2型糖尿病患者口服葡萄糖后胆囊收缩素及生长激素释放肽分泌规律分析

目的研究2型糖尿病(T2DM)患者口服葡萄糖后不同时间点血清胆囊收缩素(CCK)及生长激素释放肽(ghrelin)的分泌规律。方法选择T2DM患者82例为T2DM组,纳入同期的健康体检者34例为对照组,收集两组受试者的一般临床资料,检测其空腹和口服葡萄糖后不同时间点血糖、胰岛素、C肽、CCK及ghrelin水平并进行比较。采用Pearson相关分析探讨血清CCK及ghrelin与受试者血糖、胰岛素等因素的相关性。结果T2DM组患者服糖后0、30、60、120和180 min的血糖水平均较对照组高,胰岛素和C肽水平在服糖后30、60和120 min均较对照组低,CCK水平在服糖后60和120 min均较对照组低,ghrelin水平在空腹、服糖后30、60和120 min均较对照组低(P<0.05)。Pearson相关分析结果显示,T2DM患者血清ghrelin水平与BMI水平呈负相关(r=-0.282,P=0.047)。结论T2DM患者口服葡萄糖后CCK及ghrelin分泌较正常人群减少,CCK分泌高峰明显延迟,空腹血清ghrelin与BMI呈负相关。     

Percutaneous Closure of Atrial Septal Defects in Patients with an Aberrant Retroaortic Coronary Artery: Is It Safe?

Coexistence of an ostium secundum type atrial septal defect and a coronary artery anomaly with an aberrant retroaortic course is a rare congenital anomaly that may potentially complicate percutaneous atrial septal defects (ASD) closure. If the anterosuperior rim of the defect is deficient, the abnormally located coronary artery may be compressed or distorted by the implanted device causing myocardial ischemia, arrhythmias, and eventually sudden cardiac death. Due to the potential occurrence of these fatal cardiac events, diagnosis of an aberrant coronary artery with a retroaortic course must be established before percutaneous ASD closure. In this report, two patients with this rare association are described in whom percutaneous closure of the defect was feasible and uneventful. The importance of a careful periprocedural, noninvasive echocardiographic coronary artery imaging is emphasized, and the rational for percutaneous atrial septal defect closure in this unusual anatomic arrangement is proposed.     

联合检测抗CCP、RF、抗RA33在类风湿关节炎的临床应用

目的:探讨抗环瓜氨酸肽抗体（抗CCP）、类风湿因子（RF）、抗RA33抗体联合检测在类风湿关节炎（RA）诊断中意义。方法:选取在我院确诊RA患者266例、非RA风湿病患者228例（结缔组织病、强直性脊柱炎、骨关节炎、系统性红斑狼疮、干燥综合征）、健康体检者215名,检测3组抗CCP、RF、抗RA33数值,统计各指标阳性率,并进行统计学分析比较;通过Spearman 相关分析探讨各指标之间的关系;ROC曲线比较各指标的诊断性能;通过平行试验与系列实验探讨3项指标联合检测RA的诊断效能。结果:RA患者各指标数值均显著高于非RA自身免疫疾病患者与健康对照组（P ＜0.01）;Spearman相关分析显示RA患者抗CCP与抗RA33之间不存在关系,RF与抗CCP、RF与抗RA33之间存在显著相关性（P ＜0.01）;ROC曲线分析显示,抗CCP、RF、抗RA33的AUC值分别为0.942、0.922、0.653;3项指标中,阳性率:RF＞抗CCP＞抗RA33,敏感度:RF＞抗CCP＞抗RA33,特异度:抗RA33＞抗CCP＞RF;平行试验敏感度增高（98.50%）,但特异度降低（64.91%）,系列实验敏感度为15.41%,特异度为98.68%。结论:抗CCP、RF、抗RA33联合检测可提高诊断RA的敏感度与特异性,适用于RA的早期诊断,临床上值得推广使用。     

Diagnosis and Management of Atrial Fibrillation: An Overview

Atrial fibrillation (AF) has been defined as the new cardiovascular “epidemic”. Its prevalence is rising in developed countries, and the associated social and economic costs are high. In the last few years, there has been an increasing interest in understanding the mechanisms of AF and its management. New pharmacotherapies together with novel techniques for surgical and catheter treatment of AF have been developed, allowing the maintenance of sinus rhythm and the alleviation of symptoms in a large number of patients with AF. However, there are still some challenges that need to be addressed. This article gives an overview of the current state of the art on novel techniques for diagnosis and management of AF.