2型糖尿病患者皮肤交感反应与心血管自主功能检查的相关性

目的:分析2型糖尿病患者皮肤交感反应(SSR)与心血管自主功能检查(CAF)及自主神经症状量表(ASP)的相关性,为2型糖尿病自主神经损害检查的选择提供参考。方法:入选者排除非糖尿病引起自主神经损害及影响检查实施的病例。病例组2型糖尿病患者19例,正常对照组血糖正常者17例,两组年龄、性别、体重指数均衡可比,均进行ASP、SSR检测、CAF检查,分析2型糖尿病ASP、SSR、CAF检查相关性。结果:①病例组与对照组ASP、SSR、CAF异常率比较,P值分别为0.001、0.003、0.000,差异有显著意义;②病例组ASP与SSR,ASP与CAF,SSR与CAF的Spearman相关系数P值分别为0.026、0.000、0.015,相互间存在统计学相关性,SSR与深呼吸、心率变异、握力试验、卧立位血压测定的Spearman相关系数P值分别为0.026、0.026、0.025,亦存在统计学相关。结论:①ASP可用于2型糖尿病患者自主神经功能症状评估;②CAF可作为反映2型糖尿病自主神经功能早期损害的较灵敏指标;③SSR与CAF相关,提示2型糖尿病患者自主神经损害时内脏与体表、交感与副交感自主神经纤维可能同时受累...     

血清脂蛋白(a)与2型糖尿病血管病变的相关性分析

脂蛋白(a)〔Lp(a)〕是由载脂蛋白(a)[Apo(a)])和含载脂蛋白B100(ApoB100)的低密度脂蛋白(LDL)分子通过二硫键连接而成的,具有抗纤溶及参与脂类代谢的特性[1]。其水平升高与动脉粥样硬化的发生、发展密切相关。但在2型糖尿病(T2DM)中,血清Lp(a)的水平是否与血管病变有关一直没有定论[2]。本文通过比较非DM者、T2DM无血管病变者和T2DM伴血管病变者间Lp(a)和内皮素(ET)水平的差异,分析T2DM患者血清Lp(a)水平与其血管病变的相关性。1资料与方法1.1标本来源选自2005年8月至2006年3月在本院住院T2DM病人及健康体检人群。T2DM的诊断…     

2型糖尿病心血管并发症发病机制的研究进展

2型糖尿病(T2DM)患者容易出现多种心血管并发症,如冠状动脉粥样硬化性心脏病、高血压、心力衰竭.导致T2DM患者并发心血管疾病的原因和机制错综复杂.有关的机制包括持续性高血糖、胰岛素抵抗、代谢紊乱、氧化应激、心肌纤维化、小血管病变和心脏自主神经病变.     

2型糖尿病并血管病变患者凝血功能指标的检测分析

心血管病变是糖尿病的主要慢性并发症之一。脂代谢异常、血栓形成、炎症、行为和习惯、遗传因素等被视为引起心血管病变的五种风险因子。本文通过对糖尿病患者脂类、止血与血栓形成的实验室常用指标的检测，探讨其在2型糖尿病血管病变发生和发展过程中的作用，以期为糖尿病血管并发症患者的预防、治疗和疗效观察提供参考依据。     

2型糖尿病患者生化指标与甲状腺功能指标分析

目的探讨2型糖尿病患者生化指标与甲状腺功能指标的变化,以及2糖尿病患者甲状腺疾病的患病情况。方法随机选取2014年1月至6月我院住院的2型糖尿病患者(T2DM)295例(2型糖尿病组),健康人员80例(对照组),检测其生化指标15项:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总蛋白(TP)、白蛋白(ALB)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、葡萄糖(GLU)、肌酸激酶(CK)、总胆固醇(CH)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、钙(Ca)、磷(P)、糖化血红蛋白(Hb A1c),甲状腺功能指标5项:甲状腺素(T4)、三碘甲腺原氨酸(T3)、游离T4(FT4)、游离T3(FT3)、促甲状腺激素(TSH),并对2型糖尿病组结合临床资料进行分析。结果2型糖尿病组中生化类指标TP、ALB、GLU、CH、TG、Ca、P、HDL、LDL、Hb A1c及甲状腺功能指标T3、FT3与对照组相比均有统计学意义(P<0.05);2型糖尿病组中患有甲状腺结节的患者比例最高,为44.7%;将2型糖尿病患者分为甲状腺结节组,其它甲状腺疾病组,甲状腺正常组,将甲状腺结节组和甲状腺正常组进行比较,年龄差异具有统计学意义(P<0.01),甲状腺结节组为53±12岁,甲状腺正常组为46±13岁,性别无差异(P>0.05),糖尿病病程差异具有统计学意义(P<0.01),甲状腺结节组为9±6年,甲状腺正常组为7±6年,对两组代谢指标进行分析,FT3差异显著(P<0.05),甲状腺结节组为4.48±0.82pmol/L,甲状腺正常组为4.67±0.67pmol/L,其它指标差异均无统计学意义(P>0.05);将2型糖尿病患者按空腹血糖水平分为A、B、C三组,血糖越高,甲状腺结节的比例越高,但差异无统计学意义(P>0.05)。结论 2型糖尿病患者其T3、FT3和一系列生化指标会发生变化,监测这些指标有助于对2型糖尿病进行更为全面的评估,且2型糖尿病患者中,甲状腺结节发病比例较高,且与年龄和病程相关,对于年龄较大和病程较长的患者更要关注甲状腺的检查。     

2型糖尿病相关基因研究进展

2型糖尿病(T2DM)是一种多基因遗传性疾病,每个基因的作用程度不同,不同基因之间存在交互作用,同时环境因素在2型糖尿病的发病过程中也发挥着十分重要的作用,提示糖尿病患者不仅存在基因结构的异常,而且在基因表达水平和表达后修饰过程中可能也存在缺陷。因此,确认2型糖尿病的易感基因实非易事。本文综述了目前对2型糖尿病致病易感基因的研究进展,包括基因组扫描与连锁分析和候选基因策略的遗传关联研究。     

实时动态血糖监测系统对2型糖尿病患者胰岛素泵强化治疗中血糖波动监测的价值

目的 探讨实时动态血糖监测系统(CGMS)对2型糖尿病(T2DM)患者胰岛素泵强化治疗中血糖波动监测的价值.方法 选择2015年1月至2016年12月我院收治的140例T2DM患者作为研究对象,随机分为研究组和对照组,每组70例,研究组采用CGMS联合胰岛素泵调整胰岛素用量进行强化治疗,对照组采用检测指尖血糖联合胰岛素泵调整胰岛素用量进行强化治疗,比较两组患者的血糖波动及血糖控制情况.结果 两组患者治疗后的HbA1c、FBG和2hBG与治疗前相比,差异具有统计学意义(P＜0.05),但研究组和对照组患者治疗后的HbA1c、FBG和2hBG相比,差异均无统计学意义(P＞0.05);治疗后两组患者的血糖水平均达标,其中研究组患者的血糖达标时间显著快于对照组(P＜0.05),血糖漂移度显著低于对照组(P＜0.05),但血糖达标后胰岛素用量与对照组相比,差异无统计学意义(P＞0.05);在治疗过程中,研究组低血糖事件检出率明显高于对照组,而且,无症状低血糖检出率也显著高于对照组,差异均具有统计学意义(P＜0.05).结论 在T2DM患者强化治疗中采用CGMS检测血糖波动,能显著提高患者的低血糖检出率,有助于改善疗效.     

利用光电容积描记法评估心血管系统功能研究进展

综述国内外有关光电容积描记法（photoplethysmography,PPG）的心血管系统功能评估作用,以期为PPG的医学应用及创新研究提供理论参考与借鉴。现阶段可从PPG信号中解析得到心率、心律、血压、容量等功能评价指标,PPG还可辅助识别诊断血压异常、糖尿病、心律失常、睡眠呼吸暂停综合征、早期缺血性休克等疾病。但PPG精确度与准确性、数据解释及标准化、波形分析和临床应用等方面仍存争议。PPG作为有效评估心血管系统功能状态与辅助诊断各类疾病的工具,已被广泛应用于医疗及科研领域并展现出重要价值,未来其有面朝高精度、多参数、非接触式、远程监护或医疗等方向多路发展的趋势。     

2型糖尿病并发症C-反应蛋白的变化

2型糖尿病(2型DM)并发症常累及肾脏、心脑血管、视网膜和神经。C反应蛋白(CRP)是炎症的一项敏感指标，与动脉粥样硬化(AS)及冠状动脉病变的发生、发展密切相关。为探讨CRP的变化与2型DM并发症的关系，本文比较了2型DM无并发症和发生并发症患者血清CRP的水平变化，结果报告如下。     

2型糖尿病合并甲状腺功能减退的影响因素分析研究

目的：探究2型糖尿病(type 2 diabetes mellitus,T2DM)合并甲状腺功能减退的影响因素。方法：选择2013年1月至2015年6月在我院接受治疗的2型糖尿病患者784例。将2型糖尿病合并甲状腺功能减退的71例患者作为甲减组,甲状腺功能正常的713例患者作为T2DM组。比较甲减组和T2DM组患者的临床资料,用单因素分析和Logistic回归分析其影响因素。结果：2型糖尿病合并甲状腺功能减退的发病率为9.06%,其中临床甲减16例,为2.04%,亚临床甲减55例,为7.02%。比较甲减组与T2DM组患者的一般临床资料,发现2型糖尿病合并甲状腺功能减退与年龄、糖尿病病程、ABI、FCP、E/A、TC、TG、LDL-C、Lp(a)、S-CRP、UAER、TPO-Ab、性别、吸烟、冠心病、DN、DNP、DR、DF、PAD、DM治疗方式有关(P<0.05)。将2型糖尿病患者是否合并甲状腺功能减退作为因变量,将上述因素纳入Logistic多元回归分析,结果显示年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素。结论：年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素,2型糖尿病患者应定期进行甲状腺功能检查,以便及早诊断和干预甲状腺功能减退。     

艾塞那肽对血糖控制不佳的肥胖糖尿病患者疗效分析

目的：观察血糖控制不佳的肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者加用艾塞那肽后的疗效。方法：选取研究对象60例(退出3例,实际完成57例),根据不同体重指数(BMI)分为A组(25 kg/m2≤BMI<30 kg/m2)23例,B组(30 kg/m2≤BMI<35 kg/m2)27例,C组(35 kg/m2≤BMI<40 kg/m2)7例,连续给予艾塞那肽治疗12周,比较治疗前后3组患者的临床疗效及血清指标变化。结果：随访结束后,所有患者平均空腹血糖(fasting blood glucose,FBG)水平、HbA1c、体重和BMI、血脂(TC、TG、LDL)等较基线有明显下降(P<0.05);所有患者平均空腹胰岛素(fasting serum insulin,FINS)水平较治疗前有所升高(P>0.05),所有患者HOMA-IR较治疗前明显降低(P均<0.05),HOMA-β较治疗前无显著变化(P>0.05)。3组间比较显示,各组FBG下降幅度C组>B组>A组(P>0.05);HbA1c下降幅度水平C组>A组(P<0.05);体重减轻幅度和BMI的下降幅度依次为C组>B组>A组(P均<0.05)。结论：艾塞那肽可以有效控制血糖控制不佳的肥胖T2DM患者的FBG、HbA1c,改善血脂水平和胰岛功能,减轻体重和BMI。其中,艾塞那肽对FBG、HbA1c、体重、BMI的疗效,在BMI较高组中疗效更显著。     

他汀类药物在2型糖尿病综合治疗中的研究进展

2型糖尿病的患病率正在世界范围内逐年增加,同时与之相关的微血管并发症和大血管并发症发生率也显著增加.他汀类药物除了调脂作用以外,还可通过抑制炎症因子、保护血管内皮细胞功能及抗氧化应激等途径延缓糖尿病并发症发生发展,显著减少心血管事件.总体而言,及时启动他汀类药物对2型糖尿病的治疗是有益的,尤其是伴有心血管危险因素的糖尿病患者.     

Crystallization of oral fluid components in patients with type 2 diabetes mellitus

Crystal aggregations of oral fluid from normal subjects and patients with type 2 diabetes mellitus were examined. Morphological signs characterizing crystal aggregations of salivary pools from patients with type 2 diabetes mellitus are described and classified.Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 138, No. 9, pp. 345–347, September, 2004     

Crystallization of oral fluid components in patients with type 2 diabetes mellitus

Crystal aggregations of oral fluid from normal subjects and patients with type 2 diabetes mellitus were examined. Morphological signs characterizing crystal aggregations of salivary pools from patients with type 2 diabetes mellitus are described and classified. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 9, pp. 345–347, September, 2004     

中国汉族人群2型糖尿病易感性相关基因多态性

2型糖尿病(type 2 diabetes mellitus,T2DM)的发病与多个基因累加效应及多种环境因素相关.已在中国汉族人群中研究过的与T2DM易感性相关的基因多态性包括:全基因组相关研究中的CDKAL1、CDKN2A/B、SLC30A8、IGF2BP2、HHEX、FTO 以及KCNQ1基因;脂联素基因;核呼吸因子基因;葡萄糖激酶基因;肿瘤坏死因子α基因等.探索这些易感基因可以为人类治疗T2DM起到极大的推动作用.但至今已明确的基因依然很少,国内外的研究结果不尽相同,尚需进一步地深入研究.     

Resting parasympathetic status and cardiovascular response to orthostatic and behavioral challenges in type I insulin-dependent diabetes mellitus

Alterations in cardiac autonomic innervation are commonly seen in individuals with diabetes mellitus. In this study, we used a cluster analysis to quantitatively separate individuals with Type I insulin-dependent diabetes mellitus (1DDM) on the basis of assessment of autonomic mediation of resting cardiac function and compared these two IDDM groups with nondiabetic control subjects. One group, termed IDDM-1, exhibited respiratory sinus arrhythmia and resting heart rale (HR) at the same level as controls. A second group, termed IDDM-2, displayed significantly reduced respiratory sinus arrhythmia and elevated resting HR, indicating reduced parasympathetic cardiac input. Noninvasive physiological assessment of the subjects’ response to orthostatic maneuvers (supine, seated, upright tilt) and behavioral stressors (speech preparation, speech talking, mirror tracing, cold pressor) revealed abnormalities in cardiovascular regulation in the IDDM groups. Specifically, under supine resting conditions the IDDM-2 group exhibited reduced myocardial contractility and stroke volume. HR was accelerated in these subjects but not enough to compensate for the decreased stroke volume, and therefore cardiac output was not maintained at normal levels. Consequently, total peripheral resistance and hlood pressure were elevated in thcse subjects. Thus. for the IDDM-2 subjects, these data sugges that blood flow to the periphery is being sacrificed In maintain flow to the heart, lungs, and brain, which cannot sustain themselves anaerobically. The IDDM subjects, when compared with the control subjects, responded with similar magnitude and pattern of cardiovascular response to the behavioral stressors that selectively challenged the heart, vasculature, or both. However, the cardiovascular pattern produced by the IDDM subjects to the seated and uprigh postural challenges suggests that the IDDM-1, and to a certain extent the IDDM-2 subjects, evidenced difficulty in regulating vasomotor and/or venomotor tone to maintain blood pressure levels. Therefore, this study demonstrates a quantitative method for assessing resting parasympathetic status that distinguishes a group of IDDM subjects with abnormal resting cardiovascular regulation and response to challenge. This work was supported by Grants POI-HL36588 and T32-HL07426 from the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Public Health Service     

Randomised controlled trial of intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION Netherlands study

Background

A growing body of evidence suggests that earlier diagnosis and treatment of diabetes may be beneficial; however, definitive evidence is lacking.

Aim

To evaluate the effectiveness of an intensified multifactorial treatment on cardiovascular risk factors in patients with screen-detected type 2 diabetes.

Design of study

Randomised controlled trial.

Setting

Seventy-nine general practices in the southwestern region of the Netherlands.

Method

In this randomised trial, patients diagnosed with diabetes by screen-detection were assigned to intensified (n = 255) or routine treatment (n = 243), and followed over 1 year. Intensified treatment consisted of pharmacological treatment combined with lifestyle education to achieve haemoglobin A1c (HbA1c) <7.0%, blood pressure <135/85 mmHg, and cholesterol <5.0 mmol/l (4.5 mmol/l if cardiovascular disease was present). Health-related quality of life (HRQoL) was assessed using the Short Form (SF)-36. Analyses were performed using generalised estimating equations models.

Results

Changes in body mass index were 0.2 (routine care) versus −1.4 kg/m² (intensified treatment), P<0.001; systolic blood pressure −19 versus −33 mmHg, P<0.001; diastolic blood pressure −7 versus −12 mmHg, P<0.001; HbA1c −0.9% versus −1.1%, P = 0.03; cholesterol −0.5 versus −1.2 mmol/l, P<0.001; high-density lipoprotein cholesterol 0.1 versus 0.1 mmol/l, P = 0.26; low-density lipoprotein cholesterol −0.5 versus −1.0 mmol/l, P<0.001; triglycerides −0.3 versus −0.4 mmol/l, P = 0.71. No difference in HRQoL between the two groups was reported.

Conclusion

Intensified multifactorial treatment of patients with screen-detected diabetes in general practice reduces cardiovascular risk factor levels significantly without worsening HRQoL.     

2型糖尿病鼠脑梗死模型的建立及相关指标分析

目的：在具有胰岛素抵抗特征近似人类2型糖尿病（T2DM）的大鼠身上建立脑梗死模型。方法：SD雄性大鼠120只,其中90只用高脂高糖和链脲佐菌素（STZ）制成T2DM模型,另30只为对照组。对照组和T2DM成模大鼠随机分为假手术组（A1组、B1组）和手术组（A2组、B2组）。采用神经功能缺损量表（NSS）评分、TTC染色与HE染色观察神经功能缺损征、脑梗死体积及病理改变。结果：T2DM成模率为72％,血脂指标与对照组相比差异有统计学意义（P〈0．01）,且血脂异常表现与临床T2DM患者近似。A2组NSS评分3—4级者占75％,脑梗死体积为（55．23±9．59）mm^3,脑梗死成模率为75％;B2组NSS评分3—4级者占60％,脑梗死体积为（54．33±6．39）mm^3,脑梗死成模率为53％。结论：高脂膳食结合STZ注射能复制出接近人类T2DM的动物模型,在此基础上制成的脑梗死模型稳定性和重复性好,是研究人类糖尿病脑梗死病理过程较为理想的动物模型。     

TNF-alpha polymorphisms and type 2 diabetes mellitus in Taiwanese patients

Type 2 diabetic mellitus (type 2 DM) comprises more than 95% of all Taiwanese patients with DM. Tumor necrosis factor-alpha (TNF-alpha) expression is linked with insulin resistance, and is under strong genetic control. The correlation between TNF promoter genotypes and type 2 DM is still controversial, because discrepancies among different studies exist. Ethnic differences play certain roles in these conflicting results, because the distribution of TNF promoter polymorphisms is different among study subjects with different racial origins. Therefore, we examined the relationship between the incidence of type 2 diabetes in Taiwanese and two polymorphisms of the TNF-alpha promoter region (positions -238 and -308) as well as the correlation between these polymorphisms and the patients' biochemical manifestations. Genomic DNA was extracted from peripheral blood cells of 261 Taiwanese patients with type 2 DM and 189 non-diabetic control study subjects, and their TNF promoter G-238A and G-308A polymorphisms were analyzed by PCR-RFLP analysis. No significant association between TNF-alpha G-238A and G-308A polymorphisms with type 2 diabetic incidence was observed. However, associations between TNF-alpha G-238A and low-density lipoprotein-cholesterol and between G-308A promoter polymorphism and high-fasting plasma glucose levels, using multiple linear regression analysis with adjustment for the subjects' age, sex, body mass index and diabetic status, were found. Our results suggested that though TNF-alpha G-238A and G-308A polymorphisms were not involved in the pathogenesis of type 2 DM, type 2 diabetic patients carrying TNFA-A or TNF-308*2 genotype might be more susceptible to diabetic complications such as atherosclerosis.