糖尿病与肺部疾病

糖尿病患者合并肺部疾病时肺功能改变主要表现为肺通气功能降低、肺弥散功能降低、肺支气管张力降低和呼吸肌功能异常,其发病机制主要包括组织蛋白非酶糖基化、氧化应激、IR、局部防御功能改变和自主神经病变。糖尿病是肺功能降低发生的独立危险因素,肺功能降低是糖尿病发生的独立预测因素。糖尿病患者肺功能变化与年龄、病程、血糖水平和并发症相关。     

糖尿病与肺部疾病

糖尿病患者合并肺部疾病时肺功能改变主要表现为肺通气功能降低、肺弥散功能降低、肺支气管张力降低和呼吸肌功能异常,其发病机制主要包括组织蛋白非酶糖基化、氧化应激、IR、局部防御功能改变和自主神经病变。糖尿病是肺功能降低发生的独立危险因素,肺功能降低是糖尿病发生的独立预测因素。糖尿病患者肺功能变化与年龄、病程、血糖水平和并发症相关。     

调脂药物小手册

医生为什么开调脂药给我？ 降低“坏”胆固醇（低密度脂蛋白胆固醇，即LDL—C）水平能够降低您发生心梗、卒中等心血管事件的风险。很多生活方式的改变可以帮助您改善血脂水平，如戒烟限酒、经常运动、低脂饮食、多吃水果和蔬菜等。     

自主神经系统与心房颤动研究新进展

心脏受交感神经和副交感神经的双重支配,其互相作用共同调节心脏。交感神经通过释放去甲肾上腺素、改变儿茶酚胺水平、影响离子电流等诱导心房颤动(简称房颤)发生,而副交感神经通过释放乙酰胆碱、改变肺静脉的电生理特征等诱导房颤发生,多数情况是两者交互作用或作用不平衡时诱导房颤发生。针对自主神经诱发房颤发生的干预措施有:①神经节消融;②脊髓刺激;③肾去交感神经;④耳屏刺激,这些措施均能起到降低房颤发生的作用。     

牙齿重度磨耗伴牙列缺损咬合重建固定义齿修复的疗效观察

正近年来,随着人们生活水平的日渐提高,饮食习惯和饮食内容在发生改变。由于不健康的饮食、咀嚼习惯大部分人有夜间磨牙习惯导致牙齿严重磨耗,表现为牙体硬组织流失,咬合面降低。牙齿重度磨耗是目前临床常见的口腔疾病,临床表现较为明显,患者咀嚼肌运动功能降低,牙体硬组织解剖形态破坏,颌骨位置关系发生改变,部分患者伴有牙列缺损,严重影响生活质量。本研究采用咬合重建法进行治疗,取得显著疗效。1资料与方法     

高密度脂蛋白胆固醇与冠心病的相关性研究

高密度脂蛋白胆固醇降低是动脉粥样硬化性心血管病的独立危险因素,血浆中高密度脂蛋白胆固醇的水平与冠心病发生呈负相关,其机制包括高密度脂蛋白逆转运胆固醇、抗氧化、促纤溶、抗血栓等作用。目前对于低高密度脂蛋白胆固醇血症患者的干预主要有生活方式改变,药物治疗,以及新近的生物疗法等策略,达到降低心血管事件的发生率。     

严重肝功能障碍的出凝血问题

严重肝功能障碍常见出凝血异常,包括血小板减少、促凝因子和抗凝因子水平降低、纤溶蛋白水平降低,以及内 皮细胞来源的促凝因子水平增高等,共同构成出凝血系统的“再平衡”状态。在感染等诱发因素作用下,严重肝功能 障碍患者既可发生低凝出血,又可发生高凝血栓形成的并发症。全面评估严重肝功能障碍患者出凝血系统改变非常 重要。全血黏弹性检测的临床评估效能可能优于常规出凝血检测。临床医生应采用目标指导性治疗策略对严重肝 功能障碍患者出血和血栓形成进行恰当的预防和治疗。     

降低冠心病伴高Hcy血症患者Hcy水平对血管内皮功能和运动耐量的影响[Dinckal MH，Aksoy N，Aksoy M，et al.Acta Cardiol

同型半胱氨酸(Hcy)可以导致血管内皮细胞损伤，血浆高Hcy水平被认为是冠状动脉粥样硬化发生和发展的独立危险因子。本文对降低血浆Hcy水平后，入选患者的内皮依赖性血管舒张功能(EDD)和运动耐量的改变进行了探讨。     

2型糖尿病与激素的研究进展

2型糖尿病患者除了胰岛素的绝对和(或)相对缺乏及胰岛素抵抗外,往往合并其他激素水平的紊乱及活性的改变。骨质疏松是糖尿病的并发症,糖皮质激素可能参与此过程,血糖控制较差的患者,此激素水平较高。性激素与胰岛素抵抗有关,雌激素水平降低与女性绝经后糖尿病的发病率增加有关。瘦素是连接肥胖和2型糖尿病的纽带。糖尿病肾病患者肾素-血管紧张索的活性发生改变。对2型糖尿病与激素的研究将有助于预防糖尿病并发症的发生,从而有效降低病残率和病死率。     

肠道菌群多样性改变在NAFLD诱发心血管疾病中的重要作用

目的 探讨肠道菌群多样性的改变在非酒精性脂肪性肝脏疾病（NAFLD）诱发心血管疾病中的重要作用。 方法 通过高脂饲料喂养的方式建立NAFLD的模型（模型组），并以正常饲料喂养的大鼠作为对照组，运用HE染色观察模型组与对照组肝脏组织形态的改变；通过Western blot检测两组肝脏细胞内SREBP-1c蛋白水平的改变；通过ELISA试剂盒检测两组血清中甘油三酯、总胆固醇、三甲胺以及氧化三甲胺的水平；运用16s rDNA高通量检测模型组与对照组肠道菌群结构的差异改变。 结果 通过高脂饲料的喂养，建立了NAFLD的大鼠模型，与对照组相比，模型组肝脏细胞内脂肪过量堆积，炎性浸润增加（P < 0.05）；血清中甘油三酯和总胆固醇水平显著增加（P < 0.05），三甲胺以及氧化三甲胺的水平显著升高（P < 0.05）；肠道菌群多样性结构发生改变，乳酸杆菌的数量及比例显著降低（P < 0.05）。 结论 NAFLD能够引起肠道菌群的多样性发生改变，肠道菌群的多样性发生改变可能参与了NAFLD诱发心血管疾病的病理过程。     

老年性皮肤瘙痒症研究概况

老年性皮肤瘙痒症是一种老年人常见的皮肤病,该病病程缠绵,常奇痒难忍而又缺乏有效的治疗手段,严重影响老年患者的身心健康.老年性皮肤瘙痒症发病机制复杂,主要与老年人机体衰老所引起的一系列生理病理变化,比如皮肤退行性变、免疫功能及内分泌的改变等有关.中西医结合综合治疗是目前治疗老年性皮肤瘙痒症的理想模式.本文主要针对老年性皮肤瘙痒症的中西医病因病机及治疗方面的研究状况做一个概述.     

Aging and the skin: recognizing and managing common disorders

Senescent changes in structure and function of the skin and chronic solar radiation damage predispose the skin of the elderly to certain inflammatory and infectious diseases. In this context, the diagnosis and treatment of senile xerosis and pruritus are discussed, as are the common types of dermatitides, infections, and infestations.     

心力衰竭合并肌少症的研究进展

心力衰竭(HF)为心脏各种疾病的严重或终末阶段,是当今最重要的心血管疾病之一。HF患者的运动耐量下降不仅与衰竭的心肌细胞有关,还与骨骼肌细胞改变相关。骨骼肌病变(肌少症)包括肌肉质量减少和肌肉功能降低,在老年人群中发病率高,可引起跌倒、衰弱、机体失能等不良事件。肌少症的发生、发展以及恶化与HF在进程上一致,两者相互影响本文详细阐述了HF合并肌少症发生机制、筛查和诊断方法以及新的治疗方法等方面的研究进展。     

Diagnosis and therapy of intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is characterized by the occurrence of pruritus mostly in the third trimenon. Diagnosis is based on the presence of pruritus and elevated levels of serum bile acids in the absence of pruritic skin diseases. There is strong evidence of a genetic predisposition for ICP. Numerous studies have investigated the association of known cholestasis genes such as ABCB4 (also designated MDR3), ABCB11 ( BSEP) and ATP8B1 ( FIC1) with ICP. The results of these studies implicate a heterogeneous etiology of this syndrome. ICP increases the risk of preterm delivery and fetal loss. Furthermore, intense pruritus may necessitate premature induction of labor with its known higher frequency of complications for mother and child. Therefore, ICP pregnancies should be managed as high-risk pregnancies. Pharmaceuticals to alleviate pruritus or improve cholestasis like antihistamines, phenobarbital, anion exchange resins, dexamethasone or S-adenosylmethionine are not widely accepted because of questionable efficacy or side effects. Recent randomized studies have shown beneficial effects of ursodeoxycholic acid (UDCA) on laboratory data and pruritus in patients with ICP. Improved knowledge about the diagnostic classification of different types and pathophysiological mechanisms of ICP may allow for a more targeted treatment of this disease in future.     

Cutaneous signs of internal disease in the elderly

The elderly are prone to several systemic diseases that have their own particular cutaneous markers. These include pruritus, pigmentary changes, and the various manifestations associated with diabetes mellitus, among others. Physician recognition of the cutaneous signs of internal disorders will prompt early diagnosis and prompt treatment of the primary disease.     

江津地区老年2型糖尿病患者皮肤病发病情况及相关因素分析

目的了解重庆江津地区老年2型糖尿病合并皮肤病的患病情况并分析其相关因素,为临床治疗提供依据。方法以重庆江津中心医院226例老年2型糖尿病住院病例为研究对象,分析其合并皮肤病的患病率及类型特征。并以其中无皮肤病患者为对照,分析糖尿病合并皮肤病相关因素。结果老年2型糖尿病患者皮肤病病变患病率为83．2％,其中前3位为皮肤真菌感染（占31．9％）、湿疹（11．9％）和皮肤瘙痒症（7．9％）。多凼素非条件Logistic回归分析显示,糖尿病并发症（OR=4．54）、高血压（OR=1．81）及血脂异常（OR=1．67）为老年糖尿病并发皮肤病的危险因素。结论重庆江津地区老年2型糖尿病患者常见皮肤病为皮肤感染和湿疹,可能与糖尿病患者糖尿病并发症、高血压及血脂异常有关。临床应重视对危险因素的控制,以降低老年糖尿病患者皮肤病的发生。     

Extracorporeal albumin dialysis: a procedure for prolonged relief of intractable pruritus in patients with primary biliary cirrhosis

BACKGROUND AND AIMS: Pruritus is a distressing symptom in patients with primary biliary cirrhosis, and when uncontrollable it is an indication for liver transplantation. Since pruritus can result from unknown substances that accumulate systemically as a consequence of impaired biliary secretion, we have assessed whether a new extracorporeal albumin dialysis (ECAD) procedure, the molecular-adsorbing recirculating system-MARS, has any effect on pruritus of cholestasis. METHODS: Four patients with primary biliary cirrhosis and resistant pruritus were treated with two 7-h ECAD sessions 1 day apart. Pruritus was recorded from 15 days before the first session, before and after each session, and during the follow-up using a visual analogue scale (VAS). Standard liver tests as well as serum bile acid levels were also measured. RESULTS: There was a clear association between ECAD treatment and relief of itching, which promptly disappeared in two patients, or decreased markedly in the other two. One patient was free of pruritus for 18 months except for short periods with mild pruritus. The second patient experienced amelioration of itching, which almost disappeared completely and recurred mildly 4 months later. In the other two patients pruritus was alleviated markedly after ECAD but gradually recurred. These two patients were treated again 9 and 7 months later with favorable effects on pruritus. The scratching skin lesions improved or disappeared in parallel with the alleviation of itching. The albumin dialysis procedure did not result in liver test changes, except for circulating bile acids, which decreased in all the patients. No significant adverse effects were observed. CONCLUSIONS: The ECAD procedure seems to be an effective alternative for the treatment of patients with pruritus of cholestasis who do not respond to other therapeutic methods.     

Urämischer Pruritus

Chronic itch (CI) is a frequent and often tormenting symptom in patients with advanced chronic kidney diseases. The skin of affected patients often shows no obvious alterations but as a sequel to scratching secondary skin lesions, such as excoriations, scars and prurigo nodularis then develop. Because of the lack of knowledge on the pathogenesis and the low number of valid clinical trials, the treatment of CI is difficult and mostly symptomatic. Almost all drugs used for treatment of pruritus are not approved for this indication in Germany. The centrally acting calcium channel blockers gabapentin and pregabalin have been shown to be effective for CI and UVB phototherapy has also been proven to provide relief from pruritus in many patients. Recent randomized controlled studies have shown that nalfurafine, a kappa opioid receptor agonist, can effectively relieve pruritus in patients but is not currently approved in Europe. For naltrexone, a µ?opioid receptor antagonist, contradictory results have been reported for CI in hemodialysis patients.     

Successful treatment of acquired perforating dermatosis with rifampicin in an Asian patient with sclerosing cholangitis

Acquired perforating dermatosis (APD) is a very rare disorder which has been described in association with systemic diseases such as diabetes mellitus, HIV infection or lymphoma. In this report we describe a patient with APD associated with sclerosing cholangitis and diabetes mellitus who was successfully treated with rifampicin. A 33-year-old Indian woman with a history of extensive pancreatic surgery, sclerosing cholangitis and insulin dependent diabetes mellitus was referred to our unit with intractable pruritus. She was treated with cholestyramine, ursodeoxycholic acid, several analgesics, UVB therapy, topical steroids, sedative antihistamines and plasmapheresis without significant improvement. Increasingly severe itching was associated with papular skin changes limited initially to the lower limbs but which later involved her entire body. Biopsy of a representative lesion showed the changes of APD. She was subsequently treated with rifampicin which produced a dramatic resolution of pruritus within 3 weeks and the skin changes progressively resolved over subsequent months. In this newly described association of APD with sclerosing cholangitis, rifampicin treatment appeared to be efficient in ameliorating pruritus and the papular skin changes typical of APD.     

糖尿病与带状疱疹相关性的研究进展

带状疱疹是由水痘-带状疱疹病毒(VZV)感染引起的皮肤急性炎性反应,常伴有严重的神经病理性疼痛。在老年患者中,带状疱疹是糖尿病常见的合并疾病之一。研究证实,糖尿病为带状疱疹的重要危险因素。糖尿病可引起机体代谢紊乱、诱发微血管病变、降低免疫水平,增加了带状疱疹的发生风险;同时带状疱疹也可导致糖尿病患者内分泌失调、血糖恶化、生活质量下降,从而加重社会经济负担。目前,关于糖尿病和带状疱疹相互作用的机制尚不清楚,需要更多高质量的研究进一步明确两者的相关关系。