2型糖尿病与代谢综合征

糖尿病是代谢综合征(MS)或胰岛素抵抗综合征(IR)的重要组成部分，80％以上的2型糖尿病合并MS。代谢综合征(MS)，又称胰岛素抵抗综合征(IR)，最早提出于1779年，Fronzo等应用正常血糖高胰岛素钳夹技术(Euglyeenic Hyperinsulinemic Clamp Technique)测定患者的胰岛素敏感性，结果发现：肥胖、2型糖尿病、高血压、高甘油三酯血症／低高密度脂蛋白血症和动脉粥样硬化等疾病患者多存在胰岛素抵抗和高胰岛素血症。随后各国学者在此领域进行了深入而广泛的研究。     

代谢综合征及其治疗

［摘要］代谢综合征主要由胰岛素抵抗和血脂代谢异常引起，临床表现主要为糖耐量异常、中心性肥胖、血压升高等。健康的生活方式，降低血糖，控制血压，调节血脂和胆固醇对代谢综合征的防治有重要临床意义。     

胰岛素和瘦素与代谢综合征相关性研究

代谢综合征是一种常见的异质性疾病,以胰岛素抵抗和/或高胰岛素血症为代谢综合征的共同病因学基础。业已证实,体内存在脂肪—胰岛内分泌轴,而瘦素与胰岛素抵抗、糖代谢异常、脂质代谢紊乱、高血压等密切相关,在代谢综合征和其它肥胖相关疾病的发生发展中演重要角色。胰岛素与瘦     

多囊卵巢综合征的内分泌与代谢失调及其药物治疗

多囊卵巢综合征(PCOS)的药物治疗主要通过调整内分泌和代谢失调达到个体化治疗目的,常用药物包括达英-35、二甲双胍及克罗米芬等.本文综述PCOS的内分泌失调和代谢紊乱的临床表现与发病机制,以及药物治疗进展.     

代谢综合征(下)

上期讲了代谢综合征的诊断，本期我们接着谈谈以下问题：哪些人应该提防代谢综合征?代谢综合征会导致哪些后果?患该病应如何治疗?     

代谢综合征的治疗进展

<正>代谢综合征(MS)是一组复杂的代谢紊乱症候群,是由体内多种代谢成分异常聚集而引起的一系列病理、生理变化。该病的发病率正逐年升高,且对患者的身体影响较大。本文对代谢综合征的定义、发     

高尿血酸症与代谢综合征

尿血酸症是嘌呤代谢紊乱所致的疾病，随着人们生活水平的逐渐提高，其发病率呈升高趋势。代谢综合症是一组以胰岛素抵抗为基础的代谢异常证侯群，本就高尿血酸症与代谢综合症诸因素之间的关系进行了阐述。     

高尿酸血症与代谢综合征相关因素分析

目的:探讨高尿酸血症(HUA)和肥胖、高血压、高血糖、脂代谢紊乱之间的关系.方法:对广州市邮区中心局2 734名职工进行体检,空腹测定血尿酸,空腹血糖和血脂,并对各项结果进行分析比较.结果:≥40岁组的HUA患病率(21.7％)与代谢综合征(MS)患病率(21.2％)明显高于＜40岁组(分别为13.6％、10.6％).HUA组MS的患病率(17.9％)明显高于尿酸正常组(13.6％),差异有统计学意义(P＜0.05).HUA组MS的各组分(肥胖、高血压、高血糖、高血脂)的患病率均高于血尿酸正常组(P＜0.05).结论:随年龄增长,HUA与MS的患病率增高,HUA患者MS发生率较高.     

高尿酸血症与代谢综合征各组分间的关系及营养治疗

高尿酸血症的发病率正逐年升高。高尿酸血症可造成关节、肾脏、心脏和眼等损害,已成为继糖尿病后严重危害人们健康的第二大代谢性疾病。高尿酸血症常伴随代谢综合征或其组分的发生,说明这两种疾病之间有密切联系。本文就此作一概要描述,并提出高尿酸血症的营养治疗原则。     

抗生素降阶梯治疗慢性阻塞性肺疾病合并重症感染的可行性及安全性探讨.

目的 探讨采用抗生素降阶梯治疗慢性阻塞性肺疾病合并重症感染的临床效果.方法 随机选取2013年2月至2015年4月本院收治的92例慢性阻塞性肺疾病合并重症感染患者,按照入院顺序先后分为观察组和对照组.对照组患者行常规抗生素治疗,观察组患者接受抗生素降阶梯治疗方案.对两组患者的临床治疗效果进行回顾性分析.结果 观察组患者的咳嗽、肺部湿罗音、痰鸣音等临床症状的消失时间均明显短于对照组,住院时间明显少于对照组,差异有统计学意义(P＜ 0.05);观察组患者的总治疗有效率明显高于对照组,差异有统计学意义(91.11％ vs.53.33％,P＜0.05).结论 对慢性阻塞性肺疾病合并重症感染患者实施抗生素降阶梯治疗,能够有效对肺部感染进行控制,对于患者临床症状及预后的改善具有十分显著的作用,建议在临床上进一步推广.     

Pharmacogenetics of the lipodystrophy syndrome associated with HIV infection and combination antiretroviral therapy

INTRODUCTION: Antiretroviral drugs have been associated with several toxicities that limit their success. Of the chronic toxicities, the lipodystrophy syndrome is of special concern due to the metabolic alterations that can accompany it. Why some patients treated with a particular antiretroviral regimen develop lipodystrophy, while others do not, is a medical mystery, but it has been suggested that individuals may (or may not) have a genetically conditioned predisposition. Pharmacogenetics is the science that studies how the genetic composition of individuals can give rise to interindividual variations in response to drugs and drug toxicity. AREAS COVERED: This article reviews the published investigations on the association between host genetic determinants in treated HIV-infected patients and the presence of lipodystrophy. Studies were identified through a PubMed database search. Case-control and longitudinal studies into pharmacogenetic association were selected. Areas covered include the data on the genetic variants of mitochondrial parameters, cytokines, adipokines, proteins involved in adipocyte biology and proteins involved in stavudine metabolism. EXPERT OPINION: Most studies provide inconsistent data due to partial genetic evaluation, different assessment of lipodystrophy and low number of patients evaluated. The pharmacogenetics of lipodystrophy in HIV-infected patients treated with antiretroviral drugs still belongs in the research laboratory.     

欧维婷阴道软膏综合治疗绝经后妇女反复性尿道感染的疗效比较

目的研究综合性药物在治疗绝经后妇女反复性尿道感染的效果。方法选择绝经后妇女有≥2次尿道感染史106例,应用敏感抗生素加经阴道给雌三醇软膏综合治疗(0.5mg/d,5～7d,继后2次/周,共3月为1疗程)。观察其疗效、副反应、抗生素使用时间与尿道感染复发率,并与其以往单用抗生素治疗进行比较。结果综合治疗组和单药治疗组用抗生素时间分别为(7±2.6)d和(25±8.3)d,症状消失时间分别为(5±3.8)d和(13±5.9)d,治疗后半年复发率分别为0和88%,以综合治疗组低于单药治疗组。且综合治疗用药前后的血清性激素水平、子宫内膜厚度无明显变化,但阴道表层细胞百分比明显变化(雌激素轻度影响﹥69%)。结论欧维婷阴道软膏配伍抗生素联合治疗绝经后妇女反复性尿道感染是安全有效,值得临床推广应用。     

抗生素的联合用药

本文介绍了联合用药的理论基础、常用的联合药敏检验方法、临床常见的药物联合应用及存在问题、联合用药的适应征几个方面，提出了进一步研究方向，为临床用药提供了一定的依据。     

Empiric therapy for treatment of infection and the influence of antibiotic guidelines on outcomes

The appropriateness of empiric therapy, how closely prescribers adhered to hospital guidelines for use of antimicrobial drugs and how relevant these guidelines proved in providing cover for the infecting pathogen were assessed from a retrospective survey of culture and sensitivity reports issued during a one-month period in a district general hospital. Blood, stool, pus, sputum and mid-stream urine specimens were reviewed. Urine specimens from a fundholding general practice unit were also included. Catheter specimens of urine and specimens from other body sites were excluded. Of 290 specimens sent for culture, 99 (34 per cent) were positive. One hundred patients, of whom 54 (19 per cent of the total) were subsequently demonstrated to have a positive culture, had been treated empirically. In 38 per cent of cases the pre-report empiric treatment was considered appropriate for the isolated pathogen, while 46 per cent of patients had negative cultures and 16 per cent had positive cultures but had been given unsuitable antibiotics. In hospitalised patients, 73 per cent of antibiotic treatments were prescribed according to hospital guidelines, although this was the case for only 45 per cent of community-based patients. Hospital guidelines were a relevant and useful aid to rational prescribing in that 75 per cent of organisms isolated were sensitive to guideline antibiotics. The guidelines were least appropriate for urine specimens from hospital. This reflects the range of organisms encountered and the emergence of resistant strains, reinforcing the need for regular updating and amending of prescribing recommendations.     

头孢曲松、头孢呋辛酯序贯治疗老年肺部感染的临床研究

目的：比较头孢曲松静滴和头孢曲松静滴与头孢呋辛酯口服序贯治疗老年社区获得性肺炎和慢性支气管炎急性发作的临床疗效、安全性和药物经济学特点。方法：采用随机、开放、对照研究的方法，86例患者分为对照组41例和试验组45例。对照组予头孢曲松1．0g，静滴，qd；试验组予头孢曲松1．0g，静滴，qd，病情稳定后，改为口服头孢呋辛酯0．5g，bid，疗程7～14d，评价临床和细菌学疗效。采用药物经济学中最小成本分析法对药物的治疗成本进行评价。结果：对照组总有效率87。8％（36／41），试验组82．2％（37／45）；细菌清除率分别为对照组90．0％（18／20），试验组87．5％（21／24）。两组临床疗效和细菌学疗效统计学上无显著差别（P〉0．05）。头孢曲松静滴后头孢呋辛酯口服序贯治疗的医疗总费用和抗生素费用低于单用头孢曲松静滴（P〈0．05）。结论：两组具有相同的临床疗效及安全性。但试验组比对照组更经济。     

降钙素原与C反应蛋白水平对老年卒中后肺部感染患者抗生素治疗的临床指导意义

目的探讨降钙素原(PCT)与C反应蛋白(CRP)水平在老年人肺部感染治疗中的指导意义。方法60例卒中后卧床老年肺部感染患者分为常规治疗组、PCT指导治疗组及CRP指导治疗组。常规治疗组按照常规评估感染控制的方法指导抗生素治疗,PCT指导治疗组通过检测血清PCT浓度来指导抗生素使用,CRP指导治疗组通过检测血清CRP浓度来指导抗生素使用。比较3组抗生素使用时间、使用率、抗生素治疗结束后3组患者炎性指标(白细胞、中性粒细胞)、血气分析[动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)]、临床肺部感染积分(CPIS)以及抗生素花费之间的差异。结果 3组经治疗后,(1)患者白细胞、中性粒细胞:PCT组[(8±4)×109/L、0.62±0.04]、CRP组[(8±3)×109/L、0.67±0.02]、常规组[(7±4)×109/L、0.65±0.04]差异无统计学意义(均P>0.05);(2)PCT组CPIS(4.0±1.4)分明显低于常规治疗组(7.7±1.0)分和CRP组(6.9±1.6)分,差异有统计学意义(P<0.05)。(3)治疗后血气分析:PCT组[PaO2(72±7)mmHg,氧合指数(302±48)];CRP组[PaO2(76±6)mmHg,氧合指数(336±47)];常规组[PaO2(76±5)mmHg,氧合指数(328±46)];差异无统计学意义(均P>0.05)。3组在治疗前后,炎性指标中除白细胞计数外,中性粒细胞及CPIS均较治疗前明显降低;血气分析较治疗前明显改善;PCT组PCT值也较治疗前降低[(1.7±0.8)mg/L至(0.5±0.8)mg/L]。同时,在抗生素使用时间上,常规组(9.5±2.4)d与PCT组(5.9±1.6)d相比,差异有统计学意义(t=11.96,P<0.01);常规组与CRP组(9.3±2.1)d比较差异无统计学意义(t=0.56,P>0.05);PCT组与CRP组差异有统计学意义(t=12.8,P<0.01)。抗生素使用率分别为常规组100%、CRP组95%和PCT组70%,常规组、CRP组与PCT组比较,差异有统计学意义(χ2=12.41,11.88,P<0.01),常规组与CRP组比较,差异无统计学意义(χ2=0.43,P>0.05)PCT组抗生素使用率及抗生素花费明显低于常规组和CRP组。结论在卒中后老年肺部感染患者治疗中,PCT水平是比传统经验评估及CRP水平评估患者感染控制与否的更为准确的指标,可以在达到更好治疗效果的同时减少抗生素的使用,对于减少耐药细菌产生具有重要意义。     

Home intravenous antibiotic therapy

Concern regarding the soaring costs of in-hospital treatment has stimulated interest in providing alternatives when patients no longer need careful observation and daily nursing care. To facilitate ongoing intravenous antibiotic therapy for selected patients, home or outpatient intravenous therapy programs have been developed. Such therapies require a team approach with an emphasis on patient selection criteria, and educational strategies, as well as careful follow-up. It is likely that in the near future more intravenous anti-infective programs will be tailored to the infectious complications of the acquired immune deficiency syndrome than for the conditions. The increasing number of effective new oral drugs will undoubtedly reduce the need for intravenous therapy for specific infections such as septic arthritis, osteomyelitis, urinary tract infections and pneumonia.