2型糖尿病患者肥胖与胰岛素抵抗的关系

目的观察照2型糖尿病患者肥胖和胰岛素抵抗的关系.方法对正常对照组20例,肥胖2型糖尿病患者41例,非肥胖2型糖尿病患者17例,分别检测体重指数（BMI）、腰围、臀围、空腹血糖（FBG）、胰岛素（INS）,计算腰臀比（WHR）和胰岛素敏感指数（ISI）,并进行对比分析.结果肥胖2型糖尿病患者较非肥胖者FBG、BMI、WHR均显著升高（P＜0.05）,但ISI显著降低（P＜0.01）.结论肥胖的2型糖尿病患者存在更为严重的胰岛素抵抗.     

C-反应蛋白与2型糖尿病

目的：观察C-反应蛋白与体重指数、腰围、臀围及糖、脂代谢等指标间的相关性，探讨C-反应蛋白与2型糖尿病的关系。方法：将131例受检对象分为肥胖2型糖尿病组、非肥胖2型糖尿病组、单纯肥胖组及对照组，测定体重指数、腰围、臀围、及糖代谢、脂代谢指标、C-反应蛋白等，以HOMA-IR及ISI来评价胰岛素的敏感性。结果：①2型糖尿病组CRP及胰岛素抵抗指数均高于对照组（P〈0．05）；肥胖者的CRP及胰岛素抵抗指数均高于非肥胖者（P〈0．05）；②BMI、ISI为血CRP水平的影响因素；③Logistic多元回归显示：HOMA-IR（OR=106．696）、CRP（OR=6．239）、TG（OR=6．923）是2型糖尿病的危险因素。     

C-反应蛋白与2型糖尿病

目的观察C-反应蛋白与体重指数、腰围、臀围及糖、脂代谢等指标间的相关性,探讨C-反应蛋白与2型糖尿病的关系.方法将131例受检对象分为肥胖2型糖尿病组、非肥胖2型糖尿病组、单纯肥胖组及对照组,测定体重指数、腰围、臀围、及糖代谢、脂代谢指标、C-反应蛋白等,以HOMA-IR及ISI来评价胰岛素的敏感性.结果①2型糖尿病组CRP及胰岛素抵抗指数均高于对照组(P＜0.05);肥胖者的CRP及胰岛素抵抗指数均高于非肥胖者(P＜0.05);②BMI、ISI为血CRP水平的影响因素;③Logistic多元回归显示HOMA-IR(OR=106.696)、CRP(OR=6.239)、TG(OR=6.923)是2型糖尿病的危险因素.     

2型糖尿病患者脂肪肝相关因素分析

检测2型糖尿病并发和不并发脂肪肝患者的空腹血糖（FBG）、甘油三酯（TG）、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）、空腹胰岛素（FINS）、空腹C肽、体重指数（BMI）、腰臀围比值（WHR）等指标,同时检查是否合并其他糖尿病慢性并发症。结果脂肪肝组与非脂肪肝组比较．血TG增高、HDL-C降低、空腹胰岛素及空腹C肽水平明显升高,胰岛素敏感指数（ISI）下降,且腹型肥胖者及冠心病发生率高。认为减肥、降脂、改善胰岛素抵抗对防治糖尿病性脂肪肝有重要意义。     

糖尿病患者24小时动态血压特点

86例Ⅱ型糖尿病病人行24小时动态血压监测,根据结果,分为糖尿病合并高血压（高压组）组42例,未合并高血压（未高组）组44例。结果：高压组较未高组的胰岛素、胰岛素敏感指数、体重指数、腰围／臀围、白天平均舒张压及夜间平均收缩压、舒张压均显增高,夜间收缩压及舒张压下降百分率均显降低;86例病人24小时平均收缩压与胰岛素、胰岛素敏感指数呈显正相关;24小时平均舒张压与体重指数及腰围／臀围呈显正相关。提示：Ⅱ型糖尿病肥胖减轻体重是预防高血压的有利措施,合并高血压时,夜间适当给予抗高血压治疗。     

广西壮族人Caveolin-3基因多态性与2型糖尿病的关系

目的探讨广西壮族人Caveolin-3基因外显子单核苷酸多态性（SNP）与2型糖尿病（T2DM）的关系。方法选择24例T2DM（T2DM组）患者及10例正常对照者（对照组）,应用PCR法对两组广西壮族人Caveolin-3基因外显子SNP进行PCR扩增后测序。结果 Caveolin-3基因第2外显子非编码区有2个位点发生突变,分别是12842 A→G和12715 A→T。2位点的等位基因频率在糖尿病组和正常对照组存在统计学差异（P〈0.05）。12842A→G和12715 A→T位点有三种联合基因型（AT、GT、GA）,其中AT、GA型的分布频率在两组中比较P〈0.05。结论 Caveolin-3基因12842 A→G和12715 A→T位点突变可能与T2DM的发病有关。     

PPAR-γ2基因Pro2Ala多态性对2型糖尿病血脂的影响

目的：探讨过氧化物酶体增殖体激活受体啦(peroxisome proliferation activated receptor-γ2，PPAR-γ2)基因外显子B的Pro12Ala多态性与2型糖尿病血脂的关系。方法：用聚合酶链反应-限制性片段长度多态性分析方法，检测202名2型糖尿病的PPAR-γ2基因型及相关临床指标。结果：PPAR-γ2基因在2型糖尿病中存在Pro12Ala变异，以PP型为主。2型糖尿病中，PPAR-γ2基因Pro12Ala多态性与体重指数(BMI)，血糖，血脂，空腹胰岛素，胰岛素抵抗，血压均无明显相关性。在BMI≥25的肥胖2型糖尿病人群中，携带A等位基因者的TG(甘油三酯)和HDL-C(高密度脂蛋白胆固醇)分别明显高于和低于携带P等位基因者，在非肥胖组中没有此差别。结论：在肥胖状态下，Pro12Ala多态性能加重2型糖尿病的脂质紊乱，可能更易发挥遗传影响。     

家族性糖尿病人群中线粒体ND-1基因点突变的分析研究

目的了解线粒体ND-1基因mt3316G→A、mt3394T→C变异在中国家族性糖尿病人群中的发生率及其临床特点。方法应用PCR-RFLP结合直接测序方法对随机抽取的无亲缘关系的770个糖尿病家系的先证者及309例非糖尿病对照者进行线粒体基因mt3316G→A、mt3394T→C变异的筛查。结果在糖尿病先证者组中发现17例（2.21%）mt3316G→A变异,18例（2.34%）mt3394T→C变异;在正常对照组中分别发现5例（1.62%）和6例（1.94%）变异携带者,变异的发生率在两组间差异无统计学意义。在糖尿病先证者组见到2例同时携带上述两种变异者。伴mt3316G→A或mt3394T→C突变的糖尿病组与无该变异的糖尿病组之间的临床特点（年龄、体质指数、胰岛素抵抗指数）比较差异无统计学意义。结论线粒体ND-1基因mt3316G→A,mt3394T→C变异可能不是中国人线粒体糖尿病发病的致病原因,而是中国人线粒体的基因多态。     

新诊断2型糖尿病患者一相胰岛素分泌和胰岛素敏感性评估

目的评估新诊断2型糖尿病患者一相胰岛素分泌与胰岛素敏感性。方法对332例新诊断2型糖尿病患者按照精氨酸刺激试验的结果分为胰岛功能正常组和异常组来评估其胰岛素分泌和胰岛素敏感性的状况。结果（1）胰岛功能正常组的体重、体重指数（BMI）、腰围、臀围、股围、空腹血清真胰岛素和甘油三酯均显著高于胰岛功能异常组（均P〈0．01）；（2）校正性别、年龄、BMI和腰臀比后，胰岛功能正常组的真胰岛素增值（△TI）和胰岛素抵抗指数（HOMA—IR）均显著高于胰岛功能异常组（均P〈0．01）；（3）胰岛素分泌功能正常伴胰岛素抵抗的个体，胰岛素分泌功能正常不伴胰岛素抵抗的个体，胰岛素分泌功能缺陷伴胰岛素抵抗的个体和胰岛素分泌功能缺陷不伴胰岛素抵抗的个体分别占总人数的35．11％、5．02％、29．78％和30．09％。结论2型糖尿病个体可分为单纯胰岛功能异常、单纯胰岛素抵抗及胰岛功能异常伴胰岛素抵抗3类，其诊断和治疗需依据此病理生理状态的评估。     

内皮细胞型NO合酶基因第7外显子894G→T点突变与糖尿病肾病相关性研究

目的 探讨内皮细胞型NO合酶（eNOS)基因第7外显子894G→T点突变与中国北方汉族人2型糖尿病（T2DM）合并肾病（DN）之间的关系。方法 运用聚合酶链式反应限制性片段长度多态性技术（PCR－RFLP），结合DNA测序技术，检测了228例中国北方汉族人的eNOS基因第7外显子894G→T错义突变位点的基因型，其中T2DM患者143例（DN79例），健康成人85例，并对各组间的等位基因频率与基因型频率进行了比较。结果 ①T2DM组的T等位基因及TG基因型频率与正常对照（N）组无显著性差异（P＞0．05）。②DN＋组T等位基因及TG基因型频率显著高于糖尿病非肾病患者（P＜0．05）。③SBP、HbA1c、TC、TG和eNOS基因第7外显子894G→T点突变均与糖尿病肾病有关（P＜0．05）。结论 eNOS基因第7外显子894G→T点突变的T等位基因可能是中国人2型糖尿病易患肾病的独立危险因素。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.