妇科恶性肿瘤化疗患者262例血糖观察

目的 观察化疗对妇科恶性肿瘤患者血糖的影响.方法 回顾性分析我科收治的262例恶性肿瘤患者化疗前、中、后糖尿病的发生情况,对并发糖尿病患者进行随访.结果 化疗后空腹血糖升高24例,糖尿病8例,糖耐量减低11例,一过性血糖升高5例.PT方案化疗较PVB方案化疗更易引起血糖增高(P＜0.05).结论 恶性肿瘤患者化疗后可引起血糖增高,甚至发生糖耐量减低或2型糖尿病. Abstract： Objective To explore the effect of chemotherapy on glucose metabolism in patients with gynecological malignant tumor.Methods Two hundred and sixty -two patients with gynecological malignant tumor who treated with chemotherapy were analyzed retrospectively.The incidence of diabetes mellitus as analyzed.The occurrence of diabetes before, during and after chemotherapy for patients with malignant tumors was observed.Results Total 24 cases had elevated fasting blood glucose after chemotherapy.Among them ,8 cases were diagnosed as diabetes mellitus, 11 cases were diagnosed as impaired glucose tolerance.Significant difference of blood glucose was observed between patients treated with PT chemotherapy and those who treated with PVB chemotherapy(P ＜ 0.05).Conclusions Chemotherapy could make the blood glucose of patients with malignant tumor increase, and may result in decreased sugar tolerance or type 2 diabetes.     

Effect of short term intensive multitherapy on carotid intima- media thickness in patients with newly diagnosed type 2 diabetes mellitus

Background Controlling plasma glucose levels, blood pressure and lipid levels is proven to reduce the risk of vascular complications in patients with type 2 diabetes mellitus. This has prompted intensive multitherapy targeted at several macrovascular risk factors. Carotid intima-media thickness （cIMT） is a reliable measure of early atherosclerosis. We sought to determine whether a 6-month intensive mutiltherapy program resulted in better goal attainment than usual care and its effect on the development of cIMT among patients with newly diagnosed type 2 diabetes mellitus.
Methods The study randomly assigned 220 patients with newly diagnosed type 2 diabetes mellitus to intensive or traditional therapy groups. The clinical parameters, such as fasting plasma glucose, total cholesterol, triglyceride, blood pressure, body weight and insulin were assessed at the baseline and after the 6-month therapy, cIMT of the patients was also obtained.
Results The average levels of fasting plasma glucose, hemoglobin Alc, total cholesterol （TC） and low-density lipoprotein cholesterol （LDL-C） in the intensive group were significantly lower than those in the control group at the end of 6-month treatment. By 6 months, a higher proportion of patients in the intensive therapy group than in the control group attained goals for fasting plasma glucose （FPG）, TC, LDL-C and hemoglobin Alc. With intensive multherapy the level of carotid intima-media thickness in the intensive therapy group was lower than that in the control group （（0.88±0.26） mm vs （0.96±0.22） mm, P 〈0.01）.
Conclusions The evidence from this clinical trial demonstrates that intensive glucose, lipid and blood pressure control in patients with newly diagnosed type 2 diabetes is associated with diabetic macrovascular benefits. Intensive multitherapy allows more patients to achieve aims of control and may reduce macrovascular complications and delay disease progression.     

Analysis of oral glucose tolerance test in pregnant women with abnormal glucose metabolism

Background Due to the controversy of the oral glucose tolerance test (OGTT), diagnostic criteria for gestational diabetes mellitus (GDM) in the world and researches on GDM remain undeveloped in China.American Diabetes Association recently recommended the clinicians to diagnose GDM by OGTT results without the third-hour glucose value. This new criteria has not been used in China. Research on the value and sensitivity of the criteria in detecting GDM is rare. The aim of our study is to analyze the characteristics of OGTT in Chinese women with GDM or gestational impaired glucose tolerance (GIGT) and to evaluate the effect of omission of the third-hour plasma glucose (PG) level in OGTT on the sensitivity of diagnosing GDM and GIGT, and the relationship between PG values of 50 g GCT or OGTT and insulin therapy.Methods A retrospective analysis was performed on medical records of 647 cases with GDM from January 1,1989 to December 31,2002, and 233 with GIGT. Among 647 cases of GDM, 535 cases were diagnosed by 75 g OGTT. All OGTT results including 535 cases of GDM and 233 patients with GIGT were evaluated.Results There were 112 cases of GDM diagnosed by elevated fasting PG (FPG) without OGTT performed. Of 535 cases of GDM diagnosed by OGTT, 49.2% (263/535) women had FPG value ≥5.8 mmol/L; 90.1%(482/535) women with 1-hour PG values ≥ 10. 6 mmol/L; 64.7% (359/535) with 2-hour PG levels ≥9.2mmol/L. There were only 114 cases (21.3%) with abnormal 3-hour PG levels among 535 women with OGTT.Among those with abnormal 3-hour PG level, 49.1% (56/114) had abnormal glucose values in the other three points of OGTT, and 34.2% (39/114) with two other abnormal values of OGTT. Our study showed thatomission of the 3-hour PG of OGTT only missed 19 cases of GDM and they would be diagnosed as GIGT. Among the 233 women with GIGT, only 4 cases had abnormal 3-hour PG. So, omission of the third-hour glucose value of OGTT only resulted in failure to diagnose 3.6% ( 19/535 ) women with GDM diagnosed by OGTIT, which means 2.9% ( 19/647 ) of all the GDM and 1.7% (4/233) of GIGT in Chinese women. PG levels ≥ 11.2mmol/L following 50 g GCT was highly associated with GDM necessitating insulin therapy (75.4%). An elevated FPG level was also associated with insulin therapy (59.7 % ).Conclusions Omission of the third-hour glucose tolerance test value still yield a higher sensitivity in diagnosing GDM and GIGT. In Chinese women, it is practicable to omit third-hour post-glucose ingestion value of the OGTT in Chinese women. PG levels ≥ 11.2 mmol/L following 50 g GCT mostly indicates that the requirement of insulin therapy.     

非洛地平对原发性高血压患者血脂、血糖及血尿酸的影响

AimTo investigate the effect of felodipine on blood lipid,sugar and uricacid in patients with essential hypertension.Methods42 patients with essential hypertension were given felodipine,10 mg per day or 10 mg BID,po,and the total time of treatment was 6 weeks.Before and after treatment,the blood was collected from patients to determine the alternation of blood sugar,lipid and uricacid.ResultsThere was a significant difference(P＜0.05) between systolic blood pressure(SBP,(25.00±6.00) kPa),diastolic blood pressure(DBP,(13.90±2.40) kPa),total cholesterol(TC,(6.7±2.3) mmol/L) and high density lipoprotein cholesterol(HDL-ch,(1.12±0.25) mmol/L) in patients before treatment,and SBP(18.9±2.1) kPa,DBP(12.1±1.9) kPa,TC(4.9±1.5) mmol/L after treatment(P＞0.05).ConclusionFelodipine is suitable for treating patients with essential hypertension and hypertension complicated with diabetes and blood lipid disorder,and the efficacy of felodipine on blood pressure smooth and dependable.     

Association between serum uric acid and different states of glucose metabolism and glomerular filtration rate

Background Recently, it has been suggested that the serum uric acid （SUA） level decreased in diabetic patients. The aim of this study was to explore the association between SUA level and different state of glucose metabolism and glomerular filtration rate （GFR） reflected by the simplified Modification of Diet in Renal Disease （MDRD） equation and to test the hypothesis that high MDRD is one of the determinants of SUA level.Methods This cross-sectional study included 2373 subjects in Beijing who underwent a 75 g oral glucose tolerance test （OGTT） for screening of diabetes. According to the states of glucose metabolism, they were divided into normal glucose tolerance, impaired glucose regulation and diabetes.Results Multiple stepwise linear regression analysis showed that adjusted by gender, SUA was positively correlated with body mass index （BMI）, waist/hippo ratio, systolic blood pressure （SBP） and triglyceride, meanwhile negatively correlated with age, hemoglobin A1c, fasting insulin and MDRD. There was an increasing trend in SUA concentration and a decreasing trend in MDRD when the levels of fasting plasma glucose （FPG） increased from low to high up to the FPG level of 8.0 mmol/L; thereafter, the SUA concentration started to decrease with further increases in FPG levels, and the MDRD started to increase with further increases in FPG levels.Conclusion This study confirmed the previous finding that SUA decreased in diabetes and provided the supporting evidence that the increased MDRD might contribute to the fall of SUA.     

60岁及以上2型糖尿病患者发生夜间低血糖的危险因素分析

This study was to evaluate the risk factors of nocturnal hypoglycemia in elderly patients with type 2 diabetes by continuous glucose monitoring system. Fifty-one type 2 diabetic patients aged 60 or above were enrolled and the episodes of nocturnal hypoglycemia were documented. The risk factors of nocturnal hypoglycemia were analyzed by logistic regression and the cut-off of glucose levels at bedtime for nocturnal hypoglycemia was evaluated. There were twenty-two patients with total 681 nocturnal hypoglycemic episodes. Logistic regression analysis showed that the lowest glucose level at bedtime was the risk factor of nocturnal hypoglycemia (OR=0.36, 95% CI:0.13-1.00, P<0.05), while the gender, age, diabetes duration, therapy regimen, the highest and average glucose levels at bedtime were not associated to nocturnal hypoglycemia. Receiver operating characteristic curve (ROC) showed that the bedtime glucose at≤6.2 mmol/L was the best cut-off point for predicting nocturnal hypoglycemia.     

Diagnosis and treatment of fungal infection after liver transplantation

Background  Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient’s health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.

Methods  Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.

Results  Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.

Conclusions  Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.

     

Enhancing the treatment of metabolic syndrome with integrative medicine

Metabolic syndrome,with the main clinical manifestations of obesity,dyslipidemia,elevated blood pressure,and elevated blood glucose levels,has become an increasingly prevalant global public health concern.@@Metabolic syndrome is a convergence of multiple risk factors related to cardiovascular disease.When the concept of metabolic syndrome was initially proposed,some researchers thought the concept was unnecessary,since there were already measures in place to describe the separate cardiovascular risk factors such as dyslipidemia,hypertension and diabetes.However,a large number of epidemiological investigations confirmed that even if blood glucose or blood pressure did not reach the cutoff point of the diseases,the superposition of multiple risk factors serves to amplify the damage of a single factor to the cardiovascular system.A meta-analysis of 87 clinical studies including 951 083 cases showed that the relative risk (RR) of metabolic syndrome for cardiovascular disease is 2.35,RR of death from cardiovascular disease is 2.40,and RR of stroke is 2.27.     

Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective： To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c （HbA1c） was kept ≤6.0%. Methods： Totally 36 cases with type 2 diabetes （T2DM） with HbA1c≤6.0% and 30 cases with normal glucose tolerance （NGT） from December 2005 to December 2007 in our department were subjected prospectively. Continuous glucose monitoring system （CGMS） was employed to record their continuous blood glucose level for 3 d. The blood glucose profiles including the mean blood glucose （MBG）, standard differentiation （SD）, mean amplitude of glycemic excursions （MAGE） and absolute means of daily differences （MODD） were analyzed. Results： T2DM group had obviously postprandial hyperglycemia, in about 2 h after meal, especially after breakfast. Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups, of which 73.1% （38 episodes） were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L. And 20 episodes took place during the day hours, while 32 episodes observed during the night hours. Compared with NGT groups, SD, MAGE and MODD were all significantly higher in T2DM groups. MBG was significantly correlated with HbA1c in T2DM groups, but SD, MAGE, NGE and MODD were all independent of HbA1c. MAGE was independent of MODD. Conclusion： The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups Thus ideally glycemic control is not only to make HbA1c reach standard, but also to lessen glycemic excursions and reduce hypoglycemia episodes.