Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease marked by apnea, hypopnea, decreased oxygen saturation, and disordered sleep structure, which is a major risk for cardiovascular disease. Recent studies have found that OSAHS patients have an increased risk of hypertension, coronary atherosclerotic heart disease, insulin resistance, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, etc. And these patients have a high prevalence of obvious glucolipid metabolism disorder (GMD) , which plays an important role in cardiovascular morbidity and mortality in OSAHS. We reviewed the latest advances in the association of GMD and OSAHS, and the potential pathogenesis of OSAHS-induced GMD and insulin resistance, aiming at providing new ideas for clinical treatment of GMD in OSAHS.

目的 分析糖尿病前期并发高尿酸血症患者超体质量或肥胖、血尿酸(SUA)与血清内皮/炎性因子之间的关系.方法 选取2019年5月—2021年4月在昆明医科大学附属延安医院全科医学科/老年病科诊治老年高尿酸血症(HUA)患者180例,按糖代谢水平分为空腹血糖受损(IFG)组72例和糖耐量异常(IGT)组108例,每组再按照体质量指数分为肥胖亚组、超体质量亚组和体质量正常亚组.检测并比较患者血清vWF、ET-1、NO、IL-1β、IL-6水平.Pearson直线相关检验分析血清内皮/炎性因子与临床病理特征相关性,Logistic回归分析血清内皮/炎性因子对肥胖及糖尿病前期合并高尿酸血症的影响因素.结果 与IFG组比较,IGT组血清NO水平降低,vWF、ET-1、IL-1β、IL-6水平升高,差异均有统计学意义(t=7.016、16.646、16.405、11.856、3.036,P均<0.001);IFG组及IGT组的各亚组间血清NO随BMI的增加而下降,vWF、ET-1、IL-1β、IL-6水平随BMI增加而上升,差异均有统计学意义(IFG组:F=5.897、12.359、7.324、6.654、35.210,P均<0.001;IGT组:F=4.332、18.965、15.674、4.859、59.687,P均<0.001);Pearson直线相关检验结果提示,血清vWF、ET-1、IL-1β、IL-6与BMI呈正相关(r=0.52、0.55、0.54、0.52,P<0.05),NO与BMI呈负相关(r=-0.44,P<0.05);Logistic回归分析结果提示,血清vWF、ET-1、IL-1β、IL-6升高为肥胖及糖尿病前期合并高尿酸血症的危险因素,血清NO升高为其保护因素[OR(95％CI)=3.435(1.792～6.585)、3.245(1.767～5.957)、3.401(1.813～6.380)、3.522(1.809～6.858)、0.191(0.079～0.459)].结论 肥胖及IGT合并高尿酸血症老年患者血清vWF、ET-1、IL-1β、IL-6水平升高,NO水平降低,且是肥胖及糖尿病前期并发高尿酸血症的影响因素.

目的 观察对比不同SBT策略对机械通气患者肺通气影响.方法 纳入2020年6月至2021年1月收住某医科大学附属医院EICU的符合纳入、排除标准,进行首次SBT的机械通气患者69例.随机分入T管组、PSV组及ATC组后进行30 min的SBT.SBT成功后24 h内拔除气管插管.所有患者SBT开始前(T0)、结束时(T1)及拔管后30 min(T2)用超声观察患者肺通气状态.结果 3组患者首次SBT通过率差异无统计学意义(P＞0.05),成功拔管的患者中:T1时3组患者LUS评分差异无统计学意义(P＞0.05),从T1到T2,T管组患者LUS变化未见明显统计学差异(P＞0.05),PSV组及ATC组患者LUS增加(P＜0.05).结论 有压力支持的SBT策略有利于患者通过SBT,同时在SBT过程中保证肺部通气量;然而,T管法SBT似乎更能预测患者拔管后的肺通气量变化.

高血压是导致脑卒中、动脉粥样硬化、心肾功能衰竭发生的重要上游危险因素,由环境和遗传共同作用引起的.我国人群高血压的患病率呈持续上升趋势,而我国高血压患者控制率仅为 16.8％.钠盐是高血压重要的易患因素,且存在盐敏感现象[1].盐敏感性高血压(SSH)的发生机制十分复杂,涉及到肾素-血管紧张素-醛固酮系统激活、交感神经系统、内皮细胞功能障碍、胰岛素抵抗、肾脏钠排泄障碍等.近年来研究发现,高盐诱导的免疫激活参与 SSH 的发生发展,天然免疫细胞和适应性免疫细胞都参与这个过程.现就SSH 的免疫机制研究做一综述.

BackgroundThe prevalence of essential hypertension complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) has been increasing year by year. However, due to the differences in medical conditions and lack of clinical understanding in different regions of China, the diagnosis of hypertension complicated with OSAHS is still insufficient. Relevant studies have shown that the pathogenesis of hypertension complicated with OSAHS is closely related to the ectopic accumulation of fat and insulin resistance.ObjectiveThis study attempted to analyze the relationship between OSAHS and abdominal visceral adipose tissue (VAT) and homeostasis model assessment of insulin resistance (HOMA-IR) , and their predictive value for hypertension complicated with OSAHS.MethodsTwo hundred and thirty-four patients with essential hypertension treated at hypertension center of Yan'an Hospital of Kunming Medical University from January 2019 to July 2020 were enrolled in the study. The HOMA-IR of the enrolled patients was calculated by polysomnography, VAT measurement, parallel glucose tolerance and insulin release experiments. According to the AHI level, 27 patients were divided into hypertension group (AHI<5 times/h) , and 207 patients were divided into hypertension complicated with OSAHS group (AHI≥5 times/h) . The levels of VAT and HOMA-IR were compared between 2 groups. The receiver operating characteristic (ROC) curve of screening hypertension patients complicated with OSAHS were determined by HOMA-IR and VAT, and the diagnosis value of area under AUC and different cut-off value were calculated. Logistic regression modeling was used to determine ROC curve with the saved probability as a separate variable to analyze the AUC of the two combined diagnosis of hypertension and OSAHS.ResultsThe VAT, HOMA-IR and BMI of hypertension complicated with OSAHS group were significantly higher than the hypertension group, while LSaO2 was significantly lower than the hypertension group. VAT, HOMA-IR and BMI were positively correlated with AHI (P<0.05) , and LSaO2 was negatively correlated with AHI (P<0.05) . The AUC of ROC curve for the diagnosis of hypertension complicated with OSAHS by VAT was 0.905 〔95%CI (0.861, 0.949) 〕, and the sensitivity and specificity were 0.763 and 0.926 when the diagnostic cut-off point was 100.5 cm2. The ROC curve AUC of HOMA-IR in the diagnosis of hypertension complicated with OSAHS was 0.813 〔95%CI (0.725, 0.900) 〕, when the diagnostic cut-off point was 2.015, the sensitivity and specificity were 0.797 and 0.778, respectively, and the AUC of ROC curve for combined factor diagnosis of hypertension complicated with OSAHS was 0.917 〔95%CI (0.871, 0.963) 〕, the diagnostic cut-off point was 2.045, the sensitivity and specificity were 0.831 and 0.963, respectively.ConclusionVAT and HOMA-IR in hypertension patients complicated with OSAHS are significantly higher than those in patients with hypertension. VAT and HOMA-IR have a certain predictive value for hypertension complicated with OSAHS, and can be applied to medical institutions that unconditionally carry out polysomnography, in order to intervene as early as possible to reduce the risk of serious complications of cardiovascular and cerebrovascular diseases.

目的:研究血清可溶性Klotho(sKlotho)水平与原发性高血压动脉硬化的相关性.方法:选取2017年1月-2018年12月在昆明医科大学附属延安医院就诊的196例初诊高血压患者(高血压组)和121例健康对照者(对照组),检测血清sKlotho、血脂、血糖、尿酸等常规生化指标,测定24 h尿钠排泄来计算估测摄盐量,同时检测臂踝脉搏波速度(baPWV)和颈动脉最大内膜中层厚度(IMT),研究血清sKlotho水平与高血压动脉弹性的关系.结果:高血压组血清sKlotho水平较对照组降低,而baPWV和Max IMT较对照组升高(均P＜0.05).高血压组估测摄盐量(10.51±4.19)g较对照组(8.97±3.48)g明显升高(P＜0.01).高血压组中,血清sKlotho水平与年龄、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)、24 h尿钠呈负相关性,与估测肾小球滤过率(eG-FR)呈正相关性(均P＜0.01);高血压组baPWV和IMT与血清sKlotho水平呈负相关性(r=-0.59、-0.61,均P＜0.01).baPWV≥1400 cm/s和IMT≥1.0 mm的患者血清sKlotho显著降低(P＜0.05).多重logistic回归分析显示,年龄、吸烟、MBP、血脂异常、估测摄盐量是baPWV的危险因素,血清sKlotho是baPWV的保护因素(P=0.024,OR=0.86,95％CI:0.295～0.977).结论:高血压患者血清sKlotho水平较非高血压患者降低,与动脉硬化指标baPWV、IMT呈负相关性,是baPWV的保护因素,可作为动脉僵硬度的生物标志物.

目的 探讨根除幽门螺杆菌(H.pylori)对老年功能性消化不良(functional dyspepsia,FD)的治疗效果.方法 选取2016年3月至2018年4月我院诊治的92例老年FD合并H.pylori阳性患者进行研究,采用随机分组表分为常规组(常规促进胃动力治疗,46例)和干预组(常规治疗联合H.pylori根除治疗,46例),比较两组患者治疗前后症状评分、疗效及药物不良反应发生率.结果 治疗前,常规组和干预组患者上腹不适、饱胀感、灼烧感评分比较差异无统计学意义(均P＞0.05).治疗14 d,两组患者上腹不适、饱胀感、灼烧感评分均下降,且干预组患者下降程度更大(均P＜0.05).干预组患者治疗总有效率显著高于常规组(95.45％ vs76.19％;x2=5.1342,P=0.0235).两组患者治疗14 d期间,口干、恶心呕吐、头晕、皮疹、乏力发生率比较差异无统计学意义(均P＞0.05).结论 对老年FD合并H.pylori阳性患者实施H.pylori根除性治疗能协助改善患者消化不良症状,提高患者疗效,同时不增加药物不良反应发生率.

目的 对我国高血压患者现阶段(2017-2019年)盐(氯化钠)摄入量状况进行调研和分析.方法 在中国23个省/市130家医院,纳入年龄18～85岁明确诊断的高血压患者9 686例,采用电极法对所有患者的全天(24 h)尿液进行尿钠测定,同时记录病史、体质量指数(BMI)和用药史(包括降压药),并对高血压患者6 494例行24 h动态血压监测(ABPM).结果 入选的高血压患者24 h平均尿钠排泄为156.8 mmol/d(相当于食入钠3.6 g/d,钠盐9.2 g/d),其中7 103例(占73％)患者平均钠盐摄入超过6 g/d,按照WHO标准钠盐＜5 g/d仅有1 840例(占19％).根据测定的平均尿钠排泄水平可将入选的患者分为低钠(尿钠＜100)、中钠(尿钠100～＜200)和高钠(尿钠≥200mmo/d)3组,3组尿钠排泄水平分别为(69.7±21.0)、(145.8土28.0)和(268.7±58.9)mmol/d.平均尿钠排泄水平在全国中以西北地区最高(184.2 mmol/d,相当于钠盐10.8 g/d),华南地区最低(111.3 mmol/d,相当于钠盐6.5 g/d).血压随着钠摄入的增加而升高.结论 我国23个省/市高血压患者平均钠盐摄入量仍显著高于中国和WHO标准,纠正高钠摄入对血压管理具有重要的意义.

Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) ( p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) ( p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.

目的:研究云南省佤族原发性高血压人群估测摄盐量与早期肾损害的关系.方法:选取2014年10月云南省临沧市耿马县四排山乡年龄≥18岁的佤族高血压患者260例(高血压组)和佤族非高血压患者286例(非高血压组).收集所有对象的年龄、性别、身高、体重、血压、腰围、臀围等基本信息.采集空腹静脉血测定空腹葡萄糖(GLU)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肾功能、电解质等指标.收集点尿标本测定尿电解质、尿白蛋白、尿肌酐,通过点尿法估算24 h尿钠的排泄量.结果:高血压组和非高血压组间体重、BMI、腰围、臀围、收缩压、舒张压、尿酸、TG、血钠、尿钾、估测摄盐量、随机尿白蛋白/肌酐比值均差异有统计学意义(均P＜0.05).高血压组估测摄盐量较非高血压组明显升高,差异有统计学意义[(20.21±5.48) g∶(15.08±3.03)g;P＜0.05].在佤族高血压患者中,估测摄盐量和随机尿白蛋白/肌酐比值高度相关(r=0.89,P=0.000),BMI、腰臀比、收缩压、舒张压、GLU、TG、LDL-C、尿钠/尿钾与尿白蛋白/肌酐比值具有相关性(r=0.243、0.351、0.349、0.291、0.327、0.203、0.298、0.178,均P＜0.05).多元线性回归分析显示,年龄、估测摄盐量、收缩压、舒张压、BMI与尿白蛋白/肌酐比值相关,估测摄盐量是影响尿白蛋白/肌酐比值的独立危险因素.结论:佤族人群普遍估测摄盐量高,该人群估测摄盐量和随机尿白蛋白/肌酐比值高度相关,且是早期肾损害的独立危险因素.

目的 分析在股静脉人工肝置管患者中应用护理干预的效果.方法 选取2017年7月～2017年12月我科接受股静脉人工肝置管的患者52例,选取时间为,随机分成2组,即对照组(26例)及观察组(26例),对照组行常规护理,观察组行综合护理.结果 护理后,观察组患者的股静脉血流速度、腘静脉血流速度,分别与对照组患者对比,差异显著,差异有统计学意义(P<0.05);观察组患者不良反应发生率为7.69％,与对照组患者的不良反应率对比,组间差异显著,差异有统计学意义(P<0.05).结论 对接受股静脉人工肝置管的患者实施综合护理,可以改善患者的静脉血流速度,减少不良反应的产生.

背景 《"胸痛中心"建设中国专家共识》推荐急性心肌梗死患者门诊-首次球囊扩张时间(D2B)时间窗为发病后90 min内,而优化医院诊疗流程、缩短D2B、尽快恢复冠状动脉血流灌注是及时救治急性心肌梗死患者的关键.目的 探讨行经皮冠状动脉介入治疗(PCI)的急性心肌梗死患者D2B延迟的影响因素及其对预后的影响.方法 选取2015-2018年在昆明医科大学附属延安医院行PCI的急性心肌梗死患者122例,根据D2B延迟情况分为D2B延迟组(D2B≥90 min)49例,D2B未延迟组(D2B＜90 min)73例.比较两组患者年龄、性别、受教育程度、月收入、有无医疗保险、吸烟史、饮酒史、高血压病史、糖尿病病史、脑梗死病史、高脂血症病史、心律失常病史、冠心病家族史、入院方式、距院距离、冠状动脉病变支数及住院期间、随访半年预后.行PCI的急性心肌梗患者D2B延迟的影响因素分析采用多因素Logistic回归分析.结果 (1)两组患者年龄、性别、吸烟史、饮酒史、高血压病史、糖尿病病史、脑梗死病史、高脂血症病史、心律失常病史、冠心病家族史、冠状动脉病变支数比较,差异无统计学意义(P＞0.05);两组患者受教育程度、月收入、有无医疗保险、入院方式、距院距离比较,差异有统计学意义(P＜0.05).(2)多因素Logistic回归分析结果显示,初中或高中〔OR=0.571,95%CI(0.344,0.946)〕、大学及以上〔OR=0.288, 95%CI(0.099,0.836)〕、医疗保险〔OR=1.065,95%CI(1.030,1.101)〕、入院方式〔OR=5.233,95%CI(1.672, 16.374)〕、距院距离〔OR=6.259,95%CI(1.338,29.269)〕是行PCI的急性心肌梗死患者D2B延迟的影响因素(P＜0.05).(3)两组患者住院期间再次非致命性心肌梗死、心力衰竭、脑血管意外发生率比较,差异无统计学意义(P＞0.05);D2B延迟组患者治疗期间心源性死亡率高于D2B未延迟组(P＜0.05).(4)两组患者随访半年再次非致命性心肌梗死、继发性心力衰竭发生率比较,差异无统计学意义(P＞0.05);D2B延迟组患者随访半年因心源性疾病再次入院、心源性死亡率、全因死亡率高于D2B未延迟组(P＜0.05).结论 受教育程度低、无医疗保险、自行入院、距院距离远是行PCI的急性心肌梗死患者D2B延迟的危险因素,且出现D2B延迟的患者预后较差.

目的 探讨床旁膈肌超声在ICU获得性衰弱(ICU-AW)早期诊断中的临床应用价值.方法 选择2018年1月至2019年1月收住昆明医科大学第一附属医院急诊重症监护病房(EICU)的患者71例.按通气方式不同分为两组,机械通气组患者33例,非机械通气组患者38例.在患者入院后第1、3、7天,使用医学研究委员会肌力评分(MRC)对患者进行评分,同时应用床旁超声测定患者膈肌厚度(DT)、膈肌移动度(DE)、计算膈肌厚度分数(DTF),将数据进行统计学分析.结果 机械通气患者的DTF随机械通气时间延长而减小(％:29.41 ±8.32,23.53±5.34,18.65±5.92),两两比较三组间差异有统计学意义(P＜0.05);呼气末膈肌厚度(TEE)随机械通气时间延长变薄(cm:0.19 ±0.04,0.17 ±0.04,0.15 ±0.04),第1天和第7天比较差异有统计学意义(P＜0.05),其余时间两两比较差异无统计学意义(P＞0.05);利用DTF＜ 16.30％预测及诊断患者ICU-AW发生的受试者工作特征(ROC)曲线下面积(AUC)为0.84,敏感度为0.86,特异度为0.80(P=0.001);利用TEE＜ 0.17 cm变化预测及诊断ICU-AW的AUC为0.80,敏感度为0.71,特异度为0.74(P=0.019).结论 对于ICU中机械通气患者,可以应用床旁膈肌超声对ICU-AW做出早期的预测及诊断,其中DTF是较为理想的指标.

胰岛素是维持机体内葡萄糖稳态的最主要激素,组织细胞保持对胰岛素的敏感性是维持健康新陈代谢的重要因素.目前,诱发胰岛素抵抗的具体机制并未研究清楚.支链氨基酸(branched-chain amino acid,BCAA)属于必需氨基酸,通过直接和间接的方式作用于代谢信号通路.尽管有报道称BCAA有益于健康的新陈代谢,然而,血浆BCAA水平升高与胰岛素抵抗、代谢紊乱及2型糖尿病密切相关.我们就BCAA与胰岛素抵抗、2型糖尿病相关研究进展综述如下.

目的 探讨在血源紧张条件下采用半量血浆置换(PE)联合双重血浆分子吸附系统(DPMAS)治疗肝衰竭患者的疗效.方法 40例肝衰竭患者接受半量PE联合DPMAS(对照组),另40例接受更少量PE联合DPMAS治疗(观察组),观察两组患者近期疗效.结果 在治疗后,两组患者肝功能较前明显好转,但观察组患者血清TBIL水平为(144.6±69.5)μmol/L,显著高于对照组的(120.8±65.4)μmol/L,血清ALB水平为(30.3±5.2)g/L,显著低于对照组的(33.5±5.2)g/L(P<0.05);经过2周内科综合治疗后,患者腹胀、恶心等消化道症状和乏力较前明显好转,PTA较前改善.对照组有效率为75.0％,观察组有效率为72.5％,两组比较差异无统计学意义(x2=0.208,P>0.05);在行人工肝治疗过程中,发生皮疹、低血糖和口唇周围麻木等,经对症处理后恢复.结论 少量血浆PE联合DPMAS治疗肝衰竭早中期患者也有一定的疗效.

目的:探讨血管紧张素转换酶(AC E2)基因多态性与佤族原发性高血压(EH)人群的关系.方法:应用SnapShot技术检测了260例云南佤族EH患者及290名正常血压对照者ACE2基因20个多态位点基因型(rs1514283、rs1514282、rs2074192、rs233575、rs714205、rs4240157、rs4646176、rs4646174、rs879922、rs4646156、rs4646155、rs4646188、rs4646140、rs2158083、rs2285666、rs2106809、rs1978124、rs6632677、rs2301692、rs2306193),应用x2检验比较组间基因型及等位基因频率,运用Hardy-Weinberg平衡检验后,用Haploview软件进行连锁不平衡分析,并用SHEsis软件进行单倍体构建,从而探讨ACE2基因多态性与佤族人群高血压的相关关系.结果:①本次研究在20个候选位点发现5个多态位点,这5个位点均存在连锁不平衡现象,但部分位点不能在以后的研究中相互代替.②rs2285666位点、rs714205位点的CC基因型及C等位基因是佤族女性EH的保护因素(P＜0.05,OR＜1),而rs2285666位点的T等位基因、rs714205位点的G等位基因是佤族女性EH患病的致病因素(P＜0.05,OR＞1);在佤族男性群体中并没有发现具有统计学意义的基因型及等位基因(P＞0.05).③对ACE2的5个多态性位点构建单倍型,未发现具有统计学意义的单倍型,说明这5个位点组成的单倍型与佤族EH均无关联.结论:ACE2基因中rs2285666及rs714205这两个多态位点可能与佤族女性EH相关.

目的 探索心脏康复在高血压心脏病患者中的应用效果.方法 选取本科自2016年1月～2017年10月收治的102例高血压心脏病患者作为此次研究对象,随机分为对照组和观察组.对照组51例患者给予常规方法进行治疗,观察组51例患者在此基础上给予心脏康复进行治疗.采用生活质量综合评定问卷、6 min步行距离评价两组的治疗效果.结果 ①经过治疗后,观察组患者生活质量综合评定问卷评分明显优于对照组,差异有统计学意义(P<0.001);②治疗前两组患者6 min步行距离差异无统计学意义(P>0.05);治疗后观察组患者6 min步行距离明显高于对照组,差异有统计学意义(P<0.001).结论 心脏康复在高血压心脏病患者中有着重要的应用价值,能有效提高患者的运动耐力和生活质量,减少患者再次入院的几率,降低医疗成本,值得在临床中广泛推广和使用.

目的 探讨不同医学营养治疗方法 对老年2型糖尿病(T2DM)患者胰岛素抵抗的影响.方法将85例T2DM患者按完全随机分组法分为三组,对照组29例、低血糖生成指数膳食组27例、水溶性膳食纤维组29例,三组均参照中国糖尿病医学营养治疗指南编制糖尿病(DM)膳食食谱,并给予口服降糖药,低血糖生成指数膳食组早晚餐完全用低血糖生成指数膳食替代,水溶性膳食纤维组在早、晚餐时各添加水溶性膳食纤维10 g.干预期1个月,干预前后观察各组患者血糖、血脂、肾功能及胰岛素抵抗情况.结果 与干预前比较,各组干预后血糖均有不同程度下降(P<0.05),低血糖生成指数膳食组及水溶性膳食纤维组干预后胰岛素抵抗指标下降(P<0.05).与对照组比较,干预后低血糖生成指数膳食组和水溶性膳食纤维组胰岛素抵抗明显低于对照组(P<0.05).结论 老年T2DM患者在DM膳食谱及口服药物治疗基础上,给予低血糖生成指数膳食替代治疗或添加水溶性膳食纤维,能有效控制血糖水平,降低胰岛素抵抗.

Objective To studythe effect of cardiac shock wave therapy(CSWT) on the apoptosis of cardiomyocytes and apoptosis-related protein expression in rats with myocardial infarction(MI) and to explore the mechanism of CSWT in ischemic cardiomyopathy.Meth-ods Thirty healthy SD rats were divided into Sham(n=10),MI(n=10),CSWT groups(n=10).And the MI model was established by per-manent ligation of the left anterior descending artery(LAD).After 4 weeks of CSWT treatment,myocardial samples from all groups were pre-pared for TUNEL and Masson staining.The expressions of Bax,Bcl-2 and Caspase-3 were detected by Western blot.Results Compared with those of sham group,the myocardial apoptosis index and the degree of fibrosis were increased obviously in MI and CSWT group.Bax and Caspase-3 expressions were increased,but Bcl-2 expression level was decreased(P<0.05).Compared with those of MI group,the myocardial apoptosis index and the degree of fibrosis were decreased in CSWT group.At the same time,Bax and Caspase-3 expressions were decreased,as well as Bcl-2 expression level was increased(P<0.05).Conclusions Myocardial apoptosis will be deteriorated greatly after MI of rats.However,CSWT could inhibit cardiomyocytes apoptosis and reduce fibrosis in left ventricular following MI.

Objective To investigate the efficacy and safety of glucocorticoid-decreasing-dose therapy in patients with hepatitis B-induced liver failure. Methods 64 patients with hepatitis B-induced acute-on-chronic liver failure at early stage were recruited in this study,and they were randomly divided into observation group and control group with 32 cases in each. The patients in control group were given the comprehensive treatment with hepatoprotective,antiviral,and supporting therapy,and the patients in observation group were intravenously given the treatment of methylprednisolone at dose of 1 mg·kg-1·d-1 at the base of comprehensive treatment. The mortality, complications,liver function index,serum HBV DNA levels were compared between the two groups after treatment. Results The occurrences of complications in observation and control groups were 12.5% and 25.0%,respectively (P<0.05);the improvement of gastrointestinal symptoms took [(3.8 ±1.3) d and (15.5 ±1.8) d,P<0.01],the disappearance of jaundice took [(28.2±9.3)d and (41.5±10.3)d,P<0.05],and the hospital stay were [(41.5±4.3) d and (52.2±4.7)d,P<0.05],respectively in the two groups;the prothrombin time activity and serum albumin levels increased,and serum alanine aminotransferase and bilirubin levels decreased in observation group more obviously than in control(P<0.05);serum HBV DNA levels were [(3.2 ±1.5)lg cps/ml and (3.3 ±1.3)lg cps/ml,P>0.05],and the fatality rates were 9.4% and 21.9%(P<0.05) in the two groups. Conclusion The application of glucocorticoids in treatment of patients with liver failure can improve the therapeutic effect and reduce mortality with relative high security.