BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal compl...BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.展开更多
Diabetes mellitus (DM) is a chronic metabolic disease and its prevalence has beensteadily increasing all over the world. DM and its associated micro andmacrovascular complications result in significant morbidity and m...Diabetes mellitus (DM) is a chronic metabolic disease and its prevalence has beensteadily increasing all over the world. DM and its associated micro andmacrovascular complications result in significant morbidity and mortality. Themicrovascular complications are usually manifested as retinopathy, neuropathy,nephropathy and macrovascular complications generally affect the cardiovascularsystem. In addition to these complications, DM also affects the lungs because of itsrich vascularity and abundance in connective tissue (collagen and elastin). DMhas been found to cause microvascular complications and proliferation ofextracellular connective tissue in the lungs, leading to decline in lung function in arestrictive pattern. Interstitial lung disease (ILD) includes a diverse group ofdisease conditions characterized by different degrees of inflammation and fibrosisin the pulmonary parenchyma. Idiopathic pulmonary fibrosis (IPF) is one of thecommon type of idiopathic interstitial pneumonia with a high mortality rate. IPFis characterized by chronic progressive fibrosis leading to progressive respiratoryfailure. In this review we focus on lung as the target organ in DM and theassociation of DM and ILD with special emphasis on IPF.展开更多
Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications...Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital-based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β: -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475;p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β: 0.2538751, 0.2261636;p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β: 0.055392;p β: 0.0055014;p 18.6% patients died due to diabetes related complications. Cardiovascular (CV)-related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and infections in T2DM patients of Eastern India. CV-related deaths were principal causes of death, similar to that in developed world.展开更多
目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否...目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否发生肺部感染分为肺部感染组和非肺部感染组,通过电子病历收集2组患者围术期临床资料并进行单因素分析,采用多因素Logistic回归分析术后肺部感染的相关因素。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线分析HGI对术后肺部感染的预测价值。结果与非肺部感染组比较,肺部感染组吸烟史比例高,糖尿病病程和卧床时间长,血清白蛋白水平低,术中出血量多,空腹血糖、糖化血红蛋白(HbA1c)和HGI水平较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病病程、卧床时间、空腹血糖、HbA1c和HGI是髋关节术后肺部感染的独立危险因素(P<0.05)。血清白蛋白是保护性因素(P<0.05)。ROC分析显示,HGI预测术后肺部感染的曲线下面积(Area Under the Curv,AUC)为0.912,明显高于空腹血糖、HbA1c的0.654和0.817(Z=4.289,P<0.05),最佳截断值为0.52%,灵敏度和特异度分别为87.21%和85.79%,提示具有良好的诊断效能。以最佳截断值为切入点将患者分为2组,高HGI组中肺部感染发生率(36.11%)显著高于低HGI组(12.86%),差异有统计学意义(P<0.05)。结论高HGI的老年2型糖尿病合并髋部骨折患者术后发生肺部感染的风险越大,其预测术后肺部感染的价值优于空腹血糖和HbA1c等传统血糖指标,临床应当密切监测HGI的变化,以更好的用于术后肺部感染的风险评估。展开更多
目的系统评价结直肠癌患者术后肺部感染的影响因素。方法检索中国知网、万方、维普、中国生物医学文献数据库(SinoMed)、PubMed、Web of Science、Embase、the Cochrane Library数据库,系统检索结直肠癌患者术后发生肺部感染影响因素的...目的系统评价结直肠癌患者术后肺部感染的影响因素。方法检索中国知网、万方、维普、中国生物医学文献数据库(SinoMed)、PubMed、Web of Science、Embase、the Cochrane Library数据库,系统检索结直肠癌患者术后发生肺部感染影响因素的相关文献,检索时间为建库至2024年6月28日。采用Stata 16.0软件进行数据分析。结果共纳入25篇文献,包含16043例结直肠癌患者、32个影响因素。Meta分析结果显示,年龄[OR=2.72,95%CI(2.04~3.61),P<0.001]、体重指数(body mass index,BMI)[OR=3.76,95%CI(2.10~6.75),P<0.001]、男性[OR=2.08,95%CI(1.49~2.91),P<0.001]、吸烟史[OR=2.78,95%CI(2.31~3.36),P<0.001]、合并慢性呼吸道疾病[OR=4.18,95%CI(2.70~6.47),P<0.001]、合并糖尿病[OR=2.59,95%CI(1.66~4.05),P<0.001]、合并低蛋白血症[OR=4.15,95%CI(1.95~8.83),P<0.001]、术前白蛋白<35 g/L[OR=2.29,95%CI(1.31~4.00),P=0.003]、手术时间[OR=2.75,95%CI(1.84~4.11),P<0.001]、开腹手术[OR=3.25,95%CI(2.42~4.38),P<0.001]、美国麻醉师协会(American Society of Anesthesiologists,ASA)评分[OR=2.26,95%CI(1.51~3.38),P<0.001]、术中输血[OR=3.51,95%CI(1.48~8.32),P=0.004]是结直肠癌患者术后并发肺部感染的主要影响因素。结论年龄、BMI、男性、吸烟史、合并慢性呼吸道疾病、合并糖尿病、合并低蛋白血症、术前白蛋白<35 g/L、手术时间、开腹手术、ASA评分、术中输血均为结直肠癌患者术后肺部感染的危险因素。有效防治慢性呼吸道疾病,积极指导患者戒烟、控制血糖和调整营养饮食,完善术前筛查、提高术者操作标准有助于预防和控制结直肠癌患者术后并发肺部感染。展开更多
文摘BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.
文摘Diabetes mellitus (DM) is a chronic metabolic disease and its prevalence has beensteadily increasing all over the world. DM and its associated micro andmacrovascular complications result in significant morbidity and mortality. Themicrovascular complications are usually manifested as retinopathy, neuropathy,nephropathy and macrovascular complications generally affect the cardiovascularsystem. In addition to these complications, DM also affects the lungs because of itsrich vascularity and abundance in connective tissue (collagen and elastin). DMhas been found to cause microvascular complications and proliferation ofextracellular connective tissue in the lungs, leading to decline in lung function in arestrictive pattern. Interstitial lung disease (ILD) includes a diverse group ofdisease conditions characterized by different degrees of inflammation and fibrosisin the pulmonary parenchyma. Idiopathic pulmonary fibrosis (IPF) is one of thecommon type of idiopathic interstitial pneumonia with a high mortality rate. IPFis characterized by chronic progressive fibrosis leading to progressive respiratoryfailure. In this review we focus on lung as the target organ in DM and theassociation of DM and ILD with special emphasis on IPF.
文摘Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital-based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β: -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475;p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β: 0.2538751, 0.2261636;p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β: 0.055392;p β: 0.0055014;p 18.6% patients died due to diabetes related complications. Cardiovascular (CV)-related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and infections in T2DM patients of Eastern India. CV-related deaths were principal causes of death, similar to that in developed world.
文摘目的探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值。方法收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否发生肺部感染分为肺部感染组和非肺部感染组,通过电子病历收集2组患者围术期临床资料并进行单因素分析,采用多因素Logistic回归分析术后肺部感染的相关因素。绘制受试者工作特征(Receiver operating characteristic,ROC)曲线分析HGI对术后肺部感染的预测价值。结果与非肺部感染组比较,肺部感染组吸烟史比例高,糖尿病病程和卧床时间长,血清白蛋白水平低,术中出血量多,空腹血糖、糖化血红蛋白(HbA1c)和HGI水平较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病病程、卧床时间、空腹血糖、HbA1c和HGI是髋关节术后肺部感染的独立危险因素(P<0.05)。血清白蛋白是保护性因素(P<0.05)。ROC分析显示,HGI预测术后肺部感染的曲线下面积(Area Under the Curv,AUC)为0.912,明显高于空腹血糖、HbA1c的0.654和0.817(Z=4.289,P<0.05),最佳截断值为0.52%,灵敏度和特异度分别为87.21%和85.79%,提示具有良好的诊断效能。以最佳截断值为切入点将患者分为2组,高HGI组中肺部感染发生率(36.11%)显著高于低HGI组(12.86%),差异有统计学意义(P<0.05)。结论高HGI的老年2型糖尿病合并髋部骨折患者术后发生肺部感染的风险越大,其预测术后肺部感染的价值优于空腹血糖和HbA1c等传统血糖指标,临床应当密切监测HGI的变化,以更好的用于术后肺部感染的风险评估。
文摘目的系统评价结直肠癌患者术后肺部感染的影响因素。方法检索中国知网、万方、维普、中国生物医学文献数据库(SinoMed)、PubMed、Web of Science、Embase、the Cochrane Library数据库,系统检索结直肠癌患者术后发生肺部感染影响因素的相关文献,检索时间为建库至2024年6月28日。采用Stata 16.0软件进行数据分析。结果共纳入25篇文献,包含16043例结直肠癌患者、32个影响因素。Meta分析结果显示,年龄[OR=2.72,95%CI(2.04~3.61),P<0.001]、体重指数(body mass index,BMI)[OR=3.76,95%CI(2.10~6.75),P<0.001]、男性[OR=2.08,95%CI(1.49~2.91),P<0.001]、吸烟史[OR=2.78,95%CI(2.31~3.36),P<0.001]、合并慢性呼吸道疾病[OR=4.18,95%CI(2.70~6.47),P<0.001]、合并糖尿病[OR=2.59,95%CI(1.66~4.05),P<0.001]、合并低蛋白血症[OR=4.15,95%CI(1.95~8.83),P<0.001]、术前白蛋白<35 g/L[OR=2.29,95%CI(1.31~4.00),P=0.003]、手术时间[OR=2.75,95%CI(1.84~4.11),P<0.001]、开腹手术[OR=3.25,95%CI(2.42~4.38),P<0.001]、美国麻醉师协会(American Society of Anesthesiologists,ASA)评分[OR=2.26,95%CI(1.51~3.38),P<0.001]、术中输血[OR=3.51,95%CI(1.48~8.32),P=0.004]是结直肠癌患者术后并发肺部感染的主要影响因素。结论年龄、BMI、男性、吸烟史、合并慢性呼吸道疾病、合并糖尿病、合并低蛋白血症、术前白蛋白<35 g/L、手术时间、开腹手术、ASA评分、术中输血均为结直肠癌患者术后肺部感染的危险因素。有效防治慢性呼吸道疾病,积极指导患者戒烟、控制血糖和调整营养饮食,完善术前筛查、提高术者操作标准有助于预防和控制结直肠癌患者术后并发肺部感染。
