DKA治疗中减量应用胰岛素的最佳血糖标准探讨

为探讨糖尿病酮症酸中毒(DKA)减量应用胰岛素的血糖标准.本文对68例DKA患者随机分为A组(13.9mmol/L组,N=32例)及B组(10mmol/L组,N=36).直至酮体转阴.结果A组及B组酮体转阴所需时间分别26.7±5.4h及15.8±4.3h(P＜0.01).血糖≤10mmol/L所需时间,分别为24.6±7.1h及13.7±3.9h(P＜0.01).两组均无低血钾、低血糖及脑水肿.但A组死亡率(9.38%)要高于B组(2.78%).结论在DKA治疗中,作为减量胰岛素用量并增用葡萄糖液的血糖标准,可定为10mmol/L.     

高血压合并糖尿病患者颈动脉内膜-中层厚度的观察

目的探讨高血压合并糖尿病患者颈动脉内膜-中层厚度(IMT)的改变,及其与各种危险因子的关系.方法对81例高血压(其中合并糖尿病40例)及33例健康者行超声波检查,测定IMT,并行血脂、血糖等检查.结果高血压非糖尿病组与高血压糖尿病组IMT、血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)、舒张压(DBP)高于正常组[IMT(0.96±0.11 vs 1.09±0.10 vs 0.61±0.04)mm; TC(5.21±1.05 vs 6.81±1.12 vs 4.47±0.29)mmol/L;LDL-C(3.64±1.11 vs 4.45±0.89 vs 2.31±0.45)mmol/L;SBP(154.3±14.6 vs 155.2±15.3 vs 115.6±14.3)mm Hg;DBP(89.5±9.5 vs 88.5±15.1 vs 75.3±7.1)mm Hg(P<0.01).高血压糖尿病组IMT、TC、LDL-C、GLU高于高血压非糖尿病组[IMT(1.09±0.10 vs 0.96±0.11)mm;TC(6.81±1.12 vs 5.21±1.05)mmol/L;LDL-C(4.45±0.89 vs 3.64±1.11)mmol/L;GLU(9.6±3.41 vs 5.50±0.74)mmol/L(P<0.01)].直线相关分析示,IMT与GLU、SBP、TC、LDL-C、DBP、年龄呈正相关,r值分别为(0.521、0.678、0.801、0.736、 0.358、0.321,P<0.05).结论高血压和糖尿病同时存在时可加速动脉粥样硬化的进展.颈动脉内膜-中层厚度能在早期反映高血压、糖尿病和高脂血症对动脉粥样硬化的促进作用.     

儿童高渗性非酮症糖尿病昏迷伴横纹肌溶解致急性肾功衰一例及文献分析

目的报道儿童Ⅰ型糖尿病高渗性非酮症糖尿病昏迷(HONK)并发横纹肌溶解症(RM)、急性肾损伤(AKI)的临床诊治经验。方法分析1例儿童Ⅰ型糖尿病高渗性非酮症糖尿病昏迷伴横纹肌溶解症并发急性肾功能衰竭的临床资料及复习相关文献。结果 48 h后患者意识障碍恢复,血肌酸激酶下降,酸中毒纠正,治疗效果显著。结论提高对HONK患者发生RM的认识和常规肌酶谱的动态监测,做好早期诊断以及预防极其重要,是RM合并急性肾损伤治疗的关键,有利于提高糖尿病患者的生存率。横纹肌溶解症的表现可能会被T1DM本身严重的病情掩盖而导致临床漏诊,故建议对T1DM患者应常规检测磷酸肌酸激酶以助诊断。     

雷帕霉素对KKAy小鼠体重及胰岛素抵抗的影响

目的 探讨雷帕霉素对KKAy小鼠体重及胰岛素抵抗(IR)的影响.方法 16周KKAy小鼠34只,随机分为对照组(NC组,12只)、雷帕霉素治疗组(R组,12只)、胰岛素治疗组(Ins组,10只),6只同龄C57BL与5只KKAy小鼠作为治疗前对照.结果 治疗前KKAy小鼠体重、血糖、TG明显高于C57BL小鼠(体重36.2±1.9 g vs 29.3±1.0 g;血糖13.4±1.7 mmol/L vs 7.8±0.5 mmol/L;TG1.59±0.16 mmol/L vs 0.75±0.09 mmol/L;P均＜0.01).治疗4周后R组体重(33.7±2.3 g),低于NC组(38.2±1.5 g)和Ins组(37.4±1.1 g),差异有统计学意义(P均＜0.05);R组血糖(17.2±7.3 nmol/L),低于NC组(29.1±3.2 mmol/L),差异有统计学意义(P＜0.05);治疗8周后R组体重(32.2±3.1 g),低于NC组(39.3±2.8 g),差异有统计学意义(P＜0.05);血糖(18.2±3.7 mmol/L),低于NC组(24.4±5.1 mmol/L),差异无统计学意义(P=0.06).胰岛素敏感试验表明R组在注射胰岛素60 min后,血糖降幅明显大于NC组(4.88±0.73 mmol/L vs 2.65±2.12 mmol/L,P＜0.05).结论 雷帕霉素可减轻KKAy小鼠体重、改善IR、降低血糖.     

不同胰岛素给药方法对糖尿病酮症酸中毒及高渗性昏迷的效果观察

目的探究不同胰岛素给药方法对糖尿病酮症酸中毒及高渗性昏迷的临床效果。方法该次选取糖尿病酮症酸中毒及高渗性昏迷患者共70例作为研究对象,收治时间2016年2月—2017年6月,分为观察组(给予胰岛素泵持续皮下注射治疗)35例、对照组(给予胰岛素皮下注射)35例;并对70例患者的治疗效果及空腹血糖、餐后2 h血糖、血糖达标时间进行观察且分析。结果两组糖尿病酮症酸中毒及高渗性昏迷患者在治疗效果对比中差异有统计学意义(P0.05),观察组总有效率97.14%(显效20例、有效14例、无效1例),对照组总有效率65.57%(显效10例、有效14例、无效11例)。两组糖尿病酮症酸中毒及高渗性昏迷患者在血糖水平及血糖达标时间对比差异有统计学意义(P0.05),观察组空腹血糖(5.70±1.05)mmol/L、餐后2 h血糖(6.75±1.35)mmol/L、血糖达标时间(4.20±1.60)d,对照组空腹血糖(6.89±1.45)mmol/L、餐后2 h血糖(8.60±1.55)mmol/L、血糖达标时间(9.25±3.25)d。结论糖尿病酮症酸中毒及高渗性昏迷患者治疗中实施胰岛素泵皮下注射具有较高的临床价值,不仅可以有效控制血糖水平,并且具有安全、操作简单等优势,临床上值得应用及推广。     

高渗性非酮症糖尿病昏迷

高渗性非酮症糖尿病昏迷早在19世纪末20世纪初就有零星报告。1957年有人称之为非酮症严重糖尿病木僵综合征(Syndrome of severe diabetic stupor without ketosis),近些年来诊断病例数逐渐增多,约占严重糖尿病症的10～20%。几乎是成年糖尿病尤其是老年糖尿病特有的并发症,临床表现有口渴多尿,脱水,进行性精神障碍以至昏迷,血糖达33.3mmol/L(600mg/dl)以上,有的报告达26.6mmol/L(4800mg/dl)。血钠高达145mmol/L。血渗透压350 mmol/升。尿酮体阴性或弱阳性,酸中毒不明显。渗透性利尿而可导致严重失水、休克。心血管系统有较多严重并发症,如心肌梗塞,心律失常等;有时肾功能衰     

儿童糖尿病合并酮症酸中毒和高血糖高渗状态临床特征分析

目的分析儿童糖尿病合并酮症酸中毒和高血糖高渗状态临床特征。方法选取该院2013年3月—2017年3月收治的糖尿病患儿260例。在260例糖尿病患儿中筛选酮症酸中毒患儿和高血糖高渗状态患儿,对比糖尿病同时合并酮症酸中毒和高血糖高渗状态的患儿以及单纯酮症酸中毒患儿的临床特点。结果 260例糖尿病患儿中,有126例患儿单纯出现酮症酸中毒,占总数的48.46%;无单纯合并高血糖高渗状态患儿,酮症酸中毒患儿中出现高血糖高渗状态的发病率为4.23%,其中有8例Ⅰ型糖尿病,3例2型糖尿病。在酮症酸中毒糖尿病患者中,年龄在10岁以上的高血糖高渗状态患者的发病率明显高于10岁以下的患儿差异有统计学意义(P0.05)。合并酮症酸中毒和高血糖高渗状态患儿的重度脱水比例、平均有效渗透压、血糖、三酰甘油、尿素氮明显高于单纯酮症酸中毒糖尿病患儿差异有统计学意义(P0.05)。合并酮症酸中毒和高血糖高渗状态患者的血清钠水平明显高于单纯酮症酸中毒患者差异统计学意义(P0.05)。结论糖尿病患儿中,高血糖高渗状态的发病率明显低于酮症酸中毒患者,10岁以上儿童合并出现酮症酸中毒和高血糖高渗状态发病率比较高,同时出现代谢紊乱,脱水等情况的发病率非常高,出现肾功能异常的发病率也非常高。     

葡萄糖激酶基因E339K突变的功能学研究

Objective To explore the molecular mechanisms of glucokinase (GCK) E339K mutation resulting in maturity-onset diabetes of the young-2 (MODY2).Methods Fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) overload 2 h glucose (2hPG), glycosylated hemoglobin Alc (HbAlc) and fasting insulin (FIns) level were measured, respectively.Mutant glutathione S-transferase (GST)-GCK-cDNA was constructed with site-directed mutagenesis.Wild type and mutant GCK protein expressed in E.Coli were purified with affinity chromatography.Enzymatic kinetics and thermal stability were tested with enzyme-coupled analysis.Results Compared with non-mutants, mutants had higher FPG [(6.92 ± 0.95) mmol/L vs (4.70 ± 0.35) mmol/L, P＜0.001], 2hPG [(9.00 ± 1.49 ) mmol/L vs (5.51 ± 0.86) mmol/L,P＜0.001],HbAlc[(6.46 ± 0.69)% vs(4.83 ± 0.30)%,P＜0.01],and lower FIns level [(6.15 ± 1.97 ) mIU/L vs ( 10.79 ± 4.93 ) mIU/L, P ＜ 0.01], HOMA-β (34.16 ±3.62 vs 172.53 ± 76.58, P ＜ 0.001 ).This mutation induced lower protein yield [( 12.7 ±1.72) mg/L vs ( 16.2 ± 2.65 ) mg/L, P ＜ 0.01], lower appetency for glucose [S0.5: ( 13.96 ± 1.89)mmol/L vs (5.92±0.99)mmol/L, P＜0.001] and ATP [Km:(3.27 ±1.14) mmol/L vs (0.30±0.09)mmol/L, P＜0.001], lower catalytic ability [Kcat:(1.62 ±0.35)/s vs (25.18 ±2.10)/s, P＜0.001].It also showed protein thermal instability.Conclusion Glucokinase gene E339K mutation promotes the development of MODY2 by affecting protein yield and protein stability as well as the enzymatic kinetics of GCK.     

葡萄糖激酶基因E339K突变的功能学研究

Objective To explore the molecular mechanisms of glucokinase (GCK) E339K mutation resulting in maturity-onset diabetes of the young-2 (MODY2).Methods Fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) overload 2 h glucose (2hPG), glycosylated hemoglobin Alc (HbAlc) and fasting insulin (FIns) level were measured, respectively.Mutant glutathione S-transferase (GST)-GCK-cDNA was constructed with site-directed mutagenesis.Wild type and mutant GCK protein expressed in E.Coli were purified with affinity chromatography.Enzymatic kinetics and thermal stability were tested with enzyme-coupled analysis.Results Compared with non-mutants, mutants had higher FPG [(6.92 ± 0.95) mmol/L vs (4.70 ± 0.35) mmol/L, P＜0.001], 2hPG [(9.00 ± 1.49 ) mmol/L vs (5.51 ± 0.86) mmol/L,P＜0.001],HbAlc[(6.46 ± 0.69)% vs(4.83 ± 0.30)%,P＜0.01],and lower FIns level [(6.15 ± 1.97 ) mIU/L vs ( 10.79 ± 4.93 ) mIU/L, P ＜ 0.01], HOMA-β (34.16 ±3.62 vs 172.53 ± 76.58, P ＜ 0.001 ).This mutation induced lower protein yield [( 12.7 ±1.72) mg/L vs ( 16.2 ± 2.65 ) mg/L, P ＜ 0.01], lower appetency for glucose [S0.5: ( 13.96 ± 1.89)mmol/L vs (5.92±0.99)mmol/L, P＜0.001] and ATP [Km:(3.27 ±1.14) mmol/L vs (0.30±0.09)mmol/L, P＜0.001], lower catalytic ability [Kcat:(1.62 ±0.35)/s vs (25.18 ±2.10)/s, P＜0.001].It also showed protein thermal instability.Conclusion Glucokinase gene E339K mutation promotes the development of MODY2 by affecting protein yield and protein stability as well as the enzymatic kinetics of GCK.     

糖尿病急症并发横纹肌溶解综合征的实验相关性研究

目的 研究不同的代谢紊乱状态与骨骼肌细胞损伤的关系,探讨糖尿病急症并发横纹肌溶解综合征(RM)的可能机制。方法 建立糖尿病急症大鼠模型,进行实验分组：Ⅰ组,糖尿病组(DM),给予腹腔注射STZ(链脲佐菌素),60mg/Kg; Ⅱ组,急性高钠模型组,给予腹腔注射4M NaCl,0.8ml/100g; Ⅲ组,糖尿病高渗组(HHS),成功制造糖尿病模型2周后,给予氢化可的松,局部肌肉注射4-6天,并于注射第三天开始禁水,不禁食,禁水持续1-3天,直到大鼠出现神经症状;Ⅳ组,正常对照组(Normal),腹腔注射等量生理盐水;Ⅴ组,激素对照组,正常wistar大鼠,与糖尿病高渗组模型同期,单纯给予局部肌肉注射氢化可的松5天。收集实验大鼠血清标本,检测血清肌酸激酶(CK)、血糖、血钠等生化指标;并同期取大鼠骨骼肌、心肌组织标本,行HE染色,光镜下(40×)观察形态学改变。结果 1)与其他组相比,DM组血糖(24.6±3.2mg/L)及HHS组(52.8±0.7mg/L)血糖明显升高(P＜0.05),HHS组血渗透压(397.8±13mOsmol/L)及高钠组血渗透压(378.3±40mOsmol/L)明显增高(P＜0.05),且血清CK值(2023±1292IU/L,2382±1069IU/L)也明显高于其他组(P＜0.05)。2) RM大鼠中,血钠、血渗透压与CK呈正相关(r=0.32, p=0.03; r=0.42, p=0.01)。3) 組织学观察:HE染色,光镜下观察糖尿病高渗组与急性高钠组可见明显骨骼肌细胞溶解征象,对照组无明显异常。结论 高血钠和高血渗透压是糖尿病状态下RM的发生的主要危险因素。     

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.     

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.     

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.     

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.