【摘要】 目的 探讨老年糖尿病患者合并脑梗死的临床特点及相关危险因素。 方法 回顾分析2008年7月-2009年7月收治的96例老年糖尿病合并脑梗死患者（A组）及116例老年非糖尿病脑梗死（B组）的临床资料，比较两组患者临床症状、体重指数（BMI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、纤维蛋白原（FIB）水平及头颅CT结果等。 结果 A组与B组相比，BMI，TC、TG、LDL及FIB水平明显增高，而HDL降低，颅内病灶直径多较小，数目较多。 结论 老年糖尿病患者合并高BMI、TC、TG、LDL及低HDL脑梗死的危险性较高，且以多发腔隙性脑梗死多见。【Abstract】 Objective To investigate the clinical features and risk factors of the cerebral infarction in elder diabetic patients. Methods The clinical data of 96 (group A) and 116 (group B) elder patients with and without diabetes mellitus treated in our hospital due to cerebral infarction from July 2008 to July 2009 were retrospectively anlalyzed. The differences in clinical symptoms, body mass index (BMI), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), fibrinogen (FIB) and the results of head CT between the two groups were compared. Results The levels of BMI, TC, TG, LDL, and FIB were obviously higher in group A than those in group B; HDL decreased, and the size and number of cerebral infarction was smaller and more in group A. Conclusion The elder diabetic patients with high BMI, TC, TG, and LDL and low HDL have a high risk of cerebral infarction, most commonly lacunar infarction.
目的:探讨老年2型糖尿病患者体重指数(BMI)与胰岛β功能状态及胰岛素抵抗(RI)的关系。方法:调查对象为2006年4月~2008年7月入我接受健康体检的成都地区离退休干部。采用1999年WHO糖尿病诊断标准,以129例已确诊T2DM患者为观察对象,根据体重指数(BMI)分为两组:肥胖组(含超重)(BMI≥25)66例,均为男性;非肥胖组(BMIlt;25)63例,其中3例为女性(无统计学意义),并与19例正常对照组进行对比研究。以氧化酶法测定空腹血葡萄糖(FBG),酶联免疫法测胰岛素(INS)及C肽(CP)水平等参数。用HOMA公式计算胰岛素抵抗(IR)和β细胞功能指数(BCI)。采用SPSS软件进行方差分析(ANOVA),分析3组间各指标的差异显著性x-±S表示。结果:三组经HOMA 公式计算的IR值为对照组(3.0±1.3)、非肥胖组(4.6±4.0)、肥胖组(5.2±6.2)依次递增,但各组间无显著性差异。HOMAβ细胞功能指数为非肥胖组(82.06±84.1)、肥胖组(138.4±179.6)、对照组(226.5±236.8)依次递增,各组间均有显著性差异(Plt;0.01～0.05)。 结论:老年2型糖尿病患者普遍存在β细胞功能减退,尤其是非肥胖组;同时也具有胰岛素抵抗,主要是肥胖组。表明BMI对老年糖尿病患者胰岛β细胞功能有影响,肥胖患者β细胞分泌能力加强,负担加重,功能受损,胰岛素抵抗明显。
ObjectiveTo observe the effect of rosiglitazone on cognitive function, serum high sensitive C reactive protein (hs-CRP) and expression of nuclear factor-κB (NF-κB), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) in hippocampal tissues of senile diabetic rats. MethodsThirty aged Wistar rats (20-22 months) were randomly divided into normal control group (n=6), diabetic model group (n=12), and rosiglitazone treatment group (n=12). Streptozotocin-induced diabetic rat model was established. In the rosiglitazone treatment group, the rats were treated with rosiglitazone 4mg/kg/d for 8 weeks. The cognitive function of rats was evaluated with the Morris water maze test. Serum hs-CRP was detected by ELISA. The expression of NF-κB in hippocampal tissues was detected by western blot and IL-6 and TNF-α by Real-time PCR. ResultsThe Morris water maze test showed that escape latency was longer in the rosiglitazone treatment group and the diabetic model group than that in the control group (P<0. 05). Compared with the diabetic model group, the rosiglitazone treatment group showed a significant decrease in the average time of escape latencies (P<0.05), and an increased percentage of time spent in the central area and the more times navigating the original platform position (P<0.05). Serum hs-CRP and the expression of NF-κB, IL-6 and TNF-α in the rosiglitazone treatment group and the diabetic model group was significantly higher than those in the control group (P<0.01). Compared with the diabetic model group, serum hs-CRP and the expression of NF-κB, IL-6 and TNF-α in the rosiglitazone treatment group was decreased (P<0.05). ConclusionCognitive impairment in senile diabetic rats is associated with serum hs-CRP. The cognitive function can be improved with rosiglitazone treatment. The protective mechanisms may be related to the decrease of serum hs-CRP, inhibition of NF-κB signal and down-regulation of the expression of IL-6 and TNF-α in hippocampal tissues.
ObjectiveTo provide the best evidence for an old diabetic patient who combined with frailty syndrome with the goal of glycemic control, treatment strategy and their prognosis. MethodsPubMed, MEDLINE (Ovid), EMbase, The Cochrane Library (Issue 11, 2015) and CNKI were searched from their inception to Nov. 2015, to collect evidence about the management of glycemic control. Evidences were analyzed by the way of evidenced-based criterions. ResultsOne clinical guideline, one meta-analysis, three RCTs, seven cohort studies and four case-control studies were included. Evidence showed that compared with patient uncombined with frailty, old diabetic patients with frailty had a higher prevalence of dementia, cardiovascular diseases and death; Aggressive glycemic control could not reduce the prevalence of cardiovascular events and the risk of death, while it could increase the risk of falling. Glycemic control was more comprehensive which would be taken frailty into consideration. Diet rich in protein (especially leucine), resistance exercise and reasonable medications based on comprehensive geriatric assessment were proved benefit for the old diabetic patient. ConclusionThe incidence of cardiovascular events, hypoglycemia and mortality are increased in this old diabetic patient who combined with frailty. Maintaining HbA1c around 7.5% is reasonable and diet with enough calorie and rich in protein (especially leucine), resistance exercises should be recommended for the person.