胰岛素抵抗和动态血压在2型糖尿病肾病中的作用

目的通过检测尿Ⅳ型胶原探讨胰岛素抵抗和动态血压对2型糖尿病肾病的影响。方法 90例2型糖尿病患者根据尿微量白蛋白排泄量分为3组(各30例):糖尿病无肾病组、糖尿病早期肾病组及糖尿病临床肾病组。另选健康体检者34例作为正常对照组。采用ELISA法测定尿Ⅳ型胶原,免疫比浊法测定尿微量白蛋白;并进行胰岛素敏感指数、相关的肾功能指标和24h动态血压监测。结果胰岛素敏感指数在2型糖尿病各组均低于正常对照组(P均<0.05)。24h平均血压、白天和夜间平均血压在糖尿病临床肾病组高于其他3组(P均<0.05)。尿Ⅳ型胶原与胰岛素敏感指数呈负相关,与24h平均舒张压、夜间血压、尿微量白蛋白排泄量、尿β2-微球蛋白、尿α1-微球蛋白和尿-乙酰-β-D-氨基葡萄糖苷酶呈正相关。结论胰岛素抵抗和动态血压通过Ⅳ型胶原影响2型糖尿病肾病的发展。     

2型糖尿病患者微量白蛋白尿与动态血压,胰岛素水平关系的研究

目的 :研究 2型糖尿病患者微量白蛋白尿与动态血压、胰岛素水平之间的关系。方法 :5 0例 2型糖尿病患者分成微量蛋白尿组 ( 2 3例 ) ,正常蛋白尿组 ( 2 7例 ) ,分别测 2 4小时动态血压、糖基化血红蛋白、胆固醇、甘油三酯、血浆胰岛素水平。结果 :①微量白蛋白尿组患者的夜间收缩压、平均动脉压分别为 ( 14 1.8± 6.8)mmHg( 1mmHg =0 .13 3kPa)和( 97.1± 0 .9)mmHg ,较正常组 ( 12 2 .3± 6.1)mmHg和 ( 88.7± 5 .2 )mmHg明显升高 ,并存在显著差异 ( P均 <0 .0 5 )。②微量白蛋白尿组血浆胰岛素水平明显高于正常组 (P <0 .0 5 )。而血脂血糖、糖基化血红蛋白两组无显著差别 (P均 >0 .0 5 )。结论 :2型糖尿病患者微量白蛋白尿与夜间收缩压、平均动脉压及胰岛素水平有显著相关关系。     

山莨菪碱对糖尿病肾病患者尿蛋白的影响

目的 :观察短期应用静脉滴注山莨菪碱 ( 65 4 Ⅱ )对不同时期糖尿病肾病患者肾功能及尿蛋白的影响。方法 :糖尿病肾病患者分为治疗组 46例和对照组 3 9例。两组患者均根据尿蛋白和肾功能的不同再分别分为早期肾病组、临床期肾功能正常组和临床期肾功能不全组 3个亚组。治疗组静脉滴注 65 4 Ⅱ 2 0mg ,每天 1次 ,连续 2 8d。对照组不给上述治疗。控制血压、血脂、血糖等其他治疗方法各组相同。结果 :和对照组比较 ,治疗组患者尿总蛋白和尿白蛋白明显降低 ,其中糖尿病肾病早期组尿总蛋白由治疗前的 ( 0 3 5± 0 0 5 )g/2 4h下降到 ( 0 2 0± 0 0 6)g/2 4h(P <0 0 1) ,尿白蛋白由 ( 192± 75 )mg/2 4h下降到 ( 98± 5 4)mg/2 4h(P <0 0 1) ;在临床期肾功能正常组尿总蛋白由 ( 3 73± 1 98)g/2 4h下降到 ( 2 3 9± 1 48)g/2 4h(P <0 0 1) ,尿白蛋白由 ( 2 85 3± 1791)mg/2 4h下降到( 163 3± 10 90 )mg/2 4h(P <0 0 1) ;在临床期肾功能不全组尿总蛋白由治疗前的 ( 1 90± 0 92 )g/2 4h下降到 ( 1 83± 1 0 9)g/2 4h(P >0 0 5 ) ;尿白蛋白由 ( 14 0 8± 83 6)mg/2 4h下降到 ( 1115± 5 5 6)mg/2 4h(P <0 0 5 )。结论 :短期静脉应用山莨菪碱治疗 ,对不同时期的糖尿病肾病患者均有减少尿蛋白的作     

厄贝沙坦对糖尿病肾病患者尿蛋白的影响

目的 :观察短期应用血管紧张素Ⅱ受体抗拮抗剂厄贝沙坦对糖尿病肾病患者尿蛋白的影响。方法 :4 9例糖尿病肾病患者 ,分为治疗组 (厄贝沙坦 15 0mg/天 ) 2 6例、对照组 (依那普利 10mg/天 ) 2 3例治疗 3月 ,观察治疗前后 2 4小时尿总蛋白及尿微量蛋白的变化。结果 :两组病人治疗后 2 4小时尿总蛋白及微量白蛋白均有明显下降 ,治疗组 2 4小时尿总蛋白由 (0 85± 0 34)g/ 2 4小时下降至 (0 4 4± 0 19)g/ 2 4小时 (P <0 . 0 0 1) ,尿微量白蛋白由 (35 1 4 2± 15 9 34)mg/ 2 4小时下降至 (16 0± 87 5 9)mg/ 2 4小时 (P <0 . 0 0 1) ;对照组尿总蛋白由(0 96± 0 4 2 )g/ 2 4小时下降至 (0 4 4± 0 17)g/ 2 4小时 (P <0 . 0 0 1)尿微量白蛋白由 (345 5 2± 170 96 )mg/ 2 4小时下降至 (177 2 6± 93 0 7)mg/ 2 4小时 (P <0 . 0 0 1) ,两组间比较无统计学意义 (P <0 . 0 5 )。结论 :厄贝沙坦对糖尿病肾病患者有减少尿蛋白的作用。     

尿RBP、TRF、mALB检测对糖尿病肾病早期诊断的探讨

目的 探讨尿标本中视黄醇结合蛋白、转铁蛋白、微量白蛋白检测在糖尿病肾病早期诊断中的作用.方法 用ELISA法检测尿中视黄醇结合蛋白、转铁蛋白、免疫比浊法检测尿微量白蛋白,酶偶联法测定尿肌酐.结果 正常对照组中尿RBP/Cr、TRF/Cr的含量分别为(2.12±0.95)mg/mmol,(1.81±0.52)mg/mmol.在糖尿病无肾病组中,其微量白蛋白的含量与正常对照组相近(P＞0.05),而RBP、TRF的含量与正常对照组相比具有显著差别(P＜0.05).在糖尿病的初期肾病组和临床肾病组,mALB、RBP/Cr、tRF/C的含量均明显高于正常对照组(P＜0.01).结论 联合检测尿RBP、TRF是诊断糖尿病肾病早期损伤灵敏、可靠的实验室指标.     

老年高血压病病人与胰岛素抵抗的关系研究

目的　探讨老年高血压 (EH)病病人的血胰岛素水平及胰岛素敏感指数 (ISH)。方法　对老年高血压病病人 6 0例、老年对照组 6 0例测定空腹及餐后 2h血糖 (BG)、胰岛素 (Ins)、C肽 ,计算胰岛素敏感指数 ,进行分析。结果　空腹血糖两组差异无显著意义 ,空腹胰岛素 :高血压组为 12 8± 6 3mU/L ,对照组是10 1± 3 2mU/L ;胰岛素敏感指数 :高血压组 - 4 1± 0 5 ,对照组 - 3 5± 0 5。结论　老年高血压病病人存在着高胰岛素血症和胰岛素抵抗     

尿IV型胶原在实验性糖尿病肾病大鼠中的变化及意义

目的:观察实验性糖尿病大鼠尿IV型胶原的变化并探讨其与糖尿病肾病其他检测指标的关系。方法:实验于2002-02/2004-10在大连医科大学中心实验室完成。①分组:取雄性SD大鼠54只,随机分成对照组24只和模型组30只。②动物模型建立:尾静脉一次性注射链尿佐菌素(55mg/kg),测血糖≥16.7mmol/L,尿糖持续阳性大鼠定为糖尿病模型动物。符合标准的为糖尿病组24只,对照组注射等量柠檬酸钠缓冲液。③检测方法及观测指标:两组分别于病程的第2,3,6,9周随机取6只大鼠,经测定尿白蛋白正常而尿IV型胶原增高的糖尿病大鼠为糖尿病肾病待定组(n=5)。随后麻醉状态下处死大鼠,检测血糖、血肌酐、肌酐清除率;用病理图像自动分析仪测定肾小球平均体积、PAS阳性物质含量。结果:对照组大鼠24只,糖尿病模型组大鼠24只,糖尿病肾病待定组大鼠5只全部进入结果分析。①糖尿病组2,3,6,9周,尿IV型胶原、尿白蛋白、肌酐清除率均显著高于对照组(P<0.05～0.001);病程第2周,尿IV型胶原增高109.1%,尿白蛋白仅增高23.7%。②糖尿病肾病待定组肾小球平均体积、肌酐清除率均高于正常参考值[肾小球平均体积(1×103mm3):糖尿病肾病待定组分别为498.88,498.88,470.05,468.26,490.44,正常参考值为(244.1～322.1)×103mm3;肌酐清除率(mL/min·kg):分别为7.36,9.52,11.62,7.57,9.69,正常参考值为(1.73～4.33)mL/min·kg]。③尿IV型胶原与血肌酐、尿白蛋白正相关(r=0.63,0.88,P<0.001),与PAS灰度、肌酐清除率负相关(r=-0.71,-0.45,P<0.001)。结论:尿IV型胶原能更早、更敏感地对糖尿病肾病作诊断,并且还能监测病情的发展变化。     

左旋氨氯地平和依那普利治疗老年2型糖尿病肾病高血压和尿蛋白的临床观察

目的探讨长效钙离子拮抗剂 (左旋氨氯地平 )和血管紧张素转换酶 (ACE)抑制剂 (依那普利 )对老年 2型糖尿病肾病高血压和尿白蛋白的影响。方法将 36例糖尿病肾病患者 (男2 3例 ,女 13例 ,平均年龄 6 3± 7岁 )随机分为三组 :左旋氨氯地平组 (12例 )、依拉普利组 (12例 )及两药联合治疗组 (12 )例。三组在治疗糖尿病的基础上 ,分别服用左旋氨氯地平 2 .5mg、依拉普利 5mg ,清晨口服 ,每日一次 ,如果治疗 2周后血压仍未降至正常 (>140 /90mmHg) ,则左旋氨氯地平增加至 5mg ,依拉普利增加至 10mg ,共用 12周。结果两药单独治疗均可明显降低糖尿病肾病高血压 (P均 <0 .0 1) ,并可减少 2 4h尿白蛋白排出 (P <0 .0 5 )。两药联合治疗降低血压和降低尿蛋白的幅度明显优于单独治疗 (P <0 .0 1)。结论左旋氨氯地平和依拉普利治疗糖尿病肾病所致的高血压均有较好的降低血压和 2 4h尿蛋白的排泄作用。两药联合起协同效应。     

2型糖尿病患者血管内皮功能的超声观测

目的 :通过血管超声观测 2型糖尿病患者的血管内皮功能是否受到损伤。方法 :采用超声显像法 ,对 4 1例 2型糖尿病患者和 4 0例正常对照组测定反应性充血后肱动脉内径变化来评估血管内皮功能。结果 :与对照组相比 ,2型糖尿病患者内皮依赖性舒张功能 (EDD)明显受损 (1.2 2± 4 .4 1vs 13.81± 8.10 % ,P <0 .0 0 1) ,而内皮非依赖性舒张功能 (EIDD)无明显变化(18.83± 17.6 6vs 2 5 .10± 11.38% ,P >0 .0 5 )。EDD与糖尿病病程、体重指数、年龄、血压、空腹血糖、血脂、空腹胰岛素水平、尿微量白蛋白、糖化血红蛋白等均无明显的相关性。结论 :2型糖尿病早期即已存在内皮细胞功能损害。     

2型糖尿病患者C反应蛋白及肿瘤坏死因子α与微血管并发症的关系

目的:探讨2型糖尿病微血管并发症患者不同时期血清C反应蛋白(C-reactiveprotein,CRP)及肿瘤坏死因子-α(TNF-α)水平的变化及其意义。方法:对2型糖尿病组100例和健康体检者30例进行研究,根据尿蛋白排泄率将糖尿病患者分为正常尿蛋白组(36例)、微量白蛋白尿组(34例)和临床蛋白尿组(30例)。测定各组研究对象血清CRP,TNF-α,胆固醇,三酰甘油,肌酐,空腹血糖和胰岛素等,并进行比较。结果:①2型糖尿病患者CRP,TNF-α犤正常血尿组、微量蛋白尿组、临床蛋白尿组CRP分别为(2.44±1.90),(6.33±5.56),(18.35±15.39)mg/L;TNF-α分别为(1.53±0.22),(1.93±0.39),(2.64±0.36)μg/L犦明显高于对照组犤(1.07±0.36)mg/L,(1.01±0.27)μg/L犦(t=2.002～2.592,P<0.05～0.01)。②CRP,TNF-α水平随尿蛋白排泄率的增加而增加。③患者的血清CRP水平与病程、血肌酐、三酰甘油、空腹胰岛素、TNF-α呈正相关(r=0.301,0.354,0.312,0.390,0.311,P<0.01),与胰岛素敏感指数(insulinsensitiveindex,ISI)呈负相关(r=-0.356,P<0.05);TNF-α水平与病程、血肌酐、三酰甘油、空腹胰岛素、CRP呈正相关(r=0.367,0.432,0.356,0.465,0.324,P<0.01),与ISI呈负相关(r=-0.595,P<0.01),与其他指标无相关性。结论:2型糖尿病患者体内高水平的血清C     

Spectrum of proteinuria in type I and type II diabetes

We prospectively investigated the evolution of proteinuria in 52 type I diabetics over 7.8 +/- 0.3 (mean +/- SE) yr and in 61 type II diabetics over 6.4 +/- 0.3 yr. Measurements of renal protein clearance were performed serially, and the time course of proteinuria was classified in each subject based on a threshold albumin clearance of 11 nl/s, equivalent to a urinary albumin excretion rate of 30 micrograms/min. The classification based on this threshold yielded four distinct patterns of albuminuria: minimal, intermittent, progressing, and established. These patterns occurred in both type I and type II diabetics independently of the duration of follow-up. This study has identified a pattern of intermittent microalbuminuria that is also associated with transient elevations of transferrin and IgG clearances. The relationship of clinical and biochemical parameters to proteinuria patterns was evaluated. No relationship was detected between proteinuria patterns and glycemic control in either type I or type II diabetics. In type I but not type II diabetics, established proteinuria was associated with higher systolic blood pressure and decreased creatinine clearance. The phase of intermittent proteinuria detected in this study may represent a reversible stage in the development of diabetic nephropathy, but the factors that trigger the transition to progressing proteinuria remain obscure.     

Lipid disorders in type 1 and type 2 diabetes

Atherosclerotic cardiovascular disease is the most important cause of morbidity and mortality in diabetic subjects. Abnormalities in circulating lipids and lipoproteins are considered to be important risk factors for cardiovascular disease because they occur with increased frequency in diabetic individuals. Because reversal of these abnormalities carries the potential for preventing or ameliorating cardiovascular disease, their identification and management with other cardiovascular disease risk factors deserve equal importance to the management of hyperglycemia and frequently are complementary to it.     

Comparison of type I,type III and type VI collagen binding assays in diagnosis of von Willebrand disease

Summary. Background: von Willebrand factor (VWF) plays a key role in coagulation by tethering platelets to injured subendothelium through binding sites for collagen and platelet GPIb. Collagen binding assays (VWF:CB), however, are not part of the routine work‐up for von Willebrand disease (VWD). Objectives: This study presents data on collagen binding for healthy controls and VWD subjects to compare three different collagens. Patients/Methods: VWF antigen (VWF:Ag), VWF ristocetin cofactor activity and VWF:CB with types I, III and VI collagen were examined for samples obtained from the Zimmerman Program. Results: Mean VWF:CB in healthy controls was similar and highly correlated for types I, III and VI collagen. The mean VWF:CB/VWF:Ag ratios for types I, III and VI collagen were 1.31, 1.19 and 1.21, respectively. In type 1 VWD subjects, VWF:CB was similar to VWF:Ag with mean VWF:CB/VWF:Ag ratios for types I, III and VI collagen of 1.32, 1.08 and 1.1, respectively. For type 2A and 2B subjects, VWF:CB was uniformly low, with mean ratios of 0.62 and 0.7 for type I collagen, 0.38 and 0.4 for type III collagen, and 0.5 and 0.47 for type VI collagen. Conclusions: Normal ranges for type I, III and VI collagen are correlated, but higher values were obtained with type I collagen as compared with types III and VI. The low VWF:CB in type 2A and 2B subjects suggests that VWF:CB may also supplement analysis of multimer distribution. However, these results reflect only one set of assay conditions per collagen type and therefore may not be generalizable to all collagen assays.     

Basal C-peptide in the discrimination of type I from type II diabetes

Basal serum C-peptide concentrations in diabetic patients showed two groups. Diabetic patients with low C-peptide levels (less than or equal to 0.16 nmol/L) have clinical characteristics of type I diabetes, and all were on insulin therapy. With long duration of diabetes, an increasing proportion had undetectable C-peptide. Diabetic patients with high C-peptide levels (greater than 0.16 nmol/L) resemble type II diabetes. In this group 30% were on insulin therapy but duration of known disease was not associated with any decline in the high basal C-peptide levels. The small proportion of diabetic patients with basal serum C-peptide in the range of 0.17-0.32 nmol/L have indeterminate status.     

Pramlintide in the treatment of type 1 and type 2 diabetes mellitus

BACKGROUND: Amylin is a 37-amino acid peptide neurohormone that is cosecreted with insulin from the pancreatic beta cells in response to meals. It lowers serum glucose by decreasing glucagon release, slowing gastric emptying, and decreasing food intake. Pramlintide, a synthetic amylin analogue, is approved by the US Food and Drug Administration for use with mealtime insulin in patients with type 1 diabetes and patients with type 2 diabetes who are using mealtime insulin only or the combination of insulin and metformin and/or a sulfonylurea. OBJECTIVE: This article reviews the available literature on pramlintide with respect to its mechanism of action, pharmacokinetics and pharmacodynamics, clinical efficacy in type 1 and type 2 diabetes, safety and tolerability, dosing, contraindications, and drug interactions. METHODS: MEDLINE (1966-April 2005), Iowa Drug Information Service (1966-April 2005), and International Pharmaceutical Abstracts (1970-April 2005) were searched for clinical trials and therapeutic reviews published in the English language. The search terms were pramlintide and amylin. The bibliographies of identified articles were reviewed for additional references. All relevant studies were included in the review. RESULTS: Six studies, ranging in duration from 4 to 52 weeks, examined the effect of administering pramlintide with premeal insulin in patients with type 1 diabetes. In these trials, pramlintide 120 to 270 microg/d reduced glycosylated hemoglobin (HbA(1c)) by 0.1 % to 0.67%, 1-hour postprandial glucose (PPG) by 4.4 to 7 mmol/L, and 2-hour PPG by 3.6 to 4.8 mmol/L. Five studies, also ranging from 4 to 52 weeks' duration, examined the effect of administering premeal pramlintide in patients with type 2 diabetes. In these trials, pramlintide 90 to 450 microg/d reduced HbA(1c) by 0.3% to 0.62%, 1-hour PPG by 4.8 mmol/L, and 2-hour PPG by 3.4 mmol/L. The principal adverse events reported in clinical trials were nausea and hypoglycemia. The incidence of hypoglycemia in the first 4 weeks of therapy was 2 to 4 times greater with pramlintide compared with placebo; thus, the manufacturer recommends reducing the dose of premeal insulin by 50% when starting pramlintide. Close monitoring of blood glucose levels is recommended when initiating pramlintide therapy. CONCLUSIONS: Use of pramlintide in addition to insulin in patients with type 1 and type 2 diabetes was associated with modest reductions in HbA(1c). The primary adverse effects of pramlintide therapy were nausea and hypoglycemia.     

Insulin therapy in the management of type 1 and type 2 diabetes

This article describes the role of insulin therapy in the management of patients with type 1 and type 2 diabetes. It outlines the different types of insulin available, insulin regimens and the key role of nurses in patient education.     

Angina pectoris in type A and type B cardiac patients

The type A behavior pattern is characterized by excessive competitive drive, a sense of time urgency, enhanced aggressiveness, hostility and a persistent desire for recognition. Type A behaviour is widely recognized as a risk factor in coronary heart disease. This study investigated whether type As and Bs differ in their experience of pain and pain coping efforts. A group of type A (n = 35) and a group of type B (n = 19) cardiac disease patients served as subjects. All subjects underwent diagnostic treadmill testing and were compared on a variety of pain measures. There were no differences between type As and Bs in age, sex, presence of state or trait anxiety or severity of cardiac disease. Type A patients, however, were much more likely than type Bs to be classified on the New York Heart Association (NYHA) functional angina scale as having more severe pain and functional limitation. Type As were also less likely to use pain coping strategies to deal with their pain. Those who assess pain and functional impairment in cardiac patients using the NYHA scale should be aware that type A personality characteristics may affect their assessments. Type A patients who tend to make little use of pain coping strategies may benefit from systematic training in pain control methods. Additional research is needed to examine whether type A-B differences in pain and pain coping strategies may affect risks of coronary morbidity and mortality.