目的 探索2型糖尿病(T2DM)男性患者血尿酸水平与骨密度(BMD)、临床骨折患病率的相关性。方法 选取广州市第一人民医院住院的T2DM男性患者192例,采用双能X线骨密度仪测定各部位BMD,记录年龄、糖尿病病程、BMI,检测血尿酸、空腹血糖、糖化血红蛋白、血脂、碱性磷酸酶等,并分析BMD与其余指标的相关性。结果 骨质疏松组血尿酸、各部位BMD均低于骨量正常组及低骨量组(P＜0.05)。血尿酸与各部位BMD正相关(P＜0.01)。右股骨颈BMD与年龄负相关,与空腹血糖正相关(P＜0.05)。多元Logistic回归分析显示,血尿酸与临床骨折呈负相关。调整年龄、空腹血糖、ALP等混杂因素后,血尿酸水平与临床骨折仍有关联。当进一步调整各部位BMD时,结果无统计学意义。结论 维持正常稍高的血尿酸水平可能有利于减少T2DM男性患者骨质疏松及脆性骨折的发生。

Objective To explore the correlation in serum uric acid level and bone mineral density (BMD) and fracture rate in male patients with type 2 diabetes mellitus (T2DM). Methods 192 cases of male patients with T2DM in Guangzhou First People's Hospital were selected in this study.BMD was measured by bone density machine. The patient's age, diabetes course and BMI were recorded. Fasting blood glucose, glycated hemoglobin (HbA1c), liver and kidney function, blood uric acid, blood lipid, alkaline phosphatase, 25 hydroxyvitamin D3 levels were measured, and the correlation between BMD and other indicators was analyzed. Results The serum uric acid level,lumbar and right femoral neck BMD in the osteoporosis group were lower than those in the normal and low bone mass groups (P<0.05). Serum uric acid was positively correlated with BMD values of lumbar spine and right femoral neck in male patients with type 2 diabetes (P<0.01). BMD value of right femoral neck was negatively correlated with age and positively correlated with fasting blood glucose (P<0.05). Multivariate logistic regression analysis showed a significant negative correlation between serum uric acid and clinical fractures in male patients with type 2 diabetes (model 1). When the model was adjusted for age, fasting blood glucose, ALP and other factors, serum uric acid levels were still associated with clinical fractures (model 2). When the BMD values of the lumbar spine and the right femoral neck were further included (model 3), the results were not statistically significant. Conclusion Slightly higher blood uric acid levels may help to reduce the incidence of OP and fracture rate in male patients with T2DM.

目的 分析石河子地区2型糖尿病(T2DM)合并消化道恶性肿瘤患者的临床特征,探讨T2DM合并消化道恶性肿瘤的影响因素。方法 ①纳入我院2015年至今消化道恶性肿瘤患者为研究对象。根据OGTT结果或既往有无T2DM病史分为三组:健康对照组(A组),消化道恶性肿瘤组(B组),T2DM合并消化道恶性肿瘤组(C组)。②全自动生化分析仪测定血清中糖脂代谢指标,化学发光法测定血清甲胎蛋白(AFP)等肿瘤标志物,分析其临床特征,进行组间比较,并探讨其影响因素。采用SPSS 22.0软件处理数据,并进行方差分析;影响因素采用Logistic回归分析;假设检验水准α＝0.05,双侧检验P<0.05差异有统计学意义。结果 ①基线资料比较显示:A组310例(男女比138/172),年龄(52.96±10.98)岁;B组513例(男女比343/170),胃癌患者居多(26.90%),年龄(62.26±12.34)岁;C组134例(男女比80/54),肝癌患者较多(26.12%),年龄(66.78±10.47)岁;与A组相比,B组与C组男性患者较多,年龄较大。②组间基线资料比较显示:三组的性别、年龄存在统计学差异(P<0.001)。③协方差分析消除影响因素后:与A组相比,B组及C组的TG、 TC、HDL-c降低(P<0.001);FPG、AFP、CEA、CA12-5、CA15-3、CA19-9、CA72-4升高(P<0.01)。④Logistic回归分析后结果显示:FPG为消化道恶性肿瘤发生的独立危险因素(OR=1.204);年龄是消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的危险因素(OR=1.072,1.105),HDL-c为消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的保护因素(OR=0.200,0.111);结论 老年男性T2DM患者易发生消化道恶性肿瘤。因此,对于高龄男性T2DM患者,尤其是HDL-c降低的情况下,应进行相关筛查,以早期防治消化道恶性肿瘤的发生发展。

Objective To analyze the clinical characteristics of patients with type 2 diabetes mellitus (T2DM)complicated with gastrointestinal malignancy in Shihezi area, and investigate the influencing factors of T2DM complicated with gastrointestinal malignancy. Methods ①Patients with malignant tumors of the digestive tract in our hospital from 2015 to the present have been included in the study. They were divided into three groups based on OGTT results or previous history of T2DM: healthy control group (group A), gastrointestinal malignant tumor group (group B), and T2DM combined gastrointestinal malignant tumor group (group C). ②Automatic biochemical analyzer measured serum glucose and lipid metabolism indicators, chemiluminescence method was used to measure serum alpha-fetoprotein (AFP)and other tumor markers, to analyze its clinical characteristics, make a comparaison between groups, and explore its influencing factors. The data was processed with SPSS 22.0 software and analysis of variance was performed; the influencing factors were analyzed by logistic reg-ression; hypothesis test level = 0.05, and the two-sided test P <0.05 was statistically significant. Results ①Comparison of baseline data showed that 310 cases (male/female 138/172)in group A were (52.96±10.98)years old. In group B, 513 patients (male/female 343/170)were diagnosed with gastric cancer (26.90%), aged (62.26±12.34)years. There were 134 cases in group C (male/female 80/54), with more liver cancer patients (26.12%), and the age was (66.78±10.47)years. Compared with group A, group B and group C had more male patients and were older. ②Comparison of baseline data among groups showed there were statistical differences in gender and age among the three groups (P<0.001). ③After covariance analysis eliminated influencing factors: compared with group A, TG, TC and HDL-c were decreased in group B and group C (P<0.001). FPG, AFP, CEA, CA12-5, CA15-3, CA19-9, and CA72-4 increased (P<0.01). ④Logistic regression analysis results: FPG was an independent risk factor for gastrointestinal malignancy (OR=1.204). Age wss a risk factor for gastrointestinal malignancy and T2DM complicated with gastrointestinal malignancy (OR=1.072, 1.105), HDL-c was the protective factor (OR=0.200, 0.111). Conclusion Elderly male T2DM patients are prone to gastrointestinal malignancies. Therefore, for elderly men with T2DM, especially when HDL-c is reduced, relevant screening should be performed to prevent and control the occurrence and development of gastrointestinal malignant tumors in the early stage.

目的 探索使用血浆中溶血磷脂酸 LPA作为老年糖尿病患者发生缺血性心脑血管病早期预警指标。方法 在公共卫生项目开展的基础上,将老年糖尿病患者随机分为观察组和对照组。对照组实施糖尿病规范管理,观察组在对照组的基础上进行血浆LPA 的水平定期检测,对LPA 明显升高者,予降脂、抗纤溶、抗血小板凝集等干预措施,比较两组间缺血性心脑血管病发生率和病情严重程度。结果 观察组缺血性脑血管发病率高于对照组,差异有统计学意义（P<0.05）。中、重型缺血性脑血管病患者的血浆LPA高于轻型组（P<0.05）,且重型组高于中型组（P<0.05）结论 血浆LPA值可作为老年糖尿病患者发生缺血性心脑血管病的预警因子,值得在基层老年糖尿病患者规范化管理中常规应用。

Objective To explore the early warning index of ischemic cardiocerebrovascular disease in elderly diabetic patients with plasma LPA. Methods On the basis of public health project,elderly diabetic patients were randomly divided into observation group and control group. Control group adopted diabetes management implementation,while observation group adopted periodic testing of the levels of plasma LPA on the basis of the control group,implementing fall fat,resisting fibrinolytic,antiplatelet aggregation and other interventions if LPA significantly increased. We compared the ischemic cardio-cerebrovascular disease incidence and disease severity between the two groups. Results The incidence of cerebral ischemia in the observation group was higher than that in the control group,and the difference was statistically significant （P<0.05）. Medium and heavy plasma LPA is higher than the light of ischemic cerebrovascular disease group （P < 0.05）,and heavy above medium group （P < 0.05） Conclusion The plasma LPA values can be used as early warning factor in elderly patients with diabetes occuring ischemic cardio-cerebrovascular disease and promote its application.

目的 本研究旨在探讨2型糖尿病不同程度肾病与chemerin、SOD及MDA的相关性。方法 选取2016年1月—2017年12月期间于广州市第一人民医院内分泌科门诊和住院的患者100例,根据尿白蛋白/肌酐比(ACR)分为正常尿蛋白组(NA组,n=33),微量白蛋白尿组(MA组,n=34)及大量蛋白尿组(CA组,n=33),另选取32例我院体检中心体检结果正常的正常健康人作为对照组(NC组,n=32),测定血糖、糖化血红蛋白、血肌酐、ACR、24小时尿蛋白定量、胆固醇、甘油三酯、SOD、MDA、chemerin等水平。结果 SOD的水平:NC组> NA组> MA组>CA组(P<0.05);MDA的水平:CA组>MA组>NA组>NC组(P<0.05);Chemerin水平:CA组>MA组>NA组>NC组(P<0.05)。相关性分析提示ACR与血清SOD呈负相关,与MDA、chemerin呈正相关。多元回归分析显示,病程、胆固醇、糖化血红蛋白、chemerin是影响ACR的主要因素。结论 Chemerin、MDA、SOD可能参与糖尿病肾病的发生发展,检测其水平可以在一定程度上反映2型糖尿病肾病患者的病情严重程度。

Objective To explore the relationship between different type of Type 2 diabetes nephropathy and chemerin,SOD,MDA. Methods A total of 100 inpatients and outpatients were enrolled in this study between January 2016 and December 2017 in Guangzhou First People's Hospital. They were divided into normal urinary protein group (NA group, n=33), microalbuminuria group (MA group, n=34) and massive proteinuria group (CA group, n=33) based on ACR. Another 32 healthy people were collected as a control group in medical examination center (NC group, n=32). The levels of blood sugar, glycated hemoglobin, serum creatinine, ACR, 24-hour urinary protein, cholesterol, triglyceride, SOD, MDA and chemerin were measured. Results The level of SOD: NC group > NA group > MA group > CA group (P< 0.05). The level of MDA: CA group > MA group > NA group > NC group (P< 0.05). The level of chemerin: CA group > MA group > NA group > NC group (P< 0.05). Correlation analysis showed that ACR was negatively correlated with serum SOD and positively correlated with MDA and chemerin. Multivariate logistic regression demonstrated that course of disease, CHOL, HbA1c and chemerin were the main factors affecting ACR. Conclusion Chemerin, MDA and SOD may be involved in the occurrence and development of diabetic nephropathy. Chemerin, MDA and SOD may reflect the severity of type 2 diabetic nephropathy

目的 探讨不同中医体质老年糖尿病患者心率变异性与自主神经功能的关系。方法 选取2016年3月—2017年4月在我院治疗的老年糖尿病患者250例,检测各中医体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF、HF、LF/HF以及空腹血糖(FBG)、糖化血红蛋白(HbA1c)。结果 总偏颇体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF和HF分别为(88.37±10.02)ms、(78.82±9.44)ms、(41.14±11.43)ms、(22.28±6.53)ms、(10.03±4.33)ms、(203.38±78.23)ms²和(122.21±80.03)ms²,低于平和质患者(P＜0.05),而LF/HF为(1.68±0.43),高于平和质患者(P＜0.05);血瘀质患者SDNN、SDANN、SDNNI、RMSSD和PNN50低于气虚质、阴虚质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF、HF低于气虚质、血瘀质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF/HF低于气虚质、血瘀质、痰湿质、湿热质患者(P＜0.05);其他型患者SDNN、SDANN、SDNNI、RMSSD、PNN50、LF、HF高于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05),而LF/HF低于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05);不同中医体质患者FBG、HbA1c比较差异无统计学意义(P＞0.05)。结论 糖尿病患者偏颇体质较平和质患者心率变异性降低,表现为交感神经张力增大,迷走神经张力降低,其平衡协调破坏。

Objective To explore the relationship between heart rate variability and autonomic nervous function in elderly diabetic patients with different constitutions of traditional Chinese medicine. Methods 250 elderly patients with diabetes mellitus in our hospital from March 2016 to April 2017 were selected; the SDANN, SDNNI, RMSSD, PN50%, LF, HF, LF/HF, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were measured. Results In patients with general biased constitution, SDANN, SDNNI, RMSSD, PN50%, LF and HF were (88.37±10.02) ms, (78.82±9.44) ms, (41.14±11.43) ms, (22.28±6.53) ms, (10.03 ±4.33) ms, (203.38±78.23) ms² and (122.21±80.03) ms², which were lower than those in patients with plain constitution (P＜0.05), while LF/HF was (1.68±0.43), which was higher than that in patients with plain constitution (P＜0.05); in patients with blood stasis, SDANN, SDNNI, RMSSD and PN50 were lower than those with Qi deficiency, Yin deficiency, phlegm-dampness, damp-heat and other types (P＜0.05); LF and HF in Yin deficiency type patients were lower than those in Qi deficiency type, blood stasis type, phlegm-dampness type, damp-heat type and other types (P＜0.05); LF/HF in Yin deficiency patients was lower than that in Qi deficiency patients, blood stasis patients, phlegm-dampness patients and damp-heat patients (P＜0.05); SDANN, SDNNI, RMSSD, PN50, LF and HF in other types of patients were higher than Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05), while LF/HF was lower than those with Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05); there was no significant difference in FBG and HbA1c in patients with different constitutions of TCM (P>0.05). Conclusion The heart rate variability of biased constitution patients with diabetes mellitus was lower than that of patients with mild constitution, manifested by increased sympathetic nerve tension, decreased vagal nerve tension and destroyed balance and coordination.

目的 观察饮食干预管理和健康教育对糖尿病酮症酸中毒(DKA)患者的干预效果。方法 90例DKA患者根据数字表法随机分为2组,对照组(n=45)予以常规治疗及护理措施,观察组(n=45)在对照组治疗及护理基础上予以饮食干预管理和健康教育,比较两组患者干预后血糖控制时间、酸中毒纠正时间和住院治疗时间;采用相关效果量表调查两组患者干预前后相关知识知晓程度及健康饮食依从度;通过生活质量评分表和问卷表比较两组患者两组生活质量和护理满意度。结果 观察组干预后血糖控制时间、酸中毒纠正时间均早于对照组(P<0.05),而住院治疗时间少于对照组(P<0.05);两组干预前相关知识知晓程度比较无差异(P>0.05),观察组干预后相关知识知晓程度及健康饮食依从度均优于对照组(P<0.05);观察组干预后生活质量及护理满意度均优于对照组(P<0.05)。结论 饮食干预管理和健康教育可明显改善DKA患者症状及生活质量,提高相关知识知晓程度及健康饮食依从度。

目的 探讨分析莫西沙星对2型糖尿病合并肺部感染患者内皮素及降钙素基因相关肽的影响。方法 回顾性分析2015年1月—2016年1月来我院就诊并确诊为2型糖尿病合并肺部感染的84例患者的临床资料,根据治疗方案将其分为对照组和观察组,每组各42例。对照组患者给予常规治疗,观察组患者在对照组的治疗基础上予以莫西沙星治疗。观察两组患者治疗后内皮素以及降钙素基因相关肽的变化。结果 ①观察组总有效率(92.86%)优于对照组(78.57%),两组患者间总有效率的比较有统计学意义(P<0.05);②两组患者治疗前ET、CGRP水平无差异(P>0.05)。治疗后,观察组ET水平低于对照组,CGRP水平高于对照组(P<0.05)。结论 临床应用莫西沙星治疗2型糖尿病合并肺部感染具有明显的临床疗效,值得临床推广应用。

目的 在糖尿病尿失禁女性患者中使用盆底肌功能训练手册,了解该手册对改善糖尿病女性尿失禁的作用。方法 将260例糖尿病尿失禁患者随机分为观察组、对照组,2组均进行常规盆底肌功能训练,每月提醒患者坚持训练,观察组在此基础上发放盆底肌功能训练手册,指导患者及家属填写方法, 每月检查填写记录情况;在治疗前、后评价2组患者尿失禁改善、观察心理健康改善情况。结果 观察组患者在干预后尿失禁改善、心理健康改善优于对照组。盆底肌功能训练手册准确真实反映患者治疗的落实情况,可督促患者落实治疗,从而提高治疗效果,提高患者生活质量。结论 盆底肌功能训练手册对糖尿病尿失禁患者实用性高,尤其对于记忆力下降的糖尿病患者实用性高。

目的 探讨前列地尔联合依帕司他对糖尿病足患者创面肉芽组织肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白介素-6 (interleukin-6,IL-6)及血管内皮生长因子(vascular endothelial growth factor,VEGF)表达的影响。方法 将90例糖尿病足患者随机分为研究组和对照组,每组45例,对照组予常规治疗,研究组在常规治疗基础上给予前列地尔+依帕司他联合治疗。监测两组患者创面愈合率,患肢足背血流动力学及腓总神经传导速度,创面肉芽组织TNF-α、IL-6、VEGF含量及基因表达变化。结果 治疗后第2、4周研究组较对照组创面愈合率升高,差异有统计学意义(P<0.05);治疗后两组患者足背动脉血流动力学及腓总神经传导速度均有改善,而研究组疗效更明显(P<0.05);治疗后研究组患者创面肉芽组织TNF-α、IL-6含量及基因表达较对照组降低,VEGF含量及基因表达则升高(P<0.05)。结论 前列地尔联合依帕司他联合治疗可改善糖尿病足患者足背动脉血流动力学,促进受损神经功能恢复;降低糖尿病足患者创面肉芽组织TNF-α、IL-6表达,减轻免疫损伤;增加VEGF基因表达,促进血管生成,加速创伤愈合。

Objective To investigate the effects of alprostadil combined with epalrestat on the expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in granulation tissue in patients with diabetic foot patients.Methods Totally 90 cases with diabetic foot were randomly divided into study group (45 cases)and control group(45 cases). The control group received conventional treatment for 4 weeks and the study group additionally received combination of alprostadil and epalatone for 4 weeks. The curative rate of wound healing, limb dorsal hemodynamics, peroneal nerve conduction velocity and the levels of TNF-α, IL-6 and VEGF in the granulation tissue of the wound were monitored in the two groups.Results The wound healing rate of the study group was significantly higher than that of the control group at the 2nd and 4th week after treatment (P<0.05). After treatment, the hemodynamics and peroneal nerve conduction velocity were improved (P<0.05). The contents and expressions of TNF-α and IL-6 in the granulation tissue of the treatment group were significantly lower than that of the control group, and the content of VEGF and gene expression were significantly increased in the study group (P<0.05).Conclusion The combination therapy of alprostadil and epalrestat may improve the hemodynamics of dorsalis pedis artery in patients with diabetic foot and promote the recovery of damaged nerve function.Also it may reduce the expression of TNF-α and IL-6 in the granulation tissue of diabetic patients and reduce the immune injury. It promotes angiogenesis and accelerates wound healing by increasing VEGF gene expression.

目的 观察同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法 选择2014年7月—2016年11月在我院就诊的68例(72只眼)患有老年性白内障合并糖尿病性黄斑水肿患者,分为2组,治疗组(32例,34只眼)行同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗;对照组(36例,38只眼)单纯行白内障超声乳化摘除;观察指标包括术前、术后最佳矫正视力、眼压及黄斑中心凹视网膜厚度,观察时间为术前、术后1周、1月、3月、6月、12月。结果 术后两组最佳矫正视力与术前相比差异有统计学意义(P<0.01);术前及术后1周2组最佳矫正视力无差异,术后1月、3月、6月、12月治疗组最佳矫正视力均优于对照组;术前2组患者黄斑中心凹视网膜厚度相比无明显差异,术后各个时间点治疗组黄斑中心凹视网膜厚度均低于对照组,二者相比差异有差异性(P均<0.001);两组患者术前及术后眼压无差异(P<0.05)。结论 对老年性白内障合并糖尿病性黄斑水肿患者,术中联合玻璃体腔注射雷珠单抗,可减轻术后黄斑水肿,改善患者术后中、远期视力。

Objective To assess the safety and efficiency of combination of micro incision phacoemulsification (PHACO) surgery and intravitreal ranibizumab injection in patients with cataract and diabetic macular edema. Methods The selected 68 patients (72 eyes) with age-related cataract and diabetic macular edema were randomly divided into two groups: the PHACO and intravitreal Ranibizumab injection (treatment group, 32 cases, 34 eyes), and only PHACO (control group, 36 cases, 38 eyes) in our hospital from July 2014 to November 2016. Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. The time points included preoperative day, 1 week, 1 month, 3 months, 6 months and 12months after surgery. Results Postoperative BCVA during the follow-up period was higher than the initial BCVA in both groups (P<0.01). There was no statistically significant difference between both groups in BCVA at pre-operation and 1 week after surgery. In the treatment group, the postoperative BCVA was significantly higher than the control group at 1 month, 3 months, 6 months and 12months after operation. The mean CMT in the treatment group was lower than the control group in all the follow-up time. There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (P>0.05). Conclusion Additional intravitreal ranibizumab injection after PHACO surgery reduced macular edema and preserved this improvement in the mid-and-long term of BCVA.