目的 对2型糖尿病患者胰岛素抵抗指数(HOMA-IR)、脂联素(APN)、瘦素(LEP)、骨密度(BMD)进行分析,以探讨HOMA-IR、APN、LEP在糖尿病性骨质疏松发病中的作用.方法 124例2型糖尿病患者,根据股骨颈Lunar双能X线骨密度仪(DEXA)测量结果 分为糖尿病并骨质疏松组(55例)及糖尿病无骨质疏松组(69例);另选取42例体检的健康人作为对照组.检测三组的APN、LEP、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、甘油三酯(TG)、腰椎BMD、左股骨BMD、HOMA-IR、糖化血红蛋白(HbA1c)水平并进行比较.结果 三组LDL-C、HDL-C、TC、TG比较差异无统计学意义(P>0.05).糖尿病并骨质疏松组、糖尿病无骨质疏松组的腰椎和左股骨BMD分别为(0.71±0.16)、(0.84±0.13)g/cm2及(0.65±0.14)、(0.76±0.16)g/cm2,均明显低于对照组的(0.95±0.09)、(0.86±0.17)g/cm2,差异有统计学意义(P<0.05).糖尿病并骨质疏松组、糖尿病无骨质疏松组的HbA1c高于对照组,差异具有统计学意义(P<0.05).糖尿病并骨质疏松组LEP、HOMA-IR、APN高于糖尿病无骨质疏松组和对照组,差异有统计学意义(P<0.05);且糖尿病无骨质疏松组LEP、HOMA-IR、APN高于对照组,差异有统计学意义(P<0.05).HOMA-IR、APN、LEP与BMD呈负相关(r=-0.372、-0.442、-0.399,P<0.05).结论 HOMA-IR和APN、LEP作为2型糖尿病发病的重要因素,同时对糖尿病性骨质疏松的发病起到重要作用,测定其水平可以预测糖尿病性骨质疏松.

目的 探究常规超声(2DE)联合心脏声学造影(LVO)对心肌致密化不全(NVM)的诊断价值.方法 选取2017年1月—2021年6月于该院经常规二维超声心动图(2DE)诊断为疑似LVNC的患者为研究对象,共43例,所有患者均进行左心声学造影(LVO)检查,以Jenni等推荐的超声诊断标准作为标准,依据AHA16节段分析法,于收缩末期、舒张末期,对比评估2DE、LVO、2DE联合LVO对心肌节段的显示率、NC节段发现率、NC/C值及左心室射血分数(LVEF),综合评价2DE联合LVO对NVM的诊断价值.结果 43例2DE检查疑似NVM患者中,32例符合Jenni诊断标准确诊.2DE联合LVO检查在舒张末期、收缩末期的心肌节段清晰显示率均较单一2DE检查、单一LVO检查明显升高(100.00％vs 94.04％vs 98.84％、100.00％vs 93.75％vs 99.13％),差异有统计学意义(χ2=23.045、68.023,P<0.05).2DE联合LVO检查在舒张末期、收缩末期对于NVM患者NC发现率均较单一2DE检查、单一LVO检查明显升高(41.99％vs 23.28％vs 34.33％、40.82％vs 22.04％vs 32.14％),差异有统计学意义(χ2=39.298、40.397,P<0.05).2DE联合LVO检查NVM患者的舒张末期、收缩末期NC/C值较单一2DE检查、单一LVO检查明显升高,差异有统计学意义(F=4.132、6.265,P<0.05);2DE联合LVO检查NVM患者的LVEF与单一2DE检查、单一LVO检查相近,差异无统计学意义(P>0.05).结论 常规超声联合心脏声学造影检查能够提升NVM患者心肌节段清晰显示率、NC节段发现率及NC/C值,更有助于准确识别NVM.

目的 探讨分析糖尿病患者体脂分布与骨质疏松的相关性,为该疾病预防治疗提供参考价值.方法 80例2型糖尿病患者,根据是否合并骨质疏松分为A组(合并骨质疏松)与B组(未合并骨质疏松),每组40例.检测两组患者生化指标、双股骨密度及L1～4骨密度.比较两组患者骨密度情况,分析骨密度与各体脂分布指标的相关性.结果 A组双股骨密度(0.96±0.02)g/cm2、L1～4骨密度(0.83±0.04)g/cm2均低于B组的(1.16±0.31)、(1.09±0.17)g/cm2,差异具有统计学意义(P<0.05).患者全身脂肪、躯干脂肪、四肢脂肪含量与双股骨密度、L1～4骨密度均呈正相关(r=0.488、0.569、0.425、0.453、0.571、0.043;P<0.05),其中,与躯干脂肪含量相关性最大.患者瘦肉组织含量与双股骨密度、L1～4骨密度无相关性(P>0.05).结论 糖尿病患者的体脂分布与骨质疏松有较大相关性,特别是躯干脂肪组织含量.

目的:探讨超声弹性成像在颈部淋巴结结核(CTL)诊断的价值.方法:选取98例因CTL就诊的患者为研究对象,选择每例患者最大淋巴结,对其均行常规超声、弹性成像及病理HE检查,对各项超声指标进行统计学分析.结果:98例淋巴结结核患者均为多发性颈部淋巴结增大或多个淋巴结融合的颈部肿物.对最大淋巴结的超声表现判定Ⅰ型31枚,超声表现为淋巴结增大,呈类圆形,横纵比0.6～0.9,内部回声较低且不均匀,髓质破坏显著,皮质增厚,血流信号可见且丰富;Ⅱ型35枚,超声表现为淋巴结部分融合呈串珠样,体积较小,横纵比0.5～0.9,内部回声很低且不均匀,边缘不光滑,髓质消失,血流信号极少见,呈条状或短棒状;Ⅲ型19枚:超声表现为淋巴结增生增大显著,形态不规则,横纵比0.4～0.7,内部回声杂乱,内壁不均匀增厚,粗糙不平,伴有高回声的炎性水肿带,可见稀疏血流信号,以静脉血流为主;Ⅳ型13枚,超声表现为淋巴结萎缩,呈长条或椭圆形,横纵比0.3～0.6,内部回声低,血流信号不可见,可见钙化或纤维化灶.Ⅰ型:髓质破坏显著,皮质增厚.Ⅱ型:可见多个典型结核肉芽肿结构,肉芽肿中心无或者仅见微小干酪样坏死区.Ⅲ型:周边为不典型肉芽肿病变,散在朗罕氏细胞,多伴有显微组织增生,中央见大片融合干酪样坏死.Ⅳ型,皮质增厚,可见大片融合干酪样坏死.Ⅰ型、Ⅱ型的病灶硬度介于Ⅲ型与Ⅳ型之间,横纵比较高,Ⅲ型病灶硬度最低,弹性评分最低,横纵比介于Ⅰ型、Ⅱ型及Ⅳ型之间.Ⅳ型病灶硬度最高,弹性评分最高,横纵比较低.不同分型的淋巴结超声弹性评分和横纵比无线性关系(r=0.463,P=0.078).结论:超声弹性成像在诊断颈部淋巴结结核分型有一定的临床意义.

垂体促甲状腺激素(TSH)瘤是一种极其罕见的能引起甲状腺功能亢进的垂体肿瘤 , 仅占垂体瘤的 1.1％～2.0％[1, 2], 1960年Jailer报道首例 TSH 瘤病例[3], 至今为止已报道的例数超过 450 例[3].该病起病隐匿 , 进展缓慢 , 多数者以甲状腺功能亢进症 ( 甲亢 ) 为首发表现就诊 , 临床易误诊为甲亢并采用抗甲状腺药物治疗 , 甚至行 131I 治疗或甲状腺次全切除术治疗 , 这不仅不能使中枢性甲亢得到有效控制 , 反而可能加剧疾病进展 , 使患者出现严重的并发症.

目的 观察双侧卵巢切除(OVX) SD大鼠不同时期血清骨生化标志物与骨小梁三维结构变化之间的关系.方法 分别于6月龄雌性SD大鼠假手术(Sham)组和双侧卵巢切除术(OVX)组术后2、4、8、12周随机取样,每组每个时间点处死4只,取血清测量雌二醇(E2)、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRAP)水平,取胫骨用显微CT(Micro-CT)和组织学HE染色观察胫骨骨小梁微结构变化.结果 术后2周,OVX组E2较Sham组开始下降,4周时差异有统计学意义(P＜0.05),一直持续到12周,Sham组E2水平随时间变化不大;OVX组血清BALP在术后2周达峰值,然后迅速下降,12周时降至术前水平;OVX组血清TRAP活性在术后迅速升高,术后4周达峰值,然后下降,术后12周时仍高于Sham组及术前水平;Micro-CT分析胫骨干骺端相对骨体积(BV/TV)、骨小梁数目(Tb.N)、骨小梁分离度(Tb.Sp)、Conn.Dn、骨密度(BMD)在2周时与Sham组比较差异无统计学意义,第4周开始出现明显差异,12周差异更加明显,骨小梁厚度(Tb.Th)始终无明显差异;Micro-CT重建显示术后12周OVX组骨小梁较Sham组稀疏,缺失严重;HE染色显示术后12周OVX组大鼠胫骨干骺端骨骺板下骨小梁变细且排列稀疏,骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端,小梁壁厚度不一致.结论 OVX术骨质疏松模型建立过程中大鼠成骨及破骨细胞活跃度先增高后降低,破骨细胞相对而言上升周期更长且下降后能维持在更高水平,比成骨细胞更活跃,骨吸收大于骨生成导致骨质疏松,主要体现为骨小梁BV/TV、Tb.N、Conn.Dn、BMD下降,Tb.Sp升高,组织学表现为骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端.

Chronic cervicitis is one of the most common genecological diseases,which can cause pelvic inflammatory diseases and has a close relationship with the incidence of cervical cancer.Its pathogenesis is diversified.The varied therapy are used to treat this dease,and the local treatment,for emample,the physical therapy,drug therapy and surgery,is the primary therapy so far.

Objective To investigate the rational therapy in treatment of tubal pregnancy.Methods Data of 110 cases with tubal pregnancy from August 2007 to January 2009 were studied retrospectively.Three treatment methods were given included Chinese medicinal herbs,conservative surgery and radical surgery.Results Intrauterine pregnant rate was16%,47.83%,10.87% in medicine therapy,conservative surgery,and radical surgery,respectively,which significant difference among three groups.Recurrent ectopic pregnant rate among three groups was no statistically significant.Conclusion Conservative surgery is suitable for the young women who hope to preserve fertility;radical surgery is suitable for the women who have no hope to preserve fertility or with bulky lesion;Chinese medicinal herbs has no trauma and is cheap and has a long follow-up.

OBJECTIVE:To investigate the constitutive characteristics and the change trend of gynecologic malignant tumors in hospitalized patients in Guangxi Zhuang Autonomous Region over the recent 20 years. METHODS:Clinical data of 8009 in-patients who suffered from gynecologic malignant tumors in 23 hospitals from 1985 to 2004 in Guangxi Zhuang Autonomous Region were analyzed, with respect to the tumor types and change trend. RESULTS:(1) The leading 4 types of malignant tumors were cervical cancers, ovarian cancers, endometrial cancers, and malignant trophoblastic tumors according to the constitutive ratios of the tumors. The constitutive ratio of cervical cancer patients rose year by year, from 17.48% during the 1985-1989 period to 49.25% during the 2000-2004 period (P < 0.01). While the constitutive ratio of malignant trophoblastic tumors dropped year by year. The changes of ovarian cancer, endometrial cancer, vulvar and vaginal carcinomas, and sarcoma of the uterus were not obvious (P > 0.05). (2) The occurring age of cervical cancers became younger obviously, from > or = 60 years old dropped to < 40 years old. (3) Cervical cancers were found mainly in urban residents in the former 10 years, the constitutive ratio being 67.1%; while in the latter 10 years it gradually shifted to rural residents, accounting for 52.6% of the total gynecological tumors. (4) Patients were usually at stages II, III, IV when they visited a doctor for their diseases. Especially for ovarian cancer, malignant trophoblastic tumors, sarcoma of the uterus, these patients were in the intermediate or advanced stage when they were diagnosed, mainly because of lack of obvious symptoms. The constitutive ratio of these advanced patients was over 60%. CONCLUSIONS:We should strengthen the screening program of cervical cancer, and pay more attention to prevention and control of other gynecological reproductive organ tumors at the same time. On the other hand, we should explore better tumor markers, new methods of diagnosis and treatment to improve early diagnosis and treatment of gynecologic malignant tumors.