2型糖尿病患者颈动脉硬化临床分析

目的 探讨2型糖尿病(T2DM)患者颈动脉硬化与临床代谢指标的关系.方法 选择T2DM患者201例,根据颈动脉硬化程度分为3组:颈动脉内膜中层厚度正常(正常组)53例,颈动脉内膜中层增厚(增厚组)56例,颈动脉内膜中层斑块形成(斑块组)92例.检测并比较3组间尿白蛋白及糖脂代谢差异.结果 3组间FPG、2hPG、TG、TC、HDL-C、LDL-C水平比较差异无统计学意义(P>0.05).3组间年龄、糖尿病病程、高血压病程、HbA1c、尿白蛋白随颈动脉病变加重,变量依次逐渐增加,差异有统计学意义(P＜0.05或P＜0.01).结论 T2DM患者年龄、糖尿病病程、高血压病程、HbA1c、尿白蛋白与颈动脉硬化密切相关.     

原发性高血压患者同型半胱氨酸和空腹血糖水平与颈动脉粥样硬化的相关性研究

目的 探讨原发性高血压(EH)患者同型半胱氨酸(Hcy)和空腹血糖(FPG)水平与颈动脉粥样硬化(CAS)的相关性.方法 采用酶法和已糖激酶法分别检测88例EH患者的血清Hcy和FPG水平.根据颈动脉内膜中层厚度(CIMT)分为≤1.0 mm组(CIMT非增厚组,30例)、内膜中层厚度＞1.0 mm组(CIMT增厚组,58例).以50名健康体检者作为正常对照组.检测各组Hcy(酶法)、FPG(已糖酶法)以及血液中的总胆固醇(TCH)(酶法)、甘油三酯(TG)(酶法)、低密度脂蛋白(LDL-C)(直接法)、高密度脂蛋白(HDL-C)(直接法)值,并分析Hcy、FPG、TCH、TG、LDL-C、HDL-C与CIMT的相关性.结果 CIMT非增厚组与对照组相比Hcy和FPG水平升高(P＜0.05).CIMT增厚组与CIMT非增厚组相比Hcy和FPG水平升高(P＜0.05),与对照组相比Hcy和FPG水平升高(P＜0.01).CIMT增厚组CIMT与Hcy和FPG呈正相关(r=0.439和r=0.537,P＜0.05).CIMT非增厚组CIMT与Hcy和FPG呈正相关(r=0.545和r=0.760,P＜0.05).对照组CIMT与Hcy和FPG也呈正相关(r=0.416和r=0.526,P＜0.05).Logistic回归分析表明Hcy和FPG均是EH患者CAS独立危险因素.结论 Hcy和FPG水平与EH合并CAS具有相关性,且为EH患者CAS的独立危险因素.     

初诊2型糖尿病患者血清25羟基维生素D水平与颈动脉内膜中层厚度及超敏CRP的相关性研究

目的探讨初诊2型糖尿病患者中血清25羟基维生素D水平与颈动脉内膜中层厚度及超敏CRP的相关性。方法选取2013年12月至2017年1月于舞钢市人民医院内分泌科住院初次诊断为2型糖尿病(T2DM)患者100例,测定所有患者的血脂、血糖、HbA1c、胰岛素、血清25(OH)D水平、颈动脉内膜中层厚度(CIMT)等。结果初诊T2DM患者中,血清25(OH)D水平与年龄、TG、FBG、HOMA-IR、HbA1c、超敏CRP呈负相关(P<0.05);CIMT与年龄、收缩压、TC、LDL-C、HOMA-IR、HbA1c和超敏CRP呈正相关,与血清25(OH)D水平和HDL-C呈负相关(P<0.05)。血清25(OH)D水平与CIMT相关(β=-0.216,P<0.001)。结论在初诊T2DM患者中,血清25(OH)D水平与颈动脉内膜中层厚度及超敏CRP均相关,血清25(OH)D水平是早期动脉粥样硬化的独立影响因素。     

2型糖尿病一级亲属的代谢状态与炎症因子的相关性

目的 研究2型糖尿病(T2DM)一级亲属的代谢状态以及与炎症因子hs-CRP的相关性.方法 将入选患者分成4组,2型糖尿病(T2DM)组41例,糖尿病前期(PDM)组38例,T2DM 患者正常糖耐量一级亲属(FDR)组46例,正常对照(NC)组48例.分别测定血清hs-CRP及相关代谢指标.结果 在校正年龄、BMI、腰围后,FPG、2hPG、HbA1c、TG、LDL-C和hs-CRP在NC 组、FDR 组、PDM组和T2DM 组均呈增高趋势,而HOMA -β和HDL-C呈降低趋势(P＜0.05).HOMA-IR和FINS在NC 组、FDR 组和PDM组均呈增高趋势(P＜0.05),而在PDM组和T2DM 组差异无统计学意义(P＞0.05).hs-CRP与BMI、FPG、2hPG、HOMA-IR及TG 呈正相关(P＜0.01),与HDL-C呈负相关(P＜0.01).结论 T2DM患者一级亲属在糖耐量正常时就已经出现胰岛素抵抗及脂代谢紊乱,慢性炎症与高胰岛素血症、血脂紊乱及肥胖有关.     

初诊2型糖尿病患者胰岛素抵抗与颈动脉内膜中层厚度的相关研究

目的:研究胰岛素抵抗与颈动脉内膜中层厚度的关系。方法:选择72例初诊2型糖尿病患者(糖尿病组)和28例健康者(对照组),测定空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS),并计算体重指数(BMI)、稳态模型评估法计算胰岛素抵抗指数(HOMA-IR),用彩色多普勒超声仪检测颈动脉内膜中层厚度(IMT)。结果:糖尿病组IMT较对照组升高,糖尿病组中IMT增厚组FINS、HOMA-IR较IMT正常组升高,差异有统计学意义(P<0.05)。IMT与年龄、BMI、FINS、ln(HO MA-IR)、LDL-C呈正相关(P<0.05)。结论:初发T2DM患者中已存在颈动脉IMT增厚,IR和高胰岛素血症是导致T2DM早期动脉粥样硬化(AS)的重要因素。     

哈萨克族肥胖与胰岛素抵抗的关系研究

目的: 研究哈萨克族人群肥胖与胰岛素抵抗的关系.方法:以1 902例年龄20～82岁哈萨克族成人作为研究对象,测定其身高、体重、腰围(WC)及空腹血糖(FPG)和空腹胰岛素水平(FIns),估算胰岛素抵抗指数(HOMA-IR)与胰岛素敏感指数(ISI),比较上述指标肥胖患者和非肥胖对照人群之间胰岛素抵抗的差异.分析哈萨克族胰岛素抵抗与肥胖发病的关系.结果:肥胖患者较非肥胖者FPG、体重指数(BMI)、WC均显著升高(P＜0.05),但ISI显著降低(P＜0.01).结论: 肥胖与胰岛素抵抗的关系密切,肥胖的患者存在更为严重的胰岛素抵抗.     

肥胖类型与冠心病危险因素的关系探讨

目的:测定中心性肥胖与外周性肥胖患者空腹血糖(FBS)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)等水平的变化,探讨肥胖类型与冠心病危险因素的关系。方法:将142例肥胖患者,按腰围(WC)分成中心性肥胖与外周性肥胖2组,观察FBS、TG、TC、HDL-C、LDL-C、UA、FINS的水平,计算胰岛素抵抗指数(HOMR-IR)值。结果:中心性肥胖组的TG、LDL-C、UA、FINS、HOMR-IR明显高于外周性肥胖组,而HDL-C则降低;WC及体重指数及(BMI)与UA、TG呈正相关,与HDL-C呈负相关,且WC与上述指标相关性更好,WC与LDL-C呈正相关,而BMI与LDL-C相关性不明显。结论:中心性肥胖较外周性肥胖更易导致冠心病。     

脂联素、C反应蛋白与2型糖尿病患者颈动脉内膜-中膜厚度的关系

目的 研究2型糖尿病患者颈动脉内膜-中膜厚度(IMT)与脂联素(APN)、C反应蛋白(CRP)的关系.方法 42例2型糖尿病患者,正常的对照组41例,分析两组人群空腹血糖(FPG)、空腹胰岛素(FINS)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、APN和CRP,测定IMT,同时计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR).结果.糖尿病组TG、LDL-C、FPG、CRP、FINS、IMT高于对照组,差异有统计学意义(P＜0.01),IMT与BMI、FPG、FINS、HOMA-IR、TC、TG、LDL～C、CRP呈正相关(P＜0.01),而与APN呈负相关(P＜0.01),其相关性有统计学意义.结论 糖尿病组IMT与胰岛素抵抗的增加、糖脂代谢紊乱及CRP的升高与APN降低有关,提示血清脂联素和CRP水平是2型糖尿病动脉粥样硬化的重要因素,可以预测2型糖尿病患者大血管病变的发生与发展.     

胰岛素抵抗稳态模式评估与LDL-C/HDL-C和TC/HDL-C比值测定关系的探讨

目的 评价胰岛素抵抗稳态模式评估胰岛素抵抗指数(HOMA-IR)与LDL-C/HDL-C和TC/HDL-C比值测定的关系.方测定正常糖耐量(NGT)组、糖耐量受损(IGT)组和2型糖尿病(MD)组,空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C).计算稳态模式评估胰岛素抵抗指数(HOMA-IR)和LDL-C/HDL-C和TC/HDL-C比值.结果 IGT组、DM组与NGT组比较,HOMA-IR、LDL-C/HDL-C、TC/HDL-C均有较显著的统计学差异(P＜0.01),其值明显升高,并且HOMA-IR与LDL-C/HDL-C和TC/HDL-C比值测定有一定的相关性.结论 我们认为联合测定胰岛素抵抗指数(HOMA-IR)和LDL-C/HDL-C、TC/HDL-C比值,可作为胰岛素抵抗较好的诊断及治疗指标.     

肥胖及2型糖尿病患者血清网膜素水平及其相关因素分析

目的 测定肥胖及新诊断2型糖尿病患者血清网膜素水平,探讨网膜素与体脂参数、糖脂代谢、胰岛素抵抗的相关性.方法 69例2型糖尿病(T2DM)和74例正常糖调节(NGR)者按BMI≥25 ks/m2分为正常体重与超重/肥胖亚组,采用ELISA法检测空腹血清网膜素水平,同时检测空腹血糖(FPG),口服葡萄糖耐量试验2 h血糖(OGTY-2 hPG),糖化血红蛋白(HbA1c)、血脂各项指标及空腹胰岛素(FINS)水平,计算体重指数(BMI)和腰臀比值(WHR),并以稳态模型(HOMA-model)计算胰岛素抵抗指数(HOMA-IR).结果 校正年龄及性别后,血清网膜素水平在T2DM组低于NGR组[(17.5±5.8)μg/L vs(20.0±7.6) μg/L,P＜0.05];T2DM组和NGT组中的超重/肥胖者均低于非肥胖者[分别为(15.2±5.6)μg/L vs(19.0±5.8)μg/L和(17.4±6.4)μg/L vs(22.8±7.9)μg/L,均P＜0.05)];且T2DM超重/肥胖组明显低于NGR超重/肥胖组.相关分析显示,血清网膜素水平与腰围、WHR、In(HOMA-IR)、甘油三酯、BMI、FINS、2 hPG均呈负相关(r=-0.166～-0.313,P＜0.01或P＜0.05);与HDL-C呈正相关(r=0.400,P＜0.01).多元逐步回归分析发现,HDL-C、腰围和In(HOMA-IR)是血清网膜素独立相关因素(分别为r2=0.155,r2=0.181,r2=0.201,均P＜0.01).结论 血清网膜素水平与腹型肥胖、胰岛素抵抗及脂代谢相关,可能参与构成胰岛素抵抗的病理生理基础.     

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.     

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.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.