单一测定空腹血糖在诊断糖尿病和糖耐量减低中的局限性

分析了经７５ｇＯＧＴＴ确诊的７９７例糖尿病（ＤＭ）和８１８例糖耐量减低（ＩＧＴ）患者的空腹血糖（ＦＢＳ）水平，并与１２８９例正常人作了比较。结果显示：７９７例糖尿病患者中ＦＢＳ≥７．８ｍｍｏｌ／Ｌ者有５０９例（６３．８６％）。ＦＢＳ≥７．８ｍｍｏｌ／Ｌ诊断糖尿病的敏感性和特异性分别为６３．８６％和９９．３０％，ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ则敏感性和特异性分别为９４．２３％和９１．５４％，假阳性率和假阴性率均不到１０％。８１８例ＩＧＴ患者的ＦＢＳ值正常者（＜６．１１ｍｍｏｌ／Ｌ）占７９．７１％，与正常人重叠较多。提示ＦＢＳ≥７．８ｍｍｏｌ／Ｌ对糖尿病的诊断不是一个敏感的指标，若ＦＢＳ≥６．１１ｍｍｏｌ／Ｌ者应作进一步检查。而用ＦＢＳ不能估价ＩＧＴ。     

不同血糖浓度2型糖尿病患者胃转流Roux-en-Y吻合术疗效的研究

目的：观察不同空腹血糖（FPG）水平2型糖尿病（T2DM）患者胃转流Roux-en-Y吻合术（RYGBP）术后血糖变化及转归情况。方法：前瞻性选取胃部疾病合并T2DM患者行胃部分或全胃切除,残胃食管近端空肠Roux-en-Y吻合术25例,根据入院时FPG水平分为3组：A组（7.0 mmol/L≤FPG〈11.1 mmol/L）、B组（11.1 mmol/L≤FPG〈15.0 mmol/L）、C组（FPG≥15.0 mmol/L）。检测各组术前（0周）、术后1、4、8、12、24周FPG水平,评估患者术后转归情况。结果：各组术后FPG较术前均有明显下降（P〈0.01）,术后24周A组与C组比较,B组与C组比较,差异均有统计学意义（P〈0.01）;A组与B组比较,差异无统计学意义（P〉0.05）。所有患者RYGBP术后T2DM均有不同程度的改善,治愈率为72%。结论：从血糖改善方面评估,RYGBP对所有T2DM患者均有不同程度的改善,但FPG水平过高时控制效果较差。     

肌电电生理诊断糖尿病早期周围神经病变的敏感指标探讨

本文报道了１７１例糖尿病患者通过肌电图电生理检查，测定运动和感觉传导速度及胫神经Ｈ反射的结果，并分析了临床症状，发现糖尿病周围神经病１１６例（６７．８％），其中单纯Ｈ反射异常２７例，神经传导异常兼有或无Ｈ反射异常８９例，提出了诊断糖尿病性周围神经病电生理检查最敏感的指标，并探讨了神经传导与年龄、病程、空腹血糖、果糖胺及ＨｂＡｌｃ之间的相互关系。     

胰腺手术病人术后血糖变化及其意义

目的探讨胰腺手术对病人术后空腹血糖的影响。方法对1994年6月至2004年6月收治的339例外科胰腺手术病人术前、术后空腹血糖的变化进行对照研究。结果胰腺手术的病人术后早期空腹血糖水平明显升高。应用胰岛素可以控制术后早期高血糖。随着术后时间的延长，术后空腹血糖水平逐渐趋于正常。结论胰腺手术可引起病人术后早期高血糖，须应用胰岛素以纠正术后高血糖。一般的胰腺手术不会破坏胰腺内分泌功能，导致病人出现糖尿病。     

Nightly amended IRI/BG ratio in fasting test during sleeping periods in subjects with insulinoma and in normal,diabetic and obese subjects

Summary In order to obtain a dynamic picture of the way abnormal insulinemia, as a function of blood glucose, occurs in the morning in subjects with insulinoma, we have measured amended plasma insulin (IRI)/blood glucose (BG) ratio during the fasting period of 4 sleeping subjects with insulinoma. Healthy subjects and subjects suffering from other diseases were used as reference in order to determine variations of this ratio during the night. BG and IRI were assayed at intervals of 15 or 30 min. Subjects with insulinoma differed from the other subjects by a very elevated ratio dispersion around the mean value with highly significant peaks (>100). Mean value always remained outside the range (7–82) which covers the total range of values measured in healthy and pathological subjects. Presented in part under abstract form to the 7th Congress of Endocrinology, Quebec City, Quebec, Canada.     

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BackgroundThe authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.Types of Studies ReviewedThrough electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies’ methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.ResultsTwelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, −2.77; 95% confidence interval, −4.56 to −0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.Conclusions and Practical ImplicationsBetter-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.     

地特胰岛素治疗妊娠期糖尿病的疗效及对母婴结局的影响研究

目的探讨地特胰岛素治疗妊娠期糖尿病的疗效及对母婴结局的影响。方法选择2017年1月～2018年1月在我院住院的妊娠期糖尿病产妇100例为研究对象,随机分为观察组与对照组,每组各50例。两组均进行饮食控制及适当运动,每天三餐餐前使用门冬胰岛素0.3 U/kg,对照组予优泌林0.1 U/kg,每天1次,于睡前注射,观察组同时加用地特胰岛素0.1 U/kg,每天1次,于睡前注射;两组均连续治疗8周。治疗后比较两组的血糖控制情况及母婴结局。结果两组患者治疗后的空腹血糖、餐后2 h血糖及糖化血红蛋白水平分别显著低于治疗前,且观察组患者治疗后的空腹血糖、餐后2 h血糖及糖化血红蛋白水平显著低于对照组,两组血糖控制情况比较,差异有统计学意义(P0.05)。观察组患者治疗后剖宫产、子痫前期、早产、胎膜早破、新生儿窒息、低血糖的发生率分别显著低于对照组,差异有统计学意义(P0.05)。结论地特胰岛素治疗妊娠期糖尿病疗效确切,显著改善母婴结局,值得临床推广和应用。     

妊娠中期糖化白蛋白对于正常空腹血糖妊娠期糖尿病的诊断价值研究

目的 探讨妊娠中期糖化白蛋白(Glycated Albumin,GA)在空腹血糖(Fasting Plasma Glucose, FPG)正常的妊娠期糖尿病(Gestational Diabetes Mellitus, GDM)患者中的诊断价值研究。方法选取2017年1月1日到6月30日在常州市妇幼保健院门诊产检的FPG＜5.1mmol/L的GDM患者186例和OGTT正常的孕妇171例(孕周24-28周)分别作为GDM组(G组)和对照组(N组),并依据FPG不同水平区间分为FPG<4.4mmol/L、4.4mmol/L≤FPG<5.1mmol/L,进一步细分G1组(114例)和N1组(91例)、G2组(72例)和N2组(80例),比较每两组孕妇年龄、孕前BMI、体重增加值、FPG、GA,以及糖化血红蛋白(HbA1c)之间的差异,ROC曲线分析血清GA预测GDM的诊断价值。结果FPG<5.1mmol/L时,GDM组年龄、GA及HbA1c均明显高于对照组,而对照组的体重增加值显著高于GDM组,差异有统计学意义(P<0.05);FPG<4.4mmol/L时,G1组的年龄及HbA1c明显高于 N1,差异有统计学意义(P<0.05),而两组间的GA差异无统计学差异(P＞0.05);4.4mmol/L≤FPG＜5.1mmol/L时,G2组的年龄、FPG、GA及HbA1c明显高于N2组,差异有统计学意义(P<0.05)。血清GA预测的ROC曲线下面积为0.626,P=0.045,最佳诊断界值为11.45%,预测GDM的敏感度则为77.8%、特异度为45.0%;FPG预测的ROC曲线下面积为0.715,P=0.042,最佳诊断界值为4.715mmol/L,预测GDM的敏感度则为55.6%、特异度为80.0%。结论 空腹在血糖正常范围内,孕妇GA值测定对GDM具有一定的诊断价值。     

Perinatal MSG treatment attenuates fasting-induced bradycardia and metabolic suppression

We studied the effect of arcuate nucleus (ARC) lesions induced pharmacologically by the perinatal treatment of monosodium l-glutamate (MSG) on the cardiovascular, metabolic, and behavioral responses to fasting. Saline and MSG-treated male Sprague-Dawley rats were instrumented with telemetry devices for measurement of mean arterial pressure (MAP) and heart rate (HR) and housed in room calorimeters at an ambient temperature (T(a)) of 23 degrees C for assessment of oxygen consumption (VO(2)). At baseline, controls and MSG-treated rats had similar MAP (control=95+/-4; MSG=91+/-2 mmHg), HR (control=323+/-4; MSG=324+/-2 bpm), and VO(2) (control=8.7+/-0.3; MSG=8.6+/-0.2 ml/min). There were no differences in fasting-induced reductions in body weight or in food intake upon refeeding. MSG-treatment significantly attenuated fasting-induced reductions in HR and VO(2). This effect was specific to reduced caloric availability, as MSG-treated rats exhibited intact capacity to both increase and decrease HR and VO(2) in response to cold (T(a)=15 degrees C) and to thermoneutrality (T(a)=30 degrees C). Additional studies were performed in saline- and MSG-treated rats chronically treated with beta(1)-adrenergic receptor blockade (atenolol) prior to and during fasting. In controls, the cardiovascular responses to fasting during beta(1)-blockade were blunted and generally mimicked the effects of MSG-treatment, while beta(1)-blockade had no additional effect on MSG-treated rats. The results are consistent with the hypothesis that ARC neuronal signaling is requisite for intact homeostatic responses to fasting and may participate in fasting-induced withdrawal of cardiac sympathetic activity.     

Glycerol kinase deficiency: follow-up during 20 years, genetics, biochemistry and prognosis

AIM: To follow two children with isolated glycerol kinase deficiency (GKD) with severe symptoms into adulthood. METHODS: The patients were followed during approximately 20 y and interviewed about symptoms, diet and physical activity. Fasting provocations, bicycle ergometer tests, dietary registrations, enzyme and mutation analysis were performed by standard protocols. RESULTS: The activity of glycerol kinase (GK) in fibroblasts was <10% of reference. One case had a deletion of exon 17, the other a mutation in exon 7 of the GK gene (601 A-->G). Both mothers were heterozygotes. Two maternal male cousins in one of the families were hemizygotes without symptoms. Tests performed in childhood documented pronounced sensitivity to fasting and physical exercise, whereas such tests at 23 and 31 y of age were essentially normal but with pronounced ketonaemia. After puberty, the boys had no hypoglycaemic symptoms and now report no problems with their condition; thus, their phenotype has changed over time. CONCLUSION: The greater importance of glycerol as a gluconeogenetic substrate in children than in adults may explain the episodes in young patients with GKD, often elicited by catabolic stress. With meals at frequent intervals, access to glucose and avoidance of strenuous sports, the prognosis is good for a normal adult life of a young child with isolated GKD and symptoms of hypoglycaemia.