妊娠期糖尿病患者并发高血压与胰岛素抵抗的关系

目的：探讨妊娠期糖尿病患者并发高血压与其胰岛素敏感性的关系。方法：血糖筛查阳性孕妇95例分为高血压疾病组和血压正常组，口服葡萄糖耐量试验后，比较2组孕妇血糖BG1、BG2、BG3、空腹胰岛素测定值及胰岛素敏感性，并以健康体检合格孕妇85名为对照组。结果：高血压疾病组空腹血糖、服糖1、2．3h后的血糖、空腹胰岛素测定值均高于血压正常组和对照组，差异有显著性（P〈0．05），胰岛素敏感指数降低高于血压正常组及对照组（P〈0．05）。结论：妊娠期糖尿病患者存在明显的胰岛素抵抗，其晚期发生妊高征的可能性较大。     

空腹血糖受损患者脂联素水平的临床观察

目的探讨空腹血糖受损（IFG）患者脂联素水平的变化。方法入选糖耐量正常（NGT）、孤立性空腹血糖受损（I-IFG）、孤立性糖耐量低减（I-IGT）、空腹血糖受损并糖耐量低减（IFG／IGT）、新发2型糖尿病（T2DM）各30例，采用酶联免疫吸附法（ELISA）测定血清脂联素，同时检测胰岛素水平及血糖、血脂，计算胰岛素抵抗指数（HOMA．IR）。结果I-IFG组、1-IGT组、IFG／IGT组及新发T2DM组脂联素均明显低于NGT组（P均〈0．01）；新发T2DM组和IFG／IGT组的HOMA-IR均〉I-IGT组〉I-IFG组〉NGT组，各组间差异有统计学意义（P均〈0．05或P〈0．01）；脂联素与空腹血糖（FBG）、餐后2h血糖（2HBG）及HOMA-IR呈负相关（Pa〈0．01）。结论在I-IFG阶段已存在脂联素水平降低，胰岛素抵抗增加，具有向糖尿病转化及并发大血管病变的风险，提高脂联素水平可为糖尿病及其并发症的防治提供一条新的思路。     

Graves病患者治疗前在葡萄糖负荷时血清脑肠肽水平的变化

目的：探讨Graves病患者治疗前在葡萄糖负荷（OGTF）时血清脑肠肽（Ghrelin）水平的变化。方法：对36例初诊Graves病患者,葡萄糖氧化酶法测定血浆血糖（PG）、放射免疫分析胰岛素（INS）及血清Ghrelin;计算胰岛素敏感性指数（ISI）、胰岛素抵抗指数（IR）;30例健康成人作为正常对照组。结果：①Graves病患者治疗前腰围、体重、BMI、ISI明显低于正常对照组（P〈0．05）;②治疗前空腹血糖（fPG）、空腹胰岛素（fiNS）、IR高于正常对照组（P〈O．05）;空腹血清Ghrelin水平（9984-194）pg／ml,明显低于正常对照组（12414-225）pg／ml（P〈O．01）;但两组在餐后30min、60min和120min的Ghrelin水平无明显差异（P〉0．05）;③Graves病患者治疗前空腹血清Ghrelin水平与fINS呈负相关（r=-0．476,P〈0．05）;其它时间点的GhreIin与INS均无相关性。结论：Ghrelin可能参与了Graves病的发生和发展。     

原发性高血压和冠心病患者胰岛素和C-肽的临床观察

目的：观察原发性高血压（EH）和冠心病（CHD）患者的胰岛素抵抗及其差异。方法：检测原发性高血压（EH）52例,冠心病（CHD）47例和健康对照组35例的空腹和服糖2h后胰岛素和C-肽,并进行比较。结果：原发性高血压病人和冠心病人空腹及服糖后2h血糖、胰岛素和C-肽明显高于正常健康人（P〈0.01）。结论：原发性高血压和冠心病患者存在胰岛素抵抗、高胰岛素血症、高C-肽水平。     

糖化血红蛋白在糖代谢异常患者中的改变及其与血糖的关系

目的探讨糖化血红蛋白（HbAlc）检测在不同糖代谢异常状态的临床价值。方法选取254名受试者（其中男149人,女105人）进行口服糖耐量试验（OGYr）和HbAlc检测。根据OGTY结果分为正常糖耐量（NGT）、单纯空腹血糖受损（I-IFG））、单纯糖耐量受损（I-IGT）、IFG合并IGT（IFG／IGT）和糖尿病（DM）5组,通过单因素方差分析比较各组HbAlc值,对各组HbAlc与空腹血糖（FPG）和OGTr2h血糖（2hPG）进行线性相关和回归分析。结果①HbAlc水平（％,下同）DM组（7．41±1．94）明显高于其余4组（以上P均〈0．01）,I-IFG组（6．06±0．37）、I-IGT组（5．91±0．39）、IFG／IGT组（6．12±0．38）3组间差异无统计学意义（P〉0．05）,但分别明显高于NGT组（P〈0．05）。②DM组HbAlc分别与FPG（r=0．934,P〈0．01）和2hPG（r=0．760,P〈0．01）存在着明显的正相关,回归方程为：HbAlc=2．957＋0．458（FPG）＋0．05（2hPG）;IFG／IGT组（r=0．326,P〈0．01）、I-IGT组（r=0．254,P〈0．05）HbAlc只与2hPG存在正相关;I-IFG组HbAlc只与FPG存在正相关（r=0．404,P〈0．01）;NGT组HbAlc与FPG（r=0．157）和2hPG（r=-0．006）均不存在相关性。结论糖化血红蛋白水平能够正确地反映正常糖代谢、糖调节受损和糖尿病3种不同糖代谢状态的血糖水平,是区分3种糖代谢状态的有用指标。     

妊娠期糖尿病患者CRP、PAI-1与IR相关性的初步探讨

目的探讨C-反应蛋白（CRP）、纤溶酶原激活物抑制剂-1（PAI—1）与胰岛素抵抗（IR）的关系及在GDM发病机制中的作用。方法分别测定29例妊娠糖尿病患者（GDM）、31例糖耐量异常（IGT）孕妇和35例糖耐量正常（NGT）孕妇的CRP、PAI-1及葡萄糖耐量试验（OGTT）的4点血糖和对应的胰岛素水平,同时计算胰岛素抵抗指数（HOMA—IR）和胰岛β细胞功能指数（HOMA—HBCI）,分析比较各组的差异与关系。结果①NGT组HOMA—IR低于IGT和GDM组,均有统计学差异（P〈0．05）,NGT组的HOMA—HBCI高于IGT和GDM组,均有统计学差异（P〈0．05）②GDM组的CRP、PAI—1水平显著高于NGT和IGT组,差异有统计学意义（P〈0．05）。③相关性分析：血清CRP与空腹血糖（FPG）（r=0．331,P=0．01）、HOMA—IR（r=0．303,P=0．035）、孕前BMI（r=0．283,P=0．040）正相关;血浆PAI-1分别与HOMA—IR、空腹胰岛素（Flns）、孕前BMI正相关,相关系数分别为：r=0．525,P=0．001;r=0．550,P=0．001;r=0．625,P=0．000。结论GDM患者IR增加,但胰岛细胞分泌功能却下降,两者共同导致GDM的发生：炎症因子CRP、PAI—1都与IR有关．可能参与GDM的发生和发展。     

妊娠期糖代谢异常患者胰岛素抵抗和胰岛β细胞功能的研究

目的探讨妊娠期糖代谢异常患者的胰岛素抵抗和胰岛β细胞功能的变化,以及对妊娠结局的影响。方法选取在我院就诊的171例孕妇检查资料,按照75g葡萄糖耐量试验（0GTT）结果分为妊娠期糖尿病组（GDM）,妊娠期糖耐量受损组（GIGT）,妊娠期空腹血糖受损组（GIFG）和正常对照组（NGT）。对各组的OGTT、胰岛素释放试验结果进行统计分析,计算出胰岛素抵抗指数（HOMA-IR）,胰岛素分泌指数和胰岛素敏感指数,将结果进行比对分析。并对各组的妊娠结局进行分析。结果胰岛素抵抗指数（HOMA-IR）GDM组〉GIFG组〉GIGT组〉对照组（P〈0.05）。胰岛素分泌指数：GDM组     

原发性肝癌并发糖代谢紊乱

目的 探讨原发性肝癌并发糖代谢紊乱的可能发生机制。方法 测定７０例原发性肝癌患者空腹血糖、空腹及餐后２小时胰岛素、Ｃ肽浓度。对检测结果进行统计分析，组间分采用ｔ检验。结果 原发性肝癌并发糖代谢紊乱４４．２９％（３１／７０），其中低血糖占２５．７１％（１８／７０），其空腹胰岛素及Ｃ肽浓度均正常，与对照组比较差异无显著性，并发高血糖占１８．６％（１３／７０），其空腹胰岛素、餐后２小时胰岛素、Ｃ肽浓度均显著升高，与对照组比较有显著性差异（ｐ〈０．０１）。结论 原发性肝癌并发低血糖可能与肝葡萄糖产生率降低及葡萄糖利用率增加有关。原发性肝癌伴高血糖可能与调节血糖激素灭活障碍及胰岛素抵抗有关。     

小儿单纯性营养不良胰腺内分泌功能研究

目的探讨单纯性营养不良（protein-energy malnutrition,PEM）患儿胰腺内分泌功能。方法采用放射免疫分析法测定空腹和摄入液体实验餐后60min时外周血胰岛素、胰高血糖素、生长抑素（SS）及血糖水平。结论与对照组比较,观察组空腹及餐后60min胰岛素、胰高血糖素、胰岛素以及胰高血糖素比值均明显降低,而SS水平则明显升高（P均〈0.01）。血糖水平则是餐前比较观察组明显降低（P均〈0.01）,餐后比较则明显升高（P均〈0.01）。与对照组相似,观察组患儿餐后与餐前比较,胰岛素、胰高血糖素、SS、胰岛素/胰高血糖素比值和血糖水平均明显升高（P均〈0.01）。结果PEM患儿存在着明显的胰腺内分泌紊乱,应引起重视。     

降钙素基因相关肽对大鼠血糖及血糖调节激素的影响

基于外周给与CGRP能使血糖升高,胰岛素分泌下降,本实验目的在于研究CCRP是否参与血糖浓度的调节及其可能机理。结果表明:静脉灌注CGRP在常态下能使血糖升高,而不影响胰岛素的浓度,在高血糖刺激下CGRP具抑制胰岛素分泌的功能;静脉灌注CGRP对糖耐量曲线有明显影响;脑室注射CGRP可使血糖明显降低。本实验提示CGRP有可能与糖尿病的发生发展有一定关系。     

无创及微创血糖仪研究进展

随着人们饮食和生活方式的改变,糖尿病已经成为了危害中国国民健康的严重问题之一。规律和动态监测血糖是糖尿病控制和一些重症疾病救治时的基础条件,而目前广泛应用的指血血糖仪虽然操作简便,测量精度较好,但由于在使用时会对皮肤造成损伤,痛感明显,在实际应用中常因患者的抵触情绪而影响坚持血糖的自我监测。有鉴于此,无创及微创血糖仪研究一直以来都受到广泛的关注。文中介绍无创及微创血糖仪的原理、发展方向和主要产品,为血糖仪研究提供一个基础框架。     

快速血糖仪测定血糖的评价及其质量控制

目的 探讨快速血糖仪测定结果的可信性和与检验科结果的可比性,以及如何提高其质量控制方法。方法采用自身前后对照实验。对108例患者空腹血糖行Glucotrend血糖仪检测微血管全血糖(CBG)、静脉全血糖(VBG)的结果与自动生化分析仪所测得的静脉血浆糖(VPG)作对照,并用误差表格分析法和统计学方法进行相关性分析。结果CBG、VBG及VPG的血糖值分别为(5.4±1.9)mmol/L、(5.3±1.9)mmol/L、(5.7±2.1)mmol/L。CBG与VPG及VBG与VPG的平均相对误差分别为3.5％、5.0％。三组之间均无明显差异(P>0.05)。结论 快速血糖仪适用于患者血糖的床边监测,采取必要的措施可以保证获取可靠的结果。     

不同水平高血糖与高血压共同危险因子的分析

探讨不同血糖水平与高血压病发病共同危险因子。对１４９９人做了葡萄糖耐量试验（ＯＧＴＴ）及血浆胰岛素、血脂、尿微量白蛋白排泄率（ＵＡＥＲ）和体重、腰臀围比、血压等检测并进行了吸烟史、、每日吸烟量的调查。（１）在糖耐量低减（ＩＧＴ）和糖尿病（ＤＭ）组中,血压≥１８．７／１２．０ｋＰａ者的比例分别为４８．７％、５５．９％明显高于正常精耐量（ＮＧＴ）组的３２．２％,Ｐ＜０．０１;（２）ＩＧＴ和ＤＭ组的血糖、胰岛素、血脂水平、尿微量白蛋白排泄率、体重指数、年龄与ＮＧＴ组比较明显增高,Ｐ＜０．０５～Ｐ＜０．０１;（３）高血压组上述临床和生化指标与非高血压组比较也明显增设,均Ｐ＜０刀１;（４）多元逐步回归分析：血糖与胰岛素、血脂水平、ＵＡＥＲ、体重指数、血压、年龄、吸烟量呈显著正相关;血压也与上述项目及血糖呈显著正相关,Ｐ＜０．０５～Ｐ＜０．０１。糖尿病与高血压病存在共同危险因子,是相关性疾病,而且在糖耐量低减患者,这些危险因子已经存在,应早期进行综合干预。     

Elevated free fatty acid levels inhibit glucose phosphorylation in slow-twitch rat skeletal muscle

The effect of increased free fatty acid concentrations on glucose metabolism in rat skeletal muscle was investigated at several different steps in glucose metabolism including glucose transport, glucose phosphorylation, glucose oxidation and glycogen synthesis. In isolated soleus (slow-twitch) muscles, insulin-stimulated (100 μml^-1) glucose phosphorylation, but not glucose transport, was inhibited by 26 and 22% in the presence of 1.0 and 2.0 mM oleate, respectively (P< 0.01). Regardless of oleate concentration (0.3 or 2.0 mM), insulin-stimulated glucose 6-phosphate levels were elevated to the same extent over the non-insulin-stimulated levels in soleus muscles {P < 0.01). Insulin-stimulated glucose oxidation was inhibited by 44% in soleus muscles exposed to 2.0 mM oleate (P < 0.05), whereas the rate of glucose incorporation into glycogen was not altered. In insulin-stimulated epitrochlearis (fast-twitch) muscles, elevated concentrations of oleate had no effect on the rates of glucose transport or glucose phosphorylation, or on the level of glucose 6-phosphate. These data suggest that increased free fatty acid availability decreases glucose utilization by selectively inhibiting glucose phosphorylation and oxidation in slow-twitch, but not fast-twitch skeletal muscle.     

纳米酶在葡萄糖分析检测中的应用研究进展

即时、准确的监控血糖和尿糖的变化对于糖尿病的早期诊断及血糖控制具有重要意义。自从2004年报道金纳米簇具有磷酸转移酶样催化活性以来,多种具备酶样催化活性的纳米材料被发现,包括过氧化物酶、过氧化氢酶、超氧化物歧化酶、氧化酶等。与天然酶相比,纳米酶具有成本低廉、制备简单、易于保存运输、环境耐受性高等优点。利用纳米酶进行葡萄糖分析检测有望降低检测成本,提高检测系统稳定性。本文总结了金属纳米颗粒、金属氧化物、金属硫化物、碳基材料以及复合材料等多种纳米酶检测系统在葡萄糖分析检测中的特点、检测限和检测范围,并对纳米酶研究面临的挑战及前景进行展望。     

Hexokinase kinetics in human skeletal muscle after hyperinsulinaemia,hyperglycaemia and hyperepinephrinaemia

The effects of 120 min of euglycaemic hyperinsulinaemia (UH, ∽ 5 mM; 40 mU m^-2 min^-1), UH plus adrenaline infusion (0.05 μgkg^-1 min^-l), and hyperglycaemic normoinsulinaemia (26 mM) on hexokinase kinetics in human skeletal muscle were examined. Biopsies were obtained from the quadriceps femoris muscle before and after each clamp. Total muscle hexokinase activity (HK_t) (measured on a 2500 g supernatant) at a saturating level of the substrate glucose (1 mM) averaged 13 mmol kg dry wt^-: min^-1 in the basal state and did not change significantly under any condition. Soluble hexokinase activity (HK_S) (16000 g supernatant) accounted for ∽ 65% of HK_t in the basal state, and this percentage was not significantly affected by any condition, suggesting that there was no major transfer of HK between cytosol and mitochondria. The activity of HK, and HK_s was inhibited by glucose 1,6-bisphosphate (G-l,6-P₂) in a concentration dependent manner in the basal state, and the sensitivity to Gl,6-P₂ inhibition was not altered by any condition. The activity of HK, and HK₈ in the presence of a subsaturating level of glucose (0.1 mM) accounted for ∽ 70% of the activity at 1 mM glucose, and this percentage was not altered by any condition. These data suggest that under the present conditions alterations in the rates of whole body glucose disposal cannot be associated with alterations in HK distribution between cellular compartments nor its measured kinetics properties.     

Facilitated glucose transporters play a crucial role throughout mouse preimplantation embryo development

The role of glucose fluctuates during preimplantation mouse embryo development, indicating that a specific interplay exists between glucose metabolism and uptake. In this study, attempts were made to characterize the role of the Na(+)-coupled active and the facilitated glucose transporters (GLUT) during preimplantation development by using specific glucose analogues and transport inhibitors and by examining the expression of GLUT1. One-cell outbred mouse embryos were cultured in medium M16 (5.5 mmol/l glucose), M16 without glucose (M16-G), M16-G + 2-deoxyglucose, M16-G + 3-O-methylglucose, M16 + phlorizin and M16 + phloretin and development to the blastocyst stage assessed. The absence of glucose, or the presence of 3-O-methylglucose, which is taken up but not metabolized, did not inhibit blastocyst development. 2-Deoxyglucose, which is phosphorylated but not metabolized, inhibited blastocyst development. Culture in M16 supplemented with phlorizin, an inhibitor of Na(+)-coupled active glucose transport did not inhibit blastocyst formation. Phloretin had no effect on the cleavage of two-cell embryos to the four-cell stage, but inhibited the morula/blastocyst transition. Both phloretin and phlorizin inhibited glucose uptake in two-cell embryos. Finally, GLUT1 expression was 10-fold less in blastocysts cultured in M16 compared to in-vivo blastocysts and those cultured in M16-G. The results show that both types of glucose transporters influence preimplantation embryo development and that the embryo has an innate ability to control the uptake of glucose by regulating the expression of GLUT1.     

皮下植入式葡萄糖传感器的研究进展

实时、连续检测葡萄糖可以有效减少和降低胰岛素依赖型的糖尿病患者低血糖症和高血糖症的并发症的发生。现在已有许多研究者在进行皮下植入式血糖测量传感器的研究 ,但到目前还没有可供临床上使用的皮下植入式葡萄糖传感器面世。目前正在研究的可连续测量皮下组织葡萄糖浓度的植入式葡萄糖传感器分可短期植入和长期植入两种 ,研究传感器的短期植入的特性研究者较多 ,并且大部分的传感器在植入后其灵敏度性能很快变坏。这可能是传感器在离体测试中并没有考虑传感器的生物兼容性。本文主要分析在复杂的在体情况下植入式葡萄糖传感器的失效机制     

Glucose kinetics during exercise in trained men

Six trained men were studied to examine the relative increases in hepatic glucose output and peripheral glucose uptake during 40 min of exercise at 75%Vo_2max. Rates of appearance (Ra) and disappearance (Rd) were measured using a primed, continuous intravenous infusion of D-[3-³H]glucose. Plasma glucose increased (P < 0.05) from 4.8 ± 0.2 mmol I^-1 at rest to 6.2 ± 0.5 mmol l^-1 after 40 min of exercise. Both Ra and Rd increased (P < 0.05) during exercise, however, during the early phase of exercise, Ra exceeded Rd (P < 0.05). Ra peaked at 42.0 ±3.2/tmol kgf¹ min^-1 after approximately 15 min of exercise. In contrast, the highest Rd of 33.9 ± 4.3 μmol kg^-1 min^-1 was measured at the end of exercise. In additional experiments, five men were studied during 40 min of exercise at 70–75%Vo_2max, 2 h after ingestion of the non-selective β-adrenergic antagonist timolol or a placebo capsule. Subjects were unable to complete the exercise bout following timolol, fatiguing after 28.0 ± 4.0 min (P < 0.05). The increase in blood glucose from 4.3 ±0.1 to 4.7 ± 0.3 mmol l^-1 (P < 0.05) following 20 min of exercise under control conditions was completely abolished by prior timolol ingestion (4.2 ± 0.2 to 4.1±0.2 mmol l^-1). These results demonstrate that during exercise at 75%Vo_2max in trained men, hepatic glucose output is not always closely matched to peripheral muscle glucose uptake and may be subject to feed-forward regulation. The abolition of the hyperglycaemia with non-selective β-adrenergic blockade implicates adrenaline in this response.