2型糖尿病合并冠心病患者血清芳香酯酶、黄嘌呤氧化酶及脂蛋白检测

目的:检测2型糖尿病并发冠心病(DM-CHD)患者血清芳香酯酶(ArE/PON1)和黄嘌呤氧化酶(XO)活性及脂蛋白含量.方法:测定78例2型糖尿病(DM)、80例DM-CHD患者与81例健康人血清ArE/PON1、XO、丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、高密度脂蛋白胆固醇(HDL-C)和氧化型低密度脂蛋白(ox-LDL)等有关指标,分析上述指标在DM-CHD发病中的意义.结果:与健康组相比,DM与DM-CHD组患者血清ArE/PON1活性降低、XO活性升高;MDA、CAT等水平升高,SOD活性降低;oxLDL水平升高,HDL-C降低,且DM-CHD组的改变较DM组明显.结论:血清ArE/PON1、OX、SOD及脂蛋白的测定可反映DM与DM-CHD患者机体氧化应激与脂代谢紊乱状况,是监测DM并发CHD的有用指标.     

Paraoxonase activity in type 2 diabetes mellitus patients with and without complications

Objective:Type 2 diabetes mellitus(DM)is a disease of metabolic dysregulation.Current study was undertaken to know the relation between fasting lipid profile and paraoxonase 1(PON1)activity in type 2 diabetic patients with and without complications.Methods:The study group consisted of a total of 155 subjects which included non-diabetic healthy control subjects(n = 50)and diabetic patients with complications(group I,n = 66)and without complications(group II,n=39).PON1 activity was measured all the subjects based on spectrophotometric methods,and fasting lipid profile and fasting plasma glucose(FPG)levels were determined in clinical chemistry analyzer Hitachi 912.Results:FPG(P<0.001)and TAG(P<0.001)significantly increased,and HDL-C(P<0.001)and PON1(P<0.001)were significantly decreased in group I patients when compared to normal controls.In group II patients FPG(P<0.001),TAG(P<0.001)and TC(P<0.05)significantly increased and HDL-C(P<0.05)was significantly decreased when compared to normal controls.On Pearson correlation,HDL-C was positively correlated with PON1 in group I patients(r=0.317,P<0.01).Conclusion:type 2 DM patients with complications have significantly decreased HDL-C levels and PON1 activity possibly indicating its decreased biochemical role in these patients.     

糖化白蛋白与糖化血红蛋白比值的临床应用进展

糖化白蛋白（GA）反映近2~3周的血糖水平,糖化血红蛋白（HbA1c）反映近2~3个月的血糖状况,糖化白蛋白与糖化血红蛋白比值（GA/HbA1c）的t1/2短,能够反映比GA周期更短的血糖波动情况,是监测糖尿病患者血糖控制的新型指标,可用于诊断暴发性1型糖尿病、胰岛细胞功能、糖尿病筛查及诊断、糖尿病肾病及糖尿病视网膜病变,也是老年人认知功能障碍的预测指标。GA/HbA1c与各项血糖监测指标互补,可以更加准确地反映血糖水平。     

Alteration of lipid peroxidation and antioxidant enzymes in young Malaysian IDDM patients

The present study was designed to explore the relationship between lipid peroxidation and antioxidant enzymes in young Malaysian insulin dependant diabetes mellitus (IDDM) patients. Indicative parameters of lipid peroxidation, activities of antioxidant enzymes and diabetes parameters were evaluated in single blood samples from 30 young type 1 diabetic patients and 30 healthy control subjects. Antioxidant enzymes namely superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were significantly decreased while plasma malondialdehyde (MDA), an indicator for lipid peroxidation was significantly increased in IDDM patients compared to control subjects. Positive correlations between HbA1c and MDA; fasting blood glucose (FBG) and MDA and negative correlations between HbA1c and SOD; MDA and SOD were observed in these patients. No significant correlation existed between HbA1c and fasting blood glucose, GPx or CAT in the diabetic patients. The strong correlations found between lipid peroxidation, antioxidant enzymes and diabetes parameters confirms the existence of oxidative stress in our IDDM patients.     

对氧磷脂酶 1 在 2 型糖尿病强化治疗前后的变化及与微血管病变关系

目的 探讨对氧磷脂酶1（PON-1）水平在2型糖尿病（2DM）强化治疗前后的变化及其与微血管病变的关系.方法 用酶联免疫吸附法分别检测40例体检正常者和80例2DM患者（其中单纯糖尿病患者30例,合并微血管病变患者50例）以及强化治疗后2个月30例回访患者血清PON-1水平,并同时测定其他临床指标.结果 2DM微血管病变组血清PON-1明显低于单纯2DM组（P＜0.05）.经过降糖、降压、降脂等有针对性的强化治疗后2个月30例回访患者与治疗前对比PON-1明显升高（P＜0.01）.糖尿病微血管病变组血清PON-1与空腹血糖呈负相关（P =0.0084）,与糖化血红蛋白呈负相关（P =0.0156）.结论 血清PON-1与2DM微血管病变密切相关,强化治疗可以使PON-1水平明显升高,筛查并监测血清PON-1水平对于防治2DM微血管病变的发生发展可能具有重要意义.     

对氧磷酸酯酶-1活性在2型糖尿病及血管病变中的改变

目的：探讨PON-1活性在2型糖尿病（DM）中的改变及其在DM血管病变发生中的作用。方法：检测100例2型DM患者及40例正常对照的对氧磷酸酯酶-1（PON1）活性、总抗氧化能力（T-AOS）、氧化低密度脂蛋白（OX-LDL）、丙二醛（MDA）浓度变化，并按不同分组进行比较。血清PON-1活性用苯乙酸酯为底物，分光光度法测定，OX-LDL用ELISA法测定，MDA用硫带巴比妥酸法测定，T-AOS检测用分光光度法。结果：2型DM组PON-1活性比正常对照组显著降低（P〈0．001），且与HDL减少无关，OX-LDL、MDA显著高于正常对照组（P〈0．001，P〈0．001），T-AOS显著低于正常对照（P〈0．001）。合并血管病变的各组2型DM患者PON-1活性、T-AOS均低于无血管病变组，OX-LDL、MDA均高于无血管病变组。相关分析显示PON-1活性与T-AOS正相关（r=0．778，P〈0．01），与OX-LDL（r=-0．643，P〈0．01）呈负相关。PON-1活性影响因素经多元线性逐步回归分析，发现只有T-AOS、CHO、LDL、OX-LDL的回归系数P值〈0．05。结论：2型DM患者PON-1活性下降，脂蛋白氧化易感性增加，血管易于损伤。PON-1活性降低是2型糖尿病大、微血管病变的危险因素。     

广东省1型糖尿病患者血糖控制现状及相关因素的横断面调查

目的 了解广东省1型糖尿病(T1DM)患者血糖控制现状和相关因素.方法 在广东省21个地级市的89家三级和二级医院收集T1DM患者的血标本和临床资料.通过分析临床资料,了解影响血糖控制的因素.以糖化血红蛋白(HbA1c)评价血糖控制水平,HbA1c统一在广东省糖尿病防治中心检测.结果 2010年8月6日至2011年5月25日共调查纳入广东省851例T1DM患者.其中男408例,女443例.患者年龄的中位数为29.6岁(20.3 ～41.3岁);发病年龄为25.3岁(15.7 ～35.5岁);病程为3.3年(1.0～7.3年);体质指数(BMI)为19.9 kg/m2(17.9 ～21.8 kg/m2).HbA1c为8.6％(6.9％ ～11.0％),234例(27.50％)患者达到相应年龄患者的血糖控制目标.13 ～ 19岁患者、家庭年收入低、未控制饮食和未接受糖尿病教育、病程短的患者血糖控制差.结论 广东省大多数T1DM患者血糖控制未达标,迫切需要采取措施改善这一现况.     

亚临床甲状腺功能减退症患者血浆对氧磷酯酶1活性与氧化应激状态的评价

目的 评价亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)患者血浆对氧磷酯酶1(paraoxonase 1,PON1)活性及氧化应激状态,以及PON1与氧化应激的关系.方法 测定56例亚临床甲减患者与48例年龄相匹配的健康体检者血浆PON1活性、血脂水平、氧化型低密度脂蛋白(ox-LDL)含量、丙二醛(MDA)水平及超氧化物歧化酶(SOD)活力,并进行相关性分析.结果 亚临床甲减患者血浆PONl[(142 4±56)kU/L]和SOD[(83.2±26.1)U/ml]明显低于对照组PON1[(167±60)kU/L,P<0.01]和SOD[(93.1±28.2)U/ml,P<0.05];MDA[(14.10 4±3.01)μmol/L]和ox-LDL[(596.2±68.1)μg/L]的水平明显高于健康对照组MDA[(10.25±3.34)μmol/L,P<0.01]和ox-LDL[(467.2±60.1)μg/L,P<0.01].亚临床甲减患者血浆PON1活性与SOD呈显著正相关(r=0.302,P<0.05),与ox-LDL(r=-0.398,P<0.01)及MDA(r=-0.401,P<0.01)呈显著负相关.结论 亚临床甲减患者活性氧(ROS)产生的增加导致氧化环境的改变,可能使血浆PON1活性显著降低.PON1可能通过降低抗氧化能力机制参与了亚临床甲状腺功能减退症的病理、生理过程.     

心衰与屏氧酶活性

目的 :探讨慢性充血性心力衰竭时血清屏氧酶活性的变化。方法 :用苯醋酸作为底物测定心衰组和非心衰组患者血清屏氧酶活性。结果 :心衰组患者血清屏氧酶活性显著降低 ;经治疗 14天后心衰组患者血清屏氧酶活性明显上升 ;心衰时屏氧酶活性与肿瘤坏死因子 α呈负相关。结论 :心衰患者屏氧酶活性显著下降     

糖尿病患者糖化血红蛋白和Lp(a)水平关系研究

目的:探讨Ⅱ型糖尿病血糖控制欠佳时,糖化血红蛋白(GHb)与Lp(a)浓度的关系。方法:采用免疫浊度法对20例GHb(HbA1c)高于正常的Ⅱ型糖尿病患者和20例正常对照组的血浆Lp(a)进行测定。结果:GHb升高组和正常对照组的Lp(a)分布均呈偏态;GHb升高组Lp(a)显著高于对照组(p<0.01);根据HbA1c水平,将GHb升高组分成三组,三组间Lp(a)的水平差异无统计学意义(p>0.05);相关分析发现Lp(a)与HbA1c无相关性(p>0.05)。结论:Ⅱ型糖尿病GHb的升高对Lp(a)水平无影响。     

心衰与屏氧酶活性

目的：探讨慢性充血性心力衰竭时血清屏氧酶活性的变化。方法：用苯醋酸作为底物测定心衰组和非心衰组患者血清屏氧酶活性。结果：心衰组患者血清屏氧酶活性显著降低；经治疗14天后心衰组患者血清屏氧酶活性明显上升；心衰时屏氧酶活性与肿瘤坏死因子－α呈负相关。结论：心衰患者屏氧酶活性显著下降。     

Correlation between 1,5-anhydroglucitol and glycemic excursions in type 2 diabetic patients

Background  The accurate and comprehensive assessment of glycemic control in patients with diabetes is important for optimizing glycemic management and for formulating personalized diabetic treatment schemes. This study aimed to analyze the correlation between 1,5-anhydroglucitol (1,5-AG) and glycemic excursions in type 2 diabetic patients.

Methods  Seventy-one outpatients with type 2 diabetes mellitus were randomly recruited from Chinese People’s Liberation Army General Hospital. Using a continuous glucose monitoring system (CGMS), these patients’ blood glucose levels were monitored for three consecutive days to obtain mean blood glucose (MBG) data. Intraday glycemic excursions were evaluated using the mean amplitude of glycemic excursions (MAGE), the largest amplitude of glycemic excursions (LAGE), standard deviation of blood glucose (SDBG) and the M-value. Interday glycemic excursion was assessed by absolute mean of daily difference (MODD). Postprandial glycemic fluctuations were evaluated using postprandial glucose excursions (PPGE) and postprandial incremental area under the curve (iAUC). Fasting venous blood samples were collected to measure serum 1,5-AG, whole-blood hemoglobin A1c (HbA1c) and serum glycated albumin (GA). Clinical markers of glycemia and parameters of glycemic excursions from CGMS were analyzed using the Pearson correlation coefficient and multivariate stepwise regression.

Results  Pearson correlation analysis revealed that 1,5-AG was significantly correlated with MAGE, SDBG, M-value, LAGE, PPGE and iAUC (r values were –0.509, –0.430, –0.530, –0.462, –0.416 and –0.435, respectively, P <0.01), especially in moderately and well-controlled patients, based on defined HbA1c levels. Multivariate stepwise regression analysis revealed a negative correlation between 1,5-AG and the above parameters, but not HbA1c and GA. Finally, HbA1c and GA were positively correlated with MBG and fasting blood glucose (FBG).

Conclusions  1,5-AG was much better than HbA1c and GA as a marker of glycemic excursions in type 2 diabetic patients. Based on these results 1,5-AG is the best metric for assessing postprandial glucose levels in moderately and well-controlled patients, while HbA1c and GA were superior to 1,5-AG for monitoring MBG and FBG.

     

Serum monocyte chemoattractant protein-1 and monocyte adhesion molecules in type 1 diabetic patients with nephropathy

BACKGROUND: Monocyte chemoattractant protein (MCP)-1 is suggested to be implicated in the pathogenesis of diabetic nephropathy by activating and recruiting monocytes to the glomerulus via regulation of adhesion molecule expressions. The aim of this study was to test potential associations between serum concentrations of MCP-1, monocyte expression of Mac-1 and LFA-1 and nephropathy in type 1 diabetes mellitus. METHODS: Serum MCP-1 levels and expression of monocyte adhesion molecules in 51 type 1 diabetic patients with and without diabetic nephropathy were compared with matched 15 healthy control subjects. Concentrations of serum MCP-1 were determined by enzyme-linked immunosorbent assays whereas monocyte expression of adhesion molecules Mac-1 and LFA-1 was measured by flow cytometry. RESULTS: Serum MCP-1 levels and expression of Mac-1, but not LFA-1, were significantly higher in diabetic patients compared with controls. The mean serum MCP-1 level was 137.2 +/- 71.4 pg/mL in control patients, whereas it was 246.2 +/- 114.9 pg/ml in diabetic patients (p = 0.002). Serum MCP-1 levels were positively correlated with HbA1c and plasma fasting glucose levels. There was no difference in serum levels of MCP-1 and expression of monocyte adhesion molecules between type 1 diabetic patients with and without diabetic nephropathy. CONCLUSIONS: In type 1 diabetic patients, the levels of circulating MCP-1 concentration and expression of Mac-1 is mostly influenced by glycemic control rather than the existence of diabetic nephropathy.     

HbA_(1c)的临床应用及检测的标准化进展

糖化血红蛋白A1c(HbA1c)是目前国际公认的糖尿病患者血糖控制的"金标准",监测中长期血糖控制和评估糖尿病并发症的风险,而且在糖尿病预测、诊断等方面也具有重要价值。近年来,提高HbA1c检测的准确性和可比性,加速HbA1c检测方法的标准化成为关注的焦点。目前,我国HbA1c标准化水平还处在初级阶段,不同实验室的检测结果差异较大。因此,进一步规范糖化血红蛋白的检测,提高其检测标准化水平对于改善我国糖尿病管理具有重要意义。     

Study of oxidative stress in type 2 diabetic patients and its relationship with glycated hemoglobin

OBJECTIVE: To evaluate the activity of antioxidant enzymes in diabetic patients and also to determine the correlation between hyperglycemia and lipid peroxidation. METHODS: Thirty patients with type 2 diabetes and 30 healthy individuals control group participated in this case-control study. The patients were referred to Sina Hospital, Hamadan, Iran from April to June 2006. Glycated hemoglobin HbA1c was measured as a marker of hyperglycemia using the chromatography method Biosystem and malondialdehyde MDA was determined using the colorimetric method. Glutathione peroxidase GPx and superoxide dismutase SOD activity were assessed using the UV-Vis spectrophotometric technique Randox kit. RESULTS: The mean of HbA1c was higher in diabetic patients compared to the healthy group, and the difference was statistically significant p<0.001. Serum MDA in diabetics was higher compared to those of healthy subjects p<0.001. There were significant differences in activities of SOD and GPx between the 2 studied groups indicating lower activity in diabetic patients p<0.001. There was a significant relationship between MDA and HbA1c in diabetic and healthy subjects. CONCLUSION: The data showed an increase in lipid peroxidation and oxidative stress in diabetes and also indicated a positive correlation between the degree of hyperglycemia and oxidative stress. Evaluation of oxidative status and choosing the appropriate treatment may help to support antioxidant defense in these patients.     

人血清对氧磷酶活性测定方法的建立及临床初步应用

目的建立对氧磷酶（ｐａｒａｏｘｏｎａｓｅ,ＰＯＮ）活性测定方法,调查正常人及肝病患者（肝癌与肝硬化）血清ＰＯＮ活性。方法ＰＯＮ活性测定用分光光度法,同时检验批内差异、批间差异、重复性、线性关系及回收率。结果正常人血清ＰＯＮ活性平均值为１５４．３ｋＵ／Ｌ,参考值范围为８２．１～２２０．６ｋＵ／Ｌ,肝病患者ＰＯＮ活性平均值为８１．１ｋＵ／Ｌ。结论肝病患者血清ＰＯＮ活性较正常人明显下降,其差别有显著性（Ｐ＜０．０１）。     

糖化血红蛋白、超氧化物歧化酶、胱抑素C、β2-微球蛋白联合检测对糖尿病患者的临床意义

目的探讨对糖尿病患者的糖化血红蛋白（HbA1c）、超氧化物歧化酶（SOD）、胱抑素C（Cys-C）、β2-微球蛋白（β2-MG）联合检测的临床意义。方法对100例糖尿病患者、50例健康人群的HbA．C、SOD、肌酐（cr）、尿素氮（BUN）、Cys-C、β2-MG含量进行测定。结果（1）糖尿病患者的HbA1c、BUN、Cr、Cys-C和β2-MG指标均显著高于健康对照组,而SOD指标则显著低于健康对照组,与健康对照组比较,差异均有统计学意义（P〈0．05）。（2）根据糖尿病患者的HbA1c水平不同,将其分为两组。HbAlc≤7．0％者为第1组,HbA1c〉7．0％为第2组;第1组患者的HbA1c、BUN、Cr、Cys-C和β2-MG检测指标较第2组低,而SOD指标较第2组高,两组上述指标比较,差异也有统计学意义（P〈0．05）。（3）两组糖艰病患者的SOD、Cys-C、β2-MG的阳性检出率均高于本组BUN、Cr的阳性榆出率,且第2组各项指标的阳性检出率均大于第1组和健康对照组的阳性检出率,差异有统计学意义（P〈0．05）。结论对糖尿病患者的HbA1c、SOD、Cys-C、β2-MG指标进行联合检测有助于糖尿病肾病的早期诊断。     

高的血糖达标值知晓率可以提高糖化血红蛋白达标率

目的: 探讨和分析影响血糖的可控因素。方法: 采用横断面研究方式,选择已确诊3个月以上的糖尿病患者430人,通过调查问卷的形式收集其人口统计学资料、临床及其他可能与血糖控制相关的资料,同时收集其血液标本测定糖化血红蛋白值(HbA1c)。采用多元线性回归分析与单因素回归分析方法进行统计分析,分析各因素对HbA1c控制达标的影响。结果: 430例糖尿病患者HbA1c为(8.7±2.6)%,34%的糖尿病患者HbA1c≤7.0%。单因素回归分析发现年龄越大、参加糖尿病教育、更高频率的血糖监测、对血糖控制目标的知晓、更好的公共卫生环境、拥有血糖仪的患者HbA1c控制较好,但是升级的治疗方法,如胰岛素治疗的患者HbA1c控制较差。多元线性回归分析发现年龄越大、参加糖尿病教育、更高频率的血糖监测、对血糖控制目标的知晓是HbA1c的保护因素,升级的治疗方法是HbA1c的危险因素。结论: 对血糖控制目标的知晓、参加糖尿病教育、更高频率的血糖监测是有利于HbA1c达标的可控因素,且提高血糖控制目标的知晓率可能是降低患者HbA1c最简单有效的方法。     

动态血糖监测在糖尿病治疗中的意义及其与同型半胱氨酸的相关性

目的探讨动态血糖监测在2型糖尿病治疗中的意义及其与同型半胱氨酸（Hcy）的相关性。方法应用动态血糖监测系统（CGMS）了解健康人群及不同并发症的糖尿病患者血糖波动的情况,并与Hcy水平进行比较。结果糖尿病患者日内平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、标准差（SD）、血糖波动次数（NGE）、最大血糖波动幅度（LAGE）明显高于对照组（均P＜0.01）,且有并发症组患者显著高于无并发症组（均P＜0.05）;平均血糖（MBG）与HbA1c呈正相关（P＜0.01）,而MAGE与HbA1c无关（P＞0.05）。2型糖尿病患者的血浆Hcy高于对照组（P＜0.01）。结论血糖波动是独立于HbA1c之外的糖尿病慢性并发症的危险因子,Hcy的水平与糖尿病慢性并发症相关。     

老年2型糖尿病患者血糖漂移与糖化血红蛋白相关性分析

目的 动态监测老年2型糖尿病患者日内血糖波动情况,探讨血糖漂移与糖化血红蛋白（HbA1c）及糖尿病慢性并发症的关系.方法 以70例老年2型糖尿病患者作为研究对象,其中35例伴糖尿病肾病,30例伴糖尿病视网膜病变.采用动态血糖监测系统（CGMS）进行连续72 h血糖监测,考察日内不同时点血糖水平、不同时段血糖漂移、餐后血糖漂移（PPGE）、平均血糖漂移幅度（MAGE）和24 h平均血糖水平（24h MBG）.Pearson法分析患者HbA1c与血糖漂移的相关性,多元Logjstic回归分析与糖尿病肾病和糖尿病视网膜病变发生相关的影响因素.结果 HbA1c与日内7个时点血糖水平、24 h MBG及3：00～6：00、19：00～20：00时段血糖漂移呈显著正相关（P＜0.05或P＜0.01）,与PPGE无明显相关（P＞0.05）;MAGE与13：00、19：00时点血糖水平和PPGE均呈显著正相关（P＜0.05）.0：00～3：00时段血糖漂移是糖尿病视网膜病变发生的影响因素（P＜0.05）.结论 CGMS能较详细地显示日内血糖波动情况.HbA1c能反映日内整体血糖水平.日内血糖波动主要归因于PPGE和夜间血糖漂移.糖尿病视网膜病变的发生可能与血糖漂移有关.