2型糖尿病家族史对患者及其同胞患病影响的分析

目的：分析明确的2型糖尿病家族史对患者及其同胞患病的影响。方法：收集我院内分泌门诊4年来就诊的具有明确糖尿病家族史的2型糖尿病患者143例,对患者的父母、同胞进行糖尿病患病情况调查,并对调查结果进行统计学分析。结果：（1）在143例糖尿病患者中,来自糖尿病母亲家族史的占55．6％,来自糖尿病父亲家族史的占31．0％,两者有显著差异（P〈0．01）。（2）具有糖尿病家族史的同胞兄弟姐妹中,二人或多人患病的比例高达52．4％。结论：（1）来自糖尿病母亲的家族史对子代糖尿病患病的影响超过父亲。（2）2型糖尿病具有明显的家族聚集性。     

单中心研究2型糖尿病合并高血压的相关危险因素

目的:探讨2型糖尿病合并高血压的相关危险因素。方法:186例2型糖尿病患者分为并发高血压组(A组136例)患者和正常血压组(B组50例),对其进行问卷及体格检查,分别观察患者性别、年龄、病程、体重指数、腰围、腰臀围比(WHR)、高血压家族史、糖尿病家族史并加以分析。结果:A组患者占73.1%;两组间性别、年龄、病程差异无统计学意义(P>0.05),A组患者体重指数(BMI)、腰臀围比(WHR)、腰围、高血压家族史比例显著高于B组患者(P<0.05～<0.01),B组糖尿病家族史比例显著高于A组(P<0.05)。结论:高的BMI、腰围、腰臀围比(WHR)以及高血压家族史增加2型糖尿病合并高血压发生的危险。     

恶性肿瘤患者化疗前后血糖变化的临床观察

目的:探讨化疗对恶性肿瘤患者血糖的影响。方法:取江苏省溧水县人民医院2008年1月~2011年3月收治的153例恶性肿瘤患者,采取回顾性分析方法对合并2型糖尿病的患者比例,以及化疗前、化疗中、化疗后血糖变化情况进行临床观察。结果:153例患者中,化疗前诊断糖尿病者占9.15%(14/153),未诊断糖尿病者139例,13.67%(19/139)化疗后空腹血糖升高,其中糖耐量异常者11人,占7.91%(11/39),诊病者5人,占3.60%(5/139),一过性血糖升高3人,占2.16%(3/153)。结论:恶性肿瘤患者接受化疗可以引起血糖升高,甚至出现糖耐量异常或2型糖尿病,需进一步分析原因,探索该现象与恶性肿瘤患者治疗效果和预后的关系。     

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。     

化疗对恶性肿瘤患者的血糖影响的初步观察

目的:探讨化疗对恶性肿瘤患者血糖的影响。方法:取我院2005年3月至2006年12月收治的恶性肿瘤患者155例。回顾性分析其化疗前后的血糖变化情况及相关临床资料。结果:155例患者中,化疗后空腹血糖升高者占13．55%(21/155),其中糖耐量低减8人,占5．16%(8/155);诊断为糖尿病者7人,占4．52%(7/155);一过性血糖增高6人,占3．87%(6/155)。各患者化疗前后血糖值的变化有统计学意义(p＜0．05)。结论:恶性肿瘤患者接受化疗后可引起血糖增高,甚至发生糖耐量低减或2型糖尿病,且多发生于化疗的第3～4周期。     

200例先天性尿道下裂患儿的临床特征及其危险因素分析

目的:研究200例先天性尿道下裂患儿的临床特征及其危险因素。方法:选择2016年1月~2019年12月我院收治的先天性尿道下裂患儿200例进行研究,记作观察组,另取同期于我院接受体检的健康儿童200例作为对照组,分析观察组患儿的临床分型情况,比较两组儿童父母的一般情况、儿童出生情况,并采用多因素Logistic回归分析先天性尿道下裂的影响因素。结果:200例先天性尿道下裂患儿临床分型按照占比从高到低的顺序依次为阴茎体型46.50%(93/200)、阴茎阴囊型28.00%(56/200)、冠状沟型17.00%(34/200)、阴囊型4.50%(9/200)、阴茎头型3.00%(6/200)、会阴型1.00%(2/200)。观察组父亲生活性接触化学物、母亲流产史、母亲孕期饮食缺乏肉类、母亲孕期饮食缺乏鱼类、母亲孕期应用保胎药、母亲孕期吸烟或被动吸烟人数占比均高于对照组(均P<0.05)。观察组早产、低出生体重人数占比高于对照组(均P<0.05)。经多因素Logistic回归分析显示,父亲生活性接触化学物、母亲流产史、母亲孕期饮食缺乏肉类、母亲孕期饮食缺乏鱼类、母亲孕期应用保胎药、母亲孕期吸烟或被动吸烟、早产、低出生体重均是先天性尿道下裂的危险因素(均P<0.05)。结论:先天性尿道下裂患儿临床分型以阴茎体型为主,双亲不良生活习惯、化学物接触史以及早产、低出生体重均是先天性尿道下裂的危险因素,值得临床重点关注。     

2 型糖尿病与干眼症的相关性研究及其危险因素分析

目的:探讨2型糖尿病和干眼症的关系并分析2型糖尿病发生干眼症的危险因素。方法:纳入2型糖尿病患者220例为观察组和健康人群50例为对照组,采集所有研究对象眼表失衡指数(OSDI)、泪膜破裂时间(TBUT)、泪液分泌试验(SIt),以及观察组性别、年龄、糖尿病病程、血糖、Hb A1c、HOMA-IR、血清CRP,对比分析两组患者干眼症发病率及干眼症症状,采用多因素Logistic回归分析影响2型糖尿病发生干眼症的危险因素。结果:对照组干眼症发病率(9/100,9.00%)明显低于观察组(108/440眼,24.52%)(P0.05)。观察组OSDI评分明显高于对照组(P0.05)。观察组TBUT、SIt明显小于对照组,两组间差异有统计学意义(P0.05)。性别、年龄、糖尿病病程、OSDI、TBUT、SIt、Hb A1c和2型糖尿病患者发生干眼症具有一定的相关性(P0.05)。年龄、糖尿病病程、TBUT、Hb A1c是2型糖尿病患者发生干眼症的危险因素(B0,OR1)。结论:2型糖尿病和干眼症具有一定的相关性,糖尿病患者年龄、糖尿病病程、血糖控制水平是2型糖尿病发生干眼症的独立危险因素。     

330例2型糖尿病患者死因分析

目的:通过对80年代、90年代及近6年(2000-2006)我院2型糖尿病患者死因的比较,探讨分析糖尿病患者的死亡原因及其变迁,为提高糖尿病防治水平,减少糖尿病死亡率提供科学依据。方法:采用回顾性调查方法对我院1983-2006年住院2型糖尿病患者死因进行分析,并分三阶段进行比较。共调查2型糖尿病死亡病例330例。结果:不同年代心脑血管疾病均是导致2型糖尿病患者死亡的主要原因,位居死因第一,占总死亡人数的38.2%。肿瘤作为2型糖尿病患者的死因所占比例明显增加,占总死亡人数的19.4%。以感染为直接死因逐渐下降,但仍为重要死因,占14.2%。而糖尿病酮症酸中毒、高渗昏迷和低血糖昏迷等急性并发症所占比例显著减少,占8.8%。结论:糖尿病慢性并发症尤其是心脑血管病变是2型糖尿病的主要死因,近年来肿瘤已经成为2型糖尿病患者的重要死因,以感染为直接死因逐渐下降,但仍为重要死因,而糖尿病酮症酸中毒、高渗昏迷和低血糖昏迷等急性并发症所占比例显著减少。     

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。     

温州地区2型糖尿病患者线粒体DNA 3243、3316位点的突变筛查

为了解浙江省温州地区2型糖尿病病人中线粒体DNA tRNALeu (UUR)基因A3243G及NADH 脱氢酶亚单位1 (ND1)基因G3316A位点突变的发生频率, 并探讨突变与2型糖尿病主要临床指标出现的相关性。对随机收集的无血缘关系的244例温州地区2型糖尿病患者进行研究, 同时选择156例无 DM 家族史的糖耐量正常者作为对照组, 用聚合酶链反应及限制性片段长度多态性分析技术进行点突变筛选, 筛选到的异质性突变样本经T-A克隆后再作测序和变性高效液相色谱(DHPLC)确证。结果在244例的2型糖尿病患者中检出A3243G突变1例(0.410%), 156例对照者中未检出该突变, 突变发生率在两组间差异无统计学意义(P>0.05); 2型糖尿病患者中检出G3316A突变4例(1.639%), 156例对照者中检出突变2例(1. 282%), 突变发生率在两组间差异无统计学意义(P>0.05)。结果表明线粒 体tRNALeu (UUR) 基因A3243G突变在浙江温州2型糖尿病人群中发生频率低, 不是温州人群中2型糖尿病的常见病因。线粒体ND1基因G3316A突变在糖尿病人群中的发生频率也较低, 且在正常人群中也有出现, 可能仅为人群中线粒体DNA的基因多态性。     

Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM).Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM.Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household.Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence.Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus     

Investigating Maturity Onset Diabetes of the Young

Maturity Onset Diabetes of Young (MODY) is a monogenic and autosomal dominant form of diabetes mellitus with onset of the disease often before 25 years of age. It is due to dysfunction of pancreatic ß cells characterised by non-ketotic diabetes and absence of pancreatic auto-antibodies. It is frequently mistaken for type 1 or type 2 diabetes mellitus. Diagnosis of MODY is important as the GCK subtype has better prognosis and may not require any treatment. Subtypes HNF1A and HNF4A are sensitive to sulfonylureas, however diabetes complications are common if not treated early. Moreover, there is genetic implication for the patient and family. Rare MODY subtypes can be associated with pancreatic and renal anomalies as well as exocrine dysfunction of the pancreas. So far there are six widely accepted subtypes of MODY described but the list has grown to nine. Although the majority of diabetes mellitus in youth remains type 1 and the incidence of type 2 is rising, MODY should be considered in patients with non-ketotic diabetes at presentation, and in patients with a strong family history of diabetes mellitus without pancreatic auto-antibodies. Furthermore the diagnosis must be confirmed by molecular studies. With advancement in genomic technology, rapid screening for MODY mutations will become readily available in the future.     

Clinical differences between patients with MODY-3, MODY-2 and type 2 diabetes mellitus with I27L polymorphism in the HNF1α gene

ObjectiveThe aim of our study was to describe and evaluate the clinical and metabolic characteristics of patients with MODY-3, MODY-2 or type 2 diabetes who presented I27L polymorphism in the HNF1α gene.MethodsThe study included 31 previously diagnosed subjects under follow-up for MODY-3 (10 subjects from 5 families), MODY-2 (15 subjects from 9 families), or type 2 diabetes (6 subjects) with I27L polymorphism in the HNF1α gene. The demographic, clinical, metabolic, and genetic characteristics of all patients were analyzed.ResultsNo differences were observed in distribution according to sex, age of onset, or form of diagnosis. All patients with MODY-2 or MODY-3 had a family history of diabetes. In contrast, 33.3% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene had no family history of diabetes (p < 0.05). No differences were observed in body mass index, prevalence of hypertension, or microvascular or macrovascular complications. Drug therapy was required by 100% of MODY-3 patients, but not required by 100% of MODY-2 patients or 16.7% of patients with type 2 diabetes mellitus and I27L polymorphism in the HNF1α gene (p < 0.05).ConclusionsOccasional difficulties may be encountered when classifying patients with MODY-2, MODY-3 or type 2 diabetes of atypical characteristics, in this case patients who present I27L polymorphism in the HNF1α gene.     

Secretin-stimulated amylase release into blood is impaired in type 1 diabetes mellitus.

BACKGROUND: Prior studies have provided data indicating the existence of close interaction between pancreatic endocrine and exocrine function, but few clinical studies have explored this relationship in depth. We compared pancreatic exocrine function non-endoscopically in individuals with type 1 diabetes mellitus, type 2 diabetes mellitus, and normal glucose tolerant controls, to assess the importance of local insulin production to pancreatic exocrine function. METHODS: The plasma amylase response to intravenous secretin challenge was measured in men with type 1 diabetes mellitus (n = 5), type 2 diabetes mellitus (n = 5), and normal controls (n = 3). Patients were characterized by their urinary excretion of c-peptide and albumin over 24 hours. Autonomic neuropathy was non-invasively assessed by measuring RR variation (with deep respiration on EKG). RESULTS: Post-secretin amylase responses were generally absent with low baseline levels in the patients with type 1 diabetes mellitus. Patients with type 2 diabetes mellitus and controls showed similar twofold increases over baseline after secretin administration. When normal glucose tolerant and type 2 diabetic patients were pooled and compared against type 1 diabetes mellitus, the differences were statistically significant (p < 0.03). Total amylase response correlated positively, but weakly, with 24 h urinary C-peptide excretion (r = 0.507; p < 0.112), but not with glycemic control, duration of diabetes, or indices of autonomic neuropathy. CONCLUSIONS: Patients with type 1 diabetes mellitus, but not type 2 diabetes mellitus, have reduced pancreatic exocrine function, supporting the concept of a local paracrine effect of insulin on pancreatic acinar cells. Further studies are needed to determine the clinical impact of this deficiency, and whether such patients with type 1 diabetes mellitus would benefit from therapy with pancreatic enzyme supplementation.     

Adiponectin concentrations as a criterion of metabolic control in persons with type 2 diabetes mellitus?

Adiponectin (ADP) is an adipocytokin with many antiatherogenic properties; its decreased level is associated with numerous atherogenic diseases and syndromes (e.g. diabetes mellitus (DM), dyslipidemia, endothelial dysfunction, hypertension, and obesity). Decreased ADP values in blood may be an independent risk factor of atherosclerotic (ATS) complications. AIM OF THE STUDY: 1) Do persons with type 2 diabetes have lower ADP values than individuals without DM but with a high risk of ATS complications? 2) Do ADP values differ between persons with well controlled and persons with uncontrolled type 2 diabetes? We examined 109 patients of the Metabolic Center of Hospital Sternberk. Out of them, 58 had type 2 diabetes, others were individuals with variously expressed risk factors of early atherosclerosis (obesity, hypertension, age, family history, smoking, dyslipidemia, etc.). In all persons under this study the following parameters were determined in peripheral venous blood: adiponectin, resistin, leptin, ObRe, cholesterol, HDL-cholesterol, triacylglycerols, glucose, HbA1c, creatinine, urea, ALT, AST, CRP, homocysteine, thrombocyte aggregation after CPG induction. The whole group was divided according to the presence of type 2DM into two subgroups; persons with diabetes were divided into the well controlled and uncontrolled subgroups. All data obtained were processed statistically using the software SPSS for Windows and Medcalc. The adiponectin/BMI index correlated negatively with HbA1c value (correlation coefficient -0.37, p = 0.00053), triacylglycerols (-0.4, p = 0.000001), P-glucose (-0.3, p = 0.0017), uricemia (-0.35, p = 0.0007) and positively with HDL-cholesterol value (0.6, p=0.00001). Women had higher adiponectin values than men. Persons with hypertension and with diabetes mellitus, individuals with atherogenic lipotype or persons with inflammation signs had lower values than individuals without these diseases and syndromes. Persons with wellcontrolled diabetes mellitus had higher values than persons with uncontrolled diabetes (medians of the adiponectin/BMI index 9.7 vs. 6.7, p < 0.01). Persons with type 2 diabetes mellitus have lower ADP values than persons with a high ATS risk without diabetes mellitus. Persons with wellcontrolled diabetes mellitus (DM) and with satisfactory compensation have significantly higher ADP levels (independently of other metabolic parameters of DM control). ADP may be a new marker of metabolic control in persons with a high risk of atherosclerotic complications.     

Type 2 diabetes in children: clinical aspects and risk factors

In the past, type 2 diabetes mellitus was considered a disease of adults and older individuals, not a paediatric condition. Over the last decade, however, in the USA and the rest of the world there has been a disturbing trend of increasing cases of type 2 diabetes in children, mirroring increasing rates of obesity. The risk factors for paediatric type 2 diabetes are: (1) obesity and increased body mass index; (2) family history of type 2 diabetes; (3) membership of ethnic minority; (4) puberty (mean age of diagnosis is approximately 13.5 years); (5) female gender; and (6) features of 'syndrome X'. The common link among these risk factors is insulin resistance, which plays a pivotal role in the pathophysiology of type 2 diabetes. Both insulin resistance and beta-cell failure are present in the fully established diabetes state. Data will be presented on how these risk factors impact on insulin sensitivity and insulin secretion in childhood, ultimately leading to type 2 diabetes. The clinical presentation of type 2 diabetes in children and its distinction from type 1 diabetes will be discussed.     

Lipodystrophy of the extremities. A dominantly inherited syndrome associated with lipatrophic diabetes.

A female patient with the following symptoms has been observed: complete absence of subcutaneous fat on the arms and legs, well developed adipose tissue on the trunk and face, severe hyperlipidemia, eruptive xanthomas, insulin resistant diabetes mellitus with lack of ketoacidosis, hepatomegaly and elevated basal metabolic rate. The patient thus exhibited all characteristics of lipatrophic diabetes (Lawrence type of diabetes). The mother and a sister of the patient were found to have the same peculiar appearance and a slight hyperlipidemia but no diabetes mellitus. The combination of this type of partial lipodystrophy with severe hyperlipidemia, insulin resistant diabetes mellitus without ketoacidosis and elevated basal metabolic rate was further observed in 2 unrelated patients without known familial occurrence. Thus partial lipodystrophy of the extremities is another, previously undescribed, syndrome associated with the Lawrence type of diabetes mellitus. In the 1 family the syndrome of lipodystrophy and hyperlipidemia is dominantly inherited. Besides the autosomal recessively inherited syndrome of congenital generalized lipodystrophy there is a heterogenous group of dominantly inherited syndromes with various types of lipodystrophy.     

SLC30A8 基因rsl3266634 多态性与内蒙古地区汉族人群2 型糖尿 病的相关性研究

目的:研究内蒙古地区汉族人群SLC30A8(solute carrier family 30,member 8)基因rsl3266634单核苷酸多态性(Single nucleotide polymorphism,SNP)的等位基因和基因型频率分布与2型糖尿病(Type 2 diabetes,T2DM)的相关性。方法:采用等位基因特异性聚合酶链式反应(AS-PCR),对222例内蒙古地区汉族人(其中T2DM组125例,正常对照NC组97例)rsl3266634进行基因分型。结果:T2DM组中rsl3266634的C等位基因频率、CC基因型频率分别为61.2%和28.4%,均显著高于NC组的53.1%和24.7%(P值均<0.05);而T2DM组的TT基因型频率为6.4%,显著低于NC组的18.6%(P<0.05)。C等位基因携带者患T2DM的风险是T等位基因的1.64倍(OR=1.64,95%CI=1.125-2.402)。结论:SLC30A8基因rsl3266634多态性位点的C等位基因可能是T2DM的风险等位基因,该位点C/T多态性与内蒙古地区汉族人群T2DM具有相关性,可能是内蒙古地区汉族人T2DM的易感基因之一。     

膀胱尿路上皮肿瘤合并2型糖尿病患者临床和病理特点的比较性研究

目的:对比分析膀胱尿路上皮肿瘤合并2型糖尿病患者的临床和病理特点,为临床诊疗工作提供一定的参考。方法:回顾性分析2015年1月至2019年2月于我院泌尿外科手术治疗且经病理确诊为原发性膀胱尿路上皮肿瘤的患者资料,合并2型糖尿病的膀胱肿瘤患者59例设为糖尿病组(T2DM组),根据性别和年龄按照1:2的比例匹配同时期未合并2型糖尿病的膀胱肿瘤118例患者为非糖尿病组(NT2DM组),比较两组患者的临床特征和病理特点。结果:T2DM组的高血压患者比例和血肌酐值高于NT2DM组(P<0.05),而在教育程度、吸烟、饮酒、BMI、前列腺增生、泌尿系感染、血常规、肝功、尿常规、肿瘤大小、数量方面无明显统计学差异(P>0.05)。T2DM组和NT2DM组在膀胱尿路上皮肿瘤良恶性分类、肿瘤数量、肿瘤大小的构成比上无明显统计学差异(P>0.05);然而,对膀胱恶性肿瘤患者进行亚组分析显示,T2DM亚组中肌层浸润性癌的比例和高级别癌的比例明显高于NT2DM亚组,差异有统计学意义(P<0.05)。结论:2型糖尿病可能使膀胱癌的病理分级和分期更高,导致患者预后更差,临床上应更加关注膀胱恶性肿瘤合并2型糖尿病患者的诊治。