154例妊娠糖尿病孕妇葡萄糖耐量试验结果分析

目的探讨妊娠糖尿病(gestafional diabetes malliths,GDM)孕妇口服葡萄糖耐量试验(oral gthcose tolerance test,OG-IT)的特点,分析父对GDM的诊断价值。方法对孕24~28周孕妇口服50g葡萄糖进行筛查,1小时血糖≥7.8mmol/L。者进行OGTT试验。结果154例GDM孕妇中80例(51.9%)空腹血糖异常,132例(85.7%)孕妇1h血糖异常,111例(71.4%)孕妇2h血糖异常,只有35例(21.7%>的孕妇3h血糖异常,其中33例(94.3%)伴有另外1项或者3项血糖异常。结论口服葡萄糖耐量试验中,取消3h血糖的检测对孕妇GDM的诊断影响甚微。     

妊娠期糖尿病糖耐量试验的数据特点及临床意义

目的探讨妊娠期糖尿病糖耐量试验的特点。方法选择2009年1月至2009年10月在我院行产前检查并常规行50g GCT的孕妇682例,对筛查结果阳性者219例再行75g葡萄糖耐量试验（OGTT）,诊断妊娠期糖尿病（GDM）31例,糖耐量减低（GIGT）47例,分析GDM和GIGT的OGTF四点血糖值特点。结果GDM组平均年龄30．6岁;GIGT组平均年龄28．8岁。两组年龄比较P〈0．05。GDM组0、1、2、3h点血糖异常率分别是：0％、80．6％、90．3％和48．4％,以1h和2h点异常为主,占GDM诊断依据的71％;GIGT组0、1、2、3h点血糖异常率分别是：0％、21．3％、42．6％和36．1％,以2h和3h点异常为主,占GDM诊断依据的78．7％。结论GDM和GIGT发生与孕妇年龄有关,两种疾病可能有不同致病机理。GIGT可能主要是胰岛素储备功能不足,后续分泌下降引起,而GDM可能主要是胰岛素峰值分泌不足,部分兼具胰岛素储备功能不足后续分泌下降引起。     

急性冠状动脉综合征患者口服糖耐量试验检查时机选择

目的探讨急性冠状动脉综合征（ACS）患者口服糖耐量试验（OGTr）的检查时机与安全性。方法选择2007年1月至2012年1月232例ACS住院患者,于病情稳定后及出院后3个月随访时行OGTr,并注意患者心电图和症状变化。结果病情稳定后于出院前OGTT检查发现血糖正常占40．95％（95／232）、糖尿病25．00％（58／232）、糖耐量减低34．05％（79／232）、空腹血糖受损2．59％（6／232）,与出院后3个月[血糖正常占39．91％（89／215）,糖尿病22．33％（48／215）,糖耐量减低33．95％（73／215）,空腹血糖受损2．33％（5／215）]比较差异均无统计学意义（x2值分别为0．051、0．441、0．001、0．032,P均〉0．05）,心电图sT段比较差异亦无统计学意义[（-0．12±0．08）mV与（-0．15±0．12）mV,t=0．23,P=0．85）。OGTr检查时不良反应少。结论ACS患者为糖代谢异常的高危人群,病情稳定后行OGTT是安全的,对于ACS患者都应常规行OGTT,及早发现糖代谢异常患者,并进行相应干预及治疗。     

糖筛查试验异常而糖耐量试验正常孕妇的妊娠结局分析

目的探讨孕期糖筛查试验(GCT)异常而口服葡萄糖耐量试验(OGTT)正常的孕妇对母婴围生期的影响,并观察和分析其妊娠结局,为孕妇孕期保健提供临床客观依据。方法选择该院2012年1月至2014年1月GCT异常而OGTT正常孕妇220例为观察组,另选该院同期240例健康孕妇作为对照组。观察两组孕妇妊娠结局及新生儿状况,并观察新生儿阿普加(Apgar)评分。结果观察组孕妇阴道顺产率61.82%(136/220),低于对照组,观察组剖宫产率为36.36%(80/220),高于对照组,差异均有统计学意义(P0.05);观察组孕妇产后出血、羊水过多、产褥感染和胎膜早破总计9.55%(21/220),高于对照组(P0.05)。观察组孕妇巨大儿、早产及新生儿高胆红素血症分别为15.45%(34/220)、5.00%(11/220)和5.45%(12/220),均高于对照组(P0.05);观察组新生儿平均体质量(3 186.35±31.20)g,高于对照组,观察组新生儿Apgar评分(9.21±0.13)分,低于对照组(P0.05)。结论 GCT异常而OGTT正常可明显影响孕妇围生期健康,生产时顺产率较低,并发症明显增多,且新生儿早产、巨大儿数量明显增多,易出现高胆红素血症等并发症,影响孕妇和围生期的健康和生命安全,临床实践中应重视GCT异常而OGTT正常的孕妇,及时给予临床干预,有效保障围生期母婴安全。     

HK和GOD法检测口服葡萄糖耐量试验结果的差异研究

目的探讨己糖激酶(HK)法和葡萄糖氧化酶(GOD)法测定糖尿病患者口服葡萄糖耐量试验(OGTT)检验结果的差异及原因。方法将进行OGTT的患者分为3组,A组:将75 g葡萄糖溶于300 mL温开水中,令受检者一次服下;B组:口服150 mL 0.5 g/mL葡萄糖注射液,令受检者一次服下;C组:将75 g葡萄糖溶于300 mL温开水中,放置过夜,令受检者一次服下。3组分别于空腹及服后30、60、120、180 min采血分离血清,用HK和GOD法分别测定各时段血糖;比较2种方法血糖测定结果的差异。结果 B组和C组各时段血糖结果HK法和GOD法之间差异无统计学意义(P>0.05);A组空腹血糖2种方法测定结果差异无统计学意义(P>0.05),而在30、60、120、180 min时2种方法存在明显差异(P<0.05)。结论 GOD法对β-D型葡萄糖高度特异,实验室如采用GOD法测定OGTT时,应注意α型葡萄糖影响造成的OGTT曲线偏低的现象。     

动态血糖监测新发2型糖尿病患者糖耐量试验时的血糖变化

目的 探讨2型糖尿病患者口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)时的血糖变化特点.方法 采用动态血糖监测系统(continuous glucose monitoring system,CGMS)对35例新诊断的2型糖尿病患者和24例糖代谢正常者进行动态血糖监测,同时进行75 g葡萄糖的OGTT,比较两组在不同糖代谢状态下糖负荷后3小时内平均血糖值(MBG)、血糖峰值(PPG)、血糖达峰时间(△t)、血糖波动幅度(PGE)和血糖的曲线下面积增值(IAUC)变化.结果 2型糖尿病组OGTT 3小时的MBG、PPG、△t、PGE和IAUC显著高于对照组,分别为 (11.6±13.16) mmol/L vs (7.66±0.80) mmol/L、(14.21±3.79) mmol/L vs (9.09±1.09) mmol/L、(117.09±36.84) min vs (84.04±34.17) min、(6.30±2.87) mmol/L vs (2.96±0.87) mmol/L、(3.22±1.97) mmol·L-1·d vs (1.69±0.71) mmol·L-1·d(均P<0.01).2型糖尿病患者OGTT 2小时血糖达到诊断标准的占68.6%(24/35),与未达该标准的31.4%(11/35)相比,MBG、PPG、PGE和IAUC均明显增高(均P<0.01),分别为(12.99±2.70) mmol/L vs (8.46±0.82) mmol/L、(15.97±3.24) mmol/L vs (10.41±1.15) mmol/L、(7.49±2.44) mmol/L vs (3.70±1.89) mmol/L、(4.02±1.73) mmol·L-1·d vs (1.47±1.21) mmol·L-1·d;△t的差异无统计学意义(P＞0.05).2型糖尿病组在不同糖化血红蛋白水平时,OGTT时除MBG有显著差异外(P<0.05),PPG、PGE和IAUC的差异均无统计学意义(均P＞0.05);而在不同空腹血糖状态时,OGTT的血糖波动指标差异均无统计学意义(P＞0.05).结论 新发2型糖尿病患者在糖负荷状态下血糖波动加剧,达峰时间延迟;筛查2型糖尿病时,对OGTT 2小时血糖接近标准值上限或糖耐量异常者应复查OGTT以减少漏诊.     

1157例体检者空腹血糖及糖耐量分析

目的 对1 157例体检者空腹血糖及糖耐量分析,掌握该区居民的血糖及其代谢情况.方法 采用人口成比例抽样(PPS)的方法,按经济条件分成3个层次,随机抽取1 157例研究对象采用葡萄糖氧化酶法测定空腹血糖,其中926例口服75 g无水葡萄糖2 h后测量血糖.结果 共计检出高血糖患者198例,检出糖耐量受损者117例,占12.63%,糖尿病患病率则为4.86%.结论 该区糖尿病患者及潜在者形势严峻,该区当前糖尿病防治应以经济较好的市区为重点向开发区辐射直至全区.     

浙江省瑞安市妊娠妇女糖耐量水平的研究

目的通过糖筛查试验及葡萄糖耐量试验（OGTT）了解瑞安市妊娠妇女糖耐量水平。方法前瞻性对2250名孕妇在孕24～28周间先行50 g糖筛查试验,结果≥7.8 mmol/L为阳性,阳性结果者再行OGTT试验,按美国国家糖尿病资料组（NDDG）标准判断结果。结果瑞安市2250孕妇中糖筛查试验阳性240例,240例孕妇均参加了OGTT试验,其中112名OGTT正常,58例为糖耐量受损（GIGT）,70例为妊娠期糖尿病（GDM）。孕前体重指数（BMI）≥25 kg/m^2,GDM的发病率为17.86%,体重指数（BMI）〈25 kg/m^2,发病率为3.12%。结论瑞安市妊娠妇女中GIGT为2.58%,GDM为3.11%。体重指数与GDM密切相关。     

一日三餐高脂低碳水化合物摄入对健康成人糖耐量的影响

目的观察葡萄糖耐量（OGTT）前1天高脂低碳水化合物撮入（热量相同但碳水化合物撮入减少,脂肪撮入增加）对健康成人糖耐量的影响,从而进一步确定是否OGTT前1天高脂低碳水化合物（HF）撮入导致糖耐量减低（IGT）的误诊。方法30例男性健康成人随机分为两组（HF组和对照组）进行交叉试验;分别于OGTT前1天早、中、晚餐时撮入热量相同的HF或对照配餐;次日清晨行75g OGTT;分别测定血糖、胰岛素、游离脂肪酸、甘油三酯厦胆固醇浓度;2次OGTT间隔1周。结果OGTT前1天HF使糖负荷后30、60、120分钟血糖分别升高33％、51％厦42％,胰岛素分泌指数（△I／△G）降低50％,空腹血浆游离脂肪酸（FFA）浓度上升100％,使30％健康成人被误诊为IGT。结论即使总热量撮入相同,OGTT前1天HF引起健康成人空腹血浆游离脂肪酸水平升高,抑制早期胰岛素分泌,引起糖负荷后血糖的升高,导致IGT的误诊。     

南京六合地区产检孕妇糖耐量试验结果分析

目的对南京六合地区产检孕妇口服葡萄糖耐量试验(OGTT)结果进行分析,以了解该地区妊娠糖尿病发病情况。方法收集2014年7月至2015年3月在该院产检的1 308例孕周为24~28周的健康孕妇的75g OGTT结果(其中当空腹血糖≥5.1mmol/L时不再做糖耐量试验,直接诊断为妊娠糖尿病),根据美国糖尿病学会的妊娠糖尿病诊断标准统计出妊娠糖尿病数量并计算其检出率。按孕妇年龄分为3组:18~25岁(A组)、25~29岁(B组)和≥29岁(C组),分别统计其妊娠糖尿病检出率并比较。结果此次调查的该地区妊娠糖尿病总检出率为7.49%(98/1 308),其中A、B、C组的妊娠糖尿病检出率分别为:5.24%(20/382)、6.97%(48/689)和12.66%(30/237),不同年龄组间妊娠糖尿病检出率差异有统计学意义(χ2=6.477,P0.05)。其中A组与B组妊娠糖尿病检出率差异无统计学意义(χ2=1.238,P0.05),A组与C组的妊娠糖尿病检出率差异有统计学意义(χ2=10.853,P0.05),B组与C组的妊娠糖尿病检出率差异有统计学意义(χ2=7.406,P0.05)。结论孕妇年龄大于或等于29岁后妊娠糖尿病检出率明显增加。     

空腹血糖及糖化血红蛋白用于筛查糖耐量减退的比较性研究

目的比较空腹血糖（FPG）和糖化血红蛋白（HbAlc）在筛查糖耐量减退（IGT）中的应用价值。方法到我院门诊为明确有无血糖异常而就诊者336人，测定空腹血糖、糖化血红蛋白，并行口服葡萄糖耐量试验（OGTT）。结果按照1999年WHO的DM诊断标准，本研究人群空腹血糖〈6．1者124例，≥6．1-〈7．0者56例，≥7．0者156例；糖化血红蛋白〈6．1者84例，≥6．1者252例；OGTT2 hPG〈7．8者92例，≥7．8-〈11．1者99例，≥11．1者145例。结论糖化血红蛋白和空腹血糖均不适用于筛查IGT人群，但糖化血红蛋白比空腹血糖提示病人是否存在血糖异常更敏感。     

Beta-cell function and insulin sensitivity contribute to the shape of plasma glucose curve during an oral glucose tolerance test in non-diabetic individuals

To clarify whether beta-cell function and/or insulin resistance contributes to the shape of plasma glucose curve during an oral glucose tolerance test (OGTT), we investigated 583 Japanese subjects with normal glucose tolerance (NGT, n = 306) or impaired glucose tolerance (IGT, n = 277). Each subject was subdivided into three shapes of plasma glucose curve as follows: monophasic pattern (M type), biphasic pattern (B type) and two peaks (T type). Homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index and insulinogenic index were assessed by plasma glucose and insulin concentrations obtained at fasting or during an OGTT. There was a greater proportion of M type in the IGT group (M = 80.9%, B = 15.5% and T = 3.6%), whereas the prevalence of B and T types was much higher in the NGT group (M = 66.6%, B = 26.5% and T = 6.9%). There were significant differences in the proportions of shape types between the NGT and IGT groups (p = 0.0006). Among the NGT category, insulin sensitivity was significantly higher in the B type than in the M type, and beta-cell function adjusted for insulin resistance was significantly higher in the B and T types than in the M type. Among the IGT category, no significant differences were seen among the three shape types with respect to insulin sensitivity, but the beta-cell function adjusted for insulin resistance was significantly lower in the M type than in the B and T types. In conclusion, both impaired insulin secretion and insulin resistance may contribute to the underlying mechanisms of the shape of plasma glucose curve in Japanese subjects.     

The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus

BackgroundGlycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT.MethodsA prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter–Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT).ResultsThe area under the curve (AUC) was 0.67 (0.58–0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT.ConclusionsAdoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.     

糖耐量减低者的冠状动脉病变特点及相关因素分析

目的 研究糖耐量减低(IGT)者的冠状动脉病变特点.方法 根据糖耐量(OGTT)结果 将疑似缺血性胸痛的住院患者490例分为IGT组(161例)、2型糖尿病(T2DM)组(159例)、糖耐量正常(NGT)组(170例),检测3组血清甘油三酯(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)和高敏C反应蛋白(hs-CRP)含量,计算BMI,记录一般临床资料(包括性别、年龄、吸烟史、高血压病史),分析3组的冠状动脉造影(CAG)结果 和冠状动脉Gensini评分情况.结果 (1)T2DM组、IGT组血清TG[(2.41±1.70)mmol/L和(2.26±1.20)mmol/L]均明显高于NGT组[(1.95±1.14)mmol/L],差异有统计学意义(t=0.4610,0.3124,P<0.01,<0.05),但IGT组和T2DM组间TG水平比较差异无统计学意义(P>0.05);3组间TC、HDL-C、LDL-C差异无统计学意义(P均>0.05).(2)T2DM组和IGT组血清hs-CRP[(2.38±1.76)ms/L和(2.33±2.03)ms/L]均明显高于NGT组[(1.54±1.32)mg/L,t=0.8391,0.7815,P均<0.01],而T2DM组与IGT组比较差异无统计学意义(P>O.05).(3)IGT组和T2DM组的BMI[(25.50±3.04)kg/m2和(26.09±2.86)kg/m2]均明显高于NGT组[(24.70±3.27)kg/m2],差异均有统计学意义(t=0.8063,1.3947,P<0.05,<0.01),但T2DM组与IGT组比较差异无统计学意义(P>0.05).(4)单支冠状动脉病变发生率NGT组为44.7%,明显高于IGT组(23.6%)和T2DM组(18.9%)(x2=16.310,25.116,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05);T2DM组、IGT组2支血管病变发生率分别为37.1%和39.8%,均明显高于NGT组(23.5%)(x2=7.200,10.099,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);3支冠状动脉病变发生率IGT组和T2DM组分别为33.5%和40.9%,均明显高于NGT组(20.O%)(x2=7.767,17.028,P均<0.05),IGT组和T2DM组间差异无统计学意义(P>0.05).(5)次全或完全闭塞发生率T2DM组和IGT组分别为22.6%和18.0%,均高于NGT组(7.6%)(x2=14.573,8.019,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);IGT组和T2DM组血管弥漫性病变发生率分别为24.8%和30.8%,均高于NGT组(12.4%)(x2=8.583,16.724,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05).(6)Gensini评分IGT组和T2DM组分别为(55.05±22.99)和(56.15±24.87),较NGT组(38.03±17.38)明显升高,其差异有统计学意义(t=17.0142,18.1186,P均<0.01),IGT组与T2DM组间比较差异无统计学意义(P>0.05).结论 IGT患者2支及3支冠状动脉病变发生率明显升高,次全或完全闭塞及弥漫性病变发生率也明显高于NGT者,与糖尿病患者冠状动脉病变特点相似,提示IGT与冠状动脉病变严重程度密切相关,临床工作中应高度重视此类患者.

Abstract：

Objective To investigate the characteristics of coronary's pathological changes in patients with impaired glucose tolerance. Methods Four-hundred and ninety patients who were suspected with ischemic chest pain were divided into three groups according to their OGTT results: (1) IGT group: n = 161,(2) 12DM group:n = 159, (3) NGT group: n = 170. Serum levels of triglyceride (TG) , total cholesterol (TC) , highdensity lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) and high sensitive Creactive protein (hs-CRP) were detected, their body mass indexes (BMI) were calculated. General clinical information (including gender, age, history of smoking, history of hypertension) were collected. All the CAG results were analyzed and Gensini scores were assessed as well. Results The TG levels in the T2DM group and IGT group ([2. 41 ± 1.70] mmol/L and [2. 26 ± 1. 20] mmol/L) were significantly higher than that of the NGT group (1.95 ± 1.14) mmol/L, the differences were significant (t=0.4610,0.3124, P<0. 01 and 0.05,respectively),whereas there was no significant difference between the IGT group and T2DM group (P >0.05);No significant difference was found among the three groups about TC, HDL-C, LDL-C levels (either P > 0.05). The levels of hs-CRP in T2DM group ([2. 38 ± 1. 76] mg/L and IGT group [2. 33 ± 2. 03] mg/L) were higher compared with the NGT group ([1. 54 ± 1. 32] mg/L), the differences were significant (t = 0. 8391,0. 7815, Ps < 0. 01), whereas there was no significant difference between the IGT group and T2 DM group (P >0.05). BMIs of the IGT group ([25.50 ± 3.04]kg/m2) and T2DM group ([26.09 ± 2.86]kg/m2) were higher than that of the NGT group ([24. 70 ± 3. 27] kg/m2), the differences were significant (t = 0. 8063,1. 3947, P<0. 05 and <0.01, respectively),whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidence of single coronary pathological changes was 44.7% in the NGT group,it was higher than that of the IGT group (23. 6%) and T2DM group (18. 9%) (x2 = 16. 310,25. 116,Ps < 0. 05), whereas there was no significant difference between the IGT group' and T2DM group (P > 0. 05);The incidences of 2 branches pathological changes in the T2DM group (37. 1%) and IGT group (39. 8%) were higher compared with NGT group (23. 5%) ,the differences were significant (x2 =1. 200,10. 099,Ps <0. 05),whereas there was no significant difference between the IGT group and T2DM group (P >0. 05) ;The incidences of 3 vessels pathological changes in the T2DM group (40.9%) and IGT group (33. 5%) were higher than that of the NGT group (20. 0%) , the differences were significant (x2 = 7. 767,17. 028, Ps < 0.05), there was no significant difference between the IGT group and T2DM group (P > 0. 05). The incidence of subtotal or total occlusion of the T2DM group and IGT group were 22. 6% and 18.0% respectively,both were higher than that of the NGT group(7. 6%) (x2 = 14. 573,8. 019 ,Pa < 0.05) , whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidences of vascular diffusing pathological change in the IGT group (24. 8%) and T2DM group (30. 8%) were higher compared with the NGT group (12.4%) (x2 =8.583,16.724, Ps < 0.05), whereas there was no significant difference between the IGT group and T2DM group (P >0.05). The Gensini scores in the IGT group (55. 05 ± 22. 99) and T2DM group(56. 15 ± 24. 87) were significnatly higher than that of the NGT group (38. 03 ± 17. 38), the differences were significant ((t =17.0142,18. 1186,Ps <0.01),whereas there was no significant difference between the IGT group and T2DM group (P>0.05). Conclusion The incidences of 2 and 3 vessels pathological changes increase significantly in patients with IGT. Moreover, the incidences of occlusion and diffuse stenosis increase significantly. This is similar to the coronary artery pathological charactersitics in patients with diabetes, which indicates that IGT is closely related to the pathological severity of coronary artery. We should pay much attention to those patients with IGT in the clinical work.     

糖尿病和糖耐量异常患者在急性缺血性脑血管病中的调查研究

目的 探讨糖尿病和糖耐量异常患者在急性缺血性脑血管病中的流行情况.方法 选择急诊内科病房及神经内科住院的115例短暂性脑缺血发作(TIA)、496例急性脑梗死患者进行空腹血糖、糖化血红蛋白检测,登记患者的临床资料,对既往未诊断糖尿病而空腹血糖在6.1～6.9 mmol/L的患者中进行口服葡萄糖耐量试验(OGTT),糖代谢分类采用2003年美国糖尿病学会建议标准.结果 611例急性缺血性脑血管病患者住院前糖尿病的诊断率18.8%,住院后系统检查发现糖尿病新的患病率45.0%,糖耐量异常18.6%;212例空腹血糖在6.1～6.9 mmol/L的患者中,OGTT发现其中33.5%患者可诊断为糖尿病,53.8%提示糖耐量异常.结论 63.8%的急性缺血性脑血管病患者合并糖尿病或糖耐量异常;空腹血糖在6.1～6.9 mmol/L的患者应常规做OGTT检查来筛查糖代谢异常患者.     

Effect of pioglitazone and acarbose on endothelial inflammation biomarkers during oral glucose tolerance test in diabetic patients treated with sulphonylureas and metformin

What is known: The increased risk of cardiovascular events in diabetic patients has been related to numerous metabolic and haemoreological factors. Some of these factors appear to be particularly evident during the post‐prandial phases and to be related to peak plasma glucose level. Aim: To compare the effect of addition of pioglitazone and acarbose to sulphonylureas and metformin therapy on metabolic parameters and on markers of endothelial dysfunction and vascular inflammation in type 2 diabetic patients. Materials and methods: We enrolled 473 caucasian type 2 diabetic patients. All patients underwent measurements of height and body weight, body mass index (BMI), glycated haemoglobin (HbA_1c), fasting plasma glucose (FPG), post‐prandial plasma glucose (PPG), fasting plasma insulin (FPI), post‐prandial plasma insulin (PPI), homeostasis model assessment (HOMA index), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein‐cholesterol (LDL‐C), high density lipoprotein‐cholesterol (HDL‐C), triglycerides (Tg), sICAM‐1, IL‐6, high‐sensitivity C reactive protein (hsCRP), sVCAM‐1, sE‐selectin and tumour necrosis factor (TNF‐α). Assessments were made at start of titration, after 3 months [before a first oral glucose tolerance test (OGTT)], after 6 months and at the study end (before a second OGTT). Results: Two‐hundred and seventy four patients completed the study: 138 were randomized to double‐blind treatment with pioglitazone and 136 with acarbose. Significant BMI and weight increase were observed after full treatment in the pioglitazone group relative to the acarbose group. A decrease in glycated haemoglobin was observed after the titration period in the pioglitazone group compared to both baseline value and the acarbose group. A decrease in glycated haemoglobin was also obtained after full treatment in the pioglitazone group when compared to the end of titration period and to the acarbose group. Significant decrease in FPG was obtained in the pioglitazone group after full treatment compared to the end of titration period. Post‐prandial plasma glucose decrease was observed in acarbose group compared to the baseline value and to the end of titration period. Fasting plasma insulin decreased in the pioglitazone group after both the titration period and the full treatment period compared to both the baseline value and the acarbose group. The HOMA index decreased significantly after the full treatment in pioglitazone group compared to the end of titration period and to the acarbose group. Interleukin‐6 and tumour necrosis factor‐α decreased after full treatment in the pioglitazone group relative to the end of titration period. Significant hsCRP decrease was obtained after the titration period when compared to the baseline value in the pioglitazone group. High‐sensitivity C reactive protein decreased in the pioglitazone group after full treatment compared to the end of titration period and to the acarbose group. What is new and conclusion: Pioglitazone reduces the inflammatory response to a glucose challenge more than acarbose in type 2 diabetic patients, already treated with maximal doses of sulphonylureas and metformin.     

循证护理在静脉留置针行口服葡萄糖耐量试验采血中的应用

目的探讨循证护理在静脉留置针行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)采血中的效果,以便减轻患者反复静脉穿刺的痛苦。方法运用循证护理方法,寻找OGTT采血的最佳途径(静脉留置针法),并制订操作规范,给予240例内分泌科住院患者应用静脉留置针实施OGTT采血。结果 240例患者均愿意接受静脉留置针采血,5次采血成功率95.0%。结论循证护理方法在静脉留置针行OGTT采血中的应用是安全有效的,而且能减轻患者多次静脉穿刺导致的痛苦,方便了护士工作,值得临床推广应用。     

罗格列酮干预糖耐量受损的疗效观察

目的观察罗格列酮对糖耐量受损（IGT）干预治疗的疗效。方法经2次OGTF试验确诊IGT64例，随机分成罗格列酮组、对照组各32例；对照组予改善生活方式，罗格列酮组予改善生活方式和罗格列酮片4mg／d，随访2年。结果罗格列酮组糖尿病发生率为3．1％，而对照组为18．8％，两组间差异有显著性（P〈0．01）；相反，IGT恢复至正常糖耐量的比率在罗格列酮组为68.8％，对照组为34．4％，两组间差异有显著性（P〈0．01）。结论罗格列酮能预防或延缓IGT向糖尿病进展。     

口服葡萄糖耐量试验采血方法的探讨

目的 探讨一种适宜口服葡萄耐量试验的采血方法。方法 于上臂用留置针穿刺置管后随机分成肝素封管组（A1）和0．9％NS封管组（B1）,分别于空腹、服药后0．5h,1h,2h,3h在留置针采血1.5ml,并同时在对侧上臂直接穿刺采血1.5ml作对照组（A2、B2）,标本配对后测血糖并作统计学处理。此外,用问卷调查30例志愿者对二种采血方法的主观接受程度。结果 经留置针采血与单次穿刺采血的血糖值无显著差异,二种封管液均可使用。30例志愿者全部愿意选择留置针采血法。结论 留置针采血可替代传统的反复直接穿刺采血行OGTT试验。