目的 分析不同尿白蛋白排泄率(AER)水平的2型糖尿病(T2DM)患者微小RNA-34a(miR-34a)、缺氧诱导因子-1α(HIF-1ot)水平及意义.方法 选取90例T2DM患者纳入T2DM组,另选取同期门诊体检的90名健康成年体检者纳入对照组.根据AER水平的不同,将T2DM组患者分为正常组、微量组和大量组,每组30例.采用双抗体夹心酶联免疫吸附法检测各组血清HIF-1α含量,并采用实时荧光定量聚合酶链反应法检测各组血清miR-34a表达水平.比较各组血糖、血清HIF-1α、血清miR-34a水平和AER水平,分析T2DM患者AER水平与血清miR-34a水平、血清HIF-1α水平的相关性,并分析miR-34a与HIF-1α的关系.绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估HIF-1 α、miR-34a对T2DM的预测价值.结果 正常组、微量组、大量组T2DM患者的AER、血清HIF-1α、血清miR-34a、血糖水平高于对照组健康体检者,且微量组水平高于正常组,大量组水平高于微量组,差异均有统计学意义(P＜0.05).相关性分析结果显示,T2DM患者AER水平与血清HIF-1α水平、血清miR-34a水平均呈正相关(r=0.75、0.73,P＜0.05),且血清HIF-1α水平与血清miR-34a水平呈正相关(r=0.55,P＜0.05).ROC曲线显示,HIF-1α、miR-34a对T2DM有较高的预测价值,AUC分别为0.991、0.934.结论 T2DM患者尿白蛋白含量越高,病情越严重,且其血清HIF-1α水平与血清miR-34a水平呈正相关,提示miR-34a、HIF-1α是T2DM病情的影响因素,且对T2DM有较高的预测价值.

目的 观察通络糖泰方在波动性高血糖大鼠周围神经病变中的作用及机制.方法 90只健康雄性SD大鼠随机分为正常对照组、稳定性高血糖组、波动性高血糖组、阳性对照组及通络糖泰方低、高剂量组,每组15只.5周后,测定大鼠热、冷刺激反应时间和坐骨神经传导速度;生化试剂测定大鼠空腹血糖(FBG)、糖化血红蛋白(GHb)含量,测定大鼠坐骨神经和红细胞的山梨醇含量,比色法测定大鼠超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量.实时荧光定量PCR(RT-qPCR)检测坐骨神经组织NGF、Cas-pase-3 mRNA的表达.蛋白质印迹(Western Blot)检测坐骨神经组织Caspase-3和Nrf2通路相关蛋白(Nrf2、HO-1和NQO-1)表达.结果 与正常对照组比较,稳定性高血糖组坐骨神经传导速度显著下降,血清FBG和GHb含量、坐骨神经组织山梨醇含量和红细胞山梨醇含量显著增加,血清SOD活性显著降低、MDA含量显著增加,坐骨神经组织NGFmRNA表达显著下调,Caspase-3mRNA和蛋白及Nrf2、NQO-1、HO-1蛋白表达显著上调(P＜0.05);波动性高血糖组上述指标变化比稳定性高血糖组更明显(P＜0.05).与波动性高血糖组比较,低、高剂量通络糖泰方显著降低热刺激反应时间,显著升高坐骨神经传导速度,降低血清FBG和GHb含量及坐骨神经组织山梨醇和红细胞山梨醇含量,显著升高血清SOD活性、降低MDA含量,显著上调坐骨神经组织NGFmRNA表达,显著下调Caspase-3mRNA和蛋白及Nrf2、NQO-1、HO-1蛋白表达(P＜0.05).结论 通络糖泰方可改变波动性高血糖大鼠周围神经病变情况,其机制可能与促进Nrf2通路蛋白表达有关.

目的 探讨姜黄素通过核因子-κB(NF-κB)信号通路对高糖高脂饮食诱导的糖尿病模型大鼠胰岛细胞形态和功能的影响.方法 采用高糖高脂饲料+ip链脲佐菌素法制备糖尿病大鼠模型,将模型成功SD大鼠随机分为5组:模型组、二甲双胍(200mg·kg-1,阳性药)组和姜黄素低、中、高剂量(50、150、250mg·kg-1)组,对照组不造模.ig给药,每天1次,连续6周,对照组同时注射等量无菌磷酸盐缓冲液(PBS).观察SD大鼠体质量变化;血糖仪检测空腹血糖;ELISA法检测血清C肽水平;生化分析仪检测血清中糖化血红蛋白、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、血肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)水平;取胰腺进行HE染色,于光镜下观察胰岛形态学改变;免疫组化染色法观察胰岛NF-κB的阳性表达;Western blotting法检测NF-κB信号通路相关蛋白表达;提取胰岛细胞,免疫荧光染色观察胰岛素分泌,葡萄糖刺激的胰岛素分泌(GSIS)实验检测胰岛素分泌量.结果 与模型组比较,各给药组体质量在治疗第2周时开始缓慢增长,第3、4周体质量显著升高(P＜0.05);血糖水平显著降低(P＜0.05),血清C肽水平显著升高(P＜0.05);糖化血红蛋白、TG、TC、LDL-C、ALT、AST、Scr、BUN、UA水平显著降低(P＜0.05),HDL-C水平显著升高(P＜0.05);胰岛大小和形态逐渐恢复正常,胰岛细胞依次变得更清晰完整,导管系统内的囊性扩张也逐渐减少;NF-κB阳性细胞减少;p-P65蛋白表达显著降低(P＜0.05),p-IKBα蛋白表达显著升高(P＜0.05);胰岛原代细胞分泌胰岛素显著增加(P＜0.05).结论 姜黄素可以保护糖尿病大鼠胰岛细胞正常形态,维持胰岛细胞功能,减轻糖尿病大鼠症状,其机制可能与调控NF-κB信号通路有关.

目的:观察和分析恩格列净降低糖尿病(DM)合并动脉粥样硬化(AS)患者主要心血管事件风险的价值.方法:选取2016年9月至2019年12月延安大学附属医院心脑血管病医院收治的136例DM合并AS患者.根据降糖治疗方案,将86例使用恩格列净的患者纳入观察组,50例未使用恩格列净的患者纳入对照组.采取常规降糖及对症治疗,两组患者随访15～33个月,中位随访时间17个月.收集患者治疗前及治疗6个月后的临床数据及三酰甘油(T G)、总胆固醇(T C)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1C)及颈动脉内膜中层厚度(CIM T)检测结果并进行比较.分析两组患者治疗前后、停药访视期间关键临床指标的变化情况.采用Logistic回归分析患者心血管事件再发风险因素.结果:治疗前,两组患者基线资料无显著差异(P>0.05).经6个月治疗后,观察组患者的TG、TC、HDL-C、LDL-C、FPG、HbA1C及CIMT水平均显著改善,而对照组患者仅TG、LDL-C及FPG水平明显降低(P<0.05),观察组患者的HDL-C、LDL-C、HbA1C及CIM T治疗前后变化值显著大于对照组(P<0.05).观察组患者停药后6个月内HDL-C水平有所下降,随访结束时保持相对稳定,但仍较治疗前升高,而对照组的HDL-C水平变化幅度较小.两组患者的LDL-C水平自停药后未出现明显波动.两组患者的HbA1C停药后均有所回升,且观察组回升更加明显.两组患者停药后的CIM T水平未出现明显变化.两组患者均未在6个月治疗期间出现心血管事件.截至随访终点,观察组9例(10.46％)发生心血管事件,而对照组为13例(26.00％),两组相比具有显著性差异(χ2=5.627,P=0.018).Logistic回归分析结果显示,HDL-C、CIM T及治疗方案与患者再次出现心血管事件风险相关.结论:DM合并AS患者口服恩格列净短期治疗,能够改善血脂和AS状态,并能显著降低其再发心血管事件风险.

特纳综合征(TS)是较罕见的性染色体疾病,染色体核型表现为X染色体部分或完全丢失.TS合并自身免疫性疾病发病率高.本例患者以DKA起病,体型瘦小,临床诊断为桥本氏甲状腺炎及LADA.本文通过探讨TS与LADA的潜在机制,旨在提高认识并及时筛查TS并发症.

目的:探讨铁皮石斛多糖是否通过调控微小RNA(miR)-363来影响高糖诱导的人肾小管上皮细胞HK-2损伤.方法:将HK-2细胞分为NG组(正常糖,5 mmol/L葡萄糖),HG组(高糖,30 mmol/L葡萄糖),HG+铁皮石斛多糖-L、M、H组(30 mmol/L葡萄糖+100 μg/mL、200 μg/mL、400 μg/mL铁皮石斛多糖),HG+miR-NC (30 mmol/L葡萄糖+转染miR-NC)、HG+miR-363组(30 mmol/L葡萄糖+转染miR-363模拟物)、HG+铁皮石斛多糖+anti-miR-363组(30 mmol/L葡萄糖+转染anti-miR-363+400 μg/mL铁皮石斛多糖).采用细胞计数试剂盒8(CCK-8)法检测细胞存活率;流式细胞术检测细胞凋亡;western blotting检测Bax、Bcl-2表达;试剂盒检测氧化应激指标超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量;定量Real-time PCR检测miR-363的表达.结果:铁皮石斛多糖提高高糖诱导的HK-2细胞的存活率、Bcl-2蛋白水平、SOD活性、miR-363表达水平,降低凋亡率、Bax蛋白水平、MDA含量,且均呈浓度依赖性(P＜0.05).过表达miR-363使高糖诱导的HK-2细胞的活性、Bcl-2蛋白水平、SOD活性、miR-363表达水平提高,凋亡率、Bax蛋白水平、MDA含量减少(P＜0.05).铁皮石斛多糖对高糖诱导的HK-2细胞存活率、凋亡及氧化应激的影响可被抑制miR-363逆转.结论:铁皮石斛多糖通过促进miR-363表达,增强高糖诱导的HK-2细胞活性,减弱其凋亡和氧化应激.

目的:研究运动康复联合曲美他嗪对冠心病患者经皮冠状动脉介入术(PCI)术后内皮功能 、炎症反应及血脂代谢的影响.方法:选择在我院接受PCI的稳定型心绞痛患者,随机分为接受术后运动康复联合曲美他嗪的观察组 、常规干预联合曲美他嗪的对照组.干预前及干预后3个月,测定反应性充血指数(RHI)及血清内皮标志物 、炎症细胞因子 、血脂指标的含量.结果:干预后3个月时,两组的RHI水平及血清NO、HDL-C、Omentin-1含量均明显升高,血清ET-1、vWF、M-CSF、IL-6、IL-8、RANTES、LDL-C、Chemerin的含量均明显降低且观察组的RHI水平及血清NO、HDL-C、Omentin-1含量均明显高于对照组,血清ET-1、vWF、M-CSF、IL-6、IL-8、RANTES、LDL-C、Chemerin的含量均明显低于对照组.结论:冠心病患者PCI术后进行运动康复联合曲美他嗪治疗能够改善内皮功能 、抑制炎症反应 、调节血脂代谢.

目的 探讨外源性胰岛素导致的胰岛素自身免疫综合征(IAS)的临床特点.方法 回顾性分析我院8例使用外源性胰岛素后诱发IAS的患者病例特点、诊疗经过及疾病转归.结果 8例患者均有低血糖表现,其中5例有典型低血糖症状,3例通过病史采集发现,且低血糖发生无特定规律;5例患者均使用了门冬胰岛素30,1例患者使用鱼精蛋白锌胰岛素和甘精胰岛素,1例患者使用生物合成人胰岛素,1例患者使用精蛋白锌重组人胰岛素30/70;75 g口服葡萄糖耐量试验(OGTT)有血清胰岛素水平和C肽水平分离现象,胰岛素自身抗体(IAA)阳性;治疗上所有患者停用外源性胰岛素,结合病情分别给予个体化治疗,如阿卡波糖、二甲双胍等,低血糖症状改善.结论 糖尿病患者应用外源性胰岛素导致IAS易被漏诊或误诊,75 g OGTT检查结果显示胰岛素和C肽分离现象及IAA阳性对外源性胰岛素导致IAS的诊断至关重要.

目的:研究病毒性心肌炎患者外周血IL-17A基因多态性与心肌损伤 、MM Ps/TIM Ps平衡的相关性.方法:选择延安大学附属医院东关分院诊断为病毒性心肌炎的80例患者作为研究的VMC组,另取同期在延安大学附属医院东关分院体检的100例健康志愿者作为研究的对照组.采集外周血并测定IL-17A基因rs2275913位点的多态性,采集血清并测定心肌损伤 、MMPs/TIM Ps指标的含量.结果:VMC组患者中IL-17A基因GG基因型所占比例低于对照组,GA+AA基因型所占比例高于对照组;VMC组患者血清中IL-17、CK-MB、cTnI、sFas、MDA、PINP、ICTP、MM P2、MM P9、TIM P1、TIM P2的含量显著高于对照组且VMC组中GA+AA基因型患者血清中IL-17、CK-MB、cTnI、sFas、MDA、PINP、ICTP、MMP2、MMP9、TIM P1、TIMP2的含量高于GG基因型患者.结论:病毒性心肌炎患者外周血IL-17A基因rs2275913位点等位基因G向A的突变能够加重心肌损伤及MMPs/TIMPs失衡.

Correlation of peripheral blood IL-17A gene polymorphism with myocardial injury and MMPs/TIMPs balance in patients with viral myocarditis Li-Li Wang, A-Ning Zhang, Yu-Mei He 1. Department of Integrated Internal Medicine, Dongguan Branch, Yan'an University Affiliated Hospital, Yan'an, Shaanxi Province, 716000, China 2. Department of Neurology, Dongguan Branch, Yan'an University Affiliated Hospital, Yan'an, Shaanxi Province, 716000, China Journal of Hainan Medical University

Objective:To study the correlation of serum Dickkopf-1 (DKK-1)content with bone destruction,inflamma-tory response and oxidation reaction in patients with gouty arthritis.Methods:40 patients with acute gouty arthritis who were treated in our hospital between 2013 and 2016 were selected as the group A of the study,56 patients with asymptomatic hype-ruricemia who were treated in our hospital during the same period were selected as the group B of the study,and 60 healthy volunteers who received physical examination in our hospital during the same period were selected as the control group of the study.The serum was collected to detect the contents of DKK-1,bone destruction indexes,inflammatory response indexes and oxidation reaction indexes.Results:Serum DKK-1,TRACP5b,RANKL,β-CTX,PGE2,sICAM-1,sVCAM-1,sCD14, MDA,8-OHdG and 3-NT levels of group A and group B were significantly higher than those of control group while SOD and GSH-Px levels were significantly lower than those of control group;serum DKK-1,TRACP5b,RANKL,β-CTX,PGE2,sI-CAM-1,sVCAM-1,sCD14,MDA,8-OHdG and 3-NT levels of group A were significantly higher than those of group B while SOD and GSH-Px levels were significantly lower than those of group B;serum DKK-1 level was positively correlated with TRACP5b,RANKL,β-CTX,PGE2,sICAM-1,sVCAM-1,sCD14,MDA,8-OHdG and 3-NT levels,and negatively correla-ted with SOD and GSH-Px levels.Conclusion:Abnormally elevated DKK-1 in patients with gouty arthritis can induce articular bone destruction as well as inflammatory response and oxidative stress response activation.

目的 探讨血清超敏C反应蛋白(hs-CRP)、单核细胞趋化蛋白-1(MCP-1)在急性心肌梗死(AMI)患者中的表达及临床意义.方法 选择2015年1月至2016年5月期间该院心内科收治的52例AMI患者(AMI组)、50例不稳定型心绞痛(UAP)患者(UAP组)、50例稳定型心绞痛(SAP)患者(SAP组)为研究对象,并选择50例健康体检者纳入对照组,比较各组研究对象血清hs-CRP、MCP-1水平;分析AMI患者血清MCP-1与hs-CRP的相关性.根据30 d有无发生心血管事件将AMI患者分为事件组(n=14)及非事件组(n=38),比较2组临床资料及血清MCP-1、hs-CRP水平.结果 血清hs-CRP和MCP-1水平在对照组、SAP组、UAP组与AMI组依次升高,差异均有统计学意义(P<0.05);经Pearson相关性分析显示,AMI组患者MCP-1与hs-CRP呈显著正相关(P<0.05);事件组患者年龄、吸烟和糖尿病的比例、心肌肌钙蛋白T(cTnT)、hs-CRP、MCP-1水平均明显高于非事件组,左室射血分数(LVEF)则明显低于非事件组,差异有统计学意义(P<0.05).结论 AMI患者血清hs-CRP和MCP-1明显升高,检测血清hs-CRP和MCP-1水平对判断冠状动脉病变的严重程度及预后具有重要的临床意义.

Stable chronic obstructive pulmonary disease (COPD) patients’ airway function and local inflammation are both in a certain safe range, but the COPD patients already have airway anatomic change, and can have acute onset in cases of pathogen infection or patients’ weakened constitution, leading to deterioration[1,2]. The treatment of patients with stable COPD is currently the focus of the clinical study, and most scholars believe that stable phase should still be given positive intervention to optimize patients’ condition and reduce the frequency of acute attack. Both tiotropium and salmeterol and fluticasone propionate powder are the main drugs in the clinical treatment of COPD, tiotropium, as anticholinergic drugs, can effectively dilate the airway, and salmeterol and fluticasone propionate powder is the compound preparation of毬2 receptor agonist and inhaled corticosteroid, with the effect of both dilating the airway and inhibiting inflammation[3]. In the research, the effect of combined application of tiotropium and salmeterol and fluticasone propionate powder on disease control in stable COPD patients was mainly analyzed, hereby reported as follows.

目的 探讨磷酸西格列汀联合二甲双胍治疗初发2型糖尿病的临床效果.方法 回顾性分析2013年1月～2015年1月延安大学附属医院收治的91例初发2型糖尿病患者的临床资料,依据治疗措施的不同将其分为二甲双胍组(41例)和磷酸西格列汀联合二甲双胍组(50例).比较两组患者治疗前后血糖、胰岛素、脂代谢情况,观察两组患者临床疗效和不良反应发生情况.结果 两组治疗前空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、体重指数(BMI)、空腹胰岛素(FIns)、胰高血糖素样肽-1(GLP-1)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)比较差异无统计学意义(P＞0.05);二甲双胍组治疗后FBG、2hPBG、HbA1c、TG均低于治疗前,HDL高于治疗前,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组治疗后FBG、2hPBG、HbA1c、HOMA-IR、TC、TG、LDL均低于治疗前,FIns、GLP-1、HDL均高于治疗前,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组治疗后FBG、2hPBG、HbA1c、HOMA-IR、TC、TG、LDL均低于二甲双胍组,FIns、GLP-1、HDL均高于二甲双胍组,差异均有统计学意义(P＜0.05);磷酸西格列汀联合二甲双胍组临床治疗总有效率显著高于二甲双胍组,不良反应发生率显著低于二甲双胍组,差异均有统计学意义(P＜0.05).结论 磷酸西格列汀联合二甲双胍治疗初发2型糖尿病效果较好,患者临床症状改善明显,值得推广应用.

Objective To investigate the impact of long - term intensive hypoglycemic therapy on quality of life and cardiovascular events of patients with type 2 diabetes mellitus. Methods A total of 136 patients with type 2 diabetes mellitus&nbsp;were selected in the Affiliated Hospital of Yan′an University from February 2009 to July 2010,and they were randomly divided into A group and B group according to random number table,each of 68 cases. The control target of HbA1c of A group was 6. 5%to 7. 5% ,while that of B group was less than 6. 5% . HbA1c and FBG before intervention,after 3 years of intervention,after 5 years of intervention were compared between the two groups;quality of life was evaluated before intervention,after 5 years of intervention, respectively; incidence of cardiovascular events ( including macrovascular complications, microvascular complications and composite endpoints of cardiovascular events)and hypoglycemia were recorded during the 5 - year follow up. Results No statistically significant differences of HbA1c or FBG was found between the two groups before intervention( P ﹥0. 05),while HbA1c and FBG of B group were statistically significantly lower than those of A group after 3 years of intervention, after 5 years of intervention(P < 0. 05);after 3 years of intervention,after 5 years of intervention,HbA1c and FBG of the two groups were statistically significantly lower than those before intervention(P < 0. 05). No statistically significant differences of WHOQOL-BREF score was found between the two groups before intervention(P ﹥ 0. 05),while WHOQOL-BREF score of B group was statistically significantly higher than that of A group after 5 years of intervention( P < 0. 05 ). No statistically significant differences of incidence of macrovascular complications or microvascular complications was found between the two groups(P ﹥ 0. 05);incidence of composite endpoints of cardiovascular events of B group was statistically significantly lower than that of A group,while incidence of hypoglycemia of B group was statistically significantly higher than that of A group( P <0. 05). Conclusion Long - term intensive hypoglycemic therapy can effectively improve the quality of life of patients with type 2 diabetes mellitus,reduce the incidence of cardiovascular events,but we should pay attention to the onset of hypoglycemia.

目的 探讨瑞舒伐他汀联合辅酶Q10治疗慢性心衰后血清炎性指标、血清脑钠肽及心功能的变化.方法 选择2014年1月～2015年2月在延安大学附属医院东关分院进行治疗的慢性心衰患者96例,根据随机数字表法分为观察组和对照组,每组各48例,对照组患者在常规治疗措施的基础上给予瑞舒伐他汀治疗;观察组在常规治疗措施的基础上加用瑞舒伐他汀和辅酶Q10治疗.对两组患者治疗前后血清炎性指标、血清脑钠肽及心功能的变化进行评估.结果 观察组患者有效率显著高于对照组(P＜0.05).治疗后观察组患者左心室舒张末期内径(LVEDD),左心室收缩末期内径(LVESD)均显著低于对照组(P＜0.05),治疗后观察组患者左心室射血分数(LVEF)显著高于对照组(P＜0.05).治疗后观察组心功能分级和BNP水平均显著低于对照组(P＜0.05),观察组患者6 min步行距离显著高于对照组(P＜0.05).治疗后观察组患者超敏C反应蛋白(hs-CRP),肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平均显著低于对照组(P＜0.05).结论 瑞舒伐他汀联合辅酶Q10能够显著降低慢性心衰后血清炎性指标和血清脑钠肽水平,并能有效改善患者心功能,可在临床推广应用.

Objective: To observe the clinical curative effect of radiofrequency ablation rhythm control in the treatment of heart failure (HF) complicated with atrial fibrillation (AF).Methods:70 patients with heart failure complicated with atrial fibrillation were divided into 2 groups by random double blind method with 35 cases in each group. The control group to were treated by drug ventricular rate control and anticoagulant therapy while the observation group were treated by radiofrequency ablation rhythm control. The clinical effects, changes of cardiac function before and after the tretment and the incidence of adverse cardiovascular and cerebrovascular events were compared between the 2 groups. Results:The total effective rate in the observation group (91.4%) was significantly higher than that in the control group (71.4%),P<0.05.After the treatment, the differences in LVEF[(51.4±13.4) VS (44.2±15.8)]% and LAD[(38.7±7.9)VS(57.0±10.2)]mm between the two group were significant (P<0.05). In 6 months of follow-up, the incidence rates of cerebral infarction and the recurrence rate of atrial fibrillation in the observation group (0.0%, 8.6%) were significantly lower than those in the control group (17.1%,37.1%),P<0.05.Conclusion:The effect of radiofrequency ablation rhythm control in the treatment of heart failure complicated with atrial fibrillation is significantly better than that of ventricular rate control. It can improve the cardiac function and reduce the incidence of adverse cardiovascular and cerebrovascular events.

Objective:To analyze the effect of liraglutide and metformin on the constitution,metabolism and micro-in-flammatory state in newly diagnosed type 2 diabetic mellitus patients with obesity.Methods:A total of 55 cases of newly diag-nosed type 2 diabetic mellitus patients with obesity were included for study and divided into observation group (n = 30)and control group (n =25)according to different treatment plans.Control group received metformin treatment alone,observation group received liraglutide and metformin treatment,and levels of glucolipid metabolism indicators,body mass index and fi-brinolytic activity-related indicators,micro-inflammation-related signaling pathways,illness-related indicators,etc of two groups were detected after one course of treatment.Results:FPG,GHbA1c,TC,TG and LDL-C values in venous blood of ob-servation group after treatment were lower than those of control group (P <0.05);waistline,hipline and waist-hip ratio of ob-servation group decreased after treatment,TM value was lower than that of control group while t-PA value was higher than that of control group (P <0.05 );TLR4-NF-κB signaling pathway and DAG/PKC signaling pathway downstream TLR4,p-NF-κB p65,DAG and PKC protein expression levels of observation group after treatment were significantly lower than those of control group (P <0.05);serum APN,Nesfatin-1 and ISI values of observation group after treatment were higher than those of control group while LP,Chemerin,RBP4 and FINS values were lower than those of control group (P <0.05).Conclusions:Combined therapy of liraglutide and metformin can significantly improve the constitution of newly diagnosed type 2 diabetic mellitus patients with obesity,optimize the general condition and be expected to improve treatment outcome.

Objective To investigate the blood sugar control effect of three insulin pump basal rate seg-ment methods for type 2 diabetes.Methods A total of 180 patients with type 2 diabetes in Affiliated Hospital of Yan′an University from Jul.2010 to Jul.2014 were included in the study and divided into three groups according to the random number table method,60 cases each:3-segment group,5-segment group and 24-seg-ment group respectively.The blood glucose reaching standard time,blood glucose level, the incidence of hypoglycemia and insulin dosage of the three groups were compared.Results After breakfast blood glucose levels rose,then decreased after lunch, after dinner,3:00 in the morning in each group,with no significant difference(P>0.05).The treatment time and insulin usage of the 5-segmentgroup[(3.6 ±0.3) d,(41 ± 5) U] and 24-segment group[(2.9 ±0.7) d,(36 ±4) U] were less than the 3-segment group[(5.5 ± 0.8) d,(43 ±6) U],and the 24-segment group less than the 5-segment group, with statistically significant difference(P<0.05).The hypoglycemia incidence of the 3-segment group was 13.3%(8/60),of the 5-seg-ment group was 6.7%(4/60),of the 24-segment group was 3.3%(2/60),the difference was not statistical-ly significant(P>0.05).Conclusion The three insulin pump basal rate segment methods to control blood sugar for type 2 diabetes have similar effect,but comprehensively speaking the 5-segment method is more sim-ple and convenient with good effect.

目的:分析噻托溴铵干粉与沙美特罗替卡松粉剂联合应用对稳定期慢性阻塞性肺疾病(COPD)患者病情控制的效果.方法:将2012年9月～2015年6月间在延安大学附属医院接受治疗的COPD患者116例纳入研究,根据相关检测确定以上研究对象均处于稳定期.根据接受的治疗方式不同,所有入组对象被分为观察组及对照组各58例.对照组患者接受临床常规治疗,观察组患者接受噻托溴铵干粉与沙美特罗替卡松粉剂联合治疗,对比两组患者的治疗后血清及诱导痰中病情相关指标水平.结果:观察组患者接受治疗后的诱导痰γ-GCS、MIP-1α、8-iso PGF2、HMGB1、IL-17、Hbd-2值低于对照组患者,SP-A值高于对照组患者(均P＜O.05);观察组患者的治疗后FEF25％～75％、FEV1％、V25、MMFR值高于对照组患者,血清CXCR3、CXCL10值低于对照组患者(均P＜0.05);观察组患者的治疗后血清和肽素、锁链素、CCL18、CC16、ANG2值均低于对照组患者(均P＜O.05).结论:稳定期COPD患者接受噻托溴铵干粉与沙关特罗替卡松粉剂联合治疗,有助于进一步稳定患者病情并改善预后.