目的 探讨2型糖尿病患者葡萄糖目标范围内时间(time in range,TIR)与颈动脉内中膜厚度(carotid artery intima-media thicknes,CIMT)的相关性.方法 选择2型糖尿病患者232例,根据颈总动脉内中膜厚度分为2组:非正常组CIMT≥0.8 cm,正常组CIMT<0.8 cm,测量身高、体重,并检测生化指标及动态血糖参数,统计TIR值,比较2组各指标及TIR值的差异,采用Pearson相关分析CIMT与CGM指标的相关性,二元Logistic回归分析检验CIMT与CGM指标的关系.结果 CIMT<0.8 cm组TIR值明显高于CIMT≥0.8 cm组[(77.22±23.26)nmol/L vs(69.47±22.03)nmol/L],且CIMT与TIR呈负相关,与SDBG、MBG、TAR呈正相关,二元Logistic回归提示TIR(P=0.016)降低,SDBG(P=0.025)、MBG(P=0.006)、TAR(P=0.014)升高是CIMT增厚的危险因素.结论 在2型糖尿病患者中,TIR与CIMT呈负相关,TIR值降低可能是颈总动脉内中膜增厚的独立危险因素.

Objective:To explore the effect of Rain Classroom combined with situational teaching in clinical clerkship of internal medicine.Methods:A total of 72 undergraduate students with clinical majors of Batch 2015 were selected and randomly divided into a control group and an experimental group using computer scrolling pause method, with 36 students in each group. The control group adopted traditional teaching methods, and the research group adopted Rain Classroom combined with situational teaching. The teaching effect evaluation was carried out through a 10-point questionnaire based on the internal medicine theory examination, clinical skill assessment and learning interest, knowledge mastery and application, and clinical thinking and practical ability. SPSS 20.0 was used to conduct t-test. Results:The average scores of the students in the experimental group including the theoretical test (87.94±5.68) and the skill test scores (88.08±5.73) were significantly higher than those in the control group (83.00±5.89) and (83.86±4.80)( P<0.01). The results of the questionnaire showed that students' interest in learning improvement, self-learning ability, new knowledge acquisition, application of knowledge, clinical thinking, clinical practice, problem solving, self-expression, teamwork, doctor-patient communication ability in the study group were better than those in the control group ( P < 0.01). Conclusion:The Rain Classroom combined with situational teaching method is helpful to improve students' knowledge mastery and application, improve clinical thinking and practical ability, improve learning interest and clinical clerkship teaching effect.

Objective — To study the clinical efficacy of miglitol combined with insulin in the treatment of newly diagnosed type 2 diabetes mellitus. Methods — 96 newly diagnosed type 2 diabetes patients admitted to our hospital from January 2021 to September 2021 were selected as the subjects of this study. They were randomly divided into two groups by drawing lots. The control group was treated with acarbose combined with insulin glargine, and the observation group was treated with miglitol combined with insulin glargine. Fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin (HbA1c), blood glucose compliance time, occurrence of adverse reactions and quality of life score of 2 groups were measured before and after treatment. Results — After treatment, fasting blood glucose, 2h postprandial blood glucose and HbA1c in both groups were lower than before (P < 0.05), and there was no statistical significance in the difference between the two groups and the time of blood glucose reaching the standard (P > 0.05). The incidence of adverse reactions in observation group was lower than that in control group, and the quality of life score in observation group was better than that in control group (P < 0.05). Conclusions — Miglitol or acarbose combined with insulin glargine can effectively control blood glucose in patients with newly diagnosed type 2 diabetes, but miglitol combined with insulin glargine has fewer adverse reactions, which can be used as the first choice for clinical treatment of newly diagnosed type 2 diabetes.

目的 探讨骨钙素(osteocalcin,OCN)基因启动子区RS1800247和RS1543297位点单核苷酸多态性(Single nucleotide polymorphisms,SNPs)与2型糖尿病(Type 2 diabetes mellitus,T2DM)葡萄糖糖、血脂谱及骨代谢指标的关系.方法 根据骨密度的值将217名T2DM患者分为2组:糖尿病合并骨质疏松症(diabetic osteoporosis DO)124例,糖尿病非骨质疏松症(Non-diabetic osteoporosis,NDO)93例.用聚合酶链式反应-限制性片段长度多态性(polymerase chain reaction restriction fragment length polymorphism,PCR-RFLP)技术对OCN基因RS1800247和RS1543297位点进行多态性分析,比较不同基因型葡萄糖、血脂、骨代谢指标的差异.结果 (1)所有研究对象RS1800247和RS1543297位点基因型频率分布均符合Hardy-Weinberg定律,DO组和NDO组间RS1800247和RS1543297位点基因型和等位基因频率分布差异无统计学意义(P>0.05);(2)RS1800247位点TT基因型携带者稳态模型胰岛素分泌指数(homeostasis model assessment insulin secretion index HOMA-β)高于CT+CC基因型携带者(P<0.05);(3)RS1543297位点TT基因型携带者胰岛素敏感性指标(Insulin sensitivity index,ISI)高于CT+CC基因型患者,稳态模型胰岛素抵抗指数(HOMA-IR)低于CT+CC基因型患者;(4)未发现RS1800247、RS1543297不同基因型与T2DM骨代谢及脂代谢指标有相关性.结论 RS1800247位点可能与T2DM胰岛细胞β细胞功能相关,其中T等位基因与胰岛β细胞功能的保护性相关,C等位基因可作为预测胰岛β细胞功能降低的一项遗传标志.RS1543297位点可能与T2DM胰岛素敏感性相关,其中T等位基因与胰岛素敏感性正相关,C等位基因与胰岛素抵抗相关.显示OCN基因多态性与影响糖代谢的关键因素相关,提示骨组织可通过OCN参与机体葡萄糖稳态的调控.

目的 探讨“一带一路”背景下昆明医科大学外国留学生参加全科医学学士教育(bachelor of medicine and bachelor of surgery,MBBS)以问题为中心,标准化临床路径实习带教法及标准化病人诊查模式.为昆明医科大学在云南省打造“一带一路”国外临床医学教育品牌奠定基础.方法 选取2016年5月月至2018年4月在昆明医科大学第一附属医院实习的全科医学学士留学生60人,随机分为2组,每组30人,研究组开展标准化临床路径病史采集操作和以问题为中心的典型病案分析教学模式,进行全英文标准化病人诊查;对照组进行传统跟随式教学查房.通过考试及问卷调查评价2组学生在临床实习中的教学效果.结果 以问题为中心,采取标准化临床路径和标准化患者诊查教学方法的研究组考核成绩及教学满意度调查评分均高于传统跟随式教学查房对照组,差异具有统计学意义(P＜0.05).结论 以临床问题为中心,标准化临床路径操作结合全英文标准化患者诊查模式MBBS留学生实习带教方法改革,对提高MBBS留学生实习兴趣,自主学习能力和培养学生临床思维能力方面具有一定促进作用,值得在临床教学中推广应用.

Objective To observe the efficacy of short-term, long-term octreotide and bromocriptine in the sequential treatment of growth hormone pituitary adenoma invading the cavernous sinus.Methods Sixteen patients with growth hormone pituitary adenoma invading the cavernous sinus were randomly divided into two groups, 8 in each.Patients in the observation group were given subcutaneous injection of short-term octreotide 100 μg each time, 3 times/d for 1 week.Then, the long-term octreotide was deep injected into the buttock muscle, 20 mg each time, once every 28 days, for 3 times, followed by oral sniffing 7.5mg/d, for 3 months.The patients in the control group were deep injected with long-term octreotide, 20 mg each time, once every 28 days, for 6 months.The clinical symptom scores, serum GH valleys, serum IGF-1 and tumor volume before and after treatment were observed and compared between these two groups.Statistics on gastrointestinal adverse reactions and total treatment costs between the two groups was conducted.Results No significant difference was found in the clinical symptoms score, serum GH valleys, serum IGF-1, tumor volume between the two groups before and after treatment (all P>0.05).The incidence of gastrointestinal adverse reactions in the observation (2 cases) was lower than that (5 cases) in the control group (25% vs 62.5%), P<0.05.The total cost of the observation group was (33 000±2 000) yuan, which was lower than that of the control group [(55 000±9 000) yuan], P<0.05.Conclusions The efficacy of short-term, long-term octreotide and bromocriptine in the sequential treatment of growth hormone pituitary adenoma invading the cavernous sinus is the same as the only use of long-term octreotide, but short-term, long-term octreotide and bromocriptine can decrease the gastrointestinal adverse reaction and total cost of the treatment.

目的 探讨利拉鲁肽对T2DM大鼠骨代谢和骨微观结构的影响及可能机制. 方法 高脂高糖饮食联合小剂量STZ诱导建立T2DM大鼠模型30只,随机分为利拉鲁肽低剂量干预组(LR-L)、高剂量干预组(LR-H)及T2DM组;另选健康对照组(NC) 10只.利拉鲁肽干预4周,检测血清Ⅰ型胶原羟基端肽p降解产物(-CTX)、Ⅰ型原胶原N端前肽(PINP)、成纤维细胞生长因子23 (FGF-23)、骨特异性碱性磷酸酶(BALP)、甲状旁腺素(PTH)、降钙素(CT)、抗酒石酸酸性磷酸酶(TRAP)、骨保护素(OPG)、κB受体活化因子配基(RANKL);HE染色制作骨组织病理学切片;IPP 6.0软件进行图像采集测骨小梁参数. 结果 LR-L组、LR-H组β-CTX、TRAP和RANKL低于T2DM组,PINP、BALP、OPG和OPG/RANKL水平高于T2DM组;LR-L组、LR-H组骨小梁面积分数(％Tb.Ar)、骨小梁厚度(Tb.Th)和骨小梁数目(Tb.N)高于T2DM组,骨小梁分离度(TB.Sb)低于T2DM组(P＜0.05). 结论 利拉鲁肽可调节骨代谢指标,增加OPG/RANKL的比例,促进骨形成,抑制骨吸收,改善T2DM大鼠的骨质量.

高泌乳素血症(hyperprolaceinemia)为内分科、妇科常见的内分泌紊乱性疾病,该病影响了人们的健康及生活质量。现就近年来国内外高泌乳素血症与代谢综合征的相关性研究进展予以综述。