牙周状况对糖尿病肾病患者血糖控制的影响

目的 研究不同血糖控制水平的糖尿病肾病(diabetic nephropathy,DN)患者的牙周状况及特点,探讨牙周炎症程度对糖尿病肾病患者血糖控制的作用。方法 纳入119例糖尿病肾病患者,分为两组,糖化血红蛋白(glycosylated hemoglobin,HbA1c)良好(HbA1c<7%)组27例和糖化血红蛋白不良(HbA1c≥7%)组92例。牙周检查内容包括探诊深度(probing depth, PD)、出血指数(blood index, BI)、临床附着丧失(clinical attachment loss,CAL)以及口内余留牙数,口腔健康问卷包括口腔健康行为等。血清检测指标包括HbA1c、空腹血糖、总胆固醇等。结果 与HbA1c<7%组的患者相比,HbA1c≥7%组患者的PD(3.99±1.05 vs 3.49±0.93,P=0.031)、BI(3.45±0.58 vs 3.10±0.67,P=0.001)、CAL (6.40±2.18 vs 5.37±1.99,P=0.003)、PD≥4 mm 百分率(中位数:54.17% vs 38.15%,P=0.001), PD≥5mm百分率 (中位数:24.13% vs 12.85%,P=0.028)增加,差异具有统计学意义。多因素Logistic回归分析结果表明,除空腹血糖增加与HbA1c控制不良高度相关外,牙周检查指标CAL增加与DN患者HbA1c控制不良亦高度相关(OR=1.36,95%CI:1.01-1.83,P=0.043)。结论 糖尿病肾病患者的HbA1c控制情况与牙周炎症程度有关,CAL增加与糖尿病肾病患者HbA1c控制不良高度相关。     

预混胰岛素转为基础胰岛素联合口服降糖药治疗方案的2型糖尿病患者的临床特征分析

目的 探讨每日两次预混胰岛素治疗的2型糖尿病患者转为每日一次基础胰岛素加口服降糖药的血糖控制情况与人群特征的关系及基础胰岛素的使用剂量.方法 为随机、开放、两中心的平行对照研究,治疗期12周,选择每日注射两次预混胰岛素(加或不加口服降糖药治疗),空腹血糖(FBG)在7.8～16.7 mmol/L,糖化血红蛋白(HbA1c)在7%～10%的2型糖尿病患者80例,随机分至每日注射一次甘精胰岛素加格列美脲3 mg或每日注射两次预混30 R(诺和灵)胰岛索加格列美脲3 mg治疗组,胰岛素剂量每3天调整1次,至目标FBG≤6.0 mmol/L.结果 治疗12周后,甘精胰岛素组和预混胰岛素组的HbA1c均较基线水平显著下降,两组HbA1c下降幅度差异无统计学意义(8.8%→8.0% vs 8.9%→7.8%,P＞0.05).治疗期间,预混胰岛素组低血糖发生频率均显著高于甘精胰岛素组,总低血糖事件分别为123次、57次,经证实的低血糖例次(94 vs 21,χ2=23.692 P=0),其中午餐前低血糖发生尤其显著(64 vs 17,χ2=7.762,P=0.005).甘精胰岛素治疗后HbA1c≤7.5%者达28.2%(11例),剂量为(0.58±0.29)U·kg-1·d-1;HbA1c＞8.5%者占23.1%(9例),剂量为(0.66±0.30)U·kg-1·d-1.甘精胰岛素两亚组治疗前HbA1c、糖尿病病程、餐后2 h C肽水平差异均有统计学意义(分别为:8.1±0.8)% vs (9.6%±1.2)%,10年(6.0～14.5年)vs 13年(8～19.5年),餐后C肽:2.5 nmol/L(1.4～3.3 nmol/L)vs 1.4 nmol/L(1.2～2.6 nmol/L),均P＜0.05.结论 每日2次预混胰岛素治疗的2型糖尿病患者转为每日1次甘精胰岛素联合口服降糖药治疗可以达到良好的血糖控制,治疗前HbA1c水平、糖尿病病程和餐后2 h C肽水平是影响一次基础胰岛素联合口服降糖药治疗疗效的主要指标.     

Renal handling of uric acid in patients with type 1 diabetes in relation to glycemic control

BACKGROUND: The aim of the study was to compare the renal handling of uric acid (UA) in 16 patients with type 1 diabetes without renal failure (age 34.8 +/- 13.3 years) and in 15 healthy subjects (age 34.9 +/- 12.6 years). METHODS: Creatinine clearance (Cr-Cl), clearance of uric acid (UA-Cl), fractional excretion of uric acid (UA-FE), and 24-h urinary UA excretion (UA-U) were determined. Glycemic control was assessed using fasting glucose, glycated hemoglobin and fructosamine tests. RESULTS: Patients with diabetes had significantly (p < 0.0001) lower serum UA concentrations compared to control group (2.8 +/- 0.7 vs. 5.7 +/- 0.8 mg/dl), and higher urinary UA excretion (813 +/- 107 vs. 423 +/- 40 mg/day), UA clearance (21.9 +/- 7.1 vs. 5.2 +/- 0.9 mL/min) and fractional UA excretion (17.1 +/- 5.5 vs. 4.8 +/- 1.3%), with higher creatinine clearance (129 +/- 16 vs. 111 +/- 12 mL/min, p < 0.005). In patients with diabetes there was a strong negative correlation between serum UA concentration and UA 24-h excretion (R = -0.79; p < 0.001). Fractional UA excretion correlated with fasting glycemia and HbA1c (R = +0.51 and +0.53; p < 0.05). CONCLUSIONS: In type 1 diabetes there is significant UA renal clearance increase, which is higher with poor glycemic control. It leads to hypouricemia despite an approximately twofold UA excretion increase and therefore despite increased UA synthesis.     

罗格列酮对KKAy小鼠肾脏小管间质结缔组织生长因子表达的影响

目的观察罗格列酮对2型糖尿病KKAy小鼠肾皮质和小管间质结缔组织生长因子(CTGF)表达的影响。方法选取16周龄KKAy小鼠25只,随机分组给予罗格列酮30mg·kg-1·d-1和安慰剂灌胃,分别于第16、20、24周龄时处死动物。用Westernblot方法分析各组小鼠肾皮质转化生长因子-β1(TGF-β1)、CTGF、纤连蛋白(FN)和过氧化物酶体增殖体激活受体-γ(PPARγ)蛋白表达,对组织切片进行免疫组织化学染色半定量分析CTGF在小管间质阳性面积比。结果20周龄罗格列酮治疗组与同周龄安慰剂组小鼠相比肾皮质区TGF-β1、CTGF和FN蛋白质表达分别下降37%、21%和52%(P<0·01),小管间质区CTGF免疫染色减少25%(P<0·01);24周龄罗格列酮治疗组与同周龄安慰剂组小鼠相比24h尿蛋白明显减少(44·53±1·96)vs(63·66±5·57)μg/24h(P<0·05),肾皮质区TGF-β1、CTGF和FN蛋白质表达分别下降61%、50%和51%(P<0·01),小管间质区CTGF免疫染色阳性面积减少44·9%(P<0·01)。肾皮质PPARγ表达增加18·1%(P<0·05)。结论外源PPARγ激动剂罗格列酮上调肾皮质PPARγ表达,并明显抑制糖尿病小鼠肾皮质和小管间质CTGF表达。     

改善胰岛素抵抗药物治疗大鼠非酒精性脂肪肝病的实验研究

目的探讨罗格列酮和二甲双胍对大鼠非酒精性脂肪肝病(NAFLD)的治疗作用。方法44只雄性SD大鼠分为正常对照组(8只)和NAFLD组(36只)。以高脂饲料饲养建立NAFLD大鼠模型,8周末,处死NAFLD组大鼠4只,证实造模成功后,将NAFLD组进一步分为4组:NAFLD对照组(8只)、罗格列酮治疗组(8只)、二甲双胍治疗组(8只)和饮食治疗组(8只),除NAFLD对照组外,其余各组均进食普通饲料。12周末,处死所有动物,检测血脂、肝功能、肿瘤坏死因子α(TNFα)、肝脂质、肝组织TNFα、脂肪酸合成酶(FAS)的mRNA表达等指标及肝组织病理学。结果罗格列酮和二甲双胍治疗组血甘油三酯(0.61mmol/L±0.17mmol/L,0.63mmol/L±0.16mmol/Lvs0.85mmol/L±0.15mmol/L),总胆固醇(2.49mmol/L±0.68mmol/L,2.49mmol/L±0.58mmol/Lvs4.55mmol/L±1.58mmol/L),肝功能(丙氨酸氨基转移酶:38.3U/L±10.6U/L,43.3U/L±27.5U/Lvs110.6U/L±44.2U/L,天冬氨酸氨基转移酶:141.7U/L±14.3U/L,174.5U/L±57.9U/Lvs251.8U/L±91.0U/L),肝组织甘油三酯含量(18.9mg/g±2.7mg/g,20.4mg/g±3.6mg/gvs54.8mg/g±7.6mg/g)均显著低于NAFLD对照组(均P<0.05),其肝脂肪变性(分级:0.8±0.3,1.0±0.2vs2.8±0.5)及炎症程度(积分:0.8±0.2,1.0±0.3vs1.8±0.4)亦显著减轻(均P<0.01)。饮食治疗也能使血脂异常和肝组织病理学改变有一定改善,但对肝功能异常和肝脏炎症改善不明显,且疗效不如两药物治疗组。罗格列酮和二甲双胍治疗组的血清TNFα(125pg/ml±21pg/ml,155pg/ml±33pg/ml vs324pg/ml±34pg/ml)及肝组织TNFαmRNA(0.24±0.14,0.30±0.12vs0.85±0.12),FAS mRNA表达水平(0.22±0.14,0.29±0.16vs0.68±0.23)亦显著低于NAFLD对照组(均P<0.05)。结论罗格列酮和二甲双胍可有效治疗大鼠NAFLD。     

中老年2型糖尿病患者骨代谢指标与糖化血红蛋白的相关性分析

目的 探讨中老年2型糖尿病（type 2 diabetes,T2D）患者骨代谢指标与糖化血红蛋白（glycated hemoglobin,HbA1c）的相关性。方法 回顾性分析复旦大学附属浦东医院内分泌科T2D患者共372例,均为绝经后女性或≥45岁的男性,其中男性192人,女性180人。收集患者一般资料及血脂、肝功能、肾功能、HbA1c、骨代谢指标[25-羟基维生素D、β胶原降解产物（特殊序列）（β-C-terminal telopeptide of type Ⅰ collagen,β-CTX）、骨钙素N端中分子片段（N-terminal osteocalcin,N-MID）、钙（calcium,Ca）、磷（phosphorus,P）指标]。并根据HbA1c水平分为3组进行组间比较：A组HbA1c<7.5%,B组HbA1c 7.5~8.9%,C组HbA1c≥9.0%,Pearson相关性分析探索HbA1c与骨代谢指标相关性,多元线性回归分析探索T2D患者HbA1c的影响因素。结果 3组间25-羟基维生素D、β-CTX、Ca、P指标差异无统计学意义,N-MID差异有统计学意义（女性：P<0.001;男性：P=0.048）。Pearson相关性分析得出HbA1c与N-MID呈负相关（女性：r=-0.302;P<0.001;男性：r=-0.207,P=0.004）,与其他骨代谢指标无相关性。多元线性回归显示调整年龄及BMI后,N-MID仍为HbA1c的影响因素（女性：β=-0.321,P<0.001;男性：β=-0.339,P<0.001）。结论 在绝经后女性及中老年男性T2D患者中,血清N-MID与HbA1c呈负相关,因而血清N-MID高水平可能有助于T2D患者血糖的控制。     

上海地区中国人餐后血糖状态的特征

目的探讨正常糖调节(NGR)及2型糖尿病(T2DM)个体餐后血糖状态的特征以及T2DM患者餐前、餐后血糖与糖化血红蛋白(HbA1c)的关系。方法采用动态血糖监测系统对上海地区41例NGR及60例新诊断T2DM个体进行连续3d的血糖监测,分析比较餐后血糖峰值与达峰时间,以及餐后血糖漂移的幅度(PPGE)、时间和曲线下面积增值(IAUC)。结果(1)三餐后血糖峰值、达峰时间及PPGE在T2DM组(早餐16·45mmol/L±0·43mmol/L、93·1min±4·7min、6·84mmol/L±0·28mmol/L,中餐14·75mmol/L±0·50mmol/L、107·4min±6·5min、4·93mmol/L±0·31mmol/L,晚餐14·91mmol/L±0·45mmol/L、109·3min±4·9min、5·84mmol/L±0·28mmol/L)显著高于NGR组(早餐6·90mmol/L±0·21mmol/L、40·8min±2·9min、2·02±0·17mmol/L,中餐6·74mmol/L±0·16mmol/L、43·7min±3·1min、2·03±0·12mmol/L,晚餐6·94mmol/L±0·19mmol/L、53·5min±3·8min、2·25mmol/L±0·18mmol/L,均P<0·01)。日内餐后血糖漂移时间及IAUC在T2DM组(14·1h±0·3h,2·04mmol·L-1·d±0·09mmol·L-1·d)亦显著高于NGR组(8·3h±0·4h,0·43mmol·L-1·d±0·03mmol·L-1·d,均P<0·01)。(2)T2DM组早餐后血糖较快达到尖峰(P<0·05),且峰值显著高于中、晚餐(P<0·01),PPGE从高到低的顺序分别为早、晚及中餐(P<0·05),晚餐的IAUC显著高于早、中餐(P<0·01)。(3)HbA1c与IAUC的相关性(r=0·29,P=0·03)在调整餐前血糖的因素后消失(P=0·05);PPGE与IAUC呈显著正相关(r=0·93,P<0·01)。(4)T2DM组餐后血糖对总体日内血糖的贡献百分比显著高于NGR组(18·1%±0·8%比8·0%±0·7%,P<0·01),但均显著低于其餐前血糖(P<0·01)。(5)当HbA1c<7·5%时,餐后血糖升高部分对总体日内高血糖的贡献大于餐前血糖(P<0·05),当HbA1c≥7·5%时,餐前高血糖的相对作用逐渐增加并占主要作用(P<0·01)。结论(1)T2DM患者表现为餐后血糖的过度漂移并持续较长时间,同时伴有血糖尖峰的延迟,其餐后急性高血糖状态以早餐最明显。(2)HbA1c不能反映餐后血糖的漂移变化,PPGE可作为估测餐后血糖漂移程度的简易临床参数。(3)在轻、中度高血糖的患者中,餐后高血糖起主要作用,提示血糖控制越接近达标,餐后血糖的控制越重要。     

2型糖尿病患者脂联素基因单核苷酸多态性与罗格列酮疗效的相关性研究

目的 研究脂联素基因（ADIPOQ）单核苷酸多态性（SNP）＋45与马来酸罗格列酮治疗2型糖尿病疗效的相关性。方法 选取103例新诊断2型糖尿病患者,口服马来酸罗格列酮24周,并定期检测糖脂代谢相关临床指标,用聚合酶链式反应-限制性片段长度多态性方法检测脂联素基因SNP＋45（T／G）多态位点。结果 （1）103例2型糖尿病患者中,TT、TG、GG基因型频率分别为55．34％（57例）、35．92％（37例）、8．74％（9例）,T、G等位基因频率分别为73．30％、26．70％;（2）TG＋GG基因型患者的治疗有效率（56．41％）显著高于TT基因型患者（33．93％）,（P=0．0295）;多变量的Logistic回归分析发现基线糖化血红蛋白（HbAlc）和ADIPOQSNP＋45是影响该药物治疗有效性的独立相关因素;（3）马来酸罗格列酮治疗24周,1TT基因型和TG＋GG基因型患者的空腹血糖（FPG）、餐后2h血糖（2hPG）、HbAlc和稳态模式评估法计算的胰岛素抵抗（HOMA-IR）水平均较基线时（13．1±0．4,14．0±0．5）显著降低（分别为4．6±0．4、4．7±0．4）,差异有统计学意义;（4）24周各临床指标及其与基线的差值和脂联素基因SNP＋45无显著相关性。结论ADIPOQSNP＋45（T／G）与马来酸罗格列酮治疗2型糖尿病患者的有效性相关,是该药物治疗有效性的主要决定因素之一,TG＋GG基因型患者的治疗有效率高于TT基因型患者。     

罗格列酮对2型糖尿病患者外周血单核细胞CD36表达的影响

目的:观察2型糖尿病患者外周血单核细胞CD36的表达及罗格列酮对其表达的影响,探讨其可能的作用机制。方法:采用流式细胞仪测定2型糖尿病患者外周血单核细胞CD36的表达,并观察罗格列酮治疗后的变化;分析CD36与2型糖尿病各临床指标间的关系。结果:2型糖尿病组患者单核细胞CD36表达明显高于正常对照组(745.9±281.3 vs 406.3±80.2,P<0.01);动脉粥样硬化组CD36表达明显高于无动脉粥样硬化组(878.2±296.1 vs 584.2±148.3,P<0.01)。罗格列酮治疗后,患者单核细胞CD36表达、空腹血糖(FBG)、餐后血糖(PBG)、HbA1c、空腹胰岛素(FIN)、餐后胰岛素(PIN)、胰岛素抵抗程度(HOMA-IR)均降低,与治疗前、安慰剂组均有统计学差异(P<0.05或P<0.01)。糖尿病患者单核细胞CD36表达与FBG(r=0.55,P<0.05)、HbA1c(r=0.62,P<0.01)、HOMA-IR(r=0.64,P<0.01)正相关,与PBG、FIN、PIN无明显相关。结论:罗格列酮可能通过有效控制血糖、降低胰岛素抵抗等途径来降低2型糖尿病患者外周血单核细胞CD36的表达。     

老年IgA肾病的临床病理特征和预后分析

目的:探讨老年IgA肾病(IgA nephropathy,IgAN)临床病理特征和预后.方法:选择肾活检确诊的年龄≥60岁的IgA肾病患者70例,与同期肾活检确诊的年龄<60岁的IgA肾病患者82例进行临床、病理及预后对比分析比较.结果:老年组与非老年组相比,收缩压[(142.0±20.4)mmHg vs (124.2±16.9)mmnHg,1 mmHg=0.133 kPa]、舒张压[(83.1 4±11.8)mmUg vs(78.9 4±12.3)millHg]、肾穿时血肌酐水平[(172.7-1±125.8)μmol/L vs(94.4 4±42.5)μmol/L]、血胆固醇[(5.7 4±1.6)mmoL/ vs (5.1±1.6)mmol/L]、24 h尿蛋白定量[(3.4±2.9)g/d vs(1.8 4±2.O)g/d]、高血压的发生率(57.1%vs32.5%)、慢性肾疾病(chronic kidney disease,CKD)分期3～5期的比例(64.O%伪14.6%)差异均有统计学意义(P<0.05).两组的病程、肉眼血尿的发生率、血甘油三酯、血WgA水平差异无统计学意义(P>o.05).病理资料上,老年组肾病理以慢性化病变为主,与非老年组相比,肾小球硬化[(19.7 4±20.1)%vs(13.4 4±17.8)%]、肾小管萎缩(>1分,34.2%vs25.6%)、间质纤维化(>1分,34.2%vs 18.2%)、肾小动脉硬化(>2分,20.O%vs 8.5%)的比例差异均有统计学意义(P<0.05).而系膜细胞增生、新月体比例、间质炎症细胞浸润在两组间差异无统计学意义(P>0.05).平均随访(34.6 4±33.3)个月,老年组3年和5年累计肾生存率显著低于非老年组(74.6%1.78 100%,62.2%vs92.9%,P=0.002).结论:老年组IgA肾病患者在确诊时高血压、肾功能不全、高脂 血症的发生率较高,肾脏病理改变以慢性病变为主,肾小动脉病变明显,这可能是导致老年IgA肾病患者预后差的原因.     

The role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

OBJECTIVE: To evaluate the roles of surface electrocardiogram (ECG) and transthoracic echocardiography (ECHO) for prediction of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). METHODS: This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion (PWD) was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. RESULTS: Postoperative AF developed in 17 (24%) cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively (60+/-19 versus 47+/-13, p=0.003), postoperative first day (56+/-12 versus 44+/-11, p<0.002) and fifth day (51+/-29 versus 41+/-11, p<0.001). Patients with AF were significantly older, the mean age of the AF group was (68+/-7) years and of the sinus rhythm (SR) group was (59+/-10 years) (p<0.001). The AF group had left ventricular systolic dysfunction (56+/-13% versus 56+/-8%, p=0.042, preoperatively; 49+/-8% versus 60+/-10%, p=0.001, postoperatively) and a larger left atrium (46+/-5 versus 39+/-5 mm, p<0.001, preoperatively and 44+/-7 versus 39+/-5 mm, p=0.046, postoperatively) than the SR group. CONCLUSION: This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG.     

Design and descriptive characteristics of the GHRAS: the Greek Health Randomized Aging Study.

BACKGROUND: The "GHRAS" study is aimed at investigating the interactions among socioeconomic, lifestyle, dietary, psychological, and biochemical factors determining the health status of elderly Greeks. The design and baseline sociodemographic, clinical, and dietary characteristics of the participants are presented here. MATERIAL/METHODS: A total of 782 elderly (>60 years of age) Greeks were randomly recruited in Athens. Standardized anthropometric, biochemical, and clinical procedures and extensive questionnaires were used to assess health parameters and lifestyle factors. RESULTS: A high prevalence of hypercholesterolemia was found in both men and women (78.7% vs. 90.1%, p<0.001) as well as hypertension (81.3% vs. 71.8, p=0.005). Obesity was found in 43.6% of all participants and 42.7% was overweight. Elderly women demonstrated higher mean BMI values than the men (30.2+/-5.0 vs. 28.7+/-4.0, p<0.001). Only 13.4% of all subjects reported current smoking. The majority of the women (77.5%) had never smoked, while most of the men (53.4%) were former smokers. The women appeared more physically active and less adherent to the Mediterranean diet than the men. 36.2% of the women and 21.0% of the men had mild to severe depressive symptoms (p<0.001), while 28.4% of the women and 25.4% of the men had cognitive decline (p=0.430). A history of cardiovascular disease was present in 19.9% and diabetes in 13.9% of all participants. CONCLUSIONS: The prevalence of morbidity risk factors in this population is high. Further investigation is required, including the interaction of compromising factors, to clarify their impact on the health status of the elderly.     

Sympathetic activity and response to ACE inhibitor (enalapril) in normotensive obese and non-obese subjects

BACKGROUND: Angiotensinogen has been proposed as a possible link between obesity and hypertension because the adipocyte produces angiotensinogen and contains the enzymes required for its conversion. Moreover, sympathetic overactivity has been reported in obese subjects. The aim of this study was to compare heart sympathetic activation and serum angiotensinogen levels in obese and non-obese normotensive subjects, their relationship, and the effect of a drug that modifies the renin-angiotensin system. METHODS: Serum angiotensinogen, leptin, lipids, glucose, and insulin levels were measured and 24-h electrocardiograph monitoring was carried out in 41 (20 non-obese and 21 obese) volunteers before and after administration of 5 mg enalapril twice/day for 7 days. RESULTS: Obese subjects had higher values than non-obese subjects for % body fat (35.1+/-4.6 vs. 30.5+/-5.2; p=0.005), triglycerides (1.93+/-0.9 vs. 1.25+/-0.7 g/L, p=0.002), insulin (114.8+/-82.5 vs. 45.9+/-22.2 pmol/L), leptin (31.4+/-20.4 vs. 14.1+/-11.2 ng/mL, p=0.002), and LF/HFn index (4.3+/-2.9 vs. 2.2+/-1.3, p<0.005). Enalapril increased angiotensinogen levels only in the non-obese group (4.2+/-3.9 vs. 9.7+/-5.4 ng/mL, p=0.001) and diminished the LF/HFn index (4.3+/-2.9 vs. 3.0+/-1.4, p=0.007) in the group of obese subjects. There was no association between angiotensinogen levels and sympathetic activity. CONCLUSIONS: Higher level of sympathetic activity was found in normotensive obese as compared with non-obese subjects. Enalapril treatment reduced heart sympathetic activity in obese subjects but did not change angiotensinogen levels.     

Effect of surgical castration on risk factors for arteriosclerosis of patients with prostate cancer

Objective To analyze the effect of castration on risk factors for arteriosclerosis of patients with prostate cancerMethods Thirty patients with primary regional prostate adenocarcinoma limited to the prostate theca were selected in this study.Serum levels of testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), prostatic specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apoprotein α(1) (APOα(1)) and apoprotein β (APOβ), insulin, plasma fibrinopeptide A (FPA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined just prior to, 1 week and 1, 4 and 8 months after castration.Results T, FT and PSA decreased significantly 1 week after castration (21.12±15.11 ng/ml vs 383.9±62.6 ng/ml, P&lt;0.001; 4.08±3.29 pmol/L vs 34.11±11.59 pmol/L, P&lt;0.001; 14.34±7.77 ng/ml vs 23.51±6.57 ng/ml, P=0.001, respectively) and continued to decrease until reaching their lowest levels 8 months after castration.DHEA and SHBG did not undergo any changes.TG, fasting insulin and glucose, 2-hour insulin and glucose levels were significantly elevated 1 month after castration (1.84±0.61 mmol/L vs 1.30±0.40 mmol/L, P&lt;0.05; 18.16±5.57 mU/L vs 9.47±3.81 mU/L, P&lt;0.05; 4.77±0.66 mmol/L vs 3.92±0.34 mmol/L, P&lt;0.05; 65.52±14.78 mU/L vs 36.94±17.12 mU/L, P&lt;0.01; 6.98±0.79 mmol/L vs 6.01±0.23 mmol/L, P=0.001, respectively).TC, LDL-C, FPA and PAI-1 levels were elevated 4 months after castration (6.56±0.99 mmol/L vs 5.29±0.75 mmol/L, P&lt;0.01; 4.09±0.86 mmol/L vs 3.04±0.15 mmol/L, P&lt;0.01; 3.39±1.67 nmol/L vs 1.48±0.50 nmol/L, P&lt;0.01; 27.02±5.98 ng/ml vs 21.78±3.16 ng/ml, P&lt;0.05, respectively), continuing to increase after that point.Insulin sensitive index (ISI) decreased significantly 1 month after surgery (-4.42±0.36 vs -3.50±0.39, P&lt;0.001), and continued to decrease from that point forward.HDL-C, APOα(1), APOβ and fibrinogen remained at pre-operative levels.There was a negative linear correlation between FT and TG, TC, LDL-C, PAI-1, FPA, fasting insulin and glucose, 2-hour insulin and glucose (r=-0.311, -0.384, -0.385, -0.339, -0.353, -0.381, -0.303, -0.460 and -0.395, respectively; P&lt;0.05).A similar phenomenon occurred with T (r=-0.308, -0.309, -0.356, -0.320, -0.430, -0.453, -0.435, -0.483 and -0.512, respectively; P&lt;0.05).T and FT were positively associated with ISI (r=0.555 and 0.501; P&lt;0.001).Conclusions At 8 months follow-up of the study subjects, we found that lower androgen levels have adverse effects on lipid metabolism, coagulative function and insulin sensitivity, related to arteriosclerosis in men.     

高体重指数(BMI)和糖化血红蛋白(HbA1c)促进结直肠息肉多发

 目的 探讨体重指数（body mass index，BMI）和糖化血红蛋白（glycated hemoglobin A1c，HbA1c）与结直肠息肉多发的相关性。方法 选取结直肠息肉患者597例，按结直肠息肉数目（number of colorectal polyps，NCP）分为结直肠息肉单发（single colorectal polyp，SCP）组（n=216）和结直肠息肉多发（multiple colorectal polyps，MCP）组（n=381）。在SCP和MCP组内，按息肉发生的部位分为直肠、左半结肠和右半结肠亚组；按结肠镜下息肉大小分为结直肠大息肉（息肉直径≥10 mm）和结直肠小息肉（息肉直径<10 mm）亚组；根据结直肠息肉的病理类型分为腺瘤性息肉（adenomatous polyp，AP）和非腺瘤性息肉（non-adenomatous polyp，NAP）亚组。比较同水平组间的BMI和HbA1c的差异，采用单因素方差分析和二元Logistic回归分析评价BMI和HbA1c与结直肠息肉多发的相关性。结果 MCP组的年龄、BMI和HbA1c均显著高于SCP组[（64.1±9.7）岁vs.（61.2±12.0）岁，P=0.001；（24.3±3.2）kg/m² vs.（23.4±3.0）kg/m²，P=0.002；5.9%±0.8% vs.5.6%±0.7%，P=0.004]，MCP组内小息肉亚组的BMI和HbA1c均显著高于SCP组内小息肉亚组[（24.5±3.2）kg/m² vs.（23.5±2.9）kg/m²，P=0.015；6.0%±0.8% vs.5.6%±0.8%，P=0.032]。二元Logistic回归分析提示，BMI和HbA1c可能是结直肠息肉多发和结直肠小息肉多发的危险因素。结论 高BMI和HbA1c可能促进多发性结直肠息肉的发生；BMI和HbA1c或可作为结直肠息肉患者随访肠镜检查的辅助参考指标。     

Effectiveness and side effects of thiazolidinediones for type 2 diabetes: real-life experience from a tertiary hospital

OBJECTIVE: To assess effectiveness and side effects of thiazolidinediones (TZDs) as adjunctive therapy in suboptimally controlled patients with type 2 diabetes. DESIGN AND SETTING: Review of a prospectively recorded database at the Royal Melbourne Hospital diabetes clinic. PARTICIPANTS: 203 patients with type 2 diabetes who received pioglitazone or rosiglitazone between 1 May 2000 and 31 October 2002. OUTCOME MEASURES: Response in glycohaemoglobin (HbA(1c)) level, lipid profile changes and side effects, including hypoglycaemia, weight gain, oedema and precipitation of cardiac failure. RESULTS: Both pioglitazone and rosiglitazone improved glycaemic control, with a reduction in the HbA(1c) level of 1.02% (range, 0.85%-1.19%) and 0.96% (range, 0.81%-1.11%), respectively, in the first 6 months of therapy. Rosiglitazone was associated with a 0.45 mmol (range, 0.31-0.59 mmol) increase in cholesterol level and 0.99 mmol (range, 0.60-1.38 mmol) increase in triglyceride level, while pioglitazone was associated with insignificant declines in cholesterol and triglyceride levels. There was reduced requirement for insulin, but not for oral hypoglycaemic agent (OHA), in most patients who used these agents. Pioglitazone and rosiglitazone were associated with increased rates of hypoglycaemia (17% and 11% of patients, respectively), significant weight gain (48% and 58%) and oedema (33% and 21%). There were four cases of acute left ventricular failure and two cases of reversible liver dysfunction in patients treated with TZDs. CONCLUSIONS: Adding pioglitazone or rosiglitazone therapy to OHA or insulin in patients with type 2 diabetes significantly improved glycaemic control. However, the use of these drugs in routine clinical practice was associated with more frequent adverse events than previously reported in clinical trials.     

Progressive impairment of autonomic control of heart rate in patients with multiple sclerosis

BACKGROUND: Data regarding the autonomic control of heart rate in multiple sclerosis (MS) patients depending on the disease duration are lacking in the literature. The goal of this study was to evaluate differences in heart rate variability (HRV) in patients with MS according to the duration of the disease. METHODS: The study included 39 patients (23 female and 16 male; median age 42 years, range 34-53 years) with relapsing-remitting MS (RRMS) in stable phase and 39 age- and sex-matched healthy controls. RRMS patients were divided into two groups: group 1 with 21 patients within 5 years and group 2 with 18 patients with >5 years from the diagnosis of MS. HRV analysis was done with 24-h Holter ECG. RESULTS: Patients with RRMS had a significantly lower overall HRV than controls: SDNN 91+/-18 msec vs. 135+/-24 msec, p<0.001. RRMS patients with lower duration of disease (Group 1) had all higher HRV parameters except LF/HF ratio compared with RRMS patients with >5 years from the diagnosis of MS (Group 2): SDNN 94+/-24 vs. 88+/-21 msec, p=0.008; TP 2028+/-1326 vs. 1683+/-1017 ms2, p=0.006. CONCLUSIONS: Results of the study suggested that the autonomic control of heart rate depends on the disease duration in RRMS patients. Longer disease duration led to progressive impairment of cardiac autonomic balance in MS patients.     

1型糖尿病患者胰岛素治疗前后血浆护骨素的变化

目的探讨1型糖尿病（T1DM）患者胰岛素治疗前后血浆护骨素（OPG）水平的变化。方法选择22例新诊断的1型DM患者和28例健康个体。T1DM患者采用胰岛素治疗6个月。血浆OPG采用ELISA法测定。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油（GTN）介导的内皮非依赖性血管舒张功能。结果T1DM患者治疗前血浆OPG水平为3．09ng／L±0．70ng／L,明显高于对照组（2．07ng／L±0．75ng／L,P〈0．01）。治疗6个月后血浆OPG水平明显降低（2．58ng／L±0．59ng／L,P〈0．01）。T1DM患者治疗前内皮依赖性血管舒张功能（3．35％．4-0．67％）明显低于对照组（5．17％．4-0．83％,P〈0．01）。治疗6个月后有明显改善（4．27％±0．63％,P〈0．01）。多元相关分析显示,治疗前血浆OPG与内皮依赖性血管舒张功能,空腹血糖（FPG）,糖化血红蛋白（HbAlc）,超敏C反应蛋白（CRP）相关（均P〈0．01）。治疗前后OPG的变化与内皮依赖性血管舒张功能,FPG、HbAlc、CRP的变化相关（均P〈0．01）。结论新诊断的T1DM患者血浆OPG水平明显增高,血浆OPG与血管内皮功能相关。     

The status of diabetes mellitus in primary care institution and restructured hospitals in Singapore

The Diabcare-Asia Singapore 1998 project was carried out using data from 22 centres collected on paper forms to provide an overview of diabetes management and metabolic control status in 1697 diabetic patients from both primary health care clinic (PHC) (67%) and restructured hospital (RH) (33%) settings. PHC patients were on average older than RH patients (61.3 +/- 11.2 years vs 51.5 +/- 17.7 years), and had a shorter duration of diagnosed diabetes (9.2 +/- 6.8 years vs 12.0 +/- 8.5 years). The mean body mass index (BMI) for PHC patients was 25.5 +/- 4.4 kg/m2 vs 24.5 +/- 4.2 kg/m2 for RH patients. Proportionately more PHC than RH patients were overweight (BMI >25 kg/m2) (49% vs 42%). Patients with type I diabetes constituted 3.5% of PHC vs 18.1% of the RH cohort. HbA1c information was available for 92.5% of RH vs 69% of PHC patients. HbA1c measurements were <1% above ULN in 50% of PHC vs 37% of RH patients, while FBG was >7.8 mmol/l in >61% of all patients. Proteinuria (>500 mg/24 hrs) was reported in 13% of PHC vs 26% of RH patients tested. Microalbuminuria (20-300 mg/l) was noted in 36% of 171 RH patients tested. Oral hypoglycaemic agents were used as sole therapy in 83.5% of PHC vs 43% of RH patients. Eye, feet, renal and severe late complications were more commonly reported by RH than PHC patients. There is a variation in the patient profiles and care between PHC and RH patients.