初诊2型糖尿病患者内脏脂肪含量与心功能的相关性研究

目的探讨初诊2型糖尿病(T2DM)患者内脏脂肪(VAT)含量与心功能的关系。方法收集2015年8月至2016年6月就诊的18~70岁初诊T2DM患者,按体质指数(BMI)分为肥胖组(BMI≥28.0 kg/m^2)、超重组(24.0 kg/m^2≤BMI<28.0 kg/m^2)及正常体重组(18.5 kg/m^2≤BMI<24.0 kg/m^2)。采用双能X线骨密度仪测量VAT质量、面积,采用心脏彩超测量右心室前壁脂肪、心尖脂肪及心功能[射血分数、舒张末期容积(EDV)、收缩末期容积(ESV)]等指标。组间比较采用方差分析和秩和检验,心功能的影响因素采用多元线性回归分析。结果共入组患者142例,其中男77例,女65例,年龄51(42,59)岁;失访3例。分为肥胖组(48例)、超重组(45例)及正常体重组(46例)。(1)三组间比较BMI、腰围、腰臀比、VAT质量、VAT面积、右室前壁、心尖脂肪差异有统计学意义(均P<0.05)。(2)单因素分析显示,射血分数与BMI、腰围、VAT面积、右室前壁脂肪、心尖脂肪相关(β=-0.590^-0.023,均P<0.05),EDV与VAT面积、心尖脂肪相关(β=0.196、4.357,均P<0.05),ESV与VAT面积、心尖脂肪相关(β=0.113、2.675,均P<0.05)。(3)多元线性回归显示,在模型Ⅰ(未调整)和模型Ⅱ(调整年龄和性别)中,心尖脂肪每增加1 mm,射血分数分别下降0.590%、0.645%,EDV依次增加4.357%、4.835%,ESV依次增加2.675%、2.931%。结论BMI、腰围、VAT质量、VAT面积、右室前壁脂肪、心尖脂肪是影响心功能的重要影响因素,尤以心尖脂肪对心功能的影响最大。     

Association between diabetes mellitus and post-stroke cognitive impairment

Stroke survivors suffer from various physical, emotional, and cognitive impairments. These changes are dynamic and depend on multiple factors, including underlying diseases, baseline brain function and pathology, the site of the stroke and the post-stroke inflammation, neurogenesis as well as the subsequent remodeling of the neuro-network. First we review the structural and pathological changes of the brain in stroke survivors with diabetes mellitus, which may lead to post-stroke cognitive dysfunction. Second, we provide evidence of hyperglycemia, diabetes mellitus, hypoglycemia, and their relationship with post-stroke cognitive impairment (PSCI) and post-stroke dementia (PSD). In addition to conventional biomarkers, such as HbA1c, we also provide other novel tools to predict PSCI/PSD, such as glycemic variability, receptor for advanced glycation end products, and gut microbiota. Finally, we attempt to provide some modifying methods for glycemic control, focusing on the prevention of PSCI/PSD.     

脂肪细胞型脂肪酸结合蛋白与2型糖尿病的关系

脂肪细胞型脂肪酸结合蛋白(FABP)4是脂肪酸结合蛋白家族中的一员,主要在脂肪细胞和巨噬细胞中表达,其表达受胰岛素、过氧化物酶体增殖物活化受体(PPAR)-γ激动剂的调控,可调节机体炎性反应,在体内脂肪酸转运和能量代谢中起重要作用.研究发现,FABP4能增加2型糖尿病的风险,预测血糖水平.同时,FABP4与2型糖尿病危险因素及糖尿病并发症的发生、发展也密切相关.     

Association between hepatitis C,diabetes mellitus,and race. a case-control study

OBJECTIVE: A higher prevalence of type II diabetes mellitus (DM) has been reported in patients with hepatitis C virus (HCV) infection. However, in most of these studies, the control population was not matched for body mass index, race, and severity of liver disease, known risk factors for the development of type II DM. The aim of this study was to determine the prevalence of type II DM in patients with HCV cirrhosis compared with a control population matched for age, sex, body mass index, and severity of liver disease. METHODS: We conducted a case-control study in a University Hospital setting. We compared 97 cirrhotic patients with HCV (cases) with 194 HCV-negative patients with cirrhosis from other causes (controls). We sought to determine the prevalence of pre- and post-transplant type II DM in cases and controls. RESULTS: The age, sex, and severity of liver disease were similar in both groups, but there were more blacks in the HCV group (24 of 97, 25%) compared with controls (16 of 194, 8%). The prevalence of pretransplant DM was higher in the HCV group (19.6%) compared with controls (11.5%) (p = 0.06, OR = 1.9, 95% CI = 0.9-3.8). Blacks with HCV had a significantly higher prevalence of pretransplant DM (33.3%) compared with whites with HCV (13.2%) (p = 0.03) and black controls (6.3%) (p = 0.05). Among whites, the prevalence of DM was similar in the HCV group (13.2%) and controls (11.9%). Logistic regression showed that age was the only independent predictor for pretransplant DM (odds ratio = 1.06, 95% CI = 1.01-1.11, p = 0.01). New onset DM was similar in the HCV group (16.7%) and controls (10.1%, p = ns). The new onset of DM was similar in blacks with HCV (31.3%) and black controls (20.0%). However, by logistic regression, black race was an independent predictor for the development of new onset DM (odds ratio = 3.4, 95% CI = 1.2-9.8, p = 0.02). CONCLUSIONS: Our study shows that the prevalence of type II DM is higher in patients with HCV cirrhosis compared with a control group of patients with cirrhosis from other causes, and this was because of a higher prevalence of DM in blacks with HCV infection.     

Association between diabetes mellitus and hearing impairment in American and Korean populations

Aims

The aim of this study was to evaluate ethnic- and sex-specific associations between DM and hearing impairment.

Relationship between sex hormones,lipids and visceral fat area in postmenopausal women with type 2 diabetes mellitus

正Objective To study the characteristics and correlation of sex hormone levels,blood lipids,and visceral fat area in postmenopausal women with T2DM.Methods A total of 258 cases of postmenopausal T2DM were recruited,including 46 cases of menopause for 1-5 years(group A),49 cases of menopause for 6-10 years(group B),and 163 cases with menopause more than 10     

2型糖尿病患者血清胆红素水平与糖尿病视网膜病变的相关性研究

目的探讨不同性别2型糖尿病患者血清胆红素水平与糖尿病视网膜病变(DR)患病风险的相关性。方法共纳入1304例2型糖尿病患者,收集其临床资料,并均进行眼底检查。根据眼底检查结果分为DR组与非DR(NDR)组,分析血清总胆红素、直接胆红素、间接胆红素水平与DR发生的相关性。结果与NDR组相比,DR组总胆红素、直接胆红素、间接胆红素水平显著降低。单因素分析显示,在女性中总胆红素与DR的发生呈负相关(P<0.05),间接胆红素、直接胆红素与DR的发生无明显相关性;在男性中,总胆红素、间接胆红素与DR的发生呈负相关(P<0.01)。调整相关混杂因素后,平滑曲线拟合显示在女性中,总胆红素、间接胆红素水平与DR发生风险呈U型关系;在男性中,总胆红素、间接胆红素与DR发生风险呈负相关。多元回归分析结果显示,调整混杂因素后,在男性中,总胆红素每增加1μmol/L,DR的发生风险降低8%(OR=0.92,95%CI 0.88~0.98,P<0.01);间接胆红素每增加1μmol/L,DR的发生风险降低9%(OR=0.91,95%CI 0.84~0.96,P<0.01)。在女性中,当总胆红素<12.8μmol/L时,总胆红素每增加1μmol/L,DR发生风险降低17%(OR=0.83,95%CI 0.72~0.95,P<0.01);当总胆红素≥12.8μmol/L时,每增加1μmol/L,DR发生风险增加10%(OR=1.10,95%CI 1.01~1.20,P<0.05)。当间接胆红素<9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险降低20%(OR=0.80,95%CI 0.68~0.94,P<0.01);当间接胆红素≥9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险增加13%(OR=1.13,95%CI 1.01~1.25,P<0.05)。结论在2型糖尿病女性患者中,总胆红素、间接胆红素水平与DR患病风险存在U型关系,在男性患者中,总胆红素、间接胆红素与DR患病风险呈负相关关系,直接胆红素与DR患病风险无明显相关性。     

Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population

It is still controversial whether type 2 diabetes mellitus (T2DM) is associated with increased left ventricular (LV) mass independent of body size. We tested the hypothesis that T2DM is independently associated with LV mass in a multiethnic cohort. In the Northern Manhattan Study (NOMAS) cohort sample, a total of 1,932 subjects (67.9+/-9.6 years, 769 men and 1,163 women, 443 with DM and 1,489 without DM) were studied by transthoracic echocardiography, and LV mass was calculated. LV hypertrophy was defined as the upper quartile of LV mass. Multivariable models were used to assess the association of T2DM with LV mass after adjusting for age, gender, race, body mass index (BMI), systolic blood pressure, education, history of coronary artery disease, physical activity, and alcohol consumption. LV mass (189+/-60 vs 174+/-59 g, p<0.0001), BMI, and systolic blood pressure were higher in the DM group than in the non-DM group, whereas age and gender distributions were similar between groups. In multivariable analysis, T2DM was independently associated with increased LV mass (p=0.03). Presence of T2DM was associated with increased risk of LV hypertrophy (adjusted odds ratio 1.46, 95% confidence interval 1.13 to 1.88, p=0.004). Although no interactions were observed between T2DM and BMI on LV hypertrophy (p=0.6), there was a significant interaction between T2DM and waist circumference on LV hypertrophy (p=0.01). In conclusion, T2DM was independently associated with increased LV hypertrophy independent of various covariates in this multiethnic sample. Presence of T2DM increased the risk of LV hypertrophy by about 1.5-fold, and it possibly interacted with central obesity.     

糖尿病与线粒体ND1点突变的关系

目的探讨湖北省线粒体基因的热点突变区域ND1点突变(3243,3316,3394,3593)与老年2型糖尿病的关系。方法采用聚合酶链反应-限制性片段长度多态性法对无血缘关系的134例老年糖尿病患者及152例正常对照个体的血细胞线粒体DNA进行突变分析。结果病例组中3316G→A点突变率为3·7%,3394T→C点突变发生率为3·0%,而对照组3316和3394的突变率分别为0·66%和0,3394组间差异比较均有显著性(P<0·05)。病例组中3593点突变发生率为0·75%,对照组未见该突变,两组间差异无显著性。未发现3243的突变。结论线粒体DNA3394T→C突变与老年线粒体糖尿病的发生与发展有关,并起着重要作用。     

CDKAL1基因多态性与妊娠期糖尿病及其临床特点的相关性研究

目的 探讨我国南方人群中CDKAL1基因两个SNP位点rs7754840和rs10448033的多态性与GDM易感性的关系. 方法 采用病例对照研究,分别选取GDM患者(GDM组)153例和正常糖耐量的孕妇(GNGT组)180名.采用聚合酶链反应-限制性片断长度多态性分析法(PCR-RFLP)测定两个SNP位点多态性分布,并进行统计学分析. 结果 GDM组孕前BMI、FPG、TG均高于GNGT组,TC、HDL-C及LDL-C均低于GNGT组(P＜0.05).SNP位点rs7754840基因型(CC,GC,GG)频率和等位基因频率与GNGT组比较,差异均无统计学意义(P=0.937、0.933);而SNP位点rs10440833基因型(AA,AT,TT)与GNGT组比较,差异有统计学意义(P=0.024),且风险基因型TT的频率高于GNGT组(TTvs TC+CC,P=0.032);GDM组A等位基因频率高于GNGT组[OR(95％CI):1.519(1.114～2.071),P=0.008];AA基因型患者的FPG高于其他基因型(P=0.011),TG高于TT基因型(P=0.007),HDL C低于TT基因型(P=0.001). 结论 CDKAL1基因SNP位点rs7754840与GDM无相关性;SNP位点rs10440833与GDM的易感性相关,且该位点多态性可能与血糖、TG及LDL-C的水平有关.     

Association between diabetes mellitus and gastroesophageal reflux disease:A meta-analysis

AIM:To investigate whether there is a link between diabetes mellitus(DM) and gastroesophageal reflux disease(GERD).METHODS:We conducted a systematic search of Pub Med and Web of Science databases,from their respective inceptions until December 31,2013,for articles evaluating the relationship between DM andGERD.Studies were selected for analysis based on certain inclusion and exclusion criteria.Data were extracted from each study on the basis of predefined items.A meta-analysis was performed to compare the odds ratio(OR)in DM between individuals with and without GERD using a fixed effect or random effect model,depending on the absence or presence of significant heterogeneity.Subgroup analyses were used to identify sources of heterogeneity.Publication bias was assessed by Begg’s test.To evaluate the results,we also performed a sensitivity analysis.RESULTS:When the electronic database and hand searches were combined,a total of nine eligible articles involving 9067 cases and 81 968 controls were included in our meta-analysis.Based on the randomeffects model,these studies identified a significant association between DM and the risk of GERD(overall OR=1.61;95%CI:1.36-1.91;P=0.003).Subgroup analyses indicated that this result persisted in studies on populations from Eastern countries(OR=1.71;9 5%C I:1.3 8-2.1 2;P=0.0 0 3)a n d i n y o u n g e r patients(mean age50 years)(OR=1.70;95%CI:1.22-2.37;P=0.001).No significant publication bias was observed in this meta-analysis using Begg’s test(P=0.175).The sensitivity analysis also confirmed the stability of our results.CONCLUSION:This meta-analysis suggests that patients with DM are at greater risk of GERD than those who do not have DM.     

Association between the severity of diabetes mellitus and coronary arterial atherosclerosis

The relation between the severity of diabetes mellitus (DM) and the risk of significant coronary artery lesions were studied in 7,655 patients undergoing coronary arteriography for suspected coronary artery disease (CAD) between 1972 and 1982. The principal treatment regimen for DM was used to estimate the severity of DM. DM treated with insulin was defined as the most severe (n = 244), followed by DM treated with oral agents (n = 344) and with diet only (n = 380); 6,687 patients did not have DM. Severity of DM in patients with CAD (70% or greater diameter stenosis) was compared with that in control subjects without CAD (0% stenosis) for each of 9 anatomic locations (proximal, middle and distal portions of right, anterior descending and circumflex coronary arteries) using a retrospective case-control approach. The risk of CAD was highest in patients with DM treated with insulin (odds ratio estimate of the relative risk [OR = 3.0]), followed by patients with DM treated with oral agents (OR = 1.8) and lastly in those treated with diet alone (OR = 1.4). Severity of DM was a significant (p less than 0.05) independent predictor of CAD in a multivariate logistic regression model, whereas age at onset and duration of DM were not. The relative risk of CAD was the same (p greater than 0.05) for each of the 9 coronary segments. The data suggest that the risk of CAD increases with the severity of DM, which was a stronger predictor of CAD than duration of DM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association between type 2 diabetes mellitus and Helicobacter pylori infection.

Background/aims: It is well known that patients with diabetes mellitus are more prone to infection. In patients with diabetes mellitus, chronic infections are frequent and severe, due to the impairment of their immune status. The aim of this study was to determine the association between Helicobacter pylori infection and type 2 diabetes mellitus in the United Arab Emirates population. This is a case and control study comparison of type 2 diabetes mellitus and non-diabetic groups. The study was conducted at the primary health care clinics in United Arab Emirates during the period from June 2002 to August 2003. The study included 210 type 2 diabetes mellitus patients and 210 non-diabetic subjects. Methods: Helicobacter pylori was assessed by histopathological examination by measuring antibody profiles (IgG and IgA) among type 2 diabetes mellitus patients and the non-diabetic group. Results: The mean age of type 2 diabetes mellitus patients infected with Helicobacter pylori was 48.1 +/- 7.9 years compared to 46.7 +/- 5.4 years in the non-diabetic infected subjects. A positive antibody titer for Helicobacter pylori infection (IgA >/=300) was found in 76.7% of the diabetic subjects compared to 64.8% of the non-diabetic subjects (p<0.009). There was higher prevalence of Helicobacter pylori infection in diabetic obese patients than the non-diabetic subjects (23.6% vs 11.8%, p<0.001). Muscular (47.2%), gastrointestinal (29.8%), chronic bronchitis (22.4%), nausea (19.9%), anemia (18%), abdominal pain (12.4%), diarrhea (10.6%) and vomiting (7.5%) were more common in diabetic patients infected with Helicobacter pylori. Conclusions: The present study suggests that there is a significant association between Helicobacter pylori infection and type 2 diabetes mellitus. Helicobacter pylori infection was significantly higher in diabetic obese patients than non-diabetic subjects.     

Association between diabetes mellitus and post‐stroke cognitive impairment

Stroke survivors suffer from various physical, emotional, and cognitive impairments. These changes are dynamic and depend on multiple factors, including underlying diseases, baseline brain function and pathology, the site of the stroke and the post‐stroke inflammation, neurogenesis as well as the subsequent remodeling of the neuro‐network. First we review the structural and pathological changes of the brain in stroke survivors with diabetes mellitus, which may lead to post‐stroke cognitive dysfunction. Second, we provide evidence of hyperglycemia, diabetes mellitus, hypoglycemia, and their relationship with post‐stroke cognitive impairment (PSCI) and post‐stroke dementia (PSD). In addition to conventional biomarkers, such as HbA1c, we also provide other novel tools to predict PSCI/PSD, such as glycemic variability, receptor for advanced glycation end products, and gut microbiota. Finally, we attempt to provide some modifying methods for glycemic control, focusing on the prevention of PSCI/PSD.     

Sudden cardiac death and diabetes mellitus

Sudden cardiac death (SCD) affects a significant percentage of diabetic patients. SCD in these patients can be due to several factors, such as diastolic dysfunction, heart failure, altered platelet function, inflammation, sympathetic nervous stimulation and other factors. In the present review, we discuss the association between diabetes mellitus and SCD.     

2型糖尿病患者甲状腺激素与内脏脂肪面积的相关性分析

目的探究2型糖尿病患者甲状腺激素与腹部内脏脂肪面积(visceral fat area,VFA)的相关性。方法收集2018年3月至2019年7月在宁波市第一医院纳入标准化代谢性疾病管理中心(National Metabolic Management Center,MMC)的729例2型糖尿病患者,测定甲状腺激素及生化指标,并应用生物电阻抗法测定VFA和皮下脂肪面积(subcutaneous fat area,SFA)。采用Spearman相关性分析和多元线性回归进行分析。结果Spearman相关性分析显示,T3、FT3与VFA呈正相关(r=0.225、0.211,P<0.01),FT4与VFA负相关(r=-0.112,P<0.01),而T4、TSH与VFA无相关性(均P>0.05)。多元线性回归分析显示,FT4、FT3与VFA有独立的相关关系(P<0.01),每增加1 pmol/L FT4,VFA减少1.759 cm^2,每增加1 pmol/L FT3,VFA增加3.256 cm^2。结论2型糖尿病患者的FT3、FT4与VFA相关。