糖尿病肾病诊治研究进展

在世界范围内糖尿病发病率日益增多。目前全世界有约 1亿 5千万糖尿病患者 ,我国已达 4 0 0 0万左右。糖尿病肾病 (diabeticretinopathy ,DN)是糖尿病最常见、最严重的慢性并发症之一 ,糖尿病患者并发DN的病死率为未并发DN者的 30倍。我国 1型糖尿病患者DN的患病率为 30 %～ 4 0 % ,2型糖尿病为 15 %～ 2 0 %。但由于后者人数超过前者 10倍以上 ,故发展为DN的绝对人数较 1型糖尿病为多。据统计DN是导致慢性肾衰竭成为血液透析与肾移植的首因 ,我国也有这种趋势。由于早期有关肾脏病变的症状不多 ,有少量蛋白尿时不易被发现。因此大多数…     

生长激素、皮质醇水平与老年人糖尿病并发症之间的关系

近年来 ,由于老年人糖尿病患病率明显增加 ,已成为老年人的多发病和最严重的几种疾病之一。目的 :本文初步探讨和研究了老年人 2型糖尿病体内的生长激素、皮质醇水平以及与糖尿病慢性并发症的关系。方法 :选择老年人 2型糖尿病者 80例 ,年龄在 60～ 78岁 ,其中 ,男 44例 ,女 36例。有慢性并发症者 55例 (冠心病、高血压、心肌梗塞、肾脏病变、视网膜病变 )。无并发症 2 5例。对照组为非糖尿病者 3例 ,年龄在 60～ 68岁。其中 ,男 2 0例 ,女 1 4例。方法 ,空腹肘静脉采血 ,用ＦＪ2 0 0 3/50ＧＲ放免计数测定。结果 :糖尿病有并发症组的生长激…     

云南汉族2型糖尿病与HLA-DQA1基因的关联研究

目的　探讨云南汉族 2型糖尿病及 2型糖尿病肾病与 HL A- DQA1基因的关联性。方法　采用聚合酶链反应 -序列特异性引物技术对云南汉族 10 8例 2型糖尿病患者及 5 6名同地区同民族健康对照人群进行 DQA1基因分型。结果　云南汉族 2型糖尿病患者与正常对照组比较 ,DQA1* 0 30 1( RR=3.0 92 ,P<0 .0 1) ,DQA1* 0 5 0 1( RR=3.2 5 7,P<0 .0 5 )等位基因频率明显增高 ,DQA1* 0 4 0 1( RR=0 .371,P<0 .0 1)等位基因频率显著下降。糖尿病合并肾病组与正常对照组及不合并肾病的 2型糖尿病组比较 ,糖尿病合并肾病患者 HL A- DQA1* 0 30 2等位基因频率显著升高 ( RR=3.35 6 ,P<0 .0 1) ,各期糖尿病肾病比较中 DQA1* 0 30 2频率差异无显著性 ( P>0 .0 5 )。结论　 HL A- DQA1* 0 30 1,DQA1* 0 5 0 1是云南汉族 2型糖尿病的易感基因 ,HL A- DQA1* 0 4 0 1是云南汉族 2型糖尿病的抵抗基因 ;HL A- DQA1*0 30 2是 2型糖尿病合并肾病的易感基因     

糖代谢紊乱致肾小球内皮细胞损伤机制进展

糖尿病肾病是糖尿病的重要慢性并发症之一,高糖状态下肾脏小球内皮细胞的损伤与糖尿病肾病的发生、发展有密切的联系.高糖可以导致肾脏的多种活性物质,包括血管紧张素Ⅱ(AngⅡ)、内皮生长因子(VEGF)、活性氧(ROS)、糖基化终末产物(AGEs)等发生改变,而这些变化都可引起内皮细胞的功能障碍,进一步参与糖尿病肾脏损害的发生和发展.     

金属硫蛋白与糖尿病并发心肌病

糖尿病(DM)是当今影响人口众多,分布范围广泛的慢性疾病,糖尿病心肌病是其主要的并发症之一。流行病学研究发现,糖尿病患者心血管疾病的发病率较非糖尿病患者高2~3倍。近期研究发现,血糖代谢正常者心力衰竭发病率为3.2%,而糖代谢异常者(糖耐量减低和空腹血糖受损者)和2型糖尿病患者心力衰竭发病率分别是6.0%和11.8%[1]。     

糖尿病肾病的诊治及进展

糖尿病肾病(diabetic nephropathy.DN)是糖尿病的严重微血管并发症之一。糖尿病肾病所导致的肾功衰竭目前已居国内终末期肾功能衰竭病因的第二位[1]。因其常合并严重的心血管并发症,治疗较复杂。一般认为糖尿病肾病(DN)特指糖尿病性肾小球硬化症,一旦起进入临床蛋白尿期,肾脏损害将无法逆转。     

糖尿病肾病早期患者的饮食护理

糖尿病肾病是糖尿病最严重的慢性并发症之一。据统计糖尿病肾病死于肾功能衰竭者占53%,是糖尿病致死的主要原因之一[1]。目前治疗糖尿病肾病尚无特效药物,主要采取严格合理的饮食控制、血糖控制、血压控制等综合治疗措施[2]。我科于2013年2~11月收治62例糖尿病肾病的患者,经合理的饮食控制及对症治疗后好转出院。     

维生素D3——非糖尿病肾病慢性肾脏病合并糖尿病的预测因子

目的:研究非糖尿病肾病慢性肾脏病(non-diabetes chronic kidney diseases,ND-CKD)3～5期患者合并糖尿病的相关因素,并用体内维生素D3水平来预测其风险.方法:对ND-CKD3～5期患者的糖尿病发生指标和维生素D3水平进行相关性分析,应用多项logistic回归分析,得出不同水平的维生素D3的ND-CKD合并糖尿病的概率值.结果:ND-CKD3～5期患者体内的维生素D3水平和餐后2h血糖有负相关性(r=-0.430,P=2.07×10-5);该人群体内维生素D3在0～99.9,100.0～199.9,200.0～299.9 nmol/L三个水平合并糖尿病的概率分别为0.393,0.227,0.154.结论:维生素D3作为ND-CKD合并糖尿病的预测因子,有一定的临床意义.     

甲襞微循环异常与糖尿病慢性并发症的关系分析

目的 :探讨甲襞微循环障碍与糖尿病慢性并发病的关系。方法 :选 2 0 0例住院Ⅱ型糖尿病病人 (单纯糖尿病 10 0例 ,有慢性并发症 10 0例 )进行了甲襞微循环检查。结果 :单纯糖尿病组的甲襞微循环的管袢清晰度、管袢形态、红细胞聚集程度及血液流态均比有慢性并发症糖尿病组好 ,二组比较有显著差异 (Ｐ <0 .0 1或 0 .0 5 )。结论 :单纯糖尿病组的微循环障碍比有慢性并发症糖尿病组轻。甲襞微循环检查可作为预测糖尿病慢性并发症的一种指标。袢周清晰度、血流状态、红细胞聚集情况是反映微循环障碍程度的基础。一旦发现糖尿病人微循环中度障碍 …     

2型糖尿病并发肾病大鼠模型的制备

糖尿病肾病 (ＤＮ)是糖尿病 (ＤＭ)的主要慢性并发症 ,因其导致尿毒症死亡者约占糖尿病病人的 2 7%～ 31% [1 ] 。糖尿病肾病的动物模型一般采用大剂量ＳＴＺ腹腔注射的方法 ,但与 2型糖尿病肾病的病理变化仍存在一定差距。本文用小剂量ＳＴＺ腹腔注射 ,饲以高脂饲料 ,单侧肾切除相结合的方法收到较为满意的结果。1　材料与方法1 1　材料 :健康Ｗｉｓｔａｒ雄性大鼠 ,体重 180～ 2 30ｇ ,由湖南中医学院实验动物中心提供 ;ＳＴＺ(Ｓｉｇｍａ公司 )、高脂饲料 (基础饲料加蔗糖、炼猪油、鲜鸡蛋等混合而成 ,比例为 6∶0 5∶2 5∶1)、血糖仪…     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.