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MI

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Title: 2 Author: Administrator Last modified by: zf Created Date: 11/14/2006 1:06:46 AM – PowerPoint PPT presentation

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Title: MI

1
????????????

??? ???

2
UKPDSCardiovascular Risk Increases With
Increasing Glyceamia
80
MI Microvascular endpoints
Adapted from Stratton IM et al. BMJ.
2000321405-412.
3
?????HbA1c??

FPG?PPG???

100
????(PPG)
80
60
??
40
70
50
45
40
20
30
0
gt10.2
10.2-9.3
9.2-8.5
8.4-7.3
lt7.3
A1C??()
Monnier L , et al, Diabetes Care. 2003
Mar26(3)881-5
4
???2???????????
2??????
??(mg/dl)
???
???
???????
Polonsky KS ,et al, N Engl J Med. 1988 May
12318(19)1231-9
5
???????????
4.0 3.0 2.0 1.0 0
???????
1????
24 20 16 12 8 4 0
20?
NPH
?????????
?????? ?????????
mg/kg/min
mmol/kg/min
?????
0 4 8 12 16 20 24
??(??)
Adapted with permission from Lepore M et al.
Diabetes. 2000492142-2148.
6
???????

CSII (continue subcutaneous insulin injection )
MDI (multiple daily injection )

7
????(Insulin Pump)

? ?????????(CSII)
???????????????????,??24???????????????
??????????
????? (Basal rate)
?????????????????
????? ( Bolus)
???????????????????

?????????????????2????

9
? ?

????????????????????2???????????,??????
??????????????????????

10
?????

2??????
??????????????????????????????????
?CSII??10????

11
CSII?

???????R(100U/ml)?????????
??????5060???????,4050?????
?????????9?

12
????

?????????????????????????????????????????????????
??????
????????????,????????,????????????5-7?????????
??????????3.5-7.0mmol/L???2h??lt9.0
mmol/L?????lt8.0mmol/L

13
????

??10?????1364?
?694?,?670?
????56.6911.07?
BMI 24.303.44 kg/m2

14
????

(1)??????(???????)
(2)????? (U/Kg.d)
(3)?????? (lt2.8mmol/L)

15
?????

SPSS11.0????
???????t??
??????2??

16
?5?????????
?? ??? ??? ??? ??? ??? ???
FPG 13.5 4.61 8.66 3.22 7.742.72 7.402.08 7.112.03 6.811.77
PPG 19.9 5.76 13.40 4.92 11.844.59 11.563.88 11.13 3.25 10.60 3.12
????? 42.23 12.47 45.43 14.78 46.6716.5 46.0118.75 46.44 19.28
???? 0.650.21 0.690.23 0.710.27 0.700.30 0.710.30
????? 57 59 61 61 61
17
?????????

?????????5.672.63?
????????????44.6817.88 u,????????0.690.31
u/kg/d
????????????7.73.51u,????????5.72.62u
????????3?
0 5??0.600.27u/h
517?1.60.68u/h
1724?0.850.39 u/h
??????????????61

18
?????????

??????????0.630.25 u/kg/d,??????8.8(Plt0.05)
?????????????3?,?????????0.590.21
u/kg/d,?????????14.3(Plt0.01)

19
???????????

????????????,???0.1u/h??????
??????2-3??????,??????1.2u/h,??????????????3-4???
??

20
?????????????

??????????4.832.34?
???????????0.700.23 u/Kg/d
21.9??????????????????????

21
?????

?????????
2hPG(r0.276,p0.034)
HbA1c (r0.187, p0.045)
BMI (r0.291, p0.016)
WHR(r0.432, p0.001)
TG (r0.128, p0.047)????

22
?????

????
FPG(r0.298, p0.017)
2hPG(r0.211, p 0.039) ????

23
? ?

CSII??2???????????????????,???????????????????2???
???,????????(?????????????????)??????????

24
? ?

??????????????????????????????,??????????-????,???
?????????????,????????,????-???

??2????????????????????

26
? ?

???????????(CSII)??????????(MDI)???
60????2?????????????????

27
?????????

????????????????????
???????
??
???????????

28
?????

2??????
??6 0?
?????1???
???????????????????????????????

29
????

???????????
?????????
?????????????????????????
??????????????????????????????????

30
? ?

CSII?236?
MDI?206?

31
CSII?

???????R(100U/ml)?????????
??????5060???????,4050?????
?????????9?

32
MDI?

???????????????R,???????N
???????5?(??????????)
?????????????

33
????

(1)??????
(2)?????
(3)??????

34
?????

SPSS11.0????
???????t??
??????2??

35
??????????

??????
CSII??6.32.1?
MDI??7.42.5? (Plt0.05)
????????????
CSII??0.630.24 IU/Kg/d
MDI??0.650.31 IU/Kg/d(Pgt0.05)

36
?????

?????
CSII?71??
MDI??65?? (Pgt0.05)
???????
CSII?11??
MDI?8?? (Pgt0.05)
CSII????60??CSII???,????????????? (Pgt0.05)

37
? ?

?????60????2??????,?????????CSII?MDI?????????????
CSII????????????,??????????????
??????????????????????2????????????????

38
??????????2????????????
39
? ?

??????????,??????35-90
????????????????????????,???????
??????????????????,?????????????

40
? ?

CSII???157?,??61.813.1?
MDI???150?,??60.312.8?
CSI????160?,?????CSII???????575????????????,??59.3
12.5

41
?? ?? ?? 6? 9? 11? 17? 22?
CSII??? 1 10.423.24 14.044.62 15.415.41 11.875.38 11.274.93
CSII??? 2 8.162.16 12.504.19 10.574.28 8.543.08 10.253.78
CSII??? 5 7.472.53 10.483.29 7.902.21 8.073.16 8.223.07
MDI??? 1 11.63.21 13.594.16 14.065.60 12.764.86 11.924.21
MDI??? 2 8.752.71 12.434.27 11.044.40 10.584.36 11.054.19
MDI??? 5 8.081.95 10.962.90 9.453.19 9.104.13 9.023.21
CSII???? 1 10.342.93 14.104.28 14.625.53 10.505.06 10.224.50
CSII???? 2 7.402.33? 11.904.27 9.624.03? 8.033.02? 9.613.41
CSII???? 5 6.831.85 10.893.21 8.213.22 7.512.78? 7.952.90
42
?????????
?? ?????????(U/Kg/d) ?????????(U/Kg/d) ?????????(U/Kg/d) ?????????(U/Kg/d) ?????????(U/Kg/d)
?? ?1? ?2? ?3? ?4? ?5?
CSII??? 157 0.520.26 0.670.24 0.720.28 0.750.29 0.770.30
MDI??? 150 0.450.21 0.570.22 0.750.23 0.830.52 0.870.55
CSII???? 160 0.430.22?? 0.590.17?? 0.630.18?? 0.650.20?? 0.650.20??
43
? ?

????????????,CSII???????,??????,??????????????
?CSII????,???????????????????18

44
? ?

???????????(CSII)??????????(MDI)???2???
??????

45
? ?

CSII???206?
MDI???180?
???2????228?

46
????
??(?/?) ?? BMI WHR ??
CSII??? 206(97/109) 56.9511.18 27.592.28 0.930.07 4.024.05
CSII???? 228(111/117) 5711.0 22.12.1 0.900.92 5.89.2
47
????
TC TG HDL-C LDL-C HbA1c () ??C-P ??C-P
CSII??? 4.871.23 2.272.17 0.930.23 2.990.95 9.141.89 1.531.20 3.802.2
CSII???? 4.671.1 1.632.1 1.060.45 2.930.99 9.522.43 1.161.1 2.712.1
48
? ?