2型糖尿病患者心血管危险因素评估及护理干预

目的 探讨2型糖尿病患者心血管危险因素和护理干预措施.方法 选取该院自2012年1月-2013年8月收治的患者100例,随机作为研究组,在进行基础治疗的基础上性饮食治疗、合理用药、健康教育和运动治疗,选取60例作为对照组,进行基础治疗.比较两组患者血压、血糖、BMI、血脂、糖化血红蛋白和尿微量白蛋白.观察两组患者转规以及其心血管和替代终点的影响.结果 治疗第6个月和12个月时进行随访,与对照组相比,干预组的多重心血管明显的得到了改善,心血管事件的发生率明显的降低,残余血管的危险明显降低,差异P＜0.05具有统计学意义.结论 2型糖尿病患者存在有多重心血管因素,合理有效的进行护理干预可以为心血管病中的高危人群提供系统的服务,具有非常重要的临床意义.     

2型糖尿病患者踝肱指数与心血管危险因素的相关性研究

目的探讨2型糖尿病(T2DM)患者踝肱指数(ABI)与心血管危险因素的相关性。方法 87例T2DM患者根据ABI分为PAD组和非PAD组,进行病史回顾,体格检查,测定血脂、血压和糖化血红蛋白。结果 T2DM合并PAD组与非PAD组相比,年龄大,病程长,BMI、收缩压、舒张压、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、HbA1c、FPG明显增高,多因素相关和回归分析显示,年龄、病程、BMI、收缩压、TC、LDL-C、HbAlc是影响ABI的独立危险因素。结论传统的心血管危险因素同样是加剧T2DM患者下肢动脉硬化的主要因素,应重视此类患者心血管危险的干预。     

2型糖尿病患者糖尿病肾病与血脂异常的关系

将2型糖尿病患者依据尿白蛋白／肌酐的比率分为正常蛋白尿组、微量蛋白尿组和大量蛋白尿组，测定各组的年龄、病程、BMI、WHR、SBP、DBP、TC、TG、HDL—C、LDL—C、VLDL—C、LP(a)，并分析。结果随尿蛋白的增加患者的TG、VLDL—C和LP(a)呈进行性增加，且各组间差异有显著性。结论2型糖尿病患者血脂异常是糖尿病肾病的重要危险因素之一。     

司美格鲁肽对2型糖尿病患者心血管危险因素的影响

目的 探讨司美格鲁肽对2型糖尿病患者心血管危险因素的影响。方法 选取2021年1月—2022年10月盐城市第一人民医院诊治的90例2型糖尿病患者,按随机数表法分为两组,即对照组45例,应用胰岛素治疗;观察组45例,另在此基础上给予司美格鲁肽治疗;对比两组血糖、血脂等心血管危险因素相关指标变化情况。结果 观察组治疗后空腹血糖（FPG）、餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）水平低于对照组,三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）、颈动脉内膜-中层厚度（CIMT）低于对照组,高密度脂蛋白胆固醇（HDL-C）高于对照组,差异有统计学意义（P<0.05）,两组不良反应发生情况比较,差异无统计学意义（P>0.05）。结论 司美格鲁肽治疗2型糖尿病患者,能够减轻心血管危险因素的影响,应用效果值得探讨。     

低血糖对青年2型糖尿病患者心血管事件的影响

目的：探讨低血糖对青年2型糖尿病患者心血管事件的影响。方法：采用回顾性研究方法,2014年8月到2016年6月选择在我院内分泌科诊治的青年2型糖尿病患者360例,收集所有患者的病历资料与血压样本检测结果,记录低血糖发生情况与调查相关因素,随访心血管事件发生情况。结果：360例患者中发生低血糖20例,发生5.6%。根据2型糖尿病患者是否发生低血糖分为低血糖组(n=20)与对照组(n=340),两组的HDL-C、HbA1c、LDL-C、TG、TC值等对比无明显差异(P>0.05),不过低血糖组的SCr、CRP、CK值等都明显高于对照组(P<0.05)。通过采用Logistic回归分析发现,引起低血糖的主要因素为CRP、病程、CK以及年龄。所有患者随访6个月,低血糖组的不稳定性心绞痛、心力衰竭、靶血管血运重建、猝死等心血管事件发生率为40.0%,明显高于对照组的3.8%(P<0.05)。结论：青年2型糖尿病患者存在低血糖状况,主要发病因素包括年龄、病程、CRP、CK等,可导致心血管事件的增加,在临床上要积极进行预防性控制。     

二甲双胍对2型糖尿病心血管危险因素的影响

众所周知，许多2型糖尿病患者伴有肥胖，高血压，血脂异常，并存在胰岛素抵抗，这些因素使得心血管疾病的发生率大为增加，研究发现，二甲双胍除了有良好的降糖作用外，还能改善胰岛素抵抗，对血脂，血压，肥胖、血小板，纤溶系统均有有益作用。对降低糖尿病患者心血管疾病的发生和死亡率具有重要意义。     

年龄＜40岁与≥40岁新诊断2型糖尿病患者心血管病变风险比较

目的 比较年龄＜40岁与≥40岁新诊断T2DM患者心血管病变（CVD）危险因素水平及聚集情况. 方法 选取既往无冠心病病史的新诊断T2DM患者568例,分为年龄＜40岁组136例和年龄≥40岁组432例,收集一般资料和主要病史等,检测血糖、血脂、HbA1c、高敏C反应蛋白（hsC-RP）和24 hUAlb等指标. 结果 年龄＜40岁组BMI、BP、血糖、血脂、HbA1c、hsC-RP、24 hUAlb、吸烟、CVD家族史、肥胖/超重、BP升高、血脂异常、蛋白尿阳性率以及合并不同CVD危险因素数量的发生率与年龄≥40岁组比较差异无统计学意义,但血脂异常、BP升高的病情知晓率及治疗率低于年龄≥40岁组（P＜0.01）. 结论 年龄＜40岁与≥40岁新诊断T2DM患者具有相似的CVD发生风险,但前者病情知晓率及治疗率更低.     

2型糖尿病脂蛋白代谢及颗粒异常与心血管风险的研究进展

2007年至2008年我国糖尿病的流行病学调查显示中国糖尿病与糖尿病前期患病率分别高达9．7％和15．5％。糖尿病患者其脑血管疾病和卒中增加2-4倍,同时有80％的糖尿病患者死于心血管事件,每年有44％的成人终末期肾病由糖尿病肾病引起口0。有关流行病学调查结果显示,普通人群血脂异常的发生率为20％-40％,而糖尿病患者合并血脂异常者约占60％。并且我国流行病学研究资料还表明：血脂异常是冠心病发病的危险因素,其作用强度与西方人群相同;我国人群血清总胆固醇水平增高不仅增加冠心病发病危险,     

2型糖尿病家系青少年一级亲属心血管危险因素研究

目的探讨2型糖尿病（T2DM）家族史对青少年心血管危险因素的影响。方法秦皇岛地区12～18岁青少年4023人横断面调查。根据父母有无糖尿病分为糖尿病家族史阳性组（FH＋）和阴性组（FH-）。测量腰围（WC）、血压、FPG、血脂,计算BMI。结果（1）FH＋组腰围、FPG、TC和LDL-C均高于FH-组（P〈0.05）,超重/肥胖、高SBP、高FPG检出率高于FH-组（P〈0.05）。（2）校正年龄、性别后FH＋组SBP、FPG升高、超重/肥胖的危险性分别是FH-组的1.54、2.06、1.33倍,95%CI分别是（1.10～2.16）、（1.46～2.89）、（1.12～1.59）,具有2项以上心血管危险因素的危险性是FH-组的1.72倍。结论T2DM患者的青少年一级亲属已存在心血管危险因素增加和聚集。应重视对这一人群进行早期筛查和干预,以减少心血管病的发生。     

2型糖尿病患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平与代谢紊乱、胰岛素抵抗之间的关系

目的探讨2型糖尿病患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)与胰岛素抵抗和代谢紊乱之间的关系。方法分析了806例2型糖尿病住院患者和103例健康体检者ALT、AST、体脂参数、血压、血脂、血糖、外周白细胞计数(WBC)水平,采用稳态模式(HOMA)评价胰岛素抵抗。根据ALT四分间距,分为ALT1组(<10 U/L)、ALT2组(10~14.9 U/L)、ALT3组(15~21.9 U/L)和ALT4组(≥22 U/L)。结果随着ALT水平升高,空腹胰岛素(FINS)和HOMA-IR呈升高趋势(P<0.05)。随着代谢紊乱数目增多,Log ALT和Log AST呈升高趋势(P<0.05)。校正性别和年龄后LogALT与LogFINS和LogHOMA-IR仍呈正相关(P<0.05),LogAST与LogHOMA-IR仍呈正相关(P<0.05)。多元逐步回归分析显示,Log ALT与代谢紊乱数目和LogHOMA-IR呈独立正相关(P<0.05)。结论2型糖尿病患者ALT、AST水平升高与胰岛素抵抗、代谢紊乱密切相关。     

腰围身高比值与2型糖尿病心血管病危险因素的关系

目的探讨腰围身高比值（WHtR）用于2型糖尿病（T2DM）评估腹型肥胖及其与心血管病危险因素的关系。方法新诊断T2DM患者4ll例，测血压、血糖、血脂、身高、体重、腰围（WC）、臀围，计算BMI、WHtR及腰臀比（WHR），分析WHtR、BMI、WC及WHR与身高的关系，各肥胖指数与血压、血脂的关系。结果（1）WHtR与血压、TG及HDL-C的相关程度均大于与BMI、WC、wHR的相关程度。WHtR与高血压、高TG及低HDL-C均显著相关。结论WHtR升高与血压、血脂关系密切，可作为评估腹型肥胖及预测T2DM心血管疾病危险因素指标之一。     

A better parameter in predicting insulin resistance： Obesity plus elevated alanine aminotransferase

AIM: To investigate the association of obesity and elevated alanine aminotransferase with insulin resistance and compare these factors with metabolic syndrome.METHODS: We enrolled a total of 1308 male workers aged from 22 to 63 years. Data was extracted from the workers’ periodic health check-ups in hospitals. All cases were from the community of northern Taiwan.This was a cross-sectional observational study from July to September in 2004. We grouped all cases into four groups, based on the quartile of homeostasis model assessment. The top fourth quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis for the odds ratio of the risk factors for insulin resistance.RESULTS: Compared with metabolic syndrome, the coexistence of both factors had a 4.3-fold (95% CI: 2.7-6.8) increased risk, which was more than metabolic syndrome with a 3.6-fold (95% CI: 2.6-5.0) increased risk. The two factors had a synergistic effect. The synergistic index of obesity and elevated alanine aminotransferase (ALT) was 2.1 (95% CI: 1.01-4.3).CONCLUSION: Obesity and elevated ALT are associatedwith insulin resistance. The effects are synergistic.Coexistence of them is better than metabolic syndrome in predicting insulin resistance.     

PNPLA3 polymorphisms are associated with raised alanine aminotransferase levels in hepatitis C virus genotype 3

Background and study aimsHepatitis C virus (HCV) infection is one of the leading causes of end-stage liver diseases. This study aimed to determine the association between polymorphisms in interleukin 28B (IL28B), PNPLA3, toll-like receptor 7 (TLR7), nucleotide-binding oligomerization domain-containing protein 2 (NOD2) and retinoic inducible gene-I (RIG-I) and HCV genotype and clinical presentation in an Indian population.Patients and methodsA total of 500 patients with chronic HCV were enrolled in 19 centres across India. Genomic DNA was extracted from whole blood samples, and single nucleotide polymorphisms (SNPs) for IL28B, PNPLA3, TLR7, NOD2 and RIG-I genes were genotyped by real-time PCR using a TaqManSNP genotyping assay.ResultsThe mean age of the patients was 45 + 13 years, and the most common genotype observed was HCV genotype 3 (54%), followed by genotype 1 (24%). Although the allelic frequencies of TLR7, NOD2 and RIG-I were in significant disequilibrium in HCV patients compared with those in controls, the PNPLA3 polymorphism correlated significantly with higher viral load and alanine aminotransferase (ALT) levels in genotype 3 patients. Patients with PNPLA3 CG/GG genotypes, along with IL28B genotype CC, had higher levels of ALT than those with other genotypes.ConclusionThese results indicate that PNPLA3 polymorphisms are associated with higher ALT levels in HCV genotype 3 patients in India and can help in identifying people who are at greater risk of developing HCV-associated liver diseases.     

戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶变化

目的　观察戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶 (ALT)变化。方法　将戊型肝炎抗体阳性及重叠乙型肝炎感染患者 2 73例分为 5组。A组 12 7例 ,为戊型肝炎病毒 (HEV) IgG阳性 ;B组 9例 ,为HEV IgM阳性 ;C组 64例 ,为HEV IgM和HEV IgG均阳性 ;D组 3 2例 ,为HEV IgM和HEV IgG均阳性并重叠乙型肝炎感染 ;E组 41例 ,为HEV IgG阳性并重叠乙型肝炎感染。另选戊型肝炎抗体阴性的非乙型肝炎患者 5 0 0例作为对照组。用速率法测定各组ALT值。结果　各组ALT异常增高百分率及异常增高者ALT值分别为 :A组 2 1例 ( 16.5 %) ,ALT( 183± 89)U /L ;B组 3例 ,ALT( 2 0 3± 112 )U /L ;C组 16例 ( 2 5 .8%) ,ALT( 2 17± 119)U/L ;D组 11例 ( 3 4.4%) ,ALT( 2 3 4± 12 8)U/L ;E组 13例 ( 3 1.7%) ,ALT( 2 10± 98)U/L ;对照组 5 1例 ( 10 .2 %) ,ALT( 112± 68)U/L。戊型肝炎抗体阳性各组ALT异常增高率与对照组间差异有显著性 (P <0 .0 5 ) ,戊型肝炎抗体阳性各组ALT异常增高者ALT值与对照组间差异有显著性 (P <0 .0 5 )。结论　戊型肝炎抗体阳性组ALT异常增高率和增高者ALT值均较对照组有明显增高 ,HEV IgM阳性或重叠乙型肝炎感染较单纯HEV IgG阳性者 ,ALT增高明显     

Serum γ-glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase activity in Iranian healthy blood donor men

AIM: To determine serum γ-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) activity, and to assess their correlation with demographic and clinical findings in healthy blood donors.METHODS: This cross-sectional study was performed in 934 male blood donors, aged 18 to 68 years, who consecutively attended Tehran blood transfusion service in 2006. All participants were seronegative for HBV or HCV infections, non alcohol users, and all underwent a standard interview and anthropometric tests. Clinical and biochemical parameters including AST, ALT, and GGT activities were determined. Patients taking drugs known to cause hepatic fat deposition were excluded. For AST, ALT, and GGT variables, we used 33.33 and 66.66 percentiles, so that each of them was divided into three tertiles.RESULTS: Mean AST, ALT, and GGT activities were 25.26 ± 12.58 U/L (normal range 5-35 U/L), 33.13 ± 22.98 (normal range 5-35 U/L), and 25.11 ± 18.32 (normal range 6-37 U/L), respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body weight, body mass index, and waist and hip circumferences (P < 0.05). By multiple linear regression analyses, ALT was found to be positively correlated with dyslipidemia (B = 6.988, P = 0.038), whereas ALT and AST were negatively correlated with age. AST, ALT, and GGT levels had positive correlation with family history of liver disease (B = 15.763, P < 0.001), (B = 32.345, P < 0.001), (B =24.415, P < 0.001), respectively.CONCLUSION: Although we did not determine the cutoffs of the upper normal limits for AST, ALT, and GGT levels, we would suggest screening asymptomatic patients with dyslipidemia and also subjects with a family history of liver disease.     

影响糖尿病患者心血管危险因素集簇现象的因素

目的 分析影响糖尿病患者多种心血管危险因素集簇现象的因素。方法 调查654例糖尿病患者并发症情况和血糖、胰岛素、HbA1c、胆固醇、甘油三酯、LDL-胆固醇、HDL-胆固醇、体重指数、腰围、臀围以及腰臀围比值等因素,采用HOMA公式计算出胰岛素抵抗指数。按照并存心血管危险因素（高血压、全身性肥胖、中心性肥胖、高胆固醇血症、低HDL-胆固醇血症）数量。进行分析。结果 并有3种以上的心血管危险因素明显地高于随机的单一因素并存在计算预测值,餐后胰岛素水平和胰岛素面积随危险因素的增加而增加,采用有性别差异的全身性肥胖和中心性肥胖的诊断标准,女性糖尿病患者有更多的心血管危险因素。如果采用男女性别相同的诊断标准。这种并存多种心血管危险因素的性别差异则消失,多数患者的这些危险因素未得以良好的控制。结论 糖尿病多种心血管危险因素集簇是常见的,可能与高胰岛素血症及性别有关。     

SGLT2 inhibitors and incretin agents: Associations with alanine aminotransferase activity in type 2 diabetes

Aim

The impact of new classes of glucose lowering medications on markers of non-alcoholic fatty liver disease (NAFLD) associated with type 2 diabetes (T2D) have been inconsistent in their magnitude and independence. This large retrospective study investigates changes in alanine aminotransferase (ALT) levels among subjects initiated on newer classes of T2D medications in comparison to a reference control group.

Drug-induced liver injury in hospitalized patients with notably elevated alanine aminotransferase

AIM:To identify the proportion,causes and the nature of drug-induced liver injury(DILI) in patients with notably elevated alanine aminotransferase(ALT).METHODS:All the inpatients with ALT levels above 10 times upper limit of normal range(ULN) were retrospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period.Relevant clinical information was obtained from medical records.Alternative causes of ALT elevations were examined for each patient,including biliary abnormality,viral hepatitis,hemodynamic injury,malignancy,DILI or undetermined and other causes.All suspected DILI cases were causality assessed using the Council for International Organizations of Medical Sciences scale,and only the cases classified as highly probable,probable,or possible were diagnosed as DILI.Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors.RESULTS:A total of 129 cases with ALT 10 ULN were identified.Hemodynamic injury(n = 46,35.7%),DILI(n = 25,19.4%) and malignancy(n = 21,16.3%) were the top three causes of liver injury.Peak ALT values were lower in DILI patients than in patients with hemodynamic injury(14.5 ± 5.6 ULN vs 32.5 ± 30.7 ULN,P = 0.001).Among DILI patients,one(4%) case was classified as definite,19(76%) cases were classified as probable and 5(20%) as possible according to the CIOMS scale.A hepatocellular pattern was observed in 23(92%) cases and mixed in 2(8%).The extent of severity of liver injury was mild in 21(84%) patients and moderate in 4(16%).Before discharge,10(40%) patients were recovered and the other 15(60%) were improved.The improved patients tended to have a higher peak ALT(808 ± 348 U/L vs 623 ± 118 U/L,P = 0.016) and shorter treatment duration before discharge(8 ± 6 d vs 28 ± 12 d,P = 0.008) compared with the recovered patients.Twenty-two drugs and 6 herbs were found associated with DILI.Antibacterials were the most common agents causing DILI in 8(32%) cases,followed by glucocorticoids in 6(24%) cases.Twenty-four(96%) cases received treatment of DILI with at least one adjunctive drug.Agents for treatment of DILI included anti-inflammatory drugs(e.g.,glycyrrhizinate),antioxidants(e.g.,glutathione,ademetionine 1,4-butanedisulfonate and tiopronin),polyene phosphatidyl choline and herbal extracts(e.g.,protoporphyrin disodium and silymarin).Diagnosis of DILI was not mentioned in the discharge letter in 60% of the cases.Relative to prevalent cases and cases from wards of internal medicine,incident cases and cases from surgical wards had a higher risk of missed diagnosis in discharge letter [odds ratio(OR) 32.7,95%CI(2.8-374.1),CONCLUSION:DILI is mostly caused by use of antibacterials and glucocorticoids,and constitutes about one fifth of hospitalized patients with ALT 10 ULN.DILI is underdiagnosed frequently.     

糖尿病患者低血糖与心血管疾病的关系

控制血糖是糖尿病治疗的首要目标,但在降糖过程中,难以避免的低血糖会减少降糖益处,甚至增加死亡风险.近年来研究发现,低血糖可以改变心血管系统神经内分泌和电生理、损害血管内皮,进而诱发糖尿病急性心血管事件或加快慢性并发症进程.低血糖的发生会抵消糖尿病患者一生高血糖治疗所带来的益处.现将低血糖与糖尿病患者心血管疾病的关系作一综述.