本文關(guān)鍵詞：減重手術(shù)治療2型糖尿病臨床療效評(píng)價(jià)與成本效果評(píng)估　出處：《山東大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 減重手術(shù) 2型糖尿病 腹腔鏡胃旁路術(shù) 胃袖狀切除術(shù) 成本效果分析

【摘要】：研究背景隨著人類生活水平的日益提高,繼心血管病、腫瘤之后,糖尿病已成為第三大威脅人類健康的慢性疾病。其高醫(yī)療高花費(fèi)、高致殘、高致死的特征是目前世界各國(guó)共同面對(duì)的公共衛(wèi)生問題。而在我國(guó),糖尿病發(fā)展情況更為嚴(yán)峻。我國(guó)2型糖尿病患病率在過去的二十多年中呈爆炸式增長(zhǎng)。1980年,我國(guó)男性的患病率不到5%;而2010年,我國(guó)糖尿病患病率約為11.6%。2015年,我國(guó)約有1.1億名糖尿病患者,約占我國(guó)成年人總數(shù)的1/10。更為嚴(yán)重的是,我國(guó)近半數(shù)成年人處于糖尿病前期,約為5億人。這不僅帶來(lái)罹患2型糖尿病的風(fēng)險(xiǎn),也帶來(lái)罹患心血管病等其他疾病的風(fēng)險(xiǎn)。盡管近百年來(lái)在糖尿病治療領(lǐng)域取得很大的進(jìn)展,使一部分患者的體重下降,血糖達(dá)標(biāo),但遺憾的是,目前的傳統(tǒng)治療方法未能徹底治愈糖尿病,同時(shí)無(wú)法延緩糖尿病并發(fā)癥的發(fā)生。近年來(lái),減重手術(shù)在肥胖型2型糖尿病的治療中取得了突破性進(jìn)展。減重手術(shù)最初被用于治療病態(tài)性肥胖,上世紀(jì)90年代觀察到,減重手術(shù)除子明顯減輕體重,還可以良好的控制血糖。隨后在一項(xiàng)前瞻性研究性對(duì)照研究后發(fā)現(xiàn)并證實(shí),術(shù)后患者不需要藥物降糖并能長(zhǎng)期保持血糖正常的例數(shù)明顯高于非手術(shù)組,且與糖尿病相關(guān)的并發(fā)癥發(fā)生率和病死率大大降低。在內(nèi)科治療病態(tài)性肥胖及2型糖尿病等代謝性疾病難以維持長(zhǎng)期穩(wěn)定的效果的情況下,減重手術(shù)經(jīng)過數(shù)十年的發(fā)展已被證明是治療病態(tài)性肥胖及2型糖尿病等代謝性疾病切實(shí)有效的方法,成為治療糖尿病新階段的專家共識(shí)。然而,現(xiàn)在階段減重手術(shù)治療2型糖尿病依然存在若干研究不足。首先,以亞洲人群為對(duì)象的,減重手術(shù)與非手術(shù)治療2型糖尿病療效的Meta分析缺乏。由于2型糖尿病與胰島素抵抗相關(guān),且不同人群表達(dá)的胰島素抵抗指數(shù)不盡相同,因而減重手術(shù)針對(duì)不同人群可能產(chǎn)生的效果也不盡相同。所以針對(duì)于亞洲人群的減重手術(shù)與非手術(shù)治療2型糖尿病療效的Meta分析具有必要性。其次,作為應(yīng)用最廣泛且最被認(rèn)可的兩種減重手術(shù)術(shù)式——腹腔鏡Roux-en-Y 胃旁路術(shù)(Laparoscopic Roux-en-Y Gastric Bypass,LRYGB)和腹腔鏡胃袖狀切除術(shù)(Laparoscopic Sleeve Gastrectomy,LSG)治療2型糖尿病療效評(píng)價(jià)的隨機(jī)對(duì)照試驗(yàn)仍然不足。第三,基于傾向性評(píng)分法研究真實(shí)世界LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià)缺乏。盡管隨機(jī)對(duì)照試驗(yàn)具有組間可比性好、防止選擇性偏倚、研究對(duì)象的診斷確切等一些優(yōu)勢(shì),但由于其嚴(yán)格的納入、排除標(biāo)準(zhǔn),導(dǎo)致研究結(jié)果的代表性和外在的真實(shí)性受到一定的局限。因此將LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià)應(yīng)用于基于傾向性評(píng)分法還原的真實(shí)世界進(jìn)行研究有必要性,但目前相關(guān)研究仍然缺乏。最后,LRYGB和LSG治療2型糖尿病的成本效果評(píng)估缺乏。減重手術(shù)治療2型糖尿病短期的臨床效果評(píng)估已經(jīng)被多項(xiàng)大型研究證實(shí),但是從衛(wèi)生經(jīng)濟(jì)學(xué)角度分析,與非手術(shù)治療策略相比,減重手術(shù)治療2型糖尿病在單位質(zhì)量調(diào)整生命年的效果情況至今還未有研究。研究目的本研究基于Meta分析法、傾向性評(píng)分法、馬爾科夫模型、首都醫(yī)科大學(xué)附屬北京世紀(jì)壇醫(yī)院糖尿病外科治療中心數(shù)據(jù)以及國(guó)家自然科學(xué)基金項(xiàng)目(71673169)的資助,進(jìn)行了"減重手術(shù)治療2型糖尿病臨床療效評(píng)價(jià)與成本效果評(píng)估"。本文通過進(jìn)行(1)針對(duì)亞洲人群,減重手術(shù)與非手術(shù)治療2型糖尿病臨床療效的Meta分析;(2)LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià)——小型隨機(jī)對(duì)照試驗(yàn);(3)LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià)——基于傾向性評(píng)分法的回顧性列隊(duì)研究;(4)LRYGB和LSG治療2型糖尿病的成本效果評(píng)估——基于馬爾科夫模型的經(jīng)濟(jì)學(xué)評(píng)價(jià),旨在比較在亞洲人群中,減重手術(shù)與非手術(shù)治療2型糖尿病患者在血糖控制、體重控制和糖尿病緩解上的優(yōu)劣以及其長(zhǎng)期的成本效果,并進(jìn)一步分析不同的手術(shù)術(shù)式(LRYGB和LSG)的療效差異和成本效果差異,以此為手術(shù)人群的篩選及適應(yīng)癥的把握上提供線索,為治療2型糖尿病的進(jìn)一步發(fā)展貢獻(xiàn)綿薄之力。研究資料與方法本研究針對(duì)于LRYGB和LSG治療2型糖尿病療效評(píng)價(jià)與成本效果評(píng)估,通過Meta分析、隨機(jī)對(duì)照試驗(yàn)以及真實(shí)世界的隊(duì)列研究對(duì)減重手術(shù)治療2型糖尿病進(jìn)行證據(jù)補(bǔ)充,為患者提供參考信息,也為治療2型糖尿病的進(jìn)一步發(fā)展提供數(shù)據(jù)。綜述所述,研究方法可以歸納為:(1)對(duì)減重手術(shù)與非手術(shù)治療2型糖尿病療效的Meta分析,為評(píng)價(jià)減重手術(shù)治療和非手術(shù)的常規(guī)治療的方案選擇提供參考;(2)通過小型隨機(jī)對(duì)照試驗(yàn)進(jìn)行LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià),有利于針對(duì)于LRYGB和LSG的手術(shù)術(shù)式選擇證據(jù)補(bǔ)充;(3)通過基于傾向性評(píng)分法的回顧性列隊(duì)研究進(jìn)行LRYGB和LSG治療2型糖尿病的療效評(píng)價(jià),有利于進(jìn)一步在真實(shí)世界驗(yàn)證LRYGB和LSG治療2型糖尿病的療效差異性,為治療糖尿病提供數(shù)據(jù)支持和指南依據(jù);(4)基于馬爾科夫模型對(duì)LRYGB和LSG治療2型糖尿病的成本效果評(píng)估,為臨床提供第一份關(guān)于減重手術(shù)治療2型糖尿病的經(jīng)濟(jì)學(xué)評(píng)價(jià),有利于證據(jù)的補(bǔ)足。研究主要結(jié)果根據(jù)以上的分析和討論,本研究主要結(jié)論為:(1)通過文獻(xiàn)綜述可得,減重手術(shù)治療2型糖尿病在國(guó)外有幾十年的歷史,而在我國(guó)只發(fā)展了十幾年,還在起步階段。而其控制血糖效果已得到研究者及越來(lái)越多的患者的認(rèn)可,2014年發(fā)布的《中國(guó)肥胖和2型糖尿病外科治療指南》,對(duì)減重手術(shù)治療2型糖尿病進(jìn)一步明確了其術(shù)前評(píng)估與準(zhǔn)備及術(shù)后并發(fā)癥等。盡管治療效果較為顯著,但針對(duì)我國(guó)人群,對(duì)于手術(shù)術(shù)式選擇以及適應(yīng)癥把握上研究仍然較淺。(2)應(yīng)用Meta分析法系統(tǒng)性評(píng)價(jià)了減重手術(shù)與非手術(shù)方式治療亞洲人群2型糖尿病患者在血糖控制、體重控制、膽固醇濃度、甘油三酯以及糖尿病緩解率的療效情況,結(jié)果顯示,與非手術(shù)方法相比,當(dāng)前常用的外科減重手術(shù)均能有效改善術(shù)后2型糖尿病患者的糖化血紅蛋白、BMI、體重、LDL、HDL、CHOL、TRIG;且減重手術(shù)在2型糖尿病緩解率方面顯著優(yōu)于非手術(shù)治療方式。(3)基于LRYGB和LSG治療肥胖合并2型糖尿病患者的小型隨機(jī)對(duì)照試驗(yàn)和回顧性隊(duì)列在"真實(shí)世界"的驗(yàn)證,結(jié)果顯示:對(duì)于我國(guó)患者,減重手術(shù)是在血糖控制、體重控制和糖尿病緩解等指標(biāo)上治療肥胖合并2型糖尿病的有效方法,且LRYGB和LSG兩種術(shù)式的臨床療效并無(wú)統(tǒng)計(jì)學(xué)差異,與其他研究結(jié)果基本一致。另外,且LRYGB和LSG兩種術(shù)式的臨床療效并無(wú)統(tǒng)計(jì)學(xué)差異,并各有其特點(diǎn):LRYGB適用于體重較小且需依靠?jī)?nèi)分泌改善的患者;LSG對(duì)于低年齡、高體重、糖尿病程度較輕、術(shù)前胰島素功能較完善的患者更為適用;而其安全性均值得信賴。(4)基于馬爾科夫模型,將3種治療2型糖尿病的方案,即LRYGB方案、LSG方案以及非手術(shù)治療方案以1年為循環(huán)周期,運(yùn)行直至80歲或者死亡,以對(duì)比三種方案單位成本的效果值。結(jié)果顯示,LRYGB方案及LSG方案的成本效果比值遠(yuǎn)遠(yuǎn)高于初期投入最低的非手術(shù)治療方案。因此我們認(rèn)為,LRYGB與LSG均為高成本效果比的治療方式,在單位成本上優(yōu)于非手術(shù)治療方式。而較為肥胖的患者更適合采用LSG手術(shù)進(jìn)行治療。政策建議(1)應(yīng)進(jìn)一步發(fā)展2型糖尿病外科治療臨床路徑標(biāo)準(zhǔn)化。(2)應(yīng)增強(qiáng)外科治療2型糖尿病科普力度。(3)應(yīng)促進(jìn)公衛(wèi)與臨床相結(jié)合,加強(qiáng)團(tuán)隊(duì)合作。(4)在鼓勵(lì)外科治療的同時(shí),應(yīng)該進(jìn)一步研究發(fā)展內(nèi)科療法。創(chuàng)新性與不足之處(1)創(chuàng)新之處:①基于傾向性評(píng)分法將回顧性數(shù)據(jù)利用模型進(jìn)行1:1匹配,以將小型臨床試驗(yàn)的結(jié)果帶入"真實(shí)世界"進(jìn)行驗(yàn)證,更一步證明研究的可靠性,為循證醫(yī)學(xué)提供依據(jù)。②基于馬爾科夫模型,模擬2型糖尿病患者不同的生存狀態(tài),并收集各個(gè)參數(shù)代入模型,以1年為循環(huán)周期,運(yùn)行直至80歲或者死亡,以對(duì)比手術(shù)治療方法和非手術(shù)治療方案單位質(zhì)量調(diào)整生命年的效果值。為我國(guó)減重手術(shù)治療2型糖尿病的經(jīng)濟(jì)學(xué)評(píng)價(jià)進(jìn)行補(bǔ)足。(2)不足之處本研究尚存在一定的局限性:①無(wú)論是隨機(jī)對(duì)照試驗(yàn)還是基于傾向性評(píng)分法的匹配研究,樣本量較小,且未能觀察到長(zhǎng)期結(jié)局;②旨在對(duì)減重手術(shù)治療2型糖尿病的情況進(jìn)行全方位的評(píng)估,但因?yàn)闀r(shí)間關(guān)系,未完成患者術(shù)后生命質(zhì)量評(píng)價(jià)問卷調(diào)查。如果能收集到這部分主觀評(píng)價(jià)相關(guān)數(shù)據(jù)并進(jìn)一步進(jìn)行研究,便可以更好的提升本研究的全面性,為循證醫(yī)學(xué)提供較為充足的證據(jù)。
[Abstract]:Background: with the increasing standards of living, after cardiovascular disease, cancer, diabetes has become a chronic disease to human health third major threats. Its high medical cost, high morbidity, high mortality characteristics is currently facing the world public health problem. But in our country, the development of more diabetes severe. Prevalence rate was the explosive growth of.1980 over the past more than 20 years China's type 2 diabetes, Chinese male prevalence rate of less than 5%; and in 2010, the prevalence rate is about 11.6%.2015 years of diabetes in China, there are about 110 million diabetic patients in China, the total of Chinese adults 1/10. is more serious in China, nearly half of all adults in pre diabetes, about 500 million people. It not only brings the risk of developing type 2 diabetes, but also bring the risk of cardiovascular disease and other diseases. Although nearly a hundred years in the treatment of diabetes The field has made great progress, the proportion of patients with decreased body weight, blood glucose, but unfortunately, not the traditional treatment method of current cure diabetes, and can delay the occurrence of complications of diabetes. In recent years, bariatric surgery in obese have achieved a breakthrough in the treatment of type 2 diabetes in bariatric surgery was initially. For the treatment of morbid obesity, in 90s observed that bariatric surgery except for significant weight loss, but also can control blood glucose well. Then in a prospective study of comparative study and found that patients do not need drugs hypoglycemic and maintain normal blood glucose were significantly higher than in non surgery group for a long period of time, and diabetes related morbidity and mortality is reduced greatly. In the medical treatment of morbid obesity and type 2 diabetes and other metabolic diseases difficult to maintain long-term stable effect Under the condition of bariatric surgery after decades of development has been proved to be a method for the treatment of morbid obesity and type 2 diabetes and other metabolic diseases effectively, a new expert consensus stage for treatment of diabetes. However, the present stage of bariatric surgery in the treatment of type 2 diabetes still exists if dry research. First of all, to the Asian population as the object the curative effect of the treatment of type 2 diabetes, bariatric surgery and non surgery Meta analysis. Due to lack of type 2 diabetes and insulin resistance, and the expression of different groups of insulin resistance index is not the same, so the bariatric surgery for different people may have the effect is not the same. So for bariatric surgery and non surgery in Asia the curative effect in the treatment of type 2 diabetes Meta analysis is necessary. Secondly, as a two weight loss surgery is most widely used and most recognized: laparoscopic Roux-en-Y Gastric bypass (Laparoscopic Roux-en-Y Gastric Bypass, LRYGB) and laparoscopic sleeve gastrectomy (Laparoscopic Sleeve, Gastrectomy, LSG) randomized controlled trials to evaluate the efficacy of treatment of type 2 diabetes is still insufficient. Third, the lack of efficacy of propensity score method to study the real world of LRYGB and LSG in the treatment of type 2 diabetes. Although based on randomized controlled trials is comparable between groups, to prevent selective bias, the exact diagnosis research object and some other advantages, but because of its strict inclusion and exclusion criteria, the results lead to the representation and in reality is limited to a certain degree. Therefore, LRYGB and LSG in the treatment of type 2 diabetes curative effect evaluation based on reduction propensity score method of the real world is necessary to study, but the study is still lacking. Finally, cost effectiveness analysis of LRYGB and LSG in the treatment of type 2 diabetes lack . to evaluate the clinical effect of bariatric surgery for type 2 diabetes mellitus in short term has been a number of large studies, but from the view of health economics analysis, compared with the non operative treatment strategies, bariatric surgery for the treatment of type 2 diabetes in unit of quality adjusted life years the situation has not yet studied. This study based on Meta analysis, tendency score method, Markov model, Beijing Shijitan Hospital, CMU affiliated to the Capital Medical University diabetes surgery center data and National Natural Science Fund (71673169) funded the "cost effectiveness evaluation and clinical efficacy of the treatment of type 2 diabetes bariatric surgery assessment. This paper (1) for the Asian population, clinical analysis of the treatment of type 2 diabetes bariatric surgery and non operation of Meta; (2) the curative effect evaluation of LRYGB and LSG in the treatment of type 2 diabetes mellitus -- small randomized controlled trial; (3) LRYG The curative effect evaluation of B and LSG in the treatment of type 2 diabetes: a retrospective cohort study based on propensity score method; (4) to assess the cost effect of LRYGB and LSG in the treatment of type 2 diabetes mellitus -- Based on the economic evaluation of the Markoff model to compare in Asian populations, bariatric surgery and non surgical treatment in patients with type 2 diabetes blood sugar control on the quality, ease the weight control and diabetes and its long-term cost effectiveness, and further analysis of different operation type (LRYGB and LSG) differences in the efficacy and cost effectiveness, in order to provide clues for the screening of surgical population and indications of the master, for the further development of the treatment of type 2 diabetes contribute to research. Materials and methods this study for LRYGB and LSG in the treatment of patients with type 2 diabetes cost evaluation and effect evaluation, through the Meta analysis of randomized controlled trials and cohort of the real world Study on bariatric surgery for the treatment of type 2 diabetes evidence supplement, provide reference information for patients, to provide data for the further development of the treatment of type 2 diabetes. A review of the research methods, can be summarized as follows: (1) analysis of curative effect in the treatment of type 2 diabetes mellitus on bariatric surgery and non operation of Meta, provide a reference for the selection of conventional treatment evaluation of bariatric surgery and non surgery program; (2) evaluate the curative effect in the treatment of type 2 diabetes through small randomized controlled trials of LRYGB and LSG, is conducive to the choice of surgery for evidence of needle type LRYGB and LSG; (3) the curative effect based on propensity score method a retrospective cohort study and LRYGB LSG for the treatment of type 2 diabetes evaluation of efficacy is conducive to further verification of LRYGB and LSG in the real world for the treatment of type 2 diabetes, for the treatment of diabetes and provide data support according to the guidelines; (4) based on the Maldives Cost effectiveness evaluation model, treatment of type 2 diabetes on LRYGB and LSG, to provide the economic evaluation of type 2 diabetes clinical report on the first bariatric surgery, is conducive to the evidence of the complement. Main research results based on the above analysis and discussion, the main conclusions of this study are: (1) available through literature review, bariatric surgery treatment of type 2 diabetes has decades of history in foreign countries, while in China, only the development of more than ten years, is still in the initial stage. The effect of blood glucose control has been studied and recognized by more and more patients, released in 2014 "China obesity and type 2 diabetes guidelines for surgical treatment of >, bariatric surgery for type 2 diabetes further defined their preoperative evaluation and postoperative complications and preparation. Although the treatment effect is remarkable, but for our people, for the selection of surgical procedures and indications of grasp are still shallow. ( 2) application of Meta analysis system of evaluation and non surgical bariatric surgery for the Asian population of patients with type 2 diabetes in glycemic control, weight control, cholesterol, triglyceride and diabetes remission rate, the results show that, compared with non operative methods, the current commonly used surgical bariatric surgery to HbA1c, 2 patients diabetes after surgery can effectively improve the BMI, LDL, HDL, weight, CHOL, TRIG; and bariatric surgery in type 2 diabetes remission rate was significantly higher than those of non surgical treatment. (3) based on LRYGB and LSG in the treatment of obese patients with type 2 diabetes mellitus patients with small randomized controlled trials and retrospective cohort in the real world the verification results show that: in our patients, bariatric surgery is in glycemic control, weight control and diabetes remission effect method indicators such as the treatment of obesity with type 2 diabetes, and LRYGB and LSG two There was no significant difference between the clinical curative effect of surgery, consistent with the results of other studies. In addition, the clinical effect and there was no significant difference between the LRYGB and LSG of the two groups, and each has its own characteristics: LRYGB is suitable for small weight and need to rely on the endocrine of patients improved; LSG for the low age, high body weight, diabetes is light, preoperative insulin function better in patients with more suitable; the safety is dependable. (4) based on the Markoff model, the 3 kinds of treatment of type 2 diabetes, namely LRYGB scheme, LSG scheme and non operative treatment in a 1 year cycle, running until the age of 80 or death. In order to compare the three schemes of the unit cost of the value. The results show that the cost effect ratio of LRYGB scheme and LSG scheme is much higher than the initial investment of the nonoperative treatment of the lowest. So we think that LRYGB and LSG are high cost effect ratio rule Therapy, superior in unit costs of non operation treatment. Which is more suitable for obese patients with LSG surgery. Policy recommendations (1) should be further development of surgical treatment of type 2 diabetes clinical pathway standardized. (2) should enhance the surgical treatment of type 2 diabetes science efforts. (3) should promote the public who combined with clinic, to strengthen the team. (4) to encourage surgical treatment at the same time, further research should be the development of medical treatment. The innovation and deficiency of innovation: (1) the propensity score method based on retrospective data using a model of 1:1, the small clinical trial results into the "real the world" to verify the reliability further proof research, provide the basis for evidence-based medicine. Based on the Markoff model, simulation of different patients with type 2 diabetes survival status, and collect all the parameters into the model, in a 1 year cycle Run, until the age of 80 or death, compared to surgical treatment and non operative treatment unit of quality adjusted life years effect value. Economic evaluation for our country bariatric surgery for the treatment of type 2 diabetes supplement. (2) the deficiencies still exist some limitations: whether the propensity score matching study the method is based on randomized controlled trials, the small sample, and the failure to observe long-term outcome; to evaluate the full range of bariatric surgery in the treatment of type 2 diabetes, but because of the time, the evaluation of quality of life after surgery did not complete the questionnaire. If this part can collect related data and subjective evaluation further, they can better enhance the comprehensiveness of this study, provide enough evidence for evidence-based medicine.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1;R656.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王玉新,李大啟,李公寶,徐琴君;糖尿病腎病患者血清可溶性白細(xì)胞介素6受體檢測(cè)[J];上海免疫學(xué)雜志;2001年02期

2 宮雅南,劉冬年,熊玉冰,黃偉文,莊萬(wàn)江;糖尿病足患者糖尿病視網(wǎng)膜病變分析[J];廣東醫(yī)學(xué);2001年06期

3 顧芹,宋守君,李向陽(yáng),尤傳一;胰激肽原酶腸溶片對(duì)早期糖尿病腎病的防治作用[J];中國(guó)臨床藥學(xué)雜志;2001年06期

4 曹愛華 ,王瑛 ,李翔;杏丁治療早期糖尿病腎病療效觀察[J];遼寧實(shí)用糖尿病雜志;2001年03期

5 ;中藥治療糖尿病腎病新進(jìn)展[J];中國(guó)中醫(yī)藥信息雜志;2001年04期

6 張桂茹;糖尿病腎病85例臨床分析[J];陜西醫(yī)學(xué)雜志;2002年02期

7 侯建明 ,林鳳輝 ,張超群;46例2型糖尿病腎病與糖尿病自主神經(jīng)病變的關(guān)系分析[J];福建醫(yī)藥雜志;2002年04期

8 陳文霖;糖尿病飲食[J];醫(yī)療保健器具;2002年Z1期

9 孫力,許玲;2型糖尿病患者糖尿病足的危險(xiǎn)因素分析[J];山東醫(yī)藥;2002年35期

10 ;糖尿病腎病診治研究進(jìn)展[J];基礎(chǔ)醫(yī)學(xué)與臨床;2003年04期

相關(guān)會(huì)議論文 前10條

1 張星;許筠;蘇建平;張軍;程立志;翟曉麗;;糖尿病腎病的臨床療效對(duì)比觀察[A];第十九次全國(guó)中醫(yī)腎病學(xué)術(shù)交流會(huì)論文匯編[C];2006年

2 楊家茂;;糖尿病腎病防治瑣談[A];全國(guó)第二屆中醫(yī)中西醫(yī)結(jié)合腎臟病臨床進(jìn)展學(xué)術(shù)研討會(huì)論文集[C];2007年

3 丁耀耿;郝桂霞;;糖尿病腎病臨床分析[A];全國(guó)第二屆中醫(yī)中西醫(yī)結(jié)合腎臟病臨床進(jìn)展學(xué)術(shù)研討會(huì)論文集[C];2007年

4 張文鎧;王志伏;王雪;孫大朋;;糖尿病腎病的治療現(xiàn)狀[A];中華中醫(yī)藥學(xué)會(huì)第二十一屆全國(guó)中醫(yī)腎病學(xué)術(shù)會(huì)議論文匯編（下）[C];2008年

5 倪青;;糖尿病腎病的中西醫(yī)結(jié)合研究[A];第六屆全國(guó)中西醫(yī)結(jié)合腎臟病學(xué)術(shù)會(huì)議論文匯編[C];2000年

6 孫怡;李健紅;宗紅燕;;黃芪桂枝五物湯加味治療糖尿病腎病16例[A];第六屆全國(guó)中西醫(yī)結(jié)合腎臟病學(xué)術(shù)會(huì)議論文匯編[C];2000年

7 葉軍;;糖尿病腎病在兒童時(shí)期的早期干預(yù)[A];中華醫(yī)學(xué)會(huì)第六次全國(guó)內(nèi)分泌學(xué)術(shù)會(huì)議論文匯編[C];2001年

8 杜旭昶;孫志紅;閆春芳;劉彩虹;;疏糖丹治療2型糖尿病50例臨床分析[A];第六次中國(guó)中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會(huì)議論文匯編[C];2002年

9 于世家;任平;馬麗佳;李小娟;鄭曙琴;武明東;劉自力;薛麗輝;;糖尿病住院患者1344例回顧性分析[A];第六次中國(guó)中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會(huì)議論文匯編[C];2002年

10 郝效槐;魏玫都;崔立俊;;中西并蓄治療糖尿病腎病[A];第七次中國(guó)中西醫(yī)結(jié)合糖尿病學(xué)術(shù)會(huì)議論文匯編[C];2004年

相關(guān)重要報(bào)紙文章 前10條

1 本報(bào)記者 向佳;糖尿病中醫(yī)藥防治項(xiàng)目立足社區(qū)[N];中國(guó)中醫(yī)藥報(bào);2011年

2 特約記者 魯海燕;逾八成公眾存在糖尿病高危因素[N];家庭醫(yī)生報(bào);2013年

3 馬明愈;現(xiàn)代生活方式導(dǎo)致 糖尿病發(fā)病率迅速上升[N];中國(guó)婦女報(bào);2005年

4 省立醫(yī)院內(nèi)分泌科主任醫(yī)師 侯建明;糖尿病腎病的防治[N];福建科技報(bào);2004年

5 王文絹 范軍星;世界糖尿病日關(guān)注焦點(diǎn):糖尿病并發(fā)癥[N];健康報(bào);2003年

6 主持人 向紅丁博士;糖尿病腎病須早防早治[N];人民政協(xié)報(bào);2002年

7 華悅;預(yù)防糖尿病，，從減肥開始[N];上海中醫(yī)藥報(bào);2004年

8 劉冬梅;肥胖糖尿病第一誘因[N];天津日?qǐng)?bào);2004年

9 劉燕玲;首部中醫(yī)專病指南定下糖尿病治則[N];健康報(bào);2007年

10 崔昕;中藥防治糖尿病腎病有進(jìn)展[N];健康時(shí)報(bào);2006年

相關(guān)博士學(xué)位論文 前10條

1 王曉杰;組蛋白去乙�；�4特異性促進(jìn)糖尿病腎病足細(xì)胞損傷[D];山東大學(xué);2015年

2 張永;MiR-346在抗TGF-β信號(hào)途徑介導(dǎo)的糖尿病腎病發(fā)生和發(fā)展中的作用機(jī)制[D];武漢大學(xué);2015年

3 魏鳳江;高尿酸血癥、2型糖尿病及糖尿病微血管病變的群體遺傳學(xué)研究[D];天津醫(yī)科大學(xué);2015年

4 孫士杰;胱抑素C對(duì)2型糖尿病視網(wǎng)膜病變預(yù)測(cè)價(jià)值研究[D];山東大學(xué);2015年

5 龍泓竹;益氣養(yǎng)陰通絡(luò)散結(jié)方防治早期糖尿病腎病的臨床及實(shí)驗(yàn)研究[D];北京中醫(yī)藥大學(xué);2016年

6 姜e

本文編號(hào)：1373318