怡开治疗早期糖尿病肾病的疗效观察

近年来，应用怡开（胰激肽原酶）配合其他药物治疗早期糖尿病肾病取得明显疗效。报告如下：     

胰激肽原酶肠溶片对早期糖尿病肾病的防治作用

糖尿病肾病是糖尿病的常见慢性并发症 ,也是糖尿病致死致残的主要原因之一 ,现今在美国 3 5 %的肾移植患者是糖尿病患者 ,已成为肾移植的首位原因[1] 。国内糖尿病肾病的发病率也成逐年上升趋势 ,如何有效地防止糖尿病肾病的发生发展 ,已成为一项重要的临床课题。目前对糖尿病肾病尚无理想的防治措施 ,更缺乏针对性强的药物。我们用胰激肽原酶肠溶片 (tabletpancreatic kallikrein,TPK)治疗早期糖尿病肾病 ,取得满意疗效。1　材料与方法1 .1一般资料　 6 5例患者符合 1 999年 WHO糖尿病诊断标准 ,并符合 Mogensen糖尿病肾病诊断分期标准 …     

“一石多鸟”防治糖尿病微血管病变

我们常说：“糖尿病本身并不可怕,可怕的是它的并发症”。因此,对待糖尿病,最重要的是关注并发症的防治。糖尿病慢性并发症包括大血管和微血管并发症,而微血管并发症发生得更早,更广泛。胰激肽原酶肠溶片（如丽珠广乐、凯尼可等）可全面防治糖尿病慢性并发症。     

糖尿病血管并发症的狙击手——胰激肽原酶

糖尿病患者极大多数因并发心脑等大血管及眼、肾、神经等微血管并发症而致残和死亡。第64届美国糖尿病学会（ADA）年会最高奖项班丁奖得主,世界著名的糖尿病学者布朗利教授指出：“如果糖尿病没有血管并发症。就不再是一个重大的公共卫生难题。”足见血管并发症的干预治疗始终是糖尿病防治的一个主旋律。     

胰激肽原酶治疗糖尿病周围神经病变32例

糖尿病周围神经病变是糖尿病常见并发症,目前临床上尚缺乏有效的治疗方法。我科根据胰激肽原酶(pancreatic kininogenase,PK)的药理和糖尿病周围神经病变的可能发病机理,于2000年1月起应用PK治疗糖尿病周围神经病变32例,收到了良好的效果,现报告如下。     

怡开治疗糖尿病肾病68例疗效观察

糖尿病肾病（DN）是糖尿病（DM）的主要慢性并发症之一，也是糖尿病患者致死的重要原因。尿微量白蛋白的测定是诊断DN的一项早期指标，在此期间如采用积极措施干预，可延缓和逆转DN的发展。2003年4月一2006年4月收治糖尿病肾病112例，采用怡开注射液治疗68例，效果满意，报告如下：     

如何筛查 糖尿病慢性并发症

糖尿病患者除了控制好血糖之外,慢性并发症的筛查是不可忽视的重要环节。     

浅谈糖尿病慢性并发症的防治措施

糖尿病(DM)是影响人类身体健康的第三大"杀手",临床研究表明,近年来DM慢性并发症有逐年攀升趋势,本文结合临床实践,重点探讨了DM慢性并发症的危险因素、具体防治措施以及五大常见并发症的防治法,以减少DM并发症的发生,提高患者生活质量。     

前列地尔对糖尿病慢性并发症的临床防治

目的:探讨前列地尔治疗糖尿病慢性并发症的临床疗效. 方法:选取我院2013年6月~2014年12月治疗的60例糖尿病慢性并发症患者,随机分为两组,观察组30例、对照组30例,对照组基于常规治疗措施添加甲钴胺进行治疗,观察组在对照组基础上行前列地尔进行治疗,观察两组治疗效果. 结果:观察组与对照组临床治疗有效率分别为96.67%、73.33%,差异具有统计学意义(P<0.05). 结论:前列地尔治疗糖尿病慢性并发症减轻心脏负荷,能有效抑制血小板聚集并改善微循环,值得在临床上推广.     

糖尿病慢性并发症的临床分析

1．1 一般资料：我院2000年1月-2004年6月糖尿病住院患者500例，男302例，女性198例，年龄16-88岁(平均年龄62．3岁)，患有慢性并发症者475例，占95％。     

Approaches to prevention of cardiovascular complications and events in diabetes mellitus

Diabetes mellitus affects about 8% of the adult population. The estimated number of patients with diabetes, presently about 170 million people, is expected to increase by 50-70% within the next 25 years.Diabetes is an important component of the complex of 'common' cardiovascular risk factors, and is responsible for acceleration and worsening of atherothrombosis. Major cardiovascular events cause about 80% of the total mortality in diabetic patients. Diabetes also induces peculiar microangiopathic changes leading to diabetic nephropathy conducive to end-stage renal failure, and to diabetic retinopathy that may progress to vision loss and blindness.In terms of major cardiovascular events, coronary heart disease and ischaemic stroke are the main causes of morbidity and mortality in diabetic patients. Peripheral arterial disease frequently occurs, and is more likely to be conducive to critical limb ischaemia and amputation than in the absence of diabetes. Although there are a number of differences in the pathogenesis and clinical features of diabetic macroangiopathy and microangiopathy, these two entities often coexist and induce mutually worsening effects. Endothelial injury, dysfunction and damage are common starting points for both conditions. Causes of endothelial injury can be distinguished into those 'common' to nondiabetic atherothrombosis, such as hypertension, dyslipidaemia, smoking, hypercoagulability and platelet activation; and those more specific and in some cases 'unique' to diabetes and directly related to the metabolic derangement of the disease, such as (i) desulfation of glycosaminoglycans (GAGs) of the vascular matrix; (ii) formation of advanced glycation end-products (AGE) and their endothelial receptors (RAGE); (iii) oxidative and reductive stress; (iv) decline in nitric oxide production; (v) activation of the renin-angiotensin aldosterone system (RAAS); and (vi) endothelial inflammation caused by glucose, insulin, insulin precursors and AGE/RAGE. Prevention of major cardiovascular events with the antithrombotic agent aspirin (acetylsalicylic acid) is widely recommended, but reportedly underutilised in patients with diabetes. However, some data suggest that aspirin may be less effective than expected in preventing cardiovascular events and especially mortality in patients with diabetes, as well as in slowing progression of retinopathy.In contrast, a recent study found picotamide, a direct thromboxane inhibitor, to be superior to aspirin in diabetic patients. Clopidogrel was either equivalent or less active in diabetic versus nondiabetic patients, depending upon different clinical settings.Recent studies have shown that some GAG compounds are able to reduce micro- and macroalbuminuria in diabetic nephropathy, and hard exudates in diabetic retinopathy, but it is as yet unknown whether these agents also influence the natural history of microvascular complications of diabetes. Lifestyle changes and physical exercise are also essential in preventing cardiovascular events in diabetic patients. Available data on the control of the metabolic state and the main risk factors show that careful adjustment of blood sugar and glycated haemoglobin is more effective in counteracting microvascular damage than in preventing major cardiovascular events. The latter objective requires a more comprehensive approach to the whole constellation of risk factors both specific for diabetes and common to atherothrombosis. This approach includes lifestyle modifications, such as dietary changes and smoking cessation and the use of HMG-CoA reductase inhibitors (statins), which are able to correct the lipid status and to prevent major cardiovascular events independently of the baseline lipidaemic or cardiovascular status. Tight control of hypertension is essential to reduce not only major cardiovascular events but also microvascular complications. Among antihypertensive measures, blockade of the RAAS by means of ACE inhibitors or angiotensin II receptor antagonists recently emerged as a potentially polyvalent approach, not only for treating hypertension and reducing cardiovascular events, but also to prevent or reduce albuminuria, counteract diabetic nephropathy and lower the occurrence of new type 2 diabetes in individuals at risk.     

Role of silibinin in the management of diabetes mellitus and its complications

Diabetes mellitus is globally approaching epidemic proportions and acts as a major cause of a number of serious health problems diagnosed as diabetic complications. The current oral drugs in the treatment of diabetes and its complications could meet some but not all of the patients’ needs, and the development of novel drugs with a hypoglycemic effect is urgently required. Silibinin, a flavonolignan traditionally used for the treatment of gallbladder and hepatic diseases, was reported to improve glycemic homeostasis by improving the activity of pancreatic β-cells, increasing insulin sensitivity of liver and muscle cells, and decreasing lipid deposition in adipocytes. Researches also indicated the effectiveness of silibinin in controlling several diabetic complications including neuropathy, retinopathy, impaired healing, hepatopathy, cardiomyopathy, nephropathy, and osteoporosis. In this review, we summarize the recent anti-diabetes findings of silibinin and clarify the underlying pharmacological mechanisms, and update the knowledge in understanding the role of silibinin in control of diabetic complications.     

Study on p-hydroxybenzoic acid on rheumatoid arthritis via inhibiting NF-κB/caspase-1 signaling pathway

探究二肽基肽酶-4抑制剂(dipeptidyl peptidase-4 inhibitors,DPP-4i)维格列汀改善糖尿病诱导心肌细胞的炎性损伤作用机制。

体外培养AC16心肌细胞随机分为空白组、棕榈酸(palmitic acid,PA)组、0.1、1、10 μmol·L⁻¹维格列汀组以及西格列汀组(阳性对照组)。采用CCK-8试剂盒检测细胞存活率;Western blotting检测目的蛋白DPP-4、p-NF-κB、IκB的表达情况;ELISA试剂盒检测炎症因子TNF-α和IL-6表达水平;TUNEL试剂盒检测细胞凋亡情况。

AC16人源心肌细胞经PA处理后,细胞形态改变;CCK-8结果显示细胞存活率下降;Western blotting结果显示NF-κB磷酸化增强,且DPP-4蛋白表达升高;ELISA结果显示炎症因子TNF-α和IL-6表达水平上升;TUNEL阳性比例增多,促进心肌细胞凋亡。维格列汀给药后能有效抑制PA诱导的DPP-4蛋白异常表达,改善心肌细胞形态,并下调NF-κB磷酸化水平。ELISA结果显示维格列汀改善PA诱导的炎症因子TNF-α和IL-6表达水平上升,降低TUNEL阳性比例(P<0.05)。

维格列汀可以有效拮抗PA诱导的心肌细胞炎性损伤,通过抑制NF-κB磷酸化水平,降低胞内炎症因子表达水平与抑制细胞凋亡,从而拮抗糖尿病心肌病诱导的心肌损伤。

     

肾移植术后糖尿病的预防和处理

目的研究肾移植术后糖尿病(PTDM)的临床规律,指导临床用药及预防。方法回顾总结1992年1月至2001年12月共140例次肾移植病人中12例PTDM患者的发病、诊治情况。结果本组PTDM的发病率为8.57%,术后发病时间为半个月至6个月,其中3个月内发生PTDM的占83.3%。经饮食控制、口服及胰岛素降糖治疗,并渐减少免疫抑制剂(主要是环孢素A、泼尼松)用量后,血糖均能得到有效的控制。结论PTDM是一种与抗排异药物密切相关的继发性糖尿病,有相当的危害性,术后早期即应加强监测,及时治疗。     

Role of oxidative stress in development of cardiovascular complications in diabetes mellitus

Diabetes represents a serious risk factor for the development of cardiovascular problems such as coronary heart disease, peripheral arterial disease, hypertension, stroke, cardiomyopathy, nephropathy and retinopathy. Identifying the pathogenesis of this increased risk provides a basis for secondary intervention to reduce morbidity and mortality in diabetic patients. Hyperglycemia and protein glycation, increased inflammation, a prothrombotic state and endothelial dysfunction have all been implicated as possible mechanisms for such complications. A linking element between many of these phenomena could possibly be, among other factors, increased production of reactive oxygen species. Vascular endothelial cells have several physiological actions that are essential for the normal function of the cardiovascular system. These include the production of nitric oxide (NO), which regulates vasodilatation, anticoagulation, leukocyte adhesion, smooth muscle proliferation and the antioxidative capacity of endothelial cells. However, under conditions of hyperglycemia, excessive amounts of superoxide radicals are produced inside vascular cells and this can interfere with NO production leading to the possible complications. This article aims at reviewing the links between reactive oxygen species, diabetes and vascular disease and whether or not antioxidants can alter the course of vascular complications in diabetic patients and animal models. A possible beneficial effect of antioxidants might present a new addition to the range of secondary preventive measures used in diabetic patients.     

Role of the decreased nitric oxide bioavailability in the vascular complications of diabetes mellitus

This mini-review takes into consideration the physiology, synthesis and mechanisms of action of the nitric oxide (NO) and, subsequently, the causes and effects of the NO bioavailability impairment. In diabetes mellitus the reduced NO bioavailability is caused by the increased free radicals production, secondary to hyperglycemia. The reactive oxygen species oxidize the cofactors of the nitric oxide synthase, diminishing their active forms and consequently leading to a decreased NO production. Furthermore the decreased concentration of reduced glutathione results in a diminished production of nitrosoglutathione. These molecules are important intermediates of the NO pathway and physiologically activate the soluble guanylate cyclase. Their decrease in oxidative states of the cell, therefore, leads to a reduced cGMP production which represents the principal molecule that carries out NO's major effects. Finally we considered the eventual therapeutic strategies to improve NO bioavailability by acting on the causes of its decrease. Therefore the treatments proposed are based on the possibility to counteract the oxidation and, in this context, the physiopathological mechanisms strongly support the treatment with thiols.     

Cardiovascular complications in diabetes mellitus

Diabetes is strongly associated with coronary, cerebral and peripheral arterial disease, as well as with microangiopathy. In those with diabetes, the extent of macrovascular disease increases and atherosclerotic plaques are more prone to rupture. Both hormonal abnormalities (insulin resistance that is typically present for many years before the onset of type 2 diabetes) and metabolic abnormalities contribute. Multi-targeted intensive therapy is imperative; however, unfortunately it is underutilized. Functional and structural derangements contribute to impaired arterial and ventricular compliance predisposing to congestive heart failure that is increasingly recognized to be a cause of morbidity and mortality in patients with diabetes.     

Role of antioxidants, essential fatty acids, carnitine, vitamins, phytochemicals and trace elements in the treatment of diabetes mellitus and its chronic complications

Nowadays, the treatment of diabetes mellitus is based on the variable use and combination of diet, antidiabetic oral agents (metformin, sulphanylureas, glynides, acarbose and thiazolidinediones) and insulin or its analogs, depending on the type of diabetes and the needs of the patient. The prevention and treatment of chronic micro- and macrovascular complications, on the other hand, is based on the achievement and maintenance of an optimal glycaemic control and requires the combined use of adjunctive therapy such as antihypertensive drugs and cholesterol-lowering medications. Furthermore, several herbal preparations and dietary supplements, such as antioxidants, essential fatty acids, lipid metabolism activators, vitamins and trace elements, are advertised and prescribed to patients as a useful adjuvant to a diabetic diet and conventional medications in order to improve glycaemic control and reduce the impact of chronic complications. In this regard, we have attempted to review the current concepts dealing with the usefulness of these complementary therapies in treating diabetic patients.     

Ⅱ型糖尿病的防治前景

糖尿病是严重危害人类健康的全球性常见内分泌 -代谢疾病。有效地控制血糖并减少心血管疾病的危险因素 ,特别是在糖尿病的早期 ,在减轻微血管、大血管并发症的发生中将起到积极作用。目前约有 1/ 3糖尿病病人还没有认识到自己已经患了糖尿病 ,为及时发现、诊断这些无症状性糖尿病病人 ,实现早期预防、早期诊断、早期治疗 ,筛选试验将成为重中之重。1　迫切性近年来随着人们生活水平的提高、饮食结构的改变及诊断技术的进步 ,糖尿病患病率每年都以一定的比例在递增 ,已成为发达国家中继心血管病和肿瘤之后的第三大疾病。据世界卫生组织估计 ,…     

Vascular complications of diabetes mellitus

1. Macro- and microvascular diseases are the main chronic complications of diabetes mellitus (DM). 2. It has been shown that DM patients have more severe nailfold microcirculatory disturbances than patients with liver cirrhosis or systemic lupus erythematosus (SLE). 3. It has been shown that the glomerular basement membrane of diabetic rats is significantly thickened compared with that of normal rats (295.5 +/- 45.1 vs 184.8 +/- 33.2 nm). 4. Gastric mucosal blood flow (GMBF) in 41 patients with non-insulin-dependent diabetes mellitus (NIDDM) was determined with a laser Doppler flowmeter. The results showed that average GMBF values at 14 sites in the gastric mucosa were significantly lower in NIDDM patients than in control subjects. 5. The percentage of painless acute myocardial infarction (AMI) among 50 patients with DM was 22.0% and the mortality of AMI was 22.0% (11 cases). Both these values were higher than the corresponding values in patients without DM (9.9 and 11.4%, respectively; P < 0.05). 6. Cerebrovascular disease is more prevalent in diabetic patients than in non-diabetics and the mortality of stroke in DM patients is two-fold higher than that of non-diabetic patients. 7. Diabetes can result in widespread macrovascular atherosclerosis and microcirculatory disorders of multiple organs.