摘要:目的:探討2型糖尿病合并糖尿病足患者與胰島素抵抗的關系。方法:205例2型糖尿病患伴糖尿病足患者作為觀察組,無足部病變的糖尿病患者作為對照組,觀察其體重指數、空腹血糖、胰島素、血脂等指標,兩組間進行比較并相關性分析、多元回歸分析。胰島素抵抗指數(HOMAIR)=FPG×FIns/22.5。結果:糖尿病足患者的HOMAIR顯著高于無糖尿病的患者(Plt;0.05)。多元回歸分析顯示糖尿病病程、LDL及BMI是影響2型糖尿病足患者胰島素抵抗的主要危險因素。結論:糖尿病足患者存在著更嚴重的胰島素抵抗。Abstract: Objective: To discuss the relationship between diabetes and pedopathy of type II diabetes and insulin resistance. Methods:The diabetes type II patients were divided into group A (combined with pedopathy) and group B (without pedopathy). The blood glucose and insulin of empty stomach, BMI,Alc and lipid were detected. The insulin resistance index (HOMAIR) was calculated and compared between two groups. Results:The HOMAIR was higher in group A than that in group B (Plt;0.05).The duration of disease,LDL and BMI was positive related with diabetes pedopathy. Conclusion:The insulin resistance was more worse in pedopathy of Type II diabetes.
Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with dexamethasone intravitreal implant (DEX) in the treatment of proliferative diabetic retinopathy (PDR). MethodsA prospective randomized controlled study. A total of 57 PDR patients with 79 eyes diagnosed by Department of Ophthalmology of The First Affiliated Hospital of Nanjing Medical University from May 2021 to February 2023 were included in the study. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) were performed in all affected eyes. Central macular thickness (CMT) was measured by OCT. The patients were randomly divided into control group and experimental group, with 27 cases and 35 eyes and 30 cases and 44 eyes, respectively. All eyes were treated with routine 25G PPV and intraoperative whole-retina laser photocoagulation. At the end of the operation, the experimental group was given 0.7 mg DEX intravitreal injection. At 1, 4, 12, and 24 weeks after operation, the same equipment and methods were used for relevant examinations. The improvement after surgery was assessed according to the diabetic retinopathy severity score (DRSS). Mixed analysis of variance was used to compare logarithm of the minimum angle of resolution BCVA and CMT between the two groups and within the two groups before and after operation. ResultsAt 1, 4, 12 and 24 weeks after surgery, BCVA was significantly improved at different time points after surgery, and the differences were statistically significant (P＜0.001). At different time after operation, BCVA and CMT in experimental groups were significantly better than that in control group, with statistical significance (P＜0.05). Compared with the CMT before surgery, the CMT at all time point after surgery in experimental group were significantly decreased, and the difference were statistically significant (P＜0.05). There was no significant difference one week after eye operation in control group (P=0.315). At 4, 12 and 24 weeks after operation, CMT decreased in control group, and the differences were statistically significant (P＜0.05). Compared with before surgery, DRSS increased two steps higher at 1, 4, 12 and 24 weeks after surgery in 20 (45.45%, 20/44), 26 (59.10%, 26/44), 32 (72.73%, 32/44) and 31 (70.45%, 31/44) eyes in the experimental groups, respectively. The control group consisted of 15 (42.86%, 15/35), 15 (42.86%, 15/35), 16 (45.71%, 16/35) and 18 (51.43%, 18/35) eyes, respectively. There was no significant difference in DRSS at 1, 4 and 24 weeks after operation between the control group and the experimental group (P=0.817, 0.178, 0.105). At 12 weeks after surgery, the difference was statistically significant (P=0.020). ConclusionPPV combined with intravitreal injection of DEX in the treatment of PDR can improve postoperative visual acuity, alleviate postoperative macular edema and improve the severity of DR.
Objective To observe the curative effect on non-obese type 2 diabetes and the effect on change of glucagon-like peptide-1 (GLP-1) of gastric bypass operation. Methods Thirty-two cases of gastric ulcer with non-obese type 2 diabetes were suffered gastric bypass operation. Plasma glucose concentrations, insulin and GLP-1 were measured respectively in fasting and postprandial conditions before operation and in week 1, 2, 3 and month 1, 3, 6 after gastric bypass operation, and the body mass index (BMI), homeostasis model assessment β cell function index (HBCI) and glycosylated hemoglobin (HbA1c， the index was detected only before operation and in month 3, 6 after operation) were also measured. The turnover of the diabetes condition in the 6th month after surgery was observed. Results Compared with the levels before operation, the fasting and postprandial plasma glucose levels were descending (P＜0.05), fasting and postprandial plasma insulin and GLP-1 levels were ascending (P＜0.05), HBCI was ascending and HbA1c was descending significantly after operation respectively (P＜0.05), while BMI changed un-significantly after operation (Pgt;0.05). The diabetes control rate was 78.1%(25/32) overall six months after operation. Level of GLP-1 was negatively correlated with level of plasma glucose (P＜0.05) and positively correlated with level of insulin (P＜0.05). Conclusions Gastric bypass operation can markedly reduce plasma glucose level on the type 2 diabetes patients with non-obese, and the hypoglycemic effect may be contributed by more GLP-1 secretion that caused more insulin secretion, which doesn’t depend on the loss of weight.
ObjectiveTo discuss the characteristics of coronary artery disease in patients with type 2 diabetes using coronary angiography of Dual Source CT. MethodsWe collected the clinical data of patients who underwent coronary angiography of Dual Source CT between December 2010 and November 2012 in Sichuan Provincial People's Hospital and Sichuan Orthopedic Hospital. A total of 302 patients (74 with type 2 diabetes, and 228 with no diabetes) were examined with CT coronary angiography. All images were comprehensively assessed. Types of plaques and luminal narrowing were evaluated. ResultsPatients with type 2 diabetes had more plaques (P<0.05), especially mixed plaques and non-calcified plaques, than non-diabetic patients (P<0.05). The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with type 2 diabetes were 29.1%, 41.1%, 29.8%, respectively. The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with nondiabetic patients were 39.7%, 36.0%, 24.3%, respectively. The difference of the composition between diabetes and nondiabetic was significant (P<0.05). There were more mild, moderate and severe narrowing in type 2 diabetic patients than those in non-diabetic patients (P<0.05). ConclusionCoronary angiography of CT depicts a high plaque burden in patients with type 2 diabetes mellitus (mixed plaque is the most common type), which may cause stenosis easily.
【摘要】 目的 研究2型糖尿病（type 2 diabetes mellitus，T2DM）合并非酒精性脂肪性肝病（non-alcoholic fatty liver disease， NAFLD）患者血漿脂肪細胞特異性脂肪酸結合蛋白（adipocyte-specific fatty acid-binding protein，A-FABP）的水平及其相關因素。 方法 2009年10月—2010年10月選取T2DM合并NAFLD組（A組）60例，未合并NAFLD組56例（B組）為研究對象。測定體質量指數（body mass index，BMI），檢測血脂、糖化血紅蛋白（hemoglobin A1c，HbA1c）等生化指標。放射免疫法測定空腹胰島素（fasting insulin，FINS），空腹C肽水平（fasting C-peptide，FCP），計算胰島素抵抗指數（homeostasis model of assessment-insulin resistance，HOMA-IR）、胰島素敏感指數（insulin sensitivity index，ISI），測定A-FABP、C反應蛋白（C-reaction protein，CRP）及腫瘤壞死因子-α（tumor necrosis factor-α，TNF-α）。 結果 與B組患者相比，A組患者其血漿A-FABP水平、BMI、腰圍、腰臀比、丙氨酸氨基轉移酶、門冬氨酸氨基轉移酶、CRP、TNF-α、FCP、FINS、總膽固醇、甘油三酯、Ln（HOMA-IR）升高，Ln（ISI）降低，差異有統計學意義（Plt;0.05）；兩組HbA1c差異無統計學意義（Pgt;0.05）。A-FABP水平變化與TNF-α、HOMA-IR、CRP呈正相關，與ISI呈負相關。 結論 T2DM伴NAFLD中，A-FABP升高與胰島素抵抗是并存的，且存在明顯相關關系，二者在疾病的發生發展中均可能具有重要的作用。【Abstract】 Objective To analyze the serum level of adipocyte-specific fatty acid-binding protein (A-FABP) in patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD), and its related factors. Methods From October 2009 to October 2010, 112 patients with T2DM were categorized into two groups: the group with NAFLD (group A) with 60 patients, and the group without NAFLD (group B) with 56 patients. Body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) were detected. Radioimmunoassay was carried out to measure fasting insulin (FINS) and fasting C-peptide (FCP), and homeostasis model of assessment-insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) were calculated. At the same time, A-FABP, C-reaction protein (CRP) and tumor necrosis factor-α (TNF-α) were also detected. Results Compared with patients in group B, plasma levels of A-FABP, BMI, waistline, waist to hip ratio, ALT, AST, TG, TC, HDL-C, LDL-C, CRP, FCP, FINS, and HOMA-IR for patients in group A were all higher, while ISI was lower; and the differences in the above-mentioned parameters were statistically significant (Plt;0.05). The levels of HbA1c in the two groups were not significantly different (Pgt;0.05). The change of A-FABP level was positively correlated with TNF-α, HOMA-IR and CRP, while it wasnegatively correlated with ISI. Conclusions In patients with T2DM with NAFLD, there is an obvious correlation between the coexisting A-FABP rise and insulin resistance. Both of them played critical roles in the onset and developing of the disease.
目的:比較羅格列酮鈉片與二甲雙胍片分別聯合胰島素治療2型糖尿病的療效和安全性。方法:40例單用胰島素控制血糖不理想的2型糖尿病患者,隨機分為A組,太羅組(羅格列酮鈉片)(21例);B組,二甲雙胍組(19例),進行為期16周的對照觀察。結果:兩組治療后空腹及餐后2小時血糖及糖化血紅蛋白(HbA1c)均呈有意義的下降(Plt;0.05),從下降幅度的百分率統計,太羅組下降幅度明顯高于二甲雙胍組。結論:太羅聯合胰島素治療對于血糖的控制明顯優于二甲雙胍聯合胰島素治療。
目的 了解老年2型糖尿病動脈僵硬度與踝臂指數（ABI）對評價外周動脈硬化的價值。 方法 2010年1月－3月，應用超聲、回聲跟蹤技術和動脈硬化檢測儀檢測80例老年2型糖尿病患者（觀察組）和40例正常老年人（對照組）的頸總動脈內中膜厚度（IMT）、僵硬系數（β）、脈搏波傳導速度（PWVβ）、ABI及動脈斑塊情況。 結果 與對照組比較，觀察組患者的IMT增厚、β增高、PWVβ增快、ABI降低及動脈斑塊發生率增多，差異均具有統計學意義（P＜0.001）。 結論 老年2型糖尿病可導致IMT增厚、動脈僵硬度增高、PWVβ增快、ABI降低及更易發生動脈粥樣硬化斑塊，這些參數可以預測外周動脈粥樣硬化的程度，利用彩色多普勒超聲診斷儀和動脈硬化檢測儀可以較容易得到這些參數，是評價外周動脈粥樣硬化病變一種簡便、易行，有臨床實際意義的方法和手段。
目的 觀察羅格列酮鈉對血糖控制未達標的2型糖尿病（T2DM）合并與不合并非酒精性脂肪肝（NAFL）患者的降糖療效和安全性。 方法 2009年1月－2011年1月60例僅用磺脲類和二甲雙胍治療血糖控制未達標的T2DM患者，按合并和不合并NAFL分為觀察組和對照組各30例，兩組均在原口服降糖藥基礎上聯合加用國產羅格列酮鈉4 mg 1次/d，治療共3個月，觀察治療前后的血糖、胰島素、糖化血紅蛋白（HbA1c）、體質量指數（BMI）、血脂、肝功、血壓水平以及藥物不良反應，并比較治療后的血糖達標率。 結果 兩組患者治療后的空腹血糖（FPG）、餐后2 h血糖（2hPG）、HbA1c、空腹胰島素、甘油三酯和極低密度脂蛋白膽固醇均較治療前下降，高密度脂蛋白膽固醇較治療前升高（P＜0.05），而丙氨酸轉氨酶、總膽固醇、低密度脂蛋白膽固醇及血壓無明顯變化（P＞0.05），但觀察組治療后的FPG和2hPG均較對照組下降更明顯（P＜0.01），且血糖達標率為73.3%，顯著高于對照組的46.7%（P＜0.05），同時觀察組餐后2 h胰島素（2hINS）水平在治療前后均明顯高于對照組而且治療后有顯著下降（P＜0.01），但對照組治療后2hINS雖然也有下降但無統計學意義（P＞0.05）。觀察組治療前后BMI無明顯變化，但對照組治療后BMI有明顯的升高（P＜0.05）。結論 國產羅格列酮鈉片對血糖控制未達標的T2DM合并和不合并NAFL患者均有進一步降低血糖、HbA1c以及改善血脂的作用，但對T2DM合并NAFL的患者的降糖療效更顯著，未見加重肝功能損壞，不良反應小，可作為此類患者聯合用藥的一種選擇。