抑郁症和糖尿病共病患者临床对照研究

目的:探讨抑郁症和糖尿病共病患者的临床特征及疗效。方法:将40例伴有糖尿病的抑郁症患者和40例单纯抑郁症患者分成共病组和抑郁组,使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和社会功能缺陷筛选量表(SDSS)评定两组患者的临床表现和社会功能,使用选择性5-羟色胺再摄取抑制剂治疗12周再次评定。结果:入组及治疗12周时,共病组HAMD、HAMA及SDSS总分均显著高于抑郁组(P<0.05),入组时HAMD焦虑/躯体化、认知障碍、迟缓、绝望感等因子分显著高于抑郁组(P<0.05),治疗12周共病组的减分率显著低于抑郁组(P<0.05)。结论:抑郁症和糖尿病共病患者的抑郁及焦虑症状重、社会功能缺陷明显,治疗效果显著差于单纯抑郁症患者。     

帕罗西汀治疗2型糖尿病伴抑郁的研究

目的:探讨帕罗西汀对2型糖尿病伴发抑郁患者生活质量的影响.方法:对45例2型糖尿病伴发抑郁患者给予帕罗西汀治疗.疗程12周.治疗前后分别进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及健康状况调查问卷(SF-36)评定.对照组50例为不伴抑郁的糖尿病患者进行SF-36评定.结果:帕罗西汀能明显改善治疗组抑郁、焦虑症状;治疗前2型糖尿病伴抑郁患者生活质量明显低于对照组.结论:帕罗西汀能明显改善2型糖尿病伴抑郁患者的生活质量及预后.     

糖尿病伴发抑郁症临床初步研究

目的调查糖尿病伴发抑郁症的临床特征、药物疗效.方法(1)实验对象34例符合CCMD-Ⅲ中抑郁症的诊断标准及美国糖尿病协会Ⅱ型糖尿病诊断标准的患者.(2)治疗方法口服盐酸氟西汀,每日一次,20 mg/日,观察十二周.(3)临床评价治疗前及治疗第2、4、6、8、12周末分别进行空腹血糖、HAMD17、HAMA、CGI评定;于治疗前及治疗后进行糖化血红蛋白、SDS评定;于治疗第2、4、6、8、12周末进行TESS评定.结果(1)糖尿病伴发抑郁症患者具有年龄大、文化水平低、糖尿病病程长、合并并发症者多的临床特征.(2)盐酸氟西汀治疗前后患者的抑郁及焦虑症状的改善具有显著性意义.(3)治疗前后空腹血糖及糖化血红蛋白的变化具有显著性差异.结论糖尿病伴发抑郁症患者趋于老龄、低文化程度、有并发症、慢性病程等,盐酸氟西汀对缓解患者伴发的抑郁症状以及协同降低血糖有一定疗效.     

糖尿病与抑郁症相互关系探讨

目的了解糖尿病人群抑郁症患病率,探讨糖尿病与抑郁症之间的相互关系。方法应用抑郁自评量表(SDS)及汉密尔顿抑郁量表(HAMD)对104例糖尿病伴发抑郁症患者进行调查评定,并对其相关因素进行分析。结果在糖尿病人群中,抑郁症的发生与性别、年龄、病程、文化程度、体重指数≥25kg/m2、糖化血红蛋白≥8%,生活事件、慢性并发症增加密切相关。结论抑郁症对糖尿病人的进展及预后都有不良影响。     

Cost-effectiveness of systematic depression treatment among people with diabetes mellitus

CONTEXT: Depression co-occurring with diabetes mellitus is associated with higher health services costs, suggesting that more effective depression treatment might reduce use of other medical services. OBJECTIVE: To evaluate the incremental cost and cost-effectiveness of a systematic depression treatment program among outpatients with diabetes. DESIGN: Randomized controlled trial comparing systematic depression treatment program with care as usual. SETTING: Primary care clinics of group-model prepaid health plan. PATIENTS: A 2-stage screening process identified 329 adults with diabetes and current depressive disorder. INTERVENTION: Specialized nurses delivered a 12-month, stepped-care depression treatment program beginning with either problem-solving treatment psychotherapy or a structured antidepressant pharmacotherapy program. Subsequent treatment (combining psychotherapy and medication, adjustments to medication, and specialty referral) was adjusted according to clinical response. MAIN OUTCOME MEASURES: Depressive symptoms were assessed by blinded telephone assessments at 3, 6, 12, and 24 months. Health service costs were assessed using health plan accounting records. RESULTS: Over 24 months, patients assigned to the intervention accumulated a mean of 61 additional days free of depression (95% confidence interval [CI], 11 to 82 days) and had outpatient health services costs that averaged $314 less (95% CI, $1007 less to $379 more) compared with patients continuing in usual care. When an additional day free of depression is valued at $10, the net economic benefit of the intervention is $952 per patient treated (95% CI, $244 to $1660). CONCLUSIONS: For adults with diabetes, systematic depression treatment significantly increases time free of depression and appears to have significant economic benefits from the health plan perspective. Depression screening and systematic depression treatment should become routine components of diabetes care.     

Non-insulin-dependent diabetes mellitus and depression in a middle-aged Finnish population

A hypothesis of a psychosocial origin of depression in diabetic persons (mainly patients with non-insulin-dependent diabetes mellitus, NIDDM) was tested. The population consisted of all the 1008 persons born in 1935 and living in a Finnish city (Oulu) on 1 October 1990. Data were collected in two phases. A screening for NIDDM and a collection of back-ground data were carried out in the first phase. Oral glucose tolerance tests (OGTTs) were performed in the second phase in order to detect those with previously undiagnosed NIDDM, and depressive symptoms were measured with the Zung Self-Rating Depression Scale (ZSDS). Participants who scored 45 raw sum points or more were considered as suffering from depression. All those who were aware of their diabetes before the second phase were considered as previously diagnosed diabetics. Depression (raw sum score 45 points or more on the ZSDS) was associated with previously diagnosed diabetes mellitus, while it was not associated with undiagnosed diabetes. The sum scores on the ZSDS did not differ significantly from each other in the groups classified according to diabetic status. This finding was explanined by the sum score of the ZSDS among the previously diagnosed diabetics, which had a skewed distribution towards higher sum scores. Among the previously diagnosed diabetic patients, all those who were depressed were on sick leave or retired, while the corresponding proportion for non-depressed patients was 52% (P=0.009). The number of diagnosed diseases was higher among the former than the latter group (P=0.025). Severe depressive symptoms were not associated with a more serious metabolic disease, but they tended to be associated with a great number of diagnosed diseases and with being on sick leave or retired. The results showed that the impact of diabetes mellitus itself on depression was not strong. Depression was not connected to elevated fasting blood glucose levels, but instead to a great number of diagnosed diseases and unfavourable social factors, such as being on sick leave or retired, which suggests a psychosocial origin of depression in NIDDM patients.     

糖尿病和非糖尿病急性动脉粥样硬化性 血栓性脑梗死患者的临床比较

目的 比较糖尿病(DM)与非糖尿病(NDM)急性动脉粥样硬化性血栓性脑梗死患者的病例资料、临床神经缺损程度及颅内动脉狭窄发生率、分布特点。方法 筛选符合条件的2017年10月-2018年5月在铜陵市立医院住院的急性动脉粥样硬化性血栓性脑梗死患者112例纳入本研究,其中DM性脑梗死患者(DM脑梗死组)43例及NDM性脑梗死患者(NDM脑梗死组)69例,收集2组患者脑血管病的危险因素、生化检查指标、入院美国国立卫生研究院卒中量表(NIHSS)评分及颅内动脉狭窄发生率、分布特点。结果 2组患者脑血管病的危险因素比较,DM脑梗死组高脂血症、冠心病的比例、血清甘油三酯水平与NDM脑梗死组比较有明显差异(P<0.05); 2组患者入院临床神经缺损程度比较,DM脑梗死组入院NIHSS≤4分患者与NDM脑梗死组入院NIHSS≤4分患者有明显差异(P<0.05); 2组患者颅内血管狭窄发生率比较,DM脑梗死组血管狭窄率62.79%,其中单支血管病变率20.93%、混合血管病变率30.23%; NDM脑梗死组血管狭窄率40.58%,其中单支血管病变率57.97%、混合血管病变率20.30%,2组比较均有明显差异(P均<0.05)。结论 糖尿病急性动脉粥样硬化性血栓形成脑梗死患者多伴有冠心病、高脂血症病史,入院临床神经缺损程度相对轻,颅内动脉狭窄发生率高,多以混合血管病变为主。     

米氮平对2型糖尿病患者合并抑郁症的疗效观察

目的 探讨果氮平对2型糖尿病患者合并抑郁症的疗效.方法 将120例合并抑郁症的2型糖尿病患者,随机分为研究组和对照组,每组60例.对照组仅用降糖药治疗,研究组在常规降糖药治疗基础上联用米氮平( 15～45mg/d)治疗,治疗8周.在治疗前和治疗8周末均进行汉密尔顿抑郁量表(HAMD)评定和空腹血糖、餐后2h血糖、糖化血...     

脑卒中后糖尿病和糖调节异常的临床研究

目的调查脑卒中患者中糖尿病和糖调节异常的发病情况，探讨口服葡萄糖耐量试验（OGTT）的临床意义。方法对2004年1月-2006年6月收治入院的547例脑卒中患者进行空腹血糖、糖化血红蛋白（GHbAlc）等检测，登记患者的临床资料，对既往未诊断糖尿病而空腹血糖在5．6～6．9mmol／L的患者在适当时候进行OGTT，糖代谢分类采用2003年美国糖尿病学会建议标准。结果547例脑卒中患者住院前糖尿病的诊断率为13.9％，住院后检查发现糖尿病的患病率34．4％，糖调节异常26．5％；脑梗死、脑出血、蛛网膜下腔出血糖尿病的伴发率分别为45．1％、20．5％、13．2％，糖调节异常的伴发率分别30．2％、23．2％、16．2％；227例空腹血糖在5．6～6．9mmol／L的患者中，OGTT检查后发现，19．8％患者可诊断为糖尿病，42.3％提示糖耐量异常。结论脑卒中患者合并高比例的糖尿病和糖调节异常；缺血性卒中发病率高于出血性卒中：空腹血糖在5．6～6．9mmol／L的患者中，OGTT可以发现大量的糖尿病和糖耐量异常患者。     

Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study

This paper describes the methodology of a population based study of primary care patients with diabetes mellitus enrolled in a health maintenance organization. The first goal was to determine the prevalence and impact of depression in patients with diabetes. The second goal was to randomize approximately 300 patients with diabetes and major depression and/or dysthymia in a trial to test the effectiveness of a collaborative care intervention in improving quality of care and health outcomes among patients with diabetes and depression.     

抑郁症和糖尿病共病患者临床特征的研究

目的探讨伴与不伴Ⅱ型糖尿病的抑郁症患者临床特征的差异。方法伴与不伴Ⅱ型糖尿病的抑郁症患者各30例进行1：1配对分组（A组和B组）,使用汉密尔顿抑郁量表（24项,HAMD）和简易智能精神状态检查量表（MMSE）评定两组患者的临床表现,对两组量表评分进行统计学分析。结果A组较B组在HAMD总分以及绝望感、迟缓等因子分增高均十分显著（P均〈0.01）,且焦虑/躯体化、认识障碍、睡眠障碍等因子分均显著增高（P均〈0.05）。A组较B组在MMSE总分以及定向力、回忆等因子分减少均十分显著（P均〈0.01）,记忆力、语言等因子分均显著减少（P均〈0.05）。两组HAMD评分与MMSE评分均呈非常显著负相关。结论抑郁症和Ⅱ型糖尿病共病时患者抑郁症状和认知功能损害均较仅患抑郁症者更为严重,且抑郁症状越严重认知功能损害越严重。     

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。     

Prevalence of co-morbid depression in out-patients with type 2 diabetes mellitus in Bangladesh

ABSTRACT: BACKGROUND: Little is known about the prevalence of depression in people with diabetes in Bangladesh. This study examined the prevalence and factors associated with depression in out-patients with Type 2 diabetes in Bangladesh. METHODS: In this cross-sectional study a random sample of 483 diabetes out-patients from three diabetes clinics in Bangladesh was invited to participate. Of them 417 patients took part. Depressive symptoms were measured using previously developed and culturally standardized Bengali and Sylheti versions of the World HealthOrganization-5 Well Being Index (WHO-5) and the Patient Health Questionairre-9 (PHQ-9) with predefined cut-off scores. Data was collected using two different modes; e.g. standard assisted collection and audio questionnaire methods. Associations between depression and patient characteristics were explored using regression analysis. RESULTS: The prevalence depressive symptoms was 34% (PHQ-9 score [GREATER-THAN OR EQUAL TO] 5) and 36% (WHO-5 score < 52) with audio questionnaire delivery method. The prevalence rates were similar regardless of the type (PHQ-9 vs. WHO-5) and language (Sylheti vs. Bengali) of the questionnaires, and methods of delivery (standard assisted vs. audio methods). The significant predictors of depressive symptoms using either the PHQ-9 or WHO-5 questionnaires were; age, income, gender, treatment intensity, and co-morbid cardiovascular disease. Further, depression was strongly associated with poor glycaemic control and number of co-morbid conditions. CONCLUSIONS: This study demonstrated that depression prevalence is common in out-patients with type 2 diabetes in Bangladesh. In a setting where recognition, screening and treatment levels remain low, health care providers need to focus their efforts on diagnosing, referring and effectively treating this important disease in order to improve service delivery.     

糖尿病合并癫痫38例临床分析

目的探讨糖尿病合并癫痫的临床特点,发病机制及防治措施。方法对38例糖尿病合并癫痫患者的临床资料进行回顾性分析,并结合文献进行讨论。结果糖尿病合并癫痫的患者中以老年人多见,尤其是既往有脑血管疾病的患者,以局限性运动性发作形式最多见,大部分患者脑电图无明显异常改变,控制血糖后癫痫发作停止或发作频率明显减少。结论癫痫的发作与血糖水平密切相关,平稳降糖有助于控制或减少癫痫发作。     

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。