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胰岛素联合罗格列酮治疗早期糖尿病肾病

【摘要】 目的 观察胰岛素联合罗格列酮治疗早期糖尿病肾病的疗效。方法 2008年3月-2009年2月,将61例符合早期糖尿病肾病的患者随机分为治疗组和对照组。对照组30例予糖尿病基础治疗,治疗组31例加用胰岛素和罗格列酮。治疗观察6个月。比较治疗前后两组空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HomaIR)、尿白蛋白排泄率(UAER)等变化情况。结果 治疗组在治疗后FBG、HbA1c、HomaIR、UAER均较治疗前明显改善,差异有统计学意义(Plt;0.05),且FBG、HbA1c、UAER的下降较对照组明显(Plt;0.05)。 结论 胰岛素联合罗格列酮可有效调控早期糖尿病肾病患者的血糖,改善胰岛素抵抗,减少尿蛋白排泄,保护肾功能。

胰岛素过敏伴脂肪萎缩治疗疗效观察及护理一例

Role of Vaspin in Roux-en-Y Gastric Bypass on Type 2 Diabetes Mellitus Rats

Objective　To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods　Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results　Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions　RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.

EFFECTS OF INSULIN-LIKE GROWTH FACTOR 1 ON INHIBITION OF OSTEOBLASTIC PROLIFERATION AND FUNCTION BY ETHANOL

Objective To investigate the effects of insulin-like growth factor 1（IGF-1） and ethanol (EtOH) on the changes in the osteoblast proliferation and the osteoblast function under the normal serum concentration and serum starvationMethodsThe osteoblasts harvested from the SD rat calvaria were incubated in the following six conditions according to the supplements in DMEM: the F15group：15% newborn calf serum (NCS)； the F15/EtOH group：100 mmol/L of EtOH added to 15% NCS； the F2 group：2% NCS； the F2/EtOH group：100 mmol/L of EtOH added to 2% NCS；the F2/IGF-1 group：25ng/ml of IGF-1 added to 2% NCS；the F2/IGF-1/EtOH group：100 mmol/L EtOH added to 25 ng/ml IGF-1 and 2% NCS. The osteoblasts were analyzed by the MTTassay, alkaline phosphatase（ALP） activity, and RTPCR at 24, 48, 72 and 96h ours after the culture. Results The absorbance (A), the ALP activity, and the expression of BGP mRNA (the proliferation and function indicators of the osteoblasts) were significantly decreased in the F15/EtOH group at all the time points when compared with those in the F15the group (P＜ 0.05); the above 3 indicators were significantly decreased in the F2 groupwhen compared with those in the F15 group (P＜0.05); they were significantly decreased in the F2/EtOH group when compared with those in the F2 group (P＜0.05); however, the indicators in the F2/IGF-1 group were significantly increased when compared with those in the F2 group (P＜0.05); the A value in the F2/IGF-1/EtOH group was not significantly decreased when compared with that in the F2/IGF-1 group, with an exception of the A value at 24 hours (P＞0.05); however, ALP and BGP mRNA were significantly decreased (P＜0.05). All the indicators were significantly increased when compared with those in the F2/EtOH group (P＜0.05) Conclusion Ethanol can inhibit the osteoblast proliferation and the osteoblast function, and can increase the inhibition when the osteoblasts were cultured under the serum starvation. This may be one of the mechanisms for alcoholic bone disease. IGF-1 can prevent the inhibition of the osteoblasts under the serum starvation and counteract the ethanolinduced proliferation inhibition; therefore, IGF-1 is an alternaive therapeutic intervention for alcoholic bone disease.

Changes of InsulinLike Growth FactorSTHZ1 in Serum of Patients with Obstructive Jaundice

【Abstract】Objective To study the changes of insulin-like growth factor-1(IGF-1) in serum of patients with obstructive jaundice.Methods The clinical data of 20 patients with obstructive jaundice were collected and the measurement of serum TNFα,ALT, ALP, endotoxin and IGF-1 were performed. Results The serum IGF-1 in obstructive jaundice was significantly lower than that in gallbladder stone(P＜0.01), while endotoxin, TNF-α, ALT，ALP and TB were higher(P＜0.01). After the biliary duct obstruction was removed, the serum IGF1 in obstructive jaundice was significantly higher than that before operation and serum endotoxin， TNF-α, ALT， ALP and TB were significantly lower than that before operation(P＜0.01). A significant negative correlation was found between serum IGF-1 and serum endotoxin in benign obstructive jaundice(r=-0.761, P＜0.01). ConclusionIn obstructive jaundice, endotoxemia can affect the secretion of IGF-1 from liver. IGF-1 can be used as an index to judge the liver function in obstructive jaundice.

Effect of Serum Insulin2Like Growth Factor-1 on Nutritional Status of Cancerous Cachexia of Mice

Objective 　To investigate the relationship between the level of serum-insulin like growth factor-1( IGF-1) and the nut ritional status of cancerous cachexia. Methods 　Colon cancer CT-26 cells were implanted subcutaneously to 30 liver2specified IGF-1 gene deleted (L ID) C57BL/ 6 mice to establish cancerous cachexia model and theother 30 C57BL/ 6 mice were included as cont rol group. The serum levels of IGF-1 , cytokine TNF-αand IL-6 , bloodglucose , albumin and t riglyceride were detected respectively on day 14 , 18 and 22 af ter the plantation of tumor. Thebody weight of mice , tumor weight and the weight af ter tumor removed in two group s were measured respectively.Results 　Af ter the plantation , the levels of IGF-1 in L ID group at different times were all significantly lower thanthose in cont rol group ( Plt; 0. 05) . The serum levels of TNF-α, IL-6 , blood glucose and t riglyceride were ascendinggradually over time ( Plt; 0. 05) , but weight s af ter tumor removed and the level of albumin were descending in twogroup s ( Plt; 0. 05) . Compared with the cont rol group , the serum levels of IL-6 , TNF-α, blood glucose and t riglyceride in L ID tumor-bearing mice were all significantly higher at different time point s ( P lt; 0. 05) . On day 18 and 22 ,the weight s af ter tumor removed and the amount of ingestion in L ID group were significantly lower than those in thecont rol group ( Plt; 0. 05) . Conclusion 　Compared with the low level of IGF-1 in cancerous cachexia , normal level ofserum IGF-1 may represent lower degree of cancerous cachexia2related cytokines and better nut ritional state , whichmay provide a novel idea of the therapy of cancerous cachexia.

Advances in Research of MicroRNA in The Pathogenesis of Type 2 Diabetes

Objective　To summarize the relationship of diabetes and its complications with microRNA. Methods　Domestic and international researches were collected by searching to summarize the role of microRNA in diabetes and its complications. Results　MicroRNA could affect the secretion of insulin and interfer metabolism of gulcose in fat cells， muscle cells， and liver cells， which resulting in insulin resistance. At the same time， the microRNA also played an role in damage of vascular endothelial cells and myocardial cell in diabetes. Conclusion　MicroRNA acts an important role in the process of diabetes and its complications.

青斑样血管病合并肥胖伴胰岛素抵抗一例

2型糖尿病肥胖患者口服降糖药失效启用胰岛素治疗方案的探讨

【摘要】　目的　探讨2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗方案的选择。　方法　选择2009年1月-2010年12月间40例口服降糖药失效的2型糖尿病肥胖患者，随机分为两组，每组20例。A组原口服药不变，睡前联用长效胰岛素（商品名:来得时）治疗，B组停用口服药，于早晚餐前使用预混胰岛素（商品名：诺和灵30R），治疗共3个月，分别于治疗前后观察空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂、血压、体质量指数的变化，记录低血糖发生次数，并填写问卷调查表，评估患者对治疗方案的满意度和接受度。　结果　两个组治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白均较治疗前明显下降（Plt;0.01），而血脂、血压变化不大；但B组体质量指数有轻微升高（Pgt;0.05），且每日胰岛素用量较A组更大（Plt;0.01），低血糖反应更多（Plt;0.05），满意度和接受度不如A组高（Pgt;0.05）。　结论　对2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗，选用口服降糖药联合基础胰岛素的治疗方案具有作用佳、安全性好，体重增加不明显，患者依从性更高的特点。【Abstract】　Objective　To investigate the selection of insulin therapy for obese patients with type 2 diabetes mellitus (T2DM) after the failure of oral antihyperglycemic drugs.　Methods　Forty obese T2DM subjects who failed the therapy of oral antihyperglycemic drugs between January 2009 and December 2010 were divided into 2 groups randomly. Patients in group A (n=20) continued using oral antihyperglycemic agents while long-acting insulin (Lantus) was added at bedtime; Patients in group B (n=20) used premixed insulin (Novolin 30R) injection before breakfast and supper instead of the oral drugs. The treatment lasted for 3 months for both groups. Fasting plasma glucose (FPG), blood glucose 2 hours after breakfast (2hPG), glycated hemoglobin (HbA1c), serum lipids, blood pressure, and body mass index (BMI) were examined before and after the trial respectively. We evaluated the satisfaction and acceptance level in all subjects who underwent the treatment with questionnaires.　Results　FPG, 2hPG, HbA1c after the treatment were significantly lower than those before the treatment in both two groups (Plt;0.01), while serum lipids and blood pressure showed no significant differences. Patients in group B had slightly higher BMI (Pgt;0.05) after the treatment. Compared with patients in group A, they needed a larger insulin dosage (Plt;0.01), had higher hypoglycemia frequency (Plt;0.05) and lower satisfaction and acceptance level (Pgt;0.05).　Conclusion　For obese patients with T2DM who have failed the therapy of oral antihyperglycemic drugs, combined oral antihyperglycemic drugs with basic insulin has better effects, security, and compliance, and less weight gain.

Relation between Diabetes and Pedopathy of Type II Diabetes and Insulin Resistance

摘要:目的:探讨2型糖尿病合并糖尿病足患者与胰岛素抵抗的关系。方法:205例2型糖尿病患伴糖尿病足患者作为观察组,无足部病变的糖尿病患者作为对照组,观察其体重指数、空腹血糖、胰岛素、血脂等指标,两组间进行比较并相关性分析、多元回归分析。胰岛素抵抗指数(HOMAIR)=FPG×FIns/22.5。结果:糖尿病足患者的HOMAIR显著高于无糖尿病的患者(Plt;0.05)。多元回归分析显示糖尿病病程、LDL及BMI是影响2型糖尿病足患者胰岛素抵抗的主要危险因素。结论:糖尿病足患者存在着更严重的胰岛素抵抗。Abstract: Objective: To discuss the relationship between diabetes and pedopathy of type II diabetes and insulin resistance. Methods:The diabetes type II patients were divided into group A (combined with pedopathy) and group B (without pedopathy). The blood glucose and insulin of empty stomach, BMI,Alc and lipid were detected. The insulin resistance index (HOMAIR) was calculated and compared between two groups. Results:The HOMAIR was higher in group A than that in group B (Plt;0.05).The duration of disease,LDL and BMI was positive related with diabetes pedopathy. Conclusion:The insulin resistance was more worse in pedopathy of Type II diabetes.