120例肝源性糖尿病患者临床特点分析

目的:探讨肝源性糖尿病的临床特点及其治疗,以提高对该病的诊疗水平.方法:120例肝源性糖尿病(HD)患者,其中46例行OGTT试验,检测了血糖、胰岛素、C肽、胰岛素敏感指数(ISI),HOMA-IR及空腹血糖、空腹胰岛素(FPG/FINS)评估胰岛素抵抗,并与50例2型糖尿病(T2DM)患者进行对比分析.结果:21例(17.5％)HD患者有三多一少糖尿病典型症状.OGTT结果显示HD组空腹血糖低于T2DM组(P＜0.05);胰岛素+C肽释放试验显示T2DM组和HD组胰岛素分泌呈高峰延迟型,HD患者各时段胰岛素及C肽水平高于T2DM患者(P＜0.05,P＜0.01).HD组的FPG/FINS及HOMA-IR低于HD组,ISI高于HD组,差异均有统计学意义(P＜0.05).经治疗后血糖大部分控制在正常或接近正常水平,9例病例均死于肝病并发症.结论:胰岛素抵抗可能是肝源性糖尿病重要的发病机制.肝源性糖尿病以餐后高血糖为特征,临床症状不典型,短期不良预后主要与原发慢性肝病有关.     

肝源性糖尿病45例临床分析

目的探讨肝源性糖尿病的临床特点及治疗。方法观察45例肝硬化合并肝源性糖尿病患者的临床表现,检测治疗前、治疗后的血糖情况并进行比较分析。结果肝源性糖尿病患者以肝病表现为主,血糖波动较大,以餐后2h血糖升高为主;而Child-pugh分级C级患者的血糖明显高于A、B级患者,有并发症的患者血糖明显高于无并发症的患者。结论肝硬化患者易发生糖代谢紊乱,血糖水平与肝功能情况密切相关,经早期积极治疗,血糖基本可降至理想范围并稳定。     

克雷伯杆菌所致肝脏巨大气性脓肿一例报告

目的:分析克雷伯杆菌导致肝脓肿的的可能原因和发病机理,提高诊断的准确性,并对临床治疗提供帮助.方法:本文报道了本院收治的一例肝内罕见巨大气性脓肿,详细分析了其影像学表现特点及临床表现、辅助检查等情况.结果:本病例细菌培养结果为克雷伯杆菌.患者经积极治疗后病情好转.结论:肺炎克雷伯杆菌引起的肝脓肿发病率呈上升趋势,并已经成为细菌性肝脓肿最常见的致病菌.克雷伯杆菌所致的肝脓肿除了有细菌性肝脓肿的普遍表现外,还有其独特的特点.另外,糖尿病是克雷伯杆菌肝脓肿常见的基础疾病,糖尿病患者的肝脓肿往往进展迅速,且早期症状及CT表现多不典型,因此对于感染入院的糖尿病患者应该警惕克雷伯杆菌肝脓肿的发生.     

肺炎克雷伯菌致肝脓肿侵袭综合征3例临床分析及文献复习

为提高对肺炎克雷伯菌感染所致肝脓肿侵袭综合征的临床表现及其危害的认识,回顾性分析3例确诊为肺炎克雷伯菌感染所致肝脓肿患者的临床经过、治疗反应及转归。结果发现3例患者均有肝外播散性病灶,符合肝脓肿侵袭综合征的临床特征。这3例患者为社区获得性感染,均有肝脓肿,其中2例合并眼内炎并造成失明,1例合并腰椎感染、腹主动脉感染及感染性心内膜炎。2例有糖尿病病史,1例免疫正常。结合文献复习,发现肺炎克雷伯菌感染引起肝脓肿及肝外播散性病灶,临床上称为肝脓肿侵袭综合征,大多由高毒力肺炎克雷伯菌引起,好发于糖尿病及免疫缺陷人群,也可发生于免疫正常人群,治疗困难,临床危害严重,需引起重视。     

自体骨髓干细胞移植治疗失代偿期肝硬化的临床效果分析

目的:观察自体骨髓间充质干细胞(BMSC)移植治疗合并不同并发症的失代偿期肝硬化的临床效果。方法:回顾性分析我院自2008年12月至2013年12月收治的148例经自体BMSC移植治疗的肝硬化合并肝性脑病、肝肾综合征、肝源性糖尿病以及消化道出血患者治疗前后的肝、肾功能、血清蛋白、血常规等指标的变化情况。结果:治疗后,肝硬化合并肝性脑病患者的ALT、血氨水平改善明显,TBIL反复;合并肝肾综合征的患者HB、Crea水平改善明显,ALT、AST、DBIL反复;合并肝源性糖尿病患者的ALT、TBIL、DBIL、TB、ALB、血糖水平改善明显;合并消化道出血患者的ALT、TP、ALB改善明显,AST、TBIL、PLT反复。结论:自体BMSC移植治疗肝硬化合并肝源性糖尿病的效果较好,对合并肝性脑病、肝肾综合征以及消化道出血患者的效果欠佳。     

肺结核合并糖尿病54例临床分析

目的:探讨肺结核合并糖尿病的临床表现及其糖尿病控制对结核病治疗的影响.方法:回顾性分析我院收治的54例肺结核合并糖尿病患者的临床资料.结果:肺结核合并糖尿病以2型糖尿病为主,肺结核X线表现以大片渗出、干酪病变为主,痰菌阳性率高,合并症多为临床特点,血糖大多数控制在7.8mmol/L以下.结论:对肺结核合并糖尿病患者应进行早期正规抗结核治疗,并适当延长疗程,同时有效控制血糖是治疗结核合并糖尿病的关键.     

黄芪甲苷在正常小鼠与2型糖尿病肾病 db/db小鼠体内分布差异的比较研究

为研究黄芪甲苷(Astragaloside IV,AS-Ⅳ)在正常小鼠(db/m)和2型糖尿病肾病(db/db)小鼠体内的组织分布差异,为AS-Ⅳ抗2型糖尿病肾病的临床运用及新药研发提供实验依据。以尾静脉注射给予2型糖尿病肾病(db/db)和正常小鼠(db/m)小鼠AS-Ⅳ,剂量为8 mg/kg。于15 min、2 h、4 h时处死小鼠,收集心、肝、脾、肺、肾、胃、小肠、脑、肌肉组织,采用HPLC-MS/MS法测定各组织中AS-Ⅳ含量,对比AS-Ⅳ在正常及病理状态下,在各组织中的分布差异。在2型糖尿病肾病状态下,AS-Ⅳ在肝、脾、肺、肾组织中浓度分别为349.72±70.72、370.69±45.46、5 830.65±581.75、4 290.63±485.34 ng/mL;正常状态下,AS-Ⅳ在肝、脾、肺、肾组织中浓度分别为202.47±47.96、267.92±41.24、4 725.80±867.51、2 354.55±256.11 ng/mL,在2型糖尿病肾病状态下,AS-Ⅳ在肝、脾、肺、肾组织中浓度显著高于其在正常组织中浓度(P0.05)。静脉注射给药后,肺、肾、心、胃、脾是其主要分布器官,其中在肺、肾组织中浓度最高;病理状态下,AS-Ⅳ组织分布发生了一定改变,为AS-Ⅳ防治2型糖尿病肾病的临床合理应用及开发提供实验依据。     

肝胆管结石伴糖尿病患者术后并发症相关因素分析

目的探讨肝胆管结石伴糖尿病患者术后并发症的危险因素。方法回顾性分析176例肝胆管结石合并糖尿病手术患者的临床资料,对9个临床相关因素进行单因素分析,并采用多因素Logistic回归分析。结果 176例患者中,72例患者出现并发症,并发症发生率为40.9%。单因素分析结果提示糖化血红蛋白(HbAc)、体重指数(BMI)、胰岛素抵抗指数(IRI)和术后血糖为主要危险因素(P0.05);多因素Logistic回归分析结果表明体重指数(BMI)、术后血糖与IRI是独立的危险因素(P0.05)。结论影响肝胆管结石合并糖尿病患者术后并发症发生率的主要危险因素为体重指数、术后血糖与胰岛素抵抗,应积极采取针对性的预防措施,在一定程度上降低并发症发生率。     

利用生物信息学研究肥胖与2型糖尿病患者肝组织基因表达变化

目的:利用芯片数据分析工具对GEO基因芯片数据进行数据挖掘,系统分析肥胖与2型糖尿病患者肝组织相关基因表达的变化,探讨肥胖与2型糖尿病的联系及糖尿病早期预防和诊断的新靶点。方法:首先在公共芯片数据库中选择肥胖与2型糖尿病相关芯片数据(GSE15653),利用R等芯片数据分析工具分析肥胖与2型糖尿病患者肝组织基因的表达变化,并预测相关差异表达基因在血中蛋白表达。结果:肥胖患者与正常人肝组织比较发现412个差异表达基因,其中上调表达基因212个,下调表达基因200个,2型糖尿病患者中控制良好者与正常人肝组织比较发现486个差异表达基因,其中上调表达基因253个,下调表达基因233个,而2型糖尿病患者中控制不良者与正常人肝组织比较发现1051个差异表达基因,其中上调表达基因560个,下调表达基因491个;2型糖尿病控制良好者与肥胖患者肝组织有263个相同的表达变化基因,而2型糖尿病控制不良者与肥胖患者肝组织有131个相同的表达变化基因;结合蛋白质组学结果分析肥胖与2型糖尿病相关的差异表达基因中有30个蛋白表达产物是分泌型蛋白。结论:肥胖及2型糖尿病患者肝组织与正常肝组织比较基因表达均发生明显变化,其基因表达变化数目随疾病的严重性增加而增多,而且2型糖尿病的控制情况与肝组织基因表达变化有密切关系。肥胖与2型糖尿病相关的差异表达基因中表达分泌型蛋白的可进一步用于研发监测疾病发生发展的候选靶分子。     

FXR与糖尿病相关性研究进展

国际糖尿病联盟(IDF)最新数据表明目前中国糖尿病患者在剧增。糖尿病是以胰岛素分泌相对或和绝对不足导致的慢性高血糖为特征的代谢性疾病,法尼醇X受体(farnesoid X receptor,FXR,NR1H4)是能被胆汁酸激活的转录因子,FXR能对胆汁酸的代谢进行调节,胆汁酸代谢与糖尿病相关,胆汁酸代谢在β细胞的功能是通过FXR介导的,本文回顾国内外有关法尼醇X受体通过抑制肝糖原异生、增加肝糖原储存、影响胰岛素信号、增加胰岛素的分泌和增强胰岛素的敏感性等机制发挥调节血糖平衡作用的研究,意在探索FXR与糖尿病的相关性,为糖尿病的发病机制提供新的理论依据。     

肾阴虚证的现代研究进展

肾阴虚证是中医学的基本证型之一.对中医证的研究,基本方法是运用现代科技手段,通过动物实验与临床研究,探讨疾病发生后"证"与人体生理变化、病理、生化等客观指标的关系,尝试揭示证的实质.几十年来,不少学者从细胞、分子等水平上对肾阴虚证本质做了深入地研究,并已取得了一定的成果,某些方面已形成了共识.这不仅丰富和发展了传统的中医肾阴虚理论,而且为肾阴虚证的临床诊断、治疗、预后判断提供了更客观的、更全面的指导作用.本文从神经内分泌、免疫、微量元素、脂代谢、自由基、细胞因子与介质、基因等方面对肾阴虚证病理生理的客观化研究进展进行了详细地阐述.     

糖尿病流行病学研究策略及分子遗传学研究进展

流行病学是现代医学的一门重要的基础学科,也是一门应用广泛的应用学科。流行病学作为方法学在复杂疾病研究中有不可替代的作用。糖尿病具有复杂疾病属性,应该以系统的多层次的流行病学方法为研究策略。本文从流行病学与临床医学、遗传学及分子生物学交叉所形成的分支学科一临床流行病学、遗传流行病学及分子流行病学三个方面对糖尿病的研究进展作一综述,并从分子遗传学角度列举了部分糖尿病的候选基因。提出糖尿病的研究应该从宏观流行病学（如社会环境等因素的影响）和微观流行病学（如分子遗传等）结合系统地进行研究。     

发酵中药--拓展中药新药研究开发的新空间

发酵中药是现代生物技术和中药研究的完美结合,依靠微生物发酵来生产发酵中药近来正逐渐成为研究的热点,并为中药的发展开辟了新空间。本文综述了发酵中药的应用历史及现况、作用机理、优势特色和发展方向。     

Effect of traditional Chinese medicine on gut microbiota in adults with type 2 diabetes: A systematic review and meta-analysis

BackgroundDespite advances in research on type 2 diabetes mellitus (T2DM) with the development of science and technology, the pathogenesis and treatment response of T2DM remain unclear. Recent studies have revealed a significant role of the microbiomein the development of T2DM, and studies have found that the gut microbiota may explain the therapeutic effect of traditional Chinese medicine (TCM), a primary branch of alternative and complementary medicine, in the treatment of T2DM. The aim of this study was to systematically review all randomized controlled trials (RCTs) on TCM for gut microbiota to assess the effectiveness and safety of TCM in T2DM patients.MethodsAll RCTs investigating the effects of TCM interventions on modulating gut microbiota and improving glucose metabolism in the treatment of T2DM adults were included. Meta-analyses were conducted when sufficient data were available, other results were reported narratively. The study protocol was pre-specified, documented, and published in PROSPERO (registration no. CRD42020188043).ResultsFive studies met the eligibility criteria ofthe systematic review. All five studies reported the effects of TCM interventions on the gut microbiota modulation and blood glucose control. There were statistically significant improvements in HbA1c (mean difference [MD]: -0.69%; [95% CI −0.24, −0.14]; p = 0.01, I² = 86%), fasting blood glucose (MD: −0.87 mmol/l; [95% CI -1.26, -0.49]; p < 0.00001, I² = 75%) and 2-h postprandial blood glucose(MD: -0.83mmol/l; [95% CI: -1.01, -0.65]; p < 0.00001, I² = 0%). In addition, there were also statistically significant improvements in homeostasis model assessment of insulin resistance (HOMA-IR) (standardized mean difference [SMD]: −0.99, [95% CI −1.25 to -0.73]; p < 0.00001, I² = 0%) and homeostasis model assessment of β-cell function (HOMA-β) (SMD: 0.54, [95% CI 0.21 to 0.87]; p = 0.001, I² = 0%).There was a significant change in the relative abundance of bacteria in the genera Bacteroides (standardized mean difference [SMD] 0.87%; [95% CI 0.58, 1.16], however, the change in Enterococcus abundance was not statistically significant (SMD: -1.71%; [95% CI: -3.64, 0.23]; p = 0.08) when comparing TCM supplementaltreatment with comparator groups. Other changes in the gut microbiota, including changes in the relative abundances of some probiotics and opportunistic pathogens at various taxon levels, and changes in diversity matrices (α and β), were significant by narrative analysis. However, insufficient evidences were found to support that TCM intervention had an effect on inflammation.ConclusionTCM had the effect of modulating gut microbiota and improving glucose metabolisms in T2DM patients. Although the results of the included studies are encouraging, further well-conducted studies on TCM interventions targeting the gut microbiota are needed.     

Equine oocyte in vitro maturation: influences of sera, time, and hormones.

Objectives of the present research were to determine the influences of types of media, sera, time and hormones on equine oocyte in vitro maturation (IVM). The following types of media and sera were evaluated: Menezo's B2 medium (B2), modified Tissue Culture Medium 199 (TCM), Defined Medium (DM), fetal calf serum (FCS), mare serum collected on the first day of estrus (MS), and mare serum collected on the day of ovulation (MSO). Resultant oocyte maturation was compared with the control: DM with bovine serum albumin (BSA). Effect of culture time (0, 15, and 32 hr) and the following hormones on oocyte IVM were evaluated: none, bovine luteinizing hormone (bLH; 1, 10, 100 micrograms/ml), equine luteinizing hormone (eLH; 100 micrograms/ml), bovine follicle-stimulating hormone (FSH; 5 micrograms/ml), and equine chorionic gonadotropin (eCG; 1 and 100 IU/ml). Cumulus expansion in the media and sera experiments was 50% (DM with BSA), 80% (TCM, B2, and DM with MS or MSO), and 100% (FCS with any medium). The proportion of metaphase II (MII) oocytes was significantly (P less than 0.05) increased the percentage of MII oocytes as compared with 0 hr of culture. Cumulus expansion in the hormone experiments was 80% (none, bLH, and eLH), and 100% (eCG and FSH). Freshly prepared bLH significantly (P less than 0.05) inhibited nuclear maturation of equine oocytes. In summary, 15 hr of culture was sufficient time for equine oocyte IVM and all combinations of medium, serum, and hormone addition were equally effective in achieving IVM except fresh bLH and DM with BSA.     

血小板体外质量评价研究进展

血小板输注是现代医学治疗的一项有效措施,近年来在临床上的应用日益普遍。血小板的临床输注效果与在体外的保存质量密切相关。我们简要介绍目前评价血小板体外质量的主要实验方法和仪器,以及它们在临床使用中的优缺点。     

Tu Youyou winning the Nobel Prize: Ethical research on the value and safety of traditional Chinese medicine

In 2015, the Chinese pharmacologist, Tu Youyou, was awarded the Nobel Prize for Physiology or Medicine for the discovery of artemisinin. Traditional Chinese medicine (TCM) was the source of inspiration for Tu's discovery and provides an opportunity for the world to know more about TCM as a source of medical knowledge and practice. In this article, the value of TCM is evaluated from an ethical perspective. The characteristics of ‘jian, bian, yan, lian’ are explored in the way they promote accessibility and economic efficiency for TCM. The article also examines how the increased use and prevalence of TCM reflects the scientific, cultural, and ethical values of TCM and their increasing attraction in meeting major challenges to medicine and health systems currently and in the future. The article discusses safety issues within TCM, which is a controversial area, and also comments on some shortcomings and challenges which pose difficulties for more widespread and greater uptake of TCM-derived clinical or therapeutic interventions. The article concludes that TCM is generally safe if it is used according to TCM theory and where such applications are cognizant of the strengths and weaknesses of TCM. TCM has important bioethical values which may inform potential measures for meeting challenges facing global health care systems and the article argues that it can have an increasing role in improving human health.     

现代生物医学科技前沿与中西医结合交叉

本文讨论了中医现代化和中西医结合的有关问题,指出中医现代化工作可分为三个方面：第一方面,应当培养大批临床上过硬的中医人才,在临床上有所突破,以此为基础进行理论研究;第二方面,将中医理论转换成现代语言;第三方面,中医与包括现代生物医学在内的多学科结合。阐述了现代生物医学科技前沿与中西医结合交叉而产生的新学科一光子中医学。指出光子中医学将为中西医结合提供理论和技术平台,成为多学科研究中医的代表性学科,并将成为中医现代化的一个重要方向,为人类卫生事业作出重大贡献。