新诊断2型糖尿病患者血清Betatrophin水平及其与代谢指标相关性分析

目的探讨新诊断2型糖尿病患者血清Betatrophin水平及其与代谢指标的相关性。方法选取2014年1月至2016年2月进行诊治的52例新诊断2型糖尿病患者为观察组,并选取同时间段内的52例健康体检者为对照组,将两组研究对象的血清Betatrophin水平、脂代谢、糖代谢及骨代谢指标进行检测与比较,同时比较观察组中不同糖化血红蛋白水平者的检测结果,并以Logistic回归分析脂代谢、糖代谢及骨代谢指标与血清Betatrophin的关系。结果观察组的血清高密度脂蛋白胆固醇(HDL-C)及骨钙素(BGP)均低于对照组,差异有统计学意义(P0.05)。血清Betatrophin水平及其他脂代谢、糖代谢、骨代谢指标均高于对照组,且不同糖化血红蛋白水平患者的以上相关指标检测结果也存在明显差异(P0.05)。经Logistic分析显示上述脂代谢、糖代谢及骨代谢指标均是血清Betatrophin水平异常的危险因素(P0.05)。结论新诊断2型糖尿病患者血清Betatrophin水平较高,且脂代谢、糖代谢及骨代谢指标是血清Betatrophin水平异常的危险因素,应给予充分的监测与干预。     

2型糖尿病患者血糖与尿糖相关性分析

目的 分析2型糖尿病患者尿糖与血糖的相关性。方法 同步测定37例2型糖尿病患者空腹血糖和尿糖，并设对照组。结果 37例2型糖尿病患者中32例血糖与尿糖呈正相关，5例血糖和尿糖无相关性；对照组尿糖均呈阴性。结论 在实施治疗以前，判断患者肾糖阈值是否异常，对尿糖能否作为糖尿病日常监控指标非常重要。     

Ventricular repolarization is correlated with metabolic control in newly diagnosed type 2 diabetes

SUMMARY. Good metabolic control may improve cardiac function in diabetic patients. It is not known, however, whether this functional improvement is associated with concomitant electrocardiographic changes. The aim of the present prospective study was to evaluate the quantitative electrocardiographic and vectorcardiographic correlates of metabolic control, left ventricular function and dimensions, and autonomic nervous function in patients with newly diagnosed Type 2 diabetes. We studied 35 patients (20 men, 15 women; age 52±6 years (mean±SD) with normal electrocardiograms at 1. 5 and 15 months after the diagnosis of Type 2 (non-insulin-dependent) diabetes. During the follow-up, body weight decreased, and significant improvement was observed in metabolic control, cardiac function and autonomic nervous function. Concomitantly, maximal spatial vector of T wave increased from 238±122 to 284± 141 μV (P < 0.01), and this increase was correlated with a decrease in glycosylated haemoglobin A_lc (r =-0.45, P < 0.01) and plasma insulin (r = -0.46, P < 0.01). In addition, duration of QRS complex shortened from 94 ± 9 to 92 ± 8 ms (P < 0.05), and this shortening was correlated with an increase in heart rate variability (r = -0.34; P < 0.05) and a decrease in peak early to late left ventricular filling flow velocity (r = 0.35, P < 0.05). These changes were most prominent in patients with co-existing hypertension and coronary artery disease. In conclusion, improving metabolic control of diabetes is associated with changes in ventricular repolarization and shortening of QRS complex duration.     

初诊2型糖尿病合并代谢综合征患者血清尿酸水平与血液流变学相关性分析

目的探讨初诊2型糖尿病(T2DM)合并代谢综合征(MetS)患者血清尿酸(UA)水平和血液流变学指标的关系。方法检测并比较91例单纯T2DM患者、122例T2DM合并MetS患者及256例健康者(对照组)体质量指数、血压、血糖、血脂、UA及血液流变学等指标检测结果。结果单纯T2DM患者和T2DM合并MetS患者体质量指数、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、UA、糖化清蛋白水平均高于健康者(P<0.05),患者组间总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、UA、糖化清蛋白比较差异亦有统计学意义(P<0.05)。患者组间红细胞刚性指数、红细胞变形指数、血液黏度、血液还原黏度、微循环滞留时间、血栓形成系数等血液流变学指标比较差异有统计学意义(P<0.05)。各研究组间高尿酸血症患病率比较差异有统计学意义(P<0.01)。控制了年龄、性别、体质量指数、总胆固醇、三酰甘油等水平后,UA水平与血细胞比容、红细胞聚集指数、红细胞刚性指数、血液黏度、血液还原黏度、微循环滞留时间、血栓形成系数等血液流变学指标存在正相关。结论合并MetS的T2DM患者较单纯T2DM患者存在更明显的血液流变学改变和更高的UA水平,且UA水平与血液流变学指标关系密切。初诊T2DM患者除应控制血糖、血压、血脂及体质量外,更应控制UA水平及改善血液流变性,从而阻止或延缓病情的发生与发展。     

Cytokine production in patients with newly diagnosed insulin-dependent (type I) diabetes mellitus

There is ample evidence that cell-mediated immune mechanisms are crucial in the initiation of insulin-dependent diabetes mellitus (IDDM). Therefore, the role of cytokines in the pathogenesis of IDDM was investigated in 51 patients with IDDM, in comparison with 20 normal controls. The patients were divided into three groups, group 1 consisting of 31 newly diagnosed type 1 diabetics, in group 2 IDDM had been diagnosed for between 2 months and 2 years, and in group 3 onset had occurred 2-20 years before. Interleukin 1 (IL 1) activity was measured by the thymocyte co-stimulator assay, and interleukin 2 (IL 2) using IL 2 dependent cell lines. Peripheral blood monocyte IL 1 production was not altered under basal conditions. However, silica-stimulated IL 1 release was normal in patients with newly diagnosed or short-term disease, but was significantly decreased in long-term diabetics. Peripheral blood T-lymphocyte IL 2 production at onset of IDDM was normal under basal conditions, and upon optimal stimulation with concanavalin A (ConA) and phorbol myristate acetate (PMA). However, in the two groups with longer standing diabetes, basal and stimulated IL 2 release was decreased. We conclude that monocytes and T-lymphocytes from patients with diabetes mellitus have a diminished capacity to release IL 1 and IL 2 only later in the course of the disease. At the time of manifestation of disease, IL 1 and IL 2 production is normal in type-I diabetes mellitus.     

动态血糖监测新发2型糖尿病患者糖耐量试验时的血糖变化

目的 探讨2型糖尿病患者口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)时的血糖变化特点.方法 采用动态血糖监测系统(continuous glucose monitoring system,CGMS)对35例新诊断的2型糖尿病患者和24例糖代谢正常者进行动态血糖监测,同时进行75 g葡萄糖的OGTT,比较两组在不同糖代谢状态下糖负荷后3小时内平均血糖值(MBG)、血糖峰值(PPG)、血糖达峰时间(△t)、血糖波动幅度(PGE)和血糖的曲线下面积增值(IAUC)变化.结果 2型糖尿病组OGTT 3小时的MBG、PPG、△t、PGE和IAUC显著高于对照组,分别为 (11.6±13.16) mmol/L vs (7.66±0.80) mmol/L、(14.21±3.79) mmol/L vs (9.09±1.09) mmol/L、(117.09±36.84) min vs (84.04±34.17) min、(6.30±2.87) mmol/L vs (2.96±0.87) mmol/L、(3.22±1.97) mmol·L-1·d vs (1.69±0.71) mmol·L-1·d(均P<0.01).2型糖尿病患者OGTT 2小时血糖达到诊断标准的占68.6%(24/35),与未达该标准的31.4%(11/35)相比,MBG、PPG、PGE和IAUC均明显增高(均P<0.01),分别为(12.99±2.70) mmol/L vs (8.46±0.82) mmol/L、(15.97±3.24) mmol/L vs (10.41±1.15) mmol/L、(7.49±2.44) mmol/L vs (3.70±1.89) mmol/L、(4.02±1.73) mmol·L-1·d vs (1.47±1.21) mmol·L-1·d;△t的差异无统计学意义(P＞0.05).2型糖尿病组在不同糖化血红蛋白水平时,OGTT时除MBG有显著差异外(P<0.05),PPG、PGE和IAUC的差异均无统计学意义(均P＞0.05);而在不同空腹血糖状态时,OGTT的血糖波动指标差异均无统计学意义(P＞0.05).结论 新发2型糖尿病患者在糖负荷状态下血糖波动加剧,达峰时间延迟;筛查2型糖尿病时,对OGTT 2小时血糖接近标准值上限或糖耐量异常者应复查OGTT以减少漏诊.     

初发2型糖尿病患者血糖控制与血小板参数的相关性研究

目的 探讨初发2型糖尿病患者血糖控制与血小板参数的相关性.方法 检测90例住院或门诊初发2型糖尿病患者和90名健康体检者的血压和血小板参数,包括血小板计数(PLT)、血小板平均体积(MPV)和血小板体积分布宽度(PDW)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标,对治疗3个月后HbA1c达标(≤7%)的2型糖尿病患者重复测定上述参数.结果 (1)初发2型糖尿病组FBG、TC、TG、MPV及PDW均高于健康对照组(t值分别为6.405、2.069、2.633、2.178、2.103,P值分别为0.001、0.046、0.010、0.031、0.043).(2)HbA1c＞7%的糖尿病患者48例,FBG、HbA1c、TC、TG、MPV及PDW均高于HbA1c≤7%组(t值分别为5.691、2.013、2.345、3.467、4.016、2.893,P值分别为0.001、0.038、0.029、0.013、0.004、0.026);糖尿病患者MPV与HbA1c(r=0.389,P=0.020)、PDW(r=0.324,P=0.010)呈正相关;与FBG(r=0.098,P=0.370)、收缩压(r=0.060,P=0.587)及舒张压(r=0.046,P=0.784)均无相关性.(3)HbA1c达标的糖尿病患者36例,控制血糖后FBG、HbA1c、TG、MPV、PDW较治疗前均有下降(t值分别为5.591、2.301、2.410、2.204、2.105,P值分别为0.001、0.031、0.023、0.035、0.041).结论 初发2型糖尿病患者的血小板活性增强,控制血糖可降低血小板活性,对防治糖尿病血管并发症有益.

Abstract：

Objective To study the relationship between glycemic control and platelet parameters in newly diagnosed type 2 diabetic patients. Methods Ninety patients newly diagnosed as type 2 diabetes and 90 healthy people were enrolled into the study. Their blood pressure, platelet parameters, including blood platelets count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), fasting blood glucose (FPG),HbA1c ,triglyceride ( TG ), total cholesterol ( TC ), high density lipoprotein cholesterol (HDL-C ), low density lipoprotein cholesterol(LDL-C) were examined and the data were analyzed. Results The level of FBG, TG, TC,MPV and PDW of patients newly diagnosed as type 2 diabetic were significantly higher than those of healthy people (t =6. 405,2. 069,2. 633,2. 178,2. 103 ;P =0. 001,0. 046,0. 010,0. 031 and 0. 043 respectively); The level of FBG, HbA1c, TC, TG, MPV and PDW in the diabetic patients, with their HbA1 c ＞ 7%, were significantly higher than the patients with HbA1c ≤ 7 % ( t = 5.691,2.013,2. 345,3. 467,4. 016,2. 893, P = 0. 001, 0. 038,0. 029,0. 013, 0. 004, 0. 026 ). There were positive correlations between MPV and HbA1c ( r = 0. 389 P =0. 020), MPV and PDW ( r = 0. 324 P = 0. 01 ) in diabetic patients, but no correlation between MPV and FBG,MPV and Systolic BP or MPV and Diastolic BP (Ps ＞ 0. 05 ). The level of FBG, HbA1c, TG, MPV and PDW decreased significantly in the diabetic patients with HbA1c ＞ 7% after treatment (t = 5. 591,2. 301,2. 410,2.204,2.105; P=0.001,0.031,0.023,0.035,0.041, respectively).Conclusion The platelet activity enhanced in newly diagnosed type 2 diabetic patients, platelet activity can be recovered through glycemic control,which may prevent the role of platelet in diabetes complications in these patients.     

监控下持续靶强度有氧运动对脑卒中合并冠心病患者有氧代谢能力和体质指标的影响

目的:探讨监控下持续靶强度有氧运动对脑卒中合并冠心病患者峰值摄氧量、无氧阈等有氧代谢能力、体质指标及日常生活自理能力的影响。方法:采用随机分组方法将43例脑卒中合并冠心病患者分为常规康复治疗+常规下肢踏车训练组(A组,21例)、常规康复治疗+监控下有氧运动组(B组,22例),康复治疗8周,常规康复治疗每周5次,每日1次,每日训练时间约2.5h,A组进行常规下肢踏车训练(每周5次,20分钟/次),B组进行监控下持续靶强度有氧运动(每周5次,20min/次),比较A组和B组患者运动治疗前后峰值摄氧量、无氧阈、最大代谢当量、体重、身体质量指数、腹围、日常生活自理能力等指标差异。结果:第8周末B组患者的峰值摄氧量(16.72±2.19)ml/min/kg、无氧阈(15.40±1.79)ml/min/kg及最大代谢当量(5.07±0.60)明显高于A组;第8周末A组Barthel指数评分(69.1±7.5),B组Barthel指数评分(67.7±4.1),与治疗前相比,两组患者的日常生活自理能力均有提高。第8周末,B组患者腰围(90.36±5.83)cm、体重(64.28±4.57)kg、体重指数(24.02±1.76)kg/m2有明显下降。结论:监控下持续靶强度有氧运动可以有效改善脑卒中合并冠心病患者的有氧代谢能力和体质指标。     

初诊糖尿病患者血尿酸和空腹血糖水平的相关性研究

目的探讨初诊糖尿病患者血尿酸和空腹血糖水平的关系。方法选择接受治疗的274例初诊为糖尿病的患者,按性别分为男性组和女性组。对2组患者进行生化检验,比较2组的血尿酸水平,以及2组不同血糖水平患者的血尿酸水平的变化。结果男性组的血尿酸水平高于女性组,差异有统计学意义(P0.05)。对2组患者进行Logistic回归性分析,2组不同空腹血糖均与血尿酸水平具有密切关系,差异有统计学意义(P0.05)。结论初诊糖尿病患者血尿酸和空腹血糖水平呈正相关,随着糖尿病患者空腹血糖水平的升高,患者血尿酸水平不断升高。不同性别的患者间血尿酸水平存在差异,女性糖尿病患者的血尿酸水平较男性患者更低(P0.05)。     

Collagen binding activity in sera of patients with insulin-dependent (type 1) and non insulin-dependent (type 2) diabetes mellitus

An increase in the capacity of serum IgG to bind to native type IV collagen was observed in patients with both insulin-dependent and non insulin-dependent diabetes mellitus. This increased binding seems to be due to circulating immune complexes in the majority of the cases and to autoantibodies in some. The increased collagen binding activity was associated in postpubertal patients with the presence of diabetic microangiopathy, suggesting a pathogenetic role.     

A longitudinal study of virus antibodies in patients with newly diagnosed type 1 (insulin-dependent) diabetes mellitus

Seventeen newly diagnosed type 1 diabetics were studied longitudinally--at diagnosis, after 5 months and after 2 years, for antibodies against the following viruses: Coxsackie B3, B4 and B5, Echo 11, and Adeno 7a. The latter two were chosen because they had been isolated frequently in the area during the year the patients were diagnosed, whereas the Coxsackie viruses previously have been associated with the aetiology of type 1 diabetes. Coxsackie B4 antibody titres fell from the diagnosis and the 5 month study to the 2 year study (p less than 0.02), and, at this time, the average titre was also lower than in 37 healthy control individuals (p less than 0.05). Over the same period Coxsackie B3 antibody titres increased (p less than 0.05). Echo 11 antibody titres were higher in the patients at diagnosis (p less than 0.05), but, otherwise, no significant titre differences, compared with controls or titre changes, were found at any of the study times. Patients with lower suppressor cell activity at diagnosis displayed higher mean antibody titres regarding the five viruses together, than did patients with higher suppressor cell activity (p less than 0.05). No significant correlations were found between, on the one hand, the antibody titres and, on the other hand, C-peptide values, insulin dosage, degree of glycaemic control, or specific tissue type, HLA-B8 or HLA-DR3 and/or 4.     

Effect of diet therapy on maximum aerobic power in obese, hyperglycaemic men with recently diagnosed type 2 diabetes

To find out the effect of correction of hyperglycaemia on maximum aerobic power and anaerobic threshold, we studied 40 middle-aged obese men with recently diagnosed type 2 diabetes before and after 3 months diet therapy. Respiratory gas exchange was measured during maximal incremental bicycle exercise test with breath-by-breath technique at rest, at anaerobic threshold and at peak exercise. As a whole group, the diabetic men reached higher work load after therapy (+9 +/- 3 W (mean +/- SEM), p less than 0.01). A weak inverse linear correlation was found between the changes in fasting blood glucose and in maximum oxygen uptake (r = -0.29, p less than 0.05). When the patients were divided into two groups according to the median values in the change in fasting blood glucose, only those men with more than 1 mmol l-1 decrease in fasting blood glucose improved maximum oxygen uptake (+124 +/- 55 ml min-1 or +6%, p less than 0.05). Oxygen uptake at anaerobic threshold did not change significantly. These results suggest that the correction of hyperglycaemia by diet therapy may improve maximal aerobic power in obese men with recently diagnosed type 2 diabetes.     

2型糖尿病糖化血红蛋白与全天不同时间血糖水平的关系

目的探讨2型糖尿病患者糖化血红蛋白(HbA1c)与全天不同时间血糖水平的关系。方法171例2型糖尿病患者检测三餐前30min、餐后2h及晚睡前共7次血糖水平,并计算平均血糖水平(MBG),同时测定HbA1c。按HbA1c水平不同将患者分为2组血糖控制尚可组(HbA1c≤7.5%)和控制差组(HbA1c>7.5%)。直线回归相关分析总体及各组HbA1c与MBG、全天7次血糖的相关性。结果MBG与HbA1c呈显著正相关(r=0.851,P<0.001),MBG=-0.70+1.30×HbA1c;HbA1c与全天7次血糖水平均呈正相关,逐步多元线形回归分析示HbA1c与空腹、晚餐后、午餐后及早餐后血糖相关。HbA1c≤7.5%组的HbA1c与晚餐后、午餐后及午餐前血糖相关,而HbA1c>7.5%组HbA1c与空腹、晚餐后、午餐后及早餐后血糖相关。结论HbA1c受全天平均血糖水平的影响,血糖控制尚可组晚餐后、午餐后及午餐前的血糖对HbA1c影响明显,而血糖控制差组空腹、晚餐后、午餐后及早餐后的血糖对HbA1c影响明显。     

中等强度有氧运动对慢性肾病患者峰值摄氧量和无氧阈的影响

目的:探索中等强度有氧运动对慢性肾病患者(chronic kidney disease,CKD)峰值摄氧量和无氧阈的影响,测定以峰值摄氧量百分数表示的无氧阈值(anaerobic threshold,AT)强度,为慢性肾病患者的临床康复运动方案提供依据。方法:70例CKD患者随机分为对照组(n=35)、运动组(n=35)。运动组以50%峰值摄氧量(peak oxygen uptake,VO_(2peak))踏功率自行车,每次30min,每周3次,共12周。12周训练前后,所有患者进行心肺运动试验(cardiopulmonary exercise test,CPET),测定受试者的峰值摄氧量(VO_(2peak)),同时利用简化V-slope法判定每位患者无氧阈值。结果:训练前两组VO_(2peak)、AT以及AT占VO_(2peak)百分比均无明显差异(P0.05);训练后,与对照组相比,运动组的VO_(2peak)、AT以及AT占VO_(2peak)百分比均有显著改善(P0.05)。结论:中等强度的有氧运动对CKD患者VO_(2peak)、AT有改善作用。CKD患者以%VO_(2peak)表示的AT值(73.50±1.31%VO_(2peak))高于未经训练的健康人群(50%—60%VO_(2peak))。     

2型糖尿病患者外周血单核细胞血红素氧合酶-1表达水平与氧化应激的相关性

目的:探讨初诊的2型糖尿病患者机体的氧化应激状态,以及患者外周血单核细胞(peripheral blood mononuclear cell,PBMC)血红素氧合酶-1(heme oxygenase-1,HO-1)mRNA的表达与机体氧化应激状态的关系。方法:应用流式细胞仪检测22例初诊2型糖尿病患者(糖尿病组)细胞内活性氧(reactive oxygen species,ROS)产量。硫代巴比妥酸比色法检测血清中丙二醛(malondialdehyde,MDA)含量,逆转录聚合酶链反应技术分析PBMC中HO-1mRNA表达水平,并与22名健康对照者(对照组)比较。结果:糖尿病组PBMC中ROS产量测定的平均荧光强度(mean fluorescence intensity,MFI)为50.36±21.69,与对照组28.80±10.14比较,差异有显著性(P<0.01)。糖尿病组血清中MDA含量测定为(14.47±5.21)nmol/mL,与对照组的(5.57±1.21)nmol/mL比较,差异亦有显著性(P<0.01)。糖尿病组PBMC中HO-1/β-actin mRNA基因表达率的平均值为0.98±0.24,与对照组0.48±0.18比较,差异有显著性(P<0.01)。HO-1 mRNA的表达水平与ROS的产量、MDA含量均呈显著正相关(r=0.491、0.745,均P<0.01)。结论:初诊的2型糖尿病患者处于氧化应激状态,其中HO-1表达水平的增高可能参与2型糖尿病的抗氧化应激损伤。     

门冬胰岛素与生物合成人胰岛素治疗新诊断Ⅱ型糖尿病的对照研究

目的比较门冬胰岛素与生物合成人胰岛素治疗新诊断Ⅱ型糖尿病的临床疗效。方法将新诊断的96例Ⅱ型糖尿病患者随机均分为2组,分别为门冬胰岛素(治疗)组和生物合成人胰岛素(对照)组。患者分别在每日餐前给予皮下注射门冬胰岛素和生物合成人胰岛素,且均每晚定时皮下注射一次甘精胰岛素。比较2组患者血糖、低血糖事件、胰岛素用量的差异。结果用药后2组餐前及餐后的血糖含量均明显降低,且门冬胰岛素组餐前、餐后血糖均低于生物合成人胰岛素组;门冬胰岛素组患者低血糖发生次数低于生物合成人胰岛素组,差异有统计学意义;但2组胰岛素用量无显著差异。结论门冬胰岛素能够更好地控制Ⅱ型糖尿病的血糖,对Ⅱ型糖尿病的治疗更加有效。     

2型糖尿病患者尿白蛋白与葡萄糖负荷后2小时血糖增值的关系

目的 探讨2型糖尿病患者尿白蛋白与口服75 g葡萄糖耐量试验(OGTT)葡萄糖负荷后2小时血糖增值(2 hPG-FBG)关系。方法 利用电子病历系统,回顾性收集我院内分泌科住院的2型糖尿病患者120例。依据尿白蛋白/肌酐比值(UACR)分为尿白蛋白正常组(N组:UACR<30 mg/g)、微量白蛋白尿组(A组:30 mg/g≤ UACR<300 mg/g)和大量白蛋白尿组(B组:UACR≥300 mg/g), 比较三组间各指标是否存在差异。结果 2 hPG-FBG中位数在微量白蛋白尿组高于尿白蛋白正常组,大量白蛋白尿组高于微量白蛋白尿组(P<0.05),HbA₁c均值在微量白蛋白尿组和大量白蛋白尿组均高于尿白蛋白正常组(P<0.05)。Spearman相关分析显示,UACR与HbA₁c(r=0.294)和2 hPG-FBG(r=0.516)呈正相关关系(均P<0.05),多元线性逐步回归分析显示2 hPG-FBG是UACR独立危险因素(β=0.211)。结论 以葡萄糖负荷后2 h血糖增值为代表的餐后血糖波动是造成2型糖尿病患者尿白蛋白增加的重要因素,其作用较持续血糖水平更为明显。     

初诊2型糖尿病合并代谢综合征患者血清高分子量脂联素水平与胰岛素抵抗、C反应蛋白的相关性

目的观察初诊2型糖尿病(T2DM)合并代谢综合征(MS)患者血清高分子量脂联素(HMW-APN)水平及其与胰岛素抵抗(IR)、C反应蛋白(CRP)的相关性。方法选取研究对象168例,分为健康人对照组80例及初诊T2DM患者88例;初诊T2DM患者再根据是否合并MS分为单纯T2DM组45例和T2DM合并MS组43例。研究对象均行75 g口服葡萄糖耐量试验及胰岛素释放试验,并检测血清HMW-APN、CRP、血脂等相关生化指标。结果与健康人对照组比较,T2DM合并MS组及T2DM组血清HMW-APN水平降低(P0.01),以T2DM合并MS组最低。T2DM合并MS组及T2DM组血清CRP升高(P0.01),以T2DM合并MS组最高。简单相关分析显示,血清HMW-APN水平与体质指数(BMI)、腰围(WC)、腰臂比(WHR)、收缩压(SBP)、空腹血糖(FPG)、餐后2小时血糖(2h PG)、糖化血红蛋白Alc(Hb A1c)、三酰甘油(TG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及CRP呈负相关(P均0.01),与高密度脂蛋白胆固醇(HDL-C)水平、胰岛β细胞功能指数(HOMA-β)呈正相关(P均0.01)。多元逐步回归分析显示,WC、2h PG及CRP是血清HMW-APN水平的独立影响因素(P均0.01)。Logistic回归分析显示,HMW-APN是T2DM发生MS的保护因素,BMI、FPG、SBP、TG是其危险因素(P0.01或P0.05)。结论血清HMW-APN水平在初诊T2DM合并MS患者中降低,其与IR及CRP密切相关,在初诊T2DM合并MS的发生、发展中起保护作用。     

Hyperproinsulinemia segregates young adult patients with newly diagnosed autoimmune (type 1) and non-autoimmune (type 2) diabetes

OBJECTIVE: To investigate whether measurements of proinsulin and/or intermediate proinsulin degradation products could be used to differentiate between autoimmune (type 1) and non-autoimmune (type 2) diabetes in young adults. MATERIAL AND METHODS: Total proinsulin, intact proinsulin and 32,33 split proinsulin concentrations were measured in 25 patients aged 15-34 years with type 1 diabetes, as defined by the presence of at least two positive islet autoantibodies, and in 23 antibody-negative patients of similar age with type 2 diabetes, at the time of clinical onset of diabetes and at 3-4 months thereafter. Comparisons were made with data from 25 healthy subjects matched for gender and age. RESULTS: Plasma levels of total proinsulin, intact proinsulin and 32,33 split proinsulin were significantly increased 2-3-fold in the patients with newly diagnosed type 2 diabetes as compared with the controls, both in absolute terms (p<0.0001) and when related to circulating insulin (p<0.01-0.0002). In contrast, absolute proinsulin and 32,33 split proinsulin concentrations were significantly lower in patients with onset of type 1 diabetes than in controls. When proinsulin and split proinsulin release were related to plasma insulin, however, similar ratios were found in the type 1 diabetes patients and in controls. Using the 90th percentile for total proinsulin in the control group as the cut-off, the sensitivity and specificity for differentiation between autoimmune and non-autoimmune diabetes were 87% and 92%, respectively. At 3-4 months after clinical onset of diabetes, proinsulin secretion was still 2-3 times higher in type 2 than in type 1 diabetes patients (p<0.001). CONCLUSIONS: Young adult patients with newly diagnosed type 2 diabetes display disproportionate hyperproinsulinemia, whereas proinsulin secretion appears to be normal in patients with clinical onset of type 1 diabetes. Evaluation of proinsulin and 32,33 split proinsulin concentrations may be useful as a diagnostic tool in differentiating between autoimmune and non-autoimmune diabetes in young adults, particularly in those lacking islet autoantibodies at diagnosis.