糖化血红蛋白的应用价值研究进展

糖化血红蛋白(HbA_(1C))是人体血液中红细胞内的血红蛋白与血糖结合的产物。属于不可逆反应过程,并与血糖浓度成正比,且保持3~4个月左右,所以可以检测到120天之前的血糖浓度~([1-2])。因此HbA_(1C)水平在一定程度上反映患者近8~12周的血糖水平。近年来,HbA_(1C)越来越受到国内外相关人士的重视,美国糖尿病协会(ADA)于2011

Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa

Objective To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries. Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L. Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6–14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75–0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81–0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru. Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation

胃转流术在肥胖合并2型糖尿病中临床应用

Objective:To explore the stomach turn flow operation application of sugar in obesity type 2 diseases. Methods:A retrospective analysis of 8 cases of stomach turn flow merger cases of type 2 diabetes treatment of obesity. Results:Postoperative blood glucose in patients with complete response rate was 87.5% in 1 year follow-up, all patients with postoperative blood glucose were significantly improved, only 1 case still need to drug control, the total effective rate was 100%. Conclusion:For the treatment of stomach turn flow with obesity with type 2 diabetes. 目的  探讨胃转流手术在肥胖合并2型糖病中的应用。方法 回顾性分析8例胃转流术治疗肥胖合并2型糖尿病病例。结果 术后1年内随访患者血糖完全缓解率达87.5%，所有患者术后血糖均明显好转，仅1例仍需药物控制，总的有效率为100%。结论  胃转流术治疗肥胖合并2型糖尿病有效。

Comparison of therapeutic effect of acarbose and metformin in patients with type 2 diabetes mellitus

目的  观察拜糖平和二甲双胍对2型糖尿病患者空腹血糖和餐后血糖的不同作用，对胰岛素分泌和肝肾功能及血脂的影响。方法  将单纯控制饮食或加用黄脲类药物治疗不满意的2型糖尿病患者80例随机分为拜糖平组48例和二甲双胍组32例，治疗疗程16周。结果  二甲双胍对空腹血糖的作用优于拜糖平（有效率分别为96.9%，85.7%；显效率分别为71.9% ，47.9%；P均<0.01），而拜糖平对餐后2h血糖的作用优于二甲双胍（有效率分别为97.6%，93.8%；显效率分别为71.4% ，65.6%；P均<0.01）。结论  两药均能明显降低血糖，拜糖平组从9.19±2.78降至6.76±1.33(P<0.01)，二甲双胍组从9.23±1.89降至15±1.24 (P<0.01)。两药相比对降血糖的作用差别无统计学意义（P>0.50）。两种药物均不刺激胰岛素的分泌，对肝肾功能和血糖无影响。Objective: To observe the clinical effect of the Acarbose and Metformin in the treatment of type 2 diabetes mellitus. Methods: 80 patients  with  type 2 diabetes mellitus, who were poorly controlled by diet only or plus sulfonylureas  treatment, were randomized into two groups and treated for 16 weeks with either acarbose 50～100mg tid (n=48) or Metformin 250～500mg tid (n=32) respectively. Results: The results showed that both acarbose and metformin led to a reduction of GHbAlc, the mean fasting and 2h postprandial blood glucose levels. The effective rate of reduction of the mean fasting blood glucose level with metformin was higher than that of acarbose (96.9% and 85.7%, P < 0.01), and the effective rate of reduction of the 2h postprandial blood glucose levels with acarbose was higher than that of metformin (97.6% and 93.8%, P < 0.01). The levels of GHba.c were reduced in both groups (P < 0.01) but without statistically significant difference (P > 0.05). Conclusion: The two medicines have no insulinotropic effect and do not effect the plasma liquid and the functions of liver or kidney

Clinical Observation of Insulin Glargine Combined With Oral Hypoglycemic Agents in the Treatment of Type 2 Diabetes

目的探讨甘精胰岛素联合口服降糖药治疗口服降糖药血糖控制不理想的2型糖尿病的临床疗效。方法选取本院接受治疗的84例口服降糖药血糖控制不理想的2型糖尿病患者,随机分成2组,各42例,其中观察组给予甘精胰岛素注射液联合格列吡嗪控释片与二甲双胍片治疗,对照组给予精蛋白锌重组人胰岛素注射液联合格列吡嗪控释片与二甲双胍片治疗,观察两组患者的临床疗效。结果观察组患者治疗6周后、12周后的糖化血红蛋白水平、空腹血糖浓度、餐后2小时血糖浓度均低于对照组,治疗12周后的空腹C肽水平、餐后2小时C肽水平均高于对照组,治疗12周后的身体质量指数、胰岛素用量以及低血糖发生率低于对照组（P〈0.05）。结论甘精胰岛素联合口服降糖药治疗口服降糖药血糖控制不理想的2型糖尿病患者能有效控制患者的血糖水平和体质量,效果明显,不良反应少。Objective To investigate the clinical efficacy of insulin glargine combined with oral hypoglycemic agents in the treatment of type 2 diabetes mellitus with poor glycemic control of oral hypoglycemic agents.Methods 84 patients with type 2 diabetes mellitus with poor glycemic control of oral hypoglycemic agents were randomly divided into two groups（n=42）.The patients in the observation group were treated with insulin glargine combined with glipizide and metformin tablets,the control group was treated with protamine zinc recombinant human insulin injection combined with glipizide controlled release tablets and metformin tablets treatment,the clinical efficacy of the two groups of patients was observed.Results After six weeks and twelve weeks of treatment,the levels of glycosylated hemoglobin,fasting blood glucose and 2 h postprandial blood glucose levels in the observation group were lower than those of the control group respectively,after twelve weeks of treatment,the fasting C peptide level and 2 h postprandial C peptide level of treatment was higher than the control group（P〈0.05）.After twelve weeks of treatment,the body weight index,the amount of insulin and the incidence of adverse reactions in the observation group were lower than those of the control group（P〈0.05）.Conclusion Glucose insulin combined with oral hypoglycemic agents can effectively control the blood glucose level and body weight of patients with type 2 diabetes mellitus with poor glycemic control of oral hypoglycemic agents.The effect is obvious and the adverse reactions are fewer

The Influence of Magnesium Supplementation on Glucose and Lipid Metabolism of Rats with Type 2 Diabetes Mellitus

目的:研究镁补充对2型糖尿病大鼠糖脂代谢的影响。方法:将用高脂饮食联合链脲佐菌素(STz)方法诱发的2型糖尿病大鼠随机分为四个组,糖尿病对照组喂饲高脂饲料,高、中、低剂量组在高脂饲料中分别加入2000、1000、200 Mg/kg的镁(以镁离子计)。自由饮食喂养四周,处死动物。用放射免疫法测血清胰岛素(InS)水平、用葡萄糖氧化酶法测空腹血浆葡萄糖(fASTIng PlASMAgluCOSE,fPg),并计算胰岛素敏感指数(InSulIn SEnSITIVITy IndEX,ISI)。比色法检测糖化血红蛋白(glyCOSylATEd HEMOglObIn,HbA1C)。用全自动生化分析仪测高密度脂蛋白胆固醇(HIgH-dEnSITy lIPOPrOTEIn CHOlESTErOl,HdlC)、甘油三酯(TrIglyCErIdE,Tg)、总胆固醇(TOTAl CHOlESTErOl,TC)。结果:高剂量组的空腹血糖、空腹血清、糖化血红蛋白、甘油三酯、总胆固醇水平均较糖尿病对照组显著性降低(P<0.05),而高密度脂蛋白胆固醇、胰岛素敏感指数较糖尿病对照组显著性升高(P<0.05)。结论:镁补充可以提高2型糖尿病大鼠胰岛素敏感性,改善糖尿病大鼠的糖脂代谢情况。Objective: To investigate the effect of magnesium supplementation on glucose and lipid metabolism of rats with type 2 diabetes mellitus.Method: Rats with type 2 diabetes mellitus were induced with high fat diet and intraperitoneal injection with small dose of STZ,then they were divided into 4 groups randomly: high,medium,low magnesium supplementation groups and diabetes mellitus control group.Diabetes mellitus control group was feed with high-fat feed only.The dosage added in high-fat feed of the high,medium,low magnesium supplementation groups are 2000,1000,200 mg/kg(measured by Mg2+).All the rats ate and drunk freely.All rats were killed after four weeks.The serum insulin(Ins) level were tested with radiation immune method,fasting plasma glucose(FPG)were mea-sured with glucose oxidase method,and calculation the insulin sensitivity index(ISI).Glycosylated hemoglobin(HbA1c) was measured by chromatometry.High-density lipoprotein cholesterol(HDLC),triglyceride(TG),total cholesterol(TC) were measured by automatic biochemical analyzer.Results: FPG,Ins,TG,TC levels of high dose group was significantly lower compared with that in the diabetic control group(P<0.05),while HDLC,ISI increased significantly compared with that in the diabetic control group(P<0.05).Conclusion: Magnesium supplement can improve insulin sensitivity,improve glucose and lipid metabolism in type 2 diabetic rats

西格列汀与瑞格列奈比较治疗2型糖尿病效果的系统评价

目的运用循证医学方法 ,对西格列汀与瑞格列奈治疗2型糖尿病的随机或者半随机对照试验进行系统评价。方法全面收集2018年3月以前发表的以西格列汀与瑞格列奈治疗2型糖尿病的随机或者半随机对照试验文献,逐一评价文献质量;运用RevMan4.2软件对多个研究结果的总体效应进行Meta分析。结果 8篇文献被纳入研究,只有3篇明确描述随机方法。Meta分析结果提示西格列汀组改善空腹血糖优于瑞格列奈组,且两组差异有统计学意义[WMD-0.19,95%CI(-0.28,-0.10),P<0.0001];西格列汀组改善餐后2 h血糖、糖化血红蛋白均优于瑞格列奈组,但两组差异均无统计学意义,分别为[WMD-0.05,95%CI(-0.24,0.15),P=0.64]和[WMD-0.02,95%CI(-0.11,0.07),P=0.68];西格列汀组降低BMI的幅度大于瑞格列奈组,且差异有统计学意义[WMD-1.44,95%CI(-1.73,-1.15),P<0.000 01]。结论目前资料表明,西格列汀组改善血糖情况非劣效于瑞格列奈组,且对体重影响更小、低血糖事件更少,但此次所纳入的研究总体质量等级不高,对结果的论证强度具有一定影响,建议今后进一步开展更多高质量的临床研究以提供更加可靠的证据

INFLUENCE of MAGNESIUM SUPPLEMENTATION ON INSULIN RESISTANCE AND THE INFINITY of RECEPTOR IN RATS WITH TYPE 2 DIABETES MELLITUS

目的观察镁补充对2型糖尿病大鼠胰岛素受体亲和力的影响。方法将用高脂饮食联合链脲佐菌素(STz)方法诱发的2型糖尿病大鼠随机分为4个组,糖尿病对照组喂饲高脂饲料,高、中、低剂量组在高脂饲料中分别加入2000、1000、200Mg/kg的镁(以镁离子计)。每周检测空腹血糖1次。自由饮食喂养4 W,处死动物。用放射性受体分析法测肝细胞胰岛素受体亲和力、放射免疫法测血清胰岛素(InS)水平、比色法检测糖化血红蛋白(HbA1C)和血浆丙二醛(MdA)、葡萄糖氧化酶法测空腹血浆葡萄糖(fPg),并计算胰岛素敏感指数(ISI)和抵抗指数(IrI)。结果高剂量组的高亲和力胰岛素受体结合常数(k1)为(4.76±0.08)x108l/MOl,低亲和力胰岛素受体结合常数(k2)与结合容量(r2)分别为(1.10±0.14)x106l/MOl,(8.49±0.43)x1013/Mg蛋白,均较糖尿病对照组显著性升高(P<0.05)。补镁第3 W开始高剂量组空腹血糖较糖尿病对照组显著性降低,高剂量组的胰岛素敏感指数较糖尿病对照组显著性升高,而胰岛素抵抗指数则显著性降低。结论镁补充可以提高2型糖尿病大鼠胰岛素受体亲和力,降低胰岛素抵抗。Objective To observe the influence of magnesium supplementation on the infinity of insulin receptor in rats with type 2 diabetes mellitus.Method The rats with type 2 diabetes mellitus were induced with high fat diet and intraperitoneal injection with small dose of STZ.They were randomly divided into 4 groups,i.e.high,medium,low magnesium(2000,1000,200 mg/kg Mg2+) supplementation groups and diabetes mellitus control group.FPG was measured weekly.All rats were killed after 4 w,and liver cells were tested with radiation receptor analysis of their combination constants and combined capacity.The serum insulin(Ins) level was determined with radioimmunoassay.FPG,glycosylated hemoglobin(HbA1c) and plasma malondialdehyde(MDA) were also measured,and insulin resistance index(IRI) and insulin sensitivity index(ISI) were calculated.Results: High affinity insulin receptor combination constant(K1),low affinity insulin receptor combination constant(K2) and combination capacity(R2) of high dosage group were(4.76±0.08)×108 L/ mol,(1.10±0.14)×106 L/ mol,(8.49±0.43)×1013 /mg protein respectively,significantly increased than those in diabetes mellitus control group(P<0.05).FPG was decreased since the 3th week during magnesium supplementation.The insulin sensitivity index(ISI) of high dosage group was significantly increased than that of model control group,but insulin resistance index(IRI) was decreased.Conclusion Magnesium supplementation could improve insulin receptor affinity and reduce insulin resistance in type 2 diabetic rats

参地糖脉宁汤对实验性2型糖尿病大鼠肝细胞脂肪变的效应*

Objective: To evaluate effects of Shendi Tang Maining Decoction on steatosis of hepatocyte in type 2 diabetes mellitus. Methods: Type 2 diabetes was induced, in female Wistar rats, by intraperitoneal injection of streptozotocin (25 mg/kg BW), fed with high sucrose and high lipid food. Animals were divided into 2 groups, type 2 diabetes control group (T2DMC group; n=12), type 2 diabetes invention group (T2DMI group; n=12). The age and sex matched Wistar rats served as normal control group (NC group, n=12). The rats of T2DMI group were fed with Shendi Tang Maining Decoction [active pharmaceutical ingredient 5mg/(kg BW•d)]. The rat of NC group and T2DMC were fed with cool boiled water. Results: Steatosis of hepatocyte was significant more in every group of type 2 diabetes than NC group (P&lt;0.01). Steatosis of hepatocyte was significant less in T2DNI group than T2DMC group （P&lt;0.01）. Hepatic PAS stain was significant lighter in every group of type 2 diabetes than NC group (P&lt;0.01). Hepatic PAS stain was significant darker in T2DNI group than T2DMC group（P&lt;0.01）. Conclusion: Shendi Tang Maining Decoction can ameliorate steatosis and glycogen quantity of hepatocyte in type 2 diabetes mellitus.目的  评价参地糖脉宁汤对2型糖尿病时肝细胞脂肪变的效应。方法  用小剂量STZ (25 mg/kg BW) 雌性Wistar大鼠腹腔内注射加含高糖和高脂饲料喂养造成实验性2型糖尿病模型，分为二组，2型糖尿病对照组（T2DMC组,n＝12），2型糖尿病干预组（T2DMI组,n＝12）。相同鼠龄的雌性Wistar大鼠作为正常对照组（NC组，n＝12）。T2DMI组用参地糖脉宁汤[原药5g/（kg WD·d）]灌胃；NC组、T2DMC组用凉开水灌胃。观察参地糖脉宁汤对2型糖尿病时肝细胞脂肪变的效应。结果  T2DM各组大鼠肝细胞脂肪变显著多于NC组（P＜0.01），而T2DMI组肝细胞脂肪变显著少于T2DMC组。T2DM各组大鼠肝PAS染色密度显著低于NC组（P＜0.01），而T2DMI组肝细胞PAS染色深度显著高于T2DMC组。结论  参地糖脉宁汤能改善2型糖尿病时的肝细胞脂肪变和糖原含量

102例初诊2型糖尿病患者中医病理特点分析

现阶段糖尿病已经成为非传染性的流行病。由于检测手段的先进性和人们健康意识的普遍提高,很多2型糖尿病患者是由于“健康“体检所发现,其临床表现已非传统消渴之“三多一少“所能概括。故运用中医学的研究方法探讨初诊2型糖尿病患者的中医病理特点,就显得尤为必要。本研究对厦门地区初诊2型糖尿病患者进行规范而全面的临床资料收集,运用中医证素辨证的方法,探讨初诊2型糖尿病福建省卫生厅资助课题(WZZZ0903