糖尿病酮症酸中毒并急发急性胰腺炎的临床探讨

目的探讨糖尿病酮症酸中毒并急发急性胰腺炎的临床表现及治疗方法。方法选取2011年9月~2013年9月在我院接受糖尿病酮症酸中毒并急发急性胰腺炎的患者52例为研究对象,均给予抑酸剂及胰岛素治疗,观察患者血淀粉酶恢复正常的时间并统计死亡率。结果患者血淀粉酶恢复正常的时间为2~15d,平均恢复正常时间为9.2d。死亡3例,均为急性坏死性胰腺炎抢救无效死亡。结论糖尿病酮症酸中毒并急发急性胰腺炎应及早诊断并实施及时治疗,以达到有效治疗以及降低死亡率的目的。     

金匮肾气丸联合西药治疗2型糖尿病临床随机对照试验系统评价

目的:系统评价金匮肾气丸治疗2型糖尿病的疗效和安全性。方法:计算机检索CBM、CNKI、万方、VIP、Chochrane Library、Pub Med,收集以金匮肾气丸联合西药降糖药为干预措施治疗2型糖尿病的随机对照试验,参照Jadad评分法对纳入研究的方法学质量进行评价并提取有效数据进行Meta分析。结果:共纳入研究7个,包括910名糖尿病患者,Meta分析结果显示金匮肾气丸联合降糖药在降低2型糖尿病患者空腹血糖、餐后2h血糖和糖化血红蛋白方面效果明显优于西药降糖药,能有效提高2型糖尿病患者治疗效果。结论:金匮肾气丸联合降糖药治疗2型糖尿病有一定的疗效且相对安全,但是由于本系统评价纳入的研究普遍为低质量试验,且试验样本量较小,因此有必要设计大样本、多中心的随机双盲对照试验以进一步证实。     

2型糖尿病患者肺通气功能临床观察

近年来的研究发现2型糖尿病对肺脏损害比较明显,肺组织也是糖尿病损害的靶器官[1-2].作者对30例2型糖尿病患者肺通气功能进行测定,观察2型糖尿病对肺通气功能的影响. 1 资料与方法 选择住院的2型糖尿病患者30例(糖尿病组),按照1999年WHO糖尿病诊断标准确诊为2型糖尿病,其中男性18例,女性12例,年龄40～72岁,平均(58.6±7.5)岁;糖尿病病程3～10年,平均(4.5±2.1)年;所有病例无急慢性呼吸系统疾病及吸烟史.     

授权教育对于2型糖尿病患者干预效果的系统评价

目的系统评价授权教育对于2型糖尿病患者的干预效果。方法计算机检索中英文数据库有关授权教育干预2型糖尿病患者的随机对照试验,按照纳入和排除标准进行文献质量评价后,采用RevMan5.3软件进行数据分析。结果最终纳入10项研究,共计1328例患者,系统评价结果显示:授权教育可提高2型糖尿病患者的自我效能、授权能力,降低2型糖尿病患者的空腹血糖水平(均P0.01)。结论授权教育能够改善2型糖尿病患者的自我效能,提高患者的授权能力,降低患者的空腹血糖水平,但对于改善糖尿病患者的健康促进生活方式还有待进一步的验证。     

成人迟发自身免疫性糖尿病临床特征分析

目的：探讨成人迟发自身免疫性糖尿病(LADA)的临床特征。方法：比较谷氨酸脱羧酶(GADA)及胰岛细胞抗体(ICA)阳性的LADA患者与2型糖尿病患者的急慢性并发症的患病率。结果：LADA患者的年龄、体重指数、空腹及餐后C肽水平均低于2型糖尿病，而酮症发生率高；视网膜病变、肾脏病变、高血压发生率低于2型糖尿病，而冠心病、脑梗塞两者无差异。结论：LADA的临床特征与2型糖尿病有所不同。     

2型糖尿病并发肺结核160例临床治疗体会

2型糖尿病急慢性并发症对于患者的生命危害极大,由于长期的血糖升高使得患者呼吸道免疫功能减退,从而极易导致外来细菌的感染.而结核菌正是2型糖尿病临床上常见的感染菌之一,糖尿病患者肺结核患病率是普通人群的10倍.本研究收集了近6年本院的2型糖尿病并发肺结核160例进行分析,探讨其临床特点其分析如下.     

初诊为暴发性糖尿病的2型糖尿病酮症酸中毒合并急性胰腺炎一例报道

糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)多为1型糖尿病所致,且其中有20%发生于初发的糖尿病患者,其余80%发生于已明确诊断为糖尿病的患者[1]。以DKA为首发症状起病的2型糖尿病并不多见,本文对1例发生DKA的2型糖尿病患者进行报道。病例:患者26岁,男性,既往体重105 kg,体质量指数(BMI)为32.41 kg/m2,半年前体检查出高三酰甘油(TG)     

血压管理对2型糖尿病患者脑卒中再复发影响的研究进展

从血压管理对预防2型糖尿病患者脑卒中再发的重要性、伴有脑卒中的2型糖尿病患者血压控制目标及其具体的血压管理策略等方面,对2型糖尿病患者脑卒中再复发血压管理方面的研究进行综述,旨在为临床伴有脑卒中的2型糖尿病患者的血压管理提供依据。     

2型糖尿病并发肺结核160例临床治疗体会

2型糖尿病急慢性并发症对于患者的生命危害极大，由于长期的血糖升高使得患者呼吸道免疫功能减退，从而极易导致外来细菌的感染。而结核菌正是2型糖尿病临床上常见的感染菌之一，糖尿病患者肺结核患病率是普通人群的10倍。本研究收集了近6年本院的2型糖尿病并发肺结核160例进行分析，探讨其临床特点其分析如下。     

中国人Resistin基因SNP-420C/G多态性与2型糖尿病发病风险关系的Meta分析

目的利用Meta分析的方法,综合评价Resistin基因SNP-420C/G位点多态与中国汉族人2型糖尿病发病的相关性。方法计算机检索2001年1月～2010年7月CNKI、万方、VIP、中国生物医学服务系统(SinoMed)和PubMed数据库,并手工检索相关杂志,收集有关中国汉族人群Resistin基因-420C/G位点多态的基因型频率和/或等位基因频率的独立病例对照研究。在评价纳入研究质量,提取有效数据后,采用RevMan 4.2软件进行Meta分析。结果共纳入5个病例对照研究,包括2型糖尿病组709例,对照组572例。Meta分析结果显示:以CC基因型为暴露因素,具有CC基因型的人群2型糖尿病发病风险无明显增高[OR=1.02,95%CI(0.81,1.29)];以GG基因型为暴露因素,具有GG基因型的人群2型糖尿病发病风险无明显增高[OR=1.34,95%CI(0.95,1.90)]。结论本Meta分析结果提示,中国汉族人群Resistin基因SNP-420C/G位点多态可能与2型糖尿病的发病不相关。     

Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis

BACKGROUND AND STUDY AIM: The identification of factors which increase the risk of acute pancreatitis, the most common and most severe complication of endoscopic retrograde cholangiopancreatography (ERCP), is of considerable importance. However, in four large prospective studies, the reported incidence of identified risk factors for post-ERCP pancreatitis was found to be variable. The aim of this study was to identify the most important risk factors for post-ERCP pancreatitis. MATERIAL AND METHODS: We performed a meta-analysis of 15 prospective clinical studies, selected out of 52 reviewed articles, in which risk factors for pancreatitis were identified. Of the 14 risk factors identified, five were patient characteristics and nine were related to the endoscopic technique. RESULTS: When patient-related risk factors were analysed, the relative risk for suspected sphincter of Oddi dysfunction was 4.09 (95 % CI 3.37 to 4.96; P < 0.001); for female gender, 2.23 (95 % CI 1.75 to 2.84, P < 0.001); and for previous pancreatitis, 2.46 (95 % CI 1.93 to 3.12, P < 0.001). Two endoscopy-related factors were confirmed: for precut sphincterotomy the relative risk was 2.71 (95 % CI 2.02 to 3.63, P < 0.001); for pancreatic injection the relative risk was 2.2 (95 % CI 1.6 to 3.01, P < 0.001). CONCLUSIONS: This meta-analysis provides a clear basis for planning pharmacological studies or studies of new endoscopic techniques in patients at high risk of developing post-ERCP pancreatitis. Knowing which patients are most at risk may also make it easier to decide who should be considered unsuitable for same-day discharge.     

中国人群脂联素基因+45位点基因多态性与2型糖尿病相关性的Meta分析

目的通过Meta分析评估中国人群脂联素基因外显子二+45位点单核苷酸多态性与2型糖尿病的相关性。方法计算机检索PubMed、Ovid、CBM、VIP、CNKI和WanFang Data中关于中国人群脂联素基因SNP45与2型糖尿病相关性的病例-对照研究,并辅以文献追溯。检索时限均从建库至2012年6月。由2名评价者按纳入排除标准独立选择文献、提取资料、评价质量后采用Stata 11.0软件进行Meta分析,采用分层和敏感性分析评估结果稳定性,并用Begg’s漏斗图和Egger’s法评估文献的发表偏倚。结果共纳入21篇文献(含22个研究),其中2型糖尿病患者3 273例,对照人群2 597例。Meta分析结果显示,无论在显性、隐性或加性遗传模式下,两组差异均有统计学意义[OR(95%CI)分别为1.36(1.04,1.78)、2.07(1.55,2.75)、2.44(1.59,3.75)]。结论脂联素基因外显子二+45位点基因多态性与中国人群的2型糖尿病具有相关性。不论是在显性、隐性还是在加性遗传模式下,G等位基因均为2型糖尿病的危险因素。     

Efficacy and Safety of Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation Undergoing Elective Surgical Procedures: A Meta-analysis

Objective: The study objective was to determine if peri-operative bridging anticoagulation in patients with atrial fibrillation is beneficial or harmful.Design: Systematic review and meta-analysis.Setting: Inpatient or in-hospital setting.Participants: Adults with atrial fibrillation having a CHADS2 score >1 undergoing elective surgical procedure on anticoagulation.Methods: A systemic search of multiple databases (Cochrane, Medline, PubMed) was performed regarding studies conducted on efficacy and safety of perioperative bridging anticoagulation in patients with atrial fibrillation. Studies identified were reviewed by two authors individually before inclusion. The results were then pooled using Review Manager to determine the combined effect. Stroke/systemic embolism was considered as the primary efficacy outcome. Major bleeding was the primary safety outcome.Results: The systematic search revealed 108 potential articles. The full texts of 28 articles were retrieved for assessment of eligibility. After full text review, 25 articles were excluded. Three articles met inclusion criteria. No significant difference in stroke/systemic embolism with bridging anticoagulation was noted (risk ratio, 1.25-95% confidence interval [CI], 0.55–2.85). Bridging was associated with significantly higher risk of major bleeding (risk ratio, 3.29-95% CI, 2.25–4.81).Conclusion: An individualized approach is required when initiating peri-operative bridging anticoagulation. There is certainly a higher risk of bleeding with bridging anticoagulation and no difference in stroke/systemic embolism. However, the results cannot be extrapolated to patients who have valvular atrial fibrillation or CHADS2 score of 5 or greater.     

The time to onset and overall analgesic efficacy of rofecoxib 50 mg: a meta-analysis of 13 randomized clinical trials

OBJECTIVE: To determine the time to onset of analgesia of rofecoxib based on a patient-level meta-analysis of randomized, placebo-controlled, postoperative oral surgery pain studies. METHODS: A search on MEDLINE and of Merck data on file was conducted to identify studies that met the inclusion criteria. Meta-analysis inclusion criteria required that patients were treated with a single oral dose of rofecoxib 50 mg when they experienced moderate or severe pain after surgical extraction of > or = 2 third molars; study design involved patient randomization, double-blinding, and matching placebo, and onset data from individual patients were available. The meta-analysis of time to onset also required that studies used the two-stopwatch method. Eleven studies fulfilled the onset criteria and included patients who received a single dose of rofecoxib 50 mg (N = 1220) or placebo (N = 483). These studies were analyzed to determine time to onset of analgesia, time to perceptible pain relief, percentage of patients achieving onset of analgesia, and duration of analgesia. Six of the 11 studies included a nonselective nonsteroidal anti-inflammatory drug (N = 303) and were included in the onset meta-analysis for comparison. The meta-analysis of overall efficacy also required that data on total pain relief scores over 8 hours were available. Over-all effectiveness of analgesia was based on analysis of 13 studies involving 1330 rofecoxib patients and 570 placebo patients on the endpoints of total pain relief scores over 8 hours and patient global assessment of response to therapy at 24 hours. Eight of the 13 studies with a nonselective nonsteroidal anti-inflammatory drug comparator (N = 391) were included for the efficacy meta-analysis. RESULTS: Patient demographics and baseline characteristics were similar across treatment groups in each study. Median time to onset of analgesia for rofecoxib was 34 minutes (95% CI, 31-38 minutes), significantly faster than placebo, which did not achieve onset within the 4 hours the assessment was conducted (P < 0.001). Duration of analgesia for rofecoxib 50 mg was > 24 hours. Rofecoxib achieved a greater mean total pain relief score over 8 hours than placebo (17.4 versus 4.4; P < 0.001) and a greater patient response rate on patient global assessment of response to therapy at 24 hours than placebo (73% versus 16%; P < 0.001). Outcomes were similar between the rofecoxib group and the nonselective nonsteroidal anti-inflammatory drug group. CONCLUSION: In this meta-analysis of over 1200 rofecoxib-treated patients, a single dose of rofecoxib 50 mg demonstrated a rapid onset of analgesia in approximately half an hour combined with sustained effectiveness, supporting its use as a treatment of acute pain.     

肾移植后糖尿病：可改变与不可改变的危险因素

背景：肾移植后糖尿病是肾移植的主要并发症,了解其发生的危险因素并进行预防,可提高肾移植患者的存活率。目的：探讨肾移植后糖尿病发生的高危因素。方法：应用文献检索的方法获取肾移植后糖尿病发生危险因素的相关研究文献,对符合研究标准的文献进行深入的数据分析。对进行肾移植的患者进行空腹血糖、餐后2 h血糖、糖化血红蛋白以及肝功能、免疫抑制剂浓度谷值等各项指标的检测观察,分析肾移植后糖尿病的发生是否与患者性别、年龄、体质量指数、糖尿病家族史、肾移植后糖尿病起病时间、肝功能以及免疫抑制剂和激素的应用等因素有关。结果与结论：研究结果显示,肾移植后糖尿病患者的症状不典型,起病早,胰岛功能受损,肝功能异常。肾移植患者的年龄、体质量指数、糖尿病家族史、糖耐量异常、肝功能异常以及免疫抑制剂的应用均是肾移植后糖尿病发生的高危因素,而患者性别则与肾移植后糖尿病的发生无明显相关性。了解肾移植后糖尿病发生的高危因素有助于预防移植后糖尿病的发生,提高肾移植患者的存活率。     

New-Onset Diabetes After Acute and Critical Illness: A Systematic Review

Hyperglycemia is commonly observed during acute and critical illness. Recent studies have investigated the risk of developing diabetes after acute and critical illness, but the relationship between degree of in-hospital hyperglycemia and new-onset diabetes has not been investigated. This study examines the evidence for the relationship between in-hospital hyperglycemia and prevalence of new-onset diabetes after acute and critical illness. A literature search was performed of the MEDLINE, EMBASE, and Scopus databases for relevant studies published from January 1, 2000, through August 4, 2016. Patients with no history of diabetes before hospital discharge were included in the systematic review. In-hospital glucose concentration was classified as normoglycemia, mild hyperglycemia, or severe hyperglycemia for the meta-analysis. Twenty-three studies were included in the systematic review, and 18 of these (111,078 patients) met the eligibility criteria for the meta-analysis. The prevalence of new-onset diabetes was significantly related to in-hospital glucose concentration and was 4% (95% CI, 2%-7%), 12% (95% CI, 9%-15%), and 28% (95% CI, 18%-39%) for patients with normoglycemia, mild hyperglycemia, and severe hyperglycemia, respectively. The prevalence of new-onset diabetes was not influenced by disease setting, follow-up duration, or study design. In summary, this study found stepwise growth in the prevalence of new-onset diabetes with increasing in-hospital glucose concentration. Patients with severe hyperglycemia are at the highest risk, with 28% developing diabetes after hospital discharge.     

Acute Pancreatitis in Association With Type 2 Diabetes and Antidiabetic Drugs: A population-based cohort study

OBJECTIVE

Previous observational studies have found an increased risk of acute pancreatitis among type 2 diabetic patients. However, limited information is available on this association and specifically on the role of antidiabetic treatment. Our aim, therefore, was to further assess the risk of acute pancreatitis in adult patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We performed a population-based case-control analysis nested in a cohort of 85,525 type 2 diabetic patients and 200,000 diabetes-free individuals from the general population using data from The Health Improvement Network database. Subjects were followed up to ascertain incident cases of acute pancreatitis.

RESULTS

We identified 419 cases of acute pancreatitis, 243 in the general population and 176 in the diabetes cohort. Incidence rates were 30.1 and 54.0 per 100,000 person-years in the general population and the diabetes cohort, respectively. In the cohort analysis, the adjusted incidence rate ratio of acute pancreatitis in diabetic patients versus that in the general population was 1.77 (95% CI 1.46–2.15). The magnitude of this association decreased with adjustment for multiple factors in the nested case-control analysis (adjusted odds ratio 1.37 [95% CI 0.99–1.89]). Furthermore, we found that the risk of acute pancreatitis was decreased among insulin-treated diabetic patients (0.35 [0.20–0.61]).

CONCLUSIONS

Type 2 diabetes may be associated with a slight increase in the risk of acute pancreatitis. We also found that insulin use in type 2 diabetes might decrease this risk. Further research is warranted to confirm these associations.Acute pancreatitis is defined as an acute inflammatory process of the pancreas. The incidence of acute pancreatitis in the general population shows geographical variation. Incidence rates reported in the literature range between 4 and up to >100 cases per 100,000 person-years in the western world (1–3). Data from western countries suggest that the incidence of acute pancreatitis has been increasing over the last 40 years (3).The reason for this increase is unknown. However, a concurrent trend has been the rapid, worldwide increase in type 2 diabetes and obesity. Several clinical factors associated with type 2 diabetes and obesity are known or putative risk factors for acute pancreatitis (e.g., gallstone disease). Therefore, it can be hypothesized that in type 2 diabetic patients the risk of acute pancreatitis might be higher than that for the general population (2). Studies exploring whether diabetes or antidiabetic treatment may act as risk factors for the development of acute pancreatitis have been limited so far (2,4–6). Three observational studies reported an approximately two- to threefold increased risk of acute pancreatitis among diabetic patients (2,4,5). The purpose of this study was to further assess the risk of acute pancreatitis in association with type 2 diabetic patients and antidiabetic treatment.     

Risk factors for pancreatitis after pancreatic sphincterotomy: a review of 572 cases

BACKGROUND AND STUDY AIMS: Endoscopic pancreatic sphincterotomy is indispensable for many therapeutic endoscopic maneuvers, but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). In this study, this subgroup of patients was investigated in order to identify risk factors and protective factors. PATIENTS AND METHODS: A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria. Charts were examined for indications, endoscopic technique, and outcomes, including pancreatitis. RESULTS: A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period. Indications for sphincterotomy included chronic pancreatitis (n = 398), access for tissue sampling (n = 52), acute recurrent pancreatitis (n = 45), transpapillary drainage of a pancreatic pseudocyst (n = 32), precut access to the common bile duct (n = 29), and others (n = 16). Pancreatic duct drainage was performed in 69.1 % of the procedures (nasopancreatic catheter, n = 290, or pancreatic stent placement, n = 105). Post-ERCP pancreatitis occurred in 69 cases (12.1 %) and was severe in 10. The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis, while an elevated C-reactive protein level, pancreatic ductal stones, sphincterotomy at only the major papilla, and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk. CONCLUSIONS: This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis. In addition to providing further definition of which patients are at risk, it also suggests that pancreatic duct drainage is an independently significant protective maneuver.