空腹血糖受损诊断标准下调对糖调节受损人群检出率的影响

目的 分析空腹血糖受损（IFG）的空腹血糖（FPG）诊断标准下调对糖调节受损（IGR）人群检出率的影响，并探讨区分糖调节正常与受损的FPG理想截定点。方法 对2882例无2型糖尿病（T2DM）史的受试者进行口服葡萄糖耐量试验。采用1997年和2003年美国糖尿病学会分类诊断标准进行比较。结果 （1）IFG诊断标准下调后，单纯IFG者增加367例，IFG者由424例增加到1032例，其中包含的糖耐量受损（IGT）者由243例增加到484例；709例IGT者，包括在IFG者中的比例由34％上升到68％。（2）与糖耐量正常（NGT）人群相比，新增单纯IFG人群体质指数、FPG、2hPG、糖化血红蛋白、甘油三酯、胆固醇均升高（均P＜0．01），超重（52．6 vs 39．7％，χ^2=6．79，P〈0．01）和高甘油三酯血症发生率（32．2％ vs 24．9％，；χ^2=3．98，P〈0．05）明显增高。（3）非T2DM人群中诊断IGR（7．8≤2hPG＜11．1mmol／L）的FPG理想截定点为5．6mmol／L。结论 IFG诊断标准下调后，IFG、IFG＋IGT检出率明显增加；新增单纯IFG人群已经出现糖、脂代谢异常；非T2DM人群中诊断IGR的FPG理想截定点为5．6mmol／L。     

张家港市城乡结合部社区老年居民糖代谢状况调查及其危险因素分析

目的 探讨江苏省张家港市杨舍社区60岁以上居民糖代谢状况及其危险因素.方法 以江苏省张家港市杨舍社区免费体检的1525名60岁以上居民为研究对象,进行问卷调查、体格检查、FPG、血尿酸(SUA)和血脂检测,对FPG≥6.1mmol/L的居民行OGTT.结果 原患有T2DM患者(T2DM组)占16.8％;新诊断糖尿病患者(NDM组)占10.1％;IGR者(IGR组)占14.2％,NGT者(NGT组)占58.9％.IGR组年龄、FPG、SBP、DBP、SUA、LDL-C均高于NGT组(P＜0.05或P＜0.01).Pearson相关分析显示,在未诊断糖尿病的社区居民中,FPG与TC、TG、LDL-C、DBP、SBP呈正相关(r=0.092、0.103、0.097、0.149、0.143,P＜0.01).进一步多元逐步回归分析结果显示,DBP、BMI、TG、LDL-C为影响FPG的独立相关因素(标准化偏回归系数β=0.118、-0.111、0.093、0.075,P＜0.01).结论 张家港市城乡结合部社区糖尿病早期筛查,老年人群的患病率达26.9％,IGR老年患者具有高血压、高SUA和高LDL-C的临床特征,FPG升高与DBP、TG、LDL-C水平升高密切相关.     

应用受试者工作特征曲线分析糖化血红蛋白对于2型糖尿病的诊断价值

目的 探讨HbA1c对于T2DM的诊断价值. 方法 选取T2DM患者230例,IGR患者130例和糖耐量正常（NGT）者102名,行75 gOGTT,同时测定FPG、2 hPG、HbA1c等临床指标. 结果 T2DM组FPG、2 hPG高于IGR、NGT组,IGR组FPG与NGT组比较差异无统计学意义.IGR组2hPG高于NGT组.T2DM组HbA1c高于IGR、NGT组（P＜0.01）,IGR组与NGT组比较差异无统计学意义.Pearson相关性分析显示,HbA1c与FPG、2hPG呈正相关（r=0.698、0.652,P=0.000）.受试者工作特征（ROC）曲线显示,HbA1c≥6.4％为诊断切点的曲线下面积0.922（95％CI：0.899～0.946）,HbA1c≥6.4％时与FPG及与2 hPG诊断T2DM的曲线下面积比较差异无统计学意义（P＞0.05）. 结论 HbA1c可作为T2DM诊断标准之一,HbA1c≥6.4％为最佳诊断切点.     

糖调节异常患者血中游离脂肪酸水平与动脉粥样硬化的关系

目的探讨糖调节受损（IGR）患者血中游离脂肪酸（FFA）及各成分水平变化与动脉粥样硬化的关系。方法对120例糖尿病高危人群行OGTT，分为IGR、2型糖尿病（T2DM）和糖耐量正常（NGT）组，测定血中FFA及各成分的水平，超声测颈动脉内膜中层厚度（IMT）和动脉斑块的发病率。结果（1）与NGT组比较，IGR和T2DM组血清FFA和饱和脂肪酸（SFA）水平明显升高（P〈0．05）；（2）多不饱和脂肪酸（PUSFA）水平降低（P〈0．01）；IMT增厚，动脉斑块的发病率增高（P〈0．05）；（3）IMT厚度与血清SFA水平呈正相关，与PUSFA水平呈负相关。结论IGR患者血中FFA水平升高和PUSFA水平降低与颈动脉IMT增厚和动脉斑块的发病率相关。     

不同糖代谢异常患者血浆载脂蛋白A5水平的变化及其临床意义

目的 通过比较不同糖耐量人群血浆载脂蛋白A5（ApoA5）、脂联素（APN）及TG水平,探讨其相互关系,以及ApoA5及APN降低TG的可能机制. 方法 选取新诊断T2DM患者（T2DM组）35例,IGR者（IGR组）30例及正常对照者（NGT组）35名,行静脉葡萄糖耐量试验（IVGTT）.ELISA测定空腹ApoA5及APN水平;比色法测定FFA.稳态模型评估胰岛素抵抗指数（HOMA-IR）及胰岛β细胞功能指数（HOMA-β）.探讨ApoA5与APN、血脂、FFA、HOMA-IR及HOMA-β的关系. 结果 （1）T2DM、IGR组ApoA5及APN水平低于NGT组（P＜0.05）,且T2DM组较IGR组降低更明显（P＜0.05）.（2）T2DM、IGR组TG、FFA、2 hFFA、LDL-C、FPG、2 hPG、FIns、HOMA-IR水平高于NGT组（P＜0.05）,且T2DM组较IGR组升高更明显（P＜0.05）.（3） ApoA5与TG、TC、FFA、2 hFFA、LDL-C、FPG、2 hPG、FIns、HOMA-IR、BMI及WHR呈负相关;与APN、HDL-C及HOMA-β呈正相关.（4）多元逐步回归分析显示,APN、TG、FFA、WHR及HOMA-IR是ApoA5的独立影响因素. 结论 低ApoA5及APN水平可能是IGR时期的早期敏感指标,低ApoA5及APN水平不能有效抑制血中FFA水平,可能导致高甘油三酯血症（HTG）及IR,从而共同导致IGR及T2DM的发生发展.     

糖尿病患者β细胞功能与血糖水平的相关性及其意义

目的：探讨老年2型糖尿病患者胰岛β细胞分泌功能（IS）状况与空腹血糖（FPG）水平的相关关系。方法：126例老年2型糖尿病患者进行口服葡萄糖耐量试验（OGTT）及胰岛索释放试验（IRT），按HOMA模型计算HOMA～IS值。结果：胰岛β细胞的分泌功能随着空腹血糖的升高而下降，当FPG≥8．33mmol／L，IS显著下降（P〈0．01）；但当FPG≥13．88mmol／L，IS下降无显著性（P〉0．05），IS与血糖浓度呈显著负相关（P〈0．01），与胰岛素浓度呈显著正相关（P〈0．01）。结论：2型糖尿病患者空腹血糖浓度与胰岛β细胞分泌功能呈负相关，当FPG≥8．33mmol／L时，IS失代偿，并不进一步显著下降，值得注意。     

不同糖耐量人群血清抵抗素水平及其相关因素分析

酶免法测定50例2型糖尿病（DM组）、50例糖耐量减低（IGT组）及40例糖耐量正常（NGT组）个体的空腹血清抵抗素水平，结果显示IGT组和DM组显著高于NGT组（P〈0．05，P〈0．01）；回归分析显示FPG和FIns与抵抗素的关系较为密切。     

空腹血糖受损与糖耐量减低的区别

1979年美国国家糖尿病资料组提出糖耐量减低（IGT）这个概念。1985年WHO将FPG〈7．0mmol／L，2hPG≥7．8mmol／L且〈11．1mmol／L作为IGT的一种临床分型。1997年美国糖尿病学会（ADA）提出了IFG，即FPG≥6．1mmol／L且〈7．1mmol／L同时2hPG〈7．8mmol／L的概念。1999年WHO提出的IFG和IGT的定义和诊断标准与ADA相同，且提出IFG的另一意思是非糖尿病性空腹高血糖状态。2003年ADA将IFG的FPG下调为5．6mmol／L。IFG与IGT都是指患者的血糖介于正常人与糖尿病患者血糖水平之间的一种中间代谢状态，有人将其称之为糖尿病（DM）前期（prediabetes），也称为糖调节受损（IGR），因此IGR包括IFG和IGT两种状态。我们复习相关文献，将IFG和IGT的主要区别总结如下。     

糖尿病患者血浆Visfatin水平变化及意义

目的 观察糖尿病患者血浆Visfatin水平变化并探讨其意义.方法 选取92例糖尿病患者,其中糖调节受损患者30例(IGR组),6.1 mmol/L≤空腹血糖(FPG)＜7.0 mmol/L和(或)7.8 mmol/L≤餐后2h血糖＜ 11.1 mmol/L;2型糖尿病患者62例(T2DM组),FPG≥7.0 mmol/L和(或)餐后2h血糖≥11.1 mmol/L.T2DM组根据体质量指数(BMI)分为2型糖尿病肥胖患者31例(F组,BMI≥25 kg/m2)和2型糖尿病非肥胖患者31例(NF组,BMI＜ 25 kg/m2).对照组为31例体检健康者.采用ELISA法测定血浆Visfatin水平,葡萄糖氧化酶法测定FPG,磁性分离酶联免疫法测定胰岛素(Fins),计算BMI,并计算胰岛素敏感指数(ISI=lnFPG/Fins).结果 与对照组和IGR组相比,T2DM组血浆Visfatin明显升高(P＜0.01);与对照组相比,IGR组血浆Visfatin明显升高(P＜0.01);与NF组相比,F组血浆Visfatin明显升高(P＜0.01).结论 2型糖尿病尤其肥胖者血浆Visfatin水平显著升高,Visfatin可能在2型糖尿病发病中扮演重要角色.     

不同糖耐量患者糖化血红蛋白与胰岛素抵抗的相关性研究

目的 探讨不同糖耐量患者HbA1 c与IR的相关性.方法 291名受试者行75 gOGTT,根据结果分为T2DM、IGR和正常糖耐量（NGT）组,分析各组HbA1c与IR相关指标的关系.结果 T2DM组FPG、2 hPG、HbA1c、LDL-C、FIns和胰岛素抵抗指数（HOMA-IR）高于IGR组,HDL-C、胰岛素分泌指数（HOMA-β）和ISI低于IGR组（P＜0.05或P＜0.01）.T2DM组HbA1c与TG、HOMA-IR呈正相关（r=0.17,P=0.03;r=0.19,P=0.02）,与HOMA-β、ISI呈负相关（r=-0.39,P=0.00;r=-0.28,P=0.00）.IGR组HbA c与HOMA-β、ISI呈负相关（r=-0.49,P=0.00;r=-0.32,P=0.02）.NGT组HbA1c与HOMA-IR、HOMA-β、ISI无相关性（P＞0.05）.结论 T2DM组HbA1 c、HOMA-IR高于IGR组,不同糖耐量组HbA1c与IR呈正相关.     

Uric acid concentration in subjects at risk of type 2 diabetes mellitus: relationship to components of the metabolic syndrome

High uric acid concentration is a common finding in subjects with risk factors for cardiovascular disease (CVD), including some characteristics of the metabolic syndrome. However, its exact role in this setting and in the progression to type 2 diabetes mellitus (DM) is not well understood and could be affected by confounding factors such as hypertriglyceridemia. Our study aimed to establish the relationship between uric acid (avoiding the interference of high triglyceride levels), insulin sensitivity, and components of the metabolic syndrome in a group of subjects at high risk of developing DM. Among 201 subjects included in the study, 111 (55.2%) showed an abnormal oral glucose tolerance and uric acid levels higher than those measured in subjects with normal glucose tolerance. Body mass index (BMI), triglycerides, diastolic blood pressure (DBP), and 2-hour glycemia in the oral glucose tolerance test (OGTT) contributed independently to uric acid concentration (R2 =.59). However, uric acid did not affect either insulin sensitivity or glucose tolerance. The recovery tests revealed that a triglyceride concentration > or = 3 mmol/L interfered with the measurement of uric acid level when a colorimetric method was used, but not when a dry-chemistry method was used. In conclusion, uric acid concentration is higher in subjects at high risk of DM with abnormal glucose tolerance and is independently determined by various components of the metabolic syndrome.     

Serum homocysteine levels are increased in women with gestational diabetes mellitus

Serum homocysteine (sHcy) has been found to be elevated in patients with type 2 diabetes mellitus, as well as in other clinical conditions associated with insulin resistance and/or vascular diseases. The aims of this study were to measure the relationship between sHcy with biohumoral markers of insulin resistance in pregnant women affected with gestational diabetes mellitus (GDM). We studied 2 groups of pregnant women categorized, after a 100-g, 3-hour oral glucose tolerance test (OGTT) as nondiabetic (n = 78) or affected with GDM (n = 15), by measuring sHcy, serum folate, albumin, vitamin B(12), uric acid, and lipids. In both groups, peripheral insulin sensitivity was measured by using the OGTT-derived index of Matsuda and DeFronzo (ISI(OGTT)). Serum homocysteine was significantly higher in the group with GDM compared with nondiabetic women (5.88 +/- 2.26 micromol/L v 4.45 +/- 1.52 micromol/L; P =.003); was inversely related to serum folate (r = -.48; P =.0001), and was significantly related to serum albumin (r =.27; P =.009), 2-hour plasma glucose (r =.25; P =.01), as well as to serum uric acid (r =.23; P =.03). No relationship was observed between sHcy and serum vitamin B(12), serum triglycerides, total, or high-density lipoprotein (HDL) cholesterol, mean blood pressure and ISI(OGTT). Vitamin B(12) was correlated with ISI(OGTT) (r =.36; P =.0005) and inversely with mean blood pressure (r = -.24; P =.02). GDM remained significantly associated with higher sHcy concentrations also after adjusting for age, serum folate, albumin, uric acid, ISI(OGTT), and vitamin B(12) (P =.006). In conclusion, we found that sHcy is significantly increased in women with GDM, independently of other confounding variables, is significantly related to 2-hour OGTT plasma glucose, and seems unrelated to insulin resistance in these subjects.     

Plasma urate in diabetes: relationship to glycaemia, glucose disposal, microvascular complications and the variations following oral glucose.

In order to provide further insights into the conflicting reports of associations between diabetes and uric acid metabolism, we studied 175 adult diabetic patients (56 IDDM, 119 NIDDM) and 114 matched control subjects. Plasma uric acid (PUA) concentrations were not significantly different between diabetic and control subjects, despite increased urinary urate in diabetic patients. There were no significant associations, in diabetic patients, between PUA and (i) type of diabetes, (ii) glycaemic control, (iii) retinopathy and (iv) proteinuria. Plasma urate did not correlate with the KG constant for glucose disposal rate during IVGTT, thus indicating that PUA may not be related to insulin action. In a separate study, PUA rose sharply, peaking at 30 min, and fell subsequently in both newly diagnosed NIDDM patients (n = 20) and subjects with impaired glucose tolerance (n = 15) in response to standard OGTT, in contrast to normal controls (n = 35) in whom PUA rose gradually to a peak at 120 min. Mean rise in PUA from baseline to peak was significant (P less than 0.05) in the diabetic group only. These differences in PUA response during an OGTT between subjects with abnormal glucose metabolism and normal controls may be a feature in the metabolic evolution of diabetes and need further investigation.     

血糖正常的高血压患者做葡萄糖耐量试验的临床意义

目的：探讨对空腹血糖正常的高血压患者进行葡萄糖耐量试验（OGTT）的意义。方法：选择既往无糖代谢异常病史，空腹血糖〈5．6mmol／L，确诊原发性高血压的成人患者；行OGTT2h血糖测定，如果OGTT2h血糖≥11．1mmol／L，再次行OGTT以排除糖尿病。同时观察年龄，入院时血压、体重指数、血肌酐、血尿酸、甘油三酯、高密度脂蛋白等参数的改变。结果：本组266例患者中检出糖耐量减低者（OGTT2h血糖≥7．8mmol／L）共98例（36．8％），其中确诊2型糖尿病29例（OGTT2h血糖≥11．1mmol／L），占10．9％。结论：所有空腹血糖正常的高血压患者均应进行OGTT，以发现可能的糖代谢异常，使患者能得到早期干预，更显著地降低心血管事件发生的风险。     

Serum uric acid and the risk for hypertension and Type 2 diabetes in Japanese men: The Osaka Health Survey.

OBJECTIVE: To investigate the association of serum uric acid level with the risk for hypertension and Type 2 diabetes. DESIGN: Prospective cohort study. SETTING: Work site in Osaka, Japan. PARTICIPANTS: A total of 6,356 Japanese men, aged 35-60 years with systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg, normal glucose intolerance, and no history of hypertension or diabetes at baseline. MAIN OUTCOME MEASURES: Blood pressure was measured by standard techniques, using 160/95 mmHg for diagnosis of hypertension. Type 2 diabetes was defined as a fasting plasma glucose level > or = 126 mg/dl or a 2 h post-loaded plasma glucose level > or = 200 mg/dl. RESULTS: During the 61,716 person-years follow-up period, we confirmed 639 cases of hypertension and 454 cases of Type 2 diabetes. Serum uric acid level was associated with an increased risk for hypertension but not for Type 2 diabetes. After adjustment for known risk factors, including daily alcohol consumption, the serum uric acid level was associated with an increased risk for hypertension; the relative risks for hypertension were 1.00 for quintile 1 of the serum uric acid level, 1.24 [95% confidence interval (CI), 0.94-1.65] for quintile 2, 1.34 (CI, 1.03-1.76) for quintile 3, 1.76 (CI, 1.35-2.29) for quintile 4, and 2.01 (CI, 1.56-2.60) for quintile 5 (P for trend < 0.001). Even among both non-drinkers and lean subjects, serum uric acid level was associated with an increased risk for hypertension. CONCLUSIONS: Serum uric acid level was associated with an increased risk for hypertension but not for Type 2 diabetes.     

高尿酸血症病人胰岛β细胞功能分析

目的了解单纯高尿酸血症（HUA）病人胰岛β细胞功能,探讨血尿酸水平与胰岛素抵抗的关系.方法采用左旋精氨酸刺激法和口服75 g葡萄糖耐量试验（OGTT）,观察HUA组56例胰岛β细胞第一和第二分泌时相变化,并与正常对照组40例进行比较.结果经左旋精氨酸兴奋后两组均在2 min达分泌峰值,4 min开始下降,HUA组胰岛素峰值明显高于对照组（t=3.71,P＜0.01）;HUA组空腹胰岛素、OGTT120 min血糖、胰岛素、新β细胞功能指数、胰岛素抵抗指数（HOMA-IR）均明显高于对照组（t=2.46～5.56,P值均＜0.05）;多元回归分析显示血尿酸与低密度脂蛋白胆固醇（LDL-C）、HOMA-IR、男性、平均动脉压及肌酐呈正相关关系（t=2.15～3.60,P＜0.05）.结论HUA病人胰岛β细胞功能代偿性增高,且血尿酸水平与胰岛素抵抗呈正相关.     

Gender differences in the relationships of serum uric acid with fasting serum insulin and plasma glucose in patients without diabetes

OBJECTIVE: To explore gender differences in the relationship of serum uric acid levels with fasting serum insulin and fasting plasma glucose concentrations among an adult Chinese nondiabetic population in Kinmen, Taiwan. METHODS: A total of 7,483 nondiabetic subjects (4,265 women, 3,218 men, aged 30 to 89 years) were involved in a community based epidemiologic study. Those with known or newly diagnosed diabetes were excluded. Overnight fasting blood samples were drawn for serum uric acid, glucose, insulin, lipid, and other biochemical measurements. Demographic and clinical variables including body mass index (weight/height2), waist-to-hip ratio, and blood pressure were measured and documented during face-to-face interviews with structured questionnaires. RESULTS: Stratified analyses revealed that (1) serum uric acid levels were positively associated with hyperinsulinemia and HOMA-insulin resistance in both men and women after adjusting for hypertriglyceridemia, hypertension, obesity, and plasma glucose levels; and (2) serum uric acid levels were more strongly associated with hyperinsulinemia and plasma glucose levels in women than in men. CONCLUSION; Hyperuricemia was positively associated with hyperinsulinemia among patients of both sexes without diabetes. Elevated levels of uric acid should alert physicians to the possibility of insulin resistance. The serum uric acid level was associated with insulin resistance and plasma glucose levels more strongly in females than in males in our study population.     

2型糖尿病HbA1c筛查值和诊断值的探讨

目的评估HbA1c在筛查和诊断T2DM中的有效性。方法对497例（男361例,女136例）体检FPG≥5．6mmol／L者行OGTT并测定HbA1c、血脂、尿酸、血压等代谢指标。结果（1）应用受试者工作特性曲线（ROC）进行统计分析,与OGTT诊断DM的相关HbA1c最佳切点为6．3％,敏感性和特异性分另U是79．60％和82．20％,曲线下面积（AUC）为0．873（95％CI0．831-0．916）,HbA1c为6．5％时的敏感性和特异性分别是62．70％和93．50％。（2）按2010年ADA的DM诊断标准,分别按HbA1c≥6．5％或OGTT标准诊断DM,无论是否去除两组重叠部分,以HbA1c≥6．5％标准诊断的DM组的HbA1c水平显著高于以OGTT标准诊断的DM组,而FPG、2hPG均显著低于以OGTT标准诊断的DM组,其余代谢指标如血压、血脂、尿酸等均无统计学差异。结论当HbA1c≥6．3％时应进一步行OGTT以明确有无DM,而HbA1c≥6．5％具有较好的特异性可用于诊断DM,与ADA的推荐一致。     

Study on background factors associated with impaired glucose tolerance and/or diabetes mellitus

In a cross-sectional health screening 636 persons with negative urine glucose, a 75-g-oral glucose tolerance test was performed. We report the clinical features of the subjects with impaired glucose tolerance or diabetes mellitus. In 96 subjects with impaired glucose tolerance, the frequencies of alcohol dependency, fatty liver, and of increased levels of serum uric acid, cholesterol, triglycerides, total serum protein and gamma-glutamyl transpeptidase were significantly higher than in normal subjects. In 37 subjects with diabetes mellitus, the frequencies of fatty liver, hypertension and of increased erythrocyte sedimentation rate, triglycerides and gamma-glutamyl transpeptidase were significantly higher than in normal subjects. In addition, significant increases in serum gamma-glutamyl transpeptidase, triglycerides, serum total cholesterol and body mass index, and a significant decrease in high density lipoprotein cholesterol were also observed in subjects with impaired glucose tolerance and diabetes mellitus. These results suggest that alcohol dependency, fatty liver, obesity and hyperlipidemia are important concomitants of impaired glucose tolerance.     

Evaluation of glycated hemoglobin in the early diagnosis of diabetes mellitus

Although oral glucose tolerance test (OGTT) has been the key examination in early diagnosis of diabetes mellitus, but it still has some problems. It may be affected by some physiological or pathological changes and also requires frequent blood sampling. We investigated the usefulness of measuring the level of glycated hemoglobin (GHb) or HbA1 and HbA1c in screening or early diagnosis of diabetes mellitus. OGTT was performed and fasting levels of HbA1 and HbA1c were measured in 168 subjects. According to the diagnostic criteria of WHO for 75g OGTT, 31 subjects were classified as normal, 35 as having impaired glucose tolerance test (IGT) and 102 as diabetics. The method used for determination of HbA1 and HbA1c was high pressure liquid chromatography (HPLC). The total discovery rate for GHb in diabetic patients was 87%. In patients with fasting level of plasma glucose (FPG) greater than or equal to 8 mmol/L the discovery rate was 100%, while in those with level of FPG less than or equal to 7.94 mmol/L the rate was 80%. Thus, GHb is very useful in screening and early diagnosis of NIDDM (type II), especially diabetes mellitus of the elderly.