2型糖尿病下肢血管病变患者血浆网膜素-1水平变化及其与hs-CRP的相关性

目的探讨联合检测血浆网膜素-1和高敏C-反应蛋白(hs-CRP)在2型糖尿病(T2DM)患者下肢血管病变(PAD)中的水平变化及相关性。方法选择该院2011年1月至2013年12月收治的T2DM患者102例,依据是否合并PAD分为PAD组(n=54)和下肢血管正常组(NPAD组,n=48),并选取同时期来该院体检的健康者作为正常对照组(NC组,n=50)。检测各组患者血浆网膜素-1和hs-CRP水平,分析PAD组患者血浆网膜素-1与hs-CRP的相关性。结果 NPAD组和PAD组血浆网膜素-1水平均显著低于NC组,且PAD组低于NPAD组(均P<0.01);NPAD组和PAD组血浆hs-CRP水平分别均显著高于NC组,且PAD组高于NPAD组(均P<0.01);PAD组患者血浆网膜素-1与hs-CRP呈负相关(r=-0.543,P<0.01)。结论 T2DM并PAD患者血浆网膜素-1水平显著降低,网膜素-1水平与炎症因子hs-CRP关系密切,二者对预测T2DM患者PAD的发生发展和预后具有重要价值。     

2型糖尿病下肢动脉病变踝臂指数与纤维蛋白原的相关性

目的 探讨纤维蛋白原变化在糖尿病下肢动脉血管病变(PAD)发生发展中的作用及踝臂指数(ABI)与纤维蛋白原(FIB)的相关性,为临床治疗提供理论依据.方法 2型糖尿病患者63例,进行ABI测定,按测定结果 分为PAD组和对照组,测量FIB及其他PAD相关危险因素.结果 (1)与非PAD组相比,重度PAD组(P＜0.01)及轻度至中度PAD组(P＜0.05)FIB水平显著升高.与轻度至中度PAD组相比,重度PAD组FIB水平显著升高(P＜0.05).(2)PAD组ABI与FIB呈明显负相关(P＜0.01),NPAD组ABI与FIB呈明显负相关(P＜0.05). 结论 (1)血浆高FIB水平是PAD的重要危险因素,与PAD严重程度密切相关.(2)ABI指数与FIB存在明显负相关.(3)ABI与心血管病变危险因素存在相关性,应成为今后临床工作中的重要检测指标.     

2型糖尿病下肢血管病变患者血管新生相关因子的变化

目的 观察2型糖尿病(T2DM)下肢血管病变患者血管新生相关因子的变化,探讨血管新生在糖尿病下肢血管病变发展中的作用.方法 测定31例T2DM无下肢血管病变患者(T2DM 组)、49例T2DM下肢血管病变患者(下肢血管病变组)及40例正常对照者(对照组)血清CXCL16、碱性成纤维细胞生长因子(bFGF)、血小板源性内皮细胞生长因子(PD-ECGF)水平和外周血内皮祖细胞(EPCs)数量.应用多普勒超声测定踝臂指数(ABI),左、右足背动脉及左、右腘动脉内径,血流流速.结果 T2DM组和对照组相比,血清bFGF、PD-ECGF水平升高(P均＜0.01),外周血EPCs数量下降(P ＜0.001).下肢血管病变组与T2DM组和对照组相比,血清CXCL16、bFGF、PD-ECGF水平升高(P均＜0.001),外周血EPCs数量下降(P＜0.01).下肢血管病变组和T2DM组、对照组相比,ABI下降(P＜0.01),左、右足背动脉,左、右胭动脉内径减小(P＜0.01或P＜0.05),下肢血管病变组和对照组相比,左、右足背动脉,左、右胭动脉血流流速减低(P＜0.05).结论 T2DM下肢血管病变患者存在血管新生障碍,血管新生相关因子的升高和EPCs数量下降在糖尿病下肢血管病变发生中可能起重要作用.     

2型糖尿病患者血清脂联素、25羟维生素D、血脂与下肢血管病变关系的研究

目的探讨T2DM患者血清脂联素(APN)、25羟维生素D[25(OH)D]、血脂与下肢血管病变的关系。方法选取2017年8月至2018年1月于我院内分泌科住院的100例T2DM患者,按照踝肱指数(ABI)分为T2DM合并下肢血管病变组(PAD,n=50)和T2DM组(n=50);另选同期我院健康体检者50名为正常对照组(NC)。ELISA检测血清APN水平,化学发光法检测25(OH)D水平,采用日立全自动生化分析仪检测血脂,分析其与下肢血管病变的关系。结果 T2DM组及PAD组APN水平低于NC组[(6.76±0.42)vs(4.54±0.63)vs(10.12±2.43)nmol/L,P0.05];PAD组血清APN水平低于T2DM组(P0.05)。Pearson相关分析显示,PAD组血清APN水平与ABI、25(OH)D呈正相关(P0.05),与BMI、FPG、2hPG、HbA_1c、TC、TG、LDL-C呈负相关(P0.05或P0.01)。Logistic回归分析结果显示,HbA_1c、LDL-C、APN、25(OH)D是T2DM合并下肢血管病变的影响因素。结论 T2DM合并下肢血管病变的发生发展与血清APN、25(OH)D水平的降低及血脂异常密切相关;高水平HbA1c、LDL-C及低水平APN、25(OH)D是T2DM合并下肢血管病变的影响因素。     

2型糖尿病患者踝肱指数与肾小球滤过率的相关性

目的探讨踝肱指数(ABI)与肾小球滤过率(e GFR)在2型糖尿病(T2DM)患者的相关性。方法回顾性研究357例T2DM的患者,测算ABI及e GFR,并根据修正肾脏病饮食(MDRD)公式计算估算e GFR。按照ABI分为ABI正常组与ABI下降组,检查甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、血肌酐(SCr)等水平,分析两组ABI及e GFR的关系。结果 ABI降低组的T2DM患者病程较长、TC、LDL-C、糖化血红蛋白(Hb A1c)显著性高于正常组(P<0.05或P<0.01),HDL-C、高敏C-反应蛋白(hs-CRP)、e GFR显著性低于正常组(P<0.05或P<0.01);e GFR是ABI下降的主要因素,并与糖尿病病程、TC、hs-CRP相关。结论合并轻中度肾功能不全的T2DM患者的ABI逐渐减低,低水平的e GFR是下肢外周动脉疾病(PAD)的危险因素,并与糖尿病病程、TC、hs-CRP相关。     

2型糖尿病患者中性粒细胞/淋巴细胞比值与踝肱指数的相关性研究

目的研究T2DM患者中性粒细胞/淋巴细胞比值（NLR）与踝肱指数（ABI）的关系,分析NLR对T2DM下肢血管病变的临床价值。方法选取198例T2DM患者,依据ABI结果分为外周血管病变组（PAD,ABI<0.9）66例和无外周血管病变组（Non-PAD,ABI≥0.9）132例,比较两组NLR的差异。结果 PAD组较Non-PAD组NLR升高[（1.78±0.61）vs（2.13±0.80）,P=0.002]。相关分析显示,NLR与ABI水平呈负相关（r=-0.224,P<0.01）;二元Logistic回归分析结果显示,HbA₁c、NLR和C-RP是下肢动脉病变的危险因素。结论 NLR是T2DM患者下肢动脉病变的危险因素,对T2DM患者下肢血管病变有提示意义。     

2型糖尿病患者血清尿酸胆红素测定的临床意义

目的探讨尿酸、胆红素浓度与2型糖尿病的关系。方法采用全自动生化分析仪,检测并比较65例2型糖尿病患者(其中血管病变患者32例)和57例健康者(对照组)血清总胆红素、直接及间接胆红素浓度和UA水平。结果 T2DM患者血清总胆红素(TBIL)、直接及间接胆红素含量明显低于对照组(P 0.05),血清UA含量显著高于对照组(P0.05)。血管病变的患者中血清TBIL10μmol/L的例数高于对照组(χ~2=13.2,P0.01),尿酸≥430μmol/L的例数高于对照组(χ~2=32.6,P0.01)。结论检测T2DM患者血清TBIL和UA水平对预测评估病情及预后T2DM有一定临床价值。     

血清可溶性凝集素样氧化低密度脂蛋白受体1与老年2型糖尿病患者下肢动脉病变的相关性观察

目的研究血清可溶性凝集素样氧化低密度脂蛋白受体1(sLOX-1)在老年T2DM患者的变化及其与下肢动脉病变(PAD)的关系。方法 108例老年T2DM患者,根据踝肱指数(ABI)检测结果分为单纯T2DM组48例,PAD组60例。测定包括血清sLOX-1在内的生化指标。结果 PAD组血清sLOX-1较T2DM组升高[(87.52±8.92)vs(135.28±12.05),P0.05];血清sLOX-1与ABI呈负相关(r=-0.621,P0.01)。多因素Logistic回归分析显示,血清sLOX-1与PAD独立相关。结论老年T2DM合并PAD患者血清sLOX-1水平与ABI有相关性,是PAD的独立危险因素。     

老年糖尿病患者下肢动脉病变的筛查及其相关危险因素

目的研究踝肱动脉血压指数(ABI)在诊断老年2型糖尿病(T2DM)患者下肢动脉病变(PAD)中的临床意义及其影响因素。方法采用多普勒血流探测仪检测老年T2DM患者足背动脉、胫后动脉与肱动脉血压,并计算其比值,以0.9为PAD组,≥0.9为非PAD组,比较并分析两组代谢参数。结果 273例老年T2DM患者中PAD组89例,占总例数33%,非PAD组184例。与非PAD组比较,PAD组年龄、糖尿病病程、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)均明显增高(P均0.01);相关分析显示,ABI与年龄、糖尿病病程、HbA1c、LDL-C呈显著负相关(分别为r=-0.346,P0.01;r=-0.202,P0.01;r=-0.252,P0.01;r=-0.279,P0.01)。结论 ABI在诊断老年T2DM下肢动脉病变中具有重要意义;年龄、病程、LDL-C、高血糖、高血压为下肢动脉病变的主要危险因素;大于65岁老年糖尿病患者PAD发生率显著增高。     

糖尿病肾病并发下肢动脉病变的相关因素分析

目的探讨糖尿病肾病（DN）和糖尿病并发下肢动脉病变（PAD）的相关影响因素。方法选取,DN患者235例（DN组）,单纯糖尿病患者102例（DM组）,测定两组踝肱指数（ABI）及其他相关指标,研究下肢动脉病变发生情况及其影响因素。结果DN组下肢动脉病变发生率（63．0％）高于DM组（11．8％）,差别有统计学意义;DNPAD＋组、DNPAD-组、DMPAD＋组、DMPAD-组的年龄、SBP、DBP、LDL-C、FPG、肾小球滤过率（GFR）、纤维蛋白原（FBG）、UAlb／Cr、24h尿蛋白定量差别均具有统计学意义;DN组发生下肢动脉病变的可能影响因素是SBP、UAlb／Cr、GFR、24h尿蛋白定量;DM组发生下肢动脉病变的可能影响因素是SBP、DBP、24h尿蛋白定量。结论收缩压、纤维蛋白原和尿蛋白可能是DN患者并发下肢动脉病变的预警因子,应对其进行筛查,并给予积极的治疗,从而减少或延缓下肢血管病变的发生及发展。     

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…     

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     

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.     

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.     

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.