Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
Objective To search evidence of angiotensin-converting-enzyme inhibitors for microalbumin-uria in type 2 diabetes for guiding clinical practice. Methods We searched MEDLINE （ 1970 -Jun. 2005 ） to identify randomized controlled trials （RCT）of the effect on angiotensin-converting-enzyme inhibitors to prevent microalbuminuria in type 2 diabetes. Results One RCT （n =1 204）was identified. The result showed that angiotensin-converting-enzyme inhibitors were significantly more effective in prevention of microalbuminuria than other medicines in type 2 diabetes. However, angiotensin-converting-enzyme inhibitors may increase the risk of cardiac mortality. We explained the evidence to patients and they were satisfied with our explanation. Conclusions Angiotensin-converting-enzyme inhibitors can decrease the incidence of microalbuminuria in patients with type 2 diabetes and hypertension.
目的：了解糖尿病患者踝肱指数的影响因素。方法：采用多普勒血流探测仪测定68例糖尿病患者的踝肱指数(Anklebranchial index，ABI)，ABI比值小于0.9为低ABI组，大于1.3为高ABI组，在0.9到1.3之间(含1.3)为正常组。结果：本组病例中ABIlt; 0.9者11例，占16.18%，ABIgt; 1.3者8例，占11.76%。低ABI组与正常组比较，前者年龄大、病程长，其脉压、HbA1C、TG、冠心病合并率、视网膜病变发生率明显增高。高ABI组与正常组比较，前者年龄大、病程长，其脉压、HbA1C、TG明显增高，HDLC明显降低。多因素logistic逐步回归分析显示年龄、病程是导致ABI异常的危险因素。结论：多个因素影响糖尿病踝肱指数变化。
【摘要】 目的 分析老年甲状腺功能亢进性心脏病(HHD)的临床特点及不同心功能级别临床特点的差异。方法 收集2000年4月—2009年4月住院老年HHD(80例)与无HHD的老年甲亢患者(180例)临床资料,分析HHD不同心功能级别的临床情况差异。结果 HHD老年组病程(70.52±10.04)个月,合并骨质疏松13例,肝功能损伤11例；无HHD老年甲亢组病程(32.59±7.83)个月,合并骨质疏松7例,肝功能损伤8例,两组比较有统计学意义(Plt;0.05)。老年HHD组伴发心房颤动51例。心功能Ⅳ级甲状腺不大者6例,心功能Ⅰ级甲状腺不大者1例；心功能Ⅲ级甲状腺Ⅲ度肿大者3例,心功能Ⅰ级甲状腺Ⅲ度肿大者0例；心功能Ⅱ级平均住院时间(14.43±6.99)天,心功能Ⅰ级平均住院时间(9.56±3.00)天,比较有统计学意义(Plt;0.05)。结论 毒性弥漫性甲状腺肿是住院老年HHD最常见病因。老年HHD好发于病程长的患者,心律失常主要表现为心房颤动,病程越长心功能越差,心力衰竭程度与甲功及甲状腺肿大的程度不成比例。〖HT5”H〗【关键词】 〖HT5”SS〗老年；甲状腺功能亢进性心脏病；临床特点
Due to the coronavirus disease 2019 pandemic, the traditional outpatient and medical center pulmonary rehabilitation models for chronic obstructive pulmonary disease have been limited, while pulmonary rehabilitation technology has always been the focus of clinical and scientific research in rehabilitation. This article reviews the application status of remote pulmonary rehabilitation for chronic obstructive pulmonary disease under the coronavirus disease 2019 epidemic in recent years. From the selection and method of remote pulmonary rehabilitation equipment before the epidemic, to the development of rehabilitation forms and equipment innovation after the epidemic, the current status and problems of remote pulmonary rehabilitation are clarified. Establishing a remote pulmonary rehabilitation model in line with China’s national conditions is the direction and goal of future development.
ObjectiveTo construct the general practice tutors’ ability system in community training bases under the background of hospital-community integrated teaching of general practice.Methods From January to April 2021, literature analysis, expert group consultation, in-depth interview and questionnaire survey were conducted to construct the grass-roots general practice tutors’ ability system, and exploratory factor analysis method was applied, using main component analysis to extract the competency elements. Results There were 4 first level indicators and 20 second level indicators in the system, among which the first level indicators were personal characteristics and professionalism, teaching and research ability, basic level clinical practice ability, and base organization management ability. Conclusion This research enriches the indicators and connotations of the general practice tutors in community training base of general practice, and provides empirical research basis for the selection, ability training and performance evaluation of tutors in community practice bases of general practice medicine.
ObjectiveTo investigate the prevalence of impaired glucose regulation (IGR) and IGR combined with cardiovascular risk factors in rural areas of Chengdu City. MethodsFrom February to October 2010, we randomly sampled 1 016 patients in a rural community 100 kilometers away from the city center as the study subjects. The investigation was carried out by using questionnaire survey, physical examination and laboratory tests. The standard 75 g oral glucose tolerance test was used. ResultsA total of 1 016 subjects were investigated, among whom there were 431 males and 585 females with an average age of 56 years old. Of these subjects, 333 were diagnosed to have IGR with a rate of 32.77% (333/1 016). The age-adjusted standardized prevalence of pre-diabetes in rural areas in Chengdu was 32.52% (336/1 016), and the male and female prevalence were respectively 30.63% (132/431) and 34.36% (201/585) without significant difference (χ2=1.569，P=0.210). Impaired glucose tolerance (IGT) was the most common type of glycometabolism abnormality. Women had a significantly higher prevalence of IGT than men. In IGR population, major cardiovascular risk factors were overweight and obesity (40.8%), high low density lipoprotein cholesterol (38.4%), high triglyceride (30.3%), hypertension (23.7%), smoking (24.3%), and drinking alcohol (23.7%). The stratified analysis showed that the prevalence of overweight, obesity and low high density lipoprotein cholesterol in female was significantly higher than that in males, while the prevalence of smoking and drinking alcohol was significantly higher in males. ConclusionIn rural areas, the prevalence of pre-diabetes is high and complicated with multiple cardiovascular risk factors.