常用虫类药治疗糖尿病的研究

虫类药是我国传统医学中不可或缺的一类中药,取其走窜之性临床多用于治疗沉疴顽疾,如风湿性、肿瘤性、骨性等疾病。近些年诸多医者逐渐将虫类药运用到糖尿病(diabetes mellitus, DM)及其并发症的临床治疗中且疗效显著。本文对近些年来常用虫类药治疗糖尿病及其并发症的现代药理学作用及其临床应用研究进行总结,发现常用虫类药在治疗糖尿病方面具有降血糖、调血脂、抗血栓、抗氧化应激、调控炎性因子等作用,并在DM、糖尿病性心脏病、糖尿病肾病(diabetic nephropathy, DN)、糖尿病周围神经病变(diabetic peripheral neuropathy, DPN)、糖尿病足(diabetic foot, DF)等并发症的临床治疗中广泛应用且疗效显著。基于以上总结以期为虫类中药资源的进一步开发应用、药理作用的深入研究以及糖尿病临床应用提供参考。     

黄连素调控胰岛素抵抗相关2型糖尿病的研究进展

胰岛素抵抗是肝脏、肌肉和脂肪组织等周围靶组织细胞对胰岛素的敏感性降低导致葡萄糖摄取和利用效率下降而产生的一系列临床表现,是2型糖尿病的重要发病机制之一。黄连素提取自天然植物,安全性高、毒副反应小,具有显著的降血糖、改善胰岛素抵抗的作用,对2型糖尿病及其并发症有较好疗效。该文对黄连素调控胰岛素抵抗相关2型糖尿病研究进展进行综述,探讨黄连素对胰岛素抵抗及2型糖尿病防治的相关机制。黄连素的生物利用度极低,提示其可能通过调节肠道菌群来发挥降脂、降糖的作用。肠道微生物可能成为黄连素治疗胰岛素抵抗相关2型糖尿病的新靶点。     

黄连素降血糖及防治糖尿病慢性并发症的作用和机制

黄连为毛莨科植物,含有多种生物碱,其中含量最高的为小檗碱(berberine),又名黄连素,其含量可达5%～8%,属异喹啉生物碱[1]。早在1926年,日本学者村山温义、北里美次郎等就报道了黄连素的提取方法[2]。此后,黄连素的药理作用得到了广泛深入的研究,如黄连素的抗菌、抗病毒、抗心律失常、保护缺血心肌、降血压、抗胃溃疡、抗肿瘤及抗HIV等作用,尤其是对其降血糖作用的报道日渐增多。笔者就黄连素降血糖及防治糖尿病慢性并发症的机制进行综述。 1 实验研究 1.1 对胰岛b细胞的影响 倪氏等[3]用四氧嘧啶造成糖尿病大鼠模型,以黄连素注射液0…     

黄连素降低 2 型糖尿病血糖机制研究进展

目的：探讨黄连素降低血糖的机制,为黄连素的研究提供参考。方法：搜集、整理、总结、归纳近年来关于黄连素降低 2 型糖尿病患者血糖机制的相关文献。结果：黄连素主要通过改善胰岛素抵抗、抑制糖异生、促进糖酵解、非胰岛素依赖途径的激活等途径降血糖。结论：黄连素降血糖作用具有多途径、多靶点的特性。     

2型糖尿病患者荧光素眼底血管造影结果评价

近年来糖尿病在我国的发病率明显升高,其主要并发症糖尿病视网膜病变(diabetic retinopathy,DR)为我国主要致盲的疾病之一.而其中大量无症状的糖尿病患者并未被发现,因此早期发现、早期诊断和早期康复是目前糖尿病研究领域的重大课题.我们参加了北京市科委重点项目<中药干预治疗2型糖尿病血管并发症的研究>,通过荧光素眼底血管造影检查,了解早期2型糖尿病患者视网膜病变的发生情况,并拟在3年后跟踪随访观察,为早期糖尿病的防治提供临床资料.     

黄连素合六昧地黄丸治疗Ⅱ型糖尿病123例

我们针对Ⅱ型糖尿病病人在临床上长期服用磺脲类及双胍类降血糖药物造成的副作用大、难以减少并发症发生等不足,自1998年～2000年间,对我院123例Ⅱ型糖尿病病人采用黄连素合六味地黄丸治疗,收效甚佳,且无明显毒副作用,现报道如下.     

Nrf2-NF-κB通路轴及表观遗传学调控与中药(天然药物)治疗2型糖尿病

糖尿病是一种以高血糖为特征的代谢性疾病,也是一种终身性疾病,发病率高、危害大。如何预防和治疗糖尿病及其并发症已成为世界各国药学研究者面临的严峻挑战和艰巨任务。2型糖尿病致病机制尚不完全明确,氧化应激、Nfr2-NF-κB信号轴及相关表观遗传基因改变与2型糖尿病存在密切的联系,已成为探究其发病机制、作用机制和药物筛选的关键热点和有效途径之一。中国传统医药学治疗消渴症(糖尿病)历史悠久而常有奇效。中药及天然药物以其毒副作用小、作用温和持久、具有综合治疗作用、可延缓并发症等优点,受到医药学界越来越多的关注。在此背景下,从中药及天然植物中筛选、发现安全有效的新型抗糖尿病药物,以满足临床个性化治疗方案及药物多样化的需求,已成为治疗糖尿病药物研究的必然发展趋势。然而,究竟是具有哪些成分起到降血糖作用?其降血糖的机制又是什么?该文系统总结了现阶段各国研究者对调控Nrf2-NF-κB通路轴关键蛋白、mRNA及表观遗传基因与治疗2型糖尿病的相关研究成果,及中药及天然药物(成分)治疗2型糖尿病的作用机制等现状,希望能为从中药及天然药物中发现治疗糖尿病创新药物提供一定的研究思路。     

黄连素片降低2型糖尿病患者空腹血糖的疗效观察

长期以来,运动、控制膳食和口服降糖药或注射胰岛素被认为是治疗糖尿病的三大法宝。也曾有口服黄连素治疗糖尿病的报道。近年来笔者在临床工作中,用口服黄连素片治疗20例2型糖尿病,取得了较好降血糖效果,现报道如下。临床资料　根据ＷＨＯ糖尿病诊断标准确诊为2型糖尿病患者20例,其中男14例,女6例;年龄49～72岁,平均605岁;病程2～7年;治疗前空腹血糖浓度为(100±29)ｍｍｏｌ/Ｌ,体重指数基本正常,无明显并发症。治疗方法　患者在用口服降糖药物(如Ｄ860、消渴丸等)未得到有效控制后,改用黄连素片(每片01ｇ,杭州民生制药厂生产,批号97354201),服用方法:每次10ｇ,每日3次饭后口服,     

高血糖——糖尿病周围神经病变的发病基础

糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病常见的慢性并发症之一,可以出现在1型糖尿病和2型糖尿病病程中,其表现有多种形式,一般末梢神经首先受累,对称性多发性神经病变及自主神经病变较常见,而且常呈慢性进行性发展.对高血糖与糖尿病周围神经病变发病机制关系的研究有助于其预防及治疗.     

绞股蓝防治糖尿病肾病研究

尿病肾病(diabetic nephropathy,DN)是由慢性高血糖所致的一系列代谢紊乱及血液动力学改变导致的肾小球硬化症,是糖尿病常见的慢性微血管并发症之一.绞股蓝有抗高血脂、抗动脉粥样硬化、降低血糖、清除氧自由基、扩张外周血管、增加脏器的血流量等药理作用,也因其一定的降血糖、改善糖尿病并发症的作用,处于被深入的...     

Efficacy and Safety of Berberine in Patients with Type 2 Diabetes Mellitus:A Meta-Analysis

Objective To assess the efficacy and safety of berberine(BBR) in patients with type 2 diabetes mellitus(T2DM) by performing a systematic review. Methods PubMed, Cochrane Library, Embase, CNKI, and CBM were searched until May 2014. The randomized controlled trials(RCTs) of the effects of BBR on blood glucose in patients with T2DM were included. The quality of RCTs was assessed by the Jadad scale, and the Review Manager 5.1 software was used for data syntheses and analyses. Results Seventeen RCTs involving 1198 patients were included. The methodological quality of these RCTs was generally low. Compared with the control groups(placebo or no intervention with medicine), BBR suggested the statistically significant benefits in improving fasting blood glucose(FBG), postprandial blood glucose(PBG), glycosylated hemoglobin, and homeostasis model assessment of insulin resistance. Subgroups analysis of BBR compared with metformin(MET) showed that 1.5g/d MET was significantly better than BBR(0.9-1.5 g/d) in lowering FBG and PBG. However, there was no significant difference between 1.5g/d BBR and 0.75g/d MET groups in blood glucose profiles. In comparison with rosiglitazone, BBR suggested the statistically significant benefits in lowering FBG. And there was no significant difference between BBR and glipizide groups in blood glucose profiles. In addition, the combination therapy of BBR and oral hypoglycemic agents had the advantages over oral hypoglycemic agents alone. No serious adverse effects of BBR have been reported. Conclusion BBR may have the beneficial effects in the control of blood glucose levels, though the efficacy of BBR is not superior to MET. BBR appeares to have advantages over rosiglitazone in improving FBG levels. In addition, the combination therapy of BBR and oral hypoglycemic agents may be a new attempt. However, the efficacy of BBR in patients with T2DM should be further evaluated by more RCTs in a larger population of patients.     

Efficacy and Safety of BBR in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis

Objective To assess the efficacy and safety of berberine (BBR) in patients with type 2 diabetes mellitus (T2DM) by performing a systematic review. Methods PubMed, Cochrane Library, Embase, CNKI, and CBM were searched until May 2014. The randomized controlled trials (RCTs) of the effects of BBR on blood glucose in patients with T2DM were included. The quality of RCTs was assessed by the Jadad scale, and the Review Manager 5.1 software was used for data syntheses and analyses. Results Seventeen RCTs involving 1198 patients were included. The methodological quality of these RCTs was generally low. Compared with the control groups (placebo or no intervention with medicine), BBR suggested the statistically significant benefits in improving fasting blood glucose (FBG), postprandial blood glucose (PBG), glycosylated hemoglobin, and homeostasis model assessment of insulin resistance. Subgroups analysis of BBR compared with metformin (MET) showed that 1.5g/d MET was significantly better than BBR (0.9?1.5 g/d) in lowering FBG and PBG. However, there was no significant difference between 1.5g/d BBR and 0.75g/d MET groups in blood glucose profiles. In comparison with rosiglitazone, BBR suggested the statistically significant benefits in lowering FBG. And there was no significant difference between BBR and glipizide groups in blood glucose profiles. In addition, the combination therapy of BBR and oral hypoglycemic agents had the advantages over oral hypoglycemic agents alone. No serious adverse effects of BBR have been reported. Conclusion BBR may have the beneficial effects in the control of blood glucose levels, though the efficacy of BBR is not superior to MET. BBR appeares to have advantages over rosiglitazone in improving FBG levels. In addition, the combination therapy of BBR and oral hypoglycemic agents may be a new attempt. However, the efficacy of BBR in patients with T2DM should be further evaluated by more RCTs in a larger population of patients.     

Electroacupuncture for control of blood glucose in diabetes: literature review

Electrical stimulation at acupuncture points (acupoints) has been investigated for its utility in lowering blood glucose in hyperglycemic humans and animal models. Only two studies were found using electroacupuncture in human subjects, and in both of these, the participants were normal (nondiabetic) and electrical stimulation was carried out at several acupoints. It had a hypoglycemic effect in obese women with calorific restriction diet using electrical stimulation of 2 Hz for 30 minutes/day for 20 days, but no change occurred in blood glucose of fasted patients in the other study using 1 Hz for 15 minutes. Fourteen animal studies were found, of which, 11 were performed in diabetic and normal rats. A hypoglycemic effect was observed in fasted type 1 diabetic rats using the Zusanli (ST36) leg acupoint with electrical stimulation of 15 Hz for 30 minutes and 60 minutes. In fasted type 2 diabetic rats, blood glucose was lowered using the Zusanli acupoint with electrical stimulation parameters of 15 Hz and 10 mA for 30 minutes. Also, using the Zhongwan (CV12) abdomen acupoint with electrical stimulation parameters of 15 Hz and 10 mA for 90 minutes had a hypoglycemic effect in fasted type 2 diabetic rats. In fasted normal rats, electrical stimulation of 2 Hz or 15 Hz for 30 minutes at the Zusanli or Zhongwan acupoint caused a decrease in blood glucose. Future studies are required in fasted diabetic rats to determine the effect of electroacupuncture on blood levels of insulin, lipids, fatty acids and β-endorphin, and blood flow and nerve conduction velocity. Studies with fasted normal and diabetic human subjects treated by electroacupuncture are warranted using data from animal experiments to inform such studies.     

扶正化痰活血方对2型糖尿病模型大鼠胰岛素抵抗的影响

目的：观察扶正化痰活血方对2型糖尿病模型大鼠的降血糖作用和对胰岛素抵抗相关指标的改善作用，并初步探讨其作用机制。方法：以链脲佐菌素加高脂饮食造成2型糖尿病胰岛素抵抗大鼠模型，观察扶正化痰活血方对大鼠空腹血糖（FBG）、糖化血红蛋白（HBAlC）、血胰岛素含量（FINS）以及胰岛素样生长因子-1（IGF-1）的影响，并计算胰岛素敏感指数和胰岛素抵抗指数。结果：扶正化痰活血方不仅可明显降低糖尿病大鼠FBG及HBAlC，还可以降低FINS水平，升高IGF-1含量，使胰岛素敏感指数升高。结论：扶正化痰活血方具有较好的降血糖、升高胰岛素样生长因子-1含量、改善胰岛素抵抗、防治糖尿病并发症的作用。     

2型糖尿病胰岛素强化治疗患者的低血糖原因分析及对策

目的:分析2型糖尿病胰岛素强化治疗患者的低血糖原因,并提出相应措施。方法:回顾性分析我院2008年6月—2009年6月收治的146例首次使用胰岛素强化治疗的2型糖尿病患者,以15天为观察期限,监测各时点指尖末梢血糖,记录病人临床表现,探讨护理干预效果。结果:无并发症组患者的血糖水平显著低于并发症组(P0.05);与无并发症组患者比较,有并发症组患者更多表现为无症状性低血糖;40～49岁组经胰岛素强化治疗后,低血糖发生频率显著低于其它3个年龄段组(P0.05);而50～59、60～69岁组发生低血糖的频率无显著性差异(P0.05);70岁及以上组中低血糖症状多以无任何自觉症状或意识障碍为主,而其它3个年龄段组低血糖症状多以心悸、出汗为主;胰岛素强化治疗过程中,两组干预前后低血糖发生率有显著性差异(P0.05),干预后患者发生低血糖几率明显降低。结论:2型糖尿病患者经胰岛素强化治疗后出现低血糖症状与年龄、并发症等相关,应加强健康教育、临床护理及血糖监测,做到及时发现、及时治疗,降低伤残率。     

盐酸小檗碱对糖尿病合并系统性白念珠菌感染大鼠的实验研究

目的：观察盐酸小檗碱对糖尿病合并系统性白念珠菌感染大鼠的降糖、抗真菌作用。方法：选用60只雄性SD大鼠,模型组通过尾静脉一次性注射四氧嘧啶建立糖尿病模型成功后,再一次性注射白念珠菌,随机分为6组：正常组,模型组,FCZ组,BBR大（300mg·kg^-1·d^-1）、小剂量组（150mg·kg^-1·d^-1）,BBR联合FCZ组。治疗干预2周后监测空腹血糖、血清TNF-α、肝肾真菌菌落形成单位（CFU）及组织病理PAS染色的变化。结果：大、小剂量BBR与联合治疗组均明显降低空腹血糖、血清TNF-α,与模型组有明显差异（P〈0.05）,大剂量BBR组与FCZ组的抗真菌作用最强。模型组肝脏出现肝细胞小泡性脂肪变,肾脏出现肾小球体积增大,肾小管上皮细胞空泡变性,并见炎症细胞浸润及大量菌丝和孢子。大剂量BBR组的肝脏、肾脏略黄染,但形态学基本正常,无菌丝与孢子。小剂量BBR与联合组的肝肾组织病理学改变明显比模型组改善。结论：盐酸小檗碱能降低血糖,血清TNF-α浓度,抗白念珠菌,呈剂量依赖性,对糖尿病合并系统性白念珠菌感染有治疗作用。     

灵芝多糖在糖尿病及其并发症防治中的研究进展

糖尿病是一种血糖水平异常增高的内分泌系统疾病,糖尿病及其并发症的流行已经对全球健康构成了重大威胁.灵芝Ganoderma是我国珍贵的传统中药材,而灵芝多糖是灵芝的主要有效成分之一,具有多种药理作用,包括抗肿瘤、提高免疫、抗肥胖及降血糖等.就灵芝多糖对糖尿病的作用及分子机制,重点是灵芝多糖对改善糖尿病并发症的研究进展进行...     

茱萸丸对大鼠实验性2型糖尿病的治疗作用

目的:观察茱萸丸对实验性2型糖尿病大鼠降糖、降脂等作用的影响。方法:Wistar大鼠110只,随机抽取50只作为正常大鼠实验组,其余60只为糖尿病大鼠组。糖尿病组以高脂饲料诱导加链脲佐菌素(STZ)30 mg.kg-1 ip建立2型糖尿病模型,7 d后选取成模大鼠50只。50只正常大鼠和50只糖尿病大鼠各自按随机数字表法分为正常组(0.9%生理盐水)、模型组(0.9%生理盐水)、药物组(盐酸二甲双胍0.2 g.kg-1)、茱萸丸组(低、中、高剂量组分别为0.75,1.5,3 g.kg-1),每组10只。连续ig给药2周后,观察各组大鼠体重、血糖、血脂的变化。结果:茱萸丸对实验性2型糖尿病大鼠血糖有明显降低作用(P<0.01),对正常大鼠血糖无明显变化;能明显改善糖尿病大鼠的血脂(P<0.01),明显降低大鼠TC,TG,对糖尿病大鼠治疗后期的体重减轻起到延缓的作用(P<0.01)。结论:茱萸丸能降低糖尿病大鼠的血糖,改善糖尿病大鼠的血脂和体重。     

2型糖尿病及其并发症中医临床疗效评价研究进展

随着人们生活水平的提高,2型糖尿病患者数量逐年增加,引起了医学界的高度重视,中医对此也进行了较多的探索。中医治疗2型糖尿病临床研究,对单纯2型糖尿病患者主要从血糖相关指标评价其疗效,另外胰岛素敏感指数、血脂、体重指数等也起到了一定的补充。对于2型糖尿病并发症,在注重血糖指标的基础上,还以各并发症相关指标为主进行疗效评价,如2型糖尿病肾损害的尿微量白蛋白,糖尿病心脑血管病的心功能指标,糖尿病周围神经病变之神经传导速度,糖尿病足之溃疡面积、肉芽生长情况,糖尿病视网膜病变之眼底检查等。除此类客观指标以外,症状积分和中医证候积分也是一个重要的评价指标。通过以上各种疗效评价指标,表明中医药治疗2型糖尿病及其并发症具有较好的疗效。但这些疗效评价标准仍存在不够统一,某些标准特异性不够等问题。