儿童1型糖尿病血脂异常的临床分析

目的分析31例儿童1型糖尿病的血脂特点以及与血糖控制的关系。方法将我院31例1型糖尿病患儿分成DKA组(n=12)和非DKA组(n=19),比较两组空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、高密度脂蛋白和低密度脂蛋白有无差异;根据血脂分为异常组(n=18)和正常组(n=13),比较两组DKA发生、病程、空腹血糖及糖化血红蛋白差异;分析糖化血红蛋白与三酰甘油、总胆固醇、高密度脂蛋白及低密度脂蛋白的关系。结果 DKA组和非DKA组的空腹血糖、三酰甘油和低密度脂蛋白差异有统计学意义(P<0.05);糖化血红蛋白、总胆固醇及高密度脂蛋白的差异无统计学意义(P>0.05)。血脂异常组和血脂正常组发生DKA的百分比分别是55.56%和15.38%,两者差异有统计学意义(P<0.05),但是两组间病程、空腹血糖和糖化血红蛋白差异无统计学意义(P>0.05)。TC、TG不随HbA1c的升高而升高(P>0.05),HDL随HbA1c升高而降低(P<0.05)。结论 1型糖尿病患儿合并DKA者三酰甘油明显升高,血脂异常组更易发生DKA。     

老年高血压患者血浆同型半胱氨酸测定及其临床意义

目的探讨血浆同型半胱氨酸(HCY)测定在老年高血压及高血压合并2型糖尿病、高血压伴缺血性脑卒中患者中的临床意义.方法将90例老年高血压患者根据病史及体检分为单纯高血压组(30例),高血压伴缺血性脑卒中组(30例),高血压合并2型糖尿病组(30例);30名正常健康者作为对照组,4组患者进行血压、血脂、血糖、血浆HCY检测.结果单纯高血压组患者、高血压合并糖尿病组患者,高血压伴缺血性脑卒中组患者与对照组血浆HCY比较,差异有显著性意义(F=47.24,P＜0.01);高血压合并糖尿病组患者与单纯高血压组血浆HCY比较差异有显著性(t=2.72,P＜0.05);高血压伴缺血性脑卒中组患者与单纯高血压组患者血浆HCY比较差别有非常显著差异意义(t=4.08 P＜0.01);而高血压合并糖尿病组患者与高血压伴缺血性脑卒中组血浆HCY比较差异无显著差异意义(t=1.34,P＞0.05),同时各组血压、血糖、血脂比较差异均无显著性意义(均P＞0.05).结论血浆HCY水平在老年高血压人群,尤其在高血压合并2型糖尿病、高血压伴缺血性脑卒中患者中明显升高,HCY的升高可能参与高血压的发生及造成血管病变,HCY是心脑血管疾病的独立危险因子.     

2型糖尿病周围神经病变与颈动脉内膜中层厚度的关系探讨

目的 探讨2型糖尿病周围神经病变(DPN)与颈动脉内膜中层厚度(IMT)的关系.方法 根据DPN的综合诊断标准,将152例2型糖尿病分为DPN组(n=61)与非DPN组(n=91),比较两组的病程、临床指标(空腹血糖、血脂、血清李腹胰岛素及C肽、糖化血红蛋白)与IMT.结果 DPN组在病程、糖化血红蛋白、甘油三酯、IMT高于非DPN组(P<0.05).结论 在2型糖尿病中,合并DPN的患者比无合并DPN的患者更易出现糖脂代谢紊乱与动脉粥样硬化.     

同型半胱氨酸与2型糖尿病患者脑卒中的相关性研究

目的探讨2型糖尿病患者血清同型半胱氨酸水平与颈部血管的关系,为脑卒中的筛查提供参考依据。方法将2011年10月至2012年3月本科室住院的102例2型糖尿病患者分为2型糖尿病合并脑卒中组(11例)及未合并脑卒中组(91例),观察两组患者的血脂、糖化血红蛋白、血清同型半胱氨酸水平及颈部血管超声检查结果。结果 (1)两组患者的年龄、性别、糖尿病病程和糖化血红蛋白等比较差异无统计学意义;2型糖尿病合并脑卒中组的高血压合并率及血清同型半胱氨酸水平均明显高于未合并脑卒中组(P<0.05);而总胆固醇、甘油三酯及低密度脂蛋白水平无明显升高;(2)2型糖尿病合并脑卒中组颈部血管狭窄发生率(72.7%)及斑块发生率(72.7%)均较未合并脑卒中组(19.8%、65.9%)高,且发生颈部血管狭窄的患者血清同型半胱氨酸水平显著升高(P<0.05)。(3)相关性分析提示血清同型半胱氨酸水平与颈动脉狭窄呈正相关(r=0.383,P=0.004)。结论 (1)高血压的合并率及血清同型半胱氨酸水平均可影响2型糖尿病患者脑卒中的发生。(2)高同型半胱氨酸血症加重了颈部血管斑块的形成,加剧了颈部血管狭窄的发生,是预防2型糖尿病脑卒中的重要筛查指标。     

缺血性脑卒中患者检测糖化血红蛋白和餐后2h血糖的价值

目的：探讨缺血性脑卒中患者检测糖化血红蛋白（HbA lc）和餐后2h血糖（2hPBG）的价值,分析其与病情严重程度、预后的关系。方法：将120例缺血性脑卒中患者分为3组：正常血糖组、高血糖组、糖尿病组,测定餐后2h血糖、糖化血红蛋白。结果：餐后2h血糖、糖化血红蛋白高血糖组和糖尿病组较正常血糖组明显升高,差异有显著性（P（0.05）。高血糖组和糖尿病组较正常血糖组,缺血性脑卒中病情重,预后差,梗死面积大,死亡率高,差异有显著性（P（0.05）。结论：糖化血红蛋白水平和餐后2h血糖与缺血性脑卒中病情严重程度密切相关,可作为判断病情、估计预后的指标。     

2型糖尿病患者骨质疏松的相关因素分析研究

目的 在2型糖尿病(T2DM)合并骨质疏松症的患者中针对发病的相关因素进行回顾性分析.方法 骨质疏松组:T2DM合并骨质疏松症患者59例,平均年龄28-80岁;非骨质疏松组:骨密度正常的2型糖尿病患者61例,平均年龄31-79岁.入组患者均测定糖化血红蛋白、股骨骨密度、腰椎骨密度、骨质疏松四项,然后对两组患者的性别、年龄、糖尿病病程、糖化血红蛋白、体重指数(BMI)、腰椎骨密度、股骨骨密度、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、Ⅰ型前胶原N-端前肽(PINP),25羟基维生素D(VitD),骨钙素(BGP)的差异性进行分析,及对引起股骨骨密度下降的危险因素进行探讨.结果 T2DM合并骨质疏松患者中股骨骨密度下降明显,伴有PINP与BGP的升高(P=0.015、0.011、0.042).骨质疏松组中股骨骨密度下降与患者年龄、糖尿病病程负相关(P=0.002、0.009);与糖化血红蛋白,β-CTX、PINP、VitD、BGP无显著相关(P值>0.05).结论 T2DM患者中性别,年龄,糖尿病病程与骨质疏松症相关.     

糖尿病酮症酸中毒患者AMS升高的高危因素分析

目的:探究糖尿病酮症酸中毒(DKA)患者血淀粉酶(AMS)升高的高危因素.方法:选取2016年2月到2018年12月我院收治的210例DKA患者作为研究对象,根据AMS是否升高分为观察组(AMS升高,n=60)和对照组(AMS正常,n=150),检测患者空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、...     

2型糖尿病合并高血压发生脑卒中的临床特点及相关危险因素分析

目的 探讨2型糖尿病合并高血压发生脑卒中的临床特点及相关危险因素.方法 方便选取重庆市渝北区人民医院2010年1月—2015年12月收治的2型糖尿病合并高血压患者540例,按是否发生脑卒中分为2型糖尿病合并高血压合并脑卒中组和2型糖尿病合并高血压组.比较两组间年龄、性别、吸烟史,饮酒史,心脏病史、肥胖和各项生化指标的差异,分析高血压分级、糖尿病病程对发生脑卒中的影响,采用Logistic回归分析型糖尿病合并高血压发生脑卒中的相关危险因素.结果 型糖尿病合并高血压合并脑卒中组与单纯2型糖尿病合并高血压组比较,发生脑卒中组年龄(64.00±12.30)岁,较未发生脑卒中组年龄(59.18±14.69)岁大(t=-2.081,P=0.039<0.05),血糖异常率及血红蛋白异常率高(P<0.01),糖尿病病程长(P<0.001),处于高血压2、3级人数多(P<0.01);多元Logistic回归分析结果显示年龄(OR=1.089,P=0.007)、糖尿病病程(OR=1.631,P=0.001)、血糖水平(OR=1.951,P=0.003),颈动脉斑块(OR=5.976,P=0.036)为2型糖尿病合并高血压发生脑卒中的危险因素.结论 2型糖尿病合并高血压发生脑卒中与患者血压、血糖、血脂、糖尿病病程、颈动脉斑块形成有关.     

2型糖尿病合并脑卒中患者VEGF、NO、ET-1的变化及其相关性

目的 探讨2型糖尿病合并脑卒中患者血管内皮生长因子(VEGF)、一氧化氮(NO)、内皮素1(ET-1)的变化及其与糖化血红蛋白(HbAlc)之间的关系.方法 以无糖尿病及脑卒中的患者为对照组(n=30),以2型糖尿病合并脑卒中的患者为实验组(n=52),检测2组的VEGF、NO、ET-1及HbAlc水平,分析2组之间各项指标的差异以及实验组反映血管内皮功能的3项指标与HbAlc的相关性.结果 实验组的VEGF、ET-1高于对照组(P＜0.01,P＜0.05),NO低于对照组(P＜0.01);实验组的HbAlc为(7.5±1.3)％,对照组为(5.5±0.7)％,2组比较差异有统计学意义(P＜0.01).实验组HbAlc与VEGF呈正相关(r=0.599,P＜0.01),与NO呈负相关(r=-0.470,P＜0.01),与ET-1呈正相关(r=0.601,P＜0.01).结论 2型糖尿病合并脑卒中患者血管内皮功能降低,其可能与血糖控制欠佳有关.     

2型糖尿病与骨质疏松关系的临床探讨

目的 探讨2型糖尿病与骨质疏松的关系及临床意义.方法 对92例2型糖尿病患者进行骨密集测定及糖化血红蛋白检测,并根据1年内数次糖化血红蛋白的平均值,分为控制较好组(糖化血红蛋白≤6%)和控制差组(糖化血红蛋白＞6%),结合病程等相关因素进行分析.结果 92例2型糖尿病患者中骨密集降低65例(70.7%),其中女性患病率为87.2%.1年内糖化血红蛋白平均高于正常水平,骨密集降低者血糖水平相对更高,两组有显著差异(P＜0.05).结论 2型糖尿病并发骨质疏松的患病率明显高于正常人群,以女性为著,病程在9年以上者明显;骨密度降低与糖化血红蛋白水平过高密切相关.     

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.     

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.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

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.