October 2013, Volume 16, No.29 Abstracts

 The British New Health and Care System and Its Implications for China

FAN Xiao-jiao. School of Public Affairs, Xiamen University, Xiamen 361005,China

Abstract In 2013,the British Department of Health declared a new reform plan of the National Health ServiceNHSsystem to establish a set of health services (the New Health and Care System, HCS) taking community health services as its core. In this paper, we firstly did a brief review of the HCS system, then introduced the NHS reform, lastly analyzed the development status of community health service in China through comparing it with the NHS system.The new HCS system extended the scope of the health service providers and shifted the health services delegated authority from central government to local ones, forming a multi-level medical security system with community health services as its core, where services providers, supporters, supervisors, duty offices should cooperate with each other. To develop community health service in China, the government should make efforts on establishing a classified medical service system, formulating the inner market of health service, and building its independent supervision department while enhancing inter-organization cooperation. The British health service system reform offers significant implications for the building of Chinese health service.

Key words Community health service; Progressive patient care; National health, British

Relationship between Type 2 Diabetic Nephropathy and Serum Bilirubin Levels

JIA Yu-mei,ZHAO Yong-zhen, XU Yuan,et al.Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020, China

Abstract Objective To investigate the relationship between type 2 diabetic nephropathy and serum bilirubin levels.

Methods A total of 1 217 T2DM patients hospitalized in this hospital from August 2010 to June 2012 were divided,based on levels of estimated glomerular filtration rate (eGFR), into groups AeGFR90 mlmin-1(1.73 m2)-1, n=891,B60 mlmin-1(1.73 m2)-1eGFR90 mlmin-1(1.73 m2)-1, n=256,CeGFR60 mlmin-1(1.73 m2)-1, n=70,and based on 8 h urinary albumin excretion rate(UAER),into groups a(UAER20 μg/min,n=946),b(20 μg/minUAER200 μg/min,n=193),c(UAER200 μg/min,n=78).Serum bilirubin levels were analyzed comparatively in all groups.

Results There was significant difference in serum bilirubin levels in groups A,B,C(P0.05), thereinto higher in group A than in group B,higher in group B than in group C(P0.05).There was significant difference in serum bilirubin levels in groups a,b,c (P0.05),thereinto higher in group a than in group b, higher in group b than in group c(P0.05).Logistic regression analysis showed that triglyceride, bilirubin and course of disease entered into the equation, OR values(95%CI) were 1.0811.021, 1.138, 0.8840.838,0.932,1.1031.013, 1.211, respectively.

Conclusion Bilirubin level,associated with the development of type 2 diabetic nephropathy,plays a protective role in renal lesions.

Key words Diabetes mellitus, type 2; Diabetic nephropathies; Bilirubin; Glomerular filtration rate

Correlation between Blood Glucose Fluctuation and Oxidative Stress in Patients with Type 2 Diabetic Nephropathy

ZHANG Jie, DONG Shan-shan, KANG Yan, et al.Department of Endocrinology, the First Hospital of Hebei Medical University, Shijiazhuang 050031, China

Abstract Objective To explore the correlation between blood glucose fluctuation and oxidative stress in patients with type 2 diabetic nephropathy.

Methods From December 2011 to March 2013, 120 patients with type 2 diabetes mellitus(HbA 1c<7%were treated in Endocrinology Department of the First Hospital of Hebei Medical University, their blood sugar levels were controlled well, they were divided into three groups according to their uriary albumin excretion rates(UAER)normal UAER group(DM group, UAER<20 μg/min, 40 cases), microalbuminuria group(NA group, 20 μg/minUAER<200 μg/min, 40 cases), and macroalbuminuria group(MA group, UAER200 μg/min, 40 cases), and thirty healthy physical examiners were included in control group(NC group).The general clinical data and oxidative stress level(SOD and MDA) were observed among four groups, and mean amplitude glycemic excursions(MAGE), mean of daily differencesMODD were measured in diabetic patients with continuous glucose monitoring system(CGMS).

Results There were statistical significances in the four groups in MAGE, MODD, SOD and MDA levelsP0.01.The MAGE in DM, NA and MA groups were4.1±1.3, 5.9±2.4, 6.9±1.6mmol/L, and the MODD were2.3±0.3, 4.0±0.5, 5.0±0.4mmol/L, separately, the MAGE and MODD increased in group sequence, significant differences of MAGE and MODD levels were found between groupsP0.05).The levels of SOD in NC, DM, NA and MA groups were93±14, 80±12, 77±11, 72±12kU/L, separately, the levels of SOD decreased in group sequence, significant difference of SOD level was found between groupsP0.05).The levels of MDA in NC, DM, NA and MA groups were2.5±1.0, 4.0±0.8, 6.0 ±1.2), 7.4±1.0nmol/L, separately, the levels of MDA increased in group sequence, significant difference of MDA level was found between groupsP0.05).Correlation analysis showed that MAGE and MODD were negatively correlated with SODr=-0.431 and -0.527, both P0.05), and were positively correlated with MDA level(r=0.532 and 0.625, both P0.05).

Conclusion Among patients with type 2 diabetes mellitus nephropathy whose blood sugar levels were controlled well, blood glucose fluctuation involved in the occurrence and development of type 2 diabetic nephropathy, and the mechanism may be related to oxidative stress.

Key words Diabetic nephropathies; Oxidative stress; Malondialdehyde; Superoxide dismutase; Blood glucose fluctuation

Relationship between Serum Adenylate Deaminase and Microalbumin to Creatinine Ratio in T2DM Nephropathies Patients

BAO Guo-xiang, FU Li-xing.Peoples Hospital of Shaoxing City,Shaoxing 312000,China

Abstract Objective To explore the relationship between serum adenylate deaminase(ADA) and microalbumin to urinary albumin to creatinine ratio(ACR) in type 2 diabetes mellitus(T2DM) nephropathies patients.

Methods One hundred and sixteen T2DM nephropathies patients admitted to this hospital from August to December 2012 were divided,based on serum ADA level,into groups A(ADA18.0 U/L, n=66),B(ADA18.0 U/L, n=50),and 50 healthy subjects were enrolled as control group. The relationship between serum ADA levels and ACR were compared in 3 groups.

Results The levels of serum ADA and ACR were higher in groups A,B than in control group(P0.05),and higher in group B than in group A(P0.05).Levels of ADA were positively correlated with ACR in 3 groups(r=0.560, 0.713, 0.846, respectively; P=0.00, 0.00, 0.00, respectively).

Conclusion The levels of ADA and ACR are higher averagely in T2DM nephropathies patients than in normal healthy group, and ADA is positively correlated with ACR.

Key words Diabetes mellitus, type 2; Diabetic nephropathies; Albuminuria; Adenosine deaminase; Creatinine

Effect of Transient Cerebral Ischemia on Secondary Cerebral Infarction and Its Risk Factors

QI Ya-chao, XIAO Xiang-jian, DUAN Rui-sheng, et al.Department of Neurology, Hebei General Hospital, Shijiazhuang 050000, China

Abstract Objective To investigate the effect of transient ischemic attack(TIAon secondary cerebral infarction and its risk factors.

Methods A total of 128 patients with cerebral infarction treated in our hospital from December 2010 to December 2011 were included in this study. Based on the occurrence of ipsilateral TIA,the patients were divided into two groups, namely the test group of 49 patients with TIA and the control group of 79 patients without TIA. The cerebral infarction volume, neurological deficits, prognostic classification, and the laboratory results such as blood glucose, blood lipid, the levels of serum creatinine and fibrinogen were compared between the two groups. And multivariate Logistic regression was performed to determine the influence factors.

Results The volume of cerebral infarction, the degree of neurological deficits, and the level of serum fibrinogen were lower in test group than those in the control group(P0.05),while the prognosis of the test group was better than that of the control group. Multivariate Logistic regression analysis showed that fibrinogen was significantly correlated with TIA in patients with cerebral infarction(P0.05 ).

Conclusion TIA may reduce the volume of cerebral infarction and the neurological injury, and improve the prognosis of the patients, which might be related to the brains tolerance to ischemia. Fibrinogen is one risk factor of secondary cerebral infarction, whose level can be used as auxiliary index of the prognosis of patients with TIA.

Key words Ischemic attack, transient; Brain infarction; Fibrinogen; Risk factors

Relationship of Non-alcohol Fatty Liver Disease to Metabolic Syndrome and Insulin Resistance in Type 2 Diabetes Mellitus Patients

XU Xiang-hong, JIN Xing, CHEN Ying-yue, et al.Department of Endocrinology, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China

Abstracts Objective To explore the relationship of non-alcohol fatty liver diseaseNAFLDto metabolic syndrome and insulin resistance(IR)in patients with type 2 diabetes mellitusT2DM.

Methods A total of 1 105 T2DM patients admitted to this hospital from January 2010 to December 2011 were divided,according to whether combined with NAFLD,into groups A(T2DM without NAFLD,n=472),B(T2DM with NAFLD,n=633).The clinical data were analyzed retrospectively.

Results Waist circumference,hip circumference,body mass indexBMI,diastolic blood pressure, uric acid, total cholesterol, triglyceridesTG, low-density lipoproteinLDL-C, alanine transarninaseALT, glutamic oxaloacetic transaminaseAST, glutamyl endopeptidase, fasting C-peptide, and postprandial C-peptide were significantly higher in group B than in group A(P0.05); Age, blood urea nitrogen, creatinine and high-density lipoprotein significantly lowerP0.05; Duration of diabetes significantly shorter(P0.05); The incidence of metabolic syndrome and hyperlipidemia significantly higher(P0.05).Logistic regression analysis showed that BMI,TG,LDL-C,ALT were independent risk factors of NAFLD,HDL-C was a protection factor.

Conclusions NAFLD is closely associated with obesity, hyperlipidemia and IR. Patients with T2DM combined with NAFLD have high IR level with a higher incidence of metabolic syndrome.

Key words Diabetes mellitus, type 2; Fatty liver, non-alcoholic; Metabolic syndrome; Insulin resistance

Relationship between Bone Mineral Density and Serum Bone Metabolism Biomarkers in Patients with Chronic Kidney Disease

TUO Su-xin, QIAN Yi-xin, YANG Li, et al.Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital of the Second Military Medical University, Shanghai 200003, China

Abstract Objective To observe the changes of bone mineral density(BMD)and serum bone metabolism biomarkers in different stages of chronic kidney diseaseCKD, and to analyze the relationship between them.

Methods A total of 228 CKD patients admitted to this hospital from March to December 2011 were divided, according to estimated glomerular filtration rate(eGFR)calculated by EPI formula, into group 1(eGFR90 ml/min, n=24),2(60 ml/mineGFR90 ml/min, n=33),3(30 ml/mineGFR60 ml/min, n=45),4(15 ml/mineGFR30 ml/min, n=51),5(eGFR15 ml/min, having not had dialysis treatment, n=39),6(having had regular dialysis treatment, n=36).Serum alkaline phosphatase (ALP),calcium(Ca),phosphorus(P),intact parathyroid hormone (iPTH) and calcaneal BMD were determined.

Results There was no significant difference in serum Ca level in the 6 groups(P0.05),but there was in levels of serum P,iPTH,ALP and BMD(P0.05).The levels of serum P,iPTH were averagely higher in group 3 than in groups 1, 2; Higher in group 4 than in groups 1,2,3;Higher in groups 5,6 than in groups 1,2,3,4,and the level of serum iPTH in group 6 higher than in group 5.The levels of ALP was higher in group 6 than in groups 1,2,3,4,5.BMD was lower in group 2 than group 1;Lower in group 3 than in groups 1,2;Lower in group 4 than in groups 1,2,3;Lower in groups 5,6 than in groups 1,2,3,4;Lower in group 6 than in group 5.By Pearson regression analysis,BMD was positively correlated with serum P, iPTH (r=0.45,0.58,P0.05),and not linearly correlated with serum Ca, ALP. Serum P was positively correlated with serum iPTH(r=0.57,P0.05),negatively with serum Ca(r=-0.25,P0.05).

Conclusion With the worsening of CKD, calcaneal BMD decreases gradually and is negatively correlated with serum P, iPTH.

Key words Chronic kidney disease; Bone density; Parathyroid hormone; Metabolism

Relationship of BP Variability to Cerebral Infarction in Essential Hypertension Patients

XU Chao, PANG Xiao.Department of Cardiology, the First Affiliated Hospital of Medical College of Shihezi University, Shihezi 832000, China

Abstract Objective To analyze the relationship of blood pressureBPVariablity to cerebral infarctionCI.Methods A total of 189 patients with essential hypertensionEHhospitalized from January 2011 to July 2012 were divided into groups Awith EH without CI, n=65, Bwith EH combined with asymptomatic CI, n=67, Cwith EH combined with symptomatic CI, n=57.The 24 h ambulatory BP monitoring was used ,and general information, average BP and BP variability compared.Results The average age was higher in groups B, C than in group A, the difference was significantP0.05.The 24 h systolic blood pressureSBP, 24 h diastolic blood pressureDBP, daytime SBP, daytime DBP, nighttime SBP, nighttime DBP were higher in groups B, C than in group A, the difference was significantP0.05.The 24 hSBP variability24 hSBPV, daytime SBP variability dSBPV) were higher in groups B, C than in group AP0.05.Conclusion Average BP, 24 hSBPV, dSBPV are dangerous signals for elderly EH patients, which is should be paid attention to.

Key words Hypertension; Brain infaction; Blood pressure variability

Effect of Different Feeding Patterns on Infants Growth and Nutrition

LIU Ting-ting, ZENG Ping, ZHONG Jun, et al.Shiqiaopu Community Health Service Center of Jiulongpo District, Chongqing 400039, China

Abstract Objective To explore the influence of different feeding patterns on infants growth and nutrition.Methods The feeding patterns were investigated,height,body mass measured at the age of 3,6,9 months,growth and nutrition assessedlength for age Z scores(LAZ) and weight for age Z scores(WAZ) were calculated in 345 healthy infants for physical examinations.Results There was no significant difference in height,body mass,LAZ or WAZ in infants receiving different feeding patterns at 3,6,9 months old(P0.05),but there was in nutrition between infants receiving mixed,artificial or breast feeding at 9 months old(P


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