2型糖尿病合并亚临床甲减患者的临床分析

目的总结与分析2型糖尿病(T2DM)合并亚临床甲状腺功能减退症(SCH)的临床特征。方法将253例T2DM患者分为合并SCH组(观察组)42例,非SCH组(对照组)211例,记录患者一般资料,比较两组患者血脂、微血管及大血管病变情况。结果观察组中女性比例明显高于对照组;观察组的三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)明显高于对照组,差异有统计学意义(P<0.05);观察组的糖尿病肾病(DN)及大血管病变发生率高于对照组,差异有统计学意义(P<0.05)。结论 T2DM合并SCH患者易发生脂代谢紊乱,SCH与糖尿病微血管及大血管并发症的发生、发展有关。     

药物综合疗法对甲状腺功能亢进症合并糖尿病患者的治疗效果

目的 研究药物综合疗法治疗甲状腺功能亢进症合并糖尿病的效果。方法 回顾性分析62例甲状腺功能亢进症合并糖尿病患者的临床资料,根据治疗方式不同分为对照组和观察组,每组31例。对照组采用常规治疗手段,观察组实施药物综合疗法治疗。比较两组患者临床疗效以及治疗前后的甲状腺素和血糖(空腹血糖、餐后2 h血糖)水平。结果 观察组治疗总有效率96.77%高于对照组的74.19%,差异有统计学意义(P<0.05)。治疗后,观察组患者甲状腺素(5.84±1.64)μg/dl、空腹血糖(6.27±1.33)mmol/L、餐后2 h血糖(9.16±1.04)mmol/L低于对照组的(8.68±1.35)μg/dl、(8.24±1.27)mmol/L、(10.82±1.12)mmol/L,差异均具有统计学意义(P<0.05)。结论 通过药物综合疗法对甲状腺功能亢进症合并糖尿病患者进行治疗可提升治疗疗效,改善患者的甲状腺素水平和血糖水平,值得推荐。     

亚临床甲状腺功能减退症对糖尿病及其并发症的影响

目的探讨亚临床甲状腺功能减退症对糖尿病及其并发症的影响。方法选取2012年3月~2014年3月收治的糖尿病患者94例作为研究对象,按照是否合并亚临床甲状腺功能减退症分为观察组(n=47)与对照组(n=47),观察组患者合并亚临床甲状腺功能减退症,对照组患者不具有亚临床甲状腺功能减退症。对两组患者资料及病史进行研究,同时行实验室检查及辅助,作回归分析,观察两组患者糖尿病指标及并发症情况。结果观察组TSH、空腹C肽、hs CRP、TC、LDL-C、胱抑素C、糖化血红蛋白及尿微量白蛋白水平均高于对照组,HDL-C水平低于对照组,差异均具有统计学意义(P<0.05);观察组患者并发症发生率明显高于对照组,差异具有统计学意义(P<0.05)。结论亚临床甲状腺功能减退症能明显增加糖尿病患者并发症发生率,加重病情,须及时诊断并控制促甲状腺激素水平,预防并发症发生。     

阿托伐他汀对糖尿病肾病患者血脂代谢的影响及临床效果分析

目的：观察阿托伐他汀对糖尿病肾病患者血脂代谢的影响,并分析其临床效果。方法糖尿病肾病的患者80例,随机分成观察组和对照组,各40例。观察组患者睡前服用阿托伐他汀片10 mg,分别于治疗后2个月测定患者的血脂含量进行比较。结果观察组间患者治疗后2个月甘油三酯(TG)(1.3±0.7)mmol/L、高密度脂蛋白胆固醇(HDL-C)(1.6±0.1)mmol/L与对照组比较差异无统计学意义。而总胆固醇(4.3±0.9)mmol/L、载脂蛋白B(Apo-B)(1.3±0.4)mmol/L、载脂蛋白A1(Apo-AI)(2.2±0.56)mmol/L及低密度脂蛋白胆固醇(LDL-C)(3.7±0.2)mmol/L与对照组比较差异有统计学意义(P<0.05)。结论对糖尿病合并肾病患者采用睡前口服阿托伐他汀,能够有效调节患者血脂,值得临床推广。     

2型糖尿病患者甲状腺功能异常患病率与相关因素分析

目的 探讨2型糖尿病患者中甲状腺功能异常的患病情况并进行相关因素分析.方法 随机横断面调查300例2型糖尿病患者,所有患者均完善甲状腺功能、糖化血红蛋白、空腹血糖、血脂等检查,测量身高、体重并记录糖尿病病程等相关资料.将其中亚临床甲减组进行单因素比较.同时将甲状腺疾病组按性别进行分组,统计不同性别在2型糖尿病患者中的患病率,并进行统计学比较.结果 300例2型糖尿病患者中,甲状腺功能异常的总患病率为26.7%(80/300),其中临床甲亢、亚临床甲亢、临床甲减、亚临床甲减的患病率分别为2.3%(7/300)、4.3%(13/300)、4.0%(12/300)、16.0%(48/300);甲状腺功能减退者明显高于甲状腺功能亢进者(20.0%,6.7%),差异有统计学意义(P＜0.05),尤其以亚临床甲减多见(16.0%),并且女性甲状腺患病率高于男性[17.3%(52/300)比9.3%(28/300)],差异有统计学意义(P＜0.05).2型糖尿病患者亚临床甲减组与非甲状腺疾病组,在年龄、糖尿病病程、BMI、TG比较差异有统计学意义(均P＜0.05),空腹血糖、糖化血红蛋白比较差异无统计学意义(P＞0.05).结论 2型糖尿病患者合并甲状腺功能异常较常见,尤以亚临床甲减最常见,并且女性多于男性.2型糖尿病患者,特别是肥胖患者,或病程较长的老年女性患者,或者血脂异常者,应常规筛查甲状腺功能,定期随访促甲状腺素,提高亚临床甲减的检出率.     

糖尿病肾病患者血清甲状腺激素水平变化及其相关性研究

目的 探讨糖尿病肾病患者肾功能状况与甲状腺功能的关系.方法 选取确诊的糖尿病患者共132例作为研究组,并选取我院健康的体检者40例,作为对照组,研究组剔除4例临床甲状腺功能亢进、2例临床甲状腺功能减退患者后,剩余126例糖尿病患者分别按照尿白蛋白排泄率(UAER)(2周内查3次取均值)、肾小球滤过率(GFR)分组,比较不同肾病组间游离T3(FT3)、游离T4(FT4)、促甲状腺激素(TSH)水平的差异.结果 随着糖尿病肾病病情的加重,FT3有逐渐下降的趋势,按UAER所分各组间差异无统计学意义(P＞0.05);按GFR所分各组中GFR≤30 ml/min组、GFR 31～60 ml/min组的FT3低于GFR≥90 ml/min组[(2.53±0.88)、(2.63±0.83) pmol/L比(3.14 ±0.64) pmol/L,P＜0.05];FT4、TSH所有分组中均无统计学意义(P＞0.05).结论 糖尿病肾病患者存在不同程度的甲状腺激素水平降低,且随着糖尿病肾病病情的加重,临床肾病期甲状腺功能趋向于亚临床甲状腺功能减退状态,而终末期肾病甲状腺功能趋向于低T3综合征.     

2型糖尿病合并慢性淋巴细胞性甲状腺炎对胰岛素抵抗及冠心病的影响

目的:探讨2型糖尿病伴有甲状腺功能减退的患者的血脂代谢紊乱、动脉硬化程度以及胰岛素抵抗与单纯2型糖尿病患者之间的差异.方法:收集2012-03～2013-12在黑龙江省医院内分泌科所有入院治疗的2型糖尿病患者的血液标本化验甲功五项,共136例,分为四组,检测血脂及胰岛素水平等指标,并行冠状动脉64排CT检查.采用t检验和x2检验统计分析,设定P＜0.05为两组之间的差异有统计学意义.结果:(1)2型糖尿病合并临床甲减组的TC、TG、LDL-C、APOB水平均显著高于2型糖尿病合并亚临床甲减组(P均＜0.05);(2)2型糖尿病合并亚临床甲减和2型糖尿病合并临床甲减组在冠心病的患病率方面明显高于其余四组研究对象冠心病的患病率(P＜0.05);(3)2型糖尿病合并亚临床甲减和2型糖尿病合并临床甲减组在空腹血胰岛素、餐后2h血胰岛素和HOMA-IR指数明显高于其余四组研究对象相应值(P＜0.05).结论:(1)桥本氏病可导致2型糖尿病患者的血脂代谢发生紊乱;(2)桥本氏病甲状腺功能减退者、亚临床甲状腺功能减退者可导致2型糖尿病患者冠状动脉多支病变、远端病变和弥漫病变患病率明显升高;(3)2型糖尿病合并亚临床甲减组和2型糖尿病合并临床甲减组患者出现胰岛素抵抗较单纯2型糖尿病重.     

老年2型糖尿病合并脑梗死的危险因素分析

目的 探讨老年2型糖尿病合并脑梗死的危险因素.方法 对148例老年2型糖尿病患者临床及实验室资料进行了回顾性调查,按是否合并脑梗死分为糖尿病合并脑梗死组和无脑梗死组,并设61例正常对照.用Logistic多元回归分析老年2型糖尿病合并脑梗死的相关危险因素.结果 糖尿病合并脑梗死组收缩压(141.15±17.46)mm Hg、BMI(23.81±3.53)kg/m2、FBG(8.82±2.81)mmol/L、TC(5.69±1.15)mmol/L、TG(2.08±0.75)mmol/L及Fg(4.08±0.65)g/L显著高于无脑梗死组[(129.78±14.65)mm Hg、(22.18±3.22)kg/m2、(7.06±1.72)mmol/L、(5.09±1.12)mmol/L、(I.62±0.43)mmol/L及(3.48±0.58)g/L](均P＜0.01).Logistic回归分析发现病程、收缩压、FBG、TC、TG及Fg是糖尿病合并脑梗死的独立危险因素.结论 对于老年2型糖尿病患者,应加强对收缩压、FBG、TC、TG及Fg等独立危险因素的早期干预,从而减少和延缓脑梗死的发生和发展.     

探究格列美脲联合利格列汀治疗2型糖尿病合并肥胖的临床效果

目的探究格列美脲联合利格列汀治疗2型糖尿病合并肥胖的临床效果。方法 200例2型糖尿病合并肥胖患者,采用随机方式分为实验组与对照组,各100例。实验组应用格列美脲联合利格列汀进行治疗,对照组应用单纯格列美脲进行治疗。对比两组治疗效果。结果治疗后,实验组患者的空腹血糖水平(5.81±1.02)mmol/L、餐后2 h血糖水平(7.58±2.64)mmol/L、糖化血红蛋白水平(6.15±0.62)%均优于对照组的(7.76±1.78)mmol/L、(12.23±2.79)mmol/L、(8.71±1.45)%,总胆固醇水平(3.12±0.52)mmol/L、甘油三酯水平(1.53±0.29)mmol/L、低密度脂蛋白胆固醇水平(1.81±0.13)mmol/L、体质量指数(25.19±2.25)kg/m^2均优于对照组的(4.93±0.96)mmol/L、(2.15±0.47)mmol/L、(2.19±0.77)mmol/L、(29.13±3.08)kg/m^2,不良反应发生率1.00%(1/100)低于对照组的10.00%(10/100),差异均具有统计学意义(P<0.05)。结论采用格列美脲联合利格列汀治疗2型糖尿病合并肥胖患者,有利于稳定患者的血糖值,改善肥胖情况,值得推广使用。     

非布司他治疗2型糖尿病性肾病合并HUA的临床效果分析

目的 观察在2型糖尿病性肾病合并高尿酸血症(HUA)治疗中应用非布司他的临床效果。方法 60例2型糖尿病性肾病合并HUA患者,依据动态随机打乱法分成常规组与实验组,每组30例。常规组开展常规治疗,实验组在常规组基础上应用非布司他治疗。比较两组患者治疗前后肾功能指标(尿蛋白肌酐比值、血肌酐、血尿酸)与血糖指标(空腹血糖、餐后2 h血糖),临床治疗效果,不良反应发生情况。结果 治疗前,两组患者的尿蛋白肌酐比值、血肌酐、血尿酸、空腹血糖、餐后2 h血糖水平比较,差异无统计学意义(P>0.05);治疗后,实验组患者的尿蛋白肌酐比值、血肌酐、血尿酸、空腹血糖、餐后2 h血糖水平分别为(442.9±120.0)mg/mmol、(104.3±10.6)μmol/L、(288.6±46.7)μmol/L、(7.15±0.79)mmol/L、(9.69±0.82)mmol/L,均低于常规组的(573.6±127.3)mg/mmol、(129.1±11.5)μmol/L、(355.7±49.7)μmol/L、(7.85±1.05)mmol/L、(10.47±1.47)mmol/L,差异具有统计学意义...     

糖尿病动脉粥样硬化与糖尿病肾病的关系

目的 探讨糖尿病动脉粥样硬化对糖尿病肾病患病率的影响.方法 根据颈动脉及下肢动脉超声检查结果,696例2型糖尿病(T2DM)患者分为T2DM伴动脉粥样硬化组(A组,551例)和T2DM无动脉粥样硬化组(B组,145例),测定两组肾小球滤过率(GFR)、24-h尿微量白蛋白.结果 两组24-h尿微量白蛋白和GFR相仿(P＞0.05).A组与B组的微量白蛋白尿和大量白蛋白尿患病率差异亦无统计学意义(22.7％和6.9％ vs.20.0％和3.4％)(P＞0.05).结论 糖尿病动脉粥样硬化不增加糖尿病肾病的发生.     

Characteristics of diabetic osteopenia in KK-Ay diabetic mice

We examined the bone mineral density (BMD) of the proximal region and the mid-diaphysis of the femur using dual energy X-ray absorption (DXA), the blood osteocalcin level and the blood glucose level every five weeks from 8 to 23 weeks old in KK-Ay diabetic mice. The BMD of the proximal region after 18 weeks old was significantly lower when compared with that at 8 weeks old (p<0.05), whereas there was no significant difference in the BMD of the mid-diaphysis at each week. The BMD of the proximal region at 18 weeks old was significantly lower than that in ddY mice, used as controls (p<0.05). The blood osteocalcin level at 18 weeks old was significantly lower than that at 8 weeks old and that in 18-week-old ddY mice (p<0.05). There was significant negative correlation between the blood glucose level and the BMD of the proximal region (r=-0.64, p<0.05). These results suggest that type 2 diabetes exerts an influence only on spongy bone, not on cortical bone, and that the BMD in the proximal region of the femur seems to be affected by blood glucose level, parallel with the progression of diabetes, through the blood osteocalcin level. In the present study, we show the characteristics of diabetic osteopenia in KK-Ay mice, an animal model of type 2 diabetes.     

Anti diabetic effect of cherries in alloxan induced diabetic rats

Diabetes mellitus (DM) is a metabolic disorder in the endocrine system resulting from a defect in insulin secretion, insulin action or both of them. Adverse side effects of chemical drugs for treatment of diabetes persuaded the using of medical plants. Cherry as a traditionally used plant for treatment of diabetes, is packed with powerful plant pigments called anthocyanins. They give cherries their dark red color and are one of the richest antioxidant sources which lower the blood sugar and bear other beneficial health effects. The purpose of this study is to evaluate the effect of ethanolic extract of cherry fruit on alloxan induced diabetic rats. In this study 36 Male Wistar rats, body weight of 150-200gr were divided into 6 groups. Diabetes was induced by intra peritoneal injection of 120 mg/kg Alloxan. The duration of the cherries treatment was 30 days in which single dose of extracts (200mg/kg) were oral administered to diabetic rats. Blood glucose levels were estimated with glucometer before treatment, 2h and 1- 4 weeks after administration of extracts. Treatment with extracts of the cherries resulted in a significant reduction in blood glucose and urinary microalbumin and an increase in the creatinine secretion level in urea. Extract of this plant is useful in controlling the blood glucose level. Cherries appear to aid in diabetes control and diminution of the complications of the disease. Some relevant patents are also outlined in this article.     

Treating diabetic ulcers

Introduction: Diabetic foot ulceration is a serious secondary complication of diabetes mellitus and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Thus, addressing all of the factors involved remains instrumental in wound healing.

Areas covered: The first part of this review focuses on the pathophysiology of diabetic foot ulceration and wound-healing impairment. The second part reviews the standard treatments, including advanced wound-care products and new therapeutic approaches currently under investigation. The reader will understand the most up-to-date research regarding the unique pathophysiology of diabetic foot ulceration along with the basic cornerstones of current recommended standard therapy.

Expert opinion: Diabetic foot ulceration is a serious complication that can lead – potentially – to devastating lower-extremity amputations. Proper adherence to standard treatment strategies can potentially prevent the need for amputation.     

Treating diabetic ulcers

INTRODUCTION: Diabetic foot ulceration is a serious secondary complication of diabetes mellitus and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature. Thus, addressing all of the factors involved remains instrumental in wound healing. AREAS COVERED: The first part of this review focuses on the pathophysiology of diabetic foot ulceration and wound-healing impairment. The second part reviews the standard treatments, including advanced wound-care products and new therapeutic approaches currently under investigation. The reader will understand the most up-to-date research regarding the unique pathophysiology of diabetic foot ulceration along with the basic cornerstones of current recommended standard therapy. EXPERT OPINION: Diabetic foot ulceration is a serious complication that can lead--potentially--to devastating lower-extremity amputations. Proper adherence to standard treatment strategies can potentially prevent the need for amputation.     

Phoenix dactylifera seeds ameliorate early diabetic complications in streptozotocin-induced diabetic rats

Abstract

Context: In Arabic folk medicine, the seeds of Phoenix dactylifera L. (Arecaceae) have been used to manage diabetes for many years. Few studies have reported the antidiabetic effect of P. dactylifera seeds; however, their effect on diabetic complications is still unexplored.

Objective: The present study investigates the protective effect of P. dactylifera seeds against diabetic complications in rats.

Material and methods: The aqueous suspension of P. dactylifera seeds (aqPDS) (1?g/kg/d) was orally administered to streptozotocin-induced diabetic rats for 4 weeks. The serum biochemical parameters were assessed spectrophotometrically. Furthermore, oxidative stress was examined in both liver and kidney tissues by assessment of thiobarbituric acid reactive substances (TBARS), nitric oxide (NO), reduced glutathione, superoxide dismutase (SOD), glutathione S-transferase, and catalase.

Results: Oral administration of aqPDS significantly ameliorated the elevated levels of glucose (248?±?42 versus 508?±?60?mg/dl), urea (32?±?3.3 versus 48.3?±?5.6?mg/dl), creatinine (2.2?±?0.35 versus 3.8?±?0.37?mg/dl), ALT (29.6?±?3.9 versus 46.4?±?5.9?IU/l), and AST (73.3?±?13 versus 127.8?±?18.7?IU/l) compared with the untreated diabetic rats. In addition to significant augmentation in the activities of antioxidant enzymes, there was reduction in TBARS and NO levels and improvement of histopathological architecture of the liver and kidney of diabetic rats.

Discussion and conclusion: The aqPDS showed potential protective effects against early diabetic complications of both liver and kidney. This effect may be explained by the antioxidant and free radical scavenging capabilities of P. dactylifera seeds.     

2型糖尿病患者蛋白尿与糖尿病视网膜病变的关系

目的 探讨2型糖尿病(T2DM)患者尿白蛋白/肌酐比值(UACR)与糖尿病视网膜病变(DR)的关系.方法 152例T2DM患者根据UACR均分为UACR正常(A)组(UACR＜30 mg/g)和UACR异常(B)组(UACR≥30 mg/g),根据糖尿病病程再分为病程＜10年(C)组(87例)和病程≥10年(D)组(65例).检测血糖、糖化血红蛋白,计算UACR.结果 B组DR患病率53.9％,明显高于A组的28.9％ (P＜0.05),B组发生DR的危险是A组的2.875倍(95％可信区间为1.471-5.620).C组中,UACR异常患者的DR患病率51.6％,明显高于UACR正常者的26.8％(P＜0.05),且前者发生DR的危险是后者的2.916倍(95％可信区间为1.162-7.314).结论 病程较短且UACR异常的T2DM患者发生DR的风险较高.     

Current approaches to the management of diabetic retinopathy and diabetic macular oedema

Diabetic retinopathy (DR) is a major cause of blindness in Europe and North America, and the incidence is expected to increase in parallel with the rising incidence of diabetes mellitus. This article reviews the current state of knowledge of the epidemiology, clinical presentation and pathophysiology of DR and its principal associated complications, diabetic macular oedema (DME) and neovascularization, and then proceeds to the primary focus of clinical management. A series of major randomized controlled trials conducted over the past few decades has confirmed that tight glycaemic regulation is the most effective measure to reduce the risk of developing DR and to minimize the likelihood of its progression, and that control of blood pressure is also an important feature of preventive management. Laser-based therapies remain the cornerstone of treatment, with panretinal photocoagulation indicated for proliferative and severe nonproliferative DR and focal photocoagulation indicated for treatment of DME. For patients who do not benefit from these approaches, vitrectomy may provide therapeutic benefits. Medical therapies include two broad classes of agents: anti-inflammatory drugs and agents with molecular targets. The utility of oral anti-inflammatory drugs remains to be established, as dose-finding studies have yet to provide definitive conclusions. Intravitreal corticosteroids may be of value in specific circumstances, although adverse effects include cataract progression and elevated intraocular pressure. However, these complications appear to have been limited with new extended-release technologies. With respect to molecular targets, evidence has been adduced for the roles of vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α and protein kinase C (PKC)-β2 in the pathogenesis of DR, and agents targeting these factors are under intense investigation. The role of VEGF in mediating pathological angiogenesis and vascular hyperpermeability has been best defined. Preliminary efficacy of pegaptanib and ranibizumab in the treatment of DME is being confirmed in additional clinical trials with these agents and with the off-label use of bevacizumab, another monoclonal antibody related to ranibizumab. Moreover, other agents targeting VEGF, as well as drugs directed against TNFα and PKC-β2, are under study. Evaluation of the ultimate utility of these approaches will await the efficacy and safety results of properly designed phase III trials.