目的:分析湿热内蕴型 2 型糖尿病患者的一般特征、生化指标、合并症及并发症种类,探讨危险因素和预测性指标.方法:选取 2021 年兰州市中医医院糖尿病科收治的 663 例 2 型糖尿病的病案资料,筛选出湿热内蕴型 2 型糖尿病患者,统计性别、年龄、合并/并发症种类数的分布情况,比较各生化指标之间的相关性.根据合并症病种数差异,将患者分为少症、中症和多症 3 组,并进行组间临床指标比较.结果:筛选出 62 例湿热内蕴型2 型糖尿病患者,以男性居多,年龄集中在 40～60 岁,至少合并 1～2 种合并症,易并发 1 种并发症.相关性分析显示,体质量指数(BMI)与糖代谢指标、脂代谢指标和震动感觉阈值(VPT 值)无相关性(P＞0.05),糖代谢指标与VPT值无相关性(P＞0.05);糖化血红蛋白(GHB)、C 肽与胰岛素抵抗指数(IRI)呈正相关(P＜0.01,r= 0.588;P＜0.05,r=0.432);脂代谢指标中三酰甘油(TG)与低密度脂蛋白(LDL)、VPT 值呈正相关(P＜0.01,r=0.460;P＜0.05,r=0.368).与少症组比较,中症组 C 肽、空腹胰岛素(INS)、空腹血糖(FBG)、2 h 血糖(2 hPG)、GHB、IRI、TG、总胆固醇(TC)、LDL、中医证候积分均有所升高,其中IRI和中医证候积分高于少症组,差异有统计学意义(P＜0.01/P＜0.05);多症组 C 肽、INS、FPG、2 hPG、GHB、IRI、TG 和中医证候积分均有所升高,其中C肽、INS和IRI高于少症组,差异有统计学意义(P＜0.05/P＜0.01).结论:高血压病、高脂血症和胰岛素抵抗是湿热内蕴型 2 型糖尿病发生合并症、并发症的危险因素.定期观测 GHB 或 C 肽可对胰岛素抵抗进行预判,从而有效干预病程发展过程.

目的 比较不同海拔对2型糖尿病(type 2 diabetes mellitus,T2DM)患者外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)迁移及黏附功能的影响.方法 选取咸阳市某医院T2DM患者25人及同期健康体检者20人,作为低海拔组,兰州市某医院T2DM患者29人及同期健康体检者20人,作为高海拔组.采集各组人群静脉血,密度梯度离心法提取PBMCs.ELISA法检测血清中缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)、基质细胞衍生因子-1(stromal cell derived factor-1,SDF-1)、白细胞介素-8(interleukin-8,IL-8)和血管内皮生长因子(vascular endothelial growth factor,VEGF)浓度;实时荧光定量 PCR 法检测 PBMCs中趋化因子受体2[chemokine(C-X-C motif)receptor 2,CXCR2]、趋化因子受体4(CXCR4)和白细胞功能相关抗原-1(leukoctes function associated antigent-1,LFA-1)基因相对表达量;Western blot法检测CXCR2和CXCR4蛋白表达水平.结果 高海拔组T2DM患者较低海拔组SDF-1和HIF-1α表达升高,IL-8和VEGF表达降低(P均＜0.05).高海拔组T2DM患者较健康者各基因相对表达量均降低,其中CXCR2和CXCR4基因相对表达量差异有统计学意义(P＜0.001);低海拔组T2DM患者较健康者各基因相对表达量降低,但CXCR2基因相对表达量差异有统计学意义(P＜0.001).高海拔组较低海拔组CXCR2和CXCR4蛋白表达水平均降低(P＜0.05),两组T2DM患者CXCR2和CXCR4蛋白表达水平均低于健康者(P＜0.05).结论 随着海拔升高,T2DM患者较健康者缺氧程度加重,PBMCs迁移增强,黏附性和成血管能力减弱.

Objective: To compare the changes in the number of circulating endothelial progenitor cells and hypoxia-inducible factors in patients with type 2 diabetes at different altitudes, and to provide a basis for the research and treatment of type 2 diabetes vascular complications. Methods: Selected Type 2 diabetes patients who were diagnosed in a low altitude area of 386 m (Xianyang City) and a high altitude area of 1 520 m (Lanzhou) (25 persons/29 persons) and healthy persons (20 persons/20 persons) were selected. An automatic biochemical analyzer was used to detect the indexes of blood lipids, blood glucose, and glycosylated hemoglobin of the two groups of people, and the concentration of Hypoxia inducible factor-1α (HIF-1α) was detected by enzyme-linked immunosorbent assay (ELISA). The number of circulating endothelial progenitor cells (EPCs) in peripheral blood was determined by a cytometer. Results: No matter in low or high altitude areas, the number of circulating EPCs in the diabetes group was lower than that in the healthy group (P＜0.01). The levels of body mass index (BMI), waist to hip ratio (WHR), triglyceride (TG), fasting blood glucose (FBG) and glycosylated hemoglobin (HbAlc) were increased (P＜0.05). Compared with the low-altitude group, the expression levels of HIF-1α in diabetic patients at high-altitude and healthy people were increased significantly (P＜0.05), while the number of circulating EPCs was decreased significantly (P＜0.05), and the number of circulating EPCs in healthy people or the patients with type 2 diabetes without vascular complications was higher than that of patients with type 2 diabetes with vascular complications (P＜0.05). Conclusion: With the increase in altitude, the expression level of HIF-1α in type 2 diabetes mellitus(T2DM)patients is increased, and the number of circulating EPCs is decreased, which is closely related to the degree of vascular disease. Therefore, it is possible through transplantation of EPCs for high altitude T2DM patients to achieve the prevention and improvement of diabetic vascular complications.

目的 分析兰州市2015-2017年重点职业病监测结果.方法 对2015-2017年兰州市重点职业病监测情况进行描述与对比分析.结果 2015-2017年报告的重点职业病人数占总职业病人数89.92％.2017重点职业病危害因素监测岗位数高于2015年和2016年,煤尘(煤矽尘)、矽尘和噪声岗位超标率下降,苯岗位超标率增加.2015-2017年个案卡收集率差异具有统计学意义(P＜0.05).2015年职业禁忌证检出率高于2016和2017年(P＜0.05),2017年疑似职业病检出率低于2015和2016年(P＜0.05).2015-2017年接触苯和噪声的劳动者疑似职业病检出率、职业禁忌证检出率和专项指标检出率差异具有统计学意义(P＜0.05),接触煤尘(煤矽尘)和矽尘疑似职业病和专项指标检出率差异具有统计学意义(P＜0.05).总工龄收集率和苯接触的劳动者血常规指标收集率较低.2015-2017年兰州市工伤保险待遇落实率37.21％.结论 2015-2017年3年期间兰州市重点职业病监测工作得到了加强,但监测范围以及工作服务体系仍需进一步提高.

Objective To evaluate the promoting effect of hepatocyte growth factor (HGF) gene therapy on tissue regeneration in rats with gastric ulcer induced by acetic acid.Methods Gastric ulcer model was established by subserosal injection with acetic acid in Wistar rats.The model rats were randomly divided into three groups on day 5 after establishment,and treated with 10％ sodium hydrogen carbonate solution containing 1 × 109 cfu TPH (attenuated salmonella carrying eukaryotic expression vector for HGF gene),10％ sodium hydrogen carbonate solution containing 1 × 109 cfu TP (attenuated salmonella carrying empty eukaryotic expression vector) and 10％ sodium hydrogen carbonate solution (control) at an equal volume (1 ml) by lavage respectively,once 3 d for 3 times.The stomach tissues of rats were collected on day 21 after the last lavage,observed for ulcer healing visually,and for regenerative repair by microscopy.The HGF expression levels in ulcer tissue on days 1,3,7,14 and 21 after the last lavage were determined by ELISA.Results The wound surface of ulcer of rats in TPH group was small in area and shallow,while the basal cells were proliferated significantly,the gastric mucosa epithelial cells were proliferated and migrated significantly,and capillary vessels were observed in basal tissue.However,no obvious proliferation of basal cells or proliferation and migration of gastric mucosa epithelial cells were observed in TP and control groups.The expression levels of HGF at various time points after lavage in TPH group were significantly higher than those in TP and control groups (P ＜ 0.05 or P ＜ 0.01).Conclusion HGF gene therapy accelerated the healing of gastric ulcers via stimulating the proliferation of gastric epithelial cells and basal cells of gastric ulcer wound.

目的 了解兰州市各级疾病预防控制中心(CDC)水质检测能力及存在的问题.方法 采用整群抽样的方法,选取兰州市及其区、县共9个CDC进行水质检测并对存在的问题进行专项调查.结果 9个CDC常规指标平均检测能力为26项,常规指标为中级水平,非常规指标和全项指标均为低级水平,兰州市的检测水平高于区、县(P＜0.01);常规指标和非常规指标的计量认证率分别为61.1％和13.5％,兰州市认证水平高于区、县(P＜0.01);导致兰州市部分非常规项目无法检测的原因为无标准品(58.3％)和无仪器(41.7％);导致区、县部分常规项目无法检测的原因包括缺乏技术人员(41.1％)、无仪器(34.3％)、无标准品(24.1％)和无试剂(0.5％),非常规项目不能检测的原因包括无仪器(39.6％)、缺乏技术人员(34.8％)和无标准品(24.6％).结论 兰州市各级CDC水质检测能力较薄弱,尤其是区、县的差距还比较大,实验室建设能力低下是主要原因.

Objective To understand the disinfection quality of medical institutions in Lanzhou city so as to provide scientific basis for strengthening the management of hospital infection and improving the disinfection quality.Methods On-site sampling and bacteriological test were used to analyze 511 different levels medical institutions disinfection quality of Lanzhou city for seven consecutive years.Results 4 967 samples were collected in this research and the overall pass rate of disinfection quality was 88%.The pass rates of enterprise hospitals and private hospitals were 90.38% and 93.81% respectively,those of county hospital,municipal hospital,community health service center and private clinics were 89.12%,88.14%,83.40% and 70.94% respectively.The indoor air and ultraviolet lamps had the lowest quality pass rates,which were 84.51% and 78.19% respectively.The pass rate of sterile equipment was 96.54%.Conclusion The majority disinfection quality pass rates of medical and health institutions are comparatively higher in Lanzhou City,while the pass rate of sterile equipment should be concerned.

Objective To understand the characteristics of nosocomial infection in the medical institutions of Lanzhou city providing a scientific basis to strengthen the prevention and control work of nosocomial infection.Methods A retrospective survey was used to study the status of nosocomial infection in Lanzhou City.Results From 2007 to 2011,the average rate of nosocomial infection in medical institutions of Lanzhou City was 1.37%,and the omission rate of that was 0.15% on average.The infection rate of municipal hospitals was 1.94%;that in hospitals of factories and mines was 1.15%;the infection rate of county hospitals was 0.92%;that of private hospitals was 0.22%.Respiratory infections accounted for 64.24% of all infections,which were followed by gastrointestinal infections,urinary tract infections and surgical wound infection.Conclusion In the medical institutions of Lanzhou City,the nosocomial infection rates are low and the omission of infection cases exists,so the management of nosocomial infection should be improved.

[Objective] To investigate the toxic effect of lead acetate on in vitro cultured cortical neurons of rats.[Methods]Primary cultured cortical neurons of newborn rats were treated with different concentration of lead acetate (50,100 and 200 μg/ml). Neutral red stain and PI-Hoechst 33342 double stain were used to compare the viability of cortex neurons, which were cultured in the medium containing different concentration of lead acetate for 6 hours, 12 hours, 24 hours and 48 hours respectively.[Results]PI-Hoechst 33 342 double staining showed pyknosis occurred in some cortical neurons and that increased with the increase of the dose of lead acetate and culture time, the cortical neurons with red fluorescent and apoptosis increased, after 12 hours of lead acetate exposure. Apoptotic rate of cortical neurons of control group was significantly lower than that in both medium and high concentration of lead acetate groups (P0.05). Neutral red staining showed time, and the difference was significant between cortical neurons treated with high concentration of lead acetate for 24 and 48 hours and cortical neurons treated for 6 hours, the rest was not significantly different (P0.05). The viability of cortical neurons treated with different concentration of lead acetate decreased with the increase of lead acetate dose, especially for the high and low concentration of lead acetate groups, the difference was significant (P0.05).[Conclusion]The viability of cortical neurons treated with high, medium and high concentration of lead acetate for 12 hours is significantly lower than that of control group, and shows dose-and time-dependent relationship.