Effect of valsartan on monocyte/endothelial cell activation markers and adiponectin in hypertensive patients with type 2 diabetes mellitus

Angiotensin II receptor blockade has been shown to have a beneficial effect on the angiopathies of hypertension and hyperglycemia in patients with type 2 diabetes. However, the effect of angiotensin II receptor blockade on monocyte and endothelial cell adhesion markers in type 2 diabetes is poorly understood. We investigated the effects of valsartan on these markers in 53 hypertensive patients with and without type 2 diabetes mellitus. Levels of monocyte activation markers (soluble CD14: 2.1+/-0.9 vs. 3.3+/-1.4 mug/ml, p<0.01; monocyte chemotactic peptide: 392+/-94 vs. 489+/-114 pg/ml, p<0.05; and monocyte-derived microparticles: 264+/-98 vs. 511+/-128/muL, p<0.01) and endothelial cell activation markers (soluble E-selectin: 41+/-11 vs. 61+/-20 ng/ml, p<0.001; and soluble vascular cell adhesion molecule-1: 478+/-82 vs. 584+/-101 ng/ml, p<0.01) were significantly increased in hypertensive patients with type 2 diabetes compared to normotensive controls. In addition, the concentrations of adiponectin were significantly decreased in patients with type 2 diabetes (8.1+/-3.1 vs. 5.2+/-2.5 mug/ml, p<0.01). Regardless of the presence of diabetic complications, both systolic and diastolic blood pressures significantly decreased after valsartan administration (valsartan 80 mg/day for 8 weeks). Monocyte and endothelial cell activation markers were decreased significantly in patients with type 2 diabetes after valsartan treatment, but not in non-type 2 diabetic patients. In addition, valsartan alleviated hypoadiponectinemia in hypertensive patients with diabetes (before vs. after: 5.2+/-2.5 vs. 7.6+/-2.7 mug/ml, p<0.001) but did not increase adiponectin levels in the non-diabetic hypertensive group, for which the average adiponectin level was normal prior to treatment. These results suggest angiotensin II receptor blockade (valsartan) may be beneficial as an anti-atherosclerotic therapy in patients with type 2 diabetes in addition to its anti-hypertensive action.     

2型糖尿病患者交感皮肤反应分析

目的探讨交感皮肤反应(SSR)对检测2型糖尿病(T2DM)患者交感神经功能损害的诊断价值。方法选择本院收治的60例2型糖尿病患者进行交感皮肤反应检测,并与40例健康人进行对比。结果60例糖尿病患者交感皮肤反应与对照组比较,起始潜伏时差异有统计学意义(P<0.05),而波幅上下肢差异无统计学意义。结论SSR可以作为评价糖尿病患者交感神经功能的一个显著指标。     

硫辛酸注射液治疗2型糖尿病耳鸣患者的疗效分析

目的探讨硫辛酸注射液治疗2型糖尿病患者耳鸣的临床疗效。方法对照组10例接受腺苷钴胺、血栓通治疗,研究组11例在对照组基础上加用硫辛酸注射液,评价2组治疗效果。结果研究组总有效率（81.8%）明显高于对照组（30%）,治疗过程中未发现不良反应。结论硫辛酸注射液治疗2型糖尿病患者耳鸣临床疗效显著,且具有良好的安全性。     

帕罗西汀对2型糖尿病伴发抑郁患者疗效观察

目的评价帕罗西汀对2型糖尿病伴发抑郁患者抑郁、焦虑症状的疗效及安全性。方法对45例2型糖尿病伴发抑郁患者给予帕罗西汀治疗12周,采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、MOS健康状况调查问卷(SF-36)评定疗效,采用副反应量表(TESS)和相关实验室检查评定安全性。结果帕罗西汀能明显改善2型糖尿病伴发抑郁患者抑郁、焦虑症状,治疗后患者生活质量明显提高；无明显副反应。结论帕罗西汀对2型糖尿病伴发抑郁患者的治疗安全有效。     

100例2型糖尿病患者交感神经皮肤反应研究

目的探讨交感神经皮肤反应(SSR)检测在评价2型糖尿病(T2DM)自主神经损害中的价值.方法对100例T2DM患者进行SSR检测,30例健康志愿者作为对照.结果2组SSR的起始潜伏期、N波潜伏期、波幅、面积比较差异有显著性意义(P＜0.05),P波潜伏期差异无显著性意义(P＞0.05).T2DM组72例(72%)患者至少有一肢SSR异常.血糖控制满意组和血糖控制不良组比较,起始和N波潜伏期差异有统计学意义(P＜0.05),波幅和面积无显著性意义(P＞0.05).T2DM组病程＜5年与病程≥5年比较,潜伏期、波幅、面积差异均无统计学意义(P＞0.05).结论SSR可作为评价T2DM自主神经损害的客观电生理指标;T2DM患者SSR与血糖控制水平相关,与病程无关.     

Long-term treatment with nifedipine modulates procoagulant marker and C-C chemokine in hypertensive patients with type 2 diabetes mellitus

In type 2 diabetes mellitus, there is increased risk of nephropathy and cardiovascular complications and the incidence of renal failure increases in advanced stages of the disease. Nifedipine, a dihydropyridine-type calcium antagonist, improves endothelial function in hypercholesterolemia by enhancing nitric oxide function, and increases endothelial nitric oxide bioavailability by antioxidative mechanisms. We administered nifedipine, 50 mg/day, to the hypertensive patients for 12 months. There were no other changes in any of the patient's pharmacologic regimen during nifedipine treatment. Clinical and biochemical data obtained before and after nifedipine administration were compared. All markers were measured by ELISA. The levels of platelet activation markers (CD62P, CD63, PAC-1, and Annexin V), microparticles (PDMP and MDMP), RANTES and soluble adhesion markers (sP-selectin and sVCAM-1) differed in the control group and the hypertension group. The levels of these markers were also different in hypertensive patients with and without type 2 diabetes but were unchanged in patients without diabetes in comparison to the control group. However, the concentrations of MDMPs, chemokines, and soluble adhesion markers in hypertensive patients without type 2 diabetes decreased significantly following nifedipine treatment, although the level of RANTES was unchanged. Systolic blood pressure correlated with CD62P, CD63, annexin V, and RANTES levels, and diastolic blood pressure with CD62P and annexin V levels. The effect of nifedipine on platelet activation markers and C-C chemokines in the present study indicates potential effectiveness of calcium antagonist therapy for hypertensive patients with type 2 diabetes.     

急性动脉粥样硬化型脑梗死患者血清CXCL16水平与2型糖尿病的相关性研究

目的探讨血清CXCL16水平与2型糖尿病、急性脑梗死的关系。方法选取2013年1月至2013年12月在石河子大学医学院第一附属医院神经内科住院的30例脑梗死患者(CI组)、30例2型糖尿病患者(DM组)、30例2型糖尿病合并脑梗死患者(DM+CI组)及30例同期体检健康者(对照组)。比较各组受检者的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、Hcy、糖化血红蛋白(Hb A1c)、CXC趋化因子配体16(CXCL16)水平,采用Pearson相关分析CXCL16的相关因素;采用二分类Logistic回归分析2型糖尿病合并脑梗死的影响因素。结果 1 4组受检者TG、TC、LDL、CXCL16、Hb A1c、Hcy水平比较,除TC外,差异均有统计学意义(P﹤0.05);CI+DM组、DM组、CI组CXCL16的水平均高于对照组,其中CI+DM组最高[0.747(0.839),P﹤0.05];2血糖控制未达标(Hb A1c≥6.5%)者血清CXCL16水平高于血糖控制达标(Hb A1c﹤6.5%)者[(0.839±0.708)ng·m L-1与(0.526±0.865)ng·m L-1,t=-2.005,P=0.047];3 Pearson相关分析显示,血清CXCL16水平与NIHSS评分、Hb A1c水平均成正相关(r分别为0.318,0.376,P值分别为0.013,0.001)。结论 CXCL16在急性脑梗死及糖尿病患者血清中表达明显增高,与神经功能缺损程度及血糖水平有明显的正相关关系,可以作为评估急性动脉粥样硬化型脑梗死及合并2型糖尿病患者预后的一个指标。     

2型糖尿病患者焦虑抑郁情绪与个性、应对方式的相关性研究

目的探讨2型糖尿病患者焦虑抑郁情绪与个性、应对方式的关系。方法采用综合性医院焦虑抑郁量表（HAD）、艾森克个性问卷修订版（EPQ）和医学应对问卷（MCMQ）对120例2型糖尿病患者进行评定。结果2型糖尿病患者中女性焦虑量表分、神经质量表分和屈服量表分高于男性；焦虑情绪与内外倾、面对的应对方式呈负相关，与神经质呈正相关；抑郁情绪与神经质、屈服的应对方式呈正相关，与内外倾及面对的应对方式呈负相关。结论2型糖尿病患者焦虑抑郁情绪与个性及应对疾病的方式有相关性。     

2型糖尿病脑梗死临床分析

目的分析2型糖尿病脑梗死临床特点,为其防治提供依据。方法将糖尿病脑梗死50例与非糖尿病脑梗死50例进行危险因素、临床特点等比较。结果糖尿病组高血压发病率、血脂水平、进展性卒中比例及复发性脑梗死比例均高于非糖尿病组,差异有统计学意义(p<0.05),而发病年龄、神经功能缺损程度、脑梗死类型及部位无显著性差异。结论糖尿病脑梗死患者易合并高血压、高血脂等多种危险因素,病情容易进展,复发的风险高,而糖尿病对脑梗死类型、部位及病情轻重无明显影响。     

2型糖尿病伴抑郁症状患者的脑诱发电位研究

目的了解2型糖尿病伴抑郁症状患者的认知功能及脑诱发电位的变化。方法102例2型糖尿病患者,按照汉密尔顿抑郁量表（HAMD）评分结果,50例合并抑郁症状者为研究组,52例不合并抑郁症状者为对照组,比较2组脑诱发电位P300、失匹配负波（MMN）、血脂及脑部核磁共振显像检查。结果2组患者血脂、脑部核磁共振显像及脑诱发电位P300无统计学差异。与对照组比较,研究组脑诱发电位失匹配负波潜伏期延长,波幅降低。结论抑郁症状进一步加重糖尿病患者认知功能及脑诱发电位改变,MMN是敏感的早期检测手段。     

脂肪因子CTRP1与2型糖尿病合并脑梗死患者脂代谢异常的相关性研究

目的 探讨脂肪因子CTRP1与脂肪三酰甘油脂酶(ATGL)、内皮脂肪酶(EL)和脂蛋白相关磷脂酶A2(Lp-PLA2)与2型糖尿病合并脑梗死发病的关系.方法 选取2018-12—2020-10郑州大学第二附属医院确诊的2型糖尿病患者36例、合并脑梗死患者36例及健康体检者34例为研究对象.采用酶联免疫吸附法检测血清CT...     

游离脂肪酸与老年2型糖尿病患者轻度认知功能障碍的研究

目的探讨游离脂肪酸(FFA)与老年2型糖尿病(T2DM)患者轻度认知功能障碍(MCI)的关系。方法选择85例老年T2DM患者,应用蒙特利尔认知评估(MoCA)量表评定认知功能,分为T2DM认知功能正常组(T2DM-NC)45例和T2DM认知功能障碍组(T2DM-MCI)40例,另选择糖耐量正常且认知功能正常者35例为对照组(NC)。测定3组FFA、糖化血红蛋白(HbA1c)、血脂等。结果 T2DM-MCI组FFA水平(7.45±0.13)mmol/L高于T2DM-NC组(6.32±0.13)mmol/L及NC组(4.56±0.11)mmol/L。T2DM-MCI患者的MoCA评分与糖尿病病程(r=-0.507,P=0.001)、FPG(r=-0.581,P0.001)、HOMA-IR(r=-0.360,P=0.022)、HbA1c(r=-0.533,P0.001)、TC(r=-0.358,P=0.023)、TG(r=-0.408,P=0.009)、LDL-C(r=-0.377,P=0.016)、FFA水平(r=-0.566,P0.001)呈负相关,与HDL-C(r=0.365,P=0.021)呈正相关。多重线性回归分析结果示,FPG(β=-0.290,P=0.015)、HbA1c(β=-0.272,P=0.019)、FFA(β=-0.375,P=0.001)、病程(β=-0.248,P=0.037)是MoCA评分的危险因素。结论血清FFA是T2DM患者MCI的危险因素。     

2型糖尿病患者轻度认知功能障碍的临床分析

目的探讨2型糖尿病患者轻度认知功能障碍的特点。方法将122例2型糖尿病患者分为伴2型糖尿病轻度认知功能障碍组(45例)、不伴2型糖尿病轻度认知功能障碍组(41例)和对照组(36例),使用蒙特利尔认知评估量表(montreal cognitive assessme,MoCA)对患者的命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆进行评分评估。结果与对照组比较,伴2型糖尿病轻度认知功能障碍组在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等评分比较差异具有统计学意义(P0.01)。与不伴2型糖尿病MCI组比较,伴2型糖尿病MCI组在总分、视空间/执行功能、注意、持续注意、延迟回忆等评分2组间差异有统计学意义(P0.05)。结论伴2型糖尿病的MCI患者在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等方面有不同程度的损害;其总体认知功能损害较不伴2型糖尿病者严重,尤其在视空间/执行能力、注意、持续注意及记忆方面。     

An association between multiple sclerosis and type I diabetes mellitus

Summary We report five patients who had multiple sclerosis (MS) associated with type I diabetes mellitus (TODM). Examination of the Israeli National Neurological Disease Register revealed the prevalence of TODM among 334 MS patients under the age of 30 years to be 8.98 per 1,000. This is significantly higher than the prevalence of TODM in the general population of Israel for the same age group, which is 0.095 per 1,000. MS and TODM share clinical, epidemiological and immunological features, and both diseases have a target site that is neuroectodermal in origin. The association between these two putative autoimmune diseases may suggest a similar pathogenetic mechanism.     

2型糖尿病患者大脑中动脉狭窄与肾素-血管紧张素系统基因多态性的关系

目的 探讨大脑中动脉(MCA)狭窄与肾素-血管紧张素系统(renin angiotensin system,RAS)基因多态性的关系。方法 对2202个汉族2型糖尿病人用经颅多普勒(transcranial Doppler,TCD)筛选,MCA狭窄者为病例组,其余为对照组,然后经年龄、性别、糖尿病病程配对后选择病例组218例,对照组489例,用PCR、PCR-RFLP检测ACE、ATIR、AGT基因型。结果 病例组和对照组的三种基因的基因型、等位基因频率分布无差异;但在AGT基因的基因型为TT时,病例组的ACE基因的ID、DD基因型比例较高(P<0.1,OR=1.40),而在ACE基因的基因型为ID、DD时,病例组的AGT基因的TT基因型比例也较高(P<0.05,OR=1.71);在ATIR基因的基因型为AA时,病例组的AGT基因的TT基因型比例较高(P<0.1,OR=1.66)。结论 RAS单个基因的多态性与MCA狭窄不相关,但RAS的几个基因之间的相互作用与MCA狭窄有关。     

糖尿病患者认知功能障碍及其相关因素的分析

目的　探讨 2型糖尿病 (DM)患者的认知功能改变 ,评价 2型DM认知功能障碍的敏感指标及相关危险因素。方法　对 10 0例 2型DM患者和 4 0名健康对照者进行简易智能精神状态检查表 (MMSE)和韦氏记忆量表 (WMS R)评定及事件相关电位 (ERP)测定 ,分析其认知功能、P3 0 0 波的潜伏期 (P3 PL)与病程、治疗状况和糖化血红蛋白 (GhbA1)的关系。结果　 2型DM组MMSE和WMS R评分均低于对照组 (P <0 0 1,P <0 0 5 ) ,N2 PL和P3 PL较对照组均显著延长 (P <0 0 0 1) ,且与MMSE和WMS R呈负相关 (r =- 0 5 13,P <0 0 1;r =- 0 898,P <0 0 0 1)。病程≥ 10年组患者的P3 PL长于病程 5～ 10年组 ,后者又长于病程≤ 5年组 ;未治疗和未进行正规治疗的患者P3 PL长于正规降糖治疗者 (P <0 0 1) ;GhbA1与P3 PL呈正相关 (r=0 718,P <0 0 0 1)。结论　 2型糖尿病患者存在明显的认知功能障碍 ,ERP和其他量表一样能反映认知功能损害的程度 ;2型DM的病程、治疗以及血糖控制状况均与认知功能显著相关。     

Blood serotonergic mechanisms in type 2 (non-insulin-dependent) diabetes mellitus

Serotonin (5-hydroxytryptamine, 5HT) is believed to play a role in vasospasm and increased platelet aggregability that in turn could contribute to atherosclerosis. The present study was designed to evaluate a possible participation of serotonin in the development of vascular complications in diabetes mellitus. Whole blood and plasma serotonin, the platelet uptake and release of the amine and serotonin-induced platelet aggregation were studied in 32 patients with Type 2 diabetes. The patients were divided into three groups according to the presence and advancement of retinopathy. Mean levels of blood serotonin content were significantly lower in diabetic patients. The concentration of the amine in the plasma was markedly increased in diabetes. It was correlated with vascular changes of the retina. We established that platelets from diabetic patients took up less serotonin when compared to the control group. Concomitantly enhanced spontaneous release of 5HT from platelets was observed. The platelets of diabetic patients showed increased response to serotonin. There was a relation between serotonin-induced aggregation and the presence of retinopathy. These results suggest that serotonin may be involved in the pathogenesis of diabetic vasculopathy.     

T2DM患者脑诱发电位失匹配负波的变化观察

目的观察T2DM患者脑诱发电位失匹配负波的变化特点。方法对50例T2DM患者、40例正常人进行失匹配负波(MMN)检查。结果与正常对照组比较,T2DM患者脑诱发电位的MMN潜伏期延长、波幅降低,2组比较差异有统计学意义(P<0.05)。结论T2DM患者存在认知功能损害,MMN是敏感的检测工具。     

Neural substrates of verbal memory impairments in adults with type 2 diabetes mellitus

Background: Verbal memory impairment is well documented in type 2 diabetes mellitus (T2DM) but, to date, the neural substrates remain unclear. The present study evaluated verbal memory and ascertained the degree of frontal and temporal lobe involvement in the anticipated verbal memory impairment among adults with T2DM. Method: Forty-six late-middle-aged and elderly adults with T2DM and 50 age-, sex-, and education-matched adults without T2DM underwent medical evaluation, verbal memory assessment, and brain magnetic resonance imaging (MRI) evaluations. Results: As anticipated, participants with T2DM had clear verbal memory impairments. Consistent with prior reports, we found volume reductions restricted to the hippocampus. Our diffusion tensor imaging analysis revealed that participants with T2DM had extensive cerebral gray and white matter microstructural abnormalities predominantly in the left hemisphere, with a larger concentration present in the temporal lobe. In contrast, we uncovered mostly nonspecific microstructural abnormalities in the absence of tissue loss in the frontal lobe. Of great importance, we present the first evidence among participants with T2DM linking verbal memory impairment and compromised microstructural integrity of the left parahippocampal gyrus, a key memory-relevant structure. Conclusions: Our results suggest that the hippocampus and parahippocampal gyrus may be particularly vulnerable to the deleterious effects of T2DM. The parahippocampal gyrus in particular may play a crucial role in the verbal memory impairments frequently reported in T2DM. Future studies should employ methods such as resting state functional magnetic resonance imaging and diffusion tensor imaging tractography to better characterize network connectivity, which may help further characterize the verbal memory impairment frequently reported in T2DM.     

2型糖尿病患者伴发脑梗死危险因素的研究

目的 探讨2型糖尿病伴发脑梗死的危险因素。方法 对32例2型糖尿病伴发脑梗死患者（A组）及30例单纯2型糖尿病患者（B组）分别询问生活习惯、病史，检测血脂、血糖、体质量、身高，超声检测颈总动脉内-中膜厚度（CCA—IMT）、斑块的发生率等，并进行相关性分析。结果 A、B两组间患者在年龄、吸烟史、糖尿病病程、以及高密度脂蛋病白、空腹血糖水平比较差异有显著性（均P〈0．05）；体质量指数、血总胆固醇、纤维蛋白原、糖化血红蛋水平的比较差异具有极显著性（均P〈0.01）；CCA—IMT及斑块发生率的比较差异也具有显著性（P〈0．05～0．01）；CCA—IMT与年龄、糖尿病病程、血纤维蛋白原、空腹血糖、糖化血红蛋白水平明显正相关（r分别为0．58、0.37、0．45、0.39、0．48，均P〈0．01），与血高密度脂蛋白水平呈负相关（r=-0．41，P〈0．05）。结论 观察空腹血糖、糖化血红蛋白、高密度脂蛋白、纤维蛋白原，监测CCA—IMT及斑块情况，适时干预，对2型糖尿病患者预防脑梗死并发症是有价值的。