Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy of pentoxifylline therapy in improving the walking capacity of patients with moderate intermittent claudication. DATA SOURCES: A search of MEDLINE for trials published between 1976 and 1994 inclusive, and a bibliographic review of all articles retrieved. STUDY SELECTION: Randomized, placebo-controlled, double-blind clinical trials were selected that evaluated the pain-free walking distance (the distanced walked on a treadmill before the onset of calf pain) and the absolute claudication distance (the maximum distance walked on a treadmill) among patients with moderate intermittent claudication. Twelve study groups in 11 trials were included in the analysis. DATA EXTRACTION: In addition to information regarding the trial design, patient characteristics, dosages and treatment periods, the means and standard deviations were collected for both the pain-free walking and absolute claudication distances. Trial quality was also assessed. DATA SYNTHESIS: Overall, there was a statistically significant improvement in the pain-free walking distance after pentoxifylline therapy (weighted mean difference 29.4 m [95% confidence interval (CI) 13.0 to 45.9 m]); this finding was based on a total sample of 612 patients (308 in the treatment groups and 304 in the control groups). A significant improvement was also noted in the absolute claudication distance (weighted mean difference 48.4 m [95% CI 18.3 to 78.6 m]); this was based on a total sample of 511 patients (258 in the treatment group and 253 in the control group). In a sensitivity analysis of the pain-free walking distance, significant treatment effects and no statistically significant heterogeneity were found when only trials were included that were "medically eligible" (involved patients with stage II disease and a pain-free walking distance of 50 to 200 m). In a similar sensitivity analysis of the absolute claudication distance, the two conditions resulting in a significant treatment effect and no significant heterogeneity were the inclusion of "medically eligible" trials and those with a shorter treatment duration (13 weeks or less). CONCLUSION: Pentoxifylline therapy may be efficacious in improving the walking capacity of patients with moderate intermittent claudication. However, properly conducted clinical trials are required to provide a true estimate of the benefit.     

丙酮酸钙对小鼠力竭运动能力的研究

[目的]探讨补充3周丙酮酸钙对于小鼠力竭运动能力的影响。[方法]雄性小鼠40只,随机分为4组,分别为安静对照组、运动对照组、丙酮酸钙组、运动丙酮酸钙组。给药组每天灌胃给予600 mg/（kg.d）的丙酮酸钙共3周。3周末进行力竭运动实验,测各组运动至力竭时间,并取右侧腓肠肌组织和肝脏组织分别测肌糖原、肝糖原。[结果]与运动对照组（106.85±24.66）min比较,运动给药组（166.95±31.18）min鼠运动至力竭时间明显延长,运动能力提高,差异有显著性意义（P〈0.001）。运动前丙酮酸钙组肌糖原、肝糖原含量、超氧化物歧化酶（SOD）含量明显高于安静对照组,差异有显著性意义（P〈0.05）。运动力竭后各组肌糖原、肝糖原含量没有明显差异。与运动对照组比较,运动给药组SOD明显升高,差异有显著性意义（P〈0.05）。运动对照组肝脏丙二醛（MDA）的含量均高于其他三组,差异有显著性意义（P〈0.01）;运动给药组MDA含量明显低于运动对照组,差异有非常显著性意义（P〈0.001）。血清钙浓度各组间差异无显著性意义（P〉0.05）。[结论]补充3周丙酮酸钙能明显提高小鼠力竭运动能力,其可能的原因是提高运动前肌糖原和肝糖原水平。     

Insulin adjustment by a diabetes nurse educator improves glucose control in insulin-requiring diabetic patients: a randomized trial

BACKGROUND: Diabetic patients taking insulin often have suboptimal glucose control, and standard methods of health care delivery are ineffective in improving such control. This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control, as indicated by level of glycated hemoglobin (HbA1c). METHODS: The authors conducted a prospective randomized trial involving 46 insulin-requiring diabetic patients who had poor glucose control (HbA1c of 0.085 or more). Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher. The patients were randomly assigned to receive standard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy. RESULTS: At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level (mean [and standard deviation] for standard-care group 0.094 [0.008] and for intervention group 0.096 [0.010]), age, sex, type or duration of diabetes, duration of insulin therapy or complications. After 6 months, the mean HbA1c level in the standard-care group was 0.089 (0.010), which was not significantly different from the mean level at baseline. However, the mean HbA1c level in the intervention group had fallen to 0.078 (0.008), which was significantly lower than both the level at baseline for that group (p < 0.001) and the level for the standard-care group at 6 months (p < 0.01). INTERPRETATION: Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients.     

Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial

CONTEXT: Exercise training in patients with chronic heart failure improves work capacity by enhancing endothelial function and skeletal muscle aerobic metabolism, but effects on central hemodynamic function are not well established. OBJECTIVE: To evaluate the effects of exercise training on left ventricular (LV) function and hemodynamic response to exercise in patients with stable chronic heart failure. DESIGN: Prospective randomized trial conducted in 1994-1999. SETTING: University department of cardiology/outpatient clinic in Germany. PATIENTS: Consecutive sample of 73 men aged 70 years or younger with chronic heart failure (with LV ejection fraction of approximately 0.27). INTERVENTION: Patients were randomly assigned to 2 weeks of in-hospital ergometer exercise for 10 minutes 4 to 6 times per day, followed by 6 months of home-based ergometer exercise training for 20 minutes per day at 70% of peak oxygen uptake (n=36) or to no intervention (control group; n=37). MAIN OUTCOME MEASURES: Ergospirometry with measurement of central hemodynamics by thermodilution at rest and during exercise; echocardiographic determination of LV diameters and volumes, at baseline and 6-month follow-up, for the exercise training vs control groups. RESULTS: After 6 months, patients in the exercise training group had statistically significant improvements compared with controls in New York Heart Association functional class, maximal ventilation, exercise time, and exercise capacity as well as decreased resting heart rate and increased stroke volume at rest. In the exercise training group, an increase from baseline to 6-month follow-up was observed in mean (SD) resting LV ejection fraction (0.30 [0.08] vs 0.35 [0.09]; P=.003). Mean (SD) total peripheral resistance (TPR) during peak exercise was reduced by 157 (306) dyne/s/cm(-5) in the exercise training group vs an increase of 43 (148) dyne/s/cm(-5) in the control group (P=.003), with a concomitant increase in mean (SD) stroke volume of 14 (22) mL vs 1 (19) mL in the control group (P=.03). There was a small but significant reduction in mean (SD) LV end diastolic diameter of 4 (6) mm vs an increase of 1 (4) mm in the control group (P<.001). Changes from baseline in resting TPR for both groups were correlated with changes in stroke volume (r=-0.76; P<.001) and in LV end diastolic diameter (r=0.45; P<.001). CONCLUSIONS: In patients with stable chronic heart failure, exercise training is associated with reduction of peripheral resistance and results in small but significant improvements in stroke volume and reduction in cardiomegaly. JAMA. 2000.     

瑞格列奈治疗68例2型糖尿病的疗效观察

目的:探讨瑞格列奈治疗2型糖尿病的临床疗效,并评价其安全性。方法:选取2008年10月～2012年7月我院收治的2型糖尿病患者204例,按数字表法随机分为观察组与对照组,各102例。所有患者在严格控制饮食以及运动疗法的基础上,观察组口服瑞格列奈治疗,对照组给予格列齐特。疗程均为12周,12周后比较两组患者的空腹血糖(FPG)、餐后2h血糖(PBG)、糖化血红蛋白(HbA1c)、体重指数(BMI)及不良反应。结果:治疗后观察组和对照组的FPG、HbA1c较治疗前均有显著下降(P<0.05),组间比较差异无统计学意义(P>0.05);与对照组相比,观察组患者的PBG显著下降(P<0.05);两组疗效比较差异无统计学意义(P>0.05)。观察组低血糖反应发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论:采用瑞格列奈治疗2型糖尿病,降血糖疗效显著,且安全可靠,同时具有良好的顺应性,值得临床推广。     

心肺运动试验在指导2型糖尿病患者精准化运动中的效果

目的:探索心肺运动试验在指导2型糖尿病患者精准化运动中的效果。方法:选择接受心肺运动试验的2型糖尿病患者60例，随机分为对照组和干预组，每组30例。对照组给予患者常规运动指导，干预组根据患者心肺运动试验结果给予精准化指导。运动3个月后，比较两组患者试验前后的糖化血红蛋白（HbA1c）、BMI、峰值摄氧量（VO2peak）、峰值氧脉搏（O2Pulsepeak）、无氧阈（AT）、峰值潮气量（VTpeak）结果，统计患者运动过程中不良事件发生情况。结果:3个月后与基线比较，对照组患者HbA1c、BMI、O2Pulsepeak、VTpeak的变化有显著差异（P＜0.05），VO2peak、AT的变化无差异（均P＞0.05），干预组所有数值变化显著（均P＜0.05）；干预组除HbA1c（P＞0.05）外，其余数值较对照组改善程度明显（P＜0.05）；不良事件中，两组患者低血糖的发生无差异（P＞0.05），对照组心脏危险事件明显高于干预组（均P＜0.05）。结论:两种运动方式均能降低患者血糖水平，但是根据心肺运动试验结果指导2型糖尿病患者的精准化运动，更能有效提高患者心肺功能，减少运动过程中不良事件发生率。     

运动后糖尿病患者下肢经皮氧分压变化的趋势

目的：研究运动对2型糖尿病患者下肢经皮氧分压（ tcpO2）的影响,以探索运动时的tcpO2动态变化对糖尿病患者循环障碍的诊断价值。方法：用踩踏功率自行车运动干预方法观察了12例2型糖尿病患者（24条下肢）以及3名正常成人（6条下肢）腓肠肌tcpO2的变化情况,同时检测静息状态下的踝肱比（ ABI）和定量振动阈值（ QST）。根据患者ABI水平将患者肢体分成＞0.9而≤1.3亚组、0.7～0.9亚组和＜0.7亚组3组,比较分析各组tcpO2变化情况。结果：所有糖尿病患者的tcpO2水平在运动过程中均出现下降趋势,而正常组则出现上升趋势。在静息状态下,tcpO2运动前后的变化值与ABI呈线性相关,但与QST并无线性关系。在ABI＞0.9而≤1.3亚组tcpO2在运动早期出现轻度升高,但随即下降到基础水平;在ABI为0.7～0.9亚组,tcpO2在运动初期即出现下降;在ABI＜0.7亚组则出现快速下降。结论：在运动中测量tcpO2水平有助于对糖尿病患者微循环储备功能的判断。     

Type 2 diabetes in Singapore: the role of exercise training for its prevention and management

The prevalence of type 2 diabetes has been increasing in Singapore and is a major risk factor for cardiovascular disease. Exercise training is an important therapeutic modality for managing glycaemic control and improving cardiovascular health among persons with type 2 diabetes. It may also help to prevent or delay the onset of this harmful condition. This review examines the evidence and possible mechanisms by which exercise training produces these benefits, and gives a brief review of appropriate exercise activities.     

2型糖尿病患者甲状腺激素水平的临床分析

【目的】分析2型糖尿病患者甲状腺激素水平与糖化血红蛋白和尿微量白蛋白/肌酐比值的关系,探讨糖尿病和甲状腺疾病的关系。【方法】选取2010年1月-2012年5月在住院的2型糖尿病患者527例,分别以HbA1C、尿A/C分组,测定FT3、FT4、TSH、HbA1c、尿A/C。【结果】随着HbA1C升高FT3逐渐降低,TSH逐渐升高,各组之间统计均有差异,而HbA1C≤7.0%组与HbA1C≥10.0%组有显著差异（P〈0.01）;随着尿A/C的升高FT3逐渐降低,TSH逐渐升高,各组之间统计均有差异,而尿A/C〈30 mg/g组与尿A/C≥300 mg/g组有显著差异（P〈0.01）。【结论】2型糖尿病患者甲状腺激素水平的变化与HbA1C及尿A/C密切相关。 更多还原