目的 探究门冬胰岛素30联合二甲双胍治疗老年初诊2型糖尿病(T2DM)的疗效.方法 94例老年初诊T2DM患者,随机分为单一组及联合组,各47例.单一组采用门冬胰岛素30治疗,联合组采用二甲双胍+门冬胰岛素30治疗.比较两组患者治疗前后的空腹血糖(FBG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,血糖控制效果.结果 治疗后,联合组患者的FBG、HbA1c、2 h PG水平分别为(5.84±0.72)mmol/L、(6.23±1.04)％、(8.30±0.61)mmol/L,均低于单一组的(6.51±1.37)mmol/L、(7.92±1.05)％、(11.03±1.24)mmol/L,差异具有统计学意义(P<0.05).治疗后,联合组患者的TG、TC、LDL-C水平低于单一组,HDL-C水平高于单一组,差异具有统计学意义(P<0.05).联合组患者的血糖控制率为95.74％,高于单一组的80.85％,差异具有统计学意义(P<0.05).结论 在老年初诊T2DM治疗中,应用门冬胰岛素30联合二甲双胍,能有效控制患者血糖,值得进一步推广研究.

目的 探讨骨桥蛋白(OPN)、钙结合蛋白(S100A12)及基质金属蛋白酶-3(MMP-3)在中老年膝关节骨性关节炎患者关节液中的水平,并分析其临床意义.方法 选取2017年1月—2019年12月我院治疗的106例膝关节骨性关节炎,根据改良Mankin评分分为轻度组30例、中度组43例、重度组33例.对比3组关节液中OPN、S100A12及MMP-3水平情况,观察不同OPN、S100A12及MMP-3水平患者预后情况,分析影响患者预后不良的相关因素,并通过绘制受试者工作特征(ROC)曲线分析OPN、S100A12及MMP-3联合检测对患者预后不良的预测价值.结果 重度组关节液OPN、S100A12及MMP-3水平明显高于中度组及轻度组,中度组上述因子水平亦高于轻度组,差异有统计学意义(P<0.05).OPN、S100A12及MMP-3异常升高患者预后不良率明显高于OPN、S100A12及MMP-3正常患者(P<0.05,P<0.01).OPN异常升高、S100A12异常升高、MMP-3异常升高为中老年膝关节骨性关节炎患者预后不良的独立危险因素(P<0.01).ROC曲线下面积以OPN、S100A12及MMP-3联合检测最大.结论 OPN、S100A12、MMP-3在不同严重程度的膝关节骨性关节炎患者中的水平存在差异,三者可作为评估膝关节骨性关节炎病情进展及预后的重要指标.

目的 建立成都地区38～84岁糖代谢正常人群的糖化血清白蛋白(G A)参考值范围.方法 采用分层随机抽样的方法,对成都地区38～84岁的中老年人群进行问卷调查,并进行血压、身高、体重、腰围、臀围、糖化血清白蛋白、糖化血红蛋白、口服葡萄糖耐量试验、血脂等检测,因经费原因对全部行上述检查的641人中糖耐量正常人群的402人采用正态分布法的95％CI确定GA参考值范围.结果 402名38～84岁糖耐量正常人群的GA呈正态性分布(Z=0.038),平均值为(13.08±1.21)％,正常参考值范围是(10.71％,15.45％),其中女性组GA平均值13.13％,男性组为12.96％,两者水平没有统计学差异(t=-1.22,P=0.22≥0.05).结论 成都地区38～84岁糖代谢正常人群GA参考值范围为(10.71％,15.45％),如超过此范围,需行糖尿病诊断试验,进一步确定血糖异常的阶段.

目的 探讨对老年冠心病患者采取氯吡格雷和阿司匹林联合治疗的效果和安全性.方法 选取2019年2月～2020年2月内蒙古自治区人民医院收治的85例老年冠心病患者为本次研究对象,通过随机数表法分组,对照组40例和观察组45例.对照组采取阿司匹林用药治疗,观察组患者在对照组的治疗基础上联合氯吡格雷用药治疗,观察对比两组患者的临床疗效、用药安全性以及治疗前后生活质量.结果 在临床疗效的对比中,观察组患者的总有效率低于对照组,差异有统计学意义(P<0.05);在用药安全性对比中,两组患者不良反应发生情况均较少,总发生率比较,差异无统计学意义(P>0.05);治疗后,两组患者的生活质量评分皆较治疗前有所提高,且观察组的评分高于对照组,差异有统计学意义(P<0.05).结论 对老年冠心病患者采取氯吡格雷和阿司匹林联合治疗能够使药物发挥出协同作用,有助于提高药效,改善预后.

目的:探讨糖尿病不同诊断指标的临床意义,为选择适合的诊断指标提供参考依据.方法:于2013-10～2014-01,整群抽取成都市40～79岁的641名社区居民,测定空腹血糖(FPG)、糖化血清白蛋白(GA)和糖化血红蛋白(HbA 1 C),并进行口服糖耐量实验(OGTT).结果:调查人群糖尿病检出率为17.0％(109/641).糖尿病病人60～79岁组餐后血糖水平高于40～59岁组(P＜0.05),空腹血糖水平差异无统计学(P＞0.05).相关分析结果显示,FPG、2 hPG、GA和HbA 1 C两两相关,均有统计学意义(P＜0.05).HbA 1 c与FPG、2 hPG相关系数(r值)分别为0.857和0.666,GA与FPG、2 hPG的r值分别0.817和0.666.以OGTT为诊断标准,各指标诊断糖尿病的灵敏度:FPG为62.39％,2h PG为83.49％,HbA 1 C(6.5％)66.97％,HbA 1 C(6.3％)75.23％,GA 48.62％;特异度分别为:HbA 1 C(6.5％)94.55％,Hb 1 AC(6.3％)88.53％,GA 98.50％.结论:采用OGTT筛选糖尿病的漏诊率低于FPG,是否可以将FPG的切点值下调以降低漏诊率,适应国人筛查的需要,值得探讨.GA与HbA 1 c比较,无更多优点,但其检测费用较低,应用前景不可忽视.

Objective: To explore the relationship between hypertriglyceridemic-waist (HTWC) phenotype and clustering of cardiovascular risk factors in middle and aged population. Methods: A community-based cross-sectional survey was conducted in 5 communities of Chengdu city from 2013-10 to 2014-05 and 1004 subjects from (40-79) years of age were investigated. HTWC was defined by TG≥2.0 mmol/L and waist circumference≥90 cm in male, ≥85 cm in female. The subjects were divided into 4 groups:①Normal group, the subjects with TG<2.0 mmol/L, waist circumference<90 cm in male, <85 cm in female,n=492,②Simple abdominal obesity group, TG<2.0 mmol/L, waist circumference≥90 cm in male, ≥85 cm in female,n=301,③Simple hipertrigliceridemia group, TG≥2.0 mmol/L, waist circumference<90 cm in male, <85 cm in female,n=79 and④HTWC group,n=132. The detection rate of HTWC and its correlation with clustering of cardiovascular risk factors were analyzed. Results: The prevalence of HTWC phenotype was 13.15% (12.69% in male and 13.37% in female). In HTWC group, the detection rate of clustering of cardiovascular risk factors was 41.67% (13.21% in both Simple abdominal obesity group and Simple hipertrigliceridemia group). Multi Logistic regression analysis indicated that with adjusted age, gender, body mass index, smoking history and family history of diabetes and hypertension, the detection rate of clustering of cardiovascular risk factors in HTWC group was 4.50 folds of Simple abdominal obesity group and Simple hipertrigliceridemia group (OR=4.50, 95% CI 2.84-7.12,P<0.05). Conclusion: HTWC phenotype was closely related to clustering of cardiovascular risk factors, it could be used as an indicator for screening clustering of cardiovascular risk factors in middle and aged population.

Objective To establish a glycosylated hemoglobin reference range in normal glucose tolerance of the mid-dle-aged and old people in Chengdu area. Methods Strta randomized sampling method was used to investigate the cross-sectional study of epidemiology of the 1,025 middle-aged and old people in the comunity of Chengdu city, including the test of OGTT, HbA1c, blood plessure, blood fat, etc. and unifying the questionnaires for them. And 647 middle-aged and old people in normal glucose tolerance were tested by the 95% confidence interval of the normal distribution method to ensure the reference range of the HbA1c. Result The HbA1c of the glucose tolerance of normal crowd appeared normal distribution. The reference range was 5. 02% ~6. 28% among the 647 middle-aged and old people’s HbA1c in the glycosylated hemoglobin in normal glucose tolerance. The glycated hemoglobin of average value was 5. 67% for men and that of 5. 64% for women. There was no significant difference (F=2. 363, P=0. 095, P>0. 05). Conclusion The reference range is 5. 02% ~6. 28% in normal glucose tolerance of the middle-aged and old people’s HbA1c in Chengdu area. If their HbA1c is beyond this scope, they need to have OGTT to ensure whether there is sugar metabolic abnormalities.