二甲双胍联合阿卡波糖治疗2型糖尿病并高血脂症的临床疗效分析

目的分析二甲双胍联合阿卡波糖治疗2型糖尿病(T2DM)并高血脂症的疗效。方法收集该院内分泌科住院的T2DM伴高血脂症患者364例,其中采用二甲双胍单药治疗182例为对照组,采用二甲双胍联合阿卡波糖治疗的182例为联合组。比较治疗前后两组血糖、血脂指标变化及治疗3个月后两组疗效。结果治疗后,两组患者各项血糖及血脂指标均有明显下降(P0.05),且联合组均优于对照组(P0.05)。联合组总有效率为94.51%,显著高于对照组的73.63%(P0.05)。结论二甲双胍联合阿卡波糖治疗2型糖尿病伴高脂血症可显著改善患者血糖水平和血脂水平,临床疗效值得肯定。     

沙格列汀联合二甲双胍治疗维吾尔族老年2型糖尿病的疗效

目的观察单用二甲双胍血糖控制不佳的维吾尔族新诊断老年2型糖尿病(T2DM)患者加用沙格列汀的有效性。方法 160例单用二甲双胍12 w,血糖不达标的维族新诊断老年T2DM患者,随机分为沙格列汀组82例和阿卡波糖组78例,进行12 w的随访,对比空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、血清脂联素(APN)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)等指标的变化。结果治疗12 w后,沙格列汀组与阿卡波糖组FBG、2 h PG和HbA1c水平较治疗前明显降低,且沙格列汀组均较阿卡波糖组下降幅度大(P<0.05),HbA1c达标率明显高于阿卡波糖组(P<0.05),沙格列汀组与阿卡波糖组HOMA-IR均较治疗前明显下降而APN水平明显升高(P<0.05),沙格列汀组HOMA-IR、APN的改善优于阿卡波糖组(P<0.05),两组治疗前后BMI水平无统计学差异(P>0.05)。结论沙格列汀与二甲双胍联用治疗维吾尔族新诊断的老年T2DM患者治疗效果好。     

早期2型糖尿病患者的血小板CD62P表达及阿卡波糖的干预作用

目的 探讨早期2型糖尿病(T2DM)患者血小板CD62P表达及阿卡波糖治疗对CD62P的影响.方法 选择新诊断的早期T2DM患者83例,随机将其分为基础治疗组和阿卡波糖治疗组.两组均接受糖尿病教育、饮食控制,并进行适当的运动锻炼;阿卡波糖治疗组每日加服阿卡波糖控制血糖,共治疗16周.治疗前后,测量两组BMI、血压、空腹血糖(FPG)、餐后2h血糖(2 h PG)、血脂及血小板CD62P表达.另选40例体检健康者作为对照组,于查体时进行上述检测.结果 与对照组比较,T2DM组的FPG、2hPG与血小板CD62P表达阳性率明显升高(P均＜0.05).基础治疗组治疗前后各检测指标无明显变化(P均＞0.05);阿卡波糖治疗组治疗后FPG、2 h PG与血小板CD62P表达阳性率明显降低,且明显低于基础治疗组(P均＜0.05).多元回归分析表明,2 hPG与血小板CD62P表达率显著相关(β=0.525,P＜0.05).结论 阿卡波糖可通过降低餐后血糖,抑制早期T2DM患者的血小板CD62P表达.     

老年脑梗死2型糖尿病周围神经病肌电图与临床分析

目的研究脑梗死2型糖尿病(T2DM)周围神经病变神经电生理检查与临床相关因素关系。方法采用丹麦KEYPoin型肌电图仪测定脑梗死T2DM周围神经病患者和正常对照组神经传导速度(NCV),用Au5800型生化自动分析仪测定血糖、糖化血清蛋白(GSP),比较脑梗死糖尿病组与正常对照组肌电图改变的差异,分析脑梗死糖尿病组经甲钴胺、银杏达莫、拜阿司匹林、阿卡波糖(拜糖平)及胰岛素治疗后肌电图和血糖、GSP变化的关系。结果脑梗死糖尿病组运动神经传导速度(MCV),感觉神经传导速度(SCV),波幅、潜伏期与健康人比较差异显著(P<0.05)。治疗后MCV、SCV及GSP均较治疗前有显著改善(P<0.05)。结论脑梗死T2DM周围神经病变患者中,周围神经传导速度、波幅、潜伏期的肌电图变化明显,提示肌电图检查对脑梗死T2DM周围神经病变协助临床早期诊治和预后评估有重要价值。     

盐酸二甲双胍与阿卡波糖治疗糖耐量异常的疗效观察

目的观察阿卡波糖与盐酸二甲双胍对糖耐量异常患者的治疗效果。方法用随机双盲法比较80例糖耐量异常患者在饮食加运动控制的基础上给予口服阿卡波糖和盐酸二甲双胍干预治疗,治疗6个月后,检测空腹血糖及葡萄糖耐量试验后2h血糖水平的变化。结果阿卡波糖组和盐酸二甲双胍组治疗前糖耐量试验无显著差异（P〉0.05）。阿卡波糖组与盐酸二甲双胍组相比FPG、2hPG均有同等效果,糖尿病的发病率为5.0%。结论阿卡波糖与盐酸二甲双胍都能够降低糖耐量异常人群糖尿病的发病率,可使糖耐量异常明显改善,且药物费用明显优于阿卡波糖,具有更好的成本-效益比。     

沙格列汀联合阿卡波糖治疗初诊老年2型糖尿病的临床观察

目的分析沙格列汀联合阿卡波糖治疗初诊老年2型糖尿病的疗效。方法于2015年3月—2017年2月将86例初诊老年2型糖尿病患者分为两组各43例,对照组口服阿卡波糖、皮下注射赖辅胰岛素注射液,观察组口服阿卡波糖与沙格列汀,比较两组疗效。结果两组患者治疗后空腹胰岛素、空腹血糖、餐后2 h血糖、糖化血红蛋白等常规指标和胰岛素分泌指数、胰岛素抵抗指数与治疗前比均有明显改善,但组间均差异无统计学意义(P0.05)。观察组不良反应发生率4.65%、明显少于对照组的18.60%(P0.05)。结论沙格列汀联合阿卡波糖对初诊老年2型糖尿病患者效果明确,安全性高,值得推广。     

阿卡波糖对2型糖尿病患者血脂及尿酸代谢的研究

目的探讨阿卡波糖对2型糖尿病(T2DM)患者血脂及尿酸代谢的影响。方法选取2016年10月—2017年8月收治的T2DM患者200例,按奇偶数分为对照组、实验组,两组均给予糖尿病饮食管理和运动治疗,对照组给予二甲双胍治疗,实验组给予阿卡波糖治疗,持续服药12周。观察治疗前后空腹血糖(FPG)、餐后2 h血糖(2 hPFG)、糖化血红蛋白(HbA1c)、血脂(甘油三酯TG、总胆固醇TC、低密度脂蛋白胆固醇LDL-C、高密度脂蛋白胆固醇HDL-C)、尿酸(UA)的水平变化。结果实验组治疗后BMI、FPG、2 hPFG、HbA1c、TG、TC、LDL-C、UA较治疗前明显下降,HDL-C较治疗前明显升高,差异有统计学意义(P0.05);对照组治疗后BMI、FBG、2 hPFG、HbA1c较治疗前下降(P0.05),TG、TC、LDL-C、UA较治疗前无明显下降,HDL-C无升高,差异无统计学意义(P0.05)。两组治疗后BMI、FPG、2 hPFG、TC、LDL-C、HDL-C、UA差异有统计学意义(P0.05)。结论阿卡波糖和二甲双胍均可降低BMI、FPG、2 hPFG、HbAlc的水平,但两组HbAlc无明显差异。此外,阿卡波糖还可以降低TG、TC、LDL-C、UA的水平,升高HDL-C的水平。可知,阿卡波糖可以明显改善血脂及尿酸的代谢,早期预防T2DM慢性并发症及延缓心脑血管病的进展。     

不同剂量阿卡波糖联合人预混胰岛素治疗2型糖尿病疗效观察

目的探讨不同剂量阿卡波糖联合人预混胰岛素(30/70,重和林M30)治疗2型糖尿病(T2DM)的临床疗效。方法按照随机原则将99例T2DM患者分为三组,每组33例,A组患者单纯使用重和林M30治疗,B组患者使用重和林M30联合阿卡波糖(150 mg/d)治疗,C组患者使用重和林M30联合阿卡波糖(300 mg/d)治疗。治疗3个月后比较三组患者的低血糖发生情况。结果 A、B、C组患者的低血糖发生率分别为51.5%、36.4%和21.2%,C组患者血糖控制效果最佳,低血糖发生率最低,与A、B组患者比较,差异均具有统计学意义(P0.05)。结论不同剂量的阿卡波糖联合胰岛素治疗均可以降低T2DM患者血糖水平;阿卡波糖使用剂量为300 mg/d的疗效优于剂量150 mg/d,前者的降糖效果更好,安全性更高。     

阿卡波糖治疗对2型糖尿病患者体重和血脂谱的影响

目的 比较阿卡波糖联合预混胰岛素与单纯预混胰岛素治疗2型糖尿病患者在血糖、体重和血脂谱方面的差异.方法 将52例口服降糖药治疗失败的2型糖尿病患者随机分为阿卡波糖组和对照组(每组26例),阿卡波糖组给予阿卡波糖片和预混胰岛素制剂,对照组单纯给予预混胰岛素制剂,观察两组患者治疗前后体重指数(BMI)和血脂谱的变化,同时比较两组患者治疗后空腹血糖(FPG)、餐后2 h血糖(2 hPG)和低血糖事件发生率的差异.结果与对照组相比,治疗后阿卡波糖组患者2 hPG和低血糖发生率均降低(P<0.05);两组FPG无统计学意义(P>0.05);阿卡波糖组胰岛素日用量减少(P<0.05).阿卡波糖组治疗12周后,患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均较治疗前下降(P<0.05);BMI较治疗前有下降趋势,但无统计学意义(P>0.05);高密度脂蛋白胆固醇(HDL-C)较治疗前有升高趋势,差异无统计学意义(P>0.05).结论 较单纯使用预混胰岛素相比,阿卡波糖联合预混胰岛素治疗2型糖尿病能获得一定的改善患者体重和血脂谱的额外收益,且餐后血糖控制和安全性更好.     

甘精胰岛素联合口服降糖药治疗肥胖2型糖尿病患者的疗效观察

目的 观察甘精胰岛素联合阿卡波糖和(或)二甲双胍治疗肥胖T2DM临床疗效.方法 32例肥胖T2DM患者,在注射预混Ins一段时间后血糖控制不理想情况下,改用甘精胰岛素联合阿卡波糖和(或)二甲双胍,疗程3个月,观察治疗前后BP、FPG、HbA_1c、TC、TG、HDL-C、LDL-C、UA、C-P、UAER变化情况,计算HOMA-IR、HOMA-β.结果 治疗后BMI、FPG、HOMA-IR低于治疗前,而C-P、HOMA-β高于治疗前(P＜0.05).结论 甘精胰岛素联合阿卡波糖和(或)二甲双胍治疗肥胖T2DM,不仅成功控制血糖,且明显改善IR,治疗中无明显体重增加等不良反应.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.