不同糖调节者血糖波动与血浆8-异前列腺素F2α水平的相关性研究

目的 探讨血糖波动对氧化应激的作用.方法 入选33例糖调节正常者(NGR)、25例槠调节异常者(IGR)和25例新诊断2型糖尿病患者(T2DM).酶联免疫法测定血浆8-异前列腺素F2α(8-iso)水平;动态血糖临测系统(CGMS)评价3组受试者24 h平均血糖(MBG)和血糖标准差(SDBG),24 h各时段平均血糖、24 h内血糖>5.6 mmol/L的曲线下而积(AUC 5.6)、日内血糖波动幅度(MAGE)、日内平均餐后血糖漂移幅度(MPPGE)及日间血糖平均绝对差(MODD).结果 (1)T2DM组血浆8-iso水平中位数为230 ng/L,高于IGR(199 ng/L,P<0.05)和NGR组(156ng/L,P<0.01);(2)T2DM组糖化血红蛋白(HbAlc)、MBG、SDBG、24 h各时段平均血糖、AUC5.6、MAGE、MPPGE和MODD均高于IGR组(P<0.05,0.01),IGR组的上述指标高于NGR组(P<0.05,0.01);(3)血浆8-iso水平(对数)与MAGE(r=0.747,P=0.00)、SDBG(r=0.691,P=0.00)、MPPGE(r=0.615,P=0.00)、MBG(r=0.562,P=0.0)、AUC5.6、MODD、24 h各时段平均血糖及HbAlc(r=0.463,P=0.00)呈正相关;以血浆8-iso水平为应变量,MAGE、MBG和SDBG进入多元线性回归模型(R2=0.55,P<0.05),MAGE为影响血浆8-iso水平的最主要因素(r=0.694,P=0.000).结论 IGR和T2DM患者存在明显的日内和日间血糖波动,氧化应激增加;日内血糖波动对氧化应激的作用强于持续高血糖.     

不同糖调节受损人群的血糖波动特征

目的 研究不同糖调节受损人群的动态血糖波动特征.方法 采用动态血糖监测系统(CGMS)根据连续2次口服葡萄糖耐量试验结果,选取稳定人群中单纯空腹血糖受损(IFG)组12例,单纯餐后血糖受损(IGT)组19例,空腹血糖受损合并糖耐量低减(IFG/IGT)组11例,新诊断2型糖尿病(T2DM)组21例,正常对照(NGT)组18例,分析其各项临床指标和CGMS动态血糖数据.结果 (1)日内血糖波动:NGT、IFG、IGT、IFG/IGT至T2DM组的最大血糖波动幅度(LAGE)、平均血糖(MBG)和血糖水平标准差(SDBG)依次升高.IGT组的平均血糖波动幅度(MAGE)(3.2±1.2)mmol/L较NGT组(1.6±0.5)mmol/L高,较T2DM组(5.2±1.9)mmol/L低(P<0.05);IFG/IGT的有效血糖波动频率(FGE)(5.5±2.5)次/d较NGT组(6.1±3.4)次/d低,较T2DM组(4.8±1.8)高.糖尿病前期3组间IGT组MAGE(3.2±1.2)mmol/L最高,FGE(4.9±1.8)最低.(2)日间血糖波动:与NGT组(0.8±0.3)mmo/L相比,IGT组(1.1±0.4)mmol/L、IFG/IGT组(1.2±0.4)mmol/L和T2DM组(2.0±1.0)mmol/L的日间血糖平均绝对差依次升高(P<0.05).(3)不同糖调节受损人群血糖波动特征:IFG组空腹血糖受损程度最重,餐后高峰以IFG/IGT组为著.血糖水平曲线由低至高依次为NGT、IGT、IFG/IGT、IFG、T2DM组.(4)不同HbAlc水平的血糖波动:受试者HbAlc<7%时,空腹血糖曲线几乎重合,餐后血糖曲线略微分开;HbAlc7.0%～7.9%时,餐后高峰明显上升;HbAlc≥8%时,空腹曲线明显上移,餐后波动继续升高.结论 (1)随着糖调节受损程度的加重,日内血糖波动及日间血糖波动逐渐增加.(2)正常人血糖波动幅度小,频率高;T2DM餐后血糖波动幅度大,有效波动频率低;(3)IFG组的血糖波动特征最接近于NGT,而IGT组最接近于T2DM;(4)在糖尿病前期阶段餐后血糖受损明显早于空腹.     

动态监测1型及2型糖尿病患者血糖漂移变化

目的 通过动态血糖监测系统(CGMS)监测1型及2型糖尿病患者的血糖漂移变化,并分别探讨糖化血红蛋白及C肽水平与血糖漂移参数的关系.方法 对30例1型糖尿病(T1DM)患者、50例2型糖尿病(T2DM)患者以及30例糖调节正常(NGR)者进行连续72 h动态血糖监测,分析其血糖谱参数,包括日内平均血糖水平(24h MBG)及标准差(SDBG)、三餐前后平均血糖水平、日内最大血糖漂移幅度(LAGE)、日内平均血糖漂移幅度(MAGE)及漂移次数(NGE)、不同血糖水平所占日内时间百分比(PT)及日间血糖平均绝对差(MODD).结果 ①T1DM组和T2DM组的24 h MBG及三餐前后平均血糖明显高于NGR组(P＜0.05).②在昼夜24 h中,T1DM组处于理想血糖控制水平(＞4.4且＜8.0 mmol/L)所占日内时间百分比为(27.03±15.71)％,T2DM组为(37.77±25.40)％,均明显少于NGR组(89.20±10.34)％,P＜0.05.③与NGR组相比,T1DM组及T2DM组日内血糖漂移参数(SDBG、LAGE、MAGE、晚餐PPGE)及日间血糖漂移参数(MODD)显著升高(P＜0.05),且多数指标T1DM组显著高于T2DM组(P＜0.05).④T1DM组及T2DM组的HbAlc与日内及日间血糖漂移参数无明显相关,而其空腹C肽、餐后1h及2hC肽均与LAGE、SDBG、MODD呈负相关(P＜0.05),且T1DM组相关程度多高于T2DM组.结论 糖尿病患者存在慢性持续性高血糖及血糖漂移增加,在血糖漂移方面,T1DM较T2DM更显著.胰岛功能与血糖漂移密切相关.日内及日间血糖漂移参数是全面而精细反映血糖全方位变化的重要指标.     

上海地区中国人餐后血糖状态的特征

目的探讨正常糖调节(NGR)及2型糖尿病(T2DM)个体餐后血糖状态的特征以及T2DM患者餐前、餐后血糖与糖化血红蛋白(HbA1c)的关系。方法采用动态血糖监测系统对上海地区41例NGR及60例新诊断T2DM个体进行连续3d的血糖监测,分析比较餐后血糖峰值与达峰时间,以及餐后血糖漂移的幅度(PPGE)、时间和曲线下面积增值(IAUC)。结果(1)三餐后血糖峰值、达峰时间及PPGE在T2DM组(早餐16·45mmol/L±0·43mmol/L、93·1min±4·7min、6·84mmol/L±0·28mmol/L,中餐14·75mmol/L±0·50mmol/L、107·4min±6·5min、4·93mmol/L±0·31mmol/L,晚餐14·91mmol/L±0·45mmol/L、109·3min±4·9min、5·84mmol/L±0·28mmol/L)显著高于NGR组(早餐6·90mmol/L±0·21mmol/L、40·8min±2·9min、2·02±0·17mmol/L,中餐6·74mmol/L±0·16mmol/L、43·7min±3·1min、2·03±0·12mmol/L,晚餐6·94mmol/L±0·19mmol/L、53·5min±3·8min、2·25mmol/L±0·18mmol/L,均P<0·01)。日内餐后血糖漂移时间及IAUC在T2DM组(14·1h±0·3h,2·04mmol·L-1·d±0·09mmol·L-1·d)亦显著高于NGR组(8·3h±0·4h,0·43mmol·L-1·d±0·03mmol·L-1·d,均P<0·01)。(2)T2DM组早餐后血糖较快达到尖峰(P<0·05),且峰值显著高于中、晚餐(P<0·01),PPGE从高到低的顺序分别为早、晚及中餐(P<0·05),晚餐的IAUC显著高于早、中餐(P<0·01)。(3)HbA1c与IAUC的相关性(r=0·29,P=0·03)在调整餐前血糖的因素后消失(P=0·05);PPGE与IAUC呈显著正相关(r=0·93,P<0·01)。(4)T2DM组餐后血糖对总体日内血糖的贡献百分比显著高于NGR组(18·1%±0·8%比8·0%±0·7%,P<0·01),但均显著低于其餐前血糖(P<0·01)。(5)当HbA1c<7·5%时,餐后血糖升高部分对总体日内高血糖的贡献大于餐前血糖(P<0·05),当HbA1c≥7·5%时,餐前高血糖的相对作用逐渐增加并占主要作用(P<0·01)。结论(1)T2DM患者表现为餐后血糖的过度漂移并持续较长时间,同时伴有血糖尖峰的延迟,其餐后急性高血糖状态以早餐最明显。(2)HbA1c不能反映餐后血糖的漂移变化,PPGE可作为估测餐后血糖漂移程度的简易临床参数。(3)在轻、中度高血糖的患者中,餐后高血糖起主要作用,提示血糖控制越接近达标,餐后血糖的控制越重要。     

糖耐量低减者和新诊断2型糖尿病者动态血糖谱的特点

目的采用动态血糖监测系统(CGMS)了解糖耐量低减(IGT)者和新诊断2型糖尿病(T2DM)者动态血糖谱的特点,以便指导制定合理的干预治疗方案。方法对6例糖耐量正常(NGT)者、10例IGT者和20例新诊断T2DM者的CGMS资料进行分析。结果(1)随着糖耐量受损加重,CGMS平均血糖值、血糖值标准差、血糖≥7.8mmol/L时间百分比等逐渐升高(均P<0.05),CGMS血糖谱波动幅度逐渐增加。(2)IGT组餐后血糖达峰值时间为餐后109min±32min,全天血糖≥7.8mmol/L时间为3.0h±0.8h;新诊断的T2DM组餐后血糖达峰值时间为92min±22min,全天血糖≥11.1mmol/L时间为12.6h±1.3h。IGT组和新诊断T2DM组中,早餐后血糖上升速度较快、幅度较高且持续时间较长。结论(1)CGMS检查能比较准确地显示IGT者和新诊断T2DM者动态血糖波动规律,有利于指导制定针对性的干预治疗方案。(2)IGT者全天持续约3h血糖≥7.8mmol/L。(3)随着糖耐量受损加重,餐后血糖上升速度加快、峰值增高,血糖曲线波动幅度逐渐增加。     

Glycemic variability in insulin treated type 2 diabetes with well-controlled hemoglobin A1c and its response to further treatment with acarbose

Background  Glycemic variability, an HbA1c-independent risk factor, has more deleterious effects than sustained hyperglycemia in the development of diabetic complications. This study analyzed the characteristics of glycemic variability in type 2 diabetes mellitus (T2DM) with HbA1c <6.5% in duration of twice daily premixed insulin treatment and the effect of further treatment with acarbose.

Methods  Eighty-six T2DM patients who used premixed insulin analogue (insulin aspart 30) twice daily and had HbA1c <6.5% and 20 controlled subjects with normal glucose regulation (NGR) were monitored using the continuous glucose monitoring (CGM) system. The mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD) were used for assessing intra-day, inter-day glycemic variability. Hypoglycemia was defined as glucose level <3.9 mmol/L for at least 15 minutes in CGM. According to reference values of MAGE, T2DM patients were classified into two groups: low-MAGE group with MAGE <3.4 mmol/L (L-MAGE) and high-MAGE group with MAGE ≥3.4 mmol/L (H-MAGE). H-MAGE group received further treatment with acarbose for 2 weeks and was monitored a second time with CGM system.

Results  After first CGM, L-MAGE group had 41 cases, and H-MAGE group had 45 cases. The MAGE and MODD of T2DM group were all higher than those of subjects with NGR (P <0.01). Twenty-four percent (n=11) in H-MAGE group had a total of 13 hypoglycemic events, 10 of the 13 events occurred at night, meanwhile 5% (n=2) in L-MAGE group had a total of 2 hypoglycemic events, which also occurred at night (hypoglycemic events: 24% vs. 5%, χ²=6.40, P <0.01). MAGE value was correlated with hypoglycemia value and 2-hour postprandial plasma glucose value (r=–0.32 and 0.26, respectively, P <0.05). After further acarbose therapy and secondly CGM, MAGE and MODD values in H-MAGE group were all significantly decreased (40%, P <0.01, and 15%, P <0.05, respectively), but remained higher than in the subjects with NGR (P <0.05); 2% (n=1) had a total of 1 hypoglycemic event, incidence significantly decreased (2% vs. 24%, χ²=9.61, P <0.01).

Conclusions  CGM system can detect the glycemic variability and asymptomatic hypoglycemic events of T2DM with well-controlled HbA1c in duration of insulin treatment. Combination therapy of premixed insulin twice daily with acarbose can flat glycemic variability and decrease hypoglycemic events.

     

2型糖尿病合并冠心病患者血糖变化与内皮功能的相关性

目的探讨2型糖尿病合并冠心病患者血糖波动的变化及对其肱动脉内皮依赖性舒张功能（FMD）的影响。方法选取近期经冠脉造影术确诊为冠心病的2型糖尿病患者30例为T2DM1组作为主要研究对象,同时选取病程、糖化血红蛋白等一般临床资料匹配的经冠脉造影术排除冠心病的2型糖尿病患者20例为T2DM2组,所有对象接受FMD检测及动态血糖监测系统（CGMS）监测。比较T2DM1组血糖波动的变化,并分析其与FMD的相关性。结果 （1）与T2DM2组相比,T2DM1组的日内平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、平均餐后血糖波动幅度（MPPGE）、低血糖曲线下面积（IAUC70）明显升高,差异有统计学意义（P〈0.05）。（2）对T2DM1组FMD进行分析显示,FMD与MAGE、MODD、PPGE、IAUC70等血糖波动系数明显相关（P〈0.05）,其中与MAGE相关性最强;以FMD为因变量,各相关因素为自变量行多元逐步回归分析显示,调整其他影响因素后,MAGE仍与FMD呈负相关,且MAGE、IAUC70、收缩压均是影响FMD的独立因素。结论 2型糖尿病合并冠心病患者血糖波动较不合并冠心病患者明显增加,FMD明显受损,血糖波动与FMD受损具有相关性。     

不同体重指数不同糖耐量状态下人的血清抵抗素水平

目的：探讨不同体重指数（BMI）、不同糖耐量（GT）状态下人血清抵抗素水平与胰岛素抵抗（IR）的关系。方法：2型糖尿病（T2DM）患者、正常糖耐量者（NGT）及糖调节受损者（IGR）分别按BMI≥25kg／m。分为肥胖与非肥胖，采用酶联免疫分析法检测空腹血清抵抗素水平，并以稳态模型（HOMA-model）计算胰岛素抵抗指数（HOMA-IR）。结果：T2DM组和NGT组中的肥胖者血清抵抗素水平均高于非肥胖者，T2DM组有统计学意义（P〈0.05）；IGR组血清抵抗素水平高于T2DM组及NGT组。空腹血清抵抗素与BMI、HOMA-IR呈正相关，与甘油三酯、空腹胰岛素及餐后2h胰岛素呈正相关；与空腹血糖、腰臀比无明显相关性。结论：抵抗素可能在肥胖发展为糖尿病的过程中，成为预测糖尿病发病的一个指标。     

The relationship between glucose excursion and cognitive function in aged type 2 diabetes patients

Objective Evidence suggests that type 2 diabetes (T2DM) is associated with an increased risk of dementia and that glucose variability is an independent risk factor for diabetic complications.This study investigated the relationship between glucose excursion and cognitive function in aged T2DM patients.Methods A total of 248 aged T2DM patients wore a continuous glucose monitoring system (CGMS) for 3 days in order to evaluate glucose excursion,including mean amplitude of glycemic excursions (MAGE) and mean of daily difference (MODD).All subjects were evaluated with a number of accepted cognitive function tests,including themini‐mental status examination (MMSE).The relationship between MAGE and MODD and performance on these cognitive tests was assessed.Results The MAGE and MMSE score were negatively correlated,likewise with the correlation between MODD and MMSE.Liner multivariate regression analysis showed that MAGE and MODD were also negatively related to MMSE independent of age,sex,glycemic control,hypertension,smoking,or coronary heart disease history.Conclusion Glucose excursion is related to cognitive function in aged T2DM patients.Elevated glucose excursion decreased the MMSE score,which reflects general cognitive function.Thus,therapy aimed at controlling glucose excursion may be beneficial for maintaining cognitive function in aged T2DM patients.     

空腹血糖、餐后2h血糖及糖化血红蛋白对糖尿病的诊断价值

目的:探讨空腹血糖、餐后2h血糖及糖化血红蛋白(HbAlc)对糖尿病及糖调节受损的诊断价值。方法:收集2009年12月至2011年8月在郑州市第二人民医院和郑州市中心医院检测空腹血糖(FPG)、糖化血红蛋白(HbAlc)和餐后2h血糖(2h-PG)的738例临床资料完整的、HbAlc在5.4%～7.0%的就诊者入选该研究,采用ROC曲线确定HbAlc预测糖尿病及糖调节受损的诊断界点。结果:以FPG≥7.0mmol/L和(或)餐后2h-PG≥11.1mmol/L为诊断DM的金标准作ROC曲线,HbAlc=6.35%为诊断DM的最佳阈值,此切点敏感度0.698,特异度0.680,阳性似然比为2.18,阴性似然比为0.44。以FPG6.1～6.9mmol/L和(或)餐后2h-PG在7.8～11.1mmol/L作为诊断糖调节受损的金标准作ROC曲线,HbAlc=6.0%为诊断糖调节受损的最佳阈值,此切点敏感度0.646,特异度0.659,阳性似然比为1.89,阴性似然比为0.54。结论:用HbAlc诊断糖尿病敏感度中等,诊断糖调节受损敏感性不高,联合实验有助于提高糖尿病及糖调节受损的检出率。     

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background:

For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.

Methods:

Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.

Results:

After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034).

Conclusions:

CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.     

Association between Genetic Variants and Characteristic Symptoms of Type 2 Diabetes: A Matched Case-Control Study

Objective

To examine the association of genetic variants with characteristic symptoms of type 2 diabetes mellitus (T2DM).

Methods

A matched case-control study was performed to investigate the association between common variants in four genes (CDKAL1, GLIS3, GRK5, and TCF7L2) and symptoms of T2DM. Symptoms were examined with questionnaire for 710 subjects. Genomic DNA was extracted from peripheral blood mononuclear cell by salting-out procedure. Genotyping was carried out by direct sequencing of the unpurified polymerase chain reaction products.

Result

Most of the T2DM patients pressented characteristic symptoms, such as feeling weak in limbs (P =0.0057), hand tremor (P =0.0208), bradymasesis (P =0.0234), and polyuria (P =0.0051). Some of the T2DM patients shared characteristic symptoms, such as desire for cold drinks (P =0.0304), polyphagia (P =0.0051), and furred tongue (P =0.028). The impaired glucose regulation (IGR) cases took only one characteristic symptom of frequent micturition (P =0.0422). GLIS3 rs7034200 and GRK5 rs10886471 were significantly associated with increased T2DM risk (GLIS3 rs7034200 under dominant model: P=0.0307; GRK5 rs10886471 under recessive model: P=0.0092). However, only the rs10886471 polymorphism in GRK5 showed a significant effect on both differentiated symptoms and T2DM risk. The C-allele was involved in both dampness-heat encumbering Pi (Spleen) syndrome (P =0.047) and qi-yin deficiency syndrome (P =0.002) via increased GRK5 expression.

Conclusions

Both T2DM and IGR exhibited its corresponding characteristic symptoms. The variants of GRK5 were involved with both qi-yin deficiency syndrome and dampness-heat encumbering Pi syndrome.

     

动态血糖监测系统对2型糖尿病患者血糖漂移的影响

目的观察动态监测2型糖尿病（T2DM）患者血糖漂移的细节及波动趋势,为合理的治疗方案提供临床依据。方法采用动态血糖监测系统（CGMS）对86例T2DM患者进行72 h动态血糖监测,并对第1日及第3日评估参数进行分析。结果 24 h平均血糖水平（24 h MBG）由胰岛素剂量调整前的（10.7±2.7）mmol/L降至（7.9±1.6）mmol/L（P〈0.05）;调整后日内平均血糖波动幅度（MAGE）由（5.5±1.6）mmol/L降至（2.3±1.0）mmol/L（P〈0.05）;胰岛素剂量调整前后血糖的时间百分比均明显下降,PT1（≤3.9 mmol/L）由0.8%降至0.3%,PT3（≥7.8mmol/L）由（32.7±7.5）%降至（14.7±3.1）%（P〈0.05）;血糖低于5 mmol/L的平均发生次数由1.6次降至0.7次（P〈0.05）。结论动态血糖监测系统能详细地显示T2DM患者血糖漂移的幅度和趋势,辅助临床医师制定更为针对性的降糖方案,有效控制血糖波动和低血糖的发生,缩短住院时间。     

北京市顺义区南法信地区人群高血糖的危险因素分析

目的了解北京市郊区农村人群2型糖尿病(2DM)及糖调节受损(impaired glucose regulation,IGR)患病的危险因素。方法调查对象为2007年5月至10月参加北京市顺义区南法信地区村民体检的1873名当地常住人口。体检内容:问卷调查、体检和实验室检查。问卷调查包括:一般情况、既往病史和家族史等。体检:身高、体质量、腰围、臀围和血压等。实验室检查:空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)等。对无糖尿病史但空腹血糖大于5.5mmol/L者行口服75g葡萄糖耐量试验。按1999年WHO诊断标准将受试人群分为正常血糖组、IGR组及2-DM组。结果①参加体检者中2型糖尿病患者为360人,IGR129人,血糖正常者1384人。与正常血糖组比较,2DM组受试者年龄、体质量、腰围、腰臀围比值(WHR)、体质量指数(BMI)、收缩压、舒张压、TC、TG、LDL-C显著升高,HDL-C显著降低,差异有统计学意义(P<0.05);IGR组除HDL-C外其他各项与正常血糖组比较差异均有统计学意义(P<0.05)。②Logistic回归分析结果显示:年龄、糖尿病家族史、腰围、WHR、TG和LDL-C等6个因素为2DM的危险因素(OR分别为1.066、8.943、1.650、1.744、1.196和1.411,P<0.01);年龄、糖尿病家族史、BMI、TG和LDL-C等5个因素为IGR的危险因素(OR分别为1.049、3.276、1.586、1.130和1.431,P<0.05)。结论糖尿病前期及肥胖者是2DM的"后备军",并有心血管疾病的风险,应引起足够的重视。建议对农民进行必要的健康普查及健康知识普及;对超体质量、肥胖人群开展早期干预,以减少其发生糖尿病及心血管疾病的风险。     

Association of serum uric acid with different levels of glucose

Background  Previous studies have demonstrated that serum uric acid (UA) is an independent predictor of incident type 2 diabetes mellitus (T2DM) in general populations. This study aimed to investigate specific characteristics of UA and its relationship between UA and blood glucose and other risk factors in the Chinese population.

Methods  A total of 946 subjects were included in this study. UA, glucose, insulin, fractional excretion of UA (FEua), creatinine clearance rate (Ccr), hemoglobin A1c (HbA1c), fructosamine (FA), blood pressure and lipids were studied and also reexamined after the patients underwent two weeks of combined therapeutics.

Results  UA levels were the highest in subjects with impaired glucose regulation (IGR), followed by subjects with normoglycemia (NGT) and finally by subjects with T2DM. The level of the 2-hour postprandial insulin and the area under the curve for insulin (AUCins) showed a similar tendency. The UA levels initially increased with increasing fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels, up to 7 mmol/L and 10 mmol/L, respectively, and thereafter decreased at higher FBG and PPBG levels. Compared with subjects in the lower serum UA quartile, subjects in the upper quartile of serum UA levels had higher weights, triglyceride levels, and creatinine levels as well as lower Ccr and FEua levels. Compared with women’s group, UA levels were higher, and FEua levels were lower in men’s group. Sex, body mass index (BMI), mean arterial blood pressure (MAP), serum triglycerides (TG), FA and Ccr were independent correlation factors of UA. UA decreased and FEua increased after the patients underwent a combined treatment.

Conclusions  UA increased initially and then decreased as glucose levels increased from NGT to IGR and T2DM. Compared with NGT and T2DM, IGR subjects had higher SUA levels, which related to its high levels of insulin. Under T2DM, male gender, BMI, MAP, Ccr, TG and FA are independent correlation factors of UA. Glucose-lowering, antihypertensive, lipemia-regulating combined treatments were of advantage to decline of SUA of T2DM.

     

不同体质量糖调节异常人群血清vaspin水平变化

目的研究不同糖耐量及体质量人群中血清内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(vaspin)水平的变化。方法研究对象按糖调节水平分为糖调节正常组(NGR组)、糖调节受损组(IGR组)及2型糖尿病组(T2DM组)。测定各组空腹血糖(FPG)、空腹C肽(FCP)、空腹血浆胰岛素(FINS)、糖化血红蛋白(HbA1c)、胆固醇(CHO)、三酰甘油(TG)、低密度脂蛋白(LDL-C)和高密度脂蛋白(HDL-C)水平。采用ELISA法测定血清vaspin水平,并分析各组血清vaspin变化及其与各种参数的相关性。结果 T2DM组和IGR组血清vaspin水平比较差异无显著性,但均显著高于NGR组(F=22.96,q=8.74、7.92,P<0.01);女性和肥胖者血清vaspin水平分别显著高于男性和非肥胖者(t=3.43~4.18,P<0.05)。vaspin水平与性别、腰围、BMI、FPG、HOMA-IR、FCP、HbA1C、腰臀比、FINS、CHO、LDL-C呈正相关(r=0.178~0.436,P<0.05),性别、BMI、FPG是影响血清vaspin水平的独立相关因素。结论血清vaspin水平升高与体质量超标或肥胖和血糖升高相关,且有性别差异。     

血糖波动与下肢血管病变程度的关系研究

目的探讨糖化血红蛋白(HbA1c)控制良好的2型糖尿病(T2DM)患者慢性血糖波动与下肢血管病变程度的关系。方法对68例HbA1c≤6.5%的T2DM下肢血管病变患者(DM组)及30例健康者(NC组)进行72 h动态血糖监测,分析平均血糖波动幅度(MAGE)。然后以大于NC组MAGE的(x±1.96s)为MAGE升高的诊断标准,将DM组患者分为MAGE升高组和MAGE正常组,并对每个患者进行下肢血管病变评分。结果 (1)DM组高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、HbA1c、MAGE与NC组比较,差异均有统计学意义(P<0.05)。(2)DM组患者中,MAGE升高36例,MAGE正常32例,两者的年龄、病程、HbA1c水平、下肢血管病变评分间差异有统计学意义(P<0.05)。Pearson相关分析显示,MAGE、年龄、病程、HDL-C与下肢血管病变评分相关(P<0.05);病程与MAGE相关(P<0.05)。(3)多元线性回归分析显示,病程、年龄、MAGE是下肢血管病变评分的影响因素(P<0.05)。结论慢性血糖波动是HbA1c控制良好的T2DM患者下肢血管病变的重要危险因素,糖尿病病程是影响血糖波动水平的重要因素。     

空腹血糖受损下限切点下调对中国成人糖调节异常分布的影响

目的　明确美国糖尿病学会 2 0 0 3年修订的空腹血糖受损 (IFG)的下限新切点 (5 6mmol/L)对中国成人糖调节异常各组分患病率的影响 ,并探讨新切点的诊断价值。方法　研究对象为 1994年全国糖尿病防治协作组资料库中具有完整口服糖耐量试验 (OGTT)资料的 15 5 6 4例中国成人 (≥ 2 5岁 )。以空腹血糖 (FPG) 5 6mmol/L(简称新标准 )和 6 1mmol/L(简称旧标准 )作为IFG的诊断下限切点 ,分别计算单纯空腹血糖受损 (i IFG)、单纯糖耐量异常 (i IGT)、同时IFG和IGT(IFG/IGT)的患病率。以OGTT 2h血糖 (7 8mmol/L≤PG2h <11 1mmol/L)为诊断糖调节异常(IGR)的金标准 ,分析不同FPG水平对IGR诊断的敏感性和特异性 ,并描绘FPG诊断IGR的ROC曲线 (receiveroperatorcharacteristiccurve)。 结果　 (1)i IFG、i IGT和IFG/IGT患病率以旧标准诊断分别为 8 71%、12 0 8%和 5 95 % ,以新标准诊断分别为 2 1 2 5 %、6 89%和 11 13%。 (2 )ROC分析提示诊断IGR的FPG最佳切点为 5 6mmol/L ,此切点的敏感性和特异性分别为 6 1 9%和 6 3 9%。结论　FPG标准从 6 1mmol/L下调至 5 6mmol/L使本组人群IFG患病率增加 1 2倍。从尽量缩小IFG和IGT诊断分歧的角度 ,IFG的下限切点为 5 6mmol/L可能是合适的。     

血糖波动对2型糖尿病大鼠认知功能的影响

目的 探讨血糖波动对2型糖尿病大鼠认知功能的影响及其与海马组织氧化应激指标的相关性。方法 通过高糖高脂饮食联合腹腔注射链脲菌素(streptozotocin,STZ)建立2型糖尿病(type 2 diabetes mellitus, T2DM)模型,采用简单随机化法分为血糖正常对照组(control group, C group)(n=10)和2型糖尿病组(n=26)。24只造模成功的2型糖尿病大鼠采用简单随机化法随机分为持续高糖组(sustained hyperglycemia group, SHG group)(n=12)和血糖波动组(intermittent hyperglycemia group, IG group)(n=12),其中IG组通过改变大鼠的饮食习惯和生活节律来建立血糖波动模型。6周后每周随机测定各组大鼠一日内9个时间点的血糖浓度,从而得到血糖日平均水平(mean blood glucose,MBG)、日平均血糖的标准差(standard deviation of daily average blood glucose, SDBG)、最大血糖波动幅度(largest amplitude of glycemic excursions, LAGE)和平均血糖波动幅度(mean amplitude of glycemic excursion, MAGE)的改变情况。第10周Morris水迷宫检测各组大鼠空间学习记忆能力。第11周检测大鼠海马组织内氧化应激指标丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px),比较各组氧化应激指标及其与认知功能的相关性。结果 1)血糖波动6周后,IG组和SHG组MBG、SDBG、LAGE、MAGE均明显高于C组(P<0.05);IG组的SDBG、LAGE、MAGE高于SHG组,MBG低于SHG组(P<0.05)。2)大鼠学习记忆能力比较,糖尿病大鼠(IG组和SHG组)第4天的逃避潜伏期比C组延长(P<0.05),且第5天穿越平台的次数、经过目标象限(定位航行实验中平台所在象限)的活动路程比与活动时间比均较C组减少(P<0.05)。IG组与SHG组比较,第5天穿越平台次数、经过目标象限的活动路程比与活动时间比均较少(P<0.05)。3)氧化应激指标检测:IG组、SHG组与C组比较,MDA含量升高,SOD及GSH-Px含量降低(P<0.05)。IG组与SHG组比较,MDA升高、SOD及GSH-Px降低。4) 氧化应激指标与学习记忆能力相关性分析显示:MDA与活动路程比、活动时间比及穿越平台次数呈负相关(P<0.01)。GSH-Px、SOD与活动路程比、活动时间比及穿越平台次数呈正相关(P<0.01)。结论 1) 通过高糖高脂饮食联合腹腔注射小剂量的 STZ(30 mg/kg),并通过改变饮食习惯及生物节律可以成功建立T2DM血糖波动模型。2) 血糖波动比持续高血糖更易影响T2DM大鼠的认知功能。3) 血糖波动会加剧海马区氧化应激损伤。     

应用持续血糖监测系统评估2型糖尿病患者一级亲属的糖代谢特征

目的 用持续血糖监测系统(CGMS)评估口服葡萄糖耐量正常人群及2型糖尿病患者一级亲属的血糖稳定性.方法 用CGMS对50例受试者进行48～72 h的血糖监测,其中2型糖尿病患者一级亲属(FDR)22名,尤糖尿病家族史的正常糖调节人群(对照组)28名,比较CGMS监测中连续48 h的平均血糖水平(MBG)及其血糖水平标准差(SDBG)、日内平均血糖波动幅度(MAGE)及日间血糖平均绝对差等指标.用稳态模型评估法评估胰岛β细胞功能和胰岛素抵抗性(HOMA-IR),计算胰岛素分泌指数(△I30/△G30),修正的β细胞功能指数(MBCI)等指标.结果 FDR组的MAGE明显高于对照组[(2.3±0.5)mmol/L比(2.0±0.6)mmol/L,P<0.05)],MBCI在FDR组明显低于对照组[17.6(16.9～50.0)比36.0(15.7～59.6),P<0.05],其余指标在两组间差异无统计学意义.结论 CGMS监测剑2型糖尿病患者的FDR的血糖波动性较大,主要表现为MAGE增大.