Adiponectin hs-CRP和IL-6在糖尿病肾病中的表达及临床意义

目的探讨血清脂联素、超敏C-反应蛋白和白细胞介素-6在2型糖尿病肾病发生、发展中的作用。方法测定38例健康对照组,34例2型糖尿病患者正常蛋白尿期;35例2型糖尿病肾病患者微量白蛋白尿期;32例2型糖尿病肾病患者临床蛋白尿期的血清Adiponectin、hs-CRP和IL-6含量,并分析其与HbA1c的关系。结果2型糖尿病组血清Adiponectin、hs-CRP和IL-6水平明显高于正常对照组(P<0.01),糖尿病组中微量白蛋白尿组和临床蛋白尿组2个亚组血清Adiponectin、hs-CRP和IL-6水平明显高于正常蛋白尿组(P<0.01),hs-CRP与Adiponectin和HbA1c呈正相关(F=5.43,P<0.05)。结论Adiponectin、hs-CRP和IL-6与糖尿病肾病发生、发展有关,检测血清三者水平可能对早期诊断和评估糖尿病肾病有作用。     

2型糖尿病肾病患者尿脂联素水平与尿白蛋白、血脂及血糖的相关性研究

目的分析2型糖尿病肾病患者尿脂联素水平与尿白蛋白、血脂及血糖的相关性。方法选取2015年1月至2016年8月开封市中心医院收治的2型糖尿病患者45例,健康体检者25例,依据尿白蛋白/肌酐(ACR)水平将2型糖尿病患者分为单纯糖尿病组22例(ACR<30 mg/g)与糖尿病肾损伤组23例(ACR≥30 mg/g)。检测对比各组血糖[空腹血糖(FBG)、糖化血红蛋白(HbA1c)]、血脂[甘油三酯(TG)、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]及24 h尿白蛋白、尿脂联素(APN)。结果糖尿病肾损伤组FBG、HbA1c、LDL-C、24 h尿白蛋白、尿脂联素均高于单纯糖尿病组及健康组,差异有统计学意义(P<0.05),3组TG、TC比较,差异无统计学意义(P>0.05);尿脂联素与24 h尿白蛋白、FBG、HbA1c、LDL-C、年龄呈正相关关系(P<0.05)。结论 2型糖尿病肾病中,尿脂联素水平与尿白蛋白、FBG、HbA1c、LDL-C、年龄关系密切,脂联素可作为DN病情发展重要检测指标。     

2型糖尿病肾病患者血清超敏C-反应蛋白、脂联素测定的临床意义

目的 探讨超敏C-反应蛋白(hs-CRP)及脂联素在2型糖尿病肾病诊断中的水平变化、相互关系及临床应用价值.方法 选择2型糖尿病住院患者136例作为观察对象,并根据尿白蛋白排泄量分为3组:极微量白蛋白尿(n=42),微量白蛋白尿组(n=44),大量白蛋白尿组(n=50);同时选择健康体检者50例作为正常对照组.随后分别用胶乳增强免疫比浊法测定hs-CRP、ELISA法测定脂联素,同时测定空腹血糖(FBG)、血肌酐(Scr)、血脂水平、尿白蛋白(UAlb),比较各组间的差异.结果 2型糖尿病肾病组hs-CRP水平随尿白蛋白排泄量和Scr水平的增加而升高,而hs-CRP与血清脂联素水平呈负相关. 结论 hs-CRP及脂联素联合监测对于2型糖尿病早期肾损伤诊断有重要参考价值.     

2型糖尿病肾病患者血清脂联素水平分析

目的:检测2型糖尿病肾病(diabetic nephropathy,DN)患者血清脂联素、尿白蛋白排泄量、血脂水平,探讨2型糖尿病肾病患者血清脂联素与各影响因素的关系,及DN不同阶段血清脂联素水平的变化趋势。方法:从入院的2型糖尿病患者中随机选择60例患者与30例正常健康体检者(对照组),根据尿白蛋白排泄量将糖尿病患者分为3组:<30 mg/d的极微量白蛋白尿组(32例),30～300 mg/d的微量白蛋白尿组(14例),>300 mg/d的大量白蛋白尿组(14例)。检测血清脂联素,同时测定HbAlc、血脂水平、尿白蛋白排泄量,比较各组间的差异。结果:正常人血清脂联素[(9.69±2.23)mg/L]明显高于2型糖尿病患者[(2.17±1.95)mg/L],微量白蛋白尿组的血清脂联素[(2.52±0.61)mg/L]高于极微量白蛋白尿组[(0.74±0.47)mg/L],大量白蛋白尿组的血清脂联素水平最高[(5.32±1.86)mg/L,P<0.001]。直线相关分析显示:血清脂联素水平与尿白蛋白定量、肌酐呈正相关(分别为r=0.42,r=0.38);与HbAlc、BMI、甘油三脂(TG)呈负相关(分别为r=-0.41,r=-0.29,r=-0.23);对糖尿病患者逐步回归分析显示,血清脂联素受尿白蛋白排泄量、HbAlc、BMI及肌酐的影响较大。结论:2型糖尿病肾病存在糖代谢与脂代谢紊乱及胰岛素抵抗,这可能是血清脂联素较正常健康体检者降低的原因,但2型糖尿病患者随着尿白蛋白排泄量的升高,其血清脂联素水平事实上是升高的,其原因尚待进一步探讨。     

血清脂联素在2型糖尿病肾病不同时期中的变化

目的 通过检测2型糖尿病肾病病人血清脂联素、尿清蛋白排泄率水平,探讨血清脂联素在2型糖尿病肾病不同阶段的变化.方法 从住院的2型糖尿病病人中选取60例作为实验组,根据24 h尿清蛋白排泄量分为3组:正常蛋白尿组、微量清蛋白尿组和大量清蛋白尿组,以健康体检者20例作为对照组.测定血清脂联素水平及尿清蛋白排泄量,同时观察血糖、血脂情况,分析脂联素在各组间的差异及与上述各项指标间的相关关系.结果 对照组血清脂联素水平与正常蛋白尿组、大量清蛋白尿组血清脂联素水平与微量清蛋白尿组、微量清蛋白尿组血清脂联素水平与正常蛋白尿组比较,差异均有显著性(F=14.227,q=2.82～3.73,P<0.05).血清脂联素水平与尿清蛋白排泄量、血肌酐水平呈正相关(r=0.633、0.316,P<0.05),与血糖、三酰甘油水平呈负相关(r=-0.306、-0.295,P<0.05).结论 2型糖尿病肾病病人血清脂联素水平随着尿蛋白排泄量、血肌酐水平升高而升高,且与糖脂代谢显著相关.     

不同尿白蛋白排泄率2型糖尿病患者血清可溶性E-选择素的变化

目的:探讨不同尿白蛋白排泄率(UAER)的2型糖尿病患者血清可溶性E-选择素(sE-S)水平的变化及其意义。方法:选择正常对照组20例和2型糖尿病组65例,根据UAER将糖尿病患者分为正常白蛋白尿组(22例)、微量白蛋白尿组(20例)和临床蛋白尿组(18例)。采用酶联免疫吸附法测定sE-S。结果:2型糖尿病各组血清sE-S水平均显著高于正常对照组,临床蛋白尿组、微量白蛋白尿组又显著高于正常白蛋白尿组;血清sE-S水平与HbA1C呈正相关。结论:E-S作为一种黏附分子参与了糖尿病肾病的病理过程,可作为早期糖尿病肾病发生的预报指标,并在一定程度上反映糖尿病代谢控制水平。     

2型糖尿病肾病患者内脂素、脂联素和C反应蛋白变化及其临床意义

目的 检测2型糖尿病肾病患者血清内脂素、脂联素和C反应蛋白(CRP)水平,探讨三者在2型糖尿病肾病发生、发展机制中的作用及临床意义.方法 选择97例2型糖尿病患者,根据尿清蛋白排泄率(UAER)分为3组:正常蛋白尿组(UAER＜20 μg/min)35例,微量蛋白尿组(UAER 20～200 μg/min )30例,大量蛋白尿组(UAER＞200 μg/min)32例;另选健康体检正常者35例为对照组.采用酶联免疫吸附法(ELISA)检测受检者内脂素、脂联素水平,免疫比浊法测定CRP.同时测定空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿素氮(BUN)、血肌酐(SCr)及UAER,比较各组间的差异.结果 3组患者血清内脂素和CRP水平明显高于对照组,差异均有统计学意义(P＜0.05).正常蛋白尿组血清脂联素低于对照组,微量蛋白尿组、大量蛋白尿组血清脂联素高于对照组,差异有统计学意义(P＜0.01).内脂素和CRP分别与病程、收缩压(SBP)、HbA1c、FPG、TG、TC、LDL-C、BUN、SCr、UAER呈正相关(P＜0.01),与HDL-C呈负相关(P＜0.01).脂联素与病程、SBP、BUN、SCr、UAER呈正相关(P＜0.01).结论 血清内脂素、脂联素和CRP可能参与了2型糖尿病肾病的发生、发展,联合检测三者水平可能对评估早期糖尿病肾病有意义.     

血清脂联素检测对2型糖尿病肾病早期诊断的应用价值

目的探讨脂联素在2型糖尿病肾病不同阶段的水平变化及临床诊断应用价值。方法选择2型糖尿病住院患者120例作为观察对象,并根据尿清蛋白排泄量分为4组：单纯糖尿病组、极微量清蛋白尿组、微量清蛋白尿组、大量清白蛋白尿组;同时选择健康体检者30例作为正常对照组。测定血清脂联素水平,同时测定空腹血糖（FBG）、血清肌酐（Scr）、血清尿素（BUN）、尿微量清蛋白（mAlb）、尿β2-微球蛋白（β2-MG）,比较各组间的差异。结果 2型糖尿病组血清脂联素水平明显低于正常对照组（P〈0.05）,大量清蛋白尿组血清脂联素水平明显高于单纯糖尿病组（P〈0.05）,血清脂联素水平与血清肌酐、血清尿素、尿微量清蛋白、尿β2-微球蛋白水平呈正相关（P〈0.05）。结论脂联素与糖尿病肾病发生、发展有关,检测血清脂联素对于2型糖尿病早期肾损伤的诊断有重要参考价值。     

2型糖尿病微量白蛋白尿患者sICAM-1的检测及其临床意义

目的:研究2型糖尿病微量白蛋白尿患者血清可溶性细胞间粘附分子(sICAM-1)的水平及其与尿白蛋白排泄率(UAER)的相互关系。方法:采用ELISA法和放免法分别测定30例健康人(正常对照组)、30例2型糖尿病正常白蛋白尿患者、28例2型糖尿病微量白蛋白尿患者sICAM-1和UAER水平。结果:①2型糖尿病正常白蛋白尿组sICAM-1水平明显高于正常对照组(P<0.05);②在排除代谢因素影响后(两组年龄、病程、BM I、空腹血糖、空腹胰岛素、HbA1 c等无显著性差异),2型糖尿病组中微量白蛋白尿组与正常白蛋白尿组sICAM-1相比有显著性差异(P<0.05);③2型糖尿病组UAER与sICAM-1正相关,相关系数0.53(P<0.01),尤其在微量白蛋白尿组,相关系数达0.59(P<0.01)。结论:sICAM-1增高可能参与了2型糖尿病微量白蛋白尿的发生、发展过程,它的检测可作为早期糖尿病肾病(DN)的诊断、治疗、预后观察的一个临床指标。     

2型糖尿病并肾病患者检测血清胆红素的临床意义

目的探讨2型糖尿病并肾病患者检测血清胆红素的临床意义.方法 根据尿微量白蛋白排泄(UAER)将192例2型糖尿病患者分为:正常蛋白尿组(UAER<30mg/d)72例,微量蛋白尿组(30mg/d≤UAER<300mg/d)70例和大量蛋白尿组(UAER≥300mg/d)50例,分别测定各组身高、体重、血压、血肌酐、尿素,总胆红素、直接胆红素、间接胆红素、尿微量白蛋白、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和糖化血红蛋白水平并计算体重指数.大量蛋白尿组血清总胆红素、直接胆红素、间接胆红素、显著低于正常蛋白尿组及微量蛋白尿组(P<0.05),而肌酐、尿素和尿微量白蛋白排泄水平显著高于正常蛋白尿组及微量蛋白尿组(P<0.05),且血清总胆红素,直接胆红素和间接胆红素水平均与尿微量白蛋白呈负相关(r=-0.304,P<0.01;r=-0.272,P<0.01;r=-0.278,P<0.01).结论 2型糖尿病并肾病患者血清胆红素水平降低,且与尿微量白蛋白呈负相关.胆红素与糖尿病肾病密切相关.     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.