2型糖尿病家系胰岛功能和血脂代谢的改变

目的：测定2型糖尿病家系血胰岛素和血脂水平，了解胰岛功能减退和胰岛素抵抗在2型糖尿病发病中的作用。方法：收集21个河南省汉族2型糖尿病家系一级成年亲属共206人。其中糖耐量正常者118例(A组)；糖耐量减退(IGT)者22例(B组)；糖尿病(DM)患者50例(C组)；新诊断糖尿病患者16例(D组)；无糖尿病家族史且口服葡萄糖耐量试验(OGTT)正常者36例为对照(E组)。对受试者行OGTT。并于OGTT 0min，30min，60min，120min，180min行胰岛素和真胰岛素释放试验。据此计算胰岛素敏感、抵抗和释放指数，并测定血甘油三酯(Tg)，胆固醇(Ch)，低密度脂蛋白(LDL-C)和高密度脂蛋白(HDL-C)水平。结果：A、B、C、D组血LDL-C水平高于E组，其中C、D2组Tg和Ch水平亦高于E组；A、B和D组OGTT各时段(除30min外)胰岛素水平及各时段总和均高于E组；B、C和D组有免疫胰岛素分泌延迟。高峰在餐后120min，而A和E组分泌高峰在60min；A组葡萄糖刺激后30min真胰岛素水平及各时段总和低于E组，B组OGTT 0min，30min真胰岛素水平及各时段总和低于E组，C和D组OGTT各时段真胰岛素及各时段总和均低于E组；B，C和D组胰岛素敏感性指数及A，B，C和D组抵抗指数低于E组。结论：2型糖尿病家系非糖尿病同胞有血脂代谢异常和高胰岛素血症及胰岛素抵抗，IGT患者既有胰岛素抵抗又有胰岛β细胞功能减退；新诊与旧诊糖尿病患者均有明显的胰岛功能减退。     

Serum-insulin response to glucose in "pancreatic diabetes"

Thirty patients with chronic pancreatitis (mostly calcific) were tested for glucose tolerance and serum insulin response to glucose loading. The responses were very variable and the insulin values did not clearly relate to the ‘glucose-tolerance-status’. Some subjects had low insulin levels throughout, some had average to high fasting levels without further response, and some showed an excellent rise of insulin level after glucose.     

Normalization effect of preceding protein meals on “diabetic” oral glucose tolerance in Eskimos

Routine testing of 76 clinically non-diabetic Eskimos showed marked impairment of oral glucose tolerance in 54% but normal intravenous glucose tolerance in most of these.

Total insulin output following the glucose drink was not found different in Eskimos with normal and abnormal glucose tolerance nor did lean meat meals given 60 minutes before the glucose significantly increase it.

Intolerance to oral glucose loads appeared significantly related to a delay of insulin release and both timing of insulin response and shape of blood glucose curve normalized in the meat-preceded tests.

     

The impact of diabetic autonomic neuropathy on the incretin effect

BACKGROUND: The aim of this study was to determine the effect of diabetic autonomic neuropathy (AN) on the incretin effect in patients with type 2 diabetes mellitus (DM2). MATERIAL/METHODS: Forty patients with DM2 (20 with and 20 without AN) and 10 healthy controls were studied. The subjects underwent an oral glucose tolerance test (OGTT) and 7-14 days later an intravenous infusion of 25 g glucose. Blood samples were drawn for glucose, insulin, C-peptide, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide-1 (GLP-1) determination during the tests. The incretin effect was calculated from the total integrated amount of insulin or C-peptide during OGTT (A) and intravenous glucose infusion (B) according to the formula (A-B)/Ax100. RESULTS: Total insulin and C-peptide responses during OGTT were significantly higher than those after IV glucose infusion in the group of normal subjects, but not in the groups of diabetic patients. After the oral glucose load, GIP levels presented a significant increase in normal subjects and patients without AN, whereas GLP-1 levels increased only in normal subjects. Calculated either with the insulin or C-peptide responses, the incretin effect presented no significant difference between the two diabetic groups. However, using insulin responses, only the patients with AN had significantly lower incretin effect than controls, whereas when using C-peptide responses, both diabetic groups did. CONCLUSIONS: The incretin effect was impaired in both groups of diabetic patients. Autonomic neuropathy may further impair the incretin effect in DM2 through interference with GIP secretion or hepatic insulin extraction.     

2型糖尿病与高血压关系的研究

目的：探讨2型糖尿病患者高血压患病情况以及有关影响因素,方法：根据WHO1985年糖尿病诊断标准,11700例血压、体重、腰臂围资料完整的1997－1998年广东省糖尿病流行病学调查人群,分析正常糖耐量、糖耐量低减和糖尿病患者的高血压患病情况。结果：糖尿病患者高血压患现率为44．9％,是糖耐量正常者的3．4倍,糖尿病伴肥胖（BMI≥27）者高血压患病率高达54．0％。Logistic回归分析提示腹部肥胖（腰臂围比,WHR）、糖尿病和BMI增加是高血压患病的独立危险因素,结论：2型糖尿病患者的高血压患病较非糖尿病者明显增高,尤其是伴有肥胖者,其原因可能与胰纱抵抗有关。     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

Effect of glucose on plasma concentrations of individual non-esterified fatty acids of non-diabetic and insulin-independent diabetic men

The composition of plasma non-esterified fatty acids was investigated during glucose tolerance tests to determine changes in individual fatty acid concentrations after glucose administration and to determine whether differences existed between the individual fatty acid concentrations of maturity-onset diabetic and non-diabetic men. The mean fasting total non-esterified fatty acid concentration of the 9 diabetics was greater than that of the 12 non-diabetics studied. After glucose ingestion, the mean total non-esterified fatty acid concentrations of both groups decreased. Gas chromatographic analysis of the plasma non-esterified fatty acids of 6 diabetic and 6 non-diabetic men revealed that the concentrations of palmitic, stearic and oleic acids were significantly higher in the diabetic men in the fasting state. With the sole exception of stearic acid in the non-diabetic patients, the mean concentration of each of the 6 plasma non-esterified fatty acids determined decreased in both groups after glucose ingestion. At 1, 2 and 3 hr after glucose ingestion, there were no longer any significant differences between the mean concentrations of individual plasma non-esterified fatty acids of the non-diabetic and diabetic men.     

乙型肝炎肝硬化伴糖代谢异常患者胰岛β细胞功能特点分析

目的探讨乙型肝炎肝硬化伴糖代谢异常的发病机制及特点。方法选择我科乙型肝炎肝硬化住院患者90例,按照口服葡萄糖耐量试验结果将其分为糖耐量正常组、糖耐量减退组及糖尿病组,每组各30例,同时选择30例健康体检者作为对照组。对4组患者血糖、胰岛素、C肽释放量及胰岛β细胞功能指数等指标进行观察和比较。结果与对照组比较,糖耐量正常组的空腹和餐后2 h胰岛素水平明显升高(P<0.01);与糖耐量正常组比较,糖耐量减退组患者餐后2 h血糖和胰岛素水平明显升高(P<0.05);与糖耐量减退组比较,糖尿病组患者空腹和餐后2 h血糖水平明显升高,胰岛素水平明显降低,餐后2 h C肽水平和胰岛β细胞功能指数均明显降低(P<0.05)。结论乙型肝炎肝硬化患者糖耐量正常或减退时,其胰岛β细胞仍存在一定程度的分泌功能,并发糖尿病时,其胰岛β细胞的分泌功能显著降低。     

Insulin resistance in obesity and noninsulin dependent diabetes mellitus

Insulin clamp studies were carried out on 13 non-diabetics and 12 non-insulin-dependent diabetics (NIDDM). Based upon the body mass index (BMI), they were further divided into obese (BMI greater than or equal to 27 kg/m2) and nonbese groups (BMI less than 27 kg/m2). All received euglycemic insulin clamp study (Humulin-S 40mU/m2/min). Thermoregulated venous samplings were done every five minutes for measurements of plasma glucose (PG) and immunoreactive insulin (IRI). Steady state plasma glucose (SSPG) was obtained 20-80 minutes and kept for 100 more minutes. The data of final 40 minutes of clamp were used for analysis. Variations in SSPG and metabolic clearance rate of glucose (MCRG) instead of glucose infusion rate (M) value were used to assess the insulin sensitivity. The results showed that insulin resistance was noted in obese non-diabetic and diabetic subjects as well as in non-obese diabetic patients, as evidenced by higher basal IRI and lower MCRG than non-obese normal controls. Correlation analysis revealed that there was no correlation between the reduction of MCRG and the BMI in either non-diabetic or diabetic patients. There was a strong negative correlation between MCRG and the ambient fasting plasma glucose in the diabetic group, whereas this correlation was not found in the non-diabetic group. In conclusion, obesity with or without diabetes did have remarkable insulin resistance. In non-diabetic obese subjects the insulin resistance did not go up as the BMI increased further. In diabetic patients, both obesity and hyperglycemia contributed significantly insulin resistance.     

The development of diabetes mellitus and chronic liver disease in long term chelated beta thalassaemic patients

We studied 29 patients with thalassaemia major who had received intensive chelation for between 6.2 and 8.8 years. All patients had normal oral glucose tolerance tests before subcutaneous chelation therapy was introduced and 22 of 29 patients had normal liver function tests. At the end of the period of study 12 patients still had normal oral glucose tolerance (7 with normal liver function tests and 5 with chronic active hepatitis). On the other hand, 11 patients had developed impaired glucose tolerance tests (3 patients had normal liver function tests, 5 with chronic active hepatitis and 3 with cirrhosis), and 6 patients had developed frank diabetes mellitus (one with chronic active hepatitis and 5 with cirrhosis). Patients with chronic active hepatitis showed 91% positivity for one or more hepatitis B markers whilst all patients with cirrhosis were positive. Ferritin levels before subcutaneous chelation in patients with normal oral glucose tolerance tests were lower than in those patients with abnormal oral glucose tolerance or diabetes (P less than 0.05) but none had normal serum ferritin levels. In addition, a positive correlation was found between glucose area under the curve after chelation therapy and serum ferritin levels (r = 0.47, P less than 0.01). It is apparent that long term chelation therapy does not prevent the development of abnormal oral glucose tolerance in chronically transfused patients. More intensive chelation therapy is needed to prevent tissue damage. Chronic liver disease may have an important role to play in the deterioration of glucose tolerance.     

柴胡疏肝散对慢性胰腺炎大鼠肝脏核因子-κB活性的干预

目的:观察柴胡疏肝散对慢性胰腺炎大鼠肝脏胰岛素抵抗和核因子-κB活性的干预作用.方法:Wistar大鼠制备慢性胰腺炎模型后,每日给予柴胡疏肝散1.4 g/kg和2.8 g/kg体重灌胃4周,然后进行葡萄糖耐量和胰岛素耐量实验,分离肝细胞进行葡萄糖释放实验,检测肝脏组织核因子-κB活性变化.结果:慢性胰腺炎大鼠的糖耐量异常,胰岛素敏感性降低,胰岛素时离体肝细胞葡萄糖释放的抑制率减弱,肝脏核因子-κB的活性显著增加(P＜0.05)；柴胡疏肝散干预能够显著改善上述变化(P＜0.05).结论:柴胡疏肝散能够抑制肝脏核因子-κB的过度活化,进而改善慢性胰腺炎引发的肝脏胰岛素抵抗.     

Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community.

The prevalence of impaired glucose tolerance and diabetes mellitus was studied in a suburban Sri Lankan community using 1985 WHO criteria. Oral 75 g glucose tolerance tests were performed on 633 subjects aged 30-64 years. The age-standardized prevalence rates for diabetes mellitus were 5.02 (95% CI 3.59-6.43) and impaired glucose tolerance 5.27 (95% CI 3.74-6.78). A total of 21% of diabetic patients were not known to have diabetes and were diagnosed for the first time during the survey. Obesity was more common (P < 0.05) in diabetic patients (21%) when compared to non-diabetic subjects (10.5%). Diabetes mellitus is a common health problem in Sri Lanka, and there is a need for developing national policies for its prevention and control.     

Antioxidant status in diabetic and non-diabetic senile patients, with cataract or cardiovascular complications

OBJECTIVE: To assess the total antioxidant status in diabetic and non-diabetic senile patients, with cataract or cardiovascular complications, and without complications. METHODS: A comparative study on 186 senile patients and control subjects was carried out from March 2004 to November 2006 on patients from Ziauddin University Hospital, Karachi, Pakistan. Among them, 33 were diabetic patients without any clinical evidence of chronic diabetic complications, 32 with cardiovascular complications, 30 non-diabetic patients with cardiovascular complications, 30 diabetic patients with cataract, 30 non-diabetic patients with cataract, and 31 apparently normal, age, gender, and weight matched control subjects were investigated. All patients were selected on clinical grounds. RESULTS: Total antioxidant status was significantly decreased (p<0.001) in all diabetic patients with and without complications, and non-diabetic patients with same complications (155 patients) as compared with control subjects (31 subjects). Fasting plasma glucose was increased (p<0.001) in all diabetic patients with and without complications (95 patients), and correlated significantly with glycosylated hemoglobin (HbA1C) and serum fructosamine concentrations. Fasting plasma glucose, HbA1C, and serum fructosamine were not different in diabetic patients with and without complications. Fasting plasma glucose, HbA1C, serum fructosamine, and total serum protein were not different in non-diabetic patients with the same complications, as compared with control subjects. CONCLUSION: Total antioxidant status is decreased in diabetic and non-diabetic senile patients with the same complication as compared with control subjects. Some other factors may be responsible for decrease antioxidant status.     

早发2型糖尿病患者短期重组人门冬脯胰岛素注射液强化治疗的临床分析

目的探讨短期重组人门冬脯胰岛素注射液强化治疗对早发2型糖尿病(T2DM)患者胰岛β细胞功能和血糖控制的影响。方法对85例早发T2DM患者,50例进行为期4周的重组人门冬脯胰岛素注射液强化治疗,35例进行为期4周的普通胰岛素强化治疗,分析比较各组治疗前后空腹(FPG)及餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、口服葡萄糖耐量试验时0,0.5,1,2,3 h胰岛素及C肽分泌、胰岛素敏感指数。结果重组人门冬脯胰岛素注射液强化治疗后,FPG、2 hPG、HbA1c均较治疗前明显下降(P<0.01);胰岛素敏感指数均较治疗前明显升高(P<0.01)。结论短期重组人门冬脯胰岛素注射液强化治疗可显著改善早发T2DM患者胰岛β细胞功能。     

实验性胰岛素抵抗糖尿病大鼠生物学特征

目的采用高脂饮食联合小剂量链脲佐菌素(STZ)诱导胰岛素抵抗糖尿病大鼠模型,并对其生物学特征进行研究。方法选择健康雄性Sprague Dawley(SD)大鼠20只,按随机数字表分为对照组(普通饲料)和模型组(高脂饲料),每组各10只,自由进食,4周后模型组大鼠予腹腔注射STZ35mg/kg,血糖≥16.67mmol/L者造模成功。造模成功大鼠继续进食高脂饲料。于成模后1、4及8周时观察各组大鼠的体重、血糖、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和尿微量白蛋白(MAU)的水平,于成模后1、8周时行腹腔注射葡萄糖耐量实验(IPGTT)及胰岛素耐量实验(ITT)。结果与对照组比较,模型组大鼠注射STZ1周后体重显著增加(P<0.01),注射STZ4、8周后体重显著下降(P值均<0.01);模型组大鼠注射STZ1、4、8周后,TG、TC、LDL-C、血糖及MAU水平均显著升高(P值均<0.01)。IPGTT结果显示,注射STZ1、8周后,模型组AUC均显著高于对照组(P值均<0.01);ITT结果显示,注射STZ1、8周后,模型组注射30、60、120min时血糖下降相对值均显著高于对照组(P值分别<0.01、0.05)。结论高脂饮食联合小剂量STZ诱导的糖尿病大鼠存在糖脂代谢紊乱及胰岛素抵抗。这种造模方法所诱导的伴胰岛素抵抗的大鼠糖尿病更近似于临床上的2型糖尿病的表型特征及发病过程,可用于2型糖尿病及相关慢性并发症的实验研究。     

葡萄糖耐量试验异常的老年人血清镁浓度的变化

本文对58例正常老年人,22例糖耐量异常老年人,11例未经治疗糖尿病老年人在口服糖耐量试验中同时测定各时刻胰岛素、血清镁浓度。观察到糖尿病老年人和糖耐量异常老年人胰岛素释放比对照组迟缓,释放高峰下降。空腹血清镁浓度和服糖后各时刻血清镁浓度平均值均低于对照组,P<0.01。服糖后血清镁浓度下降,对照组下降值与空腹值比较有显著差异性P<0.05。糖尿病组和糖耐量异常组虽有下降但未呈现统计学意义的差异。     

持续胰岛素输注在体外循环冠状动脉搭桥术中应用价值的评估

目的：评估非糖尿病与糖尿病患者在体外循环冠状动脉搭桥术（CABG）中应用Portland胰岛素输注方案的可行性和必要性。方法：将择期行CABG的30名非糖尿病和30名糖尿病患者各随机分为试验组与对照组。试验组诱导后按照Portland胰岛素输注方案控制血糖;对照组每1h检测一次血糖,若血糖值超过10mmol/L。静脉给予胰岛素10U。分别对患者术中相应时间点血糖、乳酸等指标值进行检测,同时监测自动复跳、术中知晓、术后感染和术后认知功能障碍等情况,并进行统计学分析和比较。结果：无论是非糖尿病组或是糖尿病组,试验组在体外循环前、体外循环后和关胸后的血糖值均明显低于对照组（P〈0．05）,乳酸值也在体外循环后和关胸后与对照组相比有显著性差异（P〈0．05）,自动复跳率也高于对照组。非糖尿病对照组有2例术后脱管困难,糖尿病对照组术后出现肺部感染3例。结论：Portland胰岛素输注方案用于CABG中,可有效控制术中血糖,平稳乳酸代谢,明显改善预后状况。     

肝硬化患者胰岛素释放试验的临床意义

本文报道46例肝硬化患者口服葡萄糖胰岛素释放试验的结果,并与18名正常人和18名原发性糖尿病患者比较。肝硬化患者糖耐量减低者28例(60.9％),其中29例(43.5％)呈糖尿病型耐量曲线。胰岛素释放高峰值在服糖后2h;释放过多和分泌延迟者32例(69.6％),降低者4例(8.7％)。20例肝源性糖尿病患者的胰岛素释放指数明显高于原发性糖尿患者。笔者认为血浆胰岛素和胰岛素释放指数测定对鉴别这两种类型的糖尿病有很大价值。     

青春期多囊卵巢综合征患者糖代谢的临床研究

目的研究青春期多囊卵巢综合征（PCOS）患者糖耐量异常的发生率、内分泌特点,探讨糖代谢异常与胰岛素抵抗、体重的关系.方法 44例青春期PCOS患者, 按糖耐量低减诊断标准分为糖耐量正常组（37例）与糖耐量低减组（7例）;于卵泡早期取患者空腹静脉血行生殖激素检查后,口服75g葡萄糖, 行糖耐量及胰岛素测定,用稳态模型胰岛素抵抗指数（HOMAIR）评价胰岛素抵抗.结果 （1）糖耐量低减患者的体重指数（BMI）、空腹血糖、空腹胰岛素（FINS）及服糖后120min的血糖值、HOMAIR均高于糖耐量正常患者, 差异有统计学意义（P＜0.01）;（2） BMI、HOMAIR与服糖后120min血糖值均呈正相关,分别（r=0.671,r=0.871,P＜0.001）,BMI和FINS水平呈正相关（r=0.745,P＜0.001）;（3）糖耐量低减（IGT）发生率为15.9%.结论 （1）青春期PCOS患者存在糖代谢异常, 肥胖和胰岛素抵抗是影响其糖耐量异常的重要因素;（2）口服糖耐量试验是用于监测青春期PCOS患者糖代谢的较好指标.     

肝硬变患者血浆胰岛素和C肽—肝脏摄取胰岛素减少在糖代谢障碍中的作用

<正> 肝脏不仅是机体维持血糖动态平衡的重要器官,同时也是糖类代谢调节激素作用的靶器官和降解场所。慢性肝病时,尤其是肝硬变时常伴有糖耐量减低和糖尿病,其病理机制目前尚不清楚。一些学者的报告指出慢性肝病时常伴有血浆胰岛素水平升高和胰岛素抵抗,我们在实验中也观察到相同结果。近来Johnston等的研究表明,慢性肝病时的高