化疗对恶性肿瘤患者的血糖影响的初步观察

目的:探讨化疗对恶性肿瘤患者血糖的影响。方法:取我院2005年3月至2006年12月收治的恶性肿瘤患者155例。回顾性分析其化疗前后的血糖变化情况及相关临床资料。结果:155例患者中,化疗后空腹血糖升高者占13．55%(21/155),其中糖耐量低减8人,占5．16%(8/155);诊断为糖尿病者7人,占4．52%(7/155);一过性血糖增高6人,占3．87%(6/155)。各患者化疗前后血糖值的变化有统计学意义(p＜0．05)。结论:恶性肿瘤患者接受化疗后可引起血糖增高,甚至发生糖耐量低减或2型糖尿病,且多发生于化疗的第3～4周期。     

TP方案化疗对恶性肿瘤患者血糖代谢的影响

目的探讨紫杉醇（Taxol）联合顺铂（Cisplatin）组成的TP方案化疗对恶性肿瘤患者血糖代谢的影响。方法取TP方案化疗的恶性肿瘤患者76例,回顾性分析其化疗前后的血糖变化情况及相关临床资料。结果76例患者中,化疗后空腹血糖升高者占18．4％（14／76）,其中糖耐量减低4例,占5．3％（4／76）;诊断为糖尿病者4例,占5．3％（4／76）;一过性血糖增高6例,占7．9％（6／76）。各患者化疗前后血糖值的差异有显著性（P〈0．05）。化疗诱发的血糖异常多发生在化疗的第2、3个周期。不同肿瘤患者化疗后血糖异常升高发生率差异无显著性（P〉0．05）。结论恶性肿瘤患者接受TP方案化疗后可引起血糖增高,甚至发生糖耐量减低或2型糖尿病,化疗期间应密切监测血糖变化。     

恶性肿瘤化疗后血糖变化的蛋白质组指纹模型

目的:应用表面增强激光解析离子飞行时间质谱(Surface-enhanced laser desorption ionization time of flight mass spectrometry,SELDI-TOF-MS)技术筛选与恶性肿瘤化疗后血糖变化情况相关的血清蛋白质组指纹并建立模型.方法:应用CM10弱阳离子芯片结合SELDI-TOF-MS技术检测197例恶性肿瘤患者化疗后血清样本的蛋白质谱,2年后随访,按血糖标准分为血糖正常组(171例)、糖耐量异常组(16例)和糖尿病组(10例),利用Biomarker Wizard软件比较各组间的血清蛋白质指纹图谱,Biomarker Pattern软件建立模型.结果:M/Z为4276和4662的两个蛋白质组成的诊断模型可将糖尿痛组与糖耐量异常组准确分组,灵敏度、特异度和准确度分别为70%、81.25%和76.92%;M/Z为2818、7535和2633的三个蛋白质组成的诊断模型可将糖尿病组与血糖正常组准确分组,灵敏度、特异度和准确度分别为80%、79.53%和82.32%;M/Z为2818、7744、3187、2564、4175、5165和3374的七个蛋白质组成的诊断模型可将糖耐量异常组与血糖正常组准确分组,灵敏度、特异度和准确度分别为87.5%、87.72%和88.77%.结论:SELDI-TOF-MS技术筛选出恶性肿瘤化疗后三组血糖情况的蛋白质指纹,M/Z为4175、4276、4086、3158、3374、3316、2044、3441、4662和4290可作为预测化疗后糖尿病的指标,M/Z为2818、3374、3352、4276、2932、8817、4070、3187、7535和15525可作为预测化疗后糖耐量异常的指标,M/Z为6021、3187、2818、2932、3273、4070、7916、8817、8057和4387可作为预测化疗后可能不会发生糖尿病的指标,这为化疗副反应的防治提供了科学依据.     

禁食与非禁食处理对构建2型糖尿病小鼠模型血糖的影响

为探讨禁食与非禁食处理对构建2型糖尿病小鼠模型血糖变化的影响,分别以普通饲料和高脂饲料喂养3周龄的C57BL/6J雄性小鼠5周,于第5周末采取禁食与非禁食处理,16 h后分别注射链脲佐菌素(streptozotocin,STZ)100 mg/kg体重或相应体积的柠檬酸缓冲液.于第5周末(禁食前)和注射后3周测定非空腹血糖浓度.普通饲料与高脂饲料注射STZ前禁食组血糖水平均显著升高,达到并超过糖尿病小鼠非空腹血糖成模标准(11mmol/L).高脂饲料注射STZ前非禁食组血糖水平表现为缓慢持续升高,其余各组血糖水平均低于糖尿病小鼠非空腹血糖成模标准.结果 表明,高脂饲料联合STZ诱导2型糖尿病小鼠血糖变化是有效的,但注射STZ前的禁食处理不是必需的;单纯注射STZ同样可以诱导糖尿病小鼠血糖升高,但注射前的禁食处理是必要的.     

糖类抗原153在恶性肿瘤中的诊断价值

目的:采用电化学免疫发光法探讨糖类抗原153在不同恶性肿瘤诊断中的应用价值。方法:回顾性分析CA153对807例恶性肿瘤患者的诊断价值,包括胰腺癌162例、结肠癌101例、胃癌139例、肺癌131例、乳腺癌101例、宫颈癌65例和前列腺癌108例。结果:与健康对照组比较,糖类抗原153在7种肿瘤中的含量均有显著性升高。与乳腺癌组相比,除肺癌组异常率无统计学差异外,其余各组均有统计学差异。CA153对于乳腺癌的诊断价值最高,灵敏性和特异性分别为70.4%和56.7%。结论:血清CA153水平的检测对恶性肿瘤的诊断具有一定的临床应用价值,但其灵敏性和特异性均不高,证明单一标志物对于肿瘤的诊断价值有限。     

青岛地区HPV亚型检测及其在宫颈病变中的意义

目的调查青岛地区妇科门诊就诊女性人群人乳头状瘤病毒(human papillomavirus,HPV)感染状况和基因型分布情况,以及与宫颈病变的关系。方法选取2016年6月-2017年6月于我院妇科门诊就诊,有性生活史并要求行HPV亚型检测的患者,共计11 885例,其中5 434例患者同时行TCT检测,分别分析年龄、多重感染及HPV亚型与宫颈病变的关系。结果 11 885例受检者中HPV总感染率为33.51%(3 983/11 885),其中:高危型HPV占82.59%(5 076/6 146),主要包括HPV16、HPV52、HPV58;低危型HPV占17.41%(1 070/6 146),主要包括HPV81、HPV6、HPV11。HPV单一亚型感染率为63.65%(2 535/3 983),多重感染率为36.35%(1 448/3 983)。不同年龄段HPV感染率差异有统计学意义(P0.01),呈"U"型,≤29岁感染率最高(43.20%),HPV感染率随TCT检查诊断级别的升高而显著升高(P0.01),HSIL组HPV感染率最高(93.12%)。结论青岛地区高危型HPV主要亚型为HPV16、HPV52、HPV58;不同年龄段及不同TCT诊断级别HPV感染率不同,HPV感染与宫颈鳞状上皮内病变密切相关,为宫颈癌的筛查、防治提供初步理论依据。     

一个2型糖尿病家系中新发现的线粒体DNA G7444A 突变分析

应用PCR-RFLP和测序对一个2型糖尿病家系的线粒体DNA G7444A的突变进行检测, 并分析其临床资料的特点。结果发现, 27例家系成员中, 11例母系亲属均存在线粒体DNA G7444A突变, 而配偶及父系亲属中未发现该突变。11例突变者中确诊为2型糖尿病患者5例, 糖耐量受损1例, 均表现为乳酸和血糖增高。因此, 线粒体DNA G7444A突变是该家系中糖尿病的遗传易感因素, 是导致2型糖尿病的一个新的突变位点。     

海拔高度对2型糖尿病患者循环内皮祖细胞及低氧诱导因子的影响*

目的: 探讨不同海拔地区2型糖尿病患者循环内皮祖细胞数量及相关检测指标的变化情况,为2型糖尿病血管并发症的研究和治疗提供依据。方法: 选取386 m低海拔地区(咸阳市)和1 520 m高海拔地区(兰州市)各一家医院内被诊断的2型糖尿病患者(25人/29人)和健康体检者(20人/20人)。用全自动生化分析仪检测两组人群的血脂、血糖和糖化血红蛋白指标,用酶联免疫吸附试验(ELISA)检测低氧诱导因子-1α(HIF-1α)的浓度,用流式细胞仪测定外周血循环内皮祖细胞(EPCs)的数量。结果: 无论在低海拔还是高海拔地区,糖尿病组较健康组循环EPCs数量降低(P＜0.01),体质指数(BMI)、腰臀比(WHR)、甘油三酯(TG)、空腹血糖(FBG)及糖化血红蛋白含量(HbAlc)增高(P＜0.05);与低海拔组相比,无论高海拔的糖尿病患者还是健康者,HIF-1α的表达水平均明显增加(P＜0.05),而循环EPCs数量明显降低(P＜0.05),且有循环EPCs数量健康者高于2型糖尿病无血管并发症者高于2型糖尿病伴血管并发症者的表现(P＜0.05)。结论: 海拔高度增加,2型糖尿病(T2DM)患者体内HIF-1α表达水平增加,循环EPCs数量降低,且与其血管病变程度密切相关。因此有望通过对高海拔地区T2DM患者进行EPCs的移植来实现对糖尿病血管并发症的预防和改善。     

糖尿病患者重型颅脑外伤术后脑梗死发生的预防性治疗研究

目的:观察分析糖尿病患者重型颅脑外伤术后脑梗死发生情况.方法:重型颅脑外伤共112例,糖尿病患者31例,非糖尿病患者81例,糖尿病患者按术后血糖控制水平分为血糖控制良好组(＜16.0)和血糖控制不良组(＞16.0),分别为13例、18例;所有病人均采用常规去骨瓣开颅术清除血肿减压,术后早期行脱水治疗,糖尿病组患者给予胰岛素治疗,术后1天、3天、7天复查CT.结果:糖尿病组患者15例(48.4%)出现脑梗死,血糖控制良好组和血糖控制不良组分别为3例(23.1%)、12例(66.7%),非糖尿病组患者9例(13.2%)出现脑梗死.结论:通过术后早期控制血糖水平于合适状态(＜16.0),可有效降低糖尿病患者重型颅脑外伤术后脑梗死发生,明显改善患者预后.     

糖化血红蛋白与糖尿病及其并发症的关系

目的:探讨糖化血红蛋白(HbAlc)与糖尿病诊断、疗效评价及并发症的关系。方法:选择2型糖尿病患者250例和健康体检者150例,分别测定空腹血糖(FPG)、2h血糖(2hPG)及糖化血红蛋白(HbA1c),统计学分析HbA1c与FPG、2hPG的相关性;分析HbA1c与糖尿病并发症发生的关系。结果:糖尿病组FPG、2hPG及HbA1c水平均显著高于对照组(P<0.01);糖尿病伴有并发症患者的HbAlc明显高于无并发症者(P<0.05),HbA1c水平与糖尿病并发症的发生率存在高度相关性(P<0.01)。结论:检测外周血中HbA1c水平对2型糖尿病诊断、疗效评价具有重要临床价值,控制糖化血红蛋白对预防糖尿病并发症的发生具有重要意义。     

妊娠期糖代谢异常对新生儿出生结局的影响

目的:探讨妊娠期不同程度的糖代谢异常对胎儿发育及结局的影响。方法:前瞻性收集我院2009年1月至2010年1月分娩的糖代谢异常的331例单胎妊娠孕妇,分为糖筛查异常组69例、糖耐量异常组126例、妊娠期糖尿病(Gestaional DiabetesMellitus,GDM)组136例,并选择同期糖代谢正常的751例单胎孕妇为对照组,比较四组新生儿出生的最终结局。结果:糖筛查异常组与对照组新生儿结局差异无显著性意义(P>0.05);糖耐量异常组中巨大儿及新生儿窒息、早产儿的发生率与对照组差异有显著性意义(P<0.05);GDM组与对照组差异有显著性意义(P<0.05)。结论:母亲妊娠期不同程度的糖代谢异常对新生儿影响不同。口服葡萄糖耐量试验(Oral Glucose Tolerance Test,OGTT)异常与GDM一样对新生儿发育及结局均有影响,可使巨大儿、新生儿窒息、早产儿的发生率增高。     

Reassessment of cardiovascular risk in diabetes

PURPOSE OF REVIEW: To review recent trials and reassess cardiovascular risk in people with diabetes. RECENT FINDINGS: Recent clinical trials have tended to focus on lower-risk participants with diabetes who have had event rates considerably lower than participants in the early lipid trials. Statin studies have generally shown benefit in those without cardiovascular disease and at lower levels of low-density lipoprotein cholesterol. Results of fibrate and glitazone studies have been mixed; the question of benefit among statin-treated patients remains unanswered. Investigators failed to confirm the benefits of glucose control observed in the original Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study possibly due to study design issues. Epidemiologic follow-up of the Diabetes Control and Complications Trial showed sustained benefit of glucose control. A number of studies have shown the benefit of inpatient control of blood glucose. We await the results of ongoing blood pressure trials and other ongoing trials, which should provide much new information. A conceptual model of cardiovascular risk for people with diabetes mellitus based on the UK Prospective Diabetes Study outcomes model is discussed. SUMMARY: The majority of adults with diabetes have a substantially greater risk compared with those without diabetes and a small percentage has very high risk. A minority of individuals may have considerably lower 10-year risk.     

Blood glucose level neural model for type 1 diabetes mellitus patients

This paper deals with the blood glucose level modeling for Type 1 Diabetes Mellitus (T1DM) patients. The model is developed using a recurrent neural network trained with an extended Kalman filter based algorithm in order to develop an affine model, which captures the nonlinear behavior of the blood glucose metabolism. The goal is to derive a dynamical mathematical model for the T1DM as the response of a patient to meal and subcutaneous insulin infusion. Experimental data given by continuous glucose monitoring system is utilized for identification and for testing the applicability of the proposed scheme to T1DM subjects.     

妊娠期糖代谢异常对新生儿出生结局的影响

目的：探讨妊娠期不同程度的糖代谢异常对胎儿发育及结局的影响。方法：前瞻性收集我院2009年1月至2010年1月分娩的糖代谢异常的331例单胎妊娠孕妇,分为糖筛查异常组69例、糖耐量异常组126例、妊娠期糖尿病（Gestaional DiabetesMellitus,GDM）组136例,并选择同期糖代谢正常的751例单胎孕妇为对照组,比较四组新生儿出生的最终结局。结果：糖筛查异常组与对照组新生儿结局差异无显著性意义（P〉0.05）;糖耐量异常组中巨大儿及新生儿窒息、早产儿的发生率与对照组差异有显著性意义（P〈0.05）;GDM组与对照组差异有显著性意义（P〈0.05）。结论：母亲妊娠期不同程度的糖代谢异常对新生儿影响不同。口服葡萄糖耐量试验（Oral Glucose Tolerance Test,OGTT）异常与GDM一样对新生儿发育及结局均有影响,可使巨大儿、新生儿窒息、早产儿的发生率增高。     

Fasting Plasma Glucose as Initial Screening for Diabetes and Prediabetes in Irish Adults: The Diabetes Mellitus and Vascular Health Initiative (DMVhi)

Objective

Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi) was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years.

Research Design and Methods

Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study. Exclusion criteria: already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG). Those with FPG in the impaired fasting glucose (IFG) range had a 75gm oral glucose tolerance test performed.

Results

122,531 subjects were invited to participate. 29,144 (24%) completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG) was 7.1% and of impaired glucose tolerance (IGT) was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively) and females (4.3%, 8.6%, 10.9% respectively). Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population.

Conclusions

This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes.     

营养干预对IGT 人群糖脂代谢及胰岛素抵抗的临床研究

目的：通过营养干预的手段观察其对糖耐量减低（IGT）人群糖脂代谢厦胰岛素水平的影响。方法：通过流调,以服糖耐量试验（OGTT）筛查IGT患者,随机分为对照组和干预组,干预组通过营养师进行善食调查,营养教育,饮食评价糯导总计1．5年。对照组不进行任何指导教育。两组于试验前后检查空腹血糖（FPG）,餐后2小时血糖（2hpG）,胰岛素（Ins）水平及胰岛素抵抗指教（HOMA-IR）等。结果：饮食干预组体质指数（BMI）,FPG、Ins及HomA—IR等较对照组明显下降（P〈0．01）仅2人转为糖尿病（DM）,对照组试验前后各项指标无显著变化,有6人转为DM,两组经t检验,DM的患病率有统计学意义（P〈0．05）。结论：营养干预对改善IGT患者的糖脂代谢,胰岛素抵抗有重要作用。     

Analysis of Fasting Plasma Glucose Values for Optimal Detection of Abnormal Responses on the Oral Glucose Tolerance Test in at-Risk Study Subjects

ObjectiveTo identify the fasting plasma glucose (FPG) value with the best performance for detecting an abnormal response on the oral glucose tolerance test (OGTT) in patients at risk for having type 2 diabetes.MethodsAll patients who underwent a 2-hour OGTT during an 18-month period were included in this study. Pretest and posttest odds, likelihood ratios, and receiver operating characteristic curves were used to identify the FPG value most strongly associated with an abnormal result on the OGTT (either diabetes or impaired glucose tolerance [IGT]).ResultsOf the 1,371 patients who underwent an OGTT during the designated study period, 1,239 fulfilled the inclusion criteria. The prevalence of IGT was 25.34% (314 patients). Diabetes was diagnosed in 141 patients (11.38%). IGT was more commonly found in the FPG strata below 115 mg/dL; above this value, diabetes was more frequently diagnosed. In general, the percentage of cases of IGT increased progressively throughout the “normal” FPG range. The prevalence varied from 11.4% (in patients with FPG values < 80 mg/dL) to 32% (in those with FPG levels from 95 to 99.9 mg/dL). FPG values between 95 and 99.9 mg/dL had a likelihood ratio of 2.1 for detecting an abnormal OGTT response, of 1.8 for detecting diabetes, and of 1.66 for detecting IGT. The odds ratio for detecting either IGT or diabetes was increased 2-fold by performing an OGTT. The FPG threshold with the best ability for detecting an abnormal response on the OGTT was 95 mg/dL (sensitivity of 0.72 and specificity of 0.65).ConclusionIn patients at risk for type 2 diabetes, the FPG cut point (95 mg/dL) most useful for detecting an abnormal OGTT response is included in the normal range of the FPG. (Endocr Pract. 2007;13:583-589)     

凝结芽胞杆菌对大鼠降糖作用的实验研究

目的：考察凝结芽胞杆菌（简称TQ33）对糖尿病大鼠病理模型的降血糖作用及糖耐量的影响,方法：以四氧嘧啶制备糖尿病大鼠病理模型后,灌服TQ33口服液,以氧化酶法测定大鼠血清中血糖含量。结果：TQ33对正常大鼠的空腹血糖基本无影响,对糖耐量的Cmax有明显的降低作用,并促进血糖水平迅速恢复;TQ33可降低实验性糖尿病大鼠的血糖水平,对糖耐量的Cmax有明显的降低作用,使糖耐量减低现象好转,结论：TQ33对由于四氧嘧\啶造成的糖尿病大鼠模型有一定的治疗作用。     

Glucose gradient differences in subcutaneous tissue of healthy volunteers assessed with ultraslow microdialysis and a nanolitre glucose sensor

The abdominal subcutaneous interstitium is easily accessible for monitoring glucose for Diabetes Mellitus research and management. The available glucose sensing devices demand frequent blood sampling by finger pricking for calibration. Moreover, there is controversy about the exact relationship between the levels of glucose in the subcutis and blood. In the present study ultra-slow microdialysis was applied for subcutaneous fluid sampling, allowing continuous measurement of glucose in an equilibrated fluid using a nanolitre size sensor. The present method avoids in vivo calibration. During an oral glucose tolerance test glucose levels were measured simultaneously in blood, in adipose tissue and loose connective tissue layers of the abdominal subcutis in seven healthy subjects. Fasting glucose levels (mM) were 2.52 +/- 0.77 in adipose tissue and 4.67 +/- 0.17 in blood, this difference increasing to 6.40 +/- 1.57 and 11.59 +/- 1.52 at maximal glucose concentration. Moreover, the kinetics of glucose in blood and adipose tissue were different. In contrast, connective tissue glucose levels differed insignificantly (4.71 +/- 0.21 fasting and 11.70 +/- 1.96 at maximum) from those in blood and correlated well (r2 = 0.962). Ultra-slow microdialysis combined with a nanolitre glucose sensor could be of benefit to patients in intensive diabetes therapy. Frequent blood sampling for in vivo calibration can be avoided by monitoring glucose in the abdominal subcutaneous loose connective tissue, rather than in the adipose tissue.