过氧化质体增殖物激活的受体γ2-Pro12Ala变异对常见代谢病的影响

目的 研究过氧化质体增殖物激活的受体(PPAR)γ2-Pro12Ala变异对体脂含量及分布、胰岛素分泌及作用以及与代谢综合征的相关情况.方法 在340例中国人,其中非糖尿病者(ND)184例,2型糖尿病(DM)患者156例,用PCR下游错配引物在Ala12等位基因上引入Bst U-I酶切位点进行PPARγ2-Pro12Ala变异检测.结果 (1)中国人群体中Ala12携带者(Pro/Ala及Ala/Ala基因型)及Ala12等位基因频率分别为0.04及0.02,远低于白种人(Fisher双侧确切检验P值分别为0.005及0.006);(2)PPARγ2-Pro12Ala变异与体脂相关,BMI≥25者中Ala12携带者频率及Ala12等位基因频率均显著高于BMI＜25者(Fisher确切检验P值分别为0.034及0.025);(3)ND中PPARγ2-Pro12Ala与腹部皮下脂肪相关.高腹部皮下脂肪截面积(SA)亚组中Ala12携带者频率高于低SA亚组(Fisher确切检验P=0.045).Ala12携带者的SA值高于非携带者(P=0.006).逐步回归分析表明PPARγ2-Pro12Ala是影响SA的独立因素(P=0.012);(4)PPARγ2-Pro12Ala在ND者中与血糖、血脂谱、血压、胰岛素分泌及作用无相关.此外,与糖尿病亦无相关.结论 PPARγ2-Pro12Ala变异在病因上与有密切联系的成人常见代谢病的参与因素之一.其作用部位在体脂,尤其是对腹部皮下脂肪含量发生影响.     

上海社区糖尿病前期及糖尿病人群视网膜病变患病率及相关危险因素分析

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. Methods DR screening after the epidemiologic study of metabolic syndrome in Huayang and Canyang Community , Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbAlc, serum lipid and blood pressure were also assessed. 642 patients,312 males and 330 females, aged 65 ± 13, with complete data were enrolled into the analysis. Results The prevalence of DR was 19. 9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12. 0%, 5. 1%, 2. 3% and 0. 5%, respectively; the prevalence of DR in IGR reached 8. 0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. Conclusion The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.     

尖锐湿疣和假性湿疣的鉴别和激光治疗

尖锐湿疣和假性湿疣早期的临床表现和病理形态有些近似，易误诊，并涉及防治措施的不同。设想通过临床观察、实验室检查和特殊检测，包括滴虫、霉菌、淋菌、梅毒螺旋体、衣原体、支原体、癌涂片、病毒ＨｐＶ６，１１型（核酸斑点杂交法）、ＨｐＶ－Ａｇ（免疫组化ＡＢＣ法）和细胞ＤＮＡ图像分析法，预测有无恶变的趋势。设对照组，一一进行χ２检验，得出鉴别二者的要点。尖锐湿疣组１１２例、假性湿疣组２８２例、对照组１５９例。提出ＣＯ２激光治疗为有效的方法，并探讨了两病之间的关联和二者与癌前病变及性传播疾病的关系。     

高苯丙氨酸血症合并组氨酸血症一例报告

苯酮尿症和组氨酸血症均为先天性代谢缺陷,前者由于肝脏内苯丙氨酸羟化酶缺乏引起,后者由于组氨酸酶缺乏引起。兹报告所见高苯丙氨酸血症合并组氨酸血症一例。高×,男,22个月,第二胎,第二产,足月顺     

糖尿病患者家庭诊治和护理指导

糖尿病患者家庭诊治和护理指导安徽省蚌埠医学院附属医院（蚌埠２３３００４）张建苏李兰英陆惠娟据ＷＨＯ统计目前全世界有１．３亿糖尿病患者，到２０２５年将增加到３亿；文献报告我国糖尿病患者病率在２．０～３．６％，比十年前增加３～４倍。糖尿病是慢性终身性疾病...     

子宫动脉栓塞术治疗子宫大出血

目的探讨子宫动脉栓塞术(TUAE)治疗子宫大出血的治疗价值。方法对14例子宫大出血患者采用Seldinger技术行双侧子宫动脉插管,造影确认后注入明胶海绵颗粒,阻断血供。结果TUAE后即时止血率100%,无严重并发症发生,并保留了子宫和卵巢完整的生理功能。结论子宫动脉栓塞术治疗子宫大出血是一种微创、疗效显著的治疗方法。     

PAI-1基因多态与中国人2型糖尿病肾病的相关性

目的探讨纤溶酶原激活物抑制因子-1(PAI-1)基因多态与上海地区中国人2型糖尿病肾病的相关性。方法选取2型糖尿病(T2DM)患者247例组成T2DM组,其进一步分为糖尿病无肾病组(n=80)和糖尿病肾病组(n=167),后者又分为微量蛋白尿肾病组(n=129)和显著蛋白尿肾病组(n=38);同时设立非糖尿病对照组(n=87)。应用等位基因特异性PCR法(ASP法)检测PAI-1基因启动子区——675 bp处的4G/5G多态,确定各组PAI-1基因的基因型。采用χ2检验对组间各基因型频率及等位基因频率进行比较,并比较组间携带纯合子风险等位基因4G/4G的基因型频率差异。结果T2DM组与非糖尿病对照组相比,4G/4G基因型及4G等位基因频率无统计学差异(P>0.05)。与糖尿病无肾病组相比,糖尿病肾病组4G/4G基因型频率显著增加(P<0.01,OR=2.4,95%C I=1.3～4.4),4G等位基因频率亦显著增加(P<0.05,OR=1.6,95%C I=1.1～2.3)。结论PAI-1基因多态与中国人T2DM无肾病患者进展为糖尿病肾病显著相关;携带PAI-1基因的4G/4G纯合子基因型的糖尿病患者,其进展为糖尿病蛋白尿肾病的风险增加2.4倍。     

中国人早发性糖尿病GCK基因突变的筛查

目的了解葡萄糖激酶（glucokinase）基因GCK突变和序列变异在中国人早发性糖尿病人群中的发生情况。方法应用直接测序方法对174名无亲缘关系中国人（其中80名为非糖尿病对照组，94例为早发性糖尿病家系先证者）进行GCK基因启动子区、10个外显子及其侧翼内含子区筛查。结果未在编码区发现突变，但发现几种先前已经报道的序列变异：外显子1a的5’非翻译区，位于翻译起始点上游84bp处GGCGG→GGGGG（糖尿病组G等位基因频率0．106比对照组0．075，P=0．355）；IVS1b＋12（A→T）（糖尿病组T等位基因频率0．005而在对照组未发现该变异）；IVS5＋29（G→T）（糖尿病组T等位基因频率0．027比对照组0．019，P=0．731）；IVS9＋8（T→C）（糖尿病组C等位基因频率0．585比对照组0．694，P=0．044）。此外，还发现1个未被报道的新的序列变异IVS9＋49（G→A）（糖尿病组A等位基因频率0．011比对照组0．006，P=1．000）。未发现外显子1a的5’非翻译区，-84bp处（C→G）、IVS 5＋29（G→T）、IVS9＋8（T→C）和IVS9＋49（G→A）变异与血糖、胰岛素、C-肽及空腹血脂谱等临床变量相关。结论GCK基因突变不是中国人早发性糖尿病发病的主要原因。     

2型糖尿病家系一级亲人群代谢综合征患病情况及与肥胖相关指标的关系

Objective To compare the differences of metabolic syndrome (MS) prevalence by using four working definitions and their relationship with obesity-related indicators in first-degree relatives of type 2 diabetes mellitus pedigrees. Methods Totally, 2 372 first-degree relatives from 715 type 2 diabetic pedigrees were selected in this study. Complete laboratory data, including blood pressure, lipid profile and plasma glucose, were collected. The prevalence rates of MS and obesity of four definitions, as defined by National Cholesterol Education Program Adult Treatment Panel Ⅲ (ATPⅢ) in 2005, International Diabetes Federation (IDF) in 2005,Chinese Diabetes Society (CDS) in 2004 aml Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (JCDCG) in 2007,were analyzed. Results (1)The prevalence rates of MS were 45.40% ,38.74% ,25.08% and 39.29% aecording to four definitions respectively. The prevalence rates of MS were higher in females than in males by using ATPⅢ and IDF definitions (both P<0. 01). (2)The common comhinations of metabolic abnormality was dyslipidemia, hypertension, obesity and hyperglycemia by using four definitions,except in females by using CDS definition. (3)The prevalence rates of obesity were 58.18% ,58.18% ,33.90% and 42.96% acconling to the four definitions respectively. The prevalence rates of MS in obese subjects were 66.59% ,66.59% ,54.85% and 68.99% according to four definitions respectively. (4) Applying the cutoff point for abdominal obesity according to ATPⅢ, IDF and JCDCG definitions, the prevalence rates of abdominal obesity in subjects with body mass index (BMI) <25 kg/m2 were respectively 28.58% and 16.78%, being higher in females than in males(38.90% vs 15.02% ,21.01% vs 11.22% ,both P<0. 01). Conclusion (1)There is significant familial aggregation of MS and obesity,and the first-degree relatives of type 2 diabetic patients are high risk populations. (2) Waist circumference rather than BMI taken as a discriminating component of obesity in MS seems to be clinically more helpful to the early identification and prevention of MS.     

上海社区糖尿病前期及糖尿病人群视网膜病变患病率及相关危险因素分析

Objective To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. Methods DR screening after the epidemiologic study of metabolic syndrome in Huayang and Canyang Community , Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbAlc, serum lipid and blood pressure were also assessed. 642 patients,312 males and 330 females, aged 65 ± 13, with complete data were enrolled into the analysis. Results The prevalence of DR was 19. 9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12. 0%, 5. 1%, 2. 3% and 0. 5%, respectively; the prevalence of DR in IGR reached 8. 0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. Conclusion The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.