老年糖尿病患者的急性脑血管病的临床特点

糖尿病是发生脑血管病的重要危险因素之一。王叔咸(1937)报道的347例糖尿病患者中有神经系统症状者(主要为周围神经炎)占4.6％,而死于脑血管病的只2例。24年后,糖尿病患者发生脑血管病的机率增为4.6～5.2％,1980年已达11.4％。而老年糖尿病患者发生脑血管病的机率,据新近的统计资料为24.6～33.3％。可见糖尿病患者发生脑血管病的机率随着诊疗水平的提高和寿命的延长在不断增加。糖尿病患者的脑血管病,国内外文献均以短暂性脑缺血发作或脑血栓形成为主,很少发生脑出血,发生蛛网膜下腔出血则更少见。我科近五年诊治疗5例糖尿病性神经系统病中,有     

糖尿病并脑血管病63例临床分析

近年来研究资料表明,我国和日本的糖尿病患者死于脑血管合并症远高于欧美国家。故研究糖尿病合并脑血管病的危险因素具有重要临床意义。自1991年以来,我们收治糖尿病并脑血管病患者63例,现结合临床进行分析。 1 临床资料 1.1 一般资料 本组男35例,女28例;年龄36～68岁,平均年龄50.6岁。经CT证实脑梗塞55例(87.3％),其中多发性脑梗塞33例(52.4％),脑出血7例(11.1％),混合型1例(1.6％)。既往有脑梗塞史23例(36.5％),脑出血史1例(1.6％),TIA史15例(23.8％),高血压病史41例(65.1％)。     

59例中老年糖尿病合并心脑血管病分析

我部自1976年4月-1988年5月对507例中老年人体查,共查出糖尿病患者59例,其中合并冠心病38例,合并急性脑血管病(包括脑血栓形成和短暂性脑缺血发作)11例,现通过与同期非糖尿病人448例对照报告如下。     

糖尿病性脑血管病

脑血管病为常见疾病 ,现已公认糖尿病为脑血管病主要危险因素之一［１］。在糖尿患者群中脑血管病的发病率明显高于非糖尿患者群 ,今后随着我国生活条件的迅速改善 ,以及社会人群的老龄化 ,糖尿病的发生率及由此导致的脑血管病变的发生率、死亡率也将迅速增加 ,成为威胁人类健康的主要病因而日益引起人们的重视［４］。糖尿病性脑血管病是近年来提出的一新概念 ,是指由糖尿病所并发的脑血管病变 ,在糖、脂肪、蛋白质等一系列代谢紊乱的基础上 ,所发生的包括颅内大血管、微血管病变。临床上可表现为缺血性脑血管病、脑出血、脑萎缩。其临床特…     

58例糖尿病合并脑血栓形成的临床分析

目的探讨糖尿病合并脑血栓形成患者的临床特点。方法回顾性分析了近两年收治于我院的58例糖尿病合并脑血栓形成患者与同期58例非糖尿病脑血栓患者的临床资料,并作相应的对比。结果糖尿病合并脑血栓形成患者的肺部感染、肾功能不全、酮症酸中毒并发症均较非糖尿病组高,治疗效果比非糖尿病组低。结论糖尿病合并脑血栓形成组的临床疗效及预后均较非糖尿病脑血栓形成组差,其临床疗效差和不良预后与患者的高血糖有关。     

老年糖尿病性脑血管病30例临床分析

老年糖尿病合并脑血管病的发生,国内资料报道其发生率为10％～30％。我院于1990～2001年共收治脑血管意外患者386例,其中老年糖尿病性脑血管病变30例(7.8％)。现将临床资料报告分析如下:1 临床资料1.1 一般资料 30例糖尿病合并脑血管意外,男18例,女12例,年龄60～89岁,平均69.5+1.3岁,均为2型糖尿病,     

脑血管病合并糖尿病的护理

随着人们饮食结构的改变,脑血管病近年来已成为威胁我国人民身体健康的主要疾病之一,而合并糖尿病的脑血管病的发病率亦相应增高.因此,做好该病的护理工作尤为重要.我们对18例合并糖尿病的脑血管病患者实施综合护理,报告如下. 1 临床资料 我院2005年1月～2010年1月共收治脑血管患者103例,其中合并糖尿病患者18例,占16%.男11例,女7例,年龄56～84岁,平均70岁.全组病例均经CT或MRI确认为脑血管病,其中脑梗死16例,脑出血2例.糖尿病均按1980年WHO标准确诊为非胰岛素依赖性糖尿病.治疗后脑出管病合并糖尿病的18例中,治愈7例,好转10例,转出1例.治愈好转率94%.     

糖尿病并发脑血栓的临床分析

目的:分析总结糖尿病患者并发脑血栓的临床特征。方法:选择30例糖尿病合并脑血栓形成患者作为观察组,并选择同期收治非糖尿病脑血栓患者作为对照组,回顾性分析两组临床资料。结果:除冠心病、高血压外,观察组肺部感染、肾功能不全和酮症酸中毒并发症例数均明显多于对照组;对照组疗效明显优于对照组,差异有统计学意义(P<0.05)。结论:糖尿病并发脑血栓患者并发症临床疗效预后差,这一现象的形成与高血糖有密切联系。     

糖尿病合并急性脑血管病35例临床分析

<正>糖尿病性血管病变是糖尿病死亡的主要原因,尤以急性脑血管病多见.有作者研究认为糖尿病是脑血管意外的首发危险因子.本文总结我科近4年间收治急性脑血管病220例中糖尿病合并急性脑血管病35例占15.9％,现分析如下.     

2型糖尿病患者脑血管病变经颅多普勒超声观察

目的探讨经颅多普勒(TCD)在2型糖尿病(T2DM)患者脑血管病变及自动调节功能变化中的临床应用价值;评价颅内动脉血流异常的预后价值。方法采用TCD仪对45例无并发症的T2DM患者,53例并微血管病变的T2DM患者,44例并脑梗塞无微血管病变的T2DM患者,50名健康志愿者,检测各脑血管的血流速度和Gosling搏动指数PI,并前瞻性随访60个月,动态监测脑动脉自动调节功能。结果糖尿病组脑血管的收缩期流速及(PI)值与对照组比较有显著性差异(P<0.05及P<0.01),并发微血管病变的糖尿病PI值异常升高,且存在脑动脉自动调节功能紊乱,表现为广泛脑动脉痉挛;随访期间,17例发生非致死性脑梗塞,1例发生非致死性脑出血,3例发生一过性脑缺血发作(TIA),颅内动脉血流速度异常者脑血管事件发生率显著高于颅内动脉血流速度正常者(P<0.05)。结论TCD对糖尿病颅内动脉血流动力学的改变灵敏度较高,是动态监测脑动脉自动调节功能变化的一项有效、无创性检查手段;对早期诊断糖尿病患者脑血管病变、预测和预防脑血管事件发生,判断预后,指导早期治疗,预防脑梗死发生具有重要价值。     

Epidemiological study of prevalence of chlorpropamide alcohol flushing in insulin dependent diabetics, non-insulin dependent diabetics, and non-diabetics

An epidemiological study was carried out to compare the prevalence of facial flushing in non-diabetics, patients with insulin dependent diabetes, and patients with non-insulin dependent diabetes in response to 40 ml sherry taken 12 hours after 250 mg chlorpropamide or placebo, administered double blind in randomised order. A flush after chlorpropamide but not placebo was reported by 6.2% of non-diabetics (17/273), 9.7% of insulin-dependent diabetics (14/145), and 10.5% of non-insulin dependent diabetics (25/239), excluding those receiving long term chlorpropamide treatment. The differences were not significant. This response was unrelated to age, sex, body mass index, and family history of diabetes in all three groups. Patients taking long term chlorpropamide, however, showed a significantly (p less than 0.01) higher prevalence of flushing after both chlorpropamide and placebo (56.3%; 9/16) compared with the rest of the non-insulin dependent diabetics (16.7%; 40/239), the insulin dependent diabetics (6.9%; 10/145), and the non-diabetics (5.9%; 16/273). Patients receiving long term chlorpropamide would be expected to flush with sherry after a placebo tablet because of therapeutic plasma concentrations of the drug. It is concluded that there is no evidence of an increased prevalence of chlorpropamide alcohol flushing in response to the single challenge test in non-insulin dependent diabetics compared with insulin dependent diabetics and non-diabetics except in selected patients taking chlorpropamide long term. This study does not support the hypothesis that the chlorpropamide alcohol flush is a specific marker for a subtype of non-insulin dependent diabetes.     

Role of Helicobacter pylori in causation of diabetic gastropathies and non-gastrointestinal complications in type 2 diabetes

A cross-sectional case-control study was conducted in 80 diabetic patients, to evaluate the incidence of gastropathy by endoscopy in type 2 diabetes mellitus. An association between Helicobacter pylori infection and non-gastrointestinal complication of diabetes mellitus was also looked into. Gastric biopsies were subjected to rapid urease test for demonstration of Helicobacter pylori. The fasting blood glucose levels among Helicobacter pylori positive diabetes were 175 +/- 36.5 mg %, and in Helicobacter pylori negative diabetics were 138 +/- 39.4 mg %. The prevalence of endoscopically detectable gastro-intestinal complications were higher in Helicobacter pylori infected diabetics (odd's ratio 4:2; p < 0.05). The total prevalence of Helicobacter pylori positive in diabetics by rapid urease test was statistically significant (p < 0.05). Coronary heart disease was more prevalent in diabetics with Helicobacter pylori infection than those without Helicobacter pylori (57%). The prevalence of H. pylori positivity in other complications such as peripheral vascular diseases, cerebrovascular diseases was not significant. The association between nephropathy, retinopathy and neuropathy with Helicobacter pylori, was also observed and the strong association was seen in diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.01) and nephropathy (p < 0.001).     

Microalbuminuria in non-insulin-dependent (type 2) Nigerian diabetics: relation to glycaemic control, blood pressure and retinopathy.

Twenty-four hour urinary albumin concentrations were measured in 113 (mean age 51.1 years) non-insulin-dependent (NIDDM) Nigerian diabetics (50 males, 63 females). A high prevalence of microalbuminuria (> or = 30 mg/24 hour) was observed in male (54%) as well as female diabetics (59%). Microalbuminuria was also observed in a high proportion of diabetics (52%) with a short duration (< 5 years) of disease. Elevated blood pressure and retinopathy were present in 41% and 16% of patients respectively. Among the 49 patients with normoalbuminuria (< 30 mg/24 hour), six (12%) had retinopathy compared with 12 (18%) in the microalbuminuria group. Diastolic blood pressure levels were significantly higher (P < 0.01) in male diabetics with retinopathy but this was not associated with higher albuminuria. Urinary albumin concentrations were not influenced by elevated blood pressure. There were no significant differences in age, duration of diabetes, blood pressure or serum creatinine between diabetics with and without microalbuminuria. These results suggest that though there is a high prevalence of microalbuminuria amongst NIDDM Nigerian diabetics it may not predict retinopathy and occurs independently of either glycaemic control or elevated blood pressure levels.     

颈动脉粥样硬化与缺血性脑血管病及其危险因素的关系

目的 :探讨彩色多普勒超声检测的颈动脉粥样硬化与缺血性脑血管病及其危险因素的关系。方法 :以10 1例脑血栓形成患者、2 9例TIA患者及 4 7例非缺血性心、脑血管疾病患者为研究对象 ,检测颈动脉粥样硬化程度及其危险因素。结果 :患者组与对照组间收缩压以及左、右颈总动脉内膜中层厚度 (IMT)差异均有统计学意义 ;脑血栓形成组与对照组间舒张压、空腹血糖、总胆固醇和甘油三酯差异均有统计学意义 :粥样硬化斑块常见于颈总动脉近分叉处 ,且易发生在双侧颈动脉及与脑部病灶同侧的颈动脉 ;年龄、收缩压及空腹血糖水平是颈动脉粥样硬化的独立危险因素。结论 :颈动脉粥样硬化与缺血性脑血管病的发病有关。     

脑血管疾病的白质疏松

脑白质疏松是多种神经系统疾病表现的非特异性神经影像改变，我们通过对１２０例各种类型脑血管疾病患者及无脑血管病史的“正常”老人的影像资料研究，发现脑血管患者较非脑血管病者白质疏松的发生率高，尤其是脑出血及腔隙梗塞的患者更为常见。白质小动脉缺血导致神经胶质细胞变性和白质纤维髓鞘脱失是发生白质疏松的主要原因，它可能导致或加重智能障碍。     

脑血管患者血脂变化及调脂治疗对其预后的影响

目的通过分析脑血管病患者血脂变化规律和比较其调脂治疗疗效,探讨血脂对脑血管病发生、发展及预后的影响。方法收集脑梗死组108例、脑出血组84例及对照组92例（未发生脑卒中患者）,用比色法测其甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDLC）及低密度脂蛋白胆固醇（LDLC）水平。采用随机分组将脑出血及脑梗塞患者随机分为调脂治疗组及非调脂治疗组,并进行脑卒中临床神经功能缺损评分（FAM）（近期疗效）及3个月后日常生活能力（ADL）分级评定（远期疗效）。结果脑血管病患者（脑出血、脑梗塞）的TG、TC、LDLC水平明显高于对照组,而HDLC低于对照组;脑出血组TC、LDLC低于脑梗塞组;调脂治疗组1个月后FAM评分低于非调脂治疗组,而3个月后ADL分级评定好于非调脂治疗组。结论高TG、TC、LDLC及低HDLC水平是脑血管病的危险因素;低TC、LDLC更易发生脑出血;调脂治疗能改善脑血管病患者的预后。     

血小板反应蛋白-1基因多态性与脑卒中的相关性研究

目的　探讨血小板反应蛋白 1(THBS 1)基因G16 78A(Ala5 2 3Thr)多态性与中国汉族人群脑卒中易感性的关系。方法　采用聚合酶链反应和限制性片段内切酶的方法检测了来自于全国 6个临床中心病例 对照的THBS 1基因G16 78A多态性。疾病组为 16 34例经头颅CT或磁共振检查证实的脑卒中患者 (其中脑血栓 731例 ,腔隙性脑梗死 4 77例 ,脑出血 4 2 6例 ) ,对照组为 1171例经严格检查排除脑卒中且性别、年龄匹配的患者。结果　THBS 1基因G16 78A多态性在对照组和脑血栓组人群中的分布差异有显著意义 ,脑血栓组的AA基因型频率 ( 0 5 0 3)显著高于对照组 ( 0 4 4 1,P =0 0 0 8) ,G等位基因频率 ( 0 2 99)显著低于对照组 ( 0 339,P =0 0 0 9)。在腔隙性脑梗死组和脑出血组THBS 1G16 78A多态性与对照组比较差异均无显著意义 (P >0 0 5 )。多元Logistic回归分析结果显示 :在调整了其他危险因素后 ,具有AA基因型者脑血栓的相对危险度增加 [相对危险度 (OR) =1 4 ;95 %可信区间 (CI) 1 0 83～ 1 6 93;P =0 0 0 8]。结论　THBS 1基因G16 78A(Ala5 2 3Thr)多态性的AA基因型与汉族脑血栓的易感性有关 ,可能是影响脑卒中发病的遗传因素之一     

死亡2型糖尿病患者165例临床及病理分析

目的 分析尸体解剖糖尿病患者死亡的主要原因及主要病理改变特点.方法 对1988--2000年在解放军总医院死亡并行尸体解剖的165例糖尿病患者进行回顾性分析,并与同期死亡并行尸体解剖的165例非糖尿病患者进行比较.结果 临床诊断提示糖尿病患者冠心病、高血压、脑卒中、血脂异常、肾脏疾病的发生率均显著高于非糖尿病患者(P<0.05).病理资料提示糖尿病患者心肌病变的发生率69.6%(n=103)高于非糖尿病患者58.6%(n=85)(P=0.05).主动脉硬化分级评价结果显示糖尿病患者主动脉粥样硬化的程度大于非糖尿病组(P<0.05).两组问甲状腺、心脏、肝脏、肾脏、胰腺、肾上腺及脑重量差异无统计学意义(P>0.05).糖尿病患者的前3位主要病理死亡原因依次是恶性肿瘤39.4%(n=65),循环系统疾病35.2%(n=58)及呼吸系统疾病9.1%(n=15).结论 恶性肿瘤及循环系统疾病是糖尿病患者死亡的主要原因.

Abstract：

Objective To analyze the main mortality causes and pathological characteristics of type 2 diabetics with autopsy findings.Methods A total of 165 autopsy reports of type 2 diabetics were retrospectively reviewed and summarized at our institution.And 165 non-diabetics during the same period were analyzed similarly.Results The clinical data showed that type 2 diabetics had a higher risk for coronary heart disease,hypertension,stroke,hyperlipidemia and renal diseases than non-diabetics(P<0.05).The pathological data revealed that the rate of myocardium diseases in type 2 diabetics(69.6%,n=103)was higher than that in non-diabetics(58.6%,n=85).The evaluation of aortosclerotic grading demonstrated that the degree of arteriosclerosis in type 2 diabetics was severer than that in non-diabetics.The organ weight analysis showed the weight of thyroid,heart,liver,kidney,pancreas,adrenal gland and brain had no significant difference between type 2 diabetics and non-diabetics(P>0.05).The three major mortality causes were malignant neoplasms(39.4%,n=65),circulatory system diseases(35.2%,n=58)and respiratory system diseases(9.1%,n=15).Conclusion The onset of malignant tumors,especially gastrointestinal one,should be monitored closely during the prevention and treatment of cardiocerebrovascular diseases and complications.     

锌转运体8自身抗体对急性起病糖尿病患者分型诊断的价值

目的 探讨锌转运体8自身抗体(ZnT8A)对急性起病糖尿病患者分型诊断的价值.方法 453例急性起病糖尿病患者根据谷氨酸脱羧酶抗体(GADA)和酪氨酸磷酸酶抗体(IA2-A)阳性分为A+组276例(任一抗体阳性)和A-组177例(抗体皆为阴性);将555例2型糖尿病患者和405名健康者作为对照.分析ZnT8A在急性起病糖尿病患者和亚组中的分布规律、相关因素和ZnT8A阳性者的临床特征.抗体检测采用放射配体法.结果 (1)ZnT8A在急性起病糖尿病组的阳性率为24.3%,显著高于2型糖尿病组(1.8%)和健康对照组(1.0%)(均P＜0.01);而且ZnT8A在A+组中的检出率为29.7%,显著高于A-组患者15.8%(x2=11.318,P＜0.01).(2)ZnT8A阳性率在＜30岁各亚组高于≥30岁亚组(0～9岁,34.9%;10～19岁,26.7%;20～29岁,26.3%比≥30岁,18.3%;均P＜0.05);在体质指数(BMI)＜21.0 kg/m2和21.0～25.0 kg/m2亚组高于BMI＞25.0 kg/m2亚组(25.5%和25.9%比8.7%,均P＜0.05).(3)ZnT8A水平与IA2-A滴度间呈正相关(r=0.165,P=0.01).(4)3种抗体联合测定使自身免疫检出率从60.9%提高到67.1%.(5)与抗体阴性者相比,ZnT8A单独阳性者日胰岛素需要量较多[(35.5±9.3)U/d比(29.8±14.7)U/d,P＜0.05],而收缩压和舒张压均较低[(107±15)mm Hg比(113±16)mm Hg,(69±12)mm Hg比(73±12)mm Hg,均P＜0.05].结论 ZnT8A对急性起病糖尿病患者的免疫分型诊断有一定价值,在常见抗体(GADA和IA2-A)阴性者中可识别出一类更接近于经典1型糖尿病的临床表型.     

社区糖尿病及糖调节受损人群周围血管病变的患病率调查

目的了解上海社区糖尿病及糖调节受损(IGR)人群周围血管病变(PVD)的患病率及其主要危险因素。方法对2000—2001年间上海市曹杨社区代谢综合征流行病学调查获得的糖尿病及IGR患者(717例)进行5年后的随访,将其中完成随访并具有完整数据者427例纳入本次分析,其中男性210例,女性217例,年龄21~104岁(67·3岁±14·0岁)。PVD采用NicoletVersalabSE双向多普勒血流探测仪检测踝/肱动脉压比值(A/BI)进行诊断,同时采用爱丁堡跛行问卷调查间歇性跛行。对与PVD有关的各影响因素进行Logistic回归分析。结果曹杨社区高血糖人群PVD患病率为12·2%,其中在糖尿病人群中为15·1%,在IGR人群中为7·7%。在ABI≤0·9患者中仅13·5%出现间歇性跛行症状。Logistic回归分析发现,年龄、性别、糖尿病病程及总胆固醇是糖尿病周围血管病变的独立危险因素。结论上海社区高血糖人群中PVD患病率较高,不仅发生于糖尿病阶段,而且在糖尿病前期即已出现。大多数PVD患者无临床症状,因此在糖尿病门诊常规进行多普勒ABI检测有助于PVD的早期诊断、早期干预。