新发2型糖尿病患者血清vaspin水平与踝臂指数的相关性研究

目的 探讨新发2型糖尿病患者血清vaspin水平与糖化血红蛋白、血脂、胰岛素抵抗及踝臂指数的关系.方法 选择新发2型糖尿病患者60例,以踝臂指数≤0.9为切点分为踝臂指数正常组和踝臂指数异常组.另外选择健康体检者为对照组.测定血糖、胰岛素、血脂、肾功能、糖化血红蛋白、血压等,采用酶联免疫吸附试验（ELISA）测定血vaspin水平.结果 2型糖尿病踝臂指数异常组血清vaspin水平低于2型糖尿病踝臂指数正常组及对照组（P均＜0.01）,3组分别为（0.41±0.36） μg/L、（1.21±0.87） μg/L、（1.56±0.69） μg/L.相关分析显示,血清vaspin 与胰岛素抵抗、糖化血红蛋白、胆固醇、三酰甘油呈负相关,与高密度脂蛋白胆固醇（HDL-C）呈正相关.偏相关分析提示,血清vaspin与踝臂指数呈正相关.Logistic回归分析结果显示,HDL-C和vaspin水平是2型糖尿病踝臂指数异常患者的独立相关因素.结论 血清vaspin水平在新发2型糖尿病踝臂指数异常人群中降低,其水平下降可能与2型糖尿病患者动脉粥样硬化形成相关.     

同型半胱氨酸联合踝臂指数及C反应蛋白在下肢外周动脉疾病患者中的临床意义

目的 探讨血浆同型半胱氨酸联合踝臂指数及C反应蛋白对评估下肢外周动脉疾病病变程度的临床应用价值.方法 测定经选择性下肢动脉造影证实为下肢外周动脉疾病(PAD)患者(n=86)及正常对照组(n=80)的血浆同型半胱氨酸(Hcy)、C反应蛋白(CRP)浓度及踝臂指数(ABI),分析Hcy、CRP及ABI与下肢动脉病变之间的关系.结果 PAD组血浆Hcy及CRP均明显高于正常对照组(P＜0.05和P＜0.01),ABI明显低于正常对照组(P＜0.01).PAD组中多支病变组血浆Hcy及CRP均高于单支病变组(P＜0.01和P＜0.05),ABI低于单支病变组(P＜0.01).结论 血浆Hcy、CRP及ABI水平与下肢动脉病变程度相关,对临床病情的评估具有重要指导价值.     

踝肱指数在2型糖尿病外周动脉疾病中的应用

目的评价踝肱指数在2型糖尿病伴外周动脉疾病诊断中的意义。方法486例2型糖尿病患者按踝肱指数<0.9和≥0.9分为外周动脉疾病组和不伴外周动脉疾病组,比较两组的临床特征,并分析与踝肱指数相关的因素,确定2型糖尿病伴外周动脉疾病的危险因素。结果外周动脉疾病组平均年龄、糖尿病病程和低密度脂蛋白胆固醇水平显著高于不伴外周动脉疾病组(分别为62.09±10.53岁比56.77±9.83岁、86.90±51.94月比57.91±57.64月及3.07±1.01mmol/L比2.71±0.98mmol/L;P<0.05或P<0.01),踝肱指数显著低于不伴外周动脉疾病组(0.77±0.15比1.08±0.15,P<0.01)。Pearson相关分析显示,踝肱指数与年龄(r=-0.159,P=0.01)和总胆固醇(r=-0.161,P=0.01)负相关。Logistic回归分析显示,年龄、病程、收缩压和低密度脂蛋白胆固醇是2型糖尿病伴外周动脉疾病的危险因素,腰臀比是其发病的保护因素。结论踝肱指数是筛查2型糖尿病外周动脉疾病的简单易行又可靠的指标,年龄、病程、收缩压、低密度脂蛋白胆固醇是2型糖尿病患者踝肱指数降低的危险因素。     

冠心病及等危症住院患者踝臂指数及下肢外周动脉疾病患病率调查

目的了解冠心病及等危症住院患者踝臂指数分布情况及下肢外周动脉疾病患病情况。方法连续入选上海第十人民医院、首都医科大学附属北京同仁医院等32家医院符合条件的2509例住院患者(年龄≥45岁)为研究对象,测量每位患者踝臂指数的同时进行回顾性流行病学调查,踝臂指数≤0.9诊断为外周动脉疾病。结果冠心病及等危症住院患者踝臂指数均值为0.96±0.24,外周动脉疾病患病率为31.1%(95%CI为29.3%～33.0%);女性外周动脉疾病患病率明显高于男性(33.9%比28.8%,P<0.05);男女踝臂指数均值均随着年龄的增加而逐渐降低(P<0.0001),外周动脉疾病患病率随着年龄的增加而明显升高(P<0.0001);患者伴有高总胆固醇、高血压、糖尿病及缺血性脑卒中等危险因素具有较高的外周动脉疾病患病率和较低的踝臂指数均值;同时患有冠心病、糖尿病和缺血性脑卒中三种疾病的患者外周动脉疾病患病率达60.6%。结论我国≥45岁冠心病及等危症住院患者中外周动脉疾病普遍存在,是外周动脉疾病的高危人群,应引起临床医生的重视,并加强对危险因素的整合管理。     

踝臂指数评价2型糖尿病合并下肢外周动脉病患者疗效中的临床价值

目的 观察踝臂指数在2型糖尿病合并下肢外周动脉病患者治疗前后的变化,以探讨踝臂指数作为其疗效评价指标的可行性.方法 2型糖尿病合并下肢外周动脉病患者112例,分为单纯药物治疗组(62例)和介入治疗+药物治疗组(50例).详细记录每一患者的临床资料,包括年龄、性别、身高、体重、心率、血压、空腹血糖、餐后2 h血糖、糖化血红蛋白和血脂等结果.并分别于治疗前和治疗后1个月、3个月、6个月测踝臂指数.结果 2型糖尿病合并下肢外周动脉病患者治疗前踝臂指数小于0.90.介入治疗+药物治疗组治疗后1个月、3个月和6个月的踝臂指数与治疗前相比均有统计学意义(P<0.05),与单纯药物治疗组同期相比亦均有统计学意义(P<0.05).单纯药物治疗组治疗后1个月、3个月和6个月的踝臂指数与治疗前相比无明显变化(P>0.05).结论 踝臂指数在2型糖尿病合并下肢外周动脉病患者的治疗中起重要指导作用.介入治疗能够及早改善2型糖尿病合并下肢外周动脉病患者的血运,比单纯药物治疗疗效显著.     

2型糖尿病不同尿白蛋白排泄率患者合并外周动脉疾病临床分析

目的 探讨2型糖尿病不同尿白蛋白排泄率（UAER）合并外周动脉疾病（PAD）的发生率及其相关性.方法 依据尿微量白蛋白排泄率将375例2型糖尿病患者分为对照组（UAER〈20μg/min）、A组（微量蛋白尿组,UAER 20～200μg/min）和B组（临床蛋白尿组,UAER〉200μg/min）,检测所有患者的尿白蛋白排泄率、糖化血红蛋门和踝肱指数（ABI）,并分析各组患者外周动脉疾病的发生率、踝肱指数与尿白蛋白排泄率及其它指标的相关性.结果 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病发生率均较对照组高,两者比较差异有显著性（P〈0.05,P〈0.01）,踝肱指数随尿白蛋白排泄率的增加而减低（P〈0.05）,外周动脉疾病发生率随尿白蛋白排泄率增加而增加（P〈0.05,P〈0.01）;踝肱指数与年龄、病程、尿白蛋白排泄率呈明显负相关（P〈0.05）.结论 2型糖尿病微量白蛋白尿组和临床蛋白尿组外周动脉疾病的发生率较对照组明显增加,且尿白蛋白排泄率与踝肱指数显著相关,提示尿微量白蛋白不仅是肾脏病变的表现,同时伴有肾外血管病变发病率的增高,是全身血管病变的标志.     

不同糖代谢状况患者血浆生长停滞特异性基因产物6水平与高敏C反应蛋白、内脂素、脉搏波传导速度和踝肱指数的关系

目的探讨不同糖代谢状况患者血浆生长停滞特异性基因产物6水平变化及其与高敏C反应蛋白、内脂素、脉搏波传导速度及踝肱指数等的关系。方法采用酶联免疫吸附法检测2型糖尿病合并下肢动脉疾病、2型糖尿病、糖调节受损和正常糖耐量患者血浆生长停滞特异性基因产物6、内脂素水平;动脉硬化检测仪检测脉搏波传导速度和踝肱指数。结果 2型糖尿病合并下肢动脉疾病组血浆生长停滞特异性基因产物6低于2型糖尿病组(P<0.05),2型糖尿病组血浆生长停滞特异性基因产物6显著低于正常糖耐量组(P<0.01)。Pearson相关分析表明,血浆生长停滞特异性基因产物6与年龄、病程、空腹血糖、糖负荷后2 h血糖、糖化血红蛋白、腰臀比、内脂素、高敏C反应蛋白、脉搏波传导速度均呈负相关(P<0.01或P<0.05),与踝肱指数呈正相关(P<0.01)。多元逐步回归分析显示,腰臀比、糖化血红蛋白、高敏C反应蛋白与血浆生长停滞特异性基因产物6独立相关。结论血浆生长停滞特异性基因产物6在糖调节受损期有所下降,在糖尿病及并发下肢动脉疾病中显著降低,与炎症、周围血管动脉粥样硬化及内脏脂肪有关,可能是糖尿病的一个独立危险因子。     

2型糖尿病并脑梗死患者血浆tHcy和胰岛素抵抗关系探讨

检测106例2型糖尿病患者及40例正常对照组的血浆总同型半胱氨酸(tHcy)、空腹血糖、空腹胰岛素,计算胰岛素敏感指数(ISI),进行比较.结果 糖尿病患者血浆tHcy显著高于正常对照组,ISI显著低于正常对照组;糖尿病并脑梗死组较无脑梗死组变化更明显;血浆tHcy与ISI呈显著负相关.认为2型糖尿病并脑梗死患者存在高Hcy血症和胰岛素抵抗,它们在本病发生、发展中起重要作用.     

2型糖尿病患者血管并发症与血浆内皮素和一氧化氮的相关性及胰激肽释放酶干预治疗的研究

目的　探讨 2型糖尿病患者血管并发症与血浆内皮素 (ET)、一氧化氮 (NO)的相关性及胰激肽释放酶 (TPK)干预治疗对其影响。　方法　随机选择 2型糖尿病患者 1 82例及正常对照 4 0名。放射免疫分析测定 (RIA)及酶连免疫吸附测定 (EL ISA)检测血浆 ET、NO水平和 TPK干预治疗后各指标的变化。　结果　 2型糖尿病患者血浆 ET较正常人显著升高 (P<0 .0 1 ) ,伴血管并发症患者较单纯 2型糖尿病患者血浆 ET水平显著升高 (P<0 .0 1 )。 2型糖尿病血管并发症组较单纯 2型糖尿病组及正常对照组血浆 NO水平显著降低 (P<0 .0 1 )。2型糖尿病患者经 TPK干预治疗后血浆 ET水平降低 ,NO水平升高 ,尿白蛋白排泄率降低 ,血液流变学有所改善。　结论　内皮系统功能紊乱参与了 2型糖尿病血管并发症的发生。 TPK干预治疗可以改善 2型糖尿病患者内皮系统功能 ,防治糖尿病血管并发症的发生、发展     

四川盐边县不同体质指数人群的踝臂指数及下肢外周动脉病患病率调查

目的探讨体质指数对人群踝臂指数水平和下肢外周动脉病患病率的影响。方法采用整群随机抽样的方法,选取攀枝花市盐边县1 233人为研究对象,分别进行踝臂指数测量、身高和体重等体格检查和心血管疾病危险因素流行病学调查,比较按不同体质指数分组的平均踝臂指数水平及下肢外周动脉病患病率。结果男性18 km2≤体质指数<20 kg/m2组踝臂指数水平最低,体质指数≥28 kg/m2组踝臂指数水平最高;女性体质指数<18kg/m2组踝臂指数水平最低,24 kg/m2≤体质指数<26 kg/m2组踝臂指数水平最高。在不同体质指数水平分组里,男女性踝臂指数均值均大于0.90;男、女性体质指数与踝臂指数和下肢外周动脉病患病率之间不存在明显的线性相关关系(线性趋势检验P>0.05);男性和女性按不同体质指数标准分组的年龄调整后下肢外周动脉病患病率分别为10.7%和10.8%(体质指数<24 kg/m2)、5.6%和9.2%(24 kg/m2≤体质指数<28 kg/m2)、8.6%和13.1%(体质指数≥28 kg/m2)。结论该人群踝臂指数水平及下肢外周动脉病患病率与体质指数无统计学关联,二者之间的关系有待进一步探讨。     

糖尿病并高血压、高胰岛素血症

对１１２例Ⅱ型糖尿病（并高血压及无高血压各５６例和２０例高血压患者测定空腹胰岛索水平，发现高血压、糖尿病并高血压的胰岛素与血清甘油三酯水平均明显高于正常值，也高于糖尿病无高血压组（Ｐ＜０．００１）。糖尿病并高血压的并发症以冠心病为多。     

踝肱指数在诊断2型糖尿病患者下肢动脉病变中的临床意义

目的:了解踝肱指数(ABI)在诊断2型糖尿病下肢动脉病变(LEAD)的临床意义和影响因素。方法:对231例2型糖尿病患者测定ABI,以ABI值0.9为异常分为LEAD组(46例)和非LEAD组(对照组,185例),所有患者均进行体重量指数,腰臀比,血糖、血脂、血压、尿微量白蛋白等检查,并对其结果进行分析。结果:在231例2型糖尿病患者中,46例ABI0.9的LEAD患者的病程[(9.1±6.3)年:(4.5±5.7)年]、糖化血红蛋白[10.9±3.3)%:7.8±1.2)%]、低密度脂蛋白-胆固醇[(3.1±0.9)mmol/L:(2.6±1.1)mmol/L]及脉压[(59±15)mmHg:(52±14)mmHg],均明显高于对照组(P均0.05)。结论:糖尿病合并下肢动脉病变者具有病程长、血糖高、脉压差大、血脂紊乱等特点,踝肱指数是一项花费小、简单无创的诊断下肢动脉病变的可靠指标。     

Predictors for peripheral and carotid revascularization in a population-based cohort with type 2 diabetes

The study was aimed to define the predictors for peripheral and carotid revascularization in type 2 diabetic population. In all, 279 patients with type 2 diabetes and peripheral arterial disease were enrolled in a cohort longitudinal study. Study population was followed up for 24 months for the need and performance of peripheral or carotid revascularization. Logistic regression analysis was conducted to identify variables predictive of revascularization, when lipid plasma levels, glycemia, arterial hypertension, blood pressures, ankle-brachial index, intima-media thickness, body mass index, waist circumference, and hip distances were put in a model. Total cholesterol and maximal value of carotid intima-media thickness were presented as factors that independently influenced the performed peripheral revascularization. Waist circumference is defined as independent factor associated with carotid endarterectomy. Measurement of carotid intima-media thickness, waist circumference, and plasma lipid levels in type 2 diabetes with manifested peripheral and carotid arterial disease should be recommended in a manner of proper risk stratification of this population.     

Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients

The aim of this study was to evaluate the prevalence and risk factors of peripheral arterial obstructive disease (PAD) in Taiwanese type 2 diabetic patients. A total of 610 patients (268 men and 342 women), aged 63.3 +/- 10.8 years, were recruited from a diabetic clinic in a teaching hospital. PAD was diagnosed by an ankle-brachial index (ABI) < 0.9 on either leg. Risk factors studied were age, sex, body mass index (BMI), smoking, diabetes duration, hypertension, insulin therapy, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), serum total cholesterol (TC), and triglyceride (TG). Overall prevalence of PAD was 10.0% without significant sexual difference. Univariate analyses disclosed age, BMI (inverse association), diabetes duration, hypertension, insulin therapy, and SBP as significant risk factors. In stepwise logistic regression, age, SBP, BMI, and insulin therapy were independent risk factors with respective odds ratios (95% confidence intervals, CI) of 1.09 (1.05-1.13), 1.02 (1.01-1.04), 0.88 (0.80-0.96), and 3.37 (1.83-6.19). In conclusion, prevalence of PAD in Taiwanese type 2 diabetic patients was 10.0% and the major risk factors were older age, lower BMI, higher SBP, and insulin therapy. The inverse association between PAD and BMI is contradictory to the general impression that obesity is a risk factor for PAD.     

The effect of aerobic exercise training on β-cell function and circulating levels of adipsin in community of obese women with type 2 diabetes mellitus

It has been suggested that adipsin might affect insulin secretion or glucose homeostasis, and thus, there can be a missing link between β-cell function, obesity, and type 2 diabetes. However, as yet, the function of adipsin has been unknown and needs to be evaluated over a longer term. The objective of this semi-experimental study was to compare the effect of aerobic exercise training on β-cell function and circulating levels of adipsin in obese women with type 2 diabetes mellitus (T2DM). The T2DM women with fasting plasma glucose >126 mg/dl were targeted and chosen for further evaluations. Twenty-four women aged 35–50 years participated in the study. Subjects were divided in two groups of C and E standing for control and experimental groups, respectively (group C/n?=?12, group E/n?=?12). Anthropometric variable measurements, including fasting plasma glucose, insulin, lipid profiles, free fat acid (FFA), HOMA-IR, HOMA-β, and serum adipsin were obtained from the study samples. Following 8 weeks of aerobic training, serum adipsin levels did not alter in group E, whereas, the levels of HOMA-IR, fasting plasma glucose, weight, BMI, and percent body fat levels significantly changed in group E compared to the baseline. Other variables did not alter significantly. The study indicated that aerobic exercise training in T2DM patients had positive health effects especially on glycemic control and pancreatic β-cell function with no significant change in adipsin levels. However, adipsin is a newly identified immune regulator of metabolic diseases and more studies are needed to understand the signaling mechanisms of adipsin T2DM population.     

2型糖尿病合并高血压患者血清NO、NOS水平的研究

目的　通过对 2型糖尿病 (2 - DM)合并高血压 (EH)患者血清一氧化氮 (NO)、一氧化氮合酶 (NOS)的测定 ,探讨其在 2 - DM合并 EH发生发展中的意义。方法　设正常对照组、单纯 2 - DM组和 2 - DM合并 EH组 ,分别测定血糖、胰岛素、血脂、NO及 NOS。结果　 2 - DM合并 EH组空腹胰岛素 (FINS)、舒张压 (DBP)和收缩压 (SBP)等均显著高于单纯 2 - DM组和正常对照组 ;胰岛素敏感指数 (ISI)和 NO均显著低于其他两组。相关分析显示 NO与 FINS和血压呈明显负相关 ,与 ISI呈显著正相关。结论　血清中 NO含量与胰岛素抵抗和血压密切相关 ,2 - DM患者血清 NO水平的降低可能参与了 2 - DM患者合并 EH的发病。     

Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study

Summary We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n = 67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n = 288), an impaired (IGT) (n = 170), or a diabetic (NDM) (n = 106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0 %, 9.5 %, 15.1 % and 20.9 % in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend: p < 0.01). Prevalence rates of any peripheral arterial disease (ankle-brachial pressure index < 0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1 %, 22.4 %, 29.2 % and 41.8 % in these categories (chi-square test for linear trend: p < 0.0001). The prevalence of any peripheral arterial disease was higher in KDM and NDM than in NGT (p < 0.03, p < 0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the ankle-brachial pressure index criterion. Logistic regression analyses showed that any arterial disease was significantly associated with HbA_{1 c}, fasting and 2-h post-load plasma glucose after correction for cardiovascular risk factors (odds ratios and 95 % confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated with any peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96] Received: 11 April 1994 and in revised form: 15 July 1994     

老年胰岛素抵抗与下肢动脉病变的相关性

目的 探讨老年胰岛素抵抗(IR)与下肢动脉病变(PAD)的相关性.方法 100例新诊断老年2型糖尿病(T2DM)患者,采用稳态模型计算胰岛素抵抗指数(HOMA-IR),并根据HOMA-IR值分3组,通过测量踝臂指数(ABI)评价患者PAD情况,观察IR与PAD的相关性.结果 随着HOMA-IR的升高,收缩压(SBP)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)逐渐升高,ABI逐渐降低(F=9.115、21.954、24.9、7.524,P＜ 0.01);HOMA-IR与ABI呈负相关(r=-0.352,P＜0.01),与SBP、LDL-C、餐后2小时血糖(2 h PG)、HbA1c呈正相关(r=0.346、0.532、0.222、0.534、0.376,P＜0.05或P＜0.01).结论 老年IR与PAD有强相关性,是发生PAD的高危因素.     

积雪草对2型糖尿病大鼠胰岛素抵抗影响的研究

目的：观察积雪草提取液对2型糖尿病大鼠胰岛素抵抗（IR）的影响。方法：尾静脉注射链脲佐菌素（STZ）并高糖高脂饲料喂养诱导2型糖尿病大鼠模型。随机分为积雪草低剂量组、积雪草高剂量组、二甲双胍组、模型组与正常组。观察体重、口服糖耐量试验（OGTT）、血甘油三酯（TG）、总胆固醇（TC）、空腹血清胰岛素（FINS）、胰岛素抵抗指数（IRI）（IRI=FINS×FPG/22.5）的改变。结果：①模型组大鼠体重明显增加（P〈0.01）,OGTT、TG、TC水平较正常对照组明显增高（P〈0.01）;②药物治疗后,积雪草组及二甲双胍组体重、血糖、血脂、IRI均明显降低（P〈0.01）;③积雪草高剂量组在降低血糖、血脂水平方面与二甲双胍组之间无明显的统计学差异（P〉0.05）,在降低IRI方面与二甲双胍组之间有明显的统计学差异（P〈0.01）。结论：2型糖尿病大鼠存在糖脂代谢紊乱及IR,积雪草可明显降低其血糖水平、减轻体重、降低血脂及IRI,其降低血糖、血脂水平的作用与二甲双胍相当,其降低IRI水平的作用优于二甲双胍。