2型糖尿病患者合并下肢动脉病变的筛查及管理规范

一、前言 最新流行病学调查显示，我国20岁以上成人糖尿病患病率为9．7％，糖尿病前期的患病率为15．5％。糖代谢异常与下肢动脉粥样硬化性病变（lower extremity atherosclerotic disease，LEAD）的关系密切。我国尚无有关糖尿病患者LEAD的流行病学数据，一些局部流行病学调查和住院糖尿病患者的结果显示，50岁以上的患者中LEAD的患病率达6．9％-23．8％。     

北京社区老年男性干部人群代谢综合征的流行病学研究

目的 调查北京部分社区老年男性干部人群代谢综合，征（MS）患病率。方法 于2003年9月和2004年5月在136个驻京部队干休所社区随机抽取1736人进行横断面调查，以中国糖尿病协会的建议为诊断标准，对老年男性干部人群的MS患病率进行了分析。结果 北京部分社区老年男性干部人群的MS患病率为30．7％，肥胖为39．6％、高血压为62．0％、高血糖为56．4％、高甘油三酯血症为37．1％。老年组和高龄老年组MS和高血压的患病率相似，高龄老年组的肥胖和高甘油三酯血症患病率显著低于老年组，而高血糖患病率则明显高于老年组，MS危险率也显著高于老年组。MS、糖代谢异常和高血压随年龄逐步增加，而高甘油三酯血症和肥胖的患病率则逐步下降。结论 北京部分社区老年男性干部人群具有较高的MS患病率，MS和各组分的患病率在不同的年龄段有所不同。进一步的流行病学调查和对人群进行干预的研究十分必要。     

伊犁地区多民族人群血清甘油三酯分布特点及其与糖代谢异常的关系

目的 了解伊犁地区多民族人群血清甘油三酯（TG）分布特点及其与糖代谢异常关系的范围,为扩大对糖代谢异常防治的范围提供依据。方法采用分层随机整群抽样的方法,对占伊犁地区总人口96．8％的哈萨克族、维吾尔族、汉族、回族、锡伯族、蒙古族6个主体民族的常住人口进行血脂、血糖代谢异常的流行病学调查。在进行问卷调查和体格检查的同时,检测调查对象的血糖和血脂水平。结果伊犁地区受调查人群高TG血症患病率为36．10％,城镇高于乡村,男性高于女性（P值均〈0．001）;维吾尔族和汉族人群高TG血症患病率（分别为51．73％和46．56％）高于哈萨克族和蒙古族人群患病率（分别为16．39％和18．42％）;高TG血症患病率随着年龄的增长而呈不同程度的增加（RR值1．10～2．48）;糖代谢异常的患病率亦随着血TG水平的增加而逐渐增加（P〈0．05）。结论伊犁地区多民族人群血清TG水平存在民族、地域、年龄和性别的差异;高TG血症者糖代谢异常患病率增加。     

糖尿病标准化诊疗工作任重道远

在我国经济快速发展的背景下,糖尿病患病率也以惊人的速度快速增长。1980年全国首次进行了14省市30万人的流行病学调查,资料显示全人群糖尿病的患病率为0．67％（成年人患病率为1．0％）。2007至2008年中华医学会糖尿病学分会（CDS）组织了全国14个省市的糖尿病流行病学调查,显示我国20岁以上的成年入糖尿病患病率为9．7％。     

老年糖尿病的进展

随着经济的增长、人民生活方式的改变,人口老龄化、高热量摄入、低活动量、高压力状态等诸多凶素导致了糖尿病发病率的迅猛增长。近年来的流行病学调查显示目前我国糖尿病的患病率在4％左右,糖耐量异常人群甚至超过糖尿病人群。在糖代谢障碍的人群中,老年糖尿病患者占到了相当大的比例。解放军总医院1996～2000年对一组老年人群的随访调查显示60岁以上人群糖尿病的平均患病率为28．7％,     

辽宁省农村地区高血压人群糖代谢异常的流行病学调查

目的了解辽宁省农村地区≥35岁高血压人群糖代谢异常患病率及相关危险因素。方法采用分层整群抽样方法对阜新农村≥35岁常住（≥5年）高血压人群进行流行病学调查。FPG按1997年ADA建议分类,使用SPSS11.5进行统计分析。结果空腹血糖受损（IFG）患病率为9.7%,男性高于女性;女性IFG患病率随年龄增长而增加。糖尿病（DM）患病率为10.0%,男性低于女性;DM患病率男、女均随年龄增长而增加。IFG及DM患病率随血压级别增高而增加。Logistic回归分析显示,糖代谢异常的相关危险因素为年龄、血压级别、超重或肥胖。结论辽宁省阜新农村地区高血压人群IFG及DM患病率较高,应给予关注,综合评估,全面治疗。     

青岛城区居民2型糖尿病患者一级亲属不同糖耐量人群的糖和脂肪代谢状况

目的调查青岛城区T2DM一级亲属（FDR）不同糖代谢状态人群的糖、脂代谢异常的患病率。方法从该城区糖尿病流行病学调查数据库中，抽取既往无DM病史者1392例（T2DM患者FDR528例，非糖尿病FDR864例）作为研究对象，检测血压、体脂、OGTT、胰岛素释放试验、血脂、血尿酸（suA），计算WHR、BMI等。结果（1）T2DM患者FDR新诊DM患病率（24．24％）明显高于非糖尿病FDR（17．01％），P=0．00；（2）在FDR新诊DM患者中，单纯FPG≥7.0mmol／L者占6．25％，单纯2hPG≥11．1mmol／L者占30．47％，两者均符合DM诊断标准者占63．28％；（3）糖尿病FDR组WHR、体脂、SBP、DBP、TG、LDL-C、SUA等均显著高于非糖尿病FDR组（P＜0.01）；（4）糖尿病FDR组一种以上代谢异常及代谢综合征的发生率均明显高于非糖尿病FDR组（P=0.00）。结论2型糖尿病一级亲属不仅DM患病率明显高于普通人群，而且常存在超重或肥胖、高血压和血脂异常。     

驻湘部队老年男性干部代谢综合征的发病率调查

目的：调查驻湘部队老年男性干部人群代谢综合征的患病率。方法：于2006年3月1日～2006年11月30日，选择来我院门诊体检的年龄≥60岁驻湘老年男性干部，采用整群随机抽样方法进行横断面研究，以中国糖尿病协会的建议为诊断标准，对老年男性干部人群代谢综合征的患病率进行了分析。结果：驻湘部队老年男性干部人群的代谢综合征（MS）患病率为20．5％，肥胖患病率44．8％，高血压为47．1％，高血糖为26．8％，高血脂为22．5％。高龄老年组的各项患病率均高于老年组。结论：驻湘部队老年男性干部人群具有较高的代谢综合征患病率，代谢综合征和各组分的患病率在不同的年龄段有所不同。进一步的流行病学调查和对人群进行干预的研究十分必要。     

心房颤动的治疗进展

心房颤动（AF，简称房颤）为目前心律失常的热点之一。近年来高血压、冠心病已超过风湿性心脏病成为房颤的主要病因。胡大一等在我国13个省份进行了房颤大规模流行病学调查。研究表明，中国房颤患病率为0．77％，男性房颤患病率（0．9％）高于女性（0．7％），患病率有随年龄显著增加的趋势，80岁以上人群患病率达7．5％。     

胰岛素抵抗的基础与临床研究进展

2型糖尿病（T2DM）和代谢综合征（MS）已成为全球的慢性流行性疾病,严重威胁人群的健康,极大地增加了全球公共卫生经济负担。2000年美国第三次国家卫生和营养调查发现20岁以上人群MS的流行率达23．7％;我国2007年由中华医学会糖尿病分会组织的14个省人群的T2DM及MS流行病学调查显示,18岁以上人群标化糖尿病发生率为9．5％,MS的标化患病率达到14．77％。此外,一个非常严峻的事实就是儿童与青少年MS的患病率也急剧上升,在美国,青少年MS的患病率增加了50％。胰岛素抵抗（IR）参与T2DM发病机制在MS发病中仍不失其中心地位,故此IR问题一直是世界医学研究的热点。本文将对近年研究进展的一些重要方面作一评述。     

伊犁地区多民族人群脂代谢紊乱状态的调查

目的了解伊犁地区多民族人群脂代谢紊乱状态。方法采用分层整群抽样方法，对伊犁地区6个主体民族常住人口进行关于脂代谢异常的流行病学调查。在进行问卷调查和体格检查的同时，检测调查对象的血脂。结果（1）伊犁地区被调查人群脂代谢紊乱患病率为52．70％。高甘油三酯血症和混合性高脂血症患病率男性高于女性（P〈0．05），高胆固醇血症患病率男、女间差异无统计学意义（P〉0．05）。（2）脂代谢紊乱类型存在民族差异（x^2=17．62，P〈0．01），哈萨克族和蒙古族人群高胆固醇血症和高甘油三酯血症分别高于和低于维吾尔族、汉族、回族和锡伯族人群（P均〈0．05），混合性高脂血症患病率6个民族间差异无统计学意义（P均〉0．05）。结论伊犁地区受检人群脂代谢紊乱类型存在民族差异。     

多囊卵巢综合征患者糖代谢异常发生率及其特点

目的 探讨多囊卵巢综合征患者糖代谢异常特点及其发生率.方法 回顾性分析2006年6月1日至2009年2月1日广州中山大学孙逸仙纪念医院妇产科收治的初诊多囊卵巢综合征患者654例(青春期101例,成人553例),以120名年龄匹配的健康志愿者为对照组(青春期40名,成人80名).病例和对照组均行口服葡萄糖耐量试验和胰岛素释放试验,比较病例组和对照组、成人多囊卵巢综合征与青春期多囊卵巢综合征、不同体重指数亚组中糖代谢异常的特点及其发生率.结果 多囊卵巢综合征患者糖代谢异常的发生率为24.5%(160/654),显著高于对照组的3.3%(4/120)(χ2=27.11,P<0.0001);成人病例组糖代谢异常的发生率高于青春期病例组(分别为26.6%、12.9%,χ2=8.688,P=0.003),青春期病例组代谢异常的发生率高于青春期对照组(分别为12.9%、0%,χ2=5.671,P=0.02).多囊卵巢综合征患者糖代谢异常主要表现为糖耐量受损(62.5%),其次为空腹血糖受损(43.8%),糖尿病仅占少数(8.1%);糖尿病13例,仅4例(30.8%)空腹血糖>7.0 mmol/L,9例(69.2%)通过口服葡萄糖耐量试验筛查发现.多囊卵巢综合征组糖代谢异常的发生率随体重指数升高而升高(χ2=53.71,P<0.0001).结论 多囊卵巢综合征患者为糖代谢异常的高危人群,其糖代谢异常以糖耐量受损为主,空腹血糖受损次之.多囊卵巢综合征患者(尤其是肥胖者)应行口服葡萄糖耐最试验,以早期发现其糖代谢异常.     

Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent

This cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes and impaired glucose tolerance in subjects aged 40 years or more in Kashmir Valley, India. The study was carried out in two phases. In phase one, 6091 randomly selected subjects, 40 years or older, from all six districts of the valley were surveyed for prevalence of known diabetes mellitus. In phase two, 5083 subjects, 40 years or older, were screened with oral glucose tolerance test for prevalence of undiagnosed (asymptomatic) diabetes mellitus and impaired glucose tolerance. Abnormalities of carbohydrate intolerance were determined as recommended by WHO. Of 6091 subjects interviewed, 115 were known cases of diabetes mellitus with an overall prevalence of 1.89% (1.98% in males and 1.77% in females). Results of glucose tolerance test revealed that mean fasting as well as mean 2 h blood glucose was significantly more in females as compared to males (4.68+/-0.91 and 6.40+/-2.12 vs. 4.49+/-0.96 and 5.94+/-2.03 mmol/l, respectively, P < 0.0001). Of 5083 subjects who were subjected to glucose tolerance test (GTT), 627 (12.34%) had an abnormal test; with 411 (8.09%) having impaired glucose tolerance (IGT) and 216 (4.25%) having diabetes mellitus. The prevalence of IGT as well as of diabetes was significantly more in females as compared to males (P < 0.001). Subjects who had family history of diabetes had a significantly higher prevalence of abnormal GTT. Prevalence of known diabetes as well as that of abnormal GTT steadily increased with age, with a highest prevalence in the age group of > or = 70 years (P < 0.001). Obese subjects had a significantly higher basal as well as 2 h blood glucose in males as well as in females. Subjects with diabetes on GTT had a higher waist/hip ratio. Overall the prevalence of diabetes as well as IGT was significantly higher in the urban population. We conclude that 1.89% of the general population have known diabetes, 4.25% have undiagnosed diabetes and 8.09% have impaired glucose tolerance test; making the total load of abnormal glucose tolerance 14.23% in Kashmir Valley. In subjects greater than 40 years of age having a family history of diabetes, obesity, higher age (50 years or above), female sex, and urban origin have more chance (odds ratio: 4.65, 2.30, 1.87, 1.49 and 1.16, respectively) of developing abnormal glucose tolerance.     

Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter?

OBJECTIVE: To examine gender differences in the characteristics and prevalence of various categories of glucose tolerance in a population study in Mauritius. RESEARCH DESIGN AND METHODS: In 1998, a community-based cross-sectional survey was conducted in Mauritius. Categories of glucose metabolism were determined in 5388 adults, with an oral glucose tolerance test given to those who did not have previously diagnosed diabetes (n=4036). Other cardiovascular risk factors were assessed among those without known diabetes. RESULTS: For men and women the prevalence of diabetes (22.0 vs. 21.8%, respectively) and the prevalence of coexisting impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (3.2 vs. 2.9%) were similar. However, men were twice as likely as women to have isolated IFG [5.1% (4.2-6.0) vs. 2.9% (2.3-3.5)], despite being younger, thinner and with lower plasma insulin but higher lipids. Conversely, the prevalence of isolated IGT was lower in men [9.0% (7.9-10.2) vs. 13.9% (12.6-15.1)]. Among non-diabetic individuals, fasting glucose was higher in men than women, whereas 2-h glucose was higher in women. In people without diabetes, women had significantly higher body mass index, beta cell function (HOMA-B), fasting and 2-h insulin than men and significantly lower waist-hip ratios, waist circumference, insulin sensitivity (HOMA-S) and triglycerides. CONCLUSION: In Mauritius, the distribution of impaired glucose metabolism differs by sex. The observation that IFG is more prevalent in men and IGT more prevalent in women raises important questions about their underlying aetiology and the ability of the current glucose thresholds to equally identify men and women at high-risk of developing diabetes. IFG should be seen as a complimentary category of abnormal glucose tolerance, rather than a replacement for IGT.     

成都地区中老年高血压人群糖代谢异常流行状况及其影响因素

目的 探讨成都地区中老年高血压人群糖代谢异常流行状况及影响因素.方法 于2008年采用分层整群抽样的方法,调查成都城乡地区40～79岁中老年人口4685例,进行血压、口服葡萄糖耐量试验(OGTT)等检测,已确诊糖尿病患者只测空腹血糖,开展问卷调查.比较高血压及非高血压人群糖代谢异常患病率,获取中老年高血压人群单纯性糖耐量异常及单纯性负荷后高血糖情况,分析中老年高血压人群糖代谢异常的影响因素.结果 成都地区中老年高血压人群糖代谢异常患病率(53.4%)显著高于非高血压人群(25.1%);若不行OGTT,仅依靠检测空腹血糖,将漏诊中老年高血压人群中72.9%的糖尿病前期患者和54.4%的新诊断糖尿病患者;年龄、一级亲属糖尿病史、超重或肥胖为成都地区中老年男性高血压人群发生糖代谢异常的独立危险因素,体育锻炼、文化程度高为保护因素;年龄、一级亲属糖尿病史、腹型肥胖、高TG血症为成都地区中老年女性高血压人群发生糖代谢异常的独立危险因素.结论 成都地区中老年高血压人群超过半数合并糖代谢异常,需要通过OGTT及时发现这些合并糖代谢异常的患者.适当运动,了解糖尿病相关的保健知识以采取合理的生活方式,干预超重或肥胖、腹型肥胖及高TG血症等代谢性因素,对于减少中老年高血压人群糖代谢异常的发生有着较为重要的作用.     

Glucose intolerance and associated factors in Mongolia: results of a national survey.

AIMS: Prevalence of glucose intolerance-diabetes and impaired glucose tolerance (IGT)-and of related conditions such as obesity and hypertension, was studied in six population samples in Mongolia in 1999. METHODS: Diagnosis of glucose intolerance was made on the basis of 2-h blood glucose concentration, according to criteria recommended by the latest report of a WHO Expert Group. RESULTS: Crude prevalence of diabetes was 2.9% (2.6% in men and 3.2% in women). Prevalence of IGT was 10.2% (9.3% in men and 10.8% in women). Age standardization to the standard world population of Segi resulted in a total sample prevalence of 3.1% for diabetes and 9.2% for IGT. Prevalence of abnormal glucose tolerance differed according to district of residence. Approximately one-third of the subjects with diabetes were diagnosed prior to the survey. Of those who were diagnosed previously, approximately one-half were not under any form of treatment. Subjects with abnormal glucose tolerance were older, more obese and had higher blood pressure and prevalence of hypertension than those with normoglycaemia. One-half of men and almost one-half of women were hypertensive. Three-quarters of the diabetic subjects were hypertensive. One-third of all subjects were centrally obese. Considering the conditions of principal interest-glucose intolerance, hypertension and obesity-one-half of all subjects demonstrated one or more of these conditions. Central obesity was the most common condition, followed by hypertension and then glucose intolerance. Central obesity and hypertension was the most common combination (17% of all subjects) and 4% exhibited all three conditions. CONCLUSIONS: Non-communicable diseases are already a threat to public health in Mongolia. Although the prevalence of diabetes is not high by international standards, the relatively high prevalence of IGT suggests that the situation may deteriorate in the future in the absence of concerted action to prevent and control diabetes and related conditions.     

黑龙江省部分地区不同年龄、性别组糖代谢异常患病率调查

目的 调查黑龙江部分地区20～74岁人群的糖代谢异常年龄和性别分布情况,为糖尿病的防治提供依据.方法 选取2007年9月至2008年3月期间黑龙江省糖尿病流行病学调查中20～74岁的人群共3058例(男1219例、女1839例)作为研究对象,其中空腹血糖受损(IFG)患者143例,糖耐量异常(IGT)患者333例,IFG+IGT患者113例,糖尿病患者265例,糖调节正常(NGR)个体2204名.测定受试者空腹血糖、口服葡萄糖耐量试验(OGTT)1 h血糖及OGTT 2 h血糖.依据WHO1999年糖尿病的诊疗标准进行诊断.采用M-H x2检验分析组间数据.结果 糖尿病女性患病的高峰在60～74岁组,患病率为15.57%(20～29岁组:4.35%;30～39岁组:4.68%;40～49岁组:6.87%;50～59岁组:12.20%);男性患病的高峰在50～59岁组,患病率为21.84%(20～29岁组:5.96%;30～39岁组:10.60%;40～49岁组:11.79%;60～74岁组:15.0%).糖调节受损(IGR)女性和男性患病的高峰均在60～74岁组,患病率分别为35.33%(20～29岁组:13.04%;30～39岁组:14.56%;40～49岁组:20.62%;60～74岁组:24.58%)和30.83%(20～29岁组:16.80%;30～39岁组:14.90%;40～49岁组:28.05%;50～59岁组:17.78%).结论 IGR、糖尿病和IFG+IGT组的男性、女性和男女合计患病率和IGT组的女性和男女合计患病率均随年龄增加有上升趋势,而IFG组的男性、女性和男女合计患病率以及IGT组男性患病率和年龄无关.性别和年龄是糖尿病患病的两个重要危险因素,要采取综合措施预防和控制老年人糖尿病,特别是老年男性.     

Diabesity in Australia: an affair of the heart

The objective of the Australian Diabetes and Lifestyle Study (AusDiab) was to determine the frequency of diabetes and other categories of glucose intolerance (impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)), as well as other cardiovascular risk factors in Australia and to compare the prevalence with previous Australia data. The study involved a national sample involving 11 247 participants aged 25 years from the six states and the Northern Territory. They were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose levels. The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance. The prevalence of diabetes in Australia was 8.0% in men and 6.8% in women, and an additional 17.4% of men and 15.4% of women had IGT or IFG. The overall diabetes prevalence in Australia was 7.4%, and an additional 16.4% had IGT or IFG. Diabetes prevalence has more than doubled since 1981, and this is only partially explained by changes in age profile and obesity. Almost one in four Australians 25 years and over has either diabetes or a condition of impaired glucose metabolism. This condition is associated with substantially increased immediate risk of heart disease as well as increased risk of diabetes in the future. In addition, there were high prevalences of other key cardiovascular disease risk factors. Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly European background.     

乌鲁木齐市汉族老年人糖代谢异常的流行病学调查

目的 调查乌鲁木齐市60岁以上老年汉族居民糖尿病和糖尿病前期的患病率以及分布特点.方法 对乌鲁木齐市2个社区的居民进行查体及75 g葡萄糖耐量试验,共调查2210例,其中60岁以上老年人(老年组)为1231例,40～59岁中年人(中年组)951例.糖尿病诊断标准采用1999年WHO标准.结果 老年组糖尿病和糖尿病前期的患病率分别为32.2%、29.0%,标化后分别为25.6%、23.1%;较中年组患病率高(分别为12.3%、20.9%),差异有统计学意义(x2=192.62,P＜0.05);老年组糖耐量受损(IGT)患病率(21.6%)高于中年组(13.9%),差异有统计学意义(x2=20.97,P＜0.05);单IFG患病率在老年组与中年组间差异无统计学意义;老年组代谢综合征患病率为52.2%,高于中年组(33.7%),差异有统计学意义(x2=73.77,P＜0.05).回归分析结果显示,糖尿病家族史、高血压、高甘油三酯血症是老年人糖尿病发生的危险因素(x2=44.34,P＜0.05).结论 老年汉族人群糖尿病、IGT及代谢综合征的患病率均高于中年人群,必须重点采取干预措施.