中老年男性2型糖尿病患者颈动脉硬化与骨质疏松的相关性

目的探讨中老年男性2型糖尿病(T2DM)患者颈动脉硬化与骨质疏松的相关性。方法选择T2DM患者200例,根据颈动脉内膜中层厚度(IMT)分为正常组与动脉粥样硬化组,正常组44例,IMT<1.0 mm;动脉粥样硬化组156例,IMT≥1.0 mm。比较两组年龄、病程、体重指数(BMI)、血压、血糖、血脂及不同部位骨密度。结果观察组年龄明显大于正常组,病程显著长于正常组,BMI水平显著低于正常组,收缩压(SBP)水平显著高于正常组(均P<0.05);观察组空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)水平均显著高于正常组(均P<0.05);动脉粥样硬化组Ward三角、L1~4腰椎骨密度均显著低于正常组,骨量变化率显著高于正常组(均P<0.05);两组高密度脂蛋白(HDL-C)、舒张压(DBP)相比差异无统计学意义(P>0.05)。结论中老年男性T2DM患者颈动脉硬化与骨质疏松紧密相关,年龄、病程、血糖、血脂等均可诱发颈动脉硬化与骨折疏松,同时颈动脉硬化的发展常伴有骨量变化,易发生骨质疏松。     

利拉鲁肽对2型糖尿病合并颈动脉粥样硬化患者颈动脉内膜中层厚度的影响

目的探讨利拉鲁肽对2型糖尿病(T2DM)合并颈动脉粥样硬化(CAS)患者颈动脉内膜中层厚度(IMT)的影响。方法选择新诊断T2DM合并CAS者25例(CAS组),健康对照组25例(NGT组),测定血清网膜素(Omentin)-1、脂联素(APN)、脂肪细胞因子C1q/肿瘤坏死因子(TNF)相关蛋白(CTRP)9、TNF-α水平。观察利拉鲁肽对颈动脉IMT水平的影响。结果 (1)T2DM合并CAS患者血清Omentin-1、APN、CTRP9水平低于NGT组(P<0.01);TNF-α高于对照组(P<0.01)。(2)Omentin-1、APN、CTRP9与IMT负相关(r=-0.520、-0.542、-0.642,P<0.05或P<0.01),TNF-α与IMT正相关(r=0.572,P<0.05)。(3)利拉鲁肽治疗后Omentin-1、APN、CTRP9水平显著上升(P<0.01),IMT、TNF-α水平显著下降(P<0.05或P<0.01)。(4)利拉鲁肽治疗后IMT的变化与Omentin-1、APN、CTRP9、TNF-α的变化相关(P<0.05或P<0.01)。结论利拉鲁肽能降低T2DM合并CAS患者IMT,这与调控Omentin-1、APN、CTRP9、TNF-α有关。     

2型糖尿病颈动脉粥样硬化多因素分析

采用飞利浦iuzz型彩色多普勒超声检查仪对137例2型糖尿病（T2DM）患者进行颈动脉血管检测,按颈动脉病变情况将其分为T2DM合并动脉硬化（AS）组及单纯糖尿病组（T2DM组）,并设健康对照组,分析颈动脉粥样硬化与年龄、糖尿病病程、血糖、血压、甘油三脂（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）,尿酸（UA）、24小时尿蛋白定量（U-AER）、纤维蛋白原（FIB）、HbA1c、胰岛素敏感指数（IAI）、体重指数（BMI）的相关性。结果：三个组的年龄两两之间均有统计学差异（P〈0.05）;性别构成、BMI无统计学差异。T2DM-AS组与单纯T2DM组比较,病程、高血压例数、TG、HDL-C、LDL-C、FIB、HbA1c差异均有统计学意义（P〈0.05）;其余指标差异无统计学意义。T2DMAS组与对照组比较,TG、HDL-C、LDL-C、UA、FPG、PPG、IAI、U-AER、FIB、HbA1c、SPB、DPB差异有统计学意义;其余指标差异无统计学意义。单纯T2DM组与对照组比较,LDL-C、FPG、PPG、IAI、HbA1c、SBP、DBP差异均有统计学意义（P〈0.05）;其余指标差异无统计学意义。Logistic回归分析提示糖尿病病程、有高血压、LDL-C等3个变量是颈动脉病变的危险因素,即其数值越大则越容易发生颈动脉病变;HDL-C是颈动脉病变的保护因素,其数值越大则越不容易发生颈动脉病变。结论：糖尿病合并大血管病变是多因素综合作用的结果,防治糖尿病颈动脉粥样硬化应同时进行多因素全面控制。     

老年2型糖尿病患者颈动脉粥样硬化与骨密度及骨代谢指标的关系

目的 探讨老年2型糖尿病患者颈动脉粥样硬化与骨密度及骨代谢指标的关系。方法 选取老年2型糖尿病患者100例,收集人口学特征和临床指标,使用双能X线骨密度仪检测患者骨密度,检测部位：腰椎L1～4、股骨颈、Ward三角区、全髋部,骨质疏松诊断标准：≥1个部位骨密度值低于骨量峰值2个标准差。进行颈动脉超声检查,分为颈动脉粥样硬化组、无颈动脉粥样硬化组。抽取患者清晨空腹状态下的肘静脉血,检测血清甲状旁腺激素、骨钙素、N-端骨钙素(N-MID)、25-羟维生素[25-(OH)]D浓度、总Ⅰ型胶原氨基端肽(PINP)、Ⅰ型胶原羧基端肽交联(β-CTX)浓度。结果 颈动脉粥样硬化组糖尿病病程、糖化血红蛋白、空腹血糖、低密度脂蛋白、尿酸水平明显高于无颈动脉粥样硬化组(P<0.05)。颈动脉粥样硬化组腰椎L1～4、股骨颈、Ward三角区、全髋部骨密度水平明显低于无颈动脉粥样硬化组,骨质疏松发生率明显高于无颈动脉粥样硬化组(P<0.05)。颈动脉粥样硬化组骨钙素、N-MID、25-(OH)D、总PINP水平明显低于无颈动脉粥样硬化组,β-CTX水平明显高于无颈动脉粥样硬化组(P<0.05...     

伴有代谢综合征的2型糖尿病患者血清瘦素水平及相关因素分析

选取伴有代谢综合征的2型糖尿病患者38人,正常对照组32人,测定患者身高、体重、腰围、臀围、血压、空腹血糖、空腹胰岛素、胆固醇、空腹瘦素等。结果病例组空腹瘦素HOMA-IR均显著高于对照组;在控制年龄、性别等因素后,空腹瘦素仅与BMI、HOMA-IR相关。结论伴有代谢综合征的2型糖尿病患者血清瘦素水平显著升高,瘦素水平升高与肥胖及胰岛素抵抗有关。     

农村地区老年2型糖尿病代谢综合征患者发病危险因素

目的探讨农村地区老年2型糖尿病(T2DM)代谢综合征患者发病危险因素。方法回顾性分析2010年1月至2014年1月该院就诊的235例农村地区老年T2DM患者,其中合并代谢综合征组(MS组,125例)和非代谢综合征组(非MS组,110例),对比分析两组患者的性别、年龄、糖尿病病程、体重指数(BMI)、血压收缩压(SBP)、舒张压(DBP)、血脂〔总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)〕、空腹血糖(FPG)、糖基化血红蛋白(HbA1c)、尿酸(UA)、空腹C肽(FCP)、空腹胰岛素(FINS)、超敏C反应蛋白(hs-CRP)等因素。结果 MS组与非MS组的平均年龄、性别、SBP、DBP、糖尿病病程比较差异无统计学意义(P>0.05);但MS组的体重指数(BMI)显著性高于非MS组患者(P<0.01);MS组FPG、1、2 h的餐后血糖、FINS及胰岛素抵抗(HOMA)均显著性高于非MS组(P<0.01),β细胞功能显著性低于非MS组(P<0.01);MS组血清TC、TG、LDL-C均显著性高于非MS组(P<0.05)、HDL-C显著性低于非MS组(P<0.01);MS组UA、hs-CRP、HbA1c、FCP均显著性高于非MS组(P<0.01)。多因素Logistic回归分析,BMI、UA、TC、TG、LDL-C、HDL-C为最危险因素。结论与非MS组相比,合并MS的农村地区老年糖尿病患者的BMI、UA相对较高,脂质代谢紊乱,更容易出现相关心血管并发症。     

2型糖尿病合并高尿酸血症与代谢综合征的相关性研究

目的研究2型糖尿病患者血清尿酸水平在代谢综合征发病中的作用。方法将365例2型糖尿病患者按血清尿酸水平分成两组：高尿酸水平组77例,尿酸水平正常组288例,观察血清尿酸水平与代谢综合征主要组分的相关性。结果血尿酸与血压、甘油三酯、体质指数呈正相关（P〈0．01）,与高密度脂蛋白胆固醇呈负相关（P〈0．01）;高尿酸组代谢综合征患病率为77．92％,尿酸正常组为51．04％（P〈0．01）。结论2型糖尿病患者血尿酸水平与年龄,收缩压,甘油三酯,低密度脂蛋白胆固醇及体质指数多因素相关,提示2型糖尿病高尿酸血症可能是代谢综合征发病的危险因素之一。     

老年2型糖尿病患者血尿酸水平与代谢综合征的相关性

目的探讨老年2型糖尿病(T2DM)患者血尿酸(SUA)水平与代谢综合征(MS)的相关性。方法选取齐齐哈尔医学院附属第三医院2014年1月至2016年12月老年内科就诊的老年T2DM患者,调查其基本情况,并测定相关人体参数及生化指标,分析患者SUA水平与MS的相关性。结果老年T2DM患者高尿酸血症患病率22.83%,MS患病率53.67%;高尿酸血症组与正常尿酸组比较,性别(男性)构成、体重指数(BMI)、腰臀比、空腹血糖(FPG)、餐后2 h血糖、糖化血红蛋白(Hb A1c)、空腹胰岛素(FPIN)、高血压患病率、收缩压(SBP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、SUA、MS患病率差异有统计学意义(均P<0.05);经Spearman相关分析发现,老年T2DM患者,SUA水平与FPG、FPIN、SBP、TC、TG呈正相关,与HDL-C呈负相关(均P<0.05);MSⅠ、Ⅱ、Ⅲ、Ⅳ组SUA水平逐渐升高(P<0.05);随SUA水平升高,MS发病率逐渐增高(P<0.05);经Logistic回归分析显示,与SUA<265.81μmol/L比较,老年T2DM患者265.81~319.39μmol/L、319.38~376.01μmol/L、>376.01μmol/L SUA区间MS发病风险分别为2.077、3.232、5.414(均P<0.05)。ROC分析,SUA水平300μmol/L可作为预测诊断参考,其曲线下面积(AUC)为0.620 9。结论老年T2DM患者SUA水平与MS密切相关,且SUA水平高者MS的发病风险较高。     

Microangiopathy is independently associated with presence, severity and composition of carotid atherosclerosis in type 2 diabetes

Background and aims

Common mechanisms for the development of micro- and macroangiopathic diabetic complications have been suggested. We aimed to cross-sectionally investigate strength and characteristics of the association between carotid atherosclerosis and microangiopathy in type 2 diabetic patients.

Methods and results

Common carotid artery intima-media thickness (cIMT), carotid plaque (CP) type and degree of stenosis were evaluated by ultrasound, along with the determination of anthropometric parameters, HbA1c, lipid profile, assessment of diabetic retinopathy and nephropathy, in 662 consecutive patients with type 2 diabetes mellitus (T2DM). Patients were divided according to high/low cIMT, presence/absence of CP and of retinopathy and nephropathy. Patients with CP were older, more prevalently males, past smokers, had longer diabetes duration, significantly lower HDL cholesterol and more prevalent ischemic heart disease (all p < 0.05) as compared to those with cIMT < 1 mm. Microangiopathies were more prevalent in patients with CP than in those without. At multivariate logistic regression, factors independently associated with the presence of CP were age, past smoke, HDL cholesterol, retinopathy and retinopathy plus nephropathy. A significant independent correlation of CP stenosis with stage of retinopathy and nephropathy was found. Finally, echolucent CPs were associated with a lower prevalence of proliferative retinopathy than CP containing calcium deposits.

Conclusion

In T2DM, retinopathy, alone or in combination with nephropathy, is independently associated to CP, and severity of microangiopathy correlates with severity of carotid atherosclerosis. These observations, together with the different prevalence of proliferative retinopathy according to CP types, point to possible common pathogenic mechanisms in micro- and macrovascular complications.     

2型糖尿病患者合并代谢紊乱与血管并发症相关性分析

目的观察2型糖尿病(T2DM)患者合并代谢紊乱发生情况及其与血管并发症的相关性。方法采用2004年中华医学会糖尿病学分会(CDS)关于代谢综合征诊断标准,对230例T2DM患者按合并代谢紊乱多少分为单纯T2DM组(T2DM组,n=60)、T2DM合并1种代谢紊乱组(MS1组,n=97)、T2DM合并2种代谢紊乱组(MS2组,n=50)和T2DM合并3种代谢紊乱组(MS3组,n=23)四组,比较四组患者临床及生化检查指标,观察颈动脉内膜-中层增厚(C-IMT增厚)、糖尿病视网膜病变(DR)及糖尿病肾病(DN)发生率,采用多因素Logistic回归模型分析血管并发症与合并代谢紊乱关系。结果 T2DM合并1种代谢紊乱患者占42.2%、合并2种代谢紊乱患者占21.7%、合并3种代谢紊乱患者占10.0%。与T2DM组患者比较,合并其他代谢紊乱组患者的体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)、空腹血糖(FBG)、餐后2小时血糖(2hPG)、血尿酸(UA)、三酰甘油(TG)及总胆固醇(TC)水平显著增高,差异均有统计学意义(P0.05)。与MS1组患者比较,MS2组患者BMI、SBP、DBP、FBG、2hPG、UA、TG、TC及低密度脂蛋白胆固醇(LDL-C)水平增高,高密度脂蛋白胆固醇(HDL-C)水平降低,差异有统计学意义(P0.01);MS3组患者BMI、SBP、DBP、HOMA-IR、FBG、2hPG、UA及TG水平升高,HDL-C水平降低,差异有统计学意义(P0.01)。与MS2组患者比较,MS3组患者SBP、DBP、FBG、2hPG及UA水平升高,差异有统计学意义(P0.01)。随代谢紊乱组份的增加,C-IMT增厚、DR及DN等血管并发症的发生率增加(P0.01)。分别以C-IMT增厚、DR、DN为自变量,以BMI、SBP、DBP、FBG、2hPG、TG及HDL-C为因变量,采用二分类Logistic回归分析,结果显示SBP、DBP及2hPG是C-IMT增厚的独立危险因素;DBP和TG是DR的独立危险因素;SBP和TG是DN的独立危险因素。结论 2型糖尿病合并其他代谢紊乱与C-IMT增厚、DR及DN的发生相关。     

Association between plasma growth arrest-specific protein 6 and carotid atherosclerosis in type 2 diabetes mellitus

Background and aimsGrowth arrest-specific 6 protein (Gas6) has been established to play important roles in various biological processes, but little is currently known on the role of Gas6 signaling in humans. This research explored the association between Gas6 expression and carotid atherosclerosis (AS) in type 2 diabetes mellitus (T2DM).Methods and resultsAs many as 126 T2DM patients were recruited in this study and classified into two groups based on their carotid intima-media thickness (CIMT). Meanwhile, 50 healthy individuals were recruited for the normal control group (NC). The subgroups were compared in terms of clinical data and Gas6 expression levels. Gas6 levels were decreased in T2DM patients with or without AS compared to NC subjects (9.64 ± 1.41 ng/ml, 11.38 ± 2.08 ng/ml, and 13.64 ± 2.61 ng/ml, respectively) (p < 0.001). The interaction between Gas6 and AS in T2DM was analyzed by logistic regression model and receiver operating characteristic (ROC) curve analysis. Decreased Gas6 expression was an independent risk factor relevant to AS in T2DM (p = 0.027). The area under the ROC curve to estimate the diagnostic value of low Gas6 expression for AS in T2DM was 0.750. The correlation between Gas6 and other parameters was evaluated by Pearson correlation analysis and linear regression model. Body mass index (BMI), hemoglobin A1c (HbA1c) and tumor necrosis factor-α(TNF-α) were independently correlated with Gas6.ConclusionLow Gas6 expression is an independent risk factor for AS in T2DM. Gas6 expression is affected by BMI, HbA1c and TNF-α levels.     

高尿酸血症和2型糖尿病在代谢综合征中的作用

目的评价高尿酸血症和2型糖尿病(T2DM)在代谢综合征(MS)中的作用，并探讨其可能的作用机制。方法对124例高尿酸血症和56例血尿酸正常的T2DM患者的临床资料进行研究。结果高尿酸血症合并糖尿病组的体质指数(BMI)、甘油三酯(TG)以及冠心病和高血压病的患病率高于血糖正常组，且BMI、总胆固醇(TC)、TG以及冠心病和高血压病的患病率明显高于尿酸正常对照组。结论(1)高尿酸血症与肥胖、血脂异常明显相关。(2)高尿酸血症加重了T2DM患者的代谢紊乱，T2DM也使高尿酸血症患者的代谢紊乱加重，两者共同促进了动脉粥样硬化及冠心病和高血压病的发生。     

罗格列酮联合阿托伐他汀治疗对血脂正常的2型糖尿病患者颈动脉硬化的影Ⅱ向

目的 观察罗格列酮联合阿托伐他汀治疗对血脂正常的2型糖尿病患者颈动脉硬化（CAS）的影响.方法 将218例血脂正常的2型糖尿病患者随机分为对照组、罗格列酮组、阿托伐他汀组和罗格列酮阿托伐他汀联合组.治疗前后分别检查颈动脉内中膜厚度（IMT）、管腔内径、斑块的数量和类型.结果 治疗6个月后罗格列酮和阿托伐他汀均可使2型糖尿病患者颈动脉IMT变薄、管腔内径增大、斑块的数量减少和斑块类型改变（P〈0.05）.罗格列酮阿托伐他汀联合治疗上述指标的改变更明显,对颈动脉硬化的影响效果优于单用罗格列酮或阿托伐他汀（P〈0.05）.结论 使用罗格列酮和阿托伐他汀均可延缓血脂正常的2型糖尿病患者CAS斑块的发生,同时可在一定程度上发挥稳定斑块的作用,两者合用对CAS进展的影响更大.     

High-intensity aerobic training improves endothelium-dependent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus

Background

The aim of this study is to compare the effect of physical exercise program on the endothelial function of patients with metabolic syndrome and type 2 diabetes mellitus.

Methods

Patients were randomized for high intensity aerobic training (HI: 80% maximum heart rate, n = 10), low intensity aerobic training (LI: 55% of maximum heart rate, n = 10) and control (n = 11). Before and after 6 weeks of training, subjects performed the maximal exercise test and a study of the endothelial function, through a high resolution ultrasound of the brachial artery, which was assessed after reactive hyperemia (endothelium dependent vasodilation) and nitrate administration (endothelium independent vasodilation).

Results

A total of 31 patients with metabolic syndrome and type 2 diabetes mellitus were studied, with mean age of 58 ± 6 years, The percentage diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (HI before 2.52 ± 2.85% and after 31.81 ± 12.21%; LI before 3.23 ± 3.52% and after 20.61 ± 7.76%; controls before 3.56 ± 2.33% and after 2.43 ± 2.14%; p < 0.05).

Conclusions

High intensity aerobic training improved the functional capability and endothelium dependent vasodilator response, but it does not improve the endothelium independent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus.     

THE metabolic syndrome and accurate cardiovascular risk prediction in persons with type 2 diabetes mellitus

BackgroundPersons with type 2 DM have a cardiovascular risk 2–4 times that of the normal population. Co-occurrence of metabolic syndrome (MS) with type 2 DM is associated with an increased risk of development of cardiovascular disease. The aim of this study was to determine the prevalence of the MS in patients with type 2 diabetes mellitus and to compare absolute cardiovascular risk in type 2 DM Patients with MS with those without MS.MethodsAnthropometric measurements and Blood Pressure of 340 eligible patients with type 2 DM recruited into the study were taken. Participants’ FPG, FLP and glycated haemoglobin were also estimated. Cardiovascular risk score was calculated using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Diagnosis of the MS was the International Diabetes Federation Criteria (IDF).ResultsOver 66% participants had MS. The absolute cardiovascular risk score was found to be similar in persons with type 2 DM whether they fulfilled the criteria for diagnosis metabolic syndrome or not.ConclusionThe absolute cardiovascular risk score was similar in type 2 DM patients with or without the metabolic syndrome.     

2型糖尿病患者血浆同型半胱氨酸水平与下肢动脉硬化的关系

目的 探讨血浆同型半胱氨酸（Hcy）水平与2型糖尿病（T2DM）患者下肢动脉硬化的关系,并分析影响2型糖尿病患者Hcy代谢的因素.方法 将118例2型糖尿病患者分为2组：无下肢动脉硬化并发症组（55例）和2型糖尿病合并下肢动脉硬化病变组（63例）;60例体检正常者作为正常对照组.采用酶联免疫吸附法（ELISA）测定血浆Hcy浓度,发光免疫法测定叶酸、VitB12浓度;自动生化分析仪测定空腹血糖（FBS）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、糖化血红蛋白（HbA1c）.对各组不同指标的差异进行统计学分析.结果 2型糖尿病合并下肢动脉硬化组患者血浆Hcy浓度较2型糖尿病无下肢动脉硬化组和对照组高,差异有统计学意义（P＜0.05）,血浆Hcy水平与叶酸、VitB12水平呈负相关.结论 Hcy参与了2型糖尿病下肢动脉硬化病变的发病过程,Hcy水平与叶酸、VitB12水平有关.     

血浆睾酮水平对中青年男性2型糖尿病患者罹患代谢综合征的影响

目的 探讨血浆睾酮水平对中青年男性2型糖尿病（T2DM）患者罹患代谢综合征（MS）的影响.方法 共纳入220例年龄在18 ～50岁的男性2型糖尿病患者,按照血浆睾酮浓度四分位分组,搜集一般资料、吸烟史及人体测量学指标,检测患者空腹血糖、空腹胰岛素、血脂、糖化血红蛋白（HbAlc）水平.结果 随血浆睾酮浓度升高,MS发病率下降（P＜0.05）,吸烟者比例、年龄、糖尿病病程、腰围、体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、HbAlc、HOMA-IR、三酰甘油（TG）、总胆固醇（TC）及低密度脂蛋白胆固醇（LDL-C）等均降低（P＜0.01或P＜0.05）.相关性分析显示,血浆睾酮浓度与年龄、吸烟、糖尿病病程、腰围、BMI、SBP、DBP、HbAlc、HOMA-IR、TG、TC及LDL-C等均呈负相关（P＜0.01或P＜0.05）.Logistic回归分析显示,血浆睾酮为中青年男性2型糖尿病患者罹患MS的保护性因素,其OR值为0.479（95％CI：0.249 ～0.936,P＜0.01）,在校正年龄、吸烟、糖尿病病程、HOMA-IR及HbAlc后其OR值上升为0.759（95％CI：0.598 ～ 0.963,P＜0.05）.结论 中青年男性2型糖尿病患者血浆睾酮水平与代谢综合征呈负相关,低血浆睾酮可能是其罹患谢综合征的独立危险因素.