BackgroundCurrent screening for diabetic kidney disease (DKD) relies on the estimated glomerular filtration rate (eGFR) and albuminuria, which often fail to detect early tubular dysfunction and non-albuminuric phenotypes. The integration of macroscopic urine physical characteristics with metabolic signatures may offer a novel approach to precision stratification.MethodsWe conducted a multicenter, prospective-retrospective cohort study involving 364 participants with type 2 diabetes. We developed “FluxPro-DKD fusion model,” that integrates “Digital Physicalomics” (computer-vision quantification of urine foam stability and chromaticity) and “Dual-Fluid Metabolomics” (serum-to-urine flux ratios). The model was trained in a discovery cohort (n=282) and tested in an independent external validation cohort (n=82). The primary outcome was the detection of early-stage DKD. We also assessed the model’s prognostic utility for major adverse renal events over a simulated 3-year period.ResultsMetabolic profiling identified a distinct “serum-to-urine flux mismatch” of protein-bound uremic toxins (e.g., indoxyl sulfate), suggesting tubular secretory failure prior to glomerular damage. Digital physicalomics revealed that urine foam half-life was correlated with albuminuria (r=0.78). In the discovery cohort, the FluxPro-DKD fusion model achieved an area under the receiver operating characteristic curve (AUC) of 0.90 (95% confidence interval [CI], 0.87 to 0.93), significantly outperforming the standard clinical model (AUC, 0.78; P<0.001). The model maintained robust discrimination in the external validation cohort (AUC, 0.85; 95% CI, 0.79 to 0.91). Among patients with normoalbuminuria, those classified as high-risk by the model had a significantly higher projected 3-year event rate than those classified as low-risk (35.3% vs. 2.3%).ConclusionsThe integration of digital urine physical phenotypes and metabolic flux ratios effectively reveals early tubular secretory dysfunction and improved risk stratification for diabetic kidney disease compared with standard clinical metrics.

Objective:To observe the effects of traditional Chinese medicine(TCM)compound Tangnai Kang on blood sugar,body weight,interleukin-6(IL-6)and inhibitor of nuclear factor kappaB kinase beta(IKKβ)in Toll-like receptor 4(TLR4)signaling pathway and glucose transporter 4(GluT-4)in KKAy mice,and to discuss its possible mechanism in improving type 2 diabetes mel-litus(T2DM).Methods:SPF KKAy and C57BL/6J mice(spontaneous T2DM animals)were selected and fed with high fat food.After 8 weeks,blood sugar and body weight were evaluated and the levels of IL-6 and GluT-4 in plasma were measured by semi-quantitative ELISA.The protein expressions of TLR4 in liver tissue and IKKβin muscle tissue were detected by Western blot.Re-sults:High dose of Tangnai Kang reduced blood glucose(P＜0.05)and controlled the growth trend of body weight.It also de-creased the level of IL-6 and increased the level of GluT-4(P＜0.01,P＜0.05),and inhibited the protein expressions of TLR4 in liver tissue and IKKβ in muscle tissue(P＜0.01,P＜0.05).Conclusion:Tangnai Kang may reduce the low-grade inflammation response by down-regulating the key inflammatory factors in the LPS-mediated TLR4 signaling pathway,and thus inhibit the inflam-matory cascade effect to some extent.It also enhances the transposition and activity of GluT-4 in the insulin signal transduction pathway,to jointly improve the insulin resistance.

胰岛素自身免疫综合征(insulin automotive syn-drome,IAS)是一种罕见的低血糖症,其实验室检查显示异常升高的胰岛水平和胰岛素自身抗体阳性.IAS患者常以反复发作低血糖就诊,部分患者伴有血糖升高.其发病与遗传因素和环境因素、免疫缺陷、应用含巯基的药物或某些不含巯基的药物(如白蛋白)[1]、病毒感染(如麻疹病毒、腮腺炎病毒、风疹病毒、水痘-带状疱疹病毒、柯萨奇病毒和丙型肝炎病毒)[2]、某些血液疾病(如多发性骨髓瘤)[3]有关,亦有注射外源性胰岛素诱发者[4-5].西医治疗多以去除诱因,小剂量激素治疗为主,必要时可应用免疫抑制剂利妥昔单抗、血浆置换等,对少数不可纠正的低血糖患者可考虑胰腺切除术,但不良反应较多,患者难以接受.娄锡恩教授从事内分泌临床研究数十年,运用中医药治疗糖尿病经验丰富,现将其运用中医药治疗外源性注射胰岛素诱发的IAS合并糖尿病验案1则介绍如下.

目的 观察金匮肾气丸对肾阳虚型 2 型糖尿病合并亚临床甲状腺功能减退(甲减)患者胰岛素抵抗的影响.方法 选取2019 年1 月—2021 年12 月在北京中医药大学第三附属医院就诊的2 型糖尿病合并亚临床甲减[促甲状腺素(TSH)>10 mIU/L]且中医辨证属肾阳虚型的患者117 例为研究对象,随机分为治疗组58 和对照组59 例.2 组均给予糖尿病基础治疗加盐酸二甲双胍和左甲状腺素钠片治疗,治疗组在此基础上给予金匮肾气丸口服,2 组疗程均为12 周.比较2 组患者治疗前后胰岛功能相关指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素、空腹C肽、稳态模型胰岛素抵抗指数(HOMA2-IR)、稳定模型评估的胰岛β细胞功能指数(HOMA2-％β)]、甲状腺功能指标[TSH、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]、中医证候积分及治疗后临床疗效.结果 治疗后治疗组FPG、HbA1c、空腹胰岛素、空腹C肽、ln(HOMA2-IR)及神疲乏力、腰膝酸软、畏寒怕冷、性欲减退、夜尿频多、下肢浮肿评分均明显低于治疗前及对照组(P均<0.05).治疗后2 组ln(HOMA2-％β)、FT3、FT4 均较治疗前明显升高(P均<0.05),TSH均较治疗前明显降低(P均<0.05),但2 组间各指标比较差异均无统计学意义(P均>0.05).治疗组总有效率为94.83％(55/58),对照组为83.05％(49/59),治疗组明显高于对照组(P<0.05).结论 金匮肾气丸能有效改善2 型糖尿病伴亚临床甲减患者的胰岛素抵抗情况和临床症状,临床疗效优于单纯西药治疗.

目的:观察中药复方糖耐康对KKAy小鼠血糖、体重及低度炎症通路中关键因子的影响.方法:选取自发性2型糖尿病动物模型KKAy小鼠65只及C57BL/6J小鼠13只屏障系统饲养,给予高脂饲料喂养,连续给药8周后,评价静脉空腹血糖(禁食8 h以上)及体重变化,采用半定量酶联免疫吸附剂测定(ELISA)检测血浆中肿瘤坏死因子-α(TNF-α)及白介素-1β(IL-1β)、单核细胞趋化因子1(MCP-1)的水平.蛋白免疫印迹法检测肌肉组织核因子-κB(NF-κB)蛋白的表达水平.结果:中药糖耐康给药组中,尤其高剂量组,能够显著降低模型组血糖水平(P<0.05),具有一定控制体重增长趋势的作用;可下调炎性因子TNF-α、IL-1β及MCP-1的水平(P<0.05),下调肌肉组织中NF-κB蛋白的表达水平(P<0.05).结论:糖耐康可能通过抑制炎症信号通路中关键炎性因子的表达水平,抑制机体低度炎症反应,从而起到改善胰岛素抵抗及抗糖尿病的作用.

目的:研究二陈汤对Lewis小鼠移植瘤血管生成的影响,并探讨其对VEGF/VEGFR-2、PI3K/Akt表达的影响.方法:40只Lewis小鼠随机分为对照组、中药组、联合组和顺铂组,每组10只.造模成功后,对照组予以0.4 mL生理盐水日1次灌胃;中药组予以0.4 mL二陈汤药液日1次灌胃;顺铂组予以等量生理盐水灌胃的同时,用注射用顺铂以200μL/20 g剂量进行腹腔内灌注,隔3 d灌注1次;联合组同时给予中药灌胃和顺铂腹腔内灌注.各组小鼠均连续干预15 d后处死,提取实验目标组织.用免疫组化及Western blot法检测瘤组织中CD34、VEGFR-2、VEGF、PI3K、Akt蛋白的表达并计算微血管密度(MVD).结果:联合组抑瘤率最高,为22.94％(中药组13.04％、顺铂组21.26％).与对照组相比,中药组、联合组及顺铂组Lewis小鼠中VEGFR-2、VEGF、PI3K、Akt的蛋白表达均显著降低(P<0.05),联合组及顺铂组MVD值较其他组降低(P<0.05).结论:二陈汤联合顺铂可对Lewis瘤的增殖有一定抑制作用,其抗肿瘤的机制与通过PI3K/Akt通路干预VEGF/VEGFR-2分子轴影响肿瘤血管生成有关.

目的:观察经方葛根芩连汤对KKAy小鼠部分炎性因子及脂多糖介导的炎症通路中关键靶点的影响,探讨其改善2型糖尿病的作用机制.方法:选取SPF级自发性2型糖尿病动物模型KKAy小鼠65只及对照C57BL/6J小鼠13只予屏障系统、高脂饲料喂养,随机血糖≥13.9 mmoL·L-1,为成模小鼠44只.随机分为5组,每组11只.正常组(生理盐水20 mL· kg-1)、阿卡波糖组(3.9 mg· kg-1)、葛根芩连汤高、低剂量组(1.82、0.45 g·kg-1)及模型组(生理盐水20 mL· kg-1),连续灌胃给药8周,1次/d,系统评价血糖及体质量.末次给药12h后,摘眼球取血,提取血清及肌肉、肝脏组织.采用半定量酶联免疫吸附测定法(ELISA)检测炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及葡萄糖转运子4(GluT4)含量,蛋白免疫印迹法(Western blot)检测肌肉组织IκB磷酸化激酶β(IKKβ)蛋白、核转录因子-κB(NF-κB)及肝组织Toll样受体4(TLR4)蛋白表达水平.结果:与正常组比较,模型组体质量及血糖显著升高(P＜0.01);与模型组比较,阿卡波糖组及葛根芩连汤组能够明显降低体质量及血糖水平(P＜0.05,P＜0.01).ELISA结果显示,与正常组比较,模型组炎性因子TNF-α、IL-6含量显著升高(P＜0.01),GluT4含量明显下降(P＜0.05);与模型组比较,各给药组炎性因子TNF-α、IL-6含量均有不同程度下降(P＜0.05,P＜0.0l),阿卡波糖组与葛根芩连汤高剂量组GluT4含量明显升高(P＜0.05,P＜0.01).Western blot分析显示,与正常组比较,模型组IKKβ、NF-κB及TLR4蛋白表达均有升高(P＜0.01);与模型组比较,阿卡波糖组与葛根芩连汤组IKKβ、NF-κB及TLR4蛋白表达均明显下降(P＜0.05,P＜0.01).结论:葛根芩连汤可能在调节肠道菌群的基础上,通过下调TLR4通路中关键炎性因子的水平,抑制其激活,提高GluT4的转位及活性水平,从而在一定程度上抑制炎性级联效应,改善2型糖尿病.

目的 运用病例对照研究探讨中医药治疗与糖尿病视网膜病变发生的相关性,为该病的防治提供依据.方法 应用病例对照研究设计,在北京4家医院收集研究对象,以2型糖尿病合并视网膜病变的患者为病例组,以2型糖尿病不合并视网膜病变的患者为对照组,病例与对照以1:4的比例按照年龄、性别匹配研究对象.自行设计调查问卷,采用一对一调查的方式收集资料,应用Epi-Data 3.1软件录入数据,采用条件logistic回归的方法,应用SPSS 22.0软件分析中医药(治疗糖尿病或相关并发症为目的)与糖尿病视网膜病变患病的相关性.结果 病例组共纳入72例2型糖尿病合并视网膜病变的患者,对照组纳入236例2型糖尿病患者.病例组男性36人、女性36人,平均年龄(62.3±10.0)岁,病程[13(6,19)]年;对照组男性112人、女性124人,平均年龄(61.5±9.6)岁,病程[10(5,15)]年.单因素条件logistic回归分析显示病例组与对照组既往接受中医药治疗比例分别为52.8％和33.5％,差异有统计学意义(OR=2.505,95％CI:1.412-4.443).调整病程后,多因素条件logistic回归分析显示病例组与对照组既往接受中医药治疗比例差异有统计学意义(OR=2.296,95％CI:1.269-4.156).结论 中医药治疗与2型糖尿病患者是否合并视网膜病变具有相关性,有糖尿病视网膜病变的患者接受过中医药治疗的比例高且中医药治疗的平均时间较长,但鉴于病例对照研究的局限性,尚需要进一步前瞻性的研究设计结果加以证实.

Dysregulation of gut microbiota contributes to the development of type 2 diabetes. To investigate the antidiabetic effect of Tangnaikang and its regulation of gut microbiota in diabetic KKAy mice, a type 2 diabetes mouse model was established by feeding KKAy mice with a high-fat diet (HFD) for 2 weeks. The diabetic KKAy mice were treated with vehicle, Acarbose, or different doses of Tangnaikang once a day for 8 weeks. The fasting plasma glucose (FPG) levels and bodyweights were measured weekly. The fecal and blood samples were collected 8 weeks after treatment. The 16s rRNA sequencing and bioinformatics analysis were conducted to explore the effects of Tangnaikang treatment on the richness, diversity, and relative abundance of gut microbiota. Compared with other treatments, high-dose Tangnaikang (4.68 g/kg) significantly reduced FPG levels while elevating bodyweights in model mice. Compared with saline treatment, different doses of Tangnaikang significantly increased gut microbial species richness and diversity. Linear discriminant analysis effect size identified potential bacterial biomarkers associated with Tangnaikang treatment. Relative abundance analysis revealed that Tangnaikang treatment modulated the abundance of gut bacteria at the class and genus levels, such as Bacilli, Lactobacillus, and Alistipes. The principal component analysis demonstrated that, compared with the samples of the high-dose group, the samples of medium-dose and low-dose groups were closer to those of the model group. Tangnaikang alleviated hyperglycemia and improved the composition and abundance of gut microbiota in diabetic KKAy mice.

目的 观察葛根芩连汤对自发型2型糖尿病KKAy小鼠肠道菌群结构的影响.方法 采用自发型2型糖尿病SPF级KKAy小鼠65只及C57BL小鼠13只,高脂饲料喂养,血糖＞13.9mmol/L后,随机分为5组,正常组、阳性组(3.9 mg/kg)、葛根芩连汤高、低剂量组(18.2、4.55 g/kg)及模型组(生理盐水20 mL/kg).连续8周后留取粪便,采用16SrRNA检测菌群结构.结果 因高脂饲料喂养,各给药组体质量均有不同程度上升,其中葛根芩连汤组有相对控制体质量上升的趋势.与模型组比较,各给药组均有不同程度降低血糖的作用(P＜0.05、P＜0.01).同时,葛根芩连汤低剂量组及阳性组能够明显提高KKAy小鼠肠道菌群的群落丰度指数及多样性指数(P＜0.01),包括OTU、ACE、chaol及shannon、simpson.在菌群结构方面,从纲、属、科水平发现葛根芩连汤能够提高 Bacteroidia 的丰度,降低 Bacilli、Clostridia 和 Saccharimonadia 丰度、占比.降低 Lactobacillus 丰度,提高Akkermansia和f_Muribaculaceae_Unclassified丰度.提示葛根芩连汤具有一定程度的类似于乳酸杆菌的调节作用,同时能够调节脂代谢达到缓解2型糖尿病及胰岛素抵抗的作用.结论 葛根芩连汤能够改善糖尿病动物模型肠道菌群结构丰度及多样性,其作用机制可能是通过抑制慢性炎症水平,改善机体糖脂代谢,而达到改善2型糖尿病及胰岛素抵抗的作用.

In this paper, five representative Chinese herbal decoction pieces of Scutellariae Radix, Paeoniae Radix Alba, vinegar-processed Corydalis Rhizoma, Polygoni Multiflori Radix Praeparata and Lonicerae Japonicae Flos were selected to prepare the corresponding fine powder of pieces, extract powder, semi-extract powder and physical mixed powder. The physical properties of 20 kinds of powders, such as related parameters of particle size, density, stability and flowability, were evaluated comprehensively. The compression curves of powder porosity and tensile strength changing with pressure were plotted, and the Heckel equation and the Kawakita equation were used to describe the powder compression behavior. The results showed that compared with the fine powder of pieces, the compressibility of the semi-extract powder and the extract powder was significantly improved. Compared with the extract powder, the particle size and relative uniformity of the semi-extract powder were increased, indicating that the uniformity of the powder was improved. Besides, the semi-extract powder could reduce the hygroscopicity of the powder. Particularly, the semi-extract powder of Scutellariae Radix, Paeoniae Radix Alba and vinegar-processed Corydalis Rhizoma could maintain the porous structure of the tablet even under a high tableting pressure, which was beneficial to tablet disintegration. For some traditional Chinese medicines(such as Lonicerae Japonicae Flos), the semi-extract powder could reduce the viscosity, which avoided the sticking in the die compression. The semi-extract powder and the physical mixture powder prepared by the same Chinese herbal decoction pieces had similar physical properties and compression behaviors. Principal component analysis(PCA) was carried out on the 17 physical attributes and 5 compression parameters of the powder. It was found that the first principal component mainly reflected the differences among the material sources, while the second principal component could reflect the differences among fine powder of pieces, extract powder, semi-extract powder and physical mixed powder originating from the same Chinese herbal decoction pieces. In this paper, the mechanism of &quot;unification of drugs and excipients&quot; of Chinese medicine semi-extract powder was explained in terms of physical properties and compression behavior of powders, which provided reference for the formulation design and process development of Chinese medicine tablets.

Excessive fructose (FRU) intake can result in insulin resistance and metabolic disorder, which are related to renal injury.18α-Glycyrrhetinic acid (GA) is a bioactive component mainly extracted from Glycyrrhiza radix, and has anti-oxidant and anti-inflammatory activities. However, its effects on FRU-induced renal injury still remain unclear. In this study, we found that 18α-GA treatments could significantly ameliorate the cell viability in FRU-treated tubule epithelial cells, accompanied with improved mitochondrial membrane potential. Furthermore, reactive oxygen species (ROS) accumulation in FRU-stimulated cells was markedly reduced by 18α-GA, which were associated with the activation of nuclear factor (erythroid-derived-2)-like 2 (Nrf-2) and the blockage of MAPKs signaling. Additionally, dyslipidemia detected in FRU-treated cells was greatly inhibited by 18α-GA. We also found that 18α-GA significantly ameliorated FRU-induced inflammation in cells through reducing the expression of pro-inflammatory cytokines and chemokine. The anti-inflammatory effects regulated by 18α-GA were mainly related to the repression of nuclear factor-κB(NF-κB) signaling. Furthermore, the protective effects of 18α-GA against ROS production, lipid accumulation and inflammation were verified in renal tissues from FRU-challenged mice, consequently improving metabolic disorder and kidney injury. Taken together, these findings demonstrated that 18α-GA exerted renal protective effects through reducing oxidative stress, lipid deposition and inflammatory response, and thus could be considered as a promising therapeutic strategy for metabolic stress-induced kidney injury.

目的 探讨中药金银花对病毒性心肌炎小鼠Casp8se-3、NF-κB表达的影响.方法 将80只雄性BALB/c小鼠随机分为4组,每组20只,分别为正常对照组、模型组、金银花低剂量组和金银花高剂量组.模型组和金银花高、低剂量组小鼠均腹腔注射柯萨奇病毒B3(CVB3),建立病毒性心肌炎模型.金银花高、低剂量组于注射病毒后30 min开始灌服金银花药液,每日1次,共14 d;模型组以0.9％NaCl溶液灌胃;正常对照组用不含病毒的等量Eagle液腹腔注射,等量的0.9％NaCl溶液灌胃.各组分别在14 d随机抽取15只小鼠处死,HE染色观察心肌病理改变,免疫组化检测心肌组织中Caspase-3、NF-κB的表达.结果 模型组的Caspase-3、NF-κB表达水平均明显高于正常对照组,金银花高、低剂量组的Caspase-3、NF-κB表达较模型组均明显减轻;金银花高剂量组的Caspase-3、NF-κB表达水平较金银花低剂量组减轻.结论 金银花可明显抑制病毒性心肌炎小鼠Caspase-3、NF-κB的表达,为临床应用金银花治疗病毒性心肌炎提供了实验依据.

目的 探讨二陈汤其不同组方对Lewis肺癌小鼠免疫功能的影响.方法 60只C57BL/6小鼠建立Lewis肺癌小鼠模型,随机分为模型组、二陈汤组、二陈汤益气养阴组(二陈汤加生黄芪、知母)、二陈汤解毒散结组(二陈汤加山慈菇、姜黄)、二陈汤破血逐瘀组(二陈汤加三棱、莪术)、顺铂组,每组各10只.模型组灌胃生理盐水,二陈汤及其组方分别灌胃二陈汤及相应组方溶液,顺铂组腹腔注射顺铂溶液,每日1次,连用3天,同时灌胃生理盐水,每日1次,连续12天.测量小鼠重、脾重和胸腺重,计算脾指数和胸腺指数;全自动血液流变测试仪测定外周血细胞数量;流式细胞术测定小鼠脾脏T淋巴细胞亚群水平;CCK-8法测定脾淋巴细胞增殖能力.结果 与模型组相比,二陈汤及其组方脾淋巴细胞刺激指数均显著升高,顺铂组明显下降,二陈汤组脾指数、胸腺指数、外周血细胞及CD3+、CD4+、CD8+显著增高,益气养阴组脾指数、白细胞、血小板及CD4+升高,解毒散结组外周血细胞及CD3+、CD4+显著增高,破血逐瘀组胸腺指数、外周血细胞及CD3+、CD4+增高,顺铂组红细胞、血小板及CD4+/CD8+增高;与顺铂组相比,二陈汤及其组方脾指数、刺激指数及白细胞均显著升高,二陈汤组红细胞及CD3+、CD4+、CD8+显著升高,破血逐瘀组CD8+升高,CD4+/CD8+方面,二陈汤组、益气养阴组、破血逐瘀组均降低;二陈汤及其组方间比较,二陈汤组胸腺指数及CD3+、CD4+均显著高于益气养阴组,二陈汤组CD3+高于解毒散结组,二陈汤组CD3+、CD4+高于破血逐瘀组,破血逐瘀组胸腺指数高于益气养阴组,解毒散结组CD4+/CD8+高于破血逐瘀组.以上差异均具有统计学意义(P<0.01或P<0.05).结论 二陈汤及其不同组方均对Lewis肺癌小鼠的免疫功能指标有不同程度的提高,均可增加机体免疫功能,其中,以二陈汤增强免疫功能的作用最为明显.

Objective To explore the clinical effects of Selenious yeast tablets combined with Levothyroxine sodium in the treatment of hypothyroidism.Methods From April 2015 to April 2016,80 cases of patients with hypothyroidism treated in Beijing University of Chinese Medicine Third Affiliated Hospital were selected as research objects and divided into the control group and the experimental group by random,double-blind and control method,with 40 cases in each group.The control group was treated with oral Levothyroxine sodium combined with placebo and the experimental group was treated with oral Selenious yeast tablets on the basis of Levothyroxine sodium.Both groups were treated for 6 months.The clinical efficacy,the levels of thyroid stimulating hormone (TSH),free triiodothyronine (FT3) and free tetraiodothyronine (FT4),the adverse reactions and the patiens' satisfaction in the two groups were compared.Results After treatment,the incidence of clinical efficacy in the experimental group was higher than that of control group,with statistically significant difference (P ＜ 0.05).After treatment,the TSH was lower,the FT3 and FT4 were higher than those of before treatment in the two groups,the indicators above in the experimental group improved much more remarkably,with statistically significant differences (P ＜ 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).The patiens' satisfaction in the experimental group was higher than that of control group,with statistically significant difference (P ＜ 0.05).Conclusion Selenious yeast tablets combined with Levothyroxine sodium is helpful to control the clinical symptoms in patients with hypothyroidism.It can improve the levels ofthyroid hormone,promote the patiens' satisfactton and has high safty.It is worthy of promotion and application.

目的 观察参麦注射液治疗老年糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的临床疗效.方法 选取2010-01至2014-01北京中医药大学第三附属医院急诊科治疗的DKA患者68例,随机分为观察组34例和对照组34例.对照组给予持续静脉注射小剂量胰岛素,并同时给予扩容、抗炎、纠正酸碱平衡和电解质紊乱治疗,观察组在对照组的治疗基础上加用参麦注射液.结果 观察组的血糖控制达标时间、尿酮体消失时间、胰岛素使用剂量和酸中毒纠正时间均显著少于对照组(P＜0.05);两组患者治疗后的血钾、血钠、C反应蛋白(CRP)、血肌酐(SCr)、血尿素氮(BUN)水平均显著低于治疗前,动脉血气pH值水平均显著高于治疗前(P＜0.05);观察组治疗后的血钾、血钠、CRP、SCr、BUN均显著低于对照组,动脉血气pH值显著高于对照组(P＜0.05);观察组的总有效率是91.17％,显著高于对照组的总有效率73.52％ (P ＜0.05).结论 参麦注射液治疗老年DKA,改善临床症状、控制血糖的效果优于单用胰岛素治疗,值得临床推广.

目的 观察负荷量阿司匹林、氯吡格雷联合低分子肝素治疗短暂性脑缺血发作(aransient ischemic attack,TIA)的临床疗效及安全性.方法 96例TIA患者随机分为对照组和观察组.对照组使用单剂量阿司匹林和氯吡格雷,观察组用负荷量阿司匹林、氯吡格雷联合腹壁皮下注射低分子肝素,治疗1周时进行两组临床疗效评价.结果 观察组的总有效率为91.67％,高于对照组的70.83％ (P ＜0.01).两组脑出血、消化道出血、牙龈出血、皮肤黏膜出血等不良反应差异无统计学意义(P＞0.05).结论 负荷量阿司匹林、氯吡格雷联合低分子肝素治疗TIA疗效显著,安全可靠.

辟谷是中国古代的一种修炼养生术.通过辟谷疗法充养人体元气、健运脾肾之气、调整气机升降运动以达到轻身健体、延年益寿的效果.这正好与现代医学防治胰岛素抵抗要求限制饮食、减轻体重、改变饮食结构有异曲同工之妙.从调节肠道菌群这一研究热点出发,发掘辟谷疗法对胃肠微环境的影响在改善胰岛素抵抗方面具有广阔的研究前景和潜力.

Objective To observe the clinical effect of Yougui Pills combined with Levothyroxine Sodium Tablets in the treatment of hypothyroidism.Methods One hundred cases of patients with hypothyroidism treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from June 2015 to June 2016 were selected as research objects,and they were randomly divided into control group and experimental group according to random,double blind,control principle,with 50 cases in each group.The control group received Levothyroxine Sodium Tablets,on basis of which,the experimental group received Yougui Pills.Three months later,the clinical curative effect,scores of TCM syndrome and indexes of thyroid function between the two groups were compared.Results The total effective rate of experimental group (94.0％) was significantly higher than that of the control group (80.0％),the difference was statistically significant (P ＜ 0.05).After treatment,the scores of TCM syndrome of the two groups were significantly lower than those before treatment,and the experimental group was significantly lower than that of control group,the differences were statistically significant (P ＜ 0.05).After treatment,the contents of thyroid stimulating hormone (TSH) in the two groups were significantly lower than those before treatment,and the contents of serum free triiodothyronine three (FT3) and free triiodothyronine four (FF4) were significantly higher than those before treatment,and the content of TSH in the experimental group after treatment was significantly lower than that of the control group,while the contents of FT3 and FT4 were significantly higher than those of the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Yougui Pills combined with Levothyroxine Sodium Tablets in the treatment of hypothyroidism can not only increase the treatment efficiency but also improve the thyroid function of patients,which is worthy of promotion.

糖尿病是临床常见病、多发病，广泛分布于世界各地，对人类的危害仅次于恶性肿瘤和心脑血管病，是威胁人类健康的第三杀手。根据最新调查显示，我国糖尿病患病人数达9240万以上，糖尿病前期人数达1.48亿以上。胰岛素抵抗（IR）是产生2型糖尿病、高脂血症、高尿酸血症、心血管疾病及代谢综合征的共同发病基础。医学界已把伴有胰岛素抵抗的糖尿病、高血压、高血脂、冠心病、脑卒中称为“死亡五重奏”，是21世纪威胁人类健康与生命安全的头号杀手。因此，改善胰岛素抵抗的药物学研究具有重要的临床意义。现代学者明确指出中医药治疗2型糖尿病必须研究IR，认为中药治疗2型糖尿病的最终目的就是使 IR 逆转或减轻。