【摘要】 目的 探討2型糖尿病合并下肢血管病變血管內介入治療的臨床意義。 方法 2009年1-5月對4例2型糖尿病合并下肢血管病變患者，根據血管狹窄情況選擇不同介入治療方式，行下肢動脈造影及動脈球囊擴張或支架成形術。 結果 4例患者均有表現靜息痛及間歇性跛行，下肢血管超聲顯示糖尿病下肢動脈有不同程度的斑塊、狹窄與血栓形成，病變累及下肢股動脈、髂動脈及脛前、足背動脈。介入治療后患者下肢血管灌注得到明顯改善，靜息痛及間歇性跛行明顯改善，皮溫改善，需要截肢患者截肢平面顯著降低。 結論 通過下肢血管DSA造影檢查，準確了解糖尿病患者下肢血管的阻塞部位及程度，在保守治療基礎上選擇不同方式的介入治療，有助于下肢血管病變的明顯改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.
Objective To explore the effects of CO2 pneumoperitoneum on pancreatic function in diabetic rabbits. Methods Forty-eight rabbits were divided into 4 groups: control group (the group of N0, n=4), the group of T0 (n=4), the group of T10 (n=20), and the group of T15 (n=20). The animal used in the groups of T0, T10 and T15 was diabetic rabbit, and the pressures of pneumoperitoneum of the three groups were 0 mm Hg, 10 mm Hg and 15 mm Hg respectively.The model of diabetic rabbits were made through intrvenous administration of Allxon. Arterial blood samples were collected before the onset of CO2 pneumoperitoneum, 0, 2, 6, 12 hours after deflation for measuring blood glucose, amylase, insulin and C-peptid. Then the rabbits were sacrificed and their pancreases were removed for measuring SOD activity and MDA content. Results After abdominal deflation, the blood glucose, amylase, insulin, C-peptid, MDA content were significantly increased （P＜0.05), and SOD activity was significantly decreased（P＜0.05). Twelve hours after abdominal deflation, the levels of blood glucose, amylase, insulin, C-peptid, MDA content returned to those before pneumoperitoneum was established in group T10. But, those in group T15 were higher （P＜0.05) than the levels before insufflation. The SOD activities in both group T10 and group T15 twelve hours after abdominal deflation were significantly different （P＜0.05） from those before pneumoperitoneum was established. There were statistically significant differences （P＜0.05) between group T10 and T15 in amylase, C-peptid, MDA content and SOD activity. Conclusion CO2 pneumoperitoneum has an certain adverse influence on pancreatic function of the diabetic rabbits. The degree of injury is correlated with the pressure of pneumoperitoneum. Pancreatic function may returned to preoperative level soon after abdominal deflation in group T10, but did not return in group T15.
Objective To determine the affected factors of intraorbital hemodynamic results in diabetic retinopathy (DR) and the risk factors related to the occurrence of DR. Methods Posterior ciliary artery (PCA), central retinal artery (CRA), central retinal vein (CRV), and vortex vein (VV) of 68 patients with DR were measured by color Doppler flow image (CDFI). Thirty-one hemodynamic parameters, including systolic velocity, diastolic velocity, mean velocity, resistive index, pulsatility index and accelerative velocity of ophthalmic artery (OA), and other variates (blood pressure, blood sugar, gender, age, duration of the disease, and so on) were collected and clustered in a principal components analys is following a forward, stepwise logistic regression on these components. Results Nine principal components were extracted from 37 original variates, reflecting the velocity of OA, velocity of PCA, resistance of OA, velocity of CRA,resistance of CRA, resistance of PCA, time-related factor, venous drainage factor and gender factor, respectively. In the result of logistic regression, resistance of OA, velocity of CRA, resistance of PCA, time-related factor, and venous drainage factor were the risk factors related to DR. Conclusion The first risk factor affecting DR is time, and intraorbital hemodynamic abnormity influencing the development of diabetic retinopathy may be the increase of resistance of OA, decrease of velocity of CRA, decrease of resistance of PCA, and increase of venous drainage. (Chin J Ocul Fundus Dis，2004，20：98-100)
【摘要】 目的 觀察糖尿病合并胃癌圍手術期患者應用胰島素泵的治療效果。 方法 2004年1月-2010年12月收治的胃癌合并2型糖尿病患者86例，將患者隨機分為常規組（A組）46例和胰島素泵組（B組）40例，比較兩組患者在血糖控制、手術并發癥方面的差異。 結果 B組與A組出院時，空腹血糖以及餐后血糖均能達標，但B組明顯好于A組（Plt;0.05）；B組胃排空障礙發生率降低（Plt;0.05）。 結論 胰島素泵能更好地控制血糖、減少手術并發癥的發生。【Abstract】 Objective To observe the therapeutic effect of insulin pump on type 2 diabetes mellitus combined with gastric cancer during the perioperative period. Methods Between January 2004 and December 2010, 86 patients with type 2 diabetes mellitus combined with gastric cancer were randomly divided into control group (group A, 46 cases) and insulin pump group (group B, 40 cases). The differences in blood glucose level and infection rate of operation incisions were compared between the two groups. Results Both groups reached the aimed glucose level (fasting blood glucose and postprandial blood glucose) at the discharge from the hospital, which in group B were significantly better than those in group A （Plt;0.05）. The obstruction of gastric emptying in group B decreased significantly (Plt;0.05). Conclusion Insulin pump can control the blood glucose and reduce the surgical complications．
Objective To observe the effect of pigment epithelium-derived factor (PEDF）on glutamate metabolism in diabetic rat retina. Methods 78 Sprague-Dawley rats were randomly divided into the model group, model control group, PEDF intervention group and intervention control group. There were some dead and euglycemia rats at the end of experiment, so only 12 rats in each group were included in the statistical analysis. The diabetic retinopathy rat model of the model, PEDF intervention and intervention control group were induced with streptozotocin injection. The rats in the model group were not intervened. The monthly-age matched normal rats of model group were in the model control group. The left eyes of rats were received intravitreal injection with 5 mu;l (0.1 mu;g/mu;l) PEDF (PEDF intervention group) or 5 mu;l phosphate buffer solution (intervention control group). The expressions of L-glutamate/L-aspartate transporter in retina were analyzed by western blot and real time RT-PCR techniques and glutamate content in retina was analyzed by high-pressure liquid chromatography (HPLC). Cultured rat Muuml;ller cells were divided into the control,experimental, PEDF intervention and intervention control group, GLAST expressions were detected by fluorescence immunofluorescence and real-time RT-PCR techniques. The glutamate up-take activity of Muuml;ller cells was determined by intracellular [3H] labeled D, L-glutamate concentration with scintillation counting. Results Western blot and real-time RT-PCR showed that GLAST expression decreased (real-time RT-PCR：t=8.86,Plt;0.01；Western blot：t=3.42,P＜0.05), glutamate content increased（t=4.01,P＜0.05）in model group compared with the model control group; GLAST expression increased (real-time RT-PCR：t=3.56,P＜0.05；Western blot：t=3.52,P＜0.05), glutamate content decreased（t=4.36,P＜0.05）in the PEDF intervention group compared with the intervention control group. Real-time RT-PCR and fluorescence immunofluorescence showed that high glucose down-regulate GLAST expressions in Muuml;ller cells (rea-time RT-PCR：t=3.48,P＜0.05；fluorescence immunofluorescence：t=4.72,P＜0.05 ) and impair glutamate uptake activity of Muuml;ller cells (t=3.81, Plt;0.05). Under high glucose conditions, PEDF up-regulated GLAST expression significantly (real-time RT-PCR：t=6.82,P＜0.01；fluorescence immunofluorescence：t=3.72,P＜0.05) and ameliorated the glutamate up-take activity of Muuml;ller cells（t=4.14, Plt;0.05). Conclusions In diabetic rats, PEDF may improve the activity of GLAST in Muuml;ller cells, thus ameliorate retinal glutamate metabolism and inhibit death of retinal ganglion cells.
