肝硬化患者血清载脂蛋白水平的变化及临床意义

目的　观察肝硬化患者血清载脂蛋白Al(ApoAl)和B(ApoB)变化的意义。方法　选择肝硬化患者 80例 ,测定血清载脂蛋白Al、B及肝功能。结果　肝硬化患者血清ApoAl、ApoB水平明显低于对照组 (P <0 .0 0 1) ,且随着肝功能Child Pugh分级由A至C级降低而降低明显。结论　肝硬化患者血清ApoAl、ApoB水平显著降低 ,能较好地反映肝硬化患者肝功能损害的程度     

ICGR15在肝硬化断流术前评估肝脏储备功能的应用价值

目的 探讨吲哚菁绿试验15 min滞留率(ICGR15)在评估肝硬化断流术前肝脏储备功能的应用价值.方法 回顾性分析我院收治的75例肝硬化行断流术的患者,Child - Pugh A级患者55例,Child - Pugh B级患者20例.手术方式均为贲门周围血管离断术.对Child - Pugh A、B级两组患者术前测定的ICGR15及肝功能良好组和肝功能不全组间年龄、ALT、TBil、PT、Alb、ICGR15值、Child - Pugh评分进行比较,并应用ROC曲线评价ICGR15值的评估价值.结果 Child - Pugh A、B级两组ICGR15值分别为(17.98±12.12)％、(34.19 ±9.90)％,两组间差异具有统计学意义(P＜0.01);肝功能良好组和肝功能不全组间ICGR15值、Child - Pugh评分差异存在统计学意义(P＜0.01),年龄、ALT、TBil、PT、Alb差异无统计学意义(P＞0.01);ROC曲线下面积为0.971,差异有统计学意义(P =0.000).结论 ICGR15值是肝硬化断流术前评估肝脏储备功能较好的指标.     

拉米夫定治疗失代偿期乙型肝炎肝硬化的临床观察

目的　研究拉米夫定对失代偿期乙型肝炎肝硬化的临床疗效和安全性。方法　 2 8例乙型肝炎肝硬化患者给予拉米夫定 10 0mg/d口服 ,连用 2 4个月 ,设立对照组。在治疗开始前、治疗开始后 6个月、12个月和 2 4个月分别记录Child Pugh得分 ,并进行肝功能、肝纤维化标志物、HBV血清标志物以及血清HBVDNA定量检测。结果　 2 8例肝硬化患者拉米夫定治疗后 ,血浆白蛋白显著升高 ,血清丙氨酸转氨酶和胆红素明显降低 ,血清Ⅲ型前胶原、Ⅳ型胶厚、层粘连蛋白和透明质酸水平较治疗前显著降低 ,血清HBVDNA阴转率明显高于对照组 (P <0 .0 0 5 ) ,HBVDNA水平较治疗前显著降低。治疗组Child Pugh计分平均降低 2 .5 ,5 4.2 %患者提高了分级 (12例从B到A ,1例从C到B) ,而对照组仅有10 .5 %的患者Child Pugh分级得到了改善 ,治疗组显著高于对照组 (P <0 .0 1)。不良反应的发生率为 3 2 .1% (9/2 8)。结论　拉米夫定能使HBV复制指标阳性的活动性肝硬化患者的病毒复制受到抑制 ,肝功能改善 ,肝纤维化程度降低 ,病情缓解。应用拉米夫定治疗肝硬化患者安全可靠。     

肝硬化患者血尿酸水平的变化及其意义

目的 :探讨肝硬化患者血尿酸 (UA)水平的变化及其意义。方法 :回顾性分析我院肝硬化住院患者 (摒除患有可能影响UA代谢的疾病或服用影响UA代谢的药物的患者 ) 4 2例作为研究对象。分析其UA水平的变化及UA与多种可能影响因素如年龄、性别、腹水、肝功能分级、血肌酐 (Cr)、血直接胆红素 (D BIL)等的关系。同时按上述标准选取年龄、性别无差异的对照者 42例。结果 :UA值不存在年龄、性别的差异 (P >0 .0 5 )。总UA均值为 2 2 8.2 8± 13 6.83 μmol/L ,明显低于对照组 (P <0 .0 1) ;D BIL均值为 3 1.83± 46.0 1μmol/L ,显著高于对照组 (P <0 .0 1) ;Cr均值为 90 .41±83 .43mmol/L ,与对照组差异无显著性 (P >0 .0 5 ) ;Pugh Child分级分数均值为8.86± 2 .3 1,明显高于对照组 (P <0 .0 1)。UA正常 2 8例 ,降低 12例 ,升高 2例。UA正常组与其余 2组间UA值有显著性差异 (P <0 .0 1) ,UA降低组与正常组间D BILPugh Child分级分数有显著性差异 (P各 <0 .0 5与 <0 .0 1) ,而三组间年龄、Cr均值无显著性差异 (P >0 .0 5 )。Pugh Child分级C级患者的UA值明显低于A级的患者 (P <0 .0 5 ) ;有腹水与无腹水组间的UA值无显著性差异 (P >0 .0 5 )。多因素相关分析表明UA与年龄、D BIL、Cr及Pugh Child分级分数均无     

肝硬化患者血清维生素C水平与活性氧代谢的关系

目的　探讨肝硬化患者血清维生素C水平变化及其与活性氧代谢的关系。方法　　对 58例肝硬化患者和 30名健康人进行血清维生素C水平与活性氧的测定和分析。测定血清维生素C水平并采用化学比色法测定血浆丙二醛 (MDA)、超氧化物歧化酶 (SOD)、谷胱甘肽过氧化物酶 (GSH Px)含量。结果　肝硬化组血清维生素C水平显著低于对照组 (P <0 .0 1 ) ;根据肝功能Child Pugh分级 ,血清维生素C水平C级、B级 相似文献   

肝硬化患者肠黏膜通透性与Child—Pugh分级的相关性研究

目的探讨肝硬化患者肠黏膜通透性（IP）与Child—Pugh分级的相关性及肠道去污剂对肝硬化患者肠道屏障功能及肝功能状态的影响。方法按Child—Pugh分级标准将76例肝硬化患者分为A、B、C3组,并选择30例体检者作为对照组,采用高压液相色谱法检测各组患者尿液乳果糖／甘露醇排出比（L／M）;给予76例肝硬化患者选择性肠道去污剂,比较用药前后各组患者肝功能Child—Pugh分级和肠黏膜通透性。结果肝硬化患者尿乳果N／甘露醇排出比明显高于对照组（0．208±0．025vs0．057±0．019）,肝硬化患者按Child。Pugh分级各组尿乳果糖／甘露醇排出比也均明显高于对照组,差异有显著性（P〈0．01）;采用Spearman等级相关分析发现,肝功能Child—Pu巾评分与乳果糖／甘露醇排出比呈正相关（r=0．658,P〈0．05）;给予肠道去污药物2周后肝硬化Child-Pugh分级各组患者尿液乳果糖／甘露醇排出比与治疗前比较均明显下降（P〈0．05）,各组Child—Pugh评分均有改善。结论肝硬化患者的肠黏膜通透性与肝功能Child—Pugh评分呈正相关,即肠道通透性随肝功能下降而升高,肠黏膜通透性对于肝硬化患者的诊断和治疗有临床意义。     

13C-美沙西丁呼气试验对亚临床肝性脑病的临床价值分析

目的探讨13C-美沙西丁呼气试验对亚临床肝性脑病(SHE)发病率和预后判断等方面的临床应用价值.方法随机选择72例肝硬化患者和31例正常人作为研究对象,对所有受试者进行数字连接试验和智商(IQ)检测,以明确有无SHE,并同步进行13C-美沙西丁呼气试验、血氨等检测.比较13C-美沙西丁呼气试验的肝功能分级与临床Child Pugh分级的关系;采用多因素相关分析,比较13C-美沙西丁呼气试验的分级指标、血氨指标对并发SHE的关系;随访所有肝硬化患者的13C-美沙西丁呼气试验分级结果与SHE的关系.结果肝硬化患者13C-美沙西丁呼气试验的肝功能分级与临床Child Pugh分级的差别无统计学意义(P＞0.05).13C-美沙西丁呼气试验分级为病理性肝损害、Child Pugh A级的两组肝硬化患者中无SHE,SHE患者均出现在13C-美沙西丁呼气试验分级为Child B级或Child C级且血氨值为(90.56±13.66)μmol/L或更高的患者中.在肝硬化患者13C-美沙西丁呼气试验的肝功能分级中,Child C级中SHE的发病率高于Child B级(P＜0.05).随访发现,13C-美沙西丁呼气试验为Child B级和Child C级患者存在并发SHE的危险.结论13C-美沙西丁呼气试验可作为SHE发病的重要评判因素之一并有助于对肝硬化并发SHE的预后判断.     

肝炎肝硬化患者血浆D-乳酸、二胺氧化酶和内毒素的检测及其临床意义

目的　探讨血D 乳酸、二胺氧化酶 (DAO)和内毒素水平在肝炎肝硬化患者中的变化及其临床意义。方法　将 5 0例肝炎肝硬化患者和 3 0例健康体检者分为试验组和对照组 ,采用分光光度法检测外周血中D 乳酸、DAO和内毒素的活性。结果　肝炎肝硬化患者试验组D 乳酸活性明显高于对照组 (P <0 .0 1) ,试验组 3组间比较差异有显著性 (P <0 .0 1) ,治疗后显著低于治疗前 (P <0 .0 1) ;试验组DAO活性明显高于对照组 ,组间比较Child PughC级组活性明显低于Child PughB级组 (P <0 .0 1) ,治疗后A级组及B级组水平显著低于治疗前 (P <0 .0 5 ) ,C级组水平显著高于治疗前 (P <0 .0 5 ) ;Child PughA级组内毒素活性与对照组比较差异显著性 (P >0 .0 5 ) ,Child PughB、C级组明显高于对照组 (P <0 .0 1) ,治疗后A、B级组水平与治疗前比较差异无显著性 (P >0 .0 5 ) ,C级组水平显著降低 (P <0 .0 1)。相关分析显示 3者水平均相关。结论　血浆D 乳酸、DAO水平是肠粘膜损伤早期诊断的敏感指标 ,内毒素血症是肝硬化患者病情加重的重要因素     

血清甲状腺素检测对肝硬化患者的临床意义

目的：探讨肝硬化患者血清甲状腺激素水平的变化及其临床意义。方法：回顾分析经相关检查确诊的肝硬化患者125例。根据肝功能Child—Pugh分级分为A级、B级、C级3组,36例健康体检者为对照组,分别分析其游离三碘甲状腺原氨酸（F13）、游离甲状腺素（FT4）水平,并结合肝功能分级进行比较。结果：肝硬化患者血清FT3、FT4水平显著低于健康对照组（P〈0．01）,肝功能Child-Pugh B级组患者血清FT3、FT4水平显著低于A级组患者（P〈0．05）,肝功能Child-PushC级组患者血清FF3、FT4水平显著低于B级组患者（P〈0．01）。结论：肝硬化患者进行血清甲状腺素水平的检测有助于判断其病情严重程度及预后。     

肝硬化住院患者Child-Pugh分级与血钙浓度分析

肝硬化患者多伴有水及电解质代谢紊乱 ,其中低钙血症较为常见 ,临床上大多因症状表现不明显而易被忽视 ,然而长期低钙血症可导致骨质疏松等并发症的出现[1] ,严重影响患者的生存质量。本研究旨在调查分析肝硬化住院患者肝功能Child Pugh分级与血钙浓度的关系 ,以期为肝硬化患者低钙血症的防治提供参考。资料与方法一、临床资料研究对象为 2 0 0 2年 9～ 12月期间的 5 1例乙型肝炎肝硬化住院患者 ,其中男 3 2例 ,女 19例 ,平均年龄 ( 4 8.4± 9.8)岁 ;按肝功能Child Pugh分级标准 ,A级 13例 ,B级 17例 ,C级 2 1例。研究对象诊断均符合 199…     

Importance of glucagon in the control of futile cycling as studied in alloxan-diabetic dogs

Summary In order to determine the role of glucagon in futile or substrate cycling in diabetes, we measured tracer determined glucose kinetics during a combined infusion of 2-³H-glucose (total glucose production) and 6-³H-glucose (glucose production) in six alloxan-diabetic dogs. The animals received either a 420 min infusion of (1) somatostatin alone (0.3 g·kg^–1· min^–1), (2) somatostatin with insulin replacement (100 U·kg^–1min^–1) or (3) glucagon (6 ng·kg^–1· min^–1) together with somatostatin and transient insulin replacement. When somatostatin was given alone, plasma glucagon (p<0.004) and insulin (p<0.0001) were suppressed. Glucose production and disappearance and plasma glucose concentrations fell (p<0.0001), but the metabolic clearance of glucose did not change significantly. In the basal state, futile cycling comprised 29±4%, 33±4% and 33±3% of total glucose production in the three goups of studies, which is high compared to normal dogs. The absolute rate of futile cycling fell slightly but significantly from 10.0±1.7 to 8.3±1.7 mol·kg·^–1min^–1 (p<0.0008). When insulin replacement was given during somatostatin infusion to correct for the small somatostatin-induced insulin suppression, there were similar changes in plasma glucagon, glucose concentrations and glucose kinetics as seen during the infusion of somatostatin alone. Futile cycling decreased to a slightly greater extent from 12.8±2.8 to 9.5±1.7mol·kg^–1·min.^–1 (p<0.02). When glucagon was infused together with somatostatin and insulin replacement, plasma glucagon (p<0.0002) increased and plasma glucose levels rose (p<0.001) due to a transient increase in glucose production. Metabolic clearance of glucose did not change significantly. There was a marked increase in futile cycling from 12.2±1.7 to 21.7±1.7mol· kg^–1·min^–1 (p<0.0001) in response to exogenous glucagon excess. There was a slight (p<0.01) drop in free fatty acid levels with somatostatin. Free fatty acid levels nearly doubled (p<0.025) with the infusion of glucagon together with somatostatin. In conclusion, (a) futile cycling was increased in alloxan-diabetic dogs; (b) glucagon suppression can suppress futile cycling only if total insulin deficiency is prevented; and (3) hyperglucagonaemia increases futile cycling, and this effect is more pronounced during insulin deficiency.     

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.     

糖调节受损的危害与干预

糖调节受损是糖尿病重要的前期阶段,可能发展为糖尿病并形成大血管病变,也可能逆转为正常葡萄糖状态.因此,积极的干预治疗是十分重要的.生活方式的干预与药物治疗可以延缓或避免糖尿病的发生,而且生活方式的改变比药物更为有效.     

No-Coding Strategies for Glucose Monitors: ��No Coding�� of Glucose Test Strips: A Roche Perspective

Introduction

Glucose test strips vary slightly from batch to batch. These variations are accounted for by a batch-specific “code”: a set of parameters defining the relationship between the signal change induced on the glucose test strip and the blood glucose concentration.

Methods

We assessed the impact on accuracy of miscoding the ACCU-CHEK^® Aviva system across a wide range of glucose test strip batches and glucose levels, throughout the shelf life of the glucose test strips.

Results

The deviations in coding that we investigated had no effect on clinical action. Additionally, we showed, with mathematical modeling of a worst-case scenario, that the probability of an error altering clinical action is low. The batch-specific code of glucose test strips ensures the accuracy and safety of each blood glucose measurement. In addition to the parameters directly related to the blood glucose measurement, the electronic code chip contains the expiration date of the test strips and can deliver firmware updates for upgrades to the glucose meter.

Conclusions

We eliminated the handling step of coding and retained all the advantages of coding. In Roche''s newest all-in-one glucose meter, the ACCU-CHEK Compact Plus system, the batch-specific code is integrated into the drum that contains the glucose test strips. As a result, changing the drum containing the glucose test strips automatically changes the glucose test strip code. Patients with diabetes who use the ACCU-CHEK Compact Plus glucose meter do not have to be concerned with coding.     

中老年糖尿病流行病学调查方法探讨

对９１７例４０岁以上健康人利用６种方法同时进行糖尿病（ＤＭ）流行病学调查。按ＷＨＯ标准初筛出ＤＭ９４例，糖耐量异常（ＩＧＴ）９２例。方法①ＦＰＧ≥７．８ｍｍｏｌ／Ｌ；②ＦＰＧ≥６．７ｍｍｏｌ／Ｌ；③餐后２ｈ血糖≥１１．１ｍｍｏｌ／Ｌ；④空腹尿糖≥＋；⑤餐后２ｈ尿糖≥；⑥餐后２ｈ尿糖≥和（或）ＦＰＧ≥６．７ｍｍｏｌ／Ｌ并联阳性。结果①④法特异度高，灵敏度低，只查出ＤＭ１／３许。②⑤法灵敏度也低。③法灵敏度９８．１％，特异性１００％，但大规模健康普查时就要抽两次静脉血，难以做到。⑥法灵敏度８０．４％，特异性９４．０％，仅次于③法，操作与普查同步，可作为健康普查时早期诊断Ⅱ型ＤＭ初筛；即对普查时血尿化验不够ＤＭ标准而餐后２ｈ尿糖≥或ＦＰＧ≥６．７ｍｍｏｌ／Ｌ的可疑患者再进行餐后２ｈ血糖或ＯＧＴＴ确诊ＤＭ或ＩＧＴ，为大规模防治ＤＭ打下基础。     

血糖及其他体液葡萄糖测定进展

本文从糖尿病医患角度介绍血糖测定的进展。主要从血浆糖测定到毛细血管全血糖测定，以及近年的微创组织液糖测定及无创糖测定。较详细地讨论了毛细血管全血糖测定的特点和误差的原因。     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

Methodology for Quantifying Fasting Glucose Homeostasis in Type 2 Diabetes: Observed Variability and Lability

Background:

Increased glycemic variability is associated with an increase risk of adverse clinical outcomes in diabetes. Central to the understanding of diabetes is glucose homeostasis. “Good” homeostasis is equated to low glycemic variability, and “poor” homeostasis is linked to greater glycemic variability. We have, therefore, developed a method with the aim to objectively quantify the domain of glucose–insulin homeostasis. We have termed this method as Observed Variability And Lability (OVAL).

Method:

Blood samples for the measurement of glucose and insulin concentrations were acquired every 2 min for 120 min from 12 patients with type 2 diabetes mellitus [T2DM; median (range) age 35 (25–47) years and duration of diabetes 7 (2–9) years receiving oral hypoglycemic treatment] and 27 controls [aged 38(30–53) years] with an equal split of genders and equal distribution of body mass indexes. The insulin–glucose time variant data form the boundaries of OVAL, defined as the ellipse enclosing the 95% confidence intervals of the insulin and glucose concentrations plotted on an x−y scatter graph and normalized to ensure equal weighting of insulin and glucose.

Results:

Less precise OVAL homeostasis was observed in subjects with T2DM, by a factor of 4, in comparison with controls [OVAL, T2DM 7.8(3.8) versus controls 1.9(1.0); p =.0003]. The assessment remained statistically robust (p <.001) with increased sampling intervals up to 8 min.

Conclusion:

The OVAL model is a robust method for measuring glucose–insulin homeostasis in controls and T2DM subjects (available online at http://www.oval-calc.co.uk). Deranged glucose–insulin homeostasis is the hallmark of diabetes and OVAL has the capacity to quantify in the fasting state.     

Performance of the Prototype NovioSense Noninvasive Biosensor for Tear Glucose in Type 1 Diabetes

Introduction:We recently published the results of a pilot study measuring glucose in tear fluid. We now show the results of an additional 24 patients.Methods:Twenty-four subjects were recruited from Haaglanden Diabetes Centre. The patients reported in a fasting state and were given a meal with half the usual dose of insulin during the test. The device was applied under the lower eyelid. Glucose levels from capillary blood and interstitial fluid with a flash glucose measurement device were recorded every 15 minutes; the current from the tear glucose sensor was recorded continuously. The eye surface and tolerability were regularly checked. A calibration algorithm to convert tear glucose to blood values was built using a neural network regression model and validated.Results:No adverse events were attributed to the sensor coil placed under the lower eyelid. The mean absolute relative difference for the 24-patient subset was 16.7 (after 6 hours total time in the eye). The median absolute relative difference was 13.3. Compared to published data from Abbott (15.7 on day 1), the present device is comparable to Libre, considering that the device was allowed only one hour of equilibration time before the measurements were made.Conclusion:The NovioSense Tear glucose sensor measures blood glucose values with an acceptable accuracy and may become a good alternative to invasive devices.