依那普利联合氯沙坦治疗老年糖尿病肾病合并高血压的疗效

目的观察依那普利联合氯沙坦治疗老年糖尿病肾病(DN)合并高血压的临床疗效。方法 70例DN患者随机分为观察组38例及对照组32例,对照组常规治疗的基础上给予氯沙坦治疗,观察组在对照组基础上加用依那普利,两组均连续治疗12周。结果两组均有较佳的降压疗效,组间无显著差异(P0.05);治疗后两组血肌酐(Scr)、尿素氮(BUN)及24小时尿微量白蛋白排泄率(UAER)均较治疗前显著下降(P0.01),且观察组显著低于对照组(P0.05或P0.01)。结论依那普利联合氯沙坦治疗老年糖尿病肾病合并高血压疗效确切,其对肾功能的改善效果较单用氯沙坦更优,且不增加不良反应。     

血沉、白细胞计数和C反应蛋白在糖尿病足评估中的作用

目的本文旨在评估炎性因子而对不同程度的糖尿病足病患者作出早期判断的策略。方法对68例不同程度的糖尿病足病患者入院分别进行血沉、白细胞计数和C反应蛋白的测定并作比较。结果 C反应蛋白在2级~4级的糖尿病足病患者中是最有价值的标记物,而血沉、白细胞计数无法预示其程度。结论在不同程度的糖尿病足病患者中C反应蛋白是一个有价值的预测因子。     

血清胱蛋白酶抑制剂C在老年2型糖尿病患者早期肾功能损害诊断中的价值

目的探讨血清胱蛋白酶抑制剂C（CysC）在老年2型糖尿病患者早期肾功能损害诊断中的价值。方法将45例平均年龄83岁2型糖尿病住院患者,采用胶乳增强免疫比浊法检测血清胱蛋白酶抑制剂C,同时检测血清肌酐（Scr）、血清尿素氮（Bun）、尿肌酐（Ucr）,β2微球蛋白（β2-MG）,推算肌酐清除率（Ccr）,比较两组患者Bun、Scr、Ccr、CysC、β2-MG,两组各检验方法阳性率结果比较。结果两组患者Bun、Scr、Ccr、CysC、β2-MG之间有统计学差异（P〈0．01）;在糖尿病组,CysC法阳性率为55．5％,Ccr法阳性率为86．7％,β2-MG法为60％（P〈0．001）,CysC法与β2-MG法阳性率接近。CysC与Scr、Ccr、β2-MG的相关性分析有统计学意义。结论CysC能够及早发现糖尿病肾病患者肾功能的变化,对其早期的诊断有意义,是一个有价值的指标。     

前列腺素E1治疗糖尿病周围神经病变的临床观察

目的研究前列腺素E1脂微球载体制剂治疗糖尿病周围神经病变的临床疗效。方法将166例糖尿病周围神经病变患者随机分为对照组（82例）和治疗组（84例）。在控制血糖的基础上给予治疗组PGE1治疗,通过神经电生理检查及临床症状比较其治疗效果。结果糖尿病患者在降糖的基础上应用PGE1治疗,周围神经病变的症状改善明显。     

老年糖尿病足患者自我管理现状及社会支持的定性分析

目的:了解老年糖尿病足(diabetic foot ulcer,DF)患者的日常自我管理及社会支持情况,为改善其健康管理效果提供证据。方法:采用目的抽样,对2013年12月~2014年1月在南京军区糖尿病足中心住院治疗的15例老年DF患者进行个人深入访谈。结果:患者能自我监测血糖,但饮食控制、足部保健和运动干预等非药物治疗能力不足;日常照护需求未得到满足。结论:应培养老年DF患者综合自我管理技能,将跨学科的专业化服务前移至社区,并发展我国社区老年健康照护体系。     

A comparison of ordinal logistic regression models using Classical and Bayesian approaches in an analysis of factors associated with diabetic retinopathy

Estimating the risk factors of a disease such as diabetic retinopathy (DR) is one of the important research problems among bio-medical and statistical practitioners as well as epidemiologists. Incidentally many studies have focused in building models with binary outcomes, that may not exploit the available information. This article has investigated the importance of retaining the ordinal nature of the response variable (e.g. severity level of a disease) while determining the risk factors associated with DR. A generalized linear model approach with appropriate link functions has been studied using both Classical and Bayesian frameworks. From the result of this study, it can be observed that the ordinal logistic regression with probit link function could be more appropriate approach in determining the risk factors of DR. The study has emphasized the ways to handle the ordinal nature of the response variable with better model fit compared to other link functions.     

Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus

Background: 25-(OH) vitamin D (VD) deficiency has been described as potential risk factor for the development of diabetes in many epidemiological studies. 25-(OH) VD deficiency and insulin resistance associated with this deficiency are common findings in patients with type 2 diabetes mellitus. The objective of this study is to evaluate the relationship between 25-(OH) VD levels and microalbuminuria.

Methods: The patients with type 2 diabetes mellitus aged between 40 and 65 years, who were admitted to the diabetes outpatient clinics of our hospital, were evaluated in two different groups. The first group consisted of 119 patients with insufficient 25-(OH) VD levels (10–30?ng/mL) and the second group consisted of 121 patients with 25-(OH) VD deficiency (≤10?ng/mL). The relationship between 25-(OH) VD levels and the level of microalbuminuria was evaluated in the two groups.

Results: The mean 25-(OH) VD level was 11.5?ng/mL and the mean HbA1c level was 9.1%. When the patient groups were evaluated according to 25-(OH) VD levels, HbA1c values were significantly higher in patients with a 25-(OH) VD level of 10?ng/mL or lower (p?=?.039). 25-(OH) VD levels were not significantly different between patients with different stages of renal failure (p?=?.119), whereas the level of microalbuminuria was significantly different (p?=?.030).

Conclusions: This study found that the level of microalbuminuria was significantly higher in patients with 25-(OH) vitamin D deficiency compared to patients with 25-(OH) VD insufficiency.     

NF-κB在糖尿病大鼠动脉粥样硬化作用机制的研究

目的探讨NF-κB在糖尿病大鼠动脉粥样硬化病变形成中的作用。方法Wistar大鼠随机分三组：链脲佐菌素诱导的糖尿病组（DM组）、NAC治疗组（NAC组）、对照组（C组）。分别于4w、8w、12w、16w检测血糖、胆固醇（TC）、甘油三酯（TG）、糖化血红蛋白（HbA1C）水平。于相应时间分别处死大鼠并分离和摘取主动脉,采用SP免疫组化或凝胶电泳迁移率（elec-trophoretic mobility Shift assay,EMSA）方法测定主动脉内皮NF-κB的DNA结合活性。结果①DM组、NAC组的血糖及HbA1C水平显著高于C组。②DM及NAC二组的TC、TG在4w、8w无显著变化,TC、TG在12w、16w时显著高于C组。③在12w、16w时,NF-κB结合活性在DM大鼠主动脉较对照组明显增强,NAC组较DM组减弱。④HE染色在DM组于12w、16w时出现AS的早期病理改变,而在NAC和C组未发现AS的病理改变。结论①DM大鼠大血管存在NF-κB的激活,并启动下游靶基因粘附分于ICAM-1的表达,进而导致DM大鼠动脉粥样硬化的发生与发展。因此NF-κB的激活可能是导致DM大鼠AS的始动因子之一。②高血糖是NF-κB不适当激活的又一因素,因此早期有效的控制血糖是防治DM鼠AS的基本策略。     

Mean residual weighted versus the length-biased Rayleigh distribution

In some statistical applications, data may not be considered as a random sample of the whole population and some subjects have less probability of belonging to the sample. Consequently, statistical inferences for such data sets, usually yields biased estimation. In such situations, the length-biased version of the original random variable as a special weighted distribution often produces better inferences. An alternative weighted distribution based on the mean residual life is suggested to treat the biasedness. The Rayleigh distribution is applied in many real applications, hence the proposed method of weighting is performed to produce a new lifetime distribution based on the Rayleigh model. In addition, statistical properties of the proposed distribution is investigated. A simulation study and a real data set are prepared to illustrate that the mean residual weighted Rayleigh distribution gives a better fit than the original and also the length-biased Rayleigh distribution.     

Discrete and continuous bivariate lifetime models in presence of cure rate: a comparative study under Bayesian approach

The modeling and analysis of lifetime data in which the main endpoints are the times when an event of interest occurs is of great interest in medical studies. In these studies, it is common that two or more lifetimes associated with the same unit such as the times to deterioration levels or the times to reaction to a treatment in pairs of organs like lungs, kidneys, eyes or ears. In medical applications, it is also possible that a cure rate is present and needed to be modeled with lifetime data with long-term survivors. This paper presented a comparative study under a Bayesian approach among some existing continuous and discrete bivariate distributions such as the bivariate exponential distributions and the bivariate geometric distributions in presence of cure rate, censored data and covariates. In presence of lifetimes related to cured patients, it is assumed standard mixture cure rate models in the data analysis. The posterior summaries of interest are obtained using Markov Chain Monte Carlo methods. To illustrate the proposed methodology two real medical data sets are considered.