胰岛素治疗对2型糖尿病肾病血清C反应蛋白水平的影响

目的:比较2型糖尿病(无肾病)及糖尿病肾病(DN)患者血清C反应蛋白(CRP)的水平,观察应用胰岛素治疗后血清CRP水平的变化。方法:2型糖尿病患者共100例,其中糖尿病(无肾病)为DM组40例,糖尿病肾病组为DN组60例。将DN组患者随机分组,口服糖适平组为DN1、胰岛素治疗组为DN2共治疗12周。选取正常对照组(NC)30例,应用化学发光法测定血CRP水平。结果:NC、DM组、DN组血清CRP水平分别为(2.90±1.8)mg/L、(5.8±3.2)mg/L、(9.2±5.6)mg/L逐渐升高,血清CRP水平与总胆固醇(TC)(r=0.510,P<0.01)、空腹血糖(FBG)(r=0.29,P<0.01)呈正相关。血清CRP在DN2组胰岛素治疗前后分别为(9.30±3.78)mg/L、(4.78±2.11)mg/L下降明显,有统计学差异(P<0.01);DN1组糖适平治疗前后(9.04±4.9)mg/L、(8.30±1.8)mg/L下降,无统计学差异(P>0.05)。结论:2型DM(无肾病)及DN组血清CRP水平逐渐升高,且DN经胰岛素治疗后血清CRP水平明显下降。     

内皮素和超敏C反应蛋白与2型糖尿病患者不同程度蛋白尿的关系

目的探讨血浆内皮素（ET）和血清超敏C反应蛋白（hs-CRP）与2型糖尿病患者不同程度蛋白尿的关系。方法选择2006年8月至2009年5月在我院住院的无肾脏并发症的2型糖尿病患者40例为D组,有肾脏并发症的2型糖尿病患者63例为N组,将N组患者按照尿白蛋白排泄率（UAER）分为以下3组：间断白蛋白尿组（NI组,n=21）：UAER〈20μg／min;微量白蛋白尿组（N2组,n=20）：UAER20-200μg／min;临床白蛋白尿组（N3组,n=22）：UAER〉200μg／min。选择同期健康体检者40名为对照组（C组）。采用酶链免疫吸附（ELISA）法测定各组血浆ET和血清hs-CRP水平。并对各组血浆ET及血清hs-CRP水平进行相关性分析。结果与C组相比,D组血浆ET和血清hs-CRP均升高（P〈0．05）;N组血浆ET和血清hs-CRP比较,N2组较N1组升高,N3组较N2组升高（P〈0．01）。C、D和N1组血浆ET和血清hs-CI心水平无相关性（r分别为0．117、0．208和0．361,P〉0．05）;N2、N3组血浆ET和血清hs-CRP水平呈正相关（r分别为0．505和0．587,P〈0．05或P〈0．01）。结论ET和hrCRP可能参与糖尿病肾脏病的发生和发展,其可作为判断预后、指导治疗的重要参考指标。     

2型糖尿病肾病与代谢综合征的相关性探讨

目的:探讨2型糖尿病(T2DM)肾病与代谢综合征(MS)的相关性。方法:比较627例T2DM患者中糖尿病肾病(DN)与非DN患者之间MS及其主要成分的患病率和集聚状态。结果:与非DN患者相比,DN患者有更高的MS患病率和集聚状态(P<0.001)。单因素Logistic回归分析显示DN与MS、MS主要成分的集聚数目显著正相关。多因素Logistic回归分析显示DN与高血压、超重/肥胖、脂代谢紊乱显著正相关。结论:MS与DN的发生发展中扮演重要角色。进行多因素干预治疗对防治DN和心血管疾病(CVD)均有重要临床意义。     

2型糖尿病肾病患者血清C反应蛋白与脂代谢异常的相关性研究

目的：了解血清超敏C反应蛋白（hsCRP）在2型糖尿病肾病中的变化与脂代谢异常的关系。方法：根据尿白蛋白排泄率（UAER）将2型糖尿病患者分为正常蛋白组（DM）40例、糖尿病肾病组（DN）33例及健康对照者（NC）30例。测定血清超敏CRP,同时测定血总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）及载脂蛋白B（Apo-B）等指标,测定空腹血糖（FBG）、HbA1C。观察各组间hsCRP变化与血脂作相关性分析。结果：DM组、DN组较NC组HbA1C、TC、TG、LDL-C、CRP水平升高,有统计学差异（P〈0.05或P〈0.01）;DN组较DM组CRP、TG、APO-B水平升高,有统计学差异（P〈0.05或P〈0.01）。DN组CRP与TG、TC、LDL-C呈正相关（P〈0.05或P〈0.01）。结论：2型糖尿病肾病中血清炎症因子CRP水平升高与脂代谢异常密切相关。     

男性2型糖尿病伴代谢综合征患者血清维生素D水平的研究

目的观察男性2型糖尿病(T2DM)患者血清25-羟维生素D[25(OH) D]水平与代谢综合征(MS)及其组分的关系。方法收集2018年3月至2019年6月在遵义医科大学附属医院内分泌科住院的男性T2DM患者203例及同期健康男性对照组(NC组) 42例,糖尿病患者中根据有无MS分为T2DM+MS组(122例)、T2DM+非MS组(81例),另根据符合MS诊断标准数目分为T2DM组(单纯糖尿病组)、T2DM+1组(除血糖异常外另加一个组分)、T2DM+2组(除血糖异常外另加两个组分)、T2DM+3组(除血糖异常外另加三个组分)、T2DM+4组(具备MS的所有组分),分析WC、BMI、SBP、DBP、FBG、Hb Alc、HOMAIR、TG、TC、LDL-C、HDL-C和25(OH) D水平。结果 T2DM+MS组及T2DM+非MS组血清25(OH) D水平均较NC组显著降低(P0.05),T2DM+MS组血清25(OH) D水平较T2DM+非MS组显著降低(P0.05)。NC组、T2DM组、T2DM+1组、T2DM+2组、T2DM+3组、T2DM+4组血清25(OH) D水平逐渐降低,差异有统计学意义(P 0.05)。Pearson相关分析显示血清25(OH) D水平与WC、BMI、SBP、DBP、HOMA-IR、FBG、TG、TC、LDL-C呈负相关(P0.05),与HDL-C呈正相关(P0.05)。多元线性回归提示HOMA-IR是血清25(OH) D水平的独立影响因素(P0.05)。二元Logistic回归分析显示血清25(OH) D是T2DM伴MS患者的独立保护因素(P0.05)。结论血清维生素D水平在男性T2DM患者代谢综合征的发生发展中可能起着一定作用。低水平维生素D与MS组分数目增加存在一定相关性。     

2型糖尿病肾病患者大血管病变与血清淀粉样蛋白A及超敏C反应蛋白的关系

随着2型糖尿病发病率的增多,糖尿病肾病人群日益扩大,有研究认为约10%的2型糖尿病患者最终会进入糖尿病肾病肾衰竭,而心血管疾病是终末期肾衰竭患者的首位死亡原因.国内外研究资料显示终末期肾病患者心血管病的危险因素除高容量负荷、高血压及贫血等因素相关外,炎性因子也起到了十分重要的作用.血清淀粉样蛋白A和超敏C反应蛋白均为急性期时相蛋白,是血清敏感的炎症标志物,是反应动脉粥样硬化斑块稳定性的标志[1].本研究旨在检测2型糖尿病肾病患者血清淀粉样蛋白A和超敏C反应蛋白的水平及与颈动脉内中膜厚度的关系.     

代谢综合征与肾脏疾病之间的关系

代谢综合征(MS)是常由肥胖启动、以胰岛素抵抗为基础、包括肥胖、糖代谢紊乱、脂质代谢异常及高血压等生理异常聚集的临床综合征，这些异常单独或者合并存在时均能够导致肾脏损害或加速原有肾脏疾病的进展，与单纯糖尿病、高血压或脂代谢紊乱等导致的肾损害不同，MS肾损害通常由肥胖启动并且是上述多重因素综合作用的结果。本文拟就MS肾脏损害的临床特点、发生机制及对MS的干预措施的研究进展作一综述。     

氯沙坦对2型糖尿病肾病早期患者血清超敏C反应蛋白的影响

目的:探讨氯沙坦对2型糖尿病肾病(DN)早期患者血清超敏C反应蛋白(hs- CRP)的影响.方法:将72例2型DN早期患者随机分为对照组和治疗组,每组36例,对照组患者均予常规降糖治疗,治疗组在对照组治疗基础上加用氯沙坦,治疗8周.治疗前后检测两组患者FBG、UAER和hs-CRP水平的变化.结果:治疗前,两组患者FBG、UAER和hs- CRP水平比较,差异无统计学意义(P＞0.05);治疗后,治疗组患者FBG、UAER和hs-CRP水平均显著低于对照组,差异有统计学意义(P＜0.01).结论:氯沙坦能够降低2型DN早期患者血清hs-CRP水平,抑制炎症反应,延缓DN的发生和发展.     

Role of adiponectin and some other factors linking type 2 diabetes mellitus and obesity

Because of the intimate association of obesity with type 2 diabetes mellitus(T2DM), during the last two decades, extensive research work is being conducted to find out whether the coexistence of the two is a simple association or there is a positive correlating link between the two. In this article, an attempt has been made to collect and analyse the recent developments in this field and to arrive at a conclusion on the subject. The possible role of several important factors(obtained from adipocytes/not of adipocyte origin) in linking the two has been discussed in detail. Some of the agents, specifically adiponectin, are beneficial(i.e., reduce the incidence of both), while others are harmful(i.e., increase their incidence). From the analysis, it appears that obesity and T2 DM are intimately linked.     

不同胃肠吻合方式对非肥胖型2型糖尿病大鼠的降糖作用

目的 观察不同胃肠吻合方式对非肥胖型2型糖尿病(T2DM)大鼠的治疗作用.方法 将24只雄性Goto-Kakizaki(GK)大鼠随机分3组,分别为Roux-en-Y式、毕Ⅱ式胃转流术组和毕Ⅰ式组,每组8只.检测术前(0周)及术后1、3、6、12、24周空腹血糖及空腹血清胰岛素水平,采用稳态模型法计算胰岛素抵抗指数(HOMA-IR).结果 与术前比较,毕Ⅰ式组空腹血糖、空腹胰岛素、HOMA-IR术后1～24周未见明显变化(P＞0.05):而Roux-en-Y式、毕Ⅱ式组术后1～24周空腹血糖较术前显著降低(P＜0.01),术后24周,空腹血糖由(12.56±2.97)、(12.96±3.01)mmol/L下降到(7.87±0.75)、(9.21±1.53)mmol/L;空腹胰岛素术后1～24周未见明显变化(P＞0.05),HOMA-IR术后1～24周显著降低(P＜0.01),术后24周,HOMA-IR由(11.92±1.45)、(12.69±2.03)下降到(6.66±1.25)、(7.97±0.68).结论 毕Ⅰ式胃肠吻合术对2型糖尿病大鼠可能无治疗作用,Roux-en-Y式和毕Ⅱ式胃转流术可改善2型糖尿病大鼠胰岛素抵抗程度,有效控制血糖水平,且Roux-en-Y式胃转流术疗效优于毕Ⅱ式胃转流术.

Abstract：

Objective To investigate the effect after gastrojejunostomy with different types of anastomosis in an animal model of nonobese type 2 diabetes.Methods Twenty-four Goto-Kakizaki rats randomly underwent one of the following procedures:gastric bypass with different types of anastomosis of Roux-en-Y ( n = 8),Billroth Ⅱ ( n = 8 ) or Billroth Ⅰ ( n = 8 ).Rats were observed for 24 weeks after surgery.Fasting blood glucose and insulin level were tested at 0,1,3,6,12,24 weeks and homeostasis model assessment of insulin resistance (HOMA-IR) was done.Results As compared with preoperation,fasting blood glucose levels,the fasting blood insulin level and the HOMA-IR level had no significant change in Billroth Ⅰ rats during the entire follow-up period ( P ＞ 0.05).In both Roux-en-Y and Billroth Ⅱ groups,fasting blood glucose levels were significantly decreased as early as 1 week after surgery and then kept a similar level during the entire follow-up period (P＜0.01 ).Twenty-four weeks after operation,the fasting blood glucose levels was declined from (12.56 ±2.97),(12.96 ±3.01) mmol/L to (7.87 ±0.75),(9.21 ± 1.53) mmol/L;the fasting blood insulin levels were similar during the entire follow-up period ( P ＞0.05 ).The HOMA-IR level was significantly decreased after surgery in both Roux-en-Y and Billroth Ⅱ groups during the follow-up period ( P＜0.01 ).Twenty-four weeks after operation,the HOMA-IR level was declined from (11.92 ± 1.45),(12.69 ±2.03) to (6.66 ± 1.25),(7.97 ±0.68).Conclusion Billroth Ⅰ reconstruction after gastrectomy is not effective on diabetes control.Roux-en-Y and Billroth Ⅱ gastric bypass in a nonobese diabetic model were effective in terms of glucose control and improving insulin resistance.But Roux-en-Y gastric bypass seems to be more effective than Billroth Ⅱ gastric bypass on antidiabetes.     

Oxidative stress,insulin resistance,dyslipidemia and type 2 diabetes mellitus

Oxidative stress is increased in metabolic syndrome and type 2 diabetes mellitus(T2DM) and this appears to underlie the development of cardiovascular disease,T2 DM and diabetic complications.Increased oxidative stress appears to be a deleterious factor leading toinsulin resistance,dyslipidemia,β-cell dysfunction,impaired glucose tolerance and ultimately leading to T2 DM.Chronic oxidative stress,hyperglycemia and dyslipidemia are particularly dangerous for β-cells from lowest levels of antioxidant,have high oxidative energy requirements,decrease the gene expression of key β-cell genes and induce cell death.If β-cell functioning is impaired,it results in an under production of insulin,impairs glucose stimulated insulin secretion,fasting hyperglycemia and eventually the development of T2 DM.     

Management of type 2 diabetes mellitus in youth

The rising rates of obesity in youth have concurrently led to an increase in the rates of type 2 diabetes mellitus(T2DM) in this age group.However,there are limited data on the efficacy of different antidiabetic agents in youth.In this context,the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial recently reported that the majority of obese children and adolescents 10-17-years old with newly diagnosed T2DM(T2DM duration less than 2 years) could not achieve HbA1c levels < 8% for more than 1 year with metformin monotherapy,metformin plus rosiglitazone combination,or metformin and lifestyle changes.These findings suggest that,in the majority of youth with T2DM,tight long-term glycemic control with oral agents is an elusive goal and that most patients will require treatment with insulin within a few years of diagnosis to achieve HbA1c targets and reduce the risk of macroand microvascular complications.Therefore,reducing the incidence of T2DM by preventing pediatric obesity through the implementation of lifestyle changes in the community should be the primary objective of healthcare systems.     

我国2型糖尿病的外科治疗术式探讨

由于我国的2型糖尿病患者中位体质量指数（BMI）只有24 kg/m2以及我国糖尿病患者存在的饮食差异性,使得目前国内尚缺少充足的减重手术数据和指南,因此,我国医生在国际上公认的术式之外,进行了手术治疗2型糖尿病的术式探索.2011年国际糖尿病联盟（IDF）治疗2型糖尿病的推荐术式主要有：胃旁路手术（GBP）、袖状胃切除术（SG）、胆胰转流手术（BPD）、十二指肠转位术（DS）和可调节胃束带术（AGB）.本文重点分析我国外科医生的进展探索性术式,主要包括：袖状胃切除术加十二指肠空肠旁路术,十二指肠空肠旁路术,袖状胃切除加空回肠旁路术,袖状胃切除加回肠间置术,单纯回肠间置术及空、回肠短路术,胃大弯折叠术以及折叠术加胃束带术,以及其他在内镜下完成的减重术式.每种术式均各有特点,但哪种术式更为适合国内2型糖尿病患者,尚需临床的长期随访及大样本的多中心研究的开展,相信在科学规范前提下,我国的外科医生会摸索出最适合本国2型糖尿病患者的手术方式.     

Hepatitis C virus infection and type 1 and type 2 diabetes mellitus

Hepatitis C virus(HCV) infection and diabetes mellitus are two major public health problems that cause devastating health and financial burdens worldwide. Diabetes can be classified into two major types: type 1 diabetes mellitus(T1DM) and T2 DM. T2 DM is a common endocrine disorder that encompasses multifactorial mechanisms, and T1 DM is an immunologically mediated disease. Many epidemiological studies have shown an association between T2 DM and chronic hepatitis C(CHC) infection. The processes through which CHC is associated with T2 DM seem to involve direct viral effects, insulin resistance, proinflammatory cytokines, chemokines, and other immunemediated mechanisms. Few data have been reported on the association of CHC and T1 DM and reports on the potential association between T1 DM and acute HCV infection are even rarer. A small number of studies indicate that interferon-α therapy can stimulate pancreatic autoim-munity and in certain cases lead to the development of T1 DM. Diabetes and CHC have important interactions. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with nondiabetic CHC subjects. However, clinical trials on HCV-positive patients have reported improvements in glucose metabolism after antiviral treatment. Further studies are needed to improve prevention policies and to foster adequate and cost-effec-tive programmes for the surveillance and treatment of diabetic CHC patients.     

Roux-en-Y gastric bypass increases hepatic and peripheral insulin sensitivity in rats with type 2 diabetes mellitus

BackgroundRoux-en-Y gastric bypass (RYGB) surgery for the treatment of obesity leads to long-term diabetes remission in approximately 80% of cases. The aim of this study was to investigate the effects of RYGB on hepatic and peripheral insulin sensitivity in type 2 diabetic rats and their possible mechanisms. We also tested the hypothesis that RYGB reduces lipid content and improves insulin sensitivity in hepatocytes and skeletal muscle cells.MethodsSprague–Dawley rats were divided into 4 groups: diabetic RYGB group (n = 18), diabetic RYGB sham group (n = 6), diabetic group (n = 6), and nondiabetic control group (n = 6). The hyperinsulinemic-euglycemic clamp with tracer infusion was completed at 2, 4, and 8 weeks postoperatively to assess insulin sensitivity. The lipid content in liver and muscle tissue was examined.ResultsPostoperatively, the diabetic RYGB group had significant decreases in weight, fat mass, and food intake. Two weeks after surgery, RYGB had significantly improved the hepatic insulin sensitivity index and decreased the hepatic triglyceride, total cholesterol, and fatty acyl-CoA content. The significantly increased insulin sensitivity and decreased lipid content in muscle were not detected until 4 weeks after RYGB surgery. The basal insulin and C-peptide concentrations were significantly lower than those in diabetic group by 2 weeks after RYGB.ConclusionThe increased insulin sensitivity after RYGB occurs earlier in the liver than in the muscle and both may contribute to long-term remission of type 2 diabetes. Reduced lipid content of hepatocytes and skeletal muscle cells after RYGB may contribute to the improved insulin sensitivity in these cells.     

Complement activation in obesity,insulin resistance,and type 2 diabetes mellitus

Amplified inflammatory reaction has been observed to be involved in cardiometabolic diseases such as obesity, insulin resistance, diabetes,dyslipidemia, and atherosclerosis. The complement system was originally viewed as a supportive first line of defense against microbial invaders, and research over the past decade has come to appreciate that the functions of the complement system extend beyond the defense and elimination of microbes, involving in such diverse processes as clearance of the immune complexes, complementing T and B cell immune functions, tissue regeneration, and metabolism. The focus of this review is to summarize the role of the activation of complement system and the initiation and progression of metabolic disorders including obesity, insulin resistance and diabetes mellitus. In addition, we briefly describe the interaction of the activation of the complement system with diabetic complications such as diabetic retinopathy, nephropathy and neuropathy, highlighting that targeting complement system therapeutics could be one of possible routes to slow down those aforementioned diabetic complications.