目的 比较Pentacam HR三维眼前节分析系统、角膜光学显微镜SP-3000P、扫频源光学生物测量仪OA-2000及相干光眼前段成像仪(Optovue Angiovue OCT)测量中央角膜厚度(CCT)的一致性.设计 诊断技术评价.研究对象 2021年9-11月北京同仁医院眼科角膜正常的白内障患者118例(118眼).方法 分别采用上述4种仪器测量角膜厚度,比较角膜顶点CCT值的差异性和一致性,并比较Pentacam HR测量角膜顶点及瞳孔中央CCT值的差异,以及Optovue OCT测量角膜顶点及中央2 mm直径平均CCT值的差异.主要指标CCT值、组内相关系数(ICC)、Bland-Altman图中平均值差值及95％一致性界限(LoA).结果 Pentacam HR、SP-3000P、OA-2000 及 Optovue OCT 测量角膜顶点 CCT 值分别为(532.29±30.35)μm、(512.20±30.88)μm、(516.89±31.25)μm、(515.58±29.78)μm;4 种仪器比较差异具有统计学意义(F=559.469,P＜0.001);其中 OA2000 测得 CCT 与Optovue OCT比较有差异(P--0.022);其余各组比较P均＜0.001.Pentacam HR测量瞳孔中心CCT值为(531.25±30.75)μm,与角膜顶点CCT值比较差异具有统计学意义(t=6.275,P＜0.001);Optovue OCT测量中央2 mm直径平均CCT值为(516.75±29.72)μm,与角膜顶点CCT值比较差异具有统计学意义(t=4.364,P＜0.001).Pentacam HR与其他3种仪器的ICC值为0.806～0.878,Bland-Altman 分析显示平均值差值为 15.40～20.09μm,95％LoA 为 5.9～32.4 μm.SP-3000P 与 OA-2000 和 Optovue OCT 的 ICC 值为 0.973 和 0.974,平均值差值为-4.69 μm 和-3.38 μm,95％LoA 范围为-15.6～8.6 μm.OA-2000 与 Optovue OCT 的 ICC 值为0.986,平均值差值为 1.31 μm,95％LoA 为-8.3～10.9 μm.结论 角膜顶点 CCT 测量值 SP-3000P、OA-2000 与 Optovue OCT 测量值相关性和一致性好,差异在临床可接受范围内,临床上可以相互换用.Penctacam HR测量值高于其他3种仪器,一致性较差,不建议直接相互替换.

目的 观察腹部八法治疗餐后不适综合征(postprandial distress syndrome,PDS)伴焦虑状态的临床疗效.方法 将88例PDS伴焦虑状态的患者随机分为对照组和治疗组,各44例.治疗组采用腹部八法治疗,对照组采用口服枸橼酸莫沙比利治疗,共治疗4周.治疗前后以及4周、8周随访时分别对2组进行餐后不适综合征症状积分、HAMA焦虑量表评分,记录2组治疗过程中的不良反应.结果 治疗后,治疗组总有效率97.7％,高于对照组的86.4％,差异有统计学意义(P＜0.05).与治疗前比较,治疗4周后及4、8周随访时,2组餐后腹胀不适、早饱、胃纳减少、嗳气、上腹灼热症状积分及总分均降低(P＜0.05);2组8周随访时上腹灼热评分比较,差异无统计学意义(P＞0.05),其他各项评分治疗组均低于对照组(P＜0.05).治疗4周及4、8周随访,2组HAMA评分均较治疗前降低(P＜0.05),且治疗组HAMA评分均低于对照组(P＜0.05).治疗过程中及8周随访时,2组均未出现不良反应.治疗组无明显复发,对照组有4例患者在治疗结束后4～8周出现复发.结论 腹部八法能够明显缓解PDS患者的临床症状和焦虑状态,安全且无复发.

目的:应用Meta分析针刺联合中药内服治疗糖尿病视网膜病变(diabetic retinopathy,DR)的临床疗效.方法:检索PubMed、Embase、Web of Science、Cochrane Library、中国知网(CNKI)期刊数据库、万方数据库及中国生物医学文献数据库(SinoMed)中针刺联合疗法治疗DR的文献,运用Stata进行Meta分析.结果:共纳入10篇文献,Meta分析结果显示,与其他治疗疗法相比,针刺联合中药内服显著提高了总有效率(RR=1.21,95％CI为1.13～1.30)、视力水平(WMD=0.18,95％CI为0.11～0.25)、黄斑厚度(WMD=-32.25,95％CI为-48.94～-15.56)和视敏度(WMD=2.92,95％CI为2.57～3.27),与对照组相比差异均有统计学意义(P<0.01).结论:针刺联合中药内服用于治疗DR可以显著提高患者视力水平和视敏度,降低黄斑厚度,减缓疾病发展,改善患者症状.

目的 观察孙氏降糖饮治疗气阴两虚型2型糖尿病的临床疗效.方法 将入选的90例气阴两虚型2型糖尿病患者随机分为2组,各45例,均给予基础治疗,对照组予二甲双胍治疗,治疗组加用孙氏降糖饮中药治疗.比较治疗12周后患者空腹(FPG)及餐后2h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、体质指数(BMI)、中医证候积分及血常规、肝肾功的变化情况.结果 治疗12周后,治疗组与对照组FPG、2hPG、HbA1c、FINS均有明显下降,治疗组较对照组下降显著,差异有统计学意义(均P＜0.05);ISI均较治疗前明显升高,治疗组较对照组升高显著,差异有统计学意义(P＜0.05);BMI均较治疗前降低,但2组差异无统计学意义(P＞0.05).治疗组中医证候疗效显著优于对照组,差异有统计学意义(P＜0.05);2组血常规、肝肾功均无明显变化.结论 孙氏降糖饮配合二甲双胍治疗2型糖尿病,能够显著降低患者的血糖指标,减轻胰岛素抵抗,缓解临床不适症状,安全有效.

荷兰鹿特丹Erasmus大学医学中心的 Fahriye Groen-Ha-kan等在2019年9月出版的《英国眼科杂志》上提出,葡萄膜炎初发患者淋巴细胞减少是预测结节病发生的一项指标.结节病常波及眼部,主要表现为葡萄膜炎.

Objective To evaluate the clinical effect of Xueluokang decoction lavipeditum on diabetic peripheral neuropathy(DPN) of cold-stagnation and blood-stasis type.Methods From January 2017 to January 2018,70 DPN patients in Beijing Hepingli Hospital were randomly divided into observation group and control group,with 35 cases in each group.Both groups were treated by rational diet,exercise guidance,hypoglycemic drugs and mecobalamin tablets.The control group was given lavipeditum with warm water and the observation group had lavipeditum with Xueluokang decoction once daily for 4 weeks.Total curative effect,score of Toronto Clinical Scoring System(TCSS),vibration perception threshold(VPT) were assessed and adverse reactions were observed.Results Total effective rate in observation group was significantly higher than that in control group[85.7％ (30/35) vs 60.0％ (21/35)] (P ＜ 0.05).After treatment,TCSS score and VPT of bilateral lower limbs were lower than those before treatment and they were lower in observation group than those in control group [(3.2 ± 0.8) vs (6.2 ± 0.6),left VPT:(14.1 ±1.9)V vs (18.2±2.1)V,right VPT:(13.5 ±1.5)V vs (18.0 ± 1.6)V] (all P＜ 0.05).There was no significant difference of the incidence of adverse reactions between groups (P ＞ 0.05).Conclusion Xueluokang decoction lavipeditum can alleviate clinical symptoms,improve TCSS score and VPT in DPN oatients.

目的 在社区医院观察血络康足浴治疗糖尿病周围神经病变的临床效果.方法 选取社区医院2016年1月-2017年1月门诊就诊的糖尿病周围神经病变患者90例,按照随机数表法随机分成观察组和对照组,每组45人.所有患者均制定科学的饮食和运动方案,应用口服药或胰岛素控制血糖,对照组患者每天使用温水浴足1次,观察组患者每天使用血络康浴足1次,参照《22个专业95个病种中医诊疗方案(合订本)》分为显效、有效和无效3个等级.结果 2组患者的血糖控制均良好,均无不良反应,周围神经病变分级结果用统计学处理,得出2组的总有效率比较,差异有统计学意义(P＜0.05).结论 在社区医院将血络康足浴应用于辅助治疗糖尿病周围神经病变,可以减轻改善患者的麻木、疼痛等症状,治疗效果明显优于单独使用温水足浴治疗.

笔者结合《黄帝内经》与临床实践,提出"脾藏精"的假说,从以下几个方面探讨糖尿病糖代谢:血糖源于饮食由脾所主;血糖属土为脾所主;血糖为脾所藏之精气,正常范围内的血糖称为"脾藏精气而不泻也,满而不实";尿糖是脾藏精功能失常的体现;多余的血糖在脾主藏精的作用下转为肌、肝糖原,"脾不藏精",脾失主糖,则糖原分解增多,糖异生作用增强,血糖升高;治疗要重视益气固摄与健脾收涩以恢复脾藏精的功能.本假说对从脾论治糖尿病提供一个角度的理论支持,尤其是健脾益气固摄与健脾收涩的药物应用.

现代医学中的“血糖”,在中医学中应当属于“水谷精微”的范畴.贺仲晨主任认为初发糖尿病血糖异常及胰岛素抵抗与“脾主运化”、“脾藏精”、“脾主内”等功能失调有关,并提出脾主糖的理论.在调理脾胃的治疗方法上,可从养脾阴、益脾气、化脾湿等方面入手.根据辨证,或与清胃同施,或与益肾相兼,终这脾运得健,水谷精微的转输与利用恢复正常,血糖降低、糖尿病并发症等得以好转为目的.

It remains controversial whether degenerative posterior longitudinal ligaments should be removed during anterior decompression procedures for cervical spondylotic myelopathy. Few data are available from studies that have compared removing and retaining the degenerative posterior longitudinal ligament. The goal of this retrospective study was to evaluate the benefit of degenerative posterior longitudinal ligament removal during such operations. Clinical data on 130 patients with confirmed degenerative posterior longitudinal ligament who underwent anterior cervical decompression surgery were retrospectively reviewed. All procedures were performed by the same senior orthopedic surgeon at the authors' spinal surgery center. The degenerative posterior longitudinal ligament was removed in 62 patients (group A) and retained in 68 patients (group B). The 130 patients were followed for 36 months. The Japanese Orthopedic Association score improved from 9.0±2.7 to 14.7±1.5 in group A and from 9.4±2.6 to 14.1±1.7 in group B (P=.028). The recovery rate for spinal cord neurologic function was 66.7% in group A and 61.3% in group B (P=.031). Operating time was longer (P=.002) and the sagittal median diameter of the vertebral canal was enhanced in group A (P<.001). Narrowing of previously enlarged canals occurred at a significantly higher rate in group B (P=.044). No significant difference was found in the rates of common complications between groups. Removal of the degenerative posterior longitudinal ligament in anterior decompression procedures for cervical spondylotic myelopathy appeared to be beneficial and provided more complete decompression and better postoperative outcomes than surgery without removal of the ligament. Although this procedure was generally safe, it required longer operating times, was more technically challenging, and required more experienced surgeons than surgery without removal of the ligament.

Objective To investigate the changes of multifocal electroretinogram(mf-ERG) in early diabetic retinopathy(DR).Methods The first order kernel(FOK) of the mf-ERG was performed in 29 diabetic patients with normal retinal thickness and corrected visual acuity of 1.0 or more.The presence or absence of non-proliferative diabetic retinopathy(NPDR) was identified by the fundus fluorescein angiography(FFA).Fifteen age-matched healthy subjects were selected as the control group.Results Compared with the control subjects,the FOK amplitudes of N1,P1,and N2 in the NDR group were significantly decreased,and the latency of N1,P1,and N2 were not statistically delayed;while the FOK amplitudes of N1 and N2 in the NPDR group were significantly decreased,and the latency of N1 and P1 were delayed.Compared with the NDR group,the FOK amplitudes of N1 and P1 in Ring 1~6 and P1 in Ring 1~2 and 4~5 in the NPDR group were significantly decreased,and the latency of N1 and P1 were not statistically delayed.Conclusion Changes of mf-ERG in early diabetic retinopathy develop before the presence of diabetic retinopathy morphological changes.

Objective To investigate the association of ankle-brachial index(ABI) with carotid atherosclerosis in type-2 diabetic patients.Methods A total of 328 type-2 diabetic patients were selected.Theia clinical and laboratory data were collected.The ABI measurements and carotid ultrasonography were performed.The patients were divided into either a atherosclerosis group or non-atherosclerosis group according to the examination by color Doppler ultrasonography.Results The ABI value in the atherosclerosis group was lower than that in the non-atherosclerosis group.The difference was statistically significant(P<0.05).The ABI value is negatively correlated with IMT.Conclusion The ABI value is negatively correlated with the degree of carotid atherosclerosis in type-2 diabetic patients.

Objective To study the relationship between diabetic nephropathy(DN) and its risk factors.Methods A total of 381 type-2 diabetic patients were divided into three groups: normal albuminuria(NA),microalbuminuria(MA) and clinical proteinuria(CP),depending on the levels of urinary albumin excretion rate(UAER).The differences of the 3 groups in terms of age,duration of diabetes,systolic blood pressure(SBP),diastolic blood pressure(DBP),waist-to-hip ratio(WHR),body mass index(BMI),fasting plasma glucose(FPG),glycosylated hemoglobin A1c(HbA1c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),uric acid(UA) and C-peptide.Logistic regression analysis was used to analyze the possible factors that might affect the DN.Results There were statistically significant differences in age,duration of diabetes,WHR,SBP,DBP,LDL-C,TC,HbA1c C-peptide and UA among the 3 groups.Logistic regression analysis showed that diabetic duration and SBP were independent risk factors(OR=1.029 and 1.088,P<0.05 for both).Conclusion A close correlation has been found between duration of diabetes and SBP.Monitoring and evaluating systemic factors will be helpful for prevention and treatment of DN.

Objective To evaluate the sensitivity and specificity of one-field non-mydriatic,45odigital photography for diabetic retinopathy screening,compared with indirect ophthalmoscopy using slit-lamp biomicroscopy,to see if it meets the reference standard.for an effective screening program proposed by the British Diabetic Association(BDA)(sensitivity values of>80%,specificity values of>95%,with a technical failure rate of<5%)?Methods Analyses the reference of 73 patients of type 2 diabetic who have been underwent 45o,non-mydriatic,digital fundus photography using a non-mydriatic fundus camera,and dilation of their pupils,and slit-lamp biomicroscopy done by an ophthalmologist.The sensitivity and specificity of the digital photographic method were calculated with,in orderto compare with the reference method.Results The sensitivity and specificity of one-field,non-mydriatic,45odigital photography for detection of any diabetic retinopathy were 83.9% and 89.9%,and the technical failure rate was 6.9%.The sensitivity and specificity for detection of referable diabetic retinopathy were 45.5% and 100%.After the standard for referable diabetic retinopathy being lowed down to the moderate non-proliferative diabetic retinopathy,the sensitivity and specificity were 95.5% and 84.2%,respectively.Conclusions One-field,non-mydriatic,45odigital photography is an effective method for diabetic retinopathy screening,and roughly meets the refevence standavd for an effective screening program.Proposed by the British Diabetic Association(BDA).

Objective To investigate the incidence and progression of diabetic retinopathy in type 2 diabetes,and to analyze the risk factors associated with incidence and progression of diabetic retinopathy.Methods One hundred and sixty-four patients,diagnosed as type 2 diabetes mellitus(84 males,80 females;mean age: 58.84±9.12 years,age of onset: 50.65±9.31 years,diabetes duration: 8.21±6.73 years) from the endocrinology unit of Beijing Tongren Hospital from March 2003 to December 2004 were recruited in this study.All the patients had underwent one-field,non-mydriatic,digital photography,and had diagnosed as no diabetic retinopathy and mild or moderate nonproliferative diabetic retinopathy according to international clinical diabetic retinopathy disease severity scales in 2002.During follow-up in September 2006 to December 2006 the same method was used.According to the baseline degree of diabetic retinopathy,we divided the subjects into two groups: no diabetic retinopathy,mild or moderate nonproliferative diabetic retinopathy.The baseline age,diabetes duration,arterial blood pressure,body mass index,waist to hip ratio,fasting blood glucose,HbA1c,lipid profile were evaluated.Results After 2 years,DR developed in 22 of 104(21.2%) patients unaffected at baseline,progression of mild or moderate nonproliferative diabetic retinopathy in 22 of 60(36.7%).Logistic regression analysis showed that the duration,glycosylated hemoglobin,total cholesterol and urine albumin were independent risk factors of incidence of diabetic retinopathy;duration,body mass index and dyslipdemia were independent risk factors of progression of mild or moderate nonproliferative diabetic retinopathy in type 2 diabetes.Conclusion DR is a multifactorial microvascular complication of type 2 diabetes,which,apart from hyperglycemia,is influenced by blood pressure,lipid concentrations,urine albumin,and other factors.It is necessary to control the risk factors,with regular follow-up and in time treatment for preventing visual loss.