西格列汀、罗格列酮分别联合二甲双胍治疗老年2型糖尿病的疗效观察

目的:观察并对比二肽基肽酶-Ⅳ抑制剂西格列汀、胰岛素增敏剂罗格列酮分别联合降糖药物二甲双胍治疗老年2型糖尿病(T2DM)的临床疗效.方法:入选2010年4月-2012年10月间我科收治的老年T2DM患者70例,并随机单盲分为A(n=36)、B(n=34)两组,A组患者予西格列汀+二甲双胍方案,B组予罗格列酮+二甲双胍方案,服药12周后对比两组血糖水平、临床疗效并药物不良反应.结果:①两组患者服药12周后,血糖指标均较治疗前明显下降(P＜0.05),A组患者2hPG水平明显低于B组水平(P＜0.05).②A组患者显效率(50.0％)、总体有效率(91.7％)略高于B组(38.2％、85.3％),差异不具有统计学意义(P＞0.05).③两组患者均未出现严重药物不良反应,两组不良反应发生率(19.4％vs.26.5％)无统计学差异(P＞0.05).结论:两种用药方案均是治疗老年T2DM的有效方案,西格列酮+二甲双胍方案较之罗格列酮+二甲双胍方案在临床疗效中具备比较优势,尤其是对降低餐后血糖优势明显.     

罗格列酮对果糖饲养SD大鼠肝肾功能、血脂、血常规的影响

目的:了解罗格列酮(Rosiglitazone)处理果糖饲养的SD大鼠后对肝、肾功能,血常规的影响。方法:将24只成年健康SD大鼠随机分为A、B两组。A组持续喂高果糖饲料1月后再随机分为:①高果糖饲养组;②果糖饲养同时用罗格列酮处理组。B组喂标准饲料1月后随机分为:①对照组;②罗格列酮处理组。采用氧化酶法、放免法等技术方法测定大鼠的空腹血糖、血脂、胰岛素水平,肝功能,肾功能,血常规等指标。结果:与对照组相比:果糖饲养组大鼠直接胆红素、总胆红素、间接胆红素、血糖、胰岛素、总胆固醇、甘油三酯等指标均升高;而总蛋白、钾、钠、氯、胰岛素敏感指数等指标均下降,差异均具有统计学意义(P＜0．05)。而罗格列酮处理组中总胆红素、间接胆红素、尿酸和尿素/肌酐等指标均升高;而总蛋白、球蛋白、钾、钠、氨水平、甘油三酯、血常规细胞数、血红蛋白均下降,差异具有统计学意义(P＜0．05)。与果糖饲养组相比,果糖饲养罗格列酮处理组的总胆红素、直接胆红素、谷草转氨酶、间接胆红素、谷丙转氨酶、总胆固醇均升高;而胰岛素、甘油三酯、钙离子水平均下降差异均具有统计学意义,且前面三个指标的差异更明显(P＜0．05)。结论:罗格列酮在治疗过程中虽改善了果糖饲养SD大鼠所引起的胰岛素抵抗,但会加重肝肾功能障碍;对机体有一定的毒副作用。     

注射罗格列酮对多发性骨髓瘤小鼠细胞免疫功能与Caspase-3表达的影响

摘要 目的：探讨注射罗格列酮对多发性骨髓瘤小鼠细胞免疫功能与Caspase-3表达的影响。方法：多发性骨髓瘤小鼠随机平分为三组-模型组、红细胞组与罗格列酮组,红细胞组与罗格列酮组分别给予经尾静脉注射重组鼠源促红细胞生成素5.0 mg/kg与罗格列酮5 mg/kg 100 μL,模型组给予尾静脉注射等体积生理盐水,每天给药1次,检测细胞免疫功能与Caspase-3表达变化情况。结果：三组治疗第7 d与治疗第14 d的肿瘤体积高于治疗第1 d(P<0.05),红细胞组与罗格列酮组低于模型组(P<0.05),罗格列酮组低于红细胞组(P<0.05)。红细胞组与罗格列酮组治疗第7 d与治疗第14 d的血清白介素(Interleukin,IL)-6与肿瘤坏死因子(Tumor necrosis factor,TNF)-α水含量低于模型组(P<0.05),罗格列酮组低于红细胞组(P<0.05)。红细胞组与罗格列酮组治疗第14 d与治疗第28 d的脾脏B淋巴细胞、T淋巴细胞比例对比高于模型组(P<0.05),罗格列酮组高于红细胞组(P<0.05)。红细胞组与罗格列酮组治疗第14 d与治疗第28 d的脑黑质Caspase-3蛋白表达水平低于模型组(P<0.05),罗格列酮组低于红细胞组(P<0.05)。结论：注射罗格列酮在多发性骨髓瘤小鼠的应用能改善细胞免疫功能,抑制脑黑质Caspase-3的表达,同时也能促进小鼠体重恢复,抑制炎症因子的表达。     

Brite/beige fat and UCP1 — is it thermogenesis?

The presence of two distinct types of adipose tissue, which have opposing functions, has been known for decades. White adipose tissue (WAT) is the main tissue of energy storage, while brown adipose tissue (BAT) dissipates energy as heat and is required for non-shivering thermoregulation. In the last few years, a third type of adipocyte was identified, termed the brite (“brown and white”) or beige adipocyte. Their physiological control and role, however, are not fully clarified. Brite/beige adipocytes have a positive impact on systemic metabolism that is generally explained by the thermogenesis of brite/beige adipocytes; although thermogenesis has not been directly measured but is mostly inferred by gene expression data of typical thermogenic genes such as uncoupling protein 1 (UCP1). Here we critically review functional evidence for the thermogenic potential of brite/beige adipocytes, leading to the conclusion that direct measurements of brite/beige adipocyte bioenergetics, beyond gene regulation, are pivotal to quantify their thermogenic potential. In particular, we exemplified that the massive induction of UCP1 mRNA during the browning of isolated subcutaneous adipocytes in vitro is not reflected in significant alterations of cellular bioenergetics. Herein, we demonstrate that increases in mitochondrial respiration in response to beta-adrenergic stimulus can be independent of UCP1. Using HEK293 cells expressing UCP1, we show how to directly assess UCP1 function by adequate activation in intact cells. Finally, we provide a guide on the interpretation of UCP1 activity and the pitfalls by solely using respiration measurements. The functional analysis of beige adipocyte bioenergetics will assist to delineate the impact of browning on thermogenesis, possibly elucidating additional physiological roles and its contribution to systemic metabolism, highlighting possible avenues for future research. This article is part of a Special Issue entitled: 18th European Bioenergetic Conference.     

罗格列酮对2型糖尿病合并急性冠脉综合征患者血清TGF—β1及IL-1β的影响

目的：观察罗格列酮对2型糖尿病合并急性冠脉综合征患者血清转化生长因子-β1（TGF—β1）及白细胞介素-1β（IL-1β）的影响。方法：116例2型糖尿病合并急性冠脉综合征患者,随机分为罗格列酮治疗组（n=58）和常规治疗组（n=58）。检测两组患者治疗前后空腹血糖、血脂及血清TGF-β1、IL-1β的变化。结果：治疗前两组患者空腹血糖、血脂及血清TGF-β1、IL-1β的水平无显著差异（P〉0．05）;治疗4月后,两组患者空腹血糖、血脂无显著差异,血清IL-1β较治疗前下降（P〈0．01）,罗格列酮组较常规治疗组下降明显,两组间差异显著（P〈0．05）;治疗后血清TGF—β1较治疗前上升（P〈0．05）,罗格列酮组与常规治疗组比较,差异显著（P〈0．05）。结论：罗格列酮能调控糖尿病合并急性冠脉综合征患者炎症介质和抗炎因子的分泌,可能具有改善动脉粥样硬化的作用。     

Plasma fatty acid metabolic profiling and biomarkers of type 2 diabetes mellitus based on GC/MS and PLS-LDA

Metabolic profiling has increasingly been used as a probe in disease diagnosis and pharmacological analysis. Herein, plasma fatty acid metabolic profiling including non-esterified fatty acid (NEFA) and esterified fatty acid (EFA) was investigated using gas chromatography/mass spectrometry (GC/MS) followed by multivariate statistical analysis. Partial least squares-linear discrimination analysis (PLS-LDA) model was established and validated to pattern discrimination between type 2 diabetic mellitus (DM-2) patients and health controls, and to extract novel biomarker information. Furthermore, the PLS-LDA model visually represented the alterations of NEFA metabolic profiles of diabetic patients with abdominal obesity in the treated process with rosiglitazone. The GC/MS-PLS-LDA analysis allowed comprehensive detection of plasma fatty acid, enabling fatty acid metabolic characterization of DM-2 patients, which included biomarkers different from health controls and dynamic change of NEFA profiles of patients after treated with medicine. This method might be a complement or an alternative to pathogenesis and pharmacodynamics research.     

Early induction of a brown-like phenotype by rosiglitazone in the epicardial adipose tissue of fatty Zucker rats

The epicardial adipose tissue (EAT) is “hypertrophied” in the obese. Thiazolidinediones are anti-diabetic, hypolipidemic drugs and are selective agonists for the gamma isoform of peroxisome proliferator-activated receptor (PPARγ). We evaluated the short-term effects of the prototype rosiglitazone (RSG, 5 mg kg⁻¹ day⁻¹ for 4 days) on the expression of the genes and proteins (by real-time PCR and Western blot) involved in fatty acid (FA) metabolism in EAT of the obese fatty Zucker rat and compared the levels of expression with those in retroperitoneal adipose tissue (RAT). The glyceroneogenic flux leading to fatty acid re-esterification was assessed by the incorporation of 14C from [1-14C]-pyruvate into neutral lipids. RSG upregulated the mRNA for phosphoenolpyruvate carboxykinase, pyruvate dehydrogenase kinase 4, glycerol kinase, adipocyte lipid binding protein, adipose tissue triglyceride lipase and lipoprotein lipase in both RAT and EAT with a resulting increase in glyceroneogenesis that, however, was more pronounced in EAT than in RAT. Under RSG, fatty acid output was decreased in both tissues but unexpectedly less so in EAT than in RAT. RSG also induced the expression of the key genes for fatty acid oxidation [carnitinepalmitoyl transferase-1, medium chain acyl dehydrogenase and very long chain acyl dehydrogenase (VLCAD)]in EAT and RAT with a resulting significant rise of  the expression of VLCAD protein. In addition, the expression of the genes encoding proteins involved in mitochondrial processing and density PPARγ coactivator 1 alpha (PGC-1α), NADH dehydrogenase 1 and cytochrome oxidase (COX4) were increased by RSG treatment only in EAT, with a resulting significant up-regulation of PGC1-α and COX4 protein. This was accompanied by a rise in the expression of PR domain containing 16 and uncoupling protein 1, two brown adipose tissue-specific proteins. In conclusion, this study reveals that PPAR-γ agonist could induce a rapid browning of the EAT that probably contributes to the increase in lipid turnover.     

罗格列酮结合二甲双胍对多囊卵巢综合征患者胰岛素抵抗指数的影响及临床疗效

目的:探讨罗格列酮与二甲双胍联合给药对多囊卵巢综合征(PCOS)患者胰岛素抵抗指数(HOMA-IR)的变化影响与临床效果的评价。方法:回顾性选取我院收治的PCOS患者127例列为研究样本,按照用药方案差异分为两组,对照组62例采用二甲双胍进行治疗;研究组65例采用罗格列酮联合二甲双胍治疗。观察并比较两组患者治疗前后HOMA-IR、血清性激素水平、排卵率及副反应发生情况。结果:治疗后,研究组HOMA-IR低于对照组,排卵率高于对照组(P0.05);研究组患者血清E2及T水平低于对照组,而FSH及SHBG水平高于对照组(P0.05);两组患者副反应发生率比较,差异无统计学意义(P0.05)。结论:罗格列酮辅助二甲双胍治疗PCOS可显著改善患者HOMA-IR,对性激素平衡有良好作用,副作用较小。