Roux-en-Y胃旁路术对肥胖大鼠肾脏糖异生的影响

目的研究胃旁路术后肥胖大鼠糖代谢及肾脏糖异生的改变。方法将大鼠分为:对照组、肥胖模型组(高脂饮食诱导)、假手术组和手术组(胃旁路术干预模型组)。术后检测血脂、血糖和胰岛素并计算胰岛素抵抗指数(HOMA-IR),行葡萄糖耐量实验并计算曲线下面积(AUG);q-PCR检测肾脏葡萄糖6磷酸酶(G6P)和磷酸烯醇式丙酮酸羧激酶(PEPCK)mRNA表达,Western blot检测G6P、PEPCK、p-IRS1和p-Akt蛋白表达。结果相较肥胖模型组和假手术组,手术组大鼠体质量、血糖、血脂、胰岛素、HOMA-IR和AUG均明显降低(P0.05);G6P和PEPCK mRNA表达及蛋白含量明显降低(P0.05);p-IRS1和p-Akt蛋白含量明显升高(P0.05)。结论胃旁路术能够显著改善肥胖大鼠糖代谢和胰岛素抵抗,其机制可能与肾脏糖异生关键酶表达降低,肾脏糖异生及糖输出减弱有关。     

人血清Irisin和SFRP5水平变化与2型糖尿病合并肥胖患者的关系研究

目的 探讨人血清鸢尾素(Irisin)和分泌型卷曲相关蛋白5(secretory curl related protein 5,SFRP5)水平变化与2型糖尿病合并肥胖患者的关系。方法 选取2017年7月至2018年10月在孝感市中心医院内分泌科接受治疗的2型糖尿病合并肥胖患者38例作为观察组,再取同期健康体检者44例作为对照组。比较两组患者体重指数(body mass index,BMI)、空腹血糖(fasting plasma glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白-胆固醇(high density lipoprotein-cholesterol,HDL-C)、低密度脂蛋白-胆固醇(low density lipoprotein-cholesterol,LDL-C)水平,血清鸢尾素(Irisin)、分泌型卷曲相关蛋白5(secretory curl related protein 5,SFRP5)水平,并分析相关指标与血清Irisin、SFRP5水平的相关性。结果 观察组患者BMI、FPG、HbA1c水平均显著高于对照组(t值分别为28.71、16.74、13.87,P值均<0.05),HDL-C水平均显著低于对照组(t=4.640,P<0.05)。观察组患者血清Irisin、SFRP5水平显著低于对照组(t值分别为15.80、7.152,P值均<0.05)。观察组患者BMI、FPG、HbA1c与血清Irisin水平均呈显著负相关(r值分别为-0.803、-0.336、-0.644,P值均<0.05),HDL-C与血清Irisin水平均呈显著正相关(r=0.845,P<0.05);观察组患者BMI、FPG、HbA1c与血清SFRP5水平均呈显著负相关(r值分别为-0.745、-0.627、-0.614,P值均<0.05),HDL-C与血清SFRP5水平均呈显著正相关(r=0.711,P<0.05)。结论 血清Irisin、SFRP5的水平越低,2型糖尿病合并肥胖患者的病情越严重,故其对2型糖尿病合并肥胖患者的病情诊断有重要的临床意义。     

2型糖尿病患者血清瘦素水平分析

目的：探讨２型糖尿病患者血清瘦素（Ｌｅｐｔｉｎ）水平的变化及意义。方法：采用放射免疫法测定１０９例２型糖尿病患者及８４例非糖尿病对照者的血清瘦素水平,观察其与性别、年龄、体重指数（ＢＭＩ）、腰臀比率（ＷＨＲ）、空腹血糖（ＦＰＧ）、糖化血红蛋白（ＨｂＡｌｃ）、空腹血浆胰岛素（ＦＩＮＳ）等指标的关系。结果：２型糖尿病组与对照组之间血清瘦素水平无显著性差异,但无论是在２型糖尿病患者还是对照者中,女性血清     

腹腔镜胃转流术治疗2型糖尿病合并高血压

目的比较腹腔镜胃转流术与传统方法对2型糖尿病合并高血压患者的治疗疗效。方法将41例2型糖尿病合并高血压患者随机分为手术组和对照组,以糖化血红蛋白、血压、体重指数、血脂、左室质量指数、相对室壁厚度、左室射血分数为观察指标。结果与对照组比较,手术组糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数上均有明显改善,其差异有统计学意义（P〈0．05）,对照组与手术组在左室射血分数上比较无统计学差异（P〉0．05）。结论腹腔镜胃转流术治疗2型糖尿病合并高血压患者可明显改善糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数。     

2型糖尿病患者血清瘦素水平探讨

瘦素 (Ｌｅｐｔｉｎ)是由ｏｂ基因编码产生的一种蛋白质 ,在分泌入血的过程中去除 2 1个氨基酸组成的Ｎ -端信号肽 ,形成含 146个氨基酸的成熟的Ｌｅｐｔｉｎ[1] 。已知在正常人群中 ,血清瘦素水平与体脂分布及体重呈明显相关。糖尿病是严重影响人类健康的疾病 ,常伴有代谢紊乱、高脂血症、高血压和心脑血管疾病。本文旨在探讨非胰岛素依赖性糖尿病病人(ＮＩＤＤＭ)有无血清Ｌｅｐｔｉｎ异常 ,Ｌｅｐｔｉｎ在 2型糖尿病发病中有何作用 ,现将结果报道如下。对象和方法一、对象 :(一 )非胰岛素依赖性糖尿病病人 (ＮＩＤＤＭ)组 :5 8例 (男32 ,…     

新诊断2型糖尿病伴肥胖患者五种血清脂肪因子水平和腹部脂肪水平变化及相关性分析

目的:探讨新诊断2型糖尿病(T2DM)患者五种血清脂肪因子水平与腹部脂肪之间的相关性.方法:连续性纳入2019-06-2020-12于我院门诊或住院发现的108例肥胖新诊断T2DM患者,70例年龄和体重相符的非糖尿病体检患者作为对照组.所有纳入受检者均检测血清丝氨酸蛋白酶抑制剂(VAS)、脂联素(APN)、脂肪素(AP...     

2型糖尿病大鼠早期血清cTnI水平与心功能的变化

目的:研究2型糖尿病大鼠早期血清心肌肌钙蛋白I(cTnI)的水平及心功能变化,探讨早期2型糖尿病大鼠血清cTnI水平与糖尿病心肌损伤发生发展之间的关系,明确cTnI在糖尿病心肌病发生发展中的作用。方法:通过高脂饮食联合链脲佐菌素建立2型糖尿病大鼠模型,实验将大鼠分为正常对照组、糖尿病2周模型组及4周模型组,超声心动图检测心功能相关指标,血清检测空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹胰岛素(FINS)及cTnI水平,HE染色法观察心肌病理结构变化,Western blot法检测心肌cTnI蛋白表达变化,通过上述指标变化分析2型糖尿病大鼠早期血清cTnI与大鼠心功能改变之间的关系。结果:与正常组比较,2型糖尿病大鼠TC、TG、LDL-C水平显著升高,HDL-C水平显著降低;糖尿病大鼠4周模型组与2周模型组相比较,TC、TG、LDL-C水平升高更明显,HDL-C水平降低更显著(P0.01);显微镜下糖尿病组大鼠心肌可见局灶性心肌细胞变性、坏死;糖尿病组大鼠相对于正常对照组血清及心肌cTnI表达显著增加(P0.01),且4周模型组比2周模型组增加更明显。结论:糖尿病大鼠早期即出现cTnI水平升高和心功能改变,有望为糖尿病心肌病的早期诊断和治疗提供理论依据。     

2型糖尿病患者血清甲状腺激素水平的变化及临床意义探讨

目的 了解2型糖尿病患者血清甲状腺激素水平的变化情况,并探讨其临床意义.方法 选择2013年1月至2014年8月间在我院就诊的120例2型糖尿病患者,运用放射免疫技术检测血清中游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)以及促甲状腺激素含量(TSH),并与我院体检中心120例健康体检者进行比较;将120例糖尿病患者依据糖化血红蛋白水平的高低分为四组:＜5.5％组,5.5％ ～6.5％组,6.6％ ～9.5％组,＞9.5％组,并测定甲状腺激素水平.结果 2型糖尿病患者FT3明显低于正常组,差异有统计学意义(P＜0.05),而FT4及TSH与正常组相比差异无统计学意义(P＞0.05).糖化血红蛋白水平在5.5％ ～6.5％组、6.6％ ～9.5％组、＞9.5％组FT3含量明显低于＜5.5％组,差异有统计学意义(P＜0.05);而糖化血红蛋白水平中FT4与TSH各组比较差异无统计学意义(P＞0.05).结论 糖尿病患者血清甲状腺激素水平主要是FT3含量下降,其下降程度和糖尿病的严重程度成正比,因此,血清FT3水平可作为评价糖尿病患者病情严重程度的重要指标之一.     

2型糖尿病患者血清瘦素水平及影响因素

目的:回顾性分析2型糖尿病(T2DM)患者血清瘦素(Leptin)水平及其影响因素。方法:收集整理35例T2DM患者Leptin水平和体重指数(BMI)、性别、年龄等数据,分性别比较其与正常对照人群的差异,分析T2DM患者Leptin水平与相关因素的关系。结果:T2DM患者血清Leptin浓度为9.72±5.01ng/ml,与正常对照组12.85±6.06ng/ml比较无显著性差异(P>0.05);但正常女性与女性T2DM患者Leptin水平均显著高于男性(P<0.01)。T2DM组患者血清Leptin水平与其年龄、性别和BMI呈显著正相关性(P<0.05～0.01)。结论:女性Leptin水平显著高于男性,且受到年龄、BMI的明显影响。     

内脏型肥胖2型糖尿病外周动脉疾病的研究进展

内脏型肥胖2型糖尿病(T2DM)患者可能发生外周动脉疾病(PAD)等并发症.PAD起病隐匿,诊断缺乏灵敏性,确诊时或已出现不可逆血管损伤,继而使患者致残、致死.氧化应激、炎症反应及内皮功能障碍等是T2DM并发PAD的关键危险因素;内脏型肥胖通过持续加剧内皮功能障碍和血管氧化应激等机制,引起动脉粥样硬化而导致或加重PAD...     

Effects of preventative application of metformin on bile acid metabolism in high fat-fed/streptozotocin-diabetic rats

Objective: This study was designed to investigate the effects of metformin on bile acid in type 2 diabetes mellitus (T2DM). Methods: In this study, we constructed a model of T2DM by a combination of high-fat diet (HFD) and low dose of streptozotocin (STZ) intraperitoneal injection. Blood samples by tail vein and eye angular vein were withdrawn before (time 0) and 30, 60, and 120 minutes after administration of glucose before STZ injection and once a week after diabetes induction, and were analyzed to evaluate the level of the fasting blood glucose and fasting insulin using glucometer. Triglyceride, low density lipoprotein cholesterin, high density lipoprotein cholesterin were detected by automatic biochemical analyzers. Total cholesterol and total bile acid (TBA) were analyzed using ELISA kits. Results: Before STZ injection, the TBA level in HFD group was significantly higher relative to that in standard diet (SD) group and there was a moderate reduction of the TBA level in early intervention (EI) group 6 week after metformin administration comparing with that in HFD group but was still higher than that of SD group. However, after STZ injection, the TBA level was significantly higher in DM rats relative to that in normal control (NC) rats and the TBA level in late intervention (LI) (19.92 μmol/L) and EI rats (42.97 μmol/L) with metformin administration was significantly higher comparing with that in DM rats. Conclusion: The effects of metformin in plasma glucose and lipid metabolism might be associated with bile acid metabolism.     

腹腔镜下胃转流术治疗2型糖尿病临床疗效评价

目的评价全腹腔镜下胃转流手术治疗2型糖尿病的临床疗效。方法对42例实施全腹腔镜下胃转流手术治疗的2型糖尿病患者,进行术前与术后的空腹及餐后2 h血糖、糖化血红蛋白、C肽、胰岛素和体重指数（BMI）等指标的比较分析。结果术后6个月空腹血糖、餐后2 h血糖、糖化血红蛋白较术前均有不同程度下降,与手术前比较相差显著（P〈0.05）,但是餐后血糖比空腹血糖下降得更快且显著;而空腹胰岛素、空腹C肽水平变化不明显;术前胰岛素、C肽水平高者效果更明显;手术治疗有效率100%,其中临床完全缓解率79.9%、临床部分缓解率20.1%。结论全腹腔镜下胃转流手术治疗2型糖尿病,近期临床疗效满意,是一种微创、安全、有效的外科治疗2型糖尿病的方法。     

Postmortem findings in morbidly obese individuals dying after gastric bypass procedures

Mortality has been reported to complicate gastric bypass, with common causes of death attributable to anastomotic leaks, sepsis, hemorrhage, and bowel obstruction. We evaluated autopsy reports from 10 patients having undergone gastric bypass. Medical records were reviewed to identify comorbidities. Data of interest included preoperative electrocardiogram (EKG) abnormalities, cause of death, body weight, anastamosis appearance, heart weight, extent of coronary artery disease, ventricular size, liver weight, and gall bladder status. A total of 7 men and 3 women were autopsied. Average age was 40 years (range, 30-49 years), and mean body mass index at autopsy was 60.3 kg/m(2) (range, 33.2-80.9 kg/m(2)). Evidence of anastomotic leaks was present in 7 cases, resulting in 4 deaths. Death was attributed to pulmonary embolism in one case. There were 5 cardiac-related deaths, all attributed to arrhythmias. Microscopic evidence of coronary artery disease was observed in 6. Cardiomegaly was seen in all patients, left ventricular hypertrophy in 8, right ventricular hypertrophy in 3, and hepatomegaly in all 10. Nine patients were status post cholecystectomy. Of the 8 preoperative EKG available, abnormalities were identified in 5. After gastric bypass, death was attributed to cardiac-related causes, pulmonary embolism, and operative complications. A significant proportion of cardiac-related deaths occured in the absence of atherosclerosis. Most patients had preoperative EKG abnormalities. As a high incidence of cardiomegaly was observed, operative stress associated with the procedure may increase the risk of arrhythmia in morbid obesity. Consequently, in morbidly obese patients, a detailed preoperative cardiovascular evaluation is warranted to reduce postoperative mortality.     

Comparison of bypass surgery with drug-eluting stents in diabetic patients with left main coronary stenosis

Purpose

Several studies have compared the effects of coronary stenting and coronary-artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients.

Materials and Methods

We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization).

Results

In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018).

Conclusion

In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.     

糖尿病及肥胖患者血浆瘦素水平的检测

目的: 探讨非肥胖正常人与肥胖患者及糖尿病患者血浆瘦素的关系。方法: 采用放射免疫分析法测定了21例非肥胖正常人, 24例肥胖患者及20例肥胖伴糖尿病患者血浆瘦素水平。结果: 肥胖患者血浆瘦素水平(109.1±16.4) ng/L及肥胖伴糖尿病患者血浆瘦素水平(81.0±17.5)ng/L显著低于非肥胖正常人(194.3±17.7) ng/L。结论: 非肥胖正常人及肥胖患者血浆瘦素水平与体重指数、血糖、胆固醇及甘油三脂呈显著负相关, 表明人的瘦素在调节体重及内分泌代谢方面起一定的作用。     

Effects of captopril treatment versus placebo on renal function in type 2 diabetic patients with microalbuminuria: a long-term study

We evaluated the renal effect of long-term antihypertensive treatment (12 months) with the angiotensin-converting enzyme inhibitor captopril compared to placebo in 15 type 2 diabetic patients with microalbuminuria. The patients were randomly allocated to captopril (n = 9) or placebo (n = 6). After 1-year therapy no significant decrease in blood pressure was demonstrated with captopril (139 ± 17/80 ± 9 versus 138±13/76±6 mmHg) or placebo (138 ± 9/75 ± 6 versus 135 ± 14/79 ±10 mmHg). Only in a small hypertensive subgroup (n = 4) treated with captopril did we find a significant reduction in blood pressure (154 ± 2/88 ± 1 versus 142 ± 7/78 ± 5 mmHg,P < 0.05). The urinary albumin excretion rate did not change significantly either in the captopril group (95.6 mg/24 h, 25th percentile 138.4, 75th percentile 25.1; versus 127.8 mg/24 h, 25th percentile 29.3, 75th percentile 222) or in the placebo group (99.2 mg/24 h, 25th percentile 58.5, 75th percentile 125.8; versus 120.9 mg/24 h, 25th percentile 62.1, 75th percentile 179.7). There were also no alterations in renal blood flow or filtration rate. In the hypertensive subgroup treated with captopril a reduction in urinary albumin excretion rate after 3 and 6 months of treatment was observed (captopril 73.4 versus 24 and 41 mg/24 h,P < 0.05), but not after 12 months. Triglyceride and cholesterol levels remained constant before and after treatment while glycosylated hemoglobin decreased significantly after 12 months captopril (7.8 ± 0.9 versus 6.9 ± 0.7 mg%,P < 0.03). We conclude that in patients with type 2 diabetes with microalbuminuria angiotensin-converting enzyme inhibitors may have protective renal effects in so far as a lack of increase in urinary albumin excretion is equivalent to low progression in renal disease.Abbreviations ACE angiotensin-converting enzyme - GFI glomerular filtration rate - HbA glycosylated hemo globin - RPF renal plasma flow - UAER urinary albumin excretion rate Correspondence to: R. Prager