空泡蝶鞍伴发尿崩症一例报告

患者男,17岁,因多尿、口渴、多饮半月于1989年7月7日入院。患者半月前因考试复习紧张,逐渐出现尿频、尿量增多,每日总尿量约3000ml;口渴、多饮,日饮水量达1200ml。近10天来症状明显加重,每日小便达10余次之多,夜间2～3次,每日总尿量达5000ml,口渴更甚,日饮水达6000ml。在当地医院检查尿糖(-),尿比重1.008,诊为“尿崩症”转我院。患者既往体健,无头部外伤、颅内感染及严重精神创伤史。     

川芎嗪对高糖状态下大鼠肾小球系膜细胞氧化应激及TGF-β1表达的影响

目的:探讨川芎嗪(TMP)对高糖状态下大鼠肾小球系膜细胞(MCs)氧化应激和转化生长因子-β1(TGF-β1)表达的作用。方法:体外培养大鼠肾小球系膜细胞株,分对照组、高糖组、TMP组,分别培养24h、48h,以二氢二氯荧光素(DCFH-DA)标记细胞,通过流式细胞仪检测细胞内二氯荧光黄(DCF)的荧光强度而测得细胞内ROS水平;以ELISA法检测细胞上清液TGF-β1的含量。结果:与对照组相比,高糖组细胞内DCF平均荧光强度均显著升高(P<0.01),TGF-β1表达显著增加(P<0.01);与高糖组相比,TMP组细胞内DCF平均荧光强度均显著降低(P<0.01),TGF-β1表达显著降低(P<0.01)。结论:TMP可以有效抑制高糖诱导的氧化应激以及TGF-β1表达。     

血糖波动对糖尿病大鼠肾小球内皮细胞和肾小管上皮细胞凋亡的影响

目的:观察血糖波动和持续高血糖对糖尿病大鼠肾小球血管内皮细胞和肾小管上皮细胞凋亡和Bax、Bcl-2表达的影响。方法:SD大鼠24只,均分为正常对照组、糖尿病持续高血糖组、糖尿病血糖波动组。采用链脲佐菌素（STZ）60 mg/kg腹腔注射诱发糖尿病，血糖波动组每天定时腹腔注射超短效胰岛素类似物诺和锐，并错时给予葡萄糖，造成1 d中血糖浓度大幅度波动模型。制模4周后，免疫组化法检测肾组织Bcl-2和Bax蛋白表达，原位缺口末端标记法（TUNEL）检测肾小球血管内皮细胞和肾小管上皮细胞凋亡。结果:糖尿病血糖波动组的肾脏凋亡细胞明显多于、肾小球Bcl-2蛋白表达少于、肾小管Bax表达明显多于糖尿病持续高血糖组。结论:糖尿病大鼠血糖明显波动可加速肾小管上皮细胞凋亡。     

温州市糖尿病流行病学抽样调查报告

糖尿病(DM)已成为当今世界上威胁人类的第三大疾病,其患病率在不断增加。我国随着近十多年来人民生活水平的明显改善,DM患病率也在不断增加。为了解温州市糖尿病患病情况,并配合最近在全国进行的糖尿病流行病学患病率的抽样调查,我们于1994年11月中旬至1995年1月中旬对温州市不同地区及不同职业人群进行了建国以来首次DM患病率流行病学抽样调查,以进一步探索糖尿病发生和发展的规律,为糖尿病的防治提供依据。现将调查结果报道如下。     

糖尿病并发多对颅神经受累一例

患者男性,62岁,住院号146392.因两下肢疼痛3月,口角偏斜2月余,于1986年6月17日入院,外院因尿糖(+++)、空腹血糖13.87mmol/L,以胰岛素及口服降糖药物治疗.一周后出现口角向左上偏斜,发音不清,流涎和进食时食物从口角漏出,按脑血栓形成治疗一个余月,出现复视.发病来神志清、无恶心、呕吐,无明显多饮、     

Graves病患者单能X射线测定骨密度研究

目的 研究Graves病对患骨密度的影响。方法 用单能X射线骨密度仪测定146例年龄21－60岁Graves病（GD）患右跟骨骨密度，并以120例年龄，性别相匹配的健康作为对照组。结果 GD组BMD与对照组比较，P＜0．001，二组差异有非常显性；GD组骨量减少的发病率为78．08％，对照组为47．50％，P＜0．001，二组差异有非常显性；GD组BMD减少两性差异无显性。GD组骨质疏松（OP）发病率为33．50％，对照组为7．50％，P＜0．001，二组差异有非常显性。GD组OP男女二组差异无显性。GD组和对照组男女各按每10岁为一年龄段再分亚组进行BMD及T－Score的比较，除51－60岁亚组差异无显性外，其余各年龄段亚组均有显性差异或非常显性差异；对GD患性别，年龄，居住地（农村或城市），甲亢是否控制及病程与BMD作Logistic回归相关分析，仅提示甲亢病情是否控制与BMD降低有关，OR＝2．8676（95％CI1．0993－7．5216）。结论 GD患BMD明显减低，骨量减少，OP发病率明显增高，并且无性别差异，BMD的降低仅与GD患甲亢是否控制有关。     

肥胖及糖调节受损患者血视黄醇结合蛋白4的变化及临床意义

目的研究超重、肥胖（OW、Ob）及糖调节受损（IGR）患者血视黄醇结合蛋白4（RBP-4）变化及与胰岛素抵抗（IR）的关系。方法ELISA法测正常糖耐量（NGT）组52例及IGR组58例的血RBP-4水平。结果各组RBP-4渐升高，组间差异有统计学意义；与腰围、WHR、HOMA—IR、TG、FPG正相关（r分别为0．289、0．322、0．377、0．41、0．432，P均〈0.01）；FPG、TG、WHR为其独立相关因素（r^2分别为0．186、0．305、0．340）。结论OW／Ob及IGR者血RBP-4升高，FPG、TG、WHR为其独立相关因素。     

The effect of repaglinide on blood glucose and islet β-cell function in newly diagnosed type 2 diabetic patients

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.     

The effect of repaglinide on blood glucose and islet β-cell function in newly diagnosed type 2 diabetic patients

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.     

加强临床医学专业临床营养学教学的探讨与实践

通过对在校临床及临床相关专业学生与临床医务工作者营养知识的储备及需求情况进行调查,探讨针对目前临床医学专业教学现状,加强临床医学专业临床营养学教育的必要性,从而就临床营养学教学改革的手段、课程结构、教学基地、教学方法、实验教学等方面提出意见与建议。