糖化血红蛋白与2型糖尿病患者血脂和尿微量白蛋白及慢性并发症的相关性研究

目的：研究糖化血红蛋白（HbA1c）的水平与2型糖尿病（T2 DM）患者脂质代谢、尿微量白蛋白（u-ALB）及并发症的关系。方法根据278例T2 DM患者HbA1c水平分为三组：低值组HbA1c≤7%;中值组7%＜HbA1c＜10%;高值组HbA1c≥10%。同时测定空腹血糖、血脂、u-ALB水平,及糖尿病相关并发症的检查。结果（1）三组间年龄、病程、血压、TC和HDL-C差异无统计学意义。FBG、TG、LDL-C和u-ALB水平比较差异有统计学意义（P＜0.05）,与HbA1c呈正相关,（分别为r=0.992,P=0.04,r=0.998,P=0.22,r=1.0,P=0.08,r=0.845,P=0.18）;（2）随着HbA1c水平上升,糖尿病视网膜病变、糖尿病肾病和冠心病、脂肪肝的发病率升高（P〈0.05）。糖尿病周围神经病变、糖尿病足和脑梗死的发病率组间差异无统计学意义。结论 T2 DM患者HbA1c水平与血脂、尿微量白蛋白及其慢性并发症相关,应加强患者对HbA1c认识和检测,为糖尿病及其并发症的临床诊断和防治工作提供依据。     

Study of anemia in long-term care (SALT): prevalence of anemia and its relationship with the risk of falls in nursing home residents

ABSTRACT

Objective: The objectives of the current study were twofold. First, this study examined the prevalence of anemia in nursing home residents in the USA and its relationship with key resident characteristics and medical conditions. Second, the study explored whether an association between anemia and falls is evident in this same population.

Research design and methods: Chart review was conducted in 40 nursing homes across the USA. Residents were randomly sampled and considered eligible if they: were ≥18 years of age; had ≥1 hemoglobin (Hb) level reported during the data uptake period of 1/1/04–2/1/05 (first occurrence defined as index Hb); had a recorded serum creatinine level; maintained residency in the facility; and did not receive dialysis during the 6-month post-index follow-up period. Resident demographics, laboratory values, comorbid conditions, medication regimens, falling events, physical functioning measures, and hospitalizations were obtained from chart data. The relationship between selected resident characteristics and comorbidities was explored with index Hb level, using multiple linear regression. Logistic regression was used to analyze the relationship between falling and recurrent falls with anemia (index Hb <13 g/dL and <12 g/dL in men and women ≥15 years, respectively) adjusting for selected variables presumed to be related to falls.

Limitations: Study limitations include the retrospective design and limited follow-up, potential for biased selection of relevant covariates, gaps in time between index Hb levels and falling events, non-random selection of nursing homes, limits to quality and detail in data extracted from residents’ medical charts, and confounding of anemia therapy with index hemoglobin level.

Results: A total of 564 sampled residents met the criteria for data completeness and were retained for analysis; of these, 70% were female. Mean age was 81 ± 12.3 years (±SD). Mean index Hb level was 11.9 ± 1.8 g/dL (12.2 ± 2.0 for males, 11.7 ± 1.6 for females). Of all residents studied, 56% were identified as anemic (64% males, 53% females) from index Hb level. In all, 53% of anemic residents were receiving an identified therapy, with 72% of these treated residents receiving iron. None received an erythropoietic-stimulating agent (ESA). For index Hb level, the regression coefficient was significant for female (p = 0.002), African-American race (p = 0.012), glomerular filtration rate (GFR) <60 mL/min/1.73 m² (p < 0.001), diabetes (p = 0.004), cancer (p < 0.001), asthma (p = 0.002), GI bleeding (p = 0.012), and inflammatory disease (p = 0.039). Except for asthma, these factors were associated with a decrease in Hb. In the regression model for the dependent variable of falling, anemia (OR = 2.26, p < 0.001), psychoactive medication use (OR = 2.18, p = 0.001), and age 85+ years (OR = 2.08, p = 0.016) were associated with more than twice the risk of falling.

Conclusions: Anemia in nursing home residents appears to be under-recognized. For residents over 70 years, the prevalence of anemia in both male and female residents was approximately four times the rate reported in a study of older community dwellers (Salive et al., 1992). Both anemia and the use of psychoactive medications are potentially modifiable factors strongly associated with falling. Since falls and related fractures are events associated with high morbidity and mortality, each of these factors deserves special consideration for potentially reducing the risk of such events in the nursing home.     

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

Background and aimsIn type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients’ diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.Methods and resultsFor this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System.Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140–180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.ConclusionOne week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control.Registration numberin clinicaltrials.gov: NCT 03289494.     

Hb Calais [β76(E20)Ala→Pro]: A Family Study of a Variant With Decreased Oxygen Affinity

Secondary to the detection of a chronic anemia with a slightly increased Hb F level in a 7‐year-old boy carrying a hemoglobin (Hb) variant, we investigated the members of his family and found that they were related to the original case of Hb Calais. In the present study, we report the clinical and biological impacts of this Hb variant in various members of three generations of this family.     

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.     

Hb Koya Dora [α142, Term→Ser (TAA>TCA in α2)]: A Rare Mutation of the α2 Gene Stop Codon Associated with α-Thalassemia

Hb Constant Spring [(Hb CS) α142, Term→Gln (TAA>CAA in α2)] and Hb Koya Dora [α142, Term→Ser (TAA>TCA in α2)] both involve mutations of the α2 gene stop codon and while Hb CS is the most frequent cause of nondeletional α-thalassemia (α-thal) in Southeast Asia, Hb Koya Dora is limited to a restricted population from Andhra Pradesh, India. Here we identify a homozygous case of Hb Koya Dora and confirm the structure of the 31 residue α chain extension.     

Recombinant human erythropoietin attenuates weight loss in a murine cancer cachexia model

Background Within hypoxic tumor regions anaerobic dissimilation of glucose is the sole source of energy generation. It yields only 5% of the ATP that is normally gained by means of oxidative glucose catabolism. The increased need for glucose may aggravate cancer cachexia. We investigated the impact of recombinant human erythropoietin (RhEPO) and increased inspiratory oxygen concentrations on weight loss in tumor-bearing mice.Methods Fragments of the murine C26-B adenocarcinoma were implanted in 60 BALB/c-mice. The mice were divided into four groups and assigned to: (A) no treatment; (B) RhEPO- administration (25 IU daily from day 1–11, three times per week from day 12); (C) RhEPO and 25% oxygen; and (D) RhEPO and 35% oxygen. Three control groups of four healthy mice each received the same treatment as groups A, B, and D, respectively. Hematocrit and hemoglobin levels, tumor volume, and body weight were monitored. At day 17 the experiment was terminated and the serum lactate concentration was measured. The tumors were excised and weighed and, for each mouse, the percentage weight loss was calculated. The impact of tumor weight and the treatments on lactate concentration and weight loss was evaluated.Results Significant positive correlations were found between tumor weight and lactate concentration and between tumor weight and percentage weight loss. In the mice with the largest tumors, RhEPO displayed a significant weight loss-reducing effect, and a significant negative correlation was found between hemoglobin concentration and weight loss. An oxygen-rich environment did not appear to influence weight loss.Conclusion Anaerobic glycolysis in a growing C26-B tumor is related to weight loss. RhEPO administration results in a reduction of the percentage weight loss; this effect is probably mediated by an increased hemoglobin concentration.This study was financially supported by a grant from Ortho Biotech, a division of Janssen Cilag, Tilburg, the Netherlands     

Hemoglobin E and codon 17 nonsense: Two β-globin gene mutations common in Southeast Asia detected by the use of ARMS

Summary Hemoglobin E (codon 26 GAGAAG) and codon 17 nonsense (AAGTAG), two clinically important mutations of the -globin gene, are common in Southeast Asia. The detection of these mutations using allele-specific PCR is described. Together with the previously reported method for the detection of the common Southeast asian codon 41–42 frameshift mutation (del CTTT), it is possible to identify the vast majority of clinically important -globin gene mutations in Southeast Asian populations by means of nonradioactive methods.This study was supported by theVolkswagen-Stiftung     

外周血血红蛋白、血小板计数、血浆纤维蛋白原及D-二聚体检测预测孕晚期产妇产后出血的价值分析

目的:探讨孕晚期纤维蛋白原(Fib)、D-二聚体(D-D)、血小板(PLT)计数、血红蛋白(Hb)检测对产后出血的预测价值.方法:选择37例产后出血产妇为产后出血组(包括严重产后出血11例);选择40例正常产妇为对照组.比较两组产妇孕晚期Fib、D-D、PLT及Hb水平.结果:产后出血组D-D水平显著高于对照组(P＜0.05);两组Fib、PLT及Hb水平比较差异无统计学意义(P＞0.05).普通产后出血产妇Fib、PLT及Hb水平显著高于严重产后出血产妇,D-D水平显著低于严重产后出血产妇(P＜0.05).Fib及D-D对产后出血具有一定预测价值.Fib水平越高,发生产后出血的几率越低(P＜0.05);D-D水平越高,发生产后出血的几率越高(P＜0.05).PLT及Hb对产后出血无预测价值(P＞0.05).结论:检测孕晚期Fib及D-D水平对产后出血具有一定预测价值.     

Survival and mortality among users and non-users of hydroxyurea with sickle cell disease

OBJECTIVE:

to estimate survival, mortality and cause of death among users or not of hydroxyurea with sickle cell disease.

METHOD:

cohort study with retrospective data collection, from 1980 to 2010 of patients receiving inpatient treatment in two Brazilian public hospitals. The survival probability was determined using the Kaplan-Meier estimator, survival calculations (SPSS version 10.0), comparison between survival curves, using the log rank method. The level of significance was p=0.05.

RESULTS:

of 63 patients, 87% had sickle cell anemia, with 39 using hydroxyurea, with a mean time of use of the drug of 20.0±10.0 years and a mean dose of 17.37±5.4 to 20.94±7.2 mg/kg/day, raising the fetal hemoglobin. In the comparison between those using hydroxyurea and those not, the survival curve was greater among the users (p=0.014). A total of 10 deaths occurred, with a mean age of 28.1 years old, and with Acute Respiratory Failure as the main cause.

CONCLUSION:

the survival curve is greater among the users of hydroxyurea. The results indicate the importance of the nurse incorporating therapeutic advances of hydroxyurea in her care actions.