培哚普利对高血压病患者血胰岛素水平的影响

对４０例高血压病（ＥＨ）患者和２０例健康对照者行口服葡萄糖耐量试验，测定其血糖（ＧＳ）和血胰岛素（ＩＳ）水平，计算其释放曲线下面积（ＡＵＣＧ、ＡＵＣＩ），发现两组空腹血糖无显著差别，ＥＨ组空腹ＩＳ和服糖后ＧＳ、ＩＳ及其ＡＵＣＧ、ＡＵＣＩ均显著高于对照组。提示高血压患者存在糖耐量降低、高胰岛素血症和胰岛素抵抗。３１例ＥＨ患者接受培哚普利降压治疗４周后，糖耐量试验显示糖负荷后１ｈ、２ｈ的ＧＳ和ＡＵＣＧ及空腹与糖负荷后各点的ＩＳ和ＡＵＣＩ均较治疗前显著降低。提示培哚普利能够降低ＥＨ患者血ＩＳ水平，具有改善其胰岛素抵抗的作用。     

非肥胖高血压病患者的胰岛素抵抗及西拉普利对其影响

对３０例非肥胖高血压病（ＥＨ）患者、１７例正常血压者（ＮＴ）行口服葡萄糖耐量试验（ＯＧＴＴ）和胰岛素释放试验（ＩＲＴ）．结果显示：ＥＨ组空腹、服糖后２小时血清胰岛素及胰岛素释放曲线下面积（［ＡＵＣ］１）高于ＮＴ组；ＥＨ组空腹、服糖后２小时血糖及葡萄糖耐量曲线下面积（［ＡＵＣ］Ｇ）亦高于ＮＴ组，提示非肥胖ＥＨ患者存在胰岛素抵抗（ＩＲ）。西拉普利（ｃｉｌａｚａｐｒｉｌ）治疗后ＥＨ患者血清胰岛素、［ＡＵＣ］１、血糖及［ＡＵＣ］Ｇ均较治疗前降低，显示有改善ＩＲ的作用。     

病毒性肝炎和肝硬化患者糖代谢研究

为阐明病毒性肝炎及肝硬化患者胰岛Ｂ细胞功能及糖代谢状况，我们作了静脉糖耐量试验（ｉｖＧＴＴ）和胰岛素，Ｃ肽释放试验（ＩＲＴ，ＣＰＲＴ），并同时测定了基础血糖（ＧＳ），胰岛素（ＩＮＳ），Ｃ肽（ＣＰ），皮质醇（Ｆ），生长激素（ＧＨ），生长抑素（ＳＳ）和胰高血糖素（ＧＮ），结果８５例中１７例糖耐量减退，其中慢性肝炎（ＣＨ）组２例，代偿性肝炎肝硬化（ＨＬＣ－Ｉ）组５例，的代偿性肝炎肝硬化（ＨＬＣ－Ⅱ）组，     

硝苯地平对高血压胰岛素敏感性的影响

目的探讨硝苯地平对高血压（ＥＨ）患者胰岛素敏感性的影响。方法应用钙拮抗剂硝苯地平治疗老年ＥＨ患者，治疗前后行口服葡萄糖耐量试验测血糖（ＳＧ）及血胰岛素（ＩＳ）浓度，求出两者曲线下面积（ＡＵＣ），并计算ＩＳ敏感性。结果ＥＨ患者无论有无糖耐量异常，均可见ＩＳ敏感性降低和糖负荷高ＩＳ血症，糖耐量减低组表现更明显。用硝苯地平治疗后，随着血压被降至正常，症状消失，糖耐量减低组空腹及糖负荷后的ＳＧ和ＩＳ水平以及两者ＡＵＣ均较治疗前降低，ＩＳ敏感性增加，糖耐量改善。而糖耐量正常组除糖负荷后１ｈ、２ｈ血ＩＳ水平较前降低外，糖耐量及ＩＳ敏感性无显著变化。结论硝苯地平可改善伴糖耐量减低的ＥＨ患者的糖耐量及ＩＳ抵抗，增强其ＩＳ敏感性     

不同病型,病期HFRS患者特异性抗体水平测定及其临床意义

用捕获ＥＬＩＳＡ方法检测了６０例（１２０份）肾综合征出血热患者（ＨＦＲＳ）血清特异性ＩｇＡ、Ｉｇ－Ｅ、ＩｇＭ、ＩｇＧ抗体。发现４种抗体几何平均滴度均随病期进展逐渐升高，且早期（发热及休克少尿期）与后期（多尿恢复期）间有差异性。ＨＦＲＳ－ＩｇＭ、ＩｇＥ、ＩｇＧ抗体水平的差异在早期（特别是发热期）尤为显著（Ｐ＜０．０５）。结果显示，ＨＦＲＳ－ＩｇＭ确属早期较可靠诊断指标；ＨＦＲＳ－ＩｇＧ、ＩｇＥ抗体水平与病情严重度相关。ＨＦＲＳ－ＩｇＡ抗体可能是一种保护性抗体。     

十枣汤加西药用于重症HFRS少尿期疗效观察

十枣汤加西药用于重症ＨＦＲＳ少尿期疗效观察济宁市传染病医院（２７２１３１）袁毓梅，王保瑞，邢聪，李兆宏，董思澍我们采用十枣汤加西药治疗重症肾综合征出血热（ＨＦＲＳ）少尿期患者３３例，取得了满意疗效。１对象及方法将１９９１～１９９３年收治的６３例重症Ｈ...     

冠心病与合并高血压病患者胰岛素抵抗的初步研究

对１７例冠心病（ＣＨＤ）和１５例高血压合并冠心病患者进行口服葡萄糖耐量试验，测定其血胰岛素（ＩＳ）和血糖水平，并与１０例健康人做对照。结果发现，ＣＨＤ和高血压合并冠心病患者都有胰岛素抵抗（ＩＲ），高胰岛素血症（ＨＩＳ）和部分糖耐量减低。高血压合并冠心病组ＩＲ和ＨＩＳ较ＣＨＤ组更为严重，且ＩＳ浓度呈持续增高状态。ＣＨＤ组血清总胆固醇与ＩＳ水平呈正相关，高血压合并冠心病组血清高密度脂蛋白胆固醇与ＩＳ水平呈显著负相关。     

高血压患者血糖及血胰岛素水平的观察

对６９例高血压患者进行口服葡萄糖耐量试验、胰岛素和Ｃ肽释放试验，并与５５例血压正常者作比较。结果示高血压组空腹及服糖后各时相的血糖水平和糖代谢失常（ＤＭ＋ＩＧＴ）发生率、血清胰岛素水平及Ｃ肽水平都高于血压正常对照组。高血压患者血胰岛素水平增高而血糖水平未见相应降低，提示胰岛素抵抗的存在。     

胰岛素抵抗是糖耐量正常人群糖耐量恶化的重要危险因素

目的 探讨胰岛素抵抗和胰岛素分泌对糖在耐量正常人群糖耐量恶化的影响。方法 以口服葡萄糖耐量试验（ＯＧＴＴ）做人群普查一，确定糖耐量正常者（ＮＧＴ）（空腹血糖（ＦＰＧ）〈５．８ｍｍｏｌ／Ｌ及２小时血糖（ＰＧ２ｈ〈６．７ｍｍｏｌ／Ｌ＿１２５例，测定血浆胰岛素。６年后随访再以ＯＧＴＴ确定盲人 群糖耐量状态，以稳态模型（Ｈｏｍａ Ｍｏｄｅｌ）公式评估胰岛素抱搞（ＩＲ）、胰岛素分泌功能（ＩＳ），并分析其对糖     

卡托普利对高血压高胰岛素血症的干预

通过对４２例原发性高血压患者、２６例正常人测定口服葡萄糖耐量试验前后血糖、血胰岛素及其反应曲线下面积，发现ＥＨ组空腹ＧＳ与对照组之间无统计学差异；空腹ＩＳ和服糖ＥＨ组ＧＳ、ＩＳ及其曲线下面积显著高于对照组，提示ＥＨ患者存在糖耐量降抵、ＩＳ抵抗。ＥＨ组中２１例患者单纯接受卡托普利有效降压４－８周后，ＯＧＴＴ显示糖负荷１ｈ，２ｈ的ＩＳ和ＧＳ水平均显著低于治疗前水平，结果提示卡托普利可以改善ＥＨ患者ＩＲ     

Diet composition and insulin effect on amylase to lipase ratio in pancreas of diabetic rats.

In man and in rat, the diabetic state is associated with diseases of exocrine pancreatic function. In this work, streptozotocin diabetes was shown to lead to a 95% decrease in the amylase to lipase ratio in rats. Diabetes was reversed by either pancreas transplantation or insulin treatment. Transplantation of neonatal pancreases was successful in reversing the diabetic-induced alterations of exocrine pancreatic function. To assess whether insulin acts directly on the exocrine pancreas, or through the enhancement of glucose utilization, animals were fed either a low-fat diet or a high-fat diet during insulin treatment; this latter diet is well known to impair insulin's effect on glucose metabolism. When diabetic rats were fed a low-fat diet, insulin treatment was able to correct the hyperketonemia and to reverse the amylase to lipase ratio to the prediabetes level. In contrast, the insulin treatment failed to restore the amylase to lipase ratio when the diabetic rats were fed the high-fat diet. Despite insulin treatment, the hyperketonemia worsened implying that glucose utilization remained low as would be expected on high-fat diet. The dependence of the insulin effect upon diet composition demonstrates that the rate of glucose metabolism is the primary factor in the regulation of amylase to lipase ratio.     

Acute pancreatitis-induced islet dysfunction in ferrets

Background/Objectives: The pathogenesis of hyperglycemia during acute pancreatitis (AP) remains unknown due to inaccessibility of human tissues and lack of animal models. We aimed to develop an animal model to study the mechanisms of hyperglycemia and impaired glucose tolerance in AP.MethodsWe injected ferrets with intraperitoneal cerulein (50 μg/kg, 9 hourly injections) or saline. Blood samples were collected for glucose (0, 4, 8, 12, 24h); TNF-α, IL-6 (6h); amylase, lipase, insulin, glucagon, pancreatic polypeptide (PP), glucagon-like peptide-1 (GLP-1), and gastric inhibitory polypeptide (GIP) (24h). Animals underwent oral glucose tolerance test (OGTT), mixed meal tolerance test (MMTT) at 24h or 3 months, followed by harvesting pancreas for histopathology and immunostaining.ResultsCerulein-injected ferrets exhibited mild pancreatic edema, neutrophil infiltration, and elevations in serum amylase, lipase, TNF-α, IL-6, consistent with AP. Plasma glucose was significantly higher in ferrets with AP at all time points. Plasma glucagon, GLP-1 and PP were significantly higher in cerulein-injected animals, while plasma insulin was significantly lower compared to controls. OGTT and MMTT showed abnormal glycemic responses with higher area under the curve. The hypoglycemic response to insulin injection was completely lost, suggestive of insulin resistance. OGTT showed low plasma insulin; MMTT confirmed low insulin and GIP; abnormal OGTT and MMTT responses returned to normal 3 months after cerulein injection.ConclusionsAcute cerulein injection causes mild acute pancreatitis in ferrets and hyperglycemia related to transient islet cell dysfunction and insulin resistance. The ferret cerulein model may contribute to the understanding of hyperglycemia in acute pancreatitis.     

The influence of the development of diabetes mellitus in patients with chronic pancreatitis on exocrine pancreatic function measured by secretin-caerulein test

Diabetes occurs in 20-30% of patients above forty years old with chronic pancreatitis (CP). The aim of the present study was to determine the relationship between development of diabetes mellitus in CP patients and insufficiency of pancreatic exocrine secretion as well as changes in composition of pancreatic juice. Ninety CP patients with diagnosis confirmed by endoscopic retrograde pancreatography (ERP) were studied. They were divided into 3 groups in dependency on ERP changes (according to Cambridge classification) and oral glucose tolerance test (OGTT): group A--equivocal or mild changes in ERP and normal OGTT (control group); group B--moderate or marked changes in ERP and normal OGTT: group C--moderate or marked changes in ERP and diabetes mellitus. The exocrine pancreatic function was determined by the secretin-caerulein test; volume of duodenal content and bicarbonate, protein, alpha-amylase activity outputs were measured. RESULTS: All exocrine pancreatic function parameters were diminished in B and C groups compared with A group--differences were statistically significant. However in group C values of volume and bicarbonate, protein and amylase activity were especially low. CONCLUSION: Exocrine pancreatic insufficiency is strongly associated with anatomical changes of the pancreas but also depends on endocrine function.     

山东沿海地区Graves病患者糖调节异常特点分析

目的 探讨山东沿海地区汉族Graves病（GD）患者糖调节状态变化,并比较抗甲状腺药物治疗不同阶段糖调节状态变化特点.方法 选取2010年8月至2012年6月山东大学齐鲁医院收治的来自山东沿海地区的Graves病患者106例,男性45例,女性61例,平均年龄（34 ±5）岁.按患者所处治疗阶段分为3组,即初治组（GD1组,35例）、治疗期组（GD2组,37例）和减量期组（GD3组,35例）,并选取年龄相当的30名健康体检者作为对照（NC组）.入选患者均继续接受正规抗甲状腺药物治疗6个月,分别于治疗前后作口服葡萄糖耐量试验（OGTT）、胰岛素释放试验（InsRT）,观察血糖、胰岛素、早相胰岛素分泌指数（△I30/△G30）,OGTT血糖曲线下面积（GAUC）和InsRT胰岛素曲线下面积（INSAUC）的变化.应用方差分析进行数据比较.结果 基线时,GD各组空腹血糖水平显著低于NC组（F =29.85,P ＜0.05）;OGTT后血糖、胰岛素水平显著高于NC组（F=22.54、87.96,均P＜0.05）;GD各组△I30/△G30显著低于NC组（F=17.22,P＜0.05）;GAUC、INSAUC均显著高于NC组（F=79.09、112.77,均P＜0.05）;GD各组间相比,GD1、GD2组血糖、胰岛素水平显著高于GD3组（F=17.19、48.88,均P＜0.05）;治疗6个月后,GD各组血糖、胰岛素均显著低于基线水平（F=13.06、55.72,均P＜0.05）;GAUC、INSAUC均显著低于基线水平（F=53.08、96.98,均P＜0.05）.结论 沿海地区GD患者存在糖调节异常,主要特点是胰岛素早期分泌时相受损,高胰岛素血症;甲状腺功能正常后糖调节改善,糖耐量异常减轻和高胰岛素血症改善,但胰岛素早期分泌时相并无明显改善.     

阿卡波糖对餐后高血糖患者血管内皮功能的影响

目的研究阿卡波糖对餐后高血糖患者血管内皮功能的影响。方法选择新诊断为2型糖尿病、行口服葡萄糖耐量试验餐后高血糖患者58例,分为常规组26例和治疗组32例。检测患者治疗前后体重指数、TC、TG、LDL-C、HDL-C、空腹血糖、空腹胰岛素、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、葡萄糖耐量试验2 h血糖、2 h胰岛素及肱动脉内皮依赖性舒张功能(EDD)。结果与治疗前比较,治疗后2组患者体重指数、2 h血糖、2 h胰岛素、HbA1c、vWF明显降低,EDD明显增大(P0.05,P0.01);与常规组比较,治疗组患者2 h血糖、2 h胰岛素、HbA1c、hs CRP、vWF明显降低,EDD增大更明显(P0.05,P0.01)。多因素逐步回归分析显示,EDD与2 h血糖、2 h胰岛素、HbA1c、hs-CRP呈负相关。结论阿卡波糖可能通过降低餐后高血糖,改善机体胰岛素抵抗,使血管内皮功能得到改善,延缓动脉粥样硬化的发生、发展。     

Blood glucose,insulin and amylase levels in pancreatic lesion due to pancreatography

Summary Blood glucose, insulin and amylase levels were repeatedly determined in 8 patients developing pancreatic lesion after diagnostic pancreatography. The injection into the pancreatic duct of small amounts (2–8 ml) of contrast medium resulted invariably in a rise in blood amylase level, which was associated in some of the patients with insulin release and increased blood glucose. With larger doses of contrast medium (14–18 ml) blood amylase was considerably increased, the rise in plasma insulin level also being more marked. Elevation of blood insulin and glucose concentrations may be accounted for by the release of glucagon and insulin from the damaged islet cells. The biochemical changes observed in pancreatic lesions due to pancreatography might provide some information concerning the pathogenetic mechanism of spontaneous pancreatitis in man. Traduzione a cura di G. U.     

空腹血糖正常的高血压患者糖代谢状态检测的临床意义

目的 检测空腹血糖正常的高血压患者的糖代谢状态,为全面干预危险因素提供科学依据.方法 对46例高血压患者、40例血压正常者做口服葡萄糖耐量试验（OGTT）,并同步测定血清胰岛素浓度.结果 高血压组OGTT检出糖耐量减低和2型糖尿病的发生率分别为28.3%和8.7%,糖代谢异常发生率与血压正常组相比差异有统计学意义（P＜0.05）.高血压组和血压正常组的胰岛素抵抗指数分别为1.2±0.3和1.0±0.4,差异有统计学意义 （P＜0.01）.结论 以OGTT同步测定血清胰岛素浓度的方法来检测高血压患者的糖代谢状态,不仅可使部分2型糖尿病和糖耐量减低患者得以早期诊断,而且可初步评估患者胰岛素敏感性及胰岛素抵抗程度,具有重要临床意义.     

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.

     

不同Child-Pugh分级慢性乙型肝炎肝硬化患者糖代谢、胰岛素分泌情况及其与炎症反应的相关性分析

目的 探讨不同Child-Pugh分级的慢性乙型肝炎(CHB)合并肝硬化患者糖代谢和胰岛素分泌情况及与炎症反应相关性。方法 选取2013年1月-2018年1月广州市红十字会医院收治的CHB合并肝硬化患者147例,另纳入同期65例体检正常的人群作为对照组。收集患者入院12 h内资料,包括年龄、性别、BMI、收缩压、舒张压、HBV DNA载量、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、ALT、AST、TNFα、IL-6、中性粒细胞与淋巴细胞比值(NLR)、空腹血糖、血浆胰岛素、C肽水平、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌功能。记录口服葡萄糖耐量试验(OGTT)后2 h血糖、胰岛素及C肽水平,并计算患者此时的NLR。计数资料2组间比较采用χ2检验。计量资料2组间比较采用t检验。等级资料多组间比较和进一步两两比较均采用Kruskal-Wallis H秩和检验。相关性检验采用Pearson分析。结果 CHB合并肝硬化患者的TNFα、IL-6、NLR、胰岛素水平、HOMA-IR明显高于对照组,而胰岛素分泌功能明显低于对照组(P值均<0.05);根据Child-Pugh分级将147例CHB合并肝硬化患者分为3组(Child-Pugh A、B、C),3组间TNFα、IL-6、NLR、胰岛素水平、HOMA-IR、胰岛素分泌功能比较,差异均有统计学意义(P值均<0.05)。CHB合并肝硬化患者OGTT后2 h血糖、胰岛素、C肽水平及NLR、TNFα、IL-6均显著高于对照组(P值均<0.05);3组不同Child-Pugh分级患者OGTT后2 h血糖、胰岛素、NLR、TNFα、IL-6比较,差异均有统计学意义(P值均<0.05)。Child-Pugh评分与OGTT后2 h NLR、血糖、胰岛素水平均呈正相关(r值分别为0.678、0.451、0.644,P值均<0.001);OGTT后2 h NLR与血糖、胰岛素水平均呈正相关(r值分别为0.408、0.795,P值均<0.001)。结论 CHB合并肝硬化患者存在一定程度糖代谢异常和胰岛素抵抗,肝损伤越严重,糖代谢异常和胰岛素抵抗越明显,而炎症反应可能介导上述二者之间的联系。     

Acute pancreatitis in fatal anicteric leptospirosis

We report a fatal case of anicteric leptospirosis with pancreatitis (acute hyperglycemia and insulin requirement, elevated lipase and amylase levels), pulmonary infiltrates, and refractory shock. In disease-endemic areas, leptospirosis with pancreatitis should be considered in patients with fever and abdominal pain, and serum pancreatic enzymes, blood glucose, and serum electrolytes should be closely monitored.