2型糖尿病血清瘦素质量浓度与胰岛素抵抗的关系

目的探讨2型糖尿病人群血清瘦素水平与胰岛素抵抗的关系。方法2001-102002-08对河北医科大学第三医院的196例受试者(2型糖尿病者118例、对照者78名)用放射免疫法测定空腹血清瘦素水平,同时测量身高、体重、腰围、臀围。结果糖化血红蛋白(HbA1c)、收缩压(SBP)、甘油三酯(TG)和瘦素(Leptin)是影响胰岛素敏感性的因素;2型糖尿病组瘦素质量浓度高于对照组;肥胖者瘦素质量浓度显著升高,而2型糖尿病组内肥胖与非肥胖者之间瘦素质量浓度差异无显著性。结论肥胖者大多存在胰岛素抵抗;2型糖尿病人无论肥胖与否均存在一定程度的胰岛素抵抗。     

西布曲明对2型糖尿病患者瘦素及胰岛素抵抗的影响

肥胖导致的胰岛素抵抗(IR)是糖尿病、高血压、代谢紊乱发生的基础．并与糖尿病慢性并发症的发生发展密切相关。2001年1月至2002年1月，我们应用西布曲明治疗2型糖尿病患者30例，观察治疗前后患者血脂、基础胰岛素、胰岛素抵抗指数、血清空腹瘦素水平的变化．以评价西布曲明在2型糖尿病治疗中的应用价值。     

2型糖尿病患者血清瘦素水平与胰岛素抵抗的相关性研究

2003年9月至2004年11月,我们对57例2型糖尿病患者行血清瘦素(LEP)水平检测及胰岛素(INS)释放试验,旨在探讨LEP与INS抵抗的关系。     

2型糖尿病患者血清瘦素水平与胰岛素抵抗关系的研究

胰岛素抵抗是 2型糖尿病的发病机制之一 ,本研究通过对2型糖尿病患者血清瘦素、空腹胰岛素等指标的测定 ,旨在研究2型糖尿病患者血清瘦素水平与胰岛素抵抗之间的关系及影响血清瘦素水平的因素。一、对象和方法1.按 1997年 ADA/ WHO糖尿病诊断标准 ,收集 2型糖尿病患者 (糖尿病组 ) 10 1例 ,男 5 1例、女 5 0例 (排除胰岛素治疗者 )。正常对照 6 8例 ,男 36例、女 32例。2 .受试对象测量身高、体重并采空腹静脉血 ,常规方法测定空腹血糖 (FPG) ,糖化血红蛋白 (Hb A1c) ,血肌酐 (Cr) ,总胆固醇 (TC) ,甘油三酯 (TG)及高密度脂蛋白胆固…     

2型糖尿病患者血清瘦素与胰岛素、体脂分布的关系

为进一步探讨瘦素在 2型糖尿病发病中的作用 ,我们观察了 43例本病患者血清瘦素与胰岛素、腹部皮下脂肪与内脏脂肪的关系 ,现报告如下。1　资料与方法1 .1　一般资料　本组男 2 5例、女 1 8例 ,年龄 2 5～6 8岁。均未服用糖皮质激素 ,无肾功能减退史。其中1 1例行螺旋 CT测定体     

短期胰岛素强化治疗对2型糖尿病患者血清MCP-1的影响

将确诊的未用过胰岛素的2型糖尿病患者48人,随机分为2组,其中强化治疗组24人,常规治疗组24人。另选择健康体检者24人做为对照。观察胰岛素强化治疗与常规治疗前后血清单核细胞趋化蛋白-1（MCP-1）的变化。结果：（1）胰岛素强化治疗组与常规治疗组MCP-1的水平在治疗前差异无显著性。两组洽疗前与正常对照组比较,差异显著。（2）两组治疗前后MCP-1水平比较,差异显著P〈0．05,强化组下降更明显P〈0．01。（3）胰岛素强化治疗组与常规治疗组治疗前后差值的比较,差异显著。（4）胰岛素强化治疗后MCP-1水平更明显接近正常对照组,两者比较,P〉0．05,差异无统计学意义。胰岛素常规治疗后未能达到正常对照组水平,两者比较P〈0．01差异显著。（5）2型糖尿病患者MCP-1的水平与HOMA—IR呈明显的正相关。结论：（1）2型糖尿病患者经胰岛素治疗后血清单核细胞趋化蛋白-1（MCP-1）的水平明显下降。胰岛素可能通过降低MCP-1的水平而发挥抗炎作用。强化治疗组降低MCP-1的水平更明显,治疗效果更显著。（2）本研究证实2型糖尿病患者MCP-1的水平与HOMA—IR呈明显的正相关。     

二甲双胍对2型糖尿病患者血清瘦素水平的影响

DM2患者40例及正常对照者(NC)25人,行标准餐实验,测定Leptin及空腹、餐后0.5小时、餐后2小时血糖(Plasma glucose,PG)及胰岛素(insulin,Ins),同时测定甘油三酯(TG)、胆固醇(CH)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及糖化血红蛋白(HbA1c)。初诊DM2患者30例给予二甲双胍0.5bid治疗12周,复查上述指标,观察其变化。结果与NC组相比,DM2组Leptin水平明显升高(P<0.05),且女性患者高于男性(P<0.05),肥胖患者高于非肥胖者。二甲双胍治疗12周后DM2组FPG、0.5hPG、2hPG、HbA1c、TG、CH、HOMA-IR、Leptin均显著降低(P均<0.05),HDL-C升高(P<0.05)。结论二甲双胍治疗12周后,DM2患者FPG、0.5hPG、2hPG、HbA1c、TG、CH、HOMA-IR、Leptin均显著降低,HDL-C升高。     

2型糖尿病胰岛素抵抗与瘦素及糖尿病肾病的关系

为探讨 2型糖尿病患者胰岛素抵抗与瘦素和糖尿病肾病(DN)的关系 ,我们对 2 0 0 1年 7月以来在本院门诊治疗和住院的 112例 2型糖尿病患者观察了胰岛素敏感指数 (IAI)、瘦素 (L PT)和尿白蛋白排泄率 (UAER)。现报告如下。临床资料 :112例 2型糖尿病患者均按 WHO标准确诊 ,男 6 0例 ,女 5 2例 ;年龄 4 0～ 6 5岁 ;病程 1～ 6年。根据本院正常值将 112例 2型糖尿病患者分为 :1A组 :即 IAI异常组、胰岛素抵抗 (IR)组。男 30例 ,女 2 8例 ;年龄 4 0～ 6 5岁。 2 B组 :即 IAI正常组、非胰岛素抵抗 (NIR)组。男 30例 ,女 2 4例 ;年龄 4…     

新诊断的2型糖尿病短期强化胰岛素治疗

1 资料与方法 资料20例均为我院住院患，男12例，女8例，符合1999年WHO2型糖尿病的诊断。年龄40～63岁．全部患均在诊断1个月内入选，未经药物治疗。     

短期胰岛素强化治疗对初诊2型糖尿病患者胰岛素抵抗及血尿酸的影响

目的 探讨短期胰岛素强化治疗对初诊2型糖尿病患者胰岛素抵抗及血尿酸的影响.方法 对36例初诊2型糖尿病患者进行为期2周的胰岛素强化治疗,比较治疗前后血尿酸（UA）、空腹血糖（FPG）及餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、胰岛素抵抗指数、胰岛素敏感指数.结果 经胰岛素强化治疗后,患者UA、FPG、2hPG、HbA1c、胰岛素抵抗指数均较治疗前明显下降（P均＜0.01）,胰岛素敏感指数明显升高（P＜0.01）.结论 短期胰岛素强化治疗可显著改善初诊2型糖尿病患者的胰岛素抵抗,降低血UA水平.     

短期持续胰岛素输注治疗对初诊2型糖尿病患者胰岛β细胞功能的影响

目的　观察短期持续性皮下胰岛素输注 (CSII)治疗对伴明显高血糖的初诊 2型糖尿病患者的降糖效果和胰岛 β细胞功能的影响。 　方法　对空腹血糖 >11.1mmol/L的 36例初诊 2型糖尿病患者进行为期 2周的CSII强化治疗 ,分析比较其治疗前后空腹及餐后 2h血糖、糖化血红蛋白A1C、静脉葡萄糖耐量 (IVGTT)试验时胰岛素分泌第一时相和胰岛素及C肽曲线下面积、空腹血浆胰岛素原、胰岛素原与胰岛素比值和由Homa模型计算的Homaβ、HomaIR等。血浆胰岛素、C肽、胰岛素原浓度均用放免法测定。　结果　 2周的CSII治疗显示出快速稳定的降血糖效果。其中 35例患者的空腹、餐后 2h血糖分别于治疗后 ( 2 .7± 1.9)d、( 8.5± 3.5 )d达到良好控制 ,且未见明显低血糖。胰岛 β细胞功能在治疗后获得显著改善 :静脉注射葡萄糖后 10min内出现了明显增加的胰岛素、C肽分泌相 ,更有部分患者可以见到典型的胰岛素第一时相分泌尖峰 ,胰岛素、C肽曲线下面积和由Homa模型计算的Homaβ值均较治疗前明显提高 ,而胰岛素原、胰岛素原与胰岛素比值则较治疗前明显下降。反映胰岛素抵抗的HomaIR也较治疗前明显降低。　结论　对伴明显高血糖的初诊 2型糖尿病患者 ,短期CSII强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能的作用。     

新诊断2型糖尿病病人脂代谢紊乱状态与胰岛素抵抗及胰岛素分泌缺陷

目的 观察新诊断的2型糖尿病病人脂代谢紊乱状态与胰岛素抵抗及胰岛素分泌缺陷的关系。方法 143例新诊断的2型糖尿病病人,根据美国ATP Ⅲ标准分为血脂正常组,高甘油三酯组、高胆固醇组、混合性高脂组,应用稳态模型评估法评价胰岛素敏感性及胰岛B细胞功能,探讨各种类型的脂代谢紊乱与胰岛素抵抗及胰岛素分泌缺陷的关系。结果 新诊断的2型糖尿病病人血脂紊乱发生率为56．6％,高甘油三酯组的HOMA-IR较正常组显著升高。各组HOMAp无显著差别。结论 新诊断的2型糖尿病病人脂代谢紊乱类型以高TC／LDL最常见,但高TG者的胰岛素抵抗程度更为严重。     

How accurate is the smoking history in newly diagnosed diabetic patients?

A smoking history was obtained from 94 consecutive newly diagnosed diabetic patients referred to an adult diabetic clinic. The smoking load was measured using urinary cotinine/creatinine ratios (COT/Cr). Fifty-six patients (60%) claimed to be non-smokers, but COT/Cr suggested active smoking in five of these. The patients who admitted to smoking were given standardised anti-smoking advice. At 3 months, 32 smoking patients were reviewed and 21 (66%) claimed to have reduced or stopped smoking. However, the median COT/Cr in the 32 patients showed no significant reduction (11.15 vs. 9.30 μg/mg). Urinary COT/Cr indicated that 6 patients had stopped smoking (median COT/Cr 6.98 fell to 0.97 μg/mg), but several patients had a marked rise in COT/Cr, demonstrating that their smoking habit had increased considerably. Therefore the smoking history obtained from new diabetic patients can be very misleading. An objective measure of smoking habits in the initial assessment and follow-up of diabetes may be worthwhile. Anti-smoking counselling at diagnosis of diabetes may persuade some smokers to stop.     

Serum sialic acid in subjects with impaired glucose tolerance and in newly diagnosed type 2 diabetic patients

Several general population studies and those carried out in diabetic patients with complications have pointed to serum sialic acid as a marker of inflammation in atherosclerosis. In this study we examined whether total sialic acid (TSA) was changed in the sera of 28 newly diagnosed subjects with type 2 diabetes (type 2 DM), 47 subjects with impaired glucose tolerance (IGT) and 72 subjects with normal glucose tolerance (NGT). The associations between sialic acid and other atherosclerotic risk factors such as lipid profile, baseline diene conjugates in low-density lipoproteins (LDL-BDC) and fasting insulin were also investigated. We found a trend to TSA increase in subjects with impaired glucose tolerance and a significant increase in TSA in newly diagnosed patients with type 2 DM (2.2±0.3 vs. 1.9±0.3 mmol/l; p<0.03) when compared to subjects with NGT. Lipid profile and LDL-BDC, as a marker of circulating oxidized LDL, did not differ among glucose tolerance categories. Significant associations between total sialic acid and 2-h post-load glucose level, fasting insulin, insulin sensitivity, HDL-cholesterol and log of triglycerides were found in the examined subjects. Multiple regression analysis showed significant correlations between serum sialic acid and 2-h post-load glucose levels and insulin sensitivity. This study indicates that measurement of TSA as a marker of subclinical inflammation may be valuable as an independent parameter in identifying subjects at higher risk of developing type 2 diabetes and those who might benefit from anti-inflammatory treatment. Received: 10 May 2002 / Accepted in revised form: 15 April 2003 Correspondence to M. Gavella     

利拉鲁肽联合胰岛素治疗新诊断肥胖2型糖尿病的临床疗效及安全性观察

目的 探讨利拉鲁肽联合胰岛素治疗新诊断肥胖T2DM的临床疗效及安全性. 方法 筛选新诊断肥胖T2DM患者76例,按数字随机表法分为观察组和对照组,每组各38例.对照组予胰岛素联合二甲双胍,观察组在此基础上加用利拉鲁肽.治疗16周,比较两组治疗的临床疗效及不良反应.结果 与治疗前相比,两组糖基化血红蛋白[对照组：（10.94±1.55）％ vs （6.90±0.75）％;观察组：（11.41±1.43）％vs（5.86±0.76）％]、稳态模型胰岛素抵抗指数（HOMA-IR）下降[对照组：（3.40±0.63）vs（2.00±0.35）;观察组：（3.38±0.66）vs（1.60±0.54）]（P均＜0.05）,而稳态模型胰岛β细胞功能指数（HOMA-β）升高[（对照组：（13.34±4.07）vs（33.56±7.06）;观察组：（12.53±3.25） vs （49.88±10.58）]（P＜0.05）;观察组BMI降低[（28.89±1.19） vs（26.58±0.93） kg/m2] （P＜0.01）.与对照组相比,观察组治疗后HbA1 c下降[（6.90土0.75）％vs（5.86±0.76）％]、HOMA-IR [（2.00±0.35）vs （1.60±0.54）] HOMA-β升高[（33.56±7.06）vs（49.88±10.58）]（P＜0.05）;观察组低血糖发生率升高[（72.1％vs81.6％）]（P＜0.05）.两组均无严重低血糖事件发生. 结论 利拉鲁肽联合胰岛素治疗新诊断肥胖T2DM可明显降低血糖和体重,改善胰岛β细胞功能,且无严重不良反应发生.     

新诊断2型糖尿病患者血清铁蛋白与糖、脂代谢及胰岛功能的关系

目的 比较不同血清铁蛋白(SF)水平的新诊断2型糖尿病(T2DM)患者糖、脂代谢及胰岛功能,分析其与SF的关系.方法 以新诊断T2DM患者115例为观察对象,按SF浓度分为高SF组40例(SF≥274.66 μg/L)与正常SF组75例(21.80 μg/L≤SF< 274.66 μg/L).测量两组患者的身高、体重、腰围、臀围,检测空腹血糖、餐后2h血糖(2 hPG)、HbA1c、空腹胰岛素(FINS)、总胆固醇、甘油三酯、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C),计算体重指数、腰臀比、稳态模型评估-胰岛素抵抗指数(HOMA-IR)、稳态模型评估-胰岛β细胞功能指数(HOMA-β)、定量胰岛素敏感性指数(QUICKI)和处置指数,并进行Spearman相关性及多元线性回归分析.结果 高SF组体重指数、FINS、甘油三酯、HOMA-IR高于正常SF组(t=2.470、2.631、2.316、2.879,P均<0.05),HDL-C、QUICKI低于正常SF组(t=-2.030、-2.623,P均<0.05);SF水平与体重指数、腰臀比、空腹血糖、2 hPG、HOMA-IR、甘油三酯均呈正相关(r=0.191 ～0.303,P均<0.05),与HDL-C、QUICKI、处置指数呈负相关(r=-0.221、-0.261、-0.293,P均<0.05);多元线性回归分析显示体重指数、处置指数和甘油三酯是SF的独立相关因素(β=0.041、-0.443、0.270,P均<0.05).结论 高SF水平的新诊断T2DM患者其糖、脂代谢紊乱及胰岛素抵抗程度较正常SF的T2DM患者更严重,SF可能通过增加胰岛素抵抗,促进T2DM的发生和发展.     

Insulin-resistant patients with type 2 diabetes mellitus have higher serum leptin levels independently of body fat mass

In obese people, an increase of plasma leptin levels is well-known and is seen as a consequence of the increased body fat mass. Moreover, a relationship between fasting concentrations of leptin and insulin has been described. Hyperinsulinemia is considered to be indicative of insulin resistance. We aimed at elucidating the interrelations between leptin, insulin and insulin resistance in type 2 diabetic patients. Under metabolic ward conditions, we investigated 21 moderately overweight men with type 2 diabetes. The patients had a mean age of 49.1 years, a mean body mass index (BMI) of 26.8 kg/m², and a mean diabetes duration of 82.5 months. All patients were treated with diet alone. We measured fasting leptin and insulin levels, body composition by determination of total body water, and insulin resistance by euglycemic hyperinsulinemic clamp technique. At univariate analysis, fasting leptin level significantly and positively correlated with BMI (r=0.49, p=0.02) and with fasting insulin (r=0.69, p=0.001), while it negatively correlated with the glucose disposal rate (r=−0.62, p=0.002). Furthermore, leptin was inversely correlated with HDL-cholesterol (r=−0.45, p=0.04). When excluding the influence of body fat mass or of BMI in partial correlation analysis, the correlations between leptin and insulin or insulin sensitivity remained significant. The relationship between insulin resistance (as measured directly in the clamp experiments) and leptin concentrations was also shown by subdividing the diabetic patients according to tertiles of insulin sensitivity. The highest fasting leptin levels were observed in those patients with the most expressed insulin resistance. Our data point to a functional relationship between insulin resistance and leptin concentrations in insulin-resistant type 2 diabetic men, independently of body composition. This relationship is believed to be mediated by insulin. Received: 2 August 2000 / Accepted in revised form: 20 February 2002     

Influence of age on clinical and immunological characteristics of newly diagnosed type 1 diabetic patients

The aim of this study was to analyse the immunological and clinical characteristics of a group of patients at the onset of type 1 diabetes and to determine if these findings are age related. For this purpose, 68 newly diagnosed type 1 diabetes mellitus patients referred to our hospital between 1997 and 1999 were studied; 42 were adults (mean age 24±3.5 years) and 26 children (mean age 6.1±4 years). Autoantibody markers islet cell antibodies, glutamic acid decarboxylase antibodies (GADA) and tyrosine phosphatase antibodies (IA-2A), pancreatic reserve (glucagon test) and HbA_1c were determined. Some clinical characteristics, such as mode of presentation and insulin requirements, were also analysed. Type 1 diabetes mellitus was found to be autoimmune in 83.8% of the patients and idiopathic in 16.2%, without significant differences between adults and children. In the whole autoimmune group, GADA was more prevent in adults and IA-2A more frequent in children. On the other hand, adults showing autoimmune markers developed ketosis more frequently and needed higher insulin doses at diagnosis, while children did not exhibit clinically significant differences associated with the presence or absence of antibodies. In conclusion, in children the presence of autoimmune markers is not related to the mode of presentation or characteristics of type 1 diabetes. In adults, however, the autoimmune group presents with more-severe clinical disease than antibody negative patients. Age at onset seems to be an important parameter in the natural history of type 1 diabetes and must be taken into account in epidemiological or intervention studies. Received: 1 April 2000 / Accepted in revised form: 3 April 2001