目的 探讨全球领导人营养不良倡议标准(GLIM标准)对维持性血液透析(MHD)患者蛋白质-能量消耗(PEW)的诊断作用.方法 选择2021年1～12月在北京康复医院血液净化中心规律进行MHD治疗的MHD患者70例,同时使用GLIM、营养不良炎症评分(MIS)和国际肾脏营养与代谢学会(ISRNM)PEW标准诊断PEW,比较3种方法诊断PEW患病率的差异,收集患者一般资料、实验室指标和营养相关生化指标等,比较金标准、GLIM与MIS的一致性;以金标准为参照,对比GLIM与MIS的准确率、灵敏度和特异度.结果 基于GLIM、MIS与金标准,MHD患者PEW患病率分别为24.3%、28.6%和30%.3种方法对PEW的诊断一致性较高(Fleiss Kappa=0.643,P<0.001);营养相关生化指标在3种诊断方法下比较,差异无统计学意义(P>0.05);以金标准为参照,GLIM诊断PEW的准确率和特异度分别为76.47%和91.84%,均高于MIS的70%和87.76%.结论 GLIM与金标准和传统方法MIS一致性良好,以金标准为参照,GLIM的准确率和特异度均高于MIS,是预测MHD患者PEW更准确和特异的方法.

Objectives: We investigated the impact of traumatic spinal cord injury (TSCI) on daily living activities and motor function of TSCI patients. Methods: A total of 88 TSCI patients were randomly divided into Group A (N=44) and Group B (N=44). Group A received rehabilitation treatment 7 days after the stabilization of vital signs, and Group B received rehabilitation treatment 30 days after hospitalization. Results: The compliance rate of Group A (93.18%) was higher than that of Group B (72.73%) (χ 2 =6.510, p<.05); The scores of American Spinal Injury Association (ASIA) and Activities of Daily Living (ADL) in Group A were higher than those in Group B. The self-rating score of anxiety and depression was lower than that of Group B (p<.05). Conclusion: For the rehabilitation treatment of TSCI patients, it is better to choose the intervention after the vital signs are stable to improve patients' ability for daily living activities and motor function.

目的 研究基于糖尿病的健康教育对2型糖尿病患者靶器官功能的保护作用.方法 选择2015年1月至2019年10月首都医科大学附属北京康复医院内分泌科收治的602例2型糖尿病患者进行研究,随机分为观察组(302例)和对照组(300例),对照组接受2型糖尿病常规治疗,观察组在常规治疗基础上参加我院组织的糖尿病健康教育学校.收集两组患者基本临床资料,比较两组患者治疗前后对糖尿病知识的掌握水平及自我管理水平、血压、体重、体质指数、腰围/臀围、血糖、血脂变化,比较两组治疗后再住院率、并发症发生率、血糖达标率.结果 两组的基本临床资料均差异无统计学意义(P>0.05),两组具有可比性;治疗后,观察组对糖尿病知识的掌握水平及自我管理水平均明显高于对照组,血压、体重、体质指数、腰围/臀围、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白均明显低于对照组(P<0.05),高密度脂蛋白明显高于对照组(P<0.05);观察组靶器官受损及其他并发症的发生率明显低于对照组(5.96％vs 14.00％,P=0.001),再住院率明显低于对照组(9.27％vs 20.67％,P<0.001),血糖达标率明显高于对照组(P<0.05),满意度明显高于对照组(93.05％vs 77.33％,P<0.001).结论 2型糖尿病患者在常规治疗的基础上结合糖尿病健康教育,可提高血糖控制效果、减少并发症.

Objective:To study the effect of Helicobacter pylori (HP) infection on the standardized dose of postoperative thyrotropin suppression of differentiated thyroid carcinoma.Methods:A total of 82 patients diagnosed with differentiated thyroid carcinoma and receiving total thyroidectomy in Beijing Rehabilitation Hospital affiliated to Capital Medical University from Jan. 2019 to Jun. 2020 were enrolled in this study prospectively.19 patients with higher standardized dose of the thyrotropin suppression (>2.5 μg·kg -1·d -1) were selected as the experimental group, and 63 patients with the lower standardized dose of the thyrotropin suppression (≤2.5 μg·kg -1·d -1) were selected as the control group. The presence of HP infection was measured by C13 method, and the HP infection rate was compared between the two groups. The patients with HP infection in the experimental group received standard quadruple therapy to eradicate Helicobacter pylori. The standardized dose before and after treatment were observed and compared. Results:The HP infection rate in the experimental group (73.7%, 14/19) were significantly higher ( P<0.05) than those in the control group (31.7%, 20/63). In the experimental group, 14 patients with HP infection in the experimental group received standard quadruple therapy to eradicate HP. HP was successfully eradicated in 11 patients after the treatment (one patient quit the treatment before completion, the actual eradication rate was 84.6%) ; Eight weeks after the treatment, the dose adjustment of thyrotropin suppression reached steady-state in 13 patients completed the therapy. The average standardized dose was (2.15±0.25) μg·kg -1·d -1, significantly lower than that before treatment [ (2.89±0.21) μg·kg -1·d -1] ( P<0.05) . Conclusions:HP infection may be an important factor affecting the standardized dose of thyrotropin suppression in postoperative patients with thyroid cancer. For those patients with HP infection, eradication treatment of HP can significantly reduce the standardized dose and treatment-related complications.

目的 探讨血清脂质代谢指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平、内脏脂肪面积(VFA)与糖代谢异常合并肥胖的相关性.方法 选取2019年2-10月就诊于该院内分泌科的1243例2型糖尿病患者纳入研究,根据是否合并肥胖分为糖代谢异常合并肥胖组(725例)和糖代谢异常不合并肥胖组(518例),以性别、年龄、烟酒史为配对因素选取相匹配的同期于该院体检中心体检的66例糖代谢正常的肥胖成人作为糖代谢正常合并肥胖组,66例体检健康的成人作为糖代谢正常不合并肥胖组.比较4组人群的临床特征及生化指标,分析糖代谢异常合并肥胖患者各指标的相关性,不同脂质代谢指标水平和VFA发生糖代谢异常合并肥胖的趋势,以曲线下面积(AUC)评估脂质代谢指标和VFA对糖代谢异常合并肥胖的预测价值.结果 4组人群间收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、VFA、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、TC、TG、LDL-C、HDL-C和尿酸比较,差异有统计学意义(P<0.05);TC、TG和LDL-C水平与BMI、FBG、HbA1c、VFA呈正相关,HDL-C水平与BMI、FBG、HbA1c、VFA呈负相关(P<0.05);VFA水平与BMI、FBG、HbA1c呈正相关(P<0.05);随着TC、TG、LDL-C水平和VFA的增加,糖代谢异常合并肥胖的相对危险度(RR)值呈升高的线性趋势,随着HDL-C降低,糖代谢异常合并肥胖的RR呈升高的线性趋势(P<0.05);TC、TG、LDL-C、HDL-C和VFA预测糖代谢异常合并肥胖的AUC分别为0.736、0.778、0.752、0.754、0.773.结论 血清脂质代谢指标水平、VFA与糖代谢异常合并肥胖有关,可作为糖代谢异常患者肥胖预测和代谢状态监控的指标.

目的 探讨目标导向的连续性肾脏替代治疗(GD-CRRT)辅助重组人脑利钠肽治疗Ⅰ型心肾综合征的临床疗效.方法 选择Ⅰ型心肾综合征患者92例,采用简单随机数字表法分为研究组与对照组,各46例.对照组采取GD-CRRT,研究组在对照组基础上采取重组人脑利钠肽,2组均治疗7 d.统计比较2组临床疗效.结果 研究组总有效率(93.48％,43/46)高于对照组(76.09％,35/46)(P<0.05);研究组治疗后GFR高于对照组,Cr、BUN水平低于对照组(P<0.05);SV、LVEF高于对照组,NT-proBNP水平低于对照组(P<0.05);血清IL-6、PCT、CRP水平低于对照组(P<0.05);心率及APACHEⅡ评分低于对照组(P<0.05);研究组第3次全因再入院率低于对照组(P<0.05),2组不良反应发生率差异无统计学意义(P>0.05).结论 GD-CRRT辅助重组人脑利钠肽治疗Ⅰ型心肾综合征能进一步提高患者心功能和肾功能,有效抑制炎症反应,安全可靠.

目的:探讨木丹颗粒联合羟苯磺酸钙胶囊对糖尿病周围神经病变(DPN)患者神经传导速度、血液流变学和氧化应激的影响.方法:选取2018年9月～2020年8月期间我院收治的120例DPN患者.按照随机数字表法分为观察组(60例,木丹颗粒联合羟苯磺酸钙胶囊治疗)和对照组(60例,羟苯磺酸钙胶囊治疗),均治疗8周.对比两组疗效、神经传导速度、血液流变学和氧化应激,记录两组不良反应发生情况.结果:观察组的临床总有效率高于对照组(P＜0.05).观察组治疗后正中神经、腓总神经的运动传导速度(MNCV)和感觉传导速度(SNCV)均较治疗前升高,且高于对照组(P＜0.05).两组治疗后全血低切黏度、全血高切黏度、纤维蛋白原、血浆黏度均较治疗前降低,且观察组低于对照组(P＜0.05).两组治疗后丙二醛(MDA)较治疗前降低,超氧化物歧化酶(SOD)较治疗前升高(P＜0.05),且观察组MDA较对照组低,SOD较对照组高(P＜0.05).两组不良反应发生率对比无明显差异(P＞0.05).结论:木丹颗粒联合羟苯磺酸钙胶囊治疗DPN患者疗效确切,可提高患者神经传导速度和抗氧化应激能力,改善血液流变学状态,安全可靠.

目的 应用动态血糖监测系统(CGMS)评估老年2型糖尿病(T2DM)患者在短期持续胰岛素皮下输注(CSII)治疗前后的血糖控制水平及波动性变化,探讨CSII在老年T2DM患者中的应用价值.方法 纳入2018年10月至2019年10月在我院住院的老年T2DM患者39例,所有研究对象在入组前3d均维持院外降糖治疗方案,同时佩戴CGMS,记录日间平均血糖水平(MBG)、血糖达标时间(TIR)、低血糖曲线下面积(AUC3.9)、高血糖曲线下面积(AUC10.0)、平均血糖波动幅度(MAGE)、血糖标准差(SDBG)、血糖变异系数(CVBG)、最大血糖波动幅度(LAGE)、日间血糖平均绝对差(MODD)等指标,作为基线水平;第4天开始停用原降糖药物并启动CSII治疗,2周后再次佩戴CGMS,记录上述指标,比较在CSII治疗前后各研究对象的血糖变化情况.结果 与CSII治疗前相比,CSII治疗后MBG明显下降[(8.27±1.79) mmol/L vs.(9.85±2.30) mmol/L,P＜0.01]、TIR显著增加(75.69％±31.96％ vs.58.62％±33.23％,P＜0.01);CSII治疗前共发生低血糖事件3次,低血糖曲线下面积AUC3.9为(0.37±0.81)h·mmol/L,CSII治疗后未发生低血糖事件(AUC3.9 =0) (P =0.007);高血糖曲线下面积AUC10.0在CSII治疗前后比较差异有统计学意义[(19.55±24.29)h·mmol/L vs.(5.87±8.36)h·mmol/L,P＜0.01].CSII治疗后MAGE[(2.88±1.34) mmol/L vs.(5.35±3.25) mmol/L]、SDBG [(1.23±0.65) mmol/L vs.(1.82±0.78)mmol/L]、CVBG[(14.99±6.62) mmol/L vs.(20.22±9.97) mmol/L]、LAGE[(5.14±2.43) mmol/L vs.(8.02±4.20) mmol/L]、MODD[(0.70±0.38) mmol/L vs.(1.59±1.08) mmol/L]均较CSII治疗前显著减小(P＜0.01).结论 对于老年T2DM患者,CSII与常规降糖治疗方案相比,其血糖控制水平更佳、低血糖风险更低、血糖波动性更小.

目的 观察生脉四物汤加减对糖尿病性心脏病患者血脂代谢及心血管功能指标的影响.方法 将2017年1月—2019年2月首都医科大学附属北京康复医院收治的84例糖尿病性心脏病患者随机分为2组,对照组42例给予甘精胰岛素注射液皮下注射及格列齐特缓释片、阿司匹林肠溶片、阿托伐他汀钙片、盐酸贝那普利片、螺内酯片口服,观察组42例在对照组治疗基础上给予生脉四物汤加减口服,2组均连续治疗8周.对比2组治疗前后血脂代谢指标[三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]、心血管功能指标(静息卧位心率、卧立位心率差)、超声心功能指标[左室短轴缩短率(FS)、左室射血分数(LVEF)、E/A],评估2组临床疗效,统计2组不良反应发生情况.结果 2组治疗后TG、LDL-C水平均较治疗前明显降低(P均<0.05),且观察组明显低于对照组(P均<0.05);2组治疗后静息卧位心率均明显慢于治疗前(P均<0.05),且观察组明显慢于对照组(P<0.05);2组治疗后卧立位心率差及FS、LVEF、E/A均明显升高(P均<0.05),且观察组明显高于对照组(P均<0.05);观察组治疗总有效率为92.9％(39/42),对照组为73.8％(31/42),观察组明显高于对照组(P<0.05);观察组不良反应发生率为7.1％(3/42),对照组为23.8％(10/42),观察组明显低于对照组(P<0.05).结论 西医治疗基础上联合生脉四物汤加减能够明显改善糖尿病性心脏病患者血脂代谢,提高心血管功能和心脏舒张功能,提高治疗总有效率,减少西药不良反应.

目的 探讨血清维生素D水平与2型糖尿病(T2DM)大血管和微血管并发症的相关性.方法 选取2011年3月-2013年3月于我院内就诊的T2DM患者330例,根据其血清维生素D水平,将其分为A组(≥50 nmol/L)和B组(<50 nmol/L).对所有受试者进行为期5年的随访,记录其T2DM大血管和微血管并发症的发生情况.采用Logistic回归分析评估血清维生素D水平与T2DM大血管和微血管病变风险的相关性.结果 A、B两组间性别、年龄、体质指数(BMI)、病程、吸烟、收缩压、舒张压无统计学差异(P>0.05).两组患者的LDL-C和HbA1c水平无统计学差异(P>0.05);A组患者的TC、HDL-C、TG和hs-CRP水平显著低于B组,CREA水平显著高于B组,差异具有统计学意义(P<0.05).以A、B两组的血清维生素D水平中位数为分界点,将所有受试者分为四组(<30 nmol/L;30 nmol/L≤VD<50 nmol/L;50 nmol/L≤VD<65 nmol/L;≥65 nmol/L),大血管及微血管病变率随血清维生素D水平降低而升高,与维生素D水平≥65 nmol/L的患者相比,维生素D水平<30 nmol/L的T2DM患者大血管病变和微血管病变的风险均显著升高(P<0.05).结论 维生素D水平<30 nmol/L的T2DM患者大血管病变和微血管病变的风险显著升高,应进行早期干预.

To analyze the effects of fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance index (HOMA-IR) and homocysteine (Hcy) on type 2 diabetes mellitus (T2DM) complicated with ischemic stroke (IS). Methods: We selected 85 patients with T2DM and divided them into the T2DM+IS group (44 cases) and T2DM group (41 cases) according to whether the patient experienced IS. During the same period, 30 healthy volunteers were selected as the control group. The differences in body mass index (BMI), blood pressure, blood glucose, and four indexes of blood lipid among the three groups were compared, and the HOMA-IR was calculated. Multivariate logistic regression was used to analyze the influencing factors of T2DM complicated with IS, and Pearson correlation analysis was used to analyze the relationship between FBG and other indicators. Results: The levels of BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), hemoglobin A1c (HbA1c), FINS, FBG, Hcy, and HOMA-IR in the T2DM group and T2DM+IS group were significantly higher than those in control group, and the level of high density lipoprotein cholesterol (HDL-C) was significantly lower than that in the control group (P<0.05). The levels of SBP, DBP, LDL-C, HbA1c, FINS, FBG, Hcy, and HOMA-IR in the T2DM+IS group were significantly higher than those in the T2DM group (P<0.05). Multivariate logistic regression analysis showed that FINS, FBG, Hcy, and HOMA-IR were the influencing factors of IS in patients with T2DM (P<0.05). Pearson correlation analysis showed that FBG was positively correlated with HbA1c, FINS, Hcy, and HOMA-IR (P<0.01). Conclusion: There is a significant relationship between FBG level and the occurrence of IS in patients with T2DM.

To analyze the application of upper limb rehabilitation robot assistant therapy in upper limb function rehabilitation of stroke patients with hemiplegia. Methods: Ninety patients with hemiplegia after stroke were randomly divided into the control group and observation group with 45 patients in each group. Both groups received routine rehabilitation training, and the observation group additionally received upper limb rehabilitation robot assistant treatment. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and Function Independent Measure (FIM) scores of the two groups were compared before treatment and one month after treatment. Results: The MAS score of the elbow joint in the observation group decreased significantly one month after treatment compared with that of the control group (P<0.01), and there was no significant difference in control group scores before and after treatment (P>0.05). The MAS score of the shoulder joint in both groups decreased one month after treatment, and furthermore, that of the observation group was decreased compared to the control group (P<0.01). The FMA-UE score of both groups was higher at one month after treatment than before treatment, and that of the observation group was increased compared to the control group (P<0.01). Compared with before treatment, the FIM score in both groups were significantly higher one month after treatment, and that of the observation group was significantly higher compared to the control group (P<0.01). Conclusion: When used in addition to a foundation of routine rehabilitation training, upper limb rehabilitation robot assistant treatment of stroke patients with hemiplegia can effectively improve upper limb motor function and promote motor function recovery.

目的 探讨下肢正压支撑跑台训练联合肌内效贴在肌肉骨骼损伤康复中的应用及对患者平衡能力与运动功能的影响.方法 选取2016年8月-2018年8月我院收治的肌肉骨骼损伤患者68例,按照随机数字表法分为对照组和研究组,各34例.对照组应用下肢正压支撑跑台训练治疗,研究组在对照组基础上加用肌内效贴治疗.比较两组治疗效果.结果 研究组徒手肌力评定(MMT)评分高于对照组(P<0.05),研究组改良Ash-worth量表(MAS)评分低于对照组(P<0.05);研究组Berg平衡量表(BBS)评分高于对照组(P<0.05),研究组计时起立行走测试(TGUT)低于对照组(P<0.05);研究组步长、步宽以及步速均优于对照组(P<0.05).结论 在针对肌肉骨骼损伤患者进行康复治疗的过程中,下肢正压支撑跑台训练联合肌内效贴可以有效促进患者平衡能力以及运动功能的恢复,有助于患者康复.

目的 探讨超声测量自体动静脉内瘘(arteriovenous fistula,AVF)血管对AVF成熟及血液透析(hemodialysis,HD)治疗充分性的评价作用. 方法 对8个HD中心符合条件的患者进行横断面研究,超声测量前臂AVF血管,包括AVF侧上肢肱动脉末段(a1)、桡动脉(a2)和尺动脉起始段(a3)、AVF吻合口上桡动脉(a4)、AVF流出道静脉穿刺引血段(a5)等血管的内径(diameter,D)、收缩峰流速(systolic peak flow velocity,SPV)、舒张末流速(end-diastolic flow velocity,EDV)、血流量(blood flowvolume,BFV),选取其中稳定HD测算单次尿素溶质清除指数K t/V,以Da5≥0.5cm且BFVa5＞500ml/min为AVF成熟,Kt/V≥l.2为HD治疗达标,对AVF成熟和Kt/V达标进行Logistic回归分析,用受试者工作特征曲线(receiver operating characteristic curve,ROC)根据Logistic回归公式评估Kt/V达标情况;根据AVF成熟和Kt/V达标情况,分为双达标组(组1)、AVF成熟但Kt/V不达标组(组2)、AVF不成熟但Kt/V达标组(组3),对各组间各参数进行对比分析. 结果 8家HD中心入组患者324例,AVF成熟223例(68.83％),HD治疗达标310例(95.68％),AVF成熟的相关参数为Da2(相关系数为5.779,OR为0.003,P=0.003),Kt/V达标的相关参数为体质量(相关系数为-0.057,OR为1.059,P=0.000)、有无糖尿病(相关系数为0.983,OR为0.374,P=0.035)、和Da5(相关系数为6.137,OR为0.002,P=0.000),Logistic公式估算值对Kt/V进行ROC计算得到的曲线下面积=0.849 (P=0.000,95％ CI 0.784～0.914);组l有209例(64.5％)、组2有14例(4.3％)、组3有101例(31.2％),组2与另两组比糖尿病比例(78.6％对组1的40.2％,x2=15.234,P=0.000;对组2的35.6％,x2=84.236,P=0.000)、身高[(173.64±8.35)cm对组1的(167.37±7.86) cm,P=0.003,95％ CI:2.15～10.39;对组3的(166.10±6.89) cm,P=0.001,95％ CI:3.29～11.80]、体质量[(85.04±22.19)Kg对组l的(66.63±l0.72)Kg,P=0.000,95％ CI:-24.88～11.93;对组3的(65.31±12.37)Kg,P=0.000,95％ CI:-26.41～13.03]更大、Kt/V[(1.04±0.13)对组l的(1.31±0.28),P=0.000,95％ CI:0.12～0.42;对组3的(1.29±0.27)cm,P=0.001,95％ CI:0.101～0.406]更小,组3的Dal～Da4 [Dal为(0.54±0.11)cm对(0.61±0.13)cm,P=0.000,95％ CI:-0.063～0.072;Da2为(0.41±0.l0)cm对(0.48±0.13) cm,P=0.000,95％ CI:-0.062～0.016;Da3为(0.41±0.09)cm对(0.46±0.ll)cm,P=0.000,95％ CI:-0.071～-0.021;Da4为(0.31±0.08) cm对(0.35±0.l0)cm,P=0.001,95％ CI:-0.062～-0.016]、SPVal[(ll2.01±48.70) cm/s对(129.45±48.12) cm/s,P=0.003,95％ CI:-28.780～-6.097]和EDVal[(55.34±31.20)cm/s对(69.08±43.19)cm/s,P=0.004,95％ CI:-23.050～-4.415]明显小于组1,而Da5[(0.46±0.15)cm对组l的(0.75±0.31)cm,P=0.000,95％ CI:-0.349～-0.221;对组2的(0.63±0.26)cm,P=0.037,95％ CI:-0.311～-0.010]和BFVa5[(587.67±413.08)ml/min对组1的(2039.28±1550.72)ml/min,P=0.000,95％ CI:-1762.72～1140.502;对组2的(1695.37±401.58) ml/min,P=0.003,95％ CI:-1839.843～-375.571]明显小于另两组.结论 超声测量血管可以反映AVF成熟情况,Da2是AVF成熟与否的独立影响因素,包含Da5、体质量和患DM情况的回归公式可以估测单次HD的Kt/V水平,AVF成熟与Kt/V达标存在不匹配.

Objective To investigate serum levels of inflammatory factors and immune factors in patients with diabetes mellitus complicated with lower extremity vascular disease and their clinical significance. Methods A total of 144 patients with diabetes mellitus were collected from Beijing Rehabilitation Hospital between March 2016 and June 2017,who were divided into two groups:Group A(n=73)composed of patients with diabetes alone and Group B(n=71)composed of diabetic patients with lower extremity vascular disease,while another 30 healthy volunteers served as the control group. The relationships between age, blood pressure,diabetes course,BMI,FPG,HbAlc, serum levels of IL-6,Cys-C,MMP-9 and CRP were detected and com-pared between the three groups.Results The diabetes course of Group B was longer than that in Group B(P<0.05).BMI,FPG, and HbAlc of these two groups were significantly higher than those of the control group(P<0.05).The difference in TG,HDL-C and LDL-C was statistically significant between the three groups(P<0.05).There was no statistical difference in serum levels of TC in the three groups(P>0.05).There was statistically significant difference in IL-6,Cys-C,MMP-9 and hsCRP between the three groups(P<0.05). IL-6,Cys-C,MMP-9 and hsCRP were independent risk factors for diabetes complicated with low-er extremity vascular disease. Conclusion The levels of serum inflammatory factors of diabetes mellitus patients with lower extremi-ty vascular disease are higher than those with diabetes alone.IL-6,MMP-9,CRP and hsCRP may be involved in the pathophysio-logical process of hardening of the arteries,which can evaluate the risk of diabetes complicated with lower limb artery lesions.

目的 分析维持性血液透析患者并发尿路感染相关危险因素及应对的预防措施.方法 回顾性分析2016年2月-2017年8月在我院行维持性血液透析的124例患者的资料,分析患者并发尿路感染相关因素及预防措施.结果 124例患者发生尿路感染率为28.22％,检出病原菌46株,革兰阴性菌、革兰阳性菌及真菌分别占58.70％、34.78％、6.52％;患者年龄>60岁、女性、住院时间>20 d、糖尿病病程>10年、空腹血糖>8 mmol/L、糖化血红蛋白>7％、血红蛋白<90 g/L、血清白蛋白<30 g/L、其他慢性疾病≥3种、有留置导管、应用抗菌药物是发生尿路感染的相关危险因素(P<0.05).结论 维持性血液透析患者的尿路感染的相关危险因素较多,在临床实践过程中针对相关危险因素进行预防干预可有效地降低尿路感染的发生率.

Objective To observe the effect of decitabine (DAC) on macrophage polarization.Methods Bone marrow-derived macrophages (BMDMs) were obtained from six week-old C57/6L mice.The cell viability was detected by CCK8,western blot technique was adopted to detect macrophage phenotype changes treated by DAC.Macrophages were divided into control group,LPS group (LPS induced) and DAC group (LPS+DAC treatment),the levels of inflammatory factors were detected by qRT-PCR.The expression of macrophage subtype maker proteins was detected by western blot.Results Decitabine did not affect the activity and proliferation of macrophages.Compared with LPS group,DAC obviously depressed the expression of pro-inflammatory factors with IL-6 (99％) and CXCL10 (98％) decreasing most,and it upregulated anti-inflammatory factors with IL-4 increasing most by about 3 times (P ＜ 0.05).Western blot results showed that DAC also obviously decreased M1 macrophage surface maker iNOS by 72％ (1.4 vs 0.4,P=-0.001) and upregulated M2 macrophage surface maker Arg-1 for 1.8 times with significant differences (0.5 vs 0.9,P=0.01).Conclusion Decitabine treatment can promote the polarization of macrophage to regulatory macrophage (M2) and restrain chronic inflammation.

Objective To explore the TCM syndrome distribution regularity in patients with diabetic peripheral neuropathy (DPN),and provide the basis for TCM quantitative research.Methods 156 patients with DPN were investigated with formulated DPN syndromes questionnaire and cross-sectional study method.Then the obtained clinical data were analyzed with the frequency of the data statistics and clustering analysis.Results The high frequency of TCM symptoms followed by limb numbness,pricking pain,skin itching,hesitant pulse,burning sensation,general fatigue,dry mouth and throat,shortness of breath and reluctance of speaking,varicose veins under the tongue,blurred vision,etc.;clustering distribution of TCM syndrome types were spleen-qi deficiency with blood stasis in the collaterals in 49 cases (31.4％);yang deficiency of spleen and kidney and blood stasis in the collaterals in 57 cases (36.5％);yin deficiency of liver and kidney with blood stasis in the collaterals in 29 cases(18.6％);obstruction of heat and stasis in 21 cases(13.5％).Conclusion Among the TCM syndrome types in patients with DPN,the domain is obstruction of collaterals by stagnant blood,which is divided into spleen-qi deficiency;yang deficiency spleen and kidney;yin deficiency of liver and kidney;accumulation of heat and stagnation.

Objective To analyze the experience of Sitagliptin in the treatment of type 2 diabetes with metformin intolerance.Methods Elderly patients with type 2 diabetes mellitus ineffective controlled with metformin was treated with Sitagliptin based on the amount of metformin.Observe and recored the patients before treatment and after treatment of BMI,FBG,hypoglycemia incidence.Results After treatment,FBG,2hPG and HbAlc were significantly lower than those of before treatment( <0.05);patients in the treatment process did not appear severe hypoglycemia.Conclusion Sitagliptin combined with metformin in treatment of type 2 diabetes with metformin intolerance has significantly effect,can effectively reduce the metformin in patients with resistance,reduce dosage,and has higher security.

目的:研究缬沙坦和冬虫夏草制剂联合治疗对2型糖尿病肾病患者的临床疗效.方法:选取2型糖尿病肾病患者150例.按照随机数表法分为缬沙坦组和联合组,每组75例.常规降糖和控制血压治疗,缬沙坦组给予缬沙坦,联合组在给予缬沙坦的基础上给予冬虫夏草制剂.疗程90 d.观察两组患者临床疗效并比较治疗前后患者24 h尿蛋白排泄率(UAER)、血清尿素氮(BUN)、血肌酐(Scr)、血脂、炎症因子水平及血压水平变化.结果:治疗后,两组患者24 h尿蛋白清除率、超敏C-反应蛋白、肿瘤坏死因子-α及血压比较均有显著意义(P＜0.05),其他指标治疗后比较无统计学意义;联合组治疗有效率为93.33％,缬沙坦组为69.33％,两组比较具有统计学意义(P＜0.05).结论:缬沙坦和冬虫夏草制剂联合使用明显降低2型糖尿病肾病蛋白尿水平并改善炎症微环境,具有很好的临床疗效,值得在临床推广.