108例老年2型糖尿病体脂状态及其与慢性并发症相关因素调查分析和健康管理研究

目的 调查老年2型糖尿病体脂状态及其与慢性并发症的关系，为健康管理提供科学依据。方法 对诊治的l08例老年2型糖尿病患者，其中正常体重组(BMI≥22．9kg／m^2)34例，超重／肥胖组(BMI≥23kg／m^2)74例，进行总体脂、局部体脂、血糖、血压及糖化血红蛋白检测，筛查糖尿病慢性并发症。结果 超重肥胖组较正常体重组在年龄、病程、BMI、FAT％、FBS、HbAlc及糖尿病慢性并发症发生率均显著增加(P＜0．05)。结论 老年2型糖尿病患者，对糖尿病的危害性认识不足，肥胖现象随年龄增加呈上升趋势，使糖尿病的多个慢性并发症末得到满意的控制，加强对这一群体的健康管理，有计划地实施干预策略是防治的重要措施。     

体质量指数与接受成人脂肪肝供体的肝移植术后糖尿病关系探讨#br#

目的　探讨体质量指数（BMI）与接受成人脂肪肝供体的肝移植术后新发糖尿病（NODAT）的关系。方法　对接受成人脂肪肝供体的肝移植术的181例患者资料进行回顾性分析,其中消瘦组5例（BMI＜18.5 kg/m2）,正常组82例（18.5 kg/m2≤BMI＜24 kg/m2）,超重组65例（24 kg/m2≤BMI＜28 kg/m2）,肥胖组29例（BMI≥28 kg/m2）。又根据患者有无NODAT,分为NODAT组57例和非NODAT组124例。比较各组受体的一般资料、术后并发症的差异。利用二元Logistic回归分析影响脂肪肝供体肝移植NODAT的危险因素,并绘制Kaplan-Meier生存曲线对患者肝移植术后1、3、5年累积生存率进行分析。结果　肥胖组术前血清白蛋白低于正常组和超重组（P＜0.05）;超重组和肥胖组患者NODAT发生率高于正常组（P＜0.01）,肥胖组患者NODAT发生率高于消瘦组和超重组（P＜0.05）;二元Logistic回归分析示,超重（OR=3.423,95%CI：1.410~8.310）和肥胖（OR=16.808,95%CI：6.023~46.907）是脂肪肝供体肝移植NODAT发生的独立危险因素;生存曲线显示,肥胖组5年累积生存率明显低于其他3组（Log-rank χ2=44.998,P＜0.01）。结论　超重和肥胖是成人脂肪肝供体肝移植NODAT发生的危险因素,术前合理控制患者BMI可显著改善移植预后。 关键词：人体质量指数;肝移植;糖尿病;移植术后新发糖尿病;脂肪肝供体肝移植     

2型糖尿病及其并发冠心病TNF-α、IL-β、IL-6水平的比较研究

目的:探讨肥胖和非肥胖伴2型糖尿病(T2DM)患者糖代谢异常的炎症机制及其合并冠心病时肿瘤坏死因子(TNF-α)、白介素-1(IL-1β)、白介素-6(IL-6)水平的变化特点。方法:选择经临床确诊的符合入选标准的140例2型糖尿病患者,按体质量指数(BMI)分为肥胖组70例(BMI≥25 kg/m2)和非肥胖组70例(BMI 25 kg/m2);正常肥胖组30例;正常非肥胖组30例。其中肥胖组中有38例并发冠心病,非肥胖组中有21例并发冠心病。用ELISA方法分别测定血清TNF-αI、L-1β、IL-6值。结果:TNF-αI、L-6水平在2型糖尿病肥胖组不同程度的高于2型糖尿病非肥胖组,合并冠心病后升高更为显著;IL-1β水平只有在合并冠心病后才显著高于其他组。结论:糖代谢异常与冠心病可能有共同的慢性亚临床炎症起源,2型糖尿病肥胖患者合并冠心病后炎症因子表达更显著。     

妊娠期糖尿病PAI-1、D-2聚体、血脂相关因子检测的临床意义

目的探讨血浆PAI-1、D-2聚体、血脂与妊娠期糖尿病有无相关性。方法 (1)采集研究对象一般资料包括年龄、糖尿病家族史、身高、体重,计算BMI;(2)采用ELISA法分别检测55例GDM孕妇(研究组)和55例健康孕妇(对照组)血浆PAI-1的含量;采用甘油磷酸氧化酶法、酶偶联比色法、免疫比浊法分别检测两组中TG、TC、D-2聚体。同时将两组中BMI28kg/m2为Ⅰ组(非肥胖组),BMI≥28kg/m2为Ⅱ组(肥胖组)。结果 (1)GDM组血浆PAI-1、D-2聚体、血脂高于正常孕妇组,两组差异有统计学意义(P0.01);其中GDM肥胖组血浆PAI-1、D-2聚体明显高于正常孕妇组,两组差异有统计学意义(P0.01);(2)GDM相关因素多元素相关线性多元回归分析结果显示:PAI-1与D-2聚体、TG、TC有显著相关性。结论 GDM存在凝血系统异常及血管并发症可能,PAI-1、D-2聚体、血脂可作为血管并发症敏感指标,指导临床早期干预。     

肥胖2型糖尿病典型病例治疗思路浅析

2型糖尿病与肥胖之间存在着密切关系,在过去十年中,全球范围内糖尿病与肥胖的患病率迅速增加。最近的统计数据表明,全世界约有14.6亿成年人超重(BMI25.0～29.9kg/m2)和5亿200万成年人肥胖(BMI≥30kg/m2)。杨文英等对国内糖尿病患病率的调查显示,当BMI<18.5kg/m2时,糖尿病患病率为     

2型糖尿病患者体重指数与空腹胰岛素水平的关系

目的探讨2型糖尿病患者体重指数与空腹胰岛素水平的关系。方法将2型糖尿病患者分为超重及肥胖组21例[体重指数（BMI）≥25kg/m^2]和正常体重组21例（BMI〈25kg/m^2）,检测其空腹胰岛素水平。结果2型糖尿病患者中超重及肥胖组空腹胰岛素为（19.2±1.71）μ/ml,体重正常组患者胰岛素为（12.63±1.25）μ/ml,两组患者的胰岛素水平之间有显著性差异（P〈0.01）。2型糖尿病患者体重指数（BMI）与空腹胰岛素水平呈显著性正相关。结论体重指数是影响空腹胰岛素水平的重要因素,因而减轻体重有利于控制胰岛素抵抗,进而有利于糖尿病的控制。     

合并2型糖尿病的急性脑梗死患者血清脂联素、肿瘤坏死因子与胰岛素抵抗的关系

目的：分析合并2型糖尿病的急性脑梗死患者血清脂联素、TNF—a水平变化及其与胰岛素抵抗（IR）、肥胖的相关性。方法：选择合并2型糖尿病的急性脑梗死患者92例,分为肥胖组（体重指数BMI≥25kg／m2）42例、非肥胖组（BMI〈25奴／m2）50例、正常对照组40例,测定血清脂联素、TNF—a、体重、身高、血脂、空腹血糖（fPG）、餐后2h血糖（2hPG）、空腹胰岛素（fINS）、餐后2h胰岛素（2hINS）、计算胰岛素抵抗指数（HOMA—IR）,做相关性分析。结果：肥胖组脂联素低于非肥胖组（P〈0．05）及正常对照组（P〈0．01）,非肥胖组又低于正常对照组（P〈0．05）。而肥胖组TNF-a高于非肥胖组（P〈0．05）及正常对照组（P〈0．01）,非肥胖组又高于正常对照组（P〈0．05）。脂联素与BMI、HOMA-IR呈负相关TNF-a与BMI、HOMA-IR呈正相关。结论：脂联素、TNF—a与IR密切相关,参与了糖脂代谢紊乱。     

多囊卵巢综合征患者脂联素水平的变化及意义

目的研究多囊卵巢综合征(PCOS)患者血清脂联素水平的变化,探讨其参与PCOS发生发展的可能机制。方法①按照体质量指数(BMI)<24kg/m2,24kg/m2≤BMI<28kg/m2,BMI≥28kg/m2分别将初诊P-COS患者170例,分为正常体质量组(P1组69例)、超重组(P2组44例)、肥胖组(P3组57例);年龄和BMI相匹配的正常对照者143名分为正常体质量组(C1组102例)、超重组(C2组20例)、肥胖组(C3组21例)。②于月经第3～5天早8:00抽取空腹血,测定性激素、血脂、脂联素等指标;实施标准口服葡萄糖耐量试验(OGTT)、胰岛素激发试验;同时测量身高、体质量、腰围、臀围等。③基础与糖负荷后胰岛素分泌功能及胰岛素抵抗,按HOMA模型计算。结果①脂联素水平的变化:PCOS患者脂联素水平低于年龄和体质量指数相匹配的健康对照者(P1相似文献   

超重对中青年原发性高血压患者血管内皮功能的影响的临床研究

目的：探讨超重对中青年原发性高血压患者血管内皮功能的影响。方法：35例中青年原发性高血压患者按体重指数(BMI)分为4组：正常组(BMI＜23)：共3例,均为男性,年龄(43．33±6．65);超重组(BMI≥23)：共5例,均为男性,年龄(44．20±9．33);Ⅰ度肥胖组(BMI 25～29．9)：共19例,男性17例,女性2例。年龄(46．21±8．27);Ⅱ度肥胖组(BMI≥30)：共8例,男性7例,女性1例,年龄(43．13±9．43)。按WHR分为2组：正常组：共14例,男性13例,女性1例,年龄(45．70±7．43),中心性肥胖组(腰臀比≥0．90(男性)和≥0．85(女性))：共21例,男性19例,女性2例,年龄(44．55±8．95)。因女性患者的例数较少,在分组的时候对性别带来的差异忽略不计。分别测量并计算总体脂含量(体重指数)、局部体脂含量(腰围、臀围)和体脂分布(腰臀比),并应用高分辨血管外超声法检测患者肱动脉血管内皮功能。结果：随着BMI的增高,患者血流介导的肱动脉内径变化的百分率(EDD)均明显降低,但各组间没有显著性差异(p＞0．05);患者EDD与腰臀比呈负相关(p=0．04)。硝酸甘油引起的血管扩张在各组间均无显著性差异,亦与局部体脂含量和体脂分布无关。结论：超重是血管内皮功能受损的重要危险因素,血管内皮功能受损与局部体脂含量和体脂分布密切相关。     

艾塞那肽与二甲双胍联用治疗初发超重和肥胖2型糖尿病疗效观察

本文通过应用艾塞那肽注射液(商品名:百泌达)治疗超重及肥胖2型糖尿病,旨在观察其降低血糖的疗效及安全性,并探讨其作用机制,现报告如下. 1 资料与方法 1.1 临床资料:2011年3月至2012年3月在我院内分泌科就诊的初发超重和肥胖2型糖尿病患者54例,诊断均符合1999年世界卫生组织(WHO)的诊断标准,体质量指数(BMI)≥24 kg/m2,其中男性30例,女性24例,年龄(46±9)岁,BMI(26.3±0.9))kg/m2,糖化血红蛋白(HbA1C)为8％～10.2％,糖尿病病程＜15 d,均无任何治疗.目前无糖尿病急性并发症发生,均排除心、肝、肾等重要脏器疾病,无胰腺炎及胃病史.     

Interaction of estrone and estradiol with DNA and protein of liver and kidney in rat and hamster in vivo and in vitro

[6,7-³H] Estrone (E) and [6,7-³H]estradiol-17 (E₂) have been synthesized by reduction of 6-dehydroestrone and 6-dehydroestradiol with tritium gas. Tritiated E and E₂ were administered by oral gavage to female rats and to male and female hamsters on a dose level of about 300 g/kg (54 mCi/kg). After 8 h, the liver was excised from the rats; liver and kidneys were taken from the hamsters. DNA was purified either directly from an organ homogenate or via chromatin. The radioactivity in the DNA was expressed in the units of the Covalent Binding Index, CBI = (mol chemical bound per mol DNA-P)/(mmol chemical administered per kg b.w.). Rat liver DNA isolated via chromatin exhibited the very low values of 0.08 and 0.09 for E and E₂, respectively. The respective figures in hamster liver were 0.08 and 0.11 in females and 0.21 and 0.18 in the males. DNA isolated from the kidney revealed a detectable radioactivity only in the female, with values of 0.03 and 0.05 for E and E₂, respectively. The values for male hamster kidney were < 0.01 for both hormones. The minute radioactivity detectable in the DNA samples does not represent covalent binding to DNA, however, as indicated by two sets of control experiments. (A) Analysis by HPLC of the nucleosides prepared by enzyme digest of liver DNA isolated directly or via chromatin did not reveal any consistent peak which could have been attributed to a nucleoside-steroid adduct. (B) All DNA radioactivity could be due to protein contaminations, because the specific activity of chromatin protein was determined to be more than 3,000 times higher than of DNA. The high affinity of the hormone to protein was also demonstrated by in vitro incubations, where it could be shown that the specific activity of DNA and protein was essentially proportional to the concentration of radiolabelled hormone in the organ homogenate, regardless of whether the animal was treated or whether the hormone was added in vitro to the homogenate.Carcinogens acting by covalent DNA binding can be classified according to potency on the basis of the Covalent Binding Index. Values of 10³–10⁴ have been found for potent, 10² for moderate, and 1–10 for weak carcinogens. Since estrone is moderately carcinogenic for the kidney of the male hamster, a CBI of about 100 would be expected. The actually measured limit of detection of 0.01 places covalent DNA binding among the highly unlikely mechanisms of action. Similar considerations can be made for the liver where any true covalent DNA binding must be below a level of 0.01. It is concluded that an observable tumor induction by estrone or estradiol is unlikely to be due to DNA binding.Paper presented at the Satellite Symposium of the European Society of Toxicology, Rome, March 29, 1983     

Arsenic induced changes in growth development and apoptosis in neonatal and adult brain cells in vivo and in tissue culture

Arsenic at a nonlethal level in drinking water consumed over a period of time has been reported to produce chronic toxicity and various types of health problems ranging from skin cancer to disturbance in memory. Neurotoxic effects have been reported in clinical cases with chronic exposure to arsenic. Physiological detoxication of arsenic occurs partially through methylation. Arsenic and its methylated derivatives are distributed in different organs and systems. The present study examined the possible interference in the neuronal development and differentiation due to the exposure to arsenic during gestation. The experiments were carried out to examine short and long term effects of arsenic on brain explants and cells grown and maintained in tissue culture system. The effects of arsenic exposure showed changes in brain cell membrane function indicated by generation and release of reactive oxygen-nitrogen intermediates. On the morphological aspect the explants' growth was reduced, ground matrix was lost and neural networking was inhibited. Cells showed signs of apoptotic changes. Arsenic toxicity may induce damage to brain cells prior to more visible clinical conditions. The deleterious effects also pass from the maternal to fetal tissue across the transplacental barrier.     

Nicotine metabolism and urinary elimination in mouse: in vitro and in vivo

This study aimed at elucidating the in vivo metabolism of nicotine both with and without inhibitors of nicotine metabolism. Second, the role of mouse CYP2A5 in nicotine oxidation in vitro was studied as such information is needed to assess whether the mouse is a suitable model for studying chemical inhibitors of the human CYP2A6. The oxidation of nicotine to cotinine was measured and the ability of various inhibitors to modify this reaction was determined. Nicotine and various inhibitors were co-administered to CD2F1 mice, and nicotine and urinary levels of nicotine and four metabolites were determined. In mouse liver microsomes anti-CYP2A5 antibody and known chemical inhibitors of the CYP2A5 enzyme blocked cotinine formation by 85–100%, depending on the pre-treatment of the mice. The amount of trans-3-hydroxycotine was five times higher than cotinine N-oxide, and ten times higher than nicotine N-1-oxide and cotinine. Methoxsalen, an irreversible inhibitor of CYP2A5, significantly reduced the metabolic elimination of nicotine in vivo, but the reversible inhibitors had no effect. It is concluded that the metabolism of nicotine in mouse is very similar to that in man and, therefore, that the mouse is a suitable model for testing novel chemical inhibitors of human CYP2A6.     

Circulating nucleic acids in plasma and serum: roles in diagnosis and prognosis in diabetes and cancer

The presence of DNA and RNA circulating in human plasma and serum is described. The possible sources of the DNA/RNA in blood, their ability to enter other cells and to express in the recipient cells are discussed and the relationship with metastases considered. The possible role(s) of the DNA/RNA in clinical diagnosis, in monitoring treatment and in prognosis are considered for diabetes and oncology.     

SalB stimulates neurogenesis and angiogenesis in vitro and in vivo

Aims： Previous studies suggested that Salvianolic acid B （SalB） has strong protective effect against cerebral ischemia. Recently, Sal B has been reported to enhance angiogenesis in vitro. Based on the information above, in this study we are interested in the effect of SalB on neurogenesis and angiogenesis. Methods：In vitro study, we used embryonic mouse （El6） primary cortical neural cultures. Neuron was recognized by anti-MAP2 with immunocytochemistry. Neurogenesis was tested with BrdU incorporation by ELSA method. SalB（ 10 -6 -10 -8M） or vehicle was added to the culture medium 24 hrs before BrdU addition. In vivo, middle cerebral artery occlusion （MCAO） rats were used as focal cerebral ischemia model.     

Pharmacokinetic and pharmacogenetic determinants and considerations in chemotherapy selection and dosing in infants

INTRODUCTION: There is a lack of high-quality data regarding optimal chemotherapy dosage regimens among infants. Dosing regimens for chemotherapy during the first year of life are commonly based on empiric recommendations extrapolated from older children; however, balancing efficacy and toxicity is critical as severe adverse drug reactions may lead to treatment failure or reduced adherence to needed medications. AREAS COVERED: This review describes pharmacokinetic and pharmacogenetic considerations when administering chemotherapeutic agents to infants. Examples of commonly used agents are provided with practical recommendations for dosing adjustments. EXPERT OPINION: Optimal chemotherapy for children and infants in particular has lagged behind the remarkable progress in cancer treatment and it is clear that far more basic and clinical research are needed with respect to the mechanistic basis of age-dependent differences in pharmacokinetic parameters. More recent studies which have combined pharmacokinetic data with clinical toxicity and outcome data have resulted in a number of more evidence-based guidelines at least for the initial chemotherapy dosing; however, at present, the dosing of chemotherapy drugs in neonates and infants remains largely empiric.     

Consistency in catecholamine and cortisol excretion in males and females

Data from a series of experiments performed on 24 female and 24 male subjects were used to evaluate the consistency in urinary catecholamine and cortisol excretion. Data were available from 8 laboratory situations of varying activity level and content, spaced at intervals of maximum 3 months. Correlational analyses showed that for cortisol, interindividual consistency was higher for measures obtained on the same day than for measures obtained on different days. Interindividual consistency was generally high in catecholamine and cortisol excretion during non-stressful situations in both sexes. During experimental stress, however, consistency was as high as during nonstress for males, while it was lower for females. Analysis of variance components confirmed these results and showed that in males variation due to interindividual differences was high during both baseline and experimental-stress situations, while in females it was high during baseline situations only. During experimental stress, variation for females was due primarily to interaction. It is suggested that the males showed a more generalized stress response over situations than the females.     

Metabolic interaction between imipramine and carbamazepine in vivo and in vitro in rats

Summary The pharmacokinetic consequences of the combination of carbamazepine with imipramine in male Wistar rats have been investigated. It was found that a 2-week treatment with the combination resulted in the increase of the concentrations of the parent compounds and a simultaneous decrease in their metabolites in blood plasma i.e. carbamazepine inhibited imipramine demethylation in the side chain while imipramine inhibited carbamazepine 10,11-epoxidation. The velocity of imipramine 2-hydroxylation and 10,11-epoxy-carbamazepine hydration did not seem to be changed by the combination. On the basis of studies in vitro it is concluded that the observed metabolic interaction between carbamazepine and imipramine is due to the competition of the drugs for the active centre of cytochrome P 450 and to a certain qualitative alteration of the enzyme by imipramine as can be deducted from the decrease of carbamazepine binding to the cytochrome. Send offprint requests to K. J. Netter     

Nicotine metabolism and urinary elimination in mouse: in vitro and in vivo

This study aimed at elucidating the in vivo metabolism of nicotine both with and without inhibitors of nicotine metabolism. Second, the role of mouse CYP2A5 in nicotine oxidation in vitro was studied as such information is needed to assess whether the mouse is a suitable model for studying chemical inhibitors of the human CYP2A6. The oxidation of nicotine to cotinine was measured and the ability of various inhibitors to modify this reaction was determined. Nicotine and various inhibitors were co-administered to CD2F1 mice, and nicotine and urinary levels of nicotine and four metabolites were determined. In mouse liver microsomes anti-CYP2A5 antibody and known chemical inhibitors of the CYP2A5 enzyme blocked cotinine formation by 85-100%, depending on the pre-treatment of the mice. The amount of trans-3-hydroxycotine was five times higher than cotinine N-oxide, and ten times higher than nicotine N-1-oxide and cotinine. Methoxsalen, an irreversible inhibitor of CYP2A5, significantly reduced the metabolic elimination of nicotine in vivo, but the reversible inhibitors had no effect. It is concluded that the metabolism of nicotine in mouse is very similar to that in man and, therefore, that the mouse is a suitable model for testing novel chemical inhibitors of human CYP2A6.