水杨酸钠对胰岛素抵抗大鼠胰岛素受体底物-1的影响

目的探讨抗炎药水杨酸钠对胰岛素抵抗大鼠胰岛素敏感性的影响及其作用机制。方法分别给大鼠静脉输注脂肪乳+肝素,脂肪乳+肝素+水杨酸钠和生理盐水7 h,并在输注的最后2 h,行清醒状态高胰岛素-正血糖钳夹试验,测定血浆葡萄糖、游离脂肪酸(FFA)、胰岛素和C-肽水平,检测肝脏、肌肉中胰岛素受体底物-1(IRS-1)及307位丝氨酸磷酸化的IRS-1表达。结果输注脂肪乳大鼠葡萄糖输注率(GIR)是输注生理盐水大鼠的45%,水杨酸钠可使GIR提高1.3倍(P0.01)。脂肪乳输注组大鼠肝脏及肌肉中307位丝氨酸磷酸化的IRS-1分别为生理盐水输注组大鼠的3倍和3.8倍(P0.001),输注水杨酸钠,肝脏、肌肉307位丝氨酸磷酸化的IRS-1下降45%、20%(P0.05)。结论 FFA增高引起肝脏及肌肉中307位丝氨酸磷酸化的IRS-1水平增高,可能是导致胰岛素抵抗发生的机制之一,应用水杨酸钠,大鼠肝脏及肌肉组织中IRS-1丝氨酸磷酸化水平下降,胰岛素抵抗改善。抗炎药物水杨酸钠可能通过抑制FFA引起的IRS-1丝氨酸磷酸化,而发挥改善胰岛素抵抗的作用。     

高脂喂养大鼠肝脏的NF-κBp65表达与胰岛素抵抗的相关性

目的探讨高脂饲料喂养大鼠肝脏NF-κBp65蛋白的表达与胰岛素抵抗的关系。方法采用高脂饲料喂养建立胰岛素抵抗大鼠模型,并用正常血糖-高血浆胰岛素钳夹技术评估。应用Western blotting方法检测大鼠肝脏中NF-κBp65蛋白的表达。结果①高脂饲料组大鼠的葡萄糖输注率明显低于基础饲料组[GIR60~120（0.76±0.28vs4.26±0.70）mg/（kg.min）,P〈0.01]。②高脂饲料组大鼠肝脏NF-κBp65蛋白的表达明显高于基础饲料组（A值118.48±1.45vs68.13±4.84,P〈0.01）。③高脂胰岛素抵抗大鼠肝脏NF-κBp65蛋白表达与GIR60-120（r=-0.993,P=0.000）和ISI（r=-0.773,P=0.009）负相关。结论高脂诱导的胰岛素抵抗大鼠肝脏NF-κB的激活可能是产生肝脏和全身胰岛素抵抗的根源。     

胰岛素抵抗细胞与大鼠模型的建立及其应用

目的探讨胰岛素抵抗模型的建立方法和二苯乙烯对血糖的调节作用。方法①给予Wistar大鼠自制脂肪乳建立胰岛素抵抗动物模型。②给予HepG2细胞胰岛素,建立胰岛素抵抗（HepG2/IR）细胞模型。③分别给予模型大鼠和HepG2/IR细胞二苯乙烯,观察二苯乙烯对血糖的调节作用。结果给予脂肪乳后,大鼠的血糖和TG、TC、LDL、HDL分别升高了72.87%和16.21%、139.93%、56.93%、18.32%,与建模前比,差异有显著性（P〈0.01）;给予二苯乙烯,模型组动物血糖和血脂水平比给药前明显降低（P〈0.05~0.01）;HepG2/IR葡萄糖消耗量比对照组（HepG2）明显增加。结论给予Wistar大鼠自制脂肪乳或给予HepG2细胞胰岛素,可建立胰岛素抵抗模型;二苯乙烯具有降低模型动物血糖和血脂、增加HepG2/IR葡萄糖消耗量的作用。     

运动干预对胰岛素抵抗大鼠骨骼肌IL-1β表达的影响

目的观察运动干预对高脂饲料诱导胰岛素抵抗（IR）大鼠白细胞介素1β（IL-1β）表达的影响,探讨运动减轻IR的可能机制。方法健康Wistar雄性大鼠分为基础饲料喂养组（normal chow group,NC）,高脂膳食喂养组（high-fat diet group,HF）。高脂膳食喂养Wistar雄性大鼠10周,构建IR动物模型。10周后,HF组再随机分为高脂喂养运动组和非运动组,游泳运动干预4周。游泳运动干预前后以正常血糖-高血浆胰岛素钳夹实验技术[hyperinsulinemic-euglycemic clamp（HEC）technique]评估IR大鼠胰岛素敏感性,ELISA法测定大鼠血清IL-1β水平,RT-PCR法测定大鼠骨骼肌IL-1βmRNA表达。结果HF组大鼠葡萄糖输注率（glucose infusion rate,GIR）显著低于NC组（P〈0.05）,HF组血清IL-1β水平及骨骼肌组织IL-1βmRNA表达明显高于NC组（P〈0.05,P〈0.01）;运动组大鼠血清IL-1β水平及骨骼肌组织IL-1βmRNA表达明显低于非运动组（P〈0.05）,与NC组差异无显著性（P〉0.05）。结论运动改善IR大鼠胰岛素敏感性,可能与降低IR大鼠IL-1β的表达有关。     

胰岛素抵抗大鼠的肝脏中丝氨酸/酪氨酸磷酸化异常与血清TNF-α相关

目的探讨胰岛素抵抗大鼠胰岛素受体底物-1丝氨酸/酪氨酸磷酸化与肿瘤坏死因子α（TNF-α）的关系。方法雄性Wistar大鼠30只（体质量80-120 g）,随机分为普通饮食组（NC）及高脂饮食组（FH）2组,每组15只。喂养10周,以高胰岛素-正常血糖钳夹技术评估胰岛素抵抗大鼠模型。应用ELISA法检测大鼠血清TNF-α含量,Western Blot法检测肝脏组织中胰岛素受体底物-1丝氨酸磷酸化（IRS-1Ser636）及酪氨酸磷酸化（IRS-1Tyr465）表达。结果FH组葡萄糖输注率（GIR）60-120水平明显低于NC组[（1.56±0.43 vs.5.15±0.66）mg/（kg.min）,P〈0.01];FH组大鼠TNF-αI、RS-1Ser636均高于NC组[（15.43±2.16 vs.5.4±2.16）pg/mL,P〈0.01;（109.45±13.75 vs.94.23±15.05）,P〈0.05],IRS-1Tyr456水平低于NC组[（111.08±14.28 vs.125.77±14.51）,P〈0.05]。TNF-α水平与IRS-1Ser636呈正相关（r=0.503,P=0.024）,与IRS-1Tyr465呈负相关（r=-0.521,P=0.019）。结论胰岛素抵抗大鼠TNF-α水平与IRS-1Tyr465负相关,与IRS-1Ser636正相关,提示TNF-α引起胰岛素抵抗机制可能与IRS-1磷酸化异常有关。     

银杏苦内酯B对重症急性胰腺炎大鼠血浆中白介素12和血小板活化因子的影响

目的：观察重症急性胰腺炎（SAP）大鼠血浆白介素12（IL-12）、血小板活化因子（PAF）的水平变化,探讨银杏苦内酯B（BN52021）对SAP的治疗作用。方法：Wistar大鼠随机分成SAP模型组（SAP）、BN52021治疗组（BN）和阴性对照组（NC）。前两组以5%牛磺胆酸钠逆行注入主胰管制成SAP模型,NC组仅翻动十二指肠并触摸胰腺数次关腹,制模15 min后,SAP组、NC组经股静脉注射生理盐水,BN组以BN52021静注 应用ELISA技术测定血浆IL-12和PAF水平。结果：各组血浆IL-12水平存在明显差异,BN组在1 h时相点较SAP、NC组显著性升高（P〈0.01） SAP组在6 h1、2 h时相点较NC组显著性升高（P〈0.01,P〈0.05）。各组血浆PAF水平存在明显差异,在1 h时相点,SAP组与BN组PAF含量较NC组均显著升高（P〈0.01） 在6 h、12 h时相点,SAP组PAF含量显著高于NC组、BN组（P〈0.05,P〈0.01）。结论：SAP大鼠早期血浆IL-12水平降低,PAF水平显著升高 BN52021对SAP大鼠具有一定的治疗作用,使早期血浆IL-12水平升高,PAF水平下降。     

姜黄素诱导Nrf2核转位对氧化应激诱导人肝细胞胰岛素抵抗的影响

目的：研究姜黄素诱导转录因子NF-E2相关因子2（NF-E2-related factor 2,Nrf2）核转位对氧化应激诱导人肝细胞L02胰岛素抵抗的影响。方法：用15μM和30μM姜黄素干预L02肝细胞6 h和l2 h,Western blot检测Nrf2核转位水平;将肝细胞分为对照组、模型组、干预组,对照组用RPMI1640正常培养,模型组用100U/L葡萄糖氧化酶（GO）干预2 h,干预组用15μM和30μM姜黄素分别干预12h后给予100U/LGO干预2h,各细胞均给予100nM胰岛素干预30min。流式细胞术检测细胞内活性氧簇（ROS）,用荧光强度（FI）来表示ROS水平。分光光度法检测检测细胞MDA、GSH,葡萄糖氧化酶-过氧化物酶法检测细胞培养液中葡萄糖的水平,Western blot检测胰岛素受体底物-1（IRS-1）磷酸化水平。结果：①姜黄素明显诱导Nrf2核转位。②模型组FI、MDA水平较对照组显著升高（P〈0.01）,干预组FI、MDA水平均较模型组显著降低（P〈0.01）,姜黄素15μM组FI、MDA水平高于30μM组（P〈0.01）。模型组GSH水平较对照组显著降低（P〈0.01）,干预组GSH水平较模型组显著升高（P〈0.01）,姜黄素15μM组FI、MDA水平高于30μM组（P〈0.01）。③模型组上清液葡萄糖浓度显著高于对照组（P〈0.01）,干预组上清液葡萄糖浓度显著低于模型组（P〈0.01）,姜黄素15μM组上清液葡萄糖浓度高于30μM组（P〈0.01）。模型组IRS-1磷酸化水平较对照组降低,干预组IRS-1磷酸化水平均较模型组增高,姜黄素30μM组IRS-1磷酸化水平高于15μM组。结论：姜黄素通过诱导Nrf2核转位,降低细胞内氧化应激水平,进而逆转氧化应激诱导的胰岛素抵抗。     

长期高饱和、高不饱和脂肪酸饮食诱导胰岛素抵抗大鼠肾动脉舒张和收缩功能的变化

本文旨在探讨长期高饱和、高不饱和脂肪酸饮食诱导胰岛素抵抗（insulin resistance,IR）大鼠。肾动脉舒张和收缩功能的变化。成年Wistar大鼠随机分为对照组、高饱和脂肪酸组和高不饱和脂肪酸组,每组14只。喂养6个月后,用高胰岛素正常葡萄糖钳夹技术的葡萄糖输注率（glucose infusion rate,GIR）评价IR;用尾套法测定大鼠血压,同时比较三组大鼠的体重、血清甘油三酯、游离脂肪酸、胰岛素、空腹血糖和NO代谢产物NO2-／NO3-。大鼠处死后,取肾动脉放入生理盐溶液中,观察血管对各种因子的舒、缩反应。结果显示,喂养6个月后,与对照组大鼠比较,高饱和脂肪酸组和高不饱和脂肪酸组大鼠均出现血压升高、血清甘油三酯升高和胰岛素敏感性降低;体重、空腹血糖、胰岛素和游离脂肪酸均升高（P〈0．01）：而两高脂组间体重、空腹血糖、胰岛素和游离脂肪酸无显著性差异。高饱和脂肪酸组大鼠肾动脉对ACh的内皮依赖性最大舒张反应（Rmax）最低,其次为高不饱和脂肪酸组和对照组：对照组与两高脂组有显著性差异（P〈0．01）,而两高脂组间无显著性差异。血管经L-Arg孵育后,两高脂组肾动脉对ACh的内皮依赖性Rmax均比孵育前增加,经N^ω-吐硝基-L-精氨酸（N^ω-nitro-L-arginine,L-NNA）及美蓝（methyleneblue,MB）孵育后,两高脂组Rmax均比孵育前降低（P〈0．05,P〈0．01）;对照组各孵育液之间无显著性差异（P：〈0．05）。肾动脉对硝普钠的非内皮依赖性Rmax及对去甲肾上腺素的收缩反应,三组间无显著性差异（P〈0．05）。相关分析结果显示,肾动脉对ACh的内皮依赖性Rmax与收缩压、甘油三酯呈明显负相关,与NO2-／NO3-和GIR呈明显正相关,游离脂肪酸与N02-／NO3-呈明显负相关。结果提示,高饱和及高不饱和脂肪酸饮食均可引起高血压及与之密切相关的内皮依赖性血管舒张功能减弱、高脂血症和IR,高脂诱导内皮依赖性血管舒张功能减弱与L-Arg-NO-cGMP通路受损有关。     

干预脂毒性改善糖尿病大鼠胰岛素分泌及氧化应激的损害

目的探讨干预脂毒性改善糖尿病大鼠胰岛分泌功能及氧化应激损害的机制。方法将大鼠分为4组①正常组（NC）,全程普通饲料喂养;②高脂组（HF）,全程高脂饲料喂养。糖尿病组,高脂饲料喂养8周后腹腔注射低剂量STZ（30mg/kg）,48h后行OGTT试验判断成模情况后分组。③糖尿病对照组（DM）,不给予药物干预;④血脂干预组（SIM）,灌胃辛伐他汀5mg/（kg.d）4周干预脂毒性。通过免疫组化染色观察胰岛B、A细胞形态学特点,RT-PCR测定胰腺内胰岛素原mRNA表达水平,DHE荧光染色检测胰岛中活性氧化产物ROS水平。结果与糖尿病对照组相比,干预脂毒性4周后血清胆固醇（TC）和甘油三酯（TG）水平分别下降了22.9%（P〈0.01）和57.0%（P〈0.05）。OGTT血糖水平均显著下降（P〈0.01）。胰岛中B细胞相对量是对照组的2.6倍（P〈0.01）,B细胞胞质内胰岛素水平增加了26.5%（P〈0.05）,胰岛素原mRNA表达升高18.3%（P〈0.01）;A细胞相对量减少了50%（P〈0.01）。血清丙二醛（MDA）水平和胰腺中ROS表达显著下降。结论辛伐他汀干预脂毒性4周可以显著改善糖尿病大鼠胰岛分泌功能和氧化应激损害。     

己糖激酶介导小豆蔻明改善血管平滑肌细胞糖代谢的作用

目的：探讨小豆蔻明对胰岛素抵抗状态（IR）血管平滑肌细胞（VSMCs）糖代谢的影响及其作用机制。方法：采用高糖（2.5×l0-2 mol·L-1）高胰岛素（100 U·L-1）培养VSMCs,72 h后加入小豆蔻明培养48 h,观察培养液中葡萄糖消耗量、细胞内己糖激酶活性以及细胞增殖。结果：高糖高胰岛素培养72h后,血管平滑肌细胞糖消耗量降低（P〈0.01）;小豆蔻明能显著性增加IR细胞的平均糖消耗量（P〈0.01）,增强己糖激酶活性（P〈0.01）;同时明显抑制高糖高胰岛素引起的VSMCs增殖（P〈0.01）。结论：小豆蔻明能增强己糖激酶活性,改善IR状态下细胞糖代谢;同时抑制高糖高胰岛素刺激引起的VSMCs异常增殖。     

Free fatty acid-induced hepatic insulin resistance: a potential role for protein kinase C-delta

The mechanisms of the impairment in hepatic glucose metabolism induced by free fatty acids (FFAs) and the importance of FFA oxidation in these mechanisms remain unclear. FFA-induced peripheral insulin resistance has been linked to membrane translocation of novel protein kinase C (PKC) isoforms, but the role of PKC in hepatic insulin resistance has not been assessed. To investigate the biochemical pathways that are induced by FFA in the liver and their relation to glucose metabolism in vivo, we determined endogenous glucose production (EGP), the hepatic content of citrate (product of acetyl-CoA derived from FFA oxidation and oxaloacetate), and hepatic PKC isoform translocation after 2 and 7 h Intralipid + heparin (IH) or SAL in rats. Experiments were performed in the basal state and during hyperinsulinemic clamps (insulin infusion rate, 5 mU. kg(-1). min(-1)). IH increased EGP in the basal state (P < 0.001) and during hyperinsulinemia (P < 0.001) at 2 and 7 h. Also, 7-h infusion of IH induced resistance to the suppressive effect of insulin on EGP (P < 0.05). Glycerol infusion (resulting in plasma glycerol levels similar to IH infusion) did not have any effect on EGP. IH increased hepatic citrate content by twofold, independent of the insulin levels and the duration of IH infusion. IH induced hepatic PKC-delta translocation from the cytosolic to membrane fraction in all groups. PKC-delta translocation was greater at 7 compared with 2 h (P < 0.05). In conclusion, 1) increased FFA oxidation may contribute to the FFA-induced increase in EGP in the basal state and during hyperinsulinemia but is not associated with FFA-induced hepatic insulin resistance, and 2) the progressive insulin resistance induced by FFA in the liver is associated with a progressive increase in hepatic PKC-delta translocation.     

Free fatty acid-induced peripheral insulin resistance augments splanchnic glucose uptake in healthy humans

To investigate the effect of elevated plasma free fatty acid (FFA) concentrations on splanchnic glucose uptake (SGU), we measured SGU in nine healthy subjects (age, 44 +/- 4 yr; body mass index, 27.4 +/- 1.2 kg/m(2); fasting plasma glucose, 5.2 +/- 0.1 mmol/l) during an Intralipid-heparin (LIP) infusion and during a saline (Sal) infusion. SGU was estimated by the oral glucose load (OGL)-insulin clamp method: subjects received a 7-h euglycemic insulin (100 mU x m(-2) x min(-1)) clamp, and a 75-g OGL was ingested 3 h after the insulin clamp was started. After glucose ingestion, the steady-state glucose infusion rate (GIR) during the insulin clamp was decreased to maintain euglycemia. SGU was calculated by subtracting the integrated decrease in GIR during the period after glucose ingestion from the ingested glucose load. [3-(3)H]glucose was infused during the initial 3 h of the insulin clamp to determine rates of endogenous glucose production (EGP) and glucose disappearance (R(d)). During the 3-h euglycemic insulin clamp before glucose ingestion, R(d) was decreased (8.8 +/- 0.5 vs. 7.6 +/- 0.5 mg x kg(-1) x min(-1), P < 0.01), and suppression of EGP was impaired (0.2 +/- 0.04 vs. 0.07 +/- 0.03 mg x kg(-1) x min(-1), P < 0.01). During the 4-h period after glucose ingestion, SGU was significantly increased during the LIP vs. Sal infusion study (30 +/- 2 vs. 20 +/- 2%, P < 0.005). In conclusion, an elevation in plasma FFA concentration impairs whole body glucose R(d) and insulin-mediated suppression of EGP in healthy subjects but augments SGU.     

Comparison of local and systemic effects of insulin on myocardial glucose extraction in ischemic heart disease

Physiological increases in circulating insulin level significantly increase myocardial glucose uptake in vivo. To what extent this represents a direct insulin action on the heart or results indirectly from reduction in circulating concentrations of free fatty acids (FFA) is uncertain. To examine this, we measured myocardial glucose, lactate, and FFA extraction in 10 fasting men (ages 49-76 yr) with stable coronary artery disease during sequential intracoronary (10 mU/min, coronary plasma insulin = 140 +/- 20 microU/ml) and intravenous (100 mU/min, systemic plasma insulin = 168 +/- 26 microU/ml) insulin infusion. Basally, hearts extracted 2 +/- 2% of arterial glucose and extracted 27 +/- 6% of FFA. Coronary insulin infusion increased glucose extraction to 5 +/- 3% (P < 0.01 vs. basal) without changing plasma FFA or heart FFA extraction. Conversion to intravenous infusion lowered plasma FFA by approximately 50% and heart FFA extraction by approximately 75%, increasing heart glucose extraction still further to 8 +/- 3% (P < 0. 01 vs. intracoronary). This suggests the increase in myocardial glucose extraction observed in response to an increment in systemic insulin concentration is mediated equally by a reduction in circulating FFA and by direct insulin action on the heart itself. Coronary insulin infusion increased myocardial lactate extraction as well (from 20 +/- 10% to 29 +/- 9%, P < 0.05), suggesting the local action may include stimulation of a metabolic step distal to glucose transport and glycolysis.     

Free fatty acids increase basal hepatic glucose production and induce hepatic insulin resistance at different sites

To investigate the sites of the free fatty acid (FFA) effects to increase basal hepatic glucose production and to impair hepatic insulin action, we performed 2-h and 7-h Intralipid + heparin (IH) and saline infusions in the basal fasting state and during hyperinsulinemic clamps in overnight-fasted rats. We measured endogenous glucose production (EGP), total glucose output (TGO, the flux through glucose-6-phosphatase), glucose cycling (GC, index of flux through glucokinase = TGO - EGP), hepatic glucose 6-phosphate (G-6-P) content, and hepatic glucose-6-phosphatase and glucokinase activities. Plasma FFA levels were elevated about threefold by IH. In the basal state, IH increased TGO, in vivo glucose-6-phosphatase activity (TGO/G-6-P), and EGP (P < 0.001). During the clamp compared with the basal experiments, 2-h insulin infusion increased GC and in vivo glucokinase activity (GC/TGO; P < 0.05) and suppressed EGP (P < 0.05) but failed to significantly affect TGO and in vivo glucose-6-phosphatase activity. IH decreased the ability of insulin to increase GC and in vivo glucokinase activity (P < 0.01), and at 7 h, it also decreased the ability of insulin to suppress EGP (P < 0.001). G-6-P content was comparable in all groups. In vivo glucose-6-phosphatase and glucokinase activities did not correspond to their in vitro activities as determined in liver tissue, suggesting that stable changes in enzyme activity were not responsible for the FFA effects. The data suggest that, in overnight-fasted rats, FFA increased basal EGP and induced hepatic insulin resistance at different sites. 1) FFA increased basal EGP through an increase in TGO and in vivo glucose-6-phosphatase activity, presumably due to a stimulatory allosteric effect of fatty acyl-CoA on glucose-6-phosphatase. 2) FFA induced hepatic insulin resistance (decreased the ability of insulin to suppress EGP) through an impairment of insulin's ability to increase GC and in vivo glucokinase activity, presumably due to an inhibitory allosteric effect of fatty acyl-CoA on glucokinase and/or an impairment in glucokinase translocation.     

全凭静脉麻醉期间右美托咪定对靶控输注丙泊酚用量及血流动力学的影响

目的：探讨右关托咪定（dexmedetomidine,DEX）对行全凭静脉麻醉患者靶控输注（target controlled infusion,TCI）丙泊酚用量及拔管期间血流动力学的影响。方法：选择拟于全麻下行经鼻蝶窦垂体瘤切除术的患者30例（ASA I～II级）,随机分为两组,每组15例。试验组（D组）给予DEX负荷剂量0．5μg·kg-1,注药时间15rain,继以0．3μg·kg-1·h-1持续输注至修补硬膜时;对照纽（N组）在相同时间给予等容量生理盐水。两组麻醉诱导方法相同,术中以脑电双频指数（bispectral index,BIS）为麻醉深度监测指标,根据BIS值调节丙泊酚血浆靶浓度维持麻醉。记录拔管期间收缩压（SBP）、舒张压（DBP）和心率（HR）,并计算心肌氧耗指数（RPP）;记录丙泊酚平均用量、用药前后BIS值、呼吸恢复时间、睁眼时间、拔管时间及术中不良反应。结果：①D组给予负荷剂量后,BIS值由（95±3）降至（77±11）,差异有统计学意义（P〈0．01）。②与N组相比,D组丙泊酚用量减少28％,差异有统计学意义（P〈0．01）。⑧拔管期间SBP、DBP和HR与入室时比较,D组无明显变化,N组HR显著升高（P〈0．05）;D组拔管期间SBP、DBP、HR和RPP明显低于N组（P〈0．05）;④两组患者呼吸恢复时间、睁眼时间及拔管时间差异均无统计学意义;⑤两组不良反应（心动过缓、高血压、低血压）的发生率无显著性差异。结论：术中持续静脉输注DEX可减少TCI丙泊酚用量,能使BIS值进一步降低,产生良好镇静效应;同时可有效减轻拔管期间循环变化,降低RPP,减少心肌耗氧量,提高拔管质量。     

持续皮下输注赖脯胰岛素治疗老年非初诊2型糖尿病患者临床观察

目的：观察比较持续皮下输注赖脯胰岛素与常规注射预混赖脯胰岛素对老年非初诊2型糖尿病患者的疗效与安全性。方法：将58例老年2型糖尿病患者随机分为观察组（29例）与对照组（29例）,观察组用赖脯胰岛素经胰岛素泵持续皮下输注（CSI-I）,对照组用精蛋白锌重组赖脯胰岛素25注射液,2次／d,常规皮下注射。两组患者均给予糖尿病教育、饮食控制及适量运动,共治疗2周。比较治疗前后两组患者的血糖、胰岛素用量、血糖达标时间以及低血糖发生率。结果：治疗后两组患者空腹血糖、餐后血糖均较治疗前下降（P〈0．05）,观察组血糖达标时间、胰岛素用量均明显低于对照组（P〈0．05）。两组低血糖发生率无明显差异。结论：持续皮下输注赖脯胰岛素具有较好的疗效与安全性,是控制老年非初诊2型糖尿病患者较佳的方法。     

不同胰岛素给药方式救治糖尿病酮症酸中毒临床研究

目的：比较不同胰岛素给药方式治疗糖尿病酮症酸中毒（DKA）的临床疗效。方法：82例DKA患者随机分为胰岛素泵持续皮下输液胰岛素（CSⅡ）组和微量泵持续静脉泵入胰岛素（CXqI）组各41例,分别给予胰岛素泵持续皮下输注胰岛素和小剂量胰岛素持续微量泵静脉泵入不同胰岛素给药方式,观察两组治疗后血糖变化、血糖达标时间、尿酮体变化、pH值变化、胰岛素平均日用量、平均低血糖次数及平均住院时间。结果：两组治疗后空腹血糖、餐后血糖显著下降及血糖达标时间显著缩短差异无统计学意义（P〉0．05）;CSII组尿酮体转阴时间（22．3±7．4）h短于CVII组（32．1±12．1）h（P〈0．01）;CSII组PH值恢复时间（9．4±2．5）h短于CVII组（15．7±3．5）h（P〈0．01）;CSII组平均胰岛素日用量为（47±5）U比CVII组（58＋7）U少（P〈0．01）;CSII组人均低血糖次数为（0．6±O．5）次／人。少于CVII组（1．5±0．8）次／人（P〈O．01）;CSII组住院时间（9．8±1．2）天明显比CVII组（12．5±2．0）天短（P〈0．01）。结论：CSII相较于CVII能更快更有效的纠正代谢紊乱,减少胰岛素日用量,缩短住院时间,从而提高临床疗效。具有较高的安全性及患者依从性。     

Interaction of free fatty acids and epinephrine in regulating hepatic glucose production in conscious dogs

To determine the effects of an increase in lipolysis on the glycogenolytic effect of epinephrine (EPI), the catecholamine was infused portally into 18-h-fasted conscious dogs maintained on a pancreatic clamp in the presence [portal (Po)-EPI+FFA, n = 6] and absence (Po-EPI+SAL, n = 6) of peripheral Intralipid infusion. Control groups with high glucose (70% increase) and free fatty acid (FFA; 200% increase; HG+FFA, n = 6) and high glucose alone (HG+SAL, n = 6) were also included. Hepatic sinusoidal EPI levels were elevated (Delta 568 +/- 77 and Delta 527 +/- 37 pg/ml, respectively) in Po-EPI+SAL and EPI+FFA but remained basal in HG+FFA and HG+SAL. Arterial plasma FFA increased from 613 +/- 73 to 1,633 +/- 101 and 746 +/- 112 to 1,898 +/- 237 micromol/l in Po-EPI+FFA and HG+FFA but did not change in EPI+SAL or HG+SAL. Net hepatic glycogenolysis increased from 1.5 +/- 0.3 to 3.1 +/- 0.4 mg x kg(-1) x min(-1) (P < 0.05) by 30 min in response to portal EPI but did not rise (1.8 +/- 0.2 to 2.1 +/- 0.3 mg x kg(-1) x min(-1)) in response to Po-EPI+FFA. Net hepatic glycogenolysis decreased from 1.7 +/- 0.2 to 0.9 +/- 0.2 and 1.6 +/- 0.2 to 0.7 +/- 0.2 mg x kg(-1) x min(-1) by 30 min in HG+FFA and HG+SAL. Hepatic gluconeogenic flux to glucose 6-phosphate increased from 0.6 +/- 0.1 to 1.2 +/- 0.1 mg x kg(-1) x min(-1) (P < 0.05; by 3 h) and 0.7 +/- 0.1 to 1.6 +/- 0.1 mg x kg(-1) x min(-1) (P < 0.05; at 90 min) in HG+FFA and Po-EPI+FFA. The gluconeogenic parameters remained unchanged in the Po-EPI+SAL and HG+SAL groups. In conclusion, increased FFA markedly changed the mechanism by which EPI stimulated hepatic glucose production, suggesting that its overall lipolytic effect may be important in determining its effect on the liver.     

术中静脉不向剂量右美托咪啶对全髋置换术患者术后患者芬太尼静脉自控镇痛效果的影响

目的：观察气管内全身麻醉下行全髋置换术患者,术中静脉应用不同剂量右美托咪定对术后芬太尼静脉自控镇痛效果的影响及相关不良反应发生的情况。方法：选择择期在气管内全麻下行全髋置换术的患者60 例,ASA Ⅰ ～Ⅱ级,年龄47～78 岁,体重42～79 kg。患者随机分组法分为3 组（n=20）：C 组（盐水对照组）、D1 组（右美托咪定0.5 μg/kg 组）和D2 组（右美托咪定1 μg/kg组）,在手术结束前约1 小时按分组分别给予生理盐水和右美托咪啶,术后镇痛使用芬太尼静脉自控镇痛24 h。记录患者术后2h、2～6 h、6～12 h、12～24 h芬太尼的用量;VAS 评分法评估患者术前、术后2 h、6 h、12 h、24 h 时的疼痛程度;记录镇痛期间恶心呕吐、皮肤瘙痒及过度镇静等不良反应发生的情况。结果：术后2h 和术后2～6 h芬太尼用量D1组和D2 组较C 组减少（P＜0.05）,但D1组和D2 组之间比较无差异（P＞0.05）;而术后6～12 和12～24 h三组患者芬太尼用量无差异（P＞0.05）。术后2 h、2～6 hVAS评分D1 组和D2 组较C组减少（P＜0.05）,而D1组和D2 组之间比较无差异（P＞0.05）;术后6～12、12～24 h三组患者VAS 评分无差异（P＞0.05）。与C 组比较,D1 组和D2 组镇痛期间恶心呕吐发生率降低（P＜0.05）,余不良反应各组之间比较无差异（P＞0.05）。结论：气管内全身麻醉下行全髋置换术的患者,术中静脉应用右美托咪啶可在术后6 h内增强芬太尼镇痛的效果减少芬太尼的用量,但增大剂量效果并不增加而作用时间也不延长。