Objective:To establish and validate a nomogram prediction model for acute ischemic stroke in patients aged 60 years and over with type 2 diabetes mellitus (T2DM).Methods:A retrospective analysis was performed on 445 T2DM patients hospitalized in the Department of Geriatrics and Neurology, Lanzhou University Second Hospital from January 2018 to August 2021. Patients were divided into modeling group and validation group according to 3∶1 ratio. A total of 334 patients treated from January 2018 to August 2020 were selected as the modeling group. We screened for the best predictors of acute ischemic stroke in elderly T2DM patients by Lasso regression. The R software was used to construct the nomogram model. The Bootstrap method was used to internal verification, and to draw receiver operating characteristic (ROC) curve. The C-index was calculated to evaluate the predictive performance of the nomogram model. A total of 111 elderly T2DM patients from September 2020 to August 2021 were enrolled as the validation group, external verification of the nomogram model. The calibration curves were drawn and C-index, brier score, calibration intercept and calibration slope were calculated.Results:In the modeling group, Lasso combined with logistic regression analysis showed that diabetes mellitus with hypertension course(OR=1.05, 95%CI 1.01-1.10), systolic blood pressure (OR=2.40, 95%CI 1.74-3.40), high monocyte to high-density lipoprotein-cholesterol ratio (OR=1.34, 95%CI 1.14-1.58), free triiodothyronine (OR=0.36, 95%CI 0.20-0.64), carotid artery plaque area (OR=1.45, 95%CI 1.19-1.79), degree of intracranial arterial stenosis (OR=4.77, 95%CI 2.60-9.81) were the best predictors of acute ischemic stroke in elderly T2DM patients. ROC curve results showed that the C-index of the modeling group was 0.862 (95%CI 0.824-0.900), internal verification was carried out by Bootstrap method, the C-index corrected to 0.852 (95%CI 0.812-0.895), the sensitivity was 80.1%, and the specificity was 76.1%. The C-index of external validation was 0.867 (95%CI 0.803-0.932), the sensitivity was 82.0%, and the specificity was 75.4%. The Brier-score was 0.149, the calibration intercept was -0.149, and the calibration slope was 1.096.Conclusions:The nomogram prediction model constructed in this study has good discrimination and calibration, which has good value for early prediction of acute ischemic stroke in elderly patients with T2DM.

本研究旨在研究长链非编码RNA(lncRNA)H19在甲状腺癌(THCA)中的表达情况及其潜在分子机制.通过UALCAN数据库对H19在THCA中的表达和预后进行分析;利用RNA相互作用百科全书(ENCORI)和调控性RNA 2.0(RegRNA 2.0)数据库对H19靶基因进行预测,并对预测获得的靶基因进行基因本体(GO)及京都基因与基因组百科全书(KEGG)数据库分析;分析靶基因母体抗生物皮肤生长因子同源物4(SMAD4)在THCA中的表达、预后及其与H19的表达相关性.结果显示:H19在THCA中的表达与肿瘤分期显著相关,进入3期以后则显著升高,H19高表达的THCA患者其预后生存率明显低于中低表达的患者;H19和SMAD4基因的表达呈显著负相关,SMAD4在THCA中的表达显著下调,且SMAD4表达下调与THCA患者不良预后有关.推测在THCA中,H19可能通过与SMAD4相互作用下调其表达,从而对转化生长因子-β(GF-β)信号通路产生抑制,进而促进了THCA的发生、发展.

目的 探讨微小RNA-26a (miR-26a)对气道平滑肌细胞(ASMC)中PTEN的表达以及细胞增殖的影响和机制.方法 20只SPF级SD大鼠随机分为正常对照组和哮喘模型组,每组10只.予卵蛋白腹腔注射并雾化吸人制作SD大鼠支气管哮喘模型.苏木精—伊红染色法染色观察2组大鼠肺部组织病理变化.利用荧光定量聚合酶链反应检测2组大鼠气道ASMC中miR-26a的表达.预混10只正常大鼠ASMC细胞,根据不同处理方法分为:空白对照组、转染对照miRNA的阴性对照组、miR-26a转染模拟组、miR-26a抑制剂转染组、PTEN-pGC-Fu-GFP组、pGC-Fu-GFP组和Ly294002组.转染后48 h收集细胞,MTT法检测细胞增殖情况.荧光定量PCR和Western blotting检测空白对照组、阴性对照组、miR-26a转染模拟组和miR-26a抑制剂转染组细胞中PTEN的基因表达和蛋白表达,同时检测PTEN-pGC-Fu-GFP组、pGC-Fu-GFP组和Ly294002组细胞中细胞周期相关蛋白CyclinDl、p21以及通路相关蛋白p-Akt、JNK1的表达.结果 哮喘模型组大鼠ASMC中miR-26a呈现高表达,肺部组织损伤严重.与空白对照组相比,抑制miR-26a表达能够抑制ASMC细胞增殖,上调PTEN表达,过表达miR-26a能够促进ASMC细胞增殖,抑制PTEN表达.与空白对照组比较,过表达PTEN能够抑制ASMC细胞增殖,抑制细胞周期相关蛋白CyclinD1表达,上调细胞周期素依赖性激酶抑制因子p21表达,同时抑制通路蛋白p-Akt和JNK1的表达.结论 miR-26a能够通过影响PTEN的表达,调控ASMC细胞增殖以及PI3K/Akt信号通路.

Excessive neutrophil extracellular trap (NET) formation may contribute to polymyositis (PM)-associated interstitial lung diseases (ILD), but the underlying mechanism is not fully revealed. In this study, we found that NET accelerated the progression of ILD and promoted pulmonary fibrosis (PF) in vivo. miR-7 expression was down-regulated in lung tissue of PM group than control group, and NETs further decreased miR-7 expression. TLR9 and Smad2 were up-regulated in lung tissue of PM group than control group, and NETs further increased TLR9 and Smad2 expressions. In vitro experiments showed that PMA-treated NETs accelerated the proliferation of LF and their differentiation into myofibroblast (MF), whereas DNase I decreased the promotion effect of NETs. Neutrophil extracellular trap components myeloperoxidase (MPO) and histone 3 also promoted the proliferation and differentiation of LF. In addition, we demonstrated that TLR9 involved in the regulation of NETs on LF proliferation and differentiation, and confirmed the interaction between miR-7 and Smad2 in LF. Finally, miR-7-Smad2 pathway was confirmed to be involved in the regulation of TLR9 on LF proliferation and differentiation. Therefore, NETs promote PM-related ILD, and TLR9-miR-7-Smad2 signalling pathway is involved in the proliferation of LFs and their differentiation into MFs.

目的:探讨红芪多糖单用或联合厄贝沙坦对2型糖尿病大鼠心肌纤维化的影响.方法:采用高脂高糖饲料加单次腹腔注射链脲佐菌素[30 mg/kg(体质量)]制备2型糖尿病大鼠模型.将Wistar大鼠50只随机分为正常对照组(NC组)10只和造模组40只,将造模成功的36只大鼠随机分为糖尿病组(DM组)、红芪多糖组(HPS组)、厄贝沙坦组(IRB组)及红芪多糖联合厄贝沙坦组(HPS+IRB组)各9只.HPS组每日予红芪多糖150 mg/kg灌胃,IRB组每日予厄贝沙坦30 mg/kg灌胃,HPS+IRB组每日予红芪多糖150 mg/kg加厄贝沙坦30 mg/kg灌胃,NC组和DM组予等量生理盐水灌胃,干预8周.检测各组大鼠空腹血糖,计算心重指数(H/B),实时荧光定量PCR法测定心肌局部转化生长因子 β1(TGF-β1)、Smad3及Smad7 mRNA水平,免疫组化法测定TGF-β1、Smad3及Smad7蛋白水平,透射电镜下观察大鼠心肌超微结构,Masson染色法测定心肌胶原含量.结果:1)与NC组比较,其余4组大鼠心肌胶原含量增多,间质纤维化明显,H/B、TGF-β1、Smad3表达均升高,Smad7表达降低(P<0.01);与DM组相比,HPS组、IRB组及HPS+IRB组大鼠心肌纤维化减轻,H/B、TGF-β1、Smad3表达下降,Smad7表达升高(P<0.05),HPS+IRB组上述变化更显著.2)心肌病理改变:与NC组相比,DM组大鼠心肌胶原纤维增多,排列紊乱,线粒体肿胀;而HPS组、IRB组及HPS+IRB组上述改变减轻,HPS+IRB组上述改变减轻较HPS组和IRB组更明显.结论:红芪多糖及厄贝沙坦能通过抑制TGF-β1/Smads信号通路延缓2型糖尿病大鼠心肌纤维化的发生和发展,两药联合效果优于两药单用.

目的 探讨黄芪多糖对老年糖尿病大鼠糖脂代谢的影响.方法 将54只老年大鼠分为对照组、模型组(糖尿病组)、阳性对照组(糖尿病+二甲双胍)和黄芪多糖组(糖尿病+黄芪多糖,分高、中、低剂量),每组9只.2型糖尿病建模成功后,阳性对照组给予二甲双胍灌胃,黄芪多糖组给予黄芪多糖灌胃.测量各组大鼠空腹血糖、糖耐量计算曲线下面积(AUC)、空腹胰岛素及血脂水平.结果 模型组、阳性对照组和黄芪多糖高剂量组1、2、4、6 w时空腹血糖均高于对照组(P<0.05);阳性对照组、黄芪多糖高剂量组1w和2w时空腹血糖和模型组比较差异无统计学意义(P>0.05),4w和6w时空腹血糖低于模型组(P<0.05).模型组、阳性对照组和黄芪多糖高剂量组糖耐量0、0.5、1.0、1.5、2.0 h血糖水平和AUC均高于对照组(P<0.05);阳性对照组、黄芪多糖高剂量组糖耐量0.0、1.0、1.5、2.0 h血糖水平和AUC低于模型组(P<0.05),0.5 h血糖水平和模型组比较差异无统计学意义(P>0.05).模型组空腹胰岛素高于对照组,胰岛素敏感指数低于对照组,阳性对照组、黄芪多糖组高剂量空腹胰岛素低于模型组,胰岛素敏感指数高于模型组(均P<0.05).模型组和黄芪多糖高剂量组三酰甘油、总胆固醇和低密度脂蛋白水平均高于对照组(P<0.05);黄芪多糖高剂量组三酰甘油、总胆固醇、低密度脂蛋白水平均低于模型组(P<0.05),模型组高密度脂蛋白水平低于对照组(P<0.05).结论 老年糖尿病大鼠存在血糖血脂异常,黄芪多糖可以改善老年糖尿病大鼠的血糖血脂水平.

Objective To investigate the incidence of osteoporosis and bone metabolism in patients with type 2 diabetes mellitus.Methods A total of 144 patients with type 2 diabetes mellitus admitted to our hospital between 2015 and2016 were selected as subjects.The general data and clinical data of these patients were analyzed to find out about the incidence of osteoporosis and were compared with those of the non-type 2 diabetes population.The changes of bone metabolism in case of osteoporosis or non-osteoporosis among the 144 patients with type 2 diabetes were observed and compared with healthy controls.Results The incidence of osteoporosis in patients with type 2 diabetes was significantly higher than in non-diabetic patients (P＜0.05).The urine CTX in the group complicated with osteoporosis was significantly higher than that in the booc loss group and normal group (P＜0.05).The PTH of the group complicated with osteoporosis was significantly higher than that of the normal group (P＜0.05).Compared with non-diabetic patients,diabetic patients had significantly increased plasma CTX,but significantly lower levels of osteocalcin (P＜0.05).Conclusion The incidence of ostooporosis in patients with type 2 diabetes is relatively high.Their bone metabolism is characterized by increased bone resorption and decreased bone formation.Therefore,patients with type 2 diabetes should guard against osteoporosis.

目的 分析糖尿病足应用高压氧治疗的临床效果.方法 任选90例该院2013年5月—2017年5月收治的糖尿病足患者,分为两组,对照组给予常规治疗,研究组在此基础上给予高压氧治疗,观察两组治疗效果.结果 治疗后研究组空腹血糖为(3.9±1.3)mmol/L,对照组为(6.2±1.9)mmol/L,对比差异有统计学意义(P<0.05).两组治疗C反应蛋白、白细胞、糖化血红蛋白等生化指标比较,差异无统计学意义(P>0.05).研究组与对照组有效率分别为93.3%和73.3%,差异有统计学意义(P<0.05).结论 对糖尿病足患者应用高压氧治疗的临床效果显著,且不会影响患者血生化指标,具有较高疗效和安全性,可推广.

目的 探讨老年糖尿病患者的临床特点及其慢性并发症情况.方法 选取164例老年糖尿病患者,入选患者均符合1999年WH0糖尿病诊断标准.所有患者均测定血压(BP)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(T G)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C-肽(C-P)及尿微量白蛋白排泄率(UAER).样本指标间相关性采用偏相关分析.结果 老年糖尿病患者并发症发生率高,并发高血压病者占首位,其次为糖尿病肾病、糖尿病周围神经病变;糖尿病并发症的发生与病程、血糖水平、血压及总胆固醇水平密切相关.采用偏相关分析校正年龄和性别的影响,糖尿病周围神经病变、糖尿病视网膜病变、糖尿病肾病与糖尿病病程呈正相关(P＜0.01,或＜0.05).结论 老年糖尿病患者并发症发生率高,且多种并发症与病程呈正相关.

乙酰肝素酶(Heparanase,HPSE)是定位于溶酶体和高尔基体的一种内切糖苷酶,能够降解硫酸乙酰肝素蛋白聚糖中的硫酸乙酰肝素(Heparan Sulfat,HS)链,后者是组织细胞外基质和基底膜的重要组成部分,HPSE 通过降解 HS 链参与一系列生物学反应如炎症反应、胚胎发育、血管生成、肿瘤的侵袭和转移等[1]。研究证实,HPSE 还可以通过促进平滑肌细胞增生而参与动脉粥样硬化的形成[2]。本研究通过检测冠心病患者血清 HPSE 水平并分析其与冠状动脉病变的相关性,初步探讨其在冠心病发生中的作用及其在冠心病病情判断、预后评估中的临床意义。

To investigate the clinical characteristic of non-alcoholic fatty liver disease with type 2 diabetes mellitus , and to analysis its risk factors . Method:138 patients with T2DM were selected . Biochemical tests and liver ultrasound examination were retrieved. Biochemical indices between T2DM patients with and without NAFLD (NAFLD and NFLD) were compared . Results:The prevalence of NAFLD in T2DM patients was 39 . 2%, among which 69 . 23% had the elevated liver enzymes . Compared with NFLD group , the BMI , triglycerid , FINS , PINS and ALT , AST in NAFLD group were significantly higher (P<0 . 05 or P<0 . 01). Conclusion:There is high prevalence of NAFLD in patients with type 2 diabetes mellitus . BMI , TG , FINS and PINS were major risk factors for T2DM patients with NAFLD .

【Objective】 To explore the relationship between HbA1c and MT in type 2 diabetes.【Methods】 The common carotid artery intima-media thickness(CCA-IMT),CCA-IMT was observed by ultrasonography and glycated hemoglobin levels was detected in 49 patient s with Type 2 diabetes patients.【Result】 In T2DM with absence of vascular disease and T2DM with large vascular disease alone,IMT showed an increasing trend,CCA-IMT was strongly related to 2h-PG,followed by age,HbA1c.HbA1c correlated with 2h-PG strongly,and was not significantly associated with fasting glucose.【Conclusion】 Postprandial hyperglycemia is the main reason caused by elevated HbA1C.HbA1c level could predict the progress of CCA-IMT.HbA1c level lower,the slower the CCA-IMT progress.

Objective:To investigate the expression of homocysteine and Matrix Metalloproteinase9 in diabetic nephropathy.Methods: The serum MMP9 and Hcy was determined in 46 typ 2 diabetes(22 type 2 diabetes without complication,24 diabetic nephropathy) and 20 healthy controls,the clinical and biochemical data were analyse.Results: The serum MMP9 and Hcy in diabetic nephropathy was higher than that in type 2 diabetes without complications and healthy controls;Hcy was correlated positively with age;MMP9 was correlated positively with LDL,CHO,TG,blood pressure,Hcy and correlated negatively with HDL.Conclusion : MMP9 and Hcy may play an important role in the development and progression in diabetic nephropathy.

Objective:To investigate the prevalence and clinical features of depression in patients with diabetes mellitus.Methods:Eighty five patients with diabetes in our department were evaluated with Hamilton rating scale for depression from Apr 2009 to Apr 2010.Results:The prevalence of depression in patients with diabetes was 18.82% in which female prevalence of depression was 28.21% and male was 10.87%.Female patients was a higher prevalence than that of male patients in which there was statistical significance(P0.05).Conclusion:Prevalence of depression in patients with diabetes mellitus should be paid attention and give them mental nursing in time.

<正>糖化血红蛋白(HbA1c)是糖尿病(DM)并发症的独立危险因素,研究结果显示HbA1c水平降低后,DM并发症发生危险均显著降低。以HbA1c低于6.5%作为达标标准,我国达标的2型糖尿病(T2DM)患者仅占25.9%。本文通过测定DM患者HbA1c水平,了解兰州地区DM患者HbA1c的达标率。

<正>人体的血糖在日间是呈波动性变化的,以往采用的传统血糖监测方法只能测定某一点的、静态的血糖值,无法全面的了解人体血糖的全天变化趋势及波动的细节,因此,对糖耐量正常者的全天血糖波动情况不能全面、完整、细致的了解。本文采用动态血糖监测系统(CGMS)连续3 d监测一组糖耐量正常者(NGT)血糖水平的波动,探讨正常人在正常生活状态下日内

Objective To investigate the change of plasma visfatin level and the relationship between plasma visfatin level with fasting plasma glucose(FPG),fasting insulin(FINS),homeostasis model assessment(HOMA),total cholesterol(TC),triglyceride(TG),high density lipoprotein (HDL),low density lipoprotein(LDL),free fatty acids(FFA)and body weight to give different interventions in rats with type 2 diabetes.Methods With high-sucrose and high-fat diet+STZ(30 mg/kg)inducing Wistar rats,rats model with type 2 diabetes melitus was developed by means of FPG11.1 mmol/L(DM,n=28),and then given repaglinide+dimethylbiguanide(B,n=7), rosiglitazone+dimethylbiguanide(C,n=7),insulin+dimethylbiguanide(D,n=7),PS(E,n=7) in DM.Plasma visfatin levels were measured by ELISA in rats with type 2 diabetes and control after 8 weeks.The relationship of plasma visfatin level with FPG,FINS,HOMA,TC,TG,HDL, LDL,FFA and body weight were analyzed.Results FPG,FINS,HOMA,TC,TG,HDL,LDL, FFA,visfatin and body weight in diabetes rats and obese rats significantly increased and HDL significantly reduced compared with NC.FPG,FINS,HOMA in B-E groups significantly reduced compared with F.FFA in C group significantly reduced and visfatin level significantly increased compared with other groups.Correlation and multiple regression analysis showed that plasma visfatin level was closely correlated with glucolipid metabolism and body weight.Conclusion It is possible that peroxisome proliferator-activated receptors nuclear receptor joins in the express and secretory activity of visfatin.Visfatin,which is closely correlated with glucolipid metabolism and body weight,may be one of the targets of peroxisome proliferator-activated receptors excitomoter drug treat DM.

监测血糖足了解血糖控制状况的必要手段,目前对于2型糖尿病患者全天血糖波动的规律及详细漂移变化了解不多.常规的全天多时点毛细血管血糖监测并不能准确反映机体的血糖具体变化情况.动态血糖监测系统(continuous glucose monitoring system,CGMS)是近年来应用于糖尿病领域的一项新的检测方法.其可持续监测受试者血糖水平的变化.我们采用CGMS对2型糖尿病患者进行连续3日的动态血糖监测,旨在详细了解2型糖尿病患者全天血糖波动的趋势及漂移变化的细节,现报道如下.

Objective To compare hyperinsulinemic-euglycemic clamp adopting venopuncture of double venae caudalis in rats without anesthesia with that of adopting catheterization of arteria caudilis and vena caudalis in rats under local anesthesia.Methods 16 SD rats were divided into 4 groups and each group contained 4 rats.2 groups were fed with standard diet and the other 2 groups were fed with high-fat and high-sucrose diet.Eight weeks later,one vena caudalis of rats without anesthesia was used to inject insulin[0.12 U/(kg·h)]and glucose and the other vena caudalis was used to obtain blood samples for performing hyperinsulinemic-euglycemic clamp respectively. Results After the venopuncture of vena caudalis,the blood glucose of the rats was within the normal range without any significant fluctuation,and no rat died.The glucose infusion rate (GIR) of the high-fat and high-sucrose diet group was significantly lower than that of the normal diet group(P0.01).The blood glucose coefficient of variation and GIR coefficient of variation were 5.7%and 14.9%respectively.There was no significant difference between the two techniques. Conclusion Compared with hyperinsulinemic-euglycemic clamp adopting catheterization of arteria caudilis and vena caudalis in rats under local anesthesia,hyperinsulinemic-euglycemic clamp adopting venopuncture of double venae caudalis in rats without anesthesia is safer,more feasible, easier to perform,and has shorter experimental period and lower mortality.Rats fed with high-fat and high-sucrose diet are susceptible to insulin resistance.

目的 探讨体型指数(figure index,FI)与胰岛素抵抗(IR)的相关性,并与体重指数(BMI)和腰围(WC)进行比较.方法 256研究对象分为2型糖尿病(DM)组、糖调节受损(IGR)组和正常糖耐量(NGT)组,比较FI、WC、BMI与IR的相关性以及相关性在3组的差异.结果 FI、WC、BMI与稳态模型胰岛素抵抗指数均有显著相关性(P＜ 0.01),FI与IR的相关性更强;不同糖代谢各组比较,FI、WC、BMI与各指数间的相关性DM组＞ IGR组＞ NGT组,即与各指数间的相关性随糖调节异常的加重而增强.结论 FI、WC、BMI均是评估IR的良好指标,以FI敏感性最高.