【摘要】 目的 探討2型糖尿病合并下肢血管病變血管內介入治療的臨床意義。 方法 2009年1-5月對4例2型糖尿病合并下肢血管病變患者，根據血管狹窄情況選擇不同介入治療方式，行下肢動脈造影及動脈球囊擴張或支架成形術。 結果 4例患者均有表現靜息痛及間歇性跛行，下肢血管超聲顯示糖尿病下肢動脈有不同程度的斑塊、狹窄與血栓形成，病變累及下肢股動脈、髂動脈及脛前、足背動脈。介入治療后患者下肢血管灌注得到明顯改善，靜息痛及間歇性跛行明顯改善，皮溫改善，需要截肢患者截肢平面顯著降低。 結論 通過下肢血管DSA造影檢查，準確了解糖尿病患者下肢血管的阻塞部位及程度，在保守治療基礎上選擇不同方式的介入治療，有助于下肢血管病變的明顯改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.
【摘要】 目的 調查成都地區2型糖尿病患者糖耐量正常一級親屬的代謝狀態及與胰島素抵抗、胰島β細胞功能的相關性。 方法 2007年7-9月共納入糖耐量正常的一級親屬312例（NGT-FDR組），無家族史的正常對照1 348例（NGT-C組）。測量兩組血壓、體重、腰圍；檢測口服葡萄糖耐量試驗（OGTT）中0、0.5、2 h血糖、胰島素水平；測定空腹血脂；計算體重指數、HOMA-胰島素抵抗指數（HOMA-IR）、胰島β細胞功能指數（HOMA-β），β細胞早相分泌功能指數（△I30/△G30），并比較兩組間上述指標的差異和代謝綜合征（MS）及其各組分的發病情況。 結果 ①NGT-FDR組MS發生率高于NGT-C組，發生MS的風險是后者的1.737倍。NGT-FDR組高甘油三酯血癥（hypertriglyceridemia，HTG）、空腹血糖偏高（5.6~6.0 mmol/L）的發生率高于NGT-C組，合并4種及以上代謝異常的幾率亦高于NGT-C組（Plt;0.05）；②年齡lt;40歲的NGT-FDR中心性肥胖、HTG、空腹血糖偏高和MS均高于同年齡對照；男性NGT-FDR空腹血糖偏高和MS發病率高于男性對照（Plt;0.05）；③腰圍、收縮壓（SBP）、空腹血糖（FBG）、甘油三酯（TG）及糖尿病家族史同HOMA-IR呈正相關。腰圍、SBP、TG及糖尿病家族史同HOMA-β呈正相關，FBG則同HOMA-β呈負相關。 結論 2型糖尿病糖耐量正常一級親屬比無家族史的對照表現出更多的代謝異常，尤其是在年齡lt;40歲及男性中。各種代謝異常可加重胰島素抵抗，影響胰島基礎分泌功能。故有必要對糖耐量正常的一級親屬進行各項代謝指標的監測和早期預防性干預。【Abstract】 Objective To investigate the metabolic status of the normal glucose-tolerant first-degree relatives (NGT-FDR) of type-2 diabetic patients and its relationship with insulin resistance (IR) and β-cell function in Chengdu area. Methods From July to September 2007, a total of 312 NGT-FDR of type-2 diabetic patients and 1 348 normal glucose tolerant controls without positive family history of diabetes (NGT-C) were enrolled in this study. Blood pressure, weight, waists, plasma glucose at hour 0, 1/2 and 2 in oral glucose tolerance test (OGTT), insulin levels and fasting blood lipids were measured. Body mass index (BMI), HOMA-IR, HOMA-β and the early insulin secreting index (△I30/△G30) were calculated. Then, we compared the above-mentioned data and the incidence of metabolic syndrome (MS) between the two groups. Results ①The incidence of MS, hypertriglyceridemia (HTG), higher fasting blood glucose (FBG) (5.6-6.0 mmol/L) in the NGT-FDR group were all significantly higher than those in the NGT-C group. The risk of developing MS in the NGT-FDR group was 1.737 times as high as that in the NGT-C group. Furthermore, the incidence of 4 or more than 4 co-existent metabolic disorders in the NGT-FDR group was also significantly higher than that in the NGT-C group (Plt;0.05); ②For subjects less than 40 years old, the incidence of central obesity, HTG, higher FBG and MS in the NGT-FDR group were all higher than those in the NGT-C group. In male subjects, the rates of higher FBG and MS were all significantly higher in the NGT-FDR group than those in the NGT-C group. (Plt;0.05); ③Waists, FBG, systolic blood pressure (SBP), triglycerides (TG) and diabetic family history were positively correlated with HOMA-IR. Waists, SBP, TG and diabetic family history were positively correlated with HOMA-β. Conclusion NGT-FDR present significantly increased metabolic disorders than NGT controls, especially in the less than 40-year-old and the male subjects. The metabolic disorders can aggravate insulin resistance and influence islet β-cell secretion function, so it is necessary to monitor the metabolic status of the NGT-FDR of type-2 diabetic patients and provide early preventive interventions.
【摘要】 目的 總結應用經皮微創鋼板固定（minimally invasive percutaneous plate osteosynthesis，MIPPO）技術治療2型糖尿病患者脛骨遠端骨折的臨床經驗及治療效果。 方法 2007年5月-2010年11月，采用MIPPO技術治療2型糖尿病合并脛骨遠端骨折15例。其中男9例，女6例；年齡38~70歲，平均60歲。左側脛骨遠端骨折 4例，右側 11例。單發骨折10例，多發骨折5例。根據 AO分型:A1型2例，A2型1例，A3型5例，B1型3例，B3型3例，C1型1例。傷后至手術時間為2~14 d。 結果 15例患者隨訪時間8~12個月，平均10個月。手術時間平均89 min，術中失血量平均285 mL。術后1年采用Johner-Wruhs方法評估療效:優4例，良5例，中3例，差3例；總體滿意率80%。X線片示13例患者骨折均獲骨性愈合，愈合時間4~8個月，平均6個月，無再發骨折。3例發生泌尿系統感染，1例發生呼吸系統感染，感染率26.7%。 結論 MIPPO技術治療2型糖尿病脛骨近端骨折具有對骨折周圍軟組織剝離少、符合生物學固定概念、內固定牢靠、切口較小等優點，降低了切開復位內固定術后并發癥的發生率。【Abstract】 Objective To summarize the clinical experiences and effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique for type 2 diabetic patients with fractures of distal tibia. Methods From May 2007 to November 2010, 15 type 2 diabetic patients with distal tibia fractures including 9 males and 6 females were treated with minimally invasive percutaneous plate osteosynthesis. Their age ranged from 38 to 70 years old averaging at 60. Left distal tibia fracture occurred to 4 cases, and right distal tibia fracture occurred to 11 cases. Ten patients had single fracture, and 5 had multiple fractures. According to AO fracture classification, there were two cases of A1, one cases of A2, five cases of A3, three cases of B1 and B3 respectively, and two cases of C1. The time from the occurrence of fracture to operation was ranged from 2 to 14 days. Results The patients were followed up for 8 to 12 months with an average period of ten months. The average operation time was 89 minutes and perioperative blood loss was (285±38) mL. Johner-Wruhs method was used to evaluate the efficacy. Four cases were excellent, 5 were good, 3 were fair, and 3 were poor, with an overall satisfaction rate of 80%. X-ray showed that 13 patients were healed. The healing time was 4 to 8 months, averaging 6 months, and no further fractures occurred. There were 3 cases of urinary tract infection and 1 case of respiratory infection with an infection rate of 26.7%. Conclusion Minimally invasive percutaneous plate osteosynthesis technique for fractures of distal tibia in diabetic patients is a safe method with better mechanical stability, less intervention of blood supply, less soft tissue complications and smaller incisions.
Objective Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.
摘要:目的: 觀察瑞格列奈、阿卡波糖聯合治療老年性2型糖尿病患者的臨床療效及安全性。 方法 :觀察58例2型糖尿病患者服用瑞格列奈及阿卡波糖,療程12周,監測治療前后空腹及餐后2 h血糖(FBG、PBG)、糖化血紅蛋白(HbAlc)、肝功、腎功。 結果 :FBG、PBG及HbAlc較治療前顯著下降(Plt;005),尤其是餐后血糖更為明顯(Plt;001)。無一例肝腎功能損害,也無嚴重低血糖及其它嚴重不良反應發生。 結論 :瑞格列奈聯合阿卡波糖治療2型糖尿病降糖作用確切,而且安全性、耐受性良好。Abstract: Objective: To observe the clinical efficacy and safety of combined treatment of repaglinide and acarbose in aged patients with diabetes type 2 Methods : After oral administration of repaglinide and acarbose for 12 weeks, 58 patients with type 2 diabetes were observed. The concentrations of fasting blood glucose (FBG), 2 h postprandial blood glucose (PBG), glycosylated hemoglobin (HbAlc), liver and kidney functions were monitored before and after treatment. Results : The levels of FBG, PBG and HbAlc were significantly decreased compared with pretreatment (Plt;005), especially PBG (Plt;001). No case of liver and kidney dysfunction was found, without serious hypoglycemia and other serious adverse events as well. Conclusion : Repaglinide and acarbose have the precise function in the treatment of type 2 diabetes, with good security and good tolerance.
【摘要】 目的 觀察單用二甲雙胍與二甲雙胍聯合阿卡波糖對2型糖尿病（type 2 diabetes mellitus，T2DM）降糖作用的臨床療效。 方法 對2010年1—10月就診有典型易饑多食的T2DM患者45例，隨機分為二甲雙胍組20例和二甲雙胍聯合阿卡波糖25例，療程12周。 結果 二甲雙胍組與二甲雙胍聯合阿卡波糖組治療后對患者的饑餓感和食量改善差異有統計學意義（Plt;0.05），空腹及餐后血糖差異（Plt;0.01）、空腹血糖達標比例差異（Plt;0.01）、餐后血糖達標比例差異（Plt;0.05）均有統計學意義。 結論 二甲雙胍聯合阿卡波糖能顯著改善T2DM患者的食欲及食量，從而明顯降低空腹及餐后血糖。【Abstract】 Objective To observe and compare the clinical affects and curative effects between using metformin and metformin plus acarbose in the treatment of type 2 diabetes mellitus (T2DM). Methods From January to October 2010, 45 T2DM patients with common symptoms of easy-starving and overeating were randomized into two groups and treated for 12 weeks with either metformin (n=20) or metformin plus acarbose (n=25). Results After the treatment, significant differences were found between the two groups in the improvement on patients’ sense of starving and quantity of eating (Plt;0.05), fasting and postprandial blood glucose (Plt;0.01), up-to-standard rate of fasting blood glucose (Plt;0.01), and up-to-standard rate of postprandial blood glucose (Plt;0.05). Conclusion The combination of metformin and acarbose can substantially improve the appetite and quantity of eating for patients with T2DM, hence significant reductions of fasting and postprandial blood glucose level can be feasibly achieved.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) for obesity and type 2 diabetes mellitus (T2DM).
MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of LRYGB vs. LSG for obesity and T2DM. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 8 RCTs including 828 patients were included. The results of meta-analysis showed that:There were no significant differences between the LRYGB group and the LSG group in body mass index (MD=-1.02, 95%CI -2.90 to 0.86, P=0.29), remission rate of T2DM (OR=1.11, 95%CI 0.71 to 1.73, P=0.64), reoperation rate (OR=2.74, 95%CI 1.01 to 7.42, P=0.05), level of fasting plasma glucose (MD=2.71, 95%CI -0.80 to 6.21, P=0.13), and level of serum low density lipoprotein (MD=-23.85, 95%CI -47.20 to -0.50, P=0.05). However, the LSG group had lower postoperative complication rate (OR=2.28, 95%CI 1.43 to 3.62, P=0.000 5) than that of the LRYGB group.
ConclusionIn short term, both LRYGB and LSG were equally efficient in the treatment of obesity and T2DM, but LSG has lower postoperative complication rate than LRYGB. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
