1型糖尿病住院患者血尿酸与糖尿病肾脏疾病的关系

目的评估血尿酸预测1型糖尿病患者糖尿病肾脏疾病发生的价值。方法采用横断面回顾性研究方法,调阅186例1型糖尿病患者资料,分为:正常蛋白尿组(n=117)、微量蛋白尿组(n=47)、大量蛋白尿组(n=22)。结果 (1)大量蛋白尿组较正常蛋白尿组血尿酸明显升高,差异有统计学意义(P 0.05),其余组间比较差异无统计学意义;(2)血尿酸与体重指数、收缩压、血肌酐、尿素氮、甘油三酯呈正相关(P 0.05)。(3)logistic回归分析结果显示糖化血红蛋白A1C((R值1.372,95%CI1.111～1.695)和血尿酸(R值1.006,95%CI1.000～1.011)是影响糖尿病肾脏疾病发生的独立危险因素。结论血尿酸升高是1型糖尿病患者发生糖尿病肾脏疾病的独立危险因素。     

86例1型糖尿病血脂与糖尿病肾病的关系

目的探讨血脂和脂蛋白代谢的改变与1型糖尿病肾病的关系。方法将86例1型糖尿病患者参照Mogensen关于糖尿病肾病（DN）分类标准,分为DN组（65例）和糖尿病无肾病组（21例）,根据尿白蛋白排泄率（UAER）及血肌酐水平将DN又分为三个亚组,分为早期肾病组（n=28）,临床肾病组（n=23）和晚期肾病组（n=14）。观测患者血糖、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和脂蛋白A（ApoA）、脂蛋白B（ApoB）变化。结果与糖尿病无肾病组比较,DN组血清甘油三酯、低密度脂蛋白胆固醇（LDL—C）水平升高（P〈0．05或P〈0．01）;DN三亚组之间血脂、载脂蛋白随着DN程度加重而升高,差异有统计学意义（P〈0．01）;血清甘油三酯、LDL—C、载脂蛋白B水平与UAER、血糖呈正相关（P〈0.01）。结论DN患者存在明显的脂质代谢异常,与血糖控制不良有关,且随着肾脏损害程度加重而加重,高血脂促进DN的发生和发展,糖尿病则加重血脂紊乱,形成恶性循环。     

血清铁蛋白与2型糖尿病的关系探讨

目的探讨血清铁蛋白(SF)与2型糖尿病患者糖脂代谢、氧化应激和胰岛素抵抗的关系。方法选取研究对象90例,其中2型糖尿病组32例、糖耐量减低(IGT)30例和健康对照组28例。收集和记录患者的一般资料,采用放免法测定SF和空腹胰岛素(FIns),全自动生化仪测定空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和血肌酐(SCr)等生化指标,高压液相法测定糖化血红蛋白(Hb A1c),比色法测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)含量。结果 2型糖尿病组SF水平[(184.2±3.12)μg/L]高于IGT组[(171.5±2.61)μg/L],而IGT组高于健康对照组[(104.1±1.87)μg/L],差异有统计学意义(P0.05)。SF与FIns、MDA、胰岛素抵抗指数、TG、TC和糖化血红蛋呈正相关(r=0.7145,P0.05;r=0.5637,P0.05;r=0.6358,P0.05;r=0.8320,P0.05;r=0.5283,P0.01;r=0.6243,P0.01)。与SOD活性、GSH-Px含量呈负相关(r=0.3413,P0.05;r=0.3153,P0.05)。结论 2型糖尿病患者体内铁贮备增多;铁超负荷促使氧化应激发生进而导致胰岛素抵抗。     

2型糖尿病患者发生糖尿病肾病的相关因素分析

目的探讨2型糖尿病患者糖尿病肾病发生的相关因素。方法采取回顾性分析方法选取2008年1月1日至2012年12月31日间门诊的868例2型糖尿病患者,按尿微量白蛋白(MAU)水平分成两组:无糖尿病肾病组和糖尿病肾病组,对两组患者的临床数据进行比较。结果①868例2型糖尿病患者中糖尿病肾病250例,占28.8%。②两组间年龄、病程、体重指数(BMI)、收缩压、舒张压、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、空腹胰岛素、胰岛素抵抗指数,胆固醇(TC)、甘油三酯(TG)、尿酸(UA)差异具有统计学意义。③Logistic回归分析结果提示:糖尿病肾病与BMI、收缩压、空腹血糖、HbA1c、TG、UA相关。结论 2型糖尿病患者应综合控制体重、血压、血糖、血脂、UA,改善代谢紊乱情况,利于糖尿病肾病的防治。     

加强随访管理降低2型糖尿病患者的血脂水平

目的观察加强随访管理对2型糖尿病患者血脂水平的影响。方法选择曾经住院且出院半年以上的糖尿病伴血脂异常者100例,按随机数字表法分为干预组和对照组。两组在常规随访的基础上,干预组加强随访管理,如定期糖尿病教育,护士监督改善患者自我管理行为等。干预6个月后,比较两组在血脂、血糖、血压、体重等方面的变化。结果干预6个月后,干预组的低密度脂蛋白(LDL)水平显著低于对照组(P<0.05),糖化血红蛋白(HbA1c)水平和体重下降水平两组差异也有统计学意义(P<0.05)。干预组血脂、血糖和血压的达标率均好于对照组。结论强化随访管理对2型糖尿患者血脂达标有显著的影响,同时有益于减轻患者体重和改善血糖水平。     

2型糖尿病住院患者糖尿病肾病发生的危险因素分析

目的 研究2型糖尿病住院患者发生糖尿病肾病的危险因素,为临床防治提供参考.方法 选取伊犁州新华医院2020年1月至12月收治的240例2型糖尿病住院患者,进行回顾性分析.依据尿白蛋白/肌酐比值(UACR)分为两组,以UACR<30?mg/g为非糖尿病肾病组(180例),UACR≥30?mg/g为糖尿病肾病组(60例)....     

1型糖尿病患者的胰岛素治疗

胰岛素注射与进餐时间的配合是胰岛素治疗中的重要环节。它与胰岛素的剂型、剂量一起决定了胰岛素治疗的效果。国外曾有文献报道，改变胰岛素注射与进餐时间的间隔可在不改变胰岛素剂量的情况下，显著的影响餐前、餐后的血糖谱。长期以来，这一因素未予充分重视，一般根据胰岛素的起效     

2型糖尿病肾脏疾病躯体危险因素的系统评价

目的系统评价躯体因素与2型糖尿病（T2DM）肾脏疾病的相关性。方法计算机检索MEDLINE、EMbase、CBM、CNKI和VIP数据库,收集所有关于T2DM肾脏疾病躯体危险因素的研究,检索时限截至2012年12月。由2名研究者按照纳入与排除标准筛选文献,提取数据和评价纳入研究的方法学质量后,采用RevMan5.2软件进行Meta分析。结果共纳入11个研究,12957例T2DM患者。其中9个研究为横断面研究,1个为病例-对照研究,1个为队列研究。研究结果显示：与T2DM肾脏疾病相关的躯体因素主要有糖尿病病程[OR=1.11,95%CI（1.05,1.18）]、腰围[OR=1.02,95%CI（1.00,1.04）]、空腹血糖[OR=1.11,95%CI（1.07,1.16）]、糖化血红蛋白[OR=1.20,95%CI（1.06,1.36）]、收缩压[OR=1.03,95%CI（1.02,1.05）]、舒张压[OR=2.41,95%CI（1.15,4.64）]、甘油三酯[OR=1.24,95%CI（1.02,1.51）]、高密度脂蛋白[OR=0.558,95%CI（0.369,0.844）]、血尿酸[OR=1.005,95%CI（1.002,1.009）]、血尿素氮水平[OR=1.58,95%CI（1.37,1.82）]、肾脏疾病史[OR=3.26,95%CI（1.20,8.87）]及肾脏疾病家族史[OR=1.83,95%CI（1.29,2.60）]。结论现有证据表明,与T2DM并发肾脏疾病相关的躯体因素众多。受纳入研究数量和质量所限,本研究结论尚需更多高质量研究进一步验证。     

2型糖尿病患者血尿酸水平与肾脏损害的相关性研究

目的：探讨2型糖尿病患者血尿酸水平与肾脏损害之间的关系。方法102例2型糖尿病患者血尿酸浓度按照四分位数间距分为A、B、C、D四组,比较四组间一般临床指标及肾脏功能相关指标。结果随血尿酸水平增加,体质量指数、甘油三酯、血肌酐、尿素氮水平也升高,差异有统计学意义（P＜0.05）。随血尿酸水平的升高,四组微量白蛋白尿患病率升高,其中A组与B组间差异无统计学意义（ P＞0.05）,A组与C组、D组间差异有统计学意义（P＜0.05）。多元逐步回归分析示血尿酸、年龄、胰岛素敏感指数纳入回归方程,血尿酸对白蛋白尿影响最大。结论2型糖尿病患者血尿酸水平与糖尿病肾脏损害相关,血尿酸水平的监测可为临床2型糖尿病肾脏损伤的早期防治及预测提供重要的理论依据。     

2型糖尿病肾病患者血尿酸与血脂水平的检测及其临床意义

目的 探讨糖尿病肾病患者血清尿酸（UA）与血脂水平变化的相关性及其临床意义.方法 将该院收治的2型糖尿病肾病患者76例作为糖尿病肾病组,根据患者24 h尿微量清蛋白排泄率水平,将其分为微量清蛋白组（n=36）及临床清蛋白组（n=40）,选择同期接受健康体检的成年人作为对照组（n=30）.检测其血清UA、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C）等血脂指标并对其进行比较分析.结果 糖尿病肾病组患者血清UA、TC、TG及LDL-C水平均显著高于对照组（P〈0.05）,而HDL-C水平显著低于对照组（P〈0.05）.相关性回归分析显示,糖尿病肾病组患者血清UA与TG、TC、LDL-C均呈显著正相关（P〈0.05）,而与HDL-C呈显著负相关（P〈0.05）.结论 糖尿病肾病患者的血清UA与血脂水平的检测对疾病诊治具有重要临床意义.     

2型糖尿病伴脂肪肝与瘦素及血脂代谢的相关分析

目的探讨2型糖尿病(DM)伴脂肪肝与瘦素及脂代谢紊乱的相关性.方法随机选择我院内分泌科200例2型糖尿病患者,其中合并脂肪肝组89例,非脂肪肝组111例,对其进行有关临床、病史、生化指标、瘦素、C肽与肝脏B超检查. 结果 2型糖尿病伴脂肪肝组与不伴脂肪肝组比较体质量指数(BMI) (27.68±4.00) vs(24.72±3.07)kg/m2、甘油三酯(TG)(2.88±3.19) mmol/L vs (1.74±1.18) mmol/L、1小时C肽(4.23±2.87) μg/L vs (2.32±1.97) μg/L、2小时C肽(4.43±2.93)μg/L vs (2.71±1.54) μg/L、瘦素(13.08±8.88) μg/L vs (8.63±5.45)μg/L,水平明显增高.Logistic逐步回归分析显示1小时C肽、瘦素、甘油三酯水平与脂肪肝的发生呈正相关(r=0.005、0.002、0.040).结论 TG、1小时C肽、瘦素是影响2型糖尿病脂肪肝发生的主要影响因素.     

2型糖尿病视网膜病变中医证型与血脂关系探讨

目的　观察 2型糖尿病视网膜病变的发生、发展及不同中医证型与血脂改变的关系。方法　对130例 2型糖尿病患者经眼底荧光血管造影确诊为无DR 5 0例和有DR 80例患者进行血脂测定。结果　有DR组与无DR组血脂差异有显著意义 (P <0 0 5 ) ,有DR组不同中医证型血脂差异有显著意义 (P <0 0 5 ) ,且病证由阴虚热盛→气阴两虚→气滞血瘀演变过程中血脂有上升趋势。结论　血脂的异常改变是导致DR的重要因素之一 ,且与中医证型的演变存在着正相关。     

老年2型糖尿病病人餐后甘油三脂水平与大血管并发症的相关关系

目的　研究老年 2型糖尿病病人餐后甘油三脂水平与大血管并发症的关系。方法　 40例 2型糖尿病病人以空腹和餐后 4h甘油三脂水平分组 :空腹及餐后TG正常组 (11例 )为A组 ,空腹TG正常 ,餐后增高组 (15例 )为B组 ,空腹TG增高组 (14例 )为C组 ,分析其大血管并发症发生情况。结果　大血管并发症发生率依次为 2 7 2 7%、73 33 %、78 5 7%。A组与B组大血管并发症比较P <0 0 5 ,B组与C组比较P >0 0 5。结论　空腹TG正常 ,餐后TG增高的大血管并发症发生率与餐后正常者差异有显著意义     

尿NGAL、L-FABP及RBP与老年2型糖尿病肾病的相关性研究

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)及视黄醇结合蛋白(RBP)在老年2型糖尿病肾病(DKD)患者中的变化,及与尿微量清蛋白/肌酐比值(UACR)和估算的肾小球滤过率(eGFR)的相关性。方法选取2017年1月至2018年3月该院收治的老年2型DKD患者184例,根据UACR分为尿蛋白正常组(n=68)、微量清蛋白尿组(n=66)及大量清蛋白尿组(n=50),另选取同期体检健康者60例作为健康对照组。采用酶联免疫吸附测定检测各组尿NGAL、L-FABP及RBP水平。Pearson相关分析尿NGAL、L-FABP及RBP水平与UACR、eGFR的相关性。结果尿蛋白正常组、微量清蛋白尿组和大量清蛋白尿组尿NGAL、L-FABP及RBP水平明显高于健康对照组(P<0.05),微量清蛋白尿组尿NGAL、L-FABP及RBP水平明显高于尿蛋白正常组(P<0.05),大量清蛋白尿组尿NGAL、L-FABP及RBP水平明显高于尿蛋白正常组和微量清蛋白尿组(P<0.05)。相关性分析显示,老年2型DKD患者尿NGAL、L-FABP及RBP水平与UACR均呈正相关(r=0.542、0.826、0.706,P<0.01),尿NGAL、L-FABP及RBP水平与eGFR均呈负相关(r=-0.483、-0.607、-0.635,P<0.01)。结论尿NGAL、L-FABP及RBP水平在老年2型DKD患者中明显升高,与2型DKD患者的发生、发展密切相关。     

The relationship between type of care planning system and patient outcomes in hospitalized AIDS patients

The purpose of this study was to describe the problems of HIV-infected patients, hospitalized for Pneurnocystis carinii pneumonia (PCP), as documented in the nursing care plan and to examine differences in the number and type of activated patient problems and patient outcomes between manually generated, computer-supported, and standardized care planning systems. Of the sample, 22% had no care plan. In the computer-supported care planning system the fewest number of care plans were completed. The total number of problems generated for the 89 patients having care plans was 199. The problems were categorized as PCP-related (37%), AIDS-related (16%), psychosocial (23%), knowledge deficit (14%), and other (10%). There were significant differences among the three groups in the total number of problems, PCP-related problems, and knowledge deficit problems. There were no statistically significant differences in patient outcomes, as measured by HIV-QAM scale scores and patient self-rating of physical condition approximately 1 week after admission, and length of stay among the three care planning systems. Future research is needed to examine the effect of type of care planning system on the quality of patient care.     

The relationship between HbA1c level, symptoms and self-rated health in type 2 diabetic patients

Objective

Improving glycaemic control is generally supposed to reduce symptoms experienced by type 2 diabetic patients, but the relationships between glycated haemoglobin (HbA_1c), diabetes-related symptoms, and self-rated health (SRH) are unclarified. This study explored the relationships between these aspects of diabetes control.

Design

A cross-sectional study one year after diagnosis of type 2 diabetes.

Subjects

A population-based sample of 606 type 2 diabetic patients, median age 65.6 years at diagnosis, regularly reviewed in primary care.

Main outcome measures

The relationships between HbA_1c, diabetes-related symptoms, and SRH.

Results

The patients’ median HbA_1c was 7.8 (reference interval: 5.4–7.4 % at the time of the study). 270 (45.2%) reported diabetes-related symptoms within the past 14 days. SRH was associated with symptom score (γ = 0.30, p < 0.001) and HbA_1c (γ = 0.17, p = 0.038) after correction for covariates. The relation between HbA_1c and symptom score was explained by SRH together with other confounders, e.g. hypertension (γ = 0.02, p = 0.40). The relation between the symptom fatigue and SRH was not explained by symptom score and significantly modified the direct association between symptom score and SRH.

Conclusions

Symptom relief may not occur even when HbA_1c level is at its lowest average level in the natural history of diabetes, and symptoms and SRH are closely linked. Monitoring symptoms in the clinical encounter to extend information on disease severity, as measured e.g. by HbA_1c, may help general practitioners and patients to understand the possible impact of treatments and of disease manifestations in order to obtain optimum disease control.Key Words: Family practice, glycosylated haemoglobin A, health status, signs and symptoms, type 2 diabetes mellitusTo reduce complications, lowering of HbA1c is a primary objective in diabetes care.

• Many patients experience diabetes-related symptoms in spite of acceptable glycaemic control.
• These symptoms are closely related to poor SRH while the association with HbA_1c is weak.

Patients with type 2 diabetes mellitus (T2DM) are commonly treated in general practice where treatment typically aims to improve glycaemic control in order to prevent complications [1], reduce symptom burden, and improve perceived health [2]. Moreover, the experience of obtaining these goals may improve patients’ motivation for treatment adherence, e.g. lifestyle changes and medication [3,4].Poor glycaemic control is related to symptoms such as frequent urination, genital itching, and unintended weight loss [5,6]. The association between glycated haemoglobin (HbA_1c) levels and specific symptoms is not necessarily close [7,8] except among dysregulated patients, e.g. at the time of diagnosis [5] or in patients with longstanding diabetes [2,6]. Despite the central role of symptom amelioration in treatment, few studies have looked into the relation between HbA_1c level and symptoms when HbA_1c is supposed to be at its lowest average level in the natural history of diabetes [7,9].General practitioners (GPs) and patients may evaluate the patient''s health differently [10]. The association between the patient''s HbA_1c level and perceived health is weak [2], or non-existent [1,11]. The patients’ perceived health gauged by a single question, known as perceived health, self-assessed health, or self-rated health (SRH), has been shown to vary with other factors than HbA_1c such as symptoms [12,13], sociodemographic factors [14], comorbidities [14–16], and functional ability [12,14]. Recent research has shown that SRH predicts which patients have a higher risk of diabetic complications even after accounting for established risk factors such as HbA_1c, but this predictive value may be mediated by presence of symptoms which were not accounted for [16]. Yet the relationships between HbA_1c and symptoms, both of which are important treatment targets, and SRH, which is a motivational factor for treatment adherence [2,3], are unclarified. A better insight into these relationships may help GPs to tailor treatments such as to maintain or improve patients’ health, which may include motivating the patient for treatment adherence.In a population-based sample of patients with T2DM seen in general practice one year after diabetes diagnosis we examined the relationships between HbA_1c, symptoms, and SRH primarily to see whether high HbA_1c levels are associated with many symptoms and low SRH ratings, and whether many symptoms are associated with low SRH ratings.     

慢性肾脏疾病患者肾功能水平与血脂代谢的关系

目的探讨慢性肾脏疾病患者肾功能与血脂代谢的关系。方法慢性肾脏衰竭(CRF)组29例,慢性肾炎(CN)组21例,糖尿病肾脏疾病(DN)组14例,肾脏疾病综合征(NS)组,12例。以健康体检者65例纳入对照组,检测肾功能、血脂、超敏C反应蛋白(hs-CRP)、24h尿蛋白排泄量各指标的关系。结果 CN组尿素氮(Urea)、血清胱抑素C(CysC)、肌肝(Cr)、尿酸(UA)、β2-微球蛋白(β2-MG)、hs-CRP、低密度脂蛋白(LDL-C)、脂蛋白a[LP(a)]、24h尿蛋白有明显升高;DN组Urea、肌酐(Cr)、β2-MG、CysC、hs-CRP、载脂蛋白A1(ApoA1)、LP(a)、24h尿蛋白有明显升高;NS组Urea、hs-CRP、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、LDL-C、载脂蛋白B(ApoB)、LP(a)、24h尿蛋白有升高;CRF组Urea、Cr、UA、β2-MG、CysC、hs-CRP、TG、LDL-C、ApoB、LP(a)、24h尿蛋白均有明显升高。结论肾脏疾病患者在肾功能指标发生改变的同时,伴随有血脂及hs-CRP的改变。     

PPARG基因单核苷酸多态性与2型糖尿病血脂异常的相关性研究

目的研究PPARG基因单核苷酸多态性(SNPs)与中国汉族2型糖尿病(DM)及血脂异常的关系。方法测定593例2型DM患者及626名正常健康者SNPs rs1801282、rs12636454和rs11128597基因型,分析其与2型DM及血脂水平的关系。基因分型采用单碱基延伸法(SBE)。结果2型DM组SNPs rs1801282、rs12636454和rs11128597基因型及等位基因频率分布与对照组间差异均无统计学意义(P>0.05)。2型DM组中rs1801282 AB+BB基因型总胆固醇(TC)、血糖和低密度脂蛋白胆固醇(LDL-C)水平显著高于AA基因型(P均<0.01)。rs12636454 AA基因型三酰甘油(TG)水平高于AB+BB基因型(P<0.05)。rs11128597 AA基因型血糖水平高于AB+BB基因型(P<0.01)。结论PPARG基因与中国汉族人2型DM无直接相关,但可能参与2型DM的血糖水平和脂质代谢的调节。     

PPARG基因单核苷酸多态性与2型糖尿病血脂异常的相关性研究

目的研究PPARG基因单核苷酸多态性（SNPs）与中国汉族2型糖尿病（DM）及血脂异常的关系。方法测定593例2型DM患者及626名正常健康者SNPsrs1801282、rs12636454和rs11128597基因型,分析其与2型DM及血脂水平的关系。基因分型采用单碱基延伸法（SBE）。结果2型DM组SNPs rs1801282、rs12636454和rs11128597基因型及等位基因频率分布与对照组间差异均无统计学意义（P〉0．05）。2型DM组中rs1801282AB＋BB基因型总胆固醇（TC）、血糖和低密度脂蛋白胆固醇（LDL—C）水平显著高于AA基因型（P均〈0．01）。rs1l2636454AA基因型三酰甘油（TG）水平高于AB＋BB基因型（P〈0．05）。rs11128597AA基因型血糖水平高于AB＋BB基因型（P〈0．01）。结论PPARG基因与中国汉族人2型DM无直接相关,但可能参与2型DM的血糖水平和脂质代谢的调节。