绝经后2型糖尿病合并肾病患者血清脂蛋白(α)水平变化及意义

目的:探讨绝经后糖尿病肾病患者血清脂蛋白(α)[Lp(α)]水平与尿白蛋白排泄率的关系。方法:选择绝经后2型糖尿病患者68例,根据尿白蛋白排泄率(UAER)分为3组:A组23例为非糖尿病肾病组,UAER<20μg/m in,B组25例为糖尿病肾病微量白蛋白尿组,UAER<20~200μg/m in,C组20例为糖尿病肾病大量白蛋白尿组,UAER>200μg/m in。所有入选病例检测Lp(α)及血脂等。结果:①糖尿病肾病组与非肾病组比较血Lp(α)水平增高(P<0.05),大量白蛋白尿组血Lp(α)水平高于微量白蛋白尿组(P<0.05)。②血Lp(α)水平与病程和血肌酐呈正相关(r=0.802、P<0.01,r=0.825、P<0.01)。结论:绝经后糖尿病肾病者血Lp(α)水平增高,而且与肾功能损害程度正相关;血Lp(α)既是造成肾损害的原因,亦可能继发于肾脏损害,进而加重肾损害。     

血塞通注射液治疗早期糖尿病肾病临床观察

目的 探讨血塞通注射液对早期糖尿病肾病(DN)患者的临床疗效.方法 将50例早期DN患者随机分为血塞通治疗组(A组)和常规治疗组(B组),进行临床观察.治疗前、后检测空腹血糖(FBG)、尿微量白蛋白(UAER)、总胆固醇(TCh)、甘油三脂(TG)和高密度脂蛋白胆固醇(HDL-C)水平.结果 两组治疗后FBG较治疗前均显著降低(P＜0.01),治疗后A组UAER、TG较治疗前显著下降(P＜0.01);TCh也显著下降(P＜0.05);HDL-C显著提高(P＜0.01),而B组治疗后UAER、TCh、TG、HDL-C无显著变化(P＞0.05),A组治疗后UAER较B组治疗后有显著降低(P＜0.01),A组治疗后TCh、TG较B组治疗后也有显著降低(P＜0.05).结论 血塞通注射液对早期DN具有减少UAER、降血脂作用.     

糖尿病肾病中血管生成素2的表达及其与蛋白尿的相关性研究

目的 探讨糖尿病肾病患者蛋白尿与血管生成素2(Ang-2)的相关性.方法 回顾性分析104例糖尿病肾病患者临床资料,根据患者尿白蛋白排泄率(UAER)将其分为无蛋白尿组45例和蛋白尿组59例,采用放免法测定UAER,采用双抗体夹心酶联免疫吸附法测定血清Ang-2水平,同时测定患者血压、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、肌酐(Cr)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等实验室指标.结果 两组舒张压、FBG、HbA1c、TG、TC、LDL-C、HDL-C比较差异无统计学意义(P＞0.05),蛋白尿组收缩压(140.1±17.4)mm Hg(1 mm Hg=0.133 kPa)、Cr(126.7±23.8)μmol/L,与无蛋白尿组的(126.3±15.2)mm Hg、(70.3±22.1)μmol/L比较差异有统计学意义(P＜0.05).蛋白尿组血清Ang-2为(24.86±4.31)ng/L,显著高于无蛋白尿组的(18.83±7.28)ng/L,两组比较差异有统计学意义(P＜0.01).偏相关分析表明,UAER与血清Ang-2呈正相关(r=0.615,P＜0.01).结论 糖尿病肾病患者肾损害时,血清Ang-2水平显著升高.     

血清IL-1β、细胞间黏附分子与糖尿病肾微血管病变关系初探

目的 探讨IL-1β、细胞间黏附分子(ICAM)在糖尿病肾微血管病变发生、发展中的作用.方法 62例2型糖尿病患者依据尿白蛋白排泄率(UAER)分为正常白蛋白尿组(UAER＜20μg/min)20例、微量白蛋白尿组(UAER 20～200μg/min)22例、显性白蛋白尿组(UAER＞200μg/min)20例,健康体检者20例(对照组),分别用ELISA法测定其血清中IL-1β、ICAM含量的变化.结果 三组糖尿病患者IL-1β、ICAM水平均高于对照组(P＜0.05),显性白蛋白尿组IL-1β、ICAM水平高于微量白蛋白尿组、正常白蛋白尿组(P＜0.01),微量白蛋白尿组IL-1β水平高于正常白蛋白尿组(P＜0.05),微量白蛋白尿组ICAM水平与正常白蛋白尿组比较差异无统计学意义(P＞0.05).血清IL-1β、ICAM与UAER呈正相关(P＜0.05),血清IL-1β与ICAM呈正相关(P＜0.05).结论 糖尿病肾微血管病变患者血清ICAM、IL-1β水平升高与UAER关系密切,可能参与其发生、发展,早期监测对糖尿病肾微血管病变的早期诊断具有临床意义.     

尿毒清颗粒联合维生素E治疗早期糖尿病肾病临床研究

目的 探讨尿毒清颗粒联合维生素E治疗早期糖尿病肾病的临床疗效.方法 将66例早期糖尿病肾病患者按随机数字表法分为两组,每组33例,对照组给予常规治疗,治疗组在常规治疗基础上加用尿毒清颗粒联合维生素E治疗,疗程均为3个月.观察两组治疗后临床疗效、空腹血糖(FBG)、血清总胆固醇(TC)、三酰甘油(TG)、血肌酐(SCr)、血尿素氮(BUN)、尿微量白蛋白排泄率(UAER)等变化情况.结果 治疗组总有效率84.85%(28/33),明显优于对照组的45.45%(15/33)(P＜0.01);两组治疗后FBG均较治疗前下降(P＜0.05);治疗组治疗后血清TC、TG、SCr、UAER均较治疗前下降(P＜0.05),对照组上述指标变化不明显(P＞0.05).两组治疗前后BUN均无明显变化(P＞0.05).结论 尿毒清颗粒联合维生素E治疗早期糖尿病肾病疗效确切.     

2型糖尿病肾病患者血清脂蛋白(a)检测的临床意义

目的探讨脂蛋白(a)[Lp(a)]在早期糖尿病肾病(DN)诊断中的临床意义,为DN的早期诊断提供依据。方法选取于2015年1月至2017年6月在青海省交通医院进行治疗的212例2型糖尿病(T2DM)患者作为研究对象,根据尿白蛋白排泄率(UAER)将T2DM患者分为尿白蛋白正常组(UAER20μg/min,82例)、早期DN组(20μg/min≤UAER≤200μg/min,67例)、临床DN组(UAER200μg/min,63例),并选取同一时期在医院进行体检的50例健康者作为对照组。分别检测各组研究对象的Lp(a)、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)、空腹血糖(FPG)、糖化血红蛋白(Hb A1C)、载脂蛋白A(Apo A)、载脂蛋白B(Apo B)和尿胱抑素C(Cys C)。用SPSS 22.0进行统计分析,多组计量资料的比较用方差分析,应用Pearson相关分析Lp(a)与UAER及其他血脂指标的相关性,影响因素分析采用多因素非条件logistic回归分析,应用受试者工作特征(ROC)曲线评价Lp(a)诊断DN的敏感度和特异度。结果对照组和尿白蛋白正常组Lp(a)水平比较,差异无统计学意义(P0.05),早期DN组和临床DN组Lp(a)水平明显高于对照组和尿白蛋白正常组,临床DN组亦明显高于早期DN组,差异均有统计学意义(P0.05)。尿白蛋白正常组、早期DN组和临床DN组TG水平比较,差异无统计学意义(P0.05),但均明显高于对照组,差异均有统计学意义(P0.05);3组间HDL-C水平比较,差异无统计学意义(P0.05),但均明显低于对照组,差异均有统计学意义(P0.05);TC和LDL-C水平在各组间的差异均无统计学意义(P0.05)。FPG和Hb A1C在糖尿病各组间的差异无统计学意义(P0.05),但均明显高于对照组,差异均有统计学意义(P0.05)。临床DN组患者Cys C水平明显高于对照组、尿白蛋白正常组和早期DN组,差异均有统计学意义(P0.05)。Lp(a)与UAER、TC、HDL-C、LDL-C、Apo A、Apo B和Cys C均呈明显的正相关(r值分别为0.454、0.189、0.152、0.208、0.150、0.170和0.503,P0.05)。多因素logistic回归分析结果显示,Lp(a)(OR=2.021,95%CI:1.102~5.175)和Cys C(OR=2.160,95%CI:1.123~5.424)是临床DN的独立危险因素。ROC曲线分析显示,Lp(a)诊断DN的临界值为85.32 mg/L,敏感度和特异度分别为64.32%和67.26%。结论 Lp(a)可作为DN早期诊断的辅助指标,其水平可在一定程度上可反映肾脏损伤程度。     

罗格列酮对早期糖尿病肾病患者尿微量白蛋白及C-反应蛋白水平的影响

目的观察罗格列酮对早期糖尿病肾病患者尿微量白蛋白及C-反应蛋白(CRP)的影响。方法74例糖尿病肾病患者随机分为两组,两组患者在良好控制血糖、血压的基础上,治疗组加用罗格列酮4mg,每日1次口服,对照组不加罗格列酮,共12周;治疗前后监测空腹血糖(FBG)、空腹胰岛素(FINS)、24h尿微量白蛋白排泄率(UAER)、CRP,计算胰岛素抵抗指数(IRI)。结果治疗组治疗后CRP、UAER、IRI明显下降,与对照组比较差异有统计学意义(P<0.05)。结论罗格列酮能够明显降低糖尿病肾病患者的UAER和CRP水平,对早期糖尿病肾病有保护作用。     

苯那普利联合罗格列酮治疗早期糖尿病肾病疗效

目的:观察苯那普利联合罗格列酮治疗早期糖尿病肾病的临床疗效及作用机制.方法:将80例2型糖尿病合并早期糖尿病肾病患者随机分为治疗组和对照组,每组40例.两组患者均给予糖尿病饮食、控制血糖的同时,对照组给予苯那普利10mg口服,每日1次;治疗组在对照组基础上联用罗格列酮4mg口服,每日1次.疗程均为3个月.治疗前后测定空腹血糖(FPG)、尿白蛋白排泄率(UAER).结果:治疗组治疗后UAER、FPG明显下降,与对照组治疗后比较差异有统计学意义(P＜0.05).结论:苯那普利联合罗格列酮能更有效地降低早期糖尿病肾病患者尿微量白蛋白的排泄,对早期糖尿病肾病有保护作用.     

2型糖尿病患者踝臂指数与糖尿病肾病的关系研究

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者踝臂指数(ABI)与糖尿病肾病(diabetic kidney disease,DKD)之间的关系. 方法 485例T2DM患者及56例健康体检者为研究对象.根据24 h尿白蛋白定量将T2DM患者分为正常尿白蛋白组(尿白蛋白＜30 mg)、微量尿白蛋白组(尿白蛋白30～300 mg)和临床尿白蛋白组(尿白蛋白＞300mg).观察各组之间踝臂指数的差异,探讨踝臂指数与糖尿病肾病的关系. 结果 T2DM患者踝臂指数高于正常对照组(P＜0.05).T2DM患者中,微量尿白蛋白组的ABI较正常尿白蛋白组高(P＜0.05),大量尿白蛋白组的ABI高于其他两组(P＜0.01).尿白蛋白与ABI相关性分析显示尿白蛋白与ABI呈负相关(r=- 0.216,P＜0.01).糖尿病肾病患者的肾小球滤过率与ABI亦呈负相关(r=-0.529,P＜0.05). 结论 ABI对糖尿病肾病有很好的早期预测价值,且与糖尿病肾病严重程度相关.     

糖尿病患者血清C反应蛋白、肿瘤坏死因子α、白细胞介素6与微量白蛋白尿的关系研究

目的 探讨血清炎性因子C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)对早期糖尿病肾病的影响.方法 将2008年1月至2009年12月收治的糖尿病患者72例按照尿白蛋白排泄率(UAER)水平分为正常白蛋白尿组(UAER＜30mg/24 h)32例和微量白蛋白尿组(UAER 30～300 mg/24 h)40例.另外,选择同期健康体检者30例作为对照组.检测各组血清CRP、TNF-α、IL-6水平并比较.结果 与对照组比较,正常白蛋白尿组和微量白蛋白尿组的CRP、TNF-α、IL-6增高,差异有统计学意义(P＜0.05);与正常白蛋白尿组比较,微量白蛋白尿组的CRP、TNF-α、IL-6增高,差异有统计学意义(P＜0.05).结论 正常白蛋白尿和微量白蛋白尿糖尿病患者的CRP、IL-6、TNF-α增高,微量白蛋白尿糖尿病患者增高更明显.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.