糖尿病肾内动脉血流动力学改变的研究

目的：观察糖尿病肾病不同时期肾内分级动脉血流动力学的改变。方法：用脉冲多普勒方法分别测量正常对照组、糖尿病正常蛋白尿阶段，隐匿性肾病．临床糖尿病肾病肾功能代偿期及糖尿病肾病肾功失代偿期各组肾内分级动脉Vmax、Vmin、TAMX、PI、RI血流参数．并与对照组比较。结果：糖尿病不同时期Vmax均增高．与正常对照组有显著性差异；Vmin随着病程的发展．逐渐减低；PI、RI随病情的进展逐渐增高．尤以糖尿病肾病肾功能代偿期及肾病肾功失代偿期明显。结论：多普勒超声是一种简便、直观、快速非创伤性检查糖尿病血流动力学改变的方法．通过对肾内分级动脉血流参数的观察．尤其是PI、RI的变化，判断糖尿病肾损害的程度。     

循环内皮细胞水平与糖尿病肾病的相关性及银杏达莫的干预作用

目的:探讨外周血循环内皮细胞(CEC)和糖尿病肾病(DN)的相关性,以及银杏达莫注射液在DN防治中的可能作用。方法:检测65例2型糖尿病患者24h尿白蛋白排泄率(UAER)及CEC数,分析两者的相关性。将UAER为30~300mg·d-1的45例患者随机分为两组,常规治疗组22例,进行常规降血糖、控制血压等治疗;银杏达莫治疗组23例,在常规治疗基础上静脉滴注银杏达莫注射液2周。比较两组治疗前后血糖、血压、UAER及CEC水平的变化。结果:单纯糖尿病(SDM)组和早期糖尿病肾病(EDN)组的外周血CEC水平比对照组(NC)显著性升高,并呈逐渐增高的趋势(P<0.01)。UAER与收缩压(SBP)、外周血CEC水平呈正相关(P<0.01)。EDN组中,银杏达莫治疗后UAER及CEC明显降低(P<0.01);而常规治疗组无明显变化。线性多元逐步回归分析表明,银杏达莫治疗后UAER的改变与CEC数的变化成正相关(P<0.01)。结论:血管内皮细胞(VEC)损伤在DN发生发展中起重要作用,银杏达莫对VEC的保护作用可能是其延缓DN发展的重要机制。     

Improvement of endoneurial lipid abnormalities in experimental diabetic neuropathy by oxygen modification

Endoneurial hypoxia and a high frequency of closed capillaries have been found in chronic experimental diabetes and human diabetic sural nerve, respectively. These findings have led to the hypothesis that the pathogenesis of diabetic neuropathy is due to endoneurial hypoxia. To evaluate the role of endoneurial hypoxia in experimental diabetic neuropathy, the effects of supplementation and deprivation of oxygen on peripheral nerve lipid biosynthesis were studied in normal control and streptozotocin-induced diabetic rats. Defective lipid biosynthesis in diabetic nerve was partially prevented by oxygen supplementation. When normal rats were placed in a hypoxic chamber, lipid abnormalities similar to those observed in diabetic nerves were demonstrated in the absence of changes in nerve free sugars. These findings suggest that endoneurial hypoxia may underlie some key biochemical abnormalities encountered in experimental diabetic neuropathy.     

Circulating adipocytokines in non-diabetic and Type 1 diabetic children: relationship to insulin therapy, glycaemic control and pubertal development.

AIM: To determine the influence of Type 1 diabetes mellitus on circulating adipocytokines in children. METHODS: The circulating concentrations of leptin, adiponectin, resistin and tumour necrosis factor (TNF)-alpha were measured in 91 children, aged 11.1 +/- 2.7 years, with Type 1 diabetes mellitus (T1DM). Ninety-one healthy children were selected as control subjects. RESULTS: Body mass index-adjusted leptin concentrations were higher in the pubertal diabetic children compared with the control children. There was a significant positive correlation between leptin and daily insulin dose in the diabetic group. Circulating adiponectin concentrations were higher in the prepubertal diabetic children and were positively associated with HbA(1c). Resistin concentrations were lower in the prepubertal non-diabetic subjects compared with the pubertal non-diabetic children, whose values were higher than those of the diabetic children. TNF-alpha concentrations were similar in non-diabetic and diabetic children. CONCLUSIONS: Circulating concentrations of adipocytokines are abnormal in Type 1 diabetic children, although the direction of change differs by cytokine. Pubertal development, in addition to insulin treatment and glycaemic control, also influences the concentrations.     

Chronic vitamin E treatment prevents defective endothelium-dependent relaxation in diabetic rat aorta

Summary We examined the effect in rats of 2 months of streptozotocin-induced diabetes mellitus on relaxation and contraction of aortas in vitro. A further diabetic group was treated from time of diabetes induction with a 1% dietary supplement of vitamin E. Diabetes caused a 26.5% deficit (p<0.001) in maximum endothelium-dependent relaxation to acetylcholine in phenylephrine-precontracted aortas. This was 64.3% attenuated (p<0.01) by vitamin E treatment; maximum relaxation was not significantly altered compared to non-diabetic rats. Vitamin E treatment of non-diabetic rats did not significantly affect acetylcholine-induced relaxation. Diabetes or treatment did not significantly alter acetylcholine sensitivity. Endothelium-independent relaxation response to glyceryl trinitrate was not affected by diabetes or vitamin E treatment, indicating that vascular smooth muscle responses to nitric oxide remained unaltered. There was a 35.4% reduction in the maximum contractile response to phenylephrine with diabetes (p<0.05) which was unaffected by vitamin E treatment. The data suggest that the chronic deficit in nitric oxide-mediated endothelium-dependent relaxation in diabetes depends largely upon excess activity of reactive oxygen species. Treatment with vitamin E to increase free radical scavenging specifically protected vascular endothelium although it had no effect on deficits in vascular smooth muscle contractile responses.Abbreviations NO Nitric oxide - ARI aldose reductase inhibitor - ACH acetylcholine - GTN glyceryl trinitrate - GSH reduced form of glutathione - EC₅₀ effective concentration for 50% of the maximal response     

丹参注射液治疗糖尿病周围神经病变

筛选出非胰岛素依赖型糖尿病伴周围神经病变患者５３例，随机分两组。两组患者均接受糖尿病常规治疗，同时其中一组加用丹参注液治疗，一组做为对照，结果显示：与对照组相经治疗组症状改善显著，并且改善症状所需时间也缩短，表明丹参注射液有助于糖尿病周围神经病变的恢复。     

糖尿病大鼠肺病理改变及同期肾脏病理变化对比

目的:观察糖尿病(DM)大鼠肺组织改变及与同期肾脏变化的关系.方法:链脲菌素腹腔注射制作糖尿病大鼠模型,4周后胶原、网状纤维染色及透射电镜方法观察糖尿病大鼠肺组织基底膜病理改变,同期观察肾脏改变.结果:DM大鼠4周后肺组织病理改变为毛细血管基底膜及Ⅱ型肺泡上皮细胞基底膜不同程度的增厚及肺间质胶原成分等细胞外基质的增多,与同期糖尿病肾脏病变相平行.结论:DM大鼠4周后肺组织与糖尿病肾病相似,主要表现为微血管病变.     

解毒保肾汤治疗早期糖尿病性肾病

[目的 ]观察解毒保肾汤治疗早期糖尿病性肾病的疗效 .[方法 ]将诊断为早期糖尿病性肾病的病人随机分为 2组 ,其中治疗组 4 4例给予解毒保肾汤 ,对照组 2 0例给予阳性对照药络汀新 ,观察治疗前后 2组病人的临床症状、空腹血糖、糖化血红蛋白量及尿蛋白排泄率等的变化 .[结果 ]治疗组总有效率为 80 % ,对照组总有效率为 6 5 % ,治疗组疗效优于对照组 ;治疗组在改善临床症状 ,降低空腹血糖、糖化血红蛋白量及尿蛋白排泄率等方面均优于对照组 .[结论 ]解毒保肾汤能够降低早期糖尿病性肾病患者的血糖、减少尿蛋白的排泄 ,具有一定的保护肾脏功能 ,对早期糖尿病性肾病有治疗作用 .     

LOWER POSTPRANDIAL PLASMA GLUCOSE AND INSULIN AFTER ADDITION OF ACACIA CORIACEA FLOUR TO WHEAT BREAD

Many Australian Aboriginal bushfoods contain slowly digested carbohydrate which elicit low postprandial blood glucose and insulin responses compared to Western foods, such as wheat bread. This study has shown that incorporation of flour made from a slowly digested seed, Acacia coriacea , into wheat bread (18 g/82 g wheat flour) significantly reduces the initial rise in plasma glucose levels ( p < 0.05) and the area under the plasma glucose curve ( p < 0.005) in six healthy subjects. Insulin values were also lowered at 60 minutes ( p < 0.025) and 90 minutes ( p < 0.05). Our findings suggest that Acacia flour, when used to dilute wheat flour in the manufacture of breads, produces a very palatable food which could be useful in the diets of diabetic individuals.     

Sick day management using blood 3-hydroxybutyrate (3-OHB) compared with urine ketone monitoring reduces hospital visits in young people with T1DM: a randomized clinical trial.

AIMS: Diabetic ketoacidosis (DKA), a life-threatening acute complication of Type 1 diabetes, may be preventable with frequent monitoring of glycaemia and ketosis along with timely supplemental insulin. This prospective, two-centre study assessed sick day management using blood 3-hydroxybutyrate (3-OHB) monitoring compared with traditional urine ketone testing, aimed at averting emergency assessment and hospitalization. METHODS: One hundred and twenty-three children, adolescents and young adults, aged 3-22 years, and their families received sick day education. Participants were randomized to receive either a blood glucose monitor that also measures blood 3-OHB (blood ketone group, n = 62) or a monitor plus urine ketone strips (urine ketone group, n = 61). All were encouraged to check glucose levels > or = 3 times daily and to check ketones during acute illness or stress, when glucose levels were consistently elevated (> or = 13.9 mmol/l on two consecutive readings), or when symptoms of DKA were present. Frequency of sick days, hyperglycaemia, ketosis, and hospitalization/emergency assessment were ascertained prospectively for 6 months. RESULTS: There were 578 sick days during 21,548 days of follow-up. Participants in the blood ketone group checked ketones significantly more during sick days (276 of 304 episodes, 90.8%) than participants in the urine ketone group (168 of 274 episodes, 61.3%) (P < 0.001). The incidence of hospitalization/emergency assessment was significantly lower in the blood ketone group (38/100 patient-years) compared with the urine ketone group (75/100 patient-years) (P = 0.05). CONCLUSIONS: Blood ketone monitoring during sick days appears acceptable to and preferred by young people with Type 1 diabetes. Routine implementation of blood 3-OHB monitoring for the management of sick days and impending DKA can potentially reduce hospitalization/emergency assessment compared with urine ketone testing and offers potential cost savings.