老年糖尿病患者血清25羟维生素D水平与踝肱指数的相关研究

目的 探讨老年2型糖尿病(diabetes mellitus,T2DM)患者血清25羟维生素D[25-hydroxyvitaminD,25(OH)D]水平与踝肱指数(ankle-brachial index,ABI)的关系.方法 老年T2DM患者(T2DM组)180例,根据ABI值将患者分为下肢血管病变(peripheral arterial disease,PAD)组(82例),非下肢血管病变(N-PAD)组(98例),设正常对照组(50例),记录所有受试者的临床资料及检测指标.结果 T2DM组患者血清25(OH)D水平低于对照组(t=-2.45,P=0.024),T2DM患者中PAD组25(OH)D水平低于N-PAD组(t=-2.19,P=0.038),差异有统计学意义.相关分析显示,ABI值与糖尿病病程(r=-0.396,P=0.004)、收缩压(r=-0.332,P=0.016)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)(r=-0.335,P=0.015)、血尿酸(r=-0.347,P=0.012)及尿白蛋白/尿肌酐比(urinary albumin/creatinine ratio,ACR)(r=-0.367,P=0.008)呈负相关,与25(OH)D呈正相关(r =0.535,P＜0.001).多因素Logistic回归分析显示,吸烟(OR=1.145,P=0.017)、高收缩压(OR=0.972,P=0.009)、高水平HbA1c(OR=0.636,P=0.038)、高水平血尿酸(OR=0.631,P=0.033),低水平25 (OH) D(OR=2.746,P=0.009)是老年T2DM患者ABI值低于正常范围的危险因素.结论 血清25(OH)D水平与老年T2DM患者PAD的发生相关.     

129例老年男性骨密度及血清25-OHD、PⅠNP、β-Crosslaps水平分析

目的调查老年男性骨密度及25-羟维生素D(25-OHD),Ⅰ型前胶原氨基端肽(PⅠNP),β胶原降解产物(β-Crosslaps)水平,为老年男性骨质疏松的诊治提供依据。方法记录129名60~90岁受试者的年龄、身高、体质量、BMI,测量其腰椎1-4、左侧股骨颈、Wards三角、大粗隆、左侧股骨上端的骨密度(BMD),检测空腹血清25-OHD、PⅠNP,β-Crosslaps水平。根据骨密度水平将受试者分为骨量正常组(n=22)、骨量低下组(n=73)和骨质疏松组(n=34)。结果骨量低下组及骨质疏松组的BMD均明显低于正常骨量组,骨质疏松组又明显低于骨量低下组(P0.05)。骨量低下组及骨质疏松组PⅠNP、β-Crosslaps均明显高于正常骨量组,骨质疏松组β-Crosslaps又明显高于骨量低下组(P0.05)。25-OHD水平在骨质疏松组有降低趋势,但差异无统计学意义(P0.05)。结论大部分老年男性存在骨量丢失及维生素D不足,其主要原因为高骨转换状态。     

2型糖尿病患者不同部位骨密度变化及骨折情况分析

目的探讨2型糖尿病(T2DM)患者不同部位骨密度(BMD)的特征及骨折情况。方法 2012—2015年青岛市城阳区人民医院内分泌科住院T2DM患者125例为观察组,健康体检者240例为对照组,收集一般临床资料;双能X线吸收法测定腰椎(L)后前位1-4椎体和左侧股骨近端各部位(股骨颈、股骨干、大粗隆、Ward's三角和全髋部)的BMD。结果男性DM腰椎(L2)的BMD低于非糖尿病(NDM)组,差异有统计学意义(P<0.05);女性DM的Ward's三角区和股骨颈BMD低于NDM组,差异有统计学意义(P<0.05)。骨质疏松(OP)患病率,女性DM(55.20%)和NDM(29.16%)均高于男性DM(28.80%)和NDM(21.66%),差异有统计学意义(P<0.05);男性DM患者(28.80%)高于NDM患者(21.66%),其中L2和L1-4(5.40%和16.00%)高于NDM患者(1.66%和9.58%),差异有统计学意义(P<0.05);女性DM患者(55.20%)高于NDM患者(29.16%),其中Ward's三角、股骨颈和股骨全部(20.00%、12.80%和42.40%)高于NDM患者(3.33%、5.00%和17.91%),差异有统计学意义(P<0.05)。男性和女性DM患者骨折人数最多部位为腰椎。结论 T2DM患者易伴发OP,其中L2和Ward's三角区可分别作为男性和女性患者早期诊断OP的首选检查部位。     

儿童血清中25羟-维生素D_3水平与骨密度及脂代谢异常发生的关系

目的观察血清中25羟-维生素D3水平与患者骨密度及脂代谢异常发生的关系。方法选择民航总医院2015年11月～2017年11月门诊健康体检的儿童200例,所有儿童均抽血检测血脂、25羟-维生素D3水平。并根据25羟-维生素D3水平分为25羟-维生素D3缺乏组(25羟-维生素D320μg/L)25例,25羟-维生素D3偏低组(25羟-维生素D320～30μg/L)45例,25羟-维生素D3正常组(25羟-维生素D3 30μg/L)130例。行骨密度检测,探讨儿童血清中25羟-维生素D3水平与患者骨密度的关系,采用logistics回归分析探讨血清中25羟-维生素D3水平与脂代谢异常发生的关系。结果 25羟-维生素D3缺乏组儿童腰椎、股骨颈、股骨粗隆、Ward三角区骨密度水平分别为(0.95±0.19)、(0.94±0.24)、(0.75±0.13)、(0.87±0.24)g/cm2明显低于偏低组、正常组儿童,差异有统计学意义(P 0.05);25羟-维生素D3缺乏组儿童TG、TC、LDL-C水平分别为(2.45±0.32)、(5.37±1.23)、(3.12±0.25)mmol/L明显高于偏低组、正常组,HDL-C水平(0.35±0.12)mmol/L明显低于偏低组、正常组,差异有统计学意义(P 0.05);25羟-维生素D3缺乏组儿童超重、肥胖的人数分别为8、15例,明显高于其他组,差异有统计学意义(P 0.05)。结论 25羟-维生素D3水平与骨密度及脂代谢密切相关可能是儿童肥胖的危险因素。     

老年糖尿病患者血清25羟维生素D水平与踝肱指数的相关研究

目的探讨老年2型糖尿病（diabetes mellitus,T2DM）患者血清25羟维生素D[25-hydroxyvitamin D,25（OH）D]水平与踝肱指数（ankle-brachial index,ABI）的关系。方法老年T2DM患者（T2DM组）180例,根据ABI值将患者分为下肢血管病变（peripheral arterial disease,PAD）组（82例）,非下肢血管病变（N-PAD）组（98例）,设正常对照组（50例）,记录所有受试者的临床资料及检测指标。结果 T2DM组患者血清25（OH）D水平低于对照组（t=-2.45,P=0.024）,T2DM患者中PAD组25（OH）D水平低于N-PAD组（t=-2.19,P=0.038）,差异有统计学意义。相关分析显示,ABI值与糖尿病病程（r=-0.396,P=0.004）、收缩压（r=-0.332,P=0.016）、糖化血红蛋白（glycosylated hemoglobin A1c,HbA1c）（r=-0.335,P=0.015）、血尿酸（r=-0.347,P=0.012）及尿白蛋白/尿肌酐比（urinary a...     

高龄非酒精性脂肪肝患者与血清25-羟维生素D水平的相关性研究

目的探讨高龄非酒精性脂肪肝(NAFLD)患者血清25-羟维生素D[25-(OH)D]水平变化及与NAFLD发生发展的相关性。方法选择在北京大学人民医院老年科住院的老年患者434例,年龄为(80.05±8.69)岁,分为NAFLD组(n=138例),无NAFLD组(n=296例),检测血清25-(OH)D水平。结果 NAFLD组血清25-(OH)D水平[(33.43,66.01)nmol/L]显著低于无NAFLD组[(41.55,17.53)nmol/L](P0.05);在NAFLD组中维生素D缺乏的患者比例明显升高(P0.05)。结论 NAFLD组的血清25-(OH)D水平低于无NAFLD组。血清25-(OH)D水平与老年NAFLD显著相关。     

老年男性2型糖尿病患者骨质疏松相关因素分析

目的 探讨与老年男性2型糖尿病（type 2 diabetes mellitus,T2DM）骨质疏松（osteoporosis,OP）发生相关的因素。方法 选取老年男性T2DM患者288例,根据OP诊断标准分为骨量正常组（72例）、骨量减少组（118例）和骨质疏松组（98例）。测量身高、体重,计算体质指数（body mass index,BMI）;测定空腹血糖（fasting blood glucose,FBG）、糖化血红蛋白（glycosylated hemoglobinA1c,HbA1c）、甲状旁腺素（parathyroid hormone,PTH）、血清钙（serum calcium,Ca）、血清磷（serum phosphonium,P）、25羟维生素D （serum 25-hydroxyvitamin D,25-OH-VD）及尿白蛋白/肌酐（urinary albumin/creatinine ratio,ACR）,记录患者病程、降糖药物使用和糖尿病慢性并发症情况。结果 与骨量正常组比较,骨质疏松组和骨量减少组病程较长和HbA1c较高,BMI减低,差异均有统计学意义（均有P<0.05）。相关分析显示股骨颈、三角区、大转子、腰椎（lumbar vertebrae,L）2-4节骨密度（bone mineral density,BMD）与BMI均呈正相关（均有P<0.05）,但与HbA1C均呈负相关（均有P<0.05）。骨质疏松组糖尿病肾病、糖尿病视网膜病变发生率均高于骨量正常组、骨量减少组（均有P<0.05）;骨质疏松组糖尿病神经病变发生率高于骨量正常组（χ2=6.168,P=0.013）。Logistic回归分析显示BMI、HbA1c及糖尿病肾病与糖尿病骨质疏松发生相关（均有P<0.05）。结论 低BMI,血糖控制不佳和糖尿病肾病是老年男性T2DM患者OP发生的危险因素。     

血清25羟维生素D与2型糖尿病患者胰岛素抵抗及炎症因子水平的相关性分析

目的研究分析血清25羟维生素D[25(OH)D]与2型糖尿病(type 2 diabetes mellitus,T2DM)患者胰岛素抵抗(meostasis model assessment of insulin resistance,HOMA-IR)及炎症因子水平的相关性。方法回顾性分析本院2014年1月—2016年1月收治的T2DM患者58例作为调查对象,对所有患者实施颈动脉超声检查,并根据检查结果进一步确定患者为单纯的T2DM组(A组)27例及T2DM合并颈动脉粥样硬化组(B组)31例,探讨血清25(OH)D与T2DM患者胰岛素抵抗指数(meostasis model assessment of insulin resistance,HOMA-IR)及炎症因子水平的相关性。计量资料比较采用t检验,相关性分析采用Pearson相关,P0.05为差异有统计学意义。结果 B组患者的BMI、空腹胰岛素(fasting insulin,FINS)、HOMA-IR、IL-8及TNF-α水平[(35.8±2.3)kg/m2、(11.9±3.7)m U/L、(7.3±3.5)、(6.3±0.6)、(26.8±9.7)ng/L]明显高于A组[(33.4±2.1)kg/m2、(9.6±2.9)m U/L、(5.4±3.2)、(5.8±0.7)、(20.7±10.4)ng/L],空腹血浆葡萄糖(fasting plasma glucose,FPG)及25(OH)D水平[(8.4±2.6)mmol/L、(14.3±6.2)ng/ml]明显低于A组[(10.9±3.7)mmol/L、(18.6±8.8)ng/ml],差异均有统计学意义(均P0.05)。25(OH)D与BMI、FINS、HOMA-IR、IL-8及TNF-α呈负相关(r=-0.684、-0.659、-0.547、-0.617、-0.730,均P0.05),而与FPG呈正相关(r=0.711,P0.05)。结论 T2DM合并颈动脉粥样硬化患者的25(OH)D水平较低,而炎症因子水平较高,且25(OH)D水平越低,FINS、HOMA-IR、IL-8及TNF-α越高,适当补充维生素D可减轻2型糖尿病患者的胰岛素抵抗及炎症反应。     

不同分期男性糖尿病肾病患者血清骨代谢指标及骨密度变化研究

目的探讨不同分期男性糖尿病肾病(DN)患者血清骨转换指标及骨密度的变化情况。方法 2010年1月-2014年12月,对台州医院610例首诊糖尿病(DM)患者(分为单纯DM组、早期DN组、临床期DN组)及207例健康体检者的骨密度及血清骨转换指标进行统计分析。结果单纯DM组、早期DN组及临床期DN组血清钙(Ca2+)、血清磷(P)、骨钙素N端中分子片段(N-MID)、25羟维生素D(25-OH Vit D)、睾酮(TESTO)水平、腰椎及脊柱骨密度呈逐渐下降趋势,β-胶原降解产物(β-CTX)及甲状旁腺素(PTH)水平呈逐渐上升趋势,差异均有统计学意义(P0.001)。25-OH Vit D与3组的骨密度具有较高的正相关性,r值分别为0.677、0.728、0.757,P0.001;N-MID与3组的骨密度具有较高的负相关性,r值分别为-0.415、-0.515、-0.615,P0.001。结论男性DN患者骨密度随病情发展呈逐渐降低趋势,25-OH Vit D及N-MID可作为DN的重要监测指标。     

HBV感染合并2型糖尿病患者肝功能损害与骨代谢指标的关系

目的分析慢性乙型肝炎病毒(HBV)感染合并2型糖尿病(T2DM)患者肝功能损害情况及其与骨代谢指标的关系。方法选取2018年1月-2020年1月吉林医药学院附属医院128例合并慢性HBV感染的T2DM患者为研究对象,根据丙氨酸氨基转移酶(ALT)水平分为ALT异常组及ALT正常组,比较两组患者糖代谢指标空腹血糖(FPG)、糖化血红蛋白(HbA1c);胰岛功能指标空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及骨代谢指标Ⅰ型胶原交联C-末端肽(CTX)、25-羟基维生素D[25-(OH)D_3]和骨密度(BMD)差异。并根据患者BMD水平分为骨质疏松组与非骨质疏松组,采用Losigtics回归分析合并慢性HBV感染的T2DM患者发生骨质疏松的危险因素。结果 ALT异常组FPG、HbA1c、25-(OH)D_3及股骨BMD、腰椎BMD均低于ALT正常组(P0.05),而FINS、CTX高于ALT正常组(P0.05)。128例合并慢性HBV感染的T2DM患者中骨质疏松组45例(35.16%),非骨质疏松组83例(64.84%);两组腰臀比、FPG、HbA1c、FINS、HOMA-IR水平比较,差异均无统计学意义;但骨质疏松组女性占比、年龄、T2DM病程及ALT水平高于非骨质疏松组(P0.05),体质量指数(BMI)低于非骨质疏松组(P0.05); Logistics回归分析结果,女性、年龄≥65岁、T2DM病程≥8年、BMI18.50 kg/m~2、ALT40 U/L是合并慢性HBV感染T2DM患者发生骨质疏松独立危险因素。结论合并慢性HBV感染的T2DM患者骨代谢与肝功能受损、性别、年龄、病程及BMI均相关,临床应积极防控患者骨质疏松,避免发生骨折等严重不良事件。     

科技创新 建功立业

在新春来临、万象更新之际,我谨代表国家人口计生委向全国广大计划生育科技工作者致以最诚挚的新年祝福!2007年,我国人口和计划生育科技工作进入了新的发展时期。一年来全国各地认真学习、深入贯彻落实党的十七大和中央《决定》精神,按照全国人口和计划生育科技大会的工作部署,紧紧围绕中心,服务大局,锐意进取,开拓创新,科技事业蓬勃发展,科技工作取得了可喜的成就,为新时期人口和计划生育工作稳定健康发展奠定了坚实基础。2008年是充满希望、大有作为的一年,也是落实中央《决定》和《全国人口和计划生育科学技术“十一五”发展规划》的关键…     

Osteoporosis with vertebral fractures associated with pregnancy and lactation

Three cases of young women who developed severe vertebral osteoporosis after pregnancy and during lactation are described. These patients shared several features: a low-calcium diet during most of their lives, very-low body weight in two patients, and a positive family history of osteoporosis in two patients. Initial studies disclosed vertebral fractures, severely diminished bone mineral density of the spine (Z score = -3.3 to -4.1), and a less severely affected bone mineral density of the hip (Z score = -1.6 to -2.3). During the prolonged follow-up of these patients, treated with oral biphosphonates, vitamin D, and calcium, an improved clinical response with a marked recovery of spine bone mineral density was observed. Poor general nutrition, low calcium intake, and a positive family history of osteoporosis appear to be strong risk factors for pregnancy- and lactation-associated osteoporosis. Although the mechanism of action is uncertain, calcium, vitamin D, and antiresorptive agents may have been beneficial in the treatment of this severe disorder.     

Children and adolescents with cancer: experiences with chemotherapy

This study aimed to comprehend chemotherapy from the perspective of children and adolescents with cancer. Ten children and adolescents between eight and 18 years of age, in different phases of chemotherapy, participated in this exploratory, qualitative study. Data collection was carried out through semi-structured interviews and analysis of the patients' medical records. Analysis of the empirical material followed the content analysis technique. The study allowed the comprehension that, for the children and adolescents, chemotherapy is mainly remembered for its collateral effects and suffering. After the initial impact, mainly due to physical changes, preoccupations are related to disease recovery, i.e. a cure. Over time, they also mentioned that the disease was seen as something to be overcome and, due to the chemotherapy, likely to be the outcome.     

Understanding medical students' attitudes towards and experiences with persons with disabilities and disability education

BackgroundIn the United States, approximately one quarter of individuals are living with disabilities and receiving healthcare services. The undergraduate medical school curriculum provides an opportunity to improve the attitudes and skills of physicians working with persons with disabilities (PWD).Objective/hypothesisThe purpose of this study was to gain an understanding about fourth-year medical students’ self-reported attitudes towards and experiences with PWD and disability education. We hypothesized that medical students would recall having education about disabilities, would be able to identify a pivotal disability education experience, and would report being less comfortable working with PWD than persons without disabilities.MethodsThis mixed methods observational study was conducted via an online survey distributed to medical students during Winter 2020/2021. It contained an adapted instrument and a few short answer questions.ResultsOur survey had 44 respondents, a 28% response rate. Though 98% of students reported receiving disability education during one or more courses, 80% felt their disability education during medical school has been inadequate. Additionally, 64% reported having an influential learning experience involving PWD. Despite their attitudes, education, and experiences, respondents reported feeling less comfortable obtaining a history, performing a physical exam, and establishing a differential diagnosis when working with PWD.ConclusionsThis study highlights the need for continued development of disability curricula, which likely extends beyond the studied institution. Additional educational elements could be added to humanities sessions, as well as other courses and clerkships.