目的:探讨老老年患者颈动脉中层厚度(IMT)及其相关危险因素的关系,为老老年患者心脑血管疾病的预防及治疗提供临床参考。方法:根据年龄将139例老老年患者纳入分析,有血糖、血压、血脂代谢紊乱的123例作为观察组,无血糖、血压、血脂代谢紊乱的16例作为对照组,分别进行颈动脉超声检查、动态血压监测、糖化血红蛋白及血脂等生化指标检查,并结合临床资料进行分析。结果: 老老年患者均无一例外地存在着IMT增厚,在相同的年龄情况下,吸烟史、血脂紊乱、糖调节异常、血管炎症反应与IMT的增厚呈正相关,各组未显示出统计学差异,IMT的发生发展与年龄、性别、吸烟史、血糖、血压控制水平及血脂紊乱等因素在两组对照中均未显示出统计学差异,多因素Logistic回归分析,显示年龄、吸烟史及病程为危险因素(OR为0500～1196)。结论:老老年患者均不同程度地存在着IMT增厚,其中增龄是其最主要的危险因素,但是对合并有血糖、血压、血脂代谢紊乱的老老年患者也应该积极重视对各种危险因素的筛选和干预,特别在疾病发生发展的早期可能对延缓病变的进展和减少心脑血管事件有一定意义,可是其用药的安全性在该类患者就显得尤为重要。
By reviewing the current status of chronic pain and combining with the new definition of pain revised by the International Association for the Study of Pain in 2020, firstly a prevention-based approach, self-management of pain, and multidisciplinary collaboration based on the integration of bio-psycho-social-environmental factors is proposed. The medical mode will greatly improve the treatment effect of chronic pain and the quality of life of patients. Secondly, the importance of strengthening humanistic care and paying attention to health education, as well as improving medical staff’s awareness of chronic pain and the level of diagnosis and treatment are pointed out. Finally, it is clarified that innovative non-drug treatments and the establishment of digital pain management platforms are the future of chronic pain.
【摘要】 目的 探讨2型糖尿病（T2DM）胰岛素抵抗导致糖尿病性心功能不全的临床表现特点及相关激素的改变。 方法 2008年1-4月对T2DM患者35例（胰岛素抵抗指数HOMA-IRlt;2.69者19例为A1组，HOMA-IR≥2.69者16例为A2组）及健康体检者20人B组测体重指数（BMI）、空腹血糖（FPG）、胰岛素、心钠素（ANP）、脑钠素（BNP）水平；心脏彩色多普勒超声分别测E/A、e/a、S/D、LVEF、DT期。 结果 A2组BMI较A1、B组均明显增加（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。ANP、BNP及DT值在A1、A2组均较B组增高（Plt;0.05），BNP在A2组高于A1组（Plt;0.05），ANP、DT值在A1、A2组间差异均无统计学意义（Pgt;0.05）。E/A、e/a和S/D在A1、A2组均较B组降低（Plt;0.05），A1、A2组间差异均无统计学意义（Pgt;0.05）。A2组患者LVEF较A1、B组均明显降低（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。 结论 随着胰岛素抵抗加重，心肌舒张顺应性较差和收缩力下降，伴随相关激素（心脏利钠肽）分泌增加，最终产生心功能不全的临床表现、体征及多普勒超声心动图表现。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.