老年糖尿病性视网膜病变患者血小板功能及其颗粒膜蛋白的变化

观察了２９例糖尿病无视网膜病变者和５２例糖尿病性视网膜病变者血小板聚集功能、血小板颗粒膜蛋白１４０（ＧＭＰ－１４０）及电游率（ＥＰＭ）的变化，并与健康老年人对照。结果表明，无视网膜病变者ＥＰＭ低于健康人组（Ｐ＜０．０１），而血小板集率及ＧＭＰ－１４０水平无明显变化。视网膜病变组血小板聚集率和ＧＭＰ－１４０明显高于健康人组（Ｐ＜０．０５），ＥＰＭ呈显著性降低（Ｐ＜０．０１），与无视网膜病变组比较，视网膜病变组血小板聚集率和ＧＭＰ－１４０水平升高（Ｐ＜０．０５，Ｐ＝０．０５），而ＥＰＭ水平低下（Ｐ＜０．０１）．提示老年人糖尿性视网膜病变者血小板聚集释放功能亢进，这可能是视网膜病变者视网膜微循环内微血栓形成的病理生理基础。     

糖尿高见我膜恙与血小板体积关系

测定１００例Ⅱ型糖尿病患平均血小板体积（ＭＰＶ）、血小板压积（ＰＧＴ）,血小板分布宽度（ＰＤＷ）,血小板计数（ＰＬＴ）,并与５０例健康人比较,发现Ⅱ型糖尿病平均ＭＰＬ、ＰＬＴ、ＰＤＷ高于对照组（Ｐ〈０．０５）,说明Ⅱ型糖尿病存在血小板功能异常。比较有视网膜病变与无视网膜病变且与对照组之间关系,示均有显性差异（Ｐ〈０．０５）,而以有视网膜病变组差异更为显（Ｐ〈０．０１）,说明血小板功能异常在视     

糖尿病患者的左室结构及功能的变化

应用彩色多普勒超声心动图检测１５３例Ⅱ型糖尿病患者和８０例正常人的左室结构及功能参数，显示糖尿病患者的室间隔和左室后壁均有不同程度的增厚，左室心肌重量增加，伴大血管病变者更为明显（Ｐ＜０．０１）；左室舒张功能异常，表现舒张早期二尖瓣口的血流峰值速度（ＰＶＥ）和二尖瓣前叶活动曲线的Ｅ峰至Ｆ点的斜率（ＭＥＦ）降低，左房收缩时二尖瓣口的血流峰值速度（ＰＶＡ）和ＰＶＡ与ＰＶＥ的比值升高（Ｐ＜０．０１）；收缩功能异常仅见于伴大血管病变的患者，表现每搏量（ＳＶ）、心排出量（ＣＯ）和射血分数（ＥＦ）减少（Ｐ＜０．０５）。提示糖尿病患者常见左室舒张功能损害，甚至见于无血管病变的患者，左室壁厚度和心肌重量均有不同程度的增加。彩色多普勒超声心动图检查有助于糖尿病心肌病的早期诊断。     

彩色多普勒检测老年糖尿病患者四肢动脉病变50例分析

用彩色多普勒检测５０例老年糖尿病患者四肢的五对血管：并与４３例健康老年人对照，结果：糖尿病组血管壁反射增强、增厚、斑块形成、管腔狭窄及血流速度异常检出率为７２％，而对照组只有１６％；糖尿病组足背动脉内径及血流速度分别为：０．２６±０．０３ｃｍ及３５±１４ｃｍ／ｓ，对照组分别为０．２４±０．０３ｃｍ及３０±８ｃｍ／ｓ，差异有非常显著性（Ｐ＜０．００１）。糖尿病并发血管病变多见于下肢，对上肢动脉的损害也较严重，上下肢血管病变比较差异无显著性。糖尿病血管病变呈双侧多节段性改变，而对照组呈单发性。Ｐ＜０．０１，ΔＰ＜０．００１，余Ｐ＞０．０５     

2型糖尿病患者α-颗粒膜蛋白测定的临床价值

目的探讨２型糖尿病患者α颗粒膜蛋白（ＧＭＰ１４０）含量测定的临床价值。方法用放射免疫分析方法测定１０４例２型糖尿病患者（其中有微血管病变５５例，无微血管病变４９例）及３８例健康人ＧＭＰ１４０含量和血小板直接计数，并对部分患者作治疗前后的动态观察。结果血小板ＧＭＰ１４０及血浆ＧＭＰ１４０含量，２型糖尿病组显著高于健康人组（Ｐ＜０．００１），有微血管病变组显著高于无微血管病变组（Ｐ＜０．００１），有微血管病变组和无微血管病变组血小板ＧＭＰ１４０与血浆ＧＭＰ１４０含量呈显著正相关（ｒ１＝０．６９，ｒ２＝０．７５，Ｐ均＜０．００１）；２型糖尿病患者血小板计数与健康人比较，无显著差异（Ｐ＞０．０５）。部分患者血糖控制后并坚持服用阿斯匹林６个月，ＧＭＰ１４０含量及眼底改变与治疗前比较无显著差异。结论ＧＭＰ１４０含量测定对２型糖尿病微血管病变的早期诊断和病情分析有重要的临床价值     

多普勒超声技术评价心房间隔缺损修补术前后心内血流动力学

目的：探讨用多普勒超声技术评价心房间隔缺损修补术前后各瓣膜血流速度特点。方法：测量１１６例心房间隔缺损患者手术前后缺损的大小及各瓣膜的前向血流速度和过隔分流速度。结果：①术前三尖瓣（０．８０～１．２８ｍ／ｓ，平均１．０５ｍ／ｓ）及肺动脉瓣（０．９６～２．７６ｍ／ｓ，平均１．８６ｍ／ｓ）前向血流速度较正常人增快；主动脉瓣前向血流速度（０．８１～１．２９ｍ／ｓ，平均１．０５ｍ／ｓ）偏低。三尖瓣流速／二尖瓣流速（Ｖｔ／Ｖｍ）及肺动脉瓣流速／主动脉瓣流速（Ｖｐ／Ｖａ）均发生倒置。②术后三尖瓣、肺动脉瓣流速较术前显著下降（Ｐ＜０．００１），主动脉瓣流速则较术前升高（Ｐ＜０．０２）。Ｖｔ／Ｖｍ、Ｖｐ／Ｖａ恢复正常。③心房间隔缺损的大小与年龄呈正相关（ｒ＝０．３３，Ｐ＜０．００１）。术前三尖瓣流速及Ｖｔ／Ｖｍ均与心房间隔缺损大小呈正相关（ｒ＝０．３２、０．３６，Ｐ均＜０．００１）。结论：多普勒超声技术对心房间隔缺损的术前诊断及术后评价有较高的参考价值。     

粘附分子与实验性糖尿病视网膜病变的初步研究

目的　探讨粘附分子在糖尿病视网膜病变（ Ｄ Ｒ） 发病中的作用。方法　应用链脲佐菌素（ Ｓ Ｔ Ｚ） 建立糖尿病大鼠模型,分别于成模后３ 个月和６ 个月时经光镜和透射电镜观察视网膜的形态学改变。应用免疫组化方法及微机图像处理系统,对视网膜组织细胞间粘附分子１（ Ｉ Ｃ Ａ Ｍ１） 及整合素族 Ｃ Ｄ６１ 的分布与含量进行动态观察与分析;应用流式细胞术测定循环血中粒细胞表面β２ 整合素族 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 的表达。结果　病变３ 月组已有 Ｉ Ｃ Ａ Ｍ１ 及 Ｃ Ｄ６１ 的表达明显增加,并随病程延长表达进一步增多,而在正常对照组未见明显表达（ Ｐ＜ ０ ．０１） 。糖尿病大鼠粒细胞表面抗原 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 阳性细胞群体所占的比例较对照组显著升高（ Ｐ＜ ０ ．００１） 。视网膜毛细血管基底膜厚度与 Ｉ Ｃ Ａ Ｍ１ 、 Ｃ Ｄ６１ 表达灰度值呈显著正相关（ ｒ ＝ ０ ．７７２ ,０ ．６９４ , Ｐ＜ ０ ．０５） 。结论　粘附分子与其配基过度表达,加重内皮细胞损伤及微血管栓塞,很可能是导致 Ｄ Ｒ 发生中进展性微血管病变的重要因素之一。     

糖尿病视网膜病变与血浆中ET、CGRP、TXB2、6-Keto-PGF1α的相关分析

目的 为了探讨血浆内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）、血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺素Ｆ１α（６－Ｋｅｔｏ－ＰＧＦ１α）四种活性物质在糖尿病视网膜病变发生、发展过程中相互作用的动态变化。方法 采用放射免疫法测定了４０例２型糖尿病视网膜病变组,４０例２型糖尿病单纯视网膜病变组,４０例２型糖尿病增殖型视网膜病变组以及４０例正常对照组血浆中ＥＴ、ＣＧＲＰ、ＴＸＢ２、６－Ｋｅｔｏ－ＰＧＦ１α数值。结果 随着糖尿病病程的延长及视网膜受损程度的加重,ＥＴ呈递进增高趋势（Ｐ〈０．０１）,ＣＧＲＰ在糖尿病视网膜病变晚期呈下降趋势（Ｐ〈０．０５,Ｐ〈０．０１）。直线回归相关分析表明,ＥＴ／ＣＧＲＰ与ＴＸＢ２／６Ｋｅｔｏ－ＰＧＦ１α随着糖尿病视网膜病变的加重,相关性越密切（ｒ－０．４４,Ｐ〈０．０５;ｒ＝０．５９     

糖尿病患者的左室结构及功能的变化

应用彩色多普勒超声心动图检测１５３例Ⅱ型糖尿病患者和８０例正常人的左室结构及功能参数，显示糖尿病患者的室间隔和左室后壁均有不同程度的增厚，左室心肌重量增加，伴有大血管病变者更为明显；左室舒张功能异常，表现舒张早期二尖瓣口的血流值速度和二尖瓣前叶活动曲线的Ｅ峰至Ｆ点斜率（ＭＥＦ）降低，左房收缩时二尖瓣口的血流峰值（ＰＶＡ）和ＰＶＡ与ＰＶＥ的比值升高（Ｐ〈０．０１）；收缩功能异常仅见于伴大血管病变的患     

血栓调节蛋白在糖尿病微血管病变中的变化

目的探讨血浆血栓调节蛋白（ＴＭ）在糖尿病性肾病患者中的变化以了解其在微血管病变发病中的意义。方法检测５８例２型糖尿病患者血浆ＴＭ与内皮素（ＥＴ）的水平,并与３０例正常人进行比较。结果（１）糖尿病组血浆ＴＭ水平明显高于正常对照组（Ｐ＜０．００１）,其中临床糖尿病肾病组血浆ＴＭ水平明显高于早期糖尿病肾病组（Ｐ＜０．００１）及尿白蛋白正常的糖尿病组（Ｐ＜０．０１）;（２）血浆ＴＭ水平与尿白蛋白排泄率、ＥＴ水平呈显著正相关（ｒ＝０．５３９０和０．５６５０,Ｐ均＜０．００５）。结论血浆ＴＭ水平测定对２型糖尿病性肾病的早期诊断和病情分析有重要的临床价值。     

非增殖期糖尿病视网膜病变患者眼血流动力学改变

目的　探讨非增殖期糖尿病视网膜病变(non-proliferativediabeticretinopathy,NPDR)对视网膜中央动脉(centralretinalartery,CRA)、静脉(centralretinalvein ,CRV)血流动力学影响。方法　用彩色多普勒超声(colorDopplerflowimaging,CDFI)检测5 6例(1 0 8只眼)非增殖期糖尿病视网膜病变患者的视网膜中央动脉、静脉血流状态,并与40例(80只眼)正常人的视网膜中央动脉、静脉血流进行比较。5 6例非增殖期糖尿病视网膜病变患者并作眼底荧光素血管造影(fundusfluoresceinangiography,FFA)检查。结果　NPDR组与对照组相比,CRA的收缩期血流峰速(peaksystolicvelocity,PSV) ,舒张末期流速(enddiastolicvelocity ,EDV) ,平均流速(meanvelocity ,Vm)均降低,搏动指数(Pulseindex,PI)和阻力指数(resistanceindex,RI)均增高,但CRV的收缩期血流峰速,舒张末期流速,平均流速均增高。结论　非增殖期糖尿病视网膜病变患者CRA的血流速度降低,CRV血流速度增加,视网膜循环阻力升高,视网膜血液供应不良,CDFI检测对DR早期诊断有一定意义。     

Retinal arteriolar hemodynamic response to an acute hyperglycemic provocation in early and sight-threatening diabetic retinopathy

The aim was to quantify the magnitude of retinal arteriolar vascular reactivity to a hyperglycemic provocation in diabetic patients stratified by severity of retinopathy and in age-matched controls. The sample comprised 20 non-diabetic controls (Group 1), 19 patients with no clinically visible DR (Group 2), 18 patients with mild-to-moderate non-proliferative DR (Group 3) and 18 patients with diabetic macular edema (Group 4). Retinal hemodynamic measurements using the Canon Laser Blood Flowmeter (CLBF-100) were acquired before and 1 h after drinking a standardized oral glucose load drink. The magnitude of the retinal vascular response, as well as max:min velocity ratio and wall shear rate (WSR), was calculated and compared across groups. A significant change in blood glucose level was observed for all groups (p<0.05). The change in blood glucose elevation was significantly less in Group 1 compared to the other groups. No significant change in arteriolar diameter, blood velocity, blood flow, max:min velocity ratio and WSR was found in patients with diabetes and in age-matched subjects without diabetes. The results of this study indicate that retinal arteriolar blood flow is unaffected by acute elevation of blood glucose using an oral glucose load drink in patients with diabetes and in age-matched controls. This lack of a blood flow response to acute hyperglycemia in patients with early sight-threatening DR may be explained by a loss of retinal vascular reactivity.     

Diabetic retinopathy and coronary implantation of sirolimus-eluting stents

INTRODUCTION: The prognostic value of identifying the retinal status of diabetic patients undergoing coronary implantation of drug-eluting stents is unknown. METHODS: We evaluated the outcomes of 318 consecutive patients undergoing implantation of sirolimus-eluting stents for coronary artery disease. Patients were divided into 5 groups according to the diabetic and retinal status: diabetic patients without retinopathy (43 patients); diabetic patients with nonproliferative retinopathy (34); diabetic patients with proliferative retinopathy (37); diabetic patients with unknown retinal status (30); and nondiabetic patients (174). RESULTS: During a mean follow-up of 385 days, 64 patients had target-vessel failure (defined as a composite of death from cardiac causes, myocardial infarction, and target-vessel revascularization). At 1 year, Kaplan-Meier estimates of the rate of target-vessel failure were 15.3% for diabetic patients without retinopathy, 56.6% for those with nonproliferative retinopathy, 17.3% for those with proliferative retinopathy, 19.0% for those with unknown retinal status, and 16.0% for nondiabetic patients. After adjustment for the potential confounders and differences between groups, the relation of nonproliferative retinopathy to target-vessel failure remained significant. In an analysis in which diabetic patients without retinopathy were used as the reference group, the hazard ratios for target-vessel failure were 3.9 for those with nonproliferative retinopathy, 1.3 for those with proliferative retinopathy, 1.1 for those with unknown retinal status, and 1.4 for nondiabetic patients (P for trend = 0.015). CONCLUSIONS: As compared with diabetic patients without retinopathy, those with nonproliferative retinopathy have an increased risk for target-vessel failure after coronary implantation of sirolimus-eluting stents.     

Novel role of erythropoietin in proliferative diabetic retinopathy

Diabetic retinopathy is a leading cause of visual disturbance in adults. In proliferative diabetic retinopathy, ischemia-induced pathologic growth of new blood vessels often causes catastrophic loss of vision. Besides VEGF, the existence of another potent ischemia-induced angiogenic factor is postulated. Since ischemia-inducible erythropoietin (Epo) has recently been identified its angiogenic properties, we investigated its potential role during retinal angiogenesis in proliferative diabetic retinopathy (PDR). The vitreous Epo level in patients with PDR was significantly higher than that in nondiabetic patients. Multivariate logistic regression analyses indicated that Epo and VEGF were independently associated with PDR and that Epo was more strongly associated with PDR than VEGF. Blockade of Epo inhibits retinal neovascularization in vivo, and inhibits endothelial cell proliferation response to PDR vitreous in vitro. Our data provide strong evidence that erythropoietin is a potent retinal angiogenic factor independent of VEGF and is capable of stimulating ischemia-induced retinal angiogenesis in proliferative diabetic retinopathy. Inhibition of such molecular mechanisms in the retinal angiogenesis could be a new therapeutical strategy in halting or preventing pathologic angiogenesis in diabetic retinopathy.     

Severity of diabetic retinopathy is linked to lipoprotein (a) in type 1 diabetic patients

To determine the relationship between plasma Lp(a) concentration and the risk of developing diabetic retinopathy, 341 Type 1 diabetic patients underwent an annual retinal fluorescein angiography and were assigned to one of 3 groups according to the stage of their diabetic retinopathy: no retinopathy (NR), non-proliferative diabetic retinopathy (N-PDR), or proliferative diabetic retinopathy (PDR). One hundred and twenty-three Type 1 diabetic patients had no retinopathy, 188 had N-PDR and 30 had PDR. The ages of the three groups and the duration of diabetes were significantly different. Hypertension, microalbuminuria and diabetic nephropathy were more frequent in PDR than in NR or N-PDR (p < 0.0001). Plasma HbA1c was higher in PDR than in NR or N-PDR (p < 0.01). Type 1 patients who had been diabetic for at least 20 years included 30 NR, 108 N-PDR and 24 PDR. Type 1 diabetic patients with PDR had microalbuminuria and macroproteinuria more frequently than other patients (p < 0.0001 and 0.01, respectively). Type 1 diabetic patients with PDR had the highest median plasma Lp(a) and the highest frequency of Lp(a) above 30 mg/dl (p < 0.05). Multivariate analysis carried out in Type 1 diabetic patients with a duration of diabetes of at least 20 years showed that microproteinuria, HbA1c and Lp(a) accounted significantly for 21% of variance in retinal status. Lp(a) above 30 mg/dl was related to the risk of developing PDR (OR = 8.40, p < 0.05). Lipoprotein(a) appears to be associated with the severity of diabetic retinopathy in Type 1 diabetic patients, and particular attention should be paid to those with Lp(a) above 30 mg/dl and pre-proliferative retinopathy.     

Retinopathy Screening in Type 2 Diabetes: Reliability of Wide Angle Fundus Photography

The purpose of the study was to assess the reliability of mydriatic 60° fundus photography in a retinopathy screening programme for Type 2 diabetic patients in a primary health care setting. In 323 eligible consecutive Type 2 diabetic patients above 40 years of age, attending a regional shared care diabetes project, mydriatic wide angle fundus photography was compared with standardized fundoscopy in dilated pupils as the recommended test for the detection of diabetic retinopathy. Fundus photography included two black and white transparencies per eye visualizing the central and nasal retinal field. Fundoscopy findings and pictures were scored according to modified Wisconsin criteria. Fundoscopy revealed in 95/646 eyes (14.7 %) some degree of diabetic retinopathy. Sensitivity and specificity of fundus photography (omitting ungradable transparencies) were 97 % for the diagnosis of any diabetic retinopathy (DRP). All patients with moderate and severe DRP (Wisconsin grade 3 and worse) according to fundoscopy were detected by fundus photography. In conclusion, mydriatic wide angle 60° fundus photography, making two pictures per eye, can be applied effectively and reliably in the detection of diabetic retinopathy in patients with Type 2 diabetes.     

Sensitivity and specificity of digital retinal imaging for screening diabetic retinopathy.

AIMS: To assess the effectiveness of a non-mydriatic digital camera (45 degrees -30 degrees photographs) compared with the reference method for screening diabetic retinopathy. METHODS: Type 1 and 2 diabetic patients (n = 773; 1546 eyes) underwent screening for diabetic retinopathy in a prospective observational study. Hospital-based non-mydriatic digital retinal imaging by a consultant specialist in retinal diseases was compared with slit-lamp biomicroscopy and indirect ophthalmoscopy through dilated pupils, as a gold standard, previously performed in a community health centre by another consultant specialist in retinal diseases. The main outcome measures were sensitivity and specificity of screening methods and prevalence of diabetic retinopathy. RESULTS: The prevalence of any form of diabetic retinopathy was 42.4% (n = 328); the prevalence of sight-threatening including macular oedema and proliferative retinopathy was 9.6% (n = 74). Sensitivity of detection of any diabetic retinopathy by digital imaging was 92% (95% confidence interval 90, 94). Specificity of detection of any diabetic retinopathy was 96% (95, 98). The predictive value of the negative tests was 94% and of a positive test 95%. For sight-threatening retinopathy digital imaging had a sensitivity of 100%. CONCLUSIONS: A high sensitivity and specificity are essential for an effective screening programme. These results confirm digital retinal imaging with a non-mydriatic camera as an effective option in community-based screening programmes for diabetic retinopathy.     

AGEs,RAGE, and Diabetic Retinopathy

Diabetic retinopathy is a major diabetic complication with a highly complex etiology. Although there are many pathways involved, it has become established that chronic exposure of the retina to hyperglycemia gives rise to accumulation of advanced glycation end products (AGEs) that play an important role in retinopathy. In addition, the receptor for AGEs (RAGE) is ubiquitously expressed in various retinal cells and is upregulated in the retinas of diabetic patients, resulting in activation of pro-oxidant and proinflammatory signaling pathways. This AGE-RAGE axis appears to play a central role in the sustained inflammation, neurodegeneration, and retinal microvascular dysfunction occurring during diabetic retinopathy. The nature of AGE formation and RAGE signaling bring forward possibilities for therapeutic intervention. The multiple components of the AGE-RAGE axis, including signal transduction, formation of ligands, and the end-point effectors, may be promising targets for strategies to treat diabetic retinopathy.     

葛根素对糖尿病视网膜病变治疗作用的临床研究

目的寻求糖尿病视网膜病变（DR）的有效治疗药物。方法将DR患者随机分为葛根紊治疗组和对照组,比较两组治疗前后血流动力学与血液流变学指标。结果治疗组血细胞压积、全血黏度、血浆黏度、红细胞聚集指数较对照组明显降低（P〈0.01）,眼动脉和视网膜中央动脉收缩期最大血流速度及舒张末期血流速度明显增快。阻力指数明显降低（P〈0．01）。结论葛根素治疗DR安全、有效。     

激光联合益脉康片治疗糖尿病视网膜病变合并黄斑水肿的临床研究

目的探讨激光联合益脉康片治疗糖尿病视网膜病变Ⅱ期、Ⅲ期、Ⅳ期或合并糖尿病性黄斑水肿的疗效。方法60例糖尿病视网膜病变Ⅱ期、Ⅲ期、Ⅳ期或合并糖尿病性黄斑水肿的病人,随机分为激光联合中药益脉康片组(治疗组)30例(55只患眼)和单纯激光组(对照组)30例(58只患眼),观察两组的视力、玻璃体混浊、黄斑水肿及三酰甘油(TC)、低密度脂蛋白胆固醇(LDL-C)等指标。观察期为3个月。结果治疗组治疗前后比较视力、玻璃体混浊、黄斑水肿、TC、LDL-C有统计学意义(P<0.05);对照组治疗前后比较,视力、玻璃体混浊、黄斑水肿有统计学意义(P<0.05)。治疗后两组视力、玻璃体混浊、黄斑水肿、TC、LDL-C有统计学意义(P<0.05)。结论激光联合益脉康片治疗糖尿病视网膜病变Ⅱ期、Ⅲ期、Ⅳ期合并糖尿病性黄斑水肿有较好疗效。