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1.
2.
Beat Morell Manuel Meyer Othmar Porr Ulrich Bay Ernst R. Froesch 《Acta diabetologica》1984,21(4):303-313
Summary The objective of this study was to follow the development of microalbuminuria and nerve conduction velocity under continuous
i.v. insulin therapy over a limited period of 4 months. For this purpose, 8 labile type I diabetics were selected (age 33±8
years, duration of diabetes 16±9 years) and treated conventionally with two insulin injections daily over 4 months. Afterwards,
the same patients were treated with continuous i.v. insulin infusion and finally again with two injections daily over 4 months
each. This procedure allowed each diabetic to serve as his own control. HbA1, microalbuminuria, nerve conduction velocity and relative refractory period of the ulnar nerve were checked at montly intervals.
During the continuous i.v. infusion over 4 months, blood sugar values were significantly lower, glucosuria had disappeared
almost completely and the glycosylated hemoglobin had fallen to near normal values. The mean rate of albumin excretion was
16±5 μg/min at rest and 76±26 μg/min during exercise (normal: 3.9±0.4 and 4.8±1.2 μg/min, respectively) and did not change
significantly. Nerve conduction velocity in the ulnar nerve rose significantly under i.v. insulin therapy from 47.9±0.6 m/sec
to 52±0.6 m/sec. Similarly, the relative refractory period of the same nerve fell significantly from 3.7±0.2 to 1.9±0.1 msec
(i.e. to within normal range). It is concluded that functional disturbances of peripheral nerve can regress by improved blood
sugar control with continuous i.v. insulin infusion over 4 months. On the other hand, incipient microangiopathy measured as
microalbuminuria remains unchanged over the same period of time. If an improvement is at all possible, considerably longer
periods of euglycemia are likely to be necessary.
Supported by Grant No. 3.964-0.80 from the Swiss National Science Foundation. 相似文献
3.
Summary Morphological change of endoneurial and perineurial vessels accompanied severe loss of myelinated axons in peripheral nerves of each of 17 patients with diabetic neuropathy. Vascular mural thickening averaged 18.9±9.9 m2 in diabetic capillaries (n=11) vs. 6.9±4.1 m2 in controls (n=7). Electron microscopy revealed vigorous endothelial proliferation as well as thickening and reduplication of basal lamina in each instance. Particular attention was paid to vessels which penetrate the perineurium en route to the endoneurial intertitium, since they provide a major portion of the endoneurial blood supply. Luminal narrowing and mural thickening of these vessels was compounded by basal laminar thickening of the perineurium. Fenestrated endoneurial capillary endothelium was noted in one case. Both demyelination and axonal degeneration were observed with intra-axonal glycogen accumulation in some axons. Morphometric analysis revealed extensive myelinated nerve fiber loss in diabetic nerves. These morphological findings emphasize the impact of diabetic microangiopathy on specialized endothelium and suggest that local anatomic factors in the perineurial sheath render the nerve vulnerable to chronic ischemia.Supported in part by the National Institute for Communicative Disorders and Stroke NS-14162 and by the Veterans Administration Research Service 相似文献
4.
Summary Although careful measurement of the size of capillary loops is mandatory in the evaluation of diabetic microangiopathy, no
current technique allows rapid and careful morphometric analysis of capillaroscopic findings. In an attempt to solve this
problem, assembling readily available instruments, the authors have set up an original apparatus for computed videomicroscopy.
The apparatus ensures detailed morphological assessment of single loops at high magnification. Each single frame stored on
videocassettes can be digitalized for morphometric analysis, saved on floppy disk or printed by means of a graphic printer. 相似文献
5.
Microangiopathy is characterized by capillary basement membrane thickening and microthrombus formation. The process of microangiopathy involves multiple organs and tissues, and seriously endangers the patients’ health and quality of life during the later stage. Recent evidence shows that microRNAs play an important role in the regulatory mechanism of microangiopathy, including inflammatory response, oxidative stress, abnormalities of glucose and lipid metabolism, abnormal activation of the rennin-angiotensin system and so on. The regulatory mechanism has unique features of microangiopathy in different organs. At present, more and more attention has been paid to the roles of microRNAs in the pathogenesis of microangiopathy. 相似文献
6.
C. Ducos M. Rigo A. Larroumet M.-N. Delyfer J.-F. Korobelnik M. Monlun N. Foussard P. Poupon M. Haissaguerre L. Blanco K. Mohammedi V. Rigalleau 《Diabetes & metabolism》2021,47(1):101156
AimsAs diabetic retinopathy (DR) can occur even in well-controlled patients with type 2 diabetes (T2D), our study sought to determine whether it might be related to ‘glucose memory’ by evaluating patients’ HbA1c over previous years and their skin autofluorescence (SAF).MethodsIn 334 patients with T2D and HbA1c levels ≤ 8%, their available values of HbA1c from previous years were collected, and their SAF measured by an advanced glycation end-product (AGE) reader. Binary logistic regression analysis was then used to correlate DR with previously recorded HbA1c levels and to SAF, with adjustment for DR risk factors [age, gender, BMI, duration of diabetes, arterial hypertension, diabetic kidney disease (DKD), blood lipid levels and statin treatment].ResultsOur patients were mostly men (58.4%) aged 63 ± 10 years, with a duration of diabetes of 13 ± 10 years and HbA1c = 7.1 ± 0.7%. Of these patients, 84 (25.1%) had DR, which was associated with longer duration of diabetes and greater prevalence of DKD. A total of 605 HbA1c values from previous years were collected for time periods ?4 ± 3 months (n = 255), ?16 ± 4 months (n = 152), ?30 ± 4 months (n = 93) and ?62 ± 26 months (n = 105). After adjustment, the association between DR and having an HbA1c higher than the median was significant only for the oldest previous HbA1c values: OR = 6.75, 95% CI: 1.90–23.90. Moreover, SAF values were higher in those with DR [2.95 ± 0.67 arbitrary units (AU)] vs 2.65 ± 0.65 AU with no DR (P < 0.01) and were also associated with the oldest previous HbA1c values (P < 0.01).ConclusionOur study found that 25.1% of our well-controlled T2D patients had DR, which was related to both their HbA1c levels from 5 years prior to study admission and their SAF values, a marker of glucose memory. 相似文献
7.
Makino N Maeda T Sugano M Satoh S Watanabe R Abe N 《Journal of diabetes and its complications》2005,19(6):347-355
A high dose of tumor necrosis factor (TNF)-alpha induces endothelial dysfunction and enhances apoptosis in vitro. The present study was conducted to examine whether incubating human umbilical vein endothelial cells (HUVECs) with serum from Type 2 diabetic patients complicated with retinopathy and/or microalbuminemia demonstrate endothelial dysfunction. Serum levels of TNF-alpha and vascular endothelial growth factor (VEGF) were elevated in diabetic patients. Plasma levels of TNF-alpha, two soluble TNF-alpha receptors (sTNFR), and VEGF were assessed in diabetic patients (CD, n=21) complicated with retinopathy and/or nephropathy, uncomplicated diabetic patients (UD, n=18), and in healthy normal participants (NS, n=16). In HUVECs incubated with patient's serum, endothelial constitutive nitric oxide synthase (eNOS) protein expressions were measured by Western blot analysis. Apoptosis in HUVECs was determined by optical microscopy, DNA fragmentation, and CPP32-like protease activity. Serum TNF-alpha, sTNFR-I, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NOS, in CD were significantly higher than in UD or NS. While, serum sTNFR-I and VEGF levels were significantly increased in the both diabetic patients, compared with those of NS, no difference was observed in the serum TNF-alpha, sTNFR-II, and ADMA levels between UD and NS. eNOS down-regulation and apoptosis were seen in HUVECs incubated with serum from CD for 24 h, but those observations were completely counteracted in the incubation by the addition of the antihuman TNF-alpha antibody. These results imply that eNOS down-regulation in CD is associated with high serum TNF-alpha levels despite of high serum of VEGF levels. Therefore, endothelial dysfunction in diabetic patients complicated with microangiopathy may, in part, be attributed to high serum TNF-alpha levels. 相似文献
8.
目的 :观察冠状动脉 (冠脉 )无明显狭窄 (<5 0 % )而冠脉血流储备异常患者的铊 2 0 1(2 0 1T1)负荷心肌洗脱率。方法 :随机测定 2 3例冠脉造影示冠脉正常或狭窄 <5 0 %患者不同冠脉的血流储备值 ,并根据冠脉血流储备 (CFR)分为 2组 :A组为CFR≥ 2 .5 (正常对照组 ) ,包括 34支冠脉 ;B组为CFR <2 .5 (冠脉微循环异常组 ) ,包括 16支冠脉。 2 3例受试者分别行2 0 1Tl潘生丁负荷心肌显像检查 ,处理出靶心图后 ,计算两组局部室壁洗脱率。洗脱率 =(负荷态放射性计数 -延迟态放射性计数 ) /负荷态放射性计数× 10 0 %。另根据心电图正常与否将上述患者分为两组 :组Ⅰ 12例 ,心电图完全正常 ;组Ⅱ 11例 ,平时心电图存在非特异性ST T改变 [成组导联的T低平或倒置和 (或 )ST压低≥ 0 .5mV]。比较两组的室壁洗脱率。结果 :A组的室壁洗脱率高于B组[(4 8.91± 7.75 ) %∶(36 .11± 6 .80 ) % ,P <0 .0 1];心电图有ST T改变的 11例受试者的相应 13段室壁洗脱率下降 ,为 (39.2 5± 7.86 ) % ,低于心电图完全正常的 12例受试者的 36段室壁洗脱率 [(4 9.5 6± 7.31) % ,P <0 .0 1]。结论 :CFR下降及心电图异常患者其心肌洗脱率相应下降 相似文献
9.
目的探讨解偶联蛋白2基因(UCP-2)8号外显子45bp插入/缺失(I/D)多态与2型糖尿病微血管病变(DMAP)易感性的关系。方法检测所有患者的基因组DNA,用聚合酶链反应(PCR)方法对UCP-2基因进行扩增,其中无微血管并发症(DM)组62例。DMAP组101例,记录各组UCP-2等位基因及基因型频率并进行比较。结果UCP-2基因8号外显子45bp I/D多态在DMAP组和DM组中基因型分布差异无统计学意义(x2=0.58,P〉0.05),两组的等位基因频率差异也无统计学意义(x2=0.89,P〉0.05)。结论UCP-2基因8号外显子45bpI/D多态与中国人DMAP易感性无关。 相似文献
10.
生长抑素治疗糖尿病微血管病变及其机制 总被引:1,自引:1,他引:1
生长抑素及其类似物在消化系统疾病的治疗中应用普遍,用于治疗由食管静脉曲张破裂导致的消化道出血、急慢性胰腺炎、抑制消化道肿瘤细胞的生长等方面。近年来,研究发现生长抑素及其类似物在糖尿病尤其是糖尿病微血管病变中的治疗也有很好的疗效,可以起到预防和治疗作用。因此,该类药物有望成为糖尿病微血管病变治疗的新方法。 相似文献