2型糖尿病患者认知功能障碍与脑白质高信号负荷及分布特征的相关性

目的探讨2型糖尿病（T2DM）患者认知功能障碍与脑白质高信号（WMH）负荷及分布特征的关系。 方法2013—2015年，从华中科技大学同济医学院附属同济医院招募年龄匹配的T2DM患者40例，健康对照者20例（健康对照组）。T2DM患者中有轻度认知功能障碍（MCI）者20例（T2DM伴MCI组），无MCI者20例（T2DM无MCI组）。采用Fazekas量表（FS）及改良Scheltens量表（MSS）进行磁共振WMH视觉评估，对比3组WMH负荷及分布特征差异，并采用Spearman相关性分析法分析WMH负荷与认知功能评分之间的相关性。随访5年后对比健康对照者与T2DM患者的WMH负荷、分布区域及认知功能变化情况。组间比较采用方差分析、秩和检验及χ²检验。 结果3组研究对象FS、MSS评分的差异有统计学意义（F=8.600、9.176，P<0.01），其中T2DM患者明显高于健康对照组（P<0.05或0.01）。3组研究对象脑室周、额叶、基底节、颞叶、枕叶MSS评分的差异有统计学意义（F=12.069、6.575、8.358、4.869、6.037，P<0.01），其中T2DM患者高于健康对照组（P<0.05或0.01），且T2DM伴MCI组基底节区、颞叶、枕叶的MSS评分均明显高于T2DM无MCI组（P<0.05）。认知功能评分与WMH负荷呈负相关（P<0.05或0.01）。相对于5年前，健康对照者简易智能精神状态检查量表评分明显降低（t=3.167，P<0.01）；健康对照者及T2DM患者的蒙特利尔认知评估量表评分均明显降低（t=5.734、3.863，P<0.01），FS及MSS评分均明显增高（FS评分：t=3.811、4.564，MSS评分：t=4.839、6.010，P<0.01）。 结论T2DM患者认知功能障碍与WMH密切相关，磁共振WMH负荷及脑区分布特征可能作为T2DM患者认知功能障碍评估潜在的影像标志物。     

青光眼小梁切除术后早期滤过泡功能不良行滤过泡剥离治疗患者的焦虑、抑郁及睡眠障碍状况

目的 探讨青光眼小梁切除术后早期滤过泡功能不良行滤过泡剥离治疗患者的焦虑、抑郁及睡眠障碍状况。方法 选取行青光眼复合式小梁切除术后6个月复查恢复正常患者（A组）、早期滤过泡功能不良行滤过泡剥离治疗患者（B组）及查体健康成年人（C组）各30例,采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和匹兹堡睡眠质量指数量表（PSQI）进行焦虑、抑郁及睡眠障碍评分,比较三组SAS、SDS、PSQI评分以及焦虑、抑郁及睡眠障碍阳性率差异,采用Spearman相关分析早期滤过泡功能不良行滤过泡剥离治疗患者SAS、SDS、PSQI评分的相关性。结果三组性别、年龄、文化程度、婚姻状况比较差异无统计学意义（P均>0.05）,组间均衡可比。三组SAS、SDS、PSQI评分差异有统计学意义（P均<0.05）。B组与C组比较,SAS、SDS、PSQI评分差异有统计学意义（P均<0.05）;A组与C组比较,PSQI评分差异有统计学意义（P<0.05）。分别以SAS评分≥45分、SDS评分≥50分、PSQI评分>7分作为焦虑、抑郁和睡眠障碍阳性判定标准。三组抑郁和睡眠障碍阳性率比较差异...     

2型糖尿病冠心病患者甲状腺功能减退对血清肥胖抑制素水平的影响

目的 探讨2型糖尿病冠心病患者甲状腺功能减退对血清肥胖抑制素水平的影响。 方法 选取2013年 1-2 月于我院体检的健康成年人22例为健康对照组（A组），2011年12月-2013年2月我院收治的单纯2型糖尿病患者（B组）、糖尿病冠心病患者（C组）、糖尿病冠心病合并甲减患者（D组）各22例为研究对象。所有研究对象于清晨空腹状态下采集静脉血检测空腹血糖（FPG）、糖化血红蛋白（HbA1c）、低密度脂蛋白（LDL）、游离三碘甲状腺原氨酸（FT3）、总胆固醇（CHOL）、甘油三酯（TG））、高密度脂蛋白（HDL）、促甲状腺激素（TSH）、游离甲状腺素（FT4）以及血清肥胖抑制素（Obestatin）水平。 结果 B、C、D组FPG及HbA1c均明显高于A组(P<0.01)，D组TG水平较A组降低（P<0.01），而A组HDL水平明显高于其余三组（P<0.05），D组的TSH水平为四组中最高（P<0.01），而FT3水平最低（P<0.01），C组及D组的血清Obestatin水平较A组及B组显著降低（P<0.01），D组血清Obestatin水平较C组有降低趋势，但差异无统计学意义(P>0.05)。血清Obestatin水平与FINS呈正相关，与年龄、TSH、HbA1c、血压、糖尿病病程呈负相关（P<0.01）。 结论 Obestatin可能作为一种保护性因素影响单纯2型糖尿病冠心病合并甲状腺功能低下患者高血压及外周动脉硬化的发生发展。     

不同血糖代谢状态下老年骨质疏松患者骨钙素与脂联素及胰岛素抵抗的关系研究

目的：分析不同血糖代谢状态下老年骨质疏松患者骨钙素与脂联素及胰岛素抵抗的关系。方法：选取骨质疏松患者320例,依据骨质疏松建议诊断标准和2010年美国糖尿病学会标准,将患者分为3组,A组为单纯骨质疏松患者（140例）,B组为骨质疏松合并糖耐量受损患者（IGT）（110例),C组为骨质疏松合并糖尿病患者（70例）,选择同期体检健康者60例作为健康对照组。比较4组总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白（HbA1C）、稳态模型胰岛素抵抗指数（HOMA-IR）、人骨钙素（OC）、脂联素（APN）水平,用线性Pearson分析OC与糖脂代谢指标的相关性,多因素Logisitic回归分析影响OC水平的危险因素。结果：与对照组、A组、B组比较,C组TC、TG、LDL-C、HbA1C、HOMA-IR水平明显升高,HDL-C、HOMA-β、OC和APN水平明显降低(均P<0.05)。B组TC、LDL-C、HDL-C、HbA1C、HOMA-IR、HOMA-β、OC和APN水平与对照组比较,差异有统计学意义(均P<0.05),与A组比较,HDL-C、HbA1C、HOMA-IR、HOMA-β水平差异有统计学意义(均P<0.05)。A组TC、LDL-C、HOMA-IR、HOMA-β、OC和APN水平与对照组比较,差异有统计学意义（均P<0.05）;320例骨质疏松患者OC与体质指数（BMI）、收缩压（SBP）、TG、TC和HOMA-β呈明显的负相关（均P<0.05）,与APN和HOMA-IR呈明显正相关（均P<0.05）;多因素Logisitic 回归分析显示,TG、APN、HOMA-IR和HOMA-β与OC独立相关。结论：骨质疏松患者中,OC可能参与胰岛素抵抗,在糖脂代谢过程中起重要作用,参与糖尿病发生发展。     

糖化血红蛋白与非糖尿病性急性脑梗死的相关性研究

选择非糖尿病性急性脑梗死患者82例（A组）、椎基底动脉供血不足患者80例（B组）及健康查体者60例（C组）,对3组进行糖化血红蛋白（HbA1c）、血脂、凝血系列的测定。并对A组于入院时进行神经功能缺损评分,根据评分分为轻、中、重组。对脑梗死患者治疗4周,观察其预后。发现A组HbA1c水平较B、C组增高;轻、中、重组在HbA1c水平上比较均有统计学差异;根据预后分组,各组间HbA1c水平存在统计学意义（除无变化组与恶化组间）。认为HbA1c可能是非糖尿病性急性脑梗死的危险因素之一,水平越高,病情越重,预后越差。     

FPG、HbA1c水平变化与老年2型糖尿病视网膜病变患者视力严重程度的关系

目的 探究空腹血糖（Fasting Blood Glucose, FPG）、糖化血红蛋白（Glycosylated Hemoglobin A1c, HbA1c）水平变化与老年2型糖尿病视网膜病变患者视力严重程度的关系。方法 选取2020年6月—2022年6月泉州市泉港区医院收治的92例2型糖尿病患者为研究对象,根据有无视网膜病变分为非视网膜病变组48例、视网膜病变组44例;根据视力损伤严重程度将视网膜病变患者分为轻度组15例、中度组14例、重度组15例。所有患者入院次日检测空腹血糖和视力情况,分析不同组间FPG、HbA1c水平;Pearson相关性分析FPG、HbA1c水平变化与患者视力严重程度关系。结果 视网膜病变组FPG和HbA1c水平均明显高于非视网膜病变组,差异有统计学意义（P均<0.05）。中重度组FPG和HbA1c水平均明显高于轻度组,且重度组高于中度组,差异有统计学意义（P均<0.05）。FPG、HbA1c与糖尿病视网膜病变患者视力损伤程度呈正相关（r=0.436、0.531,P均<0.001）。结论 老年2型糖尿病视网膜病变患者FPG与HbA1c水平与...     

IKAP模式联合家庭运动应用于妊娠期糖尿病孕妇的效果

目的 探讨信息-知识-信念-行为（information-knowledge-attitude-practice,IKAP）模式联合家庭运动应用于妊娠期糖尿病（gestational diabetes mellitus,GDM）孕妇的效果。方法 选取福建医科大学附属龙岩市第一医院2020年9月—2022年3月收治的246例GDM孕妇,按照随机数表法分为对照组和观察组,各123例。对照组采用常规护理+家庭运动干预,观察组采用IKAP模式联合家庭运动干预。比较两组血糖水平、自我效能、妊娠与分娩结局。结果 干预后,观察组HbA1c、2 hPG、FPG水平均低于对照组,差异有统计学意义（P<0.05）;观察组足部护理、监测、急症处理、饮食、药物、运动维度分值均高于对照组,差异有统计学意义（P<0.05）;观察组孕期增长体质量为（16.65±2.80）kg、羊水指数为（108.89±27.70）mm均低于对照组,差异有统计学意义（t=2.265、3.704,P<0.05）;生产方式（顺产、剖宫产）优于对照组,差异有统计学意义（P<0.05）。结论IKAP模式联合家庭运动应...     

克罗恩病患者健康相关生存质量研究及其影响因素

为探讨克罗恩病（Crohn disease,CD）患者心理症状及影响生存质量（quality of life,QOL）的因素,调查CD组及健康对照组人群各50例,分别采用ZUNG焦虑自评量表（self?rating anxiety scale,SAS）、ZUNG抑郁自评量表（self?rating depression scale,SDS）、炎症性肠病专用量表（inflammatory bowel disease questionnaire,IBDQ）、健康调查简表（short from?36 health survey,SF?36）进行测评。结果显示,焦虑、抑郁发生率CD组SAS［（40.3±8.5）分］、SDS［（47.1±11.1）分］与健康对照组［SAS（37.6±7.0）分,SDS（41.8±9.6）分］比较,差异均有统计学意义（t=5.4,P<0.05;t=10.6,P<0.05）。IBDQ各维度得分,CD活动期患者为肠道症状（49.50±7.62）分,全身症状（23.92±5.07）分,情感功能（57.13±15.62）分,社会功能（22.15±9.08）分;CD缓解期患者为肠道症状（60.12±4.01）分,全身症状（26.24±3.97）分,情感功能（67.34±15.17）分,社会功能（25.44±2.03）分,2组各维度得分比较差异均有统计学意义（P均<0.05）。SF?36量表各维度如躯体功能、躯体疼痛、一般健康状况、情感角色、总的心理健康和总的躯体健康等方面得分,CD组均明显低于健康对照组,2组差异均有统计学意义（P均<0.05）;CD缓解期患者在躯体功能、一般健康状况和总的心理健康维度的得分均高于CD活动期患者（P<0.05）;出现营养不良的患者在总的躯体健康和活力维度的得分显著低于无营养不良组,差异有统计学意义（P<0.05）。对患者生存质量进行多因素分析显示,疾病分期、营养风险对IBDQ总分有明显影响（P<0.05）,其他因素如性别、年龄、婚姻状况、受教育背景、医疗费用、生物制剂治疗、手术治疗对IBDQ评分无明显影响（P>0.05）。综上,对CD患者进行心理疏导,活动期积极治疗,有望改善CD患者生存质量。     

高频重复经颅磁刺激联合肌电生物反馈治疗脑卒中后吞咽障碍的临床研究

目的探讨高频重复经颅磁刺激（rTMS）联合肌电生物反馈治疗脑卒中后吞咽障碍的临床疗效。 方法选取南通大学附属海安医院康复医学科自2018年7月至2021年7月收治的128例脑卒中后吞咽障碍患者，按随机数字表法分为A组、B组、C组、D组，每组32例。A组进行常规吞咽训练，B、C、D组在A组基础上分别进行肌电生物反馈治疗、高频rTMS治疗、高频rTMS联合肌电生物反馈治疗。对比4组患者治疗前后标准吞咽功能评定量表（SSA）评分、舌喉复合体移动度（包括舌骨上移、舌骨前移、甲状软骨上移、甲状软骨前移）、舌骨上肌群肌电活动均方根（RMS）值、吞咽生活质量量表（SWAL-QOL）评分以及临床疗效，并记录患者的不良反应。 结果治疗后，4组患者的SSA评分均较治疗前下降，且B、C、D组均低于A组，D组均低于B、C组，差异均具有统计学意义（P<0.05）。治疗后，4组患者的舌骨和甲状软骨上移度及前移度、舌骨上肌群RMS值均较治疗前提高，且B、C、D组均高于A组，D组高于B、C组，差异均具有统计学意义（P<0.05）。治疗后，4组患者的SWAL-QOL评分均较治疗前升高（P<0.05），且B、C、D组均高于A组（P<0.05），D组高于B、C组，差异均具有统计学意义（P<0.05）。4组患者的临床疗效分布差异有统计学意义（P<0.05）；D组总有效率高于A组，差异具有统计学意义（P<0.01）。4组患者均未出现严重不良反应。 结论高频rTMS联合肌电生物反馈治疗脑卒中后吞咽障碍能增加患者舌喉部肌肉运动，提高舌喉复合体移动度，改善吞咽障碍，提高患者生活质量，效果显著。     

基于医院-社区-家庭协同的健康教育及营养支持对妊娠期高血压综合征孕妇的影响

目的 探究基于医院-社区-家庭协同的健康教育及营养支持对妊娠期高血压综合征孕妇心理韧性、分娩压力及血压的影响。方法 选取2020年3月至2022年3月于医院就诊的妊娠期高血压综合征孕妇73例作为研究对象,按随机数字表法分为干预组和对照组,干预组37例,对照组36例。对照组采用常规护理模式,干预组在对照组基础上采用基于医院-社会-家庭协同的健康教育及营养支持干预,观察比较两组患者干预后心理弹性量表（CD RISC）评分、妊娠压力量表（PPS）评分及血压控制。结果 CD-RISC评分两组患者护理前各项评分无明显差异（P>0.05）,护理后两组评分高于护理前（P<0.05）,其中干预组护理后力量、乐观、坚韧及总分评分显著高于对照组（P<0.05）;分娩压力方面两组患者护理前PPS评分无明显差异（P>0.05）,护理后均有降低（P<0.05）,其中干预组患者护理后PPS评分较对照组更低（P<0.05）;护理前两组收缩压及舒张压间无明显差异（P>0.05）,护理后两组血压均有降低（P<0.05）,其中干预组护理后收缩压、舒张压均显著低于对照组（P&...     

基于“脑-肠轴”理论探讨老年慢性便秘患者睡眠障碍与焦虑抑郁和生活质量相关性

背景睡眠障碍可增加胃肠道症状发生率,而且长期睡眠质量的下降也是焦虑、抑郁形成的一个危险因素.本研究基于"脑-肠轴"理论探讨睡眠障碍是否加重老年慢性便秘患者的临床表现,是否影响患者心理情绪和生活质量.目的基于"脑-肠轴"理论探讨老年慢性便秘患者睡眠障碍与焦虑抑郁和生活质量相关性.方法选择2017-03/2019-09在我院住院治疗的126例老年慢性便秘患者为研究对象,对所有患者便秘评分系统,便秘患者症状自评问卷,睡眠质量评估,焦虑、抑郁量表及生活质量量表评分.结果睡眠障碍组便秘评分系统(constipatipation scoring system,CSS)评分为19.63分±3.36分,便秘患者症状自评问卷(patient assessment of constipation symptom,PAS-SYM)为1.59分±0.52分,焦虑自评量表(self-rating anxiety scale,SAS)评分为58.92分±6.72分,抑郁自评量表(self-rating depression scale, SDS)评分为57.74分±6.38分,均高于睡眠正常组(P <0.05).睡眠障碍组患者社会功能评分为71.56分±3.38分、情绪评分为75.89分±2.95分、躯体角色评分为76.86分±2.92分、躯体健康评分为80.25分±3.35分、心理卫生评分为78.36分±3.65分、总健康评分为76.19分±2.56分,均低于睡眠正常组,差异有统计学意义(P <0.05).CSS,PAC-SYM各维度评分以及总分均与SAS、SDS评分呈正相关(P <0.05);SF-36中6个维度的得分与SAS、SDS评分均呈负相关(P<0.05).结论脑-肠轴是沟通胃肠道与脑之间的桥梁,睡眠障碍和焦虑、抑郁可能是影响老年慢性便秘患者临床症状的重要因素,并影响患者生活质量.     

Evaluation of metabolite changes in visual cortex in diabetic retinopathy by MR-spectroscopy

PurposeTo evaluate metabolite changes in the visual cortex of diabetic patients with nonproliferative or proliferative diabetic retinopathy by Magnetic Resonance Spectroscopy (MRS).Materials and Methods15 normal subjects (group 1), 15 patients with diabetes who did not have diabetic retinopathy (group 2), 15 patients with nonproliferative diabetic retinopathy (NPDR) (group 3), and 15 patients with proliferative diabetic retinopathy (PDR) (group 4) were included in the study. Furthermore, diabetic patients were divided into two groups according to HbA1c levels (Group A: 20 patients, HbA1c < 8%; Group B: 20 patients, HbA1c > 8%). In all cases' left visual cortex, amounts of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were measured by MRS. NAA/Cr, Cho/Cr, and NAA/Cho ratios were calculated. Furthermore, all cases' complete blood count (CBC) and biochemical parameters were evaluated.ResultsThere was no statistically significant difference for NAA/Cr, Cho/Cr, and NAA/Cho ratios between groups 1, 2, 3, and 4 (P > 0.05). However there was a statistically significant difference for NAA/Cr and NAA/Cho ratios between groups A and B (P < 0.05). There was no statistically significant difference for Cho/Cr ratio between groups A and B (P > 0.05).ConclusionAlthough NAA/Cr and NAA/Cho ratios decrease in the visual cortex while diabetic retinopathy progresses, these decreases are not statistically significant. While HbA1c levels increase, the NAA concentration decreases in the visual cortex which indicates neuronal loss. The metabolite changes in the visual cortex are associated with acute events rather than chronic.     

2型糖尿病患者HbA1c水平与糖尿病视网膜病变DR分期的相关性

目的探讨2型糖尿病患者HbA1c水平与糖尿病视网膜病变DR分期的相关性。方法选取2019年11月—2020年8月就诊于承德市中心医院内分泌科,并诊断为2型糖尿病的患者265例,根据眼底检查结果分为非糖尿病视网膜病变(NDR)组(n=156)及糖尿病视网膜病变(DR)组(n=109)。收集两组患者的临床资料包括性别、年龄、糖尿病病程、吸烟史、随机血糖、糖化血红蛋白、血脂、25-羟基维生素D、甲状旁腺激素等。为进一步分析将DR组患者根据HbA1c水平分为两个亚组:HbA1c<10%组;HbA1c≥10%组;比较HbA1c水平与糖尿病视网膜病变DR分期的相关性。结果与NDR组比较,DR组HbA1c水平显著升高[(8.83±1.98)%vs(9.35±1.87)%],差异有统计学意义(P<0.05)。多元Logistic回归分析提示糖尿病病程、HbA1c水平与2型糖尿病患者发生糖尿病视网膜病变独立相关(OR=1.174,95%CI:1.111~1.124;OR=1.234,95%CI:1.021~1.492,P<0.05)。亚组分析结果表明,HbA1c≥10%组(n=35)增殖期(PDR)者较HbA1c<10%组(n=74)明显增多,差异有统计学意义(P<0.05)。结论HbA1c水平与2型糖尿病患者并发糖尿病视网膜病变独立相关。     

中国城市三甲医院老年2型糖尿病患者生活质量及其影响因素

目的 了解我国三甲医院中老年2型糖尿病患者的生活质量现状及其影响因素。方法 收集2015年3至11月16家三甲医院2型糖尿病费用调查研究中完成欧洲五维健康量表(EQ-5D)问卷、且年龄≥60岁的患者479例。采用线性回归模型分析患者的临床特征对生活质量的影响。采用SPSS 19.0统计软件进行数据分析。结果 191例(39.9%)患者报告至少一个维度存在问题。行动能力、自我照顾能力、日常活动能力、疼痛或不舒服、焦虑或抑郁方面报告存在问题的比例分别为15.0%、4.8%、9.0%、22.1%和24.2%。研究人群平均EQ-5D问卷总效值和直观式健康量表(EQ-VAS)分别为(0.77±0.13)和(76.9±11.9)。年龄(B=-0.003,P=0.021)、糖化血红蛋白(B=-0.010,P=0.037)和糖尿病周围神经病变(B=-0.039,P=0.01)是影响EQ-5D总效值的预测因素;糖化血红蛋白(B=-1.091,P=0.013)、糖尿病视网膜病变(B=-3.192,P=0.019)、心血管疾病(B=-3.470,P=0.019)和脑血管疾病(B=-4.649,P=0.003)是影响EQ-VAS评分的预测因素。 结论 2型糖尿病对老年患者的生活质量存在明显的影响,年龄、糖化血红蛋白、糖尿病慢性并发症以及心脑血管合并症是其重要的影响因素。     

The temporal development of retinopathy and nephropathy in type 1 diabetes mellitus during 15 years diabetes duration.

In this prospective study, the 10- and 15-year incidence and course of retinopathy were examined in relation to medical risk indicators from 3.1 +/- 1.9 (mean -/+ SD) years diabetes duration and onwards in 29 adult type 1 diabetic patients treated under routine care. A total of 28 patients were followed for 10 years and 20 patients for 15 years diabetes duration. After 10 years diabetes duration, 11 patients had developed any retinopathy (ten patients background retinopathy and one patient clinically-significant macular oedema). After 15 years diabetes duration, 16 patients had developed any retinopathy (12 patients developed background retinopathy and four patients developed potentially sight-threatening retinopathy, i.e. clinically significant macular oedema (n = 2) or severe non-proliferative retinopathy (n = 2)). None of the patients developed proliferative retinopathy. No differences were seen in mean HbA1c values between patients without any retinopathy and patients with background retinopathy, whereas patients who developed potentially sight-threatening retinopathy had higher mean HbA1c levels than patients without any retinopathy. Patients who developed potentially sight-threatening retinopathy had higher levels of mean HbA1c both after 10 (9.7 +/- 1.6 vs 6.9 +/- 1.5%; P < 0.05) and 15 years diabetes duration (9.3 +/- 1.2 vs 7.1 +/- 1.3%; P < 0.05), compared to patients without any retinopathy. They also had higher levels of mean HbA1c than patients with background retinopathy after 15 years diabetes duration (9.3 +/- 1.2 vs 7.7 +/- 1.1%; P < 0.05). There were no differences in blood pressure levels between patients who developed retinopathy and those who did not. Only two patients developed clinical signs of nephropathy (urinary albumin 320-1590 mg/l) after 12 and 13 years diabetes duration, respectively. At those time points, both patients had already developed background retinopathy since 2 years. In conclusion, the present study shows that the incidence of retinopathy is associated with the duration of diabetes and that there is a strong association between the degree of metabolic control and development of potentially sight-threatening retinopathy. The study also indicates that the development of retinopathy does not seem to be associated with hypertension or clinical signs of nephropathy.     

2型糖尿病合并冠心病患者冠脉病变与糖化血红蛋白水平的关系

目的探讨2型糖尿病（T2DM）合并冠心病（CAD）患者糖化血红蛋白（HbA1c）水平与冠脉病变特点的关系。方法 289例T2DM合并CAD患者,按照HbA1c水平分为两组,A组103例（HbA1c〈7%）,B组186例（HbA1c≥7%）,对两组患者冠脉造影结果进行Gensini积分并对比分析。结果 B组患糖尿病史、吸烟比例和微量白蛋白尿阳性率均高于A组,空腹血糖、总胆固醇、甘油三酯、血尿酸水平也高于A组;从冠脉病变看,三支病变、弥漫性病变、冠脉C型病变,B组显著高于A组,且B组冠脉病变Gensini积分较高（P〈0.01）,HbAlc水平与Gensini积分呈正相关（P〈0.01）。结论 T2DM合并CAD患者HbAlc水平高,其冠脉病变呈现复杂和严重的临床特点。因此,T2DM合并CAD患者应尽早积极有效地控制血糖水平,对于冠心病的防治甚为重要。     

血浆白脂素水平与冠心病的关系

目的 分析血浆白脂素水平与冠心病关系。 方法 收集我科2016年2月至2018年12月281例行冠状动脉造影术（CAG）检查的患者，按CAG结果分为正常对照组（n = 90)，稳定型心绞痛（SAP）组(n = 80)和急性冠脉综合征（ACS）组（n = 111)，同时收集相关临床资料进行统计学分析。 结果 ACS组和SAP组高密度脂蛋白胆固醇（HDL-C）、载脂蛋白（Apo）A1、白脂素水平显著低于正常对照组（P < 0..01）,ACS组这些因素也显著低于SAP组（HDL-C P < 0.05；其余指标均P < 0.01）；ACS组和SAP组中吸烟率、男性比例、糖尿病患病率、脂蛋白（Lp）a、Apo B、糖化血红蛋白(HbA1c)、C反应蛋白（CRP）、同型半胱氨酸（Hcy）水平均显著高于正常对照组（LPa，HbA1c P < 0.05；其余指标均P < 0.01），ACS组这些因素也显著高于SAP组（APoA1, APoB, HbA1c, Hcy P < 0.05；其余指标均P < 0.01）。二分类Logistic回归分析发现白脂素和HDL-C与冠心病呈负相关(P < 0.01)；吸烟率、CRP和Hcy与冠心病呈正相关（吸烟率P < 0.05；其余指标P<0.01）；而男性、糖尿病、ApoA1、Apo B、Lp a与冠心病无明显相关性。 结论 血浆白脂素水平是冠心病的独立相关因素，与冠心病呈负相关。     

The frequency and severity of retinopathy are related to HbA1c values after, but not at, the diagnosis of NIDDM

OBJECTIVES: To examine the relationship between previous glycaemic exposure and prevalence of retinopathy 8 years after diagnosis of diabetes in 58 islet cell antibodies (ICA)-negative noninsulin-dependent diabetes mellitus (NIDDM) patients and in a group of 14 ICA-positive 'NIDDM' and insulin-dependent diabetes mellitus (IDDM) patients. DESIGN AND METHODS: The Wisconsin retinopathy scale was used to assess the retinopathy which was graded into mild, moderate and severe nonproliferative diabetic retinopathy (NPDR), or proliferative retinopathy (PDR). The frequency and severity of retinopathy was related to HbA1c levels at diagnosis, and 3 and 5 years later. RESULTS: Thirty of the 58 ICA-negative NIDDM patients (52%) but only 2 of the 14 ICA-positive 'NIDDM' or IDDM patients (14%) had mild-moderate-severe NPDR 8 years after diagnosis (P = 0.02). None had PDR. Retinopathy 8 years after diagnosis in NIDDM (= 58 ICA-negative patients) was correlated with the degree of glycaemic control (HbA1c levels) at 3 and 5 years after diagnosis, but not to HbA1c levels at diagnosis. The relative risk for a higher average HbA1c (per percentage) at 3 and 5 years was 1.56 for any retinopathy vs. no retinopathy (95% confidence interval 1.1-2.2; P = 0.01) and 1.68 for moderate to severe NPDR in comparison with no DR and mild NPDR (95% confidence interval 1.0-2.8; P = 0.04). CONCLUSIONS: Retinopathy after 8 years of diabetes in NIDDM patients was associated with impaired glycaemic control during previous years but not with glycaemic control at baseline. Good glycaemic control may prevent retinopathy in patients with NIDDM.     

Association of plasma fibrinogen level and blood pressure with diabetic retinopathy, and renal complications associated with proliferative diabetic retinopathy, in Type 2 diabetes mellitus.

AIM: To clarify the association of several clinical parameters, including plasma fibrinogen level, with diabetic retinopathy in patients with Type 2 diabetes mellitus (DM). METHODS: A total of 294 Japanese patients with Type 2DM were studied; 53 patients with no diabetic retinopathy (NDR), 90 with background diabetic retinopathy (BDR), and 151 with proliferative diabetic retinopathy (PDR). Multiple logistic regression analysis was performed to assess variables independently associated with diabetic retinopathy in two settings: presence of retinopathy of any severity and presence of advanced retinopathy. RESULTS: The following parameters were identified as independent factors associated with the presence of diabetic retinopathy (NDR vs. BDR + PDR): type of therapy (P<0.0005), log-transformed plasma fibrinogen level (P < 0.05), mean blood pressure (P < 0.05), and duration of diabetes (P < 0.05). The independent variables associated with advanced retinopathy were type of therapy (P<0.00005), age (P<0.0005) and nephropathy (P<0.05). Body mass index, smoking and hypertensive status, HbA1c and total cholesterol levels were not independently associated. CONCLUSIONS: These data suggest that in patients with Type 2 DM, an increased blood viscosity due to high fibrinogen level as well as an elevated intravessel pressure play a role in the development of diabetic retinopathy, and that the progression to PDR is influenced or accompanied by the deterioration of renal status.     

Renal and retinal microangiopathy after 15 years of follow-up study in a sample of Type 1 diabetes mellitus patients

PURPOSE: In the present study, the objective is to determine the epidemiological risk factors in the appearance of diabetic retinopathy and nephropathy in 112 Type 1 diabetic patients after 15 years. METHODS: A 15-year follow-up study was done in a cohort of 112 consecutive Type 1 (IDDM) diabetes mellitus patients without diabetic retinopathy or nephropathy at enrolment in 1990. We studied the incidence of diabetic retinopathy and/or microalbuminuria. The epidemiological risk factors included in the study were gender, diabetes duration, HbA(1c) levels, arterial hypertension, levels of triglycerides and fractions of cholesterol (HDL-cholesterol and LDL-cholesterol). RESULTS: The incidence of diabetic retinopathy was 55.40% at the end of study; the risk factors associated were duration of diabetes mellitus (P<.001), high levels of HbA(1c) (P=.009), presence of arterial hypertension (P=.007) and high levels of LDL-cholesterol (P=.002). The incidence of microalbuminuria was 41.07% and that of overt nephropathy, 19.60%; the risk factors associated were high levels of HbA(1c) (P<.001) and presence of arterial hypertension (P=.023). At the end of study, four groups of patients were formed: patients without microalbuminuria or retinopathy, patients with microalbuminuria only, patients with retinopathy only and patients with retinopathy and microalbuminuria. From the results of the discriminate analysis, we may assume that for the development of retinal lesions only, in the diabetes mellitus, the duration of the disease, the high levels of HbA(1c) and the arterial hypertension are most important, and for the development of renal and retinal lesion simultaneously, the important factor is poor control of glycemia measured by levels of HbA(1c) and arterial hypertension. CONCLUSIONS: In conclusion, microalbuminuria correlated well with severe forms of diabetic retinopathy, and at the end of the study, two groups of patients had been configured: the first group had developed only diabetic retinopathy, and the second, their patients with diabetic retinopathy together with renal lesion (microalbuminuria). For the first group, the duration of diabetes mellitus was the most important risk factor, and for the second group, the levels of HbA(1c) and blood pressure were the most important.