多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科内分泌疾病之一.生酮饮食(KD)是一种以低碳水化合物、高脂肪、适量蛋白质为特点的饮食结构.2019年专家组组织了妇科专家和营养专家共同制定并发布了《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》.鉴于近5年KD治疗在安全性和应用范围方面出现了大量新的临床数据,专家组决定对《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》进行修订和数据更新.主要更新内容有:①更新中国PCOS患病率研究数据;②增加PCOS中的代谢综合征与饮食干预临床证据;③增加KD改善PCOS的循证证据及中国临床研究证据;④增加KD对与PCOS相关代谢综合征影响的循证医学证据;⑤提供短期和长期KD有效性和安全性证据;⑥增加低能量生酮饮食(LCKD)在PCOS中的应用及安全性证据;⑦增加PCOS治疗常用药物联合KD干预效果的证据;⑧完善KD干预PCOS的适应证、禁忌证、不良反应及对策;⑨完善KD中食物种类的选择及操作方法建议.

目的 用生物电阻抗(BIA)方法评价海军新训生长型学员干部的营养状况,探讨新型参数相位角(PhA)与常规营养参数的相关性.方法 采用新型体成分分析仪Inbody 770对315名海军新训生长型学员进行体成分测量,用SPSS 23.0统计软件评估营养状况以及评价相位角(PhA)与营养状况的相关性.结果 根据体质量指数(BMI)评估消瘦、正常体质量、超重、肥胖比例分别为9.84％、72.06％、17.14％、0.96％.尽管男女间肥胖率、腰臀比和Inbody评分差异无统计学意义(P＞0.05),但是男性超重率高于女性(P＜0.05),体脂百分比、内脏脂肪面积男性明显低于女性,肌肉量、体蛋白等参数高于女性(P＜0.05).PhA存在性别差异,男性高于女性(P＜0.05);PhA与蛋白质、去脂体质量、骨骼肌、BMI、身体细胞量等成正相关;与体脂肪、腰臀比、体脂百分比、内脏脂肪面积、脂肪质量指数成负相关(P＜0.05).结论 本次新训学员体测男性超重率高于女性,但进一步通过体成分检测男性以体蛋白、肌肉量增高为主,体脂率显著低于女性.PhA与BM1(r=0.226,P＜0.05)、体蛋白(r =0.449,P＜0.05)、肌肉量(r = 0.409,P＜0.05)呈正相关,而与体脂百分比(r =-0.438,P＜0.05)、内脏脂肪面积(r=-0.347,P＜0.05)呈负相关.BIA体成分测定可弥补BMI评估的不足,是海军指战员人体成分和营养状况精准评估的有效手段之一.

目的探究马齿苋乙醇提取物对四氯化碳所致小鼠急性肝损伤的保护作用,并对其有效成分进行分析。方法将80%乙醇马齿苋提取物经离心、减压蒸馏、真空干燥为全草提取物、上清提取物和沉淀提取物。将80只ICR雄性小鼠随机分为8组:对照组、肝损伤模型组、马齿苋全草提取物低剂量组、高剂量组、马齿苋上清提取物低剂量组、高剂量组、马齿苋沉淀提取物低剂量组、高剂量组。经口灌胃去离子水或3种马齿苋提取物不同剂量混悬液1周后,分别皮下注射橄榄油或CCl 4 橄榄油溶液,16 h后收集血清,检测小鼠血清ALT、AST、IL-6水平,以评价马齿笕对肝损伤的保护作用。采用超高效液相色谱-四极杆-飞行时间质谱（UPLC-Q-TOF/MS）技术分析马齿苋的有效成分。结果与模型组相比,马齿苋全草提取物高剂量组小鼠血清AST、ALT、IL-6水平显著降低;沉淀高剂量组小鼠血清ALT显著降低（P＜0.05）,IL-6水平有所降低,但不具统计学意义;其他各干预组小鼠血清AST、ALT、IL-6水平没有显著性变化。应用UPLC-Q-TOF/MS法共鉴别出苹果酸、柠檬酸、亮氨酸、异亮氨酸、腺苷、琥珀酸、染料木素、酪氨酸、苯丙氨酸等15种主要成分。结论马齿苋乙醇全草提取物对CCl4急性肝损伤小鼠具有保肝抗炎作用,可能是15种有效成分发挥的联合作用。

膳食营养对于肿瘤预防和康复护理至关重要,科学合理的膳食可以改善机体慢性炎症状态,从而预防肿瘤发生和促进肿瘤康复.在经典的膳食评估体系基础上,新构建和完善的膳食评估指标-膳食炎症指数是评估膳食对机体炎症效应的新型评估指标,已越来越多地应用于与肿瘤营养预防和康复的相关性研究.文章系统综述了近五年(膳食炎症指数)与肿瘤发生发展的重要临床研究,旨在为临床肿瘤高风险人群膳食指导和肿瘤、营养护理提供科学依据,进而改善居民机体炎症状态,提高全民身体素质.

目的 观察白芸豆提取物对葡萄糖耐量曲线及餐后血糖的影响,以及白芸豆提取物和餐后血糖的剂量-效应关系,以帮助糖尿病患者合理控制血糖.方法 选取16名健康的受试者为实验对象,年龄为18～45岁.16名受试者分别在2019年4～6月不连续的3个礼拜测定口服葡萄糖50g的溶液或葡萄糖50g的溶液+2g白芸豆提取物、65g白米饭(约50g碳水化合物)或65g白米饭+2、4、6g白芸豆提取物后引起的血糖反应,采用自身对照的方法,统计分析各不同时间段的组间平均血糖值的差异.结果 2g白芸豆提取物对葡萄糖血糖曲线下面积和餐后血糖曲线略有影响,但组间比较差异无统计学意义.在进食65g白米饭前服用4g、6g白芸豆提取物(加300ml水),6g白芸豆提取物在45min时血糖最低,组间比较差异有统计学意义.同时比起白米饭组,60min后,服用4g 、.6g白芸豆提取物组的餐后血糖下降趋势较稳定,并在120min时都达到餐后2h血糖正常值,提示白芸豆提取物对餐后血糖有控制作用.结论 餐前15min服用6g白芸豆提取物酶解芸豆粉溶液(加300ml水)可以有效降低进食白米饭后的血糖反应.服用剂量对其抑制餐后血糖作用具有一定效应.在本试验2～6g的研究范围内,提示服用本制剂较大剂量6g时,其餐后血糖水平控制效果更佳.

压力性尿失禁(stress urinary incontinence,SUI)是指喷嚏、咳嗽、大笑或运动时腹压增高后出现不自主的尿液自尿道口漏出.SUI限制了女性日常活动及运动,严重影响其生活质量,并导致巨大心理压力.SUI的危险因素有:年龄、遗传 因素、雌激素水平降低、便秘、慢性咳嗽及肥胖等[1],其中肥胖是SUI的独立危险因素[2].

多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是中国育龄妇女的常见疾病,具有发病率高、高雄激素血症患者比例高、继发代谢综合征比率高和重视程度低的“三高一低”特征.生活方式干预是PCOS患者首选的基础治疗,但是传统的膳食干预和运动强化方式减肥效果并不理想.生酮饮食作为一种较为高效的体质量管理方式,在PCOS的临床应用中具有较为广阔的前景.

生酮饮食(ketogenic diet,KD)在小儿癫痫的治疗应用已充分证明了其有效性与安全性[1].随着对糖脂代谢认识的不断深入,尤其是近年来一系列临床研究与动物实验的结果发布,逐步更新着学术界既往对油脂与胆固醇的观念.生酮饮食在体质量管理领域的应用也在逐步拓展,可喜的是中国生酮/低碳水化合物饮食进行慢性病管理的受众范围越来越广泛.

海军军医大学第一附属医院营养科作为全国临床营养示范单位,具备多年实习生带教和管理经验,本文总结了笔者所在科室以临床营养科研为抓手,从扎实业务学习、提高实操能力、锻炼临床思维、完善岗前培训与出科考核等方面,系统化设计实习带教工作,探讨如何做好实习生的带教和管理工作,培养优秀的营养专业人才.

The exon 19 and 21 in Epidermal Growth Factor Receptor (EGFR) mutation are the most common subtype of lung adenocarcinoma, and the strongest predictive biomarker for progression-free survival and tumor response. Although some studies have shown differences in radiological features between cases with and without EFGR mutations, they lacked necessary stratification. This article is to evaluate the association of CT features between the wild type and the subtype (exon 19 and 21) of EGFR mutations in patients with lung adenocarcinoma. Of the 721 finally included patients, 132 were positive for EGFR mutation in exon 19, 140 were positive for EGFR mutation in exon 21, and 449 were EGFR wild type. EGFR mutation in exon 19 was associated with a small-maximum diameter (28.51 ± 14.07) (p < 0.0001); sex (p < 0.0001); pleural retraction (p = 0.0034); and the absence of fibrosis (p < 0.0001), while spiculated margins (p = 0.0095), subsolid density (p < 0.0001) and no smoking (p < 0.0001) were associated with EGFR mutation in exon 21. Receiver Operating Characteristic (ROC) curves suggested that the maximum Area Under the Curve (AUC) was related to the female gender (AUC = 0.636) and the absence of smoking (AUC = 0.681). This study demonstrated the radiological and clinical features could be used to prognosticate EGFR mutation subtypes in exon 19 and 21.

Objective To study the health status of the officers with an age of 40-60 who received health check in the phys-ical examination center from 2014 to 2016, so as to provide basic evidence for the development of health intervention policies and take preventive measures by relevant authorities and or medical facilities .Methods Statistical analysis was made on such medical indicators as body mass index , blood pressure , blood glucose and lipid obtained from 2741 officers in the physical examination .Results The rate of normal BMI of the officers , especially in the male increased significantly .The detection rate of hypertension on the whole displayed a decreasing trend , and the rate of hypertension among the female decreased significantly .The detection rate of diabetes mellitus among the male officers was higher than that of the female , but the detection rate of DM among the female in 2016 increased significantly .In 2016, the detection rate of hypertriglyceridemia in the male was significantly lower than that of 2014 and 2015.The detection rate of hy-percholesterolemia in 2016 was significantly lower than that of 2014 and 2015.The detection rate of hypertriglyceridemia and hyperchol-esterolemia in 2015 was significantly higher than that of 2014 and 2016.Conclusion Results of physical examination from 2014-2016 indicated that there was some improvement in the health indicators of officers , and detection rates of chronic diseases varied differently between male and female officers , and the improvement of chronic disorders also varied between them .For this reason , different meas-ures should be taken to implement health management .

目的 研究在等量碳水化合物的前提下,通过添加膳食纤维改变膳食中碳水化合物组分,对膳食血糖生成指数的影响,以帮助糖尿病患者合理搭配食物.方法 12例健康成年人随机分为白粥组和白粥+膳食纤维组,分别在不连续的3日内测定口服相当于含有50g碳水化合物的白粥或白粥+膳食纤维及50g葡糖糖后引起的血糖反应,计算白粥和添加膳食纤维后的白粥的血糖指数.结果 白粥的血糖指数为69.16±23.77,添加膳食纤维后白粥的血糖指数降为53.94±11.39.结论 在等量碳水化合物的前提下,通过在膳食中添加膳食纤维,可有效降低膳食血糖指数,可能有利于糖尿病患者保持血糖平稳,提高患者饮食控制依从性.

马齿苋作为一种药食同源的肉质植物,在抗衰老、降血糖、降血脂、抗动脉粥样硬化,以及保肝护肝等方面具有重要的作用.国内外学者对其药理活性已经做了较为全面的研究.本文综述了近年来马齿苋药理活性的研究进展,并阐述其作用机制.

茶,“国饮”也 茶,在中国被誉为“国饮”.茶文化源远流长,当家度日七件事,柴、米、油、盐、酱、醋、茶,可见茶在日常生活中的重要性.现代研究证实,茶叶确实含有与人体健康密切相关的成分,如茶多酚、咖啡碱、脂多糖、茶氨酸等,茶不仅具有提神清心、清热解暑、消食化痰、去腻减肥、清心除烦、解毒醒酒、生津止渴、降火明目、止泻除湿等作用,还对辐射病、心脑血管病、癌症等疾病有一定的预防作用.

Objective To investigate effectiveness of anthropometric parameters and body composition analysis for the screening and prediction of metabolic syndrome and explore the best indicator for predicting metabolic syndrome in the elderly. Method A cross-sectional study of 763 (406 men and 357 women) elderly people who participated in the annual health check-up was conducted. Clinical data of all participants were obtained including anthropometric parameters, body composition, lipid profiles, fasting blood glucose, and high sensitivity C-reactive protein. Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff points for waist circumference, waist-to-hip ratio, waist-to-height ratio, percent body fat and fat mass index in relation to the area under the curve (AUC), sensitivity and specificity in the screening and prediction of metabolic syndrome. Result In total subjects, compared with non-metabolic syndrome group,the ROC curve analysis showed that parameters including waist circumference, waist-to-height ratio, waist-to-hip ratio, percent body fat and fat mass index had a significant potential for predicting metabolic syndrome (P<0.001). It was determined that waist circumference of 87.5 cm and 77.5 cm, waist-to-hip ratio of 0.89 and 0.87, waist-to-height ratio of 0.51 and 0.52, percent body fat of 24.1%and 31.7%and fat mass index of 5.00 kg/m2 and 7.80 kg/m2 were the optimal cutoff points for screening and predicting the presence of metabolic syndrome among men and women with a sensitivity of 81.3%,78.8%,87.5%, 51.3%and 83.8%(in men) and 85.1%,79.8%,71.3%, 70.2%and 80.9%(in women) and a specificity of 57.7%,62.6%,50.0%, 75.5%and 51.8%(in men) and 38.0%,53.2%,55.1%, 50.6%and 52.5% (in women),respectively. The area under the ROC curve (AUC) was 0.728, 0.755, 0.716, 0.671 and 0.725 in men and 0.652, 0.707, 0.658, 0.619 and 0.675 in women,respectively. Waist-to-hip ratio showed the highest AUC in all the parameters in men and women. Conclusion Anthropometric parameters and body composition analysis play important roles in the screening and prediction of metabolic syndrome, and waist-to-hip ratio seems to be the best parameter in the screening and prediction of metabolic syndrome in the elderly.

茶的传奇故事 中国是一个拥有五千年历史的悠悠古国,历史遗产数不胜数,在众多的历史文化中,传承至今且颇受重视的,茶文化可数其一,至今常被人津津乐道的茶的传奇故事也颇多.就说大红袍吧,传说在明朝年间一个赶考举人路过武夷时,突然发病,腹痛难忍,当时有位来自天心岩天心寺的僧人取出采自寺旁岩石上生长的茶泡给他喝,病痛即止,不药而愈.举人后来考取了状元,为了答谢和尚,专程前来拜谢,并将身穿的状元袍披在那株茶树上,该茶因而得名“大红袍”.还有龙井茶,乾隆下江南带回的茶叶,泡后,太后喝了一口,双眼顿时舒适许多,喝完了茶,红肿消了,胃不胀了.太后高兴地说:“杭州龙井的茶叶,真是灵丹妙药.”这些茶的传奇故事无不体现茶对健康的神奇功效.

随着肥胖发生率及其相关代谢性疾病发病率的迅猛攀升,肥胖已成为这个时代最重要的世界性公共卫生议题.减重手术为肥胖和2型糖尿病的治疗带来新的曙光,不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术.减重手术的手术方式包括垂直束带胃减容术(vertical banded gastroplasty,VBG)、可调节胃束带术(adjustable gastric bangding,AGB)、胃袖带切除术(sleeve gastrotomy,SG)、胆胰分流术(biliopancreatic diversion,BPD)、Roux.en-Y胃旁路术(Rouxen-Y gastric bypass,RYGB)等.

老年斑是皮肤血管供血不足,导致上皮细胞角化过度、肥厚、坏死和乳头样增生所致.老年斑不仅发生在皮肤表面,而且还会积聚于心脏、血管、肝、肾及脑等重要器官和组织中.老年斑如果沉积在血管壁上,会导致动脉硬化、高血压、心肌梗死、老年性痴呆.老年斑的出现,是身体老化的一个信号.如何对待身体中的斑呢?应遵从以下三大原则.

《内经》有“阴平阳秘,精神乃治;阴阳离决,精气乃绝”的论述,意思是人体在正常情况下,机体阴阳协调,内外环境平衡.一旦阴阳失调,容易发生各种疾病. 5月正值春夏相交,冷热空气交锋,今天艳阳高照,明天可能就阴雨连绵,早晚温差过大.环境温度的忽高忽低犹如“过山车”一般,十分容易引起人体气机逆乱、阴阳失调、免疫能力下降,导致感冒、心脑血管疾病、失眠、神经衰弱等一系列病症的发生.

进入5月份,正值春夏相交,冷热空气交锋,今天艳阳高照、明天阴雨连绵;同时早晚温差过大.由于外界环境温度变化过大,环境温度的忽高忽低犹如过山车,易引起气机逆乱,阴阳失调,阻滞全身气机,导致自身免疫能力下降.若瘀血随经脉流人于脑,与精髓错杂,可使清窍受蒙,灵机呆钝,则往往表现为头痛、头晕、神经衰弱、失眠等情况. 《内经》有“阴平阳秘,精神乃治;阴阳离决,精气乃绝”的论述,意思是人体在正常情况下,处于“阴平阳秘”的状态,机体阴阳协调,内外环境平衡.一旦阴阳失调,人体即发生各种疾病.环境温度影响气血运行,温度差异过大更易使气血运行异常,扰乱自身阴阳平衡,使脏器功能受损,从而导致免疫力下降,容易导致感冒、心脑血管疾病、失眠、神经衰弱等等一系列病症的发生.