鹦鹉热衣原体可引起人类及多种动物呼吸道感染,属人畜共患病,临床以流行性感冒症状为主,可发展至重症肺炎.重型鹦鹉热属于中医学"风温肺热病"范畴,多因外感邪气侵袭肺脏而肺气不宣,化生痰瘀而致.本案中老年重型鹦鹉热衣原体感染后高热持续不退,呼吸急促,氧合指数进行性下降,转入ICU予以辅助通气同时结合中医辨证,考虑病机为阳虚受寒,中医辨证为外感风寒证,选麻黄附子细辛汤以温少阴之阳,祛太阳之寒,有效控制体温逐渐下降至正常,临床疗效确切,有效缩短病程.

OBJECTIVE: To investigate the effects of glimepiride combined with metformin on glucose and lipid metabolism, islet function and serum miR-126 expression of newly diagnosed type 2 diabetes patients. METHODS: A total of 100 patients with newly diagnosed type 2 diabetes in Nanchuan Hongren Hospital of Chongqing during Jan. 2014-Jan. 2017 were divided into observation group and control group according to random numble table, with 50 cases in each group. Control group was given Metformin hydrochloride sustained-release tablets (Ⅱ) with initial dose of 0. 5 g, once a day, adjusted to 0. 5 g 12 weeks later, twice a day, maximal dose of 1 g at meal or after meal. Observation group was additionally given Glimepiride tablets 2 mg, once a day, at breakfast, on the basis of control group. Both group were treated at lasted for 24 weeks. The levels of blood glucose (FPG, 2 hPG, HbA1c), blood lipid (TC, TG), islet function (FINS, 2 hINS, FCP, 2 hCP, HOMA-IR), serum miR-126 before and after treatment and the occurrence of ADR were observed in 2 groups. RESULTS: Before treatment, there was no statistical significance in the levels of blood glucose, blood lipid, islet function or serum miR-126 expression between 2 groups (P＞0. 05). After treatment, the levels of blood glucose, blood lipid and HOMA-IR in 2 groups were significantly lower than before treatment, and the levels of blood glucose and HOMA-IR in observation group were significantly lower than control group. The levels of FINS, 2 hINS, FCP and 2 hCP, serum miR-126 expression in 2 groups were significantly higher than before treatment, and the observation group was significantly higher than control group, with statistical significance(P＜0. 05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS: Glimepiride combined with metformin can significantly improve glucose and lipid metabolism, islet function, and regulate serum miR-126 expression without increasing the occurrence of ADR.

亚急性甲状腺炎(以下简称亚甲炎)是甲状腺炎中比较常见的一种,亦称肉芽肿性甲状腺炎或巨细胞性甲状腺炎,是一种具有自限性的甲状腺疾病,可在数周或数月内自然消退[1].其发病原因尚不十分清楚,目前多认为与病毒感染有关,是否有自身免疫异常尚无定论,因对其临床表现的多样性,常易误、漏诊[2].有学者报道由于亚急性甲状腺炎发病率低,临床医师认识不够充分,导致初诊误诊率超过50%[3].现将2008年1月-2011年1月我院初诊时误诊为急性咽喉炎、上呼吸道感染、甲亢、桥本甲状腺炎、心肌炎、甲状腺癌等疾病的25例亚甲炎患者报告如下,总结其发病特点,以期提高对该病的诊治准确性.