2型糖尿病与恶性肿瘤关系临床分析

调查了我科2009年10月至2011年12月住院的41例2型糖尿病并有恶性肿瘤患者的临床资料,分析恶性肿瘤的发生率和分布情况。结果 2型糖尿病患者并有恶性肿瘤的发病率明显升高,以消化道肿瘤多见。结论 2型糖尿病好发恶性肿瘤,其发病机制与胰岛素抵抗、高血糖症、免疫反应以及胰岛素样生长因子等因素相关。     

IDE基因的研究进展

胰岛素降解酶(IDE)基因的表达产物胰岛素降解酶能降解多种蛋白质和肽，其功能改变将导致底物如胰岛素、β淀粉样蛋白的代谢异常，引起机体病理性改变。IDE基因位于10q23-q25，含25个外显子，全长约120kh，其异常与高胰岛素血症、2型糖尿病、阿尔茨海默病的发生有关。单核苷酸多态性研究发现，IDE基因的rs4646953、rs1887922、rs2251101多态性与2型糖尿病有关，rs1887922、rs2251101位点多态性分别对男性糖化血红蛋白、2h胰岛素水平有显著影响。     

不同病程的2型糖尿病患者的胰岛素抵抗与胰岛素缺乏

目的 调查发现在所研究的2型糖尿病病例中，体内胰岛素抵抗与胰岛素缺乏的程度。方法 1990～1994年间门诊及住院的2型糖尿病246例，均未使用胰岛素治疗。按照病程分为4组。所有的患者均在空腹取静脉血测定血糖及胰岛素水平。计算HOMA模型胰岛素抵抗指数和β细胞功能指数。结果 各组病例均没有明显的高胰岛素血症，其胰岛素抵抗指数无明显差异；糖尿病病程与空腹胰岛素水平及β细胞功能指数呈负相关性，与空腹血糖水平呈正相关性。结论 在所研究的2型糖尿病病例中胰岛素分泌不足较高胰岛素血症更为常见。     

2型糖尿病中胰岛素抵抗发生机制的研究进展

胰岛素抵抗是2型糖尿病的主要病理生理特征之一，前瞻性研究显示胰岛素抵抗是2型糖尿病的最好预测因子。这说明胰岛素抵抗在2型糖尿病的发生中起主要作用。研究表明胰岛素抵抗的发生机制十分复杂，不仅与遗传因素高度相关，而且与某些细胞因子表达失常、物质代谢异常、Ins信号传导缺陷等因素有关。     

中国新诊断2型糖尿病患者胰岛素分泌和胰岛素抵抗特点调查

胰岛素抵抗与胰岛素分泌缺陷是2型糖尿病的主要病理生理学缺陷。绝大多数的欧美2型糖尿病患者均肥胖，而肥胖所致的胰岛素抵抗被认为是导致该人群发生2型糖尿病的最主要因素。但是亚洲2型糖尿病患者中，肥胖者还不到半数。胰岛素抵抗抑或胰岛素分泌功能缺陷是亚洲糖尿病患者早期发病的主要因素尚不明了。本文调查了解中国新诊断的2型糖尿病人群胰岛素抵抗和胰岛素分泌功能的状况并观察格列齐特（达美康缓释片）强化治疗对其的影响。     

人类重组免疫球蛋白λ轻链022在2型糖尿病患者网膜脂肪组织的表达

用荧光定量RT—PCR和免疫组化方法测定2型糖尿病患者网膜脂肪组织人类重组免疫球蛋白λ轻链（HSIGVL）022 mRNA和蛋白的表达量。结果显示在2型糖尿病患者网膜脂肪组织中HSIGVL022 mRNA和蛋白表达均上调，表达量与胰岛素抵抗指数呈直线相关，提示其可能与胰岛素抵抗、2型糖尿病的发病有关。     

Ⅱ型糖尿病患者血清糖基化胰岛素水平及与胰岛素抵抗的关系

３３例Ⅱ型糖尿病患者行葡萄糖耐量试验和胰岛素释放试验。利用胰岛素抗体分离血清胰岛素，比色法测定血精糖基化胰岛素水平。糖尿病患者血清糖基化胰岛素水平显著升高，且与血糖水平呈显著正相关，与胰岛素抵抗的有关指标呈显著负相关，提示血清糖基化胰岛素水平取决于血糖水平，且可能与胰岛素抵抗的形成有关。     

胰岛β细胞自身胰岛素抵抗和2型糖尿病——胰岛素抵抗研究的新领域

2型糖尿病的发病机理尚未完全阐明，一般认为主要与胰岛素外周靶组织的胰岛素抵抗及胰岛β细胞分泌缺陷有关。但是二者在2型糖尿病发病机理中孰为原发孰为继发，以及各自在糖尿病发病中的地位一直是长期争论不休的问题。近年来发现β细胞膜上也存在胰岛素受体，即β细胞也是胰岛素的靶细胞，β细胞胰岛素信号转导障碍可导致胰岛素分泌缺陷，首次将胰岛素抵抗与β细胞分泌缺陷直接联系起来。为丰富胰岛素抵抗概念的内涵和外延，重新评价胰岛素抵抗在2型糖尿病发病中的作用提供了新的思路。     

糖尿病与恶性肿瘤发病的现代看法

国内外研究表明,在糖尿病人群中恶性肿瘤患病率明显增加[1-2],尤其是乳腺癌、子宫内膜癌、结直肠癌、肝癌和胰腺癌,在新诊断的癌症病人中糖尿病的发生率高达8-18%[3].认为可能与高血糖、胰岛素及胰岛素样生长因子、脂肪细胞因子等因素有关.本文就2型糖尿病及恶性肿瘤的发生机制作一综述,旨在引起进一步的关注.     

甘精胰岛素与格列美脲联合治疗口服降糖药控制不佳2型糖尿病的疗效

糖尿病由多种病因引起的以慢性高血糖为特征的代谢紊乱,伴有因胰岛素分泌绝对或作用缺陷引起的糖、脂肪和蛋白质代谢异常.病因与胰岛素抵抗和胰岛素分泌不足有关[1].2型糖尿病以胰岛素抵抗为主,伴胰岛素分泌或相对不足,目前,2型糖尿病多通过控制饮食、口服降糖药物、注射胰岛素等治疗[2,3].本研究主要探讨甘精胰岛素与格列美脲联合应用治疗口服降糖药控制不佳的2型糖尿病的临床效果.     

Helicobacter pylori infection and diabetes: Is it a myth or fact?

Helicobacter pylori(H.pylori)is one of the most common human bacterial pathogens,and infection causes a wide array of gastric disorders,including simple gastritis,peptic ulcers and gastric malignancies.Gastrointestinal inflammation caused by H.pylori can influence the absorption of glucose and lipids,which are also abnormal in diabetes mellitus.Type 2 diabetes mellitus(T2DM),formerly known as non-insulin-dependent diabetes mellitus or adult-onset diabetes,is a metabolic disorder that is characterized by high levels of blood glucose resulting from insulin resistance and relative insulin deficiency.It is an emerging pandemic and is rapidly becoming a serious threat to public health.Emerging data now indicate a strong relationship between H.pylori infection and the incidence of T2DM.The mechanisms underlying the pathogenesis of diabetes are complex,involving insulin resistance,chronic inflammation,insulin secretion deficiency as a result of pancreasβ-cell dysfunction,glucotoxicity,and lipotoxicity.H.pylori infection is known to be involved in the pathogenesis of insulin resistance,and the growing awareness of its role in diabetes is important for the early detection of glucose dysregulation and prevention of T2DM in high-risk communities.This review probes the possible relationship between H.pylori and diabetes according to epidemiological surveys and discusses putative mechanisms underlying this correlation.     

Type 2 diabetes mellitus and medications for type 2 diabetes mellitus are associated with risk for and mortality from cancer in a German primary care cohort

There is growing evidence that patients with type 2 diabetes mellitus have increased cancer risk. We examined the association between diabetes, cancer, and cancer-related mortality and hypothesized that insulin sensitizers lower cancer-related mortality. Participants in the Diabetes Cardiovascular Risk and Evaluation: Targets and Essential Data for Commitment of Treatment study, a nationwide cross-sectional and prospective epidemiological study, were recruited from German primary care practices. In the cross-sectional study, subjects with type 2 diabetes mellitus had a higher prevalence of malignancies (66/1308, 5.1%) compared to nondiabetic subjects (185/6211, 3.0%) (odds ratio, 1.64; 95% confidence interval, 1.12-2.41) before and after adjustment for age, sex, hemoglobin A_1c, smoking status, and body mass index. Patients on metformin had a lower prevalence of malignancies, comparable with that among nondiabetic patients, whereas those on any other oral combination treatment had a 2-fold higher risk for malignancies even after adjusting for possible confounders; inclusion of metformin in these regimens decreased the prevalence of malignancies. In the prospective analyses, diabetic patients in general and diabetic patients treated with insulin (either as monotherapy or in combination with other treatments) had a 2- and 4-fold, respectively, higher mortality rate than nondiabetic patients, even after adjustment for potential confounders (incidence of cancer deaths in patients with type 2 diabetes mellitus [2.6%] vs the incidence of cancer deaths in patients without type 2 diabetes mellitus [1.2%]). Our results suggest that diabetes and medications for diabetes, with the exception of the insulin sensitizer metformin, increase cancer risk and mortality.     

The relation of type 2 diabetes and cancer

Increasing evidence indicates that individuals with type 2 diabetes (diabetes) are at elevated risk for several common human malignancies, including cancers of the colon, breast, endometrium, pancreas, and liver. In particular, the consistent positive results reported by prospective investigations make it unlikely that methodologic issues, occult tumors, or chance results could explain the findings. Since diabetes and impaired fasting glucose together affect >25% of Americans above age 50, even a moderate etiologic association (e.g., relative risk = 1.5) would explain >10% of involved malignancies. Laboratory studies have suggested biologically plausible mechanisms. Insulin, for example, is typically at high levels during the development and early stages of diabetes. Activation of the insulin receptor by its ligand, or cross-activation of the insulin-like growth factor-I receptor, has been shown to be mitogenic and promote tumorigenesis in various model systems. A "unifying concept," in fact, holds that hyperinsulinemia may underlie the cancer associations of several additional risk factors, including high waist circumference, visceral fat, waist-to-hip ratio, body mass index, sedentary lifestyle, and energy intake. In this review, we assess current evidence regarding the relation of type 2 diabetes with cancer, and evaluate the findings in terms of well-accepted criteria for establishing causality.     

Adipositas, metabolisches Syndrom und Krebsentstehung

Type 2 diabetes mellitus and obesity are pathophysiologically closely related. This is revealed in the complex entity of metabolic syndrome, which describes the simultaneous occurence of glucose intolerance, obesity, arterial hypertension, and dyslipidemia. Patients with type 2 diabetes mellitus show an increased frequency of colorectal, pancreatic, liver, breast and endometrial cancer. Independent of diabetes manifestation, an increase of malignancies has been reported in obesity, and also mortality due to cancer is increased. The underlying pathophysiology is currently under investigation and potential factors under study include hyperinsulinemia, adipokines, sex hormones, chronic inflammation and oxidative stress. Considering the enormous and further accelerating increase of type 2 diabetes mellitus and overweight the potential enhanced risk of cancer needs to be carefully addressed in research and clinical aspects.     

肺结核合并糖尿病的研究进展

肺结核和糖尿病均是发病率高、严重威胁人类健康的全球性疾病.由于糖尿病增加罹患肺结核的风险,近年来随着糖尿病发病率的不断上升,其对结核病的防控造成困难.糖尿病合并肺结核患者的临床表现有别于单纯肺结核患者,且治疗效果不佳.因此,选择合理的方案进行双向筛查,并在规范化抗结核治疗的同时加强血糖监测,将有助于控制肺结核的流行.     

糖尿病与膀胱癌相关性研究进展

全球范围内,糖尿病与膀胱癌的发病率均呈持续上升状态,已严重危害到人类健康。从现有的相关研究中发现,两者可能在疾病的发生和发展过程中存在某些相关联的作用机制,从而对糖尿病患者的膀胱癌发病率及预后产生影响。有些研究认为糖尿病与膀胱癌存在着复杂的联系,但同时有研究结果持不同意见。本文就糖尿病与膀胱癌的流行病学特点、共同危险因素、降糖药物对膀胱癌的作用、糖尿病影响膀胱癌发生的可能机制以及糖尿病对膀胱癌预后的影响等方面进行全面系统的综述。     

The oral cavity of elderly patients in diabetes

Diabetes mellitus is a common and growing global health problem leading to several complications. Among these periodontal diseases are considered as the sixth complication of diabetes mellitus. This article reviews the relationship between diabetes and oral health, particularly focusing on periodontal diseases, dental caries and xerostomia. There is a bidirectional interrelationship between diabetes and periodontal diseases. Periodontitis is more prevalent and severe in patients with diabetes than in normal population. Therapy of periodontal infection contributes to a positive glycaemic control management and enables reduction of the burden of complications of diabetes mellitus. Diabetics have an increased predisposition to the manifestation of oral diseases like candidiasis which is associated with poor glycaemic control and therapeutic dentures. This predisposition also contributes to xerostomia, which may be due to increased glucose levels in oral fluids or immune dysregulation.     

胃转流术治疗2型糖尿病的机制

2型糖尿病是一种常见的内分泌代谢性疾病,传统的治疗方法以内科为主,但不能达到终身治愈的目的.外科治疗主要是针对其并发症.近年来研究发现,胃转流术可有效治疗2型糖尿病,减少糖尿病各种并发症.目前胃转流术治疗2型糖尿病的具体作用机制仍未完全阐明,可能与胃肠道激素、脂肪细胞因子、炎性反应因子、氧化应激及胰岛素信号转导等多方面因素有关.     

胃转流术治疗2型糖尿病的机制

2型糖尿病是一种常见的内分泌代谢性疾病,传统的治疗方法以内科为主,但不能达到终身治愈的目的.外科治疗主要是针对其并发症.近年来研究发现,胃转流术可有效治疗2型糖尿病,减少糖尿病各种并发症.目前胃转流术治疗2型糖尿病的具体作用机制仍未完全阐明,可能与胃肠道激素、脂肪细胞因子、炎性反应因子、氧化应激及胰岛素信号转导等多方面...     

Epidemiology of diabetes mellitus in old age in Japan

Epidemiological studies on diabetes mellitus revealed that the number of patients with diabetes mellitus is gradually increasing in Japan along with development of car society and westernization of food intake. Since prevalence of diabetes mellitus increases with aging, proportion of individuals with diabetes mellitus aged over 60 has exceeded two-third of estimated total number of patients (7.40 million in 2002) in Japan where aging of society is rapidly progressing. Type 2 diabetes mellitus is common in diabetes mellitus in old age, and there are rarely elderly patients with type 1 diabetes mellitus. Prevalence of both diabetic microangiopathy and atherosclerotic vascular diseases is higher in the elderly with diabetes mellitus than in the middle-aged with diabetes mellitus. Furthermore, atherosclerotic vascular diseases (ischemic heart disease, cerebro-vascular disease and peripheral vascular disease) are more prevalent in the elderly with diabetes mellitus than in those without diabetes mellitus. Many studies demonstrated that functional declines, i.e. decreases in activities of daily living, physical activity and cognitive function, deteriorated quality of life in the elderly, and functional declines are more prominent in the elderly with diabetes mellitus than in those without diabetes mellitus. In order to clarify how the elderly patients with diabetes mellitus should be treated to maintain their quality of life, a nationwide randomized controlled intervention study using 1173 Japanese elderly patients with diabetes mellitus is now performing. In summary, number of elderly patients with diabetes mellitus is overwhelmingly increasing in Japan as well as in westernized countries. It is necessary for us to treat the elderly with diabetes mellitus to maintain their function and quality of life.