抗甲状腺药物与甲状腺功能亢进症所致肝功能异常的临床分析

目的比较抗甲状腺药物(ATD)与甲状腺功能亢进症所致肝功能异常的临床特点。方法回顾性分析43例甲状腺功能亢进症合并肝功能异常患者,将其分为对照组(甲状腺功能亢进症性肝损害)24例和试验组(ATD致肝损害)19例。比较2组患者的肝损害临床表现、肝功能、甲状腺激素水平、治疗及转归等指标。结果试验组和对照组出现肝损害临床表现分别为10.53%(2例/19例)和16.67%(4例/24例),差异无统计学意义(P>0.05)。试验组和对照组的谷丙转氨酶(ALT)升高比例分别为94.74%和100.00%,谷草转氨酶(AST)升高比例分别为94.74%和91.67%。试验组和对照组的血清ALT分别为121.00和89.00 U·L^-1,AST分别为78.00和60.50 U·L^-1,差异均有统计学意义(均P<0.05)。结论甲状腺功能亢进症致肝损害和ATD致肝损害患者多数无明显症状,诊断依赖于肝功能监测,ALT和AST是敏感指标,甲状腺功能亢进症致肝损害比ATD致肝损害生化异常更轻。     

对2型糖尿病患者肾小球滤过功能的评价

目的评价临床上常用的测定肾小球滤过率（GFR）的指标在2型糖尿病患者的适用性。方法2型糖尿病患者60例，以体表面积标准化的双血浆法^99Tc^m-DTPA血浆清除率测定值（rGFR）作为测定GFR的参考指标，比较血肌酐（Scr）、肌酐清除率（Ccr）、^99Tc^m-DTPA肾动态显像法（gGFR）、基于Scr的GFR评估方程7（MDRD 7）以及血清半胱氨酸蛋白酶抑制剂C（cystatin C，Cys C）等多种方法与rGFR的相关性，测定上述方法在反映2型糖尿病患者肾功能减退的特异性和敏感性，用受试者工作特征曲线（ROC）评价上述指标检测肾小球滤过功能的准确性。结果2型糖尿病患者60例，其中男35例，女25例，年龄（62．4±11．7）岁，病史（10．66±9．35）年，Scr、Ccr、gGFR、MDRD 7及Cys C测定结果均与gGFR呈显著相关（r分别为-0．500、0．675、0．367、0．428及-0．588，P均〈0．001），其中Ccr与rGFR值相关性最好，其次为Cys C。Ccr、MDRD方程7及Cys C在判断GFR下降时的敏感度较高（分别为82．1％、85．7％及85．7％），显著高于Scr及gGFR方法（10．7％及46．6％，P〈0．01）；Scr在判断GFR下降时的特异度为100％，显著高于MDRD方程7的特异度（25．0％，P〈0．01）。Cys C和Ccr的受试者工作特征曲线（ROC）下面积显著高于Scr，MDRD方程7和gGFR。Cys C的最佳判定域值为1．18mg／L，该域值的敏感度和特异度分别为80％和57．5％；Ccr的最佳判定域值为62ml／min，该域值的敏感度和特异度分别为90％和67．9％。结论Ccr和Cystatin C能够较理想地反映2型糖尿病患者GFR的变化。     

GLP-1受体激动剂临床应用专家指导意见

正胰升血糖素样肽1(GLP-1)受体激动剂属于肠促胰素类药物,近年来在T2DM治疗领域得到了越来越广泛的应用。2005年,国际上第一个GLP-1受体激动剂成功上市,其后10余年来,随着研发的不断深入和循证医学证据的逐渐积累,该类药物在T2DM治疗中的地位不断得到提升。美国、欧洲等多个糖尿病指南~([1-2])均将GLP-1受体激动剂列为二线治疗选择,美国临床内分泌医师协会(AACE)联     

2009-2012年我国2型糖尿病患者药物治疗与血糖控制状况调查

目的 了解近4年我国T2DM患者血糖控制状况及治疗情况变化。 方法 由中华医学会糖尿病学分会“糖化血红蛋白监测网”项目组于2009-2012年连续4年在全国范围内选择各省/市具有代表性的重点医院门诊就诊的T2DM患者参加本横断面研究，按照《数据采集标准操作流程（SOP）》询问患者。收集了解患者人口学信息、治疗方案、血糖控制情况，并填写至《监测网登记表》。以HbAlc〈7.0%为达标。所有数据采用描述性统计分析。 结果 2009-2012年参加调研的T2DM患者分别为143123、172199、238656和223114例;至少有1种伴随疾病比例分别为63.8%、54.7%、52.1%和48.6%;平均HbAlc水平分别为7.97%、7.89%、7.85和7.74%;HbAlc达标率分别为35.28%、32.33%、31.77%和30.15。最常见的合并伴随疾病为高血压和血脂异常。 结论 我国T2DM患者HbAlc总体达标率低;约50%的T2DM患者合并至少1种伴随疾病。因此，多重危险因素的综合干预策略尤为重要。     

让胰岛素治疗的教育和管理更加标准化和规范化——写于《中国糖尿病患者胰岛素使用教育管理规范》即将出版之际

<正>近20年来,随着经济的快速发展和人民生活水平的提高,糖尿病患病率急剧增加,糖尿病及其并发症日益严重地威胁着人类的健康。根据国际糖尿病联盟(International Diabetes Federation,IDF)统计,2000年全球的糖尿病患者为1.51亿,目前已增至2.85亿,如按目前的增长速度计算,     

中国门诊2型糖尿病患者口服药降糖达标状况调查及格列齐特缓释片优化治疗效果分析

Objective To evaluate the current state of glycemie control in Chinese patients with type 2 diabetes mellitus who have received oral antidiabetic agents in the out-patient clinic,and the efficacy and safety of optimized regiments of gliclazide modified-release tablets (Diamicron MR, SERVIER, Tianjin) in patients with failed glycemic control (HbA1c 6.5%). Methods The patients with type 2 diabetes were enrolled from 54 hospitals in more than 20 cities and received long-term (more than 3 months) oral antidiabetic agents. HbA1c was measured and the success rate of HbA1c reduction was evaluated. The patients who failed to achieve glycemic control (HbA1c 6. 5%) and received daily multiple-dosing insulin secretagogues were provided with the optimized treatment regimen, consisting of replacing daily multiple-dosing insulin secretagogues with single-dosing gliclazide sustained-release tablets. Clinical efficacy and safety were evaluated after three months treatment. Results The survey of glycemic control revealed that the mean HbA1c of 5 586 patients with diabetes mellitus was (7.97±2.89)% ,and the success rate (HbA1c≤6.5%) was 14. 1%. Further more, HbA1c decreased from (8.23±4.00)% before optimization to (6.86±2.24)% after optimization with the average decrement of 1.37% (P<0. 001) and the success rate was raised to 34. 1%. The gliclazide modified-release tablets were well tolerated by most patients, only 2.6% of whom were reported to experience unconfirmed hypoglycemia. Conclusion The success rate of glycemic control was low in Chinese out-patients with type 2 diabetes mellitus receiving oral antidiabetic agents in the clinic. The optimized regimen of gliclazide modified-release tablets taken once daily can down-regulate glycemic levels and increase the success rate of HbA1c reduction,and thus plays efficiently and safely a key role in the optimized management of type 2 diabetes mellitus.     

对一个Liddle综合征家系临床和上皮细胞钠通道基因突变的研究

目的 通过对1个Liddle综合征家系的临床表现及其上皮细胞钠通道β亚单位（hβENaC）基因的研究,揭示本家系发病的遗传机制,为诊断（尤其产前诊断）和治疗提供有力的保证。方法 （1）对家系成员进行常规体检及血钾、血浆肾素活性、醛固酮水平测定;（2）用单链变构多态性PCR－DNA测序等分子生物学方法对hβENaC基因进行分析。结果 在这个Liddle家系中发现了hβENaC基因（SCNN1B）的1个移码突变（1bp,INS,600G),8个成员携带此突变基因,他们均有严重的高血压、低醛固酮及低肾素活性。50个无关正常人中无突变基因。结论 在这个Liddle综合征家系中发现的hβENaC基因的移码突变很可能为此家系的致病基因。     

妊娠期高血糖患者产后糖代谢和脂代谢转归及其影响因素

目的 了解妊娠期不同程度高血糖患者产后6～12周糖代谢及脂代谢转归;分析影响妊娠期高血糖患者产后转归的相关因素;初步探讨国际妊娠合并糖尿病研究组近期提出的新的妊娠期糖尿病诊断标准对产后近期随访结果的影响.方法 通过对我院2007年1月1日至2009年12月31日分娩且于产后6～12周进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的262例妊娠期高血糖患者的临床资料进行分析,根据产后糖代谢及脂代谢状态进行分组,采用多因素Logistic回归模型对糖代谢及脂代谢影响因素进行分析,了解妊娠期高血糖患者产后6～12周糖代谢及脂代谢转归及相关因素.结果 (1)产后6～12周糖代谢异常检出率为35.1%(92/262),其中空腹血糖受损1例(0.4%),糖耐量受损81例(30.9%),空腹血糖受损+糖耐量受损4例(1.5%),糖尿病6例(2.3%).(2)Logistic回归模型分析显示,妊娠期高血糖诊断孕周,早孕期OGTT 2 h及3 h血糖值高均为产后6～12周发生糖代谢异常的危险因素,产后母乳喂养为保护因素,OR值及95%CI分别为0.824(0.724～0.941)、1.521(1.196～1.934)、1.272(1.047～1.547)、0.408(0.181～0.918).(3)250例妊娠期高血糖患者在产后6～12周进行血脂检测,产后脂代谢异常的发生率为63.2%(158/250),在血脂异常的患者中,最常见的是高胆固醇血症126例(50.4%),其次分别为高低密度脂蛋白胆固醇血症,共102例(40.8%),高甘油三酯血症60例(24.0%),低高密度脂蛋白胆固醇血症11例(4.4%).(4)Logistic回归模型分析显示,孕期OGTT 2 h血糖水平高为产后发生脂代谢异常的危险因素,OR=1.364(95%CI:1.063～1.751);孕期高密度脂蛋白胆固醇水平高为保护因素,OR=0.379(95%CI:0.169～0.851).结论 妊娠期高血糖患者产后6～12周存在糖、脂代谢异常.妊娠期高血糖发现孕周早以及孕期OGTT 2 h及3 h血糖值高均为产后发生糖代谢异常的危险因素,产后母乳喂养为保护因素.孕期OGTT 2 h血糖值高为产后发生脂代谢异常的危险因素,孕期高密度脂蛋白胆固醇水平高为保护因素.

Abstract：

Objective (1) To investigate the glucose and lipid metabolism 6-12 weeks after delivery in women with hyperglycemia during pregnancy. (2) To find out factors associated with the prognosis of women with hyperglycemia during pregnancy. (3) To investigate the feasibility of the diagnostic criteria set by the International Association of Diabetes and Pregnancy Study Group according to the follow-up data of women with hyperglycemia in pregnancy. Methods Clinical data of 262 women with hyperglycemia during pregnancy delivered in our hospital from January 1, 2007 to December 31, 2009 were collected. All patients underwent oral glucose tolerance test (OGTT) at 6-12weeks after delivery. They were divided into two groups according to the postnatal status of glucose and lipid metabolism. Multivariate Logistic regression model was used to analyze the factors affected glucose and lipid metabolism after 6-12 weeks of delivery. Results (1) Among the 262 women, 92(35.1%) were reported with abnormal glucose metabolism at 6-12 weeks of delivery, including one (0. 4 % ) woman with impaired fasting glucose, 81 (30. 9 % ) with impaired glucose tolerance, 4( 1.5 % )with impaired fasting glucose+impaired glucose tolerance and 6 (2. 3%) with diabetes mellitus.glucose levels in OGTT (OGTT 2hPG and the OGTT 3hPG) were risk factors for postpartum 0. 181-0. 918)]. (3) All markers of lipid metabolism were detected in 250 women with hyperglycemia during pregnancy at 6-12 weeks after delivery, the rate of abnormal postnatal lipid metabolism was 63.2%(158/250). In the abnormal group (n= 174), the most common abnormal marker was hypercholesterolemia (n = 126, 50. 4 % ), followed by high levels of low-density lipoprotein-cholesterol (n = 102, 40. 8 %), hypertriglyceridemia (n= 60, 24. 0 %) and low levels of high-density lipoproteincholesterol (n= 11, 4. 4 %). (4) Logistic regression model showed that elevated OGTT 2hPG was the risk factor for postpartum abnormal glucose metabolism [OR= 1. 364 (95%CI: 1. 063-1. 751)], while 0. 169-0. 851)]. Conclusions Women with hyperglycemia during pregnancy are more likely to present with abnormal glucose and lipid metabolism which commonly coexisted with insulin resistance.The risk factors for the postpartum abnormal glucose metabolism in mothers with hyperglycemia during pregnancy include early diagnosis, OGTT 2hPG and OGTT 3hPG, while the protective factor is breastfeeding. The risk factor for the postpartum dyslipidaemia in mothers with hyperglycemia during pregnancy is OGTT 2hPG, while the protective factor is high-density lipoprotein-cholesterol level in pregnancy.     

年轻肥胖患者的2型糖尿病治疗

关键词显示肥胖型2型糖尿病患者服用二甲双胍后出现恶心、呕吐、口腔异味等不良反应,改服格列美脲后因出现饥饿、体重增加而服用二甲双胍肠溶胶囊(君力达).一个月后随访观察,无明显不适症状,体重减少5kg,血糖水平稳定,糖化血红蛋白为6%,血脂恢复正常,脂肪肝明显好转.     

血脂变化对OLETF糖尿病大鼠肾小球细胞外基质成分含量的影响

目的：采用OLETF大鼠来观察血脂变化对2型糖尿病鼠肾小球细胞外基质含量的影响。方法：实验动物分为三组即正常对照组，糖尿病和非诺贝特治疗的糖尿病组，非诺贝特20mg.kg^-1.d^-1灌胃22周，用免疫组化的方法检测肾小球细胞外基质成分含量的变化，结果：糖尿病组血清总胆固醇，甘油三酯，极低密度脂蛋白和高密度脂蛋白水平明显高于正常对照（P＜0．05），同时细胞外基质成分（Ⅳ型胶原，层粘连蛋白，纤维连接蛋白）含量亦较正常对照组增加（三者P＜0．01），降脂治疗后肾脏细胞外基质积聚明显减少（与糖尿病未治疗组比P＜0．05），结论：高脂血症可能与糖尿病肾小球硬化的发生有关，降脂治疗能够减缓肾脏的损害从而起到保护肾脏的作用。