血糖水平与急性脑梗死入院时神经功能的关系

为了观察血糖水平与急性脑梗死患者入院时神经功能的关系,我们对192例资料完整的首次发生急性脑梗死的患者进行临床研究。记录：年龄、性别、腰臀比、体重指数、血压、脑CT或MRI、空腹血糖、糖化血红蛋白、血脂、纤维蛋白原、C-反应蛋白、尿酸,入院时进行神经功能损伤评分。我们用欧洲卒中量表（ESS）、Barthel指数来评价脑梗死患者的神经功能。我们将血糖与ESS评分、Barthel指数纳入一元、多元线性回归分析。同时进行糖尿病组与非糖尿病组的梗死类型与梗死部位的比较。结果显示血糖水平与ESS评分、Barthel指数进行一元及多元线性回归分析,线性回归方程不成立。两组梗死类型及部位无差异性。结论为血糖水平与入院时患者神经功能损伤的严重程度无关。     

伴家族史的2型糖尿病危险因素的病例对照研究

为探讨2型糖尿病代谢特征及发病的危险因素,选取大连地区91例有家族史的T2DM患者为病例组,以44例患者的配偶（糖耐量正常）为对照组,进行流行病学问卷调查和体格检查,同时测定空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白等指标,采用稳态模型法计算两组的胰岛素抵抗指数和β细胞功能指数,并进行多因素非条件Logistic回归分析。结果显示：TG、腰臀比和Ln（HOMAIR）病例组高于对照组,而Ln（HOMAβ）则病例组低于对照组,均具有统计学意义（P〈0．05）。多因素非条件Logistic回归分析结果提示,影响T2DM发病的因素有心血管疾病史、Ln（HOMAIR）及Ln（HOMAβ）。由此可见T2DM患者存在血脂代谢异常;心血管疾病史和Ln（HOMAIR）为发病的危险因素,Ln（HOMAβ）为保护因素。     

若干新技术在糖尿病治疗中的应用

糖尿病是严重威胁人类健康的常见病,其治疗手段在不断进展和完善。近年来某些新科学技术在糖尿病治疗中发挥着重要作用,动态血糖监测和胰岛素泵的应用使糖尿病的治疗更加理想。     

Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

The current study examined fear of hypoglycemia in 81 mothers and 64 fathers of young children with type 1 diabetes (T1DM) using the Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC possible range = 26–130). Mothers and fathers completed the HFS-P-YC at enrollment and mothers completed it 2 weeks later. Families recorded daily blood glucose on a standardized meter for 2 weeks. Mothers’ mean total HFS-P-YC score was 75.0 (SD = 17.2) and fathers’ mean score was 66.5 (SD = 18.0). Mothers reported greater HFS-P-YC total and behavior subscale scores than fathers. Mothers’ HFS-P-YC scores were comparable to published HFS scores for mothers of preadolescents with T1DM and higher than adult patients with T1DM. The HFS-P-YC had good internal consistency and test–retest reliability in this sample. These findings suggest parents of young children with T1DM report a high level of fear of hypoglycemia. Additionally, the HFS-P-YC appears to be a reliable measure in this population.     

强化控制2型糖尿病患者血糖、血压＼血脂可降低尿白蛋白／肌酐比率

探讨2型糖尿病（T2DM）患者尿白蛋白／肌酐比率（UACR）的主要影响因素。89例T2DM患者实施血糖、血脂、血压强化控制,随诊1年并检测相关指标变化,统计学分析显示强化治疗后UACR降低,糖化血红蛋白和收缩压的变化值是影响UACR变化的主要因素。强化控制血糖、血脂、血压,尤其是严格控制糖化血红蛋白及收缩压,能减低糖尿病肾病发生的风险。     

小组治疗对2型糖尿病患者生活质量和临床指标的影响

观察小组治疗对2型糖尿病患者生活质量及糖代谢的影响。将67名2型糖尿病患者随机分为实验组和对照组。两组均给以降糖药物治疗,实验组并给予小组干预。每位患者均于治疗前、治疗后3个月末和5个月末检测糖代谢指标,治疗前和治疗后5个月末测查健康调查简表（SF-36）。结果为实验组临床指标改善优于对照组（P〈0．05）,实验组与对照组相比生活质量明显提高（P〈0．01）。结论认为小组治疗对改善糖尿病患者生活质量和糖代谢情况有着积极作用。     

The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes

We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples.     

老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

Knowledge and Attitudes Towards Genetic Testing: A Two Year Follow-Up Study in Patients with Asthma,Diabetes Mellitus and Cardiovascular Disease

Adequate knowledge and personal attitudes towards DNA-testing are major determinants of optimal utilization of genetic testing. This study aims to (1) assess the genetic knowledge and attitude towards genetic testing of patients with asthma, diabetes mellitus type II and cardiovascular diseases, (2) determine whether their knowledge or attitude changed since 2002, and (3) investigate the predictive role of knowledge on attitude. Data were collected within the Panel of Patients with Chronic Diseases in 2002 and 2004, resulting in 398 data-pairs. Results show that factual knowledge mainly relates to associations between genes and diseases, less is known on associations between genes, chromosomes, cells and body. The perceived knowledge on DNA-testing has not increased since 2002. The attitude towards genetic testing also appeared to be rather consistent. Less perceived medical genetic knowledge and more perceived social genetic knowledge were found predictive for a more reserved attitude towards genetic testing. In conclusion, advanced developments in the field of genetics are not accompanied by increased knowledge of patients with common multi-factorial diseases. The finding that more perceived social genetic knowledge results in more reluctance can be considered an indicator for the necessity of social debates on genetic testing.     

医学与人文

人文精神就是尊重人的价值,就是对生命价值的尊重,对头脑价值的尊重,对灵魂价值的尊重.生命是神圣的,对生命应有一种敬畏感.尊重自己的生命,同时尊重他人的生命;医生以生命为工作对象,医生应当是具有人格尊严、灵魂高尚的人道主义者;现代医学非人性化的主要表现是医学技术化和医学的市场化.