Neutrophil Bactericidal Function in Diabetes Mellitus: Evidence for Association with Blood Glucose Control

Neutrophil bactericidal activity was assessed in patients with type 1 (n=45) and Type 2 diabetes mellitus (n=68) and non-diabetic control subjects (n=40) by measurement of whole blood chemiluminescence. Though chemiluminescence values tended to be highest in the non-diabetic subjects these differences were not statistically significant (mean ± SD) (2.73 ± 1.65 mV (controls), 2.33 ± 1.41 mV (Type 1 diabetes) and 2.38 ± 1.12 mV (Type 2 diabetes), F=1.12, p=0.33). Significant negative correlations were evident, however, in patients with both Type 1 and Type 2 diabetes between chemiluminescence and glycated haemoglobin (r_s=-0.35, p=0.005 (Type 1), r_s=-0.45, p=0.002 (Type 2), fructosamine (r_s=-0.36, p=0.003 (Type 1), r_s=-0.42, p=0.004 (Type 2)), and random blood glucose (r_s=-0.25, p=0.04 (Type 1), r_s=-0.48, p=0.001 (Type 2)). Changes in whole blood chemiluminescence in a further group of 10 patients with Type 2 diabetes mellitus commenced on insulin therapy were followed for 21 days. Serum fructosamine concentrations fell significantly over this time (524 ± 58 μmol l^?1 to 405 ± 47 μmol l^?1, p<0.001), however, although chemiluminescence values tended to rise these changes were not statistically significant (1.01 ± 0.38 mV to 1.60 ± 0.91 mV, S=4.24, df=5, p=0.52). These results suggest that impaired neutrophil bactericidal function is associated with poor blood glucose control. While it is likely that neutrophil bactericidal function will improve as blood glucose control improves, further studies are required both to confirm this and to demonstrate a reduction in the incidence of clinical bacterial infection.     

Treatment of diabetic autonomic neuropathy with an aldose reductase inhibitor

To evaluate the effects of the aldose reductase inhibitor Ponalrestat (Statil) on diabetic autonomic neuropathy, a double-blind placebo controlled trial was carried out on a group of 34 diabetic patients with documented cardiac autonomic neuropathy. After a 4-week, placebo run-in period, patients were randomised for treatment with 600 mg Statil or placebo for another 24 weeks. Moreover, the reliability of the autonomic nerve function tests was investigated by comparing the results at onset and at week 4. Fifteen patients treated with Statil and 12 with placebo completed the study. Neither symptom scores nor cardiovascular reflexes, pupil reflexes and skin vasomotor reflexes improved after Statil therapy, which led us to conclude that Statil is not effective in the treatment of diabetic autonomic neuropathy. Reliability coefficients for cardiovascular reflexes and pupil reflex showed high values, ranging from 60% to 80%. Therefore these methods are recommended in future therapy trials.     

Therapeutic traditions in type 2 diabetes — are they changing?

The utilisation of antidiabetic drugs reflects both the prevalence of diabetes and the different therapeutic traditions of physicians. A questionnaire survey to study attitudes to the use of oral antidiabetic drugs amongst physicians and possible changes in treatment habits was carried out in a representative sample of Finnish physicians (n=454) in 1992 and the results were compared with those of a similar survey carried out in 1985, and with drug utilisation statistics.The mean fasting blood glucose level at which a physician would start pharmacological treatment was 8.7 mmol·l^–1, which was significantly lower than in the 1985 survey. The responses to various case histories suggested a more active approach to pharmacological treatment compared to the 1985 survey. Insulin treatment especially seems to have gained in popularity. This change in attitude was paralled by an increase in the consumption of antidiabetic drugs in Finland during the observation period. The increase in use of oral drugs was steeper in Finland than in Norway and Sweden.Whether this active approach will improve the metabolic control and prognosis of patients with Type 2 diabetes, remains to be demonstrated.     

糖尿病患者微血管病变与血小板功能

测定21例有微血管病变和27倒无并发症的糖尿病人血小板功能，并与40例正常人作比较。结果发现糖尿病人，尤其是微血管病变者血浆血栓烷素（TXB2）、第八因子相关抗原（VWF）浓度及血小板膜糖蛋白（G、P）Ib显著高于对照组。提示血小板功能异常可能对糖尿病患者做血管并发症的发生起重要作用。     

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。     

头颈部肿瘤合并糖尿病的围手术期处理

目的探讨头颈部肿瘤合并糖尿病患者围手术期的处理方法.方法从2001年1月～2003年6月我科收治的头颈部肿瘤450例,对其中33例合并糖尿病患者使用胰岛素控制血糖的资料进行分析.结果 28例无并发症发生,切口感染2例,腮腺漏2例,心律失常1例,无围手术期死亡.结论对于合并糖尿病的头颈部肿瘤患者,合理使用胰岛素控制血糖是围手术期处理的主要方法,是安全渡过围手术期的重要保证.     

实验性糖尿病早期大鼠背根神经节一氧化氮合酶基因表达的变化

目的：观察糖尿病早期(2周)大鼠背根神经节(DRG)中一氧化氮合酶(nNOS、iNOS、eNOS)的表达变化以及胰岛素对其的影响。方法：按60mg／kg一次性腹腔注射链脲佐菌素(STZ)制备胰岛素依赖性糖尿病大鼠模型(16只)，造模成功后随机分成2组(模型组和治疗组)，治疗组于造模成功后第2天开始给予胰岛素治疗，正常对照组(8只)与模型组予皮下注射同样体积的生理盐水。2周后取各组大鼠背根神经节，Trizol法提取总RNA，应用RT—PCR法测定3种NOS mRNA的表达。结果：在糖尿病早期大鼠DRG中，iNOS表达明显上调，胰岛素能有效逆转此变化。而nNOS和eNOS的表达无明显变化。结论：在早期糖尿病DRG中iNOS基因表达异常，可能与糖尿病外周神经病变的发生发展有关。     

氟西汀对2型糖尿病合并抑郁症患者下丘脑-垂体肾上腺轴功能及临床疗效的影响

目的探讨氟西汀对 2型糖尿病合并抑郁症患者的下丘脑 垂体 肾上腺轴 (HPA)功能的影响及其临床意义。方法测定 98例 2型糖尿病患者和 3 4例正常对照组基础血皮质醇 (F ,0 8:0 0am、16:0 0pm)、小剂量地塞米松抑制试验 (DST)后血F、2 4h尿游离皮质醇 (UFC)。将 64例 2型糖尿病伴发抑郁症患者随机分成A组 (服用氟西汀组 ,3 2例 )和B组 (未服用氟西汀组 ,3 2例 )。予 6周治疗。分别于治疗前、后进行HAMD评分及代谢控制水平评估。结果 ( 1)血F( 0 8:0 0am、16:0 0pm)、2 4h尿UFC、DST脱抑制例数2型糖尿病患者较正常对照组增高 (P <0 .0 1) ,2型糖尿病伴抑郁症组 (DD组 )较无抑郁症组 (DM组 )增高(P <0 .0 5 ,P <0 .0 1)。 ( 2 )经 6周治疗后 ,服用氟西汀组 (A组 )较未服用氟西汀组 (B组 )糖皮质激素水平降低 (P <0 .0 1)、HAMD评分降低 (P <0 .0 1) ,糖脂代谢改善 (P <0 .0 5 ,P <0 .0 1)。 ( 3 ) 2 4h尿UFC与HbA1C呈正相关性 (r =0 .5 69,P <0 .0 1)、IR呈正相关 (r =0 .65 3 ,P <0 .0 1)、与HAMD评分呈正相关性 (r =0 .3 5 2 ,P <0 .0 5 )。结论 2型糖尿病及合并抑郁症患者HPA轴功能紊乱 ,加重了糖代谢紊乱和胰岛素抵抗 ;氟西汀干预治疗抑郁症可改善抑郁症和糖脂代谢。     

茂名石化公司社区居民的慢性病调查及饮食建议

目的　探究成人肥胖与高血压、糖尿病的关系 ,并给予饮食方面的建议。方法　抽样调查。在社区内抽样 2 891名居民 (2 0～ 74岁 ,曾在三个生活小区之一居住 5年以上者 ) ,分析其患肥胖及其他相关因素。结果　肥胖症及超体重率分别为 4 . 0 1%、2 2 . 97%。经标准化后肥胖症发生率为 3 2 3% (男 3 .0 5 % ,女3. 4 2 % ) ,超体重率为 19. 5 5 % (男 2 2 . 4 2 % ,女 16 . 5 % )。而且 ,所有肥胖人群中发生高血压和糖尿病的危险百分率分别是 1 70、2 13。结论　在茂名石油公司社区成人超体重和患肥胖症的情况是严峻的 ,适当的营养和合理的膳食干预是减少高血压、糖尿病等慢性病发病率的有效措施之一。     

糖尿病早期肾损害指标的探讨

目的　探讨早期诊断糖尿病肾损害的方法。方法　采用免疫透射比浊法检测尿转铁蛋白 (TF)和尿微量白蛋白(mALB) ,速率法检测尿N 乙酰 B D 氨基葡萄糖苷酶 (NAG) ,Jaffe速率法测尿肌酐。结果　糖尿病患者尿蛋白定性阴性的尿TF、mALB、NAG均较对照组显著增高 (p <0 0 1) ,单项及双项检测TF、mALB、或NAG这三项指标阳性率偏低 ,联合三项检测阳性率可达 91 1%。结论　检测尿中TF、mALB、NAG是诊断糖尿病早期肾损害指标的敏感指标