2型糖尿病患者颈动脉内中膜厚度与尿蛋白排泄率的相关性

目的 探讨2型糖尿病(T2DM)患者颈动脉内中膜厚度(CIMT)与尿蛋白排泄率的关系.方法 167例T2DM患者根据CIMT水平分为两组:A组116例(CIMT＞0.9 mm);B组51例(CIMT≤0.9mm).检测两组CIMT和24-h尿蛋白定量.结果 A组年龄、全血白细胞、血浆纤维蛋白原和24-h尿蛋白定量高于B组(P＜0.05).年龄、糖尿病程、血浆纤维蛋白原和24-h尿蛋白定量与CIMT呈正相关(P＜0.05).24-h尿蛋白定量、年龄是CIMT的独立相关因素(P＜0.05).结论 年龄联合24-h尿蛋白定量可能是T2DM患者CIMT的独立预测因素.     

螺内酯联合缬沙坦对早期糖尿病肾病患者微量白蛋白尿的影响

目的 观察螺内酯联合缬沙坦与单用缬沙坦治疗早期糖尿病(DM)肾病患者微量白蛋白尿的疗效.方法 选择早期DM肾病患者48例随机分为缬沙坦联合螺内酯治疗组(A组)24例和缬沙坦组(B组)24例,检测2组尿微量白蛋白排泄率(UAER)和血钾水平.结果 2组用药后UAER均较用药前显著降低(P<0.05),且A组比B组下降更为明显(P<0.05).用药后A组血钾虽较B组高(P<0.05),但并无实际l临床意义.2组均未发现明显不良反应.结论 使用螺内酯联合缬沙坦比单用缬沙坦对控制早期DM肾病患者微量白蛋白尿更有效.     

糖尿病肾病患者血清胱抑素C检测的临床意义

目的 探讨检测糖尿病肾病患者血清胱抑素C(Cys-C)水平的临床意义.方法 根据24-h尿微量白蛋白排泄率(UAE),将2型糖尿病(T2DM)患者80例分为无蛋白尿(A组,36例,UAE＜30 mg/L)和微量蛋白尿(B组,44例,UAE 30-300 mg/L)两组,另选30例体检健康者作为对照(C组),采用免疫比浊法检测血清Cys-C,生化分析仪检测血肌酐(SCr).结果 A组血清Cys-C和SCr分别为(0.95±0.46) mg/L和(95.54±16.21)μmol/L,明显低于B组的(1.14±0.73) mg/L和(101.42±13.46)μmol/L(P＜0.05);A、B组血清Cys-C和SCr均明显高于C组的(0.63±0.07)mg/L和(55.54±10.05) μmol/L(P＜0.05).A组血清Cys-C和SCr异常检出率均明显低于B组(19.44％vs.40.91％和2.78％vs.9.09％)(P＜0.05);A、B组Cys-C异常检出率均明显高于SCr异常检出率(P＜0.05).结论 糖尿病肾病患者血清Cys-C水平升高;与SCr比较,检测血清Cys-C更有助于糖尿病肾病的早期诊断.     

血清超敏C-反应蛋白与胱抑素C检测对2型糖尿病肾病的检测意义

目的检测并比较2型糖尿病（T2DM）及T2DM伴有糖尿病肾病（DN）患者血清超敏C-反应蛋白（CRP）及胱抑素C（Cysc）的水平变化,探讨联合检测对DN诊断的意义。方法依据24h尿蛋白的定量将90例T2DM患者分为3组,每组30例。A组：正常糖尿病肾病组（尿微量白蛋白定量UmALB〈30mg/24h）;B组：早期糖尿病肾病组（尿微量白蛋白定量UmALB≥30mg~300mg/24h）;C组：临床糖尿病肾病（DN）组（尿微量白蛋白定量UmALB〉300mg/24h）;健康体检的（NC组）正常人对照组30例,分别计算各组的血清hs-CRP、CysC均值,并进行统计学分析。结果 A、B、C组血清hs-CRP及CysC水平均高于对照组,差异有统计学意义（P〈0.05）;B、C组血清hs-CRP及CysC水平均高于A组,差异有统计学意义（P〈0.05）,C组血清hs-CRP及CysC水平均高于B组,差异有统计学意义（P〈0.05）。结论血清hs-CRP与CysC检测对2型糖尿病肾病早期诊断及病情监测具有重要的临床价值。     

2型糖尿病患者蛋白尿与糖尿病视网膜病变的关系

目的 探讨2型糖尿病(T2DM)患者尿白蛋白/肌酐比值(UACR)与糖尿病视网膜病变(DR)的关系.方法 152例T2DM患者根据UACR均分为UACR正常(A)组(UACR＜30 mg/g)和UACR异常(B)组(UACR≥30 mg/g),根据糖尿病病程再分为病程＜10年(C)组(87例)和病程≥10年(D)组(65例).检测血糖、糖化血红蛋白,计算UACR.结果 B组DR患病率53.9％,明显高于A组的28.9％ (P＜0.05),B组发生DR的危险是A组的2.875倍(95％可信区间为1.471-5.620).C组中,UACR异常患者的DR患病率51.6％,明显高于UACR正常者的26.8％(P＜0.05),且前者发生DR的危险是后者的2.916倍(95％可信区间为1.162-7.314).结论 病程较短且UACR异常的T2DM患者发生DR的风险较高.     

螺内酯联合缬沙坦对早期糖尿病肾病患者微量白蛋白尿的影响

目的观察螺内酯联合缬沙坦与单用缬沙坦治疗早期糖尿病（DM）肾病患者微量白蛋白尿的疗效。方法选择早期DM肾病患者48例随机分为缬沙坦联合螺内酯治疗组（A组）24例和缬沙坦组（B组）24例,检测2组尿微量白蛋白排泄率（UAER）和血钾水平。结果 2组用药后UAER均较用药前显著降低（P〈0.05）,且A组比B组下降更为明显（P〈0.05）。用药后A组血钾虽较B组高（P〈0.05）,但并无实际临床意义。2组均未发现明显不良反应。结论使用螺内酯联合缬沙坦比单用缬沙坦对控制早期DM肾病患者微量白蛋白尿更有效。     

血清胱抑素C对糖尿病肾病临床分期的价值

目的 探讨胱抑素C(Cys-C)作为2型糖尿病(T2DM)肾病分期指标的应用价值.方法 测定137例T2DM患者血肌酐(SCr)、Cys-C和24-h尿微量白蛋白排泄率(UAER).运用MDRD公式计算肾小球滤过率(GFR).将患者分为三组:GFR>120 ml·min~(-1)·1.73 m~(-2)为A组,GFR 60～120 m1·min~(-1)·1.73 m~(-2)为B组,GFR<60 ml·min~(-1)·1.73m~(-2)为C组.绘制散点图,比较三组Cys-C和UAER的数值及与GFR的相关性.结果 C组SCr和24-hUAER高于A组[(102.41±10.72)μmol/L vs.(42.73±3.99)μmol/L和(303.90±173.66)mg vs.(164.10±114.25)mg];A组Cys-C值明显低于B、C组[(0.47±0.21)mg/L vs.(o.68±0.13)mg/L,(1.59±0.58)mg/L)].UAER和Cys-C与GFR的相关系数分别为-0.132和-0.552(P<0.01).ROC分析提示,Cys-C和UAER的曲线下面积(AUC)分别为0.885和0.605(P<0.05).结论 Cys-C能很好的反映T2DM肾病肾小球滤过功能异常,与临床分期的对应性、诊断特异性和灵敏性都优于UAER.     

老年呼吸系统疾病合并2型糖尿病患者的临床特征

目的 探讨老年呼吸系统疾病合并2型糖尿病(T2DM)患者的临床特点.方法 回顾性分析439例呼吸系统疾病合并T2DM患者资料,分为老年组(A组,275例)和非老年组(B组,164例),比较临床特征及其预后.结果 A组呼吸系统疾病合并T2DM的发生率为62.64％ (275/439),明显高于B组的37.36％(164/439)(P＜0.05).两组患者前三位呼吸系统疾病均为呼吸系统感染、慢性阻塞性肺病(COPD)和肺癌.A组呼吸系统感染和COPD的发病率分别为38.91％和30.18％,与B组54.27％和13.42％比较差异有统计学意义(P＜0.05).A组血糖控制不良者189例(68.73％),明显多于B组的85例(51.83％)(P＜0.05).A组患者尿微量白蛋白阳性者165例(60.00％),明显多于B组的56例(34.15％)(P＜0.05).A组病死率8.73％,明显高于B组的3.66％ (P＜0.05).结论 老年T2DM患者合并的呼吸系统疾病以肺部感染、COPD和肺癌为多见;老年呼吸系统疾病合并T2DM患者具有血糖控制不良、肾功能受损明显和预后较差的特点.     

肾小球滤过率联合尿微量白蛋白与肌酐比值诊断糖尿病肾病的临床意义

目的:探讨2型糖尿病病人采用改良的中国公式计算肾小球率过滤(c-aGFR)联合尿微量白蛋白与尿肌酐比值(ACR)在诊断糖尿病肾病不同阶段中的临床意义,并做c-aGFR和ACR的相关性分析.方法:根据ACR不同阶段分成4组,A组(正常对照组),B组(糖尿病正常白蛋白尿组ACR＜ 30mg/g),C组(糖尿病肾病微量白蛋白尿组ACR30～300mg/g),D组(糖尿病肾病大量蛋白尿组ACR＞ 300mg/g);应用改良中国MDRD公式c-aGFR(mL/min·1.73m2)=175×[Hit Pcr]-1.234×年龄-0.179×[女性×0.79]计算GFR,(即c-aGFR,mL/min·1.73m2).双变量相关性分析采用Pearson相关分析.结果:与正常对照组相比糖尿病正常白蛋白尿组c-aGFR无明显变化(P＞0.05),糖尿病肾病微量白蛋白尿组与正常对照组相比c-aGFR降低,有显著变化(P＜0.05),糖尿病肾病大量蛋白尿组与正常对照组相比c-aGFR降低,有显著变化(P＜0.05),糖尿病肾病大量白蛋白尿组与糖尿病肾病微量蛋白尿组相比c-aGFR降低,有显著变化(P＜0.05).与正常对照组相比糖尿病正常白蛋白尿组ACR无明显变化(P＞0.05),糖尿病肾病微量白蛋白尿组与正常对照组相比ACR增高,有显著变化(P＜0.05),糖尿病肾病大量蛋白尿组与正常对照组相比ACR增高,有显著变化(P＜0.05),糖尿病肾病大量白蛋白尿组与糖尿病肾病微量蛋白尿组相比ACR增高,有显著变化(P＜0.05).c-aGFR随着ACR的增加呈下降趋势,Pearson分析显示二者具有显著负相关性.结论:c-aGFR及ACR可以做为糖尿病肾病诊断的重要监测指标;二者联合检测可以更准确的评估糖尿病患者肾脏功能的情况,对调整糖尿病患者经肾脏代谢的药物剂量及药物的选择都有极为重要的临床指导价值.     

2型糖尿病肾病患者尿液Mindin的变化及意义

目的探讨2型糖尿病（T2DM ）患者尿mindin与糖尿病肾病（DN ）的关系。方法采用ELISA法测定90例T2DM患者（A组）和32例健康体检者（B组）尿mindin水平。依据尿白蛋白／尿肌酐相对值（ACR）水平,A组再分为无蛋白尿（A1组）、微量蛋白尿（A2组）和大量蛋白尿（A3组）三个亚组。检测并分析相关指标。结果 A组患者尿mindin相对值（MCR＝尿mindin／尿肌酐）与尿微量蛋白、糖化血红蛋白、收缩压、病程、血肌酐和24‐h尿蛋白呈正相关（ P＜0．05或P＜0．01）,与肾小球滤过率呈负相关（r＝－0．395,P＜0．01）。慢性肾脏病分期为1、2、3期患者的尿MCR递增：3期（16例）＞2期（45例）＞1期（24例）（P＜0．01）,且与ACR变化规律类似。结论尿mindin可能与T2DM患者肾损伤密切有关;联合检测尿mindin和尿微量白蛋白有助于发现早期 DN。     

Characteristics of diabetic osteopenia in KK-Ay diabetic mice

We examined the bone mineral density (BMD) of the proximal region and the mid-diaphysis of the femur using dual energy X-ray absorption (DXA), the blood osteocalcin level and the blood glucose level every five weeks from 8 to 23 weeks old in KK-Ay diabetic mice. The BMD of the proximal region after 18 weeks old was significantly lower when compared with that at 8 weeks old (p<0.05), whereas there was no significant difference in the BMD of the mid-diaphysis at each week. The BMD of the proximal region at 18 weeks old was significantly lower than that in ddY mice, used as controls (p<0.05). The blood osteocalcin level at 18 weeks old was significantly lower than that at 8 weeks old and that in 18-week-old ddY mice (p<0.05). There was significant negative correlation between the blood glucose level and the BMD of the proximal region (r=-0.64, p<0.05). These results suggest that type 2 diabetes exerts an influence only on spongy bone, not on cortical bone, and that the BMD in the proximal region of the femur seems to be affected by blood glucose level, parallel with the progression of diabetes, through the blood osteocalcin level. In the present study, we show the characteristics of diabetic osteopenia in KK-Ay mice, an animal model of type 2 diabetes.     

Anti diabetic effect of cherries in alloxan induced diabetic rats

Diabetes mellitus (DM) is a metabolic disorder in the endocrine system resulting from a defect in insulin secretion, insulin action or both of them. Adverse side effects of chemical drugs for treatment of diabetes persuaded the using of medical plants. Cherry as a traditionally used plant for treatment of diabetes, is packed with powerful plant pigments called anthocyanins. They give cherries their dark red color and are one of the richest antioxidant sources which lower the blood sugar and bear other beneficial health effects. The purpose of this study is to evaluate the effect of ethanolic extract of cherry fruit on alloxan induced diabetic rats. In this study 36 Male Wistar rats, body weight of 150-200gr were divided into 6 groups. Diabetes was induced by intra peritoneal injection of 120 mg/kg Alloxan. The duration of the cherries treatment was 30 days in which single dose of extracts (200mg/kg) were oral administered to diabetic rats. Blood glucose levels were estimated with glucometer before treatment, 2h and 1- 4 weeks after administration of extracts. Treatment with extracts of the cherries resulted in a significant reduction in blood glucose and urinary microalbumin and an increase in the creatinine secretion level in urea. Extract of this plant is useful in controlling the blood glucose level. Cherries appear to aid in diabetes control and diminution of the complications of the disease. Some relevant patents are also outlined in this article.     

Treating diabetic ulcers

Introduction: Diabetic foot ulceration is a serious secondary complication of diabetes mellitus and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Thus, addressing all of the factors involved remains instrumental in wound healing.

Areas covered: The first part of this review focuses on the pathophysiology of diabetic foot ulceration and wound-healing impairment. The second part reviews the standard treatments, including advanced wound-care products and new therapeutic approaches currently under investigation. The reader will understand the most up-to-date research regarding the unique pathophysiology of diabetic foot ulceration along with the basic cornerstones of current recommended standard therapy.

Expert opinion: Diabetic foot ulceration is a serious complication that can lead – potentially – to devastating lower-extremity amputations. Proper adherence to standard treatment strategies can potentially prevent the need for amputation.     

Treating diabetic ulcers

INTRODUCTION: Diabetic foot ulceration is a serious secondary complication of diabetes mellitus and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Thus, addressing all of the factors involved remains instrumental in wound healing. AREAS COVERED: The first part of this review focuses on the pathophysiology of diabetic foot ulceration and wound-healing impairment. The second part reviews the standard treatments, including advanced wound-care products and new therapeutic approaches currently under investigation. The reader will understand the most up-to-date research regarding the unique pathophysiology of diabetic foot ulceration along with the basic cornerstones of current recommended standard therapy. EXPERT OPINION: Diabetic foot ulceration is a serious complication that can lead--potentially--to devastating lower-extremity amputations. Proper adherence to standard treatment strategies can potentially prevent the need for amputation.     

Phoenix dactylifera seeds ameliorate early diabetic complications in streptozotocin-induced diabetic rats

Abstract

Context: In Arabic folk medicine, the seeds of Phoenix dactylifera L. (Arecaceae) have been used to manage diabetes for many years. Few studies have reported the antidiabetic effect of P. dactylifera seeds; however, their effect on diabetic complications is still unexplored.

Objective: The present study investigates the protective effect of P. dactylifera seeds against diabetic complications in rats.

Material and methods: The aqueous suspension of P. dactylifera seeds (aqPDS) (1?g/kg/d) was orally administered to streptozotocin-induced diabetic rats for 4 weeks. The serum biochemical parameters were assessed spectrophotometrically. Furthermore, oxidative stress was examined in both liver and kidney tissues by assessment of thiobarbituric acid reactive substances (TBARS), nitric oxide (NO), reduced glutathione, superoxide dismutase (SOD), glutathione S-transferase, and catalase.

Results: Oral administration of aqPDS significantly ameliorated the elevated levels of glucose (248?±?42 versus 508?±?60?mg/dl), urea (32?±?3.3 versus 48.3?±?5.6?mg/dl), creatinine (2.2?±?0.35 versus 3.8?±?0.37?mg/dl), ALT (29.6?±?3.9 versus 46.4?±?5.9?IU/l), and AST (73.3?±?13 versus 127.8?±?18.7?IU/l) compared with the untreated diabetic rats. In addition to significant augmentation in the activities of antioxidant enzymes, there was reduction in TBARS and NO levels and improvement of histopathological architecture of the liver and kidney of diabetic rats.

Discussion and conclusion: The aqPDS showed potential protective effects against early diabetic complications of both liver and kidney. This effect may be explained by the antioxidant and free radical scavenging capabilities of P. dactylifera seeds.     

Current approaches to the management of diabetic retinopathy and diabetic macular oedema

Diabetic retinopathy (DR) is a major cause of blindness in Europe and North America, and the incidence is expected to increase in parallel with the rising incidence of diabetes mellitus. This article reviews the current state of knowledge of the epidemiology, clinical presentation and pathophysiology of DR and its principal associated complications, diabetic macular oedema (DME) and neovascularization, and then proceeds to the primary focus of clinical management. A series of major randomized controlled trials conducted over the past few decades has confirmed that tight glycaemic regulation is the most effective measure to reduce the risk of developing DR and to minimize the likelihood of its progression, and that control of blood pressure is also an important feature of preventive management. Laser-based therapies remain the cornerstone of treatment, with panretinal photocoagulation indicated for proliferative and severe nonproliferative DR and focal photocoagulation indicated for treatment of DME. For patients who do not benefit from these approaches, vitrectomy may provide therapeutic benefits. Medical therapies include two broad classes of agents: anti-inflammatory drugs and agents with molecular targets. The utility of oral anti-inflammatory drugs remains to be established, as dose-finding studies have yet to provide definitive conclusions. Intravitreal corticosteroids may be of value in specific circumstances, although adverse effects include cataract progression and elevated intraocular pressure. However, these complications appear to have been limited with new extended-release technologies. With respect to molecular targets, evidence has been adduced for the roles of vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α and protein kinase C (PKC)-β2 in the pathogenesis of DR, and agents targeting these factors are under intense investigation. The role of VEGF in mediating pathological angiogenesis and vascular hyperpermeability has been best defined. Preliminary efficacy of pegaptanib and ranibizumab in the treatment of DME is being confirmed in additional clinical trials with these agents and with the off-label use of bevacizumab, another monoclonal antibody related to ranibizumab. Moreover, other agents targeting VEGF, as well as drugs directed against TNFα and PKC-β2, are under study. Evaluation of the ultimate utility of these approaches will await the efficacy and safety results of properly designed phase III trials.     

2型糖尿病肾病与中心性肥胖的相关研究

目的研究2型糖尿病肾病（DN）与中心性肥胖之间的关系。方法应用Logistic回归分析方法回顾性分析352例2型糖尿病患者的年龄、病程、血压、体重指数、腰臀比、空腹血糖、糖化血红蛋白、血脂等与糖尿病肾病间的相关性。结果糖尿病肾病（DN）组的病程、体重指数、腰臀比、三酰甘油、胆固醇、低密度脂蛋白、尿素氮、肌酐均明显高于糖尿病非肾病（DM）组;Logistic回归分析提示DN与病程、腰臀比、三酰甘油、胆固醇、低密度脂蛋白有相关性。结论减轻体质量,控制血脂、血压、血糖可在某种程度上延缓DN的发生与发展。