[目的]探讨糖尿病视网膜病变(diabetic retinopathy,DR)黄斑区血流密度(macular vascular density,MVD)和黄斑中心凹无血管区(foveal avascular zone,FAZ)面积的变化及其意义.[方法]选取2015年2月至2017年2月在本院就诊的74例糖尿病患者(DM组)及同期40例健康查体者(CON)的临床资料,糖尿病患者根据眼科检查分为无DR组(No-DR组)、非增殖性糖尿病DR组(NPDR组)和增殖性糖尿病DR组(PDR组).光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)检测各组MVD和FAZ横径、竖径和面积并比较.[结果]DM组共有135只眼,其中No-DR组共71只,NPDR组共53只眼,PDR组共11只眼,正常CON共80只眼.PDR组、NPDR组在表层、内层视网膜及脉络膜毛细血管层的MVD均明显低于CON(均P ＜0.05).No-DR组在表层、内层视网膜的MVD均明显低于CON(均P＜0.05);PDR组、NPDR组在表层、内层视网膜及脉络膜毛细血管层MVD明显低于No-DR组(均P＜0.05).与CON相比,PDR组FAZ竖径、横径及面积明显较大(均P ＜0.05);No-DR组、NPDR组FAZ面积明显较大(P=0.000),而FAZ竖径、横径无显著差别(均P＞0.05).[结论]DR患者FAZ面积扩大及MVD降低,对早期诊断DR具有重要临床价值.

目的 探讨转录因子叉头框C2(FOXC2)基因C-512T多态性与非酒精性脂肪性肝病(NAFLD)及其相关代谢因素的关系.方法 应用聚合酶连反应-限制性片段长度多态性(PCR-RFLP)方法,对269名正常对照组(NC)和237例NAFLD患者(NAFLD组)的FOXC2基因C-512T多态性进行测定,同时进行体表测量、生化指标及腹部B超检查.结果 与NC组比较,NAFLD组FOXC2基因C-512T多态性的基因型频率分布差异无统计学意义(χ2=4.455,P=0.108);而NAFLD组T等位基因频率降低(χ2=3.638,P=0.048);NAFLD组CC型患者TG、HOMA-IR高于TT型患者,差异有统计学意义(P<0.05).Logistic回归分析显示,CC基因型和HOMA-IR是NAFLD的影响因素.结论 FOXC2基因C-512T多态性CC基因型可能与NAFLD发生有关.

目的 观察重组甘精胰岛素与格列美脲联合治疗2型糖尿病的疗效.方法 选取2016年2月～2017年2月收治的2型糖尿病患者126例为研究对象,随机分为对照组和观察组各63例.对照组给予精蛋白生物合成人胰岛素联合格列美脲治疗,观察组给予重组甘精胰岛素与格列美脲治疗,观察治疗前后两组空腹血糖(FPG)、 餐后2h血糖(2hPG)、血糖总体达标时间、糖化血红蛋白(HBA1c)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)等指标的差异及治疗期间低血糖发生率.结果 治疗后,观察组FPG、2hPG、HBA1c、血糖总体达标时间、HOMA-IR、低血糖发生率均明显低于对照组(P<0.05);HOMA-β高于对照组(P<0.05).结论 重组甘精胰岛素与格列美脲联合治疗2型糖尿病可有效将血糖控制在正常范围,改善胰岛功能,减少低血糖发生率,安全、有效.

目的 观察天麦消渴片联合安诺治疗仪治疗糖尿病周围神经病变的临床疗效.方法 2型糖尿病并发周围神经病变患者160例,随机分为天麦消渴组、安诺仪组、联合治疗组、对照组,每组40例,4组均给予糖尿病常规治疗,天麦消渴组加服天麦消渴片,安诺仪组加用安诺治疗仪治疗,联合组给予天麦消渴片联合安诺治疗仪治疗,疗程均为12周.比较4组患者治疗前后胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β);评估周围神经病变临床症状量化评分(CSS)、尺神经、腓神经的运动传导速度(MNCV)及感觉传导速度(SNCV).结果 治疗12周后,仅天麦消渴组、联合治疗组的HOMA-IR均低于治疗前,HOMA-β均高于治疗前(P＜0.05),治疗后天麦消渴组、联合治疗组的HOMA-IR低于对照组,HOMA-β高于对照组(P＜0.05);联合治疗组HOMA-IR低于天麦消渴组,HOMA-β高于天麦消渴组(P＜0.05).治疗后天麦消渴组、安诺仪组、联合治疗组、对照组治疗总有效率分别为70.0％、67.5％、90.0％、25.0％,联合治疗组总有效率高于其他3组(P＜0.05).治疗后除对照组外的三组患者的尺神经、腓神经的MNCV、SNCV均快于治疗前(P＜0.05);联合治疗组尺神经及腓神经MNCV、SNCV均快于天麦消渴组、安诺仪组(P＜0.05).结论 天麦消渴片联合安诺治疗仪治疗糖尿病周围神经病变的临床效果好于单用天麦消渴片或安诺治疗仪.

Objective:To explore the value of fluid dynamic parameters and inflammatory factors in the prediction of early atherosclerosis in type 2 diabetes mellitus.Methods A total of 126 patients with type 2 diabetes mellitus who were admitted to our hospital from March 2015 to July 2016 were were selected as study subjects and diivided into non atherosclerotic group (61 cases) and atherosclerosis group (65 cases)according to carotid artery IMT.At the same time,60 healthy persons were selected as the control group.The fluid dynamics indexes (PSV,EDV and MV) and serum inflammatory factors (MCP-1,TNF-αand hs-CRP) were detected in the three groups.Results There were no significant differences in PSV,EDV and MV between left and right carotid arteries in non-atherosclerotic group and control group (P> 0.05).PSV,EDV and MV of left and right carotid artery were significantly lower in atherosclerosis group than those in control group (P<0.01).The carotid artery PSV,EDV and MV of left and right in atherosclerosis group were also significantly lower than those of non-atherosclerosis group (P<0.01).The MCP-1,TNF-αand hs-CRP levels in the non-atherosclerosis group were respectively(417.10±78.54),(85.72 ± 9.97) and (3.73 ± 0.61) ,significantly higher than those in the control group (P<0.01).The MCP-1,TNF-α and hs-CRP levels in atherosclerosis group were respectively (532.95 ± 97.48),(123.56 ± 12.85) and (5.39 ± 0.74) ,significantly higher than those in the control group and non-atherosclerosis group (P<0.01).Conclusion:Hydrodynamic parameters and serum inflammatory factors can be used as diagnostic criteria for carotid atherosclerosis in type 2 diabetic patients,and provide guidance for the early diagnosis of carotid atherosclerosis in patients with type 2 diabetes mellitus.

目的 探讨草酸艾司西酞普兰治疗2型糖尿病伴发抑郁症患者的临床效果.方法 将64例2型糖尿病伴发抑郁症患者随机分为对照组和研究组,每组32例.对照组患者进行糖尿病常规治疗;研究组患者在常规治疗的基础上联合应用草酸艾司西酞普兰治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD-17)、临床疗效总评量表(CGI-SI)、症状量表(TESS)对两组患者的临床疗效进行评定比较.结果 治疗第6周末,研究组患者HAMD总分、CGI-SI总分均低于对照组,差异有统计学意义(P＜0.05或P＜0.01);研究组血糖水平及临床疗效优于对照组(P＜0.05);两组患者TESS评分比较差异无统计学意义(P＞0.05).结论 草酸艾司西酞普兰与降糖药物联合应用可很好地控制2型糖尿病伴发抑郁症状患者血糖水平,减轻患者的抑郁症状,不良反应轻微,值得临床推广应用.

Objective:To compare the clinical characteristics,pathogens and their drug sensitivity of urinary tract infections between patients with or without diabetes.Methods:One hundred and two diabetic patients with urinary tract infection (observation group)admitted from May 2012 to July 2014 were involved in the study,and 99 pa-tients with urinary tract infection but without diabetic mellitus who were admitted to our hospital during the same period served as controls (control group). The clinical data,pathogens,drug sensitivity and the prognosis were compared between the two groups.Results:Fifty-five patients (53.92%)presented as asymptomatic bacteriuria in the observation group,and it was higher than that of the control group (9 cases,9.09%;P<0.05). The number of patients with higher level of serum creatinine (43 cases,42.16%)or urine β2-microglobulin (49 cases, 48.04%)in observation group was much higher than those of the control group (15 cases,15.15% and 21 cases, 21.21%;P<0.05). In both groups,Escherichia coli was the main pathogen and it accounted for 57.46% in the observation group and 47.62% in control group. Escherichia coli in the control group showed higher sensitivity to sulperazon,cefepime hydrochloride for inj ection,imipenem and ceftazidine,whereas in the observation group, sulperazon,imipenem and ceftazidin were shown to be sensitive. Compared to the control group,the curative rate (31.37%)was lower and the hospital stay time [(20.51±10.17)days]was longer in diabetic patients than those of the observation group [90.91% and (15.16±11.43)days,P<0.05].Conclusions:Asymptomatic bacteriuria is found to be the main entity in diabetic patients with urinary tract infection,and the incidence of renal inj ury is ob-viously higher. For these patients,urine bacterial culture should be frequently to help select sensitive antibiotics for the treatment.

探究依帕司他联合甲钴胺治疗糖尿病周围神经病变的临床效果。选取70例糖尿病周围神经病变患者s作为研究对象，并将其随机分为对照组和研究组各35例。给予对照组甲钴胺进行治疗，研究组采用依帕司他联合甲钴胺治疗，比较分析两组患者的治疗效果。结果研究组的总有效率为91．43%，明显高于对照组的71．43%，且差异具有统计学意义（P<0．05）。依帕司他联合甲钴胺治疗糖尿病周围神经病变效果显著，值得临床推广应用。

目的:探讨彩色多普勒超声检测在糖尿病患者颈动脉硬化诊断过程中的临床应用价值.材料与方法:选取2013年6月至2014年10月在我院就诊的2型糖尿病(DM)患者(DM组)108例,另选取同期门诊健康体检者100例作为对照组,比较两组颈动脉斑块存在情况、颈动脉内膜中层厚度(IMT)以及血流动力学的差异.结果:通过彩色多普勒超声检测颈动脉IMT[(1.16 ±0.15)mm]较对照组[(0.77 ±0.10)mn]明显增厚(P<0.05);DM组斑块检出率为83.33％,对照组检出率为26.00％,两组比较,DM组斑块检出率明显增高(P<0.05);血管轻度狭窄(狭窄<50％),彩色多普勒超声检测无血流动力学改变;血管狭窄明显(狭窄>50％)时,与对照组比较SPV与EDV加快,狭窄远端的血流频谱低平,峰值流速减低,RI和PI均增高,表现出明显的血流动力学改变(P<0.05).结论:彩色多普勒超声检测在糖尿病颈动脉硬化过程中能够清晰的显示颈动脉内-中膜厚度和形态以及血流动力学,具有很高的临床应用价值.

糖尿病已成为严重影响人们身体健康的主要公共卫生问题［1］。近20年来，糖尿病发展突飞猛进，每年以5％左右的速度递增，其中92％为2型糖尿病。我国糖尿病患病率为4％，发病患者数接近5000万例，是危害人体健康的主要疾病之一［2］。糖尿病患病率的上升，以及它所引起的酮症酸中毒、低血糖以及大血管、微血管和周围神经病变等严重的并发症，已成为患者致死、致残并造成医疗费用增高的一个主要原因［3］。在糖尿病的治疗中，加强护理干预，减少并发症的发生，提高病人的生活质量尤为重要。对糖尿病所引起的酮症酸中毒及昏迷等严重并发症护理进行综述。

目的 探讨血清单核细胞趋化蛋白-1 (MCP-1)水平与T2DM、IGT及其危险因素的相关性.方法 检测新诊断T2DM患者32例、IGT患者46例和健康(NC)者111名血清MCP-1水平及其他生化指标,分析血清MCP-1与T2DM、IGT及其危险因素的相关性.结果 T2DM、IGT组血清MCP-1水平高于NC组(P＜0.01).MCP-1与WHR、TC、胰岛素抵抗指数(HOMA-IR)呈正相关,与年龄、BMI、血压、FPG、2hPG和HbA1c无相关性.结论 血浆MCP-1水平与T2DM、IGT均有相关性,与WHR、TC和HOMA-IR均独立相关.MCP-1可能对T2DM和IGT发病有影响.

<正>代谢综合征(Metabolic Syndrome,MS)是以腹型肥胖、糖耐量异常、高血压、血脂异常为主要内涵,以多种代谢疾病集结出现为临床特征的一组严重影响人类健康的临床症候群。它是2型糖尿病的前期表现,又与心血管(Cardiovas-cular Disease,CVD)病有密切联系[1～3]。近年来,积累的证据提示慢性亚临床炎症及炎症细胞因子被认为在MS的病

Objective To study the effects of Compound Di Gui Capsule (CDGC) on the levels of glucose and lipid in diabetic rats.Methods Rats models with diabetes mellitus were induced by intraperitoneal injection of streptozotocin (50mg·kg-1).Then the diabetic rats were divided into different groups at random.CDGC groups were given CDGC in the dosages of 2.4,1.2,0.6 g·kg-1·d-1 respectively by gastric gavage for 90 d.Levels of whole blood glucose,glycosylated hemoglobin,total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),nitric oxide (NO),total antioxidation capacity (T-AOC) were determined.The insulin level and the pathological changes of pancreatic tissues were also observed.Results The glucose level of diabetic rat was decreased 2h after administration.After administration of CDGC for 90d,the glycosylated hemoglobin,TG,LDL-C and NO were markedly decreased,islet βcells were protected and restored,and the insulin level and T-AOC were increased.Conclusion CDGC can regulate the metabolism of glucose and lipid in diabetic rats,and can protect and restore the pancreatic islet cells.

目的　探讨2型糖尿病(DM)患者白蛋白尿与血脂代谢异常和自主神经病变的关系。方法　通过测定89例2型DM患者24 h尿白蛋白排泄率(UAER)，并依其水平分组，分别观察各组血脂水平和自主神经功能变化。结果　随着UAER的增加，血清总胆固醇(TC)、低密度脂蛋白(LDL)、载脂蛋白B(Apo-B)显著增加(P＜0.05)，高密度脂蛋白(HDL)显著下降(P＜0.05)；自主神经功能受损(交感、副交感神经功能同时受累)明显加重；多元逐步回归分析显示，对UAER水平影响最大的是副交感神经活性。结论　2型DM伴有不同程度蛋白尿的患者中存在血脂代谢异常和自主神经功能损害，且UAER水平增加与自主神经病变密切相关。

目的:探讨QT间期延长在2型糖尿病肾病中的意义.方法:回顾性分析住院2型糖尿病73例,其中糖尿病肾病者(DN)30例,非糖尿病肾病者43例.入院后行常规6导联心电图,测定QT间期,计算校正QT间期(QTc).同时常规行空腹血糖、纤维蛋白原、血脂、血肌酐、24 h尿蛋白定量等检查.结果:DN组中,心血管疾病的危险因素即高血压、高纤维蛋白原、TCH、TG高、HDL降低等与非DN组比较有显著差异(P<0.05,P<0.01),且在DN组中QTc间期延长(P<0.001).结论:在DN者中QT间期延长可能是DN心脏病性死亡的危险标志.

目的:观察2型糖尿病合并高血压、冠心病的脂代谢变化.方法:对204例2型糖尿病患者分组比较血脂代谢指标,同时观察新的脂代谢指标总胆固醇与高密度脂蛋白的比值(TCH/HDL-c)在糖尿病合并高血压、冠心病、不同空腹血糖水平等情况下的变化.结果:TCH/HDL-c较其它单项的血脂代谢指标更易反映出各组间差异.结论:TCH/HDL-c有可能作为2型糖尿病患者反映脂代谢紊乱的一个有效指标,与糖尿病合并大血管病变有一定关系.