卡格列净对超重及肥胖2型糖尿病患者骨代谢指标的影响

目的观察钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)卡格列净对超重及肥胖的2型糖尿病(T2DM)患者骨转换标志物的影响。方法选取2019年10月9日至2020年12月28日住院的42例超重及肥胖T2DM患者, 随机分为实验组(n=18)和对照组(n=24), 实验组应用卡格列净联合其他类降糖药物, 对照组应用非SGLT-2i类降糖药物, 比较两组治疗前及治疗24周后血清Ⅰ型胶原N端前肽(PINP)及Ⅰ型胶原C末端肽交联(β-CTX)的变化。结果治疗后两组比较, PINP无显著差异, 实验组β-CTX水平低于对照组(P<0.05)。结论应用卡格列净对超重及肥胖T2DM患者骨形成无明显影响, 可能对骨吸收有一定抑制作用。     

吡格列酮对不稳定型心绞痛合并糖尿病患者内皮祖细胞数量及脂联素水平的影响

目的探讨吡格列酮对不稳定型心绞痛(UAP)合并2型糖尿病患者内皮祖细胞(EPCs)数量及脂联素水平的影响。方法入选自2010年6月至2011年5月在湖北医药学院附属太和医院住院的有UAP合并2型糖尿病患者57例,随机分为吡格列酮组(n=28)和对照组(n=29),吡格列酮组应用吡格列酮(30 mg/d)治疗,对照组患者不使用噻唑烷二酮类药物。治疗前及治疗12周时通过流式细胞技术双色分析法检测所有患者外周血中EPCs占有核细胞的百分比,其中EPCs用CD34+/KDR+双标记定位,比较两组患者在干预前后内皮祖细胞数量的变化及血清脂联素水平的变化。结果两组患者在治疗前EPCs的数量无统计学差异(P0.05)。治疗12周时,吡格列酮组患者EPCs数量较治疗前明显增加(0.023±0.010 vs.0.051±0.012,P0.01);对照组患者EPCs数量在治疗前后无统计学差异(P0.05);12周时,吡格列酮组患者EPCs数量高于对照组患者(P0.028)。吡格列酮组血清脂联素水平在治疗前、后有统计学差异(P0.05);对照组患者血脂联素水平在治疗前、后无统计学差异(P0.05);12周时,吡格列酮组患者血清脂联素水平高于对照组患者(P0.05)。结论吡格列酮能够促进冠心病合并糖尿病患者EPCs的动员,提高患者血清脂联素水平。     

老年骨质疏松性椎体压缩性骨折病人骨转换标志物的早期变化

目的 探究老年骨质疏松性椎体压缩性骨折(OVCF)病人骨转换标志物水平的早期变化情况。方法 选取我院35例老年OVCF病人作为研究组,另选择同期35例老年健康体检者作为对照组,比较2组临床资料、血清Ⅰ型前胶原氨基末端前肽(PINP)、Ⅰ型胶原交联羧基末端肽(CTX)、25羟维生素D[25(OH)D]水平以及双能X线骨密度,并比较研究组不同性别、年龄、椎体骨折数量病人骨折后第1、2、3、6、8、12周血清PINP、CTX、25(OH)D水平,骨折后第1、12周骨密度的差异,分析骨折后第1周各指标与病人性别、年龄、椎体骨折数量的相关性。结果 研究组入院时血清PINP、CTX、25(OH)D水平及骨密度均低于对照组(P<0.05)。研究组中,不同性别病人第2、3、6、8、12周血清PINP、CTX、25(OH)D水平均较骨折后第1周明显升高(P<0.05);女性病人骨折后第1周血清PINP、CTX、25(OH)D水平及骨密度,骨折后第12周骨密度均低于男性(P<0.05)。>80岁、70～80岁病人第2、3、6、8、12周血清PINP、CTX、25(OH)D水平均较骨...     

吡格列酮对2型糖尿病患者血清脂联素的影响及其意义

目的 探讨吡格列酮对2型糖尿病(T2DM)患者血清脂联素水平影响.方法 用ELISA法检测67例T2DM患者和52例非糖尿病对照组的血清脂联素水平,用随机双盲法比较47例T2DM患者用安慰剂和吡格列酮干预治疗8 w后的血清脂联素、血糖、胰岛素抵抗(IR)水平.结果 T2DM患者组与对照组比较,血清脂联素水平降低(P<0.05);应用吡格列酮治疗后,患者血清脂联素水平显著升高(P<0.05),血糖降低(P<0.05),IR明显改善,而常规组治疗前后无显著性差异(P>0.05).结论 吡格列酮能提高2型糖尿病患者血清脂联素水平,降低血糖水平及改善胰岛素抵抗.     

吡格列酮对2型糖尿病并发心血管病患者血清脂联素与胰岛素抵抗的影响

目的探讨吡格列酮对2型糖尿病并发心血管病患者血清脂联素与胰岛素抵抗(IR)的影响。方法随机选取2型糖尿病合并冠心病患者60例,正常对照组30例。分别检测血清脂联素、瘦素、肿瘤坏死因子(TNF-α)、游离脂肪酸(FFA)、空腹血糖(FPG)和胰岛素、体重指数(BMI)、血压(BP)、总胆固醇(TC)、甘油三酯(TG)等指标,计算胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR)。再将60例2型糖尿病并发心血管病患者分成2组,吡格列酮治疗组32例,常规治疗组28例,吡格列酮治疗组用吡格列酮治疗8w,治疗前后均检上述指标。结果(1)2型糖尿病合并冠心病患者与对照组比较,血清脂联素水平降低(P<0.01),吡格列酮治疗组与常规治疗组比较,血清脂联素无差异(P>0.05);(2)应用吡格列酮治疗后,患者血清脂联素水平显著升高(P<0.01),TNF-α、FFA、胰岛素水平下降(P<0.01),IR明显改善。结论吡格列酮能增加2型糖尿病并发心血管病患者血清脂联素水平,改善IR。     

吡格列酮对2型糖尿病患者血浆纤溶酶原激活抑制物及血清肿瘤坏死因子-α表达的影响

目的观察2型糖尿病(DM)血浆纤溶酶原激活抑制物 (PAI)、血清肿瘤坏死因子-α(TNF-α)在糖尿病血管病变中的作用以及吡格列酮对其潜在的改善作用.方法 2型糖尿病患者54例,正常对照组35例,其中DM组又随机分为吡格列酮组(30例)和一般治疗组(24例),分别给予磺脲类 双胍类 吡格列酮与磺脲类 双胍类 安慰剂治疗12周,用ELISA法分别检测正常对照组以及DM组治疗前后PAI、TNF-α的改变.结果 DM组PAI、TNF-α水平均显著高于正常对照组(P＜0.05),吡格列酮治疗12周后,甘油三脂、PAI、TNF-α均有显著性下降(P＜0.05),而HDL,胰岛素敏感指数上升.结论 2型糖尿病患者PAI、TNF-α表达明显增加,吡格列酮除明显降低血糖,调节血脂紊乱,增加胰岛素敏感性作用外,能够降低PAI、TNF-α等心血管危险因素.     

绝经后女性2型糖尿病患者骨转换指标与骨量的相关性分析

目的探讨绝经后女性2型糖尿病患者骨转换指标与骨量的变化,以及二者的相关性。方法将绝经后女性2型糖尿病患者78例作为研究对象,根据骨质疏松症分级标准将研究对象分为骨量正常组(19例),低骨量组(27例)和骨质疏松组(32例),检测血清25-(OH)D3、I型前胶原氨基末端(N端)前肽(PINP)、Ⅰ型前胶原氨基末端(C端)前肽(PICP)和骨钙素(N-MID)水平以及腰椎、髋骨的骨密度水平。结果低骨量组患者血清PINP、PICP和N-MID水平高于骨量正常组,血清25-(OH)D3水平以及腰椎、髋骨骨密度低于骨量正常组,骨质疏松组患者血清PINP、PICP和NMID水平高于其他两组,血清25-(OH)D3水平以及腰椎、髋骨骨密度低于其他两组,差异有统计学意义(P0.05);研究对象血清25-(OH)D3与腰椎、髋骨骨密度呈明显正相关,血清PINP、PICP、N-MID与腰椎、髋骨骨密度均呈明显负相关,差异有统计学意义(P0.05)。结论绝经后女性2型糖尿病患者25-(OH)D3、PINP、PICP和N-MID等骨转换指标与骨量变化存在密切关系,可反映机体骨代谢情况。     

吡格列酮和二甲双胍对2型糖尿病胰岛素抵抗的影响

目的　观察吡格列酮和二甲双胍治疗对 2型糖尿病患者胰岛素抵抗 (IR)的影响。方法 5 0例血糖控制不良的 2型糖尿病患者在原治疗方案下 ,随机给予盐酸吡格列酮片 3 0mg(2片 ) 1次 /日和模拟二甲双胍片 (1片 ) 2次 /日 ,即吡格列酮组 ;或随机给予盐酸二甲双胍片 5 0 0mg(1片 ) 2次 /日和模拟吡格列酮片 (2片 ) 1次 /日 ,即二甲双胍组 ,所有治疗疗程 12周。结果　在两组患者取得相当降糖疗效基础上 ,二甲双胍组和吡格列酮组在治疗后空腹和馒头餐后C肽水平均较用药前有明显降低、IR稍有降低 ,β细胞功能明显改善。吡格列酮在减低餐后胰岛素、改善IR方面优于二甲双胍。两种药物治疗前后血游离脂肪酸水平则差异未见显著性。结论　吡格列酮和二甲双胍均能有效地降低IR和改善 β细胞功能。在改善IR方面 ,吡格列酮稍优于二甲双胍。     

吡格列酮治疗对2型糖尿病患者血清游离脂肪酸成分的影响

采用反相高效液相色谱法测定25例2型糖尿病患者和25例健康对照者空腹血清游离脂肪酸(FFA)的主要成分,并比较吡格列酮治疗前、治疗后3个月和1年FFA各成分水平的改变,发现2型糖尿病患者血清中月桂酸、豆蔻酸和硬脂酸的水平比对照组明显升高,吡格列酮治疗可以降低2型糖尿病患者上述脂肪酸的水平.     

吡格列酮对2型糖尿病患者血清视黄醇结合蛋白4和网膜素1的影响

目的 观察吡格列酮对2型糖尿病患者血清视黄醇结合蛋白4(RBP4)和网膜素1的影响.方法 选择80例新诊断2型糖尿病患者,随机分为对照组和吡格列酮组,每组40例,治疗3个月.比较两组患者治疗前后空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)及血清BBP4和网膜素1的水平变化.结果 与对照组比较,吡格列酮组治疗后FPG和HOMA-IR明显降低(P＜0.05),血清RBP4水平也明显降低(P＜0.01),而网膜素1水平明显升高(P＜0.01).Pearson相关分析显示,RBP4与FPG、体质指数及HOMA-IR呈正相关,与低密度脂蛋白呈负相关(P＜0.05);网膜素1与低密度脂蛋白呈正相关,与FPG、体质指数及HOMA-IR呈负相关(P＜0.05).结论 吡格列酮可能通过调节血清RBP4和网膜素1水平而改善胰岛素抵抗.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.