瘦素、脂联素在肝源性糖尿病患者发病机制中的作用

目的 探讨瘦素、脂联素在肝源性糖尿病中的作用。方法对25例肝源性糖尿病患者、23例肝硬化患者、20例2型糖尿病患者及20例健康体检者进行血浆瘦素（LPT）、脂联素（ADPN）、空腹胰岛素（FINS）水平测定,计算胰岛素抵抗指数（HOMAIR）、胰岛素敏感指数（ISI）,分析LPT、ADPN与其他影响糖代谢紊乱因素的相关性。结果肝源性糖尿病组的LPT水平显著高于肝硬化和健康体检组,（2．77±0．11）μg／L,（2．69±0．11μg／LVS（2．91±0．15）μg／L（P〈0．05）,肝源性糖尿病组的ADPN水平显著高于2型糖尿病和健康体检组,（5．03±1．63）mg／L,（11．94±2．55）mg／Lvs（16．79±3．36）mg／L（P〈0．05）。相关分析显示,LPT与HOM艮IR呈正相关（r=0．613,P=0．000）,与ISI呈负相关（r=-0．613,P=0．000）,ADPN与各指标未表现出明显相关性（P〉0．05）。结论肝源性糖尿病组与肝硬化组均存在胰岛素抵抗,LPT、ADPN参与了肝病患者的糖代谢紊乱,LPT可能通过胰岛素抵抗诱发或加重肝病患者的糖代谢异常,肝源性糖尿病患者的ADPN水平显著高于2型糖尿病患者。     

2型糖尿病患者血清生长激素水平与微量清蛋白尿的关系

目的探讨2型糖尿病患者血清生长激素(GH)的变化及其与微量清蛋白尿的关系。方法采用免疫透射比浊法和放射免疫法检测150例2型糖尿病患者的尿微量清蛋白和血清GH水平。按尿蛋白排泄率(UAE)水平将患者分为正常清蛋白尿组(n=60)、微量清蛋白尿组(n=40)和临床清蛋白尿组(n=50)。结果从微量清蛋白尿组到临床清蛋白尿组,血清GH水平依次增高,差异均有统计学意义(P<0.01)。2型糖尿病患者血清GH水平与UAE呈正相关(r=0.856,P<0.01);偏相关分析结果显示,调整年龄、性别、血压和血脂等混杂因素的影响后,血清GH水平仍与UAE呈正相关(r=0.585,P<0.01)。多元逐步回归分析结果显示,GH是UAE的独立影响因素(r2=0.282,P<0.01)。结论 2型糖尿病血清GH水平与临床分期和UAE密切相关,检测血清GH水平有助于2型糖尿病患者的病情评估和预后判断。     

糖尿病家系患者与血清瘦素水平的相关分析

目的 :探讨中国河南汉族糖尿病 (DM )家系患者与瘦素 (leptin)水平的相关性。 方法 :在中国河南汉族人群中选择 12个DM家系 ,符合常染色体显性遗传规律 ,全部成员 197例 ,共收集到外周静脉血标本 5 1例 ;111例 2型DM患者 (家系中患DM者不超过 2例 ) ;10 2例健康献血者作对照。用放射免疫技术测定血清leptin、C肽 ;对糖化血红蛋白、谷氨酸脱羧酶抗体、葡萄糖耐量 (OGTT)、体重指数 (BMI)等指标进行检测。结果 :DM家系与正常人群的leptin比较无显著性差异(P >0 0 5 ) ;111例 2型DM中男性及女性患者分别与 10 2例正常人群男性及女性leptin水平比较均有显著性差异 (P <0 0 5 ) ;2型DM人群中leptin水平分别与餐后 2h血糖水平、BMI呈正相关。 结论 :leptin在中国河南汉族DM家系人群中可能不是主要致病原因 ,血清leptin增高可能是 2型DM的致病原因之一。     

瘦素和皮质醇与2型糖尿病胰岛素抵抗的关系探讨

目的探讨2型糖尿病患者血清瘦素、皮质醇水平与胰岛素抵抗的关系。方法以稳态模型胰岛素抵抗指数（HOMA—IR）作为评估胰岛素抵抗程度的指标，采用放射免疫法测定瘦素与糖皮质激素水平，分别测定30例2型糖尿病患者和30例对照组患者的空腹血糖、空腹胰岛素、瘦素、皮质醇。结果2型糖尿病患者血清瘦素、糖皮质激素水平高于对照组，且呈正相关。多元逐步回归分析提示瘦素、糖皮质激素是胰岛素抵抗的独立影响因素。结论血清瘦素、皮质激素水平与胰岛素抵抗在2型糖尿病患者呈正相关，并且是2型糖尿病的独立危险因子。     

Ayurvedic concept of obesity, metabolic syndrome, and diabetes mellitus

Obesity, metabolic syndrome, and diabetes mellitus are increasing to epidemic proportions globally. There are 400 million clinically obese adults worldwide and there are more than 220 million people who have diabetes. The global impact of these disorders is immense in terms of human suffering and economic burden. There is an urgent need for a more effective understanding of these disease processes and their management, including the use of natural strategies that are affordable and efficacious. The health care system known as Ayurveda has much to offer in this regard. Ayurveda describes a set of complex clinical disorders, collectively called Prameha, that are characterized by frequent abnormal micturition. The clinical conditions associated with Prameha correlate in many ways with obesity, metabolic syndrome, and diabetes mellitus. The etiology, classification, pathogenesis, and management of Prameha are discussed at length and in detail in the Ayurvedic texts. The theoretical background and comprehensive set of strategies Ayurveda utilizes to treat Prameha may be valuable in managing obesity, metabolic syndrome, and diabetes mellitus in an efficacious and cost-effective manner.     

Abnormal angiogenesis in diabetes mellitus

The adverse long-term effects of diabetes mellitus have been well described and involve many organ systems. While diabetes management has largely focused on control of hyperglycemia, the presence of abnormalities of angiogenesis may cause or contribute to many of the clinical manifestations of diabetes. When compared with non-diabetic subjects, diabetics demonstrate vascular abnormalities of the retina, kidneys, and fetus. Diabetics have impaired wound healing, increased risk of rejection of transplanted organs, and impaired formation of coronary collaterals. In each of these conditions, and possibly in diabetic neuropathy as well, abnormalities of angiogenesis can be implicated in the pathogenesis. A perplexing feature of the aberrant angiogenesis is that excessive and insufficient angiogenesis can occur in different organs in the same individual. In this review, the clinical features, molecular mechanisms, and potential therapeutic options of abnormal angiogenesis in diabetes will be reviewed.     

冠心病与糖尿病患者血清甲状腺激素水平的变化

[目的]探讨冠心病、糖尿病与血清甲状腺激素水平的变化的关系及其临床意义。[方法]用化学发光免疫分析法测定临床确诊的32例糖尿病患者，59例冠心病患者，36例正常健康人血清中的甲状腺激素水平。[结果]血清TT3水平在两组病例中均显著低于正常对照组（P〈0．05），冠心病心衰组T13水平显著低于非心衰组（P〈0．05），糖尿病治疗前T13水平显著低于治疗后（P〈0．05），TT4、TSH水平在3组中变化不大（P〉O．05）。[结论]冠心病、糖尿病患者与甲状腺激素密切相关，血清中TT3水平的动态观察可作为判断病情变化和预后评估的指标之一。     

2型糖尿病患者脂联素/瘦素比例与代谢指标关系的研究

目的探究2型糖尿病患者脂联素/瘦素比例与代谢指标关系。方法选取2013年1月至2014年1月来本院内分泌科就诊的2型糖尿病病患167例为研究对象,以空腹血糖(FPG)水平将所有病患分成3组(7.2mmol/L为1组42例,7.2~9.4mmol/L为2组59例,9.4mmol/L为3组66例)。已经排除接受胰岛素或者胰岛素增敏剂进行治疗的病患。要求病患禁食10~12小时,后取其空腹血样,将样本送往本院检验科利用生化分析测定的方式,将患者的糖化血红蛋白,空腹血糖值,血脂指标进行检测,计算病患的相关指标,并进行分析。结果病患的身体质量指数(BMI)、空腹胰岛素(FINS)、低密度脂蛋白胆固醇(LDL)、三酰甘油(TG),瘦素以及脂联素,年龄之间无统计学意义存在,HDL、FPG、HOMA-IR以及糖化血红蛋白之间有统计学意义,3组之间数据比较差异有统计学意义(P0.05),男性病患的脂联素水平和TG,BMI,HDL以及LDL有着较为密切的关系且3组之间数据比较差异有统计学意义(P0.05)。其中患者的瘦素水平和BMI比较差异有统计学意义(P0.01)。女性病患的脂联素水平和TG、LDL、HD密切相关(P0.05)。体内的瘦素水平和TG与BMI相关,脂联素/瘦素(A/L)比例在男性和女性患者中与所有指标有关(P0.05)。结论 HOMA-IR并不能作为评估胰岛素抵抗的重要指标。A/L和其相比则较为适合。     

孕晚期妊娠糖尿病脂联素、瘦素、抵抗素水平与胰岛素抵抗的相关性研究

目的：观察孕晚期妊娠糖尿病（GDM）患者的脂联素（ADP）、瘦素（LEP）、抵抗素水平及其与胰岛素抵抗（IR）的相互关系。方法选取2013年3月-2014年3月孕晚期GDM患者64例设为观察组,同期口服葡萄糖耐量试验正常的妊娠期妇女60例设为对照组,观察2组脂代谢相关指标、血ADP、LEP、抵抗素水平的差异及其与胰岛素抵抗指数（IRI）的相关性。结果观察组ADP水平显著低于对照组（P＜0．01）,LEP、抵抗素水平及IRI显著高于对照组（P＜0．01）。相关性分析发现,ADP与IRI显著负相关,抵抗素与IRI显著正相关（P＜0．01）。结论妊娠晚期GDM患者的血LEP、抵抗素水平显著上升,ADP水平显著下降,LEP和抵抗素是影响IR的独立危险因子。     

The effect of advanced hybrid closed loop system on glycated hemoglobin (HbA1c) in a young male with type 1 diabetes mellitus and growth hormone treatment: A case report

The advanced hybrid closed loop system MiniMed 780G can be an effective tool to improve glycemic control and decrease the health burden in a young male with type 1 diabetes and short stature.     

2型糖尿病与睡眠呼吸暂停低通气综合征

2型糖尿病(T2DM)和睡眠呼吸暂停低通气综合征(SAHS)均是具有较高潜在危害性的现代常见病,两者具有较高的临床并存率.该文就T2DM和SAHS的相关性、发病机制及干预治疗作一介绍.     

Insulin resistance syndrome, pre-diabetes, and the prevention of type 2 diabetes mellitus

Insulin resistance syndrome (IRS), also known as the metabolic syndrome, is now well recognized as a distinct pathological and clinical entity, with multiple significant ramifications for both the high-risk individual as well as the public health system. The primary contributory cause is obesity. Common manifestations associated with IRS may include atherosclerotic heart disease, hypertension, impaired glucose tolerance, dyslipidemia, polycystic ovary syndrome, and hypercoagulability. This review will present the features associated with the disorder, the accepted clinical diagnosis, available and potential treatment modalities, and ongoing or completed trials which suggest that progression from IRS to type 2 diabetes mellitus and early coronary heart disease may be prevented in adolescents and adults.     

男性2型糖尿病患者肥胖与性激素水平的相关性研究

目的观察男性2型糖尿病(T2DM)患者的肥胖与性激素相关性。方法 T2DM患者100例以及对照组100例,测量腰围,检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、睾酮(T)、雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)。检测2组糖化血红蛋白(Hb A1c)水平,记录糖尿病病程。分析性激素与其余指标相关性。结果 T2DM组的平均腰围、TC、E2水平高于对照组;HDL-C、T水平低于对照组;腹型肥胖使E2升高,T降低,E2与腰围相关性最大;E2与TC、病程、TG呈正相关,T与TC、病程、Hb A1c呈负相关。结论男性T2DM的T水平降低,E2的水平增高。男性T2DM肥胖者比非肥胖者E2水平更高,T水平更低。     

Serum leptin concentration and fuel homeostasis in healthy man

We studied the interrelationship between the obese gene product serum leptin, insulin and counterregulatory hormone concentrations and glycogen synthesis in 26 healthy men. A 4-h euglycaemic insulin clamp with muscle biopsies was performed after a resting control day in 26 subjects, and in 14 of them also after heavy, glycogen-depleting (32%, P < 0.01) exercise. Serum leptin concentrations were at baseline 34% (0.67 ± 0.18 vs. 1.03 ± 0.13 ng L^?1, P ± 0.05) lower after the exercise, and rose during hyperinsulinaemia by 56% (to 1.38 ± 0.19 ng L^?1, P < 0.001) and 34% (to 1.05 ± 0.20 ng L^–1, P < 0.01) after the post-exercise and control studies respectively. Basal serum leptin concentration correlated positively with body mass index (r = 0.42, P < 0.05), serum cortisol concentration (r = 0.70, P < 0.001) and the rise in muscle glycogen content during the clamp (r = 0.43, P < 0.05) and inversely with serum growth hormone concentration (r = ?0.43, P < 0.05). There was a positive correlation between serum leptin after hyperinsulinaemia and serum insulin concentration during the hyperinsulinaemia (r = 0.42, P < 0.05). After exercise, basal serum leptin level correlated with serum triglyceride concentration (r = 0.82, P < 0.001) and after hyperinsulinaemia serum leptin correlated positively with muscle glycogen content (r = 0.56, P < 0.05). It was concluded that serum leptin concentrations correlate directly with serum insulin, cortisol and triglyceride and inversely with growth hormone concentrations. They are decreased by glycogen-depleting exercise and increase during hyperinsulinaemic clamp. These data suggest that leptin is associated with factors regulating fuel homeostasis and its hormonal control in man.     

Schmidt's syndrome in a child with diabetes mellitus

Schmidt's syndrome (thyroid and adrenal insufficiency) and concurrent diabetes mellitus represent an intriguing multiple endocrinopathy in children. This report describes an eleven-year-old girl with diabetes of eight years' duration presenting in adrenal crisis. Serum thyroxine was undetectable, and antibodies to both thyroglobulin and adrenal tissue were found in high titer. The child's condition stabilized with hormonal replacement therapy, except for persistent growth failure. Approximately two years later she succumbed during a rapidly fulminant episode of ketoacidosis. The natural history of her illness supports recent speculation based on serologic data that juvenile diabetes mellitus may be an immunologic disorder in some children.     

Variability in the leptin receptor gene and other risk factors for post-transplant diabetes mellitus in renal transplant recipients

Aim: Post-transplant diabetes mellitus (PTDM) is one of the main complications after kidney transplantation. It is known that leptin plays an important role in glucose metabolism and mutations in the leptin receptor gene (LEPR) are responsible for different complications in renal transplant recipients. We aimed to analyse the association of polymorphisms in LEPR with the development of PTDM in these patients.Methods: A total of 315 renal transplant recipients were genotyped for the Lys109Arg, Gln223Arg and Lys656Asn polymorphisms. The impact of these genetic variables together with other clinical and demographic parameters on PTDM risk was evaluated in a multivariate regression analysis.Results: The 223Arg variant showed a significant association with PTDM risk [OR = 3.26 (1.35–7.85), p = 0.009] after correcting for multiple testing. Carriers of this variant also showed higher BMI values (26.95 ± 4.23) than non-carriers (25.67 ± 4.43, p = 0.025). In addition, it was BMI at transplant and not the BMI increment in the first year after grafting that was associated with PTDM (p > 0.00001). Haplotype analyses did not reveal significant associations.Conclusions: Our result show, for the first time to our knowledge, that genetic variability in the LEPR may contribute significantly to the risk for PTDM in renal transplant recipients.

KEY MESSAGES

• The LEPR Gln223Arg polymorphism significantly contributes to the development of PTDM in renal transplant recipients.
• The effect of the 223Arg variant on PTDM is strongly modulated by the age of the recipient.
• The 223Arg variant in the leptin receptor is related to higher BMI in renal transplant recipients.