黄芪治疗糖尿病肾病近期疗效观察

目的　观察黄芪注射液治疗Ⅳ期糖尿病肾病的疗效。方法　Ⅳ期糖尿病肾病 58例随机分为两组 ,治疗组在常规治疗基础上加黄芪注射液 30ml/d静滴。对照组不用黄芪注射液 ,余同治疗组 ,共治疗 2个疗程 2 8d。结果　治疗组治疗前后对比尿蛋白减少 (P <0 0 1 ) ,血白蛋白上升 ,LDL、TG、TC下降 (P <0 0 5) ,疗效优于对照组。结论　黄芪注射液治疗Ⅳ期糖尿病肾病有效     

Bilaterale Ruptur des Lig.patellae bei Diabetes mellitus

Bilateral ruptures of patellar tendon are a rare event and occur mainly in older patients suffering from systemic diseases like lupus erythematosus, chronic renal failure, rheumatoid arthritis or are taking longterm corticosteroids. Only few cases of spontaneous bilateral rupture of patellar tendon without underlying systemic disease are described in literature up to now. This report provides a patient with bilateral patellar tendon rupture, where in further check up and follow up only a mild diabetes mellitus treated by diet could be detected as systemic disease. In current opinion diabetes mellitus does not belong to the "typical" underlying systemic diseases for tendon ruptures. In literature research diabetes mellitus was only mentioned once together with a bilateral patellar tendon rupture.     

组织相容性复合物DQ基因与胰岛素依赖型糖尿病易感相关性剂量效应规律的研究

为研究中国北方汉族人中组织相容性复合物ＤＱ（ＨＬＡ－ＤＱ）基因与胰岛素依赖型糖尿病（ＩＤＤＭ）遗传易感性相关的剂量效应规律，采用聚合酶链反应和序列特异性寡核苷酸探针杂交技术，对５４例胰岛素依赖型糖尿病患儿和４０例正常成年供血员ＨＬＡ－ＤＱ基因进行了研究。结果：携带４个易感性基因的个体只见于患者，携带３个易感性基因的个体在患者中为３３．３％，正常对照中为１０％；携带２个或１个易感性或保护性基因的个体在正常对照中频率较患者为高，但差异无显著意义；携带３个保护性基因的个体只见于正常对照。提示：ＩＤＤＭ易感性基因具有部分隐性遗传的特点且具有累加效应。个体中１个或２个易感性基因的存在不能对ＩＤＤＭ构成显著的易感性，３个或３个以上易感性基因的存在方可对ＩＤＤＭ构成显著易感性。ＤＱ保护性基因具有部分显性遗传的特点并且也具有累加效应。携带１个或２个保护性基因的个体患ＩＤＤＭ的机会将大大减少，而携带３个保护性基因的个体则可以不发生ＩＤＤＭ。     

Insulin resistance is associated with decreased clinical status in cystic fibrosis

Patients with cystic fibrosis (CF) frequently have impaired glucose tolerance and progression to diabetes (DM) with clinical features of both insulin-dependent and non-insulin-dependent diabetes. One feature of non-insulin-dependent DM is decreased insulin sensitivity, also known as insulin resistance. The goal of this study was to determine whether patients with CF exhibit insulin resistance and to determine the potential effect of insulin resistance on clinical status. We also sought to determine whether insulin resistance is associated with a specific CF genotype. We studied 18 patients with CF (8 with normal glucose tolerance, 5 with impaired glucose tolerance, 5 with DM), and 20 lean control subjects matched for age, weight, and sex. All control subjects had normal glucose tolerance. The clinical status for each CF patient was determined according to a modified National Institutes of Health scoring system. Each subject underwent a three-step hyperinsulinemic euglycemic clamp (insulin doses of 10, 40, 120 mU/m ² per minute). Results from the 120 mU/m ² per minute infusion defined maximal glucose disposal rate (defined in milligrams per kilogram body weight per minute) at steady state with peripheral insulin levels 195 ± 20 mU/ml. Subjects with CF demonstrated insulin resistance (control subjects = 13.6 ± 1.1, patients with CF = 10.2 ± 1.6 mg/kg per minute; p = 0.003). When each subgroup was compared separately with control subjects, all subgroups were statistically insulin resistant (glucose disposal rate, patients with CF and normal glucose tolerance = 10.8; those with impaired glucose tolerance = 8.4; those with DM = 10.1 mg/kg per minute), and the patients with CF with impaired glucose tolerance were the most insulin resistant. When plotted versus glucose disposal rate, a striking positive correlation between worsened clinical status and insulin resistance ( r = 0.85) is demonstrated. Furthermore, there is no correlation between insulin resistance and fasting blood glucose, subject age, or percent ideal body weight (all r values not significant). In conclusion, patients with CF exhibit insulin resistance that is associated with worsened clinical status. We believe it is the combination of insulin resistance and decreased insulin secretion that is responsible for the high incidence of CF-related diabetes. (J Pediatr 1997;130:948-56)     

糖尿病合并妊娠伴视网膜病变孕妇的临床观察

目的：研究糖尿病合并妊娠伴视网膜病变孕妇的妊娠结局及孕期视网膜病变。方法：回顾性分析１９８１～１９９５年间４９例糖尿病孕妇妊娠情况。伴视网膜病变的１６例分为第Ⅰ组；无视网膜病变的３３例分为第Ⅱ组。第Ⅰ组糖尿病病程平均为８．９２±４．３５年；第Ⅱ组为３．１１±１．７４年。结果：第Ⅰ组孕妇并发症及围产儿发病率较高，但两组比较，差异无显著性（Ｐ＞０．０５）。３１．１％孕妇视网膜病变在孕期加重，但仍属单纯型（背景期）。结论：糖尿病合并妊娠伴眼底病变时，仍可以继续妊娠，但孕期应密切观察眼底变化和严格控制血糖。     

妊娠期糖尿病患者高密度脂蛋白糖基化与妊高征发病的关系

目的：了解妊娠期糖尿病孕妇体内高密度脂蛋白（ＨＤＬ）糖化程度及受体代谢途径情况，探讨其与妊高征发病的关系。方法：用荧光法测定妊娠期糖尿病患者糖化血红蛋白，≤８．０％为组Ⅰ，共３２例、＞８．０％为组Ⅱ，共３４例，并测定正常妊娠组３６例及正常非妊娠组３２例ＨＤＬ糖化值。用酶联免疫受体法观察ＨＤＬ与培养的人胚肺成纤维细胞表面受体特异结合情况。结果：妊娠期糖尿病患者组Ⅰ、组ⅡＨＤＬ糖化值明显高于正常妊娠组和正常非妊娠组（Ｐ＜０．０１）。其细胞结合、摄入和降解糖化ＨＤＬ均较正常妊娠组和正常非妊娠组升高，使细胞内总胆固醇含量升高（Ｐ＜０．０１）。结论：妊娠期糖尿病患者ＨＤＬ糖化值含量的变化及脂质沉积，可能是妊高征小动脉痉挛的原因之一。     

妊娠期糖尿病孕妇与正常孕妇血清铬含量的研究

目的　通过对血清铬含量的测定 ,探讨妊娠期糖尿病孕妇是否缺铬。方法　 2 0 0 0～ 2 0 0 1年 ,选择妊娠期糖尿病孕妇 5 0例 ,正常孕妇 4 7例 ,以电感耦合高频等离子体发射光谱法 (ICP AES)测定两组孕妇血清铬含量。结果　妊娠期糖尿病孕妇血清铬含量较正常孕妇明显降低 ,差异有显著性意义 (P <0 0 5 )。结论　建议妊娠期糖尿病孕妇适量补铬     

妊娠期口服葡萄糖负荷试验合理血糖界值的探讨

目的 探讨目前适合我国卫生经济条件的妊娠期葡萄糖负荷试验(GCT)的筛查界值.方法 资料来源于2006年4月1日至2006年9月30日在全国18个城市25家医院保健并进行首次50 g GCT的16 286例孕妇,对其GCT结果进行统计和分析.结果 以NDDG标准诊断妊娠期糖尿病(GDM),50 g GCT的界值选取7.2 mmol/L时的敏感度和特异度分别为98.2%和59.0%,选取7.8 mmol/L时分别为96.0%和73.0%,选取8.3 mmol/L时分别为90.2%和81.5%;以ADA标准诊断GDM,选取GCT界值为7.2 mmol/L时敏感度为97.9%,特异度为60.4%;选取7.8 mmol/L时分别为96.2%和74.7%;而选取8.3 mmol/L则分别为87.0%和83.1%.以NDDG标准诊断妊娠期糖代谢异常(包括GDM及妊娠期糖耐量受损),选取7.2 mmol/L时敏感度和特异度分别为97.7%和61.4%,选取7.8 mmol/L时分别为95.4%和75.8%,选取8.3 mmol/L时分别为84.9%和84.1%.结论 据我国目前的卫生经济情况,以7.8 mmol/L作为50 g GCT的界值是合理的.     

基于混合正态模型的糖尿病住院病人医疗保险设计

目的提出一种基于混合正态模型来拟合糖尿病住院病人风险损失规律的精算方法.方法采用EM算法对混合正态风险模型进行参数估计;采用Kolmogorov-Smirnov检验对混合正态风险模型的拟合优度进行检验;采用随机抽样模拟和t检验法比较随机样本指标与模型参数之间的差异;采用逐步判别分析方法,对随机保单进行分类与甄别;设计保险条款,作为保险双方有约束力的合同.结果由训练样本拟合得到四元混合正态模型;模型的拟合精度很高（P=0.99701）;按μi＋1.645σi可得到4种保险等级下的总保费;样本指标与模型参数之间的差异无统计学意义.结论 本文设计的面向糖尿病住院病人的医疗保险,可根据投保人因糖尿病住院风险损失额划分成4种类型保单持有者,并由此厘定出4种不同等级的保险费,因而体现了高风险损失应承担高额保险费的保险原则,有利于投保人根据自身情况选择保单类别.     

糖尿病并心电图缺血性ST-T改变相关因素分析

目的探讨糖尿病人发生心电图缺血性ST-T改变的发生率及相关影响因素。方法对比分析糖尿病人在不同危险因素(高血压、高脂血症、病程5年上下、同时合并有高血压和高脂血症)的情况下,发生心电图缺血性ST-T改变的发生率。结果合并高血压时发生率为64.5%,合并高脂血症时发生率为56.3%,同时合并高血压和高脂血症时发生率为66.7%(且呈广泛ST-T改变),病程>5年的发生率为49.3%,均明显高于不伴高血压、高血脂及病程<5年者,均P<0.05。结论糖尿病合并高血压、高脂血症、同时有高血压和高脂血症及病程>5年的发生心肌缺血性ST-T改变的危险性明显增加。糖尿病如合并其他危险因素存在,应在控制血糖的同时尽早对其他危险因素进行干预。