替米沙坦对2 型糖尿病合并高血压患者胰岛β 细胞功能影响 的临床观察

目的:观察替米沙坦对糖尿病合并高血压患者胰岛β细胞功能的影响,探索血管紧张素Ⅱ阻断剂降压以外的胰岛功能修复作用.方法:70例糖尿病合并轻、中度高血压的患者随机分为替米沙坦治疗组和氨氯地平治疗组,每组35例患者;替米沙坦治疗组在控制血糖的治疗上给予替米沙坦进行降压治疗;氨氯地平治疗组在控制血糖的治疗上给予氨氯地平进行降压治疗;两组的观察周期均12周,每2周观察1次血压、空腹血糖、并记录低血糖及其它不良反应.治疗前后测糖化血红蛋白(HbAlc)、餐后2小时血糖,并按照HOMA稳态模型公式计算胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR).结果:两组患者在降压效果方面无显著性差异,收缩压、舒张压对比,P＞0.05;与氨氯地平组比较,替米沙坦组胰岛素峰值和HOMA-3显著升高,HOMA-IR则显著降低.结论:替米沙坦可更显著改善糖尿病合并高血压的患者的胰岛β细胞功能,具有降压以外的改善胰岛细胞功能的作用.     

辛伐他汀对Ⅱ型糖尿病合并肾病葡萄糖代谢的研究

目的:探讨辛伐他汀治疗对Ⅱ型糖尿病(T2DM)合并肾病患者糖代谢水平的影响.方法:选取新乡医学院第一附属医院60名T2DM合并肾病患者行辛伐他汀治疗3个月.比较治疗前后空腹血糖(FBG)、游离脂肪酸(FFA)、脂联素(ANP)、C肽、HOMA-IR、胰岛素/葡萄糖比率(IGR)、胰岛素敏感指数(ISI)、空腹胰岛素水平(FINS)、C反应蛋白(CRP)、糖基化血红蛋白(HbA1c)水平等变化,以评价辛伐他汀对T2DM病合并肾病患者的治疗效果.结果:在辛伐他汀治疗3个月后的葡萄糖耐量试验(OGTT)中,对比治疗前,各时点血糖水平均显著下降(P＜0.05),而C肽与胰岛素在0 min和30 min时显著下降(P＜0.05).在辛伐他汀治疗后,HO-MA-IR、游离脂肪酸(FFA)、ISI、FINS、胰岛素AUC、血糖曲线下面积(AUC)、CRP、HbA1c、FBG与治疗前相比均显著下降(P＜0.05),尿白蛋白排泄率(UAER)也明显下降(P＜0.01),但是APN(P＜0.01)以及C肽AUC(P ＜0.05)均显著上升,而校正胰岛素反应(CIR)及IGR无显著变化(P＞0.05).结论:辛伐他汀治疗可以改善胰岛素抵抗,提高患者对胰岛素的敏感性,并显著降低血糖,从而改善T2DM合并肾病患者的糖代谢.     

alpha-硫辛酸对2 型糖尿病早期肾病的保护作用研究

目的：探讨注射用alpha-硫辛酸对2 型糖尿病早期肾病（DN）的保护作用。方法：将56 例2 型糖尿病早期肾病患者随机分为治 疗组28 例,采用注射alpha-硫辛酸加常规治疗;对照组28 例,仅给予常规治疗。治疗前后测定尿微量白蛋白排泄率（UAER）、超氧化 物歧化酶（SOD）、丙二醛（MDA）、一氧化氮（NO）水平。结果：与治疗前比较,治疗组UAER及MDA均显著降低（P＜0.05）,SCr、 SOD及NO 显著升高（P＜0.05）。对照组SCr、UAER、SOD、MDA 及NO与治疗前比较差异无统计学意义（P＞0.05）。结论：注射用 alpha-硫辛酸能减少2型糖尿病肾病患者尿微量白蛋白的排泄,对早期肾病具有保护作用。     

大剂量胰岛素联合西格列汀对老年2 型糖尿病患者的疗效

目的:研究大剂量胰岛素联合西格列汀对老年2型糖尿病患者的疗效。方法:选择2012年1月~2015年12月在我院进行诊治的老年2型糖尿病患者82例,随机分为两组,观察组采用大剂量胰岛素联合西格列汀治疗,对照组采用大剂量胰岛素治疗,两组均治疗3个月。比较两组治疗前后的甘油三酯、总胆固醇、低密度脂蛋白和高密度脂蛋白水平,餐后2 h血糖、空腹血糖、糖化血红蛋白,胰岛素抵抗指数、胰岛素分泌指数、每日胰岛素总量和低血糖发生次数。结果:对照组治疗前后的血脂水平无明显差异(P0.05),观察组治疗后的甘油三酯、总胆固醇和低密度脂蛋白明显降低(P0.05),高密度脂蛋白明显升高(P0.05);治疗后,两组的餐后2 h血糖、空腹血糖、糖化血红蛋白均明显降低(P0.05),且观察组降低更为明显(P0.05);对照组治疗前后的胰岛素抵抗指数、胰岛素分泌指数和每日胰岛素总量均无明显差异(P0.05),观察组治疗后的胰岛素抵抗指数和每日胰岛素总量均明显降低(P0.05),胰岛素分泌指数明显升高(P0.05);两组治疗前后低血糖发生次数和身体质量指数均无明显差异(P0.05)。结论:大剂量胰岛素联合西格列汀能有效控制老年2型糖尿病患者的血糖水平,改善胰岛β细胞功能,减少胰岛素用量,是一种安全有效的治疗方法。     

疏肝化瘀通络法对初诊2型糖尿病患者血糖及胰岛β细胞功能的影响

目的:观察中医疏肝化瘀通络法治疗初诊2型糖尿病患者的胰岛β细胞及胰岛素抵抗的影响.方法:将60例符合入选标准的新诊断的2型糖尿病患者,随机分组2组(治疗组与对照组),2组在饮食控制和运动治疗方案的基础上,对照组给予口服二甲双胍片;治疗组在口服二甲双胍的基础上加服以疏肝化瘀通络法组方的中药方剂,两组治疗疗程均为12周.观察治疗前后患者血糖、糖化血红蛋白、胰岛素敏感性及胰岛β细胞功能的影响并记录低血糖及其它不良反应.结果:与治疗前相比,二甲双胍+疏肝化瘀通络方治疗后患者空腹、餐后2 h血糖均下降(P＜0.05);HbA1C下降(P＜0.05);体重指数(BMI)下降(P＜0.05);胰岛素敏感性增加;未观察到低血糖或其它不良反应.结论:疏肝化瘀通络法对初诊2型糖尿病患者有良好的临床疗效.可望为2型糖尿病的中西治疗提供新方法,值得进一步深入研究.     

2型糖尿病患者泌尿系结石形成的相关影响因素分析

目的:探讨2型糖尿病(T2DM)患者泌尿系结石形成的相关影响因素。方法:根据是否合并泌尿系结石,将106例糖尿病患者分为观察组和对照组,每组53例,比较两组患者临床资料及生化指标的差异,并采用多因素回归分析研究2型糖尿病与泌尿系结石的相关关系。结果:观察组和对照组患者的年龄、性别、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、空腹血糖(FBG)、餐后2 h血糖(2h FBG)、糖化血红蛋白(Hb A1C)等资料比较差异均无统计学意义(P0.05),而两组患者在体重指数(BMI)、甘油三酯(TG)、尿p H值、胰岛素抵抗指数(HOMA-IR)、血尿酸(SUA)、24小时尿酸(TUA)水平比较差异具具有统计学差异(P0.05),多因素Logistic回归分析显示血尿酸、尿p H值和HOMA-IR为2型糖尿病患者泌尿系结石形成的重要危险因素(P0.05)。结论:高尿酸血症、高甘油三酯血症、高尿酸排泄、胰岛素抵抗、肥胖或超重等因素促进了泌尿系结石的形成,其中血尿酸、尿p H值、HOMA-IR是2型糖尿病患者合并泌尿系结石形成的独立危险因素。     

胃大部切除后不同吻合术式对胃癌合并2型糖尿病患者血糖的影响

目的:探讨胃大部切除后不同吻合术式对胃癌合并2型糖尿病患者血糖的影响.方法:选择66例在本院行手术治疗的胃癌合并2型糖尿病的患者为研究对象,随机分为毕Ⅰ式组26例,毕Ⅱ式组24例,Roux-en-y组16例.检测和比较三组患者术前和术后随访3月时患者的OGTT空腹及负荷后血糖值、糖化血红蛋白等水平.结果:术前三组OGTT空腹血糖、2h血糖、糖化血红蛋白水平、空腹胰岛素水平、稳态模型评估胰岛素抵抗(HOMA-IR)的比较均无统计学差异(P均＞0.05).术后3月,与毕Ⅰ式组比较,毕Ⅱ式组与Roux-en-y组未达2型糖尿病诊断标准的患者百分率显著升高(X2=7.866,P=0.020),OGTT空腹血糖(F=6.472,P=0.005)水平、OGTT 2 h血糖水平(F=3.431,P=0.041)、糖化血红蛋白水平(F=5.456,P=0.009)、空腹胰岛素水平(F=6.120,P=0.008)、HOMA-IR(F=8.091,P＜0.001)均显著降低.毕Ⅱ式组与Roux-en-y组之间以上指标比较均无统计学差异(P＞0.05).结论:胃癌合并2型糖尿病的患者在消化道重建术后部分可得缓解,采用毕Ⅱ式或Roux-en-y吻合术可能更适宜胃癌合并2型糖尿病的患者.     

替米沙坦联合氢氯噻嗪治疗高血压疗效评估

目的:研究为高血压患者联合应用氢氯噻嗪与替米沙坦的临床效果,总结其应用价值。方法:收集2013年08月~2014年08月高血压患者53例,将其分成实验组28例,对照组25例,对两组患者的血压变化进行动态监测,单独为对照组应用替米沙坦治疗,联合应用氢氯噻嗪、替米沙坦治疗实验组患者,比较两组血压控制效果。结果:治疗后,实验组平均收缩压为(105.41±6.12)mm Hg,舒张压为(66.89±4.78)mm Hg,与对照组比较,差异有统计学意义(P0.05)。结论:氢氯噻嗪与替米沙坦联合治疗高血压,临床疗效显著,可进一步应用、推广。     

糖尿病性视网膜病变术后CRT、SFCT、mALB、MBG、HbA1c水平的变化及相关性

本研究通过观察糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度,脉络膜厚度,尿微量白蛋白、血糖、糖化血红蛋白的水平,试图了解其差异及相关性。我们选取2016年1月至2017年12月于我院就诊的糖尿病性视网膜病变患者200例,根据其有无视网膜病变、有无肾病、术后有无黄斑水肿分为合并组和未合并组,同时选取100例正常成年人作为对照。观察糖尿病患者和对照组、未合并和合并并发症糖尿病患者的黄斑中心凹视网膜厚度(central retinal thickness, CRT),凹下脉络膜厚度(subfoveal choroidal thickness,SFCT),尿微量白蛋白(microAlbunminuria, mALB)、平均血糖(mean blood glucose, MBG)和糖化血红蛋白(glycated haemoglobin, HbA1c)水平,进一步分析了糖尿病黄斑水肿患者的尿微量白蛋白水平与黄斑中心凹视网膜厚度、脉络膜厚度、血糖、糖化血红蛋白的相关性。研究结果表明,糖尿病组患者的CRT水平较对照组低,SFCT、mALB、MBG和HbA1c水平高于对照组;合并视网膜病变、合并肾病和合并黄斑水肿组患者的CRT水平较未合并组低,SFCT、mALB、MBG和HbA1c水平均高于未合并组;黄斑水肿患者的m ALB水平与CRT水平负相关,与SFCT、MBG和HbA1c水平正相关。本研究得出结论:糖尿病性视网膜病变术后患者黄斑中心凹视网膜厚度(CRT)较薄,脉络膜厚度(SFCT)变厚,且与尿微量白蛋白密切相关。     

动态血糖监测在老年2 型糖尿病患者降糖治疗中的应用价值

目的：通过对老年2 型糖尿病患者进行动态血糖监测了解降糖治疗的疗效,评价动态血糖监测系统的应用价值,确定其在 治疗老年2 型糖尿病患者中的地位。方法：选取2008 年8 月至2013 年8 月住院的老年2 型糖尿病患者95 例,随机分为对照组 48 例和观察组47 例,对照组行予常规的指尖血糖监测,观察组行动态血糖监测,比较两组患者血糖的控制情况。结果：观察组患 者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h 血 糖等与治疗前相比较比较,差异均有统计学意义,P＜0.05。对照组患者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖 最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h血糖等与治疗前相比较比较,差异均无统计学意义,P＞0.05。两 组患者空腹血糖治疗前、后差异均无统计学意义,P＞0.05。结论：动态血糖监测系统用于监测老年2 型糖尿病患者的降糖治疗疗 效优于常规血糖检测。     

细菌Ⅲ型分泌系统

1 .细菌分泌机制概述致病细菌和宿主细胞相互作用的特点是将致病因子定位到细菌表面或分泌到胞外。虽然其分泌的细菌蛋白质数量和种类都很多且具有范围很广的作用 (包括蛋白质水解、溶血、细胞毒性、蛋白质的磷酸化和去磷酸化 ) ,但是只存在几种途径把这些蛋白质从细菌的细胞质运输到胞外。在革兰氏阴性细菌中已发现四种蛋白质分泌途径 ,称为Ｉ、ＩＩ、ＩＩＩ、ＩＶ型分泌机制。另外 ,第五种大分子分泌途径和质粒的接合转移有关。根癌农杆菌Ｔ ＤＮＡ的转移 ,百日咳杆菌毒素的分泌 ,称之为Ｖ型分泌 ,这方面的研究很少[1] 。ＩＩ型和ＩＶ型是…     

Immunohistochemical Video-microdensitometry of Myocardial Collagen Type I and Type III

Collagen is an essential part of the cardiac interstitium. Collagen subtypes, their location, total amount and the architecture of the fibrillar network are of functional importance. Architecture in terms of density of the fibrillar network is assumed to be reflected by the intensity of immunohistochemical staining of collagen. The aim of this study was to evaluate a video-based microdensitometric method for quantifying density expressed as absorbance of collagen subtypes I and III stained with an indirect immunoperoxidase method in myectomy specimens of patients with hypertrophic obstructive cardiomyopathy. Various factors influencing the immunohistochemical staining product and the technical properties of the image analysis system were investigated. Linearity between collagen concentration and the absorbance of the immunohistochemical staining product was demonstrated for collagen I using a dot-blot technique. Immunohistochemical collagen staining and density measure ment were easily reproducible. The cardiac disability of the patients was assessed according to the New York Heart Association (NYHA) criteria. There was a significant increase in collagen type I density with higher NYHA class, whereas no significant association was found for total collagen area fraction. Thus, video-based microdensitometry gives further insight into the structural remodelling of myocardial collagens and reveals their significance in the process of heart failure in hypertrophic cardiomyopathy.     

Type III Hyperlipoproteinaemia

Eighteen patients with type III hyperlipoproteinaemia, diagnosed on the basis of skin lesions, serum lipids, and lipoprotein electrophoresis, have been fully investigated over a period of 15 years. The incidence of coronary artery disease was only slightly increased, and was not increased at all among first-degree relatives. Peripheral occlusive arterial disease was probably more common. An increased incidence of carbohydrate intolerance was found in neither the patients nor their relatives. The effects of treatment on the skin were uniformly good.     

Blood Metals Concentration in Type 1 and Type 2 Diabetics

Mechanisms for the onset of diabetes and the development of diabetic complications remain under extensive investigations. One of these mechanisms is abnormal homeostasis of metals, as either deficiency or excess of metals, can contribute to certain diabetic outcomes. Therefore, this paper will report the blood levels of chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), mercury (Hg), nickel (Ni), lead (Pb), selenium (Se), and zinc (Zn) in subjects with type 1 diabetes (n?=?192, mean age 48.8 years, mean disease duration 20.6 years), type 2 diabetes (n?=?68, mean age 68.4 years, mean disease duration 10.2 years), and in control subjects (n?=?59, mean age 57.2 years), and discuss the results indicating their possible role in diabetes. The metal concentrations were measured by sector field inductively coupled plasma mass spectrometry after microwave-induced acid digestion of blood samples. The accuracy was checked using a blood-based certified reference material, and recoveries of all elements were in the range of 92–101 % of certified values. Type 1 diabetes was found to be associated with Cr (p?=?0.02), Mn (p?<?0.001), Ni (p?<?0.001), Pb (p?=?0.02), and Zn (p?<?0.001) deficiency, and type 2 diabetes with Cr (p?=?0.014), Mn (p?<?0.001), and Ni (p?<?0.001) deficiency. These deficiencies were appreciated also subdividing the understudied patients for gender and age groups. Furthermore, in type 1 diabetes, there was a positive correlation between Pb and age (p?<?0.001, ρ?=?0.400) and Pb and BMI (p?<?0.001, ρ?=?0.309), while a negative correlation between Fe and age (p?=?0.002, ρ?=??0.218). In type 2 diabetes, there was a negative correlation between Fe and age (p?=?0.017, ρ?=??0.294) and Fe and BMI (p?=?0.026, ρ?=??0.301). Thus, these elements may play a role in both forms of diabetes and combined mineral supplementations could have beneficial effects.     

Comparison of Coding Capabilities of Type I and Type II Neurons

We consider the dependence of information transfer by neurons on the Type I vs. Type II classification of their dynamics. Our computational study is based on Type I and II implementations of the Morris-Lecar model. It mainly concerns neurons, such as those in the auditory or electrosensory system, which encode band-limited amplitude modulations of a periodic carrier signal, and which fire at random cycles yet preferred phases of this carrier. We first show that the Morris-Lecar model with additive broadband noise ("synaptic noise") can exhibit such firing patterns with either Type I or II dynamics, with or without amplitude modulations of the carrier. We then compare the encoding of band-limited random amplitude modulations for both dynamical types. The comparison relies on a parameter calibration that closely matches firing rates for both models across a range of parameters. In the absence of synaptic noise, Type I performs slightly better than Type II, and its performance is optimal for perithreshold signals. However, Type II performs well over a slightly larger range of inputs, and this range lies mostly in the subthreshold region. Further, Type II performs marginally better than Type I when synaptic noise, which yields more realistic baseline firing patterns, is present in both models. These results are discussed in terms of the tuning and phase locking properties of the models with deterministic and stochastic inputs.     

IL-10 Dependent Suppression of Type 1, Type 2 and Type 17 Cytokines in Active Pulmonary Tuberculosis

Background

Although Type 1 cytokine responses are considered protective in pulmonary tuberculosis (PTB), their role as well as those of Type 2, 17 and immunoregulatory cytokines in tuberculous lymphadenitis (TBL) and latent tuberculosis (LTB) have not been well studied.

Aim and Methods

To identify cytokine responses associated with pulmonary tuberculosis (TB), TB lymphadenitits and latent TB, we examined mycobacterial antigen-specific immune responses of PTB, TBL and LTB individuals. More specifically, we examined ESAT-6 and CFP-10 induced Type 1, Type 2 and Type 17 cytokine production and their regulation using multiplex ELISA.

Results

PTB individuals exhibited a significantly lower baseline as well as antigen-specific production of Type 1 (IFNγ, TNFα and IL-2); Type 2 (IL-4) and Type 17 (IL-17A and IL-17F) cytokines in comparison to both TBL and LTB individuals. TBL individuals exhibited significantly lower antigen-specific IFNγ responses alone in comparison to LTB individuals. Although, IL-10 levels were not significantly higher, neutralization of IL-10 during antigen stimulation resulted in significantly enhanced production of IFNγ, IL-4 and IL-17A in PTB individuals, indicating that IL-10 mediates (at least partially) the suppression of cytokine responses in PTB.

Conclusion

Pulmonary TB is characterized by an IL-10 dependent antigen-specific suppression of Type 1, Type 2 and Type 17 cytokines, reflecting an important association of these cytokines in the pathogenesis of active TB.