非糖尿病患者血浆尿酸水平与空腹血糖关系的研究

目的探讨血清尿酸水平与中国非糖尿病患者空腹血糖的关系。方法 青岛港健康研究建立于1999至2000年,共15208例18岁以上港口职工参加。本研究来自于青岛港健康研究2000—2001年体检数据,13378例非糖尿病患者入选。所有研究对象进行了详细的问卷调查和体检。计算分性别的血清尿酸五分位数,将研究对象分成5组,观察各组空腹血糖水平。结果血浆尿酸水平高者的空腹血糖浓度升高。各组间空腹血糖浓度分别为：5．41±0．56mmol／L,5.38±0.58mmol／L,5．42±0．56mmol／L,5．46±0．57mmol／L,5．58±0.58mmol／L,呈逐级升离趋势,差异有显著性,偏相关分析显示,在校正了年龄、性别,吸烟、饮酒、血压、血脂、心血管病史后,血浆球酸水平与空腹血糖浓度仍然成正相关。结论非糖尿病患者中血清尿酸水平与空腹血糖显著相关。     

The Effect of Spironolactone on Lipid,Glucose and Uric Acid Levels in Blood during Long-Term Administration to Hypertensives

Spironolactone, an aldosterone antagonist, was given in a daily dose of 100 mg to 15 patients with primary hypertension for one year. Fasting levels of lipids, uric acid, glucose, insulin, potassium and growth hormone were measured before and after 6 and 12 months of treatment. Total cholesterol, LDL cholesterol, glucose, potassium and growth hormone were unchanged, HDL cholesterol fell from (mean±SD) 1.5±0.6 to 1.1 ±0.3 mmol/l (p<0.05) after 6 months of treatment and remained lowered (1.0 ±0.3 mmol/l) (p<0.01) after 12 months of treatment. There was a transient fall after 6 months of treatment in triglycerides from 2.4±1.5 to 2.0±1.1 mmol/l (p < 0.05), uric acid from 380±73 to 342±58 μmol/l (p<0.05) and an increase in insulin from 16±9.5 to 28.6±26.8 mU/l (p<0.05). The blood glucose curves above fasting levels after glucose loading were unchanged during spironolactone treatment, whereas the area under the net insulin curve was higher after 6 months of treatment (163±103 mU · h/l) than before treatment (105±71 mU·h/l), indicating a small and transient insulin resistance. Thus, spironolactone impaired the glucose tolerance transiently and gave small and almost transient changes in fasting serum lipid and uric acid levels.     

The Effect of Glucose on the Plasma Concentration of Somatostatin during Caloric Deficiency in Man

Somatostatin produced in the D-cells of the stomach and the pancreas plays an important role in the carbohydrate metabolism and has been suggested to be involved in the disturbed glucose homeostasis during starvation. We investigated two groups of subjects during severe caloric deficiency. Nine healthy subjects (mean age, 32 years) fasted for 4 days, and the plasma concentration of somatostatin increased greatly, from 11.0 ± 1.3 pM to 21.7 ± 2.3 pM (p = 0.001). Intravenous infusion of 50 g glucose after a 60-h fast and oral loading of 50 g glucose after an 80-h fast normalized temporarily the plasma concentration within 45min and 60min, respectively. In another group of 12 subjects (mean age, 34 years), who participated in a 90-km cross-country ski race lasting 4.45-6.50 h and who were suspected of being in severely catabolic metabolic state, the plasma concentration of somatostatin increased from 6.1 ± 0.8 pM to 26.9 ± 4.7 pM (p < 0.001). Post-race oral feeding of 100 g glucose in seven of the subjects normalized the plasma concentration within 30 min, but the concentration remained increased in the five subjects who had no post-race caloric supply. The results indicate a close relationship between somatostatin and glucose during caloric deficiency in man.     

The Mechanism of Insulin Secretion after Oral Glucose Administration

Summary In conscious trained dogs (Alsatians) the IRI-concentration in the peripheral venous blood after oral administration of glucose increases when the blood glucose is still unchanged. After one or two peaks during the first 20 min IRI increases parallel to the blood sugar increase. In relation to the intravenous injection of glucose the IRI maximum after oral administration occurs earlier. Furthermore the ratio of the IRI to blood sugar areas is raised. Without any blood sugar change the IRI concentration after oral application of tap water increases with one or two peaks. These peaks correspond to the first peaks after oral administration of glucose. These findings are discussed in the sense of a feed-forward of insulin secretion after feeding via N.vagus as well as via enterohormones. More attention should be payed to the IRI course during the early phase of the oral glucose tolerance test.

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Der Mechanismus der Insulinmobilisierung nach oraler GlucosegabeI. Mehrphasigkeit der Insulinmobilisierung nach oraler Glucosegabe beim wachen Hund und Differenzen zum Verhalten nach intravenöser Glucoseinjektion

Zusammenfassung Bei wachen trainierten Schäferhunden steigt die Insulinkonzentration im peripheren Venenblut nach oraler Glucosegabe schon zu einem Zeitpunkt an, da die Glykämie noch nicht verändert ist. Nach Durchlaufen von 1 oder 2 Gipfeln in den ersten 20 min tritt der Anstieg ein, der parallel dem Blutzuckergipfel verläuft. Im Verhältnis zur intravenösen Glucosegabe liegt das erste IRI-Maximum nach oraler Verabfolgung zeitlich früher. Auch ist der Quotient aus IRIÜberschreitungsfläche und Blutzuckerüberschreitungsfläche erhöht. Ohne daß es zu einer Blutzucker Veränderung kommt, steigt auch nach oraler Gabe von Leitungswasser die IRI-Konzentration 1-oder 2gipflig an. Diese Gipfel entsprechen den beiden ersten Erhöhungen nach oraler Glucosegabe. Die beobachteten Phänomene werden im Sinne einer Vorwärtskopplung der Insulinsekretion nach Nahrungsaufnahme via N.vagus und Enterohormone diskutiert. Der Beurteilung des IRI-Verlaufs in der frühen Phase des oralen Glucosetoleranztests sollte größere Beachtung geschenkt werden.

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Mécanisme de la sécrétion d'insuline après administration orale de glucoseI. Déroulement multiphasique de la mobilisation de l'insuline après administration orale de glucose chez le chien éveillé. Différences de comportement après administration intraveineuse

Résumé Chez des chiens-bergers éveillés et entraînés, après administration orale de glucose, la concentration d'IRI dans le sang veineux périphérique augmente déjà alors que la glycémie n'a pas encore changé. Après un ou deux pics durant les vingt premières minutes, l'IRI augmente parallèlement au glucose sanguin. Comparativement à l'injection intra-veineuse de glucose, le maximum d'IRI, après administration orale, se produit plus tôt. De plus, le quotient des surfaces d'IRI et de glycémie est élevé. Sans aucun changement du glucose sanguin, la concentration d'IRI augmente avec un ou deux pics après administration orale d'eau potable. Ces pics correspondent aux deux premiers pics après administration orale de glucose. Ces résultats sont discutés dans le sens d'une sécrétion d'insuline précédant la digestion via N.vague et via entérohormones. Il faut accorder plus d'attention à l'évolution d'IRI durant la première phase du test de tolérance au glucose par voie orale.

     

Pancreatic Secretion in Man: Effect of Fasting, Drugs, Pancreatic Enzymes, and Somatostatin

The inhibitory effecl of different drugs on pancreatic secretions was assessed in a patient with a posttraumatic pancreatic-cutaneous fistula. The various drugs examined were: pancreatic enzymes, cimetidine, verapamil, propantheline, acetazolamide., and somatostatin analog octreotide. Only fasting and octreotide reduced pancreatic secretion. The optimum dose of octreotide was 50 g bid given subcutaneous I y; increasing the dose up to 100 Hg tid had no additional benefit. A stable pancreatic-cutaneous fistula is an excellent model to assess the effect of different therapeutic measures on pancreatic secretion.     

A Higher Proinsulin Response to Glucose Loading Predicts Deteriorating Fasting Plasma Glucose and Worsening to Diabetes in Subjects with Impaired Glucose Tolerance

To evaluate the clinical significance of proinsulin determination, we measured glucose, insulin, C-peptide and proinsulin during 75-g oral glucose loading in 59 patients. In a 2.5-year follow-up study of 37 subjects with impaired glucose tolerance (IGT) at the initial test, 11 patients changed from IGT to a normal state and 5 patients showed worsening to overt Type 2 diabetes with elevation of fasting plasma glucose; 21 patients remained unchanged. Although our data showed that both fasting (IGT: p = 0.4523) and 120-min plasma glucose (IGT: p = 0.8168) values at the initial test were not significantly correlated with increased fasting plasma glucose levels in a 2.5-year follow-up study, subjects with a higher 120-min proinsulin response to glucose during the initial OGTT showed a significant correlation (IGT: p <0.0001) with increased fasting plasma glucose levels after follow-up period and developed Type 2 diabetes. The present findings suggest that the proinsulin response to glucose loading might be a useful indicator for predicting worsening to diabetes in subjects with impaired glucose tolerance.     

Serum Amylase and Serum Lipase Levels in Man after Administration of Secretin and Pancreozymin

A simple evocative test has been used to study pancreatic function. Serial estimations of amylase and lipase in blood serum are made at intervals up to six hours and again at 24 hours after injecting intravenously standard doses of secretin and pancreozymin. The results of 213 tests on a normal group, in pancreatic disease, in biliary and hepatic diseases have been analysed and compared with the results of duodenal intubation and an oral glucose tolerance test. A combined evocative test and oral glucose tolerance test provide evidence of pancreatic dysfunction in the majority of cases of cancer of the pancreas and chronic pancreatitis. The conditions of the test are described and the pathological lesions in which false positive evocative tests may be found are indicated.

The simple evocative test provides the earliest biochemical evidence of pancreatic disease in some patients with cancer of the pancreas and chronic pancreatitis.

     

Effect of Adrenergic Blocking Agents on Plasma Gastrin and Secretin Levels in Man

The effect of adrenergic blocking agents on gastrin and secretin secretion before and after a bolus arginine injection (arginine pulse) was investigated in normal subjects. Repeated arginine pulses given at 30-minute intervals caused abrupt and almost identical rises of plasma gastrin with each pulse. On the other hand, plasma secretin levels were unchanged by repeated injections of arginine. The increase in plasma gastrin induced by arginine pulse was significantly suppressed by the infusion of beta-adrenergic blocking agent, propranolol, while the infusion of alpha-adrenergic blocking agent, phentolamine tended to enhance the arginine-induced gastrin secretion slightly but not significantly. Whereas, the infusion of neither phentolamine nor propranolol had significant influence on secretin secretion. These results suggest that alpha- and beta-adrenergic receptors play an important role in the regulation of arginineinduced gastrin secretion.     

Inhibition of Gastric Acid Secretion by Jejunal Glucose and Its Relation to Osmolality and Glucose Load

Intrajejunal infusion of hypertonic glucose and hypertonic saline inhibits penta-gastrin-stimulated gastric acid secretion in man. This effect is generally ascribed to the hyperosmolality of the solutions. Five volunteers were given 50 g glucose in osmolar concentrations of 2700 mosmol/l and 900 mosmol/l, and five were given 25 g glucose in osmolar concentrations of 2700 mosmol/l and 300 mosmol/l. Control studies with intrajejunal infusion of physiologic saline were performed in all subjects. Median inhibition of gastric acid secretion was 91% after 50 g glucose and 47% after 25 g glucose and was unrelated to the osmolar concentration. These findings suggest that the acid-inhibitory effect of intrajejunally administered glucose is related to the glucose load and not to the osmolar concentration. Plasma responses of intact neurotensin, immunoreactivity, NH,-terminal neurotensin immunoreactivity, entero-glucagon, and gastric inhibitory polypeptide were all related to the amount of glucose given. Glucagon and somatostatin, both of which are potent inhibitors of gastric secretion, were not released by intrajejunally administered glucose.     

The Influence of Intraduodenal Administration of Pancreatic Juice on the Bile-Induced Pancreatic Secretion and Immunoreactive Secretin Release in Man

The exocrine pancreatic secretion of water, bicarbonate, amylase, and protein and the plasma levels of immunoreactive secretin (IRS) were studied after intraduodenal infusions of bile and pancreatic juice. Pancreatic secretion was obtained by endoscopic cannulation of the main pancreatic duct. Bile and pancreatic juice were infused into the duodenum through separate catheters attached to the outside of the duodeno-scope. The unstimulated secretion was collected for 20 min. After intraduodenal stimulation of the pancreatic secretion with a nearly neutral solution of dried cattle bile, juice was collected for another 20-min period. Then, pure pancreatic juice was infused into the duodenum. It was shown that pancreatic juice reduced the flow rate and output of bicarbonate, amylase, and protein significantly (p < 0.05). A significant reduction in plasma concentration of IRS (p < 0.05) was also found. In the controls, i.e., when no pancreatic juice was instilled into the duodenum, a further increase in flow rate, bicarbonate secretion, and IRS was found. It is concluded that the exocrine pancreatic secretion and IRS release induced by intraduodenal administration of bile may be depressed by reinfusions of pancreatic juice. The corresponding effect on bicarbonate secretion and IRS release found in this study supports the view that secretin may play an important role in the exocrine pancreatic secretion induced by intraduodenal infusion of bile.     

Addition of a Gastrointestinal Microbiome Modulator to Metformin Improves Metformin Tolerance and Fasting Glucose Levels

Background:

Adverse effects of metformin are primarily related to gastrointestinal (GI) intolerance that could limit titration to an efficacious dose or cause discontinuation of the medication. Because some metformin side effects may be attributable to shifts in the GI microbiome, we tested whether a GI microbiome modulator (GIMM) used in combination with metformin would ameliorate the GI symptoms.

Methods:

A 2-period crossover study design was used with 2 treatment sequences, either placebo in period 1 followed by GIMM in period 2 or vice versa. Study periods lasted for 2 weeks, with a 2-week washout period between. During the first week, type 2 diabetes patients (T2D) who experienced metformin GI intolerance took 500 mg metformin along with their assigned NM504 (GIMM) or placebo treatment with breakfast and with dinner. In the second week, the 10 subjects took 500 mg metformin (t.i.d.), with GIMM or placebo consumed with the first and third daily metformin doses. Subjects were permitted to discontinue metformin dosing if it became intolerable.

Results:

The combination of metformin and GIMM treatment produced a significantly better tolerance score to metformin than the placebo combination (6.78 ± 0.65 [mean ± SEM] versus 4.45 ± 0.69, P = .0006). Mean fasting glucose levels were significantly (P < .02) lower with the metformin–GIMM combination (121.3 ± 7.8 mg/dl) than with metformin-placebo (151.9 ± 7.8 mg/dl).

Conclusion:

Combining a GI microbiome modulator with metformin might allow the greater use of metformin in T2D patients and improve treatment of the disease.     

胃十二指肠溃疡者不同状态下血中生长抑素、胃泌素水平

本文对胃十二指肠溃疡患者在并发出血、幽门螺旋菌(HP)感染、H_2受体阻滞剂治疗后等不同情况下血浆生长抑素(SS)、胃泌素(Gas)水平作了测定,结果提示在上述各种状态下,血中SS、Gas水平均无显著改变,H_2RA治疗后呈现SS水平下降而Gas水平升高的趋势。     

糖尿病患者空腹血糖水平与新发脑梗死的相关性研究

目的探讨糖尿病患者空腹血糖水平与新发脑梗死事件的相关性。方法选取苏州大学附属第二医院住院的糖尿病患者512例,进行定期随访,记录新发脑梗死事件情况并进行统计分析。结果入院时各组生化检查空腹血糖水平越高,LDL-C、总胆固醇和甘油三酯就越高;随访结束统计,空腹血糖水平越高新发脑梗死发生率则越高;高危组脑梗死发生率14.9%,正常组发生率5%,差异有统计学意义(P0.05)。结论糖尿病患者空腹血糖水平与新发脑梗死事件关系密切,空腹血糖水平越高出现脑梗死事件率则越高。     

The Effect of Graded Doses of Secretin on Serum Trypsin,Serum Pancreatic Amylase,Serum Insulin,Plasma Somatostatin,and Plasma Pancreatic Polypeptide in Man

Six healthy men were studied with intravenous infusions of 0.3. 1.0, and 3.0 CU/kg-h of pure porcine secretin on separate days. The secretin elimination followed a first-order kinetics. Low pharmacological doses of secretin had no significant effects on blood levels of trypsin, pancreatic amylase, insulin, somatostatin, or pancreatic polypeptide (PP). whereas high pharmacological doses significantly elevated the blood levels of trypsin, pancreatic amylase, insulin, and somatostatin but were without effect on PP.     

Noninvasive Skin Fluorescence Spectroscopy is Comparable to Hemoglobin A1c and Fasting Plasma Glucose for Detection of Abnormal Glucose Tolerance

Aim:

We compare performance of noninvasive skin fluorescence spectroscopy (SFS), fasting plasma glucose (FPG), and hemoglobin A1c (A1C) for detection of abnormal glucose tolerance (AGT).

Methods:

The NSEEDS trial evaluated SFS, FPG, and A1C in an at-risk population of 479 previously undiagnosed subjects from nine US centers, each of whom received a 75 g, 2 h oral glucose tolerance test (OGTT). Skin fluorescence spectra were collected and analyzed with SCOUT DS^® devices. Disease truth was AGT, defined as OGTT ≥140 mg/dl. Abnormal glucose tolerance sensitivity, false positive rate (FPR), and receiver operating characteristic (ROC) curves were computed for each measurement technique. Skin fluorescence spectroscopy reproducibility was also assessed.

Results:

The AGT sensitivity of SFS was 68.2%, higher than that of FPG (thresholds of 100 and 110 mg/dl) and A1C (thresholds of 5.7% and 6.0%). The FPR of SFS was 37.7%, comparable to A1C at the 5.7% threshold (30.7%). Partial ROC areas of SFS, FPG, and A1C were similar for FPRs of 20–50% (average sensitivities of 64.0%, 59.0%, and 68.6%, respectively). The interday coefficient of variation for SFS was 7.6%.

Conclusions:

Skin fluorescence spectroscopy has similar screening performance to FPG and A1C and is a viable approach for detection of AGT.     

Stimulation of Biliary Secretion by Duodenal Acidification and Secretin

The volume and bicarbonate output of hepatic bile was observed in chronic biliary fistula dogs during intravenous infusion of varying doses of secretin or intraduodenal introduction of varying loads of acid. Secretin and acid produced a dose-related increase in bile flow and in bicarbonate output reaching a maximum at the dose of 16 units per kg per hr of secretin and 32 mEq per hr of acid. The maximal volume and bicarbonate output with secretin was about 25% higher than with acid. Closing the gastric fistula during the maximal gastric acid response to histamine or pentagastrin and thus permitting the gastric acid to pass the duodenum, resulted in the increase in bile flow and bicarbonate output comparable to that obtained with exogenous duodenal acidification.     

不同血糖水平糖尿病患者动脉弹性指数的变化

目的 观察不同血糖水平糖尿病患者动脉弹性指数的变化及其与血压、糖代谢等因素的关系.方法 选取空腹血糖＞5.6 mmol/L的糖尿病患者共313人,男性176人,女性137人,年龄(52.9±11.5)岁.根据1999年WHO糖尿病诊断标准,将所有受试者按照口服葡萄糖耐量试验(OGTT)结果分为4组:正常血糖组(n=86)、空腹血糖受损组(IFG,n=36)、糖耐量减低组(IGT,n=45)和糖尿病组(n=146).采用美国HDI公司CVProfilorTMDO-2020型动脉弹性功能测定仪系统测量血管弹性.结果 1)校正年龄后,与血糖正常组、IFG组、IGT组相比,糖尿病组大动脉弹性指数(C1)、小动脉弹性指数(C2)明显下降.血糖正常组、IFG组、IGT组3组间的C1、C2差异无统计学意义.2)多元逐步回归分析显示:C1与脉压、脉率、年龄、餐后2 h血糖负相关.C2与年龄、餐后2 h血糖、平均动脉压负相关.结论 1)糖尿病患者动脉弹性指数降低,而糖尿病发病前状态(IFG,IGT)未见动脉弹性的异常.糖尿病对血管弹性的影响独立于血压水平.2)脉压对C1的影响较大,而餐后2 h血糖对C2的影响大于血压的影响.     

糖化血红蛋白联合空腹血糖检测筛查对糖尿病的临床价值

目的分析并研究糖化血红蛋白联合空腹血糖检测筛查对糖尿病的临床检验效果,为糖尿病的筛查提供指导和依据。方法于2014年4月—2014年8月期间依据纳入排除标准随机抽取200例,其中已确诊为糖尿病的患者数为40例,采用随机数字表法将160例分为两组,并同时将40例糖尿病患者分为两组,试验组采用的检验方式为糖化血红蛋白联合空腹血糖检验筛查,对照组采用的检验方式为空腹血糖检验方法,对两组的检验结果进行分析研究并比较。结果试验组在经过糖化血红蛋白联合空腹血糖检测后,确诊为糖尿病患者人数、疑似糖尿病患者人数、确诊未患糖尿病患者人数依次为20例、1例、79例;对照组依次为12例、16例、72例。试验组在经过糖化血红蛋白联合空腹血糖检测后,总有效率为100%,对照组总有效率为92%。结论对于糖尿病的筛查,糖化血红蛋白联合空腹血糖检测筛查方式相较于只对患者进行空腹血糖检测更为有效,效果更好。     

太原市社区人群与定期体检人群空腹血糖、血脂及血尿酸水平的调查分析

目的比较社区人群与定期体检人群之间血糖、血脂和血尿酸水平以及糖尿病、高血脂和高尿酸血症患病率的差异,为糖尿病、高脂血症、高尿酸血症的一级预防提供依据。方法对9960名太原市社区常住居民及我院体检中心定期体检的健康体检者的空腹血糖、血脂、尿酸水平及异常率进行调查,并比较其差异。结果太原市社区人群空腹血糖、血脂、血尿酸水平与定期体检人群比较差异无统计学意义;两人群高密度脂蛋白胆固醇、血尿酸水平有性别差异(P<0.05);同性别两人群各指标水平差异无统计学意义。社区人群糖尿病和高血脂患病率高于定期体检人群(P<0.05),高尿酸血症患病率未发现有差异;社区人群和定期体检人群糖尿病、高血脂(除高甘油三酯血症外)、高尿酸血症患病率有性别差异(P<0.05);两人群中男性低密度脂蛋白胆固醇异常率和高尿酸血症患病率差别有统计学意义,两人群中女性三种疾病患病率均有统计学差异(P<0.05)。社区男性人群糖尿病患病率、低密度脂蛋白胆固醇异常率随年龄增加有增高趋势,高密度脂蛋白胆固醇异常率、高尿酸血症随年龄增加有降低趋势,女性人群三种疾病患病率随年龄增加均有增高趋势;定期体检男性人群高密度脂蛋白胆固醇、低密度脂蛋白胆固醇患病率及...