胃肠术后应激性高血糖患者实施早期低能量肠内营养支持的临床研究

目的 研究胃肠切除术后出现应激性高血糖患者实施早期肠内营养支持对血糖控制、胃肠道功能恢复、营养状况改善、并发症预防等方面的效果。方法 将40例胃肠切除术后出现应激性高血糖患者分成标准肠外营养支持组（30kcal/kg/d）、标准肠内营养支持组（30kcal/kg/d）、允许性低热量肠外营养支持组（20kcal/kg/d）及允许性低热量肠内营养支持组（20kcal/kg/d），监测各组术前、术后血常规、肝肾功能、IgA等，并观察有无感染发生现象。结论 术后短期的允许性低能量摄入并不妨碍患者肠功能、营养状况、免疫功能等的恢复及改善，而在此基础上的允许性低能量肠内营养支持依然是适用的。     

高血糖对脑出血疾病预后的影响

目的:观察高血糖对脑出血患者预后的影响。方法:128例脑出血患者根据血糖有无异常分为高血糖组与血糖正常组,2组患者治疗方法相似,观察2组患者生存率以及治疗效果。结果:高血糖组存活率为58.14%,血糖正常组为75.29%,后者显著高于前者,P<0.05。存活者经相似的治疗,血糖正常组治疗效果显著优于高血糖组,P<0.01。结论:高血糖对脑出血患者预后有不利影响,应加强血糖监测与控制。     

柠檬草水提物对高血糖模型小鼠降糖作用的实验研究

目的探讨柠檬草水提物对高血糖模型小鼠的降血糖作用。方法采用高脂饮食加小剂量链脲佐菌素建立高血糖小鼠模型,随机分为三组：高血糖模型组（模型组）、消渴丸组[给予1 g/（kg·d）消渴丸灌胃]、柠檬草水提物组[给予0.1 mL/（10 g·d）柠檬草水提物灌胃],每组8只,雌雄各半,连续给药28 d;同时随机抽取10只小鼠（雌雄各半）作为正常对照组。在实验的第7、14、21、28天测定各组小鼠的体质量和血糖值,在实验的第28天取小鼠肝、肾、脾、胸腺称其质量,比较各组小鼠体质量、血糖水平及内脏质量的变化。结果与正常对照组比较,模型组小鼠体质量下降,血糖升高,胸腺萎缩,胸腺质量下降,差异均有统计学意义（P〈0.05）。与模型组比较,消渴丸组和柠檬草水提物组小鼠体质量变化率减小,消渴丸组血糖值下降,差异均有统计学意义（P〈0.05）;柠檬草水提物组血糖值与模型组比较,差异无统计学意义（P〉0.05）。结论通过高脂饮食加链脲佐菌素成功复制了高血糖小鼠模型,与模型组比较,消渴丸对该模型小鼠的体质量下降和血糖升高有对抗作用;柠檬草水提物可对抗小鼠体质量的下降,但对造模引起的血糖升高无对抗作用。     

Hyperglycemia induces embryopathy,even in the absence of systemic maternal diabetes: An in vivo test of the fuel mediated teratogenesis hypothesis

Embryonic exposure to excess circulating fuels is proposed to underlie diabetic embryopathy. To isolate the effects of hyperglycemia from the many systemic anomalies of diabetes, we infused 4 mg/min glucose into the left uterine artery of non-diabetic pregnant rats on gestation days (GD) 7–9. Right-sided embryos and dams exhibited no glucose elevation. Embryos were assessed on GD13, comparing the left versus right uterine horns. Hyperglycemic exposure increased rates of embryopathy, resorptions, and worsened embryopathy severity. By contrast, saline infusion did not affect any of these parameters. To assess for possible embryopathy susceptibility bias between uterine horns, separate dams were given retinoic acid (25 mg/kg, a mildly embryopathic dose) systemically on GD7.5. The resultant embryopathy rates were equivalent between uterine horns. We conclude that hyperglycemia, even in the absence of systemic maternal diabetes, is sufficient to produce in vivo embryopathy during organogenesis.     

A prospective randomized trial comparing computerized columnar insulin dosing chart (the Atlanta protocol) versus the joint British diabetes societies for inpatient care protocol in management of hyperglycemia in patients with acute coronary syndrome admitted to cardiac care unit in Alexandria,Egypt

BackgroundHyperglycemia in acute coronary syndrome (ACS) is linked to raised morbidity and mortality. Insulin administration using insulin infusion protocols (IIP) is the preferred strategy to control hyperglycemia in critically ill patients. To date, no specific IIP has been identified as the most efficient for achieving glycemic control.Aimto compare glycemic achievements (safety) (primary objective), and coronary and other clinical outcomes (efficacy) (secondary objective) by hyperglycemia management in Cardiac Care Unit (CCU) using computerized Atlanta Protocol (Group (I)) versus paper-based Joint British Diabetes Societies (JBDS) For Inpatient Care Protocol (Group (II)).Patients and methodsThe study was done on 100 ACS patients admitted to Alexandria Main University hospital CCU with RBG >180 mg/dL. They were randomized into the 2 groups in a 1:1 ratio. CBG was measured hourly for 72 hours and was managed by IV insulin infusion.ResultsGroup (I) showed statistically significant less mean time for target BG achievement (3.52 ± 1.53hours), lower incidence of Level 1 hypoglycemia (2%) than Group (II) (4.76 ± 2.33 hours, 22%, p = 0.013, 0.002 respectively) and statistically significant less mean number of episodes above the glycemic target after its achievement than Group (II) (p < 0.001). Regarding Level 2 hypoglycemia the difference was not significant statistically.ConclusionBoth protocols successfully maintained target BG level with low incidence of clinically significant hypoglycemia, however, the computerized Atlanta protocol achieved better glycemic outcomes. We recommend the use of the computerized Atlanta protocol in CCU rather than JBDS for Inpatient Care Protocol whenever this is feasible.     

浙江省三地区人群血脂、血糖、体质指数与血压关系的分析

目的　探讨浙江省三地区自然人群血脂、血糖、体质指数与血压之间的关系。方法　对三地区 2 5～ 74岁自然人群进行血压、血脂、血糖和身高、体重的调查。结果　 ( 1)三地区高血压患病率为 2 5 .5 8% ,标化率 2 1.0 6 ,其中 :嘉兴 2 4 .91% ,绍兴 2 7.80 % ,丽水 2 4 .0 7% ,>5 5岁年龄组患病率显著高于≤ 5 5岁年龄组 ,差异有显著性 ( P<0 .0 5 )。( 2 )三地区人群血脂、血糖异常率和超重分别为 :高胆固醇 ( TC) 2 3.39% ,高甘油三酯 ( TG) 32 .72 % ,低高密度脂蛋白胆固醇 ( HDL - C) 6 .81% ,高血糖 ( GL U ) 5 .73% ,体质指数 ( BMI)≥ 2 5为 2 2 .31%。( 3)高血糖、超重和高血脂人群中高血压患病率分别为 :5 3.6 2 %、39.70 %、36 .5 0 %、36 .18% ,明显高于血糖、血脂和体重正常的人群 ,血压与GL U、BMI、TG、TC水平呈正相关。结论　高血糖、超重、高血脂是高血压的主要危险因素 ,尤其以 >5 5岁龄组为显著。提示 :高血糖、超重、高血脂以及中、老年人群是社区高血压干预的重点对象。     

Severe hyperglycemia: a determinant factor for hypofiltration in alloxan diabetic rats

Abstract. The relationships among glomerular filtration rate, renal plasma flow and extracellular fluid volume were investigated in control and severely hyperglycemic (442±33 mg/dl) untreated, alloxan diabetc rats. Most of diabetic animals showed significant lower values of inulin clearance (diabetics, 0.55±0.07 ml/min·100 g; controls, 0.97±0.04) and p-aminohippurate clearance (diabetics, 2.11±0.39 ml/min·100 g; controls, 3.93±0.25). Diabetic rats exhibited reduced efficiency in tubular Na⁺ reabsorption, increased urinary Na⁺ excretion (diabetics, 3.12±0.27 mEq/day; controls, 1.25±0.14) and diminished values of plasma renin activity (diabetics, 3.34±0.44 ng/ml·h; controls, 8.64±0.79). Significant negative correlations were found between glycemia and renal hemodynamic variables. Acute overload with glucose further decreased these variables in both groups: inulin clearance in diabetics vs. controls, 0.26±0.04 vs. 0.44±0.05 ml/min·100 g; p-aminohippuric acid clearance in diabetics vs. controls, 1.09±0.20 vs. 1.55±0.21 ml/min·100 g. We conclude that chronically hyperglycemic alloxan diabetic rats showed diminished glomerular filtration rates (inulin clearance), renal plasma flow (p-aminohippurate clearance) and extracellular fluid volume associated with urinary Na⁺ losses and alterations in the renin-angiotensin system. Decreased reninangiotensin system activity might reduce aldosterone secretion, which in turn could result in (succesively) urinary sodium loss, extracellular fluid volume contraction and reductions in glomerular filtration and renal plasma flow.     

深圳地区8 559例健康体检人员空腹血糖受损分析

目的:探讨深圳地区空腹血糖受损(IFG)分布情况及与其与脂肪肝和高血脂的关系。方法:对2004年深圳地区事业单位的8 559名健康体检者进行空腹血糖、总胆固醇、甘油三酯的测定,且每人均以超声检查脂肪肝的状况。数据以不同年龄、性别及有无IFG的发生进行分组统计分析。结果:8 559例健康体检人员中男性IFG阳性率为 2．50％,女性IFG阳性率为1．52％。20岁起每10岁为一组,男性IFG分别为0．77％、1．81％、5．23％、7．21％;女性为0．25％、0．93％、2．76％、5．06％。各年龄组间IFG发生率有极显著性差别(P<0．01)。IFG者的脂肪肝、高脂血症的发生率明显高于血糖正常者(P<0．005)。结论:深圳地区空腹血糖受损男性高于女性,且有随年龄的增长而上升的趋势;空腹血糖受损者的脂肪肝和高血脂的发病率明显高于空腹血糖正常者。