早期应用胰岛素泵控制高血糖与重型颅脑损伤预后研究

目的 探讨早期应用胰岛素泵控制重型颅脑损伤后高血糖与患者预后的关系.方法 80例格拉斯哥昏迷量表(GCS)评分≤8分的重型颅脑损伤后高血糖患者,根据入院时GCS评分分为G1组(GCS评分3～5分,39例),G2组(GCS评分6～8分,41例);根据高血糖控制方法的不同,按随机数字表法分为胰岛素皮下持续输注(CSⅡ)治疗组40例,多次皮下胰岛素注射(MSⅡ)治疗组40例,均控制血糖目标在相同范围.记录两组治疗后达到目标血糖所需时间、胰岛素用量、低血糖反应发生情况及治疗2个月的格拉斯哥预后量表(GOS)评分.结果 G1组入院随机血糖为(12.0±2.4) mmol/L,G2组人院随机血糖为(8.6±1.5) mmol/L,差异有统计学意义(P＜0.05).CSⅡ治疗组与MSII治疗组比较,血糖达标时间明显缩短[(3.35 ±0.98)d比(6.20±1.02)d]、胰岛素用量明显减少[(39.3±7.6) U/d比(52.6±10.2) U/d]、低血糖发生率亦明显降低[5.0％(2/40)比15.0％.(6/40)],差异均有统计学意义(P＜0.05).80例患者中预后良好42例,血糖水平为(7.1±1.8)mmol/L,预后较差26例,血糖水平为(9.1±2.2) mmol/L,死亡12例,血糖水平为(11.9±2.5) mmol/L,差异有统计学意义(P＜0.05).结论 早期胰岛素泵治疗能够快速平稳控制重型颅脑损伤后高血糖,而且能够明显改善重型颅脑损伤患者的预后.     

Neuroprotective effect of Momordica charantia in global cerebral ischemia and reperfusion induced neuronal damage in diabetic mice

Ethnopharmacological relevance

Momordica charantia L. (Cucurbitaceae) fruits have been used traditionally for centuries, especially for treating diabetes and associated complications.

Aim of the study

The present study was performed to evaluate neuroprotective effect of lyophilized M. charantia fruit juice against global cerebral ischemia and reperfusion induced neuronal injury in diabetic mice.

Materials and methods

Global cerebral ischemia induced by occluding both common carotid arteries for 10 min followed by 24 h reperfusion was used to induce neuronal injury. Ischemia-reperfusion induced neuronal injury was evaluated in terms of cerebral infarct size, generation of free radicals measured as thiobarbaturic acid reactive substances (TBARS), and neurological functions measured as short term memory and motor activity.

Results

The cerebral oxidative stress and damage, and neurological deficits were dose dependently attenuated by pre-treatment with the lyophilized M. charantia juice (200-800 mg/kg, p.o., o.d.). Moreover, M. charantia also exhibited dose dependent antihyperglycemic activity in diabetic mice.

Conclusions

These results suggest that M. charantia has potent neuroprotective activity against global cerebral ischemia-reperfusion induced neuronal injury and consequent neurological deficits in diabetic mice.     

创伤后早期神经内分泌改变与应激性高血糖

为观察应激时血糖代谢与神经内分泌改变的关系，探讨胰岛素抵抗的机制和意义。对外科大手术后病人30例，于术毕即刻（AS）、脱离呼吸机后（AW）和术日次晨（NW）分别测定外周血糖和胰岛素（INS）、C－肽（GP）、皮质醇（CDRT）、促肾上腺皮质素（ACTH）、生长激素（GH）、胰高糖素（GL）（以上放免法），肾上腺素（E）和去甲肾上腺素（NE）（高效液相色谱法）水平。结果：术后患者的血糖及CORT、ACTH、E和NE均显著升高，分别为2．3g／L，280．7μg／L、47．6ng／L、324．4ng／L和1511．0ng／L，脱机后逐渐下降，至次展显著降低，分别为1．89g／L、134．4μg／L、7．38ng／L、92．6ng／L和9755ng／L。C－P明显升高并和INS一起逐渐递增，在AS和NM分别为3．59μp／Lvs．5．27μg／L和20．8mU／Lvs．32．7mU／L。GH和GL3个时相均在正常范围。结论：外科术后早期存在应激性高血糖和胰岛素抵抗，血糖水平主要受NE调节，24小时后逐渐复常，胰岛素抵抗的原因在于效应细胞的受体下调，是机体应激时重要的自我保护手段。     

Spice plant Allium cepa: Dietary supplement for treatment of type 2 diabetes mellitus

ObjectiveDiabetes mellitus (DM) is associated with significant morbidity and mortality and its prevalence is increasing worldwide. Although conventional antidiabetic agents are known to ameliorate the symptoms of diabetes, they also may cause adverse effects. The purpose of this review was to organize and discuss various studies that have been previously conducted indicating the efficacy of Allium cepa in DM.MethodsA comprehensive English literature search was conducted using various electronic search databases. Different search terms were used and an advanced search was conducted by combining all the search fields in abstracts, keywords, and titles.ResultsAllium cepa, a spice plant, is commonly known as onion and belongs to the family liliaceae. Since ancient times, it has been used traditionally for the treatment of different diseases. Among various activities of Allium cepa, regulation of hypoglycemic activity is considered one of its important effects in DM. Sulfur compounds including S-methylcysteine and flavonoids such as quercetin are mainly responsible for the hypoglycemic activity of Allium cepa. S-methylcysteine and flavonoids help to decrease the levels of blood glucose, serum lipids, oxidative stress, and lipid peroxidation, as well as increasing antioxidant enzyme activity and insulin secretion. Extracts of onion also have been shown to have hypoglycemic and hypolipidemic effects by normalizing the activities of liver hexokinase, glucose 6-phosphatase and HMG coenzyme-A reductase. In preliminarily clinical trials, patients with diabetes safely consumed slices of Allium cepa, exhibiting sufficient hypoglycemic activity. In the future, further studies must be conducted to investigate and confirm the hypoglycemic activities of Allium cepa and its constituents and/or their synthetic analogs.ConclusionThis review will not only elucidate the nutritious facts of Allium cepa but may also help in understanding the molecular basis of its effects in DM. This review will explore in particular the medicinal characteristics of Allium cepa supporting that the consumption of dietary onion could lower blood glucose levels, thus contributing to the reduction of risk factors associated with DM.     

血糖控制与合并应激性高血糖危重症患者预后的关系探讨

目的探讨不同血糖控制水平与重症监护病房(ICU)危重症应激性高血糖患者预后的关系。方法将192例合并应激性高血糖的危重症患者随机分为强化治疗组(目标血糖4.1～6.1mmol/L)57例、胰岛素常规治疗组(目标血糖6.1～8.1mmol/L)76例和对照组(目标血糖8.1～11.1mmol/L)59例。比较3组患者ICU停留时间,院内感染、全身炎性反应综合征(SIRS)、多器官功能衰竭综合征(MODS)、低血糖发生率及病死率。结果强化治疗组和常规治疗组ICU停留时间短于对照组,院内感染、SIRS、MODS发生率及病死率均明显低于对照组,差异均有统计学意义(P<0.05或P<0.01)。胰岛素强化治疗组SIRS、低血糖发生率和病死率均高于常规治疗组,差异均有统计学意义(P<0.05)。结论积极控制危重症患者合并的应激性高血糖有利于改善患者的预后,将目标血糖控制在6.1～8.1mmol/L间获益最大。     

超负荷血糖对鼠脑缺血再灌注后神经细胞凋亡及FADD、Daxx表达的影响

目的 观察超负荷血糖对大鼠脑缺血再灌注缺血半暗带侧皮质区FADD、Daxx表达的影响,进一步探讨超负荷血糖加重脑缺血再灌注损伤的分子机制.方法 SD大鼠腹腔内注射链脲佐菌素(STZ),建立糖尿病高血糖大鼠模型,之后应用栓线法建立大鼠脑缺血再灌注模型.随机分为三大组:假手术组(A)、脑缺血再灌注组(B)和糖尿病脑缺血再灌注组(C).于缺血1h再灌注12h行神经功能评分,TTC染色测梗死面积,Tunel法检测细胞凋亡数目,免疫组化及Western blot检测FADD、Daxx的表达,并进行图像分析.结果 糖尿病脑缺血再灌注组的神经功能评分为(3.50±0.55),梗死面积为(39.99±2.23),细胞凋亡数为(27.51土3.43),免疫组化检测FADD为(110.18±4.21)、Daxx为(101.26士3.27);Western blot检测FADD为(1.191±0.041),Daxx为(1.389±0.052).脑缺血再灌注组的神经功能评分为(2.67±0.81),梗死面积为(30.13±2.04),细胞凋亡数为(18.28±2.09),免疫组化检测FADD为(131.46士3.24),Daxx为(123.16士2.19);Western blot检测FADD为(1.035±0.032),Daxx为(1.146±0.083).与脑缺血再灌注组相比,糖尿病脑缺血再灌注组的神经功能评分、梗死面积、细胞凋亡数、FADD及Daxx蛋白表达均明显增加(P＜0.05).结论 FADD、Daxx可能参与了超负荷血糖加重脑缺血再灌注损伤过程,上调FADD、Daxx表达可能是超负荷血糖加重脑缺血再灌注损伤的机制之一.     

30岁以上人群空腹血糖水平的实验室调查

目的 了解来我院检测血糖的、≥30岁的人群的空腹血糖状况.方法 取近2年来我院就医的、年龄≥30岁的患者以及来我院作健康检查的人共34 318例,于早上空腹取受检者静脉血,用罗氏H7600全自动生化仪检测血糖,然后分6个年龄段分性别进行统计分析.结果 各个年龄段正常血糖、空腹血糖受损和高血糖在组内比较,差异均有统计学意义（P＜0.01）;男性和女性的正常血糖检出率均以30岁年龄段最高,空腹血糖受损检出率均以50岁年龄段最高,高血糖检出率均以＞ 80岁最高;空腹血糖受损和高血糖所占比例在男女之间差不多;全体受检人群空腹血糖受损者占11.9％,高血糖者占12.7％.结论 与全国性总糖尿病患病率相比,来我院作血糖检测的人群的糖尿病发病率和/或患病率比较高.     

体重指数对血压、血糖、血脂及尿酸的影响

目的探讨体重指数（BMI）对血压、血糖、血脂及尿酸的影响。方法对2011年医院体检中心3404名健康体检人群的BMI、血压、血糖、血脂、尿酸等结果进行统计分析。结果超重检出率为33．84％,肥胖检出率为15．54％;随BMI的升高,高密度脂蛋白胆固醇水平减低,收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、尿酸、低密度脂蛋白胆固醇水平逐渐升高,高血压、高血糖、高血脂、高尿酸检出率亦增高。结论健康体检人群超重、肥胖率较高,超重、肥胖与高血压、高血糖、高血脂、高尿酸关系密切,需早期采取有效措施控制超重和肥胖倾向。     

Addressing hyperglycemia from hospital admission to discharge

Abstract

Background:

This review examines glycemia management practices in hospitalized patients. Optimal glycemic control remains a challenge among hospitalized patients. Recent studies have questioned the benefit of tight glycemic control and have raised concerns regarding the safety of this approach. As a result, medical societies have updated glycemic targets and have published new consensus guidelines for management of glycemia in hospitalized patients. This review highlights recent inpatient glycemic trials, the new glycemic targets and recommended strategies for management of glycemia in hospitalized patients.     

Colesevelam in the treatment of hypercholesterolemia and hyperglycemia: a retrospective analysis from an ambulatory care medical network

Abstract

Objective:

To examine outcomes associated with colesevelam treatment among patients with hypercholesterolemia in real-world clinical practice.