[目的]探讨2型糖尿病肾病(DN)患者抵抗素水平的变化及其与血管内皮功能改变的关系.[方法]2型糖尿病患者62例,按24小时尿微量白蛋白分为正常蛋白尿组(NAU组),微量蛋白尿组(MAU组),及大量蛋白尿组(CAU组).空腹检测血清抵抗素和生化指标(血脂、血糖、肝肾功能等)及内皮功能和心室结构指标.内皮功能指标包括肱动脉内皮依赖性舒张功能(FMD),含服硝酸甘油后肱动脉内皮依赖性舒张功能(NID),颈动脉内-中膜厚度(IMT).心室结构指标包括左室内径(LVD)、左室后壁厚度(LWPWT)、室间隔厚度(IVST).比较各组间上述指标的变化并分析抵抗素与各指标的相关性.[结果]①CAU组NAU组的2倍,明显高于MAU组(P<0.01和P<0.05).②FMD、NID随着抵抗素水平的增加而下降(P<0.05).LVD、LWPWT、IVST随着抵抗素水平的升高,明显增加(P<0.05).IMT随抵抗素水平的升高有增加的趋势(P>0.05).③抵抗素与24 h尿白蛋白排出量、血肌酐、载脂蛋白B、空腹胰岛素水平IVST呈正相关(r值分别为0.281、0.805、0.399、0.33、0.335,均P<0.05),与FMD、NID呈负相关(r值为-0.445、-0.338,均P<0.05).[结论]糖尿病合并肾病患者抵抗素随24小时尿微量白蛋白的增加而升高,并且与血管内皮功能的损害呈正相关,抵抗素可作为糖尿病肾病患者合并大血管风险的一个早期预测指标.

目的 探讨不同肥胖程度的2型糖尿病患者肝脾CT值比值与胰岛素抵抗(IR)指标的相关性.方法 选取我院收治的13例2型糖尿病患者作为糖尿病组,按体重指数(BMI)分为糖尿病肥胖组(7例)和糖尿病非肥胖组(6例).另选取31例正常糖耐量者作为对照组,按BMI分为对照肥胖组(7例)和对照非肥胖组(24例).通过CT测定其肝脾CT值比值,检测其生化指标,计算胰岛素抵抗指数(HOMA-IR)及胰岛素敏感指数(HOMA-B).比较各组的上述指标并分析其与IR的相关性.结果 糖尿病组的肝脾CT值比值显著低于对照组,两组中的肥胖亚组的肝脾CT值比值均低于非肥胖亚组(P均<0.05).糖尿病组的1n-HOMA-IR显著高于对照组,两组中的肥胖亚组的1n-HOMA-IR均高于非肥胖亚组(P<0.05).Pearson's相关分析显示,肝脾CT值比值与1n-HOMA-IR、BMI呈负相关(r=-0.471,P=0.001;r=-0.434,P=0.003).多元线性回归分析显示,1n-HOMA-IR和BMI是肝脾CT值比值的独立危险因素(R2分别为0.227、0.296,P均<0.01).结论 2型糖尿病合并肥胖患者的肝脾CT值比值明显降低;IR和肥胖是其独立危险因素,可能与非酒精性脂肪肝发病密切相关.

Aim. In this study, we aimed to investigate the effects of febuxostat, a novel inhibitor of xanthine oxidase (XO), on renal damage in streptozotocin- (STZ-) induced diabetic rats. Methods. Diabetes was induced by the intraperitoneal injection of STZ in male Sprague-Dawley rats. Sham-injected rats served as controls. The control and diabetic rats were treated with and without febuxostat for 8 weeks, respectively. Fasting blood and 24-h urine samples were collected every 4 weeks. Rat livers were extracted for detecting gene expression, content, and bioactivity of XO. Results. Diabetic rats showed significantly increased serum uric acid (SUA), serum creatinine (SCr), and urea nitrogen (BUN) levels. Daily urinary albumin (UAE), uric acid (UUA), and creatinine (UCr) excretion were also significantly increased in these rats. In diabetic rats, at week 8, febuxostat decreased SUA by 18.9%, while UAA was increased by 52.0%. However, UCr and urinary urea nitrogen (UUN) levels remained unchanged, while SCr and BUN levels decreased by >30% in these rats. Although hepatic gene expression, content, and activity of XO increased significantly in diabetic rats, febuxostat only slightly decreased its content. Conclusions. Febuxostat significantly attenuated renal damage in STZ-induced diabetic rats in addition to exerting hypouricemic effect.

1 病例资料 患者男性,80岁.因“发现血糖升高6年,全身浮肿10余天”入院.患者于6年前体检发现血糖升高,诊断为“2型糖尿病”,一直口服阿卡波糖及二甲双胍控制血糖,具体剂量不详.3年前始出现口干、多饮、多尿,饮水量至少5升/日,尿量及次数均明显增多,夜尿5～6次/晚.曾于外院就诊检测血清钠120 mmol/L,当时建议予每日正常饮食基础上另增加9 g食盐加入水中饮用.多次复测血清钠仍偏低.近10余天开始出现双下肢、颜面部及眼脸浮肿,以双下肢明显,无气促、胸闷、胸痛、腹胀、夜间阵发性呼吸困难等,尿量一直较多.体重无明显下降.

Objective To observe the effect of fluid infusion on fluid balance in patients with diabetic ketoacidosis(DKA).Methods Seventy-two patients with DKA were divided into polyuria (PU)group(n=18)and non-polyuria(NPU)group(n=54).Clinical data and laboratory indices were recorded in both groups.The volume of intravenous and gastrointestinal infusion in early and late stages of treatment and the correction of electrolyte imbalance were compared between the two groups.Results PU group had a younger age and a shorter disease course than NPU group(P <0.05).There were no significant differences in biochemical indexes between the two groups(P > 0.05).Compared with NPU group,the volume of gastrointestinal infusion in early and late stages of treatment was increased and the level of serum sodium after DKA correction was decreased in PU group(P <0.01 and P <0.05,respectively).Conclusion In the process of fluid infusion for DKA,urine volume should be closely observed,and fluid infusion should be ad-justed according to serum sodium level and water loss.

目的:观察新诊断的原发性甲状腺功能减退症(甲减)患者血脂谱特点;采用单纯左甲状腺素替代及联合阿托伐他汀治疗并动态观察血脂改变.方法:58例新诊断的甲减患者给予左甲状腺素(L-T4)替代治疗3个月后随机分为单纯替代治疗组(L-T4组)及联合阿托伐他汀(10mg/d)治疗组(阿托伐他汀组),每3个月复查患者的甲状腺功能(包括游离甲状腺素、游离三碘腺原氨酸及促甲状腺素)、血脂指标(包括甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)及谷丙转氨酶、肌酸激酶的变化.结果:L-T4替代治疗3个月后两组血游离甲状腺素、游离三碘腺原氨酸水平明显上升至正常范围,而促甲状腺素显著下降(P＜0.05);患者存在明显的高总胆固醇、低密度脂蛋白胆固醇血症;L-T4组在第6个月总胆固醇及低密度脂蛋白胆固醇仍呈高水平;阿托伐他汀组在第6个月总胆固醇、低密度脂蛋白胆固醇明显降低(P＜0.05),并在观察期间维持稳定.观察期间两组谷丙转氨酶、肌酸激酶水平均正常且无显著差别(P＞0.05).结论:甲减患者存在显著的高胆固醇血症;单纯左甲状腺素替代治疗难以改善血脂异常,而联合阿托伐他汀治疗有助于长期维持血脂正常和稳定.

1 病例资料<br>　　患者1：女，56岁，因“精神异常2年，言语不清1周”入院。患者精神异常主要表现为认知功能、智力、记忆力明显减退，呈渐行性加重。1周前出现构音不清，伴有吞咽困难、饮水呛咳。30年前因“甲状腺功能亢进症”，行“甲状腺次全切除术”；有“2型糖尿病”史2年，服用二甲双胍治疗，血糖控制欠佳。查体：生命体征稳定；面容呆滞，构音不清，言语基本成句，伸舌左偏，咽反射明显减弱，四肢肌力 V －级，双侧Babinski’s 征阳性；心肺腹部无明显异常。入院查血清钙为2．40 mmol ／l，两次游离钙分别1．22 mmol ／l、1．10 mmol／l，血清磷1．26mmol ／l，两次甲状旁腺素分别为2．19 pmol／L 、1．94 pmol ／L，1，25－羟维生素 D 136．00 nmol／L，均在正常范围；甲状腺功能：游离三碘甲状腺原氨酸2．49 pmol／L ，游离甲状腺素9．40 pmol ／L ，超敏促甲状腺激素7．63 mIU／L，抗甲状腺过氧化物酶抗体54．81 kIU／L，提示原发性甲状腺功能减退。

Objective To explore various predicators related to Graves' disease(GD) relapse after withdrawal of antithyroid drugs (ATD). Methods Sixty-six GD patients who targeted to discontinue their ATDs were divided into relapse group(n=28) and non-relapse group(n=38) according to their clinical aspects within a 3-year follow-up after cure. Differences of gender, age, family history of GD, new onset or recurrent, the degree of goiter, combination of L-thyroxine(L-T4), iodine-free salt intake during ATD treatment and after discontinuation, serum levels of thyroid stimulating hormone antibodies(TRAb) at baseline and cure, etc., were compared between two groups. Results (1) Clinical features:In contrast to the non-relapse group, relapsed patients showed much younger age(P<0.05), higher percentage of GD family history(P<0.01), higher percentage of recurrent patients and more severe goiter(P<0.01), higher serum levels of TRAb either at baseline or cure (P<0.01), lower percentage of iodine-free salt intake during ATD treatment and after cure(P<0.01). There were no difference between two groups in serum concentrations of thyroglobulin antibodies(TGAb) and thyroid perioxidase antibodies(TPOAb), ATD categories, and combination with L-T4(P>0.05). (2) In a Logistic regression model, not adhering to iodine-free salt intake and high level of TRAb at baseline were independent risk factors for recurrence. Conclusion Various clinical predicators may relate to relapse of GD after discontinuation of ATD.Especially, Long-term iodine-free salt intake, and prolonging the course of ATD treatment according to serum TRAb level may reduce the recurrence of GD.

Objective To investigate the risk factors for severe hypoglycemia in the treatment of type 2 diabetes mellitus (T2DM) and to provide scientific rationales for the prevention of hypoglycemia in treating diabetes.Methods Clinical data of 49 T2DM patients with severe hypoglycemia (hypoglycemic group) and 98 T2DM patients without hypoglycemia as control group were retrospectively analyzed.Severe hypoglycemia was defined as that patient requiring assistance for intaking carbohydrate to alleviate hypoglycemia and plasma glucose concentration was less than 3.9 mmol/L.Clinical and biochemical indexes were analyzed by the single-factor analysis.Logistic regression model was established by multi factors regression analysis,and the receiver operating characteristic (ROC) curve was used to assess the performance of the logistic regression model.Results The mean serum glucose level was (2.3±0.7) mmol/L during hypoglycemia in hypoglycemia group.The mean age was higher in hypoglycemia group than in control group [(76.2±6,5) years vs.(69.8±11.5) years,P=0.001].The mean glycosylated hemoglobin Alc (HbAlc) level was lower in hypoglycemia group than in control group [(6.4±0.8)％ vs.(9.1± 2.5)％,P＜0.001].Endogenous creatinine clearance rate (Ccr) was lower in hypoglycemia group than in control group [(46.8±21.0) ml/min vs.(74.2 ± 24.5) ml/min,P＜0.001].Logistic regression analysis indicated that female and HbA1c level were the independent risk factors for severe hypoglycemia (OR=11.83,0.91 and 0.18,95％CI:1.82 76.93,0.86-0.97 and 0.08-0.44,respectiely] ; T2DM therapies with insulin and insulin secretagogues increased the risk of hypoglycemia (OR＝12.31 and 5.36,95％CI:1.70-88.88 and 1.08-26.56); however,duration of diabetes,body mass index (BMI),and urinary microalbumin (UMA) had no correlation with severe hypoglycemia (all P＞0.05).The area under the ROC curve was 96.5％ by the logistic regression model.Conclusions Gender,Ccr,HbA1c,insulin and insulin secretagogues are the main risk factors for severe hypoglycemia in T2DM patients.Preventive interventions of hypoglycemia should be taken earlier for the patients with the high risk factors.

目的 探讨糖尿病足溃疡(DFU)发生的危险因素,分析糖尿病周围神经病变(DPN)和糖尿病血管病变(PAD)与DFU的相互作用.方法 选取T2DM患者278例,按其是否合并DFU分成糖尿病足溃疡组(DFU,102例)和糖尿病非足溃疡组(NDFU,176例),回顾性分析两组生化特征和并发症情况.采用Logistic回归分析DFU发生的危险因素,并通过相对超额危险度比(RERI),归因比(AP)和相互作用指数(S)评价DPN与PAD的相加相互作用.结果 与NDFU组比较,DFU组HbA1c和纤维蛋白原(FIB)水平,DR、DPN和PAD发生率均升高,血红蛋白(Hb)、血白蛋白(Alb)、TC和LDL-C降低(P＜0.05).Logistic回归分析显示,DFU相关影响因素有:HbA1 c、DPN、PAD、Hb、Alb和FIB(OR分别为1.41、3.66、3.00、0.98、0.79和2.51).DPN和PAD对DFU的相加相互作用指标RERI、AP和S分别为3.45(95％CI:1.22～8.56)、0.29(95％CI:0.02～0.58)和1.45(95％CI:1.03～4.96).结论 血糖控制欠佳、合并DPN和PAD、营养不良及FIB代谢失衡是DFU发生的主要危险因素.DPN和PAD对DFU存在相加相互作用,同时患有DPN和PAD可增加DFU的患病风险.

OBJECTIVE To investigate the changes of the liver fat contents in Zucker fatty rats by treatment with different rennin-angiotensin system blockers.METHODS Twelve-week old male Zucker fatty rats(ZF rats,n=24) were randomly divided into four groups: one served as control group and the other 3 groups were treated with olmesartan(ARB group),temocapril(ACEI group),olmesartan and temocapril(ARB+ACEI group) for 4 weeks,respectively.Liver fat content and the blood lipid profiles were measured.RESULTS Blood pressure of 3 treatment groups was significantly lowered as compared with the control.Plasma levels of triglyceride(TG) and cholesterol(TC) were compared between 4 groups.Olmesartan treatment remarkably decreased the liver TG content ·g-1 vs.(31.6±9.6) mg·g-1,P0.05] and liver TC content ·g-1 vs.(1.52±0.07) mg·g-1,P0.05] when compared to the control group.Temocapril treatment did not exert any effects on LTG and LTC.Interestingly,the combination with olmesartan and temocapril increased LTG and LTC to some extent.CONCLUSION Olmesartan treatment significantly lowers LTG and LTC in ZF rats,while tempocapril and its combined treatment with olmesartan might not be beneficial to hepatic fat deposition.

南方人爱喝汤,许多人认为老火汤煲的时间越久,营养价值越高,这是个误区. 一般而言,要将汤里的菜和肉煮熟,煲半小时即可.煲汤煲上两三个小时甚至更长时间,肉类释出的嘌呤更多,进入人体的代谢产物就是尿酸,容易引起高尿酸血症和痛风发作.炖汤与煲汤,道理都一样.同时,肉类煲的时间长了,脂肪大部分弥散在水中,容易引起血脂升高和肥胖.另外,有研究表明,老火汤中磷含量高,长期摄入高磷饮食对肾有害.

Aim. Several studies indicated that hyperuricemia may link to the worsening of diabetic nephropathy (DN). Meanwhile, low protein diet (LPD) retards exacerbation of renal damage in chronic kidney disease. We then assessed whether LPD influences uric acid metabolism and benefits the progression of DN in streptozotocin- (STZ-) induced diabetic rats. Methods. STZ-induced and control rats were both fed with LPD (5%) and normal protein diet (18%), respectively, for 12 weeks. Vital signs, blood and urinary samples for UA metabolism were taken and analyzed every 3 weeks. Kidneys were removed at the end of the experiment. Results. Diabetic rats developed into constantly high levels of serum UA (SUA), creatinine (SCr) and 24 h amounts of urinary albumin excretion (UAE), creatintine (UCr), urea nitrogen (UUN), and uric acid (UUA). LPD significantly decreased SUA, UAE, and blood glucose, yet left SCr, UCr, and UUN unchanged. A stepwise regression showed that high UUA is an independent risk factor for DN. LPD remarkably ameliorated degrees of enlarged glomeruli, proliferated mesangial cells, and hyaline-degenerated tubular epithelial cells in diabetic rats. Expression of TNF-α in tubulointerstitium significantly decreased in LPD-fed diabetic rats. Conclusion. LPD inhibits endogenous uric acid synthesis and might accordingly attenuate renal damage in STZ-induced diabetic rats.

Objective To explore alteration of three kinds of lipoprotein cholesterol and their relations to age, gender, and fasting plasma glucose in healthy adults. Methods We recruited 1 310 healthy examinees and divided them into 6 groups according to their age. Plasma levels of three kinds of lipoprotein cholesterol and glucose were measured. Changes of lipoprotein cholesterols along with age and their differences between male and female were statistically analyzed. Results Plasma concentrations of very low density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) increased gradually along with age in both genders (r = 0.19 and 0.25 respectively, both P 0.01). VLDL-C of men slightly decreased but women increased after 60, correspondingly, men always kept up higher level of VLDL-C than women before 60 (P = 0.000) but compared after that. LDL-C showed the same trend as VLDL-C between male and female (P 0.05) except that they were similar after 50. The high density lipoprotein cholesterol (HDL-C) did not change significantly with age increasing (P 0.05), but concentrations of HDL-C of women were always higher than men among all ages (P 0.01). As to the fasting plasma glucose, VLDL-C showed a very weak positive correlation (r = 0.08, P 0.01) with it, but LDL-C positively (r = 0.13, P 0.01) and HDL-C negatively (r = -0.18, P 0.01) correlated to it remarkably. Conclusions Dyslipidemia is inevitable along with aging even in healthy subjects. Men are highly prone to be dyslipidemic. Increased fasting plasma glucose may partially affect lipid metabolism.

OBJECTIVE To assess the status of oral antidiabetic drugs(OADs) and metabolic indicators in outpatient patients with type 2 diabetes.METHODS This survey recruited 347 case of type 2 diabetic patients receiving oral antidiabetic agents randomly.Demographic data,treatment,blood glucose,blood pressure,lipid profile and chronic complications were collected through outpatient interview and case history investigation.Target profiles of various metabolic indicators were analyzed according to the Chinese Guideline on Prevention and Treatment of Type 2 Diabetes(2010).RESULTS Metformin was the most frequently used OAD(55.2%),followed by sulfonylurea(51.6%).For therapeutic protocols,35.2% of patients were undertaking the single OAD treatment,while 49.0% of patients with two kinds of OAD and 15.8% with three kinds or more.The targeted rates of HbA1c,fasting and postprandial plasma glucose were 59.1%,73.2% and 71.8% respectively.Totally 33.4% of patients were up to the targeted standard of blood pressure,and only 40% of them were up to the targeted standard of lipid profile.The number of OADs was increased along with the duration of diabetes.HbA1c was comparable between patients treated with single,two kinds and three kinds of OADs.CONCLUSION According to the latest Chinese Guideline on Prevention and Treatment of Type 2 Diabetes(2010),the targeted rates of blood glucose increased significantly among our outpatient type 2 diabetic patients,but the targeted rates of blood pressure and lipid profile were still lower.There have been still 40.9% of patients far from the guiding standard.

Aim To study alterations in particle components of high density lipoprotein subspecies and activities of the key lipid transfer proteins for its metabolism in type 2 diabetic patients,the correlation between these alterations and related blood glucose indicators were also explored. Methods 26 new-onset type 2 diabetic patients(T2DM group) and 25 healthy subjects(control group) were recruited. Plasma was both fasting and postprandial sampled for all subjects,then blood glucose,insulin and lipid spectrum were determined. High density lipoprotein 3 was separated by modified one-step precipitation method and the compositions were measured,then the major compositions of high density lipoprotein 2 were calculated. Activities of cholesterol ester transfer protein and phospholipid transfer protein was determined by enzyme fluorescence assay kits. Results (1)There were no differences in plasma high density lipoprotein cholesterol(HDLC) between T2DM group and control group(P=0.579).(2)There were no significant differences in either cholesterol ester transfer protein or phospholipid transfer protein activity between T2DM group and control group(P>0.5).(3)The following particle components of high density lipoprotein 3(HDL_3) in T2DM group were decreased significantly than those in control group(P<0.01): HDL_3C(0.60±0.17 mmol/L vs 0.75±0.22 mmol/L),phospholipids(PL,1.14±0.19 mmol/L vs 1.29±0.22 mmol/L),free cholesterol(FC,0.021±0.012 mmol/L vs 0.033±0.012 mmol/L),cholesterol ester(CE,0.97±0.28 mmol/L vs 1.19±0.36 mmol/L).All the subjects' FC and CE from HDL_3 were significantly and negatively correlated with the following indicators(P<0.05): postprandial blood glucose(PBG),glycosylated hemoglobin(HbA1c),home-ostasis model assessment of insulin resistance(HOMA-IR).(4)The apolipoprotein AI(Apo AI) of HDL_2 in T2DM group was significantly decreased than those in control group(604.8±233.3 mg/L vs 755.4±198.0 mg/L,P<0.05),and the Apo AI of HDL_2 in all subjects was significantly and negatively correlated with PBG,HOMA-IR and plasma triglycerides(TG)(P<0.05). Conclusions The major components of HDL_3 and HDL_2 were decreased significantly in T2DM group than that in control group. We speculate that the size of HDL_3 and HDL_2 particle shrinks and might relate to hyperglycemia and insulin resistance. DL 3 were significantly and negatively correlated with the following indicators(P < 0.05) : postprandial blood glucose(PBG),glycosylated hemoglobin(HbA1c),home-ostasis model assessment of insulin resistance(HOMA-IR).(4) The apolipoprotein AI(Apo AI) of HDL 2 in T2DM group was significantly decreased than those in control group(604.8 ± 233.3 mg / L vs 755.4 ± 198.0 mg / L,P < 0.05),and the Apo AI of HDL 2 in all subjects was significantly and negatively correlated with PBG,HOMA-IR and plasma triglycerides(TG)(P < 0.05).Conclusions The major components of HDL 3 and HDL 2 were decreased significantly in T2DM group than that in control group.We speculate that the size of HDL 3 and HDL 2 particle shrinks and might relate to hyperglycemia and insulin resistance.

Objective To explore the pathogenic bacteria species of inpatients with diabetic foot ulcer surface and their sensitivities to antibiotics. Methods A retrospective study was carried out on the 87 strains of pathogens isolated from the wound surface secretion of 69 inpatients with diabetic foot ulcer and the changing trend of drug sensitive from 2003 to 2010. Results ①The infections in diabetic foot were increasing from 2003 to 2010. In 87 strains, 63.2% were Gram positive (G+) bacteria, 31.1% were Gram negative(G-) bacteria, and 5.7% were fungi. ②Staphylococcus aureus, enterococcus faecalis, proteus and streptococcus were main pathogenic bacteria in diabetic foot ulcer infections. The G+ bacteria were all sensitive to vancomycin. The sensitivity of G- bacteria to amikacin was the highest. MRSA, MRCNS, MRS and CNS were all sensitive to vancomycin. Conclusion The G+ bacteria are predominant in diabetic foot ulcer infections. The drug resistance rates of bacteria are very high. We should pay attention to germiculture of diabetic foot ulcer and drug sensitive test as soon as possible to provide a guideline in choosing antibiotics reasonably for diabetic foot infections.

Aim To investigate the level of plasma adiponectin in patients with diabetic nephropathy,and its relationship to vascular endothelial function.Methods Fifty type 2 diabetic patients without clinical macrovascular complications were randomly assigned to normal albuminuria group(NAU),microalbuminuria group(MAU) and macroalbuminuria group(CAU) according to the daily urinary albumin excretion(UAE).Plasma adiponectin,soluble vascular cell adhesion molecule-1(sVCAM-1) and other biochemical indexes were measured.Color Doppler examination was followed to evaluate flow-mediated vasodilation(FMD),nitroglycerin vasodilation(NID),cardiologic parameters and intima-media thickness(IMT).Results In CAU group,plasma concentration of adiponectin was 4-fold and 2-fold higher than that in NAU group and MAU group respectively(13.3±5.0 mg/L vs 3.7±1.6 mg/L vs 5.7±2.2 mg/L,P<0.01 and P<0.05),while the difference between NAU group and MAU group was also significant(P<0.05).The ratio of adiponectin to serum creatinine followed the same trend along three groups(P<0.05).Plasma sVCAM-1 was significantly increased in MAU group and CAU group than that in NAU group(P<0.01 and P<0.05).FMD and NID were signifi-cantly decreased in contrast to the increment of plasma adiponectin(P<0.05).IMT was comparable between three groups(P>0.05).Finally,adiponectin was positively correlated with sVCAM-1,UAE,creatinine,left ventricular posterior wall thickness and IMT(r=0.338,0.704,0.470,0.331,0.324 respectively,all P<0.05),while negatively correlated with FMD and NID(r=-0.397 and-0.413 respectively,P<0.01).Conclusions Diabetic nephropathy is accompanied with hyperadiponectinemia,which is closely related to vascular endothelial dysfunction.Adiponectin may act as an early predictor of vascular endothelial dysfunction in these patients.

Objective To assess the status of metabolic control and hypoglycemic agents treatment in outpatient type 2 diabetic patients.Methods This survey recruited 343 type 2 diabetic patients randomly.According to the Chinese Guideline on Prevention and Treatment of Type 2 Diabetes,a cross-sectional investigation was performed to evaluate targeted status of HbA1c,lipid profile and blood pressure.Hypoglycemic agent protocols and occurrence of macrovascular complications were analyzed simultaneously.Results There were 21.9% of informants targeted HbA1c ≤ 6.5%,while 24.5% and 30.3% of informants got well control in fasting and postprandial plasma glucose respectively.33.2% of patients targeted well blood pressure control,and only 1/3 of them were up to the targeted standard of lipid profile.The ordinal ratio of oral antidiabetic drugs(OAD) consumption was metformin(48.4%),sulfonylureas(36.4%),α-glucosidase inhibitors(33.5%),TZDs(26.5%),and glinides(16.3%).For therapeutic protocols,25.4% of patients were undertaking the single OAD treatment,while 39.1% of patients with two kinds of OAD and 11.0% with three kinds or more,24.5% of patients were treated with OADs combined with insulin.Consequently,the targeted ratio of HbA1c significantly decreased in accordance with the above protocol sequence,and correlated to the diabetic duration of each protocol group.The most common marcovascular complication was hypertension(61.2%).Conclusion The targeted rate of blood glucose control in our survey is a little higher than results from national survey,but there have been still 78.1% of patients far from the guiding standard.Early initialization of OADs combined with insulin may improve the situation of outpatient diabetic treatment.