2型糖尿病合并上消化道出血急性期血糖治疗观察

目的对2型糖尿病合并上消化道出血急性期血糖的临床治疗进行观察研究。方法随机选择2016年7月—2017年7月该院接收的80例2型糖尿病合并上消化道出血患者,依据双盲法将他们划分成两组,对照组40例采用常规治疗,研究组40例采用皮下注射甘精胰岛素治疗,对两组的临床治疗效果进行观察对比。结果通过不同用药治疗后,所有研究对象血糖均得到有效控制;且研究组治疗后空腹血糖(6.5±1.3)mmol/L、饭后2 h血糖(7.4±1.0)mmol/L,对照组(10.2±1.4)、(11.5±1.4)mmol/L,两组之间差异有统计学意义(P0.05);研究组24 h尿蛋白定量(1.1±0.3)g/d、血白蛋白(32.3±4.1)g/L,对照组24 h尿蛋白定量(3.2±0.8)g/d、血白蛋白(25.1±5.5)g/L,两组之间差异有统计学意义(P0.05);研究组总有效率92.5%,对照组67.5%,两组之间差异有统计学意义(P0.05)。结论甘精胰岛素应用于治疗2型糖尿病合并上消化道出血急性期血糖效果可观,具备临床推广价值。     

血清C肽与糖化血红蛋白检验在糖尿病诊断价值

目的分析血清C肽与糖化血红蛋白检验在糖尿病诊断价值。方法选择2018年3月—2019年3月该院收治90例糖尿病患者为研究组,选取同期90名行健康体检者为对照组,两组均给予血清C肽和糖化血红蛋白检验,对两组血糖水平、血清C肽及糖化血红蛋白指标进行比较。结果研究组患者空腹血糖及餐后2 h血糖为(9.63±2.24)mmol/L、(12.57±2.60)mmol/L,明显高于对照组患者,差异有统计学意义(P0.05);研究组患者血清C肽水平(0.11±0.03)μg/L明显比对照组低,糖化血红蛋白(2.40±0.99)%比对照组高,差异有统计学意义(P0.05)。结论血清C肽联合糖化血红蛋白检验诊断糖尿病,应用效果显著,可为临床诊治提供有效依据。     

血清C肽与糖化血红蛋白检验对糖尿病诊断的意义

目的探讨血清C肽与糖化血红蛋白检验对糖尿病诊断的意义。方法选取该院2015年2月—2016年2月收治的糖尿病患者32例作为实验组,选取重度糖尿病患者32例作为治疗组,另外选取32例正常体检人员作为对照组。抽取三组人员的空腹以及餐后2 h的静脉血,对比分析两组人员的空腹状态下以及餐后2 h的血清C肽和糖化血红蛋白指标。结果实验组患者空腹血糖(8.93±2.59)mmol/L,餐后2 h血糖(13.54±2.68)mmol/L,空腹血清C肽(1.49±0.41)μg/L,餐后2 h血清C肽(4.65±0.91)μg/L,糖化血红蛋白(9.16±2.58)%;治疗组患者空腹血糖(12.51±2.24)mmol/L,餐后2 h血糖(19.64±4.72)mmol/L,空腹血清C肽(0.86±0.23)μg/L,餐后2 h血清C肽(1.64±0.35)μg/L,糖化血红蛋白(12.13±2.31)%;实验组患者空腹和餐后2 h血清C肽明显高于对照组人员,糖化血红蛋白与空腹、餐后2 h血清C肽呈正相关性。治疗组患者空腹和餐后2 h血清C肽明显低于对照组人员,糖化血红蛋白与空腹、餐后2 h血清C肽呈负相关性。结论联合应用血清C肽和糖化血红蛋白检验,可以有效诊断糖尿病患者的病情程度,值得临床广泛推广与应用。     

糖耐量、糖化血红蛋白、糖化白蛋白联合C肽检测应用于糖尿病诊断中价值分析

目的探讨糖耐量、糖化血红蛋白、糖化白蛋白联合C肽应用于糖尿病诊断中的价值,为临床诊疗提供参考价值。方法选取该院2018年1月—2019年1月所收治2型糖尿病患者315例为研究组,另选同期健康体检者255例为对照组。分别进行糖耐量、糖化血红蛋白、糖化白蛋白、C肽检测,比较组间差异。结果在4个时间点,研究组糖耐量均高于对照组,差异有统计学意义(P<0.05);在T0、T2、T3,研究组C肽水平均高于对照组,差异有统计学意义(P<0.05);在T1时,研究组C肽水平为(2.2±0.5)mmol/L,低于对照组的(8.4±1.6)mmol/L,差异有统计学意义(P<0.05)。研究组患者中,糖化白蛋白为(18.6±4.9)mmol/L、糖化血红蛋白为(8.1±1.9)mmol/L,均高于对照组(P<0.05)。结论糖耐量、糖化血红蛋白、糖化白蛋白及C肽联合检测可全面反应血糖控制及胰岛素分泌情况,有利于鉴别有无糖尿病、胰岛素水平及长短期治疗效果,对临床诊疗具有积极意义,值得临床推广应用。     

维生素D对LADA患者胰岛β细胞功能的影响

为探讨维生素D对成人隐匿性自身免疫性糖尿病(LADA)患者胰岛β细胞功能的影响,本研究对临床初诊为2型糖尿病(DM)的患者进行谷氨酸脱羧酶抗体(GAD Ab)检测,筛选出GAD Ab阳性的LADA患者。纳入病程≤5年和空腹C肽≥0.2nmol/L的LADA患者62例,首先对患者的GAD Ab滴度和空腹C肽水平进     

2型糖尿病患者血浆酰化刺激蛋白和C3水平与胰岛素抵抗和血脂的相关性

目的　了解 2型糖尿病 (T2DM)患者血浆中酰化刺激蛋白 (ASP)及补体C3 与胰岛素抵抗 (IR)及血脂紊乱的相关性 ,探讨ASP与C3 可能参与IR的机制。　方法　根据体质指数 (BMI)将82例T2DM患者分为肥胖组 (BMI≥ 2 5kg/m2 )及非肥胖组 ,同时将 10 5名非糖尿病者分为单纯肥胖(Ob)组 (BMI≥ 2 5kg/m2 )及正常体重对照组。测定ASP、游离脂肪酸 (FFA)、空腹胰岛素 (FIns)、C3 ,空腹血糖 (FPG)、甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)和胰岛素抵抗指数 (HOMA IR)。　结果　非肥胖糖尿病组 [( 6 7± 38)nmol/L]及Ob组患者ASP水平 [( 6 0± 2 9)nmol/L]显著高于对照组 [( 4 5± 2 1)nmol/L],肥胖糖尿病组ASP水平 [( 5 7± 33)nmol/L]也高于对照组 ,但差异无显著意义。肥胖糖尿病组C3 水平 [( 2 8± 1 2 ) g/L]显著高于对照组 [( 1 9± 0 9) g/L]及Ob组 [( 2 1± 0 9) g/L],Ob组ASP/C3 率 ( 0 7± 0 1)显著高于对照组( 0 5± 0 4 )。相关分析结果显示 ,ASP与BMI、TC、FFA及FPG呈正相关 (r =0 191,P =0 0 0 9;r=0 14 6 ,P =0 0 4 9;r =0 132 ,P =0 0 5 ;r =0 14 0 ,P =0 0 5 ) ;C3 与FPG、FIns及HOMA IR呈正相关 (r =0 2 12 ,P =0 0 0 3;r =0 2 6     

六例暴发性1型糖尿病患者临床特征分析

目的 比较分析暴发性1型糖尿病及经典1型糖尿病的临床特征,探讨暴发性1型糖尿病的发病机制.方法 入选2005年9月至2009年9月在我院内分泌科住院的以酮症酸中毒为首发症状的暴发性1型糖尿病患者6例(暴发性1型糖尿病组)和以酮症酸中毒为首发症状的初发经典1型糖尿病患者24例(经典1型糖尿病组),回顾性分析两组患者的临床特征,包括发病年龄、糖尿病病程、咽痛、咳嗽、发热等流感样症状、恶心、呕吐、腹痛等消化道症状、入院时随机血糖、糖化血红蛋白、C肽、丙氨酸转氨酶、肌酸激酶、肌酐、血钾、白细胞计数等.计量资料和计数资料分别采用t检验或x2检验进行统计分析.结果 与经典1型糖尿病组相比,暴发性1型糖尿病组发病年龄升高[分别为(46±6)、(19±6)岁,t=9.89,P＜0.01],糖尿病病程明显缩短[分别为(3.5±2.7)、(52.5±32.6)d,t=3.63,P＜0.01],咽痛、咳嗽、发热等流感样症状明显增多[分别为50%(3/6)、0(0/24),x2=13.33,P＜0.01],恶心、呕吐、腹痛等消化道症状亦增多[分别为83%(5/6)、0(0/24),x2=24.00,P＜0.01].与经典1型糖尿病组相比,暴发性1型糖尿病组入院时随机血糖升高[分别为(44±7)、(23±4)mmol/L,t=9.22,P＜0.01],糖化血红蛋白降低[分别为(7.1±1.0)%、(14.4±2.2)%,t=7.66,P＜0.01],餐后2 h C肽减少[分别为(0.21±0.17)、(0.58±0.39)μg/L,t=2.29,P＜0.05],丙氨酸转氨酶增高[分别为(206±124)、(10±2)U/L,t=8.18,P＜0.01],肌酸激酶升高[分别为(1038±447)、(79±10)U/L,t=11.11,P＜0.01],肌酐增加[分别为(179±39)、(55±16)μmol/L,t=12.33,P＜0.01],血钾升高[分别为(5.2±0.7)、(3.4±0.8)mmol/L,t=5.07,P＜0.01],白细胞计数增多[分别为(21.0±8.1)×109个/L、(6.0±1.9)×109个/L,t=8.64,P＜0.01].结论 暴发性1型糖尿病患者存在胰岛β细胞功能衰竭,代谢紊乱更为严重,免疫反应更加强烈,容易导致多脏器功能损害.     

血清C肽和糖化血红蛋白联合检验在诊断糖尿病方面的临床价值

目的评估血清C肽和糖化血红蛋白联合检验在诊断糖尿病方面的临床价值。方法筛选2017年9月—2018年2月该院收治的118例糖尿病病例,将其作为研究组,同时选同期健康体检者118名,将其作为对照组,对入选的236例研究对象均选血清C肽联合糖化血红蛋白检验展开综合检查,统计2组检查结果并做深入分析。结果检测结果发现,研究组空腹血糖值(10.87±2.34)mmol/L,餐后2 h血糖水平(13.50±2.25)mmol/L,糖化血红蛋白水平(11.55±2.48)%,血清C肽水平(1.57±0.44)ng/mL,明显优于对照组的(3.68±0.78)mmol/L,(3.94±0.53)mmol/L,(5.20±0.42)%,(0.86±0.07)ng/mL,差异有统计学意义(P0.05)。结论临床对糖尿病病例展开专业诊断时,选用血清C肽和糖化血红蛋白联合检验的方法,诊断效果确切,可较好的反映病例在某段时间机体内的血糖状况。     

沙格列汀联合前列地尔治疗老年糖尿病肾病临床评价

目的评价沙格列汀联合前列地尔治疗老年糖尿病肾病临床疗效。方法将该院2018年10月—2019年9月收治的92例老年糖尿病肾病患者,进行随机分组,对照组采取常规治疗方法;观察组采取沙格列汀联合前列地尔治疗方法,对比分析两组方法治疗效果。结果观察组患者空腹血糖(FPG)(3.36±0.49)mmol/L、餐后2 h血糖(2 hPG)(3.36±0.49)mmol/L、尿素氮(BUN)(3.36±0.49)mmol/L、肌酐(Scr)(3.36±0.49)μmol/L、24 h尿蛋白(24 hUpro)(9.47±0.54)g、胱抑素(Cys-C)(0.78±0.24)mg/L、C反应蛋白(4.87±0.98)mg/L、血同型半胱氨酸(Hcy)(0.78±0.24)mmol/L。对照组患者空腹血糖(FPG)(5.05±0.49)mmol/L、餐后2 h血糖(2 hPG)(10.56±0.51)mmol/L、尿素氮(BUN)(5.05±0.49)mmol/L、肌酐(Scr)(10.56±0.51)μmol/L、24 h尿蛋白(24 hUpro)(10.46±0.53)g、胱抑素(Cys-C)(1.46±0.27)mg/L、C反应蛋白(7.66±0.52)mg/L、血同型半胱氨酸(Hcy)(10.23±0.85)mmol/L。两组数据对比差异有统计学意义(P0.05)。结论沙格列汀联合前列地尔治疗老年糖尿病肾病临床治疗效果显著,降低血糖水平,改善肾功能水平,值得临床推广。     

血清C肽与糖化血红蛋白联合检测对糖尿病诊断的意义

目的总结血清C肽与糖化血红蛋白联合检测对糖尿病诊断的意义,重点研究能够提升糖尿病病人诊断效率的重要方案。方法该研究资料选取2013年11月—2014年11月期间在该院接受诊治的糖尿病病人45例,视作实验组。同期选取45名来院体检的健康者为对照组,均予以血清C肽与糖化血红蛋白联合检测,同时对两组研究对象糖化血红蛋白、餐后2 h血糖值、空腹血糖值等指标进行对比。结果研究结果发现,对照组病患血清C肽值是(1.42±0.41)μg/L,实验组是(1.02±0.08)μg/L;实验组糖化血红蛋白是(10.05±2.19)%,对照组是(5.08±0.41)%;实验组空腹血糖值是(8.91±2.62)mmol/L,对照组是(4.19±0.62)mmol/L;实验组餐后2 h血糖值是(12.05±2.04)mmol/L,对照组是(4.79±1.52)mmol/L,两组研究对象在糖化血红蛋白、餐后2 h血糖值、空腹血糖值等指标方面的对比差异十分显著(P0.05)。结论血清C肽与糖化血红蛋白联合检测对糖尿病诊断的意义十分突出,这是由于糖尿病病人血清C肽与糖化血红蛋白均会出现异常,因此检测结果可用作判断机体疾病严重性的重要指标。     

Fasting plasma C-peptide,glucagon stimulated plasma C-peptide,and urinary C-peptide in relation to clinical type of diabetes

Summary Many patients with Type 2 (non-insulin-dependent) diabetes mellitus are treated with insulin in order to control hyperglycaemia. We studied fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and 24 h urinary C-peptide in relation to clinical type of diabetes in 132 insulin treated diabetic subjects. Patients were classified clinically as Type 1 (insulin-dependent) diabetic subjects in the presence of at least two of the following criteria: 1) significant ketonuria, 2) insulin treatment started within one year after diagnosis, 3) age of diagnosis 40 years, and 4) weight below 110% of ideal weight of the same age and sex. Eighty patients were classified as Type 1 and 52 as Type 2 diabetic subjects. A second classification of patients into 6 C-peptide classes was then performed. Class I consisted of patients without islet B-cell function. Class II-VI had preserved islet B-cell function and were separated according to the 20%, 40%, 60% and 80% C-peptide percentiles. The two classifications of patients were compared by calculating the prevalence of clinical Type 1 and Type 2 diabetes in each of the C-peptide classes. This analysis showed that patients with a fasting plasma C-peptide value <0.20 nmol/l, a glucagon stimulated plasma C-peptide value <0.32 nmol/l, and a urinary C-peptide value <3.1 nmol/l, or <0.54 nmol/mmol creatinine/24 h, or <5.4 nmol/24 h mainly were Type 1 diabetic patients; while patients with C-peptide levels above these values mainly were Type 2. At these limits the percentage, predictive value of positive tests as indicators of Type 2 diabetes were as follows: fasting C-peptide 83%, stimulated C-peptide 86%, and urinary C-peptide expressed as nmol/l 76%, as nmol/mmol creatinine/24 h 79%, and as nmol/24 h 78%. Similarly, the percentage predictive value of negative tests as indicators of Type 1 diabetes were as follows: fasting C-peptide 86%, stimulated C-peptide 88%, and urinary C-peptide expressed as nmol/l 79%, as nmol· mmol creatinine·24 h 81%, and as nmol/24 h 80%. If patients without detectable C-peptide were excluded, the predictive value of negative tests were as follows: fasting C-peptide 81%, stimulated C-peptide 88%, urinary C-peptide expressed as nmol/l 61%, as nmol/mmol creatinine/24 h 69%, and as nmol/24 h 64%. In conclusion, post glucagon C-peptide gives a good distinction between Type 1 and Type 2 diabetes mellitus in insulin treated diabetes while 24 h urinary C-peptide gives a less sensitive distinction between the clinical types of diabetes.     

436例糖尿病足截肢相关因素分析

目的 研究与糖尿病足溃疡截肢相关的重要因素.方法 回顾性分析436例糖尿病足溃疡患者的人口学资料、糖尿病及相关疾病治疗、足溃疡严重程度、溃疡大小、是否合并感染和血生化结果.根据是否截肢将436例患者分为未截肢组和截肢组.结果 436例患者中有97例患者被截肢,截肢率为22.2%.与未截肢组患者相比,截肢组患者的年龄、性别、足病病程和血糖水平差异无统计学意义.但截肢组的外周血管疾病发病率更高(94.8%vs 86.1%,P<0.05),血白细胞计数[(10.80±6.03 vs 8.09±3.59)×10~9/L,P<0.01]、超敏C反应蛋白[(10.2+6.2 vs 6.9+6.1)mmol/L,P<0.01]明显增高,血浆白蛋白[(35.0±5.1 vs 36.8±5.0)g/L,P<0.01]、血红蛋白[(104.3±18.9 vs 114.1±21.0)g/L,P<0.01]、血清总胆固醇[(4.2±0.9 vs 4.7±1.3)mmol/L,P<0.01]、甘油=三酯[(1.2±0.5 vs 1.6±1.3)mmol/L,P<0.01]、高密度脂蛋白胆固醇[(1.1±0.5 vs 1.2±0.3)mmo/L,P<0.01]、低密度脂蛋白胆固醇[(2.7±0.8 vs 3.0±1.0)mmol/L,P<0.05]明显降低.多因素逐步logistic回归分析显示,外周血管病变、血白细胞计数、血清总胆同醇、超敏C反应蛋白为截肢的独立危险因素.结论 足溃疡严重程度、外周血管病变、炎症因素和营养不良可能是截肢相关的重要因素.     

High prevalence of proliferative retinopathy in diabetic patients with low pancreatic B-cell capacity

A retrospective study on the role of pancreatic B-cell insulin secretory capacity in the development of proliferative diabetic retinopathy was performed in 160 diabetic patients with a duration of diabetes of more than 10 years (mean 19.5 +/- 7.9 years). Pancreatic B-cell insulin secretory capacity was assessed in terms of the quantity of C-peptide excreted into urine per day (24-h urinary C-peptide). When the patients were divided into three groups according to the quantity of 24-h urinary C-peptide (group I, C-peptide less than 30 micrograms, n = 49; group II, 30 micrograms less than or equal to C-peptide less than 80 micrograms, n = 76; and group III, C-peptide greater than or equal to 80 micrograms, n = 35), the prevalence of proliferative diabetic retinopathy was much higher in group I (26.5%) than in group II (5.3%) or group III (2.9%). The incidence of proliferative diabetic retinopathy during the follow-up period (mean 9.8 +/- 4.8 years) was also highest in group I (20.0%, 2.7%, and 2.9% in groups I, II, and III, respectively). Other factors which might affect the development of proliferative diabetic retinopathy, including duration of diabetes and past glycemic control, were comparable in these three groups. In contrast, a division of the patients according to glycemic control revealed a strong correlation between glycemic control and background diabetic retinopathy whereas no such correlation was apparent with proliferative diabetic retinopathy. These data are consistent with the view that low pancreatic B-cell insulin secretory capacity may be a risk factor for the development of proliferative diabetic retinopathy.     

短期胰岛素泵强化治疗对初发2型糖尿病患者血浆vaspin水平的影响

目的 观察短期胰岛素泵强化治疗对初发2型糖尿病患者血浆内脏脂肪组织来源的丝氨酸蛋白酶抑制物vaspin水平的影响,探讨其与胰岛素敏感性的关系.方法 30例初发2型糖尿病患者使用胰岛素泵强化治疗2周,治疗前后采用高胰岛素-正葡萄糖钳夹术评价其胰岛素敏感性,用酶免法测定血浆vaspin及相关代谢指标.结果 2型糖尿病组空腹血浆vaspin水平高于正常糖耐量(NGT)组和糖调节受损(IGR)组.2型糖尿病组经胰岛素泵强化治疗后葡萄糖代谢率升高[(5.10±0.51对2.99±0.42)mg·kg-1·min-1,P＜0.05],稳态模型评估的胰岛素抵抗指数(HOMA-IR)降低[2.30(1.09～7.20)对4.28(1.70～6.47),P＜0.05],同时血浆vaspin水平也显著降低[(1.19±0.57对1.83±0.55)ng/ml,P＜0.05],且vaspin水平的降低与HOMA-IR的改变呈明显正相关.结论 胰岛素泵强化治疗能有效改善2型糖尿病患者的胰岛素敏感性,降低血浆vaspin水平;且血浆vaspin水平与2型糖尿病患者胰岛索敏感性有关.     

Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics

We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection.In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 ± 6.53 and 9.83 ± 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 ± 11.26 and 15.20 ± 10.21V (P < 0.02), ankle brachial ratio was 1.05 ± 0.19 and 1.14 ± 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively.In the diabetic and the control group, VPT was 15.62 ± 10.39 and 8.36 ± 3.61 V (P < 0.01), ankle brachial ratio was 1.14 ± 0.18 and 1.15 ± 0.12, and the questionnaire scores were 57% and 40.3%, respectively.In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes.     

肾炎康复片对早期糖尿病肾病患者肾小球、肾小管标志性蛋白/酶的影响

目的 研究肾炎康复片对早期糖尿病肾病患者肾小球、肾小管标志性蛋白/酶的影响.方法 早期糖尿病肾病患者50例,随机分为治疗组和对照组,各25例,两组均采用糖尿病适宜的饮食、运动方案,在控制血糖、血脂等基础上,治疗组给予肾炎康复片5片,每日3次口服,3个月为1个疗程,对照组给予安慰剂.观察治疗前、后两组血肌酐（Scr）、尿素氮（BUN）、糖化血红蛋白A1c（HbA1c）、超敏C反应蛋白（hs-CRP）及24 h尿总蛋白、白蛋白、N-乙酰-β-氨基葡萄糖苷酶（NAG）、β2-微球蛋白（β2-MG）、视黄醇结合蛋白（RBP）的变化.结果 治疗组治疗后血hs-CRP由（4.52±2.01） mg/L降至（3.09±0.85） mg/L,尿NAG由（19.28±7.04） U/L降至（13.70±6.61） U/L,β2-MG由（0.56±0.13） mg/L降至（0.35±0.20） mg/L,RBP由（2.83±1.21） mg/L降至（1.40 ± 0.69） mg/L,较治疗前明显下降,差异有统计学意义（t值分别为2.808,4.523,3.418,3.977,P ＜0.05）,而对照组治疗前、后无明显变化（P均＞0.05）.治疗组治疗后24h尿总蛋白由（0.40±0.12） g/24h降至（0.28±0.15） g/24h,ALB由（105.91±41.50） mg/24h降至（65.05±42.52） mg/24 h,治疗前、后差异有统计学意义（t值分别为5.726,4.234,P均＜0.05）,对照组24 h尿总蛋白和ALB也均下降（t值分别为2.325,1.701,P均＜0.05）,但治疗组下降更明显（P＜0.05）.结论 肾炎康复片可减少肾小球性尿白蛋白排泄,减轻肾小管损伤.     

Sensitivity and reproducibility of urinary C-peptide as estimate of islet B-cell function in insulin-treated diabetes

The aims of the present study were to evaluate the ability of urinary C-peptide determination to demonstrate presence of residual insulin secretion, and to evaluate the reproducibility of urinary C-peptide excretion in 125 insulin-treated diabetic patients. C-peptide was determined in two consecutive 24-h urine specimens and related to plasma C-peptide 6 min after the intravenous injection of 1 mg glucagon. The detection limit of C-peptide in plasma was defined analytically (greater than or equal to 0.02 nmol l-1) and from pancreatectomized patients (greater than or equal to 0.06 nmol l-1), and in urine only analytically (greater than or equal to 0.1 nmol l-1). If the analytical detection limit of plasma C-peptide was used as indicator of residual insulin secretion, islet B-cell function was preserved in all patients. In patients with stimulated plasma C-peptide levels from 0.02- less than 0.06 nmol l-1 no increase was found in plasma C-peptide values after stimulation with glucagon. This unresponsiveness of islet B-cells is in good agreement with the existence of a biological detection limit of C-peptide in plasma of 0.06 nmol l-1. Using this biological plasma C-peptide detection limit, 49 of 125 patients were without residual insulin secretion. In contrast to this, only 7 patients were diagnosed as C-peptide nonsecretors using the analytical detection limit of urinary C-peptide. Eighty-four per cent of patients considered to have Type 1 (insulin-dependent) diabetes with a duration of diabetes of more than 15 years had detectable C-peptide in the urine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factor analysis of thermal and vibration thresholds in young patients with Type 1 diabetes mellitus.

AIMS: To identify factors that represent relationships among sets of interrelated thermal and vibration threshold variables and to find clinical correlates that are significantly associated with these factors. METHODS: Thermal and vibration perception thresholds were tested in the hands and feet of Type 1 diabetic patients treated in an outpatient clinic for juvenile-onset diabetes. Factor analysis was used to identify factors that represent relationships among sets of thermal and vibration threshold variables. RESULTS: One hundred and forty-eight patients (47.3% males, median current age 22.3 years and median duration of diabetes 11.4 years) were evaluated. Three factors explained 77% of the total variance: 'hand sensation' factor, underlying cold, warmth and vibration perception thresholds in the hand; 'foot sensation' factor, underlying the same sensory thresholds in the foot; and 'heat-related pain' factor, underlying heat pain perception threshold in both limbs. The 'foot sensation' factor was the only factor that significantly correlated with diabetes-related variables (e.g. duration and cumulative glycaemic control of the disease) and concurrent diabetic microangiopathy. Male sex was associated with higher values of the 'heat-related' factor, while the 'hand sensation' factor did not correlate with any of the study variables. CONCLUSIONS: The distribution of the various thermal and vibration threshold variables according to the three factors may point at length-dependent mechanism of axonal degeneration. Cold, warmth and vibration perception thresholds in the foot may be the only valuable psychophysical parameters in the evaluation of early sensory impairment associated with diabetes.     

The role of Sudoscan feet asymmetry in the diabetic foot

The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot.Patients and methodsIn this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups – group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris).ResultsPatients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot.ConclusionIn this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.     

2型糖尿病患者慢性并发症的患病率及相关因素分析

<正>糖尿病是一组呈全球流行趋势的慢性代谢性疾病。随着经济的发展和人民生活方式的改变以及人口老龄化,糖尿病患病率逐年增加是全球范围内的共同趋势。美国国家糖尿病委员会报道糖尿病病人患