Use of fluorquinolones is associated with a reduced risk of coronary heart disease in diabetes mellitus type 2 patients.

AIMS: The aim of the present study was to investigate whether use of specific antibiotic drugs decreases the risk of coronary heart disease in diabetes mellitus type 2 patients. METHODS AND RESULTS: Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and hospitalizations for all 450,000 residents of eight Dutch cities. In a nested case-control study among diabetes mellitus type 2 patients, 244 cases with a first hospitalization for coronary heart disease and 686 controls without coronary heart disease matched on age, sex, calendar time, and registration date in PHARMO RLS were selected. Use of antibiotic drugs among cases and controls was determined over 3 years prior to the event. Use of fluorquinolones for more than 14 days compared to no use of fluorquinolones was associated with a lower risk of coronary heart diseases (OR(adj)=0.30 (95%CI: 0.12-0.75)). No association between tetracycline, macrolide and lincosamide treatment, or other antibiotic drugs (penicillins, cephalosporines, sulphonamides and trimethoprim), and the risk of coronary heart disease was found. CONCLUSION: Our results suggest that treatment with fluorquinolones in doses commonly prescribed in routine clinical practice is associated with a reduction in the risk of coronary heart diseases among diabetes mellitus type 2 patients.     

2型糖尿病患者心律失常的临床特点分析

目的研究2型糖尿病患者合并心律失常情况及其临床特点。方法回顾性分析375例住院的2型糖尿病患者资料,根据心电图检查结果分为合并心律失常组（94例）和不合并心律失常组（28例）。对比分析两组患者的临床资料和心电图特点。结果心律失常总发病率为25％（94／375）,以房性期前收缩发病率最高。2型糖尿病合并心律失常组原发性高血压（高血压）,冠状动脉粥样硬化性心脏病（冠心病）发病率高于不合并心律失常组,差异有统计学意义[37．2％（35／94）US．32．7％（92／281）,P〈O．05;7．4％（7／94）帆5．7％（16／281）,P〈0．05]。Logistic回归分析显示,2型糖尿病患者的体质量,性别,年龄,血脂浓度,收缩压,糖尿病病程,疾病种类。劳动方式是发生心律失常的相关危险因素。结论2型糖尿病患者合并其他心血管疾病更容易发生心律失常．这可能与糖尿病病程、高血压、冠心病造成的心肌细胞,血管,自主神经系统受损有关。     

2型糖尿病伴冠心病患者血清胱抑素C水平及其意义

目的:探讨血清胱抑素C(Cys C)水平与2型糖尿病伴冠心病的关系。方法:收集40例单纯2型糖尿病患者(DM组)、120例2型糖尿病伴冠心病(CHD)患者(DM+CHD组)及40例健康者(对照组)的血清。分别测定基础代谢率、血压、血脂、血清糖化血红蛋白及Cys C水平。结果:血清Cys C水平在DM组[(1.58±0.78)mg/L]、DM+CHD组[(2.12±0.94)mg/L]较对照组[(0.82±0.23)mg/L]明显升高,差异有统计学意义(P<0.01),DM+CHD组明显高于DM组(P<0.05)。冠状动脉狭窄支数越多,血清Cys C水平越高。结论:2型糖尿病伴CHD患者的血清Cys C水平增高,且随冠状动脉狭窄病变支数的相应增加呈增高趋势,提示Cys C在2型糖尿病伴CHD的发生发展中起一定作用。     

ApoE基因多态性与中国人2型糖尿病及其心血管并发症的关系

目的为研究载脂蛋白Ｅ（ＡｐｏＥ）基因多态性与２型糖尿病及其心血管并发症的关系。方法以载脂蛋白Ｅ（ＡｐｏＥ）基因为候选基因，运用聚合酶链反应限制性片段长度多态性（ＰＣＲＲＦＬＰ）方法检测了１１２例２型糖尿病患者及６０例正常对照者的ＡｐｏＥ基因型。结果两组研究对象其ε３、ε２和ε４等位基因的分布频率分别为０．８４４，０．０９３，０．０６３和０．８６７，０．０８３，０．０５０（Ｐ＞０．０５），说明ＡｐｏＥ基因多态性与中国人２型糖尿病发病无相关性，通过比较２型糖尿病患者不同ＡｐｏＥ基因型与其血脂指标的关系发现：ＡｐｏＥ基因多态性与血总胆固醇水平（Ｐ＝０．００２９）及血低密度脂蛋白（ＬＤＬ）Ｃ水平（Ｐ＝０．００２１）相关，携带ε４等位基因的个体具有较高的ＴＣ及ＬＤＬＣ水平，而携带ε２等位基因的个体具有较低的ＴＣ及ＬＤＬＣ水平。ＡｐｏＥ基因多态性与２型糖尿病伴高血压无相关（Ｐ＝０．１１１）。携带ε４等位基因的患者冠心病发病率明显较携带其他等位基因患者为高（Ｐ＝０．００８）。结论ε４等位基因可能是２型糖尿病合并冠心病的一个危险因子     

胰岛素在2型糖尿病合并冠心病中作用的研究进展

与2型糖尿病相关的冠心病的发病率及死亡率呈上升趋势,相关研究表明胰岛素自身可能存在双向性作用,而在2型糖尿病患者中胰岛素对冠状动脉粥样硬化病变的作用仍然存在很大的争议。近年来,多项大型的观察性研究以及少量的随机对照性研究结果也不尽一致。目前,胰岛素在2型糖尿病合并冠心病中的作用机制较为流行“双信号通路”假说。进一步研究和阐明胰岛素在2型糖尿病合并冠心病中的作用显得尤为重要。     

新双源flash-CT评价老年冠心病合并2型糖尿病患者血管成像特点

目的探讨老年冠心病（CAD）合并2型糖尿病（T2DM）患者冠状动脉CT血管成像（CTA）的成像特点。方法入选2012年10月至2013年10月冠状动脉造影检查确诊为CAD的老年患者640例,其中合并T2DM者350例,无合并T2DM者290例,冠状动脉造影后2周内行新双源flash-CT冠脉成像,分析老年CAD合并T2DM患者冠状动脉CTA的诊断特点。结果新双源flash-CT冠状动脉CTA对T2DM合并CAD患者冠状动脉病变的诊断特异性为89.6%。CAD合并T2DM患者冠状动脉钙化较严重,病变支数多,随着钙化积分的增高,特异性有所下降,但CTA对于介入治疗仍有指导作用。结论新双源flash-CT冠状动脉CTA是诊断老年CAD合并T2DM患者冠状动脉病变可靠、无创的检查方法,但严重钙化者要结合冠脉造影结果进行综合判断。     

老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点分析

目的探讨老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点。方法471例经冠状动脉造影确诊的老年冠心病（年龄≥60岁）患者,将其分为冠心病伴2型糖尿病组（179例）,单纯冠心病组（292例）。对比分析两组患者临床相关危险因素及冠状动脉造影资料。结果多因素非条件的logistic回归分析显示,低密度脂蛋白胆固醇（LDL—C）、空腹血糖（FBG）、餐后2h血糖（2hPBG）是2型糖尿病并发冠心病的独立危险因素（P≤0．001）。与单纯冠心病组相比较,冠心病伴2型糖尿病组发生3支病变较多（P〈0．01）、冠状动脉重度狭窄、完全闭塞及弥漫病变比例更高（P〈0．01）,其Gensini积分亦显著高于单纯冠心病组（P=0．009）。结论LDL-C、FBG及2hPBG是老年2型糖尿病并发冠心病的独立危险因素,老年冠心病伴2型糖尿病患者冠状动脉累及范围广且程度重。     

Ischemic heart disease is associated with vertebral fractures in patients with type 2 diabetes mellitus

Aims/Introduction

Discordant results about the relationship between diabetes complications and the risk of fragility fractures have been reported. Our aims were to analyze the factors related to morphometric vertebral fractures (VFs) in patients with type 2 diabetes mellitus, and to explore the association between the presence of VFs and the main cardiovascular risk factors.

Materials and Methods

We carried out a cross‐sectional study including 123 patients with type 2 diabetes mellitus, and in 72 of these patients we recorded data about the risk factors for VFs and comorbidities of diabetes including diabetes‐related microvascular disease and cardiovascular disease.

Results

In the crude analysis, diabetic retinopathy (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.01–12.5), ischemic heart disease (OR 5.02, 95% CI 1.1–9.7) and waist circumference (OR 1.06, 95% CI 1.006–1.114) were related to VFs. In the full model (adjusted for age, sex, body mass index), ischemic heart disease was the only determinant of VF (OR 3.33, CI 1.02–10.91, P = 0.047); whereas diabetic retinopathy did not reached significance (OR 2.27, CI 0.71–7.27, P = 0.16).

Conclusions

In summary, ischemic heart disease is associated with an increased risk of VFs in type 2 diabetes mellitus.     

The adiponectin gene SNP+45 is associated with coronary artery disease in Type 2 (non-insulin-dependent) diabetes mellitus.

BACKGROUND: The ACRP30/adiponectin gene on chromosome 3q27, a region linked to the metabolic syndrome, encodes for the abundant adipocyte-specific secreted protein. Consistent rodent and human studies suggested that this adipokine may be a molecular link between metabolic and cardiovascular diseases. AIMS: In order to investigate the role of single nucleotide polymorphisms (SNPs) within the APM1 gene in the susceptibility to coronary artery disease (CAD), we performed a case-control study on Caucasian Type 2 (non-insulin-dependent) diabetic patients, a population at high-risk for CAD. METHODS: Five APM1 SNPs were genotyped in 162 Type 2 diabetic French and Swiss subjects with CAD and in 315 Type 2 diabetic French and Swiss subjects without CAD. RESULTS: In univariate analysis, SNP+45 T>G was associated with CAD (OR 1.9 95% CI 1.2-2.9 P = 0.0036). In multivariate analysis, SNP+45 T>G remained associated with CAD (OR 1.2 95% CI 0.8-1.9 P = 0.017), independently of classical cardiovascular risk factors including components of the metabolic syndrome. SNP haplotype analyses revealed a CAD protective combination of all SNP wild-type alleles (OR 0.5 95% CI 0.3-0.7 P = 0.0006). CONCLUSIONS: Our study, performed in diabetic subjects, revealed an association between individual SNP+45 in the APM1 gene and CAD. Furthermore, the susceptibility for CAD due to SNP+45 was independent of classic cardiovascular risk factors. Further studies will be necessary to confirm the role of SNP+45 in the development of CAD. However, ACRP30/adiponectin may contribute to atherosclerosis susceptibility in high-risk populations such as Type 2 diabetic subjects.     

Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients

Background: Mean platelet volume (MPV) is an indicator of platelet activation which is a central process in the pathophysiology of coronary heart disease (CHD). The aim of the study was twofold; first to determine whether MPV values is increased in patients with DM, and secondly to evaluate the relation between diabetic complications and MPV. Methods: The study population included 258 patients divided into two groups. Group A composed of 158 type 2 diabetic patients with coexistent coronary artery disease (stenotic lesions of 50%) (78 women, 80 men; mean age 53.9_10.8; mean diabetes duration 13.1_6.0). One hundred subjects (48 women, 52 men; mean age 53.9_11) without type 2 diabetes with normal coronary angiographies were taken as the control group (group B). To evaluate the extension of CHD, Gensini scoring system was used. Results: The MPV was significantly different in the patient group compared to the controls (9.79 ± 1.5 fl vs 8.3 ± 0.9 fl, P<0.001). The existence of CHD was associated with MPV with odds ratio (95% CI) of 2.31 (1.55–4.42, p50.001). Conclusion: We have found that diabetic patients with coronary heart disease have significantly higher MPV values compared to control subjects without diabetes and with angiographically normal coronary arteries.     

2型糖尿病合并冠心病患者微量蛋白尿检测的临床意义

目的探讨2型糖尿病合并冠心病患者微量蛋白尿检测的临床意义。方法按照微量蛋白尿分组,对184例2型糖尿病合并冠心病患者的临床资料及冠状动脉造影（CAG）结果进行对照分析。结果与微量蛋白尿阴性组相比,微量蛋白尿阳性组患者具有高龄、高血压、高体重指数、高血糖、高甘油三酯、高低密度脂蛋白胆固醇等心血管危险因素,且CAG单支血管病变少,多支血管及弥漫性病变多,血管狭窄程度重,左室射血分数低,心肌梗死和心力衰竭的发生率高。结论微量蛋白尿检测可作为早期预测2型糖尿病合并冠心病患者冠状动脉病变的指标之一。微量蛋白尿阳性的2型糖尿病合并冠心病患者冠状动脉广泛、弥漫且严重。     

老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析

【摘要】 目的 探讨老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析。方法 选取我院2012年3月至2015年2月经冠状动脉造影诊断为冠心病,且年龄>60岁的患者248例,根据是否合并糖尿病分为糖尿病组124例和非糖尿病组124例。统计患者基本临床资料及入院24h内实验室检查结果、超声心动图及心电图检查。根据冠状动脉狭窄直径≥50%累及左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）或左主干（LM）分为单支、双支（累及左主干为双支病变）及三支病变组。根据Gensini积分标准对每位患者冠状动脉病变进行评分。结果 冠心病合并糖尿病组空腹血糖（FPG）比非糖尿病组明显升高（P<0.001）。糖尿病组冠状动脉三支病变发生率高于非糖尿病组（P<0.001）,单支病变、两支/左主干病变发生率低于非糖尿病组（P<0.001）。与非糖尿病组相比,糖尿病组冠状动脉病变部位更多累及前降支、左回旋支和右冠状动脉,两组比较差异有统计学意义（P<0.05）。两组患者冠状动脉左主干病变并比较差异无统计学意义（P >0.05）。与非糖尿病组相比较,糖尿病组冠状动脉病变支数更多、Gensini积分更高（P<0.001）。结论 冠心病合并糖尿病患者冠状动脉病变更为广泛、严重,具有更高的致死风险。     

Association of non-alcoholic fatty liver disease with microvascular complications of type 2 diabetes

IntroductionNon-alcoholic fatty liver disease (NAFLD) affects risks of type 2 diabetes (T2D), diabetes-related complications, and cardiovascular disease in a complex manner. This study is designed to clarify associations of sonographically-detected NAFLD and serum liver enzymes with diabetes-related microvascular complications.MethodsA matched case-contorl study was designed for 440 patients with T2D and at least one of the chronic diabetes-related microvascular complications and 495 age- and gender-matched control patients with T2D.ResultsConsidering pre-existing and newly developed chronic microvascular complications, diabetic peripheral neuropathy was found in 347 out of 935 (37.1%) study patients, diabetic retinopathy in 141/935 (15.1%), and diabetic nephropathy in 103/935 (11.0%). Diagnosis of diabetic retinopathy and diabetic nephropathy were inversely associated with the presence of NAFLD in the crude logistic regressions (OR [95% CI] = 0.18 [0.05–0.63], p value = 0.007; OR [95% CI] = 0.17 [0.04–0.59], p value = 0.011, respectively). The subgroup of NAFLD with elevated liver enzymes had lower odds of having diabetic peripheral neuropathy in the fully adjusted model (OR [95% CI] = 0.34 [0.12–0.98], p value = 0.048).ConclusionDiagnosis of NAFLD with or without elevated serum liver enzymes was inversely correlated with certain chronic diabetes microvascular complications. Possible explanations for this counter-intuitive and unexpected finding are discussed and center on reverse-causality, wherein sicker patients may develop beneficial compensatory physiological and behavioral adaptations. Diversity of studied patients, in particular with regards to the ethnic and racial differences among the Western and Asian populations may also partly account for contrasting findings of the relationship between NAFLD and microvascular complications of diabetes.     

冠心病合并糖尿病患者血清超敏C反应蛋白水平与冠脉病变特点关系分析

目的探讨冠心病合并2型糖尿病患者冠状动脉病变与血清超敏C反应蛋白（hs—CRP）的相关性。方法经冠状动脉造影确诊冠心病患者，并根据既往或入院后OGTT试验结果分为合并2型糖尿病组和非糖尿病组，检测其hs-CRP、血糖、血脂水平及平均动脉压，并对合并2型糖尿病组冠状动脉病变程度与hs—CRP、血糖、血脂水平、平均动脉压、性别及吸烟史等因素作Logistic回归分析。结果冠心病合并2型糖尿病组hs—CRP水平及冠脉病变程度明显高于非糖尿病组（均P〈0.05）。Spearman秩相关分析表明，冠心病合并2型糖尿病组及非糖尿病组hs-CRP水平与冠状动脉病变支数均呈正相关（无糖尿病组r=0．827，P〈0．01；合并糖尿病组r=0．897，P〈0．01）。Logistic回归分析表明，年龄、吸烟史、hs—CRP、血糖、低密度脂蛋白及总胆固醇等是冠心病合并2型糖尿病患者冠脉病变严重程度的危险因素（均P〈0．05），且hs—CRP是其中最重要的危险因素；而性别、甘油三酯、高密度脂蛋白及平均动脉压不是冠心病合并2型糖尿病患者冠脉病变严重程度的危险因素（均P〉0．05）。结论冠心病合并2型糖尿病组炎症反应水平明显强于非糖尿病组，且患者炎症反应水平与冠脉损伤正相关；糖尿病可能通过炎症反应促进冠心病的发生及发展。监测冠心病合并2型糖尿病患者血清hs—CRP水平，对预测其冠状动脉粥样硬化病变的严重程度有一定意义。     

Clustering of microvascular complications in Type 1 diabetes mellitus

Aims

To describe to what extent microvascular complications exhibit clustering in persons with Type 1 diabetes, and to assess whether the presence of one complication modified the strength of the association between the other two.

Exercise is not associated with better diabetes control in type 1 and type 2 diabetic subjects

In the clinical setting, the impact of educational efforts on the amount of regular exercise and its effects on diabetes control are unclear. Fifty type 1 diabetic, 50 type 2 diabetic and 70 non-diabetic subjects were evaluated using a questionnaire for type, duration and intensity of exercise to assess weekly energy expenditure. Diabetic subjects did not exercise more than controls: 36% of the type 1, 46% of the type 2 and 46% of the control subjects admitted no physical activity, and those exercising regularly had similar energy expenditure: 1808±320, 2722±617, 2523±304 (mean±SEM) kcal/week respectively (P=NS). There was no correlation between the degree of activity and HbA_1c levels, or hypoglycaemic events. HbA_1c levels were less than 6,8% in 31% of non-active active patients versus 21% of active patients (P=NS). A negative correlation was found between physical activity and daily insulin usage (r=0.27,P<0.05), but differences between patients averaged only 4 IU/1000 kcal energy expenditure/day. We conclude that patients' attitude towards exercise was not improved by our educational methods and that physical exercise was not necessarily associated with good blood glucose control.     

血尿酸与2型糖尿病及并发冠心病的关系

目的探讨血尿酸(SUA)水平与2型糖尿病(T2DM)及T2DM并发冠心病的关系和SUA的影响因素。方法80例T2DM患者(DM组)、92例T2DM并发冠心病患者(DC组)及119例健康查体者(NC组),均检测SUA。结果(1)SUA水平NC组为280±81 mmol/L、DM组257±76 mmol/L,DC组302±72 mmol/L;DM组的SUA水平较NC组(P=0.037)、DC组(P=0.000)明显降低,DC组较NC组SUA水平有升高趋势(P=0.050);(2)男性SUA水平高于女性(t=3.330,P=0.001);(3)男性腰臀比(R=0.354)为SUA的独立影响因素;女性年龄(R=0.623)和体质指数(R=0.286)为SUA的独立影响因素;(4)高尿酸血症是T2DM并发冠心病的独立危险因素,并与吸烟和高血压有协同作用。结论DM组患者较NC组SUA水平下降,而相同病程的T2DM并发冠心病患者SUA反而升高;男性SUA高于女性,且两性SUA的影响因素不同。     

2型糖尿病合并冠心病患者心电图及冠脉造影结果的分析

目的探讨2型糖尿病合并冠心病的心电图和冠脉造影特点。方法对在我院住院经冠脉造影确诊为冠心病的2型糖尿病患者53例作为观察组；随机选择同期住院不合并2型糖尿病的冠心病患者53例作为对照组。分析两组患者的心电图与冠脉造影结果。结果冠心病合并2型糖尿病患者，冠状动脉三支病变的发生率、受累血管总数、弥漫性病变血管数明显高于非糖尿病组（p〈0．05），单支病变的发生率明显低于非糖尿病组（p〈0．05），而双支病变、左主干病变、100％闭塞血管相比无显著性差异（p〉0．05）。ST-T改变导联在Ⅱ、Ⅲ、aVF、V4、V5、V6导联出现的频率高，但与冠脉病变的支数无明显关系。结论冠心病合并2型糖尿病患者，冠状动脉三支病变的发生率、受累血管总数、弥漫性病变血管数明显高于非糖尿病冠心病患者；心电图ST-T改变导联与冠脉病变的支数无明显关系，冠脉病变的严重程度与心电图缺乏对应性关系。