报道安徽省芜湖市第二人民医院内分泌科1例健康状态中等的老年2型糖尿病患者应用德谷门冬双胰岛素简化治疗方案得到满意效果的诊疗过程，并进行文献复习。患者为82岁独居女性，因“近2个月来不明原因血糖控制不佳”入院，入院前应用甘精胰岛素U100联合门冬胰岛素注射液治疗，但血糖出现不明原因异常升高，后发现血糖波动原因为患者存在一定程度用药障碍，无法辨别门冬胰岛素与甘精胰岛素，每次注射时随机使用其中一种。经简化治疗方案，改为德谷门冬双胰岛素注射液一日2次注射。更换治疗方案后，胰岛素用量减少，达到中等老年综合状态2型糖尿病患者血糖控制目标。德谷门冬双胰岛素的使用对老年糖尿病患者简化治疗方案，减少胰岛素使用错误导致的低血糖和血糖波动，减轻治疗负担起到了积极作用。

糖尿病的致病原因包括遗传和环境因素,近年来,在遗传因素无明显变化的情况下,2型糖尿病的患病率迅速上升,说明环境因素在其发病中的重要作用,本研究随机选取596例糖尿病患者,对其配偶行糖尿病筛查.了解夫妻共患糖尿病趋势;进一步研究环境因素(生活习惯、饮食结构等)对糖尿病发病的影响;寻找糖尿病发病的高危人群.

Objective To investigate the long-term effect of the implantation of human umbilical cord-derived mesenchymal stem cells（ HUC-MSCs） for type 1 diabetes mellitus.Methods Fifteen patients with type 1 diabetes mellitus were treated with HUC-MSCs from September 2009 to December 2011 at Department of Endocrinology and Metabolism,the Second People’ s Hospital.

目的 在血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)治疗基础上加用螺内酯,观察其对2型糖尿病患者合并糖尿病肾病(DN)的保护作用.方法 明确诊断的2型糖尿病患者,病程>5年,合并有持续微量白蛋白尿,并使用ACEI/ARB类药物治疗≥6个月,共入选48例患者,随机分成螺内酯干预组(SG组)和对照组(CG组),SG组给予螺内酯25 mg/d,CG组给予安慰剂,干预6个月.每2周监测血钾,每月监测空腹血糖、晨间血压,分别于干预前、干预3个月及干预6个月监测糖化血红蛋白(HbA1c)、胱抑素-C(Cys-C)、肾小球滤过率(GFR)、尿白蛋白/肌酐比值(UACR).结果 在干预6个月结束后,两组血糖、血压、HbA1c差异无统计学意义(P>0.05);与CG组相比,SG组Cys-C及UACR显著下降,GFR显著上升,差异有统计学意义(P<0.05).结论 在ACEI/ARB基础上加用螺内酯可减少蛋白尿,改善肾小球滤过功能,该保护作用不依赖于降糖、降压作用.

目的分析2型糖尿病（T2DM）患者血尿酸（SUA）水平与糖尿病周围神经病变（DPN）的关系。方法对60例T2DM患者进行糖化血红蛋白（HbA1c）、空腹C肽、血压、血脂、血尿酸、血肌酐等测定,并计算体重指数（BMI）、胰岛素抵抗指数（HOMA-IR）,同时进行糖尿病周围神经病变体征的筛查和神经传导速度检查,分析SUA水平与DPN的相关性。结果将患者分别根据有或无DPN进行分组,DPN组SUA水平显著高于N-DPN组[（369.74±87.92）μmol/L、（336.26±64.47）μmol/L,P＜0.05]。将患者分别按SUA是否正常分为N-SUA组和H-SUA组,不同SUA水平组的运动/感觉神经振幅和传导速度差异有统计学意义（P＜0.05）。SUA水平与运动/感觉神经幅值及CV值呈负相关（P＜0.05）。Logistic多元回归分析显示,糖尿病病程、SUA水平、高胆固醇（TC）水平与DPN的发生明显相关（P＜0.05）。结论 SUA水平与DPN之间存在显著相关性。SUA升高可能是预测DPN在T2DM患者中发生的重要指标。

Objective To explore the clinical effect of insulin in patients with type 2 diabetes (T2DM) complicated with pulmonary infection and the changes in blood biochemical indexes of the patients.Methods Sixty T2DM patients complicated with pulmonary infection were selected from December 2014 to March 2017 and were randomly divided into control group and treatment group (n =30,each).Based on conventional treatment such as anti-inflammation,phlegm suctioning,relieving asthma and oxygen inhalation,the multiple subcutaneous insulin injection was conducted in control group,and insulin pump therapy was given in treatment group.Two weeks later,the total clinical effective rate and the improvement of clinical symptoms were compared between two groups.The blood glucose control,levels of serum inflammatory factors and other blood biochemical indexes before and after treatment were detected and compared between two groups.Results The total effective rate in treatment group was significantly higher than that in control group (93.3％ vs 73.3％,P ＜ 0.05).Compared with pre-treatment,serum levels of fasting plasma glucose (FPG)and 2hPG significantly decreased after treatment (P ＜ 0.05,P ＜ 0.01),and there were no significant differences in them between two groups (all P ＞ 0.05).Compared with control group,the time to reach target glucose obviously shortened,and the dosage of insulin decreased in treatment group (all P ＜ 0.05).Compared with pre-treatment,scores of symptom of fever,cough and expectoration and serum levels of procalcitonin (PCT),C reactive protein (CRP) and interleukin 6 (IL-6) significantly decreased after treatment in both two groups (all P ＜ 0.01) and were significantly lower in treatment group than those in control group (all P ＜0.01).Compared with control group,post-treatment concentration of blood sodium and potassium,plasma colloid osmotic pressure significantly decreased in treatment group (P ＜ 0.05,P ＜ 0.01).Conclusions In the treatment of patients with T2DM complicated with pulmonary infection,insulincan significantly control the blood glucose level,correct metabolic disorders,improve blood biochemical parameters,effectively reduce serum levels of inflammatory factors,alleviate inflammatory injury and improve the clinical symptoms.Insulin pump therapy is more significant than multiple subcutaneous injection.

OBJECTIVE:To observe the clinical efficacy of sitagliptin combined with benazepril in the treatment of diabetic nephropathy(DN). METHODS:Sixty DN patients admitted to our hospital during Sept. 2014-Jun. 2015 were divided into sitagliptin group,benazepril group,drug combination group according to random number table,with 20 cases in each group. Based on routine treatment,sitagliptin group was given sitagliptin 100 mg orally,qd;benazepril group was given Benazepril 10 mg orally,qd;drug combination group was given sitagliptin 100 mg+benazepril 10 mg orally,qd. The drug dosage would be doubled if the blood pressure of patients in 3 groups had not yet reached the standard. Treatment course of 3 groups lasted for 12 weeks. The levels of 24 h urine protein,IL-6 and Cys-C were measured in 3 groups before and after treatment. Clinical efficacies and the occurrence of ADR were observed. RESULTS:Total response rate of drug combination group(90.00%)was significantly higher than those of sitagliptin group (65.00%)and benazepril group(70.00%);there was statistically significance(P<0.05). After treatment,the levels of 24 h urine protein,IL-6 and Cys-C in 3 groups were significantly lowered,compared to before treatment;those of drug combination group was significantly lower than those of other 2 groups;there was statistically significance(P<0.05). There was no statistical significance in above indexes between sitagliptin group and benazepril group(P>0.05). No obvious ADR was found in 3 groups during treatment. CONCLUSIONS:Both sitagliptin and benazepril can decrease the levels of 24 h urine protein,IL-6 and Cys-C,while drug combination shows better effect and clinical response rate,and does not influence the safety of drug use.

ObjectiveTo explore the effect of serum 25-hydroxyvitamin D[25(OH)D]level on thyroid hormones and its auto-antibody in patients with autoimmune thyroid disease(AITD)and study the correlation among them.Methods 48 cases AITD outpatients(GD group and HT group)and 19 cases healthy subjects(control group)were selected from Aug. 2011 to Feb 2013. The levels of serum 25(OH)D,free triiodothyronine(FT3),free thyroxine(FT4),total triiodothyronine(TT3),total thyroxine(TT4),thyroid-stimulating hormone(TSH), thyroid peroxidase antibody(TPOAb),thyrotrophin receptor antibody(TRAb)were detected in GD group and HT group as well as control group.The correlation between serum 25(OH)D levels and the levels of FT3,FT4,TT3,TT4,TSH,TPOAb,TRAb were analyzed.Results Compared with the control group,the levels of 25(OH)D in GD group and HT group were decreased,there were statistically significant difference(P<0.05). In GD group,the levels of 25(OH)D and TPOAb(r=-0.9261,P<0.01)were negatively related,but the levels of 25(OH)D and FT3,FT4,TT3,TT4, TSH,TRAb had no obvious relation. In HT group,the levels of 25(OH)D and FT4(r=-0.8632,P<0.01),TPOAb(r=-0.4222,P<0.05),TRAb (r=-0.9561,P<0.01)were negatively related,and the levels of 25(OH)D and FT3,TT3,TT4,TSH had no obvious relation.Conclusion Vitamin D deficiency universally exists in AITD patients,and it may play an important role in the pathogenesis of AITD.

Objective:To analyze the clinical distribution and antimicrobial resistance of pathogens causing diabetic foot infections in order to provide the basis for clinical rational choice of antibiotics.Methods:95 cases of diabetic foot infection were chosen from January 2012 to December 2014.The antimi-crobial susceptibility test to isolated pathogens was performed by agar dilution method .The results were judged according to the criteria recommended by Clinical and Laboratory Standards Institute (CLSI) 2013.Results:Of 95 cases of diabetic foot infection, 105 strains were isolated, in which 55 were Gram-positive bacteria (52.4%), 35 Gram-negative bacteria (33.3%), and 15 fungi (14.3%).The results of antimicrobial susceptibility test showed that Gram-negative bacteria were highly susceptible to the carbapenem and β-lactamase inhibitor; Gram-positive bacteria were highly susceptible to the glycopeptide, carbapenem and aminoglycoside;fungus were susceptible to amphotericin B and caspofungin .Conclusion:Infection is an important factor in diabetic foot patients, and the rate of multi-drug resistance is high.With the increase in the severity of diabetic foot infections, the leading pathogens tran-sited from Gram-positive bacteria to Gram-negative bacteria.

越来越多的研究证实，糖尿病发病率仍在快速上升，据预测未来20年内，全球糖尿病的发病率将增加65％[1]。人们经过长期的临床观察和实验研究证明，糖尿病的发病是多因性的，除遗传、肥胖、感染等因素外，心理社会紧张刺激引起的紧张焦虑等心理问题与糖尿病的发生、发展也有一定的关系，紧张焦虑的情绪会引起一些应激激素如肾上腺素、去甲肾上腺素、肾上腺皮质激素及胰高血糖素的分泌，从而拮抗胰岛素，引起血糖升高，使病情加重[2]。我科2014年对251例门诊和住院的糖尿病患者进行了心理问卷调查，了解其心理健康状况。

Objective:To study the clinical characteristics and risk factors of carotid artery plaques in patients with type 2 dia-betes mellitus(T2DM ) and ischemic stroke .Methods :A total of 185 patients with ischemic stroke from Jul 2013 to Dec 2013 were divided into T2DM group(n=72) and non-T2DM group(n=113) .All the patients underwent ultrasonic examination to confirm the incidence of carotid artery plaques .And 22 patients received computed tomographic arteriography (CTA) for further diagnosis of carotid artery plaques .The relationships of glucose metabolism and lipid metabolism with the size of carotid artery plaquewereanalyzed.Results:Theincidencerate,natureandsizeofcarotidarteryplaque,intima-mediathickness(IMT)ofca-rotid artery in T2DM group were significantly different from those in non-T2DM group(P<0 .05) .The main factors affecting the sizes of carotid artery plaques were T 2DM ,2 h postprandial blood glucose(2 h PBG) ,homeostatic model assessment for in-sulin resistance(HOMA-IR) ,fasting blood glucose(FBG) ,low density lipoprotein-cholesterol(LDL-C) , P<0 .05 .There was significant difference in the degree of lumen stenosis detected by ultrasound and CTA in the 22 patients(P<0 .05) .Conclu-sions:The size of carotid artery plaque in patients with ischemic stroke are influenced by T 2DM ,2 h PBG ,HOMA-IR ,FBG and LDL-C .The incidences of plaques as well as vulnerable plaques increases when patients suffer with T 2DM simultaneously .Ul-trasound can be applied as the preferred method for carotid artery plaque screening .CTA manifests as a more promising manner to demonstrate the characteristics of the plaques and the severity of lumen stenosis .

AIM:To investigate the correlation between nonalcoholic fatty liver disease(NAFLD)and metabolic syndrome(MS)by detecting the index of enzyme and metabolism.METHODS:122employees who receive physical examination in Physical Examination Center of the No'2people'hospital of Wuhu were involved in the group,and the index of enzyme,metabolism,and complication were detected all of them. RESULTS:Compared with the pure NAFLD group,the levels of weight index,TG,systolic blood pressure,diastolic blood pressure and the fasting blood glucose in NAFLD with MS group were increased,there was statistically significant difference(P0.05).the levels of TC,HDL-C,LDL-C,UA and the complications in two groups were similar,there was no statistically significant difference(P0.05).CONCLUSION:The rate of abnormal index of metabolism and the complications of patients of NAFLD with MS were higher,and physician should pay attention to it and give some suggestion about it to patients of NAFLD with MS.

Objective: To investigate the etiology and clinical features of hypoglycemic encephalopathy. Methods: The etiology and clinical features of 56 patients with hypoglycemic encephalopathy were retrospectively analysed. Results: Among 56 patients with hypoglycemic encephalopathy,39 cases were related to hypoglycemic drugs,5 cases were caused by the fluoroquinolone drugs,4 cases were caused by insufficient food,3 cases were caused by unknown components and health products,the causes of 3 cases were unknown and 2 cases were complicated with upper respiratory tract infection. The clinical features were disturbance of consciousness,insanity, epilepsy,hemiplegia and choreic movement. Conclusions: The etiology and clinical features of hypoglycemia encephalopathy are complicated and lack of specificity,which is ease to misdiagnose. The hypoglycemic encephalopathy in the patients with central nervous system damage should be taken into account.

随着经济的发展和人民生活方式的改变以及人口老龄化,我国的糖尿病患病率呈现快速增加趋势,糖尿病的病死率也随之上升[1].对糖尿病死亡原因的认识是糖尿病预防及治疗的重要因素.本文对资料完整的125例糖尿病住院死亡病例的临床资料进行回顾性分析,现总结如下.

糖尿病肾病(DN)是糖尿病常见的微血管并发症.约30%～40%的患者发生DN.DN患者的动脉硬化性心血管疾患的发生率及死亡率明显高于无DN者,而脂代谢紊乱是动脉硬化的危险因素.本文探讨114例糖尿病住院病人的血脂变化,就其在DN发生、发展中的作用进行初步分析.