糖尿病足与糖尿病视网膜病变相关性分析

目的：分析糖尿病足( diabetic foot, DF)与糖尿病视网膜病变( diabetic retinopathy, DR)的相关性及DR进展的风险因素。方法回顾性分析2010年12月—2016年4月诊断DF并同期行眼底照相明确DR分期的病例249例次,分析二者在疾病分级和分期的相关性;并分析上述资料中同一患者多次以DF住院治疗时DR的进展情况,以及DF无进展患者的糖尿病病程、糖化血红蛋白、甘油三酯及胆固醇对DR进展的影响。结果糖尿病患者的DF分级与DR分期呈现明显正相关(P<0．01,rs =0.6026)。在多次住院的DF患者中,DF无进展患者中有21例(70．0%)DR分期发生了进展,而DF有进展患者中有13例(76．5%)DR病变分期发生了进展,差异无统计学意义(P>0．05)。在DF无进展的患者中,DR无进展组糖化血红蛋白、胆固醇及甘油三酯均低于DR有进展组( P=0.0146、<0.001和<0.001)。结论 DF与DR的严重程度呈正相关,DF比DR的进展存在滞后性,糖化血红蛋白、胆固醇及甘油三酯可能是预测DR病变进展更为迅速而敏感的指标。     

糖尿病视网膜病变

糖尿病视网膜病变是糖尿病眼部并发症中最严重的病变。虽然过去40多年的糖尿病视网膜病变；台疗进展使这种病变致盲的危险性大大降低，但是糖尿病仍然是最常见的疾病之一(大约6％的美国人患病)．所以视网膜病变依然是一个很严峻的问题。     

Diabetic neuropathy

Many factors contribute to the nerve damage of diabetes--metabolic (myo-inositol), microvascular, glycosylation and ageing. The variety of clinical syndromes indicates the complexity of the disease. Measurement of peripheral and autonomic nerve function is improving allowing the establishment of prospective natural history and therapeutic studies. There is a need for standardization of clinical definition and staging.     

Diabetic emergencies

Diabetic emergencies continue to be a significant cause of premature death in patients with diabetes. They include the diabetic comas (hypoglycaemia, severe diabetic ketoacidosis, hyperosmolar hyperglycaemic non-ketotic coma, lactic acidosis), emergency surgery and myocardial infarction. There is still considerable avoidable morbidity and mortality during treatment, and as a result of misdiagnosis. Simple guidelines are thus needed for the general practitioner and admitting physician to improve management. Hypoglycaemia is far the commonest diabetic emergency, and is relatively easy to diagnose and treat. Delays in treatment are potentially damaging and largely unnecessary. Diabetic ketoacidosis is still relatively common but is often preventable. Initial treatment for this and hyperosmolar nonketotic coma is rehydration. This is followed by IM or IV infusion of moderate amounts of insulin, early potassium replacement, and alkali only if the acidaemia is severe. Lactic acidosis requires mainly rigorous alkalinisation but is very rare. The metabolic derangements in emergency surgery and myocardial infarction are best treated by combined glucose, potassium and insulin infusions. In all cases treatment is easiest and probably more successful if consistent simple guidelines are provided.     

Diabetic retinopathy

Involvement of the retinal microvascular vessels is an almost inevitable consequence of long standing diabetes. In the only large scale epidemiology study of a Caucasian population Klein et al. found some degree of retinopathy in up to 97% of patients with insulin dependent diabetes mellitus (IDDM) after about 15 years diabetes duration and in about 60% of insulin treated patients of older onset, presumably non-insulin dependent diabetic patients (NIDDM). The presence of retinopathy does not indicate impending visual loss in all patients. Thus in IDDM the sight threatening forms of retinopathy is most commonly associated with neovascularization; up to 60% of patients develop this lesion after 20 years diabetes duration, while in the older age group new vessels are far less common. In clinic populations the commonest cause of visual loss in NIDDM is associated with macular oedema but in the population studies of Klein, prevalence of macular oedema was almost as common in IDDM as in NIDDM patients.     

Diabetic peripheral neuropathy

Diabetes mellitus leads to several recognizable clinicopathologic neuropathic syndromes. Diagnosis and evaluation requires a thorough history and neurologic examination, electrophysiologic studies, blood studies and, in selected cases, cerebrospinal fluid analysis and nerve and muscle biopsy. Microangiopathy is the leading cause of diabetic neuropathy associated with metabolic, vascular ischemic and immunologic injury. Tight glycemic control and symptomatic therapy is beneficial in a minority of patients but does not prevent the relentless progression of symptoms and signs. Intravenous immune globulin is a novel therapy in patients with mononeuropathy multiplex, primary demyelinating neuropathy and peripheral nerve T-cells microvasculitis associated with C5b-9 membrane attack complex protein deposits.     

糖尿病酮症和糖尿病酮症酸中毒176例治疗分析

目的：研究糖尿病酮症及糖尿病酮症酸中毒的诱因、治疗及预防方法。方法：对176名符合WHO的诊断标准的糖尿病酮症及糖尿病酮症酸中毒患者进行分类及治疗。结果：117例DK、51例DKA经治疗后治愈。8例DKA死亡。结论：糖尿病酮症及糖尿病酮症酸中毒是糖尿病的急性并发症,但经过积极治疗能取得很好的疗效。并且通过预防其诱因,可以减少其发病率。