不同标准空腹血糖受损人群高血压分布特征及相关因素分析

目的:探讨2种标准空腹血糖受损人群高血压分布特征及相关危险因素.方法:时年龄>40岁3 828人进行流行病学调查,分析空腹血糖≥5.6 mmol/L和空腹血糖≥6.1 mmol/L者的血压状况.结果:空腹血糖≥5.6 mmol/L 627例中,高血压患病率为31.74%,男性(34.54%)高于女性(29.89%)(P<0.05),高血压前期患病率为47.05%,男性(51.41%)高于女性(44.18%)(P<0.05);Logistic回归结果分析显示,血压升高的危险因素为高血压家族史、腰围、总胆固醇升高和高密度脂蛋白胆固醇降低.空腹血糖≥6.1mmol/L 245例中,高血压患病率为31.43%,男性(34.55%)高于女性(28.89%)(P<0.05);高血压前期患病率为44.90%,男性(43.64%)低于女性(45.93%)(P>0.05);Logistic回归分析结果显示,血压升高的危险因素为年龄、高血压家族史、腰围和低密度脂蛋白胆固醇升高.结论:分别以空腹血糖≥5.6 mmol/L和≥6.1 mmol/L为诊断切点的空腹血糖受损人群高血压和高血压前期总患病率分别为78.79%和76.33%,可控危险因素主要是中心性肥胖和血脂代谢紊乱.     

长春市30405例体检人群血脂、血糖与尿酸异常及相关性分析

目的研究长春市18周岁以上30 405例体检人群高尿酸血症(HUA)检出率,探讨HUA与血脂、空腹血糖(FBG)的相关性。方法选取2015年1月至2015年6月在吉林大学第一医院检验科接受检查的30 405名18周岁以上体检者为研究对象,检测其血清三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HLD-C)、空腹血糖(FBG)及尿酸(UA)的水平。整理并分析各项指标异常检出率,并分析血脂、空腹血糖与HUA的关系。结果 30 405例体检人群中,高三酰甘油血症、高胆固醇血症、高低密度脂蛋白血症、低高密度脂蛋白血症、高血糖及HUA检出率分别为18.37%、7.7%、8.53%、10.64%、15.30%、24.41%。男性和女性HUA患病率分别为36.28%、12.42%,男性高于女性,差异有统计学意义(P0.05)。在男女性别分组后可见HUA组的TG、TC、LDL-C、FBG水平高于尿酸正常组,而HDL-C水平低于尿酸正常组,差异有统计学意义(P0.05)。多因素Logistic回归分析,男性、年龄、高TG、高LDL-C、低HDL-C、高FBG为HUA的危险因素。结论长春市18岁以上体检人群高血脂、高血糖、HUA患病率较高,尿酸升高与血脂、血糖代谢异常有一定相关性,合理膳食、加强运动并定期体检对预防此类疾病的发生具有重要意义。     

乌鲁木齐市汉族人群心血管危险链构成及其影响因素

目的:调查乌鲁木齐市汉族人群代谢综合征及其相关疾病的患病状况,并探讨其影响因素。方法:①于2001-08/09采用整群抽样方法调查乌鲁木齐新市区25岁以上汉族成人2688人。排除有高血压病史、严重心、肝、肾功能不全的人群,排除资料不全者,纳入2670人。按下列标准分为4组:代谢综合征组(n=243):1个个体同时存在高血糖、高血压、血脂紊乱3种成分;两种代谢紊乱组(n=701):1个个体同时存在高血糖、高血压、血脂紊乱3种成分中任意2种;一种代谢紊乱组(n=1087):即个体存在高血糖、高血压、血脂紊乱3种成分中的任意1种;无代谢紊乱组(n=639):无代谢异常。②所有调查对象均进行血压、体质量指数、腰围、血糖、血脂、胰岛素等指标的测定。比较分析不同性别及血脂紊乱状况人群的糖脂代谢紊乱、肥胖患病情况。③组间比较用方差分析,多因素分析采用Logistic回归。结果:纳入汉族成人2688人,排除资料不全者,2670人纳入结果分析并完成问卷调查。①男性糖尿病、糖耐量低减/空腹血糖受损、高血压、高三酰甘油血症、高低密度脂蛋白胆固醇血症、低高密度脂蛋白胆固醇血症、超重、肥胖、代谢综合征患病率均明显高于女性(P<0.01);高总胆固醇血症患病率明显低于女性(P<0.01)。②代谢综合征组、2种代谢紊乱组、1种代谢紊乱组、无代谢紊乱组体质量指数、腰臀比、空腹血糖、餐后2h血糖、收缩压、舒张压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇呈降低趋势,且组间两两比较均有明显差异(P<0.01);高密度脂蛋白胆固醇呈上升趋势,无代谢紊乱组明显高于其余3组(P<0.01),而代谢紊乱各组间差异不明显(P>0.05)。③多因素非条件Logistic回归分析结果提示,体质量指数、腰臀比、年龄与代谢综合征高度相关(OR=2.6610,1.8710,3.7768,P<0.01)。结论:①乌鲁木齐市汉族男性成年人血糖、血脂紊乱、肥胖发生情况较女性严重。②代谢紊乱种类越多,血糖、血脂紊乱情况越严重。③代谢综合征患病与体质量指数、腰臀比、年龄有关。     

北京地区体检人群血脂紊乱及高血糖患病率的研究

目的 了解北京市人群血脂紊乱、高血糖患病率及其特点.方法 对2008年10月至2011年8月在该院体检的7 605例北京市机关、企事业单位体检者进行调查,内容包括性别、年龄、既往史等.并采集空腹静脉血对血糖、血脂等结果进行统计学分析.结果 (1)调查人群中高总胆固醇(TC)血症、高三酰甘油(TG)血症、低血清高密度脂蛋白胆固醇(HDL-C)血症、高血清低密度脂蛋白胆固醇(LDL-C)血症患病率分别为45.0%(3 424例)、34.6%(2 633例)、16.1 %(1 228例)、21.1%(1 605例);符合高血糖诊断标准者927例,检出率为12.2%.(2)以上各项目男性患病率均高于女性,但大于50～60岁、＞60岁年龄组高TC血症、高LDL-C血症女性患病率高于男性,＞60岁年龄组高TG血症女性患病率高于男性.(3)高TG血症、高TC血症、高LDL-C血症患病率明显高于1986年统计结果.结论 北京市高血糖、高脂血症患病率与1986年比较明显升高,因此,从中青年开始特别是男性更应改善生活方式,加强膳食平衡,增强体育锻炼,提高生活质量,以预防相关疾病的发生.     

空腹血糖受损合并高血压患者高血压视网膜病变伴随状况及特征分析

目的:探讨空腹血糖受损合并高血压患者高血压视网膜病变伴随状况及相关危险因素.方法:对85例>40岁空腹血糖受损合并高血压患者中高血压视网膜病变的发病率及其相关危险因素进行分析.结果:高血压视网膜病变患病率为82.35%,男性(76.19%)与女性(88.37%)患病率比较差异无统计学意义(P=0.141),随年龄增长和高血压痛程延长,高血压视网膜病变患病率明显增加.Logistic回归分析结果显示,高血压视网膜病变的危险因素为年龄、高血压病程和高总胆固醇.结论:空腹血糖受损合并高血压患者可控危险因素主要是血脂代谢紊乱.     

健康体检人群高血压前期与糖脂代谢异常状况研究

目的研究健康体检人群高血压前期与血糖血脂代谢异常状况。方法选择2014年1月至2015年6月在该院接受健康体检者200例,测量血压、体质量指数,及血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、尿酸等指标;比较不同性别、年龄段人群高血压检出率和糖脂代谢异常检出率,比较合并及不合并糖脂代谢异常高血压患者各指标水平。结果共检出高血压前期患者54例,检出率为27.00%,且男性患者所占比例高于女性(P0.05)。高血压前期患者中,25~45岁者所占比例高于血压正常者和高血压患者(P0.05)。高血压前期患者HDL-C水平低于血压正常者且高于高血压患者,其他血清指标水平高于血压正常者且低于高血压患者(P0.05)。单纯脂代谢异常、高TG血症、高TC血症及混合型高血脂症患者中,男性所占比例高于女性(P0.05),各年龄段人群糖脂代谢异常检出率比较差异有统计学意义(P0.05)。高血压前期患者糖脂代谢异常检出率高于血压正常者且低于高血压患者(P0.05)。合并糖脂代谢异常高血压前期患者年龄、舒张压、TG、TC、LDL-C等指标水平高于不合并者,HDL-C水平低于不合并者(P0.05)。结论健康体检人群高血压前期和糖脂代谢异常发病呈年轻化趋势,且男性所占比例较大,合并糖脂代谢异常高血压前期患者存在更多的心脑血管疾病危险因素。     

甲状腺结节患病率与血糖、血脂代谢异常的相关性研究

目的探讨甲状腺结节患病率与血糖、血脂代谢异常的相关性,分析影响甲状腺结节患病率的危险因素。方法收集2018年1—12月中国医科大学附属盛京医院体检中心行甲状腺功能(5项)检测及甲状腺超声检查的3 840例健康体检者的资料。根据空腹血糖水平将研究对象分为血糖正常组、血糖升高组和糖尿病组,根据是否患有甲状腺结节将研究对象分为甲状腺结节阳性组和甲状腺结节阴性组。分析各组甲状腺结节患病率及相关生化指标。结果本研究共1 942例检出甲状腺结节,甲状腺结节患病率为50. 57%,其中男性甲状腺结节患病率为46. 83%,女性甲状腺结节患病率为55. 89%,女性甲状腺结节患病率显著高于男性(P 0. 05)。随着年龄的增长,甲状腺结节患病率显著升高(P 0. 05)。甲状腺结节阳性组的空腹血糖、总胆固醇、低密度脂蛋白胆固醇水平均显著高于甲状腺结节阴性组(P 0. 01)。甲状腺结节患病率随着血糖水平的升高呈上升趋势,其中血糖正常组的甲状腺结节患病率为49. 18%,显著低于血糖升高组的56. 13%和糖尿病组的58. 64%(P 0. 05或P 0. 01)。多元Logistic回归分析表明,性别、年龄是沈阳地区健康体检人群罹患甲状腺结节的独立影响因素。结论来本院健康体检的人群甲状腺结节的患病率较高,其中性别、年龄是导致人群罹患甲状腺结节的独立影响因素,而血糖、血脂异常也可能导致甲状腺结节患病率升高,需要引起临床关注。     

深圳市8884例体检者脂肪肝危险因素分析及护理

目的探讨普通人群脂肪肝发生的相关危险因素,为脂肪肝的预防提供依据。方法对8 884例自愿参加本次研究的体检者,由经过专门培训的工作人员对其进行身高、体质量、血压、空腹血糖、血脂、肝脏B超等项目的检查,记录体检结果。危险因素分析用Logistic多元回归分析。结果本组对象中,患脂肪肝2 732例,患病率30.75%,其中男性患病率为42.58%,女性患病率为18.09%;Logistic多元回归分析显示:性别、年龄、收缩压、舒张压、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿酸、体质量指数进入回归方程,均有统计学意义(P<0.001)。结论深圳市体检人群中脂肪肝患病率高,男性及随着年龄、收缩压、舒张压、空腹血糖、甘油三酯、低密度脂蛋白胆固醇、尿酸、体质量指数增高,脂肪肝发生的危险性增加,高密度脂蛋白胆固醇增高脂肪肝发生的危险性降低。     

南宁市城乡心血管病危险因素流行现况调查

目的:了解南宁市城乡居民心血管病危险因素流行现况.方法:采用分层整群抽样的方法,对南宁市区401名市民及市郊乡村727名居民进行问卷调查并测量血压,检测血脂、空腹血糖.结果:乡村中年男性的高胆固醇血症及糖代谢异常患病率高于城市中年男性(P<0.01,P<0.05);乡村老年男性高血压及高胆固醇血症患病率高于城市老年男性(均P<0.01):乡村中年女性的高血压、高胆固醇血症及糖代谢异常患病率高于城市中年女性(均P<0.01);乡村老年女性高血压患病率高于城市老年女性(P<0.01).结论:南宁乡村居民心血管病危险因素流行率高,需加强综合干预措施,以预防心血管病.     

北京高校教职工血尿酸水平调查及其与相关生化指标间关系的临床研究

目的调查北京高校教职工群体血尿酸水平异常情况及其与相关生化指标之间的关系。方法对6690名教职工2014年健康体检数据进行处理,分析高、低尿酸血症患病率,及这两组人群同正常组的肝肾功能、血糖、血脂等指标差异,采用Logistic多因素回归模型分析高尿酸血症与血糖、肝功能、血脂等高危因素的关系。结果高尿酸血症患病率男性23.50%,女性为9.95%。男女高尿酸血症组的丙氨酸氨基转移酶(ALT)、肌酐(CREA)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)显著高于尿酸正常组(P0.01),高密度脂蛋白胆固醇(HDL-C)低于尿酸正常组;Logistic多因素回归分析GLU、ALT、CREA、TG、LDL各项的OR值为1.02~2.11,HDL的OR=0.94。结论糖脂代谢异常与高尿酸血症多合并存在,血尿酸异常与肝功能异常、糖脂代谢紊乱、胰岛素抵抗等可能互为因果。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.