血和尿层粘连蛋白与2型糖尿病患者尿白蛋白关系的研究

目的　研究血、尿层粘连蛋白 (LN)与早期糖尿病肾病 (DN)的关系。方法　 2型糖尿病 (DM)患者 116例 ,分为正常蛋白尿组 (DMN组 ) 83例 ,微量蛋白尿组 (DMMA组 ) 3 3例 ;对照组 (C组 ) 3 1例。检测尿液LN、白蛋白(Alb)、肌酐 (Cr)和血清LN。结果　①尿LN/Cr在DMMA组高于C组 (P <0 0 5 ) ;血清LN在DMMA组高于C组及DMN组 (P <0 0 5 )。②DM患者尿Alb/Cr与尿LN/Cr(r =0 183 ,P <0 0 5 )、血清LN(r =0 3 5 7,P <0 0 1)均呈显著的正相关。③DM病程进入了血、尿LN和尿Alb/Cr的回归方程。结论　① 2型DM患者血、尿LN与尿Alb排出有一致性升高的趋势 ,血清LN是DM早期肾病标志蛋白。②整体DM组中DM病程为血、尿LN和Alb/Cr升高的危险因子。③本研究提示 2型DM患者中血、尿LN水平升高 ,并与DN的发生和严重程度有较好的相关性 ,尿、血LN水平可以用来监测DN的发生、病情进展和治疗效果     

肥胖及糖调节受损患者血视黄醇结合蛋白4的变化及临床意义

目的研究超重、肥胖（OW、Ob）及糖调节受损（IGR）患者血视黄醇结合蛋白4（RBP-4）变化及与胰岛素抵抗（IR）的关系。方法ELISA法测正常糖耐量（NGT）组52例及IGR组58例的血RBP-4水平。结果各组RBP-4渐升高，组间差异有统计学意义；与腰围、WHR、HOMA—IR、TG、FPG正相关（r分别为0．289、0．322、0．377、0．41、0．432，P均〈0.01）；FPG、TG、WHR为其独立相关因素（r^2分别为0．186、0．305、0．340）。结论OW／Ob及IGR者血RBP-4升高，FPG、TG、WHR为其独立相关因素。     

高浓度葡萄糖对人胰岛β细胞凋亡影响的分子机制

目的　初步探讨高浓度葡萄糖对人胰岛 β细胞凋亡的影响及其分子机制。　 方法　分离培养人胰岛细胞 ,并分为对照组、高糖组和高糖 氨基胍组 ,3 7℃ ,5 %CO2 培养 72h ,测定培养液上清液中胰岛素、一氧化氮 (NO)、还原性谷胱甘肽 (GSH)水平。原位末端核苷酸标记法 (TUNEL)和胰岛素免疫组化双染色法及ELISA法检测胰岛 β细胞凋亡 ,RT PCR检测胰岛细胞p5 3、Bcl 2和胰岛素基因启动转录因子 1 (PDX 1 )mRNA表达水平。　结果　高糖组胰岛 β细胞凋亡小体富计因子(1 91± 0 6 9)、β细胞凋亡率 (1 4 8% )、NO〔(1 82 3± 1 5 5 ) μmol/L〕和 p5 3mRNA(0 3 0 6± 0 0 3 9)表达水平均显著高于高糖 氨基胍组〔分别为 1 1 9± 0 3 3、6 8%、(1 5 4 2± 1 9 7) μmol/L、0 1 3 9±0 0 6 9,P <0 0 1〕和对照组〔分别为 1 0 6± 0 2 6、4 2 %、(1 1 7 3± 2 1 7) μmol/L、0 1 2 5± 0 0 1 5 ,P <0 0 5〕 ,而胰岛素释放量、GSH、bcl 2mRNA和PDX 1mRNA表达水平则显著低于高糖 氨基胍组(P <0 0 5 )和对照组 (P <0 0 5 )。　结论　高浓度葡萄糖可通过诱导人胰岛 β细胞凋亡及PDX 1表达降低使胰岛素分泌减少 ,其机制与高糖状态下胰岛 β细胞抗氧化能力降低引起NO介导的p5 3高表达和PDX 1低表     

The effect of repaglinide on blood glucose and islet β-cell function in newly diagnosed type 2 diabetic patients

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.     

The effect of repaglinide on blood glucose and islet β-cell function in newly diagnosed type 2 diabetic patients

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.     

G蛋白β3亚单位C825T等位基因多态性与原发性高血压的关系

目的 探讨温州地区汉族人群G蛋白β3亚单位(GNB3)C825T等位基因多态性与原发性高血压的相关性.方法 原发性高血压患者109例,正常对照组378例,聚合酶链反应(PCR)/酶解-琼脂糖凝胶电泳检测基因型.结果 (1)温州地区汉族人群GNB3 825T等位基因频率为43.5%,与其他人种的该基因频率显著不同.(2)原发性高血压组的TT基因型携带率明显升高(P＜0.01),TT基因型携带者与CT型携带者比较,其致高血压的比数比(OR值)为2.5(P＜0.01);TT型与CC型比,其OR值为2.4(P＜0.01);等位基因T与C比较,致高血压的OR值为1.5(P＜0.05).(3)GNB3不同基因型间的血压水平比较,收缩压CT和TT携带者与CC携带者比较均增高(P＜0.05和P＜0.01),TT携带者与CT携带者比较亦有升高(P＜0.01),舒张压TT携带者比CC携带者增高(P＜0.05),而CT携带者与CC携带者比较差异无显著性(P＞0.05),TT携带者与CT携带者比较,收缩压和舒张压均增高(P＜0.01和P＜0.05).结论 GNB3 825T基因型可作为早期预测原发性高血压的遗传学指标之一.     

血管紧张素转换酶2和血管紧张素转换酶基因多态性与妊娠期糖尿病相关性研究

目的探讨血管紧张素转换酶2(angiotensin converting enzyme 2,ACE2)单核苷酸多态性位点rs2285666及血管紧张素转换酶(angiotensin converting enzyme,ACE)插入/缺失(insertion/deletion,I/D)多态性与妊娠期糖尿病(GDM)的相关性。方法选取GDM孕妇360例,糖耐量受损(IGT)孕妇167例,以糖耐量正常(NGT)孕妇428例及50 g葡萄糖激发试验阴性[GCT(-)]孕妇273例[NGT+GCT(-)]为对照。共纳入受试者1,228例,采用聚合酶链反应(PCR)及聚合酶链反应-限制性片断长度多态性(PCR-RFLP)方法检测ACE2及ACE基因多态性。结果各组间ACE2 rs2285666和ACEI/D基因型及等位基因分布频率均无统计学差异(P>0.05)。GDM组ACE2 TT和ACE(DD+ID)基因型的组合TT(DD+ID)频率显著高于对照组(18.9%vs12.6%,P=0.005),具有TT(DD+ID)基因型者患GDM的危险性是具有其他基因型组合者的1.577倍[OR=1.577,95%CI(1.144～2.173)],通过logistic回归分析,校正年龄、血压、白细胞总数、甘油三脂的影响后,具有TT(DD+ID)基因型的孕妇患GDM的危险性是具有其他基因型组合者的1.699倍[OR=1.699,95%CI(1.129～2.556),Wald=6.46,P=0.011]。对照组中ACE基因型为(DD+ID)者的舒张压比ACE基因型为II者高[(68±9)mmHgvs(66±8)mmHg,t=2.635,P=0.009]。结论ACE2基因型TT和ACE基因型(DD+ID)的组合即TT(DD+ID)可能会增加妇女发生GDM的危险性,在正常妊娠妇女中携带ACE D等位基因者有相对较高的舒张压水平。     

知识教育在农村糖尿病防治调查分析

现代化农业操作模式的日趋改善，农民体力作业的强度大大降低，加上膳食结构的变化导致农村糖尿病发病率不断上升。而控制率与治疗率分别仅为8．1％和23．7％。作者于2004年10月至2005年10月在绍兴农村进行糖尿病知识教育。通过对糖尿病知识教育，改善了当地农村糖尿病防治状况，报道如下。     

2型糖尿病视网膜病变相关因素的分析

本文对近2年来住院的2型糖尿病患者并发视网膜病变（DR）并与蛋白尿，糖化血红蛋白，年龄等相关因素做一临床分析。1对象和方法1．1对象随机分析本院内分泌科2004年6月至2005年9月住院的2型糖尿病患者150例，男69例，女81例，年龄45。75岁，糖尿病（DM）病程1—15年。并发DR组84例，平均年龄（63．25±11．44）岁，病程4．0—13．8年。     

糖尿病并发肺脓肿诊治分析

感染是糖尿病患者常见的并发症,但糖尿病并发肺脓肿并不常见。能否及时作出正确诊断与治疗对病人的预后有重要影响。现笔者对我院收治的糖尿病并发肺脓肿进行回顾性分析,以期进一步提高对本病的认识。