我国东北一个县自然人群糖尿病流行病学调查

按照ＷＨＯ和中华医学会糖尿病学会规定的标准，１９９３年我们对吉林省柳河县进行了糖尿病流行病学调查，发现糖尿病（ＤＭ）及糖耐量低减（ＩＧＴ）的患病率已分别达到４．５２％和２．５３％。城镇ＤＭ患病率（５．３８％）略高于农村（２．３４％）。ＤＭ及ＩＧＴ患病率均随年龄增加而增高。ＩＧＴ患病率与标准体重百分比呈正相关关系，ＩＧＴ组平均标准体重百分数为１１３．６±２３．７％，显著高于对照组（Ｐ＜０．０２）。肥胖组ＩＧＴ患病率高达８．２９％，与非肥胖组（２．４０％）相比亦有增高的趋势。无论男性还是女性，ＤＭ和ＩＧＴ患者的腰／臀比值均显著高于对照组（Ｐ＜０．００１）。ＤＭ和ＩＧＴ患者的血压也明显高于对照组（Ｐ＜０．００１）。按体力劳动强度分组分析，随劳动强度的增加，ＤＭ患病率有减少的趋势。上述结果表明，该县糖耐量异常的比例已达很高的水平，这种情况可能与当地饮食习惯不良、体力劳动过少、腹部型肥胖者比例较大等因素有关。     

新诊NIDDM人群中血浆胰岛素水平与血压的相关性

作者观察了４０１例新诊ＮＩＤＤＭ血浆胰岛素与血压的关系。血浆胰岛素较高组（ＩＮＳ２ｈ≥８２ｍＵ／Ｌ）高血压患病率为４５．８％（３３／７２），明显高于较低组（ＩＮＳ２ｈ＜８２ｍＵ／Ｌ）的２７．４％（９０／３２９），血压水平也较高（８８Ｐ１８．８±０．４ｋＰａｖｓ１７．７±０．２ｋＰａ，ＤＢＰ１２．０±０．２ｋＰａｖｓ１１．４±０．１ｋＰａ，Ｐ＝０．０００１）。多因素回归分析在排除年龄、性别、ＢＭＩ、血糖等混杂因素影响后，口服葡萄糖耐量试验（ＯＧＴＴ）２小时血浆胰岛素水平与ＳＢＰ显著正相关（Ｐ＜０．０１），与ＤＢＰ边缘相关（Ｐ＝０．０５）。提示现行放射免疫测定的糖负荷后２小时胰岛素水平是致血压升高的独立危险因素。     

老年糖尿病病人空腹血糖诊断水平的探讨

近来ＷＨＯ糖尿病（ＤＭ）诊断专家委员会提出以空腹血糖（ＦＰＧ）≥７．０ｍｍｏｌ／Ｌ（１２６ｍｇ／ｄｌ）来取代ＦＰＧ≥７．８ｍｍｏｌ／Ｌ（１４０ｍｇ／ｄｌ）作为诊断ＤＭ的新标准〔１〕。我国对２５岁以上人群ＤＭ普查结果表明,以ＦＰＧ≥７．０ｍｍｏｌ／Ｌ为...     

单一测定空腹血糖在诊断糖尿病和糖耐量减低中的局限性

分析了经７５ｇＯＧＴＴ确诊的７９７例糖尿病（ＤＭ）和８１８例糖耐量减低（ＩＧＴ）患者的空腹血糖（ＦＢＳ）水平，并与１２８９例正常人作了比较。结果显示：７９７例糖尿病患者中ＦＢＳ≥７．８ｍｍｏｌ／Ｌ者有５０９例（６３．８６％）。ＦＢＳ≥７．８ｍｍｏｌ／Ｌ诊断糖尿病的敏感性和特异性分别为６３．８６％和９９．３０％，ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ则敏感性和特异性分别为９４．２３％和９１．５４％，假阳性率和假阴性率均不到１０％。８１８例ＩＧＴ患者的ＦＢＳ值正常者（＜６．１１ｍｍｏｌ／Ｌ）占７９．７１％，与正常人重叠较多。提示ＦＢＳ≥７．８ｍｍｏｌ／Ｌ对糖尿病的诊断不是一个敏感的指标，若ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ者应作进一步检查。而用ＦＢＳ不能估价ＩＧＴ。     

2型糖尿病患者初诊时血管并发症患病率的调查分析

按ＷＨＯ多国家血管研究方案，对１９９３年患病率调查所筛选出来的２型糖尿病患者的血管病变进行了前瞻性的调查分析。ＤＭ９６６例和正常糖耐量２９９６０例（均经７５ｇＯＧＴＴ诊断）。并发症判定标准：①高血压（ＨＴ）：收缩压（ＳＢＰ）≥２１．３ｋＰａ（１６０ｍｍＨｇ）或舒张压（ＤＢＰ）≥１２ｋＰａ（９０ｍｍＨｇ）；②冠心病（ＣＨＤ）：临床症状及明尼苏达编码的心电图诊断；③微量白蛋白尿（ＭＡＵ）：尿白蛋白排出量（ＵＡＥ）２０～２００μｇ／ｍｉｎ；④脑血管病（ＣＶＤ）：采用问卷和查体调查，有阳性征象者行ＣＴ证实；⑤糖尿病视网膜病变（ＤＲ）为散瞳检查或眼底荧光造影确定。结果显示：初诊２型糖尿病患者ＨＴ、ＣＨＤ、ＣＩ和ＭＡＵ的患病率分别为３７．３７％，９．３２％，５．５３％和２１．０５％均显著地高于对照组的相应患病率（１４．４％，２．４６％，１．１９％和４．３２％）。ＤＲ的患病率为１６．６％，对照组未进行荧光造影。经多元逐步回归分析，ＦＢＳ、ＭＢＰ和ＢＭＩ升高以及血脂紊乱为其血管并发症的独立危险因素。上述并发症的患病率显著高于对照组。控制血糖和血压、保持理想体重、纠正脂质代谢紊乱等，对防止糖尿病血管并发症将起积极作用     

中老年糖尿病流行病学调查方法探讨

对９１７例４０岁以上健康人利用６种方法同时进行糖尿病（ＤＭ）流行病学调查。按ＷＨＯ标准初筛出ＤＭ９４例，糖耐量异常（ＩＧＴ）９２例。方法①ＦＰＧ≥７．８ｍｍｏｌ／Ｌ；②ＦＰＧ≥６．７ｍｍｏｌ／Ｌ；③餐后２ｈ血糖≥１１．１ｍｍｏｌ／Ｌ；④空腹尿糖≥＋；⑤餐后２ｈ尿糖≥；⑥餐后２ｈ尿糖≥和（或）ＦＰＧ≥６．７ｍｍｏｌ／Ｌ并联阳性。结果①④法特异度高，灵敏度低，只查出ＤＭ１／３许。②⑤法灵敏度也低。③法灵敏度９８．１％，特异性１００％，但大规模健康普查时就要抽两次静脉血，难以做到。⑥法灵敏度８０．４％，特异性９４．０％，仅次于③法，操作与普查同步，可作为健康普查时早期诊断Ⅱ型ＤＭ初筛；即对普查时血尿化验不够ＤＭ标准而餐后２ｈ尿糖≥或ＦＰＧ≥６．７ｍｍｏｌ／Ｌ的可疑患者再进行餐后２ｈ血糖或ＯＧＴＴ确诊ＤＭ或ＩＧＴ，为大规模防治ＤＭ打下基础。     

葡萄糖转运蛋白基因多态性与糖尿病和糖尿病肾病的关系

目的：探讨葡萄糖转运蛋白（ＧＬＵＴ１）基因多态性与糖尿病及糖尿病肾病（ＤＮ）的关系。 方法：应用ＰＣＲ方法对１３１例Ⅱ型糖尿病（ＮＩＤＤＭ）患者ＧＬＵＴ１基因多态性与ＮＩＤＤＭ及ＤＮ发生之间的关系进行了观察，并结合患者体重指数（ＢＭＩ）和胰岛素敏感指数（ＩＳＩ）进行分析。 结果：①ＮＩＤＤＭ组患者Ｘｂａ Ｉ（＋／－）基因型的发生频率明显高于正常人群（６２％ｖｓ３３％，Ｐ〈０．０１），而Ｘｂａ Ｉ（     

非胰岛素依赖型糖尿病和糖耐量低减患者的胰岛素敏感性及其相关因素研究

为评价糖耐量异常者的胰岛素敏感性改变及其有关因素，对５７２例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）、６４７例糖耐量低减（ＩＧＴ）和５４３名正常对照者进行了研究。结果显示，空腹血浆胰岛素（ＦＩｎｓ）水平和高胰岛素血症的百分率，在ＮＩＤＤＭ组＞ＩＧＴ组＞正常对照组（Ｐ＜０．０１）。胰岛素敏感性指数（ＩＳＩ）［－ｌｎ（ＦＩｎｓ×空腹血糖）］从大到小的排列顺序为：正常对照组、ＩＧＴ组，新诊断糖尿病组和原诊断糖尿病组（Ｐ＜０．０１）。各组肥胖者的ＩＳＩ小于非肥胖者（Ｐ＜０．０１）。单因素相关性分析显示，各组ＩＳＩ与体重指数（ＢＭＩ）呈负相关，与高密度脂蛋白胆固醇呈正相关。糖尿病组和ＩＧＴ组的ＩＳＩ与血压也呈负相关。多元逐步回归分析显示，ＩＳＩ与ＢＭＩ呈负相关，部分与血压、血脂也有相关性。提示糖耐量异常者伴有高胰岛素血症和胰岛素抵抗，ＩＳＩ与血管病变的危险因素有相关性。     

非胰岛素依赖型糖尿病和糖耐量低减患病情况研究

我们于１９９４年７月－１９９５年３月对湖北省部分地区２５岁及以上的９４５０名居民进行了非胰岛素依赖型糖尿病与糖耐量低减患病率的抽样调查。结果表明：ＮＩＤＤＭ患病率为２．６２％，ＩＧＴ患病率４．４８％，男女性的ＮＩＤＤＭ与ＩＧＴ患病率差异无显著性，城乡ＮＩＤＤＭ，ＩＧＴ患病率差异有显著性，ＮＩＤＤＭ和ＩＧＴ的患病率均随着年龄升高而升高。     

糖耐量减低的干预治疗

随着对糖尿病（ＤＭ）的深入研究,糖耐量减低（ｉｍｐａｉｒｅｄ ｇｌｕｃｏｓｅ ｔｏｌｅｒａｎｃｅ,ＩＧＴ）也逐渐受到重视。 ＩＧＴ是一种重要的代谢紊乱综合征。大量证据表明ＩＧＴ患者发展成为ＤＭ及合并大血管疾病的危险性较正常糖耐量（ＮＧＴ）者相比显著增加［１,２］,减少２型ＤＭ及其并发症发生的重要环节之一,是早期发现ＩＧＴ,及早干预治疗。１ＩＧＴ的定义 ＩＧＴ是介于葡萄糖自身稳定和ＤＭ之间的中间状态。根据ＩＤＦ（国际糖尿病联盟）１９９７年建议的诊断标准为空腹血糖≥ ６．１ｍｍｏｌ／Ｌ,而＜ ７．０ｍｍｏ…     

INCIDENCE OF RHEUMATOID ARTHRITIS IN A GENETICALLY PREDISPOSED POPULATION

A follow-up study (mean duration five years) was undertakenon 370 previously unaffected first degree relatives from multicaserheumatoid arthritis (RA) families. The objectives were to determinethe incidence of RA in this group and the possible predictorsof disease development. In all, 14 individuals developed RA,equivalent to an incidence of 8/1000 person-years of observation.There was no control group included in this study as the intensivefollow-up required substantial compliance from highly motivatedfamilies. Population-based estimates, however, from a numberof sources would suggest an annual incidence below 0.5/1000per year, substantially less than the rate obtained in thisstudy. The small number of incident cases precluded definitiveconclusions about risk factors within these families but therewere no important effects of age or sex. Possession of HLA-DRIor DR4 explained only some of the increased risk. The increasedincidence observed in the previously unaffected relatives ofsuch families would suggest that this familial clustering didnot for the most part arise by chance and that other sharedgenetic or environmental influences are relevant. KEY WORDS: Multicase rheumatoid arthritis families, Disease development, Incidence, Genetic contribution     

GENIC VARIATION IN A NATURAL POPULATION OF Drosophila persimilis

The understanding of the speciation process can best be achieved by a knowledge of the genic differences between two closely related species and the correlation of such differences with the characteristics which demarcate the two species. D. persimilis and D. pseudoobscura are two sibling species differing from each other in morphology, ecological preferences, and behavior, and no hybrids exist in nature. I have compared the genetic changes in 24 loci of 25 strains of D. persimilis from Mather, California, with those in D. pseudoobscura by the method of acrylamide gel electrophoresis. The proportion of the genome heterozygous in individual D. persimilis is 10.5 per cent, which is comparable to the heterogeneity found in similar D. pseudoobscura populations. I did not find any locus which is monomorphic or polymorphic for entirely different allele(s) than in D. pseudoobscura. The different frequencies of shared alleles in the two species can only be explained by selection acting differentially in these species, since the frequencies of different alleles at various loci in several populations of D. pseudoobscura are very similar or show a very stable pattern of association with the third chromosome gene arrangements.     

SERUM TRIIODOTHYRONINE AND HYPERTHYROIDISM IN A POPULATION SAMPLE OF WOMEN

The serum T3 assay has been regarded as the most sensitive single test for hyperthyroidism although impaired conversion of T4 to T3 in non-thyroidal illness (NTI) might decrease its diagnostic sensitivity. The present report gives experience from the T3 assay in middle-aged females under conditions similar to those in a general health survey. The assays were performed during two periods with an interval of six years. In 1974–75 we studied a representative sample (n= 1283) of women of ages 44, 52, 56, 60 and 66 years in Göteborg, Sweden. Individuals with serum T3 concentration > mean + 2·5 SD were selected for a follow-up study (n= 21). Of 16 individuals with no previous thyroid disease and no present treatment with thyroid hormones or oestrogens, 14 were subjected to a TRH-stimulation test giving a normal TSH response in 10 cases having T3 concentrations up to mean + 3·5 SD. Four women with serum T3 concentration ≥ mean + 3·5 SD had previously unrecognized autonomous function thyroid function, of whom two developed hyperthyroidism after two years. The original population sample was reinvestigated after six years in 1980-81 (n= 1138) together with an additional sample of women giving a total sample of 1422 women of ages 26, 38, 50, 58, 62, 66 and 72 years. Of the females studied in 1974–75 eight had developed hyperthyroidism between the two studies; three of these had raised serum T3 at the investigation in 1974–75. No case of hyperthyroidism had been missed by the T3 assay in the 1974–75 study. Of individuals with serum T3≥mean + 2·5 SD selected for a follow-up (n= 29) at least five were found to have previously unrecognized thyroid autonomy. We found a raised serum T3 to be associated with hyperthyroid (n= 2) and euthyroid GRAVES' disease, autonomously functioning thyroid adenoma(s), possible painless subacute thyroiditis, possible thyrotoxicosis factitia, diminished thyroid reserve and thyroid substitution therapy. Since we did not correct for variations in protein binders a number of individuals with oestrogen-associated rise of total T3 were identified, but the rises were usually modest. The incidence of hyperthyroidism for the original sample as calculated for the six-year period was 1.3 cases/1000 women/year whereas the prevalence by 1980-81 was 13 cases/1000 women. We conclude that a single T3 determination will in most cases be sufficient for the diagnosis of clinical hyperthyroidism in a non-hospitalized population. Our study indicates some of the problems associated with the follow-up of a general screening for hyperthyroidism, the possible benefit of which remains to be studied.     

上海市黄浦区社区高尿酸血症与痛风流行病学调查

目的：对上海市黄浦区宁波里、山北里按门牌号次序随机调查了２１０３名居民的高尿酸血症与痛风的患病率。调查表的完成率为９６９％（２０３７人）。方法：其中按双数门牌号次序选择１０１７人抽取静脉血，采用尿酸酶—过氧化物酶的酶学方法检查血尿酸值。结果及结论：高尿酸血症在男性血尿酸值＞７０ｍｇ／Ｌ（＞７ｍｇ／ｄｌ）中患病率为１４２％（６２例），女性血尿酸值＞６０ｍｇ／Ｌ（６ｍｇ／ｄｌ）中患病率为７１％（４１例）。男女性别合计，高尿酸血症患病率为１０１％。痛风共７例，皆为男性，患病率为０７７％，男女性别合计为０３４％。与方圻等〔１〕１９８０年上海、北京、广州、杭州调查相比较，本文在上海调查同年龄组的血尿酸平均值显著高于１９８０年上海的血尿酸平均值（Ｐ＜００５）。男性增高１６７ｍｇ／Ｌ（１６７ｍｇ／ｄｌ），女性增高１１９ｍｇ／Ｌ（１１９ｍｇ／ｄｌ）。１９８０年调查四地未发现１例痛风。     

江西省人群蛔虫感染的现状

１９８８—１９８９年对我省６个片区，２３个县、市中的１００个调查点５２０４２人进行了粪检，蛔虫总感染率为７１．２％。男、女感染率分别为６９％（１８０７０／２６１８８）和７３．４％（１８９７７／２５８５４）。经χ２检验，两者间差别具有显著意义（χ２＝１２２．７７３３，Ｐ＜０．０１）。５岁以下年龄组感染率为６２．６％，虫卵计数，ＥＰＧ随年龄增长有明显下降趋势。８０％的抽查县的人群蛔虫感染率＞６０％，属重流行区。但根据虫卵计数，６８．９％的蛔虫感染者属轻度。     

上海人群中HLA与桥本甲状腺炎关联的研究

36例上海地区增生型桥本甲状腺炎患者以同一地区的正常人为对照,作了HLA-A、-B和-DR抗原测定。患者中HLA-DR9与Bw46抗原频率均显著高于正常对照组(DR9:55.56％Vs21.97％,Bw46:25％vs 5.32％),而HLA-B15抗原频率则低于正常对照组(8.33％Vs 29.79％)。三者P值各以所测定的抗原数校正后,仅DR9的增高具统计学显著性。