振动觉阈值测定在农村糖尿病患者中的临床应用

采用SensiometerA数字震动感觉阀值检查仪、测定2012年1月至2012年4月在我科住院的63例农村糖尿病患者进行振动觉阀值,根据振动觉阀值风险度将其分为低风险组(<15V)32例、中风险组(15～25V)10例、高风险组(>25V)21例。比较患者周围神经病变症状、基本情况和血糖控制指标。结果低风险组、中风险组、高风险组分别占49.2%、26.9%、23.8%。各组年龄、糖尿病病程、高血压、高血脂、糖化血红蛋白呈正相关。男性,女性振动觉阀值无明显差异。与病前治疗情况、入院时血糖无明显相关性。结论:振动觉阀值与年龄、糖尿病病程、高血压、糖化血红蛋白、血脂呈正相关,年龄大、病程长,可促进糖尿病足溃疡的发生、风险率明显增加。     

初诊2型糖尿病患者微血管病变的患病率及相关危险因素分析

目的明确北京地区初诊2型糖尿病患者微血管病变(外周神经病变,视网膜病变,糖尿病肾病)的患病率,并对其相关危险因素进行分析。方法对402例新诊断的2型糖尿病患者进行眼底荧光造影和尿微量白蛋白、神经传导速度及相关指标测定,计算微血管病变的患病率,并对相关因素行Logistic回归分析。结果(1)初诊糖尿病的患者中糖尿病肾病的患病率为16.1%;糖尿病视网膜病变的患病率为18.7%;糖尿病神经病变的患病率为37.3%。(2)收缩压和糖化血红蛋白为糖尿病视网膜病变的独立危险因素。(3)年龄、收缩压、舒张压、空腹血糖、餐后两小时血糖及糖化血红蛋白为糖尿病外周神经病变的独立危险因素。(4)初诊2型糖尿病女性糖尿病视网膜病变、糖尿病肾病的患病率高于男性。结论北京地区初诊2型糖尿病微血管病变占一定比例,微血管病变的患病率存在性别差异,控制血压、血糖有利于改善糖尿病微血管病变。     

糖化白蛋白与糖尿病并发冠心病的关系

目的探讨糖化白蛋白与糖尿病并发冠心病的关系。方法测定349例糖尿病患者和340例正常对照者的血清糖化白蛋白和糖化血红蛋白浓度。糖尿病患者根据冠状动脉造影管腔直径狭窄是否超过70%分为冠状动脉非显著狭窄组(n=166)和显著狭窄组(n=183)。采用多元回归分析判断糖尿病患者冠状动脉显著狭窄的独立危险因素。结果冠状动脉显著狭窄组血清糖化白蛋白浓度显著高于非显著狭窄组和对照组(P<0.01)。血清糖化白蛋白浓度与冠状动脉血管病变数呈显著相关(r=0.19,P<0.01)。但冠状动脉非显著狭窄组和显著狭窄组之间糖化血红蛋白浓度无统计学差异。多元回归分析发现年龄≥65岁、男性、血清糖化白蛋白浓度、脂蛋白(a)和高血压是糖尿病并发冠心病的独立危险因素。结论糖尿病患者糖化白蛋白水平与冠心病发生及病变严重程度显著相关,是并发冠心病的独立危险因素。     

2型糖尿病患者听觉阈值与周围神经病变的关系分析

目的 通过比较无糖尿病的人群和2型糖尿病患者的纯音听阈值、振动觉阈值(VPT),了解2型糖尿病患者周围神经病变(DPN)与耳聋的关系.方法 测定173例研究对象的VPT及纯音听阈值,2型糖尿病患者同时测定感觉神经传导速度(SCV)和运动神经传导速度(MCV),将其分为对照组35例,无糖尿病神经病变组74例,糖尿病伴神经病变组64例.比较3组的基本情况、感音神经性耳聋(SNHL)发生率、纯音听阈值和VPT值,分析听阈值和神经传导速度的关系.结果 伴神经病变的糖尿病组SNHL发生率为29.69%,明显高于无糖尿病神经病变组(17.57%)和对照组(17.14%),且3组的年龄、糖尿病病程、HbA1c、糖化血清蛋白(GA)、空腹血糖、餐后2 h血糖、VPT和听阈值之间有显著性差异(均P＜0.05).不同VPT亚组的听阈值之间也存在明显差异(均P＜0.05).正中神经传导速度与1.00、2.00、4.00、8.00kHz听阈值呈明显负相关,logistic回归分析显示,年龄(回归系数=0.088,P＜0.01)是SNHL的独立危险因素,正中神经MCV(回归系数=-0.135,P=0.046)是影响SNHL的重要因素.结论 糖尿病患者易影响中高频听力,DPN患者常同时合并听力受损,年龄、正中神经MCV是影响SNHL的主要危险因素.

Abstract：

Objective In order to investigate the relationship between hearing loss and diabetic peripheral neuropathy( DPN ) via comparing the pure tone thresholds and vibration perception threshold(VPT) in type 2 diabetic patients and control person without diabetes. Methods 173 subjects including 138 type 2 diabetic patients(DM)and 35 non-diabetes controls were examined for VPT and hearing threshold. Nerve conducting velocity ( NCV )including sensory nerve conducting velocity( SCV )and motorial nerve conducting velocity( MCV )of diabetic patients were determined. The participants were divided into three groups: control group (n = 35 ), DM group without peripheral neuropathy( non-PN group, n = 74 ), and DM group complicated with peripheral neuropathy (PN group,n = 64 ). The clinical characteristics, biochemical parameters , the incidence of sensorineural hearing loss ( SNHL),pure tone threshold, and VPT were compared among three groups. At last, the relationship between hearing thresholds and NCV were analyzed. Results The incidence of hearing impairment of sensorineural type was 29.69% in PN group, which was significantly higher than that of non-PN group( 17.57% )and control group( 17. 14% ). There was significant differences in age, duration of diabetes, glycolated hemoglobin (HbA1c), glycolated serum albumin ( GA), Fasting blood glucose( FPG), 2h postprandial blood glucose( PPG), VPT, and hearing threshold among the three groups( all P＜0. 05 ). The value of hearing threshold increased significantly( all P＜0. 05 ) in 3 VPT subgroups with VPT≤ 15 V, VPT 16-25 V, and VPT ＞25 V. The Spearman correlation analysis showed median NCV was negatively correlated with hearing threshold on 1.00, 2.00, 4. 00, and 8. 00 kHz ( All P ＜ 0. 05 ). The logistic regression analysis indicated that the age( regression coefficient =0. 088, P＜0. 01 ) was the independent risk factor of SNHL, median nerve MCV ( regression coefficient = -0. 135, P = 0. 046 ) was the important influencing factor of SNHL. Conclusion Diabetic patients are more likely to suffer from impaired middle-frequency and high-frequency hearing, DPN in patients is often complicated with hearing impairment. Age and median nerve MCV were major risk factors of SNHL in diabetic patients.     

2型糖尿病患者视网膜病变与颈动脉内膜中层厚度的关系

目的 探讨2型糖尿病患者视网膜病变(DR)与颈动脉内膜中层厚度(IMT)之间的关系.方法 选取2008、2009年在哈尔滨医科大学附属第四医院内分泌科确诊的2型糖尿病患者123例作为观察对象,根据眼底检查结果 分为DR组和非DR(NDR)组.采集病史(病程、吸烟、家族史等),同时检测颈动脉IMT、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、体质量指数等指标.两组颈动脉IMT增厚发生率的比较采用χ2检验,两组平均颈动脉IMT值的比较采用独立样本t检验:应用Logistic回归分析糖尿病DR病变的影响因素.结果 ①DR组IMT增厚的发生率为50.98%(26/51),NDR组为33.33%(24/72),两组比较差异有统计学意义(χ2=3.85,P<0.05).②DR组平均颈动脉IMT值为(1.01±0.23)mm,NDR组为(0.91±0.24)mm,两组比较差异有统计学意义(t=-2.21,P<0.05).③单因素分析糖尿病DR病变的影响因素为;吸烟(χ2=6.20,P<0.05),病程(t=-4.13,P<0.01),高密度脂蛋白胆固醇(t=4.49,P<0.01),颈动脉IMT(t=-2.21,P<0.05),收缩压(t=-2.37,P<0.05).④Logistic回归分析糖尿病DR病变的影响因素为:病程、高密度脂蛋白胆固醇、颈动脉IMT、吸烟(χ2值分别为7.77、12.77、6.05、4.15,P均<0.01或0.05).结论 2型糖尿病DR病变患者颈动脉IMT增厚的比例明显增加,且平均颈动脉IMT厚度亦明显增加.2型精尿病合并DR病变与其颈动脉IMT厚度之间关系密切.     

振动觉阈值对糖尿病足溃疡风险的预测价值及其危险因素研究

目的探讨振动觉阈值(vibration perception thresholds,VPT)对糖尿病足溃疡风险的预测价值及其危险因素。方法采用美国振动感觉定量检查仪测定60例未发生足溃疡的2型糖尿病患者及30例正常人双足第1跖骨关节头的VPT。结果糖尿病患者的VPT显著高于年龄匹配的正常人(P<0.001)。60例糖尿病患者中VPT升高46例(76.7%),其中低度风险8例(17.4%),中度风险23例(50.0%),高度风险15例(32.6%),有糖尿病周围神经病变(diabetic peripheral polyneuropathy,DPN)症状31例(67.4%),无症状15例(32.6%)。<65岁年龄组,以低中度风险为主,≥65岁年龄组,以高度风险为主,差异有统计学意义(P<0.001)。<5年病程组,以低中度风险为主,≥5年病程组,以高度风险为主,差异有统计学意义(P<0.01)。VPT升高组与正常组比较,前者的年龄较大(P<0.001),病程较长(P<0.005)。二组性别、体重指数(BMI)、空腹血糖(FBS)、糖化血红蛋白(HbA1c)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白蛋固醇(LDL-C)、糖尿病视网膜病变合并率、心电图缺血性改变合并率、高血压合并率、吸烟率和饮酒率差异无统计学意义(P>0.05)。多元线性回归分析显示,年龄、病程是影响VPT的独立危险因素。结论VPT是一项花费小、简单无创的预测糖尿病足溃疡风险的可靠指标。增龄、病程长可促进糖尿病足溃疡的发生。     

血清25(OH)D3水平与2型糖尿病患者周围神经病变的相关性

目的探究血清25羟维生素D3〔25(OH)D3〕与2型糖尿病患者周围神经病变的相关性。方法 2型糖尿病患者120例,根据患者病情分为单纯糖尿病组(A组)50例和糖尿病合并周围神经病变组(B组)70例,收集患者临床资料,检测血清25(OH)D3水平与四肢末梢神经传导功能。以周围神经病变为因变量,年龄、病程、血清25(OH)D3含量、糖化血红蛋白、空腹C肽为自变量进行Logistics回归分析。结果两组患者临床资料对比,B组年龄、病程、糖化血红蛋白高于A组(P<0.05),空腹C肽低于A组(P<0.05)。Logistic逐级回归分析结果显示,25(OH)D3、空腹C肽同周围神经病变呈负相关(P<0.05)、年龄、病程、糖化血红蛋白与周围神经病变呈正相关(P<0.05)。结论 25(OH)D3的水平变化对糖尿病并发症周围神经病变的发生具有较大影响,糖尿病患者适度补充25(OH)D3可在某种程度上预防周围神经病变的发生。     

综合分析法诊断糖尿病周围神经病变对其临床特点和发病危险因素的影响

目的:通过临床和仪器等检查,综合分析诊断糖尿病周围神经病变,探讨其临床特点与发病相关危险因素的变化。方法:筛选434例2型糖尿病患者,收集其一般临床数据,如病史、身高、体重、血压、空腹血糖(FPG)、餐后2h血糖(PPG)、空腹血浆胰岛素(FIns)水平和血脂指标等,结合神经传导速度(NCV)、定量感觉检查(QST)(包括温度觉、振动觉、触觉和痛觉)结果,将其分为有或非糖尿病神经病变组,统计分析神经病变发病情况以及与这些指标的关系。结果:入选糖尿病患者的NCV检查异常率为52.3%,QST异常为62.9%,综合分析结果异常为63.6%,随着年龄和糖尿病病程的增长,神经病变的发生率增加;神经病变组的年龄、糖尿病病程、糖尿病家族史、吸烟史、饮酒史、身高、体重指数、收缩压、PPG、FIns水平、尿微量蛋白、血肌酐(Scr)等数据明显高于非神经病变组,并与神经病变发病相关(P<0.05),这些指标中年龄、身高、糖尿病病程、PPG、FIns水平、Scr是神经病变发病的危险因素(P<0.05)。结论:结合临床和仪器检查综合分析诊断糖尿病神经病变符合疾病的实际特点,最大限度地减少漏诊;分析后的发病相关危险因素与其他诊断方法相似。     

门诊2型糖尿病足高危患者的踝肱指数与糖尿病足的相关性研究

目的 对有下肢症状的门诊2型糖尿病患者进行踝肱指数(ankle-brachial index,ABI)监测,了解糖尿病下肢血管病变的患病率并探讨ABI与糖尿病足的关系.方法 在上海市糖尿病临床医学中心门诊就诊的1010例有下肢症状的2型糖尿病患者中测定ABI,同时测定空腹和餐后血糖、糖化血红蛋白(HbA1e)、血压、体重指数(BMI)、双下肢的振动感觉阈值等,按ABI结果将患者分为5组:A组(ABI>1.3,35例)、B组(0.91.3占3.5%(35/1010).合并足病者83例(8.02%),包括溃疡50例(4.95%),坏疽13例(1.29%),感染20例(1.98%).相关分析显示ABI与年龄、病程、收缩压、HbA1c和糖化血清白蛋白呈显著负相关(r值分别为-0.201、-0.171、-0.113、-0.160、-0.137,均P<0.01).Logistic回归分析显示ABI是糖尿病足病的独立危险因素(t=6.805,P=0.00).结论 门诊2犁糖尿病足高危患者中26.4%存在下肢动脉病变,8.02%存在足病.年龄、病程、血糖控制不佳是影响ABI的关键因素.ABI的降低与足病的发生密切关联.     

2型糖尿病视网膜病变的危险因素分析

目的 探讨导致2型糖尿病患者发生糖尿病视网膜病变的危险因素,并对其进行分析.方法 选取202例2型糖尿病患者,眼底镜观察视网膜变化,并检测HbAlc,24小时尿白蛋白定量,甘油三脂、总胆固醇,测量收缩压,舒张压.结果 202例患者中有84例合并糖尿病视网膜病变(DR),患病率为41.6%.在DR组中,尿白蛋白总量＞30 mg/24 h的2型糖尿病病例有42例,占DR组总数的67.86%;非DR组中,尿白蛋白总量＞30 mg/24 h的2型糖尿病病例有20例,占非DR组总数的16.95%.通过对两组数据的数值进行独立样本t检验,.DR组和非DR组中,收缩压,'病程,糖化血红蛋白等危险因素有统计学意义(P＜0.05),并对两组的24小时尿白蛋白定量进行非参数检验,结果显示两组的24小时尿白蛋白有显著统计学意义(P＜0.01).将上述可疑危险因素纳入Spearman相关分析,其中收缩压,病程,糖化血红蛋白及24小时尿白蛋白量与糖尿病视网膜病变有明显的相关性(P＜0.05).结论 糖尿病视网膜病变发生及其严重程度与病程、糖化血红蛋白和血压有关,其中病程长短对糖尿病视网膜病变的发生影响最大,是决定糖尿病视网膜病变发生发展的关键因素,24小时尿白蛋白总量与糖尿病视网膜病变的严重程度具有平行关系.     

住院老年2型糖尿病患者微血管病变的相关因素分析

目的探讨老年2型糖尿病患者微血管病变的构成比及相关因素。方法用回顾性分析的方法研究2003年～2010年于卫生部北京医院住院治疗的年龄≥60岁的2型糖尿病患者876例,分为糖尿病肾病(DN)组和非糖尿病肾病(非DN)组,糖尿病视网膜病变(DR)组和非糖尿病视网膜病变(非DR)组,糖尿病周围神经病变(DPN)组和非糖尿病周围神经病变(非DPN)组,计算DN、DR、DPN构成比,比较患者的临床特点,并探寻老年2型糖尿病患者DR、DN、DPN的相关因素。结果 (1)DN构成比为34.5%,DR构成比为42.4%,DPN构成比为82.3%。(2)DN与非DN两组间体质量指数(BMI)、糖尿病病程、高血压病程、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBS)、糖化血红蛋白(HbA1c)、空腹胰岛素(Fins)、高密度脂蛋白胆固醇(HDL)、甘油三酯(TG)、尿酸(UA)均有显著性差异(P<0.05或P<0.01);DR与非DR两组间仅糖尿病病程、SBP、空腹C肽(FCP)有显著性差异(均P<0.01);DPN与非DPN两组间年龄、糖尿病病程、HbA1c、TC、LDL有显著性差异(P<0.05或P<0.01)。(3)Logistic回归结果显示,DN与SBP、HbA1c、FBS、HDL、UA、糖尿病病程有关(OR值分别为1.022、1.098、1.075、0.501、1.004,1.048,P<0.05或P<0.01);DR与SBP、HbA1c、糖尿病病程有关(OR值分别为1.017、1.102、1.097,P<0.05或P<0.01);DPN与HbA1c、LDL、糖尿病病程、年龄有关(OR值分别为1.226、1.370、1.041、1.058,P<0.05或P<0.01)。结论对于老年2型糖尿病患者,DN、DR、DPN均与糖尿病病程和HbA1c有关,控制血糖对防治微血管病变意义重大,综合控制血糖、血压、血脂、尿酸可以更好的防治糖尿病微血管并发症。     

Established diabetic neuropathy seems irreversible despite improvements in metabolic and vascular risk markers--a retrospective case-control study in a hospital patient cohort.

AIMS: To gain insight into the natural history of diabetic peripheral neuropathy (DPN) and its risk factors by means of sequential quantitative testing in a hospital patient cohort. METHODS: A retrospective case-control study involving 300 diabetic patients (100 subjects with neuropathy and 200 control subjects) attending Poole Hospital diabetes clinic between 1995 and 2002. All subjects had a detailed annual clinic assessment including vibration perception threshold (VPT) and physical and metabolic assessments and were categorized according to neuropathy status. Established neuropathy was defined as a VPT > 25 V. Cross-sectional data were analysed by means of a t-test and longitudinal data by means of ANOVA. RESULTS: VPTs increased over time in neuropathy patients, with no change in control patients (P < 0.001). Glycaemic control was better over that period in control patients but the rate of improvement in HbA1c over time was similar in both groups. Triglyceride and high-density lipoprotein cholesterol levels improved in both groups, with significantly greater change in the control group. CONCLUSIONS: Data on reversibility of neuropathy are scarce and our 8-year series shows a continual deterioration in VPT in patients with a threshold > 25 V despite modest improvements in glycaemic control and lipid parameters. This work also supports a vascular association with neuropathy and identifies neuropathic patients as a high-risk cardiovascular group in whom, despite little influence on neuropathy itself, the above metabolic factors should be actively addressed.     

Exercise training can modify the natural history of diabetic peripheral neuropathy

BACKGROUND: Diabetes is the most important cause of peripheral neuropathy (DPN). No definitive treatment for DPN has been established, and very few data on the role of exercise training on DPN have been reported. AIM OF THE STUDY: We sought to examine the effects of long-term exercise training on the development of DPN in both Types 1 and 2 diabetic patients. PARTICIPANTS AND METHODS: Seventy-eight diabetic patients without signs and symptoms of peripheral DPN were enrolled, randomized, and subdivided in two groups: 31 diabetic participants [15 f, 16 m; 49+/-15.5 years old; body mass index (BMI)=27.9+/-4.7], who performed a prescribed and supervised 4 h/week brisk walking on a treadmill at 50% to 85% of the heart rate reserve (exercise group: EXE), and a control group of 47 diabetic participants (CON; 24 f, 23 m; 52.9+/-13.4 years old; BMI=30.9+/-8.4). Vibration perception threshold (VPT), nerve distal latency (DL), nerve conduction velocity (NCV), and nerve action potential amplitude (NAPA) in the lower limbs were measured. RESULTS: We found significant differences on Delta (delta) in NCV for both peroneal and sural motor nerve between the EXE and CON groups during the study period (P<.001, for both). The percentage of diabetic patients that developed motor neuropathy and sensory neuropathy during the 4 years of the study was significantly higher in the CON than the EXE group (17% vs. 0.0%, P<.05, and 29.8% vs. 6.45%, P<.05, respectively). In addition, the percentage of diabetic patients who developed increased VPT (25 V) during the study was significantly higher in the CON than the EXE group (21.3% vs. 12.9%, P<.05). Change on Hallux VPT from baseline to the end of the study was significantly different between the EXE and CON groups (P<.05); no significant change in Malleolus VPT between the two groups occurred. CONCLUSIONS: This study suggests, for the first time, that long-term aerobic exercise training can prevent the onset or modify the natural history of DPN.     

血浆同型半胱氨酸和胱抑素C与糖尿病周围神经病变的相关性研究

目的 探讨同型半胱氨酸（Hcy）和胱抑素C（Cys-C）与糖尿病周围神经病变（DPN）的相关性. 方法 选取2009年1月至2013年10月于我院就诊的T2DM患者248例,根据2010年版《中国2型糖尿病防治指南》诊断标准将对象分为亚临床糖尿病神经病变组（SDPN组）80例、糖尿病神经病变组（DPN组）52例和单纯T2DM组（T2DM组）116例.检测各组Hcy、Cys-C、FPG、HbA1 c、TG及TC等水平. 结果 3组年龄、性别比、BMI、FPG、TG、TC、HDL-C和LDL-C、SBP、DBP及血清肌酐（Scr）比较差异无统计学意义（P＞0.05）.与T2DM组比较,SDPN组和DPN组病程、Hcy和Cys-C升高（P＜0.05或P＜0.01）,且DPN组Hcy高于SDPN组（P＜0.05）.SDPN组和DPN组正中神经运动神经传导速度（MCV）和感觉神经传导速度（SCV）、腓总神经MCV和SCV较T2DM组降低（P＜0.05或P＜0.01）;DPN组正中神经MCV和SCV、腓总神经MCV和SCV较SDPN组低（P＜0.05或P＜0.01）.SDPN组和DPN组正中神经F波潜伏期和腓总神经H反射潜伏期较T2DM组升高（P＜0.05或P＜0.01）;DPN组正中神经F波潜伏期,腓总神经H反射潜伏期较SDPN组高（P＜0.05或P＜0.01）.Logistic回归分析显示,Hcy、Cys-C、病程、SBP和HbA1c是DPN的独立影响因素. 结论 SDPN和DPN患者神经反射潜伏期延长,MCV和SCV减慢,且血浆Hcy与肌电图各参数相关,提示血浆Hcy与神经传导异常相关,说明血浆Hey可作为DPN的预测因子与危险因素.这两类患者Cys-C浓度升高,且与Hcy水平相关,提示Cys-C可能与Hcy共同作用,加重DPN.     

Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening

OBJECTIVE: To evaluate the effectiveness of the Semmes-Weinstein monofilament examination (SWME) for diabetic peripheral neuropathy (DPN) screening at an outpatient clinic. METHODS: Eighty-two type 2 diabetic outpatients were questioned about 13 subjective symptoms and tested for deep reflexes. They were examined using two types of quantitative sensory testing: SWME (using 4.31/2 g and 5.07/10 g monofilaments) and vibration testing (using the C-64 quantitative tuning fork). The patients were diagnosed with DPN when two of the following three criteria from both legs were met: (1) the presence of either pain, numbness, or paraesthesia; (2) a diminished or absent ankle reflex; or (3) a scale below 4 for their vibration perception thresholds (VPT). RESULTS: The most common subjective symptoms were muscle cramps and numbness in the extremities. SWME 4.31/2 g at the great toe or the plantar aspect of the fifth metatarsal was the most useful diagnostic test for DPN, providing 60.0% sensitivity and 73.8% specificity. SWME 4.31/2 g was correlated with lower limb VPT (P=.029) and three subjective symptoms including fainting. SWME 5.07/10 g was correlated with lower limb VPT (P=.011), the ankle reflex (P=.013), the knee reflex (P=.031), and two subjective symptoms. However, the sensitivity to diagnose DPN was low (30.0%). CONCLUSIONS: The abnormalities indicated by SWME correlated well with those identified by lower limb VPT. Moreover, SWME 4.31/2 g correlated with fainting, suggesting that it could detect abnormalities in the small fibers. Considering the minimal time for this examination, SWME 4.31/2 g is a useful examination in an outpatient setting along with lower limb VPT and ankle reflex testing.     

The relative value of glycated albumin, hemoglobin A1c and fructosamine when screening for diabetes mellitus

We compared the usefulness of three glycated serum proteins, glycated albumin (GA), glycated hemoglobin (HBA1c) and fructosamine (FA), for diabetic screening purposes. We measured these indices in 302 adults, most of whom underwent yearly physical examinations. We measured GA and HbA1c with high precision using high-performance liquid chromatography (interassay coefficients of variation 4.9 and 4.0%, respectively) and FA using commercial reagents (interassay coefficient of variation 1.65%). All the individuals underwent a 75-g oral glucose tolerance test, which revealed significant correlations between the values of the three glycated proteins and the four plasma glucose concentrations measured as well as the sum of these glucose concentrations, sigma BS (GA, r = 0.80; HbA1c, r = 0.80; FA, r = 0.65). On the basis of the test, 130 of the subjects were classified as normal (N), 123 as borderline and 49 as having diabetes mellitus (D) according to the criteria of the Japan Diabetes Society. Of the 123 borderline cases, 26 showed impaired glucose tolerance (IGT) according to the WHO criteria. The normal group values of GA, HbA1c and FA were 17.8 +/- 0.17% (mean +/- SEM), 5.02 +/- 0.03%, and 2.55 +/- 0.02 mM/l, respectively. Borderline and IGT subjects had significantly more GA and HbA1c than normal but not more FA (P less than 0.01). We divided the subjects into 10 groups on the basis of their sigma BS values; those with values higher than 671 +/- 4.7 mg/dl had significantly more GA and HbA1c than normal, while those with values higher than 1068 +/- 40.9 mg/dl (the most extreme cases) had significantly more FA.(ABSTRACT TRUNCATED AT 250 WORDS)     

血管内皮生长因子基因3'-非翻译区936C/T多态性与2型糖尿病外周神经病变相关

目的 探讨血管内皮生长因子(VEGF)基因3'-非翻译区936C/T多态性与山东地区汉族人2型糖尿病合并周围神经病变(DPN)之间的关系.方法 194例糖尿病患者分为单纯糖尿病组(n=92)和糖尿病神经病变组(n=102),另120名健康个体设为健康对照组.采用PCR-限制性片段长度多态性(RFLP)方法确定全部个体的基因型;对不同基因型间及病例组间的临床与生化参数、血清VEGF浓度以及VEGF基因936C/T多态性进行了统计分析.结果 糖尿病神经病变组C等位基因及CC基因型频率显著高于对照组(x2为9.406和9.677,P＜0.05)和糖尿病组(x2为5.578和5.614,P＜0.05),而携带T等位基因的基因型(CT+TT)频率及T等位基因频率显著低于对照组(x2为9.406和9.677,P＜0.05)和糖尿病组(x2为5.578和5.614,P＜0.05).Logistic多元回归分析显示血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇、HbA1c水平以及VEGF浓度与DPN发生呈正相关,而VEGF基因936C/T多态性与糖尿病周围神经病变发病危险呈负相关(β=-1.046,OR=0.457,P=0.006,95%CI:0.166～0.741).结论 中国山东地区汉族人群中存在VEGF基因936C/T多态性,C等位基因及CC基因型患者可能是糖尿病易于发生神经病变危险性的遗传标志,而T等位基因和携带T等位基因的基因型(936TF基因型和936CT基因型)可能是降低糖尿病发生神经病变风险的遗传标志.

Abstract：

Objective To elucidate the relationship between a 936C/T mutation at 3'-untranslated region of human vascular endothelial growth factor(VEGF) gene and diabetic peripheral neuropathy ( DPN ). Methods All subjects recruited in this study were assigned into DM (n = 92, diabetes without neuropathy, retinopathy or nephropathy), DPN (n = 102, diabetes with peripheral neuropathy only ), and healthy control (n = 120 ) groups,respectively. The gene polymorphism was determined by PCR-RFLP, as well as the other clinical parameters including serum VEGF by ELISA. Results The frequencies of both genotype CC and allele C were significantly higher in DPN group than those in either DM group(x2 = 5.578 and 5.614, P＜0. 05 ) or control group (x2 = 9. 406 and 9. 677, P＜0. 05 ). However, the frequencies of genotype(CT+TT) and allele T were significantly lower in DPN group than that in either DM group(x2 =5.578 and 5.614, P＜0. 05) and control group (x2=9.406 and 9.677, P＜0.05). The multivariate logistic regression analysis showed that the levels of HbA1c, total cholesterol, low-density lipoproteincholesterol( LDL-C ), and serum VEGF positively correlated with DPN, while the 936C/T polymorphism of VEGF gene negatively correlated with DPN(β= -1. 046, OR=0. 457, P=0. 006, 95% CI: 0. 166-0. 741 ). Conclusions Allele 936C of VEGF gene may serve as a genetic marker susceptible to DPN, while allele 936T may be a protective genetic marker of DPN.     

2型糖尿病患者不同HbA1c水平和骨代谢指标的关系

目的 观察2型糖尿病患者不同HbA1c水平对骨代谢指标骨γ-羧谷氨酸包含蛋白(骨钙素)、Ⅰ型胶原交联羧基端肽(CTX-Ⅰ)、碱性磷酸酶(ALP)的影响.方法 选取2013年10月—2014年1月在哈尔滨医科大学附属第二医院内分泌科住院的120例男性2型糖尿病患者和来自体检中心的40名健康男性作为研究对象.将120例2型糖尿病患者根据HbA1c水平分为为HbA1c≤7％组、HbA1c 7％～ 9％组、HbA1c≥9％组,将40名健康男性作为对照组.采集其年龄、体重指数、病程及血钙、血磷、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶等临床指标,检测血清HbA1c、骨钙素、CTX-Ⅰ、ALP等指标.对4组间HbA1c水平与骨钙素、CTX-Ⅰ、ALP进行相关性和回归分析.结果 与对照组相比,HbA1c≤7％组、HbA1c 7％～9％组及HbA1c≥9％组血清骨钙素水平显著降低(F=7.211,P<0.05),血清ALP、CTX-Ⅰ水平显著升高(F=4.382、809.475,P<0.05);与HbA1c≤7％组相比,HbA1c7％～ 9％组和HbA1c≥9％组血清ALP水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05);与HbA1c7％～9％组相比,HbA1c≥9％组血清骨钙素水平显著降低(P<0.05),血清CTX-Ⅰ水平显著升高(P<0.05).Spearman相关分析发现,骨钙素与空腹血糖(r=-0.249,P=0.002)、糖化白蛋白(GA,r=-0.321,P=0.000)、HbA1c(r=-0.288,P=0.000)水平呈负相关,ALP、CTX-Ⅰ与空腹血糖(r=0.218、0.321)、GA(r =0.302、0.291)、HbA1c(r =0.321、0.238)水平呈正相关(P均<0.01).进一步经线性回归分析发现,骨钙素水平与GA(β=-0.086,P=0.008)、HbA1c(β=-0.502,P=0.001)呈负相关,CTX-Ⅰ水平与空腹血糖(β=0.042,P =0.003)、GA (β=0.007,P=0.015)、HbA1c(β=0.037,P=0.009)呈正相关.结论 2型糖尿病患者存在骨代谢指标异常,且HbA1 c与骨钙素、CTX-Ⅰ水平相关.     

维生素D缺乏与糖尿病周围神经病变的相关性研究

目的 研究2型糖尿病患者维生素D缺乏与糖尿病周围神经病变(DPN)的相关性.方法 选取2型糖尿病患者200例和正常对照者100名,其中2型糖尿病患者分为DPN组(109例)和无糖尿病周围神经病变(NDPN)组(91例).通过ELISA法测定25 (OH) D3水平,常规测定肝、肾功能,HbA1c,血脂,血钙、磷,β2微球蛋白,尿微量白蛋白等指标.25 (OH) D3与各指标之间进行相关性分析.结果 与正常对照组相比,NDPN组和DPN组25 (OH) D3水平降低,DPN组降低更加明显(F=202.265,P＜0.01),且DPN组维生素D缺乏患者比例(76.1％)明显高于NDPN组(47.3％)(x2=17.763,P＜0.01).维生素D水平与DPN、病程、年龄、性别、空腹血糖、HbA1c、总胆固醇、低密度脂蛋白-胆固醇、24 h尿微量白蛋白、β2微球蛋白均呈显著负相关(r=-0.315～-0.144,P均＜0.05),而与血钙呈正相关(r=0.193,P=0.006).二元Logistic回归分析显示,维生素D缺乏是DPN的独立危险因素(OR=3.564,95％ CI:1.950 ～6.511,P＜0.001).结论 维生素D缺乏是DPN的独立危险因子,并可能在2型糖尿病及DPN的发生、发展中发挥作用.