2型糖尿病患者尿白蛋白排泄率与血浆纤溶活性的相关性分析

目的 探讨2型糖尿病患者24 h尿微量白蛋白排泄率(UAE)与血浆纤溶活性改变的关系.方法 129例2型糖尿病患者根据UAE分为尿白蛋白正常组、微量白蛋白尿组和大量白蛋白尿组,并以40例健康人为对照组,采用发光底物法测定血浆组织型纤溶酶原激活物(t-PA)和纤溶酶原激活抑制物-1(PAI-1)活性,计算PAI-1/t-PA,并进行UAE、血糖、血脂、血尿素氮、肌酐测定.结果 与健康对照组比较,2型糖尿病患者血浆PAI-1活性显著增高,t-PA活性显著降低(P＜0.01);三组2型糖尿病患者PAI-1/t-PA比值差异有统计学意义(P＜0.05),以大量蛋白尿组患者PAI-1/t-PA比值最高;单因素相关分析发现,AER与PAI-1/t-PA比值呈正相关,其中以微量白蛋白尿组最为明显(r=0.5422,P＜0.001).结论 2型糖尿病患者尿白蛋白排泄率与血浆纤溶活性密切相关.     

血浆PAI-1、Fg与糖尿病肾病的相关性研究

目的探讨2型糖尿病患者血浆中纤溶酶原激活物抑制物-1和纤维蛋白原活性水平变化及其与糖尿病肾病的相关性。方法对168例心内科的2型糖尿病患者及52例健康体检者检查血糖、空腹胰岛素、血脂、尿酸、血常规、凝血功能、PAI-1、Fg,测量血压、腰围、身高和体重并计算体重指数;根据尿蛋白排泄率分为正常对照组52例,2型糖尿病无DN组48例、DN微量白蛋白尿组66例、DN临床蛋白尿组54例;分析PAI-1、Fg与糖尿病肾病的相关性。结果与正常对照组相比,2型糖尿病组患者PAI-1、Fg水平明显升高,差异有统计学意义(P<0.05),且PAI-1、Fg水平随着UAER的增高而递增。多元回归分析显示,2型糖尿病患者的血浆PAI-1、Fg水平与UAER独立相关,提示体内PAI-1、Fg水平的高低与糖尿病肾病密切相关。结论 2型糖尿病患者炎症标志物PAI-1、Fg水平增高,PAI-1、Fg水平与糖尿病肾病密切相关,提示PAI-1、Fg水平升高可能是2型糖尿病合并微血管病变的危险因素。     

2型糖尿病白蛋白尿与颈动脉内膜中层厚度关系的探讨

目的:探讨2型糖尿病(T2DM)患者白蛋白尿与颈动脉内膜中层厚度的关系.方法:146例T2DM患者行24h尿微量白蛋白检测,根据结果分为正常白蛋白尿组(86例)和异常白蛋白尿组(60例,包括微量白蛋白尿组和大量白蛋白尿组),对2组患者分别进行各项生化指标及颈动脉内膜中层厚度(IMT)的检测,并对2组数据进行单因素、多因素Logistic回归分析,比较正常尿、微量白蛋白尿(MAU)以及大量白蛋白尿3组间颈动脉IMT的差异.结果:病程、视网膜病变发生率、三酰甘油、颈动脉IMT和血肌酐是2型糖尿病白蛋白尿的影响因素;病程长、三酰甘油高、颈动脉IMT增厚、血肌酐增高是2型糖尿病患者白蛋白尿的独立危险因素(OR值分别为1.105、1.528、12.781和1.029).3组间颈动脉IMT比较差异有统计学意义(P＜0.01),而微量白蛋白尿组与大量白蛋白尿组之间比较差异无统计学意义(P＞0.05).结论:2型糖尿病患者颈动脉IMT是白蛋白尿的一个独立危险因素,糖尿病肾病的严重程度增加,颈动脉IMT无明显增厚.     

糖尿病动脉粥样硬化与糖尿病肾病的关系

目的 探讨糖尿病动脉粥样硬化对糖尿病肾病患病率的影响.方法 根据颈动脉及下肢动脉超声检查结果,696例2型糖尿病(T2DM)患者分为T2DM伴动脉粥样硬化组(A组,551例)和T2DM无动脉粥样硬化组(B组,145例),测定两组肾小球滤过率(GFR)、24-h尿微量白蛋白.结果 两组24-h尿微量白蛋白和GFR相仿(P＞0.05).A组与B组的微量白蛋白尿和大量白蛋白尿患病率差异亦无统计学意义(22.7％和6.9％ vs.20.0％和3.4％)(P＞0.05).结论 糖尿病动脉粥样硬化不增加糖尿病肾病的发生.     

伴微量白蛋白尿的2型糖尿病患者血清唾液酸的变化

目的测定伴或不伴微量白蛋白尿的2型DM患者的血清唾液酸(SA)浓度,以探讨血清SA水平与DM血管病变之间的关系。方法选75例门诊和住院的2型DM患者,和年龄、性别、体重指数与之相匹配的正常对照者28人。DM患者根据尿白蛋白排泄率分作正常白蛋白尿组和微量白蛋白尿组。测定各组的SA、糖基化血红蛋白、血脂、肌酐。结果微量白蛋白尿组的SA水平[(631±34)μg/ml]显著高于正常白蛋白尿组[(544±24)μg/ml]和正常对照组,而且正常白蛋白尿组的SA水平亦显著高于正常对照组。结论血清SA水平增加可能是DM患者心脑血管疾病的危险因子。     

糖尿病肾病患者血浆及尿液血管内皮生长因子水平的变化

目的探讨血管内皮生长因子和糖尿病肾病的关系。方法81例2型糖尿病患者根据尿微量白蛋白排泄率(UAER)分为3组:正常蛋白尿组(NA组)27例;微量蛋白尿组(MA组)28例;临床蛋白尿组(ODN组)26例。分别检测各组患者的血浆VEGF、尿液VEGF、空腹血糖(FBG)、糖化血红蛋白(HbA1c)及肾功能(BUN、Cr)等指标。结果与对照组(NC)相比,NA组、MA组和ODN组血浆及尿液VEGF水平显著性升高(P<0.01)。由NA到ODN的三组DM患者中,血、尿VEGF水平均呈逐渐增高的趋势(P<0.05)。相关分析表明,血VEGF水平与血Cr、HbA1c和UAER呈正相关(r值分别为0.393、0.402和0.654,P<0.01),尿VEGF与Cr、UAER呈正相关(r值分别为0.372和0.534,P<0.05)。结论糖尿病肾病患者的血浆、尿液VEGF水平均明显增高,且和糖化血红蛋白、肾功能损害呈正相关,提示VEGF可能在糖尿病肾病的发生发展中发挥着一定的作用。     

2型糖尿病及糖尿病肾病患者氧化型低密度脂蛋白检测的意义

目的 探讨2型糖尿病(T2DM)及合糖尿病合并肾病(DN)患者血浆氧化型低密度脂蛋白(ox-LDL)浓度变化及临床价值.方法 根据尿清蛋白排泄率(UAER)将115例T2DM患者分为单纯糖尿病组(SDM组,46例),早期糖尿病肾病组(EDN组,40例)和临床糖尿病肾病组(CDN组,29例);另选30例健康体检者作为对照组(NC组).采用酶联免疫吸附试验双抗体夹心法检测ox-LDL.结果 SDM组、EDN组、CDN组血浆ox-LDL、ox-LDL/低密度脂蛋白-胆固醇(LDL-C)、高敏C反应蛋白(hs-CRP)较NC组升高(P<0.05);随病情加重,升高更为明显.ox-LDL与hs-CRP高度相关(r=0.83,P<0.01),T2DM患者血浆ox-LDL水平随着尿清蛋白的增加而升高.结论 T2DM患者血浆ox-LDL水平明显升高,可作为DN早期敏感的诊断指标.     

糖尿病视网膜病变时t-PA和PAI-1活性变化的临床意义

目的探讨糖尿病视网膜病变(DR)时血浆组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制物-1(PAT-1)的变化规律及临床意义.方法t-PA和PAI-1活性采用发色底物法.结果DR组血浆t-PA低于单纯糖尿病组(P＜0.05)和对照组(P＜0.01),PAI-1高于单纯糖尿病组(P＜0.05)和对照组(P＜0.01),单纯糖尿病组t-PA低于对照组(P＜0.05)及PAI-1高于对照组(P＜0.05).结论DR有纤溶功能损害,检测糖尿病患者血浆t-PA和PAI-1活性水平,对DR预防和治疗具有一定的临床意义.     

MMP-9-1562C/T基因多态性与2型糖尿病肾病关系的研究

目的:探讨2型糖尿病(T2DM)患者基质金属蛋白酶-9基因-1562C/T(MMP-9-562C/T)多态性与糖尿病肾病(DN)及DN不同病期的关系.方法:将150例T2DM患者按DN诊断标准分为 DN 组与非糖尿病肾病(NDN)组,DN组分为微量白蛋白尿期、临床白蛋白尿期和肾功能不全期.另择52例健康人作为正常对照(NC)组.应用限制性片段长度多态性(RFLP)分析各组基因型.结果:DN组的糖化血红蛋白(HbA1c)、收缩压(SBP)、肌酐(Cr)、尿素氮(BUN)、尿微量白蛋白排泄率(UAER)值高于 NDN、NC组(P<0.01).DN组与NDN 组、NC组之间基因型分布差别均有统计学意义(P<0.01).T2DM中CC、CT、TT各基因型DN发生率依次递减,其中TT基因型组DN发生率低于CC基因型组(P<0.01).携 T 等位基因者发生DN的风险是携C等位基因者的0.47倍 (P<0.01,95%CI 0.29～0.75).MMP-9-1562 C基因型、HbA1c、TG、TC、Cr、BUN、SBP是DN发生的危险因素;DN组内微量白蛋白尿期、临床自蛋白尿期和肾功能不全期TT基因型与T等位基因频率随肾功能减退而降低(P<0.05或P<0.01).结论:MMP-9-1562C/T 基因多态性与DN发生有关,T等位基因是DN患者的保护基因.     

N-末端B型脑钠肽前体与糖尿病肾病的相关性

目的探讨N-末端B型脑钠肽前体(NT-pro-BNP)与糖尿病肾病(DN)的关系。方法选取2型糖尿病(T2DM)患者88例,并根据血肌酐(Scr)、尿微量白蛋白排泄率(UAER)分为肾功能不全的DN组(A组,20例)、肾功能正常而有大量蛋白尿的DN组(B组,18例)、仅有微量白蛋白尿的DN组(C组,25例)、非DN患者的T2DM组(D组,25例)及非T2DM的正常对照组(E组,28例),采用电化学发光法检测各组血浆NT-pro-BNP水平。结果 A、B、C、D、E组血浆NT-pro-BNP水平依次递减,并有统计学意义(P<0.05)。结论 DN患者的血浆NT-pro-BNP水平显著升高,且随肾功能损害的加重逐级升高,在DN的发生、发展过程中起重要作用。     

Degraded and undegraded carrageenans and experimental gastric and duodenal ulceration

The prevention of histamine-induced gastric and duodenal ulceration in the guinea-pig has been examined using a series of undegraded and degraded carrageenans. Undegraded carrageenans were active at lower doses than degraded carrageenans. The high viscosity of the undegraded carrageenans in solution prevented their use in larger doses. Degradation of carrageenan without serious loss of sulphate, gives a product which allows the dose to be increased to an extent that its effect more than offsets the slight loss in activity caused by the degradation. No single feature of carrageenan structure can be related to anti-ulcer activity although degradation, and hence reduction of molecular size, generally reduces activity. Sulphate contents over 30% have little apparent effect on activity; κ-carrageenans were not consistently different in anti-ulcer activity from Λ-carrageenans. This contrasts with the antipeptic activity of carrageenans where κ-carrageenans are less active than their Λ-counter-parts. As with antipeptic activity, the degree of anti-ulcer activity is probably determined by a combination of structural features which includes molecular size and polyanionic properties.     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Alcohol and Substance Use and Abuse in Women and Children

No abstract available for this article.     

Modelling and simulation of variability and uncertainty in toxicokinetics and pharmacokinetics

Two important methodological issues within the framework of the variability and uncertainty analysis of toxicokinetic and pharmacokinetic systems are discussed: (i) modelling and simulation of the existing physiologic variability in a population; and (ii) modelling and simulation of variability and uncertainty when there is insufficient or not well defined (e.g. small sample, semiquantitative, qualitative and vague) information available. Physiologically based pharmacokinetic models are especially suited for separating and characterising the physiologic variability from the overall variability and uncertainty in the system. Monte Carlo sampling should draw from multivariate distributions, which reflect all levels of existing dependencies in the intact organism. The population characteristics should be taken into account. A fuzzy simulation approach is proposed to model variability and uncertainty when there is semiquantitative, qualitative and vague information about the model parameters and their statistical distributions cannot be defined reliably.