目的 研究红景天苷(Salidroside,Sal)对糖尿病肾病(Diabetic nephropathy,DN)的保护作用及其作用机制.方法 通过测定血浆脂质、β2-微球蛋白、血浆肌酐、血液尿素氮水平以及肾脏组织HE染色检测Sal对小鼠肾脏的保护作用.MTT法检测高级糖基终产物(Advaned glycation end product,AGE)对HK-2细胞活性的影响.免疫蛋白印记法检测Sal对AGE诱导的HK-2细胞中凋亡相关蛋白Bax、Bcl-2、细胞核因子2相关因子2(Nrf2)、TGF-β1以及胶原蛋白Ⅰ的蛋白表达,caspase-3和caspase-9试剂盒检测其活性.结果 Sal能够降低DN模型体内血浆脂质、β2-微球蛋白、血浆肌酐和血液尿素氮水平.Sal能够减轻糖尿病对肾脏组织的损伤.Sal能够逆转由AGE诱导的HK-2细胞活性降低.Sal能够上调由AGE导致的Nrf2蛋白表达下调;TGF-β1以及胶原蛋白Ⅰ表达上调,Bax以及Bcl-2比例下降,caspase-3、caspase-9活性降低.结论 Sal通过调控Nrf2的表达逆转由AGE引起的HK-2细胞凋亡以及糖尿病导致的肾脏组织损伤,进而对抗DN,产生类似二甲双胍(Metform-in,MET)的作用.Sal可成为DN的潜在治疗药物.

Objective To estimate the serum uric acid(SUA) levels and the prevalence of hyperuricemia(HUA) among the community-dwelling residents in Chengdu area,and investigate the association between SUA and blood pressure in this population.Methods A cross-sectional population-based survey for chronic diseases in Chengdu was performed in 2008.By analyzing the data of population aged 40 years and over,we compared the SUA levels and the prevalence of HUA in different ages and genders,and further analyzed the associations between different levels of SUA with blood pressure and prevalence of hypertension.Results The average SUA level was 295.85±83.10umol/L in this population,344.25±83.81umol/L in male and 265.93±67.01umol/L in female.The total prevalence of HUA was 11.36%,15.94% in male and 8.97% in female.Both SUA level and prevalence of HUA were significantly higher in men than women(P0.01).SUA levels and prevalence of HUA were increasing gradually after age 50 in men,but they were increasing gradually with age in women.Systolic blood pressure,diastolic blood pressure levels and prevalence of hypertension were significantly increased with the elevated levels of SUA.Correlation analysis showed SUA level was positively correlated with blood pressure.Logistic regression analysis showed that compared with the lowest quartile,the odds ratio of the prevalence of hypertension were 1.27,1.60 and 2.21 respectively.The differences were statistically significant(P0.01).Conclusion The HUA is highly prevalent among the community middle-aged and elderly in Chengdu area,especially in the male population.SUA is closely correlated with blood pressure.Elevated level of SUA is a risk factor to hypertension.There may be a potential significance to reducing the incidence and the development of hypertension by intervening SUA in the community-dwelling people.

Objective To explore the therapeutic effect of helicobacter pylori(H.pylori) eradication on diabetic gastroparesis(DGP) patients.Methods A total of 100 DGP patients with H.pylori infection diagnosed between March 2008 and January 2010 were included and randomly divided into two groups.The patients in group A underwent the treatment with mosapride 5 mg(thrice per day) for four weeks and H.pylori eradication therapy(esomeprazole 20 mg,twice per day;clarithromycin 500 mg,twice per day;amoxicillin 1.0 g,twice per day for two weeks).The patients in group B was administered with mosapride 5 mg(thrice per day) for four weeks.The symptom scores(SS) were recorded pretreatment,4 weeks later and 4 weeks after stopping treatment.Results Ninety-two patients finished the study.The SS in group A decreased significantly(P0.01) 4 weeks after the treatment and didn't differ much from that 4 weeks after stopping the treatment.Both of the SS were lower than those in group B at the same time.In group B,compared with that before the treatment,the SS were much lower than that 4 weeks after the treatment(P0.01) and 4 weeks after stopping the treatment(P0.05);the former was significantly lower than the latter(P0.05).The marked efficacy rate and total efficacy rate in group A were higher than those in group B(4-week treatment: 57.4% and 91.5% vs.35.6% and 75.6%,4 weeks after stopping the treatment: 40.4% and 83% vs.15.6% and 53.3%)(P0.05).Conclusion H.pylori eradication can increase the therapeutic effect on H.pylori positive patients with DGP and reduce the recurrence of the symptoms remarkably.

Objective To observe the efficacy of helicobacter pylori(Hp) eradication in treatment of diabetic gastroparesis(DGP) and the influence of gastric mucosa inflummation activty on the symptomatic response.Methods 100 DGP patients with Hp infection were included and randomly divided into two groups.The gastric histological changes were examined before treatment.A group received mosapride and ranitidine bismuth triple Hp eradication theapy.B group was adminstered with mosapride and ranitidine bismuth.The symptom scores(SScs) were recorded before treatment(1sttime-point)、4 weeks later(2ndtime-point) and 4 weeks after cease of treatment(3rdtime-point).Results 92 patients completed the study.Compare to the 1sttime-point.The SSc in A group decreased significantly(P0.01) at 2ndtime-point and not different 3rdtime-point.Both of the SScs in A group were lower than those in B group at the same times significantly.In B group,the SScs at 2ndtime-point was significantly lower than that at 1sttime-point(P0.01) and 3rdtime-point(P0.05).In A group,the SScs of active gastritis groups at 2nd and 3rd time-point were more mild than B group(P0.05 or 0.01),there was no significant.difference between inactive gastritis group and B group(P0.05).At the 3rdtime-point,the SScs of moderate-severe active gastritis group was significantly lower than mild group(P0.05),the SScs of the mild active gastritis and the inactive gastritis group were higher than those at the 2ndtime-point(P0.01),while there was no significant difference in moderate-severe group(P0.05).Conclusion Hp eradication can increase the efficacy in treatment of Hp positive DGP patients and reduce the symptom recurrence remarkably,especially in those with high grade active gastritis.

目的用随机对照方法观察那格列奈和瑞格列奈对2型糖尿病的血糖、胰岛素、血脂控制的疗效和安全性.方法 本文共观察46例2型糖尿病病人,随机分为瑞格列奈组(A组23例)和那格奈组(B组23例)进行治疗和比较,治疗前2～4周平衡期或清理期,疗程为12周.结果共有44例完成了试验(A组21例,B组23例).与用药前相比,用药6周A、B组的空腹血糖分别下降17.32%和15.67%,餐后2h血糖分别下降26.71%和31.18%;用药12周后A组、B组空腹血糖分别下降22.35%和18.57%,餐后2h血糖分别下降34.15%和37.56%;HbA1c值分别下降1.80%和1.10%,A组下降幅度略大于B组,但差异无统计学意义.治疗后餐后各时段胰岛素水平均有不同程度的增高,两组TC明显降低,体重指数无明显变化.结论那格列奈有良好的降糖作用,尤其是降低餐后2h血糖.

糖尿病肾病(DN)是糖尿病(DM)最常见的致死致残性微血管并发症.尿白蛋白排泄率(UAER)水平升高,是2型DM进展成终末阶段肾病的高危险性的标志,已有几项研究支持降低UAER是肾脏保护的有效治疗目标[1].维生素C和维生素E是体内重要的抗氧化剂,动物试验及临床试验均已证实,补充药理剂量的维生素C和维生素E,可以降低UAER升高的2型DM患者的UAER[2].为进一步证实这种作用,我们观察了维生素C和维生素E联合治疗对2型DM患者UAER的影响.

目的评价血炎性细胞因子变化在慢性心衰中的临床意义.方法1999年1月至2002年1月对558例慢性心衰患者、慢性气管炎阻塞性肺气肿30例,肺心病87例(代偿期38例,失代偿期49例),30例2型糖尿病及70例正常人作了肿瘤坏死因子α(TNFα)、白介素I β(1L-Iβ)、白介素6(IL-6)的测定.对肺冠心、冠心、高血压、肺心病严重心衰作了1:1:1:1的病例对照研究.对49例肺冠心严重心衰作了氯沙坦与福辛利的干预治疗.结果①心衰患者TNFα、IL-Iβ、IL-6高于正常人,有统计学意义.②2型DM与慢性气管炎肺气肿都有炎性细胞因子增加.③血中炎性细胞因子水平与NYHA心功能分级成正相关,严重心衰患者增加显著,心功I级、Ⅱ级增加不明显.④炎性细胞因子3分位数及以上病死率明显增加.死亡病例的炎性细胞因子水平明显高于存活组.⑤TNFα、IL-Iβ、IL-6、EF、MYHAⅢ、Ⅳ是独立的预测存活率的危险因子,多变量分析示TNFα、NYHAⅢ、Ⅳ级是影响存活率的独立危险因素.⑥冠心合并肺心病心衰血炎性细胞因子水平最高,依次为冠心病、高血压、肺心病.⑧氯沙坦及福辛普利干预治疗1月,血炎性细胞因子均有下降,氯沙坦组更明显.血内皮素及NO/ET比值改善,福辛普利组＞氯沙坦组,生存质量改善两组相似,但前者3例咳嗽加重,后者无;6分步行试验,两组改善相同.结论血炎性细胞因子与严重心衰心室重构有关,是独立的预测存活率的危险因素,其水平受病因影响,以冠心病心衰合并肺心病最高,氯沙坦治疗安全有效.

病例女,65岁.因烦渴、多饮、多尿7年,心累气促1+年,少尿10d,于1999-08-27入院.入院时,脉博86次/min,呼吸22次/min,血压16/8.5kPa,左肺闻少许干鸣,心界扩大,心律齐,无杂音,肝肋下2cm,脾未触及,双下肢凹陷性水肿明显.

为观察糖尿病(DM)合并高血压患者内皮素(ET)、一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)的变化,本文对109例糖尿病患者以上三项的测定,以了解ET、NO、TNF-α与糖尿病并发高血压的关系,现报道如下:

Objective: To assess the responses of a symptom complex related to partial androgen deficiency in the aging male (PADAM) to androgen supplementation. Subjects and methods: Eighty-six men from five hospitals in Beijing aged 50-70 years with symptoms related to PADAM received oral testosterone undecanoate for 2 months, and the effects of the therapy were evaluated. Results: After treatment, the symptom scores were significantly improved (all p < 0.001). Serum levels of luteinizing hormone and follicle stimulating hormone were suppressed, and free testosterone and albuminbound testosterone levels were elevated. However, they were not significantly different from the pretreatment values. Waist/hip ratio and blood pressure were markedly decreased, but no changes were found in serum levels of total cholesterol, triglyceride, albumin and prostate specific antigen. Conclusions: Two months of treatment with oral testosterone undecanoate clearly improved the symptoms related to PADAM. No statistical relationship was found between symptom improvement and androgen levels. Androgen therapy for 2 months was beneficial to the waist/hip ratio and blood pressure, and no harm was done to the prostate gland or lipid metabolism.

糖尿病周围神经病变是糖尿病最常见的并发症之一.1996年1月-2000年1月,我们应用补阳还五汤加味治疗本病,取得较满意疗效,现报告如下.

患者,男,80岁,因上腹部持续性胀痛14h,于1999年6月30日收入我院.入院前14h,患者进食早餐后突然出现上腹部持续胀痛,进行性加重,无放射痛,伴恶心、呕吐,呕吐物为胃内容物,活动后感心悸、气促、伴胸闷,休息后缓解,无返酸、嗳气及皮肤巩膜黄染,门诊查尿淀粉酶为153.60U/L,以"急性胰腺炎"收入院.入院查体:T36.8℃,P 86次/分,BP 21/12kPa,急性病容,神清,全身皮肤粘膜未见异常,双肺未闻及干湿啰音,心率86次/分,律齐.

OBJECTIVE:To analyse the routine WBC count's effect on predicting antithyroid drugs-induced agranulocytosis developing and risk factors of antithyroid drugs-induced agranulocytosis.METHODS:Retrospective analysis of 18 Graves' cases with agranulocytosis induced by antithyroid drugs during 1984-1995.RESULTS AND CONCLUSIONS:Most of antithyroid drugs-induced agranulocytosis happens 2-12 weeks after the administration of antithyroid drug, and are related with the drug's doses. Some agranulocytosis happens abruptly, routine WBC and granulocyte count can not predict some agranulocytosis developing. Fever and throat sore are the intitial symptoms of agranulocytosis, if it happens, the WBC and granulocyte count must be checked immediately. The treatment of granulocyte-macrophage colony stimulating factor is effective, the corticosteroid therapy seems not to be useful for the recovery of granulocyte count.

巯甲丙脯酸（ＡＣＥ－１）及氨酰心安对延迟糖尿病肾病的进展同样有效──２年前瞻性随机研究的结果［ＥｌｖｉｎｇＬ，ｅｔａｌ．Ｄｉａｂｅｔｏｌｏｇｉａ，１９９４，３７：６０４．］糖尿病肾小球硬化症患者，肾小球入球小动脉扩张。高血压可使肾小球内压力增高，治疗...