糖尿病视网膜病变与糖尿病肾病的关系：附100例分析

检查了１９９４年１月至１９９５年１２月门诊１００例非胰岛素依赖型糖尿病患者的视网膜病变和肾脏病变的情况，所有病例均除外继发性糖尿病和胰岛依赖型糖尿病患者，结果显示糖尿病视网膜病变（ＤＲ）占４６％，糖尿病肾病（ＤＮ）占２０％，这两种并发症的发生及其严重程度都是糖尿病的病程呈平行进展，对于ＤＲ与ＤＮ两者之间的关系也做了简单的讨论。     

2型糖尿病合并非糖尿病性肾脏疾病--附33例2型糖尿病肾活检结果及文献复习

目的：分析探讨我国2型糖尿病（diabetes mellitus,DM）患者并发非糖尿病性肾脏疾病（non-diabetic renal disease,NDRD）的情况。方法：回顾性分析了本院近6年来33例接受肾活检的2型糖尿病患者的临床表现、病理和治疗情况。结果：33例DM患者中7例为糖尿病肾病（diabete nephropathy,DN）,22例为NDRD,两组患者在糖尿病的病程、肌酐清除率、血肌酐、血白蛋白水平、24h尿蛋白和糖尿病眼底、高血压及外周神经病变的发生率等方面差异均无显著性。NDRD患者更易出现血尿及非肾病范畴的蛋白尿。IgA肾病占本院NDRD的40.9％。结论：血尿和非肾病范畴的蛋白尿提示2型DM患者可能并发NDRD,IgA肾病可能是亚洲地区NDRD最常见的类型。     

糖尿病视网膜病变及糖尿病肾病的关系研究

目的研究糖尿病视网膜病变及糖尿病肾病之间的关系。方法对我院2007～2008年住院的2219名2型糖尿病患者中资料齐全的1887名患者进行回顾性研究,检测患者血糖、糖化血红蛋白、胰岛功能、血脂、尿酸,检查眼底、24h尿蛋白排泄率。通过Pearson检验、χ^2检验及Logistic回归分析数据。结果糖尿病视网膜病变与肾病呈平行关系（P〈0．05）,但又不完全平行。男性、病程长、周围神经病变、糖尿病肾病、高胆固醇血症及家族史是视网膜病变的危险因素（P〈0．05）;病程长、视网膜病变、空腹血糖高、高甘油三酯血症、高密度脂蛋白低、高尿酸、高血压是肾病的危险因素（P〈0．05）。对已患视网膜病变的患者来说,甘油三酯高、血尿酸高、血压高的患者易合并。肾病（P〈0．05）;对已患肾病患者来说,病程长、有周围神经病变易合并视网膜病变和高密度脂蛋白为保护因素（P〈0．05）。结论糖尿病视网膜病变及糖尿病肾病有一定的相关性。     

老年2型糖尿病血清总同型半胱氨酸与糖尿病视网膜病变的关系

目的:探讨血清总同型半胱氨酸(HCY)水平与老年人2型糖尿病(DM)视网膜病变(DR)的关系。方法:70例2型糖尿病患者,对照组42例,分别测定血压(Bp)、体重指数(BMI),同型半胱氨酸(HCY)、空腹血糖(FPG)、空腹胰岛素(FNS)、糖化血红蛋白(GHb)、总胆固醇(CHO)、三酰甘油(TG)、血肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、微量蛋白尿(UmAlb)、血浆总蛋白(TP)。病例组中53例作眼科临床检查,视力、眼压、裂隙灯检查,裂隙灯下前置镜检查眼底。参照中国眼底协会(1984年)制定的标准对视网膜进行分型、分期。典型病例作前置镜下眼底照相。结果:①糖尿病组与对照组对比,HCY、微量蛋白尿、尿素氮、血肌酐、尿酸无统计学差异;②在所有受检者中,HCY与年龄、性别、肌酐、尿酸有明显相关性;③在对照组,HCY与微量蛋白尿有负相关性,与三酰甘油正相关,与BMI正相关;在糖尿病组无上述相关关系;④糖尿病视网膜病变(DR)程度与空腹血糖、空腹胰岛素正相关;与HCY无明显相关性;⑤两性别组间,BMI、HCY、Cr、UA差异有统计学意义(P<0.05),男性高于女性。结论:高血糖为影响DR发展的明显优势因素,同型半胱氨酸在糖尿病视网膜病变及糖尿病性肾病中的意义尚需进一步研究。     

Coronary artery bypass surgery in the diabetic patient

Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61±1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months – 35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.     

2 型糖尿病性肝损害相关因素分析

目的探讨2型糖尿病患者肝损害的相关因素。方法回顾性总结316例2型糖尿病患者的临床资料,对伴有肝功能损害情况进行分析。结果2型糖尿病性肝损害发生率为13．29％;肝功能异常组患者的血糖、血脂显著高于肝功能正常组（P〈0．001）;肝功能异常组发生糖尿病肾病、神经病变、视网膜病变、酮症酸中毒等并发症发生率明显升高（P〈0．01）;经降糖等治疗,肝功能异常组患者的肝功能明显好转（P〈0．05）。结论高血糖、高血脂和糖尿病肾病、神经病变、视网膜病变、酮症酸中毒等因素是导致2型糖尿病性肝损害的重要因素,较好地控制血糖是改善2型糖尿病性肝损害患者肝功能的主要措施。     

2型糖尿病患者蛋白尿与糖尿病视网膜病变的相关性研究

目的探讨2型糖尿病患者蛋白尿与糖尿病视网膜病变发病率的关系。方法将2010年3月-2013年2月我院2型糖尿病患者70例分为观察组（蛋白尿组）与对照组（无蛋白尿组）各35例,均给予眼底检查,观察两组患者视网膜病变的发生情况。结果观察纽发生糖尿病视网膜病变的比例明显高于对照组（P〈005）。结论2型糖尿病患者蛋白尿与糖尿病视网膜病变存在明显相关,伴有蛋白尿的2型糖尿病患者发生视网膜病变具有较高的风险性。     

2型糖尿病合并亚甲减对微血管并发症的影响

目的 探讨亚临床甲状腺功能减退对2型糖尿病(T2DM)患者微血管并发症的影响.方法 根据是否合并亚临床甲状腺功能减退将入组的280例T2DM患者分为单纯T2DM组(228例)和糖尿病合并亚临床甲减(SCH)组(52例),并且根据不同促甲状腺激素(TSH)水平将SCH组分为两组,即SCH1组(4.2≤TSH≤10 μIU/ml,45例)和SCH2组(TSH≥10μIU/ml,7例),分析TSH水平与糖尿病肾病及视网膜病变的相关性.结果 SCH组总胆固醇、低密度脂蛋白、TSH水平高于DM组,SCH组DM肾病和视网膜病变的发生率显著高于DM组(P＜0.05),且SCH2组DM肾病和视网膜病变的发生率高于SCH1组(P＜0.05);Logistic回归分析结果显示亚临床甲状腺功能减退为T2DM患者糖尿病肾病及视网膜病变的危险因素.结论 T2DM合并亚临床甲减患者其糖尿病肾病及视网膜病变的发生率明显增高,且T2DM合并高水平TSH的患者发生糖尿病微血管并发症的风险更高,提示亚临床甲减是T2DM患者微血管病变独立的危险因素.     

Studies on central nervous system function in diabetes mellitus

Fifty-seven insulin dependent (IDDM) and non-insulin dependent (NIDDM) diabetic patients and 25 controls were studied. Patients with history of strokes, hypoglycaemia, hearing impairment, diabetic retinopathy, etc, were excluded. Clinical examination of central nervous system (CNS) and computerised tomography scan of brain were absolutely normal in all cases. Neuroelectrophysiological tests done were the visual evoked potential (VEP), brainstem auditory evoked response (BAER) and somatosensory evoked potential (SEP). The mean VEP latency was significantly raised in both NIDDM and IDDM compared with controls. The mean BAER and SEP latencies were both significantly raised in NIDDM but not in IDDM. The percentage of cases with abnormally raised CNS latencies were as follows: In NIDDM, VEP-16.7%, BAER-50% and SEP-26.7%; in IDDM, VEP-11.1%, BAER-14.8% and SEP-18.5%. Thus, subclinical CNS dysfunction is common in diabetes mellitus particularly in NIDDM and this can be reliably detected by measuring the CNS latencies, specially VEP.     

Ⅱ型糖尿病微血管并发症与高血压的关系

采用均衡对照的原则,将162例Ⅱ型糖尿病患者分为合并高血压组和未合并高血压组;比较两组间糖尿病肾病和糖尿病视网膜病变的发生率,并就Ⅱ型糖尿病微血管病变的相关因素进行多元回归分析。研究表明,Ⅱ型糖尿病合并高血压组微血管病变的发生率显著高于未合并高血压组(P<0.05);相关分析表明,糖尿病微血管病变与高血压病程呈正相关。提示高血压是糖尿病微血管病变的相关危险因素。     

Prevalence and risk factors for diabetic retinopathy--a study of 217 patients from University of Malaya Medical Centre

Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy, and peripheral neuropathy).     

幽门螺杆菌与糖尿病视网膜病变关系的研究

目的: 分析老年人群幽门螺杆菌感染与2型糖尿病视网膜病变（DR）的关系。方法: 随机选择老年2型糖尿病患者和健康对照者各300例,均接受幽门螺杆菌感染检测,糖尿病患者接受眼科DR检查。采用多因素logistic回归分析法,评价幽门螺杆菌感染与DR发生的相关性。结果: 与健康对照组相比,糖尿病患者同时发生幽门螺杆菌感染的可能性显著增加（OR: 1.57,95%CI: 1.09~2.25,P＜0.001）。在糖尿病患者中,205例患者合并DR,95例患者未合并DR。与未合并DR的患者相比,DR患者同时发生幽门螺杆菌感染的可能性亦显著增加（OR: 5.01,95%CI: 2.77~9.05,P＜0.001）。结论: 老年人群幽门螺杆菌感染与DR发生之间存在显著的相关性。     

Properdin factor B allotypes in diabetic Nigerians. A preliminary report on chromosome 6 markers

Properdin factor B(Bf) allotypes were determined in patients with insulin dependent (type 1) diabetes mellitus (n = 15); in patients with non-insulin dependent diabetes mellitus n = 15); and in healthy Nigerians (n = 252) from various tribal groups. In all three groups only commonly reported Bf allotypes namely BfF, F1, S and S1 were observed. More important, BfF1 allele was significantly increased in patients with insulin dependent (type 1) diabetes mellitus (expected 1/15, observed 5/15), X2 = P less than 0.005). It is suggested that this allele is probably the same as that reported in caucasoids and is part of a supratype or ancestral haplotype defined by HLA-B18, C4A3, C4A3, BQo, BfF1, DR3 marking type 1 (insulin dependent) diabetes mellitus.     

Relationship between angiotensinogen gene M235T variant with diabetic nephropathy in Chinese NIDDM

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Copper, zinc, and magnesium levels in non-insulin dependent diabetes mellitus

A relationship has been reported between trace elements and diabetes mellitus. This study evaluated the role of such a relationship in 83 patients with non-insulin dependent diabetes mellitus (40 men and 43 women), with a mean duration of diabetes of 3.9 +/- 3.6 years. Patients with nephropathy were excluded. Thirty healthy non-diabetic subjects were studied for comparative analysis. Subjects were subdivided into obese and non-obese. Diabetic subjects were also subdivided into controlled and uncontrolled groups; control was based on fasting blood glucose and serum fructosamine levels. Plasma copper, zinc and magnesium levels were analysed using a GBC 902 double beam atomic absorption spectrophotometer. Plasma zinc and magnesium levels were comparable between diabetic and non-diabetic subjects, while copper levels were significantly elevated (p < 0.01) in diabetic patients. Age, sex, duration and control of diabetes did not influence copper, zinc, or magnesium concentrations. We conclude that zinc and magnesium levels are not altered in diabetes mellitus, but the increased copper levels found in diabetics in our study may merit further investigation of the relationship between copper and non-insulin dependent diabetes mellitus.     

Lipoprotein (A) levels in type 2 diabetic patients with diabetic retinopathy

To examine a possible association between lipoprotein(a) [Lp(a)] levels and diabetic retinopathy in patients with type 2 diabetes mellitus. 100 type 2 diabetic patients were assessed with the following parameters: age, body mass index, duration of diabetes, blood pressure, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides, blood urea nitrogen, creatinine, Lp(a), and albumin excretion rate (AER). Retinopathy was classified as normal retina (NR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) by an ophthalmologist. The PDR group had higher cholesterol (t=-2.24, p<0.05) and creatinine (z=-2.547, p<0.05) levels than the NPDR group. The PDR group had a higher value of AER (z=-2.439, p<0.01) than the NR group. The possibility of developing diabetic retinopathy after 10 years of diabetes was found to be 6.5 fold high (OR; 6.57, 95% CI 1.74-24.79; p<0.05). The Lp(a) levels were similar in the patients with retinopathy and those without retinopathy. In the study, there was no evidence for a relationship between the serum Lp(a) levels and diabetic retinopathy in type 2 diabetic patients.     

Retinopathy in a diabetic population

Aims and Objectives: The study was conducted with the aim to find out the prevalence of diabetic retinopathy among diabetics on treatment, to find out the presence of associated risk factors and to determine the knowledge of diabetic retinopathy among patients with diabetic mellitus. Methodology: Cross sectional screening of 316 diabetic patients on treatment presenting to Kalimati Diabetic Clinic and Kathmandu Medical College was done over a period of 8 months for the presence of diabetic retinopathy, associated risk factors and the knowledge of diabetic retinopathy. Results: 21% of the known diabetics had evidence of various grades of diabetic retinopathy although 75.3% of the enrolled patients had history of diabetes mellitus of less than 10 years. Associated risk factors were present in 66.46%. However, only 50% diabetics had the knowledge of diabetic retinopathy. Conclusion: As 21% of the diabetic patients on treatment had various grades of diabetic retinopathy and 50% of the diabetic patients were not aware of diabetic retinopathy, emphasis has to be given for the awareness of ocular involvement in diabetes mellitus such that blindness from retinopathy can be prevented. The responsibility lies on treating physicians or Diabetic Centres for referral of diabetic patients for ophthalmic evaluation. Similarly, control of associated risk factors like hypertension, hyperlipidemia is equally important. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Laser Photocoagulation.     

糖尿病患者视网膜病变与降钙素基因相关肽及内皮素的关系

目的 观察糖尿病患者视网膜病变与降钙素基因相关肽（ＣＧＲＰ）及内皮素（ＥＴ）的关系。方法 应用眼底血管荧光造影法、放射免疫计数法、微柱层析法等观察６０例糖尿中层得（ＤＭ组、ＤＭⅠ～Ⅲ组）及３０例正常对照者的降钙素基因相关肽（ＣＧＲＰ）、内皮素（ＥＴ）、糖化血红蛋白（ＧＨｂＡ１Ｃ）、胰岛素（Ｉｎｓ）、Ｃ肽（ＣＰ）、空腹血糖（ＦＢＧ）、２４ｈ尿白蛋白基因相关肽（ＣＧＲＰ）、内皮素（ＥＦ）、糖化血红蛋白     

Serum metrix metalloproteinase-9 combined with homocysteine, IL-6, TNF-α, CRP, HbAlc and lipid profile in the incipient diabetic nephropathy with or without macrovascular diseases

Objective ： To evaluate the changes of serum matrix metalloproteinase-9 （romp-9） in patients of incipient diabetic nephropathy with or without macrovascular disease and to analyze the factors associated with homocysteine（hcy）, interleukin-6（IL-6）, tumor necrosis factor-alpha （TNF-α）, highly sensitive C-reactive protein （hsCRP）, HbAlc and lipid profile in those patients in order to know whether this marker or other factors are more important to induce diabetic macrovascular disease. Methods： Type 2 diabetes mellitus（T2DM） subjects with incipient diabetic nephropathy with or without macrovascular disease were selected for participation and divided into 2 groups. The patients in group 1 （n= 38） used insulin, and patients in group 2 （n=34） were treated with an oral antidiabetic drug. Then serum mmp-9, hey, IL-6 and TNF-α in these patients were measured, and compared to the healthy subjects as control （n= 16）. The results were analyzed by SPSS13. Results： Serum romp-9 and hcy of the patients having incipient diabetic nephropathy with macrovascular disease were higher than that of patients without macrovascular disease （P〈0.01）. For insulin-injected patients, whether they accompanied with macrovascular diseases or not, the serum levels of romp-9, hcy, IL-6 and TNF-α were all lower, but no significant statistics compared with non-insulin used patients or the healthy subjects. The serum level of romp-9 was more correlated with the serum hcy in antidiabetic drug used patients. （P〈0. 000） Conclusion： The serum level of romp-9 plays an important role of pathogenesis in the macrovascular disease in the incipient diabetic patients, and the serum level of hcy also can reflect the severely degree of macrovascular disease in these patients, insulin can reduce these markers.     

Comparative evaluation of ophthalmoscopy and angiography for the assessment of retinopathy in type 2 diabetes mellitus

Diabetic retinopathy (DR) is emerging as a common cause of visual loss. This study was aimed at comparing the relative utility of fundus fluorescein angiography (FFA) with ophthalmoscopy (OPT) in its diagnosis with a cross-sectional cohort. A total of 100 patients of type 2 diabetes mellitus was divided into 3 groups depending on the duration from initial diagnosis and matched by important risk factors. Group A was < 5 years duration and had 31 patients; group B ranged between 5 and 15 years and had 40 patients; and group C were > 15 years with 29 patients. Parameters compared were: Normal retina (NR), background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPR), proliferative diabetic retinopathy (PDR); and clinically significant maculopathy (MAC). Dye leakage (DL) and micro-aneurysms (MA) were assessed separately as they are recognised early markers of DR. Result analysis revealed that FFA is well correlated with OPT (0.99) for all groups except group A, where DL (35.5%) played a significant role in altering the correlation (0.85 versus 0.98--OPT versus FFA); 8% of total patients revealed a worse grade with FFA compared to OPT, so appropriate grading of retinopathy is better with FFA at any duration. Less severe varieties of DR predominate in all the groups (BDR-77.4%, 80%, 24.1% respectively), more severe varieties dominate in group C (17.2% and 58.6% of PPR and PDR respectively). MAC is present significantly in group C. FFA is strongly advised, at least in the high-risk groups, at initial diagnosis for detection of DL and also appropriate grading. OPT is a simple and adequate option beyond 5 years of duration. OPT is as good as FFA for the diagnosis of MAC.