无缝隙护理院后服务对糖尿病患者糖化血红蛋白的影响

目的探讨无缝隙护理院后服务对糖尿病患者糖化血红蛋白的影响。方法将80例2型糖尿病患者随机分为干预组和对照组各40例。干预组除药物治疗外采用无缝隙护理院后服务干预,对照组采用常规出院指导。2组均随访1年。比较出院后第3,6,9,12个月2组患者空腹血糖（FPG）,餐后2h血糖（2hPG）,糖化血红蛋白（HbAlc）的变化情况,对数据进行t检验。结果干预组糖化血红蛋白控制程度显著优于对照组,各项指标都显著改善。结论无缝隙护理院后服务能维持糖尿病患者良好的糖化血红蛋白水平,减少并发症的发生,提高患者生活质量,值得推广。     

Glycaemic Control,Smoking Habits and Diabetes Duration Affect the Extrinsic Fibrinolytic System in Type I Diabetic Patients but Microangiopathy Does Not

ABSTRACT The fibrinolytic system was studied in 43 type I diabetic patients with long duration of the disease, with or without evidence of microangiopathy, and in 26 control subjects. There were positive and independent correlations between tissue plasminogen activator (tPA) activity after venous occlusion and HbA_lc, and between triglycerides and plasminogen activator inhibitor (PAI-1) and tPA antigen concentrations before and after venous occlusion. The tPA activities both at rest and after venous occlusion were higher in the patients. There were no differences with regard to sex, hypertension or nephropathy for the levels of fibrinolytic variables in these patients. Subjects with retinopathy did not differ from those without retinopathy. Diabetes duration showed a significant negative association with tPA activity in multivariate regression analysis. Tobacco-smoking diabetics, as compared to non-smoking, had an increased tPA antigen release at venous occlusion, but also higher PAI-1 levels and reduced specific activity of the tPA protein. When assessed with the new specific assays now available, the fibrinolytic parameters appear to be specific indicators of endothelial dysfunction related to smoking and to degree of glycaemic control in type I diabetic subjects.     

PPAR泛激动剂对自发性2型糖尿病恒河猴血糖及心脏功能的影响

目的 考察过氧化物酶体增殖物激活受体(PPAR)泛激动剂口服给药对自发性2型糖尿病(T2DM)恒河猴降血糖作用及心脏功能的影响.方法 连续给予Ⅱ型糖尿病恒河猴服药一个月,测定试验期内PPAR泛激动剂组、吡格列酮组与模型组的空腹血糖、糖耐量试验、糖化血红蛋白、体重和胰岛素;检测给药前后猴心脏功能的变化.结果 在给药后第14、21、28天,各给药组的空腹血糖均明显降低.给药后PPAR泛激动剂组和吡格列酮组的平均空腹血糖分别下降14.54％、15.09％;各给药组的餐后血糖降低幅度均大于模型组的;各给药组的糖化血红蛋白均明显低于给药前的;给药前、后各组猴的体重无明显变化.给药后,PPAR泛激动剂组的空腹胰岛素明显降低,左室平均舒张末期容积、收缩末期容积和每搏输出量显著增加.结论 自发性Ⅱ型糖尿病恒河猴在连续给予PPAR泛激动剂一月后表现出显著的血糖和空腹胰岛素降低,其对心脏功能的影响还需要进一步研究.     

社区糖尿病一体化管理对糖化血红蛋白和血脂的影响研究

目的:评价社区糖尿病一体化管理对糖尿病患者糖化血红蛋白和血脂异常的控制效果,为糖尿病患者社区管理个体化方案提供依据.方法:将已管理的糖尿病患者随即分为实验组138例和常规管理组139例,常规管理组按照传统模式管理,由社区公共卫生医生按组定期随访,患者自主就诊;实验组在此基础上,采用"公共卫生医生-全科医生-专科医生"一体化无缝式管理模式,随访1年,比较两组患者糖化血红蛋白和血脂指标的变化.结果:与常规管理组比较,干预后实验组的平均糖化血红蛋白(HbAlc)比对照组低0.89%;血清三酰甘油(TG)明显下降,差异有统计学意义(P ＜0.01).血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)没有明显变化(P ＞0.05).结论:一体化管理模式在降低HbAlc和TG方面存在更明显的优势.     

78例2型糖尿病患者药物治疗后血糖控制水平与血清同型半胱氨酸水平的关系

本文通过观察胰岛素治疗与非胰岛素治疗的2型糖尿病患者血糖控制水平与血清同型半胱氨酸水平的关系,阐述了检测血清同型半胱氨酸的重要性。     

绝经后女性2型糖尿病患者骨代谢研究

目的探讨绝经后女性2型糖尿病患者骨代谢及生化指标的特征。方法对我院内分泌科住院44例中老年女性2型糖尿病患者（均为绝经后）的骨代谢及相关指标进行检测。糖尿病患者根据病程分为糖尿病1组（糖尿病病程10年以下）及糖尿病2组（糖尿病病程10年以上,含10年）;根据糖化血红蛋白水平（HbA1c）分为糖尿病3组（HbA1c〈8％）及糖尿病4组（HbA1c≥8％）。同时选取我院50例体检健康女性作为对照组。结果①糖尿病组25-羟维生素D3、I型前胶原氨基末端（C端）前肽（PICP）及估计肾小球滤过率（eGFR）明显低于正常对照组,而抗酒石酸碱性磷酸酶（TrACP一5b）N显较正常对照组升高,且有统计学差异fP〈O．05）。②糖尿病2组患者血I型前胶原氨基末端（N端）前肽fPINP）、PICP和eGFR水平明显低于糖尿病1组患者（P〈0．051,而TrACP-5b水平高于糖尿病1组,雌二醇（estradiol,E）、25-羟维生素D,则无明显统计学差异。③糖尿病3组血PINP、PICP和eGFR明显高于糖尿病4组,TrACP-5b低于糖尿病4组,差异存在统计学意义（P〈0．05）。（4）HbAlc和eGFR与PINP、PICP和TrACP-5b存在显著相关性（相关系数〉0．3）,而雌二醇与PINP、PICP、25-羟维生素D3、TrACP-5b无明显相关性。结论（1）2型糖尿病患者的骨形成降低,而骨吸收增加,肾脏出现较重的损害,这提示糖尿病患者的骨质形成减弱、骨质破坏增加。②随着糖尿病病程的延长,患者的骨质形成速率减慢,骨吸收增加,肾脏损害加重。③血糖控制不佳会对骨的形成及骨质的吸收产生影响,而肾脏损害亦是加重发生骨质疏松的重要因素,因而严格的血糖控制可有效延缓骨质疏松进展。     

U-mALB、尿β_2-MG和HbAlc的联合检测在糖尿病肾病早期的诊断价值

目的:探讨尿mALB、β2-MG和血HbAlc的联合检测在糖尿病肾病早期的诊断价值。方法:选取体检科、门诊和住院患者100例,分为A组正常对照组40例,B组糖尿病无肾病者(DM)组36例,C组糖尿病肾病(DN)24例,取空腹静脉血测糖化血红蛋白(HbAlc),取晨尿测尿微量白蛋白(U-mALB)和β2-微球蛋白(β2-MG)。结果:B组、C组与A组比较,差异有统计学意义(P<0.01),C组与B组比较,差异有统计学意义(P<0.01),U-mALB、β2-MG和HbAlc行直线相关性分析,三个变量之间两两比较呈正相关性(P<0.001)。结论:尿mALB、β2-MG和血HbAlc的联合测定在糖尿病肾病早期有诊断价值,可以提高糖尿病肾病的早期检出率。     

Sub-antimicrobial doxycycline for periodontitis reduces hemoglobin A1c in subjects with type 2 diabetes: A pilot study

In vitro and animal studies suggest a possible role for the tetracycline class of drugs in the inhibition of non-enzymatic protein glycation. We conducted a 3-month, randomized placebo-controlled pilot clinical trial of conventional sub-gingival debridement (periodontal therapy), combined with either a three month regimen of sub-antimicrobial-dose doxycycline (SDD), a two week regimen of antimicrobial-dose doxycycline (ADD), or placebo in 45 patients with long-standing type 2 diabetes (mean duration 9 years) and untreated chronic periodontitis. Subjects were taking stable doses of oral hypoglycemic medications and/or insulin. Treatment response was assessed by measuring hemoglobin A1c (HbA1c), plasma glucose, and clinical periodontal disease measures. At one-month and three-month follow-up, clinical measures of periodontitis were decreased in all groups (data to be presented elsewhere). At three months, mean HbA1c levels in the SDD group were reduced 0.9% units from 7.2% units ± 2.2 (±SD), to 6.3% units ± 1.1, which represents a 12.5% improvement. In contrast, there was no significant change in HbA1c in the ADD (7.5% ± 2.0 to 7.8% ± 2.1) or placebo (8.5% ± 2.0 to 8.5% ± 2.6) groups. Mean HbA1c change from baseline was significantly greater in the SDD group compared with the ADD group (p = 0.04) but not placebo (p = 0.22). Moreover, a larger proportion of subjects in the SDD group experienced improvement (p < 0.05) compared to the ADD or placebo groups. Mean plasma glucose levels were not significantly different between or within the groups. The results of this pilot study suggest that the treatment of periodontitis with sub-gingival debridement and 3-months of daily sub-antimicrobial-dose doxycycline may decrease HbA1c in patients with type 2 diabetes taking normally prescribed hypoglycemic agents.     

格列吡嗪与格列齐特合治2型糖尿病的观察

目的：观察格列吡嗪与格列齐特合用是否可以更有效地控制2型糖尿病患者的血糖。方法：取63名患者，根据其一天中血糖变化分别服用格列吡嗪及格列齐特，监测血糖随时调整药量，4个月后将其各时段血糖及HbAlc与治疗前所检测结果进行统计学处理。结果：合用格列吡嗪与格列齐特4个月后各时段血糖及HbAlc控制基本达标，比治疗前的血糖及HbAlc有显著好转。结论：利用格列吡嗪与格列齐特作用时间和半衰期的不同，根据血糖波动情况分别服用，可达到良好控制血糖的目的。     

糖化血红蛋白在糖尿病监测中的意义探讨

目的探讨糖化血红蛋白（HbAlc）在糖尿病监测中的意义。方法分别检测健康对照组和糖尿病组的HbAlc及空腹血糖（FBG），结果进行统计学分析。结果糖尿病组的HbAlc及空腹血糖均显著高于健康对照组（P〈0．01）；糖尿病组的HbAlc与空腹血糖之间呈正向相关关系（r=0．646）。结论HbAlc在糖尿病监测中的作用优于空腹血糖，为减少并发症，糖尿病患者应常规检测HbAlc。