2型糖尿病患者褪黑素水平与下丘脑-垂体-肾上腺轴激素关系的研究

目的 探讨不同血糖平均水平T2DM患者下丘脑-垂体-肾上腺（HPA）轴激素与褪黑素（MLT）的关系. 方法 将90例T2DM患者根据HbA1 c水平分为HbA1 c＜7％组28例、7％≤HbA1 c≤10％组32例和HbA1 c＞ 10％组30例,另选取健康对照（NC）组30名,分析不同HbA1c水平内源性MLT与HPA轴激素的关系. 结果 （1）HbA1c＜7％组和NC组HPA轴激素、MLT水平相对较低,而7％≤HbA1 c≤10％组和HbA1 c＞ 10％组相对较高.（2）多元相关分析显示,在HbA1 c＜7％组和NC组中,MLT与促肾上腺皮质激素（CRH）呈正相关（r=0.476、0.487,P均＜0.05）;在7％≤HbA1 c≤10％组和HbA1 c＞10％组MLT与血清皮质醇（CORS）呈正相关（r=0.318、0.047,P均＜0.05）.（3）多元逐步回归分析表明,T2DM患者血清CRH、促肾上腺皮质激素释放激素（ACTH）、CORS是MLT升高的独立影响因素. 结论 不同血糖水平的T2DM患者MLT与HPA轴的关系及作用机制不同.过高的CORS可刺激MLT分泌,HPA轴与MLT相互影响,协同作用影响糖尿病的发生发展.     

老年2型糖尿病合并慢性心力衰竭病人HbA1c水平对心脏结构和功能的影响

目的 分析老年慢性心力衰竭(心衰)合并T2DM病人HbA1c水平与心脏结构及功能的关系。方法 210例慢性心衰(NYHAⅡ～Ⅳ级)合并T2DM的老年病人以HbA1c平均值≤7%或>7%分为2组,比较2组血脂水平、心脏结构和功能差异,并分析上述指标与HbA1c的相关性。结果 HbA1c≤7%组和HbA1c>7%组室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室短轴缩短率(Fs)、LVEF、E/e′以及TC、LDL-C水平差异均具有统计学意义(P<0.05)。经Spearman相关性分析,HbA1c水平与IVS、LVPW、TC、LDL-C呈正相关(r=0.138、0.152、0.289、0.290,P<0.05),与LVEF呈负相关(r=-0.196,P<0.05)。结论 HbA1c>7%的T2DM合并慢性心衰的老年病人血TC和LDL-C水平更高。HbA1c水平控制在低于7%范围内可有效延缓心脏结构及功能减退。     

2型糖尿病患者睡眠质量对空腹血糖水平影响的探讨

目的 探讨在2型糖尿病(T2DM)患者睡眠质量对空腹血糖(FBG)水平的影响. 方法 选择在我院糖尿病门诊就诊的合并睡眠障碍的T2DM患者40例,睡眠障碍均经过神经内科专科治疗.同时选择40例不伴睡眠障碍的T2DM患者作为对照组.分别测定患者基线时及合并睡眠障碍的T2DM治疗后的FBG、餐后2小时血糖(2hBG)、HbA1c及空腹胰岛素(FIns)、胰岛素抵抗指数(HOMA-IR). 结果 与不伴睡眠障碍的T2DM患者相比,合并睡眠障碍的T2DM患者的FBG以及HbA1c水平较高,而且存在IR状态,两组间的差异有明显的统计学意义(P<0.05).合并睡眠障碍的T2DM患者的FBG和2hBG以及HOMA-IR较治疗前均减低(P<0.05). 结论 合并睡眠障碍的T2DM患者的FBG以及HbA1c水平较高,且存在IR状态;而针对患者睡眠质量的改善措施对糖尿病患者的血糖水平具有一定影响,尤其FBG更为明显.     

2型糖尿病患者血浆Atg7和Beclin-1的表达

目的探讨自噬相关基因(Atg)7、Beclin-1在2型糖尿病(T2DM)患者血浆中的表达情况。方法选取无糖尿病大/微血管并发症的T2DM患者37例为T2DM组,另选取32例年龄匹配的健康人为对照组,测定各受试者血糖、血脂、糖化血红蛋白(HbA1c)、血清空腹胰岛素(FINS)等。应用稳态模型评估胰岛素抵抗指数(HOMA-IR),应用酶联免疫吸附试验(ELISA)测定血浆自噬标志物自噬相关基因(Atg)7和Beclin-1水平。结果与对照组相比,T2DM组的空腹血糖(FBG)、口服葡萄糖耐量试验中2 h静脉餐后血糖(PBG)、HbA1c、HOMA-IR、血浆Atg7和Beclin-1水平均明显升高(P0.01,P0.05),Atg7和Beclin-1均与高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(APO)A1呈负相关(P0.05),与FBG、PBG、HbA1c、FINS及HOMA-IR均呈正相关(P0.05)。结论 T2DM患者血浆自噬标志物Atg7和Beclin-1的水平明显升高,自噬在2型糖尿病的病理生理进程中发挥作用。     

腹部皮下注射重组促胰岛素分泌素对2型糖尿病患者成纤维细胞生长因子21水平的影响

目的分析腹部皮下注射重组促胰岛素分泌素(E-4)对2型糖尿病(T2DM)患者成纤维细胞生长因子21(FGF-21)水平的影响。方法选取2010年10月—2013年10月浚县人民医院内科收治的T2DM患者85例,将其随机分为对照组42例和试验组43例。对照组腹部皮下注射0.9%氯化钠溶液150μl,试验组腹部皮下注射E-45μg/150μl,均连续注射12周。比较两组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-IS)及血浆FGF-21水平。结果治疗前两组患者FBG、2 hPBG、HbA1c、HOMA-IR、HOMA-IS及FGF-21水平比较,差异均无统计学意义(P0.05);治疗后试验组患者FBG、2 hPBG、HbA1c、HOMA-IR及FGF-21水平低于对照组,HOMA-IS高于对照组(P0.05)。结论腹部皮下注射E-4能够长期改善T2DM患者糖代谢,降低HOMA-IR和血浆FGF-21水平,提高HOMA-IS。     

血清钙水平对老年2型糖尿病患者血糖控制状况的影响

目的探讨血清钙水平对2型糖尿病(T2DM)老年患者血糖控制状况的影响。方法 396例确诊T2DM的老年患者根据其糖化血红蛋白(Hb A1c)水平分为血糖控制较好组(Hb A1c≤7.0%)115例,一般组(7.0%Hb A1c≤9.0%)150例,较差组(9.0%Hb A1c)131例。抽取静脉血检测相关生化指标及血清钙水平,比较其差异并分析血清钙对血糖控制的影响。结果较差组空腹血糖(FBG)、Hb A1c、血尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数(IRI)、血清钙明显高于一般组与较好组(P0.05);一般组FBG、Hb A1c、TC、TG、IRI、血清钙明显高于较好组(P0.05)。血清钙与FBG、Hb A1c、UA、TC、TG、LDL-C、IRI呈正相关关系(P0.05)。结论血清钙水平通过胰岛素抵抗对T2DM老年患者血糖控制状况产生影响,血清钙水平越低,血糖控制水平越差,因此在临床实际中可以通过补充钙离子增加胰岛素抵抗促进血糖水平的控制。     

初发2型糖尿病患者HbA1c水平与CA19-9、CEA的相关性

目的探讨初发2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)水平与血清糖链抗原199(CA19-9)、癌胚抗原(CEA)水平的相关性。方法选取2011年1月至2014年12月的初发T2DM患者120例(年龄﹥40岁)为研究对象,129例在该院体检中心接受体检的HbA1c正常且年龄匹配的人群作为对照组,比较两组的体重指数(BMI)、CA19-9、CEA、C-反应蛋白(CRP)及各生化指标之间的差异。根据CA19-9、CEA的测定数值把T2DM组又分为CA19-9、CEA阳性亚组,比较CA19-9、CEA阳性亚组血糖控制前后CA19-9、CEA数值差异,并测定CA19-9及CEA血糖控制前后的阳性率。结果初发糖尿病组的BMI、甘油三酯(TG)、CA19-9、CEA、空腹血糖(FBG)、HbA1c、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)及CRP都明显高于对照组(均P0.01);T2DM组CA19-9及CEA阳性亚组比较血糖控制前后CA19-9、CEA的数值有统计学意义(均P0.01);FBG、HbA1c与CA19-9、CEA有明显的正相关性。结论初发T2DM患者中CA19-9、CEA的水平明显高于血糖正常组,此二项指标与FBG及HbA1c水平有关,且HbA1c水平是CA19-9、CEA的独立相关因素。     

2型糖尿病患者血清Perilipin 1水平与大血管病变的相关性研究

目的探讨2型糖尿病(T2DM)患者血清Perilipin 1变化与大血管病变的相关性。方法回顾性分析2016年10月—2017年11月就诊于丹阳人民医院内分泌科的T2DM患者268例,根据有无大血管并发症分为合并大血管病变组(A组,168例)和单纯T2DM组(B组,100例),另选取同期来该院进行体检的健康人员作为对照组(C组,50名)。检测各组血清Perilipin 1水平,并测定空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)及其他生化指标;采用超声检查所有T2DM患者的颈动脉内膜中层厚度(IMT)。结果 A组和B组患者血清Perilipin 1水平明显高于C组(P0.01),A组患者血清Perilipin 1水平高于B组(P0.05)。血清Perilipin 1水平与年龄、HbA1c、FBG、LDLC呈正相关,与HDL-C呈负相关。Logistic回归分析显示,血清Perilipin 1是T2DM大血管病变的危险因素。结论血清Perilipin 1水平是T2DM患者大血管病变的独立危险因素之一,与大血管病变的发生发展密切相关。     

1,5-脱水葡萄糖醇与2型糖尿病患者尿白蛋白水平的相关性研究

目的探讨1,5-脱水葡萄糖醇(1,5-AG)与T2DM患者UAlb水平相关性。方法选取住院T2DM患者411例,根据HbA1c水平分为≤7%组81例和7%组330例,另根据24hUAlb将两组各分为30mg/24h亚组及30~299mg/24h亚组,检测相关生化指标及1,5-AG水平。结果在HbA1c≤7%组中,UAlb 30~299 mg/24h亚组1,5-AG低于UAlb30 mg/24h亚组[17.3(12.34,23.83)vs 10.40(7.20,13.78)μg/ml,P0.05];在HbA1c7%组中,两亚组1,5-AG水平比较,差异无统计学意义[2.67(1.26,6.35)vs 2.44(1.22,5.30)μg/ml,P0.05]。结论在HbA1c≤7%的T2DM患者中,1,5-AG可能是UAlb水平的相关因素。     

2型糖尿病患者24小时动态血糖变化与糖化血红蛋白水平的相关性

目的探讨T2DM患者24小时动态血糖变化与HbA1C水平之间的相关性。方法根据HbA1c水平将578名T2DM患者分为4个组,采用动态血糖监测系统（CGMS）监测患者全天血糖。结果组内分析显示,仅在7．5％≤HbA1c〈10．0％组及HbA1c≥10．0％组内HbA1c水平和高血糖曲线下面积、高血糖持续时间、平均血糖及血糖波动幅度呈正相关;仅在HbA1c〈6．5％组内HbA1c水平和空腹状态低血糖曲线下面积及持续时间呈负相关。结论当HbA1c处于不同区间内时,HbA1c水平与高血糖及低皿糖暴露、平均血糖水平及血糖波动幅度的相关性不同。     

2型糖尿病患者糖化血红蛋白水平与内皮功能评估指数的相关性

目的 探讨糖化血红蛋白(HbA1c)与反应性充血指数(RHI)的相关性.方法 入选2017年1月至2019年2月南京医科大学第一附属医院内分泌科收治的2型糖尿病患者608例,住院期间所有患者均使用Endo-PAT无创血管内皮功能检测技术计算出评估指数RHI.根据RHI结果分组,RHI≥1.67为对照组,RHI<1.67...     

2型糖尿病患者不同HbA1c水平和骨代谢指标的关系

目的 观察2型糖尿病患者不同HbA1c水平对骨代谢指标骨γ-羧谷氨酸包含蛋白(骨钙素)、Ⅰ型胶原交联羧基端肽(CTX-Ⅰ)、碱性磷酸酶(ALP)的影响.方法 选取2013年10月—2014年1月在哈尔滨医科大学附属第二医院内分泌科住院的120例男性2型糖尿病患者和来自体检中心的40名健康男性作为研究对象.将120例2型糖尿病患者根据HbA1c水平分为为HbA1c≤7％组、HbA1c 7％～ 9％组、HbA1c≥9％组,将40名健康男性作为对照组.采集其年龄、体重指数、病程及血钙、血磷、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶等临床指标,检测血清HbA1c、骨钙素、CTX-Ⅰ、ALP等指标.对4组间HbA1c水平与骨钙素、CTX-Ⅰ、ALP进行相关性和回归分析.结果 与对照组相比,HbA1c≤7％组、HbA1c 7％～9％组及HbA1c≥9％组血清骨钙素水平显著降低(F=7.211,P<0.05),血清ALP、CTX-Ⅰ水平显著升高(F=4.382、809.475,P<0.05);与HbA1c≤7％组相比,HbA1c7％～ 9％组和HbA1c≥9％组血清ALP水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05);与HbA1c7％～9％组相比,HbA1c≥9％组血清骨钙素水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05).Spearman相关分析发现,骨钙素与空腹血糖(r=-0.249,P=0.002)、糖化白蛋白(GA,r=-0.321,P=0.000)、HbA1c(r=-0.288,P=0.000)水平呈负相关,ALP、CTX-Ⅰ与空腹血糖(r=0.218、0.321)、GA(r =0.302、0.291)、HbA1c(r =0.321、0.238)水平呈正相关(P均<0.01).进一步经线性回归分析发现,骨钙素水平与GA(β=-0.086,P=0.008)、HbA1c(β=-0.502,P=0.001)呈负相关,CTX-Ⅰ水平与空腹血糖(β=0.042,P =0.003)、GA (β=0.007,P=0.015)、HbA1c(β=0.037,P=0.009)呈正相关.结论 2型糖尿病患者存在骨代谢指标异常,且HbA1 c与骨钙素、CTX-Ⅰ水平相关.     

Impact of sub-gastrectomy on glucose regulation in gastric cancer patients with T2DM: a follow-up study

This study aims to investigate the changing characteristics of glucose regulation after gastric surgery for normal gastric cancer patients with type 2 diabetes mellitus (T2DM) (T2DM group) and without T2DM (normal group) in a tertiary hospital located in western China. We conducted a case-control study which retrospectively collected the data of 73 patients: (1) diagnosed as gastric cancer, (2) underwent sub-gastrectomy and Billroth II gastrointestinal anastomosis between October 2007 and December 2012, and (3) did not suffer a recurrent cancer and with sufficient clinical data. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin sensitive index (HOMA-IS), insulin resistance index (HOMA-IR), and beta cell function index (HOMA-BCF) were compared at baseline and postoperative 7, 14, 28, 56, 120, and 356 days. Baseline FBG, HbA1c, HOMA-IS, HOMA-IR, and HOMA-BCF in the T2DM group were significantly higher than those in the normal group. Immediate postoperative glucose changed significantly, and it became stable and normal during follow-up period in both the T2DM and normal group that there was no significance anymore after postoperative 28 days between them. Normal patients with T2DM would benefit from gastric surgery in glucose control, and it may involve not only decreased food intake and weight loss but also gastrointestinal reconstruction.     

2型糖尿病及酮症患者血浆丝氨酸蛋白酶抵制剂水平变化及相关因素分析

目的 探讨初诊2型糖尿病(T2DM)及酮症(T2DK)患者血浆丝氨酸蛋白酶抵制剂(Vaspin)水平变化与BMI、血脂、血糖、胰岛素抵抗指数(HOMA-IR)等的关系.方法 采用ELISA法测定28例T2DM患者、32例T2DK患者及25例正常人(NC组)血浆Vaspin水平,分析血浆Vaspin水平与BMI、血脂、血糖和HOMA-IR等的关系.结果 T2DM组血浆Vaspin水平明显高于NC组[(0.71±0.18 )μg/L vs (0.52±0.13 )μg/L,P＜0.05],T2DK组又明显高于T2DM组[(1.95±0.21)μg/L vs (0.71±0.18)μg/L,P＜0.01].空腹血浆Vaspin水平分别与BMI、三酰甘油(TG)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)和HOMA-IR呈明显正相关(P＜0.05),与Fins和胰岛素分泌指数(HOMA-IS)呈明显负相关(P＜0.05).BMI、FPG和HOMA-IR是影响血浆Vaspin水平的独立相关因素.结论 血浆Vaspin水平的改变与糖脂代谢紊乱和胰岛素抵抗有关,并可能参与了T2DM及T2DK的发生和发展.     

罗格列酮和二甲双胍治疗新发2型糖尿病的疗效比较

为观察胰岛素增敏剂治疗初发2型糖尿病（T2DM）的临床疗效，新诊断T2DM患者120例被随机分为三组，分别给予马来酸罗格列酮、二甲双胍和二者联合治疗。结果马来酸罗格列酮和联合治疗明显降低新发T2DM的FPG、HbA1c、HOMA-IR，明显升高脂联素，使体重较治疗前增加。     

Fatty acid binding protein 1 (FABP1) and fatty acid binding protein 2 (FABP2) as a link between diabetic nephropathy and subclinical atherosclerosis in children and adolescents with type 1 diabetes

BackgroundDiabetic nephropathy is a major cause of morbidity and mortality in type 1 diabetes mellitus (T1DM). Fatty acid binding proteins (FABP1 and FABP2) play a role in the development and progression of chronic kidney disease including type 2 diabetes mellitus.AimWe assessed serum FABP1 and FABP2 levels in children and adolescents with T1DM as potential markers for diabetic nephropathy and their relation to carotid intima media thickness (CIMT).MethodsSixty patients with T1DM were divided into 2 groups according to the presence of nephropathy and compared with 30 healthy controls. CIMT, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), urinary albumin creatinine ratio (UACR), fasting lipid profile and serum FABP1 and FABP2 levels were assessed.ResultsFABP1 and FABP2 levels were significantly higher among type 1 diabetic patient with and without nephropathy compared with healthy controls with the highest levels among patients with nephropathy (p < 0.001). There were significant positive correlations between FABP1 and FABP2 and each of systolic blood pressure, CIMT, FBG, HbA1c and total cholesterol among T1DM patients. FABP1 was negatively correlated to glomerular filtration rate. Multivariable linear regression analysis showed that systolic blood pressure, CIMT, FBG and HbA1c were the significant independent variables related to FABP1 levels in type 1 diabetic patients with nephropathy. ROC curve analysis was performed to determine the cutoff value of FABP1 and FABP2 that could detect nephropathy.ConclusionFABP1 and FABP2 levels are elevated in children and adolescents with T1DM and could represent a link between diabetic nephropathy and subclinical atherosclerosis.     

Efficacy and safety of mitiglinide versus nateglinide in newly diagnose patients with type 2 diabetes mellitus: a randomized double blind trial

This study was performed to examine the efficacy and safety of mitiglinide in type 2 diabetes patients (T2DM). Enrolled patients had received treatment with diet and exercise in the previous 3 months with glycosylated haemoglobin (HbA1c) 7-10%, and were randomized to receive mitiglinide (n = 111, 5-20 mg/meal) or nateglinide (n = 114,60-120 mg/meal) for 16 weeks. Primary and secondary efficacy endpoints were assessed by the changes in HbA1c, fasting blood glucose (FBG) and postprandial glucose (PBG) levels. The baseline HbA1c value was 8.2 and 8.3% in both groups. At the end of study, the reduction of HbA1c values from baseline by mitiglinide was slightly more than that by nateglinide (-1.11% vs. -0.76%), but not statically significant (p = 0.06). Final FBG and PBG were comparable for the two treatments. There were 2.8% subjects treated with nateglinide who had hypoglycaemic episodes, but none in the mitiglinide treatment group. The results indicate that mitiglinide and nateglinide had similar effects on FBG, PBG and HbA1c in T2DM patients after the 16-week treatments.     

Relations among Glycemic Control, Circulating Endothelial Cells, Nitric Oxide, and Flow Mediated Dilation in Patients with Type 2 Diabetes Mellitus

Circulating endothelial cells (CEC) have been identified as a surrogate marker of endothelial dysfunction. The aim of this study was to determine the association of glycemic control with CEC and endothelial function in patients with type 2 diabetes mellitus (DM).We studied 30 patients with type 2 DM and 20 age and sex matched healthy controls (HC). Number of circulating endothelial cells was measured by flow cytometry. Endothelial function was studied by measuring flow mediated vasodilation (FMD%) in the brachial artery and serum level of nitric oxide (NO).CEC count was significantly elevated in patients with DM, than HC (35.3±15.1 vs. 7.3±2.4, p<0.001) and in patients with HbA1c>7 than patients with HbA1c≤7 (47.4±5.5 vs. 19.5±5.7, p<0.001). FMD% and NO were lower in DM patients than HC (3.5±0.85 vs. 9.5±3.1, p<0.001 and 37.8±6.1 vs. 64.1±5.7, p<0.001 respectively). FMD% and NO were lower in patients with HbA1c>7 as compared to patients with HA1c≤7 (2.8±0.4 vs. 4.3±0.4, p<0.001 and 33.1±2.9 vs. 43.9±2.8, respectively, p<0.001). HbA1c correlated negatively with FMD% and NO levels and positively with CEC. CEC count correlated negatively with FMD% and NO. There was a significant positive correlation between CEC count and HBA1c (p<0.001 for all correlations).CEC is associated with markers of endothelial dysfunction and disease control in patients with type 2 DM. These findings suggest a potential role of CEC in the pathophysiology of cardiovascular disease in type 2 diabetic and raise the importance of tight glycemic control.     

Determining the optimal fasting glucose target for patients with type 2 diabetes: Results of the multicentre,open-label,randomized-controlled FPG GOAL trial

The optimal fasting blood glucose (FBG) target of achieving HbA1c less than 7.0% in type 2 diabetes (T2D) patients remains controversial. This open-label trial randomized (1:3:3) 947 adults with uncontrolled T2D (HbA1c >7% to ≤10.5%) who were using one to three oral antidiabetic drugs to achieve an FBG target of 3.9 < FBG ≤5.6 mmol/L (Group 1), 3.9 < FBG ≤6.1 mmol/L (Group 2) or of 3.9 < FBG ≤7.0 mmol/L (Group 3). Targets were achieved using a pre-defined insulin glargine 100 U/mL titration scheme. The primary endpoint was proportion of patients achieving HbA1c <7.0% at 24 weeks. At 24 weeks, 44.4%, 46.1% and 37.7% of patients achieved HbA1c <7.0% in Groups 1, 2 and 3, respectively (P = 0.017; Group 2 vs Group 3). Alert hypoglycaemia (glucose ≤3.9 mmol/L) was significantly more frequent in Group 1 than in Group 3 (38.9 vs 23.3%; P < 0.001) but was not in Group 2 vs Group 3 (27.5% vs 23.3%; P = 0.177). Clinically important hypoglycaemia (glucose ≤3.0 mmol/L) was reported in 4.8%, 2.0% and 3.8% of patients in Groups 1, 2 and 3, respectively. In conclusion, the optimal FBG target for most Chinese patients with T2D appears to be 3.9-6.1 mmol/L.