目的 分析不同尿白蛋白排泄率(AER)水平的2型糖尿病(T2DM)患者微小RNA-34a(miR-34a)、缺氧诱导因子-1α(HIF-1ot)水平及意义.方法 选取90例T2DM患者纳入T2DM组,另选取同期门诊体检的90名健康成年体检者纳入对照组.根据AER水平的不同,将T2DM组患者分为正常组、微量组和大量组,每组30例.采用双抗体夹心酶联免疫吸附法检测各组血清HIF-1α含量,并采用实时荧光定量聚合酶链反应法检测各组血清miR-34a表达水平.比较各组血糖、血清HIF-1α、血清miR-34a水平和AER水平,分析T2DM患者AER水平与血清miR-34a水平、血清HIF-1α水平的相关性,并分析miR-34a与HIF-1α的关系.绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估HIF-1 α、miR-34a对T2DM的预测价值.结果 正常组、微量组、大量组T2DM患者的AER、血清HIF-1α、血清miR-34a、血糖水平高于对照组健康体检者,且微量组水平高于正常组,大量组水平高于微量组,差异均有统计学意义(P＜0.05).相关性分析结果显示,T2DM患者AER水平与血清HIF-1α水平、血清miR-34a水平均呈正相关(r=0.75、0.73,P＜0.05),且血清HIF-1α水平与血清miR-34a水平呈正相关(r=0.55,P＜0.05).ROC曲线显示,HIF-1α、miR-34a对T2DM有较高的预测价值,AUC分别为0.991、0.934.结论 T2DM患者尿白蛋白含量越高,病情越严重,且其血清HIF-1α水平与血清miR-34a水平呈正相关,提示miR-34a、HIF-1α是T2DM病情的影响因素,且对T2DM有较高的预测价值.

目的 观察通络糖泰方在波动性高血糖大鼠周围神经病变中的作用及机制.方法 90只健康雄性SD大鼠随机分为正常对照组、稳定性高血糖组、波动性高血糖组、阳性对照组及通络糖泰方低、高剂量组,每组15只.5周后,测定大鼠热、冷刺激反应时间和坐骨神经传导速度;生化试剂测定大鼠空腹血糖(FBG)、糖化血红蛋白(GHb)含量,测定大鼠坐骨神经和红细胞的山梨醇含量,比色法测定大鼠超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量.实时荧光定量PCR(RT-qPCR)检测坐骨神经组织NGF、Cas-pase-3 mRNA的表达.蛋白质印迹(Western Blot)检测坐骨神经组织Caspase-3和Nrf2通路相关蛋白(Nrf2、HO-1和NQO-1)表达.结果 与正常对照组比较,稳定性高血糖组坐骨神经传导速度显著下降,血清FBG和GHb含量、坐骨神经组织山梨醇含量和红细胞山梨醇含量显著增加,血清SOD活性显著降低、MDA含量显著增加,坐骨神经组织NGFmRNA表达显著下调,Caspase-3mRNA和蛋白及Nrf2、NQO-1、HO-1蛋白表达显著上调(P＜0.05);波动性高血糖组上述指标变化比稳定性高血糖组更明显(P＜0.05).与波动性高血糖组比较,低、高剂量通络糖泰方显著降低热刺激反应时间,显著升高坐骨神经传导速度,降低血清FBG和GHb含量及坐骨神经组织山梨醇和红细胞山梨醇含量,显著升高血清SOD活性、降低MDA含量,显著上调坐骨神经组织NGFmRNA表达,显著下调Caspase-3mRNA和蛋白及Nrf2、NQO-1、HO-1蛋白表达(P＜0.05).结论 通络糖泰方可改变波动性高血糖大鼠周围神经病变情况,其机制可能与促进Nrf2通路蛋白表达有关.

目的 观察薤白皂苷对冠心病大鼠心肌细胞凋亡及炎性因子、核转录因子κB(NF-κB)表达的影响.方法 将50只大鼠分为正常组、模型组、薤白皂苷低剂量组、薤白皂苷中剂量组和薤白皂苷高剂量组,每组10只.分别检测各组大鼠血清炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平和血浆NF-κB浓度;采用脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)检测各组心肌细胞凋亡率;采用苏木精-伊红染色(HE)观察各组大鼠心肌组织的病理学变化;采用蛋白质印记法检测各组大鼠心肌组织NF-κB蛋白表达.结果 与正常组比较,模型组血清TNF-α、IL-1β、IL-6水平和NF-κB浓度均明显增加(P<0.05);与模型组比较,薤白皂苷低剂量组、薤白皂苷中剂量组和薤白皂苷高剂量组血清TNF-α、IL-1β、IL-6水平和NF-κB浓度均明显降低(P<0.05),且呈逐渐递减趋势(P<0.05).与正常组比较,模型组心肌细胞凋亡率明显升高(P<0.05);薤白皂苷低剂量组、薤白皂苷中剂量组和薤白皂苷高剂量组心肌细胞凋亡率均明显低于模型组(P<0.05),且呈逐渐递减趋势(P<0.05).HE染色结果显示,正常组大鼠心肌组织正常,模型组大鼠心肌细胞明显肥大增厚,细胞浆呈浓染、增大,细胞间距增大,单位面积内心肌细胞数较正常组明显减少,血管壁增厚,血管周围有较多胶质沉淀,出现大量的炎症细胞浸润.且改善程度呈剂量依赖性,薤白皂苷高剂量组>薤白皂苷中剂量组>薤白皂苷低剂量组.与正常组比较,模型组大鼠心肌组织中NF-κB蛋白表达明显升高(P<0.05);与模型组比较,薤白皂苷低剂量组、薤白皂苷中剂量组和薤白皂苷高剂量组大鼠心肌细胞中NF-κB蛋白表达明显降低(P<0.05),且呈逐渐递减趋势(P<0.05).结论 薤白皂苷可有效抑制冠心病大鼠心肌细胞凋亡,减缓炎症反应,同时抑制NF-κB蛋白的表达.

目的:探讨铁皮石斛多糖是否通过调控微小RNA(miR)-363来影响高糖诱导的人肾小管上皮细胞HK-2损伤.方法:将HK-2细胞分为NG组(正常糖,5 mmol/L葡萄糖),HG组(高糖,30 mmol/L葡萄糖),HG+铁皮石斛多糖-L、M、H组(30 mmol/L葡萄糖+100 μg/mL、200 μg/mL、400 μg/mL铁皮石斛多糖),HG+miR-NC (30 mmol/L葡萄糖+转染miR-NC)、HG+miR-363组(30 mmol/L葡萄糖+转染miR-363模拟物)、HG+铁皮石斛多糖+anti-miR-363组(30 mmol/L葡萄糖+转染anti-miR-363+400 μg/mL铁皮石斛多糖).采用细胞计数试剂盒8(CCK-8)法检测细胞存活率;流式细胞术检测细胞凋亡;western blotting检测Bax、Bcl-2表达;试剂盒检测氧化应激指标超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量;定量Real-time PCR检测miR-363的表达.结果:铁皮石斛多糖提高高糖诱导的HK-2细胞的存活率、Bcl-2蛋白水平、SOD活性、miR-363表达水平,降低凋亡率、Bax蛋白水平、MDA含量,且均呈浓度依赖性(P＜0.05).过表达miR-363使高糖诱导的HK-2细胞的活性、Bcl-2蛋白水平、SOD活性、miR-363表达水平提高,凋亡率、Bax蛋白水平、MDA含量减少(P＜0.05).铁皮石斛多糖对高糖诱导的HK-2细胞存活率、凋亡及氧化应激的影响可被抑制miR-363逆转.结论:铁皮石斛多糖通过促进miR-363表达,增强高糖诱导的HK-2细胞活性,减弱其凋亡和氧化应激.

目的 分析血清蛋白聚糖-1(syndecan-1)与壳多糖酶3样蛋白1(CHI3L1)诊断早期糖尿病肾病(DN)的临床价值.方法 选择2017年12月至2019年12月在延安大学附属医院门诊诊治的146例早期糖尿病患者作为研究对象,根据尿微量清蛋白/肌酐比值(ACR)将146例患者分为单纯糖尿病组(86例)和早期DN组(60例);同时选取52例健康人作为对照组.检测并比较各组血清syndecan-1与CHI3L1水平,同时比较各指标阳性检出率以及单一指标与联合指标对早期DN检测的灵敏度.结果 早期DN组患者血清syndecan-1与CHI3L1水平均明显高于单纯糖尿病组、对照组(早期DN组>单纯糖尿病组>对照组,P<0.05);早期DN组血清syndecan-1与CHI3L1阳性检出率均高于单纯糖尿病组、对照组(P<0.05);血清syndecan-1联合CHI3L1检测早期DN的灵敏度、特异度、准确率高于血清syndecan-1、CHI3L1的单项检测.结论 早期DN患者血清syndecan-1、CHI3L1水平均明显高于健康人群与单纯糖尿病患者,且syndecan-1联合CHI3L1能够明显提高诊断早期DN的准确率,值得临床应用与推广.

目的 探讨瞬感扫描式葡萄糖监测系统(FGM)在2型糖尿病患者血糖管理中的应用效果.方法 选取于我院综合内科住院的102例2型糖尿病患者,随机分为对照组(n=42,血糖监测+胰岛素泵)和观察组(n=60,FGM+胰岛素泵).比较两组患者治疗前、后的各项生化指标、治疗满意率及视觉模拟评分法(VAS)评分.结果 观察组治疗后第7天空腹血糖、餐后2 h血糖、24 h平均血糖、低血糖次数、低血糖时间、高血糖时间百分比、达标血糖范围时间百分比、低血糖时间百分比、血糖达标时间和胰岛素剂量均优于对照组(P<0.05).观察组患者的治疗满意率为70.00％,明显高于对照组的47.62％(P<0.05).观察组患者的VAS评分明显低于对照组(P<0.05).结论 FGM能够随时监测血糖,减少患者疼痛感,且能精确地调整胰岛素剂量,降低低血糖发生风险及次数,使血糖平稳、快速地达到标准,提高患者满意度.

目的 探讨血清成纤维细胞生长因子21(FGF21)与DKD及DR的关系.方法 选取2016年3月至2018年3月于延安大学附属医院综合内科就诊的T2DM患者227例,根据UACR及散瞳眼底照相结果分为单纯T2DM患者(T2DM组)160例、T2DM合并DKD患者(DKD组)33例及T2DM合并DR患者(DR组)34例.比较各组血清FGF21并分析其与DKD、DR的相关性.结果 DKD、DR组血清FGF21高于T2DM组[(275.44±62.20)vs(334.13±29.28)vs(171.50±24.07)pg/ml,P<0.05].Pearson相关分析显示,血清FGF21与糖尿病病程、BMI、SBP、DBP、FPG、HbA1c、UACR及血β2微球蛋白呈正相关(r=0.315、0.141、0.197、0.527、0.634、0.502、0.534、0.224,P<0.05).多因素Logistic回归分析显示,血清FGF21是DKD的危险因素(OR 1.21,95％CI 2.09～4.13,P<0.01).结论 DKD、DR患者血清FGF21上升;血清FGF21是DKD的危险因素.

Objective:To study the correlation of serum Dickkopf-1 (DKK-1)content with bone destruction,inflamma-tory response and oxidation reaction in patients with gouty arthritis.Methods:40 patients with acute gouty arthritis who were treated in our hospital between 2013 and 2016 were selected as the group A of the study,56 patients with asymptomatic hype-ruricemia who were treated in our hospital during the same period were selected as the group B of the study,and 60 healthy volunteers who received physical examination in our hospital during the same period were selected as the control group of the study.The serum was collected to detect the contents of DKK-1,bone destruction indexes,inflammatory response indexes and oxidation reaction indexes.Results:Serum DKK-1,TRACP5b,RANKL,β-CTX,PGE2,sICAM-1,sVCAM-1,sCD14, MDA,8-OHdG and 3-NT levels of group A and group B were significantly higher than those of control group while SOD and GSH-Px levels were significantly lower than those of control group;serum DKK-1,TRACP5b,RANKL,β-CTX,PGE2,sI-CAM-1,sVCAM-1,sCD14,MDA,8-OHdG and 3-NT levels of group A were significantly higher than those of group B while SOD and GSH-Px levels were significantly lower than those of group B;serum DKK-1 level was positively correlated with TRACP5b,RANKL,β-CTX,PGE2,sICAM-1,sVCAM-1,sCD14,MDA,8-OHdG and 3-NT levels,and negatively correla-ted with SOD and GSH-Px levels.Conclusion:Abnormally elevated DKK-1 in patients with gouty arthritis can induce articular bone destruction as well as inflammatory response and oxidative stress response activation.

目的 研究血清nesfatin-1水平与老年2型糖尿病共病抑郁症患者的相关性.方法 选取老年2型糖尿病(T2DM)患者90例,根据患者健康问卷(PHQ)-9和抑郁自评量表(SDS)得分,分为2型糖尿病非抑郁组(ND-DM组)60例和2型糖尿病抑郁组(DDM组)30例.测定血清nesfatin-1水平.结果 DDM组血清nesfatin-1、体重指数(BMI)、糖化血红蛋白(HbA1c)水平、PHQ-9分数及SDS分数显著高于NDDM组(P＜0.05),且DDM组较NDDM组有较多的丧偶、糖尿病并发症及有精神病家族史的老年2型糖尿病患者(P＜0.05).回归分析发现,丧偶率、糖尿病并发症、HbA1 c、nesfatin-1是老年2型糖尿病患者共病抑郁症的独立危险因素.结论 老年2型糖尿病共病抑郁症患者血清nesfatin-1水平升高.提示血清nesfatin-1可能参与老年糖尿病共病抑郁症的发生,并与其严重程度相关.

Objective:To observe the effect of levosimendan on cardiac function and cTnT,hs-CRP and NT-proBNP levels in patients with acute heart failure.Methods:327 cases of patients with acute heart failure in our hospital were selected in accordance with the different treatment modalities,163 patients in the control group were given routine treatment and 164 casesin the observation group were given conventional treatment combined with levosimendan.The left heart shot ejection fraction (LVEF),stroke volume (SV),cardiac troponin T (cTnT) and ultra sensitive C reactive protein (hs CRP) and N-terminal pro-B-type natriuretic peptide (NT proBNP) level were detected before treatment and 24 h after treatment and compared between two groups.Results:There was no significant difference in LVEF and SV before treatment between the two groups (P＞0.05).After treatment,LVEF and SV level were significantly higher than before treatment inthe observation group,(P＜0.05);and the LVEF level in control group was significantly higher than before treatment (P＜0.05),but SV level was not statistically significant compared with before treatment (P＞0.05).After treatment,the LVEF and SV level were significantly higher observation group than that of control group (P＜0.05).The difference in the level of cTnT,hs-CRP,NT-proBNPwas not statistically significant before treatment (P＞0.05),and after treatment,the levels of cTnT,hs-CRP and NT-proBNP were significantly lower compared with before treatment (P＜0.05),and they were significantly lower in the observation group than those of the control group (P＜0.05).No significant differences in the rote of adverse reactions between the two groups (P＞0.05).Conclusions:Levosimendan can significantly increase myocardial contractility,inhibit myocardial remodeling,reduce the inflammation and improve the prognosis of pa-tients with acute heart failure.

Stable chronic obstructive pulmonary disease (COPD) patients’ airway function and local inflammation are both in a certain safe range, but the COPD patients already have airway anatomic change, and can have acute onset in cases of pathogen infection or patients’ weakened constitution, leading to deterioration[1,2]. The treatment of patients with stable COPD is currently the focus of the clinical study, and most scholars believe that stable phase should still be given positive intervention to optimize patients’ condition and reduce the frequency of acute attack. Both tiotropium and salmeterol and fluticasone propionate powder are the main drugs in the clinical treatment of COPD, tiotropium, as anticholinergic drugs, can effectively dilate the airway, and salmeterol and fluticasone propionate powder is the compound preparation of毬2 receptor agonist and inhaled corticosteroid, with the effect of both dilating the airway and inhibiting inflammation[3]. In the research, the effect of combined application of tiotropium and salmeterol and fluticasone propionate powder on disease control in stable COPD patients was mainly analyzed, hereby reported as follows.

目的 探讨磷酸西格列汀联合二甲双胍治疗初发2型糖尿病的临床效果.方法 回顾性分析2013年1月～2015年1月延安大学附属医院收治的91例初发2型糖尿病患者的临床资料,依据治疗措施的不同将其分为二甲双胍组(41例)和磷酸西格列汀联合二甲双胍组(50例).比较两组患者治疗前后血糖、胰岛素、脂代谢情况,观察两组患者临床疗效和不良反应发生情况.结果 两组治疗前空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、体重指数(BMI)、空腹胰岛素(FIns)、胰高血糖素样肽-1(GLP-1)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)比较差异无统计学意义(P＞0.05);二甲双胍组治疗后FBG、2hPBG、HbA1c、TG均低于治疗前,HDL高于治疗前,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组治疗后FBG、2hPBG、HbA1c、HOMA-IR、TC、TG、LDL均低于治疗前,FIns、GLP-1、HDL均高于治疗前,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组治疗后FBG、2hPBG、HbA1c、HOMA-IR、TC、TG、LDL均低于二甲双胍组,FIns、GLP-1、HDL均高于二甲双胍组,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组临床治疗总有效率显著高于二甲双胍组,不良反应发生率显著低于二甲双胍组,差异均有统计学意义(P＜0.05).结论 磷酸西格列汀联合二甲双胍治疗初发2型糖尿病效果较好,患者临床症状改善明显,值得推广应用.

Objective:To explore the clinical efficacy of edaravone combined with alteplase in acute cerebral infraction and its effect on inflammatory factors.Methods:115 patients with acute cerebral infraction accepted in our hospital from May 2012 to May 2015 were selected and randomly divided into observation group with 58 cases and control group with 57 cases.The patients in control group were given alteplase,and the patients in observation group were given edaravone additionally.The inflammatory factors,NIHSS scores,clinical effect and adverse reactions of two groups were observed and compared between two groups.Results:The level of CRP,IL-6,IL-8,TNF-α and NIHSS scores of two groups before treatment had no difference (P＞0.05).The inflammatory factors of two groups were decreased after treatment,and they were lower in observation group than those of control group with statistically difference (P＜0.05).The total effective rate of observation group (96.55 ％) was higher than that of control group (85.96 ％) after 3 months of treatment with statistically significance (P＜0.05).The adverse reaction rate of observation group (5.17 ％) had no statistically difference with control group (7.02 ％),P＞0.05.Conclusions:Edaravone combined with alteplase can effectively decrease the serum level of inflammatory factors and has good effect and safety in treatment of acute cerebral infraction,which is worth of clinical application.

Objective To investigate the impact of long - term intensive hypoglycemic therapy on quality of life and cardiovascular events of patients with type 2 diabetes mellitus. Methods A total of 136 patients with type 2 diabetes mellitus&nbsp;were selected in the Affiliated Hospital of Yan′an University from February 2009 to July 2010,and they were randomly divided into A group and B group according to random number table,each of 68 cases. The control target of HbA1c of A group was 6. 5%to 7. 5% ,while that of B group was less than 6. 5% . HbA1c and FBG before intervention,after 3 years of intervention,after 5 years of intervention were compared between the two groups;quality of life was evaluated before intervention,after 5 years of intervention, respectively; incidence of cardiovascular events ( including macrovascular complications, microvascular complications and composite endpoints of cardiovascular events)and hypoglycemia were recorded during the 5 - year follow up. Results No statistically significant differences of HbA1c or FBG was found between the two groups before intervention( P ﹥0. 05),while HbA1c and FBG of B group were statistically significantly lower than those of A group after 3 years of intervention, after 5 years of intervention(P < 0. 05);after 3 years of intervention,after 5 years of intervention,HbA1c and FBG of the two groups were statistically significantly lower than those before intervention(P < 0. 05). No statistically significant differences of WHOQOL-BREF score was found between the two groups before intervention(P ﹥ 0. 05),while WHOQOL-BREF score of B group was statistically significantly higher than that of A group after 5 years of intervention( P < 0. 05 ). No statistically significant differences of incidence of macrovascular complications or microvascular complications was found between the two groups(P ﹥ 0. 05);incidence of composite endpoints of cardiovascular events of B group was statistically significantly lower than that of A group,while incidence of hypoglycemia of B group was statistically significantly higher than that of A group( P <0. 05). Conclusion Long - term intensive hypoglycemic therapy can effectively improve the quality of life of patients with type 2 diabetes mellitus,reduce the incidence of cardiovascular events,but we should pay attention to the onset of hypoglycemia.

目的 探讨颈动脉粥样硬化性狭窄对急性脑梗死患者神经功能缺损的影响.方法 本院收治的急性脑梗死患者231例均行颈动脉彩色多普勒超声检测,计算颈动脉狭窄率,同时记录患者卒中量表(NIHSS)及格拉斯哥昏迷量表(Glasgow)评分.结果 231例患者中,重度狭窄(狭窄率≥70％)11例(4.76％),中度狭窄(狭窄率50％～ 69％)21例(9.09％),轻度狭窄(狭窄率1％ ～49％)133例(57.58％),无狭窄(狭窄率0％)66例(28.57％).各组NIHSS评分有显著差异(P＜0.05);各组Glasgow评分差异无统计学意义(P＞0.05);颈动脉狭窄率与NIHSS评分呈显著正相关(r=0.422,P＜0.05).结论 颈动脉粥样硬化性狭窄对急性脑梗死患者神经功能缺损有一定影响,颈动脉狭窄率越高,患者NHISS评分越高,但对Glasgow评分无显著影响.

Objective: To observe the clinical curative effect of radiofrequency ablation rhythm control in the treatment of heart failure (HF) complicated with atrial fibrillation (AF).Methods:70 patients with heart failure complicated with atrial fibrillation were divided into 2 groups by random double blind method with 35 cases in each group. The control group to were treated by drug ventricular rate control and anticoagulant therapy while the observation group were treated by radiofrequency ablation rhythm control. The clinical effects, changes of cardiac function before and after the tretment and the incidence of adverse cardiovascular and cerebrovascular events were compared between the 2 groups. Results:The total effective rate in the observation group (91.4%) was significantly higher than that in the control group (71.4%),P<0.05.After the treatment, the differences in LVEF[(51.4±13.4) VS (44.2±15.8)]% and LAD[(38.7±7.9)VS(57.0±10.2)]mm between the two group were significant (P<0.05). In 6 months of follow-up, the incidence rates of cerebral infarction and the recurrence rate of atrial fibrillation in the observation group (0.0%, 8.6%) were significantly lower than those in the control group (17.1%,37.1%),P<0.05.Conclusion:The effect of radiofrequency ablation rhythm control in the treatment of heart failure complicated with atrial fibrillation is significantly better than that of ventricular rate control. It can improve the cardiac function and reduce the incidence of adverse cardiovascular and cerebrovascular events.

Objective:To analyze the effect of liraglutide and metformin on the constitution,metabolism and micro-in-flammatory state in newly diagnosed type 2 diabetic mellitus patients with obesity.Methods:A total of 55 cases of newly diag-nosed type 2 diabetic mellitus patients with obesity were included for study and divided into observation group (n = 30)and control group (n =25)according to different treatment plans.Control group received metformin treatment alone,observation group received liraglutide and metformin treatment,and levels of glucolipid metabolism indicators,body mass index and fi-brinolytic activity-related indicators,micro-inflammation-related signaling pathways,illness-related indicators,etc of two groups were detected after one course of treatment.Results:FPG,GHbA1c,TC,TG and LDL-C values in venous blood of ob-servation group after treatment were lower than those of control group (P <0.05);waistline,hipline and waist-hip ratio of ob-servation group decreased after treatment,TM value was lower than that of control group while t-PA value was higher than that of control group (P <0.05 );TLR4-NF-κB signaling pathway and DAG/PKC signaling pathway downstream TLR4,p-NF-κB p65,DAG and PKC protein expression levels of observation group after treatment were significantly lower than those of control group (P <0.05);serum APN,Nesfatin-1 and ISI values of observation group after treatment were higher than those of control group while LP,Chemerin,RBP4 and FINS values were lower than those of control group (P <0.05).Conclusions:Combined therapy of liraglutide and metformin can significantly improve the constitution of newly diagnosed type 2 diabetic mellitus patients with obesity,optimize the general condition and be expected to improve treatment outcome.

Objective To investigate the blood sugar control effect of three insulin pump basal rate seg-ment methods for type 2 diabetes.Methods A total of 180 patients with type 2 diabetes in Affiliated Hospital of Yan′an University from Jul.2010 to Jul.2014 were included in the study and divided into three groups according to the random number table method,60 cases each:3-segment group,5-segment group and 24-seg-ment group respectively.The blood glucose reaching standard time,blood glucose level, the incidence of hypoglycemia and insulin dosage of the three groups were compared.Results After breakfast blood glucose levels rose,then decreased after lunch, after dinner,3:00 in the morning in each group,with no significant difference(P>0.05).The treatment time and insulin usage of the 5-segmentgroup[(3.6 ±0.3) d,(41 ± 5) U] and 24-segment group[(2.9 ±0.7) d,(36 ±4) U] were less than the 3-segment group[(5.5 ± 0.8) d,(43 ±6) U],and the 24-segment group less than the 5-segment group, with statistically significant difference(P<0.05).The hypoglycemia incidence of the 3-segment group was 13.3%(8/60),of the 5-seg-ment group was 6.7%(4/60),of the 24-segment group was 3.3%(2/60),the difference was not statistical-ly significant(P>0.05).Conclusion The three insulin pump basal rate segment methods to control blood sugar for type 2 diabetes have similar effect,but comprehensively speaking the 5-segment method is more sim-ple and convenient with good effect.

目的 探究产前超声征象评分联合甲胎蛋白(alpha fetoprotein,AFP)检测对前置胎盘合并胎盘植入的诊断价值,为前置胎盘合并胎盘植入的早期诊断提供参考依据.方法 回顾性分析本院2012年3月至2016年3月收治的291例产妇的临床资料.按照其产检及剖宫产术后病理结果,将前置胎盘合并胎盘植入者纳入植入组(89例),前置胎盘未合并胎盘植入者纳入未植入组(106例),未合并前置胎盘、胎盘植入但剖宫产次数≥1次、孕次≥3次者纳入对照组(96例).比较各组产妇产前超声征象评分和孕晚期血清AFP水平,分析其对前置胎盘合并胎盘植入的诊断价值.结果 植入组产妇产前超声征象评分和孕晚期血清AFP水平均高于未植入组和对照组(P＜0.05),未植入组和对照组产妇产前超声征象评分和孕晚期血清AFP水平比较差异均无显著性(P＞0.05).产前超声征象评分联合AFP检测诊断前置胎盘合并胎盘植入的灵敏度为97.67％ (84/86),特异度为97.56％ (200/205).接受者操作特征曲线(ROC曲线)提示,产前超声征象评分联合AFP检测诊断前置胎盘合并胎盘植入的曲线下面积(AUC)为0.891,95％CI为0.871～0.926(P＜0.05).结论 产前超声征象评分联合AFP检测对前置胎盘合并胎盘植入的诊断具有较高的灵敏度和特异度,可为临床诊治提供参考依据.

目的:分析噻托溴铵干粉与沙美特罗替卡松粉剂联合应用对稳定期慢性阻塞性肺疾病(COPD)患者病情控制的效果.方法:将2012年9月～2015年6月间在延安大学附属医院接受治疗的COPD患者116例纳入研究,根据相关检测确定以上研究对象均处于稳定期.根据接受的治疗方式不同,所有入组对象被分为观察组及对照组各58例.对照组患者接受临床常规治疗,观察组患者接受噻托溴铵干粉与沙美特罗替卡松粉剂联合治疗,对比两组患者的治疗后血清及诱导痰中病情相关指标水平.结果:观察组患者接受治疗后的诱导痰γ-GCS、MIP-1α、8-iso PGF2、HMGB1、IL-17、Hbd-2值低于对照组患者,SP-A值高于对照组患者(均P＜O.05);观察组患者的治疗后FEF25％～75％、FEV1％、V25、MMFR值高于对照组患者,血清CXCR3、CXCL10值低于对照组患者(均P＜0.05);观察组患者的治疗后血清和肽素、锁链素、CCL18、CC16、ANG2值均低于对照组患者(均P＜O.05).结论:稳定期COPD患者接受噻托溴铵干粉与沙关特罗替卡松粉剂联合治疗,有助于进一步稳定患者病情并改善预后.