2型糖尿病患者社区获得性肺炎的临床特征分析

目的通过对住院2型糖尿病患者和2型糖尿病合并肺部感染患者的观察,探讨2型糖尿病患者合并社区获得性肺炎的危险因素和病原菌特点。方法对58例2型糖尿病合并肺炎患者和74例单纯2型糖尿病患者的一般指标进行对比分析,并取痰进行细菌学培养。结果 2型糖尿病合并肺炎组血糖、白细胞计数、C反应蛋白、胆固醇、胰岛素抵抗指数均明显高于单纯2型糖尿病组,相反胰岛素分泌指数则明显低于单纯2型糖尿病组。白细胞计数、C反应蛋白、空腹血糖、糖化血红蛋白是2型糖尿病患者发生肺炎的危险因素,肺部感染病原菌主要以G-杆菌多见。结论 2型糖尿病患者血糖控制不佳容易并发肺部感染,在选择抗生素时,首选有效、敏感的抗生素是治疗的关键。     

安徽某县村级门诊糖尿病筛检结果分析与评价

目的:探讨在村级门诊中进行糖尿病筛查的可行性,加强糖尿病患者预防的积极性.方法:通过随机抽样和现场调查收集资料,对安徽省某县村级门诊的1248条有效血糖检测信息进行记录并做统计分析.结果:糖尿病患者112人(2型糖尿病),其中包括以往已确诊糖尿病患者25人,糖尿病总体患病率为9.0%;随着年龄增加,患病率升高(P<0.05);男性组糖尿病患病率高于女性组(P<0.05);肥胖人群组糖尿病发病率高于非肥胖组(P<0.05).结论:村级门诊开展糖尿病筛检有利于糖尿病早发现、早诊断、早治疗,有利于加强糖尿病患者自我保健积极性和减轻农村居民经济负担,可行性较高.     

Determination of pancreatic and gut Glucagon-Like Immunoreactivity (GLI) in normal and diabetic subjects

Summary Oral glucose tolerance tests (1.75 g glucose/ kg ideal body weight) were performed in 29 normal subjects, 17 maturity-onset diabetics (D I) and 8 juvenile type diabetics (D II). Glucose, IRI, pancreatic and gut glucagon-like immunoreactivity (GLI) were determined at various intervals. The basal levels of pancreatic GLI in the three groups were as follows: normals: 0.33 ±0.03; D I: 0.43±0.06; and D II: 0.50±0.05 ng equiv./ml (mean±s.e.m.). After glucose, a significant decrease in pancreatic GLI was observed in the normals, whereas the diabetics showed no significant change. An increase in gut GLI was observed in all persons. The importance of the GLI levels and variations is discussed.     

Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001–2010: Report of the Committee on Causes of Death in Diabetes Mellitus

The principal causes of death among 45,708 patients with diabetes (29,801 men and 15,907 women) who died in 241 hospitals throughout Japan during 2001–2010 were determined based on a survey of the hospital records. Autopsy had been conducted in 978 of the 45,708 cases. The most frequent cause of death was malignant neoplasia (38.3%), followed by, in order of descending frequency: infections (17.0%); and then vascular diseases (14.9%), including renal failure (3.5%), ischemic heart diseases (4.8%) and cerebrovascular diseases (6.6%). Diabetic coma associated with hyperglycemia with or without ketoacidosis accounted for only 0.6% of the deaths. In regard to the relationship between the age and cause of death in patients with diabetes, the incidence of death due to vascular diseases was higher in patients over the age of 30 or 40 years, and the 97.0% of the total death due to vascular diseases was observed in patients over the age of 50 years. The incidence of death due to infectious diseases, especially pneumonia, increased in an age‐dependent fashion, and the 80.7% of the total death due to pneumonia was observed in patients over the age of 70 years. ’Poorer’ glycemic control was associated with the reduced lifespan of patients with diabetes, especially of those with nephropathy. The average age at death in the survey population was 72.6 years. The lifespan was 1.6 years shorter in patients with ‘poorer’ glycemic control than in those with ‘better’ glycemic control. In patients with diabetes of less than 10 years’ duration, the incidence of death due to macroangiopathy was higher than that due to nephropathy. Of the 45,708 patients with diabetes, 33.9% were on oral medication, 41.9% received insulin therapy and 18.8% were treated by diet alone. Among the patients in whom the cause of death was diabetic nephropathy, a high percentage, 53.7%, was on insulin therapy. The average age at death of the 45,708 patients with diabetes was 71.4 years in men and 75.1 years in women. However, the report of the Ministry of Health and Welfare of Japan in 2010 set the average lifespan of the Japanese at 79.6 years for men and 86.3 years for women. Thus, the average lifespan of patients with diabetes still appears to be shorter than that of the general population in Japan. However, the differences in lifespan between patients with diabetes and the general population were shorter than those in the former surveys.     

不同剂量的黄芪桂枝五物汤加减治疗糖尿病周围神经病变患者的对比研究

目的比较不同药物剂量的黄芪桂枝五物汤加减治疗糖尿病周围神经病变(DPN)患者的临床疗效。方法将68例DPN患者随机分为观察组和对照组各34例,两组均给予基础治疗及黄芪桂枝五物汤加减,其中对照组药物剂量按1两等于9g计算;观察组药物剂量按1两等于15g,两组均每日1剂,连用8周。于治疗前后分别检测肝肾功能及腓神经传导速度(NCV)变化,并判定临床疗效。结果观察组总有效率为91.2%,对照组总有效率为70.6%,两组比较差异有统计学意义(P<0.01);两组患者治疗后NCV均较治疗前明显提高,差异有统计学意义(P<0.05),治疗后两组间比较差异亦有统计学意义(P<0.05);两组患者治疗前后均无肝、肾功能异常及其他不良反应。结论药物剂量按1两等于15g换算的黄芪桂枝五物汤加减可明显提高DPN的临床疗效,并优于药物剂量按1两视为9g计算,而且未见明显毒副作用。     

老年糖尿病肺部感染患者临床病原学特点及治疗

目的通过对住院老年糖尿病合并肺部感染患者和非糖尿病合并肺部感染患者的观察,探讨老年糖尿病和非糖尿病合并肺部感染的病原菌学分布特点和药物敏感性。方法对2年住院诊断为老年糖尿病合并肺部感染患者54例和非糖尿病合并肺部感染患者46例,采用痰标本进行细菌学培养与鉴定。结果老年糖尿病合并肺部感染的患者病原菌以G-杆菌多见,主要为肺炎克雷伯杆菌、铜绿假单孢杆菌、产气杆菌,其次以金黄色葡萄球菌多见,真菌位于第三位。且老年糖尿病合并肺部感染的患者更易出现抗生素耐药。选择有效、敏感的抗生素是治疗老年糖尿病合并肺部感染患者的关键。     

Critical limb ischaemia in a diabetic population from an Asian Centre: angiographic pattern of disease and 3-year limb salvage rate with percutaneous angioplasty as first line of treatment

Purpose:

Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005.

Methods and Material:

26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme’s amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients).

Results:

Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25).

Conclusion:

Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.     

The effects of soybean isoflavones and 17β-estradiol in uterus and mammary glands of diabetic rat models

The objective of this study was to evaluate the action of soy isoflavones and 17 beta estradiol on the extracellular matrix in the uterus and mammary gland of diabetic rats. Sixty adult female rats underwent ovariectomy, then randomized into seven groups of ten animals each: Non-diabetic: GI Sham control animals ovariectomized; and GII control ovariectomized that received propylene glycol vehicle. Diabetic: GIII Sham control diabetic animals ovariectomized; GIV ovariectomized diabetic animals receiving propylene glycol vehicle; GV diabetic ovariectomized animals treated with soy isoflavones (150?mg/kg by gavage); GVI ovariectomized diabetic rats treated with estrogen (17b-estradiol, 10?mg/kg, subcutaneously); GVII diabetic ovariectomized animals treated with soy isoflavones (150 mg/kg by gavage), and with estrogen (17b-estradiol, 10 mg/kg combination therapy). Treatments occurred during 30 consecutive days. After animals euthanasia, a portion of the uterus was immersed in liquid nitrogen for molecular biology analysis, the other portion of uterus and mammary glands were removed and processed for paraffin embedding. Soy isoflavones (GV) and 17b estradiol improved the production of compounds of extracellular matrix, such as small leucine-rich proteoglycans (SLRPs). The combination of both therapies had an additive effect in SLRPs expression. Soy isoflavones contribute to the uterine integrity of SLRPs of diabetic rats.     

糖尿病胃轻瘫的超声临床研究

目的探讨Ⅱ型糖尿病患者胃液体半排空功能的改变,以利于糖尿病性胃轻瘫的诊断和治疗.方法应用B超检测20例Ⅱ型糖尿病患者及22例健康人的胃半排空时间,对比观察.结果Ⅱ型糖尿病患者组胃液体半排空时间(T/2)为(28±8.94)min,健康对照组胃液体半排空时间为(14.8±4.35)min,二者之间差异非常显著,P＜0.001.结论糖尿病患者有明显胃排空功能障碍,B超可以准确有效地检测糖尿病性胃轻瘫及观察胃肠动力药对胃排空功能障碍的改善.     

Body Mass Index as a Proxy Indicator for Poor Oral Hygiene Habits in Adult Diabetic Patients

AimTo analyse if body mass index (BMI) could be used as a fast proxy indicator of poor oral hygiene habits (POHH) among the adult population with diabetes mellitus.MethodsAdults, aged 25-74, from the Slovenian 2016 nationwide cross-sectional survey based on the Countrywide Integrated Non-Communicable Disease Intervention (CINDI) Health Monitor methodology, who reported being diabetic, were included in the study (n=560). We assessed the relationship between POHH and BMI, adjusted to confounders, using multiple binary logistic regression.ResultsIn the total sample, the POHH prevalence was 50.9%. Taking into account BMI, POHH prevalence in participants with normal BMI values was only 37.8%, in the overweight group it was 1.22-times higher (46.0%), while in the obese group it was 1.63-times higher (61.6%) (p<0.001). Also, the odds for POHH were 2.64-times higher in the obese group in comparison to the normal BMI group (95% CI: 1.55-4.51; p<0.001). After adjustment for confounders, this OR decreased only moderately (OR=2.45; 95% CI: 1.35-4.44; p=0.003).ConclusionsBMI could be used as a readily assessable, fast, simple, and cheap tool indicating higher odds for having POHH among the diabetic population. By defining the high-risk group it could be easier for physicians and dentists to take further referrals and actions for promoting oral health in this group. The suggested tool can save time and could have an important positive impact on the quality of life of diabetics, as well as on health expenditures.