磺脲类合并二甲双胍继发失效的2型糖尿病加用拜糖平的疗效观察

目的　观察磺脲类合并二甲双胍继发失效的２ 型糖尿病加用拜糖平的疗效。方法　将５０ 例磺脲类与双胍类联合治疗继发失效的２ 型糖尿病人按非等量随机分组的原则分为拜糖平组（３０例） 和安慰剂组（２０ 例） ，治疗３ 个月，比较治疗。结果　拜糖平组患者的空腹和餐后１ 、２ 小时血糖明显下降，有效率为４８ ．３ ％ ；安慰剂组治疗前后血糖维持不变，仅１ 例有效。结论　加用拜糖平可作为磺脲类与双胍类药物联合应用失效后的治疗方法之一。     

拜糖平与二甲双胍治疗2型糖尿病疗效及药物不良反应分析

目的分析评价拜糖平与二甲双胍治疗2型糖尿病疗效及药物副作用。方法选取2013年2月—2015年2月该院100例2型糖尿病患者,根据计算机随机数字表系统进行分组,拜糖平组以拜糖平为降糖药物,二甲双胍组以二甲双胍为降糖药物。对比两组治疗效果、安全性、干预前后血糖水平的变化、低血糖反应发生率、血糖达标率。结果二甲双胍组治疗总有效47例,为94.00%,拜糖平组92.00%,差异无统计学意义(P0.05)。两组均出现轻微腹泻、腹胀、排气次数增多等不良反应,但差异无统计学意义(P0.05)。两组干预后血糖指标FBG、2 hPBG、HbA1c均显著降低,跟治疗前对比,差异有统计学意义(P0.05),但拜糖平组2 hPBG降低更显著,跟二甲双胍组对比,差异有统计学意义(P0.05);二甲双胍组FBG降低更显著,跟拜糖平组对比,差异有统计学意义(P0.05)。两组低血糖反应发生率、血糖达标率相似,差异无统计学意义(P0.05)。结论拜糖平与二甲双胍治疗2型糖尿病均有确切的疗效,可有效改善患者血糖水平,且用药不良反应少,安全性高,但相对来说,拜糖平对降低餐后2 h血糖作用更显著,二甲双胍则对降低空腹血糖作用更显著,在临床可根据具体情况选择相应的药物。     

卡博平与拜糖平治疗2型糖尿病安全性比较

目的对比分析卡博平与拜糖平治疗2型糖尿病患者临床疗效及其安全性。方法选自2015年1—12月期间该院收治的2型糖尿病患者127例,依据随机数字表法随机分为卡博平组64例与拜糖平组63例。卡博平组口服卡博平,拜糖平组口服拜糖平。两组疗程均为3个月。比较两组治疗疗效,治疗前后糖代谢水平、空腹胰岛素、HOMA-IR及HOMA-β水平变化及不良反应发生情况。结果卡博平组与拜糖平组治疗总有效率比较差异无统计学意义(P0.05);两组空腹胰岛素、HOMA-IR及HOMA-β治疗后均下降(P0.05);卡博平组空腹胰岛素、HOMA-IR及HOMA-β治疗后低于拜糖平组(P0.05);两组FPG、Hb A1c、2h PG治疗后均下降(P0.05);卡博平组FPG、Hb A1c、2h PG治疗后低于拜糖平组(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论卡博平与拜糖平治疗2型糖尿病患者疗效相当,安全可靠,卡博平改善糖代谢及改善胰岛功能明显优于拜糖平。     

瑞格列奈和拜糖平对2型糖尿病降糖作用的比较

目的　比较瑞格列奈和拜糖平治疗 2型糖尿病时的降糖作用。方法　将 5 6例 2型糖尿病患者分为瑞格列奈组 3 2例和拜糖平组 2 4例 ,观察治疗 8周。定期检测患者的空腹及餐后血糖、HbA1c、C肽和体重。结果　瑞格列奈组的空腹血糖从 (11.0 1± 1.63 )mmol/L降至 (6.73±1.47)mmol/L(P <0 .0 1) ,平均下降了 3 .47mmol/L ;拜糖平组空腹血糖从 (10 .43± 0 .5 3 )mmol/L降到 (7.0 5± 1.2 1)mmol/L (P <0 .0 1) ,平均下降了 2 .84mmol/L。瑞格列奈组的餐后血糖从(13 .98± 2 .5 6)mmol/L降至 (8.67± 2 .5 9)mmol/L(P <0 .0 1) ,拜糖平组的餐后血糖从 (14 .17±3 .71)mmol/L降至 (8.80± 2 .14 )mmol/L(P <0 .0 1)。瑞格列奈和拜糖平都能明显降低HbA1c(P <0 .0 1) ,分别降低 1.16%和 0 .91%。两药对C肽和体重均无明显影响。结论　瑞格列奈和拜糖平均有明显的降低空腹和餐后血糖以及HbA1c的作用。瑞格列奈降空腹血糖的作用优于拜糖平 ,两种药物对餐后血糖和HbA1c的降低程度相似。     

拜糖平联合胰岛素治疗对老年2型糖尿病左心室舒张功能的影响

目的观察拜糖平联合胰岛素对老年2型糖尿病左心室舒张功能的影响及临床疗效。方法老年2型糖尿病患者100例，随机分为拜糖平联合胰岛素治疗组（治疗组）和单纯胰岛素治疗组（对照组），疗程24W。治疗前后采用多普勒超声心动图测量二尖瓣口舒张早期峰值速度（E）、舒张晚期峰值速度（A），并计算E／A比值。结果治疗组左心室舒张功能明显改善（P〈0．05）。两组达到相同血糖水平，治疗组所需治疗时间、胰岛素用量以及低血糖发生率明显减少（P〈0．05），空腹及餐后2hC肽轻度下降，且肝肾功能无明显变化。结论拜糖平联合胰岛素治疗能改善老年2型糖尿病患者左心室舒张功能，增加胰岛素的敏感性。     

拜糖平与二甲双胍治疗2型糖尿病的临床效果研究

目的探讨拜糖平与二甲双胍药物在治疗2型糖尿病患者中的应用效果。方法2017年3月—2019年5月,选取该院78例2型糖尿病患者作为研究对象,按照随机数字表法分为对照组39例(采用二甲双胍治疗),观察组39例(采用拜糖平治疗),比较两组患者的临床效果、不良反应以及血糖水平。结果对比患者临床治疗有效率差异有统计学意义(P<0.05)。对照组患者空腹血糖水平、餐后2 h血糖水平,均明显高于观察组(P<0.05)。对照组患者不良反应发生率为28.21%,明显高于观察组5.13%(P<0.05)。结论通过对比拜糖平与二甲双胍药物在治疗2型糖尿病患者中的应用效果,结果证实,与二甲双胍药物相比,拜糖平药物能够减少不良反应的发生,改善其血糖水平,提高临床治疗效果,临床应用价值及临床推广极高。     

胰岛素联合拜糖平在老年2型糖尿病患者血糖控制中的应用分析

目的探讨对胰岛素联合拜糖平在老年2型糖尿病患者血糖控制中的应用效果进行探究。方法将2012年8月—2013年6月在该院接受治疗的108例老年2型糖尿病患者临床资料进行回顾性分析。结果治疗后,观察组患者的空腹血糖、糖化血红蛋白以及餐后2 h血糖改善情况显著优于对照组(P<0.05);观察组患者的低血糖发生率显著低于对照组(P<0.05)。结论治疗老年2型糖尿病患者采用胰岛素联合拜糖平,能够明显控制血糖,降低不良反应,安全性较高。     

胰岛素联合拜糖平在老年2型糖尿病患者血糖控制中的应用分析

目的探讨对胰岛素联合拜糖平在老年2型糖尿病患者血糖控制中的应用效果进行探究。方法将2012年8月—2013年6月在该院接受治疗的108例老年2型糖尿病患者临床资料进行回顾性分析。结果治疗后,观察组患者的空腹血糖、糖化血红蛋白以及餐后2 h血糖改善情况显著优于对照组(P0.05);观察组患者的低血糖发生率显著低于对照组(P0.05)。结论治疗老年2型糖尿病患者采用胰岛素联合拜糖平,能够明显控制血糖,降低不良反应,安全性较高。     

拜糖平与二甲双胍治疗2型糖尿病效果及药物不良反应治疗

目的探讨拜糖平与二甲双胍治疗2型糖尿病的效果及不良反应。方法抽选2型糖尿病患者140例随机分为两组,分别给予二甲双胍治疗(对照组70例)及拜糖平治疗(观察组70例),测定患者治疗后空腹血糖、餐后2 h血糖以及糖化血红蛋白含量差异,评估其治疗效果以及不良反应。结果观察组患者治疗有效率(94.3%)与对照组患者(95.7%)相比差异有统计学意义(P0.05)。观察组患者治疗后空腹血糖、餐后2h血糖以及糖化血红蛋白水平与对照组患者相比差异无统计学意义(P0.05)。同时观察组患者不良反应发生率(5.7%)与对照组(7.1%)相比差异无统计学意义(P0.05)。结论拜糖平与二甲双胍治疗2型糖尿病患者均具有良好效果,值得临床推广。     

拜糖平治疗非胰岛素依赖型糖尿病的临床观察

采用随机分组、双盲对照的方法，对７７例非胰岛素依赖型糖尿病患者进行２４周的拜糖平临床疗效及副作用的观察。结果显示拜糖平对降低空腹及餐后１小时血糖、糖化血红蛋白有明显疗效，对胆固醇亦有明显降低作用。对体重、胰岛素、甘油三酯、高密度脂蛋白、胆固醇等无明显影响。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.