六味地黄汤加减结合胰岛素治疗妊娠糖尿病的临床疗效研究

目的探讨对妊娠糖尿病患者采用六味地黄汤加减+胰岛素完成治疗后获得临床效果。方法将该院2010年1—9月收治的150例妊娠糖尿病患者进行数字奇偶法分组;联合用药组(75例):采用六味地黄汤加减+胰岛素完成疾病治疗;单一用药组(75例):采用胰岛素完成疾病治疗,就组间妊娠糖尿病患者治疗总有效率、血糖控制水平(糖化血红蛋白、空腹血糖以及餐后2 h血糖)以及不良母婴结局(巨大儿、早产儿、新生儿窒息以及胎儿窘迫、新生儿低血糖)展开对比。结果联合用药组妊娠糖尿病患者治疗总有效率(97.33%)高于单一用药组(85.33%),差异有统计学意义(P0.05);治疗前,联合用药组妊娠期糖尿病患者糖化血红蛋白水平(8.29±2.59)%、空腹血糖水平(12.31±2.69)mmol/L以及餐后2 h血糖水平(9.65±2.81)mmol/L同单一用药组糖化血红蛋白水平(8.33±2.63)%、空腹血糖水平(12.29±2.72)mmol/L以及餐后2 h血糖水平(9.59±2.83)mmol/L比较差异无统计学意义(P0.05);治疗后,联合用药组妊娠糖尿病患者糖化血红蛋白水平(5.25±0.72)%、空腹血糖水平(4.31±1.11)mmol/L以及餐后2 h血糖水平(6.11±1.02)mmol/L均低于单一用药组糖化血红蛋白水平(6.99±0.83)%、空腹血糖水平(6.72±1.69)mmol/L以及餐后2 h血糖水平(7.52±1.25)mmol/L,差异有统计学意义(P0.05);联合用药组妊娠期糖尿病患者巨大儿(1.33%)、早产儿(1.33%)、新生儿窒息(1.33%)、胎儿窘迫发生率(1.33%)以及新生儿低血糖率(1.33%)均低于单一用药组巨大儿(9.33%)、早产儿(9.33%)、新生儿窒息(8.00%)、胎儿窘迫发生率(9.33%)以及新生儿低血糖率(10.67%),差异有统计学意义(P0.05)。结论六味地黄汤加减+胰岛素治疗方法有效运用,可使妊娠糖尿病患者疗效获得明显增强,并同时将糖化血红蛋白、空腹血糖以及餐后2 h血糖水平显著降低,将巨大儿、早产儿、新生儿窒息、胎儿窘迫以及新生儿低血糖等发生率显著降低,最终显著改善妊娠糖尿病患者预后。     

枸橼酸抗凝在连续性静脉—静脉血液滤过中的应用

目的 :研究枸橼酸置换液用于解决高危出血倾向急性肾衰患者行连续性静脉 静脉血液滤过 (CVVH)的抗凝问题。　 方法 :选择高危出血倾向急性肾衰患者 1 0例 ,行CVVH治疗 ,随机分为A、B两组 ,A组患者置换液输入速度 2 0 0 0ml/h ,血流量 2 0 0ml/min ;B组患者置换液输入速度 4 0 0 0ml/h ,血流量 2 50ml/min。两组患者所用枸橼酸置换液不含钙及镁离子 ,枸橼酸根浓度分别为 1 3 3mmol/L和 7mmol/L ,同时通过外周静脉补充钙 (A组 :4mmol/h ,B组 :5 5mmol/h)及镁离子 (A组 :1 3mmol/h ,B组 :2 4mmol/h)。监测患者治疗前后及治疗中全血活化凝血时间 (WBACT)、血清总钙、离子钙水平及酸碱变化 ,滤器使用时间 ,治疗中不良反应。　 结果 :1 0例患者共行CVVH治疗 37次 ,总治疗时间 334 3h。治疗前后及治疗中血清总钙、离子钙没有大幅度变化 ,置换液输入前WBACT无明显变化 ,置换液输入后WBACT明显延长 ,A组比B组更明显 (P =0 0 1 )。治疗后患者碱剩余 (BE)及pH无大幅度上升 ,无碱中毒出现。平均滤器使用时间达 [42 99± 9 1 2 (30 5～ 67 6) ]h。无出血并发症 ,无严重不良反应。　 结论 :枸橼酸置换液在CVVH治疗过程中可取得良好局部抗凝效果 ,对患者全身凝血状态无明显影响 ,不加重全身出血倾向 ,无明显副作用     

“降糖煎”对糖尿病血糖疗效的临床观察

目的 :探讨中药益气养阴之剂“降糖煎”对糖尿病空腹血糖水平的影响。方法 :比较 30例降糖煎治疗组和 2 0例中成药降糖舒对照组糖尿病患者的血糖变化。结果 :治疗组有效率为 86 .7% ,对照组有效率为 5 5 % ,两组比较有显著差异 ,P <0 .0 5 ,;治疗组血糖由 9.6 2± 0 .47mmol/L降为 7.32± 0 .36mmol/L(P <0 .0 1) ,对照组由 8.5 9± 0 .45mmol/L降为 7.2 2± 0 .2 3mmol/L (P <0 .0 1)。结论 :益气养阴降糖剂可以改善糖尿病糖代谢紊乱     

稳定性心绞痛患者血糖水平与循环微小RNA-92a表达关系的研究

目的探讨稳定性心绞痛(SAP)患者循环微小RNA-92a(microRNA-92a,miR-92a)表达与血糖的关系。方法将93例SAP患者分为A组:降糖治疗+空腹血糖(FPG)<7.0 mmol/L 18例,B组:降糖治疗+FPG≥7.0 mmol/L8例,C组:非降糖治疗+FPG<7.0 mmol/L 61例,D组:非降糖治疗+FPG≥7.0 mmol/L 6例。比较4组患者血糖水平与循环miR-92a表达的关系。结果 SAP患者合并2型糖尿病发病率为34.4%,降糖治疗后,仍有30.8%FPG≥7.0 mmol/L。A组与B组miR-92a是否>-0.1或>0.5水平的OR值分别为2.67或0.17,C组与D组OR值分别为0.36、0.48。A组miR-92a>-0.1的患者为88.9%,显著高于C组的41.0%(P<0.01)。B组miR-92a>0.5的患者为75.0%,高于A组的33.3%(P>0.05)。结论单纯测定FPG诊断2型糖尿病漏诊率高。循环miR-92a有助于FPG<7.0 mmol/L的SAP合并2型糖尿病的诊断及疗效评价。     

美吡达引起顽固性低血糖报告

患者,男,69岁.病人5年前测空腹血糖14mmol/L,确诊为糖尿病.平时饮食控制,间断口服达美康(每日2片),血糖控制不佳.近2年出现下肢水肿,尿蛋白+～++,FBG12.7mml/L,BUN14.7mmol/L,Cr238.7mmol/L,CO221.6mmol/L,肝功能正常,HbA1C8.7%,肝胆胰CT正常,心电图:S-T段稍降低.     

老年急性心肌梗死患者介入治疗后ST段回落与血糖和肌钙蛋白的相关性

目的 观察老年急性心肌梗死患者入院时血糖水平对其经皮冠状动脉血运重建术(PCI)后ST段回落程度和肌钙蛋白T(cTNT)峰值的影响.方法 收集1996-2007年收治的412例行急诊PCI治疗的首次急性心肌梗死老年患者的临床资料并进行分析,根据患者入院后首次空腹血糖水平分为3组:＜7.0 mmol/L组、7.0～11.1 mmol/L组和＞11.1 mmol/L组.观察患者血糖与PCI术后90 min ST段回落程度和血清cTNT峰值的相关性.结果 血糖＞11.0 mmol/L组PCI术后3 h ST段回落＞70%患者较血糖＜7.0 mmol/L组显著减少(18.0%与51.5%,P(0.01),血糖7.0～11.1 mmol/L组PCI术后3 h ST段回落30%～70%与血糖水平的高低无相关性;PCI再灌注治疗后,ST回落＞70%的患者cTNT水平低于ST回落＜30%的患者,分别为(0.033±0.018)ng/L和(0.107±0.055)ng/L,二者比较差异有统计学意义(P＜0.05);Logistic回归分析显示,入院时血糖水平与cTNT水平呈正相关,入院时血糖水平越高,血清cTNT升高越明显,其中血糖＞11.1mmol/L组cTNT升高与血糖的相关性较显著(r=0.399,P＜0.01).结论 老年急性心肌梗死患者行PCI后,血糖水平直接影响ST段回落程度和cTNT峰值,控制血糖对老年急性心肌梗死患者行PCI后有效的心肌再灌注具有重要意义.     

入院血糖水平对糖尿病和非糖尿病ST段抬高急性心肌梗死患者预后的影响

目的 探讨人院时血糖水平与糖尿病和非糖尿病患者ST段抬高急性心肌梗死(STEMI)患者近期病死率的相关性.方法 观察性分析国际性随机对照临床试验中7446例出现症状12 h内STEMI的中国患者,以入院血糖不同水平将已知糖尿病和非糖尿病的患者分组:入院血糖水平<6.1 mmol/L组(2018例),6.1～7.7 mmol/L组(2170例),7.8～11.0 mmol/L组(1929例),11.1～13.0 mmol/L组(465例)和>13.0 mmol/L组(864例),后3组定义为入院高血糖组.分析各组患者30 d的病死率.结果 在人院高血糖患者中有相当比例无既往的糖尿病史;各血糖水平组内,非糖尿病的患者使用胰岛素的比例均明显低于糖尿病患者.随血糖水平升高,非糖尿病患者病死率呈逐渐增加趋势(血糖<6.1 mmol/L组6.8%,6.1～7.7 mmol/L组8.3%,>13.0 mmol/L组18.6%,P<0.001),而糖尿病患者的病死率呈先降低后升高的变化(血糖<6.1 mmol/L组16.7%,6.1～7.7 mmol/L组8.2%,>13.0 mmol/L组22.0%,P<0.001);除显著高血糖(血糖>13.0mmol/L)外,非糖尿病的高血糖患者病死率高于相同血糖水平的糖尿病患者(均P<0.05).多变量logistic回归分析显示,在非糖尿病患者中,随血糖升高死亡危险逐步增加(血糖7.8～11.0 mmol/L组:OR=1.85,95%CI:1.45～2.34,P<0.001;血糖>13.0 mmoL/L组:OR=2.69,95%CI:1.97～3.66,P<0.001);而糖尿病患者中,除显著高血糖组外(血糖>13.0 mmol/L组:OR=3.08,95%CI:1.16～8.17,P=0.024),其他组近期死亡危险均无明显增加(均P>0.05).结论 与糖尿病患者相比,无既往糖尿病史的STEMI患者入院血糖水平升高也很常见,但接受治疗的比例较低,并且是与近期预后不良更密切相关的危险因素.     

短期应用甲基强的松龙对传染性非典型肺炎患者血糖水平的影响

目的　研究短期应用甲基强的松龙 (mythylprednisolone)治疗传染性非典型肺炎(SARS)对患者空腹血糖和电解质水平的影响。　方法　采用病例回顾性分析的方法 ,对比分析了10 3例SARS患者中 3 9例使用甲基强的松龙在治疗第 1周和停药后 1周空腹血糖和电解质水平的变化。　结果　甲基强的松龙的平均日用量为 (113± 44)mg ,疗程 (12± 4)d ,总剂量达 (13 4 7± 773 )mg时 ,可引起下列变化 :(1)激素治疗 1周时患者空腹血糖比对照组升高约 2 5.5% [(6.4± 2 .5)mmol/L与 (5.1± 1.1)mmol/L ,P <0 .0 0 1]。停用 1周时复查空腹血糖 ,治疗组和对照组间差异无显著意义 [(4 9± 1 8)mmol/L与 (4.9± 0 .9)mmol/L ,P >0 .0 5]。 (2 )激素治疗组中空腹血糖≥ 7.0mmol/L的患者比例显著高于对照组 [(3 9.5%与 11.9% ) (P <0 .0 5) ] ,正常血糖患者的比例明显低于对照组 ,为 55.3 %与 85.5% (P =0 .0 1)。 (3 )停用甲基强的松龙后 ,血钠和氯低于对照组 (P <0 0 5) ,但仍在正常范围以内。　结论　 (1)甲基强的松龙治疗的第 1周可以观察到空腹血糖水平上升达2 5.5%。在停药后 1周基本可以恢复到正常水平。 (2 )短期应用糖皮质激素对血清钾、钠和氯的水平无不良影响     

甘精胰岛素联合口服降糖药治疗2型糖尿病1例

1例2型糖尿病患者使用口服降糖药物治疗血糖控制不佳,且BMI 29. 4kg/m~2,加用甘精胰岛素治疗3个月,指尖血糖由13. 2mmol/L降至6. 5mmol/L,糖化血糖蛋白由8. 9%降至7. 3%。患者监测餐后2小时指血血糖12～15mmol/l,加用沙格列汀5mg qd治疗4个月。后监测空腹指血血糖5～7mmol/L,餐后2小时指血血糖7～10mmol/L,复查糖化血红蛋白7. 3%。体重由83kg降至80kg,无不良反应和低血糖发生,结论:口服降糖药控制不佳的2型糖尿病患者,调整为甘精胰岛素联合口服降糖药后可有效控制血糖,且6月体重无增加。     

拜唐苹联合其他口服降糖药治疗2型糖尿病的有效性和安全性临床研究——多中心、非随机、开放性、自身对照研究

目的 评价已用其他口服降精药物治疗血糖不能达标的2型糖尿病患者,联合拜唐苹后的有效性和安全性.方法 全国17个中心的493例糖尿病患者参加了本次多中心、非随机、开放性、自身对照的临床研究,在患者已用其他口服降糖药物基础上加用拜唐苹治疗后观察12周,主要的疗效参数是空腹血糖(FBG)和餐后2 h血糖(PBG)水平的变化及糖化血红蛋白(Hb)A1c水平的变化.结果 联合拜唐苹治疗后总体FBG下降1.3 mmol/L,早餐PBG下降3.3 mmol/L,午餐PBG下降3.2mmol/L,晚餐PBG下降3.44 mmol/L,HbA1c降低了0.90%,P均＜0.001.拜唐苹联合非胰岛素促泌剂组、磺脲类组和格列奈类组的FBG分别下降1.24 mmol/L、1.30 mmol/L和1.13 mmol/L;早餐PBG分别下降3.36 mmol/L、3.35 mmol/L和2.25 mmol/L;午餐PBG分别下降3.57 mmol/L、3.61 mmol/L和3.15 mmol/L,晚餐PBG分别下降3.65 mmol/L、3.48 mmol/L和3.09 mmol/L;HbA1c分别降低了0.99%、1.06%和1.01%;P均＜0.001.联合拜唐苹治疗后无严重低血糖反应,体重无增加,消化道不良反应发生率为3.60%,多为腹胀和(或)排气,但可耐受.结论 当2型糖尿病患者使用一种或多种口服降糖药治疗血糖不能达标时,联用拜唐苹可使血糖控制获得明显改善,达标率显著提高,且有良好的安全性和耐受性.     

Intravenous glucose intake independently related to intensive care unit and hospital mortality: an argument for glucose toxicity in critically ill patients

OBJECTIVE: It is assumed that the toxic effects of glucose play a role in the outcome of critically ill patients. We studied the impact of the amount of infused glucose as a determinant of mortality. DESIGN: A retrospective cohort study design was used as blood glucose levels in critically ill patients are nowadays tightly controlled. PATIENTS: Long-stay critically ill patients (7-30 days). MEASUREMENTS: The association between the mean amount of glucose infusion and both intensive care unit (ICU) and hospital mortality was determined. We corrected for the mean glucose serum concentration, the mean dosage of insulin and for severity of illness, using the acute physiology and chronic health evaluation (APACHE II) score. RESULTS: Of the 2,042 admitted patients, 273 met the inclusion criteria. The mean length of stay was 14.4 days [interquartile range (IQR) 9-18]. Hospital mortality was significantly lower for patients with a mean glucose level below 8 mmol/l (30/79; 38%) compared to patients with a level above 8 mmol/l (104/194; 54%, P=0.023). Logistic stepwise multivariate regression analysis for both ICU and hospital mortality as dependent variables showed that APACHE II score and the mean daily amount of infused glucose were associated with mortality. CONCLUSION: In long-stay ICU patients without blood glucose level control, the ICU and hospital mortality was independently related to the mean amount of infused glucose. In addition, mortality in patients with a mean glucose level above 8.0 mmol/l was higher. Both these determinants of mortality can exert their effects by insulin-independent uptake of glucose with subsequent toxic intracellular effects.     

门冬胰岛素和人胰岛素强化治疗内科危重症高血糖疗效比较

目的 比较门冬胰岛素和人胰岛素强化治疗内科危重症高血糖的有效性和安全性.方法 选取中南大学湘雅二医院老年病科符合全身炎症反应综合征诊断标准的内科危重患者186例,入组时空腹血糖水平为(10.8±2.3)mmoL/L,根据患者入组时恢复进食情况分为多次皮下注射胰岛素组(MDI,n=90)和持续皮下注射胰岛素组(CSⅡ,n=96),2组均随机分为门冬胰岛素和人胰岛素亚组.MDI组中门冬胰岛素和人胰岛素亚组分别为44、46例,CSⅡ组分别为46、50例.MDI组餐前大剂量采用门冬胰岛素或人胰岛素,基础量均采用甘精胰岛素,CSⅡ组餐前大剂量及基础量均采用门冬胰岛素或人胰岛素.根据多点指尖血糖监测结果调整胰岛素用量,强化胰岛素治疗疗程7 d,使血糖控制在4.4～8.3 mmol/L,7 d后改为常规胰岛素治疗,使血糖控制在4.4～11.1 mmol/L,观察各哑组患者基线及第7天日内平均血糖水平、日内血糖标准差、日内血糖极差(最高和最低血糖之差)、血清C反应蛋白(CRP)水平、急性生理与慢性疾病评分(APACHE Ⅱ),统计7 d内低血糖发生率、严重低血糖发生率、日平均胰岛素用量及28 d内各组死亡率.统计学分析采用t检验和x~2检验.结果 (1)MDI及CSⅡ组的门冬胰岛素亚组和人胰岛素亚组强化治疗各项指标差异无统计学意义.(2)强化治疗后第7天门冬胰岛素哑组较人胰岛素组日内平均血糖水平更低,MDI组:(6.2±1.3)mmol/L比(7.6±1.6)mmol/L;CSⅡ组:(6.0±1.2)mmol/L比(7.4±2.5)mmol/L,均P＜0.05.(3)门冬胰岛素亚组血糖标准差更小,MDI组:(1.54±0.27)mmol/L比(1.92±0.38)mmol/L;CSⅡ组:(1.24±0.27)mmol/L比(1.83±0.45)mmol/L,均P＜0.05.(4)门冬胰岛素亚组极差更小,MDI组:(3.0±0.5)mmoL/L vs(3.9±1.1)mmoL/L;CSⅡ组:(3.1±0.6)mmol/L vs(3.9±1.0)mmol/L,均P＜0.05.(5)门冬胰岛素业组7 d内日平均胰岛素用量更少,低血糖发生率及严重低血糖发生率更低.同时,门冬胰岛素亚组7 d内血清CRP?     

Regulation of the somatotropic axis by intensive insulin therapy during protracted critical illness

The catabolic state of critical illness has been linked to the suppressed somatotropic GH-IGF-binding protein (IGFBP) axis. In critically ill patients it has been demonstrated that, compared with the conventional approach, which only recommended insulin therapy when blood glucose levels exceeded 12 mmol/liter, strict maintenance of blood glucose levels below 6.1 mmol/liter with intensive insulin therapy almost halved intensive care mortality, acute renal failure, critical illness polyneuropathy, and bloodstream infections. Poor blood glucose control in diabetes mellitus has also been associated with low serum IGF-I levels, which can be increased by insulin therapy. We hypothesized that intensive insulin therapy would improve the IGF-I axis, possibly contributing to the clinical correlates of anabolism. Therefore, this study of 363 patients, requiring intensive care for more than 7 d and randomly assigned to either conventional or intensive insulin therapy, examines the effects of intensive insulin therapy on the somatotropic axis. Contrary to expectation, intensive insulin therapy suppressed serum IGF-I, IGFBP-3, and acid-labile subunit concentrations. This effect was independent of survival of the critically ill patient. Concomitantly, serum GH levels were increased by intensive insulin therapy. The suppression of IGF-I in association with the increased GH levels suggests GH resistance induced by intensive insulin therapy, which was reflected by the decreased serum GH-binding protein levels. Intensive insulin therapy did not affect IGFBP-3 proteolysis, which was markedly higher in protracted critically ill patients compared with healthy controls. Also, intensive insulin therapy did not suppress the urea/creatinine ratio, a clinical correlate of catabolism. In conclusion, our data suggest that intensive insulin therapy surprisingly suppressed the somatotropic axis despite its beneficial effects on patient outcome. GH resistance accompanied this suppression of the IGF-I axis. To what extent and through which mechanisms the changes in the GH-IGF-IGFBP axis contributed to the survival benefit under intensive insulin therapy remain elusive.     

Automated insulin infusion trials in the intensive care unit

The objective is to demonstrate the effectiveness of a simple automated insulin infusion for controlling the rise and duration of blood glucose excursion following a glucose challenge in critically ill patients with impaired glucose tolerance. A two-compartment model of the glucose regulatory system was developed for intravenous infusion control design. On two subsequent days a critically ill patient with impaired glucose tolerance was given a 75 g oral glucose tolerance test (OGTT), and the glucose level was measured every 15 min. The first day's data were used to design a heavy-derivative insulin infusion controller for the second day. Ethics approval was granted for this test. Five patients were studied. In four patients, the magnitude and duration of blood glucose excursion were reduced over 50%. Fasting level was reduced 15%, from an average of 7.2 mmol/L to 6.1 mmol/L. The fifth patient's results showed a diminished response due to the antagonistic effects of hydrocortisone on insulin, a data point not provided prior to testing. Modeling to account for this effect yielded better correlation with the test. The automated algorithm provided rapid, effective control of the blood glucose rise in response to an OGTT input. These results highlight the effectiveness of automated infusions for regulating blood glucose rise and excursions, and the potential of this approach for non-hospitalized individuals.     

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

Continuous renal replacement therapy is a standard treatment in critically ill patients with acute kidney injury. All CRRT techniques provide a high low‐molecular weight clearance but even with hemofiltration, clearance of middle molecules is low. We investigated whether a new super high‐flux hemofilter provides effective and sustained middle molecule clearance during citrate‐anticoagulated continuous venovenous hemodialysis for up to 72 h. We included 14 critically ill patients with AKI‐KDIGO‐III in a prospective observational trial. We measured/calculated blood and urine concentrations, clearances and sieving coefficients of eight molecules with molecular weights from 60 to 66 kDa, hemodynamic parameters and SAPS‐II scores. All filters were patent at 72 h. Clearance and sieving coefficients of small solutes were high and sustained over time, those for larger solutes decreased over 72 h but remained high enough to decrease blood concentrations of solutes up to 25 kDa. Albumin serum levels remained unaffected. Catecholamine doses and SAPS‐II scores decreased significantly. This new hemofilter may improve blood purification in critically ill patients with AKI.     

Glycemic control in the ICU

Hyperglycemia is common in critically ill patients, with approximately 90% of patients treated in an ICU developing blood glucose concentrations > 110 mg/dL (6.1 mmol/L). Landmark trials in Leuven, Belgium, suggested that targeting normoglycemia (a blood glucose concentration of 80-110 mg/dL [4.4-6.1 mmol/L]) reduced mortality and morbidity, but other investigators have not been able to replicate these findings. Recently, the international multicenter Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study reported increased mortality with this approach, and recent meta-analyses do not support intensive glucose control for critically ill patients. Although the initial trials in Leuven produced enthusiasm and recommendations for intensive blood glucose control, the results of the NICE-SUGAR study have resulted in the more moderate recommendation to target a blood glucose concentration between 144 mg/dL and 180 mg/dL (8-10 mmol/L). As critical care practitioners pay greater attention to glycemic control, it has become clear that currently used point-of-care measuring systems are not accurate enough to target tight glucose control. Unresolved issues include whether increased blood glucose variability is inherently harmful and whether even moderate hypoglycemia can be tolerated in the quest for tighter blood glucose control. Future research must first address whether intensive glucose control can be delivered safely, and whether computerized decision support systems and newer technologies that allow accurate and continuous or near-continuous measurement of blood glucose can make this possible. Until such time, clinicians would be well advised to abide by the age-old adage to "first, do no harm."     

Evaluation of the superiority of insulin glargine as basal insulin replacement by continuous glucose monitoring system

To evaluate the superiority of insulin glargine as basal insulin replacement by continuous glucose monitoring system (CGMS). Twenty-four patients with type 2 diabetes mellitus (T2DM) whose blood glucose was not well controlled with sulphanylureas were enrolled. At first, they were treated with extended-release glipizide (glucotrol XL) 5mg/d before breakfast for 2 weeks, then randomized to combination treatment with glargine (16 patients) or NPH (8 patients) and treated for 12 weeks. CGMS were carried in the second week after treatment with glucotrol XL, and in the 12th week after combination treatment. The data of CGMS showed: (1) When FPG were well controlled in both groups (glargine group versus NPH group: 6.0+/-1.0 mmol/L versus 5.8+/-1.3 mmol/L), the blood glucose level at 3:00 a.m. (5.1+/-0.9 mmol/L versus 4.2+/-0.8 mmol/L) were higher (P<0.05), TPG< or =3.0 mmol/L at night were lower (2.56+/-1.79 versus 5.88+/-1.96), and the rate of nocturnal hypoglycemia (1/16 versus 4/8) were less (P=0.028) in glargine group than those in NPH group. (2) CGMS showed that the daily blood glucose profile excursion were more smoother in glargine group than those in NPH group. In conclusion, it was confirmed with CGMS that compared with traditionally basal insulin replacement with NPH, the combination treatment with glargine injection at bedtime may be predominant for stabilizing the daily blood glucose profile excursion and decreasing the nocturnal hypoglycemia events incidence. So glargine may be a more ideal basal insulin replacement than NPH.     

血液生化检验在糖尿病诊疗中的临床应用分析

目的讨论血液生化检验在糖尿病诊疗中的临床应用。方法将2018年9月—2020年8月期间就诊于该院内分泌科的122例糖尿病患者作为该次研究对象,并将其设定为实验组,选取同期来该院体检中心的健康人群122名作为对照组,对两组人群均采用血液生化检验(血清甘油三酯水平、空腹血糖、糖耐受测定),并对其血液生化检验情况进行对比和分析。结果实验组空腹血糖为(8.95±1.62)mmol/L,对照组空腹血糖为(5.11±0.15)mmol/L;实验组糖耐受平均值为(13.4±3.30)mmol/L,对照组糖耐受平均值为(5.13±1.01)mmol/L;实验组血清甘油三酯为(2.38±1.06)mmol/L,对照组血清甘油三酯为(1.34±0.61)mmol/L,实验组患者的空腹血糖、糖耐受平均值以及血清甘油三酯水平与对照组相比明显较高,差异有统计学意义(t=26.070、27.651、9.392、P<0.001)。结论血液生化检验在糖尿病的诊疗中可靠性较高。     

动态血糖参数正常参考值的建立及临床应用

目的建立动态血糖评估参数的正常参考值,为临床应用提供依据。方法采用动态血糖监测系统（CGMS）对48例正常糖调节者进行连续3d的血糖监测,并分析24h的平均血糖水平（MBG）及其标准差（SDBG）、餐前1h及餐后3h的MBG、血糖的时间百分比（PT）、血糖的曲线下面积（AUC）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）及日间血糖平均绝对差（MODD）。各参数非正态分布者以百分位数法估计95％的正常参考值范围,呈正态分布者按x±1.96s计算。结果（1）除血糖的frr及AUC呈非正态分布外（P〈0．05）,其余参数均呈正态分布（P〉0．05）,各参数在不同性别间的差异无统计学意义（P〉0．05）。（2）动态血糖参数的正常参考值上限：24hMBG〈6．5mmol／L,早、中及晚餐前1hMBG分别〈6．0mmol／L、〈6．3mmol／L和〈6．0mmol／L,早、中及晚餐后3hMBG分别〈7．0mmol／L、〈6．7mmol／L和〈7．0mmol／L,血糖≥7．8mmol／L及≤3．9mmol／L的PT分别〈9％和〈20％,血糖≥5．6mmol／L的AUC〈0．9d·mmol·L^-1,SDBG〈1．4mmol／L,LAGE〈5．7mmol／L,MAGE〈3．4mmol／L,MODD〈1．4mmol／L。（3）24hMBG与MAGE、MODD及SDBG均不相关（P〉0．05）,MAGE与SDBG显著正相关（r=0．93,P〈0．01）。结论初步建立了CGMS各血糖参数的正常参考值,应用上述参数能较全面地反映受试者整体血糖水平和血糖稳定性的特征。     

空腹血糖与血清瘦素、白细胞介素6的关系

目的研究空腹血糖与血清瘦素（LEP）、白细胞介素6（IL-6）水平的关系。方法将受试者258例根据空腹血糖（FPG）值分组：A组为FPG≤5．0mmol／L者65例,B组为5．0mmol／L〈FPG〈5．6mmol／L者67例,C组为5．6mmol／L≤FPG〈6．1mmol／L者64例,D组为6．1mmol／L≤FPG〈7．0mmol／L者62例。以上四组均检测FPG和空腹胰岛素（FINS）,并计算胰岛素抵抗指数（HOMA-IR）;检测血清LEP、IL-6、总胆固醇（TG）、甘油三酯（TC）、高密度脂蛋白胆固醇（HDL-C）。结果①各组随着FPG的升高,HOMA-IR、血清LEP水平明显升高。②各组内血清LEP水平女性明显高于男性（P〈0．01）。③血清LEP与FPG、FINS、HOMA—IR呈正相关（P〈0．01或〈0．05）。结论LEP参与了FPG升高、胰岛素抵抗的发生和发展,尤其在男性T2DM的发生过程中发挥着更为重要的作用。