2型糖尿病合并冠心病患者心血管危险因素控制的临床分析

目的探讨心血管危险因素控制在2型糖尿病合并冠心病患者中的意义。方法筛选2型糖尿病合并冠心病患者140例,行问卷调查,对比心血管危险因素控制良好、差者血糖控制水平、近2年心血管事件发生情况。结果心血管危险因素控制水平良好93人、差者47人,心血管危险因素控制良好者血糖控制59.14%、一般34.41%、不佳6.45%,优于心血管危险因素控制者10.64%、53.19%、36.1%,急诊8.60%、门诊16.13%、医疗资源获取例次率24.73%,低于差者19.15%、104.26%、123.40%,心肌梗死4.30%、心衰3.23%、心绞痛37.63%、心血管事件合计发生例次率45.16%,低于差者14.89%、23.40%、93.62%、131.91%,差异具有统计学意义(P0.05)。结论对于2型糖尿病合并冠心病患者而言,积极控制心血管病危险因素,有助于提高血糖控制水平,降低心血管事件发生风险,进而改善预后。     

Advances in reducing cardiovascular risk in the management of patients with type 2 diabetes mellitus

Treatment intended to lower cardiovascular (CV) risk in patients with diabetes has always been a primary goal of diabetes treatment. Due to the subdued effects of reducing hemoglobin A1c (HbA1c) on macrovascular complications, controlling other CV risk factors such as hypertension and hyperlipidemia instead of hyperglycemia has been the mainstay treatment to improve CV outcome in patients with type 2 diabetes mellitus (T2DM) until recent years. This review is intended to summarize and compare the results from the available cardiovascular outcome trials (CVOTs) for the two classes of glucose lowering drug: sodium-glucose co-transporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA). The results including the EMPA-REG, CANVAS program and DECLARE-TIMI 58 trials for SGLT2i, and the ELIXA, LEADER, SUSTAIN-6, EXSCEL and HARMONY trials for GLP-1 RA were summarized. The potential mechanisms of these CV beneficial effects and the optimal CV risk reduction treatment in patients with T2DM based on patient risk stratification and evidence from these CVOTs in real-world setting were discussed.     

2019 novel-coronavirus: Cardiovascular insights about risk factors,myocardial injury,therapy and clinical implications

From December 31st, 2019, a novel highly pathogenic coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide, reaching at present the dimension of a pandemic. In addition to damaging the lungs, SARS-CoV-2 may also damage the heart and this is corroborated by the evidence that cardiovascular comorbidities are associated with a higher mortality and poor clinical outcomes in patient infected by the virus. During the infection myocardial injury, myocarditis and arrhythmias have also been reported, but the pathophysiological mechanisms of these complications are yet to be understood. Great attention is also being posed on the potential beneficial/harmful role of angiotensin converting enzyme (ACE) inhibitors, as far as the virus binds to ACE2 to infect cells, but evidences lack. Furthermore, SARS-CoV-2 can also affect the aspect of acute coronary syndromes, not only because these two distinct pathological entities share pathogenic aspects (such as the systemic inflammatory state and cytokine release), but also and above all for the consequences that the need to contain the infection has on the management of cardiological urgencies. The aim of this review was therefore to summarize the relationship between the virus and the cardiovascular system.     

Occupational exposure to heavy metals,alcohol intake,and risk of type 2 diabetes and prediabetes among Chinese male workers

ObjectiveBoth exposure to heavy metals and alcohol intake have been related to the risk of type 2 diabetes (T2D). In this study, we aimed to assess the potential interactions between metal exposure and alcohol intake on the risk of T2D and prediabetes in a cohort of Chinese male workers.MethodsWe conducted a cross-sectional analysis of 26,008 Chinese male workers in an occupational cohort study from 2011 to 2013. We assessed metal exposure and alcohol consumption at baseline in these workers who were aged ≥20 years. Based on occupations which were categorized according to measured urine metal levels, multiple logistic regression analyses were used to evaluate the independent and joint effects of metal and alcohol exposure on the risk of T2D and prediabetes.ResultsRisks of T2D (P_trend = 0.001) and prediabetes (P_trend = 0.001) were significantly elevated with increasing number of standard drinks per week, years of drinking, and lifetime alcohol consumption. An adjusted odds ratio (OR) of 6.1 (95% confidence interval [CI]: 4.8–7.8) was observed for the smelting/refining workers (highest metal exposure levels) who had the highest lifetime alcohol consumption (>873 kg) (P_interaction = 0.018), whereas no statistically significant joint effect was found for prediabetes (P_interaction = 0.515).ConclusionsBoth exposures to metal and heavy alcohol intake were associated with the risk of diabetes in this large cohort of male workers. There was a strong interaction between these two exposures in affecting diabetes risk that needs to be confirmed in future studies.     

探讨对2型糖尿病患者采用个体化护理的临床效果

目的探讨个体化护理对2型糖尿病患者的临床效果。方法选择2011年8月~2014年8月收治的82例2型糖尿病患者,随机分为对照组与观察组各41例。对照组实施常规的护理,观察组实行个体化的护理,在第三个月末时对两组患者的血糖等多项指标进行统计和对比分析。结果护理三个月后观察组患者的空腹血糖、糖化血红蛋白等生化指标都明显低于对照组,两组对比差异P0.05,具有统计学意义;观察组生活质量的各项评分都明显高于对照组,对比差异也具有统计学意义,P0.05。结论对2型糖尿病患者采用个体化的护理,可以获得良好临床护理效果。     

2型糖尿病合并非酒精性脂肪性肝病的危险因素及其与胰岛素抵抗的关系

目的探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的危险因素及其与胰岛素抵抗的关系。方法将246例T2DM患者根据是否合并NAFLD分为观察组(108例)与对照组(138例),对比两组患者性别、年龄、空腹血糖(FBG)、空腹血胰岛素(FINS)、体质指数(BMI)、腰臀比(WHR)、糖尿病病程、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、糖化血红蛋白(Hb Alc)、胰岛素抵抗指数(HOMA-IR),并将具有统计学差异的指标进行多因素Logistic回归分析,同时采用超声进行肝脏检查,分析肝脏超声评分与HOMA-IR的相关性。结果两组患者性别、年龄、FBG、FINS、HDL比较差异均无显著性(P>0.05),BMI、WHR、糖尿病病程、ALT、AST、TC、TG、LDL、Hb Alc、HOMA-IR比较差异显著(P<0.01)。Logistic回归分析显示,BMI、TG、LDL、Hb Alc以及HOMA-IR均为T2DM患者合并NAFLD的独立危险因素(P<0.05或P<0.01)。结论 HOMA-IR与NAFLD的超声评分呈显著正相关,研究结果提示HOMA-IR能够反映T2MD患者合并NAFLD的风险,有助于患者病情的评估。     

吡格列酮对2型糖尿病合并冠心病患者动脉粥样硬化相关危险因素及预后的影响

目的探讨吡格列酮治疗2型糖尿病合并冠心病患者对其动脉粥样硬化相关危险因素及预后的影响。方法选取2010年8月至2012年1月在本院进行治疗的2型糖尿病合并冠心病患者202例,随机分为治疗组和对照组,两组均给予常规治疗;在此基础上,治疗组(101例)加用吡格列酮(15mg/次,1次/天)治疗,期间定期随访,1年后比较2组血液动脉粥样硬化相关危险因素及心血管不良事件发生率。结果治疗组血清PAI-1(纤溶酶原激活物抑制物-1)水平为(4.15±0.47)ng/ml,P-选择素水平为(12.38±3.56)ng/ml,对照组血清PAI-1水平为(7.46±1.73)ng/ml,P-选择素水平为(15.84±6.32)ng/ml,两组比较差异显著(P<0.05);治疗组空腹血糖、餐后血糖、空腹胰岛素、糖化血红蛋白水平和胰岛素抵抗指数及急性冠脉综合征、不稳定性心绞痛和靶血管重建发生率显著低于对照组,(P<0.05)。结论吡格列酮用于治疗2型糖尿病合并冠心病,能降低其动脉粥样硬化相关危险因素从而改善预后。     

α-硫辛酸联合二甲双胍对2型糖尿病合并非酒精性脂肪性肝病的影响研究

目的研究α-硫辛酸联合二甲双胍对2型糖尿病合并非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者的影响。方法将96例2型糖尿病合并NAFLD患者随机分为观察组及对照组。两组患者均采用糖尿病饮食控制及二甲双胍治疗。观察组患者在此基础上加用α-硫辛酸。4周为一疗程,两组患者均治疗3个疗程。结果治疗后,观察组患者甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)及γ-谷氨酰转肽酶(γ-GT)水平均明显低于对照组(P<0.01),同时高密度脂蛋白胆固醇(HDL-C)水平明显高于对照组(P<0.01)。治疗后,观察组患者空腹血糖(FPG)、餐后2小时血糖(2h PG)及糖化血红蛋白(Hb Alc)水平均明显低于对照组(P<0.01),超氧化物歧化酶(SOD)水平明显高于对照组(P<0.01)。治疗后观察组患者超声影像学脂肪肝分度优于对照组(P<0.05)。结论α-硫辛酸与二甲双胍联用可有效调节2型糖尿病合并NAFLD患者血脂、血糖水平与氧化应激状态,达到治疗的目的。     

2型糖尿病患者尿白蛋白/肌酐与肾素-血管紧张素系统活性相关性研究

目的研究2型糖尿病患者尿白蛋白/肌酐(A/C)与肾素-血管紧张素系统(RAS)活性的相关性。方法选择160例2型糖尿病患者行A/C检测,将其分为A/C正常组96例(A/C≤30 mg/g)及A/C异常组64例(A/C>30 mg/g),选择健康志愿者作为对照组(60例),检测三组研究对象静脉血RAS指标并比较各组的差异性,采用Logistic回归分析患者A/C与RAS各指标的相关性。结果A/C异常组及A/C正常组患者静脉血肾素(PRA)、血管紧张素Ⅱ(AngⅡ)及醛固酮水平均高于对照组,A/C异常组患者静脉血PRA、AngⅡ及醛固酮水平均高于A/C正常组,差异均具有显著性(P<0.05)。Logistic回归分析显示,A/C与静脉血PRA无明显相关性(P>0.05),A/C与AngⅡ、醛固酮水平呈正相关(r=0.495,0.316;P=0.000,0.002)。结论 2型糖尿病患者A/C与RAS活性具有相关性,RAS激活可能与2型糖尿病患者肾及血管损伤有关,A/C检测能够反映患者体内RAS激活程度,为2型糖尿病患者微循环损伤的早期发现提供新的指标。     

延续性护理在2型糖尿病患者中的应用效果

目的探讨延续性护理干预在2型糖尿病患者中的应用效果。方法选择2017年5月-2019年5月孝感市中心医院收治的110例2型糖尿病患者,按随机数字表法分为对照组和观察组,每组55例。对照组采取常规护理,观察组实施延续性护理干预,比较两组患者干预前后的自我效能、血糖及生活质量水平。结果观察组干预后GSES(47.13±5.62)分,高于对照组的(34.32±6.74)分,SF-36中躯体功能(70.05±12.53)分、社会功能(76.43±13.34)分、心理功能(71.37±12.47)分、物质功能(74.63±10.98)分,均高于对照组的(63.14±9.70)分、(63.87±10.24)分、(62.16±10.04)分、(64.79±9.52)分,有统计学差异(P <0.05)。观察组干预后空腹血糖(7.43±0.55)mmol/L、餐后2 h血糖(9.93±0.73)mmol/L、糖化血红蛋白(6.13±1.24)g/L,均低于对照组的(8.50±0.42)mmol/L、(12.10±1.17)mmol/L、(7.24±1.44)g/L,有统计学差异(P <0.05)。结论延续性护理干预能够提高2型糖尿病患者自我效能,改善患者血糖水平,利于生活质量的提高。     

2型糖尿病患者中延续护理干预的应用分析

目的予2型糖尿病患者开展延续性护理,分析护理干预对其影响。方法研究时限为2017年3月—2018年6月,研究对象为此期间医院收治的2型糖尿病患者93例,随机分为常规组(46例)、延续组(47例),分别开展常规护理、延续性护理,将两组患者护理后护理依从性、血糖水平及生活质量进行分组比较分析。结果护理后延续组患者血糖水平与常规组相比,差异具鲜明性(P<0.05);延续组患者依从性评分、生活质量评分与常规组相比,差异具鲜明性(P<0.05)。结论予2型糖尿病患者开展延续性护理,可提升其护理依从性,改善血糖水平,并对生活质量产生积极影响。     

2型糖尿病并发症预防护理及健康教育体会

目的探讨2型糖尿病患者的健康教育和并发症预防性护理效果。方法选取我院于2017年1月-2019年1月收治的100例2型糖尿病患者,随机分成对照组和试验组,每组各50例,对照组行常规护理,试验组行健康教育和并发症预防护理,比较两组患者的护理效果。结果试验组的空腹血糖、血糖下降幅度改善程度均优于对照组(P<0.05),试验组的肾病、心脑血管和眼病等并发症发生率低于对照组(P<0.05),试验组的疾病知晓率和护理满意度均高于对照组(P<0.05)。结论健康教育能有效提高2型糖尿病患者对疾病知晓率和护理满意度,增加患者的临床治疗配合度,进而有效控制患者血糖。同时对并发症进行预防性护理效果明显,能有效降低糖尿病患者并发症的发生。     

长效胰岛素、口服降糖药对2型糖尿病的效果

目的探讨长效胰岛素联合口服降糖药对2型糖尿病的治疗作用。方法选择本院100例2017年2月-2019年1月2型糖尿病患者。随机分组,长效胰岛素治疗组给予长效胰岛素治疗,长效胰岛素+口服降糖药沙格列汀组则实施长效胰岛素+口服降糖药沙格列汀治疗。比较两组2型糖尿病疗效;血糖达标的天数;治疗前后患者修整胰岛β细胞分泌指数、糖化血红蛋白、空腹、餐后血糖和血糖曲线下面积;低血糖率。结果长效胰岛素+口服降糖药沙格列汀组2型糖尿病疗效、血糖达标的天数、修整胰岛β细胞分泌指数、糖化血红蛋白、空腹、餐后血糖和血糖曲线下面积相比较长效胰岛素治疗组更好(P<0.05)。长效胰岛素+口服降糖药沙格列汀组低血糖率低于长效胰岛素治疗组(P<0.05)。结论长效胰岛素+口服降糖药沙格列汀治疗2型糖尿病效果确切,可获得理想效果,可更好改善血糖和胰岛功能,降低低血糖风险。