初发2型糖尿病患者血浆IAPP水平分析

为了探讨胰淀素水平与2型糖尿病胰岛β细胞功能的关系,本文以初发2型糖尿病患者39例和无糖尿病家族史的健康对照者53例作为研究对象,进行血浆IAPP水平、胰岛素水平、C肽水平、糖、脂代谢等指标的测定。结果：2型糖尿病组IAPP水平与正常对照组相似。IAPP与胰岛素等相关指标之间均无明显的相关性。结论：胰岛淀粉样蛋白沉积持续积累取代胰岛β细胞导致β细胞功能缺陷。     

超敏CRP、同型半胱氨酸与2型糖尿病大血管并发症的关系研究

目的探讨超敏CRP(hs-CRP)、同型半胱氨酸(Hcy)与2型糖尿病大血管并发症的关系。方法收集30例2型糖尿病无并发症者、30例2型糖尿病合并大血管并发症者、30例健康体检者的血清,分别测定hs-CRP、Hcy、Hb A1c、LDL水平。结果 2型糖尿病无并发症组和2型糖尿病大血管并发症组血清hs-CRP、Hcy、LDL水平均高于正常对照组(P﹤0.01),2型糖尿病大血管并发症组血清hs-CRP和Hcy又高于2型糖尿病无并发症组(P﹤0.05);相关性分析表明hs-CRP与LDL呈正相关,hs-CRP与Hcy呈正相关,Hcy与Hb A1c呈正相关。结论 hs-CRP和Hcy对2型糖尿病大血管并发症的早期诊断及病情监测有一定的临床意义。     

初发2型糖尿病患者血浆IAPP水平分析

为了探讨胰淀素水平与2型糖尿病胰岛β细胞功能的关系,本文以初发2型糖尿病患者39例和无糖尿病家族史的健康对照者53例作为研究对象,进行血浆IAPP水平、胰岛素水平、C肽水平、糖、脂代谢等指标的测定。结果：2型糖尿病组IAPP水平与正常对照组相似。IAPP与胰岛素等相关指标之间均无明显的相关性。结论：胰岛淀粉样蛋白沉积持续积累取代胰岛β细胞导致β细胞功能缺陷。     

血清同型半胱氨酸与2型糖尿病患者冠状动脉病变SYNTAX评分的相关性研究

目的探讨血清同型半胱氨酸(HCY)与2型糖尿病合并冠心病患者冠状动脉病变SYNTAX评分的相关性。方法选取2016-06~2017-06在该院治疗的2型糖尿病患者160例以及健康对照组80例。依据冠状动脉造影检查将2型糖尿病患者分为两组:无冠心病组80例,合并冠心病组80例。2型糖尿病合并冠心病组根据SYNTAX评分分为低危组23例、中危组30例、高危组27例。采用循环酶法检测研究对象血清HCY水平,并对比分析检测结果。结果 2型糖尿病无冠心病组和2型糖尿病合并冠心病组血清HCY检测水平高于健康组,2型糖尿病无冠心病组血清HCY水平低于2型糖尿病合并冠心病组;低危组和中危组组血清HCY水平均低于高危组,差异有统计学意义(P0.05)。结论血清HCY水平与2型糖尿病合并冠心病患者SYNTAX评分紧密相关,血清HCY水平可作为判断2型糖尿病患者冠状动脉病变严重程度的指标。     

脂联素基因SNP+276与延边地区2型糖尿病及其颈动脉IMT的相关性

目的探讨血清脂联素水平及其基因SNP+276基因多态性与延边地区2型糖尿病及其颈动脉内膜中膜厚度(IMT)的相关性。方法对象均来自吉林省延边地区,3代无亲缘关系,排除冠心病、肝肾疾病、恶性肿瘤及免疫系统疾病。入组人群分对照组,2型糖尿病组,2型糖尿病组按民族分为汉族与朝鲜族组;2型糖尿病组根据颈动脉IMT分为颈动脉硬化组(GG基因型组,GT基因型组,TT基因型)和无颈动脉硬化组:采用Taqman探针法进行SNP基因分型,荧光测序法进行SNP测序。结果对照组与2型糖尿病组脂联素SNP+276T/G基因多态性分布差异存在显著性:2型糖尿病组汉族和朝鲜族脂联素SNP+276T/G基因多态性分布差异无显著性;2型糖尿病动脉硬化组与无颈动脉硬化组脂联素SNP+276基因多态性分布差异无显著性;2型糖尿病颈动脉硬化组血清脂联素水平与2型糖尿病无颈动脉硬化组差异存在显著性;2型糖尿病颈动脉硬化患者GG基因型组年龄,病程和脂联素水平与TT基因型组差异存在显著性。结论脂联素基因SNP+276T/G与延边地区2型糖尿病有相关性。脂联素基因SNP+276T/G与延边地区2型糖尿病颈动脉IMT无相关性。血清脂联素水平与延边地区2型糖尿病及颈动脉IMT有相关性。脂联素是2型糖尿病及颈动脉硬化的保护因子。G等位基因可能是2型糖尿病及颈动脉硬化的风险基因。     

2型糖尿病患者血瘦素水平与高血压的相关性研究

选择122例2型糖尿病患者,分为合并高血压组和血压正常组,各组又分别分为肥胖和非肥胖亚组.测定其体重指数(BMI)、空腹血糖(FBG)和胰岛素、糖化血红蛋白(HbA1c)及血清瘦素水平,并作相关性分析.结果显示,2型糖尿病患者高血压组与非高血压组间血清瘦素水平无差异(P＞0.05);血清瘦素水平与BMI、空腹胰岛素呈正相关关系(P＜0.01),与血压无明显相关性(P＞0.05);但在合并高血压组,血清瘦素水平与HbA1c呈负相关关系(P＜0.05).提示2型糖尿病患者的血清瘦素水平与血压无明显相关性,但合并高血压患者长时间血糖控制不良可能会导致血清瘦素水平的下降.     

2型糖尿病患者部分肿瘤标志物变化的意义

测定386例2型糖尿病患者的CA199、CA125、CEA及AFP水平,并与健康体检人员对照分析。结果 2型糖尿病患者血清CA199、CA125升高与长期血糖控制不佳有关,而CEA、AFP的水平无相关性。     

2型糖尿病患者动态血糖变化与糖化血红蛋白水平的相关性分析

目的探讨2型糖尿病患者动态血糖变化与糖化血红蛋白(HbAlc)水平的相关性,为预防2型糖尿病并发症的发生提供参考。方法选取2009-05～2011-05收治的18例2型糖尿病患者,采用动态血糖监测系统(CGMS)观察2型糖尿病患者血糖变化与HbAl c的相关性。结果经Pearson分析显示,HbAlc与日内血糖水平呈正相关(P0.05),与餐后血糖波动幅度(PPGE)无明显相关性(P0.05)。结论 CGMS能详细显示日内血糖波动情况,HbAlc能反映日内整体血糖水平。     

2型糖尿病合并脑梗死患者糖化血红蛋白、血清同型半胱氨酸与颈动脉内膜中层厚度分析

目的探讨老年2型糖尿病合并脑梗死患者糖化血红蛋白（HbA1c）,血清同型半胱氨酸（Hcy）水平与颈动脉内膜中层厚度（IMT）的关系。方法对49例老年2型糖尿病脑梗死患者、40例老年2型糖尿病无脑梗死患者、43例健康老年人（对照组）进行HbA1c,血清Hcy与IMT的相关性分析。结果老年2型糖尿病合并脑梗死组的HbA1c、血清Hcy、IMT水平明显高于老年2型糖尿病无脑梗死组和对照组（P〈0.05）,2型糖尿病合并脑梗死组中的IMT与HbA1c、血清Hcy、总胆固醇呈正相关（P〈0.05）。结论老年2型糖尿病患者除严格控制血糖外,有必要检测HbA1c、血清Hcy与IMT,以早期预防或延缓大血管并发症的出现,从而降低脑梗死的患病率和病死率。     

C反应蛋白和纤维蛋白原水平升高与2型糖尿病并发脑血管病的关系探讨

目的探讨炎性因子C反应蛋白（CRP）和纤维蛋白原水平升高与2型糖尿病患者发生脑血管事件之间的关系。方法调查135例2型糖尿病患者，分析C反应蛋白和纤维蛋白原水平升高对53例患者发生脑血管事件的影响及作用。结果Logistic回归分析：经年龄、吸烟、高血压、LDL等混杂因素调整后，CRP和纤维蛋白原与2型糖尿病患者脑血管事件的发生无显著相关性。结论C反应蛋白和纤维蛋白原水平升高不能作为2型糖尿病患者发生脑血管事件的预测因子。     

Association of the polymorphism of interleukin-1B (−511C/T) with type 2 diabetes mellitus patients with and without family history of a first degree relative with diabetes mellitus

Diabetes mellitus (DM) of a first degree relative is an important risk factor for developing type 2 diabetes mellitus (T2DM). The study investigated whether genetic polymorphism of the cytokine interleukine-1β (?511C/T) (IL-1B) was associated with the development of type 2 diabetes mellitus (T2DM) among first degree relative having diabetes mellitus (DM). Thirty five T2DM patients from north-eastern Thailand with a first degree relative with DM, 55 T2DM patients without a DM history of a first degree relative and 30 healthy controls were studied. Heterozygous individuals of IL-1B (CT) in the group of T2DM patients with a first degree relative with DM are significantly more frequent in comparison with the group of T2DM patients without a first degree relative with DM and with the controls. Genotypes between the T2DM patients without a DM relative and the controls were similar. The allele C did not differ between groups but the allele T significantly was more frequent for the T2DM patients with a relative with DM in comparison with the two other groups.     

Hyperresistinemia is associated with coexistence of hypertension and type 2 diabetes

Numerous studies have demonstrated that high blood pressure substantially increases the risk of microvascular and macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Currently, we found that serum resistin, an adipocyte- and monocyte-derived cytokine, was positively correlated with several components of the metabolic syndrome, including hypertension in T2DM. To investigate the association of resistin with an etiologic difference among subjects with hypertension with T2DM, hypertension without T2DM, and normotensive T2DM, we analyzed 210 subjects, including 91 with hypertension with T2DM, 55 with hypertension without T2DM, and 64 with normotensive T2DM. Serum resistin level was higher in subjects with hypertension with T2DM, followed by subjects with normotensive T2DM and hypertension without T2DM, irrespective of antihypertensive treatment status (20.9+/-17.6 and 14.0+/-8.9 versus 11.2+/-7.6 ng/mL, respectively; P<0.01). Simple regression analysis revealed that resistin positively correlated with blood pressure (systolic blood pressure: r=0.29, P<0.01; diastolic blood pressure: r=0.21, P<0.05) and intima-media thickness (r=0.27; P<0.05) in patients with T2DM but not in subjects with hypertension without T2DM. Multiple regression analysis, adjusted for age, gender, body mass index, fasting glucose, high-density lipoprotein cholesterol, white blood cell counts, and glomerular filtration rate, further revealed that resistin was an independent factor for high blood pressure in patients with T2DM (P<0.05). In vitro gene expression analysis in human coronary endothelial cells revealed that resistin induced fatty acid binding protein, a key molecule of insulin resistance, diabetes, and atherosclerosis. These results suggest that hyperresistinemia would contribute to the pathogenesis of hypertension in patients with T2DM, significantly linked to vascular complications and cardiovascular events.     

Prevalence and incidence of cardiovascular and renal diseases in type 1 compared with type 2 diabetes: A nationwide French observational study of hospitalized patients

BackgroundType 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) increase risks of cardiovascular (CV) and renal disease compared with diabetes-free populations. There are only a few studies comparing T1DM and T2DM for the relative risk of these clinical events.MethodsAll adult patients hospitalized in French hospitals in 2013 with at least 5 years of follow-up were identified and categorized by their diabetes status. A total of 50,623 patients with T1DM (age 61.4 ± 18.6, 53% male) and 425,207 patients with T2DM (age 68.6 ± 14.3, 55% male) were followed over a median period of 5.3 years (interquartile range: 2.8 - 5.8 years). Prevalence and event rates of myocardial infarction (MI), heart failure (HF), ischemic stroke, chronic kidney disease (CKD), all-cause death and CV death were assessed with age stratification of 10-year intervals. For clinical events during follow-up, we report hazard ratios (HRs) in T1DM relative to T2DM.ResultsThe age and sex-adjusted prevalence of CV diseases was higher in T2DM for ages above 40 years whereas the prevalence of CKD was more common in T1DM between ages 18 and 70 years. During 2,033,239 person-years of follow-up, age and sex-adjusted HR event rates comparing T1DM, versus T2DM as reference, showed that MI and HF relative risks were increased above 60 years (1.2 and 1.4 -fold). HR of ischemic stroke did not markedly differ between T1DM and T2DM. Risk of incident CKD was 2.4-fold higher in T1DM above 60 years. All-cause death HR risk was 1.1-fold higher in T1DM after 60 years and the CV death risk was 1.15-fold higher in T1DM between 60 and 69 years compared to T2DM.ConclusionsAlthough the crude prevalent burden of CV diseases may be lower in T1DM than in T2DM, patients with T1DM may have a higher risk of incident MI, HF, all-cause death and CV death above 60 years of age, highlighting the need for improved prevention in this population.     

Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study

BACKGROUNDMany studies have demonstrated an association between type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF). However, the potential independent contributions of T2DM and AF to the prevalence of visual impairment have not been evaluated.AIMTo determine whether such an association between T2DM and incident AF with visual impairment exists, and if so, the prevalence and magnitude of this association.METHODSWe conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study had evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. T2DM patients were categorized into two groups: patients without and with incident AF. T2DM patients without AF were selected as the reference group. The association between incident AF and visual impairment among T2DM patients was assessed using multivariate logistic regression.RESULTSA total of 27281 T2DM patients with available eye examination data were included in this analysis. The mean age was 60.7 ± 10.5 years, and 31.2% were male. The incident AF was 0.2%. The prevalence of severe visual impairment in all T2DM patients, T2DM patients without AF, and T2DM patients with incident AF were 1.4%, 1.4%, and 6.3%, respectively. T2DM patients with incident AF were associated with an increased OR of 3.89 (95%CI: 1.17-13.38) for severe visual impairment compared with T2DM patients without AF.CONCLUSIONT2DM patients with incident AF were independently associated with increased severe visual impairment. Therefore, early eye screening should be provided for these high-risk individuals.     

维生素D受体基因FokⅠ多态性与2型糖尿病及其合并动脉粥样硬化的相关性

目的探讨维生素D受体（VDR）基因FokⅠ的多态性与T2DM及其合并动脉粥样硬化（AS）之间的相关性。方法通过提取全血DNA,PCR扩增VDR基因,FokⅠ酶切扩增产物,检测大连地区T2DM合并AS者（AS组）,DM非AS者（non-AS组）及健康对照者（NC组）的基因型。应用单因素非条件logistic回归分析研究VDR基因变异对T2DM及合并AS的影响。结果（1）VDR基因FokⅠ酶切位点各基因型在T2DM组和NC组中分布具有统计学差异（P〈0．01）。（2）AS组和non-AS组VDR基因FokⅠ酶切各基因型分布无统计学差异（P〉0．05）。（3）VDR等位基因f与T2DM呈显著正相关,等位基因F与T2DM呈显著负相关。结论在大连地区的汉族人群中,VDR基因FokⅠ的多态性与T2DM相关,而与T2DM合并AS无关。等位基因f是T2DM的易感基因,而等位基因F对T2DM具有保护作用。     

Epitope-restricted 65-kilodalton glutamic acid decarboxylase autoantibodies among new-onset Sardinian type 2 diabetes patients define phenotypes of autoimmune diabetes

The 65-kDa glutamic acid decarboxylase (GAD65) autoantibodies (GAD65Abs), commonly found in type 1 diabetes mellitus (T1DM) patients, are also found at lower frequencies in type 2 diabetes mellitus (T2DM) patients. GAD65Abs in T1DM patients are epitope specific, in contrast to those found in other GAD65Ab-positive individuals, including T2DM patients. Our aim was to assess whether epitope-specific GAD65Abs, or the additional presence of islet antigen 2 (IA-2) autoantibodies, better define T1DM phenotypes among T2DM patients. GAD65 and IA-2 autoantibodies were analyzed in 1436 Sardinian subjects classified with T2DM and in 384 nondiabetic patient controls. Autoantibody binding specificity to the N-terminal, middle (M), and C-terminal (C) portions of the GAD65 molecule was evaluated. Among the T2DM patients, 5.1% had GAD65 (P < 0.001) and 2.4% had IA-2 autoantibodies, compared with 1.3 and 1.6%, respectively, among the controls. GAD65Ab-positive T2DM patients with M+C (epitope-specific) reactivity were found to have the lowest body mass index (P < 0.001), followed by GAD65Ab/IA-2Ab-positive patients (P < 0.01), and non-M+C-reactive (non-epitope-specific) patients (P < 0.02). In GAD65Ab-positive T2DM patients, c-peptide levels were lower in M+C-reactive compared with non-M+C-reactive patients. Sardinian T2DM patients with M+C-predominant GAD65Ab reactivity have clinical features more similar to those of T1DM patients. Thus, GAD65Ab epitope analysis may help to define T1DM phenotypes among newly diagnosed GAD65Ab-positive patients classified with T2DM.     

Mild peripheral neuropathy prevents both leg muscular ischaemia and activation of exercise-induced coagulation in Type 2 diabetic patients with peripheral artery disease.

AIM: To study the influence of peripheral neuropathy on intermittent claudication in patients with Type 2 diabetes (T2DM). METHODS: Twenty-five patients with T2DM were grouped according to the ankle/brachial index (ABI): 10 with ABI > 0.9 without peripheral artery disease (PAD; group T2DM) and 15 with ABI < 0.9 with PAD (group T2DM + PAD). Twelve individuals without T2DM with PAD (group PAD without T2DM) were also enrolled. Tests for peripheral neuropathy were performed in all patients. ABI, rate pressure product, prothrombin fragments 1 + 2 (F1+2), thrombin-anti-thrombin complex (TAT), and d-dimer were measured before and after a treadmill test. During exercise both initial and absolute claudication distance and electrocardiogram readings were recorded. RESULTS: We found mild peripheral neuropathy in 20% of group T2DM and 46.7% of group T2DM + PAD (P < 0.01). After exercise, the rate pressure product increased in each group; ABI fell in T2DM + PAD (P < 0.0001) and in PAD without T2DM (P = 0.0005); the fall was greater in the latter group. Initial and absolute claudication distances were similar in PAD patients. In group T2DM + PAD, absolute claudication distance was longer in the subgroup without peripheral neuropathy (P < 0.05), whereas ABI and rate pressure products were similar. F1+2 values at rest were higher in group T2DM + PAD. After exercise, F1+2 values and TAT increased only in group PAD without T2DM. CONCLUSION: Only group PAD without T2DM experienced muscular ischaemia, whereas group T2DM + PAD did not. Mild peripheral neuropathy may have prevented them from reaching the point of muscular ischaemia during the treadmill test, because they stopped exercising with the early onset of pain. Reaching a false absolute claudication distance may induce ischaemic preconditioning. These findings suggest a possible protective role of mild peripheral neuropathy in T2DM patients with intermittent claudication, by preventing further activation of coagulation during treadmill testing.     

NAFLD合并T2DM患者糖化血红蛋白和甲状腺激素水平的变化及其临床意义*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者糖化血红蛋白(HbA1C)和甲状腺激素水平的变化及其临床意义。方法 2017年4月～2019年3月我院内分泌科就诊的T2DM患者50例和NAFLD合并T2DM患者55例,检测人体学指标,采用电化学发光法检测空腹胰岛素(FINS)水平,采用胶体金法检测血糖化血红蛋白(HbA1C)水平,采用化学发光免疫分析法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)和促甲状腺激素(TSH)水平。结果 NAFLD合并T2DM患者体质指数(BMI)为(28.4±2.7)kg/m²,显著大于T2DM患者【(24.0±2.4)kg/m²,P<0.05】,NAFLD合并T2DM患者腰围为(94.5±8.5)cm,显著大于T2DM患者【(84.0±7.6)cm,P<0.05】,NAFLD合并T2DM患者臀围为(97.1±8.0)cm,显著大于T2DM患者【(89.7±7.2)cm,P<0.05】;NAFLD合并T2DM患者血清谷丙转氨酶(ALT)水平为(79.5±7.6)U/L,显著高于T2DM患者【(42.3±4.3)U/L,P<0.05】,NAFLD合并T2DM患者血清谷草转氨酶(AST)水平为(59.7±6.1)U/L,显著高于T2DM患者【(41.2±3.9)U/L,P<0.05】,NAFLD合并T2DM患者血清谷氨酰转肽酶(GGT)水平为(105.8±9.4)U/L,显著高于T2DM患者【(60.9±6.5)U/L,P<0.05】;NAFLD合并T2DM患者血甘油三酯(TG)水平为(4.2±1.7) mmol/L,显著高于T2DM患者【(2.4±0.9)mmol/L,P<0.05】,NAFLD合并T2DM患者空腹血胰岛素(FINS)水平为(12.0±2.5)mU/L,显著大于T2DM患者【(9.1±1.8)mU/L,P<0.05】;NAFLD合并T2DM患者血清TSH水平为(3.4±1.2)mU/L,显著大于T2DM患者【(1.9±0.8)mU/L,P<0.05】,而两组FT3和FT4水平无显著性差异(P>0.05)。结论 NAFLD合并T2DM患者BMI、肝功能指标、TG、FINS和TSH水平均显著增大或升高,与T2DM患者有明显的不同,在临床诊治过程中应当有所甄别,深入研究NAFLD患者发病机制对诊治将大有裨益。     

新诊断2型糖尿病合并血脂异常患者血清淀粉样蛋白A和C反应蛋白的变化

目的研究血清淀粉样蛋白A（SAA）、C反应蛋白（CRP）与2型糖尿病血脂异常的关系。方法测定30例非糖尿病对照者、22例新诊断2型糖尿病无血脂异常及38例新诊断2型糖尿病伴血脂异常患者的总胆固醇（Tc）及甘油三酯（TG）等血脂指标,同时检测其SAA、CRP水平。比较各组间的差异,将SAA、CRP与血脂作相关性分析。结果SAA、CRP在新诊断2型糖尿病血脂异常组均高于血脂正常组和对照组（P〈0．05或P〈0．01）。新诊断2型糖尿病患者的CRP与TG呈正相关,SAA与血脂指标无明显相关。结论新诊断2型糖尿病患者确实存在炎症因子的升高,伴血脂异常者炎症因子的升高更明显。     

2型糖尿病与良性前列腺增生合并慢性炎症的相关性研究

目的 探讨前列腺增生合并2型糖尿病对前列腺组织中慢性炎症的影响。方法 收集术后病理确诊为前列腺增生合并炎症的病例,在考虑前列腺体积、尿路感染、尿潴留以及患者年龄因素的情况下,分析合并2型糖尿病患者前列腺腺周、腺体及基质炎症是否与非糖尿病患者有区别,是否影响血清前列腺特异性抗原（PSA）。结果 2型糖尿病组比非糖尿病组腺体炎症重,但不影响血清PSA。结论 2型糖尿病不是影响血清PSA的危险因素,但对腺体炎症程度有影响。