The objective of this study was to observe the clinical efficacy of apatinib (AP) combined with 131I in the treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) and the prognostic significance of MIP-1α after treatment, and to provide reference and guidance for future treatment and disease assessment of RAIR-DTC. One hundred and six patients with RAIR- DTC admitted to our hospital from January 2019 to October 2020 were selected for the study. All the patients were treated with TC surgery with 131I at our hospital, and 58 of them were subsequently transferred to AP treatment, which was considered as the research group; the other 48 patients were transferred to thyroid stimulating hormone (TSH) suppression treatment, which was considered as the control group. The clinical efficacy of the research group was better than that of the control group (P < 0.05), while no difference was seen in the comparison of the incidence of adverse effects and thyroid function (P > 0.05). After treatment, Tg, TL, maximum diameter of C/B lymph nodes, number of lymph nodes and number of calcified spots were lower in the research group than in the control group (P < 0.05). ROC analysis revealed that the predictive sensitivity of MIP-1α for prognosis of 3-year RAIR-DTC death in the research group of patients was 84.63 % and the specificity was 72.16 %. AP combined with 131I is effective in the treatment of RAIR-DTC and is worth using in the clinical practice. In addition, elevated levels of MIP-1α predicted a poor prognosis for patients with RAIR-DTC.

The objective of this study was to observe the clinical efficacy of apatinib (AP) combined with 131I in the treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) and the prognostic significance of MIP-1 alpha after treatment, and to provide reference and guidance for future treatment and disease assessment of RAIR-DTC. One hundred and six patients with RAIRDTC admitted to our hospital from January 2019 to October 2020 were selected for the study. All the patients were treated with TC surgery with 131I at our hospital, and 58 of them were subsequently transferred to AP treatment, which was considered as the research group; the other 48 patients were transferred to thyroid stimulating hormone (TSH) suppression treatment, which was considered as the control group. The clinical efficacy of the research group was better than that of the control group (P < 0.05), while no difference was seen in the comparison of the incidence of adverse effects and thyroid function (P > 0.05). After treatment, Tg, TL, maximum diameter of C/B lymph nodes, number of lymph nodes and number of calcified spots were lower in the research group than in the control group (P < 0.05). ROC analysis revealed that the predictive sensitivity of MIP-1 alpha for prognosis of 3 -year RAIR-DTC death in the research group of patients was 84.63 % and the specificity was 72.16 %. AP combined with 131I is effective in the treatment of RAIR-DTC and is worth using in the clinical practice. In addition, elevated levels of MIP-1 alpha predicted a poor prognosis for patients with RAIR-DTC.

目的 分析坎地沙坦酯联合环磷酰胺对2型糖尿病肾病患者炎性因子、肾功能的影响.方法 选取浙江省金华市人民医院2020年7月～2022年9月收治的183例2型糖尿病肾病患者为研究对象,按照随机分组法分为坎地沙坦酯组61例,环磷酰胺组57例,联合组65例,坎地沙坦酯组采用坎地沙坦酯治疗,环磷酰胺组采用环磷酰胺治疗,联合组采用坎地沙坦酯联合环磷酰胺治疗,最终共有坎地沙坦酯组55例,环磷酰胺组50例,联合组58例完成治疗.3个月后检测并比较各组炎性因子、肾功能、血脂水平、氧化应激指标、临床疗效.结果 与治疗前相比,治疗后各组IL-6、IL-8、TNF-α、Scr、BUN、UAL、TC、TG、LDL-C、丙二醛(MDA)水平降低,(HDL-C)、超氧化物歧化酶(SOD)水平升高,差异有统计学意义(P＜0.05).治疗后与坎地沙坦酯组、环磷酰胺组相比,联合组IL-6、IL-8、TNF-α、Scr、BUN、UAL、TC、TG、LDL-C、MDA水平较低,HDL-C水平较高,差异有统计学意义(P＜0.05).与炔坎地沙坦酯组、环磷酰胺组相比,联合组临床疗效好,差异有统计学意义(P＜0.05).结论 采用坎地沙坦酯联合环磷酰胺治疗可降低2型糖尿病肾病患者炎性因子水平,改善者肾功能,临床效果较好.

目的 探讨依帕司他联合贝那普利对老年糖尿病肾病患者细胞间黏附分子(ICAM)-1、血管细胞黏附分子(VCAM)-1和高迁移率族蛋白(HMG)B1 水平及炎症因子影响.方法 选择老年糖尿病肾病患者 100 例,运用随机表法将其分为对照组与治疗组,各 50 例.对照组给予贝那普利治疗,治疗组在贝那普利基础上结合依帕司他治疗.两组治疗疗程12 w.比较两组治疗疗效;治疗前后糖代谢指标,肾功能指标,肾间质动脉血流动力学参数,ICAM-1、VCAM-1和HMGB1 水平,炎症因子水平变化.结果 治疗组总有效率显著高于对照组(P<0.05).两组治疗后空腹血糖(FPG)、餐后 2 h血糖(2 h PG)和糖化血红蛋白(HbA1c)、血肌酐(Scr)、尿素氮(BUN)和24 h尿蛋白定量(24 h UP)水平显著低于治疗前(P<0.05);治疗组治疗后FPG、2 h PG和HbA1c、Scr、BUN和24 h UP水平显著低于对照组(P<0.05).两组治疗后肾间质动脉舒张末期血流速度(Vmin)和收缩期峰值血流速度(Vmax)显著高于治疗前,而阻力指数(RI)低于治疗前(P<0.05);治疗组治疗后肾间质动脉Vmin和Vmax显著高于对照组,而RI显著低于对照组(P<0.05).两组治疗后ICAM-1、VCAM-1和HMGB1 水平显著低于治疗前(P<0.05);治疗组治疗后ICAM-1、VCAM-1和HMGB1水平显著低于对照组(P<0.05).两组治疗后白细胞介素(IL)-6 和肿瘤坏死因子(TNF)-α水平显著低于治疗前(P<0.05);治疗组治疗后IL-6和TNF-α水平显著低于对照组(P<0.05).结论 依帕司他联合贝那普利治疗老年糖尿病肾病疗效显著,可降低ICAM-1、VCAM-1和HMGB1水平,减轻炎症反应.

目的 探讨miRNA-126对高糖诱导的内皮细胞自噬与凋亡的影响及分子机制.方法 采用高糖(HG)诱导HUVECs模型,随机分为4组,即正常葡萄糖(5.5 mmo/L)对照组,HG模型组,miRNA-126-5p mimics组(转染miRNA-126-5p mmics组),miRNA-126-5p inhibitor组(转染miRNA-126 inhibitor组).HG模型组即终浓度为33.3 mmol/L的葡萄糖诱导24 h,miRNA-126-5p mimics组是miRNA-126-5p mimics转染至HUVECs细胞,48 h后在培养基中加入33.3 mmol/L(终浓度)葡萄糖,培养24 h.miRNA-126-5p inhibitor组是miRNA-126-5p inhibitor转染至HUVECs细胞,48 h后在培养基中加入33.3 mmol/L(终浓度)的葡萄糖,培养24 h.再利用miRNA-126-5p mimics组模型,分别予自噬抑制剂3-甲基腺嘌呤(3-methyl adenine,3-MA)5 mmol/L、ERK通路抑制剂(U-0126)10 mmol/L干预24 h.RT-qPCR检测细胞中miRNA-126-5p的表达水平,CCK-8检测细胞活性,划痕实验检测细胞迁移能力,Westernblot检测细胞培养液中血管内皮生长因子(VEGF)和肝细胞生长因子(HGF),p-ERK、ERK蛋白,p-AKT、AKT蛋白,Bax、Bcl-2蛋白,cleaved-caspase-3蛋白,Beclin-1和Lc3蛋白含量.结果 与正常组比较,HG模型细胞中miRNA-126水平,p-ERK/ERK蛋白水平低于正常对照组(P<0.05);与HG模型组相比较,miRNA-126-5p mimics组细胞中miRNA-126、p-ERK/ERK蛋白表达明显升高(P<0.01),细胞中Bax/Bcl-2蛋白,cleaved caspase-3蛋白表达下降(P<0.05),Beclin-1和Lc3蛋白的表达水平升高(P<0.01),细胞活性增强(P<0.01),细胞迁移率提高(P<0.01),VEGF水平升高(P<0.05);与miRNA-126-5p inhibitor组比较,miRNA-126-5p mimics组细胞中miRNA-126、pERK/ERK蛋白表达升高(P<0.01),细胞中Bax/Bcl-2蛋白,cleaved caspase-3蛋白表达下降(P<0.05),Beclin-1和Lc3蛋白表达水平升高(P<0.01),细胞活性增强(P<0.05),细胞迁移率提高(P<0.05),VEGF水平升高(P<0.01);在miRNA-126-5p mimics组中加入3-MA后凋亡蛋白表达明显下降(P<0.01),加入ERK抑制剂后,自噬蛋白表达明显下降(P<0.01).结论 miRNA-126可通过激活ERK信号通路促进细胞的自噬并抑制细胞凋亡,减轻HG诱导的内皮细胞损伤.

目的:探讨LPL基因多态性与妊娠期糖尿病患者胰岛素抵抗的相关性.方法:选取2019年1月-2020年 4月本院分娩的妊娠期糖尿病患者93例作为GDM组,同期分娩的健康产妇105例作为正常组,采用聚合酶链反应-限制性内切酶片段长度多态性分析法分析胎盘组织LPL Hind基因多态性,统计分析两组对象及子代空腹血糖(FBG)、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹胰岛素(FINS)、胰岛素抵抗指数(IR)、体质指数(BMI)以及胰岛素抵抗指数(IR)与LPL 多态性的关系.结果:GDM组H+等位基因的频率(82.8％)高于正常组(64.8％),H+H+基因型患者TC、TG、HDL、LDL、FINS、BMI与非H+H+基因型患者存在差异(均P＜0.05);GDM组组织中LPL Hind基因多态性与胰岛素抵抗指标呈正相关性;GDM组H+H+基因型产妇子代BMI、IR、FINS均高于非H+H+基因型产妇子代(均P＜0.05).结论:LPL基因多态性是妊娠糖尿病患者胰岛素抵抗有关,可能影响其子代胰岛素抵抗发生异常.

目的:探讨胰岛素强化治疗对初诊 2型糖尿病(T2DM)患者血清炎症因子、氧化应激的影响.方法:初诊TDM患者 75例随机分为对照组 35例和观察组 40例.对照、组患者口服二甲双胍治疗,观察组患者给予胰岛素泵强化治疗.治疗 2周后,比较两组患者血糖、糖化血红蛋白(HbA1c)水平变化及血糖达标时间,以及治疗前后炎症因子、氧化应激水平变化.结果:两组患者治疗后空腹血糖(FPG)、餐后 2 h血糖(2hPG)、HbA1c水平较治疗前明显下降(P＜0.05),且观察组患者 FPG、2hPG,HbA1c水平明显低于对照组(P＜0.05),血糖达标时间明显少于对照组(P＜0.05).两组患者治疗后 C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平和血浆丙二醛(MDA)水平较治疗前明显下降(P＜0.05),超氧化物歧化酶(SOD)、还原型谷胱甘肽(RGSH)水平较治疗前明显升高(P＜0.05);且观察组患者除 RGSH外其他各项指标均显著优于对照组(P＜0.05).结论:胰岛素泵强化治疗能显著提高初诊T2DM患者的治疗效果,缩短血糖达标时间,减轻炎症反应及氧化应激,值得临床推广应用.

目的 观察α-硫辛酸联合胰岛素强化治疗对初诊2型糖尿病患者脂肪因子和胰岛素抵抗的影响,分析相关因素间存在的关系.方法 将88例初诊2型糖尿病患者随机分为单纯胰岛素组和联合硫辛酸组,2组均接受胰岛素强化治疗,后者同时接受静脉滴注α-硫辛酸600 mg、每日2次,2组总疗程均为14d.比较2组治疗前、后的血糖、血脂、血浆胰岛素、脂联素、瘦素、胰岛素敏感性和胰岛细胞分泌功能.结果 包括:①治疗后,2组GHbA1c、血糖、甘油三酯、总胆固醇较治疗前显著下降(P均＜0.05);BMI、HDL-C、LDL-C与治疗前比较差异无统计学意义(P均＞0.05).②除稳态模型评估的胰岛素敏感性指标(HOMA-IS),联合硫辛酸组的其它指标治疗后均较治疗前有改善(P均＜0.05);治疗后联合硫辛酸组超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)、脂肪细胞因子脂联素及HOMA-IS均高于单纯胰岛素组,瘦素、空腹胰岛素、稳态模型评估的胰岛素抵抗指数(HOMA-IR)则低于单纯胰岛素组(P均＜0.05).③SOD、GSH与脂联素呈正相关,SOD、GSH与瘦素呈负相关,脂联素与HOMA-IR、HOMA-IS呈正相关,瘦素与HOMA-IR、稳态模型评估的胰岛细胞分泌指数(HOMA-β)和HOMA-IS呈负相关(P均＜0.05).结论 与单纯使用胰岛素强化治疗相比,α-硫辛酸联合胰岛素强化治疗2型糖尿病更能减轻机体氧化应激程度并提高胰岛素的敏感性.氧化应激指标、脂肪细胞因子及胰岛素相关指标间可能有一定关联.

目的 观察不同期糖尿病肾病(DN)患者血管内皮功能的改变.方法 136例2型糖尿病患者按照蛋白尿及肾功能分组,正常白蛋白尿组(DN0)41例,微量白蛋白尿组(DN1)36例,临床蛋白尿组(DN2)31例,肾功能不全组(DN3) 28例,另设正常对照组30例.测定各组DN患者和正常对照者血浆假性血友病因子(vWF)、一氧化氮(NO)和内皮素-1(ET-1)水平,超声检测反应性充血时和含服硝酸甘油后肱动脉内径水平的变化.结果 各期DN患者较正常对照组NO水平明显下降,ET-1、vWF水平明显升高(P＜0.01).DN0组和DN1组间NO、ET-1、vWF水平差异无统计学意义(P ＞0.05);DN1组和DN2组、DN2组和DN3组NO、ET-1、vWF水平差异显著(P＜0.01,P＜0.05).反应性充血时,各组DN患者均出现肱动脉内径水平下降;含服硝酸甘油后,仅DN2组和DN3组出现肱动脉内径水平下降(P＜0.01,P＜0.05).结论 DN各期均存在血管内皮功能障碍,早期DN患者即可出现内皮依赖性血管舒张功能障碍,小晚期DN患者同时出现非内皮依赖性血管舒张功能障碍.

糖尿病足(diabetic foot,DF)是糖尿病病人常见的慢性并发症之一,据流行病学资料显示,糖尿病病人的DF患病率为4%～10%.目前认为糖尿病引起的氧化应激损伤是慢性并发症发生的共同通路和致病原因,抗氧化治疗糖尿病各种并发症的疗法也应运而生.α-硫辛酸(Alpha lipoic acid,ALA)作为一种强力的抗氧化剂,目前已用于糖尿病神经病变的治疗有显著疗效,但国内对DF方面的临床研究甚少.

儿童单纯性肥胖症患者存在明显的胰岛素抵抗,发生代谢综合征的比例明显升高[1].肥胖儿童体能素质显著低于非超重肥胖儿童[2],应及早防治.本研究观察74例肥胖儿童减重前后的体重指数、体脂含量、糖、脂代谢、胰岛素抵抗指数、胰岛素敏感指数等代谢状况指标,及肺活量、立定跳远、握力、俯卧撑、坐位体前屈、1000 m(男)、800 m(女)等体能素质改善情况,现报告如下. 1资料与方法 1.1一般资料选择参加“浙大诺特营养中心金华市人民医院分中心”组织的“肥胖儿童营养干预减重夏令营”活动的肥胖儿童74例,男49例,女25例,年龄(7.2±3.3)岁,排除其他内分泌及遗传代谢疾病.糖尿病家族史不详.

目的 探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)的发生与胰岛素抵抗及血脂代谢紊乱的关系.方法 收集98例T2DM患者,全部病例经肝脏彩超扫描证实,将其分为T2DM合并NAFLD组(47例)与T2DM无NAFLD组(51例),另选取50例健康体检者作为对照组.检测三组体质指数(BMI)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、餐后2 h血糖(2hBG)、空腹血浆胰岛素(FINs)、糖化血红蛋白(HbA1c),计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-ISI)等,并进行比较.结果 T2DM合并NAFLD组FINS、HOMA-IR、TC、TG、LDL-C、BMI均高于T2DM无NAFLD组和对照组(P＜0.05);HOMA-ISI、HDL-C则低于T2DM无NAFLD组和对照组(P＜0.05);BMI、FINS、TC、TG、LDL-C与糖尿病脂肪肝呈显著正相关(r=0.628、0.735、0.841、0.762、0.850,P＜0.05),HOMA-ISI、HDL-C与糖尿病脂肪肝呈显著负相关(r=-0.351、-0.427,P＜0.05).结论 T2DM患者合并NAFLD与血脂代谢紊乱、胰岛素抵抗及肥胖等有关,减肥、降脂、改善胰岛素抵抗对防治糖尿病NAFLD具有重要意义。

Objective To observe the effect of combined rehabilitation therapy on the diabetic gastroparesis patients.Methods Forty type 2 diabetic gastroparesis patients were randomly divided into control group and therapy group. Patients in control group took orally only domperidone, 3 times per day. Patients in therapy group get the same drugs and received the combined rehabilitation therapy(electroacupuncture + hyperbaric oxygenation +outdoor exercises).Fasting blood glucose,2 hours postprandial blood glucose, lipid, insulin resistant index, body mass index, enteron symptom score, curative effect, gastric emptying time, dysautonomia and motilin were compared before and after treatment in all patients Results There were statistic differences in FBG, 2hPBG, HbA1c,TC,TG and LDL before and after treatment in the therapy group(t=0.93,0.64,1.01,1.27,2.01,1.54, P<0.05). FBG, 2hPBG, HbA1c, TC, TG and LDL in the therapy group had statistic differences compared with that of the control group after treatment(t=0.98,0.71,1.25,1.79,2.08,1.68,P<0.05). Enteron symptom score, gastric emptying time and body mass index were decreased after treatment in the therapy group and there were statistic differences compared with those before treatment(t=0.66,1.58,1.97, P<0.05)and compared with the control group after treatment there were statistic differences(t=1.39,1.98,2.07, P<0.05). Conclusions Combined rehabilitation therapy has significant therapeutic effect on the diabetic gastroparesis patients.

目的 探讨胰岛素抵抗与2型糖尿病微血管病变之间的相互关系.方法 检测126例2型糖尿病患者,其中有微血管并发症64例(糖尿病有微血管病变组),无微血管并发症62例(糖尿病无微血管病变组),以及50例健康体检者(对照组)的空腹血糖、空腹胰岛素,计算稳态模型评估法的胰岛素敏感指数(HOMA-ISI),并进行比较.结果 糖尿病有微血管病变组HOMA-ISI为-5.87±2.12,糖尿病无微血管病变组为-4.43±0.96,对照组为-3.82±0.52,糖尿病有微血管病变组和糖尿病无微血管病变组HOMA-ISI均明显低于对照组,差异有统计学意义(P<0.05),且糖尿病有微血管病变组与糖尿病无微血管病变组比较差异有统计学意义(P<0.05).Logistic回归分析显示,糖尿病微血管病变与糖尿病病程、空腹血糖、餐后2 h血糖和糖化血红蛋白呈显著正相关(r值分别为0.538、0.472、0.459、0.371,P值均<0.05),与HOMA-ISI呈显著负相关(r=-0.337,P<0.05).结论 2型糖尿病微血管病变患者存在严重的持续性高血糖,胰岛素抵抗在2型糖尿病发生、发展中起着重要作用,糖尿病病程的延长、严重的胰岛素抵抗为2型糖尿病微血管病变的主要危险因素.

2型糖尿病(T2DM)患者住院率、致死率和致残率增高的重要原因为大血管病变,对大血管早期病变的指标及相关因素进行检测,并早期进行干预治疗,可以预防T2DM并发症的发生和发展.颈动脉内膜中层厚度(IMT)可以早期反映大血管病变的情况,血液流变学异常可能是T2DM血管并发症发生发展的重要原因之一,故本文对194例T2DM患者进行血液流变学检测及颈动脉IMT的测定,以探讨两者之间的关系,现报道如下.

随着生活水平的提高和生活方式的改变,2型糖尿病的发生率迅猛增高.具有里程碑意义的糖尿病控制和并发症试验(DCCT)和英国前瞻性糖尿病研究(UKPDS)表明,强化控制血糖对减少和预防糖尿病各种并发症的发生具有重要意义~([1]).

To explore the effect of ginkgo leaf extract (GLE) on vascular endothelial function (VEF) in patients with early stage diabetic nephropathy (DN).

随着糖尿病患者冠状动脉粥样硬化呈进展性发展,心脏事件发生率明显高于非糖尿病患者.本研究对64例糖尿病合并冠心病患者的冠状动脉造影的特点进行了分析,现报告如下.

POEMS综合征是一组以多发性感觉运动性周围神经病变为突出表现,常有多系统损害及与浆细胞瘤相关的临床症候群,临床较罕见,表现复杂多样,易误诊.现将本院1999～2004年收治的5例患者的临床资料分析报道如下.

Objective To investigate the changes of C reactive protein (CRP) in coronary heart disease (CHD) and the effect of simvastatin on CRP. Methods The plasma CRP levels were evaluated in patients with CHD and age-matched normal control group. Patients with CHD were randomized to simvastatin group and non-simvastatin group, and the CRP levels were measured before and after treatment. Results The plasma CRP levels in patients with CHD were significantly higher than those of normal controls (9.87±2.32)mg/ml vs (4.28±1.23)mg/ml(P0.01) . In simvastatin group the plasma CRP levels were significantly decreased after treatment (7.31±2.87)mg/ml, while those of non-simvastatin group remained higher level (9.22±2.54)mg/ml. The latter was significantly higher than former (t=2.34, P0.05). Conclusion Patients with CHD have significantly higher plasma CRP. Simvastatin can decrease the CRP level in patients with CHD.