黄芪六一汤对2型糖尿病大鼠降糖作用的机制研究

目的:探讨黄芪六一汤对糖尿病大鼠的降糖作用及其机制。方法:采用高脂高糖饲养合并腹腔注射链脲佐菌素(30 mg/kg)建立糖尿病大鼠模型。造模成功的大鼠随机分为模型组、达格列净阳性对照组及黄芪六一汤低、中、高剂量组。实验期间每周称体质量,尾静脉采血测量空腹血糖、糖化血红蛋白及胰岛素的含量;蛋白免疫印迹法(Western blot)测定2型葡萄糖转运蛋白(GLUT2)和钠-葡萄糖转运蛋白(SGLT2)的表达;荧光定量PCR分别检测GLUT2、SGLT2 mRNA表达。结果:与正常对照组比较,模型组大鼠体质量显著降低,血糖、糖化血红蛋白水平及SGLT2、GLUT2蛋白表达显著升高(P<0.01);与模型组比较,黄芪六一汤各组糖化血红蛋白、SGLT2蛋白表达均显著降低,GLUT2蛋白表达显著升高(P<0.05或P<0.01)。黄芪六一汤对模型大鼠体质量及GLUT2、SGLT2 mRNA表达无明显影响。结论:黄芪六一汤对高脂高糖饲养合并腹腔注射STZ致糖尿病大鼠具有降糖作用,治疗效果与达格列净相似,其作用机制与抑制SGLT2蛋白功能有关。

耐多药结核病患者营养风险筛查及影响因素分析

目的 探讨MDR-TB患者的营养风险状况及影响因素,为营养干预提供参考。方法 应用营养风险筛查2002(nutritional risk screening 2002,NRS2002)对241例MDR-TB患者进行营养风险筛查,评分<3分的患者纳入无营养风险组,评分≥3分的纳入营养风险组,先采用单因素分析初步筛选可能的影响因素,再采用Logistic多因素回归分析进行筛选。结果 按照NRS2002评分标准,MDR-TB患者存在营养风险发生率为57.26%(138/241);单因素分析显示家庭月收入、职业、婚姻状况、居住地、初治/复治、体重下降>5%、肺叶受累情况、年龄、血红蛋白、白蛋白、BMI等11项因素有统计学意义(P<0.05),再进行多因素Logistic回归分析,最终进入回归模型的因素为初治/复治、体重下降>5%、白蛋白,调整的OR值及OR 95%CI分别为4.184(2.163~8.093)、1.524(1.093~2.126)、1.164(1.105~1.227)。结论 营养师对复治MDR-TB患者、体重下降>5%、白蛋白降低的MDR-TB患者给予重点关注营养状况。采用适用的营养干预措施,改善患者的营养不良,提高MDR-TB的治疗效果。

广西地区HIV/AIDS患者院内信息化转介状况及影响因素分析

目的探讨广西地区HIV/AIDS患者院内信息化转介状况及相关影响因素,为提高HIV/AIDS院内转介成功率,避免患者流失提供依据。方法以2017年1月—2019年12月广西艾滋病临床治疗中心院内转介成功HIV/AIDS患者为对照组,未转介成功患者为观察组,收集患者性别、年龄、民族、地区、医师性别、HIV初筛阳性、CD4;T淋巴细胞、失访者、接收人员沟通9项因素,采用Logistic回归分析影响因素与转介的关系。结果3383例HIV/AIDS患者转介成功2715例,转介成功率80.25%。转介成功的HIV/AIDS患者中,24 h内转介成功占96.46%。2017—2019年院内HIV/AIDS患者转介成功率依次升高,分别为68.33%、79.96%、92.20%,差异有统计学意义(χ^(2)=207.760,P<0.05)。将地区、医师性别、HIV初筛阳性、CD4;T淋巴细胞、失访者、接收人员沟通6项单因素分析差异有统计学意义的因素纳入多因素Logistic回归分析,最终进入回归模型的因素为HIV初筛阳性、CD4;T淋巴细胞、失访者、接收人员沟通,其调整的OR值及95%CI分别为1.523(1.100~2.110)、1.475(1.095~1.988)、0.236(0.057~0.980)、0.590(0.441~0.788)。结论2017—2019年广西艾滋病临床治疗中心HIV/AIDS患者院内信息化转介效果逐年提升,影响HIV/AIDS患者转介成功的危险因素为HIV初筛阳性和CD4;T淋巴细胞≥200个/mm^(3),失访者和接收人员沟通也有利于转介成功。

Diagnosis of pulmonary tuberculosis among asymptomatic HIV＋ patients in Guangxi, China

Background Pulmonary tuberculosis （PTB） among asymptomatic Chinese patients with HIV infection has not been investigated despite high tuberculosis burden in China. This study was aimed to evaluate the prevalence, risk factors and clinical outcomes of PTB among asymptomatic patients with HIV/AIDS in Guangxi to facilitate the development of diagnostic and treatment strategies.Methods All asymptomatic adult HIV-infected patients with CD4 ＜350 cells/μl who attended four HIV clinics in Guangxi between August 2006 and March 2008 were evaluated for active PTB with physical examination, chest X-ray （CXR）,sputum smear and/or sputum liquid culture. Data were described using median （interquartile range, IQR） and frequencies.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with PTB.Results Among 340 asymptomatic subjects, 15 （4%） were diagnosed with PTB, with 4 （27%） sputum smear positive and 8 （53%） sputum culture positive. CXR has higher diagnostic sensitivity （87%） than sputum smear （25%） and sputum culture （67%）, but lower specificity （56%） compared with sputum smear （99%） and culture （100%）. In univariate analysis,injection drug user, body mass index （BMI） ＜18 kg/m2, CD4 ＜50 cells/μl and presence of peripheral lymphadenopathy were associated with an increased risk of asymptomatic PTB, while in multivariate analysis only peripheral lymphadenopathy maintained statistical significance （OR=7.6, 95% CI 1.4-40）. Patients with negative smear and minor or no abnormalities on CXR had longer interval between screening and TB treatment.Conclusions PTB was relatively common in this group of HIV＋ asymptomatic Chinese patients. Diagnosis is challenging especially where sputum culture is unavailable. These findings suggest that an enhanced evaluation for PTB needs to be integrated with HIV care in China and transmission prevention in China to control at both households and health care facilities, especially for patients with factors associated with a higher risk of PTB.