2型糖尿病患者糖尿病视网膜病变的发生情况及影响因素调查

目的 探究2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）发生情况及危险因素。方法 以2017年6月至2019年5月期间首次在南京市某医院门诊就诊的T2DM患者为研究对象进行基本信息及患病情况调查、体格检查、实验室指标检测及DR检查,采用描述流行病学分析方法进行分析,并采用单、多因素分析方法对T2DM患者并发DR影响因素进行分析。结果 本研究共对1 248例T2DM患者进行分析,男性占45.99%,女性占54.01%。检出DR 348例,检出率为27.88%,以中度为主（201例,57.75%）。多因素Logistic回归分析结果显示,年龄越大（OR_50~59=2.259、OR_60~69=2.321、OR_70~79=5.388）、T2DM病程≥5年（OR=6.372）、使用胰岛素治疗（OR=2.753）、糖化血红蛋白（HbA1c）异常（OR=4.658）、高血压（OR=4.565）、尿微量白蛋白异常（OR=3.034）、低密度脂蛋白胆固醇（LDL-C）异常（OR=3.554）的T2DM患者发生DR风险越高。结论 T2DM患者DR发生率较高,与年龄、病程、使用胰岛素治疗、HbA1c异常、高血压等因素有关,对于存在危险因素的T2DM患者进行监测及积极开展针对性干预措施,可降低DR发生风险,提高患者生存质量。     

影响2型糖尿病视网膜病变进展的相关危险因素研究

目的探讨影响2型糖尿病（T2DM）视网膜病变（DR）进展的危险因素,以利于早期发现病变。方法 260例T2DM患者根据有无视网膜病变及病变程度分为无视网膜病变组（NDR,88例）、T2DM合并非增殖性视网膜病变组（NPDR,92例）和增殖性视网膜病变组（PDR,80例）,检测DR可能相关临床因素并进行统计分析。结果 3组间的年龄、性别、糖化血红蛋白（HbA1C）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、体质指数（BMI）、空腹血糖（FPG）、餐后2 h血糖（2 hPG）差异均无统计学意义（P〉0.05）。3组间糖尿病病程、尿白蛋白肌酐比值（ACR）、血管生成素2（Ang-2）和血管内皮生长因子（VEGF）差异均有统计学意义（P〈0.01）;PDR组病程、ACR、Ang-2、VEGF明显高于NDR组和NPDR组,NPDR组高于NDR组,差异均有统计学意义（P〈0.05,P〈0.01）;与NDR组比较,NPDR组和PDR组载脂蛋白B100（ApoB 100）升高,收缩压升高,差异有统计学意义（P〈0.05,P〈0.01）,但二者在NPDR和PDR组间差异无统计学意义（P〉0.05）;PDR和NPDR组间舒张压差异有统计学意义（P〈0.05）。logistic回归分析显示,糖尿病病程、HbA1C、VEGF、ACR、收缩压与DR独立相关,OR值及95%CI分别为1.823（1.280~2.643）、1.376（1.121~1.843）、1.268（1.116~1.612）、1.205（1.101~1.375）、1.052（1.015~1.091）。结论糖尿病病程、ACR增加、长期血糖控制不佳、血压、血脂控制不良及促新生血管形成的生长因子包括VEGF和Ang2均是导致DR进展的重要因素。     

糖尿病患者血清瘦素、内皮素水平与糖尿病视网膜病变不同分期的相关性研究

目的探讨血清瘦素、内皮素水平与糖尿病视网膜病变的关系。方法收集本院内分泌科住院的2型糖尿病患者80例,将其分为增殖性视网膜病变组23例,非增殖性视网膜病变组30例,糖尿病无视网膜病变组27例,另设健康对照者30例。采用放射免疫法测定血浆瘦素水平,采用酶联免疫吸附双抗体夹心法原理（ELISA）定量测定内皮素水平,并于生化检验室检验空腹血糖、餐后2h血糖、糖化血红蛋白、胆固醇、三酰甘油。结果病例组,包括增殖性视网膜病变组、非增殖性视网膜病变组、糖尿病无视网膜病变组与对照组血浆瘦素分别为（17．41±5．81）μg／L、（13．32±6．78）μg／L、（9．52±4．34）μg/L、（5．1-4-3．4）μg/L;血浆内皮素水平分别为（80．68±13．57）mg／L、（73．38±12．37）mg／L、（65．33±11．24）mg／L、（45．25±9．06）mg／L。各病例组与对照组比较差异均有统计学意义（P〈0．01）;各病例组组问比较差异均有统计学意义（P〈0．01）;血浆瘦素水平与年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、胆固醇、三酰甘油等无相关。血浆瘦素水平与体重指数呈正相关（r=0．468,P〈0．01）。结论血浆瘦素、内皮素水平是2型糖尿病视网膜病变发病的一种独立危险因子,且随着病情的加重,血浆瘦素、内皮素水平逐渐增高。为糖尿病视网膜病变的早期干预治疗提供了新思路。     

Decreased serum magnesium and zinc levels: atherogenic implications in type-2 diabetes mellitus in Nigerians

Serum magnesium, zinc and total cholesterol were evaluated in 40 Nigerian patients suffering from type-2 diabetes mellitus (21M, 19F) and 20 (14M, 6F) apparently normal non diabetic control subjects. The mean age of the diabetic patients was similar to that of controls (p > 0.05). The mean duration of the disease was (4.7 + 0.7 SEM) in these patients. Fasting blood glucose and total cholesterol were significantly higher in diabetics than in non diabetic control subjects (p > 0.001). The serum total cholesterol showed inter-group variation when the patients were classified into four different age groups. In contrast, the serum level of magnesium (Mg) and zinc (Zn) were significantly lower in diabetics than in controls (p > 0.001). There were no significant correlation between glucose and the minerals, Mg. and Zn. Serum total cholesterol showed a significant positive correlation with magnesium (r = 0.6: p > 0.001), while the correlation with zinc was not significant. In type-2 diabetic mellitus the concentration of both Mg and Zn levels were significantly reduced, probably suggesting lower antioxidant status in this condition. The implication is the greater susceptibility to LDL-cholesterol oxidation. The attendant risk of development of premature Coronary Heart Disease is discussed. Magnesium and zinc are nutritional minerals that play crucial roles in the regulation of carbohydrate and lipid metabolism.     

Alteration of amine oxidase activity in the adipose tissue of obese subjects

OBJECTIVE: To explore the activity of monoamine oxidases (MAOs) and semicarbazide-sensitive amine oxidases (SSAOs) in adipose tissue and blood of lean and moderately obese subjects and to study whether there is a link between these hydrogen peroxide-generating enzymes and blood markers of oxidative stress. RESEARCH METHODS AND PROCEDURES: Nine obese male subjects (BMI 32.6 +/- 0.4 kg/m(2)) and nine controls (BMI 23.4 +/- 0.5) of 24- to 40-year-old subjects were included in the study. MAO and SSAO activities were measured on microbiopsies of abdominal subcutaneous adipose tissue by quantifying (14)C-tyramine and (14)C-benzylamine oxidation. Levels of soluble SSAO, lipid peroxidation products, and antioxidant agents were measured in plasma, whereas cytoprotective enzymes were determined in blood lysates. RESULTS: The high MAO activity found in adipose tissue was diminished by one-half in obese subjects (maximum initial velocity of 1.2 vs. 2.3 nmol tyramine oxidized/mg protein/min). There was no change in SSAO activity, either under its adipose tissue-bound or plasma-soluble form. Plasma levels of lipid peroxidation products and antioxidant vitamins remained unmodified, as well as erythrocyte antioxidant enzymes, whereas circulating triglycerides, insulin, and leptin were increased. DISCUSSION: Although they already exhibited several signs of endocrino-metabolic disorders, the obese men did not exhibit the increase in blood markers of oxidative stress or the decrease in antioxidant defenses reported to occur in very obese or diabetic subjects. The reduced MAO and the unchanged SSAO activities found in obesity suggest that these hydrogen peroxide-generating enzymes expressed in adipocytes are probably not involved in the onset of the oxidative stress found in severe obesity and/or in its complications.     

社区2型糖尿病患者自我管理水平与糖尿病视网膜病变的相关性研究

目的探讨社区人群2型糖尿病(type 2 diabetes mellitus,T2DM)患者自我管理相关行为与糖尿病视网膜病变(diabetic retinopathy,DR)的关系。方法 2012年4—5月在苏州市金阊区随机抽取四个街道社区,招募社区T2DM患者,患者在签订知情同意书的前提下被纳入调查。由经过培训的调查员采用统一设计的调查表,收集并记录调查对象的人口统计学特征、生活行为方式、病程、家族史、DM微血管并发症等资料。正态分布资料用x珋±s表示,两组间的比较用t检验;非正态分布资料用中位数(四分位数间距)表示,两组间比较用Wilcoxon秩和检验;计数资料用率表示,两组间的比较用χ2检验。采用Logistic回归模型分析自我管理水平与DR的相关性。检验水准α=0.05,P0.05为差异有统计学意义。结果 887例患者中,有34.3%的患者HbA1c控制达标。有DR的T2DM患者比无DR的T2DM患者具有更长的病程[7(3~11)年vs.5(2~9)年]、更高的收缩压[(140.0±16.1)mm Hg(1mmHg=0.133kPa)vs(137.0±16.9)mm Hg]、更高的空腹血糖(8.01±2.73)mmol/L vs(7.57±2.30)mmol/L)和HbA1c水平[(7.84±1.40)%vs.(7.53±1.31)%]。多因素Logistic回归分析结果表明,与HbA1c未达标者相比,HbA1c达标者合并DR的危险性显著降低,其OR(95%CI)为0.63(0.44~0.91)。结论 HbA1c达标是T2DM患者合并DR的保护因素,控制血糖并使其达标是防止T2DM患者合并DR的关键。     

Telepaediatrics and diabetic retinopathy screening of young people with diabetes in Queensland

We have examined the feasibility of a telemedicine-enabled screening service for children and adolescents with diabetes in Queensland. There are approximately 1400 young people with diabetes in Queensland and only about two-thirds of them are screened in accordance with international guidelines. A regional retinal screening service was established using a nonmydriatic digital retinal camera. Seven centres volunteered to participate in the study. During a five-month pilot trial, 83 of the young people with diabetes who attend these centres underwent digital retinal screening (3.7%). Retinal images were sent via email to a paediatric ophthalmologist for review and results were returned via email. A copy of each participant's results was forwarded by mail to the referring diabetes doctor and the participant and family. The majority of the image files (96%) were rated as excellent or good. Only one participant was identified as having an abnormal result. Participants and their families expressed satisfaction with the digital retinal screening process.     

Language barrier and its relationship to diabetes and diabetic retinopathy

ABSTRACT: BACKGROUND: Language barrier is an important determinant of health care access and health. We examined the associations of English proficiency with type-2 diabetes (T2DM) and diabetic retinopathy (DR) in Asian Indians living in Singapore, an urban city where English is the predominant language of communication. METHODS: This was a population-based, cross-sectional study. T2DM was defined as HbA1c >=6.5%, use of diabetic medication or a physician diagnosis of diabetes. Retinal photographs were graded for the severity of DR including vision-threatening DR (VTDR). Presenting visual impairment (VI) was defined as LogMAR visual acuity > 0.30 in the better-seeing eye. English proficiency at the time of interview was assessed. RESULTS: The analyses included 2,289 (72.1%) English-speaking and 885 (27.9%) Tamil- speaking Indians. Tamil-speaking Indians had significantly higher prevalence of T2DM (46.2 vs. 34.7%, p < 0.001) and, among those with diabetes, higher prevalence of DR (36.0 vs. 30.6%, p < 0.001), VTDR (11.0 vs. 6.5%, p < 0.001), and VI (32.4 vs. 14.6%) than English speaking Indians. Oaxaca decomposition analyses showed that the language-related discrepancies (defined as the difference in prevalence between persons speaking different languages) in T2DM, DR, and VTDR could not be fully explained by socioeconomic measures. CONCLUSIONS: In an English dominant society, Tamil-speaking Indians are more likely to have T2DM and diabetic retinopathy. Social policies and health interventions that address language-related health disparities may help reduce the public health impact of T2DM in societies with heterogeneous populations.     

Nephropathy in non-insulin-dependent (type-2) diabetes mellitus

There is a dramatic increase in the incidence of end-stage renal disease in non-insulin dependent diabetes mellitus (NIDDM) requiring renal replacement therapy. The most important risk factors of the onset of nephropathy in NIDDM are genetic predisposition (history of diabetes, hypertension and cardiovascular events in first-degree relatives), hypertension, quality of glycaemic control and smoking. These risk factors play an important role also in the progression of diabetic nephropathy. In about 20-25% of NIDDM patients nondiabetic renal diseases cause the renal damage (other primary nephropathies, ischaemic nephropathy). NIDDM is mainly the part of metabolic x syndrome (hypertension, obesity, dyslipidaemia, impaired glucose tolerance or NIDDM) and, for this reason, all members of metabolic x syndrome has to be involved in treatment strategies e.g. blood pressure "subnormalization", aggressive glycaemic control, cessation of smoking, the treatment of obesity and dyslipidaemia with diet, physical activity and antilipidaemic drugs, as well as restriction of dietary protein and salt intake. The successful prevention and treatment of diabetic nephropathy needs the development of an interdisciplinary interaction that involves general practitioners, diabetologists and nephrologists.     

Lipid-lowering therapy in patients with type-2 diabetes mellitus

Diabetic dyslipidemia is mainly characterised by hypertriglyceridaemia, low HDL-cholesterol level, an increased small dense HDL concentration, i.e. by atherogenic dyslipidemia. Dyslipidaemia occurs in some two third of the type 2 diabetes cases. In the treatment of dyslipidaemia it is essential to control the diabetes, to reduce the intake of saturated fat and supplement it with monounsatured fat ty acid or complex carbohydrates. Based on the latest studies diabetes is considered the same risk as coronary heart disease and, therefore, diabetic dyslipidaemia should be treated in the same aggressive way. According to the simplified guidelines, after the diet--above 5.2 mmol/l cholesterol level--antilipaemic drugs, i.e. statin should be administered in order to achieve the primary goal of the therapy, namely the 2.6 mmol/l LDL-cholesterol level. In patients with combined II/b type hyperlipoproteinaemia statins are the drugs of first choice, fibric acid derivates being only considered in case of normal LDL-cholesterol level (< 3.4 mmol/l), if the HDL-cholesterol level is also low. Fibrate therapy is the first choice in the isolated hypertriglyceridaemia (> 2.3 mmol/l) as well as in type V. hyperlipoproteinaemia. On the basis of the guidelines far more patients with diabetes should be treated with lipid lowering therapy than before.     

上海市延吉社区2型糖尿病患者糖尿病视网膜病变巢式病例对照研究

目的 分析上海市延吉社区2型糖尿病患者糖尿病视网膜病变(diabetic retinopathy,DR)的发病率及其相关的影响因素,为早期预防及干预治疗提供依据.方法 选取在2017年7月基线调查中无糖尿病视网膜病变(non-diabetic retinopathy,NDR)的597名研究对象,随访2年后2019年8月...     

男性2型糖尿病患者骨质疏松相关因素分析

糖尿病（DM）是慢性代谢性疾病,其合并钙磷代谢紊乱及骨质疏松已被多数学者所公认。因此,防治骨质疏松对糖尿病患者有重要意义。通过对68例男性2型糖尿病患者进行骨密度测定,并对相关生化指标进行分析,进一步确定2型糖尿病与骨质疏松的关系,现报告如下。     

CA199在2型糖尿病患者的表达

目的 比较2型糖尿病患者与年龄与性别匹配正常人的血清癌抗原(CA)199水平.方法 选择60例2型糖尿病患者(糖尿病组)和40例健康体检者(对照组),检测并比较两组血清CA199、空腹血糖、餐后血糖及糖化血红蛋白水平.结果 糖尿病组血清CA199水平为(45.2±18.6) U/ml,高于对照组的(11.3±6.4) U/ml,差异有统计学意义(P＜0.01),Pearson相关分析显示血清CA199水平与空腹血糖、餐后血糖及糖化血红蛋白水平无相关性.结论 CA199是诊断胰腺癌的指标,但也可以作为糖尿病引起的胰腺组织损伤的一个标志.检测2型糖尿病患者CA199水平应该高于其正常参考值范围去评价,以利于正确评估良恶性胰腺疾病.2型糖尿病患者轻度升高的CA199或许反映了患者胰腺外分泌功能紊乱.     

糖尿病及并发视网膜病变患者生命质量评价

目的 了解评价糖尿病及并发视网膜病变患者的生命质量。方法 在上海市长宁区社区居民中选取糖尿病患者、糖尿病合并视网膜病变(DR)患者及健康居民,采用生命质量量表(SF-36)与糖尿病患者生存质量特异性量表(DSQL)相结合进行生命质量评价;采用Epidata软件建立数据库,采用SPSS软件进行统计分析。结果 糖尿病合并视网膜病变组在SF-36量表的躯体功能(69.74±28.88)、躯体角色(70.72±43.28)、躯体疼痛(76.09±18.15)及总健康维度(48.54±19.74)的生命质量评分均显著低于常模,但心理健康(77.89±14.54)维度评分明显高于常模;糖尿病组在SF-36量表的躯体功能(72.81±22.85)、躯体疼痛(75.32±19.32)2个维度的评分显著低于常模,而心理健康(72.82±17.9)维度评分明显高于常模;糖尿病合并视网膜病变组的躯体功能(69.03±11.07)、总健康(14.71±3.95)、心理/精神维度(54.66±6.69)、社会功能维度(26.68±2.95)及疾病治疗效果维度(12.74±1.75)等方面较普通人群显著为低,糖尿病组的躯体功能(72.19±9.26)、心理/精神维度(53.99±7.20)、社会功能(26.25±2.99)、疾病治疗效果(13.12±1.72)等方面明显低于普通人群;DR组与糖尿病组在SF-36量表总评分及DSQL量表总评分方面均差异无统计学意义,但是在DSQL量表的躯体功能维度上,DR组的评分(45.08±7.40)显著低于糖尿病组评分(47.63±7.21)。结论 糖尿病及其并发视网膜病变患者多个维度的生命质量明显下降。     

老年2型糖尿病视网膜病变与尿白蛋白排泄率等关系探讨

目的探讨老年2型糖尿病视网膜病变的危险因素。方法55例老年2型糖尿病视网膜病变增殖期（C组）与55例老年2型糖尿病视网膜病变单纯期（B组）及55例老年2型糖尿病无视网膜病变（A组）进行临床和生化等指标的检测。结果C组与A组相比,SBP、UAER、病程、BMI、UA高于A组（P〈0.05）,Fc-p、HDL-ch、ApoA低于A组（P〈0.05）;C组与B组相比,CR、UAER、年龄、病程,UA高于B组（P〈0.05）;B组与A组相比,UAER高于A组（P〈0.05）,年龄、病程,ApoA低于A组（P〈0.05）。logistic回归分析发现尿白蛋白排泄率升高是糖尿病患者视网膜病变的危险因素。影响力度依次为尿白蛋白排泄率〉BUN〉年龄〉病程。结论为预防糖尿病视网膜病变的发生,必须严格控制血压、血糖、血脂、降低尿白蛋白排泄率。     

Determination of Ca2+-atpase activity in streptozotocin-induced diabetic rat liver

Microsomal Ca2+-ATPase activity was studied in control and streptozotocin (STZ)-induced diabetic rat livers. Male rats were rendered diabetic by injection of STZ (45 mg/kg body weight) via the tail vein. Diabetic rats at 1, 4, 8, 10 or 15 wk and control rats were sacrificed. Liver tissues were obtained for the isolation of Ca2+-ATPase. Ca2+-ATPase activity was determined spectrophotometrically and lipid peroxidation [measured as tiobarbituric acid reactive substances (TBARS)] in liver tissues was determined spectrofluorometrically. Total calcium was measured by atomic absorption spectrophotometry. Blood glucose levels of the diabetic animals were >500 mg/dl at 4, 8, 10 and 15 wk of diabetes. Ca2+-ATPase activity was significantly decreased at all weeks of diabetes compared to control group (p<0.001). Ca2+-ATPase activity of control rats was 0.193 +/- 0.015 U/I whereas activity was 0.130 +/- 0.015 U/I at 15 wk of diabetes. The difference in calcium levels of diabetic rat livers was not significantly different compared to control group. On the other hand TBARS were elevated by 67% at 15 wk of diabetes. The decrease in enzyme activity may have been caused by elevated TBARS levels observed in liver tissue sindicative of increased lipid peroxidation.     

Primary combined oral antidiabetic therapy in type-2 diabetes mellitus

New target values of the metabolic control and recent directions in the therapeutic strategies of type 2 diabetes mellitus are overviewed. Attention is called to the atherogenic effect of blood glucose elevations exceeding physiological level, even when only post-prandial and with short duration. The significance of early phase prandial insulin secretion in the metabolic state is underlined, and the related new therapeutic possibilities are discussed. Practical guidelines are given to the introduction of oral antidiabetic therapy, and the importance of the early, aggressive, combined treatment with a complex mechanism of action is emphasized.