奎的平、氯丙嗪、氯氮平对精神分裂症病人脑电图影响的对比研究

目的观察精神分裂症病人服用奎的平、氯丙嗪、氯氮平后对脑电图影响的差异。方法分别对单一使用奎的平、氯丙嗪、氯氮平治疗6周后的精神分裂症病人的脑电图进行对比分析，探讨不同药物治疗后病人的脑电图改变及其与疗效的关系。结果脑电图异常率奎的平组为36．7％，氯丙嗪组66．7％，氯氦平组90．0％，氯氮平和氯丙嗪对脑电图的影响明显大于奎的平（P〈0．05或P〈0．01）：3组病人的脑电图改变均与疗效无关（P〉0．05）。结论奎的平对脑电图的影响较小，是一种较为安全可靠的抗精神病药物。     

抗精神病药物对心电图的影响

目的探讨精神分裂症患者应用新型抗精神病药物及典型抗精神病药物后心电图变化的差异情况。方法600例精神分裂症患者分别使用阿立哌唑、利培酮、氯氮平、氯丙嗪治疗，分别于第一、二、三月复查心电图。结果使用新型抗精神病药物三月后患者心电图改变显著，低于使用典型抗精神病药物患者（P〈0．05）；心电图改变与性别、年龄无关，与使用药物剂量有关。结论新型抗精神病药物导致心电图异常率较典型抗精神病药物低，临床使用具有较高的安全性。     

典型及非典型抗精神病药物在精神分裂症病人中的临床应用

目的 了解目前典型及非典型抗精神药物在精神分裂症中的应用情况及发展趋势。方法 采用1个月法于2003-05-01／2003-05-31．用自制调查表对两所医院住院及门诊1006例精神分裂症的用药情况进行了调查，(其中住院病人603例，门诊病人403例)。结果精神分裂症病人单一用药以氯氮平为首位占41．2％，其次为奋乃静占19．8％，利培酮占16．9%；合并用药占前二位的是：氯氮平加利培酮占18.2％；氯氮平加奋乃静占15．0％；最为常用安坦及苯二氮革的使用率明显下降。结论 非典型抗精神病药物已成为目前门诊及住院精神分裂症病人的常用抗精神病药物。     

抗精神病药物对血糖检测结果的影响分析

目的分析抗精神病药物对血糖检测结果的影响。方法随机在选取2011年3月—2014年2月该院就诊180例精神分裂症患者,依照治疗药物不同分为3组各60例,A组患者服用氯丙嗪,B组患者服用利培酮,C组服用阿立哌唑,对比3组患者治疗后的血糖水平。结果 A组患者治疗6个月后血糖水平与治疗前对比差异有统计学意义(P0.05),B组和C组患者治疗前后血糖水平差异无统计学意义(P0.05)。且A组患者41~68岁患者治疗后1、3、6个月血糖水平明显高于同期的20~40岁患者血糖差异有统计学意义(P0.05)。结论 3种抗精神病药物对患者血糖水平均有较大影响,氯丙嗪对患者血糖水平影响最大,会显著提高患者的血糖水平。     

阿立哌唑治疗首发精神分裂症的疗效评价与安全性分析

目的评估阿立哌唑治疗首发精神分裂症的临床疗效和安全性。方法将80例首发精神分裂症患者随机分为阿立哌唑组和利培酮组（各40例）,治疗前后分别评定阳性及阴性症状量表（PANSS）,以PANSS减分率评定疗效,副反应量表（TESS）及实验室相关检查评定药物副反应。结果治疗8周后,两组PANSS各项评分较治疗前均显著降低（P〈0．05）,两组PANSS各项评分减分比较差异均无统计学意义（P〉0．05）;阿立哌唑组总有效率为72．5％,对照组总有效率为70．0％,两组总有效率比较差异无统计学意义（P〉0．05）;两组均未发生严重相关不良事件。结论阿立哌唑是一种安全有效的抗精神病药物,对首发精神分裂症的疗效与利培酮相当。     

抗精神病药治疗精神分裂症引致糖尿病的相关因素分析

目的分析探讨抗精神病药治疗精神分裂症引致糖尿病的相关因素分析。方法选取2014年5月以前在该院接受精神分裂症治疗的650例患者,其中精神分裂症合并糖尿病患者51例,对其临床资料进行回顾性分析,比较治疗前后血糖的变化情况,比较各种抗精神病药物对糖代谢异常产生的影响。结果该组患者中男女的发病率差异无统计学意义(P>0.05);病程<10年与病程≥20年的患者与年龄<40岁与≥40岁组比较,发病率差异有统计学意义(P<0.05);抗精神病药物引发糖尿病的发生率依次为:氯氮平发生率为14.53%、氯丙嗪发生率为7.83%、;利培酮发生率为7.01%、其他药物发生率为6.19%。氯氮平组与利培酮组比较差异有统计学意义(P<0.05)。餐后2 h的血糖差异有统计学意义(P<0.01)。结论精神分裂症合并糖尿病与患者的年龄、病程有关,年龄在40岁以上的精神分裂症患者发生糖尿病的危险更大。氯氮平相较于其他药物,引发糖尿病的发生率较高,临床治疗中应注意。     

氯氮平等治疗精神分裂症药物血糖改变对照研究

将首次发病住院，符合CCMD－2－R诊断的18－40岁精神分裂症患者随机依次分为A、B、C、D四组。入组患者须无糖尿病家族史，血糖正常。每组分别单一服用氯氮平、氯丙嗪、舒必利、利培酮药物，服药后第6、12周末复查血糖。所得数据进行统计学处理。结果发现A、B、C组治疗后血糖均显著高于治疗前（P＜0．01），其中A组为最。D组治疗前后血糖无显著变化（P＞0．05）。结论本文提示A、B、C三组均可引起糖代谢异常，定期复查血糖是十分重要的。     

阿立哌唑与利培酮治疗精神分裂症的疗效观察

目的比较阿立哌唑与利培酮两种非典型抗精神病药物对住院精神分裂症患者的疗效。方法将71例精神分裂症患者随机分为阿立哌唑组与利培酮组,于治疗前和治疗6周末分别评定PANSS量表;测量身高、体质量及晨起空腹血清葡萄糖、三酰甘油、总胆固醇、HDL-C、LDL-C。结果阿立哌唑与利培酮治疗精神分裂症的疗效差异无显著性（P〉0.05）;利培酮治疗后血糖水平下降,阿立哌唑对血糖影响不显著;两种药物治疗后三酰甘油水平均升高;利培酮治疗后血清总胆固醇水平升高,阿立哌唑对胆固醇影响不显著。结论阿立哌唑与利培酮在治疗精神分裂症时对精神分裂症的疗效相当,对血糖、血脂生物学指标的影响有差异。     

氯氮平、利培酮致女性精神分裂症病人心电图异常情况及干预措施

目的观察氯氮平、利培酮致女性精神分裂症病人心电图异常情况,并探讨其应对策略。方法对单一口服氯氮平、利培酮致女性精神分裂症病人分别于治疗前及治疗后2周、4周、6周、8周末进行常规心电图检查,并对心电图异常者对症处理或调整原药物剂量,观察心电图的恢复情况。结果两种抗精神病药物致女性精神分裂症病人心电图异常率为50.00%,其中氯氮平组为63.16%,利培酮组为37.50%,利培酮组所致心电图改变明显低于氯氮平组(χ~2=5.132,P0.05);两种抗精神病药物引起心电图改变以窦性心律失常最多,其中氯氮平组以窦性心动过速最多,利培酮组以窦性心动过缓最多;对心电图异常者采取对症处理后大部分病人恢复正常。结论两种抗精神病药对女性精神分裂症病人心电图均有影响,经对症处理后预后良好;入院时基础心率偏高者慎用氯氮平;入院时基础心率偏低者慎用利培酮。     

氯氮平和利培酮对体重和血糖的影响

经典抗精神病药对体重和血糖的影响有一些报道，氯氮平和利培酮作为非典型抗精神病药的代表在精神科临床上应用已十分普遍，本文通过对氯氮平和利培酮对首发精神分裂症患者治疗前后体重和血糖的分析，以了解其对病人的影响。     

血糖及其他体液葡萄糖测定进展

本文从糖尿病医患角度介绍血糖测定的进展。主要从血浆糖测定到毛细血管全血糖测定，以及近年的微创组织液糖测定及无创糖测定。较详细地讨论了毛细血管全血糖测定的特点和误差的原因。     

Importance of glucagon in the control of futile cycling as studied in alloxan-diabetic dogs

Summary In order to determine the role of glucagon in futile or substrate cycling in diabetes, we measured tracer determined glucose kinetics during a combined infusion of 2-³H-glucose (total glucose production) and 6-³H-glucose (glucose production) in six alloxan-diabetic dogs. The animals received either a 420 min infusion of (1) somatostatin alone (0.3 g·kg^–1· min^–1), (2) somatostatin with insulin replacement (100 U·kg^–1min^–1) or (3) glucagon (6 ng·kg^–1· min^–1) together with somatostatin and transient insulin replacement. When somatostatin was given alone, plasma glucagon (p<0.004) and insulin (p<0.0001) were suppressed. Glucose production and disappearance and plasma glucose concentrations fell (p<0.0001), but the metabolic clearance of glucose did not change significantly. In the basal state, futile cycling comprised 29±4%, 33±4% and 33±3% of total glucose production in the three goups of studies, which is high compared to normal dogs. The absolute rate of futile cycling fell slightly but significantly from 10.0±1.7 to 8.3±1.7 mol·kg·^–1min^–1 (p<0.0008). When insulin replacement was given during somatostatin infusion to correct for the small somatostatin-induced insulin suppression, there were similar changes in plasma glucagon, glucose concentrations and glucose kinetics as seen during the infusion of somatostatin alone. Futile cycling decreased to a slightly greater extent from 12.8±2.8 to 9.5±1.7mol·kg^–1·min.^–1 (p<0.02). When glucagon was infused together with somatostatin and insulin replacement, plasma glucagon (p<0.0002) increased and plasma glucose levels rose (p<0.001) due to a transient increase in glucose production. Metabolic clearance of glucose did not change significantly. There was a marked increase in futile cycling from 12.2±1.7 to 21.7±1.7mol· kg^–1·min^–1 (p<0.0001) in response to exogenous glucagon excess. There was a slight (p<0.01) drop in free fatty acid levels with somatostatin. Free fatty acid levels nearly doubled (p<0.025) with the infusion of glucagon together with somatostatin. In conclusion, (a) futile cycling was increased in alloxan-diabetic dogs; (b) glucagon suppression can suppress futile cycling only if total insulin deficiency is prevented; and (3) hyperglucagonaemia increases futile cycling, and this effect is more pronounced during insulin deficiency.     

Understanding the clinical implications of differences between glucose management indicator and glycated haemoglobin

Laboratory measured glycated haemoglobin (HbA1c) is the gold standard for assessing glycaemic control in people with diabetes and correlates with their risk of long-term complications. The emergence of continuous glucose monitoring (CGM) has highlighted limitations of HbA1c testing. HbA1c can only be reviewed infrequently and can mask the risk of hypoglycaemia or extreme glucose fluctuations. While CGM provides insights in to the risk of hypoglycaemia as well as daily fluctuations of glucose, it can also be used to calculate an estimated HbA1c that has been used as a substitute for laboratory HbA1c. However, it is evident that estimated HbA1c and HbA1c values can differ widely. The glucose management indicator (GMI), calculated exclusively from CGM data, has been proposed. It uses the same scale (% or mmol/mol) as HbA1c, but is based on short-term average glucose values, rather than long-term glucose exposure. HbA1c and GMI values differ in up to 81% of individuals by more than ±0.1% and by more than ±0.3% in 51% of cases. Here, we review the factors that define these differences, such as the time period being assessed, the variation in glycation rates and factors such as anaemia and haemoglobinopathies. Recognizing and understanding the factors that cause differences between HbA1c and GMI is an important clinical skill. In circumstances when HbA1c is elevated above GMI, further attempts at intensification of therapy based solely on the HbA1c value may increase the risk of hypoglycaemia. The observed difference between GMI and HbA1c also informs the important question about the predictive ability of GMI regarding long-term complications.     

Blood glucose testing in the hospital: error sources and risk management

Glucose testing in the hospital with point-of-care devices presents multiple opportunities for error. Any device can fail under the right conditions. For glucose monitoring in the hospital, with thousands of operators, hundreds of devices, and dozens of locations involved, there is ample opportunity for errors that can impact the quality of test results. Errors can occur in any phase of the testing process: preanalytic, analytic, or postanalytic. Common sources of meter error include patient or methodology interferences, operator mistakes, environmental exposure, and device malfunction. Early models of glucose meters had few internal checks or capability to warn the operator of meter problems. The latest generation of glucose monitors has a number of internal checks and controls engineered into the testing process to prevent serious errors or warn the operator by suppressing test results. Some of these control processes are built into the software and data management system of the meters, others require the hospital to do something, such as regularly clean the meter or analyze control samples of known glucose concentration, to verify meter performance. Hospitals need to be aware of the potential for errors by understanding weaknesses in the testing process that could lead to erroneous results and take steps to prevent errors from occurring or to minimize the harm to patients when errors do occur. The reliability of a glucose result will depend on the balance of internal control features available from manufacturers in conjunction with the liquid control analysis and other control processes (operator training, device validation, and maintenance) utilized by the hospitals.     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Evaluation of the analytical performance of the coulometry-based Optium Omega blood glucose meter

Background

The goal of diabetes treatment is maintaining near normoglycemia based on self-monitoring of blood glucose (SMBG). In this study, an evaluation of the analytical performance of the coulometry-based Optium Omega™ glucose meter designed for SMBG has been carried out.

Methods

The assessment of precision and between-lot variability was based on glucose measurements in ethylene-diaminetetraacetic acid venous blood samples. Glucose concentrations measured in 289 fresh capillary blood samples using the Omega glucose meter and the Biosen C_line analyzer were compared.

Results

Within-run imprecision coefficient of variation for the lower and higher glucose concentrations amounted to 5.09 and 2.1%, respectively. The relative lot-dependent differences found for the lower and higher glucose concentrations were equal to 6.8 and 2.6%, respectively. The glucose meter error calculated for various concentration ranges amounted from 2.22 to 4.48%. The glucose meter error met the accuracy criteria recommended by the International Organization for Standardization and the American Diabetes Association. The Passing-Bablok agreement test and error grid analysis with 96% of results in zone A indicated good concordance of results, including glucose concentrations below 100 mg/dl.

Conclusions

The evaluated Optium Omega glucose meter fits the analytical requirements for its use in blood glucose monitoring in diabetes patients.     

空腹糖耐量受损及空腹血糖偏低和老年人轻度认知障碍的关系探讨

目的探讨轻度认知障碍(MCI)风险与血糖代谢异常的相关性,并为MCI的预防提供依据。方法本研究对1074例认知功能正常且无糖尿病、高脂血症、痛风的老年门诊患者进行了调查。随访5年,根据简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能评估,有121例受试者被诊断出患有MCI。此外,监测受试者每年血糖、糖化血红蛋白。结果入组的1074例受试者根据认知功能的不同分为MCI组和非MCI组,与非MCI组相比,MCI组中空腹血糖(FBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)和总胆固醇(TC)的平均值更高(均P<0.05)。在高血糖组中,FBG的临界值为6.2 mmol/L(敏感性=84.1%,特异性=90.9%,曲线下面积=0.875,P<0.001);在低血糖组中,FBG的临界值为4.5 mmol/L(灵敏性=77.4%,特异性=87.3%,曲线下面积=0.823,P<0.001)。HbA1c的临界值为5.5%(敏感性=76.0%,特异性=87.0%,曲线下面积=0.815,P<0.001)。多元Logistic回归分析MCI的风险增加与空腹血糖平均值<4.5 mmol/L和≥6.2 mmol/L(RR:1.69,95%CI:1.11~2.59;RR:1.81,95%CI:1.15~2.86)以及糖化血红蛋白平均值≥5.5%(RR:2.13,95%CI:1.51~2.99)相关。结论空腹糖耐量受损及空腹血糖偏低是老年人MCI发生风险的独立危险因素。     

糖调节受损的危害与干预

糖调节受损是糖尿病重要的前期阶段,可能发展为糖尿病并形成大血管病变,也可能逆转为正常葡萄糖状态.因此,积极的干预治疗是十分重要的.生活方式的干预与药物治疗可以延缓或避免糖尿病的发生,而且生活方式的改变比药物更为有效.     

The oral glucose tolerance test: A study of the influence of age on the response to the standard oral 50 g glucose load

Summary 160 women and 133 men over 50 were chosen for the experiment. They were divided into three age groups. In order to study a group of subjects who were normal for their age, caution was taken to discard known overt diabetics and to avoid any interfering factor that might influence glucose tolerance. The results are expressed by the median and the 5th and 95th percentiles. The median increases progressively with age. There is a highly significant difference between subjects over and under 65, but none between sexes. The 5th percentile varies very little whereas the 95th percentile shows a large increase. This is more evident in women than in men. This would indicate an increased prevalence of diabetes with age rather than a general reduction of glucose tolerance. The therapeutic problems are discussed.

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Beeinflussung der oralen Glucosebelastung (mit 50 g Glucose) durch das Alter

Zusammenfassung Die Untersuchung bezog sich auf 160 Frauen und 133 Männer über 50, verteilt auf drei Altersgruppen. Um ein normales Bevölkerungsmuster zu untersuchen, wurden bekannte, manifeste Diabetiker und Patienten mit diabetischer Veranlagung ausgeschlossen. Die Resultate wurden ausgedrückt in Medianen und den Perzentilen 5 und 95. Der Median steigt allmählich mit dem Alter. Es existiert ein hoch signifikanter Unterschied zwischen den Altersklassen über und unter 65, aber nicht zwischen beiden Geschlechtern. Das Perzentil 5 schwankt wenig, das Perzentil 95 hingegen steigt stark. Dies ist ausgesprochener bei Frauen als bei Männern der Fall. Dieses würde dann eher eine steigende Frequenz des Diabetes mit dem Alter bedeuten, als eine allgemein verringerte Grlucosetoleranz. Die therapeutische Bedeutung wird besprochen.

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Influence de l'âge sur l'épreuve d'hyperglycémie par administration orale de 60 g de glucose

Résumé L'expérimentation porte sur 160 femmes et 133 hommes de plus de 50 ans répartis en 3 classes d'âge. L'étude d'une population âgée normale a nécessité l'exclusion des diabétiques avérés et de tout facteur diabétogène possible. Les résultats sont exprimés par la médiane et les percentiles 5 et 95. La médiane augmente progressivement avec l'âge; la différence entre les sujets de plus et de moins de 65 ans est hautement significative, sans variation statistique entre les sexes. Le percentile 5 évolue très peu, par contre on observe une augmentation importante des valeurs du percentile 95; cet aspect est plus marqué chez les femmes. Ces données démontreraient une fréquence croissante du diabète avec l'âge plutôt qu'une diminution générale de la tolérance au glucose. L'implication thérapeutique est discutée.