紫檀芪对2型糖尿病大鼠肾脏的影响

目的：研究紫檀芪对2型糖尿病大鼠肾脏的影响。方法：采用高糖高脂饮食结合小剂量链脲菌素构建2型糖尿病大鼠模型。将大鼠随机分为正常对照组、2型糖尿病组、紫檀芪低剂量组、紫檀芪中剂量组、紫檀芪高剂量组。干预7w后,检测大鼠血糖和血脂的变化,测定肾功能指标血尿素氮和血肌酐的含量及肾脏氧化应激水平,取肾脏组织做HE染色,观察大鼠肾组织病理学变化。结果：2型糖尿病组大鼠血糖、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（LDL C）水平升高,低密度脂蛋白胆固醇（HDL C）水平降低;血尿素氮和血肌酐升高;肾脏组织的超氧化物歧化酶（SOD）活性下降,丙二醛（MDA）水平升高;肾组织局部可见大量炎性细胞灶性浸润,炎症灶周围肾小管上皮细胞广泛水肿。紫檀芪干预后,血糖、TG、TC、LDL C水平降低;血尿素氮和血肌酐降低;肾脏组织的SOD活性升高,MDA水平下降;肾小球和肾小管病变减轻。结论：紫檀芪能够降低血糖和血脂、血尿素氮和血肌酐,改善肾脏的病理损伤,对2型糖尿病大鼠肾脏的损伤具有一定的治疗作用。     

血清晚期氧化蛋白产物与2型糖尿病合并冠状动脉病变的相关性研究

为了研究血清晚期氧化蛋白产物与2型糖尿病患者冠状动脉病变并发症的相关性。本研究选择50例2型糖尿病患者和30例健康体检者,取血后用分光光度法测定血清中晚期氧化蛋白产物的含量,使用全自动生化分析仪检测空腹血糖、总胆固醇和甘油三酯水平,使用微柱亲和层析法测定糖化血红蛋白的含量。研究显示血清晚期氧化蛋白产物在2型糖尿病组中的含量显著高于健康体检者组(p0.05);在血糖控制不良组中显著高于血糖控制良好组(p0.05)。2型糖尿病高晚期氧化蛋白产物患者组的空腹血糖、总胆固醇、甘油三酯和糖化血红蛋白水平显著高于低晚期氧化蛋白产物患者组(p0.05)。单因素相关分析显示血清晚期氧化蛋白产物与空腹血糖、总胆固醇、甘油三酯、糖化血红蛋白水平正相关。2型糖尿病患者中,患有冠状动脉病变并发症的患者血清晚期氧化蛋白产物水平显著高于非冠状动脉病变并发症患者(p0.05)。Logistic回归分析显示年龄、平均动脉压和AOPP的水平是2型糖尿病患者冠状动脉病变并发症发生的独立危险因素。本研究表明2型糖尿病患者体内氧化应激反应增强,血清晚期氧化蛋白产物水平升高,与冠状动脉病变并发症密切相关。     

糖尿病肾脏病与血纤溶酶原激活物抑制剂-1的相互影响

目的:观察糖尿病肾脏病进展过程中血纤溶酶原激活物抑制剂-1的水平变化及应用药物干预其变化后产生的对糖尿病肾脏病的影响。方法:选择于聊城市人民医院就诊的糖尿病肾脏病患者88例,DKDⅢ期43例,DKDⅣ期45例。分别检测各期患者血PAI-1水平,观察其变化趋势。针对DKDⅢ期患者分为对照组(DKDⅢ-C组)和观察组(DKDⅢ-O组),对照组给予常规降糖、保护肾脏及血管紧张素转化酶抑制剂等药物治疗。观察组在对照组治疗的基础上给予尿激酶5万U加入100ml生理盐水静脉滴注,每天1次,共14d。比较两组治疗前后血PAI-1水平、24 h尿白蛋白量、血肌酐、空腹血糖和凝血酶原时间的变化。结果:DKDⅣ期患者血PAI-1水平明显高于DKDⅢ期患者(P<0.001)。DKDⅢ-O组患者治疗后血PAI-1水平下降(P<0.01),且尿白蛋白减少程度有统计学意义(P<0.01),空腹血糖、血肌酐、凝血酶原时间影响无统计学差异(P>0.05)。DKDⅢ-C组治疗前、后血PAI-1、24h尿白蛋白量、空腹血糖、血肌酐、凝血酶原时间变化均无统计学差异(P>0.05)。结论:随糖尿病肾脏病进展,血PAI-1水平呈上升趋势,应用药物降低其水平后可减少早期DKD患者尿白蛋白量,对保护肾功能、延缓肾脏病进展有积极意义。     

胰岛素治疗及血糖监测记录表的设计与应用

据世界卫生组织（WHO）的最新数据预测,到2010年全世界将有2．4亿糖尿病患者。糖尿病属终身性疾病,血糖水平是反映该病控制好坏的重要指标,良好的血糖控制是预防糖尿病并发症的主要措施。使用胰岛素治疗是对糖尿病患者最有效、副作用最小的治疗手段,如何保证病人的正确用药和血糖检测是病房管理工作中重要的一环。     

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（HbAlc）,统计学分析HbAlc与FPG、2hPG的相关性;分析HbAlc与糖尿病并发症发生的关系。结果：糖尿病组FPG、2hPG及HbAlc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）,HbAlc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HbAlc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。     

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。     

不同血糖水平对体外循环心脏手术围术期患者血乳酸以及康复进程的影响

目的:探讨体外循环(CPB)心脏手术围术期患者不同血糖水平对血乳酸值及术后康复进程的影响。方法:选择2016年3月至2018年5月在我院行CPB心脏手术的患者78例为研究对象,根据术前血糖水平分为糖尿病组(术前空腹血糖≥7.0 mmol/L)33例和非糖尿病组(术前空腹血糖7.0 mmol/L)45例,于术前2h(T_1)、麻醉后(T_2)、CPB转机后5 min(T_3)、主动脉阻断后5 min(T_4)、停止CPB时(T_5)、手术结束时(T_6)、术后2h(T_7)、4h(T_8)、6h(T_9)、8h(T_(10))、12h(T_(11))、24h(T_(12))及48h(T_(13))监测两组血糖及血液乳酸水平,比较两组康复进程指标及并发症发生情况。结果:糖尿病组患者围手术期各时间点血糖及血乳酸水平均高于非糖尿病组,且两组血糖与血乳酸水平呈正相关(P0.05);两组各时间点血糖及血乳酸水平均高于T_1时刻(P0.05)。非糖尿病组患者呼吸机辅助通气时间、ICU停留时间、术后住院时间均短于糖尿病组(P0.05)。非糖尿病组并发症发生率为4.44%(2/45),与糖尿病组的15.15%(5/33)比较无统计学差异(P0.05)。结论:CPB心脏手术患者围术期血糖及血乳酸水平明显升高,二者呈正相关关系,但术前糖尿病患者围手术期血糖及血乳酸水平波动更明显,控制围手术期血糖水平有助于加快康复进程。     

IL-17、IL-8、IL-10水平与早期糖尿病肾病的关系

目的观察糖尿病大鼠肾脏早期IL-17、IL-8、IL-10水平的变化,并分析糖尿病大鼠肾脏早期IL-17、IL-8、IL-10水平与糖尿病肾病的关系。方法健康雄性SD大鼠被随机分为正常对照组和糖尿病模型组,模型组以一次性腹腔注射STZ诱导糖尿病模型;造模成功后在1周、2周、4周、6周,12周时间点分别取两肾,称量两肾的重量及大鼠体重,常规方法检测血清生化指标和尿蛋白含量,ELISA检测IL-17、IL-8、IL-10水平。分析IL-17、IL-8、IL-10水平与糖尿病肾病的关系。结果糖尿病各组大鼠IL-17、IL-8随时间逐渐升高,IL-10随时间逐渐降低,IL-17、IL-8与血糖、CRP、肾脏肥大指数、24小时尿蛋白、肌酐、血尿素氮呈正相关,IL-10与血糖、CRP、肾脏肥大指数、24小时尿蛋白、肌酐、血尿素氮呈负相关,IL-17、IL-8与IL-10呈负相关。结论 IL-17、IL-8可能促进糖尿病大鼠肾病的发展,IL-10可能抑制糖尿病大鼠肾病的进展。     

糖尿病肾脏病与血纤溶酶原激活物抑制剂-1的相互影响

目的：观察糖尿痛肾脏病进展过程中血纤溶酶原激活物抑制剂-1的水平变化及应用药物干预其变化后产生的对糖尿病肾脏病的影响。方法：选择于聊城市人民医院就诊的糖尿病肾脏病患者88例,DKDⅢ期43例,DKDⅣ期45例。分别检测各期患者血PAI-1水平,观察其变化趋势。针对DKDⅢ期患者分为对照组（DKDⅢ-C组）和观察组（DKDⅢ-O组）,对照组给予常规降糖、保护肾脏及血管紧张素转化酶抑制剂等药物治疗。观察组在对照组治疗的基础上给予尿激酶5万U加入100ml生理盐水静脉滴注,每天1次。共14d。比较两组治疗前后血PAI-1水平、24h尿白蛋白量、血肌酐、空腹血糖和凝血酶原时间的变化。结果：DKDⅣ期患者血PAI-1水平明显高于DKDⅢ期患者（P〈0．001）。DKDⅢ-O组患者治疗后血PAI-1水平下降（P〈0．01）,且尿白蛋白减少程度有统计学意义（P〈0．01）,空腹血糖、血肌酐、凝血酶原时间影响无统计学差异（P〉0．05）。DKDⅢ-C组治疗前、后血PAI-1、24h尿白蛋白量、空腹血糖、血肌酐、凝血酶原时间变化均无统计学差异（P〉0．05）。结论：随糖尿病肾脏病进展,血PAI-1水平呈上升趋势,应用药物降低其水平后可减少早期DKD患者尿白蛋白量,对保护肾功能、延缓肾脏病进展有积极意义。     

葡糖激酶小分子活化剂及其作用机制

葡糖激酶在调节血糖平衡过程中发挥着重要的作用,其活性的增强能够降低Ⅱ型糖尿病患者的血糖水平。近年来越来越多的研究表明,葡糖激酶小分子活化剂将成为治疗Ⅱ型糖尿病的一个重要调节物。     

Potentiation of hypoglycemic response of glibenclamide by piroxicam in rats and humans.

Influence of piroxicam (PX) on glibenclamide (GL) induced hypoglycemia has been studied in rats, healthy human volunteers and diabetics. GL per se has significantly reduced blood sugar levels in rats and in humans. PX per se has significantly reduced BSLs, in diabetics, while having no significant influence on blood sugar level in rats and healthy human volunteers. Prior administration of PX has potentiated the hypoglycemic effect of GL in rats, healthy human volunteers and diabetics. GL, PX + GL administration have also significantly influenced the glucose tolerance test (GTT) in healthy human volunteers.     

Rate of digestion of foods and postprandial glycaemia in normal and diabetic subjects.

Carbohydrate portions (2 g) of lentils, soya beans, and wholemeal bread were incubated for three hours with human digestive juices and the effect of digestibility on blood glucose examined. Lentils and soya beans released only 39% and 8% respectively of the sugars and oligosaccharides liberated from bread. In healthy volunteers 50 g carbohydrate portions of cooked lentils and soya beans raised blood glucose concentrations by only 42% (p < 0.001) and 14% (p < 0.001) of the bread value. There was a similar response in diabetics. These results suggest that rate of digestion might be a important factor determining the rise in blood glucose concentration after a meal and that supplementing chemical analysis with in-vitro and in-vivo food testing might permit identification of especially useful foods for diabetics.     

Changes in glycosylated haemoglobin after oral glucose load.

To study the relation between hyperglycaemia and a change in the concentration of glycosylated haemoglobin (HbA1) blood glucose and HbA1 concentrations were measured during an oral glucose tolerance test and for 120 days afterwards in 20 normal subjects. These measurements showed that a minor degree of hyperglycaemia led to a significant increase in lycosylated haemoglobin concentrations. The increase appeared 10 days after the test, and values remained raised until 30 days and returned to normal 60 days after the test. If such a minor fluctuation of blood glucose can lead to a significant increase in HbA1 concentrations the test may be too sensitive as an index of long-term blood glucose control in diabetics.     

Suppression of GLUT1; A new strategy to prevent diabetic complications

High blood glucose results in high glucose levels in retina, because GLUT1, the sole glucose transporter between blood and retina, transports more glucose when blood glucose is high. This is the ultimate cause of diabetic retinopathy. Knockdown of GLUT1 by intraocular injections of a pool of siRNAs directed against SLC2A1 mRNA which codes for GLUT1 significantly reduced mean retinal glucose levels in diabetic mice. Systemic treatment of diabetic mice with forskolin or genistein, which bind GLUT1 and inhibit glucose transport, significantly reduced retinal glucose to the same levels seen in non‐diabetics. 1,9‐Dideoxyforskolin, which binds GLUT1 but does not stimulate adenylate cyclase had an equivalent effect to that of forskolin regarding lowering retinal glucose in diabetics indicating that cyclic AMP is noncontributory. GLUT1 inhibitors also reduced glucose and glycohemoglobin levels in red blood cells providing a peripheral biomarker for the effect. In contrast, brain glucose levels were not increased in diabetics and not reduced by forskolin. Treatment of diabetics with forskolin prevented early biomarkers of diabetic retinopathy, including elevation of superoxide radicals, increased expression of the chaperone protein β2 crystallin, and increased expression of vascular endothelial growth factor (VEGF). These data identify GLUT1 as a promising therapeutic target for prevention of diabetic retinopathy. J. Cell. Physiol. 228: 251–257, 2013. © 2012 Wiley Periodicals, Inc.     

Dirty electricity elevates blood sugar among electrically sensitive diabetics and may explain brittle diabetes

Transient electromagnetic fields (dirty electricity), in the kilohertz range on electrical wiring, may be contributing to elevated blood sugar levels among diabetics and pre-diabetics. By closely following plasma glucose levels in four Type 1 and Type 2 diabetics, we find that they responded directly to the amount of dirty electricity in their environment. In an electromagnetically clean environment, Type 1 diabetics require less insulin and Type 2 diabetics have lower levels of plasma glucose. Dirty electricity, generated by electronic equipment and wireless devices, is ubiquitous in the environment. Exercise on a treadmill, which produces dirty electricity, increases plasma glucose. These findings may explain why brittle diabetics have difficulty regulating blood sugar. Based on estimates of people who suffer from symptoms of electrical hypersensitivity (3-35%), as many as 5-60 million diabetics worldwide may be affected. Exposure to electromagnetic pollution in its various forms may account for higher plasma glucose levels and may contribute to the misdiagnosis of diabetes. Reducing exposure to electromagnetic pollution by avoidance or with specially designed GS filters may enable some diabetics to better regulate their blood sugar with less medication and borderline or pre-diabetics to remain non diabetic longer.     

Clinical Use of the Glucose Disappearance Rate

An intravenous glucose tolerance test, coupled with a graphical or mathematical analysis, has been used in normal, diabetic, and glycosuric subjects, and patients suspected of having hypoglycemia. From the analysis, a single value, K, is derived which integrates the disappearance of the injected glucose. A significant difference was found between normals and known diabetics: this difference becomes even more distinct when the disappearance of the glucose load is measured as K1 or Increment Index, as opposed to decrease of the total blood glucose, K2 or Total Index. A 300-g. carbohydrate diet was shown to be important to the success of this test. More than 400 patients have been tested in the investigation of different disorders of glucose metabolism. Renal glycosuria was diagnosed in 35 patients. Rapid disappearance of the glucose load has been observed in 18 of 40 patients suspected of having hypoglycemia. Of 64 patients diagnosed in the hospital as previously unknown diabetics, 59 presented K1 values below the normal range.     

A portable, pre-programmable insulin infusion system in diabetes mellitus.

A miniaturized portable pump has been developed in order to study the effects of pre-programmed insulin infusion patterns on the blood glucose levels in juvenile-onset, insulin-requiring diabetics. Six diabetics undergoing 7 insulin infusion periods of up to 4 days were studied. The mean blood glucose was 7.0 +/- 2.3 (SD) mmol/l and the mean amplitude of glycemic excursions was 5.0 +/- 1.4 mmol/l. Success in achieving normoglycemia will depend on choosing the correct dose of insulin for infusion.     

Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia.

A study was performed to examine the feasibility of achieving long periods of near-normoglycaemia in patients with diabetes mellitus by giving a continuous subcutaneous infusion of insulin solution from a miniature, battery-driven, syringe pump. Twelve insulin-dependent diabetics had their insulin pumped through a subcutaneously implanted, fine nylon cannula; the basal infusion rate was electronically stepped up eightfold before meals. The blood glucose profile of these patients was closely monitored during the 24 hours of the subcutaneous infusion and compared with the profile on a control day, when the patients were managed with their usual subcutaneous insulin. Diet and exercise were standardised on both days. In five out of 14 studies the subcutaneous insulin infusion significantly lowered the mean blood glucose concentration without producing hypoglycaemic symptoms; in another six patients the mean blood glucose concentration was maintained. As assessed by the M value the level of control was statistically improved in six out of 14 studies by the infusion method and maintained in six other patients. To assess the effects of blood glucose control on diabetic microvascular disease it will be necessary to achieve long-term normoglycaemia in selected diabetics. The results of this preliminary study suggest that a continuous subcutaneous insulin infusion may be a means of maining physiological glucose concentrations in diabetics. Though several problems remain--for example, in determining the rate of infusion--longer-term studies with the miniature infusion pumps are now needed.     

近红外光谱无创血糖检测

糖尿病患者减少由糖尿病引起的并发症的重要手段是自我监测,目前主要的检测方法是有创或微创的,给患者不可避免的带来痛苦和不便。本文对利用近红外光谱技术进行无创血糖检测研究进行了综述,分析了其优缺点,总结了目前研究原理,并结合我们的研究提出了一些看法。     

Intensive attention improves glycaemic control in insulin-dependent diabetes without further advantage from home blood glucose monitoring: results of a controlled trial.

Forty-six diabetics treated with twice-daily insulin were seen every two weeks for six months in an intensive education programme aided by regular home urine glucose testing. Control was improved with a decrease in 24-hour urinary glucose excretion (median 138 mmol/24 h (24.8 g/24 h) falling to 70 mmol/24 h (12.6 g/24 h); p less than 0.002), glycosylated haemoglobin concentration (mean 11.4 +/- SD 2.3% falling to 10.4 +/- 1.5%; p less than 0.001), and Diastix score (median 3.0 falling to 1.3; p less than 0.001). There was no reported increase in hypoglycaemia. Thirty-eight of the diabetics proceeded to a nine-month randomised cross-over study of the effect on blood glucose control of monitoring urinary glucose or blood glucose measured visually or by a reflectance meter using appropriate reagent strips. No further improvement in control was observed after home blood glucose monitoring. Nevertheless, 29 out of 37 patients preferred blood to urine glucose monitoring. During both the education and cross-over studies there was evidence of an initial improvement in control followed by deterioration. This was independent of the monitoring method used in the cross-over period and may have been due to waning enthusiasm. Despite patient enthusiasm and other reports to the contrary, home blood glucose monitoring offered no improvement in control over intensive attention and conventional urine glucose monitoring.