Hyponatremia is strongly associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH). We present an 82-year-old male with refractory hyponatremia unresponsive to the discontinuation of hydrochlorothiazide and comprehensive treatment (fluid restriction, sodium supplementation, and tolvaptan). Two consecutive urine cultures identified extensively drug-resistant Klebsiella pneumoniae (XDRKP). After tigecycline treatment, serum sodium returned to normal and remained stable during one-year follow-up. This case suggests a close relationship between XDRKP infection and SIADH, highlighting the need to evaluate drug-resistant pathogens in patients with refractory hyponatremia and the importance of antimicrobial therapy in the management of electrolyte disorders secondary to drug-resistant urinary tract infections.

Altitude and eosinophil (EOS) are closely related to chronic obstructive pulmonary disease (COPD). There are limited studies on the association of altitude and EOS with mortality of COPD patients. Our aim was to explore the association of altitude and EOS with one-year all-cause mortality of patients hospitalized for acute exacerbation of COPD (AECOPD). A total of 351 inpatients with AECOPD in two hospitals from 2021 to 2022 were enrolled and divided into two groups based on the altitude and followed up for one year. Logistic and Cox regression analyses were used to determine the relationship of altitude and eosinophil with one-year all-cause mortality. Restricted cubic spline (RCS) was used to investigate the relationship between variables and outcome. In addition, a post hoc analysis was conducted to explore the relationship between EOS and one-year mortality of AECOPD patients at high altitude. Patients at high altitude had a higher one-year all-cause mortality compared with patients at low altitude (P = 0.001). Multivariate COX regression showed that altitude (HR 3.03, 95

Osteoporosis (OP) prevalence is significantly higher in type 2 diabetes (T2DM) patients, but the connecting molecular mechanisms are unclear. This study identified diabetes-related gene signatures in OP using integrated bulk and single-cell RNA-seq datasets from OP and T2DM. Bioinformatics and machine learning (LASSO, RF, SVM-RFE) analyses were employed, with hub genes validated clinically and in an OVX mouse model. We identified 40 immune-related diabetes-associated genes (DRGs), including four hub genes (BCL2L11, IL1R2, IL4R, TLR4) for OP diagnosis. A nomogram based on these showed high accuracy (AUC = 0.925), validated externally (p < 0.01). Immune infiltration revealed changes in plasma cells, NK cells, and macrophages. Single-cell analysis highlighted myeloid-specific DRG enrichment and active roles in RESISTIN and VISFATIN pathways. Pseudotime analysis linked DRG score negatively to differentiation. Elevated IL1R2 in OP mice was confirmed. The four identified genes represent diagnostic value and potential therapeutic targets for modulating the T2DM-OP interaction. Our results further uncover critical myeloid-mediated mechanisms underlying this comorbidity, thereby providing new insights for future therapeutic development.

Objective Placenta-derived inflammation plays a vital role in the pathophysiology of gestational diabetes mellitus (GDM). IL-32 is a novel pro-inflammatory cytokine and metabolic regulator involved in the development of metabolic disease. We investigated the effect of IL-32 in GDM. Materials and Methods First-trimester C-reactive protein (CRP) level was monitored in a case-control study of 186 women with GDM and 186 women without. Placental tissue was lysed and analyzed by high-resolution liquid chromatography-tandem mass spectrometry. Circulating level of inflammatory cytokines IL-32, IL-6, and TNF-α were measured by ELISA kits. The expression of placenta-derived macrophages, inflammatory cytokines, and related pathway proteins were assessed by reverse transcriptase-quantitative PCR, western blot, immunohistochemistry, or immunofluorescence. Results First-trimester CRP level in peripheral blood was closely associated with glucose and insulin resistance index and was an independent correlation with the development of GDM. High-resolution liquid chromatography-tandem mass spectrometry revealed that placenta-derived CRP expression was dramatically elevated in women with GDM. Interestingly, the expression of placenta-derived IL-32 was also increased and located in the macrophages of placental tissue. Meanwhile, the expression of IL-6, TNF-α, and p-p38 were up-regulated in the placental tissues with GDM. Either IL-6 or TNF-α was colocated with IL-32 in the placental tissue. Importantly, circulating IL-32 throughout pregnancy was increased in GDM and was related to placental-derived IL-32 expression, circulating IL-6, and TNF-α, glucose and insulin resistance index. Conclusion Increased circulating IL-32 throughout pregnancy was closely associated with placenta macrophage-derived IL-32 expression and GDM. First trimester IL-32 level in peripheral blood may serve to predict the development of GDM.

BACKGROUND:Diabetic kidney disease (DKD) is the most frequent complication in patients with type 2 diabetes mellitus (T2DM). It causes a chronic and progressive decline in kidney function, and ultimately patients require renal replacement therapy. To date, an increasing number of clinical studies have been conducted to explore the potential and novel biomarkers, which can advance the diagnosis, estimate the prognosis, and optimize the therapeutic strategies at the early stage of DKD. In the current study, we sought to investigate the association of plasma myoglobin with DKD.METHODS:A total of 355 T2DM patients with DKD and 710 T2DM patients without DKD were enrolled in this study. Laboratory parameters including blood cell count, hemoglobin A1c, biochemical parameters, and plasma myoglobin were recorded. Patients were classified on admission according to the tertile of myoglobin and clinical parameters were compared between the groups. Pearson correlation analysis, linear regression, logistic regression, receiver operating characteristics (ROC) analysis, and spline regression were performed.RESULTS:Plasma myoglobin significantly increased in patients with DKD and was associated with renal function and inflammatory parameters. Plasma myoglobin was an independent risk factor for the development of DKD. The area under ROC curve of myoglobin was 0.831. Spline regression showed that there was a significant linear association between DKD incidence and a high level of plasma myoglobin when it exceeded 36.4 mg/mL.CONCLUSIONS:This study shows that elevated plasma myoglobin level is closely associated with the development of kidney injury in patients with T2DM.

Background To compare whether the general population, especially those without characteristic symptoms, need spirometry screening for chronic obstructive pulmonary disease (COPD). Methods Residents aged > 40 years old in Minhang, Shanghai, China, filled out screening questionnaires and underwent spirometry. The structured questionnaire integrating COPD population screening and COPD screening questionnaire was designed to obtain data on demographic characteristics, risk factors of COPD, respiratory symptoms, lifestyle habits, and comorbidities. We assessed the correlations between variables and COPD and the impact factors of FEV 1 % predicted. Results A total of 1,147 residents were included with a newly diagnosed mild to moderate COPD prevalence of 9.4% (108/1,147); half of the patients (54/108) were asymptomatic. Multivariate analysis did not reveal any significant differences in symptoms or lifestyle factors between newly diagnosed COPD patients and non-COPD participants. However, according to the generalized linear model, older age (β = −0.062, p < 0.001), male sex (β = −0.031, p = 0.047), and respiratory symptoms (β = −0.025, p = 0.013) were associated with more severe airflow limitation. Conclusion Newly diagnosed COPD patients had few differences compared with the general population, which suggests that a targeted case finding strategy other than general screening was currently preferred. More attention should be paid to respiratory symptoms when making a diagnosis and exploring new therapies and interventions for COPD in the early stage.

桥本甲状腺炎( HT)又名慢性淋巴细胞细胞性甲状腺炎,发病核心是炎性细胞及炎症因子浸润甲状腺[1].最新研究发现,HT患者可伴有胰岛素抵抗( IR) [2-3] ,甲状腺功能亢进或减退均伴有不同程度的IR,但具体机制尚不清楚.此外,有学者发现HT患者肾脏组织甲状腺过氧化物酶抗体( TPO )染色阳性,也反映出HT患者中多器官的自身免疫损害[4].IR是一种慢性系统性低度炎症,巨噬细胞( M?)浸润内脏脂肪是IR发生的关键步骤[5].脂肪组织的M?存在不同的表型:M1 型M?,主要参与促进细胞免疫和炎症;M2 型M?,主要参与减轻炎症的发生[6] ,促进组织的修复.本课题组前期研究发现甲状腺功能正常的HT患者及诱导HT模型小鼠均伴有IR,本研究通过检测HT患者大网膜内M?的水平,明确内脏脂肪M?水平与IR的相关性及M?在其中所扮演的角色,为探讨IR治疗新靶点提供依据.

CONTEXT:The immune system plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). Monocytes, the main innate immune cells, are especially important in the maintenance of a normal pregnancy. OBJECTIVE:Here, we investigated the potential effect of monocytes in GDM. METHODS:Monocyte count was monitored throughout pregnancy in 214 women with GDM and 926 women without in a case-control and cohort study. Circulating levels of inflammatory cytokines, placenta-derived macrophages, and their products were measured. RESULTS:Throughout pregnancy, monocyte count was significantly decreased in women with GDM, and was closely associated with glucose level, insulin resistance, and newborn weight. First-trimester monocyte count outperformed that of the second and third trimester as a risk factor and diagnostic predictor of GDM and macrosomia both in the case-control and cohort study. In addition, our cohort study showed that as first-trimester monocyte count decreased, GDM and macrosomia incidence, glucose level, and newborn weight increased in a stepwise manner. Risk of GDM started to decrease rapidly when first-trimester monocyte count exceeded 0.48 × 109/L. Notably, CD206 and interleukin 10 (IL-10) were significantly lower, whereas CD80, CD86, tumor necrosis factor α (TNF-α), and interleukin 6 (IL-6) were higher both in GDM placental tissue and peripheral blood. First-trimester monocyte count was positively related to IL-10 and CD206, but negatively related to CD80, CD86, TNF-α, and IL-6. CONCLUSION:Decreased monocyte count throughout pregnancy was closely associated with the development of GDM, macrosomia, and the chronic inflammatory state of GDM. First-trimester monocyte count has great potential as an early diagnostic marker of GDM.

Aims/hypothesis IgM is the primary antibody produced by B cells and we hypothesise that IgM antibodies to gut microbiota may play a role in immunometabolism in obesity and type 2 diabetes. To test our hypothesis, we used B6 mice deficient in activation-induced cytidine deaminase ( Aid −/− [also known as Aicda −/− ]) which secrete only IgM antibodies, and human faecal samples. Methods We studied the immunometabolic effects and gut microbial changes in high-fat-diet-induced obesity (HFDIO) in Aid −/− B6 mice compared with wild-type mice. To determine similarities between mice and humans, human stool samples were collected from children and adolescents who were obese with normal glucose tolerance (NGT), obese with glucose intolerance (IGT), or obese and newly diagnosed with type 2 diabetes, for faecal microbiota transplant (FMT) into germ-free (GF) B6 mice and we assessed IgM-bound bacteria and immune responses. Results Compared with wild-type mice, Aid −/− B6 mice developed exacerbated HFDIO due to abundant levels of IgM. FMT from Aid −/− B6 to GF B6 mice promoted greater weight gain in recipient mice compared with FMT using wild-type mouse faecal microbiota. Obese youth with type 2 diabetes had more IgM-bound gut bacteria. Using the stools from the obese youth with type 2 diabetes for FMT to GF B6 mice, we observed that the gut microbiota promoted body weight gain and impaired glucose tolerance in the recipient GF B6 mice. Importantly, some clinical features of these obese young individuals were mirrored in the GF B6 mice following FMT. Conclusions/interpretation Our results suggest that IgM-bound gut microbiota may play an important role in the immuno-pathogenesis of obesity and type 2 diabetes, and provide a novel link between IgM in obesity and type 2 diabetes in both mice and humans. Data availability The 16s rRNA sequencing datasets supporting the current study have been deposited in the NCBI SRA public repository ( https://www.ncbi.nlm.nih.gov/sra ; accession no. SAMN18796639). Graphical abstract

Autoimmune thyroiditis (AIT), characterized by an endless inflammatory process of self-destruction, ultimately leads to chronic swelling of the thyroid gland and its dysfunction. Here, we investigated the involvement of the NLR pyrin domain-containing 3 (NLRP3) inflammasome in AIT development. We found that NLRP3 is signifi-cantly upregulated in the thyroid of AIT patients and mice with experimental autoimmune thyroiditis (EAT). Pharmacological suppression of NLRP3 using its inhibitor MCC950 suppressed the progression of EAT in vivo. Furthermore, MCC950 treatment significantly reduced the numbers of infiltrating CD4+ and CD8+ T cells in the thyroid. Moreover, MCC950 significantly lowered the amounts of T helper 1 cells, T helper 17 cells, interferon gamma, and interleukin-17A; however, it significantly increased regulatory-T-cell numbers and interleukin-10 levels. These results suggest that suppression of NLRP3 inflammasome activation reverses AIT by inhibiting Th1-and Th17-cell responses and promoting Treg cell responses. Hence, the NLRP3 inflammasome is a promising therapeutic and theragnostic target in AIT.inhibits Th1-and Th17-cell responses and promotes Treg cell responses.

Objective:To Investigate comprehensive predictive ability of first-trimester complete blood count combined with maternal characteristics for gestational diabetes mellitus (GDM).Methods:From May 2015 to July 2018, 1 412 pregnant women were retrospectively screened at the Fifth People′s Hospital of Shanghai, Fudan University. We recruited 258 women who developed GDM and 1 154 women who had normal glucose level during pregnancy. At the first visit, clinical data and complete blood count result were obtained. GDM prediction models were established through logistic regression analysis of GDM related risk factors and the prediction abilities of each model were compared.Results:Logistic regression analyses identified age, pre-pregnancy body mass index, previous GDM history, family history of diabetes mellitus, the neutrophil-to-lymphocyte ratio, leukocyte, neutrophil, and monocyte counts were significantly independent predictors of GDM. In the entire cohort, the predictive ability of neutrophil and monocyte counts together with maternal basal characteristics model for the development of GDM [areas under the receiver operating characteristic curve (AUC-ROC)=0.809, integrated discrimination improvement (IDI)=0.056, P=0.001] was the best among various models (basal characteristics model, AUC-ROC=0.753; Monocyte count+ basal characteristics model, AUC-ROC=0.764; neutrophil count + basal characteristics model, AUC-ROC=0.775). Similar results obtained by the same way in all pregnant women without previous GDM history. Conclusion:It could improve the prediction of GDM with model incorporated maternal characteristics and first-trimester neutrophil and monocyte counts.

BACKGROUND:Papillary thyroid carcinoma (PTC) is considered to be an inflammatory disease. This study aimed to investigate the association of monocyte to high-density lipoprotein cholesterol ratio (MHR) with PTC. METHODS:Clinical parameters from 300 patients with PTC and 552 patients with benign thyroid nodule were compared. Serum renal function and liver enzymes, fasting plasma glucose, lipid profile, and blood cell count were measured. RESULTS:Patients with PTC had a higher MONO (p < 0.001) and MHR (p < 0.001). There was a step-wise increase in the prevalence of PTC (p = 0.003) with the tertile of MHR. Logistic regression analysis revealed that MHR could be considered an independent risk factor (p < 0.001) in the case-control study and the cohort study. Pearson correlation analysis and simple linear regression analysis indicated that MHR was positively associated with neutrophil (NEU) and lymphocyte (LYM) count as well as neutrophil-to-lymphocyte ratio (NLR). Area under the curve (AUC) was 0.711. The optimal cutoff of MHR was 0.33 × 109 /mmol. CONCLUSION:This study identifies novel evidence that patients with PTC have a higher MHR. MHR is an independent risk factor for PTC. These findings support the application of MHR to predict, diagnose, and evaluate the occurrence of PTC.

目的 探讨正常糖耐量孕妇孕前体质量指数(body mass index,BMI)及孕期体重增长对新生儿体重的影响.方法 选取2016年1月～2017年12月在复旦大学附属上海市第五人民医院和上海市闵行区吴泾医院的正常糖耐量妊娠初产妇746例,根据美国国家科学院研究所(Institute of Medicine,IOM)指南(2009年)对孕前BMI及体重增长情况进行分组,分析孕前BMI、孕期体重增长与新生儿体重的关系.结果 随着孕前BMI及孕期体重增长,新生儿体重逐渐增长,消瘦组新生儿体重为(3178.56±486.59)g,正常组为(3350.75±449.10)g,超重组为(3488.36±406.25)g,肥胖组为(3581.50±534.44)g(P<0.05);孕期体重低增长组新生儿体重为(3223.37±434.71)g,正常增长组为(3343.11±433.38)g,高增长组为(3521.56±451.85)g(P<0.05).预测巨大儿的受试者工作特征曲线(receiver operator characteristic curve,ROC)所得的孕前BMI切点值为23.24 kg/m2,孕期体重增长的切点值为14.75 kg.结论 孕前肥胖及孕期体重增长过多可导致新生儿体重过快增长,控制孕前BMI和孕期体重增长对于减少巨大胎儿的出生非常重要.

Purpose Diabetic kidney disease (DKD) is an inflammatory disease. This study aimed to investigate the association of fibrinogen to albumin ratio (FAR) with DKD. Patients and Methods A total of 1022 type 2 diabetes mellitus (T2DM) patients with DKD and 1203 T2DM patients without DKD were enrolled in this study. Laboratory values including blood cell count, hemoglobin A1c, biochemical parameters, and fibrinogen and albumin creatinine ratio were recorded. Patients were classified according to tertile of admission FAR. Clinical parameters were compared between groups. Logistic regression, linear regression, ROC analysis and spline regression were carried out. Results FAR in the DKD group was significantly higher than that in the non-DKD group. FAR had the highest odds ratio as an independent risk factor for the development of DKD and the highest area under ROC curve for predicting DKD compared with albumin (ALB) or fibrinogen (FIB) alone. Simple linear regression analyses revealed a significant and linear correlation of FAR with neutrophil and neutrophil-to-lymphocyte ratio. FAR was an independent risk factor for development of DKD. Spline regression showed that there was a significant linear association between DKD incidence and continuous FAR value when it exceeded 67.3mg/g. Conclusion FAR is a stronger independent predictor of DKD than FIB and ALB. FAR is an independent risk factor for DKD development when it exceeded 67.3mg/g. FAR might be one of novel diagnostic biomarkers to predict and prevent DKD progression. However, a prospective study to validate the prognostic model is still needed.

*These authors contributed equally to this work Purpose: Diabetic kidney disease (DKD) is an inflammatory disease. This study aimed to investigate the association of fibrinogen to albumin ratio (FAR) with DKD. Patients and Methods: A total of 1022 type 2 diabetes mellitus (T2DM) patients with DKD and 1203 T2DM patients without DKD were enrolled in this study. Laboratory values including blood cell count, hemoglobin A1c, biochemical parameters, and fibrinogen and albumin creatinine ratio were recorded. Patients were classified according to tertile of admission FAR. Clinical parameters were compared between groups. Logistic regression, linear regression, ROC analysis and spline regression were carried out. Results: FAR in the DKD group was significantly higher than that in the non-DKD group. FAR had the highest odds ratio as an independent risk factor for the development of DKD and the highest area under ROC curve for predicting DKD compared with albumin (ALB) or fibrinogen (FIB) alone. Simple linear regression analyses revealed a significant and linear correlation of FAR with neutrophil and neutrophil-to-lymphocyte ratio. FAR was an independent risk factor for development of DKD. Spline regression showed that there was a significant linear association between DKD incidence and continuous FAR value when it exceeded 67.3mg/g. Conclusion: FAR is a stronger independent predictor of DKD than FIB and ALB. FAR is an independent risk factor for DKD development when it exceeded 67.3mg/g. FAR might be one of novel diagnostic biomarkers to predict and prevent DKD progression. However, a prospective study to validate the prognostic model is still needed.

Background: Intestinal flora is associated with Graves’ disease (GD). This study explored the association of serum 25(OH)D with the diversity of the intestinal flora and serum IL-17 in GD patients. Methods: Patients newly diagnosed with GD at 2 centers between 2018 and 2021 were consecutively included. According to their 25(OH)D levels, they were divided into the deficiency group, the insufficiency group, and the sufficiency group. Some patients with vitamin D deficiency or insufficiency were randomly selected and were matched with healthy volunteers (normal control [NC]) in terms of sex, age, and case number. The diversity and differential species of the intestinal flora and serum IL-17 levels were compared. Results: Serum 25(OH)D negatively correlated with serum IL-17, the platelet/lymphocyte ratio, and TSH receptor antibody. The diversity of the intestinal flora decreased in the GD group, with noticeable differences in the composition of the intestinal flora when compared with the NC group. At the phylum level, the GD group exhibited a significantly lower abundance of Firmicutes but a higher abundance of Actinobacteria. At the genus level, the GD group exhibited higher relative abundances of Bifidobacterium, Collinsella, and Pediococcus but lower abundances of Roseburia and Dialister. Conclusions: The changes in the vitamin D level and the composition of the intestinal flora may partially contribute to the development of GD.

Objective The aim of this study was to evaluate the effect of TFR2 on iron storage in type 2 diabetes. Methods A cross-sectional study was conducted among 1938 participants from the Jiangchuan Community of Shanghai. A total of 784 participants with T2DM and 1154 normal participants (non-T2DM) were enrolled in this study. Serum ferritin, fasting blood glucose, postprandial blood glucose, and HbA1C (glycated hemoglobin A1c) levels were determined. Eighteen Wistar male rats were randomly assigned into three groups (n = 6/group): rats in a high-fat diet streptozotocin (HFD+STZ) group were fed with HFD for 4 weeks and intraperitoneally injected with streptozotocin (STZ); rats in a control group were fed with a standard diet for 4 weeks and intraperitoneally injected with buffer; rats in an STZ group were fed with a standard diet for 4 weeks and intraperitoneally injected with streptozotocin. Glucose tolerance test was performed at the end of the study. Blood samples and liver tissues were assessed for liver TFR2, blood glucose, serum ferritin, and iron levels. Results The mean serum ferritin level of T2DM participants was significantly higher than that of the control group (227 (140–352) vs 203.5 (130.5–312) ng/mL, P < 0.05). Serum ferritin level was an independent risk factor for T2DM (high ferritin group vs low ferritin group, 1.304 (1.03–1.651), P < 0.05). Diabetic rats showed reduced liver TFR2 levels, with increased serum ferritin levels. Conclusion T2DM participants exhibited iron disorder with elevated serum ferritin levels. Elevated serum ferritin levels in diabetic rats were accompanied by reduced liver TFR2 levels.

OBJECTIVE:The aim of our study was to explore the association between serum cystatin C (CysC) and euthyroid Hashimoto's thyroiditis.METHODS:There were 119 female euthyroid Hashimoto's thyroiditis patients and 225 healthy controls who were recruited. Serum CysC, thyroid function, thyroid autoantibodies, fasting glucose, liver enzymes, and lipid profile were determined. Clinical parameters were compared between two groups.RESULTS:Serum CysC levels were significantly higher in euthyroid Hashimoto's thyroiditis patients compared with controls. In the lowest, middle, and highest tertile groups of CysC, the percentage of Hashimoto's thyroiditis was 15.9%, 34.2%, and 53.5%, respectively. The percentage of Hashimoto's thyroiditis was significantly higher in the highest tertile than in the lowest and middle tertiles. Spearman's correlation analysis showed that serum CysC levels were negatively correlated with free triiodothyronine (FT3), and positively correlated with serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). Logistic regression analysis showed that serum CysC was independently related to the status of euthyroid Hashimoto's thyroiditis.CONCLUSIONS:The present study shows the first evidence suggesting that serum CysC levels are positively correlated with TPOAb and TGAb. Serum CysC might underlie the pathophysiologic features of euthyroid Hashimoto's thyroiditis.

Background: It’s unclear the exact level of serum urate acid (SUA) which can prevent renal function worse although all internists has been known the target of blood glucose, blood pressure and lipid in diabetes. It’s time to aim for a reasonable SUA target to prevent renal failure in diabetes.Methods: Using the physical examination results of 3427 diabetic patients in Jiangchuan Community, Shanghai, China, the relationship between SUA and estimated glomerular filtration rate (eGFR) decline was analyzed, and the appropriate cut-off point for SUA to predict eGFR decline was determined. Meanwhile, the population attributable risk proportion (PARP) of eGFR decline in diabetic patients above this SUA cut-off point was calculated. Results: eGFR decreased accompany with the increased SUA level and was negatively associated with the level of SUA significantly. After adjusting for potential confounders, SUA also was an independent risk factor of eGFR decline. The best appropriate SUA point, predicting eGFR decline obtained by ROC curve, was 326.5μmol/L which may prevent from eGFR decline in 33% male patients and 355.5μmol/L which may prevent from eGFR decline in 18% female patients. Compared with SUA>326.5μmol/L male and SUA>355.5μmol/L female group respectively, the relative risk of eGFR decline in SUA≤326.5μmol/L male and SUA≤355.5μmol/L female group is decreased significantly. Conclusions: SUA is an impotant risk factor for eGFR decline in diabetes. 326.5μmol/L in male and 355.5μmol/L in female may be used as the reasonable SUA target to retard renal function to worse in Chinese diabetes.

The aim of our study was to explore the diagnostic value of prealbumin to fibrinogen ratio (PFR) for predicting prognosis with the optimal cut-off value in diabetic peripheral neuropathy (DPN) patients. A total of 568 type 2 diabetes mellitus (T2DM) patients were enrolled in this study. The values including Toronto clinical neuropathy score (TCNS), nerve conduction velocity (NCV), vibration perception threshold (VPT), blood cells count, biochemical parameters, fibrinogen and PFR were recorded. The patients were divided into tertiles based on admission PFR value. First, clinical parameters were compared among the groups. Secondly, a logistic regression and ROC analysis were performed as the statistical model. The percentage of DPN, TCNS and VPT were significantly higher in the lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01-0.001). NCV was significantly lower in lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01-0.001). The Spearman correlation analysis showed that PFR was negatively correlated with TCNS and VPT (P < 0.001), while PFR was positively correlated with median motor NCV (P < 0.001), peroneal motor NCV (P < 0.001), median sensory NCV (P < 0.001), and peroneal sensory NCV (P < 0.001). After adjusting these potentially related factors, PFR was independently related to DPN (P = 0.007). The area under ROC curve was 0.627. This study finds the first evidence to suggest PFR may be the key component associated with DPN in T2DM, while PFR might underlie the pathophysiologic features of DPN.