目的:探讨下肢神经剪切波弹性成像(SWE)对不同程度糖尿病周围神经病变(DPN)的诊断效能.方法:收集DPN患者65例,按下肢病变程度分为无溃疡组(49例,轻症)与溃疡组(16例,重症).纳入同期体检健康者32例为对照组.应用SWE技术对双侧下肢神经(胫神经、腓总神经及腓肠神经)进行成像,测量参数包括弹性模量峰值(Emax)、平均弹性模量(Emean)、最大剪切波传导速度(Vmax)、平均剪切波传导速度(Vmean).比较三组胫神经、腓总神经及腓肠神经SWE参数并评价对不同程度糖尿病周围神经病变的诊断效能.结果:溃疡组胫神经Emean、Emax、Vmean和Vmax高于无溃疡组和对照组(均P<0.05).溃疡组和无溃疡组腓总神经Emean、Emax、Vmean和Vmax高于对照组,且溃疡组高于无溃疡组(均P<0.05).ROC曲线分析显示,胫神经和腓总神经SWE参数对不同程度DPN具有中等诊断效能,而腓肠神经诊断效能较低.结论:DPN患者下肢神经损害程度不一,其中胫神经和腓总神经SWE参数对不同程度DPN具有一定的诊断效能.

Objective:To investigate the association between glycated hemoglobin A 1c (HbA 1c) and subclinical left ventricular (LV) systolic function in patients with type 2 diabetes mellitus (T2DM). Methods:T2DM patients who consecutively admitted to the Department of Endocrinology, First Affiliated Hospital of Air Force Medical University, Shaanxi Province from June to December 2021 were selected. The age, heart rate, systolic blood pressure, fasting plasma glucose (FPG), HbA 1c, triglyceride (TG) and urinary albumin to creatinine ratio (UACR), LV global longitudinal strain (GLS) were collected. According to the GLS results, patients were divided into three groups: T1 (GLS≤16.6%), T2 (16.6%19.4%). One-way analysis of variance, Fisher exact test or chi-square test, and Kruskal-Wallis H test were used to compare the differences in clinical characteristics and metabolic indexes among groups. Pearson correlation analysis was used to evaluate the correlation between HbA 1c and GLS, and multiple linear regression analysis was used to analyze the influencing factors of LV subclinical myocardial systolic dysfunction in patients with T2DM. Results:A total of 152 patients were included. There were 51 cases in T1 group, 51 cases in T2 group, and 50 cases in T3 group. HbA 1c level decreased with increasing GLS group [(10.01±2.39)% vs. (8.69±1.77)% vs. (7.78±1.38)%, P<0.001]. Pearson correlation analysis showed that HbA 1c was negatively correlated with GLS ( r=-0.48, P<0.001). The results of univariate linear regression analysis showed that HbA 1c, age, heart rate, systolic blood pressure, FPG, TG and UACR were significantly correlated with GLS (all P<0.05). Multivariate analysis showed that HbA 1c was independently associated with GLS ( β=-0.613, P<0.001). In addition, the results showed that logUACR was an independent and major risk factor for reduced GLS ( β=-1.010, P=0.024). Conclusions:HbA 1c was negatively associated with the progression of LV subclinical systolic function in patients with T2DM. High UACR level was the main influencing factor of LV longitudinal dysfunction.

患者,女,34岁,汉族,因"发现血糖升高15年,视力下降3月余"入院.患者15年前因"带状疱疹"于外院就诊时查随机血糖高达20.6 mmol/L,尿糖(++++),尿酮体(-).行口服葡萄糖耐量试验(OGTT)确诊为"糖尿病",未明确分型.予诺和灵30R 12 ～ 16 U/日降糖治疗,空腹血糖控制在5～6 mmol/L,餐后2小时血糖7 ～ 10 mmol/L.5年前因妊娠将降糖方案调整为门冬胰岛素联合地特胰岛素治疗,产后再次调整为诺和灵30R,血糖控制欠佳.近3个多月前出现视力下降,血糖控制不佳,遂来我院就诊.患者否认乙肝、结核传染病史,无高血压、心脏病慢性病史,无手术、外伤史,对"青霉素"过敏.

目的:本文主要研究二甲双胍联合利拉鲁肽治疗新诊断超重2型糖尿病患者疗效,从而提升临床治疗效果,提高患者治疗满意度.方法:选取我院2018年10月-2019年8月收治的68例新诊断超重2型糖尿病患者作为研究对象,将患者分为对照组与观察组,每组患者34例.两组患者均给予饮食、运动基础治疗,对照组患者为给予二甲双胍治疗,观察组患者为二甲双胍联合利拉鲁肽治疗,对比两组患者治疗疗效.结果:治疗前,两组患者腹围、体质量指数(BMI)以及体质量情况无明显变化(P>0.05);治疗后,观察组患者腹围、体质量指数(BMI)以及体质量情况显著优于对照组患者;观察组患者FPG2hPG、LDL-C、HbAlc各项生化指标均优于对照组患者,两组之间数据差异显著(P<0.05).结论:临床治疗新诊断超重2型糖尿病患者中,使用二甲双胍联合利拉鲁肽开展治疗,有利于改善体重、血糖、血脂情况,临床治疗效果显著,有效改善患者身心健康,值得临床广泛推广.