吲哚美辛对感染病人糖代谢及胰岛素敏感性的影响

探讨吲哚美门牌对感染病人糖代谢及仰望同素敏感性的影响。选择严重腹腔感染病人,ＡＰⅡ〉１０分,血糖〉１０ｍｍｏｌ／Ｌ,序贯分为两组：对照组８例;吲哚美辛组７例,两组病人皆在静脉输液中加入普通胰岛素约３２Ｕ／ｄ（胰岛素：葡萄糖＝１：４）。吲哚美且吲哚美辛栓纳肛,１００ｍｇ／ｄ,于实验开始前１天及第５天,分别采取标本和作项目测定。测定空腹血糖,肌酐、尿素氮、三酰甘油、游离脂肪酸浓度。应用间接能量测定仪测     

正常糖耐量患者胰岛素抵抗与冠状动脉病变的相关性分析

目的探讨正常糖耐量患者胰岛素抵抗(IR)与冠状动脉病变的相关性。方法纳入浙江医院2007年1月-2010年12月收治的正常糖耐量患者129例,根据新HOMA稳态模型按胰岛素敏感指数(ISI)分为胰岛素敏感(IS)组(n=68)和IR组(n=61),分别测定两组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、同型半胱氨酸(HCY)、血尿酸(UA)水平,并进行选择性冠状动脉造影及Gensini评分,采用Spearman、偏相关和多元逐步回归对结果进行相关性分析。结果与IS组比较,IR组冠状动脉病变程度严重,0支病变(29.8%vs11.8%,P<0.05)和1支病变(26.3%vs11.8%,P<0.05)比例显著降低,而多支病变比例(14.1%vs49.0%,P<0.01)、Gensini评分(10.6±12.7vs32.2±34.3,P<0.01)显著增高。校正影响因素后,Gensini评分与ISI呈明显的负相关(r=-0.354,P<0.01);多元逐步线性回归分析显示,ISI、HCY是影响Gensini评分的独立因素。结论在正常糖耐量患者中,IR与冠状动脉病变显著相关,是其独立的危险因子。     

初诊2型糖尿病两种胰岛素治疗模式效果比较

目的探讨多次胰岛素注射法和胰岛素泵持续皮下胰岛素输注用于初诊2型糖尿病治疗临床效果。方法比较两组患者临床缓解率、血糖达标时间,治疗前后FPG、2hPG血糖指标。结果对照组和治疗组患者临床缓解率分别为30.0%,64.0%;而血糖达标时间分别为（7.1±1.4）天,（3.3±0.5）天;治疗组患者临床缓解率及血糖达标时间均明显优于对照组,组间比较差异显著（P〈0.05）;对照组和治疗组患者治疗前FPG、2hPG等血糖指标组间比较无显著差异（P〉0.05）;两组患者治疗后FPG、2hPG等血糖指标较治疗前均明显改善,且改善程度组间比较无显著差异（P〈0.05）。结论胰岛素泵持续皮下胰岛素输注用于初诊2型糖尿病可有效改善临床症状,缩短疗程,血糖控制效果更佳。     

The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients.

Insulin has a trophic effect on pancreatic acinar tissue, so the pancreas might be expected to atrophy in persons who have diabetes. Accordingly, we analyzed the density, contour (smooth or lobulated), and thickness of the pancreas on CT scans of diabetic patients and compared the results with those in control subjects. The prevalence of pancreatic lobulation (incisurae deeper than 2 mm) and its correlation with age in diabetic and control subjects were determined. The thickness of the pancreas was measured at three levels (head, body, tail). Three groups of diabetic patients were examined: 20 insulin-dependent patients, 25 patients not treated with nor dependent on insulin, and 12 patients treated with but not dependent on insulin. A control group included 57 nondiabetic patients. The ages of the control subjects were similar to those of the diabetic patients. The statistical significance of the differences between groups of diabetic patients and control subjects was estimated by using Student's t test for the values of density and thickness and the chi 2-test for the prevalence of pancreatic lobulation. The density of the pancreas in diabetic patients and control subjects was not statistically different. Diabetic patients had increased lobulation of the pancreas. All parts of the pancreas tended to be smaller in diabetic patients, but the degree of reduction varied. It was modest in the patients not treated with insulin, pronounced in insulin-dependent patients, and intermediate in non-insulin-dependent, insulin-treated patients. Moreover, the size of the body was significantly reduced in all three groups, whereas the size of the pancreatic head was preserved in patients not treated with insulin. In conclusion, CT of the pancreas shows that although density in diabetic patients is normal, lobulation is increased. Reduction in size involves the body of the pancreas more than other parts of the gland and is more pronounced in insulin-treated diabetic patients. CT of the pancreas might be useful to predict which diabetic patients will require insulin therapy.     

Comparison between basal insulin glargine and NPH insulin in patients with diabetes type 1 on conventional intensive insulin therapy

BACKGROUND/AIM: Insulin glargine is a long-acting insulin analog that mimics normal basal insulin secretion without pronounced peaks. The aim of this study was to compare insulin glargine with isophane insulin (NPH insulin) for basal insulin supply in patients with type 1 diabetes. METHODS: A total of 48 type 1 diabetics on long term conventional intensive insulin therapy (IT) were randomized to three different regimens of basal insulin substitution: 1. continuation of NPH insulin once daily at bedtime with more intensive selfmonitoring (n = 15); 2. NPH insulin twice daily (n = 15); 3. insulin glargine once daily (n = 18). Meal time insulin aspart was continued in all groups. RESULTS: Fasting blood glucose (FBG) was lower in the glargine group (7.30+/-0.98 mmol/1) than in the twice daily NPH group (7.47+/-1.06 mmol/1), but without significant difference. FBG was significantly higher in the once daily NPH group (8.44+/-0.85 mmol/l; p < 0.05). HbAlc after 3 months did not change in the once daily NPH group, but decreased in the glargine group (from 7.72+/-0.86% to 6.87+/-0.50%), as well as in the twice daily NPH group (from 7.80+/-0.83% to 7.01+/-0.63%). Total daily insulin doses were similar in all groups but only in the glargine group there was an increase of basal and decrease of meal related insulin doses. The frequency of mild hypoglycemia was significantly lower in the glargine group (6.56+/-2.09) than in both NPH groups (9.0+/-1.65 in twice daily NPH group and 8.13+/-1.30 in other NPH group) (episodes/patients-month, p < 0.05). CONCLUSION: Basal insulin supplementation in type 1 diabetes mellitus with either twice daily NPH insulin or glargine can result in similar glycemic control when combined with meal time insulin aspart. However, with glargine regimen FBG, HbAlc and frequency of hypoglycemic event are lower. These facts contribute to better patients satisfaction with insulin glargine versus NPH insulin in IIT in type 1 diabetics.     

甘精胰岛素联合格列美脲在2型糖尿病初始胰岛素治疗中的疗效观察

目的：观察甘精胰岛素（Glargine）联合格列关脲（Amaryl）治疗口服药控制不佳的2型糖尿病患者的疗效及安全性。方法：选用口服降糖药控制差的2型糖尿病患者46例,随机分为A组采用甘精胰岛素联合格列美脲治疗,B组采用中效低精蛋白胰岛素联合格列美脲,持续观察治疗12周,比较两组空腹血糖（FBC）、餐后2h血糖（2hPBG）、糖化血红蛋白（HbAlc）、空腹胰岛素（FINS）、空腹血糖达标时间、低血糖出现次数,监测肝肾功能、血常规及体重增加情况。结果：甘精胰岛素组FBG达标时间、HbAlc水平及出现低血糖次数、体重增加值均低于中效低精蛋白胰岛素组（P〈0．05）。结论：口服降糖药疗效差的2型糖尿病患者应用甘精胰岛素（Glargine）联合格列美脲（Amaryl）治疗,有更显著的降糖效果,临床应用安全,病人依从性更好。     

血胰岛素和C肽水平与严重多发伤炎症反应的关系

目的 探讨严重多发伤患者血胰岛素和C肽水平的变化及其与炎症反应的关系.方法 检测30例严重多发伤患者伤后第1,3,7天的血胰岛素、C肽、TNF-α、IL-10、C反应蛋白(CRP),分析伤后血胰岛素和C肽的动态变化情况及其与急性生理和慢性健康评分Ⅲ(APACHE Ⅲ)、炎症因子和CRP的相关性,并与炎症因子和CRP的变化进行比较.同时检测35例健康体检者的血胰岛素和C肽作为对照. 结果 患者伤后各时相点血胰岛素和C肽均显著高于对照组;与APACHE Ⅲ均呈显著正相关.无论是否控制血糖和年龄因素,血胰岛素和C肽与IL-10在各时相点均呈显著正相关,与TNF-α和CRP在伤后第3,7天呈显著正相关.在不同预后两组中血胰岛素、C肽、IL-10水平随时间变化均下降;TNF-α和CRP水平在生存组中均呈下降趋势,但死亡组随时间变化均升高;以上指标在相同时相点死亡组均显著高于生存组. 结论 严重多发伤后血胰岛素和C肽水平的升高与炎症反应有关,其变化不仅可以反映损伤严重程度,而且可以作为动态监测机体抗炎程度的有效参考指标.     

二甲双胍联合胰岛素治疗2型糖尿病临床疗效观察

目的探讨二甲双胍联合胰岛素治疗2型糖尿病（T2DM）的治疗效果。方法选择已确诊为T2DM的患者110例，随机分为两组，A组为单纯胰岛素治疗，B组为二甲双胍加胰岛素治疗。所有患者均有使用胰岛素的适应症并且无使用二甲双胍的禁忌症，血清肌酐水平〈131umol／L，分别记录2组血糖达标时间，日胰岛素用量以及治疗前后的体重和糖化血红蛋白（HbAIc），空腹血糖（FPG），餐后两小时血糖（2HPG）变化。结果治疗前两组间FPG、2HPG、HbAIc及日胰岛素用量在统计学上均无显著性差异（P〉0.05），治疗后两组相比血糖达标时间、日胰岛素用量差异均非常显著（P〈0．01），体重改变和HbAIc的组之间进行比较差异显著（P〈0．05）。结论二甲双胍联合胰岛素治疗，优化降糖，安全达标。     

Impact of intensive insulin treatment on the development and consequences of oxidative stress in insulin-dependent diabetes mellitus

BACKGROUND/AIM: The aim of this study, which included patients with insulin-dependent diabetes mellitus, was to determine the influence of the application of various treatment modalities (intensive or conventional) on the total plasma antioxidative capacity and lipid peroxidation intensity expressed as malondialdehyde (MDA) level, catalase and xanthine oxidase activity, erythrocyte glutatione reduced concentration (GSH RBC), erythrocyte MDA level (MDA RBC), as well as susceptibility of erythrocyte to H2O2-induced oxidative stress. METHODS: This study included 42 patients with insulin-dependent diabetes mellitus. In 24 of the patients intensive insulin treatment was applied using the model of short-acting insulin in each meal and medium-acting insulin before going to bed, while in 18 of the patients conventional insulin treatment was applied in two (morning and evening) doses. In the examined patients no presence of diabetes mellitus complications was recorded. The control group included 20 healthy adults out of a blood doner group. The plasma and erythrocytes taken from the blood samples were analyzed immediately. RESULTS: This investigation proved that the application of intensive insulin treatment regime significantly improves total antioxidative plasma capacity as compared to the application of conventional therapy regime. The obtained results showed that the both plasma and lipoproteines apo B MDA increased significantly more in the patients on conventional therapy than in the patients on intensive insulin therapy, most probably due to intensified xanthine oxidase activity. The level of the MDA in fresh erythrocytes did not differ significantly between the groups on intensive and conventional therapy. The level of GSH and catalase activity, however, were significantly reduced in the patients on conventional therapy due to the increased susceptibility to H2O2-induced oxidative stress CONCLUSION: The presented study confirmed positive effect of intensive insulin therapy on metabolic control expressed through glycemia level glycolysed hemoglobine (HbAlc) and fructosamine, as well as through antioxidative/prooxidative homeostasis. This is the confirmation that an adequate treatment choice can prevent numerous diabetes mellitus complications induced by free radicals.     

青春期多囊卵巢综合征的临床特点分析简

目的：探讨青春期多囊卵巢综合征（PCOS）的临床特征。方法选择在我院妇科就诊的PCOS患者80例,其中青春期组34例,育龄期组46例。对比分析两组间的临床差别、性激素和血脂水平及胰岛素释放试验结果。结果（1）青春期组的发病年龄、病程和体重指数（BMI）均明显少于育龄期,P＜0.05;但超重/肥胖的构成比、腰围和血压与育龄期组无统计学差异,P＞0.05。（2）两组间的月经失调均主要表现为月经稀发,其次为闭经,均无统计学差别;青春期组的多毛和痤疮的评分及构成比均显著高于育龄期组, P＜0.05。（3）青春期组血清睾酮（T）,硫酸脱氢表雄酮（DHEAs）均显著高于育龄期组,P＜0.01或P＜0.05;性激素其余项无统计学差别P＞0.05。（4）两组间空腹血糖、胰岛素和HOMA-IR均无统计学差别,P＞0.05。但青春期组有胰岛素抵抗构成比和75g葡萄糖试验后,1h、2h和3h血糖和胰岛素显著低于育龄期组,P＜0.05。青春期组血脂中仅LDL显著低于育龄期组,P＜0.05,余项无统计学差别,P＞0.05。结论与育龄期PCOS患者相比,青春期PCOS患者有更明显的高雄激素血症,较轻的肥胖、胰岛素抵抗和血脂异常。     

协同干预模式对胰岛素联合格列美脲治疗糖尿病患者的影响

目的 探讨协同干预模式对胰岛素联合格列美脲治疗糖尿病患者的影响.方法 将106例胰岛素联合格列美脲治疗糖尿病患者随机分为观察组和对照组各53例,对照组给予常规干预模式,观察组在此基础上实施协同干预模式.结果 干预前两组依从性、空腹血糖、餐后2h血糖及糖化血红蛋白水平比较差异无统计学意义（P＞0.05）;干预后观察组治疗依从性明显优于对照组,空腹血糖、餐后2h血糖及糖化血红蛋白水平均明显低于对照组（P＜0.05）.结论 协同干预模式的实施,有助于提高胰岛素联合格列美脲治疗糖尿病患者的治疗依从性和疗效.     

诺和锐30和诺和灵30R治疗2型糖尿病疗效及剂量比较

目的观察CSII强化治疗后的2型精尿病患者改用诺和锐30和诺和灵30R的疗效及剂量比较。方法120例经CSII强化治疗达标（FBG〈7mmol／L，2hBG〈10mmol／L）的2型糖尿病患者随机分为A组：诺和锐30组（60例），B组：诺和灵30R组【对照组，60例）。观察患者日胰岛素总量、血糖控制情况、体质量及低血糖发生率。结果两组患者治疗12周后FBG、PBG2h均调整至正常范围，体质量变化差异无统计学意义。未出现皮疹、发热、瘙痒、肝功损害情况。但A组24小时血糖控制更稳定，日胰岛素用量A组明显少于B组，两组差异有统计学意义，P〈0.01。低血糖和其他不良事件：诺和锐30组低血糖发生率明显少于诺和灵30R组，两组差异有统计学意义，P〈0.01。两组均无严重低血糖事什记录。结论诺和锐30较诺和灵30R能更有效怏速降低血糖，有良好的安全件及依从性。且诺和锐30组剂量明显少于诺和灵30R组。     

胰岛素泵治疗糖尿病酮症酸中毒的观察及护理

目的:探讨胰岛素泵治疗糖尿病酮症酸中毒(DKA)的临床效果及护理措施.方法:将76例DKA患者随机分为胰岛素泵(CSII)组和对照组,每组38例.分别采用CSII和连续静脉输注胰岛素治疗,对患者进行观察及护理干预.结果:两组血糖达标时间、尿酮转阴时间、每日胰岛素用量及低血糖发生率比较均有极显著性差异(P<0.01),CSII组优于对照组.结论:对DKA患者采用胰岛素泵治疗并进行综合护理,能更有效地控制高血糖,减少低血糖发生.     

路路通静滴加胰岛素强化治疗Ⅱ型糖尿病疗效观察

目的　观察路路通静滴辅助胰岛素强化治疗与单纯运用胰岛素强化治疗疗效。方法　选择磺脲药继发失效住院治疗的Ⅱ型糖尿病病人 86例 ,随机分为试验组和对照组。对照组给予胰岛素强化治疗 ,试验组给予胰岛素强化治疗加路路通静脉滴注。治疗前后均行标准馒头餐试验及同步胰岛素 ,C 肽释放试验 ,计算胰岛素敏感性和胰岛功能 ,并观察两组病人治疗时间。结果　所有胰岛素强化治疗病人治疗后胰岛素敏感性、胰岛功能明显高于治疗前 ,治疗前后比较统计学差异非常显著。试验组与对照组相比胰岛素敏感性、胰岛功能HOMA ,IRT指标没有显著性差异 ,CRT指标显示试验组胰岛功能明显高于对照组 ,治疗时间也明显短于对照组。结论　路路通静滴结合胰岛素强化治疗 ,能够加快糖尿病人胰岛素敏感性的恢复 ,改善胰岛功能 ,缩短住院时间     

非肥胖2型糖尿病中LADA的发病状况

目的：了解非肥胖2型糖尿病中LADA的发病状况。方法：依据据胰岛素需要与否，将149例非肥胖糖尿病患者分为A、B二组；再依据胰岛细胞抗体（ICA）阳性与否，又分A组为A1组与A2组进行对比研究，测定胰岛β细胞功能。结果：A组胰岛功能明显差于B组，ICA阳性率则高于B组；A1、A2组差异尤著。结论：在非肥胖2型糖尿病中，如口服降糖药效差、ICA阳性、胰岛功能很差，应诊断LADA。     

运动疗法对2型糖尿病患者血糖的影响

目的 :探讨运动疗法对 2型糖尿病患者康复的影响。方法 :随机选择 36例 2型糖尿病患者并随机分成A、B、C、D四组 ,其中A组进行饮食治疗 ,B组进行饮食 +运动治疗 ,C组进行饮食+药物治疗 ,D组进行饮食 +运动治疗 +药物治疗 ,共治疗 6个月 ,测定各组治疗前后空腹血糖、餐后 2h血糖和糖化血红蛋白 (GHbA1c) ,并行胰岛素释放试验。结果 :治疗后 ,B组、D组的空腹血糖、餐后 2h血糖、糖化血红蛋白及胰岛素释放试验的高峰值的降低、高峰出现时间的提前均有显著意义 (P <0 0 5 ) ,且D组的下降有极显著性意义 (P <0 0 1)。结论 :运动对 2型糖尿病的治疗和预防并发症的发生起着积极的辅助治疗作用 ,配以运动的综合治疗方案是糖尿病患者康复治疗的最优化治疗方案     

强化胰岛素治疗重度烧伤并发应激性高血糖的临床研究

目的 探讨强化胰岛素治疗重度烧伤患者应激性高血糖的效果.方法 大面积烧伤合并应激性持续高血糖患者32例,根据降糖治疗方法不同分为两组,短效胰岛素组(A组)和强化胰岛素组(B组),对两组治疗7 d内平均血糖变化、7d内平均胰岛素用量、第一次术前占床天数进行分析.结果 强化胰岛素组在患者入院后7d内,平均随机血糖明显降低,在4.1 ～ 6.3 mmol/L之间波动,平均胰岛素用量14.6～19.4 U,明显低于短效胰岛素组;第一次术前占床天数强化胰岛素组为3.4～5.8 d,明显缩短.结论 在烧伤重症患者中,选择强化胰岛素能更及时、有效地控制血糖,缩短第一次术前占床天数,是重度烧伤时高血糖理想的治疗措施.     

地特胰岛素治疗妊娠糖尿病的疗效

 目的 观察地特胰岛素治疗妊娠糖尿病的临床疗效。方法 选取2016-06至2017-06武警内蒙古总队医院收治的88例妊娠糖尿病患者,随机分为2组,每组44例。对照组皮下注射优泌林N治疗,观察组皮下注射地特胰岛素,比较两组临床相关指标情况。结果 治疗2周后,观察组血糖达标率为79.55%(35/44),高于对照组59.09%(26/44),差异有统计学意义(P<0.05);观察组血糖达标时间[(9.33±1.74)d]比对照组短[(11.25±2.05)d],且胰岛素用量[(16.25±3.24)U]少于对照组[(26.35±7.54)U],差异均有统计学意义(P<0.05)。观察组治疗3个月后的FPG、HbA₁c水平均比对照组低,差异均有统计学意义(P<0.05)。观察组妊娠结局明显优于对照组(P<0.05)。结论 妊娠糖尿病应用地特胰岛素治疗后,能有效控制血糖水平,并改善母婴结局,且低血糖发生率低,安全、有效。     

维格列汀联合门冬胰岛素30注射液对肥胖型2型糖尿病患者胰岛β细胞功能及血清糖化血红蛋白水平的影响

 目的 探讨维格列汀联合门冬胰岛素30注射液对肥胖型2型糖尿病患者胰岛β细胞功能及血清糖化血红蛋白(HbA₁c)水平的影响。方法 选取西安交通大学第一附属医院2017-03至2018-07肥胖型2型糖尿病患者157例,按照随机数字表法分为对照组(n=78)与联合治疗组(n=79),对照组采取门冬胰岛素30注射液治疗,联合治疗组在对照组基础上联合维格列汀治疗,疗程均为12周。观察对比两组疗效及不良反应发生率,并对两组治疗前后空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖(2 h blood glucose,2 h PG)、糖化血红蛋白(HbA₁c)、胰岛β细胞功能指数(HOMA-β)及丝氨酸蛋白酶抑制药(visceral adipose tissue-derived serine protease inhibitor,VASPIN)水平进行比较。结果 联合治疗组HbA₁c达标率和控制理想率均明显高于对照组,差异有统计学意义(P<0.05)。两组治疗后FPG、2 h PG、HbA₁c水平均比治疗前降低,联合治疗组明显低于对照组,差异有统计学意义(P<0.05)。两组治疗后血清HOMA-β、VASPIN水平均较治疗前升高,联合治疗组较对照组明显升高,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义。结论 维格列汀联合门冬胰岛素30注射液治疗肥胖型2型糖尿病效果确切,能改善患者的血糖和VASPIN水平,保护胰岛β细胞功能,降低低血糖事件的发生率。     

Susceptibility to oxidative stress, insulin resistance, and insulin secretory response in the development of diabetes from obesity

BACKGROUND/AIM: [corrected] Oxidative stress plays a critical role in the pathogenesis of various diseases. Recent reports indicate that obesity may induce systemic oxidative stress. The aim of the study was to potentiate oxidative stress as a factor which may aggravate peripheral insulin sensitivity and insulinsecretory response in obesity in this way to potentiate development of diabetes. The aim of the study was also to establish whether insulin-secretory response after glucagonstimulated insulin secretion is susceptible to prooxidant/antioxidant homeostasis status, as well as to determine the extent of these changes. METHODS: A mathematical model of glucose/insulin interactions and C-peptide was used to indicate the degree of insulin resistance and to assess their possible relationship with altered antioxidant/prooxidant homeostasis. The study included 24 obese healthy and 16 obese newly diagnozed non-insulin dependent diabetic patients (NIDDM) as well as 20 control healthy subjects, matched in age. RESULTS: Total plasma antioxidative capacity, erythrocyte and plasma reduced glutathione level were significantly decreased in obese diabetic patients, but also in obese healthy subjects, compared to the values in controls. The plasma lipid peroxidation products and protein carbonyl groups were significantly higher in obese diabetics, more than in obese healthy subjects, compared to the control healthy subjects. The increase of erythrocyte lipid peroxidation at basal state was shown to be more pronounced in obese daibetics, but the apparent difference was obtained in both the obese healthy subjects and obese diabetics, compared to the control values, after exposing of erythrocytes to oxidative stress induced by H2O2. Positive correlation was found between the malondialdehyde (MDA) level and index of insulin sensitivity (FIRI). CONCLUSION: Increased oxidative stress together with the decreased antioxidative defence seems to contribute to decreased insulin sensitivity and impaired insulin secretory response in obese diabetics, and may be hypothesized to favour the development of diabetes during obesity.