脂蛋白Ｅ（ａｐｏＥ）的浓度。结果ＡＤ组与健康对照组在ａｐｏＥ基因频率及等位基因频率分布上的差异有显著性（χ２＝１１．５，Ｐ＜０．０５；χ２＝１６．２，Ｐ＜０．０１）；ＭＩＤ组与健康对照组间差异无显著性（Ｐ＞０．０５）；应用Ｗｏｏｌｆ公式计算，发现ａｐｏＥε４等位基因与ＡＤ之间有显著性关联（χ２＝７．７，Ｐ＜０．０１），相关危险度（ＲＲ）＝３．０。ＡＤ组血清ａｐｏＥ水平显著高于对照组（Ｐ＜０．０５），而ＴＣ、ＬＤＬ－Ｃ、ａｐｏＡⅠ、ａｐｏＢ显著低于对照组（Ｐ＜０．０５）。结论结果提示ａｐｏＥε４等位基因与老年性痴呆有显著性关联，ａｐｏＥε４可能是ＡＤ发病的危险因素。     

痴呆患者载脂蛋白E基因型及表型的研究

目的研究载脂蛋白Ｅ（ＡｐｏＥ）多态性与痴呆疾病的关系。方法对对照组（５３例）和痴呆组［其中包括Ａｌｚｈｅｉｍｅｒ’ｓ病（ＡＤ）１８例，血管性痴呆（ＶＤ）２３例和帕金森病痴呆（ＰＤＤ）１３例］的载脂蛋白Ｅ基因频率和表型多态性的关系进行了比较。结果对照组ＡｐｏＥ基因频率以ε３最为常见，占９２．５％，其表型分布以Ｅ３／３型为主（占８６．８％）；在痴呆组中，ＡＤ组ＡｐｏＥε４和ε２基因频率分别为１９．４％和１３．９％，明显多于对照组（Ｐ＜０．０５～０．０１），而ＶＤ组和ＰＤＤ组ＡｐｏＥε４和ε２基因频率与非痴呆对照组相比差别无显著性（Ｐ＞０．０５）；ＡＤ组ＡｐｏＥ表型中的Ｅ３／４型和Ｅ２／３型明显高于对照组，而ＶＤ组和ＰＤＤ组中其他各型差异均不显著。结论ＡｐｏＥε４和ε２与ＡＤ关系极为密切，与ＶＤ和ＰＤＤ的关系尚需进一步研究     

老年NIDDM患者apoE等位基因频率变化的研究

为研究老年ＮＩＤＤＭ患者ＡｐｏＥ等位基因频率的变化，采用ＰＣＲ技术检测了４０￣８０岁ＮＩＤＤＭ患者１４０例的ａｐｏＥ基因型。结果表明，老年组ε４等位基因率为８．６％，明显低于非老年组的１７．９％（Ｐ〈０．０５）。当调整年龄和性别的影响后，ＮＩＤＤＭ患ε４和ε３与ＴＣ呈正相关（Ｐ分别〈０．０１及〈０．０５），ε４与ＬＤＬ－Ｃ呈正相关（Ｐ〈０．０１）。故我们推测，携ε４的ＮＩＤＤＭ患者ＴＣ和ＬＤＬ－Ｃ     

陈旧性心肌梗塞者血胆固醇低水平的临床意义

本文观察了１９８例老年及老年前期陈旧性心肌梗塞患者的血脂质和载脂蛋白的变化，重点探讨血胆固醇不高患者的致病因素，特别是脂蛋白（ａ）〔Ｌｐ（ａ）〕的临床意义。结果显示，Ｉ组（ＴＣ＞３．８８ｍｍｏｌ／Ｌ）的ＴＣ、ＴＧ、ＬＤＬ－Ｃ和ＡｐｏＢ水平均高于Ⅱ组（ＴＣ≤３．８８ｍｍｏｌ／Ｌ）（Ｐ＜０．０５～０．００１），但Ｌｐ（ａ）水平却明显低于Ⅱ组（Ｐ＜０．０５），高脂蛋白血症［Ｌｐ（ａ）＞０．３ｇ／Ｌ］的发生率也明显低于Ⅱ组（２７．４％比４８．２％）。ＨＤＬ－Ｃ和ＡｐｏＡ１水平在２组间无显著差异。由此提示，Ｌｐ（ａ）作为心肌梗塞的危险因素，可能不依赖于ＴＣ、ＬＤＬ－Ｃ而发挥作用。因此对血胆固醇不高的心肌梗塞患者应特别注意监测Ｌｐ（ａ）水平，在心肌梗塞后的二级预防中对于高脂蛋白血症者宜采取适当措施。     

载脂蛋白E基因多态性与冠心病关系的研究

目的：探讨载脂蛋白（Ａｐｏ）Ｅ基因多态性与冠心病的相关性，以及ＡｐｏＥ基因多态性对冠心病患者血脂水平的影响。方法：１００例冠心病患者和４３例正常对照者。按常规方法测定血浆脂质和Ａｐｏ水平。ＡｐｏＥ基因型的确定采用聚合酶链反应和ＨｈａＩ酶切的方法。结果：本研究只发现３种常见的ＡｐｏＥ基因型，即Ｅ３／３，Ｅ３／４，Ｅ３／２。在病例组和正常对照组之间，ＡｐｏＥ等位基因频率以及基因型频率分布没有统计学差异（Ｐ＞０．０５）。在冠心病患者不同基因型之间，总胆固醇和ＡｐｏＢ的水平有差异（Ｐ＜０．０５）；其它血脂指标无差异（Ｐ＞０．０５）。结论：本研究证实ＡｐｏＥ基因多态性影响冠心病患者总胆固醇和ＡｐｏＢ的水平；但ＡｐｏＥ基因多态性并不是冠心病发病的直接危险因子。     

老年人冠心病载脂蛋白E基因多态性的临床意义

目的：载脂蛋白Ｅ（ＡｏｏＥ）基因的多态性对老年冠心病发病的意义。方法：选择１００例老年冠心病患（ＣＨＤ组）及１００例键康。测定其血清血脂及脂蛋白「（ＬＰ（ａ）」。应用聚合酶链反应法（ＰＣＲ）,Ｈｈａｌ内切酶消化法确定ＡｏｏＥ基因多态性。结果：在冠心病组和对照组间ＡｏｏＥ基因频率及Ｅ２、Ｅ３、Ｅ４等位基因频率有显差异（Ｐ〈０．０５）;本组Ｅ４／３、Ｅ３／３基因组间比较,冠心病组ＴＣ、ＴＧ、Ａｏ     

外科手术伴糖尿病患者的护理研究

目的分析探究外科手术伴糖尿病患者的护理方法及应用效果。方法此次研究采取随机盲选法,将2018年3月-2019年4月进入该院接受手术治疗的74例伴糖尿病患者划分为2组,各组平均37例;其中,对照组患者采取常规护理方法,观察组患者采取个体化护理干预方法,进一步比较两组患者的血糖指标、VAS评分及护理满意度。结果①护理后,观察组空腹血糖、餐后2 h血糖及糖化血红蛋白3项血糖指标水平均显著要比对照组低(P<0.05)。②护理后,观察组VAS评分与对照组对比要低(P<0.05)。③观察组护理总满意度的94.59%,明显低于对照组的72.97%(P<0.05)。结论针对外科手术伴糖尿病患者,采取个体化护理干预的效果显著,可以改善患者的血糖水平,减轻患者术后疼痛程度,进一步提高患者的护理满意度;所以,具备采纳及应用。     

老年糖尿病患者的预防及护理探析

目的老年糖尿病患者的预防及护理探析。方法选取该院2016年12月-2019年6月收治的老年糖尿病患者82例,将其按照随机分组法分为对照组和实验组,其中对照组41例采用常规化护理,实验组41例采用综合化护理干预,对比两组患者经过护理1个月后,患者护理满意度,护理干预有效率以及并发症发情况。结果经过护理干预后,实验组患者护理满意度高于实验组,实验组为41例(100.00%)高于对照组38例(92.68%);实验组护理并发症低于对照组,其中实验组6例(14.63%),对照组12例(29.27%),实验组护理有效率为40例(97.56%),优于实验组36例(87.80%)。所有指标综合数据对比,差异有统计学意义(P<0.05),表示护理干预有效。结论对老年糖尿病患者进行综合化护理干预有效。     

Effects of Secretin on Parathyroid Hormone and Calcium in Normal Subjects,Patients with Hyperparathyroidism and Patients with Gastrinoma

ABSTRACT In vitro studies have demonstrated that secretin can stimulate the release of parathyroid hormone (PTH), but reports concerning its effects on PTH and calcium in vivo are contradictory. To examine this question further, a bolus injection of secretin (75 IU) was given to 12 normal subjects and 10 patients with primary hyperparathyroidism (HPT). Six of the patients had multiple endocrine neoplasia and five had endocrine pancreatic tumours (EPT). Three normocalcaemic patients with EPT were also included in the study. The mean serum gastrin level rose significantly (from 19 to 40 pmol/1, p<0.01) within 15 min of secretin injection in the normal subjects. HPT patients without EPT had a somewhat higher mean basal level of gastrin (39 pmol/1, p<0.05 compared with controls), but it did not increase significantly after the secretin bolus. In six EPT patients the gastrin concentrations rose by more than 300 pmol/1. Although secretin had a biological capacity to release gastrin, it had no discernible effects on either serum PTH or serum calcium in any of the groups studied. Nor were any changes in PTH or calcium observed when secretin was given as a continuous infusion (3 IU/kg/h) over 90 min. Thus, our data do not support the concept that secretin, in vivo, is a secretagogue of PTH.     

Effect of Lisinopril and Atenolol on Aortic Stiffness in Patients on Hemodialysis

Background and objectives

Whether improvements in arterial compliance with BP lowering are because of BP reduction alone or if pleiotropic effects of antihypertensive agents contribute remains unclear. It was hypothesized that, among patients on hemodialysis, compared with a β-blocker (atenolol), a lisinopril-based therapy will better reduce arterial stiffness.

Design, setting, participants, & measurements

Among 200 participants of the Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril Trial, 179 patients with valid assessment of aortic pulse wave velocity at baseline (89 patients randomly assigned to open-label lisinopril and 90 patients randomly assigned to atenolol three times a week after dialysis) were included in the secondary analysis. Among them, 109 patients had a valid pulse wave velocity measurement at 6 months. Monthly measured home BP was targeted to <140/90 mmHg by addition of antihypertensive drugs and dry weight adjustment. The difference between drugs in percentage change of aortic pulse wave velocity from baseline to 6 months was analyzed.

Results

Contrary to the hypothesis, atenolol-based treatment induced greater reduction in aortic pulse wave velocity relative to lisinopril (between drug difference, 14.8%; 95% confidence interval, 1.5% to 28.5%; P=0.03). Reduction in 44-hour ambulatory systolic and diastolic BP was no different between groups (median [25th, 75th percentile]; atenolol: −21.5 [−37.7, −7.6] versus lisinopril: −15.8 [−28.8, −1.5] mmHg; P=0.27 for systolic BP; −14.1 [−22.6, −5.3] versus −10.9 [−18.4, −0.9] mmHg, respectively; P=0.30 for diastolic BP). Between-drug difference in change of aortic pulse wave velocity persisted after adjustments for age, sex, race, other cardiovascular risk factors, and baseline ambulatory systolic BP but disappeared after adjustment for change in ambulatory systolic BP (11.8%; 95% confidence interval, −2.3% to 25.9%; P=0.10).

Conclusions

Among patients on dialysis, atenolol was superior in improving arterial stiffness. However, differences between atenolol and lisinopril in improving aortic stiffness among patients on hemodialysis may be explained by BP-lowering effects of drugs.     

甲状腺机能亢进和减退患者的胃电图改变初探

目的通过胃电图(EGG)检查,观察32例甲状腺机能亢进(甲亢)病人,29名甲状腺机能减退(甲减)病人及30名正常健康人餐前和餐后30min的体表胃电频谱变化。结果3组内餐后胃电图主频(DF)、平均幅值(AP)、正常慢波百分比(N%)与餐前相比均有显著增加(P<0.01)。甲亢组主频和平均幅值与对照组相比,无显著差异(P>0.05),甲减组平均幅值与正常慢波百分比较对照组差异显著(P<0.01)。结论甲亢组食欲亢进在胃电图上无特殊反映,表现为主频正常,胃电节律正常,振幅亦无明显升高。甲减组食欲减退可能与胃动过缓,胃电节律紊乱增多有关。     

Differences in Metabolic Variables between Adult Coeliac Patients at Diagnosis and Patients on a Gluten-Free Diet

Background: Coeliac patients often have nutrient malabsorption with nutritional status impairment, but no report on their energy requirements is available. In this study body composition, dietary habits, basal energy expenditure, and substrate oxidation were investigated in patients with the classic form of coeliac disease. Methods: Sixteen untreated and 18 adult coeliac patients on a gluten-free diet participated in the study. Body composition was assessed by anthropometry and bioimpedance. Energy expenditure was measured by indirect calorimetry. A food diary over 7 days was collected. Results: Coeliac patients showed reduced body weight components but not a different fat-free mass percentage compared with age-and sex-matched healthy volunteers. Basal metabolic rate normalized by fat-free mass (BMR/FFM) was higher in coeliac patients than in controls. Untreated patients showed a significantly higher non-protein respiratory quotient with regard to both treated patients (P < 0.01) and controls (P < 0.05), an increased percentage of carbohydrate intake, and a good correlation between Hpid faecal loss and carbohydrate oxidation (Spearman R = 0.74; P < 0.01). Conclusions: Both groups of patients had lower fat mass and FFM content than controls. The preferential carbohydrate oxidation in untreated patients might be a result of both lipid malabsorption and high carbohydrate intake.     

Satisfaction with Care of Patients on Hemodialysis

Background and objectives

Little is known about patients receiving dialysis who respond to satisfaction and experience of care surveys and those who do not respond, nor is much known about the corollaries of satisfaction. This study examined factors predicting response to Dialysis Clinic, Inc. (DCI)’s patient satisfaction survey and factors associated with higher satisfaction among responders.

Design, setting, participants, & measurement

A total of 10,628 patients receiving in-center hemodialysis care at 201 DCI facilities between January 1, 2011, and December 31, 2011, aged ≥18 years, treated during the survey administration window, and at the facility for ≥3 months before survey administration. Primary outcome was response to at least one of the nine survey questions; secondary outcome was overall satisfaction with care.

Results

Response rate was 77.3%. In adjusted logistic regression (odds ratios with 95% confidence intervals), race other than black (white race, 1.23 [1.10 to 1.37]), missed treatments (1.16 [1.02 to 1.32]) or shortened treatments (≥5 treatments, 1.40 [1.22 to 1.60]), more hospital days (>3 days in the last 3 months, 1.89 [1.66 to 2.15]), and lower serum albumin (albumin level <3.5 g/dl, 1.4 [1.28 to 1.73]) all independently predicted nonresponse. In adjusted linear regression, the following were more satisfied with care: older patients (age ≥63 years, 1.84 [1.78 to 1.90]; age <63 years, 1.91 [1.86 to 1.97]; P<0.001), white patients (1.76 [1.71 to 1.81]) versus black patients (1.93 [1.88 to 1.99]) or those of other race (1.93 [1.83 to 2.03]) (P<0.001), patients with shorter duration of dialysis (≤2.5 years, 1.79 [1.73 to 1.84]; >2.5 years, 1.96 [1.91 to 2.02]; P<0.001), patients who had missed one or fewer treatments (1.83 [1.78 to 1.88]) versus those who had missed more than one treatment (1.92 [1.85 to 1.98]; P=0.002) and those who had shortened treatment (for one treatment or less, 1.84 [1.77 to 1.90]; for two to four treatments, 1.87 [1.81 to 1.93]; for five or more treatments, 1.92 [1.87 to 1.98]; P=0.004).

Conclusions

Survey results represent healthier and more adherent patients on hemodialysis. Shorter survey administration windows were associated with higher response rates. Older, white patients with shorter dialysis vintage were more satisfied.     

血液透析滤过与血液透析对维持性血液透析患者疗效的比较

目的比较联机血液透析滤过（OL-HDF）与常规血液透析（RHD）对维持性血液透析（MHD）患者的临床疗效。方法将入选的60例MHD患者按随机排列表法分为两组,HDF组30例行后稀释法OL-HDF,HD组30例行RHD治疗。观察治疗前后及组间并发症发生情况,以及甲状旁腺素（PTH）、β2-微球蛋白（β2-MG）、超敏C反应蛋白（hs-CRP）、Kt/V值的变化。结果 OL-HDF可减少MHD患者的顽固性皮肤瘙痒、周围神经病变、慢性骨痛等并发症;治疗6个月后HDF组血清PTH、β2-MG、hs-CRP水平较HD组显著降低,而Kt/V值变化差异无统计学意义。结论 OL-HDF能更好地清除尿毒症毒素,预防和减少透析相关并发症的发生,明显改善MHD患者微炎症状态,提高患者治疗效果及生活质量。