Objective To explore the effects of application of antioxidant N-acetylcysteine（NAC） on vascular endothelial changes induced by blood glucose fluctuations. Methods From January 2008 to December 2009, twenty-four male Wistar rats were selected and randomly divided into four groups according to 6 in each group.Group A（control group）was injected with normal saline. Group B（acute glucose fluctuation group） needed intermittent glucose infusion.Group C（NAC intervention group 1） required continuous NAC infusion（0.35 mg/kg·min） and intermittent glucose infusion. Group D（NAC intervention group 2） required continuous NAC（0.7 mg/kg·min） infusion and intermittent glucose infusion. The control group maintained blood glucose at around 5.5 mmol/L and the other three groups adjusted blood glucose fluctuations between 5.5-20.0mmol/L. The rats were given fluids for a total of 48 hours while awake,and the aorta was retained as a specimen. NO and GSH-PX were detected by colorimetry, TNF-αand IL-6 were detected by Elisa, iNOS was detected by immunohistochemistry, and the apoptosis of aortic endothelial cells was detected by TUNEL. Results The level of NO（2.83±0.48） μmol/L, TNF-α（35.13±2.16） pg/mL,I L-6（20.56±3.78） pg/mL in the acute glucose fluctuation group were significantly increased than the control group NO（1.11±0.14） μmol/L TNF-α（17.66±1.09） pg/mL, IL-6（9.82±0.61） pg/mL. The expression of iNOS was also significantly increased, and the difference was statistically significant（P＜0.05）; and the GSH-PX（6.26±0.38） nmol/mgprot level in the acute glucose fluctuation group was significantly lower than that in the control group（10.02±1.10） nmol/mgprot, and the difference was statistically significant（P＜0.05）. Apoptotic cells were detected in the aortic endothelium of the acute blood glucose fluctuation group. The above conditions could be improved after the application of NAC, and there was no significant difference between the large and small doses of NAC（P＞0.05）. Conclusion Blood glucose fluctuations enhance inflammatory and oxidative stress responses in aortic endothelial cells leading to apoptosis,which is improved by the application of the antioxidant NAC.

目的:探讨沙格列汀对糖尿病肾病患者肾功能的影响.方法:选取2014年10月至2015年10月于湛江中心人民医院就诊的2型糖尿病血糖控制不佳患者120例,根据尿微量白蛋白(UAE)分为3组:A组无蛋白尿组46例、B组微量蛋白尿组42例、C组大量蛋白尿组32例,每组随机分成治疗组与观察组,治疗组予以胰岛素+沙格列汀治疗,对照组单纯予以胰岛素治疗.测量患者UAE、肌酐(Cr)、胱抑素C(Cys C)等指标,比较观察组、对照组治疗前后各观察指标的差异.结果:A组(无蛋白尿组)中,观察组与对照组治疗前后各项指标无明显差异;B组(微量蛋白尿组)和C组(大量蛋白尿组)中,加用沙格列汀后,肾功能相关的各项指标均好转,差异具有统计学意义(P＜ 0.05);观察组治疗前后各指标相比,差异均无统计学意义(P＞0.05);和观察组治疗后比较,差异有统计学意义(P＜0.05).结论:沙格列汀对糖尿病肾病患者肾功能有一定的帮助,对于糖尿病伴有糖尿病肾病患者的治疗安全有效.

目的:观察比较胰高血糖素样肽1(GLP-1)类似物艾塞那肽以及格列美脲干预治疗2型糖尿病合并肥胖患者血糖水平及心血管相关标志物水平变化探讨GLP-1心血管保护机制.方法:40例诊断2型糖尿病合并肥胖患者,近3个月使用二甲双胍单药治疗达1500 mg且血糖控制不佳的患者为研究对象,按照随机数字表法分为两组.艾塞那肽组采用艾塞那肽5μg,2次/d,皮下注射,1个月之后剂量增至10 μg,2次/d,皮下注射;格列美脲组采用格列美脲2 mg,1次/d起始,根据患者的血糖情况适当调节格列美脲最高剂量至4 mg,1次/d.治疗24周后,观察两组体重、BMI、腰围、空腹血糖、餐后2h血糖、血脂、糖化血红蛋白(HbA1c)、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS水平改变.结果:与治疗前相比,两组治疗后空腹、餐后2h血糖及HbA1c水平均显著降低(P＜0.05),但两组比较差异均无统计学意义(P＞0.05).艾塞那肽组体重、BMI、腰围、血脂、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS较治疗前均明显下降(P＜0.05),而格列美脲组无明显变化.结论:艾塞那肽降糖效果与格列美脲相当,但其可通过有效降低体重、改善胰岛素抵抗并降低心血管相关危险因素水平,从而发挥心血管保护作用.

OBJECTIVE:To observe the efficacy of saxagliptin in treatment of patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease .METHODS:100 patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease admitted from Oct .2013 to Dec.2015 were selected to be divided into observation group and control group via the random number table , with 50 cases in each .Based on the conventional treatment , the observation group were given saxagliptin (5 mg, once a day), while the control group received metformin (0.5 g, 3 times a day).After treatment of 3 months, the glutamic pyruvic transaminase (ALT), aspartate aminotransferase (AST), triglyceride ( TG) , total cholesterol ( TC ) , fasting blood glucose ( FPG ) , 2-hour postprandial blood glucose ( 2 hPG ) , glycosylated hemoglobin ( HbA1 c) of two groups were observed;and liver ultrasound was conducted before treatment and after treatment of 3 months, the improvement rate of liver ultrasound was evaluated; the incidence of adverse drug reactions was statistically analyzed .RESULTS:After treatment of 3 months, the ALT, AST, TG, TC were lower than those of before treatment in both groups , and the observation group was lower than that of control group , the difference&nbsp;was statistically significant (P<0.05).The treatment therapy of observation group had more significant improvement on liver function and blood lipid .Meanwhile , FPG, 2 hPG and HbA1c in both groups decreased significantly , the difference was statistically significant (P<0.05), yet there was no significant difference between the two groups (P>0.05).The improvement rate of the situation in liver ultrasound in observation group was better than that in control group, the difference was statistically significant (P<0.05).CONCLUSIONS:The efficacy of saxagliptin in treatment of patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease is safe and effective .

Objective:To discuss the relationship between daily carbohydrate intake and diabetes occurrence in the early stage of diabetes,aim to provide scientific basis for the prevention and prediction of the development mechanism and treatment of diabetes.Method:A total of 132 cases of abnormal blood glucose in our hospital from July 2013 to September 2014 were retrospectively selected as the research objects,they were divided into three groups according to the daily carbohydrate intake,each group had 44 cases.Three groups were given different daily intake of carbohydrates,the changes of body mass index,incidence of diabetes mellitus and the correlation between carbohydrate intake and the value of OGTT in the three groups were compared.Result:Before study,there were no significant differences between three groups in body mass index(P>0.05),after study,the body mass index of the three groups were all higher than before study,the differences were statistically significant between three groups(P<0.05).The incidence of diabetes in third group was highest,the second group was better and the first group was the lowest,the differences were statistically significant(P<0.05).The average daily total energy intake and the average daily total carbohydrate intake were significantly correlated with OGTT at 2 h (r=0.108,0.100,P=0.000).The average daily total carbohydrate energy percentage and OGTT in 0 h glucose value was no significant correlation(r=0.004,P=0.083).The average daily total carbohydrate energy percentage was significantly negatively correlated with the value of OGTT at 2 h(r=-0.058,P=0.011),while the average daily total energy intake and the average daily total carbohydrate intake were not significantly correlated with OGTT at 2 h(r=-0.029,-0.009,P=0.104,0.091).Conclusion:There is a certain relationship between the daily carbohydrate intake and the occurrence and development of diabetes in the early stage of diabetes,when patients with abnormal blood glucose,should be reasonable planning of eating habits,strict control daily carbohydrate intake,so as to reduce the risk of diabetes,majority of medical and health workers should paid attention.

选取我院2010年2月～2012年1年收治的90例糖尿病并发下肢感觉异常患者，依照患者的年龄分为三组，即A、B、C组，采用硫辛酸注射液600mg/d静脉注射进行治疗，1个疗程为期4周，待疗程结束，比较不同年龄患者临床疗效的差异性。结果硫辛酸注射液治疗糖尿病并发感觉异常A组治疗后疾病控制率为36%，B组为26．7%，C组为25．7，A组明显高于B、C两组（P<0．05）；A组的总有效率为88%，B组的总有效率为86．7%，C组的总有效率为82%，三组比较无明显差异（P>0．05）。硫辛酸注射液适合应用于每个年龄阶段，其中低年龄存在明显的优势，能够较佳的对临床症状加以控制。不过对于糖尿病引发下肢感觉异常，及时发现并治疗十分重要。

Objective:To observe the parameters of bone metabolism and bone mineral density(BMD) in patients with Type 2 diabetes mellitus(T2DM) complicated with hyperthyroidism,to discuss the effect of hyperthyroidism for the parameters of bone metabolism and BMD in patients with T2DM.Method:57 patients with T2DM complicated with hyperthyroidism from February 2013 to April 2015 in the department of endocrinology of our hospital were selected as the observational group,and 79 patients with T2DM whose thyroid function was normal on the same period were selected as the control group.The diabetes and thyroid function related indicators,serum levels of bone-specific alkaline phosphatase(BAP),N-end middle osteocalcin (N-MID-OT),total type 1 collagen amino terminal peptide(T-P1NP),β-collagen special sequence(β-CTX), 25(OH)2D3 and BMD of Lumbar 2-4(L2-4),femoral neck,Ward’s triangle,trochanter region and whole body between the two groups were compared.Result:The serum levels of FT3,FT4 in the observation group were significantly higher than the control group(P<0.05),the serum level of TSH was significantly lower than the control group(P<0.05).The serum levels of BAP, N-MID-OT、T-P1NP、β-CTX of the observational group were significantly higher than those of the control group(P<0.05), and 25(OH)2D3 was significantly lower than that of the control group(P<0.05).The body mass index of observational group and BMD of Lumbar 2-4(L2-4),femoral neck,Ward’s triangle,trochanter region and whole body were significantly lower than those of the control group(P<0.05).There was no significant difference in the osteoporosis incidence between the two groups (P>0.05),and the bone loss incidence of the observational group was significantly higher than that of the control group(P<0.05). Conclusion:T2DM complicated with hyperthyroidism can reduced BMD,increase bone metabolism indexes,need screening the BMD and bone metabolism actively,with clinical value for the prevention and treatment of metabolic bone disease.

Objective To detect the heart rate variability(HRV) of patients with type 2 diabetes and h coronary heart disease by using 24-hour Holter ECG.Methods All 42 cases of patients combined with type 2 diabetes and coronary heart disease were selected as the research object of observe group,and 30 cases of healthy volunteers were selected as the control group.Then the heart rate variability index of the two groups was compared by using the 24-hour dynamic electrocardiogram.Results The difference in the average heart rate of the observation group and control group was not statistically significant(P>0.05).The difference in time-domain heart rate variability parameters in the sleep state was not statistically significant as compared to those in the awake state(P>0.05) in the observe group,but this difference was statistically significant in the control group(P<0.05).Conclusion To determine the HRV by using 24-hour Holter ECG is a non-invasive way to find heart autonomic neuropathy,it can accurately assess the autonomic nervous system injury of the type 2 diabetes combined with coronary heart disease.

目的观察高压氧辅助治疗糖尿病并发脑梗死的临床疗效。方法将90例2型糖尿病合并脑梗死患者随机分为高压氧组和对照组,每组45例。两组均给予控制血糖、抗血小板凝集、降脂、改善血液循环、营养神经及对症支持治疗。高压氧组同时联用高压氧治疗。治疗30d后,采用日常生活自理能力量表(ADI)和美国国立卫生究院卒中量表(NIHSS)对两组患者进行测定,并比较其疗效。结果治疗后两组的ADI分值均升高,NIHSS分值均降低,且以高压氧组变化更显著(P<0.05或0.01)。高压氧组的疗效优于对照组(P<0.01)。结论常规联合高压氧治疗2型糖尿病合并脑梗死能显著改善患者预后。

目的 观察短期胰岛素强化治疗初诊的2型搪尿病(T2DM)患者的临床疗效及对胰岛B细胞功能的影响.方法 将新诊断的T2DM患者70例随机分为两组,观察组35例予胰岛素强化治疗,对照组35例给予口服降糖药物治疗,比较两组治疗前后空腹血糖(FPG)、餐后2h血搪(2hPG)、糖化血红蛋白(HbAIc)、空腹胰岛素(FINS)、胰岛素抵抗指数(HoMA-IR)和胰岛素分泌指数(HOMA-B).结果 治疗后两组的血糖均控制达标,但观察组血糖达标时间较对照组明显快,差异有统计学意义(P＜0.05)；两组胰岛B细胞功能指数均有改善,但观察组较对照组改善明显,观察组FINS、HOMA-B功能指数较对照组升高明显,差异有统计学意义(P＜0.05),低血糖发生率两组差异无统计学意义(P＞0.05).结论 短期胰岛素强化治疗可更快速控制血糖达理想目标,显著改善胰岛B细胞分泌功能,比常规口服降糖药物更具优势.

Objective To observe the effectiveness and safety of Berapros combined with vitamin E in the treatment of type 2 diabetic patients with lower limb vascular diseases.Methods 104 cases of type 2 diabetes patients were divided into treatment group(54 cases) and control group(50 cases).Both groups were given drugs to lower sugar levers and Vitamin E 100 mg,qd.In treatment group,Berapros was implemented,40 μg,tid.In control group,Aspirin was given 75 mg,qd.12 weeks later,the improvement of symptoms including cold feeling,intermittent limp,still pain,ankle brachial index(ABI),walk distance without pain,maximum walk distance and drug adverse reactions of the two groups were observed.Results Evident effective rates in both treatment group and control group were 48.1% and 22.0%,total effective rates of 2 groups were 81.4% and 60.0%,there were statistically significant differences(P 0.05).12 weeks after treatment,ABI,walk distance without pain and maximum walk distance of 2 groups were both higher than before treatment,there were statistically significant differences(P 0.05).12 weeks after treatment,ABI,walk distance without pain and maximum walk distance of treatment group were higher than those of control group,there were statistically significant differences(P 0.05).There were no severe drug adverse reactions in two groups.Conclusion Berapros combined with Vitamin E is effective and safe in the treatment of type 2 diabetic patients with lower limb vascular diseases.

目的 探讨同型半胱氨酸(Hcy)、胱抑素C(Cys C)及血脂代谢与2型糖尿病合并下肢血管病变的关系.方法 对比25例2型糖尿病合并下肢血管病变患者(PAD组)、25例2型糖尿病无下肢血管病变患者(DM组)及25例正常者(对照组)的血浆Hcy、Cys C、糖化血红蛋白(HbA1c)及血脂等指标的水平.所有受试者均测量体质量、身高,计算体质量指数(BMI)及腰臀比.结果 PAD组的Hcy、Cys C、HbA1c值和血浆总胆固醇(CHO)及甘油三酯(TG)水平最高(P＜0.01或0.05); DM组的Hcy、Cys C、HbA1c值及TG水平较对照组高(P＜0.01或0.05); PAD组和DM组的BMI高于对照组(P＜0.01)；PAD组的腰臀比高于对照组(P＜0.01); PAD组的病程较DM组长(P＜0.05).结论 高Hcy C、Cys水平及高血脂是2型糖尿病合并下肢血管病变发生的危险因素.

　　目的探讨二甲双胍联合吡格列酮治疗肥胖伴多囊卵巢综合征的疗效。方法108例肥胖伴多囊卵巢综合征患者随机分成二甲双胍治疗组(单药组)及二甲双胍联合吡格列酮治疗组(联合组)各54例。两组患者均给予二甲双胍1500 mg/d，分3次口服；联合组在此基础上加用吡格列酮15 mg/次，1次/d口服，治疗12周后观察两组患者的各项指标改变情况及临床症状改善情况。结果治疗后单药组与联合组患者的空腹胰岛素、稳态模型胰岛素评价指数、C-反应蛋白、体质量指数、腰臀比、甘油三酯、黄体生成素、睾酮与其治疗前相比，均有显著下降(P＜0.01)，差异均具有统计学意义。治疗后联合组与单药组患者的空腹胰岛素、稳态模型胰岛素评价指数、甘油三酯、C-反应蛋白、黄体生成素、睾酮相比，改善效果更佳(P＜0.05)。治疗后联合组与单药组患者的临床症状(闭经、痤疮、多毛、黑棘皮样皮损、葡萄糖耐量受损)均得到改善。结论二甲双胍联合吡格列酮治疗肥胖伴多囊卵巢综合征，能更全面地改善胰岛素抵抗、纠正高胰岛素血症及代谢紊乱，疗效更佳。

目的探讨胰岛素泵连续皮下输注胰岛素(CSII)与多次胰岛素皮下注射强化治疗(MDI)对初诊2型糖尿病合并脑卒中患者的血糖控制、神经功能缺损改善情况和胰腺β细胞功能的影响。方法将20例初诊2型糖尿病合并脑卒中患者随机分为两组,治疗组予胰岛素泵治疗(n=10),对照组(n=10)予胰岛素每日4次皮下注射控制血糖。治疗两周后比较两组患者血糖控制情况、低血糖发生、胰岛素用量、神经功能缺损评分、胰岛素分泌指数、胰岛素抵抗指数。结果治疗组血糖控制达到靶血糖值的时间和胰岛素用量与对照组比较差异均有统计学意义(P<0.05),低血糖的发生次数较对照组低(P<0.01);两组患者治疗前后NIHSS评分比较治疗组优于对照组,差异有统计学意义(P<0.05)。胰岛素分泌指数、胰岛素抵抗指数等值差异无统计学意义(P>0.05)。结论对于初诊2型糖尿病合并脑卒中患者采取CSII治疗高血糖,不仅可以较好地控制患者血糖,还可以改善神经功能缺损症状。但对于显著改善胰腺β细胞功能无明显优势。

Objective To investigate the clinical characteristics of hyperthyroidism accompanied by hepatic injury.Methods 45 patients with hyperthyroidism accompanied by hepatic injury were retrospectively studied.Changes of hepatic function were compared before and after treatment including the level of ALT,AST,GGT,ALP and TBIL.Results Hepatic and thyroid function recovered after 2 months treatment.Conclusion Patients with hyperthyroidism are susceptible to hepatic injury,and anti-thyroid medication is effective in the treatment of hyperthyroidism accompanied by hepatic injury.

Objective: To investigate the relationship between the insulin resistance of type 2 diabetes mellitus and carotid atherosclerosis.Methods: Carotid intima-media thickness(IMT),plaque and other index were examined by type B uhrasonicd in 60 patients with type 2 diabetes mellitus.Results: The incidence rate of IMT and plaque in group of patients with insulin resistance were significantly higher than the group of patients without insulin resistance.Conclusion: The carotid atherosclerosis degree is related with the insulin resistance in patients with type 2 diabetes mellitus.

目的:探讨弥可保联合莫沙必利治疗糖尿病合并胃瘫的临床效果。方法:抽取72例糖尿病合并胃瘫的临床确诊病例,将其分为A、B两组,每组36例。A组采用莫沙必利进行治疗;B组采用弥可保联合莫沙必利进行治疗。观察两组临床效果。结果:B组患者治疗后的总有效率明显高于A组;B组在停止治疗后一段时间,病症再次发作的人数明显少于A组;两组患者在治疗过程中未出现不良反应。结论:弥可保联合莫沙必利治疗糖尿病合并胃瘫临床效果显著。

目的:对糖尿病合并高血压患者的用药情况进行分析.方法:随机抽取在2009年-2011年这段时间里我院收治的糖尿病患者病例132例,将这132例患者中合并有高血压的患者定义为观察组,将未合并高血压的患者定义为对照组,对两组患者的用药情况进行比较分析.结果:对于观察组患者而言所采取的降压药一般以血管紧张素转换酶抑制剂以及血管紧张素Ⅱ受体阻断剂为主,该组患者所附用的降压药的种类明显多于对照组.结论:对于合并高血压的糖尿病患者在应用降压药时要予以特别的注意.

目的 观察胰岛素泵持续皮下注射(CSⅡ)胰岛素和传统胰岛素皮下注射(MDⅡ)两种方法对2型糖尿病(DM)患者短期强化治疗中的血糖控制及胰岛素用量情况,探讨胰岛素泵使用过程中的护理问题.方法 148例2型DM患者随机分为CSⅡ组和MDⅡ组,比较两组治疗前后空腹血糖及餐后2 h血糖、胰岛素用量、血糖达标时间及低血糖反应.结果 CSⅡ和MDⅡ患者空腹血糖及餐后2 h血糖均逐渐降低,但CSⅡ胰岛素用量少、达标时间短,且低血糖发生率低.结论 胰岛素泵是2型DM短期强化控制血糖的安全有效、简便可靠的手段.