2型糖尿病膝下动脉病变患者介入治疗前后缺血动脉内氧化应激标志物的变化及意义

目的观察2型糖尿病(T2DM)下肢动脉硬化闭塞症(ASO)患者下肢动脉介入治疗前后病变动脉内氧化应激标志物的变化,探讨T2DM合并ASO患者体内氧化应激水平及介入治疗对动脉内氧化应激标志物的影响。方法选择接受介入治疗的T2DM合并膝下动脉(胫腓动脉)病变的患者30例,入组患者均行下肢动脉造影检查(DSA),部分患者还需要行经皮腔内血管成形术(PTA)。单纯行DAS患者为14例(造影组),DSA+PTA患者为16例(治疗组)。造影组和治疗组患者均在介入手术前行常规检查并抽取静脉血测血脂、糖化血红蛋白(Hb A1c)和氧化应激标志物水平,包括超氧化物歧化酶(SOD)以及脂质过氧化物终产物丙二醛(MDA)。造影组、治疗组还需取介入治疗前动脉血3 mL,此外治疗组在缺血动脉远端同一部位取PTA术前术后动脉血。上述标本均测SOD、MDA水平。结果造影组患者下肢动脉造影未见明显狭窄。治疗组术前动静脉血SOD水平低于造影组,MDA水平高于造影组(P0.05)。造影组、治疗组各组内介入术前静脉血与动脉血SOD、MDA比较差异无统计学意义(P0.05)。治疗组介入术前缺血部位SOD水平较介入治疗前动脉血水平低(P0.05),MDA水平较介入治疗前动脉血水平高(P0.05)。治疗组介入术后缺血部位SOD水平较介入术前缺血部位及介入术前动脉血SOD均降低(P0.05),MDA水平较介入术前缺血部位及介入术前动脉血中水平均升高(P0.05)。结论介入术前后患者使用抗氧化应激药物可能会改善处理病变的远期预后,减少血管再狭窄发生。     

Effects of carvedilol versus metoprolol on endothelial function and oxidative stress in patients with type 2 diabetes mellitus

BACKGROUND: Data suggest that carvedilol possesses antioxidant properties that might provide vascular protection. We sought to compare the effects of carvedilol and metoprolol tartrate on endothelial function and oxidative stress in a head-to-head trial. METHODS: Thirty-four patients with type 2 diabetes mellitus (T2DM) and hypertension were randomized to receive either carvedilol (n = 16) or metoprolol (n = 18) in addition to their current antihypertensive medications for 5 months. The following variables were measured pre- and posttreatment: blood pressure, fasting glucose and insulin, insulin resistance by homeostasis-model assessment, hemoglobin A1c, lipids, C-reactive protein (CRP), 8-isoprostane, asymmetric dimethylarginine, oxidized LDL cholesterol, ultrasound assessment of brachial-artery flow-mediated dilation (FMD), nitroglycerin-induced endothelium-independent dilation (EID), brachial and carotid artery distension, distensibility and compliance, and carotid artery intima-media thickness (cIMT). RESULTS: Both carvedilol and metoprolol treatment resulted in significant and similar decreases in systolic (P < .05) and diastolic (P < .0001) blood pressure. Compared with metoprolol, carvedilol significantly improved FMD (P < .001). No differences between groups were noted for any of the glycemic or lipid variables except for HDL cholesterol, which significantly decreased (P < .05) in the metoprolol group compared with the carvedilol group. No differences were observed between groups for CRP, the markers of oxidative stress, EID, arterial stiffness, or cIMT. CONCLUSIONS: Compared with metoprolol, carvedilol significantly improves endothelial function in patients with T2DM. Changes in glycemic control and oxidative stress do not seem to explain the observed improvements in FMD, which suggests that other mechanisms may be involved.     

2型糖尿病与良性前列腺增生合并慢性炎症的相关性研究

目的 探讨前列腺增生合并2型糖尿病对前列腺组织中慢性炎症的影响。方法 收集术后病理确诊为前列腺增生合并炎症的病例,在考虑前列腺体积、尿路感染、尿潴留以及患者年龄因素的情况下,分析合并2型糖尿病患者前列腺腺周、腺体及基质炎症是否与非糖尿病患者有区别,是否影响血清前列腺特异性抗原（PSA）。结果 2型糖尿病组比非糖尿病组腺体炎症重,但不影响血清PSA。结论 2型糖尿病不是影响血清PSA的危险因素,但对腺体炎症程度有影响。     

同型半胱氨酸对老年2型糖尿病患者大血管病变的影响

目的 探讨血清总同型半胱氨酸(tHcy)水平与2型糖尿病(T2DM)患者大血管病变间的关系,并分析影响T2DM患者tHcy代谢的因素. 方法 167例老年T2DM 患者分为2组:无大血管并发症组(75例)和T2DM合并大血管病变组(92例);42例正常体检老人作为正常对照组.酶联免疫吸附法测定血清tHcy浓度;自动生化分析仪测定空腹血糖(FBS)、尿素氮(BUN)、肌酐(CREA)、总胆固醇(TC)和三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c);电化学发光仪测定血清胰岛素(INS).对各指标的组间差异进行统计学分析. 结果 tHcy在T2DM合并大血管病患者组血浆浓度较T2DM无大血管并发症组和对照组高,差异具有统计学意义(P＜ 0.05),血清Hcy水平仅与空腹INS水平呈正相关(r= 0.56,P＜0.01). 结论 tHcy参与了T2DM大血管病变的发病过程,tHcy水平可能与胰岛素抵抗有关.     

对2型糖尿病患者启动胰岛素治疗的思考

在2型糖尿病的治疗中尽早启动胰岛素治疗,是血糖达标的需要,也是保护胰岛β细胞、恢复其功能,从而延缓糖尿病进展的需要。初诊2型糖尿病患者经过3个月的生活方式干预和优化的口服降糖药物治疗血糖仍不能达标时,即应启动胰岛素治疗。对代谢紊乱严重、血糖水平较高的患者,应及时启动胰岛素强化治疗。可供选择的胰岛素治疗方案很多,各有优缺点和适应人群,临床上应当因患者而异地选择适宜的起始治疗方案。如何依据糖化血红蛋白（Hb）A1c选择起始治疗方案,目前尚无定论。推荐当HbA1c≤8．5％时主要选择基础胰岛素,HbA1c〉8．5％时选择预混胰岛素或基础—餐时或持续皮下胰岛素输注（CSII）作为起始胰岛素治疗方案。     

Self-reported goals of older patients with type 2 diabetes mellitus

OBJECTIVES: New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored. DESIGN: Exploratory study involving semistructured interviews. SETTING: Four clinics of a midwestern, urban academic medical center. PARTICIPANTS: Patients aged 65 and older with type II diabetes mellitus (N=28). MEASUREMENTS: Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach. RESULTS: The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens. CONCLUSION: As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.     

糖尿病合并肺结核90例临床分析

目的探讨糖尿病合并肺结核患者的临床特点以及血糖控制对疾病治疗的影响。方法对90例糖尿病合并肺结核患者利用胰岛素和降糖药物控制血糖以及抗痨治疗,观察血糖、痰抗酸杆菌涂片转阴率、病灶吸收和空洞闭合,临床症状以及疾病复发等情况。结果 90例患者的临床疗效总有效率为74.4%,血糖控制水平对痰抗酸杆菌涂片转阴率肺结核临床症状改善有一定的影响,其中血糖控制水平较好的患者痰菌转阴率为73.7%,病灶吸收好转率为86.5%、空洞闭合症状好转率为88.5%;血糖控制水平较差者的转阴率为28.6%,病灶吸收好转率为43.8%、空洞闭合症状好转率为33.3%。结论糖尿病合并肺结核的治疗,首先要控制血搪,同时进行抗结核治疗。     

前列地尔治疗老年糖尿病合并慢性肾脏病患者的效果分析

目的探讨前列地尔联合常规治疗对老年2型糖尿病(T2DM)合并慢性肾脏病(CKD)患者的治疗效果。方法人选2014年2月至2016年2月在攀枝花市中心医院内分泌科治疗的90例老年T2DM合并CKD患者,采用数字表法随机分为前列地尔组和对照组,每组45例。对照组给予常规治疗,前列地尔组在常规治疗基础上加用前列地尔10μg/d,静脉推注,1次/d,2周为1个疗程,共治疗3个疗程。比较两组患者血脂、血糖、肝功能、肾功能等指标。所有数据采用SPSS 16.0软件进行统计学分析。计量资料用均数±标准差(±s)表示,两组比较采用t检验。计数资料用百分率表示,组间比较用χ~2检验。结果两组患者治疗前空腹血糖(FPG)、糖化血红蛋白(HbAlc)、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)、同型半胱氨酸(Hcy)、血β2微球蛋白(β2-MG)、尿白蛋白排泄率(UAER)、血肌酐(SCr)、估算肾小球滤过率(eGFR)差异均无统计学意义(P0.05)。治疗后,前列地尔组患者的TG、TC、LDL-C、Hcy、β2-MG、UAER显著低于对照组,差异具有统计学意义(P0.05)。两组患者治疗前后的凝血酶原时间(PT)、血小板(PLT)、活化部分凝血活酶时间(APTT)差异无统计学意义(P0.05)。两组不良反应发生率差异无统计学意义(χ~2=0.212,P=0.645)。结论前列地尔联合常规治疗能显著降低老年T2DM合并CKD患者尿蛋白水平,对患者的肾功能具有一定的保护作用。     

老年2型糖尿病患者中同型半胱氨酸与炎症相关细胞因子的检测

目的 探讨老年2型糖尿病（T2DM）大血管病变患者血清总同型半胱氨酸（they）水平与炎症相关细胞因子间的关系。方法135例老年T2DM患者分为2组：无大血管并发症组（71例）和T2DM合并大血管病变组（64例）;32例体检正常老人作为正常对照组（CTR）。酶联免疫吸附试验（enzyme linked immunosorbentassay,ELISA）法检测受试者血清中tHey、白细胞介素2（IL-2）、IL-4、IL-6、IL-8、IL—10、IL-18和γ-干扰素（INF-7）水平。对各指标的组间差异进行统计学分析。结果与正常对照组比较,T2DM患者血清tHey、IL-2、IL-6、IL-8、IL-18和INF-γ显著升高,IL—10显著降低（P〈0．05）;T2DM合并大血管病变组tHcy、IL-6、IL-8、IL-18和INF-γ显著高于无大血管病变组（P〈0．05）;IL-6、IL-8、IL-18与tHey呈正相关（r=0．33、0．49、0．27,P〈0．01、0．01、0．05）。结论老年糖尿病患者tHey、IL．2、IL-6、IL-8、IL—18、和INF-γ显著高于正常老年人;测定这些指标可能对T2DM患者的血管病变起辅助诊断作用。     

中青年2型糖尿病患者窦性心率震荡的分析

目的探讨中青年初发2型糖尿病患者窦性心率震荡(HRT)的可能变化及其临床意义。方法选择初发室性期前收缩(VPB)的中青年2型糖尿病患者76例(糖尿病组),有VPB的健康人76例作为对照组。两组均行24h动态心电图(DCG)检查,分析单次VPB后HRT的初始值(TO)、斜率(TS)以及TO和TS异常的发生率。结果糖尿病组TO、TS值明显异常,与对照组比较均有显著性差异(p<0.01);糖尿病组TO及TS异常发生率分别为35.3%和38.2%,而对照组分别为7.9%和5.3%,糖尿病组TO、TS值异常率较对照组明显升高,差异有显著性意义(p<0.01)。结论初发青中年2型糖尿病患者HRT现象明显减弱,同时HRT异常率明显增高。临床上HRT可作为青中年初发2型糖尿病自主神经病变的预测指标。     

2型糖尿病患者血瘦素水平与高血压的相关性研究

选择122例2型糖尿病患者,分为合并高血压组和血压正常组,各组又分别分为肥胖和非肥胖亚组.测定其体重指数(BMI)、空腹血糖(FBG)和胰岛素、糖化血红蛋白(HbA1c)及血清瘦素水平,并作相关性分析.结果显示,2型糖尿病患者高血压组与非高血压组间血清瘦素水平无差异(P＞0.05);血清瘦素水平与BMI、空腹胰岛素呈正相关关系(P＜0.01),与血压无明显相关性(P＞0.05);但在合并高血压组,血清瘦素水平与HbA1c呈负相关关系(P＜0.05).提示2型糖尿病患者的血清瘦素水平与血压无明显相关性,但合并高血压患者长时间血糖控制不良可能会导致血清瘦素水平的下降.     

老年2型糖尿病肾功能异常的相关影响因素分析

目的探讨老年2型糖尿病（T2DM）肾功能异常的相关影响因素及临床意义。方法回顾性分析1997-2006年在解放军总医院住院治疗的老年T2DM患者临床资料,根据其肾小球滤过率（GFR）水平分为：GFR≥90（A组）、60～90（B组）、〈60（C组,肾功能异常组）ml/（min.1.73m^2）。对各组临床及实验室指标进行比较。结果共收集老年T2DM病例525例,A组159例（30.3%）,B组239例（45.5%）,C组127例（24.2%）。临床诊断糖尿病肾病（DN）者占13.7%,合并高血压者占71.05%;肾功能异常组中,DN仅占29.9%。在老年T2DM中,高血压病程、收缩压（SBP）、舒张压（DBP）、餐后2h血糖（2hPBG）、血清总胆固醇（TC）、血尿酸（BUa）为肾功能异常的独立相关影响因素,且高血压对其肾功能的影响更为显著。随血压水平增高、DM病程延长、尿白蛋白/肌酐比值（Alb/Cr）增加,GFR下降,肾功能异常发生率增加。血压〈130/80mmHg、≥130/80mmHg者,肾功能异常发生率分别为4.09%、41.72%;DM病程〈5年、5～10年、〉10年者,肾功能异常发生率依次为18.64%、26.09%和28.90%;尿Alb/Cr〈30、30～299、≥300mg/g者,肾功能异常发生率分别为10.53%、40.38%和75%。结论老年T2DM肾功能异常的影响因素较多,高血压病程、SBP、DBP、2hPBG、TC、BUa与之独立相关,高血压对其影响更为显著。血压、血糖控制良好为保护因素,针对上述影响因素的综合治疗对预防及延缓肾功能异常的发生、发展有重要的临床意义。     

Association of glutathione-S-transferase with patients of type 2 diabetes mellitus with and without nephropathy

Statements of the problemHyperglycemia induced oxidative stress is implicated as a contributor to the onset and progression of type 2 diabetes mellitus (T2DM) and its complications like diabetic nephropathy (DN). Glutathione-S-transferase (GST) is primarily involved in the neutralization of reactive oxygen species (ROS) by enzymatic conjugation with the scavenger peptide glutathione (GSH). Therefore, present study was aimed to evaluate the role of GST along with oxidative stress markers and their correlation in patients with Type 2 diabetes mellitus with and without nephropathy.MethodsThis study comprised of 300 participants divided into three groups of 100 each: healthy controls (HC), T2DM without complications and DN. Plasma GST, malondialdehyde (MDA), reduced GSH levels and ferric reducing ability of plasma (FRAP) were estimated spectrophotometrically.ResultsHighest GST levels was observed in T2DM which was significantly higher (p < 0.05) as compared to DN and HC. However, GSH and FRAP levels were found to be significantly lowest whereas MDA levels were significantly highest in DN as compared to T2DM and HC. GST showed a significant negative correlation with GSH, FRAP and positive correlation with MDA in both patients groups.ConclusionsHighest activity of GST in T2DM might be as a compensatory mechanism in response to oxidative stress. GST is found to have significant negative association with decreased GSH. Altered redox milieu in DN collectively conspire to increase the risk of renal damage in T2DM.     

Levels of reactive oxygen metabolites in patients with knee osteoarthritis

Aim: Oxidative stress may be associated with the pathophysiology of knee osteoarthritis (OA), a health‐care issue. The present study aimed to compare oxidative status levels of patients with and without knee OA, using the Reactive Oxygen Metabolites (d‐ROMs, Diacron, Italy) test, which has proved to be clinically useful as an oxidative stress marker. Methods: Forty‐nine women (mean age 71.3 ± 5.8 years, mean body mass index 24.4 ± 2.2 kg/m²) with mildly severe knee OA and 49, without knee OA, female controls' serum d‐ROMs concentrations were assessed together with mean blood pressure, fasting plasma glucose and serum total cholesterol concentrations, using the age‐, sex‐ and body mass index‐matched method. Results: Patients with knee OA showed significantly higher d‐ROMs levels than controls (338 ± 56 vs 315 ± 47 U. Carr., P < 0.05). This difference remained statistically significant after adjusting for other clinical variables. Conclusions: The present results suggested that knee OA might be an impaired oxidative condition. Further studies are necessary to establish the knee OA–oxidative status relationship, which may lead to its clinical application in the management of knee OA.     

2型糖尿病患者血小板参数的检测及初步分析

目的通过对2型糖尿病患者的血液参数[血小板计数（PLT）、平均血小板体积（MPV）、血小板体积分布宽度（PDW）、大血小板比率（P-LCR）、血小板压积（PCT）]的调查分析，探讨糖尿病患者血小板参数变化与糖尿病的关系，以及糖尿病患者血小板变化的临床意义。方法选择2000～2006年我部30例2型糖尿病患者作为试验组。选50例年龄为50～72岁的老年人，排除有血液性疾病及其他代谢性疾病者作为对照组，分别采血3次，测血小板参数，包括血小板数（PLT）平均血小板体积（MPV）、血小板体积分布宽度（PDW）、血小板压积（PCT）、大血小板比率（P-LCR）。对所得结果行）χ^2检验。结果试验组与对照组比较，血小板参数变化差异有显著性（P〈0．05）。结论血小板参数变化在糖尿病的病程中对血管病变的发生、发展有重要作用，对临床研究糖尿病有较大参考价值。     

老年2型糖尿病共患抑郁症的机制及治疗现状

流行病学调查资料证实2型糖尿病(T2DM)易共患抑郁症。目前研究认为下丘脑-垂体-肾上腺(HPA)轴功能过度活跃,炎症介质、神经递质及基因变化等因素可能在两者的共患机制中起重要作用。不同类型抗抑郁药物对T2DM患者的血糖影响不同,选择合适的抗抑郁药物或精神、心理干预措施,可能有益于T2DM共患抑郁症患者的综合管理。抑郁症的诊治专科性质较强,应由精神专科医师进行评估,提供系统治疗方案。