Background: Some studied reported the association between CCR5 rs333, rs1799987 and diabetic nephropathy (DN) risk. However, the results were controversial. Therefore, we performed this meta-analysis. Method: We searched PubMed and Embase databases. The strength of association was assessed by computing odds ratio (OR) with its corresponding 95% confidence interval (CI). Results: Nine studies with including 3475 cases and 3492 controls were included. The result showed that rs1799987 polymorphism significantly predicted DN risk (OR=1.38, 95% CI, 1.17-1.63). In the stratified analysis by ethnicity, the significant association was observed in Asians and Caucasians. In the subgroup analysis by type of diabetes, both T1D and T2D patients with rs1799987 polymorphism had increased DN risk. In addition, rs1799987 polymorphism significantly associated with EDN risk, while this polymorphism was not associated with AND risk. As for rs333, no significant association between this polymorphism and DN risk was found (OR=1.36, 95% CI, 0.79-2.33), even in the subgroup analyses. Conclusion: In conclusion, this meta-analysis suggests that individuals with CCR5 rs333 polymorphism may have an increased DN risk.

口腔颌面部间隙感染为临床常见的面部感染疾病,若治疗不及时,加之糖尿病患者本身血糖控制差,感染细菌很容易入血,引起局部脓肿,甚至败血症,严重时可导致患者死亡.同时少数患者可以因感染导致急性视神经炎,影响患者视力.现报道此患者1例的诊断及治疗经过,希望加强对本病的认识,有利于指导临床治疗.

目的 了解2型糖尿病(T2DM)患者医院感染的临床特点、病原菌分布及其对抗菌药物的耐药性.方法 对内分泌科2009年1月-2011年12月住院52例T2DM患者医院感染临床资料进行回顾性分析.结果 52例医院感染患者感染部位主要为泌尿系(25例)、呼吸道(18例)、肝脓肿(4例)、皮肤软组织(3例)及未发现明确感染部位(2例);检出病原菌以革兰阴性菌多见,其中大肠埃希菌26株、肺炎克雷伯菌16株、弗氏柠檬酸杆菌1株、葡萄球菌属7株、其他革兰阳性球菌2株;药敏试验中对革兰阴性杆菌敏感性较高的抗菌药物是亚胺培南及美罗培南,敏感率均为100.00％,其次是头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及阿米卡星,敏感率分别为95.8％、90.5％和88.0％,对革兰阳性球菌敏感抗菌药物多为利奈唑胺、万古霉素、呋喃妥因,敏感率分别为100.0％、85.7％和85.7％.结论 T2DM合并败血症病原菌仍以革兰阴性杆菌多见,主要为大肠埃希菌及肺炎克雷伯菌;临床上早期诊断,积极抗感染治疗,同时应用胰岛素控制血糖,利于改善患者预后,临床宜根据药敏结果选择抗菌药物并合理使用,加强病原菌检测及耐药性监测.

Objective To observe the effect of levocarnitine combined with hemodialysis in the treatment of patients with uremic peripheral neuropathy.Methods Eighty-four patients with uremic peripheral neuropathy were randomly assigned to hemodialysis group(HD,n=30),hemodiafiltration group(HDF,n=27),or levocarnitine combined with hemodialysis group(LCN + HD,n=27).Patients in HD group received regular hemodialysis thrice a week.Patients in HDF group received regular hemodialysis twice a week and hemodiafiltration once a week.Patients in L-CN+HD group were given levocarnitine 2.0g dripped and intravenously thrice a week.Clinical symptoms and the sensory conduction velocity(SCV)of median nerve,tibial nerve and lateral popliteal nerve were observed in the three groups at baseline and after the treatment for 8 weeks.Results In HDF and L-CN+HD groups after the treatment for 8 weeks,peripheral neuropathy symptoms of Pain in the extremities、Sensory disturbances、 Numbness、Restless Legs Syndrom improved,as compared with HD group(χ 2 =13.87,17.52,25.37,9.20;P0.05),and SCV of L-CN+HD and HDF groups after the treatment became faster than that before treatment(t=L-CN+HD/ HDF=10.1/12.3,12.7/13.4,16.8/18.1;P0.05),with wider range of SCV change in treatment group than in HD group(F=25.63,32.83,22.5;P0.01).While the changes of SCV before and after the treatment for 8 weeks were statistically indifferent between HDF group and L-CN+HD group(F=0.613,P0.05).Conclusions Both levocarnitine combined with hemodialysis and hemodiafiltration are effective for the treatment of patients with uremic peripheral neuropathy.

目的探讨低血糖酷似胰岛β细胞瘤临床表现的机制,减少误诊误治。方法对服用降糖药导致低血糖伴高胰岛素血症2例的临床资料进行回顾性分析。结果本文2例均为老年患者,例1入院前2 h于睡眠中突发意识恍惚,不能回答问话伴全身大汗,面色苍白。例2因突发胡言乱语半小时就诊,急诊行脑CT检查未见明显异常。2例急诊查指尖血糖1.2 mmol/L、2.5 mmol/L,予葡萄糖静脉推注后仍处于持续低血糖状态并伴高胰岛素血症,考虑为胰岛β细胞瘤,进一步完善相关检查并追问病史,得知患者入院前均自认为有糖尿病而服用降糖药物,药物致低血糖诊断明确,后复查空腹血糖、空腹胰岛素水平均正常。结论老年患者服用格列本脲后可出现严重低血糖伴血清胰岛素水平升高,表现酷似胰岛β细胞瘤,应引起临床足够的重视。

Objective To investigate the changes of thyroid function in patients with end stage renal disease (ESRD) with or without dialysis. Methods Serum free-T3 (FT3), free-T4 (FT4) and thyrotropin (uTSH) concentrations were measured by electrochemiluminescence. These levels were compared in ESRD patients not on dialysis (n=42), those on hemodialysis (n=36), those on hemodialysis before and after hemodialysis sessions (n=12), and normal control subjects (n=30). Results (a) Compared with normal controls, serum levels of FT3 and FT4 were significantly lower (P< 0.05), and uTSH content was significantly higher (P < 0.01) in patients with ESRD. However, the differences of serum FT3 and FT4 levels were insignificant between ESRD patients on dialysis group and not on dialysis group (P > 0.05). (b) Serum FT3 and FT4 changed insignificantly in hemodialysis patients before and after hemodialysis sessions (P> 0.05). (c) The prevalence of hypothyroidism was higher in ESRD patients than in normal controls (P< 0.01), but the prevalence of hyperthyroidism was similar in ESRD patients and normal controls (P > 0.05). Conclusion Thyroid dysfunction with hypothyroidism is frequently found in ESRD patients. Dialysis can not change this abnormality.

抵抗素(resistin)是近年发现的由脂肪组织特异分泌的一种多肽类激素,它可以导致胰岛素抵抗,与2型糖尿病关系相当密切.最近有文献报道,肝脏也是抵抗素重要的靶器官,抵抗素可以明显损害肝胰岛素的敏感性,促进肝糖输出,升高血糖[1].但是抵抗素参与肝胰岛素抵抗的发生发展机制尚不明了.本文通过观察抵抗素对肝细胞糖酵解关键酶-葡萄糖激酶活性及mRNA表达水平的影响,初步探讨抵抗素在胰岛素抵抗形成中的作用及机制.

Objective:To investigate the effect of adiponectin on enzymatic activity of glucokinase and phosphoenolpyruvate carboxykinase in cultured rat's liver cells.Methods:The BRL was used as cell model.The rat liver cells were incubated with adiponectin of three different concentrations (10μg/ml,30μg/ml and 50μg/ml).Controlled cells were incubated without adiponectin.Enzymatic activity of GK was investigated by using a standard G6P-coupled assay.Enzymatical activity of PEPCK was assessed by using a standard LDH-coupled assay.Results:Compared with the control group,treated group with adiponectin of all concentrations for 24h had no significant effect on enzymatic activity of glucokinase.Enzymatic activity of phosphoenolpyruvate carboxykinase was significantly decreased even in the lowest concentration of adiponectin,and along with increased in adiponectin concentration enzymatic activity of phosphoenolpyruvate carboxykinase decreased more significantly.Conclusion:Adiponectin has no significant effect on ezymatic activity of glucokinase.However adiponectin decreases enzymatic activity of phosphoenolpyruvate carboxykinase significantly.Through this effect,adiponectin decreases liver glucose production and improves insulin resistance.

Objective:To observe the effect of resistin on activity of glucoskinase(GK) and phosphoenolpyruvate carboxykinase(PEPCK) in cultured rat liver cells.Methods:Rat liver cells were incubated with resistin of different doses(ranging from 10nM/L to 100nM/L).Controled liver cells were invubated without resistin.Glucose-6-phosphate dehydrogenase couple chromatometry and lactate dehydrogenase couple chromatometry were used to determine activity of GK and PEPCK.Results:Compared with the control group,treated with resistin of 10nM/L and 50nM/L for 24h had no significant effect on activity of GK,but activity of PKPCK increased significantly(P0.05).At the dose of 100nM/L,resistin inhabited activity of GK markedly(P0.01),while activity of PKPCK increased more significantly(P0.01).Conclusion:The increase of Resistin leads to the decrease of activity of GK and increase of activity of PEPCK in rat liver cells,hence inhabite glycolysis and promote glyconeogenesis and increase blood glucose as well.The activity of two enzymes shows dose dependent relation with resistin.

单核细胞趋化因子-1(MCP-1)是作用于单核细胞趋化过程的主要细胞因子,糖尿病合并的糖脂代谢紊乱、氧化应激增强、肿瘤坏死因子(TNF-α及同型半胱氨酸水平升高等多种因素可导致MCP-1水平上升,促使单核细胞进入动脉血管内膜,摄取已进入内膜并已发生修饰的脂蛋白形成单核细胞源泡沫细胞,参与动脉粥样硬化的形成,在糖尿病大血管病变的发生和发展中起着重要的作用.糖尿病大血管并发症的病理基础是动脉粥样硬化(AS)形成,直接导致冠心病、脑血管病和外周血管疾病,是糖尿病患者致死、致残的主要病因.目前认为高血糖、高血脂等是糖尿病大血管并发症的危险因素,但其详细的机制尚不清楚.近几年来对MCP-1在糖尿病大血管病变中的作用进行了研究,取得了重要的进展.