中西医结合治疗糖尿病临床观察─附88例对照分析

将８８例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）按病情随机分成两组，治疗组４８例用中药益肾降糖方加优降糖治疗，对照组４０例用优降糖治疗。结果：治疗组显效３８例，有效５例，无效５例，总有效率为８９．５８％，对照组显效２２例，有效７例，无效１１例，总有效率为７２．５０％；两组总有效率比较，经统计学处理有非常显著性差异（Ｐ＜０．０１）。     

格列苯脲可以拮抗吗啡的心肌保护作用

目的研究吗啡预处理对心肌的保护作用以及格列苯脲对其的影响。方法采用新生大鼠的原代心肌培养细胞作为研究对象,将培养心肌细胞随机分配到4组：Ⅰ组,空白对照组,共有10瓶细胞,该组细胞没有进行缺氧再复氧;Ⅱ组,缺氧再复氧组,共有10瓶细胞,该组细胞进行缺氧条件下培养6h再有氧条件下培养18h;Ⅲ组,吗啡预处理组,与Ⅱ组细胞基本相同,唯一区别是在缺氧再复氧之前,向细胞培养瓶内加入吗啡,使细胞培养瓶内培养基中含有1μmol/L浓度的吗啡,15min后,再进行缺氧再复氧。Ⅳ组,格列苯脲组,首先在缺氧再复氧之前,向细胞培养瓶内加入格列苯脲,使细胞培养瓶内培养基中含有100μmol/L浓度的格列苯脲,15min后,再向细胞培养瓶内加入吗啡,使细胞培养瓶内培养基中含有1μmol/L浓度的吗啡,15min后,再进行缺氧再复氧。最后所有细胞进行电镜检查,并且通过PI染色的流式细胞术来检测细胞凋亡情况。结果缺氧再复氧组细胞在经历6h的缺氧培养,再18h的有氧培养后,细胞大部分出现凋亡,与空白对照组细胞相比,有明显的升高（P〈0.05）,而吗啡预处理组细胞凋亡指数与缺氧再复氧组相比有明显的降低（P〈0.05）。但是格列苯脲组细胞的凋亡指数与吗啡组相比有明显升高（P〈0.05）,与缺氧再复氧组相比没有明显差别。根据电镜结果,格列苯脲组细胞与缺氧再复氧组细胞线粒体和内质网有明显的空泡变性,细胞核浓缩,而吗啡预处理组细胞形态基本正常。结论吗啡预处理可以明显抑制缺氧再复氧损伤所引起的细胞凋亡,格列苯脲可以拮抗吗啡的心肌保护作用。     

The involvement of KATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain in rats

This study investigated the role of K_ATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain. The K_ATP channel modulators (K_ATP channel opener, diazoxide 100 mg/kg, p.o, and K_ATP channel blocker, glibenclamide, 3 mg/kg i.p.) were administered with morphine (80 mg/kg, i.p.). Antinociception was assessed by the tail‐flick and formalin tests in rats and measured by the area under the curve values and the maximum percent effect for 3 h. The indices of hepatic oxidative stress: glutathione, glutathione peroxidase, and malondialdehyde were then determined in the liver homogenates obtained from the treated animals. In both tests, glibenclamide antagonized morphine‐induced antinociception, whereas diazoxide augmented it in the tail‐flick test only. In the formalin test, glibenclamide alone has a significant hyperalgesic effect, whereas diazoxide decreased the number of flinches. Coadministration of glibenclamide with morphine antagonized the hepatotoxic effect of morphine in both animal models. In the tail‐flick test, glibenclamide administered alone significantly increased malondialdehyde's level. Coadministration of diazoxide with morphine increased glutathione level in the formalin test. Diazoxide administered alone exacerbated the hepatic oxidative stress in both animal models. These findings suggest a role of K_ATP channel modulators on morphine‐induced antinociception and hepatic oxidative stress. The administration of glibenclamide may prevent morphine‐induced hepatotoxicity. The effectiveness of diazoxide in the management of pain is limited due to its deleterious effect on the liver. However, the interaction of the K_ATP channel modulators with morphine depends on the differential sensitivity to the pain stimulus.     

Glyburide/metformin tablets: a new therapeutic option for the management of Type 2 diabetes

Oral antidiabetic combination therapy is a proven means of establishing glycaemic control in the hyperglycaemic, Type 2 diabetic patient, but co-administering two oral antidiabetic agents separately may hinder compliance with therapy. A new single-tablet of glyburide/metformin combination therapy (Glucovance^®, Bristol-Myers Squibb, Inc.) has recently been developed, which addresses the primary defects of Type 2 diabetes: β-cell dysfunction and insulin resistance. The glyburide/metformin tablet, taken with meals, is designed to optimise the absorption of glyburide and to address the postprandial glucose rise. Glyburide/metformin tablets are more effective in controlling fasting and postprandial glycaemia than its component monotherapies, at lower doses of metformin and glyburide compared with monotherapy because of the synergy between its glyburide and metformin components. Moreover, a double-blind study showed that glyburide/metformin tablets are more effective than a free combination of glyburide co-administered with metformin in controlling postprandial glucose. Retrospective analyses suggested that glyburide/metformin tablets control glycated haemoglobin (A1C) more effectively than a free combination of glyburide co-administered with metformin, at lower mean doses of glyburide and metformin. The incidence of side effects is lower than separate component therapy for any given A1C. Glyburide/metformin tablets are an effective option for optimising the control of blood glucose in Type 2 diabetic patients and appear to enhance adherence to therapy.     

Differential effects of sulphonylureas on the vasodilatory response evoked by K(ATP) channel openers

The potency of three sulphonylureas, glibenclamide, glimepiride and gliclazide in antagonizing the vasorelaxant action of openers of adenosine triphosphate (ATP)-regulated K+ channel (KATP) was studied in vivo and in vitro in micro- and macrovessels, respectively. In the hamster cheek pouch, the vasodilatation and the increase in vascular diameter and blood flow induced by diazoxide were markedly reduced by the addition of either glibenclamide or glimepiride (0.8 microm) while they were not affected by gliclazide up to 12 microm. Similarly, in rat and guinea-pig isolated aortic rings, glibenclamide, glimepiride and gliclazide reduced the vasodilator activity of cromakalim. However, the inhibitory effect of gliclazide was considerably less when compared with either glimepiride or glibenclamide. These results suggest that, in contrast to glibenclamide and glimepiride, therapeutically relevant concentrations of gliclazide do not block the vascular effects produced by KATP channel openers in various in vitro and in vivo animal models.     

Role of KATP channels in the regulation of rat dura and pia artery diameter

The aim of the present study was to examine the effect of K(ATP) channel openers pinacidil and levcromakalim on rat dural and pial arteries as well as their inhibition by glibenclamide. We used an in-vivo genuine closed cranial window model and an in-vitro organ bath. Glibenclamide alone reduced the dural but not the pial artery diameter compared with controls. Intravenous pinacidil and levcromakalim induced dural and pial artery dilation that was significantly attenuated by glibenclamide. In the organ bath pinacidil and levcromakalim induced dural and middle cerebral artery relaxation that was significantly attenuated by glibenclamide. In conclusion, K(ATP) channel openers induce increasing diameter/relaxation of dural and pial arteries after intravenous infusion in vivo and on isolated arteries in vitro. Furthermore, dural arteries were more sensitive to K(ATP) channel openers than pial arteries.     

优降糖对KATP通道介导缺血预适应心肌再灌注损伤的影响

目的 :探讨优降糖在完整大鼠心脏模型中 ,对 ATP敏感钾通道 (KATP)介导心肌缺血预适应作用的影响。方法 :将 4 4只大鼠随机分为 4组 :心肌缺血预适应组 (IPC组 )、优降糖组 (GL I组 )、优降糖 IPC组 (G P组 )和对照组 (C组 )。心肌缺血预适应由 3次 10分钟缺血和 10分钟再灌注组成。所有大鼠均接受 30分钟缺血和 6 0分钟再灌注。梗死范围由饱和曲利本蓝和红四氮唑蓝染色判定 ,并以坏死区占缺血区的百分比表示。 导联记录心脏室性心律失常。结果 :IPC能显著缩小缺血再灌注后的心肌梗死范围 ,且这种作用能被 KATP通道阻滞剂优降糖完全取消。 IPC可减少缺血再灌注所致的室性心律失常的发生 ,但这种保护作用不能被优降糖所阻断。结论 :优降糖对 KATP介导 IPC的心肌保护作用有影响。     

Extrapancreatic and pancreatic actions of glibenclamide in rats

Summary The aim of this study was to investigate the influence of glibenclamide on insulin release via insulinotropic gut factors and via a direct action on the pancreas. Maximum peripheral IRI levels appeared 1 minute after intragastric administration of the minimal effective dose of glibenclamide to rats. The corresponding drug levels were high (600 ng/g) in the duodenal mucosa, but low (2 ng/ml) in the peripheral serum. These concentrations were too low to cause insulin release by direct action on the pancreas. Intragastric glibenclamide increased the amount of duodenal insulin releasing activity (DIRA) in the mucosa immediately after drug administration. When glibenclamide was dissolved in plasma at a high concentration (1 g/ml) and then injected into the coeliac trunk of an in-situ rat pancreas preparation, no additional effect on portal IRI levels was measured as compared with injection of serum alone. In contrast significant IRI release was noticed when glibenclamide was dissolved in serum (1 g/ml) of rats pretreated with the drug intragastrically. The plasma of pretreated rats without addition of glibenclamide was ineffective. The results suggest that glibenclamide may have two effects, one releasing insulin at the pancreas directly, and the other inducing the release of a gastrointestinal factor which amplifies the first effect. Neither glibenclamide nor the factor alone can provoke an IRI release under physiological conditions. The possible importance of these findings for the regulation of insulin secretion is discussed.Presented at the 11th EASD Congress, Munich, September 1975     

格列苯脲低血糖反应致死亡37例文献分析

目的 调查格列苯脲低血糖反应致死亡病例的情况并分析相关因素,为临床合理用药提供参考.方法 对37例格列苯脲低血糖反应致死亡病例进行分类统计与分析.结果 男女比例为1.6∶1,87.8％的病例为老年人(＞60岁),86.5％的病例不规范用药,8.1％单独用药,75.7％联合用药,100％的病例临床表现均为不同程度的低血糖昏迷,54.1％的病例因发现不及时、误诊、漏诊等原因而延误治疗、抢救时机.死亡的原因是多方面的,56.8％的病例因长时间低血糖昏迷造成多器官衰竭或呼吸、循环衰竭而死亡.结论 格列苯脲低血糖昏迷危害极大,要重视降糖药物安全性.使用时须慎重考虑年龄、用法用量等相关因素,做到合理用药,做到早诊断,早治疗,以减少格列苯脲低血糖反应及其严重后果的发生.     

二甲双胍格列本脲片中两种成分的离子对HPLC法测定

目的：建立用离子对HPLC法测定二甲双胍格列本脲片（复方盐酸二甲双胍片）中盐酸二甲双胍和格列本脲含量的方法。方法：以地西泮为内标,采用Symmetry C18柱（150mm×4．6mm,5ym）,流动相为甲醇～2mmol／L十二烷基磺酸钠溶液（58：42）,流速1．0mL／min．检测波长分别为232nm（盐酸二甲双胍）和300nm（格列本脲）。结果：盐酸二甲双胍和格列本脲分别在0．500～16．016μg／mL（r=0．9995）和20．040～120．240μg／mL（r=0．9998）范围内线性关系良好。平均方法回收率分别为（100．14±1．79）%（RSD=0．62％,n=3）和（99．95±1．16）％（RSD=0．56％,n=3）。结论：本方法操作简便,结果准确,重现性好,可用于二甲双胍格列本脲片的质量控制。