胃束带术治疗2型糖尿病效果及其机制初探

目的:通过观察胃束带术(gastric banding)治疗链脲佐菌素(STZ)诱发2型糖尿病大鼠模型的效果,来初步阐明其机制?方法:将42只成模2型糖尿病大鼠分为手术组(O组)12只;假手术组(S组)10只;饮食控制组(F组)10只;对照组(C组)10只?检测术前?术后1?2?3?4?8和16周的空腹血糖;空腹血浆瘦素(leptin);空腹血浆胰岛素水平(FINS);体重及进食量?结果:O组术后第16周空腹血糖下降至(12.6±3.7)mmol/L ?空腹血浆胰岛素水平升至(42.7±9.2)mIU/L?空腹血浆瘦素降至(14.6±3.3)pg/ml?体重(212.6±15.1)g/只与术前相比均有统计学意义(P < 0.01)?O组血糖下降过程中与空腹血浆胰岛素成负相关(r=-0.881,P < 0.01),与空腹血浆瘦素呈正相关(r=0.784,P < 0.01)?F组与O组相比较,2组间空腹血浆胰岛素和空腹血浆瘦素在术后3?4周相比有统计学意义(P < 0.05),及体重术后3周2组相比有统计学意义(P < 0.05),血糖无组间差异(P > 0.05)?结论:胃束带术能降低2型糖尿病大鼠的血糖,饮食控制体重减轻可能是胃束带术改善2型糖尿病大鼠模型血糖的主要机制?其后血浆胰岛素及空腹血浆瘦素的水平改变在胃束带术治疗2型糖尿病机制中发挥着重大作用?     

血糖安对2型糖尿病大鼠小肠α-葡萄糖苷酶mRNA表达的影响

目的　观察血糖安对 2型糖尿病大鼠小肠α 葡萄糖苷酶mRNA表达的影响。方法　建立 2型糖尿病大鼠模型。随机分成 5组 :血糖安大剂量组 (9mg kg .d)、血糖安中剂量组 (3mg kg·d)、血糖安小剂量组 (1mg kg·d)、糖尿病模型组、苯乙双胍组 (75mg kg·d)。连续用药 7天用电极试纸法测空腹血糖值及糖耐量值。用小肠α 葡萄糖苷酶原位杂交试剂盒检测小肠α 葡萄糖苷酶mRNA的表达。结果　① 2型糖尿病大鼠经血糖安给药后 ,空腹血糖值与模型组相比明显降低 (P <0 .0 5 ) ;②用药组大鼠的糖耐量曲线下面积 (AUC)较模型组显著减少 (P <0 .0 1 ) ;③用药组大鼠小肠α 葡萄糖苷酶mRNA的表达与模型组和正常组相比均有明显减少。结论　血糖安对 2型糖尿病大鼠有明显的降糖作用 ,对糖耐量具有保护作用 ,对 2型糖尿病大鼠小肠α 葡萄糖苷酶mRNA的表达有抑制作用     

胃旁路术对非肥胖2型糖尿病大鼠肝脏葡萄糖激酶表达的影响

目的:探讨胃旁路术对非肥胖2型糖尿病GK大鼠肝脏葡萄糖激酶(glucokinase,GCK)表达的影响?方法:雄性GK和Wistar大鼠各20只,随机分为GK手术组(GO组)?GK假手术组(GS组)?Wistar手术组(WO组)和Wistar假手术组(WS组),每组10只?检测术前及术后第1?4?8周各组空腹血糖和血清胰岛素水平,术后8周取大鼠肝脏组织,采用RT－PCR检测肝脏GCK mRNA表达水平?结果:GO组术后第1周空腹血糖已开始下降,术后第1?4?8周分别由术前(8.73 ± 1.30)mmol/L下降到(6.84 ± 0.89)?(6.27 ± 0.93)?(5.86 ± 0.57)mmol/L(P < 0.05);随访过程中,GO组空腹血清胰岛素较术前和相应时间点GS组均有所升高,尚未达统计学差异(P > 0.05);GO组术后第8周肝脏GCK mRNA表达水平明显高于GS组(P < 0.05)?结论:胃旁路术能显著改善非肥胖2型糖尿病大鼠的糖代谢,手术的降糖作用可能与肝脏葡萄糖激酶表达增加有关?     

葡萄糖耐量试验对早期糖尿病筛查及转归的预测研究

目的:研究糖尿病早期筛查的意义,评估其胰岛素敏感性及分泌功能,同时预测其发生糖尿病及其相关并发症的转归情况,为临床早期干预提供指导?方法:通过对患者进行口服葡萄糖耐量试验(OGTT),计算其体质指数,同时行血脂检测,早期筛查糖尿病并评估其胰岛素敏感性?结果:糖耐量减低(IGT)组患者平均年龄低于糖尿病(DM)组(52.0±10.9 vs 65.1±14.3,P < 0.05);与正常葡萄糖耐量(NGT)组患者相比,空腹血糖调节受损(IFG)组?IGT组患者及DM组患者胰岛素敏感性(ISI0,120)明显下降,胰岛素抵抗明显(NGT vs IFG:92.0±22.3 vs 69.1±22.0;NGT vs IGT:92.0±22.3 vs 64.7±13.1;NGT vs DM 92.0±22.3 vs 28.5±8.2,P < 0.05);IGT组患者较IFG组患者胰岛素敏感性下降更明显(IFG vs IGT 69.1±22.0 vs 64.7±13.1,P < 0.05);胰岛素生成指数(IGI)IGT组明显高于IFG组(IFG vs IGT:1.69±0.80 vs 1.90±1.20,P < 0.05);与NGT组相比,IFG组及DM组胰岛素早期相分泌(EPIR)明显降低(NGT vs IFG 1stPH:243.9±173.5 vs 124.2±110.2,2ndPH:99.2±33.5 vs 62.6±37.4;NGT vs DM 1stPH:243.9±173.5 vs 136.7±123.2,2ndPH:99.2±33.5 vs 38.8±33.3,P < 0.05);且IGT组高于IFG组(IFG vs IGT 1stPH:124.2±110.2 vs 200.4±186.3,P < 0.05)?结论:IFG患者与IGT患者可能存在不同的发病机制,部分患者在正常葡萄糖耐量(NGT)时已经存在β细胞功能受损,OGTT检查对于揭示胰岛分泌功能及胰岛素抵抗,早期筛查糖尿病具有重要的意义,从而对糖尿病早期诊断早期干预提供临床指导意义?     

高脂饮食和地塞米松联合诱导胰岛素抵抗大鼠模型

目的 用高脂饲料 地塞米松(dexamethasone,DEX)隔日腹腔注射建立实验性胰岛素抵抗大鼠模型,研究该模型糖代谢、脂代谢和激素水平等方面的变化.方法 采用Wistar雄性大鼠,分为正常对照组、高脂组、DEX组(1 mg/kg,i.P.)和高脂 DEX组(1 mg/kg,i.p.),连续观察8周,每周测定大鼠空腹血糖,分别于造模第2周和第8周测糖耐量,8周后处死大鼠,测定胸腺、脾脏、肝脏等脏器重量.结果 高脂饲料能加重腹腔注射DEX造成的空腹血糖升高,造模第8周空腹血糖(7.7±0.7)较空白组(6.5±0.6)显著升高.使模型动物糖耐量明显异常,肝糖原、肌糖原含量显著增加,血浆胰岛素及游离脂肪酸水平显著升高,各脏器指数明显增加.结论 高脂 DEX隔日腹腔注射能成功诱导胰岛素抵抗大鼠模型,这种造模方法较单纯注射DEX或单纯高脂饲养成模率高,造模周期短.     

轻度空腹高血糖人群的非药物干预研究

目的 观察轻度空腹高血糖人群饮食和/或运动的干预效果、及胰岛素抵抗对干预效果的影响。方法 选取初诊发现空腹血糖在6.1～7.8mmol/L之间的轻度空腹高血糖者129人,按不同干预方法随机分为单纯饮食组、饮食+运动组和对照组3组,在初访和随访1年后分别测量空腹血糖、空腹胰岛素,比较不同干预方法降低空腹血糖的作用,以及胰岛素抵抗的程度对干预效果的影响。结果 干预1年后,饮食+运动组平均空腹血糖低于单纯饮食组[(5.91±1.0)mmol/L,(6.9±1.5)mmot/L,P=0.000],平均胰岛素敏感性指数显著提高(-3.7±0.5,-4.0±0.6,P=0.011);单纯饮食组与对照组相比平均空腹血糖水平差异无显著性[(6.9±1.5)mmol/L,(7.1±1.0)mmol/L,P=0.454],但平均胰岛素敏感性指数显著升高(-4.0±0.6,-4.4±0.7,P=0.003)。以胰岛素敏感性指数值-4.2146为截点做分层分析,与干预前比较,胰岛素抵抗较轻干预组平均空腹血糖明显下降[(6.7±0.6)mmol/L,(6.2±1.0)mmol/L,P=0.001],胰岛素抵抗较重干预组血糖维持原有水平[(6.7±0.5)mmol/L,(6.6±1.6)mmol/L,P=0.505)。干预1年后的血糖变化与胰岛素敏感性改变、运动量的增加和每日摄入热量的改变存在线性相关(P<0.05)。结论 饮食、运动干预能改善高血糖人群胰岛素敏感性,使血糖、血压水平明显下     

Gc球蛋白在不同方式治疗慢性重型肝炎中的检测意义

目的:探讨慢性重型乙型肝炎患者经内科治疗及肝移植前后Gc球蛋白的变化以及丙氨酸氨基转移酶(alanine transarninase,ALT)变化的相关性,初步阐明Gc球蛋白在重型乙肝患者中的检测价值?方法:选取兰州大学第一医院2004~2009年慢性重型乙型肝炎肝移植治疗患者14例,慢性重型乙型肝炎内科治疗患者20例,分别于治疗前?后各阶段留取血液标本,另取健康对照者20例?采用ELISA法检测肝功能及Gc球蛋白?结果:慢性重型乙型肝炎内科治疗组血清中Gc球蛋白含量治疗前?治疗后2?4?6?8周分别为(295.74 ± 76.13)?(159.37 ± 41.02)?(109.72 ± 30.48)?(100.19 ± 29.21)?(86.20 ± 28.38)mg/dl,与正常对照组相比,差异有统计学意义(P < 0.05);慢性重型乙型肝炎肝移植组血清中Gc球蛋白含量术前?术后6?12?18?24个月分别为(4.19 ± 1.17)?(30.89 ± 23.04)?(88.30 ± 52.87)?(200.07 ± 108.32)?(324.17 ± 119.14)mg/dl,与正常对照组相比,差异具有统计学意义(P < 0.05);内科治疗组治疗后ALT呈下降趋势,与治疗前相比差异有统计学意义(P < 0.05),肝移植组手术前后ALT变化不明显?结论:血清GC球蛋白的变化可以预测内科治疗和肝移植后的重型乙型肝炎患者病情演变,可为临床医师选择合理治疗方式提供参考?     

速效胰岛素类似物和可溶性人胰岛素在初诊2型糖尿病胰岛素泵治疗中作用的比较

目的比较速效胰岛素类似物门冬胰岛素和中性可溶性人胰岛素在初诊2型糖尿病患者胰岛素泵强化治疗中的作用差异。方法59例初诊2型糖尿病患者,男35例,女24例,年龄51岁±12岁,体重指数25kg/m2±3kg/m2,随机使用速效胰岛素类似物门冬胰岛素(类似物组,30例)和中性可溶性人胰岛素(人胰岛素组,29例),进行2周的胰岛素泵治疗。比较两组治疗中空腹及餐后血糖下降速度、程度,所需胰岛素剂量及低血糖事件的差异;比较泵治疗前后两组胰岛β细胞功能改善程度的差异。结果在胰岛素泵治疗第2天,类似物组早晚餐后2h血糖即明显低于人胰岛素组(8·4mmol/L±2·8mmol/L比11·3mmol/L±3·8mmol/L,9·0mmol/L±2·4mmol/L比10·7mmol/L±2·8mmol/L,P<0·05),至第7天类似物组空腹和午餐后2h血糖降低程度也明显大于人胰岛素组(4·6mmol/L±0·8mmol/L比5·3mmol/L±0·9mmol/L,7·3mmol/L±2·2mmol/L比8·1mmol/L±1·8mmol/L,P<0·05)。治疗第14天,则只有空腹血糖存在差异;停止治疗后,空腹和早晚餐后2h血糖在两组间差异仍有统计学意义。类似物组获理想血糖控制时间短于人胰岛素组(2·0d比6·0d,P<0·01),所需胰岛素剂量又较小(0·6U/kg比0·8U/kg,P=0·002)。泵治疗前后胰岛β细胞功能指标如静脉葡萄糖耐量试验中胰岛素急性分泌时相、胰岛素和C肽曲线下面积,Homaβ,胰岛素原在两组间差异无统计学意义。治疗中两组仅见轻度低血糖事件:类似物组8例次(27%),人胰岛素组10例次(35%)。结论速效胰岛素类似物门冬胰岛素用于初诊2型糖尿病患者胰岛素泵强化治疗,和人胰岛素相比,可更快更好地改善空腹和餐后血糖,但对胰岛β细胞功能改善程度,差异无统计学意义。     

厄贝沙坦对2型糖尿病SD大鼠胰岛结构和功能的影响

目的：观察厄贝沙坦干预对2型糖尿病（T2DM）大鼠胰岛结构和功能的影响,以探讨其保护胰岛结构和功能的可能机制.方法：40只SD大鼠随机分为4组,每组10只,即A组（普通饲料组）,B组（高糖高脂饲料组）,C组（T2DM对照组）、D组（厄贝沙坦干预组）.观察厄贝沙坦干预对T2DM大鼠血糖、胰岛素等胰岛结构和功能的影响.结果：D组与C组比较,空腹血糖下降25.08％,稳态模型评价胰岛素抵抗指数下降30.87％,ISI提高了11.93％,明显改善糖耐量.D组与C组大鼠比较,胰岛内β细胞相对量增加67.35％,胰岛β细胞内胰岛素水平增加43.86％,胰岛β细胞胰岛素mRNA表达水平增高9.79％.结论：厄贝沙坦干预可降低T2DM大鼠空腹血糖、HOMA-IR,提高ISI,改善胰岛结构和功能.     

利拉鲁肽对糖耐量异常OLETF大鼠胰岛白细胞介素-1β表达的影响

目的观察利拉鲁肽对糖耐量异常大鼠胰岛炎症因子白细胞介素-1β(IL-1β)和凋亡基因caspase3表达的影响。方法 12周龄糖耐量异常OLETF大鼠分为生理盐水组和不同剂量利拉鲁肽干预组(50、100、200μg/kg),8只LETO作为正常对照组。实验12周结束时,所有大鼠均检测糖耐量试验空腹及服糖后30 min胰岛素,并检测胰岛IL-1β和caspase3 mRNA和蛋白水平。结果利拉鲁肽干预的糖耐量异常大鼠和生理盐水干预组相比,胰岛IL-1β和caspase3表达显著降低,血糖、胰岛β细胞功能及早期胰岛素分泌指数明显改善。结论利拉鲁肽可能通过抑制胰岛IL-1β炎症因子表达,从而改善胰岛功能及糖代谢,延缓或阻止糖尿病发生发展。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.