老年2型糖尿病病人炎症因子及25羟维生素D水平与骨质疏松症的关系研究

目的观察老年T2DM合并骨质疏松症(OP)病人的炎症因子及25羟维生素D3[25(OH) D3]、促甲状腺素(TSH)、甲状旁腺素(PTH)的水平变化。方法收集老年T2DM合并OP病人40例(T2DM合并OP组),老年单纯T2DM病人43例(T2DM组),同时收集同期体检健康者50例做为对照组。观察并比较3组病人生化指标、25-OH-D3、TSH、PTH、胱抑素C(Cys-c)、炎症因子水平变化。结果 T2DM合并OP组年龄、DM病程和SBP均显著高于T2DM组及对照组,差异有统计学意义(P 0. 05)。T2DM合并OP组和T2DM组血脂、血糖、Hb A1c、PTH、Cys-c、TSH、CRP、TNF-α、IL-6水平均显著高于对照组,HDL-C和25(OH) D3水平均显著低于对照组,且T2DM合并OP组和T2DM组间上述指标比较,差异亦有统计学意义(P0. 05)。结论老年T2DM病人25-OH-D3及TSH、Cys-c、炎症因子等指标可能与OP的发生发展相关。     

阻塞性睡眠呼吸暂停综合征对老年2型糖尿病患者血糖水平的影响

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对老年2型糖尿病(T2DM)患者血糖水平的影响。方法选取2013年1月至2015年1月于该院就诊且确诊为T2DM的老年患者60例,根据呼吸暂停/低通气指数(AHI)分为单纯T2DM组(T2DM组)、T2DM组合并轻度OSAS组(轻缓合并组)、T2DM合并中度OSAS组(中度合并组)、T2DM合并重度OSAS组(重度合并组),分别比较四组患者的空腹血糖、餐后2 h血糖、空腹C肽、糖化血红蛋白水及同型半胱氨酸(HCY),并比较四组患者夜间血糖波动的平均幅度(MAGE)、白天MAGE及24 h MAGE。结果空腹血糖、餐后2 h血糖、空腹C肽、HCY、糖化血红蛋白、肌酐重度合并组中度合并组轻度合并组T2DM组(均P0.05);提示随着合并OSAS的程度加深,腹血糖、餐后2 h血糖、空腹C肽、HCY、糖化血红蛋白、肌酐值均增高。白天、夜间及24 h的血糖波动重度合并组中度合并组轻度合并组T2DM组(均P0.05);说明随着合并OSAS的程度加深,白天、夜间及24 h MAGE越大。结论 OSAS病情与老年T2DM患者的血糖水平呈正相关,控制OSAS的病情进展对控制T2DM患者血糖紊乱有重要意义。     

老年2型糖尿病病人肌少症的发生情况及影响因素研究

目的分析老年2型糖尿病(type 2 diabetes mellitus,T2DM)病人肌少症(sarcopenia)的发生情况及其影响因素。方法选取280例老年T2DM病人(T2DM组)及258例健康老年人(对照组),测定2组血生化指标、糖化血红蛋白(HbA1c)、血清25羟基维生素D[25(OH) D]水平以及步速、握力、身体成分及四肢骨骼肌质量指数(skeletal muscle mass index,ASMI)。将老年T2DM病人分为肌少症组与非肌少症组,比较2组25(OH) D水平;根据25(OH) D水平将老年T2DM病人与对照组分为维生素D充足组、维生素D不足组、维生素D缺乏组、维生素D严重缺乏组,分别比较不同维生素D水平下T2DM组与对照组ASMI水平差异。采用相关分析、回归分析探讨老年T2DM病人ASMI与年龄、病程、HbA1c、血清25(OH) D水平之间的关系。结果 (1)老年T2DM病人肌少症的发生率为30. 4%,明显高于对照组的10. 9%(χ~2=30. 786,P0. 001)。(2)老年T2DM合并肌少症病人血清25(OH) D水平较非肌少症组显著下降(t=-2. 945,P=0. 013)。(3)维生素D充足组中,老年T2DM病人与对照组相比,ASMI差异无统计学意义(P0. 05)。维生素D不足组、缺乏组、严重缺乏组中,老年T2DM病人与对照组相比,ASMI显著下降,差异有统计学意义(P0. 05)。(4)相关分析发现,老年T2DM病人ASMI与年龄(r=-0. 404,P=0. 008)、HbA1c(r=-0. 382,P=0. 013)、病程(r=-0. 418,P=0. 006)呈负相关,与血清25(OH) D水平(r=0. 366,P=0. 017)呈正相关。Logistic回归分析发现,年龄(OR=1. 208,P=0. 006)、HbA1c水平(OR=1. 851,P=0. 015)、病程(OR=1. 482,P0. 001)、血清25(OH)D缺乏(OR=2. 853,P0. 001)是肌少症发生的危险因素。结论老年T2DM病人常合并肌少症,年龄增加、糖尿病病程长、糖尿病控制差、维生素D缺乏是肌少症的危险因素。     

老年2型糖尿病患者维生素D水平的表达及与胰岛β细胞功能的相关性

目的探讨老年2型糖尿病(T2DM)患者维生素D(VD)水平的表达以及与胰岛素β细胞功能的相关性。方法选取2012年9月至2014年5月该院收治的老年T2DM患者600例,采用酶联免疫吸附法测定患者血清中的25-羟维生素D含量,采用稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(IAI)、胰岛β细胞功能指数(HBCI)以及空腹胰岛β细胞功能指数(FBCI),评估胰岛β细胞的功能以及HOMA-IR,并分析研究组25-羟维生素D水平与上述参数的相关性。结果 T2DM患者血清中的25-羟维生素D水平显著低于正常水平(P=0.018);T2DM患者25-羟维生素D与HOMA-IR呈正相关关系(r=0.438,P=0.019),与IAI呈负相关关系(r=-0.392,P=0.023),与HBCI、FBCI无相关关系。线性回顾分析显示25-羟维生素D是IAI和HOMA-IR的影响因素。结论老年T2DM患者血清中的25-羟维生素D水平较低,补充25-羟维生素D对T2DM的治疗和预防均有帮助。     

老年2型糖尿病合并肌少症患者血清25羟维生素D与外周血单个核细胞血红素加氧酶1 mRNA的表达水平及意义

目的探讨老年T2DM合并肌少症(SP)患者血清25羟维生素D[25(OH)D]与外周血单个核细胞(PBMC)血红素加氧酶1(HO-1)mRNA的表达水平及意义。方法选取2018年11月至2019年4月于我院内分泌科收治的120例门诊及住院老年患者,分为单纯SP组(SP组)、单纯T2DM组(T2DM组)、T2DM合并SP组(T2DM+SP组),每组各40例。另选取40名同期我院老年健康体检者为正常对照组(NC组)。采用双能X线吸收测量法测定四肢骨骼肌质量指数(SMI),RT-PCR测定各组PBMC中HO-1 mRNA的表达水平。Pearson相关分析SMI与其他指标的相关性;Logistic回归分析老年T2DM患者合并SP的影响因素。结果与NC组比较,SP、T2DM组HO-1mRNA表达升高[(24.28±11.9)vs(49.53±12.3)vs(51.45±12.1),P0.05],25(OH)D降低[(26.27±5.45)vs(16.27±3.53)vs(15.17±2.48),P0.05];T2DM+SP组HO-1 mRNA较NC组升高[(24.28±11.9)vs(63.59±12.5),P0.05],25(OH)D降低[(26.27±5.45)vs(8.23±1.57),P0.05];与T2DM+SP组比较,SP、T2DM组HO-1 mRNA表达降低[(63.59±12.5)vs(49.53±12.3)vs(51.45±12.1),P0.05],25(OH)D升高[(8.23±1.57)vs(16.27±3.53)vs(15.17±2.48),P0.05]。Pearson相关分析显示,SMI与HO-1 mRNA表达呈正相关(r=0.546,P=0.012),与25(OH)D呈负相关(r=―0.554,P=0.024)。Logistic回归分析结果显示,HbA_1c、TG、HO-1 mRNA及25(OH)D均为老年T2DM患者合并SP的影响因素。结论 25(OH)D水平降低及HO-1 mRNA表达升高可能通过氧化应激反应共同参与老年人群糖脂代谢紊乱和肌量流失。     

老年2型糖尿病患者血清维生素D水平与同型半胱氨酸及胰岛素敏感性的相关性研究

正该文探讨老年2型糖尿病(type 2diabetes mellitus,T2DM)患者血清维生素D[25(OH)D_3]水平与同型半胱氨酸(homocysteine,Hcy)及胰岛素敏感的相关性。方法:选取T2DM患者122例,按25(OH)D_3值分为正常组[25(OH)D_3≥30μg/L]、不足组     

不同骨量水平的老年2型糖尿病合并肌少症患者血清骨形态发生蛋白2、25羟维生素D水平差异的研究

目的比较不同骨量水平的老年T2DM合并肌少症(SP)患者血清骨形态发生蛋白2(BMP-2)、25羟维生素D[25(OH)D]水平及作用机制。方法选取2019年5月至2020年3月于遵义医科大学附属医院内分泌科门诊及住院新诊断老年T2DM患者90例,按照骨量分为正常组、减少组、骨质疏松(OP)组,另选取同期于本院体检者,根据有无DM分为单纯DM组,每组各30例,以及健康人群的正常对照(NC)组30名。采用电化学发光法检测各组血清25(OH)D,ELISA法检测各组血清BMP-2含量。结果与NC、DM、正常骨量组比较,OP组25(OH)D、BMP-2、骨骼肌指数(SMI)水平降低(P0.05)。与骨量减少组比较,OP组BMP-2水平降低(P0.05)。偏相关分析显示,血清BMP-2水平与HDL-C、25(OH)D呈正相关(r=0.414、0.511,P0.05),与FPG、HbA_1c、HOMA-IR、TG呈负相关(r=-0.311、-0.351、-0.310、-0.269,P0.05)。Logistic回归分析显示,TG、FPG、HbAlc、HOMA-IR、25(OH)D、BMP-2是不同骨量水平老年T2DM合并SP患者的影响因素。结论血清BMP-2、25(OH)D水平降低可能是老年T2DM患者骨量流失及SP的危险因素。     

老年2型糖尿病患者血清Omentin-1、ANGPTL4、25(OH)D水平及其与下肢血管病变的相关性

目的分析老年2型糖尿病(T2DM)患者血清网膜素(Omentin)-1、血管生成素样蛋白(ANGPTL)4、25-羟维生素D[25(OH)D]水平及其与下肢血管病变(LEAD)的相关性。方法T2DM老年患者132例根据是否合并LEAD分为病变组和无病变组,同期体检健康者55例为对照组;其中合并LEAD患者根据病变程度分为A级、B级和C级,比较各组血清Omentin-1、ANGPTL4、25(OH)D水平,分析上述指标与老年T2DM患者LEAD的相关性。结果与对照组比较,病变组、无病变组体重指数、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α及C反应蛋白(CRP)水平显著升高,白蛋白(ALB)、Omentin-1、ANGPTL4及25(OH)D水平显著降低(P<0.05),且病变组上述指标及肌酐(Cr)水平显著高于无病变组(P<0.05)。HbA1c、ANGPTL4及25(OH)D是老年T2DM患者发生LEAD的影响因素(P<0.05)。Omentin-1、ANGPTL4、25(OH)D联合检测对于病变组有一定的筛查能力;B级和C级患者血清Omentin-1、ANGPTL4、25(OH)D水平显著低于A级,且C级Omentin-1、ANGPTL4、25(OH)D水平显著低于B级(P<0.05)。结论老年T2DM患者合并LEAD的发生发展与血清Omentin-1、ANGPTL4、25(OH)D水平降低密切相关,可作为老年T2DM合并LEAD的潜在筛查指标。     

绝经期2型糖尿病患者合并微量白蛋白尿对骨密度及25羟维生素D影响的观察

目的探讨绝经期T2DM患者合并微量白蛋白尿影响骨密度(BMD)及血25羟维生素D[25(OH)D]水平的相关性。方法选取2016年3月至2017年10月于本院内分泌科住院的绝经期T2DM患者89例,根据UACR分为单纯T2DM组(T2DM,n=56),合并微量白蛋白尿组(UAlb,n=33),比较两组生化指标、BMD及25(OH)D。结果两间25(OH)D、BMD比较,差异无统计学意义(P>0.05),UAlb组血钙低于T2DM组[(2.23±0.21)vs(2.29±0.13)mmol/L,P<0.05]。Pearson相关分析显示,BMD与BMI呈正相关(r=0.363,P<0.01),与年龄呈负相关(r=-0.380,P<0.01)。25(OH)D与FPG、HbA1c呈负相关(r=-0.228、-0.360,P<0.05或P<0.01)。多元线性回归分析结果显示,BMI、HbA1c是BMD的影响因素,HbA1c是25(OH)D的影响因素。结论绝经期T2DM患者合并微量白蛋白尿BMD、25(OH)D无明显降低。HbA1c水平升高可能引起BMD、25(OH)D降低。     

宜兴地区50岁以上2型糖尿病患者血清25羟维生素D与糖脂代谢关系的研究

目的检测25羟维生素D[25(OH)D]在≥50岁2型糖尿病(T2DM)患者中的水平,分析其与糖脂代谢的关系。方法收集非糖尿病(NDM)患者200例,≥50岁T2DM患者178例。对2组人群进行形体测量,同时检测25(OH)D及生化指标。结果 T2DM组与NDM组间25(OH)D、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、C反应蛋白(CRP)水平差异有统计学意义(P0.05)。T2DM患者25(OH)D水平与FPG、Hb A1c、CRP呈负相关(r=-0.52、-0.57、-0.32,P0.05),与高密度脂蛋白胆固醇(HDL-C)呈正相关(r=0.30,P0.05)。25(OH)D缺乏相关的独立危险因素分别是FPG、Hb A1c、CRP(P0.05)。结论在宜兴地区≥50岁T2DM患者中,25(OH)D明显缺乏,其水平下降与糖脂代谢关系密切,因此对老年T2DM患者应行常规25(OH)D检测。     

阻塞性睡眠呼吸暂停综合征患者鼻阻力变化

目的探讨阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）患者鼻阻力的变化在睡眠呼吸暂停发病机制中的作用。方法对３０名正常人、３０例鼾症、６０例ＯＳＡＳ患者在进行多导睡眠监测的基础上,行鼻阻力检测。结果轻、中度ＯＳＡＳ组鼻阻力为（１．０６±４．２５）Ｐａｓ／ｍｌ,重度ＯＳＡＳ组鼻阻力为（２．２９±９．７４）Ｐａ·ｓ／ｍｌ,鼾症组鼻阻力为（０．７１±０．３１）Ｐａ·ｓ／ｍｌ,均明显高于正常对照组（０．４０± ０．１３）Ｐａ· ｓ／ｍｌ（Ｐ＜０．０１）,鼻阻力与鼾声指数呈正相关（ｒ＝０．２５８,Ｐ＜０．０１）,但鼻阻力与睡眠呼吸紊乱指数（ＡＨＩ）、醒觉次数、最低血氧均无相关关系。结论鼾症、ＯＳＡＳ患者鼻阻力增加,可能与ＯＳＡＳ的发病有关。     

Studies of platelet volume, chemistry and function in patients with essential thrombocythaemia treated with Anagrelide

Anagrelide (imidazoquinazolin derivative) is a new compound proposed for the treatment of myeloproliferative disorders. In this study, Anagrelide was given to patients with essential thrombocythaemia (ET) in a compassionate-use protocol. The aim of this study was to test the effect of this drug not only on the platelet count but also on platelet volume, chemistry and function, which has not previously been reported. Thus, in ET, different functional or structural platelet abnormalities were reported: a shortening of the bleeding time, hypoaggregation to several agonists, and in particular a lack of response to adrenalin, an increase in the amount of total platelet glycoprotein IV (or CD36), and an abnormal migration of thrombospondin on electrophoresis. These different parameters were studied before and during therapy with Anagrelide. Although the platelet count was corrected, no functional or chemical abnormality was improved. Furthermore, platelet volume was shown to be constantly increased under Anagrelide. Thus, Anagrelide, in reducing the platelet count, may possibly decrease the risk of thrombosis and haemorrhage. Nevertheless, if the risk of thromboses and/or myelofibrosis is related not only to the platelet count but also to the platelet abnormalities, the persistence of a thrombocytopathy in patients treated with Anagrelide must be taken in consideration. Our data suggest that thromboses and myelofibrosis are clinical end-points which should be included in future large-scale use of Anagrelide.     

The association of OSAS and uvula: the role of MRI in this egg-chicken problem in OSAS

Sleep and Breathing - Obstructive sleep apnea syndrome (OSAS) is a condition resulting from repetitive partial or complete upper airway obstruction, and its etiology remains uncertain....     

Platelet calmodulin correlates with platelet turnover

We measured the calmodulin content in platelets in 13 normal persons and in 62 patients with hematological diseases. The level of platelet calmodulin was higher in patients with idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus, myeloproliferative disorders, acute leukemia in a recovery phase, aplastic anemia, thrombosis and hypersplenism as compared to the controls. Among the patients with ITP, calmodulin was lower in responders than in nonresponders and those at the initial diagnosis. We also measured the volume, life-span and aggregation of the platelets and demonstrated a significant relationship between the calmodulin level and the platelet volume, and a negative relationship between the calmodulin level and platelet life-span, there was no correlation between the calmodulin level and platelet aggregation. We thus conclude that platelet calmodulin is inversely correlated with platelet turnover.     

CPAP对高血压伴代谢综合征的OSAS患者的影响

目的探讨持续气道正压通气（Continuous positive airway pressure,CPAP）干预对有阻塞性睡眠呼吸暂停综合征（Obstructive sleep apnea syndrome,OSAS）的高血压伴代谢综合征患者的血压及异常代谢组分的影响。方法采用双盲、安慰剂对照设计,将患者随机分配接受5个月CPAP治疗或者5个月假性CPAP。在每种干预之前和之后,检测受试者的血压、空腹血糖、胰岛素抵抗指数、空腹血脂谱、糖化血红蛋白及人体测量学参数等指标。结果共128例完成研究。CPAP治疗与下列指标平均值的显著降低相关：收缩压（6.1mmHg;95%可信区间[CI]：1.3～6.2,P=0.001）,舒张压（4.5mmHg;95%CI：0.8～4.2,P〈0.001）,血清总胆固醇（16.5mg/dl;95%CI：5.2～21.4,P=0.005）,非高密度脂蛋白胆固醇（16.1mg/dl;95%CI：4.7～21.9,P=0.008）,低密度脂蛋白胆固醇（12.8mg/dl;95%CI：2.4～16.9,P=0.007）,甘油三酯（21.9mg/dl;95%CI：4.2～42.1,P=0.03）和糖化血红蛋白（0.4%;95%CI：0.1～0.5,P=0.004）。CPAP治疗后代谢综合征显著好转（128例患者中23例逆转[18%]vs.假性CPAP治疗后仅3例逆转[2%]）。结论在有中重度OSAS的高血压伴代谢综合征患者中,CPAP治疗5个月可降低血压并改善伴随的代谢异常。     

OSAS合并高血压患者IL-6及IL-8水平的研究

目的 探讨阻塞性睡眠呼吸暂停(Obstructive Sleep Apnea Syndrome,OSAS)患者及OSAS合并高血压患者体内炎性水平.方法 根据多导睡眠监测、血压和病史将受试者分正常、轻度、中度、重度和重度合并高血压五组;采集静脉血,以ELISA法分别测定血清中IL-6及IL-8浓度.结果 与正常组比较,各实验组的IL-6、IL-8水平均增高(P＜0.05);IL-6及IL-8水平随OSAS程度加重而增加(P＜0.05);IL-6及IL-8在重度组与重度合并高血压组间水平不同(P＜0.05),均具统计学意义.结论 OSAS可对机体造成炎性损伤,炎性反应水平具程度依赖性.重度合并高血压患者炎性反应水平高于重度OSAS患者.     

Survival and recovery of apheresis platelets stored in a polyolefin container with high oxygen permeability

Background and Objectives Oxygen permeability is important in platelet storage media. We compared a new polyolefin container with enhanced oxygen permeability (PO‐80; Kawasumi, Tokyo, Japan) to a widely used alternative (PL2410; Baxter Healthcare, Deerfield, IL, USA). Materials and Methods In vitro characteristics of paired platelet concentrates (PCs; mean 4·2 × 10¹¹/250 ml plasma/bag) stored in PO‐80 or PL2410 were assessed through 9 days of storage. In vivo recovery and survival of 7‐day‐old autologous PCs were assessed according to the Murphy method. Results Laboratory assessment of platelet quality favoured PO‐80 during 9 days of storage with statistically significant differences in glucose consumption (2·75 vs. 4·93 mmol/10¹²/24 h in the interval 120–168 h), lactate generation (4·37 vs. 8·11 mmol/10¹²/24 h in the interval 120–168 h), pressure of oxygen (pO₂) (59·3 vs. 38·1 mmHg at day 1), and (14·7 vs. 13·4 mmol/l at day 1). Statistically significant differences were not seen in aggregation, hypotonic shock response or pH. In vivo assessment of autologous platelets stored 7 days in the PO‐80 container revealed that recovery was 82·1% and survival was 81·0% of fresh control. Seven‐day stored PCs in PO‐80 were shown in vivo to be non‐inferior to fresh platelets, with upper confidence limits (UCL₉₅) in recovery and survival of stored PCs below the maximum acceptable difference (MAD); 15·3% UCL₉₅ < 20·4% MAD and 2·1 days UCL₉₅ < 2·1 days MAD. Conclusions The in vitro characteristics of PCs stored in a highly oxygen‐permeable container were stable at least 7 days. The in vivo study supports the suitability of PO‐80 for 7‐day platelet storage.     

In vitro quality of platelets during prolonged storage after washing with three platelet additive solutions

Background and Objectives Patients with anaphylactic transfusion reactions require washed platelet concentrates (PCs) for subsequent platelet (PLT) transfusions. New PLT additive solutions (PASs) contain substances that might be beneficial for the preservation of PLT function during storage. This study compares the quality of PLTs washed and stored with T‐Sol, Composol or SSP+. Study Design and Methods Fifteen buffy coats were pooled and divided into three parts. PCs with 30% plasma and 70% PAS (T‐Sol, Composol or SSP+) were prepared. Washing was performed on day 5 of storage. Ten PCs were prepared and washed with each PAS. In vitro variables including haemostatic function (clotting time and clot retraction) were analysed on day 5 before, directly after and up to 2 days after washing. Results Swirling was well preserved, and pH was within acceptable limits (6·4–7·4) during storage for all PASs. The PLT number was reduced by washing for all PASs, and T‐Sol PCs had a further decrease during storage. PLTs in T‐Sol were spontaneously more activated and had lower capacity to respond to an agonist than Composol or SSP+ PLTs. The haemostatic function was only slightly changed by washing and during postwashing storage. Conclusion PLTs washed with T‐Sol, Composol or SSP+ had good in vitro quality for two days after washing despite absence of glucose. PLTs in T‐Sol were more affected by the washing procedure and subsequent storage than Composol or SSP+ PLTs as judged by higher spontaneous activation.