第12页／亚临床糖尿病心肌病患者微量白蛋白尿与心功能相关性

目的：探讨亚临床糖尿病心肌病患者微量白蛋白尿与Tei指数及其他传统左心室收缩舒张功能指标的相关性。方法：采用彩色多普勒超声诊断仪对正常对照组、2型糖尿病组、2型糖尿病亚临床心肌病伴微量白蛋白尿组及不伴微量白蛋白尿组进行Tei指数和其他左心室收缩舒张功能指标的测定，     

2型糖尿病患者微量白蛋白尿与心功能的关系

目的探讨2型糖尿病患者微量白蛋白尿与心功能关系。方法对正常对照、冠心病、2型糖尿病以及2型糖尿病合并冠心病患者甘油三酯、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等临床生化指标以及左心房直径、射血分数等超声心动图指标进行观察,分析微量白蛋白尿与心功能之间的关系。结果发现微量白蛋白尿水平与射血分数斜率呈现独立正相关,与左心房直径呈现独立负相关。结论 2型糖尿病患者微量白蛋白尿水平与其心功能密切相关。     

2型糖尿病患者尿微量白蛋白与血清甲状腺激素的相关性研究

选取2型糖尿病患者105例,分为糖尿病微量蛋白尿组及糖尿病正常蛋白尿组,设对照组30例,检测血清游离T3(FT3)、游离T4(FT4)、促甲状腺素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、尿微量白蛋白等指标,分析2型糖尿病患者尿微量白蛋白与血清甲状腺激素之间的相关性。结果三组之间FT3、T3、尿微量白蛋、HbA1c的差异有统计学意义(P<0.05),进一步两两比较,DM微量白蛋白尿组的FT3、T3显著低于DM正常蛋白尿组及对照组,尿微量白蛋白、HbA1c显著高于DM正常蛋白尿组及对照组,差异有统计学意义(P<0.05);尿微量白蛋白、FT3与病程有关,随病程的延长,尿微量白蛋白逐渐升高,FT3则逐渐降低,尿微量白蛋白与FT3呈负相关,相关系数为-0.496(P<0.05)。结论糖尿病伴有微量白蛋白尿患者会出现FT3、T3降低,尿微量白蛋白与FT3呈负相关,检测这两项指标对诊断、治疗及评估预后有重要意义。     

2型糖尿病患者微量白蛋白尿与心衰相关关系研究

55例2型糖尿病并心衰患者,按其尿白蛋白排泄量将患者分为正常白蛋白尿组25例(24小时尿白蛋白＜30mg)、微量白蛋白尿组30例(24小时尿白蛋白30～300mg),分析比较两组心血管疾病危险因素、心电图和超声心动图变化.结果微量白蛋白尿组较正常白蛋白组心电图异常的发生率明显升高,EF值显著下降,以LVEF＜50%计算,微量白蛋白尿组发生率明显升高.结论2型糖尿病并心衰患者,微量白蛋白尿的出现提示了左室功能的显著减退,同时心脑血管事件的发生率显著增加,临床预后差.     

2型糖尿病患者微量白蛋白尿与胰岛素抵抗关系

伴微量白蛋白尿的2型糖尿病患者（DM-MA）36例，不伴微量白蛋白尿的（DM-NA）29例，正常对照组（NC）20例。3组患者均行空腹血糖、胰岛索、血脂等测定，并计算HOMA-IR评估组织胰岛索抵抗．根据结果进行比较分析，将所有患者的尿白蛋白排泄率（UAER）与有关因素进行多元回归分析。结果：DM-MA组与DM-NA组HOMA-IR均高于NC组，差异非常显著（P〈0．01），DM-MA组HOMA-IR示明显高于DM-NA组（P〈0．05），而且HOMA-IR与UAER呈独立相关（r=0．4875，P〈0．01）。结论：与DM-NA相比，DM-MA有更严重的IR，IR是MA尿的独立危险因索。     

尿微量白蛋白水平与糖尿病合并冠心病患者心功能的相关性分析

免疫比浊法测定50例糖尿病合并冠心病患者治疗前后尿微量白蛋白(Malb)水平.结果随着心功能NYHA级别的升高,Malb值逐渐升高,各级别间比较,P＜0.05;治疗后心功能Ⅰ、Ⅱ级者Malb下降(P＜0.01),而Ⅲ、Ⅳ级者无明显变化.随访1 a,42例Malb30 mg/L者心脑血管事件的发生率42.9%.认为糖尿病合并冠心病心衰患者Malb越高,心功能越差;Malb水平可判断糖尿病合并冠心病心衰患者的预后.     

老年2型糖尿病合并冠心病患者尿微量白蛋白与心功能的关系

目的探讨老年2型糖尿病(T2DM)并冠心病(CHD)患者尿微量白蛋白(MALB)与心功能的关系。方法将252例患者分为T2DM+CHD组(67例)、CHD组(68例)和T2DM组(67例),同时选择本院同期健康体检者50例作为对照组。测定所有研究对象的左心房直径(LA)、左心室后壁厚度(LVPW)及左室射血分数(LVEF)及MALB、血糖、胰岛素C肽(空腹+餐后2 h)、血脂、糖化血红蛋白(HbA1c)等指标。结果T2DM+CHD组的血脂(TC、LDL、HDL)、血糖、胰岛素和C肽与对照组和CHD组比较,差异有统计学意义(P<0.05);T2DM+CHD组的LA和LVEF与其余三组比较,差异有统计学意义(P<0.05),LVPW显著高于对照组和T2DM组(P<0.05);T2DM+CHD组中MALB与LVPW、LA呈正相关(r=0.356、0.326,P<0.05),与LVEF呈负相关(r=-0.447,P<0.05)。结论老年T2DM+CHD患者MALB水平与心功能具有相关性,高水平MALB可导致心功能的减退。     

2型糖尿病患者微量白蛋白尿与脑梗塞关系的研究

目的探讨2型糖尿病患者微量白蛋白尿与脑梗塞关系.方法分析2型糖尿病患者157例.根据尿白蛋白排泄率(UAER)分为三组,即Ⅰ组(UAER＜20 μg/min),Ⅱ组(UAER20 μg/min～200 μg/min),Ⅲ组(UAER＞200 μg/min),对各组的脑梗塞发生率等情况进行比较.结果三组间脑梗塞发生率呈递增关系.UAER与收缩压、空腹血糖、糖化血红蛋白、血尿酸、脑梗塞呈现正相关.结论微量白蛋白尿是2型糖尿病患者发生脑梗塞的独立危险因素.     

2型糖尿病患者的微量白蛋白尿与胰岛素抵抗

微量白蛋白尿(MAU)主要预测糖尿病肾病(DN)的发生发展。MAU不仅是?型糖尿病患者DN的一项指征,更是反映广泛血管功能障碍的标志．是反映糖尿病(DM)患者心血管病变的强烈预测因子。研究发现MAU的存在使2型糖尿病的发病率和病死率增加1倍,总死亡率也增加1倍。MAU在2型糖尿病的发生率26%～40％．部分患者在DM诊断之前已经存在MAU。临床健康人群MAU与动咏粥样硬化的危险因素密切相关,提示MAU是胰岛素抵抗(IR)综合征的一个特征。     

2型糖尿病患者尿微量白蛋白与外周动脉疾病的相关性

目的 探讨2型糖尿病患者的尿微量白蛋白与外周动脉疾病之间的关系.方法 选取广州市第一人民医院内分泌内科2018年9月—2020年7月的2型糖尿病患者468例,根据尿微量白蛋白排泄率分为无蛋白尿组(尿微量白蛋白<20 mg/L,165例)、微量白蛋白尿组(尿微量白蛋白20～200 mg/L,139例)、大量蛋白尿组(尿微...     

亚临床甲状腺机能减退与2型糖尿病大血管病变的相关性研究

目的观察探讨亚临床甲状腺机能减退与2型糖尿病大血管病变的相关性研究。方法选取该院2015年12月—2016年11月收治的530例糖尿病患者进行回顾性资料分析,汇总高危因素对105例伴有亚临床甲状腺机能减退的糖尿病患者大血管病变特点进行总结分析。结果伴有亚临床甲状腺机能减退的糖尿病患者在心血管病变、动脉粥样硬化、周围神经病变、脑梗塞等方面与单纯组相比明显更多(P<0.05),在是否有高血压方面差异无统计学意义(P>0.05);伴有亚临床甲状腺机能减退的糖尿病患者在T4、TSH、HDL-C、LDL-C、TSH、总胆固醇、甘油三酯等方面与单纯组相比差异有统计学意义(P<0.05);危险因素回归分析后结果可知,亚临床甲状腺机能减退是影响糖尿病患者发生大血管病变的主要危险因素差异有统计学意义(P<0.05)。结论亚临床甲状腺机能减退是糖尿病患者发生大血管病变的独立危险因素。     

Comparison of Platelet Aggregability in Japanese Type 2 Diabetic Patients With and Without Microalbuminuria

Microalbuminuria is associated with higher cardiovascular morbidity and mortality in Type 2 (non-insulin-dependent) diabetic patients. This study was designed to assess whether Type 2 diabetic patients with microalbuminuria (urinary albumin excretion rate (AER) 20–200 μg min^?1) is associated with alterations in platelet aggregability as compared with those with normal urinary albumin excretion (AER < 20 μg min^?1). Platelet aggregability was compared between 21 Japanese Type 2 diabetic patients with microalbuminuria and 21 individually pair-matched (for age, sex, body mass index, treatment, and HbA_1c level) patients with normoalbuminuria. The in vitro platelet aggregation induced by 1.0 and 3.0 μmol I^?1 ADP and 0.5 and 1.0 mg I^?1 collagen was measured using platelet-rich plasma. No significant differences were observed between the two groups in the values for maximum percent platelet aggregation, percent aggregation at 3 min, and aggregation velocities after adding ADP or collagen. Microalbuminuric patients had significantly higher mean values for systolic (p < 0.004) and diastolic (p < 0.02) blood pressures and plasma fibrinogen level (p < 0.03) as compared with the respective mean values in normoalbuminuric patients. The results suggest that Japanese microalbuminuric Type 2 diabetic patients do not differ in the degree of platelet aggregability as compared with normoalbuminuric patients, despite an increase in certain other coronary risk factors.     

Raised Ambulatory Blood Pressure in Type 1 Diabetes with Incipient Microalbuminuria

Whether raised blood pressure precedes, follows or develops in parallel with the onset of microalbuminuria, remains unclear. Previous studies, using conventional blood pressure recordings, have yielded discrepant results. Ambulatory blood pressure (ABP) monitoring detects borderline hypertension more reliably, and correlates more closely with end-organ damage. We have therefore compared ABP and left ventricular dimensions in normotensive insulin-dependent diabetic patients with or without microalbuminuria, and matched non-diabetic control subjects. Those diabetic patients with microalbuminuria, and to a lesser extent those without, had higher 24 h mean arterial blood pressure than matched non-diabetic control subjects, with corresponding increases of left ventricular mass, interventricular septal width and posterior wall thickness. These observations suggest that raised arterial blood pressure is present at an early stage of ‘incipient’ microalbuminuria.     

Screening for Microalbuminuria in Type 2 Diabetic Patients: the Evaluation of a Dipstick Test in General Practice

To evaluate the Micral test, a semiquantitative dipstick test, in a general practice setting, 317 Type 2 diabetic patients completed a screening for microalbuminuria by means of the Micral test as well as immuno-nephelometry with the Disc 120 immuno-nephelometer (Hyland, Nivelles, Belgium). Data were collected in 10 general practices performing the Nijmegen Monitoring Project. At a regular check-up each Type 2 diabetic patient was asked to collect first morning urine samples on three consecutive days. The sensitivity of the Micral test was 67 %, the specificity 93 %. Between the practices the sensitivity ranged from 58 % to 81 %, the specificity from 87 % to 95 %. Microalbuminuria, defined as a mean urine albumin concentration ≥ 20 mg l^?1 by nephelometry on three consecutive days, was found in 66 patients (21 %). The first Micral test correctly picked out these patients with microalbuminuria in 70 % of the cases and in 90 % those patients without microalbuminuria. The diagnostic performance of the Micral test was further proved by a Receiver Operating Characteristic (ROC) curve. The Area Under the Curve (AUC) of the Micral test was 0.84 (95 % Cl 0.78–0.90). Micral test results of 0 and 10 should be regarded as negative.     

非酒精性脂肪肝伴2型糖尿病患者左室舒张功能的影响

目的探讨非酒精性脂肪肝（NAFLD）对2型糖尿病患者左室舒张功能的影响。方法纳入596例2型糖尿病住院患者,进行腹部超声、颈动脉超声、心脏超声等检查,以E/A作为评估左室舒张功能的指标,分为NAFLD组和非NAFLD组,组内或组间差异比较用单因素方差分析或χ^2检验,并采用多因素Logistic回归分析对可能影响舒张功能的因素进行分析。结果 2型糖尿病合并NAFLD组的BMI、收缩压、丙氨酸氨基转移酶、甘油三酯、LDL胆固醇、HbA1c、HOMA-IR、颈动脉内膜中层厚度显著高于无NAFLD组（P〈0.05）,E/A值显著低于无NAFLD组（P〈0.05）;NAFLD与左室舒张功能减退的相关性经多因素Logistic回归分析进行校正后OR值为1.72（95%CI 1.26～2.75,P〈0.05）。结论在2型糖尿病患者中,NAFLD是左室舒张功能减退的重要危险因素。     

The Natural Course of Microalbuminuria among African Americans with Type 2 Diabetes: A 3-Year Study

Background

The natural course of microalbuminuria in African Americans (AA) with type 2 diabetes is not well established.

Method

Longitudinal analysis of 186 African Americans with type 2 diabetes enrolled in Project Sugar, a randomized controlled trial of primary care-based interventions to improve diabetes control.

Results

Mean age was 59.4 years and 85% were female. Mean estimated glomerular filtration rate and urinary albumin-to-creatinine ratio were 75.90 mL/min/1.73 m² and 1.62, respectively. Thirty-nine patients had macroalbuminuria and significantly higher systolic blood pressure compared with those with microalbuminuria (P = .01). Sixty patients had microalbuminuria, 19 progressed to macroalbuminuria, and none regressed. Progression was associated significantly with systolic blood pressure ≥115 mm Hg and requirement for blood pressure medication in the univariate model. In the multivariate model, the degree of albumin-to-creatinine ratio (odds ratio 35.51, 95% confidence interval, 2.21-571.65) and need for blood pressure medication (odds ratio 8.96, 95% confidence interval, 1.35-59.70) were independently associated with progression. No association was observed with the use of specific antihypertensive agent.

Conclusion

This study suggests that African Americans with type 2 diabetes and microalbuminuria experience irreversible disease that not infrequently progresses to overt proteinuria. The degree of microalbuminuria and blood pressure are key determinants in this process and should be primary targets in treating this population regardless of the antihypertensive class used.     

Left Ventricular Function in Newly Diagnosed Non-insulin-dependent (Type 2) Diabetics Evaluated by Systolic Time Intervals and Echocardiography

ABSTRACT Systolic time intervals (STI) and echocardiography were recorded in 133 (70 men, 63 women) newly diagnosed non-insulin-dependent diabetics aged 45–64 years and in 144 (62 men, 82 women) non-diabetic control subjects of the same age. Both male and female diabetics had significantly increased pre-ejection period/left ventricular ejection time ratio (PEP/LVET) in STI as compared with the respective non-diabetic control subjects. Male diabetics showed a reduced ejection fraction (EF) in echocardiography, but no significant difference was found in this respect between female diabetics and controls. A significant negative correlation was found between 2-hour postglucose serum insulin level and EF in male and female diabetics. After adjusting for the effect of age, coronary heart disease, hypertension, obesity and haemoglobin concentration, male diabetics still had a higher PEP/LVET ratio and a lower EF than male controls. In women, no significant differences were found between diabetics and controls in the PEP/LVET ratio or EF adjusted for the above factors. The results of this study are compatible with the view that impaired left ventricular function may be an early phenomenon in the clinical course of non-insulin-dependent diabetes.     

新诊2型糖尿病患者血浆视黄醇结合蛋白4与亚临床动脉粥样硬化的关系

目的探讨新诊2型糖尿病(T2DM)患者血浆视黄醇结合蛋白4(RBP4)与亚临床动脉粥样硬化(subAs)的关系。方法对217例新诊T2DM患者测定血浆RBP4浓度、空腹及餐后血糖、糖化血红蛋白、血脂、空腹胰岛素及颈总动脉内膜中膜厚度(IMT)、髂总动脉IMT、股动脉IMT,分析其subAs的发生情况。结果合并subAs的T2DM患者平均年龄、空腹胰岛素、血浆RBP4浓度均高于非subAs组患者(均P0.05)。将患者按RBP4浓度三分位数分组,随RBP4浓度增加,患者颈总动脉IMT、髂总动脉IMT、股动脉IMT均增加,高浓度RBP4组患者的颈总动脉IMT高于其余两组(P0.05);随RBP4浓度增加,subAs患病率也逐步升高,高浓度RBP4组患者的subAs患病率显著高于其余两组(P0.05)。相关分析显示新诊T2DM患者RBP4浓度与颈总动脉IMT、髂总动脉IMT、体质指数、收缩压、血糖、空腹胰岛素呈正相关。多元逐步Logistic回归分析显示:新诊T2DM患者subAs的发生与血浆RBP4、年龄、低密度脂蛋白胆固醇显著相关。结论新诊T2DM患者血浆RBP4水平与subAs呈正相关关系,血浆RBP4升高可能是新诊T2DM患者subAs的独立危险因素之一。     

Subclinical hypothyroidism is independently associated with albuminuria in people with type 2 diabetes

We examined a possible association between subclinical hypothyroidism and albuminuria in 159 people with type 2 diabetes. Patients with subclinical hypothyroidism had significantly higher levels of urinary albumin-to-creatinine ratio (UACR) than those with euthyroidism. Multivariate logistic regression analyses demonstrated that serum TSH level was an independent risk factor of albuminuria.     

Haemostatic Measures in Type 2 Diabetic Patients with Microalbuminuria

The major cause of disability and early mortality in Type 2 diabetes is cardiovascular disease. An enhanced urinary albumin excretion is strongly predictive of increased mortality, but the causal relationship behind this association is unclear. Abnormalities in the haemostatic system may be involved in the vascular pathology. We therefore studied the level of von Willebrand factor (vWf:Ag), factor VIII (VIII:Ag), fibrinogen, and fibronectin in male diabetic patients 50–70 years of age, with normal albumin excretion (n = 14), microalbuminuria (n = 14), and frank albuminuria (n = 7). Fourteen healthy age-matched males served as a reference group. There were no significant differences between normo-and micro-albuminuric patients but vWf:Ag (p < 0.01), VIII:Ag (p < 0.01), and fibrinogen (p < 0.05) were increased in those with frank albuminuria. Urinary albumin excretion rate was significantly correlated to vWf:Ag (r = 0.46, p = 0.005), VIII:Ag (r = 0.45, p = 0.007), and fibrinogen (r = 0.49, p = 0.003). The known duration of diabetes was correlated to vWf and F VIII. The increased level of vWf:Ag in Type 2 diabetes and the significant association to the urinary albumin excretion rate may suggest a linkage between albuminuria and cardiovascular disease. However, the present study demonstrated no increase in haemostatic variables in patients with microalbuminuria as compared with those with normal albumin excretion.