【摘要】 目的 探討2型糖尿病（T2DM）胰島素抵抗導致糖尿病性心功能不全的臨床表現特點及相關激素的改變。 方法 2008年1-4月對T2DM患者35例（胰島素抵抗指數HOMA-IRlt;2.69者19例為A1組，HOMA-IR≥2.69者16例為A2組）及健康體檢者20人B組測體重指數（BMI）、空腹血糖（FPG）、胰島素、心鈉素（ANP）、腦鈉素（BNP）水平；心臟彩色多普勒超聲分別測E/A、e/a、S/D、LVEF、DT期。 結果 A2組BMI較A1、B組均明顯增加（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。ANP、BNP及DT值在A1、A2組均較B組增高（Plt;0.05），BNP在A2組高于A1組（Plt;0.05），ANP、DT值在A1、A2組間差異均無統計學意義（Pgt;0.05）。E/A、e/a和S/D在A1、A2組均較B組降低（Plt;0.05），A1、A2組間差異均無統計學意義（Pgt;0.05）。A2組患者LVEF較A1、B組均明顯降低（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。 結論 隨著胰島素抵抗加重，心肌舒張順應性較差和收縮力下降，伴隨相關激素（心臟利鈉肽）分泌增加，最終產生心功能不全的臨床表現、體征及多普勒超聲心動圖表現。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.
Objective To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody (IAA). Methods We searched The Cochrane Library (Issue 3, 2008), PubMed (1966-July 2009), EMbase (1974-July 2009) and CBM (1978-July 2009) to identify relevant evidence. The quality of the retrieved studies was critically assessed. Results A total of 291 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more effective and safer than conventional therapies. Conclusion The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.
