非胰岛素依赖型糖尿病患者代谢控制差时肾脏体积增大和肾小球滤过率升高(简报)

胰岛素依赖型糖尿病(IDDM)患者在发病早期肾脏体积增大,肾小球滤过率增高。尚未见非胰岛素依赖型糖尿病(NIDDM)患者这方面系统研究的报告。本文对北京协和医院内分泌科糖尿病专病门诊随诊的87名NIDDM患者(年龄40～70岁,男性35名,女性52名,病程1周～32年)测定肾脏体积,肾小球滤过率(内生肌酐清除率法)、糖化血红蛋白(HbA_1)和尿白蛋白排除率。并对本院24名职工(年龄40～65岁,男性11名,女性13名,口服75g葡萄糖耐量正常,心,肝、肾功能正常,身高体重正常)进行上述测定,作为正常对照。NIDDM患者的病情不一,有刚从糖耐量低减转变成临床糖尿     

早期糖尿病患者肾小球滤过率改变

糖尿病肾病是糖尿病患者的严重并发症,是胰岛素依赖型糖尿病患者(IDDM)死亡的重要原因。过去对糖尿病肾病的研究多集中于晚期,但对晚期糖尿病肾病目前仍无有效治疗办法。因此,了解发生糖尿病肾病之前肾脏功能和形态学的变化,澄清其发病机制,提出有效的防治措施,是糖尿病研究中的一个重要课题。近年来国外对糖尿病早期肾脏改变研究较多,提出肾小球滤过率(GFR)增高是早期肾脏改变的主要特点之一。本文用~(99m)锝-二乙三胺五醋酸(~(99m)Tc-DTPA)测定了16例 IDDM 和7例非胰岛素依赖型糖尿病患者(NIDDM)GFR。现将结果报告如下。     

NIDDM患者糖尿病肾病早期肾动态功能显象观察

随着糖尿病患者生存期延长,慢性合并症已成为死亡的主要原因,据估计其死于糖尿病肾病者比糖尿病非肾病者多17倍。如何防止其肾病的发生和恶化,在胰岛素依赖型糖尿病(IDDM)患者已有较多的研究,而对非胰岛素依赖型糖尿病(NIDDM)患者的研究则较少。我们对57例NIDDM患者进行了肾脏动态功能显象研究,报告如下。     

非胰岛素依赖型糖尿病基因定位研究进展

糖尿病是一种严重危害人类健康的多基因遗传病。根据其发病机制,分为胰岛素依赖型(insulin-dependent diabetes mellitus,IDDM)和非胰岛素依赖型(non-insulin-dependent diabetes mellitus,NIDDM)两大类,其中,NIDDM占所有糖尿病的90％左右。未来的10-20年内,许多遗传学家将致力于对它的研究。其中,NIDDM的基因定位及克隆将是一个热点。要想将NIDDM基因定位,最关键的是寻找合适的家系。找到好的家系就如同发掘到了宝藏,这样说一点也不夸张,因为好的家系是连锁分析结果可信的保证。由于NIDDM发病较晚而其严重并发症又使患者较早死亡,寻找大的家系几乎不可能。     

非胰岛素依赖型糖尿病尿蛋白与临床关系探讨

<正> 糖尿病肾病(DN)是糖尿病的并发症之一。对于非胰岛素依赖型糖尿病(NIDDM)肾病的研究远远少于对胰岛素依赖型糖尿病     

NIDDM早期肾病免疫指标的改变

胰岛素依赖型糖尿病免疫功能改变已有诸多报道,而非胰岛素依赖型糖尿病(以下简称NIDDM)免疫功能紊乱越来越引起人们的关注.研究表明,NID-DM病人不仅存在体液和细胞免疫异常,红细胞免疫系统亦存在异常,且有血管病变者较无血管病变者异常更为显著.现报告41例NIDDM早期肾病各项免疫     

99mTc-DTPA肾动态显像测定非胰岛素依赖型糖尿病患者GFR的临床意义

糖尿病性肾病(DN)是糖尿病常见的微血管性并发症,为糖尿病患者的主要死因之一.本文对46例非胰岛素依赖型糖尿病(NIDDM)患者进行99mTc-DTPA肾动态显像,测定其肾小球滤过率(GFR),并与患者24h尿蛋白总量(UTP)测定结果进行分析,以探讨GFR对NIDDM患者肾功能改变的临床意义.     

非胰岛素依赖型糖尿病患者血清SA水平变化的研究

目的：研究非胰岛素依赖型糖尿病(NIDDM)患者血清唾液酸(SA)水平的变化及其临床意义。方法：对45名健康人和106名非胰岛素依赖型糖尿病患者血清采用单一试剂显色法,测定其唾液酸含量。结果：非胰岛素依赖型糖尿病患者血清中唾液酸水平随病程的延长而升高,且有并发症患者与无并发症患者血清唾液酸水平也相差显著。结论：检测非胰岛素依赖型糖尿病患者血清中唾液酸的水平对病情的判定和并发症的预测,有一定的使用价值,也为临床提供了更有价值的预后判断指标。     

糖尿病肾病研究新进展

1936年,Kimmeitiel和Wilson首次描述了一些有蛋白尿的非胰岛素依赖型糖尿病(NIDDM)患者的肾脏组织学改变,即称Kim-meistiel-Wilson损害的结节型糖尿病肾小球硬化,以后又陆续发现了与糖尿病有关的其他一些肾小球硬化类型。人们即把与糖尿病代谢异常有关的,为糖尿病患者所特有的肾     

NIDDM患者检测尿微量蛋白和免疫球蛋白的意义

肾功能异常是临床上非胰岛素依赖型糖尿病(NIDDM,Ⅱ型)最常见的并发症之一.其基本病理改变特征为肾小球毛细血管基底     

体外循环术中自体血洗涤回输对机体红细胞免疫及肾功能的影响

目的探讨体外循环心脏直视手术中自体血洗涤回输对机体红细胞免疫及肾功能的影响。方法32例心脏瓣膜置换患者,分为自体血洗涤回输实验组及体外循环剩余机血、库存红细胞回输的对照组(各16例)。体外循环术中采用血液处理机将失血回收、洗涤处理后回输。分别于术前,术后12 h、24 h、72 h及7 d抽取肝素抗凝的外周静脉血,比较两组红细胞免疫功能即红细胞C3b受体花环率(C3bRR)、红细胞免疫复合物花环率(RBCICR),血浆游离血红蛋白含量(FHB),尿蛋白,肌酐清除率(Ccr)。记录两组术后输注的库存红细胞及血浆量。结果(1)实验组术后12、24、72 h,7d RBC-C3bRR(14．3％±4．7％、15．9％±3．6％、16．6％±2．8％、19．9％±4．1％),RBC-ICR (8．7％±1．9％、9．2％±2．0％、9．5％±2．6％、12．0％±2．0％)均明显高于对照组RBC-C3bRR (10．7％±2．4％、11．3％±3．0％、12．3％±3．5％、14．5％±2．0％),RBC-ICR(5．9％±1．4％、6．0％±1．8％、7．0％±1．7％、8．7％±2．7％),受损红细胞免疫功能恢复较快,明显优于对照组(均P< 0．05)。(2)实验组术后12 h,24 h FHB(0．41g／L±0．13 g／L、0．03 g／L±0．02 g／L)明显低于对照组(1．02 g／L±0．23 g／L、0．54 g／L±0．09 g／L)(P<0．01),术后24 h尿蛋白(0．19 g／d±0．08 g／d)明显低于对照组(0．32 g／d±0．07 g／d,P<0．05)。(3)实验组术后24 h肌酐清除率(68 ml·min-1·1．73 m-2±10 ml·min-1·1．73 m-2)明显高于对照组(45 ml·min-1·1．73 m-2±4 ml·min-1·1．73 m-2,P<0．01)。(4)实验组术后输库存红细胞量(2．0 U±1．1 U)明显低于对照组(7．4 U±2．3 U, P<0．01)。结论体外循环术中自体血洗涤回输后在促进机体受损红细胞免疫功能的恢复和减少对肾功能损害方面明显优于回输体外循环剩余机血和库存红细胞。     

Endothelin and acute renal failure: study on their relation and possible mechanisms]

In order to investigate the role of endothelin in the pathogenesis of ARF, we determined the plasma endothelin (pET) level in different clinical ARF patients and experimental ARF rat models. It was found that pET level was significantly higher in hepatic renal syndrome (n = 9, pET 210.1 +/- 32.0 pg/ml), epidemic hemorrhagic fever (n = 18, 113.3 +/- 14.86 pg/ml), septic shock ARF (n = 8, 121.5 +/- 13.5 pg/ml), gentamicin ARF (n = 7, 55.9 +/- 6.23 pg/ml) patients, and in HgCl2 ARF (n = 8, 31.75 +/- 3.07 pg/ml), glycerine ARF (n = 8, 44.75 +/- 9.8 pg/ml) rats, compared with that of normal persons (n = 9, 33.6 +/- 3.08 pg/ml) or of normal rats (n = 10, 11.4 +/- 0.98 pg/ml). Both in the patients and animal groups, there were a linear relationship between the levels of pET and Scr (r = 0.603 4 and 0.844, P less than 0.01, respectively). Intrarenal infusion ET in dosage of 0.16 micrograms.kg-1/h produced a severe reduction of RPF and GFR in the infused kidney, without significant similar changes on the contralateral kidney. Pretreated with captopril ameliorated the renal hemodynamic changes induced by iv ET (0.67 micrograms.kg-1/h), whereas indomethacin potentiated this effect. It is concluded that both circulating or local generated ET during the ARF play an important role in the pathogenesis of ARF. RAS and PG might involve in its mechanisms.     

Intermittent clinical proteinuria and renal function in diabetes: evolution and the effect of glycaemic control

The evolution of renal disease was studied in 12 insulin dependent diabetics selected for intermittent clinical proteinuria. After a run in period during which patients were studied three monthly for at least 12 months members of pairs of patients matched for age and duration of diabetes were allocated either to receive continuous subcutaneous insulin infusion or to continue with their usual conventional insulin injection therapy (controls) and studied three monthly for a further year. Mean (SEM) plasma glucose concentration and glycosylated haemoglobin (HbA1) value improved significantly in the insulin infusion group (glucose 10.1 (1.0) v 5.3 (0.3) mmol/l (182 (18) v 95 (5) mg/100 ml); HbA1 9.6 (0.8) v 7.6 (0.5)%; p less than 0.001 and p less than 0.005, run in v experimental periods) but not in the control group. Blood pressure was kept normal throughout. Glomerular filtration rate fell significantly in the insulin infusion and control groups throughout the study, from mean (SEM) baseline values of 114 (16) and 119 (15) ml/min/1.73 m2 to final values of 92 (15) and 95 (13) ml/min/1.73 m2 respectively (p less than 0.05 and p less than 0.01). The mean rate of decline in glomerular filtration rate did not change significantly in either group (run in v experimental periods: insulin infusion group 1.0 v 0.8 ml/min/month; controls 0.8 v 0.9 ml/min/month). Mean (SEM) plasma creatinine concentration rose slightly in the insulin infusion group only (93 (5) to 109 (11) mumol/l (1.1 (0.06) to 1.2 (0.1) mg/100 ml), 0.1 greater than p greater than 0.05; controls 94 (6) to 96 (6) mumol/l (1.1 (0.07) and 1.1 (0.07) mg/100 ml]. The urinary excretion rate of albumin varied widely and unpredictably throughout, while beta 2 microglobulin excretion remained normal and unchanged in both groups. Thus a at the stage of intermittent clinical proteinuria when albumin excretion rate is unpredictably variable (breaking through the "clinically positive" threshold only episodically) renal function, though still in the "normal" range, is already declining progressively; and the study failed to show that sustained improvement in mean glycaemia exerts a significant effect on this early deterioration of renal function.     

Prostacyclin and thromboxane in diabetes

Concentrations of the stable antiaggregatory prostacyclin metabolite 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and of the proaggregatory thromboxane A2 metabolite thromboxane B2 were measured by radioimmunoassay in plasma from 53 diabetics. In 33 of these patients the ability of platelets to produce thromboxane B2 during spontaneous clotting was also studied. Plasma 6-keto-PGF1 alpha concentrations were higher (p less than 0.05) in the diabetics (mean 107.7 +/- SE 7.6 ng/l) than in non-diabetic controls matched for age and sex (87.5 +/- 4.7 ng/l), and diabetics with microangiography (n = 28) and higher (p less than 0.01) concentrations (124.3 +/- 10.8 ng/l) than those without microangiography (n = 25; 89.2 +/- 9.3 ng/l). Plasma thromboxane B2 concentrations were also higher (p less than 0.01) in the diabetics (mean 218.5 +/- SE 25.3 ng/l) than in the controls (127.7 +/- 9.8 ng/l), but this increase was not related to microangiography. The ability of platelets to generate thromboxane B2 did not differ between the diabetics (181.4 +/- 16.4 microgram/l) and controls (195.8 +/- 11.8 microgram/l). Platelets of diabetics with microangiopathy or taking oral hypoglycaemic agents (n = 19), however, produced decreased amounts of thromboxane B2 during clotting. Plasma concentrations of 6-keto-PGF1 alpha and thromboxane B2 were not related to concentrations of glucose, haemoglobin A1, high-density lipoprotein cholesterol, cholesterol, triglycerides, magnesium, or creatinine. These results suggest that in diabetics with microangiopathy a balance between prostacyclin and thromboxane A2 is shifted to dominance by prostacyclin.     

Hyperprolactinaemia in male diabetics

We recently investigated two patients with diabetes and elevated serum prolactin levels in whom no cause of hyperprolactinaemia could be found. For this reason we measured fasting serum prolactin levels in 72 diabetic males and compared the results with those of 63 healthy males and 90 nondiabetic males attending an Impotence Clinic. The diabetic group had significantly higher serum prolactin levels (13.1 +/- 0.9 ng/ml) than the two control groups (9.9 +/- 0.6 ng/ml for normal males and 7.7 +/- 0.3 ng/ml for the non-diabetic impotent group). Eighteen percent of the diabetics studied had serum prolactin levels above the normal range for males (greater than 20 ng/ml). There was no correlation between serum prolactin levels and duration of diabetes, glycosylated haemoglobin level or presence of clinically apparent retinopathy. The correlation between serum prolactin level and fasting plasma glucose was weak though statistically significant (r = 0.26, P less than 0.05).     

2型糖尿病患者血清CA19-9水平分析及影响因素研究

目的:探讨2型糖尿病(T2DM)患者血清CA19-9水平的变化及相关影响因素。方法:选取T2DM患者100例,根据糖化血红蛋白(HbA1C)含量分为T2DM血糖控制不良组(HbA1C≥7%,49例)和T2DM血糖控制良好组(HbA1C<7%,51例),选取健康体检者50例为对照组。对比分析3组血清CA19-9水平的差异,并对血清CA19-9水平的影响因素进行相关分析。结果:T2DM血糖控制不良组血清CA19-9水平明显高于T2DM血糖控制良好组和对照组(P<0.05);T2DM血糖控制良好组血清CA19-9水平明显高于对照组(P<0.05)。CA19-9水平与HbA1C呈正相关(r=0.321 5,P<0.05)。结论:T2DM患者血清CA19-9水平高于正常人,且与血糖控制水平相关。     

Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes

To determine whether treatment with a somatostatin analogue can reduce kidney hyperfiltration and hypertrophy in insulin-dependent diabetes mellitus, we studied 11 patients with insulin-dependent diabetes mellitus and glomerular hyperfiltration. The patients were assigned randomly to receive continuous subcutaneous infusion of either octreotide, 300 micrograms/24 h (five patients) or placebo (six patients) for 12 weeks. At baseline, mean glomerular filtration rate and mean total kidney volume were not significantly different in the two groups. However, after 12 weeks of treatment, the mean glomerular filtration rate was significantly lower in the octreotide group (136 mL/min per 1.73 m2; range, 91 to 158 mL/min per 1.73 m2) than in the placebo group (157 mL/min per 1.73 m2; range, 138 to 184 mL/min per 1.73 m2). Furthermore, the mean total kidney volume was significantly lower after treatment in the octreotide group (379 mL/1.73 m2; range, 307 to 454 mL/1.73 m2) than in the placebo group (389 mL/1.73 m2; range, 347 to 465 mL/1.73 m2). Glycemic control did not change significantly in either group. We conclude that subcutaneous infusion of octreotide for 12 weeks reduces increased glomerular filtration rate and kidney size in patients with insulin-dependent diabetes mellitus despite the fact that glycemic control remains unchanged.     

2型糖尿病患者甲状腺激素及抗体水平变化研究

背景　近年来,临床上发现2型糖尿病患者甲状腺激素的改变和抗体升高的现象多于非糖尿病人群,而真正危害2型糖尿病患者身心健康的正是其多种并发症及合并症,考虑到甲状腺疾病对人体的危害同样重大,由此引发了对2型糖尿病患者甲状腺激素和抗体改变的思考。目的　探讨2型糖尿病患者甲状腺激素及抗体水平的变化情况。方法　选取2018年4月-2019年3月中国医科大学附属第一医院全科医学科收治的172例2型糖尿病患者作为2型糖尿病组,同时选取160例非糖尿病患者作为对照组。收集患者性别、年龄、糖尿病病程、糖化血红蛋白（HbA1c）水平、高血压病史、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）等指标,并测定甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、促甲状腺素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）水平。再根据糖尿病病程,将糖尿病患者分为病程<1年组（19例）、1~10年组（69例）、>10年组（84例）;根据HbA1c水平,将糖尿病患者分为HbA1c≤6.5%组（67例）、6.5%10年组TGAb水平高于<1年组,>10年组FT3水平低于1~10年组（P<0.05）。不同HbA1c水平糖尿病组TGAb水平比较,差异有统计学意义（P<0.05）;其中6.5%相似文献   

Relation of pale tongue, purple tongue and TXA2-PGI2 regulation system

This paper analysed the relationship between pale tongue, purplish tongue and TXB2, 6-keto-PGF1 alpha levels in plasma of 70 cases with coronary heart disease (CHD) and 45 normal subjects. The results showed the following characteristics: The pale tongue group (217.76 +/- 30.5 pg/ml) showed no significant difference in TXB2 level compared with the normal group (164.49 +/- 10.85 pg/ml, P greater than 0.05), while both showed significant difference compared with the purplish tongue group (360.1 +/- 31.3 pg/ml) and that with purple spots (485.07 +/- 106.1 pg/ml, P less than 0.01). The pale tongue group (179.29 +/- 9.08 pg/ml) showed a significant difference in 6-keto-PGF1 alpha level compared with the normal group (244 +/- 19.31 pg/ml, P less than 0.01), but it showed no significant difference compared with the purplish tongue group (185.08 +/- 17.07 pg/ml) and that with purple spots (229.3 +/- 33.2 pg/ml, P greater than 0.05). The comparison between the groups of purplish tongue and that with purple spots and the normal group showed no significant difference (P greater than 0.05). The pale tongue group (1.33 +/- 0.18) showed a marked difference in TXB2/6-keto-PGF1 alpha ratio compared with the normal group (0.72 +/- 0.04, P less than 0.01), the purplish tongue group (2.12 +/- 0.22, P less than 0.01) and that with purple spots (2.25 +/- 0.55, P less than 0.05). The purplish tongue group and that with purple spots showed significant difference compared with the normal group (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum resistin levels in Syrian obese patients with diabetes mellitus type II

OBJECTIVE: To determine serum resistin levels in obese patients with diabetes mellitus type II. METHODS: We studied 87 subjects in an sectional study, divided into 3 groups: obese, obese diabetic and normal subjects. Their age, gender and body mass index were recorded. Serum resistin, insulin, glucose, cholesterol, high-density lipoproteins, low-density lipoproteins, triglyceride, urea and creatinine were measured. RESULTS: The mean +/- SD plasma resistin for the obese diabetic group is 7.32 +/- 3.74 ug/ml versus 4.25 +/- 1.77 ug/ml in the control group (p=0.021). Intro-group comparison of obese subjects (diabetics versus non-diabetics) revealed higher levels of resistin, glucose, triglyceride, cholesterol and low density lipoproteins in diabetic subjects, but no statistically significant difference of high density lipoproteins. Furthermore, resistin correlated significantly and positively with body mass index (r = 0.375; p<0.05), resistin correlated significantly and negatively with high-density lipoproteins (r = -0. 363; p<0.05). CONCLUSION: Serum resistin levels are increased in obese patients with type 2 diabetes compared with controls. Resistin appears to be a possible link between obesity and type 2 diabetes in humans.