目的 探讨农村地区糖尿病患者在镇卫生院—村卫生站一体化管理模式下的效果。方法 于2013年10月—2014年9月对花山镇26个村1267名糖尿病患者实行镇卫生院—乡村卫生站一体化管理,镇卫生院定期组织医疗队到村卫生站健康宣教、义诊、体检,村卫生站乡医为本村糖尿病患者开展跟踪随访、血糖监测、用药及饮食运动指导。一年后比较患者的规范管理率、血糖控制率。结果 实施管理后农村糖尿病患者的规范管理率和血糖控制达标率均有提高,尤以血糖控制达标率为明显。结论 对农村社区糖尿病患者实施镇卫生院—村卫生站一体化管理能更好地跟踪监测患者血糖水平,增强患者防病意识,有效提高农村社区糖尿病患者血糖控制率。

目的 探讨血糖控制情况对胰岛素抵抗型糖尿病合并肺结核的临床治疗转归的影响。方法 选取我站收治的胰岛素抵抗型糖尿病合并肺结核的患者180例,随机分成对照组和观察组两组,每组各90例,对照组给予常规监测晨起空腹血糖和餐后2 h血糖,观察组给予监测血糖谱(包括三餐前、三餐后2 h、凌晨3点和晨起空腹血糖);观察组与对照组中患者均利用2HRSZ(E)／10HR(E)方案来进行治疗;记录两组患者治疗前后空腹血糖、餐后2 h血糖、痰菌阴转情况、X线胸片病灶情况和空洞变化情况,对比分析两组的临床治疗效果。结果 观察组的痰菌阴转、X线胸片病灶、空洞变化等均比对照组的效果好,且两组差异有统计学意义(P＜0.05);观察组的总体有效率87.8%(79/90)高于对照组的71.1%(64/90),两组差异有统计学意义(χ²=7.655,P=0.006)。结论 控制血糖能有效提高胰岛素抵抗型糖尿病合并肺结核的临床治疗效果,在临床上值得推广应用。

目的 探讨糖化血红蛋白(HbA1c)联合超敏C反应蛋白(hs-CRP)在筛查妊娠期糖尿病(GDM)的临床意义。方法 选择2013年9月1日—2014年8月31日在我院妇产科孕期产前检查及分娩的孕妇,根据糖耐量试验(OGTT)、HbA1c和hs-CRP检查,筛查出92例孕妇为GDM组,并随机抽取OGTT正常的健康孕妇90例为NGT组,25例健康孕龄女性为对照组,分析3组FPG、HbA1c、hs-CRP及OGTT结果。结果 GDM组OGTT、HbA1c、hs-CRP高于NGT组和对照组,差异有统计学意义(P<0.01),NGT组与对照组比较,HbA1c、hs-CRP浓度差异无统计学意义(P>0.05),但3组FPG差异无统计学意义(P>0.05),Pearson相关分析显示,HbA1c与hs-CRP呈正相关(r=0.79,P<0.01)。结论 GDM患者HbA1c、hs-CRP水平升高,HbA1c联合hs-CRP可能成为GDM筛查的良好指标。

Objective To evaluate the feasibility of combination of glycosylated hemoglobin A1c(HbA1c) and high-sensitivity CRP in screening of gestational diabetes mellitus(GDM). Methods According to glucose tolerance test(OGTT),HbA1c and hs-CRP during 24~28 pregnant weeks,92 women with GDM (GDM group) and 90 normal pregnant women (NGT group) were enrolled in this study with another 25 women of child-bearing age as the control group. The results of FBG, OGTT, HbA1c and hs-CRP among three groups were analyzed. Results OGTT, HbA1c and hs-CRP level in GDM group were higher than that in NGT group and control group (P<0.05), but there were no significant differences of the level of FPG of 3 groups(P>0.05).Compare with NGT group and control group, There were no significant differences of the level of HbA1c and hs-CRP(P>0.05). Pearson correlation analysis showed that HbA1c had significant association with hs-CRP(r=0.79, P<0.01). Conclusion HbA1c and hs-CRP level in GDM group were increased, HbA1c combined with hs-CRP could be of some value in screening of GDM.

目的 评价自我管理小组干预对社区2型糖尿病患者的管理效果。方法 在2013年底选取本区社区卫生服务中心100例患者研究,运用自身对照方法,管理1年后对其自我管理效能、生化指标、空腹血糖、糖化血红蛋白进行比较。结果 管理一年后饮食控制、运动控制、药物依从性、监测依从性、足部护理等指标差异有统计学意义(P<0.05)。空腹血糖、糖化血红蛋白、总胆固醇、尿酸下降,差异有统计学意义(P<0.05)。空腹血糖达标率由12%上升到37%,糖化血红蛋白达标率由10%上升到34%,差异有统计学意义(P<0.05)。结论 自我管理小组干预提高了社区2型糖尿病患者自我管理水平,改善了主要的生化指标,值得社区推广应用。

Objective To evaluate the function of self-management group program on patients with type 2 diabetes in community. Methods Self-management was carried out for one year among 100 patients with type 2 diabetes, the effect of management was analyzed. Results There was statistically significant difference in diet control, motion control, drug compliance, monitoring compliance, and foot care after one year intervention (P<0.05). GLU, HbA1c, CHOL, UA were decreased. The difference was statistically significant (P<0.05). Conclusion Self-management of group intervention is effective in patients with type 2 diabetes, is worthy of further popularization and application.

目的 探讨2型糖尿病患者发生医院感染危险因素。方法 收集2010年1月—2015年1月我院收治890例2型糖尿病患者临床资料行回顾性分析,根据是否发生医院感染分为感染组(75例)和非感染组(815例),对两组患者相关因素进行分析。结果 2型糖尿病医院感染发生率为8.43%,好发于呼吸系统感染。年龄、病程、住院时间、血糖控制差、侵袭性操作、合并并发症、合并基础疾病为2型糖尿病患者发生感染的危险因素。结论 2型糖尿病患者发生医院感染危险因素较多,临床针对高危患者应重点进行预防,降低感染率,提高患者治疗效果。

目的 探讨莫西沙星结合抗结核药物治疗糖尿病合并肺结核患者的临床疗效分析。方法 将本组126例糖尿病合并肺结核患者分为对照组(n=63)和观察组(n=63);对照组给予降血糖治疗及抗结核药物降糖治疗,观察组在对照组治疗基础上服用莫西沙星;两组治疗均以3个月为一个疗程,2个疗程后统计疗效。结果 观察组总有效率(93.65%)高于对照组(76.19%),差异有统计学意义(P<0.05);观察组痰菌检测转阴率(94.59%)高于对照组(79.49%),差异有统计学意义(P<0.05);治疗过程中观察组与对照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 莫西沙星结合抗结核药物治疗糖尿病合并肺结核疗效显著,具有较强的杀菌作用。

Objective To investigate the clinical efficacy of moxifloxacin combining with antituberculosis drug in the treatment of diabetic patients with pulmonary tuberculosis. Methods A group of 126 patients of diabetes complicated with pulmonary tuberculosis were divided into control group (n=63) and observation group (n=63); the control group was given by hypoglycemic therapy and therapy of antituberculosis drug only, and the observation group was also given by moxifloxacin; two groups were treated for 3 months as a course.The clinical efficacy was evaluated after 2 courses. Results The total effective rate of observation group (93.65%) was significantly higher than that of the control group (80.95%), and the difference was statistically significant (P<0.05); the negative sputum rate of observation group (94.59%) was higher than that of the control group (79.49%), and the difference was statistically significant (P<0.05); there was no statistically significant difference between the observation group and the control group in adverse effects. Conclusion The curative effect of moxifloxacin combining with antituberculosis drug in the treatment of diabetes mellitus complicated with pulmonary tuberculosis was good, with strong bactericidal effect.

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.

       随着糖尿病患者的增加,因肺炎住院的糖尿病患者数也呈现出明显上升趋势。由于糖代谢紊乱及机体免疫功能下降等因素,细菌在高血糖的机体环境中快速繁殖并分泌大量毒素,增加了抗菌药物使用的时间跨度和细菌清除难度,对患者预后造成了极大的威胁。文章主要对糖尿病合并细菌性肺炎患者的病原学特征、耐药情况及药物治疗等进行阐述,旨在进一步为临床预防和治疗提供参考依据。

        With the increasing incidence in diabetes, the number of hospitalized diabetes patients with pneumonia is also increasing. Due to factors such as glucose metabolism disorders and decreased immune function in the body, bacteria rapidly multiply and secrete a large amount of toxins in the hyperglycemic environment,increasing the duration of antibiotic use and the difficulty of bacterial clearance, posing a great threat to patient prognosis. This article mainly elaborates on the pathogenic characteristics, drug resistance, and drug treatment of diabetes patients with bacterial pneumonia, aiming to provide reference for the clinical prevention and treatment.

       目的   探讨长病程2型糖尿病（T2DM）患者体质指数（BMI）与胰岛β细胞功能间的相关关系。方法    选取2023年12月—2024年3月于承德市中心医院内分泌风湿免疫科住院的260例长病程（病程≥10年）T2DM患者作为研究对象，依据BMI将其分成正常组、超重组和肥胖组，比较三组间一般资料、检验学指标及检查的差异，分析胰岛β细胞功能与各指标间的相关性。结果   三组研究对象在空腹静脉血糖（FPG）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、尿酸（UA）、甘油三酯（TG）等上差异有统计学意义（P＜0.05），在胰岛β细胞功能指数（HOMA-β）比较差异无统计学意义（P＞0.05）；肥胖组的FPG、FCP、HOMA-IR、UA、TG均高于正常组（P＜0.05），超重组的UA、TG均高于正常组（P＜0.05），肥胖组的FPG、HOMA-IR、UA高于超重组（P＜0.05），Spearman相关分析结果显示HOMA-β与体质量指数（BMI）无相关性（r=0.046，P=0.461），HOMA-β与UA（r=0.226，P＜0.001）、TG（r=0.148，P=0.017）呈正相关，HOMA-IR与BMI（r=0.279，P＜0.001）与、UA相关（r=0.284，P＜0.001）及TG（r=0.349，P＜0.001）呈正相关，多元线性回归分析显示UA是HOMA-β的影响因素（P＜0.05），BMI、UA、TG是HOMA-IR的影响因素（P＜0.05）。结论    长病程的T2DM患者，其胰岛素抵抗水平随着BMI的增加逐渐升高，而胰岛β细胞功能指数与BMI的相关性不显著。同时，UA和TG也是长病程T2DM患者胰岛β细胞功能的影响因素。

       Objective  To explore the correlation between body mass index（BMI）and islet β cell function in patients with long course type 2 diabetes mellitus（T2DM）．Methods  A total of 260 patients with T2DM with a long course of disease（course≥10 years）admitted to the Department of Endocrinology and Rheumatology of Chengde Central Hospital from December 2023 to March 2024 were selected as the study objects，and were divided into normal group，overweight group and obese group according to BMI．Comparison among the three groups in general data，inspection index and and the difference of the islet β cell function were performed，and the correlation among the indexes was analyzed．Results  There were statistically significant differences in fasting plasma glucose（FPG），fasting C peptide（FCP），homeostasis model assessment-insulin resistance（HOMA-IR），uric acid（UA）and triglycerides（TG）among the three groups（P＜0.05），but no statistically significant differences in homeostatic model assessment of β-cell function（HOMA-β）（P＞0.05）．The levels of FPG，FCP，HOMA-IR，UA and TG in the obese group were higher than those in the normal group（P＜0.05）；the levels of UA and TG in the overweight group were higher than those inthe normal group（P＜0.05）；the levels of FPG，HOMA-IR and UA in the obese group were higher than those in the overweight group（P＜0.05）．Spearman correlation analysis showed that HOMA-β was not correlated with BMI（r=0.046，P=0.461），but was positively correlated with UA and TG（r=0.226，P＜0.001；r=0.148，P=0.017），HOMA-IR was positively correlated with BMI，UA and TG（r=0.279，P＜0.001；r=0.284，P＜0.001；r=0.349，P＜0.001）．Multiple linear regression analysis showed that UA was the influencing factor of HOMA-β（P＜0.05），BMI，UA and TG were the influencing factors of HOMA-IR（P＜0.05）．Conclusions  In T2DM patients with long disease course，the level of insulin  resistance increased gradually with the increase of BMI，but the correlation between β-cell function index and BMI was not significant．At the same time，UA and TG are also factors affecting the function of islet β cells in patients with long-course T2DM．

       目的   探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法   选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果   高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论   高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。

       Objective  To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods  From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results  The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions  Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．