血压正常的胰岛素依赖型糖尿病患者动态血压的改变

为观察胰岛素依赖型糖尿病（ＩＤＤＭ）患者动态血压的改变及其与尿白蛋白排泄率（ＵＡＥ）和自主神经病变的关系，我们对血压正常的ＩＤＤＭ患者２４例进行了２４小时动态血压监测（ＤＢＰＭ），并与糖耐量正常（ＮＧＴ）者进行了比较。结果发现，ＩＤＤＭ患者无白天血压和２４小时血压的明显改变，但夜间血压升高，昼夜血压差值明显降低，该改变与自主神经功能计分、ＵＡＥ、偶测ＳＢＰ、夜间ＳＢＰ和夜间ＤＢＰ呈显著负相关。     

糖尿病患者白蛋白尿与血管病变

糖尿病患者白蛋白尿与血管病变陈荣月，陆菊明分析了我院２１７例糖尿病（ＤＭ）患者尿白蛋白排出率（ＵＡＥ）与ＤＭ大、微血管病变的关系，报告如下。对象与方法ＤＭ患者共２１７例，其中ＩＤＤＭ２３例，ＮＩＤＤＭ１９４例，全部为住院患者。按ＵＡＥ分为三组：大量白...     

血压正常的Ⅱ型糖尿病患者尿白蛋白排泄率与胰岛素抵抗的关系

目的 了解血压正常的Ⅱ型糖尿病患者尿白蛋白排泄率（ＵＡＥＲ）与胰岛素抵抗的关系。方法 对血压正常的３１例Ⅱ型糖尿闰中并微量白蛋白尿（ＭＡＵ）患者与３２例未合并ＭＡＵ患者的血糖，胰岛素、胰岛素敏感性指数（ＩＳＩ）进行比较分析，并对所有患者的ＵＡＥＲ与有关因素进行多因素逐步回归分析。结果 Ⅱ型糖尿病合并ＭＡＵ时ＩＳＩ显著降低，而且ＩＳＩ与ＵＡＥＲ呈独立的相关性「偏回归系数（β）＝－０．３９，Ｐ〈０．０     

非胰岛素依赖型糖尿病患者视网膜病变有关因素分析

对１４９例非胰岛素依赖型糖尿病患者进行了眼底检查，同时测其２４小时尿白蛋白排泄量（２４ｈｒＵＡＥ）２４小时尿Ｎ－乙酰－β－Ｄ氨基葡萄糖苷酶（２４ｈｒＵＮＡＧ）、血β－微球蛋白、糖基化血红蛋白、并记录血压及病程等。结果显示，糖尿病视网膜病变的发生率随病程延长，血压升高、２４ｈｒＵＡＥ及２４ｈｒＵＮＡＧ增加及肾功能降低而明显增加，血糖控制不良促进共发生。     

胰岛素依赖型糖尿病预防研究进展

胰岛素依赖型糖尿病（ＩＤＤＭ）的预防研究近几年取得新进展。主要方法是应用免疫抑制剂或清除淋巴细胞以终止自身免疫反应，或应用自身抗原（谷氨酸脱羧酶、胰岛素、热休克蛋白）、超抗原（ｓｕｐｅｒ ａｎｔｉｇｅｒ）、免疫佐剂（卡介苗）等激活Ｔｈ２细胞，产生白介素－４／１０，抑制Ｔｈ１细胞，诱导对自身原的免疫耐受，以防止免疫系统对Ｂ细胞的攻击，预防率高达７５％－１００％。     

胰岛素对糖尿病大鼠海马病变的预防研究

选择与学习记忆密切相关的神经结构———大脑海马部位为研究对象 ,从普通光镜、透射电镜以及一氧化氮合酶(ＮＯＳ)阳性细胞、乙酰胆碱酯酶 (ＡｃｈＥ)阳性纤维表达等方面观察胰岛素治疗对较长病程糖尿病大鼠脑病变的防治作用。一、材料和方法1.动物模型制备 :6周龄ＳＤ大鼠 ,体重 (2 5 0± 30 )ｇ ,腹腔注射 2 %链脲佐菌素 (ＳＴＺ) 5 5ｍｇ/ｋｇ ,一周后尾静脉血糖大于 16 .7ｍｍｏｌ/Ｌ者作为糖尿病模型鼠〔1〕。正常对照组 (Ｎ组 10只 ) ;成模大鼠分 2组 :糖尿病组 (Ｄ组 10只 ) ;糖尿病治疗组 (Ｔ组 10只 ,皮下注射鱼精蛋白锌胰岛素 2…     

胰岛素依赖型糖尿病预防研究进展

胰岛素依赖型糖尿病（ＩＤＤＭ）的预防研究近几年取得了新进展。主要方法是应用免疫抑制剂或清除淋巴细胞以终止自身免疫反应，或应用自身抗原（谷氨酸脱羧酶、胰岛素、热休克蛋白）、超抗原（ｓｕｐｅｒａｎｔｉｇｅｎ）、免疫佐剂（卡介苗）等激活Ｔｈ２细胞，产生白介素－４／１０，抑制Ｔｈ１细胞，诱导对自身抗原的免疫耐受，以防止免疫系统对Ｂ细胞的攻击，预防率可达７５％￣１００％。     

正常血压Ⅱ型糖尿病患者尿微量白蛋白多因素分析

应用多因素逐步回归的分析方法对７０例正常血压Ⅱ型糖尿病患者有关微量尿白蛋白排泄率（ＵＡＥＲ）的危险因素，包括年龄、体重指数（ＢＭＩ）、病程、收缩压、舒张压、空腹血糖（ＦＢＧ）、糖化血红蛋白（ＨｂＡ１ｃ）、红细胞山梨醇（ＲＢＣＳ）、血脂、血浆纤维蛋白原（Ｆｇ）、血浆镁、心血管交感神经活性（ＳＡ）和副交感神经活性（ＰＡ）等作了探讨。结果显示：糖尿病患者尿ＵＡＥＲ水平明显增高；多因素分析表明，在上述１７     

2型糖尿病患者尿白蛋白排出量与大血管病变的关系

目的　研究微量白蛋白尿与 2型糖尿病早期大血管病变的关系。方法　采用高分辨率的彩色多普勒超声波仪器测量伴有不同程度白蛋白尿的 2型糖尿病患者颈总动脉内膜 -中层厚度 (IMT)及胫前动脉内径。结果　伴微量白蛋白尿及明显蛋白尿的糖尿病病人其颈动脉 IMT大于尿蛋白正常的糖尿病病人 (0 .6 5± 0 .12 mm vs 0 .48± 0 .0 6 mm,P<0 .0 0 1) ,而胫前动脉内径小于后者 (1.98± 0 .49mm vs 2 .45± 0 .30 mm,P<0 .0 1)。结论　伴微量白蛋白尿的糖尿病患者存在早期大血管病变。     

Structural basis of diabetic nephropathy in microalbuminuric NIDDM patients: a light microscopy study

Summary The objective of the study was to evaluate early structural changes occurring in patients with non-insulin-dependent diabetes mellitus (NIDDM) and microalbuminuria by light microscopy. Basal renal biopsy was performed in patients who were subsequently randomized to different antihypertensive treatments. Fourteen NIDDM patients aged 36–65 years (duration of diabetes 9 ± 7 years) with microalbuminuria (mean urinary albumin excretion 66 ± 49 μg/min) underwent percutaneous renal biopsy. Control biopsies were obtained from five patients of similar age undergoing nephrectomy for renal neoplasia with normal renal function and no history of renal disease. Control and diabetic biopsies were processed by light microscopy and stained with haematoxylin and eosin, periodic acid Schiff, Masson's trichrome and silver methenamine. The percentage of globally sclerotic glomeruli was evaluated. Glomerular volume was determined using perimeter analysis. A semiquantitative assessment (range 0 to 3 +) was made of mesangial sclerosis, interstitial fibrosis, tubular atrophy, arteriosclerosis and arteriolar hyalinosis. Glomerular volume was significantly increased in diabetic as compared to control glomeruli (3.2 ± 8 vs 1.8 ± 7, p < 0.01). Mesangial sclerosis (0.9 vs 0, p < 0.0001) and arteriolar hyalinosis (0.91 vs 0.2, p < 0.022) were significantly higher in diabetic compared to control subjects. No significant differences between diabetic and control subjects were found in the percentage of globally sclerotic glomeruli or in the extent of interstitial fibrosis, tubular atrophy and arteriosclerosis. Thus NIDDM patients with microalbuminuria show histological findings consistent with diabetic nephropathy characterized by glomerular hypertrophy, mesangial sclerosis and arteriolar hyalinosis. However, the renal histological changes are mild and appear less marked than in insulin-dependent diabetic patients. [Diabetologia (1996) 39: 1625–1628].     

Diabetic retinopathy assessed by fundus photography in Pima Indians with impaired glucose tolerance and NIDDM

In a population-based epidemiological study, 991 Pima Indians with non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) and 288 without diabetes aged ≥15 years were examined for retinopathy by fundus photography with a 45° fundus camera after mydriasis. The photographs were graded using a modified Airlie-House classification scheme. The associations of several factors with retinopathy were studied by logistic regression. Non-proliferative retinopathy was present in 11.2 % (19/169) subjects at the time of diagnosis of diabetes and in 8.3 % (4/48) in newly diagnosed subjects who had a documented non-diabetic oral glucose tolerance test within 4 years prior to diagnosis of diabetes. The prevalence of retinopathy in subjects with impaired glucose tolerance was 12 % (8/68). Retinopathy at the time of diagnosis of diabetes was significantly associated with lower body mass index and higher systolic blood pressure but not glycaemia. Retinopathy was present in 375 (37.8 %) diabetic subjects and 14 (5.2 %) non-diabetic subjects. Among all subjects with diabetes (duration 0–37 years), stepwise multivariate analysis showed non-proliferative retinopathy to be associated with duration of diabetes, mean blood pressure, fasting plasma glucose, treatment with insulin and albuminuria. Proliferative retinopathy was seen in 34 (2.7 %) of diabetic and none of the non-diabetic subjects, and was associated with 2 h post-load glucose concentrations, as well as albuminuria, insulin treatment, younger age, and diastolic blood pressure. These data confirm the need for fundus examination at the time of diagnosis of diabetes and during long-term follow-up. Albuminuria and blood pressure are potentially modifiable risk factors and the impact of treating these on incidence and progression of diabetic retinopathy need to be assessed. © 1997 by John Wiley & Sons, Ltd.     

Microalbuminuria as Identified by a Spot Morning Urine Specimen in Non-insulin-treated Diabetes: an Eight-year Follow-up Study

This study followed up a cohort of patients with microalbuminuria identified on a spot morning urine sample 8 years earlier and aimed to determine if a spot morning urinary albumin concentration was able to identify patients with non-insulin treated diabetes at increased risk of mortality and progression to nephropathy. In 1984, 47 of 216 patients chosen by random selection from our teaching hospital-based diabetes clinic were identified as having microalbuminuria (urinary albumin concentration 35–300 μg ml^?1). Subjects were compared with an age-matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, 22 of 47 (46.8 %) patients with microalbuminuria had died compared to 10 of 47 (21.3 %) patients without albuminuria (p < 0.05). The majority of deaths were from cardiovascular disease (53.1 %). Logistic regression showed microalbuminuria to be an independent predictor of mortality, not influenced by age, duration of diabetes, blood pressure, glycosylated haemoglobin or creatinine at the initial examination. Eight years later, in the group with initial microalbuminuria, eight still had microalbuminuria and five patients had developed nephropathy. In the group without albuminuria in 1984, only one patient had progressed to microalbuminuria and no patients to nephropathy. In conclusion, a spot urinary albumin concentration is of value in identifying patients with an increased risk of mortality or progression to nephropathy, and is simple to obtain at a clinic.     

卡托普利对高血压病及非胰岛素依赖型糖尿病患者运动血压及微蛋白尿的短期作用

对血压正常的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者１４例（ＮＩＤＤＭ组）、高血压病（ＥＨ）患者１２例（ＥＨ组）、ＥＨ合并ＮＩＤＤＭ患者１２例（ＥＨ并ＮＩＤＤＭ组）给予卡托普利口服２５ｍｇｂｉｄ，在１ｄ半内共服３次，服药前后做踏车运动试验测定血压、心率、尿白蛋白排泄率（ｕＡＥＲ）及尿转铁蛋白排泄率（ｕＴＥＲ），并以１０例正常人作对照（对照组）。结果：①服卡托普利后ＥＨ组血压明显下降，ｕＡＥＲ及ｕＴＥＲ无明显改变，而ＥＨ并ＮＩＤＤＭ组却相反；②运动状态下，三组患者服卡托普利后尿白蛋白均明显下降，但与血压互不相关；③ＥＨ组服药后，运动血压有所下降，但血压变化的绝对值服药前后相似；④血压正常的ＮＩＤＤＭ组运动后血压明显升高，服药后这种异常消失。提示：①运动状态下，早期ＥＨ和ＮＩＤＤＭ有不同的病理生理机理，似乎糖尿病更依赖于肾素－血管紧张素系统，卡托普利有较好的疗效。②对于正常血压、尿白蛋白（－）的ＮＩＤＤＭ患者，运动激发是观察尿白蛋白及血压改变的灵敏方法，若被运动激发，应当考虑给予卡托普利治疗。     

Increased night:day blood pressure ratio in microalbuminuric normotensive NIDDM subjects

Objective: To determine the relationship of day- and night-time blood pressure (BP) with the degree of albuminuria in subjects with non-insulin-dependent diabetes (NIDDM). Research design and methods: BP was determined hourly for 24 h in 27 NIDDM normotensive patients, and 10 age- and BMI-matched controls. Diabetic subjects were separated into normo- and microalbuminuric groups according to the urinary albumin excretion rate (AER<15 and ≥15 μg/min), respectively. Results: Non-dippers defined by a nocturnal fall in BP of less then 10/5 mmHg represented 68.8% of the normo- and 81.8% of the microalbuminuric patients. Microalbuminuric diabetics demonstrated a significantly higher ratio of night:day BP in comparison to controls, but not to normoalbuminuric diabetics. AER was significantly correlated with BP ratio in the normoalbuminuric, but not in microalbuminuric group. Conclusions: Ambulatory 24-h BP monitoring is useful to find blunted nocturnal fall in BP even in normotensive NIDDM subjects with or without microalbuminuria. However, whether or not an increase in the night-time BP and/or the night:day ratio in NIDDM patients plays a pathogenetic role in the progression of diabetic nephropathy remains to be clarified.     

Prevalence and incidence of NIDDM in Iceland: evidence for stable incidence among males and females 1967–1991— the Reykjavik Study

This is the first large survey carried out in Iceland to estimate the prevalence and incidence of known and unknown non-insulin-dependent (Type 2) diabetes (NIDDM) among males and females, aged 34–79. The population in this survey was 9128 males and 9759 females born between 1907 and 1935 and examined in the prospective Reykjavik Study 1967–1991. Participants were invited from one to five times during the 24 years. The overall age-standardized prevalence (95 % confidence limits) was 2.9 % (2.5 to 3.3) for males and 2.1 % (1.8 to 2.5) for females, aged 30–79, according to the European standard population. The overall annual age-standardized incidence rate per 100 000 was 377 (303 to 457) for males and 266 (212 to 320) for females, aged 35–74, standardized to the European population. Our study indicates that the prevalence of NIDDM is relatively low compared to other Nordic and western countries, and has not been increasing over the past 20 years. Furthermore, the incidence of NIDDM has not been changing during the past 20 years of follow-up among Icelandic males and females aged 34–79. © 1997 by John Wiley & Sons, Ltd.     

Update on diabetic nephropathy in NIDDM

Diabetic nephropathy is an important clinical entity in the geriatric population. One half of newly enrolled patients in dialysis programs have non-insulin-dependent diabetes mellitus (NIDDM), and the number of NIDDM patients with chronic renal insufficiency is estimated to be eight times greater than those with insulin-dependent diabetes mellitus. In view of this growth potential, this paper is intended to briefly review the epidemiology and pathogenesis of diabetic nephropathy, and to highlight some important considerations in the clinical evaluation and treatment of patients with NIDDM.     

Evaluation of serum adiponectin levels in diabetic nephropathy

IntroductionDiabetic nephropathy is one of the major microvascular complications of diabetes mellitus. Adiponectin is an adipose tissue-derived cytokine that was identified in a human adipose tissue cDNA library. Serum adiponectin levels are found to be reduced in various pathological states including obesity, diabetes mellitus, ischaemic heart disease and arteriosclerosis obliterans and elevated in end stage renal diseases. Objective: to assess the level of plasma adiponectin as an early predictor of microvascular complications in patients with type 2 diabetes mellitus.Methods44 patients with type 2 diabetes recruited from outpatient diabetes clinic in Kasr Alainy hospital. All patients were subjected to full laboratory work-up including: Fasting blood glucose and Post prandial blood glucose, Glycated haemoglobin A1C, Serum creatinine, Serum total cholesterol, Triglycerides, Low density lipoprotein, High density lipoprotein, C-reactive protein titre, serum adiponectin and Urinary albumin/creatinine (UAC) ratio.ResultsThe present study demonstrated that serum adiponectin concentrations had significant positive correlation with UAC ratio (r = 0.534, p = 0.0001). Adiponectin levels showed significant positive correlation in patients with diabetes and hypertension with microalbumiuria (p = .001) or normoalbumiuria (p = 0.004).ConclusionSerum adiponectin level can be a good predictor of diabetic nephropathy in patients with type 2 diabetes mellitus.     

Long-term Effect of Acarbose on Glycaemic Control in Non-insulin-dependent Diabetes Mellitus: A Placebo-controlled Double-blind Study

The efficacy and safety of acarbose therapy (100 mg tds for 24 weeks) was investigated in a placebo-controlled double-blind study in patients with non-insulin dependent diabetes mellitus who could not achieve satisfactory glycaemic control by diet alone. In the acarbose group, the 2 h postprandial blood glucose and haemoglobin A₁ levels decreased significantly from 14.0 mmol l^?1 to 11.3 mmol l^?1 and from 11.1 % to 9.7 %, respectively. In the placebo group, the 2 h postprandial blood glucose (14.4 mmol l^?1 to 14.2 mmol l^?1) and the hemoglobin A₁ level (10.3% to 9.9%) showed no significant changes. A 75 g oral glucose tolerance test was performed before and after the study, the difference not being significant in either the acarbose group or the placebo group. The incidence of side-effects (mainly gastrointestinal symptoms such as flatulence and abdominal distension) was high at 78.9 % in the acarbose group and 61.1 % in the placebo group. However, there was no significant difference between the groups, and side-effects in the acarbose group tapered during the trial, suggesting that some at least were not related to the drug. From these findings, it was concluded that acarbose is an effective new treatment for diet treated non-insulin-dependent diabetic patients.