2型糖尿病患者高血压与糖尿病性神经病变的关系

目的 探讨2型糖尿病患者高血压与糖尿病性神经病变的关系。方法 利用心自主神经功能检测系统和神经电生理检测仪对107例（高血压组52例,非高血压组55例）2型糖尿病患者的心自主神经功能和肢体的末梢神经传导速度、皮肤痛温觉、振动沉进行测定,以判断心自主神经病变和末梢神经病变。结果 两组间末梢神经功能和心自主神经功能各指标除心的是距频谱分析的高频值外差异均无显著性（P＜0.05）。Logistic回归分析显示高血压与心自主神经病变显著相关（P＜0.01）,而与末梢神经病变无显著相关。结论 2型糖尿病患者高血压是心自主神经病变发病的危险因素,而与末梢神经病变无明显关系。     

Ulnar entrapment neuropathy in patients with type 2 diabetes mellitus: An electrodiagnostic study

Aims

This study aimed to assess the prevalence and electrophysiological features of ulnar entrapment neuropathy in patients with type 2 diabetes mellitus (DM).

Methods

Nerve conduction studies (NCS) were performed in a sample of consecutive diabetic patients aged 25–75 years, referred by the Diabetology Unit. NCS of the median, ulnar, radial, peroneal and sural nerves were performed on the non-dominant side. Median entrapment neuropathy at the wrist (MNW) and ulnar neuropathy at the elbow (UNE) and wrist (UNW) were diagnosed according to standard electrodiagnostic criteria.

Results

Sixty-four patients were enrolled, 28 male (44%), average age 61, average DM duration 14.5 years. Polyneuropathy was diagnosed in 45 subjects (70%). UNE was detected in 22 patients (34%) (4 did not have polyneuropathy), in the abductor digiti minimi in 16, the first interosseus in 14 and in both in 8. UNW was detected in 7 (11%) subjects and MNW in 40 (63%). NCS alterations consistent with ulnar neuropathy were detected in a high proportion of patients (45%), suggesting that the ulnar nerve is very susceptible to focal entrapment in DM.

Conclusions

Upper limb sensory and motor NCS, including motor conduction velocity across the elbow, should be considered in the staging of DM patients.     

Problem of amputations in patients with newly diagnosed diabetes mellitus

A reduction of 50 % or more in diabetes-related amputations is a primary target of the St Vincent Declaration. This is thought to be achievable because both primary and secondary preventative healthcare strategies are effective in reducing the incidence of diabetic foot ulceration and progression to amputation. Unfortunately there is a group who cannot benefit from preventative health care, that is, newly diagnosed diabetic patients with already established severe complications. Using our population-based district diabetes information system we investigated, during the period 1 January 1992 to 31 December 96, the incidence and prevalence of lower extremity amputations (LEAs) and the proportion occurring in patients newly or recently diagnosed as having diabetes. Seventy-nine diabetic patients (59 male, 20 female) were recorded as having had 94 LEAs, the incidence of diabetes-related LEA being 475 per 100 000 diabetic patient-years. Of these LEAs 16 (20.2 %) were performed within 1 year of diabetes being diagnosed. This study highlights an appreciable and previously unrecognized problem: patients presenting with established complications of diabetes who cannot benefit from secondary preventative healthcare. These patients pose a potential obstacle to achieving targets for reductions in diabetes-related amputations. © 1998 John Wiley & Sons, Ltd.     

Decline of neuroadrenergic bronchial innervation and respiratory function in type 1 diabetes mellitus: a longitudinal study

BACKGROUND AND AIM: Type 1 diabetes mellitus complicated by autonomic neuropathy (AN) is characterized by depressed cholinergic bronchomotor tone and neuroadrenergic denervation of the lung. We explored the effects of AN on the rate of decline of pulmonary sympathetic innervation and respiratory function during a 5-year follow-up. METHODS: Twenty diabetic patients, 11 with AN, were enrolled in 1998 and then followed-up until 2003. During follow-up, glycosylated haemoglobin (HbA1c) was measured every 3 months. In 1998 and 2003 the patients underwent respiratory function tests and a ventilatory scintigraphic study of neuroadrenergic bronchial innervation using 123I-MIBG. RESULTS: During follow-up 4 patients, all with AN, were lost, and 1 developed AN. Forced vital capacity (FVC), and diffusing capacity of the lung for carbon monoxide (DLCO) showed comparable rates of decrease in patients with and without AN. The yearly decline of forced expiratory volume in 1 s (FEV1) was about double the physiologic rate, in both AN and AN-free patients. The MIBG clearance significantly increased both in patients with AN (T1/2: 118.88 +/- 30.14 min at baseline and 92.10 +/- 24.52 min at the end of follow-up) and without AN (135.14 +/- 17.09 min and 92.68 +/- 13.52 min, respectively), indicating a rapidly progressive neuroadrenergic denervation. The rate of the neuroadrenergic denervation was inversely related to the severity of autonomic dysfunction at baseline (Spearman's rho - 0.62, p = 0.017). Neither respiratory function indexes nor MIBG clearance changes correlated with the overall HbA1c values. CONCLUSIONS: Neuroadrenergic denervation of the lung parallels the decline of respiratory function indexes in diabetic patients both with and without AN and seems to be independent from the quality of glycemic control.     

Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far. Received: 8 September 1999 / Accepted: 16 November 2000     

2型糖尿病患者糖皮质激素变化的临床研究

目的　探讨 2型糖尿病患者糖皮质激素分泌变化的规律及其临床意义。方法　测定 2 2名健康人 (对照组 )和 6 3例 2型糖尿病患者 (其中 39例 2型糖尿病无微血管病变、2 4例 2型糖尿病并微血管病变 )的血皮质醇 (F) ( 8Am、4Pm )、2 4h尿游离皮质醇 (UFC)及血糖 (FBG、2hPG)、HbA1c、TC和TG。结果　 2型糖尿病组的血F( 8Am、4Pm)及 2 4hUFC与对照组比较 ,差异有显著性 (P <0 .0 5 )。糖尿病有微血管病变组的 2 4hUFC的排量高于无微血管病变组 (P <0 .0 5 )。糖尿病组 2 4hUFC与HbA1c呈正相关 (r =0 .2 76 ,P <0 .0 5 ) ,与病程呈正相关 (r =0 .72 4,P <0 .0 1) ,与 2 4h尿微量白蛋白 (UAP)呈正相关 (r =0 .486 ,P <0 .0 1) ,与TG呈正相关 (r= 0 .42 1,P <0 .0 1)。结论　 2型糖尿病患者糖皮质激素水平增高 ,加重了糖代谢和脂代谢紊乱 ,使糖尿病患者的病情恶化 ,最终促使糖尿病并发症的发生。     

老年2型糖尿病并发败血症患者的临床分析

目的 探讨老年2型糖尿病并发败血症患者的临床特点，以提高治疗水平。方法 对我院近13年来收治的58例老年2型糖尿病并发败血症患者的临床资料进行总结分析。结果 58例败血症患者致病菌入侵途径分别为：泌尿系统19例，呼吸系统17例，深静脉导管7例，胆管7例，破损皮肤1例，入侵途径未明7例。58例中，医院感染23例，占39．7％。血培养显示：肺炎克雷伯菌24例，大肠埃希菌16例，金黄色葡萄球菌10例，科氏葡萄球菌科氏亚种、表皮葡萄球菌、恶臭假单胞菌和光滑假丝酵母菌各2例。24例肺炎克雷伯菌败血症患者中，肝脓肿12例（50．0％），有肝内胆管积气现象15例（62．5％）。58例患者均用胰岛素强化降糖，其中56例细菌性败血症患者应用三代头孢和氟喹诺酮类抗生素；2例光滑假丝酵母菌败血症患者静脉应用氟康唑。死亡7例，病死率12．1％。结论 2型糖尿病并发败血症以革兰阴性菌败血症多见，其中肺炎克雷伯菌败血症常有迁移病灶形成肝脓肿和肝内胆管积气现象。深静脉穿刺留置导管与留置导尿是导致医院感染败血症危险的因素。强有力抗菌及病菌迁移病灶的处理非常重要，同时胰岛素强化降糖和对症支持治疗也是抢救成功的关键。     

2型糖尿病下肢神经病变心率变异性频域参数的昼夜节律

采用24 h动态心电图检测58例2型糖尿病伴下肢神经病变组、59例2型糖尿病不伴下肢神经病变组(非下肢神经病变组)和50例对照组的心率变异性,比较其频域参数的水平及昼夜间的变化.结果 显示非下肢神经病变组、下肢神经病变组较对照组频域指标减小,平均心率增加;昼夜间比较在对照组差异有统计学意义,在非下肢神经病变组昼夜节律发生改变,在下肢神经病变组昼夜节律消失.提示糖尿病不伴和伴下肢神经病变均存在自主神经功能受损,后者受损更明显.

Abstract：

Heart rate variability(HRV)analysis and its circadian rhythm(CR)were determined in 58patients with type 2 diabetes mellitus with lower extremity neuropathy(diabetic neuropathy group), 59 patients with type 2 diabetes mellitus without lower extremity neuropathy(diabetes group), and 50 healthy controls according to 24-hour Holter recording. Frequency domain parameters of HRV were significantly decreased in both diabetes groups. Frequency domain parameter of HRV in healthy controls,and daytime/nighttime difference were statistically significant. CR of HRV was changed in diabetes group and disappeared in diabetic neuropathy group. Impaired and seriously impaired autonomic nervous function developed in type 2 diabetes mellitus without and with lower extremity neuropathy respectively.     

微小RNA在2型糖尿病相关机制中的研究进展

2型糖尿病及其慢性并发症严重威胁人类健康,但其确切发病机制并不十分清楚.微小RNA是一种非编码单链RNA,参与2型糖尿病等多种疾病的发生.微小RNA在胰岛素抵抗、胰岛功能缺陷这两个2型糖尿病主要病理生理过程及其并发症发生中的重要作用引发越来越多的关注.     

2型糖尿病患者体脂分布与胰岛素抵抗及下肢血管病变的关系

目的应用双能x线吸收法（DEXA）测量2型糖尿病患者体脂分布情况并分析其与胰岛素抵抗、下肢血管病变的关系。方法选取2010年12月至2011年5月山西省人民医院内分泌科住院或门诊收治的2型糖尿病患者123例作为观察组,测量其腰围、身高、体重、血压,使用DEXA测量躯干脂肪比例,检测空腹胰岛素（FINS）、空腹血糖（FPG）、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）、糖化血红蛋白（HbAle）,并与同期健康体检的112名健康人（对照组）做横断面对照。根据是否患有糖尿病和是否肥胖将总体对象分为4组：肥胖糖尿病组（DMOB组,78例,男41例,女37例）、非肥胖糖尿病组（DMNOB组,45例,男23例,女22例）、肥胖对照组（OB组,69名,男35名,女34名）及非肥胖对照组（NOB组,43名,男21名,女22名）。计量资料比较行独立样本t检验,采用多重线性回归分析评估腰围、体质指数（BMI）、躯干脂肪比例对稳态模型胰岛素抵抗指数（HOMA-IR）的影响。结果DMOB、DMNOB、OB、NOB组躯干脂肪比例分别为38％±4％、24％±6％、38％±5％、26％±6％。DMOB组HOMA-IR均较DMNOB、OB、NOB组显著增高,差异有统计学意义（分别为2．1±1．0、1．6±0．8、1．6±0．4、1．3±0．4,F=1．518,P〈0．05）;DMOB组收缩压（SBP）、舒张压（DBP）、TC、TG均较DMNOB组增高（t=2．173～3．058,均P〈0．05）。DMNOB组DBP、HbAlc、TC、TG及LDL-C均较OB及NOB组增高（F=0．569～47．704,均P〈0．05）。多重线性回归分析发现观察组BMI、躯干脂肪比例均为HOMA-IR的影响因素（OR=1．749、1．987,均P〈0．05）。Spearman相关性分析显示躯干脂肪比例、腰围、BMI、SBP、糖尿病病程、TG、LDL-C、HbAle、FPG、FINs、HOMA-IR与糖尿病患者下肢血管病变的严重程度呈正相关（r=0．232-0．470,均P〈0．05）。结论DEXA测量的躯干脂肪比例可评价腹型肥胖,其在一定程度上影响2型糖尿病患者胰岛素抵抗的程度,且与2型糖尿病患者下肢血管病变程度相关。     

2型糖尿病合并高血压的临床分析及对策

目的:探讨2型糖尿病(T2DM)合并高血压与否对脂代谢、微血管病变、血液流变学的影响。方法:192例T2DM患者被分为血压正常组(A组,96例)和合并高血压组(B组,100例),对两组的一般情况、血压、脂代谢、微血管损害及血液流变学情况进行比较分析。结果:B组的血压(148±24)mmHg/(86±15)mmHg、胆固醇(6.0±0.9)mmol/L、血肌酐(70±21.1)μmol/L、血尿酸(343±81)μmol/L和低切粘度(11.02±2.3)均高于A组,有显著性差异(P<0.05～<0.01)。结论:T2DM和高血压病均可导致血脂代谢异常,微血管损害和血液流变学的改变,当T2DM合并高血压时,前述异常和损害加重,应及早控制。     

Association of hyperglycemia episodes on long-term mortality in type 2 diabetes mellitus with vascular dementia: A population-based cohort study

Aim

This study investigated the effect of severe hyperglycemia episodes on survival and associated factors related to risk of mortality in type 2 diabetes mellitus (DM) patients with dementia.

2型糖尿病患者生物阻抗式胃动力的测定

目的 观察2型糖尿病患者的胃动力情况并探讨其可能的影响因素.方法 采用基于小波转换的阻抗式胃动力采集系统检测65例2型糖尿病患者及30名健康志愿者的胃动力,并检测空腹血糖(FBG)和HbA1c.结果 65例2型糖尿病患者胃动力异常的发生率为53.85%,主要胃肠症状为腹胀、早饱、嗳气.2型糖尿病患者的胃动力主功率百分比较正常对照明显降低(P<0.05).HbA1c≥6.5%组患者的胃电主功率百分比较HbA1c<6.5%组显著降低(P<0.01).老年组胃动过缓功率百分比较青、中年组均显著增高(P<0.05).FBG及病程与2型糖尿病患者的胃动力障碍无关.结论 2型糖尿病患者胃动力障碍发生率高,HbA1c≥6.5%及老年患者更易发生胃动力障碍,FBG及病程与胃动力障碍无关.     

2型糖尿病患者合并非糖尿病肾损害的临床病理分析

目的　分析 2型糖尿病 (T2DM)患者合并非糖尿病肾损害 (NDRD)的临床与病理特点。　方法　回顾性分析 4 2例T2DM患者临床与病理资料 ,比较NDRD患者与糖尿病肾病 (DN)患者发病年龄、病程、视网膜改变、急性肾功能衰竭 (ARF)、尿检等临床表现的异同。　结果　 (1)该组肾活检诊断NDRD 2 8例 ,占 6 6 7% ,以轻中度系膜增生性肾炎最常见 (7例 ,2 5 0 % ) ,其次为局灶节段性肾小球硬化 (4例 ,14 3% )和膜性肾病 (3例 ,10 7% ) ;3例患者为DN基础上合并肾小管间质性损害(10 7% )。 (2 )两组患者发病年龄、病程、蛋白尿差异无显著意义 ,但NDRD患者镜下血尿明显 (17/2 8vs 3/14 ,P <0 0 5 ) ,3例患者表现为肉眼血尿 ,4例患者出现急性肾功能衰竭 ,与DN组比较差异有显著意义 (P <0 0 5 )。 (3)肾外表现中 ,NDRD组视网膜病变发生率明显低于DN组 (3/14vs 7/10 ,P <0 0 5 ) ,但高血压发生率、心血管病变两组间差异无显著意义。 (4)该组 4例ARF患者和 8例以大量蛋白尿为主要表现的NDRD患者治疗后获得完全缓解。　结论　糖尿病常伴有NDRD。对于病程短、血尿明显、伴有ARF或不伴有糖尿病视网膜病变者 ,应重视NDRD诊断。     

Meal intake increases circulating procoagulant microparticles in patients with type 1 and type 2 diabetes mellitus

Diabetes mellitus (DM) is associated with prothrombotic alterations, and postprandial hyperglycemia is an independent risk factor for cardiovascular complications. We therefore investigated whether a standardized mixed meal alters circulating microparticles (MPs) and their procoagulant activity in DM patients.

Patients with DM type 1 (T1DM, n = 11) and type 2 (T2DM; n = 9) were studied before and 90 min after a standardized meal (without premeal insulin). MPs in plasma derived from platelets (PMPs), endothelial cells (EMPs), or monocytes (MMPs) were measured by flow cytometry. MP-induced thrombin generation in plasma was assessed by a calibrated automated thrombogram.

In the fasting state, MPs did not differ significantly between T1DM and T2DM. Meal intake increased the following microparticles: PMPs expressing phosphatidylserine (by 55%, on average), P-selectin (by 86%), and tissue factor (TF; by 112%); EMPs expressing E-selectin (by 96%) and MMPs expressing TF (by 164%), with no significant group differences between T1DM and T2DM. There were no increments in EMPs expressing phosphatidylserine or TF. Meal intake increased MP-induced thrombin generation similarly in T1DM and T2DM with increased endogenous thrombin potential (p = 0.02) and peak thrombin (p = 0.03) and shortened time to peak (p = 0.02). Phosphatidylserine inhibition by lactadherin completely abolished MP-induced thrombin generation, while an anti-TF antibody had no effect.

In conclusion, meal intake increased several types of circulating MPs in patients with diabetes mellitus. These MPs have a procoagulant potential, which is related to phosphatidylserine expression and negatively charged MP surfaces rather than to TF.     

1型糖尿病和2型糖尿病患者低血糖恐惧感和生活质量的比较研究

目的:比较1型糖尿病（T1DM）和2型糖尿病（T2DM）患者低血糖恐惧感和生活质量的差异。方法:采用多中心目的抽样方法选取2019年2至8月于天津市三家三级医院内分泌科就医的T1DM（21例）和T2DM（269例）患者作为研究对象,其中男156例（53.8%）,女134例（46.2%）,年龄（55.12±9.54）岁。...     

Platelet signalling abnormalities in patients with type 2 diabetes mellitus: a review

The hyperactivation of platelets is involved in the cardiovascular complications associated with type 2 diabetes mellitus. Altered platelet behavior contributes to the angiopathies associated with diabetes. A number of mechanisms involved in platelet activation are altered in diabetes. Platelets from type 2 diabetic patients show an enhanced endogenous reactive oxygen species production and a reduced antioxidant capability, which increase the activity of several tyrosine kinases, such as the Bruton's tyrosine kinase, MAP kinases or proteins of the SRC family. Oxidative stress is also involved in the abnormal intracellular calcium homeostasis observed in platelets from type 2 diabetics, including an enhanced resting cytosolic calcium concentration and calcium release and entry in response to agonists. Moreover, diabetes alters the bioavailability of nitric oxide in platelets. Basal nitric oxide synthase activity is reduced in homogenates of platelets obtained from patients with type 2 diabetes mellitus. The study of these abnormalities might be helpful in the development of new pharmacological strategies to reduce platelet activation in type 2 diabetes mellitus.     

Associations of plasma homocysteine concentration in subjects with type 2 diabetes mellitus

We investigated the potential relationship between hyperhomocysteinemia and the presence of coronary heart disease (CHD) and chronic complications in a consecutive series of 358 (156 men) Kuwaiti type 2 diabetic subjects. The median (2.5^th, 97.5^th percentiles) fasting plasma concentration of total homocysteine (tHcy) in the patients was 10.2 (5.4, 19.1) μmol/l. Fasting tHcy concentration was significantly (p<0.001) higher among men [11.3 (7.1, 24.6) μmol/l] compared to women [8.8 (5.3, 16.3) μmol/l]. Of the 57 patients with a history of CHD and/or electrocardiographic (ECG) evidence of CHD, 9 (16%) had hyperhomocysteinemia (tHcy ≥15 μmol/l) compared to 8.3% (25 of 301) of patients without evidence of CHD. In univariate analysis, plasma tHcy concentration was significantly (p<0.01) higher in those diabetic subjects with history of CHD and/or abnormal ECG. Although hyperhomocysteinemia was more common in patients with microalbuminuria (15%) compared to patients with normoalbuminuria (12%), there was no significant association between hyperhomocysteinemia and the degree of albuminuria. After controlling for age and sex, multiple regression analyses showed significant associations of plasma tHcy concentration with glycated hemoglobin (p<0.05), plasma concentrations of creatinine (p<0.001) and apolipoprotein-B (p<0.05), but not with smoking, neuropathy or retinopathy. It seems that the association of hyperhomocysteinemia with diabetic microvascular complications is mediated by the confounding effect of other factors like age, sex and plasma creatinine concentration. In conclusion, we have found a univariate association between hyperhomocysteinemia and CHD but not with microalbuminuria, neuropathy and retinopathy. Although routine estimation of plasma homocysteine may be useful, the association with cardiovascular disease or microvascular complications in patients with type 2 DM deserves prospective studies. Received: March 2000 / Accepted in revised form: 4 June 2002 Correspondence to N.A. Abdella