冠心病动脉造影正常的老年高血压患者负荷试验的分析

目的：探讨老年高血压患冠心病动脉储备功能（CFR）。方法：冠状动脉造影正常的高血压患76例，无左心室肥厚（LVH）32例（Ⅰ组），合并LVH44例（Ⅱ组），正常对照组26例（Ⅲ组）。三组受检查分别行静态、运动心肌核素断层显像及心电图潘生丁负荷试验。结果：心肌核素显像：Ⅰ组运动后单光子发射型计算机断层仪（ECT）呈缺血性改变3例（9．4％），Ⅱ组运动后ECT呈缺血性改变11例（25．0％），有反向再充填现象2例（4．5％，P＜0．05）。心电图潘生丁试验，Ⅰ组阳性1例（3．1％），可疑阳性3例（9．4％）；Ⅱ组阳性7例（15．95），可疑阳性9例（20．5％，P＜0．05）。心电图潘生丁试验阳性或可疑阳性伴ECT缺血性改变：Ⅰ组：无；Ⅱ组8例（18．2％，P＜0．01）。正常对照组心肌核素显像及潘生丁试验均无异常 。结论：高血压患存在不同程度CFR下降，合并LVH尤为明显，其原因可能与冠状动脉微循环结构及功能异常有关。     

2型糖尿病并发冠心病的血脂水平变化

目的；研究2型糖尿病合并冠心病（CHD）患血脂水平的变化。方法：采用美国贝克曼全自动生化分析仪对门诊的60例2型糖尿病无CHD患（I组），37例2型糖尿病合并CHD患（Ⅱ组）及72例正常对照组（Ⅲ组）进行系列血脂指标的测定。结果：I组TC、TG、LDL－C、ApoA、ApoB水平显高于对照组（P＜0．05－＜0．01）；Ⅱ组TC、TG、ApoB水平显高于对照组（P＜0．05－＜0．01）；I、Ⅱ两组之间的HDL－C水平存在显性差异（P＜0．05）。Ⅱ组的TG／HDL－C比值显高于I组和对照组（P＜0．05）。结论：2型糖尿病无CHD患与2型糖尿病合并CHD患之间的脂质代谢紊乱有所不同，HDL－C水平降低，TG／HDL－C比值异常升高，可能是糖尿病患发生CHD的易患因素。     

糖尿病肾病相关影响因素调查性研究

本调查了1999－2000年507例住院的糖尿病病人并做了分析。结果：（1）糖尿病肾病114例，占糖尿病总数的22.49%，其中微量白蛋白尿组1.97%，临床白蛋白尿组占16.37%，氮质血症组占4.14%；（2）糖尿病肾病发生与年龄呈正相关，51－60岁段发生率最高；（3）与病程呈正相关，≥10年组高达58.06%，≤3年组也有不少发生；6.76%；（4）与收缩压与舒张压均呈正相关；（5）也与血脂相关，但与HDL表达出显性；（6）与性别、类型、体重指数不相关。结论：早期控制血糖、血压、和血脂将是防治糖尿病的重要措施。     

脂肪肝

脂肪肝与胰岛素抗性的关系——汤亚飞（湖北江汉油田中心医院内科433124）；《医学信息》，2005，18（5）：493．495[目的：探讨脂肪肝与胰岛素抗性的关系。方法：对30例诊断为脂肪肝患作回顾性分析。结果：多数患合并胰岛素抗性综合征（高血压、肥胖症、糖尿病、高脂血症），18例接受口服葡萄糖耐量试验（OGTT）中，1例确诊为Ⅱ型糖尿病，17例患中3例空腹血糖减损（IFG）。     

平板运动试验假阳性分析

目的 了解平板运动试验假阳性率及其临床意义。方法 选择资料完整的77例平板运动试验阳性患与冠脉造影结果对照。观察运动引起ST改变与冠状动脉造影阳性之间的关系。结果 从中检出平板试验阳性，冠脉造影阴性的19例患，占24．7％(17/19)，在假阳性患中植物神经功能紊乱52．6％(10／19)，高血压36．8％(7／19)，肥厚型心肌病和X综合征各占10．5％(2／19)，冠状动脉瘘与原发性肺动脉高压各1例。结论 平板运动试验假阳性患，半数为心脏植物神经功能紊乱，半数有原发性心脏病，主要病因是高血压及肥厚型心肌病等。     

急性心肌梗死早期康复治疗初探

目的：探讨早期康复治疗对无合并症急性心肌梗死（ＡＭＩ）患住院期病情及疗效的影响。方法：５５例患随机分为早期康复治疗组（２８例）及对照组（２７例）。治疗组采用早期治疗方案,对照组采用传统康复治疗方案。结果：两组在到射血分数、踏车运动试验阳性、ＬｏｗｎⅢ级以上室性心律失常以及梗死后心绞痛、再梗死、死亡等的构成比上无显性差异（Ｐ〉０．０５）。结论：无合并症ＡＭＩ患实施早期康复治疗是安全可行且有效     

心电图运动试验与运动核素心肌断层显像对冠心病诊断价值的探讨

目的 探讨心电图（ECG）、心电图运动试验（ETT）、运动^99mTC-MIBI心肌断层显像（SPECT）相结合，在冠心病中的诊断价值。方法 对可疑冠心病（CHD）患与正常人组及已确诊为冠心病组分别使用美国产Marguette Case 16系统按Bruce方案进行运动心电图试验；用美国产GE Starcam 4000XR/T SPECT仪行SPECT。结果 冠心病组ETT阳性SPECT也均为阳性，与正常组比较（P＜0．01）。结论 对可疑冠心病应行ETT和SPECT检查。运动SPECT阴性患CHD的可能性小。     

运动康复对冠心病合并糖尿病人的影响

目的：研究运动康复对冠心病合并糖尿病的影响。方法：23例冠心病合并糖尿病患被随机分为康复组与对照组,康复组（12例）在常规药物治疗基础上,辅以康复运动,对照组（11例）给予单纯药物治疗。结果：康复组病人：血糖,血清胆固醇,甘油三酯,血尿素氮水平改善均优于对照组（P＜0．05）,心电图缺血改变消失显多于对照组（83．3％：27．2％）。结论：运动康复可改善冠心病并糖尿病患的血脂等指标,增进疗效。     

37例急性心肌梗死早期康复临床观察

目的：探讨急性心肌梗死（AMI）无并发症病人早期康复护理对促进心肌功能恢复，预防病情复发，提高生活质量，避免长期卧床的并发症及缩短住院日期的作用。方法：将57例无并发症的AMI患随机分为两组：实验组37例，对照组20例。对于实验组，制定康复运动处方、观察指标、康复程序暂停指标，按无并发症AMI康复程序实施早期康复护理。对照组实施传统护理方法。结果：实验组；住院日6－34日（平均20）日，≥20天18例，占49％，＜2天19例，占51％，对照组：住院日15－113（平均48日），≥20天17例，占85％，＜20天3例；两组平均住院日有显差异（P＜0．05），早期康复护理使无并发症AMI患平均住院日数由传统治疗护理时的48天下降至20天，结论：早期康复护理是无并发症AMI病人的有效护理方法之一。     

156例平板运动试验与冠状动脉造影结果对照分析

目的将平板运动试验的结果与冠状动脉造影（CAG）的结果对照，探讨平板运动试验与冠状动脉病变的相关关系。方法选择临床拟诊冠心病（CHD）患者156例，2周内行平板运动试验与CAG检查。将平板运动试验的结果与CAG的结果对照分析。结果①156例患者中，平板运动试验阳性67例，其中CAG阳性50例，CAG阴性17例。平板运动试验阴性89例，其中CAG阴性75例，CAG阳性14例。平板运动试验检出CHD的敏感性为75．3％（67／89），特异性为81．5％（75／92），阳性预测值74．6％（50／67），阴性预测84.3％（75／89），预测准确性80．1％（125／156），假阳性率为25．4％（17／67），假阴性率为15．7％（14／89）。②平板运动试验阳性率与冠状动脉病变支数有关；平板运动中ST段下移程度、出现时间及持续时间与冠状动脉狭窄程度有关。③女性平板运动试验假阳性率高于男性（P〈0．05）。结论平板运动试验是目前诊断冠心病较理想的非创伤性的检查方法，并可估测冠状动脉病变程度，适合临床广泛应用。     

Tumour necrosis factor-alpha plasma level in patients with type 1 diabetes mellitus and its association with glycaemic control and cardiovascular risk factors

OBJECTIVES: Diabetic patients reveal a significant increase in their cardiovascular risk. Beside glycaemic control and management of established risk factors, determination of cytokines, like serum levels of tumour necrosis factor-alpha (TNF-alpha), might offer a tool to determine patients at high risk. The cytokine TNF-alpha reveals a complex relationship with diabetes. It is involved in beta-cell damage leading to type 1 diabetes, causes insulin resistance associated with obesity and is of influence in the formation of atherosclerotic vascular lesions. We were interested in the possible association of this cytokine with metabolic control and cardiovascular risk factors in patients with type 1 diabetes. DESIGN AND SUBJECTS: TNF-alpha plasma levels were determined in 44 outdoor patients (15 women, 29 men) with type 1 diabetes mellitus (mean duration 11.2 +/- 8.7 years) and in 24 healthy controls by use of a solid phase enzyme amplified sensitivity immunoassay (TNF-alpha ELISA, Biosource Fleurus, Belgium). None of our study participants suffered from inflammatory or other concurrent diseases. Relationships between variables were evaluated by non-parametric Spearman correlation coefficients. RESULTS: TNF-alpha plasma levels were significantly higher in diabetic patients (19.3 +/- 7.5 pg mL-1) than in non-diabetic subjects (11.1 +/- 5.8 pg mL-1; P < 0. 023), and revealed a significant positive correlation with glycated haemoglobin (HbA1c) (r = 0.43; P < 0.004) and fructosamine (r = 0. 31; P < 0.049) values, and a negative correlation with HDL cholesterol (r = -0.36; P < 0.018) and apoAI-levels (r = -0.37; P < 0.015). These relationships could be observed in patients with a duration of diabetes for more than 5 years, as well as in patients with a shorter duration of diabetes. In the male group, TNF-alpha plasma levels revealed a significant positive correlation with plasma levels of thiobarbituric acid reacting substances (r = 0.61; P < 0.001). Plasma levels of thiobarbituric acid reacting substances showed a positive correlation with the duration of diabetes (r = 0. 58; P < 0.008), as well as with the serum levels of the vascular adhesion molecules intercellular adhesion molecule (ICAM) (r = 0.34; P < 0.051) and vascular cell adhesion molecule (VCAM) (r = 0.30; P < 0.052). CONCLUSIONS: Our data indicate that TNF-alpha plasma levels are increased in type 1 diabetes mellitus and reveal a significant association with metabolic long-term control parameters, HbA1c and fructosamine for glycaemic control, and HDL cholesterol for triglyceride metabolism, as well with lipid peroxidation.     

Neither homeostasis model assessment nor quantitative insulin sensitivity check index can predict insulin resistance in elderly patients with poorly controlled type 2 diabetes mellitus

To clarify whether homeostasis model assessment (HOMA IR) and quantitative insulin sensitivity check index (QUICKI) may be indicators of insulin resistance in elderly patients with type 2 diabetes mellitus, their relationship with the glucose infusion rate during the euglycemic hyperinsulinemic clamp study (clamp IR) was assessed. This study comprised 56 Japanese patients with type 2 diabetes mellitus; of these, 28 were 70 yr of age or older (group 1) and 28 were less than 70 yr of age (group 2). Their blood sugars were in poor control (fasting plasma glucose levels: group 1, 9.0 +/- 2.6 mmol/liter; group 2, 8.9 +/- 2.3 mmol/liter; hemoglobin A1c: group 1, 9.5 +/- 2.0%; group 2, 9.2 +/- 1.7%). Log-transformed HOMA IR was significantly correlated with the clamp IR in group 2 patients (r = -0.51, P < 0.01), but not in group 1 patients (r = -0.28, P = 0.15). There was a significant positive correlation between QUICKI and clamp IR in group 2 patients (r = 0.50, P < 0.01). However, no significant correlation was observed between QUICKI and clamp IR in group 1 patients (r = 0.31, P = 0.12). There was a significant correlation between log-transformed HOMA IR (r = -0.37, P < 0.01) or QUICKI (r = 0.37, P < 0.01) and clamp IR when both groups were combined. In conclusion, neither HOMA IR nor QUICKI should be used as an index of insulin resistance in elderly patients with poorly controlled type 2 diabetes mellitus. The results of this study suggest the need for developing a new noninvasive method for evaluating insulin resistance in those patients.     

Aortic elastic properties in patients with hypertensive response to exercise.

BACKGROUND: The aim of this study was to evaluate whether there is a relationship between aortic elastic properties in patients with a suggestive response to treadmill exercise testing. METHODS AND RESULTS: The study group comprised 32 patients suggesting hypertensive response to exercise and 20 patients suggesting normal blood pressure response to treadmill exercise testing. Baseline demographic characteristics were similar in both groups. However, the mean aortic stiffness index of patients suggesting hypertensive response to treadmill exercise testing was significantly higher (4.8+/-1.26 vs 2.36+/-1.09; p=0.001) whereas aortic distensibility was significantly lower (12.82 +/-5.84 vs 22.64+/-14.54; p=0.001) than the control group. The aortic strain of patients with hypertensive response to exercise was lower than the control group (12+/-3% vs 19.2+/-5%, p<0.001). The left ventricular mass (LVM) of these patients was also higher than control group (206.5+/-46.3 vs 134.2+/-19.97; p=0.01). A negative correlation between LVM and distensibility was found (r=-0.64; p=0.001) well as a positive correlation between LVM and aortic stiffness index (r=0.51; p=0.004) in patients suggesting hypertensive response to exercise. Pressure--rate product was also found to be correlated with LVM (r=0.47; p=0.006). CONCLUSION: Elastic properties of the aorta may be impaired in subjects showing exaggerated blood pressure response to exercise long before clinically manifest hypertension, particularly if the LVM is increased.     

Homocysteine concentrations and vascular complications in patients with type 2 diabetes

OBJECTIVE: Hyperhomocysteinemia is a well known risk factor for the diseases of the cardiovascular system, which seem to be the main cause of increased mortality in patients with type 2 diabetes. The aim of the study was to evaluate the levels of homocysteine in patients with type 2 diabetes in respect to the regimen of diabetes treatment as well as the presence of diabetic complications. METHODS: The investigation was carried out in the group of 64 patients with type 2 diabetes and in 18 healthy subjects from the control group. Clinical examination and measurements of homocysteine, folic acid, vitamin B12, glycosylated hemoglobin concentration and evaluation of parameters of the lipid metabolism, microalbuminuria and creatinine were done in both groups. RESULTS: Homocysteine concentration was significantly higher in the group of patients with diabetes in comparison to the control group (p = 0.0007). Diabetic patients had significantly lower concentrations of folic acid (p = 0.028) and HDL cholesterol (p = 0.025) together with higher levels of systolic blood pressure (p = 0.007). In the group of patients with diabetes no differences in homocysteine levels were found in respect to diabetes treatment. Diabetic patients with coronary artery disease had significantly higher homocysteine concentration in comparison to the group with diabetes without history of coronary artery disease (p = 0.0097). Homocysteine levels correlated significantly with incidence of ischaemic heart disease (r = 0.44, p = 0.001) and microalbuminuria (r = 0.26, p = 0.019). Negative correlation was noticed in HDL concentrations (r = -0.30, p = 0.013) and the levels of folic acid (r = -0.30, p = 0.008). CONCLUSION: Our results suggest that hyperhomocysteinemia in diabetic patients may contribute to the development of chronic complications. The influence of diabetes treatment on Hcy levels requires further observations.     

Graves病及1型糖尿病患者促甲状腺激素受体抗体、锌转运体8抗体及谷氨酸脱羧酶抗体表达水平比较

目的探讨Graves病患者促甲状腺激素受体抗体、锌转运体8抗体、谷氨酸脱羧酶抗体水平及其相关性。方法招募2009年11月至2011年3月吉林大学白求恩第二医院内分泌科门诊和病房收治的51例Graves病患者（Graves病组;男9例,女42例）及72例1型糖尿病患者（1型糖尿病组;男30例,女42例）,另以70名志愿者为健康对照组。利用放射免疫分析法检测各组血清促甲状腺激素受体抗体水平,采用放射免疫沉淀法检测锌转运体8抗体及谷氨酸脱羧酶抗体水平。Pearson相关分析进行组问相关性分析。结果Graves病组促甲状腺激素受体抗体、锌转运体8抗体、谷氨酸脱羧酶抗体的阳性率分别为90．2％（46／51）、15．7％（8／51）和5．9％（3／51）,1型糖尿病组上述3种抗体的阳性率依次为4．2％（3／72）、45．8％（33／72）和41．7％（30／72）,健康对照组上述3种抗体的阳性率依次为0、1．4％（1／70）和1．4％（1／70）。Graves病组促甲状腺激素受体抗体与锌转运体8抗体呈正线性相关（r=0．278,P〈0．05）;促甲状腺激素受体抗体阳性的Graves病患者促甲状腺激素受体抗体与锌转运体8抗体呈正线性相关（r=0．537,P〈0．01）。1型糖尿病组锌转运体8抗体与谷氨酸脱羧酶抗体呈明显正线性相关（r=0．892,P〈0．01）。结论自身免疫性甲状腺病与自身免疫性糖尿病可能存在一定关联。1型糖尿病患者锌转运体8抗体水平与谷氨酸脱羧酶抗体水平高度相关。     

2型糖尿病尿白蛋白排泄率与血栓调节蛋白的相关性研究

目的　探讨2型糖尿病(T2DM)患者尿白蛋白排泄率(UAER)与血栓调节蛋白(TM)的相关性。　方法　68 例T2DM患者分为正常白蛋白尿(NAU)组,微量白蛋白尿(MAU)组,临床白蛋白尿(CAU)组。30 例健康人作对照(NC)组。检测各组对象的血浆TM 水平、血小板计数(PC)、血小板平均容积(MPV)、血小板分布宽度(PDW)。　结果　MAU组和CAU组UAER显著高于NC组(P<0.01)。T2DM患者血浆TM含量均高于NC组(P<0.01)。UAER与TM水平呈正相关(r=0.798,P<0.05)。T2DM患者PC与NC组比较差异有统计学意义(P<0.01)。MPV、PDW在MAU组和CAU组显著高于NC组(P<0.01)。　结论　T2DM患者UAER与TM水平呈正相关。两者对糖尿病肾病的早期诊断及血管内皮细胞损伤程度的评价有重要意义。T2DM患者的PC、MPV和PDW高于NC组,且随着UAER的升高而增加。     

Glucose-lowering effect of colestimide is associated with baseline HbA1c in type 2 diabetic patients with hypercholesterolemia

We previously reported that colestimide, an anion exchange resin, improved glycemic control in patients with type 2 diabetes. However, the factors associated with the decrease of HbA1c remain unclear. In present study, we retrospectively compared glycemic control between groups receiving colestimide (n=71), atorvastatin (n=99), pravastatin (n=85), and pitavastatin (n=95) until 3 months after the start of treatment. In the colestimide group, fasting plasma glucose decreased significantly from 169 ± 59 to 138 ± 29 mg/dL after 3 months (P<0.01), and glycated hemoglobin (HbA1c) declined from 8.1 ± 1.0% to 7.4 ± 0.8% (an 8% reduction, P<0.01). Fasting plasma glucose and HbA1c did not change in the pravastatin and pitavastatin groups. On the other hand, both parameters increased significantly in the atorvastatin group. Multivariate analysis revealed that baseline HbA1c was the main determinant of the decrease of HbA1c in the colestimide group while age, sex, BMI, and baseline lipid levels were not correlated with the effect of colestimide treatment. The decrease of HbA1c showed a positive correlation with baseline HbA1c (r=0.60, P<0.0001), and patients with a larger change of HbA1c (>8.4%) displayed a better response to colestimide. In conclusion, since patients with type 2 diabetes often have hyperlipidemia as well, colestimide therapy may have a clinically useful dual action in such patients. Baseline HbA1c has the most important independent influence on the glucose-lowering effect of colestimide.     

2型糖尿病患者认知功能与脑磁共振质子波谱研究

目的 探讨2型糖尿病患者认知功能改变特点及与脑磁共振质子波谱的相关性.方法 对2007年10月至2008年10月就诊于同济大学附属上海东方医院及上海浦东新区周家渡社区、北蔡社区所有志愿者进行一般资料及既往史资料收集,空腹10 h后行血糖、糖化血红蛋白及血脂检测,并进行尿常规及血压检查,日常生活能力量表、全面衰退量表及汉密尔顿抑郁量表评分,对其中的84例2型糖尿病患者及对照者进行1∶1配对研究.运用简易智能精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MOCA)进行认知功能测查.3.0 TMR成像系统分别行左侧海马及左侧基底节单体素质子波谱(STEAM序列)采集.分析N-乙酰天冬氨酸(NAA)、含胆碱复合物(Cho)、肌酸复合物(Cr)、肌醇(mI)及谷氨酸复合物-α(Glx-α)代谢物峰下面积变化,并将代谢物峰下面积与2型糖尿病患者MOCA量表中的分项指标评分进行Spearman's相关性分析,组间比较采用Wilcoxon符号秩和检验.两组分析采用配对t检验.结果 2型糖尿病组MMSE和MOCA的中位数(四分位数间距)分别为26.00(5.00)和19.50(7.00),低于对照组的29.00(3.00)和23.50(5.00),组间差异均有统计学意义(均P＜0.05).2型糖尿病组左侧海马Cr、mI、Glx-α峰下面积[分别为96.40(201.00)、71.25(98.90)、57.40(108.10)]高于对照组[分别为53.20(51.50)、40.15(62.25)、45.20(40.50)],组间差异均有统计学意义(P均＜0.05).左侧海马NAA、Cho峰下面积[分别为85.20(113.78)、62.90(111.28)]与对照组左侧海马[分别为62.00(69.45)、53.95(42.08)]比较,差异均无统计学意义(P均＜0.05).2型糖尿病组中,左侧海马Cr峰下面积绝对值与视觉执行能力(r=-0.219,P=0.031)、语言功能(r=-0.239,P=0.018)及记忆(r=-0.268,P=0.009)的评分呈负相关.结论 2型糖尿病可损害认知功能.运用1H-MRS检测发现2型糖尿病患者左侧海马存在代谢物质的改变,表现为Cr、mI及Glx-α值的升高.其中Cr峰值的?     

2型糖尿病患者血清可溶性细胞间粘附分子1水平变化及与血管内皮功能的关系

目的研究2型糖尿病患者血清可溶性细胞间粘附分子1水平的变化,并以血浆假性血友病因子水平作为内皮功能损伤的指标,观察细胞间粘附分子1与血管内皮细胞功能损伤之间的关系。方法62例2型糖尿病患者按照有无血管并发症分为无血管病变组(n=19)、微血管病变组(n=20)和大血管病变组(n=23),选择20例健康者作为对照组。应用酶联免疫吸附法检测各组患者血清可溶性细胞间粘附分子1水平和血浆假性血友病因子水平,并测定糖脂代谢指标和尿微量白蛋白水平。结果2型糖尿病患者血清可溶性细胞间粘附分子1水平明显高于健康对照组(P<0.01),在无血管病变组、微血管病变组和大血管病变组的水平逐步升高(P<0.01);血浆假性血友病因子水平在大血管病变组高于微血管病变组,微血管病变组高于无血管病变组(P<0.01),无血管病变组与对照组间无显著性差异。可溶性细胞间粘附分子1与血浆假性血友病因子、甘油三酯、收缩压、舒张压呈正相关(r分别为0.43、0.45、0.52和0.62,P<0.01)。结论细胞间粘附分子1可能参与了2型糖尿病血管病变的发生和发展,可作为早期2型糖尿病患者慢性血管并发症尤其是大血管病变发生的预测及监测指标。     

脂质代谢水平与冠状动脉粥样硬化病变的关系

目的 探讨脂质代谢水平与冠状动脉粥样硬化病变的关系.方法 回顾性分析182 例疑似冠状动脉粥样硬化病变患者的资料,均实施冠状动脉数字减影血管造影(DSA)检查,将有冠状动脉粥样硬化病变者列为研究组,否则列为对照组.检测受试者血浆甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LD...