女性2型糖尿病患者合并无症状菌尿的临床分析

目的 探讨影响女性2型糖尿病合并无症状菌尿(ASB)的主要危险因素以及有关临床特点。方法 采用病例对照研究，2型糖尿病伴无症状菌尿(ASB^ )组128例，2型糖尿病不伴ASB(ASB^-)组300例，正常对照组74例。结果 ①女性2型糖尿病合并ASB的发病率为30％；②与ASB有关的危险因素包括年龄、病程、糖尿病视网膜病变、糖尿病肾病、糖尿病神经病变、既往尿路感染史、大血管疾病、高脂血症、绝经史，其中最主要的3个危险因素是年龄、大量白蛋白尿、既往尿路感染史；③随着糖尿病肾病、视网膜病变病情的加重，糖尿病合并ASB的发病率也相应增加；④糖尿病合并ASB^ 中段尿培养病原微生物以大肠埃希菌为主。结论 ①影响女性2型糖尿病合并ASB的因素众多，主要因素是年龄、大量白蛋白尿、既往尿路感染史；②血糖对女性2型糖尿病合并ASB发病作用降低；③ASB可能是女性2型糖尿病的一个并发症。     

2型糖尿病患者合并无症状性菌尿78例临床分析

目的分析探讨影响2型糖尿病(T2DM)合并无症状性菌尿(ASB)的相关因素及临床特点。方法对78例糖尿病合并无症状性菌尿患进行回顾性分析。结果与ASB有关的危险因素包括年龄、性别、血糖水平等；糖尿病病程与并发ASB关系不显；中段尿培养以大肠埃杆菌感染为主；喹诺酮类敏感性最高。结论老年、女性、血糖控制不佳的糖尿病患更易发生ASB。     

成年女性2型糖尿病合并无症状菌尿的临床分析

女性糖尿病患者发生尿路感染（urinary tract infectionuTrI）比例较高，严重危害患者的健康，但部分糖尿病患者发生尿路感染时无发热及尿路刺激症状称为无症状菌尿（asymptomatic bacteriuriaASB）。为探讨成年女性2型糖尿病合并无症状菌尿主要危险因素、菌群分布及临床特点，作者对2001年3月至2005年10月在本院门诊或住院的部分糖尿病患者和同期体检者进行临床分析，报道如下。     

糖尿病合并无症状性菌尿患者临床特征及治疗效果评价

目的探讨糖尿病合并无症状性菌尿的感染状况、菌谱特点及治疗效果。方法对51例糖尿病合并无症状性菌尿患者的清洁中段尿进行细菌培养、菌群鉴定及药物敏感分析,并根据药敏予以治疗。结果糖尿病合并无症状性菌尿患者中男：女=1：7．5,年龄≥60a占78．4％;革兰氏阴性杆菌占90．2％,绝大多数为大肠埃希菌感染,其中有产超广谱p内酰胺菌株出现。依据药敏予以抗菌治疗效果显著。结论糖尿病合并无症状性菌尿患者以老年女性为多,细菌以革兰阴性杆菌为主,部分细菌耐药率较高,依据药敏予以抗菌治疗效果显著。     

2型糖尿病合并无症状尿路感染影响因素探讨

目的探讨影响2型糖尿病合并无症状尿路感染的影响因素。方法通过对同期住院的80例2型糖尿病合并无症状尿路感染患者以及100例无尿路感染患者的临床特点进行分析,比较两组患者年龄、性别、糖尿病病程、体重指数、空腹血糖、糖化血红蛋白、人血白蛋白以及是否合并糖尿病周围神经病变、糖尿病肾病、糖尿病视网膜病变、是否有残余尿、既往是否有尿路感染病史等指标。结果年龄、性别、糖尿病病程、空腹血糖、糖化血红蛋白、人血白蛋白、糖尿病肾病、是否有残余尿以及既往尿路感染病史在两组之间差异显著（P〈0.05）。而其余指标在两组之间无差别。回归分析显示年龄、性别、糖尿病病程、是否有残余尿以及既往尿路感染病史是影响无症状尿路感染的独立危险因素。结论 2型糖尿病合并无症状尿路感染与年龄、性别、糖尿病病程、空腹血糖、糖化血红蛋白、人血白蛋白、糖尿病肾病、是否有残余尿以及既往尿路感染病史等因素有关。而对于老年女性、糖尿病病程长、存在残余尿以及既往有尿路感染病史患者更易出现无症状尿路感染,应定期查尿常规,以及时发现无症状性尿路感染,选择适当治疗,改善预后。     

糖尿病合并无症状性菌尿36例临床治疗分析

糖尿病患者易合并泌尿系感染,一部分患者表现为无症状性菌尿,故易被忽视而延误治疗。现将我院2004年1月至2005年10月收治的36例糖尿病合并无症状性菌尿36例患者进行回顾性分析。     

2型糖尿病合并脂肪肝患者的临床特征及其对健康教育的启示

目的 分析30例2型糖尿病合并脂肪肝患者的临床特征，探讨其对糖尿病健康教育的启示。方法 30例2型糖尿病合并脂肪肝患者为研究对象，分析其饮食、运动行为与代谢变化特点。结果 糖尿病合并脂肪肝患者临床上往往缺乏典型的临床症状；近80％的糖尿病合并脂肪肝患者超重、肥胖、饮食习惯不良、饮食结构不合理；80％的糖尿病合并脂肪肝患者平时喜静少动、几乎不参加运动；糖尿病合并脂肪肝患者各项代谢指标明显异常。结论 糖尿病合并脂肪肝组患者饮食、运动行为不良，体重指数、血脂等代谢指标明显异常，是糖尿病健康教育的重点对象。     

糖尿病并发尿路感染192例临床分析

本文对收治的192例糖尿病并发尿路感染患者回顾性分析，报告如下。 1 临床资料 1987年2月～2006年2月，我们收治糖尿病患者480例，346例做了尿培养，真性菌尿者192例，其中男64例，女128例；年龄34～80岁。1型糖尿病11例，2型糖尿病178例，继发性糖尿病3例。     

冠心病合并2型糖尿病患者临床及冠脉病变特点

目的:观察冠心病合并2型糖尿病患者的临床特征和冠脉病变特点。方法:112例经冠脉造影确诊为冠心病的患者,根据1999年WHO标准分为冠心病合并2型糖尿病组(A组)54例,单纯冠心病组(B组)58例。对比分析两组患者的临床和冠脉造影资料。结果:A组患者高血压、心肌梗死、无症状性心肌缺血、心力衰竭、多支病变、C型病变、弥漫性、闭塞性病变发生率较B组高(P<0.05)。结论:冠心病合并2型糖尿病患者冠脉病变累及范围广且程度重,易发生心肌梗死、心力衰竭、无症状性心肌缺血。     

2型糖尿病患者合并泌尿系感染的病原菌分布及耐药性分析

[目的]了解本地区2型糖尿病（T2DM）患者合并泌尿系感染的病原菌分布以及耐药情况,为临床治疗提供可靠依据,指导临床合理用药.[方法]对2012年1月至2013年12月期间本院625例T2DM住院患者的尿细菌培养与药敏结果进行回顾性分析.[结果]在625例T2DM患者无菌中段尿中,捡出病原菌122株,革兰阴性杆菌占75.41％,其中无症状感染患者占43.58％.大肠埃希菌和肺炎克雷伯菌对氟喹诺酮类抗菌药物的耐药性大于60％.[结论]T2DM患者合并泌尿系感染,临床治疗应积极控制血糖,及早发现,根据药物敏感试验选用抗生素治疗.     

Management of asymptomatic bacteriuria in patients with diabetes mellitus

OBJECTIVE: To review the literature regarding the management of asymptomatic bacteriuria (ASB) in patients with diabetes mellitus. DATA SOURCES: A MEDLINE (1967-June 2003) and bibliographic search of the English-language literature was conducted using the search terms diabetes mellitus, asymptomatic, bacteriuria, and urinary tract infection. DATA SYNTHESIS: ASB occurs in diabetic women more commonly than in non-diabetics and is associated with an increased risk of symptomatic urinary tract infection (UTI) among patients with type 2 diabetes. Symptomatic UTIs tend to follow a more complicated course in diabetics. Despite these independent observations, antimicrobial therapy has not been shown to reduce symptomatic UTIs, pyelonephritis, or hospitalization for UTI. CONCLUSIONS: Available evidence does not support antimicrobial treatment of ASB among patients with diabetes mellitus.     

Asymptomatic bacteriuria may be considered a complication in women with diabetes. Diabetes Mellitus Women Asymptomatic Bacteriuria Utrecht Study Group

OBJECTIVE: To study the prevalence of and risk factors for asymptomatic bacteriuria (ASB) in women with and without diabetes. RESEARCH DESIGN AND METHODS: A total of 636 nonpregnant women with diabetes (type 1 and type 2) who were 18-75 years of age and had no abnormalities of the urinary tract, and 153 women without diabetes who were visiting the eye and trauma outpatient clinic (control subjects) were included. We defined ASB as the presence of at least 10(5) colony-forming units/ml of 1 or 2 bacterial species in a culture of clean-voided midstream urine from an individual without symptoms of a urinary tract infection (UTI). RESULTS: The prevalence of ASB was 26% in the diabetic women and 6% in the control subjects (P < 0.001). The prevalence of ASB in women with type 1 diabetes was 21%. Risk factors for ASB in type 1 diabetic women included a longer duration of diabetes, peripheral neuropathy, and macroalbuminuria. The prevalence of ASB was 29% in women with type 2 diabetes. Risk factors for ASB in type 2 diabetic women included age, macroalbuminuria, a lower BMI, and a UTI during the previous year. No association was evident between current HbA1c level and the presence of ASB. CONCLUSIONS: The prevalence of ASB is increased in women with diabetes and might be added to the list of diabetic complications in these women.     

Asymptomatic bacteriuria among hospitalized diabetic patients: Should they be treated?

Diabetes Mellitus is a significant health care challenge in the United States. The Center for Disease Control and Prevention estimates approximately 9.4% of patients in the United States are afflicted by diabetes. The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive clean-catch voided urine specimens with isolation of the same bacterial strain in counts ≥ 10⁵ cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics. Urinary tract infections (UTIs) tend to be the most common infection contracted by this population. UTIs are not only a significant cause of morbidity and mortality, they are also a significant financial burden. The data are conflicting, in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications. However, clinicians continue to prescribe antibiotics empirically. Further randomized controlled study looking into the specific population as immunocompromised diabetic patients, patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.     

Asymptomatic bacteriuria and hemoglobin A1

We measured hemoglobin A1 (HbA1) and performed clean-catch urine cultures in 752 patients (411 men and 341 women) with non-insulin-dependent diabetes mellitus (NIDDM) attending an outpatient diabetes clinic. Prevalence of bacteriuria was significantly greater in diabetic women than in controls (9.1 vs. 5.0%, P less than .001) but not in diabetic men. Risk of bacteriuria was not related to level of HbA1 at the time of urine culture. However, mean duration of diabetes mellitus was significantly greater in diabetic women with bacteriuria than in those without infection (9.9 +/- 1.5 vs. 5.4 +/- 0.4 yr, P less than .025), and the prevalence of bacteriuria was significantly greater in patients with complications of long-standing diabetes mellitus than in those without complications (P less than .005).     

Bacteriuria and autonomic nerve function in diabetic women

Significant bacteriuria (viable count greater than or equal to 10(5)/ml) was found on single testing in 10% of 400 consecutive diabetic women aged 15-65 yr routinely attending a diabetic clinic. Twenty patients with and 21 without significant bacteriuria were then randomly selected for measurement of cardiovascular autonomic reflexes, bladder ultrasound, and mictiography. There were no significant differences between these two groups in age, duration and type of diabetes, glycosylated hemoglobin, blood urea, and creatinine. Abnormalities of cardiovascular autonomic function were more common in the bacteriuric group (P less than .01). Although the bacteriuric group voided a smaller volume of urine, none had evidence of increased residual bladder volume of urine on ultrasound. Diabetic women with cardiovascular autonomic neuropathy appear to be at increased risk of developing bacteriuria. However, age is probably the most important factor influencing the prevalence of bacteriuria in diabetic and in nondiabetic women.     

Asymptomatische Bakteriurie

Zusammenfassung Unter asymptomatischer Bakteriurie versteht man definitionsgemäß, daß in einer oder in konsekutiven Urinkulturen > 10⁵ Keime/ml desselben Erregers ohne klinische Erscheinungen nachgewiesen werden. Die asymptomatische Bakteriurie findet sich bei 2,7% der Frauen im Alter zwischen 15 und 24 Jahren, sie erhöht sich auf 20 bis 50% der Frauen > 80 Jahre. Die Prä,valenz ist bei Männern deutlich niedriger; sie beträgt 0,1% im Alter < 64 Jahren, 6 bis 20% im Alter > 80 Jahre. Der am häufigsten nachgewiesene Keim ist Escherichia coli, der durch die Expression verschiedener Virulenzfaktoren charakterisiert ist, die sich deutlich von jenen unterscheiden, die bei unteren oder oberen Harnwegsinfektionen nachgewiesen wurden. Ohne anatomische oder funktionelle Abnormitäten des Harntraktes führt die asymptomatische Bakteriurie nicht zur Niereninsuffizienz, Hypertonie oder Narbenbildung der Nieren. Bei Schwangeren findet sich eine asymptomatische Bakteriurie in 2 bis 10% mit dem Risiko der Entwicklung einer symptomatischen Harnwegsinfektion vor allem im letzten Trimester. Es bestehen Beziehungen zu einem niedrigen Geburtsgewicht des Kindes. Bei Nierentransplantierten findet sich eine asymptomatische Bakteriurie in 4 bis 60% der Patienten, hä,fig mit einer geringeren Keimzahl von 10² bis 10³/ml. Die Inzidenz der asymptomatischen Bakteriurie bei Diabetikern liegt bei erwachsenen Frauen mit 7,9 bis 11,1% besonders hoch. Das renale Risiko ist jedoch gering. Bei einer insgesamt guten Funktionsprognose einer unkomplizierten asymptomatischen Bakteriurie besteht eine Behandlungsnotwendigkeit während der Schwangerschaft, nach Nierentransplantation, vor urologischen Intergentionen und bei häufigen Episoden einer asymptomatischen Harnwegsinfektion. Abstract With the availability of methods to quantitate microbes in urine, one has come to recognize that a certain proportion of apparently healthy individuals have bacteria in their urine in the absence of any clinical symptoms. By definition, asymptomatic bacteriuria is present, if on 1, 2 or more consecutive occasions > 100,000 colony forming units/ml are found in aseptically collected midstream urine, granted that the same microorgamism is isolated. Such asymptomatic bacteriuria is found in 2.7% of women aged between 15 and 24 years and increases to 20 to 50% in women above an age of 80 years. In men the prevalence of asymptomatic bacteriuria is considerably lower, but increases to 6 to 20% above the age of 80 years. The microbe most frequently involved in asymptomatic bacteriuria is Escherichia coli, which is characterized by the expression of multiple virulence factors. In this respect they differ from bacteria found in patients with lower or upper urinary tract infections. There is a consensus that in the absence of anatomical or functional abnormalities of the urinary tract asymptomatic bacteriuria per se does not lead to renal scarring, renal dysfunction, or hypertension. The overall prevalence of asymptomatic bacteriuria in pregnancy varies between 2 and 10% with the very small risk of an acute symptomatic episode of urinary tract infection in early pregnancy, but with a substantial risk (30 to 60%) during the last trimester. There is an association between asymptomatic bacteriuria and low birth weight. Asymptomatic bacteriurias are seen in 4 to 60% of immunosuppressed renal graft recipients. The incidence of asymptomatic bacteriuria is also high among patients with diabetes mellitus; the prevalence is approximately 3fold higher in adult women (7.9 to 11.1%). In these patients asymptomatic bacteriuria does not carry a renal risk. Renal functional prognosis in uncomplicated asymptomatic bacteriuria is excellent. Therefore asymptomatic bacteriuria should be treated during pregnancy, after renal transplantation, prior to urological interventions and in patients with frequent episodes of symptomatic urinary tract infection.     

Risk factors for symptomatic urinary tract infection in women with diabetes

OBJECTIVE: Women with diabetes have urinary tract infections (UTIs) more often than women without diabetes. The aim of the present multicenter study was to evaluate which clinical characteristics are associated with the development of a symptomatic UTI during an 18-month follow-up period. RESEARCH DESIGN AND METHODS: Patients with either type 1 or type 2 diabetes who were between 18 and 75 years of age were included. Follow-up results were available for 589 of the 636 women included in this study. All patients were interviewed, their medical history was noted, and at least one uncontaminated urine culture was collected at the moment of study entry. RESULTS: Of the 589 women, 115 (20%) developed a symptomatic UTI, 96 (83%) of whom were prescribed antimicrobial therapy A total of 34 women (14%) with type 1 diabetes developed a UTI. The most important risk factor for these women was sexual intercourse during the week before entry into the study (44% without vs. 53% with sexual intercourse, relative risk [RR] = 3.0, P = 0.01). A total of 81 (23%) women with type 2 diabetes developed a UTI. The most important risk factor for these women was the presence of asymptomatic bacteriuria (ASB) at baseline (25% without vs. 42% with ASB, RR = 1.65, P = 0.04). CONCLUSIONS: Risk factors for developing a UTI are the presence of ASB for women with type 2 diabetes and sexual intercourse during the week before entry into the study for women with type 1 diabetes.     

Silent myocardial ischemia in patients with diabetes: who to screen.

OBJECTIVE: Silent myocardial ischemia (SMI) is more common in diabetic patients than in the general population. However, the exact prevalence of SMI is not known, and routine screening is costly. The purpose of this 1-year study was to estimate the prevalence of SMI and define a high-risk diabetic population by systematically testing patients with no symptoms of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: The criteria for inclusion in this study were age (between 25 and 75 years), duration of diabetes (>15 years for type 1 diabetes, 10 years for type 2 diabetes with no cardiovascular risk factors, and 5 years for type 2 diabetes with at least one cardiovascular risk factor), and absence of clinical or electrocardiogram (ECG) symptoms of CAD. For 1 year, 203 patients were screened, including 28 women and 45 men with type 1 diabetes (aged 41.5+/-10.9 years, mean duration of diabetes 20.9+/-7.7 years [mean +/- SD]) and 61 women and 69 men with type 2 diabetes (aged 60.7+/-8.7 years, duration of diabetes 16.5+/-7.1 years). Exercise ECG was the first choice for screening method. If exercise ECG was not possible or inconclusive, thallium myocardial scintigraphy (TMS) with exercise testing and/or dipyridamole injection was performed. If any one of these tests was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =50%. RESULTS: Positive screening results were obtained in 32 patients (15.7%). Coronary angiography demonstrated significant lesions in 19 patients (9.3%) and nonsignificant lesions in 7 patients (1 false-positive result for exercise ECG and 6 false-positive results for TMS). Coronary angiography was not performed in six patients. All but 3 of the 19 patients (15 men and 4 women) in whom silent coronary lesions were detected presented with type 2 diabetes. The main differences between the 16 type 2 diabetic patients presenting with coronary lesions and the type 2 diabetic patients without SMI were a higher prevalence of peripheral macroangiopathy (56.2 vs. 15.1%, respectively, P < 0.01) and a higher prevalence of retinopathy (P < 0.05). No correlation was found between SMI and duration of diabetes, HbA1c level, renal status, or cardiovascular risk factors except for family history of CAD. CONCLUSIONS: The results of this study allowed us to determine a high-risk group for SMI in the diabetic population. SMI with significant lesions occurs in 20.9% of type 2 diabetic male patients who are totally asymptomatic for CAD. Based on these findings, we recommend routine screening for male patients in whom the duration of type 2 diabetes is >10 years or even less when more than one cardiovascular risk factor is present.     

Asymptomatic bacteriuria in adults

A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic bacteriuria unless there is evidence of potential benefit. Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated, if positive. Treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.     

老年2型糖尿病合并无症状性脑梗死患者血清尿酸与血脂及胰岛素敏感指数的改变

目的探讨2型糖尿病(T2DM)并发无症状性脑梗死(SCI)与血清尿酸(SUA)、血脂、胰岛素(Ins)水平的关系。方法122例T2DM患者,分为T2DM合并SCI组、单纯SCI组和单纯糖尿病(DM)组,分别进行SUA、血胆固醇(TC)、血甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、极低密度脂蛋白胆固醇(VLDLC)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)及脂蛋白LP(a)测定,对DM患者均做馒头餐试验和Ins水平测定并计算胰岛素敏感性指数(IAI)。结果T2DM合并SCI组的血TC、TG、LDLC、VLDLC及ApoB水平均比单纯SCI组高;T2DM合并SCI组的SUA水平比单纯SCI组和单纯DM组增高(P<0.05);T2DM合并SCI组与单纯DM组相比较,血Lp(a)及Ins水平升高(P<0.05),而HDLC、ApoA降低(P<0.01),同时IAI降低。结论DM合并高尿酸血症、低HDL血症等脂代谢异常及胰岛素抵抗在DM合并SCI的发病中可能起重要作用。