血浆中高级糖化终产物的水平与糖尿病并发症的关系研究

目的 探讨高级糖化终产物与糖尿病并发症的关系。方法 采用本实验室自行研制的竞争性酶联免疫吸附分析方法，测定了糖尿病有并发症组病人血浆95例，糖尿病无并发症组人血浆65例，正常对照65例。结果：在糖尿病有并发症组中，高级糖化终产物（AGEs）浓度[（6．625（1．691）U／mL，n=95]明显高于糖尿病无并发症组[（5．904（2．071）U／mL，n=65，P=0．017]，也明显高于正常人组[（5．337（1．138，n=65，p〈0．005]。以有无并发症为应变量进行多元logistic回归分析显示，血浆AGEs浓度〉6．085U／ml者，糖尿病并发症发生的危险性增加（OR值为2．989，95％可信限为1．407—6．350）。多元逐步线性回归显示：糖尿病病程、冠心病史与血浆AGEs浓度之间有线性关系。结论血浆AGEs浓度是糖尿病发生并发症的独立危险因素。     

The effects of intermittent administration of human parathyroid hormone (1–34) on streptozotocin-induced diabetic rats

Intermittent administration of low doses of human parathyroid hormone (h-PTH) has been reported to exhibit an anabolic effect on bone, increasing its mass. We investigated the effects of intermittent administration of h-PTH on bone changes in streptozotocin- (STZ-) induced diabetes mellitus (DM) rats by measuring bone mineral density and bone mineral contents and by bone histomorphometry. Wistar rats, 7–8 months old, were used. Osteoporosis was induced by diabetes mellitus, which was established by an intraperitoneal injection of STZ. Rats were separated into five groups: sham-injected, baseline control, vehicle-only-administered, and low-dose (6.0μg/kg) or high-dose (60.0μg/kg) h-PTH-administered groups. h-PTH or vehicle was injected subcutaneously six times a week for 4 weeks beginning 9 weeks after STZ administration. Bone mineral density and mineral contents were significantly lower in the baseline control and vehicle groups than in the control group. The PTH-administered groups showed higher values compared with both vehicle and baseline control groups. In bone histomorphometry, both bone volume and bone formation in the STZ group were markedly reduced. The h-PTH-administered rats showed increase in both bone volume and bone formation, which are related parameters, but administration of h-PTH did not alter the extent of eroded surface. Our results suggest that intermittent administration of h-PTH is effective in activating bone formation and in preventing further bone loss in osteoporosis developed by STZ-induced DM.     

伊那普利治疗糖尿病肾病的临床研究

目的评估伊那普利治疗糖尿病肾病(DN)的临床疗效 ,并探讨其作用机制。方法40例持续微量蛋白尿的非胰岛素依赖型糖尿病(NIDDM)患者随机分为常规治疗组(n=19)和伊那普利治疗组(n=21)。利用 131I -邻碘马尿酸钠测定有效肾血浆流量(ERPF) ;肾小球滤过率(GFR)以内生肌酐清除率表示 ;通过ELISA法测定尿微量蛋白 ,包括白蛋白(ALB)、转铁蛋白(TF)、视黄醇结合蛋白(RBP)和N -乙酰 - β氨基葡萄糖苷酶(NAG)。结果伊那普利治疗组增高的尿ALB、TF、RBP和NAG均显著下降 ;ERPF显著增加 ;增加的滤过分数(FF)显著减低。而常规治疗组这些参数无显著变化。结论伊那普利具有改善DN患者的肾小球血流动力学 ,保护肾小球和肾小管功能的作用     

Measuring oscillatory potentials: Fourier analysis

Studying the oscillatory potentials in diabetic retinopathy, the authors experienced several problems interpreting results of digital filtering. The main problem was the separation of the first potential from the a-wave, since their frequencies are within the same range. To improve the procedure of measuring implicit times and of calculating amplitudes, the filtering was started with a finite impulse response filter and followed by a fast Fourier transform. The power of the oscillatory potential was calculated by determining the dominant frequency in the Fourier transformed response and expressed in microwatts. A group of normal subjects was compared with a group of early diabetic retinopathy patients. It appears that even in pathological circumstances a quantitative expression of the oscillatory potential is possible.     

国产鼻喷鲑鱼降钙素治疗骨质疏松性疼痛的疗效观察

目的观察国产鼻喷鲑鱼降钙素治疗骨质疏松性疼痛的疗效。方法采用随机分组对照设计。选择骨质疏松患者53例,随机分为两组,治疗组(30例)给予鼻喷鲑鱼降钙素,20u/次,1次/天,8周为1个疗程,停药后继续观察3周。对照组(23例)口服钙尔奇D片,1片/次,1次/天,共8周;采用国际惯用分级标准对疼痛予以评估。结果治疗组患者的疼痛明显改善,其总有效率为95%;在停药后缓解疼痛的作用仍可维持4周以上,Ⅲ度骨质疏松患者的治疗效果较Ⅰ度和Ⅱ度患者的效果差;对照组症状未见明显改善。结论用国产鼻喷鲑鱼降钙素治疗骨质疏松性骨痛,可明显缓解患者的疼痛症状。     

低剂量激素替代治疗对绝经后妇女骨代谢的影响

目的 探讨低剂量结合型雌激素（ＣＥ）和安宫黄体酮（ＭＰＡ）联合应用对骨代谢的影响，方法３４例绝经后妇女随机分为两组，试验组１７例，ＣＥ０．６２５ｍｇ与ＭＰＡ２ｍｇ隔日口服交替应用，对照组１７例，口服ＣＤ０．６２５ｍｇ／ｄ，每月连续服用２５ｄ，后１０ｄ加用ＭＰＡ４ｍｇ。两组均连续服用４周期，于用药前后分别测定血碱性磷酸酶（ＡＬＰ）及尿Ｃａ／Ｃｒ比值。结果 实验组完成治疗者１６例，对照组完成治疗者１５     

糖尿病患者第3腰椎骨密度测量的意义

糖尿病（ＤＭ）患者继发骨质疏松较多见，为探讨早期诊断，对３０例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和４０例正常对照者，进行血清钙（Ｃａ）、磷（Ｐ）、碱性磷酸酶（ＡＫＰ）的测定，拍照胸部、腰椎和骨盆Ｘ线片，并分别经ＣＴ进行第３腰椎骨密度（ＢＭＤ）测量。结果，ＤＭ组ＢＭＤ均值为１２７．１±２５．７７ｍｇ／ｃｍ３，对照组ＢＭＤ均值为１８９．１１±７１．６８ｍｇ／ｃｍ３，两组比较有非常显著差异（Ｐ＜０．０１），提示第３腰椎骨密度测量对ＤＭ患者骨质疏松的早期诊断有一定价值。     

Long-term follow-up study of 268 diabetic patients undergoing haemodialysis, with special attention to visual acuity and heterogeneity

We studied the long-term outcome of 268 patients suffering fromdiabetic end-stage renal disease (DM-ESRD) treated with long-termhaemodialysis between 1978 and 1991, with special emphasis onvisual acuity as well as the heterogeneity of DM-ESRD The 50%patient survival on haemodialysis was 60 months. Visual disturbanceswere found in 73.1% (392/536) of eyes at the start of haemodialysis.Chronological assess ment of visual acuity demonstrated thestabilization of visual acuity and 87.1% (364/418) of eyes werestable, 4.8% (20/418) were improved, and 8.1% (34/418) wereaggravated in the long term respectively. The change of visualacuity was frequently seen in the short term, and rapid shiftsof body fluid to correct overhydration induced abrupt changesof glycaemic control as well as retraction of macular oedema.Hence it might be one of the factors affecting rapid changeof visual acuity in the short term. Meanwhile, long-term deterioration of visual acuity resulted from either hyperten sionunresponsive to medical treatment or poor glycaemic control.Some DM-ESRD patients had only background retinopathy at thestart of haemodialysis and these were likely to have the nephroscleroticglomerular lesion. They were old, not nephrotic and had a milddegree of diabetes during the predialysis stage. Thus, DM-ESRDpatients seem to have some heterogeneity in their clinical characteristics,and old DM-ESRD patients with only background retinopathy havethe appearance of diabetic macroangiopathy rather than microangiopathy.     

Angiotensinogen gene M235T polymorphism is not associated with diabetic nephropathy

BACKGROUND.: There is agreement that a family history of hypertension (HT),is a predictor for the risk of diabetic nephropathy (DN) inpatients with type 2 diabetes, and possibly also type 1 diabetes.It follows that genes related to the risk of hypertension mustalso be considered candidate genes for DN. The 235T allele ofthe angiotensinogen gene was found to be related to primaryHT. METHODS.: To examine whether it is predictive for DN as well, we examinedthe angiotensinogen gene polymorphism in 230 healthy local controls,423 patients with type 1 diabetes (n=180 with DN; n=243 withoutDN) and 663 patients with type 2 diabetes (n=310 with DN; n=353without DN). The angiotensinogen gene M235T polymorphism wasdetermined using PCR amplification. RESULTS.: The following results were obtained (i) no significant differenceof genotype distribution (type 1: MM/MT/TT(%) 27.6/57.2/15.2vs. 27.2/56.1/16.7 (P=0.92); type 2: MM/MT/TT (%) 31.7/48.2/20.1vs. 32.9/46.8/20.3 (P=0.93)) or allele frequencies (type 1:M 0.56 vs. 0.55 (P=0.795); type 2: M 0.56 vs. 0.56 (P=0.86))was found, between diabetic patients with or without DN, (ii)no difference was found between normotensive and hypertensivediabetic patients. CONCLUSION.: The data argue against a role of the angiotensinogen gene M235Tpolymorphism in the manifestation of diabetic nephropathy orhypertension in diabetic patients.     

基于骨免疫微环境探讨补肾活血方防治绝经后骨质疏松症的研究进展

骨质疏松症（OP）是我国人群中最常见的多发病,好发于绝经后的老年妇女,增加了患者骨折的风险。绝经后骨质疏松症（PMOP）是一种以骨量减少和骨折风险增加为特征的全身性疾病,主要是绝经后雌激素水平显著降低导致的。除了雌激素缺乏对骨骼的直接负面影响外,绝经后妇女免疫状态的改变间接导致骨骼的持续破坏,因为绝经后妇女通常表现出慢性低级别炎症表型,细胞因子表达和免疫细胞谱发生改变。PMOP已严重危害我国女性健康。补肾活血方是一种应用广泛的补肾活血中药,近年来,随着我国临床医师与患者越来越重视中医药,补肾活血方被应用于多种疾患,包括骨科的多种疾病,其对PMOP的防治效果亦明显。该文基于骨免疫微环境,以骨代谢对PMOP产生影响为基础,论述补肾活血方的作用机制。