血清尿酸与老年2型糖尿病的相关性研究

目的:血清尿酸与老年2型糖尿病的相关性分析。方法:选取2013年6月至2016年7月我院1510例老年2型糖尿病患者(T2DM),根据尿酸水平分为高尿酸血症(HUA)组268人和正常血清尿酸(NUA)组1142人,临床指标、胰岛素β细胞分泌功能。结果:HUA组舒张压、TG、UAE、γ-GGT指标比NUA组高,且差异明显(P0.05),FPG、HbA1c、HDL-C等指标较NUA组低,差异明显(P0.05),年龄、体重、BMI、腹围、病程、收缩压、TC、LDL-C等指标与NUA组比较无明显差异(P0.05);血清尿酸水平与HbA1c、FPG、HDL-C、γ-GGT、TG、UAE的相关性有统计学意义(P0.05),且SUA与TG、γ-GGT、UAE水平呈正相关,与HbA1c、FPG、HDL-C呈负相关;HUA组总胰岛素水平(InsAUC120)、早相胰岛素分泌指数(INSR30)、总体胰岛素分泌指数(INSR120)、β细胞功能指数(HOMA-β)显著高于NUA组(P0.05),女性患者指标水平均高于男性。经相关性分析显示,与血清尿酸水平呈正相关联系,经多元线性回归校正分析后相关性依然存在。结论:尿酸与脂代谢紊乱、糖尿病并发肾病等疾病有密切联系,研究尿酸与胰岛素代谢之间的相互关系、对2型糖尿病的评估和临床治疗有重要意义。     

病程和体重对2型糖尿病胰岛功能的影响

目的:分析病程和体重对2型糖尿病患者胰岛素分泌能力的影响?方法:以横断面研究的方法,分析不同病程组3个胰岛素分泌指数(HOMA-β?INSR30?INSR120)与初诊断组的变化,并比较超重和肥胖患者的3个胰岛素分泌指数和相同病程非肥胖患者的差异?结果:胰岛素分泌功能随病程延长而逐步衰退,与初诊断组相比,病程超过2年后统计学差异显著?超重和肥胖患者的胰岛素分泌能力强于同病程的非肥胖患者,但病程达15年以上时这种差异消失?病程2~4年的超重和肥胖患者INSR30?INSR120与初诊断组比较分别升高9.40%?5.39%,与非肥胖患者的胰岛素分泌能力有显著性差异?结论:2型糖尿病患者胰岛素分泌能力随病程延长而逐步衰退,超重和肥胖患者的分泌能力和随病程变化模式与非肥胖患者间存在差异?     

定期胰岛素泵强化治疗对2型糖尿病胰岛β细胞功能的影响

目的 观察初诊2型糖尿病定期应用胰岛素泵强化胰岛素治疗对胰岛β细胞功能的影响.方法 128例初诊2型糖尿病患者被随机分为胰岛素泵治疗组(观察组)和口服降糖药物治疗组(对照组),观察组每年应用胰岛素泵强化胰岛素治疗2周,其余时间均与对照组一样在门诊接受口服降糖药治疗,所有患者根据血糖和HbA1c调整用药,每半年检测空腹血糖、空腹胰岛素、HbA1c、β细胞功能指数(HOMA-β)及早期胰岛素分泌指数(△I30/△G30).结果 观察组和对照组初次治疗后空腹血糖和HbA1c均降低(均P＜0.05),空腹胰岛素、HOMA-β及△I30/△G30升高(均P ＜0.05),观察组空腹胰岛素、HOMA-β及△I30/△G30高于对照组(均P ＜0.05).随访结果显示,两组HOMA-β和△I30/△G30都有下降趋势,但HOMA-β和△I30/△G30在观察组随访至2.5年和2.0年时差异有统计学意义(均P＜0.05),而对照组随访至1.0年时差异有统计学意义(P＜0.05～0.01);每次随访时比较两组HOMA-β和△I30/△G30,观察组均高于对照组(P ＜0.05～0.01),后者HOMA-β和△I30/△G30下降的幅度也均大于观察组(P＜0.05～0.01).结论 胰岛素泵强化治疗可显著改善胰岛β细胞分泌功能,定期治疗可延缓β细胞功能衰竭,对β细胞具有长期的保护作用.     

老年2型糖尿病患者血清脂联素水平及胰岛β细胞功能变化分析

目的探讨老年2型糖尿病患者血清脂联素水平及其胰岛β细胞功能的变化特点。方法采用病例对照研究设计,主要观察正常对照组、老年2型糖尿病组和老年无糖尿病组的血清脂联素水平以及胰岛β细胞功能包括胰岛素基础分泌(HOMA-β)和早期分泌指标(ΔI30/ΔG30)的变化情况,进一步观察吡格列酮治疗后老年2型糖尿病组的血清脂联素水平及其胰岛β细胞功能的变化。结果①老年两组的HOMA-β和ΔI30/ΔG30以及血清脂联素水平均显著低于正常对照组(P<0.05),老年2型糖尿病组的HOMA-β和ΔI30/ΔG30以及血清脂联素水平低于老年无糖尿病组(P<0.05);②控制性别和体质量指数后的偏相关因素分析显示,在老年人群中血清脂联素水平与胰岛素抵抗指数呈负相关(r=-0.289,P<0.05),与HOMA-β无显著相关性(P>0.05),但与胰岛β细胞的ΔI30/ΔG30呈正相关(r=0.396,P<0.05);③吡格列酮在改善老年2型糖尿病患者的胰岛素敏感性、改善糖代谢的同时还可以增加血浆脂联素的水平和改善胰岛β细胞早期分泌。结论老年2型糖尿病患者的血清脂联素水平及胰岛β细胞功能低下,吡格列酮可以增加血浆脂联素的水平,进而改善胰岛β细胞早期分泌。     

2型糖尿病家系一级亲属的胰岛素抵抗和胰岛β细胞功能研究

目的评估2型糖尿病家系一级亲属不同糖耐量状态下的胰岛素抵抗状况和胰岛β细胞功能。方法 440名2型糖尿病家系一级亲属分为2型糖尿病组(T2DM组,n=144)、糖调节受损组(IGR组,n=139)和糖耐量正常组(NGT组,n=157),另选取121名无糖尿病家族史、血糖异常史和妊娠糖尿病病史的糖耐量正常者作为正常对照组(NC组)。所有受试者进行口服葡萄糖耐量试验和胰岛素释放试验,以稳态模型评估的胰岛素抵抗指数(HOMA-IR)和胰岛素作用指数(IA I)评估胰岛素敏感性,以基础胰岛素分泌功能指数(HOMA-β)、早期胰岛素分泌功能指数(ΔI30/ΔG30)、修正的胰岛β细胞功能指数(MBCI)和葡萄糖处置指数(D I)评估胰岛β细胞功能。结果与NGT组和NC组比较,T2DM组和IGR组的IAI明显降低,HOMA-IR显著升高,差异均有统计学意义(P<0.05);T2DM组的HOMA-IR也显著高于IGR组(P<0.05);NGT组与NC组的HOMA-IR和IAI比较,差异均无统计学意义(P>0.05)。胰岛β细胞功能指标比较结果显示:各项指标均为NC组>NGT组>IGR组>T2DM组,除NGT组的HOMA-β...     

南京市鼓楼区居民胆囊疾病与胰岛功能及糖尿病发生风险的研究

目的:探索南京市鼓楼区居民胆囊疾病与胰岛素抵抗?胰岛β细胞功能的关系以及胆囊疾病患者的糖尿病发生风险?方法:对南京市鼓楼区8 180例既往无糖尿病的居民进行问卷调查?体格检查?血样采集?口服糖耐量试验(OGTT)及胰岛素释放试验?分析胆囊疾病各组的特征,比较各组胰岛素抵抗与胰岛β细胞功能指标,分析胆囊疾病患者糖尿病风险?结果:性别?年龄?血压?体重指数(BMI)?腰臀比(WHR)?负荷后血糖?糖化血红蛋白(HbA1c)?血脂?肝酶?生活方式及糖尿病发病率在无胆囊疾病?胆囊疾病未手术及胆囊疾病术后3组的分布不同?2组胆囊疾病患者胰岛素敏感性指标胰岛素抵抗(HOMA-IR)?胰岛素敏感指数(ISI)?胰岛素释放指数(INSR120)与无胆囊疾病者的差异有统计学意义(P < 0.05)?胆囊疾病手术后糖尿病及代谢综合征风险增加?结论:胆囊疾病在既往无糖尿病史的南京市鼓楼区居民中是胰岛素抵抗的标志,胆囊疾病术后状态是糖尿病的危险因素?     

61例朝鲜族老年2型糖尿病患者胰岛β细胞功能

[目的]观察朝鲜族老年2型糖尿病患者的胰岛素抵抗(IR)及胰岛β细胞功能.[方法]检测61名新诊断的老年2型糖尿病患者、16例糖调节受损及19例糖耐量正常者的临床指标及血脂水平,并进行口服葡萄糖-胰岛素释放试验.计算胰岛素敏感性指数、HOMA-IR、胰岛β细胞功能指数(HOMA-β)及ΔI30/ΔG30.[结果]与糖耐量正常及糖调节受损组相比较,新诊断的2型糖尿病组患者ΔI30/ΔG30差异无统计学意义(P=0.733,P=0.068),HOMA-β差异有统计学意义(P=0.000,P=0.014);与糖耐量正常组相比较,糖尿病组HOMA-IR及胰岛素敏感性指数差异有统计学意义(P=0.001,P=0.000);与糖调节受损组相比较,糖尿病组HOMA-IR及胰岛素敏感性指数差异无统计学意义(P=0.148,P=0.078).[结论]朝鲜族老年2型糖尿病患者的IR在糖调节受损时期就比较明显,胰岛β细胞功能障碍从糖调节受损到2型糖尿病逐渐加重.     

胰岛素泵强化治疗对初发2型糖尿病患者胰岛β细胞功能的影响

目的:探讨胰岛素泵强化治疗对初发2型糖尿病患者胰岛β细胞功能的影响。方法:初发2型糖尿病患者150例,对照组75例给予常规口服降糖药物治疗,观察组75例给予胰岛素泵强化治疗,随访2年,对比两组患者空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c),β细胞功能指数(HOMA-β)、早期胰岛素分泌指数(△I30/△G30)。结果:两组治疗后3个月FBG、HbAlc、FINS、HOMA-β、△I30/△G30等指标均较治疗前显著改善(P均<0.01);治疗后两组FBG与HbA1c比较差异无统计学意义(P<0.05),FINS与HOMA-β、△I30/△G30比较差异具统计学意义(P均<0.01)。2年内HOMA-β及△I30/△G30均降低,但观察组HOMA-β在每个随访时点与治疗后3个月时比较均无显著差异(P均>0.05),对照组随访1年时即出现显著差异(P<0.05);观察组△I30/△G30在随访1.5年时与治疗后3个月时出现差异(P<0.05),而对照组在随访1年时即出现显著差异(P<0.01)。结论:胰岛素泵强化治疗可有效保护初发T2DM患者胰岛β细胞功能。     

HbA1c检测及胰岛素释放试验诊断2型糖尿病临床研究

目的分析糖化血红蛋白(HbA1c)检测及胰岛素释放试验诊断2型糖尿病的临床价值。方法选取2018年1月‐2018年9月该院收治的2型糖尿病患者114例为研究对象,根据患者空腹胰岛素分泌水平将其分为研究A组和研究B组,各57例,另选取同期在该院健康体检者57例为对照组。分别检测3组HbA1c、胰岛素释放水平、空腹血糖、空腹胰岛素、胰岛素抵抗指数及胰岛β细胞功能指数等指标。结果研究A组、研究B组空腹血糖、HbA1c、稳态模型胰岛素抵抗指数(HOMA-IR)高于对照组,胰岛β细胞功能指数(HOMA-β)低于对照组(P 0.05);研究A组空腹胰岛素高于对照组,研究B组空腹胰岛素低于对照组(P 0.05);研究A组空腹胰岛素、HOMA-β高于研究B组,HbA1c低于研究B组(P 0.05);研究A组、B组空腹时、30 min、60 min胰岛素释放水平均低于对照组,180 min胰岛素释放水平高于对照组(P 0.05);研究A组120 min胰岛素释放水平高于对照组,研究B组低于对照组(P 0.05);研究A组空腹时、30 min、60 min、120 min、180 min胰岛素释放水平均高于研究B组(P 0.05)。结论 HbA1c检测及胰岛素释放试验可进一步分析胰岛素β细胞功能变化情况,可指导2型糖尿病的诊治。     

胰岛素强化治疗初诊2型糖尿病的临床观察

目的:观察胰岛素强化治疗新诊断的2型糖尿病对胰岛β细胞功能恢复的作用。方法:对72例饮食控制无效,新诊断的2型糖尿病患者,分成胰岛素强化治疗组(36例)和常规口服降糖药治疗组(36例),用稳态模式评估法(HOMA)评价胰岛素抵抗(HOMA-IR)及胰岛β细胞基础功能(HOMA-βcell)。结果:胰岛素强化治疗使血糖很快降至正常,胰岛素敏感性、胰岛β细胞功能明显高于治疗前。与对照组相比,空腹血糖、空腹胰岛素、HOMA-IR、HOMA-βcell均有显著性差异(P<0.01)。结论:新诊断的2型糖尿病患者经短期胰岛素强化治疗,能有效减轻胰岛素抵抗、改善胰岛细胞功能,并维持长期良好的血糖而无需口服降糖药治疗。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.