石家庄市中老年人群HbA1c诊断2型糖尿病可行性研究

目的 探讨中老年人群中糖化血红蛋白(HbA1c)诊断糖尿病(DM)的理想切点及可行性.方法 采用分层随机抽样方法选择石家庄市9个社区,居住5年以上年龄≥45岁的社区居民,进行横断面流行病学调查,共调查1 845例.其中符合入选条件的1 244例行口服75 g葡萄糖耐量试验(OGTT);测定空腹血糖、服糖后2h血糖及HbA1c.采用受试者工作特征曲线(ROC曲线)进行判断,得到以OGTT诊断DM的HbA1c值,计算最佳切点.并与OGTT标准比较,评价两者对于DM诊断率的差异.结果 按照1999年WHO的DM诊断标准,研究人群中糖耐量正常(NGT)467例,空腹血糖受损(IFG)92例,糖耐量低减(IGT)198例,合并IFG+IGT 97例,新诊断糖尿病(NDDM)390例.通过绘制ROC曲线,得到HbA1c诊断DM相关的临界点为6.2％,敏感性和特异性分别为66.8％和96.1％,曲线下面积为0.859(95％ CI为0.829 ～ 0.890).与OGTT结果的符合率为75.9％.以HbA1c≥6.2％作为DM诊断切点,阳性似然比(+LR)17.13,阴性似然比(-LR)0.35,阳性预测值(+PV)74.3％,阴性预测值(-PV)77.1％.结论 以HbA1c≥6.2％作为石家庄市中老年人群诊断DM的切点具有较高的敏感度与特异度.可作为临床DM筛查的切点.     

糖耐量异常对原发性高血压患者血压变异性的影响

目的观察并评估糖耐量异常（IGT）对原发性高血压（EH）患者血压变异性（BPV）的影响。方法选取2011年1月-2013年1月收治的单纯EH患者74例为对照组;另选取同期IGT合并EH患者74例为观察组。对2组患者进行24h动态血压监测（ABPM）,观察患者BPV的特点。结果观察组患者的24h收缩压变异系数（0．12±0．03）、白天收缩压标准差（15．28±2．63）m／nHg和变异系数（0．13±0．02）、夜间平均收缩压平均值（131．12±10．73）mmHg均高于对照组的（0．09±0．01）、（13．19±2．25）mmHg、（0．10±0．02）和（128．15±10．52）mmHg,差异均具有统计学意义（P〈0．05）。结论IGT对于EH患者的BPV有明显影响,EH合并IGT患者在治疗时,除了要采取降压治疗外,同时还应该关注BPV的调节,积极改善体内糖代谢异常。     

高血压合并冠心病患者理想舒张压的临床观察

目的探讨高血压合并冠心痛患者理想的舒张压指标。方法随机选取280例高血压合并冠心病患者,并将其按照不同的舒张压水平分为5组,分别为舒张压小于70mmHg组、70～80mmHg组、80～90mmHg组、90～100mmHg组、舒张压大于100mmHg组,观察不同组别与心肌梗死之间的联系。结果5组患者心肌梗死发生率与患者舒张压水平呈U形曲线,当舒张压为阀值80～90mmHg时,心肌梗死发生率最低,舒张压值为70～80mmHg、90～100mmHg时,心肌梗死发生率较高,舒张压低于70mmHg、高于100mmHg时,心肌梗死发生率最高。结论高血压合并冠心病患者临床治疗中不能盲目降低舒张压。应结合其临床实际机体情况给予合理降压,有效调节舒张压指标。     

骨髓间充质干细胞移植改善糖尿病肾病大鼠血糖及尿总蛋白

BACKGROUND: Common strategies for preventing diabetic nephropathy include effective control of blood sugar and blood pressure, inhibition of the rennin-angiotensin system and lipid-lowering therapy, but it is often difficult to get the desired results. OBJECTIVE: To investigate the effect of transplantation of bone marrow mesenchymal stem cells on levels of blood glucose and urinary total protein in diabetic nephropathy rats. METHODS: Forty-five Sprague-Dawley rats were randomly divided into three groups (n=15 per group): normal control group, diabetic nephropathy group and stem cell transplantation group. Rats in the diabetic nephropathy and stem cell transplantation groups were given single use of 60 mg/kg streptozotocin to make diabetic nephropathy models. The same dose of citric acid-sodium citrate buffer was injected in the normal control group. After modeling, 200 μL of bone marrow mesenchymal stem cell solution (2×106) was injected into the left ventricle of rats in the stem cell transplantation group, and then at 7 days after the first transplantation, the cell transplantation was conducted again. The same dose of serum-free L-DMEM was injected intracardially into the rats in the normal control and diabetic nephropathy groups. Levels of urinary total protein and blood glucose were detected.  RESULTS AND CONCLUSION: At 1, 4, 8 weeks after treatment, the urinary total protein and blood glucose levels were significantly higher in the stem cell transplantation group and diabetic nephropathy group than the normal control group (P < 0.05). At 1 week after treatment, the urinary total protein and blood glucose levels were significantly lower in the stem cell transplantation group than the diabetic nephropathy group (P < 0.05). At 4 and 8 weeks after treatment, the total urinary protein and blood glucose levels were slightly higher in the diabetic nephropathy group than the stem cell transplantation group, but there was no significant difference (P > 0.05). These findings indicate that bone marrow mesenchymal stem cell transplantation in diabetic nephropathy rats can get good results in a short period, significantly improve the blood glucose and urinary total protein levels, but the long-term treatment effect is poor.      

石家庄市中老年代谢综合征人群糖代谢状态及HbA1c水平分析

目的了解石家庄市中老年代谢综合征(MS)人群糖化血红蛋白(HbA1c)水平及糖代谢特点,了解不同糖代谢及HbA1c水平下MS患病情况。方法分层随机抽样选择石家庄市9个社区,居住5年以上,年龄≥45岁的社区居民,进行横断面流行病学问卷调查和体格检查,检测空腹血糖(FPG)、HbA1c、血脂及口服糖耐量试验。据1999年WHO糖尿病诊断标准和2005年IDF代谢综合征全球共识定义诊断。以HbA1c及糖代谢状态分成不同亚组,并进行统计学分析。结果石家庄市中老年人群MS患病率为21.2%,女性为14.8%,男性为6.4%(P0.05);65岁以上和65岁以下人群分别为24.8%和19.7%(P0.01)。HbA1c以6.5%为切点MS患病率分别为14.1%和59.7%(P0.01)。其中除HbA1c5.0%与HbA1c介于5.0%~6.0%时各组间MS患病率无差异外,HbA1c6.5%时各分层之间及其与HbA1c≥6.5%时各分层间MS患病率两两不同。NGT、DM之间及其与IFG、IGT、IFG+IGT间,MS患病率两两不同。年龄、性别、糖尿病家族史、喜食甜食、BMI、WHR、TG、HDL-C、SBP、DBP、FPG、2h-PG、HbA1c为MS高发的主要危险因素。结论石家庄市MS患病率较高,HbA1c水平监控、糖代谢状态筛查,有助于MS的诊断及防控。     

炭黑中性墨水的流动曲线及动态黏弹特性

测试了炭黑中性墨水的流变性能,探讨了炭黑中性墨水的流变性能与书写和存储稳定性等应用性能的关系。结果表明,炭黑中性墨水具有显著的剪切变稀特性,用Hersegel Bulkley方程拟合得到的流动指数为0.3~0.6。同时发现日本进口针管型笔头炭黑中性墨水为黏性流体,子弹型笔头炭黑中性墨水为黏弹性流体。跟踪测试存储150 d的炭黑中性墨水的弹性模量(G’) 时间的关系,得到的墨水存储稳定性结论与通过线性黏弹区结构分析得到的稳定性结论一致,表明结构稳定性是中性墨水存储稳定性的关键,可以通过线性黏弹区的特性快速判断中性墨水的存储稳定性。     

不同分期糖尿病视网膜病变泪液IL-6的表达

目的 测定并比较2型糖尿病不同分期视网膜病变患者及正常人泪液中白细胞介素-6( inter-leukin-6,IL-6)的含量,探讨泪液白细胞介素-6与糖尿病及糖尿病视网膜病变的关系.明确泪液IL-6与血清IL-6水平的相关关系.方法 正常对照者(normal control group,NC组)30例、2型糖尿病无视网膜病变患者(NDR组)30例、2型糖尿病单纯性视网膜病变患者(DR组)30例,2型糖尿病增生性视网膜病变患者(PDR 组)30例,4组年龄、性别比例相匹配.用ELISA法检测4组人群泪液、血清中IL-6的含量.实验资料采用SPSS 12.0统计软件分析,数据比较用单因素方差分析,并对泪液、血清IL-6进行相关分析.结果 泪液中IL-6的含量:NC组浓度为(3.12±1.07 )pg/mL,NDR组浓度为(10.23±3.16)pg/mL,DR组浓度为(16.42±5.71)pg/mL,PDR组浓度为(25.13±4.96 )pg/mL.组间两两比较均差异有统计学意义(P＜0.01或P＜0.05).血清中IL-6的含量:NC组浓度为(88.86±16.71)pg/mL,NDR组浓度为(126.43±20.93)pg/mL,DR组浓度为(240.42±39.21 )pg/mL,PDR组浓度为(269.50±30.20 )pg/mL.组间两两比较差异均有统计学意义(P＜0.01).泪液IL-6与血清IL-6水平有相关性(r=0.758,P ＜0.05).结论 糖尿病患者泪液IL-6含量增高;随着糖尿病视网膜病变程度的加重,泪液IL-6含量逐渐升高,提示泪液IL-6水平与糖尿病及不同分期糖尿病视网膜病变的发生有关.泪液IL-6与血清IL-6水平之间呈直线正相关关系.     

糖化血红蛋白在老年人群诊断2型糖尿病标准的意义

目的探讨老年人群中糖化血红蛋白(HbA1c)诊断糖尿病(DM)的理想切点及可行性。方法采用分层随机抽样方法选择石家庄市9个社区,居住5年以上年龄≥60岁的社区居民,进行横断面流行病学调查,共调查1 220例。其中符合入选条件的938例行口服75 g葡萄糖耐量试验(OGTT);测定空腹血糖、服糖后2 h血糖及HbA1c。采用受试者工作特征曲线(ROC曲线)进行判断,得到以OGTT诊断DM的HbA1c值,计算最佳切点。并与OGTT试验诊断标准比较,评价两者对于DM诊断率的差异。结果按照1999年WHO的DM诊断标准,研究人群中糖耐量正常(NGT)440例,空腹血糖受损(IFG)69例,糖耐量低减(IGT)148例,合并IFG+IGT 73例,新诊断DM(NDDM)208例。通过绘制ROC曲线,得到HbA1c与诊断DM相关的临界点为6.2%,敏感性和特异性分别为69.8%和95.8%,曲线下面积为0.860(95%CI 0.832～0.898)。与OGTT结果的符合率为77.5%。以HbA1c≥6.2%作为DM诊断切点,阳性似然比(-LR)16.62,阴性似然比(-LR)0.32,阳性预测值(+PV)75.4%,阴性预测值(-PV)78.1%。结论 HbA1c≥6.2%作为石家庄市老年人群筛查DM切点具有较高敏感度与特异度,可作为临床DM筛查的切点。     

脐血干细胞对1型糖尿病大鼠血糖及PDX-1、MafA表达水平的影响

背景：1型糖尿病是一种自身免疫性疾病,以胰腺β细胞选择性破坏,导致患者体内胰岛素分泌绝对不足为特征。脐血干细胞具有多分化潜能,在体内外均可以诱导分化为胰岛细胞,发挥出一定的降糖作用。目的：探讨脐血干细胞对1型糖尿病大鼠血糖水平及胰腺组织PDX-1、MafA表达的影响。方法：30只SD大鼠随机分为3组,每组10只,治疗组和模型组大鼠建立1型糖尿病模型,造模成功后,治疗组尾静脉一次性注射脐血干细胞,正常组给予相同体积的生理盐水,模型组给予相同体积的脐血干细胞缓冲液。采用口服葡萄糖耐量试验评价大鼠胰岛功能,苏木精-伊红染色观察大鼠胰腺形态,Western blot 和PCR 检测胰腺组织PDX-1、MafA蛋白和mRNA表达。结果与结论：①模型组和治疗组大鼠0,30,60,90 min的血糖值均显著高于正常组,差异均有显著性意义(P < 0.05);120 min时间点模型组血糖值显著高于正常组(P < 0.05);治疗组则与正常组之间差异无显著性意义(P > 0.05)。②模型组胰岛数量出现下降,边界模糊不清,呈不规则形态,治疗组胰岛数量出现一定的减少,但尚维持清晰的结构。③治疗组PDX-1及MafA表达水平与正常组比较差异无显著性意义(P > 0.05),但显著高于模型组(P < 0.05)。以上结果表明,脐血干细胞可以显著降低1型糖尿病大鼠的血糖水平,改善胰岛功能及胰腺组织形态,并具有上调PDX-1、MafA表达的作用。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

血小板反应蛋白1在纤维化模型大鼠肾组织中的表达

BACKGROUND:Thrombospondin-1 is an important endogenous activator of transforming growth factor beta 1 in this experimental inflammatory kidney disease model. Transforming growth factor beta 1 is considered the major cytokine that causes tissue fibrosis in many different inflammatory disease processes, in particular in renal disease. OBJECTIVE:To investigate the expression of thrombospondin-1 on renal fibrosis in rats. METHODS:Healthy male Sprague-Dawley rats were randomly divided into sham surgery group and model group. In the model group, right ureters of rats were ligated to construct models of renal fibrosis. 3 weeks after surgery, blood and urine were obtained weekly. Enzyme linked immunosorbent assay and Bradford method were used to detect the contents of serum creatinine, blood urea nitrogen and urinary protein. After rats were sacrificed, kidneys were fixed. Western blot assay was utilized to identify the expression of vascular endothelial growth factor, transforming growth factor beta 1 and thrombospondin-1 protein. Hematoxylin-eosin staining was applied to detect the changes in pathological structure of the kidney after surgery. RESULTS AND CONCLUSION: (1) One week after model induction, urinary protein, serum creatinine and urea nitrogen levels were significantly higher in the model group than in the sham surgery group (P < 0.05). Three weeks later, the difference in each index was significant (P < 0.01), which showed that the injury of the kidney was aggravated. (2) Transforming growth factor beta 1 protein and thrombospondin-1 expression was significantly higher in the model group than in the sham surgery group, but vascular endothelial growth factor protein expression was significantly lower in the model group than in the sham surgery group. (3) Hematoxylin-eosin staining results demonstrated that severe pathological changes of renal tissue in rats were detected after ligation of renal tubule. (4) These results confirmed that thrombospondin-1 expression increased in renal tissue, and its expression was strongly associated with vascular endothelial growth factor protein and transforming growth factor beta 1, which may play an important role in the renal fibrosis.