目的：探讨研究型PBL（以问题为基础）/CBL（以案例为基础）的整合式教学模式在内分泌学住院医师规范化培 训中的应用价值和效果。方法：选取2020年9月-2021年3月在内分泌科规范化培训的临床专业型硕士研究生共50名 作为主要研究对象；根据随机化原则分为对照组和研究组。研究组采用研究型PBL/CBL整合式教学法，对照组采 用传统教学方法。两组学员均由内分泌学中心的带教老师进行教学查房和临床操作的培训，以理论考核及操作技能 考核成绩进行比较分析，并结合问卷调查表的形式反馈教学效果。结果：研究组与对照组的入科成绩比较差异无 统计学意义（P＞0.05），而研究组与对照组出科考核成绩比较差异有统计学意义（P＜0.05），且研究组的出科成 绩（85.4±7.46分）高于对照组（78.84±6.81分）；问卷调查结果显示，与对照组比较，研究组满意度得分较高（P ＜0.05）。两组学生在分析及解决问题能力、医患沟通能力、团队合作能力以及文献检索能力方面的得分差异有统计 学意义（P＜0.05），并且研究组的能力得分均高于对照组。结论：研究型PBL/CBL整合式教学有助于提升专硕研究 生分析与解决问题的能力、医患沟通能力等。通过整合式教学，学员考核成绩更好，满意度更高。

目的 探讨绝经期T2DM患者合并微量白蛋白尿影响骨密度(BMD)及血25羟维生素D[25(OH)D]水平的相关性.方法 选取2016年3月至2017年10月于本院内分泌科住院的绝经期T2DM患者89例,根据UACR分为单纯T2DM组(T2DM,n=56),合并微量白蛋白尿组(UAlb,n=33),比较两组生化指标、BMD及25(OH)D.结果 两间25(OH)D、BMD比较,差异无统计学意义(P>0.05),UAlb组血钙低于T2DM组[(2.23±0.21)vs(2.29±0.13)mmol/L,P<0.05].Pearson相关分析显示,BMD与BMI呈正相关(r=0.363,P<0.01),与年龄呈负相关(r=-0.380,P<0.01).25(OH)D与FPG、HbA1c呈负相关(r=-0.228、-0.360,P<0.05或P<0.01).多元线性回归分析结果显示,BMI、HbA1c是BMD的影响因素,HbA1c是25(OH)D的影响因素.结论 绝经期T2DM患者合并微量白蛋白尿BMD、25(OH)D无明显降低.HbA1c水平升高可能引起BMD、25(OH)D降低.

目的 探讨SLCO1B1基因多态性及脂代谢在2型糖尿病肾病发病中的作用.方法 选择166例研究对象,其中对照组66例,2型糖尿病(T2DM)患者100例,按尿白蛋白与肌酐比值(ACR)分为糖尿病未合并肾病DN(-)组60例和糖尿病肾病DN(+)组40例.收集各组人群年龄、性别、身高、体重、BM1、TC、TG、LDL-C、HDL-C、尿微量蛋白等临床资料.比较各组SLCO1B1基因型、等位基因频率以及各项血脂指标.结果 在云南地区人群中SLCO1B1基因388A＞G位点检出A、G2种等位基因,构成AA、AG、GG 3种基因型,521T＞C位点检出T、C2种等位基因,构成TT、TC、CC 3种基因型,两位点构成SLCO1 B1*15、SLCO1B1* 1a、SLCO1B1* 1b 3种单倍体类型.DN(+)组的高密度脂蛋白胆固醇明显降低,差异有统计学意义(P＜0.05).SLCO1B1 388A＞G位点、521T＞C位点基因型和等位基因频率以及SLCO1 B1基因单倍体频率在对照组、DN(-)组、DN(+)组中的分布差异均无统计学意义(P＞0.05).高密度脂蛋白胆固醇降低是2型糖尿病肾病发病的危险因素.结论 SLCO1B1基因388A＞G和521T＞C多态性与2型糖尿病、2型糖尿病肾病无明显相关性.高密度脂蛋白胆固醇降低是2型糖尿病肾病发生的危险因素.

目的 了解昆明地区成年健康女性骨质疏松症患病现状,为昆明地区骨质疏松症的防治工作提供临床资料.方法 健康成年女性1067人;一般情况采集,体格检查,BMD测定;SPSS进行统计分析.结果 昆明地区成年健康女性骨量减少的患病率为37.2％,骨质疏松的患病率为7.4％.青年人组的骨质疏松患病率为0.0％、中年人组为6.33％、年轻老人组为39.32％、老老年人组为54.43％,P<0.001.分娩次数≤1次的患病率为17.72％;分娩次数=2次的患病率为45.57％;分娩次数≥3次的患病率为36.71％.哺乳时间<6个月的患病率为0％;在哺乳时间≥6个月的患病率为100％,P<0.001.结论 年龄、分娩次数、BMI、母乳喂养与女性骨密度相关,分娩次数增多以及年龄的增大是女性OP的危险因素,高BMI是女性OP的保护性因素.

获得性免疫缺陷综合征(acquired immune deficiency syndrome, AIDS,别称艾滋病)是由人免疫缺陷病病毒(human immunodeficiency virus, HIV)感染引起的以免疫系统结构破坏和功能缺陷为主的一种传染病.它能通过性接触、血液、母婴传播,引起感染者各种组织器官的机会性感染和肿瘤,最终导致死亡.中国自1985年发现第 1例AIDS患者以来,AIDS已从局部流行进入广泛的快速增长期[1-3].骨质疏松症(osteoporosis, OP)是一种常见的临床慢性病,是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病.

Objective To investigate the effect of depression on the incidence of osteoporosis in patients with maintenance peritoneal dialysis (MPD).Methods We enrolled 80 MPD patients,who underwent peritoneal dialysis in our dialysis center.The clinical data and biochemical parameters of all patients were collected,bone mineral density was detected and the Self-rating depression scale was used to evaluate depression state.Results Among the 80 enrolled MPD patients,34 patients had osteoporosis (42.5％),48 patients had the presence of depression (60％).Logistic regression analysis showed that age,dialysis age,gender,diabetes history and depression state were the risk factors for osteoporosis in MPD patients,the depression state was negatively correlated with BMD of lumbar and femoral neck (r=-0.347,r=0.426,P＜0.05).Conclusion Depression state may be a risk factor for osteoporosis in clinic,it is of great significance to focus on the psychological state of MPD patients in the prevention and treatment of osteoporosis.

目的 探讨云南地区非卧床持续腹膜透析(CAPD)患者发生心脑血管事件的危险因素.方法 收集云南省不同地区医院1a内就诊的270例CAPD患者,进行12个月的随访,按有无心脑血管事件发生分成未发生心脑血管事件组(178例)和发生心血管事件组(92例),对比分析2组患者的人口学调查资料、临床资料、生化指标等,采用Logistic回归分析进行统计学处理.结果 2组患者在年龄、性别、学历程度、原发病、透析龄、血清尿素氮(BUN)和血清肌酐(Scr)方面并无差异(P＞0.05).发生心脑血管事件组患者在血红蛋白(Hh),总KT/V水平方面均低于未发生心脑血管事件组(P＜0.05),而血磷,全段甲状旁腺激素(iPTH),总胆固醇(TG),低密度脂蛋白胆固醇(LDL-C),高敏C反应蛋白(hsCRP)水平方面均高于无心脑血管事件组(P＜0.05).结论 云南地区CAPD患者发生心脑血管事件与多因素有关,其中血压控制情况、血清总胆固醇水平、低密度脂蛋白胆固醇水平是心脑血管事件发生的重要危险因素.

目的 对比睡眠呼吸暂停低通气综合征(obstructive sleep-hypopnea syndrome,OSAHS)患者与单纯鼾症者骨密度,探讨OSAHS对骨组织的影响.方法 126例男性鼾症患者,分为单纯鼾症组、轻度OSAHS组、中度OSAHS组、重度OSAHS组,采用双能X线吸收法(DXA)测定腰椎、左侧股骨近端、左髋部总体和全身骨密度,对各组各部位骨密度进行比较.结果 重度OSAHS组各部位骨密度均低于单纯鼾症组,差异有统计学意义(P＜0.05);中度OSAHS组L1、L、T-hip、FN及GT的骨密度测量值低于单纯鼾症组,差异具有统计学意义(P＜0.05);轻度OSAHS组与单纯鼾症组比,各部位骨密度无统计学差异(P＞0.05).结论 OSAHS是骨质疏松的危险大素,对于中重度OSAHS患者,应及时了解其骨密度水平.

目的 研究人类免疫缺陷病毒(HIV)感染的患者是否存在甲状腺激素的紊乱,观察甲状腺激素的紊乱与CD4细胞计数的关系.方法 采用放射免疫法测定研究对象的甲状腺激素,检测患者CD4值,分析其与甲状腺激素水平的相关性.结果 38.7％的患者出现一种或多种甲状腺激素的改变,19.1％的发生亚临床甲减.随着CD4值的下降,FT3和FT4随之下降,两者间有正相关关系.年龄、病程、血脂高低、白蛋白、CD4和CD8均不是超敏促甲状腺激素(sTSH)变化的影响因素.结论 HIV感染患者存在甲状腺激素的紊乱,激素的变化与患者免疫功能相关,能预示疾病的严重程度.改善其代谢紊乱对抗病毒治疗有协同作用.

目的 研究男性HIV感染患者是否存在性激素紊乱,观察性激素水平变化与CD4+T细胞计数及性功能障碍的关系.方法 采用放射免疫法测定研究对象的性激素,检测患者CD4+T细胞值,分析其与性激素水平的相关性,同时对患者进行有关性功能的问卷调查.结果 与健康对照人群相比睾酮(T)、雌二醇(E2)差异有统计学意义(P＜0.05),T值低于正常值的占75.5％,E2高于正常值的占21.8％;性激素水平变化与CD4+T细胞之间无相关关系(P＞0.05);在问卷调查中性功能障碍发生率为84.9％,以轻度障碍为主;且性功能障碍与T水平无相关.结论 HIV感染男性患者存在性激素紊乱,有较高的性功能障碍发生率.

目的 探讨人类免疫缺陷病毒(HIV)感染患者是否有血糖、血脂、尿酸等代谢指标异常以及与CD4细胞计数的关系.方法 根据国家2004年制订的获得性免疫缺陷综合征诊疗指南标准,入选HIV感染的患者为云南省传染病关爱中心2010年3~9月门诊和住院患者及德宏州陇川县HIV感染患者,共220例作为观察组,另选取昆明医学院第二附属医院2010年9~10月健康体检者182例为健康对照组.对所有研究对象均进行血脂、血糖、肾功能、CD4的测定.结果 代谢指标异常以低血糖多见及高三酰甘油,低胆固醇为主.随着CD4值的下降,胆固醇、三酰甘油随之下降.结论 HIV感染患者存在代谢指标的异常,血脂的变化与CD4值有相关性.

医学双语教学是我国医学教育改革发展必然趋势.神经病学的学科特点决定了神经病学双语教学的紧迫性和较高的难度.本文分析了双语教学的方法,结合本院多年对双语教学的改良经验,探讨了如何更好地进行神经病学双语教学.

The aim of this study is to understand the influences of the social custom of foot binding on female osteoporosis by means of comparing and analyzing the lumbar vertebrae and hip bone mass differences between the foot-binding aged women and unbound women of the same age at Qujing District of Yunnan Province. Of the examined people, 81.37% suffer from osteoporosis on the basis of lumbar vertebra (L1–L4) and femoral neck BMD, of which 82.14% for the foot-binding group and 80.44% for the unbound group. There is no statistical difference for the osteoporosis morbidity of the two groups. Compare the BMD value for various vertebrae, femoral neck, and rehabilitation of the two groups and find the BMD value for the other parts have no statistical difference except the BMD value of L1 centrum, which shows that foot binding does not significantly influence the overall bone mineral density of foot-binding women.

<正>阻塞性睡眠呼吸暂停综合症(obstractive sleep apnea hyperpnoea sysndrome,OSAS)是一种全身性疾病,主要表现为睡眠时打鼾并伴有呼吸暂停和呼吸表浅,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,导致白天嗜睡、心脑肺血管并发症乃至多脏器损害,严重影响患者的生存质量和寿命

Objective To investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.Results Compared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).Conclusion Triglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

目的 了解景洪地区勐海县基诺族18岁以上成人随机血糖水平的情况.方法 对景洪地区勐海县6个自然村593人,按性别、年龄划分为:①18～20岁组,女性23例,男性15例;②21～30岁组,女性67例,男性40例;⑤31～40岁组,女性120例,男性76例;④41～50岁组,女性63例,男性46例;⑤51～60岁组,女性32例,男性44例;⑥61～70岁组,女性20例,男性21例;⑦71岁以上组,女性14例,男性12例.用强生公司微量血糖仪对其进行随机血糖观察.结果 仅3例随机血糖＞11.1mmol/L;各年龄组不同性别的随机血糖比较无显著性差异,P值均＞0.05;而男女各组随年龄的增加,随机血糖水平亦随之增加,采用线性回归分析,有显著性差异,P值均＜0.05 0结论 基诺族的随机血糖水平均无明显增高,与其传统的生活方式导致热量摄入较低,并从事较繁重的农业生产活动所致.但随着年龄的增大,体力活动也随之减少,热量消耗减少,故血糖水平逐步升高.

Objective To investigate the possible occurrence of thyroid dysfunction and changes of sexual hormone level in human immunodeficiency virus(HIV)infected females,and to observe the correlation between changes of thyroid hormone and sexual hormone.Methods thyroid hormone and sexual hormone ofpatients were determined by radioimmunoassay and the correlation between them was tested.Results As many as 34% of the patients had one or more changes in thyroid hormone and 19%of the patients had the occurrence of subclinical hypothyroidism.There were significant changes in T,E2,P,PRL(P＜0.05)and the patients with thyroid hormone changes had more obvious decrease in T level(P＜0.05).Conclusion Thyroid hormone disorders and sexual hormone disorders exist in HIV infected female patients.HIV infected females with thyroid hormone disorders showed more significant changes in sexual hormone leveL

Objective To research sexual satisfaction and sexual dysfunction of female patients with HIV infection.To investigate relationship between the changes of sexual hormone and sexual satisfaction,other factors which affect the sexual satisfaction.Methods Questionnaires were used to learn sexual dysfunction and sexual satisfaction of patients, and then, we evaluated the level of sexual hormone of patients so as to analyze its connection with sexual satisfaction.Results According to the questionnaires,sexual satisfaction was (4.5± 1.0),obviously lower than the normal level,the incidence of sexual dysfunction was 92%,mainly mild form, and there was no correlation between sexual satisfaction and T level.Conclusions (1) The level of sexual satisfaction of female patients with HIV infection is low,accompanied with severe sexual dysfunction;(2) There is no correlation between sexual satisfaction and the level of hormone.

研究一:将60例T2DM患者随机分为三组,其中餐时A组赖脯,B组门冬,C组餐前30分钟短效睡前均中效,剂量据血糖调整,研究二:将60例随机分为三组,A组睡前甘精,B组睡前甘精,B组睡前地特,C组睡前中效餐前注射速效。结果研究一:赖脯、门冬和短效三组降糖效果无明显差异(P>0.05),赖脯和门冬组低血糖发生率明显低于短效组(P<0.05)。研究二:甘精、地特和中效三组降糖效果无明显差异(P>0.05),甘精组及地特组低血糖发生率明显低于中效组(P<0.05)。结论胰岛素类似物降糖效果显著,安全性高,依从性好。

Objective To investigate the relationship between insulin level and mild cognitive impairment(MCI) of type 2 diabetes and analyze the risk factors for MCI. Methods We collected 101 type 2 diabetes subjects who were divided into two groups:MCI and normal cognition(NC).All subjects were evaluated with cognition scores of MMSE,GDS,CMS,ADL.Insulin,glycosylated hemoglobin,blood routine test,blood pressure,ECG,brain CT were detected.Independent t-test,correlation and multiple regression analysis were performed. Results 1. The diabetic patients with MCI showed the higher levels of insulin at fasting, 2hr and 3hr after meal than did NC(P<0.05).2. Education, insulin level at 2hr after meal,hypertension,and high glucose were variables entering into the equation. Conclusions Hyperinsulinemia contributes to the pathogenesis and development of diabetic MCI