Ghrelin在GDM患者血浆中的检测及意义

目的:测定妊娠期糖尿病(Gestational diabetes mellitus,GDM)患者血浆ghrelin的水平,并分析该指标与体重指数、血糖、血脂和胰岛素抵抗的关系。方法:采用ELISA方法检测50例GDM患者、40例正常妊娠妇女及40例对照组的空腹血浆ghrelin浓度,并测定各组的空腹血糖、胰岛素及血脂,计算体重指数及胰岛素抵抗指数(HOMA-IR);进一步分析ghrelin与血糖、胰岛素、血脂、HOMA-IR的相关性。结果:(1)GDM组血浆ghrelin显著低于正常妊娠妇女及对照组,差异有显著性(P<0.01);GDM组体重指数、空腹血糖、空腹胰岛素、总胆固醇及甘油三酯的水平及HOMA-IR均明显高于正常妊娠妇女及对照组,差异均有显著性(均P<0.05);(2)GDM组血浆ghrelin浓度与体重指数、空腹血糖、空腹胰岛素,甘油三酯及HOMA-IR呈显著负相关(r=-0.48,P<0.05;r=-0.49,P<0.05;r=-0.43,P<0.05;r=-0.64,P<0.01)。结论:ghrelin参与了GDM胰岛素抵抗的发生过程;血浆ghrelin浓度可能作为一种新的敏感指标在评价GDM胰岛素抵抗程度方面具有一定的临床价值。     

A simple index for detection of gestational diabetes mellitus

The conventional screening test for gestational diabetes mellitus is measurement of plasma glucose 1 hour after 50 g glucose by mouth. The sensitivity and specificity of this test are lower than desirable; we therefore developed an index including other plasma constituents. In a preliminary study, 138 pregnant women had the standard oral glucose load screening test, and plasma fructosamine and total proteins were measured, in addition to glucose, in the 1-hour samples. An index value (I) was calculated as [fructosamine (micro mol/L) divided by total proteins (g/L)]x[glucose (mmol/L) divided by 100]. Cut-off values for I were then assessed in a second prospective study, of 642 pregnant women. Definitive diagnosis of gestational diabetes was by oral glucose tolerance test (OGTT). The index was also assessed in terms of fetal macrosomia (birthweight>or=4000 g). With a cut-off value of I=27.2, sensitivity was 98%, specificity 89%, diagnostic efficiency 90%, positive likelihood ratio 8.76. Application of the index would have avoided 42% of the OGTTs demanded by the standard screening test, reducing false positives from about 24% to 10%. Predictive efficacy for macrosomia was 10.3% versus 7.9%. Our index offers an efficient screening test for gestational diabetes, and with more stringent cut-off points may be applicable as a single-step diagnostic procedure.     

影响初孕妇妊娠糖尿病和产后糖尿病发病的因素

目的:探讨影响初孕妇妊娠糖尿病和产后糖尿病发病的因素。方法:2035例符合标准的初孕妇,由产科医师进行问卷调查,完成产前检查的同时记录随访结果。主要终检标准:发生产后糖尿病。影响妊娠糖尿病事件的因素用Logistic回归分析、组间产后糖尿病发生率比较用Kaplan-Meier曲线表示,并作对数秩检验。结果:2035例初孕妇平均年龄27.9岁,妊娠糖尿病146例,妊娠糖尿病发病率7.2%。孕前体重指数(RR=6.4,P=0.000)及孕妇母亲2型糖尿病史(RR=4.5,P=0.000)是妊娠糖尿病的危险因素(Logistic回归分析:χ2=272.1,ν=5,P=0.000)。2035例平均随访3.6年,产后糖尿病63例,产后糖尿病发病率3.1%,平均年产后糖尿病发病率0.9%。妊娠糖尿病组产后糖尿病发生率明显高于非妊娠糖尿病组产后糖尿病发生率(对数秩检验:统计量=101.7,ν=1,P=0.0000)。肥胖组产后糖尿病发生率最高,超重组产后糖尿病发生率居中,体重正常组产后糖尿病发生率最低(对数秩检验:整体比较,统计量=150.1,ν=2,P=0.0000。组间比较,正常组vs超重组,统计量=36.8,P=0.0000;正常组vs肥胖组,统计量=175.0,P=0.0000;超重组vs肥胖组,统计量=22.5,P=0.0000)。结论:母亲2型糖尿病史是初孕妇妊娠糖尿病的危险因素,妊娠糖尿病亦是产后糖尿病的危险因素,而孕前体重指数高既是初孕妇妊娠糖尿病的危险因素,又是产后糖尿病的危险因素。     

妊娠期糖尿病患者晚孕期血脂水平检测的临床意义

目的研究妊娠期糖尿病(gestational diabetes mellitus,GDM)患者晚孕期血脂水平检测的临床意义。方法选择2012年5月至2015年10月在深圳市龙岗区第七人民医院妇产科被确诊为GDM的孕晚期孕妇85例为观察组,同期待产的健康孕晚期孕妇100例为对照组,采集血清并测定血脂指标、血糖及血清胰岛素(insulin,INS)含量、炎性因子含量,计算胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR)和胰岛β细胞分泌指数(homeostasis model assessment–β,HOMA-β)。结果观察组患者总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度胆固醇(low density lipoprotein cholesterol,LDL-C)、载脂蛋白B(apolipoprotein B,Apo B)的含量明显高于对照组,高密度胆固醇(high density lipoprotein cholesterol,HDL-C)、载脂蛋白A(apolipoprotein A,Apo A)的含量明显低于对照组(P0.05);INS含量、HOMA-IR均明显高于对照组,HOMA-β均明显低于对照组(P0.05);血清C反应蛋白(C-reaction protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、同型半胱氨酸(homocysteine,HCY)含量均明显高于对照组(P0.05);血清TC、TG、LDL-C、Apo B含量与INS、CRP、TNF-α、IL-6、HCY的含量以及HOMA-IR呈正相关,与HOMA-β呈负相关(P0.05);血清HDL-C、Apo A1的含量与INS、CRP、TNF-α、IL-6、HCY的含量以及HOMA-IR呈负相关,与HOMA-β呈正相关(P0.05)。结论 GDM患者晚孕期血脂水平的检测不仅能够评估血脂代谢情况,还与胰岛素敏感性、全身炎症反应具有良好一致性。     

Charcot-arthropathy in diabetes mellitus

Charcot's arthropathy is a relative uncommon complication of diabetic neuropathy. The aetiology remains poorly understood. According to the neurotraumatic theory, the foot, which has become insensitive through neuropathy, is subjected to extensive (micro)trauma through continuation of use. Ultimately this leads to destruction. According to the neurovascular theory, autonomic neuropathy results in an increased blood flow in the foot with osteopenia consequently resulting due to increased osteoclastic activity and decreased osteoblastic activity. Acute Charcot's arthropathy presents with a red, warm, swollen foot, which is usually not painful and which eventually becomes ulcerated. An insidious development of the condition is also possible. The X-ray of the foot often is normal at presentation, but will later show local osteoporosis, erosions, subluxations or fractures. Technetium scintigraphy will be abnormal from the beginning, while IgG scans are usually normal. The traditional treatment is cast immobilisation with careful introduction of protected weight-bearing. After stabilisation, orthopaedic footwear is necessary to improve foot function and to prevent ulceration. Regular checkups are important.     

镁与糖尿病

糖尿病具有镁缺乏的倾向，可能与糖尿相关的高尿镁症、营养因素以及高胰岛素血症相关的高尿镁症等因素有关。已证明，血浆镁水平与胰岛素敏感性呈负相关，补充镁可提高2型糖尿病病人的胰岛素敏感性及胰岛素的分泌；但是，并未证明在1型糖尿病及2型糖尿病病人中口服补充镁对基血糖控制品有有缓作用。对糖尿病易感大鼠口服补充镁可减少其发病。与无视网膜病变的病人相比，有(严重的)视网膜病变的病人血镁水平降低。前瞻性研究表明，血镁水平与视网膜病变的发生发展呈负相关，进一步研究补充镁预防2型糖尿病及视网膜病变的进展，并作为降低高血压的一种方法，是值得的。     

Dyslipidemia in diabetes mellitus

Patients with diabetes mellitus are at high risk of cardiovascular diseases. Dyslipidemia is an important risk factor for cardiovascular complications in diabetes. Increased triglyceride and reduced HDL-cholesterol plasma concentrations are common features of dyslipidemia in type 2 diabetes. The LDL particles are small and dense and have an increased atherogenity. Abnormalities in lipoprotein composition are observed in diabetes mellitus, especially in type 2. Post-hoc subgroup analyses of studies on the effect of lipid-lowering therapy on cardiovascular events suggest that treatment of dyslipidemia in diabetes may prevent cardiovascular complications. There are increasing indications that dyslipidemia in diabetes mellitus deserves aggressive treatment and that lipid target levels should be very low.     

糖尿病医院感染患者糖化血红蛋白的监测意义

目的探讨糖化血红蛋白值监测对糖尿病患者发生医院感染评估的临床意义。方法检测61例糖尿病医院感染患者(感染组)与61例糖尿病未发生医院感染患者(对照组)的糖化血红蛋白值与空腹血糖值,并进行统计分析。结果感染组糖化血红蛋白值为(9.68±2.38)%,空腹血糖值为(9.65±2.89)mmol/L;对照组糖化血红蛋白值为(6.35±2.07)%,空腹血糖值为(8.98±2.64)mmol/L;两组糖化血红蛋白值比较,差异有显著性(P<0.01),空腹血糖值差异无显著性(P>0.05)。结论糖化血红蛋白值可作为糖尿病患者医院感染高危因素的监测指标之一,其稳定性优于空腹血糖值。     

孕前糖尿病和妊娠期糖尿病患者的母婴结局分析

目的观察孕前糖尿病和妊娠期糖尿病患者的母婴结局。方法选取2013年1月-2015年5月在该院营养门诊就诊并住院分娩的妊娠合并糖尿病患者879例进行回顾性分析,分为孕前糖尿病(PGDM,68例)和妊娠期糖尿病(GDM,811例)两组,对比分析母婴结局情况。结果本研究中妊娠期高血压疾病的总发病率为5.2%,PGDM患者妊娠期高血压疾病的发病率(16.2%)显著高于GDM患者(4.3%)(P0.05)。通过营养治疗,妊娠合并糖尿病巨大儿的发病率为6.5%,新生儿黄疸的发病率为5.0%。巨大儿的发病率、新生儿黄疸的发病率PGDM患者与GDM患者比较差异无统计学意义(P0.05)。PGDM患者新生儿低血糖发病率略高于GDM患者,但差异无统计学意义(P0.05)。PGDM患者新生儿肺炎和早产儿的发病率(19.1%、16.2%)显著高于GDM患者(9.5%、4.8%)(P0.05)。结论 PGDM患者的母婴并发症比GDM严重,应在孕期指导糖尿病患者饮食和运动相结合,并配合使用胰岛素,保持血糖平稳,降低母婴并发症的发病率。     

Pentamidine-induced diabetes mellitus

Twelve cases of diabetes mellitus following pentamidine isethionate ( Lomidine ) treatment for antimonial -resistant cases of kala-azar are reported. 11 were found to be insulin-dependent and one insulin-independent. One patient died at home two months later and the rest still had diabetes mellitus at follow-up after two to five years.