Objective: This study was undertaken to investigate the relationship between amino acids (AAs) and nonalcoholic fatty liver disease (NAFLD), and how AAs changed following long-term exercise training under different exercise intensities. Methods: NAFLD participants (n = 220) were recruited and randomly assigned to control, moderate exercise and vigorous exercise groups with a 6-month follow-up. Clinical characteristics were carefully calculated and plasma AAs concentrations were determined using a validated ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method. Results: At baseline, AAs concentrations were closely associated with clinical characteristics in NAFLD, particularly, the sum of branched chain amino acids (BCAAs) positively associated with intrahepatic triglyceride (IHTG) content (r = 0.18, p = 0.007). After 6-month exercise intervention, several AAs concentrations altered, and different exercise intensities exerted inverse effects on histidine, serine, glutamine, valine, tyrosine, and tryptophan concentrations changes, particularly, moderate exercise was much more efficient on decreasing BCAAs than vigorous exercise with a significant difference (p = 0.0008). Conclusion: Several AAs was closely associated with IHTG content in NAFLD patients, and 6-month moderate exercise more strongly reduced AAs concentrations, particularly BCAAs, compared to vigorous exercise. These findings suggest that exercise intensity optimization could enhance the metabolic benefits of exercise therapy in NAFLD.

目的 分析老年2型糖尿病患者治疗中联合应用六味地黄汤加减方与西格列汀的价值.方法 选取2020年1月—2021年11月在厦门大学附属第一医院门诊及病房治疗的98例老年2型糖尿病患者,随机分为两组.对照组49例患者单用西药治疗(磷酸西格列汀片),观察组49例患者在此基础上联合应用六味地黄汤加减方治疗.比较两组血糖指标、胰岛功能指标、血清炎性因子水平.结果 治疗后,观察组患者空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平均明显低于对照组,差异有统计学意义(P<0.05);观察组胰岛β细胞功能指数(HOMA-β)明显高于对照组,胰岛素抵抗指数(HOMA-IR)明显低于对照组,差异有统计学意义(P<0.05);观察组白细胞介素(IL)-17A、IL-22、干扰素-γ(IFN-γ)水平均明显低于对照组,差异有统计学意义(P<0.05).结论 联合应用六味地黄汤加减方与西格列汀治疗老年2型糖尿病患者能够提高治疗效果,有效控制血糖,下调血清炎性因子水平.

Background Patients with diabetes are prone to asymptomatic hypoglycemia (AH) due to diminished ability to perceive the onset of hypoglycemia. However, the actual prevalence and influencing factors of AH in outpatients with type 2 diabetes (T2DM) have not been well investigated. Methods A total of 351 outpatients with T2DM underwent glucose monitoring by continuous glucose monitoring system (CGMS) for consecutive 72 h without changing their lifestyle and treatment regimens. Hypoglycemia is defined as a blood glucose level less than 3.9 mmol/L, which was further divided into Level 1 hypoglycemia (blood glucose 3.0–3.9 mmol/L) and Level 2 hypoglycemia (blood glucose < 3.0 mmol/L). Univariate and multivariate logistic regression analyses were used to determine the possible risk factors of AH. Results In all 351 subjects studied, 137 outpatients (39.0%) were captured AH events, in which Level 1 AH and Level 2 AH accounted for 61.3% and 38.7%, respectively. 85 (62.0%) of the AH patients experienced nocturnal asymptomatic hypoglycemia (NAH) and 25 (18.2%) exclusively NAH. Multivariate logistic regression analysis demonstrated that patients with younger age, lower hemoglobin A1c (HbA1c), and higher systolic blood pressure (SBP) levels were associated with increased risk of AH. While after further grading of AH, male sex and Dipeptidylpeptidase-4 inhibitors (DPP4i) regime were shown to be associated with lower risk of Level 2 AH. Conclusions Hypoglycemia unawareness could be frequently observed at either daytime or nighttime, although NAH was more common, in outpatients with T2DM. Relative relax HbA1c targets should be considered for patients who are prone to AH.

Patients with diabetes are confronted with numerous obstacles to achieve adequate glycemic control during hospitalization. The aim of this study was to explore the risk factors associated with glycemic control in hospitalized patients with type 2 diabetes mellitus (T2DM) treated with continuous subcutaneous insulin infusion (CSII). This cross-sectional study included 5223 patients hospitalized with T2DM in a tertiary hospital in Xiamen (China) between January 2017 and December 2019. All patients were managed according to established protocols for glycemic monitoring and insulin pump treatment regimens. Demographic information and clinical profiles were collected from electronic health records. Multiple linear regression analysis was used to identify the risk factors associated with glycemic control. Among the 5223 hospitalized patients with T2DM receiving CSII therapy, 55.2

APS (autoimmune polyglandular syndrome) is defined as the coexistence of at least two kinds of endocrine autoimmune diseases. APS type 3 comprises autoimmune thyroid diseases and other autoimmune diseases but does not involve autoimmune Addison's disease. So far, APS-3 combined with isolated gonadotropin-releasing hormone (GnRH) reduction caused by the suspected autoimmune hypothalamic disease has not been reported. We recently received a 43-year-old woman with a one-year history of Graves' disease (GD) and a four-month history of type 1 diabetes presented with hyperthyroidism and hyperglycemia. After the GnRH stimulation test, she was diagnosed with secondary amenorrhea attributed to suspected autoimmune Hypothalamitis and APS type 3 associated with Graves' disease and Latent Autoimmune Diabetes (LADA). According to this case, the hypothalamus cannot be spared from the general autoimmune process. It is recommended to carry out the GnRH stimulation test when encountering APS patients combined with secondary amenorrhea.

The relationship between obstructive sleep apnea (OSA) and diabetic microvascular complications (DMC) are controversial. Whether low education is associated with increased risk of DMC independently of poor lifestyles are currently unknown. The aim of this study is to explore the independent associations of different PSG index and educational attainment with risks of DR, DKD, and DPN. A cross-sectional study of 330 patients with T2DM who underwent overnight polysomnography (PSG) tests. Multivariable logistic regression analysis was performed to determine the associations of PSG index and educational attainments with DR, DKD, and DPN. The prevalence rates of DMC were 30.6% for DR, 24.9% for DKD, and 64.6% for DPN. All PSG index (AHI, REM-AHI, NREM-AHI, the severity of OSAS, ODI, MAI, and lowest SaO2) were not significantly associated with risks of DR, DKD, or DPN with adjustment for potential confounding factors. Subjects with increasing educational attainments showed significantly decreased prevalence rates of DR (42.6, 27.3, and 21.3%, p = 0.005), DKD (31.7, 25.3, and 14.7%, p = 0.035) and DPN (74.3, 63.6, and 53.3%, p = 0.015), respectively. Logistic regression analyses showed that educational attainment of primary or below showed significantly increased risks of DR (OR (95% CIs): 3.596 (1.453–8.899, p = 0.006)) and DKD (OR (95% CIs): 3.201 (1.244–8.242, p = 0.016)) as compared with that of college or above. There were significant trends of lower educational attainment with increased risks of DR and DKD (p values < 0.05). PSG index were not significantly associated with DMC. But lower education was significantly associated with increased risks of DR and DKD, and strategies to prevent DMC for those with low education should be strengthened.

The aim of this study was to compare the efficacy of vildagliptin as add-on therapy to short-term continuous subcutaneous insulin infusion (CSII) with CSII monotherapy in hospitalized patients with type 2 diabetes mellitus (T2DM). A total of 200 hospitalized patients with inadequately controlled T2DM were randomized into groups, with one group receiving CSII monotherapy (CSII group, n =100) and the other group receiving CSII plus vildagliptin as add-on (CSII + Vig group, n = 100). Of these, 191 completed the 7-day trial (CSII group, n = 99; CSII + Vig group, n = 92) and included in the analysis. The glycemic control and variability of the patients were measured using all-day capillary blood glucose (BG) monitoring. Weight and fasting C-peptide levels were evaluated before and after the interventions. Mean BG concentrations during the whole treatment period were lower and the time to reach target BG was reduced in the CSII + Vig group compared with the CSII group (9.89 ± 3.37 vs. 9.46 ± 3.23 mmol/L, P < 0.01; 129 ± 4 vs. 94 ± 5 h, P < 0.01, respectively). Similarly, the indicators of glycemic variability, namely the standard deviation of BG and the largest amplitude of glycemic excursion, were significantly decreased in the CSII + Vig group compared with the CSII group (2.68 ± 1.05 vs. 2.39 ± 1.00 mmol/L, P < 0.01; 7.19 ± 2.86 vs. 6.23 ± 2.73 mmol/L, P < 0.01, respectively). Short-term CSII with vildagliptin as add-on therapy may be an optimized treatment for hospitalized patients with T2DM compared with short-term CSII monotherapy.

目的:观察惜视饮对血虚络阻型非增殖期糖尿病视网膜病变的临床疗效.方法:将152例非增殖期糖尿病视网膜病变(NPDR)患者随机分成治疗组(79例)、对照组(73例)两组.治疗组在基础治疗上加惜视饮(10mL/次,3次/天);对照组在基础治疗上加羟苯磺酸钙胶囊(0.5g/次,3次/天),疗程均为12周.结果:治疗12周后,两组中医证候积分均明显下降,治疗组总有效率优于对照组.统计眼症总疗效(通过眼底照相、眼底荧光血管造影等评估视力、眼底),两组疗效差异无统计学意义.结论:惜视饮治疗NPDR安全有效,在改善中医证候方面优于羟苯磺酸钙,在改善视力及眼底病变方面与羟苯磺酸钙相当.

PURPOSE:We aimed to investigate the association between serum uric acid (SUA) levels and obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients with type 2 diabetes.METHODS:A cross-sectional study of 212 type 2 diabetes mellitus (T2DM) patients was conducted in Xiamen, China. All patients underwent polysomnography (PSG) recordings for OSAHS diagnosis. Patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-14.9), moderate (15-29.9), and severe (≧30) OSAHS. Patients with AHI ≤ 4.9 served as the control group. Weight, body mass index (BMI), SUA, liver function, renal function, blood pressure, lipid profiles, and glycemic parameters were measured.RESULTS:A total of 158 patients (101 men and 57 women) with complete data were analyzed in this study. 127 patients were identified as OSAHS. Among the 127 patients with OSAHS, 56 (44.1%), 37 (29.1%), and 34 (26.8%) had mild, moderate, and severe OSAHS, respectively. Correlation analyses showed that the SUA level was significantly related to the apnea-hypopnea index (AHI) (r = 0.194, p = 0.016). The level of SUA was significantly higher among OSAHS patients compared to the control group (control group: 333.14 ± 80.52 μmol/L, mild group: 345.50 ± 90.27 μmol/L, moderate group: 363.59 ± 134.26 μmol/L, and severe group: 428.37 ± 123.58 μmol/L and p = 0.029). Multivariable logistic regression analyses showed that SUA was the independent risk factor for OSAHS (OR: 1.006, 95% CI: 1.001-1.011, p = 0.020).CONCLUSIONS:The SUA level is significantly associated with the severity of OSAHS and should be controlled when managing OSAHS.

目的:探讨影响T2DM合并OSAS患者呼吸障碍程度的危险因素;运用中医证素辨证方法,探讨痰证素的作用.方法:纳入135例本院内分泌糖尿病科住院且以T2DM为第一诊断的患者,据AHI分为无OSAS组、 轻度OSAS组、 中度OSAS组和重度OSAS组,采集相关资料.结果:1)与无、 轻度、 中度OSAS组比较,重度OSAS组在BMI、 腰臀比、 颈围、 痰证素积分上高于其他3组,而HbA1c则较其他3组低,差异均有统计学意义(P<0.05或P<0.01);中度、 重度OSAS组UA明显高于无、 轻度OSAS组,差异有统计学意义(P<0.05或P<0.01).2)以BMI、 腰臀比、 颈围为控制变量,偏相关分析显示AHI与HbA1c呈负相关(r=-0.260,P<0.05),与UA、 痰证素积分呈正相关(r=0.219、0.190,P<0.05).3)BMI、HbA1c、UA、 痰证素积分是影响AHI的重要因素.结论:1)BMI、HbA1c、UA是评估T2DM合并OSAS患者呼吸障碍程度的重要预测指标;其中,BMI、UA与呼吸障碍程度呈正相关,而HbA1c则为负相关,且独立于肥胖之外;2)痰证素可作为中医判断T2DM合并OSAS的一个危险因素.

目的 探讨痰证素与2型糖尿病(Type 2 Diabetes Mellitus,T2DM)合并阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome,OSAS)的关系.方法 选择完成睡眠呼吸监测的T2DM患者96例,根据监测结果分为T2DM合并OSAS组61例,T2DM组35例,采集所有患者的一般资料及中医四诊信息,运用“证素辨证”方法计算得出痰证素积分.结果 T2DM合并OSAS组的年龄、BMI、腰围、痰证素积分均大于单纯T2DM组(P＜0.05);低通气指数(Apnea Hypopnea Index,AHI)与痰证素积分呈正相关(r=0.287,P＜0.01);当T2DM患者痰证素积分达到83.7分时,可初步预测OSAS的发生.结论 中医痰证素与T2DM并OSAS疾病存在相关性,且随着病情加重,痰证更加明显.