目的 分析156例健康体检人群中甲状腺功能检测结果.方法 选取医院体检中心2018年8月1日至2018年8月31日的156例健康体检者为研究对象,均抽取外周静脉血进行甲状腺功能检测,检测指标包括促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4).分析甲状腺功能检测结果 .结果156例体检者中有15例(9.61％)检测出甲状腺功能异常,其中以亚临床甲减的检出率最高为4.49％,亚临床甲亢有5例(3.21％),甲亢有1例(0.64％),甲减有2例(1.28％).亚临床甲状腺疾病的检出率为7.69％(12/156),高于临床甲状腺疾病的1.92％(3/156)(P<0.05).女性甲状腺功能异常的检出率高于男性(P<0.05).>40～50岁、>50～60岁的甲状腺功能异常率高于其他各年龄组.结论 体检人群中亚临床甲状腺功能异常的检出率较高,女性更容易发生甲状腺功能异常,应加强对该者甲状腺疾病的早期诊断和鉴别诊断,尽早干预.

目的 探讨血浆TM、AT-Ⅲ检测在大面积烧伤削痂术后凝血功能监测中的临床应用价值.方法 选择2014年2月至2016年2月本院ICU收治的大面积烧伤并有削痂手术指征的患者35例,其中早期削痂组19例,非早期削痂组16例,并选取同期本院体检中心健康体检者20例作为对照组,检测三组TM和AT-Ⅲ水平.结果 早期削痂组休克期尿量高于非早期削痂组,而回收期心率和创面愈合时间均显著低于非早期削痂组(P<0.01).早期削痂组和非早期削痂组的TM水平分别较对照组明显上调,而AT-Ⅲ水平明显下调,非早期削痂组的TM水平高于早期削痂组,AT-Ⅲ水平则低于后者(P<0.01).烧伤病变发展与血浆TM和AT-Ⅲ水平具有相关性,且TM水平及AT-Ⅲ水平均与休克期尿量、回收期心率和创面愈合时间有明显相关性(P<0.01).结论 大面积烧伤时,由于组织和血管内皮的大面积损伤导致血液的高凝状态,焦痂早期切除可以在很大程度上控制病情发展,预防或缓解血栓形成.

Objective To investigate the application value of the detection of serum chemerinmRNA and TRB3mRNA in type 2 diabetes with insulin resistance. Methods The serum and clinical data of 110 cases of patients with type 2 diabetes were collected,52 cases of volunteers from the general population were extracted. Real-time fluorescent quantitative PCR technology was used to detect the expression of serum chemer-inmRNA and TRB3mRNA. People with diabetes were divided into insulin resistance group (IR group)and insulin resistance group (NIR group), compared with control group to observe the changes of expression levels of serum chemerinmRNA and TRB3mRNA on relationship with IR. Results Compared with control group,the expression of serum chemerinmRNA and TRB3mRNA significantly raised in case groups,and the difference was statistically significant (P < 0. 01). The expression levels of two markers in IR group were higher than those in NIR group (P < 0. 01). In two groups the expression of two markers had a positive correlation (r = 0. 759,0. 781,P < 0. 01),which respectively had a significant correla-tion with those of FPG,FINs,HbA1c level and HOMA IR (r = 0. 683,0. 647,0. 683,0. 647,P < 0. 01;r = 0. 713,0. 672,0. 713,0. 672, P < 0. 01)〗. Conclusion The detection of expression of serum chemerinmRNA and TRB3mRNA can predict the occurrence of IR and determine its dangerous degree,evaluate the development of the disease.

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.

目的 探讨中老年人群血清脂联素(APN)等脂类代谢指标在甲状腺功能紊乱疾病中的变化及其相关性.方法 采用电化学发光法检测159例甲状腺功能亢进症(简称甲亢)、120例甲状腺功能减退症(简称甲减)患者及140名体检正常者(正常对照组)甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)]水平,采用酶联免疫吸附试验(ELISA)测定各组血清APN水平,对比各组血清APN、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)、载脂蛋白A1 (apo A1)、载脂蛋白B(apo B)、载脂蛋白E(apo E)的差异,并分析其相关性.结果 甲亢组、甲减组、正常对照组之间血清APN、TC、TG、LDL-C、apo E水平差异有统计学意义(P＜0.05),血清HDL-C、apo A l、apo B差异无统计学意义(P＞0.05);相关分析显示甲亢组和甲减组FT4与TC的相关性最高(r值分别为-0.498、-0.461,P=0.000).结论 中老年甲状腺功能紊乱患者血清APN等脂类指 标有明显变化.TC与FT4的关系最为密切.

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.

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.