2型糖尿病肾病患者血清脂联素水平分析

目的:检测2型糖尿病肾病(diabetic nephropathy,DN)患者血清脂联素、尿白蛋白排泄量、血脂水平,探讨2型糖尿病肾病患者血清脂联素与各影响因素的关系,及DN不同阶段血清脂联素水平的变化趋势。方法:从入院的2型糖尿病患者中随机选择60例患者与30例正常健康体检者(对照组),根据尿白蛋白排泄量将糖尿病患者分为3组:<30 mg/d的极微量白蛋白尿组(32例),30～300 mg/d的微量白蛋白尿组(14例),>300 mg/d的大量白蛋白尿组(14例)。检测血清脂联素,同时测定HbAlc、血脂水平、尿白蛋白排泄量,比较各组间的差异。结果:正常人血清脂联素[(9.69±2.23)mg/L]明显高于2型糖尿病患者[(2.17±1.95)mg/L],微量白蛋白尿组的血清脂联素[(2.52±0.61)mg/L]高于极微量白蛋白尿组[(0.74±0.47)mg/L],大量白蛋白尿组的血清脂联素水平最高[(5.32±1.86)mg/L,P<0.001]。直线相关分析显示:血清脂联素水平与尿白蛋白定量、肌酐呈正相关(分别为r=0.42,r=0.38);与HbAlc、BMI、甘油三脂(TG)呈负相关(分别为r=-0.41,r=-0.29,r=-0.23);对糖尿病患者逐步回归分析显示,血清脂联素受尿白蛋白排泄量、HbAlc、BMI及肌酐的影响较大。结论:2型糖尿病肾病存在糖代谢与脂代谢紊乱及胰岛素抵抗,这可能是血清脂联素较正常健康体检者降低的原因,但2型糖尿病患者随着尿白蛋白排泄量的升高,其血清脂联素水平事实上是升高的,其原因尚待进一步探讨。     

血清脂联素水平与2型糖尿病、胰岛素抵抗的关系

目的:探讨血清脂联素与胰岛素抵抗、2型糖尿病的相关性.方法:以我院诊治的89例2型糖尿病患者(观察组)和90例年龄、性别与体质量指数(BMI)相匹配的体检健康者(对照组),测定血清脂联素(APN)、空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及三酰甘油(TG)的水平,并计算所得胰岛素抵抗指数(HOMA-IR),比较上述指标在两组中的检测水平.分析血清脂联素与胰岛素抵抗、空腹血糖、空腹胰岛素的相关性.结果:观察组血清脂联素水平(3.98±1.34) mg/L,显著低于对照组(6.19±1.06) mg/L(P＜0.01),观察组的FPG、FINS、HOMA-R、TC、TG水平均高于对照组(P＜0.05),差异有统计学意义;Pearson相关分析显示,观察组患者血清脂联素水平与BMI、FPG、FINS、HOMA-R、HDL-C、TC、TG(均P＜0.05)呈负相关.Partial相关分析消除BMI因素影响显示,观察组的脂联素水平只与FPG、FINS、HOMA-R(均P＜0.05)呈负相关;对照组的脂联素水平与FPG、FINS、HOMA-R(均P＞0.05)无相关性.结论:低水平的脂联素参与胰岛素抵抗及2型糖尿病的发生.     

2型糖尿病患者血清脂联素水平及影响因素的研究

目的探讨脂联素在2型糖尿病发生发展中的作用。方法选择140例2型糖尿病患者,将体质指数(BMI)<25者定为非肥胖糖尿病组,BMI≥25者定为肥胖糖尿病组。选择80例健康者作为正常对照组。用ELISA方法检测空腹血清脂联素浓度,同时测定各组的血糖、血脂、血压、胰岛素等,分析各指标与血清脂联素的相关性。结果①糖尿病组血清脂联素水平为(5.64±3.29)μg/ml,明显低于正常对照组的(13.47±6.94)μg/ml(P<0.001),肥胖糖尿病组血清脂联素水平为(4.77±3.29)μg/ml,低于非肥胖糖尿病组(P<0.001),有显著性差异。②血清脂联素与性别因素有关,单因素相关分析显示血清脂联素与BMI、腰臀比呈负相关,与高密度脂蛋白$胆固醇HDL$C呈正相关。③多因素回归分析显示,腰臀比、HDL$C为影响脂联素水平的最为显著的因素。结论血清脂联素与肥胖及血脂异常相关,脂联素的增高可能是有益的。     

瘦素受体基因rs1137101位点多态性与2型糖尿病的Meta分析

目的:采用Meta分析的方法综合系统地评价瘦素受体基因rs1137101位点多态性与2型糖尿病的相关关系。方法:通过检索CNKI、CBM、PubMed、万方等数据库收集相关文献,采用Stata11.0软件进行Meta分析。结果:最终纳入10篇病例对照文献,6 324例研究对象,其中2型糖尿病患者3 633例(病例组),对照组2 691例。Meta分析结果显示,病例组和对照组基因频率分布比较差异有统计学意义(P0.05),携带A等位基因者可能增加T2DM的患病风险[A vs G:OR值(95%CI)=1.599(1.337,1.913)],病例组和对照组基因型分布比较差异无统计学意义[AA vs GG:OR值(95%CI)=1.069(0.787,1.453):(AA+AG) vs GG:OR值(95%CI)=1.040(0.905,1.194):AA vs (GG+AG):OR值(95%CI)=0.995(0.798,1.239)]。按种族进行亚组分析,在等位基因模式下,黄种人群携带A等位基因者是携带G等位基因者的1.808倍[OR值(95%CI)=1.808(1.571,2.081)],白种人群携带A等位基因者是携带G等位基因者的1.261倍[OR值(95%CI)=1.261(1.052,1.511)],病例组和对照组基因型分布差异均无统计学意义[黄种人AA vs GG:OR值(95%CI)=1.020(0.620,1.679):AA vs (AG+GG):OR值(95%CI)=1.032(0.892,1.194);(AA+AG) vs GG:OR值(95%CI)=1.019(0.875,1.187);白种人:AA vs GG:OR值(95%CI)=1.101(0.746,1.623):AA vs (AG+GG):OR值(95%CI)=0.990(0.775,1.265);(AA+AG)vs GG:OR值(95%CI)=1.144(0.818,1.600)]。结论:LEPRrs1137101位点多态性与2型糖尿病存在关联,等位基因A可能会增加2型糖尿病的患病风险。     

脂联素基因启动子区-11377C/G单核苷酸多态性与陕西汉族人血清脂联素水平和2型糖尿病的关系

目的: 探讨中国陕西地区汉族人群脂联素基因启动子区-11377C/G单核苷酸多态性(SNPs-11377C/G )和血清脂联素水平与2型糖尿病的关系. 方法: 研究对象304例,其中2型糖尿病203例,非糖尿病对照101例,用PCR-RFLP方法鉴定SNPs-11377C/G,进行了OGTT(75 g葡萄糖)及胰岛素释放实验,测定脂联素、血脂、血糖、胰岛素水平并计算Homa胰岛素分泌和抵抗指数. 结果: 2型糖尿病组血清脂联素水平明显低于非糖尿病对照组(mg/L, 12.8±6.5 vs 15.0±6.9, P＜0.05). SNPs-11377C/G基因型和等位基因频率在糖尿病和非糖尿病对照组间分布无统计学差异(P＞0.05),非糖尿病组-11377 GG基因型脂联素水平明显低于CC基因型,而TG明显高于CC基因型(P＜0.05). 结论: 脂联素基因启动子区SNPs-11377C/G与陕西地区汉族人血清脂联素水平相关,提示这一基因位点多态性可能增加陕西地区汉族人2型糖尿病的遗传风险.     

脂联素与新发2型糖尿病血脂代谢的关系

目的探讨血脂代谢紊乱与血清脂联素的关系。方法经患者知情同意及医院伦理委员会批准,并签署知情同意书后,将70名新发无大血管并发症的2型糖尿病患者分成A、B 2组,每组35人。A组给予降糖、降压治疗,B组给予降糖、降压及降脂治疗,观察7个月后血清脂联素水平的变化。其后进入开放治疗阶段,观察1年后血清脂联素水平的变化。结果新发的无大血管并发症的2型糖尿病患者,联合降糖、降压、降脂治疗组的血清脂联素水平明显升高[治疗前:(5.01±1.96)mg/L,治疗后:(5.65±2.33)mg/L]。结论脂质代谢异常的改善可以增加血清脂联素水平。     

2型糖尿病肾病患者尿脂联素水平与尿白蛋白、血脂及血糖的相关性研究

目的分析2型糖尿病肾病患者尿脂联素水平与尿白蛋白、血脂及血糖的相关性。方法选取2015年1月至2016年8月开封市中心医院收治的2型糖尿病患者45例,健康体检者25例,依据尿白蛋白/肌酐(ACR)水平将2型糖尿病患者分为单纯糖尿病组22例(ACR<30 mg/g)与糖尿病肾损伤组23例(ACR≥30 mg/g)。检测对比各组血糖[空腹血糖(FBG)、糖化血红蛋白(HbA1c)]、血脂[甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]及24 h尿白蛋白、尿脂联素(APN)。结果糖尿病肾损伤组FBG、HbA1c、LDL-C、24 h尿白蛋白、尿脂联素均高于单纯糖尿病组及健康组,差异有统计学意义(P<0.05),3组TG、TC比较,差异无统计学意义(P>0.05);尿脂联素与24 h尿白蛋白、FBG、HbA1c、LDL-C、年龄呈正相关关系(P<0.05)。结论 2型糖尿病肾病中,尿脂联素水平与尿白蛋白、FBG、HbA1c、LDL-C、年龄关系密切,脂联素可作为DN病情发展重要检测指标。     

血浆脂联素水平下降与2型糖尿病合并慢性稳定性心绞痛患者冠状动脉病变的严重性相关

目的研究血浆脂联素水平与2型糖尿病合并慢性稳定性心绞痛(DM-SAP)患者冠状动脉病变严重程度的关系。方法 236例DM-SAP患者的诊断依靠冠状动脉造影确诊,采用Gensini积分计算方法评价冠脉病变的严重程度,并根据Gensini积分四分位数分成4组,另外选取138例健康体检者作为阴性对照组。所有研究对象均采用ELISA法测定血浆脂联素水平,以免疫比浊法测定血清hs-CRP水平。结果 DM-SAP组血浆脂联素水平较阴性对照组明显降低(6.51±1.97μg/ml:7.55±1.63μg/ml,P<0.001)。较高Gensini积分四分位组(组4、3和2)的DM-SAP患者其血浆脂联素水平明显低于最低四分位组(组1)(P<0.001)。DM-SAP患者脂联素水平与当前吸烟、HbA1c水平呈显著负相关(P<0.05)。多因素Logistic回归分析显示,低脂联素水平是DM-SAP患者冠脉病变严重程度的独立危险因素(OR=17.78,95%CI 6.453～49.01,P<0.001)。结论血浆脂联素水平随着2型糖尿病合并慢性稳定性心绞痛冠脉病变的严重性显著下降,表明血浆脂联素水平下降可能参与了动脉粥样硬化的病理过程。     

血清维生素水平与糖尿病及其并发糖尿病足的关系

目的:探究2型糖尿病(DM)患者血清维生素水平变化与其并发糖尿病足(DF)的关系。方法:选取我院收治的2型糖尿病患者68例作为观察组(分为两个亚组:DM组32例,DM+DF组:36例)以及同期本院体检者68例(健康对照组),比较两组血清维生素水平;进一步探究血清维生素水平与糖尿病患者并发糖尿病足的关系。结果:观察组与健康对照组空腹血糖、餐后2 h血糖、糖化血红蛋白比较,差异均具有统计意义(P<0.001);两组维生素B_6、维生素B_1、维生素B_9、维生素C、维生素D差异具有统计学意义(P<0.001)。观察组两亚组维生素B_6、维生素B_1、维生素B_9、维生素C存在统计学差异(P<0.001)。Logistic回归分析显示维生素B_6[OR95%CI 0.633(0.434,0.924)]、维生素B_1[OR95%CI 0.705(0.524,0.949)、维生素B_9[OR95%CI 0.248(0.063,0.978)、维生素C[OR95%CI 0.584(0.409,0.835)是糖尿病足发生的危险因素。结论:维生素B_6、维生素B_1、维生素B_9、维生素C缺乏会增加糖尿病患者并发糖尿病足的风险。     

2型糖尿病患者瘦素、血脂水平与肥胖的相关性研究

目的研究2型糖尿病患者血清瘦素、血脂、糖化血红蛋白等指标水平与肥胖的关系。方法选取102例2型糖尿病患者,按体重指数(BMI)分为肥胖症与非肥胖组,其中肥胖组50例,非肥胖组52例。记录两组的性别、年龄、测量体重、身高,检测两组糖化血红蛋白、甘油三酯、胆固醇、低密度脂蛋白、高密度脂蛋白水平,同时用酶联免疫法测定两组血清瘦素水平。结果 2型糖尿病合并肥胖组的瘦素(6.53±2.49)明显高于非肥胖组(5.40±2.23),其他实验室指标,包括胆固醇(TC)、甘油三酯(TG)、糖化血红蛋白(Hb A1c)、瘦素(Leptin)均高于非肥胖组,差异具有统计学意义(P0.05)。进一步应用多因素logistic回归显示:高胆固醇(OR=2.377;95%CI:1.404-4.024;P0.05)、甘油三酯(OR=1.832;95%CI:1.128-2.975;P0.05)、糖化血红蛋白(OR=2.670;95%CI:1.628-4.379;P0.05)、瘦素(OR=1.440;95%CI:1.115-1.861;P0.05)水平均与2型糖尿病合并肥胖呈正相关。结论2型糖尿病中肥胖患者存在高瘦素水平,较非肥胖的2型糖尿病患者更容易合并高胆固醇、高甘油三酯等脂代谢紊乱,血糖控制更差。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.