妊娠期糖尿病筛查225例结果分析

目的分析妊娠期糖筛查异常与妊娠期糖尿病及妊娠结局的关系。方法对225例妊娠24周后的孕妇进行口服50g葡萄糖筛查试验(50gGCT),阳性者进一步行75g葡萄糖耐量试验(OGTT),并观察妊娠结局。结果妊娠期糖尿病(GDM)发生率为2.22%,妊娠期糖耐量受损(GIGT)的发生率为6.22%,GDM组剖宫产率、早产率、羊水过多及新生儿并发症明显高于50gGCT正常组(P<0.05或P<0.01)。结论妊娠期糖尿病可导致母婴并发症增加,应重视GDM的早诊断、早治疗,降低母婴并发症,改善妊娠结局。     

妊娠期糖尿病筛查675例临床分析

目的:了解妊娠期糖尿病发病情况与部分高危因素存在的关系。方法:对675例妊娠24周后的孕妇进行50g葡萄糖筛查试验,阳性者进一步行75g葡萄糖耐量试验。结果:妊娠期糖尿病发生率2.37%,妊娠期糖耐量受损的发生率6.96%。结论:妊娠期糖尿病无明显症状体征,应重视妊娠期糖尿病的早期诊断、早治疗,降低母婴并发症。     

妊娠期糖尿病的产前筛查分析

目的探究妊娠期糖尿病的产前筛查的临床意义。方法选取本院自2015年6月至2016年6月接诊的600例妊娠24周后的孕妇做为本次调查的研究对象,这600例孕妇均进行75 g葡萄糖耐量试验(OGTT),观察记录这600例孕妇的妊娠结果。结果 600例妊娠24周后的孕妇中,确诊为妊娠期糖尿病的患者有39例,妊娠期糖尿病发生率为6.50%(39/600),正常健康率为93.50%(561/600);妊娠期糖尿病孕妇的早产率、剖宫产率、羊水过多、新生儿并发症等发生率均明显的高于正常健康孕妇(P<0.05)。结论妊娠期糖尿病的产前筛查有利于控制阳性率,而且妊娠期糖尿病容易导致早产、母婴并发症增加等,应重视产前筛查,改善妊娠结局。     

1型糖尿病妇女妊娠期间胰岛素应用剂量研究

目的:研究胰岛素泵1型糖尿病妇女妊娠期间胰岛素应用剂量。方法:选择2016年12月~2017年12月某院收治的1型糖尿病妊娠妇女15例,记录患者孕前胰岛素使用情况、孕期胰岛素及血糖控制情况及妊娠结局情况。结果:随着患者妊娠时间延长,胰岛素的摄入量逐渐增加,且孕中期、孕晚期与孕前相比均具有统计学差异(P<0.05)。患者孕中期及孕晚期胰岛素总量摄入较孕前相比增加分别为35.48%和66.13%;孕早期胰岛素基础量较孕前相比降低6.06%,孕中期及晚期分别增加9.09%和15.15%;孕早期,中期及晚期胰岛素大剂量较孕前相比增加10.34%、103.45%及134.48%;孕早期,中期及晚期胰岛素大剂量比例较孕前增加8.50%、28.17%和39.76%。结论:1型糖尿病妊娠妇女随着孕周期延长胰岛素需求量逐渐增加,在临床工作中应该根据孕周期调整胰岛素摄入量。     

胰岛素释放试验在心脑血管病中的应用分析

目的：探讨胰岛素释放试验（IRT）在冠心病、高血压、脑梗死等心脑血管病中的应用价值。方法：选取在本院住院的228例心脑血管病患者为观察组（包括冠心病、高血压、脑梗死3个小组）,选取同期健康者168例为对照组。对两组患者进行胰岛素释放试验,并比较两组差异。结果：空腹血糖两组比较差异有统计学意义（P〈0.05）;餐后2h、餐后3h糖耐量浓度比较,差异有显著统计学意义（P〈0.01）;空腹、餐后2h、餐后3h胰岛素水平比较,差异均有统计学意义（P〈0.05）。胰岛素敏感指数比较,差异有统计学意义（P〈0.01）;空腹、餐后1h、餐后2h、餐后3hC-肽浓度比较,差异有统计学意义（P〈0.01）。结论：胰岛素释放试验可作为监测冠心病、高血压、脑梗死等心脑血管病的重要指标。     

妊娠期糖尿病妇女脂肪细胞中胰岛素受体底物-1的研究

目的探讨妊娠期糖尿病(GDM)妇女孕晚期脂肪细胞胰岛素受体底物-1(IRS-1)表达的改变。方法健康孕妇和GDM孕妇各20例,入院第2天采用葡萄糖氧化酶法测定空腹血糖和餐后2h血糖,剖宫产时取皮下脂肪约1cm3,用Wester-blot方法测定IRS-1。结果GDM孕妇空腹血糖与健康孕妇差异无统计学意义(P>0.05);GDM孕妇餐后2h血糖较健康孕妇显著升高(P<0.05);GDM孕妇脂肪细胞IRS-1含量显著低于健康孕妇(P<0.05)。结论GDM孕妇与健康孕妇相比皮下脂肪细胞IRS-1表达显著降低。     

趋于无峰、可重复的长效胰岛素——基于葡萄糖钳夹试验的基础胰岛素类似物评价

虽然已经证实两种基础胰岛素类似物——甘精胰岛素和地特胰岛素优于中性鱼精蛋白胰岛素，但是对这两种胰岛素类似物的相对优势尚存在争议。普遍认为这两种类似物在药效学方面存在差异，尤其是作用的峰值和时间。     

门冬胰岛素和生物合成人胰岛素治疗妊娠期糖尿病的疗效及安全性分析

目的比较两种不同的胰岛素治疗妊娠糖尿病的效果和不良反应的发生。方法 2015年1月至2016年6月,我们医院内妇产科患者78例妊娠期糖尿病患者,分为对照组(应用生物合成人胰岛素)和观察组(应用门冬胰岛素),比较两组的效果和不良反应的发生。结果观察组患者空腹和餐后2 h血糖、糖化血红蛋白水平和胰岛素的每天的剂量优于对照组(P<0.05),观察组低血糖的发生率为5.13%,对照组为17.95%,观察组患者不良妊娠结局的发生率为7.69%,对照组的17.95%,两组之间的差异有统计学意义(P<0.05)。结论生物合成的胰岛素和门冬胰岛素都能够改善妊娠期糖尿病患者的血糖水平,但门冬胰岛素的临床疗效和安全性更显著,值得在临床中广泛应用。     

葡萄糖浓度感应型胰岛素控制释放膜研究

The pore size and permeability control of a glucose-responsive gating membrane with plasma-grafted poly(acrylic acid) (PAAC) gates and covalently bound glucose oxidase (GOD) enzymes were investigated systematically. The PAAC-grafted porous polyvinylidene     

2型糖尿病患者糖耐量试验与胰岛素释放试验相关性分析

目的 通过对糖耐量试验与胰岛素释放试验相关性研究,探讨其对2型糖尿病的诊断与治疗的临床意义.方法 对248例糖病病患者入院治疗前按其空腹胰岛素水平分为空腹低值组(A组)、空腹低值有峰组(B组)、空腹中值组(C组)、空腹高值组(D组)及44例正常对照组(E组),分别采用Backman LX20已糖激酶法测定空腹、糖耐量试验1、2、3 h的血糖和用美国Backman Asscey化学发光仪测定相应的胰岛素水平.结果 糖尿病患者各组胰岛素水平较正常人群组差异有显著性意义(P＜0.05)或非常显著意义(P＜0.01),A组、B组、C组、E组其血糖水平与相应的胰岛素水平具有正相关性,D组血糖水平与相应的胰岛素水平无相关性.结论 2型糖尿病患者在治疗前做糖耐量试验(OGTT)与胰岛素释放试验对其诊断治疗与预后有很重要临床意义.     

Glucose metabolism and insulin receptor signal transduction in Alzheimer disease

Nosologically, Alzheimer disease is not a single disorder in spite of a common clinical phenotype. Etiologically, two different types or even more exist. (1) In a minority of about 5% or less of all cases, Alzheimer disease is due to mutations of three genes, resulting in the permanent generation of βA4. (2) The great majority (95% or more) of cases of Alzheimer disease are sporadic in origin, with old age as main risk factor, supporting the view that susceptibility genes and aging contribute to age-related sporadic Alzheimer disease. However, disturbances in the neuronal insulin signal transduction pathway may be of central pathophysiological significance. In early-onset familial Alzheimer disease, the inhibition of neuronal insulin receptor function may be due to competitive binding of amyloid beta (Aβ) to the insulin receptor. In late-onset sporadic Alzheimer disease, the neuronal insulin receptor may be desensitized by inhibition of receptor function at different sites by noradrenaline and/or cortisol, the levels of which both increase with increasing age. The consequences of the inhibition of neuronal insulin signal transduction may be largely identical to those of disturbances of oxidative energy metabolism and related metabolism, and of hyperphosphorylation of tau-protein. As far as the metabolism of amyloid precursor protein (APP) in late-onset sporadic Alzheimer disease is concerned, neuronal insulin receptor dysfunction may result in the intracellular accumulation of Aβ and in subsequent cellular damage. In this context, the desensitization of the neuronal insulin receptor in late-onset sporadic Alzheimer disease is different from that occurring in normal aging and early-onset familial Alzheimer disease. In late-onset sporadic Alzheimer disease changes in the brain are similar to those caused by non-insulin-dependent diabetes mellitus.     

Glucose transporters and insulin action: Some insights into diabetes management

Insulin stimulates glucose uptake in muscle and adipose cells primarily by recruiting GLUT4 from an intracellular storage pool to the plasma membrane. Dysfunction of this process known as insulin resistance causes hyperglycemia, a hallmark of diabetes and obesity. Thus the understanding of the mechanisms underlying this process at the molecular level may give an insight into the prevention and treatment of these health problems. GLUT4 in rat adipocytes, for example, constantly recycles between the cell surface and an intracellular pool by endocytosis and exocytosis, each of which is regulated by an insulin-sensitive and GLUT4-selective sorting mechanism. Our working hypothesis has been that this sorting mechanism includes a specific interaction of a cytosolic protein with the GLUT4 cytoplasmic domain. Indeed, a synthetic peptide of the C-terminal cytoplasmic domain of GLUT4 induces an insulin-like GLUT4 recruitment when introduced in rat adipocytes. Relevance of these observations to a novel euglycemic drug design is discussed.     

复方阿奇霉素葡萄糖注射液无菌检查法方法学研究

目的：建立复方阿奇霉素葡萄糖注射液的无菌检查方法。方法：本试验取复方阿奇霉素葡萄糖注射液，按《中国药典》2005年版二部（附录ⅪH）（以下简称“CP2005”）所载“无菌检查方法”项下进行试验。结果：样品管无菌生长，六珠阳性对照菌生长良好。结论：采用方法验证试验Ⅲ进行复方阿奇霉素葡萄糖注射液无菌检查，可行。     

糖代谢异常孕妇380例临床分析

目的 探讨孕妇糖代谢异常与妊娠并发症的关系及应用胰岛素改善妊娠结局的情况.方法 380例糖代谢异常孕妇按照糖代谢异常情况分为糖尿病合并妊娠24例(DM组)、妊娠期糖尿病164例(GDM组)、妊娠期糖耐量异常192例(GIGT组),观察三组妊娠并发症发生情况;同时将380例孕妇分成饮食加胰岛素治疗136例(胰岛素组)、单纯饮食控制244例(饮食组)进行妊娠结局对比分析.结果 DM组、GDM组、CIGT组的子痫前期发生率分别为41.7%(10/24)、15.9%(26/164)、15.6%(30/192),早产发生率分别为41.7%(10/24)、18.3%(30/164)、20.7%(38/192),差异均有统计学意义(均P<0.05);巨大儿、羊水过多、胎儿宫内窘迫发生率三组比较,差异无统计学意义(均P>0.05);DM组新生儿窒息、低血糖的发生率均高于GDM组和GIGT组(均P<0.01).胰岛素组新生儿出生体重平均为(2.9±1.3)kg,低于饮食组(3.8±1.0)kg,差异有统计学意义(P<0.05).结论 孕妇早产、子痈前期发生率、新生儿窒息、低血糖发生率与糖代谢紊乱有关,胰岛素的应用可以改善糖代谢异常孕妇的妊娠结局.     

Glucose, insulin and the brain: modulation of cognition and synaptic plasticity in health and disease: a preface

The brain has long been viewed as an insulin-insensitive organ. Following the demonstration of insulin receptors in the brain, this assumption has been challenged, and a whole new field of research has emerged. Insulin appears to play a role in brain physiology, and disturbances of cerebral insulin signalling and glucose homeostasis are implicated in brain pathology. This special issue of the European Journal of Pharmacology provides an overview of research into the involvement of glucose and insulin in the modulation of cognition and synaptic plasticity in health and in disease. In three sections, the effects of glucose and insulin on the brain will be discussed from a physiological perspective, in relation to brain ageing and Alzheimer's disease, and in relation to diabetes mellitus, respectively. These subjects will be covered from various angles, from the level of molecular neurosciences, to the level of applied neuropsychology.     

Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK

ABSTRACT

Objectives: In women with type 1 diabetes, poor glycaemic control during pregnancy is associated with high risk of pre-term delivery, perinatal mortality and morbidity. This economic analysis utilises clinical effectiveness data from the Insulin Aspart Pregnancy Study Group Trial to assess costs and outcomes associated with insulin aspart (IAsp) and human insulin (HI) as part of a basal-bolus insulin regimen in pregnant women with type 1 diabetes in the UK.

Research design and methods: Women with type 1 diabetes were enrolled if ≤?10 weeks pregnant or planning to become pregnant, and had HbA_1c ≤?8% at confirmation of pregnancy. Subjects were randomised to treatment with IAsp or HI in a basal-bolus regimen with NPH insulin, with doses titrated according to American Diabetes Association guidelines. An effectiveness endpoint, retrospectively defined for this analysis, was the percentage of women with a live birth at term (≥37 weeks’ gestation). We considered costs of insulin, adverse events, delivery, and neonatal care for pre-term infants. Expected need for neonatal care was estimated from gestational age, using data from the literature and a large UK hospital. Costs were calculated from the perspective of the UK National Health Service.

Results: A total of 322 pregnant women were enrolled in the study and the outcome of pregnancy was known for 302, 151 in each arm. More women experienced a live birth at term with IAsp (72.8%) than with HI (60.9%), difference 11.9% (95% CI 2.0%, 22.5%, p?=?0.028). Mean cost per woman was £3222 for IAsp and £3539 for HI, difference ?£318 (95% CI ?£1353, £576; p?=?0.49).

Conclusions: Compared with HI, the use of IAsp in pregnant women with type 1 diabetes resulted in more live births at term, without increasing total costs of treatment. A prospectively defined study is required to confirm these conclusions.     

不同糖代谢状态血管内皮功能及胰岛素抵抗、胰岛素分泌功能研究

目的研究不同糖代谢状态血管内皮功能和胰岛素抵抗、胰岛素分泌功能及其相互关系。方法初诊2型糖尿病组47例,糖调节受损组89例,正常糖耐量组137例。采用高分辨率血管外超声法检测肱动脉血管血流介导的内皮依赖性血管舒张功能(EDD)和硝酸甘油介导的内皮非依赖性血管舒张功能(NTG),并应用胰岛素抵抗指数评价胰岛素抵抗,B细胞功能指数、△I30/△G30分别评价基础状态下及糖负荷后的早期胰岛素分泌功能。结果初诊2型糖尿病组和糖调节受损组EDD较正常糖耐量组显著降低,分别为6.16±2.92,7.87±3.19和9.32±3.46(P<0.05~0.01),初诊2型糖尿病组又低于糖调节受损组(P<0.05)。初诊2型糖尿病组和糖调节受损组HOMA-IR显著升高(P均<0.01),△I30/△G30显著降低(P<0.05~0.01),后者在初诊2型糖尿病组降低更明显(P<0.05)。初诊2型糖尿病组HOMA-B显著降低(P<0.05)。EDD与HOMA-IR负相关(r=-0.301,P<0.01),与△I30/△G30正相关(r=0.418,P<0.01)。结论糖代谢紊乱早期即可见内皮功能障碍,后者主要与胰岛素抵抗和早期胰岛素分泌缺陷相关。     

甲亢患者糖耐量的改变及胰岛素抵抗的研究

目的：探讨甲状腺功能亢进症（甲亢）患者糖耐量的改变及其发病机制。方法：对本院收治的84例甲状腺功能亢进患者的临床资料进行回顾性分析,甲亢糖耐量减低者52例,为A组。甲亢糖耐量达诊断糖尿病标准者32例,为B组。正常对照组24例,为C组。进行空腹及早餐后2 h血糖、胰岛素测定,计算胰岛素敏感性指标（ISI）、胰岛细胞分泌功能指标（HOMA-IS）及胰岛素抵抗指数（HOMA-IR）并进行比较。结果：IAI、HOMAIR：A、B两组与C组相比明显低下或增高（P〈0.05）。HOMAIS：A组与C组相比差异无统计学意义,B组与C组相比明显低（P〈0.05）。结论：甲状腺激素可影响糖代谢,出现高血糖及高胰岛素血症,存在胰岛素抵抗。     

妊娠合并慢性丙型病毒性肝炎患者胰岛素抵抗状况分析

目的 分析妊娠合并慢性丙型病毒性肝炎患者的胰岛素抵抗状况.方法 选择87例妊娠合并慢性丙型病毒性肝炎患者为观察组,80例未合并丙型肝炎孕妇为对照组.检测并比较两组空腹血糖(FPG)、空腹胰岛素(FINS)水平和胰岛素抵抗指数(IRS).结果 观察组FPG、FINS、IRS分别为(5.40±1.01)mmol/L、( 69.43±38.05) mU/L和(16.65±12.29),对照组分别为(4.53±0.56) mmol/L、( 50.54±20.07) mU/L和(10.17±4.66),两组差异均有统计学意义(=3.26、3.87、4.01,均P＜0.05).结论 妊娠合并慢性丙型病毒性肝炎患者存在明显的胰岛素抵抗.     

六黄合剂对胰岛素抵抗大鼠糖耐量和血清胰岛素的影响

目的探讨六黄合剂对胰岛素抵抗大鼠糖耐量和血清胰岛素的影响。方法应用地塞米松致大鼠胰岛素抵抗(IR)模型,观察六黄合剂对大鼠血糖、血清胰岛素的变化。结果六黄合剂能够降低胰岛素抵抗大鼠口服葡萄糖耐量试验后2h血糖浓度(2hBG)和空腹血清胰岛素水平(FINS)(P<0.01)。结论六黄合剂可以改善葡萄糖耐量减退(IGT)和IR。