糖代谢异常患者胰岛素抵抗和胰岛β细胞功能与血清高半胱氨酸的相关性分析

摘要:目的：探讨糖代谢异常人群胰岛素抵抗和胰岛β细胞功能与高半胱氨酸(Hcy)的关系。 方法：对67例糖耐量正常（NGT）者及104例糖耐量受损（IGT）、58例空腹血糖调节受损（IFG）、109例2型糖尿病（T2DM）患者,检测空腹血糖（FPG）、口服葡萄糖耐量试验（OGTT) 2 h血糖、Hcy及空腹胰岛素水平,计算稳态模型评估胰岛素抵抗指数(HOMA-IR)、HOMA胰岛β细胞功能指数(HBCI)、空腹胰岛β细胞功能指数(FBCI)。 结果：与NGT、IFG组比较,IGT组HOMA-IR、HBCI、Hcy差异有统计学意义（P均<0.05）;与NGT、IFG、IGT组比较,T2DM组HOMA-IR、HBCI、FBCI、Hcy差异有统计学意义（P均＜0.05）。Hcy与HOMA-IR呈正相关（r=0.233,P<0.05）,与HBCI、FBCI呈负相关（r分别为－0.354、－0.289,P均<0.05）。 结论：Hcy与葡萄糖代谢异常有相关性,可作为评价胰岛素抵抗、胰岛β细胞分泌功能受损的一项观察指标。     

老年人不同糖耐量状态胰岛素抵抗和胰岛β细胞功能的研究

目的观察老年人群中空腹血糖受损(IFG)、糖耐量受损(IGT)和糖调节受损(IFG/IGT)三种不同糖耐量状态下的胰岛素抵抗(IR)和胰岛β细胞功能的变化,了解其发病机制。方法筛选60~75岁的IFG40例,IGT60例,IGT/IFG40例,正常糖耐量(NGT)70例。HOMA-IR评价胰岛素抵抗,HBC I和I30/G30分别评价基础及糖负荷后早期胰岛β细胞功能。结果(1)HOMA-IR:IFG、IFG/IGT和IGT组明显高于NGT组,P<0.01,IFG/IGT组高于IFG和IGT组,P<0.01;(2)HBC I:IFG组和IFG/IGT组明显低于NGT和IGT组,P<0.01;(3)I30/G30:IGT组和IFG/IGT组明显低于NGT组及IFG组,P<0.01。结论老年人群IFG主要表现基础状态下β细胞功能受损伴有胰岛素抵抗,IGT主要表现为早期胰岛素分泌缺陷,IFG/IGT胰岛β细胞早期胰岛素分泌功能受损更明显,胰岛素抵抗更严重。     

血糖调节异常者胰岛素抵抗及胰岛β细胞功能研究

目的研究胰岛素抵抗和胰岛β细胞功能与中国人血糖调节异常(IGR)的关系。方法根据口服葡萄糖耐量试验(OGTT)将209例受试者分为正常糖耐量(NGT)组、空腹血糖受损(IFG)组、糖耐量减退(IGT)组、IFG/IGT组和糖尿病(DM)患者组,用胰岛素敏感指数(ISI-COM)评价胰岛素抵抗(IR),用调整β细胞功能指数(modifiedβcell function index,MBCI)评价β细胞功能,并用早期胰岛分泌指数(△I30/△G30)评价急性期胰岛分泌功能,OGTT胰岛素曲线下面积评价二相期胰岛素分泌功能。结果IGR各组与DM组ISI-COM较NGT组有显著降低,差异有统计学意义(P0.01),而IGR各组间差异无统计学意义(P0.05)。IFG组和IGT组β细胞功能较NGT组显著降低,差异有统计学意义(P0.01),而IFG/IGT组与DM组间差异无统计学意义(P0.05)。各病例组早期胰岛分泌功能亦较NGT组有显著性降低,差异有统计学意义(P0.01),IGT组与IFG组间差异也有统计学意义(P0.01)。结论IGR各阶段均存在不同程度的IR和β细胞功能异常,其中IFG和IGT有不同的发病机制和过程,提示对于不同糖代谢异常的患者需要不同的治疗方式,以延缓血糖代谢异常的进展。     

真胰岛素对观察胰岛素抵抗与胰岛B细胞功能的意义——附128例报告

目的：探讨以真胰岛素为指标观察胰岛素抵抗和胰岛B细胞功能的意义。方法：将35名有糖尿病家族史的正常糖耐量者（NGT）、31例糖耐量异常者（IGT）和62你新诊断的2型糖尿病患者分别按体重指数分为肥胖亚组与非肥胖亚组，以35名健康人作为对照组，采用微粒子化学发光法测定空腹血清真胰岛素，以稳态模型评估法评价胰岛素抵抗和胰岛细胞功能。结果：在非肥胖亚组中，NGT、IGT、糖尿病组随空腹血糖的升高，胰岛素抵抗指数（HomaIR）逐渐高于正常，B细胞功能指数（HBCI）逐渐低于正常，而空腹血糖的升高，胰岛素抵抗指数（HomaIR）逐渐高于正常。B细胞功能指数（HBCI）逐渐低于正常，而空腹真胰岛素与对照组比较无明显差异。肥胖亚组中，NGT组的空腹血糖虽然正常，但已有HomaIR升高，NGT和IGT组有HomaIR升高，但HBCI无异常，但此时的真胰岛素均已显示高于对照组且有统计学升高，NGT和IGT组有HomaIR升高，但HBCI无异常，但此时的真胰岛素均已显示高于对照组且有统计学差异，P＜0.01。结论：体重指数和血糖值均会影响HomaIR和HBCI，而真胰岛素的测定却能更真实地反映胰岛素抵抗及胰岛B细胞功能。     

胰岛功能及胰岛素抵抗指数在不同阶段的糖耐量变化

目的:探讨2型糖尿病在发病之前胰岛素抵抗和胰岛功能的演变情况.方法:通过对非糖尿病(NGT)人群、糖耐量减低(IGT)人群和初诊2型糖尿病(DM)人群的胰岛素抵抗程度和胰岛β细胞分泌功能的测定,比较舷NGT、IGT、DM三者的胰岛素抵抗和胰岛β细胞功能的变化.结果:NGT、IGT、DM三者的胰岛素抵抗呈现逐渐增加的趋势;在糖尿病发生前β细胞功能就已经逐渐减退.结论:NGT、IGT、DM三者间随病情的发展其胰岛功能呈现进行性下降,到糖尿病阶段β细胞分泌胰岛素的状态最差.在临床糖尿病到来之前,胰岛素抵抗持续存在且有逐渐增高的趋势,即使在临床糖尿病发生之后,胰岛素抵抗的倾向并未有所缓解,与此同时,β细胞的胰岛素分泌功能却在逐步减退.     

不同糖耐量人群胰岛素抵抗的比较

【目的】研究不同糖耐量人群胰岛素抵抗程度的差异。【方法】将412名门诊患者按OGTT分为4组：糖尿病组（NDM，n=180），空腹血糖受损组（IFG，n=35），糖耐量异常组（IGT，n=46），糖耐量正常组（NGT，n=151）。测定血压、血脂（TG和HDL）、体质指数（BMI）；应用胰岛素抵抗（HOMA-IR）及胰岛素作用指数（IAI）对不同糖耐量人群进行测定。【结果】DM、IFG及IGT组均较NGT组IAI下降，HOMA-IR增高，DM组表现得尤为显著；而IFG组与IGT组比较，亦有显著的IAI下降及HOMA-IR增高（P〈0．05）。【结论】不同糖耐量人群随着糖调节不同程度的受损HOMA-IR和IAI均有增幅变化，这两种指标可较准确的评估胰岛素敏感性。IFG与IGT人群胰岛素抵抗的机制可能有所不同。     

不同糖耐量人群胰岛素抵抗指数及血管内皮功能变化的意义

目的探讨空腹血糖调节受损(IFG)、糖耐量减低(IGT)、糖尿病(DM)等高血糖人群的胰岛素抵抗指数(IR)及血管内皮功能变化的意义。方法选择不同糖耐量且不伴心血管及其他疾病的183例,按糖耐量分为IFG组47例、IGT组52例、DM组41例、糖耐量正常组(NGT)43例,分别检测血糖、胰岛素、血脂,计算IR,并应用高分辨率血管外超声监测肱动脉血管内皮功能,比较各组空腹血糖、餐后2 h血糖、IR及血管内皮功能。结果IFG组、IGT组、DM组空腹胰岛素及餐后胰岛素均高于NGT组,差异有统计学意义(P<0.05);DM组空腹胰岛素高于IGT组,而DM组餐后胰岛素高于IFG组及IGT组,IGT组餐后胰岛素高于IFG组,差异均有统计学意义(P<0.05);IFG组、IGT组、DM组的IR高于NGT组;反应性充血时肱动脉血管内径变化在NGT组、IFG组、IGT组、DM组依次降低,两两比较差异均有统计学意义(P<0.05)。结论IGT人群表现出IR增高,发展到DM阶段更为严重,在血糖升高的同时往往合并脂代谢紊乱;IGT期血管内皮功能开始下降,至DM期更为明显。     

糖尿病前期人群经综合治疗1年后的转归

目的探讨糖尿病前期人群经综合治疗1年后糖代谢的转归情况。方法选取2015年2月至2016年1月山东省青岛疗养院住院及健康查体的糖尿病前期患者189例,将研究对象分为空腹血糖受损(IFG)组、糖耐量异常(IGT)组和IFG+IGT组。经综合干预1年后调查研究对象糖代谢转归情况。结果随访1年糖尿病前期人群2型糖尿病(T2DM)发病率为12.70%,其中IFG组、IGT组、IFG+IGT组的T2DM年发病率分别为6.35%、13.00%、18.18%。糖尿病前期转归为正常糖代谢(NGT)年发生率为11.64%,其中IFG组、IGT组、IFG+IGT组转归为NGT年发生率为17.46%、11.67%、6.06%。结论本研究采用综合干预方式,IFG组与IGT组向NGT及T2DM转归无差异,而IFG+IGT组向糖尿病发展的概率更高,较IFG更应早期综合干预。     

血清小而密低密度脂蛋白胆固醇与2型糖尿病患者胰岛素抵抗的相关性分析

目的探讨2型糖尿病患者血清小而密低密度脂蛋白胆固醇(sdLDL-C)与胰岛素抵抗的相关性。方法依据糖尿病诊断和分类标准将受试者分为三组,分别为正常糖代谢(NGT)组150例、糖耐量异常(IGT)组138例和2型糖尿病(T2DM)组152例。比较三组受试者的一般资料、脂质代谢和糖代谢水平。分析脂质代谢与糖代谢指标的相关性。通过多重线性回归分析,探讨胰岛素抵抗的相关影响因素。结果 NGT组、IGT组和T2DM组受试者的体质指数(BMI)、腰臀比(WHR)、总甘油三酯(TG)、sdLDL-C、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)呈逐渐升高的趋势。sdLDL-C与FBG、HbA1c、FINS和HOMA-IR等指标存在显著相关性。多重线性回归分析结果表明,BMI、WHR、TG、sdLDL-C对HOMA-IR影响最大。结论 sdLDL-C与2型糖尿病患者胰岛素抵抗密切相关。     

探讨糖尿病前期患者血浆IL-18、PAI-1水平变化与胰岛素抵抗的相关性

目的探讨血浆白细胞介素-18(IL-18)、纤溶酶原激活物抑制物-1(PAI-1)水平变化与Ⅱ型糖尿病发病危险因素的关系.方法 设立健康人对照(NGT)组、糖耐量减低( IGT )组、空腹血糖受损合并糖耐量减低(IFG/IGT)组,每组各100例.测定各受试者血浆 IL-18、PAI-1、血清空腹胰岛素、空腹血糖、餐后2 h血糖,应用稳态模型评估法评价胰岛素抵抗(HOMA-IR).结果 IGT组、IFG/IGT组血浆 IL-18、PAI-1 水平均高于NGT组(P<0.01).IFG/IGT组血浆 IL-18、PAI-1 水平均高于IGT组(P<0.05).相关分析显示IL-18、PAI-1 水平与空腹血糖、餐后2 h血糖、HOMA-IR呈正相关(P<0.01).结论血浆 IL-18、PAI-1 水平升高可能是加重糖尿病前期患者胰岛素抵抗的危险因素;在糖尿病前期,IL-18、PAI-1可能参与了Ⅱ型糖尿病的发生、发展.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。