2型糖尿病合并高血压病患者的动态血压特点

目的了解2型糖尿病合并高血压病患者动态血压的特点.方法对2型糖尿病合并高血压病患者40例及单纯高血压病患者45例进行动态血压监测,并探讨合理的护理措施.结果两组患者比较,昼夜血压节律消失、夜间平均收缩压、白天收缩压负荷值、夜间收缩压负荷值糖尿病合并高血压病组高于单纯高血压病组,差异有显著性意义;24h平均收缩压及24h平均舒张压、白天平均舒张压、白天平均收缩压、白天舒张压负荷值、夜间舒张压负荷值两组间差异无显著性意义.结论糖尿病合并高血压病患者失去正常昼高夜低的血压波动规律,尤以收缩压负荷、夜间收缩压升高为明显.24h平稳降压是治疗2型糖尿病合并高血压病患者的有效治疗方法.     

2型糖尿病并发高血压病人健康教育需求的调查分析

[目的]探讨2型糖尿病并发高血压病人对健康教育内容和方式的需求,并分析其影响因素。[方法]对选取符合条件的2型糖尿病并发高血压病人52例进行健康教育内容、健康教育方式的需求的调查。[结果]不同年龄病人对于自我检查的方法及注意事项、集体上课需求差异有统计学意义(P<0.05);不同文化程度病人对于疾病心理变化知识、建立宣传栏和发放宣传册的需求差异有统计学意义(P<0.05)。[结论]不同年龄和文化程度病人对于健康教育的需求存在差异,工作中应该根据病人的不同需求实施相应的健康教育,以有效地提高健康教育效果。     

Clinical usefulness of doxazosin in patients with type 2 diabetes complicated by hypertension: effects on glucose and lipid metabolism

This uncontrolled study investigated the effects of using the alpha 1-blocker doxazosin (2 mg or 4 mg daily for 3 months) to treat 21 hypertensive patients with type 2 diabetes, including eight obese individuals (body mass index [BMI] > or = 25.0 kg/m2). A significant reduction in systolic and diastolic blood pressure, beginning after 1 month of treatment, was seen. There was no significant change in BMI. Although there was no obvious improvement in glucose metabolism, doxazosin treatment noticeably reduced insulin resistance and significantly lowered triglyceride and free fatty acid levels. No significant changes were found in total cholesterol, high- or low-density lipoprotein-cholesterol, atherosclerotic index, or small or large subfractions of low-density lipoprotein-cholesterol. None of the patients showed any adverse effects. The beneficial effects of doxazosin on blood pressure and lipid and glucose metabolism shown in this study suggest that this drug is clinically useful as an anti-hypertensive agent for patients with diabetes.     

Orthostatic hypertension in patients with type 2 diabetes

OBJECTIVE: The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy. RESEARCH DESIGN AND METHODS: The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from <90 to >or=90 mmHg and/or an increase in systolic blood pressure (SBP) from <140 to >or=140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms. RESULTS: The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P < 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 +/- 11.4 mmHg in SBP and 9.1 +/- 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (-1.0 +/- 9.0 and 3.8 +/- 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT. CONCLUSIONS: Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.     

Magnesium metabolism in hypertension and type 2 diabetes mellitus

The increasing evidence for the clinical relevance of altered magnesium metabolism to states of altered insulin resistance confirms the role of magnesium deficit as a possible underlying common mechanism of the "insulin resistance" of hypertension and altered glucose tolerance. The pioneer work of Lawrence M. Resnick and his group using the cellular ion-based approach that we are only partially presenting here has consistently contributed to the progress of the field, demonstrating (a) the critical importance of magnesium metabolism in regulating insulin sensitivity as well as vascular tone, and blood-pressure homeostasis; (b) that magnesium deficiency, defined on the basis of intracellular free magnesium levels, and or serum ionized magnesium is a common feature of both diabetic and hypertensive states as well as various other cardiovascular and metabolic processes and aging; (c) the ability of environmental factors such as dietary nutrient-sugar and mineral content to alter the set point of steady-state cell ion activity; and (d) that magnesium supplementation is indicated in conditions associated with magnesium deficit although well-designed therapeutic trials of magnesium in essential hypertension and type 2 diabetes mellitus are needed in the near future.     

劳-蒙-毕综合征伴2型糖尿病患儿的护理

总结1例劳-蒙-毕综合征(Laurence-Moon-Biedl syndrome)伴2型糖尿病患儿的护理.护理要点包括:密切监测血糖及使用胰岛素、加强饮食管理、合理运动、心理支持、安全护理、健康教育.该惠儿住院期间配合治疗,家长学会正确监测血糖、使用胰岛素、掌握疾病相关知识,住院9d后患儿血糖控制后平稳出院.     

Enalapril in low-renin essential hypertension

The antihypertensive efficacy of N-[(S)-1-(ethoxycarbonyl)-3-phenyl-propyl]-L-alanyl-L-proline (enalapril maleate) was evaluated in a randomized, double-blind trial in 23 patients with mild low-renin essential hypertension ranging in age from 32 to 70 yr (20 were black and 3 were white). All underwent a 4-wk washout-placebo phase and were then assigned to a dosing schedule of either 10 mg enalapril once daily, 5 mg enalapril twice daily, or placebo twice daily for 12 wk. Conditional on diastolic pressure, the dose was increased at 4-wk intervals to a maximum of 40 mg daily or until control was achieved or the end of the study reached. At the end of the 12-wk titration phase, there was a follow-up period during which measurements were made after discontinuation of the medication. Mean supine diastolic pressure decreased from baseline (98.5 +/- 2.6 mm Hg) during the titration phase (86.3 +/- 4.6 mm Hg) in the group taking enalapril once daily. In three of the eight patients in the once-daily group and five of eight in the twice-daily group, supine diastolic pressures fell below 90 mm Hg. Neither supine nor standing systolic pressure nor standing diastolic pressure decreased significantly from pretreatment levels during enalapril once or twice daily. Heart rates measured after 5 min supine rest were not altered by enalapril. Enalapril induced inhibition of converting enzyme activity at all dose levels and with both dosing schedules. No adverse effect attributable to enalapril occurred during the study. The data indicate that once-daily enalapril is safe and effective treatment for mild low-renin essential hypertension.     

血清超敏C反应蛋白、脂蛋白相关性磷脂酶A2与老年原发性高血压合并2型糖尿病的相关性

目的探讨血清超敏C反应蛋白(hs-CRP)、脂蛋白相关性磷脂酶A2(Lp-PLA2)与老年原发性高血压(EH)合并2型糖尿病(T2DM)的相关性。方法选取EH且年龄≥60岁患者128例为研究对象,根据是否合并T2DM分为单纯EH组(n=60)和EH+DM组(n=68),选择同期单纯T2DM患者为单纯DM组(n=63)及健康体检者为对照组(n=61),分析EH合并T2DM患者在不同高血压亚组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、hs-CRP、Lp-PLA2的差异;分析hs-CRP、Lp-PLA2不同亚组中FPG、HbA1c、收缩压(SBP)、舒张压(DBP)的差异,分析hs-CRP、Lp-PLA2与HbA1c、SBP、DBP的相关性。结果EH+DM组、EH组、DM组低密度脂蛋白胆固醇(LDL-C)、hs-CRP、Lp-PLA2均高于对照组,而高密度脂蛋白胆固醇(HDL-C)低于对照组(均P<0.05),EH+DM患者随高血压级别的升高,FPG、HbA1c、hs-CRP、Lp-PLA2均升高(均P<0.05);随hs-CRP水平的升高,FPG、HbA1c、SBP均升高(均P<0.05);随Lp-PLA2水平升高,SBP、DBP均升高(均P<0.05);hs-CRP与HbA1c、SBP、DBP呈正相关;Lp-PLA2与HbA1c、SBP、DBP呈正相关;同时HbA1c与SBP、DBP呈正相关,在校正了年龄、性别、吸烟史、体质量指数(BMI)、三酰甘油(TG)后,hs-CRP、Lp-PLA2水平升高是EH合并T2DM的危险因素(均P<0.05)。结论hs-CRP、Lp-PLA2水平高低在一定程度上可预测EH合并T2DM的严重程度,且hs-CRP、Lp-PLA2是EH合并T2DM的危险因素,可以反应患者血压、血糖控制情况及高血压分级情况。     

Managing stress response to control hypertension in type 2 diabetes

The purpose of this article is to help clinicians understand how biological, psychological, and sociological stress responses synergistically influence blood pressure in individuals with type 2 diabetes mellitus.     

Treatment of hypertension in type 2 diabetes mellitus--2002 update

Arterial hypertension and diabetes are potent independent risk factors for cardiovascular, cerebral, renal and peripheral (atherosclerotic) vascular disease. The prevalence of hypertension in diabetic individuals is approximately twice that in the non-diabetic population. Diabetic individuals with hypertension have a greater risk of macrovascular and microvascular disease than normotensive diabetic individuals. Hypertension is a major contributor to morbidity and mortality in diabetes, and should be recognized and treated early. Type 2 diabetes and hypertension share certain risk factors such as overweight, visceral obesity, and possibly insulin resistance. Life-style modifications (weight reduction, exercise, limitation of daily alcohol intake, stop smoking) are the foundation of hypertension and diabetes management as the definitive treatment or adjunctive to pharmacological therapy. Additional pharmacological therapy should be initiated when life-style modifications are unsuccessful or hypertension is too severe at the time of diagnosis. All classes of antihypertensive drugs are effective in controlling blood pressure in diabetic patients. For single-agent therapy, ACE-inhibitors, angiotensin receptor blocker, beta-blockers, and diuretics can be recommended. Because of concerns about the lower effectiveness of calcium channel blockers in decreasing coronary events and heart failure and in reducing progression of renal disease in diabetes, it is recommended to use these agents as second-line drugs for patients who cannot tolerate the other preferred classes or who require additional agents to achieve the target blood pressure. The choice depends on the patients specific treatment indications since each of these drugs have potential advantages and disadvantages. In patients with microalbuminuria or clinical nephropathy, both ACE-inhibitors and angiotensin receptor blockers are considered first line therapy for the prevention of and progression of nephropathy. Since treatment is usually life-long, cost effectiveness should be included in treatment evaluation.     

2型糖尿病并发低镁血症的因素分析

目的：探讨2型糖尿病（DM）并发低镁血症的发生率及影响因素。方法：对152例2型DM其中并发低镁血症的36例病人进行多因素线性回归分析。结果：2型DM患低镁血症的发生率为23．7％,血清镁浓度与空腹血糖、糖化血红蛋白（HbA1c）以及DM微血管并发症积分呈显负相关（P＜0．05）。结论：2型DM患有较高的低镁血症发生率,FPG、HbA1c以及微血管并发症是影响病人低镁血症发生的主要因素。     

2型糖尿病合并高尿酸血症的护理

随着人们生活水平的提高和饮食结构的改变,2型糖尿病患病率逐年增加。2008年调查显示,我国糖尿病患病率已达9．7％。糖尿病病人易合并肥胖、高血压、高血脂、高尿酸等多种代谢异常。     

2型糖尿病合并戊型肝炎患者的临床特征分析

目的：探讨2型糖尿病合并戊型肝炎患者的临床特征。方法：回顾性分析119例2型糖尿病合并戊型肝炎患者的性别、年龄等临床特征,另设无肝炎的2型糖尿病组（单纯糖尿病组）及单纯戊型肝炎组患者作为对照,比较3组的实验室检查结果。结果：2型糖尿病合并戊型肝炎组中,50~69岁年龄段的患病人数较多（占65%）。2型糖尿病合并戊型肝炎组患者的糖化血红蛋白（hemoglobinA1c, HbA1C）水平低于单纯糖尿病组患者[（8.0±1.8）%比（8.4±2.0）%]（P<0.01）,但2组间比较空腹血糖及餐后血糖差异无统计学意义（P>0.05）;2型糖尿病合并戊型肝炎组的总胆红素及天冬氨酸转氨酶明显低于单纯戊型肝炎组（P<0.05）;单纯糖尿病组、单纯戊型肝炎组、2型糖尿病合并戊型肝炎组这3组间比较的肾功能、血脂指标差异均无统计学意义（P>0.05）。结论：2型糖尿病合并戊型肝炎患者的HbA1c低于单纯糖尿病患者,其余血糖指标没有差异;与单纯戊型肝炎组患者相比,2型糖尿病合并戊型肝炎组患者的肝功能并没有出现进一步的减退。     

Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community.

OBJECTIVE: To describe the use of insulin pump therapy in women with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite multiple injections of subcutaneous insulin. RESEARCH DESIGN AND METHODS: As part of a service audit, deliveries to women with diabetes at a single South Auckland hospital were reviewed from 1991 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-control study, pregnancies complicated by GDM/type 2 diabetes with use of an insulin pump were compared with those without insulin pump therapy and peak insulin requirements of 100-199 units/ day, matched for ethnicity and type of diabetes. RESULTS: A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An additional two women with high insulin requirements discontinued pump therapy. None of the women with GDM/type 2 diabetes experienced severe hypoglycemia, whereas 79% of the women had improved glycemic control within 1-4 weeks. Mothers using a pump had greater insulin requirements (median maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienced greater hypoglycemia than control subjects. CONCLUSIONS: Insulin pump therapy seems to be safe and effective for maintaining glycemic control in pregnancies complicated by GDM/type 2 diabetes and requiring large doses of insulin.     

有氧运动疗法对高血压伴有糖尿病患者的疗效

目的探讨有氧运动疗法对高血压并发糖尿病患者的疗效。方法按“3,5,7"方案对43例高血压伴有糖尿病的患者进行心率控制下的慢跑运动,观察运动前后血压、血糖、血脂及临床症状的变化。结果2个疗程后,病人血压、血糖、血脂等有不同程度下降(P<0.01),临床症状消失或减轻(P<0.05);随访6个疗程后发现,坚持运动可以保持运动效果。结论慢跑作为一种中等强度的有氧运动可控制高血压伴有糖尿病者的病情,长期规律运动效果更佳。<P>     

Low paraoxonase activity in type II diabetes mellitus complicated by retinopathy

Human serum paraoxonase 1 (PON1) is located on high-density lipoprotein and has been implicated in the detoxification of organophosphates, and possibly in the prevention of lipid peroxidation of low-density lipoprotein. PON1 has two genetic polymorphisms, both due to amino acid substitutions: one involving glutamine (Q genotype) and arginine (R genotype) at position 192, and the other involving leucine (L genotype) and methionine (M genotype) at position 55. We investigated the effects of these polymorphisms, and of a polymorphism of the PON2 gene at position 310 (Cys/Ser; C and S genotypes respectively), on serum PON1 activity and concentration, plasma lipids and lipoproteins and glycaemic control in 93 individuals with type II diabetes with no complications and in 101 individuals with type II diabetes with retinopathy. Serum PON1 activity in the group with no complications [median 164.1 nmol.min(-1).ml(-1) (range 8.0-467.8)] was significantly higher than in the group with retinopathy [113.4 nmol. min(-1).ml(-1) (3.0-414.6)] (P<0.001), but the serum PON1 concentration was not different between the groups. The gene frequencies of the PON1-55 and PON1-192 polymorphisms and of the PON2-310 polymorphism were not different between the study populations. The PON1-55 and PON1-192 polymorphisms affected PON1 activity in the way described in a previous study of a control group and subjects with type II diabetes. The PON2-310 polymorphism also significantly affected serum PON1. PON1 activity was significantly higher in individuals with the PON2-310 CC genotype in both groups with type II diabetes, and the PON1 concentration was significantly higher in PON2-310 CC homozygotes with no complications than in the group with retinopathy. Neither the PON1-55 nor the PON1-192 polymorphism was correlated with the serum lipid or lipoprotein concentration in either group. In the group with retinopathy (but not the group with no complications), all three PON polymorphisms were correlated with glycaemic control, which was worse for the PON1-55 genotypes in the order MM>LM>LL (P=0.0032), for the PON1-192 genotypes in the order RR>QR>QQ (P=0.011) and for the PON2-310 genotypes in the order CC>CS>SS (P=0.010). Low serum PON1 activity in retinopathy may be related to an increased tendency for lipid peroxidation. Our findings thus raise the possibility that, in retinopathy, the PON2 gene may influence PON1, and that an inter-relationship between the PON1 and PON2 genes may influence glycaemic control in subjects with type II diabetes complicated by retinopathy.     

Significant increase in natural-killer T cells in patients with tuberculosis complicated by type 2 diabetes mellitus

This study examined the frequency of Vα24(+)/Vβ11(+) natural-killer T (NKT) cells from peripheral blood and bronchoalveolar lavage fluid in pulmonary tuberculosis (TB) patients with or without diabetes mellitus (DM). The clinical grade of TB was significantly higher among diabetic patients. NKT cells from both peripheral blood and bronchoalveolar lavage were significantly increased in diabetic TB patients compared with non-diabetic TB patients. This may be due to the generally higher bacillary burden in diabetic TB patients. NKT cells from peripheral blood mononuclear cells in TB patients with or without DM were significantly increased, compared with levels in non-TB diabetic patients and healthy controls. The measurement of NKT cells from peripheral blood has the potential to be a reliable, non-invasive, practical diagnostic marker for active TB.