糖尿病和糖耐量低减患者生命质量评价

目的 了解糖尿病和糖耐量低减患的生命质量,并探讨其影响因素。方法 采用SF-36量表评价：108例糖尿病、109例糖耐量低减和116例糖耐量正常的生命质量,并研究其影响因素。结果 糖尿病患中,自我确认健康感觉非常好或很好占12．04％,与同龄人比较,健康感觉好或较好占62．04％;糖耐量低减患中上述比例较高,分别为13．76％和69．72％;生命质量综合评分很好或好的比例在糖尿病患为72．23％,糖耐量低减患为83．49％。糖尿病患生命质量已普遍下降,生命质量各维度评分最低为情绪角色功能,最高为躯体功能,波动在58．33-87．38之间,其中躯体功能、躯体角色功能、总体健康、精力和综合评分显低于糖耐量正常,精力、心理健康和综合评分显低于糖耐量低减;糖耐量低减患生命质量各维度有不同程度的损害,但其生命质量评分与糖耐量正常无统计学差异。相关分析显示,年龄、职业、离退休、病程、糖尿病症状数、并发症数量、空腹血糖和餐后2h血糖水平对糖尿病患生命质量有影响。结论 提高糖尿病患的生命质量,应该从疾病早期开始。控制血糖稳定,重视患的心理治疗和采取有针对性的措施,可提高不同特征患的生命质量。     

糖耐量减退与冠状动脉病变关系的研究

目的探索糖耐量减退与冠状动脉病变的关系,为预防控制冠心病提供科学依据。方法 125例冠心病患者分为正常糖耐量组(A组)、糖耐量减退组(B组)、2型糖尿病组(C组),所有病例均测定口服75 g葡萄糖2 h后血糖、空腹血糖、胰岛素、糖化血红蛋白、血脂等指标,并行冠状动脉造影,采用单因素方差分析,校正的χ2检验对上述临床资料进行分析。结果 A、B、C组空腹血糖、口服75 g葡萄糖2 h后血糖等指标的差异有统计学意义(均有P<0.05),B、C组的冠状动脉造影均显示病变,且多支血管病变的患病率明显高于A组,差异有统计学意义(均有P<0.05),而B组和C组间多支血管病变的患病率的差异无统计学意义(均有P>0.05)。结论冠心病合并糖耐量减退患者的冠状动脉病变程度较正常糖耐量者更为严重,应采取综合措施进行干预。     

Alcohol intake and 19-year mortality in diabetic men: NIPPON DATA80

Although moderate alcohol intake in diabetic Caucasians is associated with a reduction in coronary heart disease mortality, no study in Japanese with diabetes has examined the association between alcohol intake and mortality outcomes. We analyzed the relationship between alcohol intake and all-cause and cause-specific mortality using the database from NIPPON DATA80. At the baseline in 1980, data on history, lifestyle, and physical examinations were collected on study participants aged 30 years and older from randomly selected areas in Japan. After excluding participants with comorbidities, we followed 4,018 male participants (3,614 nondiabetics, 195 with impaired glucose tolerance and 209 diabetic) for 19 years. During the 19 years of follow-up, there were 990 deaths; 328 were from cardiovascular disease and 157 from all-heart diseases. With the never-drinking category serving as a reference, the Cox multivariate-adjusted hazard ratios for non-daily and daily drinkers for cardiovascular mortality were 0.43 (95% confidence intervals: 0.19-0.95) and 0.45 (0.25-0.80), respectively, and 0.33 (0.12-0.91) and 0.31 (0.15-0.67) for all-heart disease mortality in the combined impaired glucose tolerance and diabetic Japanese men. Alcohol drinking in men with glucose intolerance was associated with a significant reduction in cardiovascular and all-heart disease mortality as seen in the general population in Japan.     

社区居民吸烟、饮酒与糖尿病关系的研究

目的探索社区居民吸烟、饮酒与糖尿病的关系。方法采用整群抽样的方法对黑龙江省南岗区和兰西县平山镇35岁以上6195人进行调查。单因素分析采用χ2检验和趋势χ2检验,多因素分析时采用logistic回归调整混杂因素。结果按定性分析,吸烟、饮酒均是糖尿病的危险因素;随着吸烟指数和饮酒量的增加,糖尿病的患病率均出现先减少后增加的趋势,差异有统计学意义;调整性别、年龄、体重指数、就业、文化程度等因素后,年龄、BMI、文化程度和吸烟指数85~184组、185~329组、330及以上组是糖尿病的独立危险因素。结论少量吸烟和饮酒,不增加糖尿病的患病危险,吸烟指数85及以上是糖尿病的独立危险因素,日饮酒精量30g及以上是糖尿病的非独立危险因素。     

Alcohol consumption and higher incidence of impaired fasting glucose or type 2 diabetes in obese Korean men

It is inconclusive whether moderate alcohol consumption reduces the diabetes risk. We observed the development of impaired fasting glucose or type 2 diabetes according to the amount of alcohol intake and body mass index. The annual health evaluation data of 2,500 male workers from 2002 to 2006 were reviewed retrospectively deleting personal identification code. The information contained sex, age, medical history, smoking status, alcohol consumption, participating regular exercise, anthropometric, and biochemistry measurement. Impaired fasting glucose or diabetes was determined when fasting plasma glucose was ≥100 mg/dL. Thousand seven hundred seven subjects were eligible after excluding medical history of diabetes or fasting glucose ≥100 mg/dL at baseline. The relative risks of its development in group of taking 1-14, 15-29, and ≥30.0 g ethanol were 0.842 (95% confidence interval [CI], 0.603-1.176), 1.068 (95% CI, 0.736-1.551), and 1.019 (95% CI, 0.662-1.568) within normal weight group, 1.164 (95% CI, 0.795-1.705), 1.421 (95% CI, 0.947-2.133), and 1.604 (95% CI, 1.031-2.495) within overweight group, and 1.498 (95% CI, 1.042-2.153), 1.634 (95% CI, 1.091-2.447), and 1.563 (95% CI, 1.019-2.396) within obese group each after adjusting age, family history of diabetes, smoking, exercise, serum fasting glucose, aspartate aminotransferase, and γ-glutamyltransferase with nondrinkers as a reference group. Not only high alcohol consumption but also moderate drinking was related with higher incidence of impaired fasting glucose or diabetes in obese Korean men.     

维吾尔族和汉族妇女妊娠期糖尿病相关因素对比分析

目的:探讨维吾尔族和汉族妊娠期糖尿病的高危因素。方法:采用前瞻性对照研究的方法,对2005年10月～2006年9月门诊产前检查诊断的糖代谢异常孕妇593例[其中GDM260例(汉族172例,维吾尔族88例)、GIGT333例(汉族265例,维吾尔族68例)],(OGTT+组)和糖代谢正常孕妇1425例(汉族1135例,维吾尔族290例)(对照组)的临床资料进行分析,探讨各因素对维吾尔族和汉族GDM和GIGT发病的影响。结果:①糖筛异常发生率,汉族(37.10%)低于维吾尔族(44.34%)(P<0.005)。糖耐量阳性率,维吾尔族(15.58%)高于汉族(10.30%)(P<0.005)。维吾尔族GDM发生率(8.73%)明显高于汉族(4.06%)(P<0.005),而GIGT发生率(6.75%)和汉族(6.26%)相当(P>0.05)。②维吾尔族孕妇年龄≥35岁、孕妇孕期增重>18kg发生率,汉族VVC、糖尿病家族史发生率,均为GDM组高于GIGT组(P<0.05);而孕妇BMI≥25、不良孕产史发生率,在维吾尔族和汉族中均为GDM组高于GIGT组(P<0.05)。在GDM组中,孕妇BMI≥25、VVC发生率为维吾尔族高于汉族(P<0.05),孕妇孕期增重>18kg发生率为汉族高于维吾尔族(P<0.05);在GIGT组中,VVC、糖尿病家族史的发生率,维吾尔族高于汉族(P<0.005),而孕妇年龄≥35岁发生率为汉族高于维吾尔族(P<0.05)。结论:①维吾尔族糖筛查异常、糖耐量试验异常以及GDM发生率均高于汉族。②≥35岁和增重>18kg的维吾尔族孕妇、VVC和有糖尿病家族史的汉族更易发展为GDM,而肥胖、不良孕产史是两民族共同的GDM高危因素。维吾尔族肥胖、VVC,汉族增重>18kg,更易使GIGT向GDM转化,特别是维吾尔族VVC更应引起重视。糖尿病家族遗传史对维吾尔族、孕妇年龄≥35岁对汉族GDM发病亦有一定影响。     

中国人群饮酒与代谢综合征发病关系的前瞻性研究

目的研究我国成年人饮酒状况对代谢综合征（MS）发病的影响。方法本项目为前瞻性队列研究。2007至2008年对分别于1998和2000年基线调查的中国心血管病流行病学多中心协作研究35～74岁的27020例队列人群开展随访调查。结果基线14572例非MS人群经8年随访,共发生MS2362例。在调整了年龄、南北方、城乡、受教育程度、体力活动、吸烟、体质指数以及MS组分数后,和不饮酒者相比,男性饮酒者发生MS的相对危险度（RR）为1．24（95％CI：1．06～1．45）,人群归因危险度为10．13％;每日摄入酒精量10．1～20g,20．1—40g,〉40g组的RR分别为1．36（95％CI：1．02～1．82）,1．34（95％CI：1．03—1．74）和1．41（95％CI：1．13,～1．77）;每周饮酒2～5次和／〉6次的RR分别为1．25（95％CI：1．01～1．55）和1．26（95％CI：1．04～1．52）;只喝啤酒组、只喝白酒组和混合饮酒组的RR分别为1．60（95％CI：1．05～2．45）、1．30（95％CI：1．02～1．65）和1．27（95％CI：1．06～1．52）。女性每日摄入酒精量在10．1～20g组和〉20g组RR分别为2．67（95％CI：1．26—5．65）和2．38（95％CI：1．35—4．22）。结论在全人群中,每13摄入酒精量〉10g就会显著增加MS发病风险,在女性中尤为明显。男性每周饮酒≥2次以及只饮啤酒、只饮白酒和混合饮酒者均明显升高MS的发病风险。为减少MS的流行,应提倡限制酒精过量摄入,尤其女性更应限制酒精摄入量（≤10g／d）。     

包头钢铁公司职工糖尿病流行病学调查

目的 了解包头钢铁公司(包钢)职工糖尿病(DM)的患病率及其影响因素并进行有效的干预。方法 调查时间：1999年7月至2000年2月。调查对象为包钢主体单位20岁以上的工人和干部,受检人数占各单位20岁以上人数的90％。诊断标准采用美国糖尿病协会制定的标准(1997年)。结果 20221人中共检出DM600例,糖耐量低减(IGT)635例,空腹血糖受损(IFG)425例,标化后的患病率分别为3．22％、3．48％和2．09％,且随年龄、体重指数和腰臀比的增加而增高。新诊断的糖尿病病例占56．30％。肥胖、糖尿病家族史、女性有巨大胎儿史、脑力劳动及低文化程度者糖尿病的患病率明显增高。高温作业者与非高温作业者DM、IGT及IFG的患病率未见明显差异。结论 增龄、肥胖、糖尿病家族史、女性有巨大胎儿史、脑力劳动及低文化程度是易患糖尿病的高危因素,高温作业对糖尿病的患病率未见明显影响。     

血清超敏C反应蛋白检测在糖耐量减低及糖尿病患者中的临床意义

目的 比较不同糖耐量受试者血清超敏C反应蛋白(hs-CRP)水平,探讨hs-CRP检测在糖耐量减低(IGT)及糖尿病患者中的作用.方法 所有受试者均行口服葡萄糖耐量试验(OGTT),用免疫透射比浊法测定正常糖耐量(NGT)、IGT、2型糖尿病(T2DM)受试者血清hs-CRP水平.结果 NGT、IGT和T2DM者血清hs-CRP水平分别为(1.57±0.46)、(2.84±0.48)、(4.18±0.76)mg/L,hs-CRP分别与体重指数、收缩压、舒张压、空腹血糖、OGTT试验中2h血糖、三酰甘油和总胆固醇呈正相关.结论 T2DM患者早在IGT阶段就已经存在炎性反应,炎性反应可能参与了T2DM的发生和发展.hs-CRP作为炎性反应因子,在预测和监视T2DM方面有重要意义.     

血清超敏C反应蛋白检测在糖耐量减低及糖尿病患者中的临床意义

目的比较不同糖耐量受试者血清超敏C反应蛋白（hs-CRP）水平,探讨hs-CRP检测在糖耐量减低（IGT）及糖尿病患者中的作用。方法所有受试者均行口服葡萄糖耐量试验（OGTT）,用免疫透射比浊法测定正常糖耐量（NGT）、IGT、2型糖尿病（T2DM）受试者血清hs-CRP水平。结果NGT、IGT和T2DM者血清hs-CRP水平分别为（1．57±0．46）、（2．84±0．48）、（4．18±0．76）mg／L,hs-CRP分别与体重指数、收缩压、舒张压、空腹血糖、OGTT试验中2h血糖、三酰甘油和总胆固醇呈正相关。结论T2DM患者早在IGT阶段就已经存在炎性反应,炎性反应可能参与了T2DM的发生和发展。hs-CRP作为炎性反应因子,在预测和监视T2DM方面有重要意义。     

妊娠期糖耐量异常对妊娠结局的影响

目的:探讨妊娠期糖尿病(GDM)及妊娠糖耐量异常(G IGT)对妊娠结局的影响。方法:2 208例孕妇行50 g葡萄糖筛查(50 g GCT),对149例异常者行75 g葡萄糖耐量试验(OGTT),确诊糖耐量异常者(G IGT组)71例,妊娠期糖尿病者(GDM组)86例并与对照组300例分别比较妊娠结局。结果:50 g GCT阳性率为6.74%,G IGT及GDM检出率分别是3.22%和3.89%。GDM及G IGT两组患者妊娠期高血压疾病、羊水过多、巨大儿、剖宫产率、新生儿病率的发生率明显高于对照组(P<0.05),且两组对妊娠结局的影响无明显差异。结论:对所有孕妇进行50 g GCT,及早确诊GDM及G IGT,GDM与G IGT均能对妊娠造成不同程度的危害,应引起重视。     

Zinc Status Affects Glucose Homeostasis and Insulin Secretion in Patients with Thalassemia

Up to 20% of adult patients with Thalassemia major (Thal) live with diabetes, while 30% may be zinc deficient. The objective of this study was to explore the relationship between zinc status, impaired glucose tolerance and insulin sensitivity in Thal patients. Charts from thirty subjects (16 male, 27.8 ± 9.1 years) with Thal were reviewed. Patients with low serum zinc had significantly lower fasting insulin, insulinogenic and oral disposition indexes (all p < 0.05) and elevated glucose response curve, following a standard 75 g oral load of glucose compared to those with normal serum zinc after controlling for baseline (group × time interaction p = 0.048). Longitudinal data in five patients with a decline in serum zinc over a two year follow up period (−19.0 ± 9.6 μg/dL), showed consistent increases in fasting glucose (3.6 ± 3.2 mg/dL) and insulin to glucose ratios at 120 min post glucose dose (p = 0.05). Taken together, these data suggest that the frequently present zinc deficiency in Thal patients is associated with decreased insulin secretion and reduced glucose disposal. Future zinc trials will require modeling of oral glucose tolerance test data and not simply measurement of static indices in order to understand the complexities of pancreatic function in the Thal patient.     

空腹血糖水平影响2型糖尿病患者心肌梗死的发生及其严重程度

目的探讨2型糖尿病患者空腹血糖水平与心肌梗死发生及严重程度的关系。方法经冠状动脉造影证实有冠心病的161例2型糖尿病患者（合并心肌梗死61例），根据其空腹血糖水平分为4组：≤6．1、6.2～7．6、7.7～10．0和〉10.0mmol／L，观察心梗死的患病率和心肌酶谱的水平。结果随着空腹血糖水平升高，心肌梗死患病率增加（P〈0.05），心肌酶水平明显升高，空腹血糖水平与心肌酶水平呈显著正相关，Logistic回归分析显示心肌梗死与空腹血糖水平密切相关。结论空腹血糖水平明显地影响2型糖尿病患者心肌梗死的发生及其严重程度。     

糖耐量减低患者血清肝细胞生长因子水平及相关因素分析

目的 观察糖耐量减低(IGT)患者血清肝细胞生长因子(HGF)水平.方法 选取IGT患者(IGT组)、2型糖尿病(T2DM)患者(TxDM组)及健康对照者(NC组)各30例,分别测定血清HGF、空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(GHbA1c)、空腹胰岛素(FINS)、收缩压(SBP)、舒张压(DBP)等指标,并对HGF的相关因素进行分析.结果 IGT组与T2DM组血清HGF水平均高于对照组[分别为(413.22±102.48)、(422.76±126.77)、(120.45 4-25.11)ng/L](P<0.05),IGT组与T2DM组比较差异无统计学意义(P>0.05);FBG与HGF呈正相关(r=0.326,P<0.05),多元回归分析显示,HGF与DBP具有高度相关性(r=4.730,P<0.05).结论 血清HGF水平在IGT阶段即升高,表明存在血管内皮功能异常.     

Alcohol consumption and mortality: a dose-response analysis in terms of time

PurposeLow-to-moderate alcohol consumption is associated with decreased mortality. However, many aspects of this association are still debated. Our aim was to complement available information by conducting a dose-response analysis of the association between alcohol consumption and survival time.MethodsIn a Swedish population-based cohort of 67,706 middle-aged and elderly men and women, frequency and amount of drinking were assessed through a self-administrated questionnaire. During 15 years of follow-up, 13,323 participants died. Differences in survival (10th percentile differences, PDs) according to levels of alcohol consumption were estimated using Laplace regression.ResultsWe found evidence of nonlinearity between alcohol consumption and survival. Among women, we observed a rapid increase in survival up to 6 g/d of alcohol consumption (0.5 drinks/d) where survival was 17 months longer (PD = 17 months, 95% confidence interval, 10 to 24). After this peak, higher alcohol consumption was progressively associated with shorter survival. Among men, survival improved up to 15 g/d (1.5 drinks/d) where we observed a PD of 15 months (95% confidence interval, 8 to 22).ConclusionsLow alcohol consumption was associated with improved survival up to 1.5 years for women with an average consumption of 0.5 drinks per day and to 1.3 years for men with an average consumption of 1.5 drinks per day.     

男性饮酒与缺血性脑卒中发病关系的研究

目的 探讨中国男性人群中饮酒与缺血性脑卒中发病的关系。方法 1982～1985年在全国10组人群中分别整群随机抽取2000～4000人进行饮酒及心血管病危险因素调查,并对其中无冠心病、脑卒中及恶性肿瘤者脑卒中事件的发生情况进行随访观察,随访至1999～2000年,平均随访15.2年。结果 在12352名男性中共发生缺血性脑卒中283例。在控制了多种危险因素后,每日饮酒量(酒精含量)在0～、15～、30～和60g各组与不饮酒者相比,发生缺血性脑卒中的相对危险(OR值95％CI)分别为0.86(0.57～1.27)、1.20(0.87～1.65)、1.26(0.86～1.84)、1.96(1.30～2.93)。结论 在中国男性人群中,小量饮酒并不增加缺血性脑卒中发生的危险性,大量饮酒会使缺血性脑卒中发生的危险明显增加。     

Alcohol consumption and lipodystrophy in HIV-infected adults with alcohol problems

Lipodystrophy is a common long-term complication of HIV infection that may lead to decreased quality of life and less adherence to antiretroviral therapy (ART). A complete understanding of the etiology of HIV-associated lipodystrophy has not yet been achieved, although factors related to the virus, per se, and use of ART appear to be related. Alcohol use is common among HIV-infected patients and has biological effects on fat distribution, yet alcohol's relationship to HIV-associated lipodystrophy has not been examined. The goal of this clinical study was to assess the effect of alcohol consumption on lipodystrophy in HIV-infected adults with alcohol problems. This was a prospective study (2001-2006) of 289 HIV-infected persons with alcohol problems. The primary outcome was self-reported lipodystrophy, which was assessed at one time point (median 29 months after enrollment). Alcohol use was assessed every 6 months and classified as: abstinent at all interviews; ≥1 report of moderate drinking but no heavy drinking; 1 or 2 reports of heavy drinking; or ≥3 reports of heavy drinking. Multivariable logistic regression models were fit to the data. Fifty-two percent (150/289) of subjects reported lipodystrophy. Alcohol consumption was: 34% abstinent at all interviews; 12% ≥1 report of moderate drinking, but no heavy drinking; 34% 1-2 reports of heavy drinking; and 20% ≥3 reports of heavy drinking. Although not statistically significant, subjects with alcohol use had a higher odds of lipodystrophy (adjusted odds ratios and 95% confidence interval: ≥1 report of moderate drinking, 2.36 [0.89, 6.24]; 1-2 reports of heavy drinking, 1.34 [0.69, 2.60]; ≥3 reports of heavy drinking, 2.07 [0.90, 4.73]). Alcohol use may increase the odds of developing HIV-associated lipodystrophy among subjects with alcohol problems. However, larger studies are needed to fully elucidate the role and impact of alcohol consumption on the development of this common long-term complication of HIV infection and its treatment.     

Alcohol questionnaires and HDL: Screening scores as scaled markers of alcohol consumption

Improving the quality of alcohol-related care requires practical approaches to assessing alcohol consumption to guide management and monitor outcomes. Given the increasing use of alcohol screening questionnaires to identify alcohol misuse it would be ideal if scores on screening questionnaires were also indicators of average alcohol consumption. However, the questionnaires were not designed for this purpose and include dimensions of drinking that may not reflect average consumption (e.g. heavy episodic drinking, alcohol-related problems). In a general population sample, scores on the AUDIT-C screen correlated with reports of alcohol consumption in detailed interviews, but the relationship is unknown for clinical populations and other questionnaires. Serum high-density lipoprotein cholesterol (HDL) is a biomarker routinely obtained in clinical care and is known to rise with average alcohol consumption. This cross-sectional study of 11,175 male U.S. Veterans Affairs patients enrolled in a primary care study used HDL as an objective biomarker to evaluate whether average alcohol consumption increased as scores increased on 3 brief alcohol screens – the AUDIT-C, AUDIT Question #3 (a single-item screen), and the CAGE questionnaire. Mean HDL progressively increased as screening scores increased for the AUDIT-C and AUDIT Question #3: about 12 mg/dL from the lowest to the highest scores. The association was much weaker for the CAGE questionnaire. Results were minimally affected by adjustment for covariates (e.g. age, race, medical comorbidity, smoking, medication count, and depression) but the association was modified (p = 0.008) and mildly attenuated by adherent use of lipid-lowering medications. This study using HDL as a biomarker of average alcohol consumption adds to evidence that some alcohol screening scores may also serve as scaled markers of average alcohol consumption.     

饮酒与男性肺癌发病关系的前瞻性队列研究

目的 研究我国男性饮酒与肺癌发病风险之间的关联。方法 对开滦集团队列（2006－2015年）男性人群每两年随访一次,收集饮酒相关信息及肺癌发病资料;此外,检索开滦附属医院医疗信息系统、开滦集团社保系统、唐山市医疗保险系统,补充收集随访过程中可能遗漏的肺癌新发病例。以不饮酒人群为参比组,利用Cox风险比例回归模型分别分析饮酒频率、饮酒类型与男性肺癌发病风险的关联,计算发病风险比（HR）及其95% CI。按照吸烟状况对研究人群分层,分别分析从不吸烟与既往吸烟/现在吸烟人群中饮酒与肺癌发病的关联。结果 共纳入101 751名男性,总随访808 146.56人年,中位随访时间8.88年,共收集肺癌新发病例913名。调整年龄、吸烟状态、吸烟量、文化程度、粉尘暴露、BMI等潜在的混杂因素后,既往饮酒、现在饮酒频率<1次/d、现在饮酒频率≥1次/d人群肺癌发病风险HR值（95% CI）分别为1.30（0.90～1.88）、0.80（0.64～1.01）和1.04（0.85～1.27）。饮用啤酒/红酒（HR=0.91,95% CI：0.69～1.20）和饮用白酒（HR=0.99,95% CI：0.83～1.19）与肺癌发病无统计学关联。依据吸烟状况分层分析,所得结果类似。结论 本研究结果尚不支持饮酒与男性肺癌发病风险存在关联。