彩色多普勒超声诊断糖尿病下肢中小型动脉病变的价值

目的 应用彩色多普勒超声对糖尿病人下肢膝以下中小型动脉病变的研究,探讨其临床价值。方法 对145例糖尿病患者腘动脉、胫前动脉、足背动脉、胫后动脉进行彩色多普勒超声检查,观察动脉壁硬化、狭窄程度和血流改变情况,并对糖尿病人按病程长短和血糖控制好坏进行分组对照。结果 145例糖尿病人中101例下肢小型动脉有不同程度粥样硬化改变,总发生率为69.7％,其中又以足背动脉发病最高,发生率为63.4％。糖尿病患者病程较长组与病程较短组动脉硬化斑块发生率无显著差异(p>0.05),但动脉狭窄与闭塞发生率明显增高(p<0.05)。血糖控制较差组比血糖控制较好组各种动脉粥样硬化病变发生率均显著增高(p<0.05)。7例糖尿病足患者均有动脉硬化闭塞,且未见侧支循环形成。结论 糖尿病人病程长、血糖控制较差者膝以下动脉粥样硬化发生早,损伤后果严重,用彩色多普勒超声检测不仅对糖尿病下肢动脉病变患者确定病变的部位和程度,而且对早期无症状患者也能提供诊断依据,对临床有重要的意义。     

糖尿病患者下肢动脉病变及相关危险因素探讨

目的　采用彩色多普勒超声诊断仪 (CDFI)来探讨糖尿病患者下肢动脉病变及相关危险因素。方法　对 15 0例糖尿病患者 ,4 8例正常对照组 ,进行 CDFI下肢动脉检查 ,观察血管内径、流速、流量、阻力指数及搏动指数 ,并给予空腹血糖、糖化血红蛋白、血脂等生化检查。结果　糖尿病组下肢动脉病变 10 8例 (72 .0 % )较对照组下肢动脉硬化病变发生率明显增高 (P<0 .0 1) ,单支血管病变发生率占检出者 4 6 .3% ,双支以上血管病变发生率占检出者 4 4 .4 % ,糖尿病病程大于 5年以上患者下肢血管病变发生率占检出者 79.6 % ,斑块检出率占检出者 80 .5 % ,糖尿病组流速、血管内径、血流量较对照组明显减少 (P<0 .0 1) ,下肢动脉病变与高血压、冠心病、周围神经病变、空腹血糖、糖化血红蛋白、甘油三脂及总胆固醇 /高密度脂蛋白比值呈正相关。结论　糖尿病患者下肢动脉有明显损伤、动脉硬化发生率高。彩色多普勒超声早期诊断下肢动脉病变准确、可信有重要临床价值 ,糖脂代谢紊乱高血压、冠心病等是糖尿病下肢动脉病变的危险因素。     

彩色多普勒超声对2型糖尿病足踝部动脉与神经的变化及危险因素的相关性研究

目的:探讨糖尿病患者下肢动脉病变彩色多普勒超声诊断仪(CDFI)的诊断及其危险因素的相关性分析。材料与方法:对2011年5月至2014年5月入院的100例糖尿病患者及30例健康志愿者进行CDFI下肢动脉彩色多普勒超声,观察比较血管内径、血流、流量、阻力指数及搏动指数;检测糖尿病患者踝臂指数(ankle-brachial index,ABI),空腹血糖(FPG),餐后2小时血糖(PG2h),糖化血红蛋白(Hb A1c),总胆固醇(TC),甘油三酯(TG),高密度脂蛋白(HDL-C),低密度脂蛋白(LDL-C)等相关生化指标。结果:糖尿病患者中下肢动脉病变75例,与健康志愿者相比下肢动脉硬化病变发生率明显增高(P0.01),病变患者中单支血管病变发生率为45.3%,而双支以上血管病变发生率为42.7%,糖尿病病程超过5年患者下肢血管病变发生率79.7%,斑块发生率82.6%。与对照组相比较,糖尿病组患者下肢动脉血管流速增快,血管内径明显变小、血流量明显减少(P0.05);下肢动脉病变与高血压、冠心病、周围神经病变、空腹血糖(FPG)、餐后2小时血糖(PG2h)、糖化血红蛋白(Hb Alc)、甘油三酯(TG)、总胆固醇(TC)与高密度脂蛋白(HDLC)等因素密切相关。结论:彩色多普勒超声检查诊断糖尿病下肢血管病变安全、可靠,血脂代谢异常、高血糖等是糖尿病下肢血管病变的主要危险因素。     

彩色多普勒超声在2型糖尿病下肢动脉病变中的诊断价值

目的：探讨彩色多普勒超声对2型糖尿病（T2DM）下肢动脉病变的诊断价值。方法：2型糖尿病组100例,对照组52例,分别应用彩色多普勒超声观察双侧下肢动脉的管壁、管腔及彩色血流的特点。结果：2型糖尿病所致的下肢动脉硬化为弥漫性或多节段性病变,其下肢动脉硬化的斑块、狭窄、闭塞的发生率明显高于正常对照组,有统计学差异（P〈0．05）。结论：彩色多普勒超声对2型糖尿病患者在出现糖尿病足临床症状之前的诊断、预防及治疗方面有重要的临床价值。     

彩色多普勒诊断糖尿病下肢动脉病变的价值

目的： 探讨彩色多普勒超声 （ＣＤＩ） 诊断糖尿病下肢动脉病变的价值。方法： 用彩色超声对糖尿病患者９６ 例, 正常对照组４２ 例, 进行双下肢动脉检查, 选用超９－ＨＤＩ超声诊断仪, 观察多项血流参数。结果： 糖尿病组较对照组下肢动脉硬化发生率明显增高 （Ｐ＜ ０．０１）, 发病年龄提前（Ｐ＜ ０．０５）, 足背动脉最先受累, 损伤最重。糖尿病组最大流速 （Ｖｍ ａｘ ）、血管内径 （Ｄ）、血流量 （Ｖｏｌ） 较对照组明显减少 （Ｐ＜ ０．０１）。阻力指数 （ＲＩ）、搏动指数（ ＰＩ） 两组间无显著差异 （Ｐ＞ ０．０５）。糖尿病患者血糖控制差组血管损伤程度较血糖控制较好组明显加重 （Ｐ＜０．０１）。９ 例糖尿病患者出现股动脉、腘动脉闭塞, 同期与血管照影对照, 病变部位及范围相符合。结论： 糖尿病患者下肢动脉有明显损伤, 动脉硬化发生率增高。ＣＤＩ诊断下肢动脉阻塞性病变准确、可信、有重要临床价值。     

彩色多普勒超声在糖尿病下肢动脉病变中的应用

目的探讨彩色多普勒超声在糖尿病下肢动脉病变的应用价值。方法对52例临床确诊为糖尿病患者(糖尿病组)和44例正常人进行双下肢动脉彩色超声检查。结果 52例糖尿病患者中有38例下肢动脉出现不同程度的动脉粥样斑块,发生率为73.1%,6例出现狭窄闭塞,发生率11.5%。44例正常对照组斑块发生率为36.3%,无一例发生狭窄闭塞。结论彩色多普勒超声检查能准确反映糖尿病下肢动脉病变性质、部位、范围和程度,对诊断糖尿病下肢动脉病变有重要临床价值。     

2型糖尿病下肢血管病变超声诊断的临床应用价值

目的:评价彩色多普勒超声对2型糖尿病(DM)下肢血管病变(LEAD)的诊断应用价值。方法:2型DM患者91例与41例同期住院非2型DM患者进行下肢血管彩色多普勒超声检查对照,并以踝肱压指数(ABPI)对比观察。结果:2型DM动脉硬化为弥漫性或多节段病变,单纯动脉硬化多为血管分叉处局灶性病变,2型DM患者下肢血管管腔的硬化斑块、狭窄、闭塞的发生率明显高于对照组,呈显著性差异(P<0.01)。硬化斑块的发生率以股动脉最常见,而管腔狭窄、闭塞率以累及腘动脉以下的远端动脉血管多见,胫前动脉受累最为明显(P<0.05)。结论:彩色多普勒超声是2型DM患者下肢血管病变检查的有效手段,可评估病变部位、阻塞的性质、病变长度以及解剖的异常,对早期诊断、预防及治疗具有重要的临床应用价值。     

彩色多普勒超声对2型糖尿病患者下肢动脉病变的诊断价值

目的探讨彩色多普勒超声检查对2型糖尿病(DM)患者下肢动脉病变的诊断价值。方法105例2型DM患者与57例正常对照组进行下肢动脉彩色多普勒超声检查对比,观察其内膜-中层厚度(IMT)、粥样硬化斑块、管腔狭窄部位、管腔闭塞部位及血流动力学情况。结果①下肢动脉动脉病变的发生率,2型DM组明显高于对照组(P0.01);②2型DM组下肢动脉粥样硬化斑块、狭窄、闭塞的发生率明显高于对照组,2型DM组所致下肢动脉粥样硬化为弥漫性或多节段性,对照组动脉粥样硬化多为血管分叉处局灶性病变;③有下肢症状组动脉狭窄和闭塞检出率明显高于无症状组(P0.01);④病程较长组动脉狭窄及闭塞检出率明显高于病程较短组(P0.05)。结论彩色多普勒超声检查对2型DM下肢动脉病变早期诊断、预防及早期治疗具有重要的临床价值。     

彩色多普勒超声在诊断糖尿病患者颈动脉及下肢动脉硬化中的应用研究

目的:研究彩色多普勒超声在诊断糖尿病患者颈动脉以及下肢动脉硬化中的应用效果。方法:选取2015年7月~2016年5月我院收治的45例糖尿病的患者为观察组资料,同时间段在我院体检正常的健康人45例为对照组资料。所有研究对象均行颈动脉和下肢动脉彩色多普勒超声检查,比较两组研究对象的检查结果。结果:观察组患者颈动脉和下肢动脉斑块、血管狭窄、内膜增厚的发生率与对照组各指标比较明显增高,差异具有统计学意义,P<0.05。结论:彩色多普勒超声可提高糖尿病患者颈动脉及下肢动脉硬化的临床检出率,且安全可靠。     

彩色多普勒超声对糖尿病下肢血管病变的诊断价值

目的 探讨彩色多普勒超声诊断糖尿病下肢动脉病变的价值。方法 用彩色超声对糖尿病患者128例，对照组40例，进行双下肢动脉检查，观察两侧股动脉、胭动脉、胫后动脉、足背动脉，并计测血管内径（D），内膜-中层厚度（IMI），收缩期最高流速（MAX）及观察有无斑块形成。结果 IMT增厚及管壁斑块形成，糖尿病组较对照组明显增多（P〈0．05）。结论 糖尿病下肢动脉病变与动脉粥样硬化的程度有关。如定期观察，可以判断糖尿病动脉硬化的进展情况、治疗效果及预后。     

Thiols, malonaldehyde and total antioxidant status in the Turkish patients with type 2 diabetes mellitus

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) is a risk factor for cardiovascular diseases (CVD). Oxidative stress mechanisms are often reported to be implied in type 2 diabetes mellitus. In order to determine their clinical relevance, we investigated several plasma indicators in the Turkish patients with NIDDM: (i) homocysteine (Hcy) and cysteine (Cys) which contribute to increase the risk of atherosclerosis during NIDDM, (ii) glutathione (GSH) and cysteinylglycine (CysGly) resulting from GSH degradation catalyzed by gamma-glutamylcysteine transferase (GGT), (iii) malonaldehyde (MDA) as a marker for lipid peroxidation, and (iv) total antioxidant status (TAS). Our main results were evaluated based on sex and diabetic status. In female patients, plasma concentrations of MDA and Hcy were significantly higher than in controls, while GSH levels were significantly lower. In males, a difference between control and diabetic groups was noticed only for Hcy, levels being also higher in patients. In the diabetic group, increase in serum glucose concentration was significantly correlated with increased GGT activity. In both controls and diabetic patients, GGT activity was correlated with a raised Cys concentration and a decreased GSH level. In both controls and diabetic patients, there were significant positive correlations between Cys and Hcy and between GSH and Hcy. We concluded that GSH and MDA levels are clinical indicators for an oxidative process linked to type 2 diabetes mellitus, especially in women.     

Serum amyloid A protein in patients with non-insulin-dependent diabetes mellitus

We determined the serum amyloid A protein (SAA) levels in patients with non-insulin-dependent diabetes mellitus (NIDDM), and investigated the possible association between SAA and the complications of NIDDM.

The concentrations of SAA were measured in the plasma of 105 patients with NIDDM (52 men and 53 women, age mean ± SD, 61 ± 13 years) and 91 healthy subjects (37 men and 54 women, aged 57 ± 11 years). SAA concentrations were assayed by enzyme-linked immunosorbent assay.

SAA concentrations in the patients with NIDDM were significantly higher than those in healthy subjects (2.1 ± 1.3 vs. 1.2 ± 0.5 mg/L). There were no obvious relationships between SAA lebels and duration of diabetes, type of therapy, or control of blood sugar in the patients with NIDDM. However, SAA levels in patients with NIDDM increased significantly, with increase of urinary albumin excretion (p = 0.027). The increase of SAA in the patients with NIDDM did not influence the serum concentrations of lipid or lipoprotein.

The SAA concentration in NIDDM was unrelated to the type of treatment, but seemed to be related to the development of diabetic nephropathy.     

彩色多普勒超声在下肢动脉疾病诊断中的价值

目的：探讨彩色多普勒超声在下肢动脉疾病诊断中的价值。方法：对临床疑诊下肢动脉病变者76例进行彩色多普勒超声检查。结果：76例患者中发现阳性结果65例,其中动脉粥样硬化21例,血栓闭塞性脉管炎15例,糖尿病下肢动脉病变29例。结论：彩色多普勒超声可区分各种下肢肢动脉疾病并评价其严重程度,是一种无创伤、实时而又敏感的诊断方法。     

Effects of glibenclamide on serum lipids, lipoproteins, thromboxane, beta-thromboglobulin, and prostacyclin in non-insulin-dependent diabetes mellitus

A study was conducted to determine the effects of glibenclamide on serum lipoproteins, apolipoproteins, thromboxane (TXA2), prostacyclin (PGI2), and beta-thromboglobulin (B-TGL) in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM). In 20 NIDDM patients, aged 34 to 67 (mean, 53.6) years, without clinical signs of atherosclerotic disease and whose blood sugar level was over 140 mg/dl after four weeks of dietary treatment, fasting blood samples were taken before the beginning of the trial, after four weeks of dietary treatment, and after four and eight weeks of combined dietary and glibenclamide treatment. Pretrial levels of total serum cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) in the diabetic patients did not differ from those in nondiabetic controls, whereas high-density lipoprotein cholesterol (HDL-C) levels and the percentage of TC bound to HDL (HDL-C%) were significantly lower in the patients than in controls. After combined dietary and glibenclamide treatment and the normalization of blood sugar, both HDL-C (mg/dl) levels and HDL-C% levels increased significantly. TC, TG, and LDL-C levels decreased. Levels of apolipoproteins A1 and A2 rose and apolipoprotein B fell, but differences were not significant. TXB2 and 6-keto-PGF1-alpha (the inert metabolites of TXA2 and PGI2) and B-TGL were determined by radioimmunoassay. TXB2 and B-TGL levels decreased significantly after glibenclamide administration, indicating attenuation of platelet aggregation. No changes in PGI2 were observed. The results demonstrate the favorable effect of glibenclamide on lipoproteins and apolipoproteins in NIDDM patients, especially in increasing HDL-C levels and HDL-C%, and in attenuating platelet aggregation as indicated by reduction of TXB2 and B-TGL.     

血清血管生成素样蛋白4和血管内皮生长因子与2型糖尿病下肢动脉病变的相关性研究

目的探讨血清血管生成素样蛋白4(angiopoietin-like protein 4,ANGPTL4)和血管内皮生长因子(vascular endothelial growth factor,VEGF)与2型糖尿病下肢动脉病变的关系。方法采用回顾性队列研究方法,选取2017年10月至2018年12月上海市徐汇区大华医院内分泌科收治的164例2型糖尿病住院患者作为2型糖尿病组,收集同期健康体检者69名为正常对照组。按踝肱指数<0.9将糖尿病患者分为无下肢动脉病变组及合并下肢动脉病变组。检测所有研究对象的各项生化指标并计算胰岛素抵抗指数,用酶联免疫吸附法检测血清ANGPTL4及VEGF浓度。结果(1)与正常对照组比较:2型糖尿病合并下肢动脉病变组及2型糖尿病无下肢动脉病变组血清ANGPTL4浓度分别为(44.78±15.15)μg/L与(47.46±10.43)μg/L,均低于正常对照组(52.87±12.74)μg/L,差异有统计学意义(P均<0.05);血清VEGF浓度分别为(340.98±76.18)ng/L与(314.83±75.30)ng/L,均高于正常对照组(282.58±81.44)ng/L,差异有统计学意义(P均<0.05)。(2)与无下肢动脉病变组比较:2型糖尿病合并下肢动脉病变组血清ANGPTL4浓度低于2型糖尿病无下肢动脉病变组,但差异无统计学意义(P>0.05);2型糖尿病合并下肢动脉病变组血清VEGF浓度高于2型糖尿病无下肢动脉病变组,差异有统计学意义(P<0.05)。(3)相关性分析:合并糖尿病且糖尿病病程>10年(OR 4.594,95%CI 2.540~8.311,P<0.001)、空腹血糖>8 mmol/L(OR 2.353,95%CI 1.023~5.416,P=0.044)、糖化血红蛋白>8%(OR 6.442,95%CI 2.874~14.441,P<0.001)、VEGF升高(OR 3.745,95%CI 1.566~8.953,P=0.003)是2型糖尿病发生下肢动脉病变的危险因素,而ANGPTL4的升高(OR 0.154,95%CI 0.064~0.372,P<0.001)可减少2型糖尿病发生下肢动脉病变的发生。结论ANGPTL4为2型糖尿病下肢动脉病变保护因素而VEGF为危险因素,两者相互影响共同参与其发生、发展。     

运动康复疗法对老年糖尿病合并脑卒中患者血糖、下肢功能、神经功能及预后的影响

目的探讨运动康复疗法在老年糖尿病合并脑卒中患者中的应用效果,并分析对患者神经下肢功能的影响。方法将某院收治的109例老年糖尿病合并脑卒中患者以随机数表法分为常规组与运动组,其中常规组共54例予常规康复训练措施包括下肢主被动关节训练、肌力训练等,运动组55例实施运动康复疗法进行训练。治疗结束后评价患者下肢运动功能、神经功能、血糖水平及死亡率等。结果治疗后运动组患者的Berg平衡量表(BBS)评分、下肢Fugl-Meyer运动量表(FMA)评分、10 m步速(10MWT)均高于常规组(P<0.05);运动组的餐后2 h血糖值、空腹血糖值、美国国立卫生研究院卒中量表(NIHSS)评分低于常规组,P<0.05;两组死亡率对比差异无统计学意义(P>0.05)。结论运动康复疗法可提高老年糖尿病合并脑卒中患者的下肢运动功能及平衡能力,降低血糖水平,减轻神经功能损伤。     

Low frequency of 5'-flanking insertion of human insulin gene in Japanese non-insulin-dependent diabetic subjects

Polymorphism in the 5'-flanking region of the human insulin gene in 149 unrelated Japanese subjects [77 with non-insulin-dependent diabetes mellitus (NIDDM), 17 with insulin-dependent diabetes mellitus (IDDM), and 55 controls] was analyzed with Southern blot hybridization. We used the size of the hybridized fragments to classify the locus into three groups according to Bell's method (a short, class 1 allele averaging 570 base pairs; an intermediate-size, class 2 allele averaging 1320 base pairs, and a long, class 3 allele averaging 2470 base pairs in size). The allelic frequency of classes 2 and 3 in 298 alleles was 5.0% and in the 146 alleles of NIDDM, 7.8%. The value is lower than in Caucasians, American Blacks, and Pima Indians, and the results suggest that the 5'-flanking insertion is not a genetic marker in most NIDDM patients who are Japanese. However, the frequency of the 5'-flanking insertion in those who were not obese and had a family history of diabetes was higher than that of other NIDDM patients (P = .013), and the frequency in NIDDM patients with onset of diabetes at age less than or equal to 39 yr was lower than those whose onset was at age greater than or equal to 40 yr (P = .053). As NIDDM is a heterogeneous disorder, further analysis is needed. These results suggest that we cannot completely exclude the meaning of the insertion in NIDDM. On the other hand, the frequency in IDDM was 0%, lower than in NIDDM (P = .094). Because the number of subjects studied was small, this result is speculative.     

老年糖尿病合并心血管疾病相关探讨

目的探讨老年糖尿病患者合并心血管疾病的相关因素。方法回顾1998年7月～2003年10月在本院疗养体检的军队老干部及配偶的临床资料，从中筛选146例Ⅱ型糖尿病合并心血管疾病患者以及同期疗养的94例健康老人进行对比分析。参检人员进行常规体检、体重指数测定，空腹和餐后2h血糖、尿糖、总胆固醇（CHO）、甘油三脂（TG）、低密度脂蛋白-胆固醇（LDL—CHO）和血液流变学等检查。结果老年糖尿病合并心血管疾病组不论空腹和餐后2h血糖，血脂三项和血液流变学等各项指标均高于健康老人组（P〈0．05）。结论老年糖尿病合并肥胖，血糖控制欠佳，脂代谢异常和血液流变学改变是糖尿病患者并发心血管疾病的重要原因。从而为糖尿病疾病本身及其心血管合并症的预防和治疗提供相关依据。     

2型糖尿病患者不对称二甲精氨酸浓度变化及临床意义

目的观察2型糖尿病(non-insu lin dependen t d iabetes m e llitus,N IDDM)患者血浆中不对称二甲精氨酸(asym-m etric d im ethy larg in ine,ADM A)浓度变化以及对一氧化氮(n itric ox ide,NO)和内皮素(endothe lin,ET)的影响,并探讨其临床意义。方法采用高效液相色谱法(h ighperforance liqu id chrom atography,HPLC)、硝酸盐还原酶比色法及放射免疫法,分别对98例N IDDM患者(其中并发血管病变者54例)血浆中ADM A、NO、ET浓度进行测定,并与30例健康人进行对比分析。结果N IDDM患者与健康人相比,患者血浆中ADM A、ET浓度明显增高,NO浓度明显降低,差异均有显著性意义(P<0.05),并发血管病变者较无并发症者这种变化更显著(P<0.01)。结论ADM A是内皮功能障碍的一个新的危险因子。血浆ADM A浓度变化在N IDDM血管并发症的发生发展过程中起重要作用。     

24-hour arterial hypertension profile and heart rhythm variability in patients with arterial hypertension and NIDDM

The study covered 72 patients with non-insulin-dependent diabetes mellitus (NIDDM) whose mean age was 54.2 +/- 0.8 years, duration of the disease 8.6 +/- 3.6 years. They had also mild or moderate arterial hypertension mean duration of which was 12.4 +/- 4.3 years. The examination of the patients consisted of 24-h arterial pressure (AP) monitoring, Holter ECG monitoring, cardiointervalography. For eight weeks 19 patients received enalapril (5-20 mg/day), 14 patients were given felodipin (5-10 mg/day) and 15 patients were treated with valsartan (80-160 mg/day). Enhanced activity of the sympathetic nervous system in hypertensive subjects with NIDDM raises daily average values of systolic and diastolic AP, variability and speed of AP morning rise. In NIDDM patients with moderate arterial hypertension vegetative regulation of AP was more stressed than in mild hypertension. Optimal medication of NIDDM patients' arterial hypertension may consist of ACE inhibitors and antagonists of angiotensin II receptors. These drug lower stress of the sympathetic nervous system and thus promote normalization of daily profile of AP.