目的 分析乙型肝炎病毒（HBV）感染患者并发2型糖尿病（T2DM）相关风险因素。方法 研究收集2024年1月~2025年5月期间，于周口市传染病医院（周口市结核病防治所、周口市第五人民医院）接受治疗的HBV感染患者临床资料，共纳入患者95例，根据HBV感染后是否并发T2DM分组，合并T2DM患者纳入并发组（n=21），非合并T2DM患者纳入对照组（n=74），比较两组患者基线资料及实验室检查数据，逻辑回归分析HBV感染患者并发T2DM风险因素。结果 并发组年龄、体重指数（BMI）、甘油三酯（TG）高于对照组（P＜0.05），年龄≥45岁、BMI肥胖、HBV感染时间≥6个月、TG≥1.7mmol/L、吸烟、乙型肝炎表面抗原（HBsAg）阳性及纤维化-4（FIB-4）指数≥2.67例数占比高于对照组（P＜0.05）。年龄≥45岁[OR=21.599（95%CI：2.875-162.262）]、BMI（肥胖）[OR=16.729（95%CI：1.443-193.981）]、HBV感染时间≥6个月[OR=6.199（95%CI：1.101-34.904）]、吸烟[OR=9.429（95%CI：1.344-66.141）]、TG≥1.7mmol/L[OR=71.834（95%CI：7.060-730.897）]是HBV感染患者并发T2DM危险因素（P＜0.05）。结论 HBV感染患者并发T2DM受人口学特征年龄、BMI、临床病程HBV感染时间、共病血脂异常及生活方式吸烟的共同影响。
Abstract: Objective To analyze risk factors associated with the development of type 2 diabetes mellitus (T2DM) in patients with hepatitis B virus (HBV) infection. Methods Clinical data were collected from HBV-infected patients treated at the Zhoukou City Infectious Disease Hospital (Zhoukou City Tuberculosis Prevention and Control Institute)between January 2024 and May 2025. A total of 95 patients were included in the study, Patients were grouped based on the presence or absence of T2DM following HBV infection. Patients with T2DM were included in the T2DM group (n=21), while those without T2DM were included in the control group (n=74). Baseline characteristics and laboratory test data were compared between the two groups, and logistic regression analysis was performed to identify factors associated with the development of T2DM in HBV-infected patients. Results The age, body mass index (BMI), and triglycerides (TG) in the intervention group were higher than those in the control group (P < 0.05); The proportion of cases with age ≥45 years, obese BMI, HBV infection duration ≥6 months, TG ≥1.7 mmol/L, smoking, hepatitis B surface antigen (HBsAg) positivity, and a FIB-4 score ≥2.67 was higher than that in the control group (P < 0.05). Age ≥ 45 years [OR = 21.599 (95% CI: 2.875–162.262)], BMI (obesity) [OR = 16.729 (95% CI: 1.443–193.981)], duration of HBV infection ≥ 6 months [OR = 6.199 (95% CI: 1.101–34.904)], smoking [OR=9.429 (95% CI: 1.344–66.141)], and TG ≥ 1.7 mmol/L [OR=71.834 (95% CI: 7.060–730.897)] were risk factors for T2DM in patients with HBV infection (P < 0.05). Conclusion The development of T2DM in patients with HBV infection is influenced by a combination of demographic factors (age and BMI), clinical course (duration of HBV infection), comorbid dyslipidemia, and lifestyle factors (smoking).
目的 残余胆固醇（RC）是反映动脉粥样硬化性血脂异常的重要指标，其在糖尿病合并冠心病患者中的临床意义尚不明确。本研究旨在探讨RC水平对糖尿病合并冠心病患者心力衰竭风险的预测价值，并分析其相关性。方法 本研究为回顾性横断面研究，纳入2021年1月—2024年1月期间在鹤壁市人民医院接受诊治的292例糖尿病合并冠心病患者。根据是否存在心力衰竭分为心力衰竭组（128例）和无心力衰竭组（164例）。对基线特征进行比较，采用单因素和多因素Logistic回归分析RC与心力衰竭的相关性。同时，通过限制性立方样条（RCS）分析探讨RC与心力衰竭风险的线性关系，并通过受试者操作特征（ROC）曲线和曲线下面积（AUC）评估RC的预测价值。结果 心力衰竭组患者的男性比例、高血压患病率、RC水平等高于无心力衰竭组，而估算肾小球滤过率水平显著降低（P＜0.05）。单因素分析显示，RC＞0.7 mmol/L显著增加心力衰竭风险（OR=1.854，95%CI：1.161~2.960，P=0.010）。多因素Logistic回归分析中，全调整模型结果显示，RC作为分类变量时，RC＞0.7 mmol/L的患者心力衰竭风险显著增加1.891倍（OR=1.891，95%CI：1.047~3.415，P=0.035）；作为连续变量时，RC每增加1单位，心力衰竭风险增加2.464倍（OR=2.464，95%CI：1.495~4.064，P＜0.001）；Log10RC的风险比为6.411（95%CI：2.246~18.302，P=0.001）；标化RC的风险比为1.687（95%CI：1.262~2.255，P＜0.001）。限制性立方样条分析表明RC与心力衰竭风险呈线性正相关，ROC分析显示RC预测心力衰竭的AUC为0.621（95%CI：0.555~0.687，P＜0.001）。结论 RC水平与糖尿病合并冠心病患者心力衰竭风险显著相关，且呈线性正相关。RC具有一定的预测价值，可作为该人群心力衰竭风险评估的潜在指标。
Objective Residual cholesterol（RC）is an important marker reflecting dyslipidemia associated with atherosclerosis．Its clinical significance in patients with diabetes and coronary heart disease（CHD）remains unclear．To explore the predictive value of RC level for the risk of heart failure（HF）in patients with diabetes and CHD and analyze their association．Methods This retrospective cross-sectional study included 292 patients with diabetes and CHD who were treated at Hebi People’s Hospital between January 2021 and January 2024．Patients were divided into the HF group（128 cases）and the non-HF group（164 cases）based on the presence of HF．Baseline characteristics were compared，and univariate and multivariate Logistic regression analyses were performed to assess the association between RC and HF．Additionally，restricted cubic spline（RCS）analysis was used to explore the linear relationship between RC and HF risk，and the predictive value of RC was evaluated using receiveroperating characteristic（ROC）curves and the area under the curve（AUC）．Results The HF group had significantly higher proportions of males，hypertension prevalence and RC levels，while estimated glomerular filtration rate were significantly lower compared to the non-HF group（P＜0.05）．Univariate analysis showed that RC＞0.7 mmol/L significantly increased the risk of HF（OR=1.854，95%CI：1.161–2.960，P=0.010）．In the fully adjusted multivariate Logistic regression model，RC（RC＞0.7 mmol/L）was associated with a 1.891-fold increased risk of HF as a categorical variable（OR=1.891，95%CI：1.047–3.415，P=0.035）．As a continuous variable，each increased unit in RC was associated with a 2.464-fold increased risk of HF（OR=2.464，95%CI：1.495–4.064，P＜0.001）．The odds ratios for Log10RC and standardized RC were 6.411（95%CI：2.246–18.302，P=0.001）and 1.687（95%CI：1.262–2.255，P＜0.001），respectively．ROC analysis indicated a linear positive association between RC and HF risk（P=0.002）．ROC analysis showed that RC had predictive value for HF，with an AUC of 0.621（95%CI：0.555–0.687，P＜0.001）．Conclusions RC levels are significantly associated with the risk of HF in patients with diabetes and CHD，demonstrating a linear positive correlation．RC has potential predictive value and may serve as a useful indicator for assessing HFrisk in this population．
目的 探讨妊娠期糖尿病（GDM）患者载脂蛋白B（Apo-B）、载脂蛋白A1（Apo-A1）水平在分娩巨大儿中的预测价值。方法 选取2023年1月—2024年1月在珠海市第五人民医院建档并进行孕检、分娩的85例GDM患者，按照分娩的新生儿体质量情况分为分娩正常组55例（新生儿体质量＜4 000 g）和分娩异常组30例（新生儿体质量≥4 000 g）。比较两组孕妇一般资料及孕早期的Apo-B、Apo-A1、Apo-B/Apo-A1比值，采用受试者操作特征（ROC）曲线分析Apo-B、Apo-A1、Apo-B/Apo-A1对GDM患者分娩巨大儿的预测价值。结果 分娩异常组Apo-B水平、Apo_B/Apo_A1比值（1.05±0.15）g/L、（0.81±0.23）］高于分娩正常组（0.95±0.12）g/L、（0.65±0.18）］（t分别为3.357、3.544，P＜0.05）；Apo-A1水平［（1.29±0.26）g/L］低于分娩正常组［（1.47±0.23）g/L］（t=3.292，P＜0.05）；ROC曲线显示，Apo-B、Apo-A1水平及Apo-B/Apo-A1比值预测GDM患者分娩巨大儿的曲线下面积（AUC）分别为0.705、0.660、0.709，灵敏度分别为63.33%、63.33%、66.67%，特异度分别为72.73%、74.55%、76.36%，其中Apo-B/Apo-A1比值预测效能最高（P＜0.05）。结论 GDM患者分娩巨大儿与孕早期Apo-B升高、Apo-A1水平降低密切相关，监测患者孕早期的Apo-B、Apo-A1水平及Apo-B/Apo-A1比值有助于临床对分娩巨大儿进行预测。
Objective To explore the predictive value of apolipoprotein B（Apo-B）and apolipoprotein A1（Apo-A1）levels on delivery of macrosomia in patients with gestational diabetes mellitus（GDM）．Methods From January 2023 to January 2024，85 patients with GDM who were filed in the hospital and received pregnancy examination and delivery were selected．According to the neonatal body mass，the patients were divided into 55 cases in normal delivery group（newborn birth weight ＜4 000 g）and 30 cases in abnormal delivery group（ newborn birth weight ≥4 000 g）．The general data and levels of Apo-B，Apo-A1 and Apo-B/Apo-A1 in early pregnancy were compared between the two groups．Receiver operating characteristic（ROC）curve was used to analyze the predictive value of Apo-B，Apo-A1 and Apo-B/Apo-A1 on delivery of macrosomia in GDM patients．Results The Apo-B and Apo-B/Apo-A1 in abnormal delivery group were（1.05±0.15）g/L and（0.81±0.23），which were higher than（0.95±0.12）g/L and（0.65±0.18）in normal delivery group（t=3.357，3.544，P＜0.05）．While the level of Apo-A1 in abnormal delivery group，（1.29±0.26）g/L，was lower than（1.47±0.23）g/L in normal delivery group（t=3.292，P＜0.05）．ROC curve showed that the areas under the curve（AUC）of Apo-B，Apo-A1 and Apo-B/Apo-A1 in predicting macrosomia in GDM patients were 0.705，0.660 and 0.709，and the sensitivities were 63.33%，63.33% and 66.67%，and the specificities were 72.73%，74.55% and 76.36%，respectively．Apo-B/Apo-A1 had the highest predictive efficiency（P＜0.05）．Conclusions The delivery of macrosomia in GDM patients is closely related to the increase of Apo-B and the decrease of Apo-A1 in early pregnancy．Monitoring Apo-B，Apo-A1 and Apo-B/Apo-A1 in early pregnancy is helpful to predict the delivery of macrosomia．
目的 探讨2型糖尿病（T2DM）患者葡萄糖目标范围内时间（TIR）与高尿酸血症（HUA）的相关性。方法 纳入2021年10月—2024年10月厦门大学附属第一医院收治的110例T2DM合并HUA的患者，将其分为T2DM并HUA组，另选取同期110例单纯T2DM患者，分为单纯T2DM组，比较两组一般资料及实验室相关指标，采用Logistics回归模型分析T2DM患者HUA发生的影响因素。随后将110例T2DM合并HUA的患者依照其病情严重程度分为轻度组（58例）、中度组（37例）及重度组（15例），比较三组临床相关指标及TIR水平，分析临床相关指标及TIR水平与T2DM患者HUA严重程度的相关性。结果 T2DM并HUA组与单纯T2DM组患者体质指数（BMI）、糖化血红蛋白、总胆固醇、甘油三酯、血肌酐（Scr）、TIR对比差异有统计学意义（P＜0.05）；将具有统计学差异的指标纳入Logistics回归模型，以是否合并HUA作为因变量（合并HUA=1，未合并HUA=0），结果显示，BMI、糖化血红蛋白、总胆固醇、甘油三酯、Scr、TIR为T2DM患者HUA发生的重要影响因素（P＜0.05）；HUA不同严重程度患者临床相关指标及TIR水平对比发现，轻度组、中度组与重度组糖化血红蛋白、总胆固醇、甘油三酯、Scr水平对比差异无统计学意义（P＞0.05），轻度组、中度组与重度组BMI、TIR对比差异显著（P＜0.05），重度组BMI高于轻度组对比差异有统计学意义（P＜0.05），重度组TIR低于轻度组和中度组对比差异有统计学意义（P＜0.05）；Spearman相关分析显示：BMI与HUA严重程度呈正相关，TIR与HUA严重程度呈负相关（P＜0.05）。结论 TIR降低为T2DM患者HUA发生的重要影响因素之一，且TIR水平与HUA严重程度密切相关。
Objective To explore the correlation between time in range（TIR）of glucose and hyperuricemia（HUA）in patients with type 2 diabetes mellitus（T2DM）．Methods From October 2021 to October 2024，110 patients with T2DM complicated with HUA admitted to our hospital were divided into T2DM with HUA group，and 110 patients with T2DM only in the same period were divided into T2DM group．The general data and laboratory related indicators of the two groups were compared，and the influencing factors of the occurrence of HUA in T2DM patients were analyzed by logistic regression model．Subsequently，110 patients with T2DM complicated with HUA were divided into mild group（58 cases），moderate group（37 cases），and severe group（15 cases）according to their severity．The clinical related indicators and TIR levels of the three groups were compared，and the correlation between clinical related indicators and TIR levels and the severity of HUA in T2DM patients was analyzed．Results Body mass index（BMI），glycosylated hemoglobin，total cholesterol，triglyceride，and blood creatinine（Scr）between T2DM with HUA group and T2DM group were significantly different（P＜0.05）．The indicators with statistical differences were included in the logistics regression model to determine whether to merge HUA as the dependent variable（with HUA=1，without HUA=0）．The results showed that，BMI，glycosylated hemoglobin，total cholesterol，triglycerides，Scr，and TIR were important influencing factors for the occurrence of HUA in T2DM patients（P＜0.05）．Comparison of clinical indicators and TIR levels in patients with different degrees of HUA revealed no significant differences in glycosylated hemoglobin，total cholesterol，triglycerides，and Scr levels among the mild，moderate，and severe groups（P＞0.05），while there were significant differences in BMI and TIR levels among the mild，moderate，and severe groups（P＜0.05）．The difference between the severe group and the mild group was statistically significant（P＜0.05），and the difference between the severe group and the moderate group was statistically significant（P＜0.05）．The Spearman correlation analysis results showed that BMI was positively correlated with the severity of HUA，while TIR was negatively correlated with the severity of HUA（P＜0.05）．Conclusions The decrease of TIR is one of the important influencing factors of HUA in T2DM patients，and the level of TIR is closely related to the severity of HUA．
目的 探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法 选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后, 按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况, 新生儿Apgar评分。结果 研究组阴道分娩率高于对照组（88.0% vs 72.0%, P<0.05）, 而阴道检查次数（4.18±0.8 vs 6.82±0.8, P<0.05）少于对照组、不良事件发生率（4% vs 16%, P<0.05）低于对照组。相对于对照组,研究组血红蛋白水平较高（104.10±5.25 vs 100.30±4.78, P<0.05）、而白细胞计数（11.40±1.49 vs 12.04±1.66, P<0.05）以及中性粒细胞百分比较低（72.79±4.04 vs 75.01±5.53, P<0.05）。结论 通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。
Objective To explore the application value of intrapartum ultrasound for labor management of pregnant women with gestational diabetes mellitus．Methods A total of 100 primiparous women with gestational diabetes mellitus who gave birth in the Obstetrics and Gynecology Department of Foshan Gaoming District People’s Hospital from January 1, 2022 to December 31, 2023 were selected．After signing the informed consent form, the patients were randomly divided into a control group and a study group with 50 cases in each group according to a ratio of 1∶1, using a random number table method．The control group underwent vaginal digital examination to assess the labor process and delivery method．For the study group, the labor process and delivery mode were determined using transabdominal ultrasound measurement．Blood glucose level,routine blood test results, delivery methods, 24-hour postpartum bleeding volume and incision conditions of two groups of primiparas, as well as the Apgar score of newborns were collected．Results The study group demonstrated a significantly higher vaginal delivery rate than the control group（88.0% vs 72.0%, P<0.05）, with fewer vaginal examinations（4.18±0.80 vs 6.82±0.80, P<0.05）and a lower incidence of adverse events（4% vs 16%, P<0.05）．Compared to the control group, the study group exhibited higher hemoglobin levels（[104.10±5.25]g/L vs [100.30±4.78] g/L, P<0.05）, but lower white blood cell counts（[11.40±1.49]×109/L vs [12.04±1.66]×109/L, P<0.05）and reduced neutrophil percentages（[72.79±4.04]% vs [75.01±5.53]%, P<0.05）．Conclusions Intrapartum ultrasound monitoring for assessing labor progression in primiparas with gestational diabetes mellitus reduces infection risks associated with vaginal procedures, increases vaginal delivery rates, effectively decreases maternal infections, enhances maternal satisfaction and comfort during delivery,and improves maternal-neonatal outcomes．
目的 分析共同照护模式联合回授法健康教育在2型糖尿病患者中的应用效果。方法 将2023年1月—2023年12月广州市第一人民医院收治 的114例2型糖尿病患者作为此次研究对象,分为研究组（n=57）和对照组（n=57）,对照组患者给予常规护理结合健康教育,研究组患者给予共同照护模式联合回授法健康教育,评估两组在培训前及培训后1、3个月的血糖控制情况及糖尿病患者自我管理行为量表（SDSCA）等指标。结果 培训1、3个月后,两组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白均低于培训前,且研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于对照组（P<0.05）。培训1、3个月后,两组患者的糖尿病患者SDSCA评分高于培训前,且研究组各项评分高于对照组（P<0.05）。重复测量方差分析表明随着时间的推移,患者的血糖控制状况随着不同护理培训策略而得到改善。结论 使用共同照护模式联合回授法健康教育对2型糖尿病患者可以更显著改善血糖控制水平、提高自我管理效能。
Objective To analyze the effect of co-care mode and feedback health education on patients with type 2 diabetes．Methods From January 2023 to December 2023,114 patients with type 2 diabetes admitted to Guangzhou First People's Hospital were divided into two groups：experimental group（n=57）and control group（n=57）．Patients in control group were given routine nursing combined with health education．Patients in study group were given co-care and feedback health education． Before intervention and 1,3 months after intervention,patients' blood glucose control and diabetic self-management behavior scale（SDSCA）were evaluated．Results After 1 and 3 months of intervention,the fasting blood glucose,2-hour blood glucose and HbA1c of the two groups were significantly lower than those before intervention,and the fasting blood glucose,2-hour blood glucose and HbA1c of the experimental group were significantly lower than those of the control group（P<0.05）．After 1 month and 3 months of intervention,the SDSCA scores of diabetic patients in both groups were higher than those before intervention,and the scores of study group were higher than those of control group（P<0.05）．Repeated measures analysis of variance indicating that glycemic control improved significantly over time with different nursing training strategies．Conclusions Co-care mode and feedback health education can significantly improve blood glucose control and self-management efficiency in patients with type 2 diabetes．
随着糖尿病发病率不断攀升,人们逐渐聚焦于糖尿病合并骨质疏松。围绕此疾病,国内外学者开展了广泛而深入的研究,临床实践聚焦于两点：糖尿病的精准治疗和骨质疏松的有效干预。在确保血糖稳定的基础上,致力于抑制骨吸收、促进骨形成。在此治疗理念指导下,临床医生应当更加全面了解血糖管理与抗骨质疏松药物的作用机制并合理应用,更大程度改善患者的临床症状及预后。然而,药物作用机制复杂,联合应用存在潜在药物相互作用问题。未来研究方向包括探索更安全有效的联合治疗方案,更加精确化地治疗以提高临床疗效。文章分析了降糖药物及抗骨质疏松药物对疾病的疗效,并展望未来的研究方向,旨在为临床实践提供更为深刻与全面的指导。
As the incidence of diabetes mellitus continues to rise,people are also gradually focusing on diabetes mellitus combined with osteoporosis,which puts patients at a higher risk of fragility fracture．Scholars at home and abroad have conducted extensive and in-depth research around this condition,and clinical practice has focused on two points：first,the precise treatment of diabetes,and second,the effective intervention of osteoporosis．On the basis of ensuring blood glucose stabilization,we are committed to inhibiting bone resorption and promoting bone formation．Under the guidance of this therapeutic concept,we should have a more comprehensive understanding of the mechanism of action of blood glucose management and anti-osteoporosis drugs and apply them rationally,aiming to improve the clinical symptoms and prognosis of patients to a greater extent through dual intervention． However,the mechanism of action of different drugs is complex,and there are potential drug-drug interactions and safety issues associated with their combined use．Future research directions should include exploring safer and more effective combination therapies,developing novel drugs,and more precise and individualized treatments to improve clinical efficacy．This article analyzes the efficacy of glucose-lowering drugs and anti-osteoporosis drugs on the disease and looks forward to future research directions,aiming to provide more profound and comprehensive guidance for clinical practice．
目的 探讨长病程2型糖尿病（T2DM）患者体质指数（BMI）与胰岛β细胞功能间的相关关系。方法 选取2023年12月—2024年3月于承德市中心医院内分泌风湿免疫科住院的260例长病程（病程≥10年）T2DM患者作为研究对象,依据BMI将其分成正常组、超重组和肥胖组,比较三组间一般资料、检验学指标及检查的差异,分析胰岛β细胞功能与各指标间的相关性。结果 三组研究对象在空腹静脉血糖（FPG）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、尿酸（UA）、甘油三酯（TG）等上差异有统计学意义（P<0.05）,在胰岛β细胞功能指数（HOMA-β）比较差异无统计学意义（P>0.05）;肥胖组的FPG、FCP、HOMA-IR、UA、TG均高于正常组（P<0.05）,超重组的UA、TG均高于正常组（P<0.05）,肥胖组的FPG、HOMA-IR、UA高于超重组（P<0.05）,Spearman相关分析结果显示HOMA-β与体质量指数（BMI）无相关性（r=0.046,P=0.461）,HOMA-β与UA（r=0.226,P<0.001）、TG（r=0.148,P=0.017）呈正相关,HOMA-IR与BMI（r=0.279,P<0.001）与、UA相关（r=0.284,P<0.001）及TG（r=0.349,P<0.001）呈正相关,多元线性回归分析显示UA是HOMA-β的影响因素（P<0.05）,BMI、UA、TG是HOMA-IR的影响因素（P<0.05）。结论 长病程的T2DM患者,其胰岛素抵抗水平随着BMI的增加逐渐升高,而胰岛β细胞功能指数与BMI的相关性不显著。同时,UA和TG也是长病程T2DM患者胰岛β细胞功能的影响因素。
Objective To explore the correlation between body mass index（BMI）and islet β cell function in patients with long course type 2 diabetes mellitus（T2DM）．Methods A total of 260 patients with T2DM with a long course of disease（course≥10 years）admitted to the Department of Endocrinology and Rheumatology of Chengde Central Hospital from December 2023 to March 2024 were selected as the study objects,and were divided into normal group,overweight group and obese group according to BMI．Comparison among the three groups in general data,inspection index and and the difference of the islet β cell function were performed,and the correlation among the indexes was analyzed．Results There were statistically significant differences in fasting plasma glucose（FPG）,fasting C peptide（FCP）,homeostasis model assessment-insulin resistance（HOMA-IR）,uric acid（UA）and triglycerides（TG）among the three groups（P<0.05）,but no statistically significant differences in homeostatic model assessment of β-cell function（HOMA-β）（P>0.05）．The levels of FPG,FCP,HOMA-IR,UA and TG in the obese group were higher than those in the normal group（P<0.05）;the levels of UA and TG in the overweight group were higher than those in the normal group（P<0.05）;the levels of FPG,HOMA-IR and UA in the obese group were higher than those in the overweight group（P<0.05）．Spearman correlation analysis showed that HOMA-β was not correlated with BMI（r=0.046,P=0.461）,but was positively correlated with UA and TG（r=0.226,P<0.001;r=0.148,P=0.017）,HOMA-IR was positively correlated with BMI,UA and TG（r=0.279,P<0.001;r=0.284,P<0.001;r=0.349,P<0.001）．Multiple linear regression analysis showed that UA was the influencing factor of HOMA-β（P<0.05）,BMI,UA and TG were the influencing factors of HOMA-IR（P<0.05）． Conclusions In T2DM patients with long disease course,the level of insulin resistance increased gradually with the increase of BMI,but the correlation between β-cell function index and BMI was not significant．At the same time,UA and TG are also factors affecting the function of islet β cells in patients with long-course T2DM．
目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA1c水平。
Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA1c level in the third trimester．
目的 探讨远程药学管理模式联合延续护理在2型糖尿病（T2DM）合并冠状动脉病变患者居家用药中的应用效果。方法 选取2021年6月—2023年6月在广州医科大学附属第三医院诊治的200例T2DM合并冠状动脉病变患者为研究对象,根据干预方式不同分为常规组100例和研究组100例。常规组患者给予院内院外常规护理,研究组在常规组的基础上给予远程药学管理模式联合延续护理。评估患者用药依从性、饮食依从性、运动依从性、自我管理能力、生活质量[36条目简明健康量表（SF-36）]及心血管事件发生情况。结果 研究组用药、饮食、运动依从性均高于常规组（P<0.05）。相较于干预前,两组患者在干预后的自我管理机能、自我责任感、自我概念及健康知识分值均升高,且研究组高于常规组（P<0.05）。相较于干预前,两组患者在干预后的活力（VT）、精神健康（MH）、情感职能（RE）、躯体疼痛（BP）、生理功能（PF）、社会功能（SF）、生理职能（RP）、总体健康（GH）分值均升高,且研究组高于常规组（P<0.05）。研究组与常规组患者心血管不良事件发生率分别为2例（2.00%）、15例（15.09%）,研究组高于常规组（χ2=10.865,P<0.05）。结论 远程药学管理模式联合延续护理能够提高T2DM合并冠状动脉病变患者的用药管理依从性,提高患者自我管理能力,改善生活质量,降低不良心血管事件的发生率。
Objective To explore the application effect of remote pharmacy management mode combined with continuous nursing in the home medication of type 2 diabetes mellitus（T2DM）patients with coronary artery disease．Methods A total of 200 patients with T2DM complicated with coronary artery diseases who were diagnosed and treated in the Third Affiliated Hospital of Guangzhou Medical University from June 2021 to June 2023 were selected as the study subjects．They were divided into a conventional group of 100 patients and a study group of 100 patients based on different intervention methods．The patients in the conventional group received routine care both in and out of the hospital,while the study group received remote pharmaceutical management mode combined with continuous care on the basis of the conventional group．Patient medication compliance,dietary compliance,exercise compliance,self-management ability,quality of life[36 item concise health scale（SF-36）] and incidence of adverse cardiovascular events were assessed．Results The compliance of medication,diet and exercise in the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the self-management function,sense of responsibility,self-concept and health knowledge scores of both groups of patients were significantly increased after intervention,and the scores of the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the Vitality（VT）,Mental Health（MH）,Emotional Function（RE）,Physical Pain（BP）,Physiological Function（PF）,Social Function（SF）,Physiological Function（RP）and Overall Health（GH）scores of both groups of patients were significantly increased after intervention,and the scores of the study group was significantly higher than those of the conventional group（P<0.05）．The incidence of cardiovascular adverse events in the study group and the conventional group were 2 cases（2.00%）and 15 cases（15.09%）,respectively,with the study group significantly higher than the conventional group（χ2=10.865,P<0.05）．Conclusions The combination of remote pharmaceutical management mode and continuous care can significantly improve the medication management compliance of T2DM patients with coronary artery disease,improve their self-management ability,improve the quality of their life and reduce the incidence of adverse cardiovascular events．
