1型糖尿病与猝死

发生在 1型糖尿病年轻患者夜间猝死的事件 ,称为“睡眠死亡综合征 (ｄｅａｔｈｉｎｂｅｄｓｙｎｄｒｏｍｅ) 〔1〕” ,其病因未明。本文就目前所见的这种综合征的资料作一综述。一、睡眠死亡综合征的背景1991年Ｔａｔｔｅｒｓａｌｌ和Ｇｉｌｌ报道 2 2例年轻的 1型糖尿病患者发生猝死的事件 ,其共同特征是 :晚上发生无法预测的猝死 ,患者于次日发现安静地死在床上〔2〕。患者的年龄多在40岁以下 ,糖尿病病程从数月到 2 5年不等 ,大部份患者平素看起来健康 ,血糖控制在正常水平且夜间常有低血糖发生的经历 ,尸检报告没有发现解剖学方面的异常…     

睡眠中死亡综合征——1型糖尿病猝死研究进展

睡眠中死亡综合征是指发生于1型糖尿病患者中不明原因的猝死,其机制较为复杂,近年来研究认为可能与反复、严重的低血糖、心脏复极化异常、阻塞性睡眠呼吸暂停及遗传因素等有关.未来有必要进一步深入了解其发病机制,建立完善的1型糖尿病患者危险分层系统,利用实时动态血糖监测技术防止严重的低血糖事件,对于高危患者进行预防性治疗措施,从而避免睡眠中死亡综合征的发生.     

1型糖尿病与卒中

多项研究显示,1型糖尿病(type l diabetes mellitus,T1DM)的发病率正在以每年2％～5％增高.与2型糖尿病一样,T1DM也是卒中的危险因素.尽管一些T1DM研究将卒中作为心血管事件复合终点的组成部分,但很少有研究专注于T1DM患者的卒中风险.最近的研究显示,T1 DM患者的卒中风险显著高于无糖尿病者,特别是在50岁以下人群中.此外,TIDM患者死于卒中的风险较普通人群增高3～4倍.文章对T1DM与卒中的关系进行了综述.     

免疫耐受与1型糖尿病

1 型糖尿病(T1MD)主要发生于青少年,是儿科常见的内分泌疾病之一,其发病率呈逐年上升趋势.1型糖尿病是一种T细胞依赖性自身免疫疾病,其典型特征是胰岛β细胞特异性损伤导致胰岛素分泌的不足.近年来,通过对动物模型的研究以及临床治疗,对1型糖尿病的易感基因和病理生理学的认识方面都有了显著的发展.     

细胞因子与1型糖尿病

1型糖尿病是由于免疫调节功能紊乱导致Th1细胞介导的自身免疫性疾病.IFN-γ、IL-1β等Th1类细胞因子可通过氧自由基和/或氮自由基介导胰岛β细胞破坏,IL-4、IL-10可通过下调自身反应性T细胞的活性而发挥其保护作用;然而,细胞因子是一个复杂网络系统,单一细胞因子在1型糖尿病不同发病阶段可起完全不同的作用.     

骨髓移植与1型糖尿病

自体和同种异体骨髓移植治疗难治性自身免疫性疾病是近年来研究的热点。1型糖尿病是最常见的器官特异性自身免疫性疾病之一,自体骨髓移植能够缓解自身免疫性胰岛炎,重建相对正常的免疫系统;而同种异体骨髓移植则不仅能纠正自身免疫状态,而且能对供者的胰岛产生特异性免疫耐受。因此,骨髓移植对1型糖尿病的防治以及胰岛移植等都具有重要的价值。     

1型糖尿病与2型糖尿病血脂对照分析

目的：观察1型糖尿病和2型糖尿病血脂代谢特征。方法：比较两型糖尿病病人血脂代谢与空腹血糖、年龄、体重的关系。结果：①不论是1型糖尿病还是2型糖尿病，均以TG升高为主，TG值明显高于正常人；②两种类型糖尿病。空度血糖控制不好的病人血脂异常的患病率均较高；③1型糖尿病病人年龄与血脂无相关性；2型糖尿病病人年龄越大，血脂异常患病率越高；④1型糖尿病病人体重指数与血脂异常患病率不相关，2型糖尿病病人体重指数越大，血脂异常患病率越高。结论：1型糖尿病和2型糖尿病的血脂异常与空腹血糖、年龄及体重指数具有不同的相关性。     

双束支文氏型传导阻滞致猝死1例

患者女性,27岁,既往体健。1983年5月28日16时因头痛、流涕伴胸闷1周住观察室,当晚20时猝死。16时30分心电图(附图A,见第103页)示:P-P0.68—0.72s,R-R1.00—1.04s,QRS形态有两种:1.正常型:时间0.10s(R(1、3、5))。2.右束支阻滞型:时间0.16s(R_(2、4、6))。房室比例3:2。心电图(附图B)示P_1- R_10.16s,为正常窦性传导。P_2-R_20.52s,但关系固定,QRS形     

免疫调节失衡与1型糖尿病

1型糖尿病是一种胰岛β细胞特异性自身免疫性疾病,免疫调节失衡学说认为患病个体存在T淋巴细胞两亚群Th1和Th2细胞及其细胞因子功能失衡,表现为β细胞损害性Th1反应强于保护性Th2反应.另外,导致β细胞损害的Th1反应与自由基有关.     

Prevention of sudden cardiac death and diabetes mellitus

Conclusions Appropriate medical therapy and revascularization play a pivotal role in preventing or treating myocardial infarction and left ventricular systolic dysfunction, thereby reducing the incidence of SCD. Nevertheless, the ever-growing population of diabetic patients with coronary artery disease, prior myocardial infarction, and left ventricular systolic dysfunction continue to comprise a high-risk population. Thus, appropriate screening and utilization of ICD therapy will remain essential modalities in the ongoing battle against SCD. The use of devices capable of both biventricular pacing and ICD therapy will continue to grow in the ongoing effort to improve both quality of life and mortality in patients with systolic congestive heart failure.     

Type 1 diabetes mellitus and pregnancy

As a result of the advances in glucose monitoring and insulin administration, there has been a dramatic improvement in the outcomes of pregnancy in diabetic women over the past decades. Pregnancy in type 1 diabetic women is associated with an increase in risk both to the fetus and to the mother. The normalization of blood glucose in order to prevent congenital anomalies and spontaneous abortions is considered a priority. As the pregnancy progress, the mother is at an increased risk for hypoglycemia or diabetic ketoacidosis. Later in the pregnancy, she is at risk of accelerated retinopathy, pregnancy-induced hypertension and preeclampsia-eclampsia, urinary tract infection, and polyhydramnios. At the end of pregnancy, there is also an increased risk of macrosomia and sudden death of the fetus in uterus. All of these complications can be prevented or, at least, minimized with careful planning of the pregnancy and intensive tight glucose control.     

Type 1 diabetes mellitus and eating disorders

The choice of type and quantity of food is vital to achieving glycaemic control in diabetes, more so in type 1 diabetes mellitus. The attention to detail could however reach a level of obsession of an eating disorder and thereby have a negative impact on glycaemic control. We conducted a study to see if there was a risk of developing eating disorders among adolescent, young and middle-aged adults with type 1 diabetes mellitus and whether it has an association with HbA₁C levels. A cross-sectional study was conducted on 113 type 1 diabetes mellitus patients and age-gender-matched healthy controls. The two groups were screened using the Eating Attitude Test-26 (EAT-26) questionnaire. EAT-26 identified type 1 diabetes as having a high risk for developing eating disorder when compared to those without diabetes (OR = 38.5 with 95% CI 8.7, 170.7; p < 0.001). The risk of developing eating disorder increased with the duration of diabetes. There was no significant difference in the risk between males and females. The risk of developing eating disorder did not correlate with glycaemic control. EAT-26 identified subjects with type 1 diabetes as high risk for developing eating disorder in comparison to those without diabetes. In our setting, this did not reflect on poor glycaemic control.     

1型糖尿病与多囊卵巢综合征

多囊卵巢综合征(PCOS)是育龄期女性最常见的内分泌疾病之一.研究显示,1型糖尿病患者中PCOS或高雄激素血症的发病率非常高,且这些患者的临床表现较轻.传统观点认为肥胖和胰岛索抵抗是PCOS的常见原因,但是不能用于解释此类PCOS的发病机制.现对1型糖尿病合并PCOS的发病机制、危害和防治手段进行阐述.     

Prediction and prevention of Type 1 diabetes mellitus

Type 1A diabetes mellitus (T1DM) is caused by autoimmune islet β-cell destruction with consequent severe insulin deficiency. We can now predict the development of T1DM by determining four biochemically characterized islet autoantibodies, namely those antibodies against insulin, glutamic acid decarboxylase 65, insulinoma antigen (IA)-2 (ICA512) and the zinc transporter ZnT8. We can also prevent T1DM in animal models, but the final goal is the prevention of T1DM in humans. Multiple clinical trials are underway investigating methods to prevent β-cell destruction.     

GAD-alum immunotherapy in Type 1 diabetes mellitus

Glutamic acid decarboxylase (GAD)-alum (Diamyd(?), Diamyd Medical, Stockholm, Sweden) is an adjuvant-formulated vaccine incorporating recombinant human GAD65, the specific isoform of GAD expressed in human pancreatic β-cells and a major antigen targeted by autoreactive T lymphocytes in Type 1 diabetes mellitus. Intermittent vaccination with this protein is theorized to induce immune tolerance to GAD65, thereby potentially interrupting further β-cell destruction. Hence, clinical trials are ongoing to examine the efficacy and safety of GAD-alum immunotherapy in patients with autoimmune-mediated forms of diabetes, including Type 1 diabetes and latent autoimmune diabetes in adults.