DM2患者血脂、尿酸和CRP测定的临床分析

目的:为了探讨2型糖尿病(DM2)患者血脂、尿酸(SUA)和C-反应蛋白(CRP)测定的临床意义.方法:采用生化法测定了78例DM2患者和66例正常对照组的血脂(TC、TG、HDL-C和LDL-C)水平,过氧化物酶免疫分析测定了SUA水平以及免疫比浊法测定了CRP水平,并与66例正常对照组进行了对比性分析.结果:78例...     

维生素D水平与2型糖尿病合并抑郁症相关性研究

目的 测定2型糖尿病合并抑郁症患者血清25-羟维生素D3水平,探讨维生素D缺乏与2型糖尿病合并抑郁症的关系。方法 选择2015年9月~2017年3月于我院住院的2型糖尿病患者84例,根据HAMD评分将患者分为T2DM组44例和T2DMD组40例。收集两组患者临床资料,检测FBG、HbA1c、TC、TG、LDL-C、HDL-C、血清25-羟维生素D3水平,进行Pearson相关分析和Logistic回归分析,并比较两组患者血清25-羟维生素D3缺乏患病率。结果 两组患者年龄、BMI、TC、TG比较,差异无统计学意义（P＞0.05）;T2DMD组FBG、HbA1c、LDL-C均高于T2DM组,且糖尿病病程长于T2DM组,差异具有统计学意义（P＜0.05）。T2DM组血清25-羟维生素D3平均水平为（20.94±1.68）ng/ml,高于T2DMD组的（16.44±2.05）ng/ml,差异具有统计学意义（P＜0.05）。T2DMD组血清25-羟维生素D3缺乏患病率为95.00%,高于T2DM组的31.82%,差异具有统计学意义（P＜0.05）。Pearson相关分析显示,血清25-羟维生素D3水平与FBG、HbA1c、LDL-C、病程均呈负相关（P＜0.05）,与HDL-C呈正相关（P＜0.05）,与BMI、TC及TG均无相关性（P＞0.05）。多元Logistic回归分析显示,血清25-羟维生素D3水平、FBG、HbA1c及病程是2型糖尿病合并抑郁症的独立危险因素（P＜0.05）。结论 2型糖尿病合并抑郁症患者维生素D缺乏更加普遍,维生素D缺乏可能参与2型糖尿病合并抑郁症的发病过程。     

肾小球滤过率与血清VEGF、胆红素水平在糖尿病肾病中的关系研究

目的 研究糖尿病肾病(DKD)患者肾小球滤过率(eGFR)与血清血管内皮生长因子(VEGF)、胆红素水平的关系.方法 选取2016年1月至2017年2月我院收治的DKD患者90例为研究对象(DKD组),按照eGFR水平分为A1组:＜60mL/[min·(1.73m2)],A2组60mL/[min·(1.73m2)]≤eGFR＜ 90mL/[min·(1.73m2)],A3组:eGFR≥90mL/[min·(1.73m2)],另选取单纯糖尿病(DM)及健康志愿者各50例,分别纳入DM组和健康组,比较DKD组、DM组、健康组eGFR、血清白蛋白(ALB)、尿酸(UA)、血肌酐(SCr)、总胆红素(TBIL)、直接胆红素(DBIL)、VEGF及总胆固醇(TC)、甘油三酯(TG)水平,同时对比A1、A2、A3组病程及上述指标,分析eGFR与其他生化指标的相关性,评价eGFR、VEGF、胆红素诊断DKD的效能,并分析DKD患者中影响eGFR水平的独立危险因素.结果 DKD组血清eGFR(70.18±20.56) mL/[min· (1.73m2)]、ALB(35.29±10.67) g/L、TBIL(9.18±2.65) μmol/L、DBIL(2.17±0.45) μmol/L较DM组及健康组低,DKD组UA(401.23±10.09)μmol/L、SCr(1.29±0.67) mg/dL、VEGF(55.29±1.25) pg/mL、TC(6.30-±2.12) mmol/L、TG(2.79±1.36) mmol/L显著高于DM组及健康组(P ＜0.05);A1组病程长于A2、A3组,A1组血清ALB、SCr、TBIL、DBIL低于A2、A3组,A1组UA、VEGF、TC、TG较A2、A3组高(P＜0.05);相关分析显示DKD患者eGFR与TBIL、DBIL呈正相关(P＜0.05),与SCr、VEGF、TC、TG呈负相关(P ＜0.05);eGFR、VEGF、胆红素联合诊断DKD的灵敏度、准确度、特异性高于单项指标诊断;Logistic回归分析显示病程、血清VGEGF、TG、TBIL是影响DKD患者eGFR的独立危险因素(P＜0.05).结论 糖尿病肾病患者eGFR与其血清VEGF、胆红素水平密切相关,临床可综合上述指标进行诊断.     

Estimation of plasma small dense LDL cholesterol from classic lipid measures

Calculated low-density lipoprotein cholesterol (cLDL-C) may differ from direct measurement (dLDL-C), and this difference may depend on presence of small, dense LDL (sdLDL) particles in addition to variation in triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) concentrations. The presence of such dependence would offer a simple means to estimate sdLDL. We studied dependence of sdLDL on cLDL-C, dLDL-C, and other variables. We measured the levels of glucose, creatinine, total cholesterol, TG, HDL-C, and dLDL-C using standardized methods in 297 samples. For sdLDL cholesterol (sdLDL-C), a novel homogeneous assay was used. The cLDL-C was calculated using the Friedewald formula for 220 subjects after excluding for liver or renal disease. Using stepwise regression analysis identified non-HDL-C, cLDL-C, and dLDL-C as significant variables (P < .001; R(2) = 0.88). The regression equation was as follows: sdLDL-C (mg/dL) = 0.580 (non-HDL-C) + 0.407 (dLDL-C) - 0.719 (cLDL-C) - 12.05. The sdLDL-C concentration can be estimated from non-HDL-C, dLDL-C, and cLDL-C values. Identification of a simple, inexpensive marker for sdLDL particles provides a cost-effective method for screening cardiovascular disease risk.     

CXCL16与糖尿病肾病关系的研究

糖尿病肾病( diabetic nephropathy,DN)是糖尿病微血管并发症之一,CXC趋化因子配体16 (CXC chemokine ligand16,CXCLl6)是新近发现的一种细胞因子,具有清道夫受体作用和免疫炎症属性.本研究主要探讨CXCLl6与2型糖尿病肾病之间的关系,进而为糖尿病肾病的诊断、治疗与预...     

Burden and pattern of micro vascular complications in type 2 diabetes in a tertiary health institution in Nigeria

Introduction

Diabetes mellitus (DM) afflicts at least 5 million people in Nigeria, with more than 80% having type 2 diabetes mellitus (T2DM). Microvascular complications increase both morbidity and mortality inpatients with T2DM. The aims of this study were to report the burden of various microvascular complications in T2DM and to identify various factors associated with these complications in patients with T2DM attending the diabetes outpatients'' clinic.

Methods

Ninety (90) patients with T2DM who have attended diabetes clinic for at least 3 months were recruited for this study. Detailed history, physical examination and biochemical analysis was done in each of the patients. All patients underwent a detailed standard evaluation to detect diabetic retinopathy (fundoscopy), neuropathy (10g monofilament and/or diabetes neuropathy scores), and nephropathy (microalbuminuria, macroalbuminuria, serum creatinine and estimated glomerular filtration rate).

Results

There was high prevalence of microvascular complications among patients with T2DM. Almost half of patients with T2DM had some form of microvascular complications; diabetic neuropathy being the commonest (69.6%),followed by nephropathy (54.5%) and retinopathy (48.9%). The factors associated with developing these complications were increasing age, duration of diabetes, hypertension and dyslipidaemia for nephropathy and neuropathy.

Conclusion

There is a high burden of microvascular complications in patients with type 2 diabetes. Age, male gender, hypertension, glycaemic control, BMI and duration of diabetes, and glycaemic control were factors associated with microvasular complications.     

血清游离脂肪酸浓度和hs-CRP在老年DM2中的应用

目的:通过血清游离脂肪酸浓度(FFA)和超敏C反应蛋白(hs-CRP)水平的变化特征,探索血清FFA和hs-CRP与老年2型糖尿病(DM2)的关系。方法:应用免疫比浊法和生化法测定156名老年DM2患者和75名无DM2的健康对照组的FFA、hs-CRP、GLU、TG、TC、HDL-C和LDL-C的浓度,将测得的数据进行DM2组和健康对照组的对比分析。结果:DM2组患者血清FFA、hs-CRP、TG和LDL-C均比健康对照组高,差异有统计学意义(其中FFA和hs-CRP P<0.01,TG和LDL-C P<0.05);HDL-C低于健康对照组,差异有统计学意义(P<0.05);两组TC比较无统计学意义。结论:老年DM2患者血清FFA和ha-CRP浓度升高,FFA是反映糖代谢及脂代谢的灵敏指标。此外,可能参与患者代谢异常的发生、发展起重要作用。     

2型糖尿病家系成员血浆致动脉粥样硬化指数(AIP)变化及阿卡波糖或格列美脲治疗对2型糖尿病患者AIP的影响

为探讨2型糖尿病家系中患者(T2DM)与其糖耐量正常一级亲属(Normoglycemicfirst-degreerelatives,NFDR)血浆致动脉粥样硬化指数(Atherogenicindexofplasma,AIP)的特点及阿卡波糖或格列美脲治疗对T2DMAIP的影响,对29个家系中62例T2DM、67例NFDR及45例正常对照的血脂和99例T2DM在阿卡波糖或格列美脲治疗前后的血脂变化进行测定,以Log(TG/HDL-C)计算AIP指数。结果表明:T2DM及NFDR的AIP均显著高于对照组(P<0.01);T2DM与其子女AIP明显相关(P<0.05)。阿卡波糖可明显降低T2DM的AIP(P<0.05);格列美脲组AIP下降无统计学意义。由于AIP与小而密低密度脂蛋白(sdLDL)密切相关,本研究提示:2型糖尿病家系成员AIP显著增高,NFDR也具有较健康对照高的AIP;阿卡波糖在降糖同时可明显降低AIP,格列美脲使AIP下降幅度较小,对sdLDL的治疗也可能具有潜在的益处。     

2型糖尿病鼠脑梗死模型的建立及相关指标分析

目的：在具有胰岛素抵抗特征近似人类2型糖尿病（T2DM）的大鼠身上建立脑梗死模型。方法：SD雄性大鼠120只,其中90只用高脂高糖和链脲佐菌素（STZ）制成T2DM模型,另30只为对照组。对照组和T2DM成模大鼠随机分为假手术组（A1组、B1组）和手术组（A2组、B2组）。采用神经功能缺损量表（NSS）评分、TTC染色与HE染色观察神经功能缺损征、脑梗死体积及病理改变。结果：T2DM成模率为72％,血脂指标与对照组相比差异有统计学意义（P〈0．01）,且血脂异常表现与临床T2DM患者近似。A2组NSS评分3—4级者占75％,脑梗死体积为（55．23±9．59）mm^3,脑梗死成模率为75％;B2组NSS评分3—4级者占60％,脑梗死体积为（54．33±6．39）mm^3,脑梗死成模率为53％。结论：高脂膳食结合STZ注射能复制出接近人类T2DM的动物模型,在此基础上制成的脑梗死模型稳定性和重复性好,是研究人类糖尿病脑梗死病理过程较为理想的动物模型。     

2型糖尿病患者肝脂肪酶基因标签单核苷酸多态性与血脂水平分析

观察汉族人群肝脂肪酶(HL)基因2个标签单核苷酸多态性(SNP)与2型糖尿病(T2DM)及血脂代谢的相关性.应用荧光标记单碱基延伸分型技术及寡核苷酸微阵列芯片杂交技术检测HL基因rs 12462668和rs10426971多态性.用全自动生化分析仪检测CHO、TG、HDL-C、LDL-C、载脂蛋白Al( ApoAl)及...     

2型糖尿病患者血清瘦素水平及临床意义

目的：观察2型糖尿病（DM2）患者血清瘦素（leptin）水平及其与肥胖、血糖、血脂的关系。方法：采用放射免疫分析（RIA）测定42例DM2患者和38例正常对照组的血清leptin水平。结果：DM2组血清leptin水平明显高于对照组（P〈0．01）;血清leptin与体重指数（BMI）、血清胰岛素（INS）、总胆固醇（TC）、甘油三酯（TG）、脂蛋白LDL-C呈正相关。结论：DM2患者的高leptin血症与肥胖、血脂异常及胰岛素抵抗（IR）密切相关。     

LDL species heterogeneity in the atherogenic dyslipidemia of polycystic ovary syndrome

One of the important risk factors for coronary heart disease is dyslipidemia. Several lipid abnormalities have been studied in patients with polycystic ovary syndrome (PCOS), but the relationship between PCOS and low-density lipoprotein (LDL) subclass pattern is not clear. A case-control study was designed to look into lipid differences, and LDL size was analyzed by a newly developed polyacrylamide tube gel electrophoresis method. Results indicated that only PCOS status and serum triglyceride levels were independently associated with LDL particle size. The apolipoprotein (Apo)A-I level was higher in PCOS patients with small dense LDL (sdLDL). PCOS seems to result in smaller LDL particle size and higher ApoA-I levels independent of triglyceride levels. After adjusting for triglyceride levels, other traits of insulin resistance syndrome (IRS) were not associated with LDL size phenotype, suggesting that the IRS-related sdLDL is linked most strongly to alterations in triglyceride levels.     

2型糖尿病血管并发症患者血清可溶性细胞粘附分子-1和C-反应蛋白的检测分析

目的:测定2型糖尿病(T2DM)患者血清可溶性细胞间粘附分子-1(sICAM-1)及C-反应蛋白(CRP)水平,分析两者在T2DM血管并发症发生、发展中的作用。方法:检测25例T2DM并血管并发症患者空腹血糖(FBS)、甘油三酯(TG)、糖化血红蛋白(HbA1c)、sICAM-1和CRP水平,并与33例无血管并发症患者和50例正常对照组比较。结果:T2DM患者组FBS、TG、HbA1c、sICAM-1和CRP等均显著高于正常对照组(P<0.01),T2DM血管并发症组TG、sICAM-1和CRP显著高于非血管并发症组(P<0.01)。HbA1c与sICAM-1和CRP呈正相关(P<0.01),TG、FBS与sI-CAM-1和CRP水平无相关性。结论:ICAM-1和CRP参与血管内皮细胞的炎症损伤,并在T2DM血管并发症发生发展中起重要作用。     

内源性分泌型糖基化终末产物受体及糖基化白蛋白与2型糖尿病合并冠心病的关系

目的:探讨血清内源性分泌型糖基化终末产物受体(esRAGE)、糖基化白蛋白(GA)水平与糖尿病合并冠心病及冠脉病变严重程度的关系。方法:入选2型糖尿病患者(冠状动脉正常)302例(2型糖尿病组)及2型糖尿病合并冠心病(CAD)患者357例(2型糖尿病并CAD组)。测定并比较二组血清esRAGE、GA水平并分析其与CAD及冠脉病变严重程度的关系。结果:2型糖尿病并CAD组血清GA水平(21.28±4.31%)及GA/esRAGE比值(1.21±0.68)明显高于2型糖尿病组(19.41±3.62%及0.78±0.46,均P<0.01),esRAGE水平(0.22±0.10ng/ml)明显低于2型糖尿病组(0.31±0.14ng/ml,P<0.01);冠脉3支病变组血清esRAGE水平低于1及2支病变组(均P<0.01);冠脉3支病变组血清GA水平、GA/esRAGE比值高于1及2支病变组(均P<0.01)。血清GA水平及GA/esRAGE比值与冠脉病变严重程度呈正相关,esRAGE水平与冠脉病变严重程度呈负相关。结论:血清高GA水平及低esRAGE水平与2型糖尿病并CAD及冠脉病变严重程度相关。糖基化负荷增加伴保护因素削弱,是2型糖尿病患者合并CAD的易感因素,GA/esRAGE比值是反映糖基化负荷与保护因素之间不平衡的简易而有效的指标。     

Hearing loss in individuals with osteogenesis imperfecta in North America: Results from a multicenter study

Hearing loss (HL) is an extra‐skeletal manifestation of the connective tissue disorder osteogenesis imperfecta (OI). Systematic evaluation of the prevalence and characteristics of HL in COL1A1/COL1A2‐related OI will contribute to a better clinical management of individuals with OI. We collected and analyzed pure‐tone audiometry data from 312 individuals with OI who were enrolled in the Linked Clinical Research Centers and the Brittle Bone Disorders Consortium. The prevalence, type, and severity of HL in COL1A1/COL1A2‐related OI are reported. We show that the prevalence of HL in OI is 28% and increased with age in Type I OI but not in Types III and IV. Individuals with OI Types III and IV are at a higher risk to develop HL in the first decade of life when compared to OI Type I. We also show that the prevalence of SNHL is higher in females with OI compared to males. This study reveals new insights regarding prevalence of HL in OI including a lower general prevalence of HL in COL1A1/COL1A2‐related OI than previously reported (28.3 vs. 65%) and high prevalence of SNHL in females. Our data support the need in early routine hearing evaluation in all types of OI that can be adjusted to the severity of the skeletal disease.     

The Relationship Between Obstructive Sleep Apnea and Self-Reported Stroke or Coronary Heart Disease in Overweight and Obese Adults with Type 2 Diabetes Mellitus

STUDY OBJECTIVES: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common, increasingly recognized as comorbid conditions, and individually implicated in the development of cardiovascular disease (CVD). We sought to determine the association between OSA and CVD in an overweight and obese population with T2DM. DESIGN: Cross-sectional. SETTING: Ancillary study to the Look AHEAD trial. PARTICIPANTS: Three hundred five participants of the Sleep AHEAD study who underwent unattended full polysomnography at home with measurement of the apnea-hypopnea index (AHI). MEASUREMENTS AND RESULTS: Self-reported prevalent CVD was obtained at the initial assessment of the parent study and included a history of the following conditions: stroke, carotid endarterectomy, myocardial infarction, coronary artery bypass grafting, and percutaneous coronary intervention. Logistic regression was used to assess the association of OSA, measured continuously and categorically, with prevalent CVD. OSA was present (AHI ≥ 5) in 86% of the population, whereas the prevalence of all forms of CVD was just 14%. The AHI was associated with stroke with an adjusted odds ratio (95% confidence interval) of 2.57 (1.03, 6.42). Neither the continuously measured AHI nor the categories of OSA severity were significantly associated with the other forms of CVD assessed. CONCLUSIONS: We found suggestive evidence of a greater prevalence of stroke at greater values of the AHI. OSA was not associated with prevalent coronary heart disease in the Sleep AHEAD trial. Future studies should confirm the link between OSA and stroke and examine mechanisms that link OSA to stroke in adults with T2DM. CITATION: Rice TB; Foster GD; Sanders MH; Unruh M; Reboussin D; Kuna ST; Millman R; Zammit G; Wing RR; Wadden TA; Kelley D; Pi-Sunyer X; Newman AB. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. SLEEP 2012;35(9):1293-1298.     

吡格列酮对2型糖尿病大鼠肾脏及单核细胞 趋化蛋白 1表达的影响

目的：观察吡格列酮对2型糖尿病(Type 2 diabetes mellitus,T2DM)大鼠血、尿单核细胞趋化蛋白 1（monocyte chemoattractant protein 1,MCP 1）表达及肾脏组织结构和功能的影响。方法：正常对照组(NC组)喂以常规饲料;采用高糖高脂膳食、小剂量链脲佐菌素（streptozotocin,STZ）注射的方法建立2型糖尿病大鼠模型,将成模的大鼠随机分为糖尿病（DM组）和吡格列酮（PIO组）,后用吡格列酮对PIO组大鼠进行干预治疗。8周后检测血糖水平、尿生化结果、肾脏组织病理的改变情况,同时检测尿MCP 1指标的变化。结果：与NC组比较,DM组和PIO组第8周空腹血糖及糖化血红蛋白水平均明显升高,但DM组、PIO组间差异无统计学意义（P＜0.05）;第8周DM组、PIO组尿白蛋白/尿肌酐(urinary albumin／creatinine ratio,ACR)、尿视黄醇结合蛋白(urinary retinol binding protein,URBP)、尿MCP 1(urinary monocyte chemoattractant protein 1,UMCP 1)和肾脏肥大指数均高于NC组,PIO组4项指标较DM组明显降低,且UMCP 1与ACR,URBP及肾脏肥大指数呈正相关;病理显示PIO组大鼠肾小球病变程度均较DM组明显减轻,MCP 1表达减少。结论：吡格列酮对2型糖尿病大鼠肾脏有明显的保护作用,这种保护作用是独立于降糖作用之外的。其机制可能与其抑制肾组织MCP 1表达及其排泄有关。     

初诊2型糖尿病患者甲状腺结节影响因素分析

目的 探讨影响初诊2型糖尿病(T2DM)患者甲状腺结节的危险因素.方法 选择北京市垂杨柳医院内分泌科2015年5月至2016年10月的初诊2型糖尿病患者239例.根据甲状腺彩超结果分为有结节组(n=79)和无结节组(n=160),进行初诊2型糖尿病患者甲状腺结节与临床指标、甲状腺功能的相关性分析.结果 初诊2型糖尿病患者甲状腺结节的患病率33.1%;女性患病率44.1%,明显高于男性患病率26.0%.两组间的年龄、血清25羟维生素D[25(OH)D]比较差异有统计学意义(P<0.05).Logistic回归分析结果显示女性、年龄、吸烟、甲状腺球蛋白抗体(TgAb)与甲状腺结节呈独立正相关(P<0.05).结论 女性、年龄、吸烟、TgAb是初诊2型糖尿病患者甲状腺结节的独立危险因素.     

多种脂源性细胞因子与2型糖尿病患者胰岛素抵抗相关

目的探讨2型糖尿病(T2DM)患者多种脂源性细胞因子与胰岛素抵抗作用关系。方法选择T2DM患者40例,根据BMI水平分为每20例为1组的obesity组和non-obesity组及正常对照组20人,检测血清空腹胰岛素(FINs)、空腹血糖(FPG)、血浆脂质(TG、TC、LDL、HDL)、脂联素(APN)、C1q/TNF相关蛋白3(CTRP3)、瘦素(leptin)及肿瘤坏死因子(TNF-α)等指标,根据HOMA公式,计算HOMA-AR并分析各指标之间相关性。结果 1)与正常对照组比较,T2DM组血清APN和CTRP3水平明显降低,leptin和TNF-α水平升高;与non-obesity组比较,obesity组APN和CTRP3的水平明显降低(P0.05或P0.01),leptin水平升高(P0.05);2)相关分析发现,APN浓度与年龄、BMI、FPG、TC、TG、LDL、FINs和HOMA-IR呈负相关(P0.05);CTRP3与FPG、FINs和HOMA-AR呈负相关(P0.05),与TG呈正相关(P0.05);leptin与FPG呈负相关(P0.05);TNF-α与FPG呈正相关(P0.05)。结论2型糖尿病患者血清中低APN、CTRP3和高leptin水平与肥胖和HOMA-IR密切相关可能是发病因子,其中FPG和TG作为独立因子,可作为评价胰岛素抵抗程度的新的敏感指标。     

Gliadin,endomysial and thyroid antibodies in patients with latent autoimmune diabetes of adults (LADA)

Latent autoimmune diabetes of adults (LADA) manifested after the age of 35 is characterized by the presence of disease-specific autoantibodies (anti-glutamate decarboxylase GADAb, anti-IA2Ab). However, autoimmunity in Type 1 diabetes mellitus is not targeted only to pancreatic beta-cells. No data have so far been published concerning the antibodies associated with other autoimmune disease in LADA patients. The presence of anti-thyroglobulin (TGAb), anti-thyroid peroxidase (TPOAb), anti-gliadin IgA (AGAAb) and IgG (AGGAb) and endomysial antibodies (EMAb) in sera of 68 diabetics typed as LADA was compared with the antibody presence in sera of 85 patients with Type 2 diabetes. We found a significantly higher occurrence of gliadin antibodies in LADA patients: the rate of AGGAb was 19.1% in comparison with 3.5% in the T2DM group (P = 0.0026), the rate of AGAAb was 13.2% in comparison with 3.5% (P = 0.035). The prevalence of EMAb was very low in both groups (1.5% and 0). The two groups differed significantly in the TPOAb rate: 22.1% in LADA compared to 9.4% in T2DM (P = 0.04), whereas no significant difference was found in the presence of TGAb (8.8% and 3.5%, P = 0.187). In comparison with T2DM patients, LADA patients were found to express higher antibody activity against gluten-related antigens and against TPO.