• 【孕妇1型糖尿病的胎盘甘油三酸酯蓄积与脂肪酶基因表达增加有关。】 复制标题 收藏 收藏
    DOI:10.1194/jlr.M600236-JLR200 复制DOI
    作者列表:Lindegaard ML,Damm P,Mathiesen ER,Nielsen LB
    BACKGROUND & AIMS: :Maternal diabetes can cause fetal macrosomia and increased risk of obesity, diabetes, and cardiovascular disease in adulthood of the offspring. Although increased transplacental lipid transport could be involved, the impact of maternal type 1 diabetes on molecular mechanisms for lipid transport in placenta is largely unknown. To examine whether maternal type 1 diabetes affects placental lipid metabolism, we measured lipids and mRNA expression of lipase-encoding genes in placentas from women with type 1 diabetes (n = 27) and a control group (n = 21). The placental triglyceride (TG) concentration and mRNA expression of endothelial lipase (EL) and hormone-sensitive lipase (HSL) were increased in placentas from women with diabetes. The differences were more pronounced in women with diabetes and suboptimal metabolic control than in women with diabetes and good metabolic control. Placental mRNA expression of lipoprotein lipase and lysosomal lipase were similar in women with diabetes and the control group. Immunohistochemistry showed EL protein in syncytiotrophoblasts facing the maternal blood and endothelial cells facing the fetal blood in placentas from both normal women and women with diabetes. These results suggest that maternal type 1 diabetes is associated with TG accumulation and increased EL and HSL gene expression in placenta and that optimal metabolic control reduces these effects.
    背景与目标: 孕产妇糖尿病会导致胎儿巨大儿,并在后代成年后增加肥胖,糖尿病和心血管疾病的风险。尽管可能涉及胎盘脂质转运的增加,但母体1型糖尿病对胎盘脂质转运分子机制的影响尚不清楚。为了检查母体1型糖尿病是否影响胎盘脂质代谢,我们测量了1型糖尿病女性(n = 27)和对照组(n = 21)的胎盘中脂质和脂肪酶编码基因的mRNA表达。糖尿病女性胎盘中胎盘甘油三酸酯(TG)的浓​​度和内皮脂肪酶(EL)和激素敏感性脂肪酶(HSL)的mRNA表达增加。糖尿病和代谢控制欠佳的女性比糖尿病和代谢控制良好的女性更明显。糖尿病女性和对照组胎盘脂蛋白脂肪酶和溶酶体脂肪酶的mRNA表达相似。免疫组织化学显示,正常妇女和糖尿病妇女的胎盘中母体血液中的合体滋养层细胞和胎儿血中的内皮细胞中的EL蛋白。这些结果表明,母亲1型糖尿病与TG积累和胎盘中EL和HSL基因表达增加有关,最佳的代谢控制可降低这些影响。
  • 【疾病机制:2型糖尿病的肝脂肪变性-发病机理和临床意义。】 复制标题 收藏 收藏
    DOI:10.1038/ncpendmet0190 复制DOI
    作者列表:Roden M
    BACKGROUND & AIMS: :Hepatic steatosis is defined by an increased content of hepatocellular lipids (HCLs) and is frequently observed in insulin-resistant states including type 2 diabetes mellitus. A dietary excess of saturated fat contributes significantly to HCL accumulation. Elevated HCL levels mainly account for hepatic insulin resistance, which is probably mediated by partitioning of free fatty acids to the liver (fat overflow) and by an imbalance of adipocytokines (decreased adiponectin and/or increased proinflammatory cytokines). Both free fatty acids and adipocytokines activate inflammatory pathways that include protein kinase C, the transcription factor nuclear factor kappaB, and c-Jun N-terminal kinase 1 and can thereby accelerate the progression of hepatic steatosis to nonalcoholic steatohepatitis and cirrhosis. Proton magnetic resonance spectroscopy has made it possible to quantify HCL concentrations and to detect even small changes in these concentrations in clinical settings. Moderately hypocaloric, fat-reduced diets can decrease HCL levels by approximately 40-80% in parallel with loss of up to 8% of body weight. Treatment with thiazolidinediones (e.g. pioglitazone and rosiglitazone) reduces HCL levels by 30-50% by modulating insulin sensitivity and endocrine function of adipose tissue in type 2 diabetes. Metformin improves hepatic insulin action without affecting HCL levels, whereas insulin infusion for 67 h increases HCL levels by approximately 18%; furthermore, HCL levels positively correlate with the insulin dosage in insulin-treated type 2 diabetes. In conclusion, liver fat is a critical determinant of metabolic fluxes and inflammatory processes, thereby representing an important therapeutic target in insulin resistance and type 2 diabetes mellitus.
    背景与目标: 肝脂肪变性是由肝细胞脂质(HCL)含量增加所定义的,并且经常在包括2型糖尿病在内的胰岛素抵抗状态中观察到。饮食中饱和脂肪过多会大大增加HCL的积累。 HCL水平升高主要是肝脏胰岛素抵抗的原因,这可能是由于游离脂肪酸在肝脏中的分配(脂肪溢出)和脂肪细胞因子的失衡(脂联素减少和/或促炎性细胞因子增加)引起的。游离脂肪酸和脂肪细胞因子均激活包括蛋白激酶C,转录因子核因子kappaB和c-Jun N端激酶1在内的炎症途径,从而可以加速肝脂肪变性发展为非酒精性脂肪性肝炎和肝硬化。质子磁共振波谱使量化HCL浓度和检测临床环境中这些浓度的微小变化成为可能。适度低热量,低脂肪饮食可将HCL水平降低约40-80%,同时最多可减少8%的体重。噻唑烷二酮类药物(例如吡格列酮和罗格列酮)治疗可通过调节2型糖尿病的胰岛素敏感性和脂肪组织的内分泌功能将HCL水平降低30-50%。二甲双胍在不影响HCL水平的情况下改善了肝胰岛素的作用,而胰岛素输注67 h使HCL水平增加了约18%。此外,在用胰岛素治疗的2型糖尿病中,HCL水平与胰岛素剂量呈正相关。总之,肝脏脂肪是代谢通量和炎症过程的关键决定因素,因此代表了胰岛素抵抗和2型糖尿病的重要治疗靶标。
  • 【糖尿病患者的高血压治疗不足。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【经医师营养专家培训后的家庭医师营养实践。】 复制标题 收藏 收藏
    DOI:10.1093/ajcn/65.6.2007S 复制DOI
    作者列表:Lazarus K
    BACKGROUND & AIMS: Although nutrition is an important part of medical care, nutrition education is not provided in most training programs for physicians in the United States, resulting in limited nutrition knowledge among physicians and limited nutritional care of patients. A nutrition education program was provided by a physician nutrition specialist in a family practice residency program. For 6 mo, the nutrition specialist provided the family physicians with recommendations for nutritional care for their patients. The effects of the education program on residents' and faculty physicians' nutrition knowledge and nutritional patient care, patients' perceptions of the importance of nutrition, and physicians' dietary patterns were determined by pre- and post-intervention nutrition exams for physicians and patients, patient questionnaires about attitudes toward nutrition, chart reviews, and physicians' diet records. The nutrition education program resulted in an increase in physicians' nutrition knowledge scores (P < 0.01) and an increase in the frequency with which physicians discussed nutrition and recommended diets for their patients (P < 0.05). This suggests that nutrition education by a physician nutrition specialist within a family practice residency program can be effective in increasing nutritional care provided to patients.

    背景与目标: 尽管营养是医疗保健的重要组成部分,但在美国大多数医师的培训计划中并未提供营养教育,这导致医师之间的营养知识有限,患者的营养保健也有限。营养保健教育计划是由医师营养专家在家庭执业驻留计划中提供的。营养专家在6个月内为家庭医生提供了有关为其患者提供营养护理​​的建议。通过干预前和干预后对医师和患者的营养检查来确定教育计划对住院医师和教职医师的营养知识和患者营养的影响,患者对营养重要性的看法以及医师的饮食方式的影响,有关营养态度的患者问卷调查表,图表评论以及医生的饮食记录。营养教育计划导致医师的营养知识得分增加(P <0.01),医师讨论营养和为患者推荐饮食的频率增加(P <0.05)。这表明在家庭执业住院医师计划中,由医生营养专家进行的营养教育可以有效地增加提供给患者的营养保健服务。

  • 【肥胖和糖尿病突变小鼠胰腺和垂体中神经肽的含量:品系和性别差异。】 复制标题 收藏 收藏
    DOI:10.1016/0026-0495(90)90252-8 复制DOI
    作者列表:Timmers K,Coleman DL,Voyles NR,Powell AM,Rökaeus A,Recant L
    BACKGROUND & AIMS: :The nature of the primary genetic defects in ob/ob and db/db mice are unknown. Both the obese (ob) and diabetes (db) mutations produce similar, multicomponent obese-hyperinsulinemic syndromes when maintained in the same strain of mouse. In an attempt to find differences between these mutations in neuroendocrine function affecting the islets of Langerhans or the pituitary, tissue content of four neuropeptides that are known to be capable of influencing the rate of insulin secretion was examined in obese (ob/ob) and diabetes (db/db) mice. In the first study, C57BL/6Job/ob and control males were studied at 3, 4, and 11 weeks of age. In the second study, db/db mice of both sexes and two inbred strains (C57BL/6J and C57BL/KsJ), which differ markedly in the severity of expression of the diabetes phenotype, were studied at 3 weeks of age, before the development of hyperglycemia and secondary consequences thereof. Immunoreactive peptides were measured in acetic acid extracts of pancreas and pituitary. No differences between male ob/ob and db/db mice of the C57BL/6J strain were found. Marked sex differences in lean control mice were found at 3 weeks of age in pancreatic Met-enkephalin-LI and galanin-LI (with two- to threefold higher content in males). Low pancreatic content (50% to 70% lower than in control mice) of galanin-LI, Met-enkephalin-LI and Leu-enkephalin-LI was associated with hyperinsulinemia in male B6 ob/ob and db/db mice at 3 weeks of age, though not in B6 db/db females and not in BKs db/db mice of either sex.(ABSTRACT TRUNCATED AT 250 WORDS)
    背景与目标: :ob / ob和db / db小鼠的主要遗传缺陷的性质尚不清楚。肥胖(ob)和糖尿病(db)突变在同一小鼠品系中均会产生相似的多成分肥胖-高胰岛素血症综合征。为了发现影响兰格罕氏岛或垂体的胰岛的神经内分泌功能的这些突变之间的差异,在肥胖(ob / ob)和糖尿病患者中检查了四种已知能够影响胰岛素分泌速率的神经肽的组织含量(db / db)小鼠。在第一个研究中,研究了C57BL / 6Job / ob和对照男性在3、4和11周的年龄。在第二项研究中,在发育前的3周龄研究了具有性别和两种近交系(C57BL / 6J和C57BL / KsJ)的db / db小鼠,它们在糖尿病表型的表达严重程度上有显着差异。高血糖及其继发后果。在胰腺和垂体的乙酸提取物中测量了免疫反应性肽。在C57BL / 6J株的雄性ob / ob和db / db小鼠之间未发现差异。在瘦瘦对照小鼠中,在三周龄的胰腺Met-脑啡肽-LI和甘丙肽-LI中发现明显的性别差异(雄性含量高2至3倍)。在3周龄的雄性B6 ob / ob和db / db小鼠中,甘丙肽-LI,Met-脑啡肽-LI和亮-脑啡肽-LI的胰腺含量低(比对照小鼠低50%至70%)与高胰岛素血症相关。年龄,但不是在B6 db / db雌性中,也不是在BK s db / db两种性别的小鼠中。(摘要以250字截断)
  • 【I型糖尿病易感性候选基因的分析:2q31-35号染色体上基因的病例对照和家庭关联研究。】 复制标题 收藏 收藏
    DOI:10.2337/diab.46.6.1069 复制DOI
    作者列表:Owerbach D,Naya FJ,Tsai MJ,Allander SV,Powell DR,Gabbay KH
    BACKGROUND & AIMS: Recent genome searches suggest a putative linkage of many loci to susceptibility to type I diabetes. The chromosome 2q31-35 region is reported to be linked to susceptibility to type I diabetes and is thought to contain several diabetes susceptibility loci. These candidate genes include the HOXD gene cluster, BETA2, CTLA4, CD28, IGFBP2, and IGFBP5. Association studies in populations and families are required to confirm and/or identify the actual susceptibility loci. We hereby report several previously unknown DNA polymorphisms for HOXD8, BETA2, and IGFBP5, which we have used along with previously known polymorphisms of HOXD8 and CTLA4 to test whether these candidate loci are the susceptibility genes on chromosome 2q31-35. Using a case-control design with a subsequent family-association approach to confirm associations, we find no evidence that these candidate genes are associated with susceptibility to type I diabetes.

    背景与目标: 最近的基因组搜索表明,许多基因位点与I型糖尿病易感性的推测联系。据报道,染色体2q31-35与I型糖尿病易感性相关,并被认为含有几个糖尿病易感性基因座。这些候选基因包括HOXD基因簇,BETA2,CTLA4,CD28,IGFBP2和IGFBP5。需要在人群和家庭中进行协会研究,以确认和/或识别实际的易感基因座。我们在此报告了HOXD8,BETA2和IGFBP5的几种先前未知的DNA多态性,并将其与HOXD8和CTLA4的先前已知多态性一起用于测试这些候选基因座是否为2q31-35染色体上的易感性基因。使用病例对照设计和随后的家庭关联方法来确认关联,我们没有发现这些候选基因与I型糖尿病易感性相关的证据。

  • 【急诊医学教育奖学金的作者指南:教育创新(第3部分)。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2018-05-01
    来源期刊:CJEM
    DOI:10.1017/cem.2017.28 复制DOI
    作者列表:Hall AK,Hagel C,Chan TM,Thoma B,Murnaghan A,Bhanji F
    BACKGROUND & AIMS: OBJECTIVE:The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education. METHODS:We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted. RESULTS:Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled. CONCLUSION:The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.
    背景与目标: 目的:对医学创新实践的学术传播有助于拓宽此类工作的范围,使奖学金的影响力超越单一机构。对于那些寻求发布程序评估研究和创新论文的人,文献中几乎没有指导。这项研究旨在得出一组有关急诊医学教育创新的高质量报告的基于证据的特征。
    方法:我们进行了范围审查和主题分析,以确定医学教育创新报告的质量标志,重点是EM。通过手动搜索相关的出版指南,作者指南以及医学教育和EM期刊的网站提交门户,扩大了对MEDLINE,EMBASE,ERIC和Google Scholar的搜索。研究调查人员审查了选定的文章,并进行了主题分析。
    结果:我们的搜索策略确定了14篇相关文章,从中提取了34篇质量标记。这些标记分为七个重要主题:创新的目标和需求,准备,创新发展,创新实施,创新评估,反思性实践的证据以及报告和传播。此外,还确定并汇编了多个出版新兴市场教育创新的渠道。
    结论:创新的出版和传播对新兴市场教育界和卫生专业人员的培训至关重要。我们期望EM教育创新者将使用我们的创新报告质量标记列表来支持新颖教育实践的传播。
  • 【社交,运动,饮食和年龄对食蟹猴发展中和未治疗的糖尿病的作用。】 复制标题 收藏 收藏
    DOI:10.1016/j.exger.2017.06.010 复制DOI
    作者列表:Yue F,Zhang G,Quintero JE,Gash DM,Zhang Z
    BACKGROUND & AIMS: :Type 2 diabetes mellitus is the most common form of diabetes that occurs in both human and nonhuman primates. Although spontaneously diabetic nonhuman primates are used extensively in diabetic related research and are a proven valuable tool for the study of the natural history of diabetes, little is known about the key factors that can cause this metabolic disorder and the preventative measures that could be employed to minimize the consequences of diabetes. Using a model of developing and untreated diabetes, this study describes the effects of housing arrangement (socially group- versus individually single-housed), exercise, diet, age, and sex on fasting plasma glucose, key lipids associated with diabetes, and bodyweight in two large cohorts of nonhuman primates. Key findings include exercise/housing arrangement's contribution to significant differences in bodyweight, levels of fasting plasma glucose, total cholesterol, and high- and low-density lipoproteins. Age also had profound effects on glucose, triglyceride and high-density lipoproteins, particularly in single-caged animals. Moreover, females had higher fasting glucose, total cholesterol and triglyceride levels than male counterparts within the same housing situations. These factors may be critical to identifying preventive measures that could eventually be used to minimize obesity and diabetes in humans.
    背景与目标: 2型糖尿病是人类和非人类灵长类动物中最常见的糖尿病形式。尽管自发性糖尿病非人类灵长类动物在糖尿病相关研究中被广泛使用,并且是研究糖尿病自然史的一种有价值的工具,但对引起这种代谢紊乱的关键因素以及可以用于预防该疾病的预防措施知之甚少最大限度地减少糖尿病的后果。本研究使用发展中的糖尿病和未经治疗的糖尿病模型,描述了住房安排(集体居住与个人独居),运动,饮食,年龄和性别对空腹血糖,糖尿病相关的主要脂质和体重的影响。两个大型的非人类灵长类动物。主要发现包括运动/住房安排对体重,空腹血糖水平,总胆固醇以及高密度和低密度脂蛋白的显着差异的贡献。年龄对葡萄糖,甘油三酸酯和高密度脂蛋白也有深远的影响,特别是在单笼动物中。此外,在相同的居住环境下,女性的空腹血糖,总胆固醇和甘油三酸酯水平高于男性。这些因素对于确定预防措施至关重要,这些预防措施最终可用于最大程度地减少人类的肥胖和糖尿病。
  • 【花生对患有高2型糖尿病风险的肥胖女性的血糖反应和食欲的急性和第二餐作用:一项随机交叉临床试验。】 复制标题 收藏 收藏
    DOI:10.1017/S0007114512004217 复制DOI
    作者列表:Reis CE,Ribeiro DN,Costa NM,Bressan J,Alfenas RC,Mattes RD
    BACKGROUND & AIMS: :Nut consumption is associated with a reduced risk of type 2 diabetes mellitus (T2DM). The aim of the present study was to assess the effects of adding peanuts (whole or peanut butter) on first (0-240 min)- and second (240-490 min)-meal glucose metabolism and selected gut satiety hormone responses, appetite ratings and food intake in obese women with high T2DM risk. A group of fifteen women participated in a randomised cross-over clinical trial in which 42·5 g of whole peanuts without skins (WP), peanut butter (PB) or no peanuts (control) were added to a 75 g available carbohydrate-matched breakfast meal. Postprandial concentrations (0-490 min) of glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), appetitive sensations and food intake were assessed after breakfast treatments and a standard lunch. Postprandial NEFA incremental AUC (IAUC) (0-240 min) and glucose IAUC (240-490 min) responses were lower for the PB breakfast compared with the control breakfast. Insulin concentrations were higher at 120 and 370 min after the PB consumption than after the control consumption. Desire-to-eat ratings were lower, while PYY, GLP-1 and CCK concentrations were higher after the PB intake compared with the control intake. WP led to similar but non-significant effects. The addition of PB to breakfast moderated postprandial glucose and NEFA concentrations, enhanced gut satiety hormone secretion and reduced the desire to eat. The greater bioaccessibility of the lipid component in PB is probably responsible for the observed incremental post-ingestive responses between the nut forms. Inclusion of PB, and probably WP, to breakfast may help to moderate glucose concentrations and appetite in obese women.
    背景与目标: :食用坚果与降低2型糖尿病(T2DM)的风险有关。本研究的目的是评估添加花生(全脂或花生酱)对第一次(0-240分钟)和第二次(240-490分钟)膳食葡萄糖代谢的影响,以及选择的肠饱腹感激素反应,食欲等级患有T2DM风险较高的肥胖女性的饮食和食物摄入量。一组15名妇女参加了一项随机交叉临床试验,在该试验中,将75.g可用碳水化合物匹配的42·5克无皮的全花生(WP),花生酱(PB)或无花生(对照)添加早餐餐。早餐后评估餐后血糖,胰岛素,NEFA,胰高血糖素样肽1(GLP-1),肽YY(PYY),胆囊收缩素(CCK),食欲感觉和食物摄入的浓度(0-490分钟)。标准午餐。与对照早餐相比,PB早餐的餐后NEFA增量AUC(IAUC)(0-240分钟)和葡萄糖IAUC(240-490分钟)响应较低。 PB摄入后120和370分钟时的胰岛素浓度高于对照组摄入后的胰岛素浓度。与对照组相比,PB摄入后的按需饮食评分较低,而PYY,GLP-1和CCK浓度较高。 WP产生了相似但不重要的影响。早餐中添加PB可减轻餐后血糖和NEFA的浓度,增强肠饱腹感激素的分泌并减少进食的欲望。 PB中脂质成分的更大生物可及性可能是观察到的坚果形式之间渐增的消味后反应的原因。在早餐中加入PB和可能的WP可能有助于减轻肥胖女性的葡萄糖浓度和食欲。
  • 【糖尿病和胰腺癌的风险:来自胰腺癌队列财团的汇总分析。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-012-0078-8 复制DOI
    作者列表:
    BACKGROUND & AIMS: PURPOSE:Diabetes is a suspected risk factor for pancreatic cancer, but questions remain about whether it is a risk factor or a result of the disease. This study prospectively examined the association between diabetes and the risk of pancreatic adenocarcinoma in pooled data from the NCI pancreatic cancer cohort consortium (PanScan). METHODS:The pooled data included 1,621 pancreatic adenocarcinoma cases and 1,719 matched controls from twelve cohorts using a nested case-control study design. Subjects who were diagnosed with diabetes near the time (<2 years) of pancreatic cancer diagnosis were excluded from all analyses. All analyses were adjusted for age, race, gender, study, alcohol use, smoking, BMI, and family history of pancreatic cancer. RESULTS:Self-reported diabetes was associated with a forty percent increased risk of pancreatic cancer (OR = 1.40, 95 % CI: 1.07, 1.84). The association differed by duration of diabetes; risk was highest for those with a duration of 2-8 years (OR = 1.79, 95 % CI: 1.25, 2.55); there was no association for those with 9+ years of diabetes (OR = 1.02, 95 % CI: 0.68, 1.52). CONCLUSIONS:These findings provide support for a relationship between diabetes and pancreatic cancer risk. The absence of association in those with the longest duration of diabetes may reflect hypoinsulinemia and warrants further investigation.
    背景与目标: 目的:糖尿病是怀疑为胰腺癌的危险因素,但有关它是该疾病的危险因素还是结果仍存在疑问。这项研究从NCI胰腺癌队列联合会(PanScan)收集的数据中前瞻性地检查了糖尿病与胰腺腺癌风险之间的关联。
    方法:汇集的数据包括使用嵌套病例对照研究设计的来自十二个队列的1,621例胰腺腺癌病例和1,719例匹配的对照。所有分析均排除在胰腺癌诊断时间(<2年)内被诊断出患有糖尿病的受试者。所有分析均根据年龄,种族,性别,研究,饮酒,吸烟,BMI和胰腺癌家族史进行了调整。
    结果:自我报告的糖尿病与胰腺癌风险增加40%相关(OR = 1.40,95%CI:1.07,1.84)。该关联因糖尿病持续时间而异;持续时间为2-8年的患者风险最高(OR = 1.79,95%CI:1.25,2.55);糖尿病9年没有相关性(OR = 1.02,95%CI:0.68,1.52)。
    结论:这些发现为糖尿病与胰腺癌风险之间的关系提供了支持。糖尿病持续时间最长的患者缺乏相关性可能反映了低胰岛素血症,需要进一步研究。
  • 【HMGA2基因的常见变异会增加2型糖尿病患者对肾病的易感性。】 复制标题 收藏 收藏
    DOI:10.1007/s00125-012-2760-5 复制DOI
    作者列表:Alkayyali S,Lajer M,Deshmukh H,Ahlqvist E,Colhoun H,Isomaa B,Rossing P,Groop L,Lyssenko V
    BACKGROUND & AIMS: AIMS/HYPOTHESIS:Type 2 diabetes is a chronic metabolic disorder associated with devastating microvascular complications. Genome-wide association studies have identified more than 60 genetic variants associated with type 2 diabetes and/or glucose and insulin traits, but their role in the progression of diabetes is not established. The aim of this study was to explore whether these variants were also associated with the development of nephropathy in patients with type 2 diabetes. METHODS:We studied 28 genetic variants in 2,229 patients with type 2 diabetes from the local Malmö Scania Diabetes Registry (SDR) published during 2007-2010. Diabetic nephropathy (DN) was defined as micro- or macroalbuminuria and/or end-stage renal disease. Estimated glomerular filtration rate (eGFR) was assessed using the MDRD-4 formula. Replication genotyping of rs1531343 was performed in diabetic (Steno type 2 diabetes [n = 345], Genetics of Diabetes Audit and Research in Tayside Scotland [Go-DARTS] [n = 784]) and non-diabetic (Malmö Preventive Project [n = 2,523], Botnia study [n = 2,247]) cohorts. RESULTS:In the SDR, HMGA2 single-nucleotide polymorphism rs1531343 was associated with DN (OR 1.50, 95% CI 1.20, 1.87, p = 0.00035). In the combined analysis totalling 3,358 patients with type 2 diabetes (n = 1,233 cases, n = 2,125 controls), carriers of the C-allele had a 1.45-fold increased risk of developing nephropathy (95% CI 1.20, 1.75, p = 0.00010). Furthermore, the risk C-allele was associated with lower eGFR in patients with type 2 diabetes (n = 2,499, β ± SEM, -3.7 ± 1.2 ml/min, p = 0.002) and also in non-diabetic individuals (n = 17,602, β ± SEM, -0.008 ± 0.003 ml/min (log( e )), p = 0.006). CONCLUSIONS/INTERPRETATION:These data demonstrate that the HMGA2 variant seems to be associated with increased risk of developing nephropathy in patients with type 2 diabetes and lower eGFR in both diabetic and non-diabetic individuals and could thus be a common denominator in the pathogenesis of type 2 diabetes and kidney complications.
    背景与目标: 目的/假设:2型糖尿病是与破坏性微血管并发症相关的慢性代谢性疾病。全基因组关联研究已鉴定出与2型糖尿病和/或葡萄糖和胰岛素性状相关的60多种遗传变异,但尚未确定它们在糖尿病进展中的作用。这项研究的目的是探讨这些变异是否也与2型糖尿病患者的肾病发展有关。
    方法:我们研究了2007年至2010年间发表的2 229例2型糖尿病患者的28种遗传变异,这些变异来自当地的马尔默斯堪尼亚糖尿病登记处(SDR)。糖尿病性肾病(DN)被定义为微蛋白尿或巨蛋白尿和/或晚期肾病。使用MDRD-4公式评估估计的肾小球滤过率(eGFR)。 rs1531343的复制基因分型是在糖尿病(Steno 2型糖尿病[n = 345],Tayside Scotland糖尿病的遗传学研究和研究[Go-DARTS] [n = 784])和非糖尿病(Malmö预防项目[n == 2,523],Botnia研究[n = 2,247]队列。
    结果:在SDR中,HMGA2单核苷酸多态性rs1531343与DN相关(OR 1.50,95%CI 1.20,1.87,p = 0.00035)。在总共3358名2型糖尿病患者的综合分析中(n = 1,233例,n = 2,125对照),C-等位基因携带者患肾病的风险增加了1.45倍(95%CI 1.20,1.75,p = 0.00010 )。此外,高风险C等位基因与2型糖尿病患者的eGFR较低有关(n = 2,499,β±SEM,-3.7±1.2 ml / min,p = 0.002),在非糖尿病患者中(n = 17,602) ,β±SEM,-0.008±0.003 ml / min(log(e)),p = 0.006)。
    结论/解释:这些数据表明,HMGA2变异似乎与2型糖尿病患者发生肾病的风险增加以及糖尿病和非糖尿病患者的eGFR降低有关,因此可能是2型糖尿病发病机制的共同指标2糖尿病和肾脏并发症。
  • 【回复:Bayomi等人的“ Plasminogen Activator Inhibitor-1和2型糖尿病患者的心包脂肪”。 (Metab Syndr Relat Disord 2017; 15:269-275)。】 复制标题 收藏 收藏
    DOI:10.1089/met.2017.0070 复制DOI
    作者列表:Avogaro A
    BACKGROUND & AIMS: :Plasminogen activator inhibitor-1 (PAI-1) is a member of the serine protease inhibitor (serpin) superfamily, which inactivates tissue plasminogen activator (tPA); therefore, increased level of PAI-1 antigen counteracts the anticoagulant effect of tPA and facilitates the fibrin clot formation. Plasma PAI-1 antigen and activity levels are associated with increased body mass index and with features of the insulin resistance syndrome like obesity and diabetes. Visceral adipose tissue produces more PAI-1 than subcutaneous adipose tissue: This increased production of PAI-1 from the visceral adipose tissue is one important link between visceral obesity and cardiovascular disease. Besides visceral adipose tissue, there is mounting evidence that epicardial adipose tissue may be an important source of PAI-1, especially in patients with type 2 diabetes.
    背景与目标: :Plasminogen activator inhibitor-1(PAI-1)是丝氨酸蛋白酶抑制剂(serpin)超家族的一员,它可以使组织纤溶酶原激活物(tPA)失活。因此,PAI-1抗原水平的增加抵消了tPA的抗凝作用,并促进了纤维蛋白凝块的形成。血浆PAI-1抗原和活性水平与体重指数增加以及胰岛素抵抗综合征(如肥胖症和糖尿病)的特征有关。内脏脂肪组织比皮下脂肪组织产生更多的PAI-1:内脏脂肪组织增加的PAI-1产生是内脏肥胖与心血管疾病之间的重要联系。除内脏脂肪组织外,越来越多的证据表明心外膜脂肪组织可能是PAI-1的重要来源,尤其是在2型糖尿病患者中。
  • 【加纳人口的一般和中枢肥胖和2型糖尿病风险的度量。】 复制标题 收藏 收藏
    DOI:10.1111/tmi.12024 复制DOI
    作者列表:Frank LK,Heraclides A,Danquah I,Bedu-Addo G,Mockenhaupt FP,Schulze MB
    BACKGROUND & AIMS: OBJECTIVE:The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS:A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS:The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION:Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.
    背景与目标: 目的:肥胖症和2型糖尿病的流行在撒哈拉以南非洲(SSA)中很明显。但是,在该地区几乎没有检查过它们的关联。
    方法:一项基于医院病例对照研究,由加纳市区的1221名成年人(542例和679名对照)组成,研究了人体测量学参数在糖尿病中的作用。 Logistic回归用于分析。糖尿病的鉴别力和特定人群的临界点通过接受者的操作特征曲线来确定。
    结果:腰臀比与糖尿病的关系最大:女性每1个标准差的年龄校正比值比为1.95(95%置信区间[CI]:1.64-2.31),而女性为1.40 [1.01-1.94] ]的男人。另外,在女性中,糖尿病的几率随着腰围(1.35 [1.17-1.57])和腰高比(1.29 [1.12-1.50])的增加而增加。在男人中,这是不明显的。相反,髋围呈负相关(0.69 [0.50-0.95])。体重指数与女性(1.01 [0.88-1.15])和男性(0.74 [0.52-1.04])均与糖尿病无关。在这两个性别中,腰臀比在该人群中表现出对糖尿病的最佳判别能力,并且最佳的临界点是女性≥0.88,男性≥0.90。推荐的体重指数和腰围临界点的预测能力较差。
    结论:我们的研究结果表明,中枢性肥胖而非一般性肥胖与SSA中的2型糖尿病有关。 SSA中预防肥胖症的人体测量指标是否与发达国家不同,尚需从更大的基于人群的流行病学研究中得到验证。
  • 【链脲佐菌素诱发的糖尿病易感性的菌株差异:对高甘油三酯血症和心肌病的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0008-6363(97)00045-x 复制DOI
    作者列表:Rodrigues B,Cam MC,Kong J,Goyal RK,McNeill JH
    BACKGROUND & AIMS: OBJECTIVE:Streptozotocin (STZ)-induced diabetes in Wistar rats results in severe hyperlipidemia and a characteristic cardiomyopathy. However, Wistar-Kyoto (WKY) rats made diabetic with a similar dose of STZ did not develop heart dysfunction or hypertriglyceridemia at 12 weeks post-STZ. We investigated whether an apparent resistance of the WKY strain to develop diabetic cardiomyopathy and hypertriglyceridemia following chronic diabetes could be due to a reduced susceptibility to the diabetogenic effects of STZ.

    METHODS:Adult male WKY and Wistar rats were made diabetic with a moderate (55 mg/kg) or high (75 mg/kg) dose of STZ. At 6 weeks of diabetes, glucose tolerance, cardiac function, pancreatic insulin content and basal and post-heparin plasma lipolytic activity were determined.

    RESULTS:Administration of a moderate dose of STZ produced cardiac dysfunction in Wistar but not WKY rats at 6 weeks after diabetes induction. The same dose of STZ in WKY rats also resulted in a lesser degree of hyperglycemia and glucose intolerance, and significantly higher pancreatic insulin content relative to Wistar rats. Following a high dose of STZ, the apparent resistance to developing cardiomyopathy was lost in the WKY rats. As well, the WKY rats demonstrated an equal degree of hyperglycemia and glucose intolerance as Wistar rats. However, unlike the Wistar strain, WKY rats did not demonstrate either hypertriglyceridemia or a reduced heparin-releasable plasma lipoprotein lipase (LPL) activity following a high dose of STZ.

    CONCLUSIONS:These results suggest that the incidence of diabetes-related cardiomyopathy and hypertriglyceridemia in rats may be independently influenced by strain-dependent susceptibilities to the beta-cytotoxic effects of STZ. The absence of hypertriglyceridemia in severely diabetic WKY rats may be linked to the maintenance of a critical level of plasma LPL activity.

    背景与目标: 目标:链脲佐菌素(STZ)诱导的Wistar大鼠糖尿病会导致严重的高脂血症和典型的心肌病。但是,在STZ后12周,使用相似剂量的STZ患糖尿病的Wistar-Kyoto(WKY)大鼠并未出现心脏功能障碍或高甘油三酯血症。我们调查了WKY菌株对慢性糖尿病后糖尿病性心肌病和高甘油三酯血症的明显抵抗是否可能是由于对STZ的致糖尿病作用的敏感性降低所致。

    方法:成年男性用中度(55 mg / kg)或高(75 mg / kg)剂量的STZ使WKY和Wistar大鼠患糖尿病。在糖尿病的6周时,测定了葡萄糖耐量,心脏功能,胰腺胰岛素含量以及肝素基础和血浆中的脂解活性。

    结果:服用中等剂量的STZ诱导糖尿病后6周,Wistar大鼠出现心脏功能障碍,但WKY大鼠没有。与Wistar大鼠相比,WKY大鼠中相同剂量的STZ还导致较低的高血糖和葡萄糖耐受不良,以及显着较高的胰腺胰岛素含量。服用高剂量的STZ后,WKY大鼠失去了明显的对发展性心肌病的抵抗力。同样,WKY大鼠表现出与Wistar大鼠相同程度的高血糖和葡萄糖耐受不良。但是,与Wistar菌株不同,WKY大鼠在高剂量的STZ后既未表现出高甘油三酸酯血症或肝素释放性血浆脂蛋白脂肪酶(LPL)活性降低。

    结论:这些结果表明,大鼠与糖尿病有关的心肌病和高甘油三酯血症的发生可能受到STZ的β细胞毒性作用的应变依赖性敏感性的独立影响。严重糖尿病WKY大鼠缺乏高甘油三酸酯血症可能与维持血浆LPL活性临界水平有关。

  • 【调整i.v.继续手术前接受血液透析的患者服用铁和EPO剂量:我们能否保护我们的患者接受铁缺乏性贫血的教育?】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Deaver K,Bennington L
    BACKGROUND & AIMS: :Ongoing blood loss and iron-deficiency anemia are common problems in patients on hemodialysis; therefore, nephrology clinicians are particularly concerned with their patients who are scheduled for surgery Surgery can cause significant blood and iron losses, thereby worsening their preexisting anemia. However, patients on hemodialysis can be effectively treated preoperatively by adjusting their continued doses of intravenous (i.v.) iron and recombinant human erythropoietin (EPO) therapy, based on expected blood and iron losses. This valuable strategy can help improve surgical and anemia outcomes as well as decrease EPO requirements and the need for transfusions. This article examines the use of IV iron and EPO therapy as preventive therapy for anemia in patients on hemodialysis prior to invasive surgical procedures, illustrated with an experience from a dialysis unit and patient case studies.
    背景与目标: :持续的失血和缺铁性贫血是血液透析患者的常见问题;因此,肾脏病临床医生特别关心计划进行手术的患者。手术可能会导致大量的血液和铁丢失,从而加剧他们先前的贫血。但是,可以根据预期的血液和铁损失,通过调整静脉注射铁和重组人促红细胞生成素(EPO)治疗的持续剂量,对接受血液透析的患者进行术前有效治疗。这种有价值的策略可以帮助改善手术和贫血结果,并降低EPO需求和输血需求。本文探讨了在进行侵入性外科手术之前,静脉铁剂和EPO疗法作为血液透析患者贫血的预防性疗法的用途,并结合透析部门和患者案例研究的经验进行了说明。

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