ObjectiveTo explore the effect of type 2 diabetes mellitus (T2DM) on the vascular endothelial function of patients with heart failure with mid-range ejection fraction (HFmrEF), and the impact of endothelial function damage on the long-term prognosis of HFmrEF. Metohds87 patients with T2DM and heart failure with mid-range ejection fraction (T2DM-HFmrEF), 98 patients with HFmrEF alone, and 70 healthy control who had been hospitalized at the department of cardiology of the First Affiliated Hospital of Xinjiang Medical University from December 2018 to January 2020 were included. The levels of serum TNF-α, IL-6, vWF, eNOs and E-selectin were determined by enzyme-linked immunosorbent assay. The oxidative stress and vascular endothelial function related indicators of the 3 groups were analyzed. The primary endpoint (all-cause death, exacerbation of heart failure and rehospitalization, or exacerbation of heart failure) and secondary endpoint events (non-fatal myocardial infarction, stable and unstable angina pectoris, or stroke) were followed up for 1 year after discharge.ResultsThe levels of TNF-α, IL-6, vWF, and E-selectin in the HFmrEF combined with diabetes group were higher than those in the HFmrEF without diabetes group (P<0.05). Multivariate Cox regression analysis showed that BNP (HR=1.001, P=0.036), eNOs (HR=1.04, P<0.001), and IL-6 (HR=1.002, P<0.001) were related to the primary end point of all patients with HFmrEF. Glycated hemoglobin (HR=1.37, P=0.046), E-selectin (HR=1.01, P=0.003), vWF (HR=1.02, P=0.017), and IL-6 (HR=1.006, P=0.005) were related to the secondary end point of all patients with HFmrEF. The results of subgroup analyze showed that E-selectin (HR=1.014, P=0.012) and IL-6 (HR=1.008, P=0.007) were related to the secondary endpoint events in the HFmrEF combined with diabetes group, but were not related to the secondary end point events of the non-diabetic group (P>0.05).ConclusionsOxidative stress and vascular endothelial function damage may be involved in the pathogenesis of T2DM-HFmrEF. Serum IL-6 and E-selectin levels are related to the endpoint events in T2DM-HFmrEF patients.
ObjectiveTo investigate the short-term efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity with type 2 diabetes mellitus (T2MD) in China. MethodsClinical randomized controlled trial literatures about domestic LSG treatment of obesity with T2MD were obtained from Wanfang Data, China Knowledge Resource Integrated Database, PubMed and Web of Science English Data. The literatures were selected according to the inclusive and exclusive criteria, then evaluated. Methodological quality assessment and meta analysis were evaluated according to the data extracted from those literatures. The short-term efficacy (fasting blood glucose or glycosylated hemoglobin) was evaluated after operation. ResultsOne hundred and seven patients performed LSG were retrieved from 7 literatures. The levels of fasting blood glucose and glycosylated hemoglobin on the postoperative 6 months were all obviously decreased as compared with the levels before operation (fasting blood glucose:MD=2.99, 95% CI 2.39-3.60, P < 0.000 01; glycosylated hemoglobin:MD=2.24, 95% CI 1.43-3.04, P < 0.000 01), which on the postoperative 12 months were all obviously decreased as compared with the levels on the postoperative 6 months (fasting blood glucose:MD=0.56, 95% CI 0.16-0.95, P=0.006; glycosylated hemoglobin:MD=0.52, 95% CI 0.22-0.81, P=0.000 6). The postoperative fasting blood glucose and glycosylated hemoglobin levels in patients accepted LSG showed a downward trend. ConclusionsLSG on obesity with T2MD has an obvious short-term curative effect. But its long-term efficacy still needs to be supported by large samples randomized controlled clinical research data.
摘要:目的:了解甘精胰島素聯合二甲雙胍治療對口服降糖藥血糖控制不理想的2型糖尿病患者的療效和安全性。方法:對30例口服降糖藥血糖控制不理想的2型糖尿病患者給與甘精胰島素聯合二甲雙胍治療,共12周。治療前后測身高、體重、空腹血糖(FPG)、餐后2小時血糖(PPG)以及糖化血紅蛋白(HbA1c)水平。了解治療期間低血糖發生情況。結果:治療后的FPG、PPG以及HbA1c水平明顯下降,分別下降了303mmol/L、510mmol/L和198%,差異有統計學意義(Plt;005)。治療后5330%的患者HbA1c水平lt;70%。治療前HbA1c水平≥70%lt;90%的患者,治療后706%的患者HbA1c水平lt;70%,治療前HbA1c水平≥90%的患者,治療后307%的患者HbA1c水平lt;70%,兩者的HbA1c達標率有明顯差異(Plt;005)。治療前后體重及BMI無明顯差異(Pgt;005)。30例患者中僅發生兩次輕微低血糖。結論:甘精胰島素聯合二甲雙胍治療對口服降糖藥治療血糖控制不理想的2型糖尿病患者是安全有效的,尤其是對HbA1c水平lt;90%的患者,血糖控制更好,達標率更高。
Objective To investigate the effect of type 2 diabetes mellitus on the prognosis of coronary heart disease patients who had a complication of heart failure with preserved ejection fraction. Metohds A retrospective study was performed with 393 coronary heart disease patients who were complicated with heart failure with preserved ejection fraction. The diagnosis was based on the results of echocardiography and coronary angiography at the heart center of the First Affiliated Hospital of Xinjiang Medical University assessed from January 2017 to December 2017. The patients were divided into diabetic group and non-diabetic group. The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. In addition, the incidence of MACE was compared between the complete revascularization group and the incomplete revascularization group. Multivariate Cox regression analysis was used to analyze the effect of the risk factors on prognosis. Results The prevalence of hypertension and the use of ACEi/ARB in the diabetic group were higher than those in the non-diabetic group (P<0.05), and the level of high-density lipoprotein in the diabetic group was lower than that in the non-diabetic group (P<0.05). The incidence of MACE in the diabetic group (35.8%) was higher than that in non-diabetic group (25%, P=0.027). Complete revascularization improved the prognosis and reduced the incidence of MACE in both the diabetic group and non-diabetic group (P<0.05). Multivariate Cox regression analysis showed that a history of myocardial infarction (HR=0.44, 95%CI 0.20 to 1.00, P=0.049), incomplete revascularization (HR=17.28, 95%CI 2.34 to 127.43, P=0.005), and ejection fraction (HR=0.90, 95%CI 0.82 to 1.00, P=0.046) were associated with the occurrence of MACE in patients with coronary heart disease complicated with heart failure with preserved ejection fraction. Conclusion Type 2 diabetes mellitus affects the prognosis of coronary heart disease patients who have complication of heart failure with preserved ejection fraction. Complete revascularization can improve the prognosis of type 2 diabetic patients with coronary heart disease who have complications of heart failure with preserved ejection fraction.
Objective To evaluate the efficacy and safety of saxagliptin in type 2 diabetes patients. Methods The following databases as The Cochrane Library (Issue 2, 2011), PubMed (1978 to May 2011), EMbase (1974 to May 2011), CNKI (1978 to May 2011), VIP (1989 to May 2011) and CBM (1978 to May 2011) were searched. The quality of included randomized controlled trials (RCTs) was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using RevMan 5.0. Results A total of 7 RCTs were included. The results of meta-analyses showed that HbA1c was significantly reduced in the saxagliptin group than that in placebo group (MD= –0.69, 95%CI –0.78 to –0.60, Plt;0.000 01). There was no significant difference in the incident rate of adverse reaction between two groups (RR=1.02, 95%CI 0.98 to 1.06, P=0.26). Conclusion Saxagliptin is effective and safe for type 2 diabetes. But its long-term efficacy and safety still need to be confirmed by performing more high quality, large sample RCTs with long-term follow-up.
【摘要】 目的 以99mTc-DTPA腎動態顯像法腎小球濾過率（glomerular filtration rate，GFR）測定為標準，將血清胱抑素C（cystatin C， CysC）檢測與其比較，探討CysC測定在2型糖尿病腎病（type 2 diabetic nephropathy，T2DN）診斷中的意義。 方法 2010年6月—2011年1月76例2型糖尿病（type 2 diabetes mellitus，T2DM）患者按24 h尿微量白蛋白（microalbuminuria，m-Alb）分為兩組:正常蛋白尿組（31例）和微量蛋白尿組（45例），同時測定GFR、CysC、血清肌酐（serum creatinine， Scr）和糖化血紅蛋白（hemoglobin A1c， HbA1c），并設正常自愿者38名作為對照組，進行統計學分析。 結果 對照組、T2DM正常蛋白尿組及T2DM微量蛋白尿組CysC水平分別為（1.1±0.6）、（1.6±0.7）、（1.0±0.3） mg/L，各組差異均有統計學意義（Plt;0.05）；HbA1c水平分別為（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、兩組T2DM患者與對照組比較，差異均有統計學意義（Plt;0.05）；GFR水平分別為（80.9±23.0）、（74.2±26.1）、（79.3±19.7） mL/（min?1.73 m2），各組差異無統計學意義（Pgt;0.05）；Scr水平分別為（87.7±23.8）、（93.7±38.4）、（81.5±11.4） μmol/L，組間差異無統計學意義（Pgt;0.05）。CysC、Scr和GFR之間呈負相關（r=-0.694，-0.692；Plt;0.001）；CysC和Scr之間呈正相關（r=0.903，Plt;0.001）。 結論 CysC可作為早期T2DN的檢測指標，具有較高的敏感性，但對于輕度到中度GFR降低的診斷準確性并不優于Scr。【Abstract】 Objective To demonstrate the clinical value of serum cystatin-C (CysC) in the assessment of renal function in type-2 diabetic nephropathy (T2DN) by comparing it with the glomerular filtration rate (GFR) measured by 99mTc-DTPA method. Methods From June 2010 to January 2011, 76 patients with type 2 diabetes mellitus (T2DM) were classified into two groups according to their 24 h microalbuminuria (m-Alb) level: the normal albuminuric group (n=31) and the microalbuminuric group (n=45). GFR, Serum creatinine (Scr), CysC, and hemoglobin A1c (HbA1c) were measured. Thirty-eight healthy subjects were recruited as the control group, and statistical analysis was carried out. Results The CysC levels in the control group, the normal albuminuric group and the microalbuminuria group were respectively (1.1±0.6), (1.6±0.7) and (1.0±0.3) mg/L, with a significant difference among the three groups (Plt;0.05). HbA1c level in the three groups were respectively (7.1±2.7)%, (7.9±3.1)% and (5.4±0.6)%, with a significant difference between the two diabetic groups and the control group (Plt;0.05). Scr levels in the three groups were respectively (87.7±23.8), (93.7±38.4), (81.5±11.4) μmol/L; GFR levels in the three groups were respectively (80.9±23.0), (74.2±26.1), (79.3±19.7) mL/(min?1.73 m2); among the three groups the differences of both Scr and GFR were not significant. Both CysC and Scr were negatively correlated with GFR (r=-0.694,-0.692;Plt;0.001), and CysC was positively correlated with Scr (r=0.903, Plt;0.001). Conclusion Increased CysC may be an early indicator of incipient diabetic nephropathy, but the diagnostic accuracy of CysC is not superior to that of Scr in distinguishing between mildly and moderately reduced GFR.
摘要:目的: 觀察格列美脲對2型糖尿病患者心血管的保護作用并探討其可能的機制。 方法 :112例T2DM患者隨機分為格列美脲組(格列美脲+二甲雙胍)和對照組(格列本脲+二甲雙胍),觀察治療前后兩者空腹及餐后兩小時血糖(FBG,2hPBG)、糖化血紅蛋白(HbA1c)、空腹胰島素(FINS)、HOMA模型胰島素抵抗指數(HOMAIR)、甘油三脂(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDLC)、低密度脂蛋白膽固醇(LDLC)、同型半胱氨酸(HCY)、血漿脂聯素的變化。 結果 :兩組患者的TC、LDLC、TG、FBG、2hPBG都較治療前降低,連續服用6個月以上格列美脲的T2DM患者其血漿HCY、HOMAIR、血糖水平明顯下降,血漿脂聯素水平明顯升高,與對照組相比差異有統計學意義(〖WTBX〗P lt;005)。 結論 :格列美脲能降低多項心血管危險因子水平,對血脂、HCY和動脈粥樣硬化都有良性調節作用,其作用基礎可能與改善胰島素抵抗,增加血漿脂聯素相關。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
Objective To perform a meta-analysis and investigate the correlation between angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism and type 2 diabetic nephropathy, assessing the bias of small sample size study and heterogeneity between studies. Methods MEDLINE, EBSCO, EMbase, PubMed, CHKD, CNKI, CBM, VIP and WanFang Data were searched (from January 1994 to March 18th 2011) for relevant case-control studies. Two reviewers independently identified the literature according to inclusion and exclusion criteria. Also references of the included literature were retrieved. Then data were extracted and assessed by the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.0.0 software. Results A total of 61 studies comprising 9 979 cases and 7 252 control subjects were included. There was b evidence of heterogeneity (Plt;0.05, I2=60%) and a random effect model was employed to summarize the data. Results of meta-analysis showed that T2DM patients with II genotype had lower incidences of DN than those with DD+DI genotype (OR=0.65, 95%CI 0.57 to 0.74). The results of subgroup meta-analysis showed that Chinese, Japanese and Brazilians patients with II genotype had lower incidences of DN. However, there were no relation among Caucasus, Middle-East, Indian, Mexican, Korean, and Malaysian patients. Conclusion As for T2DM patients, their angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism relates to DN. T2DM patients with II genotype have lower incidences of DN. But the difference of this relation varies with ethnicity.