Bone Mineralization in Young Patients with Type 1 Diabetes Mellitus and Screening-identified Evidence of Celiac Disease

The aims of this study were to evaluate bone mineral density (BMD) and bone turnover markers in patients with type 1 diabetes and screening-identified evidence of celiac disease, i.e., celiac autoimmunity. We screened 50 consecutive type 1 diabetic patients for IgA antitissue transglutaminase to identify those with celiac autoimmunity. Eight seropositive patients were identified on this screening, and 12 patients matched for gender and age range were selected as a control group from among the type 1 diabetic patients without celiac autoimmunity. Patients and controls underwent dual-energy X-ray absorptiometry (DEXA) for measurement of bone mineral status and had their blood levels of osteocalcin, carboxy-terminal telopeptide of type I collagen (CTX), calcium, and phosphorus determined. BMD was further adjusted for height, weight, and pubertal stage. Radiographic and blood markers of bone mineralization were compared between patients and controls. BMD (Z-score) at the lumbar spine was −1.44 ± 0.5 SD for patients and 0.04 ± 0.2 SD for controls (P = 0.02). Bone mineral content was 37.9 ± 4.5 g for patients and 49.4 ± 2.6 g for controls (P = 0.049). Adjusted BMD was −0.62 ± 0.5 SD for patients and 0.81 ± 0.09 SD for controls (P = 0.04). After adjustment, four patients and none of the controls presented BMD < −1 SD (P = 0.01). Osteocalcin, CTX, calcium, and phosphorus blood levels were not significantly different between patients and controls. Celiac autoimmunity is associated with reduced bone mineralization in type 1 diabetic patients. The pathophysiological mechanisms and clinical relevance of this finding remain to be further investigated.     

Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes

Objective:The prevalence of celiac disease (CD) varies between 1% and 10% in patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the frequency of spontaneous recovery of celiac serology and the biopsy-proven CD (BPCD) frequency in patients with T1DM.Methods:The data of 668 patients with available celiac serology tests from a total of 779 patients who were followed for the last 10 years with the diagnosis of T1DM were retrospectively evaluated.Results:Positive serology was detected in 103 out of 668 (15.4%) patients. There was spontaneous normalization in 24 (23.3%), fluctuation in 11 (10.7%) and permanently positive serology in 68 (66%). In 46 out of 53 (86.8%) patients with positive serology and biopsy, CD diagnosis was confirmed by biopsy (BPCD). The frequency of BPCD was 6.9%, and the serology in 76.1% was positive at the time of diagnosis of T1DM. The weight, height and body mass index-standard deviation score at diagnosis were lower in patients with BPCD compared to the group without CD. An anti-tissue transglutaminase-IgA (anti-TTG-IgA) level of 11.8 times the upper limit of normal was the most sensitive (93%) and specific (90%) cut-off for BPCD (area under the curve: 0.95; 95% confidence interval: 0.912-1; p<0.001).Conclusion:In our cohort, the frequency of positive serology for CD was 15.4%, while the rate of BPCD was 6.9%. The majority (97.8%) of cases were diagnosed within the first five years of T1DM. In 23.3% of cases, positive anti-TTG-IgA spontaneously resolved without a gluten-free diet (GFD). Therefore, serological follow-up instead of immediate duodenal biopsy or GFD therapy, particularly for patients with asymptomatic and mild anti-TTG IgA level, is warranted.     

Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.     

1型糖尿病患者血浆microRNA-126 变化与内皮功能的相关性

目的 探讨1型糖尿病患者血浆microRNA-126表达水平的变化及其临床意义,并分析microRNA-126与内皮功能的关系。方法 采用实时荧光定量聚合酶链反应检测47例1型糖尿病患者及50例健康对照组人群血浆microRNA-126的表达水平,酶联免疫吸附法检测人内皮型一氧化氮合酶（eNOS）含量,分析血浆microRNA-126表达水平与人内皮型一氧化氮合酶含量的相关性。结果 与健康对照组相比,1型糖尿病组血浆microRNA-126表达水平明显下降（P<0.05）,人内皮型一氧化氮合酶含量也明显下降（P<0.05）。相关分析显示血浆microRNA-126表达水平与人内皮型一氧化氮合酶含量呈明显正相关（P<0.05）。结论 1型糖尿病患者血浆microRNA-126水平呈低表达,而糖尿病患者常伴有内皮功能损伤,提示microRNA-126的下调可能与内皮损伤有关。microRNA-126可能通过介导内皮功能的损伤而参与1型糖尿病血管并发症的发生发展。     

Celiac Disease in an Adult Turkish Population with Type 1 Diabetes Mellitus

Celiac disease is a frequent cause of morbidity among patients with type 1 diabetes mellitus. In this study our objective was to determine the prevalance of celiac diasease in a Turkish adult population with type 1 diabetes mellitus. Patients included 122 type 1 diabetes cases from adult diabetes clinic. Total IgA and IgA-antiendomysial antibody (AEA) assays were performed. Patients positive for IgA-AEA were asked to undergo small intestinal biopsy. Of the 122 patients, none was IgA deficient and 3 had positive IgA-AEA results (2.45%). All three of these patients had biopsies diagnostic of celiac disease. The body mass index (BMI) values of patients with positive AEA were significantly lower than normal (P = 0.024). Among the gastrointestinal complaints there was an association between early satiety and AEA positivity (P = 0.02). None of the other gastrointestinal complaints or age, duration of diabetes, glycosylated hemoglobin values, or insulin doses used were found to be related to AEA positivity. Celiac disease has a high prevalence among Turkish paients with type 1 diabetes mellitus. Screening for IgA-AEA during routine investigations of type 1 diabetic patients is important to prevent celiac-associated symptoms.     

基于核磁共振代谢组学对2型糖尿病合并脑梗死的研究

目的 应用氢谱核磁共振代谢组学(1H-NMR)方法研究2型糖尿病(T2DM)合并脑梗死患者血清中小分子代谢物代谢轮廓的变化,探讨2型糖尿病合并脑梗死的可能发病机制.方法 选择T2DM合并脑梗死患者19例、单纯T2DM患者25例及健康对照者29例,利用1H-NMR方法检测血清的代谢轮廓,通过偏最小二乘判别分析方法,鉴别各组别间血清小分子代谢物的区别.结果 从血清偏最小二乘判别分析得分图中可以区分3组患者,与T2DM合并脑梗死有关的特征代谢物包括极低密度脂蛋白、低密度脂蛋白、葡萄糖、乳酸、丙酮酸、3-羟基丁酸、N-乙酰糖蛋白、亮氨酸、缬氨酸、前列腺素D2、前列腺素E2、同型半胱氨酸、氧化三甲胺、甜菜碱等.结论 脂类代谢、糖代谢、氨基酸代谢的紊乱可能在T2DM合并脑梗死的发病中起到重要作用.炎症因子、同型半胱氨酸的增加,肠道茵群失调引起的氧化三甲胺、甜菜碱的浓度改变可能也与T2DM合并脑梗死的发生有一定关系.     

血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的相关性

目的探讨血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系。方法选择因心绞痛行冠状动脉造影的2型糖尿病患者197例,根据造影结果,冠状动脉正常为对照组(n=89),冠状动脉病变为冠心病组(n=108)。根据冠状动脉病变支数分为单支病变、双支病变和三支病变;Gensini积分评价冠状动脉病变狭窄程度。ELISA测定血清YKL-40和高敏C反应蛋白水平(hs-CRP)。结果冠心病组和对照组间血清YKL-40、hs-CRP、收缩压、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、脂蛋白(a)、餐后2 h血糖、糖化血红蛋白水平及吸烟率存在明显的差异(P<0.05)。不同冠状动脉病变支数组血清YKL-40水平和Gensini积分存在显著差异(P<0.01);血清YKL-40与Gensini积分存在明显相关性(r=0.611,P<0.01)。Logistic回归分析显示,血清YKL-40是2型糖尿病患者罹患冠心病的危险因素(OR=1.229,95%CI为1.086～1.427,P=0.003)。结论 YKL-40可能参与2型糖尿病粥样硬化的发生发展过程,血清YKL-40水平与2型糖尿病患者冠状动脉病变的严重性相关。     

二甲双胍对2型糖尿病患者血浆同型半胱氨酸水平的影响

目的探讨二甲双胍对2型糖尿病患者血浆总同型半胱氨酸水平的影响。方法采用高效液相荧光检测的方法测定30例健康对照者3、0例2型糖尿病患者及服二甲双胍(0.75~1.00 g/天)治疗3个月后的糖尿病患者血浆总同型半胱氨酸的水平。结果2型糖尿病患者血浆总同型半胱氨酸水平(14.1±5.7μmol/L)高于对照组(9.5±3.4μmol/L,P<0.01),并且总同型半胱氨酸水平与年龄、体质指数、空腹血糖和空腹胰岛素明显正相关(P<0.05),与胰岛素敏感指数呈负相关。二甲双胍治疗3个月后,血浆总同型半胱氨酸水平(11.6±4.7μmol/L)比治疗前降低(P<0.05)。结论2型糖尿病患者血浆总同型半胱氨酸水平增高,二甲双胍治疗后可降低血浆总同型半胱氨酸水平。     

Safety of Metformin in Patients with Chronic Obstructive Pulmonary Disease and Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is commonly associated with chronic obstructive pulmonary disease (COPD). Metformin is a valuable treatment for T2DM, and may offer additional benefits in COPD. However, due to its rare association with lactic acidosis, its safety in COPD is uncertain. We retrospectively identified patients with T2DM who had been admitted to hospital for COPD exacerbations. We compared those who were taking metformin with those who were not, with respect to their lactate concentration (primary endpoint) and survival (secondary endpoint). The study cohort (n = 130) had a mean (±standard deviation) age of 73.0 ± 9.8 years and 47 (36%) were female. Arterial blood gases were recorded in 120 cases: 88 (73%) were hypoxemic, 45 (38%) were in respiratory failure and 33 (28%) had respiratory acidosis. The 51 patients (39%) in the metformin group had a median (interquartile range) lactate concentration of 1.45 mmol/L (1.10–2.05) versus 1.10 mmol/L (0.80–1.50) in the non-metformin group (p = 0.012). Median survival was 5.2 years (95% CI 4.5–5.8) versus 1.9 years (1.1–2.6), respectively (hazard ratio 0.57; 95% CI 0.35–0.94). This remained significant in a multivariate model adjusted for measurable confounders. In conclusion, among patients with COPD at high risk for lactate accumulation, metformin therapy was associated with a minor elevation of lactate concentration of doubtful clinical significance. Metformin was associated with a survival benefit, but this must be interpreted cautiously due to possible effects from unmeasured confounders. Viewed collectively, the results suggest that COPD should not present a barrier to the investigational or clinical use of metformin.     

踝臂指数评价2型糖尿病合并下肢外周动脉病患者疗效中的临床价值

目的 观察踝臂指数在2型糖尿病合并下肢外周动脉病患者治疗前后的变化,以探讨踝臂指数作为其疗效评价指标的可行性.方法 2型糖尿病合并下肢外周动脉病患者112例,分为单纯药物治疗组(62例)和介入治疗+药物治疗组(50例).详细记录每一患者的临床资料,包括年龄、性别、身高、体重、心率、血压、空腹血糖、餐后2 h血糖、糖化血红蛋白和血脂等结果.并分别于治疗前和治疗后1个月、3个月、6个月测踝臂指数.结果 2型糖尿病合并下肢外周动脉病患者治疗前踝臂指数小于0.90.介入治疗+药物治疗组治疗后1个月、3个月和6个月的踝臂指数与治疗前相比均有统计学意义(P<0.05),与单纯药物治疗组同期相比亦均有统计学意义(P<0.05).单纯药物治疗组治疗后1个月、3个月和6个月的踝臂指数与治疗前相比无明显变化(P>0.05).结论 踝臂指数在2型糖尿病合并下肢外周动脉病患者的治疗中起重要指导作用.介入治疗能够及早改善2型糖尿病合并下肢外周动脉病患者的血运,比单纯药物治疗疗效显著.     

Altered Endothelial Function in Asymptomatic Male Adolescents with Type 1 Diabetes

Objective. While adult men and women with diabetes experience similar rates of cardiovascular disease, early microvascular complications show significant gender differences during adolescence. The goal of this study was to determine whether a gender contrast in a preclinical stage of atherosclerosis, or endothelial dysfunction, is present in pediatric diabetic patients. Methods. Reactive hyperemia‐peripheral arterial tonometry (RH‐PAT), a noninvasive method to assess endothelial dysfunction, was used. Measurements were performed at rest and after hyperemia in 20 diabetic subjects and 20 age‐ and gender‐matched nondiabetics, aged 12–16 years. Confounding risk factors for endothelial dysfunction, including smoking, obesity, and hypertension, were excluded. Results. RH‐PAT was lower for male diabetic subjects vs. controls (n = 12, 1.60 ± 0.32 vs. 1.92 ± 0.28, P < .001). RH‐PAT was similar in female diabetic patients vs. controls. Male and females with type 1 diabetes subjects had equivalent metabolic control (HbA1C 7.48 ± 1.0 vs. 7.51 ± 0.9) and lipid profiles. No difference was observed in age, HbA1C, and diabetes duration, between male and female diabetic subjects. However, diabetic female patients had a greater body mass index (24.2 ± 2.5 vs. 20.6 ± 2.0, P = .003) and were more mature in pubertal status as compared with diabetic male patients. Conclusion. Endothelial dysfunction was present in adolescent male diabetic subjects as measured using RH‐PAT. Considering that endothelial dysfunction is reversible, early detection of this process may have theurapeutic and prognostic implications in this young age group.     

2型糖尿病并发脑血管病患者内皮功能的研究

目的 :探讨 2型糖尿病并脑血管病患者的内皮功能变化。方法 :以循环内皮细胞 (CEC)作为血管内皮细胞 (VEC)损伤的指示物 ,以血浆内皮素 (ET 1)、一氧化氮 (NO)作为VEC功能变化的标示物。采用Hlandove方法检测CEC ,放免法测定血浆ET水平、比色法测定NO水平。结果 :2型糖尿病并发脑血管病患者CEC、血浆ET水平均较正常对照组显著升高 (P <0 .0 0 1) ,NO水平显著下降 ,CEC与血浆ET水平显著正相关 ,与NO水平显著负相关。结论 :2型糖尿病并发脑血管病患者内皮功能严重受损。     

2型糖尿病合并冠心病患者QT离散度的临床研究

目的探讨2型糖尿病合并冠心病患者心电图QT离散度（QTd）及校正QT离散度（QTcd）的变化特点及临床意义。方法通过观察120例2型糖尿病合并冠心病患者心电图QTd及QTcd变化,并与112例非糖尿病冠心病患者及105例健康者对照比较。结果T2DM合并冠心病患者与非糖尿病冠心病相比,QTd及QTcd明显延长,差异有统计学意义（P〈0．01）。冠心病患者与健康者相比,QTd及QTcd明显延长,差异有统计学意义（P〈0．01）。QTd及QTcd大小顺序为：T2DM合并冠心病组〉非糖尿病冠心病组〉健康对照组。结论2型糖尿病合并冠心病患者的心肌复极不均一性增强,动态观察QTd和QTcd可作为提示糖尿病心脏病变的有效指标。     

对氧磷酶1192Gln/Arg和对氧磷酶2311Cys/Ser多态性与2型糖尿病合并大血管病变的相关性

目的探讨对氧磷酶1基因192 Gln/Arg和对氧磷酶2基因311 Cys/Ser多态性与山东青岛地区2型糖尿病患者合并大血管病变的关系。方法通过抽提基因组DNA并应用聚合酶链反应检测对氧磷酶1 192 Gln/Arg和对氧磷酶2 311 Cys/Ser多态性在2型糖尿病合并大血管病变组、单纯2型糖尿病组以及正常对照组的基因频率。联合分析两种基因变异在2型糖尿病合并大血管病变的发病中有无协同效应。结果山东青岛地区人群存在对氧磷酶1 192 Gln/Arg和对氧磷酶2 311 Cys/Ser多态性。2型糖尿病合并大血管病变组与单纯2型糖尿病组和正常对照组比较对氧磷酶1的3种基因型(QQ、QR、RR)的构成比差异无显著性,而对氧磷酶2的3种基因型(CC、CS、SS)的构成比差异有显著性(P<0.05或P<0.01),S等位基因频率较其他两组显著增高(P<0.05或P<0.01)。联合分析发现对氧磷酶2 311 S等位基因是2型糖尿病合并大血管病变的独立危险因素,当对氧磷酶2 311 S等位基因与对氧磷酶1 192 R等位基因并存时,患2型糖尿病合并大血管病变的相对危险度明显增加(OR=49.494,95%CI为0.907~2701.872)。结论在山东青岛地区人群中,对氧磷酶2 311 Cys/Ser多态性与2型糖尿病合并大血管病变具有相关性,其S等位基因可能是该地区2型糖尿病合并大血管病变的危险因素之一。当同时检测出对氧磷酶1 192 R等位基因时对2型糖尿病合并大血管病变更具有预测或诊断价值。     

α2-HS-糖蛋白基因与2型糖尿病及其合并下肢动脉粥样硬化的相关性

目的探讨α2-HS-糖蛋白的4个单核苷酸多态性位点(rs4917、rs4918、rs1071592和rs2248690)与2型糖尿病及其合并下肢动脉粥样硬化的相关性。方法采用聚合酶链反应-限制性片长多态性及等位基因特异引物-聚合酶链反应技术对包括88例正常对照和245例2型糖尿病患者(其中无下肢动脉粥样硬化者84例和合并下肢动脉粥样硬化者161例)4个多态性位点检测,通过B超检测其下肢动脉,比较三组间4个多态性位点的基因频率,分析筛选2型糖尿病及其合并下肢动脉粥样硬化的危险因素。结果α2-HS-糖蛋白基因rs4917(C/T)、rs4918(C/G)、rs2248690(A/T)多态性在三组中其基因型分布及等位基因频率无明显差异(P>0.05);rs1071592(C/A)多态性在单纯糖尿病组、糖尿病合并下肢动脉粥样硬化组与正常对照组比较其基因型分布及等位基因频率差异有显著性(P<0.01或P<0.05);多元回归分析显示携带rs1071592的A等位基因者2型糖尿病患病风险明显增加(OR=8.501,95%CI 1.201～60.153)。结论α2-HS-糖蛋白基因rs1071592的A等位基因是2型糖尿病的易感基因,但没有发现α2-HS-糖蛋白基因的4个多态性与2型糖尿病合并下肢动脉粥样硬化相关。     

对氧磷酶2基因311Cys/Ser多态性与2型糖尿病合并大血管病变的相关性

目的探讨对氧磷酶2基因311 Cys/Ser多态性与山东青岛地区2型糖尿病患者合并大血管病变的关系。方法通过抽提基因组DNA并应用聚合酶链反应扩增包含对氧磷酶2基因311位点的基因片段,然后应用聚合酶链反应限制片长多态性技术检测对氧磷酶2基因311 Cys/Ser多态性在2型糖尿病合并大血管病变组、单纯2型糖尿病组以及正常对照组的基因频率。结果山东青岛地区人群存在对氧磷酶2基因311 Cys/Ser多态性。2型糖尿病合并大血管病变组对氧磷酶2基因的3种基因型(CC、CS、SS)的构成比与单纯2型糖尿病组和正常对照组比较差异具有显著性(P<0.05或P<0.01),S等位基因频率较单纯2型糖尿病组和正常对照组显著增高(P<0.05或P<0.01);携带S等位基因的个体患糖尿病大血管病变的风险为非携带者的2.932倍;对氧磷酶2基因311 Cys/Ser多态性不同基因型亚组间血脂水平无明显差异。结论在山东青岛地区人群中,对氧磷酶2基因311 Cys/Ser多态性与2型糖尿病合并大血管病变具有相关性,其S等位基因可能是该地区2型糖尿病合并大血管病变的危险因素之一。     

踝肱指数在2型糖尿病外周动脉疾病中的应用

目的评价踝肱指数在2型糖尿病伴外周动脉疾病诊断中的意义。方法486例2型糖尿病患者按踝肱指数<0.9和≥0.9分为外周动脉疾病组和不伴外周动脉疾病组,比较两组的临床特征,并分析与踝肱指数相关的因素,确定2型糖尿病伴外周动脉疾病的危险因素。结果外周动脉疾病组平均年龄、糖尿病病程和低密度脂蛋白胆固醇水平显著高于不伴外周动脉疾病组(分别为62.09±10.53岁比56.77±9.83岁、86.90±51.94月比57.91±57.64月及3.07±1.01mmol/L比2.71±0.98mmol/L;P<0.05或P<0.01),踝肱指数显著低于不伴外周动脉疾病组(0.77±0.15比1.08±0.15,P<0.01)。Pearson相关分析显示,踝肱指数与年龄(r=-0.159,P=0.01)和总胆固醇(r=-0.161,P=0.01)负相关。Logistic回归分析显示,年龄、病程、收缩压和低密度脂蛋白胆固醇是2型糖尿病伴外周动脉疾病的危险因素,腰臀比是其发病的保护因素。结论踝肱指数是筛查2型糖尿病外周动脉疾病的简单易行又可靠的指标,年龄、病程、收缩压、低密度脂蛋白胆固醇是2型糖尿病患者踝肱指数降低的危险因素。     

糖尿病合并急性冠状动脉综合征患者血小板表面PAC-1和CD62P表达水平

目的探讨糖尿病合并急性冠状动脉综合征患者血小板表面血小板膜糖蛋白Ⅱb/Ⅲa纤维蛋白原受体(PAC-1)和P选择素(CD62P)的表达水平及其与血浆同型半胱氨酸(Hcy)的关系。方法选择单纯急性冠状动脉综合征患者40例、糖尿病合并急性冠状动脉综合征患者24例及对照组30例,采用全血流式细胞术结合三色荧光技术检测血小板表面PAC-1和CD62P的表达水平,并与血浆Hcy作相关性分析。结果糖尿病合并急性冠状动脉综合征患者的血小板PAC-1、CD62P和血浆Hcy水平较对照组明显升高(P0.05),同时血小板CD62P表达水平较单纯急性冠状动脉综合征患者明显升高(P0.05);血小板PAC-1、CD62P与血浆Hcy水平呈正相关(r分别为0.441和0.408,均P0.05)。结论糖尿病合并急性冠状动脉综合征患者血小板表面PAC-1、CD62P表达水平明显升高,并与血浆Hcy呈明显正相关。血小板表面PAC-1和CD62P的表达水平可能对预示糖尿病患者发生血栓事件具有重要的意义。     

2型糖尿病患者尿微量白蛋白/肌酐比值与臂踝脉搏波传导速度的相关性

目的 探讨2型糖尿病患者尿微量白蛋白/肌酐比值（UACR）与臂踝脉搏波传导速度（baPWV）的相关性,同时探讨其他可能影响baPWV的因素。方法 800例住院的2型糖尿病患者,行baPWV、UACR、血脂、肾功能、空腹血糖、空腹C肽、糖化血红蛋白、血钙磷、血甲状旁腺激素等测定。采用单因素方差分析及多元线性逐步回归分析评价baPWV与UACR及其他各因素相关情况。结果 2型糖尿病患者随着年龄增大,baPWV逐渐增大（P<0.001）。按UACR不同水平分为3组后,＞300 mg/g组baPWV（1958.10±530.76 cm/s）较＜30 mg/g组（1609.86±310.98 cm/s）、30～300 mg/g组（1659.88±354.27 cm/s）显著增大（均P<0.005）。Pearson相关分析显示,baPWV与年龄、收缩压、脉压差、血清尿素氮及UACR呈正相关（r＝0.554、0.393、0.440、0.158、0.300,均P<0.05）,与血清白蛋白、肾小球滤过率、血磷、钙磷乘积呈负相关（r＝－0.195、－0.261、－0.203、－0.176,均P<0.05）。多元逐步线性回归分析显示,baPWV与年龄、收缩压、UACR呈独立正相关（β＝0.488、0.266、0.143,t＝14.55、8.12、4.47,均P<0.001）,与血磷呈独立负相关（β＝－0.083,t＝－2.57,P<0.05）。结论 2型糖尿病患者baPWV与年龄、收缩压、UACR及血磷独立相关。     

2型糖尿病患者血清可溶性细胞间粘附分子1水平变化及与血管内皮功能的关系

目的研究2型糖尿病患者血清可溶性细胞间粘附分子1水平的变化,并以血浆假性血友病因子水平作为内皮功能损伤的指标,观察细胞间粘附分子1与血管内皮细胞功能损伤之间的关系。方法62例2型糖尿病患者按照有无血管并发症分为无血管病变组(n=19)、微血管病变组(n=20)和大血管病变组(n=23),选择20例健康者作为对照组。应用酶联免疫吸附法检测各组患者血清可溶性细胞间粘附分子1水平和血浆假性血友病因子水平,并测定糖脂代谢指标和尿微量白蛋白水平。结果2型糖尿病患者血清可溶性细胞间粘附分子1水平明显高于健康对照组(P<0.01),在无血管病变组、微血管病变组和大血管病变组的水平逐步升高(P<0.01);血浆假性血友病因子水平在大血管病变组高于微血管病变组,微血管病变组高于无血管病变组(P<0.01),无血管病变组与对照组间无显著性差异。可溶性细胞间粘附分子1与血浆假性血友病因子、甘油三酯、收缩压、舒张压呈正相关(r分别为0.43、0.45、0.52和0.62,P<0.01)。结论细胞间粘附分子1可能参与了2型糖尿病血管病变的发生和发展,可作为早期2型糖尿病患者慢性血管并发症尤其是大血管病变发生的预测及监测指标。