124 维生素C改善非胰岛素依赖性糖尿病患者内皮依赖性血管扩张反应

１２４维生素Ｃ改善非胰岛素依赖性糖尿病患者内皮依赖性血管扩张反应［英］／ＴｉｎｇＨＨ…ＪＣｌｉｎＩｎｖｅｓｔ．－１９９６，９７．－２２～２８糖尿病患者内皮依赖性血管扩张反应受损。糖尿病动物实验模型发现，这种血管反应性受损与氧自由基对内皮源性一氧化氮的...     

糖尿病的“双C”治疗模式

“双C”治疗模式即持续皮下胰岛素输注（C0ntinuous Subcutaneous Insulin Infusion，CSII）和动态血糖监测系统（Continuous Glucose Monitoring System，CGMS）的联合应用。临床上常常先给患者佩戴CGMS监测24～72小时，然后根据其监测结果，分析患者的血糖波动特点；再为其制订个体化的CSII治疗方案并及时进行恰当的胰岛素剂量的调整，使患者的血糖快速达到控制标准；     

“双C”方案治疗难治性或脆性糖尿病18例

血糖监测是糖尿病(DM)管理的重要组成部分,动态血糖监测是指通过葡萄糖感应器监测皮下组织间液的葡萄糖浓度而反映血糖水平的技术,可提供连续、全面、可靠的全天血糖信息,了解血糖波动趋势,发现不易被传统方法所探测的高血糖和低血糖,为传统血糖监测方法的有效补充[1],动态血糖监测系统(CGMS)有助于了解血糖变化整体趋势和个体化特征,以指导制定临床个体化治疗方案[2].本文拟观察CGMS和胰岛素泵(CSⅡ)组成的"双C"方案治疗血糖波动大、难治性、脆性DM患者的疗效.     

非胰岛素依赖性糖尿病患者的激素代谢变化（附60例报告）

对６０例肥胖型非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者和３０例单纯性肥胖者（对照组）进行了空腹及糖负荷后血糖、胰岛素、胰高糖素、生长激素水平比较。根据空腹血糖水平（ＦＢＧ）将ＮＩＤＤＭ患者分为ＤＭＡ组和ＤＭＢ组，结果显示：①ＤＭＡ组胰岛素分泌相对不足，胰高糖素分泌基本正常。②ＤＭＢ组胰岛素分泌明显不足，胰高糖素水平明显升高。③ＤＭＡ和ＤＭＢ组空腹及餐后１、２小时生长激素水平明显高于对照组。提示胰高糖     

新生儿激素性糖尿病二例报告

近年来,我们发现治疗剂量的糖皮质激素诱发新生儿激素性糖尿病2例,现报告如下: 例1:女患,10天,于1981年11月2日入院,诊为新生儿肺炎、新生儿硬肿症。入院空腹血糖为127mg/dl(本文血糖及尿糖检测标本均在奶前空腹、滴流停止后10小时以上采集)。在给予抗生素治疗同     

非胰岛素依赖型糖尿病伴特发性尿崩症一例报告

患者男,70岁,退休工人。1989年6月起多饮、多尿伴体重下降及全身乏力。外院查空腹血糖12.4～13.3mmol/L,尿糖( )。诊断为糖尿病,使用D8601.5g/d,治疗后空腹血糖下降至4.67～7.3mmol/L。但口渴多饮症状未见好转,即来我院检查。每日饮水量8000～10000ml,尿排量为7000～9000ml。以往无明显头痛及精神应激史,无头部外伤史。查体:神志清、两瞳孔等大、对光反射存在、无视野缺损、眼底(-)。皮肤干燥、心率76次/分、律齐、血     

双阑尾炎一例报告

双阑尾畸形颇罕见,我们遇一例双阑尾炎,其中一个是桥形畸形阑尾,报告如下。     

新生儿上颌骨骨髓炎一例报告

患儿,男,出生19天。因发烧、右侧上颌部及眼外眦部红肿8天,用青、链、红霉素等治疗未效而入院。患儿为足月分娩,产程顺利,无产伤,脐带无感染,牛奶喂养。患儿精神萎靡,体温38.7℃。右侧外眦部红肿,结合膜充血,眼裂小,眼球外突。右上龈颊沟处红肿,并有一点状溃烂面。心     

新生儿囊尾蚴病一例报告

患儿为女性,1岁,河南开封人。其母1977年曾驱出绦虫1条,有皮下结节300余个,后者经病理检查证实为猪囊尾蚴。因当时怀孕,故未治疗。1982年2月25日足月顺产此婴,接生者发现婴儿颈部左侧有一结节,能活动。随着患儿的长大,结节愈来愈明显,于1983年2月26日来我院就诊。体检:颈     

新生儿瘧疾一例报告

新生儿瘧疾包括生后一月內自然感染、輸血感染及通过胎盘感染的先天性瘧疾。临床上往往因为新生儿对許多传染病具有抵抗力而忽略瘧原虫的感染。先天性瘧疾及新生儿自然感染的瘧疾,在国內外已有不少报告,高瘧区較为多見,但我地区尚未見报导。我院于1961年10月份遇一8个月早产儿出生后第20天开始瘧疾发作,并找到瘧原虫。診断为間日瘧。主要表現間日发热、寒战、嗜睡。患儿母亲在产前三天患间     

原发性血色病继发性糖尿病一例报告

血色病(hemochromatosis)是一组铁代谢紊乱所致的罕见疾病,主要表现为铁沉积于体内,引起脏器不同程度的组织结构破坏及功能障碍。1957年以来血色病国内报道约100例,经肝活检确诊病例仪14例,出现继发性精尿病5例。今报告一例原发性血色病继发性糖尿病。     

糖尿病合并中枢性尿崩症一例

患者女性,55岁,因"口干、多饮、多尿伴体重下降18天"人院.患者18天前无明显诱因开始出现口干、多饮、多尿症状,每天饮水量约10 L,伴随尿量增多约每天10 L,无明显多食,但体重下降约7.5 kg.     

Congenital hyperinsulinism and neonatal diabetes mellitus

This special edition of the Reviews in Metabolic and Endocrine Disorders provides a state of the state update on congenital hyperinsulinism and neonatal diabetes mellitus. Understanding the molecular mechanisms of these two disorders has provided fundamental insights into pancreatic beta-cell physiology. This knowledge has also had a significant impact on our clinical approach to patients with these two disorders and fundamentally changed patient management.     

A case of chronic hepatitis C developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy

We report a case of chronic hepatitis C presenting insulin-dependent diabetes mellitus (IDDM) associated with various autoantibodies including possible anti-insulin receptor antibody (AIRA) during interferon (IFN) therapy. A 57-year-old man having chronic hepatitis C virus (HCV) infection with chronic thyroiditis received IFN therapy. The thyroid function was well-controlled by administration of thyroid hormone, although thyroid autoantibodies were positive. At 15 weeks after starting IFN (reaching 530 million units of total dose), marked thirst happened, with increased fasting plasma glucose level (488 mg/dl) and decreased daily urinary C peptide immunoreactivity level (less than 4.2 microg/day). IDDM occurred with anti-nuclear antibody (ANA), anti-DNA antibody and possible AIRA, and thyroid autoantibodies titers increased, but without pancreatic islet cell antibody and anti-glutamic acid decarboxylase antibody. Administration of IFN was stopped and insulin treatment was started, but plasma glucose level was not controlled well. AIRA became negative 2 months later, however, insulin antibody (IA) was positive when tested after 18 months. Serum HCV RNA has been negative, and a normal level of serum transaminase has been observed since IFN therapy. It is likely that IFN therapy induced the immunological disturbance and resulted in occurrence of various autoantibodies and IDDM in the patient.     

Maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus

Background and aimsThe aim of the study was to evaluate the maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus (GDM), compared to women with GDM.MethodsThis prospective observational cohort study was done on multiparous women with GDM attending the two tertiary care hospitals. Subjects were divided into two groups, recurrent GDM and GDM. Demographics, clinical variables, and maternal and neonatal outcomes were recorded between the two groups. The postpartum glycemic status was determined at six months.ResultsThere were 36 (20.2%) women with recurrent GDM and 142 (79.8%) women with GDM. Women with recurrent GDM were older (32.4 ± 6.2 versus 29.8 ± 5.6 years), had higher frequency of obesity, and insulin resistance than women with GDM. Women with recurrent GDM had poor glycemia at diagnosis as compared to GDM. Although the glycemic goals achieved were comparable but women with recurrent GDM have increased frequency of gestational hypertension, preeclampsia, and need for cesarean section. Women with recurrent GDM significantly had higher frequency of large for gestational age (LGA) and macrosomic neonates. Postpartum diabetes at six months was significantly higher in women with recurrent GDM.ConclusionWomen with recurrent GDM are at increased risk of adverse maternal and perinatal outcomes despite achieving optimal glycemic goals and also at the most significant risk of postpartum diabetes.     

Platelets and antiplatelet therapy in patients with diabetes mellitus

Atherosclerotic heart disease is the leading cause of death in patients with diabetes mellitus. Platelets play a major role in the clinical manifestations of ischemic heart disease. Diabetic patients have hyperreactive platelets with exaggerated adhesion, aggregation and thrombin generation. Antiplatelet agents, including aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors, have shown significant efficacy in reducing recurrent ischemic events in patients with diabetes. Treatment with glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention reduces mortality in diabetic patients.     

Genetics and pathophysiology of neonatal diabetes mellitus

Neonatal diabetes mellitus (NDM) is the term commonly used to describe diabetes with onset before 6 months‐of‐age. It occurs in approximately one out of every 100,000–300,000 live births. Although this term encompasses diabetes of any etiology, it is recognized that NDM diagnosed before 6 months‐of‐age is most often monogenic in nature. Clinically, NDM subgroups include transient (TNDM) and permanent NDM (PNDM), as well as syndromic cases of NDM. TNDM often develops within the first few weeks of life and remits by a few months of age. However, relapse occurs in 50% of cases, typically in adolescence or adulthood. TNDM is most frequently caused by abnormalities in the imprinted region of chromosome 6q24, leading to overexpression of paternally derived genes. Mutations in KCNJ11 and ABCC8, encoding the two subunits of the adenosine triphosphate‐sensitive potassium channel on the β‐cell membrane, can cause TNDM, but more often result in PNDM. NDM as a result of mutations in KCNJ11 and ABCC8 often responds to sulfonylureas, allowing transition from insulin therapy. Mutations in other genes important to β‐cell function and regulation, and in the insulin gene itself, also cause NDM. In 40% of NDM cases, the genetic cause remains unknown. Correctly identifying monogenic NDM has important implications for appropriate treatment, expected disease course and associated conditions, and genetic testing for at‐risk family members. Early recognition of monogenic NDM allows for the implementation of appropriate therapy, leading to improved outcomes and potential societal cost savings. (J Diabetes Invest, doi:10.1111/j.2040‐1124.2011.00106.x, 2011)     

Insulin therapy in elderly patients with diabetes mellitus

Insulin therapy is an effective measure of improving glucose control even in elderly patients with type 2 diabetes. However, it is controversial whether insulin therapy does disturb the quality of life (QOL) as well as cognitive function in the elderly. In our previous study of 455 diabetic patients, the well-being as assessed by the morale scale was similar in three treatment groups. In contrast, the symptom-burden, social burden, and worry about diabetes as assessed by the Elderly Diabetes Burden Scales was more increased in insulin-treated group as compared to the diet-treated group after adjustment for age, gender, HbAlc, frequency of hypoglycemia, microangiopathy, macroangiopathy, and social support. In another study of 213 patients, MMSE scores were similar among treatment groups, while attention and learning were most impaired in insulin-treated groups after adjustment for age, gender, HbAlc, and duration of diabetes. Although the mechanism for the association between insulin treatment and cognitive impairment is unknown, hyperglycemia, hypoglycemia, and cerebral complications in insulin-treated patients may be possible explanations. Whatever mechanism may be involved, hypoglycemia should be considered especially if unexpectedly low HbAlc (< 6.5%) is observed or atypical neuropsychological symptoms appear. It is unknown how insulin withdrawal is successful in elderly diabetic patients. Using rapid or ultrarapid insulin injections three times daily, good glucose control achieved the goal of plasma glucose level of < 140 mg/dl before meals and at bedtime. Then, insulin therapy was converted to oral treatment of glimepiride (2 to 6 mg/day) and/or voglibose (0.6 mg/day) in 30 patients with poorly controlled Type 2 diabetes. About 83% of the patients were successful in the insulin withdrawal according to the criteria of HbAlc levels after two months < 8.0%. After removal of glucose toxicity, insulin withdrawal should be attempted to improve QOL in elderly patients with diabetes mellitus.