糖尿病神经源性膀胱的治疗进展

糖尿病神经源性膀胱(DNB)是糖尿病自主神经病变在泌尿生殖系统的表现.DNB发病机制复杂,因此治疗方法繁多,包括营养神经、抗氧化应激、改善胆碱能神经突触传递、电刺激、导尿、手术及中医药等.近年来对神经营养因子及其靶向基因治疗的研究较多,但多数仍处于动物实验阶段.膀胱治疗仪的出现,为DNB的治疗提供了一种新方法.各种治疗方法机制和疗效不同,且大多疗效不尽人意,更有效的治疗方法有待进一步研究.     

核因子-κB在糖尿病大鼠肾脏的表达水平及贝那普利的调节作用

目的 探讨NF-κB在糖尿病大鼠肾脏中的表达水平及贝那普利的调节作用.方法 将34只Wistar大鼠随机分为正常对照(n)组、糖尿病肾病(DN)组、贝那普利治疗(DNB)组.腹腔注射STZ诱导糖尿病模型,处理12 w末检测血糖、血胆固醇、血肌酐、尿素氮、尿蛋白,应用免疫组织化学方法检测肾脏NF-κB的表达水平.结果 DNB组大鼠血胆固醇、肌酐及尿白蛋白排泄较DN组明显减少(P<0.01或P<0.05).免疫组化显示:DNB组大鼠肾脏NF-κB表达明显低于DN组(P<0.01).结论 贝那普利对糖尿病大鼠肾脏有保护作用,可能通过抑制糖尿病大鼠肾脏NF-κB的表达,减少细胞外基质沉积.     

补中益气汤加减治疗2型糖尿病神经源性膀胱52例

笔者自1998年以来，运用补中益气汤加减治疗2型糖尿病神经源性膀胱（DNB）52例，并与常规治疗组44例做对照，疗效显著，现报告如下：     

糖尿病神经源性膀胱患者血清铁蛋白水平的改变及其临床意义

目的 探讨糖尿病神经源性膀胱（DNB）患者血清铁蛋白（SF）水平变化及两者的相关性.方法 选取单纯T2DM患者（T2DM组）,DNB患者（DNB组）和正常对照（NC组）者,各30例,采用化学发光法测定SF水平. 结果 DNB组和T2DM组SF水平均高于NC组,且DNB组高于T2DM组[（689.75±67.31）vs（498.98±49.76）vs（278.15±38.65） ng/ml,P＜0.01].SF水平与TC、TG、HbA1 c水平均呈正相关（r=0.48、0.42、0.57,P均＜0.01）.非条件Logistic回归分析显示,DNB与病程、年龄、SBP、HbA1 c、FIns、TC及SF呈正相关（P＜0.05或P＜0.01）. 结论 SF的升高与DNB的发生发展密切相关,可作为DNB的检测指标之一,为临床干预治疗提供理论依据.     

经皮电脉冲刺激治疗糖尿病神经原膀胱的疗效研究

目的探讨经皮电脉冲刺激治疗糖尿病神经原膀胱(DNB)的临床效果。方法以该院2012年1月—2014年1月收治的152例患者作为研究对象,按照DNB患者膀胱残余尿(BRU)量分为轻度、中度和重度患者,对患者进行膀胱仪治疗,对比患者治疗后的ULR及BRU变化。结果患者治疗后ULR与BRU显著低于治疗前(P<0.05),并发尿潴留患者消失的尿意恢复,可自行排尿。结论对经皮电脉冲刺激能够显著提高DNB患者的治疗效果与生活质量,不良反应较少,值得临床推广应用。     

莫沙必利联合胰激肽原酶治疗糖尿病神经源性膀胱疗效观察

目的探讨莫沙必利联合胰激肽原酶治疗糖尿病神经源性膀胱（DNB）的疗效及其安全性。方法将80例DNB患者随机分为观察组和对照组各40例,两组均采用基础治疗包括降糖、降压、营养神经、改善微循环及调节血脂等,观察组在基础治疗上加用莫沙必利和胰激肽原酶治疗,治疗21d后观察两组的血糖、血脂、血压和膀胱残余尿量改善情况。结果观察组治疗后总有效率明显高于对照组（P〈0．05）;两组治疗前后血糖、血压及血脂组间相比无明显差异（P〉0．05）,两组治疗后膀胱残余尿量明显少于治疗前（P〈0．05）,观察组治疗后膀胱残余尿量明显少于对照组（P〈0．05）;两组均未出现不良反应。结论莫沙必利联合胰激肽原酶治疗DNB能有效缓解患者的症状、体征,减少膀胱残余尿量,临床应用安全有效。     

糖尿病膀胱功能障碍的临床治疗及康复进展

糖尿病（diabetic mellitus,DM）是老年人常见的慢性疾病,下泌尿道（lower urinary tract,LUT）相关并发症是DM常见的并发症,其中以糖尿病性膀胱病（diabetic cystopathy,DCP）最为常见,DCP或称糖尿病膀胱功能障碍（diabetic bladder dysfunction,DBD）、糖尿病神经源性膀胱（diabetic neurogenic bladder,DNB）等[1]。现将DBD的临床治疗及康复进展综述如下。     

糖尿病神经性膀胱患者血浆同型半胱氨酸、血清叶酸、维生素B_(12)的水平及尿动力学变化分析

目的 探讨糖尿病神经性膀胱(DNB)患者血清叶酸(FA)、维生素B_(12)(VitB_(12))、血浆同型半胱氨酸(Hcy)及尿动力学指标的变化及其临床意义。方法 选取许昌市中心医院内分泌科收治的T2DM患者251例,其中合并DNB患者86例(DNB组)、单纯T2DM患者165例(T2DM组),比较两组FA、VitB_(12)、Hcy及尿动力学指标。结果 DNB组FPG、2hPG、HbA1c、尿微量白蛋白(UMA)、膀胱最大测压容量(VMBC)、Scr、BUN、Hcy高于T2DM组(P0.01);FIns、FA、VitB_(12)、最大尿流率(MFR)、最大尿流率时逼尿及压力(PQmax)、膀胱顺应性(BC)低于T2DM组(P0.01)。结论 DNB患者血清FA、VitB_(12)、Hcy及尿动力学指标均发生改变。     

糖尿病的中医疗法探析

目的 中医治疗糖尿病的方法与独特疗效.方法 从糖尿病的病因入手,结合临床实践病例分别从中医食疗、中医治疗糖尿病的偏方、以及糖尿病的针灸治疗、现代气功治疗等临床案例分析论证.结果 中医治疗糖尿病的偏方独特,中医食疗治疗糖尿病有许多明显的优点.结论 疗效显著,值得推广.     

糖尿病强化治疗的利弊浅析

自1993年糖尿病控制与并发症试验(DCCT)研究结果 公布以后,糖尿病的强化治疗一直是众多学者研究和关注的热点之一.大量研究表明,强化治疗通过严格控制血糖,可以有效的保护胰岛β细胞功能、增加胰岛素的敏感性,并能预防和延缓糖尿病慢性并发症的发生、发展.而了解强化治疗的含义、掌握强化治疗的方法 和策略、认识强化血糖控制目标、关注强化治疗的风险以及目前存在的困惑,对于全面理解糖尿病强化治疗具有重大意义.     

Pain Management in chronic pancreatitis

Opinion statement Painful chronic pancreatitis is difficult to manage. We believe a multidisciplinary approach is the best means of evaluating this complex syndrome. In our opinion, the initial evaluation should aim at firmly establishing the diagnosis of chronic pan-creatitis: calcifications on imaging; duct morphologic changes on pancreatography; parenchymal changes on ultrasound; or evidence of pancreatic dysfunction on secre-tin/ cholecystokinin stimulation tests. In addition, psychological assessment and qual-ity-of-life measurements are recommended. Once the diagnosis of chronic pancreatitis has been made, characterization of the chronic pain syndrome (visceral, non-visceral) with a diagnostic differential nerve block (DNB) is performed. Unlike celiac plexus block, which interrupts visceral afferent impulses traveling through the celiac plexus, a DNB is a meticulous, diagnostic tempo-rary block that localizes the origin of chronic abdominal pain. This pain can be classi-fied as visceral, psychologic/central, somatosensory, or mixed when more than one pain pathway is involved. Treatment modalities are different for these different types of pain syndromes. Chronic pancreatic pain should be visceral in origin if pain is stemming from an inflamed/scarred gland [1]. There is evidence that DNB may be helpful in characterizing abdominal pain in chronic pancreatitis [1]. Furthermore, it allows better selection of patients for treatment of chronic pancreatic pain [2]. Initial treatment in all patients should include pancreatic enzyme therapy, abstinence from alcohol, non-narcotic analgesics, and a low-fat diet. Patients who fail initial therapy should be considered for surgery or enrollment in medical treatment trials. Those identified by DNB as having visceral-type pain should be directed to med-ical and surgical therapy based on pancreatic duct morphology. Visceral-pain patients with dilated ducts or focal disease should undergo pancreatic duct drainage, or surgi-cal resection procedures. Patients with nonciliated ducts should undergo further medi-cal therapy, including celiac plexus blocks, enrollment into treatment trials of endoscopic therapy, or drug trials with new agents such as tramadol, gabapentin, or octreotide, or nutritional supplementation. Finally, those patients with visceral pain unresponsive to all medical therapy and who are not surgical candidates should be enrolled in a trial of thorascopic splanchnicectomy for intractable pain (Fig. 1). Patients identified by DNB as having a non-visceral type of chronic abdominal pain should undergo initial medical therapy as above ( enzymes, cessation of alcohol, diet modifications, analgesics).     

Acupuncture for diabetic neurogenic bladder: A protocol for systematic review and meta-analysis

Background:Diabetic neurogenic bladder (DNB) is one of the common complications of diabetes mellitus, which has a high prevalence rate. Some research suggested that acupuncture can improve the clinical symptoms of diabetic neurogenic bladder patients, but there is no systematic review or meta-analysis to assess this therapy. Therefore, this study aims to explore the effectiveness and safety of acupuncture for patients with DNB.Methods:In this study, we will search for electronic databases including the Cochrane Library, Web of Science, PubMed, MEDLINE, EMBASE,China National Knowledge Infrastructure (CNKI), Wan-Fang, and Baidu Scholar Database from inception to December 2020. We will select randomized controlled trials that have been published in English or Chinese related to acupuncture for DNB. Selection of study, extraction of data, and assessment of study quality will be performed independently by 2 researchers, and we will use Revman 5.3 software which is provided by Cochrane assistance network, to perform the data analysis.Results:This study will provide evidence of the effectiveness and safety of acupuncture for DNB.Conclusion:This study will clarify whether acupuncture is an effective treatment for DNB, and will also provide a reference for clinical practice and guidelines development.     

DNB: a partial D with anti-D frequent in Central Europe

To improve routine D typing and define transfusion strategy, it is important to establish the frequency of partial D alleles and their susceptibility to anti-D alloimmunization due to transfusion or pregnancy. We identified the partial D DNB that was caused by an RHD(G355S) allele associated with a CDe haplotype and whose phenotype presented a normal D in routine typing. The antigen density was about 6000 D antigens per red blood cell, and the Rhesus index was 0.02. Five anti-D immunization events with allo-anti-D titers up to 128 were observed. Twelve carriers of DNB were whites of Central Europe; the only Danish proband had Austrian ancestry. DNB was the most frequent partial D recognized so far in whites, occurring with frequencies of up to 1:292 in Switzerland. DNB was the underlying partial D phenotype in a relevant fraction of anti-D immunizations occurring in whites.     

Radioactive iodine therapy for Graves' disease in childhood and adolescence

While the diagnosis of Graves' disease in childhood and adolescence is relatively straightforward, its treatment remains controversial. The first choice therapy is the use of anti-thyroid drugs, although side effects are more frequent than in adults and remission is low. Surgery is not usually indicated as initial treatment. Instead, it is generally recommended after recidive of the disease or due to side effects of medical treatment. The use of radioiodine therapy is increasing in this age group, especially in North America, and control of the hyperthyroidism is achieved in 3 to 6 months in 90% of the cases. There is no evidence that radioiodine therapy is associated with a higher risk of thyroid cancer, and the occurrence of side effects is lower than surgery. Based on the positive results obtained with this therapy, patients with poor responsiveness to medical treatment should be considered for early radioiodine therapy.     

Psychological side effects of MTX treatment in juvenile idiopathic arthritis: a pilot study

OBJECTIVE: To document the psychological side effects of methotrexate (MTX) treatment in children with juvenile idiopathic arthritis (JIA) and to explore the usefulness of psychological therapy to ameliorate these side effects. METHODS: The patients included in this study consisted of 29 patients with JIA using MTX. Of these, ten were referred to a pediatric psychologist because of MTX side effects, and had behavioural therapy to cope with these side effects with a strong behavioural component (anticipatory nausea, anxiety). The behavioural therapy was adapted to age and used systemic desensitization (distraction in a positive atmosphere) or cognitive behavioural therapy (relaxation and overruling negative thoughts by positive ones). The parents of the 29 children were interviewed about MTX treatment and the side effects their child had developed. Parents of children referred to the psychologist were also interviewed for their impression of the results of the behavioural therapy. RESULTS: Prior to the behavioural therapy, nine out of 10 children reported MTX related nausea. Six of these ten were nauseous even before the administration and developed anticipatory nausea. Nine out of ten patients also showed some sign of distress in anticipation of MTX treatment, either orally of via injections. The behavioural therapy they had fully abolished side effects in five children and decreased the severity of nausea and distress in two children. Of the remaining nineteen children, not referred to the pediatric psychologist, 11 reported nausea after MTX treatment and four of these developed anticipatory nausea. In addition, eight of these 18 developed behavioural distress in anticipation of the treatment. CONCLUSION: This study showed that children with JIA who receive MTX treatment frequently develop psychological side effects, such as anticipatory nausea and behavioural distress in anticipation of treatment. This is true for patients selected for reported MTX side effects, as well as for randomly chosen JIA patients using MTX. As MTX is still the first choice in the treatment of severe JIA, more attention should be given to the treatment and prevention of side effects. Psychological intervention can be of help, but further studies are needed on the nature of the side effects, as well as on the prerequisites and efficacy of behavioural therapy.     

What an interventional cardiologist should know about the pharmacological treatment of acute myocardial infarction.

The treatment of acute myocardial infarction consists of pain and anxiety relief, anti-ischaemic treatment and antithrombotic therapy. Due to its bleeding complications and, in some cases, procoagulant effects, antithrombotic therapy has consequences for coronary procedures in the setting of acute myocardial infarction. Antiplatelet therapy has no procoagulant effects, and its bleeding complications can easily be managed. Antithrombin therapy has rebound effects, for which no clear solution is available. Thrombolytic therapy has also procoagulant effects, which may interfere with coronary procedures in the early hours of acute myocardial infarction. Heparin may counteract the thrombolysis-induced thrombin generation, but has an unpredictable effect. Postprocedural therapy after angioplasty in the setting of acute myocardial infarction should consist of antiplatelet therapy.     

Do the Frequencies of Adverse Events Increase, Decrease, or Stay the Same with Long-Term Use of Statins?

Statins are widely used for their cholesterol-lowering properties and proven reduction of cardiovascular disease risk. Many patients take statins as long-term treatment for a variety of conditions without a clear-cut understanding of how treatment duration affects the frequency of adverse effects. We aimed to evaluate whether the frequencies of documented adverse events increase, decrease, or remain unchanged with long-term statin use. We reviewed the established literature to define the currently known adverse effects of statin therapy, including myopathy, central nervous system effects, and the appearance of diabetes, and the frequency of these events with long-term medication use. The frequency of adverse effects associated with long-term statin therapy appears to be low. Many patients who develop side effects from statin therapy do so relatively soon after initiation of therapy, so the frequency of side effects from statin therapy when expressed as a percentage of current users decreases over time. Nevertheless, patients may develop side effects such as muscle pain and weakness years after starting statin therapy; however, the absolute number of patients affected by statin myopathy increases with treatment duration. Also, clinical trials of statin therapy rarely exceed 5 years, so it is impossible to determine with certainty the frequency of long-term side effects with these drugs.     

The use of high-dose pulse methylprednisolone in rheumatoid arthritis. Unproved therapy

Pulse methylprednisolone therapy has been used for the treatment of rheumatoid arthritis. The recent literature describing pulse therapy for this disorder is reviewed. The effects of pulse steroids on the immune system, potential side effects of therapy, and recommendations for its use are presented. Because of the lack of substantial benefit and the possibility of adverse side effects, pulse methylprednisolone therapy should be considered investigational for short-term use in patients with aggressive rheumatoid arthritis undergoing induction therapy with long-term agents such as gold or penicillamine. More study is indicated before generalized use of this modality can be advocated.     

Current status of the use of growth factors and other adjuvant medications in patients receiving peginterferon and ribavirin

Hepatitis C virus (HCV) is the most common chronic infection in the United States, affecting almost 3.9 million Americans. The most effective treatment for chronic HCV infection is combination antiviral therapy with peginterferon and ribavirin. However, combination therapy is also associated with significant adverse effects and is contraindicated in certain patient populations. Hematological adverse effects are common and are a frequent cause of dose reduction and interruption or discontinuation of therapy. Currently there are no approved treatments for the hematological adverse events associated with HCV therapy. However, emerging data suggest that utilization of hematopoietic growth factors can provide a useful adjunct to treatment and optimize sustained virologic response rates.