原发性高血压并2型糖尿病患者脉压与蛋白尿的相关性探讨

目的　研究 2型糖尿病及高血压病患者脉压 (PP)与尿微量白蛋白的关系。方法　对 2 4 1例患者 ,高血压 (EH)患者 75例、2型糖尿病 (T2 DM)患者 77例和高血压病合并 2型糖尿病 (EH +T2 DM)患者 89例进行血压检测和尿微量白蛋白测定。结果　T2 DM组微量白蛋白与收缩压 (SBP)相关性不显著 (P >0 .0 5 ) ;而与PP显著正相关 (P <0 .0 5 )。EH组微量白蛋白与SBP和PP呈显著正相关 (P <0 .0 5 ) ;EH +T2 DM组微量白蛋白与SBP和PP呈显著正相关 (P <0 .0 5 ) ,微量白蛋白与PP相关性在EH +T2 DM组最大。反映肾功能的其它指标则与SBP、PP无相关性。结论　在上述 3种患者中只PP与早期肾损害相关 ,故为防止DM和EH患者肾脏损害加重 ,降低PP很重要。     

高血压病合并糖尿病患者的动态脉压监测

目的　探讨高血压病合并糖尿病患者动态脉压 ( APP)监测的临床意义。方法　对 43例健康者 ,64例原发性高血压 ( EH) ,3 0例 EH+DM患者的 APP进行对比研究。结果　 ( 1) EH+DM组 APP≥ 5 0 mm Hg者 ,病例数多 ,年龄偏大 ,左心室肥厚 ( LVH)、心电图异常、心脑血管事件 ( CVD)发生率高 ,与 EH组、对照组相比差异显著 ( P<0 .0 1) ;( 2 ) EH+DM组 APP≥ 5 0 m m Hg组与 <5 0 mm Hg组之间 2 4h平均收缩压 ( SBP)、舒张压 ( DBP)比较无差异 ,但前者其 LVH、心电图异常 ,CVD增高明显 ( P <0 .0 5～0 .0 1) ;( 3 ) 2 4h平均脉压较偶测脉压更能反映病人平时真正脉压水平。结论　 ( 1)高脉压是心脑血管疾病发生和死亡的一个独立和重要的因素 ,其有助于危险分层和指导药物选择 ;( 2 ) APP比偶测脉压更适宜用于临床研究     

收缩压水平对2型糖尿病人群终末期肾病发病率影响的研究

目的观察不同SBP水平对T2DM人群终末期肾病发病率的影响。方法采用前瞻性队列研究,以参加2006~2007年度开滦集团职工健康体检的糖尿病患者9375例作为观察队列,根据不同SBP水平分为<130mmHg组、130~139mmHg组和≥140mmHg组。以进入规律血液透析定义为终末期肾病作为终点事件,采用COX回归模型分析影响发生终末期肾病的因素。结果 (1)观察队列平均随访时间(71.89±4.25)个月,新发血液透析者53例,其中<130mmHg组12例、130~139mmHg组8例和≥140mmHg组33例,各组发生率比较差异有统计学意义(χ2=7.78,P<0.05);(2)COX回归分析显示,与<130mmHg组比较,130~139mmHg组和≥140mmHg组发生终末期肾病事件的OR值分别为1.27(95%CI:0.50~3.23,P=0.615)、2.48(95%CI:1.19~5.16,P=0.015)。结论 SBP升高可增加糖尿病人群终末期肾病的发病风险,但并非SBP降得越低,获益越多。     

2型糖尿病患者心血管并发症与平均血小板容积的相关性研究

目的探讨T2DM患者心血管并发症与平均血小板容积(MPV)的相关性及其临床价值。方法选取T2DM患者81例,分为伴心血管病变(T2DM+CVD)组37例和单纯T2DM(T2DM)组44例。另选取健康对照(NC)组20名。检测各组MPV、血小板分布宽度(PDW)、血小板压积(PCT)、血小板计数(PLT)和白细胞(WBC)、TC、TG、LDL-C、HDL-C、载脂蛋白A(ApoA)、SUA和HbA1c等指标,并进行统计学分析。Logistic回归分析影响T2DM心血管病变并发症的因素;分析T2DM合并高血压、冠心病和脑梗死患者的血小板参数。结果 T2DM组SBP、DBP和TG均低于T2DM+CVD组[SBP:(121.55±21.13)vs(136.33±12.47)mmHg;DBP:(75.34±9.42)vs(86.42±9.47)mmHg;TG:(1.84±1.24)vs(2.34±1.17)mmol/L](P0.05)。T2DM+CVD、T2DM组MPV及PDW较NC组均有不同程度的升高,而PLT降低(P0.05)。Logistic回归分析显示,MPV和SBP是T2DM患者发生血管病变的危险因素。T2DM合并高血压患者血液中MPV值最高为(19.74±7.73)fl,T2DM合并冠心病患者血液中PDW最高为(25.95±4.99)%。结论 MPV与T2DM患者心血管并发症有相关性。     

高血压病和糖尿病患者餐后状态血压及心率变化的研究

目的　研究高血压病 (EH)和 2型糖尿病 (DM)患者餐后状态血压和心率的变化特点。　方法　 187例患者 ,分 3组 :高血压病组 (EH,71例 ) ,2型糖尿病组 (DM,49例 )和 2型糖尿病伴高血压组 (DM EH,6 7例 )。观察各组 2 4h动态血压和心率 ,进标准定量饮食 ,分析进餐前后收缩压(SBP)、舒张压 (DBP)和心率的变化。　结果　 EH组和 DM EH组 2 4h平均收缩压 (2 4h ABPS)和2 4h平均舒张压 (2 4h ABPD)较 DM组明显增高 (P<0 .0 1) ,而 DM组和 DM EH组 2 4h平均心率较 EH组快 (P<0 .0 1) ;EH组在餐后 30 m in至 6 0 min的 SBP、DBP和心率较餐前对应时间点升高(P<0 .0 1) ,餐后 90 m in SBP、DBP和心率恢复至餐前水平。 DM组和 DM EH组在餐后 30 m in至90 min SBP、DBP和心率下降 (P<0 .0 1) ,餐后 12 0 min SBP、DBP和心率恢复至餐前水平。　结论　高血压病和 2型糖尿病患者餐后状态血压和心率的变化有不同的特点 ,表现为高血压病患者餐后血压升高和心率增快 ,而 2型糖尿病或伴高血压病的 2型糖尿病患者餐后血压和心率下降 ,且其血压和心率恢复至餐前水平较单纯高血压病患者慢。     

老年2型糖尿病合并原发性高血压患者动态血压昼夜节律及血压变异性

目的探讨老年2型糖尿病(T2DM)合并原发性高血压(EH)患者的24 h动态血压(ambulatory blood pressure,ABP)昼夜节律变化及血压变异性(blood pressure variability,BPV)。方法纳入60例诊断为T2DM合并EH的老年患者作为观察组,同时选取60例仅诊断为EH的人群作为对照组,再随机抽取30例健康体检人群为正常组。所有受试者均进行血压昼夜节律及血压变异性检测。结果观察组与对照组比较,dSBP、nSBP、24 h收缩压标准差、24 h收缩压变异系数、夜收缩压标准差、夜收缩压变异系数差异有统计学意义;观察组与正常组比较,24 h SBP、dSBP、nSBP、24 h DBP、24 h收缩压标准差、24 h收缩压变异系数、24 h舒张压标准差、24 h舒张压变异系数、夜收缩压标准差、夜收缩压变异系数差异有统计学意义;对照组与正常组比较,24 h SBP、dSBP、nSBP、24 h收缩压标准差、24 h DBP变异系数、夜SBP标准差、夜SBP变异系数差异有统计学意义;观察组分别与对照组、正常组及对照组与正常组比较:SBP昼夜差值、DBP昼夜差值均有统计学差异。结论 T2DM合并EH的老年患者夜间血压下降较单纯EH患者及健康对照组明显减少,血压变异性增大,单纯EH患者较健康对照组亦明显减少。老年T2DM合并EH患者的昼夜血压调节功能损害较大,为减少心脑血管系统疾病的发生,改善体内糖代谢具有重要的意义。     

高血压合并2型糖尿病病人血浆IL-17水平变化

目的分析高血压(EH)、2型糖尿病(T2DM)及二者并发病人血浆白介素-17(IL-17)水平变化。方法选取2017年6月—2018年6月在山西医科大学第二医院体检中心体检者120例,根据体检结果分为高血压(EH)组、2型糖尿病(T2DM)组、高血压合并2型糖尿病(EH+T2DM)组和对照组(健康者),各30例。采用酶联免疫吸附双抗体夹心法测定所有病人免疫标志物IL-17水平,并与对照组进行比较。结果 EH组、T2DM组和EH+T2DM组血浆IL-17水平均高于对照组,差异有统计学意义(P0.05);EH+T2DM组血浆IL-17水平高于EH组、T2DM组,差异有统计学意义(P0.05)。结论高血压合并糖尿病病人血浆IL-17水平明显升高,其可能为高血压合并糖尿病病人提供新的治疗靶点。     

老年冠心病合并高血压及2型糖尿病患者核素心肌显像与血清学指标研究

目的 应用99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像对比分析老年冠心病患者(CHD)与CHD合并2型糖尿病(T2DM)和/或原发性高血压(EH)患者心肌缺血、心功能差异,并比较各组间血清学指标差异.方法 对237例老年CHD患者行门控SPECT核素心肌灌注显像,按病情分为4组:单纯CHD组、合并T2DM组、合并EH组、合并T2DM及EH组.分别统计4组总负荷评分(SSS)、总静息评分(SRS)、和总差值(SDS)、左室射血分数(LVEF)及血清学各项指标,并对4组数据进行对比分析.结果 合并T2DM组、合并EH组、合并T2DM及EH组核素心肌灌注显像SSS、SDS及D-二聚体(D-D)、血管性假血友病因子(vWF)、超敏C-反应蛋白(hs-CRP)均高于单纯CHD组(P＜0.05),而LVEF明显小于单纯CHD组(P＜0.05);合并T2DM及EH组SSS、SDS及D-D、vWF、hs-CRP均高于单纯合并T2DM组或合并EH组,左室射血分数(LVEF)则明显降低(P＜0.05);合并T2DM组、合并EH组两组间无明显差异(P=0.34);4组间血脂无明显差异.多因素分析显示D-D、vWF、hs-CRP水平与SSS、SDS呈正相关.结论 核素心肌灌注显像可有效评价冠脉心肌血供情况;CHD合并T2DM或EH患者心肌缺血显著,心功能较差;合并T2DM及EH患者心肌缺血最严重,而且心功能最差;D-D、vWF、hs-CRP水平可反映心肌缺血程度.     

2型糖尿病合并血管并发症患者纤维蛋白原水平的变化及其与血糖波动的相关性研究

目的探讨T2DM合并血管并发症患者的血糖波动与纤维蛋白原(FIB)的关系。方法选取2014年2月至2016年10月于我院内分泌科住院的T2DM患者1175例。根据有无合并血管并发症,分为T2DM组(n=424)和T2DM合并血管并发症组(n=751)。根据FIB四分位数分为4组,FIB≤2.53为Q1_(Fg)组,2.53FIB≤3.06为Q2_(Fg)组,3.06FIB≤3.79为Q3_(Fg)组,FIB3.79为Q4_(Fg)组。比较各组间血糖波动相关指标,并进行回归分析。结果 (1)T2DM合并血管并发症组年龄、病程、SBP、FIB、最大血糖波动幅度(LAGE)、血糖水平标准差(SDBG)均高于T2DM组(P0.05或P0.01);(2)Q1_(Fg)～Q4_(Fg)组年龄、病程、SBP、HbA_1c水平、胰岛细胞β功能指数(HOMA-β)、血糖平均值(MBG)、LAGE和SDBG比较,差异有统计学意义(P0.05或P0.01),血管并发症发生率逐渐升高(62.32%vs 68.00%vs 72.08%vs 78.23%,P0.05);(3)多元线性回归分析结果显示,年龄、HOMA-β、SDBG是糖尿病患者纤维蛋白升高的危险因素。Logistic回归分析结果显示,年龄、病程、FIB是糖尿病血管并发症的危险因素。结论 T2DM患者的血糖波动幅度大,FIB升高,可能增加糖尿病合并血管并发症的风险。     

2型糖尿病合并甲状腺功能异常的临床特征研究

目的研究2型糖尿病(T2DM)合并甲状腺功能异常的临床特征。方法选取该院2015年6月—2017年10月收治的T2DM患者共240例,分析临床资料及相关指标,对其中合并甲状腺功能异常患者的临床特征进行研究。结果 240例T2DM患者中,合并甲状腺功能异常患者44例(18.3%)。T2DM合并与未合并甲状腺功能异常患者的病程、CSII时间、UAlb 30～299 mg/24 h、C-P120 min、TSH对比差异有统计学意义(P0.05)。甲亢组较甲减组SBP和FT4升高,IAA降低(P0.05)。低T3组较甲亢组SBP、FT3、FT4降低,TSH升高;较甲减组FT3、TSH降低;较甲亢组和甲亢组年龄增加(P0.05)。结论 T2DM合并甲状腺功能异常的临床表现形式多样,早期监测T2DM患者的甲状腺功能对甲状腺功能异常的筛查具有重要意义。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

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.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.