糖尿病已成为全球最严重的健康问题之一。需要白内障手术的糖尿病患者也日益增多,虽然糖尿病的眼表并发症很常见,但由于糖尿病患者全身和眼部疾病十分复杂,使得眼前段如角结膜和泪腺的糖尿病并发症往往被忽视。糖尿病患者白内障超声乳化术有引发或加重眼前节疾病的风险,包括干眼病（DED）、角膜上皮糜烂、上皮缺损迁延不愈,甚至威胁视力的角膜溃疡。这些风险里最为常见的是DED,并且可能因白内障超声乳化手术而加重。眼科医生需要在手术前预先评估已存在的DED是否需要术前治疗,并且需要注意在已存在 DED 的情况下,各项术前检查数据测量的准确性会降低,以及尽可能减少对眼表造成损害的各种手术因素;并考虑通过管理减少术后 DED。本综述就评估白内障超声乳化术对合并糖尿病的老年性白内障患者的眼表术中的影响因素进行分析。

Diabetes mellitus(DM)has become one of the most serious health problems in the world. The number of diabetic patients requiring cataract surgery is also increasing. Although ocular surface complications of DM are common,the complexity of systemic and ocular disease in diabetic patients makes diabetic complications in the anterior segment,such as the cornea and lacrimal gland,often be overlooked. Phacoemulsification in diabetic patients carries the risk of triggering or exacerbating ocular segment disease,including dry eye disease,corneal epithelial erosion,persistent epithelial defects and even vision-threatening corneal ulcers. The most common of these risks is dry eye disease,and it can be exacerbated by cataract phacoemulsification. Ophthalmologists need to preemptively assess the need for preoperative treatment of pre-existing dry eye disease(DED),be aware of the reduced accuracy of preoperative data measurements in the presence of DED,and minimize surgical factors that can damage the ocular surface;and consider management to reduce postoperative DED. In this review,we analyze the factors that influence phacoemulsification in ocular surface surgery for senile cataract patients with diabetes.

目的 探讨2型糖尿病（T2DM）患者慢性肾脏病（CKD）发生的危险因素以及其与肥胖之间的相关性。方法 选择2019年3月—2021年12月我院收治的552例T2DM患者作为研究对象,根据是否发生CKD进行分组,其中合并CKD患者136例、未合并CKD患者416例,对2组患者的一般资料及实验室指标进行单因素回归分析比较;对于未合并CKD的T2DM患者进行为期1年的随访,统计T2DM患者CKD的发生率,并针对随访群体的一般资料及实验室指标进行对比分析,通过单因素Logistic回归分析患者发生CKD的影响因素,了解T2DM患者CKD的发生与肥胖之间的关系。结果 合并CKD和未合并CKD的T2DM患者间的年龄、病程、肝功能指标、血脂指标中的低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、肾功能指标中的尿酸、肾小球滤过率（eGFR）比较差异均无统计学意义（均P>0.05）,组间在性别构成、BMI、血压、白蛋白、血红蛋白、血脂指标中的总胆固醇（TC）及甘油三酯（TG）、血糖及肾功能指标中尿白蛋白/肌酐比（UACR）比较差异均有统计学意义（均P<0.05）。396例未合并CKD的T2DM患者随访结果显示,随访期间发生CKD患者123例、未发生CKD患者293例,组间的性别构成、BMI、舒张压、血红蛋白、丙氨酸氨基转移酶、白蛋白、总胆红素、TC、LDL-C、HDL-C、尿酸、糖化血红蛋白及eGFR比较差异均无统计学意义（均P>0.05）,而组间年龄、病程、收缩压、天冬氨酸氨基转移酶、TG、空腹血糖（FPG）及UACR比较差异均有统计学意义（均P<0.05）。单因素Logistic回归分析结果显示,T2DM患者发生CDK的独立危险因素包括肥胖和收缩压、TG及FPG等指标升高（P<0.05）。T2DM患者的BMI与CKD的发生有关,当患者的BMI在28~31 kg/m²之间时,其CKD的发生率明显增加。结论 T2DM患者的CKD发生与肥胖因素有一定相关性,危险因素包括肥胖、血脂血压血糖异常等,T2DM患者的BMI在28~31 kg/m²之间时,其发生CKD的风险会有所增加,故需要对患者的BMI进行有效控制,降低CKD发生率,以避免病情恶化。

目的 探讨绝经后2型糖尿病人群性激素水平与体质指数（BMI）的关系。方法 收集2022年1月—2023年1月在我院住院的2型糖尿病患者,随机选取自然绝经后女性184例,根据其BMI分组,其中肥胖组23例、超重组74例、BMI正常组87例,比较3组间临床资料及性激素差异。结果 3组间腰围、空腹血糖（FPG）、甘油三酯、高密度脂蛋白胆固醇、血尿酸、卵泡刺激素（FSH）、黄体生成素（LH）、雌激素（E₂）比较差异均有统计学意义（均P<0.05）,肥胖组和超重组的E₂高于正常组,FSH及LH低于正常组。3组间年龄、糖化血红蛋白、收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、催乳素、睾酮、孕酮比较差异均无统计学意义（均P>0.05）。Logistic回归分析显示,过高的腰围和较低的FSH、LH是绝经后2型糖尿病女性肥胖的影响因素。结论 2型糖尿病绝经后女性应控制腹型肥胖,定期复查LH、FSH,提早干预。

Objective To investigate the relationship between sex hormone levels and body mass index（BMI）in postmenopausal women with type 2 diabetes mellitus（T2DM）．Methods A total of 184 cases of natural postmenopausal women with T2DM admitted to our hospital from January 2022 to January 2023 were randomly selected,including 23 cases of obesity,74 cases of over weight and 87 cases of normal BMI．The clinical data and sex hormones among the three groups were analyzed．Results Waist circumference,fasting plasma glucose（FPG）,triglyceride,high density lipoprotein cholesterol,uric acid,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）and oestrogen（E₂）levels were significantly different among the three groups（P<0.05）．E₂ levels of the obesity group and the over weight group were significantly higher than that of the normal group,while FSH and LH levels were significantly lower than that of the normal group．There was no significant difference in age,hemoglobin A1c,systolic blood pressure,diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol,prolactin,testosterone and progesterone levels among the three groups（P>0.05）．Logistic regression analysis showed that higher waist circumference and lower FSH and LH levels were significantly correlated with obesity in postmenopausal women with T2DM．Conclusions Abdominal obesity should be controlled in postmenopausal women with T2DM,and LH and FSH should be periodically reviewed,in order to treat in advance．

目的 研究联合电生理检查用于糖尿病周围神经病变早期诊断的价值。方法 选取160例糖尿病患者,根据患者是否存在肢体麻木、疼痛、无力、烧灼感或凉感等周围神经损伤临床症状,将患者分为有症状组84例,无症状组76例。所有患者均行电生理检查,检测神经传导(nerve conduction studies,NCS)及F波,检测指标包括运动神经运动末端潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound muscle action potential,CMAP)波幅、感觉神经动作电位(sensory nerve action potentia,SNAP)波幅、感觉神经传导速度(sensory nerve conduction velocity,SCV)、F波平均潜伏期(Flmean)、F波离散度(Fchd)。比较2组电生理检查指标。结果 有症状组胫神经及腓总神经DML均高于无症状组(P＜0.05),胫神经及腓总神经CAMP均低于无症状组(P＜0.05)。有症状组正中神经、尺神经、胫神经及腓总神经SCV、SNAP均低于无症状组(P＜0.05)。有症状组正中神经及胫神经Flmean、Fchd均高于无症状组(P＜0.05)。NCS、F波联合诊断糖尿病周围神经病变的灵敏度为0.857、特异度0.829、准确率0.844、阳性预测值为0.847、阴性预测值为0.840、kappa值0.687。结论 糖尿病周围神经病变早期联合电生理检查具有一定价值。

目的 探究百令胶囊联合前列地尔对早期糖尿病肾病患者血液流变学及肾功能影响。方法 选我院2020年1月—2021年1月期间100例糖尿病肾病患者为研究对象,将其以随机数字表法分为对照组、观察组,各50例,分别应用前列地尔治疗、前列地尔+百令胶囊治疗,比较2组治疗前后血液流变学指标、肾功能指标。结果 治疗前2组血浆粘度、全血粘度、红细胞聚集指数水平相近,差异无统计学意义(P＞0.05);治疗后观察组血浆粘度、全血粘度、红细胞聚集指数水平较对照组低,差异有统计学意义(P＜0.05);治疗前2组微量蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(Scr)水平相近,差异无统计学意义(P＞0.05);治疗后观察组UAER、BUN、Scr水平较对照组低,差异有统计学意义(P＜0.05);2组治疗期间均未见严重不良反应。结论 对早期糖尿病肾病患者应用百令胶囊+前列地尔治疗,可改善其血液流变学指标及肾功能指标,降低炎症反应程度,治疗安全且疗效理想。

Objective To explore the effect of Bailing capsule combined with alprostadil on hemorheology and renal function in patients with early diabetic nephropathy. Methods A total of 100 patients with diabetic nephropathy in our hospital from January 2020 to January 2021 were randomly divided into control group and observation group, 50 cases in each group.They were treated with alprostadil and alprostadil with Bailing capsule respectively.The indexes of hemorheology and renal function before and after treatment were compared between the two groups. Results Before treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Before treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). There was no serious adverse reaction in the two groups during the treatment. Conclusion Bailing capsule combined with alprostadil in the treatment of early diabetic nephropathy can improve the indexes of hemorheology and renal function, lower the inflammatory reaction, and the treatment is safe and effective.

目的 探究乙型病毒性肝炎不同状态合并2型糖尿病患者的临床特点。方法 对62例乙型肝炎病毒携带合并2型糖尿病(组1)、129例乙型病毒性肝炎合并2型糖尿病(组2)和83例乙型病毒性肝炎肝硬化合并2型糖尿病(组3)患者的临床资料进行回顾性分析。结果 各组间在性别和年龄上差异有统计学意义(χ²=11.133、P=0.004,F=7.640、P=0.001)。3组研究对象糖化血红蛋白(HbA1c)、总胆固醇(Tch)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)和总胆汁酸(TBA)水平差异有统计学意义(F=4.028、P=0.019,F=4.140、P=0.017,F=3.172、P=0.044,F=6.701、P=0.002,F=53.156、P<0.001,F=4.920、P=0.008,F=4.173、P=0.017,F=7.181、P=0.001,F=9.170、P<0.001)。进一步两两比较,肝炎肝硬化组HbA1c、Tch 、LDL-C、ALB水平降低,但TBIL、IBIL、TBA增高,分别与另2组比较差异有统计学意义(P<0.05);组2空腹血糖(FBG)、HDL-C水平最高,前者高于组1,后者高于组3。各组糖尿病并发症居前三的都是周围神经病变、糖尿病肾病和糖尿病视网膜病变。结论 乙型病毒性肝炎合并2型糖尿病时其不同状态间具有不同的疾病特点,主要体现在携带状态Tch、TG、LDL-C高水平,肝炎状态FBG高水平,肝炎肝硬化状态HbAlc、ALB低水平但胆红素、胆汁酸水平高,在糖尿病并发症方面均以周围神经病变、糖尿病肾病和糖尿病视网膜病变为主。

Objective To study the clinical feature of different viral hepatitis B status with type 2 diabetes. Methods A retrospective analysis was carried out on 62 hepatitis B virus carriers with type 2 diabetes (group 1),129 viral hepatitis B patients with type 2 diabetes (group 2) and 83 viral hepatitis B cirrhosis patients with type 2 diabetes (group 3). Results The differences in gender and age among the three groups were significantly different (χ²=11.133, P=0.004 and F=7.640,P=0.001). The levels of HbA1c, total cholesterol (Tch), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum albumin (ALB), total bilirubin(TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)and total bile acid (TBA)in three groups were significantly different (F=4.028, P=0.019.F=4.140, P=0.017.F=3.172, P=0.044.F=6.701, P=0.002.F=53.156, P<0.001.F=4.920, P=0.008.F=4.173, P=0.017.F=7.181, P=0.001.F=9.170, P<0.001). In further pairwise comparison, the levels of HbA1c, Tch, LDL-C and ALB of group 3 decreased significantly compared with other two groups, but the levels of TBIL, IBIL and TBA increased, with significant differences.The levels of fasting blood glucose(FBG) and HDL-C in group 2 were the highest,and the FBG was significantly higher than that in group 1, while the HDL-C was significantly higher than that in group 3.In the three groups, the top three diabetic complications were peripheral neuropathy, diabetic nephropathy and diabetic retinopathy. Conclusion Different statuses of viral hepatitis B with type 2 diabetes had different disease characteristics, mainly reflected in the high levels of Tch, TG and LDL-C in the hepatitis B virus carriers, high FBG level in the viral hepatitis B patients, low levels of HbAlc and ALB but high levels of bilirubin and bile acid in the cirrhosis patients.Peripheral neuropathy, diabetic nephropathy and diabetic retinopathy were the main complications of diabetes.

目的 探究2型糖尿病患者的肾糖阈(RTG)及相关因素。方法 本院对2014年12月—2018年9月466例2型糖尿病患者为研究对象,正常肾糖阀值为8.9～10 mmol/L,据此将患者分为高阀值组、中等阀值组以及低阀值组,不同组肾糖范围分别为RTG＞10 mmol/L、8.9 mmol/L≤RTG≤10 mmol/L、RTG＜8.9 mmol/L,以此对各组生化特征进行分析。结果 高阀值组与中等阀值组相比,RTG值、年龄、病程、空腹血糖(FPG)、体质量指数(BMI)、总胆固醇(TC)、血糖均值(MBG)、24 h血糖对比差异明显,P＜0.05。高阀值组与低阀值组相比,RTG值、性别、FPG、BMI、TC、MBG、糖化血红蛋白(HbA1C)对比有差异,P＜0.05。性别、年龄、BMI、HbA1C、TC以及低密度酶蛋白胆固醇(LDL-C)与2型糖尿病相关,且呈正比关系,P＜0.05;通过多元线性回归分析发现,2型糖尿病的影响因素主要有BMI、HbA1C、LDL-C,数据具有统计学意义,P＜0.05。结论 较多2型糖尿病患者肾糖阀值较高,且肾糖阀值与HbA1C、LDL-C相关。

目的 系统评价胰岛素联用α-葡萄糖苷酶抑制剂(AGIs)治疗成人1型糖尿病(T1DM)的疗效和安全性。方法 检索中英文数据库,纳入关于胰岛素联用AGIs治疗成人T1DM患者的随机或非随机对照试验。使用Review Manager 5.3软件进行Meta分析。结果 共纳入10项研究,616例患者。与安慰剂或空白对照相比,在有效性方面,胰岛素联合AGIs可改善成人T1DM患者的糖化血红蛋白;降低平均血糖、空腹血糖和餐后2小时血糖;改善血糖波动情况,包括平均血糖波动幅度和最大血糖波动幅度(均P<0.05)。在安全性方面,AGIs增加总不良反应发生的风险(P<0.05),其中主要是胃肠道不适,但未增加低血糖的发生率和发生次数(均P>0.05)。胰岛素联合AGIs减少了每日胰岛素总剂量(P<0.05),但对体重、甘油三酯和高密度脂蛋白胆固醇无显著影响(均P>0.05)。结论 胰岛素联合AGIs可降低成人T1DM患者的糖化血红蛋白,改善血糖水平和血糖波动情况。AGIs不会增加低血糖的风险,但需重视其不良反应,特别是胃肠道不良反应。

Objective To systematically evaluate the efficacy and safety of adding alpha-glucosidase inhibitors (AGIs) to insulin therapy in adult patients with type 1 diabetes (T1DM). Methods Articles about randomized or non-randomized controlled trials of insulin combined with AGIs in adult patients with T1DM were retrieved from Chinese and English database. Meta-analyses were performed by using Review Manager 5.3. Results A total of 616 patients were included from 10 clinical trials. Compared with adding placebo or nothing, in terms of efficacy, the addition of AGIs resulted in decreased HbA1c, mean blood glucose, fasting plasma blood glucose and 2-hour postprandial blood glucose levels (all P<0.05). And this scheme improved the glucose variability including mean amplitude of glycemic excursions and the largest amplitude of glycemic excursions (P<0.05, respectively). As to safety, AGIs increased the risk of total adverse reactions (P<0.05), most of them were gastrointestinal complaints, while the occurrence and the frequency of hypoglycemia were similar (P>0.05, respectively). This scheme could also lead to the reduced total daily insulin dose (P<0.05) but had no significant effect on body weight, triglyceride or cholesterol concentration (P>0.05, respectively). Conclusions The addition of AGIs to insulin therapy in adult patients with T1DM may reduce HbA1c and improve the glucose levels and glucose variability. But total adverse effects especially the gastrointestinal complaints should also be considered in the use of AGIs although it does not increase the risk of hypoglycemia.

目的 观察首诊-复诊-住院-产后管理的模块化护理干预对妊娠期糖尿病(GDM)围产期患者的影响。方法 回顾性收集我院2020年1月—2021年1月GDM患者91例,按照患者意愿及不同护理方案分组。常规护理组45例予以常规护理,模块化管理组46例在常规护理基础上予以首诊-复诊-住院-产后管理的模块化护理。比较2组患者首诊时、分娩后血糖控制水平、围产期患者并发症发生情况、围产期新生儿并发症发生情况、护理工作满意度。结果 分娩前模块化管理组空腹血糖、餐后2 h血糖低于常规护理组(P＜0.05);模块化管理组围产期患者并发症发生率8.70%(4/46)低于常规护理组24.44%(11/45)(P＜0.05);模块化管理组围产期新生儿并发症发生率6.52%(3/46)低于常规护理组22.22%(10/45)(P＜0.05);模块化管理组护理工作满意度93.48%(43/46)高于常规护理组77.78%(35/45)(P＜0.05)。结论 首诊-复诊-住院-产后管理的模块化护理干预可改善GDM患者的血糖水平,降低围产期患者及新生儿并发症发生率,同时能提升患者护理工作满意度。

Objective To observe the effect of modularized nursing intervention on perinatal patients with gestational diabetes mellitus (GDM), including first visit, subsequent visit, hospitalization and postpartum management. Methods Ninety-one patients with GDM in our hospital from January 2020 to January 2021 were retrospectively grouped according to patients' wishes and different nursing plans, and their data were collected. Forty-five patients in the routine nursing group received routine nursing, and 46 patients in the modular management group received modularized nursing in addition to the routine nursing, including first visit, subsequent visit, hospitalization and postpartum management. The blood glucose level at the first visit and after delivery, the incidence of complications in perinatal patients, the incidence of complications in perinatal neonates, and the satisfaction of nursing work were compared between two groups. Results Before delivery, FPG and 2hPG levels in modularized management group were lower than those in routine nursing group (P<0.05). The incidence of perinatal complications in modularized management group was 8.70% (4/46), lower than that in routine nursing group (24.44%, 11/45, P<0.05). The incidence of neonatal complications in the modularized management group was 6.52% (3/46), lower than that in the routine nursing group (22.22%, 10/45, P<0.05). The nursing job satisfaction rate of modular management group was 93.48% (43/46), higher than that of routine nursing group (77.78%, 35/45, P<0.05). Conclusions Modularized nursing intervention of first visit, subsequent visit, hospitalization and postpartum management could improve the blood glucose level of patients with GDM, reduce the incidence of complications in perinatal patients and neonates, and improve patients' satisfaction with nursing work.

目的 分析妊娠中期血清25(OH)D₃水平对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测价值。方法 选取2019年7月—2020年3月在广州市妇女儿童医疗中心及广东省计划生育专科医院进行产前检查的孕中期妇女,根据孕妇的空腹血糖(FBG)水平和口服糖耐量试验(OGTT)结果分为GDM组(100例)和对照组(320例)。分别测定两组孕妇的年龄、孕前BMI、空腹血糖、服糖后l h血糖、服糖后2 h血糖、空腹胰岛素及25(OH)D₃等指标,进行统计分析与比较。结果 GDM组维生素D不足及缺乏的发病率高于对照组(P＜0.05)。年龄、空腹胰岛素在两组之间无统计学差异(P＞0.05);GDM组25(OH)D₃水平低于对照组(P＜0.05);GDM组空腹血糖、服糖后1 h、2 h血糖及孕前BMI均高于对照组(P＜0.05)。血清25(OH)D₃水平与空腹血糖、服糖后1 h、2 h血糖呈负相关(P＜0.05),而与年龄、BMI及空腹胰岛素无显著相关性(P＞0.05)。25(OH)D₃水平与妊娠期糖尿病发生风险呈负相关。结论 妊娠中期血清25(OH)D₃水平降低可能增加GDM的发生风险,联合检测妊娠中期血清25(OH)D₃水平有助于GDM的早期预测。

Objective To analyze the predictive value of serum 25(OH)D₃ level in the second trimester of pregnancy for gestational diabetes mellitus. Methods From July 2019 to March 2020, pregnant women who had prenatal examinations in Guangzhou Women and Children's Medical Center and Guangdong Family Planning Hospital were selected and divided into GDM group (100 cases) and control group (320 cases) according to FBG level and oral glucose tolerance test (OGTT) results.The age, pre-pregnancy BMI, fasting blood glucose, l h blood glucose after taking sugar, 2 h blood glucose after taking sugar, fasting insulin, 25(OH)D₃ and other indicators of the two groups of pregnant women were measured, respectively, for statistical analysis and comparison. Results The incidence of vitamin D deficiency and deficiency in GDM group was higher than that in control group (P<0.05).There was no significant difference in age and fasting insulin between the two groups (P>0.05).The level of 25(OH)D₃ in the GDM group was lower than that in the control group (P<0.05).Fasting blood glucose, blood glucose at 1 h and 2 h after taking sugar and BMI before pregnancy were all higher in the GDM group than in the control group (P<0.05).Serum 25(OH)D₃ level was negatively correlated with fasting blood glucose and blood glucose at 1 h and 2 h after taking sugar (P<0.05), but not significantly correlated with age, BMI and fasting insulin (P>0.05).The level of 25(OH)D₃ was negatively correlated with the risk of gestational diabetes. Conclusion Reduced serum 25(OH)D₃ levels in the second trimester may increase the risk of GDM, and combined detection of serum 25(OH)D₃ levels in the second trimester is helpful for early prediction of GDM.