格列美脲对人胰岛素和非促泌剂联用效果不佳的2型糖尿病患者疗效观察

在临床工作中，可以遇到一些使用人胰岛素同时联合2种或以上非促泌剂治疗而血糖控制不佳的患者，传统的治疗方法是继续增加胰岛素及口服药用量，近期国内有学者报道应用格列美脲联合胰岛素治疗单用胰岛素控制血糖不佳的患者效果明显。笔者对2型糖尿病患者加用格列美脲后可以明显降低血糖和糖化血红蛋白（HbA1c），减少胰岛素用量，报告如下。     

格列美脲双重作用机制的临床观察

目的观察胰岛素联合格列美脲治疗的2型糖尿病患者的治疗效果,探讨格列美脲双重作用机制在临床治疗中的实际意义。方法将60例单纯应用预混胰岛素,或胰岛素联合≤2种非胰岛素促泌剂口服药物且每日胰岛素剂量>40 U,血糖控制仍不佳的2型糖尿病患者随机分为单药组(胰岛素)和联合用药组(胰岛素+格列美脲),观察并对比分析两组治疗后血糖水平、血糖达标时间、胰岛素用量及治疗期间低血糖发生次数。结果 2组治疗后血糖水平明显减低,两组比较无统计学意义(P>0.05);联合治疗组血糖达标时间、胰岛素用量及低血糖发生率均较单药组低,两组比较有高度统计学意义(P<0.01)。结论联合应用格列美脲和胰岛素治疗2型糖尿病疗效优于单用胰岛素治疗。格列美脲不仅有助于降低胰岛素用量,缩短血糖达标时间,缩短住院日期,而且较单用胰岛素明显减少了低血糖发生率。     

格列美脲联合胰岛素治疗2型糖尿病的临床观察

目的评价格列美脲联合胰岛素对2型糖尿病（T2DM）的临床疗效。方法 T2DM患者64例,均为单用胰岛素血糖控制欠佳者,随机分为观察组和对照组,观察组加用格列美脲2~4 mg/d,根据血糖调整胰岛素用量;对照组继续应用胰岛素治疗,并根据血糖加大剂量。12周后观察治疗前后空腹血糖（FBG）、餐后2 h血糖（2 hBG）、糖化血红蛋白（HbA1c）、体重指数（BMI）、每日胰岛素用量变化以及药物不良反应。结果治疗后观察组FBG、2 hBG、HbA1c较对照组明显降低,胰岛素用量减少（P〈0.05）;所有入选者共发生低血糖6例,其中观察组2例,对照组4例。结论 T2DM单用胰岛素血糖控制不佳者,加用格列美脲可显著改善血糖控制,低血糖发生率低,并可减少胰岛素用量。     

优泌乐 50 与优泌林 70/30 治疗 2 型糖尿病 50 例简

目的比较优泌乐50和优泌林70／30治疗2型糖尿病的临床疗效。方法选择口服降糖药物血糖控制不佳的2型糖尿病患者100例,随机分成优泌乐50组和优泌林70／30组,两组适当加用阿卡波糖或二甲双胍,不用胰岛素促泌剂,每隔3—7d监测4次血糖（空腹,早餐、中餐、晚餐后2h）,根据血糖调整胰岛素及口服药物用量,12周后比较两组的空腹血糖,早餐后2h血糖,晚餐后2h血糖,糖化血红蛋白,低血糖发生次数,胰岛素用量,观察其治疗效果。结果两组在空腹血糖及糖化血红蛋白的控制上差异无显著性,但在控制餐后2h血糖、低血糖发生率、胰岛素用量上有显著性差异（P〈0．05）。结论优泌乐50治疗2型糖尿病优于优泌林70／30。     

格列美脲联合治疗单用胰岛素效果不佳2型糖尿病患者的临床观察

目的分析加用格列美脲治疗单用胰岛素效果不佳2型糖尿病患者的临床效果。方法取昆山市第二人民医院收治的单用胰岛素治疗效果不佳的2型糖尿病患者作为研究对象,分别给予格列呲嗪控释片、格列美脲进行治疗,比较两组患者接受治疗后的FBG、PBG、HbAlc水平、胰岛素用量及低血糖发生率等情况差异。结果观察组患者接受治疗后1月及3月的各项糖尿病指标均明显优于对照组患者（P〈0．05）;接受治疗后1月,观察组与对照组患者的胰岛素用量无明显差异,观察组患者的低血糖发生率明显低于对照组患者（P〈0．05）;接受治疗后3月,观察组患者的胰岛素用量明显少于对照组患者（P〈0．05）,低血糖发生率明显低于对照组患者（P〈0．05）。结论格列美脲可以有效改善患者对于胰岛素的抵抗,优化其血糖水平,同时避免低血糖的发生。     

格列美脲联合胰岛素治疗老年糖尿病疗效观察

目的观察格列美脲联合胰岛素治疗老年糖尿病的疗效及安全性。方法将68例正接受门冬胰岛素30注射液(诺和锐30)治疗而疗效不佳的老年糖尿病患者随机分为A组和B组各34例。B组继续行诺和锐30治疗,A组在B组治疗基础上加用格列美脲治疗。观察2组治疗前后糖化血红蛋白(HbA1c)、餐后血糖(PBG)、空腹血糖(FBG)、体质量指数(BMI)及胰岛素每天用量,并记录2组低血糖发生情况。结果 2组治疗后HbA1c、PBG、FBG、胰岛素用量均较治疗前改善,A组胰岛素用量较B组明显减少,差异均有统计学意义(P<0.05或P<0.01)。结论格列美脲联合胰岛素治疗老年2型糖尿病疗效显著,能减少胰岛素用量,且不增加患者体质量及低血糖风险,值得推广应用。     

亚莫利联合预混胰岛素类似物治疗2型糖尿病的临床观察

目的 研究亚莫利联合预混胰岛素类似物治疗2型糖尿病的临床疗效和安全性。方法 纳入60例单用胰岛素治疗血糖控制不佳的2型糖尿病患者。随机分为接受胰岛素联合亚莫利组(A组)和继续胰岛素单药治疗组(B组),根据监测血糖情况,调整胰岛素和亚莫利剂量,观察12周后,监测治疗后血糖、餐后血糖、糖化血红蛋白,比较2组治疗前后体重、胰岛素用量和低血糖发生率。结果 2组治疗后空腹血糖、餐后血糖、糖化血红蛋白较治疗前降低(P<0.05)。治疗后A组胰岛素剂量、低血糖发生率与B组比较均有减少(P<0.05),而2组治疗后体重无明显改变。结论 亚莫利联合预混胰岛素类似物是控制2型糖尿病高血糖的有效手段之一,与单用胰岛素治疗相比,能减少胰岛素用量及低血糖发生率,对体重影响不大。     

甘精胰岛素联合格列美脲治疗2型糖尿病的疗效观察

目的观察甘精胰岛素联合格列美脲治疗2型糖尿病的疗效。方法选择58例口服降糖药血糖控制不理想的2型糖尿病患者随机分为两组,A组为甘精胰岛素联合格列美脲组,B组为诺和灵30R治疗组,观察两组患者空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、胰岛素用量、低血糖发生率。结果两组治疗后FPG、2hPG及HbA1c水平均较治疗前明显下降（P〈0.01）,两组间比较差异无统计学意义（P〉0.05）。A组胰岛素用量、低血糖发生率明显低于B组（P〈0.05）。结论甘精胰岛素联合格列美脲能较好控制血糖,低血糖发生率低,具有安全、方便的特点。     

探究沙格列汀在胰岛素控制不佳的2型糖尿病中的疗效与安全性

目的 观察病程在5年以上的2型糖尿病患者使用胰岛素联合二肽基肽酶4（DPP-4）抑制剂治疗,血糖控制不佳的情况下加用沙格列汀对血糖控制和改善胰岛功能的作用.方法 选取2012年1月-2013年1月在我院内分泌科住院的2型糖尿病患者64例,随机分成原方案组（对照组）和加用沙格列汀组（试验组）,对照组根据血糖情况继续加用胰岛素至血糖控制达到规定目标,试验组在原方案基础上加用沙格列汀,根据血糖情况调整胰岛素和沙格列汀剂量.比较治疗12周前后两组空腹血糖、餐后2h血糖、糖化血红蛋白（HbA1c）、空腹C肽、空腹胰岛素、稳态模型评估的胰岛素抵抗指数（HOMA-IR）、胰岛素每日剂量、体质量及低血糖事件的变化.结果 两组患者经过12周治疗,空腹血糖、餐后2h血糖、HbA1c、HOMA-IR均较治疗前降低,差异有统计学意义（P＜0.05）;试验组治疗前后体质量变化比较,差异无统计学意义（P＞0.05）.治疗12周后,试验组空腹血糖、餐后2h血糖、HbA1c、HOMA-IR、空腹C肽、胰岛素用量均低于对照组,差异有统计学意义（P＜0.05）.结论 胰岛素联合非DPP-4抑制剂治疗血糖控制不佳的2型糖尿病患者加用沙格列汀后,明显降低胰岛素每日使用量,不增加低血糖风险的前提下有效控制血糖达标,改善胰岛素抵抗.     

格列美脲联合胰岛素治疗2型糖尿病46例临床观察

目的 探讨应用胰岛素治疗的2型糖尿病(T2DM)患者,联合格列美脲治疗的有效性及安全性.方法 46例胰岛素治疗剂量＞40u/日,联用1～2种非胰岛素促泌剂的T2DM患者,加用格列美脲治疗12周.治疗前后对照.结果 12周后空腹(FBG)、餐后2h血糖(2hBG)均明显下降(P＜0.01),糖化血红蛋白(HbAlc)下降...     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.