Classification tree model analysis on related factors of early renal damage in type 2 diabetic patients

Objective To analyze the impact factors for early renal damage in type 2 diabetic patients by the classification tree model. Methods A total of 601 patients with type 2 diabetes were enrolled. According to glomerular filtration rates and urine albumin quantification, the patients were divided into type 2 diabetes group ( 418 cases ) and early diabetic renal damage group ( 183 cases ). The clinical data of the patients were recorded to analyze the main influential factors for the microalbuminuria of type 2 diabetic patients using the Exhaustive CHAID classification tree algorithm. Results Six important explanatory variables were screened out by the classification tree model from the 34 candidate variables related to early renal damage, including fibrinogen, history of hypertension, retinopathy, Cys C levels, SBP and peripheral neuropathy. Elevated fibrinogen was the main factor. Conclusion The classification tree model can analyze the major influential factors of early renal damage in type 2 diabetic patients effectively, and it can help develop the prevention and treatment methods.     

2型糖尿病骨密度变化及相关因素初探

目的：观察2型糖尿病骨密度变化及影响因素。方法：对59例男性60例女性2型糖尿病患及148例健康用双能X射线吸收法行L2-4、Wards区、股骨颈、大转子骨密度测量,并测定糖尿病患空腹、餐后血糖,空腹、餐后胰岛素,空腹C肽、24小时尿白蛋白等。结果：①男性糖尿病患L4骨密度较健康显降低,其余部位无显差别。女性糖尿病患L2-4、Wards、股骨颈、大转子均较健康显降低。②多元分析显示：男女性糖尿病患骨密度改变与C肽正相关、与尿白蛋白负相关,男性糖尿病患骨密度改变与病程负相关,女性糖尿病患骨密度改变还与绝经年龄负相关。结论：糖尿病患存在骨密度降低,女性患更为显。2型糖尿病患胰岛功能减退及尿白蛋白增加对骨密度降低有一定作用。     

不同骨量状态的2型糖尿病患者骨密度影响因素分析

目的观察不同骨量状态的2型糖尿病(T2DM)患者的糖脂代谢、骨代谢生化指标水平,探讨T2DM患者的骨质疏松(OP)相关危险因素。方法选择北京大学人民医院T2DM患者264例(男性133例,女性131例),采用双能X线骨密度仪测定患者腰椎、股骨颈及全髋BMD,按T值不同分为3个亚组:骨密度正常组(T值-1.0);骨量减少组(-2.5T值≤-1.0);OP组(T值≤-2.5)。比较3组之间各种生化、骨代谢指标及BMD的差异并进行相关性分析。结果 1OP组的年龄明显大于其余两组,体重及血尿酸水平明显低于其余两组(P均0.05)。2OP组的血清BALP及TRACP-5b水平明显高于其余两组(P均0.05)。OP组和骨量减少组的L1-4、股骨颈及全髋BMD均明显低于正常组,尤以OP组下降明显(P均0.05)。3男性T2DM患者中,OP组的血尿酸明显低于其余两组,而血清TRACP-5b明显高于其余两组(P均0.05)。女性T2DM患者中,OP组的血清BALP明显高于其余两组(P0.05)。4在校正性别、年龄及体重等因素影响后,腰椎骨密度与尿酸正相关(r=0.137,P0.05),与BALP、TRACP-5b负相关(r=-0.281,-0.146,P均0.05)。股骨颈骨密度与舒张压、BALP、TRACP-5b负相关(r=-0.135,-0.237,-0.136,P均0.05),全髋骨密度与BALP负相关(r=-0.25,P0.05)。5Logistic回归分析结果显示:T2DM患者的年龄、BALP、低体重、低血尿酸水平与OP发生有关(P0.05)。结论年龄、BALP、低体重、低血尿酸水平与T2DM患者发生OP有关。     

Risk factor analysis and clinical decision tree model construction for diabetic retinopathy in Western China

BACKGROUNDDiabetic retinopathy (DR) is the driving force of blindness in patients with type 2 diabetes mellitus (T2DM). DR has a high prevalence and lacks effective therapeutic strategies, underscoring the need for early prevention and treatment. Yunnan province, located in the southwest plateau of China, has a high pre-valence of DR and an underdeveloped economy. AIMTo build a clinical prediction model that will enable early prevention and treatment of DR.METHODSIn this cross-sectional study, 1654 Han population with T2DM were divided into groups without (n = 826) and with DR (n = 828) based on fundus photography. The DR group was further subdivided into non-proliferative DR (n = 403) and proliferative DR (n = 425) groups. A univariate analysis and logistic regression analysis were conducted and a clinical decision tree model was constructed.RESULTSDiabetes duration ≥ 10 years, female sex, standing- or supine systolic blood pressure (SBP) ≥ 140 mmHg, and cholesterol ≥ 6.22 mmol/L were risk factors for DR in logistic regression analysis (odds ratio = 2.118, 1.520, 1.417, 1.881, and 1.591, respectively). A greater severity of chronic kidney disease (CKD) or hemoglobin A 1c increased the risk of DR in patients with T2DM. In the decision tree model, diabetes duration was the primary risk factor affecting the occurrence of DR in patients with T2DM, followed by CKD stage, supine SBP, standing SBP, and body mass index (BMI). DR classification outcomes were obtained by evaluating standing SBP or BMI according to the CKD stage for diabetes duration < 10 years and by evaluating CKD stage according to the supine SBP for diabetes duration ≥ 10 years.CONCLUSIONBased on the simple and intuitive decision tree model constructed in this study, DR classification outcomes were easily obtained by evaluating diabetes duration, CKD stage, supine or standing SBP, and BMI.     

2型糖尿病伴骨质疏松患者健康素养状况及影响因素分析

目的了解2型糖尿病伴骨质疏松患者健康素养状况及影响因素,为制定提高2型糖尿病伴骨质疏松患者健康素养干预措施提供参考。方法采用自制的健康素养量表对268名2型糖尿病伴骨质疏松患者进行问卷调查,分析调查对象的健康素养状况及其影响因素。结果 268名2型糖尿病伴骨质疏松患者健康素养得分为144.68±62.81分,占满分的62.91%(满分230分),其中书面素养得分为124.82±58.74分,占该领域满分的75.65%(满分165分);运算能力得分为26.84±10.42分,占该领域满分的41.30%(满分65分)。其中有109例(40.71%)的患者得分150分,属于健康素养缺乏;有86例(32.10%)的患者得分为150~180分,属于临界健康素养;另有73例(27.20%)的患者得分180分,属于健康素养充足。多元线性回归分析结果显示,年龄、文化程度、病程、有无职业、月收入、住院次数、居住地是2型糖尿病伴骨质疏松患者健康素养的影响因素。结论 2型糖尿病伴骨质疏松患者存在较低健康素养现象,对其影响因素制定针对性的干预措施是提高患者健康素养的重要途径。     

Disordered eating behaviors in type 1 diabetic patients

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.     

胰岛素样生长因子1对2型糖尿病合并骨质疏松中骨钙素表达的影响

随着流行病学的调查研究发现,2型糖尿病患者与健康人群相比,其罹患骨折事件的发生率明显增高,所以骨质疏松及骨折等并发症需引起2型糖尿病患者的足够重视。在分子机制层面的研究显示,2型糖尿病合并骨质疏松的发生可能与胰岛素样生长因子1、葡萄糖毒性、硬骨素、骨钙素及氧化应激等多种代谢途径的改变有关。胰岛素样生长因子1是骨形成的调节因子,在调节成骨细胞和破骨细胞介导的骨骼重建过程中起着重要的作用。骨钙素是由成骨细胞产生的一种非胶原蛋白,能够反映成骨细胞的活性,常作为骨形成和骨转换的特异性指标。有研究显示,胰岛素样生长因子1以浓度依赖方式刺激骨钙素的合成增加,本文试就胰岛素样生长因子1对2型糖尿病合并骨质疏松中骨钙素表达的影响做一综述,探讨在2型糖尿病合并骨质疏松患者中胰岛素样生长因子1与骨钙素之间的相关性,以期对2型糖尿病合并骨质疏松患者能够进行早期诊断及治疗,预防骨折事件的发生,提高患者生活质量。     

Similar risks of nephropathy in patients with type I or type II diabetes mellitus

It is commonly assumed that in patients the risks of developing nephropathy and uraemia are high in type I and low in type II diabetes mellitus. Since type II occurs mostly in elderly individuals with limited life expectancy and high cardiovascular mortality, the true risk may have been underestimated, as many patients do not survive to experience renal complications. To assess renal risk further, we evaluated all patients with type II and type I diabetes mellitus without severe secondary disease who were followed in the outpatient clinic between 1970 and 1985. The cumulative risk of proteinuria after 20 years of diabetes mellitus was 27% in type II and 28% in type I, the findings after 25 years were 57% and 46% respectively. The cumulative risk of renal failure, i.e. serum creatinine greater than 1.4 mg/dl, after 3 years of persisting proteinuria was 41% in both type II and type I, and after 5 years of proteinuria were 63% and 59% respectively. We conclude that the renal risk is similar in patients with type II and type I diabetes mellitus.     

Treatment of type 2 diabetic patients with kidney disease with AT1-receptor antagonists: lessons from recent trials

Background. As the incidences of type 2 diabetes (non-insulin dependent diabetes mellitus; NIDDM) and associated nephropathy increase worldwide at epidemic rates, the occurrence of serious renal outcomes such as end-stage renal disease has become a critical burden to patients and health care systems. Methods. The Irbesartan Diabetic Nephropathy Trial (IDNT), Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL), and Losartan Intervention For Endpoint reduction in hypertension (LIFE) trials are reviewed. Results. In the IDNT trial, treatment with irbesartan significantly reduced the composite primary endpoint [doubling of serum creatinine (SCr), end-stage renal disease (ESRD; dialysis, transplantation, or SCr ≥ 6 mg/dl), or death] by 20% compared with placebo (P = 0.02), and by 23% compared with amlodipine (P = 0.006). In the RENAAL study, treatment with losartan resulted in a significant risk reduction of 16% in the primary composite endpoint [doubling of SCr, ESRD (dialysis or transplantation), or death]; P = 0.02. In the diabetic subgroup of LIFE, losartan reduced the risk of the primary composite endpoint of cardiovascular morbidity and mortality by 24% (P = 0.031). The risk of cardiovascular mortality was 37% lower in the losartan group than in the atenolol group (P = 0.028). These benefits in IDNT, RENAAL, and LIFE appeared to be beyond the blood pressure effect. Conclusions. The findings from recent clinical trials support the use of angiotensin receptor antagonists in patients with nephropathy due to type 2 diabetes, and have shown a significant reduction in the progression towards ESRD (losartan) and proteinuria (losartan, irbesartan), effects that were independent of blood pressure lowering achieved with these agents. Reduction in cardiovascular morbidity and mortality have also been shown in a trial with losartan in diabetics. Collectively, these studies will have worldwide beneficial impact on the treatment of this devastating disease. Received: September 2, 2002 / Accepted: October 23, 2002 Correspondence to:W.F. Keane     

Follow-up of kidney biopsies in normoalbuminuric patients with type 1 diabetes

To study the development of diabetic glomerulopathy, we performed two kidney biopsies after 10.5 and 17 years of type 1 diabetes in 19 normoalbuminuric, normotensive adolescents (10 males). The biopsies were examined with light and electron microscopy. The glomerular filtration rate and effective renal plasma flow, determined with inulin and para-aminohippuric acid clearances, respectively, and ambulatory blood pressure were studied. Between the biopsies, significant increases occurred in glomerular volume, foot process width, mesangial matrix, and mesangial volume fraction/glomerulus. The metabolic control affected the basement membrane thickness, mesangial matrix, and mesangial volume fraction/glomerulus. The mesangial matrix and mesangial volume fraction/glomerulus were higher in female patients on the first biopsy, but on the second biopsy, the levels in males increased to those in females. The night-time systolic and mean arterial blood pressures from the first biopsy seemed to predict the mesangial matrix and mesangial volume fraction/glomerulus, foot process width, and slit pore length on the second biopsy. Despite normoalbuminuria and normal blood pressure, patients with type 1 diabetes have morphological changes of diabetic glomerulopathy that progress. The night-time blood pressure can be used to predict morphological changes of diabetic nephropathy in adolescents who are normoalbuminuric and normotensive.     

Stable impulsive zone model predictive control for type 1 diabetic patients based on a long-term model

In this work, the problem of regulating blood glucose (glycemia) in type I diabetic patients is studied by means of an impulsive zone model predictive control (iZMPC), which bases its predictions on a novel long-term glucose-insulin model. Taking advantage of the impulsive version of the model—which features real-life properties of diabetes patients that some other popular models do not—the given control guarantees the stability under moderate-to-severe plant-model mismatch and disturbances. Long-term scenarios—including meals and physiological parameter variations—are simulated and the results are satisfactory as every hyperglycemic and hypoglycemic episodes are suitably controlled.     

Dyslipidemia and cardiovascular disease risk factors in patients with type 1 diabetes: A single-center experience

BACKGROUND Type 1 diabetes(T1 D) contributes to altered lipid profiles and increases the risk of cardiovascular disease(CVD). Youth with T1 D may have additional CVD risk factors within the first decade of diagnosis.AIM To examine risk factors for dyslipidemia in young subjects with T1 D.METHODS Longitudinal and cross-sectional retrospective study of 170 young subjects with T1 D(86 males; baseline mean age 12.2 ± 5.6 years and hemoglobin A1 c 8.4% ± 1.4%) were followed in a single tertiary diabetes center for a median duration of 15 years. Predictors for outcomes of lipid profiles at last visit(total cholesterol [TC], triglycerides [TGs], low-density lipoprotein-cholesterol [LDL-c], and highdensity lipoprotein-cholesterol [HDL-c]) were analyzed by stepwise linear regression models.RESULTS At baseline, 79.5% of the patients had at least one additional CVD risk factor(borderline dyslipidemia/dyslipidemia [37.5%], pre-hypertension/hypertension [27.6%], and overweight/obesity [16.5%]) and 41.6% had multiple(≥ 2) CVD risk factors. A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1% of the cohort. Predictors of elevated TC: family history of CVD(β[SE] = 23.1[8.3], P = 0.006); of elevated LDL-c: baseline diastolic blood pressure(DBP)(β[SE] = 11.4[4.7], P = 0.003) and family history of CVD(β[SE] = 20.7[6.8], P = 0.017); of elevated TGs: baseline DBP(β[SE] = 23.8[9.1], P = 0.010) and family history of CVD(β[SE] = 31.0[13.1], P = 0.020); and of low HDL-c levels: baseline DBP(β[SE] = 4.8[2.1], P = 0.022]).CONCLUSION Our findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD. It is of utmost importance to prevent and control modifiable risk factors such as these, as early as childhood, given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.     

2型糖尿病合并胆囊结石的相关危险因素

目的 探讨2型糖尿病患者发生胆囊结石的相关危险因素.方法 回顾性分析2007年1月至2010年5月北京协和医院体检中心2574例2型糖尿病患者的临床资料,对其中429例2型糖尿病合并胆囊结石患者(研究组)和2145例2型糖尿病不合并胆囊结石患者(对照组),按照年龄、性别进行1∶5配比以进行病例对照研究.计数资料采用x2检验,对收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、TC、TG、高密度脂蛋白胆固醇(HDL-CH)、低密度脂蛋白胆固醇(LDL-CH)和体质指数(BMI)等相关危险因素进行单因素分析,采用四格表x2检验筛选出有统计学意义的可疑危险因素,再对这些可疑因素进行多因素Logistic回归分析.结果 单因素分析结果显示在SBP、FBG、TC、HDL-CH及BMI 5个方面,研究组与对照组比较,差异有统计学意义(x2=20.323,4.365,4.028,7.049,7.319,P＜0.05).去除年龄、性别的影响后,多因素分析结果证实SBP、TC、HDL-CH及BMI是2型糖尿病合并胆囊结石患者的危险因素(x2=18.047,6.905,12.884,7.557,P＜0.05).结论 BMI、SBP和TC水平增高及HDL-CH浓度降低可能是2型糖尿病合并胆囊结石的危险因素.

Abstract：

Objective To explore risk factors for type 2 diabetes mellitus complicated with gallstone disease. Methods The clinical data of 429 type 2 diabetes mellitus patients complicated with gallstone disease (case group) and 2145 type 2 diabetes mellitus patients without gallstone disease (control group) were collected from the Health Center of Peking Union Medical College Hospital from January 2007 to May 2010. According to sure (SBP), diastolic blood pressnre (DBP), fasting blood glucose (FBG), total cholesterol (TC), Triglyceride (TG), high-density lipoprotein cholesterol (HDL-CH), low-density lipoprotein cholesterol (LDL-CH) and body mass index (BMI) were statistically analyzed by fourfold table chi-square test or conditional Logistic regression.Results Univariate analysis showed that there was a significant difference in the levels of SBP, FBG, TC, HDL-CH and BMI between the case group and the control group (x2 =20.323, 4.365, 4.028, 7.049, 7.319, P＜0.05). Multivariate analysis confirmed that SBP, TC, HDL-CH and BMI were risk factors for gallstone disease in patients with type 2 diabetes mellitus (x2 = 18. 047, 6. 905, 12. 884, 7. 557, P ＜ 0. 05). Conclusion Increased SBP, TC and BMI and decreased HDL-CH may be the risk factors for type 2 diabetes mellitus complicated with gallstone disease.     

胃转流术对2型糖尿病大鼠的血糖及胰高血糖素样肽-1的影响

目的 观察胃转流术(GBP)对糖尿病大鼠血糖的控制效果及胰高血糖素样肽-1(GLP-1)的影响.方法 采用链脲佐菌素建立糖尿病SD大鼠模型20只,随机分为糖尿病手术组(DO组)和糖尿病对照组(DC组),另取20只非糖尿病大鼠随机分为正常对照组(NC组)和正常手术组(NO组).分别检测各组大鼠术前、术后72 h、1周、4周和8周空腹血糖水平以及血清GLP-1浓度.结果 术前DO组与DC组以及NC组与NO组大鼠空腹血糖之间的比较差异均无统计学意义(P＞0.05);DO组大鼠术后空腹血糖进行性下降,术后8周由术前的(20.84±1.98) mmol/L下降到(5.56±0.11) mmol/L(P＜0.05);DC组大鼠术前及术后各时相的差异无统计学意义(P＞0.05).DO组和NO组大鼠术后血清GLP-1浓度出现明显升高(P＜0.05),术后8周分别由术前的(7.10±0.55)、(10.73 ±0.67) pmol/L上升到(26.48±1.14)、(13.98±0.92) pmol/L(P＜0.05).结论 GBP对2型糖尿病大鼠具有明显的降糖作用,GLP-1的升高在其中起着重要作用,但对正常大鼠血糖无影响.     

走出自设的心理困境

英语老师已经连续两个星期没有在课堂上提问小琴了,这让小琴非常忧虑,她觉得一定是英语老师对自己有意见了。更让小琴担心的是,此种状况如果持续下去的话,她的英语学习就会受到很大的影响,她找到我,特别想改变英语老师不提问她的现状。"小琴,你从感觉到英语老师对你有意见到现在多长时间了?""一个星期吧。"小琴回答。     

Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths

AIM:To evaluate the long-term effect of aerobic and/or anaerobic exercise on glycemic control in youths with type 1 diabetes.METHODS:Literature review was performed in spring and summer 2014 using Pub Med/MEDLINE,Google Scholar,Scopus,and Science Direct with the following terms:aerobic,anaerobic,high-intensity,resistance,exercise/training,combined with glycemic/metabolic control,glycated haemoglobin A1c(Hb A1c) and type 1diabetes.Only peer-reviewed articles in English were included published in the last 15 years.It was selected from 1999 to 2014.Glycemic control was measured with Hb A1 c.Studies with an intervention lasting at least 12 wk were included if the Hb A1 c was measured before and after the intervention.RESULTS:A total of nine articles were found,and they were published between the years of 2002-2011.The sample size was 401 diabetic youths(166 males and 235 females) with an age range of 10-19 years except one study,in which the age range was 13-30 years.Study participants were from Australia,Tunisia,Lithuania,Taiwan,Turkey,Brazilia,Belgium,Egypt and France.Four studies were aerobic-based,four were combined aerobic and anaerobic programs,and one compared aerobic exercise to anaerobic one.Available studies had insufficient evidence that any type of exercise or combined training would clearly improve the glycemic control in type 1 diabetic youth.Only three(two aerobic-based and one combined) studies could provide a significant positive change in glycemic control.CONCLUSION:The regular physical exercise has several other valuable physiological and health benefits that justify the inclusion of exercise in pediatric diabetes treatment and care.     

新诊断男性2型糖尿病患者骨密度临床分析

目的研究新诊断男性2型糖尿病患者(T2DM)骨密度改变情况及危险因素。方法应用双能X射线吸收法测定了200例新诊断男性T2DM和200例男性对照组的L2-4、Wards区、股骨颈、大转子骨密度。并记录年龄、体重指数、血糖、胰岛素及糖化血红蛋白(HbAlc)等临床指标进行比较。结果男性T2DM的血糖、糖化血红蛋白显著高于对照组(P<0.001),而BMD较对照组显著降低(P<0.05)。T2DM的骨质疏松检出率明显高于对照者(P<0.05)。线性回归分析显示HbA1c为BMD独立危险因素(P=0.003,OR=2.15,95%可信区间:2.89～3.52)。结论 T2DM的骨密度降低明显,骨质疏松发生率高,加强控制糖尿病。     

Predialysis factors related to prognosis in type 2 diabetic patients on chronic dialysis in Japan

SUMMARY: We investigated to clarify the predialysis factors associated with prognosis in type 2 diabetic patients entering chronic dialysis. One hundred and twenty-four type 2 diabetic patients who started chronic dialysis in our department between January 1992 and November 2000 were studied. the variables in the predialysis period and those at initiation of dialysis were collected and evaluated in association with prognosis after a mean follow up of 37 ± 23 months from initiation of dialysis by using Cox's proportional-hazards model. the 1-, 3-, and 5-year survival rates after initiating chronic dialysis were 92.7, 74.6, and 56.5%, respectively. During follow up, 40 patients died. Univariate analysis demonstrated that serum albumin (Alb) levels, haemoglobin A1c, and no preparation for permanent vascular or peritoneal access at initiation of dialysis were significantly associated with prognosis. In multivariate analysis, Alb levels (hazard ratio, 2.09, per decrease of 1 g/dL; confidence interval, 1.05–4.19), and age (1.54, per decrease of 10 years; 1.06–2.22) at initiation of dialysis remained significant predictors of mortality. In conclusion, Alb levels and age at initiation of dialysis are associated with prognosis in type 2 diabetic patients on chronic dialysis. It should be elucidated whether improvement of Alb levels at initiation of dialysis would have a favourable influence on survival after diabetic patients with renal failure are entered into chronic dialysis.     

Significance of age in the survival of diabetic patients after kidney transplantation

Background: In recent years acceptance ofdiabetic patients for renal replacement therapyhas increased. Renal transplantation for Type Idiabetic patients is widely accepted but theappropriate treatment for Type II diabeticpatients is still a matter of dispute. Ourstudy was done to determine whether the age ofType II diabetic patients constituted anadditional risk factor.Methods: We analyzed the outcome of renaltransplantation in 56 diabetic patients, 31Type I and 25 Type II diabetics (we excludedany who had combined kidney-pancreastransplants). We compared them with 51non-diabetic patients who were transplantedbecause of end-stage renal failure due tonephrosclerosis and age-matched to type IIdiabetic patients. We assessed the one- andthree-year patient and graft survival, thequality of renal function, the maincomplications and causes of mortality.Results: The overall one- and three-yearpatient survival was 69% and 60% in Type IIpatients; 73% and 69% in Type I diabetespatients and 88% and 80% in patients withnephrosclerosis. The overall one- andthree-year actuarial graft survival was 50%and 38% in patients with Type II disease and58% and 50% in Type I diabetes, and 76% and64% in nephrosclerosis. The main cause ofgraft loss in all groups was death (withfunctioning kidney) due to infections andcardiovascular complications.Conclusions: Diabetes itself is the mostimportant variable in patients who have poorresults after kidney transplantation.Increasing age increases slightly the risk forpoor graft and patient survival. Both groups ofdiabetic patients have poorer results thancontrols but in this comparison age was anindependent factor.     

甘肃地区2型糖尿病患者骨密度变化及影响因素

目的研究甘肃地区2型糖尿病患者的骨密度变化及其影响因素。方法采用双能X线骨密度仪对206例2型糖尿病患者(糖尿病组)和2433例非糖尿病被调查者(对照组)进行左前臂和右足跟的骨密度测定。对两组人群的骨密度变化进行t检验,并对年龄、体质量指数、血压、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血尿酸、糖化血红蛋白、维生素D、血钙、血磷进行Pearson相关分析,将存在相关性的因素进行多元逐步回归分析,得出主要危险因素。结果糖尿病组中左前臂诊断为骨质疏松症者为83例(40. 29%),右足跟为74例(35. 92%);对照组中左前臂诊断为骨质疏松症者为454例(18. 66%),右足跟为529例(21. 74%)。糖尿病组左前臂和右足跟骨密度得测定值均明显低于对照组,差异具有统计学意义(P 0. 05)。2型糖尿病患者左前臂骨密度改变与收缩压、高密度脂蛋白、血磷、年龄呈负相关,与血尿酸、维生素D呈正相关;右足跟骨密度改变与高密度脂蛋白、血磷、年龄呈负相关,与血尿酸呈正相关。结论 2型糖尿病患者的左前臂骨密度值减低,且其影响因素较多,若对其影响因素在临床治疗时对上述影响因素实施积极有针对性的干预,对降低2型糖尿病患者骨质疏松的发生率以及维护其健康具有一定的临床意义。