前列腺素E1对2型糖尿病合并冠心病患者血液流变学的影响

目的:研究2型糖尿病合并冠心病患者血液流变学改变及其前列腺素E1治疗对其的影响.方法:对86例2型糖尿病患者(其中合并冠心病患者53例,单纯糖尿病患者33例)进行血液流变学指标检测,并与对照组比较,2型糖尿病合并冠心病患者采用前列腺素E1治疗,观察其血液流变学的改变.结果:与对照组相比,2型糖尿病患者的全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原、红细胞聚集指数和血小板聚集率均明显升高(P＜0.05),红细胞变形指数明显降低(P＜0.05),其中糖尿病合并冠心病组变化更为显著(P＜0.05).前列腺素E1可以明显降低糖尿病合并冠心病患者的血液黏度和血小板聚集率(P＜0.05).结论:2型糖尿病合并冠心痛患者的血液黏度和血小板聚集性增高,前列腺素E1可以明显改善血流动力学和微循环.     

Management of diabetic ketoacidosis.

Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated properly. The incidence of this condition may be increasing, and a 1 to 2 percent mortality rate has stubbornly persisted since the 1970s. Diabetic ketoacidosis occurs most often in patients with type 1 diabetes (formerly called insulin-dependent diabetes mellitus); however, its occurrence in patients with type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus), particularly obese black patients, is not as rare as was once thought. The management of patients with diabetic ketoacidosis includes obtaining a thorough but rapid history and performing a physical examination in an attempt to identify possible precipitating factors. The major treatment of this condition is initial rehydration (using isotonic saline) with subsequent potassium replacement and low-dose insulin therapy. The use of bicarbonate is not recommended in most patients. Cerebral edema, one of the most dire complications of diabetic ketoacidosis, occurs more commonly in children and adolescents than in adults. Continuous follow-up of patients using treatment algorithms and flow sheets can help to minimize adverse outcomes. Preventive measures include patient education and instructions for the patient to contact the physician early during an illness.     

Diabetic ketoacidosis in a community-based population

Ninety-two cases of diabetic ketoacidosis were identified in residents of Rochester, Minnesota, over a 52-year period; 42% occurred in patients with juvenile-onset diabetes. The most common cause of diabetic ketoacidosis was infection. In 23% of the patients, diabetic ketoacidosis was the initial manifestation of diabetes mellitus. The frequency of retinopathy, neuropathy, and glomerulosclerosis was significantly increased in the surviving diabetic patients with ketoacidosis in comparison with diabetic patients matched for age and sex who did not experience ketoacidosis. Seven deaths occurred in the first 24 hours of diagnosis of ketoacidosis, but only one could be attributed to ketoacidosis alone. An additional six patients died within 48 hours of the recognition of ketoacidosis. The major cause of all deaths occurring within 48 hours of hospitalization for ketoacidosis was myocardial infarction.     

糖尿病慢性并发症患者的血流变观察

观察了３０例糖尿病慢性并发症的血流变改革，并与２０例健康对照组比较。结果表明全血、血浆粘度、红细胞压积、血沉及Ｋ值均比对照组显著升高，红细胞聚集指数，血小板聚集率与对照组相比同样有非常显著的改变。     

State of the microcirculatory component of hemostasis and microhemodynamics in patients with diabetic angiopathies

A total of 150 patients presenting with diabetes mellitus were examined. Patients with diabetic angiopathy demonstrated substantial impairment of platelet aggregation (secondary adhesion, spontaneous aggregation), of the functional activity of heparinocytes, lipid metabolism and microhemodynamics.     

Intracellular free magnesium deficiency plays a key role in increased platelet reactivity in type II diabetes mellitus.

OBJECTIVE--Mg deficiency may be an important factor leading to cardiovascular disease. Diabetic subjects show an increase in platelet reactivity that can enhance the risks of vascular disease. In addition, diabetic patients have been reported to be at risk of developing extracellular Mg deficiency. However, the intracellular free Mg concentration and its role in the enhanced platelet reactivity in diabetes is not known. RESEARCH DESIGN AND METHODS--We evaluated the intracellular erythrocyte (RBC) Mg2+ concentration in 20 non-insulin-dependent (type II) diabetics. In addition, the effects of intravenous 3-h drip or 8 wk of oral Mg supplementation on intracellular RBC Mg2+ levels and platelet reactivity was studied. To more clearly evaluate the direct role of Mg in these effects, we induced isolated Mg deficiency in 16 nondiabetic control subjects with an Mg-free liquid diet for 3 wk. RESULTS--The intracellular RBC Mg2+ concentration of diabetic patients was significantly reduced compared with values in nondiabetic control subjects (166 +/- 7 vs. 204 +/- 7 microM, P less than 0.01). Serum Mg levels were also reduced in the diabetic patients compared with the control subjects (1.59 +/- 0.04 vs. 1.9 +/- 0.1 mEq/L, P less than 0.05). Oral Mg supplementation for 8 wk (400 mg/day) restored RBC Mg2+ concentration to normal without significantly changing serum Mg concentration. Both intravenous and oral Mg supplementation markedly reduced platelet reactivity in response to the thromboxane A2 analog, U46619. The Mg-free diet resulted in a significant reduction in RBC Mg2+ concentration and markedly enhanced the sensitivity of platelet aggregation to U46619 and ADP. CONCLUSIONS--These results suggest that type II diabetic patients have intracellular Mg2+ deficiency and that Mg deficiency may be a key factor in leading to enhanced platelet reactivity in type II diabetes. Therefore, Mg supplementation may provide a new therapeutic approach to reducing vascular disease in patients with diabetes.     

Thromboxane production in diabetes mellitus

Summary A correlation between increased platelet adhesiveness and aggregation and the development of angiopathy in diabetes mellitus can be made. Thromboxane produced by platelets represents a potent platelet aggregation factor. We studied the platelet TXB₂ production during blood coagulation in carefully selected patients with type II diabetes mellitus in good metabolic control and the results were correlated with the presence or absence of microangiopathy, fasting blood glucose levels, type of therapy, age, duration of diabetes and the most important hematochemical parameters. No statistically significant differences were found between serum TXB₂ concentrations in diabetic patients and control subjects, in diabetics with or without microangiopathy and in diabetics on insulin therapy or on oral hypoglycemic agents. We did not observe any correlation between TXB₂ production and age, duration of diabetes, sex, basal blood glucose levels, total and HDL-cholesterol, triglycerides, blood creatinine and blood electrolytes. The thromboxane production may be a not important factor for determining the increased platelet aggregation which is at the origin of the angiopathy in diabetes mellitus.     

Biorheological views of diabetic macroangiopathy

Diabetes mellitus markedly increases the risk of myocardial infarction, stoke, amputation which cause most morbidity and mortality. Elevated low shear blood viscosity with erythrocyte aggregation and elevated high shear blood viscosity with reduced erythrocyte deformability might be important and potentially treatable factors in the etiology or progression of diabetic macroangiopathy. The metabolic abnormalities caused by diabetes induce both rheological changes of blood and vascular dysfunction that predisposes this patient population to atherosclerosis. Lowered shear stress and vortices with oscillatory shear stress induce atherosclerosis. Abnormalities in platelet function and increased blood coagulability may exacerbate the progression of atherosclerosis and the consequences of plaque rupture or erosion in diabetes.     

Platelet aggregation and fatty acid composition of platelets in type 1 diabetes mellitus.

A raised content of arachidonic acid in platelets from diabetic patients with retinopathy was found without differences in platelet aggregation: platelet aggregability was not related to platelet fatty acid composition. In diabetes, platelet aggregation was inversely correlated to non-esterified fatty acids in plasma and may suggest an inhibiting effect. Mean platelet volume was raised in the diabetic patients, but without hyperaggregability. The findings do not exclude a relationship between platelet fatty acids and platelet aggregability, but suggest that variations in levels of non-esterified fatty acids in plasma might interfere with platelet aggregation.     

Ketoacidotic conditions in patients with diabetes mellitus (problems of classification and therapeutic tactics)

The paper is concerned with the characteristics of ketoacidotic conditions in patients with diabetes mellitus. The results of the clinical observation over 434 patients suffering from diabetes mellitus associated with diabetic ketoacidotic conditions of different gravity are analyzed. The causes that promoted the development of such complications and the clinico-biochemical characteristics of the patients are presented. Based on the analysis of the patients' condition, the laboratory and clinical findings the authors stress the necessity of differentiating between diabetic ketosis and ketoacidosis. The treatment measures are discussed in terms of the complications. It is indicated that in the treatment of ketoacidosis use can be made of splenin. The mechanisms of the beneficial effect of the drug on diabetic ketoacidosis are under discussion. It is also emphasized that diabetic ketoacidosis may develop in patients with any type and gravity of diabetes mellitus. Diabetic ketosis and ketoacidosis are regarded as different stages of the same disease. In case of the late and erroneous therapy any ketosis may transform to ketoacidosis.     

吲哚布芬对2型糖尿病患者血小板聚集及凝血机制的影响

[目的]观察吲哚布芬对2型糖尿病患者血小板聚集功能及凝血机制的影响.[方法]分别以比浊法和凝固法检测应用吲哚布芬治疗前后2型糖尿病患者的血小板最大聚集率(MAR)和凝血全套各指标的变化.[结果]经吲哚布芬治疗后,61例2型糖尿病患者活化部分凝血活酶时间(APTT)、纤维蛋白原凝固时间(FIBT)明显延长(P<0.05)...     

Nationwide survey to compare the prevalence of transient elevation of liver transaminase during treatment of diabetic ketosis or ketoacidosis in new-onset acute and fulminant type 1 diabetes mellitus

Background aims. A mild increase in liver enzyme levels is sometimes observed in patients with diabetic ketosis or ketoacidosis. The aim of the present study was to assess the cause and prevalence of the elevation of liver transaminase levels in fulminant and acute-onset type 1 diabetic patients experiencing diabetic ketosis or ketoacidosis.

Methods. We analyzed data on the liver transaminase levels of 108 patients over 18 years of age with newly diagnosed type 1 diabetes complicated by ketosis or ketoacidosis. The data were collated from a nationwide survey on fulminant type 1 diabetes and retrospective medical records.

Results. Thirty-two (60.4%) out of the 53 patients suffering from fulminant type 1 diabetes were detected with transient elevation of liver transaminase (TELT) levels during the first month after initiation of insulin therapy; in the case of acute-onset type 1 diabetes, such an observation was noted in 16 (29.1%) out of 55 patients. Fatty liver was diagnosed in 20% of the patients, and 65% of these patients exhibited TELT. The dosage of insulin injected in these patients was significantly high.

Conclusions. High blood glucose and fatty liver may influence the elevation of liver transaminase levels during the treatment of new-onset type 1 diabetes.     

酮症酸中毒起病的糖尿病患者的实验室指标比较

目的 提高临床医师对糖尿病酮症酸中毒(DKA)起病的暴发性1型糖尿病(FT1DM)的认识。方法 93例DKA起病的糖尿病患者根据糖尿病分型分为3组: 2型糖尿病（A）组、非暴发性1型糖尿病（B）组、FT1DM（C）组,对3组年龄、血糖、血钠、血钾、糖化血红蛋白、血pH值进行比较。结果 与2型糖尿病组相比,FT1DM组的血糖、血钾更高,HbA1c、血钠、血pH值更低,随着病程缩短,血pH值的比较无统计学意义。与非暴发性1型糖尿病组相比,FT1DM组的血糖、血钾更高,HbA1c更低,在血钠和血pH值的比较差异无统计学意义。结论 DKA起病的FT1DM患者具有更高的血糖和血钾,注意重视。除糖尿病类型外,糖尿病病程也影响酸中毒的实验室指标。     

2型糖尿病合并脑梗死患者血清同型半胱氨酸和血小板聚集率检测的临床价值

目的探讨血清同型半胱氨酸(Hcy)和血小板聚集率(PagT)对诊断2型糖尿病合并脑梗死患者的临床价值。方法选取该院2型糖尿病合并脑梗死患者65例(合并脑梗死组),2型糖尿病患者55例(单纯糖尿病组),50例健康体检者作为健康对照组。分别检测3组研究对象的Hcy、PagT、血压、体质量、身高等各项指标并进行比较;再通过多因素Logistic回归分析确定2型糖尿病合并脑梗死的危险影响因子。结果合并脑梗死组Hcy、PagT水平明显高于单纯糖尿病组及健康对照组,差异有统计学意义(P0.05)。Hcy和PagT均为2型糖尿病合并脑梗死的危险影响因素;Person相关性分析显示,Hcy、PagT对糖尿病合并脑梗死疾病的严重程度呈正相关关系。结论 Hcy、PagT水平在2型糖尿病合并脑梗死患者中显著升高,可通过检测糖尿病患者Hcy、PagT水平预测脑血管疾病的发展进程。     

Sodium–glucose cotransporter‐2 inhibitors induced euglycemic diabetic ketoacidosis: Two case reports and a review of the literature

If not detected early, euglycemic diabetic ketoacidosis can be a serious adverse effect of sodium–glucose cotransporter‐2 (SGLT2) inhibitors. Unfortunately, euglycemic diabetic ketoacidosis is underreported in recent trials and missed because of normal blood sugar levels and nonspecific symptoms on presentation. We present two patients with type 2 diabetes mellitus who developed dapagliflozin‐associated euglycemic diabetic ketoacidosis followed by hyperglycemic ketoacidosis. The second patient had euglycemic ketoacidosis twice despite instructions to stop using the medication dapagliflozin.     

2型糖尿病患者糖化血红蛋白水平与红细胞变形能力的相关性研究

目的 探讨2型糖尿病患者不同糖化血红蛋白水平与红细胞变形能力的相关性.方法 选取2型糖尿病患者90例为实验组,根据糖化血红蛋白水平分为≤6.5%、6.5%～8.5%、≥8.5%三组;选取体检健康者30名为对照组.测定不同糖化血红蛋白水平的红细胞变形指数及红细胞聚集指数,以红细胞变形指数表示红细胞变形能力.结果 2型糖尿病患者糖化血红蛋白〉6.5%时红细胞变形指数显著降低（P＜0.05）,红细胞聚集指数显著升高（P＜0.05）,红细胞变形指数随着糖化血红蛋白的升高逐步降低（P＜0.05）,红细胞聚集指数随着糖化血红蛋白的升高逐步升高（P＜0.05）.结论 2型糖尿病患者红细胞变形能力在糖化血红蛋白＞6.5%时开始下降,并随着糖化血红蛋白的升高逐步降低.     

Diabetic ketoacidosis in toddler with a diaper rash

The term diabetes does not denote a single disease entity but rather a clinical syndrome. Fundamental to all types of diabetes is impairment of insulin secretion by the pancreatic beta cells. Diabetes is divided into (1) diabetes associated with certain syndromes or conditions, (2) gestational diabetes, (3) non-insulin-dependent diabetes or type 2 diabetes, and (4) insulin-dependent diabetes (IDDM) or type 1 diabetes. The impairment of insulin secretion seen in diabetes is due to progressive loss of pancreatic beta-cell function secondary to an autoimmune-mediated process. Diabetes mellitus is the most common metabolic disorder of childhood (2). We present a patient with a common finding in children, diaper candidiasis. Surprisingly, our patient was found to have IDDM and be in diabetic ketoacidosis.     

Ketonuria in hospitalized patients with non-insulin-dependent diabetes mellitus

Physicians routinely order urinary ketone testing for most patients with diabetes mellitus upon hospitalization, even in the absence of a history of diabetic ketoacidosis. To determine whether testing for urinary ketones is clinically useful in patients with non-insulin-dependent diabetes mellitus (NIDDM), a retrospective review was undertaken of 152 charts of patients admitted to the hospital during a 6-mo period with the diagnosis of diabetes mellitus. Of the 135 patients with NIDDM, 96% had routine testing performed for urinary ketones. Surprisingly, 26% of the patients with NIDDM had positive urine ketones at some time during hospitalization, and the degree of ketonuria was markedly greater did not reflect diabetic ketoacidosis. Ketonuria was accompanied by significant hyperglycemia and most likely reflects relative insulinopenia. Only 23% of the episodes of ketonuria were acknowledged in the progress notes. Although NIDDM patients who had ketonuria in the hospital were more likely to be transiently treated with insulin than patients without ketonuria, in no instance did the progress notes state that a diagnostic test or change in therapy was ordered because of the presence of a positive test for urinary ketones. The primary goal for therapy of patients with NIDDM should remain good control of blood glucose. In the hospitalized patient in whom frequent blood glucose determinations are made, it is not clear that urinary ketone testing needs to be routinely done.     

Symptomatic diabetes mellitus in patients with chronic recurrent pancreatitis

Out of 279 patients with chronic recurrent cholepancreatitis 34 (12.2%) developed secondary diabetes mellitus. The secondary genesis of the diabetes was suggested in view of its origin in the presence of chronic pancreatitis and absence of hereditary predisposition, concomitant diseases promoting diabetes onset. The frequency of pancreatitis exacerbations and the degree of pancreatic exocrine insufficiency correlate with the occurrence of symptomatic diabetes. Diminished blood levels of insulin and C-peptide, inhibited response to pancreozymin registered in the patients may be indicative of symptomatic diabetes onset. Ketoacidosis was recorded in 9 patients, diabetic retinopathy in no patients. Ten patients out of 34 patients with chronic pancreatitis with secondary diabetes, 9 of which had episodes of ketoacidosis, received insulin. The sequence chronic cholecystitis-pancreatitis-diabetes was discussed in detail.     

Prevalence and characteristics of brittle diabetes in Britain

We investigated the prevalence and characteristics of 'brittle diabetes', defined as insulin-dependent diabetes mellitus associated with glycaemic instability of any type, leading to life disruption with recurrent and/or prolonged hospitalizations. A questionnaire was sent to all physicians and paediatricians running diabetic clinics in the UK, from lists held at the British Diabetic Association. A total of 414 brittle patients were reported (72% questionnaire return). Most were young (mean age +/- SD was 26 +/- 15 years), though there was a small peak at ages 60-70 years. There was an excess of females (66%) and overall clinic prevalence was 1.2 per 1000 diabetic patients and 2.9 per 1000 insulin-treated diabetic patients. On average, there was 1.0 brittle patient per diabetic clinic. The most common form of brittleness was recurrent ketoacidosis (59%), with 17% having predominant hypoglycaemia, and 24% mixed instability. Female excess was highest and mean age lowest in the recurrent ketoacidosis group, whilst the reverse was true for those with recurrent hypoglycaemia. Causes of brittleness were offered by 58% of consultants, and most (93%) considered various psychosocial problems as likely underlying factors. We conclude that brittle diabetes is a small but significant problem, currently affecting about 1 per 1000 diabetic patients. Most, but by no means all, are young females--often with recurrent ketoacidosis. Older age groups are more likely to have recurrent hypoglycaemic or mixed types of brittleness. Perceived causes of brittleness are usually psychosocial.