甘精胰岛素联合口服降糖药强化治疗2型糖尿病的疗效分析

目的探讨甘精胰岛素联合口服降糖药强化治疗2型糖尿病的疗效。方法选取2016年9月—2018年11月期间88例2型糖尿病患者,根据治疗方法分组,对照组(n=44)单纯口服二甲双胍,观察组(n=44)在此基础上联合甘精胰岛素,对比两组患者临床治疗效果。结果观察组治疗后FBG、2 hPBG、HbA1c水平改善程度均优于对照组(P0.05);观察组用药后生活质量(心理健康、躯体症状、生理情况、睡眠状况)评分均高于对照组(P0.05)。结论给予2型糖尿病患者甘精胰岛素联合口服降糖药进行强化治疗,可有效改善血糖水平,提高生活质量。     

胰岛素或磺脲类药物联合二甲双胍治疗初发2型糖尿病疗效观察

目的 探讨胰岛素或磺脲类药物联合二甲双胍治疗初发2型糖尿病(T2DM)的临床疗效.方法 选择初发T2DM患者87例,按就诊先后顺序随机分为A组44例、B组43例.两组均控制饮食、餐后适当运动,在此基础上,A组采用人胰岛素联合二甲双胍治疗,B组采用磺脲类口服降糖药联合二甲双胍治疗,疗程均为3年.治疗前后检测两组的空腹血糖(FPG)、餐后2h血糖(2 h PG)及糖化血红蛋白(HbA1c),治疗期间观察其糖尿病并发症发生情况.结果 两组治疗1个月与治疗前比较,FPG、2 hPG、HbA1c均有统计学差异(P均＜0.05).A组治疗1、3年与B组同期比较,FPG、2hPG、HbA1c均有统计学差异(P均＜0.05).A组糖尿病并发症发生率较B组降低(P＜0.05).结论 胰岛素联合二甲双胍对初发T2DM患者的血糖、HbA1c有良好的控制作用,并能减少其糖尿病并发症发生率.     

不同方案短期强化血糖控制对短病程2型糖尿病患者的影响

目的 探讨单纯口服降糖药(OHA)、单纯胰岛素强化治疗(Ins)以及口服降糖药联合胰岛素(OHA+Ins)治疗对短病程、未用过降糖药的2型糖尿病(T2DM)患者减轻胰岛素抵抗、改善胰岛功能的效应差异.方法 90例病程≤1年、未用过降糖药的T2DM患者随机分为3组,即OHA组、Ins组和OHA+Ins组.每组有效病例30人,进行强化降糖治疗,以末梢空腹血糖≤6.0 mmol/L和餐后2 h血糖≤8.0 mmol/L为血糖控制目标,使血糖在7～10 d达标,并维持达标2～4周.比较3组治疗前后的静脉葡萄糖耐量试验(IVGTT)胰岛素第一时相分泌、胰岛素抵抗指数(Homa A)和胰岛素分泌指数(Homa B)的变化.结果 3组治疗后IVGTT曲线下面积和Homa B均明显升高,Homa A明显下降.3组间治疗前后变化的差别不显著.结论 3种强化降糖治疗方案均可以使短病程、未用过降糖药的T2DM患者的胰岛素抵抗以及胰岛β细胞功能得到同样程度的改善.     

优泌乐50R治疗2型糖尿病的疗效观察

目的观察初诊T2DM患者与口服降糖药失效T2DM患者优泌乐50R强化治疗的疗效。方法初诊T2DM患者与口服降糖药失效T2DM患者各30例,均给予优泌乐50R强化降糖治疗,分别于治疗前、后对血糖、糖化血红蛋白、胰岛素用量等指标进行组间比较。结果两组治疗后的空腹血糖（FBG）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbA1c）均明显下降,疗效显著,初诊组治疗达标时间短,胰岛素用量小。结论优泌乐50R治疗2型糖尿病疗效肯定,对餐后血糖的控制存在优势。初诊T2DM患者早期胰岛素治疗更能有效改善高血糖状态,提高β细胞基础分泌功能。     

甘精胰岛素联合口服降糖药治疗2型糖尿病磺脲类继发性失效临床观察

目的研究甘精胰岛素联合口服降糖药治疗磺脲类继发性失效的2型糖尿病的临床疗效。方法选择该院2015年3月—2016年9月患有磺脲类继发性失效的2型糖尿病的临床病例80例进行分析,随机分为观察组和对照组,每组40例。对照组采取常规的治疗,观察组采取甘精胰岛素联合口服降糖药的方式治疗,所有患者在治疗前后12周测定空腹血糖(FBG)、餐后2 h的血糖值(2hBG)和糖化血红蛋白值(HbA1c),观察比较两组结果。结果两组患者治疗3个月后,空腹血糖(FBG)、餐后2 h的血糖值(2hBG)和糖化血红蛋白值(HbA1c)较治疗前明显降低,对于空腹血糖值而言,观察组明显高于对照组,差异有统计学意义(P0.05);观察组治疗期间出现低血糖的例数明显低于对照组,差异有统计学意义(P0.05)。结论采取甘精胰岛素联合口服降糖药治疗磺脲类继发性失效的2型糖尿病,能有效的控制血糖,低血糖发生率低,治疗安全性高,值得在临床上广泛使用。     

糖化血红蛋白对妊娠期糖尿病的筛查价值及妊娠期糖尿病患者的早期护理干预研究

目的探讨糖化血红蛋白(HbA1c)对妊娠期糖尿病(GDM)的筛查价值及GDM患者的早期护理干预。方法选取2013年6月—2014年2月我院妇产科门诊收治的GDM患者45例(GDM组)、糖耐量异常患者45例(糖耐量异常组)、血糖正常孕妇45例(血糖正常组)。检测3组受试者HbA1c及空腹血糖(FBG),然后行口服葡萄糖耐量试验(OGTT),并对GDM患者进行早期护理干预。结果 GDM患者HbA1c阳性率(88.9%)OGTT(77.8%)FBG(42.2%)(P0.05)。GDM组患者HbA1c、FBG高于其他两组(P0.05)。结论 HbA1c对GDM患者诊断准确率较高,操作便捷、所需血量少、不易受其他因素的影响,可作为筛查GDM的重要指标。早期护理干预可以辅助临床治疗,帮助GDM患者有效控制血糖。     

口服降糖药血糖控制不佳的老年2型糖尿病患者加用甘精胰岛素的疗效观察

目的通过比较甘精胰岛素和诺和灵N对口服降糖药血糖控制不佳的老年2型糖尿病患者的治疗效果,探讨甘精胰岛素在老年2型糖尿病患者血糖达标治疗中的临床运用价值。方法44例口服降糖药治疗空腹血糖控制不佳的老年2型糖尿病患者随机分为两组：甘精胰岛素治疗组22例,诺和灵N治疗组22例,治疗12周。观察两组治疗前后的糖化血红蛋白（HbA1c）值、空腹血糖（FBG）、餐后两小时血糖（2hPG）、体重指数（BMI）和每日所需的胰岛素剂量以及两组治疗过程中低血糖发生的频率。结果治疗12周后两组HbA1c、FBG、2hPG与治疗前比较差异有统计学意义（P〈0．05）;而两组间HbA1c、2hPG、低血糖事件的发生率比较差异有统计学意义（P〈0．05）,每日胰岛素的用量、BMI、FBG比较差异无统计学意义（P〉0．05）。结论加用甘精胰岛素对口服降糖药血糖控制不佳的老年2型糖尿病患者能更有效更安全地控制血糖。     

高血压患者糖化血红蛋白检测的临床价值

目的:探讨高血压患者糖化血红蛋白(HbA1c)检测的临床价值.方法:对699例无糖尿病病史的住院患者,根据有无高血压病史分为高血压组(376例)与非高血压组(323例).所有研究对象均行75 g口服葡萄糖耐量试验(OGTT),检测HbA1c、空腹血糖(FPG)、餐后2h血糖(2h-PPG)、空腹胰岛素(FINS)、血脂...     

3种胰岛素治疗方案治疗老年2型糖尿病的疗效比较

目的探讨不同胰岛素治疗方案治疗老年2型糖尿病(T2DM)患者的疗效。方法 114例老年T2DM患者按照治疗方法分为3组,每组38例。A组采用地特胰岛素和二甲双胍组治疗,B组采用预混胰岛素(诺和锐30)治疗,C组采用预混胰岛素组(诺和灵30R)治疗,分别比较3组治疗前后血糖变化、临床疗效及安全性。结果 3组治疗后空腹血糖(FBG)、餐后2 h血糖(2 h BG)、评价血糖(MBG)及糖化血红蛋白(HbA1c)水平均明显降低,A、B组治疗后FBG、2 h BG、MBG及HbA1c水平明显低于C组(P<0.05),A、B组治疗后FBG、2 h BG、MBG及HbA1c水平差异无统计学意义(P>0.05);A、B组治疗后平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)、最大血糖波动幅度(LAGE)水平均显著低于C组(P<0.05),A、B组治疗后MAGE、SDBG、LAGE水平差异无统计学意义(P>0.05);A、B组血糖达标时间及低血糖发生率明显低于C组,每日胰岛素用量显著高于C组(P<0.05)。A、B组血糖达标时间、每日胰岛素用量及低血糖发生率差异无统计学意义(P>0.05)。结论地特胰岛素联合二甲双胍方案、诺和锐30皮下注射方案可以降低T2DM患者的血糖波动,缩短血糖达标时间,对降低低血糖发生风险具有重要意义。     

短期胰岛素泵强化治疗对初诊2型糖尿病患者胰岛β细胞功能及血脂代谢的影响

观察短期胰岛素泵强化治疗对初诊2型糖尿病患者的胰岛β细胞功能及血脂代谢的影响。方法新诊断的2型糖尿病患者57例,给予为期2周的胰岛素泵强化治疗,治疗前后行口服葡萄糖耐量试验(OGTT)、胰岛素释放试验(OGIRT)、糖化血红蛋白(HbA1c)检测;对糖脂控制情况、空腹胰岛素浓度(FIns)、胰岛素曲线下面积(AUC)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、早时相胰岛素分泌指数(I30/G30)进行比较。结果经2周胰岛素泵强化治疗后,患者空腹血糖(FPG)、餐后2h血糖(2hPG)、HOMA-IR、血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、甘油三酯(TG)均较治疗前明显降低,空腹胰岛素浓度、胰岛素曲线下面积、I30/G30、HOMA-β、高密度脂蛋白胆固醇(HDL-c)明显升高。结论初诊2型糖尿病短期应用胰岛素泵治疗能早期解除糖脂毒性,显著改善糖脂代谢及胰岛β细胞功能,减轻胰岛素抵抗。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.