目的 观察益气化气养血法联合头颈部推拿治疗慢性失眠的临床疗效,分析比较其对主客观睡眠的影响.方法 共纳入符合标准的病例67例,随机分为2组,对照组33例,头颈部推拿手法2次;实验组34例,在对照组基础上服用益气化气养血加减汤,治疗周期均为2周,观察患者治疗前后睡眠改善情况.结果 2组治疗后睡眠客观各项数据指标比较,睡眠主观指标比较(P<0.05),差异具有统计学意义,主观指标与客观数据具有一定一致性;治疗后2组中医症状积分较治疗前均显著降低,且实验组显著低于对照组(P<0.01).结论 益气化气养血法结合头颈部推拿疗效显著,临床上可用于治疗慢性失眠.

Background The principal objective of this study was to gain a better understanding of the mechanisms of type 2 diabetes mellitus (T2DM) patients with fatigue (D-T2DM) through exome and transcriptome sequencing. Methods After whole-exome sequencing on peripheral blood of 6 D-T2DM patients, the consensus mutations were screen out and analyzed by a series of bioinformatics analyses. Then, we combined whole-exome sequencing and transcriptome sequencing results to find the important genes that changed at both the DNA and RNA levels. Results The results showed that a total of 265,393 mutation sites were found in D-T2DM patients compared with normal individuals, 235 of which were consensus mutations shared with D-T2DM patients. These genes significantly enriched in HIF-1 signaling pathway and sphingolipid signaling pathway. At the RNA level, a total of 375 genes were identified to be differentially expressed. After the DNA-RNA joint analysis, eight genes were screened that changed at both DNA and RNA levels. Among these genes, FUS and LMNA were related to carbohydrate metabolism, energy metabolism, and mitochondrial function. Subsequently, we predicted the herbs, including Qin Pi and Hei Zhi Ma, that might play a therapeutic role in D-T2DM through the SymMap database. Conclusion These findings have significant implications for understanding the mechanisms of D-T2DM and provide potential targets for D-T2DM diagnosis and treatment.

目的 观察腹部八法治疗餐后不适综合征(postprandial distress syndrome,PDS)伴焦虑状态的临床疗效.方法 将88例PDS伴焦虑状态的患者随机分为对照组和治疗组,各44例.治疗组采用腹部八法治疗,对照组采用口服枸橼酸莫沙比利治疗,共治疗4周.治疗前后以及4周、8周随访时分别对2组进行餐后不适综合征症状积分、HAMA焦虑量表评分,记录2组治疗过程中的不良反应.结果 治疗后,治疗组总有效率97.7％,高于对照组的86.4％,差异有统计学意义(P＜0.05).与治疗前比较,治疗4周后及4、8周随访时,2组餐后腹胀不适、早饱、胃纳减少、嗳气、上腹灼热症状积分及总分均降低(P＜0.05);2组8周随访时上腹灼热评分比较,差异无统计学意义(P＞0.05),其他各项评分治疗组均低于对照组(P＜0.05).治疗4周及4、8周随访,2组HAMA评分均较治疗前降低(P＜0.05),且治疗组HAMA评分均低于对照组(P＜0.05).治疗过程中及8周随访时,2组均未出现不良反应.治疗组无明显复发,对照组有4例患者在治疗结束后4～8周出现复发.结论 腹部八法能够明显缓解PDS患者的临床症状和焦虑状态,安全且无复发.

目的 观察孙氏降糖饮治疗气阴两虚型2型糖尿病的临床疗效.方法 将入选的90例气阴两虚型2型糖尿病患者随机分为2组,各45例,均给予基础治疗,对照组予二甲双胍治疗,治疗组加用孙氏降糖饮中药治疗.比较治疗12周后患者空腹(FPG)及餐后2h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、体质指数(BMI)、中医证候积分及血常规、肝肾功的变化情况.结果 治疗12周后,治疗组与对照组FPG、2hPG、HbA1c、FINS均有明显下降,治疗组较对照组下降显著,差异有统计学意义(均P＜0.05);ISI均较治疗前明显升高,治疗组较对照组升高显著,差异有统计学意义(P＜0.05);BMI均较治疗前降低,但2组差异无统计学意义(P＞0.05).治疗组中医证候疗效显著优于对照组,差异有统计学意义(P＜0.05);2组血常规、肝肾功均无明显变化.结论 孙氏降糖饮配合二甲双胍治疗2型糖尿病,能够显著降低患者的血糖指标,减轻胰岛素抵抗,缓解临床不适症状,安全有效.

Objective To evaluate the clinical effect of Xueluokang decoction lavipeditum on diabetic peripheral neuropathy(DPN) of cold-stagnation and blood-stasis type.Methods From January 2017 to January 2018,70 DPN patients in Beijing Hepingli Hospital were randomly divided into observation group and control group,with 35 cases in each group.Both groups were treated by rational diet,exercise guidance,hypoglycemic drugs and mecobalamin tablets.The control group was given lavipeditum with warm water and the observation group had lavipeditum with Xueluokang decoction once daily for 4 weeks.Total curative effect,score of Toronto Clinical Scoring System(TCSS),vibration perception threshold(VPT) were assessed and adverse reactions were observed.Results Total effective rate in observation group was significantly higher than that in control group[85.7％ (30/35) vs 60.0％ (21/35)] (P ＜ 0.05).After treatment,TCSS score and VPT of bilateral lower limbs were lower than those before treatment and they were lower in observation group than those in control group [(3.2 ± 0.8) vs (6.2 ± 0.6),left VPT:(14.1 ±1.9)V vs (18.2±2.1)V,right VPT:(13.5 ±1.5)V vs (18.0 ± 1.6)V] (all P＜ 0.05).There was no significant difference of the incidence of adverse reactions between groups (P ＞ 0.05).Conclusion Xueluokang decoction lavipeditum can alleviate clinical symptoms,improve TCSS score and VPT in DPN oatients.

目的 探讨2型糖尿病患者尿白蛋白肌酐比与腹围和血尿酸的关系.方法 对110例2型糖尿病患者根据尿白蛋白肌酐比,分为3组,分别是正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组,比较各组腹围与尿酸水平.结果 ①正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组血尿酸及腹围水平组间比较差异均有统计学意义(P<0.05).②以尿微量白蛋白/肌酐分级为因变量进行二元Logistic 回归,结果显示血尿酸的相对危险度为1.158,P=0.008.结论 血尿酸与肾脏白蛋白排泄率独立相关,可反映肾脏的早期病变.

现代医学中的“血糖”,在中医学中应当属于“水谷精微”的范畴.贺仲晨主任认为初发糖尿病血糖异常及胰岛素抵抗与“脾主运化”、“脾藏精”、“脾主内”等功能失调有关,并提出脾主糖的理论.在调理脾胃的治疗方法上,可从养脾阴、益脾气、化脾湿等方面入手.根据辨证,或与清胃同施,或与益肾相兼,终这脾运得健,水谷精微的转输与利用恢复正常,血糖降低、糖尿病并发症等得以好转为目的.

Objective:To compare the onset of type 2 diabetes mel itus (T2DM) different glycosylated hemoglobin (HbA1c) levels and blood glucose, C-peptide and insulin secretion function relationships. Methods:Selected the 110 patients with newly diagnosed T2DM from endocrine clinic in Our hospital from September 2012 to September 2013, 67 males, 43 females;aged 38~76 years, mean (53.2±3.4) years of age. Divided into three groups according to the level of HbA1c,Meanwhile selected 30 cases(17 males, 13 females;aged 36~73 years, mean (46.2±3.4) years old) of healthy people as controls. Al group objects into line oral glucose tolerance test (OGTT) test and insulin release test,took blood Fasting and afterload 120min, Determined HbA1c,FPG,2hPG,FCP,2hCP,Fins,2hIns, Calculated HOMA-IR and HOMA-β. Results:(1) FPG, 2hPG increases with the rise of HbA1c. (2) T2DM patients compared with healthy people, 2hCP, 2hIns showed ifrst increased and then decreased, the speciifc performance of HbA1c≤10%when, 2hCP, 2hIns elevated, HbA1c>when 10%, 2hCP, 2hIns reduced. (3) Compared with healthy people, T2DM patients were signiifcantly higher HOMA-IR, different levels of HbA1c, HOMA-IR was no signiifcant difference. (4) T2DM patients with HbA1c and FPG, 2hPG was signiifcantly positively correlated with CP, 2hCP, FIns, 2hIns, HOMA-βwas signiifcantly negatively correlated. Conclusion:The onset T2DM patients OGTT test and insulin release test can relfect the level of correlation between HbA1c and insulin secretion, can provide a reference for clinical use.