代谢综合征各组分与非酒精性脂肪肝发病风险的关系

[目的]分析基线代谢综合征(MS)及其各组分与新发非酒精性脂肪肝(NAFLD)的关系。[方法]研究对象选择每年定期在大连医科大学附属第二医院体检中心行健康体检者1 305例,取得2007年6月—2008年12月的基线资料。2011年3月—2011年12月随访复查,两次调查资料均完整者1 303人,选择基线调查时未患NAFLD的838人进行分析。以随访时是否为NALFD分为两组,对比两组基线时各代谢综合征组分的差异,采用多因素lo-gistic回归分析影响NAFLD的因素。[结果]基线时有MS者新发NAFLD累计发生率45.98%,无MS者新发NAFLD累计发生率15.58%。在不同性别均可见有MS者新发NAFLD累计发生率显著高于无MS组(P<0.05)。新发NAFLD者基线的年龄、血压、血糖、尿酸、体质指数、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平均显著高于非NAFLD组人群,高密度脂蛋白胆固醇水平明显低于非NAFLD组人群。随着基线时存在代谢异常的数量增多,新发NAFLD的累计发生率明显增多,差异有显著性意义(P<0.01)。Logistic回归分析显示,男性性别、高总胆固醇、高甘油三酯和超重/肥胖发生NAFLD的风险分别为2.51(95%CI 1.63～3.86)、1.34(95%CI 1.07～1.68)、1.57(95%CI 1.20～2.07)和1.37(95%CI 1.27～1.47)。[结论]男性、高TC血症、高TG血症和肥胖增加NAFLD的患病风险。     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.     

中西医结合治疗糖尿病足的临床观察

[目的]观察中西医结合治疗糖尿病足的临床疗效。[方法]将32例糖尿病足患者随机分为治疗组16例和对照组16例。两组患者均给予相同的基础治疗、营养神经、抗凝、扩张血管、改善微循环、外治法治疗,治疗组在此基础上加用中医辨证施治。[结果]治疗组显效9例,有效6例,无效1例,总有效率93.7%;对照组显效5例,有效7例,无效4例,总有效率75%;两组比较,差异有显著性(χ2=15.8,P<0.05)。治疗组溃疡大小、新鲜创面肉芽例数与对照组比较,差异有显著性(P<0.05)。两组治疗后空腹血糖,餐后2h血糖均有改善,与治疗前比较,差异有显著性(P<0.05)。[结论]中西医结合治疗糖尿病足的疗效比单用西药治疗为好。     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.     

CT引导下组织间植入125Ⅰ放射粒子结合中药治疗脊柱转移瘤的临床应用体会

目的:介绍CT引导下组织间植入125I放射粒子结合中药治疗脊柱转移瘤的技术方法并评价具体临床价值.方法:12例脊柱转移瘤患者,均在CT引导下进行肿瘤内125I粒子植入术.使用的设备为东软公司生产的双排螺旋CT-Neuviz Dual,采用珠海和佳公司生产的TPS计划系统及穿刺针,中科院生产的125I粒子.首先根据肿瘤的大小,利用放射性粒子治疗计划系统计算出治疗肿瘤所需要125I的最佳数量,然后经CT导向下经皮穿刺将125I粒子均匀植入到肿瘤内进行组织间放疗、并配以中医中药.结果:所有病人术后1个月、2个月、3个月内分别进行CT检查随访.结论:CT引导下组织间植入125I放射粒子结合中药治疗是一种治疗脊柱转移瘤安全可靠、疗效显著的治疗方法.     

处女膜闭锁超声显像分析

1资料与方法46例患者年龄12～21岁。青春期后无月经来潮,并逐渐加重的周期性下腹痛,有时下腹部可触及到包块。应用美国产APR4O00Sth实时超声显像仪及挪威威曼CFM－725型彩色多普勒超声,患者采取仰卧位,行盆腔扫查,必要时行全腹扫查。2结果1型即阴道积血型23例（61％）行纵切面超声显像,阴道扩张显著,内为无回声或液性粘稠液体,内含密集的强回声光点,可见到薄而均匀的阴道壁。11型即阴道子宫积血型12例（25％）。如阴道积血继续积存,使子宫增大,因子宫壁较厚,扩张程度不如阴道,经实时超声静片刻有时可见到子宫收缩与舒张以…     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.     

不同糖代谢人群血尿酸、血脂及胰岛素抵抗相关性研究

Objective To study the levels of senlm uric acid(UA)in normal glucose(NC),impaired glucose regulation(IGR)and type 2 diabetes mellitus(T2DM),and investigate its relationship with insulin resistance and dyslipidemia.Method The levels of blood glucose,lipids,fasting insulin(HNS)and serum UA were measured in patients of 45 T2DM(T2DM group),20 IGR(IGR group)and 29 NC(NC group).Status of insulin resistance and insulin secretion function was evaluated by HOMA-IR and ISI.Results The levels of triglyceride(TG)and UA in T2DM group and IGR group were significantly higher than those in NC group[(3.34±8.77),(1.85±0.67),(1.26±0.38)mmoi/L and(316.71±96.20),(403.62±76.80),(325.45±94.43)mmol/L](P<0.01).HDL-C levels in T2DM group were significantly lower than those in IGR and NC group[(1.05±0.30),(1.07±0.21),(1.12±0.20)mmol/L](P<0.01).NO significant difference of FINS levels was found in the three groups.HOMA-IR level in T2DM and IGR group was higher than that in NC group(3.84,3.77,2.34)(P<0.01).ISI in T2DM and IGR group was lower than that in NC group(-4.52±0.79,-4.44±0.19,-4.03±0.58)(P<0.01).Correlation analysis indicated that the level of UA was positively related with BMI.TG and negatively related with HDL-C.Conclusion Increased UA in IGR indicates that hyperurieacidemia developes before DM.     

健康体检人群糖尿病发病风险的评估方法

目的建立适合健康体检个体糖尿病发病风险的评估方法。方法结合国内外的研究结果分析近年糖尿病发病率资料及发病风险因素,得出我国成年人糖尿病发病的主要风险因素,将目标人群随机分为两组队列,队列1用于危险因素评分方法的建立,采用非条件logistic回归分析筛选糖尿病的危险因素,根据危险因素的回归系数确定不同变量的积分值,以累计积分值的大小判断个体患病的危险性,并以队列2的资料验证该方法进行人群筛检的价值。结果研究结果表明男性与女性分别当积分值为65．0与65．5时,约登指数最大,故将65．0与65．5作为判别不同性别发生糖尿病风险的阈值,其筛检的灵敏度分别为90．6％与83．3％,特异度分别为89．4％与97．7％,阳性预测值分别为58．8％与80．0％,阴性预测值为98．3％与98．2％。曲线下面积分别为0．955与0．899,危险因素评分法用于筛查糖尿病,差异有统计学意义（P=0．000）。结论该方法简易经济,可操作性强,有望成为健康体检机构筛查人群糖尿病发病的高危人群的实用、有效的方法。     

体脂肪率在代谢综合征诊断中的应用

目的：探讨不同性别个体体脂肪率（BF%）与代谢综合征（MS）之间的关系,阐明BF%是不同性别体检者MS的判定因素之一。方法：选择健康体检者904人,其中男性554人,女性350人。检测其BF%、体质量指数（BMI）、腰臀比（WHR）、收缩压（SBP）、舒张压(DBP)、空腹血糖（FBG）和血脂（BL）等指标,分析不同性别体检者各代谢指标差异;采用Spearman相关分析方法分析不同性别体检者各代谢指标与BF%的相关性;采用Logistic回归分析方法分析不同性别体检者BF%与MS的发病风险;采用受试者工作特征（ROC）曲线分析不同性别体检者BF%判定MS的可靠性和适宜切点。结果：男性体检者SBP、DBP、FPG、BMI和WHR水平高于女性(P<0.05)。男性体检者BF%低于女性(P<0.05);男性和女性BF%分别与SBP(r=0.27,r=0.41)、DBD(r=0.27,r=0.34)、FBG(r=0.18,r=0.37)、总胆固醇（TC）(r=0.19,r=0.31)、甘油三酯（TG）(r=0.42,r=0.47)和低密度脂蛋白-胆固醇(LDL-C)(r=0.17,r=0.33)水平均呈显著正相关关系,与高密度脂蛋-胆固醇（HDL-C）水平呈显著负相关关系（r=－0.28,r=－0.30）。在调整MS相关因素后,BF%仍为MS的独立危险因素（OR=1.090,95%CI 1.044~1.137）,男性BF%异常升高发生MS的风险是BF%正常者的1.086倍（95%CI ：1.030~1.144）,女性BF%异常升高发生MS的风险是BF%正常者的1.107倍（95%CI 1.02
7~1.192）。男性BF%诊断MS的ROC曲线下面积为0.710 （95%CI 0.665~0.754）,BF%在29.050%为最佳切点值;女性BF%诊断MS的ROC曲线下面积为0.811（95%CI：0.749~0.873）,BF%在38.550%为最佳切点值。结论：不同性别个体的BF%是MS的危险因素,对MS的发生具有预测价值。