2型糖尿病患者血钾水平与胰岛素抵抗及胰岛功能的关系

目的探讨T2DM患者血钾水平与IR和胰岛β细胞功能的关系。方法选取256例新诊断T2DM患者,均行75g OGTT,收集空腹血样本及糖负荷后30min、120min血样本,并对入选者行问卷调查、体格检查、胰岛素及血钾相关指标的测定,计算评价IR的参数[胰岛素抵抗指数(HOMA-IR)、Matsuda指数]和胰岛β细胞功能的参数(DI0、DI30、DI120)。结果在T2DM中,HOMA-IR与BMI、TC、TG呈正相关,与血钾呈负相关(P0.05),Matsuda指数与BMI、TC、TG呈负相关,与血钾呈正相关(P0.05),DI0与TC、LDL-C呈负相关(P0.05),DI30与TC、TG、LDL-C呈负相关(P0.05),DI120与TC、TG、LDL-C呈负相关,与血钾呈正相关(P0.05)。多元线性回归分析显示,校正血脂、年龄等因素后,血钾是HOMA-IR、Matsuda指数、DI120的独立危险因素。结论在T2DM中,血钾水平与HOMA-IR及胰岛β细胞功能密切相关。     

急性ST段抬高型心肌梗死患者LDL-C/HDL-C比值与冠状动脉病变严重程度的相关性

目的:探究急性ST段抬高型心肌梗死(STEMI)患者血脂谱中部分指标及比值与冠状动脉(冠脉)病变严重程度的相关性。方法:选取2017年9月至2018年9月在中国科学技术大学附属第一医院因胸痛接受冠脉造影的221例患者,其中174例STEMI患者作为试验组,47例冠脉造影正常的患者作为对照组。入院后测量空腹血脂,包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、极低密度脂蛋白胆固醇(VLDL-C),并通过Gensini评分衡量冠脉病变严重程度。结果:两组间年龄、高血压、吸烟、D-二聚体、肌钙蛋白、TC、LDL-C均差异有统计学意义。相关性分析发现,TC、LDL-C、TC/TG、TG/LDL-C、LDL-C/HDL-C均与Gensini评分有相关性,其中TC、LDL-C、TC/TG、LDL-C/HDL-C与Gensini评分呈正相关,TG/LDL-C与Gensini评分呈负相关。经过多元线性回归分析校正后,LDL-C/HDL-C与Gensini评分仍呈正相关(R~2=0.146,β=0.383,P=0.020),LDL-C/HDL-C也是Gensini评分的危险因素(OR=1.538,95%CI:1.117～2.119,P=0.008)。结论:STEMI患者LDL-C/HDL-C比值与冠脉病变严重程度呈正相关,是预测冠脉病变严重程度较好的指标。     

吕梁地区140例2型糖尿病患者血脂水平分析

目的对近期吕梁市就诊的2型糖尿病患者的血脂水平,包括血清三酰甘油(TG)、总胆固醇(CH)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)进行分析,观察其相关性。方法对吕梁市140例2型糖尿病及30例正常人群的血清GLU、TG、CH、HDL-C、LDL-C应用上海维仕康WP-21E型生化分析仪检测,观察不同指标与健康人群之间差异性。结果正常组GLU平均水平(5.86±1.04)、TG平均水平(1.37±0.67)mmol/L,CH平均水平(3.16±1.35)mmol/L,HDL-C平均水平(1.30±0.34)mmol/L,LDL-C平均水平(2.76±0.62)mmol/L。糖尿病组GLU平均水平(10.43±2.64)、TG平均水平(1.49±0.83)mmol/L,CH平均水平(4.15±1.26)mmol/L,HDL-C平均水平(1.28±0.39)mmol/L,LDL-C平均水平(3.29±1.56)mmol/L。正常组与对照组TG、CH、LDL-C比较差异有统计学意义(P0.05),HDL-C比较无差异统计学意义(P0.05)。结论糖尿病患者血脂水平偏高,容易形成糖尿病合并高血脂引起的心脑血管疾病。     

2型糖尿病患者血清铁蛋白与血脂、体重指数等相关性分析

目的探讨血清铁蛋白(SF)与2型糖尿病(T2DM)的关系。方法以2型糖尿病患者220例为观察对象,按其SF浓度分别分为高SF组(150例,SF≥300 ng/m L)与正常SF组(70例,SF300 ng/m L),检测分析两组患者的身高、体重、血清铁蛋白(SF)、总胆固醇(TC)、三酯甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(Hb A1c)、空腹血糖(FBG)、空腹胰岛素(FINS)、体重指数(BMI)、胰岛素抵抗指数(HOMR-IR)和胰岛β细胞功能(HOMA-β)。结果 2型糖尿病患者的SF水平与BMI、FBG、FINS、HOMR-IR、Hb A1c、TG、LDL-C均呈正相关(P均0.05),与HDL-C呈负相关(P0.05),与TC、LDL-C、HOMA-β无相关性(P0.05);2型糖尿病高SF组患者FBG、Hb A1c、FINS、HOMR-IR显著高于正常SF组患者(P0.05)。结论血清SF水平升高可能影响糖尿病患者的糖脂代谢;SF可能通过胰岛素抵抗来介导糖尿病的早期发展。     

应用三酰甘油/高密度脂蛋白胆固醇比较和评估老年及中青年2型糖尿病患者小而致密LDL水平的变化

目的比较和评估老年及中青年2型糖尿病(T2DM)患者小而致密LDL水平的变化情况。方法 113例老年和119例中青年T2DM患者根据低密度脂蛋白-胆固醇(LDL-C)和糖化血红蛋白(HbA1c)水平进行分组分层。检测指标主要有HbA1c、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-胆固醇(HDL-C)、LDL-C,并应用TG/HDL-C评估小而致密LDL(sdLDL)水平。结果老年T2DM患者的TC、TG、HDL-C及LDL-C明显低于中青年T2DM患者。分别有58.82%和33.63%的中青年和老年T2DM患者发生sdLDL水平的升高。当LDL-C<3.12 mmol/L或HbA1c≤7%时,中青年T2DM患者人群中发生sdLDL升高的患者比例均明显高于老年T2DM患者人群(P<0.05);但这一差异在LDL-C≥3.12 mmol/L或HbA1c>7%时则不明显。结论老年T2DM患者的TC、TG、LDL-C及HDL-C水平普遍低于中青年T2DM患者。与老年T2DM患者相比,中青年T2DM患者更易发生sdLDL水平的升高,尤其是在LDL-C正常和血糖控制良好时。     

2型糖尿病合并冠心病脂质及ApoA1/ApoB变化分析

目的研究2型糖尿病(T2DM)合并冠心病患者脂质及载脂蛋白A1/载脂蛋白B(ApoA1/ApoB)变化的临床意义。方法收集本院收治的住院病人155例,按是否有冠心病分成两组,即A、B两组,A组为合并冠心病组,共60人;B组为不合并冠心病组,共95人。另外收集门诊健康体检病人作为对照组,即C组,共70人。比较三组间总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、ApoA1、ApoB及ApoA1/ApoB值。结果 A、B两组相比,A组TC、TG、LDL-C、ApoB较B组明显升高(P<0.05),HDL-C和ApoA1/B比值较B组明显下降,差异有统计学意义(P<0.05);与C组相比,A、B两组中HDL-C及ApoA1下降(P<0.05),TC、TG、LDL-C、ApoB水平升高,差异有统计学意义(P<0.05)。结论 2型糖尿病合并冠心病存在多种脂质代谢紊乱。血清HDL-C、ApoA1水平和ApoA1/ApoB值与2型糖尿病合并冠心病病变严重程度呈负相关。     

2型糖尿病患者血尿酸与血脂、血清谷氨酰转肽酶的相关性

目的探讨2型糖尿病患者血尿酸与血脂、血清谷氨酰转肽酶(GGT)之间的关系。方法收集吉林大学第一医院二部内分泌科1 606例(女694人,男912人)2型糖尿病住院患者的临床资料,根据血尿酸水平分为5组,观察不同血尿酸(SUA)水平与甘油三酯(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)、血清谷氨酰转肽酶(GGT)等指标的相关关系。结果随着SUA水平逐渐升高,TG、TC、LDL-C、GGT水平逐渐升高(P<0.05),HDL水平逐渐下降(P<0.05)。2型糖尿病患者血清TG、TC、LDL-C、GGT与SUA呈正相关(女性r依次为0.300,0.110,0.179,0.139,均P<0.001;男性r依次为0.278,0.080,0.147,0.196,均P<0.05),血清HDL-C呈SUA成呈负相关(女性r为-0.187,P<0.000,男性r为-0.110,P<0.001)。结论 SUA水平升高与脂代谢紊乱、肝酶升高相关,进一步提示其与2型糖尿病患者的血管病变发生密切相关。     

社区2型糖尿病患者血脂控制现状的调查探究

选取2016年4月到2017年4月本社区T_2DM患者120例,对患者血清中等指标进行检测,观察各组指标达标情况。结果:总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)、HDL-C达标率分别为35%、64.17%、66.67%、40%,其中TC的达标率最低,男性TC达标率明显高于女性,P0.05。结论:社区T_2DM患者中TC、LDL-C达标率偏低,应提高社区人群对糖尿病的意识。     

2型糖尿病患者血尿酸水平与血糖、血脂水平的相关性

选取2016年4月至2019年2月96例2型糖尿患者,依据尿酸水平分为对照组47例(血尿酸正常)和试验组49例(高尿酸血症)。结果试验组HbA 1c、FBG、TC、TG、LDL-C水平较对照组高,HDL-C水平较对照组低,(P 0. 05); Pearson分析显示,血尿酸水平与HbA 1c、FBG、TC、TG、LDL-C水平呈正相关(r 0,P 0. 05),与HDL-C水平呈负相关(r 0,P 0. 05)。结论 2型糖尿病患者的血尿酸水平与血糖、血脂水平具有一定相关性,血尿酸水平升高是诱发糖脂代谢紊乱的危险因素。     

血清Vaspin水平与老年2型糖尿病肾病患者糖脂代谢和炎症因子的关系

目的探讨血清脂肪特异性丝氨酸蛋白酶抑制剂(Vaspin)水平与老年2型糖尿病肾病患者糖脂代谢和炎症因子的相关性。方法老年2型糖尿病肾病患者80例为2型糖尿病肾病组,根据患者的尿微量白蛋白的排泄率的差别分为正常蛋白尿组(30例)、微量蛋白尿组(26例)、大量蛋白尿组(24例)。另选取健康体检的健康者43例为对照组,检测各组受试者血清Vaspin、白细胞介素(IL)-1、IL-6、C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、空腹血糖(FPG)、空腹胰岛素(FIns)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,并分析Vaspin与各指标的相关性。结果与对照组对比,正常蛋白尿组、微量蛋白尿组、大量蛋白尿组血清Vaspin、IL-1、IL-6、CRP、TNF-α、FPG、FIns、TC、TG、LDL-C水平均明显升高(P0.05),HDL-C水平明显降低(P0.05);正常蛋白尿组、微量蛋白尿组、大量蛋白尿组患者的血清Vaspin水平、HDL-C水平逐渐降低,而IL-1、IL-6、CRP、TNF-α、FIns、TC、TG、LDL-C水平逐渐升高,两两比较差异均有统计学意义(P0.05)。Pearson相关分析表明,血清Vaspin与IL-1、IL-6、CRP、TNF-α、HDL-C呈显著负相关(P0.05),与FPG、FIns、TG呈显著正相关(P0.05)。结论老年2型糖尿病肾病患者血清vaspin呈上升趋势,且血清Vaspin水平与患者的糖脂代谢和炎症因子密切相关。动态监测老年2型糖尿病肾病患者vaspin水平对该病的防治有积极的临床意义。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.