硝苯地平对人体糖代谢的影响

应用双盲平行法观察硝苯地平（每天30mg,共4周）对15例伴轻至中度高血压的非胰岛素依赖型糖尿病（NIDDM）和18例非糖尿病高血压病患者糖代谢的影响。结果表明硝苯地平对高血压病患者的血糖、胰岛素、C-肽和胰升糖素水平无明显影响,而NIDDM患者馒头餐负荷时的峰期（120分钟）,胰岛素和C-肽水平（分别为26.20±4.35mU/L和4.54±0.70μg/L）在服用硝苯地平后显著减低（分别为17.10±3.94mU/L和3.74±0.53μg/L）,血糖和胰升糖素水平无明显变化。推测血糖不升高与胰岛素释放延迟有关。     

Modulation of plasma cholesteryl ester transfer protein activity by unsaturated fatty acids in Tunisian type 2 diabetic women

BACKGROUND AND AIM: Type 2 diabetes mellitus is associated with atherosclerosis, which has been, in part, ascribed to abnormalities in the reverse cholesterol transport system. Among the key actors involved in this pathway is cholesteryl ester transfer protein (CETP) which mediates the transfer of cholesteryl esters (CE) from HDL to apoB-containing lipoproteins. METHODS AND RESULTS: The purpose of this study was to examine CETP activity in 220 patients with type 2 diabetes mellitus (type 2 DM) treated with diet alone or diet and sulphonylurea drugs and to identify the factors that may regulate it in the diabetic state. We also examined the effect of diet on the activity of plasma CETP in a subgroup of type 2 DM women. CETP activity was assessed by measuring plasma-mediated cholesteryl ester transfer (CET) between pooled exogenous HDL and apoB-containing lipoproteins. In 220 patients with type 2 DM, CET was significantly higher in conjunction with higher plasma triglycerides and lower HDL-cholesterol compared to 100 matched healthy controls. Correlation analysis showed that CETP activity was significantly correlated with the HDL-C to apoA1 ratio (r = -0.205, P = 0.003) and to LDL-C to HDL-C ratio in diabetic women (P = 0.010). Furthermore, CETP activity was correlated marginally with total energy intake (P = 0.052) but to a statistically significant extent with the amount of fat consumed daily (P = 0.008). A significant negative correlation was found between plasma CETP activity and MUFA of plasma phospholipids or free PUFA (P = 0.032), especially with omega3-fatty acids (P = 0.001). CONCLUSION: Our findings indicate that CET is accelerated in patients with type 2 DM and that this may be regulated by dietary fatty acids in the diabetic state.     

阶段改变模式对2型糖尿病患者行为改变的影响

目的 探讨阶段改变模式对2型糖尿病患者行为改变的影响.方法 将169例2型糖尿病患者随机分为对照组84例和实验组85例,对照组按常规对患者进行自我行为改变的健康教育,实验组在对照组的基础上应用阶段改变模式对患者进行健康教育.采用自行设计调查表对2组患者于实施前及实施后6个月、12个月进行调查,比较2组患者阶段行为时期及行为改变情况.结果 实验组患者阶段行为时期终点期患者例数显著多于对照组,行为改变显著好于对照组.结论 阶段改变模式对2型糖尿病患者的行为改变有积极的促进作用.     

The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

BackgroundCorticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine.MethodsA retrospective cohort study was conducted using data collected from the National Surgical Quality Improvement Program database data from 2005 to 2016. Lumbar decompression surgeries, including discectomies, laminectomies, and others were identified using CPT codes. Chi-square analysis was used to evaluate differences among the corticosteroid and non-corticosteroid groups for demographics, preoperative comorbidities, and postoperative complications. Logistic regression analysis was done to determine if long-term corticosteroid use predicts incidence of postoperative infections following adjustment.Results26,734 subjects met inclusion criteria. A total of 1044 patients (3.9%) were on long-term corticosteroids prior to surgical intervention, and 25,690 patients (96.1%) were not on long-term corticosteroids. Patients on long-term corticosteroids were more likely to be older (p < 0.001), female (p < 0.001), nonsmokers (p < 0.001), and have a higher American Society of Anesthesiologist class (p < 0.001). Multivariate analysis demonstrated that long-term corticosteroid usage was associated with increased overall complications (odds ratio [OR]: 1.543; p < 0.001), and an independent risk factor for the development of minor complications (OR: 1.808; p < 0.001), urinary tract infection (OR: 2.033; p = 0.002), extended length of stay (OR: 1.244; p = 0.039), thromboembolic complications (OR: 1.919; p = 0.023), and sepsis complications (OR: 2.032; p = 0.024).ConclusionLong-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.     

Potent antihyperglycaemic property of a new imidazoline derivative S-22068 (PMS 847) in a rat model of NIDDM

1. Recent data suggest that some imidazoline derivatives can lower plasma glucose in experimental animal models of diabetes. We studied the activity of an imidazoline S-22068, in rat model of non-insulin-dependent diabetes mellitus (NIDDM) produced with a low dose of streptozotocin (35 mg kg⁻¹, i.v.) in the adult.
2. The respective increase over basal value in glucose (ΔG) and insulin (ΔI), and the rate of glucose disappearance (K), were measured during a 30 min intravenous glucose tolerance test. After an intraperitoneal injection of S-22068 (24 mg kg⁻¹), ΔG (mM min ⁻¹) was decreased (91.67±5.83 vs 120.5±3.65; P<0.001), whereas K was increased (1.74±0.09 vs 1.18±0.05; P<0.001). Although insulinaemia was increased at time-point 0 of the test, ΔI was unchanged.
3. During oral glucose tolerance tests (OGTT), S-22068 (24 mg kg⁻¹, p.o.) improved glucose tolerance, and its efficiency was potentiated after chronic treatment (15 days). Basal glycaemia was unaffected by the treatment. Under the same conditions, a higher dose of S-22068 (40 mg kg⁻¹) further improved glucose tolerance without causing hypoglycaemia.
4. Binding experiments revealed that S-22068 displays no affinity for either adrenoceptors or the two imidazoline receptors I₁ or I₂.
5. These results demonstrate that S-22068 improves glucose tolerance without causing hypoglycaemia. Thus S-22068 represents a new potential option in the treatment of NIDDM.

     

Increased frequency of apolipoprotein ε2 allele in non-insulin dependent diabetic (NIDDM) patients with nephropathy

The genetic polymorphism of apolipoprotein E (ε2, ε3 and ε4) is associated with lipid abnormalities. It has been suggested that lipid abnormalities may contribute to the development and progression of kidney diseases, including diabetic nephropathy. Thus, in this study we compared the apo E allele frequencies among 146 non-insulin-dependent diabetic (NIDDM) patients with nephropathy, 135 NIDDM patients without nephropathy and 576 of the general Japanese population. The ε2 allele frequency was significantly higher in diabetic patients with nephropathy (7.2%) and with renal failure (9.7%) than in diabetic patients without nephropathy (2.6%) and in the general Japanese population (3.7%). It is concluded that there is a possibility that the ε2 allele is associated with nephropathy in NIDDM.     

Insulin-independent diabetes mellitus. Current aspects of its morphology,etiology, and pathogenesis

Summary Type I and type II diabetes are the most common types of diabetes. The ratio of type I to type II diabetes is about 1:9. Type I diabetes is caused by an absolute insulin deficiency and is therefore referred to as insulin-dependent diabetes.The disease becomes manifest clinically in childhood or adolescence („juvenile diabetes“), although manifestation in adulthood is being increasingly observed. Morphologically, a subtotal ( > 80 %) to total loss of beta cells in the pancreatic islets occurs. Lymphocytic insulitis, which disappears after the beta cells have been totally destroyed, is pathognomonic of type I diabetes. This insulitis is an expression of an autoimmune event that is triggered by a multitude of factors. An important factor appears to be a genetic predisposition (HLA DR3/DR4/DQ8) in connection with as yet unknown environmental factors (e. g., viruses). Autoantibodies, such as islet cell cytoplasmic antibodies (ICA), insulin autoantibodies (IAA), and/or autoantibodies to the GABA-synthesizing enzyme glutamic acid carboxylase (GAD), are already detectable in a prediabetic phase, although it is not possible to predict the time of clinical manifestion. The course of the disease is dependent on age. Young children require insulin therapy sooner than juveniles or adults.      

糖尿病与胰岛素基因的实验研究

用分子生物学的实验方法对非胰岛素依赖型糖尿病（NIDDM）患者的胰岛素基因进行检测。从NIDDM患者外周血的白细胞中提取DNA，以胰岛素基因5′-末端上游的某一DNA序列为引物，对特定的靶序列进行体外扩增，即TaqDNA聚合酶链式反应（PCR），将其扩增产物进行电泳分离，在紫外分析仪下观察结果并与正常人对照，发现16例NIDDM患者的胰岛素基因有所改变，提示胰岛素基因改变可能是导致NIDDM的原因之一。     

2型糖尿病病人的营养状况分析

了解 2型糖尿病患者的膳食营养状况及存在的问题 ,提出相应对策。 [方法 ]　采用 2 4小时膳食回顾调查法 (连续 3天 )、个人史回顾询问记录法以及有关知识与行为测试法 ,所得数据利用上海医科大学SY营养计算软件进行分析处理。 [结果 ]　糖尿病患者 3餐热能比分配不合理 ,动物性脂肪摄入偏高 ,均存在钙、锌、视黄醇、维生素B2 摄入量不足 ,豆谷类摄入多 ,而几乎不吃水果及奶制品。 [结论 ]　 2型糖尿病病人营养缺乏和营养比例不平衡问题并存 ,膳食结构不合理。应针对缺乏合理膳食营养和不良行为习惯等问题 ,研究制定有效的健康促进、干预措施。     

Association of HLA class II alleles with different subgroups of diabetes mellitus in Eastern India identify different associations with IDDM and malnutrition-related diabetes

Genetic studies of Malnutrition related diabetes are few. We have analyzed HLA class II gene polymorphism in different types of diabetes mellitus patients from Cuttack in Eastern India. Patients with insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM) and malnutrition-related diabetes mellitus (MRDM), which is subdivided into protein-deficient diabetes mellitus (PDDM) and fibrocalculous pancreatic diabetes (FCPD), were studied and their associations with autoantibody markers. IDDM and PDDM were associated with DR3 and DQ2 but not DR4 and DQ8. FCPD was positively associated with DQ9 (A*0201-B*0303). The association of DQ9 with FCPD suggests differences in the genetic background for susceptibility between IDDM and MRDM in the Cuttack population. There is no association seen between HLA-DR-DQ and NIDDM patients from Eastern India. Clinical classification of diabetes into IDDM, NIDDM and MRDM does not identify the underlying pathological mechanisms. Presence of autoantibodies to IDDM autoantigens in clinical MRDM and NIDDM identifies the slow-onset form of IDDM. Due to the absence of autoantibody assays for diagnosis of IDDM in India, slow onset IDDM is not diagnosed and the patients are classified as NIDDM or MRDM. Our study demonstrates that the presence of GAD65 antibody and DR3-DQ2 positivity in MRDM and NIDDM patients in Eastern India would suggest the presence of slow-onset IDDM. Our data would indicate alternatively that MRDM can coexist with IDDM in these patients and malnutrition could be one of the reasons for the slower onset in IDDM-prone individuals.