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??OBJECTIVE Blood tends to deposit in atrium to form thrombus in patients with atrial fibrillation. Patients with diabetes are in high coagulation state, for whom thrombosis is easy to occur. The number of diabetic patients with atrial fibrillation is large. Warfarin is one of the most widely used oral anticoagulants, which can cause major or fatal bleeding, so it is necessary to perform regular monitoring of international normalized ratio (INR) on all patients treated with warfarin. New kinds of antidiabetic drugs are widely used in clinic, among which a lot affect INR levels achieved with warfarin therapy. Clinical pharmacists should pay attention to drug interactions and monitor adverse drug reactions. As a new antidiabetic drug, exenatide has less reports of interaction with warfarin. The characteristic of the interaction between exenatide and warfarin was investigated, with the aim to optimize the rational and individualized medication. METHODS A case was introduced in which exenatide was administrated combined with warfarin, so that the possible mechanism of exenatide affecting to warfarin were analyzed. RESULTS INR declined from 2.13 to 1.57 after exenatide being added, and decreased further to 1.43 with concurrency of the increasing exenatide dose. On the contrary, INR was on rise as result of discontinuing exenatide. At last, INR returned to 1.78 when the patient discharged. CONCLUSION Exenatide inhibited the absorption of warfarin, which lead to INR decline attributed to its effect of slowing down the gastric emptying. When exenatide and warfarin are combined,the dose of warfarin must be adjusted based on INR under clinical monitoring.     

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??OBJECTIVE To evaluate the quality of now available clinical guidelines and consensus statements on type 2 diabetes. Based on this assessment, the comparison of guidelines and consensuses is made to give some suggestions on the METHODS of making these documents. METHODS PubMed, Embase, CNKI, Wanfang, SinoMed and guideline websites were systematically searched. Literatures were screened according to defined criteria for including. AGREE ?? was used to instrument assess the quality of the guidelines and consensuses. RESULTS The result showed that the quality of included guidelines is various, but the overall quality of guidelines is still higher than consensuses. Guidelines got high scores in scope and purpose domain and clarity of presentation domain, but low scores in rigor of development domain and applicability domain. Consensus statements got low scores in all 6 domains. CONCLUSION The main reason for the difference is consensuses have poor methodology. Rapid advice guidelines were suggested as an alternative for consensus statements.     

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??OBJECTIVE To investigate the effects of prolonged exposure to isoflurane on the expression of glial fibrillary acidic protein(GFAP) and excitatory amino acid transporter-2 (EAAT2)in cortex of frontal lobe and hippocampus of neonatal rats.METHODS Forty Wistar rats at postnatal day 7 were randomly divided into isoflurane group and control group according to the random number table method (n=20).Isoflurane group were exposed to 1.1% isoflurane (equivalent to 0.5 MAC for neonatal rats) for 6 h, the others were exposed to the gas mixture of 30% of the oxygen and nitrogen for 6 h in the control group. Five neonatal rats were sacrificed 12, 24 h, 3 and 7 d after exposure in each group. The brain were frozen and sliced, brain sections were double-stained with GFAP and EAAT2 markers.The fluorescence intensity of GFAP and EAAT2 double-labeled immunofluorescence was quantified in cortex of frontal lobe and hippocampus at 12, 24 h, 3 and 7 d after exposure by the Image J programme.RESULTS Compared with the control group, the immunofluorescence intensity of GFAP in cortex of frontal lobe after exposure 12, 24 h in isoflurane group was significantly decreased(P<0.01),whereas there was no significant difference after exposure 3, 7 d.The immunofluorescence intensity of GFAP in hippocampus after exposure 12, 24 h and 3 d in isoflurane group decreased compared with control group(P<0.01), except 7 d after exposure.Double-labeled immunofluorescence showed lowered expression of GFAP and EAAT2 co-stained region in cortex of frontal lobe and hippocampus at 12, 24 h, 3 and 7 d after exposure in isoflurane group when compared with control group(P<0.01). CONCLUSION The 1.1% isoflurane prolonged exposure transiently reduces the expression of GFAP in the cortex and hippocampus, and delays the development of cytoskeleton. Whereas inhibiting the expression EAAT2 of astrocytes is prolonged, that may be one of the mechanisms for isoflurane-induced neurotoxicity.     

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??OBJECTIVE To evaluate the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RA) on nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). METHODS The randomized controlled trials (RCTs) of GLP-1 RA, placebo, and anti-diabetes drugs in the treatment of NAFLD in patients with T2DM were collected from PubMed, Embase, CNKI, Wangfang database, VIP, and CBM. The trials were evaluated for the quality and selected, and the RESULTS of the studies were reviewed and analyzed using RevMan 5.2 software. RESULTS Four RCTs were included, involving 154 patients. The Meta-analysis showed that compared with the control group, GLP-1RA could significantly improve the ALT [MD:-8.36,95%CI(-13.41-3.31), P=0.001], HbA1c [MD:-0.43%,95%CI(-0.73-0.31), P=0.005], FBG [MD:-0.71%, 95%CI(-1.39-0.03),P=0.04],BMI [MD:-1.38%, 95%CI(-2.18-0.58), P=0.000 8], TG [MD:-0.49%, 95%CI(-0.82-0.16), P=0.004]. CONCLUSION GLP-1 RA can obviously improve the metabolic index of patients with NAFLD and T2DM. Given the quality and quantity of the literature, large RCTs are still needed in the future.     

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??OBJECTIVE To systematically review the efficacy and safety of dipeptidyl peptidase-4(DPP-4) inhibitors versus glucagon like peptide-1(GLP-1) receptor agonists for type 2 diabetes mellitus(T2DM). METHODS Databases including EMbase,PubMed, The Cochrane Library, Clinical Trial, CBM,CNKI and WanFang Data, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors versus GLP-1 receptor agonists for T2DM up to December 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using RevMan 5.3 soft ware. RESULTS A total of 13 RCTs were included. The RESULTS of Meta-analysis showed that compared with DPP-4 inhibitors, GLP-1 receptor agonists were more effective in reducing the levels of fasting plasma glucose [MD=0.93, 95%CI(0.48,1.38), P??0.000 1] and glycated hemoglobin [MD=0.53,95%CI(0.34,0.73), P??0.000 01] and BMI [MD=1.53,95%CI(0.83,2.22),P??0.001]. However, DPP-4 inhibitors were more effective than GLP-1 receptor agonists in the reducing the 2-hour postprandial blood glucose level. And GLP-1 receptor agonists were more prone to cause gastrointestinal adverse reactions than DPP-4 inhibitors [RR=0.44,95% CI (0.33, 0.59), P<0.000 1]. CONCLUSION GLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling the fasting plasma glucose and glycated hemoglobin levels and reducing the body weight of T2DM patients, while DPP-4 inhibitors have better efficacy in reducing 2-hour postprandial blood glucose level, with better tolerability.     

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??OBJECTIVE To review systematically the association of dipeptidyl peptidase-4 inhibitors on pancreatitis and/or pancreatic cancer risk in type-2 diabetes mellitus. METHODS Databases including The Cochrane Library, PubMed, Embase, Clinical Trials.gov, CNKI, WanFang Data and CBM, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors in pancreatitis and pancreatic cancer risk in T2DM patients up to June 2017. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS A total of 39 RCTs involving 65 189 patients were included. The results of Meta-analysis showed that there were no significant differences between the DPP-4 inhibitors group and the control group in the pancreatitis and/or pancreatic cancer adverse events (RR=0.92, 95%CI 0.69 to 1.23, P=0.59), pancreatitis (RR=1.05, 95%CI 0.76 to 1.4, P=0.79) and pancreatic cancer (RR=0.62, 95%CI (0.35, 1.08), P=0.09). Subgroup analyses showed there were no significant differences of acute pancreatitis events between DPP-4 inhibitors group and the control group (RR=1.42, 95%CI 0.82 to 2.47, P=0.21). CONCLUSION The present Meta-analysis of RCTs data does not suggest that DPP-4 inhibitors are associated with pancreatitis and/or pancreatic cancer. Long-term clinical studies are required to further prove this conclusion.     

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??OBJECTIVE To evaluate the cost-effectiveness of insulin aspart30(BIAsp 30) versus premixed human insulin 30/70 (BHI 30) in patients with type 2 diabetes (T2DM) in China so as to provide a reference for relevant decision of drug selection and drug pricing. METHODS Based on a secondary document study method and literature review both at home and abroad, a summary and screening were made on the safety and effectiveness of BIAsp 30 versus BHI 30 for the treatment among insulin-naive people with T2DM. A Meta-analysis was performed to assess the effectiveness and safety of the selected data by using software RevMan5.2. Then combine the price from the National Development and Reform Commission, National Health and Family Planning Commission to perform cost-effectiveness analysis from a social prospective. Sensitivity analysis and publication bias were conducted. RESULTS Treatment with BIAsp 30 is associated with more cost than BHI 30 (??1 665.44 vs ??1 383.86),and the effectiveness data of BIAsp 30 was higher than BHI 30 (2.46 vs 1.83). Compared with BHI 30, BIAsp 30 is more efficient in pharmacoeconomic cost-effectiveness analysis, and sensitivity analyses demonstrated robustness of the RESULTS. CONCLUSION BIAsp 30 is better than BHI 30 in terms of the economy, but it still needs further research.     

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??Nrf2/ARE pathway has become an attractive target using phytochemicals for the prevention and treatment of oxidative stress-related diseases including neurodegenerative diseases,such as Alzheimer??s disease(AD), and Parkinson??s disease(PD). Among phytochemicals, sulforaphane (SFN) has demonstrated neuroprotective effects in several in vitro and in vivo studies. In particular, evidence suggests that beneficial effects of SFN could be mainly ascribed to its peculiar ability to activate the Nrf2/ARE pathway. Therefore, SFN appears to be a promising compound with neuroprotective properties that may play an important role in preventing neurodegeneration. This contribution focuses on Nrf2/ARE-mediated signaling pathways, particularly in relation to neuroprotective effects of sulforaphane.     

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??Urotensin ?? (U??) and urotensin ?? receptor (UTR) have significant effects on the pathogenesis of type 2 diabetes (T2D). UTR, as a G protein-coupled receptor (GPCR), mediates U?? signal transduction.The gene polymorphism of U?? and UTR is high related to the susceptibility of diabetes, suggesting a relationship between U?? system and T2D. U?? system can influence the process of T2D by affecting body weight, lipid and glucose metabolism and inflammatory response. U?? can also induce insulin resistance by regulating insulin-related signaling pathway or accelerating oxidative stress.Therefore, U?? system might be a potential target for T2D treatment.     

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??OBJECTIVE To study the chemical constituents of Fomes fomentarius (L.Ex.Fr.). METHODS The compounds were isolated by chromatography on silica gel column, Sephadex LH-20 column, and their structures were elucidated by spectral analysis. RESULTS Six compounds were obtained and identified as fomentarinin (1), 2-hydroxy hexacosanoic acid ethyl ester (2),syringic acid (3), syringyl alcohol (4), vanillin (5), and ergosta-7,22-diene-3,6-dione (6), respectively. CONCLUSION Compound 1 is a new compound, and compound 2-6 are isolated from the fungus for the first time.
     

2型糖尿病治疗简况

2型糖尿病(T2DM)是临床上最常见的内分泌疾病,近年来其发病率和患病率有上升趋势,本病以胰岛素相对分泌不足及胰岛素抵抗为特点,治疗方法各异,本文围绕近年来关于2型糖尿病的西医、中药、针灸以及中西医结合治疗进展进行了简要概述。     

中医体质类型与2型糖尿病相关性的系统评价

目的:系统评价中医体质类型与2型糖尿病相关性,探究2型糖尿病患者中医体质的分布规律,为其临床防治提供循证医学证据.方法:以"2型糖尿病""中医体质"为主题检索词,检索中国知网(CNKI)、中国生物医学文献服务系统(CBM)、万方(Wanfang)及维普(VIP)数据库自建库至2021年5月关于2型糖尿病与中医体质相关性研究的文献,依次进行文献筛选、质量评价,提取各体质类型在2型糖尿病患者中的分布数据.采用Review Manager 5.3软件对纳入的文献进行Meta分析.结果:最终纳入17篇研究文献,2型糖尿病患者8405例,2型糖尿病患者各中医体质类型所占比例依次为平和质26.72％[RD=0.24,95％CI(0.15,0.33)]、阴虚质15.62％[RD=0.18,95％CI(0.13,0.22)]、痰湿质15.57％[RD=0.16,95％CI(0.11,0.21)]、气虚质14.37％[RD=0.15,95％CI(0.12,0.19)]、阳虚质10.84％[RD=0.11,95％CI(0.08,0.14)]、湿热质6.17％[RD=0.07,95％CI(0.05,0.09)]、血瘀质5.81％[RD=0.06,95％CI(0.04,0.08)]、气郁质3.53％[RD=-0.04,95％CI(0.03,0.05)]、特禀质1.36％[RD=0.01,95％CI(0.01,0.02)],差异均有统计学意义(P＜0.01).男性最常见偏颇体质为痰湿质18.24％[RD=0.17,95％CI(0.11,0.24)],女性最常见偏颇体质为阳虚质16.62％[RD=0.17,95％CI(0.13,0.21)].结论:2型糖尿病患者最常见的中医体质类型为平和质、阴虚质、痰湿质、气虚质及阳虚质,男性、女性最常见的偏颇体质分别为痰湿质、阳虚质.     

黄芪注射液治疗2型糖尿病随机对照试验的系统评价

目的:系统评价黄芪注射液治疗2型糖尿病的疗效及安全性。方法:检索黄芪注射液治疗2型糖尿病随机对照试验文献,选择合格研究,应用Jadad评分法进行质量评价,运用异质性检验、Meta-分析、漏斗图分析、敏感性分析统计相关数据。结果:4项研究符合纳入标准,Jadad评分均为1分,属低质量文献。黄芪注射液治疗2型糖尿病总有效率比较的合并RR(99%CI)为1.58(1.20,2.09)。结论:Meta-分析结果提示,黄芪注射液治疗2型糖尿病有效、安全。由于纳入研究质量低、统计结果不稳定等因素影响,降低了上述结果的可靠性、真实性,目前证明黄芪注射液治疗2型糖尿病安全有效的证据尚不够十分充分。     

自发性2型糖尿病啮齿类动物模型研究概况

人们筛选成功并保存下来的自发性的T2DM动物模型主要是啮齿类,由于这类动物模型的最大优点是其疾病的发生、发展与人类的很相似,因此在研究T2DM生理、病理及临床新药等方面有着非常大的应用价值。目前,此类动物模型主要有小鼠、大鼠和沙鼠模型,其中小鼠有单基因突变小鼠(ob/ob,db/db,KK-ay)、新西兰肥胖小鼠和NSY小鼠,大鼠包括GK大鼠、OLETF大鼠和ZUCKER大鼠等。该文对各个模型的发病机制、生理和病理特点等方面进行了阐述,以利于此类模型在研究T2DM方面的应用。     

埋线治疗2型糖尿病临床报道

目的针对胰岛素严重抵抗,注射胰岛素并口服降糖药血糖控制不理想达6个月以上者,在原治疗基础上配合穴位埋线治疗,用维生素B1/B12注射液浸泡医用羊肠线4～6h后埋入胰俞等十穴,观察疗效,总有效率92.48%。     

黄芪桂枝五物汤治疗2型糖尿病对照研究

[目的]观察黄氏桂枝五物汤对2型糖尿病的临床疗效。[方法]将90例2型糖尿病患者分为两组,治疗组48例,对照组42例。对照组采用口服降糖药或胰岛素治疗,治疗组在对照组治疗基础上加用黄芪桂枝五物汤加减(药用生黄芪、桂枝、肉桂、白芍、赤芍、生姜、干姜、大枣),1剂/d,早晚分2次服,4周为1疗程。观测血糖下降情况。治疗4周后判定疗效。[结果]治疗组总有效率91.70%,对照组总有效率71.40%,临床疗效治疗组优于对照组(P<0.05)。与治疗前比较,两组空腹血糖、餐后2h血糖均显著降低,且治疗组降低较对照组更为明显,差异均具有统计学意义(P<0.05)。[结论]黄芪桂枝五物汤加减治疗2型糖尿病体现出中医整体治疗的优势。     

糖平煎治疗2型糖尿病30例

目的 观察自拟中药复方糖平煎治疗2型糖尿病患者的临床疗效。方法 选取自2015年1月—2016年12月于我院内分泌科收治的糖尿病患者60例,采用信封法随机分为试验组和对照组,对照组30例,采用常规西医治疗糖尿病的方法,试验组30例,在对照组基础上口服中药糖平煎,观察两组患者血糖、血脂和糖化血红蛋白。结果 试验组优于对照组,有统计学差异(P0.05)。结论 糖平煎汤治疗2型糖尿病患者疗效肯定。     

金芪降糖片治疗2型糖尿病临床经验

金芪降糖片是以中医辨证为主,集中医古代与现代治疗糖尿病之精华,结合2型糖尿病的发病特点,以及中药的现代药理学研究开发而成的中药三类新药.本方由黄连、黄芪、金银花等组成,具有清热益气之功效,主治轻、中型的2型糖尿病.     

黄连素治疗Ⅱ型糖尿病

黄连素治疗 型糖尿病 ,既往文献多有报道 ,近几年来笔者在临床加以验证 ,取得了较满意的疗效 ,现报告如下。一般资料本组 2 6例中男性 6例 ,女性 2 0例 ;年龄 42～80岁 ;病程 1个月～ 9年 ;有慢性并发症者 8例。临床表现以口渴引饮 ,消谷善饥 ,尿频量多 ,或小便浑浊 ,消瘦 ,头晕等为主。治疗方法所有病例均停止使用降糖药物 ,在饮食疗法的同时口服黄连素 ,每次 0 .6g,每日 3次 ,3个月为 1个疗程 ,2周测空腹血糖 1次。疗程结束时测尿糖及空腹血糖 ,如已恢复正常 ,则可继续服 0 .4g,每日 3次以巩固疗效 ,并坚持糖尿病饮食。治疗效果本组经治…     

不同剂型五味消渴方治疗2型糖尿病的临床研究

目的研究不同剂型五味消渴方对2型糖尿病患者血糖水平及临床症状疗效的差异,并对其作用机制进行探讨。方法选取2017年11月-2018年11月我院80例2型糖尿病患者,随机分为2组,观察组及对照组各40例。观察组使用浓缩丸治疗,对照组使用汤剂治疗。观察两组患者治疗前后血糖变化情况及临床疗效。结果对照组总有效率82.5%,与观察组总有效率80.0%比较,差异无统计学意义(P 0.05)。治疗后,2组患者FPG及2 hPG水平均显著低于治疗前(P 0.05),但观察组与对照组对改善血糖情况疗效未见明显差别(P 0.05)。结论五味消渴方2种剂型均能有效改善患者血糖情况,丸剂与汤剂降糖效果无明显差异,但丸剂发生不良反应少。