2型糖尿病患者骨质疏松发生率及骨代谢特征调查分析

目的探讨2型糖尿病患者骨质疏松发生率及骨代谢特征。方法选取本院2015-2016年收治的144例2型糖尿病患者为调查对象,经过整理患者的一般资料及临床资料分析144例2型糖尿病患者骨质疏松发病率并与非2型糖尿病人群进行对比;比较144例型糖尿病患者中发生骨质疏松者与未发生骨质疏松者的骨代谢生化指标变化,并与健康对照组进行对比。结果 2型糖尿病患者中骨质疏松的发生率明显高于非糖尿病人群的发生率(P0.05)。2型糖尿病患者中各组之间比较,合并骨质疏松组的尿CTX明显高于骨量减少组和骨量正常组(P0.05);合并骨质疏松组的血PTH明显高于骨量正常组(P0.05)。糖尿病患者与非糖尿病人群比较,糖尿病患者的尿CTX明显升高,骨钙素明显降低(P0.05)。结论 2型糖尿病患者中骨质疏松发生率比较高,其骨代谢特征为:骨吸收增加、骨形成下降,因此2型糖尿病患者应注意预防骨质疏松的发生。     

血清性激素和骨代谢指标在2型糖尿病骨质疏松患者中的表达及意义

目的探讨血清性激素和骨代谢指标在2型糖尿病骨质疏松患者中的表达及意义。方法选取2018年3月至2019年5月本院收治的2型糖尿病合并骨质疏松症患者110例为2型糖尿病骨质疏松组,单纯骨质疏松症患者100例为对照组。采集两组空腹肘静脉血4 ml,检测血清雌二醇、总睾酮、脱氢表雄酮(DHEA)、性激素结合球蛋白(SHBG)、骨钙素、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平;留取清晨中段尿,检测尿Ⅰ型胶原交联氨基末端肽(NTx)水平。结果 2型糖尿病骨质疏松组血清雌二醇、总睾酮明显低于对照组,SHBG水平明显高于对照组,差异均有统计学意义(均P0.05)。2型糖尿病骨质疏松组血清骨钙素、尿NTx明显低于对照组,血清β-CTX明显高于对照组,差异均有统计学意义(均P0.05)。Pearson相关性分析显示,血清雌二醇、总睾酮水平与骨钙素呈正相关,与β-CTX、尿NTx呈负相关(均P0.05);血清SHBG水平与骨钙素呈负相关,与β-CTX、尿NTx呈正相关(均P0.05);血清DHEA水平与骨钙素、β-CTX、尿NTx无相关性(均P0.05)。结论血清雌二醇、总睾酮、SHBG与骨代谢指标有明显相关性,可用于监测2型糖尿病骨质疏松患者病情进展。     

绝经后妇女2型糖尿病肾病患者骨代谢指标变化分析

目的：了解绝经后妇女2型糖尿病肾病患者骨代谢指标变化。方法：2型糖尿病肾病患者依据骨密度分为36例合并骨质疏松的患者及34例骨密度正常患者,对照组为2型糖尿病未达到肾病诊断标准者,分别测定钙、磷、碱性ALP、PTH、PINP和β-CTX以及25-OHD。结果：糖尿病肾病合并骨质疏松组及糖尿病肾病骨量正常组的血ALP、PTH、PINP及β-CTX均明显高于糖尿病无肾病组（P〈0.05或P〈0.01）;糖尿病肾病合并骨质疏松组及糖尿病肾病骨量正常组的血25-OHD均明显低于糖尿病无肾病组（P〈0.05或P〈0.01）;血磷、血钙测定各组间比较差异无统计学意义。结论：绝经后妇女2型糖尿病肾病患者ALP、PTH升高,PINP、β-CTX为骨质疏松敏感指标。     

老年骨质疏松症患者骨代谢指标变化、生长分化因子15及其炎症因子水平分析

目的研究老年骨质疏松症患者骨代谢指标变化、GDF15及其炎症因子水平,为患者的诊疗提供临床指导。方法选取2017年1月-2019年6月本院接收的165例老年骨质疏松症患者作为观察组,选择同期在本院体检的健康老年人100例作为对照组。测量比较患者腰椎L2～4正位和股骨颈骨密度,采集患者空腹静脉血,检测患者骨代谢指标骨钙素N段中分子片段(N-MID)、I型胶原羧基端肽β特殊系列(β-CTX)、I型前胶原氨基端延长肽(P1NP)、血清25羟维生素D3[25-(OH) D_3],生长分化因子-15(GDF15)以及炎症因子IL-1β、IL-6、TNF-α。结果观察组腰椎L2～4、股骨颈的骨密度低于对照组;观察组N-MID、β-CTX、PINP水平高于对照组;观察组25-(OH) D3水平低于对照组观察组GDF15水平高于对照组观察组IL-1β、IL-6、TNF-α水平高于对照组,上述差异均有统计学意义(P 0.05)。结论骨质疏松患者骨密度显著降低,N-MID、β-CTX、PINP水平显著上升,25-(OH) D3水平显著下降,GDF15、IL-1β、IL-6、TNF-α水平显著上升,对于老年骨质疏松症的筛查以及治疗有重要意义。     

2型糖尿病合并骨质疏松患者生化指标及骨代谢指标分析

目的分析2型糖尿病合并骨质疏松患者生化指标及骨代谢指标。方法选取2016年5月至2017年12月本院收治的2型糖尿病患者236例。根据骨密度检查结果,分为骨量正常组82例、骨量减少组84例、骨质疏松组70例。收集各组患者年龄、性别、糖尿病病程、身高、体重,计算体质量指数(BMI);检测空腹血糖、糖化血红蛋白、血钙、血磷、总胆固醇(TC)、甘油三酯(TG)、碱性磷酸酶、甲状旁腺素、Ⅰ型前胶原氨基端前肽(PINP)、β-胶原降解产物(β-CTX)水平。结果骨质疏松组患者年龄明显高于骨量正常组,糖尿病病程明显长于骨量正常组,差异均有统计学意义(均P0.05);骨质疏松组中女性比例明显高于骨量正常组和骨量减少组,体重、BMI值明显低于骨量正常组和骨量减少组,差异均有统计学意义(均P0.05);骨量减少组患者年龄明显高于骨量正常组,糖尿病病程明显长于骨量正常组,差异均有统计学意义(均P0.05)。骨质疏松组和骨量减少组患者空腹血糖、糖化血红蛋白水平明显低于骨量正常组,差异均有统计学意义(均P0.05);骨质疏松组和骨量减少组患者碱性磷酸酶水平(81.57±27.65) U/L、(92.16±31.83) U/L明显高于骨量正常组(70.09±15.17) U/L,骨质疏松组患者甲状旁腺素水平明显高于骨量正常组,差异均有统计学意义(均P0.05)。骨质疏松组和骨量减少组患者PINP、β-CTX水平明显高于骨量正常组,差异均有统计学意义(均P0.05);骨质疏松组患者PINP、β-CTX水平明显高于骨量减少组,差异均有统计学意义(均P0.05)。Pearson分析显示,股骨颈骨密度与年龄、糖尿病病程、空腹血糖、糖化血红蛋白、PINP、β-CTX呈负相关(P0.05)。结论监测血糖及血清PINP、β-CTX水平有助于防治2型糖尿病合并骨质疏松。     

骨代谢标志物与糖尿病患者骨质疏松症的关系

目的评估骨代谢标志物在糖尿病患者中引发骨质疏松症中变化及其关系。方法采用回顾性病例分析,用双能X线骨密度仪对104例糖尿病患者进行测定腰椎骨密度,分为骨质疏松症组(57例)和非骨质疏松组(47例)。然后分别进行血清总I型前胶原氨基端前肽(TPINP)、β-胶原降解产物(β-CTX)、N端骨钙素(N-MID)、25羟维生素D[25-(OH)-VD]、血清Ca、P、肌酐、糖化血红蛋白(Hb A1c)的检测。用Pearson相关分析对8项骨相关标志物与糖尿病患者并发骨质疏松的相关性进行分析。结果骨质疏松组腰椎总密度和腰椎(L1~L4)均显著低于非骨质疏松组;骨质疏松组T-P1NP、β-CTX明显高于非骨质疏松组,差异均有统计学意义(P0.05)。经Pearson分析,骨质疏松组的T-P1NP、β-CTX与骨密度呈负相关(r值分别-0.204、-0.274,P0.05)。结论糖尿病患者的骨代谢标志物与骨密度之间具有一定的相关性,结合T-PINP、β-CTX两项指标可有助于评价糖尿病骨质疏松症各阶段,具有一定的临床意义。     

血清25(OH)D3、hs-CRP及Hcy水平与老年2型糖尿病合并骨质疏松的相关性

目的研究探讨血清25羟基维生素D3[25(OH)D3]、超敏C反应蛋白(hs-CRP)及血清同型半胱氨酸(Hcy)水平与老年2型糖尿病(T2DM)合并骨质疏松(OP)的相关性。方法收集2017年6月至2019年6月本院收治的老年2型糖尿病患者189例纳入观察组,根据患者骨密度测定结果分为T2DM合并OP组68例、T2DM骨量减少组57例及单纯T2DM组64例。另选同期在本院进行健康体检的50例健康受试者为对照组。测量各组血清25(OH)D3、hs-CRP、Hcy及骨代谢指标[骨钙素(BGP)、I型胶原羧基端肽交联(β-CTX)及I型前胶原氨基末端前肽(PINP)水平]。对各组25(OH)D3、hs-CRP、Hcy,BGP、PINP、β-CTX水平差异进行比较,采用Pearson对T2DM合并OP组患者血清25(OH)D3、hs-CRP、Hcy与骨代谢指标的相关性进行分析。结果观察组血清25(OH)D3、BGP水平均低于对照组,hs-CRP、Hcy、PINP、β-CTX水平均高于对照组,差异均有统计学意义(均P<0.05)。T2DM合并OP组25(OH)D3、BGP水平均低于T2DM骨量减少组、单纯T2DM组,hs-CRP、Hcy、PINP、β-CTX水平均高于T2DM骨量减少组、单纯T2DM组,差异均有统计学意义(均P<0.05)。经Pearson分析,T2DM合并OP组患者的25(OH)D3与BGP呈正相关(P<0.05),与PINP、β-CTX呈负相关(均P<0.05);hs-CRP、Hcy与BGP呈负相关(均P<0.05),与PINP、β-CTX呈正相关(均P<0.05)。结论血清25(OH)D3、hs-CRP、Hcy可能参与老年2型糖尿病合并骨质疏松的发生、发展过程,与骨代谢指标有显著相关性。     

绝经期2型糖尿病患者骨质疏松症的危险因素调查

目的分析绝经期2型糖尿病患者骨质疏松症的相关危险因素,为临床预防和治疗提供参考依据。方法选取2013年12月-2016年12月门诊收治的绝经期2型糖尿病患者90例,45例合并骨质疏松症患者设为观察组,45例未合并骨质疏松症患者设为对照组。90例患者均采用双能X线吸收法测量骨密度水平观察患者骨质疏松情况,采用Bekeman生化分析仪测定血脂、血糖水平,分析绝经期2型糖尿病患者血脂、血压与骨质疏松的关系。结果观察组三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及收缩压水平均高于对照组,差异均有统计学意义(均P0.05);观察组舒张压、双股骨骨密度及腰椎1~4骨密度水平均低于对照组,差异均有统计学意义(均P0.05);Logistic回归分析显示:绝经期2型糖尿病患者骨质疏松症发生率与年龄、TG、LDL-C及收缩压有关(P0.05)。结论绝经期2型糖尿病患者骨质疏松症发生率与年龄、TG、LDL-C及收缩压密切相关。     

骨代谢标志物在老年痴呆患者骨质疏松症早期诊断中的临床价值

目的 分析骨代谢标志物测定用于老年痴呆患者骨质疏松症早期诊断的临床价值。方法 选择老年痴呆患者100例作为疾病组,根据检测骨密度不同将其分为骨质正常组、骨量减少组和骨量疏松组,同时选取同时期住院年龄相仿的非痴呆老年人60例作为对照组,对所有研究对象进行临床痴呆评定量表(CDR)、简明心理状况(MMSE)的评定以及血液中骨代谢标志物水平的测定,包括血钙(Ca)、血磷(P)、碱性磷酸(ALP)、甲状旁腺激素(PTH)、总I型前胶原氨基末端肽(PINP)、25羟基维生素D[25(OH) D]和β-型胶原分解产物(β-CTX),并对其进行比较分析。结果 老年痴呆患者骨质疏松的发生率明显高于对照组,疾病组β-CTX、PTH水平明显高于对照组,25(OH) D、血Ca水平明显低于对照组,差异均有统计学意义(P <0.05);发现骨质疏松组的血Ca、25(OH) D、腰椎BMD和股骨颈BMD的水平均低于骨量减少组和骨量正常组,β-CTX和PTH水平明显高于骨量减少组和骨量正常组,差异均有统计学意义(P <0.05)。相关分析显示PTH和β-CTX与老年痴呆患者骨质疏松发生率成正相关(P ...     

济南市某社区65岁以上女性2型糖尿病并发骨质疏松患者与BMI、受教育程度、血脂的相关性研究

目的了解济南市某社区65岁以上女性2型糖尿病并发骨质疏松患者与BMI、受教育程度、血脂的相关性。方法选择80例65岁以上女性2型糖尿病患者,分成观察组(骨质疏松40例)和对照组(非骨质疏松40例),收集比较两组患者的各项指标。结果观察组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)明显高于对照组(P0.05);观察组BMI指数低于对照组(P0.05);观察组受教育程度低于对照组(P0.05);空腹血糖(FBG)和高密度脂蛋白(HDL-C)观察组和对照组间差异无统计学意义(P0.05)。Logistic回归分析显示受教育程度、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、BMI指数是社区65岁以上女性2型糖尿病患者合并骨质疏松的危险因素。结论济南市某社区65岁以上2型糖尿病女性患者合并骨质疏松症者均受到BMI、受教育程度、血脂紊乱等因素的影响。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.