老年糖尿病患者胰岛细胞抗体测定及其与β与细胞功能的关系

目的 观察老年糖尿病患者胰岛细胞抗体（ＩＣＡ）与β细胞功能的关系。方法 用ＩＣＡ法测定８０例老年糖尿病患者ＩＣＡ并与４８例健康老年人对照,同时测定糖耐量试验、胰岛素、Ｃ肽释放试验。结果 （１）老年糖尿病患者ＩＣＡ阳性率为１３．７５％,显著高于对照组（Ｐ〈０．０５）。（２）ＩＣＡ阳性患者空腹及餐后血糖均高于ＩＣＡ阴性患者,但无统计差异。（３）ＩＣＡ阳性患者餐后１ｈ、２ｈ的胰岛素、Ｃ肽均低于ＩＣＡ阴性     

老年糖尿病患者胰岛细胞自身免疫现象

目的：了解老年糖尿病患者胰岛细胞抗体（ICA）及谷氨酸脱羧酶抗体（GADA）的检出情况及其胰岛β-细胞功能状况。方法：87例新发的老年糖尿病患者为实验组,100例新发非老年糖尿病病人为对照组。2组均行ICA、GADA检测、口服葡萄糖耐量实验及C－肽释放实验。结果：实验组中有14．9％呈ICA和（或）GADA阳性,对照组中有16％呈上述抗体阳性,2组阳性率无明显差异（P＞0．05）。与其他组相比,抗体阳性的老年糖尿病患者服糖前后各点血清C－肽浓度均较低（P＜0．01）。结论老年糖尿病中亦有一定数量的1型糖尿病患者,其发生率与非老年组相同,但这类患者胰岛细胞储备能力减退更为明显。     

胰岛自身抗体与β细胞功能关系的研究

目的分析胰岛自身抗体与β细胞功能关系,探讨胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GADA)在类似2型糖尿病的成人隐匿性自身免疫糖尿病(LADA)中的诊断价值,指导临床糖尿病分型诊断和治疗。方法初诊2型糖尿病病人70例,正常糖耐量者70例,测定ICA、GADA及胰岛素释放,计算胰岛素分泌指数(HOMA-IS)、胰岛素抵抗指数(HOMA-IR)及ICA、GADA阳性率。初诊2型糖尿病自身抗体阳性组与阴性组进行年龄、体重指数(BMI)、腰臀比值(WHR)、糖化血红蛋白(HbA1c)、空腹和餐后2h胰岛素(FINS、餐后2hINS2h)、HOMA-IS及HOMA-IR等临床特征比较。结果初诊2型糖尿病组ICA阳性率为11.4%,正常糖耐量组为0.0%(P<0.01);GADA阳性率在糖尿病组为18.6%,正常糖耐量组为4.3%(P<0.01)。空腹及餐后2h胰岛素在抗体阳性组明显低于阴性组(P<0.001);HOMA-IS指数及HOMA-IR指数在抗体阴性组、抗体单阳性组及双阳性组依次降低。结论临床诊断为2型DM病人中可能有LADA病人,抗体阳性者胰岛功能明显低于抗体阴性者,提示其胰岛功能有明显损伤,而抗体阴性组胰岛素抵抗明显,提示胰岛自身抗体结合胰岛β细胞功能对LADA病人早期诊断有帮助。     

糖尿病患者胰岛自身抗体与β细胞功能的关系

目的 研究胰岛自身抗体与糖尿病（DM）临床表现，β细胞功能的关系。方法 分析733例住院DM患者的临床和生化特征。测定血清C肽，胰岛细胞抗体（ICA），谷氨酸脱羧酶抗体（GADA）和蛋白酪氨酸磷酸酶抗体（IA-2A）水平。结果 58例速发型1型DM中34.5%，GADA阳性，22.4%ICA阳性，27.3%IA-2A阳性，在临床初诊为2型DM的675例患者中，13.5%有一种以上抗体阳性，其中10.1%GADA阳性，2.7%ICA阳性，8.7%IA-2A阳性，在不同病程的成人隐匿性自身免疫性糖尿病（LADA）中自身抗体阳性率无明显变化。而病程2年以上的1型DM患者中则呈降低趋势，随着病程延长，患者均有空腹和餐后C肽水平降低，但下降的速度以1型DM最快，LADA次之，2型DM最慢，多因素逐步回归分析表明，GADA是导致空腹与餐后C肽水平降低的危险因素。结论 在速发型1型DM和LADA患者中GADA，ICA和IA-2A阳性率不同，联合抗体检测有助于诊断，LADA患者β细胞功能衰退较慢，保护残存β细胞可有利于延缓病情进展。     

胰岛细胞抗体阳性的老年糖尿病患者B细胞功能的变化

一、资料与方法１．对象：老年２型糖尿病患者（ＤＭ２组）８０例,均为我院１９９７年１月至１９９８年２月收治的住院或门诊患者。男５２例,女２８例,年龄６０～７１岁,平均（６３．９±４．８）岁。病程３个月至２４年,单纯饮食和（或）口服降糖药控制血糖,均未用...     

继发性磺脲类药物失效糖尿病患者谷氨酸脱羧酶抗体与胰岛β细胞功能的关系

我们通过对继发性磺脲类药物失效的2型糖尿病患者GAD抗体与胰岛β细胞功能的关系研究，以期对继发性磺脲类药物失效的机制进行探讨。     

老年糖尿病患者胰岛β细胞功能及其与胰淀素和褪黑素的关系

目的观察新诊断老年糖尿病(DM)患者胰岛β细胞功能特点及其与胰淀素、褪黑素的关系。方法收集初诊DM患者60例,其中老年DM组27例,成年DM组33例,对照组30例。均行口服葡萄糖耐量试验(OGTT),计算胰岛β细胞功能指数(HOMA-β)。采用ELISA法检测患者空腹血清胰淀素、褪黑素水平。同时测定所有受试者的血脂、体重指数(BMI)和腰臀比(WHR),并对结果进行统计分析。结果 (1)老年DM组与成年DM组比较HOMA-β明显降低〔(58.20±24.89)vs(81.20±40.80),P0.01〕,而OGTT2h血糖、胰岛素值及胰岛素抵抗指数(HOMA-IR)明显升高(P均0.05)。(2)与对照组相比,老年DM组血清胰淀素水平显著增高〔(21.57±15.88)vs(17.82±12.15)ng/L,P0.01〕;而褪黑素水平明显降低〔(6.56±1.32)vs(7.65±1.39)pg/ml,P0.01〕。(3)老年糖尿病组HOMA-β与褪黑素呈正相关(r=0.403,P=0.016),与胰淀素(r=-0.461,P=0.003)、HOMA-IR(r=-0.238,P=0.009)呈负相关,与空腹血糖、胰岛素、甘油三酯(TG),WHR则无明显相关性。结论新诊断的老年DM患者存在明显的胰岛素分泌缺陷,胰淀素的增高和褪黑素的降低可能与老年糖尿病的发生有关。     

2型糖尿病与胰岛β细胞功能缺陷

2型糖尿病(DM)的发病与胰岛素抵抗和胰岛素分泌缺陷有关,目前一般认为在胰岛素抵抗的基础上,由于遗传及环境因素作用出现的胰岛素分泌缺陷是导致2型DM发病的主要原因,对糖尿病的发生发展起关键性作用。一、2型DM不同阶段胰岛素分泌缺陷的状况对2型DM高危人群的研究发现,在出现糖耐量异常之前,有空腹及(或)葡萄糖刺激后的高胰岛素血症,提示已存在胰岛素敏感性下降。而胰岛素敏感性同样是胰岛素分泌的调节因子,此时已开始胰岛素分泌的代偿性改变,若胰岛素分泌不能适应血糖的变化,就会出现糖耐量减低(IGT)。在IGT阶段,空腹血糖正常而餐后…     

胰岛细胞抗体与胰岛β细胞功能关系的探讨

对251例1型糖尿病（T1DM）患者进行胰岛细胞抗体（ICA）检测,发现ICA阳性组中谷氨酸脱羧酶抗体（GADA）和蛋白酪氨酸磷酸酶抗体（IA-2A）阳性率均显著高于ICA阴性组（P〈0.01）,空腹和餐后胰岛素水平明显低于ICA阴性组（P〈0.05,P〈0.01）,胰岛素抵抗指数亦明显下降（P〈0.05）,提示T1DM患者中ICA阳性更易于合并有GADA、1A-2A阳性,且对胰岛β细胞功能的破坏更大。     

酮症倾向的糖尿病患者胰岛自身抗体与胰岛功能的意义

目的探讨酮症倾向糖尿病（KPD）患者临床特征、自身抗体检出情况及胰岛8细胞功能。方法检测78例KPD患者血清谷氨酸脱羧酶抗体（GAD-Ab）、胰岛细胞抗体（ICA）、胰岛素自身抗体（IAA）、GP。任一抗体阳性为A＋，3种抗体均阴性为A-，空腹FGP≥0．333nmol／L为8＋，反之为β-。根据结果78例KPD患者分4组：A＋β＋；A＋β-；A—β＋；A-β-。比较各组的临床特征、自身抗体及胰岛功能。结果A-β＋组发病年龄最大，BMI、合并高血压和肥胖的百分率、TG、TC、TC—P和餐后C-P较高；A＋β-组发病年龄最轻，BMI、合并高血压和肥胖的百分率、C-P水平最低；A＋β＋组和A—β-组临床特征介于A＋β-组和A-β-组之间。结论KPD临床特点不同，自身免疫抗体和胰岛β细胞功能差异显著，提示应根据不同临床特点采取不同的治疗。     

The presence of islet cell antibodies in malnutrition-related diabetes mellitus

The etiology of malnutrition-related diabetes mellitus (MRDM), mostly seen in the developing countries, is still unknown, though an excessive consumption of cassava and a low intake of protein are considered to be its causative factors. Previous immunological studies, though rarely performed, have so far, to our knowledge, shown no case of MRDM with iselt cell antibodies (ICA). We found a 16-year-old MRDM boy with ICA and report on this in the present communication.     

Results of transplantation of pancreatic islet cell cultures to patients with diabetes mellitus

Altogether 110 intramuscular pancreatic islet cell (PIC) culture transplantations were performed in diabetes mellitus patients from April 1981 to May 1984 at the Research Institute of Transplantology and Artificial Organs, USSR Ministry of Health: 65 allotransplantations of human fetal PIC and 45 xenotransplantations fo swine fetal PIC. Immunosuppressive therapy was not employed. The paper is concerned with an analysis of a therapeutic effect of the IC cell cull culture transplantation on 30 patients who were followed-up for not less than 1 year after operation. A pronounced and long-term antidiabetic effect was observed in wost of the recepients subjected to the intramuscular human fetal PIC culture transplantation: demand in exogenous insulin decreased, a durable stabilization of a course of disease in patients with labile diabetes mellitus was observed, and in patients with such diabetic complications as polyneuropathy, retinopathy and glomerulosclerosis certain regress of these complications was observed. As to the results of the intramuscular swine fetal PIC culture xenotransplantation the authors note that xenogenic transplantation as compared with IC culture allotransplantation possesses a less noticeable offect on diabetes mellitus complications.     

Aspects of pancreatic islet transplantation in diabetes mellitus

The justification for pancreatic or islet transplantation in diabetes mellitus is to halt progression of diabetic vascular complications. Although this goal has so far not been achieved, technical progress in transplanting the whole or segmental, vascularized pancreas has been remarkable. However, the operation is complicated and not without risk; immune rejection is furthermore a major problem, and the availability of suitable organs is limited. Transplantation of isolated pancreatic islet grafts, i.e. isolated islets or fetal pancreas, has therefore emerged as an attractive alternative. Iso-, allo- or xenografts of such preparations have been found to reverse diabetes in experimental animals. Only a minor operation is required and islets, although highly immunogenic, may be accessible to immunomodulation in vitro in order to decrease or abolish the allograft rejection and prevent cells from becoming targets for the autoimmune assault. However, problems and difficulties have emerged in this context also. Thus, islets are extremely difficult to isolate from the adult human pancreas. Such glands, be they adult or fetal, are not easily available, and clinical trials have so far remained without documented success. Considerable efforts are being made to overcome the difficulties encountered in islet transplantation. Attempts are being made to improve the techniques for preparation of clean and viable islets and to understand critical factors in the cellular interactions between the graft and the host after transplantation. Factors of importance in this context are the nutritional requirements of the graft and the vascularization process at the site of implantation. In order to provide unlimited access to cells with a high potential for insulin production and adaptive growth in the diabetic recipient, ongoing research is also directed towards methods for preparation of porcine fetal and adult islets suitable for xenotransplantation. The obvious problems involved in immune rejection of the grafted tissue are being investigated with respect both to the possibility of immunomodulation of the graft in vitro, the design of new immunosuppressive drugs, and the possibility of immuno-isolation of the insulin-producing cells with the aid of artificial membranes.     

老年2型糖尿病患者纤维蛋白原与尿微量白蛋白的相关性研究

目的探讨老年2型糖尿病患者正常范围内血浆纤维蛋白原(FIB)与尿微量白蛋白(UMA)的相关性。方法收集2012年10月至2014年10月上海市第五人民医院收治的869例老年2型糖尿病患者的临床资料。将患者按FIB四分位数分为Q1组(<2.42 g/L)、Q2组(2.42~2.89 g/L)、Q3组(2.90~3.61 g/L)、Q4组(≥3.62 g/L),分析FIB与尿白蛋白与肌酐比值(UACR)的相关性。结果随着FIB水平升高,UACR水平显著升高(P<0.05)。Pearson相关分析显示,在男性和女性患者中FIB与年龄、糖尿病病程、肌酐和UACR均呈显著正相关(P<0.01)。多元逐步回归分析显示FIB是UACR的独立影响因素(P<0.01)。Logistic多元回归分析显示,在校正性别、年龄、糖尿病病程、体重指数(BMI)、收缩压、舒张压、空腹血糖(FPG)、HbAlC、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐、丙氨酸氨基转移酶(ALT)、吸烟史和饮酒史因素后,Q4组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的4.536倍(95%CI 2.516~8.175,P<0.01)和13.314倍(95%CI 2.925~60.612,P<0.01),Q3组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的2.177倍(95%CI 1.273~3.724,P<0.01)和4.098倍(95%CI 1.101~19.226,P<0.05)。以UACR 30 mg/g和300 mg/g为分界值,分别行FIB与UACR的ROC曲线所得FIB的最佳切点值分别为3.18 g/L和3.22 g/L。结论老年2型糖尿病患者血浆FIB与UMA密切相关,可能是糖尿病肾病的预测指标之一。     

Relationship between diastolic hypertension and myocardial morphology and function in elderly males with diabetes mellitus

Summary The existence of a distinct diabetic cardiomyopathy, characterized by a raised left ventricular mass, has previously been suggested. However, as diabetes mellitus is associated with both left ventricular hypertrophy and hypertension a confounding effect of raised blood pressure in diabetic patients has to be considered. In the present cross-sectional study an echocardiographical examination was performed as part of a health screening survey in 582 males, aged 70 years. After the exclusion of subjects with coronary heart disease or those on regular antihypertensive treatment, 30 normotensive subjects with diabetes were compared with 10 subjects with non-insulin-dependent diabetes (NIDDM) and a diastolic blood pressure 90 mm Hg or more and 203 normotensive control subjects with normal glucose tolerance. Both groups with NIDDM showed a significantly increased left atrial diameter (4.4 ± 0.7 vs 4.0 ± 0.5 cm, p < 0.05) and an increased atrial component in diastole (A-wave, p < 0.01) compared to the control subjects. Left ventricular mass was, however, only marginally and not significantly elevated in the diabetic subjects when compared to the healthy control subjects (133 ± 19 and 133 ± 28 vs 128 ± 25 g/m²). Only in the subjects with concomitant diabetes and a raised blood pressure was the intraventricular septum significantly enlarged (p < 0.05). Thus, in the present sample no distinct diabetic cardiomyopathy with an increased left ventricular mass, independent of the influence of hypertension could be detected. The myocardial alterations in these diabetic males were restricted to an increased left atrial size and an impaired diastolic function. [Diabetologia (1996) 39: 1603–1606]     

Relationship between diabetes control and pulmonary function in insulin-dependent diabetes mellitus

PURPOSE: To evaluate the effect of different levels of glycemic control on the pulmonary function of subjects with type I insulin-dependent diabetes mellitus. PATIENTS AND METHODS: Eighteen subjects with type I insulin-dependent diabetes mellitus with no history or physical findings of respiratory disease. Patients were given insulin therapy with a standard twice-daily insulin injection regimen (standard treatment group) or a subcutaneous insulin infusion device (insulin pump) (intensive treatment group). Glycosylated hemoglobin (HbA1c) levels were determined at quarterly intervals in both groups of patients (standard treatment group, n = 10; intensive treatment group, n = 8). Pulmonary function and diffusing capacity for carbon monoxide (DLCO) were measured after 6 years of continuous follow-up. RESULTS: The average HbA1c in the standard treatment group was significantly higher than that of the intensive treatment group throughout the 6 years of follow-up (p less than 0.001). The forced vital capacity of the standard treatment group was 85 +/- 3% of predicted as compared with 106 +/- 4% of predicted in the intensive treatment group (p less than 0.001). The DLCO was also significantly diminished in the standard treatment group as compared with that in the intensive treatment group (65 +/- 2% versus 87 +/- 4% of predicted) (p less than 0.001). CONCLUSION: These data confirm previous reports of abnormal respiratory function in subjects with insulin-dependent diabetes mellitus and suggest that long-term near-normoglycemia may be beneficial in preventing the deterioration of pulmonary function associated with diabetes mellitus.     

Short- and long-term gliclazide effects on pancreatic islet cell function and hepatic insulin extraction in non-insulin-dependent diabetes mellitus.

Nine non-obese males with non-insulin-dependent diabetes mellitus (NIDDM) were evaluated before and after 3 and 12 months (6 patients) treatment with the second generation hypoglycemic sulfonylurea: gliclazide. They underwent an oral glucose tolerance test, intravenous glucose and arginine tests measuring plasma insulin and C-peptide responses. Pre-hepatic insulin production and insulin delivery to peripheral tissues were calculated by deconvolution techniques and hepatic extraction of insulin estimated. An improvement was observed in the beta-cell function of the patients on gliclazide treatment: reduction of fasting plasma glucose associated with a progressive increase in C-peptide level but insulin levels decreased at 12 months, suggesting an increase in hepatic insulin extraction at this time. In the same way, while plasma glucose values after oral and i.v. glucose were greatly reduced at 3 and 12 months treatment, insulin did not change but C-peptide levels increased significantly at 12 month treatment. While the prehepatic insulin secretion rate increased progressively on gliclazide during all glucose challenges, the fractional hepatic insulin extraction fell after 3 and increased at 12 month treatment, with opposite changes in insulin delivered to peripheral tissues. Thus the insulinogenic effect of gliclazide could be masked during long-term administration by a concomitant effect of gliclazide which increases hepatic extraction of insulin. The maintenance of the responsiveness to the non-glucose secretagogue, arginine, as evaluated by the C-peptide levels, before and after correction of hyperglycemia, suggested improvement of beta-cell sensitivity to glucose after sulfonylurea treatment.(ABSTRACT TRUNCATED AT 250 WORDS)