目的 研究探讨倍氯米松联合盐酸氨溴索对急性加重期老年慢性阻塞性肺疾病(COPD)患者肺功能及血气指标的影响.方法 选取2017年8月～2019年8月期间解放军总医院第六医学中心收治的急性加重期老年慢性阻塞性肺疾病(COPD)患者252例为研究对象,随机数表法分为空白对照组、氨溴索组、联合治疗组,每组各84例.空白对照组给予给予COPD基础治疗,氨溴索组在此基础上增加盐酸氨溴索治疗,联合治疗组在氨溴索组基础上加用倍氯米松治疗.连续治疗2周后,对3组患者临床疗效、肺功能指标、血气指标、炎性因子水平、不良反应发生率等进行统计对比.结果 联合治疗组总有效率为91.67％(77/84),高于氨溴索组为80.95％(68/84),且高于空白对照组为72.62％(61/84),3组间差异有统计学意义(P<0.05).治疗后,联合治疗组患者的肺功能指标包括用力肺活量(FVC)、1秒用力呼气量(FEV1)、最大呼气流速(PEF)均高于氨溴索组,且高于空白对照组,3组间比较差异有统计学意义(P<0.05);联合治疗组患者血气指标血氧分压(PO2)、氧合指数(OI)水平高于氨溴索组,而二氧化碳分压(PCO2)低于氨溴索组,组间比较差异有统计学意义(P<0.05);联合治疗组患者的炎症因子指标包括血清降钙素原(PCT)白介素-6(IL-6)、C反应蛋白(CRP)水平低于氨溴索组患者,且低于空白对照组,组间差异有统计学意义(P<0.05).治疗期间联合治疗组、氨溴索组、空白对照组组不良反应发生率分别为13.10％(11/84)、8.33％(7/84)、5.95％(5/84),组间对比差异无统计学意义(P>0.05).结论 倍氯米松联合盐酸氨溴索治疗老年急性加重期COPD的疗效显著,能够改善患者的肺功能、血气指标,降低炎性反应水平,治疗安全性好,值得临床推荐.

目的 研究分析晚期前列腺癌患者应用戈舍瑞林与比卡鲁胺治疗的效果与安全性,为临床治疗晚期前列腺癌患者提供可靠的参考依据.方法 选取2015年3月 ～2016年1月解放军总医院第六医学中心收治的晚期前列腺癌患者112例,按照随机数表法分为两组,每组56例.观察组患者联合应用戈舍瑞林与比卡鲁胺间歇性治疗,对照组患者则联合应用戈舍瑞林与比卡鲁胺持续治疗,比较分析两组晚期前列腺癌患者的治疗效果.结果 两组患者治疗1、3个月的疼痛缓解率比较差异无统计学意义(P>0.05).治疗6、12个月后,观察组的疼痛缓解率较对照组高,差异有统计学意义(P<0.05).两组患者治疗后的血清PSA值、不良反应发生率、骨转移情况、血清睾酮比较,差异无统计学意义(P>0.05).结论 联合应用戈舍瑞林与比卡鲁胺间歇性治疗与持续治疗均有显著疗效,间歇性治疗能够更好的缓解患者疼痛.

Objective To explore the efficacy of Getong Tongluo capsule combined with defibrase injection in the elderly patients with acute cerebral infarction. Methods A total of 128 elderly patients with acute cerebral infarction in our hospital from June 2016 to April 2018 were enrolled. The control group was treated with defibrase injection on the basis of routine treatment,and experimental group was treated with Tongluo capsule on the treatment of control group,the course of treatment was 15 days.The efficacy,the levels of angiopoietin-1 (Ang-1), endothelin-1, vascular endothelial growth factor (VEGF),and the incidence rate of adverse reactions in two groups were observed and compared. Results The total effective rate of experimental group was significantly higher than that of control group (95.31％ vs 78.13％,P＜0.05). There were no significant differences in levels of ANG-1,endothelin-1,VEGF,and neurological deficit score between the two groups before treatment.After treatment,the levels of ANG-1 and endothelin-1,and the neurological deficit score in the experimental group were significantly lower, the level of VEGF was higher than those in the control group (P＜0.05). The incidence rate of total adverse reactions was 6.25％ in both experimental group and the control group (P＞0.05). Conclusions Getong Tongluo capsule combined with defibrase injection can regulate the cytokine levels and promote the recovery of neurological function in the elderly patients with acute cerebral infarction.

Objective To compare the effects of remote ischemic conditioning at different time points,before myocardial ischemia, during myocardial ischemia and after myocardial ischemia,on myocardial injury and oxidative stress in the rats with ischemia reperfusion (IR).Methods Forty Wistar rats were randomly divided into IR group,remote ischemic perconditioning(RIPerC) group,remote ischemic preconditioning(RIPreC) group and remote ischemic postcondioning(RIPostC) group,with 10 rats in each group.The model of IR was established in all groups.Then remote ischemic conditioning during corresponding periods was conducted in the other three groups except the IR group.After reperfusion,the contents of myocardial superoxide dismutase(SOD),catalase(CAT),nitric-oxide synthase(NOS) and malondialdehyde(MDA) were detected in all groups,and the contents of serum creatinine kinase,MB isoenzyme(CK-MB) and cardiac troponin I(cTNI) were detected as well.Results Compared with the IR group,the levels of myocardial SOD,CAT and NOS were higher while the levels of myocardial MDA,serum CK-MB and cTnI were lower in the RIPerC group,RIPreC group and RIPostC group(all P<0.05). There were no significant differences in the levels of those indices above among the RIPerC group,RIPreC group and RIPostC group(all P<0.05).Conclusion Remote limb ischemic conditioning during different periods of myocardial IR can decrease the level of myocardial oxidative stress and alleviate myocardial injury of rats,achieving similar effects.

目的 通过大鼠心肌缺血再灌注(ischemic reperfusion,IR)模型,观察不同时期肢体非致死性缺血处理对大鼠过氧化物酶体增殖物激活受体γ(peroxisome proliferator activated receptorγ,PPARγ)mRNA和蛋白表达的影响。方法 选取40只健康雄性Wister大鼠随机均分为4组,IR组、心肌缺血期肢体处理(limb ischemic perconditioning,LI-perC)组、心肌缺血前肢体处理(limb ischemic preconditioning,LI-preC)组、心肌缺血后肢体处理(limb ischemic postconditioning,LI-postC)组,每组各10只。4组大鼠均给予IR处理,LI-perC、LI-preC、LI-postC组大鼠分别在冠状动脉前降支结扎前30min、结扎起始、结扎结束后,给予双侧股动脉夹闭5min、开放5min共3个循环的缺血处理。试验结束后,留取血清和心肌组织标本,采用酶联免疫吸附测定法(enzyme linked immunosorbent assay,ELISA)检测血清肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)和心肌肌钙蛋白I(cardiac troponin I,cTnI)含量,分别采用逆转录酶-聚合酶链反应(reverse transcription-polymerase chain reaction,RT-PCR)和Western blot方法检测心肌组织PPARγmRNA和蛋白表达水平。结果 与IR组相比,LI-perC、LI-preC、LI-postC组大鼠心肌损伤标志物CK-MB和cTnI均明显降低,心肌PPARγmRNA和蛋白表达均升高,组间比较差异均具有统计学意义(P 0.05)。结论 在大鼠IR不同时期给予肢体缺血再灌注均可减轻心肌损伤,升高心肌PPARγmRNA和蛋白表达。

Objective To observe the expressions of peroxisome proliferator activated receptor γ(PPARγ) mRNA and protein at different periods in the myocardium of myocardial ischemia-reperfusion(IR) injury rat model.Methols A total of 40 healthy male Wister rats were randomly divided into 4 groups:IR group,limb ischemic perconditioning (LI-perC) group,limb ischemic preconditioning (LI-preC) group,limb ischemic postconditioning (LI-postC) group,10 in each group.Four groups were all treated with IR.Rats in LI-perC,LI-preC and LI-postC groups were treated with the ligation of anterior descending coronary artery before 30 min,at the starting,at the end,respectively.After the ligation,the bilateral femoral arteries were occluded for 5 min,and then opened for 5 min with 3 cycles in 3 groups.Since the study ended,serum and injured mycardium tissue specimens were taken.The contents of creatine kinase isoenzymes (CK-MB) and cardiac troponin Ⅰ (cTnⅠ) in the serum were detected by enzyme linked immunosorbent assay (ELISA).The expressions of PPARγmRNA and protein in the myocardium were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and western blot,respectively.Results Compared with IR group,the contents of cTnⅠ and CK-MB markers in other three groups were significantly lower,but the expressions of PPARγmRNA and protein in the myocardium were significantly higher (P＜0.05).There were no significantly differences in serum CK-MB and cTnⅠ contents,the expressions of PPARγ rmRNA and protein in the myocardium among LI-perC,LI-preC and LI-postC groups (P＞ 0.05).Conclusion Limb ischemic conditioning of IR rats at different periods can decrease myocardial injury and increase the expressions of PPARγmRNA and protein.

目的 在大鼠心肌缺血再灌注不同时期(心肌缺血前、心肌缺血同时、心肌缺血再灌注同时)给予远隔肢体缺血处理,比较大鼠血清CK-MB、cTnI和心肌PPARβ/δ mRNA和蛋白表达水平的差异.方法 40只健康雄性Wister大鼠,均进行心肌缺血再灌注处理,根据下肢缺血的处理不同,随机分为4组:单一心肌缺血再灌注对照组(MI-R组)、心肌缺血期远隔肢体处理组(RLIPerC)、心肌缺血前远隔肢体处理组(RLIPreC)、心肌缺血再灌注时远隔肢体处理组(RLIPostC).实验结束后,留取各组血清和缺血部位心肌组织标本,采用ELISA法检测血清CK-MB和cTnI含量,逆转录酶多聚酶链反应(RT-PCR)检测心肌PPARβ/δmRNA表达水平,Western blot方法检测PPARβ/δ蛋白水平.结果 与MI-R组相比,RLIPerC、RLIPreC、RLIPostC组CK-MB和cTnI明显降低(P＜0.05),心肌PPARβ/δmRNA和蛋白表达均升高(P＜0.05).血清CK-MB、cTnI含量、心肌PPARβ/δ mRNA和蛋白表达在RLIPerC、RLIPreC、RLIPostC各组之间无明显差异(P＞0.05).结论 在大鼠心肌缺血再灌注不同时期,给予间断多次远隔肢体缺血再灌注处理,均可减轻心肌损伤,提高心肌PPARβ/δ mRNA和蛋白表达水平.心肌PPARβ/δ表达增加可能对缺血再灌注心肌有保护作用.

Objective:To observe the levels of CK-MB、cTnI and the expressions of peroxisome proliferator activated receptor-α(PPARα) mRNA and protein in myocardium of rats following myocardial ischemia-reperfusion(IR) injury and the impact of limb-ischemia (LI) conditioning for three times during different myocardial ischemic period.Methods:Fourty Wistar rats were randomly divided into 4 groups:IR group,LI-perC group (LI perconditioning),LI-preC group (LI precondioning),LI-postC group (LI postcondioning),ten rats in each group.Serum specimens and injured cardium of rats in four groups were kept after treatment.The contents of CK-MB and cTnI in the serum were detected according corresponding kits.The expressions of PPARα mRNA and protein in the myocardium were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and Western blot respectively.Results:The levels of CK-MB and cTnI in LI-perC group,LI-preC group and LI-postC were significantly lower than those in IR group(P＜0.05),while the expressions of PPARα mRNA and protein in the three groups were significantly higher than those in IR group (P＜0.05).There were no significant changes in the contents of CK-MB and cTnI,the expressions of PPARα mRNA and protein in LI-perC group,LI-preC group and LI-postC group (P ＞0.05).Conclusion:.Limb-ischemia conditioning during different myocardial ischemic period may decrease myocardial injury and increase the expressions of PPARα mRNA and protein.

Objective: To study the Correlation of serum 25-hydroxyvitamin D3 [25- (OH) D3]concentration with immune function and pulmonary function in elderly patients with bronchial asthma. Methods: 96 elderly patients with bronchial asthma who were treated in our hospital from January 2016 to December 2017 were selected as the research group, the patients were divided into mild asthma group (n=30), moderate asthma group (n=38) and severe asthma group (n=28) according to the pulmonary function test results, 40 healthy elderly people who have been examined in our hospital for the same period as the control group. The serum 25- (OH) D3, maximum expiratory volume in first second (FEV1/FVC), FEV1 account for the percentage of estimated value (FEV1％pred), CD4+, CD8+, CD4+/CD8+, serum immunoglobulin A (IgA), immunoglobulin M (IgM) and immunoglobulin G (IgG) level were compared, the correlation between serum 25- (OH) D3 and the immune function index and pulmonary function index were analyzed. Results: The serum levels of 25- (OH) D3 and FEV1％ pred in the research group were lower than those in the control group (P＜0.05), there was no significant difference between the two groups of FEV1/FVC levels (P＞0.05). The level of CD4+, CD4+/CD8+, serum IgA, IgM and IgG in the research group were all lower than those in the control group, and the level of CD8+ was higher than that of the control group (P＜0.05). The levels of serum 25- (OH) D3, IgA, IgM, IgG, FEV1％pred, CD4+ and CD4+/CD8+ in severe asthma group were lower than those in moderate asthma group and mild asthma group, while those in moderate asthma group were lower than those in mild asthma group (P＜0.05), the level of CD8+ in severe asthma group was higher than that in moderate asthma group and mild asthma group, and the moderate asthma group was higher than that of mild asthma group (P＜0.05). Pearson correlation analysis showed that the serum 25- (OH) D3 was positively correlated with FEV1％pred, CD4+, CD4+/CD8+, IgA, IgM and IgG in elderly patients with bronchial asthma (P＜0.05), and negatively correlated with CD8+ (P＜0.05). Conclusion: The serum 25- (OH) D3 concentration of the elderly patients with bronchial asthma is significantly lower, and it is related to the pulmonary function and immune function, the detection of 25- (OH) D3 concentration can be used to assess the severity of the patient's condition.

Objective To observe the serum level of lipoprotein(a) in high blood pressure patients with low density lipoprotein cholesterol (LDL-C) standards and its association with carotid atherosclerotic plaques.Methods Five hundred and thirty patients with history of hypertension for over 5 years were recruited for the study.They were stratified by depending on whether or not they reached the LDL-C standards.Then,by depending on whether there was presence of carotid plaques in each layer,they were divided into 4 groups:Group A with LDL-C standards and plaques,Group B with LDL-C standards but without plaques,Group C without LDLC standards but with plaques,Group D without LDL-C standards but without plaques.Close observations were made on the levels of Lp (a) in each groups.Results (1) The Lp (a) levels of the groups with LDL-C standards were lower than those of the groups without LDL-C standards.Statistical significance could be noticed when comparisons were made between them(P ＜ 0.01).(2) In the group with LDL-C standards,the Lp (a) level in the patients of Group A was higher than that in the patients of Group B,but there was no statistical significance when comparisons were made between them (P ＞ 0.05).In the group without LDL-C standards,the Lp (a) level in the patients of Group C was higher than that in the patients of Group D,with statistical significance (P ＜ 0.01).Conclusion For the patients with LDL-C level reaching the required standards at the admission,baseline level of Lp (a) seemed to have no obvious correlation with carotid atherosclerotic plaques.However,for the patients without LDL-C level reaching the required standards at the admission,elevated baseline LDL-C level might be a predicting factor in the formation of carotid atherosclerotic plaques.

Objective:To investigate the clinical efficacy and safety of targeted Cryocare surgical system through percutaneous lung puncture in the treatment of primary pulmonary malignant tumors for senile patients.Methods: The 230 lesions from 227 patients (over 70 years) with primary pulmonary malignant tumor were treated by using targeted Cryocare surgical system through percutaneous lung puncture. The coverage situations of tumor ice ball of different diameter were immediately observed, and the curative effects were evaluated as response evaluation criteria in solid tumors (RECIST). Besides, the change, complication and survival rate of pulmonary malignant tumor before and after treatment were dynamic observed.Results: After the targeted cryocare surgery, the coverage rate of 90 ice balls (diameter of tumor was less than 4 cm) was (98.6±0.4)%, and the tumor diameters of 140 ice balls were larger than 4cm and their coverage rate was (90.3±5.4)%. The difference of the coverage rate of tumor ice ball between two kind diameters was significant (t=4.69,P<0.01). The effective remission rates (CP+PR) post-surgery 1 month, 3 months, 6 months and 12 months were 56.4%, 56.2%, 55.4% and 53.9%, respectively, and there were no significant difference among these groups (x2=3.705,x2=3.500,x2=1.604,x2=0.935,P>0.05). The whole process of treatment was safety and there was no death cases, while 81 cases were fever post-operation (35.7%), 31 cases were hemoptysis post-operation (13.7%), 18 cases were pneumothorax post-operation (7.9%), 14 cases were pleural effusion post-operation (6.2%) and 1 cases was cold shock post-operation. And all of them recovered to normal situation after were treated as their relative symptom. Follow-up of post-operation 6 months, 1 years, 2 years and 3 years, the survival rates of patients were 89%, 68%, 26% and 12%, and the median survival time was 14 months.Conclusion: CT guided percutaneous targeted cryocare surgical system for pulmonary malignant tumors of the elderly patient is an effective and safe treatment method.

Objective To evaluate the efficacy and toxicity of cyberknife therapy combined hyperthermia with tegafur for treatment of recurrent and metastatic hepatocellular carcinoma.Methods From January 2013 to January 2015,84 patients with recurrent and metastatic hepatocellular carcinoma, in accordance with different therapeutic methods, were divided into control group and observation group.Forty-three patients in control group were treated with cyberknife therapy and hyperthermia, while forty-one patients in observation group used cyberknife combined hyperthermia with tegafur.Results Total efficacy rate after a three-month treatment was 79.76%.The efficiency rate, 1-and 2-year local control rate in observation group were 87.80%, 60.00%, 35.00%,and all higher than 72.09%, 46.34% and 24.39% in control group.No significant differences were found between two groups (P>0.05).One-and three-year survival rate in control group were separately 46.34% and 7.32% with the median survival of 10.5 months.One-and three-year survival rate in observation group were separately 65.00% and 17.5% with the median survival of 13.5 months(P<0.05).The adverse reaction rates in two groups were not significantly different (P>0.05).Conclusion The combination of cyberknife therapy with hyperthermia and tegafur is a safe and useful method in treatment of recurrent and metastatic hepatocellular carcinoma.

Objective To investigate the incidence and high risks of the kidney injury caused by high intensive military training among Navy special force agents, and to explore the results of rational interventions during ten years' observational study. Methods Three large sample epidemiological investigations during 2006 to 2015 were investigated. Different time urine samples of more than 1000 Navy special force agents after a 5 km cross-country run to detect the abnormalities of hematuria, proteinuria, urine N-acetyl-β-d-glucosaminidase (NAG) by dry chemistry and nitrophenol colorimetry method were collected. Questionnaire investigations were implemented and high risks to improve the training guidance were analyzed. Results The abnormalities of hematuria, proteinuria, urine NAG caused by high intensive military training was 9.47%、44%、56.97% respectively, higher than those reported in Sports Medicine field. The high risks of kidney injury were training time less than one year and training on hard roads. By adjusting the training plan, survey in 2012 found that after training, the abnormalities of hematuria decreased, while the abnormalities of proteinuria, urine NAG remained high. The high risks of kidney injury included improper training methods, lacking of preparation activities, over high training intensity, bad psychological emotions and sports frequency less than 3 times per week previously. The incidence of kidney injury significantly decreased by adjusting the training plan in 2015. Conclusion The incidence of kidney injury after high intensity military training was high. Adjusting the training plan and improving the training methods according to the high risks may reverse the disease course and significantly reduce the incidence in the early.

Naval forces diversification missions increase gradually with the deepen reform in the army.At the same time there are more and more care objects.Elderly care objects rise expectations of the quality of care.At the new period,our hospital optimize the structure of the health care team.Through scientific management to achieve health care moved forward.Improving the ability of pre-hospital emergency treatment to highlight the " specialized and versatile".To promote care doctor level and ability by experts formulate the follow-up tracking guidance after their assessment.

目的 应用北京地区中老年男性体检资料研究空腹血糖异常切点下调对糖调节受损(IGR)诊断和防控的影响.方法 选取北京地区中老年男性共计864人,行75g口服葡萄糖耐量(OGTT)试验,根据ADA2003年标准分为四组:糖耐量正常组317(NGT)、单纯空腹血糖受损(I—IFG) 325例、单纯糖耐量减低(I-IGT) 126例和空腹血糖受损合并糖耐量减低(IFG/IGT)96例,其中IFG组根据5.6mmol/L为界值分为IFG1和IFG2两组,分析空腹血糖异常切点下调对糖调节受损各组分构成比的影响,评估合并代谢综合征相关疾病的差异.结果 ①按照WHO1999和ADA2003标准诊断的糖调节受损人群构成比有显著差异:NGT组56.02％ vs 36.69％,I-IFG组18.29％ vs 37.62％,I-IGT组19.68％ vs 14.58％,IFG/IGT 6.02％ vs 11.11％;②随着糖代谢紊乱程度的逐渐加重,代谢综合征各组分的异常比例逐渐升高:③两种诊断标准下糖调节受损人群合并体重指数(F=14.02,P＜0.01)、腰围(F=14.70,P＜0.01)和甘油三酯(F =6.00,P =0.01)异常的组间比较有显著性差异.结论 与WHO1999年诊断标准相比,ADA2003标准明显扩大IFG和IFG/IGT人群比例,新增诊断人群合并多种代谢紊乱的比例明显增加,从糖耐量异常早期防控角度,诊断切点下移有一定的合理性.

目的 分析海军师以上干部人群尿白蛋白/肌酐比值(urinary albumin to creatinine rate,ACR)异常率及初步干预效果.方法 2013年820名海军师以上干部接受病史采集、体格检查,留尿,酶联免疫吸附法(ELISA)检测尿微量白蛋白,碱性苦味酸法(Jaffé reaction-rate method)检测尿肌酐,计算ACR.随后对受检者开展饮食宣教、社区讲座健康教育及临床干预随访.2年后(2015年)同一样本人群复测ACR.用SPSS 16.0统计软件分析白蛋白尿率、ACR异常率的变化.结果 2015年,该人群总体ACR异常率和微量白蛋白尿率分别为10.89％、9.88％,均较2013年(ACR异常率和微量白蛋白尿率分别为13.14％,12.8％)显著降低,P＜0.05,而临床白蛋白尿患病率为0.85％,显著高于2013年(0.34％),P＜0.05.ACR异常率最高的年龄段为81～90岁(异常率42.86％),71～ 80岁(19.76％),61～ 70岁(14.67％).结论 ACR异常人群,采取早期诊断及综合宣教,可有效逆转病程,降低发生率;而临床白蛋白尿期患者病程呈不可逆、缓慢进展趋势.在分析人群ACR异常率时,要充分考虑年龄因素.

目的 探讨军队干休所离退休干部生活照料现状及其相关影响因素.方法 采用整群抽样、横断面调查方法,调查驻京部队干休所60岁及以上离退休干部的社会人口学信息、生活照料方式、业余活动及各系统慢性病史.结果 增龄、不良婚姻状况、既往脑梗死和眼底病变史均为离退休干部生活照料需求增加的独立危险因素,OR值分别为2.258和1.256;1.515和1.094(P＜ 0.001).积极参与体育锻炼和社会活动,以及受教育程度高均显著降低离退休干部的生活照料需求,OR值分别为0.082、0.826、0.708.结论 增龄和慢性疾病是导致老人生活照料需求增加的首要因素,有效的慢病防控、健康积极的生活方式,有助于改善老年人的健康状况、维持躯体功能,减轻生活照料所造成的社会经济压力,具有积极的意义.

Objective: To study the relationship between repair of vascular endothelial cell function loss and atherosclerosis. Methods 3400, patients with atherosclerosis treated in different hospitals from August 2012 to August 2015 were studied, adopting corresponding detection methods to study vascular endothelial cell function loss. Results: Occurrence of atherosclerosis is mainly due, to damage of vascular endothelial cells caused by viruses, immune complexes and oxidized low -density lipoprotein, which leads to serious chronic inflammatory reaction of load vessels. Conclusion: To treat patients with atherosclerosis, we need to coordinate the relationship between vascular endothelial tissue function and atherosclerosis, then provide some guidance for clinical treatment and promote health.

Objective: The issue of non-response in dementia epidemiological studies, which may result in the underestimation of the prevalence of dementia, has attracted little attention. We aimed to explore the causes and related factors of non-response in a dementia survey among Chinese veterans.Methods: A two-phase, cross-sectional study investigated the prevalence of dementia and mild cognitive impairment in Chinese veterans aged >= 60 years. We collected the socio-demographic data and prior medical history, evaluated the health status of veterans and their caregivers, assessed the cognitive status of veterans, and evaluated the care burden of caregivers by Caregiver Burden Inventory (CBI).Results: Of 9676 eligible participants, 525 (5.4%) veterans in phase 1 and 1706 (35.0%) veterans among 4875 veterans in phase 2 did not respond. Illness, hospitalization and death accounted for 63.0% and 75.5% non-response in phases 1 and 2, respectively. Non-participation in social activities, self-perceived poor health status, worsened health changes, self-reported need for life care, and history of hearing loss or glaucoma independently predicted non-response in phase 1 or 2. The heavy care burden, suggested by the higher CBI scores and self-reported health deterioration of the primary caregivers, predicted non-response in phase 1 or 2.Conclusions: The negative factors from both the participants and their caregivers independently predicted the non-response in the dementia study in an older population. Preventative strategies from the perspectives of the participants and caregivers should be developed to improve the response rates in both phases in a cross-sectional study. (C) 2015 Published by Elsevier Ireland Ltd.

目的 评价糖调节受损合并高胰岛素血症患者的胰岛功能,分析其影响因素.方法 选取北京地区中老年男性共计547例,行75g口服葡萄糖耐量(OGTF)试验,根据美国糖尿病协会(ADA) 2003年标准分为三组:空腹血糖受损(IFG)325例、糖耐量减低(IGT)126例和空腹血糖受损合并糖耐量减低(IFG/IGT) 96例;各组根据胰岛素测定结果再分为高胰岛素血症组(HINS)以及非高胰岛素血症组(非HINS),对比各组间的代谢特征、胰岛素抵抗和胰岛β细胞分泌功能,评估合并代谢综合征相关疾病的差异.结果 ①高胰岛素血症患者IFG组和IFG/IGT组的胰岛素抵抗指数(HOMA-IR)分别是IGT组的1.42倍和1.41倍(P＜0.05);非HINS人群胰岛素抵抗情况与之类似:②高胰岛素血症患者胰岛分泌功能IFG/IGT组受损最为严重,其HOMAβ细胞功能指数(HBCI)分别是IGT和IFG组的74.04％和80.98％ (P ＜0.05);经HOMA-IR校正后,与IGT组的显著性差异更加明显,而与IFG组的差异消失;③三组糖调节受损-高胰岛素血症组合并代谢异常疾病的构成比均较相应非HINS组明显升高;IFG/ IGT组合并肥胖、高血压和高脂血症的构成比最高.结论 ①高胰岛素合并IFG主要的病理机制为肝脏的胰岛素抵抗;②高胰岛素血症合并IGT基础状态的胰岛分泌功能优于合并IFG者;③高胰岛素血症更易合并多种代谢紊乱,尤其是IFG/IGT患者,需要综合干预.