甘精胰岛素治疗新发糖尿病的疗效观察

26例新发2型糖尿病（T2DM）患者给予2周甘精胰岛素强化治疗（三餐配合使用速效胰岛素）;治疗前后测定空腹血糖（FPG）、空腹胰岛素（FINS）,并计算IAI、胰岛素抵抗指数（HOMA—IR）。结果IAI明显增加,HOMA—IR显著改善。结论对新发T2DM,胰岛素强化治疗可以快速、稳定控制血糖,改善胰岛B细胞功能和IAI。     

CSII对血糖控制和胰岛功能的影响

32例2型糖尿病随机分为MDI和CSII两组。结果：治疗前后比较显示：两组均能降低空腹（FPG）和餐后血糖（PPG）以及升高空腹（FCP）和餐后2小时C-肽（P〈0.01）;两组之间比较显示：与MDI组比较,CSII组对空腹、餐后血糖以及空腹、餐后2小时C-肽的改善更明显（P〈0.05）,血糖达标所需时间和所耗胰岛素用量少（P〈0.01）,所需住院时间短（P〈0.01）,日平均费高（P〈0.01）,但两组住院总费用无差异（P〉0.05）,且间接经济损失明显减少（P〈0.01）。结论：CSII具有平稳快速控制血糖、减少胰岛素用量、缩短住院时间,且不增加患者的经济负担等特点。     

老年高血压合并2型糖尿病患者餐后血糖与血压关系的研究

目的探讨老年高血压合并2型糖尿病患者,餐后血糖与炎症因子C-反应蛋白、脉压、昼夜血压的关系及临床意义。方法选择单纯高血压、高血压合并2型糖尿病餐后高血糖患者及健康体检者各30例,均测定空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹血浆胰岛素（FINs）、糖化血红蛋白（HbAlC）、血清C-反应蛋白（CRP）,计算胰岛抵抗指数（IRI）,高血压患者行动态血压监测（ABPM）。对各组的CRP、糖代谢指标、动态血压参数等进行统计学分析,并比较高血压合并2型糖尿病餐后高血糖患者治疗前后各项指标。结果高血压合并糖尿病组FPG、2hPG、FINS、IRI、HbAlC及CRP各指标与单纯高血压组及正常对照组比较差异有统计学意义（P〈0．05）,单纯高血压组FINS、IRI及CRP高于正常对照组,差异有统计学意义（P〈0．05）;与单纯高血压患者相比,高血压合并糖尿病餐后高血糖组患者脉压（PP）增大,非杓型比率高,差异有统计学意义（P〈0．05）;高血压合并糖尿病餐后高血糖患者治疗后PP、非杓型比率下降,与治疗前比较差异有统计学意义（P〈0．05）。结论高血压与糖尿病同样存在胰岛素抵抗,高血压合并糖尿病患者,餐后血糖与CRP水平、PP、血压昼夜节律异常相关,餐后血糖的控制可能有助于夜间杓型血压的恢复,延缓动脉粥样硬化的进程。     

门冬胰岛素30强化治疗初诊2型糖尿病患者的临床观察

目的观察预混双相门冬胰岛素30强化治疗伴有明显高血糖的初诊2型糖尿病患学的血糖控制及对8细胞功能的影响。方法采用自身前后对照,42例初诊的2型糖尿病患者就诊时空腹血糖（FPG）≥11．1mmol／L和（或）餐后2小时血糖（2hPG）≥14mmol／L,糖化血红蛋白（HbA1c）〉18．0％,予门冬胰岛素30餐前皮下注射控制血糖12周,治疗前后分别检测FPG、空腹胰岛素（Fins）、空腹C-肽（FPC）、HbA1c和2hPG、餐后2小时胰岛素（2hIns）、餐后2小时C-肽（2hPC）、体重指数（BMI）,计算并比较治疗前后胰岛β细胞功能（HOMA-β）、胰岛素抵抗指数（HOMA-IR）。结果42例患者血糖达标时间平均为（12．3±4．5）天,治疗后FPG、2hPG、HbA1c较治疗前显著下降（P〈0．01）;FIns、2hIns、FPC、2hPC、HOMA—β较治疗前明显升高（P〈0．05）。结论门冬胰岛素30强化治疗伴有明显高血糖的初诊2型糖尿病患者,能够快速降低血糖并达标,有助于保护胰岛β细胞功能、延缓其衰竭。     

门冬胰岛素30对初诊2型糖尿病颈动脉粥样硬化影响

流行病学研究认为餐后高血糖是心血管疾病独立危险因素。门冬胰岛素30是一种双相预混人胰岛素类似物,能更好模拟生理性胰岛素分泌,能快速有效降低餐后血糖。本研究选择空腹血糖（FPG）〉11．1mmol／L的初诊2型糖尿病患者,分别使用门冬胰岛素30和预混胰岛素（诺和灵30R）治疗,探讨初诊2型糖尿病患者餐后高血糖与颈动脉内膜中层厚度及炎症标志物的关系。     

血糖波动与糖尿病大血管并发症的相关性

目的 分析糖尿病大血管并发症与血糖波动之间的关系。方法 选取2型糖尿病（T2DM）患者作为研究对象,根据是否伴有大血管并发症分为大血管并发症组（66例）和无大血管并发症组（76例）。记录研究对象的一般临床资料、实验室指标及动态血糖监测（CGM）资料。结果 ①大血管并发症组的年龄、DM病程、高血糖时间百分比、高血糖AUC、MBG、低血糖发生率、2hPPG、SDBG、MAGE、LAGE均显著大于或高于无大血管并发症组（P<0.05或P<0.01）。而两组间性别比例、吸烟史、高血压史、降糖药物使用情况、血脂、肝功、FPG及HbA1c等指标均无统计学差异。②逐步Logistic回归分析显示大血管并发症与年龄、MAGE呈独立正相关。③Spearman相关性分析显示大血管并发症与年龄、DM病程、高血糖时间百分比、高血糖AUC、低血糖发生率、MBG、2hPPG、SDBG、MAGE、LAGE均呈正相关。结论 血糖波动指标MAGE与2型糖尿病患者大血管并发症相关。     

初发2型糖尿病患者早期胰岛素治疗对β细胞功能影响

选择70例26～58岁初发首次治疗2型糖尿病病人,随机分配到胰岛素治疗组和口服药物治疗组,半年后分析比较两组治疗前后空腹血糖（FPG）及餐后2小时血糖（2HPG）、糖化血红蛋白（HbA1c）、空腹胰岛素和餐后2小时胰岛素、HOMA-β（胰岛素分泌指数）和HOMA-IR（胰岛素抵抗指数）.结果：胰岛素组胰岛功能有较大的改善,有显著的统计学意义.结论：2型糖尿病者早期使用胰岛素有助于β细胞分泌功能的改善.     

瑞格列奈在2型糖尿病合并脑血管病中的应用

选取2型糖尿病合并脑血管病病人36例，随机分为瑞格列奈组，对照组，治疗前、后检测空腹和餐后2h血糖，糖化血清蛋白（GSP）、血胆固醇（TC）、血甘油三脂（TG），肝、肾功能、血压、体重、低血糖发生率。结果：瑞格列奈组FPG，PPG2h，GSP，治疗前后差异P〈0．05，低血糖发生率5％。胰岛素组治疗前后FPG，PPG2h，GSP，治疗前后差异P〈0．05，低血糖发生率18．8％。两组比较低血糖发生率有统计学意义。P〈0．05。结论：在2型糖尿病合并脑血管病患者中与常规胰岛素治疗相比瑞格列奈亦可迅速、安全降糖，但在低血糖发生率明显低于胰岛素治疗组。     

血清骨保护素与2型糖尿病及合并冠心病的关系

［摘要］　目的　探讨血清骨保护素（OPG）与2型糖尿病及合并冠心病的关系。方法　选择健康个体、2型糖尿病患者及2型糖尿病合并冠心病患者各30例。用ELISA方法测定OPG,生化法测定空腹血糖（FPG）及糖化血红蛋白（HbA1c）,免疫化学发光法测定空腹胰岛素（FINS）,计算胰岛素敏感指数(ISI)及胰岛素抵抗指数(HOMA-IR),并观察组间各指标的变化。结果　2型糖尿病组及合并冠心病组血清OPG、FPG、HbA1c、HOMA-IR明显高于对照组（P均<0.01）,ISI明显低于对照组（P<0.01）。2型糖尿病合并冠心病组FINS显著高于对照组（P<0.05）。2型糖尿病组HbA1c明显高于2型糖尿病合并冠心病组（P<0.01）。结论　2型糖尿病及其合并冠心病患者血清OPG水平、血糖、胰岛素及HOMA-IR明显增高,2型糖尿病患者冠心病发生与血清OPG、血糖、胰岛素升高以及胰岛素抵抗有关,OPG作为心血管疾病的预测因子可能与胰岛素的影响有关。     

初诊2型糖尿病患者短期胰岛素强化治疗后血浆肿瘤坏死因子α及超氧化物歧化酶的变化

目的观察短期胰岛素强化治疗对伴有明显高血糖的初诊2型糖尿病患者的降糖效果及对血浆肿瘤坏死因子α（TNFα）和超氧化物歧化酶（SOD）的影响。方法对30例2型糖尿病患者进行2周的胰岛素强化治疗，以空腹血糖（FPG）〈7．0mmol／L、餐后2h血糖（2hPG）〈10．0mmol／L为血糖控制目标，12周后不用胰岛素或胰岛素促泌剂仍能血糖达标者为完全缓解。治疗前及治疗后13周检测空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1C）、血脂、TNFα、SOD。结果强化胰岛素治疗后，17例患者12周后完全缓解；FPG、2hPG、HbA1C、SOD较治疗前均有明显降低（P〈0．01或〈0．05）。结论2型糖尿病短期胰岛素强化治疗可在纠正高血糖的同时，对血脂代谢也产生有利影响。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.