2型糖尿病患者发生糖尿病肾病的相关因素分析

目的探讨2型糖尿病患者糖尿病肾病发生的相关因素。方法采取回顾性分析方法选取2008年1月1日至2012年12月31日间门诊的868例2型糖尿病患者,按尿微量白蛋白(MAU)水平分成两组:无糖尿病肾病组和糖尿病肾病组,对两组患者的临床数据进行比较。结果①868例2型糖尿病患者中糖尿病肾病250例,占28.8%。②两组间年龄、病程、体重指数(BMI)、收缩压、舒张压、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、空腹胰岛素、胰岛素抵抗指数,胆固醇(TC)、甘油三酯(TG)、尿酸(UA)差异具有统计学意义。③Logistic回归分析结果提示:糖尿病肾病与BMI、收缩压、空腹血糖、HbA1c、TG、UA相关。结论 2型糖尿病患者应综合控制体重、血压、血糖、血脂、UA,改善代谢紊乱情况,利于糖尿病肾病的防治。     

血清血管生成素1与血管生成素2比值对2型糖尿病微血管病变的诊断价值

目的 探讨血清血管生成素1(Ang-1)与血管生成素2(Ang-2)比值对2型糖尿病(T2DM)微血管病变的诊断价值。方法 选取2018年1-12月期间在山西医科大学附属第二医院(下称本院)接受治疗的T2DM患者98例,根据是否合并微血管病变将98例患者分为微血管病变组(42例)和单纯T2DM组(56例),另选取同期在本院体检的健康人群50例作为对照组。检测各组研究对象的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、Ang-1、Ang-2、Ang-1/Ang-2。结果 微血管病变组的体质量指数、FPG、HbA1c、HOMA-IR、Ang-2均高于单纯T2DM组和对照组,Ang-1/Ang-2低于单纯T2DM组和对照组,差异有统计学意义(P<0.05),微血管病变组的病程长于单纯T2DM组,FINS高于对照组,差异有统计学意义(P<0.05),单纯T2DM组的体质量指数、FPG、FINS、HbA1c、HOMA-IR、Ang-2均高于对照组,Ang-1/Ang-2低于对照组,差异有统计学意义(P<0.05),Ang-2与病程、HbA1c呈正相关(r分别为0.421、0.391,P<0.05),Ang-1/Ang-2与病程、HbA1c呈负相关(r分别为-0.548、-0.423,P<0.05),Ang-1、Ang-2、Ang-1/Ang-2曲线下的面积分别为0.625、0.737、0.902,约登指数分别为0.134、0.549、0.744。结论 血清Ang-2在T2DM微血管病变患者中呈高表达,而Ang-1/Ang-2则明显降低,且Ang-1/Ang-2对T2DM患者微血管病变有较高的诊断价值。     

Enhanced leukocyte–platelet cross-talk in Type 1 diabetes mellitus: relationship to microangiopathy

Summary. Background: Platelets and leukocytes may influence each others' function, i.e. platelet–leukocyte cross‐talk. Diabetes mellitus (DM) is associated with platelet and leukocyte dysfunction. Objective: To evaluate platelet–leukocyte cross‐talk, and if this might contribute to platelet and leukocyte dysfunction and microangiopathy in DM patients. Patients and methods: We evaluated platelet and leukocyte function, and cross‐talk between these cells in Type 1 DM patients without (n = 19) and with (n = 20) microangiopathy, and healthy subjects (n = 27), using whole blood flow cytometry. Platelet–leukocyte cross‐talk was studied in hirudinized whole blood incubated at 37 °C with stirring. Results: Basal single platelet P‐selectin and leukocyte CD11b expression were similar in DM patients and healthy subjects, whilst circulating platelet–leukocyte aggregates and plasma elastase levels were elevated in DM patients. The thromboxane A₂ analog U46619 (3 × 10^?7 m ) induced more marked increases of platelet P‐selectin expression and platelet–leukocyte aggregation in DM patients than in healthy subjects. The leukocyte‐specific agonist N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP) (10^?7 m ) induced more marked CD11b expression in DM patients with microangiopathy, compared with healthy subjects. Platelet–leukocyte cross‐talk induced by U46619 (10^?6 m ) showed no difference between DM patients and healthy subjects. fMLP (10^?6 m ) evoked marked leukocyte activation, which subsequently caused mild platelet P‐selectin expression. This leukocyte–platelet cross‐talk was more pronounced in DM patients than in healthy subjects. Furthermore, enhanced leukocyte–platelet cross‐talk was correlated to platelet hyperreactivity among DM patients with microangiopathy only. Conclusions: Type 1 DM is associated with platelet and leukocyte hyperactivity, and enhanced leukocyte–platelet cross‐talk, which may contribute to platelet hyperactivity and the microvascular complications seen in Type 1 DM.     

青少年1型糖尿病患者抑郁状况及影响因素调查

目的调查青少年1型糖尿病患者抑郁状况并探讨其影响因素,为制订治疗方案提供科学依据。方法采用抑郁自评量表和影响因素调查表对106例青少年1型糖尿病患者进行调查,分析影响青少年1型糖尿病患者抑郁状况的因素。结果青少年1型糖尿病患者抑郁阳性检出率为40．57％,患者起病年龄、出现酮症次数是患者抑郁发生的危险因素,文化程度、糖化血红蛋白是患者抑郁发生的保护因素。结论针对研究得出的因素,可定期对青少年1型糖尿病患者进行集中健康教育、开展咨询工作、举办集体活动、建立患者信息管理系统,增加与患者沟通,从而改善其心理状况。     

2型糖尿病并发眼底病的危险因素分析

目的探讨2型糖尿病（T2DM ）眼底病变并发症的危险因素,同时探讨可能的机制。方法将195例T2DM患者按照是否出现眼底病变分为2组,分别比较其一般资料,包括年龄、性别、血压、糖尿病病程、身高体质量指数（BMI）等;生化指标,包括三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血糖（GLU）、C-肽、胰岛素（INS）、尿素（Urea）、肌酐（Cr）、尿微量清蛋白（mALB）、糖化血红蛋白（HbA1c）等;对其进行单因素χ2检验与Logistic逐步回归分析,寻找与 T2DM 眼底病变可能相关的危险因素。结果 T2DM眼底病变的发生与患者年龄、糖尿病发生的病程、TG、TC、LDC-C、HbA1c、Cr、mALB等生化指标的水平有一定关联（P＜0．05）;Logistic逐步回归分析显示均有统计学意义（P＜0．05）,为 T2DM 并发眼底病的重要危险因素。结论患者年龄、糖尿病发生的病程、LDL-C、TC、TG、HbA1c、Cr、mALB等指标,都可能是T2DM 易发眼底病变的主要危险因素,应持续监测。     

2型糖尿病并微血管病变患者血清肿瘤坏死因子α的测定及临床意义

目的:探讨肿瘤坏死因子α在2型糖尿病并微血管病变患者中的变化及临床意义。方法:采用放射免疫法测定76例2型糖尿病患者(包括有微血管病变者42例,无微血管病变者34例)及34例健康体检者(对照组)肿瘤坏死因子α的表达水平。结果:2型糖尿病患者肿瘤坏死因子α水平较对照组有明显增高(P<0.01),糖尿病有微血管病变组较无微血管病变组其表达亦有明显增高(P<0.01)。结论:2型糖尿病患者尤其合并微血管病变者肿瘤坏死因子α表达水平明显增高,糖尿病患者体内高水平的血清肿瘤坏死因子α可能参与糖尿病微血管并发症的发生和发展。     

Identification of independent risk factors for diabetic neuropathy progression in patients with type 2 diabetes mellitus

ObjectiveTo identify independent risk factors for diabetic neuropathy (DN) in patients with type 2 diabetes mellitus (T2DM).MethodsWe retrospectively analyzed 376 patients with T2DM at the First Affiliated Hospital of Fujian Medical University, China between January 2013 and October 2016. Multivariate logistic regression was used to explore potential risk factors for progression of DN in patients with T2DM. Effect sizes were estimated using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of DN in patients with T2DM was 43.1%. Multivariate logistic regression indicated that retinopathy (OR: 2.755, 95% CI: 1.599–4.746); diabetic nephropathy (OR: 2.196, 95% CI: 1.279–3.772); longer duration of T2DM (OR: 1.081, 95% CI: 1.045–1.120); use of insulin (OR: 1.091, 95% CI: 1.018–1.170); longer history of alcohol consumption (OR: 1.034, 95% CI: 1.010–1.059); and higher blood urea nitrogen (OR: 1.081, 95% CI: 1.009–1.159) were associated with increased risk of DN in patients with T2DM.ConclusionsRetinopathy, diabetic nephropathy, longer duration of T2DM, use of insulin, longer history of alcohol consumption, and higher blood urea nitrogen were independent risk factors for DN. These findings should be verified in large-scale prospective studies.     

Fulminant type 1 diabetes mellitus with remarkable elevation of serum pancreatic enzymes

Fulminant type 1 diabetes mellitus progresses extremely rapidly and is accompanied by ketoacidosis. Patients with the disease present at emergency departments with non-specific symptoms, including fever, nausea, vomiting, and abdominal pain. Here, we present a case of fulminant type 1 diabetes mellitus where the patient was initially misdiagnosed with gastroenteritis and acute pancreatitis. A 50-year-old Japanese woman was referred to our hospital with coma and shock. She had presented with nausea, vomiting, abdominal pain and thirst from 5?days before admission, and had been misdiagnosed with gastroenteritis by her primary care physician. Upon examination, metabolic acidosis and remarkable elevation of pancreatic exocrine enzymes were found (amylase 4322?IU/L, lipase 1046?IU/L). Acute pancreatitis was initially suspected because of the high pancreatic enzyme levels and abdominal pain. However, her plasma glucose level was markedly elevated at 1357?mg/dL. The patient was diagnosed with fulminant type 1 diabetes mellitus. Computed tomography showed no radiological evidence of acute pancreatitis. In conclusion, fulminant type 1 diabetes mellitus is often referred to hospital with flu-like or gastrointestinal symptoms and elevation of serum pancreatic enzymes. Physicians must be sure not to misdiagnose it as gastroenteritis or acute pancreatitis.     

Prevalence,characteristics and risk factors of diabetic retinopathy in type 2 diabetes mellitus patients in Jordan: a cross-sectional study

ObjectivesTo measure the prevalence of diabetic retinopathy in patients with type 2 diabetes, to define their characteristics, and identify the associated risk factors.MethodsWe performed a cross sectional study of 1316 adult patients with type 2 diabetes mellitus who attended an ophthalmology clinic. Demographic, clinical, and laboratory data were analyzed. Diabetic retinopathy (DR) was diagnosed using a complete ophthalmic evaluation, including a fundic examination. Two regression models were constructed to identify the risk factors associated with DR and the parameters associated with the stage of retinopathy.ResultsMen accounted for 774 (58.8%) of the participants. The prevalence of DR was 28.2% (371 participants). DR was significantly more common in participants who were ≥60 years old, were women, had had diabetes for >10 years, were taking insulin, were not taking metformin, had a body mass index >30 kg/m², were current smokers, or had a history of hypertension. Advanced stages of DR were more common in participants in the later stages of nephropathy and with albuminuria.ConclusionsPoor glycemic control, smoking, and advanced diabetic kidney disease are most closely associated with retinopathy. Further longitudinal studies are necessary to identify the mechanisms underlying these relationships and to guide community-based interventions.     

早期糖尿病肾病合并颈动脉粥样硬化危险因素分析

目的观察早期糖尿病肾病（EDN）动脉粥样硬化（As）情况,并分析相关因素。方法选择EDN患者58例为观察组,对照组为58例单纯2型糖尿病（T2DM）患者,观察两组AS情况。同时将EDN分为非AS组、合并AS组．两组患者禁食】2h后抽血送检糖化血红蛋白（HbAlc）、空腹血糖（FBG）、三酰甘油（TG）、胆固醇（Tc）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）水平,并测定血压、身高、体质量和计算体质量指数（BMI）。结果EDN组颈动脉厚度,颈动脉硬化例数及颈动脉硬化率明显高于对照组,差异有统计学意义（P〈0．05）;EDN合并As组在病程、BMI、HbAlC、FBG、TG、LDL-C、收缩压水平与EDN非As组相比,差异有统计学意义（P〈0．05）。结论EDN较单纯T2I）M更容易发生AS,EDN合并AS的危险因素可能为HbAlc、FBG、血压、TG、LDL—C、BMI。     

成人1型糖尿病患者抑郁发生现状与相关因素分析

目的 分析成人1型糖尿病（T1DM）患者抑郁现状及发病相关因素。方法 采用Zung氏抑郁自评量表评估291例T1DM患者的抑郁情况,收集其临床资料,用logistic回归分析抑郁发生的影响因素。结果 291例T1DM患者中抑郁发生率为48.1%。抑郁者合并糖尿病肾病百分率、焦虑自评量表（SAS）评分、尿白蛋白肌酐比值及血尿素氮水平均高于无抑郁者（P均 < 0.05）。logistic回归显示视网膜光凝治疗、 SAS评分及血尿素氮是T1DM患者抑郁的危险因素（OR分别为16.243、1.205及1.389,P均 < 0.05）。结论 抑郁在成人T1DM患者中发生率较高,与焦虑及糖尿病慢性并发症可能相关。     

1—型糖尿病患者血清铁蛋白测定的临床意义

采用化学免疫发光法,检测５０例１－型糖尿病患者及５５例正常对照的血清铁蛋白。结果表明,１－型糖尿病患者血清铁蛋白水平显著高于正常对照组（Ｐ〈０．０１）;１－型糖尿病患者组中血糖控制良好的（ＨｂＡ１Ｃ〈７％）因糖控制不良的（ＨｂＡ１Ｃ〉７％）两者之间铁蛋白水平也有显著差别（Ｐ〈０．０１）。其铁蛋白水平与ＨＢＡ１Ｃ水平有一定相关（Ｐ〈０．０５）。铁蛋白水平随血糖的短期波动而波动。     

Hypoglycemia secondary to insulinoma masking the onset of type 1 diabetes in an adolescent

Type 1 diabetes and insulinoma can co‐occur in pediatric patients and may present with episodes of hypo‐ and hyperglycemia, significant glycemic variability, and weight gain. Surgical resection leads to development of fulminant diabetes.     

GLP-1 gene delivery for the treatment of type 2 diabetes

Glucagon-like peptide-1 (GLP-1) is a potent insulinotrophic hormone, which makes GLP-1 an attractive candidate for the treatment of type 2 diabetes. However, the short plasma half-life of the active forms of GLP-1 poses an obstacle to the sustained delivery of this peptide. In this study, we evaluated the effect of GLP-1 gene delivery both in vitro and in vivo using a new plasmid constructed with a modified GLP-1 (7-37) cDNA. This cDNA contains a furin cleavage site between the start codon and the GLP-1 coding region. The expression of the GLP-1 gene was driven by a chicken β-actin promoter (pβGLP1). The level of the GLP-1 mRNA was evaluated by RT-PCR 24 h after transfection. The in vitro results showed a dose-dependent expression of GLP-1. Coculture assay of the GLP-1 plasmid-transfected cells with isolated rat islet cells demonstrated that GLP-1 increased insulin secretion by twofold, compared to controls during a hyperglycemic challenge. A single injection of polyethyleneimine/pβGLP1 complex into ZDF rats resulted in increasing insulin secretion and decreasing blood glucose level that was maintained for 2 weeks. This GLP-1 gene delivery system may provide an effective and safe treatment modality for type 2 diabetes.     

新诊断2型糖尿病伴高尿酸血症的相关因素分析

目的 探讨新诊断2型糖尿病(T2DM)患者伴高尿酸血症(HUA)的相关因素.方法 选取新诊断T2DM患者158例,根据血尿酸(SUA)水平(男性SUA≥420 μmol/L,女性SUA≥360μmol/L),将其分为正常尿酸(NUA)组126例,HUA组32例.比较两组临床指标的差异.结果 新诊断2型糖尿病患者HUA患病率为20.3％,其中男性26.3％,女性11.1％;HUA组患者舒张压(DBP)、体质量指数(BMI)、腰围(WC)、甘油三酯(TG)、血肌酐(SCr)、血尿素氮(BUN)、24小时尿微量白蛋白(UAER)均高于NUA组(P＜0.05),而高密度脂蛋白胆固醇(HDL-C)低于NUA组(P＜0.05),两组患者糖尿病病程、空腹血糖(FPG)、餐后2小时血糖(2 hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)差异无统计学意义(P＞0.05).直线相关分析显示,TG、HDL-C、BMI、WC、DBP、SCr及UAER是高尿酸血症的影响因素(P＜0.01).结论 新诊断T2DM患者高尿酸血症与高血压、血脂异常、肥胖和肾脏病变相关.     

1型糖尿病患者血浆外泌体蛋白质组学分析

目的探讨1型糖尿病(T1DM)患者与健康者血浆外泌体中蛋白质组学的差异。方法收集T1DM患者与健康者血浆各6例,用试剂盒分离外泌体,提取蛋白,TMT标记后,采用高效液相色谱-质谱联用鉴定T1DM患者与健康者血浆外泌体中蛋白表达的差异,并进行生物信息学分析。结果共检测到可定量蛋白质948个,并确定其中37个在T1DM患者血浆外泌体中表达上调,122个表达下调。差异表达的蛋白质涉及多个生物进程,集中于凝血与补体级联反应、胆固醇代谢及沙门氏菌感染等信号通路。结论鉴定出159个在T1DM患者血浆外泌体表达具有差异的蛋白质,为进一步阐明T1DM发病机制及治疗靶点筛选提供了新的候选分子。     

Gestational diabetes mellitus is associated with increased C-reactive protein concentrations in the third but not second trimester

OBJECTIVE: Serum C-reactive protein (CRP) concentrations were measured longitudinally throughout pregnancy to test the hypothesis that CRP could relate more closely to glucose tolerance than to adiposity. METHODS: The CRP concentrations in pregnant women with normal glucose tolerance (NGT) and those with gestational diabetes mellitus (GDM) were measured at the same time as the oral glucose tolerance test (OGTT), at the 24th and 28th weeks of gestation and between the 37th and 38th weeks of gestation. RESULTS: At the end of the third trimester, women with GDM had significantly higher CRP levels than women with NGT [median (interquartile range), 9.7 mg L(-1) (5.4-16.0) and 5.7 mg L(-1) (5.1-7.2); P < 0.001, respectively], but at the time of the diagnostic OGTT no significant difference between the two groups was observed. This was owing to a significant increase of CRP in women with GDM between the time of the OGTT and the 37th-38th gestational weeks [median (interquartile range), 1.9 mg L(-1) (-2.2, 6.7); P = 0.01]; whereas, no change in CRP was found in women with NGT [median (interquartile range), -0.1 mg L(-1) (-2.4, 3.1); P = 0.76]. Multiple linear regression analysis showed only a significant independent influence of GDM (P < 0.001) on maternal CRP concentrations in the 37th-38th gestational weeks and a significant influence of body mass index (P < 0.007), but no influence of GDM at the time of the OGTT. CONCLUSION: These data suggest that in women with gestational diabetes the CRP concentration is primarily related to the degree of adiposity until the second trimester and that thereafter impaired glucose metabolism appears to be the predominant predictor of changes in CRP.     

HbA1c对糖调节受损和2型糖尿病的诊断价值

摘要：目的：评估糖化血红蛋白（HbA1c）不同cut off值诊断2型糖尿病（T2DM）的效能,初步探讨美国糖尿病协会（ADA）推荐的HbA1c诊断T2DM及T2DM前期标准对中国人的适用性。 方法：招募接受口服葡萄糖耐量（OGTT）试验且试验前未诊治为T2DM的志愿者338例,用高效液相色谱法检测HbA1c;以WHO标准诊断糖调节受损（IGR）、糖耐量正常和T2DM;用受试者工作特征（ROC）曲线分析不同 cut off值HbA1c诊断IGR和T2DM的效能。 结果：HbA1c在诊断T2DM时,ROC曲线下面积（AUC^ROC）为0.954,最佳cut off值为6.0%,敏感性为92.5%,特异性为86.0%;当HbA1c为6.5%时,敏感性为64.8%,特异性为96.7%;当HbA1c为5.6%时,诊断T2DM阴性预测值为100.0%;HbA1c诊断IGR的AUC^ROC为0.653。 结论: HbA1c用于IGR的诊断效能不高;HbA1c诊断T2DM最佳cut off值为6.0%,此界值诊断敏感性较FPG高,但特异性较差;ADA推荐用于T2DM诊断的cut off值6.5%主要考虑到诊断的特异性,该诊断标准适用于中国人群。     

Liraglutide for type 2 diabetes mellitus

Introduction: Prevalence of type 2 diabetes mellitus (T2DM) is increasing. Management of this condition and minimizing the cardiovascular risks associated with it poses a significant burden on healthcare resources across the world. Currently available therapeutic agents are effective in glycemic management; however, the majority of these are associated with undesirable effects such as hypoglycemia and weight gain. Incretin-based therapies have been introduced over the last few years and are associated with less risk of hypoglycemia and weight gain.

Areas covered: This review includes current challenges in the management of T2DM, and an overview of glucagon-like peptide-1 (GLP-1)-based therapies, in particular the results of Phase III clinical studies of recently approved liraglutide. Apart from glycemic control, multifactorial interventions are needed to minimize the cardiovascular risks associated with T2DM. Liraglutide is effective in improving glycemic control measured by HbA1c and it is also shown to improve weight. Recently, the National Institute of Health and Clinical Excellence in the UK has approved liraglutide 1.2 mg dose in dual and triple therapy for T2DM.

Expert opinion: Liraglutide, a once-daily GLP-1 analog, has a definite role in selected patients with T2DM and the long-term cardiovascular safety is currently being ascertained in ongoing trials.