非肥胖2型糖尿病中LADA的发病状况

目的：了解非肥胖2型糖尿病中LADA的发病状况。方法：依据据胰岛素需要与否，将149例非肥胖糖尿病患者分为A、B二组；再依据胰岛细胞抗体（ICA）阳性与否，又分A组为A1组与A2组进行对比研究，测定胰岛β细胞功能。结果：A组胰岛功能明显差于B组，ICA阳性率则高于B组；A1、A2组差异尤著。结论：在非肥胖2型糖尿病中，如口服降糖药效差、ICA阳性、胰岛功能很差，应诊断LADA。     

家族性Ⅰ型神经纤维瘤病2例

<正>例1,男,35岁。自幼发现全身多处皮肤肿物,以上肢、胸腹部为主,初始黄豆大小,随年龄逐渐增大、增多,近7年来头枕部肿物明显增大。查体见枕部头皮肿物,大小约19 cm×14 cm×3 cm,左前胸3处相连的纵行条索状肿物,各约15 cm×10 cm×3 cm,肥厚呈皮囊样下垂,无压痛,无红肿,无破溃。躯干表面可见散在的基底部略窄的类圆形蒂状肿物,大小介于蚕豆与核桃之间,触之有橡     

重庆某社区中国人内脏脂肪指数与2型糖尿病发病的相关性分析

目的研究中国人内脏脂肪指数(CVAI)与2型糖尿病(T2DM)发病风险的相关性。方法以2013年重庆主城某社区参加健康体检的成人为研究对象,共收集原始体检资料6426人份(其中男性3568人,女性2858人),排除部分不符合要求的数据后,最终共纳入5039例(男性2834例,女性2205例)研究对象进行横断面研究。将研究对象分为男性、女性组;根据CVAI值的四分位数将研究对象分为男性、女性Q₁、Q₂、Q₃、Q₄组;比较各组一般资料及血糖、血脂、尿酸等生化指标水平,采用二元logistic回归分析不同CVAI值纳入者的T2DM发病风险。结果对年龄、收缩压、舒张压、总胆固醇、三酰甘油、低密度脂蛋白、血尿酸等可能影响糖尿病发病的混杂因素进行校正后,男性CVAI值的Q₂、Q₃、Q₄组相对于Q₁组,发生T2DM的风险分别为1.146倍(OR=1.146,95%CI:0.764～1.718)、2.033倍(OR=2.033,...     

2型糖尿病患者C肽浓度测定的临床意义探讨

目的研究血清C肽浓度测定的临床意义。方法160例2型糖尿病患者，以60岁为界分为老年组和非老年组；以病程10年为界分为2组；按WHO对亚太地区的肥胖分级标准以体重指数24为界分为2组。所有患者入院检查，计算体重指数（BMI），BMI=体重（kg）／身高（cm）^2，取空腹静脉血进行C肽释放试验：进食标准馒头餐（含糖量为75g），分别于餐后1h、2h、3h采血，分离后血清置20℃待检。采用酶联免疫分析法测定。结果不同病程间C肽比较：以病程10年为界，两组间除1hC肽水平接近外，其他时点短病程组均高于长病程组；不同年龄组间C肽比较：〈60岁组各时点C肽值均高于〉60岁组，差异有显著性；不同肥胖程度间C肽释放水平比较，统计学分析显示，不同BMI间C肽值均存在差异，C肽不同时点间有差别，各时间点C肽含量依次升高。至2h最高，3hC肽含量下降。BMI与时间的交互作用对C肽的影响有统计学意义。结论C肽的测量对内源性胰岛素的分泌能力评价更具有临床意义，并可间接评估糖尿病慢性并发症的发生。     

家族性肥大性心肌病多样性发病的研究

最近，作研究了两个家庭中肥大性心肌病发生的多样性。结果发现这是由于固定在染色体14长臂上的心脏β-肌浆球蛋白重键基因(β-MHC)存在突变引起的。     

茯苓对2型糖尿病患者的降糖作用

为了解不溶性膳食纤维对糖尿病患者食疗的效果。选择 6 0岁以上老年 2型糖尿病患者 13例 ,并以含不溶性膳食纤维为主的茯苓为代表进行试验 ,每天每人 5 0g茯苓 ,将其制作成馒头 ,分早晚食用 ,共食用 7天 ,测定试验前后空腹与餐后血糖。结果 :空腹血糖 ,受试前为 (8 76± 2 0 4)mmol/L ,受试后为 (7 94± 1 45 )mmol/L(P <0 0 0 1) ;餐后 2h血糖 ,受试前为 (13 71± 2 49)mmol/L ,受试后为 (11 6 9± 2 19)mmol/L(P <0 0 0 1)。提示食用茯苓馒头对 2型糖尿病患者具有一定降糖效果。     

家族性多发性内分泌腺瘤2A型的基因诊断

目的：提高对多发性内分泌腺瘤2型（multiple endocrine neoplasia 2, MEN2）的诊断和预测诊断水平。方法对临床已诊断首发症状为嗜铬细胞瘤的一个家族内两姐妹患者进行RET（外显子10～16）、VHL（外显子1～3）、SDHD（外显子1～4）、SDHB（外显子1～8）及SDHC（外显子1～6）基因测序。发现两患者均有RET基因634号核酸发生突变,并对其家族其他成员的RET基因进行测序。结果其家族内共有5例患者均有RET基因634号突变（ TGC突变为CGC）,导致其氨基酸编码由半胱氨酸变为精氨酸。其中2例先为临床诊断然后基因诊断,1例先由基因诊断然后临床诊断,2例（均为儿童,分别为6岁及7岁）为基因诊断,目前尚未发病。其中3例行腹腔镜双侧肾上腺肿瘤切除术,病理确诊为双侧嗜铬细胞瘤;1例行甲状腺切除术,病理诊断为甲状腺髓样癌。结论对于多发性内分泌多发肿瘤2A型患者及其家族成员行基因检查不仅可以作为确诊手段,更可以作为无症状者的预测诊断途径。     

肥胖对2型糖尿病患者甲状腺功能的影响研究

目的 探讨肥胖对2型糖尿患者甲状腺功能的影响.方法 选取2010年我院内分泌科初诊2型糖尿病患者,测量体重、身高,计算体重指数(BMI).选择BMI正常者(对照组,BMI 18.5～23.9 kg/m2)和肥胖者(肥胖组,BMI≥28.0 kg/m2)为研究对象.采用化学发光法,分别检测两组的甲状腺功能[甲状腺素(T4)、血清三碘甲状腺原氨酸(T3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)]及甲状腺自身抗体[抗甲状腺过氧化物酶抗体(aTPO)、抗甲状腺球蛋白抗体(aTG)]水平,同时收集空腹血糖、糖化血红蛋白(HbA1c)、血脂等相关临床资料.对比分析两组患者上述指标间的差异及影响因素.结果 肥胖组患者T3水平(89±19)ng/dl较对照组(128±21)ng/dl显著降低,肥胖组患者aTPO(92±186)U/ml较对照组(51±137)U/ml显著升高,差异均有统计学意义(P＜0.05).Spearman相关分析结果显示:T3水平与TSH、BMI、空腹血糖水平呈负相关(P＜0.05).aTPO与aTG呈正相关(P＜0.05).结论 肥胖2型糖尿病患者甲状腺功能及甲状腺自身抗体已有改变,表现为T3水平下降,aTPO水平升高.aTPO与aTG呈相关性.     

艾塞那肽治疗肥胖2型糖尿病临床观察

目的探讨艾塞那肽治疗肥胖2型糖尿病患者的临床疗效及安全性。方法对56例血糖控制欠佳的肥胖2型糖尿病患者进行为期3个月的艾塞那肽治疗,分别于治疗前及治疗3个月后测定患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、C肽、体质量,并观察不良反应。结果艾塞那肽治疗3个月后患者空腹血糖、餐后2 h血糖、糖化血红蛋白和体质量均显著下降(P<0.05),胰岛功能改善;不良反应可耐受。结论艾塞那肽有明显降低肥胖2型糖尿病患者空腹及餐后血糖、糖化血红蛋白及改善胰岛功能的作用,同时能够明显降低体质量,是治疗肥胖2型糖尿病有效且安全的降糖药物。     

2型糖尿病内脏脂肪面积与肌少症的相关性分析

目的探讨2型糖尿病(T2DM)内脏脂肪面积(VFA)与肌少症的相关性。方法选取2016年1月-2018年12月在重庆医科大学附属第一医院内分泌科住院的T2DM患者291例,其中男202例,女89例,年龄(56.9±10.3)岁。收集研究对象的临床资料,包括年龄、病程、体重指数(BMI)、糖化血红蛋白(HbA_1c)、并发症、合并症、用药情况等,并计算胰岛素抵抗指数(HOMA2-IR),采用双能X线吸收测量法(DEXA)进行人体成分测量。根据有无肌少症将患者分组并进行对比分析,采用多因素logistic回归模型分析肌少症的影响因素,绘制矩阵分布散点图分析相关指标与肌少症的关系,并根据中国参考标准以BMI分组,每组再次进行上述logistic回归模型分析。采用受试者工作特征(ROC)曲线分析VFA对肌少症的预测价值。结果根据有无肌少症将291例患者分为两组,无肌少症组233例,肌少症组58例。肌少症组的BMI、收缩压、舒张压、三酰甘油(TG)、VFA、四肢骨骼肌指数(ASMI)低于无肌少症组,吸烟比例高于无肌少症组,差异有统计学意义(P<0.05)。男性、BMI低...     

Magnetic resonance imaging in familial central diabetes insipidus

Summary More detailed examinations of the pituitary gland in central diabetes insipidus (CDI) has been possible with magnetic resonance imaging (MRI). Compared to the high signal findings in the posterior lobes of normal subjects, the absence of such signal in adults and children with primary CDI has been reported. Familial CDI is a hereditary form of primary CDI with a variety of clinical expressions among affected individuals which is said to be related to varying degrees of an arginine vasopressin (AVP) deficiency. However, the structural correlates have yet to be documented by MRI technique. This report describes the pituitary gland MRI findings (using a superconducting magnet; 3 mm-slice thickness; spinecho, repetition time 400 ms, echo time 25 ms) in five patients in one family with familial CDI. A signal of high intensity was detected in the posterior part of the pituitary gland in 2 patients but not in 3 others. We concluded that MRI of the posterior pituitary lobe in familial CDI seem to vary in members of the same family.     

妊娠糖尿病饮食生活因素调查分析

 目的 调查分析妊娠糖尿病的饮食生活相关因素.方法 随机选择确诊妊娠糖尿病孕妇145例(29.5±4.3岁)作为病例组,同期就诊非妊娠期糖尿病孕妇140例(28.3±3.3岁)作为对照组.对其妊娠期间的饮食生活相关因素进行调查并进行比较.结果 病例组和对照组的年龄、孕前BMI和当前BMI、甜食的喜好程度、每周豆制品食用次数、荤菜和蔬菜的食用比例、每周动物原料汤的食用次数、每天水果食用量、夜宵的食用情况、每周坚果类食物的食用量、每天的活动量、受教育程度以及一级亲属的糖尿病发生情况差异均有统计学意义(P<0.01),奶类饮用情况、每天鸡蛋食用个数、油炸食品的食用情况差异均无统计学意义(P>0.05).结论 妊娠期间BMI、甜食的喜好程度,荤菜和蔬菜的食用比例,动物原料的汤和豆类制品的次数,水果、夜宵和坚果类的食用情况,每天的活动量,被调查者的受教育程度和一级亲属患糖尿病情况均和妊娠糖尿病的发生有关,奶类、鸡蛋和油炸类食品食用情况和妊娠糖尿病无相关性.     

Magnetic resonance imaging of posterior pituitary for evaluation of the neurohypophyseal function in idiopathic and autosomal dominant neurohypophyseal diabetes insipidus

We investigated the role of MR imaging for evaluation of the functional status of the neurohypophyseal system in both idiopathic central diabetes insipidus (DI) and familial autosomal dominant neurohypophyseal DI. The patients and family with DI were analyzed retrospectively for the presence or absence of posterior pituitary gland hyperintense signal on MR images. A total of 19 adult patients with idiopathic central DI, 7 members of a family with autosomal dominant DI and 20 control subjects were included in the study. Diagnosis of idiopathic DI was based on the presence of central DI in the absence of any alteration that is known to be responsible for DI. The patients were studied retrospectively and the morphology and intensity of the posterior lobe by MR imaging was assessed by blinded reading. In all patients with idiopathic central DI and the affected members of the family, the posterior bright signal was absent while the stalk was normal on MR images. In contrast, normal posterior pituitary bright signal and stalk were found in unaffected members of the family and all control subjects. We conclude that MR imaging of the posterior pituitary lobe can be used to evaluate the functional status of the neurohypophyseal system in idiopathic central DI and familial autosomal dominant DI. Received 24 June 1996; Revision received 23 September 1996; Accepted 8 November 1996     

维生素C改善Ⅱ型糖尿病内皮依赖性血管舒张功能

目的：探讨维生素C对Ⅱ型糖尿病（non—insulin dependent diabetes，NIDD）患者血管内皮功能的保护作用。方法：选择新诊断的NIDD患者30例，随机分为2组（各15例），一组采用饮食、运动及胰岛素治疗（胰岛素组）。另一组在胰岛素组基础上加用维生素C 0．1，3／d（维生素C组）。治疗6个月。同期，选择14例健康个体作为对照。采用血管外超声法检测肱动脉血流介导的内皮依赖性血管舒展功能（EDD）和硝酸甘油（GNT）介导的内皮非依赖性血管舒展功能。结果：与对照组相比，NIDD患者治疗前空腹血糖（FPG）、2h血糖（2hPG）、胆固醇（TC）、三酯酰甘油（TG）明显增高（P〈0．05），且低密度脂蛋白胆固醇（LDL—C）亦明显增高（P〈0．05），而高密度脂蛋白胆固醇（HDL—C）明显降低（P〈0．05），同时伴随EDD明显降低（P〈0．05）。不论在维生素C组还是在胰岛素组，与治疗前比较，治疗后HbA1c、FPG、2hPG、TC、TG、LDL—C水平明显降低（P〈0．05），同时伴随EDD明显改善（P〈0．01），维生素C组治疗后EDD明显高于胰岛素组治疗后（P〈0．05）。结论：维生素C明显改善NIDD患者血管内皮功能。     

Role of insulin resistance in heart and skeletal muscle F-18 fluorodeoxyglucose uptake in patients with noninsulin-dependent diabetes mellitus

BACKGROUND: Altered heart and skeletal glucose usage has been reported in patients with non-insulin-dependent diabetes mellitus (NIDDM). Although elevations in plasma free fatty acid (FFA) concentrations have been implicated in reduced myocardial 18fluorine-fluoro-2-deoxy-D-glucose uptake (MFU), the specific role of whole-body insulin resistance in MFU in patients with NIDDM compared with skeletal muscle metabolism remains controversial. PURPOSE: MFU and skeletal muscle 18fluorine-fluoro-2-deoxy-D-glucose uptake (SMFU) were compared with positron emission tomography and the whole-body glucose disposal rate (GDR) during hyperinsulinemic euglycemic clamping in 26 normotensive asymptomatic patients with NIDDM who were not taking medication. These factors were also compared in 12 age-matched control subjects to increase the knowledge of the influence of whole-body insulin resistance on MFU. In addition, independent factors for both SMFU and MFU were investigated. RESULTS: GDR in control subjects (10.0 +/- 2.97 mg/min per kilogram) was significantly higher than in patients with NIDDM (4.05 +/- 2.37 mg/min per kilogram, P < .01). SMFU in patients with NIDDM (0.826 +/- 0.604 mg/min per 100 g) was significantly lower than that in control subjects (1.86 +/- 1.06 mg/min per 100 g, P < .01). MFU in patients with NIDDM (5.35 +/- 2.10 mg/min per 100 g) was also significantly lower than that of control subjects (7.05 +/- 1.66 mg/min per 100 g, P = .0182). SMFU significantly correlated with GDR (r = .727, P < .01) and FFA (r = -.52, P < .01) in patients with NIDDM. MFU also correlated with GDR (r = .778, P < .01) and FFA (r = -.72, P < .01) in patients with NIDDM. Multivariate stepwise regression analysis showed that GDR (F = 36.8) was independently related to MFU (r = .85, P < .01) whereas FFA was not (F = 1.763), where F is the value for statistical analysis of multivariate stepwise regression analysis. CONCLUSION: Insulin resistance is the most essential factor for both heart and skeletal muscle FDG uptake in patients with NIDDM.     

多模式MRI与2型糖尿病患者脂肪代谢标志物的相关性分析

目的：利用双回波同反相位技术（DEI）、磁共振波谱技术（MRS）等方法评价2型糖尿病（T2DM）患者脂肪组织分布,并探讨其影响因素。方法对58例T2 DM 患者进行人体学特征、血生化指标检测及磁共振扫描,测量肝脏脂肪含量、骨骼肌细胞内、外脂肪含量、腹壁皮下脂肪面积、腹腔内脂肪面积及腹部脂肪总面积。将不同部位脂肪含量进行单因素和多因素回归分析。结果餐后2h血糖（2hPPG）、腹腔内脂肪面积（VAT）、腹部脂肪总面积（TA）、肝脏脂肪变指数（HFF）、肝脏相对脂肪含量（RLC）在是否合并脂肪肝组间有明显差异（ P ＜0．05）,身体质量指数（BMI）与脂肪面积指标（VAT、SAT、TA）及肝脏脂肪含量指标（HFF、RLC）呈明显正相关（ P ＜0．01）,且对脂肪面积指标（VAT、SAT、TA）有正向影响;2hPPG与VAT、TA呈正相关（ P ＜0．05）,2hPPG对VAT有正向影响,总胆固醇（TC）、低密度脂蛋白（LDL）与VAT、TA呈正相关（ P ＜0．05）;丙氨酸转氨酶（ALT）与HFF、RLC呈正相关。结论对于 T2DM 患者应积极预防、治疗脂肪肝,磁共振能更好的检测异位脂质。     

2型糖尿病肾病危险因素分析

目的探讨2型糖尿病患者糖尿病肾病相关危险因素。方法对132例2型糖尿病患者据24h尿白蛋白排泄率分为DN0组、DN组、DN1组、DN2组并进行临床分析。结果①DN组患者女性的比例、SBP和HOMA-IR较DN0组高,DN2组患者中糖尿病病程、HbA1c、SBP、DBP和HOMA-IR等指标均高于DN0和DN1组（P〈0.05）;②TG和LDL-C与DN正相关（P〈0.05）;③女性、TC、HOMA-IR、UA与DN正相关（P〈0.01）,HDL-C与DN负相关（P〈0.01）。结论5年以上糖尿病病程、血糖、血脂、尿酸等代谢紊乱、高血压、胰岛素抵抗及女性可能是T2DM患者DN的危险因素。     

Ability of FDG-PET to detect all cancers in patients with familial adenomatous polyposis, and impact on clinical management

Purpose Familial adenomatous polyposis (FAP) is characterised by colonic and duodenal adenomatous polyps that carry a risk of malignant transformation. Malignant degeneration of duodenal adenomas is difficult to detect. We speculated that 2-(¹⁸F)-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) might be able to detect early duodenal cancer in FAP. Accordingly, we investigated the role of FDG-PET in the management of FAP patients.Methods FDG-PET was performed in 24 FAP patients. Eight had advanced duodenal adenomas (Spigelman IV), including two patients with duodenal cancer. Scans were defined as positive on the basis of focal FDG accumulation.Results Pathological FDG accumulation was absent in 19 of 24 patients. All six patients with Spigelman IV duodenal adenomas (without cancer) were negative; two of these underwent a duodenectomy and pathological examination did not reveal duodenal cancer. In five patients, FDG-PET revealed significant uptake, in the duodenum (2), lower abdomen (1), lung (1) and multiple sites in the abdomen (1). These hot spots correlated with duodenal cancer (2), abdominal metastasis (1) and sclerosing haemangioma of the lung (1). We failed to make a histopathological diagnosis in the single patient with multiple intra-abdominal sites of FDG uptake. None of the patients from the FDG-PET-negative group developed cancer during follow-up (mean 2.8 years).Conclusion FDG-PET detected all the cancers present, and none of the patients with negative FDG-PET developed cancer. This suggests that positive FDG-PET in FAP patients should lead to further examinations to rule out cancer. In patients with negative FDG-PET a more conservative approach seems justified.     

Magnetic resonance imaging of Achilles tendon xanthomas in familial hypercholesterolemia

The demonstration of tendon xanthomas is helpful in diagnosing heterozygous familial hypercholesterolemia, but in many patients lipid may accumulate without clinical abnormality being present. We investigated the possibility of detecting the lipid element with magnetic resonance (MR) imaging in seven patients with familial hypercholesterolemia and six controls. Although the mean relative signal intensities measured on long TR/TE spin echo sequences of the tendon were signifycantly higher in patients than in controls, the lack of such elevation does not rule out the presence of such lesions. In vitro measurements indicated that the signal intensity of triglycerides was quenched by cholesterolesters. The anatomic findings of MR imaging were compared with those of ultrasonography (US), showing excellent correlation in measurements between MR images and US [r(S) = 0.95 and 0.97 respectively] MR imaging and US provide equal information on the anatomy of the Achilles tendon; as an abnormally increased signal intensity within the xanthoma on MRI was found in only a minority of our patients, the value of MRI in the demonstration of Achilles tendon xanthomas is limited when using conventional T1 and T2 spin echo sequences.     

2型糖尿病患者合并脑梗死的相关危险因素分析

目的探讨2型糖尿病患者合并脑梗死的危险因素。方法收集448例2型糖尿病患者的临床资料,根据是否合并脑梗死将患者分为糖尿病脑梗死组和糖尿病非脑梗死组,比较可能诱发脑梗死的危险因素。结果 81例患者合并脑梗死占总数的18.1%。脑梗死组与非脑梗死组比较,年龄[(70.53±7.79)岁与(60.72±13.03)岁]、糖尿病病程[(130.25±85.77)月与(94.54±92.41)月]、踝肱指数[(0.90±0.23)与(0.98±0.19)]、尿素氮[(6.84±2.49)mmol/L与(6.17±2.21)mmol/L]、糖化血红蛋白[(9.09%±2.41)%与(8.24±1.77)%]及高血压(84.0%与59.1%)、冠心病(63.0%与43.1%)、糖尿病视网膜病变(35.8%与22.6%)、糖尿病肾病(50.6%与31.9%)、下肢动脉斑块(87.7%与70.3%)的合并率两组之间的差异均有统计学意义(P<0.05)。Logistic回归显示年龄(P=0.000)、糖化血红蛋白(P=0.027)与脑梗死的发生密切相关。结论年龄、糖化血红蛋白升高为影响2型糖尿病脑梗死的主要危险因素,积极控制血糖可减少脑梗死的发生。