糖尿病肾病发病机制研究进展

从遗传易感因素、糖代谢异常、脂代谢异常、肾血流动力学改变、炎性反应及细胞因子等方面研究并阐述糖尿病肾病的发病机制,从而寻找预防和治疗糖尿病肾病的最有效方法．     

持续气道正压通气治疗阻塞型睡眠呼吸暂停低通气综合征合并2型糖尿病的疗效观察

目的通过观察持续气道正压通气（CPAP）治疗对合并2型糖尿病（T2DM）的阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患者的胰岛素抵抗（IR）的影响。方法 46例合并T2DM的OSAHS患者随机分为2组,对照组（22例）行保守治疗,而实验组（24例）加用CPAP治疗。观察所有患者治疗前及治疗后1、3、6个月的临床指标变化,采用稳态模式评估（HOMA）指数评价IR。结果实验组患者治疗1个月后,其最低SaO 2水平明显高于治疗前及同一时段的对照组（P〈0.01）;治疗3个月后,其呼吸暂停低通气指数明显低于治疗前及同一时段的对照组（P〈0.01）;治疗6个月后,其空腹胰岛素及HOMA水平明显低于治疗前及同一时段的对照组（P〈0.01）。结论长期CPAP治疗可显著改善合并T2DM的OSAHS患者的IR。     

Exendin-4 improves resistance to Listeria monocytogenes infection in diabetic db/db mice

The incidence of diabetes mellitus is increasing among companion animals. This disease has similar characteristics in both humans and animals. Diabetes is frequently identified as an independent risk factor for infections associated with increased mortality. In the present study, homozygous diabetic (db/db) mice were infected with Listeria (L.) monocytogenes and then treated with the anti-diabetic drug exendin-4, a glucagon-like peptide 1 analogue. In aged db/db mice, decreased CD11b⁺ macrophage populations with higher lipid content and lower phagocytic activity were observed. Exendin-4 lowered high lipid levels and enhanced phagocytosis in macrophages from db/db mice infected with L. monocytogenes. Exendin-4 also ameliorated obesity and hyperglycemia, and improved ex vivo bacteria clearance by macrophages in the animals. Liver histology examined during L. monocytogenes infection indicated that abscess formation was much milder in exendin-4-treated db/db mice than in the control animals. Moreover, mechanistic studies demonstrated that expression of ATP binding cassette transporter 1, a sterol transporter, was higher in macrophages isolated from the exendin-4-treated db/db mice. Overall, our results suggest that exendin-4 decreases the risk of infection in diabetic animals by modifying the interaction between intracellular lipids and phagocytic macrophages.     

Time-dependent changes of calbindin D-28K and parvalbumin immunoreactivity in the hippocampus of rats with streptozotocin-induced type 1 diabetes

The hippocampus is affected by various stimuli that include hyperglycemia, depression, and ischemia. Calcium-binding proteins (CaBPs) have protective roles in the response to such stimuli. However, little is known about the expression of CaBPs under diabetic conditions. This study was conducted to examine alterations in the physiological parameters with type 1 diabetes induced with streptozotocin (STZ) as well as time-dependent changes in the expression of two CaBPs changes of were being evaluated. Rats treated with STZ (70 mg/kg) had high blood glucose levels (>21.4 mmol/L) along with increased food intake and water consumption volumes compared to the sham controls. In contrast, body weight of the animals treated with STZ was significantly reduced compared to the sham group. CB-specific immunoreactivity was generally increased in the hippocampal CA1 region and granule cell layer of the dentate gyrus (DG) 2 weeks after STZ treatment, but decreased thereafter in these regions. In contrast, the number of PV-immunoreactive neurons and fibers was unchanged in the hippocampus and DG 2 weeks after STZ treatment. However, this number subsequently decreased over time. These results suggest that CB and PV expression is lowest 3 weeks after STZ administration, and these deficits lead to disturbances in calcium homeostasis.     

Actinomyces bowdenii ulcerative keratitis in a dog

A 5‐year‐old spayed female diabetic mixed‐breed dog underwent phacoemulsification and intraocular lens implantation to correct bilateral hypermature cataracts. Two months postsurgery, the patient presented with ulcerative keratitis and multifocal stromal abscessation OD, which was controlled, but never resolved, with topical fluoroquinolone therapy. The patient re‐presented 2 months later with a new, raised, white gritty corneal opacity associated with hyperemia, chemosis, and blepharospasm OD. Cytology of the right cornea revealed filamentous bacteria, suggestive of Actinomyces spp. Actinomyces bowdenii was subsequently isolated in pure culture and identified via 16s rDNA sequencing. Actinomyces bowdenii has never before been described as a cause of ocular infection. An immunosuppressed corneal environment likely contributed to this opportunistic Actinomycosis. The infection was not controlled with fluoroquinolone therapy, and the isolate, in vitro, was resistant to three fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin), which also has not been previously reported for this species of Actinomyces. A superficial keratectomy with conjunctival graft was employed to successfully manage the infection.     

王行宽教授论治糖尿病的学术观点及临证经验

国家级名中医王行宽教授善于从心肝肾三脏论治糖尿病,认为心肝火旺、耗伤阴血为发病之本;心火亢盛,肝气郁结,郁火燔灼游行三焦,内外皆病,故善饥消渴;肾精亏损,阴阳不调,津液不布,燥热内生,发为消渴则是疾病演变的必然结果。王教授临床采用自拟消渴方清肝泻心、补益肝肾、滋阴润燥治疗消渴,获满意疗效。     

社区综合干预对Ⅱ型糖尿病患者自我管理和疗效的影响

目的：评价Ⅱ型糖尿病患者通过社区综合干预疗法后对其自我管理能力和治疗效果的影响.方法将100例Ⅱ型糖尿病患者随机分为观察组和对照组,每组各50例,两组患者原治疗方案不变,观察组在维持原治疗方案的基础上进行为期10个月的社区综合干预.分别于干预前后进行糖尿病相关知识问卷调查及自我管理能力的测试,并检测空腹血糖和糖化血红蛋白等.结果综合干预10个月后,观察组有关糖尿病知识掌握情况、自我管理能力大大提高,与对照组比较差异具有统计学意义（P〈0.05）.观察组空腹血糖（FBG）、餐后2 h血糖（PBG）、糖化血红蛋白（HbAlc）干预前后比较差异具有统计学意义（P〈0.05）.结论社区综合干预可有效提高Ⅱ型糖尿病患者的糖尿病知识水平和自我管理能力,患者FBG,PBG,HbAlc控制较好,可提高Ⅱ型糖尿病患者的治疗效果.