目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。

Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.

目的 了解广东地区糖尿病足患者创面病原菌分布及耐药性变迁。方法 回顾性分析A组(2010年1月—2014年12月就诊的糖尿病足患者)和B组(2015年1月—2018年1月就诊的糖尿病足患者)研究者创面病原菌分布及耐药性变迁。结果 B组中创面G⁺菌及G^-菌均有下降趋势且G^-菌下降较快,细菌种类明显增加,真菌及混合感染明显上升,A组以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌感染为主;B组以金黄色葡萄球菌、奇异变形杆菌、铜绿假单胞菌及真菌感染为主;B组相对于A组的细菌耐药性增加。结论 近年来糖尿病足患者病原菌种类明显增加且混合感染及真菌感染上升,且其耐药性增加,因此早期经验用药而后根据药敏选择抗菌药物治疗是糖尿病足感染治疗的关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in diabetic foot wounds in Guangdong area. Methods Patients with diagnosis of diabetic foot between group A (from Jan 2010~Dec 2014 ) and group B (from Jan 2015 to Jan 2018) were retrospectively analyzed. We studied the bacteria distribution and drug resistance of pathogenic changes of group A and group B. Results In group B, both G+ and G- bacteria had a decreased trend while G- bacteria decreased rapidly, but the species of bacteria increased obviously just as fungi and mixed infection increased obviously. Bacteria infection in group A were mainly about Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli wihle group B were Staphylococcus aureus, Proteus mirabilis, Aeruginosa and Fungal infection; the resistance of group B to A was lower. Conclusion In recent years, kinds of pathogenic bacteria of diabetic foot were significantly increased and the mixed infection and increased fungal infection as well as its drug resistance increased, so the early experience of medication choice of antibiotics based on drug sensitivity and treatment are the key to the treatment of diabetic foot infection.

目的 探讨利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨代谢的影响。方法 选取2016年1月—2017年6月在我院就诊并确诊为新诊断2型糖尿病患者50例,按照随机数字表法将研究对象随机分为利拉鲁肽组及二甲双胍组,每组各25人。两组患者均单药治疗24周后比较两组患者骨密度、骨代谢指标变化情况。结果 两组患者骨密度、血清ALP以及BGP、PINP水平治疗前后相比,无改变(P>0.05);而利拉鲁肽组患者的β-CTx水平较治疗前降低(P<0.05);两组患者治疗后FPG、2hFPG、HOMA-IR、HbA1c均较治疗前下降(P<0.05),而空腹胰岛素较治疗前上升(P<0.05);利拉鲁肽组患者治疗24周后BMI值低于治疗前(P<0.05)。结论 利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨密度的影响均不明显,两种药物可有效降低血糖,改善胰岛素抵抗,利拉鲁肽在使用过程中可明显降低患者血清β-CTx水平,但其是否存在骨质保护作用仍需进一步研究。

Objective To explore the effect of liraglutide and metformin on bone metabolism in newly diagnosed type 2 diabetic patients. Methods From January 2016 to June 2017, 50 patients with type 2 diabetes mellitus admitted to our hospital were selected. According to the random number table method, the subjects were randomly divided into liraglutide group and metformin group, 25 in each group. Changes in bone mineral density and bone metabolism were compared between the two groups after 24 weeks of monotherapy. Results That there was no significant change in bone mineral density, serum ALP, TPINP,and BGP levels before and after treatment (P>0.05). The β-CTx levels in patients in the liraglutide group were lower than that before treatment (P<0.05); FPG, 2hFPG, HOMA-IR, and HbA1c levels in the two groups were lower than that before treatment (P<0.05). Fasting insulin was higher than that before treatment (P<0.05); BMI was lower in the liraglutide group after 24 weeks of treatment than that before treatment (P<0.05). Conclusion The effects of liraglutide and metformin on the bone mineral density of patients with newly diagnosed type 2 diabetes are not obvious. Liraglutide may reduce serum β-CTx levels during use. We need to have further study whether it has a bone protection.

目的 分析并探讨应用通窍活血汤配合舒血宁注射液在治疗糖尿病视网膜病变(单纯型)中的临床效果。方法 80例患者(80只眼)按照随机的方式将其列入对照组(40只眼)和治疗组(40只眼)两组,对照组给以调节血糖、饮食控制、运动疗法等常规治疗控制血糖稳定并口服通窍活血汤,治疗组在对照组的基础上,口服通窍活血汤再配合舒血宁注射液离子导入,所有患者均由同一位眼科专科医生分别在治疗前后对所选患者行眼压、视力、眼底镜检查,同时观察其治疗前后血液流变学、血脂变化情况,观察治疗效果。结果 治疗前后血糖、糖化血红蛋白改变无差异,治疗组视力、眼底均较对照组明显改善(P＜0.01),血液流变学,血及血脂各指标的改善较对照组比较有统计学意义(P＜0.01)。结论 通窍活血汤配合舒血宁注射液在单纯型糖尿病视网膜病变中的治疗效果显著,可有明显改善患者的血脂及血液流变学,安全可靠,适合临床长期推广应用,具有较高的社会效益和经济效益,值得临床推广应用。

目的 探讨血管介入治疗糖尿病足的疗效以及术后血管再狭窄的影响因素。方法 选取2013年2月—2015年3月在我院接受治疗的糖尿病足患者96例,采用随机数表法将患者分为观察组和对照组两个各48例,观察组患者给予血管微创手术介入治疗,对照组患者给予常规治疗,比较两组患者治疗后的临床疗效、住院费用、住院天数、Wagner分级以及患者观察组患者术后血管再狭窄的影响因素。结果 治疗后,观察组患者的总有效率为93.75%高于对照组72.91%,两组比较差异有统计学意义(P<0.05);将观察组患者术后发生发生血管再狭窄的22例患者作为A组,未出现血管再狭窄的26例患者作为B组。A、B两组患者病程、TG、LDL-C、MDA含量、HbA以及BMI比较差异无统计学意义(P>0.05);术后,A组患者的TC明显高于B组,两组比较差异有统计学意义(P<0.05),由此可见,TC是导致患者术后出现血管再狭窄的危险因素;观察组患者的住院费用以及住院天数低于对照组,两组比较差异显著(P<0.05)。结论 采用血管介入治疗糖尿病足患者疗效显著,高TC是患者术后血管再次发生狭窄的影响因素。

目的 初步研究2型糖尿病并视网膜病变患者的血浆趋化素(chemerin)水平及其与骨密度的关系。方法 选择150名糖尿病患者,按视网膜病变分为视网膜病变组(DR组)和眼底正常对照组(NDR组),采用全自动生化检测仪测定糖化血红蛋、甘油三脂、总胆固醇、低密度脂蛋白、高敏C反应蛋白;使用ELISA法检测血浆chemerin水平。骨密度采用双能X线骨密度仪分别测定腰椎正位(L2、L3、L4)、左侧股骨颈、大粗隆区、Ward's三角区的骨密度。结果 ①与NDR组相比,DR组的糖尿病病程较NDR组显著延长(P<0.05)。②DR组的TC、LDL-C、HbA1c、hs-CRP、chemerin水平较NDR组均显著升高(P<0.05)。③DR组的股骨颈、大粗隆区、Ward's三角区的骨密度较NDR组显著降低(P<0.05)。④血清chemerin水平与病程、BMI、HbA1C呈正相关,与股骨颈、大粗隆区、Ward's三角区的骨密度呈负相关。结论 DR患者的chemerin显著升高,chemerin可能参与DR的发生发展,并可能促使DR患者的骨密度降低。

Objective To explore the relationship between the circulation level of chemerin level and bone mineral density(BMD)in type 2 diabetes retinopathy patients. Methods A total of 150 patients with type 2 diabetes were selected. They were divided into two groups: retinopathy group(DR group), non- retinopathy group(NDR group). HbAlc, triglycerides(TC), total cholesterol(TG), low density lipoprotein cholesterol(LDL-C)and high-sensitivity C-reactive protein(hs-CRP)was measured by automatic biochemical detector. Bone mineral density was measured by the dual-energy X-ray absorptiometry. The BMD of lumbar vertebrae 2-4 and the left side of the femoral neck, the greater trochanter and Ward's triangle were assessed. Results ①Compared with the NDR group, the duration of diabetes in group DR was significantly longer(P<0.05); ②The levels of TC, LDL-C, HbA1c, hs-CRP and chemerin in DR group were significantly higher,③The BMD of the femoral neck, trochanter regionandward's triangle were significant reduction;④The level of chemerin was positively correlated with the duration of diabetes, BMI, HbA1C, and negatively correlated with the bone mineral density of the femoral neck, the greater trochanter, and the s' Ward triangle. Conclusion The level of chemerinin DR patients were significantly increased, and chemerin may play a role in the occurrence and development of DR, may promote the bone density decreased.

目的 探讨呼出气体中丙酮能否用于糖尿病肾病的早期诊断。方法 对健康对照组、2型糖尿病组(T2MD)和糖尿病肾病组(DN)分别采用气相色谱-质谱(GC-MS)法测定呼气丙酮含量、全自动生化仪的乳胶透射免疫比浊法测定尿微量白蛋白、酶速率法测试β-羟丁酸以及全自动尿液分析仪干化学法测定尿酮体,并对上述结果进行分析。结果 在T2MD组和DN组中呼气中的丙酮含量均高于健康对照组(P<0.01);在DN组,丙酮与尿微量白蛋白水平呈线性相关(r=0.79,P<0.05)。结论 检测呼气中的丙酮有助于糖尿病肾病的早期诊断,能及时反映病人肾脏损伤情况。

Objective To explore the early diagnosis of diabetic nephropathy by exhaled acetone. Methods Respectively using GC-MS method for the determination of exhaled acetone content, emulsion transmission turbidimetric immunoassay method in automatic biochemical analyzer for determination of urinary microalbumin, enzyme rate method for testing β-hydroxybutyric acidand and dry chemical method in urine automatic analyzer for determination of urine ketone on healthy control group, type-2 diabetes mellitus group(T2MD), and diabetic nephropathy group(DN), and the above results were analyzed. Results The exhale acetone level in T2MD and DN groups were higher than those in control group(P<0.01); In DN group, the level of exhale acetone with urinary microalbumin had a linear correlation. Conclusion The detection of exhale acetone is helpful to early diagnosis in diabetic nephropathy, also may reflect the renal injury promptly.

目的 探讨DPP-4抑制剂西格列汀对成人隐匿性自身免疫性糖尿病(LADA)早期患者胰岛β细胞功能的影响。方法 把14例新诊断为LADA患者随机分为两组,胰岛素治疗100 mg/d西格列汀(A组,n=7)或无西格列汀(B组,n=7)共治疗9个月。结果 9个月后两组之间的血糖和糖化血红蛋白水平无差异。9个月后A组空腹C肽(FCP),餐后C肽(CP),和ΔCP(ΔCP=2 h CP-FCP)水平与基线相比无明显差别(P＞0.05),B组FCP,2 h的CP和ΔCP进行比较基线显著下降(P<0.05)。A组2 h CP水平明显高于B组(P<0.05)。结论 胰岛素与西格列汀联用较单用胰岛素治疗成人隐匿性自身免疫糖尿病早期患者似乎能更好保护胰岛β细胞功能,西格列汀或可延长LADA非胰岛素依赖期的时间。

Objective The Objective of the study was to investigate the effects of the DPP-4 inhibitor on β-cell function in patients with recent-onset latent autoimmune diabetes in adults LADA. Methods Fourteen recently diagnosed LADA patients were randomized into two groups, A and B, to receive insulin therapy with 100 mg/d sitagliptin (group A, n=7) or without sitagliptin (group B, n=7) for 9 months. Results There were no differences in the clinical baseline data between the two groups. During the 9 months of follow-up, there were no significant differences in glucose and glycosylated hemoglobin levels between the two groups. At 9 months, there were not different in group A including fasting C-peptide (FCP), 2-hour postprandial C-peptide (CP), and ΔCP(ΔCP=2 h CP-FCP) levels (P>0.05). Compared with baseline, whereas in group B the levels of FCP, 2-hour CP and ΔCP were significantly decreased compared with baseline (P<0.05). Levels of 2-hour CP were higher in group A, it was higher than group B at 9 months (P<0.05). Conclusion LADA patients treated with sitagliptin and insulin was more likely maintain β-cell function by comparison with insulin alone. Sitagliptin administration in patients with LADA might prolong the insulin-free period.

目的 探讨川芎嗪对链脲佐菌素(STZ)诱导2型糖尿病大鼠肾病的治疗作用及机制。方法 SD大鼠50只,随机分为正常组和模型组。除正常组外,其余大鼠均给予高脂-高糖饲料喂养4周,再给予链脲佐菌素(40 mg/kg,ip),72 h后测定空腹血糖,将血糖值高于16.67 mmol/L的大鼠随机分成4个组即模型组,二甲双胍阳性组(250 mg/kg),川芎嗪低、高剂量组(80、160 mg/kg),连续给予相应试药8周。其中正常组和模型组的大鼠均给予同等量蒸馏水灌胃。实验结束时,测定大鼠血糖、尿蛋白、血尿素氮和血肌酐含量;免疫组化法测定大鼠肾组织TLR4和caspase3蛋白表达。光镜下观察肾脏病理学变化。结果 与模型组比较,二甲双胍组和川芎嗪高剂量组给药8周后,大鼠动态空腹血糖均能明显降低(P<0.05),大鼠动态尿蛋白显著性降低(P<0.01,P<0.05); 二甲双胍和高剂量组TLR4和caspase3蛋白表达明显低于模型组(P<0.05);肾脏组织病理性损伤明显减轻。结论 川芎嗪对STZ诱导2型糖尿病大鼠肾病具有保护作用,其机制可能与下调TLR4表达作用有关。

Objective To investigate the therapeutic effects and mechanisms of tetramethylpyrazine (TMP) on streptozocin(STZ)-induced-nephropathy in type 2 diabetic rats. Methods 50 SD rats were randomly divided into normal group(n=10) and model group(n=40). The model rats were fed on high fat and sugar diets for 4 weeks, then given STZ(40 mg/kg,ip). After 72 hours, the fasting blood glucose (FBG) was measured. Rats with high FBG above 16.67mmol/L were randomly divided into four groups: model, metformin(Met, 250 mg/kg)and TMP (80 mg/kg, 160 mg/kg) groups for treating 8 weeks, and both the control and model groups were given equals distilled water by intragastric administration. At the end of the experiment, blood glucose, urine protein, blood urea nitrogen and creatinine were measured. The expression of TLR4 and caspase3 protein in kidney tissue of rats was determined by immunohistochemistry. Pathological changes of kidney were observed under light microscope. Results Compared with the model group, metformin and high dose of TMP administered after 8 weeks, rats can significantly reduce the dynamic fasting blood glucose(P<0.05). Urinary protein excretion of total dynamic decreased significantly (P<0.01, P<0.05); the protein expression of TLR4 and caspase3 in the metformin group and high dose group was significantly lower than that in the model group (P<0.05); kidney tissue pathological damage was significantly reduced. Conclusion TMP has a protective effect on STZ induced nephropathy in type 2 diabetic rats, and its mechanism may be related to the down-regulation of TLR4 expression.

环孢素A(cyclosporin A,环孢素A)是强效的免疫抑制剂,常用于抑制器官移植后的排斥反应,器官移植后新发糖尿病与免疫抑制剂的使用有关。除器官移植,环孢素A还被用于治疗其他自身免疫性疾病,例如1型糖尿病。但环孢素A对胰岛β细胞和其他多种器官有毒副作用,长期使用环孢素A会导致胰岛素抵抗和胰岛β细胞功能损伤,这也是器官移植后糖尿病(post-transplant dibetes mellitus,PTDM)的主要原因。因此在糖尿病领域环孢素A的使用需要对病情进行具体分析和仔细斟酌。

Cyclosporin A (CsA) is a powerful immunosuppressant that is widely used to prevent organ rejection and to treat several autoimmune diseases, such as type 1 diabetes mellitus. Post-transplant diabetes mellitus (PTDM) is related with immunosuppressant. Moreover, there are many toxicity and side effects of CsA on pancreatic β cell and other organs, Long-term treatment of CsA may cause insulin resistance and β cell dyfunction. That's the main reason for post-transplant dibetes mellitus (PTDM). In diabetes mellitus fields, CsA must be used carefully considered.