初诊2型糖尿病胰岛素泵强化治疗的现状

2型糖尿病是一种慢性进展性疾病,其发病的中心环节是胰岛β细胞功能缺陷和胰岛素抵抗。初诊2型糖尿病患者早期予胰岛素泵强化治疗,模拟生理性胰岛素分泌方式,可良好控制血糖,改善第一时相分泌,促进胰岛β细胞功能的修复,减轻胰岛素抵抗,延缓糖尿病微血管和大血管并发症的进展。早期胰岛素泵强化治疗有利于糖尿病的治疗及预后。     

2型糖尿病患者在短期胰岛素强化治疗下的胰岛素分泌变化

目的:通过短期胰岛素强化治疗手段,分析2型糖尿病患者的胰岛β功能在治疗前后的变化,旨在进一步提高与优化2型糖尿的临床效果与质量。方法:从本院自2013年9月到2014年8月收治的2型糖尿病的患者中选取80例患者作为本次治疗研究对象,以15天为治疗周期,对患者采取胰岛素强化治疗措施,并以高葡萄糖钳夹技术对患者治疗前后的胰岛β细胞功能进行评估。结果:80例糖尿病患者患者经过本次短期胰岛素强化治疗后胰岛β细胞功能都有所改善,在治疗前,2型糖尿病患者的第一时相胰岛素分泌为93±11mU/L,第二时相胰岛素分泌为32±10mU/L,最大时相胰岛素分泌为38±13mU/L,与正常人胰岛素分泌水平相比处于明显偏低的状态,但经本次短期胰岛素强化治疗后,患者的第一、第二以及最大时相的胰岛素分泌分别提升至129±31mU/L、57±11mU/L、48±9mU/L,治疗后患者胰岛素分泌水平与治疗前相比都取得较为显著的提高,具有统计学意义(P0.05)。结论:短期胰岛素强化治疗在临床应用过程中能够对2型糖尿病患者的胰岛β细胞功能产生一定的改善效果,让患者不同时相胰岛素分泌水平有所提高,值得在临床应用中大范围推广。     

短期胰岛素泵强化治疗对新诊断2型糖尿病胰岛素第一时相分泌的影响

目的 通过观察新诊断2型糖尿病患者接受持续性皮下胰岛素输注(CSII)治疗前后,了解胰岛β-细胞对血糖刺激后的胰岛素第一时相分泌的变化 方法 新诊断的2型糖尿病患者接受两周CSII治疗,治疗前后均测IVGTT各点胰岛素 结果 治疗前后AIR有显著性差异（p<0.05） 结论 新诊断的2型糖尿病患者短期应用CSII,可以恢复或部分恢复糖刺激的胰岛素第一时相分泌。     

短期胰岛素强化治疗改善初诊2型糖尿病患者胰岛β细胞功能

目的观察短期胰岛素强化治疗对初诊2型糖尿病患者胰岛β细胞功能和血糖控制的影响.方法对初诊2型糖尿病患者用静脉葡萄糖耐量试验(IVGTT)和精氨酸刺激试验两种方法检测β细胞功能后,给予2周的胰岛素强化治疗(采用每日多次皮下注射胰岛素法).比较治疗前后血糖、胰岛β细胞对葡萄糖和精氨酸刺激的胰岛素第一时相分泌的变化、空腹胰岛素与空腹血糖比值(FINS/FPG)、Homa-β、Homa-IR和胰岛素敏感指数(ISI).结果 25例纳入研究,18例完成.治疗结束时,所有患者血糖均达到理想控制,空腹和餐后2h血糖较治疗前明显降低(P<0.001).静脉葡萄糖耐量试验胰岛素第一时相分泌、曲线下面积(AUC)、Homa-β和FINS/FPG治疗后有明显升高(P<0.05).反映胰岛素抵抗的Homa-IR治疗后明显下降,ISI明显升高(P<0.05).精氨酸刺激试验胰岛素第一时相分泌无明显变化(P=0.7).随访3个月时,4例患者仅靠饮食和运动血糖控制满意,其余患者均需加用降糖药物才能使血糖达到良好控制.结论对早期2型糖尿病患者进行短期胰岛素强化治疗可以快速控制高血糖,改善葡萄糖刺激的胰岛素第一时相分泌,但对精氨酸刺激的胰岛素第一时相分泌无影响.     

瑞格列奈对初诊2型糖尿病患者血糖及第一时相胰岛素分泌的影响

目的 探讨瑞格列奈的降糖作用及对2型糖尿病胰岛β细胞功能的影响.方法 35例初诊2型糖尿病患者服用瑞格列奈治疗16周,治疗前及停药后测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG),并于次日行静脉葡萄糖耐量-胰岛素释放试验(IVG-IRT),测定第一时相胰岛素分泌水平,计算基础胰岛素分泌功能指数(HOMA-β)、第一时相胰岛素曲线下面积(AUCINS0～10 min)、急性胰岛素反应(AIR)等.结果 35例初诊2型糖尿病患者,瑞格列奈治疗16周后,FPG、2 h PG、HbA1c均较基线显著降低(P<0.01),HOMA-β、AUCINS0～10 min及 AIR 均明显增加(均P<0.01).结论 瑞格列奈能明显改善初诊2型糖尿病患者的血糖及胰岛β细胞功能,急性胰岛素反应也可得到一定恢复.     

两种不同治疗方法对初诊2型糖尿病患者胰岛β细胞功能的影响

近年来的研究表明,在2型糖尿病自然病程的早期即有β细胞功能的改变.而胰腺β细胞功能的逐渐减退又使糖尿病病情逐渐加重.因此,保护β细胞功能与防止糖尿病进展的研究已成为近年来糖尿病研究的热点.近年来有研究显示,短期胰岛素强化治疗可以恢复代表胰岛β细胞功能的血糖刺激的胰岛素第一时相分泌,使患者的糖尿病回到2型糖尿病自然病程的更早期阶段[1].本研究的目的是通过观察两种不同治疗方案对初诊2型糖尿病患者胰腺β细胞功能的影响,为临床治疗方法的选择提供依据.     

血糖控制对初诊2型糖尿病患者胰岛β细胞功能的影响

目的:探讨短期持续皮下胰岛素输注(CSII)治疗对初诊2型糖尿病(T2DM)患者的降糖效果和胰岛β细胞功能的影响。方法:对30例初诊T2DM患者进行为期2周的CSII强化治疗,分析比较治疗前后空腹(FPG)及餐后2h血糖(2hPG)、静脉葡萄糖耐量试验时第一时相胰岛素及C肽分泌、△I30/△G30和由Homa模型计算的Homaβ、HomaIR。结果:CSII强化治疗显示出快速稳定的降血糖效果。葡萄糖刺激后第一时相胰岛素和C肽的分泌、△I30/△G30和Homaβ均较治疗前明显升高(P<0.01)。HomaIR较治疗前明显下降(P<0.01)。结论:短期CSII强化治疗可显著改善初诊T2DM患者胰岛β细胞功能。     

胰岛素强化治疗对不同时期2型糖尿病患者胰岛β细胞功能的影响

目的 观察胰岛素强化治疗对不同时期2型糖尿病患者胰岛β细胞功能的影响。方法 选择20例初诊2型糖尿病患者,23例磺脲类药物（SU）治疗有效及17例磺脲类药物（SU）继发失效的2型糖尿病患者,对所有入组患者进行基础-餐时量模式胰岛素强化治疗2周,比较三组患者治疗前后胰岛β细胞功能指标的变化。以口服葡萄糖耐量试验（OGTT）30min内C肽曲线下面积（AUCCP30）及120min内C肽曲线下面积（AUCCP120）分别反映胰岛素分泌第一时相变化及总量。结果 胰岛素强化治疗后,三组患者胰岛β细胞功能指标AUCCP30、AUCCP120均有不同程度的升高,差异均有统计学意义(P<0.05)。结论 短期胰岛素强化治疗能改善不同时期2型糖尿病患者胰岛β细胞功能,尤初诊2型糖尿病患者改善更明显,从而强调胰岛素强化治疗应作为2型糖尿病的早期治疗方法。     

胰岛素持续皮下输注对新诊断2型糖尿病患者胰岛β细胞功能影响的研究

目的探讨应用胰岛素泵持续皮下输注胰岛素强化治疗对新诊断2型糖尿病(T2DM)患者胰岛β细胞功能的影响。方法对32例新诊断T2DM患者进行为期11±4天的胰岛素泵输注胰岛素强化治疗,分析比较患者治疗前后空腹胰岛素、早时相胰岛素分泌指数、HOMA模型胰岛素分泌指数及胰岛素抵抗指数的变化。结果治疗前后空腹胰岛素水平差异无显著性;早时相胰岛素分泌指数、HOMA模型胰岛素分泌指数显著增加(P<0.05);胰岛素抵抗指数显著降低(P<0.01)。结论持续皮下输注胰岛素强化治疗可显著改善新诊断T2DM患者胰岛β细胞功能,改善胰岛素抵抗。     

胰岛素分泌调控机制与胰岛素启动子因子的研究进展

2型糖尿病不仅存在明显的胰岛素抵抗 ,也存在早期的胰岛素分泌功能损害 ,尤其是胰岛素分泌第一时相的损害。近年来 ,国外对胰岛素分泌的分子生物学进行了广泛、深入的研究 ,发现胰岛素启动子因子 (IPF 1 )的缺陷不仅是青少年发病的 2型糖尿病 (MODY)的病因之一 ,IPF 1与胰岛素分泌调节也有密切的联系 ,现将此方面研究进展综述如下。1　胰岛细胞分化和胰岛素分泌与PDX 1的关系胰岛内分泌细胞包括α细胞、β细胞、δ细胞和PP细胞 ,分别分泌胰高血糖素、胰岛素 (INS)、生长抑素 (SS)和胰多肽。这些胰岛实质细胞发源于前肠的内胚叶的多…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.