缺血修饰白蛋白、尿微量白蛋白水平与糖尿病合并冠心病患者心功能的相关性

目的 探讨糖尿病合并冠心病患者血清缺血修饰白蛋白(IMA)、尿微量白蛋白(UMalb)水平与心功能的相关性及临床意义.方法 测定60例糖尿病合并冠心病患者IMA与UMalb,分析其与心功能之者间的关系.结果 IMA、UMalb均随着心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者级别的升高逐渐升高(P＜0.05).与治疗前相比,治疗后各级IMA均下降(P＜O.05);心功能Ⅰ、Ⅱ级患者UMalb治疗后下降(P＜0.05).结论 糖尿病合并冠心病患者IMA、UMalb水平与心功能具有相关性.     

Correlation between resistin and vascular endothelial function in patients with type 2 diabetes mellitus (DM) complicated by coronary heart disease

目的 探讨抵抗素(resistin)与2型糖尿病(DM)合并冠心病患者血清内皮素(ET-1)、一氧化氮(NO)、一氧化氮合酶(NOS)、胰岛素抵抗(IE)的相关性及其在糖尿病合并冠心病发生发展中的作用.方法 糖尿病患者组120例[其中单纯糖尿病60例(DM组),合并冠心病60例(DC组)]和正常组60例,采用酶联免疫吸附法(ELISA)、硝酸还原酶法、酶比色法测定3组血清空腹胰岛素、resistin、ET-1、NO、NOS水平.用空腹血糖(FBG)和空腹胰岛素的数值计算胰岛素抵抗指数(HOMA-IR).结果 DM血清resistin、ET-1、HOMA-IR显著高于正常组(P<0.05),而NO、NOS显著低于正常组(P<0.05),且并发冠心病患者血清resistin、ET-1、HOMA-IR显著高于DM组(P<0.05),NO、NOS显著低于DM组(P<0.05).相关性分析显示,升高的resistin与ET-1、HOMA-IR呈正相关(P<0.05),与NO、NOS呈负相关(P<0.05).结论 血清resistin、ET-1、NO、NOS水平与糖尿病病情发展存在相关性.对以上指标的测定有利于监测糖尿病病情发展,并对预防其并发症具有重要临床意义.     

冠心病合并糖尿病患者胰岛素抵抗及其抵抗素相关性分析

目的探讨分析冠心病(Coronary heart disease,CHD)合并糖尿病(Diabetes mellitus,DM)患者胰岛素抵抗(Insulin Resistance,IR)及其抵抗素(Resistin,RE)的相关性。方法入选2010年9月至2010年12月住院的冠心病合并糖尿病患者60例,入选同期住院的单纯冠心病患者60例,另取健康对照组50例。采用酶联免疫吸附测定(ELISA)法检测各组的血清RE,空腹血糖及空腹胰岛素,用后二者计算胰岛素抵抗指数(Insulin Resistance Index,IRI)。结果与健康对照组比较,冠心病合并糖尿病组及冠心病组血清RE﹑IRI均升高;冠心病合并糖尿病组较冠心病组血清RE﹑IRI升高;相关性分析显示升高的RE与升高的IRI正相关。结论冠心病合并糖尿病患者IRI及RE高于冠心病患者;冠心病患者IRI及RE高于健康对照组。RE与IR呈正相关。     

2型糖尿病患者合并脂代谢紊乱与冠心病的关系

目的 探讨2型糖尿病患者血脂变化水平与冠心病的关系.方法 将106例确诊为2型糖尿病患者随机分为合并冠心病组(A组)56例和未合并冠心病组50例(B组),分别测定血糖及血脂,并进行对比分析.结果 A组患者空腹血糖(FBG)、餐后2 h血糖(2 hBG)、糖化血红蛋白(HbA1c)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)明显高于B组 (t=4.142、t=4.953、t=5.481、t=3.797、t=4.016、t=3.83,P<0.01),但高密度脂蛋白(HDL-C)明显低于B组(t=5.15,P<0.01).结论 2型糖尿病患者血脂明显异常,且血糖值高低与血脂水平具有一定相关性.因此,在有效控制血糖的同时,重视对血脂异常的治疗,对防止冠心痛的发生发展具有重要意义.     

2型糖尿病患者糖耐量试验与胰岛素释放试验相关性分析

目的 通过对糖耐量试验与胰岛素释放试验相关性研究,探讨其对2型糖尿病的诊断与治疗的临床意义.方法 对248例糖病病患者入院治疗前按其空腹胰岛素水平分为空腹低值组(A组)、空腹低值有峰组(B组)、空腹中值组(C组)、空腹高值组(D组)及44例正常对照组(E组),分别采用Backman LX20已糖激酶法测定空腹、糖耐量试验1、2、3 h的血糖和用美国Backman Asscey化学发光仪测定相应的胰岛素水平.结果 糖尿病患者各组胰岛素水平较正常人群组差异有显著性意义(P＜0.05)或非常显著意义(P＜0.01),A组、B组、C组、E组其血糖水平与相应的胰岛素水平具有正相关性,D组血糖水平与相应的胰岛素水平无相关性.结论 2型糖尿病患者在治疗前做糖耐量试验(OGTT)与胰岛素释放试验对其诊断治疗与预后有很重要临床意义.     

糖代谢异常与冠脉狭窄程度相关性研究

目的：分析伴有糖代谢异常的冠心病患者的冠脉病变特征。方法所有入选冠心病患者均选自吉林市中心医院心血管疾病诊治中心,共260例。根据患者的血糖情况分组：一组为单纯空腹血糖调节受损的冠心病患者,两组为混合型糖耐量减低的冠心病患者,三组为合并糖尿病冠心病患者,四组为血糖正常的冠心病患者。对上述4组患者的年龄、性别、血糖及冠脉病变支数进行统计学分析。结果三组糖尿病患者的多支病变发生率明显高于四组糖代谢正常组与1组单纯空腹血糖异常组, P〈0.05,差异有统计学意义;三组糖尿病患者的多支病变发生率与两组混合型糖耐量异常患者相当, P〉0.05,无显著差异。结论混合型糖耐量异常与糖尿病,二者与心血管并发症及冠心病严重程度相当,且二者的影响程度明显高于空腹血糖。     

急性冠脉综合征中糖代谢异常与血浆P选择素、冠脉病变程度的关系

目的 探讨急性冠脉综合征(ACS)患者血糖异常与血浆P选择素和冠状动脉病变程度的关系.方法 ACS患者116例,其中单纯ACS组40例、ACS合并糖调节异常组(糖耐量受损组/空腹血糖受损)34例、ACS合并2型糖尿病组42例,单纯2型糖尿病组26例,正常对照组26例.采用ELISA法测定各组血浆可溶性P选择素水平.结果 单纯ACS组、ACS合并糖调节异常组、ACS合并2型糖尿病组、单纯2型糖尿病组P选择素水平均高于正常对照组,其中ACS合并糖调节异常组、ACS合并2型糖尿病组P选择素水平均高于单纯ACS组(P＜0.05).ACS合并糖调节异常组以及ACS合并2型糖尿病组多支冠状动脉病变的发生率以及冠状动脉狭窄的严重程度均明显高于单纯ACS组(P＜0.05).结论 糖代谢紊乱的ACS患者较糖耐量正常的ACS患者具有更严重的血小板活化状态.ACS合并糖代谢异常患者冠脉病变程度更严重、范围更广泛,临床预后更差.     

不同糖耐量受损尿微量白蛋白检测的意义

目的：探讨不同糖耐量受损患者尿微量白蛋白浓度变化及意义。方法：正常对照组30例,2型糖尿病组172例,糖耐量受损合并空腹血糖异常组59例,单一糖耐量受损组24例,测定晨尿微量白蛋白浓度。结果：不同糖耐量受损组尿微量白蛋白浓度均比正常对照组明显升高,差异有显著性（P〈0．05）,其中2型糖尿病组升高更显著。与血糖值水平有正相关性。结论：尿微量白蛋白检测在不同糖耐量受损中发现早期肾损伤方面有明确的意义。     

青年男性非酒精性脂肪肝患者糖耐量评价

目的观察30岁以下既往无糖尿病的非酒精性脂肪性肝病男性患者口服糖耐量试验,预测NAFLD与临床前期糖尿病的相关性。方法选择52例合并丙氨酸氨基转移酶升高的NAFLD年青男性患者,所有患者均行75g标准口服糖耐量实验,空腹血糖受损是指空腹血糖水平≥6.1mmol/L但<7mmol/L,糖耐量异常是指餐后2h血糖水平≥7.8mmol/L但<11.1mmol/L。结果 11(21%)名患者被诊断为空腹血糖受损,18(35%)名患者被诊断为糖耐量异常,6(12%)名患者被诊断为糖尿病,17(33%)名患者糖耐量正常。与糖代谢正常的NAFLD患者相比,体重指数、腰围、转氨酶水平、总胆红素、总胆固醇、甘油三酯、空腹血糖、HOMA-IR均有显著差异。结论建议对合并丙氨酸氨基转移酶升高的非酒精性脂肪肝患者,即使是年青病人,亦应行口服糖耐量实验来预测2型糖尿病的危险性。     

血清YKL-40水平对冠心病合并糖尿病患者的影响研究

目的 观察冠心病合并糖尿病患者血清YKL-40水平及与相关影响因素分析,探讨血清水平对冠心病合并糖尿病患者的影响.方法 选取在我科住院治疗患者120例,随机分为正常对照组、单纯冠心病组及冠心病合并糖尿病组,各40例,采取酶联免疫吸附法(Elisa)测定血清YKL-40水平,线性回归相关分析相关影响因素.结果 与正常对照组比较,冠心病组及冠心病合并糖尿病组YKL-40水平升高明显,差异有统计学意义(P＜0.05);冠心病合并糖尿病组YKL-40水平与年龄、FPG、TG、HbAIC等因素存在相关性,差异具有统计学意义(P＜0.05).结论 YKL-40可作为评估冠脉病变程度及血管壁炎症反应程度的重要指标;年龄、FPG、TG、HbAIC是其影响因素.     

2型糖尿病及糖尿病肾病患者C反应蛋白水平观察

目的观察C反应蛋白水平在2型糖尿病及糖尿病肾病患者时的浓度变化。方法将63例2型糖尿病患者分为糖尿病组(32例)和糖尿病合并肾病组(31例),而以正常体检健康人作为对照组(31例),测定各组的空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清C反应蛋白(CRP),将组间的C反应蛋白(CRP)进行统计学比较。结果糖尿病组及糖尿病并发肾病组血清C反应蛋白(CRP)均比正常对照组明显升高(P<0.01)。而糖尿病并发肾病组与糖尿病组相比亦明显升高(P<0.01)。结论CRP与糖尿病及其血管慢性并发症有关。     

Proteinuria associated with hypertension and diabetes mellitus

Proteinuria, a complication of both diabetes mellitus and hypertension, was compared in 2 genetically induced models: insulin-dependent diabetic BB rat (BB), and Okamoto-Aoki spontaneously hypertensive Wistar rats (SHR). Both disease states were clearly distinguished from each other and their respective age-matched controls by analysis of 24-hour urine samples for glucose, urobilinogen, bilirubin and total protein. Then individual protein components between 15,000 and 120,000 daltons were separated by molecular weight and quantitated by laser densitometric analysis. The results indicated that insulin-dependent diabetic BB rats excreted urine having elevation of glucose (100-250 mg/dl), bilirubin (0.05 +/- 0.03 mg/dl) and urobilinogen (6.6 +/- 3.8 Ehrlich units/dl) in contrast to all age-matched SHR and normotensive Wistar-Kyoto (WKY) and nondiabetic controls, which excreted urine having normal urobilinogen and no detectable glucose or bilirubin. Both SHR and insulin-dependent BB rats exhibited proteinuria, urinary protein excretion being increased approximately 4-5 times that of their age-matched controls. BB rats excreted 18.80 +/- 2.62 mg protein/day attributed to an increase in albumin and an entire array of proteins between 30,000 and 120,000 daltons not present in controls which primarily excreted proteins below 20,000 daltons. In the SHR, proteinuria did not include an array of proteins; the increase in excreted protein (39.20 +/- 16 mg/day) was primarily attributed to albumin and another protein having a higher molecular weight. The SHR urinary proteins were similar to proteins excreted by streptozocin-induced, noninsulin-dependent diabetic rats treated with the aldose reductase inhibitor sorbinil. If hypertension is associated with diabetic nephropathy, our preclinical results suggest that coadministration of sorbinil with antihypertensive therapy may promote a positive synergistic effect further diminishing proteinuria.     

糖尿病及其并发症患者血浆中左卡尼汀及其酰化物的含量分析研究

目的探究糖尿病及其并发症患者体内左卡尼汀(Lcarnitine,LC)、乙酰左卡尼汀(acetyl-L-carnitine,ALC)和丙酰左卡尼汀(propionyl-L-carnitine,PLC)的含量变化。方法复制柱前衍生化HPLC同时检测血浆中LC、ALC、PLC的含量的方法,检测并比较健康受试者、糖尿病患者以及糖尿病并发症患者(糖尿病视网膜病变、糖尿病肾病、糖尿病周围神经病变、糖尿病并高血压、糖尿病并冠心病)体内3种物质含量的变化。结果健康受试者、糖尿病患者以及糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病并高血压、糖尿病并冠心病患者血浆LC浓度分别为(41.01±8.05)μmol·L-1、(36.72±8.23)μmol·L-1、(33.31±6.26)μmol·L-1、(33.81±5.61)μmol·L-1、(33.57±6.67)μmol·L-1、(33.67±5.36)μmol·L-1、(32.87±6.05)μmol·L-1。糖尿病组的血浆LC浓度明显低于健康对照组(P<0.05),其他并发症组(糖尿病视网膜病变组、糖尿病肾脏病变组、糖尿病周围神经病变组、糖尿病并高血压和糖尿病并冠心病组)的LC浓度又明显低于糖尿病组,但各并发症的血浆LC浓度组间比较无差异(P>0.05),ALC和PLC的检测结果显示各组之间差异并没有显著性(P>0.05)。结论在中国健康受试者、DM患者以及并发症患者中,DM患者的LC血浆浓度低于健康受试者,糖尿病并发症患者LC的血浆浓度低于DM患者。     

Quetiapine-induced diabetes with metabolic acidosis

Medication adherence with antipsychotics is adversely impacted by the burden of untoward adverse effects. In particular, sexual side-effects may interfere with compliance, but are often underreported by patients. Sexual dysfunction related to hyperprolactinemia is commonly described, but ejaculatory disturbance due to potent alpha1 adrenergic antagonism may also occur, and has been reported frequently with certain typical antipsychotics such as thioridazine, but rarely with atypical antipsychotics. Presented here is the case of a 51 year old male with schizophrenia who developed retrograde ejaculation on high dose risperidone therapy (8 mg/day) with prompt resolution of symptoms upon dose reduction. The absence of decreased libido or erectile dysfunction indicates that alpha1 adrenergic antagonism and not low serum testosterone due to hyperprolactinemia is the etiology for this side-effect. This case illustrates another mechanism for sexual adverse effects, and the need for routine inquiry into sexual dysfunction during atypical antipsychotic therapy.     

Haemostatic variables associated with diabetes and its complications

To study the possible role of an "increased thrombotic tendency" in the vascular complications of diabetes several tests of haemostatic function were carried out on 91 men and 63 women with diabetes aged 35-54 years and the results compared with findings in 686 men and 393 women of the same age in the Northwick Park Heart Study. Mean values for factors VII and X, fibrinogen, and platelet adhesiveness were higher in the diabetics, but mean fibrinolytic activity and whole blood platelet counts were lower. Antithrombin III values were also higher in the diabetics, which may have constituted a protective response to other changes favouring the onset of vascular disease. Diabetics with retinopathy had higher factor VII and antithrombin III values, and those with proteinuria had higher values for factor VII, fibrinogen, and platelet adhesiveness than those without these complications. These findings suggest a potentially important association between a thrombogenic tendency and vascular disease in diabetes. Nevertheless, prospective data are needed to clarify whether the haemostatic abnormalities precede the onset of clinically manifest vascular complications or are a consequence of them.     

胰岛素个体化治疗

时至今日,新的降糖药物不断涌现,但胰岛素治疗仍是控制高血糖的重要手段,具有不可替代的作用。1型糖尿病患者需要胰岛素维持生命,也必须使用胰岛素控制高血糖。2型糖尿病患者虽然不需要胰岛素来维持生命,但由于口服降     

糖尿病对肺结核治疗的影响

目的观察糖尿病对肺结核抗痨疗效的影响。方法通过对36例肺结核患者糖尿病疗效的观察．分析肺结核患者病灶、空洞和痰菌变化情况。结果29铡糖尿病好转患者中，肺结核病灶吸收好转率、空洞缩小或关闭率、痰菌阴转率分别为96．6％、93.8％、92.9％；7例糖尿病恶化患者中，病灶好转吸收率仅为14．3％，无一例空洞缩小或关闭，痰菌持续阳性，2例死亡。两组病灶吸收率及痰菌隅转率差异有显著意义（P〈0．01）。结论糖尿病与肺结核互有不利影响，糖尿病治疗结果对肺结核患者预后有重要影响。因此．建议对所有肺结核及糖尿病患者常规进行血耱和胸部X线检查。