陈旧性心肌梗塞患者糖代谢及相关因素的调查分析

追踪调查了２２４例陈旧性心肌梗塞患者的糖代谢状况，分析该人群糖耐量异常与冠心病发病危险因素的联系。２２４例中，符合ＮＩＤＤＭ诊断者５２例，符合ＩＧＴ诊断者５４例，计高血糖占４７．３％。与同期同社区３万普通人群成年糖尿病调查结果比较，分别是其５０－５９岁及≥６０岁同年龄组ＮＩＤＤＭ患病率的２．７及３．２倍，ＩＧＴ患病率的３．４及３．７倍。显示了心肌梗塞与糖代谢异常二者间的密切联系。     

空腹血糖异常、糖耐量减低患者血清胰岛素水平的变化及其意义

目的 观察空腹血糖异常(IFG)、糖耐量减低(IGT)患者血清胰岛素水平的变化。方法 对50例空腹血糖和糖耐量正常者(NGT)、40例IFC和80例IGT患者行口服葡萄糖耐量试验(0GTT)，用氧化酶法检测血糖，用放免法测定血清空腹及餐后2小时胰岛素。结果 IFG、IGT组空腹血糖、空腹胰岛素水平及胰岛素敏感指数较NGT组明显升高(P＜0.05或P＜0．01)，IFG组胰岛素敏感指数与IGT组比较无显著性差异(P＞0．05)。结论 在IFG、IGT状态下已经存在胰岛素抵抗，而且在程度上两者间并没有显著性差异，应早期干预治疗。     

空腹血糖受损患者糖耐量异常及影响因素分析

目的了解空腹血糖受损(IFG)患者糖耐量异常(IGT)情况及其影响因素。方法纳入空腹血糖为5.6~6.1 mmol/L的IFG患者337例,检测患者口服75克葡萄糖后2小时血糖等资料,分析患者IGT情况及其影响因素。结果纳入的337例IFG患者中46.6%(157/337)伴有IGT。口服葡萄糖耐量异常和正常组超重和肥胖率分别为75.0%和63.1%(P0.05);口服葡萄糖耐量异常组甘油三酯水平显著高于正常组,高密度脂蛋白胆固醇水平低于正常组,均有统计学差异(P0.05)。多因素Logistic回归分析结果显示,年龄、体重指数、甘油三酯水平是IFG患者葡萄糖耐量异常的影响因素,相对危险分别为:1.06(95%CI:1.03~1.08);1.11(95%CI:1.05~119);1.58(95%CI:1.23~2.09)。进一步对体重正常者发生糖耐量异常的影响因素进行分析,除年龄外,甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素,相对危险为2.10(95%CI:1.29~3.43)。结论空腹血糖受损患者约半数伴有糖耐量异常,体重指数和甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素。     

高血压合并糖耐量减低患者血清脂联素水平的研究

非高血压(HT)者43例,其中糖耐量正常者(NGT)30例,糖耐量减低者(IGT)13例。HT者45例,其中17例伴NGT,28例伴IGT,研究显示:脂联素水平(mg/L)HT伴NGT组低于非HT的NGT组(4.3±1.7vs7.1±3.6),HT伴IGT组低于非HT的IGT组(4.0±2.1vs6.6±1.4)(P均<0.05);NGT与IGT组脂联素水平的差异无统计学意义;IGT组脂联素与DBP、TG、C肽负相关;NGT组脂联素水平与BMI、SBP负相关。     

Uric acid,impaired fasting glucose and impaired glucose tolerance in youth with overweight and obesity

Background and aimThe relationships between uric acid (UA) and prediabetes is poorly explored in youth. We investigated the association between UA, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), insulin resistance (IR) and low insulin sensitivity (IS) in youth with overweight/obesity (OW/OB).Methods and resultsA cross-sectional study was performed in 2248 youths with OW/OB (age 5–17 years). The sample was stratified in sex-specific quintiles (Q1 to Q5) of UA and the associations with fasting (FG), 2-h post-load glucose (2H-PG), IR and low IS were investigated. IR and low IS were estimated by assessment model of insulin resistance (HOMA-IR) and whole-body IS index (WBISI), respectively. IFG was defined as FG ≥ 100 < 126 mg/dL, IGT as 2H-PG ≥140 < 200 mg/dL, IR as HOMA-IR ≥75th percentile and low IS as WBISI ≤25th percentile by sex. Age, body mass index z-score, 2H-PG, HOMA-IR and WBISI, increased across sex-quintiles of UA while FG did not. The prevalence of IFG and IR were significantly increased in Q5 vs Q1 (reference quartile, P < 0.025). The prevalence of IGT increased from Q3 to Q5 vs Q1 (P < 0.025–0.0001) and that of low IS from Q2 to Q5 vs Q1 (P < 0.005–0.0001).ConclusionsIn youth with OW/OB, rates of IGT and low IS increased progressively across quintiles of UA. On the contrary, IFG and IR were associated only with the highest quintile of UA. Our data suggest that UA is a biomarker of impaired glucose metabolism prevalently in post–challenge condition rather than in fasting state.     

应用血浆脑钠素评价急性心肌梗死患者不同糖代谢状态下的心脏功能

目的通过测定急性心肌梗死(AMI)患者再灌注治疗后不同糖代谢状态下的血浆脑钠素(BNP)变化,探讨不同糖代谢状态下的患者心功能受损情况。方法75例ST段抬高型AMI患者,分为糖耐量正常(NGT)组、糖耐量受损(IGT)组和糖尿病(DM)组。于发病后24h、发病第7天测定患者血浆BNP水平。结果发病后24h和第7天两次测定血浆BNP水平,DM组均明显高于NGT组,IGT组与NGT组比较差异无统计学意义。发病第7天复查BNP,NGT组血浆BNP水平较前明显下降,DM组和IGT组血浆脑钠素水平无明显下降。结论测定血浆BNP水平可以较好地评价不同糖代谢状态下AMI患者的心功能,糖代谢异常可能会加重AMI患者心功能的受损。     

依那普利对原发性高血压糖耐量低减的影响

目的：了解依那普利对原发性高血压糖耐量低减的影响。方法：37例原发性高血压伴糖耐量低减的患者,于依那普利降压治疗3周后,测量治疗前后空腹血糖,血胰岛素,口服葡萄糖耐量试验（OGTT）2h血糖,血胰岛素,胰岛素敏感性指数（ISI）,糖化血红蛋白（HbA1c),总胆 醇和甘油三酯等指标。结果：治疗后OGTT2h血糖和空腹血胰岛素显著降低（P＜0．05）,ISI升高（P＜0．01）。结论：依那普利可改善原发性高血压病人的糖耐量低减。     

佛山市成人糖耐量减低患者十年转归追踪调查

佛山市127例患者10年随访结果发现，糖耐量减低转归为2型糖尿病的频率，按1985年WHO糖尿病诊断标准为54％，按1999年WHO标准为76％。年龄、BMI、血压和血糖是这种转归的危险因子。     

吡格列酮对伴糖耐量减低的代谢综合征患者血管内皮细胞功能的影响

目的 研究吡格列酮（PIO）对伴糖耐量减低（IGT）的代谢综合征（MS）患者血管内皮细胞功能的影响.方法 对22例伴IGT的MS患者用PIO30mg/d治疗4个月.治疗前后测定外周组织葡萄糖摄取率（GDR）、胰岛素敏感指数（ISI）、内皮依赖性血管舒张功能（EDVD）,并监测血丙二醛（MDA）、还原型谷胱甘肽（GSH）、高敏C反应蛋白（hsC-RP）、血糖、Ins、HbA1c和FFA水平的改变.结果 治疗后EDVD明显改善、GDR增加（P均＜0.01）,ISI升高（P均＜0.05）.血糖、Ins、HbA1c、FFA、MDA及hsC-RP水平降低（P均＜0.01）,GSH水平升高（P＞0.05）.结论 短期PIO治疗能使伴IGT的MS患者的内皮细胞功能明显改善,其机制可能与缓解内皮细胞胰岛素抵抗以及氧化应激和慢性炎症状态有关.     

糖耐量低减患者的尿白蛋白排出率观察

测定了７７２例ＩＧＴ患者尿白蛋白排出率（ＵＡＥ），并与７８７例正常对照者作了比较。结果显示ＩＧＴ患者ＵＡＥ和微量白蛋白尿发生率明显高于正常对照组。此外，ＩＧＴ患者的血压、ＢＭＩ、血清Ｃｈ、Ｔｇ、Ｃｒ也明显增高，而ＨＤＬ－Ｃｈ则明显低于正常对照组。ＩＧＴ伴高血压者的ＵＡＥ高于正常血压者。正常血压组中肥胖者的ＵＡＥ高于非肥胖者。多元逐步回归分析显示ＩＧＴ和正常人的ＵＡＥ与ＢＭＩ、ＭＢＰ、服糖后２小时血     

糖耐量异常对原发性高血压患者血压变异性的影响

目的观察糖耐量异常对原发性高血压患者血压变异性的影响情况。方法入选正常血压及原发性高血压患者260例,按动态血压水平及是否合并糖耐量异常分为正常血压组（n=68）,正常血压合并糖耐量异常组（n=60）,原发性高血压组（n=70）,原发性高血压合并糖耐量异常组（n=62）。所有受试者进行24小时动态血压监测,观察各组血压变异性特点。结果原发性高血压合并糖耐量异常组24小时收缩压变异系数[（0.12±0.03）vs.（0.10±0.02）]、白天收缩压标准差[（15.37±2.66）vs.（13.34±2.27）]、变异系数[（0.12±0.02）vs.（0.10±0.02）]均高于原发性高血压组（P〈0.01）;正常血压合并糖耐量异常组与正常血压组各时间段血压标准差、变异系数差异无统计学意义（P〉0.05）。结论糖耐量异常影响原发性高血压人群血压变异性（以收缩压为主）,对正常血压人群无明显影响。     

Abnormal myocardial kinetics of 123I-heptadecanoic acid in subjects with impaired glucose tolerance

Summary Increased triglyceride accumulation has been observed in the diabetic heart, but it is not known whether the abnormalities in myocardial fatty acid metabolism differ between insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients or whether they are present even prior to overt diabetes. Therefore, we studied myocardial fatty acid kinetics with single-photon emission tomography using ¹²³I-heptadecanoic acid (HDA) in four groups of men: impaired glucose tolerance (IGT) (n = 13, age 53 ± 2 years, mean ± SEM), IDDM (n = 8, age 43 ± 3 years), NIDDM (n = 10, age 51 ± 2 years) and control subjects (n = 8, age 45 ± 4 years). Echocardiography and myocardial perfusion scintigraphy (IGT and NIDDM groups) were performed to study cardiac function and flow. In the IGT subjects, myocardial HDA beta-oxidation index was reduced by 53 % (4.6 ± 0.4 vs 9.7 ± 1.0 μmol · min^–1· 100 g^–1, p < 0.01) and HDA uptake by 34 % (3.7 ± 0.2 vs 5.6 ± 0.3 % of injected dose 100 g, p < 0.01) compared with the control subjects. The fractional HDA amount used for beta-oxidation was lower in the IGT compared with the control subjects (43 ± 4 vs 61 ± 4 %, p < 0.05). NIDDM patients also tended to have a lowered HDA beta-oxidation index, whereas IDDM patients had similar myocardial HDA kinetics compared to the control subjects. Myocardial perfusion imaging during the dipyridamole-handgrip stress was normal both in the IGT and NIDDM groups, indicating that abnormal myocardial perfusion could not explain abnormal fatty acid kinetics. In conclusion, even before clinical diabetes, IGT subjects show abnormalities in myocardial fatty acid uptake and kinetics. These abnormalities may be related to disturbed plasma and cellular lipid metabolism. [Diabetologia (1997) 40: 541–549] Received: 26 August 1996 and in revised form: 21 November 1996     

天芪降糖胶囊对糖耐量减低患者的疗效和机制

目的观察天芪降糖胶囊预防糖耐量减低（IGT）患者进展为2型糖尿病的疗效。方法以口服75g葡萄糖耐量试验（OGTT）确诊的IGT患者168例,其中男74例,女94例。随机分为对照组74例,天芪降糖胶囊治疗组94例,两组均进行相同的生活方式干预。对照组予以安慰剂胶囊口服,1次5粒,3次／d;治疗组采用天芪降糖胶囊1次5粒,3次／d;每3个月作1次OGTT及胰岛素释放试验,同时测身高、体重,观察1年。结果天芪降糖胶囊治疗组糖尿病转化率明显低于对照组（22．47％vs 40．00％,P〈0.05）,而逆转为正常糖耐量比率明显高于对照组（50．56％ vs 24．29％,P〈0．05）;天芪组HOMA-IR较对照组显著降低（1．87±0．71 vs 2．20±0．71,P〈0．05）。结论天芪降糖胶囊可能通过改善IGT人群胰岛素抵抗,延缓其向2型糖尿病转化。     

Fasting plasma glucose and glycated haemoglobin in the screening of diabetes and impaired glucose tolerance

Abstract. The use of fasting plasma glucose (FPG) only has been proposed for the screening and diagnosis of diabetes, but its sensitivity has been reported to be unsatisfactory. The use of HbA_1C, alone or combined with FPG, has been suggested for the screening of diabetes and impaired glucose tolerance (IGT). In a sample of 1215 adult subjects without previously known diabetes, we assessed the sensitivity and specificity of FPG and HbA_1C in diagnosing diabetes and IGT, determined by oral glucose tolerance test (OGTT). All lean diabetic patients, and 85% of overweight and obese diabetic individuals, had FPG 7 mmol/l. FPG >6.1 mmol/l had a sensitivity of 98.8% and a specificity of 32.9%; HbA_1C had a lower specificity and sensitivity for the screening of diabetes. A screening strategy for diabetes based on FPG, with OGTT in all overweight subjects with FPG >6.1 mmol/l, is suggested. Neither FPG nor HbA_1C is effective in the screening of IGT; although combined FPG and HbA_1C could be useful for case finding, screening for IGT with OGTT is advisable in all subjects at high risk.     

糖耐量受损患者肱动脉内皮依赖性血管舒张功能变化的研究

采用高分辨血管外超声检测糖耐量受损(IGT)患者肱动脉血流介导的内皮依赖性血管舒张功能(EDD)和硝酸甘油介导的内皮非依赖性血管舒张功能(EID)。IGT组EDD明显低于对照组(P<0.05)。EID在两组间无明显差异(P>0.05)。     

Prevalence of diabetes mellitus and impaired glucose tolerance in cystic fibrosis

Summary The aim of this study was to evaluate the prevalence of impaired glucose tolerance or diabetes mellitus in 99 patients (53 M, 46 F; mean age 10.5±6.9 years), with cystic fibrosis. Glucose tolerance was evaluated in all patients without overt diabetes using the oral glucose tolerance test (OGTT). Six patients showed a pathological OGTT and 2 patients had insulin-requiring diabetes mellitus. The mean age of the patients with impaired glucose tolerance was significantly higher than that of the subjects with normal glucose metabolism (p<0.0001). Patients with overt diabetes mellitus were the oldest subjects in the study group. Preliminary results of this study were presented at the XX European Pancreatic Club, August 29–31, 1988. Budapest, Hungary and published in Digestion40, 72, 1988.     

Myocardial fatty acid oxidation in patients with impaired glucose tolerance

Abstract Aims/hypothesis. Fatty acids are an important source of energy in the myocardium. Abnormal myocardial fatty acid metabolism could contribute to the deterioration of cardiac function frequently observed in patients with Type II (non-insulin-dependent) diabetes mellitus. In our previous study, myocardial total uptake of non-esterified fatty acid (NEFA) was measured in patients with impaired glucose tolerance and found to be normal. This study aimed to investigate the subsequent metabolic steps and β-oxidation of NEFA. Methods. A total of 6 men with impaired fasting glucose (age 50 ± 2 years, BMI 29 ± 1 kg/m², means ± SEM) and 6 healthy men (50 ± 1 years, 25 ± 1 kg/m²) were studied in the fasting state. Myocardial blood flow was measured with [¹⁵O]H₂O and positron emission tomography and myocardial NEFA metabolism with [¹¹C]palmitic acid. Results. Myocardial blood flow was normal and not different between the impaired glucose tolerance and the control group (78 ± 6 vs 73 ± 13 ml/100 g/min, NS). The [¹¹C]palmitic acid uptake indices were similar between the groups (10.4 ± 0.5 vs 11.2 ± 0.8 ml/100 g/min, respectively, NS). The clearance of [¹¹C]-palmitate from the myocardium, an index of NEFA β-oxidation, was similar between the groups (half-times of activity 17.6 ± 1.6 vs 19.5 ± 2.3 min, respectively, NS) Conclusion/interpretation. The results indicate that myocardial NEFA uptake and β-oxidation are not altered in patients with IGT. Thus, it is not likely that altered NEFA metabolism contributes to the deterioration of the cardiac function in patients with IGT or Type II diabetes. [Diabetologia (2001) 44: 184–187] Received: 9 June 2000 and in revised form: 25 September 2000     

糖耐量减退及空腹血糖异常患者血清载脂蛋白B、AI检测及其临床意义

目的　探讨糖耐量低减 (IGT)及空腹血糖异常 (IFG)患者血清载脂蛋白B(ApoB)及载脂蛋白AI(ApoAI)水平的变化。 方法　分三组进行研究 ,IGT组 5 8例 ,IFG组 5 5例 ,6 4例血糖正常者为对照组。分别检测其甘油三脂 (TG)、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL c)、高密度脂蛋白胆固醇 (HDL c)、脂蛋白 (a) [LP(a) ]、载脂蛋白B(ApoB)、载脂蛋白AI(ApoAI)、空腹血糖 (FPG)、糖化血红蛋白 (HbA1c)、C 肽 (C P)、胰岛素 (Ins)及体重指数 (BMI) ,间隔 2周共检测 4次。结果　IGT及IFG患者LDL c、LP(a)、ApoB水平较对照组高 ,HDL c、ApoAI及ApoAI/ApoB水平较对照组低 ,其中ApoB升高及HDL c、ApoAI/ApoB、ApoAI降低与对照组比较差异有显著性 (P <0 .0 1) ,且IGT组ApoB较IFG组明显升高 ( P <0 .0 1)。ApoB及ApoAI与HbA1c、C P、Ins及BMI水平比较无明显相关 (P >0 .0 5 )。结论　IGT及IFG患者的脂代谢紊乱以ApoB升高及ApoAI降低为主 ,这可能是 2型糖尿病患者动脉粥样硬化的重要危险因素。