NIDDM合并高血压的血液流变学变化及其意义

１９例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）合并高丘压患者，１７例 ＮＩＤＤＭ无高血压患者及２０例正常人对照研究发现，ＮＩＤＤＭ各组低切变率下全血粘大、红细胞聚集指迁、纤维蛋白原、糖化血清蛋白指数均显著高于正常对照组（Ｐ＜０．０５）；合并高血压组上述参数又显著高于无高血压组（Ｐ＜０．０５）．ＮＩＤＤＭ各组血沉、血程方程Ｋ值、甘油三酯均显著高于正常对照组（Ｐ＜０．０５）。ＮＩＤＤＭ各组血清白天白、超氧化对物岐化酶（ＳＯＤ）均显著低于正常对照组（Ｐ＜０．９５）．合并高血压组血清 ＳＯＤ又显著低于无高血压组（Ｐ＜０．０１）。结果提示，ＮＩＤＤＭ患者红细胞聚集性增高，合并高血压患者更为显著。ＮＩＤＤＭ患者并发高血压可能与红细胞聚集性增高有关。     

糖尿病患者血液流变性与甲襞微循环相关性研究

目的：研究糖尿病（ＤＭ）患者血液流变与甲襞微循环的相关性。方 法收测３５例糖尿病患者血流变、甲襞微循环及部分生化指标，与３５例正常人对照。结果（１）非胰岛素依赖性糖尿病（ＮＩＤＤＭ）组全血高、低切粘度和高、低切还原粘度及血浆粘度均显著高于对照组（Ｐ＜０．０１～０．００１）．而胰岛素依赖性糖尿病（ＩＤＤＭ）组上述各粘度指标仅轻度增高（Ｐ＞０．０５）；（２）各ＤＭ组及不同并发症亚组均有红细胞刚性指数增高，微循环血流速度减慢，红细胞聚集性增强，白色微血栓等指标显著异常（Ｐ＜０．０５～０．００１）；（３）ＮＩＤＤＭ 组及并发症亚组，微血管畸形数增多，管禅长度增加，微血管周围有明显渗出及出血等形态和管围指标的改变（Ｐ＜０．０５～０．００１）；（４）直线相关分析显示各ＤＭ组全血高切还原粘度与红细胞刚性指数，血浆粘度与甘油三酯水平，微循环内红细胞聚集程度与白色微血栓数量均呈正相关（Ｐ ＜０．０５～０．００１）；空腹血糖与微循环内血流速度呈负相关（Ｐ＜０．０５），ＩＤＤＭ组血浆粘度与全血高、低切粘度、白色微血栓呈正相关（Ｐ＜０．０５）。结论：（１）各型 Ｄ Ｍ 患者均有不同程度血液流变性异常及微循环障碍。（２）Ｄ Ｍ患者血液流变与     

胰岛素依赖型糖尿病患者外周T淋巴细胞亚群及血清SIL─2R变化

检测胰岛素依赖型糖尿病（ＩＤＤＭ）患者１４例、非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者２３例和正常对照组３０例血清可溶性白介素２受体（ＳＩＬ─２Ｒ）水平以及Ｔ淋巴细胞亚群的变化，结果发现，ＩＤＤＭ患者ＳＩＬ─２Ｒ水平显著低于正常对照组和ＮＩＤＤＭ组（Ｐ＜０．０１；Ｐ＜０．０５）。ＣＤ８显著低于正常对照组和ＮＩＤＤＭ组（Ｐ均＜０．０１），ＣＤ４／ＣＤ８比值明显升高，与正常对照组和ＮＩＤＤＭ组比较有显著性差异（Ｐ＜０．０１）。ＩＤＤＭ患者ＳＩＬ─２Ｒ水平与糖化血红蛋白和空腹血糖均无明显相关，但与空腹Ｃ肽呈显著性正相关（ｒ＝０．６８３，Ｐ＜０．０１）。结果表明，病程小于１年ＩＤＤＭ患者血清ＳＩＬ─２Ｒ以及淋巴细胞亚群异常改变导致免疫功能紊乱，血清ＳＩＬ─２Ｒ可作为衡量ＩＤＤＭ免疫异常指标之一，并对判断病情及胰岛功能、指导治疗都具有一定临床意义。     

肥胖型非胰岛素依赖型糖尿病者的脂代谢异常和脂肪肝的并发率

２６例肥胖的非胰岛素依赖型糖尿病（ＮＩＤＤＭ），体重指数（ＢＭＩ）≥２５，２４例ＮＩＤＤＭ（ＢＭＩ〈２５）分别分析其血脂、载脂蛋白Ａ和Ｂ１以及与脂肪肝并发率的关系。ＮＩＤＤＭ肥胖组平均胆固醇、甘油三酯、低密度脂蛋白胆固醇、载脂蛋白Ｂ１、空腹胰岛素、较ＮＩＤＤＭ非肥胖组明显增高，差异有显著性（Ｐ＜０．０５～Ｐ＜０．００１）。肥胖组高密度脂蛋白胆固醇较非肥胖组低，两组间差异有显著性（Ｐ＜０．０５）。两组载脂蛋白Ａ、空腹血糖、餐后２ｈ血糖差异无显著性。肥胖组脂肪肝并发率６５．４％，较非肥胖组（３３．３％）明显增高（Ｐ＜０．０５）。提示ＮＩＤＤＭ患者随着体重增加，脂代谢异常逐渐加重，脂肪肝的并发率也明显增高。     

胰岛素依赖型糖尿病患者外周T淋巴细胞亚群及血清SIL—2R变化

检测胰岛素依赖型糖尿病（ＩＤＤＭ）患者１４例、非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者２３例和正常对照组３０例血清可溶性白介素２受体（ＳＩＬ－２Ｒ）水平以及Ｔ淋巴细胞亚群的变化，结果发现，ＩＤＤＭ患者ＳＩＬ－２Ｒ水平显著低于正常对照组和ＮＩＤＤＭ组（Ｐ〈０．０１；Ｐ〈０．０５）。ＣＤ８显著低于正常对照组和ＮＩＤＤＭ组（Ｐ均〈０．０１），ＣＤ４／ＣＤ８比值明显升高，与正常对照组和ＮＩＤＤＭ组比较有显著     

一氧化氮、SOD与腰椎间盘突出症的关系

目的：探讨一氧化氮（ＮＯ）和超氧化物歧化酶（ＳＯＤ）在腰椎间盘突出症（ＬＩＤＰ）发病中的作用和意义。方法：分别用微盘测定法和亚硝酸盐形成法测定２０例ＬＩＤＰ患者及１８例正常人血浆ＮＯ及ＳＯＤ含量。结果：ＬＩＤＰ患者血浆ＮＯ水平比正常人显著增高（Ｐ＜０．０１），ＮＯ为：６．３９±３．６５μｍｏｌ／Ｌ与３．４８±０．９５μｍｏｌ／Ｌ；ＬＩＤＰ患者血浆ＳＯＤ水平比正常人增高，但无统计学意义（Ｐ＞０．０５），ＳＯＤ为：３７．５０±１６．３４ＮＵ／ｍｌ与３２．９３±１７．７７ＮＵ／ｍｌ。结论：ＬＩＤＰ的发病与自由基损伤有关。清除自由基、提高ＳＯＤ活性可能是治疗ＬＩＤＰ的方法之一     

100例糖尿病患者血液流变学变化及分析

作者对１００例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）惠者和４５例健康人对照，观察了红细胞变形指数、红细胞聚集指数、全血高切还原粘度、全血低切还原粘度、血浆比粘度．显示高血糖状态组、高脂血症组与对照组比较上述指标均有显著性差异（Ｐ＜０．０５），有血管病变组与对照组比较差异更显著（Ｐ＜０．０１）．结论：糖尿病（ＤＭ）患者高血糖状态、高血脂影响血液流变学，监测血液流变学改变，采取相应措施，对减少ＤＭ血管并发症的发生是有意义的．     

吸入一氧化氮治疗兔油酸急性呼吸窘迫综合征

目的：探讨吸入一氧化氮（ＮＯ）对急性呼吸窘迫综合征（ＡＲＤＳ）肺换气功能的影响及其毒副作用。方法：油酸诱发新西兰兔ＡＲＤＳ模型后分组（ｎ＝９）进行机械通气治疗４ｈｒ：（１）对照组；（２）吸入２０ｐｐｍＮＯ（ＮＯ组）。于动物实验的基础状态、治疗前测定ＰａＯ２／ＦｉＯ２、肺内静动脉分流（Ｑ·ｓ／Ｑ·ｔ）、血ＮＯ２－／ＮＯ３－和高铁血红蛋白（ＭｅｔＨｂ），治疗后ＰａＯ２／ＦｉＯ２于１、２、４ｈｒ，其余指标于４ｈｒ复查一次。观察肺病理并测定肺湿干重比（Ｗ／Ｄ）。结果：治疗后，对照组ＰａＯ２／ＦｉＯ２较治疗前呈下降趋势（４ｈｒ，Ｐ＜０．０５），Ｑ·ｓ／Ｑ·ｔ增加（４ｈｒ，Ｐ＜０．０１），ＮＯ组各时点ＰａＯ２／ＦｉＯ２均较治疗前和同时点的对照组明显增加（Ｐ＜０．０１～０．０５），Ｑ·ｓ／Ｑ·ｔ明显低于治疗前和同时点的对照组（４ｈｒ，Ｐ＜０．０５，Ｐ＜０．０１）。实验结束时，ＮＯ组ＮＯ２－／ＮＯ３－和ＭｅｔＨｂ较对照组显著增加（Ｐ＜０．０５，Ｐ＜０．０１），两组的肺病理和Ｗ／Ｄ无明显区别。结论：吸入２０ｐｐｍ能够明显改善兔油酸型ＡＲＤＳ的肺换气功能，无明显近期毒副作用     

慢性阻塞性肺病对血液流变学的影响

为了解慢性阻塞性肺病（ＣＯＰＤ）伴夜间低氧血症对血液变学的影响，对伴有不同程度的夜间低氧血症的ＣＯＰＤ患者６４例进行了血液流变学的测定。结果提示夜间脉搏血氧饱和度ＳＰＯ２≤８０％时间占睡眠时间＜３０％组（Ｂ组）红细胞压积、切变率为５．７５Ｓ－１、２３０Ｓ－１下全血粘度红细胞聚集指数较正常对照组明显升高，有显著性差异（Ｐ＜０．０１）；但ＳＰＯ２≤８０％时间占睡眠时间＜３０％组（Ａ组）仅切变率为５．７５Ｓ－１全血粘度增高有显著性差异（Ｐ＜０．０１）。切变率为２３０Ｓ－１全血粘度亦增高，有显著性差异（Ｐ＜０．０５）Ｂ组与对照组相比血浆粘度下降，有显著性差异（Ｐ＜０．０１）。说明ＣＯＰＤ伴夜间低氧血症可使血液粘滞性增加且与夜间低氧严重程度相一致。     

糖尿病人血浆血小板4因子及纤维蛋白原的研究

用肝素凝血酶凝固时间法测定４７例糖尿病病人血浆血小板４因子（ＰＦ＿４）高于３１例正常人（Ｐ＜０．００１），其中视网膜微血管病变组血浆ＰＦ＿４高于无微血管病变组（Ｐ＜０．０１），经治疗后有视网膜病变者血浆ＰＦ＿４下降（Ｐ＜０．０５）；用双缩脲法测定４７例糖尿病病人血浆纤维蛋白原高于３１例正常人（Ｐ＜０．００１），而视网膜微血管病变组较无视网膜微血管病变者增高（Ｐ＜０．０１）。     

Changes in glycosylated proteins in long-term complications of diabetes mellitus

Increased glycosylation of various proteins in diabetic patients has been reported by many authors. In the present study, the extent of non-enzymatic glycosylation in diabetic patients with or without chronic complications was investigated. Eighty-five diabetic patients were studied, 20 were without any clinical evidence of chronic complications while the remainder were suffering from cataract (n = 18), retinopathy (n = 16), peripheral neuropathy (n = 16) and cardiovascular complications like angina pectoris, myocardial infarction and hypertension (n = 15). All patients were selected on clinical grounds. Fifteen apparently healthy subjects of similar age and weight were studied as control subjects. Fasting plasma glucose was increased in all diabetic patients and correlated significantly with glycosylated hemoglobin, glycosylated plasma protein and serum fructosamine concentrations. There was no significant difference between diabetic patients with or without chronic complications in the levels of fasting plasma glucose, glycosylated plasma proteins, glycosylated hemoglobin, serum fructosamine, mucoprotein, hexosamine, sialic acid and fucose. Alpha-2 globulin fraction was increased in both uncomplicated and complicated diabetic patients and albumin was found to be decreased in patients with cataract, peripheral neuropathy and cardiovascular diseases. Alpha-1 and beta globulins were significantly decreased in patients with cardiovascular diseases and retinopathy respectively while gamma globulin was increased in retinopathy patients. In uncomplicated diabetic patients alpha-1 glycoprotein was decreased and gamma glycoprotein was increased. In diabetic patients with retinopathy, alpha-1 glycoprotein was elevated significantly while beta glycoprotein was decreased.     

Vascular endothelial cell antibodies in diabetic patients. Association with diabetic retinopathy.

OBJECTIVE--To determine the incidence of antiendothelial cell antibodies in diabetic patients with and without retinopathy. RESEARCH DESIGN AND METHODS--The study consisted of 70 insulin-dependent diabetic (IDDM) subjects, 36 non-insulin-dependent diabetic (NIDDM) subjects, and 40 nondiabetic control subjects. Blood samples were obtained from diabetic patients and control subjects and patients with background and proliferative retinopathy were identified. RESULTS--Vascular endothelial cell (VEC) antibodies were examined in the sera of 36 NIDDM subjects, 70 IDDM subjects, and 40 nondiabetic control subjects by indirect immunofluorescence. VEC antibodies were present in 5 of 40 (12%) control subjects, 7 of 23 (30%) newly diagnosed IDDM patients, 6 of 17 (35%) IDDM patients without retinopathy, 12 of 18 (67%) IDDM patients with background retinopathy (P less than 0.05), and 9 of 12 (75%) IDDM patients with proliferative retinopathy (P less than 0.01). Three of 13 (23%) NIDDM patients with retinopathy and 6 of 23 (26%) without retinopathy were VEC antibody positive. No associations were observed between the presence of VEC antibodies and either the quality of glycemic control or the duration of diabetes. A significant association between VEC antibodies and large-vessel disease was found in IDDM patients with retinopathy (P less than 0.05). CONCLUSIONS--Antibodies directed against vascular endothelial cells may play a role in the development of microvascular, and possibly macrovascular, disease in diabetes.     

Increased plasma endothelin in NIDDM patients with retinopathy.

OBJECTIVE--To elucidate the significance of ET in diabetic microvascular disease. RESEARCH DESIGN AND METHODS--We determined plasma levels of ir-ET-1 in 25 NIDDM patients without hypertension and/or renal dysfunction. RESULTS--The plasma levels of ir-ET-1 in NIDDM patients with simple (n = 8) and proliferative (n = 8) retinopathy were 0.58 +/- 0.04 pM and 0.60 +/- 0.04 pM, respectively, which were significantly higher than those in normal, nondiabetic subjects (0.24 +/- 0.02 pM [n = 31]) and NIDDM patients without retinopathy (0.30 +/- 0.05 pM [n = 9]). CONCLUSIONS--These results suggest that plasma ET-1 is related to diabetic microvascular disease.     

N-Acetyl β-d-glucosaminidase and α-l-fucosidase activities in relation to glycosylated hemoglobin levels and to retinopathy in diabetes

N-Acetyl β-d-glucosaminidase and α-l-fucosidase were determined in human sera from 25 control subjects, in 23 diabetic patients without retinopathy and in 22 diabetic patients with retinopathy.The results show significantly higher N-acetyl β-d-glucosaminidase activity in diabetic patients independently of the development of retinopathy and also independently of the length of diabetes. No correlation was found between either serum enzymes and serum glucose concentration and glycosylated hemoglobin (HbA,).     

NIDDM患者血清生长激素,C肽水平与微血管病变的关系

本文测定了20例NIDDM患者血清GH、C肽水平并观察其与视网膜病变及肾脏病变的关系。结果表明有视网膜病变组血GH水平明显高于无视网膜病变组,C肽水平在两组中无明显变化。提示糖尿病患者血GH水平增高与微血管病变有一定关系。     

C反应蛋白在糖尿病视网膜病变中的预测价值

目的 探讨C反应蛋白和糖化血红蛋白检测在糖尿病患者视网膜病变中的临床价值。方法 选取2012年3月至2013年10月该院内分泌科收治的2型糖尿病患者101例,根据患者视网膜病变并发情况,分为病变组（合并视网膜病变）42例和无病变组（未合并视网膜病变）59例,分别检测两组患者血清C反应蛋白水平。结果 病变组与无病变组患者血清C反应蛋白分别为（2．11±0．81）mg／L和（2．98±0．93）mg／L,病变组显著高于无病变组,差异有统计学意义（P〈0．05）,同时随着患者视网膜病变分级的升高,C反应蛋白水平依次升高。结论 糖尿病患者合并视网膜病变后血清C反应蛋白水平显著升高,并随着视网膜病变分期的升高而逐渐增强,提示C反应蛋白水平对2型糖尿病患者视网膜病变的严重程度具有一定的临床价值。     

Skin reactive hyperemia in diabetic patients. A study by laser Doppler flowmetry.

OBJECTIVE: To assess whether laser Doppler flowmetry could detect differences in the cutaneous response to postischemic reactive hyperemia between patients with non-insulin-dependent diabetes mellitus (NIDDM) and nondiabetic controls and among subgroups of NIDDM patients. RESEARCH DESIGN AND METHODS: We measured the cutaneous blood flow on the forearms during the postischemic reactive hyperemia test in diabetic patients and nondiabetic controls. Subjects were 25 patients with NIDDM from the outpatient clinics of dermatology, ophthalmology, and endocrinology and 25 nondiabetic volunteers matched for sex and age. Of the patients with NIDDM, 14 had proliferative retinopathy, and 13 were obese. Cutaneous postischemic reactive hyperemia test monitored by measuring the cutaneous blood flow with laser Doppler flowmetry was used. Peak blood flow (P) after arterial occlusion, the time required to reach this peak (Tp) and the ratio (K) between these two quantities (K = P/Tp) were measured. RESULTS: In diabetic patients, P was significantly lower (P less than 0.02) than in nondiabetic control subjects. In diabetic patients with proliferative retinopathy, K was lower (P less than 0.05) than in diabetic patients without retinopathy. Diabetic patients with a body mass index (BMI; wt/ht2) less than 25 kg/m2 had a longer Tp (P less than 0.002), whereas the control group BMI did not affect this parameter. The combination of retinopathy and BMI less than 25 gave the longest Tp values (P less than 0.0001). CONCLUSIONS: Postischemic hyperemia tests in diabetic patients reveal cutaneous microcirculatory changes in the forearm (lower P). Advanced retinopathy is associated with functional disturbances (lower K), especially when combined with a low BMI (less than 25; longer Tp).     

老年糖尿病性视网膜病变的血液流变学的分析

目的探讨老年Ⅱ型糖尿病患者的糖尿病视网膜病变与血流变紊乱 的关系。方法对ＤＲ组２７例、无ＤＲ组２４例以及正常对照组２５例进行血流变指标 和血脂的检测。结果 糖尿病组的全血粘度、血浆粘度、纤维蛋白原、红细胞聚集指 标、甘油三脂和总胆固醇明显高于正常对照组,红细胞变形指数低于正常对照组, 这些变化在 ＤＲ组更显著（ｐ＜０．０１）。提示血流变紊乱与老年Ⅱ型 ＤＭ患者 ＤＲ的 发生发展有密切关系,及时和长期控制高血粮、高脂血症,降低血液粘度对防治老 年病人 ＤＲ有重要的临床意义。     

Serum amyloid A protein in patients with non-insulin-dependent diabetes mellitus

We determined the serum amyloid A protein (SAA) levels in patients with non-insulin-dependent diabetes mellitus (NIDDM), and investigated the possible association between SAA and the complications of NIDDM.

The concentrations of SAA were measured in the plasma of 105 patients with NIDDM (52 men and 53 women, age mean ± SD, 61 ± 13 years) and 91 healthy subjects (37 men and 54 women, aged 57 ± 11 years). SAA concentrations were assayed by enzyme-linked immunosorbent assay.

SAA concentrations in the patients with NIDDM were significantly higher than those in healthy subjects (2.1 ± 1.3 vs. 1.2 ± 0.5 mg/L). There were no obvious relationships between SAA lebels and duration of diabetes, type of therapy, or control of blood sugar in the patients with NIDDM. However, SAA levels in patients with NIDDM increased significantly, with increase of urinary albumin excretion (p = 0.027). The increase of SAA in the patients with NIDDM did not influence the serum concentrations of lipid or lipoprotein.

The SAA concentration in NIDDM was unrelated to the type of treatment, but seemed to be related to the development of diabetic nephropathy.     

The relationship of hand abnormalities to diabetes and diabetic retinopathy

The hands of 299 diabetic patients with and 161 without retinopathy were examined for abnormalities. Almost all abnormalities were finger joint contractures resulting in limited joint mobility (LJM) and/or Dupuytren's contractures (DC). Both LJM and DC occurred not only in insulin-dependent diabetes (IDDM) but also in non-insulin-dependent diabetes (NIDDM). In retinopathy patients LJM and DC occurred in 48% and 36% of patients, respectively, compared with 24% and 16% in those without retinopathy. These differences were statistically significant (P less than 0.001). The higher prevalence of LJM in the retinopathy group affected mainly those with severe retinopathy, there being no difference between background and nonretinopathy patients. DC was less clearly related to severe retinopathy. LJM was more severe in those with than without retinopathy. LJM and DC were also related to age and duration of known diabetes. Subgroups matched for age and duration of known diabetes showed that the main relationship of hand abnormalities was to retinopathy in IDDM, but more to age and duration of known diabetes in NIDDM.