血清对氧磷酶1活性与2型糖尿病患者颈动脉粥样硬化的关系

目的：探讨血清对氧磷酶1（paraoxonase 1,PON1）活性与2型糖尿病患者颈动脉粥样硬化的关系。方法2型糖尿病患者117例,根据颈动脉彩色多普勒超声测定结果,分为无动脉粥样硬化（AS）组38例,AS组79例;选择同期健康体检者75例（对照组）,测量血压、体质量指数（BMI）、腰臀比、空腹血糖、餐后2小时血糖、糖化血红蛋白、总胆固醇、甘油三酯（TG）、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸等各项指标,同时测定血清 PON1活性。分析血清PON1活性与颈动脉粥样硬化的关系。结果与对照组比较,糖尿病组血清 PON1（240．0±15．6） kU／L vs （229．5±19．6）kU／L、AS发生率（44．0％ vs 67．5％）、BMI（24．3±3．6）kg／m2 vs （25．8±3．2）kg／m2、腰臀比（0．89±0．05）vs （0．93±0．06）、收缩压（131．0±8．3）mmHg（1 mmHg＝0．133 kPa）vs （134．0±8．8）mmHg、TG （1．8±0．8）mmol／L vs （2．1±1．3）mmol／L等比较差异有统计学意义（P＜0．05）;AS组血清 PON1活性明显低于非AS组（235．5±19．9）kU／L vs （226．7±18．9）kU／L（P＜0．05）;糖尿病患者血清PON1活性与年龄呈负相关（r＝－0．382,P＜0．01）,与血清TG水平呈正相关（r＝0．223,P＜0．05）。结论2型糖尿病患者血清PON1活性显著下降,PON1活性降低与颈动脉粥样硬化发生密切相关。     

对氧磷酶2基因多态性（C311S）与2型糖尿病合并冠心病的关系

目的探讨对氧磷酶2（paraoxnase2,PON2）基因多态性（C311S）与2型糖尿病合并冠心病的关系。方法用聚合酶链反应．限制性片段长度多态性（PCR．RFLP）分析法探查PON2基因多态性（C311S）在正常对照组、单纯糖尿病组以及2型糖尿病合并冠心病组中的基因频率,组间频率比较采用X^2检验,数据用SPSS软件进行分析。结果发现检测者存在PON2基因多态性（C311S）,且在2型糖尿病合并冠心病患者中PON2基因的C等位基因频率明显高于正常对照组和单纯糖尿病组（P〈O．01）。结论2型糖尿病患者PON2基因的C等位基因第311位密码子的多态性可能与并发冠心病有关。     

Management of type II diabetes mellitus

Although type II diabetes remains a major disease with the potential for serious complications, new discoveries have improved management techniques and methods of assessment. With a carefully prescribed program of therapy and proper monitoring, patients can hope to achieve optimum metabolic control, according to Drs Emanuele and Lawrence.     

1型糖尿病患者对氧磷酶1活性和氧化低密度脂蛋白水平变化

目的观察1型糖尿病(type 1diabetes mellitus,T1DM)患者血清对氧磷酶1(paraoxonase 1,PON1)活性和氧化低密度脂蛋白(oxidative low-density lipoprotein,ox-LDL)水平的变化。方法 51例T1DM患者(T1DM组)分为有并发症组36例和无并发症组15例,45例体检健康者对照组,测定各组血清PON1活性、ox-LDL及血生化水平,并分析其相关性。结果 T1DM组血清PON1活性低于对照组(P<0.01),ox-LDL水平高于对照组(P<0.01);有并发症组血清PON1活性低于无并发症组(P<0.01),ox-LDL和三酰甘油水平高于无并发症组(P<0.05);血清PON1活性和ox-LDL水平呈负相关(r=-0.3660,P<0.01)。结论血清PON1活性和ox-LDL水平变化对阐述T1DM的发病机制,预防T1DM并发症的发生有重要意义。     

Economic impact of type II diabetes mellitus

Diabetes is a dangerous, expensive disease with a major economic impact. The cost to the nation in 1984 was estimated to be $14 billion. We now believe the total costs approach $20 billion. Of this, $10.5 billion is guesstimated to be direct cost due to the diagnosis and treatment of the disease, while indirect costs (due to complications, work days lost, decreased productivity, and premature death) are about $9.5 billion. A typical patient with NIDDM and hypertension spends about $1000 per year for doctor visits, lab tests, oral diabetes tablets, blood pressure medications, lancets and blood test strips (4 per week), and miscellaneous expenses. NIDDM is clearly the major diabetes cost to the nation because it represents 85 to 90 per cent of all diabetes and because half the patients are undiagnosed and untreated. We believe the morbidity, mortality, and economic burden of NIDDM can be favorably affected by a concerted national effort as defined by the National Diabetes Advisory Board in its 1987 National Long Range Plan to Combat Diabetes. Finally, one must not forget the "other costs" of NIDDM, which are statistically unmeasurable: emotional costs, loss of freedom, inconvenient life style changes, and the permanent dependence on "others" (family, professionals, and so on) for help.     

Catalase and paraoxonase in hypertensive type 2 diabetes mellitus: correlation with glycemic control

OBJECTIVES: Type 2 diabetes mellitus (DM) is well recognized as being associated with increased prevalence of hypertension. Experimental and epidemiologic studies have shown that oxygen-free radicals are elevated because antioxidant enzyme activities are altered both in uncontrolled essential hypertension and DM itself. Recently paraoxonase (PON) has been recognized as an antioxidant enzyme that hydrolyzes lipid peroxides. The aim of this study is to evaluate simultaneously PON activities and antioxidant status in hypertensive type 2 DM cases and to establish any possible relationship between these parameters and duration of hypertension or diabetes, hemoglobin (Hb) A1c levels, and lipid parameters. DESIGN AND METHODS: Nineteen normotensive subjects with type 2 DM, 37 hypertensive (diastolic blood pressure 90 mm Hg or more) subjects with type 2 DM, and 25 normotensive control subjects with normal glucose tolerance were selected for this study. Superoxide dismutase (SOD), catalase, and basal-stimulated PON activities were measured by the methods of Sun et al.; Goth; and Eckerson, Wyte, and La Du, respectively; other lipid parameters were determined using an autoanalyzer. RESULTS: Catalase activities of either hypertensive patients with type 2 DM or type 2 DM patients without complication were found to be higher than controls (p<0.01), although no significant difference in SOD and basal-stimulated PON activities was observed between these groups. A significant elevation in catalase activity (p = 0.004) of patients with high HbA1c levels (>7.0%) (n = 37) compared with patients with low HbA1c levels (<7.0%) (n = 19) was detected. There was also a positive correlation between the catalase activities and fasting glucose levels and HbA1c concentrations in hypertensive patients with type 2 DM (r = 0.4567, p<0.05 and r = 0.3686, p<0.05, respectively). An increase in catalase activity of patients with B and/or AB phenotype compared with patients with A phenotype was also noted. CONCLUSION: Poor glycemic control in diabetes is strongly associated with an increase in free radicals and consequent diabetic complications. Uncontrolled glucose metabolism may also be the cause of alterations in antioxidant enzymes. Among these, catalase correlates best with poor glycemic control. The current data reveal that B allele carriers of PON are more susceptible to oxidant stress.     

Macrosomia in pregnancy complicated by insulin-dependent diabetes mellitus

We assessed the factors influencing the birth weight of infants born to 83 women with insulin-dependent diabetes mellitus (IDDM) over a 5-yr period. Maternal glycosylated hemoglobin (HbA1) concentrations at delivery correlated with the percentile birth-weight ratios (r = .43, P less than .001) and indicated that approximately 18% of variance in the birth weight could be ascribed to glycemic control in the third trimester. Fetal macrosomia occurred in 22 (27%) pregnancies. When 20 of these pregnancies were compared closely with 20 nonmacrosomic pregnancies in diabetic women, the mothers of macrosomic infants were found to be more obese, have a history of previous macrosomic birth, and have higher concentrations of serum human placental lactogen and urinary estriols in the third trimester. Macrosomic pregnancy was further distinguished by accelerated fetal growth (judged by serial ultrasonography) from the 32nd wk of gestation and by biochemical (but asymptomatic) hypoglycemia in the neonate. In our study, no serious neonatal morbidity could be attributed to macrosomic pregnancy. Good glycemic control was attained in both groups, and no significant differences between the groups in overall glycemic control throughout pregnancy were noted. Thus, despite good glycemic control, macrosomia remains comparatively common in modern pregnancy complicated by IDDM, and factors other than maternal hyperglycemia must contribute to its etiology.     

1型糖尿病并发严重神经病变的护理

报告1例1型糖尿病并发植物神经病变、周围神经病变的护理。对患者注重心理护理、用药护理,对植物神经病变引起的胃轻瘫、腹泻、体位性低血压、泌尿系感染,以及周围神经病变引起的疼痛进行有针对性的护理,同时预防糖尿病足。经过80d治疗和精心护理,患者各种症状明显好转后出院。     

2型糖尿病并发低镁血症的因素分析

目的：探讨2型糖尿病（DM）并发低镁血症的发生率及影响因素。方法：对152例2型DM其中并发低镁血症的36例病人进行多因素线性回归分析。结果：2型DM患低镁血症的发生率为23．7％,血清镁浓度与空腹血糖、糖化血红蛋白（HbA1c）以及DM微血管并发症积分呈显负相关（P＜0．05）。结论：2型DM患有较高的低镁血症发生率,FPG、HbA1c以及微血管并发症是影响病人低镁血症发生的主要因素。     

2型糖尿病合并高尿酸血症的护理

随着人们生活水平的提高和饮食结构的改变,2型糖尿病患病率逐年增加。2008年调查显示,我国糖尿病患病率已达9．7％。糖尿病病人易合并肥胖、高血压、高血脂、高尿酸等多种代谢异常。     

Serum paraoxonase activity in patients with type 1 diabetes compared to healthy controls

BACKGROUND: The oxidation of low-density lipoprotein (LDL) is central to current theories on the initiation and progression of atherosclerosis. Type 1 diabetes is associated with an increase in oxidative stress, which may be responsible for the increased susceptibility to coronary heart disease seen in type 1 diabetes. High-density lipoprotein (HDL) associated paraoxonase (PON1) can retard the oxidation of LDL. DESIGN: Paraoxonase activity, concentration and genotype were therefore investigated in 152 people with type 1 diabetes and 282 healthy controls. These parameters were also investigated in the group with type 1 diabetes in relation to the presence of diabetic complications. RESULTS: Both PON1 activity and concentration were significantly lower by 16.7% and 19.2% (both P < 0.05) in the type 1 diabetes group. These differences were independent of the PON1 coding region polymorphisms. The distribution of PON1 activity and mass were the same in both populations, i.e. for the PON1-192 polymorphism RR > RQ > QQ and for the PON1-55 polymorphism LL > LM > MM. There were no differences in either the PON1 polymorphisms, PON1 activity and concentration in people with type 1 diabetes in the presence or absence of micro and macro vascular complications of diabetes. CONCLUSIONS: Low PON1 activity may contribute to the increased atherosclerosis found in type 1 diabetes by reducing the ability of HDL to retard LDL oxidation despite the frequently-found increased HDL in type 1 diabetes when good glycaemic control is established.     

2型糖尿病合并视网膜病变患者凝血功能分析

目的分析2型糖尿病(T2DM)合并视网膜病变(RD)患者的凝血功能。方法选择T2DM确诊患者154例,根据患者眼底检查结果分为无DR(NDR)组、DR组,DR组患者分为增殖性视网膜病变(PDR)组和非PDR(NPDR)组。采集所有患者一般资料,同时检测空腹血糖(FPG)、糖化血红蛋白A1c(HbA1c)、胆固醇(CHOL)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(DD)、纤维蛋白降解产物(FDP)等指标水平。对各研究组检测结果进行统计学分析。结果各研究组间FPG、HbA1c、CHOL、TG、HDL、LDL、PT、APTT、TT、DD、FDP水平比较差异无统计学意义(P0.05)。DR组FIB水平高于NDR组(P0.05),NPDR组、PDR组FIB水平比较差异无统计学意义(P0.05)。结论糖尿病合并DR患者FIB水平升高,FIB可能在T2DM合并DR的发生、发展过程中起到一定的作用。     

Cardiac autonomic activity and Type II diabetes mellitus

CAN (cardiac autonomic neuropathy) is a common complication of diabetes. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function, as measured by heart rate variability, is strongly associated with an increased risk of silent myocardial ischaemia and mortality. A major problem in ischaemia-induced impairment of vascular performance in the diabetic heart is unrecognized cardiac sympathetic dysfunction. Determining the presence of CAN is based on a battery of autonomic function tests and techniques such as SPECT (single-photon emission computed tomography) and PET (positron emission tomography). Nevertheless, spectral analysis of heart rate variability seems to remain the primary technique in evaluating CAN, due to its low cost, easy use and good intra-individual reproducibility.     

2型糖尿病患者并发脑卒中的危险因素

目的:研究2型糖尿病并发脑卒中的危险因素,探讨其发病机制。方法:将96例2型糖尿病患者分为两组:伴有脑卒中的2型糖尿病患者50例(患者组)和不伴有脑卒中的2型糖尿病患者46例(对照组),测定两组患者的空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B以及体质量、血压,行Logistic多元逐步回归,筛选脑卒中的危险因素。结果:患者组糖尿病病程(OR,2.16;95%CI,1.31～4.23)、舒张压(OR,1.85;95%CI,1.25～3.89)、糖化血红蛋白(OR,3.94;95%CI,2.89～4.56)、总胆固醇(OR,1.72;95%CI,1.09～3.49)是脑卒中的独立危险因素,载脂蛋白A(OR,0.33;95%CI,0.25～0.89)是脑卒中的保护因素。结论:控制血糖、血压、血脂,可以有效降低脑卒中的发生率,改善糖尿病患者的生活质量。     

阿托伐他汀在2型糖尿病合并高脂血症患者的疗效观察

目的探讨阿托伐他汀应用于糖尿病合并高脂血症患者的治疗效果。方法选取2010年6月至2013年6月该院收治的2型糖尿病伴高脂血症患者110例,将其随机分为观察组及对照组,每组55例,对照组单纯予以二甲双胍(1 500mg/d)治疗,观察组在给予二甲双胍(1 500mg/d)控制血糖的基础上予以阿托伐他汀10mg/d进行治疗;治疗4周后观察比较两组患者治疗前后空腹血糖、餐后2h血糖、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。结果治疗前,两组患者TC、TG、LDL-C、HDL-C水平比较无明显差异;治疗后,观察组患者TC、TG、LDL-C水平均较治疗前明显降低,HDL-C较治疗前明显升高,且与对照组相比差异有统计学意义(P0.05)。两组患者治疗后空腹血糖以及餐后2h血糖均较治疗前明显降低(P0.05),且与对照组比较,观察组患者下降的幅度更加明显(P0.05)。结论阿托伐他汀应用于糖尿病合并高脂血症患者的治疗不仅可以明显控制患者的血脂水平,而且在与降糖药物联合运用时还有协同降糖效应,改善患者的生活质量。     

老年2型糖尿病患者糖尿病视网膜病变危险因素分析

目的：探讨老年2型糖尿病患者糖尿病视网膜病变的危险因素。方法：将158例老年2型糖尿病患者分为合并视网膜病变组75例，无视网膜病变组83例，分析两组患者之间病程、空腹血糖、餐后2h血糖、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、收缩压、舒张压、血清脂蛋白α、载脂蛋白Al、载脂蛋白B等因素与视网膜病变的相关性。结果：两组间性别、年龄差异无统计学意义（P〉0．05），组间病程、空腹血糖、餐后2h血糖、糖化血红蛋白、血清脂蛋白α、载脂蛋白Al、载脂蛋白B、甘油三酯收缩压、舒张压相比差异有统计学意义（P〈0．05）。结论：病程、血糖、血脂以及血清脂蛋白α等均是发生视网膜病变的主要因素。