Study on T lymphocyte subsets and NK cells in patients with Graves＇ disease combined with type 2 diabetes

Objective To investigate changes in T lymphocyte subsets and NK cells in patients with simple Graves' disease (GD)and Graves' disease combined with type 2 diabetes mellitus (GD/T2DM). Methods Fifteen cases of GD/ T2DM were selected from our hospital from November 2001 to November 2004. Before and after therapy thyroid function, thyroglobulin antibody (TGA), thyroid microsomal antibody (TMA) and blood glucose level were measured, and T lymphocyte subsets (CD3, CD4, CD8, CD4/CD8) and NK cells (CD56) were measured by immunofluorescence double labeling monoclonal antibody and flow cytometry, respectively. At the same time, comparison was made with simple GD (15 cases), T2DM (15 cases) and healthy control (20 cases). Results Before therapy, CD4/CD8, CD4 and NK cells in GD/T2DM were less than normal, and there was no significant difference in comparison with simple GD (P<0.05). In T2DM group, only CD4/CD8 and CD4 were less than those of healthy controls (P<0.05). When thyroid function recovered after 1 to 3 months of methimazole treatment in both GD/T2DM and simple GD groups, various indexes recovered, which were more obvious in simple GD. Conclusion Immune hypofunction of GD may be the key to the immune abnormality of GD/T2DM, which is more significant than that of simple GD or T2DM. The recovery of thyroid function and immune abnormality is not consistent, and the recovery of GD is more significant than that of GD/T2DM.     

2型糖尿病患者一级亲属正常糖代谢人群胰岛素抵抗分析

目的探讨2型糖尿病(T2DM)患者糖耐量正常的一级亲属胰岛β细胞功能及胰岛素抵抗情况,并分析胰岛素抵抗的相关因素。方法选取T2DM患者糖耐量正常的一级亲属63例,根据胰岛素抵抗指数分为胰岛素抵抗组及非抵抗组;选取30例健康体检者作为正常对照组。对所选的93例对象进行血压、血糖、胰岛素、血脂的测定,并计算稳态模型胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)。结果①糖尿病患者一级亲属组与对照组相比,胰岛素水平、HOMA-IR、HOMA-β明显升高(P<0.05);②胰岛素抵抗组体质指数、舒张压、甘油三酯、餐后血糖、HOMA-β明显高于胰岛素非抵抗组(P<0.05);③相关分析示胰岛素抵抗与体质指数、舒张压、甘油三酯、餐后胰岛素呈正相关(P<0.01,P<0.05),与空腹血糖、餐后血糖、空腹胰岛素、收缩压、胆固醇无显著相关性(P>0.05)。结论T2DM患者一级亲属存在胰岛β细胞代偿性的高分泌,早期已经出现胰岛素敏感性的下降和胰岛素抵抗。胰岛素抵抗与体重增加、舒张压升高及甘油三酯的升高有关。提示对糖尿病患者一级亲属应严格控制体重、血压及血脂,对减少T2DM具有积极意义。     

自主神经功能检测对早期糖尿病自主神经功能损害的诊断价值

目的评价自主神经功能检测对早期糖尿病自主神经功能损害的诊断价值。方法50例2型糖尿病患者进行自主神经功能检查,即交感皮肤反应和心血管自主神经功能检测,并与30名健康人进行对比分析。结果糖尿病患者自主神经功能检测中交感皮肤反应,瓦氏比值和深呼吸时心率变异与对照组比较均有显著性差异(P<0.05),三者的异常率分别为70%,46%和50%;以交感皮肤反应的异常率最高,尤其以双下肢明显。立卧位血压差和冰水试验与对照组比较无显著性差异(P>0.05),其异常率分别为12%和16%。结论检测外周器官自主神经功能状态的方法中以交感皮肤反应的阳性率最高,可以作为检测早期糖尿病自主神经功能的常规筛选检查。     

糖尿病与高血压病患者血管内皮功能的变化特点

目的　利用多普勒超声检测糖尿病与高血压病的血管内皮功能 ,评价其变化特点。方法　运用多普勒超声对2 5例糖尿病 (DM )及 2 5例高血压病 (EH)患者和 2 0例正常人肱动脉充气加压及舌下含服硝酸甘油前后血管直径的变化进行观察。结果　DM和EH组充血状态下内径扩张程度较正常对照组明显减低。含服硝酸甘油后DM组内径扩张程度较正常对照组明显减低 ,EH组无显著性改变。结论　DM患者存在内皮依赖性舒张功能及非依赖性舒张功能障碍 ,EH患者内皮依赖性舒张功能障碍 ,非依赖性舒张功能正常     

拜糖平治疗糖尿病的初步临床观察

观察了拜糖平对27例糖尿病患者的空腹及餐后2h血糖的影响及其副作用，并与非拜糖平降糖药疗效进行了对比。结果显示：并糖平可使糖尿病患者餐后2h血糖明显下降，用药1周，餐后2h血糖下降幅反为13．38％～14.42％，2周，餐后2h血糖下降幅度为18.42％～18．94％，对空腹血糖无明显影响。除轻度胃肠道副作用外，无肝肾功及血、尿常规异常。提示拜糖平是降低餐后高血糖的一种良好的选择。     

内皮依赖性血管舒张与2型糖尿病血管病变的关系

目的　探讨内皮依赖性血管舒张与 2型糖尿病 (2 DM )血管病变的关系及其可能原因。方法　利用彩色多普勒超声对 4 1例 2 DM患者和 12例正常人在反应性充血及含服硝酸甘油前后肱动脉内径进行检测 ,评价不同情况下 2 DM内皮依赖性血管舒张 (△D1% )及非内皮依赖性血管舒张 (△D2 % )反应的变化。结果　无论有无微血管病或动脉粥样硬化 ,所有病例△D1%均较正常人组显著减退 (P <0 0 0 1) ;而△D2 %在所有组间均无显著差异。结论　 2 DM在无大 /微血管病变时 ,内皮依赖性血管舒张功能显著减退 ,此变化可能参与了动脉粥样硬化、糖尿病微血管病变的发生 ;而非内皮依赖性血管舒张功能无变化。     

尿酸水平对冠脉病变的预测

目的探讨尿酸水平在冠心病发病中的作用及其与冠脉病变的相关性。方法根据冠状动脉造影结果分为冠心病(CHD)组(164例)和正常对照组(51例),比较两组间尿酸水平的差别及与CHD之间的关系。结果CHD组患者的尿酸水平明显高于正常对照组[(316.67±97.35)μmol/Lvs.(286.16±98.33)μmol/L,P<0.01]。随后进行多元Logistic回归分析,显示在调整了糖尿病、性别和纤维蛋白原(FIB)等因素的作用后,尿酸对回归方程的影响达不到统计学意义。亚组分析显示有高尿酸血症的糖尿病患者冠心病发病风险明显提高。结论高尿酸血症作为独立的冠心病危险因素尚缺乏充分证据,应用尿酸与血糖综合评估冠心病的发生风险可能有一定意义。     

254例糖尿病患者的死因分析

目的分析糖尿病(DM)死亡原因,为防治提供依据。方法回顾性分析西安交通大学医学院第一、二附属医院自1991年1月1日至2003年12月31日期间住院的DM死亡病例。结果13年两院DM死亡254例,占住院总死亡人数3.2%;死因依次为:慢性并发症42.5%(心脑血管病28.3%,肾病14.2%),肿瘤20.1%,感染11.4%,急性并发症6.7%,肝硬化6.3%;慢性并发症死因中合并高血压66.7%(72/108)。结论慢性并发症已成为DM的主要死因,其中心脑血管病变是最重要的,高血压是增加其死亡率的主要危险因素。因此,严格控制血糖和血压,对降低DM心脑血管病变的病死率有重要意义。     

肾清饮对糖尿病大鼠肾脏的保护作用及其可能的机制

目的 探讨肾清饮对糖尿病大鼠肾脏的保护作用及可能的机制.方法 40只链脲佐菌素诱导的糖尿病大鼠随机分成模型组、肾清饮组、贝那普利组和肾清饮联合贝那普利组,连续给药8周后观察血糖、肾功能和24h尿蛋白定量的变化,分别检测肾组织及尿中丙二醛(MDA)含量,肾组织中超氧化物岐化酶(SOD)的活性,血清转化生长因子(TGF-β_1)水平的变化,光镜观察肾脏病理形态学的改变.结果 各药物组肾功能明显改善,与对照组比较无显著性差异(P>0.05),但对血糖无明显改善作用,24h尿蛋白量较模型组显著下降(P<0.05或 P<0.01),联合组下降最为显著(P<0.01);各药物组肾组织及尿MDA含量、肾组织SOD活性和血清TGF-β_1表达与模型组有显著性差异(P<0.05或 P<0.01),联合组与其他药物组比较差异显著(P<0.05).光镜观察各药物组肾脏病理改变均有不同程度改善,各组间无明显差异.结论 肾清饮对糖尿病大鼠肾脏有保护作用,与贝那普利联用有协同作用.其作用机制可能与抑制氧化应激和增强机体抗氧化能力,降低炎症因子TGF-β_1的表达有关.     

Survey on arteriovenous fistula in maintenance hemodialysis patients with type 2 diabetic nephropathy

This paper summed up the characteristics of native arteriovenous fistulas (AVFs) in maintenance hemodialysis patients with type 2 diabetic nephropathy (DN) in Chinese hemodialysis centers. A survey was conducted on AVF in maintenance hemodialysis patients with type 2 DN. A total of 224 cases of maintenance hemodialysis patients were included in this study, among which, 65 cases in DN group, 33 cases in diabetes mellitus (DM) group and 126 cases in non-diabetic control (C) group. Hemoglobin, albumin, blood urea nitrogen, parathyroid hormone and calcium-phosphate product of the three groups of patients were not significantly different. Glycated hemoglobin A1c of DN group and DM group was not significant different. AVF life of (28.7 ± 10.0) months in DN group was significantly shorter than that of (36.5 ± 19.4) months in C group (statistic probability P <0.01), and AVF life of (32.5 ± 10.1) months in DM group (P <0.05) was also shorter than that in C group, while there was no significant difference in AVF life between DN group and DM group. Proportion of upper arm fistula in DN patients (11/65) was significantly higher than that in C group (6/123, P < 0.01). Life of AVF in patients with DN was relatively short, with more times of angioplasty and greater possibility of selecting upper arm internal fistula.