吡格列酮二甲双胍片联合诺和锐30治疗Ⅱ型糖尿病的临床分析

目的 探讨吡格列酮二甲双胍片（卡双平）联合诺和锐30对改善Ⅱ型糖尿病（T2DM）血糖、血脂、糖化血红蛋白、C-肽、体重指数、胰岛素用量及低血糖反应的临床效果.方法 将就诊的300例T2DM患者随机分为对照组150例及观察组150例,对照组患者单纯给予胰岛素治疗,观察组在对照组用药的基础上给予吡格列酮二甲双胍片治疗,观察两组患者治疗后6个月血糖、血脂、糖化血红蛋白、C-肽、体重指数、胰岛素用量及低血糖等指标的变化.结果 观察组治疗后FPG、2hPG、HbAlc、TC、TG、LDL-C显著低于对照组,而HDL-C高于对照组（P＜0.05）.观察组治疗后胰岛素用量小于对照组,空腹C-肽（C-P）、餐后2h C-P则高于对照组（P＜0.05）.观察组餐后低血糖发生率为1.33％,对照组为10.67％ （P＜0.05）.治疗前体重指数无统计学差异,治疗后观察组与对照组体重指数有显著差异（P＜0.05）.结论 对T2MD患者应用吡格列酮二甲双胍片联合诺和锐30治疗能有效改善患者血糖、血脂、糖化血红蛋白,并可改善胰岛功能,减少胰岛素的用量,同时减轻体重,减少低血糖反应发生.     

吡格列酮和二甲双胍联合诺和灵30R治疗体重超重2型糖尿病疗效观察

目的:观察吡格列酮和二甲双胍联合诺和灵30R治疗体重超重2型糖尿病的疗效性和安全性。方法:选取体重超重的2型糖尿病患者58例,将其随机分为两组,观察组29例接受吡格列酮、二甲双胍和诺和灵30R治疗,对照组29例用二甲双胍联合诺和灵30R治疗。疗程12周,观察疗效及安全性。结果:两组患者经治疗后体重指数、糖化血红蛋白均明显改善,观察组胰岛素用量、血糖达标时间、低血糖发生率等方面均低于对照组,两组对比差异有统计学意义(P<0.05)。结论:吡格列酮和二甲双胍联合诺和灵30R治疗体重超重2型糖尿病患者,体重指数、血糖、糖化血红蛋白均明显降低,且胰岛素用量少,低血糖发生率低,值得临床推广和应用。     

二甲双胍联用盐酸吡格列酮治疗2型糖尿病的疗效观察

目的观察二甲双胍联用盐酸吡格列酮治疗T2[）M的疗效及优点。方法将56例TzDM患者随机分为二甲双胍联用盐酸吡格列酮组（A组）和二甲双胍联用格列齐特组（B组），进行6个月治疗，观察治疗前后FPG、2hPG、HbA1c、Fins、血脂、BMI的变化。结果2组治疗后FPG、2hPG、HbA1C、血脂、BMI均较治疗前下降（P〈0．05），但A组同时可使Fins水平下降（P〈0．05）。结论二甲双胍联用盐酸吡格列酮可改善T2DM患者的糖脂代谢紊乱及胰岛素敏感性，其作用优于二甲双胍联用格列齐特组。     

二甲双胍与吡格列酮治疗非酒精性脂肪性肝病

目的探讨二甲双胍、吡格列酮联合用药与单独用药治疗非酒精性脂肪性肝病（NAFLD）的疗效。方法将120例NAFLD患者随机分成对照组、二甲双胍组、吡格列酮组、联合治疗组,每组各30例。对照组不采用任何药物治疗;二甲双胍组采用二甲双胍治疗;吡格列酮组采用吡格列酮治疗;联合治疗组采用二甲双胍、吡格列酮联合治疗,比较各组的临床疗效。结果所有药物治疗组的各项指标与治疗前比较均明显改善（P〈0.05）。联合治疗组的总有效率为96.7%,明显高于二甲双胍组的80%和吡格列酮组的76.7%（P〈0.05）;3个药物治疗组的治疗,总有效率均明显高于对照组（P〈0.05）。结论二甲双胍、吡格列酮在NAFLD的治疗中具有一定的疗效,二者联合用药治疗的临床疗效更为显著。     

格列本脲联合二甲双胍长期治疗对2型糖尿病患者胰岛素抵抗的影响

目的探讨格列本脲联合二甲双胍对2型糖尿病（T2DM）患者糖代谢和胰岛素功能的影响。方法选取我院门诊病人61例,分为格列本脲治疗（格列本脲组,n=32）和格列本脲＋二甲双胍治疗（格列本脲＋二甲双胍组,n=29）,格列本脲组为初诊病人;格列本脲＋二甲双胍组在保持平时服用二甲双胍的剂量不变的基础上加用格列本脲。随访24周,每4周根据空腹血糖（FBG）调整剂量,治疗前后做血脂、血糖、胰岛素、C肽测定,并计算胰岛素抵抗指数（HOMA-IR）。结果两组患者治疗后HbAlc较治疗前均显著降低（均P〈0.01）。格列本脲＋二甲双胍组治疗后FIns和HOMA-IR较治疗前均有显著降低（均P〈0.05）。结论格列本脲单用或与二甲双胍合用都能有效降低血糖,并没有明显的胰岛β细胞功能损害。但在改善胰岛素抵抗方面,两者联用效果更优。     

吡格列酮对2型糖尿病患者内脂素影响的临床研究

目的观察吡格列酮与二甲双胍对初诊肥胖T2DM患者血清Visfatin水平的影响，探讨Visfatin与T2DM发病的关系和药物的治疗机制。方法80例T2DM患者在运动饮食控制的基础上随机分为吡格列酮组和二甲双胍组各40例，吡格列酮组每日口服盐酸吡格列酮片30mg，二甲双胍组每日早晚口服二甲双胍缓释片500mg，疗程为16周。结果吡格列酮组治疗后空腹血清visfatin、IR、TG较用药前有明显降低（P分别为〈0．01，〈0．05，〈0．05），B细胞功能有改善（P〈0．05）。二甲双胍组血清Visfatin、TG无明显改变（P均〉0．05）。两组治疗后比较，吡格列酮组的Visfatin、IR、TG降低明显，与二甲双胍组比较，差异有统计学意义（P〈0．05，〈0．01，〈0．05），但二甲双胍组的BMI较吡格列酮组下降更明显（P〈0．05）。结论对初诊的肥胖T2DM患者吡格列酮与二甲双胍均能较好地控制血糖水平，而且吡格列酮在有效降糖同时还能明显降低血清Visfatin的水平，提示吡格列酮通过下调Visfatin水平而在T2DM的发病机理中发挥抗炎作用。     

西格列汀与吡格列酮联合二甲双胍在二甲双胍单药治疗控制不佳的2型糖尿病肥胖患者血糖的疗效观察

目的:研究分析西格列汀与吡格列酮联合二甲双胍在二甲双胍单药治疗控制不佳的2型糖尿病肥胖患者血糖的临床效果。方法:选取40例二甲双胍单药治疗控制不佳的2型糖尿病肥胖患者作为研究对象,将所有患者随机分为对照组和观察组各20例,对照组给予西格列汀+二甲双胍进行治疗,观察组给予吡格列酮+二甲双胍进行治疗,疗程均为12周。对比观察两组患者治疗前后的糖化血红蛋白、空腹血糖、餐后2 h血糖、体重指数变化情况以及低血糖发生情况。结果:两组患者的糖化血红蛋白、空腹血糖以及餐后2 h血糖等指标均明显低于治疗前,差异有统计学意义(P<0.05),对照组的餐后2 h血糖下降程度明显大于观察组,差异有统计学意义(P<0.05);而观察组的空腹血糖下降程度和体重质量增加程度均明显大于对照组,差异有统计学意义(P<0.05);两组患者的低血糖等不良反应发生情况相比,差异无统计学意义(P>0.05)。结论:采用西格列汀与吡格列酮联合二甲双胍在二甲双胍单药治疗控制不佳的2型糖尿病肥胖患者血糖中均有较高的临床应用价值,疗效显著,然而西格列汀在降低患者餐后2h血糖方面效果优于吡格列酮,吡格列酮在降低空腹血糖方面效果优于西格列汀。     

二甲双胍联合吡格列酮治疗2型糖尿病疗效观察

目的：了解二甲双胍联合吡格列酮（PGZ）治疗2型糖尿病（T2DM）的疗效及优点。方法：将60例T2DM患者随机分为二甲双胍联合格列齐特组（A组）、二甲双胍联用PGZ组（B组）,进行6个月治疗,测定治疗前后血压（BP）、血糖（PG）、体重指数（BMI）、糖化血红蛋白（HbA1C）、胰岛素（Ins）、血脂等指标,并计算胰岛素抵抗指数（HOMA-IR）。结果：两组治疗均可使BP、PG、BMI、HbA1C及LDL-C下降（P〈0.05）,但B组同时可使INS水平下降（P〈0.05）,HOMA-IR降低（P〈0.01）。结论：二甲双胍联用PGZ可改善T2DM患者的糖脂代谢紊乱,并降低血压,减轻体重,同时改善胰岛素抵抗（IR）。     

二甲双胍、吡格列酮联合应用治疗肥胖2型糖尿病患者的疗效观察

目的观察二甲双胍、吡格列酮联合应用治疗新诊断肥胖2型糖尿病（T2DM）的疗效。方法选取71例新诊断肥胖他DM患者随机分成两组，治疗组25例给予二甲双胍500mg、2次／d，吡格列酮30mg、1次／d联合治疗；对照组包括二甲双胍组（M组）和吡格列酮组（P组），M组24例给予二甲双胍500mg、2次／d治疗；P组22例给予吡格列酮30mg、1次／d治疗患者。所有治疗疗程12周，观察空腹血糖（FPG）及餐后2h血糖（2hPG）、空腹胰岛素（FINS）及餐后2h胰岛素（P2hINS）和糖化血红蛋白（HbA1c）的变化情况。结果三组患者在治疗后FPG、2hPG、HbA1c、FINS、P2hINS均明显下降。M组和P组疗效相似；治疗组在减低患者胰岛素水平、改善糖代谢紊乱方面均优于M组和P组。结论联合应用二甲双胍和吡格列酮治疗，可作为经过单一使用二甲双胍或吡格列酮治疗血糖控制仍然不良的肥胖T2DM患者选用的治疗的方法之一。     

达格列净与吡格列酮联合二甲双胍治疗2型糖尿病的疗效及对胰岛素敏感性和胰岛α和β细胞功能的影响

目的:探讨达格列净与吡格列酮联合二甲双胍治疗2型糖尿病(T2DM)的疗效及对胰岛素敏感性和胰岛α和β细胞功能的影响。方法:选取100例T2DM患者为研究对象,依据治疗方法不同分为达格列净组和吡格列酮组,每组各50例。达格列净组予以达格列净+二甲双胍治疗;吡格列酮组予以吡格列酮+二甲双胍治疗。比较两组患者血糖指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)]、血脂指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)]、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性[葡萄糖输注率(GIR)]、胰岛α和β细胞功能指标[α:胰高血糖素曲线下面积(AUCglc);β:早相胰岛素分泌指数(I30/G30)、胰岛素分泌曲线下面积(AUCins)]及不良反应发生情况。结果:治疗后,两组患者FPG、2hPG、HbAlc、TC、TG、LDL-C、HOMA-IR、AUCglc均降低(P<0.05),且达格列净组低于吡格列酮组(P<0.05);GIR、I30/G30、AUCins均升高(P<0.05),且达格列净组高于吡格列酮组(P<...     

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.     

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.     

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.