目的 探讨 2 型糖尿病合并冠心病(冠状动脉粥样硬化性心脏病)老年患者外周血微小RNA(miR)-4465 和miR-6089 水平变化及临床意义.方法 选取河北省唐山市人民医院 2020 年 11 月至2021 年 1 月收集的90 例受试者,包括 30 例T2 DM不合并冠心病(非冠心病组)、30 例T2 DM合并冠心病(冠心病组)以及30 例健康受试者(对照组).分析3 组临床资料、外周血miR-4465 和miR-6089 水平.采用多因素Logistic回归模型分析 T2 DM合并冠心病的危险因素.采用Pearson相关性分析法分析外周血miR-4465 和miR-6089 水平与Gensini评分的相关性.绘制受试者工作特征(ROC)曲线分析外周血miR-4465和miR-6089 对T2 DM合并冠心病的诊断价值.结果 冠心病组空腹血糖、糖化血红蛋白、收缩压、低密度脂蛋白胆固醇(LDL-C)、总胆固醇水平及血糖控制不佳比例均高于非冠心病组和对照组,高密度脂蛋白胆固醇、三酰甘油水平均低于非冠心病组和对照组,差异均有统计学意义(均P＜0.05).冠心病组外周血miR-4465、miR-6089 水平均高于非冠心病组和对照组[(17.6±3.4)比(8.4±2.6)、(3.1±0.8),(33.1±4.5)比(19.5±2.8)、(4.2±1.3)](均 P＜0.05);非冠心病组 miR-4465、miR-6089 水平均高于对照组(均 P＜0.05).多因素Logistic回归分析结果显示,miR-4465、miR-6089、LDL-C水平升高、高血压病、血糖控制不佳均是T2 DM合并冠心病的独立危险因素(均P＜0.05).Pearson相关性分析结果显示,T2 DM合并冠心病患者外周血miR-4465 和miR-6089 水平均与Gensini评分呈正相关(均P＜0.001).受试者工作特征曲线分析结果显示,外周血miR-4465 和miR-6089 诊断T2 DM合并冠心病的曲线下面积为0.912(0.806～0.956)、0.920(0.823～0.987).结论 T2 DM合并冠心病的老年患者外周血miR-4465 和miR-6089 水平均明显增高,二者可作为评估T2 DM患者冠心病风险的参考指标.

目的 探讨基于微信平台的同伴教育护理模式对糖尿病患者的血糖、生存质量及护理满意度的影响.方法 回顾性分析80例2型糖尿病患者的资料,根据护理模式不同,将其分为同伴教育组(n=42)和传统护理组(n=38).同伴教育组基于微信群同伴教育,采用多维度、全方位、一站式的预见性护理模式.传统护理组采用传统护理模式,比较2组患者出院后12个月时空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA1c)、患者生活质量以及护理满意度.结果 出院后12个月,同伴教育组空腹血糖、餐后2 h血糖、HbA1c水平均低于传统护理组,差异有统计学意义(P＜0.001);同伴教育组中文版世界卫生组织生存质量测定量表(WHOQOL-BREF)评分高于传统护理组,差异有统计学意义(P＜0.001);同伴教育组护理满意度为97.62％,高于传统护理组的78.95％,差异有统计学意义(P＜0.05).结论 基于微信群同伴教育护理模式能够有效平稳血糖水平,提高患者长期自我管理能力,从而提高患者生存质量及护理满意度.

目的:探讨二甲双胍联合利拉鲁肽对糖尿病前期患者疾病转归的影响.方法:抽取2018年开滦总医院收治的空腹血糖受损(IFG)或糖耐量减低(IGT)的糖尿病前期患者180例,随机分为A组(生活方式干预)、B组(生活方式干预+二甲双胍)、C组(生活方式干预+二甲双胍+利拉鲁肽),每组60例,IFG、IGT和IFG+IGT每个亚组各20例.三组患者干预后每6个月进行1次随访,检测空腹血糖(FBG)、餐后2 h血糖(2 hBG)、糖化血红蛋白(HbA1c)和血清总胆固醇(TC)水平,计算体重指数(BMI).确诊糖尿病为观察终点.记录不良反应发生情况.结果:共175例患者完成随访,平均随访(28.56±4.03)个月.末次随访时,A组IGT亚组患者的2 hBG水平低于干预前,差异有统计学意义(P<0.05).B组和C组中IFG、IFG+IGT亚组患者的FBG水平低于干预前,IGT、IFG+IGT亚组患者的2 hBG水平低于干预前,且均低于A组对应亚组,差异均有统计学意义(P<0.05).C组中IFG亚组患者的FBG水平和IFG+IGT亚组患者的2 hBG水平低于B组对应亚组,差异均有统计学意义(P<0.05).A组中IFG亚组患者的HbA1c水平高于干预前,其余组的HbA1c水平均低于干预前,但干预前后和组间的差异无统计学意义(P>0.05).B组和C组各亚组患者的TC水平低于A组,C组各亚组患者的BMI低于A组,C组IGT和IFG+IGT亚组患者的BMI低于B组,差异均有统计学意义(P<0.05).A组患者的2型糖尿病进展率为18.97％(11/58),B组为6.78％(4/59),C组为0％(0/58),B组低于A组,C组低于A组、B组,差异均有统计学意义(P<0.05).B组、C组患者的不良反应发生率分别为10.17％(6/59)、17.24％(10/58),组间差异无统计学意义(P>0.05).结论:与单纯生活方式干预比较,二甲双胍和二甲双胍联合利拉鲁肽治疗均能改善患者的IFG和IGT情况,降低糖尿病前期人群进展为糖尿病的风险.二甲双胍联合利拉鲁肽的应用效果更佳.

目的 观察不同糖代谢状态人群口服糖耐量试验(OGTT)后血糖、胰岛素、胰高血糖素(GCG)和胰高血糖素样肽1(GLP-1)的变化,分析GCG、GLP-I与早相胰岛素分泌的关系.方法 选取2020年1月 ～2021年12月于唐山市开滦总医院进行糖尿病筛查人群中糖耐量正常、糖耐量受损(IGT)、2型糖尿病(T2DM)者各30例.对3组OGTT后0、0.5、1、1.5、2 h的血糖、胰岛素、胰高血糖素、胰高血糖素样肽1进行比较.分析GCG、GLP-1与早相胰岛素释放指数(IRI)的关系.结果 T2DM组的GCG在整个OGTT期间均处于高水平,IGT组居中,正常组在最低水平.正常组GLP-1达峰后迅速下降,IGT组和T2DM组缓慢下降,糖负荷后正常组GLP-1水平最高、IGT组居中、T2DM组最低平.胰高血糖素与早相IRI负相关(r=-0.359),GLP-1与早相IRI正相关(r=0.467).结论 胰岛素和胰高血糖素两种激素的分泌异常在糖耐量受损时即已出现.早相胰岛素分泌的降低与GLP-1的低分泌和GCG的高分泌相关.

Objective To explore the characteristics of changes in the levels of high-sensitivity C-reactive protein (hs-CRP) in patients with type 2 diabetes mellitus (T2DM) with depression for the first time and their relationship with the Hamilton depression scale

目的:探讨葛根芩连祛浊方联合西药治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝炎(NASH)患者的疗效及对血浆可溶性CD36(sCD36)、脂肪分化相关蛋白(ADRP)水平的影响.方法:选取2019年5月至2020年5月我院内分泌科收治住院的T2DM合并NASH患者62例,随机分为两组,各31例.对照组患者在常规治疗基础上加服二甲双胍肠溶胶囊和阿托伐他汀钙片;中药组患者,在对照组患者治疗基础上加服自拟葛根芩连祛浊方汤剂.比较两组患者治疗前后血糖、血脂、蛋白、促炎性因子相关指标的变化及临床疗效.结果:治疗后两组患者的FPG、2 hPG、FINS、HOMA-IR、TG、Chol、FFA、sCD36、ADRP、CRP、IL-6、TNF-α水平均比治疗前下降,且中药组患者各指标下降更明显(P<0.05);治疗后两组患者的症状积分均比治疗前降低,且中药组患者降低更显著(P<0.05);中药组患者NASH的治疗总有效率为90.32％,明显高于对照组的70.97％.两组患者不良反应事件发生率比较,无统计学意义(P>0.05).结论:葛根芩连祛浊方联合西药治疗T2DM合并NASH临床疗效显著,能改善HOMA-IR,达到降糖调脂,纠正炎症状态的目的.

目的 探讨肥胖合并高胰岛素血症病人的综合治疗措施,并观察其效果.方法 选取2017年3月至2018年11月开滦总医院收治的肥胖合并高胰岛素血症病人92例,利用计算机软件生成的随机数表分为两组,对照组仅给予基础治疗,包括饮食、运动疗法和芬特明口服,观察组在上述疗法的基础上给予口服奥利司他、二甲双胍和胃旁路手术治疗.比较两组治疗前、3个月、6个月后体质量指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(IR)水平变化,比较两种方案对肥胖的疗效、对高胰岛素血症的疗效,病人满意度,分析安全性.结果 两组BMI、FPG、FINS、IR组间、时间、交互对比均差异有统计学意义(P<0.05),两组BMI、FPG、FINS和IR均随着时间的延长下降(P<0.05),且观察组治疗3个月、6个月后BMI、FPG、FINS和IR均低于对照组(P<0.05);两组对肥胖的疗效、对高胰岛素血症的疗效分布比较,均差异有统计学意义(P<0.05),观察组对肥胖的总有效率93.48％和对高胰岛素血症的总有效率95.65％均高于对照组73.91％和78.26％(P<0.05);观察组病人对治疗方案操作(91.30％比69.57％)、有效性(93.48％比67.36％)、舒适度的满意率(97.83％比69.57％)均高于对照组(P<0.05);对照组未见副作用,观察组有1例低血糖、未见术后并发症,两组对比差异无统计学意义(P>0.05).结论 对肥胖合并高胰岛素血症病人在饮食、运动疗法和基础药物治疗的同时给予专科药物和手术治疗可降低BMI、FPG、FINS和IR,控制肥胖、降低高胰岛素血症,提高病人满意率,安全可靠.

目的 探大豆异黄酮对小鼠免疫力的影响.方法 120只小鼠随机分为三批12个实验组,每组10只.实验组分为对照组和大豆异黄酮高、中、低剂量组(30、20、10mg/kg).灌胃量10ml/kg,连续30d.进行脏器/体重比值测定、脾淋巴细胞转化实验和NK细胞活性测定实验.结果 经口给与大豆异黄酮30d后,相比对照组,中、高剂量组的脾脏/体重比值明显升高(P<0.05),高剂量组的胸腺/体重比值明显升高(P<0.05),差异有统计学意义;中、高剂量组脾淋巴细胞增殖能力明显提高,中、高剂量组NK细胞活性率显著增加(均P<0.05)差异有统计学意义.结论 大豆异黄酮可促进淋巴细胞增殖和免疫器官发育,从而提高机体的免疫能力.

目的 探讨吡格列酮联合二甲双胍对肥胖合并高胰岛素血症患者血糖血脂代谢和胰岛功能的影响.方法 选取开滦总医院自2015年7月至2017年7月收治的肥胖合并高胰岛素血症患者76例,随机分为常规组和观察组,每组各38例.两组患者均予以控制饮食,合理运动.在此基础上,常规组予以二甲双胍片口服;观察组在常规组基础上予以盐酸吡格列酮片口服.分别于治疗前及治疗3个月后,计算体质量指数(BMI)和腰臀比(WHR)值,测定空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、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)、空腹胰岛素( FINS)、餐后 2 h 胰岛素( 2 h INS),并计算胰岛素抵抗指数( HOMA-IR)和敏感性指数( ISI).结果 治疗后,两组患者的BMI、WHR、FPG、HbA1c、TC、TG、LDL-C、FINS、2 h INS和HOMA-IR均较治疗前下降,HDL-C和ISI均较治疗前升高,观察组2 h PG较治疗前下降,差异有统计学意义(P<0.05);且观察组BMI、WHR、FPG、2 h PG、HbA1c、TC、TG、LDL-C、FINS、2 h INS和HOMA-IR均低于常规组,HDL-C和 ISI均高于常规组,组间比较,差异均有统计学意义( P <0.05).结论 吡格列酮联合二甲双胍治疗肥胖合并高胰岛素血症,可以减轻体质量,改善患者血糖血脂代谢紊乱,同时,具有降低高胰岛素水平,改善胰岛素抵抗,增强胰岛素敏感性的作用.

Objective It is to observe the effects of Dachaihu decoction combined with Liraglutide on insulin resist -ance,beta-cell function and low inflammatory response in obese type 2 diabetic patients.Methods 86 obese patients with type 2 diabetes were randomly divided into observation group and control group, each group had 43 cases.The control group was treated with subcutaneous injection of lilarupeptide,and the observation group was treated with Dachaihu decoc-tion based on the treatment of the control group.After treatment for 3 months,the changes of body mass,BMI,glucose me-tabolism index[fasting plasma glucose(FPG), 2 h postprandial blood glucose(2hPG), glycosylated hemoglobin (HbA1c)],the index of insulin resistance(HOMA-IR),beta cell function index(HOMA-beta)and inflammatory cyto-kines[(tumor necrosis factor alpha(TNF-alpha),interleukin 6(IL-6)and adiponectin(ADP)]of both groups were com-pared,and the clinical efficacy was evaluated.Results The total effective rate was 88.4% after treatment, significantly higher than 69.8%in the control group(P<0.05).After treatment body mass,BMI,the levels of FPG,2hPG,HbA1c, HOMA-IR,TNF-a,IL-6 were significantly decreased(P<0.05), that of HOMA-beta, ADP were significantly increased (P<0.05)in both groups,the improvements of above indexes after treatment in observation group were significantly better than that of control group(P<0.05).Conclusion Dachaihu decoction combined with Liraglutide can effectively correct low-grade inflammation and sugar metabolism disorder, reduce body quality, and can significantly improve IR and beta cell function in the treatment of obesity with type 2 diabetes mellitus,the curative effect is definite.

糖化血红蛋白(HbA1c)可反映个体长期的血糖情况,是糖尿病诊断、治疗及预防的重要监测指标[1-3],为国际公认的评估长期血糖控制情况的金标准.HbA1c与糖尿病血管病变的发生呈正相关,应用超声检查双侧颈动脉是观察和评估糖尿病外周血管病变的有效手段.有研究证实HbA1c与动脉粥样硬化及冠心病的发生发展相关[4-5].本研究旨在对体检男性HbA1c水平与颈动脉粥样硬化发生的关系进行分析.

Objective:To investigate the effects of liraglutide combined with metformin on lipid metabolism and microinflammatory response in T2DM patients with obesity.Methods:138 T2DM patients with obesity who were treated in the hospital between May 2016 and August 2017 were divided into control group (n =69) and liraglutide group (n =69) by random number table method.Control group received metformin therapy and liraglutide group received liraglutide combined with metformin therapy,which lasted for 3 months.The differences in the levels of insulin resistance indexes,cholesterol-related indexes,apolipoprotein and inflammatory mediators were compared between the two groups.Results:After 3 months of treatment,serum insulin resistance-related indexes FBG and FINS levels of liraglutide group were lower than those of control group;serum cholesterol-related indexes TC and LDL-C contents were lower than those of control group whereas HDL-C content was higher than that of control group;serum apolipoprotein Apo A Ⅰ and Apo A Ⅱ contents were higher than those of control group whereas Apo C Ⅱ and Apo CⅢ contents were lower than those of control group;serum inflammatory mediators IL-6,IL-17 and TNF-α contents were lower than those of control group.Conclusion:Metformin combined with liraglutide therapy can further optimize the glycolipid metabolism and inhibit the micro-inflammatory state in T2DM patients with obesity.

Objective To explore the clinical effect of liraglutide on type 2 diabetes mellitus complicated with polycystic ovary syndrome.Methods Sixty type 2 diabetic patients with polycystic ovary syndrome who visited Kailuan General Hospital from January 2015 to December 2016 were randomly divided into control group and observation group,with 30 cases in each group.The control group had diet and exercise intervention;the observation group was treated by liraglutide for 24 weeks.Waist circumference,body mass index,fasting blood glucose,glycosylated hemoglobin and blood lipid were analyzed before and after treatment.Diameter of mature follicle was measured by color Doppler ultrasound.Results There were no significant differences of age,waist circumference,body mass index,fasting blood glucose,glycosylated hemoglobin,blood lipid and mature follicle diameter between groups before treatment (P ＞ 0.05).After treatment,fasting blood glucose,glycosylated hemoglobin,body mass index,waist circumference in control group were significantly lower and mature follicle diameter was significantly higher than those before treatment (P ＜ 0.05);low-density lipoprotein cholesterol,triacylglycerol,total cholesterol,fasting blood glucose,glycosylated hemoglobin,body mass index,waist circumference in observation group were significantly lower and high-density lipoprotein cholesterol,mature follicle diameter were significantly higher than those before treatment(P ＜ 0.05).Total cholesterol,fasting blood glucose and glycosylated hemoglobin after treatment in observation group were significantly lower than those in control group [(5.4 ±0.8) mmol/L vs (5.8 ±0.8)mmoL/L,(6.6 ±0.5) mmol/L vs (7.7 ±0.8) mmol/L,(5.2 ±0.4)％ vs (5.8 ± 1.0) ％];high-density lipoprotein cholesterol and mature follicle diameter after treatment in observation group were significantly higher than those in control group [(1.43 ± 0.22) mmol/L vs (1.25 ± 0.27) mmol/L,(1.10 ± 0.10) cm vs (0.83 ± 0.11) cm] (P ＜ O.05).Conclusion Lirolipotine treating type 2 diabetes complicated with polycystic ovary syndrome can effectively reduce blood glucose,glycosylated hemoglobin,total cholesterol and promote follicular development.

目的 探究多种治疗方式干预在肥胖合并高胰岛素血症人群中的应用效果.方法 86例肥胖合并高胰岛素症患者随机分组,各43例.对照组予以一般治疗、饮食及运动干预;实验组在对照组基础上予以(二甲双胍、奥利司他、芬特明)+手术治疗(胃旁路手术).对比两组治疗效果、治疗后3、6个月随访体质量(BMI)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、空腹胰岛素(FINS)、胰岛素抵抗(IR)、胰岛素敏感性(IS).结果 实验组有效率高于对照组(P＜0. 05);治疗后3、6个月实验组BMI、2 hPG、FBG低于对照组(P＜0. 05); FINS、IR、IS均低于对照组(P＜0. 05).结论 多种治疗方式干预用于肥胖合并高胰岛素血症人群疗效显著,可控制血糖,降低胰岛素水平.

Objective To study the effect of luteinizing hormone level on ovulation in patients with polycystic ovary syndrome during different ovulation induction.Methods One hundred and fifty patients with polycystic ovary syndrome who were treated in author's hospital from January 2014 to January 2016 were divided into study group and control group according to the principle of random assignment.The patients in the study group were treated with Letrozole and treated with Clomiphene in the control group.The therapeutic effect,pregnancy outcome,and levels of luteinizing hormone before and after treatment were compared between the two groups.Results There was no significant difference in the level of luteinizing hormone between the two groups before treatment (P＞0.05),but the level of luteinizing hormone in the study group was significantly higher than that in the control group (P＜0.05).The ovulation,pregnancy rate of the study group was significantly better than that of the control group (P＜0.05).Conclusion In the different ovulation regimen,Letrozole is helpful to improve the therapeutic effect and improve the ovulation,pregnancy rate of patients with polycystic ovary syndrome.It is worthy of further application in clinical practice.

<正>胰高血糖素样肽-1(Glucagon-like peptide-1,GLP-1)是30个氨基酸的多肽,是目前所知最强的葡萄糖依赖型的胰岛素分泌促进激素。GLP-1是第一个被描述的肠促胰岛素(incre-tin),是一种消化时由胃肠道系统释放出来的物质,促进葡萄糖依赖性的胰岛素从胰腺β细胞中释放出来。不仅如此,GLP-1还具有降低血浆中的胰高血糖素水平,降低胃排空的速率,促进

Objective To investigate the relationship between insulin resistance(IR) and dyslipidemia in prediabetes and type 2 diabetes mellitus(T2DM) patients.Methods Glucose tolerance test,insulin release test,and serum lipid profile determination were carried out in 31 cases of T2DM,20 cases of prediabetes patients,and 20 cases of healthy controls,with the data of body mass index(BMI),waist hip ratio(WHR),fasting C peptide(FC) and lipid metabolism indices obtained at the same time.Results Levels of BMI,WHR,FC,HOMA-IR,and triglycerides(TG) in the T2DM group were higher than those in the control group(P<0.05);Early insulin secretion index(EISI),insulin sensitivity index(ISI) and pancreatic β-cells function index(HOMA-β) in the T2DM group were lower than those in the prediabetes group and the control group(P<0.05).BMI,WHR and TG in the prediabetes group were higher than those in the control group(P<0.01).Pearson correlation analysis indicated positive correlations between insulin resistance index(HOMA-IR) and BMI,WHR,fast blood glucose(FBG),2-hour postprandial glucose(2 hPG),TC,TG,very low density lipoprotein(VLDL),fasting insulin(FINS),and FC(P<0.05).Conclusion No distinct insulin resistance and failure of islet β cells were seen in prediabetes patients.T2DM and prediabetes lipid metabolism disorders are mainly characterized by high TG levels,which reflects the degrees of insulin resistance in these patients.BMI could be regarded as a hazard factor for the decline in islet β cell function in prediabetes and T2DM patients.