参芪复方对2型糖尿病GK大鼠胰岛β细胞功能的影响

目的:以自发性2型糖尿病GK大鼠为研究对象,应用全基因组表达谱芯片技术,旨在探讨参芪复方调节胰岛细胞功能的分子机制,为中医药防治2型糖尿病提供理论依据。方法:GK大鼠每日给予高脂饲料喂养,连续4周,随机从GK大鼠中选取大鼠检测随机血糖,验证2型糖尿病模型成功。实验分为4组,空白组,模型组,参芪复方组(1.44 g?kg~(-1)),西格列汀组(16 mg·kg~(-1)),于灌胃前、灌胃4周、灌胃8周测早上8:00各组大鼠尾尖血糖;灌胃8周后,运用酶联免疫吸附测定(ELISA)检测大鼠血清胰岛素(INS)水平;采用原位末端标记(TUNEL)荧光法定量检测并观察胰岛β细胞凋亡情况;运用全基因组表达谱芯片技术对各组大鼠胰腺组织进行差异基因检测;采用实时荧光定量聚合酶链式反应(Real-time PCR)检测关键差异基因的mRNA转录水平。结果:与空白组比较,灌胃前、灌胃4周、灌胃8周,GK大鼠各组血糖显著升高(P0.01);灌胃4,8周,与模型组比较,各药物干预组大鼠血糖均显著较低(P0.01)。灌胃8周,与空白组比较,模型组大鼠INS水平显著较低(P0.01);与模型组比较,参芪复方组具有INS水平更高的趋势,西格列汀组INS水平显著较高(P0.01)。灌胃8周,与空白组比较,模型组大鼠胰岛β细胞凋亡数明显升高(P0.05);与模型组比较,参芪复方组、西格列汀组大鼠胰岛β细胞凋亡数均明显较低(P0.05,P0.01)。基因芯片及Real-time PCR检测均显示磷脂酰肌醇3-激酶受体1(PIK3R1)在参芪复方组/模型组中表达上调,在西格列汀组/模型组、模型组/空白组中表达下调;蛋白激酶B1(Akt1)在参芪复方组/模型组、西格列汀组/模型组中表达上调,在模型组/空白组中表达下调。结论:参芪复方可减少胰岛β细胞凋亡,增加胰岛素分泌,上调基因PIK3R1,Akt1的表达,推测具有养阴益气活血功效的参芪复方可能通过上调基因PIK3R1,Akt1的表达,抑制胰岛β细胞凋亡,改善胰岛β细胞功能,调节胰岛素分泌,从而防治2型糖尿病。     

Pharmacological management of cardiovascular risk in chronic inflammatory rheumatic diseases

ABSTRACT

Introduction

Cardiovascular comorbidity is a major burden in patients with chronic inflammatory rheumatic diseases and a significant determinant of their outcome. In addition to optimal management of the underlying inflammatory condition according to current guidelines, individual cardiovascular risk factors, particularly dyslipidaemia, hypertension, and impaired glucose tolerance should be assessed regularly and guide risk stratification and requirement for treatment.     

Rapid progression of type 2 diabetes and related complications in children and young people—A literature review

Type 2 diabetes (T2D) is suggested to progress faster in children and young people vs type 1 diabetes (T1D) in the same age group and T2D in adults. We reviewed the evidence base for this. A literature search was performed of PubMed‐indexed publications between 2000 and 2018, for the terms “pediatric” and “T2D.” Results were combined and filtered for those relating to “progression.” Searches of abstract books from Latin American and Asian congresses were performed to include these populations. Pediatric populations were defined as <25 completed years of age. Of the articles and congress abstracts found, 30 were deemed relevant. Dividing the studies into categories based on how T2D progresses, we found the following: (a) yearly beta‐cell function deterioration was shown to be 20% to 35% in children with T2D compared with 7% to 11% in adults with T2D, despite similar disease durations; (b) retinopathy progression was likely dependent on diabetes duration rather than diabetes type; however, nephropathy, neuropathy and probably hypertension progressed faster in youth‐onset T2D vs T1D. Nephropathy progression was similar to adults with T2D, allowing for disease duration. Youth with T2D had a worse cardiovascular (CV) risk profile than youth with T1D, and a faster progression to CV death. (c) Progression to treatment failure was faster in youth‐onset T2D vs adult‐onset T2D. Substantial evidence exists for faster progression of T2D in pediatric patients vs T1D or adult‐onset T2D. New treatments targeting the pathology are needed urgently to address this issue.     

Therapeutic plasma exchange for exogenous insulin antibody syndrome in combined variable immunodeficiency: a case report

A 32-year-old male with type I diabetes presented with profound hypoglycemia due to exogenous insulin antibody syndrome in the setting of newly-diagnosed common variable immunodeficiency. Immunomodulatory therapy was not initially effective, but after the initiation of plasma exchange hypoglycemia resolved, and glucose lability improved.     

Minireview: Current status of endoscopic duodenal mucosal resurfacing

Several strategies are being pursued to overcome the alarming pandemics of obesity and type 2 diabetes (T2D). In recent years, duodenal mucosal resurfacing (DMR) has shown its potential to improve glycemic indices. Following animal studies, which demonstrated feasibility and safety, the procedure has been applied in two human studies. The DMR procedure has been considered feasible and safe in humans with a limited occurrence of complications and adverse events. Reductions in glycated haemoglobin, weight, fasting plasma glucose, and alanine transaminase have been proven at different follow-up time-points. The length of the ablation may induce different outcomes, having the patients with long duodenal segment ablated showed greater beneficial effects. The current evidence does not still prove the apparent insulin-sensitizing mechanism explaining the impact of the DMR procedure on hepatic glucose production. However, the initial findings have demonstrated a positive risk-benefit ratio and an effect on the treatment of metabolic diseases, such as T2D. Future studies should clarify the mechanisms underlying the positive effects and durability of the treatment using controlled trial conditions on larger number of patients.     

Perioperative management of diabetes

Diabetes is a complex, chronic metabolic disorder affecting approximately 9.3% of the adult population with the estimated number of adults with diabetes worldwide having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Diabetes affects 10–15% of the surgical population. These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a co-ordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in manging their own diabetes and should be involved in doing so whenever possible.     

基于网络药理学的小陷胸汤治疗2型糖尿病的药理机制

目的:利用网络药理学探索小陷胸汤治疗2型糖尿病(T2DM)的药理机制。方法:在中药系统药理学技术平台(TCMSP)网站检索小陷胸汤的主要活性成分、对应的作用靶点及靶标基因,通过人类基因数据库(Gene Cards)获得T2DM的相关靶标基因,将药物活性成分靶点与T2DM靶点相映射,获得交集靶点即为小陷胸汤作用于T2DM的预测靶点。利用Cytoscape 3. 7. 1软件构建药物活性成分-交集靶点网络模型,选出关键活性成分。利用STRING网站构建交集靶点蛋白相互作用网络(PPI),选出关键靶点基因。利用DAVID 6. 8在线工具对交集靶点进行基因本体(GO)分析和基于京都基因与基因组百科全书(KEGG)通路富集分析。结果:小陷胸汤作用于T2DM的活性成分有30个,相关靶点156个,关键有效成分14个,关键靶点基因18个。GO分析显示,小陷胸汤治疗T2DM潜在基因的生物功能主要涉及转录调控、氧化应激、蛋白结合和炎症反应等;KEGG通路富集显示小陷胸汤治疗T2DM影响的通路主要有缺诱导因子-1(HIF-1)信号通路,肿瘤坏死因子(TNF)信号通路,Toll样受体信号通路,甲状腺激素信号通路,磷脂酰肌醇氧3激酶/蛋白激酶B(PI3K/Akt)信号通路,乙肝,丙肝,酪氨酸激酶受体2(Erb B)信号通路,钙离子信号通路和核转录因子-κB(NF-кB)信号通路等。结论:小陷胸汤治疗T2DM机制可能是通过抑制炎症因子分泌,参与抗炎反应,降低氧化应激,升高细胞内钙离子浓度,阻断胰高血糖素信号通路,激活PI3K/Akt通路等来改善胰岛素抵抗,提高胰岛素敏感性,降低血糖。     

延续护理在2型糖尿病患者中的应用效果及并发症发生率影响观察

目的:研究对2型糖尿病患者实施延续护理的效果。方法:选取2018年1月~2018年12月在某院治疗后出院的2型糖尿病患者120例展开研究,按护理施差异分为两组,对照组常规护理,观察组在常规护理基础上实施延续护理,对比分析护理效果、护理后并发症发生率以及生活质量改善情况。结果:经护理后观察组血糖各指标均明显低于对照组(P<0.05);观察组发生率21.6%,对照组发生率41.6%(P<0.05);护理后观察组生活质量各项评分均明显高于对照组(P<0.05)。结论:对2型糖尿病患者实施延续护理效果显著,值得推广。