早孕期孕妇糖化血红蛋白水平与胎儿畸形的关系

目的探讨早孕期孕妇糖化血红蛋白（GHb）水平与胎儿畸形的关系。方法以来我院早孕门诊孕周小于16w,有糖尿病家族史或糖尿病史的孕妇126例为对象,用高效液相色谱仪（HPLC）测定HbAlc,孕20～24w进行彩色B超检查。B超未发现异常的胎儿继续妊娠,追踪观察至胎儿娩出,分析HbAlc水平与胎儿畸形的相关性。结果早孕期HbAlc水平大于11％时,胎儿畸形发生率明显升高。结论早孕期孕妇糖化血红蛋白水平异常升高与胎儿畸形有密切关系     

社区糖尿病病人血糖控制及慢性并发症调查

目的调查分析社区糖尿病病人血糖控制及慢性并发症的情况,为糖尿病的社区防治和慢性病管理提供依据。方法以随机方式调查六家社区卫生服务中心2007年11月至2007年12月在社区门诊随诊的糖尿病病人共194人,检测其空腹血糖和餐后2h血糖,并调查糖化血红蛋白（HbA1c）的检测情况和慢性并发症的发生情况。结果随机抽查的194个病人中,血糖控制达到良好的只占24％;只有23％的病人在半年内检测过糖化血红蛋白（HbA1c）,糖化血红蛋白（HbA1C）达到良好的病人不足30％;在社区诊治的糖尿病病人的慢性并发症患病率较低,只有5．7％～22．7％。结论社区糖尿病病人血糖控制不理想,需要加强社区卫生服务中心对糖尿病病人的科学管理和治疗。有效控制血糖和加强慢性并发症的筛查是今后社区糖尿病病人管理的重点。     

番石榴叶总三萜对2型糖尿病大鼠的降血糖和血脂作用

目的: 探讨番石榴叶总三萜(TTPGL)对2型糖尿病大鼠血糖及血脂的影响。方法: 采用高糖高脂饮食加腹腔注射小剂量链脲佐菌素(STZ, 35 mg·kg^-1)方法建立2型糖尿病大鼠模型。将造模成功的糖尿病大鼠随机分为5组:糖尿病模型组,TTPGL低、中、高剂量组(60、120、240 mg·kg^-1),罗格列酮阳性对照组(3 mg·kg^-1)。另取12只正常大鼠设为正常对照组。给药组每天灌胃给药1次,连续给药6周;模型组和正常对照组则给予同体积的生理盐水灌胃。给药6周后,采用葡萄糖氧化酶法测定大鼠的空腹血糖(FBG);放射免疫法测定空腹胰岛素(FINS),并计算胰岛素敏感指数(ISI);酶联免疫法测定大鼠的甘油三酯(TG)、总胆固醇(TCH)、游离脂肪酸(FFA)和糖化血红蛋白(GHb);果糖胺法测定糖化血清蛋白(GSP);Western blotting检测脂肪组织过氧化物酶体增殖物激活受体γ(PPARγ)的表达情况。结果: 与正常对照组相比,糖尿病模型组血脂、FBG以及GHb显著升高,FINS及ISI显著下降,脂肪细胞PPARγ蛋白表达水平降低。与模型组相比,TTPGL中、高剂量组大鼠的FBG和GSP显著降低,FINS以及ISI显著升高,脂肪组织PPARγ蛋白的表达水平升高(P<0.01或P<0.05);此外,TTPGL能显著降低糖尿病大鼠血脂水平,TG、TCH和FFA含量均明显降低(P<0.01或P<0.05)。结论: TTPGL能显著降低2型糖尿病大鼠的血糖和血脂水平,明显改善糖尿病动物的糖脂代谢紊乱,升高血清胰岛素水平,提高胰岛素敏感指数;其抗糖尿病作用机制可能与其增加PPARγ蛋白的表达有关。     

健康体检人群空腹血糖、糖化血红蛋白联合检测的应用研究

目的 分析空腹血糖、糖化血红蛋白联合检测在健康体检中的应用价值.方法 选择北京市海淀医院437名健康体检者作为研究对象,分别检测其空腹血糖、糖化血红蛋白水平,并对二者的相关性进行分析.结果 437名研究对象中,糖化血红蛋白＜5.5％者139例,5.5％ ～6.5％者257例,＞6.5％者41例.糖化血红蛋白＞6.5％者的空腹血糖水平均明显高于＜5.5％、5.5％ ～6.5％者(P＜0.01).相关分析显示,437名体检者的糖化血红蛋白水平与空腹血糖水平之间呈正相关(P＜0.01).结论 健康人群空腹血糖、糖化血红蛋白联合检测对糖尿病的筛查具有重要价值,适合在健康人群体检中推广.     

ARKRAYHA-8180全自动糖化血红蛋白分析仪性能评价

目的 对以离子交换高效液相色谱（HPLC）法为原理的ARKRAY HA-8180型全自动糖化血红蛋白分析仪（简称HA-8180）检测全血糖化血红蛋白（HbAlc）的性能进行评价.方法 参考美国临床和实验室标准化协会（CLSI）文件（EP15-A2,EP6-A,EP28-A3C）及相关文献,对HA-8180测定HbAlc的精密度、携带污染、准确度、回收试验、线性范围以及生物参考区间等进行评价,并将实验结果与制造商提供的分析性能或公认的质量指标进行比较.结果 HbAlc低值和高值样本对应的重复性不精密度变异系数（CV）分别为0.76％和0.50％,实验室内不精密度CV分别为0.79％和0.51％;高值样本对低值样本的结果无明显携带污染（携带污染率为1.08％）;相对偏倚在-1.39％～1.29％之间,偏差符合率为100％;平均回收率为101.54％;在4.7％ ～ 15.8％范围内线性良好;生物参考区间验证结果在美国糖尿病控制与并发症试验/英国前瞻性糖尿病研究（DCCT/UKPDS）提供的4.0％ ～6.0％范围内.结论 HA-8180糖化血红蛋白分析仪检测全血HbAlc性能良好,可在临床广泛使用.     

血糖控制对2型糖尿病患者载脂蛋白A水平的影响

目的 观察分析2型糖尿病患者载脂蛋白A（apoA）水平变化与血糖控制状态关系及其可能的影响机制。方法 采用自动生化仪检测213名2型糖尿病患者血浆总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、极低密度脂蛋白（VLDL）、低密度脂蛋白（LDL）、载脂蛋白A（apoA）、载脂蛋白B（apoB），用离子交换高效液相色谱分析法测定糖化血红蛋白（HbAlc），比较其与血脂指标的相关性。结果 两组HDL-C水平差异无统计学意义[（1．26±0．45）mmol／L vs （1．13±0．35）mmol／L，P〉0．05]；控制满意组apoA水平显著高于非满意组[（1．16±0．31）g／L vs （0．98±0．32）g／L，P〈0．01]，apoB／apoA显著低于非满意组（P〈0．05）。TC、TG、LDL、VLDL水平两组差异无统计学意义（P〉0．05）。直线相关分析显示apoA与HbAlc、FBG呈显著负相关（r=-0．30，P〈0．01；r=-0．24，P〈0．01）：apoA与HDL、TC呈显著正相关（r=0．74，P〈0．01；r=0．39，P〈0．01）。结论 2型糖尿病患者血糖控制状态显著影响apoA水平，这可能是HDL功能紊乱的重要原因。     

胰岛素与硒合用对糖尿病大鼠心肌重构的影响

 目的：观察胰岛素与硒合用对糖尿病心肌病大鼠心肌重构的影响并初步探讨其机制。方法：SD大鼠经腹腔注射链脲佐菌素（STZ），诱导12周后建成糖尿病大鼠心肌重构动物模型。采用One TouchⅡ血糖仪和血糖试纸测定血糖水平；微柱法测定糖化血红蛋白浓度；酶学法测定甘油三酯和总胆固醇的含量；Mallory三色染色检测心肌组织内胶原纤维含量的变化；双抗体夹心ABC-ELISA法检测血清TNF-α的动态变化，免疫组化检测各组心肌组织TNF-α的表达。结果：与对照组比较，模型组大鼠糖脂代谢紊乱，心脏功能明显下降（P<0.01），心肌组织异常胶原纤维大量堆积，血液及心肌组织中TNF-α的表达显著升高（P<0.01）。胰岛素与硒合用比单用胰岛素治疗更能明显改善糖尿病大鼠的糖脂代谢紊乱，减轻心肌胶原网络重构，抑制血液及心肌组织中TNF-α的表达（P<0.01），改善心脏的结构与功能。结论：胰岛素与硒合用对糖尿病心肌病大鼠心肌重构有明显的改善作用，其对TNF-α表达的抑制可能是其作用的分子机制之一。     

糖尿病大鼠胰腺血管紧张素受体Mas表达降低

 目的 糖尿病大鼠观察胰腺血管紧张素受体Mas在糖尿病发病机制中的可能作用。方法 选48周龄的雄性OLETF大鼠及年龄和性别匹配的同品系LETO大鼠行口服糖耐量试验。氧化酶法测定血糖,ELISA法测定血清胰岛素,血浆生化仪测定血清甘油三酯及总胆固醇。免疫组化检测Mas及血管紧张素转换酶2（ACE2）在胰腺的表达。应用淋巴细胞分离液分离胰岛细胞,QRT-PCR方法检测胰岛细胞Mas及ACE2的mRNA表达,Western印迹法测定大鼠胰岛细胞Mas及ACE2的蛋白表达。结果 OLETF大鼠的体重、甘油三脂、总胆固醇、空腹血糖及服糖后2h血糖、空腹胰岛素水平较LETO大鼠均显著升高（P<0.05～0.01）。Mas及ACE2在胰腺的内、外分泌腺均有表达。OLETF糖尿病大鼠其胰岛细胞Mas的mRNA及蛋白表达均明显低于LETO对照组（P<0.05）,两组间ACE2的mRNA及蛋白水平无显著差异。结论 糖尿病发生过程中胰腺Mas mRNA及蛋白水平的下降先于ACE2出现。Mas在胰腺的表达可能成为治疗胰腺疾病的靶点之一。     

氧化应激在糖尿病大鼠胃动力变化中的意义

 目的：观察糖尿病大鼠胃组织中氧化应激水平,探讨氧化应激对糖尿病胃动力和胃Cajal间质细胞（ICC）的影响。方法：38只8周龄雄性SD大鼠腹腔注射链脲佐菌素（STZ）,选取造模成功的36只大鼠分为糖尿病组和糖尿病治疗组,每组18只,另取同批正常SD大鼠18只作为正常对照组。检测各组大鼠体重、血糖和糖化血红蛋白。实验第1周末和第10周末分别处死各组9只大鼠测定胃排空率,以及胃平滑肌中丙二醛（MDA）、超氧化物歧化酶（SOD）、肿瘤坏死因子α（TNF-α）、酪氨酸激酶受体c-Kit和干细胞因子（SCF）水平。通过免疫细胞化学和原位末端标记（TUNEL）法检测胃组织ICC凋亡。结果：与正常组比较,糖尿病大鼠胃动力明显减弱。糖尿病大鼠胃平滑肌内MDA含量升高,SOD活性减弱,TNF-α含量升高,c-Kit和SCF水平下降,ICC凋亡明显增加。糖尿病大鼠治疗后氧化应激水平降低,抗氧化能力提高,c-Kit和SCF水平显著升高,ICC凋亡减少。抗氧化治疗后胃动力明显改善,与糖尿病组比较有明显差异。结论：高血糖影响大鼠胃组织中抗氧化酶的表达。氧化应激水平在糖尿病胃组织中明显增强,在糖尿病大鼠胃动力变化中发挥重要作用。氧化应激促使c-Kit/SCF系统受损,导致胃平滑肌ICC凋亡增多。     

2型糖尿病患者mtDNA变异筛查研究

目的探讨线粒体基因突变与2型糖尿病的关系。方法随机筛查222例散发2型糖尿病患者和191名正常对照，以聚合酶链反应、限制性内切酶片段长度多态性及T-A克隆测序和变性高效液相色谱分析技术验证等方法检测线粒体基因突变。结果糖尿病组线粒体基因（3153—3551nt）突变总的发生率（24．32％）明显高于正常组（7．33％）（P〈0．05）；发现3个尚未见报道的新突变位点：A3209T、T3253G和A3467C，而C3497T则在糖尿病中是首次报道；起病年龄、体重指数、空腹血糖、糖化血红蛋白、高密度脂蛋白和糖尿病肾病等指标是线粒体基因突变的相关因素（P〈0．05）。结论温州地区糖尿病患者存在多种线粒体基因点突变，其在糖尿病的发生发展中起重要作用。     

Interinstitutional variation in glycohemoglobin monitoring and glycemic control of diabetic patients

OBJECTIVES: To compare how frequently institutions monitor glycohemoglobin in diabetic patients, the level of glycemic control achieved and to identify institutional factors associated with higher rates of monitoring and lower glycohemoglobin levels. METHODS: A total of 212 institutions retrospectively abstracted laboratory and outpatient records of up to 30 diabetic patients who had initial glycohemoglobin monitoring performed in their laboratories. Data from a cohort of 5586 diabetic patients and 17 365 assays were analyzed. RESULTS: Overall, 31.3% of patients underwent glycohemoglobin monitoring at least quarterly, the frequency recommended by the American Diabetes Association (ADA) to stabilize patients at target hemoglobin A(1c) (HbA(1c)) levels. A total of 64.9% of patients were monitored at least semiannually, the ADA recommendation for patients with stable diabetes in glycemic control (final HbA(1c) level <7%). When we compared the top and bottom deciles of the 212 institutions, there was more than an eightfold difference in the proportion of patients monitored at least quarterly and more than a twofold difference in the proportion of patients monitored at least semiannually. Glycemic control was assessed by examining the value of the last glycohemoglobin determination on record after at least 8 months of management. For all 5586 diabetic patients, the median value of the last HbA(1c) assay was 7.4%. Comparing the top and bottom deciles, there was almost a fourfold difference among institutions in the proportion of diabetic patients in glycemic control. The use of reminders to order glycohemoglobin monitoring was associated with higher rates of semiannual monitoring (P <.05) and tighter glycemic control (P <.05). In addition, patients who were monitored more frequently experienced glycohemoglobin reductions of greater magnitude (P <.001). The presence of diabetes clinics and the use of rapid methods for testing glycohemoglobin were not associated with monitoring frequency or glycohemoglobin levels. CONCLUSIONS: There is wide interinstitutional variation in the frequency with which diabetic patients are monitored and the level of glycemic control achieved. The use of prompting systems to remind providers to order glycohemoglobin monitoring was associated with more frequent monitoring and superior glycemic control.     

姜黄素对糖尿病大鼠心肌的保护作用*

 目的： 研究姜黄素对糖尿病大鼠心肌的保护作用及可能机制。方法: 雄性Wistar大鼠75只,随机抽取10只大鼠作为正常对照组,其余65只大鼠给予高糖高脂饮食喂养8周后腹腔注射链脲佐菌素40 mg/kg,给药72 h和7 d空腹血糖≥11.6 mmol/L为糖尿病模型成功大鼠。糖尿病大鼠随机分为糖尿病心肌病组、姜黄素小剂量治疗组和大剂量治疗组。测定心肌谷胱甘肽过氧化物酶（GSH-Px）活性和丙二醛（MDA）含量,酶联免疫吸附试验检测血清心肌钙蛋白I（cTnI）的变化,Western blotting检测蛋白激酶C（PKC）蛋白表达。结果: 姜黄素治疗后可明显改善糖尿病所致的动物体重下降和空腹血糖升高,抑制心肌中MDA的产生并升高GSH-Px活性,减少血清中cTnI的释放,下调心肌组织PKC蛋白表达。结论: 姜黄素对大鼠糖尿病心肌病具有保护作用,其机制可能与抑制氧化应激有关。     

Measurement of plasma glycoalbumin levels with a monoclonal antibody based ELISA

We have reported the establishment of hybridomas secreting monoclonal antibody that specifically recognizes glycated albumin. The antibody, raised in mice immunized with nonenzymatically glycated albumin isolated from human plasma, recognizes glycated epitopes residing in albumin but not in other plasma proteins, and does not react with unglycated albumin. We now report utilization of this antibody to measure the amount of nonenzymatically glycated albumin in human plasma. When immobilized onto microtiter wells in ELISA format, A717 yields a linear dose-response relationship upon incubation with authentic purified glycoalbumin. This allows construction of standard curves from which the amount of circulating glycoalbumin can be determined. The glycoalbumin level (mean +/- SEM) in 12 samples from nondiabetic subjects was 2.4 +/- 0.22% of total albumin. In normal plasma spiked with known amounts of purified glycoalbumin, values measured with this assay were close to 100% of expected values. Glycoalbumin levels in samples from 25 diabetic subjects ranged from 1.6 to 11.6%, with a mean +/- SEM of 4.5 +/- 1.2%. Glycoalbumin levels in diabetic samples correlated significantly (r = 0.93) with glycohemoglobin values. The ability of this assay to quantitate glycoalbumin, an index of the prevailing blood glucose concentrations over the preceding 2-3 weeks, makes it a favourable candidate for utilization in the clinical setting to monitor glycemic control in diabetic subjects.     

Glycohemoglobin quantitation by alkaline gel electrophoresis. A reliable technique with practical clinical advantages

The Beckman Paragon alkaline gel electrophoresis system was evaluated for utility in identification and quantitation of glycosylated hemoglobin in the clinical laboratory setting. In contrast to other alkaline hemoglobin electrophoresis systems, this system provides adequate separation of HbA0 from its glycosylated form. A band anodal to HbA0 was identified as glycohemoglobin; in vitro synthesis of glycohemoglobin confirmed the migration pattern of the glycohemoglobin band. In both in vitro synthesis studies and in a series of 48 patients, quantitation of the glycohemoglobin band by densitometry showed good correlation (r = 0.99 and r = 0.96, respectively) with values obtained by a standard column chromatographic technique. Beyond reliable quantitation of glycohemoglobin, this system offers two advantages. First, it discriminates hemoglobin F and hemoglobins with low isoelectric points that may coincidentally be measured as glycohemoglobin by other techniques. Second, it provides simultaneous detection of common hemoglobinopathies, a necessity for accurate reporting of glycohemoglobin in the diabetic patient with a concomitant hemoglobinopathy.     

控制血糖促进糖尿病大鼠心肌葡萄糖代谢

目的 观察控制血糖对2型糖尿病大鼠心肌能量代谢的影响.方法 18只SD雄性大鼠随机分为对照组(6只)、糖尿病组(6只)和治疗组(6只).采用高脂喂养及腹腔注射链脲佐菌素建立2型糖尿病大鼠模型,应用离体心脏Langendorf灌注,测定心肌葡萄糖氧化率;采用Western blot法检测心肌细胞GLUT4的表达.结果 糖尿病组大鼠心肌葡萄糖总氧化量较对照组减少(P相似文献   

Clinical significance of serum LpA-I levels measured by immunoturbidimetric assay in type 2 diabetes mellitus patients

Previously, we developed an immunoturbidimetric assay method for lipoprotein A-I(LpA-I) on sera pre-absorbed with anti-apolipoprotein A-II. In the present study, correlations between serum lipoprotein A-I and other serum parameters levels were examined and LpA-I levels were studied in patients with type 2 diabetes mellitus. The serum levels of LpA-I did not correlate with those of diabetic markers such as fasted blood glucose, glycohemoglobin(HbA1c) and fructosamine, but correlated well with the levels of total cholesterol and HDL cholesterol, phospholipids, apolipoprotein A-I and seemed to correlate inversely with arteriosclerosis index. In patients with type 2 diabetes mellitus, LpA-I levels were significantly lower than those in normal subjects. Especially, LpA-I levels of patients with diabetic complications were significantly lower than those in normal subjects and non-complicated diabetic patients. Then, the measurement of LpA-I levels in patients with type 2 diabetes mellitus was considered to be useful for prevention and management of arteriosclerosis.     

血清C肽免疫检测方法的对比分析及临床意义探讨

采用四种常规免疫检测方法同时检测血清C肽,分析检测方法间的差异性并研究检测差异对临床判断胰岛β细胞功能的影响。随机选取病人51例152份血清样本,其中正常糖耐量13例,空腹血糖受损8例,糖耐量减低9例及2型糖尿病21例。免疫检测方法包括放射免疫法一种、化学发光法两种和电化学发光法一种。四种方法检测血清C肽的结果相互之间总体相关系数在0.74~0.99之间;检测数值间差异均显著（P〈0.0001）。在监测血清C肽的变化节律方面,四种免疫检测的变化趋向性表现一致,对临床判断无显著差异。     

Effects of ACE inhibition on the expression of type IV collagen and laminin in renal glomeruli in experimental diabetes

In the present study, we examined electron microscopically and immunohistochemically the effects of perindopril, an angiotensin-converting enzyme inhibitor, on renal microangiopathy in streptozotocin-induced diabetes in rats. To investigate changes in glomerular basement membrane (GBM) and tubular basement membrane components, we immunohistochemically localized type IV collagen and laminin. Animals have been divided into three groups of eight adult male rats each. The first group was the non-diabetic control group. The second group consisted of untreated diabetic rats. The third group consisted of diabetic rats that were treated with perindopril for 6 weeks. Blood glucose levels and body weight were measured. Morphometric analysis of kidney tissue was performed using light and electron microscopy to quantify glomerular size and thickness of the GBM. Blood glucose levels in diabetic rats were significantly increased when compared with non-diabetic controls. Blood glucose levels were not affected by perindopril treatment. Untreated diabetic rats showed increased glomerular size, thickening of the GBM and an increase in mesangial matrix as compared with controls. Treatment with perindopril prevented effectively glomerular hypertrophy and thickening of the GBM. Significant increase in type IV collagen and laminin was found in thickened GBM and mesangial matrix in kidneys of untreated diabetic rats. In perindopril-treated diabetic rats, staining of type IV collagen and laminin was less strong when compared with untreated diabetic rats. In conclusion, our data suggest that perindopril treatment is effective in preventing renal lesions possibly by ameliorating the diabetes-induced increase in expression of type IV collagen and laminin.     

Effects of stress on exacerbation of diabetes mellitus, serum glucose and cortisol levels and body weight in rats.

OBJECTIVE: The effects of stress on the serum glucose, serum cortisol levels and body weight were investigated to clarify the possible link between the stress and diabetes. METHODS: The experiments were performed on nondiabetic and streptozotocin diabetic rats divided to control, sham and stressed groups. Water immersion was used as stressor. After the experiment, blood samples were collected. The serum glucose level (SGL) was measured by the glucose oxidase method and serum cortisol level (SCL) was determined by radioimmunoassay. RESULTS: Stress caused a significant increase in glucose level in both nondiabetic and diabetic rats. In diabetes rats, a significant increase in SCL was observed. Stress did not cause, however, significant increases in SCL. A significant weight loss took place in rats exposed to stress and that was much greater in diabetic animals. CONCLUSION: The stress with mainly psychic component exacerbated the diabetes in streptozotocin treated rats and the glucose levels increased significantly also in nondiabetic controls, but no glucose was detected in their urine.     

Dissociation of the effects of training on oxidative metabolism,glucose utilisation and GLUT4 levels in skeletal muscle of streptozotocin-diabetic rats

The effects of long-term, moderate physical exercise on in vivo glucose uptake, levels of two glucose transporter proteins (GLUT1 and GLUT4) and activities of various key enzymes of energy metabolism were measured in skeletal muscle from streptozotocin-diabetic rats. Diabetes (12–16 weeks) reduced the in vivo glucose uptake (glucose metabolic index, GMI) in muscle containing mainly type I fibres by 55% but had no effect in muscles containing mainly type IIa and IIb fibres. GMI was increased in the diabetic white skeletal muscle (mainly type IIb fibres) by more than 120%. In contrast to the complex changes in GMI, GLUT4 levels were reduced in all types of skeletal muscle from diabetic rats with no change in GLUT1 levels. Exercise training had no effects on GMI or the glucose transporter levels. Streptozotocin induced diabetes significantly reduced the oxidative capacity of skeletal muscle assayed as the activities of citrate synthase, succinate dehydrogenase and cytochrome c oxidase. Training increased the activities of oxidative enzymes, with this increase being more prominent in the diabetic animals. The present data indicate that long-term streptozotocin-induced diabetes decreases oxidative metabolic capacity and GLUT4 protein levels in skeletal muscle, but that the changes of glucose transport largely depend on the fibre type composition. Moderate training fully reverses the effect of insulinopenia and hyperglycaemia on muscle oxidative metabolism. In contrast to the previous suggestions, the expression of GLUT4 is not correlated with the capacity of oxidative metabolism in skeletal muscle of streptozotocin-diabetic rats.