2型糖尿病患者血液流变学检测的临床价值分析

2型糖尿病fdiabetesmellitus）是一组以慢性血葡萄糖（简称血糖）水平增高为特征的代谢病群。主要特点是血糖过高、糖尿、多尿、多饮、多食、消瘦和疲乏。随着人们生活水平的提高,人口老龄化以及肥胖发生率的增加,2型糖尿病的发病率呈逐年上升趋势。我们对2005年1月-2008年8月来我院就诊的2型糖尿病患者186例进行了血液流变学指标与血糖和糖化血红蛋白（HbAlc）的检测及相关性分析,现做如下报告。     

检测2型糖尿病患者C-反应蛋白的临床意义分析

目的探讨C-反应蛋白水平的变化在2型糖尿病患者中的临床意义。方法 2011年10月—2012年4月用免疫比浊法和己糖激酶法分别检测118例2型糖尿病患者和55名正常健康体检者的血清C-反应蛋白和空腹血糖水平,同时用Sysmex XT-1800i全自动五分类血细胞分析仪检测白细胞水平,并对各组检测结果进行对比分析。结果空腹血糖、C-反应蛋白和白细胞计数水平观察组分别为(8.50±1.18)mmol/L、(5.92±1.85)mg/L、(7.28±1.25)×109/L;对照组分别为:(4.95±0.54)mmol/L、(1.31±0.47)mg/L、(5.46±0.91)×109/L。两组比较差异均有统计学意义(均P﹤0.05)。结论 C-反应蛋白是发展为2型糖尿病的重要预测因子,可作为2型糖尿病的早期协助诊断指标之一,其与白细胞联合检测对2型糖尿病患者治疗效果的监测具有重要的临床意义。     

空腹血糖与糖化血红蛋白在2型糖尿病诊断中的应用

目的评估空腹血糖（FPG）和糖化血红蛋白（HbAlc）诊断2型糖尿病（T2DM）的敏感性和特异性。探讨FPG、HbAlc及联合指标诊断T2DM的最佳切点。方法采用WHO糖尿病诊断标准,将423例研究对象分为T2DM组（n=60）和非T2DM组（n=363）,所有受试者均行口服葡萄糖耐量试验（OGTT）,同时测定其FPG及HbAlc。绘制FPG和HbAlc诊断糖尿病的受试者工作曲线（ROC曲线）。结果①HbAlc诊断T2DM的切点为6．1％,此时灵敏度为91．7％,特异度为78．5％,曲线下面积0．910（95％CI,0．873～0．946）,阳性预测值（＋PV）为41．4％,阴性预测值（-PV）为98．3％,You＆n指数为O．702,正确率为80．4％,Kappa值为0．465。HbAlc≥6．5％时,灵敏度为61．7％,特异度为93．7％,＋PV为61．7％、-Py为93．7％,Youden指数为0．553,正确率为89．1％,Kappa值为O．553。②FPG诊断T2DM的切点为6．09mmol／L,此时灵敏度83．3％,特异度89．3％,曲线下面积0．898（95％CI,0．885-0,957）,＋PV50．5％,一州96．9％。Youden指数0．726,正确率86．1％,Kappa值0．549。当FPG≥7．00mmol／L时,灵敏度33．3％,特异度99．2％,＋w87．0％、-PV90．0％、Youden指数0．325、正确率89．8％、Kappa值0．438。③HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有较好的诊断性能。且优于单个指标,此时的灵敏度83．3％．特异度93．7％,＋PV68．5％,-PV97．1％,Youden指数0．770,正确率92．2％,Kappa值0．706。结论HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有很好的灵敏度和特异度,且Youden指数、正确率、Kappa值都高于其他指标,与OGTT有很好的一致性,对T2DM的诊断有较好应用价值。     

2型糖尿病病人的护理干预效果观察

目的：探究2型糖尿病病人的护理干预效果。方法：抽取2012年6月～2013年6月在我院就诊的120例2型糖尿病患者作为研究对象,按随机数字表法分为观察组与对照组,各60例;对照组患者给予常规护理,观察组患者给予综合护理干预;对两组患者不良行为改善情况及治疗前后空腹血糖（FBG）改善情况进行观察比较。结果：观察组患者不良行为改善情况明显优于对照组,两组数据差异显著（P<0.05）,有统计学意义;两组患者治疗后的空腹血糖较治疗前均呈现下降趋势,观察组下降程度明显优于对照组,两组数据显著（P<0.05）,有统计学意义。结论：对于2型糖尿病患者,采取综合护理干预效果显著,能够有效改善患者饮食、服药及运动等方面的不良行为,同时能够使患者血糖得到有效控制。     

2型糖尿病病人的护理干预效果观察

目的:探究2型糖尿病病人的护理干预效果。方法:抽取2012年6月~2013年6月在我院就诊的120例2型糖尿病患者作为研究对象,按随机数字表法分为观察组与对照组,各60例;对照组患者给予常规护理,观察组患者给予综合护理干预;对两组患者不良行为改善情况及治疗前后空腹血糖(FBG)改善情况进行观察比较。结果:观察组患者不良行为改善情况明显优于对照组,两组数据差异显著(P<0.05),有统计学意义;两组患者治疗后的空腹血糖较治疗前均呈现下降趋势,观察组下降程度明显优于对照组,两组数据显著(P<0.05),有统计学意义。结论:对于2型糖尿病患者,采取综合护理干预效果显著,能够有效改善患者饮食、服药及运动等方面的不良行为,同时能够使患者血糖得到有效控制。     

代谢综合征组分对2型糖尿病影响及预测

目的 探讨代谢综合征(MS)各组分与2型糖尿病(T2DM)发病的关系,比较MS与空腹血糖受损(IFG)在预测T2DM时的作用.方法 采用队列研究方法,对黑龙江省电业局1 318人(≥30岁)按MS和非MS分组后进行5年随访,每年定期进行问卷调查和身体检查,获取血糖(GLU)、腰围(WC)、血压(BP)等数据,进行分析比较.结果 随访5年后,MS组发病73人,非MS组发病25人,2组间差异有统计学意义;MS及其组分中GLU、WC、和BP都会增加T2DM的发病风险;MS(RR=7.83,P<0.01)和GLU(RR=7.72,P<0.01)较强,WC和BP相对弱一些,而高密度脂蛋白(HDL)、甘油三酯(TG)对T2MD的发病基本无影响;灵敏度等指标分析表明,MS与GLU的灵敏度、特异度均较好,阳性预测值、正确指数较高;ROC曲线分析表明,在预测T2DM时,ROC曲线下面积(Az)MS(Az₁=0.786,P=0.000)高于IFG(Az₂=0.729,P=0.000),差异有统计学意义(U=2.75,P<0.05),表明MS和IFG对T2DM都有较高的预测价值,但MS稍高于IFG.结论 MS及其组分中的GLU、WC和BP都会增加T2DM的发病风险,特别是MS作为一个整体时预测价值较高,稍高于IFG.     

藏族居民2型糖尿病及空腹血糖受损情况调查

目的 了解西藏自治区拉萨市城镇藏族居民2型糖尿病和空腹血糖受损情况.方法 随机抽样调查30～70岁藏族居民370人.采用世界卫生组织诊断标准,判定2型糖尿病和空腹血糖受损情况,同时进行问卷调查及血糖、血脂的测量,计算体质指数和腰臀比.结果 拉萨市30～70岁城镇居民糖尿病患者率为7.6%.其中,男性为2.2%,女性为10.3%,差异有统计学意义,P=0.009.空腹血糖受损的患病率为13.5%.其中男性为11.0%,女性为15.0%,P=0.405.30～69岁人群年龄结构与世界人口年龄进行标化后,糖尿病的患病率为7.2%,其中男性为2.1%.女性为8.9%.结论 藏族居民2型糖尿病患病率与2002年的调查结果相比,有逐年增高趋势;女性糖尿病的患病率高于男性.空腹血糖受损人群患病率较高.     

糖化血红蛋白检测在糖尿病患者中的应用

目的探讨糖化血红蛋白（HbA1c）检测在糖尿病患者中的应用。方法选择80该院收治的糖尿病患者为观察组,选择同时期在该院进行健康体检的80例体检者为对照组,检测两组的HbA1c、空腹血糖及餐后2h血糖。结果经过检测,观察组的HbA1c、空腹血糖及餐后2h血糖显著高于对照组,差异有统计学意义（P〈0.05）。结论对于糖尿病患者,HbA1c检测优于多次连续血糖测定,是评价长期血糖控制的良好指标,有很高的准确性、敏感性与特异性,对指导临床调整、制订合理的治疗方案有重要临床意义[1]。     

门冬胰岛素30治疗2型糖尿病40例

目的探讨早期使用门冬胰岛素30治疗2型糖尿病的临床效果。方法选择2010年1月—2013年6月收治的2型糖尿病患者80例,随机分为对照组和观察组各40例。所有患者入院均签署知情同意书,两组均给予饮食控制、运动控制、健康教育,对照组根据患者病情给予口服降糖药治疗,观察组给予门冬胰岛素30注射液早晚餐前注射,起始剂量0.5U·kg-1·d-1,根据餐前、餐后指尖血糖变化调节剂量。两组均治疗14 d,比较两组治疗前后空腹和餐后2 h血糖及并发症。计量资料采用t检验,P<0.05为差异有统计学意义。结果治疗后观察组空腹和餐后2 h血糖[(5.4±1.3)、(6.3±1.5)mmol/L]均低于对照组[(8.6±1.7)、(10.7±2.1)mmol/L],比较差异均有统计学意义(均P<0.05)。并发高血糖、低血糖、酮症酸中毒对照组分别为8、8、1例,观察组均为1例。结论门冬胰岛素30治疗2型糖尿病能更好地控制血糖,减少并发症发生,提高临床疗效。     

上海市某社区老年2型糖尿病患者管理效果

目的 了解上海市浦东新区塘桥社区65岁以上老年人2型糖尿病的患病情况和管理效果,以及影响老年人空腹血糖(FBG)达标的相关因素。方法 通过问卷调查包括主要病史、饮食、体育锻炼、饮酒、吸烟情况,体格检查包括身高、体重、腰围、臀围和血压,以及实验室检测包括空腹静脉血糖、肝肾功能、血脂等来调查和评估社区老年2型糖尿病患者的管理效果。结果 在4 219名65岁以上老年人中,有807名明确诊断为2型糖尿病的患者,2型糖尿病患病率为19.1%。2型糖尿病患者空腹血糖达标率为59.4%。在无明确糖尿病病史的人群中FBG异常的有603人,异常率为14.3%。FBG未达标的老年2型糖尿病患者和FBG异常者收缩压、体质指数、腰围、腰臀比、总胆固醇、三酰甘油水平均值都不同程度地高于FBG达标的老年2型糖尿病患者,差异有统计学意义(P<0.05)。logistic回归分析显示:腹型肥胖、高收缩压是影响FBG达标的独立危险因素;经常体育锻炼、高密度脂蛋白胆固醇增高是促进FBG达标的独立保护因素。结论 上海市塘桥社区老年居民2型糖尿病的患病率较高,FBG异常发生率较高。影响老年2型糖尿病患者FBG达标的因素是高血压、腹型肥胖和缺乏锻炼。在老年2型糖尿病干预过程中要同时加强对血脂和血压的管理。加强体育锻炼、控制体重是有效管理糖尿病的重要措施。     

Serum Vitamin D Affected Type 2 Diabetes though Altering Lipid Profile and Modified the Effects of Testosterone on Diabetes Status

Numerous studies have investigated the associations between serum vitamin D or testosterone and diabetes; however, inconsistencies are observed. Whether there is an interaction between vitamin D and testosterone and whether the lipid profile (total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)) mediates the association between vitamin D and diabetes is unclear. To investigate the effect of vitamin D and testosterone on impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM), 2659 participants from the Henan Rural Cohort were included in the case-control study. Generalized linear models were utilized to estimate associations of vitamin D with IFG or T2DM and interactive effects of vitamin D and testosterone on IFG or T2DM. Principal component analysis (PCA) and mediation analysis were used to estimate whether the lipid profile mediated the association of vitamin D with IFG or T2DM. Serum 25(OH)D₃, 25(OH)D₂, and total 25(OH)D levels were negatively correlated with IFG (odds ratios (ORs) (95% confidence intervals (CIs)): 0.99 (0.97, 1.00), 0.85 (0.82, 0.88), and 0.97 (0.96, 0.98), respectively). Similarity results for associations between serum 25(OH)D₂ and total 25(OH)D with T2DM (ORs (95%CIs): 0.84 (0.81, 0.88) and 0.97 (0.96, 0.99)) were observed, whereas serum 25(OH)D₃ was negatively correlated to T2DM only in the quartile 2 (Q2) and Q3 groups (both p < 0.05). The lipid profile, mainly TC and TG, partly mediated the relationship between 25(OH)D₂ or total 25(OH)D and IFG or T2DM and the proportion explained was from 2.74 to 17.46%. Furthermore, interactive effects of serum 25(OH)D₂, total 25(OH)D, and testosterone on T2DM were observed in females (both p for interactive <0.05), implying that the positive association between serum testosterone and T2DM was vanished when 25(OH)D₂ was higher than 10.04 ng/mL or total 25(OH)D was higher than 40.04 ng/mL. Therefore, ensuring adequate vitamin D levels could reduce the prevalence of IFG and T2DM, especially in females with high levels of testosterone.     

Distribution of fasting plasma glucose and prevalence of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes in the Mexican paediatric population

Published data on the distribution of fasting plasma glucose (FPG) in children are scarce. We therefore set out to examine the distribution of FPG and determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2-DM) in Mexican children aged 6–18 years in a community-based cross-sectional study. A total of 1534 apparently healthy children were randomly enrolled and underwent an oral glucose tolerance test. IFG was defined by an FPG value between ≥100 and <126 mg/dL, IGT by glucose concentration 2-h post-load between ≥140 and <200 mg/dL, and T2-DM by glucose concentration 2-h post-load ≥200 mg/dL.
The FPG level at the 75^th percentile of distribution was 98.0, 100.0 and 99.0 mg/dL for children aged 6–9, 10–14 and 15–18 years, respectively; the 95^th percentile of FPG was greater than 100 mg/dL for all the age strata. In the population overall, the prevalences of IFG, IGT, and T2-DM were 18.3%, 5.2% and 0.6%, respectively. Among obese children and adolescents, the prevalences of IFG, IGT, IFG + IGT and T2-DM were 19.1%, 5.7%, 2.5% and 1.3%. Our study shows a high prevalence of prediabetes and is the first that reports the distribution of FPG in Mexican children and adolescents.     

2型糖尿病患者进食不同食物对餐后2h血糖的影响

目的 观察糖尿病患者进食不同种类的食物对餐后血糖的影响。方法 将150例2型糖尿病患者随机分成豆渣包组、标准馒头组和普通面包组，每组50例，分别进食不同种类的食物，测定其空腹血糖(FPG)和餐后2h血糖(2hPBC)。结果 3组的2hPBG有差别，以标准馒头组最高，普通面包组次之，豆渣包组最低；3组的2hPBG与FPG的差值也有差异，标准馒头组最高，普通面包组次之，豆渣包组最低。结论 糖尿病患者进食不同种类的食物对2hPBG有不同的影响，监测2hPBG比FPG更重要。     

2型糖尿病风险评估方法研究进展

该文从2型糖尿病风险评估建模角度,重点介绍了芬兰、丹麦、泰国、美国、中国目前糖尿病风险评分过程中引入变量的异同。提出未来2型糖尿病风险预测建模不仅需要考虑环境因素,遗传因素的作用也不可忽视。     

The Association between Fasting Glucose and Sugar Sweetened Beverages Intake Is Greater in Latin Americans with a High Polygenic Risk Score for Type 2 Diabetes Mellitus

Chile is one of the largest consumers of sugar-sweetened beverages (SSB) world-wide. However, it is unknown whether the effects from this highly industrialized food will mimic those reported in industrialized countries or whether they will be modified by local lifestyle or population genetics. Our goal is to evaluate the interaction effect between SSB intake and T2D susceptibility on fasting glucose. We calculated a weighted genetic risk score (GRSw) based on 16 T2D risk SNPs in 2828 non-diabetic participants of the MAUCO cohort. SSB intake was categorized in four levels using a food frequency questionnaire. Log-fasting glucose was regressed on SSB and GRSw tertiles while accounting for socio-demography, lifestyle, obesity, and Amerindian ancestry. Fasting glucose increased systematically per unit of GRSw (β = 0.02 ± 0.006, p = 0.00002) and by SSB intake (β[cat4] = 0.04 ± 0.01, p = 0.0001), showing a significant interaction, where the strongest effect was observed in the highest GRSw-tertile and in the highest SSB consumption category (β = 0.05 ± 0.02, p = 0.02). SNP-wise, SSB interacted with additive effects of rs7903146 (TCF7L2) (β = 0.05 ± 0.01, p = 0.002) and with the G/G genotype of rs10830963 (MTNRB1B) (β = 0.19 ± 0.05, p = 0.001). Conclusions: The association between SSB intake and fasting glucose in the Chilean population without diabetes is modified by T2D genetic susceptibility.     

Plasma Transthyretin Levels and Risk of Type 2 Diabetes Mellitus and Impaired Glucose Regulation in a Chinese Population

Plasma transthyretin may be engaged in glucose regulation. We aimed to investigate the association between plasma transthyretin levels and the risk of newly diagnosed T2DM and impaired glucose regulation (IGR) in a Chinese population. We conducted a case-control study including 1244 newly diagnosed T2DM patients, 837 newly diagnosed IGR patients, and 1244 individuals with normal glucose tolerance (NGT) matched by sex and age. Multivariate logistic regression analysis was utilized to estimate the independent association of plasma transthyretin concentrations with the risk of T2DM and IGR. Plasma transthyretin concentrations were significantly higher in T2DM and IGR patients compared with control subjects (p < 0.005). After multiple adjustment and comparison with the lowest quartile of plasma transthyretin concentrations, the odds ratios (95% confidence intervals) of T2DM and IGR in the highest quartile were 2.22 (1.66, 2.98) and 2.29 (1.72, 3.05), respectively. Plasma transthyretin concentrations also showed a great performance in predicting the risk of T2DM (AUC: 0.76). Moreover, a potential nonlinear trend was observed. Our results demonstrated that higher plasma transthyretin concentrations, especially more than 290 mg/L, were associated with an increased risk of T2DM and IGR. Further studies are warranted to confirm our findings and elucidate the potential mechanisms.     

糖化血红蛋白与2型糖尿病患者慢性并发症的相关性研究

目的探讨糖化血红蛋白(HbA1c)水平与2型糖尿病患者慢性并发症的相关性。方法 92例2型糖尿病患者按有无慢性并发症分为慢性并发症组52例和无慢性并发症组40例,另选70例健康成年人为对照组,对三组对象进行HbA1c、空腹血糖(FBG)测定,并进行分析比较。结果 2型糖尿病患者的HbA1c和FBG明显高于对照组,差异有统计学意义(P<0.01);有慢性并发症患者的HbA1c明显高于无并发症者,差异有统计学意义(P<0.01)。结论糖尿病患者慢性并发症的发生与HbA1c有密切关系,HbA1c的控制有助于预防糖尿病及其慢性并发症的发生。