2 型糖尿病合并高血压患者发生心房颤动的相关因素分析

目的:探讨2型糖尿病合并高血压住院患者发生心房颤动的相关因素。方法:选取我院收治的2型糖尿病合并高血压发生心房颤动的患者112例为研究对象(房颤组,n=112例),同期选取与房颤组年龄及性别相匹配的未发生房颤的2型糖尿病合并高血压患者150例为对照组(n=150例),比较两组患者的一般临床资料、实验室检查指标等的差异,用Logistic回归方程分析患者并发房颤的相关因素。结果:与对照组比较,房颤组患者收缩压(SBP)较高,高血压比例高、服用ACEI/ARB类药物偏低(P0.05)、左室射血分数(LVEF)偏低(P0.05)、左房内径(LAD)长(P0.05)、甘油三酯(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)、血肌酐(Scr)、B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、尿酸均较高(P0.05);多因素Logistic回归方程分析提示:LAD、HbA1c、BNP、hs-CRP、尿酸是患者并发房颤的独立危险因素(P0.05),而服用ACEI/ARB类药物为保护性因素。结论:LAD、HbA1c、BNP、hs-CRP、尿酸均可能是2型糖尿病合并高血压患者发生心房颤动的独立危险因素。     

糖尿病合并急性心肌梗死患者PCI术后造影剂肾病的危险因素及SHI、HbA1c的预测价值研究

摘要 目的：探讨糖尿病合并急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后造影剂肾病（CIN）的危险因素,并分析应激性高血糖指数（SHI）和糖化血红蛋白（HbA1c）对CIN的预测价值。方法：选取2019年1月～2022年1月我院收治的102例接受PCI治疗的糖尿病合并AMI患者,根据PCI术后是否发生CIN分为CIN组26例和非CIN组76例。收集患者基线资料和计算SHI,采用单因素和多因素Logistic回归分析糖尿病合并AMI患者PCI术后CIN的影响因素,受试者工作特征（ROC）曲线分析SHI、HbA1c对糖尿病合并AMI患者PCI术后CIN的预测价值。结果：单因素分析显示,CIN组年龄大于非CIN组,高血压比例、Killip分级≥Ⅱ级比例和心肌肌钙蛋白T、N末端B型利钠肽前体（NT-proBNP）、超敏C反应蛋白（hs-CRP）、血糖、HbA1c、血尿酸、血尿素氮、血肌酐、SHI高于非CIN组,淋巴细胞计数、白蛋白、估算肾小球滤过率（eGFR）低于非CIN组（P＜0.05）。多因素Logistic回归分析显示,年龄增加、高血压、Killip分级≥Ⅱ级、NT-proBNP升高、白蛋白降低、hs-CRP升高、HbA1c升高、血肌酐升高、eGFR降低、SHI升高为糖尿病合并AMI患者PCI术后CIN的独立危险因素（均P＜0.05）。ROC曲线分析显示,SHI、HbA1c联合预测糖尿病合并AMI患者PCI术后CIN的曲线下面积大于两者单独预测的曲线下面积。结论：年龄增加、高血压、Killip分级≥Ⅱ级、NT-proBNP、hs-CRP、HbA1c、血肌酐、SHI升高及白蛋白、eGFR降低为糖尿病合并AMI患者PCI术后CIN的独立危险因素,SHI联合HbA1c对糖尿病合并AMI患者PCI术后CIN的预测价值较高。     

西格列汀对老年2型糖尿病合并轻中度慢性心衰患者hs-CRP及NT-proBNP的影响

目的:探讨使用西格列汀对老年2型糖尿病合并轻中度慢性心衰患者外周血超敏C反应蛋白(high-sensitivity C-reactive Protein,hs-CRP)、N-端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)的影响。方法:将我院90例老年2型糖尿病合并轻中度慢性心衰患者随机分成观察组和对照组分别46例和44例。两组患者均给予常规抗心衰治疗,对照组予以格列吡嗪控释片降糖,观察组予以西格列汀口服降糖治疗。检测试验前后患者血清hs-CRP及NT-proBNP的水平,并常规检测血压、血脂、糖化血红蛋白、血糖及肝肾功能等指标。结果:两组治疗后HbA1c水平与治疗前比较均有下降,差异均有统计学意义(P0.05);西格列汀组的hs-CRP、NT-proBNP水平治疗后分别下降至6.67±0.85 mg/L,1412.27±92.28 pg/m L,与治疗前比较差异均有统计学意义(P0.05);治疗后西格列汀组的hs-CRP、NT-proBNP水平与对照组比较差异有统计学意义(P0.05)。结论:2型糖尿病合并轻中度慢性心功能不全患者服用西格列汀除有效降糖外还能一定程度地降低hs-CRP和NT-proBNP水平,提示其潜在改善心脏功能的作用。     

糖化血红蛋白与糖尿病及其并发症的关系

目的:探讨糖化血红蛋白(HbAlc)与糖尿病诊断、疗效评价及并发症的关系。方法:选择2型糖尿病患者250例和健康体检者150例,分别测定空腹血糖(FPG)、2h血糖(2hPG)及糖化血红蛋白(HbA1c),统计学分析HbA1c与FPG、2hPG的相关性;分析HbA1c与糖尿病并发症发生的关系。结果:糖尿病组FPG、2hPG及HbA1c水平均显著高于对照组(P<0.01);糖尿病伴有并发症患者的HbAlc明显高于无并发症者(P<0.05),HbA1c水平与糖尿病并发症的发生率存在高度相关性(P<0.01)。结论:检测外周血中HbA1c水平对2型糖尿病诊断、疗效评价具有重要临床价值,控制糖化血红蛋白对预防糖尿病并发症的发生具有重要意义。     

不同糖代谢冠心病患者的糖化血红蛋白水平与冠状动脉病变的关系

目的：研究不同糖代谢冠心病患者的糖化血红蛋白（HbA1c）水平与和冠状动脉病变的关系。方法：选取2013 年5 月到2014 年5 月我院收治的冠心病患者100 例,分为糖代谢正常组、异常组和糖尿病组。分析三组患者的HbA1c 水平、冠状动脉狭窄程度 及冠状动脉病变指数之间的关系和冠状动脉病变的危险因素。结果：三组患者的冠状动脉狭窄程度、冠状动脉病变支数、空腹血 糖（FPG）、餐后2 小时血糖（2hPG）、HbA1c 和三酰甘油（TG）水平比较,差异具有统计学意义（P<0.05）;HbA1c 水平与冠状动脉狭 窄程度呈正相关（P<0.05）;Logistic 结果显示年龄、性别、高血压、HbA1c、FPG、总胆固醇（TG）和高密度脂蛋白胆固醇（HDL-C）是 冠状动脉病变的危险因素（P<0.05）。结论：HbA1c 水平和冠状动脉病变具有相关性,是影响冠状动脉病变的重要危险因素。     

2型糖尿病眼底增殖改变与冠状动脉病变关系的研究

目的:探讨2型糖尿病眼底增殖改变与冠状动脉病变的关系.方法:对330例2型糖尿病合并冠心痛患者进行眼底检测及冠状动脉造影,根据眼底是否具有增殖性改变进行对比分析,并应用多因素分析方法探讨与眼底增殖改变相关的危险因素.结果:2型糖尿病伴眼底增殖改变者,年龄较大,病程较长,尿微量白蛋白阳性检出率增加,TG、TC及HbA1c显著性升高;多支血管病变及钙化病变受累比例增高;Logistic回归分析显示,经调整糖尿病病程、HbA1c、微量白蛋白尿后,2型糖尿病眼底增殖改变仍与冠状动脉钙化相关.结论:2型糖尿病眼底增殖改变与冠状动脉钙化相关.     

血清LPA、AngII及β2-MG在老年2型糖尿病患者病情监控中的作用及其与胰岛素抵抗的相关性分析

摘要 目的：分析血清溶血磷脂酸（LPA）、血管紧张素II（AngII）及β2-微球蛋白（β2-MG）在老年2型糖尿病患者病情监控中的作用及其与胰岛素抵抗的相关性。方法：选择我院自2020年1月至2023年6月收治的106例老年2型糖尿病患者作为观察组,其中34例患者并发肾病（糖尿病肾病组）,72例患者不并发肾病（单纯糖尿病组）;另选106例健康体检者作为对照组。检测所有入选者血清LPA、AngII及β2-MG表达水平,使用多因素Logistic 回归分析血清LPA、AngII及β2-MG与老年2型糖尿病患者并发肾病的关系,Pearson相关性分析血清LPA、AngII及β2-MG表达水平与空腹血糖（FPG）、餐后2 h血糖（2hPG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）的关系。结果：观察组血清LPA、AngII、β2-MG表达水平均高于对照组（P＜0.05）;糖尿病肾病组血清LPA、AngII、β2-MG表达水平均明显高于单纯糖尿病组（P＜0.05）;经多因素Logistic 回归分析,血清LPA、AngII及β2-MG均是老年2型糖尿病患者并发肾病的独立预测因素（P＜0.05）;观察组FPG、2hPG、FINS、HbA1c表达水平均高于对照组,HOMA-IR大于对照组,HOMA-β小于对照组（P＜0.05）;经Pearson相关性分析,老年2型糖尿病患者血清LPA、AngII及β2-MG均与FPG、2hPG、FINS、HbA1c、HOMA-IR呈正相关（P＜0.05）,与HOMA-β呈负相关（P＜0.05）。结论：血清LPA、AngII及?茁2-MG表达水平升高对老年2型糖尿病患者的病情监控具有一定作用,且均与胰岛素抵抗程度密切相关,值得进一步研究应用。     

维吾尔族2 型糖尿病患者糖尿病肾病相关因素分析

目的:探讨维吾尔族2型糖尿病肾病(DN)发病的相关临来因素。方法:分析292例维吾尔族2型糖尿病患者的临床资科。结果:维吾尔族2型糖尿病患者糖尿病肾病(DN)发病率为43.49%(127/292)。DN患者的病程、SBP、TC、TG、FBG、HbAIC、LDL-C、BUN和Cr均显著高于NDN患者(P<0.05);但DBP、HDL-C、BMI之间无统计学差异(P>0.05)。Logistic归分析结果显示,DM病程、患病年龄、SBP、FBP、TC、TG、LDL-C、HbA1c、BUN、Cr是DN的危险因素(OR值>1)。结论:维吾尔族2型糖尿病患者的DM病程、患病年龄、SBP、FBP、TC、TG、LDL-C、HbA1c、BUN、Cr等参数与糖尿病肾病并发率之间有相关性。     

血清Fractalkine、Apelin水平与糖尿病视网膜病变患者血糖、血脂以及病程的关系研究

目的:研究血清Fractalkine(FKN)、爱帕琳肽(Apelin)水平与糖尿病视网膜病变(DR)患者血糖、血脂以及病程的关系。方法:选取我院于2015年1月至2016年12月收治的160例糖尿病患者为研究对象,行眼底荧光造影、裂隙灯显微镜检查,按照检查结果将其区分为非增生型DR组(稳定组,43例)、背景期DR组(背景组,62例)和增殖期DR组(增殖组,55例),另外于同期选取我院40例健康体检者为健康对照组(健康组),测量4组血清FKN、Apelin、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、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)和总胆固醇(TC)水平,使用Pearson相关性分析分析血清FKN、Apelin与FPG、2hPG、HbA1c、HDL-C、LDL-C、TG、TC、糖尿病病程的相关性。结果:血清FKN、Apelin水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清FPG、2hPG、HbA1c、LDL-C、TG、TC水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清HDL-C水平比较:健康组稳定组背景组增殖组,各组间比较差异具有统计学意义(P0.05);采用Pearson相关性分析显示,血清FKN水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.321、0.215、0.645、0.154、0.215、0.325、0.578,P0.05),与HDL-C呈负相关性(r=-0.547,P0.05);血清Apelin水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.245、0.574、0.951、0.357、0.357、0.159、0.546,P0.05),与HDL-C呈负相关性(r=-0.459,P0.05);糖尿病病程、HbA1c、LDL-C、HDL-C、FKN和Apelin为DR病程的相关影响因素。结论:糖尿病伴发DR患者血清FKN、Apelin水平随着病程的加重逐渐增加,且这两种因子的水平与患者血糖、血脂代谢关系密切。     

2型糖尿病合并非酒精性脂肪肝患者的临床特征及与慢性并发症的关系研究

目的:探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者的临床特征,并分析其与糖尿病慢性并发症的关系。方法:选取2016年1月至2017年1月期间来我院就诊的T2DM患者245例作为研究对象,根据肝胆超声和生化检查结果,将单纯T2DM患者105例作为对照组,将T2DM合并NAFLD患者140例作为观察组,对比两组的一般情况和生化指标,并采用单因素和多因素Logistic回归分析T2DM合并NAFLD与大血管慢性病的关系。结果:与对照组比较,观察组病程较短,HDL-C水平较低,BMI、SBP、TC、TG、LDL-C、ALT、AST、HbA1c、FINS、INS-120、HOMA-IR、FPG、2 h PG、空腹C肽、餐后2 h C肽水平较高(P0.05)。观察组大血管发病率明显高于对照组(P0.05)。Logistic回归分析结果显示,T2DM合并NAFLD患者合并大血管慢性病的影响因素依次是:BMI、HOMA-IR、SBP、LDL-C、HbA1c、TG。结论:合并NAFLD的T2DM患者糖尿病大血管慢性病发病率显著增加,合并NAFLD的影响因素依次为BMI、HOMA-IR、SBP、LDL-C、HbA1c、TG。     

Association of NT-proBNP and multiple biomarkers with severity of angiographic coronary artery disease in diabetic and pre-diabetic Chinese patients

Background

Little is known about the plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), and the relationship between the severity of coronary heart disease (CHD) with NT-proBNP and multiple biomarkers in diabetic and pre-diabetic patients, compared to individuals with normal glucose levels.

Methods

Four hundred and fifteen consecutive Chinese patients of both sexes were assigned to three groups on the basis of the new hemoglobin (Hb) A1c (HbA1c) cut-off points for diagnosis of diabetes and pre-diabetes. The three groups were divided into tertiles according to NT-proBNP, hs-CRP, cystatin C, and troponin T levels. Gensini scores were compared among the three groups and biomarker tertiles. Receiver operating characteristic (ROC) curves were used to obtain the angiographic CHD cut-off points for each biomarker. Stepwise multivariate linear correlation analysis was applied to examine the association between the severity of CHD and biomarker levels.

Results

Gensini scores increased with increasing biomarker tertile levels and HbA1c. Gensini scores were significantly different in the middle and upper NT-proBNP tertiles of the diabetic, pre-diabetic and control groups. NT-proBNP had the highest positive and negative predictive values and area under the curve for CHD. Only NT-proBNP was identified as an independent variable for Gensini score.

Conclusions

Plasma NT-proBNP may be an important biomarker to evaluate the severity of CHD and screen for CHD in diabetic or pre-diabetic patients.     

Reversibility of autonomic nerve function in relation to rapid improvement of glycemic control.

To determine the reversibility of autonomic nerve function in relation to the rapid improvement of glycemic control, we studied 54 patients with type 2 diabetes mellitus (33 men and 21 women; mean age, 49+/-8 years; mean duration of diabetes, 10+/-7 years). For 4 weeks of admission, the subjects were placed on strict dietary therapy, and 10 of them were under dietary therapy, 16 initially continued treatment with oral hypoglycemic agents, while 28 were treated with insulin. We measured the dark-adapted pupillary area (DAPA) by infrared photography, an indicator of diabetic autonomic neuropathy, on the second and 28th day after hospitalization. The change in FPG (delta FPG = - 111+/-49 mg/dl; mean +/- SD, p<0.001) and the change in HbA1c (delta HbA1c = -1.3+/-0.3%, p<0.001) were significantly improved. We observed significant improvements in the change in DAPA (delta DAPA) of all patients (25.1+/-11.0 vs. 25.7+/-11.6 mm2, delta DAPA = 0.6+/-1.4 mm2, p<0.01) and in those of patients without retinopathy (delta DAPA = 1.0+/-0.6 mm2, p<0.01). No change was observed in those of patients with retinopathy (delta DAPA= -0.02+/-0.3 mm2, NS). The delta DAPA was related to the delta HbA1c (r = -0.479, p<0.001) and also to the diabetic duration (years, r = -0.517, p<0.001). These findings suggest that a rapid improvement of glycemic control improves autonomic nerve function observed in type 2 diabetes with shorter duration. Particular attention should be paid to maintaining strict glycemic control at the stage of diabetic patients without retinopathy and those with shorter duration.     

Increased serum levels of interleukin-18 in patients with diabetic nephropathy

In the present study we measured interleukin-18 (IL-18) and tumour necrosis factor-alpha (TNF-alpha) levels by enzyme linked immunosorbent assay (ELISA) in sera from 65 diabetic [30 with type 1 insulin dependent diabetes mellitus (IDDM) and 35 with type 2 non-insulin dependent diabetes mellitus (NIDDM)] patients and 15 healthy volunteers, to investigate their associations with metabolic parameters and to elucidate their roles in the pathogenesis of diabetic complications especially diabetic nephropathy. Levels of IL-18 and TNF-alpha were significantly higher in both IDDM and NIDDM individuals as compared to the control group. Similarly, their levels in patients with diabetic nephropathy increased gradually according to the clinical stage of the disease, being highest in macroalbuminuric stage. Correlation analyses showed that the serum IL-18 and TNF-alpha concentration were positively correlated with each other and positively with fasting plasma glucose (FPG), 2h postprandial glucose, glycosylated hemoglobin (HbA1c), triglyceride, and urinary albumin levels and negative correlation between TNF-alpha and high density lipoprotein cholesterol (HDL-C) were also found in diabetic subjects. High serum levels of IL-18 and TNF-alpha suggested that they might play a role in the pathogenesis of DM and in the development of nephropathy in diabetic patients whether of type 1 or 2.     

Dietary Fiber Intake Is Associated with HbA1c Level among Prevalent Patients with Type 2 Diabetes in Pudong New Area of Shanghai,China

Background

Dietary factors play an important role in glycemic control in diabetic patients. However, little is known about their effects among Chinese diabetic patients, whose diets are typically abundant in fiber and high in glycemic index (GI) values.

Methodology/Principal Findings

934 patients with type 2 diabetes and 918 healthy volunteers from Pudong New Area, Shanghai, China, were interviewed during the period of Oct-Dec, 2006 to elicit demographic characteristics and lifestyle factors. Dietary habits were assessed using a validated food frequency questionnaire. Anthropometric measurements, bio-specimen collection and biochemical assays were conducted at the interview according to a standard protocol. In this population, diabetic patients consumed lower levels of energy and macronutrients but had higher levels of fasting plasma glucose (FPG), glycolated hemoglobin A1c (HbA1c), triglyceride and body mass index than healthy adults. While the average consumption levels of the nutrients among diabetic patients did not vary along duration of the disease, the average levels of FPG and HbA1c increased with increasing duration. Regardless of diabetes duration, HbA1c level was observed lower in patients having a higher fiber or lower GI intake. Compared with those with the lowest tertile intake of fiber, the adjusted odds ratios (ORs) for poor glycemic control reduced from 0.75 (95%CI: 0.54–1.06) to 0.51 (95%CI: 0.34–0.75) with increasing tertile intake (P for trend <0.001).

Conclusions

Dietary fiber may play an important role in reducing HbA1c level. Increasing fiber intake may be an effective approach to improve glycemic control among Chinese diabetic patients.     

2型糖尿病性视网膜病变临床因素分析

目的:探讨影响2型糖尿病视网膜病变(DR)发病的相关临床因素。方法:回顾性分析483例2型糖尿病患者的临床资料。结果:2型糖尿痛DR患病率为35%(169/483),其中非增殖型视网膜病变(NPDR)73.4%(124/169),增殖型视网膜病变(PDR)26.6% (45/169)。DR患者的病程、SBP、合并肾脏病变、合并心脏病变、HbA1c、TC、TG、LDL-c、BUN和Cr均显著高于NDR患者(P<0.05);Logistic回归分析显示病程、年龄、SBP、TC、LDL-c、合并心脏病变和/或肾脏病变是DR发病的危险因素。结论:DM病程、患病年龄、SBP、HbA1c、TC、LDL-c、合并心脏病变和/或肾脏病变、肾功能是DR发生发展的危险因素。     

Clinical Factors Associated With the Diagnosis and Progression of Diabetic Nephropathy

As an important complication of diabetic mellitus, diabetic nephropathy (DN) has been the main cause of end-stage renal disease. It is of great importance to diagnose DN early, and to identify the risk factors of disease progression in order to carry out in-time and effective therapies. Previous literatures have reported the role of several clinical factors in the diagnosis and progression of DN, including age, longer diabetes duration, diabetic retinopathy, higher level of hypertension and HbA1c, and so on. However, the significance of these clinical factors is still controversial and limited. This review aimed to evaluate the values and limitations of these factors in diagnosing and predicting the renal outcome of DN.     

血清sST2在心力衰竭诊断、预后中的应用价值

心力衰竭(心衰)的发病率正随着人口老龄化的加速而显著上升,目前仍然是一个重大的公共健康问题。尽管近年来在心衰治疗方面取得了显著成效,但患者的生存率依旧很低,预后差,确诊心衰后5年内死亡率高达50%。如果能够对心衰进行快速有效的诊断并按危险程度进行合理分层,将为临床医生制定治疗方案提供重要的参考依据。生物标志物在心衰的诊断、疗效评估及预后判断方面都具有重要的意义。心力衰竭是一种复杂的疾病,涉及多种生理病理过程。心力衰竭时,神经内分泌系统被激活,同时伴随着血容量和心室壁压力增加,心室肌细胞分泌NT-proBNP/BNP,因此,其可作为心衰诊断和预后生物标志物。然而血浆中NT-proBNP/BNP易受到年龄、性别、体型、左室肥大、心动过速、右心室过载、低氧血症、肾脏功能等诸多因素影响。sST2作为一种新型心力衰竭标志物,近年来备受关注,它不仅能够反映心肌纤维化程度并预测是否发生心室重构,且不受年龄、性别、肾功能等因素的影响,同时具有更低的参考变化值和个体指数,更适合用于连续监测和指导治疗,是评价心力衰竭的理想指标之一。文中对近年来sST2在心衰诊断和预后方面的研究进展进行总结归纳,并对其发展...