Sodium-glucose co-transporter-2 inhibition and ocular outcomes in patients with type 2 diabetes: A systematic review and meta-analysis

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are effective for the treatment of macrovascular complications and nephropathy in type 2 diabetes, but effects on microvascular eye outcomes are unclear. We conducted a systematic review and meta-analysis of randomized placebo-controlled trials to evaluate the effect of SGLT2 inhibition on total ocular events and retinopathy in patients with type 2 diabetes. We searched MEDLINE and Embase for the period from database inception date to October 11, 2019. Two reviewers working independently extracted relevant data. Random-effects models with inverse variance weighting were selected to estimate summary risk ratios (RRs) and 95% confidence intervals (CIs). We included nine studies, involving 39 982 patients with a mean follow-up of 2.8 years. There were 1414 total ocular events, of which 624 were retinopathy events. SGLT2 inhibition was not associated with a change in the risk of total ocular events (RR 0.97, 95% CI 0.85, 1.11) or retinopathy (RR 0.98, 95% CI 0.84, 1.16), with consistent effects across studies (P for heterogeneity = 0.35 and 0.45, respectively). The effects of SGLT2 inhibition on eye disease in individuals with type 2 diabetes are probably null, although the available data cannot exclude small to moderate benefits or harms.     

免疫球蛋白联合去乙酰毛花苷注射液治疗老年扩张型心肌病的临床研究

目的探讨免疫球蛋白联合去乙酰毛花苷注射液治疗老年扩张型心肌病的临床疗效。方法选取2010年1月—2014年12月榆林市第一医院心血管内科收治的老年扩张型心肌病患者200例,随机分为对照组和治疗组,每组各100例。两组患者均接受利尿剂等常规基础治疗。对照组患者静脉滴注去乙酰毛花苷注射液,0.5 mg/次,2次/d;治疗组在对照组基础上静脉滴注静注人免疫球蛋白,400 mg/d。两组均连续治疗4周。观察两组的临床疗效,同时比较两组治疗前后左心室射血分数(LVEF)、舒张早期血流峰值速度(EPFV)、充盈早期速率/晚期速率(E/A)、舒张晚期血流峰值速度(APFV)、左心室收缩末期容积(LVESV)、左心室质量(LV)、左心室舒张末期容积(LVEDV)、心胸比(CTR)、Ig G抗体的变化情况。结果治疗后,对照组和治疗组的总有效率分别为69.00%、85.00%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者LVEF、E/A、EPFV显著升高,APFV、LVESV、LVEDV、LV、CTR、Ig G抗体均显著降低,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论免疫球蛋白联合去乙酰毛花苷注射液治疗老年扩张型心肌病具有较好的临床疗效,可显著改善患者的心功能,降低Ig G抗体水平,具有一定的临床推广应用价值。     

α-硫辛酸联合甲钴胺对2型糖尿病周围神经病变患者神经传导功能的影响

目的探讨2型糖尿病周围神经病变甲钴胺联合α-硫辛酸对患者神经传导功能的影响。方法回顾性选取2018年6月—2020年6月该院2型糖尿病周围神经病变患者100例,依据治疗方法分为甲钴胺联合α-硫辛酸治疗组(联合治疗组,n=50)、甲钴胺单独治疗组(单独治疗组,n=50)两组,统计分析两组患者的血糖水平、肢体疼痛程度、神经传导功能、临床疗效、不良反应发生情况。结果联合治疗组患者治疗后较治疗前的VAS评分降低幅度显著高于单独治疗组,差异有统计学意义(P<0.05),但两组患者治疗后较治疗前的空腹血糖、餐后2 h血糖水平降低幅度之间的差异无统计学意义(P>0.05)。联合治疗组患者治疗后较治疗前的胫神经MCV、尺神经、正中神经SCV升高幅度均显著高于单独治疗组,差异有统计学意义(P<0.05)。联合治疗组患者治疗的总有效率90.0%(45/50)显著高于单独治疗组62.0%(31/50),差异有统计学意义(χ²=10.746,P<0.05)。联合治疗组和单独治疗组患者的不良反应发生率6.0%(3/50)、4.0%(2/50)间的差异无统计学意义(χ²=0.000,P>0.05)。结论2型糖尿病周围神经病变甲钴胺联合α-硫辛酸治疗较甲钴胺单独治疗更能有效改善患者神经传导功能。     

Takotsubo Syndrome: Clinical Manifestations,Etiology and Pathogenesis

The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β₂ adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using ¹²⁵I-metaiodobenzylguanidine (¹²⁵I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.     

急诊糖尿病高渗性昏迷患者的综合护理干预价值

目的探讨急诊糖尿病高渗性昏迷患者的综合护理干预应用方法及效果。方法选取该院急诊2019年1月—2020年1月期间收治的100例糖尿病高渗性昏迷患者,以随机数字表法为分组标准将其分为观察组(50例)和对照组(50例),对照组患者采用常规护理,观察组患者应用综合护理干预,比较两组患者空腹血糖、血清渗透压恢复时间、住院时间,患者护理后生活能力、心理功能、生理功能及社会功能的生活质量评分情况。结果护理后观察组患者空腹血糖恢复时间、血清渗透压恢复时间以及住院时间均比对照组患者更少,差异有统计学意义(P<0.05),表明观察组患者康复更快。在生活质量方面,观察组患者各项指标评分均高于对照组,差异有统计学意义(P<0.05)。结论为医院急诊糖尿病高渗性昏迷患者提供综合护理干预,效果显著,有助于促进患者尽早恢复,控制血糖,提高生活质量。