睡前加服吡格列酮/二甲双胍片可改善预混胰岛素治疗的2型糖尿病患者黎明现象

目的:比较吡格列酮/二甲双胍复方片剂与单药二甲双胍片对预混胰岛素治疗的2型糖尿病患者黎明现象的影响。方法:选择2019年1-12月在荆门市第二人民医院住院的使用预混胰岛素治疗后行末梢血糖监测仍存在黎明现象的2型糖尿病患者54例,随机分为2组:吡格列酮/二甲双胍组(A组) 28例、二甲双胍组(B组) 26例。A组睡前加服吡格列酮/二甲双胍(吡格列酮15 mg、二甲双胍500 mg),B组睡前仅加服二甲双胍500 mg,动态监测血糖,根据情况适时减少胰岛素用量,治疗1周,比较2组治疗前、后空腹血糖及黎明现象严重程度(Δ黎明)。结果:治疗1周后,2组空腹血糖和Δ黎明较治疗前下降(P均0. 05);且A组下降更显著(P均0. 05)。结论:使用预混胰岛素治疗的2型糖尿病患者,睡前加服吡格列酮/二甲双胍片较二甲双胍单药能更有效改善黎明现象。     

二甲双胍对2型糖尿病患者血管内皮功能的影响

目的研究二甲双胍对2型糖尿病患者血管内皮功能的影响。方法 93例血糖控制不满意的2型糖尿病(T2DM)患者随机分为二甲双胍组(500 mg,3次/d)及吡格列酮组(15 mg,1次/d),疗程12个月。观察血管内皮功能的变化。结果与治疗前相比,治疗12个月后两组患者的血糖、胰岛素抵抗指数(IRI)均显著下降,空腹及餐后胰岛素水平、胰岛素功能均显著升高(均P0.05)。治疗12个月后两组患者血糖、IRI、胰岛素水平、胰岛素功能比较,差异均无统计学意义(均P0.05);但治疗12个月后二甲双胍组的体质指数(BMI)低于吡格列酮组(P0.05)。与治疗前相比,治疗12个月后两组患者的血管内皮功能均显著改善(均P0.05),但治疗12个月后二甲双胍组的血管内皮功能改善优于吡格列酮组(P0.05)。结论二甲双胍与吡格列酮两种药物对T2DM患者均具有明显的降糖、改善胰岛素功能、降低胰岛素抵抗(IR)及改善血管内皮功能的作用。在降低BMI及改善血管内皮功能方面,二甲双胍优于吡格列酮。     

吡格列酮与二甲双胍对初诊肥胖2型糖尿病患者血清内脏脂肪素影响的研究

目的观察吡格列酮与二甲双胍对初诊肥胖T2DM患者血清内脏脂肪素（visfatin）水平的影响,探讨visfatin与T2DM发病的关系和药物的治疗机制。方法100例初诊肥胖T2DM患者随机分为吡格列酮组50例,每日口服盐酸吡格列酮片30mg,二甲双胍组50例,每日早晚口服二甲双胍缓释片500mg,疗程24周。结果吡格列酮组空腹血清visfatin、IR、TG较用药前明显降低,B细胞功能有改善（P〈0．05或P〈0．01）。二甲双胍组血清visfatin、TG无统计学改变。两组治疗后比较,吡格列酮组的visfatin、IR、TG降低明显,差异有统计学意义（P〈0．05或〈0．01）,但二甲双胍组的BMI较吡格列酮组下降更明显（P〈0．05）。结论对初诊肥胖T2DM患者吡格列酮与二甲双胍均能较好地控制血糖,吡格列酮还能明显降低血清visfatin的水平,提示吡格列酮通过下调visfatin水平发挥抗炎作用。     

二甲双胍和吡格列酮对糖尿病大鼠胃组织胃促生长素表达的影响

目的 探讨2型糖尿病大鼠分别用二甲双胍和吡格列酮治疗后血浆和胃组织胃促生长素(ghrelin)水平的变化及其与胰岛素敏感性的关系.方法 38只清洁级雄性Wistar大鼠随机分为正常对照组(n＝7)、糖尿病对照组(n＝9)、二甲双胍治疗组(n＝9)、吡格列酮治疗组(n＝9).高糖高脂饮食加小剂量链脲佐菌素建立2型糖尿病大鼠模型,成模大鼠分别给予生理盐水、二甲双胍和吡格列酮干预8 w,酶联免疫法检测血浆ghrelin水平,免疫组织化学法检测胃组织中ghrelin的表达水平.结果 二甲双胍组和吡格列酮组血浆及胃组织中ghrelin水平较糖尿病对照组均显著升高(均P＜0.01).相关分析显示:糖尿病对照组、二甲双胍组及吡格列酮组血浆ghrelin与空腹胰岛素呈负相关,与胰岛素敏感性(ISI)呈正相关.结论 二甲双胍和吡格列酮可升高2型糖尿病大鼠血浆及胃组织中ghrelin水平,改善胰岛素抵抗.     

吡格列酮联合二甲双胍对2型糖尿病患者胰岛素抵抗及脂肪细胞因子水平的影响

目的观察吡格列酮联合二甲双胍治疗2型糖尿病(T2DM)的疗效,探讨治疗对患者胰岛素抵抗及脂肪细胞因子水平的影响。方法将我院收治的T2DM患者72例随机分为观察组和对照组,每组36例。对照组给予口服二甲双胍治疗,观察组给予二甲双胍联合盐酸吡格列酮治疗。观察两组患者治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(F-INS)和胰岛素抵抗指数(Homa IR)。并应用酶联免疫吸附法(ELISA)检验两组治疗前后血浆瘦素和脂联素水平。结果治疗后两组患者FPG、2 h PBG、HbA1c和Homa IR均显著降低(均P<0.05);治疗后研究组2 h PBG、HbA1c和Homa IR显著低于对照组(均P<0.05);治疗前两组瘦素和脂联素比较无统计学差异(均P>0.05),治疗结束后两组患者血清瘦素均显著降低,血清脂联素显著升高(均P<0.05),研究组血清瘦素显著低于对照组,血清脂联素显著高于对照组(P<0.05)。结论吡格列酮联合二甲双胍治疗可以有效调节T2DM患者瘦素和脂联素水平,进一步改善患者胰岛素抵抗。     

吡格列酮二甲双胍片联合甘精胰岛素治疗2型糖尿病患者的疗效分析

目的探讨吡格列酮二甲双胍片对2型糖尿病患者血糖、血脂以及临床疗效的影响。方法选择2型糖尿病患者60例,对照组常规治疗,观察组常规治疗基础上加服吡格列酮二甲双胍片,对比两组临床疗效以及血糖、血脂的变化情况。结果两组患者的血糖、血脂以及Hb A1C水平均有所下降,但观察组的下降程度明显高于对照组,两组患者均未出现严重不良反应。结论吡格列酮二甲双胍片治疗2型糖尿病能增加胰岛素敏感性,有效控制血糖,同时还可减少胰岛素用量,明显改善临床症状。     

初诊2型糖尿病采用吡格列酮和二甲双胍治疗效果及对胰岛素抵抗、生活质量改善作用的对比研究

目的研究分析初诊2型糖尿病患者采用吡格列酮和二甲双胍的治疗效果以及对胰岛素抵抗、生活质量的改善作用。方法将该院于2018年12月—2019年12月接收的94例初诊2型糖尿病患者分成常规组(二甲双胍)、研究组(吡格列酮),每个小组47例。观察两组血糖水平、糖化血红蛋白、空腹C肽、胰岛素抵抗指数、生活质量。结果研究组与常规组餐后2 h血糖、空腹血糖、糖化血红蛋白在用药前后差异无统计学意义(P0.05),但研究组用药后空腹C肽、胰岛素抵抗指数水平低于常规组(P0.05);研究组与常规组用药后生活质量评分高于用药前,但组间差异无统计学意义(P0.05)。结论二甲双胍与吡格列酮都能够显著降低患者血糖水平,改善其生活质量。但相比而言,吡格列酮对初诊2型糖尿病患者的胰岛素抵抗指数水平改善作用更加突出。     

吡格列酮和二甲双胍治疗2型糖尿病的疗效及改善胰岛素敏感作用分析

目的分析吡格列酮和二甲双胍治疗2型糖尿病的疗效及改善胰岛素敏感作用。方法随机抽取我院自2015年3月~2016年3月收治的2型糖尿病患者100例,分为A组和B组,各50例。B组采用二甲双胍治疗,A组在B组的基础上联用吡格列酮。对比两组患者治疗后的血糖情况以及胰岛素指标。结果 A组患者治疗后的血糖情况以及胰岛素指标均明显优于B组的,差异有统计学意义(P0.05)。结论吡格列酮与二甲双胍联合治疗2型糖尿病取得了显著的效果,改善了胰岛素的敏感性,值得进一步推广和使用。     

二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响

目的了解二甲双胍和吡格列酮对男性2型糖尿病患者骨代谢指标的影响。方法将口服降糖治疗的90例男性2型糖尿病患者随机分为格列吡嗪组、格列吡嗪＋二甲双胍组和格列吡嗪＋吡格列酮组3组,治疗1年。治疗前后检测患者的空腹血糖（FBS）、空腹胰岛素（Ins）、糖化血红蛋白（HbAlc）、骨钙素、尿吡啶酚／尿肌酐（尿PYD／Cr）。采用双能x线骨密度测量仪测量腰椎、髋部骨密度。结果二甲双胍组腰椎骨密度平均增加0．49％,髋部骨密度平均增加1．82％。而吡格列酮组腰椎、髋部骨密度分别下降1．46％和1．97％左右。治疗后二甲双胍组髋部骨密度明显高于吡格列酮组。结论与吡格列酮组比较,二甲双胍能明显增加男性糖尿病患者髋部骨密度。     

吡格列酮和二甲双胍治疗早期糖代谢异常临床研究

目的　观察吡格列酮和二甲双胍治疗早期糖代谢异常的疗效。方法　于 2 0 0 3- 0 1～ 2 0 0 4 - 0 2对浙江省台州市中心医院 2 2例年龄在 31～ 5 8岁的初诊糖代谢异常 (6 1mmol/L 相似文献   

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.