妊娠糖尿病的研究进展

妊娠糖尿病是2型糖尿病的高危人群，是围产期常见并发症，发病存在种族差异，肥胖、年龄超过30岁、糖尿病家族史等均是发病危险因素，25％的患者产后转为持久糖耐量异常，日后发生糖尿病的危险性也明显增加，其中多数发展为2型糖尿病，也有少数发展为1型糖尿病。目前对该病的诊断方法存在许多争议，控制血糖、改变不良的生活习惯、补充一些微量元素以及干预危险因素和产后随访是防治妊娠糖尿病和减少糖尿病的策略。     

影响初孕妇妊娠糖尿病和产后糖尿病发病的因素

目的:探讨影响初孕妇妊娠糖尿病和产后糖尿病发病的因素。方法:2035例符合标准的初孕妇,由产科医师进行问卷调查,完成产前检查的同时记录随访结果。主要终检标准:发生产后糖尿病。影响妊娠糖尿病事件的因素用Logistic回归分析、组间产后糖尿病发生率比较用Kaplan-Meier曲线表示,并作对数秩检验。结果:2035例初孕妇平均年龄27.9岁,妊娠糖尿病146例,妊娠糖尿病发病率7.2%。孕前体重指数(RR=6.4,P=0.000)及孕妇母亲2型糖尿病史(RR=4.5,P=0.000)是妊娠糖尿病的危险因素(Logistic回归分析:χ2=272.1,ν=5,P=0.000)。2035例平均随访3.6年,产后糖尿病63例,产后糖尿病发病率3.1%,平均年产后糖尿病发病率0.9%。妊娠糖尿病组产后糖尿病发生率明显高于非妊娠糖尿病组产后糖尿病发生率(对数秩检验:统计量=101.7,ν=1,P=0.0000)。肥胖组产后糖尿病发生率最高,超重组产后糖尿病发生率居中,体重正常组产后糖尿病发生率最低(对数秩检验:整体比较,统计量=150.1,ν=2,P=0.0000。组间比较,正常组vs超重组,统计量=36.8,P=0.0000;正常组vs肥胖组,统计量=175.0,P=0.0000;超重组vs肥胖组,统计量=22.5,P=0.0000)。结论:母亲2型糖尿病史是初孕妇妊娠糖尿病的危险因素,妊娠糖尿病亦是产后糖尿病的危险因素,而孕前体重指数高既是初孕妇妊娠糖尿病的危险因素,又是产后糖尿病的危险因素。     

妊娠合并先天性心脏病患者预后不良的危险因素探讨

目的 探讨妊娠合并先天性心脏病(CHD)患者预后不良的危险因素,为降低其产后不良事件的发生率提供依据.方法 对本院57例妊娠合并CHD患者产后合并症进行回顾性调查,采用Logistic回归方法 对产后不良事件的相关因素进行分析.结果 重度妊娠高血压疾病、肢深静脉血栓、脓毒血症、肺动脉高压、糖尿病等危险因素与妊娠并CHD患者预后不良的发生有关.结论 妊娠合并CHD,重度妊娠高血压、肢深静脉血栓、脓毒血症、肺动脉高压和糖尿病是妊娠并CHD患者预后不良的危险因素,对预后不良的危险因素及时处理,可降低其产后不良事件的发生率.     

妊娠合并先天性心脏病患者预后不良的危险因素探讨

目的 探讨妊娠合并先天性心脏病(CHD)患者预后不良的危险因素,为降低其产后不良事件的发生率提供依据.方法 对本院57例妊娠合并CHD患者产后合并症进行回顾性调查,采用Logistic回归方法 对产后不良事件的相关因素进行分析.结果 重度妊娠高血压疾病、肢深静脉血栓、脓毒血症、肺动脉高压、糖尿病等危险因素与妊娠并CHD患者预后不良的发生有关.结论 妊娠合并CHD,重度妊娠高血压、肢深静脉血栓、脓毒血症、肺动脉高压和糖尿病是妊娠并CHD患者预后不良的危险因素,对预后不良的危险因素及时处理,可降低其产后不良事件的发生率.     

妊娠合并先天性心脏病患者预后不良的危险因素探讨

目的 探讨妊娠合并先天性心脏病（CHD）患者预后不良的危险因素,为降低其产后不良事件的发生率提供依据.方法 对本院57例妊娠合并CHD患者产后合并症进行回顾性调查,采用Logistic回归方法 对产后不良事件的相关因素进行分析.结果 重度妊娠高血压疾病、肢深静脉血栓、脓毒血症、肺动脉高压、糖尿病等危险因素与妊娠并CHD患者预后不良的发生有关.结论 妊娠合并CHD,重度妊娠高血压、肢深静脉血栓、脓毒血症、肺动脉高压和糖尿病是妊娠并CHD患者预后不良的危险因素,对预后不良的危险因素及时处理,可降低其产后不良事件的发生率.     

妊娠期糖尿病患病危险因素及其对妊娠结局的影响

目的探讨妊娠期糖尿病(GDM)患病危险因素及其对妊娠结局的影响。方法选择2013年1月-2015年12月余杭区第一人民医院妇产科门诊及病房记录或收治入院的孕妇为研究对象,按照1∶2频数匹配方式分组,其中对照组为正常产妇124例,病例组为GDM产妇62例。对所有产妇进行问卷调查,将孕期可能引发GDM的危险因素进行比对分析,并对比两组患者最终妊娠结局差异。结果糖尿病家族史、妊娠期间进食水果多少、每日运动量1 h、妊娠前BMI24 kg/m~2、大学及以上学历、高血压病史、妊娠期间增重15 kg等7个相关因素比较,差异具有统计学意义(P0.05)。其中妊娠期间增重15 kg、妊娠期间每日运动量1 h是降低GDM发病的保护因素;甜食摄入量大是GDM发病的危险因素(P0.05)。对照组患者剖宫产、产后出血、胎膜早破及巨大儿的发病率均低于病例组,两组比较,差异具有统计学意义(P0.05)。结论 GDM的发病与妊娠期体质量增重过多、进食甜食过量、运动较少相关,而血糖升高增加了产妇剖宫产、产后出血剖宫产、产后出血、巨大儿及新生儿肺透明病的风险。因此孕妇在妊娠期间应注意健康饮食、适当锻炼、控制体质量,以避免以上危险因素的发生,预防和减少妊娠糖尿病的发病。     

儿童肥胖与2型糖尿病易感基因的研究进展

儿童肥胖与2型糖尿病的发病密切相关,是2型糖尿病最重要的危险因子.儿童肥胖参与2型糖尿病的发病,其中一个很重要的方面就是与遗传因素的相互作用.遗传因素对在2型糖尿病发病的影响上,呈现出极其复杂的现象,表现为:单基因遗传、多基因遗传和线粒体遗传等,另外,其他某些基因也参与了2型糖尿病的发病.该文从以上4个方面,综述了儿童肥胖和2型糖尿病易感基因的研究进展.     

妊娠期糖尿病孕妇产后血糖异常的影响因素调查

目的:探讨妊娠期糖尿病孕妇产后血糖异常的影响因素。方法:选取2010年1月~2013年6月在本院住院分娩的产妇110例,均在产前诊断为妊娠期糖尿病且产后2个月时行口服葡萄糖耐量试验(OGTT,75g)检查并对其进行问卷调查。结果:产后血糖正常者76例(69.09%),血糖异常者34例(29.91%),糖耐量降低者13例(11.82%),2型糖尿病者21例(19.09%);单因素分析血糖异常组与血糖正常组在妊娠年龄、孕前体重指数(BMI)、产前BMI、糖尿病家族史、产后运动锻炼时间等方面比较差异具有统计学意义(P0.05),两组在民族、吸烟史、饮酒史、不良孕产史、高血压病史方面比较差异无统计学意义(P0.05),多因素非条件logistic回归分析结果显示妊娠年龄、孕前BMI、糖尿病家族史是引起产后血糖异常的独立危险因素(P0.05),产后运动锻炼是保护因素(P0.05)。结论:年龄大、孕前BMI高、合并有糖尿病家族史是引起妊娠期糖尿病孕妇产后发生血糖异常的主要危险因素。     

昆明地区2型糖尿病Calpain10基因与环境危险因素病例对照研究

目的研究Calpain10基因多态性与环境危险因素的交互作用及与2型糖尿病发病的关系。方法选取131例2型糖尿病患者和131例健康对照，进行流行病学调查，检测Calpain10基因SNP43G／A位点和SNP44T／C位点基因型，分析主要环境危险因素和基因的交互作用。结果①与对照组相比，Calpain10基因SNP43GG基因型和SNP44TC基因型在2型糖尿病人群中显著升高（P〈0．01）。②Calpain10基因SNP44位点基因变异、超重肥胖、胰岛素抵抗、高血脂、不良生活事件、喜食甜食是2型糖尿病的主要危险因素；体育锻炼、食用植物油和新鲜蔬菜是2型糖尿病的保护因素。③Calpain10基因SNP44T／C多态性与肥胖有明显的协同作用与胰岛索抵抗也存在协同作用。结论Calpain10基因变异与昆明地区人群2型糖尿病遗传易感性有关，其SNP44位点基因变异与肥胖和胰岛素抵抗在2型糖尿病发病中存在明显的协同作用。     

妊娠期糖尿病产妇产后糖尿病发生情况及危险因素研究

目的研究与分析妊娠期糖尿病产妇产后糖尿病发生情况及危险因素。方法选取2014年5月-2016年2月期间温州医学院附属温岭医院的315例妊娠期糖尿病产妇为研究对象,将其产后糖尿病发生率进行统计,并比较不同妊娠前因素(年龄、BMI值、糖尿病家族史、WHR)及妊娠中及产后因素(血脂、血压、孕期空腹血糖、发病时间、孕期活动量及分娩后体重)者其产后糖尿病的发生率,同时以Logistic分析上述因素与产后糖尿病发生的关系。结果 315例妊娠期糖尿病产妇产后发生糖尿病33例,发生率为10.48%,年龄较高、BMI值较高、存在糖尿病家族史、WHR较高、高血脂、高血压、孕期空腹血糖较高、孕早期发病、孕期未锻炼及分娩后体重升高者的产后糖尿病发生率明显高于年龄较低、BMI值较低、无糖尿病家族史、WHR较低、无高血脂、无高血压、孕期空腹血糖较低、孕中期及孕晚期发病、孕期锻炼及分娩后体重未升高者,且经Logistic分析显示,年龄(OR=9.421,95%CI:2.467~32.563)、BMI值(OR=2.994,95%CI:1.976~14.568)、糖尿病家族史(OR=8.721,95%CI:2.253~31.563)、WHR(OR=8.104,95%CI:2.015~30.567)、血脂(OR=5.281,95%CI:2.087~22.637)、血压(OR=4.211,95%CI:1.993~18.524)、孕期空腹血糖(OR=1.052,95%CI:1.015~3.142)、发病时间(OR=0.375,95%CI:0.141~1.252)、孕期活动量(OR=0.948,95%CI:1.256~10.251)及分娩后体重(OR=1.161,95%CI:1.134~3.567)均与产后糖尿病的发生有密切的关系(均P0.05)。结论 2014年5月-2016年2月期间温州医学院附属温岭医院妊娠期糖尿病产妇产后糖尿病发生率较高,且其妊娠前因素、妊娠中及产后因素均是其发生产后糖尿病的重要因素,应给予针对性干预。     

Ⅱ型糖尿病患者医院感染危险因素研究

目的 探讨Ⅱ型糖尿病患者医院感染发病情况、危险因素及预防措施。方法 采用回顾性调查的方法,分析Ⅱ型糖尿病患者医院感染发生率及其相关危险因素。结果 418例Ⅱ型糖尿病患者中,发生医院感染66例,感染率为15.79％,高于同期医院平均医院感染发病率4.18％(P<0.01);病原菌中,G~-杆菌占61.91％;医院感染主要与住院时间长,原发病控制情况(尿酮体),有并发症及治疗措施(应用抗菌药物和激素、侵入性医疗操作)等有关。结论 Ⅱ型糖尿病患者医院感染发病率高于平均医院感染发病率,G~-杆菌是主要病原菌。积极控制血糖,防治并发症,合理应用抗菌药物,尽量避免侵入性医疗操作和注意提高患者免疫力等,是防治Ⅱ型糖尿病患者发生医院感染的有效措施。     

Current aspects and future perspectives of pharmacotherapy or type II diabetes

Type II diabetes mellitus is a group of metabolic disorders of fat, carbohydrate and protein metabolism that results from defects in insulin action. It is associated with microvascular and macrovascular disease complications. Goals of therapy in management of type II diabetes mellitus are directed at reducing symptoms of hyperglycemia, reducing the onset and progression of retinopathy, nephropathy and neuropathy complications, intensive therapy of associated cardiovascular risk factors and improving quality and quantity of life. Multidisciplinary teams of health care professions are needed to optimize outcomes in persons with diabetes mellitus. This article will focus on the pharmacotherapeutic agents used in type II diabetes mellitus with or without microvascular and macrovascular disease risk. We will describe also the agents used in prevention of this disense.     

Management of Hypertension in Patients with Diabetes Mellitus

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years’ treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.     

A Multifactorial Approach to Reduce Cardiovascular Disease in Type 2 Diabetes Mellitus: Now More Than Ever

Managing cardiovascular (CV) risk is an important part of caring for patients with type 2 diabetes mellitus, as the disease itself confers CV risk. Many CV risk factors (such as hypertension, dyslipidemia, and obesity) have been found to be more common among individuals with diabetes than in the general population. A growing body of evidence provides guidance for clinicians on how to balance control of hyperglycemia with management of these risk factors. Newer classes of antihyperglycemic agents have been associated with beneficial effects on several CV risk factors; several studies evaluating the effect of these newer diabetic medications on CV outcomes have been published, and several more are in progress. While evidence continues to unfold about the benefits of risk factor control in patients with type 1 diabetes mellitus, this article reviews evidence related to risk-factor control in patients with type 2 diabetes mellitus as well as recent findings on the effect of newer drug classes on CV risk factors and outcomes. Favorably altering CV risk factors appears to improve outcomes, and is more important now than ever before.     

What is the most effective approach to the reduction of cardiovascular risk in type-2 diabetes mellitus?

It is well known that the target blood glucose values are not fulfilled in treatment of patients with type 2 diabetes mellitus. (UKPDS) The high mortality rate in type 2 diabetes mellitus is associated with the augmented cardiovascular risk. It is well documented, that the beneficial influence of high blood pressure, dyslipidaemia, and hypercoagulation compared to hyperglycaemia, is a more powerful approach in reduction of cardiovascular risk in type 2 diabetes mellitus. The effect of medical interventions on alteration of cardiovascular risk and glucose homeostasis is not always concordant: beta-blockers automatically reduce cardiovascular risk, but may result in deterioration of blood glucose values, sulfanylurea drugs effectively reduce hyperglycaemia, but could paradoxically increase the cardiovascular risk. The acarbose, metformin, thiazolidindione, fibric acid treatment improves the profile of vascular risk factors, additionally could have a beneficial metabolic effect resulting in reducing cardiovascular risk in patients with type 2 diabetes mellitus. In conclusion: the cardiovascular risk in type 2 diabetes mellitus can be most effectively influenced by reduction of high blood pressure, dyslipidaemia, and dysfunction of haemostasis. The improvement of glucose homeostasis is, novel medical interventions seem to be important tools in reducing cardiovascular risk in patients with type 2 diabetes mellitus.     

我国农村居民2型糖尿病常见危险因素的系统分析

目的了解我国农村居民2型糖尿病常见的危险因素。方法应用Cochrane系统评价方法。结果共纳入16篇研究文献,调查人口51998人,糖尿病患者2441人,患病率为4.69%。农村2型糖尿病的常见危险因素为家族史[OR值为3.08,95%CI（2.26～4.19）]、体重[（OR值为0.41,95%CI（0.36～0.47）]、文化程度[OR值为1.71,95%CI（1.49～1.96）]、年龄[OR值为0.41,95%CI（0.38～0.45）]。结论在农村防治糖尿病时,需要注意常见的危险因素,加强糖尿病防治知识的宣传和教育。     

PGD5 Predicting Hospitalization of Patients with Diabetes Mellitus: An Application of the Bayesian Discriminant Analysis

An estimated 8 million people in the U.S. have type II diabetes mellitus but are unaware of it.
OBJECTIVES: The study investigated the cost-effectiveness of early detection of type II diabetes mellitus in various risk groups.
METHODS: A Markov model was constructed based on a societal perspective. There were 4 stages in the model: (1) unknown diabetes status; (2) alive with diagnosed diabetes; (3) alive with diagnosed diabetes and related complications, namely, retinopathy, blindness, neuropathy, end-state renal disease, lower leg amputations, circulatiory disorders; and (4) die secondary to diabetes or its complications. Individuals could transit from one state to another annually as a function of the predicted risk factors from epidemiological studies. The model assumed that the patients who were screened positive for diabetes and received treatment would have reduced rate of related complications as observed in the Diabetes Control and Complications Trial. Health care costs included in the model were screening tests, diabetes treatment cost, complications and death. Various screening test thresholds have also been considered in the model analysis.
RESULTS: Diabetes screening of the entire nonpregnant adult US population yielded a cost-effectiveness ratio of $24,600 per quality-adjusted life year. The cost-effectiveness of screening only extremely obese patients with a family history of diabetes was $10,083 per quality adjusted life year.
CONCLUSIONS: The study suggested that active screening for type II diabetes mellitus in high-risk individuals was cost-effective. More information on the actual clinical outcomes for oral diabetes medications is needed to establish the precision of these estimates.     

Urinary tract infections in women with diabetes mellitus

Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) more frequently than women without DM. For type 1 diabetes mellitus, risk factors for asymptomatic bacteriuria include a longer duration of diabetes, peripheral neuropathy and macroalbuminuria. For type 2 diabetes, the risk factors are higher age, macroalbuminuria and a recent symptomatic UTI. Poorly-controlled diabetes and residual urine after urination are no risk factors. The most important risk factor for a UTI in type 1 diabetes patients is sexual intercourse. In type 2 diabetes patients the major risk factor is the presence of asymptomatic bacteriuria. This higher prevalence does not appear to be based on a difference in virulence of the causative microorganism. Differences in host response may explain this higher prevalence: E. coli with type 1 fimbriae adhere better to uroepithelial cells in women with DM than to those in women without DM; women with DM and ASB have lower urinary cytokine concentrations and leukocyte counts compared to women without DM and ASB; in vitro studies show that E. coli grow better when glucose is present in urine. There is no consensus on whether ASB should be treated in these patients. There are indications that UTIs in diabetes patients should be treated as complicated UTIs.     

Vascular endothelium as a target of beraprost sodium and fenofibrate for antiatherosclerotic therapy in type 2 diabetes mellitus

Diabetes mellitus is an important risk factor for cardiovascular morbidity and mortality. The metabolic abnormalities caused by diabetes mellitus induce vascular endothelial dysfunction that predisposes patients with diabetes mellitus to atherosclerosis. Two mega clinical trials showed that intensive glycemic control does not have favorable effects on reducing macrovascular events although it demonstrated significant reductions in microvascular complications. It is becoming worthwhile to clarify the beneficial effects of tight controls on blood pressure, serum lipids, and postprandial hyperglycemia to prevent atherosclerosis in patients with type 2 diabetes mellitus. Here, we focus on vascular endothelium as a target of the prostaglandin I2 analog beraprost sodium and the peroxisome proliferators-activated receptor alpha activator fenofibrate for the prevention and treatment of atherosclerosis in patients with type 2 diabetes mellitus. Beraprost sodium lowered circulating vascular cell adhesion molecule- 1 (VCAM-1) concentration and prevented the progression of carotid atherosclerosis in type 2 diabetic patients, probably through inhibiting VCAM-1 expression in vascular endothelium. Fenofibrate up-regulated endothelial nitric oxide synthase expression, which may explain its effects to improve endothelium-dependent vasodilatation and to prevent the progression of coronary atherosclerosis. The approaches to target the molecules expressed in vascular endothelium will become important for preventing the atherosclerosis in type 2 diabetes mellitus.     

家族性2型糖尿病与心血管病危险因素研究

目的 研究2型糖尿病家系人群的心血管疾病危险因素聚集情况。方法 选择有2个或2个以上2型糖尿病患者的家系115个，共有287例患者为病例组，非糖尿病亲属168人为对照组，进行病例一对照研究。应用X^2检验、二项分类Logistic回归方法分析病例组和对照组的心血管疾病危险因素检出率及聚集性。结果 病例组、对照组心血管疾病危险因素聚集检出率分别为82．2％和53．0％；二项分类Logksdc回归分析显示心血管疾病危险因素聚集是2型糖尿病的独立危险因素，其OR值为2．201。结论 心血管疾病危险因素聚集是家族高发性2型糖尿病的主要危险因素。