不同糖耐量水平者血清炎症介质水平比较分析

80例受试者,行口服75g葡萄糖耐量试验(OGTT)确诊糖耐量正常(NGT)22例,IGT38例,新诊断的2型糖尿病(2型DM)20例,采用酶联免疫吸附法(ELISA)检测每位受试者血清TNF-α与IL-6水平,同时监测C反应蛋白(CRP)以评估炎症强度。结果:(1)NGT、IGT、新诊断的2型DM者中,TNF-α、IL-6及CRP逐渐升高,三者比较起来有显著差异(P0.05)。(2)血清CRP水平与OGTT2h血糖(r=0.36,P0.01)、总胆固醇(TC,r=0.17,P0.05)、甘油三酯(TG,r=0.27,P0.01)呈正相关。2型DM的发病因素中可能有炎症因素参与,IGT与2型DM一样可能也存在机体对内外因素刺激后产生的急性时相反应。     

糖耐量低减患者血清C反应蛋白与颈动脉内膜中层厚度的相关性分析

目的观察糖耐量低减（IGT）患者血清C反应蛋白（CRP）和颈动脉内膜中层厚度的变化及其相互关系。方法检测34例IGT患者和30例正常糖代谢人群（NGT）一般临床资料及血清CRP水平，同时应用高分辨彩色B超测定颈动脉内膜中层厚度（IMT）。所有受试者均行75g口服葡萄糖耐量试验（OGTT）。结果IGT组血清CRP、颈动脉平均IMT、增厚阳性率均显著高于NGT组（P〈0．05）；IGT患者血清CRP与颈动脉平均IMT呈正相关（P〈0．05），颈动脉平均IMT与OGTT 2h血糖、BMI也成正相关（r值为0．31、0．48，P〈0．05），而与FBG无明显相关性。结论炎症反应在IGT状态已经存在，且此阶段动脉涮样硬化性血管病变危险性已明显增加，炎症反应参与了IGT及其AS的发展与发展。     

2型糖尿病血清铁蛋白水平的检测及其意义

目的:探讨铁代谢状态与2型糖尿病的关系。方法:测定48例非糖尿病者、33例糖耐量减低(IGT)患者和58例2型糖尿病患者的身高、体重、腰围、臀围和血压,取晨静脉血检测血清铁蛋白(SF)、空腹血糖(FSG)、胰岛素(FINS)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG),同时检测餐后2h血糖(2h-SG)。结果:2型糖尿病组SF水平高于IGT组,而IGT组高于非糖尿病组。非糖尿病组SF与FINS和胰岛素抵抗(HOMA IR)呈正相关,IGT组SF与2h-SG、TC、LDL-C、FINS、HOMA IR呈正相关,2型糖尿病组SF与腰围、臀围、腰臀围比、FSG、2h-SG、FINS和HOMA IR呈正相关。结论:2型糖尿病患者SF水平高于IGT患者和非糖尿病者,铁蛋白代谢异常与2型糖尿病相关。     

糖耐量异常与颈动脉血管壁弹性的关系及相关因素分析

目的 在一组选择人群中调查糖耐量异常(IGT)患者的早期血管病变状况.方法 按照葡萄糖耐量试验(OGTT)结果将120例受试者分为糖耐量正常组(NGT)60例和IGT组60例,进行颈动脉超声检查,利用超声机带的血管回声跟踪技术,测量并计算出压力应变弹性系数(Eρ)、僵硬度(β)、和动脉顺应性(AC).受试者均检测血糖、血脂、胰岛素水平.结果 在IGT组β值和Eρ值均较NGT组升高,8.96±1.39 vs 7.17±1.25,(121.37±10.18)kPavs(96.42±7.64)kPa(P<0.05),AC值有所下降(0.784±0.11)mm2/kPa vs(0.95±0.10)mm2/kPa(P<0.05).IGT组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数时数转换值(HOMA-IR)较NGT组升高(均P<0.05).单因素相关分析显示颈动脉僵硬度β值与HOMA-IR、餐后2小时血糖、TG、TC呈正相关(r=0.818,0.769,0.846,0.632,均P<0.05).结论 与NGT相比,IGT已经具有较显著意义的颈动脉弹性指标的改变,表明早期动脉硬化改变早在IGT阶段就已经开始.血糖、特别是OGTT 2小时血糖、HOMA-IR及血脂与糖代谢异常患者的早期血管病变指标有相关性.     

2型糖尿病患者血脂代谢及CRP水平的研究

收集我院2013年3月~2014年4月1000例参与健康检查的体检人群血液标本,按血液标本中的空腹血糖水平分为糖耐量异常组、2型糖尿病组。糖耐量异常组54例,2型糖尿病组68例。比较2型糖尿病组和糖耐量异常组总胆固醇、甘油三酯、低密度脂胆固醇及CRP水平。结果 2型糖尿病组总胆固醇、甘油三酯、低密度脂胆固醇及CRP分别为:5.56±0.85、1.89±0.23、2.86±0.72、9.75±2.35mmol/L,糖耐量异常组分别为:4.86±0.758、1.72±0.86、2.38±0.85、4.53±0.25mmol/L,两组差异有统计学意义(P0.05)。我们认为2型糖尿病患者较糖耐量异常患者血脂水平及慢性炎症CRP指标更高。     

正常血糖、糖耐量减低及2型糖尿病人群胰岛素抵抗与非酒精性脂肪肝的相关分析

目的　探讨正常血糖、糖耐量减低及 2型糖尿病人群体重、血压、血脂、尿酸及胰岛素抵抗指数与非酒精性脂肪肝之间的相互关系。方法　采用口服葡萄糖耐量试验 (OGTT)检测正常血糖、糖耐量减低和 2型糖尿病患者空腹及餐后 2h血糖和胰岛素 ,用HOMA模型计算胰岛素抵抗指数 ,同时测定空腹总胆固醇、甘油三酯和尿酸水平。测量 3组人员身高、体重、血压、腰围及臀围 ,并计算体重指数、腰臀比值。脂肪肝的诊断依据超声影像学检查。结果　与正常血糖组比较 ,糖耐量减低、2型糖尿病组血压、体重指数、腰臀比值、血糖、胰岛素、甘油三酯、总胆固醇、尿酸和胰岛素抵抗指数依次增高 ,差异有显著性 (P <0 .0 0 1)。与糖耐量减低组比较 ,2型糖尿病组血压、血糖、胰岛素、甘油三酯、总胆固醇和胰岛素抵抗指数明显升高 (P <0 .0 5～ 0 .0 0 1) ;腰臀比值和尿酸水平升高 ,体重指数下降 ,但差异无显著性 (P >0 .0 5 )。受试 3组脂肪肝的患病率依次升高 ,差异有显著性 (P <0 .0 5～ 0 .0 0 1)。结论　随着血压、体重指数、腰臀比值、血糖、胰岛素及尿酸升高 ,血脂紊乱和胰岛素抵抗加剧 ,非酒精性脂肪肝的患病率逐渐上升 ,并且非酒精性脂肪肝与上述指标呈正相关。     

糖尿病前期个体血脂比值与胰岛素抵抗相关性的研究

目的比较空腹血糖受损(IFG)、糖耐量减低(IGT)及IFG IGT个体的血脂比值,并对其与胰岛素抵抗(IR)的相关性进行分析。方法将221例37~65岁非糖尿病个体根据口服葡萄糖耐量试验(OGTT)分为4组,即正常糖耐量(NGT)、单纯IFG、单纯IGT和IFG IGT组;比较各组间空腹血脂及血脂比值的差异,并对其与IR的相关性进行统计学分析。结果IGT组比IFG组甘油三酯(TG)(1.92±0.98 vs 1.49±0.79)mmol/L、TG/高密度脂蛋白胆固醇(HDL-C)比值升高(2.27±0.68 vs 1.61±0.45),HDL-C下降(1.14±0.25 vs 1.35±0.23)mmol/L,差异有统计学意义(均P<0.01),IFG组与NGT组以及IGT组与IFG IGT组间的上述指标差异无统计学意义(P>0.05);各组间总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和极低密度脂蛋白胆固醇(VLDL-C)水平差异无统计学意义(P>0.05);直线相关分析显示,TG和TG/HDL-C比值与IR呈正相关(r值分别为-0.395、-0.361,均P<0.01)。结论在糖调节受损和NGT人群中,TG/HDL-C比值与IR呈正相关。     

老年糖代谢异常患者颈动脉硬化与C反应蛋白的关系

目的:了解老年糖代谢异常患者颈总动脉内中膜厚度(IMT)与C反应蛋白(CRP)水平的关系。方法:158例年龄为68～93岁老年非糖尿病患者,每例均行标准75g口服糖耐量试验,同时测定血脂、血清CRP水平、空腹胰岛素等生化指标。超声测定颈总动脉内IMT并了解斑块情况。结果:患者中糖耐量正常者(NGT组)48例,糖耐量异常者(IGT组)71例,2型糖尿病(DM组)39例,3组体重指数、血压、血脂等均无明显差异。3组颈总动脉IMT均值分别为0.72、0.78、0.83mm,DM组及IGT组较NGT组显著升高(P<0.01),DM组与IGT组间差异无显著性,DM组斑块发生率(62%)明显高于其他两组(P<0.01)。3组CRP水平分别为(1.05±0.64)、(1.77±0.82)、(2.03±0.63)mg/dL,并呈上升趋势,两两比较DM组及IGT组较NGT组差异有显著统计学意义(P<0.01),而DM组与IGT组间无明显差异。结论:老年糖耐量异常人群颈总动脉IMT明显增厚,CRP水平明显升高,提示慢性亚临床炎症在2型糖尿病的发生发展过程中起到一定作用。     

探讨糖尿病前期患者血浆IL-18、PAI-1水平变化与胰岛素抵抗的相关性

目的探讨血浆白细胞介素-18(IL-18)、纤溶酶原激活物抑制物-1(PAI-1)水平变化与Ⅱ型糖尿病发病危险因素的关系.方法 设立健康人对照(NGT)组、糖耐量减低( IGT )组、空腹血糖受损合并糖耐量减低(IFG/IGT)组,每组各100例.测定各受试者血浆 IL-18、PAI-1、血清空腹胰岛素、空腹血糖、餐后2 h血糖,应用稳态模型评估法评价胰岛素抵抗(HOMA-IR).结果 IGT组、IFG/IGT组血浆 IL-18、PAI-1 水平均高于NGT组(P<0.01).IFG/IGT组血浆 IL-18、PAI-1 水平均高于IGT组(P<0.05).相关分析显示IL-18、PAI-1 水平与空腹血糖、餐后2 h血糖、HOMA-IR呈正相关(P<0.01).结论血浆 IL-18、PAI-1 水平升高可能是加重糖尿病前期患者胰岛素抵抗的危险因素;在糖尿病前期,IL-18、PAI-1可能参与了Ⅱ型糖尿病的发生、发展.     

糖耐量受损者血浆C反应蛋白水平及二甲双胍干预作用

目的：了解糖耐量受损（IGT）者血浆C反应蛋白（CRP）水平,观察IGT者二甲双胍干预后CRP水平变化。方法：收集糖耐量正常（NGT）30例,IGT 60例,并对60例IGT进行12周随机、双盲、安慰剂对照、二甲双胍干预,治疗前后检测CRP、血糖、血脂。结果：IGT血浆CPR比NGT明显增高P〈0.01;治疗组12周后CPR、血糖、TG水平下降,HDL-C升高P〈0.05;对照组各指标无明显统计学差异。结论：IGT时血清CRP已升高,IGT者二甲双胍的治疗使糖代谢改善的同时,血清CRP水平也下降。     

C-reactive protein predicts the deterioration of glycemia in chinese subjects with impaired glucose tolerance

OBJECTIVE: Recent studies have shown that C-reactive protein (CRP) predicts future risk of diabetes in healthy Caucasians. We determined whether plasma CRP level was elevated in Chinese subjects with impaired glucose tolerance (IGT) and whether CRP level could be used to predict progression to type 2 diabetes or reversion to normal glucose tolerance (NGT) in these high-risk individuals. RESEARCH DESIGN AND METHODS: A total of 228 subjects with IGT at baseline from the Hong Kong Cardiovascular Risk Factors Prevalence Study underwent repeat oral glucose tolerance testing after 2 years. Plasma high-sensitivity CRP was measured from their stored baseline samples and from 228 subjects with NGT matched for age and BMI by an immunoturbidimetric assay. RESULTS: Subjects with IGT at baseline had higher plasma CRP levels than subjects with NGT: 1.18 mg/l (0.52-2.52) vs. 0.87 mg/l (0.37-1.84), median (interquartile range), P = 0.01. At 2 years, 117 subjects with IGT reverted to NGT, 84 remained in IGT, and 21 progressed to diabetes. Individuals who progressed to diabetes had the highest plasma CRP levels at baseline (P < 0.0001). Those with baseline CRP levels in the third and top quartile had a relative risk of remaining in IGT or progressing to diabetes of 2.87 (95% CI 1.06-7.82) and 2.76 (1.06-7.31), respectively, after adjusting for anthropometric measure and lifestyle factors. CONCLUSIONS: CRP independently predicts the risk of remaining in IGT or progressing to diabetes in Chinese subjects with IGT. CRP might provide an adjunctive measure for identifying subjects with the highest risk of progression to diabetes who would derive the greatest benefits from preventive interventions.     

不同血糖水平人群血清脂联素水平与胰岛素抵抗的关系

目的研究天津地区不同糖耐量人群血清脂联素水平与胰岛素抵抗的关系。方法290例受试者中2型糖尿病患者(DM组)124例、糖耐量减低者(IGT组)66例、正常对照组(NGT组)100例,各组按体重指数(BMI)分成肥胖亚组和非肥胖亚组。测定受试者的身高、体重、腰围、臀围及血浆胆固醇和甘油三酯,并采用放射免疫法测定胰岛素(FINS)、酶联免疫吸附测定(ELISA)法测定血清脂联素水平。结果(1)IGT组和DM组脂联素水平较NGT组明显降低,分别为5.31±1.20mg/L,4.12±0.73mg/L和8.09±0.39mg/L,DM组降低最显著(P<0.05)。(2)与NGT组相比,IGT组的BMI、腰臀比(WHR)、空腹血糖(FBG)、总胆固醇(TC)明显升高,高密度脂蛋白胆固醇(HDL-C)明显下降(P<0.05或P<0.01);DM组的收缩压(SBP)、BMI、WHR、FBG、胰岛素抵抗指数(IRI)、TG的水平均高于前两组,HDL-C明显低于NGT组(P<0.05或P<0.01)。(3)血清脂联素与BMI、WHR、腰围(YW)及体脂含量(FAT%)呈显著负相关,与血胆固醇(TC)水平无相关性,与甘油三酯呈负相关。在本年龄段中,与年龄关系不大。结论(1)脂联素水平在IGT和DM人群中明显降低,提示脂联素在2型DM发病中可能起着一定作用,可以作为2型DM发病的一个预测指标。(2)各组肥胖亚组中IRI明显升高,说明肥胖人群存在IR,而各组肥胖亚组脂联素水平也明显降低,提示肥胖是影响该脂肪因子的重要因素。脂联素可能是联系肥胖、IR和2型DM的一个纽带。     

血清C-反应蛋白与妊娠糖尿病的关系研究

目的探讨血清C-反应蛋白（C-reactive protein,CRP）水平与妊娠糖尿病（gestational diabetes mellitus,GDM）的关系。方法选取2002年6月至2006年6月本院门诊及住院患者经75g葡萄糖耐量试验（OGTT）确诊为妊娠期糖尿病患者（GDM）48例和糖耐量异常妊娠妇女32例,并随机选择同期相匹配的正常糖耐量妊娠妇女80例（作为对照组）,同时检测空腹血清CRP水平。结果GDM组C-反应蛋白水平明显高于另两组（P〈0.05）;CRP水平与孕前体重指数（BMI）、空腹血糖、空腹胰岛素呈正相关,相关系数分别为0.348、0.156和0.296,P值分别为0.0001、0.0178和0.0004。直线回归方程y=0.0741x1＋0.0147x2＋0.0397x3-1.457,r2=0.2469。结论C-反应蛋白与GDM密切相关,参与了其发病机制。     

The Singapore impaired glucose tolerance follow-up study: does the ticking clock go backward as well as forward?

OBJECTIVE: To 1). document the change in glucose tolerance for subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) over time, 2). identify baseline factors associated with worsening of glucose tolerance, and 3). determine whether cardiovascular disease (CVD) risk factors associated with IGT improved in tandem with glucose tolerance. RESEARCH DESIGN: Subjects with IGT and NGT (matched for age, sex, and ethnic group) were identified from a cross-sectional survey conducted in 1992. Subjects with IGT (297) and NGT (298) (65.0%) were reexamined in 2000. Glucose tolerance (assessed by 75-g oral glucose tolerance test), anthropometric data, serum lipids, blood pressure, and insulin resistance were determined at baseline and at the follow-up examination. RESULTS: For NGT subjects, 14.0% progressed to IGT and 4.3% to diabetes over 8 years. For IGT subjects, 41.4% reverted to NGT, 23.0% remained impaired glucose tolerant, and 35.1% developed diabetes. Obesity, hypertriglyceridemia, higher blood pressure, increased insulin resistance, and lower HDL cholesterol at baseline were associated with worsening of glucose tolerance in both IGT and NGT subjects. Those with IGT who reverted to NGT remained more obese and had higher blood pressure than those with NGT in both 1992 and 2000. However, serum triglyceride, HDL cholesterol, and insulin resistance values in 2000 became indistinguishable from those of subjects who maintained NGT throughout the study period. CONCLUSIONS: Some, but not all, CVD risk factors associated with IGT and with the risk of future diabetes normalize when glucose tolerance normalizes. Continued surveillance and treatment in subjects with IGT, even after they revert to NGT, may be important in the prevention of CVD.     

糖耐量低减患者的血管内皮生长因子及血清C反应蛋白水平分析

目的探讨糖耐量低减患者血管内皮生长因子、血清C反应蛋白水平的变化。方法口服75g葡萄糖耐量试验筛查出糖耐量低减患者61例和糖耐量正常的体检健康者30例，测定两组人群血清内皮生长因子、血清C反应蛋白水平。结果糖耐量低减组血管内皮生长因子、血清C反应蛋白水平均高于糖耐量正常组（P〈0．01）。结论在糖耐量低减阶段，患者血管内皮生长因子、血清C反应蛋白已开始升高，提示糖耐量低减人群具备了发生血管并发症的危险。     

高血压患者动态血压变化与糖代谢异常55例分析

目的 探讨糖代谢异常对高血压患者动态血压变化的影响。方法 对55例既往无糖尿病的高血压患者行24小时动态血压监测和糖耐量试验（OGTT），根据OGTT分为糖耐量正常（NGT）、糖耐量减低（IGT）和新发现2型糖尿病（2-DM）3组。结果 从NGT至IGT至2-DM，非杓型血压发生率逐渐增高（分别为52．17％、64．70％和80．00％，P〈0．01），且2-DM患者夜间高血压的发生率较NGT及IGT显著增加（分别为13．04％、17．64％和33．33％，P〈0．01）；IGT组的24小时舒张压负荷、24小时舒张压和夜间舒张压均显著低于NGT组和2-DM组（P〈0．05），且脉压增大；并且发现，从NGT至IGT至2-DM过程中，胰岛素抵抗指数逐渐增加（分别为1．41、1．66和1．92，P〈0．05），胰岛素敏感指数在IGT阶段较NGT增高（39．90比33．83，P〈0．05），而到2-DM阶段较NGT下降（27．15比33．83，P〈0．05）；Logistic回归分析显示，影响脉压的主要因素为餐后血糖。结论 糖代谢异常的高血压惠者其24h血压的昼夜节律紊乱，其中以IGT患者的舒张压降低和脉压增大为著，而脉压增大与餐后血糖及血浆胰岛素水平相关。     

Alcohol consumption in relation to metabolic regulation, inflammation, and adiponectin in 64-year-old Caucasian women: a population-based study with a focus on impaired glucose regulation

OBJECTIVE: The aims of this study were to examine alcohol drinking patterns in women with type 2 diabetes, impaired glucose tolerance (IGT), and normal glucose tolerance (NGT) and to investigate whether alcohol intake was associated with improved insulin sensitivity, decreased biomarkers of inflammation, and increased adiponectin levels and if these effects were limited to dysmetabolic women. RESEARCH DESIGN AND METHODS: From a cohort of 64-year-old Caucasian women, 209 with type 2 diabetes, 205 with IGT, and 186 with NGT were recruited. Alcohol consumption and medication use were assessed by questionnaires. Anthropometric data were collected, and blood glucose, insulin, HDL cholesterol, triglycerides, C-reactive protein, white blood cell count, and serum adiponectin were measured. RESULTS: Compared with the NGT group, alcohol consumption was lower in the IGT group and lowest in the diabetes group. Mean alcohol intakes of >9.2 and > or =3-9 g/day were positively associated with adiponectin and insulin sensitivity (homeostasis model assessment [HOMA]), respectively, independently of obesity, metabolic control, and other confounders. Alcohol intake correlated negatively with inflammatory markers, although this did not remain after adjustment for HOMA and waist circumference. The inverse associations between alcohol consumption and factors related to the metabolic syndrome such as HOMA, waist circumference, and inflammatory markers were more obvious among women with diabetes and IGT than in healthy women. CONCLUSIONS: In these women, moderate alcohol consumption showed beneficial associations with the prevalence of type 2 diabetes, IGT, insulin sensitivity, and serum adiponectin. There is a need to clarify whether adiponectin may be a mechanistic link and also to clarify the clinical implications of these observations.     

Predictors of changes in glucose tolerance status in obese youth

OBJECTIVE: Type 2 diabetes in obese youth is an emerging problem. The metabolic and anthropometric predictors of change in glucose tolerance status in obese youth are unknown. RESEARCH DESIGN AND METHODS: A total of 117 obese children and adolescents were studied by performing an oral glucose tolerance test (OGTT) at baseline and after approximately 2 years. Data from both OGTTs and changes in weight were examined to identify youth at highest risk for developing diabetes and the factors that have the strongest impact on glucose tolerance. RESULTS: Eighty-four subjects had normal glucose tolerance (NGT) and 33 impaired glucose tolerance (IGT) at baseline. Eight subjects (all of whom had IGT at baseline) developed type 2 diabetes, whereas 15 subjects with IGT reverted to NGT. In this cohort, severe obesity, impaired glucose tolerance, and African-American background emerged as the best predictors of developing type 2 diabetes, whereas fasting glucose, insulin, and C-peptide were nonpredictive. Changes in insulin sensitivity, strongly related to weight change, had a significant impact on the 2-h glucose level on the follow-up study. CONCLUSIONS: Severely obese children and adolescents with IGT, particularly of African-American descent, are at very high risk for developing type 2 diabetes over a short period of time. Parameters derived from an OGTT and not fasting samples can serve as predictors of changes in glucose tolerance.