Objective?To explore the glucometabolic state of angiographically documented inpatients with coronary artery disease (CAD) but without diagnosed diabetes mellitus (DM). Methods?The study recruited 449 patients, who were performed a coronary angiography as well as an oral glucose tolerance test (OGTT) when admitted in the cardiovascular medical ward in our hospital from January 2007 to May 2009. According to the results of coronary angiography, the patients were divided into a coronary artery disease (CAD) group and a non-coronary artery disease (non-CAD) group, and abnormal glucose metabolism (AGM) status was compared between the two groups. Results?The random plasma glucose (RPG) and fasting plasma glucose (FPG) had no significant differences (P values were 0.249 and 0.444, respectively) in the two groups, while the OGTT 2-hour plasma glucose (2hPG) was much higher in the CAD group, with a significant difference (Plt;0.001) compared with the non-CAD group. The CAD group had a prevalence of AGM up to 74.0%, of which 32.1% were newly diagnosed DM patients, and 39.0% were impaired glucose tolerance (IGT) patients, much higher than that in the non-CAD group, respectively, there being a significant difference (P=0.006). Logistic regression analyses revealed that the risk of IGT and newly diagnosed DM was 1.6 times (OR=1.603, 95% CI 1.023 to 2.512, P=0.04) and 2.3 times (OR=2.292, 95% CI 1.391 to 3.777, P=0.001) as much as that in non-CAD patients, respectively; when adjusted for the factors such as hypertension, dyslipidemia, BMI, hs-CRP, and other factors, CAD patients still had a higher risk of newly diagnosed DM (OR=1.852, 95%CI 1.064 to 3.223, P=0.029), compared with the non-CAD patients. Conclusion?AGM is common in the admitted patients with CAD but undiagnosed diabetes, most of whom need an OGTT to be diagnosed timely and accurately. OGTT should be considered to be a routine inspection item to diagnose AGM in the inpatients with CAD; if possible, all hospitalized patients with cardiovascular disease should be performed an OGTT routinely.
【摘要】 目的 调查成都地区2型糖尿病患者糖耐量正常一级亲属的代谢状态及与胰岛素抵抗、胰岛β细胞功能的相关性。 方法 2007年7-9月共纳入糖耐量正常的一级亲属312例（NGT-FDR组），无家族史的正常对照1 348例（NGT-C组）。测量两组血压、体重、腰围；检测口服葡萄糖耐量试验（OGTT）中0、0.5、2 h血糖、胰岛素水平；测定空腹血脂；计算体重指数、HOMA-胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β），β细胞早相分泌功能指数（△I30/△G30），并比较两组间上述指标的差异和代谢综合征（MS）及其各组分的发病情况。 结果 ①NGT-FDR组MS发生率高于NGT-C组，发生MS的风险是后者的1.737倍。NGT-FDR组高甘油三酯血症（hypertriglyceridemia，HTG）、空腹血糖偏高（5.6~6.0 mmol/L）的发生率高于NGT-C组，合并4种及以上代谢异常的几率亦高于NGT-C组（Plt;0.05）；②年龄lt;40岁的NGT-FDR中心性肥胖、HTG、空腹血糖偏高和MS均高于同年龄对照；男性NGT-FDR空腹血糖偏高和MS发病率高于男性对照（Plt;0.05）；③腰围、收缩压（SBP）、空腹血糖（FBG）、甘油三酯（TG）及糖尿病家族史同HOMA-IR呈正相关。腰围、SBP、TG及糖尿病家族史同HOMA-β呈正相关，FBG则同HOMA-β呈负相关。 结论 2型糖尿病糖耐量正常一级亲属比无家族史的对照表现出更多的代谢异常，尤其是在年龄lt;40岁及男性中。各种代谢异常可加重胰岛素抵抗，影响胰岛基础分泌功能。故有必要对糖耐量正常的一级亲属进行各项代谢指标的监测和早期预防性干预。【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 了解心脏瓣膜置换术后认知功能障碍（POCD）的危险因素，明确围手术期脑糖代谢异常是否为术后POCD的可能发病机制之一。 方法 选取2004年3月-2009年7月心脏瓣膜置换术患者70例，根据术后第7天患者认知功能测定结果分为POCD组（n =31）和非POCD组（n =39），比较两组患者年龄、性别、体外循环（CPB）时间、主动脉阻断时间、主动脉阻断后平均动脉压和平均灌注流量，并且分别于麻醉后手术前（T1）、CPB稳定的低温期（T2）、复温至33℃（T3）、CPB结束后30 min（T4）4个时点采动脉及颈内静脉血，测定血气、血糖浓度，计算出脑摄氧率（CEO2）、脑糖摄取Glu（a-v）。 结果 发生POCD的患者年龄较非POCD组大，并且CPB时间和主动脉阻断时间也更长，两组之间比较有统计学差异（Plt;0.05），但是两组在性别、主动脉阻断后平均动脉压和平均灌注流量比较无统计学差异。两组的CEO2变化趋势一致，各时点的值无明显变化，两组间比较无差异；非POCD组的Glu（a-v）各时点间比较无统计学差异，POCD组的Glu（a-v）T1、T2时点也无明显变化，但POCD组的Glu（a-v）在T3、T4明显降低，并且与非POCD组比较有统计学意义（Plt;0.05）。 结论 年龄、CPB时间和主动脉阻断时间是POCD发生的危险因素。脑糖代谢异常是POCD发生的可能机制之一。【Abstract】 Objective To understand the risk factor of postoperative cognitive dysfunction (POCD), and identify whether perioperative brain glucose metabolism disorder was or not pathogenesis of POCD after heart valve replacement operation. Methods From March 2004 to July 2009, 70 patients with heart valve replacement were divided into POCD group (n=31) and non-POCD group (n=39) according to cognitive function status tested on the seventh day after operation. The age, sex, cardiopulmonary bypass (CPB) duration, aortic crossclamp duration, mean arterial blood pressure and mean priming volume after aortic crossclamp of two groups were compared. Blood samples were drawn from the radial artery and jugular bulb catheters for determination of blood gas and glucose after induction of anaesthesia (baseline), at the time of the lowest CPB temperature, rewarming to 33℃, and 30 minutes after termination of CPB, CEO2 and Glu (a-v) were calculated: CEO2= (CaO2－CvO2) /CaO2. Results In POCD group, the average age was larger and CPB duration and aortic crossclamp duration was longer than in non-POCD group (Plt;0.05) , but there were no statistical differences in sex, mean arterial blood pressure and mean priming volume after aortic crossclamp. The change tendency of CEO2 of two groups were similar and without significant difference. Glu (a-v) of non-POCD group had no difference in every point, and Glu (a-v) of POCD group had no difference in T1 and T2 points, but value of Glu (a-v) of POCD group decreased obviously and had distinct difference with that of non-POCD group in T3 and T4 points (Plt;0.05). Conclusion Age, CPB duration, and aortic crossclamp duration were risk factors of POCD. Brain glucose metabolism disorder was possibly one of pathogenesis of POCD.
ObjectiveTo investigate the prevalence of chronic obstructive pulmonary disease (COPD) with lipid metabolism disorders patients in Chengdu. MethodsWe randomly selected four communities from urban and rural areas in Chengdu between February and December, 2010, with multistage cluster random sampling method; 1 931 residents aged from 40 to 70 received special questionnaire from the BOLD Study, lung examination, blood biochemical examination, and physical examination. ResultsThe prevalence of COPD was 60.26% (91/151) with dyslipidemia; while non-COPD was 68.17% (972/1 428), and the difference was significant (P<0.05), in which the most obvious difference is triglycerides (TG). The prevalence of COPD was 6.62% (10/151) with underweight; while non-COPD was 4.97% (71/1 428), and the difference was significant (P<0.001). The prevalence of COPD was 21.19% (32/151) with abdominal obesity; while non-COPD was 30.81% (440/1 428), and the difference was significant (P<0.05). ConclusionThe prevalence of COPD with lipid metabolism disorders is lower than which with non-COPD in Chengdu. It provides an evidence for the nutrition support therapy in the treatment of COPD.
ObjectivesTo systematically review the risk of arterial ischemic and metabolic adverse events in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect clinical trials, observational studies and case reports of adverse events in CML patients treated with TKIs from inception to February 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 22 studies involving 4 223 patients were included. The incidence rates of ischemic heart disease in any grade were 2 per 100 patient-years (95%CI 2 to 3) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 3) for imatinib. The incidence of ischemic heart disease in grade 3 or 4 was 1 per 100 patient-years (95%CI 0 to 2) for nilotinib. The incidence of peripheral arterial occlusive disease in any grade was 2 per 100 patient-years (95%CI 0 to 14) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 2) for imatinib. The incidence of hypertension in any grade was 1 per 100 patient-years (95%CI 0 to 3) for nilotinib, and 44 per 100 patient-years (95%CI 27 to 71) for ponatinib. The incidence of hypertension in grade 3 or 4 was 2 per 100 patient-years (95%CI 0 to 15) for nilotinib, and 22 per 100 patient-years (95%CI 8 to 58) for ponatinib. The incidence of hyperlipidemia in any grade was 17 per 100 patient-years (95%CI 5 to 59) for nilotinib. The incidence of hyperglycemia in any grade was 11 per 100 patient-years (95%CI 9 to 15) for nilotinib, 2 per 100 patient-years (95%CI 1 to 4) for imatinib, 1 per 100 patient-years (95%CI 0 to 5) for dasatinib, and 19 per 100 patient-years (95%CI 19 to 20) for bosutinib. The incidence of hyperglycemia in grade 3 or 4 was 4 per 100 patient-years (95%CI 3 to 5) for nilotinib, and 1 per 100 patient-years (95%CI 1 to 2) for bosutinib.ConclusionsPatients treated with nilotinib have a greater possibility of ischemic heart and peripheral arterial occlusive disease compared with patients treated with imatinib. Patients treated with ponatinib have a high incidence rate of hypertension, and patients treated with nilotinib have a high incidence rate of hyperlipidemia. Patients treated with bosutinib and nilotinib have higher risk of hyperglycemia compared with patients treated with imatinib or dasatinib.
Diabetic panvasculopathy refers to a clinical syndrome in which a wide range of blood vessels (including heart, brain, kidney, eye, peripheral and other large vessels and microvessels) in diabetic patients have atherosclerosis as the common pathological feature, cardiovascular and cerebrovascular events as the main outcome, and active intervention of metabolic abnormalities is helpful to improve the prognosis. Early diagnosis, early prevention and active exploration of clear therapeutic targets are very important to prevent and delay the occurrence and development of diabetic panvasculopathy, but they are also challenges at present. The cardiorenal benefit of new hypoglycemic drugs is independent of blood glucose control, which has attracted increasing academic attention. The concept of panvasculopathy in diabetes plays an important role in improving the comprehensive management of the disease and multidisciplinary collaborative diagnosis and treatment, which is helpful to promote the vigorous development of the subspecialty of panvasculopathy and the continuous improvement of the comprehensive prevention and treatment level.