Objective To investigate the serum changes of 25-hydroxyvitamin D level in the male patients with type 2 diabetes,and the relationships between 25-hydroxyvitamin D level and bone mineral density.Methods Eighty-seven male patients with type 2 diabetes mellitus were selected as the case group,and 90 male healthy people were selected as the control group.ELISA were used for the detection of serum 25-hydroxyvitamin D,relevant clinical and biochemical index were also detected.Then the serum differences of 25-hydroxyvitamin D levels in the two groups were contrasted and the relationship between 25-hydroxyvitamin D and the T2DM male patients was analyzed.Results ①Serum 25-hydroxyvitamin D level of T2DM group was significantly lower than that of the control group(P ＜0.05).②There was no significant difference in serum 25-hydroxyvitamin D level between osteoporosis patients group and no osteoporosis patients group in T2DM group (P ＞ 0.05).Conclusions Serum 25-hydroxyvitamin D level in male patients with type 2 diabetes was significantly lower than that of control group.No correlation was found between serum 25-hydroxyvitamin D level and bone mineral density in male patients with type 2 diabetes.

雌、孕激素均为女性甾体激素.雌激素主要来源于卵巢,少部分由外周组织转化而来,其主要作用是促进女性生殖器官及第二性征的发育,并维持其在正常状态;对骨代谢、脂质代谢、血管平滑肌细胞及血管内皮细胞的功能等也有着重要的调节作用.孕激素主要来源于卵巢和黄体,其主要作用是诱导子宫内膜的分泌期变化;在子宫肌层对抗雌激素的刺激作用;促进乳腺发育等.雌、孕激素相互协调、共同作用对维持下丘脑-垂体-卵巢-靶器官(组织)轴的生理功能是十分重要的.鉴于雌、孕激素在人体不可或缺的生理作用,使得雌、孕激素类药物在临床中应用非常广泛,涉及内分泌代谢、妇科内分泌、药物避孕、辅助生殖、围生医学等领域.

【Objective】To investigate the serum changes of 25-hydroxyvitamin D level from the male patients with type 2 diabetes.【Methods】87 male patients with type 2 diabetes mellitus were selected as the case group,and 90 male healthy people were selected as the control group.ELISA was used for the detection of serum 25-hydroxyvitamin D,【Resluts】1.Serum 25-hydroxyvitamin D level of T2DM group significantly lower than those of the control group(P < 0.05).2.Serum 25-hydroxyitamin D level in T2DM group was positive correlation with body mass index(r = 0.230) and calcium(r = 0.257),and negative correlation with creatinine(r =-0.245).3.Compared with control group,fasting blood glucose(FBG) in T2DM group was significantly higher(9.08±3.52)mmol/L vs(4.55±0.46)mmol/L,P < 0.05),high-density lipoprotein cholesterol was significantly lower(1.06±0.28)mmol/L vs(1.40±0.55)mmol/L,P < 0.05).【Conclusion】Serum 25-hydroxyvitamin D in male patients with type 2 diabetes was significantly lower than that of control group and serum 25-hydroxyitamin D was positively correlated with body mass index,blood calcium and negatively correlated with creatinine.

By research on movable external shading,the article summarizes the type and characteristics of common movable external shading of residential architecture,expounds some requirements of integrated design of movable external shading and residential architecture based on problems of external shading of residential architecture,and puts forward some application suggestions,design methods and implementing regulations,so as to promote popularization and application of movable external shading in residential architecture.

目的探讨醋酸去氨加压素致类抗利尿激素分泌不当综合征的原因及临床特点。方法回顾性分析1例醋酸去氨加压素致类抗利尿激素分泌不当综合征的临床资料。结果患者6个月前因急性胆源性胰腺炎入院,行手术治疗。6个月内24 h尿量多在3500～5050 ml,持续低钠血症。有尿崩症史,长期服用糖皮质激素、甲状腺激素及醋酸去氨加压素替代治疗。考虑尿崩症复发,逐渐增加醋酸去氨加压素用量,同时补充氯化钠,尿量无减少,仍为顽固性低钠血症。1个月前出现轻度喘憋、气短、全身水肿、心率增快;双肺底闻及少量中小水泡音。测中心静脉压17 cmH2O,连续测定血渗透量浓度260～270 mmol/L,尿渗透量浓度630～670 mmol/L;尿钠180～240 mmo/L。回顾治疗过程,考虑不除外醋酸去氨加压素用量较大导致的类抗利尿激素分泌不当综合征,调整醋酸去氨加压素并停止补充氯化钠,病情好转。结论尿崩症患者抗利尿激素使用过量会导致类抗利尿激素分泌不当综合征,临床医师应注意与尿崩症进行鉴别,以避免误诊误治。

<正>目前2型糖尿病(diabetes mellitus,T2DM)发病率日益增长,其合并骨质疏松症(osteoporosis,OP)已成为不容忽视的问题。男性骨质疏松症危害不亚于女性,本文就近年来男性T2DM并发骨质疏松症的发病机制研究进展综述如下。

Objective To investigate the change of bone mineral density(BMD) in postmenopausal osteoporotic patients after alendronate treatment.Methods The data of 120 postmenopausal osteoporotic patients were retrospectively analyzed.They were divided into the control group with 88 cases treated with 600 mg calcium and 0.25 ug calcitriol daily and the treatment group with 32 cases treated with 70 mg alendronate weekly in addition of calcium and vitamin D uptake.The changes of BMD in both groups were observed after 1 year.Results BMD of the lumbar vertebra 2-4 in control groups decreased from 0.763±0.098 g/cm2 before the treatment to 0.742±0.095 g/cm2 after the treatment,and the difference was statistically significant(P=0.000).Compared to baseline,BMD of the femoral neck in control groups decreased from 0.637±0.073 g/cm2 to 0.601±0.078 g/cm2,and the difference was statistically significant(P=0.006).After alendronate treatment,BMD of the lumbar vertebra 2-4 increased from 0.729±0.122g/cm2 to 0.743±0.129 g/cm2,and the difference was statistically significant(P=0.007).BMD of the femoral neck increased from 0.599±0.086 g/cm2 to 0.635±0.112 g/cm2,and the difference was statistically significant(P=0.000).Conclusion Alendronate can increase BMD in postmenopausal osteoporosis patients.The treatment of calcium and vitamin D only cannot prevent further loss of bone mass.

Objective To investigate the risk factors of cerebral infarction among diagnosed type 2 diabetic patients.Methods Clinical data were collected in 448 patients with type 2 diabetes.All the patients were divided into two groups according to the complication of cerebral infarction.There were 81 patients (18.1% ) complicated with cerebral infarction.Results Between complication group and non-complication,there were statistically significant differences in age (70.53±7.79 vs 60.72±13.0 years) , diabetic duration (130.25±85.77 vs 94.54±92.41 months) ,ankle brachial index (0.90±0.23 vs 0.98±0.19) ,urea nitro-gen(6.84 ±2.49 vs 6.17 ±2.21 mmol/L) ,HbA1c (9.09%±2.41% vs 8.24%±1.77% ) ,and rates of hypertension (84.0% vs 59.1% ) ,coronary heart disease (63.0% vs 43.1% ) ,diabetic retinopathy (35.8 vs 22.6% ) ,diabetic kidney disease (50.6% vs 31.9% ) and lower limb arterial plaque of merger (87.7% vs 70.3% ) (P<0.05) .The result of logistic regression showed that age (P=0.000) and HbA1c (P=0.027) were related strongly to diabetes complicated with cerebral infarction.Conclusion Age and HbA1c are the risk factors in type 2 diabetic patients with cerebral infarction.Proper blood glucose control is an effective way to prevent cerebral infarction.

我是一位患有多年糖尿病的老患者,但对于许多糖尿病知识仍是一知半解.我发现糖尿病至今已有10年的时间,一直坚持服药治疗,没有出现严重的并发症.在阅读贵刊的同时也认识到.只有血糖控制达标,才能延缓并发症的发展.而糖尿病就是因为血糖过高而被定义的,所以我们也大多采用降糖治疗.但从贵刊得知,不仅高血糖对人体有害,低血糖同样对人体有害.因此,我想请教贵刊的专家们,低血糖是怎么产生的,怎么避免?

BACKGROUND: Osteoporosis is a multifactorial disease which is regulated by genetic and environmental factors. Polymorphism of the vitamin D receptor (VDR) gene has been reported to play a major role in variations for genetic regulation of bone mass, but its role within various ethnic populations is controversial. OBJECTIVE: To investigate the association between VDR genetypes of Fok I polymorphism and bone mineral density, so as to explore the genetic susceptibility for osteoporosis in male from Beijing. DESIGN, TIME AND SETTING: The randomized controlled observation was performed at Department of Endocrine at the Second Artillery General Hospital of Chinese PLA and Laboratory of Molecular Biology, Institute of Geriatrics and Gerontology, General Hospital of Chinese PLA between September 2004 and December 2007. PARTICIPANTS: A total of 230 healthy male from Han nationality who dwelled in Beijing, aged 20-80 years, were selected from September 2004 to December 2006. METHODS: The genotypes of VDR gene Fok I polymorphism were analyzed using the polymerase chain reaction-restriction fragment length polymorphism method. Bone mineral density values were determined on random chosen 100 subjects by dual energy X-ray absorptiometry at lumbar vertebra and hip. MAIN OUTCOME MEASURES: Circled digit oneThe subjects' age, height and body weight. Circled digit twoThe genotypes of VDR gene Fok I polymorphism. Circled digit threeBone mineral density values at lumbar spine (L 2-4), femoral neck, trochanter and Wards triangle. RESULTS: The genetypes and gene frequency distribution of VDR gene Fok I polymorphism was FF 36.96%, Ff 46.96%, ff 16.08%, in accordance with Hardy-Weinberg equilibrium. After adjusting for age, height, body weight and body mass index, the bone mineral density in the men with ff genetype was lower than with Ff and FF genetypes (P = 0.037). There was a trend of ff genetype with lower bone mineral density at other sites, but no significant differences in other groups (P > 0.05). CONCLUSION: There is a possible correlation between CDR gene Fok I polymorphisms and bone mineral density in Han male of Beijing. It can be employed to screen the high risk population of osteoporosis in men.

Osteoporosis is a complex multifactorial disease which is regulated by genetic and environmental factors. The vitamin D receptor(VDR) gene has been suggested as one of possible candidate genes for the regulation of bone mass but the relationship between VDR polymorphisms and osteoporosis(bone mineral density and osteoporotic fracture two phenotype) is controversial in different ethnic groups studied.This article reviews the relationship between vitamin D receptor gene polymorphism and osteoporosis.

AIM: The pathophysiological mechanism of arteriosclerosis is the same as osteoporosis. The study analyzed the changes in ankle brachial index and bone mineral density (BMD) in type 2 diabetes patients with coronary atherosclerotic heart disease (CAHD). METHODS: 503 patients with type 2 diabetes at the Second Artillery Forces General Hospital from April 2004 to April 2007 were enrolled, including 272 males and 231 females. Diabetes diagnosis had complied with the American Diabetes Association (ADA) (1997). The patients ranged from 25 to 86 years in age (mean 63±13) years, course of 1-600 months. Patients lying in bed or ankle-brachial index of over 1.4 were excluded. Informed consents were obtained from all patients. All patients were divided into two groups, CAHD and non-CAHD groups. Height, body mass, systemic blood pressure (SBP), body mass index (BMI) and ocular fundus, as well as glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood urea nitrogen (BUN), creatinine, uric acid, urinary microalbuminuria protein levels were measured in the morning at day 1 after admission. Routine 12 lead electrocardiogram (ECG) was performed. The ankle brachial index, lumbar spine (L2-4), the left femoral neck, the greater trochanter, bone mineral density (BMD) of fahrenheit triangle were determined by ES-1000SPM Doppler detector and the dual-energy X-ray densitometer (NORLAND, USA). RESULTS: 503 cases of type 2 diabetes were included in the final results. There were 231 cases in the CAHD group, including 106 male cases, 125 female cases, and 272 cases in the non-CAHD group, including 144 male cases, 128 female cases. Patients in the CAHD group were older, with long diabetes duration, high BMI and low ankle brachial index, and there were significant differences between both groups (P < 0.05). After correction in age, diabetes duration and BMI, BMD of femoral neck was statistically significant between both groups in men (P < 0.05); BMD of all parts between both groups was no statistically significant in women (P > 0.05). CONCLUSION: ①Ankle brachial index is low in type 2 diabetic patients with CAHD compared to those without CAHD. ②BMD of femoral neck was low in men from the CAHD group. There is no significant difference in BMD in females between both groups.

AIM:To analyze the correlation between ankle brachial index(ABI) and the incidence of great blood vessel pathological changes in type 2 diabetes mellitus patients,so as to verify if ABI could serve as the simple index to evaluate or predict the great blood vessel pathological changes in type 2 diabetes mellitus.METHODS:213 inpatients with type 2 diabetes in the General Hospital of Second Artillery Forces from April 2006 to April 2007 were retrospectively analyzed.Diabetes diagnosis was complied with the ADA(1997).There were 108 males,and 105 females,averagely aged(60.5±12.9) years(range,25 to 86 years);the course of illness was 1-600 months.ABI was measured by ES-1000SPM Doppler detector(Japan).On the first morning of hospitalization,the height,body mass,and blood pressure were detected to calculate body mass index,glycosylated hemoglobin,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,blood urea nitrogen,creatinine,uric acid,urinary microalbuminuria protein,ankle brachial index.Meanwhile,eye ground examination and conventional 12-lead ECG were performed.All patients were divided into two groups according to their ABI:ABI < 0.9 group(n =29) and ABI ≥ 0.9 group(n =184).RESULTS:Among 213 diabetic patients,the prevalence of peripheral arterial occlusion disease was 13.6%,with no significant sexual difference.ABI lower than 0.9 group showed older age,longer diabetes duration,and higher occurrence of diabetic nephropathy,coronary artery disease and cerebral infarction(P < 0.05).ABI was negatively correlated with age,duration of diabetes,glycosylated hemoglobin,and low-density lipoprotein cholesterol levels(P < 0.05).The results of multivariate logistic regression analysis indicated that age,diabetes duration,and cerebral infarction are independent risk factors for ABI.CONCLUSION:ABI is closely correlated with the incidence of great blood vessel pathological changes in type 2 diabetes mellitus.It is an effective predictor for peripheral arterial occlusion disease in patients with type 2 diabetes mellitus.

OBJECTIVE:To investigate the utilization of aspirin in patients with type 2 diabetes mellitus.METHODS:The utilization of aspirin in 510 inpatients with type 2 diabetes mellitus in the department of Endocrinology in our hospital from April 2004 to April 2007 was analyzed retrospectively.RESULTS:Of the total 510 cases,68.2% received aspirin,with daily dose reached 50～100mg.Aspirin was more often used in patients complicated with coronary heart disease and hypertension(P0.05).CONCLUSION:The proportion of patients who received aspirin in our hospital is on the high side,therefore,standardized management on the application age and dose of aspirin should be strengthened.

To analyze prevalence and risk factors for osteoporosis in elderly men military men(150 men aged 66~89,(76.2±8.7) yrs).A questionaire was conducted to corelate life style and osteoporosis risk factor,proximal femur BMD was measured by dual X-ray absorptiometry.It was found that: 1) Ninety elderly men showed osteoporosis as indicated by BMD in hip(60.0%).The prevalence for osteoporosis in 60~80 group was 42.5%,63.9% and 71.1% respectively,and increased significantly in 70 and 80 years old men than in 60 years old men(P0.05;P0.01).2)BMD declined gradually after 60,the BMD of femoral neck and Ward's triangle in 80 years old significantly decreased compared with 60 years old(P0.01).3)Bone loses in hip was the most severe in Ward's triangle,then femoral neck and troach.4) Age,BMI,milk drinking and exercise influenced hip BMD(P0.05),BMI showed statistically positive correlation with BMD(P0.05),smoking,drinking,tea and sunshine was not related with hip BMD.It was found that proportions of osteoporosis in elder men not lower than female.

Objective To evaluate the relationship between hyperuricemia and incidence of blood vessel pathological changes in patients with type 2 diabetic mellitus. Methods Serum uric acid and other clinical data of 468 type 2 diabetes were collected. According to serum uric acid the patients were divided into high uric acid group and normal uric acid group. Results The prevalence of hyperuricemia was 16.4% in type 2 diabetes. The patients with higher serum uric acid were higher in BMI, higher triglycerides(TG),blood urea nitrogen,serum creatinine and microalbuminuria level and lower high-density lipoproteins cholesterol, more patients with coronary artery disease and hypertension than normal uric acid group. Serum uric acid was correlated with BMI,HDL,TG,FPG and BUN level. Conclusions The level of blood uric acid with type 2 diabetes was closely correlated to coronary artery disease and hypertension,obesity,hyperlipemia,renal function.

Aim: Diabetic patients are often complicated by osteoporosis and peripheral arterial disease. Studies show that there are common pathological mechanisms between arteriosclerosis and osteoporosis. In this study, the correlation between ankle brachial index (ABI) and bone mineral density (BMD) in female patients with type 2 diabetes mellitus was explored. Methods: 1 A total of 230 female inpatients with type 2 diabetes mellitus, 36-88 years old with an average age of (63.87±10.80) years, diabetes duration of 1 month to 25 years, were selected from the Department of Endocrinology, General Hospital of Second Artillery of Chinese PLA between January 2004 and December 2007 and divided into two groups according to ABI: ABI < 0.9 group and ABI≥0.9 group. 2 The ABI, BMD and biochemical indicator of L2-4, left neck of femur, greater trochanter and Wards area in all cases were measured by ES-1000SPM Doppler blood stream detector and dual energy X-ray absorptiometry. Redults: 230 cases were all involved in the result analysis. 1 Fifty patients with ABI < 0.9 (21.7%) suffered from PAD, and 180 of patients with ABI≥0.9 from PAD. 2 Patients with ABI < 0.9 had older age, longer diabetes duration, higher systolic blood pressure, lower BMD in neck, troch, and Wards, higher low-density lipoprotein cholesterol, blood urea nitrogen, creatinine (Cr) and log10(UAlb/Cr) level, higher ratio of smoking history and higher prevalence of hypertension, cerebral infarction and diabetic nephropathy significantly than in patients with ABI≥0.9 (P < 0.05). 3 The multiple linear regression with AMI as the dependent variable showed that BMD level at troch site was positively correlated with ABI (r= 0.788, P=0.000). Conclusion: Patients with low ABI (< 0.9) have lower BMD than those with normal ABI (≥0.9). Therefore, ABI might be a simple and practical index for the detection of osteoporosis as well as for the peripheral arterial disease in type 2 diabetes.

目的:探讨糖尿病足危险因素的分析和预防。方法:回顾性分析68例糖尿病足患者的临床资料。结果:GH-bA1c>7.5的有59例,占86.76%,周围神经病损有47例,占69.11%,彩色多普勒证实有不同程度的下肢动脉狭窄50例,占73.53%。结论:高血糖、高血脂、吸烟、糖尿病知识缺乏等是糖尿病足的重要发病因素,应反复进行教育。

[目的]探讨空气波压力治疗仪(IPC)在糖尿病下肢血管病变(PAD)治疗中的作用.[方法]将113例糖尿病足患者分为治疗组(52例)和对照组(61例),两组采用常规降糖并给予前列地尔、维生素B12治疗.治疗组在此基础上加用空气波压力治疗(IPC)治疗15 d.观察静息痛、麻木无力、间歇性跛行、行走距离的改善情况,进行组间对比分析和治疗前后自身比较.[结果]治疗组与对照组比较,静息痛、麻木无力、间歇性跛行、行走距离明显改善(P＜0.05),治疗组治疗后比治疗前显著好转(P＜0.05).[结论]空气波压力治疗仪能明显改善糖尿病下肢血管病变症状.