帕罗西汀对女性2型糖尿病伴抑郁患者胰岛素敏感性的影响

目的:探讨帕罗西汀对女性2型糖尿病伴抑郁患者胰岛素敏感性的影响. 方法:50例女性2型糖尿病伴抑郁患者随机分为合用组(二甲双胍联合帕罗西汀治疗)和单用组(单用二甲双胍治疗),每组25例.于治疗前和治疗8周,采用汉密尔顿抑郁量表(HAMD)评定情绪;并测定性激素结合球蛋白(SHBG)和皮质醇水平. 结果:治疗8周,合用组HAMD评分及皮质醇水平均显著低于单用组(P<0.05或P<0.01);而SHBG浓度明显高于单用组(P<0.01). 结论:帕罗西汀能提高胰岛素敏感性,降低胰岛素抵抗,控制血糖水平,明显改善2型糖尿病伴抑郁患者的抑郁情绪.     

胰岛素强化治疗对糖尿病患者甲状腺激素及抑郁状态的影响

目的研究胰岛素强化治疗对糖尿病患者甲状腺激素及抑郁状态的影响。方法选取我院内科收治的糖尿病患者170例,随机分为观察组(n=85)和对照组(n=85),观察组给予胰岛素强化治疗,对照组给予口服降糖药治疗,检测2组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)水平及游离甲状腺激素FT3、FT4和促甲状腺激素(TSH)水平,比较BDC抑郁指数改善情况。结果 2组治疗后FPG、2hPG及HbA1c水平均显著下降,差异有统计学意义(P0.05);治疗前2组抑郁者FT3、FT4水平低于非抑郁者,TSH水平高于非抑郁者,差异有统计学意义(P0.05);治疗后观察组抑郁患者FT3、FT4水平均显著上升,TSH及抑郁指数水平显著降低,差异有统计学意义(P0.05)。结论胰岛素强化治疗不仅可控制糖尿病患者血糖,还可改善其甲状腺激素水平及抑郁指数,提示糖尿病患者抑郁症状与甲状腺激素具有一定的相关性。     

2型糖尿病并发脑梗死危险因素临床分析

目的探讨2型糖尿病并发脑梗死的危险因素。方法随机选取120例患者,分为2型糖尿病并发脑梗死者组(A组)和单纯2型糖尿病组(B组),每组60例。对所入选患者测量空腹血糖(FBG)、空腹胰岛素(FBI)、血流变、甘油三酯(TG)、血胆固醇(TCHO)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL),测量身高、体质量、血压,计算腹围指数(IBM)和胰岛素敏感指数(ISI),对所得结果进行分析。结果 2型糖尿病并发脑梗死患者其空腹血糖、甘油三酯、胆固醇、低密度脂蛋白、腹围指数、血压均高于单纯2型糖尿病者,而高密度脂蛋白、胰岛素敏感指数低于后者。结论高血压、高血糖、肥胖、高黏血症、高血脂、胰岛素抵抗是2型糖尿病并发脑梗死的危险因素。     

血糖水平对2型糖尿病合并脑梗死患者预后影响的临床分析

目的探讨血糖水平对2型糖尿病合并脑梗死患者预后的影响。方法117例2型糖尿病合并脑梗死患者分为A、B、C 3组进行预后分析。结果空腹血糖在<16.7mmol/L范围内时(A组和B组),血糖水平与疗效间无明显关系,但随着血糖水平的逐渐增高(C组≥16.7mmol/L),2型糖尿病合并脑梗死患者的疗效呈显著下降。结论2型糖尿病合并脑梗死患者的预后随血糖升高而加重。     

西酞普兰对2型糖尿病患者抑郁症状的疗效观察

目的探讨西酞普兰对2型糖尿病患者合并抑郁症的疗效。方法对52例合并抑郁症的2型糖尿病患者,随机分为研究组(服用西酞普兰组,26例)和对照组(未服用西酞普兰组,26例),治疗8周。以汉密尔顿抑郁量表(HAMD)评定疗效,用糖化血红蛋白(HbA1c)水平监测血糖控制情况。结果治疗8周后,研究组抑郁症状的改善明显优于对照组(P<0.01),显效率(65.4%)和有效率(80.8%)均明显高于对照组(分别为26.9%和46.2%)(P均<0.01);研究组HbA1c水平较治疗前显著下降,且明显低于对照组(P<0.01)。结论西酞普兰能明显改善2型糖尿病患者的抑郁症状,更有利于患者血糖的控制。     

胰岛素抵抗对2型糖尿病患者周围神经病变的影响

目的探讨及分析胰岛素抵抗对2型糖尿病患者周围神经病变的影响。方法选取2型糖尿病患者161例为研究对象,按照是否合并周围神经病变将患者分为糖尿病周围神经病变组(DPN组,n=102)和非糖尿病周围神经病变组(NDPN组,n=59);比较2组一般资料、餐后胰岛素敏感性(Matsuda指数)、空腹胰岛素抵抗(HOMA-IR)、空腹及糖耐量实验(OGTT)后各时间点的血糖、胰岛素素及C-肽水平之间的差异。结果 DPN组年龄、糖尿病病程、HbA1c、LDL-C水平均高于NDPN组,差异有统计学意义(P0.05),Matsuda指数、HOMA-IR、空腹血糖及胰岛素水平[OGTT(0 min)]均高于NDPN组(P0.05),OGTT(120min)胰岛素水平显著低于NDPN组(P0.05);Logistic回归分析提示:年龄、空腹血糖(FBG)、胰岛素(FIRI)水平、HOMA-IR、Matsuda指数与患者周围神经病变的发生呈正相关(P0.05),而OGTT(120min)胰岛素水平与其呈负相关(P0.05)。结论 2型糖尿病患者空腹胰岛素抵抗与周围神经病变的发生密切相关,而患者餐后胰岛素抵抗则可能对周围神经病变的发生起到抑制作用。     

苯扎贝特对血栓性疾病危险因素的影响

目的 探讨苯扎贝特对载脂蛋白(a)[LP(a)],高纤维蛋白原(FIB)及胰岛素抵抗(IR)的影响.方法 临床筛选单纯高脂血症患者50例,合并2型糖尿病(NIDDM)患者50例,随机分成4组,不合并(A组)和合并(B组)NIDDM各30例为治疗组,口服苯扎贝特;另不合并(C组)和合并(D组)NIDDM各20例为对照组,口服安慰剂,疗程12周.结果 A、B组经治疗后血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、LP(a)、空腹血糖(FBG)和FIB均有较明显下降、高密度脂蛋白胆固醇(HDL-C)升高,糖耐量、胰岛素抵抗改善,胰岛素敏感指数(AS指数)上升,延长PT、KPTT时间,而对照组无显著差别.结论 苯扎贝特具有全面改善脂代谢紊乱的作用,同时还有改善胰岛素抵抗、降低LP(a)、FIB以及改善凝血纤溶功能.     

2型糖尿病患者合并认知功能障碍的危险因素分析

目的分析2型糖尿病合并认知功能障碍的危险因素,为其早期防治提供临床指导。方法选取2012-04—2015-04我院收治的200例2型糖尿病患者为研究对象,采用MOCA(蒙特利尔认知评估)量表对患者作认知功能评估,据量表结果将其分为NC组(认知功能正常组,n=110)与CI组(认知功能障碍组,n=90),收集2组患者临床资料,总结2型糖尿病合并认知功能障碍的相关危险因素。结果单因素分析结果提示,2型糖尿病合并认知障碍组与认知功能正常组,其年龄、病程、P2BG、Hbalc、CHO、高血压史、糖尿病家族史、焦虑、抑郁、胰岛素治疗、神经病变及视网膜病变等因素对比差异有统计学意义(P0.05);多元回归分析证实:年龄、HbAlc、CHO、视网膜病变、抑郁为2型糖尿病合并认知功能障碍的独立危险因素。结论高龄、抑郁、高胆固醇、合并糖尿病视网膜病变、血糖控制率低均可加大2型糖尿病患者发生认知功能障碍风险,需积极控制,并予以防治。     

胰岛素联合艾司西酞普兰治疗糖尿病合并焦虑抑郁症状患者的临床效果影响

目的研究艾司西酞普兰联合胰岛素治疗糖尿病合并焦虑抑郁症状患者的临床效果。方法选取我院从2014年5月至2015年6月收治的糖尿病伴焦虑抑郁症状的患者80例,采用随机数字表法将80例患者分为观察组(40例)和对照组(40例);对照组采取常规胰岛素治疗,观察组在对照组的基础上联用艾司西酞普兰。观察对比两组患者的临床有效率、HAMD评分、HAMA评分以及餐后2h血糖与糖化血红蛋白。结果观察组的临床有效率87.50%显著高于对照组67.50%(P0.05);观察组的HAMA评分与HAMD评分明显低于对照组(P0.05);观察组的餐后2h血糖与糖化血红蛋白均显著低于对照组(P0.05)。两组不良反应率没有统计学差异(P0.05)。结论艾司西酞普兰联合胰岛素治疗糖尿病焦虑抑郁症状的患者具有明显的临床效果,减轻患者的负性情绪,使患者的血糖水平得到有效的控制。     

社区老年2型糖尿病患者共病抑郁的现况调查及相关危险因素分析

目的 了解社区老年2型糖尿病人群伴发抑郁的现状及相关危险因素.方法 选取2015年1月~2016年12月在上海市梅陇社区卫生服务中心就诊的550例老年2型糖尿病(T2DM)患者进行病人健康问卷抑郁量表(PHQ-9)评定及相关问卷调查,根据PHQ-9评分情况将患者分为共病抑郁组和非抑郁组,对两组患者人口学资料进行比较,采用多因素Logistic回归分析探讨糖尿病共病抑郁的相关危险因素.结果 所调查老年2型糖尿病人群抑郁的发生率为45.27%;糖尿病病程、合并躯体疾病数、空腹血糖、HbA1C为社区老年T2DM患者共病抑郁的独立危险因素(P<0.05).结论 老年T2DM患者中抑郁的发病率高,在对社区老年T2DM患者进行指导、治疗时,除了需要积极控制血糖、HbA1C外,还需要积极关注其可能存在的抑郁症状,做到前期预防、早期发现并及时治疗.     

Effects of ECT on diabetes mellitus. An attempt to account for conflicting data

The authors review the recent, conflicting findings of the effect of ECT on diabetes mellitus. To further explore this relationship, they present case reports of three adult-onset diabetic patients with varying degrees of diabetic management who were treated for depression with ECT. The results point to the variability of effects which ECT may have on blood glucose in diabetic patients. ECT may produce a potentially dangerous hyperglycemia in severely diabetic patients, but ECT does not appear to exert a major diabetogenic or diabetolytic effect on patients with mild diabetes mellitus. Possible mechanisms by which ECT affects blood glucose levels are discussed.     

Acute changes in blood glucose affect resistance to ischemic nerve conduction failure

We studied resistance to ischemic nerve conduction failure (RINCF) following rapid alterations of blood glucose in normal and diabetic rats. We measured RINCF hourly for 4 hours in normal and diabetic rats. We then made normal rats hyperglycemic and diabetics euglycemic. In normal rats, we measured RINCF sequentially for 4 hours immediately after glucose injection and once after 1, 2, 3, or 4 hours of hyperglycemia. In diabetics, we measured RINCF sequentially for 4 hours after insulin injection. In normal rats, in sequential measurements, RINCF progressively fell but glucose injection prevented this fall. Hyperglycemia without preceding ischemia increased RINCF. In diabetic rats, sequential measurements also produced a decline in RINCF, accentuated with insulin injection. The results suggest that both glucose and insulin are important in determining the response of peripheral nerve to ischemia. They also underscore the importance of knowing the blood glucose and time of most recent insulin injection when measuring RINCF.     

焦虑、抑郁情绪对2型糖尿病疗效的影响

目的：探讨焦虑、抑郁情绪对2型糖尿病患者疗效的影响。方法：136例糖尿病患者治疗前根据抑郁自评量表（SDS）或焦虑自评量表（SAS）评分后分为焦虑、抑郁组64例（SDS或SAS≥50分）和对照组72例（SDS或SAS〈50分）;两组均给予胰岛素治疗1个月。于治疗前后进行空腹血糖（FBG）、餐后2h血糖（2hBG）、糖化血红蛋白（HbA1c）、超敏C-反应蛋白（hsC-RP）及SDS、SAS评分比较。结果：虽经胰岛素系统治疗,但伴有焦虑、抑郁情绪的糖尿病患者的FBG、2hBG及hsC-RP水平仍明显高于对照组（P〈0.05或P〈0.01）;胰岛素用量更多,血糖控制更难达标。结论：焦虑、抑郁情绪严重影响糖尿病的治疗与转归。     

Use of Antidepressants in Treatment of Comorbid Diabetes Mellitus and Depression as Well as in Diabetic Neuropathy

After a brief review of epidemiology, the focus is on biochemistry of diabetes. Animal and human studies are reviewed in terms of the impact of alterations in catecholamines and serotonin (5-hydroxytryptamine, 5HT) on glucose utilization. Then, the implications of these experimental results for the choice of antidepressant in comorbid diabetes mellitus and depression as well as in diabetic neuropathy are discussed. Results of clinical investigations are then reviewed in terms of the above hypotheses. An Index Medicus Search for the past 10 years was supplemented by references from previous related reviews of the topic as well as by pending results, where available, not previously published. The range of prevalence of depression in diabetic patients has been 8–27%, depending on study criteria and procedures. An increase of catecholamines appears to increase glucose while both reducing insulin release and reducing sensitivity to insulin that is available. In contrast, increases in serotonergic function by increased precursor, increased release, or blocked metabolism and blocked reuptake in contrast seem to increase sensitivity to insulin and reduce plasma glucose. There have been six studies of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), at a dose of 60 mg/day pursued up to 12 months that have demonstrated that medication's usefulness in diabetic patients, with reductions in weight (to 9.3 kg), in FPG (to 45 mg%), and in HbA1c (to 2.5%). In studies in comorbid diabetes mellitus and depression, nortriptyline, a norepinephrine reuptake inhibitor that produces increased synaptic catechols, has led to worsening of indices of glucose control. However, fluoxetine and sertraline, both selective serotonin reuptake inhibitors, in the same patient group, have produced results consistent with reductions in glucose levels. In diabetic neuropathy, perhaps due to the fact that catecholamines and serotonin may both be implicated in pain pathways, dual-action antidepressants appear more effective at lower doses than do specific serotonergic agents. The tricyclic antidepressants (TCA) (66.7%) have had success in double-blind studies, particularly imipramine, with a 81% response rate. Yet, there are positive reports concerning the SSRIs (paroxetine, citalopram, sertraline), as well as nefazodone, that focus on serotonin selectivity. Conclusions: In comorbid diabetes mellitus and depression, most evidence supports the use of fluoxetine in control of glucose handling. Other characteristics in terms dosing, drug interactions, cognition, and sleep make sertraline an attractive alternative agent. In diabetic neuropathy without depression, the best choices among non-TCAs may include sertraline, citalopram, and perhaps, venlafaxine, since the TCAs appear to increase cravings and increase FBG levels.     

银杏叶提取物对2型糖尿病合并脑梗死病人胰岛素敏感性的影响

目的观察金纳多对2型糖尿病合并脑梗死病人的胰岛素敏感性的影响。方法32例2型糖尿病病人合并脑梗死保持降糖药、饮食和运动不变,静滴金纳多70mg/d,疗程15d,治疗前后行胰岛素耐量试验,算葡萄糖利用常数(Kitt)值,测血黏度和红细胞变形指数(DImax)、聚集指数(ALmax)及口服葡萄糖耐量试验(OGTT),胰岛素释放试验。结果用金纳多后Kitt值上升,DImax提高(P<0.01);OGTT、血黏度改善(P<0.05),而胰岛素无变化。结论金纳多可提高2型糖尿病合并脑梗死病人胰岛素敏感性,其机制可能是通过改善红细胞膜弹性和血流状况而提高胰岛素活性。     

Comorbidity of diabetes mellitus and eating disorders. A comparison of psychological features of eating disordered and non-eating disordered patients with diabetes mellitus

As part of a multicentre study on the comorbidity of diabetes mellitus and eating disorders, the following paper compares the psychological features of diabetic patients with and without an eating disorder. In a sample of 663 diabetic patients (type 1: n = 341 type 2: n = 322), eating disorder related variables, self-esteem, body acceptance and emotional distress, especially depression in diabetic patients with and without an eating disorder, were compared. A possible relationship to diabetic control was investigated. Type 2 diabetics revealed more pronounced psychopathology in comparison to type 1 diabetics. According to our assumption, diabetic patients with an eating disorder and diabetic patients who deliberately reduced insulin in order to loose weight (insulin purging) revealed a much more severe psychopathology compared to diabetics without an eating disorder. The type of diabetes was of no importance. With the exception of the variable body and figure satisfaction in the sample of type 1 diabetes and the variable self-acceptance in the sample of type 2 diabetes, no relationship to diabetic control could be found.     

Effects of insulin on blood, plasma, and brain glucose in hyperglycemic diabetic rats

This study, in biologically bred hyperglycemic diabetic rats, examined the effect of a intravenous insulin infusion (1.5 units.hr-1) on blood, plasma, and brain glucose concentrations to determine their relationship during decreasing blood and plasma glucose levels. The data were compared to saline-treated diabetic rats and saline-treated nondiabetic littermates. The volume and duration of the treatment infusion were similar in all groups. Insulin infusion in diabetic rats produced the expected reduction in blood and plasma glucose, and normoglycemia was produced within 78 +/- 37 minutes (mean +/- SD). However, once normoglycemia was achieved, brain glucose was still significantly greater by 44% than in nondiabetic rats (p = 0.015). Moreover, the ratio of brain to plasma glucose was more than 50% greater in diabetic than nondiabetic rats, irrespective of whether or not they received insulin (p less than 0.01). We conclude that measurement of blood or plasma glucose in diabetic subjects will tend to underestimate the amount of glucose in the brain and that this relationship is not influenced by acute insulin therapy.     

2型糖尿病患者合并卒中的相关危险因素分析

目的 探讨2型糖尿病患者合并卒中的相关危险因素。方法 采用回顾性分析的研究方法对连续选取自2003年1月至2010年6月于卫生部北京大学第五临床医学院内分泌科住院治疗的2099例2型糖尿病患者进行分析,依据患者是否合并卒中分为2型糖尿病合并卒中组和2型糖尿病不合并卒中组,比较两组患者一般资料及血糖、血脂、血尿酸等代谢指标,分析2型糖尿病患者合并卒中的危险因素。性别不同相应的危险因素略有差异,进一步按照性别进行分层,分别比较不同性别2型糖尿病患者合并卒中的危险因素。结果 2099例2型糖尿病患者中,212例（10.1%）合并卒中,年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压、尿酸以及颈动脉内中膜厚度和股动脉内中膜厚度在糖尿病合并卒中组均高于糖尿病不合并卒中组,差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在男性患者中,合并卒中者130例（10.9%）。年龄、糖尿病病程、空腹胰岛素、2小时胰岛素、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、尿酸、收缩压、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组,差异具有显著性（P<0.05）。糖尿病合并高血压及合并冠状动脉粥样硬化性心脏病均较无相应并发症者卒中发病率明显增高（P均<0.01）。在女性患者中,合并卒中者82例（9.04%）。年龄、腰臀比、糖尿病病程、收缩压、尿酸、高密度脂蛋白胆固醇、颈动脉内中膜厚度和股动脉内中膜厚度在合并卒中组均高于不合并卒中组,差异具有显著性（P<0.05）。在男性及女性患者中,糖尿病合并高血压或合并冠状动脉粥样硬化性心脏病病史的均较无相应并发症者卒中发病率明显增高（P均<0.01）。多因素Logistic回归分析表明,年龄［优势比（odds ratio,OR）为1.067,95%可信区间（confidence interval,CI）1.021～1.115,P=0.004］、股动脉内中膜厚度（OR 1.590,95%CI 1.041～2.431,P=0.032）、收缩压（OR 1.026,95%CI 1.008～1.044,P=0.004）、冠状动脉粥样硬化性心脏病病史（OR 2.342,95％CI 1.081～5.070,P=0.031）与2型糖尿病患者合并卒中具有相关性。结论 2型糖尿病患者合并卒中的相关危险因素为年龄、腰臀比、糖尿病病程、空腹胰岛素、餐后2小时胰岛素、收缩压和尿酸及颈动脉内中膜厚度和股动脉内中膜厚度。不同性别2型糖尿病患者合并卒中的危险因素略有差异。合并高血压及冠状动脉粥样硬化性心脏病可增加卒中的发生。     

综合治疗对伴有负性情绪糖尿病患者的影响

目的:探讨综合疗法对伴有负性情绪糖尿病患者的疗效。方法:将150例糖尿病患者随机分为3组。药物组为单用降糖药,干预组为降糖药加心理干预,综合组为降糖药合并帕罗西汀和心理干预。疗程4周。分别于治疗前、治疗2、4周进行焦虑自评量表(SAS)和抑郁自评量表(SDS)评定,并测空腹血糖(FBG)和餐后2h血糖(2PBG)。结果:SAS和SDS评分以综合组和干预组均显著低于药物组,但综合组情绪改善较快。FBG和2PBG下降以综合组和干预组好于药物组,综合组和干预组间差异无显著性。结论:综合治疗更能有效缓解糖尿病患者负性情绪,从而更好地控制血糖。