危重症应激性高血糖患者炎症反应与胰岛素组分关系的研究

目的 研究应激性高血糖(SHG)患者炎症反应与胰岛素组分的关系,探讨炎症反应对胰岛素抵抗及胰岛β细胞分泌功能的影响.方法 选择SHG患者45例,根据其临床炎症反应状态分为应激期和应激消除期,并选择25例健康体检者作为对照;分别测定血中肿瘤坏死因子-α(TNF-α)、血糖、胰岛素组分[包括胰岛素原(PI)、免疫反应性胰岛素(IRI)、真胰岛素(TI)、C-肽(C-P)]浓度及功能指标[包括胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]水平,比较组间血糖、TNF-α、胰岛素组分及功能指标,并进行TNF-α与血糖、胰岛素组分及功能指标的相关性分析.结果 ①SHG应激期、应激消除期及健康对照组TI水平比较差异无统计学意义[3.68(1.57,7.70)、3.42(2.41,7.40)、1.46(0.35,4.90)mU/L,均P＞0.05],应激期血糖[(10.04±2.43)mmol/L]、TNF-α[13.70(11.77,20.00)ng/L]、PI[6.20(3.22,9.27)pmol/L]、IRI[13.45(9.88,19.88)mU/L]及C-P[3.01(2.37,4.00)μg/L]水平均明显高于应激消除期[血糖:(6.09±0.84)mmol/L,TNF-α:11.58(8.80,13.22)ng/L,PI:1.54(0.36,11.82)pmol/L,IRI:10.80(5.35,12.60)mU/L,C-P:2.42(1.17,3.56)μg/L]和健康对照组[血糖:(4.87±0.56)mmol/L,TNF-α:9.27(7.48,12.16)ng/L,PI:2.20(1.88,4.54)pmol/L,IRI:5.50(4.00,8.00)mU/L,C-P:1.15(0.87,1.76)μg/L,P＜0.05或P＜0.01].②SHG应激期HOMA-IR[5.17(3.41,11.51)]明显高于应激消除期[3.24(1.51,6.95)]及健康对照组[1.14(0.81,1.79),P＜0.05和P＜0.01];应激期HOMA-β[10.80(3.72,31.40)]明显低于应激消除期[28.42(6.46,125.01)]及健康对照组[21.94(7.77,62.01),P＜0.01和P＜0.05].③SHG患者TNF-α与PI、IRI、C-P及HOMA-IR呈正相关(r1=0.292,r2=0.344,r3=0.397,r4=0.324,P＜0.05或P＜0.01);与HOMA-β呈负相关(r=-0.235,P＜0.05).结论 危重症SHG患者炎症反应越重,胰岛素组分PI、IRI、C-P升高越明显,而TI相对分泌不足;炎症反应可影响危重症SHG患者胰岛素抵抗和胰岛β细胞分泌功能.

Abstract：

Objective To observe the relationship between inflammatory response and the constituents of islet β cell secretion during stress hyperglycemia(SHG)in critically ill patients, in order to study the impact of inflammatory response on insulin resistance and the secretion function of islet β cells.Methods According to the state of inflammatory response, 45 critical patients with SHG were divided into two groups: stress and the convalescence period. Twenty-five healthy individuals were enrolled as control group. The blood levels of tumour necrosis factor-α(TNF-α), blood glucose(BG), and insulin components including proinsulin(PI), immunoreactive insulin(IRI), true insulin(TI), C-peptide(C-P)were measured respectively. The levels of BG, TNF-α, insulin components, insulin resistance index (HOMA-IR) and the secretion index(HOMA-β)were compared among groups. The relationship between TNF-α and BG, insulin components, HOMA-IR, HOMA-β were analyzed. Results ①There was no difference in concentrations of TI among stress period, convalescence stage and control group[3.68(1.57, 7. 70), 3. 42(2.41, 7.40),1.46(0. 35, 4.90)mU/L, all P＞0. 05], whereas the concentration of BG[(10. 04 ± 2. 43)mmol/L],TNF-α[13. 70(11.77, 20.00)ng/L], PI[6. 20(3. 22, 9.27)pmol/L], IRI[13.45(9. 88, 19. 88)mU/L]and C-P[3. 01(2. 37, 4. 00)μg/L]in stress period were significantly higher than those in the convalescence stage[BG:(6. 09±0. 84)mmol/L, TNF-α: 11.58(8. 80, 13. 22)ng/L, PI: 1.54(0. 36, 11.82)pmol/L,IRI: 10.80(5.35, 12.60)mU/L, C-P: 2.42(1.17, 3.56)μg/L]and control group[BG:(4.87±0.56)mmol/L,TNF-α: 9.27(7.48, 12.16)ng/L, PI: 2.20(1.88, 4.54)pmol/L, IRI: 5.50(4.00,8.00)mU/L, C-P: 1.15(0.87, 1.76)μg/L, P＜0.05 or P＜0.01]. ②The HOMA-IR[5.17(3.41,11.51)]in stress period was significantly higher than that in the convalescence[3.24(1.51, 6. 95)]and control group[l. 14(0. 81, 1.79), P＜0. 05 and P＜0. 01]. The HOMA-β[10. 80(3. 72, 31.40)]of islet βcell in stress period was significantly lower than that in the convalescence[28.42(6. 46, 125.01)]and control group[21.94(7. 77, 62. 01), P＜0. 01 and P＜0. 05]. ③There were positive correlations between the concentration of TNF-α and PI, IRI, C-P and HOMA-IR(r1 = 0. 292, r2 = 0. 344, r3 = 0. 397, r4 = 0. 324,P＜ 0. 05 or P ＜ 0. 01). There were negative correlation between concentration of TNF-α and HOMA-β(r=-0. 235, P＜0. 05). Conclusion The severer the inflammatory response, the higher PI, IRI and C-P,while the secretion of TI is relatively deficient. Inflammatory response could affect insulin resistance and the secretion function of islet β cell during SHG in critically ill patients.     

白细胞介素-10和肿瘤坏死因子-α与高血压肾损害的相关性研究

目的 探讨肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)在高血压肾损害患者中的变化及其相关性.方法 将73例原发性高血压患者(原发性高血压组)根据其尿蛋白排泄率不同又分为2个亚组:单纯高血压组37例,高血压肾损害组36例;采用放射免疫法检测血清TNF-α、IL-10浓度.同期选择30名健康体检者作为正常对照组.结果 原发性高血压组TNF-α高于正常对照组[(2.91±0.94)μg/L与(0.98±0.35)μg/L,P＜0.01],其中高血压肾损害组TNF-α高于单纯高血压组[(3.75±0.88)μg/L与(1.87±0.58)μg/L,P＜0.01].原发性高血压组IL-10低于正常对照组[(19.2±5.8)μg/L与(28.6±5.7)μg/L,P＜0.01],其中高血压肾损害组IL-10又低于单纯高血压组[(15.4±4.3)μg/L与(22.5±5.9)μg/L,P＜0.01].原发性高血压组TNF-α、IL-10与尿蛋白排泄率有相关性(r=0.703,P＜0.001 ;r=-0.613,P＜0.001),而与血压水平无相关性.结论 高血压肾损害患者TNF-α升高,IL-10水平降低,细胞因子系统的失衡可能参与了高血压肾损害的进展.

Abstract：

Objective To investigate the changes of the serum levels of necrosis alpha (TNF-o)and interleukin 10( IL-10 )in patients with hypertensive renal damage,and to study the correlation of TNF-α and IL-10 with the hypertensive renal damage. Methods Seventy three patients with primary hypertension were divided into two groups according to their urinary albumin excretion rate(UAER): simple hypertensive group( n = 37 ),hypertensive renal damage group(n =36). TNF-α and IL-10 were measured using radioimmune assay. Thirty normotensive healthy persons were selected as normotensive control group. Results TNF-α were significantly higher and IL-10 significantly lower in patients with essential hypertension than those in normotensive control group(TNF-α: [2.91 ±0.94]μg/L vs [0.98 ±0.35]μg/L,P＜0. 05;IL-10:[ 19.2 ±5.8]μg/L vs [28.6±5. 7] μg/L,P ＜0. 01 ) ,and in patients with hypertension,those with renal damage had higher TNF-α and lower IL-10 than those without( TNF-α: [ 3.75 ± 0. 88 ] μg/L vs [ 1.87 ± 0. 58 ] μg/L, P ＜ 0. 01; IL-10: [ 15. 4 ± 4. 3 ]μg/L vs [ 22. 5 ± 5.9 ] μg/L, P ＜ 0. 01 ), with statistically significant difference between groups ( P ＜ 0. 01 ).TN F-α and IL- 10 were found to have correlations with UAER ( r = 0. 703, P ＜ 0. 001; r = - 0. 613, P ＜ 0. 001 ),but no correlation with the level of blood pressure. Conclusion TNF-α increased and IL-10 decreased significantly in patients with hypertensive renal damage, which indicates that the imbalanced cytokine network may play a role in the pathological mechanisms of hypertensive renal damage.     

血小板活化与炎症反应在高血压患者中的改变及其相关性研究

目的 探讨高血压患者血小板活化与炎症反应的改变及其相关性.方法 选择61例原发性高血压患者(高血压组)和64例阵发性室上性心动过速患者(对照组),测定其血清超敏C-反应蛋白(hs-CRP)及平均血小板体积.结果 高血压组患者血清hs-CRP浓度[(3.51±1.95)mg/L]明显高于对照组[(1.15±0.77)mg/L],差异有统计学意义(P＜0.05),平均血小板体积大于对照组[分别为(11.19±2.18)fl与(9.20±2.31)fl],差异有统计学意义(P＜0.05),两者之间呈线性相关(r=0.452,P=0.003).结论 高血压患者存在炎症反应及血小板活化,作为炎症反应及血小板活化的两个观察指标,两者相互作用具有相关性,与高血压的发生发展有密切关系.

Abstract：

Objective To investigate the changes and correlation between platelet activation and inflammatory response in patients with essential hypertension(EH). Methods Sixty-one patients with essential hypertension and sixty-four patients with paroxysmal supraventricular tachycardia as control group were enrolled in the study. The levels of high sensitivity C reactive protein ( hs-CRP ) and mean platelet volume ( MPV ) were measured and compared between the control group and the essential hypertension group. Results Compared with the control group,the levels of hs-CRP and MPV in the EH group were significantly higher( [3.51 ± 1.95]mg/L vs [ 1.15 ± 0. 77 ] mg/L, P ＜ 0. 05 ). The MPV in the EH group was significantly higher than that in the control group ( [ 11.29 ± 2. 18 ] flvs [ 9. 20 ± 2. 31 ] fl, P ＜ 0. 05 ). The level of hs-CRP positively correlated to the level of M PV (r = 0. 452, P = 0. 003 ). Conlusions There were inflammatory response and platelet activation in patients with EH and the serum levels of hs-CRP and MPV is correlated with the development of essential hypertension.     

氟伐他汀及缬沙坦对糖尿病肾病相关炎症因子的影响

目的 比较氟伐他汀及缬沙坦对2型糖尿病早期肾病相关炎症因子的影响及对糖尿病肾病的保护作用.方法 2型糖尿病早期肾病共90例,其中常规降糖治疗组作为对照组(DN1组),在常规降糖治疗基础上加用缬沙坦作为缬沙坦组(DN2组),在常规降糖治疗基础上加用氟伐他汀作为氟伐他汀组(DN3组).分别测定各组患者治疗前后的血糖、血脂、血肌酐(SCr)、C反应蛋白(CRP)、24 h尿蛋白定量、尿白蛋白排泄率(UAER)及数种炎症因子.结果 (1)干预前3组的血清CRP、转化生长因子-β1(TGF-β1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)浓度差异无统计学意义.DN2组治疗后与治疗前相比,IL-6[(15.99±2.87)ng/L与(17.64±2.91)ng/L,t=-3.091,P<0.01]、TNF-α[(48.72±14.62)ng/L与(52.56±17.02)ng/L,t=-2.131,P<0.05]、TGF-β1[(33.54±10.69)μg/L与(40.11±12.08)μg/L,t=-2.921,P<0.01]、IL-18[(139.65±66.37)ng/L与(158.74±74.20)μg/L,t=-2.053,P<0.05]、CRP[(5.12±3.54)mg/L与(6.08±3.39)mg/L,t=-2.072,P<0.05]均明显降低;DN3组治疗后与治疗前相比,IL-6[(15.39±2.77)ng/L与(16.49±2.81)ng/L,t=-2.071,P<0.05]、TNF-α[(45.89 ±16.22)ng/L与(53.04 ±17.02)ng/L,t=-3.651,P<0.01]、TGF-β1[(31.19±10.48)μg/L与(37.11±11.76)μg/L,t=-2.963,P<0.01]、IL-18[(141.54±66.65)ng/L与(158.01±73.23)ng/L,t=-2.182,P<0.05]、CRP[(4.94±3.61)mg/L与(5.86±3.46)mg/L,t=-2.110,P<0.05]亦均明显降低.DN2、DN3组治疗后的炎症因子含量差异无统计学意义(P>0.05).(2)在DN2、DN3组治疗前后血压均无差异情况下,DN2组治疗后与治疗前比较,UAER[(63.1±31.7)μg/min与(82.9±40.0)μg/min,t=-2.145,P<0.05]、24 h尿蛋白定量[(0.14±0.11)g/24 h与(0.18±0.15)g/24 h,t=-2.438,P<0.05]、尿微量白蛋白/肌酐(ALb/Cr)[(114.7±68.1)mg/g与(162.0 ±83.8)mg/g,t=-2.399,P<0.05]均明显降低,DN3组治疗后与治疗前比较,UAER[(65.5±32.6)μg/min与(83.5±42.1)μg/min,t=-2.131,P<0.05]、24 h尿蛋白定量[(0.15±0.12)g/24 h与(0.18±0.13)g/24h,t=-2.611,P<0.05]、尿ALb/Cr[(119.1±78.2)mg/g与(160.0±82.3)mg/g,t=-2.213,P<0.05]亦均明显降低,但2组治疗后结果 比较差异均无统计学意义(P均>0.05).结论 2型糖尿病肾病患者用缬沙坦、氟伐他汀均能降低尿蛋白,降低相关血清炎症因子含量,提示对肾功能具有保护作用.

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Objective To compare the effects of fluvastatin and valsartan on the inflammatory cytokines in the early stage of type 2 diabetic nephropathy and their protective effects on to diabetic nephropathy. Methods Ninety patients with early stage of type 2 diabetic nephropathy were divided into three groups, 30 patients receiving routine hypoglycemic agents (DN1) as control,30 patients receiving routine hypoglycemic agents plus valsartan (DN2) and the other 30 receiving routine hypoglycemic agents plus fluvastatin (DN3). Blood glucose, blood lipid,serum creatinine and C reactive protein(CRP),24-hour urine protein,urinary albumin excretion rate (UAER) and several inflammatory cytokine were measured before and after treatment. Results ( 1 ) No significant difference of the levels of serum CRP,TGF-β1,IL-6,TNF-α, IL-18 at the baseline were observedamong these three groups.In the DN2 group,after treatment,IL.6 was([15.99±2.87]ng/L and[17.64±2. 131 ,P <0. 05) ,TGF-β1 was ( [33.54 ±10. 69] μg/L and [40. 11 ± 12. 08] μg/L,t = -2. 921 ,P <0. 01 ),IL-18 was ( [139.65±66. 37] ng/L and [158.74±74. 20]ng/L,t = -2.053,P <0. 05),CRP was ( [5. 12±3. 54] mg/L and [6. 08 ±3. 39] mg/L, t = - 2. 072, P < 0. 05 ) after and before treatment, respectively. All abovemented indices significantly decreased after treatment. In the DN3 group, IL-6 was ( [15. 39 ±2. 77] ng/L ng/L,t = -3. 651 ,P <0. 01 ) ,TGF-β1 was ( [31.19 ±10. 48] μg/L and [37. 11± 11.76] μg/L,t = -2. 963,P<0.01),IL-18 was ([141.54 ±66.65] ng/L and [158.01±73.23] ng/L,t = -2. 182,P <0.05),CRP respectively. All abovemented indices significantly decreased after treatment No significant difference was observed on inflamaory factors after treatment between the DN2 and DN3 group ( P > 0. 05). (2) In the subgroup that there was no difference in blood pressure between before and after treatment in both the DN2 and DN3 group,in the DN3 group,UAER was ([63. 1 ±31.7] μg/min and[82.9±40.0] μg/min,t = -2. 145,P <0. 05) ,24 h total urokinase protein was ( [0. 14 ±0. 11] g/24 h and [0. 18±O. 15] g/24 h, t = - 2. 438, P <0. 05 ), microalbuminuria/urine creatinine was ( [ALb/Cr] [114. 7±68. 1] mg/g and [162.0±83.8] mg/g,t = - 2. 399, P < 0. 05 ) after and before treatment. All abovemention indices significantly decreased after treatment. In the DN3 group, UAER was ( [65.5 ±32. 6]μg/min and [83.5 ±42. 1]μg/min,t = - 2. 131, P <0. 05 ),24 h total urine protein was ( [0. 14 ±0. 11] g/24 h and [0. 18±0. 15] g/24 h, t = - 2. 438, P < 0. 05 ),0. 05 ) after and before treatment. All abovemention indices significantly decreased after treatment. No significant difference was observed after treatment between the DN2 and ON3 group ( P > 0. 05 ). Conclusion Both valsartan and fluvastatin are able to protect the renal function of patients with type 2 diabetic nephropathy by decreasing the levels of urine proteins and correlated serum inflammatory cytokines.     

妊娠期高血压疾病对新生儿血脂的影响

目的 探讨妊娠期高血压疾病(PIH)对新生儿血脂的影响.方法 PIH母儿80例,按第6版妇产科学PIH诊断标准分为3组:妊娠期高血压疾病组30例、子痫前期轻度组30例、子痫前期重度组20例,另设同期正常对照组40名,采用全自动生化分析仪测定脐血甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、ApoA及脂蛋白(LPA).结果 (1)妊娠期高血压疾病组、子痫前期轻度组、子痫前期重度组、正常对照组新生儿脐血TG的浓度分别为(0.25±0.10)、(0.33±0.09)、(0.39±0.06)、(0.23±0.07)mmol/L,妊娠期高血压疾病各组TG水平均高于正常对照组,且随母亲妊娠期高血压程度的加重呈进行性的升高,组间比较差异有统计学意义(F=2.765,P<0.05).(2)妊娠期高血压疾病组、子痫前期轻度组、子痫前期重度组、正常对照组新生儿脐血HDL-C的浓度分别为(0.61±0.23)、(0.54±0.25)、(0.47±0.15)、(0.65±0.14)mmol/L;ApoA的浓度分别为(0.63±0.24)、(0.59±0.16)、(0.53 ±0.21)、(0.69±0.12)g/L,妊娠期高血压疾病各组新生儿脐血HDL-C、ApoA均低于正常对照组,且随母亲妊娠期高血压程度的加重呈进行性的降低,组间比较差异有统计学意义(F=2.783,P<0.05;F=2.831,JP<0.05).(3)妊娠期高血压疾病组、子痫前期轻度组、子痫前期重度组、正常对照组新生儿脐血TC的浓度分别为(1.41±0.37)、(1.51±0.45)、(1.56±0.56)、(1.36±0.41)mmol/L;LDL-C的浓度分别为(0.79 ±0.26)、(0.80 ±0.18)、(0.82±0.30)、(0.74±0.18)mmol/L,妊娠期高血压疾病各组新生儿脐血TC、LDL-C均高于正常对照组,且随母亲妊娠期高血压程度的加重呈进行性升高,组间比较差异无统计学意义(F=0.695,P>0.05;F=0.483,P>0.05).(4)子痫前期轻度组、子痫前期重度组新生儿脐血LPA分别为(24.50±12.01)g/L与(22.68±9.50)g/L,低于正常对照组(25.70±11.90)g/L,妊娠期高血压组新生儿脐血LPA(33.46±20.10)g/L高于正常对照组,且妊娠期高血压疾病各组新生儿脐血LPA随母亲妊娠期高血压疾病程度的加重呈进行性降低,但组间比较差异无统计学意义(F=1.480,P>0.05).结论 妊娠期高血压疾病时官内的不良环境使胎儿脂代谢发生改变,且随母亲妊娠期高血压程度的加重,这种改变越重,推测妊娠期高血压组母儿以后可能发生冠心病、动脉粥样硬化与脂代谢相关性疾病的危险性较正常对照组有可能增加.

Abstract：

Objective To investigate the effect of pregnancy-induced hypertension (PIH) syndrome on the blood lipid level of neonate. Methods Eighty neonates, whose mother had PIH, were enrolled and divided into three groups according to the 6th version of diagnostic standard from published Obstetrics and Gynecology:gestational hypertension group (PIH group 1 ,n = 30) ,mild pre-eclampsia group (PIH group 2,n =30),serious pre-eclampsia group (PIH group 3,n =20) ,and 40 infants with healthy mother were enrolled as normal control group. The blood lipid was measured by automatic biochemical analyzer. Results (1) The TG levels of the cord blood were (0.28±0. 10)mmol/L in PIH group 1,(0.33 ±0.09)mmol/L in PIH group 2,(0.39 ±0.06) mmol/L in PIH group 3,and (0. 23 ±0. 07)mmol/L in normal control respectively. TG levels were significantly higher in PIH groups compared to normal control,and the TG concentration increased gradually with the mothers' gestational hypertension (F = 2. 765, Ps <0. 05). (2)The HDL-C levels of the cord blood were (0. 61 ±0. 23) mmol/L in PIH group 1, (0. 54 ± 0. 25) mmol/L in PIH group 2, (0.47 ± 0. 15) mmol/L in PIH group 3, (0. 65 ±0. 14) mmol/L in the normal contral respectively;and the ApoA levels of the cord blood were (0. 63 ±0.24)g/L in PIH group 1 ,(0. 59 ±0. 16)g/L in PIH group 2, (0.53 ±0.21)g/L in PIH group 3,(0.69 ±0. 12)g/L in the normal contral respectively. Both index were significantly higher in PIH groups compared to normal control, and the concentrations decreased gradually with the mothers' gestational hypertension (F=2.783,P<0.05;F=2.831,P<0.05). (3)The TC levels of the cord blood were (1.41 ± 0. 37) mmol/L in PIH group 1, (1. 51 ±0.45) mmol/L in PIH group 2, (1. 56 ±0. 56) mmol/L in PIH group3, (1. 36 ±0.41) mmol/L in the normal contral respectively;and the LDL-C levels of the cord blood were (0. 79 ±0. 26)mmol/L in PIH group 1,(0. 80 ±0. 18)mmol/L in PIH group 2,(0. 82 ±0. 30)mmol/L in PIH group 3,(0.74 ±0. 18) mmol/L in the normal contral respectively. The data showed that the cord blood TC and LDL-C levels of PIH were higher than normal control and increased gradually with the mothers'gestational hypertension, but they didn' treach the significant level (F = 0. 695,P>0. 05;F = 0. 483,P>0. 05). (4)The LPA levels of the cord blood were (24. 50 ± 12. 01) g/L in PIH group 2, (22. 68 ± 9. 50) g/L PIH group 3,which were lower than normal control (25.70 ±11.90) g/L, and the LPA levels of the cord blood were higher in PIH group 1(33.46 ± 20. 10)g/L,while the differences didn't reach significant level compared among four groups (F = 1.480,P> 0.05). Conclusion The unhealthy intrauterus condition of PIH lead abmoral fat metabolism in fetus, and itmight get worse along with the severity of the mother's gestational hypertension. We presumed that the neonates of PIH mothers would be more prone to have coronary heart disease,atherosclerosis and abnormal fat metabolism related disease compared with newboms from normal control group.     

不同年龄段的正常糖耐量人群血糖值及其相关因素分析

目的 分析不同年龄段正常糖耐量(NGT)者血糖水平及相互关系.方法 选择上海市杨浦区部分街道流行病学调研2098例30岁以上居民,根据糖耐量(OGTT)检测中空腹血糖值(FPG)和2 h血糖值(2 hPG),诊断为NGT、糖耐量低减(IGT)、空腹血糖受损(IFG)、IGT合并IFG(IGT/IFG)、糖尿病(DM),将NGT者按年龄分成5组,观察各年龄组的血糖水平,用稳态模式分析胰岛β细胞功能指数(HBCI),并对其进行统计学分析.结果 在NGT中60～69年龄组FPG值(5.17±0.48)mmol/L、糖化血红蛋白(HbA1c)(6.01±0.62)%较50～59年龄组FPG值(5.09±0.44)mmol/L、HbA1c值(5.95±0.66)%高(t值分别为2.06、2.48,P均<0.05).60～69年龄组FIG值较40～49年龄组FPG值(5.01±0.47)mmol/L高(t=2.26,P<0.01),50～59年龄组FPG值较40～49年龄组高(t=2.48,P<0.01),5组按年龄从小至大比较,空腹胰岛素(FINS)值变化无明显规律;60岁以上HBCI较60岁以下的HBCI值下降,差异有统计学意义(F值为33.75,P<0.01).结论 NGT人群随着年龄的增长,FPG、HbAlc可能增高.

Abstract：

Objective To compare the glucose levels and associated factors among the normal glucose tolerance subjects with different age.Methods Totally a community-based population of 2098 residences aged above 30 years Were tested with OGTT,and classified into normal glucose tolerance group(NGT),impaired glucose tolerance group(IGT),impaired fasting glucose group(IFG),both IGT and IFG group(ICT/IFC),anddiabetes group(DM) according to fasting and 2 hours glucose level(2 hPG).The subjects in NGT group were further divided into 5 groups according to different ages.The levels of blood glucose and HBCI in different groups and subgroups were measured and analyzed statistically. Results For patients in NGT,the FPG([5.17.±0.48]mmol/L vs.[5.09±0.44]mmol/L,P<0.05)and HbA1c([6.01±0.62]%vs.[5.95±0.66]%.P<0.05)in group aged 60-69 Were higher than that in group aged 50-59.The FPG in group aged 60-69 was also higher than those in group aged 40-49([5.17±0.48]mmol/L vs.[5.00±0.47]mmol/L,P<0.01),and the FPG in group aged 50-59 Was also higher than those in group aged 40-49([5.09±0.44]mmol/L vs..[5.00±0.47]mmol/L,P<0.01).There was no correlation between age and FINS,while a tendency of decreasing HBCI could be observed along with increasing of age(F=33.75,P<0.05).Conclusion In NGT subjects,the FPG and HbA1 C inereased along with age.     

一种新的复合型野战创伤早期抗休克液的实验研究

目的 依据失血性休克发生的理论基础和长期的临床实践经验,配制一种新的"复合型战地抗休克液",并利用大鼠失血性休克模型进行评价.方法 建立大鼠失血性休克模型.以乳酸林格液和羟乙基淀粉的2∶1混合液(LH)作为对照组休克复苏液;以添加地塞米松和呋塞米的LH作为加药组休克复苏液;复苏4 h后取血和器官标本检测生化、肝功能指标和肺组织含水量,并观察组织病理学变化.结果 两组液体均可使失血性休克大鼠平均动脉压恢复到基础值.与对照组比较,加药组血生化指标均无明显差异,但大鼠复苏后肺组织湿/干重比值明显降低(4.56±0.14比4.88±0.29,P＜0.05),丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)水平显著下降[ALT:(73.02±41. 89)U/L比(193.85±104.49)U/L;AST:(199.06±108.70)U/L比(395.25±137.08)U/L,均P＜0.05],利尿作用明显[开始排尿时间:(76±20)min比(153±14)min;尿量:(9.6±5.2)ml比(1.5±2.2)ml,P＜0.01和P＜0.05],腹水量减少[(1.3±0.6)ml比(5.0±3.0)ml,P＜0.05].肝、肺和小肠组织病理学观察也显示加药组损伤轻于对照组.结论 本研究中设计的"复合型战地抗休克液"配方简单,用于大鼠失血性休克复苏可快速恢复并稳定血流动力学,同时可起到减轻组织水肿及肝、肺、小肠损伤的作用.

Abstract：

Objective To propose a resuscitation fluid with a new formula for resuscitation of shock in battlefield on the basis of pathogenesis of hemorrhagic shock and clinical experiences, and to evaluate its safety and effectiveness in a rat hemorrhagic shock model. Methods After hemorrhagic shock was (referred to as LH)was used for resuscitation in animals of control group; LH supplemented with dexamethasone and furosemide(referred to as LHDF)was used as resuscitation fluid for experimental group.After 4 hours of infusion, blood and major organs were obtained for serum biochemical tests, lung water content measurement and histopathological observation. Results The mean arterial pressure of rats of both control and experimental groups recovered rapidly after resuscitation. There was no significant difference in the parameters of serum biochemistry between control group and experimental group. The wet/dry weight ratio of lung tissue in experimental group was significantly lower than control group(4. 56±0. 14 vs. 4. 88±0. 29, P＜0. 05). The blood alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels in experimental group were also significantly lower than in control group[ALT:(73. 02±41.89)U/L vs.(193. 85 ± 104. 49)U/L; AST:(199.06 ± 108. 7)U/L vs.(395.25 ± 137.08)U/L, both P＜0. 05).Diuretic effect was obviously observed in experimental group than control group[time of start urination:(76±20)minutes vs.(153±14)minutes; urine volume:(9. 6±5. 2)ml vs.(1.5±2. 2)ml, P＜0. 01 and P＜0. 05], and the amount of ascitic fluid in experimental group was significantly lower than in control group [(1.3 ± 0. 6)ml vs.(5.0 ± 3.0)ml, P＜ 0. 05). Histopathological observation of the liver, lung and intestine also showed less pathological changes in experimental group than in control group. Conclusion The designed battlefield anti-shock fluid in this study has been shown to be effective in fluid resuscitation for hemorrhage shock in rats, with reduced tissue edema and less injury to the liver, lung and intestine.     

连续性静脉-静脉血液滤过治疗血液透析伴发顽固性高血压患者的临床研究

目的 探讨连续性静脉-静脉血液滤过(CVVH)治疗血液透析患者伴发顽固性高血压的短期临床疗效及其可能的机制.方法 选择2005年以来在我院进行血液透析伴发顽固性高血压患者34例作为治疗组,经过2～3次、每次8～10 h的CVVH治疗,观察其降压效果和治疗前后干体重、血浆甲状旁腺激素(PTH)、肾素(RA)及血管紧张素Ⅰ、Ⅱ(AT Ⅰ、ATⅡ)和醛固酮(Ald)水平的变化.另外选择同期血压控制良好的血液透析患者30例作为对照组.结果 (1)治疗组所有患者经过2～3次的CVVH治疗,血压均较治疗前有明显下降,显效率64.7%,有效率100.0%;(2)治疗组治疗前与对照组比较,血浆RA[分别为(1.10±0.25)、(0.78±0.26)μg(L·h)]、AT Ⅰ[分别为(0.89±0.21)、(0.52±0.14)μg/L]、ATⅡ[分别为(177.68±89.46)、(89.25±12.84)]ng/L、Ald[分别为(72.06±11.47)、(48.92±8.65)ng/L]和PTH[(306.81±69.37)、(248.76±134.62)ng/L]水平均明显升高(P均＜0.01);(3)治疗组CVVH治疗后与治疗前比较,血浆RA[分别为(0.76±0.17)、(1.10±0.25)μg/(L·h)]、AT Ⅰ[分别为(0.50±0.12)、(0.89±0.21)μg/L]、ATⅡ[分别为(87.13±14.22)、(177.68±89.46)ng/L]、Ald[分别为(46.01±9.86)、(72.06±11.47)ng/L]和PTH(186.53±32.93)、(306.81±69.37)ng/L]水平均明显下降(P均＜0.01);而对照组常规血液透析治疗前后上述指标无明显变化(P均＞0.05).结论 CVVH不失为治疗血液透析伴发顽固性高血压的一种有效方法,其降压效果可能与CVVH能有效清除患者体内多余水分以及降低血浆RA、AT Ⅰ、ATⅡ、Ald、PTH水平有关.

Abstract：

Objective To study the short-term clinical efficacy and its possible mechanism of refractory hypertension(RH) treated by continuous veno-venous hemofiltration (CVVH) in maintenance hemodialysis (MHD) patients. Methods Thirty-four MHD patients with RH treated with CVVH enrolled in the treatment group,all these patients were treatment of 2 -3 times,each time 8 - 10 hours. Thirty MHD patients with wellcontroled blood pressure were recruited as control. Changes of blood pressure, dry weight, plasma levels of parathyroid hormone (PTH), renin ( RA), angiotensin Ⅰ , Ⅱ ( AT Ⅰ , AT Ⅱ ), aldosterone ( Ald ) were observed before and after hemodialysis. Results In the treatment group,compared with pre-treatment, the blood pressure decreased significantly with an effective rate of 64.7% and efficient rate of 100. 0%. Before treatment, plasma RA was ([1.10 ±0.25] μg/(L · h)and [0:78 ±0.26] μg/(L · h),AT Ⅰ was [0.89 ±0.21] μg/L and [ 0. 52 ± 0. 14 ] μg/L, AT Ⅱ was [ 177.68 ± 89.46 ] ng/L and [ 89. 25 ± 12. 84 ] ng/L, Ald was [72. 06 ± 11.47 ]ng/L and [ 48.92 ± 8. 65 ] ng/L, PTH was [ 306. 81 ± 69. 37 ] ng/L and [ 248.76 ± 134. 62 ] ng/L in the treatment and control group respectively. All the measurements in the treatment group were significantly higher than those in the control group (P ＜ 0. 05 ). In the treatment group, compared to pre-treatment, plasma RA significantly decreased ( [ 1.10 ± 0. 25 ]μg/ ( L · h) vs [ 0. 76 ± 0. 17 ] μg/( L · h ), as well as AT Ⅰ ( [ 0. 89 ±0.21]μg/L vs [0.50 ±0.12] μg/L),ATⅡ([177.68±89.46]ng/L vs [ 87.13±14.22] ng/L),Ald ([72.06±11.47]ng/Lvs [ 46. 01± 9. 86 ] ng/L ) and PTH ( [ 306. 81 ±69.37]ng/L vs [ 186.53 ±32.93 ] ng/L) ( P ＜ 0. 05 ). However, there was no significant changes in the above mentioned measurements between before and after hemodialysis in the control group (P ＞ 0. 05). Conclusion CVVH may be an effective methods in the treatment of MHD patients with RH, and its antihypertensive mechanisms may be that CVVH can effectively remove the excess water in the body, and reduce plasma RA, AT Ⅰ , AT Ⅱ ,Ald and PTH levels.     

卡维地洛与美托洛尔治疗高原慢性充血性心力衰竭疗效的对比研究

目的 比较卡维地洛与美托洛尔治疗高原慢性心力衰竭(CHF)的疗效.方法 90例CHF患者随机分成3组:常规治疗组(20例)给予血管紧张素转化酶抑制剂、利尿剂、地高辛等常规心力衰竭治疗.美托洛尔组(34例)、卡维地洛组(36例)在上述治疗基础上分别给予美托洛尔50 mg,2次/d;卡维地洛25 mg,2次/d口服.随访半年,治疗前、后采用超声心动图测定患者心功能并进行疗效观察.结果 治疗后美托洛尔组、卡维地洛组左心室舒张末期内径(LVEDD)[分别为(57.3±6.5)、(57.2±6.9)mm]和左心室收缩末期内径(LVSED)[分别为(46.6±7.0)、(44.0±6.9)mm]显著低于常规治疗组[分别为(64.7±9.1)、(53.4±9.8)mm],左心室射血分数(LVEF)显著高于常规治疗组[分别为(47.5±8.1)%、(52.9±8.5)%、(42.8±9.2)%](P均＜0.05).卡维地洛组LVEF改善优于美托洛尔组(P＜0.05).死亡情况:常规治疗组4例,美托洛尔组1例,卡维地洛组无死亡.美托洛尔组、卡维地洛组病死率均明显低于常规治疗组(P均＜0.05).结论 美托洛尔、卡维地洛均可明显改善高原CHF患者心功能.卡维地洛疗效及耐受性略优于美托洛尔.

Abstract：

Objective To compare the effect of carvedilol and motoprolol on high altitude chronic congestive heart failure (CHF). Methods Ninety patients with high altitude chronic CHF were divided into three groups randomly:Twenty patients in the regular treatment group treated with angiotensin-converting enzyme inhibitor (ACEI) ,diuretics and digoxin; motoprolol (50 mg twice daily) was given in the motoprolol group( 34cases) additional to regular treatment; carvedilol (25 mg twice daily) was given in the carvedilol group(36cases ) additional to regular treatment. All the patients were followed up for six months and measured the changes of cardiac function by echocardiography. Results Left ventricular end-diastolic dimension (LVEDD) was ( 57. 3 ± 6. 5 ) mm and (57.2 ± 6. 9) mm in the carvedilol group and the motoprolol group respectively, and left ventricular end-systolic dimension (LVESD) was (46. 6 ± 7.0) mm and (44. 0 ± 6. 9 ) mm in the carvedilol group and the motoprolol group respectively, which were all significantly smaller than that in the regular treatment group ([64.7 ±9. 1]mm and [53.4 ±9.8]mm for LVEDD and LVESD,respectively) (Ps ＜0.05). Left ventricular ejection fraction (LVEF) in the carvedilol group and the motoprolol group ( [47.5 ± 8. 1] % and [52. 9 ±8.5] % ,respectively) was higher than that in regular treatment group( [42. 8 ±9. 2]% ) (Ps ＜0. 05).The improvement of LVEF in the carvedilol group was better than that in the motoprolol group (P ＜ 0. 05 ). One case died in the motoprolol group and no death in the carvedilol group,4 cases died in the regular treatment group,the mortality in the motoprolol group and the carvedilol group was significantly lower than that in the regular treatment group. Conclusion Carvedilol and motoprolol significantly improved cardiac function in high latitude CHF patients,and the effect of Carvedilol is slightly better than that of motoprolol.     

糖代谢对甲状腺功能的影响

目的 调查糖尿病前期(pre-DM)患者、新发2型糖尿病(T2DM)患者和健康人群血清甲状腺激素的变化,探讨糖代谢与甲状腺功能之间的关系.方法 随机入选门诊甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺素受体抗体(TRAb)及甲状腺彩超均正常的新发T2DM患者(T2DM组)、糖尿病前期患者(Pre-DM组)和健康体检者(正常对照组)各60例,检测甲状腺激素含量.T2DM患者还检测糖化血红蛋白(HbA1c)、空腹血糖(FPG)、糖化血清蛋白(GA).对比3组患者甲状腺激素水平的差异,并分析T2DM患者甲状腺激素的影响因素.结果 (1)甲状腺激素:pre-DM组与正常对照组比较差异无统计学意义(P均＞0.05).T2DM组三碘甲状腺原氨酸(T3)[(1.34±0.24)nmol/L]及游离三碘甲状腺原氨酸(FT3)[(3.88±0.51)pmol/L]较pre-DM组[(1.48±0.29)nmol/L、(4.12±0.55)pmol/L]和正常对照组[(1.49±0.26)nmol/L、(4.13±0.55)pmol/L]显著降低(T3:t值为-0.135和-0.145,P均＜0.01;FT3:t值为-0.240和-0.260,P＜0.05或P＜0.01).(2)T2DM组T3及FT3与FPG、GA、HbA1c呈线性负相关(T3:r值分别为-0.275、-0.318、-0.453,P均＜0.05;FT3:r值分别为-0.280、-0.291、-0.336,P均＜0.05).结论 糖代谢异常患者仅在糖代谢达到一定的紊乱程度后,才会引起甲状腺激素的异常改变,从而表现出T3及FT3与血糖指标的负相关性.

Abstract：

Objective To compare the serum thyroid hormones level in patients with pre-diabetes,newly diagnosed type 2 diabetes mellitus(T2DM)and healthy people,and to investigate the association of glucose metabolism with thyroid function.Methods Sixty newly diagnosed T2DM patients(T2DM group),60 pre-diabetes patients(pre-diabetes group),and 60 healthy people(healthy group) from outpatient departments were randomly enrolled in the study.Their thyroid peroxidase antibodies(TPOAb),thyroglobulin antibodies(TGAb),thyrotropin receptor antibodies(TRAb),and thyroid color dopplar ultrasound were all normal.Thyroid hormones was measured.Glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),glycated albumin(GA) was additionally measured in T2DM patients.We compared the difference of thyroid hormones among the 3 groups and investigated the factors that influence thyroid hormones level in each T2DM patients.Results There was no significant difference found on thyroid hormones level between the pre-diabetes group and healthy group(P＜0.05).T3 and FT3 level were(1.34±0.24)nmol/L and(3.88±0.51)pmol/L in the T2DM group,respectively,which were significantly lower than those in the pre-diabetes group([1.48±0.29]nmol/L and [4.12±0.55]pmol/L,t=-0.135 and -0.145,respectively,Ps＜0.01＝ and in the healthy group([1.49±0.26]nmol/L and [4.13±0.55]pmol/L,t=-0.240 and -0.260,respectively,P＜0.05 or 0.01) .In the T2DM group,T3 and FT3 were negatively correlated with FPG,GA,HbA1c(For T3:r=-0.275,-0.318 and -0.453,respectively,Ps＜0.05;For FT3:r=-0.280,-0.291 and -0.336 ,respectively,Ps＜0.05).Conclusion In patients with abnormal glucose metabolism, thyroid hormone was influenced only when the glucose metabolism level reached a certain abnormal degree.     

代谢综合征患者辛伐他汀联合依折麦布降血脂治疗的评价

目的通过辛伐他汀联合依折麦布对代谢综合征患者降血脂的对照研究,观察其调脂疗效、不良反应及心脑血管事件发生率。方法将120例代谢综合征的患者分成两组。实验组60例,予以常规剂量辛伐他汀20mg治疗基础上加用依折麦布10mg治疗;对照组60例,予以常规辛伐他汀20mg治疗,两者疗程均为4年。观察两组降脂的疗效,副作用及心脑血管事件发生情况,并进行对比研究。结果两组均能有效降低血脂,且治疗后实验组与对照组比较总胆固醇（TC）[（3．05±1．17）mmol／L与（4．94±1．13）mmol／L]、低密度脂蛋白胆固醇（LDL-C）[（2．12±1．03）与（3．16±1．11）mmol／L]、甘油三酯（TG）[（1．02±0．29）mmol／L与（1．65±0．32）mmol／L],差异均有统计学意义（P均〈0．05）。心血管事件实验组共发生3例,对照组10例;脑血管事件实验组发生5例,对照组13例。实验组心、脑血管事件发生均低于对照组（X2值分别为4．08、4．37,P均〈0．05）。结论辛伐他汀和依折麦布的联合治疗更显著降低代谢综合征患者血脂并减少心脑血管事件发生且不良反应无明显增加。     

肾康注射液联合厄贝沙坦治疗早期糖尿病肾病的临床观察

目的 观察肾康注射液联合厄贝沙坦对早期糖尿病肾病患者 24 h 尿白蛋白排泄率(UAER)、血脂及血流动力的影响.方法 将 150 例血压正常的早期糖尿病肾病患者随机分为 3 组,均给予糖尿病知识教育、饮食控制、适量运动及常规降糖治疗,使空腹血糖控制在 7.0 mmol/L以下,餐后 2 h 血糖在 10.0mmol/L以下.对照组给予口服降糖药、胰岛素等常规西医治疗;肾康注射液组在对照组的基础上加用肾康注射液 100 ml +5%葡萄糖注射液 250 ml 静脉滴注,同时加 2～3 U 胰岛素中和葡萄糖,每天 1 次;肾康注射液加厄贝沙坦组在肾康注射液组的基础上加用厄贝沙坦 0.15 g 口服,1 次/d;3 周为 1 疗程,观察 9 周.比较3 组患者治疗前后 UAER、血脂及血流动力学指标的变化.结果治疗 9 周后与治疗前比较,在降低患者UAER、降低血脂及改善患者血流动力方面,肾康注射液组[UAER:(87.44 ± 10.06)μg/min 与(116.55 ±33.42)μg/min、总胆固醇:(4.22 ± 0.70)mmol/L 与(4.88 ± 0.69)mmol/L、全血高切黏度:(5.77 ±0.53)mPa·s 与(7.38 ± 0.41)mPa·s]和肾康注射液加厄贝沙坦组[UAER:(61.90 ± 28.02)μ.g/min 与(123.37 ± 29.98)μg/min、总胆固醇:(4.00±0.14)mmol/L与(4.90±0.12)mmol/L、全血高切黏度:(5.11 ± 0.41)mPa·s 与(7.27 ± 0.44)mPa·s]疗效显著(P 均＜0.05),对照组改善情况不明显;且肾康注射液加厄贝沙坦组疗效明显优于肾康注射液组(P 均＜0.05).结论 肾康注射液可降低早期糖尿病肾病患者 UAER、降低血脂、改善血流动力,对早期糖尿病肾病具有治疗作用,与厄贝沙坦合用可能有协同作用.     

血浆脑钠肽在急性冠状动脉综合征中的意义

目的 研究脑钠肽(BNP)在急性冠状动脉综合征(ACS)中的临床意义.方法 选择2006年5月至2008年6月间我院住院的急性冠状动脉综合征患者151例,同期住院的高血压患者212例为对照组.均常规检测血脂、血糖、血常规、肾功能、超敏C-反应蛋白、脑钠肽(BNP);并记录患者血压、心率、吸烟史及高血压、糖尿病、高血脂等病史;同时检测常规心脏超声.结果 ACS组与对照组在年龄[(69.0±10.9)与(62.0±14.2)岁,t=5.043,P＜0.001]、血肌酐[(95.0±67.4)与(72.8 4-29.0) μmol/L,t=4.164,P＜0.001]、血尿酸[(360.2±104.4)与(300.8±92.7) μmol/L,t=5.521,P＜0.001]、BNP(80.81与352.38 ng/L,Z=-7.295,P＜0.001)、hs-CRP(7.99与17.08 mg/L,Z=-3.983,P＜0.001)、外周血[WBC(7.843±3.025)×109/L与(6.333±3.569)×109/L,t=4.209,P＜0.001]、单核细胞[(0.522±0.201)×109/L与(0.417±0.157)×109/L,t=5.084,P＜0.001]、血糖[(6.518±2.303)与(5.691±2.085)mmol/L,t=3.461,P=0.001]、收缩压[(134.7±27.8)与(142.0±26.3)mm Hg,t=2.536,P=0.012]等指标差异均有统计学意义.2组间吸烟比例[43.7%(66/151)和23.1%(49/212),X2=17.283,P＜0.001]、男性比例[74.8%(113/151)和48.6%(103/212),X2=25.217,P＜0.001]差异亦有统计学意义.经过多因素回归分析发现:年龄(X2=10.369,P=0.001)、性别(X2=12.836,P＜0.001)、BNP(X2=4.807,P=0.028)、WBC(X2=10.788,P=0.001)是造成2组间差异的主要原因.在ACS组,BNP与患者的左心室射血分数值之间存在线性关系(t=5.789,P＜0.001).结论 高龄、男性、外周血WBC和BNP与ACS存在密切关系,而BNP更对ACS患者的预后具有一定的预测价值.     

促红细胞生成素联合铁剂治疗慢性心力衰竭合并贫血患者的疗效观察

目的 探讨促红细胞生成素联合铁剂治疗慢性心力衰竭(CHF)合并贫血患者的疗效.方法 选择2007年1月至2009年12月我院连续住院治疗的CHF合并贫血患者96例,随机分为治疗组和对照组各48例,治疗组以常规抗心力衰竭治疗,加用促红细胞生成素及铁剂口服,对照组仅以常规抗心力衰竭治疗,随访6个月,比较2组治疗前后血红蛋白(Hb)水平、心功能分级、左心室射血分数(LVEF)、6 min步行距离、心力衰竭再入院率、心源性病死率等指标的变化.结果 治疗组患者与治疗前比较,Hb水平[(120.12±10.42)g/L与(86.40±14.30)g/L,t=-12.837,P＜0.01]、心功能分级(2.65±0.67与3.13±0.61,t=5.052,P＜0.01)、LVEF[(37.21±4.96)%与(33.92±7.28)%,t=-3.151,P＜0.01]、6 min步行距离[(443.52±97.39)m与(379.15±59.34)m,t=-4.262,P＜0.01]显著改善.随访6个月后,治疗组患者与对照组比较,Hb水平[(120.12±10.42)g/L与(85.60±11.22)g/L,t=16.083,P＜0.01]、心功能分级(2.65±0.67与2.98±0.81,t=-2.507,P＜0.05)、LVEF[(37.21±4.96)%与(34.67±4.10)%,t=-2.736,P＜0.01]、6 min步行距离[(443.52±97.39)m与(391.04±67.98)m,t=3.061,P＜0.01]显著优于对照组.心力衰竭再入院率显著下降(20.83%与39.58%,χ2=4.002,P＜0.05),但2组病死率差异无统计学意义(0%与4.17%,χ2=2.043,P＞0.05).结论 促红细胞生成素联合铁剂治疗CHF合并贫血可显著改善患者心功能指标,显著提高患者运动耐力,降低心力衰竭再住院率.

Abstract：

Objective To explore the therapeutic effect of erythropoietin (EPO)combined oral iron in patients with chronic congestive heart failure( CHF)accompanied by anemia. Methods Ninety six patients with CHF accompanied by anemia, whom were consecutively hospitalized from January 2007 to December 2009, were enrolled into this study. They were randomly divided into treatment group accepted routine anti-heart failure therapy combined EPO and oral iron, and control group solely accepted routine anti-heart failure therapy. After 6 months follow up, the changes of hemoglobin ( Hb ), cardiac function classification, left ventricular ejection fraction(LVEF) ,6-minute walking distance,readmission rate of CHF and cardiac death were compared between two groups. Results Compared with those before therapy, we found significant improvements of hemoglobin level ( [ 120. 12 ± 10. 42 ] g/L vs [ 86.40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2. 65 ± 0. 67 vs 3. 13 ±0. 61, P ＜ 0. 01 ), LVEF ( [ 37.21 ± 4. 96 ]％ vs [ 33. 92 ± 7. 28 ]％, P ＜ 0. 01 ), 6-minute walking distance ( [ 443.52 ± 97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in treatment group after EPO combined oral iron administration. After 6 months follow up, we also found significant improvements of Hb level ( [ 120. 12 ±10. 42 ] g/L vs [ 86. 40 ± 14. 30 ] g/L, P ＜ 0. 01 ), cardiac function classification ( 2.65 ± 0. 67 vs 2. 98 ± 0. 81,P＜0.01),LVEF([37.21 ± 4.96]％ vs [34.67 ±4.10]％,P ＜ 0. 01),6-minute walking distance ( [443.52 ±97. 39 ] mvs [ 379. 15 ± 59. 34 ] m, P ＜ 0. 01 ) in the comparison between treatment and control group. The readmission rate of CHF fell significantly in treatment group compared to control (20. 83％ vs 39. 58％ ,P ＜ 0. 05 ). However, we found no significant difference in cardiac death rate ( 0％ vs 4. 17％, P ＞0. 05). Conclusion Treatment of EPO combined oral iron could significantly improve the cardiac function,increase exercise tolerance,lower the readmission rate of CHF in patients with chronic congestive heart failure (CHF)accompanied by anemia.     

2型糖尿病肾病与同型半胱氨酸及血糖波动的相关性分析

目的分析糖尿病肾病与同型半胱氨酸及血糖波动的相关性,为糖尿病肾脏疾病的防治提供依据。方法测定154例2型糖尿病（T2DM）患者的糖化血红蛋白（HbAlc）、空腹血糖（FBG）、空腹C肽、同型半胱氨酸（Hey）、血脂、24h尿微量白蛋白定量（UAlb）,行动态血糖监测后测定血糖波动系数。根据UAlb将患者分为高UAlb组8l例和正常UAlb组73例,进行组间比较,并将UAlb与各种因素间进行多元逐步回归分析。结果高UAIb组与正常UAlb组比较,糖尿病病程[（9．68±7．31）年与（5．44±3．65）年,t=3．427]、HbAlc[（9．61±2．44）％与（8．69±2．35）％,t=2．162]、血糖波动系数（3．06±0．85与2．58±O．91,t=2．437）、低密度脂蛋白胆固醇（LDL—C）[（3．46±O．83）mmol／L与（3．01±0．84）mmol／L,t=2．596]、尿微量白蛋白[（129．64±118．50）mg／24h与（18．14±3．54）mg／24h,t=6．421]、血尿酸[（335．02±90．39）mmoL／L与（287．00±92．03）mmol／L,t=2．541]及同型半胱氨酸[（15．55±4．53）mmoL／L与（13．12±4．44）mmol／L,t=2．603]差异均有统计学意义（P〈0．05或P〈0．01）。经Pearson相关性分析,糖尿病病程、LDL—C、血尿酸、同型半胱氨酸及血糖波动系数与2型糖尿病患者尿微量白蛋白成正相关（r值分别为0．363、0．270、0．220、0．252、0．236;P值分别为0．000、0．008、0．033、0．014、0．022）,多元逐步回归分析显示UAlb与糖尿病病程、Hcy、血糖波动系数相关（β=0．344,P=0．000;β=0．244,P=0．011;β=0．229,P=0．012）。结论同型半胱氨酸与血糖波动是2型糖尿病肾病的危险因子,降低同型半胱氨酸浓度,减少患者血糖波动可作为预防2型糖尿病肾病的新途径。     

2型糖尿病患者血尿酸浓度与体脂情况的相关性分析

目的探讨2型糖尿病患者不同体脂情况与血尿酸浓度的相关性及其可能的影响因素。方法回顾分析532例住院2型糖尿病患者的体脂分布、血尿酸、血糖及肾功能等指标,对其血尿酸浓度与体脂分布进行单因素和多因素相关分析。结果在2型糖尿病患者中血尿酸浓度与体脂分布密切相关：（1）根据血尿酸浓度分组,高尿酸血症组的腰臀比、体质量指数、血尿素氮、血肌酐、甘油三酯明显高于正常尿酸组[分别为（0．94±0．07）与（0．91±0．07）,（26．91±3．90）kg／m^2与（23．84±3．80）k/m^2,（8．66±5．94）mmol／L与（6．29±3．64）mmol／L,（93．9±67．6）p,molfL与（63．9±20．6）μmol／L,（2．65±1．92）mmol／L与（1．86±1．46）mmol／L,P均〈0．05];而高密度脂蛋白胆固醇降低[分别为（1．09±O,32）mmol/L与（1．24±0．45）mmol／L,P〈0．05）。（2）多元回归分析结果显示血尿酸浓度与体质量指数、血肌酐、甘油三酯（b值分别为0．201、0．500、0．153,P〈0．05）呈正相关,与糖化血红蛋白、高密度脂蛋白胆固醇呈负相关（6值分别为-0．168、-0．121,P〈0．05）。结论在2型糖尿病患者中血尿酸浓度与体脂分布密切相关。对于2型糖尿病患者不仅要控制血糖,还应控制体质量,以降低糖尿病患者心脑血管疾病的发生率。