健康高龄老年人甲状腺激素水平变化趋势分析

目的 探讨80岁以上高龄老年人甲状腺激素水平变化趋势.方法 将602例健康志愿者按年龄分为中青年组(20～59岁)226例、老年组(60～79岁)195例和高龄组(80～102岁)181例,采用化学发光法及放射免疫法测定志愿者血清三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、反T3(rT3)水平,并以SPSS 13.0进行统计分析.结果 老年组与中青年组比较,血清FT3和TT3降低,差异有统计学意义(t值分别为2.793和3.627,均为P＜0.01);高龄组与中青年组比较,TT3、TT4、FT3、TSH、rT3浓度差异有统计学意义(t值分别为10.930、6.065、15.398、-2.933、-5.643,均为P＜0.01);老年组与高龄组比较,TT3、TT4、FT3、TSH、rT3浓度差异有统计学意义(t值分别为8.382、4.298、11.573、-3.383、-5.148,均为P＜0.01).FT3、TT3、TT4浓度与年龄呈负相关(r值分别为-0.51、-0.39、-0.25,P＜0.01),rT3、TSH浓度与年龄呈正相关(r值分别为0.32、0.12,P＜0.01),FT4与年龄无相关.高龄组高于或低于临床正常参考值范围的阳性发生率,在TT3、TT4、FT3、FT4、TSH、rT3中分别为0、0、13.8%、0、6.6%、21%.结论 随着年龄增长,老年人血清甲状腺激素水平及促甲状腺激素均有改变,特别是80岁及以上高龄老年人,血清FT3、rT3、TSH变化更为明显,建议临床设立老年人不同年龄段的血清甲状腺激素正常参考值范围,以减少假阳性的发生率.

Abstract：

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

抗血管内皮生长因子玻璃体内注射治疗湿性老年性黄斑变性疗效及对房水炎性因子的影响

目的 探讨抗血管内皮生长因子(VEGF)玻璃体内注射治疗湿性老年性黄斑变性(wAMD)的疗效及对房水炎性因子的影响。方法 选择2018年1月至2020年9月河南科技大学第一附属医院收治的wAMD患者112例,采用随机数字表法将其分为观察组和对照组,每组56例。观察组予抗VEGF(雷珠单抗)玻璃体内注射治疗;对照组予光动力疗法(PDT)。比较两组治疗后视力改善情况。比较两组治疗前和治疗后3个月的眼压(IOP)、脉络膜新生血管(CNV)面积、黄斑中央区厚度(CMT)以及房水肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平。观察两组并发症发生情况。结果 治疗后3个月,两组IOP、CNV面积、CMT均较治疗前显著下降(P<0.05),但两组间比较差异无统计学意义(P>0.05)。对照组房水TNF-α、IL-6、IL-10水平较治疗前无显著变化(P>0.05)。观察组房水TNF-α、IL-6水平显著低于治疗前(P<0.05),且较对照组水平更低,差异有统计学意义(P<0.05)。在治疗后3个月,两组视力改善情况无显著差异...     

卡维地洛对老年高血压及伴有心力衰竭患者的疗效观察

目的 　探讨卡维地洛 (carvedilol)对 80岁以上老年高血压及伴有心力衰竭患者的疗效及安全性。　方法　观察了 5 1例老年高血压及 18例高血压伴有心力衰竭患者经卡维地洛治疗前后 6月的血压和心功能情况。　 结果　卡维地洛治疗后 8周的 2 4h白昼和夜间的平均收缩压 ,舒张压明显下降 ,有显著性差异 (P <0 .0 5～ 0 .0 1)。伴有心力衰竭患者 6月后左室射血分数 (EF)明显提高 ,由治疗前 0 .43± 0 .0 5上升为 0 .5 2± 0 .0 2 (P <0 .0 5 ) ,心功能改善 1级者 13例 ,改善 2级者 5例、左室壁厚度及左室质量指数 (LVMI)明显下降。　 结论　卡维地洛治疗高龄老年高血压及伴有心力衰竭患者是安全有效的 ,但要注意个体化用药。     

系统化管理模式对慢性心力衰竭患者生活质量的影响

目的探讨系统化管理模式对慢性心力衰竭患者生活质量的影响。方法采用随机、对照的研究方法,以问卷调查方式分别使用Minnesota心力衰竭生活质量问卷(MLHFQ)和36条简明健康状况调查表(SF-36)对慢性心力衰竭患者的生活质量进行调查。结果 MLHFQ对生活质量的评价:与对照组12个月时比较,干预组各领域及总分差异有统计学意义(P0.01)。SF-36简明量表对生活质量的评价:与对照组12个月时比较,干预组各维度及总分差异有统计学意义(P0.05或P0.01)。结论系统化管理模式可以提高慢性心力衰竭患者的生活质量。     

Insulin Regimens for the Non-insulin Dependent: Impact on Diurnal Metabolic State and Quality of Life

A randomized prospective study was conducted to determine whether the insulin regimen for NIDDM subjects poorly controlled on oral therapy should be designed primarily to control basal metabolism or to control mealtime hyperglycaemia. Grossly obese subjects were excluded. After a 2-month run-in phase involving intensive education, subjects were randomized to therapy with twice daily isophane or three times daily soluble insulin. Both Protaphane and Actrapid brought about similar improvement in HbA₁ (9.5 ± 0.5 and 9.7 ± 0.4%) compared with baseline (11.7 ± 0.5%; p<0.001). Diurnal blood glucose profiles showed that despite the good post-prandial control achieved by pre-meal soluble insulin, loss of control occurred overnight, resulting in higher fasting blood glucose levels compared with Protaphane therapy (8.0 ± 0.8 vs 10.6 ± 0.8 mmol l^-1; p<0.05). The overall rate of hypoglycaemia was 0.44 patient^-1 year^-1. Thirty-two mild hypoglycaemic episodes occurred on Protaphane therapy and 79 on Actrapid therapy. Using formal psychometric tests it was shown that insulin therapy was associated with improved treatment satisfaction and that this was greater on Protaphane therapy (p<0.05). Overall well-being increased similarly in the two groups. All subjects wished to continue with insulin therapy after the conclusion of the study. The insulin regimen for moderately or poorly controlled non-insulin-dependent diabetes should primarily be designed to correct the basal insulin deficiency rather than to mimic normal meal-induced insulin secretion.     

The Impact of Surgery for Colorectal Cancer on Quality of Life and Functional Status in the Elderly

Purpose Colorectal cancer is a common diagnosis in the elderly. Frequently concerns arise about outcomes after surgery, and little is known about postoperative quality of life in this older group after major bowel surgery. The objective of this study was to compare quality of life and functional status of elderly patients (older than aged 80 years) who have undergone surgery for colorectal cancer with a younger (younger than aged 70 years), procedure-matched control group. Methods Patients in the case (older than aged 80 years) and control groups (younger than aged 70 years) were identified from the colorectal cancer database at Mount Sinai Hospital, Toronto, Canada. All had treatment for colorectal cancer within the last five years. Patients were surveyed by mail using the European Organization for Research and Treatment of Cancer quality of life scales specific to cancer and colorectal cancer (EORTC-C30 and EORTC-CR38) and the Short Form-36. Student’s t-test was used to test differences. Results There were 29 patients in each of the groups. The current average ages were 83.2 (standard deviation = 2.79) years, and 67.7 (standard deviation = 5.1) years, respectively. The two groups scored similarly on the European Organization for Research and Treatment of Cancer quality of life scales in all domains except physical functioning, functional role, micturition, and stoma-related problems. Similarly, the mean scores of the Short Form-36 were similar with the exception of the vitality domain. Most patients did not require special assistance or alternate living arrangements after discharge from the hospital, and most patients seemed to be able to return to their preoperative level of functioning. However, stoma care was a greater concern to the elderly. Conclusions Elderly patients older than aged 80 years who are selected for surgery have a quality of life comparable to younger patients in most respects. Therefore, colorectal cancer surgery may be offered to the highly functioning elderly with the expectation of a good quality of life postoperatively. Reprints are not available.     

Extending the Common Sense Model to Explore the Impact of Visceral Sensitivity on Quality of Life in Inflammatory Bowel Disease

BackgroundInflammatory bowel disease is associated with poor quality of life. The aim of the cross-sectional study was to extend the common sense model to explore the impact of inflammatory bowel disease activity on quality of life and the potential mediating roles of illness perceptions, visceral sensitivity, coping styles, acceptance, and psychological distress.MethodsA total of 141 inflammatory bowel disease patients (86 with Crohn’s disease and 55 with ulcerative colitis; 74 males, 65 females, and 2 gender non-specific, mean age 40.43 years) from 2 metropolitan hospital inflammatory bowel disease outpatient clinics participated. Measures included disease activity (Crohn’s Disease Activity Index, Simple Clinical Colitis Activity Index), illness perceptions (Brief Illness Perceptions Questionnaire), visceral sensitivity (Visceral Sensitivity Index), coping styles (Brief Coping Operations Preference Enquiry), acceptance (Acceptance and Action Questionnaire-II), psychological distress (Depression, Anxiety, and Stress Scale), and European Health Interview Survey-Quality of Life (EUROHIS-QoL).ResultsA structural equation model of the extended common sense model was found to have a good fit (χ²(10) = 10.07, P = .43, root mean square error of approximation = 0.01, standardized root mean residual = 0.04, comparative index fit = 1.00, Tucker–Lewis index = 1.00, goodness-of-fit = 0.98). After controlling for irritable bowel syndrome diagnosis, the impact of disease activity on quality of life was statistically mediated by illness perceptions, maladaptive coping styles, and psychological distress. In addition, visceral sensitivity bordered on influencing the impact of disease activity and illness perceptions on quality of life through psychological distress.ConclusionsThis study demonstrates that together with illness perceptions and coping styles, visceral sensitivity plays an important role in an individual’s adaption to living with inflammatory bowel disease.     

Impact of Real-Time CGM Data Sharing on Quality of Life in the Caregivers of Adults and Children With Type 1 Diabetes

Background:To examine caregivers’ experiences with real-time continuous glucose monitoring (RT-CGM) data sharing and its impact on quality of life (QoL) and health outcomes.Methods:Parents of children with type 1 diabetes (T1D) (N = 303) and spouses/partners of T1D adults (N = 212) using the Dexcom G5 Mobile or G6 RT-CGM system and who were actively following their T1Ds’ RT-CGM data completed a survey examining their perceived value of data sharing, the impact of sharing on their own QoL and their child/partner’s health, and how they used RT-CGM data to support their T1Ds’ diabetes management. Regression analyses examined whether their actions were linked to reported changes in QoL and health outcomes.Results:Respondents were predominantly non-Hispanic White (91.1% parents; 88.7% partners), female (78.2% parents; 54.7% partners), and college-educated (65.3% parents; 61.8% partners). The majority reported that data sharing had enhanced hypoglycemic confidence (97.7% parents; 98.1% partners), overall well-being (60.4% parents; 63.2% partners), and sleep quality (78.0% parents; 61.3% partners). Of note, three positive caregiver actions were broadly consistent and significant predictors of QoL and health benefits for both parents and partners: celebrating success related to glycemic control, providing encouragement when glycemic control is challenging, and teamwork discussions about how the caregiver should respond to out-of-range values.Conclusions:RT-CGM data sharing was associated with a range of QoL and health benefits for caregivers. Degree of benefits was influenced by the collaborative actions taken by caregivers to support their child’s or partner’s diabetes management. To determine the most effective strategies for collaborative data sharing, longitudinal trials are needed.     

The Impact of COPD on Quality of Life,Productivity Loss,and Resource Use among the Elderly United States Workforce

Abstract

To address the gap in knowledge about the impact of chronic obstructive pulmonary disease (COPD) on older working adults, this study examined quality of life, worker productivity, and healthcare resource utilization among employed adults aged 65 and older with and without COPD. Among 2009 National Health and Wellness Survey (a cross-sectional, internet-based survey representative of the US adult population) respondents, employed adults aged 65 years and older, with COPD (n = 297) and without COPD (n = 3061), were included in analyses. Impact of self-reported COPD diagnosis on mean quality of life (using health utilities and mental, MCS, and physical, PCS, component summary scores from SF-12v2), work productivity and activity impairment (using the WPAI questionnaire), and resource use were examined. Adjusting for demographic and health characteristics such as co-morbidities (weighted to project to the US population) in regression models (linear, negative binomial, or logistic, as appropriate given the outcome measure), older workers with COPD reported significantly lower MCS (52.1 vs. 53.4, p < .05), PCS (40.3 vs. 47.2, p < .05), and health utilities (0.72 vs. 0.79, p < .05) than those without COPD, and significantly greater percentages of impairment while at work (presenteeism) (12.6% vs. 8.7%, p < .0001), overall work impairment (absenteeism and presenteeism combined) (19.3% vs. 10.0%, p < .05), and impairment in daily activities (23.9% vs. 13.7%, p < .05). There were no significant differences in absenteeism or healthcare use. Quality of life and work productivity suffered among employed adults aged 65 years and older with COPD, emphasizing the need for disease management in this population.     

Impact of the COVID-19 Pandemic on Health-Related Concerns,Quality of Life and Psychological Adjustment in Young Adults with Congenital Heart Disease

Background: The risk for a severe disease course in case of infection with SARS-CoV-2 in young adults with congenital heart disease is largely unknown, potentially leading to uncertainty and anxiety among affected patients. This study aims to investigate health-related concerns, health-related quality of life and psychological adjustment in patients with congenital heart disease compared to healthy peers during the COVID-19 pandemic. Methods: One-hundred patients with congenital heart disease and 50 controls (M = 29.7, SD = 3.8 years) were recruited. They completed an online survey including the assessment of health-related concerns regarding COVID-19, the 12-item Short Form Health Survey and the Brief Symptom Inventory. Results: Patients considered COVID-19 to be a more serious issue (Generalized odds ratio [GenOR] = 1.67, p = 0.04), were more concerned about becoming infected (GenOR = 2.93, p < 0.001) and expressed more fear about leaving their homes (GenOR = 1.81, p = 0.004) while general anxiety symptoms were not different between groups (p = 0.23). Patients relied more on family and friends for support (30% vs. 2% in controls, p < 0.001) and reported better compliance with protective measures (p = 0.03). Mental health-related quality of life and psychological adjustment were not different between groups (p = 0.17 and p = 0.68, respectively). Physical health-related quality of life was lower in patients compared to controls (p = 0.03). Conclusions: Young adults with congenital heart disease in Switzerland are more concerned about their health during the COVID-19 pandemic compared to healthy peers. These concerns, however, do not translate into generally impaired mental wellbeing. The impact of the easing of lockdown measures on long-term anxiety levels and quality of life requires further study     

补气化痰通络方结合表里两经并刺法对脑卒中后肩手综合征患者生活质量的影响

目的观察补气化痰通络方结合表里两经并刺法对脑卒中后肩手综合征(SHS)患者生活质量的影响。方法将90例患者随机分为治疗组(50例)与对照组(40例)。治疗组口服自拟补气化痰通络方结合表里两经并刺法,对照组给予康复疗法,均治疗3周。观察两组临床疗效。应用健康状况调查问卷(SF-36中文版)评价两组患者生活质量;随访3个月,统计复发率及复发次数。结果治疗组总有效率为94.0%,对照组为75.0%,治疗组优于对照组(P<0.05);治疗组SF-36各项评分明显高于对照组(P<0.05);治疗组复发率及复发次数明显低于对照组(P<0.05)。结论补气化痰通络方结合表里两经并刺法治疗脑卒中后SHS有显著临床疗效,能明显提高患者生活质量,远期疗效较好。     

医护一体化康复护理干预对老年糖尿病肾病腹膜透析患者生活质量的影响分析

目的针对老年糖尿病肾病患者在进行腹膜透析治疗过程中展开医护一体化康复护理干预对提升患者生活质量等的作用进行分析。方法随机抽选该院2018年2月—2019年12月接诊的100例患者为研究对象,按照随机分配的方式,对照组50例在治疗过程中对应护理方式按照常规形式进行展开,观察组50例采用医护一体化康复护理干预。分析两组生活质量、并发症、心理状态及护理满意度方面的差异。结果观察组生存质量、并发症、心理状态及护理满意度均优于对照组,差异有统计学意义(P<0.05)。结论在老年糖尿病肾病患者接受腹膜透析的过程中及时展开医护一体化康复护理干预,能够对该部分患者生活质量进行有效提升,有助于患者恢复。