课件：心血管疾病合并糖代谢异常的.ppt

* 运用危险预测工具在疾病进展早期筛查高危人群 是十分重要的。为了解中国糖尿病高危人群情况，在41家医院张贴糖尿病高危人群筛查海报，每个医院前100名具有两项高危因素的人可以免费接收血糖检查，共18,000例患者接受筛查。 strategies to identify risk factors early in the disease progression, such as risk prediction tools, are important to be recommendated. In order to screen high risk population of daibetes in china, we put up hospital posters listing 7 risk factors for diabetes. The first 100 persons admitted to each hospital who have at least 2 risk factors received postpandial blood glucose examination for free. * 2002年对中国住院病人的血糖筛查结果显示，共18，637名入组对象中，约50%血糖异常，包括糖耐量减低和糖尿病患者。 A total number of 18637 individuals were screened, about 50% of whom had abnormal blood glucose, including both IGT and DM IDF Guideline for Management of Postmeal Glucose mentioned that Postmeal hyperglycemia is harmful and should be addressed. A variety of both non-pharmacologic and pharmacologic therapies should be considered to target postmeal plasma glucose. 关于提高高血糖的诊断率，指南中有如下阐述： 如图所示，随着每一次进餐，就会相应出现一次餐后血糖高峰，而且与空腹血糖相比，餐后高血糖更容易被监测到。 如图所示1天24小时中大部分时间处于餐后状态（红色）或吸收状态（黄色）。 * 在不同的糖化血红蛋白水平,空腹血糖和餐后血糖对其的贡献率有所不同.当HbA1c小于7.3%时，餐后血糖的水平对HbA1c影响较大.随着HbA1c升高,空腹血糖对HbA1c的贡献逐渐增加, HbA1c8.5%后空腹血糖水平对HbA1c影响较大. 图中所示为两个不同个体的血糖变化情况。尽管二人的平均血糖水平和血红蛋白水平均一致，但其血糖波动情况则相差较大。 HbA1c仅反映平均血糖水平，不能反映血糖变化的全貌。 对心血管疾病患者的降糖药，降了要有效降糖以外,我们最重视的就是其安全性 为明确强化降糖与心血管事件的关系，对21名CAD合并2型DM的患者进行72小时的血糖及Holter监测，记录心脏缺血和低血糖事件。 结果记录到19名患者令人满意的连续血糖结果，共54次低血糖和59次高血糖，低血糖事件中的10次与胸痛症状相关联，而高血糖出现时仅有1次出现胸痛，血糖正常时则无胸痛症状出现。结论提示低血糖患者性藏缺血事件明显高于血糖正常及高血糖者。 OBJECTIVE— In some studies intensive diabetes treatment in patients with type 2 diabetes may be associated with increased cardiovascular events. It is not clear whether these events are related to hypoglycemic episodes. To determine whether episodes of hypoglycemia were more likely to be associated with cardiac ischemia than normoglycemia or hyperglycemia, we carried out a study in 21 patients with coronary artery disease (CAD) and type 2 diabetes treated with insulin who had good glycemic control. RESEARCH D