目的 探讨成人隐匿性自身免疫糖尿病(LADA)患者发生糖尿病(DM)周围神经病变(DPN)的影响因素.方法 选取LADA患者102例,采用踝反射、针刺痛觉、震动觉、压力觉及温度觉联合神经肌电图检测DPN的发生情况后分为DPN组(合并DPN者,n=49)和非DPN组(未合并DPN者,n=53),以同期2型DM(T2DM)合并DPN住院患者为对照组(n=49),收集3组患者的临床资料[性别、年龄、病程、吸烟史、DM家族史、舒张压和收缩压、体质量指数(BMI)],同时收集2组LADA患者住院期间DM并发症和合并症资料;分别抽取3组患者空腹及馒头餐试验后2 h静脉血,全血标本检测糖化血红蛋白(HbA1c),分离血清后检测空腹血糖(FBG)、餐后2 h血糖(PBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(SUA)、血肌酐(Scr)、胱抑素C(CysC),视黄醇结合蛋白(RBP),采用全自动化学发光免疫分析仪检测3组患者血清空腹C肽(FCP)和餐后2 h C肽(PCP),采用化学发光法检测3组患者血清胰岛细胞抗体(ICA)、谷氨酸脱酸酶抗体(GADA)及胰岛素自身抗体(IAA);采用多因素logistic回归分析LADA患者发生DPN的影响因素.结果 与非DPN组比较,DPN组LADA患者DM病程较长、PCP水平较低(P<0.05);与对照组比较,DPN组LADA患者年龄较小,DM病程较短,HbA1c、FBG及HDL-C水平较高,BMI、收缩压、FCP、PCP、TG、SUA、CysC及RBP水平较低(P<0.05);logistic回归分析显示,DM病程(OR=1.129,95％CI为1.026～1.243)和PCP(OR=0.513,95％CI为0.270～0.975)是LADA患者发生DPN的影响因素.结论 较长DM病程、较低PCP的LADA患者更易发生DPN.

目的 分析成人隐匿性自身免疫性糖尿病(LADA)的临床特点及其甲状腺自身免疫特征.方法 回顾性分析40例LADA患者(LADA组)和40例胰岛自身抗体阴性的2型糖尿病(T2DM)患者(T2DM组)的临床资料,比较两组患者的临床特点及实验室指标.将LADA患者进一步分为甲状腺自身抗体阳性组(n=15)和甲状腺自身抗体阴性组(n=25),比较两组的临床生化指标.结果 LADA组体质指数、总胆固醇、三酰甘油、LDL-C、血尿酸、空腹C肽水平低于T2DM组,甲状腺球蛋白抗体(TGAb)阳性比例高于T2DM组(均P<0.05).甲状腺自身抗体阳性的LADA患者的空腹C肽水平低于甲状腺自身抗体阴性患者,合并2个以上胰岛自身抗体比例高于甲状腺自身抗体阴性患者(均P<0.05).结论 与T2DM患者相比,LADA患者具有低体质指数和低空腹C肽、血脂、血尿酸水平,以及高TGAb阳性比例的临床特点,以上指标可用于LADA的筛查;甲状腺自身抗体阳性的LADA患者具有特定临床表型,表现为更低的空腹C肽水平.

目的 分析232例化妆品变应性接触性皮炎患者斑贴试验结果及临床资料.方法 应用标准化妆品斑贴试剂盒检测2018年1月～2020年3月我科232例诊断化妆品变应性接触性皮炎患者的过敏原,分析致敏原及不同致敏部位临床表现之间关联.结果 斑贴试验结果显示183例呈现阳性反应,阳性率为78.88％,面部过敏及一般护肤类化妆品引起的过敏最为多见.居前8位的致敏原依次为:甲基异噻唑啉酮、CL+Me-异噻唑、山梨糖醇酐倍半油酸酯、虫胶、硫柳汞、叔丁基氢醌、山梨坦油酸酯和没食子酸辛酯,强阳性反应例数居前两位的是甲基异噻唑啉酮和CL+Me-异噻唑.结论 化妆品中防腐剂、乳化剂、抗氧化剂、抗菌剂、香料类等是主要的变应原,斑贴试验可以给过敏人群提供购买化妆品的可靠参考.

目的:探讨脑出血急性期中脏腑证的临床特点.方法:临床观察165例急性脑出血(Acute Intracerebral Hemorrhage,AICH)患者,比较各类中风证型的临床表现、实验室检查、影像学检查等临床特点.结果:与急性脑出血中经络证相比较,中脏腑证患者急性期中风病类诊断标准评分常呈重型和极重型(P<0.001),实验室检查显示为白细胞明显增高(P<0.001),影像学表现颅内出血量较大(P<0.001),发生脑室受压及中线移位的比例高(P<0.001).与急性脑出血中脏腑闭证相比较,中脏腑脱证以男性为主(P=0.020),颅内出血量较大(P=0.002).Logistic回归分析显示急性脑出血中脏腑证与中线移位(P=0.003)、中风病类诊断标准评分增高(P<0.001)密切相关.结论:急性脑出血中经络证、中脏腑证在临床表现、实验室检查、影像学检查中存在明显差异,急性脑出血中脏腑证显示出更严重的神经功能缺损和血肿占位效应,而中脏腑脱证较闭证颅内出血量更大.

报道国内首例二肽基肽酶抑制剂4(DPP-4i)致关节痛不良反应.1例58岁男性患者,T2DM病史6年,先后2次服用西格列汀均出现双足关节疼痛,风湿免疫性指标及关节X光片均无异常,停药后症状缓解.与他汀类联用时,西格列汀诱导关节痛不良反应的潜伏期更短.DPP-4i引起关节痛的机制目前尚未明确,可能与细胞因子诱导的炎症相关,且不同DPP-4i致关节痛风险有所不同.

目的 采用血浆差异代谢组学的方法 筛选和评价急性脑出血瘀热病机的特征代谢物,并确立生物标志物.方法根据《中医脑出血瘀热评分量表》,采用匹配的方法收集临床瘀热型与非瘀热型急性ICH患者各40例,健康对照40例,应用液相色谱-质谱联用技术(LC-MS)检测瘀热组(YP)、非瘀热组(FP)及健康组(JP)之间血浆差异代谢物.采用主成分分析(PCA)、偏最小二乘法判别分析(PLS-DA)和正交偏最小二乘法判别分析(OPLS-DA)对代谢组学数据进行多维统计分析,筛选急性脑出血瘀热病机单元的特征代谢物.结果 YP/JP检测出27个差异代谢物;FP/JP检测出23个差异代谢物;FP/YP检测出14种差异代谢物,主要涉及类固醇激素合成、组氨酸代谢、半乳糖代谢等9个通路.结论 可的松21-乙酸酯、酸甲酯和甘油三酯可作为一组急性脑出血瘀热病机的潜在生物标志物.

目的 分析日光性角化病(AK)的临床及病理特征.方法 回顾性分析经皮肤活检病理确诊并有完整记录的84例AK患者的临床资料,观察HE染色切片,分析病理特点及相应的临床表现.结果 84例患者年龄(68.00±11.41)岁,病程2个月～20年余,男女比例为2∶3;发生部位多在面部(95.24％);初诊与最终诊断符合率19.05％.病理表现多样,均有表皮基底部不典型细胞增生,以萎缩型(44.05％)最为多见.结论 AK好发于老年人面部,组织病理及临床表现均多样化;皮肤病理检查可减少误诊率.

目的:探讨雌激素雌二醇(E2)对于体外培养的原代毛乳头细胞(DPC)的生物钟基因活性的影响.方法:体外分离培养6个月胎龄畸形引产胎儿头皮毛乳头细胞,2周后同步所有细胞生物钟活性,随机分为雌激素E2实验组和对照组.24 h中每间隔6h提取一次总RNA,采用荧光定量PCR方法检测细胞中Clock、Bmal1、Per1、Per2、Per3等主要生物钟基因的表达量.结果:贴壁后的原代DPCs呈放射状向外生长,单个细胞形态呈长梭形.无论雌激素E2实验组和空白对照组,DPCs生物钟基因均呈节律性表达.雌激素E2处理后,相对于对照组,实验组生物钟基因(Clock,Bmall,Perl,Per2)的表达量显著增加(P＜0.05).结论:雌激素E2显著调节体外培养人毛乳头细胞生物钟基因的表达水平,其生物学意义值得深入研究.

目的 探讨中药口服及熏药联合灸法对蛇串疮患者中医护理应用效果.方法 选取我院收治的蛇串疮(带状疱疹)患者42例,按照数字随机分配法分为对照组(n=20)和观察组(n=20).对照组接受西药治疗及常规护理,观察组在对照组基础上联合龙胆泻肝汤加减法及中药熏药和艾灸法中医护理干预.对比两组患者干预7d前后临床症状好转、疱疹愈合及治疗后后遗症发生情况.结果 干预前,两组患者中医临床症状评分、疼痛评分及皮损情况无明显差异,无统计学意义(P>0.05);干预后,两组患者疱疹结局指标、后遗症发生率有明显差异;观察组中医临床症状评分、皮损症状评分、平均止疱和止痛时间 、50％疱疹结痂时间和后遗神经痛发生率均显著低于对照组;差异均有统计学意义(P<0.05).结论 中药口服及熏药联合灸法对蛇串疮患者治疗效果确切,可显著改善患者临床症状及疱疹结局,减少皮损和后遗神经痛等并发症.

目的 探讨耳穴埋籽联合脑循环系统治疗对椎基底动脉供血不足性眩晕的临床效果.方法 选取椎基底动脉供血不足性眩晕患者60例,随机分为对照组和治疗组各30例,对照组给予常规护理,治疗组给予耳穴埋籽联合脑循环系统治疗中医护理干预措施,干预2周后,对比2组患者眩晕改善情况、临床治疗效率、满意度及平均住院时间.结果 2组患者入院时眩晕症状评分无统计学差异(P＞0.05),干预1周后治疗组眩晕症状评分低于对照组(P＜0.05),干预2周后治疗组眩晕症状评分显著低于对照组(P＜0.01);干预2周,治疗组患者治疗总有效率和满意度高于对照组(P＜0.05);治疗组患者平均住院时间短于对照组(P＜0.05).结论 耳穴埋籽联合脑循环系统治疗可显著改善椎基底动脉供血不足性眩晕的临床症状,提高治疗有效率和满意度,并缩短患者住院时间.

Objective: To evaluate the efficacy and safety of the Huoxue Qufeng in treating migraine.Methods: We searched CNKI, VIP, Wan Fang, CBM, and Pubmed online, Cochrane Library(January 2000 to October 2015) for randomized control trails about the Huoxue Qufeng to treat migraine. Trail screening, quality assessment, and data extract were conducted. Statistical analysis was conducted by using Rev Man 5.3 software.Results: A total of 17 randomized control trails were include with 1621 cases. Meta-analysis showed that: when compared with the control group, the Huoxue Qufeng was superior in the total effective rates [OR=3.84, 95%CI(2.88,5.13),P<0.01], superior in the cure rates [OR=3.28, 95%CI(2.36,4.57),P<0.01], lower in the recurrence rates [OR=0.07, 95%CI(0.02,0.29),P<0.01], between the two groups are significantly different; Funnel plot is asymmetric that indicates publication bias Conclusion: The Huoxue Qufeng is more effective than western medicine in the treatment of migraine, more large-scale multi-center randomized trials are needed.

Objective:To characterize the clinical features of scrub typhus. Methods:Clinical data in 45 patients with scrub typhus diagnosed from August 2012 to March 2016 were analyzed retrospectively. Results:Incubation period was 3 weeks in the series of the patients. The main clinical manifestations included fever in 45 patients (100.00%), headache in 13 (28.89%), myalgia in 25 (55.56%), cutaneous manifestations in 45 (100.00%), fatigue in 32 (71.11%) and gastrointestinal symptoms in 16 (35.55%). Macular/maculo-papular lesions on the trunk and limbs were seen in 37 patients (82.22%). The most characterized skin lesion was black eschar, mainly in chest in 13 patients ( 28. 89%) , abdomen in 11 ( 24. 44%) , axillae in 5 (11.11%) and perineum in 4 (48.89%). Conclusion: The clinical manifestations of scrub typhus vary and the most useful clue in the diagnosis of scrub typhus is the eschar lesion.

目的 探讨急性脑出血瘀热病机与临床表征的相关性.方法 收集急性脑出血患者271例,根据瘀热病机量化诊断标准分为瘀热证组97例和非瘀热组174例.比较两组一般情况,肝功能、肾功能指标:天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、肌酐(Cr);血糖、血脂指标:空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度之蛋白胆固醇(LDL-C);凝血功能:凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB).对既往史、个人史、家族史、发病诱因、实验室指标和影像学资料进行二元Logistic回归分析. 结果 瘀热组患者以腹压增高为发病诱因者占41.2％,明显高于非瘀热组患者20.7％ (P ＜0.01).瘀热组患者以体位改变为发病诱因者占18.6％,明显高于非瘀热组患者占9.8％(P＜0.05).与非瘀热证组比较,瘀热证组FBG、Cr水平升高,TT延长(P＜0.01).两组TC、TG、HDL-C、LDL-C水平比较差异无统计学意义(P＞0.05).二元Logistic回归分析显示,饮酒史、腹压增高、FBG增高、T延长与急性脑出血瘀热证呈正相关(P＜0.05或P＜0.01). 结论 饮酒史、腹压增高、空腹血糖增高、凝血酶时间延长可考虑作为急性脑出血瘀热证的临床表征指标.

The Yu- Re pathogenic unit is a tight combination of both pathogenic elements which are respectively called blood stasis and heat. The Yu- Re pathogenic unit is a central part of the pathological process in acute cerebral hemorrhage. At the same time,it plays a key role in the pathogenic unit which determines the effectiveness of compound Chinese traditional medicine intervention. Yu- Re pathogenic unit is a new production resulting from the struggling and accumulation of the blood stasis pathogenic unit and heat pathogenic unit. As the epidemiological investigation and some relevant studies indicate,the " heat" pathogenic element is mainly related with inflammatory response; meanwhile,the " blood stasis" pathogenic element is related with coagulation disorders. The interaction and inter- transformation between inflammatory response and coagulation disorders,in some extent,can prove the theoretical basis of"Yu- Re struggling and accumulation". With the modern science and technology,the microcosmic substance- elements can be combined with macroscopic syndrome differentiation theory which both concerning with the Yu- Re pathogenic unit in acute cerebral hemorrhage. It is likely to realize the standardization and objectification of measuring Yu- Re pathogenic unit. Consequently,it will contribute to revealing the pathogenic essence more objectively and dynamically,as well as laying a foundation for revealing the recognition,diagnosis and therapeutic efficacy of Yu- Re pathogenic unit.

Objective To evaluate the clinical efifcacy and tolerability of oral isotretinoin combined with imiquimod cream in the treatment of facial lfat warts. Methods In this randomized, single-blind and control study, 67 consecutive patients aged between 18 and 45 with facial lfat warts were recruited and randomly divided into 2 groups:32 cases in observation group which were treated by oral isotretinoin combined with 5%imiquimod cream;35 cases in control group which were treated only by 5%imiquimod cream. All the patients received therapy for 8 weekes continuously and had been evaluated the efifcacy on the second, fourth, sixth and eighth week of treatment. Results On the eighth week of treatment, the total effective rate of observation group was 96.88%, and there was a signiifcant difference compared with the control group(77.14%,P=0.018) . Both the two groups had not obvious side-effect during treatment. Conclusion Oral isotretinoin combined with 5%imiquimod cream is an ideal therapy for the treatment of facial lfat warts with better effect and less side-effect.

ObjectiveTo determine the clinical characteristics of herpes zoster in children, so as to better understand the diagnosis and treatment of the disease.MethodsRetrospective analysis was performed on the clinical data of 80 cases conifrmed with herpes zoster who were referred to the dermatology outpatient clinic during January 2012 to December 2015.ResultsEighty patients, aged between 0.5 and 14 years were assessed. Majority of the patients showed no evidence of immunosuppression in history and examination, 11 children had asthma history, and the disease occurred frequently in warm months. Thirty-eight patients had thoracic involvement, followed by lumbar (n=25), extremities(n=11) and cranial(n=6) involvements. The patients respond well to symptomatic treatment. The clinical course lasted 10.77±1.99 days averagely. No complications were reported.ConclusionHerpes zoster in children is generally mild and not associated with progressive pain or discomfort.

目的 探讨Oct4单因子转染人胎儿头皮来源的原代混杂细胞和第3代黑素细胞后,形成多能干细胞的可能性.方法 培养人胎儿头皮来源的原代混杂细胞和第3代黑素细胞,应用慢病毒介导Oct4单因子诱导这些细胞.所生成的克隆采用碱性磷酸酶染色及荧光显微镜观察.结果 Oct4单因子诱导的第8和第12天,被转染的原代细胞和第3代黑素细胞出现克隆.转染后第18天,人工挑取的克隆接种于基质胶包被板,克隆很快贴壁生长,荧光显微镜下显现出绿色荧光,碱性磷酸酶染色呈紫色.结论 Oct4单因子可以诱导人胎儿头皮来源的混杂细胞及第3代黑素细胞产生克隆,但产生效率很低.

接触性皮炎指皮肤、黏膜由于接触外界物质而发生的炎性反应.1由于大多数患者发病前接触物质较多,单靠询问病史很难明确诱因,此时进行斑贴试验对寻找致敏原因、有效治疗及预防本病有较高的价值.现就我院2009年5月至2011年4月219例接触性皮炎患者斑贴试验结果总结分析如下. 1资料与方法 1.1病例资料2009年5月至2011年4月我院皮肤科门诊确诊的接触性皮炎患者219例,其中面部皮炎112例,手部皮炎64例,其它部位43例.男41例,女178例,年龄18 ～ 70岁,病程2周～2年,病程中能提供明显可疑接触物者128例,其中化妆品接触者32例,家庭主妇35例,工作中可疑接触物(油漆、染料、水泥、电焊、化学物品、粉尘等)23例,其他日常接触物(如手表、眼镜、首饰、鞋帽等)18例.排除急性刺激性皮炎、激素依赖性皮炎、脂溢性皮炎、湿疹、光敏性皮肤病,抗组胺药停用3天,糖皮质激素停用1周.

目的探讨易妍光动力治疗面部中重度痤疮患者的临床疗效和安全性。方法选择面部中重度痤疮患者90例,分为A、B两组,每组45例。A组给予易妍光动力治疗,B组给予异维A酸(泰尔丝)治疗;于治疗第4、8、12周末评价疗效及安全性。结果 A组治疗第4、8、12周末有效率分别为77.78%、88.89%、91.11%,未出现严重不良反应;B组有3例因不能耐受口唇干燥而退出治疗,治疗第4、8、12周末有效率分别为52.38%、64.29%、73.81%。A组有效率高于B组(P<0.01)。结论应用易妍光动力治疗面部中重度痤疮安全有效。

Objective:To investigate the effect of gastric bypass on the expression of liver glucokinase(GCK) in non-obese GotoKakizaki(GK) type 2 diabetic rats.Methods:Twenty male GK rats and twenty male Wistar rats were randomly divided into four groups:GK operation group(GO group),GK sham operation group(GS group),Wistar operation group(WO group),Wistar sham operation group(WS group).There were 10 rats in each group.The fasting blood glucose and serum insulin levels were measured before operation and on the 1st,4th and 8th week after the operation.Liver tissues were harvested 8 weeks postoperatively and reverse transcriptase polymerase chain reaction was used to detect liver GCK mRNA expression after the operation.Results:The fasting blood glucose of GO group decreased as early as the 1st week after surgery,which decreased from preoperative(8.73 ± 1.30) mmol/L to(6.84 ± 0.89),(6.27 ± 0.93),(5.86 ± 0.57) mmol/L on the 1st,4th and 8th week postoperation(P < 0.05).The insulin level remained consistently higher in GO group with respect to GS group,but there was no significant change during the follow-up period.On the 8th week after surgery,the liver GCK mRNA level in GO group were significantly higher than GS group(P < 0.05).Conclusion:Gastric bypass can directly improve glucose metabolism in non-obese type 2 diabetic rats,the increased expression of liver tissue GCK mRNA might contribute to the hypoglycemic effect of the surgery.