糖化血红蛋白在诊断糖尿病中的意义——过去、现在和未来

糖尿病是一种合并多种并发症的慢性代谢疾病,是引起患者工作或生活能力丧失、甚至死亡的主要原因.目前,我国糖尿病的患病率达9.7%,患者数量位居世界前列.糖尿病一旦出现慢性并发症后,往往医疗花费巨大,而治疗效果甚微.因此,糖尿病的早期诊断、早期治疗极为重要.空腹血糖(FPG)、口服葡萄糖耐量试验(OGTT)是诊断糖尿病的常用方法,但是无论是检测FPG还是进行OGTT均有时间及采样要求,需要空腹或多次取血,受试者的依从性较差,限制了其在临床的广泛应用,使得相当一部分患者不能得到及时诊断.HbA1C作为评估患者长期血糖控制状况的临床指标,与糖尿病慢性并发症密切相关.由于HbA1C的检测方便、易行,不受进餐时间以及短期生活方式改变的影响,变异性小,所反映的血糖状况相对稳定,故近年有部分专业学术组织将其引入到糖尿病的诊断领域,为临床医生提高糖尿病的诊断效率提供了新的补充方法.

Abstract：

Diabetes mellitus is a chronic metabolic disease with complications associated with long-term damage,dysfunction,and failure of various organs,and has become one of the leading causes of impairment of human health.At present,the prevalence of diabetes mellitus reaches 9.7%in China,which is considered one of the countries in the world with heavy diabetes burden.Patients with established diabetic complications will be at higher risk of poor health outcomes and with higsh healthcare costs.These realities support the critical need to identify diabetes and its precursors more efficiently and earlier.The current diagnostic criteria,fasting plasma glucose(FPG),and oral glucose tolerance test(OGYT),that require fasting and multiple blood samplings,may not be acceptable to patients and may limit the clinical application so as to impede the effort to diagnose diabetes in timely fashion.HbA1C,which accurately reflects longer term glycaemia,Can be done at any time without fasting or other preparation of the patient and may not be affected by short term lifestyle changes.Given the recognized need,some panels have been considering the possible utility of HbA1C as a supplementary screening tool to make the diagnosis of diabetes efficiently.     

Ballistocardiography: past, present and future

In this paper, an analysis is given of the present state of ballistocardiography. It is concluded that several aspects of the method have to be improved before successful application in medicine can follow. These aspects are, for example, (a) physiological backgrounds of the method, and (b) signal analysis of the ballistocardiogram. Recent developments on these items are discussed and some preliminary results are given. Research on ballistocardiography is worthwhile to be continuing, since the method offers good perspectives for application in preventive medicine (early detection of coronary heart disease) and in clinical medicine.     

Biomarkers: past, present, and future

In recent decades biomarkers have become accepted tools in clinical practice [1]. Although there is no widely accepted definition of what constitutes a biomarker, for the context of this review we consider a biomarker to be a protein or other macromolecule that is associated with a biological process or regulatory mechanism. Hence measurement of this biomarker in blood, for example, might provide quantitative information that could be clinically helpful regarding this biological process or regulatory mechanism. In this paper we review recent advances with the use of biomarkers in three major clinical areas: diagnosis of myocardial infarction, diagnosis and management of heart failure, and diagnosis and management of inflammatory conditions in general and systemic infections in particular. Although these may look like unrelated medical challenges, recent clinical research in these areas by our groups and others has opened up opportunities and challenges that seem fundamental for biomarkers in general.     

Nesiritide: past, present, and future

B-type natriuretic peptide (BNP) is an endogenous cardiac neurohormone, produced in the ventricles in response to pressure and volume elevation. Nesiritide is identical to endogenous BNP and is synthesized using recombinant DNA technology. It is currently used in the treatment of acute decompensated heart failure. In clinical trials, nesiritide has been shown to decrease pulmonary capillary wedge pressure, pulmonary artery pressure, right atrial pressure, and systemic vascular resistance, as well as increase cardiac index and stroke volume index. Infusions of nesiritide have led to increased diuresis and natriuresis. Patients treated with nesiritide have reported improvements in global clinical status, dyspnea, and fatigue. Therapy with nesiritide has resulted in decreased plasma renin, aldosterone, norepinephrine, and endothelin-1 levels, as well as reduced ventricular ectopy and ventricular tachycardia. Heart rate variability also improved with nesiritide. Patients with acute coronary syndromes, serious arrhythmia, renal disease, diastolic dysfunction, or vasopressor dependence have been safely managed with nesiritide. Early treatment with nesiritide in the emergency department may lead to decreased length of hospital stay and reduced readmission rates compared to standard care. Outpatient serial infusions of nesiritide in severe heart failure patients on optimal medical therapy may result in improved clinical status, increased ejection fraction, reduced aldosterone and endothelin-1 levels, and decreased hospitalizations. Potential future uses of nesiritide include treatment of acute coronary syndromes, pulmonary hypertension, bronchospasm in chronic lung disease, and as antifibrotic/anti-remodeling therapy or bridge to cardiac transplant. The possibility of subcutaneous injections of nesiritide has been studied in both animals and humans.     

Screening for gestational diabetes; past, present and future.

Gestational diabetes is carbohydrate intolerance, with onset or first recognition of hyperglycaemia during pregnancy. Several studies have suggested that gestational hyperglycaemia is associated with adverse maternal and fetal outcomes, promoting the case for screening. Conversely, others argue that screening for gestational diabetes may colour the clinical judgement, influencing further management, e.g. more 'unjustified' caesarean sections. Additionally, the lack of definitive data either on a clear-cut glycaemic threshold for the development of adverse outcomes or on the impact of intervention is emphasized by opponents of screening. This review attempts to evaluate the available data on screening for gestational diabetes. Oral glucose tolerance test is promoted on the basis that the diabetogenic stress of pregnancy is encountered during late gestation and is best recognized in the fed state. There are different tests, including the 1 h/50-g, 2 h/75-g and 3 h/100-g tests, with practical limitations, including the time and cost involved and the unpleasant supra-physiological glucose load that is unrelated to body weight, and issues of reproducibility and sensitivity/specificity profiles. Despite its convenience, the poor sensitivity of random glucose has precluded its routine use for screening. Fasting glucose appears to be promising but further testing is required to ensure satisfactory sensitivity/specificity in different populations. Despite its limitations, the oral glucose tolerance test has become established as the 'most acceptable' diagnostic test for gestational diabetes. More convenient methods, e.g. fasting or random or post-load glucose, have to be validated therefore against the oral glucose tolerance test to gain acceptance for routine screening.