肝硬化患者红细胞体积分布宽度变化及其临床意义

共检测108例肝硬化患者红细胞体积分布宽度标准差(RDW—SD)和红细胞体积分布宽度变异系数(RDW—CV)。结果表明,肝硬化患者的RDW—SD和RDW—CV分别为62.3±6.9fl和21.2±2.1％,明显高于健康对照组的44.7±4.3fl和13.6±1.4％,两组比较均有显著性差异(P<0.001)。肝硬化患者中,Child B级的RDW—SD和RDW—CV高于Child A级的,Child C级的则高于Child B级的。RDW—SD和RDW—CV分别与血清白蛋白成员相关关系,与凝血酶原时间成正相关关系(P<0.001)。结果提示,肝硬化患者的RDW改变可以反映肝功能损害程度。     

红细胞体积分布宽度在心力衰竭中的研究进展

红细胞体积分布宽度（red blood cell volume disrtibution width，RDW）是反映外周血红细胞体积异质性的参数。常与平均红细胞体积（MCV）结合用于对贫血的诊断和鉴别珍断。按照美国的第三次国家卫生和营养调查的结果大于14％为异常。RDW是一个较恒定的参数，其测定值不受抗凝剂、时间和温度的影响，也不受急性炎症的影响。     

红细胞体积分布宽度与颈动脉粥样硬化的关系

目的探讨颈动脉粥样硬化(AS)与外周血红细胞体积分布宽度(RDW)的关系。方法选择AS患者117例,同期健康体检无AS者71例,比较两组外周血各指标的差异。采用二元Logistic回归分析AS的危险因素。绘制受试者工作特征(ROC)曲线,计算联合因子的曲线下面积(AUC)。结果两组RDW、红细胞平均体积、血小板分布宽度、血肌酐、血尿酸差异有统计学意义。采用二元Logistic回归分析AS的影响因素,RDW、红细胞平均体积、血小板分布宽度、血尿酸是颈动脉粥样硬化的危险因素。将RDW、红细胞平均体积、血小板分布宽度、血尿酸作为联合预测指标,通过Logistic回归,形成联合预测因子,其AUC=0.747(0.654～0.839),敏感性为0.780,特异性为0.625。对颈动脉内膜厚度的有序Logistic回归分析显示RDW(OR=1.61,95%CI 1.09～2.37,P=0.016)与颈动脉的内膜厚度相关。结论 RDW与颈动脉粥样硬化程度相关,动态监测RDW,有助于颈动脉粥样硬化的观察。     

糖尿病和糖尿病前期的诊断

糖尿病是一组由于血糖水平过高而引起组织、器官功能及结构异常的疾病。血糖是一种连续的变量,用一个时间点的血糖水平作为疾病诊断的切割点显然是不合理的。因此,糖尿病和糖尿病前期血糖诊断标准的确立是一种相对水平,即此切割点以上的血糖状态引发的高血糖特征性病变开始出现     

高血压患者糖代谢异常的评价

目的探讨高血压患者的糖代谢情况及其高危因素分析。方法对562例高血压患者进行口服葡萄糖耐量试验（OGTT），根据血糖分为正常葡萄糖耐量（NGT）、空腹血糖受损（IFG）、葡萄糖耐量减低（IGT）和糖尿病四组，分析各组的发病率，对各组的血脂（TG、TC、HDL、LDL）、体重指数、HOMA-IR、β细胞功能（HOMA-β）、胰岛素敏感性指数（ISI）、腰围、空腹胰岛素、餐后2小时胰岛素等进行比较。结果（1）高血压患者近2／3有糖代谢异常，发病率非常高，但知晓率很低，其中只有16％患者已知有糖尿病。（2）随糖代谢异常的加重，高血压患者的体重指数、腰围呈上升趋势，IFG和NGT组间比较无差异（P〉0.05），IGT或糖尿病组，差异有显著性（P〈0.05）；血脂异常也越加明显，TG、TC、LDL呈上升趋势，HDL则下降；IGT组HOMA-IR明显升高（P〈0.01），与糖尿病组比较无差异；IGT组HOMA-β细胞功能升高，与其他三组间比较无差异；糖尿病和IGT组ISI下降。结论高血压患者存在明显的糖耐量异常，随着糖耐量的加重，其他代谢异常也恶化；有必要对高血压患者进行糖耐量试验，做到早期发现早期干预，预防心血管并发症。     

空腹血糖受损患者糖耐量异常及影响因素分析

目的了解空腹血糖受损(IFG)患者糖耐量异常(IGT)情况及其影响因素。方法纳入空腹血糖为5.6~6.1 mmol/L的IFG患者337例,检测患者口服75克葡萄糖后2小时血糖等资料,分析患者IGT情况及其影响因素。结果纳入的337例IFG患者中46.6%(157/337)伴有IGT。口服葡萄糖耐量异常和正常组超重和肥胖率分别为75.0%和63.1%(P0.05);口服葡萄糖耐量异常组甘油三酯水平显著高于正常组,高密度脂蛋白胆固醇水平低于正常组,均有统计学差异(P0.05)。多因素Logistic回归分析结果显示,年龄、体重指数、甘油三酯水平是IFG患者葡萄糖耐量异常的影响因素,相对危险分别为:1.06(95%CI:1.03~1.08);1.11(95%CI:1.05~119);1.58(95%CI:1.23~2.09)。进一步对体重正常者发生糖耐量异常的影响因素进行分析,除年龄外,甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素,相对危险为2.10(95%CI:1.29~3.43)。结论空腹血糖受损患者约半数伴有糖耐量异常,体重指数和甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素。     

两种空腹血糖上限标准对糖调节受损分布的影响比较

878名40岁以上慈溪市部分城乡人群的筛查显示，空腹血浆葡萄糖值〉5.6mmol／L比〉6．1mmol／L诊断的空腹血糖受损增高（24．9％比13．4％），空腹糖异常增高（14．9％比3．4％），空腹糖异常合并糖耐量异常增高（3．6％比0．9％）。     

两种空腹血糖上限标准对糖调节受损分布的影响比较

878名40岁以上慈溪市部分城乡人群的筛查显示，空腹血浆葡萄糖值〉5.6mmol／L比〉6．1mmol／L诊断的空腹血糖受损增高（24．9％比13．4％），空腹糖异常增高（14．9％比3．4％），空腹糖异常合并糖耐量异常增高（3．6％比0．9％）。     

HbA1c增高、糖耐量异常与老年糖尿病发病的相关性

目的研究空腹糖耐量异常(IFG)、糖化血红蛋白(Hb A1c)增加或者两者同时具有是否能预测老年人群发生糖尿病的风险。方法采用前瞻性研究方法,以江苏省多代谢异常和代谢综合征综合防治研究队列满足条件的人群为研究对象,比较基线IFG[空腹血糖(FPG)100～125 mg/dl]及Hb A1c增加(Hb A1c 5.7%～6.4%)的研究人群在随访后发生糖尿病的风险。采用Cox回归分析模型计算在调整年龄、性别、体重指数(BMI)、吸烟、体力活动后,观察IFG、Hb A1c与随访发生糖尿病的关系。结果在607例研究人群中(平均年龄66.2岁,男性41.8%),经过5年的随访有29例进展为糖尿病。在调整后的Cox回归分析中,基线IFG人群相比于基线FPG100 mg/dl的人群发生糖尿病的RR为4.303(3.119～5.936),而基线仅Hb A1c增高人群相比于Hb A1c5.7%的人群,其发生糖尿病的RR值为2.648(2.117～3.314)。而同时考虑IFG、Hb A1c后,仅有IFG的人群、仅Hb A1c增高的人群、同时合并IFG、Hb A1c增加的人群发生糖尿病的风险分别是3.603(2.526～5.137)、5.646(3.964～6.751)、10.098(6.160～16.551)。结论老年人群同时患有IFG、Hb A1c增加,其随后进展为糖尿病的风险也增加。如果同时检测FPG、Hb A1c有助于筛查有糖尿病高危风险的老年人群。     

红细胞体积分布宽度:一种新型的心血管疾病危险标记物

红细胞体积分布宽度（red cell distribution width,RDW）是反映外周血红细胞体积异质性的参数,通常以红细胞体积大小的变异系数（RDW-CV）来表示,临床上多用于缺铁性贫血的诊断和鉴别诊断.但最近研究表明,RDW是一种新型的心血管疾病危险标记物,可独立预测死亡及心血管事件发生.本文就近年来关于RDW在心脑血管疾病方面的研究进展作一综述.     

High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius

OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.     

Psychosocial factors are independent risk factors for the development of Type 2 diabetes in Japanese workers with impaired fasting glucose and/or impaired glucose tolerance1

Aims We prospectively studied Japanese workers with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and analysed possible risk factors for diabetes, including psychosocial factors such as stress. Methods The participants were 128 male Japanese company employees (mean age, 49.3 ± 5.9 years) with IFG and/or IGT diagnosed by oral glucose tolerance test (OGTT). Participants were prospectively studied for 5 years with annual OGTTs. The Kaplan–Meier method and Cox's proportional hazard model were used to analyse the incidence of diabetes and the factors affecting glucose tolerance, including anthropometric, biochemical and social–psychological factors. Results Of 128 participants, 36 (28.1%) developed diabetes and 39 (30.5%) returned to normal glucose tolerance (NGT) during a mean follow‐up of 3.2 years. Independent risk factors for diabetes were night duty [hazard ratio (HR) = 5.48, P = 0.002], higher fasting plasma glucose (FPG) levels within 6.1–6.9 mmol/l (HR = 1.05, P = 0.031), stress (HR = 3.81, P = 0.037) and administrative position (HR = 12.70, P = 0.045), while independent factors associated with recovery were lower FPG levels (HR = 0.94, P = 0.017), being a white‐collar worker (HR = 0.34, P = 0.033), non‐smoking (HR = 0.31, P = 0.040) and lower serum alanine aminotransferase (ALT) levels (HR = 0.97, P = 0.042). Conclusions In addition to FPG levels at baseline, psychosocial factors (night duty, stress and administrative position) are risk factors for Type 2 diabetes, while being a white‐collar worker, a non‐smoker and lower serum ALT levels are factors associated with return to NGT in Japanese workers with IFG and/or IGT.     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

单一测定空腹血糖在诊断糖尿病和糖耐量减低中的局限性

分析了经７５ｇＯＧＴＴ确诊的７９７例糖尿病（ＤＭ）和８１８例糖耐量减低（ＩＧＴ）患者的空腹血糖（ＦＢＳ）水平，并与１２８９例正常人作了比较。结果显示：７９７例糖尿病患者中ＦＢＳ≥７．８ｍｍｏｌ／Ｌ者有５０９例（６３．８６％）。ＦＢＳ≥７．８ｍｍｏｌ／Ｌ诊断糖尿病的敏感性和特异性分别为６３．８６％和９９．３０％，ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ则敏感性和特异性分别为９４．２３％和９１．５４％，假阳性率和假阴性率均不到１０％。８１８例ＩＧＴ患者的ＦＢＳ值正常者（＜６．１１ｍｍｏｌ／Ｌ）占７９．７１％，与正常人重叠较多。提示ＦＢＳ≥７．８ｍｍｏｌ／Ｌ对糖尿病的诊断不是一个敏感的指标，若ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ者应作进一步检查。而用ＦＢＳ不能估价ＩＧＴ。     

Gender differences in the prevalence of impaired fasting glycaemia and impaired glucose tolerance in Mauritius. Does sex matter?

OBJECTIVE: To examine gender differences in the characteristics and prevalence of various categories of glucose tolerance in a population study in Mauritius. RESEARCH DESIGN AND METHODS: In 1998, a community-based cross-sectional survey was conducted in Mauritius. Categories of glucose metabolism were determined in 5388 adults, with an oral glucose tolerance test given to those who did not have previously diagnosed diabetes (n=4036). Other cardiovascular risk factors were assessed among those without known diabetes. RESULTS: For men and women the prevalence of diabetes (22.0 vs. 21.8%, respectively) and the prevalence of coexisting impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) (3.2 vs. 2.9%) were similar. However, men were twice as likely as women to have isolated IFG [5.1% (4.2-6.0) vs. 2.9% (2.3-3.5)], despite being younger, thinner and with lower plasma insulin but higher lipids. Conversely, the prevalence of isolated IGT was lower in men [9.0% (7.9-10.2) vs. 13.9% (12.6-15.1)]. Among non-diabetic individuals, fasting glucose was higher in men than women, whereas 2-h glucose was higher in women. In people without diabetes, women had significantly higher body mass index, beta cell function (HOMA-B), fasting and 2-h insulin than men and significantly lower waist-hip ratios, waist circumference, insulin sensitivity (HOMA-S) and triglycerides. CONCLUSION: In Mauritius, the distribution of impaired glucose metabolism differs by sex. The observation that IFG is more prevalent in men and IGT more prevalent in women raises important questions about their underlying aetiology and the ability of the current glucose thresholds to equally identify men and women at high-risk of developing diabetes. IFG should be seen as a complimentary category of abnormal glucose tolerance, rather than a replacement for IGT.     

Worsening to diabetes in men with impaired glucose tolerance (“borderline diabetes”)

Summary Two hundred and four men with impaired glucose tolerance (borderline diabetes) discovered in a screening examination have been observed for five years and repeated tests of glucose tolerance performed. By pre-determined criteria 27 men worsened to diabetes and this metabolic deterioration was not significantly influenced by treatment with carbohydrate restriction with or without a daily dose of 50 mg phenformin. Of the baseline variables measured prior to treatment allocation only the blood glucose values were significantly predictive of ultimate worsening to diabetes.     

糖代谢异常和糖尿病患者血浆纤维蛋白原的观察

目的探讨血浆纤维蛋白原在糖代谢异常和糖尿病患者中的变化。方法对155例糖尿病、糖代谢异常患者和正常对照者进行血浆纤维蛋白原、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿素氮和血肌酐检测。结果糖尿病、糖代谢异常和正常对照组之间纤维蛋白原和三酰甘油在各组之间比较差异有统计学意义(P<0.01或P<0.05);纤维蛋白原的多因素linear regression分析发现空腹血糖、三酰甘油是纤维蛋白原的相关因子(P<0.05)。结论糖尿病和糖代谢异常患者血浆纤维蛋白原升高,而且纤维蛋白原与空腹血糖水平相关。因此,血浆纤维蛋白原升高可能参与糖尿病患者心脑血管疾病的形成。     

Prevalence of diabetes mellitus and impaired glucose tolerance in parents of women with gestational diabetes

Summary Nuclear families of non-insulin-dependent diabetic (NIDDM) patients are uncommon, as usually one or both parents have died. In order to aid identification of complete nuclear families, we have ascertained the disease process at a younger age by studying subjects with previous gestational diabetes. One hundred women who had had gestational diabetes, age (±SD) 38 (6) years, were screened by fasting plasma glucose (fpg). Sixty-one were found to have either fasting hyperglycaemia (5.5fpg<7.8 mmol/l) or diabetes. Of these women 35 had both parents alive and the parents of 14 of these women agreed to the assessment of their metabolism by a continuous infusion of glucose with model assessment (CIGMA). Seven probands had impaired glucose tolerance (IGT) and seven were diabetic. They were age 35 (4) years and had body mass index (BMI) 26 (5) kg/m². The parents were aged 62 (6) years and had BMI 29 (6) kg/m² and their affection status was defined as presence of glucose intolerance (fpg or post-infusion achieved plasma glucose level >2 SD of an age and obesity matched population). In the 14 families, five probands (36%) had neither parent affected, six (43%) had one parent affected and three (21%) had both parents affected. Only three probands had a parent with diabetes as defined by World Health Organisation criteria. We concludes that the study of women who have had gestational diabetes allows detection of probands with diabetes or impaired glucose tolerance, who have both parents available for study. A substantial proportion had neither parent affected with impaired glucose tolerance or diabetes, similar to the nuclear families of NIDDM patients. The results are in accord with studies of nuclear families of NIDDM patients in suggesting polygenic inheritance or environmental influences rather than autosomal dominant inheritance with high penetrance.Abbreviations IGT Impaired glucose tolerance - GTT glucose tolerance test - NIDDM non-insulin-dependent diabetes mellitus - fpg fasting plasma glucose - apg achieved plasma glucose - CIGMA continuous infusion of glucose test - BMI body mass index     

空腹血糖受损并糖耐量受损患者血管内皮功能及代谢功能观察

目的：观察空腹血糖受损并糖耐量受损（ IFG＋IGT）患者血管内皮功能及代谢功能情况。方法选择IFG＋IGT者72例（ E组）,其中非肥胖30例（ E1组）,肥胖42例（ E2组）;另选择糖耐量正常的健康人群142例（ N组）,其中非肥胖75例（ N1组）、肥胖67例（ N2组）。做口服葡萄糖耐量试验及胰岛素释放试验检测血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸、脂联素。采用免疫比浊法检测超敏C反应蛋白（ hs-CRP）,RIA法检测血清内皮素（ SET）。留取晨尿,采用未抽提法测定内皮素（ UET）,散射比浊法检测尿微量白蛋白（ MUA）。观察血压和腰围。彩超测定肱动脉休息时、加压及服用硝酸甘油后的内径变化,计算内皮依赖性血管舒张功能（ EDD）及内皮非依赖性血管舒张功能（ EID）指标（ΔD％、ΔD1％）。结果校正性别、年龄后,E和N组比较、E2与N2组比较及E1与N1组比较,MUA、hs-CRP、UET、SET、ΔD％、ΔD1％差异有统计学意义（P均＜0．05）;N2与N1组比较hs-CRP、UET和SET差异有统计学意义（P均＜0．05）;E2与E1组比较MUA、hs-CRP、UET和SET差异有统计学意义（P均＜0．05）。结论 IFG＋IGT患者大血管和微血管内皮功能均出现异常,尤以肥胖者为著;患者的代谢功能亦出现异常,主要表现为高血压、高血糖、脂代谢紊乱、胰岛素抵抗及胰岛分泌功能下降。