关于胰岛移植治疗1型糖尿病的思考

糖尿病是一种严重影响人类健康的疾病,胰岛移植作为一项新兴技术,对于1型糖尿病而言是一种很有前景的治疗方法。通过总结和回顾该疗法的产生原因、研究现状及发展方向,揭示了认识论和系统论这些哲学基本原理在此过程中的指导作用,并以此为例阐述临床辩证思维对临床医学的促进作用。     

Intrahippocampal administration of A beta(1-40) impairs spatial learning and memory in hyperglycemic mice

Age-related neurodegenerative dementia, particularly Alzheimer's disease (AD), may be exacerbated by several interacting risk factors including genetic predisposition, beta amyloid (A beta) protein accumulation, environmental toxins, head trauma, and abnormal glycolytic metabolism. We examined the spatial learning and memory effects of A beta(1-40) administration on hyperglycemic mice by their performance in the Morris water maze. Chronic hyperglycemia was induced in male C57BL/6J mice to mimic diabetes mellitus by intraperitoneal injection of streptozotocin (STZ), which specifically destroys pancreatic beta-islet cells. Ten days after STZ treatment, intrahippocampal infusion of vehicle, monomer, or oligomer A beta(1-40) was given to these hyperglycemic mice. Our results demonstrate that in comparison with vehicle or monomer A beta(1-40), oligomer A beta(1-40) induced significant deficits of spatial learning and memory in hyperglycemic mice. Apoptotic signals were identified in the CA1 and dentate gyrus of hippocampus in hyperglycemic mice. A beta accumulation, oxidative stress, and apoptosis in the CA1 region were more intensive in hyperglycemic mice than that in normoglycemic mice after acute treatment with oligomer A beta(1-40) peptide treatment. These results indicate that CA1 apoptosis was enhanced by oxidative stress resulting from accumulation of A beta. Considered together, these findings suggest that hyperglycemic mice are more vulnerable to the A beta-induced-oxidative stress than normal subjects. We therefore propose that A beta accumulation would be enhanced by hyperglycemia, and the oxidative stress caused by A beta accumulation would in turn enhance the AD symptoms.     

防治血管剩留风险的决策探讨

针对冠心病和（或）2型糖尿病患者,已有许多有效的防治措施。然而,尽管接受了当前的标准治疗,这类患者仍会反复发生许多大血管和微血管事件,这种现象称之为血管剩留风险。有许多因素影响血管剩留风险的存在,其中最为重要的是致动脉粥样硬化性血脂异常。因此,采取积极的全面干预措施如改善生活方式、联合降脂以改善所有的脂质异常指标,是最大程度降低血管剩留风险的动向。     

解偶联蛋白2基因启动子-866G／A多态性与2型糖尿病的相关性研究

研究解偶联蛋白-2基因启动子常见-866G／A基因多态性（UCP2—866G／A）与2型糖尿病发病相关性。用多聚酶链反应-限制内切酶长度多态性技术检测了76例非糖尿病对照（NDM）和115例糖尿病患者（DM）的UCP2—866G／A基因型分布,并分析各基因型与胰岛功能、代谢参数的差异性。结果DM的AA基因型分布显著高于NDM（32．2％vs15．8％,χ^2=6．526,P〈0．038）。在NDM组GG型携带者空腹C肽（FCP）水平高于AA和GG组（两两比较分别为t=2．99,P=0．005和t=2．229,P=0．03）;在DM各基因型之间FCP和餐后2小时C肽（2hCP）情况与NDM对照相似,各基因型混和餐刺激后2hCP差异更加明显。结论为UCP2—866G／A基因多态性与大连地区2型糖尿病发病相关,该基因多态性主要影响胰岛β细胞分泌功能。     

二甲双胍对糖尿病大鼠脂联素的影响

二甲双胍能够改善胰岛素抵抗,而脂联素与胰岛素抵抗密切相关,因此本研究通过建立糖尿病大鼠模型,并给予二甲双胍治疗,观察胰岛素抵抗和脂联素的变化,研究结果显示二甲双胍的治疗改善胰岛素抵抗的同时,也增加了血清和组织中脂联素的表达,提示二甲双胍改善胰岛素抵抗的机制之一可能是通过增加脂联素的表达而获益。     

The Impact of Managing School-aged Children’s Diabetes: The Role of Child Behavior Problems and Parental Discipline Strategies

Models of diabetes management in children emphasize family relationships, particularly parent–child interactions. In adolescents, parental involvement in disease-specific management relates to better health and adherence. However, information about parental involvement in disease management for young children is limited and mixed. This study investigated behavior problems of school-aged children with Type 1 Diabetes Mellitus (T1DM) in association with parent discipline strategies and parents’ perceptions of (1) time spent managing diabetes and (2) the impact their child’s diabetes has on their discipline strategies. Parents of children ages 5–12 with T1DM completed standardized measures of child misbehavior, parent discipline strategies, and responded to questions regarding perceived time spent managing diabetes, and perceived impact of diabetes on ability to discipline. Results showed child mealtime misbehavior was common and associated with overreactive parental discipline. Further, overreactive discipline was also associated with reports of less time spent managing child’s illness. Child misbehavior was positively associated with parents’ perceived amount of time spent managing diabetes and with the impact of child diabetes on discipline. Findings suggest the importance of considering parent discipline strategies and child misbehavior when working with young children with diabetes.     

BOLD response to semantic and syntactic processing during hypoglycemia is load-dependent

This study investigates how syntactic and semantic load factors impact sentence comprehension and BOLD signal under moderate hypoglycemia. A dual session, whole brain fMRI study was conducted on 16 healthy participants using the glucose clamp technique. In one session, they experienced insulin-induced hypoglycemia (plasma glucose at ∼50 mg/dL); in the other, plasma glucose was maintained at euglycemic levels (∼100 mg/dL). During scans subjects were presented with sentences of contrasting syntactic (embedding vs. conjunction) and semantic (reversibility vs. irreversibility) load. Semantic factors dominated the overall load effects on both performance (p < 0.001) and BOLD response (p < 0.01, corrected). Differential BOLD signal was observed in frontal, temporal, temporo-parietal and medio-temporal regions. Hypoglycemia and syntactic factors significantly impacted performance (p = 0.002) and BOLD response (p < 0.01, corrected) in the reversible clause conditions, more extensively in reversible-embedded than in reversible-conjoined clauses. Hypoglycemia resulted in a robust decrease in performance on reversible clauses and exerted attenuating effects on BOLD unselectively across cortical circuits.The dominance of reversibility in all measures underscores the distinction between the syntactic and semantic contrasts. The syntactic is based in a quantitative difference in algorithms interpreting embedded and conjoined structures. We suggest that the semantic is based in a qualitative difference between algorithmic mapping of arguments in reversible clauses and heuristic linking in irreversible clauses. Because heuristics drastically reduce resource demand, the operations they support would resist the load-dependent cognitive consequences of hypoglycemia.     

Identification of risk factors for suffering fear of hypoglycemia in type 1 Diabetes Mellitus patients

Hypoglycemia is one of the main burdens for type I Diabetes Mellitus (DM I) patients. The consequences of hypoglycemia can be quite unpleasant due to the variety of disagreeable physical and psychological symptoms it triggers. The patient's previous experience with hypoglycemia episodes will condition his psychological reaction to future episodes, promoting behavioral modifications that associate with poor glycemic control and worse prognosis, and even with developing psychological disorders, leading to fear of hypoglycemia (FH). To be able to provide tailored prevention and treatment of patients with FH it is necessary to identify the risk factors in DM I patients. We developed and validated the FH‐15 scale, a novel instrument to assess FH, which showed good concurrent and predictive validity in DM I patients. In this work we aim to identify the risk factors for suffering FH by detecting DM I patients with FH using the FH‐15 scale and then analyzing the association of clinical and sociodemographic variables. We found that age, needing help to resolve an episode of hypoglycemia, and a perceived lack of social support are risk factors for suffering FH.     

单纯糖耐量受损的冠心病患者临床及冠脉造影特点分析

入选空腹血糖正常并通过冠脉造影（CAG）确诊为冠心病（CAD）的患者104例行糖耐量试验（OGTT ）,将糖耐量正常（NGT ）者、单纯负荷后2h 血糖受损者（I-IGT ）与同期合并糖尿病（DM ）并通过 CAG 确诊为 CAD 的患者38例对照。结果,（1）DM 组甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（LDL-C）、载脂蛋白（Apo）、高敏-C 反应蛋白（hs-CRP）、尿微量白蛋白、尿酸（UA）高于 NGT 组（P＜0．05或 P＜0．01）,且 I-IGT 组体质量指数（BMI）最大,与 NGT组及 DM 组比较有统计学意义（P＜0．01）;（2）I-IGT 、DM 组冠状动脉病变支数、重度狭窄、闭塞、弥漫性病变、病变总积分、右冠状动脉病变比例均高于 NGT 组（P＜0．05或 P＜0．01）;（3）DM 组三支病变、弥漫性病变、冠状动脉病变总积分均高于 I-IGT 组（P＜0．05）。因此,空腹血糖正常的 CAD 患者均应行 OGTT 检查,以降低糖耐量异常的漏诊率;I-IGT 患者发生心血管疾病的危险性增加,且随着糖代谢异常的加重而加剧,应及早干预。     

暴发性1型糖尿病：一种不可忽视的重症糖尿病

暴发性1型糖尿病以起病急骤、代谢紊乱严重、胰酶升高并缺乏糖尿病相关抗体为特征。本文回顾分析我院收治的3例暴发性l型糖尿病的临床资料并结合文献与经典1型糖尿病进行对比复习,以提高对该病的认识。3例患者平均病程5．3天,入院平均血糖27．8mmol／L,平均糖化血红蛋白（HbAlC）6．8％,平均空腹C肽0．043ng／ml,平均餐后2hC肽0．04ng／ml,平均胰岛素使用剂量0．50U／（kg·d）。随访6个月HbAlC平均值为7．5％,胰岛8细胞功能无改善。暴发性1型糖尿病较经典1型糖尿病有更严重的胰岛素缺乏、代谢紊乱,更强烈的免疫反应,预后较差。