A Study of Factors Related to the Incidence of Cataract in Patients with Non-Insulin Dependent Diabetes Mellitus

Purpose: To investigate the factors related to the development of cataract in patientswith non-insulin dependent diabetes mellitus(NIDDM).Methods: 792 NIDDM patients received ophthalmologic examinations including visualacuity, external status of the eyes, slit lamp microscopy and ophthalmoscopy. Glucose,urea nitrogen (BUN), creatinine (Cr), urine acid (UA), N-acetyl-β2-D-glucosaminidase(NAG), β2-microglobulin(β2-MG) and serum albumin in blood were quantitativelytested. Glucose, pH value, protein, cells, cast and ketobodies in urine were assayed.Diagnosis of cataract was based on lens opacities classification system Ⅱ. Any patientmeeting "NⅡ", "CⅡ" or "PⅡ" level was diagnosed as cataract.Results: The incidence of cataract in this group of NIDDM was 62.37 % (494/792),which significantly related to the duration of the disease course, but not to the sex of thepatient. The occurrence rate of cataract in patients suffering from NIDDM of less thanfive years duration, from five to ten years, and more than ten years was 49.67 % (228/459), 71.84 % (125/174), and 88.68 % (141/159), respectively. The occurrence ofcataract in patients diagnosed of the disease from five to ten years and more than tenyears was much higher than that of those with the course of the disease less than fiveyears( P ＜ 0.05 and P ＜ 0. 001, respectively) . Rising concentrations of blood ureanitrogen, creatinine, glycosylated hemoglobin HbA1c(G-HbA1c), N-acetyl-β2-D-glucosaminidase(NAG) and β2-microglobulin(β2-MG) indicated malfunction of thekidneys, and the rate of cataract occurrence in these patients was higher.Conclusion: This study indicates that prolongation of the duration of non-insulindependent diabetes mellitus, renal dysfunction, as well as poor blood glucose control,may accelerate the development of cataract.

The relationship between obese protein and noninsulin-dependent diabetes mellitus

To explore the role of obese protein (OP), the product of the obese gene, in the development of non-insulin-dependent diabetes mellitus (NIDDM). Metbods: Plasma obese protein level was measured by radioimmunoassay in 21 normal subjects, 24 adult obese patients and 20 patients with NIDDM. Results: The levels of the plasma obese protein in NIDDM patients (81. 0±17. 5 pg/ml) were very significantly lower than those in normal subjects (194. 3±17. 7 pg/ml) and obese patients (109.1±16. 4 pg/ml ) (P<0.01). The levels of the plasma obese protein in non-obese NIDDM patients were very significantly lower than those in non-obese normal subjects (P<0.01), and the levels of the plasma obese protein in obese NIDDM patients were very significantly lower than those in obese patients (P<0. 01). The leve1s of the plasma obese protein in NIDDM patients were significantly correlated with polyphagia (P<0.05), but not correlated with the body weight indexes after strict dieting, and the plasma levels of cholesterol, triglyceride, fasting glucose, hemoglobiti A, and the insulin levels during glucose tolerance test (P>0.05). Couclusion: Low plasma level of obese protein is one of the important factors contributing to obesity,and plasma obese protein may be closely related to the generation of NIDDM.

Association Studies of 3 Candidate Genes with Type 2 Diabetes Mellitus in a Chinese Population

Objectives To explore the relationship between the polymorphisms of the selected short tandem repeats (STRs) of the candidate genes and type 2 diabetes mellitus (DM) in a Chinese population,the role of genetic and environmental factors in the development of type 2 diabetes. Methods STRs including D11S916 of uncoupling protein 3 (UCP3) gene,binucleotide repeat (CA)n within intron 6 [HSLi6(CA)] of hormone-sensitive lipase(HSL)gene and D20S501 of protein tyrosine phosphatase-1B (PTP-1B)gene polymorphisms were detected, by poiymerase chain reaction(PCR) ,poly-acrylamide gel electrophoresis and silver staining in 106 patients with type 2 DM and 102 control subjects. Results The allele distribution of UCP3 and HSL gene differed significantly between patients with type 2 diabetes and control subjects (X2 = 26. 12,P<0. 005; X2 = 10. 33,P<0. 005,respectively). For UCP3 and HSL gene,the frequencies of alleles A6,A7,A8 and allele B9 were much higher in diabetic patients than in control subjects (0. 090 vs 0. 020,P<0. 005; 0. 109 vs 0. 015,P <0. 005; 0. 033 vs 0. 000,P<0. 05; 0. 033 vs 0. 005,P<0. 05,respectively),while the frequencies of allele A1 and allele B5 were lower in diabetic patients than in control subjects (0. 090 vs 0. 206,P<0. 005; 0. 057 vs 0. 118,P<0. 05,respectively). At D20S501 locus,The allele distribution of PTP-1B gene had no significant difference in two groups (X2 = 3. 77, P>0. 05). Multi-variate logistic regression analysis showed positive correlation between alleles A6,A7 of UCP3 gene,systolic blood pressure, apolipoprotein B, lipoprotein (a) and type 2 diabetes. Conclusion Our data show that D11S916 of UCP3 gene and HSLi6(CA) of HSL gene polymorphisms are associated with type 2 diabetes in Chinese suggesting that UCP3 and HSL might represent susceptibility genes for type 2 diabetes. D20S501 of PTP-IB gem polymorphism is not associated with type 2 diabetes in Chinese. Alleles A6, A7 of UCP3 gene, systolic blood pressure, apolipoprotein B,Upoprotein (a) may play some role in the development of type 2 diabetes.

Novel nervous and multi-system regenerative therapeutic strategies for diabetes mellitus with mTOR

Throughout the globe,diabetes mellitus（DM） is increasing in incidence with limited therapies presently available to prevent or resolve the significant complications of this disorder.DM impacts multiple organs and affects all components of the central and peripheral nervous systems that can range from dementia to diabetic neuropathy.The mechanistic target of rapamycin（m TOR） is a promising agent for the development of novel regenerative strategies for the treatment of DM.m TOR and its related signaling pathways impact multiple metabolic parameters that include cellular metabolic homeostasis,insulin resistance,insulin secretion,stem cell proliferation and differentiation,pancreatic β-cell function,and programmed cell death with apoptosis and autophagy.m TOR is central element for the protein complexes m TOR Complex 1（m TORC1） and m TOR Complex 2（m TORC2） and is a critical component for a number of signaling pathways that involve phosphoinositide 3-kinase（PI 3-K）,protein kinase B（Akt）,AMP activated protein kinase（AMPK）,silent mating type information regulation 2 homolog 1（Saccharomyces cerevisiae）（SIRT1）,Wnt1 inducible signaling pathway protein 1（WISP1）,and growth factors.As a result,m TOR represents an exciting target to offer new clinical avenues for the treatment of DM and the complications of this disease.Future studies directed to elucidate the delicate balance m TOR holds over cellular metabolism and the impact of its broad signaling pathways should foster the translation of these targets into effective clinical regimens for DM.

Effects of Supplemented Taohe Chengqi Decoction (桃核承气汤) in Treating Insulin Resistance in Rats with Non-Insulin Dependent Diabetes Mellitus

Objective: To investigate the effect of supplemented Taohe Chengqi Decoction (桃核承气汤,STHCQD) in treating non-insulin dependent diabetes mellitus (NIDDM). Methods: The model of rats withNIDDM was formed with injection of streptozotocin and fed on high calorie diet to study the effects of STHCQDon the release of insulin sensitivity. Results: (l ) Fasting serum glucose, serum insulin, intake of food and waterwere significantly decreased (P < 0. 05 -- 0. 01 ) in STHCQD-treated diabetic rats as compared with untreated diabetic rats, while the insulin sensitivity was significantly increased (P < 0. 05 ). (2) The liver cell membranesfrom STHCQD-treated diabetic rats released the quantity of insulin receptor which inhibited adenylate cyclaseactivity, but this effect was blunted in untreated diabetic rats (P < 0. 05). (3) A significantly increased glucoseoxidation in adipocyte of STHCQD-treated diabetic rats was found as compared with those of untreated diabeticrats (P< 0. 05). Conclusions: STHCQD therapy Increased sensitivity and responsiveness of target cells to insulin, i. e. it might decrease insulin resistance at receptor sites and POst--receptor sites in rats with NIDDM, butcould not.reverse the insulin resistance.

Therapeutic Effect of Berberine on 60 Patients with Non－Insulin Dependent Diabetes Mellitus and Experimental Research

The effects of berberine on 60 cases with noninsulin dependent diabetes mellitus and ex-perimental research results were observed in this study. The results suggest berberine has significant ef-fects on noninsulin dependent diabetes mellitus patients and experimental diabetes in animals in the re-duction of blood glucose levels. The clinical symptoms basically disappeared and the level of serum insulinrose. The total effective rate was up to 90 percent and there were no signiticant side-effects. It was foundthat berberine has an effect on the recovery of pancreas islet cells, through pathological examination onthe animal subjects.

Clinical Study on Jiang Tang San（降糖散）in Treating Non－Insulin Dependent Diabetes Mellitus Patiente

The therapeutic effect of Jiang Tang San (JTS) on 30 cases with non-insulin dependent dia-betes mellitus (NIDDM) , was observed, whose fasting blood glucose ranged trom 11. 1 mmol/L to 13. 8mmol/L. The results suggested that JTS has significant effect on NIDDM patients in lowering blood glucose,blood lipid and blood pressure levels. Clinical symptoms and blood glucose improved rapidly. JTS promotedthe elevation of serum insulin level 1 hour after meal. The total effective rate of lowering blood glucosereached 86. 7% . The results showed JTS is better than berberine on lowering blood glucose ( P< 0. 01 ) andwhen patients failed to respond to other hypoglycemics or on recurrence JTS was still effective. There wereno marked side-effects during the course of treatment.

Elevated alanine aminotransferase activity is not associated with dyslipidemias,but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease

Objective:To explore demographic and metabolic factors associated with increased alanine aminotransferase(ALT)activity in non-diabetic non-alcoholic fatty liver disease(NAFLD)patients.Methods:Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences,Tehran,Iran awere diagnosed as NAFLD entered into analysis.Exclusion criteria were having diabetes mellitus and fasting blood glucose over126 mg/dL,active hepatitis B virus infection,having hepatitis C virus positive serology,and to be under corticosteroid therapy.ALT levels were considered pathologically high when it was over30 IU/L for men and over 19 IU/L for women.Results:Bivariate analyses using t test and chisquare test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations(P=0.003).Moreover,these patients represented significantly higher homeostatic model assessment levels(P=0.003),levels of serum insulin(P=0.002),fasting blood glucose(P<0.001),and uric acid(P=0.02).The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations.Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD(P=0.027)and insulin resistance(P=0.013)were the only variables significantly associated with abnormal ALT levels.Conclusions:This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before.By excluding diabetic patients from our population,we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations.Further studies are needed to confirm our results.

Insulin producing cells established using non-integrated lentiviral vector harboring PDX1 gene

AIM: To investigate reprogramming of human adipose tissue derived stem cells into insulin producing cells using non-integrated lentivirus harboring PDX1 gene.METHODS: In this study, human adipose tissue derived stem cells(hADSCs) were obtained from abdominal adipose tissues by liposuction, selected by plastic adhesion, and characterized by flow cytometric analysis.Human ADSCs were differentiated into adipocytes and osteocytes using differentiating medium to confirm their multipotency. Non-integrated lentiviruses harboring PDX1(Non-integrated LV-PDX1) were constructed using specific plasmids(pLV-HELP, pMD2G, LV-105-PDX1-1).Then, hADSCs were transduced with non-integrated LVPDX1. After transduction, ADSCsPDX1+were cultured in high glucose DMEM medium supplement by B27, nicotinamide and βFGF for 21 d. Expressions of PDX1 andinsulin were detected at protein level by immunofluorescence analysis. Expressions of PDX1, neurogenin3(Ngn3), glucagon, glucose transporter2(Glut2) and somatostatin as specific marker genes were investigated at mRNA level by quantitative RT-PCR. Insulin secretion of hADSCsPDX1+in the high-glucose medium was detected by electrochemiluminescence test. Human ADSCsPDX1+were implanted into hyperglycemic rats.RESULTS: Human ADSCs exhibited their fibroblast-like morphology and made colonies after 7-10 d of culture.Determination of hADSCs identified by FACS analysis showed that hADSCs were positive for mesenchymal cell markers and negative for hematopoietic cell markers that guaranteed the lack of hematopoietic contamination. In vitro differentiation of hADSCs into osteocytes and adipocytes were detected by Alizarin red and Oil red O staining and confirmed their multilineage differentiation ability. Transduced hADSCs+PDX1became round and clusters in the differentiation medium. The appropriate expression of PDX1 and insulin proteins was confirmed using immunocytochemistry analysis.Significant expressions of PDX1, Ngn3, glucagon, Glut2and somatostatin were detected by quantitative RTPCR. hADSCsPDX1+revealed the glucose sensing ability by expressing Glut2 when they were cultured in the medium containing high glucose concentration. The insulin secretion of hADSCsPDX1+in the high glucose medium was 2.32 μU/mL. hADSCsPDX1+implantation into hyperglycemic rats cured it two days after injection by reducing blood glucose levels from 485 mg/dL to the normal level.CONCLUSION: Human ADSCs can differentiate into IPCs by non-integrated LV-PDX1 transduction and have the potential to be used as a resource in type 1 diabetes cell therapy.

CHANGES OF NAILFOLD MICROCIRCULATION IN PATIENTS OF TYPE II DIABETES MELLITUS WITH DIABETIC RETINOPATHY

Objective. To study the changes of microcirculation in patients with diabetic retinopathy(DR). Methods. Examination were performed in 153 cases of type Ⅱ diabetes mellitus, among them, 72 cases were male, 81 cases were female, mean age 57.0±10.0 years, mean disease course 8.2±7.5 years. All cases were examined fundi by ophthalmologist, urinary albumin excretion rate (UAE) in 24 hours was measured by radioimmunoassay. Moreover, we examined the blood glucose, blood pressure, blood viscosity and observed the changes of naifold microcirculation. Results.It was found that there were more evident disturbance of microcirculation, markedly slowed velocity of blood flow(P<0.05), significantly increased aggregation of blood cells(P<0.05) and exudation around the loop(P<0.05) in the group with DR, compared with the group without DR. Conclusion. It was more evident disturbance of nailfold microcirculation in patients with diabetic retinopathy.

Metabolic syndrome and non-alcoholic fatty liver disease:Asian definitions and Asian studies

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), as conventionally recognized, is a metabolic disorder largely confined to residents of affluent industrialized Western countries. However, obesity and insulin resistance are not restricted to the West, as witnessed by their increasingly universal distribution. In particular, there has been an upsurge in metabolic syndrome in the Asia-Pacific region, although there are critical differences in the extent of adiposity between Eastern and Western populations. DATA SOURCES: An English-language literature search using PubMed (1999-2007) on obesity, metabolic syndrome and NAFLD, focusing on Asian definitions and Asian studies. RESULTS: NAFLD appears to be of long-standing insulin resistance and likely represents the hepatic manifestation of the metabolic syndrome. With insulin resistance as a common factor, the disease is associated with atherosclerosis and cardiovascular risk. All features of the metabolic syndrome and related events are assessed for practical management of NAFLD, although the criteria for the diagnosis of obesity and central obesity differ across racial groups. CONCLUSIONS: The increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension and ultimately metabolic syndrome, puts a very large population at risk of developing NAFLD in the coming decades. The simultaneous identification and appropriate treatment of the components of metabolic syndrome are crucial to reduce hepatic as well as cardiovascular morbidity and mortality.

糖尿病大鼠肾脏病变及其SnoN蛋白表达的变化

目的:复制2型糖尿病动物模型,并观察其肾脏病变及SnoN蛋白表达的变化。方法:SD大鼠随机分为正常对照组(NC)、高脂高糖组(HG)。高脂、高糖饮食12周后又随机分为高脂高糖对照组(HC)、糖尿病组(DM)。采用高脂、高糖饮食12周加小剂量链脲佐菌素注射(30 mg/kg)的方法复制2型糖尿病动物模型,成模大鼠随机分别于糖尿病8周(DM8)、12周(DM12)和16周(DM16)处死;Western印迹法检测肾皮质SnoN蛋白的水平;生物化学方法测血糖、血清胰岛素水平、甘油三酯、总胆固醇、血肌酐及24 h尿蛋白;光镜检查肾组织形态学改变。结果:DM组大鼠出现高血糖、高血脂、肾功能和肾组织形态学改变;HG组血清胰岛素水平、甘油三酯和总胆固醇明显升高,血糖与NC组相比差异无统计学意义;Western印迹检测发现DM8组肾组织中SnoN蛋白的表达明显低于NC组,且随病程进展逐渐减少,至DM16时减至NC组的64.20%。结论:成功复制了2型糖尿病动物模型;SnoN蛋白的表达变化可能参与了2型糖尿病肾脏病变的发生、发展过程。

Review on the Effect of Glucagon-Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors for the Treatment of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease（NAFLD） is a common liver disease and it represents the hepatic manifestation of metabolic syndrome, which includes type 2 diabetes mellitus（T2DM）, dyslipidemia, central obesity and hypertension. Glucagon-like peptide-1（GLP-1） analogues and dipeptidyl peptidase-4（DPP-4） inhibitors were widely used to treat T2 DM. These agents improve glycemic control, promote weight loss and improve lipid metabolism. Recent studies have demonstrated that the GLP-1 receptor（GLP-1R） is present and functional in human and rat hepatocytes. In this review, we present data from animal researches and human clinical studies that showed GLP-1 analogues and DPP-4 inhibitors can decrease hepatic triglyceride（TG） content and improve hepatic steatosis, although some effects could be a result of improvements in metabolic parameters. Multiple hepatocyte signal transduction pathways and m RNA from key enzymes in fatty acid metabolism appear to be activated by GLP-1 and its analogues. Thus, the data support the need for more rigorous prospective clinical trials to further investigate the potential of incretin therapies to treat patients with NAFLD.

Prevalences of Diabetes and Hypertension and Their Relationship in Community Population of Jiangsu Province

To determine the prevalences of non-insulin-dependent-diabetes mellitus (NIDDM),impaired glucose tolerance (IGT) and hypertension on urban and rural communities of Jiangsu province,8734 subjects sampled from six areas of Jiangsu were investigated. Blood glucose of 2 h after oral administration of 75 g glucose (2 h BG) was measured. WHO criteria were used for the diagnosis of NIDDMand IGT. Meanwhile epidemiological data were collected. Blood pressure, height, weight, waist and hip girths were measured. The crude prevalence was found to be 5. 82% (men 4.62%,woman 6. 69%) for NIDDM, 5. 87% (men 5. 30%, women 6. 29% ) for IGT and 14. 72% (men 16. 50%, women 13. 43 % ) for hypertension in the population obove 20 years of age. Age-adjusted prevalence was 4. 63% for NIDDM, 5. 07 % for IGT and 11. 19% for hypertension. Age increase (>40 years), obesity (BMI≥27) and central fat distribution (WHR≥0.88) were the risk factors for both diabetes and hypertension. The subjects≥40 years of age and obesity were the high risk population of NIDDM, IGT and hypertension. They were the target population for theprevention and treatment of diabetes and hypertension in the community level. High prevalences of NIDDM,IGT and hypertension were observed in the community population in Jiangsu province. To reinforce the prevention and treatment of these disorders in the province is imperative.

Effects of Xianzhen Tablet（仙贞片）on Na^+-K^+-ATPase and Ca^(2+)-Mg^(2+)-ATPase in Erythrocytic Membranes and Viscosity of Whole Blood in Non-Insulin-Dependent Diabetes Patients with Qi-Yin Deficiency, Kidney Deficiency and Blood Stasis

Objective: To assess the effects of Xianzhen tablet (XZT) on Na+-K+ -ATPase and Ca2+ Mg2+-ATPase on erythrocytic membranes, viscosity of whole blood, plasma glucose and clinical manifestations.Methods: Seventy-two cases of non-insulin-dependent diabetes mellitus (NIDDM) patients with deficiency of both Qi and Yin, deficiency of the Kidney and blood stasis were selected, and the effects of treatment on Na+ K + -ATPase, Ca2+-Mg2+ -ATPase, whole blood viscosity, blood sugar and clinical Symptoms were observed.Results: In XZT group (test group), activities of Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase rose significantly(P< 0. 01, P< 0. 05) after treatment. Viscosity of whole blood and clinical manifestations also improved obviously. The total effective rate in lowering plasma glucose was 77. 8 % with fasting blood glucose (FBG) and 69.4 % with 2 hours postprandial plasma blood glucose (2°PBG). In the control group, viscosity of whole blood andclinical manifestations had no significant improvement. Its total effective rate in lowering plasma glucose was41. 7% with FBG and 38. 9% with 2°PBG. Conclusions: XZT played a certain role in increasing activities ofNa+ -K + -ATPase and Ca2+-Mg2+ -ATPase, decreasing viscosity of whole blood and plasma glucose and improving clinical manifestations. Therefore, XZT was experimentally manifested as an effective drug in treating NIDDM patients with Qi-Yin deficiency, renal deficiency and blood stasis.

度拉糖肽联合达格列净对非酒精性脂肪肝合并2型糖尿病患者的胰岛素抵抗和肝功能的影响

目的探究度拉糖肽联合达格列净治疗非酒精性脂肪肝(NAFLD)合并2型糖尿病(T2MD)的效果及对胰岛素抵抗和肝功能的影响。方法选取2020年11月至2022年11月浙江省台州市第一人民医院诊治的88例NAFLD合并T2MD患者,根据治疗方案分为2组,其中对照组(44例)接受达格列净治疗,联合组(44例)接受度拉糖肽联合达格列净治疗。连续治疗3个月后评估2组临床疗效和不良反应,比较2组胰岛素抵抗、肝功能、糖脂代谢指标。结果联合组临床疗效(89%)高于对照组(73%)(χ^(2)=4.021,P<0.05);联合组治疗后血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)水平及胰岛抵抗指数(HOMA-IR)值低于对照组,胰岛素β细胞功能(HOMA-β)值高于对照组(t=2.841、3.102、2.985、2.018、2.394,P均<0.05);联合组治疗后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)低于对照组(t=2.621、3.961、2.143,P均<0.05);联合组治疗后血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)低于对照组、血清高密度脂蛋白胆固醇(HDL-C)高于对照组(t=2.394、3.114、2.514、2.098,P均<0.05);2组不良反应发生情况比较,差异无统计学意义(χ^(2)=1.027,P>0.05)。结论度拉糖肽联合达格列净治疗NAFLD合并T2MD可明显改善其胰岛素抵抗和肝功能,治疗效果明显,值得临床推广。

lncRNA-UCA1、miR-145-5p在妊娠期糖尿病孕妇胎盘及脐血中的表达及意义

目的探讨长链非编码RNA(lncRNA)尿路上皮癌胚抗原1(lncRNA-UCA1)、微小RNA-145-5p(miR-145-5p)在妊娠期糖尿病(GDM)孕妇胎盘组织、脐血中的表达水平及二者与胰岛素抵抗(IR)、新生儿体重的关系。方法选取2019年3月至2021年7月该院收治的86例由口服葡萄糖耐量试验(OGTT)确定为GDM的孕妇作为GDM组,另选取同期86例经OGTT判定为正常糖耐量(NGT)的孕妇为对照组。比较对照组和GDM组胎盘组织、脐血中lncRNA-UCA1、miR-145-5p表达水平及IR相关指标及新生儿体重,分析GDM孕妇胎盘组织、脐血lncRNA-UCA1、miR-145-5p表达水平与稳态模型胰岛素抵抗指数(HOMA-IR)、新生儿体重,以及胎盘组织、脐血lncRNA-UCA1表达水平与miR-145-5p的相关性。结果GDM组孕妇胎盘组织、脐血中lncRNA-UCA1表达水平低于对照组(P<0.05),miR-145-5p表达水平及空腹胰岛素(FINS)、空腹血糖(FBG)、HOMA-IR均高于对照组(P<0.05)。GDM孕妇胎盘组织、脐血lncRNA-UCA1表达水平与HOMA-IR、新生儿体重呈负相关(P<0.05),miR-145-5p表达水平与HOMA-IR、新生儿体重呈正相关(P<0.05),GDM孕妇胎盘组织、脐血lncRNA-UCA1表达水平与miR-145-5p呈负相关(P<0.05)。结论GDM孕妇胎盘、脐血中lncRNA-UCA1表达水平较低,miR-145-5p表达水平较高,二者均与IR、新生儿体重密切相关。

基于胰岛素抵抗替代指标评估非肥胖2型糖尿病患者NAFLD的价值

目的探讨胰岛素抵抗替代指标评估非肥胖2型糖尿病(T2DM)患者发生非酒精性脂肪性肝病(NAFLD)的价值。方法选取2020年5月至2022年5月张家港澳洋医院收治的201例T2DM患者为研究对象,其中119例合并NAFLD。119例患者中103例患者为非进展性肝纤维化者。收集患者基本资料,分析T2DM患者发生NAFLD的影响因素和胰岛素抵抗替代指标预测T2DM患者发生NAFLD的价值,统计不同病情NAFLD患者血清胰岛素抵抗替代指标情况。结果多因素Logistic回归分析显示稳态模型评估胰岛素抵抗指数(HOMA⁃IR)(OR=3.931,95%CI:1.618~9.555)、甘油三酯(TG)/高密度脂蛋白胆固醇(HDL⁃C)(OR=4.063,95%CI:1.672~9.875)、TG⁃葡萄糖指数(TyG)(OR=3.999,95%CI:1.645~9.718)、TyG⁃体重指数(TyG⁃BMI)(OR=3.823,95%CI:1.573~9.291)、内脏脂肪指数(VAI)(OR=3.777,95%CI:1.554~9.180)水平是T2DM患者发生NAFLD的影响因素(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI、VAI预测T2DM患者发生NAFLD的灵敏度分别为71.43%、74.79%、71.43%、73.95%、70.59%,特异度分别为70.73%、80.49%、73.17%、79.27%、70.73%,AUC分别为0.744、0.758、0.742、0.777、0.724。进展性肝纤维化组的HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI水平均高于非进展性肝纤维化组(P<0.05)。结论HOMA⁃IR、TG/HDL⁃C、TyG、TyG⁃BMI、VAI与T2DM患者发生NAFLD有关,胰岛素抵抗替代指标预测T2DM患者发生NAFLD的效能良好,且胰岛素抵抗替代指标可能与NAFLD病情有关。

从病因病机共性探讨2型糖尿病、非酒精性脂肪性肝病与高尿酸血症内在联系

2型糖尿病、非酒精性脂肪性肝病与高尿酸血症的发生存在一定相关性。三者发生发展过程中均存在胰岛素抵抗、氧化应激及肠道屏障损伤,有相似的生理病理基础。中医学认为,三者“共病”是以浊毒困脾为病机,存在湿、痰、浊、毒、瘀等证候要素,治疗以健脾化浊解毒为总则,故3种疾病在中医病因病机及治疗上有相似之处。本文基于“异病同治”理论探讨2型糖尿病、非酒精性脂肪性肝病与高尿酸血症内在相关性,以期在临床中实现早预防、早诊断、早治疗。

AMPK在非酒精性脂肪性肝病发展中的作用

单磷酸腺苷(AMP)依赖的蛋白激酶(AMPK)是生物能量代谢调节的关键分子,通过增加AMP/腺苷三磷酸(ATP)比率而被激活。AMPK蛋白由三个亚基组成,每个亚基都有多个磷酸化位点,在重要分子通路的调节中发挥作用。通过下游蛋白的磷酸化和基因转录的调节,AMPK在代谢周转率高的组织(如肝脏、骨骼肌和脂肪组织)中充当能量稳态的主开关。在慢性热能供应过剩的条件下调节AMPK成为深入了解非酒精性脂肪性肝病(NAFLD)发病机制的重要研究目标。NAFLD发病机制中的关键过程之一是新生脂肪生成失衡。因此,本综述的范围是提供证据的综合概述,说明AMPK在调节人类NAFLD的具有促进新生脂肪生成中的作用。