Akinori Hattori

Risk Factors for Development of Retinopathy in Elderly Japanese Patients With Diabetes Mellitus

OBJECTIVE To define the risk factors for the development of diabetic retinopathy in elderly patients with diabetes mellitus. RESEARCH DESIGN AND METHODS We studied 110 diabetic outpatients > 60 yr of age who were free of diabetic retinopathy at the first visit and were followed for at least 5 yr to examine the relationships between the initial findings and the subsequent development of retinopathy. RESULTS A total of 49 of the subjects developed diabetic retinopathy during the follow-up period; of these, 4 patients progressed to preproliferative and 3 to proliferative retinopathy. Univariate analysis showed that the initial fasting plasma glucose levels, the HbA1 values, the 2-h postload plasma glucose levels, the estimated duration of diabetes, and the presence of persistent proteinuria were all associated with the development of diabetic retinopathy. However, age at the initial examination, estimated age at diabetes onset, sex, body mass index, type of therapy, and hypertension had little impact on the development of retinopathy. Stepwise multiple Cox regression analysis revealed that the initial HbA1 or fasting plasma glucose, the diabetes duration, and the presence of persistent proteinuria are significant independent predictors for the development of retinopathy. CONCLUSIONS Initial fasting plasma glucose, diabetes duration, and proteinuria are important risk factors for the development of retinopathy in elderly patients with diabetes mellitus.

Inhibitory effect of transforming growth factor-β on epidermal growth factor-induced proliferation of cultured rat aortic smooth muscle cells

This study was conducted to investigate the effect of transforming growth factor-beta (TGF-beta) on the proliferation of cultured rat aortic smooth muscle cells (SMCs). DNA synthesis, measured by the incorporation of [3H] thymidine, and the cell number of monolayered SMCs were measured after incubation with TGF-beta (1-100 ng/ml) in the presence or absence of epidermal growth factor (EGF; 100 ng/ml). TGF-beta alone did not affect DNA synthesis of SMCs. EGF significantly increased both DNA synthesis and cell number, while TGF-beta inhibited the increase in both in a dose-dependent manner without accompanying the significant cellular damage. These results indicate that TGF-beta exerts an inhibitory effect on the proliferation of cultured SMCs provoked by EGF.

高齢者糖尿病患者における動脈硬化性血管障害とLp (a) の関係について

Lipoprotein(a) (Lp(a)) is an independent risk factor for cardiovascular diseases in non-diabetic people, but few studies have been done in diabetic patients. To investigate whether Lp(a) is a risk factor for cardiovascular disease in elderly people with diabetes, we examined the association of Lp(a) and serum lipid levels (total cholesterol: TC; triglycerides: TG; and high-density lipoprotein cholesterol: HDL-c) with the incidence of coronary artery disease and cerebrovascular disease. We studied 354 outpatients(131 men and 223 women, 60-97 years of age) with non-insulin-dependent diabetes mellitus. The mean concentration of Lp(a) was 21.1 +/- 19.6 mg/dl and the median was 14.0 mg/dl. The Lp(a) concentration did not correlate significantly with age or with sex, but it did correlate significantly with TC (r = 0.152, p < 0.05) and with the level of apoprotein B (r = 0.168, p < 0.05). The incidence of cerebrovascular disease was significantly higher in patients with high concentrations of Lp(a) (> or = 30 mg/ dl) than in those with low concentrations (< 30 mg/ dl). Multivariate logistic regression analysis revealed that male sex, hypertension, a high level of HbA1c, a low level of HDL, and a high level of Lp(a) were independent risk factors for cerebrovascular disease. The incidence of coronary artery disease tended to the higher in those with high concentrations of Lp(a) (> or = 30 mg/dl). However, multivariate logistic regression analysis revealed no significant correlation between Lp(a) concentration and the incidence of coronary artery disease. We conclude that a high concentration of Lp(a) is an independent risk factor for cerebrovascular disease in elderly patients with diabetes.

高齢女性インスリン非依存性型糖尿病 (NIDDM) における腰椎骨密度の検討

We measured lumbar bone mineral density (L2-4 MBMD) in the postmenopausal elderly diabetic women and made comparisons with age-matched controls in terms of the age, body mass index (BMI) and % BMD of age-matched. In addition we evaluated the correlation between BMD and menarche age, menopause age, HbA1c, serum calcium, serum phosphate, serum alkaline phosphatase (S-Alp) and the ratio of urine calcium to urine creatinine (UCa/Cr). Moreover we divided non-insulin dependent diabetic patients (NIDDM) into two groups; the high BMD group and the low BMD group. Serum Alp and the ratio of UCa/Cr were compared in these two groups. The relationships between regimen of therapy and BMD were also analyzed in female NIDDM. There were no significant differences of BMD and background factors between controls and NIDDM. The ratio of UCa/Cr in the high BMD group were significantly less than that in low BMD group (p < 0.05). BMD in NIDDM with retinopathy was lower, but not significantly, than that in NIDDM without retinopathy. The methods of therapy for NIDDM such as diet alone, an oral hypoglycemic agent and insulin did not influence BMD in elderly postmenopausal diabetics. These results indicated that BMD in elderly postmenopausal diabetics are dependent on UCa/Cr and retinopathy.

Clinical Problems in Elderly Diabetics. The Diagnostic and Control Criteria for Diabetes Mellitus in the Elderly.

In order to define the diagnostic criteria for diabetes mellitus in the elderly and to clarify how to manage the elderly diabetic patients, we examined risk factors for the development of diabetic retinopathy or ischemic heart disease in diabetics over 60 years old. Among 381 elderly diabetics, there were 127 patients with retinopathy at the first visit. Univariate analysis showed that the initial fasting plasma glucose (FPG) levels and the estimated duration of diabetes of patients with diabetic retinopathy were significantly higher than those of patients without diabetic retinopathy. The author studied 179 patients who were free of diabetic retinopathy on their first visit and were followed for at least 5 years in order to examine the relationships between the initial glucose levels and subsequent development of retinopathy. Eighty-one of the subjects developed diabetic retinopathy during follow-up period. The development of retinopathy was more common in patients with higher FPG (> 140 mg/dl), HbA1 (> 9%) or 2-h postload plasma glucose levels (> 280 mg/dl). Not only the initial FPG but also the mean FPG levels during the follow-up period were higher in subjects who developed retinopathy. These results indicate that 140 mg/dl or more of fasting plasma glucose levels in an adequate criterion for diabetes mellitus in the elderly, as well as in young and middle age subjects. In elderly diabetic patients, not only diabetic retinopathy but also ischemic heart disease developed so frequently that the quality of life in those patients is often disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical and pathological study in the recurrent myocardial infarction

老年者心筋梗塞例を対象として, 再梗塞を起こした例とそうでない例とを臨床的 (再梗塞を起こした心筋梗塞例53例, 平均74歳, 一回梗塞例64例, 平均74歳) および病理学的 (生前2回以上梗塞を繰り返した剖検例64例, 平均78歳, 一回梗塞例232例, 平均79歳) に比較検討した.梗塞部位別では, 再梗塞時には心内膜下梗塞の比率が多い傾向が認められた. 梗塞急性期の血行動態は, 再梗塞例ではCPK最高値で表した梗塞量は小さいが, 初回梗塞と合わせるとより強い心ポンプ機能の低下をきたした. また初回梗塞と再梗塞とで梗塞部位が異なる例では, 同部位例より悪い血行動態を示した. 慢性期における主な薬剤の使用率には両群で有意差は認められなかった. 再梗塞例の初回梗塞後に出現した狭心症の頻度は60%に達し, 同時期の一回梗塞例と比較すると有意に高い出現率を示した(χ2=17.5, p<0.01). 初回梗塞後に存在した冠疾患危険因子のうち, 高血圧では再梗塞例の方が有意に高い存在率を示した (χ2=6.13, p<0.05). 各危険因子の個数の和の合計を総のべ数で表すと, 初回梗塞後では再梗塞例の方が有意に高い数値を示した (χ2=10.36, p<0.01).剖検所見による梗塞サイズでは, 再梗塞64例中52例 (81.3%) は梗塞長径5cm以上の大梗塞で占められた. また, 再梗塞例では冠動脈狭窄指数で表した狭窄度が強く, その62.5%は3枝病変であった.以上より, 心筋梗塞患者の予後を考える上で再梗塞の予防は重要な課題であり, そのために梗塞後狭心症の防止や高血圧をはじめとする危険因子の是正にはとくに留意する必要があると思われる.