2010至2012年31省2120131名育龄妇女孕前营养指标趋势分析

目的 分析2010至2012年中国育龄妇女孕前营养状况的变化趋势.方法 研究人群为2010年1月1日至2012年12月31日参加“国家免费孕前优生健康检查项目”覆盖的31个省、市、自治区220个试点县的21～49岁育龄妇女,共2 120 131人.研究孕前营养指标主要包括体质量指数(BMI)、血红蛋白含量(HB)和空腹血糖(FBG).结果 2010至2012年总体上中国育龄妇女孕前平均HB含量持续升高,而孕前平均BM1和FBG水平呈逐年下降趋势.将3个孕前营养指标测定的结果均分为4类,各类构成人群均主要分布在25 ～34岁年龄组.孕前低BMI人群发生率逐年增加,从2010年10.4％(31 649/304307)增加到2012年14.14％(114 159/807 131);孕前超重人群及肥胖人群均在2012年发生率最低,分别为10.65％(85 984/807 131)和2.32％(18 735/807 131).孕前低血糖发生率由2010年5.45％(16 581/304307)降至2012年5.23％(42 199/807 131);孕前空腹血糖受损及糖尿病发生率逐年降低,分别从2010年3.17％ (9 652/304 307)和1.64％(4 982/304307)降至2012年2.71％(21 875/807 131)和1.05％(8 505/807 131).孕前轻度及中重度贫血的发生率在逐年下降,分别从2010年12.29％和0.95％降至2012年9.62％和0.78％;孕前高HB含量人群也呈现不断下降趋势.2010至2012年中国育龄妇女3个孕前营养指标的变化趋势在4个分类中均差异有统计学意义(P ＜0.001).结论 中国育龄妇女总体孕前营养状况良好,肥胖、贫血及糖尿病的发生率呈逐年下降趋势.     

Non-enzymatic glycosylation of serum proteins as an indicator of diabetic control

Summary In 44 diabetic patients treated either with insulin or with oral antidiabetic agents, non-enzymatic glycosylation of serum proteins (GSP), expressed as nmol of 5-hydroxymethylfurfural/mg protein, showed higher values than those found in control subjects. In the diabetics GSP was more closely correlated to the degree of glycometabolic control during the 15 days preceding the assay, than to the glycosylated hemoglobin (HbAl). However, GSP values did not correlate significantly with fasting blood glucose levels. It may be concluded that GSP can be used as an index of the medium-term control of diabetes mellitus.     

糖化血红蛋白在糖尿病诊断中的临床价值

目的：探讨糖化血红蛋白检测水平在糖尿病诊断中的临床价值。方法分别选择三组人群作为实验对象,分别是糖尿病确诊组（未治疗）、空腹血糖受损组、正常对照组,三组均进行空腹血糖（ FPG）及糖化血红蛋白（ HbA1c）测定,并对各组检测结果进行统计学分析。结果糖尿病确诊组与正常对照组 FPG、HbA1c比较差异有统计学意义（ P <0.01）,空腹血糖受损组与正常对照组比较 FPG差异有统计学意义（ P<0.05）,而 HbA1c差异未见统计学意义（ P>0.05）。结论 HbA1c检测水平对诊断糖尿病有价值,对空腹血糖受损人群无诊断价值,故不宜用此法筛查糖尿病的高危人群。     

非糖尿病患者血浆尿酸水平与空腹血糖关系的研究

目的探讨血清尿酸水平与中国非糖尿病患者空腹血糖的关系。方法 青岛港健康研究建立于1999至2000年,共15208例18岁以上港口职工参加。本研究来自于青岛港健康研究2000—2001年体检数据,13378例非糖尿病患者入选。所有研究对象进行了详细的问卷调查和体检。计算分性别的血清尿酸五分位数,将研究对象分成5组,观察各组空腹血糖水平。结果血浆尿酸水平高者的空腹血糖浓度升高。各组间空腹血糖浓度分别为：5．41±0．56mmol／L,5.38±0.58mmol／L,5．42±0．56mmol／L,5．46±0．57mmol／L,5．58±0.58mmol／L,呈逐级升离趋势,差异有显著性,偏相关分析显示,在校正了年龄、性别,吸烟、饮酒、血压、血脂、心血管病史后,血浆球酸水平与空腹血糖浓度仍然成正相关。结论非糖尿病患者中血清尿酸水平与空腹血糖显著相关。     

Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?

AimIn the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA_1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA_1c?MethodsEach patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as “high users” if the proportion of “informed” meals using the IDA exceeded 67% (median) and as “low users” if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA_1c levels.ResultsAmong the high users, the proportion of informed meals remained stable from baseline to the end of the study 6 months later (from 78.1 ± 21.5% to 73.8 ± 25.1%; P = 0.107), but decreased in the low users (from 36.6 ± 29.4% to 26.7 ± 28.4%; P = 0.005). As expected, HbA_1c improved in high users from 8.7% [range: 8.3–9.2%] to 8.2% [range: 7.8–8.7%] in patients with (n = 26) vs without (n = 30) the benefit of telemonitoring/teleconsultation (−0.49 ± 0.60% vs −0.52 ± 0.73%, respectively; P = 0.879). However, although HbA_1c also improved in low users from 9.0% [8.5–10.1] to 8.5% [7.9–9.6], those receiving support via teleconsultation tended to show greater improvement than the others (−0.93 ± 0.97 vs −0.46 ± 1.05, respectively; P = 0.084).ConclusionThe Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.     

NAFLD合并T2DM患者糖化血红蛋白和甲状腺激素水平的变化及其临床意义*

目的 探讨非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者糖化血红蛋白(HbA1C)和甲状腺激素水平的变化及其临床意义。方法 2017年4月～2019年3月我院内分泌科就诊的T2DM患者50例和NAFLD合并T2DM患者55例,检测人体学指标,采用电化学发光法检测空腹胰岛素(FINS)水平,采用胶体金法检测血糖化血红蛋白(HbA1C)水平,采用化学发光免疫分析法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)和促甲状腺激素(TSH)水平。结果 NAFLD合并T2DM患者体质指数(BMI)为(28.4±2.7)kg/m²,显著大于T2DM患者【(24.0±2.4)kg/m²,P<0.05】,NAFLD合并T2DM患者腰围为(94.5±8.5)cm,显著大于T2DM患者【(84.0±7.6)cm,P<0.05】,NAFLD合并T2DM患者臀围为(97.1±8.0)cm,显著大于T2DM患者【(89.7±7.2)cm,P<0.05】;NAFLD合并T2DM患者血清谷丙转氨酶(ALT)水平为(79.5±7.6)U/L,显著高于T2DM患者【(42.3±4.3)U/L,P<0.05】,NAFLD合并T2DM患者血清谷草转氨酶(AST)水平为(59.7±6.1)U/L,显著高于T2DM患者【(41.2±3.9)U/L,P<0.05】,NAFLD合并T2DM患者血清谷氨酰转肽酶(GGT)水平为(105.8±9.4)U/L,显著高于T2DM患者【(60.9±6.5)U/L,P<0.05】;NAFLD合并T2DM患者血甘油三酯(TG)水平为(4.2±1.7) mmol/L,显著高于T2DM患者【(2.4±0.9)mmol/L,P<0.05】,NAFLD合并T2DM患者空腹血胰岛素(FINS)水平为(12.0±2.5)mU/L,显著大于T2DM患者【(9.1±1.8)mU/L,P<0.05】;NAFLD合并T2DM患者血清TSH水平为(3.4±1.2)mU/L,显著大于T2DM患者【(1.9±0.8)mU/L,P<0.05】,而两组FT3和FT4水平无显著性差异(P>0.05)。结论 NAFLD合并T2DM患者BMI、肝功能指标、TG、FINS和TSH水平均显著增大或升高,与T2DM患者有明显的不同,在临床诊治过程中应当有所甄别,深入研究NAFLD患者发病机制对诊治将大有裨益。     

空腹血糖对中老年人群踝臂指数的影响

目的 探讨不同空腹血糖水平（FBG）对中老年人踝臂指数（ABI）的影响。方法 在2006年～2007年参加健康体检的101510例开滦集团职工中随机分层抽取5852例作为研究对象,进行统一问卷调查及血液生化检查,符合入选标准的为5440例。于2010年～2011年进行第三次健康体检并测量ABI,最终纳入统计分析的有效数据为5189例。根据美国糖尿病协会指南,按FBG将研究人群分成三组：理想血糖组（FBG＜5.6 mmol/L）、空腹血糖受损（IFG）组（5.6 mmol/L≤FBG＜7.0 mmol/L）、糖尿病组（FBG≥7.0 mmol/L或糖尿病患者）。对影响ABI的相关危险因素进行多因素Logistic回归分析。结果 理想血糖组、IFG组、糖尿病组ABI分别为1.10±0.09、1.09±0.11、1.08±0.13（P＜0.05）,ABI≤0.9的检出率分别为2.97%、4.74%、8.81%（P＜0.05）。多因素Logistic回归分析显示,糖尿病为ABI≤0.9的危险因素,其OR值为1.97（95% CI为1.32～2.96）;在女性人群中,IFG、糖尿病均为ABI≤0.9的危险因素,其OR值分别为2.26（95% CI为1.25～4.07）、2.37（95% CI为1.06～5.26）。结论空腹血糖是影响中老年人群ABI的独立危险因素,在女性人群中更加显著。     

健康体检者空腹血糖、胰岛素抵抗与血清谷氨酰转肽酶水平的相关性研究

目的 探讨健康体检者血清谷氨酰转肽酶（γ-GT）与FPG、IR间的关系. 方法 纳入793名健康体检者,根据FPG中位数5.42 mmol/L与胰岛素抵抗指数（HOMA-IR）中位数2.04,分为高FPG（HF）组和正常FPG（NF）组,IR组和IS组,比较各组γ-GT水平. 结果 HF、IR组γ-GT水平均高于NF、IS组（P＜0.01）.Spearman相关分析显示,γ-GT与FPG、FIns及HOMA-IR呈正相关.Logistic回归分析结果显示,FPG（OR=1.615,95％CI：1.208～2.158）、TG（OR=4.104,95％CI：2.650～6.357）、FIns（OR=2.866,95％CI：1.114～7.372）及饮酒情况（OR=3.068,95％CI：1.935～4.864）是γ-GT水平升高的危险因素. 结论 FPG、FIns与血清γ-GT水平相关,γ-GT可能成为T2DM发生风险的预测因素.     

Relationship and factors responsible for regulating fasting and post‐challenge plasma glucose levels in the early stage development of type 2 diabetes mellitus

Aims/Introduction

Elevation of 2-h plasma glucose (2-h PG) levels keeps step with fasting plasma glucose (FPG) levels elevation, but some individuals show dominant elevation of 2-h PG and others FPG. We analyzed dependent and independent relationships between 2-h PG and FPG, and investigated the factors regulating 2-h PG and FPG.

Materials and Methods

In 1,657 Japanese participants who underwent a 75-g oral glucose tolerance test at the initial examination for a medical check-up, we carried out simple linear regression analysis between 2-h PG and FPG levels on the three patterns of independent variables. We divided the participants into two subgroups: the 2-h PG-side group and the FPG-side from the regression line, and examined the relationships between 2-h PG-FPG and factors responsible for elevation of plasma glucose levels.

Results

There was a significant positive correlation between 2-h PG and FPG levels. The regression line of both 2-h PG and FPG as independent variables was in accordance with the regression line of 2-h PG as an independent variable and FPG as a dependent variable. In 2-h PG-side group, age was the independent factor affecting 2-h PG in addition to insulinogenic index and insulin sensitivity index (ISI composite). In the FPG-side group, triglyceride was the independent factor affecting FPG in addition to insulinogenic index and ISI composite.

Conclusions

Two-hour PG was an independent predictor of FPG. In addition to the importance of decreased insulin secretion and insulin sensitivity, age was the strong factor to elevate 2-h PG levels in the 2-h PG-side group and triglyceride was the strong factor to elevate FPG levels in the FPG-side group in the early stage of development of type 2 diabetes.