Pseudomelanosis duodeni associated with chronic renal failure

Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different drugs.We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin index.Gastroduodenal endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the moment.In addition,the duodenal mucosa presented marked signs of melanosis;later confirmed by histopathological study.Even though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.

Comments on“Effect of type 2 diabetes mellitus in the prognosis of acute-on-chronic liver failure patients in China”

A study addressing the influence of type 2 diabetes on the prognosis of acute-onchronic liver failure patients was reviewed.Some statistical deficiencies were found in the reviewed article,and the sample size was too small to support the study.In addition,age should have been considered as one of the prognostic factors.

Effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with diabetic nephropathy and chronic renal failure

BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications

Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.

Simultaneous liver, pancreas-duodenum and kidney transplantation in a patient with hepatitis B cirrhosis, uremia and insulin dependent diabetes mellitus

Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.

Social Cultural and Economic Factors Affecting the Practice of Secondary Prevention among Patients with Type 2 Diabetes Mellitus at Consolata Nkubu and Meru Level Five Hospital in Meru County

Diabetes is chronic metabolic disorder characterized by states of hyperglycemia with disturbances of carbohydrates, fat and protein metabolism. Diabetes affects millions of people globally every day and the prevalence of the disease is on the rise due to unhealthy diet and lifestyle. The disorder usually results to chronic complications including cardiovascular diseases, diabetic nephropathy, diabetic neuropathy, foot ulcers and diabetic eye diseases that are all preventable through secondary preventive measures. Once an individual has been diagnosed with T2DM, secondary preventive approaches are essential in preventing the occurrence of chronic complications. However, lack of awareness of these measures has been cited as the common reasons for the development of complications. The study aimed to assess the effect of social cultural and economic factors on the practice of secondary diabetes prevention among patients with Type 2 Diabetes Mellitus (T2DM) at Consolata Hospital Nkubu and Meru Level Five Hospital between March and April 2019. A descriptive correlational study design was adopted to collect data from 357 purposively sampled participants with T2DM using questionnaires and Focus Group Discussion Guide. Quantitative data were analyzed using SPSS version 25 at 95% confidence interval and a significance level p ≤ 0.05. Most respondents attended Meru Teaching and Referral Hospital. Majority of the respondents were aged between 40 - 60 years. Most respondents 31.6% had secondary level of education and majority 67% was employed. Concerning secondary prevention, majority did foot examination on every visit 70.6% and BP monitoring 69.5% while 56.5% did annual eye screening. Level of income, affordability of services, health insurance cover of the patients, monthly cost of DM management and traditional beliefs in managing DM all significantly influenced DM secondary prevention at a p value ≤ 0.05. The factors need to be addressed to reduce the global burden posed by the disease.

The Effect of Glucose Added to the Dialysis Fluid on Blood Pressure, Vasoactive Hormones and Energy Transfer during Hemodialysis in Chronic Renal Failure

Background: Previous studies showed that blood pressure was reduced in patients with chronic renal failure during hemodialysis with glucose added to the dialysis fluid. We wanted to test the hypotheses that blood pressure is reduced in non-diabetic and diabetic dialysis patients, when glucose is added to the dialysis fluid, and that blood pressure changes are caused by changes in plasma concentrations of vasoactive hormones or to vasodilation secondary to an increase in body temperature. Methods: The effect of dialysis with glucose added to the dialysis fluid was measured in three randomized, placebo-controlled, un-blinded and cross-over studies with periods of one week duration. In non-diabetic nephropathy (Study 1, n = 19) and diabetic nephropathy (Study 2, n = 15), we measured blood pressure (BP) and pulse rate (PR), plasma concentrations of glucose (p-Glucose), renin (PRC), angiotensin II (p-AngII), endothelin (p-Endot), insulin (p-Ins), glucagon (p-Glu), and human growth hormone (p-hGH). In non-diabetic nephropathy (Study 3, n = 24), we measured the effect of dialysis with glucose added to the dialysis fluid on energy transport from form the body using body temperature control. Results: Study 1 and 2 showed that BP, PRC, p-AngII, and p-Ins were unchanged, whereas P-Endot increased and P-hGH decreased, in dialysis patients with or without glucose added to the dialysis fluid. In diabetics, a marginal increase in p-Glu was measured during dialysis with glucose, but not without glucose. Study 3 showed that SBP increased significantly using dialysis with temperature control of dialysis fluid compared with no temperature control (145 versus 138 mm Hg). In parallel with the increase in SBP, the energy flux from the patients was significantly higher with temperature control than without. Conclusion: In non-diabetics and diabetics, blood pressure was unchanged during dialysis with glucose added to the dialysis fluid in a short-term study. Vasoactive hormones in plasma were changed in the same way independently of glucose in the dialysis fluid. Systolic blood pressure increased using dialysis with temperature control of dialysis fluid, presumably due to vasoconstriction to prevent or antagonize a fall in body temperature.

Which factors determine exocrine pancreatic dysfunction in diabetes mellitus?

The exocrine structure is significantly affected by diabetes because of endocrine structure-function disorder within the pancreas. Exocrine pancreatic dysfunction (EPD) is the general name of the malabsorption process resulting from inadequate production, release, decreased activation, and/or insufficient degradation of enzymes required for digestion from pancreatic acinar cells. It is important to diagnose patients early and correctly, since there may be both macro- and micro-nutrient deficiency in EPD. In this paper, EPD, the diabetes- EPD relationship, and the predictive, effective factors affecting the emergence of EPD are briefly explained and summarized with contemporary literature and our experienced based on clinical, lab, and radiological findings.

Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

The prevalence of chronic kidney disease and peripheral arterial disease is increasing.Thus,it is increasingly problematic to image these patients as the number of patients needing a vascular examination is increasing accordingly.In high-risk patients with impaired kidney function,intravascular administration of iodinated contrast media can result in contrast-induced acute kidney injury and Gadolinium can induce nephrogenic systemic fibrosis(NSF).It is important to identify these highrisk patients by means of se-creatinine/e glomerular filtration rate.The indication for contrast examination should counterbalance the increased risk.One or more alternative examination methods without contrast media,such as CO 2 angiography,Ultrasound/Doppler examination or magnetic resonance angiography without contrast should be considered,but at the same time,allow for a meaningful outcome of the examination.If contrast is deemed essential,the patient should be well hydrated,the amount of contrast should be restricted,the examination should be focused,metformin and diuretics stopped,and renal function monitored.Sodium bicarbonate and N-acetylcysteine are popular but their efficiency is not evidence-based.There is no evidence that dialysis protects patients with impaired renal function from contrast-induced nephropathy or NSF.

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising.Diabetes mellitus by itself is linked to adverse cardiovascular events,and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk.The culmination of traditional(male gender,smoking,advanced age,obesity,arterial hypertension and dyslipidemia)and non-traditional risk factors(anemia,inflammation,proteinuria,volume overload,mineral metabolism abnormalities,oxidative stress,etc.)contributes to advanced atherosclerosis and increased cardiovascular risk.To decrease the morbidity and mortality of these patients due to cardiovascular causes,timely and efficient cardiovascular risk assessment is of huge importance.Cardiovascular risk assessment can be based on laboratory parameters,imaging techniques,arterial stiffness parameters,ankle-brachial index and 24 h blood pressure measurements.Newer methods include epigenetic markers,soluble adhesion molecules,cytokines and markers of oxidative stress.In this review,the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Challenges and pitfalls of youth-onset type 2 diabetes

The incidence and prevalence of youth-onset type 2 diabetes mellitus(T2DM)are increasing.The rise in frequency and severity of childhood obesity,inclination to sedentary lifestyle,and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications.Indeed,youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM,with greater insulin resistance and more rapid deterioration of beta cell function.Therefore,intermediate complications such as microalbuminuria develop in late childhood or early adulthood,while end-stage complications develop in mid-life.Due to the lack of efficacy and safety data,several drugs available for the treatment of adults with T2DM have not been approved in youth,reducing the pharmacological treatment options.In this mini review,we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Prevalence, clinical characteristics and outcome in patients with chronic heart failure and diabetes

Background Chronic heart failure（CHF）and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction（LVEF）〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events （MCE） including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time （16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009）and age（1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years）.Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter （P〈0.05）,decreased LVEF（P〈0.01）and reduced survival（P〈0.05）.Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class（OR2.65,95%CI 1.14-6.16,P=0.024）and HbA1c level≥7%（OR2.78, 95%CI 1.00-7.68,P=0.049）were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.

司美格鲁肽对2型糖尿病伴慢性心力衰竭合并肾功能不全患者的疗效与安全性观察研究

目的 探索司美格鲁肽对2型糖尿病伴慢性心力衰竭(CHF)合并肾功能不全患者的临床效果及安全性。方法 选取2022年1月-2022年9月于新疆医科大学第一附属医院就诊的71例2型糖尿病合并CHF及肾功能不全的患者作为研究对象,根据治疗方案随机分为对照组(胰岛素治疗,35例)与治疗组(胰岛素联合司美格鲁肽治疗,36例)。比较2组治疗的临床疗效与安全性。结果 治疗3个月后,治疗组HbA1c达标有效率为72.2%,显著高于对照组的有效率(31.4%)(P <0.05)。治疗后治疗组的体质量、FBG、HbA1c和TG均出现明显下降并显著低于对照组(P <0.05)。与对照组比较,联合应用司美格鲁肽治疗后出现LVEF升高、BNP降低、UACR和尿α1MG下降,差异具有显著统计学意义(P <0.05)。但2组的不良反应无明显区别(P> 0.05)。结论 司美格鲁肽对2型糖尿病伴CHF合并肾功能不全患者具有良好的血糖控制效果,可显著改善心功能,减少肾脏病病情进展,临床应用安全性较高。

沙库巴曲缬沙坦治疗慢性心力衰竭合并2型糖尿病有效性及安全性Meta分析

目的评价沙库巴曲缬沙坦治疗慢性心力衰竭(CHF)合并2型糖尿病(T2DM)的有效性及安全性。方法采用计算机检索PubMed,Embase,Web of Science,The Cochrane Library及中国知网(CNKI)、万方(WanFang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)数据库中关于沙库巴曲缬沙坦治疗CHF合并T2DM的随机对照试验(RCT),检索时限为1990年1月至2023年2月。采用Cochrane系统评价指导手册Version 5.1.0进行偏倚风险评估,采用改良Jadad量表进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入11项RCT,涉及患者7075例,其中试验组3569例,对照组3506例。Meta分析结果显示,试验组患者的临床疗效[OR=1.94,95%CI(1.20,3.12),P=0.007],左室射血分数[MD=6.67,95%CI(4.87,8.47),P<0.00001],氨基末端脑型利钠钛前体[MD=-621.60,95%CI(-813.81,-429.38),P<0.00001],糖化血红蛋白[MD=-0.41,95%CI(-0.73,-0.09),P=0.01],空腹血糖[MD=-1.03,95%CI(-1.62,-0.45),P=0.0005]的改善程度均显著优于对照组,不良反应发生率显著低于对照组[OR=0.59,95%CI(0.38,0.93),P=0.02]。结论沙库巴曲缬沙坦治疗CHF合并T2DM的有效性和安全性均良好,可改善患者的心功能指标,降低糖化血红蛋白和空腹血糖水平。

达格列净结合标准抗心衰及降糖方案治疗老年慢性心力衰竭合并T2DM及高尿酸血症的临床分析

目的探究对老年慢性心力衰竭合并2型糖尿病(Diabetes Mellitus Type 2,T2DM)及高尿酸血症患者采用达格列净和标准抗心衰及降糖方案结合治疗后效果。方法随机选取2021年6月—2022年6月广州市花都区人民医院收治的心力衰竭合并T2DM及高尿酸血症患者120例为研究对象,采用随机数表法分成对照组(60例)、观察组(60例)。对照组采取标准抗心衰及降糖方案,观察组在对照组基础上采取达格列净,对比临床效果。结果观察组氨基末端脑钠肽前体(N Terminal Pro B Type Natriuretic Peptide,NT-proBNP)为(519.36±107.52)ng/L、血尿酸为(346.17±42.15)μmol/L低于对照组,差异有统计学意义(t=2.020、4.245,P<0.05)。观察组血脂改善更好,左室舒张末容积、左室收缩末容积、舒张早期二尖瓣血流速度/二尖瓣环运动速度(the Ratio of Early Diastolic Transmitral Flow Velocity to Mitral Annular Velocity,E/e’)低于对照组,左室射血分数高于对照组,差异有统计学意义(P<0.05)。观察组主要终点事件、次要终点事件、痛风发作率低于对照组,差异有统计学意义(P<0.05)。两组药物不良反应率对比,差异无统计学意义(P>0.05)。结论针对老年慢性心力衰竭合并T2DM及高尿酸血症患者,采用达格列净联合标准抗心衰及降糖方案,能改善血脂、心功能等指标水平,预后效果以及安全性较高。

风险防控质控护理在慢性肾衰竭腹膜透析患者中的应用效果

目的:观察风险防控质控护理在慢性肾衰竭(CRF)腹膜透析患者中的应用效果。方法:选取2018年6月至2020年6月该院收治的70例CRF腹膜透析患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各35例。对照组实施常规护理,观察组在对照组基础上实施风险防控质控护理。比较两组护理前后营养指标[总蛋白(TP)、血红蛋白(Hb)、白蛋白(ALB)]水平、生命质量[肾脏病生活质量简表(KDQOL-SF)]评分、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分,以及并发症发生率。结果:护理后,观察组TP、Hb、ALB水平和KDQOL-SF评分均高于对照组,差异有统计学意义(P<0.05);观察组SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为8.57%(3/35),低于对照组的40.00%(14/35),差异有统计学意义(P<0.05)。结论:风险防控质控护理应用于CRF腹膜透析患者可提高营养指标水平和生命质量评分,降低负性情绪评分和并发症发生率,效果优于常规护理。

非奈利酮对2型糖尿病患者心肾保护作用的研究进展

盐皮质激素受体拮抗剂是心力衰竭患者的指南推荐治疗药物。然而,高钾血症和激素副作用的相关风险限制了其在2型糖尿病合并中晚期慢性肾脏病及心血管疾病高风险患者中的广泛使用。非奈利酮是一种新型非甾体类盐皮质激素受体拮抗剂,用于与2型糖尿病相关的心血管疾病和慢性肾脏病患者,达到心肾保护的作用。本文对非奈利酮在治疗2型糖尿病中心肾保护的作用机制、药理特性、安全性等进行综述,旨在为2型糖尿病合并心力衰竭及肾脏损伤患者的临床治疗提供帮助。

达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后的影响

目的 观察达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后的影响。方法 选取2020年3月—2021年3月保定市第一中心医院收治的慢性肾脏病伴2型糖尿病合并心力衰竭患者82例,按照随机数字表法分为观察组及对照组,每组41例。对照组给予常规治疗,观察组在对照组治疗的基础上给予达格列净治疗。2组均治疗12个月。比较2组治疗前后肾功能[血肌酐(SCr)、血尿酸(UA)]、心功能[左室舒张末压(LVEDD)、左室射血分数(LVEF)、6 min步行距离(6MWD)、N端脑钠肽前体(NT-proBNP)]、炎性因子[超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、生活质量评分(MHFQL),以及预后与不良事件发生情况。结果 治疗12个月后,观察组SCr、UA水平低于治疗前及对照组(P<0.05或P<0.01),对照组治疗前后SCr、UA水平比较差异均无统计学意义(P>0.05);观察组LVEF、LVEDD均较治疗前及对照组改善(P<0.05或P<0.01),对照组治疗前后LVEF、LVEDD比较差异均无统计学意义(P>0.05),2组6MWD均长于治疗前,且观察组长于对照组(P<0.01);观察组NT-proBNP水平低于治疗前及对照组(P<0.05或P<0.01),对照组治疗前后NT-proBNP水平比较差异无统计学意义(P>0.05);2组hs-CRP、IL-6、TNF-α水平均低于治疗前,且观察组低于对照组(P<0.05或P<0.01);2组MHFQL评分均低于治疗前,且观察组低于对照组(P<0.05或P<0.01)。观察组与对照组病死率比较差异无统计学意义(9.76%vs. 12.20%,χ^(2)=0.125,P=0.724);观察组与对照组不良事件总发生率比较差异无统计学意义(24.39%vs. 9.76%,χ^(2)=3.101,P=0.078)。结论 达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后均有一定的改善作用,值得临床应用。

铁代谢与2型糖尿病相关性及胰高血糖素样肽-1调控作用的研究进展

铁代谢在多种代谢性疾病中发挥调控作用,过量铁积累会增加代谢性疾病尤其是2型糖尿病(T2DM)的发生风险。铁沉积、铁过载和铁死亡等病理过程可激活氧化应激、脂质过氧化、细胞自噬等,促进机体炎症反应级联放大和抗氧化能力降低,使胰岛β细胞功能逐渐衰退,从而促进T2DM的发生发展。胰高血糖素样肽-1(GLP-1)是由肠道L细胞分泌的一种生理性激素,GLP-1类似物或GLP-1受体激动剂可调节机体铁代谢过程,抑制铁沉积、铁过载和铁死亡相关炎症反应,促进胰岛β细胞增殖及分化,进而减轻胰岛素抵抗,抑制内皮细胞损伤,在T2DM及其并发症的防治中发挥重要作用。