氧化应激与糖尿病

高血糖引起的自由基产生过多或消除障碍导致氧化应激的出现,氧化应激与糖尿病及其并发症的发生发展密切相关。抗氧化治疗为糖尿病及并发症的防治提供了新的思路。     

氧化应激与糖尿病心血管并发症

心血管并发症如冠状动脉粥样硬化、心肌梗死和中风等是糖尿病患者致残和致死的主要原因之一。动物模型和临床研究均显示氧化应激加速了糖尿病心血管并发症的发生发展过程。活性氧可以通过多种机制产生,糖尿病患者的糖代谢和脂代谢紊乱能诱发活性氧的生成增多,引起氧化应激,最终导致糖尿病心血管并发症的发生。     

内质网应激及线粒体功能障碍在糖尿病血管内皮损伤中作用的研究进展

血管内皮损伤是糖尿病血管并发症的起始环节,涉及多种机制,氧化应激被认为其中关键的环节,但补充外源性抗氧化剂的治疗目前仍存在争议。内质网及线粒体是参与细胞内活性氧生成的关键细胞器,探讨内质网应激、线粒体功能障碍及氧化应激之间的相互关系可能对于阐明糖尿病相关血管内皮功能障碍的发病机制有重要的意义。本文综述了近年关于内质网及线粒体功能障碍在糖尿病相关血管并发症中的研究进展并分析了二者的相互作用在氧化应激中的重要作用。     

硫辛酸在糖尿病微血管病变治疗中的作用

糖尿病是危害人群健康的一种慢性疾病。糖尿病微血管病变是糖尿病的特异性病变,其并发症主要包括肾脏病变,视网膜病变及神经病变。而其发生受多种因素影响,其发生机制研究已形成多种学说,主要有非酶糖基化、多元醇通路、氧化应激及己糖胺通路学说等。近年来硫辛酸对糖尿病微血管并发症的治疗作用是国内外研究的热点,硫辛酸是高效抗氧化剂,清除自由基和活性氧,再生体内谷胱甘肽等其他抗氧化剂,减弱氧化应激,从而硫辛酸可减弱多种糖尿病微血管并发症的诱发因素,并干预多元醇通路与己糖胺通路,对糖尿病微血管并发症中的相应靶器官有保护作用,本文就硫辛酸在糖尿病微血管病变中的应用做一简要综述。     

2 型糖尿病血管并发症发生机制及中药干预作用的研究进展

糖尿病血管并发症是导致糖尿病患者死亡的主要原因之一。许多糖尿病患者非常重视血糖的控制,而对于糖尿病血管并发症并未予 以足够的关注。随着中药研究领域的开展,人们发现中药在糖尿病慢性血管并发症的治疗中具有明显的优势。从糖脂代谢异常、胰岛素抵抗、 氧化应激以及肾素-血管紧张素-醛固酮系统异常等方面,综述2 型糖尿病血管并发症的发生机制,并简介中药针对各发病机制过程的干预 作用。     

糖尿病肾病的发病机制和药物干预研究进展

糖尿病肾病作为糖尿病最严重的并发症之一,也是糖尿病患者最主要的死亡原因之一。糖尿病肾病的发病机制主要与代谢紊乱、 血流动力学紊乱、氧化应激、炎症及遗传因素等相关。综述糖尿病肾病发病机制及相关药物治疗的研究新进展,为糖尿病肾病的早期干 预和治疗提供参考。     

糖、脂代谢及氧化应激与糖尿病肾病的相关性

糖尿病肾病是糖尿病的主要并发症之一。近年来,糖尿病肾病的发病率呈逐渐上升趋势。研究发现,糖、脂代谢与糖尿病肾病的发生密切相关,而氧化应激也在糖、脂代谢异常中起重要作用。本文综述了有关糖、脂代谢与糖尿病肾病相关性研究,以及硫氧还蛋白及硫氧还蛋白结合蛋白2在糖尿病肾病发生中的作用。     

Nrf2及其药理性活化剂在糖尿病心血管并发症中的作用

糖尿病(DM)导致的心脑血管并发症是危害人类健康的重大疾病。氧化应激被认为是DM相关心血管并发症发生、发展的重要机制,但通过补充外源性抗氧化剂并未能使心血管疾病患者远期获益。核因子E2相关因子2(Nrf2)可增加内源性抗氧化酶的活性从而提高机体的抗氧化应激能力,可能是治疗糖尿病心血管并发症的一个重要靶点,提示靶向Nrf2药物的开发可能获得防治糖尿病相关血管并发症的新一代药物。本文就Nrf2在糖尿病相关心血管并发症发生、发展中的作用及其药理性活化剂对糖尿病(DM)相关心血管病变的治疗作用进行综述。     

Lp(a)在糖尿病血管并发症中的表达与机制

2型糖尿病患病率逐年上升,糖尿病血管病变是主要的慢性并发症之一,是糖尿病致死率、致残率居高不下的重要原因。脂蛋白a[lipoprotein(a),Lp(a)]是2型糖尿病及血管并发症的有效预测因子与危险因素,通过促进动脉粥样硬化、促进血栓形成、抗血管生成、诱导炎症和氧化应激等机制参与胰岛素抵抗和脂代谢异常的进程,Lp(a)与凝血功能、肾功能等相关指标有明显相关性,有望成为糖尿病血管并发症早期诊断和评估预后的潜在生物学标志物。该文旨在对Lp(a)在糖尿病血管并发症的表达与机制作一综述,以期提高其临床应用价值。     

α-硫辛酸的生物医学功能

α-硫辛酸及其还原态二氢硫辛酸是高效抗氧剂,可以清除自由基和活性氧,螯合金属离子,再生谷胱甘肽、维生素C、维生素E、硫氧还蛋白等抗氧剂,可改善葡萄糖代谢,减弱氧化应激,对糖尿病性白内障、糖尿病多发性神经病及心血管损伤等糖尿病并发症具有较好的预防和治疗作用。     

肝移植术后肝脏淋巴回流淤滞发生的影响因素初步临床分析

目的:分析肝移植术后肝脏淋巴回流淤滞(Intrahepatic lymphatic stasis,IHLS)的影响因素。方法:收集我院自2004~2012年期间行肝移植手术并经增强计算机断层扫描(Computed tomography,CT)和/或磁共振(Magnetic resonance imaging,MRI)确诊的IHLS病人,分析正常肝移植组IHLS阳性率与肝移植术后静脉并发症、胆道并发症、乙肝复发、肝癌复发、动脉并发症、移植排斥、药物性肝损害、转移瘤组IHLS阳性率的差异。结果:正常移植肝组术后IHLS的阳性率分别与术后胆道并发症、静脉并发症、乙肝复发组肝移植术后IHLS的阳性率差异有统计学意义(P0.05),与其他并发症组IHLS的阳性率差异无统计学意义(P0.05)。结论:肝移植术后静脉并发症、胆道并发症及乙肝复发可影响肝移植术后IHLS发生。     

Nasal surgery complications

This study examines the incidence of serious complications in nasal surgery and discusses the diagnosis and management of these complications. The authors review 259 consecutive cases performed between January 1, 1983, and August 31, 1988. One-hundred and ninety-five patients had septorhinoplasties, 29 had septoplasties, and 35 had rhinoplasties. Thirteen of these cases involved serious complications as follows: hemorrhage (5), perforation (4), infections (3), and pneumocephalus (1). All the patients with these serious complications had associated septal and/or turbinate surgery. The diagnosis and management of these complications will be discussed. In this small series of nasal surgery patients, the incidence of serious complications was 5.0 percent, with no fatalities reported. The higher incidence of serious complications occurred when associated septal and/or turbinate surgery was required. Awareness of these complications is essential because of the increasing number of patients presenting to plastic surgeons for nasal surgery in whom associated septal and/or turbinate surgery is necessary.     

New potentials for 3-hydroxy-3-methyl-glutaryl-coenzymeA reductase inhibitors: Possible applications in retarding diabetic complications

The prevalence of diabetes mellitus is increasing all over the world and it is apparent that treatment of diabetic complications has the same importance as primary diabetes treatment and glycemic control. Diabetic complications occur as a result of prolonged hyperglycemia and its consequences, such as advanced glycation end products and reactive oxygen species. Impairment of lipid profile is also contributed to worsening diabetic complications. Therefore, it seems that the application of lipid-lowering agents may have positive effects on reversing diabetic complications besides glycemic control. Statins, a group of lipid-lowering compounds, have been shown to exert antioxidant, immunomodulatory, anti-inflammatory, and antiproliferative properties beyond their lipid-lowering effects. Furthermore, they have been reported to improve diabetic complications with different pathways. In this review, we will discuss the clinical importance, molecular biology of the most important microvascular/macrovascular diabetic complications, possible application of statins and their mechanism of action in retarding these complications.     

Relation between blood plasma viscosity and presence of vascular and neurological complications in diabetic Africans

The relation between changes in plasma and serum viscosity and the presence of diabetic vascular and neurological complications was investigated in 50 diabetic Africans. Diabetics with complications had significantly elevated plasma and serum viscosity compared with those of both diabetics without complications and healthy non-diabetics. Hypertension also contributed to the elevation of plasma and serum viscosity in diabetics with complications. Plasma and serum viscosity of diabetics significantly correlated with the number of vascular and neurological complications. Diabetics with cerebrovascular disease had the highest plasma and serum viscosity due to the presence of many complications. The results of this study suggest that changes in plasma and serum viscosity may be associated with abnormalities of vascular and neurological function present in diabetic Africans.     

Sequelae after AF ablation: Efficacy and Safety go Hand in Hand

Although nowadays performed on a routine basis, catheter ablation of atrial fibrillation is associated with the potential for major complications. Improving the safety remains therefore an important challenge. This article summarizes the different types of complications associated with AF ablation grouping them into clinically overt major complications, subclinical injury and permanent injury. Furthermore, it describes the potential predictors for complications and highlights the dynamic interplay between efficacy and safety.     

广西地区2型糖尿病患者直接卫生费用研究

目的分析广西地区近8年2型糖尿病患者的住院费用情况。方法收集广西医科大学第一附属医院2004年4月~2011年12月出院的2型糖尿病患者的病案资料,按有无并发症分为无并发症组2050例,有并发症组4795例,用两样本比较的秩和检验比较两组住院费用的差异。按并发症个数将有并发症组分为3个亚组,即B组（1个并发症组2478例）、C组（2个并发症1444例）、D组（3个及3个以上并发症组873例）,用多个样本比较Kruskal-Wallis H检验,组间比较用扩增t检验。按有无大血管病变将患者分为2型糖尿病无大血管病变组5711例,2型糖尿病并大血管病变组1134例,采用秩和检验比较两组住院费用的差异。结果 2型糖尿病患者中位住院费用为7009.55元;无并发症组的中位住院费用为5702.2元,有并发症组的中位住院费用为7726.65元;1个并发症组中位住院费用为6999.89元,2个并发症组的中位住院费用为8060.78元,3个及3个以上并发症组中位住院费用为10396.24元;2型糖尿病无大血管病变中位住院费用为6525.84元,2型糖尿病并大血管病变中位住院费用为11215.13元。结论有并发症较无并发症住院费用更高,有大血管病变较无大血管病变的2型糖尿病费用更高,并发症个数越多,费用越高。     

柱状经腹会阴直肠癌切除术后并发症分析及对策

目的:探讨分析柱状经腹会阴直肠癌切除术术后并发症发生的可能原因,并提出解决对策。方法:回顾分析我院自2010年1月至2014年5月采用柱状经腹会阴直肠癌切除术的68例直肠癌患者的临床资料。记录并分析患者发生术后并发症的情况,探讨发生的可能原因及可行对策。结果:68例患者术后出现并发症共9例,占13.2%。切口并发症4例,术后排尿困难2例,术后骶尾部疼痛3例。结论:柱状经腹会阴直肠癌切除术因为手术切除范围大,术后并发症亦随之凸显。但通过精细的术中解剖、重叠缝合腹膜关闭盆底、骶前通畅引流、合理掌握尿管拔管时机等手段,可有效降低术后并发症的发生。     

肠道微生物与肝硬化及其并发症的研究进展

人体肠道中数量可观、种类丰富的微生物对于维持人体健康起到重要作用。大量研究表明肠道微生物对肝硬化及其并发症有重要影响。当机体内外环境改变时会引起肠道微生物的变化,影响肝硬化及其并发症的发生和发展,而肝硬化及其并发症的发生发展也会引起肠道微生物的紊乱,二者相互联系,相互影响。通过对肠道微生物的检测和调节有助于肝硬化及其并发症的诊断与治疗。本文就肠道微生物与肝硬化及其并发症关系的研究现状,以肠道微生物为靶标的诊断治疗肝硬化及其并发症的策略以及现存在的问题进行综述     

Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs: a nested case-control study

Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is hampered by gastrointestinal ulcer complications, such as ulcer bleeding and perforation. The efficacy of proton-pump inhibitors in the primary prevention of ulcer complications arising from the use of NSAIDs remains unproven. Selective cyclooxygenase-2 (COX-2) inhibitors reduce the risk for ulcer complications, but not completely in high-risk patients. This study determines which patients are especially at risk for NSAID ulcer complications and investigates the effectiveness of different preventive strategies in daily clinical practice. With the use of a nested case-control design, a large cohort of NSAID users was followed for 26 months. Cases were patients with NSAID ulcer complications necessitating hospitalisation; matched controls were selected from the remaining cohort of NSAID users who did not have NSAID ulcer complications. During the observational period, 104 incident cases were identified from a cohort of 51,903 NSAID users with 10,402 patient years of NSAID exposure (incidence 1% per year of NSAID use, age at diagnosis 70.4 ± 16.7 years (mean ± SD), 55.8% women), and 284 matched controls. Cases were characterised by serious, especially cardiovascular, co-morbidity. In-hospital mortality associated with NSAID ulcer complications was 10.6% (incidence 21.2 per 100,000 NSAID users). Concomitant proton-pump inhibitors (but not selective COX-2 inhibitors) were associated with a reduced risk for NSAID ulcer complications (the adjusted odds ratio 0.33; 95% confidence interval 0.17 to 0.67; p = 0.002). Especially at risk for NSAID ulcer complications are elderly patients with cardiovascular co-morbidity. Proton-pump inhibitors are associated with a reduced risk for NSAID ulcer complications.     

腹腔镜术中二氧化碳异常弥散所致并发症

气腹是腹腔镜手术顺利进行的重要条件,二氧化碳(CO2)是气腹时最常用的气体。然而,腹腔镜手术除可引起开放式手术类似的并发症外,尚可引起腹腔镜技术相关的并发症。临床医生应当充分重视并及时处理各种并发症。这些并发症中以CO2异常弥散引起的并发症较为常见,且症状较严重。该类并发症主要包括CO2气体栓塞、气肿和气胸等,本文将就此进行综述。