尼莫地平联合阿卡波糖治疗糖尿病周围神经病变的临床研究

目的观察尼莫地平联合阿卡波糖治疗糖尿病周围神经病变的临床疗效及对神经传导速度与神经相关生长因子的影响。方法将我院收治的76例糖尿病周围神经病变患者,随机分为试验组和对照组,每组38例。对照组给予尼莫地平40 mg,每天3次;试验组在对照组的基础上给予阿卡波糖50 mg,每天3次。所有患者均连续治疗1个月。比较2组患者的临床疗效、神经传导速度、神经相关生长因子和药物不良反应发生情况。结果治疗后,试验组的临床总有效率为89.47%(34例/38例),对照组为60.53%(23例/38例),差异有统计学意义(P<0.05)。治疗后,试验组腓总神经、正中神经运动神经传导速度(MCV)和感觉神经传导速度(SCV)分别为(45.88±4.06),(51.69±4.56),(44.12±4.09),(46.29±5.71)m·s^-1;对照组分别为(41.16±3.83),(44.98±4.46),(39.52±3.19),(43.13±4.46)m·s^-1,差异均有统计学意义(均P<0.05)。试验组的游离脂肪酸(FFA)、肿瘤坏死因子-α(TNF-α)、人磷髓脂碱性蛋白(MBP)水平分别为(471.45±44.28)μmol·L^-1,(11.15±1.18)pg·mL^-1,(1.90±0.14)μg·L^-1;对照组分别为(542.79±46.68)μmol·L^-1,(18.21±1.92)pg·mL^-1,(3.41±0.38)μg·L^-1(均P<0.05)。试验组血管内皮生长因子(VEGF)、人脑源性神经营养因子(BDNF)水平分别为(943.39±97.85),(4.87±0.58)ng·L^-1;对照组分别为(755.94±70.11),(3.09±0.26)ng·L^-1,差异均有统计学意义(均P<0.05)。试验组出现腹泻1例,腹胀3例,药物不良反应发生率为10.53%(4例/38例);对照组出现轻度头晕1例,消化道反应2例,腹胀和轻度腹部不适2例,药物不良反应发生率为13.16%(5例/38例),差异无统计学意义(P>0.05)。结论尼莫地平联合阿卡波糖治疗糖尿病周围神经病变,能有效改善患者神经传导速度与神经相关生长因子,临床疗效良好,安全性高。     

阿卡波糖和伏格列波糖治疗2型糖尿病的比较

目的：对两种α－糖苷酶抑制剂的疗效与安全性进行评价比较。方法：按1997年ADA标准诊断的2型糖尿病人60例,按1：1分为阿卡波糖组和伏格列波糖组,经2周筛选,8周治疗并比较,结果：与治疗前相比,阿波卡糖组和伏格列波糖组治疗4周和8周后,餐后1h和2h血糖有明显下降（P＜0．05）,但空腹血糖下降不明显（P＞0．05）,阿卡波糖组在治疗8周后,餐后2h血糖下降较伏格列波糖组明显（P＜0．05）,两组HbAlc治疗后较治疗前明显降低（P＜0．01）,组间比较鞠显著性（P＞0．05）,伏格列波糖组治疗前后的空腹,餐后胰岛素水平无明显变化（P＞0．05）, 卡波糖组治疗后空腹,餐后胰岛纱均明显降低（P＜0．01）,两组病人治疗前后血脂无显著变化（P＞0．05）,两组间治疗期间无低血糖,肝,肾功能损害发生,治疗之初常见胃肠道副作用,但可以耐受,组间比较差异无显著性。结论：阿卡波糖和伏格列波糖均为有效降低餐后血糖和HbA1c的药物,阿卡波糖与伏格列波糖对控制空腹血糖及餐后血糖疗效相同,阿卡波糖降低餐后2h血糖和胰岛素水平较伏格列波糖明显,阿卡波糖和伏格列波糖均用药安全,耐受性好。αααααα     

一种用微孔板筛选alpha-葡萄糖苷酶抑制剂的方法

目的：建立敏感的微孔板方法检测alpha-葡萄糖苷酶抑制活性，以进行抑制剂体外高通量筛选。方法：调整酶和底物适当配比，通过标准曲线、波长扫描、动力学分析以及最佳反应条件的研究，用阿卡波糖验证所建方法。结果：确定反应步骤，96孔板，160μl体系含2．5mmol·L~(-1)PNPG和0．2U·ml~(-1)alpha-葡萄糖苷酶，37℃，pH7．0反应15min，400 nm检测，此法正确、可靠。结论：本文所述用小体积样品筛选得到大量抑制剂的方法，利于从天然产物中开发改善餐后血糖的糖尿病及其并发症治疗药物。     

Acarbose plus metformin fixed-dose combination in the management of type 2 diabetes

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Concerns in the management of diabetes include drug-induced hypoglycemia, poor control of postprandial blood glucose level and weight gain. A carbohydrate-rich diet can cause more load on the intestinal cells producing α-glucosidase. Many patients need combination treatment based on their level of glycemic control and other associated parameters. In such cases, a therapy that provides effective glycemic control with minimal or no risk of adverse events like hypoglycemia or weight gain is highly desired. The chances of cardiovascular events are high in diabetes patients; hence, medicines providing benefits beyond glycemic control such as reduced cardiovascular risk factors may be ideal in such patients.

Areas covered: Current available data are related to the rationale and clinical trials on the fixed-dose combination of acarbose plus metformin in management of type 2 diabetes.

Expert opinion: Combination therapy is routinely prescribed in the management of T2DM. Drugs with complimentary mechanisms should be used to maximize the efficacy of combination therapy. The combination of metformin and acarbose is a rational therapy because of their different and complimentary mechanisms of action, which provides effective glycemic control with additional cardiovascular benefits and minimizes adverse events.     

拜糖平干预治疗IGT转归临床观察

目的:观察拜糖平对糖耐量低减(IGT)干预治疗的转归,寻求糖尿病(DM)二级预防的可能性。方法:选择IGT61例,随机分成两组,拜糖平组31例,对照组30例,以拜糖平50mgTid,干预治疗一年,观察IGT转归,结果与对照组相比,拜糖平能降低IGT向DM的转化率,并能增加IGT向正常糖耐量(NGT)的转化率。     

Interruption of the entero-pancreatic axis: effects of induced malabsorption

Abstract. The rate of intestinal absorption depends not only on the mode of ingestion and the chemical nature of nutrients ingested, but largely on the regulatory gastrointestinal motility processes and the digestive-absorptive capacity of the gastrointestinal tract.
This review is mainly concerned with modes of nutrient absorption and their regulatory mechanisms.
Modulation of intestinal absorptive processes possibly seems to be a valuable therapeutic strategy in various metabolic (diabetes mellitus) and gastrointestinal diseases.     

比较氯卡色林与阿卡波糖片对肥胖症患者血脂水平的影响

目的比较氯卡色林与阿卡波糖片对肥胖症患者血脂水平的影响。方法选取该院2018年1月至2019年3月收治的110例肥胖症患者为研究对象,按照随机数字表法分为氯卡色林组及阿卡波糖片组,每组55例,前者采用氯卡色林治疗,后者采用阿卡波糖片治疗,6个月后对两组体质量相关指标、血脂水平、不良反应发生率进行比较。结果治疗前两组体质量相关指标、血脂水平比较,差异无统计学意义(P>0.05);治疗后两组以上指标均较治疗前明显改善,差异有统计学意义(P<0.05),两组间比较,差异无统计学意义(P>0.05);氯卡色林组的不良反应发生率(12.73%)与阿卡波糖片组(14.55%)比较,差异无统计学意义(χ2=0.141,P=0.708)。结论氯卡色林与阿卡波糖片均能够在肥胖症治疗中取得良好疗效,且有助于调节血脂水平,改善患者健康水平。     

阿卡波糖对冠心病糖耐量减低患者经皮冠状动脉介入治疗后心肌灌注的影响及其机制

目的观察阿卡波糖治疗冠状动脉粥样硬化性心脏病(冠心病)糖耐量减低(impaired glucose tolerance,IGT)行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后完全血运重建患者的血糖、血脂、血管内皮生长因子(vascular endothelial growth factor,VEGF)和心肌灌注的变化,探讨其改善心肌灌注的可能机制。方法选择2017年1月至2018年3月河北大学附属医院收治的冠心病合并IGT,PCI治疗完全血运重建,术后6个月均复查冠状动脉造影(coronary arterial angiography,CAG)示无支架内血栓、再狭窄、新发病变的患者123例。所有入组患者均严格遵循糖尿病饮食、运动控制、监测血糖并按相关指南坚持抗栓、降脂和降压等治疗。将入组患者按照随机化原则分为试验组:A组为阿卡波糖低剂量(50 mg/次,3次/d)、B组为阿卡波糖高剂量组(100 mg/次,3次/d);对照组(C组为)安慰剂。观察3组患者的血糖、血脂、VEGF、心肌灌注显像变化。结果3组患者基线血糖、血脂、VEGF、心肌灌注显像等比较,差异无统计学意义(P>0.05)。3组患者复查CAG均未见支架内血栓、再狭窄、新发病变。3组患者治疗前、后血脂比较,差异无统计学意义(P>0.05)。治疗后,阿卡波糖低剂量、高剂量治疗组患者血糖、VEGF较对照组患者的降低,心肌灌注显像改善,差异具有统计学意义(P<0.05),且高剂量组较低剂量组疗效更显著(P<0.05)。结论阿卡波糖可降低冠心病合并IGT患者行PCI治疗后的血糖、血浆VEGF因子浓度,抑制血管内皮过度增生和改善心肌微循环,改善心肌灌注,从而降低主要不良心血管事件的发生。     

Antihyperglycemic effect of the traditional Chinese scutellaria–coptis herb couple and its main components in streptozotocin-induced diabetic rats

Ethnopharmacological relevance

Scutellaria–coptis herb couple (SC) is the main herb couple in many traditional Chinese compound formulas used for the treatment of diabetes mellitus, which has been used to treat diabetes mellitus for thousands of years in China. In this study we provide experimental evidence for the clinical use of SC in the treatment of diabetes mellitus.

Aim of the study

To confirm the anti-diabetic effect of SC extract and its main components, and to explore its mechanism from the effect on intestinal disaccharidases by in vivo and in vitro experiment.

Materials and methods

SC extract was prepared and the main components (namely berberine and baicalin) contained in the extract were assayed with high performance liquid chromatography (HPLC). And diabetic model rats were induced by intraperitoneal injection of streptozotocin (STZ). After grouped randomly, diabetic rats were administered SC extract, berberine, baicalin, berberine+baicalin, acarbose and vehicle for 33 d, respectively. Body weight, food intake, urine volume, urine sugars, fasting plasma glucose and fasting plasma insulin were monitored to evaluate the antidiabetic effects on diabetic rats. Intestinal mucosa homogenate was prepared and the activities of intestinal disaccharidases were assayed. Moreover, oral sucrose tolerance test (OSTT) was performed and the inhibitory effects of SC extract and its main components (berberine and baicalin) on the maltase and sucrase in vitro was evaluated.

Results

After the treatment of SC extract and its main components, the body weight and the fasting plasma insulin level were found to be increased while food intake, urine volume, urine sugars and fasting plasma were decreased. OSTT showed that SC extract and its main components could lower the postprandial plasma glucose level of diabetic rats. Furthermore, SC extract and its main components could inhibit the activities of intestinal disaccharidases in diabetic rats, whereas only SC extract and berberine could inhibit the activity of maltase in vitro.

Conclusions

According to our present findings, scutellaria–coptis herb couple (SC) possessed potent anti-hyperglycemic effect on STZ-induced diabetic rats. And SC extract and its main components exerted anti-hyperglycemic effect partly via inhibiting the increased activities of intestinal disaccharidases and elevating the level of plasma insulin in diabetic rats induced by STZ.