强化血糖控制与2型糖尿病患者血管并发症——ACCORD研究降糖结果解读

2型糖尿病可使一系列健康问题的危险性增加,包括心脑血管疾病、过早死亡、失明、肾衰竭、截肢、骨折、抑郁和认知功能减退等。在前瞻性流行病学研究中,通过检测血糖或糖化血红蛋白(HbA1c)水平,发现上述很多状况的转归与高血糖程度直接相关。校正其他危险因素后,HbA1c水平每增加     

2型糖尿病慢性血管病变患者2项测定及意义

目的探讨2型糖尿病患者糖化血红蛋白(HbA1c)、糖化血清蛋白(GSP)等生化指标与慢性血管并发症的关系。方法选择健康人(C组)90例、2型糖尿病无并发症患者(B组)52例、2型糖尿病有血管并发症患者(A组)68例,分别检测3组患者血清中HbA1c、GSP、血糖、三酰甘油、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平。结果 A组与其他两组比较,HbA1c与GSP显著增高,差异有统计学意义(P<0.05)。结论高水平HbA1c、GSP提示长期糖代谢紊乱在血管病变发病过程中起重要作用,临床监测HbA1c、GSP、血糖、血脂等相关指标对2型糖尿病并发慢性血管病变的诊断、治疗具有一定的参考价值。     

强化降糖不能减少糖尿病大血管并发症——ADVANCE试验解读

糖尿病是心血管疾病的主要危险因素之一。大量研究显示,随着糖化血红蛋白(HbA1c)水平的逐渐升高,糖尿病患者发生微血管事件与大血管事件的危险性亦随之增加。基于上述发现,国内外学者曾一度坚信,积极控制血糖并使其接近甚至达到健康人水平将有助于最大程度地减少糖尿病患者心血     

2型糖尿病降糖药物治疗进展

2型糖尿病(T2DM)是一种慢性疾病,是全球重要的公共卫生问题,也是患者致残、致死的主要原因。T2DM具有多重发病机制,因此糖尿病治疗应尽可能针对多种病因进行治疗,尽量逆转已知的病变,同时尽早预防和治疗糖尿病相关并发症。近些年,很多新型降糖药物不断涌现,与传统的降糖药物相比,前者更多兼顾了药物的简便性、安全性、有效性以及多靶点作用机制,同时也兼顾了心肾保护等作用,考虑了糖尿病并发症的获益因素。有些新型降糖药如胰高血糖素样肽1受体激动剂(GLP-1RA)和钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)的治疗地位在多项指南中也得到了重要提升。本文系统地回顾了现有的降糖药物,并对目前的新型降糖药物作了详细的介绍。     

强化降糖与心血管获益——ACCORD试验解读

大量流行病学研究表明,糖尿病是心血管疾病的重要危险因素,高血糖可以显著增加心血管事件的危险性。基于这一背景,许多学者一直坚信,强化控制血糖并使其接近或达到健康人的血糖水平,将有助于降低糖尿病患者的心血管系统危险性。然而强化血糖控制的基本理念是建立在逆向推理基础     

2型糖尿病患者牙周炎治疗对其血糖血脂水平的影响

目的探讨牙周炎治疗对2型糖尿病患者血糖和脂质水平的影响。方法随机选择2型糖尿病伴牙周炎患者．根据患者的病情和要求分为牙周治疗组和不做牙周治疗的对照组挥30例：治疗组给予牙周治疗,记求治疗前和治疗后4、12、24周时的牙周探诊深度、龈沟出血指数、菌斑指数以及空腹血糖、糖化血红蛋白、三酰甘油、总胆固醇水平;对照组于入选时及入选后24周观察上述指标。所有数据用SPSS12．0软件包进行统计学处理与分析。结果牙周治疗组于治疗后4、12、24周时各项牙周指标均有下降,与治疗前比较,差异有统计学意义（P〈0．01）。治疗组治疗后12、24周空腹血糖分别为（8．07&#177;1．08）、（8．05&#177;1．06）mmol/L。与治疗前（8．92&#177;1．19）mmol/L比较,差异有统计学意义（P〈0．05）;精化血红蛋白分别为（6．82&#177;1．47）％、（6．81&#177;1.56）％．与治疗前（7．6&#177;11．51）％比较,笼异有统计学意义（P〈0．05）。其中血糖控制欠佳的患者,治疗后4周糖化血蛋白有所改善,差异有统计学意义（P〈0．05）;而血糖控制较好者,其糖化血红蛋白治疗后下降不明显,牙周治疗对患者的血脂水平无显著影响。对照组各项牙周及血糖血脂指标存24周内差异无统计学意义（P〉0．05）。结论对患有牙周炎的2型精尿病患者,通过牙周治疗在一定程度上能改善其糖代谢水平。     

HBA1C与老年2型糖尿病视网膜病变的关系

目的：探讨糖化血红蛋白（ＨＢＡ１Ｃ）与老年２型糖尿病视网膜病变的关系。方法：对１０２例老年２型糖尿病患者进行ＨＢＡ１Ｃ检测及眼底检查或荧光素造影检查。结果：ＨＢＡ１Ｃ水平有糖尿病视网膜病变组料无视网膜病变组为高（Ｐ〈０．００１）,ＨＢＡ１Ｃ水平越高,视网膜病变发生率越高（Ｐ〈０．０５）,ＨＢＡ１Ｃ〉７．０％时视网膜病变发生率明显升高。结论：为防止老年２型糖尿病视网膜病变的发生和发展,ＨＢＡ１Ｃ应控     

2型糖尿病糖化血红蛋白检测的临床意义

目的 探讨糖化血红蛋白检测对糖尿病患者诊断、血糖控制及疗效评价的临床意义.方法 对胜利石油管理局肛肠病防治院51例2型糖尿病患者和29例健康体检者的临床资料进行对比分析.结果 在51例糖尿病患者中,糖化血红蛋白≥10 mmol/L患者有28例,占54.9％.健康对照组糖化血红蛋白均在4～6.5 mmol/L之间,与糖尿病组相比,差异有统计学意义(P＜0.05).结论 糖化血红蛋白对糖尿病的监测、治疗及评价疗效均有十分重要的临床意义.     

2型糖尿病患者口服降糖药物依从性研究

目的：探讨2型糖尿病住院和门诊患者口服降糖药物的依从性及其相关因素。方法：回顾性分析1998年7月至2003年7月2型糖尿病住院患者258例和门诊随访患者137例的降糖药物依从性及其相关因素；调查降糖药物的使用情况和药物副作用的发生率，观察药物依从者和不依从者的血糖水平变化。结果：2型糖尿病住院病人出院后53．1％的病人来院门诊随访，住院期间药物依从率为68．6％，出院时出院带药的依从率为81．8％，门诊随访期间药物依从率为40．9％，药物不依从的原因包括：药物副作用、血糖控制不佳、经济原因等，门诊随访过程中，磺脲类的副作用明显增加，药物依从者血糖控制佳，而不依从者血糖控制不佳。结论：出院后对出院带药的依从性最佳，住院期间的药物依从性次之，门诊随访期间的药物依从性最差。     

平板运动试验中出现心房间传导阻滞的临床意义及机制探讨

目的探讨平板运动试验中出现房间传导阻滞（IAB）的临床意义及机制。方法选择因胸闷、胸痛怀疑冠心病的患者69例,行平板运动试验及冠状动脉造影检查,按照运动试验中心电图P波时限的变化分为IAB组和无IAB组,比较两组患者的临床特征、平板试验中ST段最大下降程度和冠状动脉造影中冠状动脉狭窄程度和病变支数。结果①IAB组患者年龄高于无IAB组,（61．6±10．3）岁VS（56．8±8．9）岁（P=0．043）;②IAB组ST段最大下降≥1mm患者的比例高于无IAB组（80．5％VS48．5％,P=0．005）;ST段最大下降程度IAB组高于无IAB组,（1．78±1．45）mm VS（1．15±1．11）mm（P=0．047）;③冠状动脉造影中至少1支冠状动脉狭窄≥50％患者的比例,IAB组高于无IAB组（80．6％VS21．2％,P=0．001）;不同病变血管数患者的比例,两组间差异有统计学意义（P=0．006）。结论平板运动试验中出现IAB可能作为评价冠心病的辅助指标之一。     

The prevalence and prognostic significance of interatrial block in the general population

Abstract

Introduction: Partial and advanced interatrial block (IAB) in the electrocardiographic (ECG) represents inter-atrial conduction delay. IAB is associated with atrial fibrillation (AF) and stroke in the general population.

Material and methods: A representative sample of Finnish subjects (n?=?6354) aged over 30?years (mean: 52.2?years, standard deviation: 14.6) underwent a health examination including a 12-lead ECG. Five different IAB groups based on automatic measurements were compared to normal P waves using multivariate-adjusted Cox proportional hazard model. Follow-up lasted up to 15?years.

Results: The prevalence of advanced and partial IAB was 1.0% and 9.7%, respectively. In the multivariate model, both advanced (hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.00?2.65)) and partial IAB (HR: 1.39 (1.09?1.77)) were associated with increased risk of AF. Advanced IAB was associated with increased risk of stroke or transient ischaemic attack (TIA) independently of associated AF (HR: 2.22 (1.20?4.13)). Partial IAB was also associated with increased risk of being diagnosed with coronary heart disease (HR: 1.26 (1.01?1.58)).

Discussion: IAB is a rather frequent finding in the general population. IAB is a risk factor for AF and is associated with an increased risk of stroke or TIA independently of associated AF.

• Key messages

• Both partial and advanced interatrial block are associated with increased risk of atrial fibrillation in the general population.

• Advanced interatrial block is an independent risk factor for stroke and transient ischaemic attack.

• The clinical significance of interatrial block is dependent on the subtype classification.

     

Breathing patterns during progressive incremental cycle and treadmill exercise are different

Perceived breathlessness at comparable minute ventilation (V_E) is higher with cycling than with running. Different use of the upper extremities and chest wall may influence the breathing pattern. It was hypothetized that the relationship between tidal volume (V_T) and V_E throughout progressive incremental exercise is different with the two modes of exercise. Twelve well trained subjects (seven men) 20–25 years had incremental maximal exercise tests on a treadmill and a cycle ergometer on different days in random order. Heart rate, respiratory gases, V_E and V_T were measured on a computerized exercise testing system, and data were averaged over 20 s periods. The V_E?V_T relationship was characterized by maximum V_T, V_T at a V_E of 30 l min^?1 (V_T30), the Hey plot and by a least squares quadratic regression model. The increase in V_T by V_E was steeper and V_T30 was higher with cycling compared to running. V_Tmax was not different, but was achieved at a lower V_E with cycling. Breathing strategies are different with running and cycling in young well trained subjects, and exercise mode must be accounted for in normative studies of breathing pattern.     

Carbohydrate mouth rinse enhances time to exhaustion during treadmill exercise

Mouth rinsing with a CHO solution has been suggested to improve short (<1 h) endurance performance through central effect. We examined the effects of mouth rinsing with a CHO solution on running time to exhaustion on a treadmill. Six well-trained subjects ran to exhaustion at 85% VO_2max, on three separate occasions. Subjects received either an 8% CHO solution or a placebo (PLA) every 15 min to mouth rinse (MR) or a 6% CHO solution to ingest (ING). Treatments were assigned in a randomized, counterbalanced fashion, with the mouth-rinsing treatments double-blinded. Blood samples were taken to assess glucose (Glu) and lactate (Lac), as well as the perceived exertion (RPE). Gas exchange and heart rate (HR) were collected during all trials. Subjects ran longer (P = 0·038) in both the MR (2583 ± 686 s) and ING (2625 ± 804 s) trials, compared to PLA (1935 ± 809 s), covering a greater distance (MR 9685 ± 3511·62 m; ING 9855 ± 4118·62; PLA 7295 ± 3727 m). RER was significantly higher in both ING and MR versus PLA. No difference among trials was observed for other metabolic or cardiovascular variables (VO₂, Lac, Glu, HR), nor for RPE. Endurance capacity, based on time to exhaustion on a treadmill, was improved when either mouth rinsing or ingesting a CHO solution, compared to PLA.     

Respiratory gas exchange during treadmill exercise testing: reproducibility and comparison of different exercise protocols.

Ten subjects performed 4 maximal exercise tests to evaluate reproducibility and effects of treadmill inclination on submaximal and maximal oxygen consumption. They performed a standard Bruce protocol twice, and 1 protocol with progressive speed increase with constant, or without, inclination. At maximal exercise there was no significant difference between the protocols in oxygen consumption, respiratory gas exchange ratio, minute ventilation, plasma lactate, serum potassium or heart rate. Exercise time and treadmill distance were shorter than Bruce protocol with inclination, and considerably prolonged without. Reproducibility for Bruce protocol was good for group comparison of oxygen consumption throughout exercise. The individual variations for oxygen consumption were small at maximal exercise, but were considerable at rest and at the lowest exercise steps, this was slightly improved by analysing longer sampling time. Thus, measurement of oxygen consumption is reliable for group analysis, but interpretation must be careful in individuals unless maximal exercise is obtained. Treadmill inclination may be adjusted according to individual preferences.     

平板运动试验诱发室内阻滞对冠心病诊断的意义

目的：探讨平板运动试验诱发室内阻滞类型特征及其对冠心病诊断的意义。方法分析50例在平板运动试验（TET）中发生室内阻滞的冠状动脉造影结果。结果室内阻滞发生率为3．34％,其中14例患者发生冠状动脉狭窄（占28％）,36例发生室内阻滞但冠状动脉正常（占72％）。结论平板运动试验诱发室内阻滞对冠心病诊断具有一定价值,且不同类型的室内阻滞对冠心病诊断的意义不同。     

Direct comparison of a contractility and activity pacemaker sensor during treadmill exercise testing

There are limited data about the chronotropic capacity of the peak endocardial acceleration (PEA) sensor. This study directly compared the chronotropic function from the PEA and the activity (ACT) sensor. The study included 18 patients (age 73 ± 7 years) with ≥ 75% pacemaker-driven heart rate (HR) and a PEA sensor and 11 healthy controls (age 67 ± 7 years) underwent a chronotropic assessment exercise protocol (CAEP) exercise test with the pacemaker patients in VVIR mode after programming the sensors in the default setting with adjustment of the upper sensor rate as an age related maximum value (220-age). The ACT sensor was externally strapped on the thorax. Achieved exercise duration for the patients and controls was, respectively, 9.2 ± 3 vs 18.4 ± 4 minutes (P < 0.001). The maximal achieved HR with the PEA sensor was 124 ± 25 beats/min, versus the ACT with 140 ± 23, versus the controls with 153 ± 26 beats/min (P < 0.001 between the groups). For the PEA, ACT, and controls, the time to peak HR was, respectively, 11 ± 3, 7 ± 3.6, and 18 ± 4 (P < 0.001 between groups) and HR after 10 minutes recovery was, respectively, 80 ± 20, 65 ± 15, and 82 ± 4 beats/min (P < 0.001 between groups). The PEA sensor functions hypochonotroop during exercise programmed as a single sensor system. It is, therefore, preferable to combine the PEA sensor with an activity-based sensor in a dual sensor system. Although both groups had normal left ventricular functions, the exercise capacity of pacemaker patients is significantly lower than in the controls.     

活动平板运动试验中血压异常增高的意义

目的探讨活动平板运动试验所激发的血压异常增高的现象及临床意义。方法从561例受检者中选择运动中SBP≥200mmHg45例作为血压异常增高组,高血压血压反应正常组40例,对照组54例,比较3组间运动与血压反应关系。结果血压异常增高组:运动前静息时的血压(SBP/DBP)均高于其他两组(P<0.001);运动中SBP、血压上升幅度(ΔSBP)显著增高,有统计学意义(P<0.001);而运动时间(time)、代谢当量(Mets)均小于其他两组(P<0.05),说明该组病人运动耐量有不同程度的减退。结论运动所激发的血压异常增高可预示发生高血压的可能性,而对高血压患者应注意运动时血压高峰的控制及运动处方的制定。