目的:探讨胰腺超声弹性参数与2型糖尿病患者胰岛功能的相关性。方法:选取2022年3月—9月空军军医大学第二附属医院收治的2型糖尿病患者153例为研究组,选取同期健康体检人群153名为对照组。纳入对象均行超声剪切波弹性成像检查,比较两组胰体和胰头弹性定量参数。比较两组胰岛功能相关实验室指标,包括空腹血糖、糖化血红蛋白、餐后2 h血糖、胃泌素、胰高血糖素、空腹C肽、餐后2 h C肽、空腹胰岛素和餐后2 h胰岛素水平。观察胰腺超声剪切波弹性参数与2型糖尿病患者胰岛功能的相关性。结果:研究组的胰体和胰头剪切波速度(SWV)均高于对照组,研究组空腹血糖、糖化血红蛋白、餐后2 h血糖含量、胃泌素、胰高血糖素均高于对照组,差异有统计学意义(P<0.05);研究组空腹C肽、餐后2 h C肽、空腹胰岛素、餐后2 h胰岛素水平均低于对照组,差异有统计学意义(P<0.05);胰头的SWV值与空腹C肽呈负相关(r=-0.369,P<0.05),胰体的SWV值与空腹C肽呈负相关(r=-0.458,P<0.05)。结论:对胰腺进行超声剪切波弹性成像检查,有助于对2型糖尿病患者胰岛功能进行实时观察,有一定的临床应用价值。
目的:构建基于甘油三酯葡萄糖指数(triglyceride-glucose index, TyG)联合预测冠状动脉粥样硬化性心脏病[以下简称为冠心病(coronary heart disease, CHD)]患病风险的预测模型,并验证该模型的预测性能。方法:选取2020年1月至2023年3月泰安市中心医院收治的已行冠状动脉造影检查的患者为建模研究对象,根据冠状动脉造影结果分为冠心病组(732例,67.97%)和非冠心病组(365例,33.03%),比较两组一般资料及临床特征,采用多因素Logistic回归分析构建预测模型,绘制该预测模型的受试者工作特征(receiver operating characteristic, ROC)曲线及曲线下面积(area under the curve, AUC)分析评价该模型的预测效能,再通过选取2024年1月至2024年12月山东大学第二医院收治的已行冠状动脉造影检查的患者为验证模型的研究对象进行模型的外部验证。结果:TyG指数、年龄、纤维蛋白原是CHD发生的独立危险因素,既往是否服用阿司匹林是CHD发生的独立保护因素。男性更容易患CHD,该预测模型ROC为0.706,灵敏度为0.643,特异度为0.551。对该模型进行外部验证,模型验证的ROC曲线AUC为0.649 (95% CI: 0.611~0.687),该模型具有良好的预测性能。结论:本研究构建的基于TyG指数联合性别、年龄、纤维蛋白原、服用阿司匹林史对CHD的发生具有良好的预测性能。Objective: To construct a prediction model based on the triglyceride-glucose index (TyG) for predicting the risk of coronary atherosclerotic heart disease (hereinafter referred to as coronary heart disease, CHD), and to verify the prediction performance of this model. Methods: Those who underwent coronary angiography at Tai’an Central Hospital from January 2020 to March 2023 were selected as the modeling study subjects. According to the results of coronary angiography, the patients were divided into the CHD group (732 cases, 67.97%) and the non-D group (365 cases, 33.03%). The general information and clinical characteristics of the two groups were compared. A prediction model was constructed using multivariate Logistic regression analysis, and the receiver operating characteristic (ROC) curve and the area under the curve (AUC) of the prediction model were drawn to evaluate prediction performance of the model. Then, the external validation of the model was performed by selecting patients who underwent coronary angiography at the Second Hospital of Shandong University from January 2024 to December 2024 as the study subjects for the validation model. Results: TyG index, age, and fibrinogen independent risk factors for the occurrence of CHD, and the history of taking aspirin was an independent protective factor for the occurrence
目的研究病案思维导图联合构思-设计-实施-运作(CDIO)教学模式在老年医学临床医师规范化培训中的应用效果,为持续性改进老年医学规范化培训质量探寻更有效的教学方法。方法选择2023年1月1日—2023年12月31日期间在某院老年医学科接受规范化培训的80例临床医师。采用SPSS 25.0软件进行简单排序随机化分为2组各40例。对照组接受传统教学模式培训,观察组接受病案思维导图联合CDIO教学模式进行培训。采用t检验和χ^(2)检验对比2组教学培训效果,并评价教学满意度。结果观察组理论考核成绩(91.65±3.22 vs 84.46±3.57)分、实践考核成绩(95.32±3.38 vs 87.61±3.50)分、病案分析能力(85.2±8.3 vs 79.4±7.6)分、自我效能评价(36.64±3.21 vs 30.57±3.47)分及自主学习能力(132.15±9.03 vs 127.43±9.15)分和评判性思维能力(294.37±11.64 vs 283.48±10.76)分,均高于对照组(t=-10.022分~-2.322,均P<0.05)。观察组的教学能力(23.14±1.22 vs 19.39±1.17)分、教学质量(24.47±0.63 vs 20.62±1.25)分、教学效果(28.16±1.42 vs 24.40±1.31)分的满意度高于对照组(t=-17.395~-1.787,P<0.05)。结论病案思维导图联合CDIO教学模式不仅能够提高老年医学临床医师的综合能力,还能提高教学满意度,应用效果良好,值得推广应用。
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