空腹高血糖的2型糖尿病患者加用甘精胰岛素或中性鱼精蛋白锌胰岛素的比较研究

单用口服降糖药血糖控制不佳的2型糖尿病患者分别加用甘精胰岛素或中性鱼精蛋白锌胰岛素(NPH)联合治疗3个月,然后停止胰岛素治疗,恢复原口服治疗方案,共观察6个月。结果甘精胰岛素组的HbAIC和餐后血糖低于NPH组[治疗3个月(6．1±0．5)％vs(6．9±0．8)％和(7．2±2．1)mmol／L vs(9．3±3．1)mmol／L,治疗6个月(6．6±0．7)％vs(7．4±1．1)％和(8．8±2．8)mmol／Lvs(10．3±3．1) mmoL／L,P<0．01或P<0．05],两指标的下降值甘精胰岛素组大于NPH组[治疗3个月(4．0±0．7)％vs (3．7±0．6)％和(7．1 4-2．0)mmol／Lvs(5．9±1．8)mmol／L,治疗6个月(3．5±0．5)％vs(3．2±0．3)％和(5．5±1．4)mmol／Lvs(4．9±1．3)mmol／L,P<0．01或P<0．05],提示使用甘精胰岛素可以在不增加不良反应的情况下比NPH更加全面而有效地控制血糖。     

甘精胰岛素联合格列美脲及阿卡波糖治疗磺脲类治疗失效的2型糖尿病患者血糖控制效果的观察

目的研究甘精胰岛素联合格列美脲及阿卡波糖治疗发生磺脲类治疗失效(SFS)的T2DM患者的临床效果。方法选取SFS的T2DM患者48例,采用甘精胰岛素联合格列美脲及阿卡波糖治疗方案,持续3个月,对比治疗前后的血糖及相关指标变化情况。结果经3个月治疗后,TG、TC、LDL-C较治疗前降低,HDL-C较治疗前提高,但比较差异无统计学意义(P0.05);FPG[(11.2±1.8)vs(5.4±1.2)mmol/L]、2 hPG[(16.7±5.5)vs(8.7±3.6)mmol/L]、24 h最高血糖值[(20.1±3.5)vs(10.2土2.4)mmol/L]、平均血糖值[(15.6±3.3)vs(6.5±1.3)mmol/L]、HbA_1 c[(10.9±1.3)%vs(7.6±0.8)%]、胰岛素抵抗指数(HOMA-IR)[(13.06±6.35)vs(9.02±3.16)]均较治疗前降低(P0.05),FC-P[(2.04±0.16)vs(2.29±0.20)ng/ml]、2 hC-P[(3.59±0.61)vs(4.13±0.72)ng/ml]、胰岛β细胞功能指数(HOMA-β)[(142.64±26.95)vs(178.86±33.92)]均较治疗前提高(P0.05);24 h血糖达标维持时间长于治疗前[(19.2±-3.7)vs(2.5±1.6)h](P0.05)。结论甘精胰岛素联合格列美脲及阿卡波糖治疗SFS的T2DM患者能有效控制血糖,患者24 h血糖控制效果更佳。     

动态血糖监测探讨2型糖尿病患者睡前血糖和夜间低血糖的关系

85例2型糖尿病患者使用动态血糖监测系统(CGMS)监测血糖,每例记录48-72 h,共计完整记录220 d。以睡前血糖≤4．4 mmol／L,≤5．0 mmoL／L,≤5．6 mmol／L,≤6．1 mmol／L,≤6．7 mmol／L,≤7．2 mmol／L,评估这些患者的夜间低血糖(《2．8 mmol／L)的发生情况。26例患者39夜发生夜间低血糖,他们的睡前血糖为(4．4±2．6)mmol／L(2．2-12．6 mmoL／L)。在睡前血糖≤6．7 mmol／L时ROC曲线下面积达最大值(0．359±0．046),其阳性预测值25．0％,阴性预测值91．7％。CGMS是诊断夜间无症状性低血糖的有效方法。     

二甲双胍分别联合利拉鲁肽及甘精胰岛素治疗2型糖尿病的临床观察

目的观察单纯使用二甲双胍血糖控制不佳的2型糖尿病患者分别联合利拉鲁肽及甘精胰岛素治疗的临床疗效与安全性。方法纳入2012年2月至2013年5月在北京军区总医院内分泌科门诊就诊的单纯使用二甲双胍超过3个月血糖控制不佳[糖化血红蛋白(Hb A1c)7%]的2型糖尿病患者40例,其中男性28例,女性12例,年龄34~70岁,平均年龄(51.5±7.3)岁。所有患者在继续服用盐酸二甲双胍片(≥1500 mg/d)的基础上,随机分为两组,利拉鲁肽组和甘精胰岛素组,每组各20例。分别联合应用利拉鲁肽及甘精胰岛素治疗12周后,比较两组患者治疗前后Hb A1c、空腹血糖、餐后2 h血糖、血脂、体质指数(BMI)及低血糖等不良反应的发生情况。结果与治疗前比较,利拉鲁肽组治疗后BMI[(28.32±0.35)kg/m2 vs.(26.75±1.10)kg/m2]、空腹血糖[(10.23±2.14)mmol/L vs.(7.06±1.09)mmol/L]、餐后2小时血糖[(14.68±4.43)mmol/L vs.(9.35±1.84)mmol/L]、低密度脂蛋白胆固醇[(2.76±0.97)mmol/L vs.(2.05±0.97)mmol/L]下降,差异有统计学意义(P均0.05);Hb A1c[(8.84±1.15)%vs.(7.34±0.66)%]下降,差异有显著统计学意义(P0.01)。与治疗前比较,甘精胰岛素组治疗后空腹血糖[(9.78±1.06)mmol/L vs.(6.72±1.58)mmol/L]下降,差异有统计学意义(P均0.05);Hb A1c也[(8.34±0.48)%vs.(7.44±0.28)%]下降,差异有显著统计学意义(P0.01)。与甘精胰岛素组治疗后比较,利拉鲁肽组治疗后低密度脂蛋白胆固醇降低,差异有统计学意义(P0.05)。两组患者治疗期间均未发生低血糖,利拉鲁肽组有3例出现轻微胃肠道反应,甘精胰岛素组无胃肠道反应。结论单纯使用二甲双胍3个月后血糖控制不佳的2型糖尿病患者联合应用利拉鲁肽及甘精胰岛素治疗安全有效,利拉鲁肽值得临床推广应用。     

沙格列汀或格列美脲联合甘精胰岛素对2型糖尿病患者血糖波动影响的观察

目的观察沙格列汀联合甘精胰岛素及格列美脲联合甘精胰岛素对T2DM患者血糖波动的影响。方法 60例未接受胰岛素治疗且血糖控制不佳的T2DM患者被随机分为沙格列汀联合甘精胰岛素组和格列美脲联合甘精胰岛素组,共治疗12周。采用动态血糖监测系统(CGMS)监测血糖波动情况,观察BMI、FPG、HbA1c及胰岛素用量等指标。结果两组血糖控制均改善,沙格列汀联合甘精胰岛素组日内血糖平均波动幅度(MAGE)、日内血糖波动次数(NGE)、日间血糖平均绝对差(MODD)低于格列美脲联合甘精胰岛素组[(2.2±1.0)vs(4.1±1.9)mmol/L;(1.4±1.4)vs(2.6±1.5)次/d;(1.30±0.65)vs(2.60±0.90)mmol/L,P<0.05]。两组治疗后FPG及HbA1c均降低[沙格列汀联合甘精胰岛素组(10.5±2.1)vs(6.2±1.3)mmol/L,(8.7±1.2)%vs(6.3±1.1)%;格列美脲联合甘精胰岛素组(10.4±1.8)vs(6.1±1.4)mmol/L,(8.9±1.4)%vs(6.5±1.2)%](P均<0.01);沙格列汀联合甘精胰岛素组BMI低于格列美脲联合甘精胰岛素组[(22.2±2.4)vs(25.5±2.7)kg/m2](P<0.05)。结论沙格列汀联合甘精胰岛素可有效控制血糖,改善血糖波动,在血糖控制稳定性方面优于格列美脲联合甘精胰岛素。     

阿卡波糖治疗老年2型糖尿病合并慢性肾功能不全

采用阿卡波糖联合中效或预混胰岛素治疗52例老年T2DM合并慢性肾功能不全患者6—24月,结果治疗前后：FBG：7．7±2．7mmol／L vs 6．3±1．1mmol／L,2hPG：11．4±3．9mmol／L vs 8．7±1．2mmol/L,HbA1c：7．4±1．8％vs 6．6±1．5％,24小时尿蛋白定量：2．6±1．7g／24h vs 1．9±1．2g／24h,胰岛素用量：26．8±5．2U／d vs 22．3±3．4U／d有显著性差异（P〈0．05）。Scr（148．3±82．8 vs 150．7±98．5）及CCr（38．5±14．4ml／min vs 38．7±14．4ml／min）仅轻度升高,体重轻度下降（66．0±9．3kg vs 65．5±9．5kg）,均无统计学意义（P〉0．05）,且治疗后胰岛素用量减少（P〈0．05）。结论阿卡波糖治疗老年T2DM合并慢性肾功能不全患者,能有效控制血糖,降低且不加重肾功能损害。     

甘舒霖R联合甘精胰岛素治疗脆性糖尿病

将24例脆性糖尿病患者随机分为应用阿卡波糖联合甘精胰岛素治疗(对照组)12例、应用甘精胰岛素联合甘舒霖R治疗(治疗组)12例,观察两组患者治疗后两周内低血糖相关指标和其他血糖波动参数,包括低血糖发生率(PT3.9,即血糖低于3.9 mmol/L的时间比)、低血糖发生次数、高血糖发生率(PT7.8、PT11.1,即血糖高于7.8 mmol/L或11.1mmol/L的时间比)、血糖波动系数(即连续测定的血糖值标准差,SDBG)最大血糖波动幅度(LAGE)和平均血糖波动幅度(MAGE),3月后比较两组患者上述参数及糖化血红蛋白的水平。结果对照组PT7.8[(21.85±11.43)%]、PT11.1[(35.54±12.1)%]、SDBG(4.34±0.94)、LAGE[(13.21±1.82)mmol/L]、MAGE[(10.5±1.37)mmol/L]和HbA_(1C)(%)[(8.5.±2.1)%]等指标均高于治疗组(54.56±12.56)%、(19.45±10.5)%、(2.81±1.12)、(10.13±2.31)mmol/L、(7.4±1.45)mmol/L]、[(6.4±1.1)%]的糖尿病患者。差异均有高度统计学意义(均P0.01)。对照组的PT3.9[(10.13±2.4)%]和治疗组的[(12.57±3.5)%]结果相似,无统计学意义(P0.05)。结论甘精胰岛素联合阿卡波糖难以平稳控制脆性糖尿病患者血糖水平,应用甘精胰岛素联合甘舒霖R可以有效控制全天血糖。     

甘精胰岛素联合阿卡波糖治疗非肥胖2型糖尿病临床观察

目的 评价甘精胰岛素联合阿卡波糖对非肥胖2型糖尿病血糖控制及低血糖事件的影响.方法 非肥胖2型糖尿病患者49例,分为甘精胰岛素联合阿卡波糖组(24例)应用甘精胰岛素日一次皮下注射配合阿卡波糖片日三次口服;预混人胰岛素组(25例)应用预混型人胰岛素70/30早晚餐前30分钟皮下注射.12周后随访血糖控制和低血糖事件发生情况.结果 两组空腹血糖,餐后2小时血糖,糖化血红蛋白较治疗前明显下降(P＜0.01).甘精胰岛素联合阿卡波糖组空腹血糖控制优于B组[(6.63±0.73)mmol/ L 对(7.21±0.88)mmol/ L )](P＜0.05),甘精胰岛素联合阿卡波糖组2例,预混人胰岛素组8例出现低血糖,两组比较差异有显著性(P＜0.05).结论 甘精胰岛素与阿卡波糖联合应用更好地改善了血糖控制,减少了低血糖发生率,增加了患者依从性.     

肥胖青少年血清瘦素、胰岛素和胰岛素原水平的变化

目的　检测肥胖青少年血清瘦素、胰岛素、胰岛素原水平的变化 ,探讨青少年肥胖与代谢综合征的关系。方法　从年龄 14～ 16岁的 2 2 17例学生中筛选出体重指数 (BMI)≥ 2 5kg/m2 的肥胖学生 (肥胖组 ) 198例 ,BMI在 18 5～ 2 3 0kg/m2 之间的体重正常学生 (正常组 ) 78例 ,用放射免疫方法测定血清瘦素、胰岛素和胰岛素原水平 ,同时测定血糖及血脂水平 ,比较两组间差异。结果　血清瘦素水平女生明显高于同龄男生 [(18 5 3± 1 4 1) μg/L比 (6 33± 1 79) μg/L]。肥胖组血清瘦素、胰岛素和胰岛素原水平均高于同龄体重正常者 [分别为 (19 94± 1 91) μg/L比 (11 2 7± 2 0 4 ) μg/L ,(15 34± 1 6 6 ) μIU/L比 (13 17± 1 4 3) μIU/L ,(16 19± 1 6 4 )pmol/L比 (11 79± 1 70 )pmol/L ],血糖、甘油三酯 (TG)和高密度脂蛋白胆固醇 (HDL C)水平虽然在正常范围内 ,但肥胖者血糖和TG水平高于同龄体重正常者 [分别为 (4 6 3± 0 5 0 )mmol/L比 (4 13± 0 33)mmol/L ,(1 2 0± 0 5 6 )mmol/L比 (0 90±0 32 )mmol/L],HDL C水平低于同龄体重正常者 [(1 14± 0 2 4 )mmol/L比 (1 38± 0 2 6 )mmol/L]。结论　肥胖青少年可能存在瘦素抵抗、胰岛素抵抗及潜在的糖代谢和脂代谢异常等代谢综合征改变 ,     

应用动态血糖监测评价甘精胰岛素治疗2型糖尿病患者血糖控制的研究

目的观察应用动态血糖监测(CGM)评价甘精胰岛素治疗的门诊T2DM患者治疗方案调整前后血糖控制情况。方法选取2017年2月至2018年8月于我院内分泌科门诊治疗的T2DM患者105例,随访3个月。随访前后均进行72 h CGM监测,测定血糖、HbA_1c、胰岛功能等指标。结果 105例患者基线HbA_1c(8.11±1.52)%,HbA_1c7%达标率为24.3%。79例患者完成本研究。治疗方案调整后胰岛素及二甲双胍使用率增加[(21.59±8.36)vs(18.77±5.63)U/d,74.68%vs 53.16%,P0.05];FBG、HbA_1c及C-P_(120 min/0 min)较调整前改善[(8.63±2.62)vs(7.06±1.91)mmol/L,(8.29±1.52)%vs(7.26±1.00)%,(2.52±1.30)vs(3.60±1.67),P0.05];24 h平均血糖(24 hMBG)、日内血糖平均波动幅度(MAGE)较调整前下降[(10.15±2.59)vs(8.65±1.71)mmol/L,(5.75±2.73)vs(5.04±2.9)mmol/L,P0.05]。结论甘精胰岛素联合口服药物降糖治疗的T2DM门诊患者整体血糖控制效果欠佳。增加胰岛素剂量及二甲双胍使用率后,患者血糖、餐后胰岛功能反应性、胰岛细胞敏感性及血糖波动均得到改善。     

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.     

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.     

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.