2型糖尿病患者外周血白细胞iNOSmRNA表达的变化及意义

目的研究2型糖尿病DM患者外周血白细胞中iNOSmRNA表达的变化及其与糖尿病肾病DN发生、发展的关系。方法101例2型DM患者,根据尿微量白蛋白排泄率和血肌酐水平分为单纯DM组和不同的DN组,用原位杂交法检测外周血白细胞iNOSmRNA表达的阳性细胞的百分率,并与21例健康体检者进行比较。结果早期DN组白细胞iNOSmRNA表达的百分率明显高于对照组、DM组及晚期DN组(P<0.001)。结论外周血白细胞iNOSmRNA表达的变化参与了DN的发生、发展。     

老年2型糖尿病患者胰岛素抵抗相关指标的检测和意义

目的:探讨老年2型糖尿病胰岛素抵抗(IR)及其相关性,为老年2型糖尿病的合理防治提供临床依据。方法:选择120例老年2型糖尿病患者,按胰岛素敏感指数(HOMA)胰岛素抵抗(HOMA-IR)50百分位点将患者分为两组:胰岛素相对敏感组(HOMA-IR<3.56)和胰岛素相对抵抗组(HOMA-IR≥3.56),比较体重指数(BMI)、腰/臀比(WHR)、血压、血生化学检查等指标。用年龄>40岁,<60岁的2型糖尿病患者做对照组。结果:两组老年患者在年龄、性别、舒张压、空腹血糖、胆固醇、高密度脂蛋白、糖化血红蛋白、HOMA胰岛β细胞功能方面无差异;但BMI、WHR、收缩压、甘油三脂、空腹胰岛素、HOMA-IR差异具有显著性。多线性回归分析后,只有腰/臀比、收缩压、甘油三脂、HOMA-IR存在统计学差异。老年患者与对照组相比,IR发生率明显增加,且两者腰/臀比、收缩压、甘油三脂方面也差异显著。结论:IR与老年2型糖尿病密切相关,是临床防治糖尿病的重要靶点。     

血管紧张素转换酶基因与中国人群冠心病、高血压病及糖尿病的关系

目的：研究血管紧张素转换酶(ACE)基因与中国人群冠心病(CHD)、高血压病(EH)及2型糖尿病(T2DM)的关系。方法：250例呈不同组合的EH、T2DM以及CHD患者及90例正常对照用改良的聚合酶链反应(PCR)方法检测ACE基因型，比较基因型及等位基因频率分布。结果：①无合并CHD的T2DM及EH组ACE基因型及等位基因频率与正常对照无显著差异；②CHD组无论是否合并EH及／或T2DM，Ⅲ基因型及Ⅰ等位基因频率均显著低于正常对照，而DD基因型及D等位基因频率均显著高于正常对照；③T2DM合并CHD组及EH合并CHD组中Ⅱ基因型及Ⅰ等位基因频率均显著低于正常对照，而DD基因型及D等位基因频率均显著高于正常对照。结论：ACE基因多态性与中国人群CHD相关。这种关联亦见于EH或T2DM合并CHD中，但ACE基因仅是CHD发病的遗传学基础，而与是否合并EH及／或T2DM无关。     

Poor oxygenation in the lungs of patients with hyperosmolar hyperglycemic non-ketotic diabetic coma after cardiac surgery

The ratio of PaO₂ to FiO₂ was often low (300 or less) in four patients with complications of hyperosmolar hyperglycemic non-ketotic diabetic coma (HHNKDC) following open heart surgery. Four of our patients had poor oxygenation and subsequent spontaneous recovery from in the immediate post-operative period, although HHNKDC occurred only in one during this period. In the 3 others, poor oxygenation without accompanying HHNKDC lasted for 1–6 days and HHNKDC developed about 2 weeks after open heart surgery at time when poor oxygenation reoccurred. If a working diagnosis of congestive heart failure was made only on the basis of the most common probability, and the fluid supply was restricted, HHNKDC would readily occur or be aggravated by the dehydration iatrogenically produced. It is thus concluded that HHNKDC should be included in diagnoses for pulmonary dysfunction.     

1型糖尿病患者勃起功能障碍的患病情况及相关因素分析

目的探讨1型糖尿病（T1DM）患者勃起功能障碍（ED）的患病情况及相关影响因素。方法收集182例已婚男性T1DM患者，用无记名问卷形式根据国际勃起功能指数问卷进行自我评分。并对年龄、病程、糖化血红蛋白（HbA1c）、睾酮、尿微量白蛋白排泄量、肾功能、血压、吸烟史、饮酒史、应用药物等因素进行调查，分析其与ED的关系。结果T1DM患者ED患病率为37．36％（68／182）。Logistic逐步回归分析结果显示，病程、年龄、HbA1c、收缩压、尿微量白蛋白排泄量与T1DM患者ED发生独立相关，病程增加5年、年龄增加10岁、HbA1c增加2％、收缩压增加4kPa及尿微量白蛋白排泄量的OR值分别为1．6275、1．1613、2．4211、2．3715、1．5234，P均〈0．01。结论加强对T1DM患者ED高危因素的关注和定期检测，有助于早期发现ED。     

Axonal transport and tissue contents of substance P in rats with long-term streptozotocin-diabetes. Effects of the aldose reductase inhibitor ‘statil’

This study examined the axonal transport of substance P-like immunoreactivity (SPLI) and its content in dorsal root ganglion, trigeminal ganglion, stomach and ileum of non-diabetic rats and two groups of rats with streptozotocin-induced diabetes of 9 months duration. One diabetic group received the aldose reductase inhibitor ‘Statil’ throughout the period of study. To reduce morbidity all diabetic animals were given twice-weekly injections of a long-acting insulin which restricted weight loss but did not prevent regular and severe hyperglycaemia. Axonal transport of SPLI was studied by measurement of accumulation at 12 h ligatures on the left sciatic nerve. There were no differences between the 3 groups either in the calculated anterograde and retrograde mean rates of accumulation (ranges 6.0 to 7.6 and 0.38 to 0.72 mm/h respectively) or mobile fractions of SPLI (means from 0.54 to 0.58). There were, however, marked reductions in anterograde and retrograde accumulations of SPLI in the constricted nerves of the ‘untreated’ diabetics (respectively 57 and 33% of controls;P < 0.01 for both). In the ‘Statil’-treated rats these deficits were attenuated (80 and 75% of controls). Diabetes also reduced the SPLI content of unligated sciatic nerve and trigeminal ganglion (65 and 75% of controls). ‘Statil’ prevented the deficit in the ganglion, but not in the nerve. ‘Statil’ treatment prevented themyo-inositol depletion and attenuated the sorbitol and fructose accumulation seen in the sciatic nerves of the untreated diabetic animals suggesting effective inhibition of aldose reductase in this tissue. The total SPLI content of the stomach and 1-cm segments of ileum were unaltered in the diabetic animals but due to the increased weights of these tissues the SPLI content per unit weight was reduced. These changes were unaffected by ‘Statil’.     

罗格列酮对2型糖尿病患者冠脉支架内再狭窄的预防作用

目的 探讨罗格列酮对2型糖尿病患者行冠脉成形及支架植入术后支架内再狭窄的预防作用。方法 选择行冠脉成形及支架植入术的2型糖尿病患者60例。在原有降糖药物治疗的基础上，研究组(n=31)加服罗格列酮；对照组(n=29)用药方案不变。术后随访6mo，观察患者死亡、急性心肌梗死及再次血管重建术等心血管事件的发生情况，在随访结束时行活动平板检查，结果 阳性的再次行选择性冠脉造影术。结果2组患者随访期间均无死亡、急性心肌梗死等心血管事件发生。6mo内研究组9例再次心绞痛发作，5例活动平板试验阳性，其中5例(16．1％)冠脉支架内再狭窄；而对照组18例再次心绞痛发作，其中15例活动平板阳性，15例(48．4％)冠脉造影术证实支架内再狭窄，2组再狭窄对比有显著差异(P=0．013)。结论 对于2型糖尿病合并冠心病行冠脉成形及支架植入术患者，罗格列酮能有效降低支架内再狭窄。     

老年糖尿病患者髋关节置换手术围手术期处理

目的探讨老年糖尿病患者髋关节置换手术围手术期血糖的控制方法和对手术的影响。方法回顾性分析32例老年糖尿病髋关节置换手术治疗围手术期血糖调控情况。结果32例患者入院时空腹血糖(12.8±1.7)mmol/L,经术前用胰岛素控制空腹血糖至(7.1±1.2)mmol/L后,分别接受全髋关节置换、股骨头置换手术,术中及术后继续使用胰岛素控制血糖至基本正常水平。本组术中血糖为(8.9±1.1)mmol/L。32例中,仅1例(3.2%)伤口愈合不良,未发生感染等其他明显并发症。结论老年糖尿病患者经正确的围手术期处理,将血糖控制至基本正常水平,可耐受髋关节置换手术。     

中药泡洗治疗糖尿病足90例疗效分析

目的为了观察中药泡洗对糖尿病足的疗效。方法对90例糖尿病足患者用中药（方剂组成：桃仁、红花、桂枝、没药、乳香、花椒、川芎等各10g）水煎制后分为2袋各300ml配合足浴仪泡洗，2次，d，30min／次，10d为1疗程。结果全组90例患者显效66例，有效24例，总有效率100％。结论中药泡洗治疗糖尿病足疗效确切。     

Ⅱ型糖尿病血浆PAI-1、t-PA检测的意义和结果评价

目的:通过对Ⅱ型糖尿病患者分组(伴血管病变组、胰岛素抵抗组、胰岛素抵抗伴血管病变组、Ⅱ型糖尿病组)检测PAI-1、t-PA抗原及活性,并计算抗原比和活性比,以评价各检测指标的临床价值。方法:采用ELISA法检测PAI-1及t-PA抗原,采用发色底物法检测PAl-1、t-PA活性。结果:189例标本总体患病组及分组后各组的PAI-1活性、t-PA活性及t-PA活性/PAI-1活性比值与正常对照组比较均有显著性差异(P<0.05)。患病组间除t-PA抗原,其余检测显示胰岛素抵抗组、胰岛素抵抗组伴血管病变组与Ⅱ型糖尿病组存在显著性差异(P<0.05)。结论:在上述检测指标中t-PA活性、PAI-1活性反映血管病变的发生较敏感,t PA/PAI-1的活性比值更具临床应用价值。