微量白蛋白尿(MAU)检测已广泛用来评价糖尿病患者早期肾功能损害的程度,国内外一些研究均表明MAU是2型糖尿病(T2DM)早期肾功能损害的标志[1],是动脉粥样硬化疾病的主要危险因素[2～4].本研究用踝肱指数(ABI)评价男性T2DM患者下肢动脉硬化程度,分析下肢动脉病变与MAU的相关性,并对其可能的影响因素进行分析,旨在为糖尿病所并发的大血管病变及微血管病变的防治提供依据.

Objective To investigate the correlation between G487A variant of aldehyde dehydrogenase-2(ALDH2)gene polymorphisms and hypertension in patients with coronary heart disease.Methods Fifty-seven patients with coronary heart disease were enrolled in this study.The genotypes of ALDH2 were determined by pyrophosphate sequencing.The patients were divided into two groups according to the genotypes,namely GG group(n=43)and GA/AA group(n=14).The incidence of hypertension and the risk factors of cardiovascular disease and systolic/diastolic/pulse blood pressure,on treatment were assessed.Results The hypertension incidence of GA/AA group(85.7%)was significantly higher than that of GG-type group(53.5%),in the statistically significant manner(P= 0.05).The difference in systolic and diastolic blood pressure between the two groups were not statistically significant(P0.05),while the pulse pressure of GA/AA groupwas significantly higher than that of GG group,in the statistically significant manner(P0.01).Conclusion G487A variant of aldehyde dehydrogenase-2(ALDH2)gene polymorphism might be a risk factor for hypertension,one of the mechanisms related to endogenous NO synthesis.In addition,its effect on nitroglycerin might increase the pulse pressure in old patients with coronary heart disease.

Objective To investigate the characteristics of 24-hour ambulatory blood pressure in advanced aged hypertensive patients aged over 80 years old.Methods All patients were divided into 3 groups according to their ages,including the advanced aged group (aged≥80,n=88),aged control group (aged from 60 to 79,n=80) and middle-aged control group (aged<60,n=25).The parameters and incidence of abnormal circadian rhythm of ambulatory blood pressure,and the incidence of diastolic pressure below 60 mmHg (1 mm Hg=0.133 kPa) were analysed retrospectively in the patients of three groups during antihypertensive treatment.Results The difference of drug administration was not significant statistically (P>0.05) among three groups.The difference of average systolic pressure among the whole day,daytime and night was not significant statistically.The average diastolic pressure was lower in the advanced aged group than that in the aged control group or middle-aged control group (all P<0.01).The difference average of pulse pressure among the whole day,daytime and night was higher in the advanced aged group than that in the aged control group or middle-aged control group (all P<0.01).The incidence of abnormal circadian rhythm of 24-hour ambulatory blood pressure was higher significantly in the advanced aged group than that in the aged control group or middle-aged control group (all P<0.05).The incidence of diastolic pressure below 60 mm Hg was higher significantly in the advanced aged group than that in the aged control group and middle-aged control group (all P<0.01).Conclusion The advanced aged patients with senile hypertension will have too lower diastolic pressure and abnormal circadian rhythm of blood pressure during the antihypertensive treatment.

Objective To observe the relationship between acute hyperglycemia and acute ischemic stroke.Methods The values of fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c)were monitored in 120 patientswith acute cerebral infarction confirmed by MRI or CT.According to FPG and HbA1c values,all the patients were divided into normal glucose group,hyperglycemia groupⅠ,hyperglycemia group Ⅱ,hyperglycemia group Ⅲ.Results Compared with normal glucose group,hyperglycemia groupⅠand Ⅲ had more massive cerebral infarction and higher mortality.Conclusion Acute hyperglycemia reflected by the values of glycosylated hemoglobin and fasting plasma glucose could predict the extent of cerebral infarction and survival in patients with acute cerebral infarction.

Objective To observe the association between ankle brachial index(ABI)and bone mineral density(BMD)in old female patients with type 2 diabetes mellitus(T2DM).Methods A total of 142 old female patients with T2DM,with an average age of(70.1±6.4)years,were divided into two groups:peripheral arterial disease(PAD)group and without PAD goup according to ABI,i.e,ABI<0.9 group and ABI 0.9-1.4 group.ABI,BMD and biochemical indicator of L2-4,neck of femur,greater trochanter(troch)and Wards area in all cases were measured by ES-1000SPM Doppler blood stream detector and dual energy X-ray absorptiomtry.Results The levels of BMD in neck,troch and Wards in T2DM with PAD(0.63±0.10)g/cm2,(0.50±0.11)g/cm2 and(0.39±0.09)g/cm2 were significantly lower than those in T2DM without PAD(0.70±0.14)g/cm2,(0.56±0.13)g/cm2 and(0.46±0.14)g/cm2(all P<0.05),respectively.Patients with PAD had older age,longer T2DM duration,higher systolic blood pressure,higher urea nitrogen,higher creatinine(Cr)and microalbuminuria than patients without PAD(all P<0.05).Multiple linear regression with BMD in neck,troch and Wards as the dependent variables showed that the age was negatively correlated with BMD(r=-0.378,-0.367 and-0.41 respectively,all P<0.01),ABI was positively correlated with BMD of neck,troch and Wards(r=0.331,0.327 and 0.315 respectively,all P<0.01).Conclusion This study demonstrates that bone metabolism is associated with vascular structural change.Atherosclerosis and osteoporosis occur at the same time normally,especially in the old female with T2DM.The pathophysiological mechanisms of bone metabolism and vascular structural change should be the concern of further research.

Objective:To observe the relationship between coronary artery stenosis and acute hyperglycemia in non-diabetic patient with acute coronary syndrome (ACS).Method:Blood glucose level were monitored after admission within 24 h in the total of 126 cases of ACS who received angiography. According to the degree of coronary artery disease,all patients were divided into three groups:single-vessel,double-vessel,multi-vessel lesions group. Result:Blood glucose within 24 h admission of multi-vessel group was significantly higher than that of double-vessel group ([9.9±1.0]mmol/L vs [7.6±1.3]mmol/L,P0.01),as well as that of single-vessel group ([9.9±1.0]mmol/L vs [5.9±0.4]mmol/L,P0.01). Apparenty,blood glucose of double-vessel group was significantly higher than that of single-vessel group ([7.6±1.3]mmol/L vs [5.9±0.4]mmol/L,P0.01).Conclusion:The blood glucose levels in acute phase are associated with the degree of coronary artery stenosis in nondiabetic patients with acute coronary syndrome.