关于甲状腺结节和分化型甲状腺癌的首版诊治指南发布距今已有10年之久,随着诊断技术的进步、微创外科手术的发展和精进,多学科诊治随访实践的推广应用,我国甲状腺癌患者术后生存率大幅提高,同时,也积累了丰富的循证医学证据.2023年《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》发布,及时地总结了最新的诊治理念和技术,全面指导和促进相关疾病的规范诊治.

心血管疾病是2型糖尿病的首位死因,减少心血管事件则是防治糖尿病的重要目标.降糖药物的心血管安全性问题自"罗格列酮事件"以后受到医学界的广泛关注.传统降糖药物缺乏强有力的心血管获益临床研究证据,新近上市的部分降糖药物具有明确心血管获益效应,在心血管保护作用方面具有明显优势.对于合并有心血管疾病或高危风险的糖尿病患者应当被区分出来,并选择有明确心血管获益证据的降糖药物.

目的探讨微小RNA-126-5p（miR-126-5p）通过靶向pellino E3泛素蛋白连接酶家族成员2（Peli2）影响糖尿病肾病肾小管上皮细胞上皮-间质转化（EMT）发生的分子机制。方法本研究起止时间为2018年12月至2019年12月。体外培养人肾小管上皮细胞HK-2（美国ATCC）,分别使用5 mmol/L、30 mmol/L的D-葡萄糖处理细胞48 h,分别记作对照组、模型组。采用实时荧光定量聚合酶链反应（qRT-PCR）与蛋白免疫印迹法（Western blot）分别检测miR-126-5p、Peli2的表达水平。利用脂质体转染法分别将miR-126-5p寡核苷酸模拟物（miR-126-5p mimics）及阴性对照mimic NC序列（miR-NC）、Peli2小分子干扰RNA（si-Peli2）及其阴性对照（si-NC）转染至HK-2细胞,使用30 mmol/L的D-葡萄糖处理细胞48 h。Western blot检测上皮型钙黏蛋白（E-Cadherin）、神经型钙黏蛋白（N-Cadherin）、波形蛋白（Vimentin）、锌指蛋白（Snail）表达量;双荧光素酶报告实验验证miR-126-5p与Peli2的靶向关系。结果与对照组相比,模型组miR-126-5p[（1.00±0.10）比（0.32±0.03）]、E-Cadherin[（0.86±0.09）比（0.35±0.04）]的表达水平显著降低（P＜0.05）,Peli2[（0.42±0.04）比（1.05±0.11）]、N-Cadherin[（0.45±0.05）比（0.99±0.10）]、Vimentin[（0.32±0.03）比（0.92±0.09）]、Snail[（0.22±0.02）比（0.75±0.08）]的表达水平显著升高（P＜0.05）;转染miR-126-5p mimics,与转染miR-NC相比,E-Cadherin[（0.34±0.03）比（0.75±0.08）]的表达水平显著升高（P＜0.05）,N-Cadherin[（1.02±0.11）比（0.53±0.05）]、Vimentin[（0.95±0.10）比（0.48±0.05）]、Snail[（0.72±0.07）比（0.36±0.04）]的表达水平显著降低（P＜0.05）;转染si-Peli2后,与转染si-NC相比,E-Cadherin[（0.24±0.03）比（0.70±0.07）]的表达水平显著升高（P＜0.05）,N-Cadherin[（1.05±0.12）比（0.50±0.05）]、Vimentin[（0.96±0.10）比（0.38±0.04）]、Snail[（0.74±0.07）比（0.40±0.04）]的表达水平显著降低（P＜0.05）;miR-126-5p能够特异性结合Peli2,Peli2是miR-126-5p的靶基因;Peli2过表达后可明显逆转miR-126-5p过表达对高糖诱导的HK-2细胞EMT的影响。结论 miR-126-5p通过靶向Peli2抑制糖尿病肾病肾小管上皮细胞EMT发生。

目的 探讨西格列汀联合利拉鲁肽对糖尿病伴肥胖患者胰岛素抵抗及血清超敏C-反应蛋白(hs-CRP)、白细胞介素1β(IL-1β)、肿瘤坏死因子(TNF-α)水平的影响.方法 选取2017年1月至2019年3月重庆市武隆区人民医院收治的糖尿病伴肥胖患者124例,按照随机数字表法将其分为对照组和研究组各62例,对照组应用西格列汀治疗,研究组应用西格列汀联合利拉鲁肽治疗,分析不同治疗方案对糖尿病伴肥胖患者体质量、血糖、胰岛素抵抗及血清hs-CRP、IL-1β、TNF-α水平的影响.结果 研究组体质量、体质量指数、空腹血糖(FPG)、餐后2?h血糖(2hPG)以及糖化血红蛋白(HbA1c)均低于对照组(P<0.05);研究组患者的β-细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、IL-1β、TNF-α、hs-CRP水平均优于对照组(P<0.05).结论 针对糖尿病伴肥胖患者采用西格列汀联合利拉鲁肽治疗能够使患者的胰岛素抵抗程度、炎症水平逐渐改善,且血糖受控效果好,值得推广.

目的 探究丙硫氧嘧啶联合甲巯咪唑对甲状腺功能亢进症(甲亢)治疗效果及对患者血清趋化因子配体10(CXCL10)、白介素-6(IL-6)水平变化的影响.方法 抽选该院2017年12月—2018年12月接收的142例甲亢患者为研究对象,据随机数字法分为2组,各71例,对照组行丙硫氧嘧啶治疗,研究组行丙硫氧嘧啶+甲巯咪唑治疗,对比两组临床干预效果,血清CXCL10、IL-6水平变化及用药后不良反应情况.结果 研究组总有效率95.77％,临床疗效明显优于对照组的84.51％(x2=5.071,P=0.024).研究组治疗前CXCL10、IL-6水平与对照组相比差异无统计学意义(t=0.203、0.522,P=0.971、0.895);治疗后血清CXCL10、IL-6水平降低程度明显高于对照组(t=10.265、6.356,P=0.000、0.002).结论 丙硫氧嘧啶+甲巯咪唑治疗可有效控制血清CXCL10、IL-6水平,提升临床治疗效果,且用药后不良反应发生率与单用丙硫氧嘧啶相似,具有较高安全性,值得推广.

糖尿病患者不觉得饿,有几种情况,其中一种是血糖得到了控制.我们人体中的胰岛素像是葡萄糖的搬运工,将葡萄糖从血液中搬运至细胞里,产生能量.而糖尿病患者的胰岛素缺乏,导致血液中血糖浓度升高,而细胞内又缺乏葡萄糖供能,因此人体出于自我保护需要大量分解自身的蛋白质和脂肪来产生能量,因此患者会出现饥饿的情况.

Objective To compare the efficacy and safety of once weekly glucagon-like peptide 1 (GLP-1) analogue and insulin glargine in poorly controlled T2DM patients. Methods The data of this study were obtained from CNKI, CBM, VIP, Wan Fang, Pubmed, Embase and Cochrane. Results 6 RCTs with 3112 patients were included in this study. Compared with glargine group, the decrease of HbAic and weight in GLP-1 analogue group were more significant 0. 23％[95％CI(-0. 43, -0. 02), P< 0. 05]and 2. 49 kg[95％CI (-3. 25, -1. 73), P<0. 05]but FPG level increased with a difference of 0. 73 mmol/L[95％CI(0. 13, 1. 32), P<0. 05]. The level of 2 hPG in GLP-1 analogue group was higher than glargine group. GLP-1 analogue was associated with higher risk for gastrointestinal reactions[RR 3. 18, 95％CI(2. 42, 4. 17), P<0. 05]and lower risk for hypoglycemia[RR 0. 62, 95％CI(0. 43, 0. 89), P<0. 05] and severe hypoglycemia events[RR 0. 47, 95％CI(0. 22, 0. 99), P=0. 05]. Conclusion Once weekly GLP-1 analogue has good control for HbAi c, 2 hPG and weight loss with low risk for hypoglycemia events compared with insulin glargine.

Objective To compare the efficacy and safety of compound pioglitazone hydrochloririe glimepiride tablet and glimepiride tablet in the treatment of type 2 diabetic mellitus(T2DM) for evaluating the effectiveness and safety of compound pioglitazone hydrochloride glimepiride tablet for treating T2DM.Methods The random,double-blind,double-dummy,positive drugs parallel control clinical study method was adopted.Thirty-three T2DM patients with poorly controlled blood glucose were randomly assigned to the test group(n=22) and control group(n=11) by the 2 ∶ 1 ratio.The test group was given compound pioglitazone hydrochloride glimepiride tablet,while the control group received glimepiride tablet.The treatment cycle was 12 weeks.The differences of FBG,HbA1c,FINS and HOMA-IR in the two groups were compared between before and after treatment.Moreover the changes of body mass,blood pressure and blood lipids as well as adverse events occurrence were compared between the two groups.Results Thirty-one cases finished the treatment follow up(21 cases in the test group and 10 cases in the control group);the decreased amplitudes of HbA1c levels after 12-week treatment in the test group and control group were (0.99 ± 1.87)％ and (-0.02 ± 0.90) ％ respectively,which of FPG were (0.94 ± 1.87) mmol/L and (0.37 ± 2.62) mmol/L respectively.The FPG and HbA1c levels after treatment in the test group were decreased compared with before treatment,the difference was statistically significant (P＜0.01).The change difference of FPG and HbA1c in the control group had no statistical difference(P＞0.05).FINS and HOMO-IR in the test group were significantly decreased before and after treatment,the difference was statistically significant (P＜0.01).The incidence rate of hypoglycemia had no statistically significant difference between the test group and control group.Conclusion The effectiveness of compound pioglitazone hydrochloride glimepiride tablet in treating T2 DM is superior to the single use of glimepiride,while the safety is equivalent to single use of glimepiride.

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者动脉粥样硬化性心血管疾病(atherosclerotic cardiovasculardisease,ASCVD)高风险(心血管风险可视化评估工具QRISK2≥10％)的现状及相关危险因素.方法:搜集武警重庆总队医院2015年7月至2016年1月25～84岁住院或门诊T2DM患者共271例.按照心血管风险可视化评估工具QRISK2评分检测项目要求,采用统一的调查表,收集被调查人员的社会人口学特征、主要疾病特征以及生化指标,主要包括年龄、性别、吸烟、一级亲属早发(＜60岁)心血管疾病史、既往病史、身高、体质量、血压及血脂情况.结果:调查人群中QRISK2≥10％患者比例占82.66％.男性患者平均QRISK2评分较女性患者平均评分高1.14倍[(23.28±8.77)％ vs.(20.31±10.01)％,t=-2.364,P=0.019].QRISK2评分随年龄呈现逐渐增加趋势,男性患者ASCVD高风险较女性患者更显年轻化[(62.43±8.74)岁vs.(67.20±7.45)岁,t=4.367,P=0.000].年龄、是否吸烟、SBP、TG及有无糖尿病慢性并发症是影响QRISK2评分≥10％(ASCVD高风险)的影响因素,是否吸烟为最重要影响因素(OR=297.03,95％CI=31.00-2845.66,P=0.000).结论:通过对QRISK2评分对T2DM患者ASCVD风险进行评估,简便、有效.我院T2DM患者ASCVD风险是较高,有必要进行积极管理干预以减少不良结局事件.T2DM患者ASCVD高风险影响因素较多,包括年龄、病程、吸烟等.

目的:探讨糖尿病足护理的有效方法.方法:主要通过控制血糖、抗感染、饮食疗法及对足部局部换药并进行正确的健康指导等措施.结果:32例糖尿病足治愈22例,好转9例,截肢1例.结论:有效的护理是防止发生严重足部并发症,提高糖尿病患者生活质量的重要措施.