国产格列美脲片的药代动力学及相对生物利用度

目的 :研究健康受试者口服国产格列美脲片的人体相对生物利用度及生物等效性。方法 :2 0例健康志愿者采用随机交叉自身对照试验 ,分别单次口服国产及进口格列美脲片剂各 4mg ,用HPLC法检测血药浓度 ,以内标法定量。结果 :国产片与进口片的Cmax分别为 (462 .3± 1 32 .2 )及 (41 2 .4± 1 1 7.7) μg·L- 1 ;Tmax分别为 (3 .2± 0 .6)及(3 .3± 0 .8)h;t1 / 2 分别为 (7.1± 1 .5)及 (7.5± 1 .7)h ;AUC0 -t分别为 (2 571 .6± 564 .9)及 (2 362 .3± 51 9.6) μg·h·L- 1 ;AUC0～∞ 分别为 (2 769.8± 60 8.2 )及 (2 592 .4± 572 .5) μg·h·L- 1 。国产片与进口片比较生物利用度为 (1 1 1 .3±2 3 .3) %。Cmax,AUC0～t及AUC0～∞ 经生物等效性检验均为等效。结论 :国产格列美脲片相对进口品具生物等效性     

格列美脲治疗2型糖尿病安全性和有效性的多中心临床研究

目的 评价格列美脲对单纯饮食或用二甲双胍和/或阿卡波糖治疗控制不满意的2型糖尿病治疗的安全性、耐受性和有效性。方法 用多中心、开放性、非对照性临床研究,入选患者给予格列美脲1～4 mg,每日早餐前顿服,疗程16周。试验前后测定血糖、糖化血红蛋白、血脂和肝肾功能。结果129例患者人选,122例患者完成试验,格列美脲治疗16周空腹和餐后2h血糖平均分别下降1.3和1.8 mmol·L~(-1),糖化血红蛋白平均下降1.8％。治疗后空腹血浆胰岛素水平无变化,HOMA胰岛素抵抗指数明显下降,患者体重指数平均增加0.3 kg·m~(-2)。与格列美脲治疗有关的主要不良事件为低血糖反应和消化道症状,16例次与药物有关的低血糖反应均为轻度,进食后可自行缓解。对血脂和血压无不良影响。结论 格列美脲可以进一步降低单纯饮食控制或应用二甲双胍和/或阿卡波糖治疗的2型糖尿病患者的空腹和餐后2h时血糖以及糖化血红蛋白,且不增加空腹胰岛素水平,副作用小,耐受性好,使用较安全。     

格列美脲降血糖作用的实验研究

目的:测定格列美脲的降糖作用。方法:用葡萄糖氧化酶-过氧化物酶法测定给药前后小鼠血糖值、糖耐量、大鼠血糖值的变化;同时用放免方法测定给药前后不同时间大鼠血清胰岛素的变化。结果:格列美脲0.16 mg·kg~(-1)以上对正常小鼠和大白鼠有显著的降糖作用,分别降低20.6％,23.3％和血清胰岛素升高率为30.9％。结论:格列美脲有明显的降糖作用,这种作用主要是促进胰岛β细胞分泌胰岛素而产生的。     

Evaluation of the relaxant effect of levetiracetam on isolated rat duodenum

Levetiracetam (LEV) is an approved drug for the treatment of some epileptic disorders. With few and controversial reports addressing its possible pharmacodynamic interactions, the current study aimed at studying the effect of LEV on isolated rat duodenal strips to enlighten its possible intestinal adverse effects using the isolated smooth muscle strips of rat duodenum. LEV showed a dose‐dependent inhibition in KCl (80 mm )‐induced contractions in normal Tyrode's solution. Moreover, preincubation with LEV (3 mm ) in K⁺‐rich/Ca²⁺‐free medium led to a significant decrease in the maximum contractions (E_max) coupled to a right shift of the cumulative CaCl₂ concentration curves implying a possible Ca²⁺ channel blocking potential. In addition, LEV exhibited a typical noncompetitive inhibition in the cumulative carbachol concentration curves evidenced as a decrease in E_max without the alteration of EC₅₀, thus eliminating any possible role of the muscarinic receptors in the relaxant effect. To rule out other possible relaxant mechanisms, tests were conveyed in Tyrode's solution containing either 100 μm l ‐NAME or 10 μm glimepiride to test the possible relaxant roles exhibited by nitric oxide (NO) and K_ATP channel opening, respectively. None of the tested pathways was involved in LEV‐mediated relaxation. Taken altogether, the results of the current study entail that LEV might exert a relaxant effect on intestinal smooth muscles through blocking L‐type voltage‐operated calcium channels, but not involving either NO release or K_ATP channel opening.     

A case of hypoglycemic hemiparesis and literature review

Abstract

An 89-year-old man with diabetes treated with metformin 500 mg/day and glimepiride 4 mg/day was hospitalized because of hypoglycemic right hemiparesis and dysarthria (casual glucose value 1.8 mmol/L), which resolved quickly following administration of 40 mL of 40% dextrose. Hemiparesis is a rare symptom (4.2%) of hypoglycemia. There are about 200 case reports of hypoglycemic hemiparesis. The average glucose level at which hemiparesis developed was 1.8 mmol/L. Right-sided hemiparesis predominated (R 66%; L 34%). On imaging studies, abnormal findings were frequently observed in the internal capsule or splenium of the corpus callosum. The mechanism of hemiparesis is not fully understood. The existence of cases in which hypoglycemia cannot be distinguished from stroke on imaging studies suggests the importance of measurement of the blood glucose level when the symptoms of stroke are first recognized.     

Initial treatment with fixed-dose combination rosiglitazone/glimepiride in patients with previously untreated type 2 diabetes

Aim: This study assessed the efficacy and safety of two different dosing regimens of fixed‐dose combination (FDC) rosiglitazone (RSG) plus glimepiride (GLIM) compared with RSG or GLIM monotherapy in drug‐naive subjects with type 2 diabetes mellitus (T2DM). Methods: Drug‐naive subjects (n = 901) were enrolled into this 28‐week, double‐blind, parallel‐group study if their glycosylated haemoglobin A_1c (HbA_1c) was >7.5% but ≤12%. Subjects were randomized to receive either GLIM [4 mg once daily (OD) maximal], RSG (8 mg OD maximal) or RSG/GLIM FDC regimen A (4 mg/4 mg OD maximal) or RSG/GLIM FDC regimen B (8 mg/4 mg OD maximal). Patients were assessed for efficacy and safety every 4 weeks for the first 12 weeks of the study, and at weeks 20 and 28. The primary efficacy endpoint was change in HbA_1c from baseline. Key secondary endpoints included the proportion of patients achieving recommended HbA_1c and fasting plasma glucose (FPG) targets; change from baseline in FPG, insulin, C‐reactive protein (CRP), adiponectin, free fatty acids and lipids; and percentage change in homeostasis model assessment‐estimated insulin sensitivity and β‐cell function. Safety evaluations included adverse‐event (AE) monitoring and clinical laboratory evaluations. Results: At week 28, both RSG/GLIM FDC regimens significantly reduced HbA_1c (mean ± s.d.: ?2.4 ± 1.4% FDC regimen A; ?2.5 ± 1.4% FDC regimen B) to a greater extent than RSG (?1.8 ± 1.5%) or GLIM (?1.7 ± 1.4%) monotherapy (model‐adjusted mean treatment difference, p < 0.0001 vs. both RSG and GLIM). Significantly more subjects achieved HbA_1c target levels of ≤6.5 and <7% with either RSG/GLIM FDC regimen compared with RSG or GLIM alone (model‐adjusted odds ratio, p < 0.0001 for both comparisons). Similarly, a significantly greater reduction in FPG levels was observed in subjects treated with the RSG/GLIM FDC [mean ± s.d. (mg/dl): ?69.5 ± 57.5 FDC regimen A; ?79.9 ± 56.8 FDC regimen B) compared with RSG (?56.6 ± 58.1) or GLIM (?42.2 ± 66.1) monotherapy (model‐adjusted mean treatment difference, p < 0.0001 for both comparisons). Improvement in CRP was also observed in subjects who were treated with a RSG/GLIM FDC or RSG monotherapy compared with GLIM monotherapy. RSG/GLIM FDC was generally well tolerated, with no new safety or tolerability issues identified from its monotherapy components, and a similar AE profile was observed across FDC regimens. The most commonly reported AE was hypoglycaemia, and the incidence of confirmed symptomatic hypoglycaemia (3.6–5.5%) was comparable among subjects treated with an RSG/GLIM FDC and GLIM monotherapy. Conclusions: Compared with RSG or GLIM monotherapy, the RSG/GLIM FDC improved glycaemic control with no significant increased risk of hypoglycaemia. RSG/GLIM FDC provides an effective and well‐tolerated treatment option for drug‐naive individuals with T2DM.     

格列美脲对大鼠下颌骨成骨细胞增殖分化及矿化的影响

目的:研究格列美脲对大鼠下颌骨成骨细胞增殖、分化及矿化的影响.方法:原代培养分离下颌骨成骨细胞,将细胞接种于96孔板中,分两组:5.5mM葡萄糖(5.5mMG)(生理浓度葡萄糖)组,5.5mMG +10μmol/L格列美脲组,继续培养7d,1)MTT法检测大鼠下颌骨成骨细胞的增殖;2)生化法测定7d碱性磷酸酶(ALP)活性;3)Western blots检测Ⅰ型胶原(ColⅠ)的表达;4)RT-PCR检测骨钙素(OCN)的表达.结果:格列美脲能显著促进成骨细胞的增殖,ALP活性,ColⅠ的蛋白和OCN的mRNA的表达.结论:格列美脲能促进大鼠下颌骨成骨细胞增殖、分化及矿化.     

格列美脲联合甘精胰岛素治疗初诊2型糖尿病疗效观察

目的：探讨格列美脲联合甘精胰岛素或中性鱼精蛋白锌胰岛素强化治疗对糖化血红蛋白（HbA1c）〉9%的初诊2型糖尿病（T2DM）患者的疗效。方法：将58例新诊断的T2DM患者随机分为甘精胰岛素治疗组（IG组）和鱼精蛋白锌胰岛素治疗组（NPH组）,予睡前皮下注射胰岛素联合口服格列美脲治疗12周,对其在治疗前后血糖控制情况及胰岛β细胞功能进行自身及组间比较。结果：治疗后两组空腹血糖（FPG）、餐后2 h血糖（2 hPG）、HbA1c、胰岛素抵抗指数（HOMA-IR）均显著下降（P〈0.001）;空腹C肽（FC-P）、餐后2 h C肽（2 h C-P）、胰岛素分泌指数（HOMA-islet）均显著升高（P〈0.001）。组间比较IG组低血糖事件少于NPH组（P〈0.05）。结论：格列美脲联用甘精胰岛素或中性鱼精蛋白锌胰岛素对HbA1c〉9%的初诊T2DM患者的疗效佳,但甘精胰岛素更能减少低血糖事件的发生。