2型糖尿病周围神经病变患者尿山梨醇排泄的变化

目的探讨2型糖尿病患者尿山梨醇与周围神经病变（DPN）的关系。方法采用固相夹心酶联免疫吸附法测定63例2型糖尿病患者（无DPN组）,134例2型糖尿病周围神经病变患者（DPN组）和72例正常对照组的24h尿山梨醇排泄量,并分析其与病程、血糖、糖化血红蛋白、血清胰岛素、甘油三酯、总胆固醇、尿白蛋白排泄率（UAER）和神经传导速度的关系。结果2型糖尿病DPN患者尿山梨醇水平高于无DPN组和正常对照组（P〈0．05或〈0．01）;2型糖尿病患者尿山梨醇水平与神经传导速度呈负相关,与病程和UAER（P〈0．05或〈0．01）呈正相关。结论尿山梨醇可作为2型糖尿病周围神经病变的检测指标。     

34例非糖尿病白内障患者空腹血糖水平分析

目的观察非糖尿病白内障患者的空腹血糖水平.方法分析非糖尿病白内障患者(以下简称白内障患者)34例和正常对照组26人的空腹血糖水平.结果白内障患者组与对照组空腹血糖水平无明显差异;白内障患者男女之间血糖水平差异有统计学医意义;回族与汉族白内障患者的空腹血糖水平无明显差异;汉族白内障患者男女之间空腹血糖水平差异有统计学意义.结论非糖尿病白内障患者空腹血糖水平有性别差异,且女性血糖水平高于男性.     

糖尿病患者红细胞山梨醇含量的变化

本文报道糖尿病人37例及正常人19例的血糖及红细胞山梨醇含量,发现前者均显著高于后者。血糖与山梨醇之间呈正相关性。其中9例住院患者的分析表明,红细胞山梨醇含量与患者的年龄、分型及病程均不相关,但与正中神经的运动神经传导速度显著相关,提示山梨醇在体内的蓄积与糖尿病性神经病变等的发生有关。     

老年糖尿病患者血糖水平与颈动脉斑块的相关性

目的分析老年糖尿病患者血糖水平与颈动脉斑块的相关性。方法选择老年糖尿病患者80例,根据有无颈动脉斑块分为无斑块组和有斑块组,有斑块组根据斑块等级分为斑块Ⅰ、Ⅱ级组和斑块Ⅲ级组,根据糖化血红蛋白(HbA1c)控制情况以6.5%为界限分为控制良好组(HbA1c≤6.5%)和控制不良组(HbA1c6.5%)。彩色多普勒超声测定颈动脉斑块,全自动生化分析仪测定血糖和血脂情况,多功能全定量特种蛋白金标检测仪测定HbA1c。分析老年糖尿病患者血糖水平与颈动脉斑块的相关性。结果 80例糖尿病患者中,无斑块组9例,斑块Ⅰ级组13例,斑块Ⅱ级组17例,斑块Ⅲ级组41例。各组糖尿病患者的年龄、总胆固醇(TC)和甘油三酯(TG)水平比较差异显著(P0.05)。糖尿病有斑块组的HbA1c、空腹血糖(FPG)和餐后2 h血糖均高于无斑块组(P0.05)。斑块Ⅰ级组、斑块Ⅱ级组和斑块Ⅲ级组之间HbA1c、FPG和餐后2 h血糖比较差异显著(P0.05)。斑块Ⅱ级组斑块Ⅲ级组各指标均高于斑块Ⅰ级(P0.05);斑块Ⅱ级组和斑块Ⅲ级组之间无差异(P0.05)。HbA1c控制良好组和控制不良组之间的颈动脉斑块等级之间有显著差异(P0.05),糖化血红蛋白控制良好组无斑块和斑块Ⅰ级患者比例高于控制不良组(P0.05),斑块Ⅱ级和Ⅲ级患者比例低于控制不良组(P0.05)。糖尿病患者的颈动脉斑块和患者的年龄呈正相关(r=0.351,P0.05),糖尿病患者的颈动脉斑块和患者的HbA1c水平、FPG水平和餐后2 h血糖水平均呈正相关(r=0.413,0.479,0.598,P0.05),结论老年性糖尿病患者的血糖和HbA1c水平与颈动脉斑块的发生正相关,HbA1c控制良好可以改善颈动脉斑块的严重程度。     

甘油三酯对2型糖尿病患者胰岛素用量的影响

目的研究应用胰岛素降血糖治疗的2型糖尿病患者血甘油三酯对胰岛素用量影响。方法选取华北理工大学附属医院内分泌科2016年5月—2017年6月收治的140例院外应用胰岛素降血糖治疗且血糖控制差的2型糖尿病患者,其中78例为高甘油三酯水平患者,为高甘油三酯组,62例为甘油三酯水平正常患者为正常甘油三酯组,比较两组间血脂水平、空腹及餐后2 h血糖水平、C肽水平、胰岛素水平、出入院胰岛素用量及一般情况的差异。结果高甘油三酯组出院胰岛素用量,入院胰岛素用量、糖化血红蛋白、总胆固醇、空腹胰岛素水平、餐后2 h胰岛素水平、空腹血糖、餐后血糖高于正常甘油三酯水平组;高常甘油三酯组内经饮食运动控制人数低于正常甘油三酯组。结论 2型糖尿病合并高甘油三酯血症患者胰岛素用量、空腹及餐后2 h胰岛素、血糖水平明显高于2型糖尿病正常高甘油三酯水平患者。     

The effect of glycemic control to the leukocyte telomere length in patients with Type 2 diabetes

目的 通过检测2型糖尿病患者外周血白细胞端粒长度,探讨2型糖尿病患者血糖控制对端粒长度的影响.方法 以47例健康者为对照组,选取43例病程在5年以上的2型糖尿病患者,其中糖化血红蛋白(HbA1c)≤7％且每月监测血糖次数≥4次者纳入血糖控制良好组(22例);而HbA1c＞9％且每月监测血糖次数＜4次者则纳入血糖控制不佳组(21例).提取外周血白细胞DNA,定量聚合酶链反应(PCR)检测端粒长度比值来评估端粒长度.并检测空腹静脉血糖(FPG)、空腹静脉胰岛素水平(FIN)、高敏C反应蛋白(hs-CRP)及HbA1c,根据FPG及FIN评估胰岛素抵抗程度(HOMA-IR).结果 3组受试者年龄比较无显著差异.2型糖尿病患者中,血糖控制良好组和血糖控制不佳组的端粒长度均较对照组明显缩短,但血糖控制良好组的端粒显著长于血糖控制不佳组(P＜0.05).血糖控制良好组的hs-CRP水平显著低于血糖控制不佳组.多元线性回归分析显示,hs-CRP及HbA1c与端粒长度呈显著负相关.结论 2型糖尿病患者外周血白细胞端粒长度较正常对照者明显减短,有效的血糖控制能延缓端粒缩短的进程.     

胰岛素不足与循环生长激素升高在严重视网膜病变中的作用

严重的糖尿病性视网膜病变多由于长期血糖控制不好造成。但也有的患者虽血糖控制到正常也有视网膜病变且继续发展。在Hammersmith医院里604例糖尿病性视网膜病变中取8例血糖已控制在正常范围3—7年有严重视网膜病变者作为第Ⅰ组,另外8例非胰岛素依赖型糖尿病用饮食控制无视网膜变者为第Ⅱ组,第Ⅲ组为非糖尿病之对照组。研究方法为检查空腹血的血糖、中间代谢产物、胰岛素及生长激素等。结果是血糖及代谢产物第Ⅰ组为6.5±0.6mmol/l,第Ⅲ组为5.4±0.8mmol/l,     

Ⅱ型糖尿病患者红细胞的醛糖还原酶活性与细胞损伤

应用荧光法测定了15例无并发症的Ⅱ型糖尿病患者红细胞内醛糖还原酶的活性,患者的酶活性明显高于正常对照。同时用气相色谱法测量了红细胞内糖醇的浓度,患者的山梨醇和果糖的浓度明显高于对照,而两者的肌醇浓度差异无显著性。患者全血还原型谷胱甘肽和氧化型谷胱甘肽的浓度明显低于正常对照。实验结果提示:醛糖还原酶的激活加速了多元醇代谢途径,但山梨醇在细胞内的蓄积加速它向果糖转化,从而缓解山梨醇的堆积和细胞损伤。     

2型糖尿病餐后高血糖状态与血管病变关系的研究

目的:探讨2型糖尿病患者单纯餐后高血糖状态对大小血管并发症的影响。方法:149例2型糖尿病患者分为2组:单纯餐后血糖（PPG）增高组（Ⅰ组,50例,FPG<7.0 mmol/L）、空腹血糖（FPG）及PPG均增高组（Ⅱ组,99例,FPG≥7.0mmol/L）。正常对照组35例。测定研究对象的PPG、空腹胰岛素（FINS）、2hPPG、餐后2小时胰岛素（2hINS）、总胆固醇（TC）、甘抽三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、糖基化血红蛋白（HbA1c）,计算胰岛素敏感性指数,并分析其大小血管并发症的发生情况。结果:Ⅰ组微血管并发症发生率低于Ⅱ组（14.3％:64.4％,P<0.01）;而两组间大血管并发症发生率无显著差异（59.2％:47.1％,P>0.05）。Ⅰ组和Ⅱ组的糖尿病病程分别为1.47±1.07年,7.13±5.75年,两组有显著差异（P<0.01）。两组的胰岛素敏感指数（IAI）与对照组比较均显著降低（P均<0.01）,而Ⅱ组的IAI又较Ⅰ组显著降低（P<0.01）.结论:2型糖尿病在其早期存在单纯餐后高血糖状态,此时胰岛素敏感性已降低。此期虽然糖尿病病程较短,空腹血糖不高,微血管并发症较少,但大血管并发症发生率与FPG及PPG均增高的患者基本相当。     

糖尿病肾病与血脂关系的研究

我们观察了54例Ⅱ型糖尿病患者伴有不同时期肾病时的血脂、载脂蛋白的变化,并与无肾病的2型糖尿病患者及正常人比较,结果糖尿病肾病载脂蛋白、血脂水平与正常对照组及糖尿病无肾病纽有显著差异;糖尿病肾病三亚组之间载脂蛋白、血脂亦有差异,且血脂、载脂蛋白与糖尿病肾脏病变程度有相关性.     

Red cell sorbitol levels during hyper and hypoglycaemic clamp studies in insulin-dependent diabetic patients

The red cell sorbitol concentration has been suggested as a measure of polyol pathway activity. Red cell sorbitol levels were higher in 53 patients having insulin-dependent diabetes mellitus (IDDM) than in 16 control subjects. Six patients having IDDM underwent hyperglycaemic 'clamp' studies; the red cell sorbitol level returned to the normal range when the blood glucose was clamped at 5 mmol/l for 1 h and rapidly increased when it was clamped at 15 and 25 mmol/l for a further hour at each level. Seven patients with IDDM were rendered hypoglycaemic; red cell sorbitol levels rapidly fell to a level less than, but not significantly different from normal. The results of these studies suggest that in IDDM red cell sorbitol levels are a reflection of prevailing blood glucose concentration and do not indicate long-term sorbitol accumulation in other tissues.     

Serum insulin-like growth factor I levels in adult diabetic patients: the effect of age

Despite reports of reduced serum insulin-like growth factor (IGF) levels in experimentally diabetic animals, human diabetic patients have been reported to have decreased, normal, or even elevated levels. This study was a cross-sectional examination of the effect of age on immunoreactive IGF-I levels in adult patients with insulin-dependent or noninsulin-dependent diabetes mellitus (IDDM and NIDDM) attending a diabetes out-patient clinic. The patients and normal subjects studied were divided into the age ranges 21-30, 31-40, 41-50, 51-60, and over 60 yr. For all ages combined, the mean IGF-I level (+/- SD) was 0.84 +/- 0.26 U/ml (202 +/- 62 ng/ml) in 133 normal subjects, significantly reduced to 0.41 +/- 0.17 U/ml in 121 IDDM patients, and 0.49 +/- 0.19 U/ml in 46 NIDDM patients (both P less than 0.001). In both groups there was a marked decline in IGF-I with increasing age (P less than 0.01). Except for NIDDM patients aged 21-30 yr (only two patients), IGF-I levels in both IDDM and NIDDM patients were significantly lower in every age range than those in age-matched normal subjects, but did not differ between the two diabetic groups. Glycosylated hemoglobin levels correlated inversely with IGF-I levels only in younger patients with IDDM (r = -0.486; P less than 0.05 for patients aged 21-40 yr). We conclude that factors common to IDDM and NIDDM, perhaps related to relative nutritional deficiency at the cellular level, cause a reduction in serum IGF-I levels, and that this reduction occurs independently of age-related changes in IGF-I.     

Ⅰ型糖尿病患者外周血NK细胞活性降低

以改良铬（５１Ｃｒ）释放法检测３４例Ⅱ型糖尿病（ＮＩＤＤＭ）、２３例Ｉ型糖尿病（ＩＤＤＭ）和２８例正常人外周血ＮＫ细胞对Ｋ５６２靶细胞的杀伤活性。结果显示：①ＩＤＤＭ组患者ＮＫ细胞活性显著低于ＮＩＤＤＭ组及正常对照组，经正规治疗血糖控制以后，ＮＫ细胞活性恢复正常。②ＮＩＤＤＭ组患者血ＮＫ细胞活性在血糖控制前后无显著变化，与正常对照组比较亦无统计学差异。提示ＩＤＤＭ与机体免疫异常密切关联。     

Diurnal variation of blood ketone bodies in insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus patients: the relationship to serum C-peptide immunoreactivity and free insulin

We examined whether the rise in ketone body concentration around midnight and in the early morning was due to the lack of free insulin (IRI) or excess of insulin counterregulatory hormones such as human growth hormone (hGH), cortisol and glucagon in noninsulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) patients and whether the monitoring of blood ketone body concentration was clinically useful as an index of metabolic control for deciding to increase or decrease the insulin dose in the treatment of diabetes mellitus. Serum levels of 3-hydroxybutyrate (3-OHBA), acetoacetate (AcAc) and 3-OHBA/AcAc ratio before breakfast were significantly increased in insulin-treated NIDDM patients with well-controlled fasting plasma glucose levels and IDDM patients compared to those in normal subjects. Mirror image diurnal changes were found between serum concentrations of 3-OHBA and serum C-peptide or free IRI in normal subjects and NIDDM patients treated with diet alone or sulfonylurea during the 24-hour daily profiles. However, there were no correlations between 3-OHBA and free IRI in the NIDDM patients treated with insulin and IDDM patients who had a much larger increase in the mean concentration of serum 3-OHBA at 6 a.m. caused by a low concentration of free IRI. Counterregulatory hormones were not increased in IDDM patients compared to normal subjects in the early morning. Cortisol/free IRI and hGH/free IRI molar ratios were significantly increased in NIDDM and IDDM patients compared to normal subjects in the early morning, but glucagon/free IRI molar ratio was not changed between IDDM and normal subjects. In conclusion, the early morning rising of ketone body concentration in insulin-treated diabetic patients, particularly IDDM patients, is due to the absolute lack of free IRI and/or the relative lack of free IRI to the levels of hGH or cortisol, and the monitoring of 3-OHBA is clinically useful as a more sensitive index of metabolic control.     

Analysis of plasma lipids and apolipoproteins in insulin-dependent and noninsulin-dependent diabetics

Plasma triglycerides, cholesterol, high-density lipoprotein (HDL) cholesterol, and apolipoproteins (apo) A-I, A-II, C-II, and C-III were determined and analyzed in 170 diabetic patients and 46 age-matched healthy normal subjects. The diabetics were separated into two groups: insulin-dependent diabetes mellitus (IDDM, n = 78) and noninsulin-dependent diabetes mellitus (NIDDM, n = 92). Significantly increased triglycerides, low HDL cholesterol, and normal cholesterol levels were found in the diabetics. The lipid profiles were similar in the IDDM and NIDDM groups. Plasma apo A-I, but not apo A-II, was low in both groups of diabetics. However, only in the IDDM subjects was there a statistically significant decrease in apo A-I when compared to normal subjects. The decreased apo A-I level negatively correlated with plasma triglycerides. Apo C-II and apo C-III were slightly increased in the diabetics compared to normal subjects. Apo C-II and apo C-III levels significantly correlated with plasma triglycerides (apo C-II, r = 0.70, P less than 0.0001; apo C-III, r = 0.71, P less than 0.0001). Only apo C-II correlated with total cholesterol. Thirty-eight to forty-two percent of the IDDM and NIDDM subjects had a clinical diagnosis of coronary artery disease (CAD) and/or peripheral arteriovascular disease (PAD). In the IDDM subjects, but not in the NIDDM subjects the incidence of CAD and/or PAD was associated with the decreased apo A-I levels as evaluated by a univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary C-peptide as an index of unstable glycemic control in insulin-dependent diabetes mellitus (IDDM)

In order to investigate whether urinary C-peptide (UCP) excretion can be a useful index of insulin-dependent diabetes mellitus (IDDM) with unstable glycemic control, UCP was measured in nine IDDM patients with unstable glycemic control, nine IDDM patients with stable glycemic control, and 12 non-insulin-dependent diabetic (NIDDM) patients treated with insulin. The UCPs in overnight urine (U1) and fasting single void urine (U2) in IDDM patients with unstable glycemic control were significantly lower than those in IDDM patients with stable glycemic control (U1: 0.03 +/- 0.03 vs 0.24 +/- 0.20 nmol/mmol-Creatinine, U2: 0.02 +/- 0.01 vs 0.20 +/- 0.20 nmol/mmol-Cr, mean +/- SD, both P less than 0.01). The UCPs in U1 and U2 in both groups of IDDM were significantly lower than those in NIDDM (U1: 0.97 +/- 0.52, U2: 0.73 +/- 0.41 nmol/mmol-Cr, both P less than 0.01). The UCPs in U1 and U2 significantly correlated with incremental C-peptide response to intravenous glucagon injection and with glycemic stability assessed by the standard deviation of 10 previous fasting plasma glucose levels. These results suggest that UCP reflects their residual insulin secretory capacity and that UCP can be a useful index which distinguishes patients with unstable IDDM from those with stable diabetes mellitus.     

Lipoprotein(a) concentration in diabetes: relationship to proteinuria and diabetes control

Diabetic patients are at increased risk of cardiovascular disease, particularly when proteinuria is present. Lipoprotein(a)[Lp(a)] levels were assessed in 37 patients with insulin dependent (IDDM) and in 75 patients with non-insulin dependent (NIDDM) diabetes who showed varying degrees of proteinuria and glycaemic control. Median Lp(a) in 112 diabetic patients was significantly greater than in 116 healthy controls (113 vs 48 mg/L; p <0.01). 86 of the patients had first morning urine albumin concentration < 30 mg/L (normoalbuminuria = NA), 16 patients 30–200 mg/L (microalbuminuria = MA) and ten patients < 200 mg/L (albuminuria = ALB). There was no significant difference in median Lp(a) concentration between the three groups (NA = 108, MA = 163, ALB = 98 mg/L; p > 0.5). No significant difference in median Lp(a) concentration was found between patients with IDDM, NIDDM treated with insulin, or NIDDM treated with oral agents and/or diet (120, 98, 115 mg/L respectively; p > 0.7). When the 86 NA patients were divided on the basis of median fructosamine concentration (357 umol/L), no significant difference was found in median Lp(a) levels between those grouped below or above this median (98 mg/L vs 118 mg/L; p < 0.5). Across all diabetics studied there was no significant correlation present between Lp(a) and urinary protein or glycaemic control. These cross-sectional results suggest that median Lp(a) concentration is increased in both IDDM and NIDDM patients, but this increase is not related to the degree of proteinuria or short-term glycaemic control.     

IDDM自身抗体与胰岛功能的研究

本文测定了36例新诊断、未使用过外源胰岛素的IDDM患者的血清胰岛细胞抗体(ICA)、血清胰岛素自身抗体(IAA)及血清C肽和胰岛素水平,并以72例新诊断的NIDDM和36例正常人作为对照。研究表明:自身免疫在IDDM病因中占有重要地位;临床发病时ICA、IAA阳性可以作为IDDM自身免疫的标志,但不能反映胰岛β细胞功能损害的程度。     

High levels of erythrocyte aldose reductase and diabetic retinopathy in NIDDM patients

Summary Erythrocyte aldose reductase was determined in 90 NIDDM patients by a two-site ELISA using recombinant human aldose reductase. The level of aldose reductase did not correlate with age, duration of diabetes, fasting blood glucose and HbA_1cof the patients. Among 38 patients with diabetes for more than 10 years, aldose reductase in those with retinopathy (including non-proliferative and proliferative) was significantly higher than in those without, while no difference in the means of the average HbA_1c, maximum and minimum blood pressure levels was observed between the two groups. The results indicate that the level of aldose reductase in the erythrocyte of diabetic patients is associated with the presence of retinopathy.Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - IDDM insulin-dependent diabetes mellitus