2型糖尿病是常见的内分泌代谢性疾病,许多患者伴有血尿酸(UA)代谢异常,其多能量摄入过足,多表现为超重与肥胖,其嘌呤合成加速,可致UA水平升高.由此可见,糖尿病与高尿酸有着密切相关性.愈来愈多的临床和基础研究显示,高尿酸血症与心血管疾病密切相关.Alderman等对8 000例2型糖尿病患者进行研究,发现UA水平＞6.5 mg/dl者发生心血管事件的危险比UA水平＜5.5 mg/dl者高30％;急性心肌梗死患者高尿酸血症发生率为25.2％,是非冠心病患者的2倍.美国国家健康与营养调查(NHANES)研究结果显示,UA水平＞7 mg/dl是脑卒中的独立危险因素,脑卒中患者伴高尿酸血症预示着预后差[1].因此,高尿酸血症不仅是糖尿病代谢异常的产物,更是代谢性疾病(糖尿病、代谢综合征、高脂血症等)、心脑血管疾病的独立危险因素[2].

桥本甲状腺炎即慢性淋巴细胞性甲状腺炎,是一种病因未明,与患者自身遗传与免疫因素相关的疾病.根据其临床表现归属中医“瘿病”范畴.文章介绍了健脾化痰、理气化瘀法治疗桥本甲状腺炎病案1例.

目的 观察甲状腺乳头状癌(PTC)组织富含亮氨酸重复序列的G蛋白偶联受体5(LGR5)、组织蛋白酶D(Cath-D)表达变化,并探讨其与患者临床病理特征的关系.方法 选择PTC患者79例,取手术切除的甲状腺癌组织及其配对的癌旁正常组织,采用免疫组化法检测LGR5、Cath-D阳性表达.比较甲状腺癌组织与癌旁正常组织LGR5、Cath-D阳性表达率,并分析甲状腺癌组织LGR5阳性表达与Cath-D阳性表达的关系以及二者阳性表达与患者临床病理特征的关系.结果 甲状腺癌组织与癌旁正常组织LGR5阳性表达率分别为63.29％(50/79)、5.06％(4/79),Cath-D阳性表达率分别为72.15％(57/79)、6.33％(5/79),甲状腺癌组织LGR5、Cath-D阳性表达率均明显高于癌旁正常组织(χ2分别为59.531、71.779,P均<0.05).Spearman相关分析显示,甲状腺癌组织LGR5阳性表达与Cath-D阳性表达呈正相关关系(r=0.625,P<0.01).甲状腺癌组织LGR5阳性表达与肿瘤直径、TNM分期、淋巴结转移及局部浸润有关(P均<0.05),与患者性别、年龄、组织分化程度无关(P均>0.05);甲状腺癌组织Cath-D阳性表达与肿瘤直径、组织分化程度、TNM分期、淋巴结转移及局部浸润有关(P均<0.05),而与患者性别、年龄无关(P均>0.05).结论 PTC组织LGR5、Cath-D表达上调,二者表达上调能协同促进PTC形成和恶性进展.

目的:总结中医体质有关2型糖尿病近几年的研究成果,找寻体质与2型糖尿病之间的联系,开拓一条防治2型糖尿病的新思路.方法:通过检索近几年关于2型糖尿病与中医体质、治未病的文献,总结出更好的防治2型糖尿病的方法.结果:中医体质与“治未病”思想和2型糖尿病之间的关系密切,对2型糖尿病患者开展体质辨识,进行体质干预,对提高临床疗效大有益处.结论:因此,在中医体质与“治未病”的思想上,从近几年中医体质与2型糖尿病的研究获得巨大的进展中,为防治2型糖尿病中的临床医生提供了依据和方法,亦为2型糖尿病患者提供了良好的生活干预措施.

AIM:To observed the protective effect of diminazene aceturate(DIZE),an angiotensin-converting enzyme 2(ACE2)activator,on rats with diabetic cardiomyopathy(DCM).METHODS:Male Wistar rats(n=30)were randomly divided into normal control group ,DCM group and DIZE treatment group(DIZE group).The rats in DCM group and DIZE group were intraperitoneally injected with streptozotocin(65 mg/kg )to establish diabetic model.After 12 weeks,the diabetic rats were infused with DIZE at 15 mg· kg-1 · d-1 or the same volume of saline for 4 weeks using os-motic minipump.The cardiac function was measured at the end of the 16th week.The methods of Mason staining and HE staining were used to observe the morphological changes of the myocardial tissue.Western blot ,ELISA and immunohisto-chemistry were used to observe the changes of ACE2,angiotensin(Ang)Ⅱ,Ang-(1-7),interleukin(IL)-1,IL-6 and connective tissue growth factor(CTGF).RESULTS:DIZE significantly improved the expression of ACE 2 in diabetic rats(P<0.05).Compared with DCM group,the levels of IL-1 and IL-6 in DIZE group were significantly decreased ,and the cardiac function in DIZE group was significantly improved(P<0.05).CONCLUSION:ACE2 endogenous agonist DIZE significantly increases the ACE 2 level and reduces the level of inflammation ,thus protecting the heart function of DCM rats.

目的:观察运用中医清热利湿法,中药内服加外洗治疗糖尿病足湿性溃疡的临床效果.方法:选取60例糖尿病足湿性溃疡患者,随机分为观察组和对照组,每组30例.两组均给予糖尿病基础治疗和外科清创换药,观察组予内服清热利湿合剂(院内制剂)和外用自拟三黄洗液浸泡外洗,对照组仅外用贝复济喷剂,观察时间30d.对比两组治疗前后湿性坏疽创面愈合情况、糖化血红蛋白、空腹血糖、餐后2h血糖、胆固醇、甘油三酯、踝肱比、中医证候疗效等指标.结果:两组创面疗效评价结果显示,总有效率观察组为96.67％,对照组为73.33％,差异有统计学意义(P<0.05).两组中医证候疗效评价结果显示,总有效率观察组为100％,对照组为76.67％,差异有统计学意义(P<0.05).结论:运用清热利湿法,中药内服联合外洗治疗糖尿病足湿性溃疡,临床效果显著.

目的:探讨化浊解毒汤联合中医外治法治疗糖尿病足的临床疗效.方法:纳入30例糖尿病足患者,采用糖尿病基础治疗联合中医综合外治法加用化浊解毒汤口服,疗程30 d,观察治疗前后空腹血糖、糖化血红蛋白、糖尿病足溃疡创面等指标的变化,并进行统计学处理.结果:治疗30 d后,30例患者空腹血糖、糖化血红蛋白控制明显改善(P<0.05),创面情况明显改善,创面愈合率82.55%,总有效率93.33%.结论:化浊解毒汤联合中医综合外治方案治疗糖尿病足溃疡,效果较为明显.

慢性肾上腺皮质功能减退症是一种相对少见的内分泌疾病,吴深涛教授认为本病起病隐匿,病程较长,辨证时不能单责于肾阳虚损,当属阴阳两虚之证.肾中元阴元阳亏损,日久势必会导致五脏六腑之功能减退,故临证多以阴阳双补为主,补中寓通,以调节、激发五脏功能,促进人体自身功能的恢复,收效较好.

肠易激综合征 (irritable bowel syndrome,IBS)是一种以腹痛或排便习惯和便质性状改变为特征的常见消化道功能性疾病,多为"便秘""腹泻""腹泻便秘交替发作"3 种类型. 而糖尿病自主神经病变所导致的IBS 现已成为IBS 最常见的发病原因之一. IBS 并没有直接与之相对应的中医病名,多归属于中医学"泄泻""便秘""泄泻便秘交作"等范畴,而其中以"泄泻便秘交作"的治疗尤为棘手. 本文报道从脏腑辨证论治糖尿病合并IBS验案4则(高靖教授主治) ,整理分析如下.

Objective:To explore the relationship between cervical intraepthelial neoplasm(CIN) and tradition-al Chinese medicine(TCM) syndromes,and the importance of DNA ploidy analysis system for the diagnosis of this disease. Method:There were 389 people given cervical liquid-based cytology examination,and diag-nosed to determine the clinical TCM syndrome type ,while the remaining specimens were used for DNA ploidy analysis. Results of pathological examination were taken as gold standard. The importance of DNA ploidy for CIN and the TCM syndromes distribution in the disease were analyzed. Results:①In the 247 pa-tients with CIN,spleen deficiency and dampness accounted for 66 cases,yin deficiency and dampness 29 cases,damp heat 67 cases,kidney yang insufficien-cy 29 cases,damp stagnation 56 cases. The distri-bution of CIN in different TCM syndromes had statistical significance(P<0.05). ②In 389 people, atypical squamous cells of undetermined signifi-cance accounted for 169 cases ,atypical squamous&nbsp;cells without HSIL 10 cases,low-grade squamous intraepithelial lesions 132 cases,high-grade squamous in-traepithelial lesions 61 cases,squamous cell carcinoma 17 cases. There were 287 people determined as poly-ploid cervical epthlial cells through DNA ploidy analysis. According to pathological examination ,156 patients were of CIN Ⅰ,54 patients CIN Ⅱ,37 patients CIN Ⅲ,27 patients SCC. CIN Ⅰ and the above were pos-itive,LSIL and the above level were used as standard to assess CIN Ⅰ and the above pathologic changes, with the sensitivity being 66.24%,the specificity 66.96%,the positive predictive value 82.73%,and the nega-tive predictive value 45.56%. DNA ploidy analysis system and DNA polyploid cells were used as the stan-dard to assess CINⅠ and the above pathologic changes,with the sensitivity being 90.15%,the specificity 65.22%,the positive predictive value 86.06%,and the negative predictive value 73.53%. Conclusion:The dis-tribution of cervical intraepithelial lesions in different TCM syndromes was statistically significant ,and DNA ploidy analysis can effectively improve the positive detection rate for screening cervical cancer.

目的 探讨神经纤维瘤病Ⅰ型(NF1)的临床特点、病理特征、诊断、治疗与预后.方法 分析1例眼眶NF1患者的临床资料,并结合文献进行讨论.结果 NF1一般在儿童期发病,以皮肤色素沉着(牛奶咖啡斑)、多发性神经纤维瘤为特征,眼部损害常见.组织学表现为神经纤维瘤病,属常染色体遗传病,5％～10％有发展为恶性神经鞘瘤的可能.免疫组化标记显示:S100、NSE等阳性.结论 神经纤维瘤病是常染色体显性遗传病,可分为NF1和NF2两种亚型,NF1多见.此病临床表现多样,呈渐进性,病灶分布广泛,小儿眼眶为常发部位,以对症治疗为主,预防与新的治疗方法有待于进一步研究.

目的:探讨急性脑梗死患者养血清脑颗粒疗效和治疗前后血液流变学指标的变化.方法:选取我院2012年12月-2015年12月收治的141例急性脑梗死患者,随机分为观察组(n=71)和对照组(n=70),其中对照组实行常规治疗,观察组在对照组的基础上行养血清脑颗粒治疗.治疗30 d后,评价治疗效果,对比治疗前、后的血液流变学指标,并统计不良反应发生情况.结果:观察组基本痊愈、显著进步患者数量均明显多于对照组,差异均具有统计学意义(x 2＞7.05,P＜0.05).观察组总显效率为85.92％(61例)和总有效率95.77％(68例)也均明显高于对照组(33.80％,24例;73.24％,52例),差异均具有统计学意义(x 2＞12.84,P＜0.05).观察组治疗后全血高切(5.65±0.89) mPa/s、全血低切(9.92±1.64) mPa/s、血浆黏度(1.54±0.39) mPa/s、红细胞压积38.75％±4.67％、红细胞聚集指数(7.42±0.65)、纤维蛋白原(3.42±0.79) g/L均明显低于治疗前,差异均具有统计学意义(t≥3.225,P＜0.05).对照组治疗后血液流变学各项指标与治疗前相比均略有下降,但差异均无统计学意义(P＞0.05).观察组治疗后与对照组相比,差异均具有统计学意义(t≥2.117,P＜0.05).两组患者治疗前后血、尿常规均无显著性变化(P＞0.05),心、肝、肾功能均无显著性变化(P＞0.05),且均无严重不良反应发生.结论:养血清脑颗粒对于急性脑梗死具有极好的临床疗效,其能有效改善急性脑梗死患者的血液流变学指标,且安全性高,血液流变学指标的改善可能是养血清脑颗粒治疗急性脑梗死疗效的主要作用机制.养血清脑颗粒治疗急性脑梗死具有重要的临床推广意义.

喘证，为临床常见难治病症。《素问·咳论》云：“五脏六腑皆令人咳，非独肺也……此皆聚于胃关于肺。”张锡纯指出：“肾虚气化不摄，则上注其气于冲，则冲气又必上逆于胃，以冲上连胃也。由是，冲气兼挟胃气上逆，并迫肺气亦上逆矣，此喘之所由来也。”张锡纯《医学衷中参西录》治喘息方“参赭镇气汤”，由野台参、生赭石、生芡实、生山药、山萸肉、生龙骨、生牡蛎、生杭芍、紫苏子组成，“治阴阳两虚，喘逆迫促，有将脱之势，亦治肾虚不摄，冲气上干，致胃气不降作满闷”，此方无明显寒热偏性，降气而无泄下之弊，补气而无壅滞之患，药味不多，却配伍严谨，用之得当，收效甚速，诚为喘证治疗之良方也。笔者临床对于喘证之非肺因者投以此方亦常获奇效，特录验案2则如下。

总结吴深涛教授辨治2型糖尿病不寐的经验.吴深涛教授认为2型糖尿病不寐的主要病机为阴阳失交,分6型论治.(1)阴虚火旺、心肾不交证,治以黄连阿胶汤合酸枣仁汤、交泰丸化裁;(2)阴虚血少、心火上炎症,治以天王补心丹化裁;(3)胃失和降证,治以半夏泻心汤加减;(4)胆郁痰扰证,治以黄连温胆汤加减;(5)肝郁气结、心胆不宁证,治以柴胡加龙骨牡蛎汤化裁;(6)血虚寒凝证,治以当归四逆汤化裁.临床多以经方化裁辨证论治,每获良效.

目的 探讨脂肪瘤性血管外周细胞瘤(lipomatous haemangiopericytoma,LHPC)的病理形态学特征、免疫表型及鉴别诊断.方法　对3例LHPC进行免疫组化检测并文献复习.结果肿瘤由成熟的脂肪细胞、血管、良性的梭形细胞及不同程度胶原化的细胞外间质组成.免疫表型:肿瘤细胞CD34、CD99和BCL-2均().结论 LHPC是一种少见的血管外周细胞瘤,由成熟脂肪细胞和血管外周细胞瘤样结构构成,与胸膜外孤立性纤维性肿瘤(solitary fibrous tumor,SFT)有多种共同特征,二者在临床特点、病理形态、免疫表型及超微结构方面都有共同特点,需注意二者的鉴别诊断.

Decoction of Lianzi for Clearing Away Heart Fire from Prescriptions of the Bureau of Taiping People is composed of Scutellaria root,Ophiopogon,licorice,Cortex Lycii,lotus seed,Poria,Radix Astragali,radix ginseng and Cha Maeko with the function of clearing away heart fire,regulating the heart and the kidney,invigorating qi and yin and curing turbid strangury.According the principle of syndrome differentiation and treatment,Decoction of Lianzi for Clearing Away Heart Fire was used to treat Edema in Diabetic Nephropathy due to Spleen and Kidney Deficiency and the effect was satisfied.

Objective: To observe the efficacy and safety of Xiaoke Tongluo pills in the treatment of diabetic peripheral neuropathy(DPN) and to discuss its clinical value.Methods: 66 diabetic peripheral neuropathy patients that met the diagnosis criteria and selection criteria were randomly divided into treatment group(33 cases) and control group(33 cases).Besides the basic treatment for diabetes,the treatment group was given Xiaoke Tongluo Capsule;while the control group was given Mecobalamin Tablets.Results: The overall effective rate,the clinical symptoms and sensory nerves conduction velocity was significantly improved in treatment group.The difference between the two groups was statistically significant(P<0.05).Conclusion:Xiaoke Tongluo pills can improve significantly clinical symptoms and increase nerve conduction velocity(NCV) in patients with diabetic peripheral neuropathy.Xiaoke Tongluo pills is an effective therapy in the treatment of diabetic peripheral neuropathy.

The diabetes nephrosis pathological changes in the spleen and kidney,pathogenesis for this empty mark true,the virtual to kidney Yin deficiency,spleen qi deficiency is given priority to,standard with real blood stasis primarily,kidney empty for basic pathogenesis,and blood stasis are pathogenesis characteristics,throughout.Are virtual poisonous damaged kidney disease for winding core,benefiting kidney detoxification treatment method for dredging.Staging points with the disease differentiation type is the development of the scheme,traditional Chinese medicine and traditional Chinese medicine injection and each has its own characteristics.At present although already make dialectical classification and curative effect decision criteria,the card still is varied,les formulas among the different,clinical report comparable poor,difficult to developing the evidence-based medicine many centers cooperation.Reports of adverse drug reactions involving little,lack of its mechanism.Early treatment can reverse.Should be strict scientific research and design,to strengthen early DN.

This paper discusses Professor Wu Shentao's experience with vertigo in diabetic patients from the following aspects: syndrome differentiation,prescription and medication.

[Objective] To observe the efficacy of the treatment of diabetic nephropathy renal failure Jiedu Huoxue decoction.[Methods]66 cases of diabetic nephropathy in patients with renal failure.The control group were given high-quality low-protein diet to control blood sugar,control blood pressure and other basic treatment;treatment group I treatment of Jiedu Huoxue decoction.Both groups 10 days for a course of treatment,to determine the efficacy observed 6 courses.[Results] Treatment group,10 cases markedly effective in 15 cases,5 cases ineffective,the total effective rate was 83.30%;control group seven cases markedly effective in 13 cases,10 cases were ineffective,the total effective rate of 66.70%.[Conclusion] Jiedu Huoxue decoction treatment of diabetic nephropathy in renal failure results were satisfactory.