对新诊断的糖尿病患者筛查谷氨酸脱羧酶抗体的意义

目的 探讨筛查谷氨酸脱羧酶抗体(GADA)对新诊断糖尿病患者的临床意义.方法 分析200例糖尿病患者的生化特点,采用酶联免疫法测定GADA,放射免疫法测定血清C肽,并进行统计分析.结果 200例新诊断的糖尿病患者中,GADA阳性者15例,占7.5%;GADA阳性组患者较阴性组患者体重指数低(P＜0.01)、空腹及餐后2 h血清C肽水平低(P＜0.01),酮症发生率明显升高(P＜0.01);年龄、血糖、血脂及糖化血红蛋白值,两组比较差别无统计学意义(P＞0.05).结论 对新诊断的糖尿病患者进行GADA筛查,抗体阳性患者因其胰岛细胞功能较差,应尽早采用胰岛素降糖治疗,可延缓胰岛细胞功能衰竭及糖尿病慢性并发症的发生.     

以成人酮症起病糖尿病的临床研究

目的 探讨成人酮症起病肥胖糖尿病临床特征及其酮症起病的可能机制.方法 选择新诊断糖尿病患者80例,根据入院时BMI、FBG和尿酮体状况分为非酮症组(A组)、非肥胖酮症组(B组)和肥胖酮症组(C组).入院后均予胰岛素或胰岛素类似物强化治疗.应用稳态模型评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA-β).随访患者出院后病情转归和用药情况.结果 (1)3组胰岛素强化治疗前的FBG、2hBG比较差异均无统计学意义(P＞0.05),C组HbA1c较A组降低(P＜0.05).C组BMI、TG水平、脂肪肝患病率和HOMA-IR均高于A、B组(P＜0.05或P＜0.01),而HDL-C降低(P＜0.05),3组间TC、LDL-C比较差异无统计学意义(P＞0.05).(2)3组起病时均有IR和胰岛β细胞功能损害,C组IR更加严重.C组强化治疗后,多数患者可停用胰岛素或胰岛素类似物,甚至在一定时间内,单纯生活方式干预即可良好地控制血糖.结论 酮症倾向肥胖糖尿病患者尚保存一定的胰岛β细胞功能.与普通T2DM患者相比,该型糖尿病患者有更严重的IR,解除脂毒性在病程中可能起到更重要的作用,其临床特征及自然病程更符合T2DM.     

α-硫辛酸联合胰岛素强化治疗对初诊2型糖尿病患者的疗效观察

目的 观察α-硫辛酸联合胰岛素泵强化降糖治疗对初诊2型糖尿病患者胰岛β细胞功能的保护作用.方法 对空腹血糖≥9.0 mmol/L和(或)餐后2小时血糖≥14.0 mmol/L的50例初诊2型糖尿病患者进行为期2周的α-硫辛酸联合胰岛素泵强化治疗,比较治疗后血糖、口服葡萄糖耐量试验(OGTT)胰岛素及C肽分泌值、超敏C反应蛋白(hs-CRP)和胰岛β细胞功能等.结果 2用的强化治疗显示出确切的降糖效果,联合治疗组呈现出更好的β细胞功能状态,出现了明显增加的胰岛素、C肽分泌相(P＜0.01),胰岛β细胞功能明显改善(P＜0.01),hs-CRP值明显下降(P＜0.01).结论 初诊2型糖尿病患者采用α-硫辛酸联合胰岛素泵强化治疗,能显著改善炎症状态,恢复胰岛β细胞功能.     

自发酮症起病的糖尿病87例临床特征及分型探讨

目的探讨自发酮症起病的糖尿病的临床特征及分型。方法将2003-01～2004-05南京鼓楼医院收治的自发酮症起病的糖尿病患者(87例)根据自身抗体阳性与否,分为抗体阴性组(67例)及抗体阳性组(1A型糖尿病组)(20例)。抗体阴性的患者依据是否依赖胰岛素治疗,进一步分为胰岛素依赖组(27例)及非胰岛素依赖组(40例)。不同组别的临床特征、生化指标之间进行比较。结果抗体阴性组男性发生率显著高于女性;具明显的家族遗传倾向;起病时体重指数显著高于1型糖尿病组,甘油三酯水平高于其他两组;空腹及餐后2hC肽水平介于2型及1型糖尿病组之间。胰岛素依赖组较胰岛素非依赖组具更强的男性易患性;超重和肥胖患者所占比例较低;酮症程度较重;血糖及空腹C肽水平两组之间差异无显著性;3个月后空腹C肽水平,非胰岛素依赖组显著高于胰岛素依赖组。结论酮症起病的糖尿病依据抗体阳性与否,分为抗体阴性和抗体阳性酮症起病的糖尿病,后者即为1A型糖尿病。抗体阴性酮症起病的糖尿病可依据是否依赖胰岛素治疗,分为酮症起病的2型糖尿病和特发性1型糖尿病(1B型糖尿病)。     

西格列汀联合甘精胰岛素对老年2型糖尿病患者胰岛功能及血糖指标的影响

目的探讨西格列汀联合甘精胰岛素对老年2型糖尿病患者胰岛功能和血糖指标的影响。方法选择2017年1月—2018年1月在忻州市人民医院进行治疗的老年2型糖尿病患者90例,随机分为观察组和对照组,每组患者45例,其中观察组患者采用甘精胰岛素联合西格列汀治疗,对照组采用甘精胰岛素治疗。连续治疗12周后,对两组患者治疗前后的胰岛功能包括空腹C肽、餐后2 h C肽;血糖指标包括空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbAlc)进行统计比较,比较两组患者治疗期间不良反应发生率。结果治疗后两组患者胰岛功能指标空腹C肽、餐后2 h C肽水平均有升高,且观察组患者的空腹C肽、餐后2 h C肽均高于对照组(P0.05)。两组患者治疗后的FBG、2 h PG及HbAlc水平均有明显下降,且观察组的FBG、2 h PG及HbAlc水平均明显低于对照组,差异有统计学意义(P0.05)。观察组不良反应发生率15.56%与对照组不良反应发生率8.89%比较差异无统计学意义(P0.05)。结论西格列汀联合甘精胰岛素对老年2型糖尿病患者的胰岛功能及血糖指标有更好的改善效果,且用药安全性好,有一定的临床应用价值。     

Effect of early insulin pump intensive therapy on GLP-1 of newly diagnosed type 2 diabetes

目的 探讨早期胰岛素泵强化治疗(CSII)对初发2型糖尿病患者胰高血糖素样肽-1(GLP-1)的影响.方法 将40例初发的2型糖尿病患者随机分为两组:胰岛素泵(CSII)组(20例)及常规皮下注射胰岛素(MSII)组(20例),比较两组患者治疗前后的空腹血糖(FPG)、2小时餐后血糖(2hPG)、GLP-1及C肽等各项指标变化.结果 CSII组和MSII组治疗前后FPG、2hPG水平均较治疗前明显下降,GLP-1及C肽较治疗前明显升高,差异均具有统计学意义(P＜0.05).CSII组FPG、2hPG、GLP-1及C肽治疗前后变化量明显高于MSII组(P＜0.05).结论 早期胰岛素泵强化治疗明显升高初发2型糖尿病患者GLP-1水平,在糖尿病早期,不仅可以有效控制血糖,还可以通过升高GLP-1改善胰岛功能,提高胰岛素敏感性.     

铁过负荷对2型糖尿病患者糖脂代谢和胰岛β细胞功能的影响

目的 探讨铁过负荷对2型糖尿病患者糖脂代谢和胰岛β细胞功能的影响.方法 302例2型糖尿病患者根据血清铁蛋白水平分为铁蛋白升高组.比较两组的空腹和餐后2小时的血糖、C肽、糖化血红蛋白(HbA1C)、血清总胆固醇、甘油三酯的水平.结果 铁蛋白升高组的空腹和餐后2小时血糖、HbA1C高于铁蛋白正常组,餐后2小时C肽低于铁蛋白正常组.结论 铁过负荷可能对2型糖尿病患者的胰岛β细胞功能和血糖控制产生负面影响.     

血清IGF-1水平与2型糖尿病肾病的相关性

目的 探讨IGF-1与糖尿病肾病(DN)的相关性.方法 收集100例来自2010年9月至2013年7月于我院住院、并按WHO(1985年)标准确诊的2型糖尿病(DM)患者,其中单纯糖尿病组43例,DN组57例,通过检测IGF-1、尿微量白蛋白、空腹C肽等相关指标,进行分析.结果 (1)DM和DN组中年龄无统计学差异,DN组的病程、尿微量白蛋白、IGF-1均显著高于DM组(P＜0.01),而DN组C肽水平显著低于DM组(P＜0.01);(2)随着IGF-1水平的逐渐升高,DN逐渐加重(x2 =50.147,P＜0.01);(3)IGF-1水平与年龄无相关性,与病程、尿微量白蛋白呈正相关,与C肽水平呈负相关.结论 IGF-1水平与DN分期密切相关,其可能通过下调C肽水平促进DN的发展.     

早期胰岛素强化治疗对初发2型糖尿病胰岛B细胞功能的临床观察

目的分析对初发2型糖尿病患者采取早期胰岛素强化治疗,对患者胰岛B细胞功能的影响。方法选入该院于2016年8月—2017年8月期间进行治疗的初发2型糖尿病患者60例,以抽签法的形式将其分为实验组和对照组,分别为30例。对照组行口服降糖药物治疗,实验组行胰岛素泵强化治疗,对比2组患者不同时间段血糖变化、C肽变化,血糖达标时间。结果 2组患者在治疗之前,血糖变化、C肽变化差异无统计学意义(P0.05);治疗1个月之后,实验组的血糖变化比对照组明显,且实验组的C肽水平高于对照组(P0.05);治疗3个月之后,2组患者血糖变化差异无统计学意义(P0.05);实验组的C肽水平比对照组高(P0.05);实验组血糖达标时间比对照组短(P0.05)。结论对初发2型糖尿病患者,在早期进行胰岛素强化治疗,能够较好地控制血糖变化,解除高糖毒性,对胰岛B细胞功能起到较好的保护效果。     

2型糖尿病患者精氨酸刺激试验与胰高血糖素刺激试验的安全性比较

目的探讨2型糖尿病患者精氨酸刺激试验（AST）与胰高血糖素刺激试验（GST）的安全性。方法对68例2型糖尿病患者进行AST和GST,检测其血糖、C肽水平,记录不良反应。结果两种试验前患者空腹血糖水平无统计学差异（P〉0.05）;AST各时间点血糖水平比较差异有统计学意义（P均〈0.01）;AST后患者各时间点血糖水平低于GST后6 min（P〈0.01）;两种试验前后患者C肽水平无统计学差异（P〉0.05）。AST不良反应发生率明显低于GST（P〈0.05）。结论AST评估胰岛B细胞功能与GST结果接近,但安全性更好。     

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.     

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.     

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.     

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.