AIM： To determine the incidence, clinical characteristics and outcomes of patients with metformin associated lactic acidosis （MALA）.METHODS： Auckland City Hospital drains a population of just over 400000 people. A...AIM： To determine the incidence, clinical characteristics and outcomes of patients with metformin associated lactic acidosis （MALA）.METHODS： Auckland City Hospital drains a population of just over 400000 people. All cases presenting with metabolic acidosis between July 2005 and July 2009 were identifed using clinical coding. A retrospective case notes review identifed patients with MALA. Prescribing data for metformin was obtained from the national pharmaceutical prescribing scheme.RESULTS： There were 42 cases of metabolic lactic acidosis over 1718000 patient years. There were 51000 patient years of metformin prescribed to patients over the study period. There were thirty two cases of lactic acidosis due to sepsis, seven in patients treated with metformin. Ten cases of MALA were identified. The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin. The relative risk of lactic acidosis in patients on metformin was 13.53 （95%CI： 7.88-21.66） compared to the general population. The mean age of patients with MALA was 63 years, range 40-83 years. A baseline estimated glomerular fltration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m^2. Only two patients had chronic kidney disease G4.Three patients required treatment with haemodialysis. Two patients died.展开更多
Diabetes mellitus is categorized as a major metabolic disease. Hyperglycemia is the populest mediator. The oxygen radicals＇ production or the peroxide production in the mitochondria is preceded as a possible mechanis...Diabetes mellitus is categorized as a major metabolic disease. Hyperglycemia is the populest mediator. The oxygen radicals＇ production or the peroxide production in the mitochondria is preceded as a possible mechanism. TGF-beta is characterized as the main protagonist. TGF-b is a molecular mediator with adherent and hypertrophic properties in diabetic nephropathy. 20 Balb/c male and female mice were used. They were separated in two age groups, one of 4 weeks old （childhood, n= 10） and one of 6 weeks old （puberty, n=10）. An immunochemical study for TGF-beta was undertaken. The basal petal of the external membrane of Bowmen is thickened. In significant percentage the basal membrane was thickened and the peduncles merge together. Mature sperm cells were not normal. The two age groups did not present significant differences in morphology of the exocrine pancreatic cells. The augmented levels of TGF-beta expression promote the increased proliferation of the pancreatic glandular cells, the derangement of differentiation and the apoptosis rhythm. The renal function is diminished sooner than the clinical manifestations. The testicles are less influenced concerning principally the spermiogenesis.展开更多
文摘AIM： To determine the incidence, clinical characteristics and outcomes of patients with metformin associated lactic acidosis （MALA）.METHODS： Auckland City Hospital drains a population of just over 400000 people. All cases presenting with metabolic acidosis between July 2005 and July 2009 were identifed using clinical coding. A retrospective case notes review identifed patients with MALA. Prescribing data for metformin was obtained from the national pharmaceutical prescribing scheme.RESULTS： There were 42 cases of metabolic lactic acidosis over 1718000 patient years. There were 51000 patient years of metformin prescribed to patients over the study period. There were thirty two cases of lactic acidosis due to sepsis, seven in patients treated with metformin. Ten cases of MALA were identified. The incidence of MALA was estimated at 19.46 per 100000 patient year exposure to metformin. The relative risk of lactic acidosis in patients on metformin was 13.53 （95%CI： 7.88-21.66） compared to the general population. The mean age of patients with MALA was 63 years, range 40-83 years. A baseline estimated glomerular fltration rate was obtained in all patients and ranged from 23-130 mL/min per 1.73 m^2. Only two patients had chronic kidney disease G4.Three patients required treatment with haemodialysis. Two patients died.
文摘Diabetes mellitus is categorized as a major metabolic disease. Hyperglycemia is the populest mediator. The oxygen radicals＇ production or the peroxide production in the mitochondria is preceded as a possible mechanism. TGF-beta is characterized as the main protagonist. TGF-b is a molecular mediator with adherent and hypertrophic properties in diabetic nephropathy. 20 Balb/c male and female mice were used. They were separated in two age groups, one of 4 weeks old （childhood, n= 10） and one of 6 weeks old （puberty, n=10）. An immunochemical study for TGF-beta was undertaken. The basal petal of the external membrane of Bowmen is thickened. In significant percentage the basal membrane was thickened and the peduncles merge together. Mature sperm cells were not normal. The two age groups did not present significant differences in morphology of the exocrine pancreatic cells. The augmented levels of TGF-beta expression promote the increased proliferation of the pancreatic glandular cells, the derangement of differentiation and the apoptosis rhythm. The renal function is diminished sooner than the clinical manifestations. The testicles are less influenced concerning principally the spermiogenesis.
