含缓释淀粉的整蛋白型肠内营养剂对脏器功能、血胰岛素/血糖曲线下面积及血糖的影响(120例随机、对照、多中心临床研究)

目的观察含缓释淀粉的整蛋白型肠内营养对2型糖尿病患者血胰岛素、血糖曲线下面积及血糖的影响。标准配方的肠内营养剂为对照药。方法符合研究计划要求的2型糖尿病患者120例,按随机表进入研究组及对照组。均住入医院或疗养院观察7天,观察期间患者不得进食任何食品,可饮白水。两组患者服用两种不同的肠内营养剂(FresubinDiabetes或Fresubinneutral),研究开始前和服用不同的肠内营养剂后第7天进行各项指标的监测。其中20例患者志愿参加血糖和胰岛素曲线下面积的测定以观察服用两种不同营养剂对血糖和胰岛素的影响水平。结果(1)安全性:两组肠内营养剂对血常规和肝肾功能均无不良影响。血糖曲线下面积研究:用药后与用药前血糖曲线下面积的差值:研究组:(-10913±7528)min·mg/dl,对照组:(1140±8094)min·mg/dl,两组对比差异有显著性(P=0.003),说明研究用药对血糖的影响明显小于对照药。(2)用药前后两组患者的血胰岛素曲线下面积的差值:研究组:(-1958±1773)min·μU/L,对照组:(-336±1654)min·μU/L,两组对比有差异但不显著(P=0.053)。(3)血糖的变化:餐后2小时血糖上升值(餐后2小时血糖-空腹血糖)研究开始前:研究组:(42.22±51.82)mg/dl,对照组:(45.1±47.79)mg/dl。表明两组患者用药前有可比性(P=0.75)。?

血管紧张素转换酶基因多态性对苯那普利治疗糖尿病肾病疗效的影响

按照血管紧张素转换酶 (ACE)基因插入 /缺失多态性不同 ,将 92例 2型糖尿病肾病患者分为II型组 31例 ,ID型组 30例及DD型组 31例。用苯那普利治疗 6个月后 ,观察治疗前后各组的尿白蛋白排泄率 (UAER)、平均动脉压 (MABP)、肌酐清除率 (Ccr)及ACE的变化。结果 :苯那普利治疗后 3组UAER、MABP、ACE均下降 ,以II型组下降幅度最大 (分别为 58.6%、2 .87kPa和 72 .3% ) ,DD型组下降幅度最小 (P <0 .0 5) ;而Ccr在DD型组下降幅度最大 ,II型组下降幅度最小 (P <0 .0 5) ;多元线性逐步回归分析显示 :ACE基因型对UAER下降率有显著回归效果(R2 =0 .72 ,P <0 .0 0 1 )。提示 :ACE基因型影响血管紧张素转换酶抑制剂 (ACEI)对糖尿病肾病的疗效 ,II基因型患者对ACEI治疗更为敏感。

血管紧张素原基因M235T分子变异与2型糖尿病肾病的关系

目的 探讨血管紧张素原（ａｎｇｉｏｔｅｎｓｉｎｏｇｅｎ ， Ａ Ｇ Ｔ） 基因 Ｍ２３５ Ｔ 分子变异与中国人无肾病并发症的２ 型糖尿病（ｄｉａｂｅｔｅｓ ｍ ｅｌｌｉｔｕｓ ， Ｄ Ｍ） 、２ 型糖尿病肾病（ｄｉａｂｅｔｉｃ ｎｅｐｈｒｏｐａｔｈｙ ， Ｄ Ｎ） 的关系。方法 用 Ｐ Ｃ Ｒ及 Ｒ Ｆ Ｌ Ｐ 方法对８４ 例 Ｄ Ｍ、９６ 例 Ｄ Ｎ 及９８ 名正常对照进行了 Ａ Ｇ Ｔ 基因 Ｍ２３５ Ｔ 多态性的检测。结果 Ｄ Ｎ 组 Ｔ 等位基因频率０８２ ， Ｔ Ｔ 基因型频率０７０ ，与对照组（０６３ ，０４３） 比较有显著差异（ Ｐ＝ ０００３ ， Ｐ＝００００４） ；校正了 Ｄ Ｎ 的几种危险因素后， Ｔ Ｔ 基因型对 Ｄ Ｎ 的 Ｏ Ｒ 为３４７（９５ ％ Ｃ Ｉ 为１５１ ～７９４ ， Ｐ＝０００３３） 。 Ｄ Ｍ 组基因型频率分布与对照组比较无显著差异（ Ｐ＞ ００５） 。结论 Ａ Ｇ Ｔ 基因 Ｔ Ｔ 型可能是中国人群２ 型糖尿病肾病的独立危险因素之一。

Effect of angiotensin converting enzyme gene polymorphism on the renoprotective responsiveness to benazepril in diabetic nephropathy

Oobjective To test the potential role of an insertion/deletion polymorphism of angiotensin converting enzyme (ACE) gene on the renoprotective responsiveness to benazepril in type 2 diabetes mellitus with nephropathy Methods The insertion/deletion polymorphisms of ACE gene were determined by polymerase chain reaction(PCR) Ninety cases with diabetes nephropathy were classified according to the genotype of the ACE gene into 30 cases with II genotypes, 29 with ID and 31 with DD Mean arterial blood pressure (MABP), urinary albumin excretion rate (UAER), serum creatinine (Scr) and ACE levels were measured before and after the six month treatment of benazepril (no differences in drug dose between groups) Results At baseline the three groups with different genotypes were similar with regard to sex, age, duration of diabetes, frequency of retinopathy, body mass index, HbA 1c, MABP, UAER, serum creatinine, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, insulin dose The dose of benazepril and the number of patients receiving nifedipine after starting ACEI were also similar in the patients with II, ID, DD genotypes, respectively The serum levels of ACE in patients with DD genotype were the highest, the intermediate with ID and the lowest with II genotype ( P <0 05) Initiation of 6 month treatment with benazepril induced a significant drop in MABP,UAER and ACE levels in all three groups ( P <0 05),but the reduction was significantly greater in patients with II genotype (UAER57 9%, MABP21 4?mm?Hg, ACE74 8%), compared to patients with either ID or DD genotype ( P <0 01, respectivly) A mild increase in the serum creatinine was seen in all groups after the initiation of benazepril, but the rate of increase in DD group was the highest (8 9%) and in II group lowest (5 4%) ( P <0 05) A multiple linear regression analysis revealed that the ACE gene polymorphism influenced the decline in albuminuria after initiation of ACE inhibition (R 2=0 69, P <0 001) Conclusion The patients with II genotype are particularly susceptible to commonly advocated renoprotective treatment