围术期糖尿病与心血管病相关性研究及处理进展

糖尿病是心血管病重要的独立高危因素。糖尿病增加心肌缺血损伤的危险性，引起心肌本身和心肌内小血管病变，抑制心肌缺血预处理的作用。现就糖尿病对心血管病的影响及糖尿病病人围术期的处理进展作一综述。     

荞麦花叶黄酮对2型糖尿病大鼠胰岛素抵抗及肝组织PTP1B的影响

目的:探讨荞麦花叶黄酮(FBFL)对2型糖尿病大鼠降血糖、改善胰岛素抵抗的作用及其机制.方法:雄性健康Wistar大鼠70只,随机抽取10只作为正常对照组,其余60只大鼠每天灌胃脂肪乳,第14天开始腹腔注射小剂量四氧嘧啶,隔日1次,共3次,同时继续灌胃脂肪乳.末次腹腔注射四氧嘧啶72 h后,用血糖仪测定空腹血糖和用K_(IPT)值判定胰岛素抵抗性.K_(IPT)＜正常组的60%作为2型糖尿病胰岛素抵抗大鼠.将成模大鼠随机分为模型组,阳性药物组,FBFL低、中、高剂量组,连续4周.末次给药后禁食,用血糖仪测空腹血糖(FBG),用正糖钳技术判定胰岛素抵抗性,用生化分析仪测定游离脂肪酸(FFA),放免法测定血浆胰岛素(INS),免疫组织化学法检测肝组织蛋白酪氨酸磷酸酶1B(PTP1B)表达.结果:与正常组比较,模型组大鼠FBG,INS,FFA含量明显升高(P＜0.135,P＜0.01);大鼠葡萄糖输注速率(GIR)明显下降;肝组织PTP1B表达增加.各剂量FBFL能不同程度的改善上述指标的变化,明显改善胰岛素抵抗性,增加胰岛素敏感性,使肝组织PTP1B表达下调,并呈一定剂量依赖性.结论:FBFL对四氧嘧啶加脂肪乳所致2型糖尿病大鼠胰岛素抵抗具有明显的改善作用,并呈一定剂量依赖性.     

Electrophysiological evaluation in 4 patients with diabetic pseudotabes

BACKGROUND: Researches on diabetic nervous system lesion are mainly focus on peripheral nerve and vegetative nerve, so there are few investigations on diabetic pseudotabes. OBJECTIVE: To investigate the electrophysiological examinations on the diagnosis of diabetic pseudotabes. DESIGN: Case study. SETTING: Department of Electrophysiology and Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 4 patients with type 2 diabetes mellitus, including 3 males and 1 female aged from 50 to 72 years, were selected from Department of Neurology, Zhongshan Hospital Affiliated to Xiamen University from March 2002 to February 2005. All accepted subjects met the modified diagnostic criteria of diabetes mellitus, which was set by American Diabetes Mellitus Association (ADA) in 1997. Otherwise, the subjects had typical symptoms and physical signs of spinal posterior funiculus damage. However, patients with spinal cord lesion which was caused by other factors were excluded. All accepted subjects provided the confirmed consent. METHODS: Nicolet NT electromyography (EMG)/evoked potential meter (made in the USA) was used to detect spinal cord conduction velocity (SCCV), somatosensory evoked potential (SEP) of lower limbs, motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of extremities. Determining criteria: Measurements were performed based on the laboratory standards. SCCV, which was less than lower limit of normal value (T2–12: 40–55 m/s, T12–L4: 20–41 m/s, T2–L4: 36–45 m/s), was regarded as abnormal. SEP value of lower limbs: P40, P60 and PF, which were more than standard deviation of normal value (x(—)+2.5), were regarded as the abnormality. Normal value of P40, P60 and PF latencies (x(—)±s) in this study: P40, P60 and PF in males were (37.6±1.9) ms, (59.8±3.9) ms and (7.6±0.9) ms, respectively; meanwhile, those in females were (35.5±1.7) ms, (55.2±2.7) ms and (6.3±0.7) ms, respectively. MNCV and SNCV, which were less than 50 m/s in upper limbs and 40 m/s in lower limbs, were regarded as the abnormality. MAIN OUTCOME MEASURES: Electrophysiological examinations. RESULTS: All 4 patients with type 2 diabetes mellitus were involved in the final analysis. ① SCCV: Among 4 patients, SCCV of three patients was decreased in T2–12, T12–L4 and T2–L4, and that of the other one was decreased in T2–12 and T2–L4; however, SCCV in T12–L4 was normal. There was significant difference as compared with normal value (P < 0.01). ② SEP of lower limbs: SEP values of lower limbs were abnormal in all 4 patients. Among them, P40, P60 and PF latencies of two patients were delayed; P40 of one patient was delayed and PF was not drained out; P40 and P60 of the last one were delayed and PF was normal. ③ MNCV and SNCV: The MNCV and SNCV were normal in one patient and abnormal in three patients. The results demonstrated that MNCV and SNCV of extremities decreased; especially, sensory nerve action potential (SNAP) of both lower extremities of one patient were not drained out. CONCLUSION: Detections of SCCV, SEP of lower limbs, MNCV and SNCV of extremities are helpful to investigate whether peripheral nerve and deep sensory passage are damaged or not and determine whether deep sensory damage is caused by peripheral nerve and spinal posterior funiculus.     

Diabetes mellitus, hypertension and medial temporal lobe atrophy: the LADIS study.

HYPOTHESIS: Based on recent findings on the association between vascular risk factors and hippocampal atrophy, we hypothesized that hypertension and diabetes mellitus (DM) are associated with medial temporal lobe atrophy (MTA) in subjects without disability, independent of the severity of white matter hyperintensities. METHODS: In the Leukoaraiosis And DISability in the elderly (LADIS) study, we investigated the relationships between DM, hypertension, blood pressure and MTA in 582 subjects, stratified by white matter hyperintensity severity, using multinomial logistic regression. MTA was visually scored for the left and right medial temporal lobe (score 0-4), and meaned. RESULTS: Mean age was 73.5 years (sd 5.1), 54% was female. Of the subjects, 15% had DM, and 70% had a history of hypertension. The likelihood of having MTA score 3 was significantly higher in subjects with DM (OR 2.9; 95% CI: 1.1-7.8) compared with an MTA score of 0 (no atrophy). The odds ratio for MTA score 2 was not significantly increased (OR 1.8; CI: 0.9-4). Systolic and diastolic blood pressure and a history of hypertension were not associated with MTA. There was no interaction between DM and hypertension. Stratification on white matter hyperintensities (WMH) did not alter the associations. CONCLUSION: Our study strengthens the observation that MTA is associated with DM, independently of the amount of small vessel disease as reflected by WMH.     

仙人掌粉对糖尿病大鼠血糖的影响

目的　研究仙人掌对糖尿病血糖的影响。方法　采用四氧嘧啶造成大鼠实验性糖尿病模型 ,然后将高、中、低 3种剂量的仙人掌粉加入到基础饲料中进行实验观察。结果　仙人掌粉高 (10g kg·d)、中 (5 .0g kg·d)剂量组均可显著降低糖尿病大鼠空腹血糖 ,并且高剂量组具有显著改善糖尿病大鼠尿量增加的作用。各剂量组对正常大鼠血糖无明显影响。结论　仙人掌粉能有效降低四氧嘧啶所导致的糖尿病大鼠的血糖、尿量     

护理干预对2型糖尿病患者康复作用的研究

目的 探讨护理干预在2型糖尿病患康复中的作用。方法 对80例2型糖尿病患，随机分成干预组和对照组，干预组实施全程护理干预，对照组实施常规的治疗护理。结果 干预组血糖控制良好，并发症发生率明显降低。结论 护理干预是2型糖尿病康复治疗的有效方法。     

妊高征与眼底视网膜病变的临床探讨

目的 :探讨妊高征患者临床特征与视网膜病变的关系。方法 :观察 2 2 0例妊高征患者的眼底情况。结果 :视网膜病变与水肿关系不密切 ,与平均动脉压、蛋白尿的严重程度、病程及红细胞压积有密切关系 ;有眼底改变者 118例 ,占 5 0 .3%。结论 :眼底镜检查是临床上借以了解视网膜血管的常用方法 ,并可反映妊高征病情的程度 ,为产程处理提供依据     

还原型谷胱甘肽在预防糖尿病大鼠勃起功能障碍中的研究

目的探讨还原型谷胱甘肽(GSH)在预防糖尿病大鼠勃起功能障碍中的作用。方法通过腹腔注射链脲佐菌素65mg/kg建立糖尿病大鼠模型,然后随机分成DM组和DM+GSH组,DM+GSH组每天肌肉注射GSH200mg/kg。10周后观察大鼠勃起功能,并获取海绵体组织检测其谷胱甘肽、一氧化氮合酶(NOS)与丙二醛(MDA)水平,用TUNEL法检测细胞凋亡。结果成功建立糖尿病大鼠模型。与未注射GSH的DM组相比,DM+GSH组和正常对照组(C组)勃起功能更好,勃起率分别是20%,62.5%和100%。GSH水平DM+GSH组和C组明显比DM组高,其3组含量每克蛋白分别是(75.83±15.62)、(61.47±8.65)和(35.03±12.29)mg(P<0.05);NOS水平在DM+GSH组每毫克蛋白为(133.9±31.9)U,与正常对照组每毫克蛋白为(142.2±31.2)U相当,但较DM组每毫克蛋白为(58.4±18.9)U高(P<0.05);MDA含量在DM组每毫克蛋白为(3.71±0.62)nmol,明显高于正常对照组和DM+GSH组(P<0.05),这两组每毫克蛋白为(2.08±0.34)nmol和(2.44±0.28)nmol;细胞凋亡率在DM组、DM+GSH组和C组的分别是(22.6±3.6)%、(10.8±1.7)%和(7.2±2.1)%(P<0.05)。结论还原型谷胱甘肽对糖尿病大鼠阴茎组织有较好的抗氧化作用,能减少细胞凋亡,对延缓糖尿病性ED的发生有一定的作用。     

中、老年代谢综合征患者的临床特点分析

目的 比较中、老年代谢综合征(MS)患者的临床特点.方法 收集1996～2006年在解放军总医院门诊查体且符合中国人MS诊断标准(CDS)的947例中、老年患者的临床资料.其中老年人679例,中年人268例.分析中、老年患者MS各组分的差异,以及各组分的相关因素等.结果 947例患者中,男性582例(老年423例,中年159例),女性365例(老年256例,中年109例).老年男性患者的年龄大于老年女性(81.5±6.5 vs 74.5±8.8岁,P＜0.01),老年男性的体重指数(BMI)高于中年男性(27.14±2.51 vs 25.98±2.38,P＜0.01).老年患者的空腹、餐后血糖和收缩压均高于同性别的中年患者,而舒张压无显著差异.中年男性的甘油三酯高于老年男性.中年女性的高密度脂蛋白胆固醇高于男性.多元回归分析显示,男女患者空腹血糖均与餐后2h血糖有相关性(男性R2＝0.463,P＜0.05;女性R2＝0.613,P＜0.05).餐后2h血糖与年龄存在相关性(男性,R2＝0.522,P＜0.01;女性R2＝0.716,P＜0.05).收缩压与多种指标均有相关性,男性患者收缩压与年龄(R2＝0.396,P＜0.01)和舒张压(R2＝0.535,P＜0.05)均有相关性;女性患者的收缩压与BMI(R2＝0.557,P＜0.05)、舒张压(R2＝0.434,P＜0.05)、餐后2h血糖(R2＝0.434,P＜0.01)及空腹血糖(R2＝0.473,P＜0.05)均有相关性.Logistic回归分析示年龄(OR=2.1,95%CI:1.3～2.7)、空腹血糖(OR=1.7,95%CI:1.2～3.1)和收缩压(OR=1.4,95%CI:1.2～2.9)是预测代谢综合征组分含量的影响因素.结论 中老年代谢综合征患者的代谢指标有差异,年龄、空腹血糖和收缩压可作为代谢综合征的筛选指标.     

The opposing effects of the flavonoids isoquercitrin and sissotrin, isolated from Pterospartum tridentatum, on oral glucose tolerance in rats

The effect of an aqueous extract of Pterospartum tridentatum on the blood glucose levels of normal Wistar rats was investigated in a situation of oral glucose challenge. The extract at 300 mg/kg showed an antihyperglycaemic effect in the first 30 min after glucose challenge but then the blood glucose levels rose above those of the control group, indicating the presence of compounds with different effects on glucose tolerance. Nine compounds of isoflavone and flavonol skeletons were identified in the extract by HPLC-ESI-MS(n), four of them being identified for the first time in this species. The isoflavone sissotrin and the flavonol derivative, isoquercitrin, were selected for the oral glucose tolerance test. Isoquercitrin (100 mg/kg) showed time-dependent antihyperglycaemic activity by delaying the post-oral glucose load glycaemic peak at 30 min, as did the sodium-dependent glucose transporter inhibitor phloridzin (100 mg/kg). In contrast, sissotrin (100 mg/kg) showed an opposite effect, impairing glucose tolerance. In conclusion, these preliminary results indicate that the effect of the extract on blood glucose may be either antihyperglycaemic or hyperglycaemic. Additionally, as far as is known, these are the first in vivo results on the acute antihyperglycaemic potential of isoquercitrin.