糖尿病性大疱病40例治疗临床分析

目的：探讨糖尿病性大疱病临床治疗方法。方法：将临床诊断的糖尿病性大疱病40例病人分为两组：治疗组使用前列腺素E1^100μg静脉注射1次／日,并用注射器抽尽水疱内液,〉1cm的大疱内注入碘伏;对照组使用复方丹参注射液40m1静脉滴注,并用注射器抽尽水疱内液,予胰岛素外敷并包扎。两组均予以抗感染、降糖、全身并发症等相应治疗,共治疗2w。结果：治疗组治愈天数较对照组明显缩短,差异明显（P〈O．05）。结论：对糖尿病性大疱病患者进行前列腺素E1^100μg静脉注射1次／日,并用注射器抽尽水疱内液,然后注入碘伏入疱内治疗有明显疗效。     

Diabetes and Tooth Loss: An analysis of data from the National Health and Nutrition Examination Survey, 2003–2004

BackgroundThe authors conducted an analysis of data from the National Health and Nutrition Examination Survey (NHANES) to understand the association between diabetes and tooth loss in the United States.MethodsThe authors analyzed the oral examination and self-reported diabetes data obtained from the NHANES 2003–2004 cycle and included 2,508 participants representing a civilian, noninstitutionalized U.S. population 50 years and older. The authors calculated the prevalence of edentulism and the number of missing teeth among dentate people, and they used multiple regression analyses to assess the association between diabetes and tooth loss.ResultsThe prevalence of edentulism was 28 percent and 14 percent among people with and without diabetes, respectively. The multiple logistic regression analysis revealed that people with diabetes were more likely to be edentulous than were those without diabetes (adjusted odds ratio = 2.25; 95 percent confidence interval, 1.19–4.21). Among dentate adults, those with diabetes had a higher number of missing teeth than did adults without diabetes (mean [standard error {SE}] = 9.8 [0.67]), mean [SE] = 6.7 [0.29]); P < .01).ConclusionsThese study results revealed that adults with diabetes are at higher risk of experiencing tooth loss and edentulism than are adults without diabetes. One of every five cases of edentulism in the United States is linked to diabetes.Practical ImplicationsAlthough the association between diabetes and periodontal disease is well established, health care professionals also need to recognize the risk of tooth loss and its effect on quality of life among people with diabetes.     

糖尿病对大鼠骨组织白细胞介素-6及血清C反应蛋白水平的影响

目的探讨糖尿病对大鼠骨组织白细胞介素-6（interleukin-6,IL-6）表达和血清C反应蛋白（Creactiveprotein,CRP）水平的影响。方法48只sD大鼠随机分为糖尿病组38只和正常组10只。第24周时,2组大鼠检测血糖以及血清胆固醇、甘油三酯,免疫散射比浊法检测血清CRP浓度,取大鼠股骨及颌骨制作石蜡切片,免疫组织化学法检测大鼠骨组织中IL-6的表达情况。结果正常组和糖尿病组大鼠骨组织IL-6平均积分光密度值分别为16.42±4.25和18,78±2．14;正常组血糖、胆固醇、甘油三酯、C反应蛋白浓度分别为（3．910±0．396）mmol／L、（4．935±0．343）mmol／L、（2．137±0．092）mmol／L、（0．858±0.096）mg／L,糖尿病组血糖、胆固醇、甘油三酯、C反应蛋白浓度分别为（12．418±1．302）mmol／L．（5．041±0．336）mmolfL、（2．197±0．120）mmol／L、（5.948±0．860）mg／L。糖尿病组大鼠骨组织IL-6（t=0．642）表达以及胆固醇水平（t=0．850）与正常组比较差异无统计学意义（P〉0.05）;血糖（t=30．818）、甘油三酯（t=3．276）和C反应蛋白（t=30．751）与正常组比较,差异有统计学意义（P〈0.05）。结论糖尿病致体内多种炎症因子高表达,对于炎症类疾病的发展是一个危险信号。     

Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study

Context:

Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure.

Materials and Methods:

A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired ‘t’ test.

Results:

The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg (t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed (t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3.

Conclusions:

Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.     

糖尿病患者非心脏手术围术期心血管事件的危险因素

目的 筛选糖尿病患者发生围术期心血管事件(PCE)的危险因素.方法 择期行非心脏手术的糖尿病患者500例,根据围术期是否发生PCE分为PCE组和非PCE组.记录患者一般资料和麻醉方式、麻醉时间、术中血糖、血流动力学波动情况.将组间差异有统计学意义的因素进行logis-tic回归分析,筛选PCE的危险因素.结果 79例患者发生PCE,发生率为15.8％.2组患者年龄、甘油三酯水平、高敏C反应蛋白(hs-CRP)水平、血流动力学波动情况、ECG异常比率比较差异有统计学意义(P＜0.05).logistic回归分析结果显示,甘油三酯≥1.7 mmol/L、年龄≥65岁、hs-CRP≥8mg/L和术中血流动力学异常波动≥基础值30％是非心脏手术糖尿病患者PCE的危险因素.结论 高甘油三酯、老龄、高hs-CRP水平和术中血流动力学异常波动(≥基础值30％)是糖尿病患者非心脏手术围术期PCE的危险因素.     

糖尿病人群空腹血糖水平与新发脑梗死事件的相关性研究

目的 探讨糖尿病人群空腹血糖水平与新发脑梗死事件的相关性.方法 采用前瞻性队列研究方法,以空腹血糖≥7.0 mmol/L或＜7.0 mmol/L但已确诊为糖尿病、正在使用降糖药物的8 306例糖尿人群作为观察队列,随访(48.01 ±3.14)个月,随访期间每半年收集一次新发脑梗死事件情况.分析糖尿病人群空腹血糖水平与新发脑梗死事件的相关性.结果 (1)随访结束时,随着基线空腹血糖水平的增高,研究对象的总胆固醇、甘油三酯的水平逐渐增高[总胆固醇:(4.93±1.15,510±1.20,5.15± 1.28,5.33±1.35) mmol/L,甘油三酯:(1.70±1.26,1.83± 1.29,2.18±1.76,2.41±2.08) mmol/L,P＜0.05];低密度脂蛋白胆固醇、收缩压、舒张压、体重指数的水平也增高(P＜0.05).(2) 7.0 mmol/L≤空腹血糖＜9.0mmol/L组累积发生脑梗死事件率最低(2.1％,P＜0.01).校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体重指数、吸烟、糖尿病病程及降糖治疗因素,Cox比例风险回归分析表明,相对于7.0 mmol/L≤空腹血糖＜9.0 mmoL/L组,6.1 mmol/L≤空腹血糖＜7.0mmol/L组和空腹血糖≥9 mmol/L两组发生脑梗死事件的相对危险(RR)各分别增加1.85倍(95％CI 1.09～3.15,P＜0.05)、1.54倍(95％CI 1.16～2.05,P＜0.01).结论 糖尿病人群空腹血糖控制在7.0 ～9.0 mmol/L水平者似新发生脑梗死事件率最低.     

诱骗受体3和谷氨酸脱羧酶65重组腺病毒对糖尿病小鼠的作用研究

构建诱骗受体3(DcR3)和谷氨酸脱羧酶65( GAD65)重组腺病毒载体,转染树突状细胞,干预1型糖尿病小鼠,观察小鼠体内CD+8T细胞的活化抑制情况和血糖水平.结果显示转染重组腺病毒的树突状细胞能有效抑制GAD65特异性T细胞的增殖和细胞因子的分泌,γ-干扰素[(50.5±7.2)对(95.4±6.9)、(91.2±6.5)pg/ml]和白细胞介素2[(46.3±5.1)对(86.1±5.2)、(80.3±7.3) pg/ml]低于阴性和空白对照组(均P＜0.05),同时延缓1型糖尿病的发生.提示DcR3和GAD65重组腺病毒可用于1型糖尿病的基因治疗.     

OxLDL/LOX-1系统及NF-κB通路在糖尿病血管内皮功能障碍中的作用机制

腹腔注射链脲佐菌素建立糖尿病大鼠模型(DM组),结果显示糖尿病大鼠2周时氧化低密度脂蛋白(oxLDL)水平已高于正常对照大鼠[(2.87±0.40对2.27±0.36)μg/dl,P＜0.05],血管舒张反应迟钝;6周时oxLDL水平更高[(4.32 ±0.66) μg/dl,P＜0.01],乙酰胆碱诱导的血管环舒张最大百分比(Rmax)明显降低(P＜0.01),糖尿病大鼠主动脉植物血凝素样氧化低密度脂蛋白受体1( LOX-1)、NF-kB、内皮细胞间黏附分子1(ICAM-1)蛋白及mRNA表达明显高于正常对照大鼠(P＜0.01),糖尿病大鼠LOX-1 mRNA表达水平与外周血oxLDL水平、NF-kBp65、ICAM-1 mRNA表达水平正相关,与Rmax呈负相关.提示OxLDL/LOX-1系统可能通过激活NF-kB,上调ICAM-1的表达,导致糖尿病早期内皮功能障碍.     

DPP-4抑制剂与血糖稳态——从基础到临床

2型糖尿病的一个特征就是α、β细胞激素均有分泌缺陷.胰升糖素样肽1(GLP-1)具有α、β细胞激素双重调节作用,是近年来新型降糖药物的研究热点.DPP-4抑制剂单药或联合用药可升高GLP-1水平,有效降低HbAlC,可成为不同病程2型糖尿病患者的用药选择.