利拉鲁肽对2型糖尿病肺功能影响

40例糖化血红蛋白〉9％的2型糖尿病患者随机分为胰岛素组和利拉鲁肽组（n=20）,22例为对照,采用肺功能仪测定肺通气功能指标和DLCO（一氧化碳肺弥散功能）。结果与对照组相比,2型糖尿病患者的肺通气功能指标（VC、FVC、FEVl、TLC、MVV）和DLCO明显下降（P〈0．05）。12周后胰岛素组肺通气功能指标轻度增加,但无统计学意义,而弥散功能指标DLCO明显增加（P〈0．05）。利拉鲁肽组肺通气功能指标及弥散功能指标均明显高于胰岛素组（P值均〈0．05）。结论2型糖尿病血糖控制不良患者肺功能明显降低,与胰岛素比较,利拉鲁肽可明显改善2型糖尿病患者肺功能。     

2型糖尿病患者肺功能变化及其相关因素分析研究

目的探讨2型糖尿病患者肺功能变化及其相关因素。方法用肺功能指标测定入选74例2型糖尿病患者（糖尿病组）的肺功能并同时测定三酰甘油、胆固醇、C反应蛋白、同型半胱氨酸、脂蛋白a、空腹血糖、空腹胰岛素、糖化血红蛋白（HbA1 c）检查以及尿蛋白排泄率（AER）检测、眼底检查以及神经传导速度检查,计算胰岛素抵抗指数;74例无糖尿病患者为对照组完成9个月的观察,比较两组肺功能变化,并对糖尿病组肺功能变化的相关因素进行多因素线性回归分析。结果糖尿病组肺活量（VC）、1s用力呼气容积（FEV1）、肺总量（TLC）、最大自主通气量（MVV）、肺-氧化碳弥散量（DLCO）、肺单位体积-氧化碳弥散量（KCO）均明显低于对照组（P〈0.05）。对糖尿病组进行线性相关分析表明,VC、FEV1、TLC均与HbA1 c呈显著负相关（P〈0.01）,且VC与同型半胱氨酸呈显著负相关（P〈0.05）,MVV与微血管并发症积分呈显著相关性（P〈0.01）。DLCO、KCO均与HbA1 c、微血管并发症积分呈负相关（P〈0.05）,DLCO亦与胰岛素抵抗指数呈显著负相关（P〈0.05）,并对糖尿病患者肺功能指标与多种相关因素进行多因素线性回归分析。结论 2型糖尿病患者存在肺通气功能及弥散功能减退,肺脏可能是糖尿病慢性病变的靶器官之一,控制血糖、改善胰岛素抵抗、抗氧化应激治疗是其防治重点。     

2型糖尿病患者肺功能改变及其相关因素分析

测定87例2型糖尿病患者（DM组）和42例健康人（对照组）的肺功能，并对DM组肺功能变化进行多因素线性回归分析。结果DM组总肺活置（TLC）、用力肺活量（FVC）、1s用力呼气量（FEV1）、用力呼气流量（FEF25、FEF50、FEF75）、肺一氧化碳弥散量（DLCO）均明显低于对照组（P〈0．05或P〈0．01）；TLC、FVC、FEV1、FEF50、FEF75与空腹血糖（FPG）、餐后2h血糖、空腹胰岛紊（FINS）、餐后2h胰岛素、糖化血红蛋白、胰岛素敏感指数（ISI）、体重指数（BMI）及微血管并发症积分无明显相关性（P〉0．05），FEF25、DLCO与FPG、FINS、ISI及微血管并发症积分显著相关（P〈0．05或P〈0．01）。提示2型糖尿病患者存在以限制性为主的肺通气功能障碍和弥散功能障碍，FPG、FINS、ISI及微血管并发症等可能是影响其肺功能的主要因素。     

肺功能测定在支气管哮喘、慢性阻塞性肺疾病急性发作期鉴别中的应用价值

目的探讨肺功能测定在支气管哮喘和慢性阻塞性肺疾病（COPD）急性发作期鉴别中的应用价值。方法应用一口气法测定支气管哮喘和COPD患者急性发作期的肺功能（肺通气功能、容量测定、弥散功能、脉冲振荡）。结果COPD组各项通气功能均明显低于哮喘组,COPD组中的功能残气量及残总比明显高于哮喘组（P均〈0．05）,哮喘组的弥散功能正常或轻度降低,呼吸总阻抗、外周气道阻力及响应频率在两组之间亦存在统计学差异（P均〈0．05）。结论除肺通气功能以外,肺容量测定、弥散功能及脉冲振荡在支气管哮喘和COPD急性发作期鉴别诊断中亦具有一定的应用价值。     

糖尿病肺损伤的研究进展

研究表明,肺是糖尿病攻击的靶器官之一,其损害主要涉及肺功能及病理学改变,糖尿病患者肺功能损害主要表现为通气功能障碍、小气道功能减退和弥散功能异常,而糖尿病肺组织病理学改变主要表现为基底膜增厚和细胞外基质增生以及超微结构的改变.积极控制血糖水平及胰岛素等药物治疗可能改善糖尿病患者的肺功能.深入研究糖尿病肺部病变,有可能在防治糖尿病血管并发症方面提出新的思路.     

298例2型糖尿病对肺功能的影响

目的 分析糖尿病患者的肺功能,研究肺是否为糖尿病损害的靶器官.方法 回顾性298名糖尿病患者肺功能(包括通气功能和弥散功能),以一氧化碳弥散量(DLCO)作为肺弥散功能的指标.对照组为年龄性别匹配的300名健康志愿者.分析糖尿病病程及合并高血压对肺功能的影响.结果 糖尿病组患者中所有肺通气功能指标均低于对照组,但两组之间的差异均无统计学意义(P＞0.05).糖尿病患者DLCO平均值为91.4±16.7％,明显低于对照组(104.1±7.9％)(P＜0.001).结论 糖尿病患者肺弥散功能受损,提示肺脏是糖尿病慢性病变的靶器官之一.     

不同阶段2型糖尿病患者肺功能分析

目的通过对不同阶段2型糖尿病患者的肺功能进行分析,以明确糖尿病患者是否存在肺功能损害。方法对60例2型糖尿病患者(初发糖尿病患者30例,合并不同并发症患者30例)和60例健康志愿者分别进行肺功能检测,检测其用力肺活量(FVC)、1秒钟用力呼气容积(FEVI)、1秒率(FEVl/FVC)、肺一氧化碳弥散(DLCO)及单位肺泡一氧化碳弥散量(DLCO/VA)肺功能指标数据,采用SPSS17.0软件进行统计学处理,分析不同阶段2型糖尿病患者的肺功能变化。结果糖尿病组FVC、DLCO及DLCO/VA低于健康对照组,差异有统计学意义(P0.05);且有并发症组较无并发症组以上各项指标进一步下降,差异有统计学意义(P0.05)。结论糖尿病患者肺功能减退,且以弥散功能下降显著,且随疾病进展,糖尿病出现并发症的患者肺弥散功能更加减退,积极控制血糖,延缓并发症的产生,可进一步减缓肺功能的减退。     

33例1型糖尿病患者肺功能观察

目的 观察1型糖尿病患者的肺功能改变。方法 应用美国2100型肺功能仪对33例1型糖尿病患者及30例健康正常人的肺功能,包括VC、VC％、FEV1％、FEF25％－75％、DLCO、DLCO％6个指标进行了检测。结果 1型糖尿病患者肺通气功能正常,小气道功能轻度受损,与健康人相比无显著差异（P＞0．05）,糖尿病患者肺弥漫功能（DLCO％）明显低于正常对照组（P＜0．01）,且随病程延长及合并症的增多肺弥漫功能减退更为明显（P＜0．05）。结论 1型糖尿病可以导致肺弥漫功能减退,且同病程的延长及合并症的增加呈正相关。     

2型糖尿病患者的肺功能损害及其相关因素分析

目的研究T2DM患者的肺功能损害及其影响因素。方法选取我院100例诊断为T2DM的患者及40名健康志愿者,检测肺功能及动脉血气进行对照研究,并以肺功能各项指标与FPG、胰岛素敏感性指数（ISI）、HbA1c、BMI和糖尿病病程等进行多因素线性回归分析。结果（1）T2DM组BMI明显高于对照组（P〈0．01）。（2）T2DM组肺总量（TLC）、用力肺活量（FVC）、1秒用力呼气量（FEV1）、用力呼出气量为50％肺活量的最大呼气中期流量（MMEF50）、用力呼出气量为25％肺活量的最大呼气中期流量（MMEF25）明显低于对照组（P〈0．01）。T2DM组一氧化碳弥散量（DLCO）、弥散指数（DLCO／VA）、动脉血氧分压（PaO2）和血氧饱和度（SaO2）低于对照组（P〈0．01）。（3）TLC、FVC、FEV1、MMEF50与FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、ISI、病程无明显相关;但DL（如、DLCO／VA、MMEF25与FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、病程呈显著负相关（P〈0．05或P〈0．01）,与ISI呈显著正相关（P〈0．05）。结论（1）T2DM患者肺功能损害主要表现为限制性通气功能障碍、小气道功能减退和弥散功能异常。（2）FPG、2hPG、FC-P、2hC-P、HbA1c、BMI、病程、ISI与T2DM小气道损害和肺弥散功能障碍密切相关。     

糖尿病肺损害

大量研究表明,肺脏是糖尿病攻击的“靶器官”之一,其损害主要涉及肺功能及病理学改变。糖尿病患者肺功能损害主要表现为限制性通气功能障碍、小气道功能减退和弥散功能异常。而糖尿病肺组织病理学改变主要表现为基底膜增厚和细胞外基质增生以及超微结构的改变。积极控制血糖水平及胰岛素和噻唑烷二酮类药物治疗可能改善糖尿病患者的肺功能。深入研究糖尿病肺部病变,有可能在防治糖尿病血管并发症方面提出新的思路。     

Observational study on effect of lock down due to COVID 19 on HBA1c levels in patients with diabetes: Experience from Central India

Background and aimsDiabetes is a chronic metabolic condition characterized by hyperglycemia and is associated with several complications. Prevalence of Diabetes in adult population in India ranges from 10.9 to 14.2% in urban area and 3.0–7.8% in rural area. Glycemic control is an important factor in preventing the complications associated with diabetes. HBA1c is the indicator of long-term glycemic control and slight variation in it significantly alters the risk of diabetic complications. Thus, the aim of this study was to study the change in HBA1c levels due to lock down in patients with diabetes.Methods307 patients with diabetes who had attended our endocrine OPD in last 3 months before nationwide 68 days lockdown from 24 March 2020 to 31 May 2020, and had recent HBA1c report in past and willing to participate were included in the study after informed consent from 2nd June 2020 to 14th June 2020 when first phase of Unlock started, to identify the change in HBA1c levels during the lockdown period in our patients with diabetes.ResultsThe patients were aged between 25–69 years and male to female ratio was 181:126 (1.44: 1). The mean age and mean duration of diabetes in our patients was 55.68 years and 7.95 years respectively. Increment of 0.51% was seen in mean HBA1c levels in our patient from 7.92% mean pre-lockdown HBA1c to mean of 8.43% after release of lock down.ConclusionGlycemic control got deranged during lockdown period with significant increase of mean HBA1c by 0.51% in immediate post lock down period which may significantly increase the annual incidence of complications related to diabetes.     

乙酰乙酸/β羟丁酸检测用于1型和2型糖尿病分型的探讨

探讨乙酰乙酸(AcAA)、β羟丁酸(βHBA)检测在1、2型糖尿病分型中的临床应用价值.收集健康体检者(正常对照组)102名,1型糖尿病患者(T1DM组)33例,2型糖尿病患者(T2DM组)104例,检测血AcAA、βHBA、空腹血糖(FPG)、C肽、胰岛素浓度.结果 显示,T1DM组和T2DM组AcAA、βHBA、AcAA+βHBA(总酮体,TKB)水平显著高于正常对照组,T1DM组显著高于T2DM组(均P＜0.01);糖尿病患者(T1DM+T2DM)血AcAA、βHBA、TKB与C肽、胰岛素分别呈显著负相关(均P＜0.01);T1DM组TKB阳性率100%、低C肽检出率100%,T2DM组TKB阳性率47%,低C肽检出率26%;通过建立受试者工作特征(ROC)曲线,T1DM组与T2DM组的ROC曲线下面积0.926,TKB最佳临界点为0.532 mmol/L,具有较高的灵敏度和特异度.酶法测定TKB对于1、2型糖尿病的分型有重要的临床应用价值.

Abstract：

The clinical values of acetoacetate ( AcAA ) and β hydroxybutyrate ( βHBA ) determination in classification of type 1 and2 diabetes were explored. 102 normal control subjects,33 cases of type 1 diabetes, and 104cases of type 2 diabetes were enrolled. Serum AcAA, βHBA, fasting plasma glucose ( FPG), C-peptide, and insulin levels were measured. The results showed that serum AcAA, βHBA, total ketone tody (TKB) levels in the diabetic groups were significantly higher than those of the normal group( P＜0. 01 ). AcAA, βHBA, TKB levels in type 1diabetes were higher as compared with those of type 2 diabetes( P＜0.01 ). The AcAA, βHBA, and TKB levels were negatively related with C-peptide and insulin in diabetic patients( P＜0. 01 ). All the type 1 diabetic patient were found to have TKB and lower C-peptide levels. TKB positive and lower C-peptide in type 2 diabetes were found in 47% and 26% respectively. Receiver operating characteristic (ROC) curve suggested that the area under the ROC curve of type 1 and type 2 diabetes was 0.926. The optimal operating point of the total ketone body was 0. 532 mmol/L with higher sensitivity and specificity. Enzymatic determination of acetoacetate and β hydroxybutyrate seems to have important clinical values for classification of type 1 and 2 diabetes.     

维生素D与2型糖尿病合并肺部感染相关性

目的观察2型糖尿病合并肺部感染患者维生素D缺乏程度,研究维生素D与2型糖尿病合并肺部感染的相关性。方法收集360例2型糖尿病合并肺部感染患者作为研究对象,根据是否存在肺部感染分为观察组与对照组,其中观察组151例,对照组209例,两组患者均进行维生素D水平及相关的炎症指标ESR、CRP、PCT等检测,从而探讨维生素D与2型糖尿病合并肺部感染的相关性。结果 1观察组中发现维生素D不足可高达79.47%,而在对照组高达66.51%(P0.01);维生素水平减少在观察组中高达58.94%,在对照组中高达40.19%(P0.01);三种不同程度的维生素D缺乏对2型糖尿病合并肺部感染的危险性分别为1.745倍、2.136倍、1.949倍。2观察组相关炎症因子PCT、ESR和CRP较对照组明显升高,差异有统计学意义(P0.01);观察组HbA1c较对照组明显偏高,差异有统计学意义(P0.01)。结论维生素D的缺乏在2型糖尿病患者中患病率较高,而在合并肺部感染中更高,维生素D缺乏可能是2糖尿病合并肺部感染的相关危险因素,维生素D的缺乏将不利于炎症的控制及血糖水平的控制。     

对2型糖尿病患者肺功能变化及其相关因素的临床分析

目的分析2型糖尿病患者肺功能变化的影响因素。方法选取该院2018年10月—2019年5月期间收治的62例2型糖尿病患者以及同期于该院接受体检的60名健康体检者作为研究对象,分别作为观察组和对照组,对比两组受检者各项肺功能指标的差异,分析糖化血红蛋白(HbA1c)水平、微血管并发症积分以及胰岛素抵抗指数(HOMA-IR)对于肺功能变化的影响。结果与对照组健康体检者相比,观察组2型糖尿病患者的肺活量(VC)、1 s用力呼气容积(FEV1)、肺总量(TLC)、最大自主通气量(MVV)、肺一氧化碳弥散量(DLCO)、肺单位体积一氧化碳弥散量(KCO)相对更低,差异有统计学意义(P<0.05)。在62例2型糖尿病患者中,HbA1c>8.5%、微血管并发症积分>2分以及HOMA-IR>2患者的VC、FEV1、TLC、DLCO以及KCO等指标相对更低,差异有统计学意义(P<0.05)。结论根据2型糖尿病患者的HbA1c水平、微血管并发症积分以及HOMA-IR,准确判断肺通气功能及弥散功能减退的实际情况,能够为肺部并发症的防治提供参考。     

Peripheral neuropathy does not invariably coexist with autonomic neuropathy in diabetes mellitus

Background: Peripheral somatic and autonomic neuropathies are the most common types of diabetic polyneuropathy. Although duration and degree of hyperglycemia are considered to be risk factors for both autonomic and peripheral neuropathy, recent studies have raised the question of a different development and natural history of these neuropathies in diabetes. In addition, a few studies have investigated the relationship between chronic painful and autonomic neuropathy. The aim of this study was to investigate to what extent autonomic and peripheral neuropathy coexist, as well as whether painful neuropathy is more common in diabetic patients with autonomic neuropathy. Methods: Subjects with type 1 (n=52; mean age 31.7 years) and type 2 diabetes (n=53; mean age 54.5 years) were studied. Evaluation of peripheral neuropathy was based on clinical symptoms (neuropathic symptom score), signs (neuropathy disability score), and quantitative sensory testing (vibration perception threshold). Assessment of autonomic neuropathy was based on the battery of standardized cardiovascular autonomic function tests. Results: Prevalence rates of pure autonomic and of pure peripheral neuropathy in patients with type 1diabetes were 28.8 and 13.5%, respectively. The respective rates in patients with type 2 diabetes were 20.7% (P=0.33 vs. type 1 diabetes) and 20.7% (P=0.32). Peripheral and autonomic neuropathy coexisted in 28.8% of type 1 and in 45.3% of type 2 diabetic subjects (P=0.08). Prevalence rates of chronic painful neuropathy in subjects with type 1 diabetes, with and without autonomic neuropathy, were 16.6 and 22.7%, respectively (P=0.85) and in type 2 diabetic subjects 20 and 22.2%, respectively (P=0.58). Multivariate analysis after adjustment for age, sex, blood pressure, duration of diabetes, HBA(1c), and presence of retinopathy or microalbuminuria showed that neither the indices of peripheral nerve function (neuropathic symptom score, neuropathy disability score, vibration perception threshold) nor the presence of peripheral neuropathy or chronic painful neuropathy are associated with the presence of autonomic neuropathy in individuals with either type 1 or type 2 diabetes. Conclusions: Peripheral and autonomic neuropathies do not invariably coexist in diabetes. In addition, chronic painful neuropathy may be present irrespective of the presence of autonomic neuropathy.     

Effect of antidiabetic medications on microalbuminuria in patients with type 2 diabetes

The progression of diabetes and hypertension complications is associated with microalbuminuria. Intensive glycemic control prevents or retards microalbuminuria in patients with type 2 diabetes, but little is known about the respective benefits of different antidiabetic drugs. We studied the effect of gliclazide and pioglitazone on microalbuminuria in patients with type 2 diabetes. We excluded patients with very poor glycemic control (glycated hemoglobin [HbA(1c)] >10%), impaired liver function, nondiabetic renal diseases, and those whose urine contained red blood cells, hemoglobin, or casts. Each patient received the designated drug for 12 weeks and their body weight, blood pressure (BP), fasting plasma glucose (FPG), HbA(1c), lipids (triglycerides [TG], total, and high-density lipoprotein-cholesterol [HDL-C]), 1,5 anhidroglucitol (1,5-AG), immunoreactive insulin (IRI), and urinary albumin to creatinine ratio (UACR) were measured every month. The effects of the drugs were analyzed using 2-way repeated measures analysis of variance (ANOVA). The 2 groups of patients were well matched for age, duration of diabetes, retinal status, blood pressure, body mass index (BMI), IRI, FPG, HBA(1c), 1,5-AG, lipids, and UACR, as well as the use of antihypertensive drugs. After treatment, no significant differences were seen in drug efficacy between the 2 groups. Gliclazide and pioglitazone significantly reduced FPG (F = 26.0, P <.0001), HBA(1c) (F = 48.1, P <.0001), and total cholesterol (TC) levels (F = 3.5, P <.05). Decrements in these metabolic parameters were comparable between the groups. 1,5-AG increased in both groups (F = 27.5, P <.0001), and the increment was comparable in both groups. Gliclazide and pioglitazone significantly reduced UACR (F = 15.7, P <.0001) with a comparable decrement in both groups. No other variables changed significantly throughout the 12-week treatment. These results suggest that 12 weeks of treatment with gliclazide or pioglitazone are equally effective in reducing microalbuminuria with similar improvements in blood glucose and cholesterol levels, independent of their mechanisms of actions.     

Hb H Disease Caused by Multiple Mutations in the Polyadenylation Signal Site and − −SEA/αα

Thalassemia is the most common monogenic disease, with the highest incidence in Guangxi Zhuang Autonomous Region, People’s Republic of China (PRC). The blood test result was not consistent with α-globin gene testing in one of the patients during daily screening. It was confirmed that there were multiple mutations at the α2-globin gene polyadenylation (polyA) signal site: HBA2: c.*64(T>C), HBA2: c.*68(A>C), HBA2: c.*71(G>A), HBA2: c.*74(C>A), HBA2: c.*82(G>A), HBA2: c.*92(A>G) and HBA2: c.*98(T>C) and compound ? ?^SEA/αα by sequencing of the HBA1 and HBA2 genes of the proband and core family members. After that, we found a further two cases of unrelated patients with this type of mutation. The mutation is not an accidental phenomenon, and likely to occur with a considerable incidence in Guangxi Zhuang Autonomous Region, PRC. We analyzed the hematological manifestations of this type of thalassemia and showed that it was a Hb H (β4) disease caused by rare mutations. We suggest that it is essential to pay attention to this mutation during future clinical diagnoses and genetic counseling of patients.