2型糖尿病大血管并发症相关危险因素的特征

目的：分析2型糖尿病大血管并发症的相关危险因素，进一步分析其特征。 方法：选择2001—10／2002-08河北医科大学第三医院收治的2型糖尿病患者118例，按有无大血管并发症分为2个亚组；进一步结合体质量指数（≥25kg／m^2为肥胖，〈25kg／m^2为非肥胖）分为4个亚组；以58名健康人为正常对照组。各亚组及对照组患者的纤溶酶原激活物抑制物1水平用ELISA法、血浆凝血因子Ⅶ的凝血活性用一期生化法检测，同时比较各组临床、生化指标。 结果：176例全部进入结果分析。①2型糖尿病组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于对照组[（86．27&;#177;26．65），（62．10&;#177;24．18）μg/L，t=5．80，P〈0．01；（123．02&;#177;20．27）％，（105．64&;#177;16．88）％，t=5．64，P〈0．01]，血压、空腹血糖、空腹胰岛素、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇也明显高于正常对照组（P〈0．01）。②糖尿病并大血管并发症组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于无大血管并发症组[（92．17&;#177;26．88），（80．65&;#177;23．95）μg/L，t=2．46，P〈0．05；（124．22&;#177;20．89）％，（113．52&;#177;21．28）％，t=2．75，P〈0．01]，年龄、血压、腰臀比、腰股比、总胆固醇及低密度脂蛋白胆固醇均高于无大血管并发症组（P〈0．05，0．01），而胰岛素敏感性指数低于无大血管并发症组（P〈0．05）。③血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性在肥胖组高于非肥胖组，并且在同等体质量指数水平的2型糖尿病合并大血管并发症组高于无大血管并发症组（P〈0．05）。 结论：糖尿病合并大血管病变的患者比无大血管病变者胰岛素抵抗特征（中心性肥胖、血压升高、脂代谢异常等）更明显，并且血凝及纤溶系统的异常亦与大血管疾病的发生发展有关。     

罗格列酮对2型糖尿病患者血浆tPA和PAI1活性的影响

目的:运用胰岛素增敏剂罗格列酮治疗2型糖尿病患者,观察罗格列酮对2型糖尿病患者血浆tPA和PAI1活性水平的影响。方法:48例2型糖尿病患者,口服罗格列酮(文迪雅)4mg/d,共12周,观察治疗前后的血浆tPA和PAI1活性、血糖和胰岛素等,计算胰岛素敏感指数和胰岛素抵抗指数,并将各指标进行分析比较。结果:罗格列酮治疗后2型糖尿病患者血浆tPA活性升高(P<0.05),PAI1活性及PAI1/tPA活性比值降低(P<0.05,P<0.01)。血糖、胰岛素水平降低(均P<0.05);胰岛素敏感指数明显升高(P<0.05);胰岛素抵抗指数降低(P<0.05)。结论:罗格列酮在降低血糖、改善胰岛素抵抗、提高胰岛素敏感指数的同时,能增强糖尿病患者纤溶系统的活性,对心血管起到保护作用。     

不同剂量阿托伐他汀对2型糖尿病患者纤溶活性的影响

目的研究不同剂量阿托伐他汀对2型糖尿病患者纤溶活性的影响。方法用酶联免疫吸附法(ELISA)测定2型糖尿病患者外周血中血浆纤溶酶原激活剂(t-PA)及其血浆纤溶酶原激活剂抑制物-1(PAI-1)的水平,并比较不同剂量阿托伐他汀对它们的影响。结果10 mg和20 mg阿托伐他汀治疗前后总胆固醇(TC)、PAI-1均有显著下降(P<0.05)、t-PA水平显著上升(P<0.05),20 mg组治疗后TC、t-PA及PAI-1均较10 mg组差异有统计学意义(P<0.05)。结论阿托伐他汀对2型糖尿病患者纤溶活性有积极作用,且在一定范围内随着剂量的增加而加强,同时具有良好的安全性。     

血浆纤溶功能对2型糖尿病血管病变的影响

目的：探讨2型糖尿病患者纤溶功能的改变及其对外周血管病变的影响，分析其纤溶功能紊乱的可能原因。方法：根据研究对象的临床表现及各种检查结果，分为4组。对照组23例，无并发症2型糖尿病组20例，微血管病变组20例，大血管病变组19例，采用酶联免疫吸附法测定其血浆纤溶酶-α2抗纤溶酶复合物、组织型纤溶酶原激活剂、纤溶酶原激活剂抑制物水平，同时测定其它一些临床生化指标。结果：无并发症2型糖尿病组、微血管病变组及大血管病变组与对照组比较血浆纤溶酶-α2抗纤溶酶复合物浓度显著增高（P〈0．01），凝血酶无时间缩短（P〈0．05）。微血管病变组、大血管病变组的纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂、和纤维蛋白原高于对照组（P〈0．01）。大血管病变组纤溶酶原激活剂抑制物、APTT明显高于无并发症2型糖尿病组（分别为P〈0．01，P〈0．05），微血管病变组的纤维蛋白原高于无并发症2型糖尿病组（P〈0．01）。结论：2型糖尿病合并血管痛变者血浆纤溶酶-α2抗纤溶酶复合物、纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂水平均升高，这种纤溶功能异常可能是糖尿病性血管病变形成的原因之一。     

替米沙坦对2型糖尿病合并高血压病患者纤溶活性的影响

目的：探讨替米沙坦对2型糖尿病（2DM）合并高血压病患者纤溶活性的影响。方法：将60例2DM合并高血压患者随机分为常规治疗组（n=30）和常规＋替米沙坦（80mg,qd）治疗组（n=30）,另选择20名年龄匹配的健康查体者为对照。治疗4周后测定血中组织型纤溶酶原激活物（t-PA）及其抑制物（PAI-1）的活性。结果：与对照组比较,2DM合并高血压患者纤溶功能显著低下,虽t-PA活性无显著改变,但PAI-1活性增加了约70%（P〈0.01）。常规治疗组t-PA及PAI-1活性无显著变化（P〉0.05）;替米沙坦治疗使PAI-1活性显著下降约60%（P〈0.01）,t-PA活性无显著变化。结论：2型糖尿病合并高血压病患者存在纤溶功能低下,替米沙坦可显著降低纤溶酶原激活物抑制物-1活性,提高纤溶功能。     

血小板参数及纤溶系统在2型糖尿病患者中的变化

目的 探讨血小板参数及纤溶酶原激活剂抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)在2型糖尿病患者中的变化.方法 对50例2型糖尿病患者及50例健康体检者进行血小板(PLT)及其参数、PAI-1,t-PA的测定.结果 与对照组相比,2型糖尿病患者中血小板(PLT)、平均血小板容积(MPV)、血小板体积分布宽度(PDW)及大血小板比率(P-LCR)均有显著性变化[MPV分别为12.11±1.21 fl和11.07±0.96 fl,PLT分别为(182±54)×109/L和(225±59)×109/L,P-LCR分别为41.25%±9.55%和32.14%±8.77%,PDW分别为17.06±4.26 fl和14.85±3.12 fl,P均＜0.01],PAI-1含量显著高于对照组(109.1±19.8 ng/ml和35.3±7.7 ng/ml,P<0.01),t-PA含量显著低于对照组(10.3±4.7 ng/ml和22.1±4.8 ng/ml,P<0.01).结论 血小板参数及PAI-1,t-PA在2型糖尿病患者中有显著性改变,提示糖尿病患者存在着血小板活化及纤溶活性减低的现象,凝血系统活性改变在糖尿病患者的病情发展及血栓性并发症的发生中起着一定的作用.     

2 型糖尿病微血管病变患者纤溶系统变化与胰岛素抵抗的关系

目的 探讨2型糖尿病微血管病变患者纤溶活性变化与胰岛素抵抗(IR)之间的关系.方法 采用酶联免疫吸附试验测定53例2型糖尿病惠者(包括无血管并发症组30例和微血管并发症组23例)和25例正常对照者血浆组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)含量,结合临床资料分析其变化趋势及影响因素.结果 2型糖尿病患者血浆t-PA含量明显降低,而PAI-1含量明显升高,t-PA分别是(7.09±2.10)μg/L vs(12.40±2.11)μg/L(P＜0.05),PAI-1分别是(40.38±1.74)μg/L vs(25.28±2.83)μg/L(P＜0.05),合并微血管病变者,此变化更为显著,t-PA分别(6.22±1.23)μg/L vs(12.40±2.11)/μg/L,PAI-1分别是(44.57±2.16)μg/L vs(25.28±2.83)μg/L(均P＜0.01).多元逐步回归分析显示,HOMA模型胰岛素抵抗指教(HOMA-IR)是PAI-1升高的独立危险因素.结论 2型糖尿病患者纤溶活性降低,IR在降低其纤溶活性,并发微血管病变中起了重要作用.     

2型糖尿病患者血浆D-二聚体,t-PA,PAI-1水平与血管病变的相关性

2型糖尿病血管病变是其较常见的并发症,它是由许多原因引起,主要原因之一是由于高血糖及脂代谢异常所引起的血管内皮损伤,导致血栓或广泛的微血栓形成.我们通过对患者血浆中D-二聚体,纤溶酶原激活物(tPA),纤溶酶原激活物抑制物(PAI-1)水平的测定,了解这三种指标与2型糖尿病患者血管病变的相     

伴有糖尿病的冠心病患者纤溶系统的变化及罗格列酮的干预研究

目的通过观察伴有糖尿病(DM)的冠心病(CHD)患者纤溶系统的变化,并以罗格列酮进行干预,由此对罗格列酮防止支架术后再狭窄机制作初步探讨。方法试验对象共分为3组:伴有2型DM的CHD患者48例;不伴有2型DM的CHD患者36例;正常对照组:同期我院体检健康成人20例;3组对象均在入院后清晨抽血、分离血浆。检测一氧化氮(NO)、组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制剂(PAI-1)的含量;培养上清中NO采用硝酸还原酶法测定;t-PA和PAI-1采用酶联免疫法(ELISA)测定;另外将合并DM的CHD组48例患者分为两组,一组针对CHD和DM常规治疗,另一组在此基础上加用罗格列酮,4 mg/d,口服。治疗3个月后复查上述指标。结果伴有或不伴有DM的CHD患者NO的浓度分别为(40.83±5.34)μmol/L、(50.31±5.34)μmol/L均低于正常对照组(73.37±6.46)μmol/L(P均<0.01);t-PA的浓度分别为(18.53±7.05)μg/L、(26.72±8.20)μg/L均低于正常对照组(40.17±8.30)μg/L(P均<0.01);PAI-1的浓度分别为(86.04±8.88)μg/L(、78.52±7.34)μg/L均高于正常对照组(48.86±5.41)μg/L(P<0.01);伴有DM的CHD患者NO和t-PA的浓度均低于不伴有DM的CHD患者组(P<0.05),PAI-1的浓度高于不伴有DM的CHD患者组(P<0.05)。伴有DM的CHD患者常规治疗和常规 罗格列酮治疗后NO,t-PA显著高于治疗前:NO治疗前后的变化值分别为(20.97±3.49)μmol/L、(30.32±3.36)μmol/L(P均<0.01);t-PA治疗前后的变化值分别为(11.97±2.07)μg/L、(21.32±2.21)μg/L(P均<0.01);伴有DM的CHD患者常规治疗和常规 罗格列酮治疗后PAI-1的浓度显著低于治疗前,PAI-1治疗前后的变化值分别为(-23.98±5.12)μg/L、(-34.02±5.64)μg/L(P<0.01);和常规组比较,常规 罗格列酮治疗组改善的幅度要高于常规组(P<0.01)。结论伴或不伴DM的CHD患者冠心病患者体内存在不同程度纤溶活性的降低,这种高凝状态会促进血栓形成和再狭窄的发生。对于冠心病患者,在常规冠心病治疗基础上,加用罗格列酮能促进纤溶系统的激活,防止血栓的形成,有效防止支架术后再狭窄,特别是对于伴有糖尿病的CHD患者。     

2型糖尿病微血管并发症相关危险因素调查

目的：了解2型糖尿病微血管并发症相关危险因素,为防治提供依据。方法：调查分析226例2型糖尿病患者临床资料。结果：糖尿病微血管病变组与糖尿病组比较：病程、HbA 1c、TG、LDL-C、ACR、血压差异有统计学意义（P〈0.05）。结论：糖尿病病程、血糖、血脂、血压、尿微量白蛋白是2型糖尿病微血管病变主要危险因素。     

Effect of insulin therapy on macrovascular risk factors in type 2 diabetes

Many patients with type 2 diabetes require insulin therapy for improved glycemic control after beta-cell failure. However, many physicians are reluctant to institute insulin therapy in type 2 diabetes for fear of accelerating atherosclerosis. The epidemiological evidence is reasonably sound that hyperinsulinism correlates with increased cardiovascular disease in nondiabetic people and those with early type 2 diabetes. It is much less clear, however, that insulin concentration plays a negative role when less well controlled diabetes is considered. The data are more consistent, in fact, with the glucose hypothesis, i.e., that hyperglycemia is a risk factor, although the magnitude of the glucose effect is not well defined. Certainly, the dysmetabolism associated with poor glycemic control could increase the risk of macrovascular events through well-known mechanisms. There is direct evidence that insulin therapy can reduce the risk of macrovascular events by improving glycemic control and diabetes-associated dyslipidemias, although the beneficial effects may be significantly compromised by excessive weight gain. Insulin therapy does not appear to induce hypertension independent of changes in body weight. It is concluded that optimal glycemic control confers a known benefit and can only be achieved with insulin therapy in some people with type 2 diabetes. In these circumstances, the use of insulin has a net benefit on cardiovascular risk, mediated primarily through improvement in dyslipidemia and glycemia itself.     

Risk factors for microvascular and macrovascular complications in men and women with type 2 diabetes

Objective - To evaluate the importance of risk factors for microvascular and macrovascular complications, separated by sex, in type 2 diabetes. Design - Cross-sectional surveys of diabetic patients registered with primary health services in 1995. Setting - Three community health centres in Stockholm County. Subjects - 407 subjects with type 2 diabetes in 1995. For 78 of these, data were also registered in 1992. Main outcome measures - Odds ratio (OR) by logistic regression for risk factors predicting microvascular and macrovascular complications, for age and duration in years. Results - For microvascular complications, the most important factors were in men the duration of diabetes (OR 1.13, p&lt;0.001) and in women the duration of diabetes (OR 1.08, p&lt;0.001) and age (OR 1.04, p&lt;0.05). For macrovascular complications, the most important factors were in men, age (OR 1.09, p&lt;0.001) and hypertension (OR 4.85, p&lt;0.001) and in women, age (OR 1.08, p&lt;0.001) and duration of diabetes (OR 1.08, p&lt;0.01). Conclusions - Hypertension is more important among men and the duration of diabetes among women as risk factor for macrovascular complications in type 2 diabetes.     

2型糖尿病大血管并发症防治

糖尿病大血管并发症是2型糖尿病患者重要的致残和死亡原因,对糖尿病大血管病变的防治具有重要意义。由于大血管并发症发病机制复杂,对大血管病变的防治必须注重危险因素的全面干预。本文针对2型糖尿病大血管并发症的主要危险因素血糖、血脂、血压及抗血小板治疗的新进展做一综述。     

Risk factors for microvascular and macrovascular complications in men and women with type 2 diabetes.

OBJECTIVE: To evaluate the importance of risk factors for microvascular and macrovascular complications, separated by sex, in type 2 diabetes. DESIGN: Cross-sectional surveys of diabetic patients registered with primary health services in 1995. SETTING: Three community health centres in Stockholm County. SUBJECTS: 407 subjects with type 2 diabetes in 1995. For 78 of these, data were also registered in 1992. MAIN OUTCOME MEASURES: Odds ratio (OR) by logistic regression for risk factors predicting microvascular and macrovascular complications, for age and duration in years. RESULTS: For microvascular complications, the most important factors were in men the duration of diabetes (OR 1.13, p < 0.001) and in women the duration of diabetes (OR 1.08, p < 0.001) and age (OR 1.04, p < 0.05). For macrovascular complications, the most important factors were in men, age (OR 1.09, p < 0.001) and hypertension (OR 4.85, p < 0.001) and in women, age (OR 1.08, p < 0.001) and duration of diabetes (OR 1.08, p < 0.01). CONCLUSIONS: Hypertension is more important among men and the duration of diabetes among women as risk factor for macrovascular complications in type 2 diabetes.     

Effects of oral antihyperglycemic agents in modifying macrovascular risk factors in type 2 diabetes

Management of patients with type 2 diabetes should focus on decreasing the excess macrovascular disease with which it is associated as well as preventing or minimizing microvascular disease. Near-normoglycemic control can reduce microvascular disease. Reducing macrovascular disease requires concomitant management of the cardiovascular risk factors (components of the insulin resistance syndrome) associated with type 2 diabetes. The first phase of such treatment is to identify the effects that the various drugs to treat the hyperglycemia are likely to have on these associated cardiovascular risk factors. Appropriate combinations of antihyperglycemic agents should be selected for specific patients to help achieve good glycemic control and produce beneficial, or at least nondetrimental, effects on cardiovascular risk.     

2型糖尿病患者血清胎球蛋白A水平与大血管并发症的关系

目的 探讨胎球蛋白A(AHSG)在2型糖尿病大血管并发症中的可能作用,为预防和治疗糖尿病(DM)大血管并发症提供理论依据.方法 分别收集30例2型糖尿病大血管病变患者(DMM组)、38例2型糖尿病无大血管病变患者(DMN组)和30例健康对照组(C组)为研究对象;采用酶联免疫吸附试验测定各组血清AHSG水平.结果 DMM组、DMN组的血清AHSG浓度均较健康对照组明显升高,其中DMM组升高更明显(P<0.01);随着血清AHSG浓度升高,糖尿病伴发大血管病变发生率逐渐增加,二者呈正相关(P<0.01);血清AHSG浓度是独立的大血管病变预测因素(P<0.01),病程、高血压与大血管病变呈正相关(P<0.01).结论 血清AHSG可能参与了糖尿病大血管并发症的形成和发展.     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

目的 测定正常人群与2型糖尿病及其大血管病变患者的血清脂联素水平,探讨脂联素与2型糖尿病及其大血管病变的相关性.方法 正常对照组102例,2型糖尿病组116例、2型糖尿病并大血管病变组123例,比较各组的血清脂联素水平,分析其影响因素.结果 ①型糖尿病组及其大血管病变组的血清脂联素水平[分别为(8.62±2.97)、(6.17±2.55)mg/L]较正常对照组[(10.03±4.41)mg/L]降低,大血管病变组的血清脂联素水平较2型糖尿病组更低,差异均有统计学意义(P均<0.05);②相关分析显示,脂联素水平与体重指数、腰臀比、胰岛素抵抗指数、空腹胰岛素、糖化血红蛋白、甘油三酯负相关(r值分别为-0.492、-0.581、-0.813、-0.754、-0.619、-0.387,P均<0.05);③多元逐步回归分析显示脂联素与胰岛素抵抗指数、空腹胰岛素、糖化血红蛋白呈负相关(r值分别为-0.828、-0.769、-0.631,P均<0.01).结论 2型糖尿病及其大血管病变患者的血清脂联素水平降低,低脂联素血症可能与2型糖尿病及其大血管病变相关,在糖尿病动脉粥样硬化的发生、发展过程中有重要作用.     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.