2型糖尿病合并高血尿酸血症相关危险因素分析

目的：探讨2型糖尿病的血尿酸水平与性别、年龄、血脂、血压、血糖等指标及与合并冠心病（ CHD）、脑卒中、糖尿病肾病等糖尿病并发症的关系。方法：选取我院2010年5月～2012年5月2年间收治的2型糖尿病601例,根据患者血尿酸结果分为A组：高尿酸血症（HUA）组即男性和绝经后女性血尿酸＞420μmol/L、绝经前女性＞350μmol/L,B组：非高尿酸血症组（NUA）,男性及绝经后女性血尿酸≤420μmol/L,绝经前女性≤350μmol/L;对两组病程、年龄、血糖、血脂、血压、体质量指数（BMI）、血肌酐（SCr）、24 h微量白蛋白尿（24 h UMA）、空腹胰岛素（FINS）及临床资料等进行回顾性分析。结果：①A组的糖尿病肾病、糖尿病视网膜病变（ DR）、糖尿病周围神经病变（DPN）、脑卒中、高血压、冠心病（CHD）的发病率均高于B组,P＜0．05;其中A组DR、DPN、脑卒中、冠心病的发病率较B组有显著统计学差异,P＜0．01。②A组的年龄、糖尿病病程、血肌酐、血甘油三酯（TG）、24 h UMA、空腹胰岛素（FINS）均高于B组,P＜0．05。结论：高尿酸血症是代谢综合征组分的评价因素,也是心脑血管疾病、糖尿病肾病等2型糖尿病并发症的相关危险因素,2型糖尿病合并高尿酸血症需要重点筛查大血管及微血管并发症,临床上应予重视。     

2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系

目的 研究2型糖尿病患者血尿酸水平与尿白蛋白/肌酐的关系.方法 该院住院540例(男265例,女275例)2型糖尿病者,年龄(60.6±11.5)岁,没有用过利尿剂、降尿酸药物或饮酒史,检测血尿酸及尿白蛋白与肌酐比.根据尿白蛋白与肌酐比值分为正常(＜30.0mg/g)、微量白蛋白(30.0～299.9mg/g)、大量蛋白尿组(＞300.0 mg/g).采用单因素分析血尿酸与尿白蛋白排泄率的相关性;多元回归分析该组2型糖尿病患者血尿酸水平与收缩压、舒张压、尿白蛋白与肌酐比、糖化血红蛋白A1c、血脂的关系.结果 在糖尿病正常蛋白尿组、微量蛋白尿组及大量蛋白尿组对应的血尿酸水平分别为(242±60)μmol/L,(345±84)μmol/L,和(416±108)μmol/L,有统计学差异(P＜0.05);在男性组,异常蛋白尿发生率在低尿酸水平组(＜295μmol/L)及高尿酸水平组(＞295μmol/L)分别为35.9%,63.1%(P＜0.01)在女性组分别为33.5%,66.4%(P＜0.01).在男性组,血尿酸水平与TG、In(ACR)相关,与HDL-C负相关;而在女性组及总体人群血尿酸水平除上述相关关系外,还与CCr呈负相关(P＜0.05).在调整了CCr及年龄、BMI、高血压病史、吸烟、SBP、DBP、HbA1c、TG、TC、HDL-C和LDL-C等混杂因素后In(ACR)的标化系数为0.214(P＜0.05),血尿酸水平每增加1mg/dl则异常蛋白尿的相对危险度为1.256(P＜0.05).结论 该研究提示血尿酸水平与2型糖尿病患者尿白蛋白/肌酐相关.     

缺血性脑卒中患者与血尿酸水平相关性研究

目的：分析缺血性脑卒中患者与血尿酸水平的临床相关性。方法选取河南省南阳市南石医院缺血性脑卒中患者90例作为研究组对象,并选取同期在本院进行健康体检者90例作为对照组,对2组研究对象进行甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）及血糖水平等相关指标检测,对比分析结果。结果观察组患者的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均明显高于对照组,其中观察组血尿酸水平为（361.53±69.26）μmol/L,显著高于对照组的（307.74±73.56）μmol/L。结论血尿酸也是导致缺血性脑卒中的独立危险因素,缺血性脑卒中患者的血尿酸水平明显高于一般正常患者,与缺血性脑卒具有密切的关联性,需要引起临床治疗的重视,并进行深入研究。     

H型高血压与缺血性脑卒中的相关性

目的：研究H型高血压与缺血性脑卒中的相关性。方法回顾性分析114例高血压病患者,据血浆同型半胱氨酸（ Hcy）水平,将患者分为H型高血压组（ Hcy≥15μmol／L）和对照组（ Hcy＜15μmol／L）,比较两组患者年龄、性别、高血脂史、糖尿病、吸烟史等因素的差异,并分析缺血性脑卒中与各项危险因素的关系。结果（1）H型高血压组缺血性脑卒中患病率明显高于对照组,差异有统计学意义（P＜0.05）。（2）两组患者冠心病患病率比较,差异无统计学意义（ P＞0.05）。（3）高血压病患者中缺血性脑卒中组Hcy水平高于非缺血性脑卒中组,差异有统计学意义（P＜0.05）。（4）二元logistic回归分析显示高血压病患者中缺血性脑卒中与Hcy相关,差异有统计学意义（ P＜0.05）。结论 H型高血压为缺血性脑卒中的重要危险因素。积极防治H型高血压,可减少脑卒中事件。     

MTHFRC677T基因多态性与缺血性脑卒中合并2型糖尿病的相关性研究

目的分析急性缺血性脑卒中（AIS）合并2型糖尿病患者的5,10－亚甲基四氢叶酸还原酶（MTHFRC677T）基因分布特点及血浆同型半胱氨酸（Hcy）水平,探讨两者与缺血性脑卒中合并2型糖尿病的关系。方法选择2015年6月至2017年5月收治的100例急性缺血性脑卒中合并2型糖尿病的患者（AIS+DM组）,100例急性缺血性脑卒中不合并2型糖尿病的患者（AIS组）,100例健康体检者（对照组）。对AIS+DM组及AIS组患者进行类肝素药物治疗急性缺血性脑卒中试验（TOAST）分型。应用聚合酶链反应－限制性内切酶长度多态性方法（PCR-RFLP）检测MTHFRC677T基因多态性,同时检测血浆Hcy、叶酸、维生素B12、血脂、血糖等各项指标。结果AIS+DM组患者的血浆叶酸水平低于AIS组,血浆Hcy水平高于AIS组,差异有统计学意义（均P＜0.01）。AIS+DM组T等位基因频率（56.5%）大于AIS组（50.5%）,但差异无统计学意义（P＞0.05）。在大动脉粥样硬化性卒中亚组水平,AIS+DM组T等位基因频率（64.9%）大于AIS组（43.8%）,差异有统计学意义（P＜0.05）。TT型血浆Hcy水平的比较,AIS+DM组（19.90±4.6）滋mol/L大于AIS组（13.93±3.08）滋mol/L,差异有统计学意义（P＜0.05）。多因素logistic回归分析,MTFHRC677T携带T等位基因的OR值为2.387（95%CI：1.084～5.256,P＜0.05）。结论MTFHRC677T携带T等位基因是缺血性脑卒中合并2型糖尿病的危险因素,发病机制可能与大动脉粥样硬化有关。     

2型糖尿病患者血尿酸与大血管病变的相关性研究

目的:探讨2型糖尿病患者血浆尿酸水平与大血管病变的相关性。方法:将2型糖尿病患者分为糖尿病非大血管病变组、糖尿病大血管病变组与正常对照组,采用生化检测方法测血尿酸,对大血管病变相关危险因素行logistic回归分析。结果:2型糖尿病大血管病变组血尿酸(450.3±79.9)μmol/L和非大血管病变组(370.7±66.4)μmol/L,正常对照(258.4±71.9)μmol/L比较,差异有显著意义,P<0.01。以2型糖尿病为整体,有无大血管病变为因变量Y(有=1,无=0),以尿酸及其他危险因素为自变量,进行logistic回归,最后年龄、病程、收缩压、尿酸进入回归方程。结论:尿酸与2型糖尿病大血管病变独立相关。     

老年冠心病心功能不全血尿酸浓度测定及临床意义

目的探讨老年冠心病心功能不全与血尿酸的关系。方法选择117例冠心病心功能不全患者和125例冠心病患者（心功能正常者）,年龄≥75岁,应用尿酸氧化酶法测定血尿酸浓度（男≥420μmol/L,女≥360μmol/L为高尿酸血症）,并分析患者心功能程度与血尿酸浓度的关系。结果117例冠心病心力衰竭患者血尿酸浓度为（419.51±163.23）μmol/L,高尿酸血症发生率为44.44%,125例冠心病非心力衰竭患者血尿酸浓度为（330.83±88.04）μmol/L,高尿酸血症发生率为15.20%。血尿酸浓度与心功能程度呈正相关（P〈0.01）。结论血尿酸升高与老年冠心病心功能不全关系密切。     

2型糖尿病患者血尿酸水平与下肢血管病变的相关性

目的 分析2型糖尿病患者血尿酸(UA)水平与下肢血管病变的关系.方法 对2174例2型糖尿病患者(男1228例,女946例)进行体脂参数、血压、血糖、血脂、血UA、C反应蛋白(CRP)等测定,同时用高频超声检查下肢动脉,分析血UA水平与下肢血管病变发生率的相关性.结果 (1)将男女患者分别根据有无下肢血管病变分组,女性患者有下肢血管病变组的UA水平显著高于无下肢血管病变组[(304±76)μmol/L比(287±71)μmol/L,P<0.01],男性患者2组间差异无统计学意义[(332±76)μmol/L比(328±77)μmol/L,P=0.45].(2)将男女患者分别按血UA水平四分位间距分为4组,女性为UA<240 μmol/L组(A组),240 μmol/L≤UA<285μmol/L组(B组),285μmol/L≤UA<341 μmol/L组(C组),UA≥341 μmol/L组(D组).4组女性患者下肢血管病变发生率分别为38.56%,44.02%,47.54%和50.00%(趋势P<0.01).其中C组和D组的发生率均显著高于A组(P<0.05).(3)Logistic回归分析显示,在校正年龄、糖尿病病程、吸烟、收缩压、体质指数、总胆固醇、甘油三酯、CRP等因素后,以A组作为对照,女性2型糖尿病患者发生下肢血管病变的OR值B组为1.25(95%CI0.87～1.81;P=0.23),C组为1.44(95%CI1.01～2.08;P<0.05)和D组为1.59(95%CI 1.10～2.30;P=0.01),而男性差异无统计学意义.结论 血UA水平升高是女性2型糖尿病患者下肢血管病变的危险因素.     

妊娠期糖尿病患者血尿酸水平与胰岛素抵抗的相关性研究

目的探讨妊娠期糖尿病（GDM）患者血尿酸与胰岛素水平,及胰岛素抵抗的关系。方法选取56例妊娠糖尿病患者为观察组,选取同期健康妊娠妇女50例为对照组,检测两组血空腹血糖、血尿酸及空腹胰岛素水平,同时按照血尿酸值再将GDM组分为尿酸升高组及尿酸正常组两个亚组,比较两亚组的血清空腹胰岛素水平。结果 GDM组孕妇血尿酸值为（317.25±82.22）μmol/L,血清空腹胰岛素（15.68±4.52）mU/L,对照组孕妇血尿酸值为（208.37±59.28）μmol/L,血清空腹胰岛素（11.96±3.53）mU/L,两组比较有显著性差异（P〈0.01）。GDM高尿酸组血清空腹胰岛素（17.29±3.23）mU/L,正常尿酸组血清空腹胰岛素（13.74±3.96）mU/L,两亚组比较有显著性差异（P〈0.05）。结论 GDM患者血尿酸水平增高,与胰岛素抵抗有密切关系。     

血尿酸水平与rt-PA静脉溶栓卒中患者预后及脑出血转化的相关性分析

目的 探讨溶栓治疗的急性缺血性脑卒中患者入院时血清尿酸水平与短期预后及出血转化的关系.方法 选取2010-2013年苏州大学附属第二医院神经内科卒中单元进行rt-PA静脉溶栓治疗的230例急性缺血性脑卒中患者,记录其人口统计学特征、病情严重程度、入院时血清尿酸水平及溶栓后出血转化情况,患者在随访90d时改良Rankin评分＞2分(mRS＞2分)定义为预后不良,mRS≤2分为预后良好.采用Logistic逐步回归模型对可能影响预后及出血转化的因素进行分析.结果 预后良好组患者血尿酸水平显著高于预后不良组[(375±42) μmol/L比(250±36)μmol/L,P=0.0026],采用Logistic逐步回归分析后发现高尿酸水平预后良好(OR=1.25,95％ CI,1.04 ～ 1.47,P=0.013).非出血转化组患者血尿酸水平显著高于出血转化组患者[(350±51)μmol/L比(282±38) μmol/L,P=0.015],校正了年龄、高血压等因素的影响后,尿酸水平与出血转化仍呈负相关.结论 较高血尿酸水平与rt-PA静脉溶栓良好预后和低脑出血转化相关.     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.