2型糖尿病患者血清护骨素水平与糖尿病肾病的关系

目的 2型糖尿病(T2DM)患者血清护骨素水平与糖尿病肾病(DN)的关系.方法 110例T2DM患者根据尿白蛋白排泄率(UAER)分为正常白蛋白尿组 38例、微量白蛋白尿组 36例及大量白蛋白尿组 36例,同时选择年龄、性别相匹配的40例健康者为对照组.血清护骨素采用ELISA法测定.结果 在T2DM各组中,大量白蛋白尿组患者的血清护骨素水平[(4.45±0.76)ng/L]显著高于微量白蛋白尿组[(3.62±0.70)ng/L]、正常白蛋白尿组[(2.77±0.78)mg/L]和对照组[(2.29±0.37)ng/L](均P＜0.01);微量白蛋白尿组患者的血清护骨素水平高于正常白蛋白尿组.血清护骨素水平与空腹血糖(FPG)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)及UAER呈明显正相关.血清护骨素水平是DN的重要影响因素.结论 DN患者血清护骨素水平明显升高,护骨素可能在DN的发生中起一定作用.     

骨保护素与冠心病合并糖尿病患者冠状动脉支架内再狭窄的关系

目的探讨血清骨保护素(OPG)与冠心病合并糖尿病患者冠状动脉介入术后支架内再狭窄(ISR)的关系。方法在行经皮冠状动脉介入治疗并于约1年后行冠状动脉造影复查的1 652例糖尿病患者中,135例为ISR患者(ISR组),从其余患者中随机选取85例无ISR的冠心病合并糖尿病患者作为对照(无ISR组)。检测血清OPG水平及生物化学指标,并收集患者的临床资料。通过多变量Logistic回归分析发生ISR的独立危险因素。结果 ISR组血清OPG水平显著高于无ISR组(P<0.001)。与无ISR组相比,ISR组患者的吸烟发生率更高,血清肌酐、总胆固醇、高敏C反应蛋白、低密度脂蛋白胆固醇水平更高,冠状动脉病变更严重,累及的血管更多,肾小球滤过率更低,使用降糖药物治疗患者更少,支架直径更小(P均<0.05)。将血清OPG水平按三分位数分组,在校正了可能的混杂因素后,多变量Logistic回归分析显示血清OPG高水平组发生ISR的风险是低水平组的5.349倍(OR=5.349,95%CI为2.049～13.967,P=0.001),中水平组发生ISR的风险是低水平组的2.711倍(OR=2...     

血清护骨素水平与2型糖尿病视网膜病变的关系

将95例2型糖尿病（T2EDM）患者根据有无眼底视网膜病变分为背景期视网膜病变组（BDR组）、增殖期视网膜病变组（PDR组）及无视网膜病变组（NDR组）,应用ELISA法测定各组血清护骨素水平,同时选择年龄、性别与之匹配的4JD例健康者为对照。结果糖尿病各组血清护骨素水平显著高于对照组（P〈0．01）。BDR、PDR组的护骨素水平均高于NDR组（P〈0．01）,且PDR组的护骨素水平高于背景期视网膜病变组（P〈0．05）。Logistic分析示血清护骨素水平升高是T2DM视网膜病变的独立危险因素。证实T2DM视网膜病变患者的血清护骨素水平明显高于健康人,且与病情严重程度有关;护骨素可能在T2DM视网膜病变的发生和发展中起一定作用。     

2型糖尿病患者血清护骨素水平与大血管并发症的关系

目的探讨2型糖尿病患者血清护骨素水平与大血管并发症的关系。方法88例2型糖尿病患者根据有无大血管并发症分为2型糖尿病并发大血管病变组(46例)及无大血管病变组(42例),同时选择年龄、性别相匹配的40例健康者为对照组。采用酶联免疫吸附法测定各组血清护骨素水平,并进行组间比较。结果2型糖尿病并大血管病变组血清护骨素水平(4.12±0.64 ng/L)显著高于无大血管病变组(2.78±0.59 ng/L)与对照组(2.29±0.37 ng/L,P<0.01),无大血管病变组与对照组比较差异无显著性(P>0.05)。相关及回归分析表明2型糖尿病血清护骨素水平与空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数及高敏C反应蛋白呈明显正相关(P<0.05)。结论血清护骨素水平与糖尿病大血管并发症相关联,护骨素可能在2型糖尿病慢性血管并发症的发生中起一定作用。     

血浆内脂素在冠心病合并2型糖尿病患者中的表达

目的探讨血浆内脂素在冠心病合并2型糖尿病患者中的表达。方法 90例经过冠状动脉造影确诊为冠心病患者(冠心病组)中,其中合并2型糖尿病患者(冠心病合并2型糖尿病组)51例,不合并2型糖尿病患者(冠心病不合并2型糖尿病组)39例;另外选择32名健康者作为对照组。检测所有入选人群的血浆内脂素的水平。结果不合并2型糖尿病组的内脂素水平明显高于对照组(P<0.01)。冠心病组各亚组间比较,合并2型糖尿病组的内脂素高于不合并2型糖尿病组(P<0.01),血浆内脂素水平随着冠状动脉病变支数的增加而升高,各亚组间的比较差异有统计学意义(P<0.01)。冠心病组血浆内脂素水平与冠状动脉病变支数呈正相关(P<0.01)。结论冠心病患者血浆内脂素水平明显高于健康者,合并2型糖尿病者血浆内脂素水平升高更明显,而且与冠状动脉病变程度密切相关。     

骨保护素对2型糖尿病患者骨密度影响的研究

目的：探讨2型糖尿病（T2DM ）患者血清骨保护素（osteoprotegerin ,OPG ）的水平变化及其对骨密度的影响。方法选择已于我院明确诊断为T2DM患者102例,根据股骨颈骨密度将所有患者分为骨质疏松组（DOP组）和非骨质疏松组（DNOP组）。测定血糖、血脂、糖化血红蛋白等生化指标,并测定空腹胰岛素、OPG。计算稳态模型-胰岛素抵抗指数（HOMA-IR ）和β细胞功能指数（HOMA-HBCI ）。分析探讨骨密度与患者OPG水平、HOMA-IR、HOMA-HBCI、骨钙素水平之间的相关性。结果 DOP组患者OPG水平、FINS和HOMA-IR明显高于DNOP组（ t＝2.67、2.14、3.03,均 P＜0.05）,HOMA-HBCI水平明显低于DNOP组（ t＝2.28,P＜0.05）。多元线性回归分析结果显示血清OPG水平、HOMA-IR与骨密度呈正相关（ r＝-0.02、-0.14,均 P＜0.05）,HOMA-HBCI与骨密度呈负相关（ r＝0.22,P＜0.05）。结论T2DM患者骨密度与血清OPG水平、胰岛素抵抗和胰岛β细胞功能有关,OPG水平代偿性增加可能与T2DM患者DOP的发生有一定关系。     

高血压与2型糖尿病合并冠心病

对100对研究对象测量其血压,收集既往高血压史、既往高血压治疗和控制等方面的信息.采用条件Logistic回归模型分析高血压与2型糖尿病合并冠心病间的关系,估计比值比（OR值）及其95%可信区间（95%CI）.结果：收缩压（SBP）、舒张压（DBP）、既往高血压史与2型糖尿病合并冠心病的发生存在统计学关联,经调整可能混杂因素的作用后这种关联仍然存在.结论：血压水平增高、既往有高血压病史可增加2型糖尿病患者发生冠心病合并症的危险.     

西南地区人群尿脂联素水平与2型糖尿病合并冠心病的相关性

目的探讨西南地区人群尿脂联素水平与2型糖尿病(T2DM)合并冠心病(CHD)的相关性。方法采用酶联免疫吸附试验(ELISA)测定23例T2DM患者(T2DM组)和23例T2DM合并CHD患者(DC组)及38例健康对照(NC组)的血、尿脂联素水平,探讨各组脂联素与体重指数(BMI)、腰臀比(WHR)、血脂、血糖、颈动脉中层厚度(IMT)、尿白蛋白/肌酐(ACR)等的关系。结果 DC组尿脂联素水平较T2DM组及NC组均明显升高(分别为20.91±4.59 vs 17.75±1.90μg/ml,20.91±4.59 vs 13.61±5.74μg/ml,P<0.01),T2DM组较NC组明显升高;DC组血清脂联素水平也明显升高(分别为5.73±1.78 vs 8.43±3.55μg/ml,5.73±1.78 vs 14.46±4.18μg/ml,P<0.01)。线性相关分析表明T2DM组尿脂联素水平与血清脂联素相关,而DC组则还与糖化血红蛋白(Hb A1c)、总胆固醇(TC)、ACR相关,进一步行多元逐步回归分析表明,DC组影响尿脂联素水平的独立危险因素为ACR、Hb A1c及TC是(Y尿脂联素=0.004X ACR+2.83XHBA1C+4.055XTC-30.224)。结论尿脂联素水平改变与T2DM大血管病变有关,其参与了T2DM合并CHD的发生发展。     

2型糖尿病患者血清网膜素1水平与骨代谢及氧化应激的关系

目的 探讨2型糖尿病(T2DM)患者血清网膜素1(Omentin-1)水平与骨代谢及氧化应激的关系.方法 选取120例T2DM患者,根据病情控制情况将其分为A组(病情控制良好)68例和B组(病情控制不良)52例.另选择同期健康体检者60例作为对照组.采集受试者清晨空腹静脉血,采用ELISA法检测Omentin-1以及骨...     

骨保护素与糖尿病及其血管并发症

骨保护素（OPG）是肿瘤坏死因子受体超家族成员,是骨代谢的一个重要调节因子。近来研究发现,OPG亦是重要的血管调节因子,能够保护血管内皮细胞,抑制血管钙化。糖尿病微血管及大血管并发症患者血清OPG水平明显升高,血清OPG水平与糖尿病并发症密切相关,OPG在糖尿病并发症的发生、发展中可能起重要的调节作用。确切的机制尚不清楚,可能是一种自我代偿机制,以对抗促动脉硬化、血管钙化及血管损伤的其他因子。     

2型糖尿病患者平均血小板体积与冠心病的关系

目的 观察2型糖尿病合并冠心病患者平均血小板体积（MPV）的变化及相关影响因素.方法 接受冠脉造影的2型糖尿病患者495例,其中合并冠心病者307例（合并冠心病组）,无冠心病等大血管病变者（未合并冠心病组）188例.入院时测定MPV、血生化等参数,计算冠脉病变血管支数和Gensini积分.结果 合并冠心病组MPV显著高于未合并冠心病组（P＜0.05）.据MPV将合并冠心病组患者分为MPV低值组（MPV≤9.9fL）、中值组（9.9 fL＞ MPV≤10.6 fL）和高值组（MPV＞ 10.6 fL）,高值组急性冠脉综合征、多支病变、Gensini积分、体重指数、空腹血糖和糖化血红蛋白（HbA1c）显著高于低值组（P＜0.05或P＜0.01）,高密度脂蛋白胆固醇（HDL-C）显著低于低值组（P＜0.05）.多重线性回归分析显示,合并冠心病组患者Gensini积分、多支病变、HbA1c和空腹血糖与MPV显著独立正相关,HDL-C与MPV显著独立负相关.非条件Logistic分析显示,MPV是2型糖尿病合并冠心病的危险因素.结论 2型糖尿病合并冠心病患者MPV显著升高,与冠脉病变严重程度、糖代谢和HDL-C密切相关,MPV是2型糖尿病合并冠心病的危险因素.     

Endothelial function in individuals with coronary artery disease with and without type 2 diabetes mellitus

The goal of this study was to determine if individuals with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) had greater endothelial dysfunction (ED) than individuals with only CAD. Flow-mediated dilation (FMD), calculated as percentage increase in brachial artery diameter in response to postischemic blood flow, was measured after an overnight fast in 2 cohorts. The first cohort included 76 participants in the Northern Manhattan Study with CAD; 25 also had T2DM. The second cohort was composed of 27 individuals with both T2DM and CAD who were participants in a study of postprandial lipemia. Combined, we analyzed 103 patients with CAD: 52 with T2DM (T2DM+) and 51 without T2DM (T2DM−). The 52 CAD T2DM+ subjects had a mean FMD of 3.9% ± 3.2%, whereas the 51 CAD T2DM− subjects had a greater mean FMD of 5.5% ± 4.0% (P < .03). An investigation of various confounders known to affect FMD identified age and body mass index as the only significant covariates in a multiple regression model. Adjusting for age and body mass index, we found that FMD remained lower in T2DM+ subjects compared with T2DM− subjects (difference, −1.99%; P < .03). In patients with CAD, the concomitant presence of T2DM is independently associated with greater ED, as measured by FMD. This finding may be relevant to the greater early and late morbidity and mortality observed in patients with both CAD and T2DM.     

非糖尿病的冠心病患者尿微量白蛋白与冠脉病变程度的关系

目的 探讨非糖尿病的冠心病患者尿微量白蛋白(MAU)与冠脉病变程度的关系.方法 对172例可疑冠心病的非糖尿患者进行冠状动脉造影检查并检测其尿白蛋白排泄率(UAER).根据冠状动脉造影结果将患者分为对照组51例和冠心病组121例.根据病变血管的数量分为无血管病变组51例、单支病变组51例、双支病变组32例、三支及以上病变组38例,对比各组间UAER和MAU阳性率之间的差异.结果 冠心病组男性患者的比例、UAER、MAU的阳性率、高敏C反应蛋白和纤维蛋白原均高于对照组(P＜0.01).随着冠脉病变数量和程度的增加,UAER(分别为12.9 mg/L、34.4 mg/L、45.1 mg/L和60.7 mg/L)和MAU的阳性率(分别为9.8%、41.2%、56.3%和68.4%)均进行性升高(P＜0.05,P＜0.01).相关分析显示冠脉病变的Gensini评分与UAER呈正相关(r=0.959,P＜0.05).结论 非糖尿病的冠心病患者UAER水平升高,UAER与冠脉病变严重程度呈正相关.     

Pulse wave velocity in patients with coronary artery disease or type 2 diabetes mellitus

OBJECTIVE: To check whether the presence of coronary artery disease (CAD) or type 2 diabetes mellitus (DM) has a differentiating effect on arterial stiffness assessed with pulse wave velocity (PWV)--a simple, reproducible and clinically feasible measure of arterial stiffening. METHODS AND RESULTS: The mean age of 101 participants was 63.5 +/- 19.7 years. Fifty-one % of them had CAD, 31.0% had DM and 52.5% were hypertensive subjects. The aortic PWV ranged from 3.40 to 27.50 m/s, with an average of 1.73 +/- 4.69 m/s. PWV was significantly higher (P < 0.01) in both CAD and DM positive groups as compared with CAD and DM negatives, respectively. After adjustment for established co-variables, patients with CAD had significantly higher PWV when compared to CAD negatives (13.0 vs. 10.5 m/s, P < 0.01). After adjustment, DM did not seem to affect PWV. CONCLUSIONS: CAD patients had higher values of PWV when compared to those without the disease. DM, a metabolic equivalent of arterial damage, after adjustment for possible confounders, did not seem to contribute per se to arterial stiffening. The presence of high PWV values in that group of patients should be viewed as an indicator of established widespread atherosclerosis possibly affecting the coronary arteries.     

The association between extracoronary calcification and coronary artery disease in patients with type 2 diabetes mellitus

Cardiovascular complications are the major cause of diabetes-associated morbidity and mortality. However, not all patients with diabetes are at increased risk for cardiovascular disease (CVD). Coronary artery calcification was found to be a powerful predictor of coronary artery disease (CAD). The presence of extracoronary cardiac calcification as a useful predictor of CAD is not yet established, especially in type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the relation between extracoronary calcification and extent of CAD in a group of T2DM patients who were scheduled for computed tomographic coronary angiography (CTCA). We prospectively studied 380 patients (151 had T2DM) under the age of 60 years who were scheduled for CTCA because of suspected CAD. Severity of CAD was assessed by Gensini score. Coronary artery calcium score (CACS) as well as calcium score in the aortic valve, mitral annulus, ascending aorta, and descending aorta were measured by a 256-row multidetector computed tomography scanner with dedicated software for calcium calculation. Patients with known CAD were excluded. Diabetic and nondiabetic patients had comparable age and gender distribution. However, the diabetic group had higher Gensini score, CACS, and extracoronary calcium score (ECCS). Logistic regression analyses identified male gender and ECCS as significant predictors for the presence of CAD in diabetic patients. Age, smoking, and ECCS were the significant predictors of CAD in nondiabetic patients. Type 2 diabetic patients had increased coronary and extracoronary calcification. ECCS was found to be a significant predictor of CAD in diabetic and nondiabetic patients only when CACS was not taken into account.     

中国人群2型糖尿病患者付氧酶基因多态性与冠心病关系的研究

探讨中国２型糖尿病患者付氧酶（ＰＯＮ）基因与并发冠心病（ＣＡＤ）的关系。方法利用聚合酶链反应一变性梯度凝胶电泳技术对４９例２型糖尿病合并ＣＡＤ患者,４９例未合并ＣＡＤ的２型糖尿病对照者和１０１例健康对照者进行ＰＯＮ基因外显子筛查。结果发现中国人群ＰＯＮ基因第１９１位密码子存在Ｇｌｎ＾１９１－Ａｒｇ多态性,等位基因以Ａ／Ｂ表示。ＣＡＤ患者ＰＯＮ基因的３种基因型（ＡＡ、ＡＢ和ＢＢ）的构成比与２型糖尿病     

Silent coronary artery disease in patients with type 2 diabetes mellitus

Abstract. The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of 70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187–13.659), hypertension (OR=5.564; 95% CI, 1.446–21.400) and retinopathy (OR=3.766; 95% CI, 1.096–12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.     

2型糖尿病患者的脂代谢紊乱及其与冠心病的关系

目的：探讨2型糖尿病患脂代谢紊乱与并发冠心病（CHD）的关系。方法：56例2型糖尿病（DM）患（其中32例并发冠心病），测定其血脂、载脂蛋白浓度及血糖、胰岛素水平，与30例例健康人比较。结果：与对照组比较，2型DM并发CHD患高密度脂蛋白胆固醇（HDL－C）水平降低（P＜0．005），低密度脂蛋白胆固醇（LDL－C）及载脂蛋白B（ApoB)水平升高（P＜0．05）。单纯2型DM组仅有HDL－C水平的降低（P＜0．005）及LDL－C水平的升高（P＜0．05），无ApoB的变化，单纯DM及DM＋CHD组血糖及胰岛素水平无显差别，但均较对照组升高非常显（P＜0．005）；DM＋CHD组的ApoB水平较单纯DM组的显升高（P＜0．05）。结论：本组结果提示HDL－C水平的降低，LDL－C及ApoB水平的升高是2型DM并发冠心病的重要危险因素。     

Management of coronary artery disease in patients with type 2 diabetes mellitus

Diabetes mellitus is as much a vascular disease as it is a metabolic disorder. The metabolic abnormalities associated with diabetes include hyperglycemia, and abnormal carbohydrate, fat, and protein handling. These abnormalities increase oxidative stress and activate the renin angiotensin system, which subsequently causes endothelial dysfunction and predisposes to atherosclerosis. Type 2 diabetes has reached epidemic proportions and because of its strong association with coronary artery disease (CAD), it is responsible for increasing cardiovascular morbidity and mortality in the United States. In this article we review some of the evidence and the rationale for comprehensive risk reduction to prevent and treat CAD in individuals with diabetes mellitus. The comprehensive risk reduction strategy includes lifestyle changes, glycemic control, and control of dyslipidemia and hypertension. Advances in revascularization techniques, and superior outcomes of coronary artery bypass grafting as an interventional modality over percutaneous coronary intervention, are discussed. We also identify controversies and issues that currently remain unresolved.     

血浆纤溶酶原激活物抑制因子基因启动子多态性与2型糖尿病伴发冠心病的关系

目的从分子遗传水平进行基因多态性研究，以探讨２型糖尿病易伴发冠心病的内在原因。方法对８１例２型糖尿病患者、９３例非糖尿病（非ＤＭ）患者进行口服糖耐量试验、血脂分析、血浆纤溶酶原激活物抑制因子（ＰＡＩ１）基因多态性分析。结果２型糖尿病和非ＤＭ相比ＰＡＩ１基因启动子４Ｇ频率明显增加（４２％和３１％，Ｐ＜０００１）；２型糖尿病伴冠心病与不伴冠心病相比，ＰＡＩ１基因启动子４Ｇ频率及４Ｇ／４Ｇ基因型频率存在明显差异（５２％和３０％，３２％和１４％；Ｐ分别＜０００１、００５）；非２型糖尿病伴冠心病与不伴冠心病相比，ＰＡＩ１基因启动子４Ｇ频率及４Ｇ／４Ｇ基因型频率则无明显差异（３１％和３１％，８％和１６％，均为Ｐ＞００５）。结论ＰＡＩ１基因４Ｇ等位基因可能是糖尿病合并冠心病的内在危险因素