黄芪联合抗结核药对肺结核合并糖尿病患者细胞免疫炎性反应、凝血功能的影响

目的观察黄芪联合抗结核药对肺结核合并糖尿病(PTB-DM)患者细胞免疫炎性反应、凝血功能的影响。方法将2016年1月—2017年12月中国人民解放军联勤保障部队第九八〇医院收治的80例PTB-DM患者患者随机分为对照组和观察组,每组40例。2组均给予常规四联抗结核治疗和胰岛素皮下注射,观察组在此基础上给予中药黄芪治疗,疗程为6个月。分别于治疗前后根据肺结核症状积分标准对患者咳嗽、咳痰、乏力、盗汗和食欲情况进行评分,观察2组治疗后痰液结核杆菌涂片转阴情况、空腹血糖(FPG)、细胞免疫指标(CD3+、CD4+、CD8+、CD4+/CD8+及Th1、Th2细胞水平和Th17、Treg细胞表达率)、炎性指标[单核细胞趋化蛋白-1(MCP-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和转化生长因子-β(TGF-β)]、凝血指标[凝血酶原时间(APTT)、血浆凝血酶原时间(PT)、血浆凝血酶时间(TT)、血小板(Plt)、纤维蛋白原(FIB)和D-二聚体(D-D)]的变化,比较2组治疗期间不良反应发生情况。结果治疗后2组咳嗽、咳痰、乏力、盗汗和发热评分均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05)。治疗2个月和6个月观察组痰涂片结核杆菌转阴率均明显高于对照组(P均<0.05)。治疗2个月、6个月2组FPG均明显降低(P均<0.05),且观察组在治疗6个月时明显低于对照组(P<0.05)。治疗后2组CD3+、CD4+、Th1和Th17水平和CD4+/CD8+均升高(P均<0.05),且观察组明显高于对照组(P均<0.05);2组Th2、Treg水平及MCP-1、IL-6、TNF-α、TGF-β均明显下降(P均<0.05),且观察组明显低于对照组(P均<0.05)。治疗后2组APTT、PT、TT均明显缩短(P均<0.05),Plt、FIB、D-D水平明显降低(P均<0.05),且观察组缩短及降低程度明显大于对照组(P均<0.05)。治疗期间观察组胃肠道反应、肝功能受损、皮疹和白细胞降低发生率均明显低于对照组(P均<0.05)。结论黄芪联合抗结核药可以有效改善PTB-DM患者的临床症状,提高痰涂片转阴率,且不良反应少,可能与改善患者的细胞免疫状态和凝血功能、减轻炎性反应有关。     

Cardiovascular effects and mechanisms of sodium-glucose cotransporter-2 inhibitors

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a new type of drug for the treatment of diabetes, and they have been proven to have a good hypoglycemic effect. Several lines of clinical evidence have shown that SGLT2 inhibitors can significantly reduce the risks of atherosclerosis, hospitalization for heart failure, cardiovascular death, and all-cause mortality and delay the progression of chronic kidney disease. Because of the protective effects of SGLT2 inhibitors on the heart and kidney, they are being studied for the treatment of heart failure and chronic kidney disease in patients without diabetes. Therefore, it is necessary for cardiologists, patients with diabetes, and nephrologists to fully understand this type of drug. In this review, we summarize the following three aspects of SGLT2 inhibitors: the recent clinical evidence of their cardiovascular benefits, their mechanisms of action, and their safety.     

唐以前医籍中有关消渴病饮食服药宜忌探析

消渴病与饮食关系密切,关于消渴病发病及治疗过程中的饮食、服药宜忌古已有之。其思想发源于《内经》,具体论述始于《伤寒杂病论》,在魏晋南北朝时期的诸多医籍中不断积累完善,到了唐代《外台秘要》和《医心方》时已经比较成熟,能够自成体系。通过系统总结唐以前医籍所载关于消渴病饮食及服药宜忌内容,分析其内在规律,有助于扩展和加深对糖尿病饮食宜忌相关的学术研究。     

从胰岛微循环探索“脾气散精”环节对血糖稳态的调节机制

减少血糖波动是目前干预糖尿病和预防并发症的重点,也是中医药在糖尿病治疗中的优势所在。越来越多的研究表明,胰岛微循环障碍是胰岛功能下降进而引发血糖波动的关键病理环节,而胰岛微循环局部肾素-血管紧张素系统(renin-angiotensin system,RAS)的过度激活作为胰岛功能失代偿的使动环节,与胰岛内分泌细胞功能密切相关,是研究胰岛功能的关键靶点。中医学认为糖尿病血糖波动与"脾气散精"障碍密切相关,脾不散"精"(血糖),精滞为浊,浊邪壅塞,是血糖稳态失衡的使动环节,亦为糖尿病全病程的关键病机。通过补益"脾"气以促进"胰"中精微物质的布散能够恢复糖调节激素间的平衡,从而减少血糖波动。目前,"脾气散精"对血糖波动的调节机制尚不明确。作者基于以往的临床和科研工作基础,提出"脾气散精"环节通过促进机体胰岛微循环从而发挥其改善胰岛功能、调节血糖稳态的作用,其机制可能与抑制胰岛微循环局部RAS的激活状态相关。RAS系统在胰岛微循环中各信号通路的相互拮抗关系,与中医理论中脾气散精与固精作用的对立制约关系相类似。因此"脾气散精"环节对血糖波动的调节机制有必要从胰岛微循环RAS整体调控的角度进行深入探索,以此揭示中医药调节机体内环境稳态,减少糖尿病患者血糖波动的科学内涵。     

Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Background

The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown.

The effect of education given to type 2 diabetic individuals on diabetes self-management and self-efficacy: Randomized controlled trial

AimThis study used a randomized controlled trial design and was carried out to examine the effect of education on diabetes self-management and self-efficacy in patients with type 2 diabetes.MethodsThe study was carried out between July 2016–March 2017. Data were collected using information form, Diabetes Self-Management Questionnaire (DSMQ), self-efficacy scale for patients with type 2 diabetes (DSS).The individuals in the experimental group were given education. Both groups were reminded about the control time of their metabolic values on the phone in the 3rd and 6th months.ResultsThe average age of the individuals was 59.91 ± 8.93 (n = 78), 62.8% (n = 49) were female, 92.3% (n = 72), were married, 42.3% (n = 33) were high school graduates and their diabetes duration was 7.05 ± 3.9. There was a statistically significant difference in the 6th month metabolic values in the experimental group compared to the control group. When diabetes self-management and self-efficacy were examined, a statistically significant difference was found in the experimental group compared to the control group at 3rd and 6th months (p < 0.05, p < 0.01).ConclusionIn this study, a significant increase in diabetes self-management and self-efficacy and a significant decrease in metabolic values were observed as a result of education and phone reminders given to individuals with type 2 diabetes.     

Cardiovascular risk factors in adults with coarctation of the aorta

Background: The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hy‐ pertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardio‐ vascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA.
Methods: Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire.
Results: A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty‐six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24‐hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well‐controlled blood pressure on ambula‐ tory blood pressure measurement.
Conclusions: Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk fac‐ tors to minimize the risk of these patients also developing atherosclerotic disease.     

Depression in type 1 diabetes and risk of dementia

Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.     

Review of the renal endpoints used in cardiovascular safety clinical trials in type 2 diabetes mellitus patients and their importance in primary care

Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes mellitus (T2DM). Furthermore, CKD confers a considerable increase in the risk of cardiovascular (CV) morbidity and mortality. In line with the need to improve knowledge in this field, this article aims to describe the renal endpoints used in the different cardiovascular outcome trials (CVOTs). The objective is to better know the renal variables used in the different CVOTs in order to optimize the implementation of advances in the prevention of progressive diabetic kidney disease in patients with T2DM in clinical practice.