目的 探讨二甲双胍和胰高糖素样多肽-1对2型糖尿病患者并发骨折恢复的影响。方法 选取2016年5月—2017年4月我院骨科收治的2型糖尿病并发骨折患者120例,按随机原则分为5组,每组24例,单药低剂量二甲双胍组(A1)、单药高剂量二甲双胍组(A2)、单药GLP-1组(B)、低剂量二甲双胍联合GLP-1组(C1)和高剂量二甲双胍联合GLP-1组(C2)。二甲双胍低剂量用药量为0.5 g/次,每日2次口服,高剂量用药量为0.5 g/次,每日4次口服。皮下注射利拉鲁肽每日1次,起始量为每日0.6 mg,1周增加为每日1.2 mg,再1周后增加为每日1.8 mg。血糖控制在理想水平后按照标准的手术方法和规程行相应的手术治疗。同时给予饮食控制及其它对症治疗。分别在1、3、6个月时检测其股骨颈骨密度值(BMD)和Harris系统评分。结果 随着治疗时间延长,A1组、C1组、C2组BMD值和Harris系统评分均增高, 在术后3月和6月时,C1组骨密度值和Harris评分高于A1组(P<0.05), C1组骨密度值和Harris评分高于C2组(P<0.05)。结论 胰高糖素样多肽-1可促进2型糖尿病患者骨折愈合、功能恢复,且与低剂量二甲双胍联用促进骨折愈合效果优于与高剂量二甲双胍联用。

Objective To investigate the effects of metformin and glucagon like polypeptide -1 on fracture recovery in patients with type 2 diabetes mellitus(DM). Methods We selected 120 patients with type 2 diabetes mellitus from May 2016 to April 2017 in department of orthopedicsin in our hospital and randomly divided them into 5 groups, 24 cases in each group,includingthe low dose of metformin monotherapy group (A1), the high dose of metformin monotherapy group (A2), single drug GLP-1 group (B), and GLP-1 group low dose of metformin combination (C1) and high dose of metformin combination with GLP-1 group (C2). The low dose of metformin was 0.5 g / time, 2 times a day for oral administration. The high dose was 0.5 g / time, 4 times a day. Subcutaneous injection of liraglutide was once daily, starting at a daily dose of 0.6 mg, 1.2 mg daily after 1 week and 1.8 mg daily after another week. After an ideal level of blood glucose control, corresponding surgical procedures should be performed according to standard surgical methods and procedures. Diet control and other symptomatic treatments were also given. The femoral neck bone mineral density (BMD) and the Harris system score were examined at the first, third, and sixth month respectively. Results With the prolongation of treatment time, the BMD value and Harris system score in the A1 group, C1 group, C2 group were increased. After surgery in March and June, the BMD and Harris score of C1 group were higher than that of A1 group (P<0.05). The bone mineral density and Harris score of C1 group was significantly higher than that of group C2 (P<0.05). Conclusion Glucagon like peptide -1 may promote the fracture recovery and functional recovery in patients with type 2 diabetes mellitus, and with combination of low dose metformin is more effective than that with high dose metformin.

目的 了解DFU患者的TXA2表达水平的变化及其影响因素,并讨论其与糖尿病血管病变的严重程度的相关性。方法 选择我院内分泌科2009年6月—2012年12月收治的2型糖尿病足部溃疡并坏疽形成的患者共30例、DFU非坏疽组38例、无DFU的2型糖尿病组患者40例,收集其一般资料及检查结果。分析TXA2的表达水平与其他资料的关系。并采用相关分析TXA2的稳定代谢产物TXB2水平升高的危险因素。结果 年龄、糖尿病病程、吸烟、BMI、血浆白蛋白与TXB2水平相关。结论 2型糖尿病足部溃疡患者的血浆血栓素A2水平显著增高,并且表达水平与病情严重程度相关,且与糖尿病病程、血脂、血糖 、血胰岛素、胰岛素抵抗指数水平、血压控制水平等呈明显相关关系。提示其可作为 2 型糖尿病患者血管内皮功能及动脉硬化的早期反映。

目的 观察2型糖尿病并急性脑梗死患者颅内血管病变特点。方法 回顾分析住院的T2DM并急性脑梗死组与非DM 脑梗死组各110例,对比两组的生化检查、美国国立卫生院卒中量表(National Institutes of Health Stroke, NIHSS)评分、梗塞灶及狭窄血管等。结果 两组在年龄、性别、血压方面无统计学差异。T2DM并急性脑梗死组在C反应蛋白、总胆固醇、糖化血红蛋白、尿素氮、肌酐、NIISS评分显著高于非DM 脑梗死组。T2DM并急性脑梗死组以小穿支动脉供血区梗死、大穿支动脉供血区梗死联合皮质支动脉供血区梗死的多发性脑梗死多见,狭窄血管见于大血管合并小血管。结论 T2DM并急性脑梗死患者病灶为多发性,狭窄血管更广泛,病情较严重,预后差,应积极防治。

目的 观察养血祛瘀方联合血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)类药物对糖尿病肾病不同分期的疗效。方法 134例糖尿病肾病患者采用随机区组设计方案,以初诊时间(月份)作为配伍因素,随机分为治疗组67例和对照组67例,两组均采用常规西医综合基础治疗,对照组给予ACEI或ARB类药物治疗,治疗组在对照组治疗的基础上联用养血祛瘀方治疗,观察60 d,分析两组治疗前后24h尿微量白蛋白、24 h尿蛋白定量、血清C反应蛋白(hs-CRP)的变化。结果 对于糖尿病肾病Ⅲ期患者,治疗组较对照组尿蛋白减少,但差异无统计学意义(P＞0.05),治疗组较对照组hs-CRP水平明显下降(P＜0.05);对于糖尿病肾病Ⅳ期患者,治疗组较对照组尿蛋白减少(P＜0.05),治疗组较对照组hs-CRP水平下降(P＜0.05)。结论 养血祛瘀方联合ACEI或ARB类药物可有效减少糖尿病肾病Ⅳ期患者蛋白尿,降低糖尿病肾病患者hs-CRP水平。

Objective To investigate the efficacy of Yang Xue Qu Yu Fang combined with ARB/ACEI on different stages of diabetic nephropathy. Mehtods 134 patients who suffered from diabetic nephropathy were randomly divided into observation group and control group, each of them had 67 cases. The experiment use randomized block design and choose the time (months) of initial diagnosis as the compatibility factors. Both groups were treated by conventional therapy. The control group was given medicine of ARB/ACEI while the observation group was added Yang Xue Qu Yu Fang on the basis of control group. We observed all the patients for 60 days, to compare the microalbuminuria in urine of 24h, the urinary protein of 24h and the serum high sensitive C-reaction protein (Hs-CRP) between two groups before and after treatment. Results For patients of the 3rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously, but there was no significant difference between two groups (P>0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). For patients of the 4rd stage of diabetic nephropathy, the albuminuria in observation group decreased obviously (P<0.05), the serum Hs-CRP in observation group decreased obviously (P<0.05). Conclusion The Yang Xue Qu Yu Fang combined with ARB/ACEI can effectively reduce the albuminuria and can obviously lower the Hs-CRP level in the patients of the 4rd stage of diabetic nephropathy.

目的 探讨糖尿病胃轻瘫大鼠不同血糖水平对Cajal间质细胞(ICC)的影响及其机制。方法 选择雌性Wista大鼠60只进行随机分组,实验组40只,对照组20只。实验组糖尿病Wista大鼠模型以单次腹腔注射链脲佐菌素法诱导。免疫组织化学荧光染色检测不同血糖浓度大鼠胃ICC数量及网络结构。结果 实验组大鼠血糖浓度高于对照组,ICC数量,低于对照组,且比较差异有统计学意义(P<0.05)。实验组大鼠中血糖浓度越高,ICC数量越低,说明血糖浓度升高可能与平滑肌及神经末梢之间缝隙连接的减少及其ICC网络的超微结构损伤及异常有关。结论 DM小鼠胃组织中血糖水平的升高,可能是DM胃中ICC数量减少的原因;外源性降低血糖能改善DM相关的胃肠道ICC病变。

Objective To observe the effects of glucose fluctuations on Cajal interstitial cells (ICC) of rats with diabetic gastroparesis(DGP) and its mechanistic. Methods 60 Wistar rats were selected and randomly divided into two groups. 20 rats in experimental group and 40 rats in control group. Used immunofluorescence staining to detect the amount of gastric ICC and network structure in DGP rats with different glucose levels. Results The blood glucose concentration in the experimental group was significantly higher than that in the control group, the amount of ICC in the experimental group was significantly lower than that in the control group(P<0.05). The amount of ICC decreased with the increase of glucose levels. In the experimental group, The gap junctions between smooth muscle and nerve endings, ultrastructural damage and abnormalities of the ICC network were probably related to glucose level. Conclusion The increase of glucose level was probably the cause of the decrease of the amount in ICC. Exogenousy decrease glucose levels probably can help to improve the lesion of ICC with DGP.

目的 探讨一种适合社区糖尿病患者健康素养的干预方法,并进一步探讨提高糖尿病患者健康素养对社区卫生服务利用的影响。方法 选择2014年—2015年在我社区卫生服务中心建档的210例糖尿病居民为调查研究对象,对糖尿病患者进行健康素养干预后,比较其健康素养、基本医疗服务利用、社区卫生服务利用情况。结果 对社区糖尿病人进行健康素养干预后,患者的健康理念、传染病预防、健康行为、基本医疗知识、安全素养得分均比干预前高,差异有统计学意义(P<0.05)。首次就诊医疗机构首选社区率及区县级医疗机构就诊的比例干预后比干预前高(P<0.05),最近两周内在社区医疗机构就诊率、签约全科医生率均比健康素养干预前高,差异有统计学意义(P<0.05)。而糖尿病患者过去1年住院例数干预前后无差别,差异没有统计学意义(P>0.05)。患者参与社区健康教育活动的次数干预后比干预前多(P<0.05),参加免费体检及接受社区医生健康生活方式的指导的比例比干预前高(P<0.05)。结论 利用健康促进模式可提高糖尿病患者的健康素养,健康素养的提高可使其对卫生服务的利用有所增加,使其自身的健康状况得以改善。

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探讨两种不同治疗方案治疗老年糖尿病合并初治涂阳肺结核患者的临床疗效。方法 将85例老年糖尿病合并初治涂阳肺结核患者分为每日疗法组(n=43)和间歇疗法组(n=42)。比较两组2、3、6个月及疗程结束痰菌转阴率、胸片吸收情况、并发症发生率。结果 两组治疗2个月痰菌转阴率每日疗程组高于间歇疗法组,但两组间无差异,但5、6个月末及疗程结束转阴率每日疗法均高于间歇疗法(P<0.05);治疗后每日疗程组病灶总吸收率(97.62%)高于间歇疗法组(79.07%),且差异有统计学意义(P<0.05);治疗过程中两组出现不良反应情况相比较差异无统计学意义(P>0.05)。结论 使用每日疗法并适当延长强化期及巩固期疗程治疗老年糖尿病合并初治涂阳肺结核的痰菌转阴率及病灶吸收率均优于间歇疗法,且安全性两者无差异,值得临床借鉴。

目的 探讨老年2型糖尿病患者牙周病发生情况及相关因素,为开展综合预防和治疗措施提供参考。方法 选取到我院住院治疗的老年2型糖尿病患者273例,检查其牙周病患病情况,同时收集年龄、性别、文化程度、体重指数、病程、吸烟、空腹血糖、糖化血红蛋白、刷牙习惯等资料,比较牙周病患病组与未患病组之间上述资料的差异,探讨导致牙周病发生的影响因素。结果 273例研究对象中患有牙周病154例(56.41%),其中,牙龈炎60例,牙周炎94例。牙周病组平均存留牙数(18.54±6.31)颗,未患牙周病组平均存留牙数(21.62±7.48)颗(t=3.679,P<0.001)。年龄较大(P<0.001)、病程较长(P<0.001)、吸烟(P<0.001)、空腹血糖(P<0.001)和糖化血红蛋白(P<0.001)水平较高是老年2型糖尿病患者发生牙周病的危险因素,而文化程度高(P=0.017),刷牙>1次/d(P<0.001),竖刷(P=0.004),使用牙线(P=0.004)是其保护因素。结论 老年2型糖尿病患者中牙周病患病率较高,临床上应做好三级预防措施,降低牙周病发生风险因素的暴露。

Objective To explore the periodontal disease occurrence and its factors for elderly type 2 diabetes patients, providing reference for comprehensive prevention and treatment measures. Methods 273 cases of elderly in-patients with type 2 diabetes in our hospital were enrolled. We checked their periodontal disease conditions, collected information including age, sex, educational level, body mass index, disease duration, smoking, fasting blood glucose, glycosylated hemoglobin, brushing habits. These values were compared between periodontal disease group and no periodontal disease group. Results People with periodontal disease in 273 cases of the object of study included 154 patients (56.41%), among them, gingivitis 60 cases, 94 cases of periodontitis. The teeth number was (18.54±6.31) for periodontal disease group on average, with (21.62 ±7.48) for no periodontal disease group (t=3.679, P<0.001). Older (P<0.001), longer course of disease (P<0.001), smoking (P<0.001), higher fasting blood glucose (P<0.001) and higher glycosylated hemoglobin (P<0.001) were risk factors of periodontal disease for elderly patients with type 2 diabetes. And well-educated (P=0.017), brushing teeth frequency > 1 / d (P<0.001), vertical brush mode (P=0.004), the use of dental floss (P=0.004) were the protective factors. Conclusion Periodontal disease prevalence is high in elderly patients with type 2 diabetes. The three level preventive measures should be strengthened to reduce the exposure of the periodontal disease risk factors.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.