口服葡萄糖耐量试验在糖尿病诊断中的应用

目的探讨口服葡萄糖耐量试验(OGTT)在糖尿病诊断中的应用。方法对149例疑似糖尿病患者进行OGTT检测。结果检出糖尿病前期39例,糖尿病98例。结论 OGTT能提高糖尿病或糖尿病前期的检出率。     

口服葡萄糖耐量试验在糖尿病诊断中的探讨

目的：对口服葡萄糖耐量试验(0GTT)诊断糖尿病(DM)进行分析其意义．方法：对286例可疑糖尿病人行OGTF，分别以空腹血糖(FPG)≥7．0mmol／L和OGTT 2h血糖(PG 2h)≥11.1mmol／L作为DM诊断标准。结果：以FPG和PG2h为DM诊断标准，DM的患病率分别是31．81％、44．05％．符合率为60．31％。结论：仅凭FPG诊断DM是不是够的。PG2h是DM诊断的金标准。     

46例糖尿病并发缺血性脑血管病患者临床治疗体会

选取92例糖尿病合并缺血性脑血管病患者为研究对象,随机均分为观察组和对照组各46例。观察组采取胰岛素降糖,阿司匹林+奥扎格雷钠治疗,对照组采取胰岛素降糖,阿司匹林治疗。比较两组患者临床疗效。结果两组总有效率比较,观察组(91.30%)高于对照组(80.43%),差异具有统计学意义(P0.05)。经治疗后,两组患者神经功能缺损评分均比治疗前显著下降,差异有统计学意义(P0.05);治疗后,观察组神经功能缺损评分显著低于对照组,差异有统计学意义(P0.05)。阿司匹林+奥扎格雷钠治疗糖尿病并发缺血性脑血管病患者临床疗效显著,值得推广。     

糖尿病与缺血性脑血管病的相关性

流行病学研究显示，糖尿病是缺血性脑血管病的危险因素。其发病机制与过度糖化和氧化、内皮功能障碍、血小板聚集增加、凝血纤溶系统异常、高同型半胱氨酸血症及胰岛素抵抗有关。高血糖对非腔隙性缺血性脑卒中的病情和转归有负面影响，其机制与血管损伤和乳酸酸中毒有关。而对于腔隙性脑梗死，它的损害作用不大。高血糖产生的原因除已确诊糖尿病之外，还可能是隐性糖尿病或是脑卒中引起的应激反应的结果。胰岛素和胰岛素样生长因子-1(insulin-like growth faotor-1,IGF-1)的应用是目前具有发展前景的治疗方案，它们既可以直接与脑实质作用，也可以通过控制血糖或其他机制间接起到神经保护作用。早期发现并积极控制各种危险因素如降压、降糖、降脂、采用抗血小板药物等仍然是最有效的预防措施，但严格的血糖控制对减少脑卒中危险性的作用还不确切，有待进一步研究。随着对糖尿病缺血性脑血管病发病机制的理解的不断深入，将会有更多更有效的防治措施不断出现。     

糖尿病伴发缺血性脑血管病患者肾动脉狭窄情况的临床研究

目的初步探讨糖尿病（DM）伴发缺血性脑血管病患者动脉粥样硬化性肾动脉狭窄（ARAS）的检出率并与非DM脑血管病ARAS发生的情况进行比较。方法总结分析167例因缺血性脑血管病而行全脑血管造影并同时进行非选择肾动脉造影患者的临床资料,其中DM38例,非DM129例,比较DM和非DM脑血管病ARAS的检出率,对ARAS的发生与脑血管病的严重程度进行相关性分析。结果167例患者共发现ARAS63例（37．72％）,其中DM组为17例（44．74％）,非DIM组为46例（35．66％）,2组比较无统计学差异。但脑动脉狭窄患者中ARAS的检出率为42．64％（55／129）显著高于非脑动脉狭窄患者（P〈0．05）。结论ARAS的发生与脑血管病有一定相关性。     

糖耐量试验对妊娠期糖尿病诊断的研究

目的：分析口服葡萄糖耐量试验（OGTT）对于在妊娠期糖尿病（GDM）诊断中的作用;方法：选取我院收治的80妊娠期糖尿病患者和同期接受孕检的健康孕妇80例,分为观察组和对照组,分别给予其口服葡萄糖耐量试验;结果：观察组患者在口服后1h和2h时血糖水平明显高于对组孕妇,P＜0.05,具有统计学意义。观察组孕妇口服1h 后,期 AKP、AST 等生化学指标水平也明显高于对照组孕妇。结论：妊娠期糖尿病孕妇的口服葡萄糖耐量试验结果明显高于正常的妊娠期孕妇,其诊断结果对于GDM诊断、治疗和改善妊娠结局有着重要的作用。     

154例妊娠糖尿病孕妇葡萄糖耐量试验结果分析

目的探讨妊娠糖尿病(gestafional diabetes malliths,GDM)孕妇口服葡萄糖耐量试验(oral gthcose tolerance test,OG-IT)的特点,分析父对GDM的诊断价值。方法对孕24~28周孕妇口服50g葡萄糖进行筛查,1小时血糖≥7.8mmol/L。者进行OGTT试验。结果154例GDM孕妇中80例(51.9%)空腹血糖异常,132例(85.7%)孕妇1h血糖异常,111例(71.4%)孕妇2h血糖异常,只有35例(21.7%>的孕妇3h血糖异常,其中33例(94.3%)伴有另外1项或者3项血糖异常。结论口服葡萄糖耐量试验中,取消3h血糖的检测对孕妇GDM的诊断影响甚微。     

妊娠期糖尿病孕妇产后葡萄糖耐量相关性研究

选取诊治的300例妊娠期糖尿病并成功分娩孕妇为研究对象,根据产后6~8周糖代谢恢复情况分为正常组(189例)、糖耐量减低组(72例)、糖尿病组(39例)。比较三组一般临床资料及妊娠时糖化血红蛋白,分析与产后葡萄糖耐量异常相关性。正常组、糖耐量减低组、糖尿病组糖化血红蛋白及空腹血糖依次增高,差异有统计学意义(P<0.05)。妊娠期糖尿病孕妇糖化血红蛋白与产后葡萄糖耐量呈正相关。妊娠期糖尿病产妇糖化血红蛋白可正确反应产后糖代谢耐量异常情况,妊娠期根据糖化血红蛋白水平可评估产后糖耐量异常情况。     

医疗干预对糖耐量异常患者的疗效评价

糖尿病是继心脑血管疾病、癌症之后致残率、致死率最高的第三大疾病,是危及人类健康的现代文明病。因此早期发现、早期进行医疗干预已引起人们极大的关注。本文报道在临床上进行OGTT后按1985年WHO标准诊断为糖耐量异常者53例进行医疗干预后的结果,并以21例糖耐量异常者未接受医疗干预为对照。现将结果报道如下。 1 材料与方法 1.1 病例选择:所有患者均选自内分泌专科门诊及病房,对空腹血糖≥6.1～≤6.9mmol/L患者常规作OGTT,发现异常者74例,进行卫生宣教后根     

上海市普陀区桃浦镇糖尿病筛查及糖耐量异常干预研究

【目的】调查上海市普陀区桃浦镇糖尿病及糖耐量异常的患病率,了解对糖耐量异常者分组干预的结果。【方法】以流行病学方法于2008年10月至2009年4月对桃浦镇常住居民进行糖尿病筛查。使用问卷调查收集糖尿病疾病史,家族史,肥胖史等资料,对已知糖尿病者进行馒头餐试验,对无糖尿病史者进行葡萄糖耐量试验。对筛查发现的糖耐量异常（IGT）患者进行随机分组干预,分析IGT患者早期干预意义。【结果】2015名调查者中,糖尿病患病率为15．2％,其中新发157人,糖耐量异常216人,患病率10．7％。将IGT患者随机分组,6个月后,普通干预组血糖正常率11．1％,强化干预组血糖正常率81．5％,两者比较有显著性差异（P〈0．01）。【结论】上海普陀区桃浦镇糖尿病患病率及IGT患病率较高,对于IGT患者实行早期规范的干预,可能使其血糖恢复正常,延缓糖尿病发病时间。     

超声对糖尿病及糖耐量受损合并颈动脉病变的诊断价值

目的　探讨超声对糖尿病合并颈动脉病变的诊断价值。方法　应用超声检测一组 2型糖尿病合并糖耐量受损 (IGT)患者颈动脉血管腔径、内膜 中膜厚度 (IMT)和斑块 ,并与正常组对照。结果　 2型糖尿病患者IMT增加 ,颈动脉内径减少 ,动脉斑块增多 ,且IGT患者IMT和斑块也有增加倾向。结论　及早采用超声对IGT和糖尿病患者行颈动脉内壁厚度、内径及斑块检测将有助于了解动脉粥样硬化的程度和范围 ,为临床干预减轻甚至逆转全身动脉粥样硬化进展提供有效的检测手段。     

糖耐量减退人群社区干预的研究

目的 观察长期综合社区干预措施对糖耐量减退(IGT)人群的转归及糖尿病高危因素指标的影响，探讨糖尿病防治新模式。方法 对上海市某社区居民进行静脉血糖检测，筛选出200例IGT者，并随机分为干预组和对照组，每组100例，对干预组进行为期3年的社区干预，比较2组人群在干预前、后的空腹血糖(FBG)、餐后2h血糖(2hPG)、空腹血清胰岛素(FIns)、餐后2h血清胰岛素(2hlns)、总胆固醇(Tch)、甘油三酯(TG)和身高、体重、腰围、臀围的变化。结果 3年社区下预后，T预组在干预前、后的FBG、2hPG、FIns、2hlns、Tch、TG及体重、腰围、臀围的变化及转归与对照组相比，差异均具有统计学意义。结论 对IGT人群采取长期综合社区干预措施可明显降低糖尿病高危因素指标、并改善其转归。     

Determinants for the progression from impaired glucose tolerance to non-insulin-dependent diabetes mellitus

The World Health Organization distinguishes among non-diabetic persons a form of glucose intolerance defined as impaired glucose tolerance (IGT). The main reason for considering IGT as a diagnostic entity is its prognostic value for the development of non-insulin-dependent diabetes mellitus (NIDDM). However, the use of one or two oral glucose tolerance tests (OGTT) for the definition of IGT and the large variability of the 2-h glucose level may explain the wide range of the incidence rates reported for NIDDM in subjects with IGT. It is evident that the pathogenesis of diabetes is still poorly understood. Both insulin resistance and impaired function of the β-cell are thought to be important contributing factors in the development of diabetes. The 2-h post-load glucose level from the OGTT is most powerful for the prediction of the development of NIDDM. In addition, a fasting hyperinsulinaemia and a low glucose removal rate, both reflecting insulin resistance, were found to be associated with a higher risk for the progression of NIDDM. In the San Antonio Study and in the Hoorn Study high fasting proinsulin levels, reflecting β-cell dysfunction, were associated with progression to NIDDM. Lipid levels did not predict progression to NIDDM in most studies. A two-step model for the development of NIDDM is hypothesized. The first step, the transition from normal to impaired glucose tolerance, is assumed to depend mainly on the presence of insulin resistance. The second step, progressing from IGT to diabetes, although accompanied by some further worsening of insulin resistance, is thought to be primarily dependent on the development of β-cell dysfunction.     

糖耐量减低者的冠状动脉病变特点及相关因素分析

目的 研究糖耐量减低(IGT)者的冠状动脉病变特点.方法 根据糖耐量(OGTT)结果 将疑似缺血性胸痛的住院患者490例分为IGT组(161例)、2型糖尿病(T2DM)组(159例)、糖耐量正常(NGT)组(170例),检测3组血清甘油三酯(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)和高敏C反应蛋白(hs-CRP)含量,计算BMI,记录一般临床资料(包括性别、年龄、吸烟史、高血压病史),分析3组的冠状动脉造影(CAG)结果 和冠状动脉Gensini评分情况.结果 (1)T2DM组、IGT组血清TG[(2.41±1.70)mmol/L和(2.26±1.20)mmol/L]均明显高于NGT组[(1.95±1.14)mmol/L],差异有统计学意义(t=0.4610,0.3124,P<0.01,<0.05),但IGT组和T2DM组间TG水平比较差异无统计学意义(P>0.05);3组间TC、HDL-C、LDL-C差异无统计学意义(P均>0.05).(2)T2DM组和IGT组血清hs-CRP[(2.38±1.76)ms/L和(2.33±2.03)ms/L]均明显高于NGT组[(1.54±1.32)mg/L,t=0.8391,0.7815,P均<0.01],而T2DM组与IGT组比较差异无统计学意义(P>O.05).(3)IGT组和T2DM组的BMI[(25.50±3.04)kg/m2和(26.09±2.86)kg/m2]均明显高于NGT组[(24.70±3.27)kg/m2],差异均有统计学意义(t=0.8063,1.3947,P<0.05,<0.01),但T2DM组与IGT组比较差异无统计学意义(P>0.05).(4)单支冠状动脉病变发生率NGT组为44.7%,明显高于IGT组(23.6%)和T2DM组(18.9%)(x2=16.310,25.116,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05);T2DM组、IGT组2支血管病变发生率分别为37.1%和39.8%,均明显高于NGT组(23.5%)(x2=7.200,10.099,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);3支冠状动脉病变发生率IGT组和T2DM组分别为33.5%和40.9%,均明显高于NGT组(20.O%)(x2=7.767,17.028,P均<0.05),IGT组和T2DM组间差异无统计学意义(P>0.05).(5)次全或完全闭塞发生率T2DM组和IGT组分别为22.6%和18.0%,均高于NGT组(7.6%)(x2=14.573,8.019,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);IGT组和T2DM组血管弥漫性病变发生率分别为24.8%和30.8%,均高于NGT组(12.4%)(x2=8.583,16.724,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05).(6)Gensini评分IGT组和T2DM组分别为(55.05±22.99)和(56.15±24.87),较NGT组(38.03±17.38)明显升高,其差异有统计学意义(t=17.0142,18.1186,P均<0.01),IGT组与T2DM组间比较差异无统计学意义(P>0.05).结论 IGT患者2支及3支冠状动脉病变发生率明显升高,次全或完全闭塞及弥漫性病变发生率也明显高于NGT者,与糖尿病患者冠状动脉病变特点相似,提示IGT与冠状动脉病变严重程度密切相关,临床工作中应高度重视此类患者.

Abstract：

Objective To investigate the characteristics of coronary's pathological changes in patients with impaired glucose tolerance. Methods Four-hundred and ninety patients who were suspected with ischemic chest pain were divided into three groups according to their OGTT results: (1) IGT group: n = 161,(2) 12DM group:n = 159, (3) NGT group: n = 170. Serum levels of triglyceride (TG) , total cholesterol (TC) , highdensity lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) and high sensitive Creactive protein (hs-CRP) were detected, their body mass indexes (BMI) were calculated. General clinical information (including gender, age, history of smoking, history of hypertension) were collected. All the CAG results were analyzed and Gensini scores were assessed as well. Results The TG levels in the T2DM group and IGT group ([2. 41 ± 1.70] mmol/L and [2. 26 ± 1. 20] mmol/L) were significantly higher than that of the NGT group (1.95 ± 1.14) mmol/L, the differences were significant (t=0.4610,0.3124, P<0. 01 and 0.05,respectively),whereas there was no significant difference between the IGT group and T2DM group (P >0.05);No significant difference was found among the three groups about TC, HDL-C, LDL-C levels (either P > 0.05). The levels of hs-CRP in T2DM group ([2. 38 ± 1. 76] mg/L and IGT group [2. 33 ± 2. 03] mg/L) were higher compared with the NGT group ([1. 54 ± 1. 32] mg/L), the differences were significant (t = 0. 8391,0. 7815, Ps < 0. 01), whereas there was no significant difference between the IGT group and T2 DM group (P >0.05). BMIs of the IGT group ([25.50 ± 3.04]kg/m2) and T2DM group ([26.09 ± 2.86]kg/m2) were higher than that of the NGT group ([24. 70 ± 3. 27] kg/m2), the differences were significant (t = 0. 8063,1. 3947, P<0. 05 and <0.01, respectively),whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidence of single coronary pathological changes was 44.7% in the NGT group,it was higher than that of the IGT group (23. 6%) and T2DM group (18. 9%) (x2 = 16. 310,25. 116,Ps < 0. 05), whereas there was no significant difference between the IGT group' and T2DM group (P > 0. 05);The incidences of 2 branches pathological changes in the T2DM group (37. 1%) and IGT group (39. 8%) were higher compared with NGT group (23. 5%) ,the differences were significant (x2 =1. 200,10. 099,Ps <0. 05),whereas there was no significant difference between the IGT group and T2DM group (P >0. 05) ;The incidences of 3 vessels pathological changes in the T2DM group (40.9%) and IGT group (33. 5%) were higher than that of the NGT group (20. 0%) , the differences were significant (x2 = 7. 767,17. 028, Ps < 0.05), there was no significant difference between the IGT group and T2DM group (P > 0. 05). The incidence of subtotal or total occlusion of the T2DM group and IGT group were 22. 6% and 18.0% respectively,both were higher than that of the NGT group(7. 6%) (x2 = 14. 573,8. 019 ,Pa < 0.05) , whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidences of vascular diffusing pathological change in the IGT group (24. 8%) and T2DM group (30. 8%) were higher compared with the NGT group (12.4%) (x2 =8.583,16.724, Ps < 0.05), whereas there was no significant difference between the IGT group and T2DM group (P >0.05). The Gensini scores in the IGT group (55. 05 ± 22. 99) and T2DM group(56. 15 ± 24. 87) were significnatly higher than that of the NGT group (38. 03 ± 17. 38), the differences were significant ((t =17.0142,18. 1186,Ps <0.01),whereas there was no significant difference between the IGT group and T2DM group (P>0.05). Conclusion The incidences of 2 and 3 vessels pathological changes increase significantly in patients with IGT. Moreover, the incidences of occlusion and diffuse stenosis increase significantly. This is similar to the coronary artery pathological charactersitics in patients with diabetes, which indicates that IGT is closely related to the pathological severity of coronary artery. We should pay much attention to those patients with IGT in the clinical work.     

内中膜厚度定量及动脉僵硬度分析技术评价糖耐量减低及2型糖尿病者颈总动脉改变

目的应用血管内中膜厚度定量(QIMT)及动脉僵硬度分析(QAS)技术评价糖耐量减低(IGT)和2型糖尿病(T2DM)患者颈总动脉结构及功能的改变。方法对病例组68例患者[30例IGT(IGT亚组)和38例T2DM(T2DM亚组)]及58名正常对照(NC)组的右侧颈总动脉行QIMT、QAS及相关血清学检查,获取以下参数:内中膜厚度(IMT)、顺应性系数(CC)、扩张性系数(DC)、僵硬度参数(β)、2h血糖值(2hPG)、甘油三酯(TG),胆固醇(Ch),低密度脂蛋白(LDL),糖化血红蛋白(GHb),并分析NC组与病例组各亚组之间的差异及相关性。结果 T2DM亚组DC低于NC组(P<0.05),其余参数组间两两比较差异均有统计学意义(P均<0.05);IGT和T2DM亚组β和IMT、2hPG、LDL与GHb均呈正相关(P均<0.01)。结论 QIMT及QAS技术可反映动脉血管的早期结构及功能变化,对诊断IGT及T2DM患者早期动脉粥样硬化具有一定价值。     

Prevalence of diabetes mellitus and impaired glucose tolerance in a middle-aged Finnish population

Objective - To describe the prevalence of previously diagnosed and undiagnosed diabetes and impaired glucose tolerance (IGT) by sex, marital status, employment, exercise behaviour, and body mass index (BMI), and to compare previously diagnosed and undiagnosed diabetic patients.

Design - A survey of the total 55-year-old population living in a Finnish city on 1 October 1990. All the participants who were not on antidiabetic medication were invited for an oral glucose tolerance test (OGTT).

Setting - Oulu, a city in northern Finland.

Subjects - 1008 eligible subjects (456 men and 552 women), of whom 345 men (76%) and 435 women (79%) participated.

Main results - the prevalence of previously diagnosed diabetes was 6.1% in the men and 3.0% in the women and that of previously undiagnosed diabetes 4.5% of the men and 3.7% of the women. the prevalence of IGT was 28.6% in the men and 26.7% in the women. Diabetes was related to BMI, and previously undiagnosed diabetes was related to the amount of physical exercise in both sexes. One third of the undiagnosed diabetic men and half of the undiagnosed diabetic women were identified among the persons with marked obesity (BMI 30 kg/m² or more). the group of previously diagnosed diabetic patients included a significantly greater proportion of retired people and people on sick leave than the group of undiagnosed diabetic persons.

Conclusions - Diabetes is common in middle-aged Finns. Undiagnosed diabetes was detected especially in persons with marked obesity who were not physically active.     

空腹血糖正常的原发性高血压患者糖代谢异常状况研究

目的研究原发性高血压伴有糖代谢异常患者的各项指标,为全面干预心血管危险因素提供依据。方法选择既往无糖代谢异常病史,空腹血糖〈5.6 mmol/L的原发性高血压患者398例,测定口服葡萄糖耐量试验（OGTT）后2小时血糖（2 hPG）水平。观察年龄、性别、体质量指数、血压、血脂、尿酸、动脉硬化等参数与OGTT后2hPG的关系。结果 398例患者中检出糖耐量减低99例（24.9%）;2型糖尿病52例（13.1%）。糖代谢异常的患者动脉硬化的比例（71.5%）高于血糖正常组（52.6%）。结论原发性高血压患者合并糖代谢异常的比例高,对于空腹血糖正常的原发性高血压患者,应常规行OGTT测定,以早期发现和干预糖代谢紊乱,减少动脉硬化的发生。     

High prevalence of undiagnosed impaired glucose regulation and diabetes mellitus in patients scheduled for an elective coronary angiography

Summary Background Impaired glucose regulation (IGR) and diabetes mellitus (DM) are amongst the main risk factors for developing coronary heart disease (CHD). The aim of this study was to investigate previously unknown glucose metabolism disorder in patients scheduled for an elective coronary angiography. Methods A total of 141 patients scheduled for coronary angiography without signs of acute myocardial ischemia or previous history of a glucose metabolism disorder were prospectively included in the study. An oral glucose tolerance test (OGTT) was performed in each patient. Results IGR was diagnosed in 40.4% (95% confidence interval 32.3–49.0) and undetected DM in 22.7% (16.1–30.5) of patients undergoing an elective coronary angiography. Depending on the severity of CHD, the percentage of IGR and DM increased up to 45.3% (34.6–56.5) and 26.7% (17.8–37.4) in the subgroup with the need of percutaneous angioplasty, while the corresponding proportions in the group without CHD were 30.3% (15.6–48.7) and 12.1% (3.4–28.2). The percentage of undiagnosed DM increased with the number of epicardial vessels involved. Using the recommended fasting plasma glucose value of ≥ 126 mg/dl for the diagnosis of DM, we would have missed 71.9% of the patients with undiagnosed DM. If all patients with a fasting plasma glucose of ≥ 90 mg/dl had been subjected to OGTT, 93.8% of DM would have been identified. Conclusions Prevalences of DM and IGR are higher than expected in patients with CHD. An OGTT should be considered for all patients with a fasting plasma glucose ≥ 90 mg/dl undergoing a coronary angiography.     

Diagnosis of impaired glucose tolerance in hypertensive patients in daily clinical practice

Many patients with hypertension suffer from impaired glucose tolerance or type 2 diabetes mellitus. Although these diagnoses are generally simple and reliable, it is more difficult to diagnose impaired glucose tolerance. As the gold standard (oral glucose tolerance test (OGTT)) is complicated to perform, a simpler alternative would be useful. The aims of the Pre-Diabetes Score study are to correlate demographic and/or laboratory parameters that are clinically simple to determine with the results of the OGTT and to determine the diagnostic significance of the combinations of parameters with regard to impaired glucose tolerance. A total of 260 patients were included in the evaluation; 39% had impaired glucose tolerance and 12% had diabetes mellitus. A combination of HbA1c of > or =6%, a venous fasting glucose of > or =110 mg/dl, an age of > or =55 years, a systolic blood pressure of > or =140 mmHg and an enlarged waist size is highly predictive of impaired glucose tolerance.