To analyze the characteristics of pulmonary nodules (PNs) and related influencing factors in patients with type 2 diabetes mellitus (T2DM). Retrospectively analyzed the clinical and biochemical characteristics of 224 patients with PNs and 488 patients with non-PNs in patients with T2DM, and compared the clinical data of 72 patients with large nodules (≥ 5 mm) and 152 patients with small nodules (< 5 mm) in the pulmonary nodules (PNs) group. Compared to the non-PNs group, the PNs Patients in the group had a longer duration of diabetes, higher age, serum creatinine (SCR), blood urea nitrogen (BUN) and the lower albumin (ALB) and body mass index (BMI); women, diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), and estimated glomerular filtration rate (eGFR) < 60 ml/min1.73m2 were more represented in the PNs group; there were fewer patients with overweight in the PNs group. Age and eGFR < 60 ml/min/1.73m2 were independent risk factors for PNs in patients with T2DM, and overweight was associated with a reduced risk of PNs. Compared with the small nodule group, patients in the large nodule group had higher fasting blood glucose (FBG) and lower fasting insulin (FINS); meanwhile, patients with decreased homeostasis model assessment-β (HOMA-β) and high smoking index (SI) were higher in the large nodule group; decreased HOMA-β and high SI were independent risk factors for large nodules. Age and eGFR < 60 ml/min/1.73m2 were independent risk factors for pulmonary nodules in patients with T2DM, and overweight may be a protective factor. Moreover, decreased islet B-cell function and smoking may contribute to the presence of PNs with a diameter of over 5 mm.

Visceral adiposity index (VAI) is a reliable indicator of visceral adiposity. However, no stu-dies have evaluated the association between VAI and DKD in US adults with diabetes. Theref-ore, this study aimed to explore the relationship between them and whether VAI is a good pr-edictor of DKD in US adults with diabetes. Our cross-sectional study included 2508 participan-ts with diabetes who were eligible for the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Univariate and multivariate logistic regression were used to an-alyze the association between VAI level and DKD. Three models were used to control for pot-ential confounding factors, and subgroup analysis was performed for further verification. A tot-al of 2508 diabetic patients were enrolled, of whom 945 (37.68%) were diagnosed with DKD. Overall, the VAI was 3.36 +/- 0.18 in the DKD group and 2.76 +/- 0.11 in the control group. VAI was positively correlated with DKD (OR = 1.050, 95% CI 1.049, 1.050) after fully adjusting for co-nfounding factors. Compared with participants in the lowest tertile of VAI, participants in the highest tertile of VAI had a significantly increased risk of DKD by 35.9% (OR = 1.359, 95% CI 1.355, 1.362). Through subgroup analysis, we found that VAI was positively correlated with the occurrence of DKD in all age subgroups, male(OR = 1.043, 95% CI 1.010, 1.080), participants wit-hout cardiovascular disease(OR = 1.038, 95% CI 1.011, 1.069), hypertension (OR = 1.054, 95% CI 1.021, 1.090), unmarried participants (OR = 1.153, 95% CI 1.036, 1.294), PIR < 1.30(OR = 1.049, 95% CI 1.010, 1.094), PIR >= 3 (OR = 1.085, 95% CI 1.021, 1.160), BMI >= 30 kg/m(2) (OR = 1.050, 95% CI 1.016, 1.091), former smokers (OR = 1.060, 95% CI 1.011, 1.117), never exercised (OR = 1.033, 95% CI 1.004, 1.067), non-Hispanic white population (OR = 1.055, 95% CI 1.010, 1.106) and non-Hipanic black population (OR = 1.129, 95% CI 1.033, 1.258). Our results suggest that elevated VAI levels are closely associated with the development of DKD in diabetic patients. VAI may be a simpl-e and cost-effective index to predict the occurrence of DKD. This needs to be verified in furt-her prospective investigations.

Abstract Objective:The gut microbiota was considered to be an important hidden "organ" of the human body, which was of great significance in maintaining the body's physiology and pathological regulation. Previous studies had found that the gut microbiota was closely related to various diseases, but there was no unified conclusion on the distribution characteristics of the gut microbiota in chronic kidney disease (CKD) and its relationship with the progression of CKD. In this study, we tried to investigate the profile and function of gut microbiota in CKD and its relationship with the progression of CKD. Methods: A total of 80 people were enrolled in this study. Twenty were healthy people, and 60 were CKD patients. The CKD patients were divided into three stages including stage 3, 4, and 5. We conducted taxonomic analyses in different groups. The distributions of phyla, classes, orders, families and genera in different groups and samples were investigated. We also evaluated the correlations between clinical parameters and gut microbiota in 60 CKD patients. Results:The gut microbiota in the healthy group and CKD group had 2351 operational taxonomic units (OTUs) in total. The healthy group had 1076 OTUs, and the CKD group had 2259 OTUs. The diversity of gut microbiota in the stage 3 CKD group was smaller than that in the other groups. Bacteroides was positively correlated with serum creatinine (Scr) and serum cholesterol, while was negatively correlated with albumin (ALB), haemoglobin, and estimated glomerular filtration rate (eGFR). Blautia was positively correlated with Scr, blood urea nitrogen (BUN), 24-hour urine protein (24-h UTP), and serum cholesterol, while was negatively correlated with haemoglobin and eGFR。Bifidobacterium was positively correlated with eGFR, while was negatively correlated with Scr and BUN. Prevotella was negatively correlated with BUN, while was positively correlated with haemoglobin. Megamonas was negatively correlated with BUN, while was positively correlated with haemoglobin and eGFR. Subdoligranulum was negatively correlated with UA. Parabacteroides and megasphaera were positively correlated with serum cholesterol. Klebsiella was negatively correlated with haemoglobin. Conclusions:The gut microbiota might be one of the important pathological mechanisms underlying the development and progression of CKD. The changes of diversity in gut microbiota were associated with disease progression. Some kinds of gut microbiota including bacteroides, blautia, parabacteroides, megasphaera and klebsiella might be detrimental factors in CKD, while other kinds of gut microbiota including bifidobacterium, prevotella, megamonas and subdoligranulum might be beneficial factors in CKD.

王耀献提出辨机论治的中医诊疗模式,强调在治疗疾病时要从病机入手,并认为与慢性泌尿系统感染性疾病相关的病机主要有8种,包括初始病机、体质病机、衍生病机、对证病机、时空病机、对症病机、兼夹病机、局部病机.在治疗方面,王耀献主要针对初始病机和衍生病机以清热利湿、益气养阴、补肾疏肝为主要治法,并兼顾其他病机以行气化湿、活血利水、通淋止痛.若本病由量变发生质变进入湿、热、瘀、虚胶结不解的"微型癥瘕"阶段,则以消癥散结为主线,同时扶助正气.

辨机论治是王耀献教授为补充辨证论治之不足、更好地揭示疾病之本质而提出的临床诊疗模式.王教授认为,与高血压肾病密切相关的病机类型主要有初始病机、体质病机、对证病机、对症病机、衍生病机、共通病机、兼夹病机.临证通过辨别上述七种病机,可厘清高血压肾病的本质,从而提出针对性治疗措施.附验案两则,具体展示辨机论治在高血压肾病中的应用.

目的:探讨平均血小板体积(mean platelet volume,MPV)、血小板分布宽度(platelet distribution width,PDW)与2型糖尿病血瘀证的相关性.方法:收集553例2型糖尿病患者的临床资料,分析比较血瘀证与非血瘀证患者的肾功能指标与MPV、PDW水平.结果:(1)血瘀证患者与非血瘀证患者相比,尿素氮、血肌酐、尿酸均升高,eGFR下降;(2)血瘀证患者与非血瘀证患者相比,MPV、PDW均升高;(3)MPV与血肌酐、尿素氮、尿酸呈正相关,与eGFR呈负相关;PDW与血肌酐、尿酸呈正相关;(4)血瘀证与MPV、PDW呈正相关,随着血瘀程度的加重,MPV、PDW水平升高的回归系数逐渐增加.结论:2型糖尿病血瘀证患者与非血瘀证患者相比,肾功能更差,MPV、PDW更高;MPV、PDW与早期肾功能损伤密切相关,提示其可能成为辅助预测2型糖尿病早期肾功能损伤的新型标志物;血瘀证是MPV、PDW水平升高的危险因素之一,为临床从瘀论治2型糖尿病提供依据.

肠道微生态失调介导肾脏炎症状态,并促进肾小球硬化、间质纤维化,是糖尿病肾脏病发生发展的重要机制之一.热邪是导致肾络失衡、癥瘕形成、肾体受损的关键因素,"内热致癥"是糖尿病肾脏病的核心病机,肠源性肾损伤与"内热致癥"病机不谋而合.清热类中药在改善肠道菌群稳态、延缓糖尿病肾脏病进展方面具有显著优势,为临床治疗糖尿病肾脏病提供新靶点.

[目的]探讨痰湿与2型糖尿病(type 2 diabetes mellitus,T2DM)脂代谢紊乱的相关性.[方法]收集833例T2DM患者的临床资料,分析比较痰湿证与非痰湿证患者的肾功能指标与总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平,并探究T2DM患者血脂水平与肾功能指标及痰湿程度的相关性.[结果]与非痰湿证患者比较,痰湿证患者尿素氮、血肌酐、尿酸水平均升高(P<0.01),估算肾小球滤过率(estimated glomerular filtration rate,eGFR)降低(P<0.01);TC、TG、LDL-C水平升高(P<0.01),HDL-C水平降低(P<0.05).TC与尿素氮呈正相关,与eGFR呈负相关;TG与血肌酐、尿酸呈正相关,与eGFR呈负相关;LDL-C与尿素氮、血肌酐呈正相关,与eGFR呈负相关;HDL-C与血肌酐、尿酸呈负相关;痰湿证与TC、LDL-C呈正相关,随痰湿程度加重,其相关系数增加,轻度痰湿证与HDL-C呈负相关.[结论]T2DM痰湿证患者脂代谢紊乱程度更严重,肾功能更差.痰湿证是血脂水平发生异常的危险因素之一,脂代谢紊乱与T2DM早期肾功能损伤密切相关.本研究为从痰湿纠正T2DM脂代谢异常、延缓肾脏损伤提供了新思路.

[目的]探讨外周血单核细胞计数与高密度脂蛋白胆固醇浓度比值(MHR)、外周血中性粒细胞计数与淋巴细胞计数比值(NLR)与2型糖尿病(T2DM)内热证的相关性.[方法]收集647例T2DM患者(包括内热证311例和非内热证336例)的临床资料,分析内热证与非内热证患者的肾功能指标与MHR、NLR水平,探讨MHR、NLR与T2DM内热证的相关性.[结果](1)与非内热证患者相比,内热证患者的尿素氮、血肌酐、尿酸升高,肾小球滤过率(eGFR)下降,差异均有统计学意义(P<0.01).(2)与非内热证患者相比,内热证患者的MHR、NLR均升高,差异均有统计学意义(P<0.01).(3)相关性分析结果显示:MHR与血肌酐、尿酸呈正相关,与eGFR呈负相关,差异均有统计学意义(P<0.05);NLR与尿素氮、血肌酐呈正相关,与eGFR呈负相关,差异均有统计学意义(P<0.05).(4)线性回归分析结果显示:内热证与MHR、NLR呈正相关,内热证是MHR、NLR水平升高的危险因素,随着内热程度的加重,其回归系数逐渐增加,差异均有统计学意义(P<0.05).[结论]T2DM内热证患者与非内热证患者相比,肾功能更差,MHR、NLR更高;MHR、NLR与早期肾功能损伤密切相关,提示其可能成为预测T2DM早期肾功能损伤的新型标志物;内热证是MHR、NLR水平升高的危险因素之一,可为临床从热论治T2DM提供依据.

目的:观察中药复方玉屏风散对变应性鼻炎(AR)小鼠脾脏调节性T细胞(Treg)的影响,探讨其对变应性鼻炎的免疫调节作用机制.方法:将小鼠随机分为4组:正常对照组、模型组、氯雷他定阳性对照组和玉屏风散组,采用卵清蛋白(OVA)经腹腔注射致敏加滴鼻激发的方法诱导变应性鼻炎小鼠模型.连续灌胃给药21 d后,观察各组小鼠鼻黏膜病理变化,酶联免疫吸附(ELISA)试剂盒检测各组小鼠血清IgE及鼻腔灌洗液(NALF)中IL?4、IL?10、TGF?β1水平;流式细胞仪检测小鼠脾脏组织中CD4+CD25+Foxp3+细胞比例.结果:AR小鼠鼻黏膜病变明显.玉屏风散可明显减轻AR小鼠的鼻部症状,显著降低AR小鼠血清IgE及NALF中IL?4水平,升高NALF中IL?10、TGF?β1等细胞因子水平;流式细胞仪检测结果显示玉屏风散能显著增加AR小鼠CD4+CD25+Foxp3+Treg细胞比例.结论:玉屏风散能改善变应性鼻炎小鼠的鼻部症状,其机制可能是通过促进CD4+CD25+Foxp3+Treg细胞分化等调节机体的免疫反应从而改善变应性鼻炎的相关症状.