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    中華內分泌代謝雜志

    中華內分泌代謝雜志

    北大核心

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    Chinese Journal of Endocrinology and Metabolism
    1985年創刊，中華醫學會主辦。本刊是反映我國當代及與國外合作的，在內分泌代謝病學領域內臨床與科研最新成果的高級學術刊物。在強調刊文的先進性、科學性與新穎性的同時，也十分重視臨床的實用性和論文的可讀性。本刊設指南與共識、述評、專論、論壇、臨床研究、基礎研究、綜述、講座、臨診應對、當年學術進展與動態、臨床經驗交流、新藥研究、學術爭鳴及國外期刊論文評論等欄目。本刊的讀者對象主要為各級從事臨床和基礎內分泌代謝病學工作的醫、教、研人員及研究生，以及內、外、兒、婦科以及神經、泌尿、老年、營養等相關科室的人員。
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    • 發文量：0
    • 被引量：3952
    • H指數：3
    • 開始收錄時間：1989,5(1)
    • CNKI綜合因子：0.918
    • 維普期刊影響因子： 1.398
    • 萬方期刊影響因子：1.68
    • 創刊時間：1985
    • 國內刊號/CN：31-1282/R
      國際刊號/ISSN：1000-6699
    • 發行周期：月刊
      郵發代號：4-413
    • 主管單位：中國科學技術協會
      主辦單位：中華醫學會
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    • 郵箱：cjem@vip.163.com
    • 地址：上海市瑞金二路197號
    • 郵編：200025
    中華內分泌代謝雜志-獲獎情況
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    中華內分泌代謝雜志 >2021年第004期

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    • 摘要：對分化型甲狀腺癌(DTC)預后相關因素進行分析并復習文獻,為提高DTC診斷治療水平及生存率提供依據.回顧性隨訪分析經術后組織病理學證實為DTC的150例(女性113例,男性37例)病例資料,乳頭狀癌131例(87.3％),濾泡癌19例(12.7％).隨訪4.15 ～31年,存活140例(93.3％),復發30例(20.0％),死亡10例(6.7％).手術方式中近全或次全切手術83例(55.3％),局部切除64例(42.7％),全切3例(2.0％).63例行淋巴結切除者中45例(71.4％)檢出淋巴結轉移.發病年齡、就診時腫瘤大小及早期轉移率在死亡組與存活組、復發組與未復發組間有統計學差異(P＜0.05).年齡、就診時腫瘤大小及早期轉移影響DTC預后.%Prognostic factors of differentiated thyroid carcinomas ( DTC ) were analyzed and the related literatures were systematically reviewed in order to justify the diagnostic and therapeutic modalities for improving the patient′s survival.150 patients ( female,n =113 ; male,n =37 ) with histopathologically diagnosed DTC,including papillary thyroid carcinoma ( n =131,87.3％ ) and follicular thyroid carcinoma ( n =19,12.7％ ),were postoperatively followed up and their clinical data were retrospectively reviewed.Patients were followed up for 4.15-31 years wherein 140 patients( 93.3％ ) survived but with relapse in 30 patients( 20.0％ ),and 10 patients( 6.7％ ) died.Surgical procedures consisted of near-total or subtotal thyroidectomy ( n =83,55.3％ ),partial thyroidectomy ( n =64,42.7％ ),and total thyroidectomy ( n =3,2.0％ ).Out of the patients receiving lymph node dissection ( n =63 ),45 patients( 71.4％ ) had detectable lymph node metastasis.Age of onset,tumor size at initial visit,and early metastasis showed the statistically significant difference between mortality group and survival group (P＜ 0.05 ),as well as between relapse group and relapse-free group( P＜0.05 ).Age of onset,tumor size at initial visit,and early metastasis are prognostic factors for DTC.
    • 摘要：2型糖尿病患者118例分為阿卡波糖治療組(A組,58例)和未服阿卡波糖組(B組,60例),57名健康個體作為對照組(C組),以實時定量PCR測定糞便中雙歧桿菌、糞腸球菌的含量.結果顯示,A、B兩組糞便中雙歧桿菌數量明顯低于C組,腸球菌數量高于C組.經4周干預治療,A、B兩組雙歧桿菌數量均較基線時升高,但A組的雙歧桿菌數量升高程度更加顯著.Spearman單因素相關分析發現,基線時雙歧桿菌與脂多糖、超敏C反應蛋白(hs-CRP)、晚期糖基化指數、體重指數(BMI)呈負相關(P＜O.05或P＜O.01)；糞腸球菌與單核細胞趨化蛋白1、脂多糖、腫瘤壞死因子α、血漿纖溶酶原激活物抑制物1、hs-CRP、BMI、-HbA1c和年齡呈正相關(均P＜0.01).干預治療4周后,上述因子和腸道菌群的相關性全部消失.多因素逐步回歸分析發現,基線BMI是雙歧桿菌獨立負相關因素,BMI、HbA1c和年齡是糞腸球菌的獨立正相關因素.%A total of 118 patients with type 2 diabetes mellitus were divided into acarbose treatment group ( A group,n =58 ) and no acarbose treatment group ( B group,n =60),and 57 healthy subjects were used as control group (C group).The quantification of fecal bifidobacteria and enterococcus faecalis in these subjects was made by realtime PCR.The results showed that fecal bifidobacteria contents in A and B groups were lower and enterococcus faecalis contents were higher compared with C group.After four weeks of intervention,fecal bifidobacteria contents in A and B groups increased ( P＜0.01 ),especially in A group,while enterococcus faecalis contents decreased ( P＜0.05 )compared with the baseline.Univariate correlation analysis showed that bifidobacteria content was negatively associated with lipopolysaccharides(LPS),advanced glycation index,high sensitive C reactive protein ( hs-CRP),and body mass index ( BMI ) at baseline ( P＜0.05 or P＜0.01 ).The enterococcus faecalis content was positively associated with levels of monocyte chemoattractant protein-1,LPS,tumor necrosis factor-α,hs-CRP,plasminogen activator inhibitor-1,BMI,and HbA1c (P ＜0.01 ).After four weeks of intervention,the above associations disappeared.Stepwise multivariate regression showed that basal BMI,HbA1c,and age contributed to the increase in the number of enterococcus faecalis,and BMI negatively contributed to the decrease in number of bifidobacteria.
    • 摘要：Intensive but quite chaotic and decentralized candidate gene studies on susceptibility to Graves' disease ( GD ) carried out in small size population in the past half century have provided a quantity of inconsistent data,which,however,resulted in finding of a proven association of GD with the MHC class Ⅱ region that exerts a major effect on the genetics of GD.Using low-resolution microsatellite-based human genome-wide linkage analysis,several regions of linkage harboring putative susceptibility variants but no gene susceptibility to GD were identified.Further,high throughput genotyping of large population cohorts with help of high dense panels of single nucleotide polymorphisms (SNPs) and application of advanced tools for analysis of extended blocks of linkage disequilibrium within a candidate gene ( tagging SNP,etc.) have found several genes susceptible to GD,including immune-related genes such as MHC,CTLA4,SCGB3A2/UGRP1,FCRL3,and thyroid specific genes ( such as TSHR,etc.).Less consistent results have been obtained in cases of PTPN22 and thyroglobulin.In the nearest future,implementation of even more robust technology such as genome-whole associated analysis (GWAS) and whole-genome re-sequencing are expected to catch more genes susceptibilities to GD.%經過半個世紀對彌漫性甲狀腺腫伴甲狀腺功能亢進癥(Graves’disease,GD,甲亢)候選基因在小樣本人群中的研究,提供了不少相互矛盾的結果.在這些研究中,僅僅證實主要組織相容性復合物(MHC)是甲亢的一個致病易感位點,因為這個位點對甲亢發生影響較大.應用以低密度的微衛星標志進行全基因組連鎖分析,雖然發現了一些甲亢的致病易感區段,但并未能識別真正的甲亢致病易感基因.隨后由于大量單核苷酸多態性(SNP)的發現及其標簽SNP(Tag SNP)技術的出現,人們對候選基因上的Tag SNP在大樣本人群中的分析,發現了一些真正的甲亢致病易感基因,包括免疫相關的基因如MHC、CTLA4、SCGB3A2/UGRP1和FCRL3以及一個甲狀腺特異的基因TSHR(促甲狀腺素受體基因).同時,也發現了一些還有爭議但需要進一步證實的甲亢易感基因如PTPN22和甲狀腺球蛋白基因等.在不久的將來,全基因組關聯分析和全基因組再測序技術,在甲亢易感基因識別鑒定中的應用,無疑將會促進大量甲亢易感基因的發現,加深人們對甲亢發病機制的理解.
    • 摘要：Objective To explore the efficacy of 131 Ⅰ treatment in Graves' disease,and to analyze the related factors.Method In 87 patients with Graves' disease,thyroid uptake ratio( TUR ) and its effective half-life(EHL) were compared before and after 131 Ⅰ treatment.The weight of thyroid gland was evaluated with radio-imaging and type B ultrasonography.Result The dose of 131 Ⅰ was ( 185.2 ± 148.0 ) MBq.The TUR of tracer dose and therapeutic 131 Ⅰ dose were 76.5 ％ ±8.2％ and 73.3 ％ ±9.0％ ( t =2.451,P =0.008 ).The EHL were ( 5.2±0.7 ) and ( 5.0 ±0.8 )days,respectively ( t =1.998,P =0.023 ).After followe-up of ( 57.0 ±26.3 ) months,49 patients ( 56.3 ％ ) became euthyroid,14 ( 16.1％ )manifested delayed hypothyroidism,and 24 (27.6％)remained in hyperthyroidism.Thyroid autoantibodies were found in 34.5％ patients,of whom,the incidence of hypothyroidism was higher in patients with positive autoantibodies than those with negative ones (30.0％ vs 8.8％,x2 =6.560,P =0.009 ).Conclusion Both TUR and EHL of therapeutic doses of 131 Ⅰ are lower than the tracer doses.Positive thyroid autoantibodies may affect the outcome of the 131 Ⅰ treatment.%目的 觀察131Ⅰ治療Craves病(GD)的療效并分析其影響因素.方法 比較87例患者治療前后的甲狀腺攝碘率(TUR)和有效半衰期(EHL),甲狀腺重量由核素顯像及B超重復測量.結果 131Ⅰ治療劑量為( 185.2±148.0)MBq,示蹤和治療24 h TUR分別為76.5％±8.2％和73.3％±9.0％(t=2.451,P=0.008),EHL分別為(5.2±0.7)和(5.0±0.8)d.隨訪(57.0±26.3)個月,甲狀腺功能正常56.3％ (n=49),晚發甲狀腺功能減退16.1％ (n=14),未愈27.6％ (n=24).甲狀腺抗體陽性34.5％,甲狀腺功能減退發生率高于陰性組(30.0％對8.8％,x2=6.560,P=0.009).結論 治療劑量131Ⅰ TUR和EHL低于示蹤劑量,甲狀腺抗體陽性對治療結果有影響.
    • 摘要：Objective To study the roles of cytokeratin-19 ( CK-19 ),vimentin,vascular endothelial growth factor-C( VEGF-C ),and cyclooxygenase-2 ( COX-2 ) played in the occurrence and development of Graves'disease(GD) and Hashimoto's thyroiditis(HT).Methods 57 cases of GD and 58 cases of HT were enrolled in our study.Immunohistochemistry using SP method was carried out for assessment of the expression of CK-19,vimentin,VEGF-C,and COX-2 in the thyroid tissues.Results CK-19,VEGF-C,and COX-2 were expressed in the cytoplasm of thyroid follicular epithelial cells.Vimentin was expressed both in the mesenchyma and in the cytoplasm of thyroid follicular epithelial cells.The positive rates and expression intensities of CK-19 and VEGF-C in HT ( 86.2％,96.6％ ) were significantly higher than those in GD ( 43.9％,56.1％,all P＜0.05 ).The expression intensities of vimentin and COX-2 in GD ( 100.0％,93.1％ ) were similar to those in HT ( 100.0％,91.2 ％ ),while the expression intensity of COX-2 in HT was significantly higher than that in GD( all P＜0.05 ).The positive rates of CK-1 9 were much higher in type Ⅲ ( 81.3％ ) of GD than in type Ⅰ ( 1 5.8％ ) and type Ⅱ ( 40.9％ ) of GD,and also higher in type P( 100％ ) of HT than in type L(66.7％ ) of HT.The positive rates of VEGF-C were much higher in type Ⅲ ( 87.5％ ) of GD than in type Ⅰ ( 36.8％ ) and type Ⅱ ( 50.0％,all P ＜ 0.05 ) of GD.Conclusion Immunohistochemical detection of the expression of CK-19,vimentin,VEGF-C,and COX-2 may carry clinical significance in revealing the occurrence and development as well as evaluating the prognosis of Graves'disease and Hashimoto's thyroiditis.%目的 探討細胞角蛋白19(CK-19)、波形蛋白(vimentin)、血管內皮生長因子C(VEGF-C)和環氧化物酶2(COX-2)表達在彌漫性毒性甲狀腺腫(diffuse toxic goiter,Graves病,GD)和橋本甲狀腺炎(HT)發生和發展中的作用.方法 采用免疫組織化學SP法檢測57例Graves病和58例橋本甲狀腺炎中CK-19、波形蛋白、VEGF-C、COX-2的表達.結果 CK-19、VEGF-C、COX-2表達于甲狀腺濾泡上皮細胞的胞漿,波形蛋白在間質和濾泡上皮細胞的胞漿均有表達.HT中CK-19和VEGF-C表達陽性率(86.2％、96.6％)及陽性強度均高于GD(43.9％、56.1％,均P＜0.05),波形蛋白和COX-2表達的陽性率(100％、93.1％)近似于GD( 100％、91.2％),但COX-2的陽性強度明顯高于GD(均P＜0.05).CK-19陽性率在GDⅢ型(81.3％)明顯高于Ⅰ型(15.8％)和Ⅱ型(40.9％),HT的P型(100％)明顯高于L型(66.7％).VEGF-C陽性率在GDⅢ型(87.5％)明顯高于Ⅰ型(36.8％)和Ⅱ型(50.0％,均P＜0.05).結論 綜合檢測CK-19、波形蛋白、VEGF-C和COX-2四種免疫學指標,對探討GD和HT發生、發展過程及預后評估具有一定的參考價值.
    • 摘要：The serum level of 25-dihydroxyvitamin D3 was determined in patients with type 2 diabetes,diabetic nephropathy,and healthy objects..The results demonstrated that the serum 25-dihydroxyvitamin D3 level in type 2 diabetic patients with nephropathy was lower than that in the healthy objects or type 2 diabetes objects.Blood β2-M,total cholesterol,creatinine,24 h urinary albumin,and course of illness in type 2 diabetic patients with nephropathy have relationship with serum 25-dihydroxyvitamin D3.%比較2型糖尿病、2型糖尿病腎病與健康對照者之間血清25 -( OH)維生素D3 [25-(OH)D3]的差異,分析25-(OH)D3在糖尿病腎病中的變化及意義.結果表明血清25-( OH)D3在糖尿病腎病患者中明顯低于2型糖尿病和健康對照者.糖尿病腎病組血β2-微球蛋白(β2-M)、總膽固醇、肌酐、24h尿微量白蛋白及病程等與血清25-( OH) D3有獨立相關性.
    • 摘要：Dead-in-bed syndrome (DBS) is a rare but devastating sudden death condition that mainly affects young patients with type 1 diabetes.Its mechanism is quite complicated and may involve multiple factors.Acute onset of recurrent and severe nocturnal hypoglycemia,abnormal cardiac repolarization,genetic factors,and obstructive sleep apnea may all contribute to ventricular arrhythmias and even sudden death.The future research plans include elucidating and understanding the underlying mechanisms and triggers for DBS,developing a risk stratification system,using real-time continuous glucose monitoring system to detect severe nocturnal hypoglycemia,and initiating appropriate therapeutic interventions to uhimately prevent the tragedy.%睡眠中死亡綜合征是指發生于1型糖尿病患者中不明原因的猝死,其機制較為復雜,近年來研究認為可能與反復、嚴重的低血糖、心臟復極化異常、阻塞性睡眠呼吸暫停及遺傳因素等有關.未來有必要進一步深入了解其發病機制,建立完善的1型糖尿病患者危險分層系統,利用實時動態血糖監測技術防止嚴重的低血糖事件,對于高危患者進行預防性治療措施,從而避免睡眠中死亡綜合征的發生.
    • 摘要：Objective To investigate the in vivo effects of down-regulating the FGF-21 gene expression by shRNA on glucose and lipids metabolism in high fat diet (HFD) fed ApoE-/- mice.Methoeds Male ApoE-/- mice were randomly divided into chow diet (CF)fed group ( NF,n =10),CF fed + pAd-shFGF-21 group ( NFG,n =9),and HFD fed group ( HF,n =10),HFD fed + Adv-null vector ( pAd-GFP ) group ( GFP,n =6) and HFD fed + pAd-shFGF-21 group ( HFG,n =10).Mice were fed for 16 weeks.C57BL/6J mice were set as control group ( NC group,n=10).NFG,HFG,and GFP groups were injected with pAd-shFGF-21or pAd-GFP by tail vein at the end of 15 weeks.The insulin sensitivity and glucoselipid metabolism were assessed by the hyperinsulinemic- euglycemic clamp technique using 3-[ 3 H] glucose as a tracer at the end of 16 week.Results The plasma FGF-21 levels in NFG and HFG groups were significantly degraded than those in NF and HF groups(20％-27％,P＜0.05),respectively.In the basal state,the fasting blood glucose,fasting plasma insulin,free fatty-acids,triglycerides,total cholesterol,and LDL-C were significantly higher,while the HDL-C was lower in NFG and HFG groups compared with those in NF and HF groups,respectively (P＜0.05 or P＜0.01 ).During the steady-state of clamp,FFA was suppressed in all groups,but it was still higher in NFG and HFG groups than NF and HF groups ( P＜0.05or P＜0.01 ).The glucose infusion rate (GIR)and glucose disappearance rate (GRd)in NFG and HFG groups were significantly decreased compared with NF and HF groups (all P＜0.01 ).In addition,insulin's ability to suppress hepatic glucose production (HGP) during clamps was significantly decreased in HFG and NFG group compared with HF and NF groups (49％ and 20％,respectively; all P＜0.01 ).Conclusion FGF-21 knockdown and low FGF-21 level facilitate the development of metabolic disorder and insulin resistance.%目的 探討抑制成纖維細胞生長因子21(FGF-21)基因表達抑制對ApoE基因敲除( ApoE-/-)小鼠糖脂代謝的影響.方法 采用C57 BL/6J為對照組(n=10),ApoE-/-小鼠隨機分為普食組(NF組,n=10)；普食+pAd-shFGF-21組(NFG組,n=9)；高脂飼料組(HF組,n=10)；高脂+pAd-shFGF-21組( HFG,n=10)；高脂+空載體組(GFP,n=6),均喂養16周,NFG和HFG組于15周末予尾靜脈注射pAd-shFGF-21.采用3-[3H]葡萄糖為示蹤劑的擴展高胰島素鉗夾技術評價各組小鼠胰島素敏感性和糖脂代謝變化.結果 NFG和HFG組血漿FGF-21水平較相應對照組降低20％～27％(均P＜0.05).基礎狀態下,NFG和HFG組空腹血糖、血漿胰島素、游離脂肪酸、總膽固醇、甘油三酯、低密度脂蛋白膽固醇(LDL-C)水平均顯著高于NF和HF組(P＜0.05或P＜0.01),而高密度脂蛋白膽固醇(HDL-C)則顯著低于NF和HF組(P＜0.01).鉗夾穩態時,NFG和HFG組游離脂肪酸雖被抑制,但分別明顯高于NF和HF組(P＜0.01或P＜0.05).在相同胰島素濃度輸注下,NFG和HFG組葡萄糖輸注率(GIR)分別明顯低于NF和HF組(P＜0.01).鉗夾結束時,NFG和HFG組的葡萄糖清除率(GRd)分別明顯低于NF和HF組(均P＜0.01),而肝糖輸出率(HGP)則分別明顯高于NF和HF組,僅被抑制49％和20％(均P＜0.01).結論 FGF-21表達抑制和血漿FGF-21水平降低加重了機體糖脂代謝紊亂和胰島素抵抗.
    • 摘要：目的 觀察性激素對前脂肪細胞增殖與分化及脂肪細胞瘦素脂聯素分泌的影響.方法 原代培養人大網膜前脂肪細胞,觀察其增殖、分化過程.性激素作用前脂肪細胞增殖和分化過程,檢測瘦素、脂聯素分泌及mRNA水平.結果 成功地培養出人大網膜前脂肪細胞.雌二醇促進前脂肪細胞增殖(0.823±0.059對0.276±0.032,P＜0.05)、抑制分化(P＜0.05)；睪酮對前脂肪細胞增殖無明顯作用,但抑制分化(P＜0.05).前脂肪細胞增殖及分化期均分泌瘦素.雌二醇促進瘦素分泌,而睪酮抑制(均P＜0.05).脂聯素僅在分化期分泌,且性激素抑制其分泌.雌二醇促進瘦素mRNA表達但抑制脂聯素mRNA表達；睪酮抑制瘦素、脂聯素mRNA表達(均P＜0.05).結論 雌二醇促進脂肪細胞瘦素分泌及mRNA表達,抑制脂聯素分泌及mRNA表達；睪酮抑制二者分泌及mRNA表達.%Objective To investigate the effects of sex hormones( 17 β-estradiol and testosterone)on human omental preadipocytes proliferation and differentiation and on leptin and adiponectin secretions in adipocytes.Methods Omental preadipocytes were cultured and then differentiated into mature adipocytes in vitro.The proliferation and differentiation processes of preadipocyte were observed.The preadipocytes were incubated in the presence of sex hormones and were detected the contents and gene expressions of leptin and adiponectin.Results Human preadipocytes were primarily cultured successfully.Estradiol stimulated preadipocytes proliferation (0.823±0.059 vs 0.276 ±0.032,P＜0.05 ),and inhibited lipid accumulation in cell differentiation ( P＜0.05 ).Testosterone had no significant effect on proliferation of preedipocytes,but inhibited adipogenic differentiation ( P＜0.05).Leptin could be detected during proliferation and differentiation of preadipocytes.Estradiol increased the leptin secretion,whereas testosterone reduced it ( all P ＜ 0.05 ).The adiponectin only could be detected during differentiation.Sex hormones reduced the adiponectin secretion.17β-estradiol stimulated leptin mRNA expression and suppressed adiponectin mRNA expression in adipocytes.Testosterone suppressed the mRNA expressions of leptin and adiponectin (all P ＜ 0.05 ).Conclusion In vitro,17β-estradiol increases the leptin secretion and mRNA expression whereas reduced the adiponectin secretion and mRNA expression.Testosterone reduced the adiponectin and leptin secretion and mRNA expression.
    • 摘要：Objective To investigate the potential of human amnion-derived mesenchymal stem cells to differentiate into insulin secreting cells in vitro.Methods The hAD-MSCs were isolated from human amnion by trypsin-collagenase digestion.The phenotype of the isolated cells was identified by flow cytometry and immunocytochemical staining.The 3rd generation cells were inoculated at density of 2.5 × 106 unit/ml or 5 × 105 unit/ml in 6 well plates or preset coverslip 24 well plates.Induced groups were treated in serum-free HG-DMEM with 10 mmol/L nicotinamide and N2 supplement.The cells in the non-induced groups were incubated in LG-DMEM supplemented with 10％ fetal bovine serum.At days 7,14 and 21 after induction,insulin and β2 microglobulin was determined by immunocytochemical stain,the content of insulin in the culture supernatant was assayed by radioimmunoassay,and insulin mRNA and PDX-1 mRNA were detected by reverse transcriptase-polymerase chain reaction.Results ( 1 ) The hAD-MSCs highly expressed CD29,CD44,CD73,CD166,and vimentin.( 2 ) At 7,14,and 21 days,the percentages of insulin-positive cells in hAD-MSCs induced groups were 74.67％ ± 1.53％,75.00％:1.00％,and 74.33％ ±1.53％,respectively.Contents of insulin in the supematant of hAD-MSCs induced groups were ( 331.62 ± 1.76 ),( 330.50 ± 1.22 ),and ( 331.65 ± 0.48 ) μIU/ml,respectively,but non-induced groups were negative.(3) PDX-1 mRNA and PDX-1 protein were expressed before and after the induction of hADMSCs,but insulin mRNA was expressed only in the induced groups.( 4 ) Both hAD-MSCs induced groups and non-induced groups expressed β2 microglobulin ( all P ＞ 0.05 ).Conclusion The hAD-MSCs have a potential of differentiating into ISCs and thus may become a new cell source of therapy for type 1 diabetes.%目的 探討體外誘導人羊膜間充質干細胞(hAD-MSCs)向胰島素分泌細胞分化潛能.方法 采用胰蛋白酶-膠原酶消化法分離提取hAD-MSCs,流式細胞術分析和免疫細胞化學染色行表型鑒定.取第3代按2.5× 106個/ml或5×105個/ml細胞密度接種6孔培養板或預置蓋玻片的24孔培養板,在含10mmol/L尼克酰胺和N2補充物的無血清HG-DMEM培養基培養,未誘導組為含10％胎牛血清的LG-DMEM基礎培養基.分別于體外誘導第7、14、21天采用免疫細胞化學法檢測胰島素和β2微球蛋白的表達,采用放射免疫法檢測上清液中胰島素含量,采用RT-PCR檢測胰島素mRNA和胰十二指腸同源異型盒因子1(PDX-1)mRNA的表達.結果 (1)hAD-MSCs高表達間充質干細胞表面標志CD29、CD44、CD73、CD166及波形蛋白；(2) hAD-MSCs誘導第7、14、21天胰島素陽性細胞百分率分別為74.67％±1.53％、75.00％±1.00％、74.33％±1.53％,培養物上清液中胰島素含量分別為(331.62±1.76)、(330.50±1.22)和(331.65±0.48) μIU/ml,各時點間比較無顯著性差異(均P＞0.05),而未誘導組仍未見胰島素陽性細胞；培養上清也未檢測到胰島素；(3) hAD-MSCs誘導前后均有PDX-1 mRNA和蛋白表達,胰島素基因mRNA表達僅見于誘導組；(4) hAD-MSCs誘導組和未誘導組各時點均有β2微球蛋白表達,其陽性細胞百分率組間差異無顯著性(均P＞0.05).結論 hAD-MSCs具有向胰島素分泌細胞分化的能力,可能成為1型糖尿病細胞移植治療的新的細胞供源.
    • 摘要：目的 了解烏魯木齊地區人群目前碘營養狀況、甲狀腺疾病流行情況并探討兩者的關系.方法 對新疆烏魯木齊地區1693名成人進行體格檢查、問卷調查,并測定平均尿碘中位數、甲狀腺功能、甲狀腺相關抗體和進行甲狀腺B超檢查.結果 在調查人群中,碘缺乏人數僅占9.5％,而碘過量人數達到30.0％.平均尿碘中位數達254.9 μg/L.碘充足/超足量組TT4水平明顯高于其他兩組[(9.02±2.63)對(7.69±2.85)、(8.45±2.13)μg/dl,均P＜0.05],碘缺乏組TSH水平顯著高于其他兩組[(3.00±1.86)對(2.37±1.91)、(2.27±1.86) mIU/L,均P＜0.01].各組甲狀腺球蛋白抗體、甲狀腺過氧化物酶抗體陽性率及甲狀腺功能異常、甲狀腺結節患病率沒有統計學差別.結論 目前新疆烏魯木齊地區碘缺乏狀態已糾正,平均尿碘中位數254.9 μg/L.不同碘攝入狀態人群甲狀腺疾病患病率無統計學差別.%Objective To evaluate the relationship between iodine intake and the prevalence of thyroid diseases in Urumqi.Methods A total of 1693 subjects were investigated.Serum thyroid hormones,thyroid autoantibodies,and urinary iodine concentration were determined,and type B ultrasonography of thyroid gland was performed in all participants.Result The urinary iodine level revealed that 9.5％ of the subjects were iodine deficient and 30.0％ iodine excessive.The average median urinary iodine was 254.9 μg/L.Serum total T4 level in the idione adequate and more than adequate groups was significantly higher than the other 2 groups [ ( 9.02±2.63 ) vs (7.69±2.85)、(8.45 ±2.13 ) μg/dl,both P＜0.05 ],and serum TSH level in the idione deficient group was significantly higher than the other 2 groups [ (3.00±1.86) vs (2.37±1.91),(2.27±1.86) mIU/L,both P＜0.01 ].There was no significant statistical difference in positive rates of thyroid autoantibodies,morbidities of thyroid dysfunction and goiter among 3 groups.Conclusion The iodine deficient situation has been corrected in Urumqi.There is no difference in morbidities of thyroid diseases in population with different iodine intakes.
    • 摘要：目的 探討原發甲狀腺功能減退癥患者認知損害的特點.方法 原發性甲狀腺功能減退(甲減)患者60例,與同年齡同文化程度同性別正常人匹配共60人,進行神經心理學檢測.結果 輕度甲減組患者(亞臨床甲減組)其詞語學習能力、圖像記憶、復雜圖形記憶,圖形延遲記憶及數字順背倒背,詞語流暢性,連線A連線B有明顯差別(6.0±1.6對7.6±1.1,7.3±1.4對8.6±1.1,9.1±1.9對10.0±0.1,6.7±1.4對9.1±1.2,11.4±2.5對13.3±1.5,11.3±2.2對12.8±1.5,8.0±1.8對9.2±0.8,5.0±1.6對6.7±1.6,12.5±3.8對15.7±2.0,61.1±32.5對41.9±10.6,82.0±40.2對43.2±14.5,均P＜0.05).中度甲減患者組重度甲減組還有復雜圖形復制、鐘表、擺積木實驗,數字符號實驗均有明顯差異(26.2±5.0對29.4±4.7,6.3±1.5對6.8±1.4,8.9±2.2對9.9±0.2,28.7±9.7對37.0±6.0,6.4±1.1對9.4-1.3,8.5±1.0對9.4±0.6,11.9±3.0對12.9±1.7,8.1±1.8對9.5±1.1,5.1±1.7對6.6±1.5,11.4±2.9對15.1±2.4,55.1±12.2對41.0±11.6,均P＜0.05).結論 甲狀腺激素水平變化伴隨著認知功能損害程度的改變,說明認知功能對甲狀腺激素的強烈依賴性.%Objective To investigate the neuropsychological characteristics of primary hypothyroidism.Method Sixty patients with primary hypothyroidism were enrolled and 60 euthyroid subjects with age-,gender-,and education-matched served as control.Neuropsychological parameters were determined in all the participants.Result The word list learning,figure recall,picture recall,verbal fluency,digit span,and trail making A and B in subclinical hypothyroid patients were impaired as compared with the control (6.0± 1.6 vs 7.6± 1.1,7.3± 1.4 vs 8.6±1.1,9.1±1.9 vs 10.0±0.1,6.7±1.4 vs 9.1±1.2,11.4±2.5 vs 13.3±1.5,11.3±2.2 vs 12.8±1.5,8.0±1.8 vs 9.2±0.8,5.0±1.6 vs 6.7±1.6,12.5±3.8 vs 15.7±2.0,61.1±32.5 vs 41.9±10.6,82.0±40.2 vs 43.2±14.5,all P＜0.05 ).Neuropsychological dysfunctions in all 11 tests were found among moderate and severe hypothyroid patients(26.2±5.0 vs 29.4±4.7,6.3±1.5 vs 6.8±1.4,8.9±2.2 vs 9.9±0.2,28.7±9.7 vs 37.0±6.0,6.4±1.1 vs 9.4±1.3,8.5±1.0 vs 9.4±0.6,11.9±3.0 vs12.9±1.7,8.1±1.8 vs 9.5±1.1,5.1±1.7 vs 6.6±1.5,11.4±2.9 vs 15.1±2.4,55.1±12.2 vs 41.0±11.6,all P＜0.05).Conclusion The severity of cognitive impairment is accompanied with the decrease of thyroid function,it suggests that the cognitive function must depend on the normal levels of thyroid hormones.
    • 摘要：比較國家基本藥物中口服降糖藥治療2型糖尿病的經濟效果.選取體重指數19～27 kg/m2的2型糖尿病患者200例,分為5組,每組40例,分別給予格列本脲(A組)、格列吡嗪(B組)、二甲雙胍(C組)、格列本脲+二甲雙胍(D組)、格列吡嗪+二甲雙胍(E)進行治療,觀察療效,采用藥物經濟學中的成本-效果分析法(CEA)進行分析.5組均可有效控制血糖,均可顯著降低HbA1c.格列本脲更符合藥物經濟學原則,但由于易發生嚴重而持久的低血糖限制其臨床廣泛應用,老年患者應更加慎重；在以控制空腹血糖和體重為主要目標時選擇二甲雙胍更經濟；在以控制餐后血糖為主要目標時選擇格列吡嗪更為合理,尤其是體形偏瘦者更為合適；格列吡嗪+二甲雙胍聯合用藥方案適合單用格列吡嗪或二甲雙胍效果不佳者,值得推薦.%To compare the economic efficacies of the oral antidiabetic drugs in National Essential Medicine for treating type 2 diabetes mellitus.200 diabetic patients with body mass indices between 19-27 kg/m2 were assigned into 5 groups:group A received glibenclamide,group B glipizide,group C metformin,group D glibenclamide +metformin,and group E glipizide + metformin.Pharmacoeconomic evaluation was performed by cost-effectiveness analysis( CEA ).Fasting glucose level in patients treated with these 5 drugs all decreased significantly,as well as HbA1c.Glibenclamide was more in line with the principles of pharmacoeconomics,but should be used carefully for its serious and prolonged hypoglycemia,especially in elderly patients.According to the method of cost-effectiveness analysis,it was more economical to use metformin to control fasting glucose level while it is more reasonable to use glipizide to control the postprandial glucose whereas controlling of postprandial blood glucose is considered as a priority.Glipizide+mefformin combination may be recommended to the patients whose blood glucose level is poorly controlled by a single drug alone.
    • 摘要：一、病例摘要病例1(Ⅱ:8,圖1):女性,55歲,漢族,因“左腰酸14年,右甲狀旁腺切除術后近3年,血鈣升高1個月”于2009年8月入院.患者于14年前因左側腰部酸痛就診,發現左腎結石,未予特殊治療,增加飲水后癥狀仍反復出現;3年前無明顯誘因下出現乏力,雙膝關節酸痛不適,體重下降10余斤,至外院查骨密度示骨質疏松,血鈣3.22 mmol/L(正常參考范圍2.08 ～2.60,下同)、血PTH 76.4 pg/ml( 15～65),B超示雙側甲狀腺下極后下方低回聲腫塊,甲狀旁腺腫瘤可能,左腎結石;CT示右側甲狀腺后緣低密度影,甲狀旁腺腺瘤可能性大;于2006年11月8日在外院行右甲狀旁腺切除術,左甲狀腺結節摘除術.
    • 摘要：目的 研究安徽地區漢族Graves病患者使用抗甲狀腺藥物(ATD)致白細胞減少的易感性與HLA-DRB1基因多態性及抗中性粒細胞胞漿抗體(ANCA)的相關性.方法 采用聚合酶鏈反應-序列特異性引物方法(PCR-SSP)檢測76例ATD致白細胞減少的Graves病患者、98例ATD治療后白細胞正常患者和230名健康對照者的等位基因HLA-DRB1* 08032、DRBI* 1501、DRB1*0901的頻率.采用間接免疫熒光法(IIF)檢測白細胞減少組和白細胞正常組Graves病患者的血清ANCA陽性率.結果 (1)與健康對照組及細胞正常組比較,白細胞減少組患者等位基因DRB1 * 08032、DRB1*1501頻率明顯增加(OR分別為3.06,1.77,4.03和2.28,均P＜0.05),DRB1* 0901頻率明顯減低(OR為0.33和0.43,P＜0.05).(2)與甲巰咪唑治療后白細胞正常組患者比較,甲巰咪唑致白細胞減少組患者血清ANCA陽性率明顯增加(x2 =4.878,P＜0.05).(3)與未攜帶等位基因DRB1*08032和DRB1*1501的患者比較,攜帶者血清中ANCA陽性率明顯增加(x2為5.682,5.429,4.009和4.549,均P＜0.05).結論 等位基因HLA-DRB1*08032、HLA-DRB1*1501可能是安徽地區漢族人ATD致白細胞減少的易感基因；HLA-DRB1*0901可能是其保護基因或抗性基因.免疫反應可能參與了ATD致白細胞減少的發生.免疫反應的發生可能存在遺傳易感性.%Objective To investigate the relationship of HLA-DRB1 allele polymorphism and antineutropil cytoplasmic antibody ( ANCA ) with the susceptibility to antithyroid drug ( ATD ) -induced leucocytopenia in the patients with Graves' disease (GD) in Anhui Han Chinese.Methods The HLA-DRB1 * 08032,DRB1 * 1501,and DRB1 * 0901 allele frequencies were determined by the polymerase chain reaction-based sequence-specific primer (PCR-SSP) method in 76 patients with Graves' disease who had ATD-induced leucocytopenia and 98 patients with Graves' disease treated with ATD,who were free from leucocytopenia.The other230 healthy subjects served as controls.Indirect immunofluorescence assay (IIF) was used to detect ANCA positive rate.Result ( 1 ) Compared with the controls and the GD patients without leucocytopenia,the allele frequencies ofDRB1 * 08032 and DRB1 * 1501 in patients with ATD-induced leucocytopenia were significantly increased ( OR were 3.06,1.77,4.03,and 2.28,all P＜0.05),while that of HLA-DRB1 * 0901 was decreased ( OR were 0.33 and 0.43,both P＜0.05 ).(2)The ANCA frequencies were significantly increased in the GD patients with methimazole-induced leucocytopenia compared with those without leucocytopenia (x2 =4.878,P＜0.05 ).( 3 ) Compared with the GD patients not carrying DRB1 * 08032,DRB1 * 1501,and DRB1 * 0901 alleles,the ANCA positive rates were significantly increased in the GD patients carrying these alleles(x2 were 5.682,5.429,4.009,and 4.549,all P＜0.05).Conclusions The DRB1 * 08032 and HLA-DRB1 * 1501 alleles may be susceptible to ATD-induced leucocytopenia in Anhui Hans,while HLA-DRB1 * 0901 alleles may be protective or resistant gene.Immune response may be involved in the development of leucocytopenia.The occurrence of immune response is based on the genetic susceptibility.
    • 摘要：維格列汀是一種二肽基肽酶4( DPP-4)抑制劑,常與二甲雙胍合用治療2型糖尿病.多個臨床試驗表明,維格列汀和二甲雙胍合用可以有效降低2型糖尿病患者HbA1c、、空腹血精和餐后血糖,不增加體重,胃腸道耐受性好,而且低血糖發生率低.維格列汀通過增加血漿胰升糖素樣肽1( GLP-1)促進胰島素分泌,而二甲雙胍除增加肝臟胰島素敏感性,抑制肝糖輸出外,尚有增強維格列汀增加GLP-1的作用.%Vildagliptin,a dipeptidyl peptidase-4 (DPP-4) inhibitor,is always used in combination with metformin.Data from multiple clinical trials showed that vildagliptin and metformin combination therapy can improve HbA1c,fasting blood glucose,and postprandial blood glucose without weight gain,good gastrointestinal (GI)tolerance,and no increase in the incidence of hypoglycemia.Vildagliptin increases plasma levels of glucagon-like peptide-1 ( GLP-1 ).When glucose levels are above normal fasting levels,enhanced GLP-1 levels stimulate insulin secretion.Mefformin has been shown to increase insulin sensitivity and inhibit hepatic glucose production.The effect of vildagliptin to increase plasma levels of intact GLP-1 was enhanced in patients receiving concomitant metformin.
    • 摘要：目的 ATLAS( Asian Treat to Target Lantus Study)是在亞洲及俄羅斯人群中就患者主導對照醫師主導甘精胰島素劑量調整的有效性和安全性進行比較的研究.該研究共計劃人組554例受試者,其中中國將入組160例.中國作為此研究的主要參加國之一,在糖尿病管理方面有著自身的特點,如患者很少進行自我血糖監測、很少自己調整降糖藥物劑量、更多使用預混胰島素等.本文旨在結合中國的情況介紹該研究的原理及設計.方法 受試者為亞洲2型糖尿病患者,年齡40～75歲,體重指數≥20 kg/m2而≤4.0 kg/m2,病程＞2年,既往使用穩定劑量的2種口服降糖藥物(OAD,磺脲類、雙胍類、α-糖苷酶抑制劑、DPP-IV抑制劑、以及格列奈類)超過3個月但血糖控制欠佳,HbA1c≥7.0％且≤11.0％,且未使用過胰島素.受試者將隨機分配至患者主導或醫師主導的甘精胰島素劑量調整組,均接受甘精胰島素聯合OAD治療6個月,控制目標為空腹血糖≤110 mg/dl(6.1mmol/L).研究終點:主要終點為HbA1c自基線到終點的變化.針對主要終點將采用分層分析,并事先在分析計劃中予以闡明.如果非劣效檢驗達到HbAIc 0.3％的界限,則將采用優效性檢驗.次要終點包括:HbA1c＜7％的治療達標率(有或無低血糖)、HbA1c下降至少10％和(或)至少5％的患者數、以及空腹血糖、餐后血糖、體重、胰島素劑量、患者治療滿意度和生活質量的變化等.結論對口服降糖藥物控制不佳而使用甘精胰島素治療的患者,ATLAS研究將提供關于患者主導和醫師主導甘精胰島素劑量調整比較的安全性和有效性的信息.研究結果將為中國糖尿病患者的治療管理提供新的思路及支持性證據,有助于患者的治療達標.%Objective The ATLAS ( Asian Treat to Target Lantus Study) will compare the efficacy and safety of patient-led versus physician-led titration of insulin glargine in Asia and Russia patients with type 2 diabetes mellitus.Total 554 subjects are planned for this study and 160 subjects will be recruited in China.As one of the most important participating countries,China has some special characteristics in diabetes management,such as less self monitoring of blood glucose (SMBG),fewer self-titration and preferred premixed insulin in stead of basal insulin,et al.This report is aimed to introduce the study rationale and design of ATLAS with the situation in China.Methods Subjects (40-75 years old,body mass index ≥20 kg/m2 and ≤40 kg/m2 ) with type 2 diabetes mellitus for＞ 2 years,suboptimally controlled ( HbA1c ≥ 7.0％ and ≤ 11.0％ ) with stable doses of 2 oral anti-diabetic drugs (OADs) (sulphonylureas,biguanides,alpha-glucosidase inhibitors,DPP-IV inhibitors,and metiglinides)for＞3 months,and not using insulin.The subjects will be randomized either to the patient-led or the physician-led titration arm for6 months treatment of glargine plus OADs regimen,where the insulin dose will be adjusted to achieve a target fasting plasma glucose value of 110 mg/dl (6.1 mmol/L).Study endpoints:The primary endpoint will be change in mean HbA1c at 6 months from baseline.For the primary endpoint,if non-inferiority is achieved using a HbA1c 0.3％ boundary,superiority test will be undertaken.Secondary endpoints will include:proportion of patients reaching the target of HbA1c ＜7％ with or without hypoglycemia; the number of patients whose HbA1c decreases at least 10％ and/or 5％ ; the change of fasting plasma glucose,postprandial plasma glucose,weight,dose of insulin glargine,patient treatment satisfaction,and quality of life in the two groups.Conclusions The ATLAS trial will provide information on the relative safety and efficacy of a patient-led versus physician led titration strategy for insulin glargine-based basal insulin initiation in patients who are not controlled with two OADs.The results of the study may provide new ideas and supportive evidence for diabetes management in China,and also be helpful for patients to reach their treatment target.
    • 摘要：目的 分析自國家自然科學基金委員會(NSFC)成立以來,資助內分泌代謝領域基礎研究對該學科發展的作用.方法 收集1987年至2010年NSFC對內分泌代謝領域的資助項目數量、經費、單位分布、連續資助及獲得多次資助情況,對近兩年已結題項目的完成情況及資助的研究方向進行分析.結果 1987至2010年共資助內分泌代謝領域研究項目731項,資助總金額為1.78億元,其中面上項目462項,青年科學基金項目187項,地區基金28項,重點項目9項,國家杰出青年基金項目5項,海外學者合作研究基金2項,創新研究群體項目1項,國際合作項目11項,其他項目26項.對2009年至2010年內分泌代謝領域結題的102項資助項目進行的初步分析表明,結題時在SCI收錄雜志上發表論文279篇(平均每項2.74篇),在國內核心期刊發表論文236篇(平均每項2.3篇),培養博士后8名,博士研究生169名,碩士研究生227名.結論近25年來,NSFC對內分泌代謝領域的資助呈持續、穩定增長的態勢,尤其是研究類、人才類項目增加較多,獲得資助的單位數量逐年增多,取得了較好的研究成果,促進了內分泌代謝領域的基礎研究、人才培養和學科發展.%Objective To investigate the effect of National Natural Science Foundation ( NSFC ) on the progress of the discipline of endocrine and metabolic research from 1987 to 2010.Methods The data regarding the NSFC allocated to endocrine and metabolic research from 1987 to 2010 were collected.Total expenses and numbers of the majority of programs,unit distribution,times of funding and the situation of completed program finished in recent two years were provided.Results From 1987 to 2010,a total of 731 projects and 178 398 thousands Yuan expenses of NSFC were allocated to endocrine and metabolic research.The detailed allocations are as follows:general program ( n =462 ),Young Scientists Fund ( n =187 ),regional fund ( n =28 ),Key Program ( n =9 ),National Science Fund for Distinguished Young Scholars ( n =5 ),Joint Research Fund for Overseas Chinese Young Scholars( n =2 ),Fund for Creative Research Groups ( n =1 ),International ( regional )joint research program ( n =11 ),and the others ( n =26 ).Taking the projects ( n =102 ) completed in 2009 and 2010 as an example,279 papers were published in Science Citation Index ( SCI ) included journals and 236 papers were published in Chinese journals.During the time of the projects completed,8 post-doctoral students,169 students for PhD degree,and 227 students for Master degree have been graduated.Conclusion Over the past 25 years,the continuously increased funding of NSFC on endowrine and metabolic research has led to substantial achievement.The grants of talent training and research program have increased dramatically,and the units of funding increased yearly.Talent training and subject-specific development have increased greatly.
    • 摘要：Objective To study the epidemiological characteristics of diabetes mellitus and awareness rate in Zhejiang adults.Method A total of 17 437 adults from 15 counties were randomly selected with stratified multi-stage cluster sampling method from July to November,2010.Each participant was required to complete a set of standardized questionnaire,physical examination,and blood specimen collection.Results The overall standardized rate of diabetes mellitus was 5.94％ ( crude prevalence 8.80％ ).It was increased by 96.67％ during past 8 years,as compared with the prevalence 3.02％ in 2002.The standardized rate of diabetes mellitus of the urban and rural area were 7.52％ and 5.19％ ( crude prevalence 11.33％ and 7.09％ ),respectively.The standardized rate of diabetes mellitus in the urban was higher than rural ( u =6.58,P＜0.05 ).The standardized rate of diabetes mellitus of the male and the female were 5.74％ and 6.15％ ( crude prevalence 8.36％ and 9.13％ ),respectively,without significant difference ( u =1.39,P＞0.05 ).The awareness rate of diabetes mellitus was 59.19％ ( 56.66％ in male and 61.23 ％ in female,x2 =3.26,P＞0.05 ).The awareness rate of the urban was higher than the rural (63.47％ vs 54.69％,x2=12.20,P＜0.01 ).Conclusion The prevalence of diabetes mellitus showed a rapidly rising trend in Zhejiang province.The effective intervention should be taken at its early stage.%目的 了解浙江省18歲以上城鄉居民糖尿病流行特征及知曉情況.方法 采用多階段分層隨機整群抽樣的方法,于2010年7月至11月對浙江省15個縣區17437例18歲以上的居民進行橫斷面調查.調查內容包括問卷調查、醫學體檢和血樣采集.結果 浙江省18歲以上居民經年齡、性別和地區調整后的糖尿病標化患病率為5.94％(粗患病率8.80％),與2002年浙江省患病率3.02％相比,8年的患病率增幅達到96.67％.城市和農村糖尿病標化患病率分別為7.52％(粗患病率11.33％)和5.19％(粗患病率7.09％),城市和農村標化患病率差異有顯著性(u=6.58,P＜0.05).男性和女性標化患病率分別是5.74％(粗患病率8.36％)、6.15％(粗患病率9.13％),男性和女性糖尿病標化患病率差異無顯著性(u=1.39,P＞0.05)；浙江省居民糖尿病知曉率為59.19％,男性知曉率56.66％,女性知曉率61.23％,男性和女性糖尿病知曉率差異無顯著性(x2=3.26,P＞0.05).城市居民知曉率為63.47％,農村知曉率為54.69％.城市農村居民糖尿病知曉率差異有顯著性(x2=12.20,P＜0.01).結論 浙江省糖尿病患病率呈快速增長趨勢,應及早采取有效的干預措施.
    • 摘要：目的 探討靜脈葡萄糖耐量試驗中急性胰升糖素反應對短期胰島素強化治療誘導新診斷2型糖尿病長期緩解的影響.方法 10例初診2型糖尿病患者經2周胰島素泵強化治療,并跟蹤隨訪1年觀察緩解情況.治療前、后進行高胰島素-正常葡萄糖鉗夾試驗測定葡萄糖輸注率( GIR),靜脈葡萄糖試驗(IVGTT)測定胰升糖素和胰島素并計算急性胰升糖素反應(AGR)和急性胰島素反應(AIR).分析長期緩解組和未緩解組胰島素強化治療前后AGR變化的差異,探討與病情緩解的關聯.結果 (1)強化治療1年緩解率為50％ (5/10),長期緩解組治療后GIR、AIR均較基線顯著增加(P＜0.01).(2)長期緩解組治療前AGR顯著高于未緩解組[自然對數(5.10±0.60對2.85±1.86),P＜0.05],治療后明顯下降,低于未緩解組[0對自然對數(3.04±2.00),P＜0.01].(3)Spearman相關分析顯示,治療前AGR,治療后AGR下降值(治療前一治療后)與長期緩解顯著正相關(均r=0.731,P=0.016).結論 治療前AGR水平高,短期胰島素強化治療后AGR下降幅度大的新診斷2型糖尿病患者長期緩解可能性大,提示胰島d細胞功能的恢復在誘導長期緩解中具有獨特的地位.%Objective To investigate the role played by acute glucagon response in the short-term intensive insulin therapy induced long-term remission of newly-diagnosed type 2 diabetes.Methods Ten newly-diagnosed type 2 diabetic patients( 7 males,3 females) received intensive continuous subcutaneous insulin infusion( CSII )therapy for 2 weeks.Intravenous glucose tolerance test (IVGTT) and hyperinsulinemia euglycemia clamp test were performed before and after CSII.Glucose infusion rate ( GIR ),acute insulin response ( AIR ) and acute glucagon response (AGR) were assessed.Long-term remission was defined as good glycaemic control without any hypoglycaemic agent (fasting plasma glucose ＜ 7.0 mmol/L 及 2 h postprandial glucose ＜ 10 mmol/L) one year after CSII.Relationship between AGR and long-term remission were analyzed by one way ANOVA and Spearman correlation analysis.Results ( 1 ) Five of the ten patients achieved long-term remission in this study.GIR and AIR in the remission group were increased significantly after CSII compared with those before CSII [ GIR ( 5.39 ± 1.76 vs 2.02 ± 0.83 )mg · kg-1 ·min-1,AIR ( mean 54.1 vs mean 3.39 ) mU · L-1 · min,P＜0.01 respectively ],however both of them were not associated with the remission.(2) AGR in the remission group was significantly higher than that in the non-remission group before CSII ( 5.10±0.60 vs 2.85 ± 1.86,P＜0.05 ) and was decreased significantly after CSII.The mean of AGR after CSII was apparently lower in the remission group than that in non-remission group (0 vs 3.04±2.00,P＜0.01 ).(3)Spearman analysis showed that AGR before CSII and its range of reduction after CSII were correlated with remission ( r for both were 0.731,P=0.016).Conclusion Higher level of AGR before CSII and greater reduction after CSII in the subjects with newly-diagnosed type 2 diabetes were significantly associated with long-term remission,suggesting that pancreatic α cells may play a unique role in the induction of remission of type 2 diabetes.
    • 摘要：Parathyroid adenoma is the main cause of primary hyperparathyroidism and often associated with thyroid nodular goiter.Thyrothymic thyroid rest belong to the ectopic thyroids which are classified into 4 grades according to the state of their connection with the proper neck thyroid gland.Thyrothymic thyroid remnant can also develop into nodular goiter and may be difficult to be distinguished from parathyroid adenoma.We present herewith the diagnosis and treatment of a rare case of parathyroid adenoma accompanied by thyrothymic thyroid remnant nodular goiter in order to remind clinicians of the attention to the thyrothymic thyroid remnant disease.%甲狀旁腺腺瘤是原發性甲狀旁腺功能亢進癥的常見原因之一,常與結節性甲狀腺腫同時發生.甲狀腺胸腺區甲狀腺殘余為異位甲狀腺的一種,根據與頸部甲狀腺的解剖關系分為四級.甲狀腺胸腺區甲狀腺殘余亦可發生結節性甲狀腺腫,并與甲狀旁腺組織難以區分.本文詳細介紹一例甲狀旁腺腺瘤合并甲狀腺胸腺區甲狀腺殘余結節性甲狀腺腫的診治,旨在提醒臨床醫生重視甲狀腺胸腺區異位甲狀腺組織的病變.
    • 摘要：對二例通過基因診斷的Gitelman綜合征患者的臨床特點進行分析,并就該病發病機制、臨床表現、生化檢驗、基因診斷以及治療的國內外研究進展進行討論.%Two patients with typical Gitelman syndrome were diagnosed by gene and their clinical data and endocrine and metabolic status were evaluated.The etiology,clinical manifestation,laboratory findings,genetic diagnosis,and treatment for Gitelman syndrome were reviewed.
    • 摘要：鏈脲佐菌素誘導的SD糖尿病大鼠4周時皮膚已開始變薄,8周時表皮厚度已明顯低于正常大鼠[(0.016_+0.006對0.041±0.007)mm,P<0.01],各時間點G2/M期的表皮細胞比例顯著減少.12周時在真皮層中微血管病變常見.與同時間點正常大鼠相比,血漿晚期糖基化終末產物(AGEs)和丙二醛含量明顯升高,谷胱甘肽下降(均P<0.01),皮膚糖含量、AGEs水平均顯著升高(P<0.01).提示局部高糖和AGEs的蓄積,可能是糖尿病皮膚損害的重要機制.%Four weeks after SD diabetic rats were induced by streptozotocin,skin thickness was obviously reduced with obscure multilayer epithelium features.Moreover,the thickness of epidermic layers in diabetic rat skin was significantly thinner than that ofnornlal rat skin at the eighth week[(0.016±0.006 vs 0.041±0.007)mm,P<0.01].The percentage of G2/M phase cells in epidermic layers of diabetic group was significantly lower than that in the normal group.At the twelfth week,skin microangiopathy was easily detected in the diabetic group.The blood levels of advanced glycation end products(AGEs)and malonialdehyde were significantly increased and glutathione decreased in diabetic rats compared with control rats(aU P<0.01),along with the increased contents of local glucose and AGEs in the skin of diabetic rats.These results suggest that the local accumulation of glucose and AGEs seems to be one of the important mechanisms in the pathogenesis of diabetic skin lesions.
    • 摘要：@@ 盡管在過去四十年中已取得很大進展,但碘缺乏仍然是智力發育遲緩的主要原因,而這是可以預防的.據估計目前全世界有20億人缺碘,其中20%在歐洲.
    • 摘要：@@ 1型糖尿病與大血管病變發病率增加有關,這部分是由于高血壓和血脂異常等傳統危險因素增加,但近年研究提示高血糖也有重要作用.
    • 摘要：追趕生長是機體一過性生長抑制后出現的快速生長現象,現已證實追趕生長與胰島素抵抗存在高度相關性,但其形成的具體機制尚不明確.%Catch-up growth,a phenomenon that occurs after a short time growth-inhibiting condition,has been proved to be strongly associated with insulin resistance.But the mechanism of insulin resistance in the process of catch-up growth is not clear.
    • 摘要：Seventy-three patients with type 2 diabetes mellitus were divided into atheroselerosis(AS) group and non-AS group according to the intima-media thickness(IMT)of the carotid artery.The plasma visfatin level in AS group was higher than that in non-As group[(44.95±10.14 vs 34.52±9.08)μg/L,P<0.05],and both of them were higher than that of the control [(24.46±7.18)μg/L,both P<0.05 ].The visfatin level Was positively correlated with IMT,waist-to-hip ratio,visceral fat thickness,fasting insulin,and HOMA insulin resistance index.Age,duration of diabetes,HbA_(1C),and visfatin level were the major risk factors for IMT of the carotid artery.%73例2型糖尿病患者,根據頸動脈內中膜厚度(IMT)分為動脈粥樣硬化(AS)組和非AS組,測定血漿內脂素水平.結果 顯示,2型糖尿病AS組內脂素水平高于非AS組[(44.95±10.14對34.52±9.08)μg/L,P<0.05],均高于對照組[(24.46±7.18)μg/L,均P<0.05],并與IMT、腰臀比、內臟脂肪厚度、空腹胰島素、胰島素抵抗指數呈正相關.年齡、病程、HbA_(1c)及內脂素是影響頸動脈IMT的相關因素.
    • 29.勘誤
    • 摘要：@@ Graves眼病,或更正確地稱為甲狀腺相關性眼病,是Graves病患者常見的臨床表現.約20%～25%的患者在診斷時有明顯的Graves眼病,更多患者則是通過眶部超聲、CT或MRI發現眼部病變.

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