Objective:To explore the association of bone resorption marker β carboxyterminal peptide of collagen Ⅰ (β-CTX) with hypercalcemia in patients with Graves′ disease (GD).Methods:287 patients with GD who were hospitalized in the endocrinology department of Fuyang People′s Hospital from January 2021 to December 2021 were divided into control group ( n=251) and hypercalcemia group ( n=36) according to the corrected blood calcium level. The clinical data and serum β-CTX level of the two groups were compared. Logistic regression model was used to analyze the risk factors of hypercalcemia in GD patients. Pearson correlation was used to analyze the correlation between serum β-CTX level and other indexes. Results:Of the 287 GD patients, 36 were diagnosed as hypercalcemia, and the incidence of hypercalcemia was 12.54%. The levels of free triiodothyronine (FT3), free thyroxine (FT4), blood phosphorus (P) and β-CTX in hypercalcemia group were higher than those in control group, and the total parathyroid hormone (iPTH) in hypercalcemia group were lower than those in control group (all P<0.05). Multivariate Logistic regression analysis showed that FT3 ( OR=1.283, 95% CI: 1.049-1.570, P<0.05), iPTH ( OR=0.924, 95% CI: 0.863-0.989, P<0.05), β-CTX ( OR=2.488, 95% CI: 1.193-5.189, P<0.05) were the influencing factors for hypercalcemia in GD patients. Pearson correlation analysis showed that β-CTX was positively correlated with FT3, FT4, blood calcium, P, alkaline phosphatase (ALP), total procollagen type I amino end terminal peptide (PINP), N-bone-gamma-carboxyglutamic-acid-containing proteins (N-MID) and 25(OH)D, and negatively correlated with iPTH (all P<0.05). Conclusions:β-CTX is highly expressed in the serum of GD patients with hypercalcemia, which is a risk factor for the occurrence of hypercalcemia in GD patients.

目的 观察百令胶囊辅治对早期糖尿病肾病患者肾功能、血清胰岛素样生长因子(IGF-1)、白介素-17(IL-17)、白介素-10(IL-10)水平的影响.方法 将我院诊断为早期糖尿病患者120例随机分为对照组(常规基础治疗加口服二甲双胍片、辛伐他丁)与观察组(在对照组治疗基础上加服百令胶囊辅治)各60例.治疗12周后比较两组临床疗效,观察两组治疗前后肾功能、胰岛素样生长因子(IGF-1)、血管内皮功能及炎症反应、T细胞亚群指标变化.结果 治疗后,观察组临床有效率高于对照组(P＜0.05);两组患者肾功能指标转化生长因子-β(TGF-β)、尿素氮(BUN)、尿β2-微球蛋白(尿β2-MG)、24h尿白蛋白(TP)及IGF-1、血管内皮功能指标血管内皮生长因子(VEGF)、内皮素(ET-1)水平明显降低,且观察组上述指标均低于对照组(P＜0.05);两组患者炎症因子肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、IL-17水平均低于治疗前,IL-10水平均高于治疗前,且观察组上述指标的改善程度均优于对照组(P＜0.05);两组患者T细胞亚群指标CD8+水平均低于治疗前,CD4+、CD4+/CD8+水平均高于治疗前,且观察组上述指标的改善程度均优于对照组(P＜0.05).结论 百令胶囊辅佐常规降血糖药物治疗早期糖尿病肾病,能有效减少炎症反应,修复血管内皮功能,增强患者免疫力,有利于患者肾功能的恢复,取得较好效果.

目的:探讨生长激素-胰岛素样生长因子(GH/IGFs)轴功能检测在矮小症儿童病因诊断中的应用及其临床价值.方法:选择青春发育前期(按Tanner分期P1期)矮小症儿童90例,设为观察组;选取健康儿童50名,设为对照组.检测观察组和对照组儿童的血清胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,对观察组患儿予以GH激发试验,进行病因诊断,分为GH完全缺乏(CGHD)组、GH部分缺乏(PGHD)组、特发性矮小症(ISS)组.分析血清IGF-1、IGFBP-3诊断矮小症的敏感度、特异度、准确度.结果:根据GH激发试验结果分组,CGHD组22例,PGHD组36例,ISS组32例.CGHD组、PGHD组、ISS组血清IGF-1、IGFBP-3均明显低于对照组(P<0.01);CGHD组血清IGF-1、IGFBP-3水平均明显低于PGHD组、ISS组(P<0.01).以血清IGF-1<52.8 ng/mL为判定值,诊断CGHD的灵敏度、特异度和准确度分别为81.82％、100.00％、95.56％;以血清IGFBP-3<3.12μg/mL为判定值,诊断CGHD的灵敏度、特异度和准确度分别为100.00％、75.00％、81.11％.结论:GH/IGFs轴功能检测在矮小症儿童病因诊断中具有较高的临床价值,血清IGF-1、IGFBP-3检测可能有助于CGHD的初筛,结合GH激发试验可能更有助于PGHD、ISS的确诊.

Objective:To investigate the value of renal glucose threshold and related factors in patients with type 2 diabetes mellitus.Methods:According to the cut-off point of normal renal glucose threshold(RT G 8.9-10 mmol/L), 107 patients with type 2 diabetes mellitus hospitalized in the Endocrinology Department of our hospital were divided into three groups: high RT G group(RT G>10 mmol/L), medium RT G group(8.9 mmol/L≤RT G≤10 mmol/L), and low RT G group(RT G<8.9 mmol/L). The clinical data and biochemical characteristics of each group were collected and analyzed. Results:The proportions of patients with high, medium, and low RT G of type 2 diabetes mellitus were 56%, 29%, and 15%, respectively. There were significant differences in RT G value, age, course of disease, body mass index(BMI), fasting plasma glucose(FPG), HbA 1C, total cholesterol(TC), serum creatinine, mean blood glucose(MBG), and 24-hour urine glucose between high and medium RT G groups. RT G, gender, BMI, FPG, HbA 1C, TC, and MBG in patients with high RT G group were different from those in low RT G group. Only RT G revealed a difference between medium and low RT G groups. Correlation analysis showed that RT G was positively correlated with gender, age, BMI, HbA 1C, TC, and low density lipoprotein-cholesterol(LDL-C). Regression analysis showed that BMI, HbA 1C, and LDL-C were the related factors affecting the RT G of patients with type 2 diabetes. Conclusion:There is a larger proportion of patients with high RT G in type 2 diabetes mellitus. Their BMI, HbA 1C, and LDL-C are associated with RT G in the patients with type 2 diabetes mellitus.

目的:对甲状腺乳头状癌不同位置处的颈侧区淋巴结转移情况进行分析,并探究其跳跃性特征.方法:研究对象为2019年6月至2021年6月六安市人民医院普外二病区收治的甲状腺乳头状癌患者,选取患者数量为32例,甲状腺癌位置包括上部、中部及下部位置,对患者的颈侧区淋巴结转移率进行统计.按照患者的术后中央区及侧颈淋巴结转移情况进行分组,其中无跳跃性转移组16例,跳跃性转移组16例.对患者实施单因素及多因素分析,对患者的临床病理特征进行分析,探究出现跳跃性转移的危险因素.结果:通过分析不同位置的甲状腺癌,发现其转移率仅

利拉鲁肽是常见胰高血糖素样肽-1(GLP-1)受体激动剂之一,除有良好的降糖效应外,在控制糖尿病患者血压、体重、血脂及减少蛋白尿、改善心功能等方面都有积极的影响,其治疗2型糖尿病有效性、患者耐受性良好.国内外多项临床和基础研究显示,利拉鲁肽具有一定的降压效应,其主要涉及的机制可能包括降低体重、增加尿钠排泄、减少游离脂肪酸(FFA)、改善内皮功能等方面.本文就利拉鲁肽的降压效应具体机制进行综述.

目的:探究达格列净治疗2型糖尿病伴心功能不全效果及对患者心脏功能、血小板淋巴细胞比值(PLR)及血浆同型半胱氨酸(hcy)水平的影响.方法:选取2019年1月至2020年1月于本院住院及门诊就诊的171例2型糖尿病伴心功能不全患者,按简单随机法分为对照组(n=85)和观察组(n=86),对照组给予常规治疗,观察组在以上基础给予达格列净.比较两组临床疗效、血糖水平[糖化血红蛋白(HbA1c)、空腹血糖(FPG)及餐后2h血糖(2hPG)]、心脏功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及6min步行试验(6MWT)]、PLR和血浆hcy水平及不良反应发生情况.结果:观察组总有效率为94.19％,明显高于对照组的84.71％(P<0.05);治疗后,与对照组相比,观察组HbA1c、FPG、2hPG水平明显较低(P<0.05),LVEF、6MWT水平明显较高(P<0.05),LVEDD、PLR和血浆hcy水平明显较低(P<0.05);观察组不良反应发生率为10.47％,略高于对照组的5.88％,(P>0.05).结论:针对2型糖尿病伴心功能不全患者给予达格列净,具有较好的临床疗效,可明显改善患者的血糖水平和心脏功能,调节PLR和血浆hcy水平,安全性较好.

目的 探讨并分析影响糖尿病足(DF)患者死亡的相关因素.方法 选取2013年1月—2015年12月于阜阳市人民医院内分泌科住院的DF患者201例,电话随访3年,依据患者生存情况分为死亡组和存活组.分析两组一般资料、生化特征、病死率及死亡危险因素.结果 死亡组糖尿病病程、DF病程及糖化血红蛋白(HbA1c)高于存活组(P<0.05),两组有无心脑血管病史和有无截趾比较,差异有统计学意义(P<0.05);DF患者的3年累计病死率为16.9％,Kaplan-Meier生存分析结果示糖尿病病程、DF病程、HbA1c、截趾及心脑血管病史均影响DF患者的生存率(P<0.05);多因素Cox回归分析显示,年龄[Rl^R=1.052(95％CI:1.020,1.085)]、糖尿病病程[Rl^R=1.094(95％CI:1.036,1.156)]、DF病程[Rl^R=23.357(95％CI:5.752,94.853)]、HbA1c[Rl^R=2.185(95％CI:1.549,3.082)]及心脑血管病史[Rl^R=2.625(95％CI:1.265,5.448)]是影响DF患者死亡的危险因素.结论 DF患者的病死率受多种因素影响,与年龄、糖尿病病程、DF病程、HbA1c及心脑血管病史相关.

Objective: To investigate the recurrence and influencing factors of diabetic foot ulcer in patients with type 2 diabetes mellitus. Methods: Totally 185 type 2 diabetes patients with new-onset of diabetic foot ulcers admitted to Fuyang People's Hospital of Anhui Province from January 2011 to December 2015 were enrolled in this study, including 120 males and 65 females, aged 40-79 years. All the patients were followed up for 3 years, and their clinical data were retrospectively analyzed by the case-control study. The Kaplan-Meier cumulative recurrence curve was drawn according to the 3-year cumulative recurrence rate of diabetic foot ulcers. The time to visit, toe involvement, and amputation of involved toes in patients with recurrent diabetic foot ulcer were counted at the initial onset and the recurrence of the ulcers, respectively, and the data were statistically analyzed with t test and chi-square test. According to the recurrence of diabetic foot ulcers, the patients were divided into foot ulcer recurrence group and foot ulcer non-recurrence group. The gender, age, course of diabetes mellitus, length of hospital stay, visit time, body mass index, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, hemoglobin, white blood cell count, toe involvement, toe amputation, ankle-brachial index, diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), diabetic nephropathy (DN), history of hypertension, cardio-cerebrovascular disease, smoking, residence, solitary life, and walking disorder of patients between the two groups were compared, and the data were statistically analyzed with t test and chi-square test. Log-rank test was performed on the indexes with P<0.1 in comparison between two groups, and the indexes with statistically significant differences in Log-rank test were analyzed by multivariate Cox regression analysis to screen the influencing factors of recurrence of diabetic foot ulcer. Results: (1) The 3-year cumulative recurrence rate of diabetic foot ulcers in 185 patients with type 2 diabetes mellitus was 47.0% (87/185). (2) For 87 patients with diabetic foot ulcer recurrence, compared with that at the initial onset of the ulcers, the visit time was significantly shorter (t=10.593, P<0.01), the toe amputation rate was significantly increased (χ(2)=5.118, P<0.05), but there was no obvious change in toe involvement at the recurrence of the ulcers. (3) There were statistically significant differences in age, course of diabetes mellitus, length of hospital stay, body mass index, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, cholesterol, LDL, HDL, hemoglobin, white blood cell count, gender, toe amputation, ankle-brachial index, DR, history of cardio-cerebrovascular disease, solitary life, and walking disorder of patients between foot ulcer recurrence group (87 patients) and foot ulcer non-recurrence group (98 patients) (t=5.123, 4.242, 5.324, -24.572, 6.102, -1.984, -9.747, 3.226, 3.076, 3.646, -4.683, -7.502, 8.095, χ(2)=5.621, 18.433, 4.546, 5.785, 9.655, 7.625, 7.886, P<0.05 or P<0.01), while the rest of the indexes of patients between the two groups were similar. Log-rank test showed that the two groups had statistically significant differences in age, course of diabetes mellitus, length of hospital stay, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, ankle-brachial index, DPN, and walking disorder (χ(2)=210.046, 44.837, 34.107, 98.685, 66.532, 294.451, 260.554, 5.012, 6.818, 11.160, P<0.05 or P<0.01). Age, total bilirubin, albumin, DPN, and walking disorder were the influencing factors for the recurrence of diabetic foot ulcers in patients with type 2 diabetes mellitus (hazard ratio=1.024, 0.678, 0.849, 2.335, 4.099, 95% confidence interval=1.001-1.047, 0.558-0.823, 0.797-0.904, 1.280-4.258, 2.044-8.223, P<0.05 or P<0.01). Conclusions: The 3-year cumulative recurrence rate of diabetic foot ulcers in patients with type 2 diabetes mellitus is relatively high, with the influencing factors being age, total bilirubin, albumin, DPN, and walking disorder.

原发性肥厚性骨关节病（primary hypertrophic osteoarthropathy，PHO）是一种以杵状指（趾）、皮肤增厚及骨膜增生为主要特征的常染色体隐性遗传性疾病。报告1例SLCO2A1基因的纯合突变c.1771C>T导致的PHO合并肾性失钾患者，其父母为近亲结婚，均存在SLCO2A1基因杂合突变，其弟弟有类似临床表现，也检测出SLCO2A1基因的纯合突变。

目的 探讨尿液内β2微球蛋白(β2-MG)水平与2型糖尿病视网膜病变和肾损伤的关系.方法 选取2016年2月～2018年11月我院收治的409例2型糖尿病患者为研究对象,根据患者并发症发生情况分为对照组85例、糖尿病视网膜病变(DR)组168例和糖尿病肾损伤(DN)组156例,将糖尿病视网膜病变组进一步分为为非增生性视网膜病变(NPDR)组85例和增生性视网膜病变(PDR)组83例,将糖尿病肾损伤组进一步分为早期肾病组79例和临床肾病组77例.比较糖尿病视网膜病变组和糖尿病肾病组患者尿液β2-MG水平、UmAlb/UCr比值及GFR水平,并分析尿液β2-MG水平与糖尿病视网膜病变(DR)和糖尿病肾病(DN)严重程度的相关性.结果 DR组和DN组尿β2-MG的水平高于对照组,DN组UmAlb/UCr比值及GFR水平高于对照组(<0.05);PDR组尿β2-MG水平高于NPDR组,临床肾病组尿β2-MG的水平高于早期肾病组(<0.05),但UmAlb/UCr比值及GFR水平与早期肾病组患者比较,差异无统计学意义(>0.05).Logistic多元回归分析显示,病程、β2-MG是2型糖尿病患者发生视网膜病变的危险因素,Spearman相关分析显示,尿β2-MG水平与DR和DN的严重程度呈正相关(<0.05).结论 糖尿病微血管病变患者尿β2-MG的水平显著升高,可能作为诊断指标为2型DR和肾脏病变的早期诊断提供参考,但仍有待进一步研究.

Objective Explore the reference index of treatment options for diabetic patients with poor glucose control.Method 312 cases of poor glycemic control type 2 diabetes mellitus were selected.After admission, insulin intensive hypoglycemic treatment was performed and the function of islets was detected after glucose stability.Patients with fasting C peptide≥1 ng/mL were changed to oral administration of insulin secreting drugs combined with basal insulin therapy (plan 1).Patients with fasting C peptide <1 ng/mL continued to be treated with insulin intensive hypoglycemic treatment,4 times/d (plan 2);After patients in plan 1 were treated 7 d,if fasting blood glucose and postprandial 2 h blood glucose were not up to standard,then plan 2 was treated. Compared the sex,age,body mass index,diabetes course,fasting blood glucose,glycated hemoglobin,postprandial 2 h blood glucose,fasting C peptide,and postprandial 2 h C peptide between the two groups.Results The body mass index,fasting C peptide,postprandial 2 h C peptide and delta fasting C peptide in plan 1 were significantly higher than those of plan 2.The fasting blood glucose,postprandial 2 h blood glucose and glycated hemoglobin were significantly lower than those in plan 2,the difference was statistically significant (P<0.05).There was no significant difference in insulin dose,hypoglycemia,fasting blood glucose level and 2 h blood glucose standard rate between the two groups (P>0. 05). In the treatment of 30 d follow-up,the rate of insulin dose and hypoglycemia of plan 1 was significantly lower than that of plan 2,the rate of fasting blood glucose level and the rate of 2 h blood glucose after meal were significantly higher,the difference was statistically significant meaning (P<0.05).Two stepwise Logistic regression analysis showed that body mass index and delta fasting C peptide were independent factors of selection 1.Conclusion Diabetic patients with poor glucose control,the body mass index and postprandial 2 h C peptide proliferation can be used as the predictors.

回顾性分析1例以头晕﹑腺垂体功能减退症为主要表现,误以为垂体瘤行手术治疗,根据患者术后病理诊断为肉芽肿性垂体炎.肉芽肿性垂体炎容易误诊为垂体瘤而进行手术.难于鉴别时,可考虑进行试验性激素治疗,对于激素治疗无明显改变或者鞍区占位效应较明显者,可考虑手术,术中尽快获得快速病理支持,避免对正常垂体组织过度损伤.

1病例介绍患者,男,45岁。因"口干、多饮、多尿1个月"于2016年10月17日于安徽省阜阳市人民医院内分泌科就诊。患者入院前1个月无明显诱因出现多尿,逐渐增加至每日尿量6 L左右,伴有口干,喜冷饮,饮水量增加5 L左右。无体重减轻,无发热,无头部外伤。既往史:1999年患者曾行左眼睑囊肿手术治疗,2008年曾经出现支气管哮喘,给以激素平喘治疗2个月好转,未再发作;2011年因上腹部疼痛,就诊于上海长海医院行胰腺穿刺活检,诊断为自

1病例资料<br>　　2012年5月我院收治神经性厌食症患者1例,女性,28岁,因厌食伴闭经8个月入院。患者入院前8个月因与丈夫生气出现厌食,进食偶有呕吐,食量明显减少,一般主食100~150 g/d,少量的蔬菜。入院前3个月症状加重,呕吐明显增加,有催吐行为,呕吐为胃内容物,无胆汁及呕血,无隔夜食物,不进食一般不吐,无怕热、多汗,无腹痛、腹泻,无色素沉着,无发热等。病程中体质量下降25 kg,停经8个月,平时性格内向,易生气。曾在当地以“胃病”等治疗,未改善。既往体健,无肝炎、肺结核病史,无手术外伤史。月经史：15初潮,月经3~5 d,周期30 d,末次月经2011年9月,G2P2。体格检查：体质量指数为12 kg/m2,神志清,贫血貌,恶病质,全身皮肤黏膜干燥、黄染,浅表淋巴结未及肿大,眼睑未见浮肿,颈软,甲状腺无肿大,乳房小,两肺呼吸音清,心界不大,心率58次/min,律齐,各瓣膜区未闻及病理性杂音,舟状腹,肝脾肋下未及,双下肢无浮肿,生理反射存在,病理征未引出。

In order to investigate the therapy of primary hypernatremia,two different treatment methods were used for four patients with primary hypernatremia.Two cases were given anterior pituitary hormone therapy firstly,and then given posterior pituitary hormone therapy.The other two cases were given both anterior and posterior pituitary hormone therapy at the same time.The results showed that clinical symptoms and plasma osmolality were normal in four patients after treatment.Therapeutic duration was shortened in patients treated with both anterior and posterior pituitary,and the treatment was safe.

T2DM患者分2组(口服降糖药组30例,胰岛素治疗组30例),入院患者第二天早上空腹6:00和9:00各抽血静脉血浆血糖检测一次。结果:两患者:组内FPG6:00和9:00静脉血浆血糖值相比有统计学意义(8.52±3.861vs9.50±3.68;8.92±3.83vs10.84±3.53,均P<0.001);组内随着血糖的升高9:00血糖值-6:00血糖值/9:00血糖值的比值逐渐下降;FPG在16mmol/L以上,9:00血糖值反而低于6:00血糖值;组间9:00血糖值-6:00血糖值/9:00血糖值的比值也有统计学意义(0.126±0.091vs0.200±0.096,P=0.005)。结论:T2DMFPG9:00值高于6:00值(而6:00血糖在16mmol/L以上却相反),可用9:00值来估算6:00值,且口服降糖药组和胰岛素组是有差别的,为血糖调整提供较真实的血糖依据。

<正>患者,男,27岁,因"怕热、多汗6个月"于2010年3月28日收住我科。患者入院15天前在门诊诊断Graves病,并给予甲巯咪唑10 mg每日3次治疗,服药前无皮肤瘙痒,肝功能正常,3天后出现皮肤瘙痒,见风团疹,渐加重,后因皮肤瘙痒难忍再到门诊查间接胆红素升高,收住院。体格检查:神志清,全

脂肪萎缩性糖尿病是一种罕见的疾病,截止目前国外[1]、国内[2]报道仍不多见.现在分析我院诊断一例获得性脂肪萎缩性糖尿病患者,并复习国内外相关文献报道,以提高临床工作者对本病的认识和诊治水平.