住院期间老年2型糖尿病患者低血糖原因分析及对策

目的:探讨住院期间老年2型糖尿病患者发生低血糖的原因及相关对策。方法:选择2012年12月~2013年12月住院治疗的老年2型糖尿病患者150例。根据是否发生低血糖将其分为未发生低血糖组80例(对照组)和发生低血糖组70例(研究组)。对两组患者的临床数据资料进行统计学比较。结果:1研究组患者的平均年龄、病程、体重指数、住院天数和对照组患者比较差异均具有统计学意义(P0.05);2研究组患者血肌酐(Cr)水平和尿微量清蛋白定量(UMA)均显著高于对照组患者(P0.05);3低血糖在夜间02:00~05:59发生的频率明显较高;4研究组二甲双胍的应用比例明显低于对照组(P0.05),胰岛素的使用率和OAD+胰岛素联合应用的情况明显高于对照组(P0.05)。结论:老年2型糖尿病患者病程长、BMI低;血肌酐(Cr)水平和尿微量清蛋白定量(UMA)高;胰岛素的使用率及胰岛素联用OAD应用率高均会增加低血糖的发生风险。老年2型糖尿病患者应注意饮食治疗、运动治疗、药物治疗、血糖监测以及心理护理和健康指导。医护人员需为患者制定个体化的血糖控制目标,将老年2型糖尿病患者的血糖控制在适当水平。     

甘精胰岛素联用瑞格列奈治疗初诊2型糖尿病的疗效研究

目的:通过甘精胰岛素联用瑞格列奈与预混人工合成胰岛素(诺和灵30R)治疗初诊2型糖尿病患者的比较,探讨其疗效与安全性.方法:将初诊2型糖尿病患者随机分为甘精胰岛素+瑞格列奈组(A组)和诺和灵30R组(B组),根据血糖情况调整用药剂量.治疗12周后,比较两组的空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、体重指数(BMI)和低血糖发生率.结果:A组低血糖事件明显少于B组,在餐后2小时血糖方面也优于B组,差异有统计学意义(P<0.05);在空腹血糖、HbA1c和BMI方面差异无统计学意义(p0.05).结论:甘精胰岛素与瑞格列奈联用对于初诊2型糖尿病患者,其血糖控制满意,餐后血糖更加平稳,低血糖发生率低,是一种针对初诊2型糖尿病患者安全、有效、方便的治疗方案.     

双时相门冬胰岛素30联合艾塞那肽对血糖控制不佳2型糖尿病的疗效及安全性分析

目的:探讨双时相门冬胰岛素30联合艾塞那肽在口服降糖药物和基础胰岛素血糖控制不佳的2型糖尿病的疗效及安全性。方法:将在我院接受治疗的72例既往使用的口服降糖药联合基础胰岛素治疗血糖控制不佳的2型糖尿病患者随机、平行、开放平分成治疗组(BIAsp30+艾塞那肽治疗,早餐和晚餐前注射BIAsp30和艾塞那肽注射液)和对照组(睡前1次皮下注射甘精胰岛素),两组均与二甲双胍联合用药。比较两组治疗前后8点血糖谱;比较两组日胰岛素用量、BMI、HbA1c以及低血糖发生次数;比较两组不良事件。结果:治疗8周、16周后,两组8个点血糖与治疗前相比均有明显下降,差异有显著性(P0.05);治疗8周后、16周后,治疗组早餐前和早餐后2小时血糖、午餐前和午餐后2小时血糖值分别与对照组的血糖相比,有统计学差异(P0.05);两组之间的晚餐前和晚餐后2小时血糖、睡觉前血糖(晚上10点)和凌晨3点血糖相互比较无显著性差异(P0.05);治疗16周后,每天胰岛素类似物用量、BMI组间比较无统计学意义(P0.05);两组治疗后HbA1c分别与治疗前相比有统计学意义(P0.05),治疗组治疗后HbA1c与对照组治疗后HbA1c相比,差异有显著性(P0.05);两组低血糖发生次数有明显差异(P0.05);两组不良事件次数相互比较无统计学意义(P0.05)。结论:BIAsp30联合艾塞那肽可显著改善基础胰岛素联合OAD血糖控制不佳的2型糖尿病患者的血糖控制,有效控制血糖,并具有良好的安全性。     

黄连素对糖尿病大鼠胰岛素抵抗的治疗作用*

目的:探讨黄连素对链脲佐菌素所致糖尿病大鼠胰岛素抵抗的治疗作用。方法:采用链脲佐菌素腹腔注射的方式建立大鼠糖尿病模型,将实验大鼠分为5组:分别为模型组、黄连素低(100 mg/kg)、黄连素中(200 mg/kg)、黄连素高(300 mg/kg)剂量组和阳性对照组(二甲双胍:50 mg/kg),每组10只。另取10只正常大鼠作为正常组。黄连素低、中、高剂量组小鼠每天分别灌胃100、200和300 mg/kg黄连素;对照组每天灌胃二甲双胍50 mg/kg;正常组和模型组每天给予相同体积的生理盐水进行灌胃;1次/天,连续灌胃4周。通过测定大鼠血FBG、果糖胺水平,OGTT实验,胰岛素(FINS)水平,并计算大鼠胰岛素抵抗指数(HOMA-IR)来评价黄连素对糖尿病大鼠胰岛素抵抗作用。结果:与正常组相比,给药前模型组大鼠静脉血FBG含量显著升高(P＜0.05);与模型组比较,给药2周及以后给药4周后阳性对照组、黄连素中剂量组和高剂量组大鼠静脉血FBG含量均显著下降(P＜0.05);给药4周后,阳性对照组、黄连素低、中、高剂量组OGTT实验结果显示在不同时间节点的血糖值均显著低于模型组(P＜ 0.05),阳性对照组、黄连素低、中、高剂量组FBG、果糖胺水平和HOMA-IR指标均低于模型组(P＜0.05);而胰岛素水平水平较模型组显著升高(P＜0.05)。结论:黄连素可明显降低大鼠的空腹血糖、果糖胺含量,提高胰岛素含量,对链脲佐菌素所致糖尿病大鼠的胰岛素抵抗有明显治疗作用。且一定范围内,黄连素剂量越高,对糖尿病大鼠胰岛素抵抗作用越明显。     

短期胰岛素泵强化治疗糖尿病的临床疗效观察

目的 观察比较短期应用胰岛素泵连续皮下输注(CSII)和多次皮下胰岛素注射治疗(MSII)糖尿病患者的疗效.方法 156例糖尿病患者随机分为CSII组和MSII组,分析比较两组血糖控制达标所需时间、胰岛素量及低血糖的发生率.结果 CSII组血糖达标所需时间、胰岛索量、低血糖发生率明显低于MSII组,差异具有统计学意义(P<0.01).结论 短期胰岛索泵强化治疗能较好模拟胰岛素分泌的生理节律,更快、更有效地控制高血糖,明显缩短血糖达标所需时间,减少血糖波动和低血糖的发生.     

糖尿病低血糖昏迷急诊救治的临床效果

目的探讨糖尿病低血糖昏迷患者采用急诊系统干预方案实施救治的临床效果。方法对我院收治的糖尿病低血糖昏迷患者120例,按随机分组方案分为对照组和观察组,每组60例。对照组采用常规急诊干预方案进行救治,观察组采用急诊系统干预方案进行救治,比较两组糖尿病低血糖昏迷患者的急诊救治效果、救治后苏醒时间和治疗总时间、急诊救治期间不良事件发生情况。结果观察组糖尿病低血糖昏迷的急诊救治总有效率达91.7%,高于对照组的71.7%,组间比较差异有显著统计学意义(P0.05);救治后苏醒时间和治疗总时间比较,观察组均短于对照组,差异均具统计学意义(P0.05);观察组急诊救治期间发生不良事件1例,对照组发生不良事件8例,差异亦有统计学意义(P0.05)。结论糖尿病低血糖昏迷患者采用急诊系统干预方案实施救治,能促使患者短时间内苏醒,维持血糖稳定,改善患者预后。     

利奈唑胺对肾功能不全G~+感染患者血小板减少的相关性研究

目的:分析利奈唑胺对肾功能不全G+患者血小板减少的关系。方法:回顾性分析92例应用利奈唑胺治疗的革兰阳性球菌感染患者的临床资料,根据是否伴有肾功能不全分为肾功能不全组(33例),正常组(59例),检测用药前、用药后血小板计数,观察停药后血小板计数恢复正常时间及不良反应发生情况。结果:肾功能不全组治疗后血小板计数显著低于治疗前及正常组(P0.01),正常组治疗前、后血小板计数比较无统计学意义(P0.05);肾功能不全组血小板减少发生率高于正常组(P0.05);停药后正常组血小板恢复正常时间短于肾功能不全组(P0.01);肾功能不全组血红蛋白下降率高于正常组(P0.05),其余不良反应发生率比较差异无统计学意义(P0.05)。结论:感染患者肾功能可影响利奈唑胺所致血小板减少发生率,肾功能不全患者在应用利奈唑胺时应定期监测血小板计数。     

急性低血糖应激对大鼠下丘脑orexin-A表达的影响

目的研究胰岛素诱导的急性低血糖应激对大鼠下丘脑增食欲素-A(orexin-A)的表达影响。方法通过皮下注射胰岛素建立急性低血糖大鼠模型。采用免疫组织化学染色方法观察大鼠下丘脑orexin-A和Fos双标情况,并采用ELISA方法对脑脊液中的orexin-A含量进行检测。结果禁食组、低血糖进食组和低血糖禁食组阳性神经元计数明显高于对照组(P0.05),但三组之间计数比较差异无统计学意义(P0.05);Orexin-A/Fos双标细胞率(双标细胞占orexin-A阳性细胞的百分率)在低血糖禁食组最高,与禁食组和低血糖进食组比较差异有统计学意义(P0.05)。ELISA检测结果显示,低血糖禁食组脑脊液中的orexin-A含量显著高于其它三组,差异有统计学意义(P0.05)。结论急性血糖的降低可以增强大鼠下丘脑中orexin-A的表达,而摄食行为可以抑制此调控效应。     

地特胰岛素与NPH胰岛素治疗口服降糖药控制不佳的2型糖尿病 临床比较研究

目的:观察口服降糖药控制不佳的2型糖尿病患者分别加用地特胰岛素和NPH胰岛素治疗24周的有效性和安全性。方法:63例口服降糖药物控制不佳(HbA1c>7%)的2型糖尿病患者随机加用地特胰岛素或鱼精蛋白锌(NPH)胰岛素作为基础胰岛素,每日1次治疗24周,比较两组治疗前后糖化血红蛋白、体重、血脂的变化及低血糖的发生率。结果:两组的糖化血红蛋白、空腹血糖与基线比较均有显著下降,治疗后组间无差异。与NPH胰岛素组比较地特胰岛素组体重增加明显减少,差异有统计学意义。地特胰岛素组治疗期间全部低血糖次数较NPH胰岛素组减少54.69%(P<0.01)。结论:地特胰岛素与NPH胰岛素相比,在有效控制血糖的同时可降低低血糖发生风险,而且有减少体重增加的优势。     

脂联素与肝源性糖尿病患者胰岛素抵抗的相关性研究

目的:探讨脂联素在肝源性糖尿病患者胰岛素抵抗中的作用.方法:检测肝源性糖尿病(A组)、肝硬化(B组)、2型糖尿病(C组)患者及正常人(D组)血清脂联素(ADPN)、空腹血糖(FPG)、空腹胰岛素(FINS)水平,计算其胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(FBCI)、胰岛素敏感性指数(ISI),分析ADPN与胰岛素抵抗的相关性.结果:A组ADPN水平低于B组、D组(P<0.05);FPG水平低于C组(P<0.05);FINS,FBCI水平高于C组及D组(P<0.05);ISI低于D组(P<0.05);HOMA-IR显著高于B组及D组(P<0.05).ADPN与 FPG、FINS、HOMA-IR呈负相关;与ISI呈正相关.结论:肝源性糖尿病患者ADPN水平下降,其与胰岛素抵杭呈负相关,提示脂联素可能在肝源性糖尿病患者胰岛素抵抗中起着重要作用.     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.