老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

老年2型糖尿病患者动态血糖监测分析

目的 探讨老年2型糖尿病患者的动态血糖波动特点.方法 对老年2型糖尿病患者(老年组)92例和中青年2型糖尿病患者(中青年组)58例进行动态血糖监测,对比分析两组患者血糖谱特征及老年不同糖化血红蛋白(HbA1c)水平糖尿病患者的血糖谱特征.结果 (1)老年组与中青年组比较,血糖波动系数(BGFC)增大[(2.68±1.00)mmol/L对(2.12±0.74) mmol/L,t=-3.691,P＜0.001];餐后血糖漂移幅度(PPGE)增大,早餐后分别为 ( 5.96±2.47) mmol/L对(5.11±2.44) mmol/L(t=-2.058,P＜0.05),晚餐后分别为(5.17±2.15) mmol/L对 (4.16±2.28) mmol/L(t=-2.730,P＜0.01);餐后血糖达峰时间延长,早餐后(112.5±29.7) min对(97.0±27.2) min(t=-3.225,P＜0.01),中餐后(140.0±39.7)min对 (118.1±42.6) min(t=-3.195,P＜0.01);低血糖发生频率增加(26.3%对5.5%,P＜0.05);最大血糖漂移幅度(LAGE)增大,分别为(9.66±2.48) mmol/L对(8.40±3.13) mmol/L(t=-2.720,P＜0.01);(2)老年组患者随HbA1c下降,低血糖发生率增加(P＜0.05);随 HbA1c升高,血糖波动幅度增大;(3)HbA1c与空腹血糖(FBG)、日平均血糖(MBG)、高血糖时间比(PT7.8、PT11.1)、最低血糖(LBG)、最高血糖(HBG)、BGFC、PPGE、LAGE均正相关(r=0.899～0.289,均P＜0.001);逐步回归分析显示,MBG、FBG、PT7.8与HbA1c独立相关(校正的R2=0.807,P＜0.05).结论 老年2型糖尿病患者血糖波动幅度大,易发生餐后高血糖和夜间低血糖,动态血糖监测能较详细地显示患者的血糖水平及波动特征.

Abstract：

Objective To investigate the characteristics of the blood glucose fluctuation in elderly patients with type 2 diabetes mellitus (T2DM). Methods The 92 elderly patients with T2DM (the elderly group) and 58 young and middle-aged patients with T2DM (the non-elderly group) were monitored using the continuous glucose monitoring system(CGMS). The characteristics of glucose profiles of the two different age groups, and of the different glycosylated hemoglobin (HbA1c) level groups in the elderly were comparatively analyzed. Results (1)There was no significant difference in HbA1c level between the elderly group and the non-elderly group. Compared with the non-elderly group, the elderly group showed the increases in blood glucose fluctuant coefficient [BGFC, (2.68±1.00) mmol/L vs. (2.12±0.74) mmol/L, t=-3.691, P＜0.001], in postprandial glucose excursion (PPGE) of breakfast and supper [(5.96±2.47) mmol/L vs. (5.11±2.44) mmol/L, t=-2.058, P＜0.05; (5.17±2.15) mmol/L vs. (4.16±2.28) mmol/L, t=-2.730, P＜0.01], in the time to postprandial glucose peak of breakfast and lunch [(112.5±29.7) min vs. (97.0±27.2) min, t=-3.225, P＜0.01; (140.0±39.7) min vs. (118.1±42.6) min, t=-3.195, P＜0.01], in the frequency of hypoglycemia (26.3% vs. 5.5%, P＜0.05), and showed the largest amplitude of glycemic excursions [LAGE, (9.66±2.48) mmol/L vs.(8.40±3.13) mmol/L, t=-2.720, P＜0.01]. (2)In the elderly, along with decreased HbA1c, the incidence of hypoglycaemia increased (P＜0.05); And along with increased HbA1c, the amplitude of blood glucose fluctuation increased. There were significant differences in BGFC, PPGE of breakfast and lunch, and LAGE among different HbA1c level groups (P＜0.01, P＜0.05, P＜0.05, P＜0.001). (3)HbA1c was positively correlated with FBG, mean blood glucose (MBG), percentage of time at glycemia (PT7.8, PT11.1), the lowest blood glucose (LBG), the highest blood glucose (HBG), BGFC, PPGE and LAGE (r=0.899-0.289, all P＜0.001). Multiple stepwise regression analysis indicated that MBG, FBG and PT7.8 was the independent influential factor of HbA1c (adjusted R2=0.807, P＜0.05). Conclusions The elderly patients with T2DM are at a particularly high risk for postprandial hyperglycemia and nocturnal hypoglycemic episodes, CGMS could show glucose fluctuation characters of T2DM patients diurnally, and provide a clinical basis for reasonable therapy.     

健康高龄老年人甲状腺激素水平变化趋势分析

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

健康高龄老年人甲状腺激素水平变化趋势分析

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

Protective effect of rhIL-1β on pancreatic islets of alloxan-induced diabetic rats

AIM:To observe the protective effect of rhIL-1β on pancreatic islets of alloxan-induced diabetic rats. METHODS:Protection of rhIL-1β on pancreatic islets of alloxan-induced diabetic rats(n=5)was demonstrated with methods of immunohistochemistry and stereology.The concentration of serum glucose was measured by GOD method and that of serum insulin by RIA. RESULTS:The concentration of serum glucose increased but that of insulin decreased after administration of alloxan (150 mg/kg),and the volume density and numerical density of the islets were zero.In rhIL-1β pretreated rats, although the concentration of serum insulin decreased(from 11.9±3.0 mIU/L to 6.1±1.6 mIU/L,P<0.05),that of glucose was at normal level compared with the control group. As compared with alloxan group,the concentration of serum glucose in rhIL-1β pretreated rats decreased(from 19.4±8.9 mmol/L to 12.0±4.0 mmol/L,P<0.05)and the volume density increased(0/L to.1/L,P<0.05). CONCLUSION:rhIL-1β pretreatment may have protective effect on the islets of alloxan-induced diabetic rats.     

Chronic hepatitis B serum promotes apoptotic damage in human renal tubular cells

AIM: To investigate the effect of the serum of patients with chronic hepatitis B (CHB) on apoptosis of renal tubular epithelial cells in vitro and to study the role of hepatitis B virus (HBV) and transforming growth factor-β1 (TGF-β1) in the pathogenesis of hepatitis B virus associated glomerulonephritis (HBV-GN). METHODS: The levels of serum TGF-β1 were measured by specific enzyme linked immunosorbent assay (ELISA) and HBV DNA was tested by polymerase chain reaction (PCR) in 44 patients with CHB ,and 20 healthy persons as the control. The normal human kidney proximal tubular cell (HK-2) was cultured together with the sera of healthy persons, CHB patients with HBV-DNA nega-tive(20 cases) and HBV-DNA positive (24 cases) for up to 72 h. Apoptosis and Fas expression of the HK-2 were detected by flow cytometer. RESULTS: The apoptosis rate and Fas expression of HK-2 cells were significantly higher in HBV DNA positive serum group 19.01±5.85% and 17.58±8.35%, HBV DNA negative serum group 8.12±2.80% and 6.96±2.76% than those in control group 4.25±0.65% and 2.33±1.09%, respectively (P < 0.01). The apoptosis rate and Fas expression of HK-2 in HBV DNA positive serum group was significantly higher than those in HBV DNA negative serum (P < 0.01). Apoptosis rate of HK-2 cells in HBV DNA positive serum group was positively correlated with the level of HBV-DNA (r = 0.657). The level of serum TGF-β1 in CHB group was 163.05±91.35μg/L, significantly higher as compared with 81.40±40.75μg/L in the control group (P < 0.01). CONCLUSION: The serum of patients with chronic hepatitis B promotes apoptotic damage in human renal tubular cells by triggering a pathway of Fas up-regula-tion. HBV and TGF-β1 may play important roles in the mechanism of hepatitis B virus associated glomerulone-phritis.     

非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

Objective To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease (NAFLD) patients, and their relationship with insulin resistance. Methods A total of 120 cases were enrolled and divided into two groups: NAFLD group (n = 60) and normal control group (n = 60). The serum levels of leptin and adiponectin were measured by EL1SA. The body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol (Tchol), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting blood glucose (FBG) and HOMA-IR (homeostasis model assessment insulin resistance) were detected and analyzed. Results Compared with control group, the serum leptin level in NAFLD group was Significantly higher [(12.37 ± 1.99) μg/Lvs (5.20 ± 1.03)μg/L,P<0.01], while the serum adiponectin level was significantly lower [(12.69 ± 2.83) mg/L vs (22.83 ± 4.61) mg/L, P < 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[(4.86 ± 0.63) vs (1.91 ± 0.41), P < 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR ( P = 8.175, P < 0.01), HOMA-IR ( P = 0.974, P < 0.01 ), FBG ( β = 0.564, P < 0.01). In contrast, adiponectin inversely associated with HOMA-IR ( β = -0.495, P < 0.01 ) and BMI ( β = -0.314, P < 0.01) respectively. Conclusions The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.     

非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

Objective To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease (NAFLD) patients, and their relationship with insulin resistance. Methods A total of 120 cases were enrolled and divided into two groups: NAFLD group (n = 60) and normal control group (n = 60). The serum levels of leptin and adiponectin were measured by EL1SA. The body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol (Tchol), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting blood glucose (FBG) and HOMA-IR (homeostasis model assessment insulin resistance) were detected and analyzed. Results Compared with control group, the serum leptin level in NAFLD group was Significantly higher [(12.37 ± 1.99) μg/Lvs (5.20 ± 1.03)μg/L,P<0.01], while the serum adiponectin level was significantly lower [(12.69 ± 2.83) mg/L vs (22.83 ± 4.61) mg/L, P < 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[(4.86 ± 0.63) vs (1.91 ± 0.41), P < 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR ( P = 8.175, P < 0.01), HOMA-IR ( P = 0.974, P < 0.01 ), FBG ( β = 0.564, P < 0.01). In contrast, adiponectin inversely associated with HOMA-IR ( β = -0.495, P < 0.01 ) and BMI ( β = -0.314, P < 0.01) respectively. Conclusions The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.     

老年人贫血及营养状况分析

Objective To observe the incidence rate of anaemia and analyze the nutritional situation in the elderly population.Methods From April to August 2010,a total of 2052 elderly persons from out-department of Tianjin First Center Hospital were divided into four age groups:65-69years group (n=528),70-74 years group (n=593),75-79 years group (n=423) and 80 years and over group (n= 508).The body mass index (BMI),haemoglobin (Hb),mean corpuscular volume (MCV),triglyceride (TG),creatinine (Cr),serum albumin (ALB) and ferritin (Fer) were tested and evaluated using K-W test.Results (1) Anaemia was found in 90 subjects (4.4 %),4.0% in men and 6.l% in women,9.5% in 80 years and over group.The subjects with Hb level less than 90g/L were all 80 years and over.(2)There were significant differences among the groups in BMI,TG,Cr,ALB,Hb,MCV and Fer levels (all P＜0.01).There were significant differences among four groups in Hb and ALB levels (P＜0.01 ),and partially differences in TG, Cr and MCV levels (P＜0.05).(3)The Hb level was significantly correlated with TG, ALB, Fer and MCV levels (r=0.115,0.211, 0.114 and 0.089, all P＜0.01 ) from Pearson analysis.Conclusions Anemia incidence in elderly population is increased along with aging and is higher in women than in men, especially higher in 80 years and over group.Nutritional situation gets worse with aging.     

2型糖尿病患者一级亲属非糖尿病者游离脂肪酸水平和代谢特点

目的 探讨2型糖尿病家系一级亲属非糖尿病者血清游离脂肪酸(NEFA)的变化及影响因素.方法 测定186例2型糖尿病患者、565名2型糖尿病家系一级亲属非糖尿病者、149名正常对照者的血脂、血糖及胰岛素水平.结果 (1)一级亲属组空腹NEFA水平明显低于2型糖尿病组[(0.53±0.28 vs 0.63±0.31)mmol/L,P＜0.01],稳态模型评估的胰岛素抵抗指数(HOMA-IR)明显高于正常对照组(0.98±0.51 vs 0.89±0.47,P＜0.01).(2)一级亲属组体重指数(BMI)、血糖及葡萄糖曲线下面积(AUCglu)较高者空腹NEFA明显高于较低者(均P＜0.05).(3)相关分析显示,一级亲属组空腹NEFA与BMI、收缩压、舒张压、AUCglu明显相关(r分别为0.12、0.148、0.21、0.281,均P＜0.05);多元逐步回归分析显示,AUCglu、舒张压、年龄是影响一级亲属组空腹NEFA水平的独立相关因素(均P＜0.01).结论 2型糖尿病家系一级亲属非糖尿病者已经存在胰岛素抵抗,后者与NEFA水平的升高密切相关.     

丙氨酸转移酶升高的2型糖尿病患者伴有更多的心血管风险因素

根据血丙氨酸转氨酶(ALT)水平将4 509例2型糖尿病患者分为A组(n=449,ALT增高)和B组(n=4 060,ALT正常),ALT升高的患者为10%.与B组患者相比,A组患者相对年龄更轻[(48.5±11.3对55.7±11.4)岁,P＜0.01]、糖尿病病程更短[(36.8±45.0对56.2±58.8)个月,P＜0.01]、体重指数以及腰臀比更大[(27.7±3.9对25.8±3.4)kg/m2,P＜0.01;0.95±0.06对0.93±0.07,P＜0.01].两组之间的血压存在差别[收缩压(132±19对131±21)mm Hg,1 mm Hg=0.133 kPa,P=0.60;舒张压(78±10对75±10)mm Hg,P＜0.01].A组的空腹血糖[(9.04±2.91对8.63±3.05)mmol/L,P=0.008]、餐后血糖[(13.85±4.67对13.07±4.92)mmol/L,P=0.002]、HbA1C(8.11%±1.82%对7.74%±1.96%,P＜0.01)、空腹胰岛素[(10.59±7.31对7.97±7.18)mU/L,P＜0.01]和餐后胰岛素[(48.96±43.80对35.25±32.37)mU/L,P＜0.01]及稳态模型评估的胰岛素抵抗指数(HOMA-IR,4.11±2.85对3.00±2.92,P＜0.01)、甘油三酯[(2.77±2.50对2.19±2.99)mmoL/L,P＜0.01]明显增高,高密度脂蛋白胆固醇[HDL-C,(1.20±0.30对1.29±0.83)mmol/L,P=0.01]更低.Logistic回归分析说明,HbA1C、餐后胰岛素、HOMA-IR、尿酸和尿白蛋白与ALT水平正相关,HDL-C则为负相关.提示ALT增高的2型糖尿病患者发病年龄更轻,有更严重的胰岛素抵抗和更多的心血管危险因素.     

老年2型糖尿病并存非酒精性脂肪性肝病患者体成分及危险因素分析

目的 对老年2型糖尿病合并与未合并非酒精性脂肪性肝病患者体成分、血脂、腹型肥胖和代谢综合征发生率等进行比较,探讨合并非酒性脂肪性肝病的可能危险因素.方法 将入选老年2型糖尿病患者分为合并非酒精性脂肪性肝病组(脂肪肝组)83例及未合并非酒精性脂肪性肝病组(非脂肪肝组)85例,比较两组体成分、血脂、腹型肥胖和代谢综合征发生率等临床资料. 结果 脂肪肝与非脂肪肝组比较,组体质指数[(26.9±2.5)kg/m~2对(24.1±2.5j)kg/m~2,P=0.000]、腰臀围比(0.92±0.07对0.87±0.06,P=0.000)、总体脂肪比[(29.6±6.6)%对(25.3±5.5)%,P=0.000]、腹部脂肪[(11.0±2.5)kg对(8.7±2.3)kg,P=0.000]、内脏脂肪[(3.0±0.7)kg对(2.3±0.6)kg,P=0.000]、内脏脂肪面积[(97.6±22.2)cm~2对(75.5±21.1)cm~2,P=0.000]、三酰甘油[(1.98±0.94)mmol/L对(1.22±0.61)mmol/L,P=0.000]均升高,高密度脂蛋白胆醇[(1.23±0.32)mmol/L对(1.40±0.37)mmol/L,P=0.002]水平降低,差异均有统计学意义;体脂过高(68.7%对36.5%,P=0.000)、血脂异常(47.0%对21.2%,P=0.000)、腹型肥胖(69.9%对43.5%,P=0.001)和代谢综合征(49.4%对9.6%,P=0.000)的发病率亦明显升高,差异均有统计学意义;而总胆醇[(4.93±0.94)mmol/L对(4.73±1.07)mmol/L,P=0.219]和低密度脂蛋白胆固醇[(3.23±0.80)mmol/L对(3.07±0.89)mmol/L,P=0.229]两组比较,差异无统计学意义.Logistic回归分析显示体质指数超标(β=1.268,P=0.000,OR=3.56)、总体脂肪比过高(β=0.902,P=0.023,OR=2.47)和代谢综合征(β=1.664,P=0.000,OR=5.28)与老年2型糖尿病患者合并非酒精性脂肪性肝病相关. 结论 体质指数超标、总体脂肪比过高与老年2型糖尿病患者合并非酒精性脂肪性肝病相关,非酒精性脂肪性肝病可能是代谢综合征的一个组成部分.     

糖调节受损和2型糖尿病患者血浆nesfatin-1水平的变化

采用酶联免疫法测定了初诊2型糖尿病患者、糖调节受损(IGR)患者、正常糖耐量(NGT)者血浆nesfatin-1水平.结果显示,2型糖尿病和IGR组血浆nesfatin-1水平明显高于NGT组[(1.91±0.79和1.80±0.80对1.41±0.58)μg/L,P＜0.01].血浆nesfatin-1水平与体重指数(BMI)、空腹血糖、空腹胰岛素、HbA1C、稳态模型评估的胰岛素抵抗指数(HOMA-IR)呈明显正相关(P＜0.05或P＜O.01).多元回归分析结果表明HOMA-IR和BMI分别是影响血浆nesfatin-1水平的独立相关因素(均P＜0.01).提示血浆nesfatin-1可能参与了胰岛素抵抗和2型糖尿病的发生和发展.     

腹部内脏脂肪沉积的老年非代谢综合征患者脂联素瘦素比值的变化

目的 观察体质指数正常、腹部内脏脂肪沉积的非代谢综合征老年男性患者血清脂联素、瘦素水平及脂联素瘦素比值的变化.方法 将入选的老年非代谢综合征男性患者109例分为2组,内脏无脂肪沉积组67例,内脏脂肪沉积组42例.采用CT方法测定内脏脂肪面积,当腹部内脏脂肪面积≥100cm2,为内脏脂肪沉积;采用LINCO公司提供的放射免疫试剂盒测定空腹血脂联素、瘦素水平;代谢综合征的诊断采用2004年中国糖尿病学会制定的标准.结果 (1)脂肪沉积组与无脂肪沉积组比较,体质指数、内脏脂肪面积均显著升高,体质指数分别为(22.94±1.35)kg/m2对(21.38±2.55)kg/m2(P＜O.001),内脏脂肪面积(135.6±31.7)cm2对(68.6±22.6)cm2(P＜O.001);脂联素瘦素比值降低.分别为2.17±1.77对4.54±7.00(P=0.031);而脂联素、瘦素水平在两者间差异无统计学意义;(2)脂联素瘦素比值与体质指数(r=-0.552,P＜0.001)、腰围(r=-0.390,P＜0.001)、腹部内脏脂肪面积(r=-0.311,P＜0.001)呈负相关.结论 体质指数正常有内脏脂肪沉积与无内脏脂肪沉积的老年男性比较.脂联素瘦素比值明显下降.并与腹部脂肪面积显著负相关.提示血清脂联素瘦素比值可能可用于筛选体质指数正常有腹部内脏脂肪肪沉积的患者.     

血清脂联素和抵抗素与2型糖尿病及其大血管病变相关

测定2型糖尿病患者血清脂联素和抵抗素水平,发现2型糖尿病组血清脂联素浓度(2.51±1.42)mg/L低于正常对照组(5.26±0.78)mg/L,2型糖尿病大血管病变组为(1.38±0.77)mg/L又低于非大血管病变组(3.66±0.91)mg/L,差异均有统计学意义(均P＜0.01).2型糖尿病组血清抵抗素浓度(7.07±1.11)μg/L高于正常对照组(6.09±0.47)μg/L,2型糖尿病大血管病变组为(7.96±0.65)μg/L又高于非大血管病变组(6.10±0.43)μg/L,差异均有统计学意义(均P＜0.01).     

老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系

目的 探讨老年人不同甲状腺功能状态下脂代谢特征与氧化应激的关系.方法 初诊老年甲状腺疾病患者86例[甲状腺功能亢进(甲亢)47例,甲状腺功能减退(甲减)39例]、非老年甲状腺疾病患者83例(甲亢43例,甲减40例)和老年健康对照组20例.检测空腹血浆丙二醛(MDA)和超氧化物歧化酶(SOD),氧化型低密度脂蛋白(OX-LDL)水平,同时测定血脂指标及甲状腺功能,计算SOD/MDA比值.结果 老年甲亢组血脂各组分均高于非老年甲亢组、低于老年对照组(P＜0.05或P＜0.01);老年甲亢组与非老年甲亢组、老年对照组比较,丙二醛[分别为(10.23±6.29)、(7.37±4.58)μmol/L和(3.66±2.53)μmol/L]、游离脂肪酸(FFA)[分别为(0.86±0.58)、(0.61±0.46)mmol/L和(0.45士0.12)mmol/L]和SOD显著升高(P＜0.01或P＜0.05).老年甲减组与非老年甲减组和老年对照组比较,MDA[(9.03±5.98)、(6.59±3.18)μmol/L和(3.66±2.53)μmol/L]、OX-LDL[(387.36±71.04)、(355.22±45.01)μg/L和(324.53±56.19)μg/L]及部分血脂组分均显著增高(P＜0.05或P＜O.01).老年甲亢组、甲减组SOD/MDA比值均低于老年对照组和非老年组(均为P＜0.01).多元回归分析,甲亢组游离甲状腺素(FT4)和FFA是影响MDA的因素,甲减组非HDL-C和LDL-C与MDA独立相关.结论 初诊老年甲亢和甲减患者氧化应激增强,氧化损伤程度与脂代谢紊乱有关.     

甲状腺功能亢进症患者血清抵抗素水平与血糖、血脂及甲状腺激素的关系

目的 探讨甲状腺功能亢进症（简称甲亢）患者血清抵抗素水平与血糖、血脂、甲状腺激素(TH)的关系。方法 甲亢组50例,来源于2008、2009年就诊于哈医大二院内分泌科患者,均为新确诊尚未服药病例;以同时间到医院体检的40例健康者为对照组,两组均排除糖尿病、肥胖、高血压、高血脂。ELISA法测定血清抵抗素水平;化学发光法测定空腹胰岛素、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素(FT4)、促甲状腺激素(TSH);葡萄糖氧化酶-过氧化物酶(GOD-PAP)法测定空腹血糖;胆固醇氧化酶法测定总胆固醇(T-CH);磷酸甘油氧化酶(GPO)法测定甘油三酯(TG);均相酶比色法测定高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。同时测定身高、体重、腰围、臀围,计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)。组间比较采用t检验,相关分析采用Pearson相关检验,用多元逐步回归方法比较抵抗素与血糖、血脂、TH的关系。结果 甲亢组血糖[(5.2±0.7)mmol/L]、抵抗素[(132.1±41.3)μg/L]、FT3[(19.8±8.7) pmol/L]、FT4[(54.1±29.6)pmol/L]、胰岛素[(7.9±2.8)mU/L]、胰岛素抵抗指数[(2.3±1.0)]明显高于对照组[(4.7±0.5)mmol/L,(65.1±5.9)μg/L、(4.1±0.6)pmol/L、( 14.3±2.2)pmol/L、(6.4±2.7)mU/L、(1.5±1.2);t值分别为4.64、10.17、11.42、8.49、4.48、9.42,P＜ 0.01或＜0.05]。甲亢组T-CH[(3.7±0.8)mol/L]、LDL-C[( 1.8±0.6)mol/L]、TSH[(0.01±0.01 )mU/L]明显低于对照组[(4.6±0.7) mol/L、(2.3±0.7)mol/L、( 1.80±0.90)mU/L;t值分别为5.30、3.33、14.48,P均＜0.01）]。相关分析显示,甲亢组抵抗素与FT3、FT4、HOMA-IR呈正相关(r=0.719、0.790、0.396,P＜0.01或＜0.05),与T-CH、LDL负相关(r=-0.364、- 0.519,P＜0.05或＜0.01)。多元逐步回归显示,甲亢组抵抗素与FT3、FT4、HOMA-IR正相关（r=0.756,P均＜0.01）。结论 抵抗素水平的调节受甲状腺激素影响,甲亢患者血抵抗素可能与胰岛素抵抗及糖脂代谢紊乱有关。     

脂质体携载前列腺素E1对冠心病合并糖尿病患者发生造影剂肾病的预防作用

目的 探讨脂质体携载前列腺素E1(PGE1)对冠心病合并糖尿病的患者发生造影剂肾病的预防作用.方法 选取行冠脉造影或介入治疗的合并糖尿病的冠心病患者198例,随机分为对照组和PGE1组.PGE1组在常规治疗的基础上予PGE1 20μg+生理盐水20ml静脉注射,1次/d,共10 d,比较两组造影前、造影后48 h、5d血肌酐(Scr)、尿素(BUN)、胱抑素C(CysC)水平及造影剂肾病发生率等.结果 造影后48 h、5dScr、BUN、Cys C等在PGE1组分别为(113.92±54.89)μmmol/L、(7.85±4.05)mmol/L、(1.38±0.34)mg/L和(86.72±35.26)μmmol/L、(6.61±3.09 )mmol/L、(1.29±0.29)mg/L优于对照组(129.22±50.18)μmmol/L、(9.26±3.95) mmol/L、(1.56±0.23)mg/L和(109.83±31.76)μmmol/L、(8.07±3.11)mmol/L、(1.37±0.21)mg/L,差异有统计学意义(均P＜0.05).经直线相关分析,造影剂剂量与BUN、Scr呈显著正相关(r=0.74,P＜0.05; r=0.82,P＜0.01).结论 PGE1对冠心病合并糖尿病的患者发生造影剂肾病有预防作用.