北京、苏州和广州女性产后体重滞留现况与影响因素调查分析

目的了解中国女性产后体重滞留的现况并探索其影响因素。方法采用整群抽样,分别选取北京、苏州、广州产后第0~1、1~2、2~4、4~8个月的女性共578名。通过身体测量记录身高、体重。通过问卷调查并结合医疗记录收集调查对象的一般人口学资料和孕前体重、分娩时体重及相关孕产信息。结果调查对象孕前BMI为(20.8±2.7),产后BMI为(23.4±3.2),体重滞留数随时间逐渐减小。但至产后第4~8个月,仍有78.4%的女性体重滞留,且有53.4%的女性体重滞留数超过5 kg。孕期增重与产后体重滞留相关(P=0.015)。体重滞留者中学历较高者比例较大(P=0.044)。结论中国产后女性存在较为严重的体重滞留问题,孕期过度增重与产后体重滞留关系密切,对围产期女性从怀孕伊始即进行全方位的指导有助于改善体重滞留的现状。     

Association of interleukin-18 promoter polymorphism and atherosclerotic diseases in Chinese patients with diabetic nephropathy

Aim: Interleukin‐18 (IL‐18) is a pro‐inflammatory cytokine and possibly plays an important role in the pathogenesis of cardiovascular disease. The relationship between two IL‐18 gene polymorphisms, namely C‐607A and G‐137C, and cardiovascular disease in patients with diabetic nephropathy was examined. Methods: Two hundred and twenty patients (91 male) with diabetic nephropathy were studied. The IL‐18 promoter genotypes were determined. All patients were then prospectively followed for the cardiovascular events. Cardiovascular mortality and all‐cause mortality were also compared. Results: Mean age was 64.3 ± 10.6 years; average follow up was 73.9 ± 33.6 months. The frequencies of CC, CA and AA genotypes of the C‐607A polymorphism were 25.5%, 48.2% and 26.8%, respectively; GG, GC and CC genotypes of the G‐137C polymorphism were 71.8%, 25.0% and 3.2%, respectively. Neither of the polymorphisms were associated with the development of primary cardiovascular end‐point. Cardiovascular survival was 84.8% and 70.6% at 60 months for GG and GC/CC genotypes of the G‐137C polymorphism, respectively (P = 0.027); the corresponding actuarial survival was 69.0% and 54.8%, respectively (P = 0.053). However, the G‐137C genotype was not an independent predictor of cardiovascular or actuarial survival after adjusting for confounders by multivariate analysis with the Cox model. The C‐607A polymorphism had no significant effect on cardiovascular or actuarial survival. Conclusion: The G‐137C polymorphism of the IL‐18 promoter is associated with the cardiovascular mortality, and a trend of association with all‐cause mortality, in patients with diabetic nephropathy. The association, however, becomes insignificant after adjusting for confounding factors. Further studies are needed to test other genetic determinants of the association between systemic inflammation and cardiovascular disease in renal failure patients.     

THYROTOXICOSIS AND RENAL TUBULAR ACIDOSIS PRESENTING AS HYPOKALAEMIC PARALYSIS

A 34-yr-old Chinese woman presented with hypokalaemic periodicparalysis. She had a goitre and was biochemically thyrotoxic.However, she also had urinary potassium loss with a metabolicacidosis and reduced ability to acidify her urine. The co-existenceof distal renal tubular acidosis (RTA) was confirmed. Therewas no evidence of xerostomia or xerophthalmia, although anti-Roantibody and rheumatoid factor were positive. Paralytic attacksdid not recur after the thyrotoxicosis was controlled with radioactiveiodine. Possible pathogenic mechanisms for the association ofthese disorders are discussed. Female patients presenting withthyrotoxic periodic paralysis (TPP) should be thoroughly investigatedfor possible additional precipitating factors in view of thestrong male predominance of TPP, particularly when there areatypical metabolic features. KEY WORDS: Hypokalaemic paralysis, Renal tubular acidosis, Thyrotoxicosis     

罗陆一教授运用经方治疗脑动脉粥样硬化症的临床经验

广东省名中医罗陆一教授主任医师行医四十余载,临证经验颇丰,善用经方治疗心脑血管疾病,本文介绍其在临床上运用经方治疗脑动脉粥样硬化症的经验。     

转铁蛋白结合镱跨膜转运及镱对U-87MG细胞增殖的影响

目的:研究转铁蛋白/转铁蛋白受体转运系统对转铁蛋白结合镱(Yb₂Tf)跨膜转运进入神经胶质瘤U-87MG细胞,以及转铁蛋白结合镱和非转铁蛋白结合镱对U-87MG细胞增殖的影响。方法:细胞培养及ICP-MS镱测定法。结果:随Yb₂Tf浓度增加,细胞镱摄入量增加。当浓度达2μmol/L时,细胞摄取镱基本达到饱和状态。细胞摄入镱量也随镱:apoTf摩尔比增大而增加,当摩尔比达到1.5时,摄入量达到最高水平。0.4μmol/LYb₂Tf可显著抑制U-87MG细胞增殖,而Yb³⁺浓度高达10μmol对细胞增殖仅有轻微影响。结论:转铁蛋白/转铁蛋白受体介导的膜转运可能是镱跨越U-87MG细胞的机制之一。转铁蛋白结合Yb³⁺可以有效地抑制U-87MG细胞的增殖。     

Relationship between β1‐adrenergic receptor polymorphisms and cardiovascular disease in patients with diabetic nephropathy

Aim: Activation of β1‐adrenergic receptor (β1AR) enhances contractility and heart rate. The polymorphism Arg389Gly in the β1AR gene was found to be functionally important in determining receptor activity. The relationship between this polymorphism and the risk of cardiovascular disease was investigated in Chinese subjects with overt diabetic nephropathy. Methods: A total of 219 type 2 diabetic subjects with nephropathy were recruited. Genotyping of the β1AR Arg389Gly polymorphism was determined. Patients were followed up to 96 months for the development of cardiovascular events. Results: There were 122, 86 and 11 patients with Arg/Arg, Arg/Gly and Gly/Gly genotype, respectively. At 96 months, the event‐free survival of primary composite cardiovascular end‐point was 33.0% and 44.3% for Gly⁺ and Gly^‐ groups, respectively (log–rank test, P = 0.105), while the event‐free survival for first ischaemic heart disease was 62.4% and 75.9%, respectively (log–rank test, P = 0.038). However, with multivariate analysis by the Cox proportional hazard model to adjust for confounders, only low‐density lipoprotein and baseline glomerular filtration rate were independent predictors of first ischaemic heart event. Conclusion: The β1AR Arg389Gly polymorphism is not an independent predictor of cardiovascular events in subjects with overt diabetic nephropathy.     

毫火针与温针灸改善肱骨外上髁炎患者肘功能的疗效比较

目的观察毫火针与温针灸配合康复训练对恢复肱骨外上髁炎患者肘功能的效果。方法肱骨外上髁炎患者90 例随机分成2 组,分别接受毫火针和温针灸治疗,均同时配合康复训练。观察临床疗效、肘功能评定量表总分及项目分变化。结果毫火针组临床疗效优于温针灸组(P<0.05)。肘功能量表总分两组间无显著性差异,但治疗后2 周和4 周,毫火针组症状体征评分高于温针灸组(P<0.05)。治疗后2 周,温针灸组日常生活评分高于毫火针组(P<0.05)。结论毫火针与温针灸在改善患者肘功能方面效果相当,毫火针改善症状体征方面较优,而温针灸能短期内改善患者日常生活活动能力。     

罗陆一教授经方治疗冠心病经验

冠状动脉粥样硬化性心脏病简称冠心病,是因冠状动脉粥样硬化使冠状动脉管腔狭窄甚至闭塞,导致心肌缺血、缺氧而引起的一种心脏病。临床可表现为心绞痛、心肌梗死、心律失常、心力衰竭和心脏猝死等。根据其临床表现当属中医学＂胸痹心痛＂、＂心悸＂、＂真心痛＂等病的范畴。