老年糖尿病并发症的临床分析

目的了解老年糖尿病并发症的发病情况及相关因素,为防治老年糖尿病并发症发生提供依据.方法对2010年1月~2011年11月收治的病历资料完整的老年糖尿病病人496例进行回顾性分析,其中男283例,女213例,年龄60~83岁,平均(71.3±10.4)岁,病程0.5年~19年,平均(8.2±3.6)年.结果老年糖尿病并发症以心血管疾病发生率最高,冠心病共发生214例,发生率为43.1%,并且老年糖尿病并发症中高血压病、冠心病及脑出血的发生率在患者体重肥胖、血脂异常及血糖控制不佳情况下显著高于患者在体重非肥胖、血脂正常及血糖控制良好情况下的发生率,糖尿病肾病、周围神经病变、视网膜病变及糖尿病足的发生率在患者血糖控制不佳及病程>10年情况下显著高于患者在血糖控制良好及病程≤10年情况下的发生率,脑梗塞的发生在患者血脂异常、血糖控制不佳情况下显著高于患者在血脂正常血糖控制良好情况下的发生率.结论对糖尿病人的体重、血脂、血糖及初次治疗时间采取积极控制可有效防治老年糖尿病并发症.     

老年糖尿病并发症的临床分析

目的探究老年糖尿病患者并发症的发生情况及一般特点。方法通过采集于2015年4月至2016年5月期间来我院就诊并接受治疗的462例糖尿病患者的病情资料并进行统计分析,总结归纳糖尿病患者并发症的发病情况及其一般特点。结果本次研究中的462名糖尿患者均有不同程度的并发症发生,这其中就包括有周围神经病变,心脑血管疾病,糖尿病肾病,视网膜病变以及糖尿病足等。在这其中,相比较其他糖尿病并发症而言心血管并发症的发病率明显较高,差异显著具有统计学意义(P0.05)。此外,对于血脂体重控制情况不良的患者,其心血管并发症的发病率要明显高于控制良好的患者(P0.05)。血糖控制不良的患者,其周围神经病变,视网膜病变,糖尿病足以及糖尿病肾病的发生率要明显高于血糖控制良好的患者(P0.05)。结论临床上糖尿病患者多种并发症的发生及并发症发展程度均与患者自身血糖血脂等因素相关紧密,因此合理的血糖血脂及体重的控制能够有效地改善防止糖尿病患者并发症的发生和发展。     

青海高原地区501例糖尿病患者慢性并发症调查分析

目的 了解青海高原地区501例住院糖尿病患者慢性并发症的发生情况。方法 调查1996～2000年住院糖尿病患者的一般情况、血糖状态、血压、血脂及慢性并发症的发生情况。并进行统计学处理。结果 高龄、病程长、超体重者发生糖尿病肾病、肾病、神经病变的危险性高；血糖、血脂、血压高者糖尿病肾病、周围神经病变、心脑血管病的发生率高。结论 年龄、病程、肥胖是糖尿病多种慢性并发症的独立或综合危险因素；严格控制血糖、血脂及血压可减少糖尿病慢性并发症的发生发展。     

青海高原地区501例糖尿病患者慢性并发症调节分析

目的：了解青海高原地区501例住院糖尿病患者慢性并发症的发生情况。方法：调查1996－2000年住院糖尿病患者的一般情况、血糖状态、血压、血脂及慢性并发症的发生情况。并进行统计学处理。结果：高龄、病程长、超体重者发生糖尿病肾病、肾病、神经病变的危险性高；血糖、血脂、血压高者糖尿病肾病、周围神经病变、心脑血管病的发生率高。结论：年龄、病程、肥胖是糖尿病多种慢性并发症的独立或综合危险因素；严格控制血糖、血脂及血压可减少糖尿病慢性并发症的发生发展。     

2型糖尿病早期视网膜神经厚度检测与并发症相关因素分析

目的基于病程分析常用临床指标与视网膜神经厚度的相关性,将有助于对糖尿病视网膜神经退行性病变患者进行早期发现和提前干预。方法回顾性收集因2型糖尿病住院且眼底视网膜情况符合无糖尿病视网膜病变(NDR)或非增殖糖尿病视网膜病变(NPDR)的92例患者的各项临床指标,依据病程<10年及病程≥10年分为两组,分析所有患者黄斑区视网膜神经纤维层(RNFL)、视网膜神经节细胞层(RGCL)、视网膜神经节细胞复合体(RGCC)厚度与常用基础临床指标［糖尿病肾病相关指标、血压、血脂、血糖、糖尿病周围神经病变(DPN)、糖尿病周围血管病变(PVD）］的相关性。结果DM病程≥10年患者中糖尿病视网膜病变（P=0.004）、糖尿病肾病（P=0.05）、糖尿病周围神经病变(P=0.038）、高血压（P=0.018）的患病率明显高于DM病程<10年者。DM病程<10年时,糖尿病肾病对视网膜神经厚度的影响主要表现为RNFL、RGCC厚度增加;而在DM病程≥10年者,血压（高压）升高同时伴随RNFL、RGCL、RGCC厚度变薄（P=0.006、P=0.005、P=0.004）,血压（低压）升高同时伴随RNFL、RGCL厚度变薄（P=0.011、P=0.023）,三酰甘油升高亦同时伴随RNFL、RGCL、RGCC厚度变薄（P=0.036、P=0.001、P=0.002）。结论以糖尿病为代表的慢性基础性疾病的长期存在,病程、血压、肾病、三酰甘油是导致患者视网膜神经厚度变薄的明显促进因素。     

怀化地区2型糖尿病慢性并发症临床特点分析

目的　分析怀化地区2型糖尿病（T2DM）住院患者糖尿病慢性并发症临床特点。方法　收集本科室住院1　033例2型糖尿病患者临床资料,登记其生活背景,以及实验室检查指标（血糖、血脂、胰岛素、24　h尿白蛋白）。根据国际临床分类法,眼底荧光造影,24　h尿白蛋白情况,神经肌电图,彩超检查,头部CT,心电图以及酶学诊断糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病大血管并发症,并进行对比分析。结果　就诊2型糖尿病患者女性年龄、糖尿病病程、高血压病史状况高于男性（P<0.05）,女性高血脂、吸烟、喝酒患者较男性少（P0.005,0.000,0.000）。女性糖尿病视网膜病变及糖尿病周围神经病变患病率明显高于男性（P0.000,0.000）;糖尿病肾病的患病率则以男性多见（P0.038）。大血管病变患病率没有性别差异。结论　怀化地区糖尿病慢性并发症与年龄、糖尿病病程、肥胖、吸烟、血糖控制、高血压、高血脂有密切的关系;糖尿病慢性并发症存在明显的性别差异。     

社区2型糖尿病慢性并发症患病状况分析

目的：研究2型糖尿病发生慢性并发症的危险因素。方法：分析向阳医院社区门诊、家床、住院2006～2008年189例2型糖尿病患者慢性并发症的患病情况及其与病程、年龄、体重指数、血糖、血脂、血压及代谢综合征的关系。结果：有慢性并发症患者的发病年龄、病程、血糖均明显高于无慢性并发症组,差异有显著性（P〈0.05,P〈0.001）,糖尿病视网膜病变组和糖尿病周围血管病变组的总胆固醇水平,较无慢性并发症组明显偏高;有DM慢性并发症组的高血压、脂代谢紊乱及代谢综合征均高于无并发症组。结论：有效控制糖尿病患者的血糖、血压、血脂和体重,是预防和延缓DM慢性并发症发生、发展的重要手段。     

2型糖尿病患者合并肾病的临床特点及发病率的影响因素

目的:探讨2型糖尿病患者合并肾病临床特点以及发病率的影响因素。方法:对296例2型糖尿病患者进行身体测量、实验室指标检验并统计分析。结果:糖尿病肾病组(DN组)病程比DM组长,DN组有糖尿病家族史患者的比例、合并视网膜病变及高血压的比例、体重指数(BMI)、收缩压、舒张压、血尿素氮(BUN)、尿酸(UA)及肌酐(SCr)均比DM组高,DN组糖化血红蛋白低于DM组,且两组间差异有统计学意义(P<0.05)。BMI<24,SBP<130 mm Hg(1 mm Hg=0.1333 k Pa)是2型糖尿病肾病的保护因素,有糖尿病家族史、DM病程>5年、伴糖尿病视网膜病变、高血压、脑梗死、冠状动脉粥样硬化、SCr高、BUN高、UA高等是影响2型糖尿病肾病发生发展的危险因素。结论:应对糖尿病家庭史以及病程较长的2型糖尿病患者进行定期监测,要以控制血糖、调节血脂、抗高血压、保护肾功能等综合治疗措施防止糖尿病肾病发生、发展。     

2型糖尿病合并亚甲减对微血管并发症的影响

目的 探讨亚临床甲状腺功能减退对2型糖尿病(T2DM)患者微血管并发症的影响.方法 根据是否合并亚临床甲状腺功能减退将入组的280例T2DM患者分为单纯T2DM组(228例)和糖尿病合并亚临床甲减(SCH)组(52例),并且根据不同促甲状腺激素(TSH)水平将SCH组分为两组,即SCH1组(4.2≤TSH≤10 μIU/ml,45例)和SCH2组(TSH≥10μIU/ml,7例),分析TSH水平与糖尿病肾病及视网膜病变的相关性.结果 SCH组总胆固醇、低密度脂蛋白、TSH水平高于DM组,SCH组DM肾病和视网膜病变的发生率显著高于DM组(P＜0.05),且SCH2组DM肾病和视网膜病变的发生率高于SCH1组(P＜0.05);Logistic回归分析结果显示亚临床甲状腺功能减退为T2DM患者糖尿病肾病及视网膜病变的危险因素.结论 T2DM合并亚临床甲减患者其糖尿病肾病及视网膜病变的发生率明显增高,且T2DM合并高水平TSH的患者发生糖尿病微血管并发症的风险更高,提示亚临床甲减是T2DM患者微血管病变独立的危险因素.     

2型糖尿病患者血清糖类抗原199水平与血糖控制及微血管并发症的关系

目的 分析2型糖尿病(T2DM)患者血清糖类抗原199 (CA199)水平与血糖控制及微血管并发症的关系.方法 测定173例T2DM患者血清CA199、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2h血糖(2hPBG)及空腹C肽水平,计算胰岛素抵抗指数及胰岛B细胞功能指数.通过眼底检查、尿微量白蛋白及尿肌酐测定、肌电图检查评估糖尿病微血管并发症的存在情况.分析T2DM患者CA199水平与HbA1c、FBG、2hPBG及胰岛素抵抗指数及胰岛B细胞功能指数的相关性,采用多因素logistic回归分析影响T2DM患者血清CA199水平的因素;比较有糖尿病微血管并发症患者与无糖尿病微血管并发症患者的CA199水平.结果 HbA1c、FBG与CA199呈正相关(P＜0.05),2hPBG、胰岛素抵抗指数及胰岛B细胞功能指数与CA199无相关性(P＞0.05).有微血管并发症的患者CA199水平高于无微血管并发症患者(P＜0.05),存在糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变的患者CA199水平分别高于无糖尿病肾病、无糖尿病视网膜病变、无糖尿病周围神经病变的患者(P＜0.05).HbA1c是T2DM患者CA199升高的独立危险因素(P＜0.05).结论 T2DM患者CA199水平高于健康人群平均水平时需要评价其血糖状态及微血管并发症的存在情况.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.