2型糖尿病患者口服药物治疗现况分析

目的：分析顺德地区2型糖尿病患者口服药物治疗的血糖控制情况,并分析不良影响因素,为本地区2型糖尿病的防治工作提供必要参考。方法2010年9月~2012年12月,选择顺德地区2型糖尿病患者进行研究,以调查问卷方式收集其基本资料,分别将HbA1c≤6.5%及HbA1c<7%作为血糖控制达标标准,比较不同年龄、病程、文化程度、治疗方案等患者的血糖控制达标率,并对血糖达标的影响因素进行Logistic回归分析。结果总达标人数为126例,占63.00%,未达标74例,占37.00%;≥70岁患者的未达标率为56.25%,显著高于<70岁患者的27.94%;病程>10年患者的未达标率为72.41%,显著高于<5年、5~10年的21.95%、39.33%;未接受教育患者的未达标率更高,占43.59%,显著高于受过高等教育的13.64%;3种药物联合使用的未达标率为68.42%,显著高于单药及2种药物联合的43.68%、24.47%(P<0.05);Logistic回归结果分析显示,年龄、联合用药时间、合理饮食、运动、教育与否是影响血糖达标的独立危险因素。结论顺德地区2型糖尿病患者口服药物的血糖达标率有待提高,影响达标率的主要因素包括年龄、运动、饮食、受教育程度,上述因素需引起重视。     

依达拉奉联合依帕司他治疗糖尿病周围神经病变的疗效观察

目的:探讨依达拉奉联合依帕司他治疗糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的临床疗效.方法:将87例糖尿病周围神经病变患者随机分为两组,治疗组采用依达拉奉联合依帕司他治疗,对照组采用甲钴胺治疗.观察临床疗效及肌电图变化.结果:治疗组总有效率明显高于对照组(P＜0.05),治疗组感觉神经传导速度及运动神经传导速度均明显高于对照组(P＜0.05).结论:依达拉奉联合依帕司他治疗糖尿病周围神经病变效果优于甲钴胺.     

甲巯咪唑致粒细胞缺乏合并甲亢危象7例临床分析

目的：分析甲巯咪唑致粒细胞缺乏合并甲亢危象患者的临床特点与治疗方法。以提高对此类疾病的抢救治疗水平。方法：对2003年9月至2009年12月我院住院的符合甲巯咪唑致粒细胞缺乏合并甲亢危象患者的病例资料进行分析。结果：7例患者,男2例,女5例,粒细胞计数：0．01～0．1×10 9／L,Burch甲亢危象定量评分：55～95分,所有病例停用甲巯咪唑,并予碘剂、心得安、广谱抗生素、重组人粒细胞集落刺激因子、肾上腺皮质激素等治疗。5例治愈,1例失访,1例死亡。结论：①甲巯咪唑致粒细胞缺乏合并甲亢危象病情重,死亡率高,抢救的关键是早期诊断,停用抗甲状腺药物,尽早使用糖皮质激素并及时应用碘剂、β-肾上腺素能受体阻滞剂、控制感染及升白细胞治疗。（参甲亢治疗初期应密切监测白细胞计数和分类。     

腹型肥胖者下丘脑-垂体-肾上腺轴功能改变及其与胰岛素抵抗的关系

本文主要介绍了腹型肥胖者下丘脑-垂体-肾上腺轴(HPA轴)功能改变及其与胰岛素抵抗的关系的研究进展。近年的研究认为在有遗传易感性的个体，长期心理、社会、经济的应激作用可导致HPA轴功能紊乱，并与胰岛素抵抗及2型糖尿病、冠心病有密切关系。     

精氨酸刺激试验与胰高血糖素刺激试验对β细胞功能评估的比较

通过对68例2型糖尿病患者进行精氨酸刺激试验(AST)和胰高血糖素刺激试验(GST)，比较其对胰岛β细胞功能的评价，发现精氨酸刺激后C肽于3min达高峰，此峰值与胰高血糖素刺激后6min C肽差异无统计学意义，而且以精氨酸刺激试验3min C肽是否大于0.6nmol／L作为选择治疗方案的参考(与GST结果接近)，与临床符合情况较好。     

精氨酸刺激试验评估胰岛β细胞功能的临床价值

目的 研究精氨酸刺激试验评估糖尿病患者胰岛β细胞功能的价值.方法 21例Ⅰ型糖尿病患者(DM1组)及113例2型糖尿病患者(DM2组)[分为DM2a组(病程≤1年)58例和DM2b组(病程>1年)55例两个亚组]分别行精氨酸刺激试验,测定空腹及注射精氨酸后2、3、4、5min C肽水平,评估胰岛β细胞功能及临床治疗的符合率.结果 DM1组精氨酸刺激后C肽与空腹C肽比较差异无统计学意义(P>0.05),DM2组精氨酸刺激后C肽于3 min达高峰,与空腹C肽比较差异有统计学意义(P<0.01);空腹C肽、精氨酸刺激后C肽水平DM2a组>DM2b组>DM1组;DM1组3 min C肽均<600 pmol/L,全部需胰岛素治疗,符合率为100.0%,DM2组3 min C肽≥600pmol/L者可饮食控制或口服降糖药治疗的符合率为93.4%(85/91),3minC肽<600pmol/L者需胰岛素治疗的符合率为86.4%(19/22).结论 精氨酸刺激试验是一种简单可行、方便、安全性好的评估糖尿病患者胰岛β细胞功能的方法.建议今后临床可考虑以精氨酸刺激试验3 min C肽水平作为鉴别Ⅰ型及2型糖尿病,并以是否≥600 pmol/L作为2型糖尿病指导治疗的参考.     

利拉鲁肽联合二甲双胍治疗2型糖尿病合并肥胖症的临床疗效探讨

目的探讨应用利拉鲁肽联合二甲双胍治疗2型糖尿病合并肥胖症患者的临床效果及安全性。方法选取2013-06~2015-05收治的2型糖尿病合并肥胖症患者62例为研究对象,通过随机数字表法分为观察组和对照组,每组31例。对照组给予二甲双胍治疗,观察组在对照组基础上加用利拉鲁肽,治疗12周。观察两组患者血糖、体重控制情况及不良反应发生情况。结果治疗前两组患者各项指标差异均无统计学意义(P均0.05),治疗后观察组空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白、腰臀比及体质量指数(BMI)均明显低于对照组,差异有统计学意义(P均0.05)。观察组和对照组治疗期间不良反应发生率分别为9.68%和6.45%,差异无统计学意义(P0.05),均未出现严重不良反应。结论 2型糖尿病合并肥胖症患者给予利拉鲁肽联合二甲双胍治疗,能有效控制血糖,改善体质量,且安全性高,值得推广。     

精氨酸刺激试验评估胰岛β细胞功能的临床价值

Objective To investigate the value of intravenous arginine stimulation test (AST) in evaluating function of pancreatic islet beta cell response in patients of diabetes mellitus. Methods Twentyone patients with type 1 diabetes mellitus (DM1, DM1 group) and 113 patients with type 2 diabetes mellitus (DM2, DM2 group) were recruited in this study. DM2 patients were divided into two sub-groups, DM2a group (duration of no more than 1 year, 58 patients) and DM2b group (more than 1 year, 55 patients). The serum levels of C-peptide (CP) were determined at fasting and 2,3,4,5 minutes after intravenous injection of 5 g arginine. Results In DM1 group, the level of CP after injection of arginine was. similar to the fasting level (P> 0.05 ). In DM2 group, the peak level of CP appeared at 3th minute (CP3) during AST, and was significantly higher than fasting CP level(P < 0.01 ). The level of fasting and arginine-stimulated CP in DM2a group was significantly higher than that in DM2b group, and the level of fasting and arginine-stimulated CP in DM2b group was significantly higher than that in DM1 group. The patients of DM1 group whose level of CP3 < 600 pmol/L all needed insulin injection to control hyperglycemia, and the coincident rate was 100.0%.In DM2 group, there were 91 patients whose CP3 ≥600 pmol/L, among which 85 patients could be well controlled with diet or oral hypoglycemic agents, and the coincidentrate was 93.4%; there were 22 patients whose CP3 < 600 pmol/L, among which 19 patients need insulin injection to control hyperglycemia, and the coincident rate was 86.4%. Conclusions AST is valuable in assessing the function of pancreatic islet beta cell in patients with diabetes mellitus. The level of CP3 ≥600 pmol/L can be considered as a reference in diagnosis and treatment of diabetes mellitus.     

精氨酸刺激试验评估胰岛β细胞功能的临床价值

Objective To investigate the value of intravenous arginine stimulation test (AST) in evaluating function of pancreatic islet beta cell response in patients of diabetes mellitus. Methods Twentyone patients with type 1 diabetes mellitus (DM1, DM1 group) and 113 patients with type 2 diabetes mellitus (DM2, DM2 group) were recruited in this study. DM2 patients were divided into two sub-groups, DM2a group (duration of no more than 1 year, 58 patients) and DM2b group (more than 1 year, 55 patients). The serum levels of C-peptide (CP) were determined at fasting and 2,3,4,5 minutes after intravenous injection of 5 g arginine. Results In DM1 group, the level of CP after injection of arginine was. similar to the fasting level (P> 0.05 ). In DM2 group, the peak level of CP appeared at 3th minute (CP3) during AST, and was significantly higher than fasting CP level(P < 0.01 ). The level of fasting and arginine-stimulated CP in DM2a group was significantly higher than that in DM2b group, and the level of fasting and arginine-stimulated CP in DM2b group was significantly higher than that in DM1 group. The patients of DM1 group whose level of CP3 < 600 pmol/L all needed insulin injection to control hyperglycemia, and the coincident rate was 100.0%.In DM2 group, there were 91 patients whose CP3 ≥600 pmol/L, among which 85 patients could be well controlled with diet or oral hypoglycemic agents, and the coincidentrate was 93.4%; there were 22 patients whose CP3 < 600 pmol/L, among which 19 patients need insulin injection to control hyperglycemia, and the coincident rate was 86.4%. Conclusions AST is valuable in assessing the function of pancreatic islet beta cell in patients with diabetes mellitus. The level of CP3 ≥600 pmol/L can be considered as a reference in diagnosis and treatment of diabetes mellitus.