2型糖尿病全天血糖水平与糖化血红蛋白血糖漂移幅度的相关性分析

目的探讨2型糖尿病（T2DM）患者日内不同时间的血糖水平与糖化血红蛋白（HbA1c）及血糖漂移幅度的关系。方法选取2002年12月至2005年10月上海交通大学附属第六人民医院内分泌代谢科新诊断T2DM患者60例，采用动态血糖监测系统（CGMS）进行持续3d的血糖监测并分析日内不同时点、时段的血糖水平、HbA1c、餐后血糖漂移幅度（PPGE）及平均血糖漂移幅度（MAGE）之间的关系。结果（1）他DM患者HbA1c与全天8次血糖水平均呈显著正相关（r=0．62～0．70，P均〈0．01），与PPGE不相关（P〉0．05），逐步回归分析显示空腹及中、晚餐后2h血糖进入最后的方程（校正R^2=0.566，P〈0．01）。（2）HbA1c与全天不同时段的平均血糖水平均呈显著正相关（r=0．57～0．74，P均〈0．01），晚餐前1h、晚餐后2～3h及晨3：00～6：00时间段的平均血糖水平是其独立影响因素。（3）CGMS所示的日内平均血糖水平与HbA1c相关性最强（r=0．81，P〈0．01）。（4）MAGE与HbA1c不相关（P〉0．05），三餐PPGE及晨3：00的血糖水平为影响MAGE的独立参与因素（校正R^2=0．427，P〈0．01）。结论T2DM患者HbA1c与全天平均血糖水平的关系最密切，而日内血糖的漂移变化主要归因于餐后及夜间血糖的漂移。因此，他DM的血糖监测及干预治疗应针对全天血糖谱。     

2型糖尿病患者不同水平糖化血红蛋白与动态血糖的关系

目的探讨2型糖尿病患者不同水平糖化血红蛋白（HbA1c）与动态血糖的相关性。方法 159例2型糖尿病患者行动态血糖监测,并测定HbA1c,按HbA1c水平高低依次分为A、B、C组,分析动态血糖及动态平均血糖标准差（SDBG）与HbA1c的相关性。结果平均血糖、空腹、早餐后、午餐后、晚餐后血糖平均值、SDBG与HbA1c均呈正相关（r=0.746、0.731、0.550、0.543、0.475、0.658,P均〈0.01）。结论 2型糖尿病患者HbA1c与动态血糖水平显著相关。     

双相门冬胰岛素与预混入胰岛素的疗效对比研究

为期8周的随机、开放性比较研究。60例T2DM患者被随机分为以诺和灵30R治疗的A组、以诺和锐30治疗的B组和以诺和锐30治疗的C组，A组和B组采用每日早、晚餐前两次皮下注射方案，C组采用每日早、晚餐前及睡前三次皮下注射方案。比较两组患者7个时点血糖、HbA2c、低血糖事件及其他不良事件的差异。结果B组和C组三餐后血糖水平明显低于A组（P〈0．05）；B组和C组低血糖事件发生次数低于A组（P〈0．05）；C组空腹血糖明显低于其余两组（P〈0．05）。两组HbA2c指标、胰岛素用量及其他不良事件差异无统计学意义（P〉0．05）。结论诺和锐30对餐后血糖控制更满意，且低血糖事件发生率减少；睡前加用诺和锐30可较好控制空腹血糖。     

胰岛素治疗后血糖控制与2型糖尿病患者血浆同型半胱氨酸的关系

目的观察单纯胰岛素治疗的2型糖尿病患者,血糖控制水平与血浆总同型半胱氨酸（total homocysteine,tHcy）水平的关系。方法68例符合入选标准的2型糖尿病患者单纯给予胰岛素治疗3个月。基线和治疗3个月后取空腹血测定空腹血糖（FBG）、糖化血红蛋白（HbA1c）、tHcy,餐后2h取血测定餐后血糖（PBG）。结果所有患者经过3个月的单纯胰岛素治疗后,FBG、PBG和HbA1c均比治疗前显著下降（P〈0．01）。虽然治疗后血浆tHcy水平有下降趋势,但没有达到统计学显著水平（P〉0．05）。以HbA1c7．0％作为判断血糖控制水平的界值,治疗后HbA1c≤7．0％的患者31例（45．6％）,HbA1c〉7．0％的患者37例（54．4％）。治疗后HbA1c≤7．0％的患者,除FBG、PBG和HbA1c较治疗前显著下降外（P〈0．01）,tHcy也比治疗前显著降低（P〈0．01）。结论胰岛素强化治疗后,随着血糖控制改善,2型糖尿病患者血浆tHcy水平也明显下降。     

甘精胰岛素联合格列美脲治疗控制欠佳2型糖尿病患者的疗效观察

84例口服降糖药血糖控制欠佳的2型糖尿病患者换用甘精胰岛素联合格列美脲治疗,在治疗第0周及16周分别记录三餐前、三餐后2小时、睡前血糖及HbA1c(糖化血红蛋白)。结果治疗16周后三餐前、三餐后2小时、睡前血糖及HbA1c均较基线水平显著下降。低血糖事件共发生6人次。结论口服降糖药血糖控制欠佳的2型糖尿病患者换用甘精胰岛素联合格列美脲治疗能有效并安全的控制血糖。     

甘精胰岛素加超短效胰岛素在2型糖尿病治疗观察

2型糖尿病具备FPG〉10.0mmol/L HbA1c〉9.0%者,采用甘精胰岛素加超短效胰岛素观察患者8时点（三餐前、后、睡前及凌晨3点）血糖及安全性。结果：2周后8个时点血糖均达标,1例发生严重低血糖,3例发生低血糖反应。结论：初诊的2型糖尿病采用甘精胰岛素加超短效胰岛素是安全有效的。     

甘精胰岛素加超短效胰岛素在2型糖尿病治疗观察

2型糖尿病具备FPG〉10.0mmol/L HbA1c〉9.0%者,采用甘精胰岛素加超短效胰岛素观察患者8时点（三餐前、后、睡前及凌晨3点）血糖及安全性。结果：2周后8个时点血糖均达标,1例发生严重低血糖,3例发生低血糖反应。结论：初诊的2型糖尿病采用甘精胰岛素加超短效胰岛素是安全有效的。     

睡前胰岛素联合口服降糖药治疗2型糖尿病观察

目的对54例2型糖尿病口服降糖药仍难以控制血糖的患者予以睡前中效胰岛素（NPH）联合口服降糖药的疗效观察。方法54例2型糖尿病随机分为2组，A组使用格列哌嗪5—10mg tid，中效胰岛素（NPH）每日睡前（22：00）皮下注射。B组使用二甲双胍0．5gtid，半效胰岛素（NPH），每13睡前（22：00）皮下注射，治疗过程中监测5次末梢指尖血糖谱（空腹，三餐后2h，睡前）每周2次，糖化血红蛋白每2个月1次，使空腹血糖≤7．0mmol／L，餐后2h血糖≤10mmol／L。结果2组治疗后FPH，2hPG，HbA1C均显著性下降。2组治疗前后对照差异有非常显著性（P〈0．01）。结论睡前中效胰岛素（NPH）联合口服降糖药物治疗是治疗2型糖尿病的有效方法。     

沙格列汀对初诊2型糖尿病患者血糖、胰岛功能的影响

目的：评价沙格列汀对初诊2型糖尿病患者血糖、胰岛功能的影响。方法将100例初诊2型糖尿病分为治疗组和对照组各50例,分别给予沙格列汀、二甲双胍治疗,治疗前后检测患者空腹血糖（ FPG）、治疗后空腹胰岛素（ FINS）、糖化血红蛋白（ HbA1c ）、三餐后2 h血糖,计算胰岛细胞功能指数（ HOMA-β）。结果治疗后两组FPG、HbA1c、三餐后2 h血糖较治疗前明显下降,HOMA-β明显升高（P均＜0．01）;与对照组治疗后比较,治疗组治疗后三餐后2 h血糖下降更明显（P均＜0．05）。结论沙格列汀能有效控制血糖,同时改善胰岛功能,减轻餐后血糖波动。     

2型糖尿病患者HbA1C水平与NPH终剂量相关性研究

对268例2型糖尿病（T2DM）患者采取多次多成分胰岛素注射治疗，治疗中检测其五点血糖，五点血糖稳定在理想水平的胰岛素量为终剂量，分析睡前胰岛素（NPH）终剂量与糖化血红蛋白（HbA1c）的相关性；检测其中119例患者治疗前五点血糖，分析HbA1c与五点血糖的关系。结果HbA1c〉9．3g／L时，其与NPH终剂量明显相关（r=0．635，P〈0．01）；治疗前五点血糖的总平均值与HbA1c的相关性最好，其次为空腹血糖。认为HbA1c水平对NPH终剂量有一定的预测作用，可指导T2DM患者的临床治疗。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.