多学科团队协作在1例重症异位ACTH综合征高皮质醇血症的护理管理实践

异位促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)综合征是由垂体以外的肿瘤细胞分泌大量ACTH,刺激双侧肾上腺增生并过度分泌皮质醇所致的库欣综合征。重症异位ACTH综合征临床少见,病因诊断困难,预后差,高皮质醇血症导致的病死率远高于肿瘤本身,如不积极治疗干预,病死率可达100%[1]。本次研究回顾性分析1例异位ACTH综合征患者的临床资料及诊治经过,旨在提高对重症异位ACTH综合征的护理水平,现报道如下。

TG/HDL-C与胰岛素抵抗的相关性研究

目的探讨TG/HDL-C与胰岛素抵抗(IR)的相关性。方法选取杭州市某社区40~65岁的自然居民960例为研究对象,收集体格检查、实验室检测资料,计算稳态模型评估的IR指数(HOMA-IR)。分析IR影响因素以及其对IR的预测效能。结果960例受试者中,IR(HOMA-IR≥2.69)389例,非IR 571例。经单因素logistic回归分析显示,年龄、BMI、腰围、臀围、收缩压、舒张压、腹内脂肪面积(VFA)、皮下脂肪面积、TG、TC、HDL-C、LDL-C、TG/HDL-C、TC/HDL-C、LDL-C/HDL-C与IR有关(均P<0.05);经多因素logistic回归分析显示,腰围、收缩压、VFA、TG、TG/HDL-C是IR的独立影响因素(均P<0.05)。单独TG/HDL-C、TG预测IR的效能较低,AUC分别为0.674、0.664;TG/HDL-C、收缩压、腰围联合预测IR的AUC为0.755,TG、收缩压、腰围联合预测IR的AUC为0.751,较单独TG/HDL-C、TG预测IR的效能明显提升。结论TG/HDL-C是IR的独立影响因素,其与腰围、收缩压联合预测IR的效能较好。

Correlation between the Amplitude of Glucose Excursion and the Oxidative/Antioxidative System in Subjects with Different Types of Glucose Regulation

Objective To investigate effects of glucose excursion on the oxidative/antioxidative system in subjects with different types of glucose regulation. Methods A total of 30 individuals with normal glucose regulation (NGR), 27 subjects with impaired glucose regulation (IGR) and 27 subjects with newly diagnosed type 2 diabetes mellitus (T2DM) were selected and recruited for 3 days’ continuous glucose monitor system (CGMS) assessment. The data from CGMS was used to calculate the mean amplitude of glycemic excursion (MAGE), mean blood glucose (MBG) and its standard deviation (SDBG), area under the ROC curve when the blood glucose 5.6 mmol/L within 24 h (AUC 5.6), mean of daily differences (MODD), and mean postprandial glucose excursion (MPPGE). In all groups, the content or activity of malondialdehyde (MDA), total antioxidation capacity (TAOC) and glutathione peroxidase (GSH‐Px) were detected. Results Glucose excursion parameters of subjects with T2DM or IGR were higher than those of NGR subjects (P0.05 or 0.01). Moreover, Glucose excursion parameters of T2DM subjects were higher than those of IGR subjects (P0.05 or 0.01). Subjects with T2DM or IGR had significant higher MDA levels and lower GSH‐Px/MDA and TAOC/MDA levels compared to NGR subjects (P0.01). T2DM subjects had even higher MDA levels and lower GSH‐Px/MDA levels than IGR (P0.05 or 0.01). According to the median of normal population for MAGE, T2DM and IGR subjects were divided into MAGE2.6mmol/L Group and MAGE≤2.6mmol/L Group. MAGE2.6mmol/L Group had higher levels of MDA and lower levels of GSH‐Px/MDA than MAGE≤2.6mmol/L Group (P0.05). There was no significant difference between the two groups (P0.05) in terms of the levels of TAOC/MDA. Pearson correlation analysis showed that MDA was positively correlated with FPG, 2hPG, MAGE, and SBP. GSH‐Px/MDA was negatively correlated with MAGE and TC. TAOC/MDA was negatively correlated with FPG. Partial correlation analysis showed that the relationship between MDA and MAGE, GSH‐Px/MDA, and MAGE remained significant after adjustments for the other differences among groups. Conclusion Glucose excursion contributed significantly to promoting lipid peroxidation and decreasing antioxidation capacity than chronic sustained hyperglycemia did in the subjects with different types of glucose regulation.

住院患者低钠血症的患病率和病因分析

目的探讨住院患者低钠血症的患病率及相关病因,低钠血症对死亡的影响。方法回顾性分析2014年1—4月在浙江大学舟山医院住院的525例年龄≥14岁的低钠血症患者,按照低血钠程度分为轻、中、重度低钠血症组,分析各组的常见病因,并应用logistic回归模型分析低钠血症对患者死亡的影响。结果(1)该时段全院≥14岁住院患者9989例,低钠血症患者525例,患病率5.26%,老年患者(≥60岁)患病率为6.1%(264/4334)。(2)恶性肿瘤、感染性疾病在各组中均多见,脑出血在中、重度组多见。恶性肿瘤中肺癌最多,感染性疾病中肺炎最多;中、重度组脑出血中颅脑外伤致蛛网膜下腔出血最多。老年患者以恶性肿瘤、感染性疾病比例最高。(3)低钠血症中抗利尿激素分泌不当综合征(syndrome of inappropriate antidiuretic hormone secretion,SIADH)和脑耗盐综合征(cerebral salt-wasting syndrome,CSWS)的比例分别为13.7%和3.8%,老年患者中SIADH和CSWS的比例分别为17.4%和4.2%。(4)中、重度组排钠药物使用比例较轻度组更高(42.2%比21.4%,43.2%比21.4%,P值均<0.05)。(5)Logistic回归分析显示,中度组死亡风险是轻度组的6.92倍(95%CI 2.53~18.92,P<0.001),重度组死亡风险是轻度组的4.54倍(95%CI 1.05~19.58,P=0.043),而重度与中度组死亡风险差异无统计学意义。结论低钠血症是住院患者常见的电解质紊乱,主要的原发病因为恶性肿瘤(肺癌)、感染性疾病(肺炎)和脑出血,伴发SIADH和CSWS是上述疾病导致低钠血症的重要原因,排钠药物的使用更易发生中重度低钠血症。与轻度组比较,中、重度低钠血症增加住院患者死亡风险。

进食速度与肥胖的相关性分析

目的探讨进食速度与肥胖的关系。方法选取杭州市采荷街道40~65岁居民644名,收集人口学资料,完成居民健康调查问卷、体格检查和实验室检查。根据进食速度将研究对象分为非快速进食组和快速进食组。比较2组间肥胖相关指标的差异,并采用logistic回归模型分析进食速度与肥胖的关系。结果快速进食组的体重指数、腰围、内脏脂肪面积均大于非快速进食组(均P<0.01)。多元logistic回归分析显示,校正性别、年龄、吸烟、饮酒、每周体力活动水平及主食摄入量之后,与非快速进食比较,快速进食与腹型肥胖(OR=1.66,95%CI 1.11~2.48,P=0.014)、内脏型肥胖(OR=1.65,95%CI 1.14~2.39,P=0.007)有显著相关性。进一步按照性别分层后,男性研究对象中,快速进食与腹型肥胖(OR=2.04,95%CI 1.07~4.04,P=0.032)、内脏型肥胖(OR=1.85,95%CI 1.04~3.31,P=0.037)有显著相关性;女性研究对象中,快速进食与超重及肥胖(OR=1.59,95%CI 1.04~2.42,P=0.031)有显著相关性。结论进食速度过快与肥胖症患病风险升高存在相关性。对进食速度进行干预,或许有利于控制体重。