糖尿病并发症的药物治疗研究进展

糖尿病是一种慢性终身疾病,随着病程的延长,会继发感染、冠心病、肾和视网膜等微血管及周围神经病变等并发症。因此,除了要严格控制血糖外,还需对其并发症进行对症治疗。笔者现对糖尿病并发症的药物治疗进行综述。     

糖尿病并发症的药物治疗新进展

糖尿病是一种常见的慢性疾病,胰岛素治疗固然可延长糖尿病患者的生命,但不能预防糖尿病并发症的发生。糖尿病并发症,诸如白内障、视网膜病变、角膜上皮病变、神经病变、肾脏病变、微血管病变和动脉粥样硬化等,均会给糖尿病患者带来极大的痛苦,甚至是导致患者死亡的原因之一。现在发现许多药物在防治糖尿病并发症上有较好的疗效,现综述如下。 1.醛糖还原酶抑制剂醛糖还原酶抑制剂(ARI)是一种磷酸烟酰胺—腺嘌呤二核苷酸(NADP)—依赖酶,可将葡萄糖还原成山梨醇,再经山梨醇脱氢酶脱氢变成果糖。目前,许多学者认为,糖尿病并发症与多醇代谢(多醇代谢是指葡萄糖、木糖、木酮糖等单糖的羰基被还原分别生成山梨醇,半乳糖醇、木糖醇等     

糖尿病慢性并发症的药物治疗进展

随着社会经济的发展和人均寿命的延长,糖尿病(d iabe-tes m ellitus,DM)患病率急剧增加,已成为影响人类健康的主要疾病之一。DM若没有得到及时正规的治疗可引起多种慢性并发症。据统计,与非糖尿病人群比较,糖尿病人群心、脑血管病的患病率为非糖尿病人群的2~4倍,糖尿病足为15倍     

老年糖尿病血管并发症危险性药物治疗研究进展

糖尿病 (ＤＭ )的发病率随增龄而增加 ,老年人患ＤＭ者日益增多 ,其中 95 %属 2型ＤＭ。心血管并发症是 2型ＤＭ的主要并发症 ,是导致失明、肾衰、截肢和心血管卒中等严重事件发生的主要原因。据统计 75 %～ 80 %的 2型ＤＭ死于心血管疾病 ,老年ＤＭ心脑血管和外周血管并发症的死亡率是同龄非ＤＭ者的 2倍[1] 。因此 ,加强对老年ＤＭ心血管危险因素的控制 ,对于延缓和阻滞ＤＭ大血管、微血管等并发症的发生和加重 ,降低致残率和致死率有重要现实意义。1　老年ＤＭ药物治疗绝不仅是降糖血糖作为评价ＤＭ防治效果的指标无可厚非 ,但是长期以来…     

糖尿病并发症的发病机制及其药物治疗研究进展

目的重点整理糖尿病常见并发症的发病机制及其药物治疗的研究成果,对该病的深入探究、临床规范给药及新药研制等明确方向。方法查阅与梳理国内外相关文献资料,对其进行归纳与研究。结果对糖尿病临床常见的7类并发症及其药物治疗做了阐述,并对其并发症发病机制和药物治疗做了总结。结论糖尿病并发症的发病机制非常复杂,通过临床研究来看,应对不同病人的发病机制实施个性化的药物治疗方案,确保临床用药更加科学、规范,真正地为病人的健康安全保驾护航。     

糖尿病并发症的药物治疗

糖尿病并发症对人类健康造成极大危害，针对各种糖尿病并发症的病因开发其治疗药物已成为人们关注的热点，并取得可喜进展。本文分类概述糖尿病并发症治疗药物的作用机制、临床应用及疗效研究，其药物包括醛糖还原酶抑制剂、糖基化终产物抑制剂、抗氧剂以及血管紧张素转换酶抑制剂。     

牙周病治疗对预防糖尿病患者口腔并发症的临床效果研究

目的:研究牙周病治疗对预防糖尿病患者口腔并发症的临床效果。方法:将某院收治的糖尿病的患者用随机抽签的方式分为对照组和观察组各41例。观察组的患者接受常规的口腔检查治疗,并且对观察组的患者牙体牙髓以及牙周病等相关方面进行检查,给予相应的治疗;对照组的患者则是接受未实施任何治疗措施的健康口腔检查,最后比较两组患者的临床治疗效果。结果:观察组患者的临床治疗整体有效率达到了85.35%,而对照组为65.53%;且观察组口腔并发症发生率明显低于对照组,各项数据的对比差异具有统计学意义(P<0.05)。结论:对牙周病治疗对于预防糖尿病患者口腔并发症具有很好的临床效果,也能降低口腔并发症。     

治疗糖尿病并发症的药物研究进展

糖尿病并发症是一种由糖尿病病变转化而来的常见慢性疾病,主要包括糖尿病心血管病变、糖尿病肾病、糖尿病眼病等,这些并发症是糖尿病致死致残的主要原因。目前糖尿病并发症已成为我国面临的巨大公共卫生问题,如何通过药物有效地防治糖尿病并发症已成为糖尿病治疗研究的热点和难点。本文就近几年来有关治疗糖尿病并发症的药物研究进展进行综述。     

糖尿病并发症的中医治疗分析

糖尿病并发症期,可出现心、脑、肾、眼底、足等多种血管神经并发症,常为多种并发症并存的局面,或以一种并发症为主,同时兼有另一种或几种并发症。     

糖尿病合并泌尿系感染及抗感染药物的应用：附116例临床分析

糖尿病(DM)患者并发泌尿系感染较为常见。在DM合并的各种感染中占第二位,其隐匿性大,严重时可出现酮症酸中毒。因此,了解DM合并泌尿系感染的易感因素及其治疗原则,合理使用抗感染药物就显得尤为重要。为此本文调查了1994～1999年收治的DM住院病人580例,其中合并泌尿系感染116例,现分析如下。     

Oral hypoglycaemic drugs and gastrointestinal symptoms in diabetes mellitus

BACKGROUND: Gastrointestinal symptoms are commonly reported as side-effects of oral hypoglycaemic drugs. It may be very difficult to distinguish between spontaneous and truly drug-related symptoms due to the high background incidence of gastrointestinal symptoms. Gastrointestinal symptoms in diabetic patients have also been linked to factors associated with long-standing disease and suboptimal control. AIM: To explore the association between gastrointestinal symptoms and treatment with oral hypoglycaemic drugs in a large cohort of subjects with type 2 diabetes. PATIENTS AND METHODS: 956 subjects with type 2 diabetes participated in the study. All subjects completed a validated, self-administered questionnaire on gastrointestinal symptoms, diabetes, drug use and various potential risk factors for gastrointestinal symptoms. The association between oral hypoglycaemics and nine gastrointestinal symptom groups was assessed based on logistic regression. RESULTS: 405 of the 956 patients used oral hypoglycaemic drugs. Metformin use was independently associated with chronic diarrhoea (odds ratio 3.08, 95% CI: 1.29-7.36, P < 0.02) and with faecal incontinence (odds ratio 1.95, 95% CI: 1.10-3.47, P < 0.05). Use of sulphonylureas was associated with less abdominal pain, but not with any other gastrointestinal symptom. CONCLUSIONS: Troublesome gastrointestinal symptoms do not appear to be caused by oral hypoglycaemics, except for diarrhoea and faecal incontinence, which are strongly and independently associated with metformin use.     

Study on p-hydroxybenzoic acid on rheumatoid arthritis via inhibiting NF-κB/caspase-1 signaling pathway

探究二肽基肽酶-4抑制剂(dipeptidyl peptidase-4 inhibitors,DPP-4i)维格列汀改善糖尿病诱导心肌细胞的炎性损伤作用机制。

体外培养AC16心肌细胞随机分为空白组、棕榈酸(palmitic acid,PA)组、0.1、1、10 μmol·L⁻¹维格列汀组以及西格列汀组(阳性对照组)。采用CCK-8试剂盒检测细胞存活率;Western blotting检测目的蛋白DPP-4、p-NF-κB、IκB的表达情况;ELISA试剂盒检测炎症因子TNF-α和IL-6表达水平;TUNEL试剂盒检测细胞凋亡情况。

AC16人源心肌细胞经PA处理后,细胞形态改变;CCK-8结果显示细胞存活率下降;Western blotting结果显示NF-κB磷酸化增强,且DPP-4蛋白表达升高;ELISA结果显示炎症因子TNF-α和IL-6表达水平上升;TUNEL阳性比例增多,促进心肌细胞凋亡。维格列汀给药后能有效抑制PA诱导的DPP-4蛋白异常表达,改善心肌细胞形态,并下调NF-κB磷酸化水平。ELISA结果显示维格列汀改善PA诱导的炎症因子TNF-α和IL-6表达水平上升,降低TUNEL阳性比例(P<0.05)。

维格列汀可以有效拮抗PA诱导的心肌细胞炎性损伤,通过抑制NF-κB磷酸化水平,降低胞内炎症因子表达水平与抑制细胞凋亡,从而拮抗糖尿病心肌病诱导的心肌损伤。

     

Vascular complications of diabetes mellitus

1. Macro- and microvascular diseases are the main chronic complications of diabetes mellitus (DM). 2. It has been shown that DM patients have more severe nailfold microcirculatory disturbances than patients with liver cirrhosis or systemic lupus erythematosus (SLE). 3. It has been shown that the glomerular basement membrane of diabetic rats is significantly thickened compared with that of normal rats (295.5 +/- 45.1 vs 184.8 +/- 33.2 nm). 4. Gastric mucosal blood flow (GMBF) in 41 patients with non-insulin-dependent diabetes mellitus (NIDDM) was determined with a laser Doppler flowmeter. The results showed that average GMBF values at 14 sites in the gastric mucosa were significantly lower in NIDDM patients than in control subjects. 5. The percentage of painless acute myocardial infarction (AMI) among 50 patients with DM was 22.0% and the mortality of AMI was 22.0% (11 cases). Both these values were higher than the corresponding values in patients without DM (9.9 and 11.4%, respectively; P < 0.05). 6. Cerebrovascular disease is more prevalent in diabetic patients than in non-diabetics and the mortality of stroke in DM patients is two-fold higher than that of non-diabetic patients. 7. Diabetes can result in widespread macrovascular atherosclerosis and microcirculatory disorders of multiple organs.     

Sulfonyl group-containing compounds in the design of potential drugs for the treatment of diabetes and its complications

Sulfonyl group-containing compounds constitute an important class of therapeutical agents in medicinal chemistry presumably because of the tense chemical structure and functionality of the sulfonyl, which could not only form hydrogen bonding interactions with active site residues of biological targets but also, as incorporated into core ring structure, constrain the side chains and allowed their specific conformations that fit the active sites. This review focuses on sulfonamides and sulfones, which cover more than 40 series and are associated with at least 10 potential pharmaceutical targets in pathways of glucose metabolism and insulin signaling. A large number of such compounds have been reported as pharmaceuticals every year in the last decade. In particular, increasing studies suggest that sulfonamides and sulfones play a key role in the design of pharmaceutical agents with potential application for the treatment of diabetes and its complications. First, they are inhibitors of a variety of enzymes including 11β-hydroxysteroid dehydrogenase type 1, α- glucosidase, carnitine palmitoyltransferase and cytosolic phosphoenolpyruvate carboxykinase, and in turn involved in the regulation of the metabolism of glucose. In addition, they are active as activators of glucokinase and as antagonists of ghrelin receptors. These enzyme and receptors are tightly associated with the regulation of glucose metabolism and the improvement of insulin resistance. Secondly, sulfonamides and sulfones act in the insulin secretion. As agonists, they activate insulin receptor tyrosine kinase and thus increase insulin sensitivity. Moreover, they as inhibitors suppress protein tyrosine phosphatase 1B and dipeptidyl peptidase IV, and thus normalize the insulin signaling pathway. Finally, a number of sulfonamides and sulfones are inhibitors of aldose reductase, which have been linked to diabetic complications.     

深圳市509例2型糖尿病患者常见口服降糖药物基因多态性分析

目的：探索深圳市糖尿病患者口服降糖药物相关单核苷酸多态性（single nucleotide polymorphism,SNPs）的分布特征,为糖尿病患者个体化用药指导提供参考。方法：采用外周血DNA抽提/焦磷酸测序检测509例糖尿病患者四大类降糖药物4个药物相关基因位点SNPs。采用SPSS 25.0软件统计相关基因位点的等位基因和基因型的频率分布差异。参照国内外不同人群的基因型频率数据,回顾性分析深圳市2020—2021年社区糖尿病患者的降糖药物相关SNPs的分布特征。结果：PPARG、SLCO1B1的SNPs与国外人群存在较大差异,与国内报道基本相符。CYP2C9*3的SNPs与欧洲人群存在差异,但与中国人群和美洲人群相关报道基本相符。然而有机阳离子转运体OCT2的SNPs与中国南方人群存在一定的差异,但与中国北京、欧洲、美洲相关报道的情况基本相符。结论：深圳市糖尿病患者降糖药物相关SNPs分布有自身特点,临床药师及医生应根据药物相关SNPs提供个体化用药指导建议。药物基因组学的个体化用药在参考PharmGKB等数据库的同时应结合国人的特点,不能完全参考国外人群数据库。     

Cardiovascular complications in diabetes mellitus

Diabetes is strongly associated with coronary, cerebral and peripheral arterial disease, as well as with microangiopathy. In those with diabetes, the extent of macrovascular disease increases and atherosclerotic plaques are more prone to rupture. Both hormonal abnormalities (insulin resistance that is typically present for many years before the onset of type 2 diabetes) and metabolic abnormalities contribute. Multi-targeted intensive therapy is imperative; however, unfortunately it is underutilized. Functional and structural derangements contribute to impaired arterial and ventricular compliance predisposing to congestive heart failure that is increasingly recognized to be a cause of morbidity and mortality in patients with diabetes.