Emotions and Attitudes in Insulin-dependent Diabetes

ABSTRACT We asked 192 well-defined patients with insulin-dependent diabetes (IDDM) and free of advanced complications, about their experiences of the influence of the disease on daily life and worries about complications. Semantic differentials were used to measure attitudes to diabetes. The patients were divided into quintiles according to their metabolic control. The groups did not differ significantly as regards the distribution of age, living conditions, absence from work, duration of the disease or number of insulin injections daily. Patients with good metabolic control (HbA_1c < 6.7) had higher number of hypo-glycaemic comata (7 vs. 1, p < 0.001) and somewhat higher levels of endogenous insulin production (NS) when compared with those in poor metabolic control (HbA_1c > 9.0). There were more university graduate patients in the group with good metabolic control (p < 0.05). Patients in the poor-controlled group more often reported that they were smokers (p= 0.003) and the women in fertile ages in this group more often reported problems with metabolic control during menstruation (p < 0.05). There were no significant differences between the groups regarding the experiences of being a diabetic or worries about complications. Patients with poor metabolic control gave expression to more positive attitudes on the semantic differentiales. Implications for nursing are discussed.     

The Prevalence of Hyperlipidaemia and Related Clinical Features in Insulin-dependent Diabetes Mellitus

SUMMARY The Prevalence of hyperlipidaemia and related clinical featureswas examined in 205 individuals with insulin -dependent diabetesmellitus. Overall, 40 per cent (82) of the individuals had hyperlipidaemia.Whilst the prevalence of hypertriglyceridaemia and combinedhyperlipidaemia was greater in patients with insulin-dependentdiabetics, mellitus than non-diabetics, this was not the casefor hypercholesterolaemia. Hyperlipidaemia was present in olderpatients, and the daily insulin dose and levels of HbA₁ werehigest in those with combined hyperlipidaemia. In addition normolipidaemicsubjects had the lowest levels of serum creatinine. Triglyceridelevels were predicated (in order of importance) by insulin dose,age at diagnosis, HbA₁ and body. mass index, whilst cholesterollevels were predicted by the age at the time of study, bodymass index, Urinary protein excretion, and levels of fastingblood gluciose and HbA₁. Hyperlipidaemia is common in insulin-dependent diabetes mellitus,and may be particularly apparent in older patients and/or thosewith early renal dysfunction or poor glycaemic control.     

The Influence of Autonomic Neuropathy on Mortality in Insulin-dependent Diabetes

Five-year survival was investigated in 506 randomly selectedpatients with insulin-dependent diabetes mellitus screened forautonomic neuropathy with a series of cardiac autonomic functiontests. Of the 484 diabetics traced, 44 (9 per cent) had died. The cumulative 5-year mortality rate was increased more thanfive-fold in those with autonomic neuropathy: 27 per cent vs.5 per cent in those with normal autonomic function. Discriminantanalysis of survivors and non-survivors showed that autonomicneuropathy was the most important independent predictor of death.Among those who died, autonomic neuropathy was associated withan increased frequency of retinopathy and peripheral neuropathyand a slightly lower frequency of macrovascular disease. Autonomicneuropathy was associated with an increased mortality rate fromrenal failure, but not from any other causes.     

老年糖尿病合并肺部感染的临床与淋巴细胞免疫学分析

目的：分析老年糖尿病合并肺部感染的临床特点与免疫学变化。方法：将297例老年肺部感染者，按有无糖尿病分为糖尿病组及非糖尿病组，对照分析其临床表现、实验室检查、合并症、并发症、治疗与转归及T细胞亚群CD4／CD8的比值差异。结果：糖尿病组以发热、纳差、神志不清、大小便失禁为首发症状、低氧血症、低蛋白血症、贫血、电解质紊乱的比例数明显高于非糖尿病组，其合并症、并发症、平均住院天数及死亡率均高于非糖尿病组。糖尿病组T细胞亚群CD4／CD8的比值明显低于非糖尿病组。结论：老年糖尿病患者比一般老年患者免疫力低，更易发生肺部感染，且临床表现不典型，病情危重的多，死亡率高。     

Role of HLA Genes in Predisposition to Develop Insulin-dependent Diabetes Mellitus

Insulin-dependent diabetes mellitus (IDDM), or type I diabetes, is the end result mainly of a T-cell mediated autoimmune destruction of pancreatic islet β cells. Genetical and environmental factors are both of importance in the pathogenesis. Genes in the HLA complex seem to be the most important genetical factors. Among Blacks, Caucasoids and Orientals, IDDM susceptibility is associated with some particular combinations of DQA1 and DQB1 genes in cis or trans position. This strongly argues that susceptibility is primarily associated to the corresponding HLA-DQ molecules themselves. However, weaker contributions by other genes in the HLA complex cannot be excluded. Similarly, a dominant protection is strongly associated with some other DQ molecules, in particular HLA-DQ6, in all three ethnic groups.

The function of HLA-DQ (and other class II) molecules is to present peptide-fragments of antigens to CD4⁺ T cells (mainly helper T cells). Thus, the recognition of certain islet β cell derived peptides by self-reactive CD4⁺ T cells, may be an initial event in the pathogenesis. The DQ molecules involved in IDDM susceptibility or protection may exert their function either during thymic development of potential self-reactive CD4⁺ T cells, or by preferential presentation of certain β–cell derived peptides to CD4⁺ T cells, or both. The finding that certain DQ molecules as such confer IDDM susceptibility may lead to new methods to prevent IDDM, for example by using blocking peptide analogues.     

老年糖尿病肾功能检查中血清胱抑素C的临床意义

目的：探究老年糖尿病肾功能检查中血清胱抑素C的临床意义。方法：资料随机选自2011年12月-2013年12月在本院诊治的Ⅱ型的糖尿病肾病患者42例作研究组,同期选择单纯的糖尿病患者42例作对照组,同期选择健康的体检者30例作参照组,进行血清胱抑素C检测,分析三组四项相关检测指标以及各组肾功能相关指标阳性检出情况。结果：研究组相关Cys C、SCr、BUN和β2-MG肾功能指标,均比对照组和参照组高,差异具明显统计学上的意义（P＜0.05）;并且研究组Cys C指标的阳性检出率97.62%,均比SCr、BUN和β2-MG的66.67%、61.90%和76.19%高,具统计学差别（P＜0.05）。结论：血清胱抑素C作为老年糖尿病肾功能检测指标,在患者早期诊断治疗疗效及预后评佑具有一定临床意义。     

Comparison of the Prevalence and Associated Features of Abnormal Albumin Excretion in Insulin-dependent and Non-insulin-dependent Diabetes

Overnight albumin excretion rates were measured in 940 diabeticpatients, 416 with insulin dependent and 524 with non-insulindependent diabetes, and in 106 healthy volunteers. A significantlyhigher number of noninsulin dependent diabetic patients hadabnormal albumin excretion compared with the insulin-dependentgroup (     

Familial Distribution of Thyroid Disease and Diabetes: Further Evidence for Aetiological Heterogeneity of Diabetes Mellitus

The prevalences of thyroid disease, insulin-dependent and non-insulin-dependentdiabetes were compared in first degree relatives of diabeticswith and without coexisting autoimmune thyroid disease. Thyroiddisease was more common in siblings of diabetics with thyroiddisease than in those of diabetics without thyroid disease.Insulin-dependent diabetes was more common in siblings of diabeticswith a personal or family history of thyroid disease than inthose of diabetics without such a history. The prevalence ofnon-insulin-dependent diabetes was unrelated to that of thyroiddisease but was greater In siblings of non-insulin-dependentdiabetics than in those of insulin-dependent diabetics. Thesefindings add further support to the aetiological distinctionbetween insulin-dependent and non-insulin-dependent diabetesand suggest that further heterogeneity exists within the populationof insulin-dependent diabetics based on the presence of a personalor family history of thyroid disease.     

老年人颈椎损伤临床特点及治疗选择

目的总结老年人脊髓损伤的发病特点和治疗特点。方法总结我院2002～2006年收治的59例60岁以上老年颈椎损伤患者的临床资料,回顾性分析老年人脊髓损伤的发病特点和治疗特点。结果交通事故和跌倒损伤是最常见的致伤因素,均可造成颈椎过伸过屈性损伤,引起中央脊髓损伤综合征;经早期手术和早期康复治疗,大部分患者ASIA分级提高1～2级,实现独立性步行,且可有效预防脊髓损伤严重并发症。结论老年人颈椎损伤治疗的重点在于如何使患者早期离床活动,减少脊髓损伤卧床并发症的产生;早期手术结合早期康复可降低脊髓损伤的严重并发症,提高患者的生活质量。     

53例老年急性髓细细胞白血病的疗效观察

目的分析老年急性髓细胞白血病(AML)的临床特点和不同治疗方案的疗效.材料和方法年龄≥60岁的老年AML患者53例,原发性AML44例和继发性AML 9例.AML分别采用亚常规标准剂量蒽环类药物或高三尖杉酯碱联合阿糖胞苷(Ara-C)或小剂量的高三尖杉酯碱和Ara-C作为诱导方案.结果发病时以发热和贫血症状最多见,以M5亚型常见,颅内出血是导致老年AML早期死亡的最常见的原因.急性髓细胞白血病(AML)总的完全缓解(CR)率43.4%,亚标准剂量方案治疗AML的CR率明显高于小剂量HA的疗效,但继发性AML患者无1例获CR.结论对原发性AML老年患者尽可能地采用亚标准剂量的诱导治疗方案.     

53例老年急性髓细胞白血病的疗效观察

目的：分析老年急性髓细胞白血病（AML）的临床特点和不同治疗方案的疗效。材料和方法：年龄≥60岁的老年AML患者53例，原发性AML44例和继发性AML9例，AML分别采用亚常规标准剂量蒽环类药物或高三尖杉酯碱联合阿糖胞苷（Ara-C)或小剂量的高三尖杉酯碱和Ara-C作为诱导方案，结果：发病时以发热和贫血症状最多见，以M5亚型常见，颅内出血是导致老年AML早期死亡的最常见的原因。急性髓细胞白血病（AML）总的完全缓解（CR）率43.4%，亚标准剂量方案治疗AML的CR率明显高于小剂量HA的疗效，但继发性AML患者无1例获CR。结论：对原发性AML老年患者尽可能地采用亚标准剂量的诱导治疗方案。     

Type 2 Diabetes Care in the Elderly

Type 2 diabetes mellitus is a major chronic disease worldwide. Over the next decade, the largest increase in diabetes prevalence is expected to be in those > 75 years old. Diabetes self-care and prevention of complications can be challenging, but, when combined with the demands of self-care for other chronic conditions, it can become overwhelming to patients and caregivers. The glycemic targets and treatment options are unique to older adults. Clinicians should treat elderly patients with diabetes based on comorbid conditions, functional status, and life expectancy using a person-centered, team-based approach.     

老年与青年急性心肌梗死临床特点分析

目的 :探讨老年人与青年人急性心肌梗死的临床特点。方法 :分析老年人组及青年人组发病的危险因素及促发因素和冠状动脉造影的阳性指标 ,确诊为急性。结果 :冠心病危险因素 :吸烟 :老年组占 70 % ,青年组占 95 %。饮酒 :老年组占 76 % ,青年组占 90 %。血脂水平 :血清胆固醇 ,两组P >0 .0 1无显著性差异。血清甘油三脂 ,两组有显著性差异P <0 .0 1。促发因素 ;高血压病、糖尿病、心绞痛老年组患病率为 16例 (2 6、6 % ) ,青年组患病率为 2例(10 % )。冠状动脉粥样硬化情况 ;老年组以双支及多支狭窄为。青年组以单支狭窄为主。冠状动脉狭窄的程度 :老年组 86 .4 4 %± 11.13,青年组 6 5 .6 9%± 11.36 ,两组有显著性差异P <0 .0 1。并发症 :室壁瘤 :两组病例均以单支狭窄的发生率为高。心律失常 :老年组以复杂的心律失为主 ,青年组以单纯性心律失常为主。结论 :冠心病危险因素青年组明显高于老年组 ,老年组甘油三脂的水平、以及促发因素明显高于青年组。冠状动脉粥样硬化的情况 :老年组以双支及多支病变为主而青年组则以单支病变为主。冠状动脉狭窄的程度 :老年组以重度狭窄为主而青年组以中度狭窄为主。老年组并发症明显高于青年组 ,且程度较青年组重     

72例高龄急腹症的临床特点及护理

本文通过对７２例高龄急腹症的观察、分析,认识了高龄急腹症的临床特点和护理要求,认为对老年患者不能因症状轻而忽略对病情的观察,要根据其临床特点,进行严密地观察、分析、准确的判断病情变化,有的放矢地实施护理措施;要注重心理护理;积极作好术前准备及抢救工作,术后在护理外科疾病的同时,不可忽视并存症的观察,尽量减少术后并发症的发生,从而降低病死率,使患者早日康复。     

健康教育在老年糖尿病患者临床护理中的应用

目的探讨健康教育在老年糖尿病患者中的应用效果。方法抽取2014年1月~2015年1月医院接诊的80例老年糖尿病患者作为研究对象,按照入院顺序的单双号法将其随机分为观察组与对照组各40例,观察组患者给予健康教育的干预措施,对照组给予常规护理措施,观察患者的临床治疗效果,并进行护理满意度的调查。结果观察组的护理满意度100.0%明显高于对照组的80.0%,两组比较差异具有统计学意义(χ2=8.889,P0.05)。观察组40例患者中,依从性评分结果为93.5±2.0;而对照组40例病例中,依从性评分结果为82.0±3.0,组间比较差异具统计学意义(t=10.01,P0.05)。结论对糖尿病患者实施健康教育可有效提高患者的治疗效果,达到更高的依从度及护理满意度,可临床推广。     

老年患者反流性食管炎的临床特征分析

[目的]探讨老年患者反流性食管炎（reflux esophagitis,RE）的临床特点.[方法]收集经胃镜检查确诊为RE的患者106例,分为两组：老年组74例,非老年组32例,按照洛杉矶标准分级,同时填写症状调查表.[结果]老年RE内镜检出率（12.5%）明显高于非老年RE（7%）,且重度RE所占比例也高于非老年组（17.6%和6.3%）,典型症状反酸、烧心的发生率老年RE组明显低于非老年RE组（28.4% vs 46.9%,31.1% vs 53.1%）,而非典型症状上腹不适、咳嗽、支气管炎均高于非老年组（64.9% vs 40.6%,63.5% vs 46.9%,48.6% vs 37.5%）,幽门螺杆菌（Hp）感染率在两组间无明显差别（P〉0.05）.[结论]老年RE具有内镜检出率高,食管炎症程度重,典型症状发生率低,非典型症状发生率高;Hp感染率与RE年龄无关的特点.     

老年人重型颅脑损伤的临床特点及预后分析

目的：探讨老年重型颅脑损伤的特点与预后的影响因素。方法：对60岁以上格拉斯哥计分（GCS）〈8分的颅脑损伤167例临床资料进行单因素、多因素分析。结果：老年颅脑损伤病人中．70．0％伤前伴有慢性疾病．25．7％同时合并其它脏器损伤，38．3％伤后出现各种并发症。老年颅脑损伤病人的预后受颅脑损伤的严重程度、原有的慢性疾病、合并损伤和伤后并发症等多因素综合影响。结论：老年颅脑损伤具有自身的特点。处理老年颅脑损伤病人时，应特别注意原有慢性疾病的处理和各种并发症的防治。     

老年社区获得性肺炎的临床特征分析

目的探讨老年社区获得性肺炎的临床特征、病原学特点及抗生素的合理选择。方法选择2010年1月1日-12月31日呼吸内科和干部病房住院治疗并确诊为社区获得性肺炎,年龄≥60岁的126例患者,从病原学、临床表现、辅助检查结果及治疗转归方面入手,回顾性分析老年社区获得性肺炎的临床特征。结果 77.7%(98/126)的老年社区获得性肺炎患者合并有其他基础疾病,其中84.7%(83/98)合并慢性阻塞性肺病,81.6%(80/98)合并高血压,39.2%(40/98)合并冠心病,25.5%(25/98)合并有糖尿病。126例患者中,68.3%(86/126)有气促等呼吸道症状,75.6%(95/126)有食欲减退等消化道症状,61.1%(77/126)有反应迟钝等精神状态的改变;72.2%(91/126)的患者肺部体征明显,而27.8%(35/126)的患者无明显肺部体征;88.9%(112/126)的老年患者胸部CT提示有斑点状、小片状阴影。有89例患者进行了痰培养,其中58例出现阳性结果,46例对头孢菌素敏感、36例对喹诺酮类药物敏感、39例对氨基糖甙类敏感及青霉素敏感。给予抗感染、支持对症治疗后,56.3%(71/126)的患者治愈、33.3%(42/126)的患者病情好转、10.3%(13/126)的患者死亡,死亡原因均为呼吸衰竭。结论老年社区获得性肺炎患者临床特征复杂,应重视其社区获得性肺炎的早期诊断,并进行及时有效的治疗。