2型糖尿病实用目标和治疗

诊断糖尿病和其他类型高血糖的数据 (静脉血浆葡萄糖ｍｍｏｌ/Ｌ)糖尿病 :空腹　或≥ 7.0 (≥ 1 2 6)葡萄糖负荷后 2小时 /或随机 ≥ 1 1 .1 (≥ 2 0 0 )糖耐量低减 (ＩＧＴ) :空腹 (如果测定 )和 <7.0 ( <1 2 6)葡萄糖负荷后 2小时 ≥ 7.8(≥ 1 4 0 )且<1 1 .1 ( <2 0 0 )空腹血糖受损 (ＩＦＧ) :空腹≥ 6.1 (≥ 1 1 0 )且<7.0 ( <1 2 6)2小时 (如果测定 ) <7.8( <1 4 0 )　　 毛细血管血浆相应值 :糖尿病 ,空腹≥ 7.0 (≥1 2 6) ,2 ｈ≥ 1 2 .2 (≥ 2 2 0 ) ;糖耐量低减 ,空腹 <7.0 ( <1 2 6)及 2 ｈ≥ 8.9(≥ 1 60 )且 <1 2 .2 ( <2…     

内地高辛、钠、钾、镁与高血压病胰岛素抵抗的相关性

目的 :探讨内地高辛及钠、钾、镁在高血压病胰岛素抵抗病理机制中的作用。方法 :测定 30例高血压病患者(EH组 )的空腹血浆葡萄糖 (FPG)、胰岛素 (FINS)水平 ,同时测定血清内地高辛 (EDX)及细胞内 Na+、 K+、 Mg2 +含量并与 2 6例正常血压对照者 (NC组 )作对照。结果 :EH组 FPG、FINS、EDX、Na+水平显著高于 NC组 (P<0 .0 5 ,<0 .0 1,<0 .0 1、 <0 .0 0 1) ,胰岛素敏感性指数 (ISI)、 K+、 Mg2 +显著低于 NC组 (P<0 .0 0 2 ,<0 .0 1,<0 .0 0 1) ;EH组 FINS与体重、体重指数 (BMI)、臀围、 EDX呈显著正相关 (r=0 .5 2 ,0 .35 ,0 .45 ,0 .41;P<0 .0 0 5 ,<0 .0 5 ,<0 .0 1,<0 .0 5 ) ,ISI与体重、BMI、臀围呈显著负相关 (r=- 0 .5 8,- 0 .42 ,- 0 .5 7;P<0 .0 0 1,<0 .0 5 ,<0 .0 1)。结论 :高血压患者血胰岛素水平与内地高辛、肥胖呈显著正相关 (P<0 .0 5～ <0 .0 0 5 ) ;ISI与肥胖呈显著负相关。     

Formoterol,a new long-acting selectiveβ 2-agonist,decreases airway responsiveness in children with asthma

We compared the protective effect and duration of action of inhaled formoterol with salbutamol and placebo in 16 asthmatic children in a double-blind, cross-over study. All had an FEV₁ ≥ 70% predicted normal and a provocative concentration of methacholine (MCh) required to decrease their FEV₁ by 20% (PC₂₀) ≤ 4 mg/ml. On each study day, FEV₁ was within 10% and PC₂₀ within one doubling-dose of the initial visit. Patients received either placebo, salbutamol 200μg, formoterol 12μg, or formoterol 24μg by metered-dose inhaler. FEV₁ and PC₂₀ were measured repeatedly over 12 h. After salbutamol, peak FEV₁ was 120% of baseline at 30 min and returned to baseline in 3 h. After formoterol (12 or 24μg) peak FEV₁ was 118% at 3 h and remained above baseline for at least 12 h. Protection from MCh by both doses of formoterol was significantly better than by salbutamol. Protection from formoterol 12 and 24μg at 12 h was equivalent to that from salbutamol at 3 h. The PC₂₀ of four children 48 h after formoterol 24μg was more than twice their baseline PC₂₀. Formoterol by inhalation is potent and long-acting and provides significantly better antiasthma protection than salbutamol.     

Sarcosine1, glycine8 angiotensin II is a functional AT1 angiotensin receptor antagonist

Sarcosine¹, glycine⁸ angiotensin II (SG Ang II) displayed unusual characteristics in early pharmacological studies. It was a potent antagonist of the dipsogenic actions of intracerebroventricularly administered Ang II in the rat, but showed low affinity for bovine cerebellar Ang II receptors. It has recently been shown that SG Ang II binds preferentially to the AT₁ receptor, To determine if SG Ang II is a functional antagonist of the AT₁ receptor-mediated calcium signaling, CHO cells stably transfected with AT₁ receptors were exposed to Ang II in the presence and absence of SG Ang II. At concentrations of 10–100 nM, SG Ang II completely inhibited Ang II-stimulated intracellular Ca²⁺ mobilization in AT_1A and AT_1B receptor-transfected cells. SG Ang II and ¹²⁵I-SG Ang II bound to AT_1A and AT_1B receptor-transfected cells with K _D and K ₁ values of 2–4 nM. In contrast, SG Ang II bound to AT₂ transfected cells with a K ₁ value of 7.86 μM. These results demonstrate that SG Ang II is a selective and functional peptide antagonist of the AT₁ angiotensin II receptor subtype.     

慢性心力衰竭校正QT间期与QT离散度及心功能相关性

目的 :探讨慢性心力衰竭患者校正QT间期 (QTc)与QT离散度 (QTd)及心功能超声参数相关性。方法 :研究了 12 6例左室射血分数 (LVEF) <4 5 %的慢性心力衰竭患者QTc与QTd、QRS间期、临床指标、心脏超声心动图参数的相关性。结果 :QTc与年龄 (r =0 .2 1,P <0 .0 1)、左室舒张末期直径 (r =0 .2 6 ,P <0 .0 1)、左房直径 (r =0 .2 4 ,P <0 .0 1)、QRS间期 (r =0 .37,P <0 .0 1)、QTd(r =0 .4 1,P <0 .0 1)呈正相关 ;与短轴缩短率 (r=- 0 .2 8,P <0 .0 1)、LVEF(r =- 0 .33,P <0 .0 1)呈负相关 ;与二尖瓣E波和A波峰值速度比值、等容舒张时间无相关性 (P >0 .0 5 )。多元回归分析显示 ,QTc和QTd、QRS间期、LVEF存在独立相关性。结论 :QTc与心力衰竭患者预后影响因素有关 ;QTc与QTd存在独立相关性 ,其生物相关性值得进一步研究     

肥胖病人血清胰岛素样生长因子结合蛋白1、3水平与代谢因素的关系

目的　观察肥胖病人血清胰岛素样生长因子结合蛋白 1、3 (IGFBP 1、IGFBP 3 )水平 ,分析其与年龄、性别、体重指数、糖代谢、脂代谢等指标的关系。方法　应用ELISA法测定 92例肥胖病人和 84例正常人血清IGFBP 3、IGFBP 1及真胰岛素水平。结果　肥胖组与对照组比较 ,IGFBP 3明显增高 (P <0 .0 1) ;IGFBP 1下降 (P <0 .0 5 )。IGFBP 1与BMI(r =-0 .418,P <0 .0 1)、FINS(r =-0 .3 5 7,P <0 .0 5 )和Homa IR指数 (r =-0 .3 1,P <0 .0 5 )呈负相关。IGFBP 3与FINS呈正相关 (r =0 .2 6,P <0 .0 5 )。结论　肥胖病人血清IGFBP 1浓度降低 ;IGFBP 1水平可能反映胰岛素抵抗状态     

糖尿病脂代谢紊乱的调脂治疗

2型糖尿病患者常合并有脂代谢异常 ,单纯控制血糖不能完全消除糖尿病患者发生冠心病等大血管并发症 ,因此 ,在控制血糖的同时 ,必须进行调脂治疗。现简要介绍如下。一、血脂治疗目标亚太地区 2型糖尿病政策组 2 0 0 2年制订的血脂控制目标 (第 3版 )见表 1。表 1　血脂控制目标血脂　良好一般不良总胆固醇(mmol/L) <4.5≥ 4 .5≥ 6 .0高密度脂蛋白胆固醇(mmol/L) >1 .1 1 .1～ 0 .9<0 .9甘油三酯(mmol/L) <1 .5 <2 .2≥ 2 .2低密度脂蛋白胆固醇(mmol/L) <2 .5 2 .5～ 4 .0 >4.0　　 2型糖尿病患者的血脂倾向为显著增高的甘油三酯 (TG)和…     

高分辨率超声检测代谢综合征患者血管内皮功能

为了研究代谢综合征患者的血管内皮功能及与心血管危险因素的相关性 ,采用高分辨率超声测定 2 1例正常对照者、35例代谢综合征患者的肱动脉反应性充血及含服硝酸甘油后的血管内经和血流量的变化。结果发现 ,两组间甘油三酯、空腹血糖、餐后 2h血糖、收缩压、舒张压和体质指数差异有显著性 (P <0 .0 5或P <0 .0 1) ,而性别、年龄、总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇差异均无显著性 (P >0 .0 5 )。两组间反应性充血后血管内径变化率、含服硝酸甘油后血管内径变化率和含服硝酸甘油后血流量变化率差异有显著性 (P <0 .0 1或P <0 .0 5 ) ,而肱动脉基础内径、肱动脉基础血流量、反应性充血后血流量、含服硝酸甘油后血流量、反应性充血后血流量变化率差异无显著性 (P >0 .0 5 )。两组反应性充血后血管内径变化率较含服硝酸甘油后血管内径变化率降低 (P <0 .0 1)。反应性充血后血管内径变化率与患者年龄 (r=- 0 .2 9,P <0 .0 5 )、甘油三酯 (r=- 0 .38,P <0 .0 5 )、收缩压 (r=- 0 .71,P <0 .0 1)、舒张压 (r=- 0 .6 1,P <0 .0 1)、空腹血糖 (r =- 0 .6 2 ,P <0 .0 1)、餐后 2h血糖 (r=- 0 .6 6 ,P <0 .0 1)和体质指数 (r=- 0 .4 7,P <0 .0 1)呈负相关。结果提示 ,代谢综合征患者存在血管内皮依     

ERCP and MRCP--when and why

Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the 1970s, gastroenterologists have a wide spectrum of diagnostic and therapeutic options in the biliopancreatic ductal system at their disposal. With its arrival in the 1990s, magnetic resonance cholangiopancreatography (MRCP) developed as a potent diagnostic tool in biliopancreatic pathology. Currently, MRCP is widely replacing diagnostic ERCP and thereby avoiding complications related to endoscopic technique.We summarize evidence-based data and demonstrate indications and differential indications for MRCP and ERCP in pancreatic disease. Complications related to the procedures and possible medical prevention are discussed. The feasibility of interventional endoscopy in pancreatic disease is reported in detail. The role of gastroenterologists in performing MRCP is outlined on the basis of practical examples.     

Micronutrients and infection: interactions and implications with enteric and other infections and future priorities

Symposium presentations have focused on the elegant molecular science and the biologic mechanisms by which micronutrients play critical roles in cellular and humoral immune responses, cellular signaling and function, and even in the evolution of microbial virulence. The concluding session examined the practical issues of how best to evaluate the nutritionally at-risk host, especially in the areas of greatest need-an analytical model of nutrient-immune interactions, implications of nutritional modulation of the immune response for disease, and the implications for international research and child health. This overview illustrated how malnutrition may be a major consequence of early childhood diarrhea and enteric infections, as enteric infections may critically impair intestinal absorptive function with potential long-term consequences for growth and development. The potentially huge, largely undefined DALY (disability-adjusted life years) impact of early childhood diarrheal illnesses demonstrates the importance of quantifying the long-term functional impact of largely preventable nutritional and infectious diseases, especially in children in developing areas.