利拉鲁肽、吡格列酮对2型糖尿病并非酒精性脂肪肝的疗效观察

目的探讨利拉鲁肽与吡格列酮治疗2型糖尿病(T2DM)并非酒精性脂肪肝(NAFLD)的临床疗效。方法选取该院2015年6月‐2016年12月收治的50例T2DM并NAFLD患者为研究对象,以随机数字表法将其分为A组和B组,每组患者各25例,A组患者接受二甲双胍联合利拉鲁肽治疗,B组患者接受二甲双胍联合吡格列酮治疗,对两组患者疗效、血脂、血糖、肝功能和胰岛素抵抗等指标进行观察。结果 A组患者治疗后总有效率为96%(24/25),明显高于B组患者的76%(19/25)(P0.05);治疗前两组患者血脂、血糖、肝功能和胰岛素抵抗等指标比较差异均无统计学意义(P0.05);治疗后两组患者血糖相关指标比较差异无统计学意义(P0.05);两组患者治疗后各指标均有改善,两组患者治疗后与同组患者治疗前各指标比较差异均有统计学意义(P0.05);治疗后A组患者血脂、肝功能及胰岛素抵抗等指标均明显优于B组患者(P0.05)。结论利拉鲁肽与吡格列酮治疗T2DM并NAFLD均有一定作用,但是利拉鲁肽降血脂、改善肝功能及胰岛素抵抗效果更强,值得临床推广。     

二甲双胍联合利拉鲁肽治疗肥胖2型糖尿病的临床疗效及安全性评价

目的研究二甲双胍联合利拉鲁肽治疗肥胖2型糖尿病的临床应用疗效及安全性。方法纳入2016年2月～2018年2月科室收治的2型糖尿病患者138例,随机分为两组:对照组69例,接受二甲双胍联合地特胰岛素治疗;试验组69例,接受二甲双胍联合利拉鲁肽治疗,比较两组的治疗效果、不良反应发生率、体重、血糖等指标。结果试验组的总有效率95.65%,高于对照组的78.26%,差异有统计学意义(P0.05);试验组不良反应发生率与对照组比较,差异无统计学意义(P0.05);试验组腰围、体重指数等指标均低于对照组,差异显著(P0.05);试验组FBG、2hPG、HbA1c、HOMA-IR等指标低于对照组,差异有统计学意义(P0.05)。结论肥胖2型糖尿病患者接受二甲双胍联合利拉鲁肽治疗3个月后,能够有效降低患者的血糖水平,安全性高,值得推广应用。     

利拉鲁肽治疗2型糖尿病合并非酒精性脂肪肝的临床效果

目的观察利拉鲁肽治疗2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的临床疗效。方法选取2017年2月至2018年10月安阳市第六人民医院收治的72例T2DM合并NAFLD患者,将患者以随机数表法分为对照组和观察组,每组36例。对照组接受二甲双胍治疗,观察组在对照组治疗基础上加用利拉鲁肽,对两组患者治疗前后血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平]及血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)水平]进行测定和比较;评估两组患者治疗前后脂肪肝严重程度。结果治疗后观察组患者FPG、2 h PG、HbA1c水平和TG、TC、LDL-C水平均低于对照组,差异有统计学意义(均P<0.05);治疗后观察组患者脂肪肝改善程度明显优于对照组,差异有统计学意义(P<0.05)。结论利拉鲁肽可有效改善T2DM合并NAFLD患者的血糖和血脂代谢功能,具有较好的临床应用价值。     

利拉鲁肽治疗超重和肥胖2型糖尿病的临床疗效观察

目的观察利拉鲁肽治疗超重和肥胖2型糖尿病患者的临床疗效和安全性.方法对68例接受口服降糖药后不能有效控制血糖的2型糖尿病(T2DM)患者利拉鲁肽治疗前后临床和实验资料进行对比和统计分析.结果利拉鲁肽治疗后与治疗前比较空腹血糖(FPG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、体重差异有统计学意义(P<0.05).结论利拉鲁肽能降低T2DM 患者的FPG、2hPBG、HbA1c和体质量;并且改善胰岛β细胞功能,但胃肠道反应较常见.     

利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病的临床效果观察

目的观察分析利拉鲁肽联合二甲双胍治疗肥胖型2型糖尿病(T2DM)的临床效果。。方法选取2014年10月至2016年6月长垣县人民医院收治的98例肥胖型T2DM患者,按随机数表法将其分为两组,各49例。对照组接受二甲双胍治疗,观察组接受利拉鲁肽联合二甲双胍治疗,治疗周期为2个月。统计对比两组治疗前后血糖相关指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb Alc)]、体质量及不良反应发生情况。结果治疗前,两组FPG、2 h PG、Hb Alc水平比较,差异无统计学意义(P>0.05);治疗后,两组2 h PG、FPG、Hb Alc水平均降低,且观察组低于对照组,差异有统计学意义(P均<0.05)。治疗前,两组体质量比较,差异无统计学意义(P>0.05);观察组治疗后体质量低于治疗前,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组(6.12%比26.53%),差异有统计学意义(P<0.05)。结论利拉鲁肽联合二甲双胍治疗肥胖型T2DM效果显著,能有效控制血糖水平,减轻体质量,安全性高,值得推广。     

利拉鲁肽联合阿卡波糖治疗肥胖型2型糖尿病临床疗效观察

目的探讨利拉鲁肽联合阿卡波糖治疗肥胖型2型糖尿病(T2DM)的临床疗效。方法将2010年2月至2013年6月沧州市中心医院南院区内分泌科收治的98例肥胖型T2DM患者按随机数字表法分为两组:对照组(49例)应用阿卡波糖治疗,治疗组(49例)应用利拉鲁肽联合阿卡波糖治疗,观察两组治疗前后的血糖、血脂水平及体质量指数(BMI)、空腹胰岛素、稳态模型评估的胰岛β细胞功能指数(HOMA-β)和血清nesfatin-1水平变化情况。结果两组患者治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白、胆固醇、三酰甘油水平均较治疗前显著降低,且治疗组低于对照组,差异均有统计学意义(P<0.05);治疗后治疗组BMI较治疗前降低(P<0.05),HOMA-β值和血清nesfatin-1水平较治疗前增加(P<0.05),对照组BMI、HOMA-β值和血清nesfatin-1水平治疗前后差异无统计学意义(P>0.05)。结论利拉鲁肽联用阿卡波糖通过升高血清nesfatin-1水平、降低BMI、改善糖脂代谢对肥胖型T2DM起到治疗作用,可作为肥胖型T2DM的优选治疗方案。     

利拉鲁肽对肥胖2型糖尿病患者的疗效及心外膜脂肪组织厚度的影响

目的:探讨利拉鲁肽对肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者的疗效以及对心外膜脂肪组织(epicardial adipose tissue,EAT)厚度的影响。方法:选取本院2016年6月-2017年6月收治的T2DM患者92例,按照随机数字表法将其分为观察组和对照组,各46例。对照组给予盐酸二甲双胍治疗,观察组在对照组基础上给予利拉鲁肽皮下注射治疗,均治疗12周。比较两组治疗前后的体重指数(BMI)、腰围指标、空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、甘油三酯和EAT水平,记录治疗过程中的不良反应。结果:治疗后,两组BMI、腰围指标、FPG、2 h PBG、HbA1c和甘油三酯水平均低于治疗前,且观察组均低于对照组,比较差异均有统计学意义(P0.05);治疗后,观察组EAT厚度低于对照组(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论:利拉鲁肽治疗T2DM可有效改善糖尿病的常规监测指标,且对EAT厚度有一定的改善作用,值得推广应用。     

利拉鲁肽联合格列美脲治疗糖尿病的效果分析及对患者SF-36评分的影响

目的探讨利拉鲁肽联合格列美脲治疗糖尿病的效果并分析其对患者SF-36评分的影响。方法从我院2014年7月~2016年7月收治的糖尿病患者中随机选取96例患者,依照随机数表法将他们分为研究组和对照组,各48例。对照组患者给予常规治疗,研究组患者在此基础上采用利拉鲁肽联合格列美脲进行治疗。治疗结束后对比两疗法对患者血糖指标、SF-36评分的影响,并比较两组临床治疗效果。结果治疗前两组患者的体质指数(BMI)、糖化性血红蛋白(Hb Alc)、餐后2 h血糖(2h PG)以及空腹血糖(FPG)等血糖指标无明显区别(P0.05),治疗结束后两组患者BMI、Hb Alc、2h PG、FPG均降低,且研究组低于对照组(P0.05);治疗前两组患者SF-36评分无明显区别(P0.05),治疗结束后两组患者的SF-36评分显著提高,研究组高于对照组(P0.05);临床疗效方面,研究组患者临床疗效明显优于对照组(P0.05)。结论采用利拉鲁肽联合格列美脲治疗糖尿病效果十分显著,安全性有保障,能够有效改善改善患者健康状况,可在临床上大范围推广使用。     

利拉鲁肽联合二甲双胍治疗2型糖尿病临床疗效和安全性评估

目的评估利拉鲁肽联合二甲双胍治疗2型糖尿病(T2DM)的临床疗效及安全性。方法将80例T2DM患者采用随机数字表分为两组:利拉鲁肽组应用利拉鲁肽联合二甲双胍治疗(40例)和甘精胰岛素组应用甘精胰岛素联合二甲双胍治疗(40例)。治疗12周,观察两组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)水平,计算胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR),以及体质指数(BMI)和低血糖发生情况等。结果治疗后两组患者FBG、2 h PG和Hb A1c与治疗前相比均显著降低(P<0.01),但组间比较差异无统计学意义(P>0.05);治疗后HOMA-β较治疗前明显升高(P<0.01),HOMA-IR明显降低(P<0.01),但组间比较差异无统计学意义(P>0.05);治疗后利拉鲁肽组的BMI明显降低,与治疗前相比差异有统计学意义(P<0.01),且低血糖发生率较低。结论利拉鲁肽联合二甲双胍治疗T2DM具有良好的临床疗效和安全性,能够明显改善患者胰岛β细胞功能,比甘精胰岛素更能有效地降低患者增加的体质量。     

利拉鲁肽对腹型肥胖2型糖尿病患者内分泌功能的影响

目的探讨利拉鲁肽治疗腹型肥胖2型糖尿病(T2DM)患者对内分泌功能的影响。方法选取我院内分泌科收治的100例腹型肥胖的T2DM患者作为研究对象,采用随机数字表法分为利拉鲁肽组和对照组各50例;两组患者均给予降糖、控制饮食、适当运动指导等基础措施,利拉鲁肽组同时使用利拉鲁肽治疗;对比两组治疗前后的体质量指数(BMI)、腰臀比、空腹血糖(FPG)、餐后2h血糖(2hPG)、C肽、空腹胰岛素(Fins)、糖化血红蛋白(Hb A1c)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、胰岛素敏感指数(ISI)及血脂指标。结果治疗前,两组的腰臀比、BMI测定值差异无统计学意义(P>0.05);治疗后,治疗组患者的腰臀比、BMI测定值低于对照组,差异有统计学意义(P<0.05);治疗前,两组的FPG、2hPG、C肽、Fins、Hb A1c、HOMA-IR、HOMA-β、ISI测定值差异无统计学意义(P>0.05);治疗后,治疗组患者的FPG、C肽、Fins、HOMA-IR、ISI测定值低于对照组,治疗组患者的HOMA-β测定值高于对照组,差异有统计学意义(P<0.05);治疗前及治疗后,治疗组和对照组的TC、TG测定值在两组间比较,差异无统计学意义(P>0.05);治疗后,两组患者的TC、TG测定值均较治疗前降低,差异有统计学意义(P<0.05)。结论基础治疗+利拉鲁肽治疗腹型肥胖T2DM患者,能有效改善患者胰岛素分泌功能、降低胰岛素抵抗,对于改善患者腹型肥胖有一定的临床价值。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.