天津地区内分泌科就诊的2型糖尿病患者视网膜病变及黄斑水肿的患病率调查

9 237例住院2型糖尿病患者的分析结果表明,糖尿病视网膜病变(DR)患病率为32.9%,其中轻度、中度、重度非增生性DR的患病率分别为10.1%、18.3%、3.2%,增生性DR患病率为1.3%;糖尿病黄斑水肿(DME)患病率为3.56%,占DR患者的10.8%;糖尿病病程和蛋白尿是DR和DME的共同危险因素.

Abstract：

According to the analysis of 9 237 hospitalized type 2 diabetic patients, the prevalence of diabetic retinopathy ( DR )was 32.9％ , with the prevalence of mild, moderate, and serious non-proliferative DR and proliferative DR being 10. 1％, 18. 3％, 3.2％, and 1.3％ respectively. The prevalence of diabetic macular edema ( DME ) was 3.56％ in type 2 diabetics and i 0. 8％ in patients with DR. Diabetes duration and proteinuria were the common risk factors of DR and DME.     

糖化血红蛋白和血管内皮生长因子与2型糖尿病视网膜病变关系的研究

目的探讨糖化血红蛋白(glycated hemoglobin,HbAlc)及血管内皮生长因子(vascular endothelial growth factor,VEGF)与2型糖尿病性视网膜病变(diabetic retinopathy,DR)的关系。方法选取2010年7月—2012年7月收治的50例2型糖尿病患者,根据其有无糖尿病视网膜病变及病变程度分为3组:正常视网膜组(non-diabetic retinopathy group,NDR)、非增殖型视网膜病变组(nonproliferative diabetic retinopathy group,NPDR)和增殖型视网膜病变组(prolifemtive diabetic retinopathy gmup,PDR),同时测定患者HbAlc及VEGF浓度。结果 PDR和NPDR患者血浆HbAlc及VEGF水平之间的比较差异有统计学意义(P=0.0410.05、P=0.0450.05);NDR和NPDR患者血浆HbAlc及VEGF水平之间的比较差异有统计学意义(P=0.0360.05、P=0.0390.05);PDR和NDR患者血浆HbAlc及VEGF水平间的比较差异有统计学意义(P=0.0070.01、P=0.0230.05)。结论 HbAlc及VEGF可能在DR发生、发展过程中发挥重要作用。     

2型糖尿病并发视网膜病变患者血小板-白细胞聚集体的水平及其与血超敏C反应蛋白的关系

观察2型糖尿病视网膜病变患者血小板-白细胞聚集体( PLA)水平和超敏C反应蛋白水平的变化及关系.采用流式细胞术和酶联免疫吸附测定法检测30例增殖性糖尿病视网膜病变患者( PDR组)和30例非增殖性糖尿病视网膜病变患者(NPDR组)外周血中血小板—中性粒细胞聚集体(PNA)、血小板-单核细胞聚集体(PMA)和超敏C反应蛋白水平,并与25例单纯糖尿病患者(糖尿病组)和30名健康者(对照组)进行比较.结果显示外周血PNA、PMA和血超敏C反应蛋白水平PDR组高于对照组、糖尿病组和NPDR组,NPDR组亦高于对照组和糖尿病组,糖尿病组高于对照组,差异均有统计学意义(P＜0.01或P＜0.05).糖尿病视网膜病变患者PNA、PMA水平与超敏C反应蛋白呈正相关性(r值分别为0.587、0.576,P＜0.05).提示糖尿病视网膜病变患者外周血PLA水平和超敏C反应蛋白浓度增高,PLA水平与糖尿病视网膜病变严重程度及炎性反应正相关,在其发展过程中起着重要作用.     

2型糖尿病患者尿白蛋白排泄量与视网膜病变的相关性研究

目的 探讨2型糖尿病患者尿白蛋白排泄量与糖尿病视网膜病变的相关性及其在视网膜病变不同阶段的应用价值.方法 测定133例住院2型糖尿病患者24小时尿白蛋白排泄量,并进行眼底荧光血管造影检查(FFA),根据尿白蛋白排泄量和视网膜病变程度进行分组,分析尿白蛋白排泄量与视网膜病变的相关性.结果 微量白蛋白尿组和大量白蛋白尿组患者非增殖性视网膜病变和增殖性视网膜病变的患病率均显著高于正常白蛋白尿组(P＜0.01).非增殖性视网膜病变组、增殖性视网膜病变组尿白蛋白排泄量均显著高于无视网膜病变组(P＜0.01),且增殖性视网膜病变组尿白蛋白排泄量高于非增殖性视网膜病变组(P＜0.05).结论 尿白蛋白排泄量与视网膜病变程度密切相关,可以作为视网膜病变的预报和监测指标,糖尿病患者自确诊起即应定期监测尿白蛋白排泄量.     

2型糖尿病患者血清血管生成素2与血管内皮生长因子和颈动脉内膜中层厚度的关系

目的 探讨血清血管生成素2（Ang-2）与血管内皮生长因子（VEGF）与2型糖尿病（T2DM）患者颈动脉内膜中层厚度（IMT）的关系.方法 用ELISA法测定T2DM患者80例（其中IMT增厚组44例、IMT正常者36例）及正常者对照组（36例）的血清Ang-2及其Tie-2受体、VEGF的血清水平.结果 T2DM患者IMT增厚组Ang-2及VEGF血清中位数水平明显高于T2DM患者IMT正常组及正常对照组（Ang-2为4.62ng/ml比2.83ng/ml和1.71ng/ml,P值分别＜0.05,＜0.01）;（VEGF为297.5pg/ml比182.1pg/ml和97.4pg/ml,P值分别＜0.05,＜0.01）;T2DM患者IMT正常组又明显高于正常对照组（P＜0.01）;Tie-2在三组间差异无统计学意义（P＞0.05）.在T2DM组,Spearman相关性分析表明,IMT与VEGF、糖尿病病程、收缩压、Ang-2呈正相关（r值分别为0.32,0.29,0.24,0.22,均P＜0.05）;Ang-2与VEGF及Tie-2强相关（r值分别为0.42,0.41,均P＜0.05）;Logistic回归分析显示,糖尿病病程、VEGF与T2DM患者IMT独立相关.结论 血清Ang-2及VEGF水平与2型糖尿病颈动脉内膜中层厚度密切相关,提示Ang-2和VEGF可能是导致T2DM患者早期动脉粥样硬化的主要危险因素.     

2型糖尿病下肢神经病变心率变异性频域参数的昼夜节律

采用24 h动态心电图检测58例2型糖尿病伴下肢神经病变组、59例2型糖尿病不伴下肢神经病变组(非下肢神经病变组)和50例对照组的心率变异性,比较其频域参数的水平及昼夜间的变化.结果 显示非下肢神经病变组、下肢神经病变组较对照组频域指标减小,平均心率增加;昼夜间比较在对照组差异有统计学意义,在非下肢神经病变组昼夜节律发生改变,在下肢神经病变组昼夜节律消失.提示糖尿病不伴和伴下肢神经病变均存在自主神经功能受损,后者受损更明显.

Abstract：

Heart rate variability(HRV)analysis and its circadian rhythm(CR)were determined in 58patients with type 2 diabetes mellitus with lower extremity neuropathy(diabetic neuropathy group), 59 patients with type 2 diabetes mellitus without lower extremity neuropathy(diabetes group), and 50 healthy controls according to 24-hour Holter recording. Frequency domain parameters of HRV were significantly decreased in both diabetes groups. Frequency domain parameter of HRV in healthy controls,and daytime/nighttime difference were statistically significant. CR of HRV was changed in diabetes group and disappeared in diabetic neuropathy group. Impaired and seriously impaired autonomic nervous function developed in type 2 diabetes mellitus without and with lower extremity neuropathy respectively.     

血浆同型半胱氨酸与2型糖尿病外周神经病变的相关性

目的 探讨血浆总同型半胱氨酸浓度与糖尿病外周神经病变的关系.方法 入选2型糖尿病患者227例,进行横断面研究.用临床表现及肌电图诊断外周糖尿病神经病变,并测定血浆同型半胱氨酸水平及与糖尿病神经病变相关或可能影响血浆同型半胱氨酸水平的指标.结果 糖尿病外周神经病变患者80例,糖尿病无神经病变者147例.糖尿病神经病变组血浆总同型半胱氨酸水平(12.6±3.6)μmol/L,高于糖尿病非神经病变组(8.2±0.9)μmol/L(P＜0.01).在校正外周神经病变传统危险因素(糖尿病病程、糖化血红蛋白)及高同型半胱氨酸浓度的影响因素(年龄、性别、血清叶酸和维生素B12、肾功能状态和双胍类使用)后,同型半胱氨酸与糖尿病神经病变仍相关[OR1.15(1.02～1.28),P＜0.05].在校正每单位上述混杂因素增加后,每增加4.0 μmol/L的血浆同型半胱氨酸也与神经病变发生密切相关[OR 1.17(0.94～1.33),P＜0.05].结论 高血浆总同型半胱氨酸浓度与糖尿病神经病变的发生相关,为糖尿病外周神经病变的独立危险因素.

Abstract：

Objective To explore the relationship between plasma homocysteine levels and diabetic peripheral neuropathy (DPNP). Methods A crossectional analysis was conducted on 227 patients with type 2 diabetes. Peripheral neuropathy was confirmed using electromyography (EMG). The risk factors possibly associated with diabetic neuropathy or plasma homocysteine levels were analyzed in relation to likelihood of occurrence of DPNP. Results Eighty patients with neuropathy and 147 patients without neuropathy were included. Plasma homocysteine levels were significantly higher in patients with diabetic neuropathy [( 12. 6 ± 3.6 ) μmol/ L] than without diabetic neuropathy [( 8. 2 ± 0. 9 ) μmol/L] ( P ＜0. 001 ), and the relationship remained significant after adjusting for duration of diabetes, glycosylated hemoglobin A1c (HbA1c), age, renal status, serum folate acid and vitamin B12, and metformin [OR 1.15( 1.02-1.28 ) ,P ＜ 0. 05]. In addition, per increase of 4. 0 μmol/L plasma homocysteine was closely related to the occurrence of neuropathy after controlling for per unit increase of other confounding factors [OR 1.17(0. 94-1.33), P ＜ 0. 05]. Conclusions Hyperhomocysteinemia was an independent risk factor for the occourence of diabetic peripheral neuropathy.     

老年人血镁水平降低与血糖代谢异常的关系

目的 探讨老年人血镁水平降低与血糖代谢异常的关系.方法 收集我院门诊126例老年人的查体资料,其中2型糖尿病患者50例,糖调节异常者35例,血糖正常者41例,对3组老年人临床资料进行比较分析.结果 (1)3组的年龄、体质指数、血脂水平差异均无统计学意义,糖尿病组和糖调节异常组血清镁明显低于血糖正常组,分别为(0.75±0.11)mmol/L和(0.78±0.12)mmol/L对(0.84±0.1)mmol/L,差异有统计学意义(P＜0.01、＜0.05);(2)低血镁发病率在2型糖尿病和糖调节异常组明显高于血糖正常组,分别为24.0%和28.6%对7.3%(均为P＜0.01);(3)相关分析结果显示,血镁水平与空腹血糖及糖化血红蛋白水平呈明显负相关(r=-0.343、-0.271,均为P＜0.01),与年龄及体质指数无相关.结论 老年人血清镁水平降低与血糖代谢异常有关.

Abstract：

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

脑缺血预处理对脑缺血大鼠血管生成素-1及其受体Tie-2 mRNA表达的影响

目的 探讨脑缺血预处理对脑缺血大鼠血管生成素-1(angiop oietin-1,Ang-1)及其受体Tie-2 mRNA表达的影响.方法 99只Wistar大鼠随机分成假手术组(n=9)、非缺血预处理组(nonischemic preconditioning,NIP)(n=45)和缺血预处理组(ischemic preconditioning,IP)(n=45),后两组再随机分为缺血再灌注1d、3d、7d、14 d和21 d等5个亚组(每组n=9).线栓法建立短暂性大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)模型进行局灶性缺血预处理(缺血10min后恢复灌注).2,3,5-氯化三苯基四氮唑染色法测定脑梗死体积.原位杂交法检测Ang-1/Tie-2 mRNA表达水平.结果 IP组1d、3d和7 d亚组梗死体积显著小于NIP组相应亚组(P均＜0.01),IP组3d和7 d亚组Ang1 mRNA以及1d、3 d和7 d亚组Tie-2 mRNA表达较NIP组显著性上调(P均＜0.05).IP组3 d亚组梗死体移缩小最显著(P＜0.05),7d亚组Ang-1 mRNA表达显著上调,而其受体Tie-2 mRNA表达高峰出现在IP后3d,并持续至7 d.Pearson相关性分析显示,IP组Ang-1/Tie-2 mRNA表达水平与梗死体积呈显著性负相关(P＜0.01).结论 Ang-1和Tie-2 mRNA在缺血预处理后产生脑缺血耐受时间窗内(预处理后1～7 d)表达上调,其中Ang-1可能主要作用于脑缺血耐受的后期阶段.     

血管内皮生长因子基因3'-非翻译区936C/T多态性与2型糖尿病外周神经病变相关

目的 探讨血管内皮生长因子(VEGF)基因3'-非翻译区936C/T多态性与山东地区汉族人2型糖尿病合并周围神经病变(DPN)之间的关系.方法 194例糖尿病患者分为单纯糖尿病组(n=92)和糖尿病神经病变组(n=102),另120名健康个体设为健康对照组.采用PCR-限制性片段长度多态性(RFLP)方法确定全部个体的基因型;对不同基因型间及病例组间的临床与生化参数、血清VEGF浓度以及VEGF基因936C/T多态性进行了统计分析.结果 糖尿病神经病变组C等位基因及CC基因型频率显著高于对照组(x2为9.406和9.677,P＜0.05)和糖尿病组(x2为5.578和5.614,P＜0.05),而携带T等位基因的基因型(CT+TT)频率及T等位基因频率显著低于对照组(x2为9.406和9.677,P＜0.05)和糖尿病组(x2为5.578和5.614,P＜0.05).Logistic多元回归分析显示血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇、HbA1c水平以及VEGF浓度与DPN发生呈正相关,而VEGF基因936C/T多态性与糖尿病周围神经病变发病危险呈负相关(β=-1.046,OR=0.457,P=0.006,95%CI:0.166～0.741).结论 中国山东地区汉族人群中存在VEGF基因936C/T多态性,C等位基因及CC基因型患者可能是糖尿病易于发生神经病变危险性的遗传标志,而T等位基因和携带T等位基因的基因型(936TF基因型和936CT基因型)可能是降低糖尿病发生神经病变风险的遗传标志.

Abstract：

Objective To elucidate the relationship between a 936C/T mutation at 3'-untranslated region of human vascular endothelial growth factor(VEGF) gene and diabetic peripheral neuropathy ( DPN ). Methods All subjects recruited in this study were assigned into DM (n = 92, diabetes without neuropathy, retinopathy or nephropathy), DPN (n = 102, diabetes with peripheral neuropathy only ), and healthy control (n = 120 ) groups,respectively. The gene polymorphism was determined by PCR-RFLP, as well as the other clinical parameters including serum VEGF by ELISA. Results The frequencies of both genotype CC and allele C were significantly higher in DPN group than those in either DM group(x2 = 5.578 and 5.614, P＜0. 05 ) or control group (x2 = 9. 406 and 9. 677, P＜0. 05 ). However, the frequencies of genotype(CT+TT) and allele T were significantly lower in DPN group than that in either DM group(x2 =5.578 and 5.614, P＜0. 05) and control group (x2=9.406 and 9.677, P＜0.05). The multivariate logistic regression analysis showed that the levels of HbA1c, total cholesterol, low-density lipoproteincholesterol( LDL-C ), and serum VEGF positively correlated with DPN, while the 936C/T polymorphism of VEGF gene negatively correlated with DPN(β= -1. 046, OR=0. 457, P=0. 006, 95% CI: 0. 166-0. 741 ). Conclusions Allele 936C of VEGF gene may serve as a genetic marker susceptible to DPN, while allele 936T may be a protective genetic marker of DPN.     

2型糖尿病患者泪液蛋白表达分析

目的 通过蛋白质组学技术分析2型糖尿病患者泪液中蛋白质的表达.方法 选取2007年2月至2008年2月西安交通大学医学院第一附属医院内分泌科住院的2型糖尿病合并视网膜病变患者15例(DR组)、无视网膜病变患者15例(NDR组)、非糖尿病正常对照者15名(CTL组),收集3组研究对象的基础泪液约5～10μl,采用双向凝胶电泳技术和Progenesis Samespots图像分析软件对3组泪液中表达差异的蛋白质进行分析.采用单因素方差分析比较3组间蛋白点表达的差异,对有差异的变量采用Bonferroni检验进行两两比较.各蛋白点表达水平与糖化血红蛋白(HbAlc)、糖尿病病程间的关系采用Pearson相关性分析.结果 与CTL组相比,DR组11种泪液蛋白表达上调(F值分别为3.635、3.479、4.427、5.031、3.508、5.253、3.368、4.186、3.669、3.778和3.856,均P＜0.05),DR组、NDR组患者5种泪液蛋白的表达下调(F值分别为5.149、8.179、6.692、4.733和3.539,均P＜0.05);另外,DR组患者6种泪液蛋白的表达显著高于NDR组患者(F值分别为4.427、5.031、4.186、3.669、3.778和3.856,均P＜0.05).糖尿病患者泪液蛋白Spot200的表达水平与HbAlc水平呈显著正相关(r=0.370,P＜0.05),其他15种泪液蛋白(Spot2、32、251、180、167、 199、231、185、283、80、197、132、137、242、255)的表达水平与HbAlc之间无相关性显示.另外,蛋白点的表达水平与糖尿病病程无显著相关性(均P＞0.05).结论 糖尿病视网膜病变可以导致泪液中蛋白质表达水平变化,这些蛋白表达对理解该病的发病机制、评估治疗具有重要的价值.     

血浆纤维蛋白原在糖尿病视网膜病变患者中的水平及意义

目的 探讨血浆纤维蛋白原在糖尿病视网膜病变(DR)患者中的水平及意义.方法 886例2型糖尿病住院患者根据眼底照相结果,分为无视网膜病变组(NDR组,552例)和视网膜病变组(DR组,334例),比较两组间的一般资料和血浆纤维蛋白原水平的差异,Spearman法分析纤维蛋白原与DR相关性,二元Logistic回归法对其危险因素建立方程.结果 DR组血浆纤维蛋白原水平高于NDR组(t=-5.758,P＜0.001).并且,DR与纤维蛋白原呈正相关(r=0.177,P＜0.001).二元Logistic回归分析显示,糖尿病病程(OR=1.097,95％ CI:1.072～1.123)、血浆纤维蛋白原(OR=1.238,95％ CI:1.036～1.480)和糖尿病肾病(OR=3.534,95％ CI: 2.589～4.822)纳入回归方程(P均＜0.05),是DR的独立危险因素.进一步将DR组分为非增殖期视网膜病变组和增殖期视网膜病变组,结果显示随着DR病变程度的加重,血浆纤维蛋白原水平不断升高(F=19.963,P＜0.001).结论 DR患者体内血浆纤维蛋白原水平随着病变程度不断升高,是DR的独立危险因素.     

Aqueous levels of macrophage migration inhibitory factor and monocyte chemotactic protein-1 in patients with diabetic retinopathy.

AIMS: To investigate the relationship of aqueous macrophage migration inhibitory factor (MIF) and monocyte chemotactic protein-1 (MCP-1) levels with the clinical stage of diabetic retinopathy. METHODS: We assayed MIF and MCP-1 levels in aqueous humour samples obtained from 40 diabetic patients (49 eyes) and 24 non-diabetic patients (31 eyes) using enzyme-linked immunosorbent assay. According to the clinical stage of diabetic retinopathy, the diabetic patients were classified into non-diabetic retinopathy (11 eyes), non-proliferative diabetic retinopathy (14 eyes) and proliferative diabetic retinopathy (24 eyes). RESULTS: The aqueous levels of MIF (mean +/- sd) were 6.34 +/- 4.53 ng/ml in proliferative diabetic retinopathy, 3.22 +/- 1.71 ng/ml in non proliferative diabetic retinopathy, 1.25 +/- 0.96 ng/ml in non-diabetic retinopathy and 1.07 +/- 0.94 ng/ml in non-diabetic patients. Significant differences were found among these four groups (P < 0.0001). Aqueous MCP-1 levels were 1668.6 +/- 1442.3 pg/ml in proliferative diabetic retinopathy, 1528.6 +/- 1994.6 pg/ml in non-proliferative diabetic retinopathy, 690.2 +/- 402.1 pg/ml in non-diabetic retinopathy and 622.7 +/- 245.3 pg/ml in non-diabetic patients. Significant differences were also found among these four groups (P < 0.0001). After correcting for total aqueous protein, the ratios of MIF and MCP-1 to total protein remained significantly correlated with the clinical stage of diabetic retinopathy (P < 0.0001, P = 0.0004, respectively). The ratios of MIF to total protein significantly correlated with the ratios of MCP-1 to total protein in diabetic patients (r = 0.680, P < 0.0001). CONCLUSIONS: Aqueous MIF levels significantly correlated with aqueous MCP-1 levels and the clinical stage of diabetic retinopathy. The results suggest that MIF has a co-operative role with MCP-1 in the progression of diabetic retinopathy.     

Plasma thrombomodulin concentration in diabetes mellitus

Thrombomodulin is an endothelial cell membrane protein acting as a cofactor for the activation of plasma protein C. Recently, it was found that soluble forms of thrombomodulin exist in plasma. Although the physiological significance of circulating thrombomodulin is presently obscure, it may reflect injury of the endothelial cell. In the present study, we examined plasma thrombomodulin concentrations in 106 Type 2 (non-insulin-dependent) diabetic patients. Plasma thrombomodulin was determined by a sandwich ELISA employing monoclonal anti-thrombomodulin antibodies. The patients with proteinuria had higher plasma thrombomodulin concentrations (61.0 +/- 36.0 ng/ml) compared to the patients without proteinuria (33.6 +/- 9.5 ng/ml, P less than 0.001) and control subjects (32.8 +/- 6.5 ng/ml, P less than 0.001). Plasma thrombomodulin concentrations were positively correlated with the level of serum creatine, blood urea nitrogen, urinary albumin and urinary beta 2-microglobulin (P less than 0.001 for each), but not with fasting plasma glucose, hemoglobin A1c or fructosamine. Elevated plasma thrombomodulin was also observed in the patients with pre-proliferative (63.4 +/- 28.9 ng/ml) or proliferative retinopathy (57.4 +/- 34.7 ng/ml), but not in the patients with non-proliferative retinopathy (33.5 +/- 12.9 ng/ml) or those without retinopathy (32.4 +/- 8.9 ng/ml). Even in the 81 diabetic subjects without proteinuria as determined by a dip and read method, and whose serum creatinine was lower than 1.0 mg/dl, the plasma thrombomodulin concentration was significantly higher in the patients with pre-proliferative (41.5 +/- 4.4 ng/ml) and proliferative retinopathy (41.0 +/- 12.8 ng/ml) compared to the patients without retinopathy (32.2 +/- 8.8 ng/ml) and those with non-proliferative retinopathy (31.9 +/- 7.8 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)     

结合珠蛋白基因多态性与糖尿病视网膜病变（二）

目的探讨结合珠蛋白（Hp）多态性与2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）发病的关系。方法418例T2DM患者分为3组：糖尿病无视网膜病变（NDR）组、非增生型糖尿病视网膜病变（NPDR）组、增生型糖尿病视网膜病变（PDR）组,另选取100名性别构成、年龄与之相匹配的健康者作为对照（NC）组。采用PCR技术扩增Hp1和Hp2特异目的片段,利用聚丙烯酰胺凝胶电泳技术对Hp分型,分析Hp多态性及各项临床指标与DR的关系。结果NDR组、NPDR组与PDR组两两组间,T2DM组与NC组间,Hp基因型及等位基因频率均无统计学差异（P〉0．05）。经Logistic回归分析显示：DM病程、SBP、TC、24h尿白蛋白（24h UAlb）是DR的独立危险因素（P〈0．05）,Hp与DR发病无关。结论Hp多态性与天津地区DR发病可能无相关性。     

应用心脏电影磁共振成像评估无明显心血管症状的2型糖尿病患者左心室功能

目的 利用心脏电影磁共振成像(MRI)评估无明显心血管症状的2型糖尿病患者左心室结构及功能变化.方法 入选2005年11月至2006年1月至天津医科大学总医院糖尿病门诊就诊的2型糖尿病患者85例(2型糖尿病组)及同期健康体检者43名(正常对照组),采用单因素两样本组内随机设计方法进行研究.行左心室短轴位电影MRI,计算并比较左心室整体功能指标(包括舒张末期容积指数、收缩末期容积指数、每搏输出量指数、心脏指数、射血分数、舒张末期质量指数和收缩末期质量指数)、局部功能(舒张末期厚度、收缩末期厚度、室壁增厚率和室壁运动)和血液动力学指标(高峰射血率、高峰射血时间、高峰充盈率和高峰充盈时间).计量资料行独立样本成组t检验,性别构成采用x2检验.采用Logistic逐步回归分析评估性别、年龄、身高、体重、体重指数、病程和空腹血糖对左心室功能影响的显著性.结果 2型糖尿病组收缩末期容积指数低于正常对照组[分别为(22±8)、(25±5)ml/m2,t=2.265,P＜0.05],射血分数高于正常对照组(分别为59%±9%、56%±6%,t=-2.457,P＜0.05),室壁增厚,高峰充盈率低于正常对照组[分别为(282±73)、(321±99)ml/s,t=2.508,P＜0.05].Logistic逐步回归分析显示,空腹血糖对左心室功能受损的影响近乎有统计学意义(x2=3.781,P=0.052).结论 心脏电影MRI是左心室功能测量的"金标准",能可靠评价无明显心血管症状的2型糖尿病患者左心室功能改变.无明显心血管症状的2型糖尿病患者舒张功能障碍早于收缩功能障碍,控制空腹血糖水平对避免发生左心室功能受损可能具有意义.     

2型糖尿病非增生型视网膜病变与颈动脉内膜中层厚度的关系

目的探讨2型糖尿病（T2DM）患者非增生型视网膜病变（NPDR）与颈动脉内膜中层厚度（IMT）之间的关系。方法选择NPDR组97例,糖尿病正常眼底（NDR）对组照100例。B超检测IMT。结果（1）NPDR组IMT明显高于NDR组（P〈0．01）。（2）NPDR与年龄、病程、收缩压、舒张压、糖化血红蛋白、IMT、尿白蛋白呈正相关（P〈0.05）,与HDL-C、餐后2hC肽呈负相关（P〈0．05）。Logistic回归显示IMT是NPDR的主要危险因素（P〈0.01）。（3）IMT增厚组（60．7G）NPDR发病率明显高于正常组（44．1％）（P〈0.05）。结论T2DM合并颈动脉IMT增厚者NPDR发病率显著增高,推测动脉粥样硬化可能是NPDR的一个重要的相关因素。     

2型糖尿病肾病亚甲基四氢叶酸还原酶基因多态性研究

目的探讨亚甲基四氢叶酸还原酶(methylenetetrahydrofolate     

2型糖尿病患者外周血细胞增殖／抑制因子失衡与视网膜病变的关系

目的观察胰岛素降糖治疗下,2型糖尿病患者血管内环境中相关细胞增殖和抑制因子失衡状态以及视网膜病变（DR）发生的情况,以期为临床个体化监控提供参考。方法选取2010年9月至2011年3月于上海交通大学附属第-人民医院眼科门诊就诊的90例2型糖尿病患者为研究对象,其中男46例、女44例,以眼底荧光血管造影结果作为眼底判断标准,分为非DR组（30例）和DR组（60例）,其中DR组分为轻度非增殖期DR组（NPDR组,36例）和中重度NPDR组（24例）。检测所有90例2型糖尿病患者外周血管增殖和抑制因子表达情况,包括血管内皮生长因子（VEGF）和CXC趋化因子[外周血基质细胞源因子-1（SDF-1）、白细胞介素-8（IL-8）、生长相关癌基因仅（GRO（x）、干扰素诱导蛋白10（IP-10）、吖干扰素诱生单核因子（MIG）],应用受试者工作特征曲线（ROC曲线）分析筛选并制定3组促／抑血管增殖因子对,依照ROC曲线下面积进行比较。组间比较采用单因素方差分析,两两比较采用t检验。结果非DR组与轻度NPDR组相比外周血中SDF—I的变化有统计学意义[非DR组（0．0104-0．000）,轻度NPDR组（12．920±6．630）,t=-2．977,P：0．005J,ROC曲线下面积（AUC）=0．643。在DR进展期（轻度NPDR组与中重度NPDR组相比）外周血中差异有统计学意义的因子为VEGF[轻度NPDR组（39±14）,中重度NPDR组（120±102）,t=3．333,P〈0．05,AUC=0．952]、IP-10[轻度NPDR组（338±96）,中重度NPDR组（565±236）,t=-3．45,P〈0．05,AUC=0．857]、IL-8[轻度NPDR组（18±5）,中重度NPDR组（24±18）,t=-3．05,P〈0．05,AUC=0．5]。ROC分析比较3组促／抑血管增殖因子比率[SDF-1与IP-10的比率（S／I）,IL-8与IP-10的比率（L／I）,~EGF与IP。10的比率（v／D]发现在初期I／I[AUC：0．561,灵敏度（Sen）=62．5％,特异度（Spe）=51．5％]、S／I（AUC=0．625,Sen=12．5％,Spe=100％）、V／I（AUC=0．655,Sen=87．5％,Spe=57．6％）均有临床诊断参考价值（AUC均〉0．5）,在进展期仅V／I（AUC=0．787,Sen=60．O％,Spe=87．5％）有临床诊断参考价值。结论早期DR患者外周血促／抑血管增殖因子存在失衡现象,其中VEGF与IP-10的比率可能是明确糖尿病患者视网膜病变加速进展的较好指标。     

短期胰岛素泵强化治疗对初发2型糖尿病患者血浆vaspin水平的影响

目的 观察短期胰岛素泵强化治疗对初发2型糖尿病患者血浆内脏脂肪组织来源的丝氨酸蛋白酶抑制物vaspin水平的影响,探讨其与胰岛素敏感性的关系.方法 30例初发2型糖尿病患者使用胰岛素泵强化治疗2周,治疗前后采用高胰岛素-正葡萄糖钳夹术评价其胰岛素敏感性,用酶免法测定血浆vaspin及相关代谢指标.结果 2型糖尿病组空腹血浆vaspin水平高于正常糖耐量(NGT)组和糖调节受损(IGR)组.2型糖尿病组经胰岛素泵强化治疗后葡萄糖代谢率升高[(5.10±0.51对2.99±0.42)mg·kg-1·min-1,P＜0.05],稳态模型评估的胰岛素抵抗指数(HOMA-IR)降低[2.30(1.09～7.20)对4.28(1.70～6.47),P＜0.05],同时血浆vaspin水平也显著降低[(1.19±0.57对1.83±0.55)ng/ml,P＜0.05],且vaspin水平的降低与HOMA-IR的改变呈明显正相关.结论 胰岛素泵强化治疗能有效改善2型糖尿病患者的胰岛素敏感性,降低血浆vaspin水平;且血浆vaspin水平与2型糖尿病患者胰岛索敏感性有关.