β1整合素在糖尿病大鼠肾脏的表达与肾小球损害程度的关系

目的 观察β1整合素在糖尿病大鼠肾脏组织内的表达与肾小球损害程度的关系。方法 将SD大鼠随机分对照组、模型组、治疗组，比较尿蛋白定量分析、白蛋白排泄率和肾功能的变化，并用病理学检查肾小球损害程度和免疫组化检测β1整合素的表达。结果 糖尿病大鼠肾组织β1整合素的表达显著增加，与肾小球的损害程度呈显著正相关。胰岛素治疗能抑制β1整合素的表达，减轻肾功能损害。结论 胰岛素可能是通过抑制β1整合素的表达对肾功能起到直接的保护作用。     

艾塞那肽单克隆抗体的制备及其ELISA检测方法的建立

正艾塞那肽(exenatide)是Exendin-4的人工合成品,是首获批准应用于2型糖尿病的胰高血糖素样肽1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)~([1-2])。注射给药后,通过模拟胰岛素抑制胰高血糖素的分泌,减慢     

氯沙坦对糖尿病大鼠肾小管间质p38MAPK和TGF-β1表达的影响

目的：研究血管紧张素ⅡⅠ型受体拮抗剂（AT1RA）氯沙坦对糖尿病大鼠肾小管间质p38激活丝裂原活化蛋白激酶（p38MAPK）和转化生长因子-β1（TGF-β1）表达的影响。方法:建立STZ诱导的糖尿病(DM)大鼠模型，设正常对照组(NC)、糖尿病组(DM)和氯沙坦治疗组(DT)。用免疫组化和RT-PCR方法观察肾小管间质p38MAPK和TGF-β1蛋白及其mRNA表达。结果:p38MAPK和TGF-β1在DM大鼠肾小管间质的表达较正常对照组显著升高（P<0.05），氯沙坦治疗组与同期糖尿病组相比明显降低（P<0.05）。结论:氯沙坦降低糖尿病大鼠肾小管间质p38MAPK和TGF-β1的表达，缓解肾小管间质病理改变。     

黄芪、灯盏花素对实验性糖尿病大鼠肾脏内皮素-1、TGF-β1的作用

目的:黄芪、灯盏花素对实验性糖尿病(DM)大鼠肾脏内皮素-1(ET-1)、转化生长因子β1(TGF-β1)水平变化的影响。方法:SD大鼠45只随机分为3组:正常对照组(NC)、DM对照组和DM治疗组(DT)。DT组用黄芪7.0 g/kg和灯盏花素1.2 g/kg,水煎后灌喂,1次/d,共6周。观察大鼠血糖、胰岛素、总胆固醇(TC)、三酰甘油(TG)、肌酐清除率(Ccr)、尿白蛋白排泄率(UAE)、尿β2微球蛋白排泄率(β2-MG)等水平变化;以放射免疫法检测血浆、尿液中ET-1水平;以ELISA法检测血清、尿液TGF-β1水平。结果:糖尿病大鼠的血糖、胰岛素、TC和TG升高;治疗组血糖、血胰岛素、TC和TG显著降低。糖尿病模型组血、尿中ET-1、TGF-β1均显著高于正常对照组;治疗组血、尿中ET-1、TGF-β1水平及Ccr、UAE、β2-MG显著降低。结论:黄芪、灯盏花素对糖尿病大鼠的肾脏具有保护作用,而抑制糖尿病大鼠ET-1、TGF-β1水平可能是其重要作用机制。     

苯那普利对糖尿病大鼠肾皮质JAK/STAT信号蛋白磷酸化的影响

目的: 探讨血管紧张素Ⅱ转换酶抑制剂苯那普利对糖尿病大鼠肾皮质p-JAK2、p-STAT1和p-STAT3信号蛋白表达的影响。方法: 雄性Wistar大鼠随机分为对照组、糖尿病组和苯那普利治疗组。腹腔注射STZ诱发糖尿病大鼠模型，治疗组每日灌胃给予苯那普利10 mg/kg，共2周。采用免疫沉淀和Western blotting检测JAK2磷酸化，Western blotting检测肾皮质p-STAT1、p-STAT3和TGF-β₁蛋白的表达，半定量RT-PCR检测肾皮质细胞TGF-β₁ mRNA的表达。结果: 糖尿病组肾皮质p-JAK2、p-STAT1、p-STAT3及其TGF-β₁表达明显高于对照组，同时TGF-β₁ mRNA表达亦明显强于对照组；苯那普利治疗组p-JAK2、p-STAT1和p-STAT3表达低于糖尿病组，同时TGF-β₁ 蛋白及其mRNA 表达亦低于糖尿病组。结论: JAK/STAT信号途径可能参与糖尿病早期肾脏变化的过程，苯那普利的肾脏保护作用可能部分是通过影响JAK/STAT信号途径的激活而实现。     

核黄素对STZ诱导的大鼠糖尿病肾病的治疗作用

目的:探讨核黄素对STZ诱导的大鼠糖尿病肾病的治疗作用及机制。方法:将雄性Sprague-Daw-ley大鼠随机分为3组,即正常对照组、糖尿病模型组、核黄素治疗组,采用腹腔注射链脲佐菌素法建立糖尿病大鼠模型,收集各组血、尿及肾组织,生化方法检测24h尿蛋白量、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)的活性及丙二醛(MDA)的含量,并计算肾脏脏器系数(KW/BW);Western blotting检测不同组别肾皮质TGF-β1、纤溶酶原活化抑制因子-1(PAI-1)蛋白质水平;光镜观察肾组织形态改变。结果:与糖尿病模型组大鼠比较,核黄素治疗组大鼠尿蛋白量显著降低(P0.01),肾组织及血清SOD、CAT活性升高(P0.01),肾组织MDA含量显著降低(P0.01),核黄素治疗组肾皮质TGF-β1及PAI-1蛋白表达明显低于糖尿病模型组。结论:核黄素对STZ诱导的糖尿病大鼠肾脏有一定的保护作用,其机制可能与其降低肾组织TGF-β1、PAI-1蛋白表达有关。     

单味中药对糖尿病肾病中TGF-β_1的影响

肾脏病变在糖尿病患者中发病率和病死率较高,其主要病理特征为肾纤维化,转化生长因子-β1是其肾纤维化过程中的核心因子。近几年来,在防治糖尿病肾病中抑制TGF-β1的单味中药方面研究较多,以活血化瘀药、补益药、清热药为多见。从这三大类的药物中筛选做为防治糖尿病肾病的的新药,这可为新药的开发提供一个新的思路。     

单味中药对糖尿病肾病中TGF-β1的影响

肾脏病变在糖尿病患者中发病率和病死率较高,其主要病理特征为肾纤维化,转化生长因子-β1是其肾纤维化过程中的核心因子.近几年来,在防治糖尿病肾病中抑制TGF-β1的单味中药方面研究较多,以活血化瘀药、补益药、清热药为多见.从这三大类的药物中筛选做为防治糖尿病肾病的的新药,这可为新药的开发提供一个新的思路.     

血管内皮生长因子、转化生长因子在糖尿病肾病的改变及治疗后的变化

目的:探讨糖尿病肾病时血清中血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)的改变及前列腺素E1(PGE1)治疗后肾病好转时上述因子的变化.方法:将128例糖尿病肾病Ⅲ、Ⅳ及Ⅴ期的患者随机分为2组,分别给予常规治疗及常规 PGE1治疗,采用双抗体夹心ELISA法测定血清中VEGF含量及TGF-β1含量.结果:糖尿病肾病时VEGF及TGF-β1水平明显升高(P<0.01);肾病Ⅲ期及Ⅳ期患者中,PGE1组治疗后VEGF、TGF-β1水平明显降低(P<0.01);在Ⅴ期患者中,治疗后PGE1组VEGF、TGF-β1水平较治疗前降低(P<0.05),但效果不如Ⅲ期及Ⅳ期组明显;而对照组治疗后VEGF、TGF-β1水平无统计学意义(P>0.05).结论:糖尿病肾病时VEGF及TGF-β1水平升高,而糖尿病肾病好转时上述因子水平下降,提示其与VEGF、TGF-β1的严重程度及治疗效果相关,可能在其发病过程中扮演重要的角色.     

胰高血糖素样肽-1对胰岛β细胞的影响

胰高血糖素样肽-1,作为一种"肠促胰素",对胰岛β细胞具有多方面积极的影响.它可刺激胰岛β细胞分泌胰岛素,促进它的增殖分化再生并抑制其凋亡,在糖尿病的治疗中有很好的应用前景.     

Comparative efficacy of exenatide versus insulin glargine on glycemic control in type 2 diabetes mellitus patients inadequately treated with metformin monotherapy

PurposeComparative efficacy of exenatide versus insulin glargine primarily on glucemic control, and secondarily on body mass index (BMI), lipid profile and blood pressure, in type 2 diabetes mellitus (T2DM) patients suboptimally treated with metformin monotherapy.Material/MethodsForty-seven inadequately treated T2DM patients on metformin assigned to exenatide (n=18) or insulin glargine (n=29) for 26 weeks. Glycosylated hemoglobin (HbA1c), serum lipids, BMI, systolic and diastolic blood pressure, and adverse events, including episodes of hypoglycemia and gastrointestinal symptoms, were recorded.ResultsEither treatment had a similar favorable mean reduction in HbA1c. However, more patients in exenatide group achieved HbA1c ≤ 7% at the 26th week compared with insulin glargine group (p=0.036). Insulin glargine group had significantly more episodes of hypoglycemia compared with exenatide group (p=0.039). Gastrointestinal adverse events were non-significantly higher in the exenatide group. A significantly greater BMI reduction was observed in exenatide group, whereas BMI was not altered in insulin glargine group. Total and LDL cholesterol (p=0.012), and triglycerides (p=0.016) significantly decreased, whereas HDL cholesterol increased (p=0.021) in the exenatide group, whereas only total cholesterol decreased in insulin glargine group. Changes in systolic and diastolic blood pressure were insignificant in both groups.ConclusionsExenatide provided similar reduction in HbA1c, but fewer episodes of hypoglycemia, compared with insulin glargine. Exenatide had also a favorable effect on weight loss, although more gastrointestinal adverse events. Exenatide may provide a justified alternative in second line treatment of T2DM, but more trials are required to elucidate its long-term safety and cost-effectiveness.     

Exenatide: use in humans

Exenatide is the first synthetic agonist of the GLP-1 (glucagon-like peptide 1) receptor approved for clinical use in patients with type 2 diabetes. The multiplicity of its effects over glucose metabolism, appetite, body weight and its potential capacity to preserve the ?cell mass, makes it an attractive therapeutic alternative. This article attempts to review the current literature on pharmacokinetics, pharmacodynamics, efficacy, and safety of exenatide in humans, derived from the early phase I and II studies, and from the clinical controlled trials that led to its approval for clinical use as a combination therapy with sulphonylureas and metformin.     

Exenatide improves excessive daytime sleepiness and wakefulness in obese patients with type 2 diabetes without obstructive sleep apnoea

We investigate the effects of exenatide on excessive daytime sleepiness (EDS), driving performance and depression score in patients with type 2 diabetes with EDS. Eight obese patients with diabetes but without obstructive sleep apnoea (OSA) participated in a placebo‐controlled single‐blind study during which multiple wakefulness and sleep latency test, Epworth score, driving performance, depression score, fasting glucose and glycated haemoglobin (HbA1c) levels were assessed at baseline, end of placebo and treatment phase at baseline and after 22 weeks of treatment. Mean (±standard error of the mean) age, body mass index (kg m²) and HbA1c [mmol mol^?1 (%)] of patients at baseline were 50 ± 4.9 years, 37.6 ± 1.1 and 65 ± 19 (8.06 ± 0.41), respectively. When compared to placebo, exenatide treatment was associated with a decrease in both subjective and objective sleepiness, based on the Epworth score reduction and the sleep latency increase assessed by multiple objective sleepiness and sustained attention (OSLER) tests, respectively. Mean sleep latency time (adjusted for change in HbA1c and weight) were 32.1 ± 1.7, 29.1 ± 1.7 and 37.7 ± 1.7, respectively (P = 0.002). Modelling for covariates suggested that improvement in mean sleep latency time is predicted by changes in weight (P = 0.003), but not by changes in HbA1c (P = 0.054). Epworth sleepiness score was reduced significantly (values for placebo versus exenatide: 11.3 ± 1.2 versus 5.7 ± 1.3; P = 0.003). No significant change was noted in the depression score and driving performance. Exenatide is associated with a significant reduction in objective sleepiness in obese patients with type 2 diabetes without OSA, independent of HbA1c levels. These findings could form a basis for further studies to investigate the pathophysiological mechanisms of sleepiness in obese patients with type 2 diabetes.     

艾塞那肽对血糖控制不佳的肥胖糖尿病患者疗效分析

目的：观察血糖控制不佳的肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者加用艾塞那肽后的疗效。方法：选取研究对象60例(退出3例,实际完成57例),根据不同体重指数(BMI)分为A组(25 kg/m2≤BMI<30 kg/m2)23例,B组(30 kg/m2≤BMI<35 kg/m2)27例,C组(35 kg/m2≤BMI<40 kg/m2)7例,连续给予艾塞那肽治疗12周,比较治疗前后3组患者的临床疗效及血清指标变化。结果：随访结束后,所有患者平均空腹血糖(fasting blood glucose,FBG)水平、HbA1c、体重和BMI、血脂(TC、TG、LDL)等较基线有明显下降(P<0.05);所有患者平均空腹胰岛素(fasting serum insulin,FINS)水平较治疗前有所升高(P>0.05),所有患者HOMA-IR较治疗前明显降低(P均<0.05),HOMA-β较治疗前无显著变化(P>0.05)。3组间比较显示,各组FBG下降幅度C组>B组>A组(P>0.05);HbA1c下降幅度水平C组>A组(P<0.05);体重减轻幅度和BMI的下降幅度依次为C组>B组>A组(P均<0.05)。结论：艾塞那肽可以有效控制血糖控制不佳的肥胖T2DM患者的FBG、HbA1c,改善血脂水平和胰岛功能,减轻体重和BMI。其中,艾塞那肽对FBG、HbA1c、体重、BMI的疗效,在BMI较高组中疗效更显著。     

Long-Acting GLP-1 Analogs for the Treatment of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is characterized by insulin resistance, impaired glucose-induced insulin secretion, and inappropriately elevated glucagon levels which eventually result in hyperglycemia. The currently available treatment modalities for type 2 diabetes are often unsatisfactory in getting patients to glycemic goals, even when used in combination, and therefore many patients develop microvascular and macrovascular diabetic complications. Additionally, these treatment modalities are often limited by inconvenient dosage regimens and safety and tolerability issues, the latter including hypoglycemia, bodyweight gain, edema, and gastrointestinal intolerance. There is, therefore, a need for new and more efficacious agents, targeting not only treatment, but also prevention of the disease, its progression, and its associated complications. Recently, an entirely new therapeutic option for the treatment of type 2 diabetes has become available in the US (since October 2005) and in Europe (since May 2007): the incretin-based therapies. The incretin-based therapies fall into two different classes: (i) incretin mimetics, i.e. injectable peptide preparations with actions similar to the natural incretin hormones; and (ii) the incretin enhancers, i.e. orally available agents that inhibit the degradation of the incretin hormones in the body and thereby increase their plasma levels and biologic actions. This article focuses on the incretin mimetics and outlines the scientific basis for the development of glucagon-like peptide-1 (GLP-1) analogs, reviews clinical experience gained so far, and discusses future expectations for long-acting forms of GLP-1 analogs.     

Lixisenatide: A Review of Its Use in Patients with Type 2 Diabetes Mellitus

Lixisenatide (Lyxumia^®) is a glucagon-like peptide-1 receptor agonist that acts in a glucose-dependent manner to improve glycemic control in adult patients with type 2 diabetes mellitus. Subcutaneous once-daily prandial lixisenatide is indicated for the treatment of adult patients with type 2 diabetes to achieve glycemic control in combination with oral antihyperglycemic drugs (OADs) and/or basal insulin when these antihyperglycemic drugs do not provide adequate glycemic control. In an extensive phase III clinical trial program, lixisenatide once daily in combination with OADs and/or basal insulin for 24 weeks improved glycemic control, had beneficial effects on bodyweight, and was generally well tolerated in adult patients with inadequately controlled type 2 diabetes despite treatment with OADs and/or basal insulin. At 24 weeks, in terms of the primary efficacy endpoint of each trial, combination therapy with lixisenatide was associated with better efficacy than placebo in patients inadequately controlled on OADs and/or basal insulin, was shown to be noninferior to exenatide in patients inadequately controlled on background metformin therapy, and showed similar efficacy to sitagliptin in patients inadequately controlled on background metformin therapy. Further clinical experience/post-marketing surveillance studies and long-term safety data, along with pharmacoeconomic analyses, are required to fully define the position of lixisenatide in relation to other antihyperglycemics. In the meantime, once-daily prandial lixisenatide in combination with OADs and/or basal insulin (plus diet and exercise) is an effective option for improving glycemic control in adult patients with type 2 diabetes, including in patients where bodyweight loss is an essential component in their management.     

Expression of SIRT1 in the ovaries of rats with polycystic ovary syndrome before and after therapeutic intervention with exenatide

Aim: To investigate the expression of silent information regulator 1 (SIRT1) in rats with polycystic ovary syndrome (PCOS) and its alteration after exenatide treatment. Methods: PCOS rat model was established by dehydroepiandrosterone induction. The animals were randomly divided into exenatide treatment group (EX group, n = 10), metformin treatment group (MF group, n = 10), PCOS group (PCOS group, n = 9) and normal control group (NC group, n = 10). Histological changes of the ovarian tissues were examined by HE staining. SIRT1 expression in the ovarian tissue was detected by RT-PCR and immunohistochemistry. Results: Rats in the PCOS group lost their estrous cycle. Histological observation of the ovary showed saccular dilatation of the follicle, decreased number of corpora lutea, fewer layers of granulosa cells aligned loosely, and thickened layer of theca cells. The changes in reproductive hormones and the development of insulin resistance suggested the successful establishment of the animal models. Immunohistochemistry and Q-PCR detected the mRNA and protein expressions of SIRT1 in the ovary tissues of rats in the normal control group. The SIRT1 expression was significantly lower in PCOS group than in control group (P < 0.05); after drug intervention, the SIRT1 expression significantly increased in EX and MF groups (compared with the PCOS group), whereas no significant difference was noted between the EX group and MF group. Conclusions: The SIRT1 expression in the ovary tissue decreases in PCOS rats (compare with the normal rats) but can be up-regulated after Ex or MF treatment. These drugs may affect the process and development of PCOS by regulating the SIRT1 expression. Exenatide may be therapeutic for PCOS by up-regulating the SITR1 expression.     

胰岛β细胞退分化在β细胞功能衰竭中的作用

正随着生活水平的提高和饮食结构的改变,2型糖尿病患病率逐年增高,预防和治疗2型糖尿病已经成为一个亟待解决的问题~([1-2])。除了胰岛素抵抗之外,胰岛β细胞功能衰竭亦是引起2型糖尿病发生发展的中心环节。通常认为由胰岛β细胞凋亡引起的胰岛细胞数量减少是引起糖尿病的重要致病机制~([3]),然而近年来研究发现,胰岛β细胞凋亡程度与胰岛素下降程度不平行,因而胰岛素分泌功能的研究成为热点。引起β细胞分泌功能缺陷的作用机制