报道1例未被识别的肢端肥大症合并糖尿病患者应用钠葡萄糖共转运蛋白2抑制剂（SGLT2i）后迅速出现非高血糖性糖尿病酮症酸中毒（euDKA）的诊治经过。患者以“口干、多饮、多尿”为首发表现就诊当地医院，使用SGLT2i降糖治疗后发生“恶心、呕吐1 d”就诊我院，检测患者血糖、血酮体、阴离子间隙、乳酸均增高，动脉血气分析pH为7.13，实际碳酸氢根降低，诊断为euDKA。立即停用SGLT2i，予以静脉补液、胰岛素持续泵入。生长激素及胰岛素样生长因子均升高，磁共振示鞍区巨大占位，诊断为肢端肥大症。经鼻蝶入路手术切除，组织病理检查示垂体生长激素腺瘤。我们整理该患者的诊治经过，以此警示临床医师在活动性肢端肥大症合并糖尿病患者中应用SGLT2i有发生euDKA的可能，慎重应用以减少药物相关不良结局的发生。

目的 观察利拉鲁肽治疗超重、肥胖2型糖尿病(type 2 dabetes mellitus,T2DM)并肾脏疾病的临床效果.方法 筛选超重、肥胖T2DM患者70例,糖化血红蛋白(glycated hemoglobin,HbA1c)符合(7％≤HbA1c≤11％),随机分成2组,胰岛素联合二甲双胍和(或)阿卡波糖组(胰岛素组)、利拉鲁肽联合二甲双胍和(或)阿卡波糖(利拉鲁肽组):治疗24周,观察治疗前后体重(body weight,WT)、腰围(waist circumference,WC)、HbA1 c、胰岛素抵抗指数(insulin resistance index,HOMA-IR)、尿白蛋白肌酐比值(urinary albumin creatinine ratio,UACR)、估计肾小球滤过率(estimate glomerular filtration rate,eGFR)、血、尿α1-微球蛋白(α1 microglobulin,α1-MG)、血、尿β2-微球蛋白(β2 microglobulin,β2-MG)等指标的变化.结果 研究结束时胰岛素组完成30例,利拉鲁肽组完成31例,胰岛素组治疗后与治疗前比较HbA1c、HOMA-IR、UACR、eGFR、血α1-MG、尿α1-MG、血β2-MG、尿β2-MG明显降低,差异有统计学意义(P＜0.01).利拉鲁肽组治疗后与治疗前比较WT、WC、体重指数、HbA1c、HOMA-IR、UACR、eGFR、血α1-MG、尿α1-MG、血β2-MG、尿β2-MG明显降低,差异有统计学意义(P＜0.01).利拉鲁肽组治疗后与胰岛素组治疗后比较,UACR、eGFR、血α1-MG、尿α1-MG、尿β2-MG降低更加明显,差异有统计学意义(P＜0.05).结论 利拉鲁肽治疗超重、肥胖T2DM合并肾脏疾病患者不仅可以降低血糖、减轻体重,还可以改善肾功能,延缓肾脏疾病的进展,并且这种作用是独立于降糖之外的作用.

目的 观察利拉鲁肽对胰岛素联合二甲双胍治疗血糖控制不佳的超重、肥胖2型糖尿病(type 2dabetes mellitus,T2DM)患者胰岛素抵抗及内脏脂肪的影响.方法 筛选超重、肥胖T2DM患者80例,糖化血红蛋白(glycated hemoglobin,HbA1 c)符合(7％≤HbA1 c≤11％),随机分成2组,胰岛素联合二甲双胍组(对照组)、胰岛素联合二甲双胍的基础上加用利拉鲁肽(利拉鲁肽组),治疗24周,观察治疗前后体重(body weight,WT)、腰围(waist circumference,WC)、体重指数(body mass index,BMI)、空腹血糖(fasting plasma glucose,FPG)、总胆固醇(total lesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、HbA1 c、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(insulin resistance index,HOMA-IR)及内脏脂肪面积(visceral fat area,VFA)的变化.结果 治疗后,对照组FPG、TC、TG、LDL-C、HbA1 c、FINS、HOMA-IR较治疗前均降低,HDL-C升高,差异有统计学意义(P<0.05);利拉鲁肽组WT、WC、BMI、FPG、HbA1 c、TC、TG、LDL-C、FINS、HOMA-IR、VFA较治疗前均降低,HDL-C升高,差异有统计学意义(P<0.05).治疗后,利拉鲁肽组WT、WC、BMI、VFA较对照组均降低(P<0.05).利拉鲁肽组与每日应用胰岛素剂量比对照组减少(P<0.05).VFA降低与WT、WC、BMI降低呈正相关(P<0.05).结论 利拉鲁肽应用于超重、肥胖2型糖尿病患者不仅可以降低血糖还可以减轻体重,改善胰岛素抵抗,减少内脏脂肪,具有临床获益.

目的 探讨青春前期无追赶性生长的小于胎龄儿(SGA)应用重组人生长激素(rhGH)治疗前后骨代谢相关指标的变化及在随访中的临床意义.方法 选取SGA患儿44例为SGA组,健康儿童52例对照组.SGA组患儿予以rhGH 0.15IU/(kg·d),每日皮下注射,分别于治疗前、治疗3个月、治疗6个月测定胰岛素样生长因子(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP3)、骨形成指标Ⅰ型前胶原氨基端前肽(PINP)及骨吸收指标Ⅰ型胶原交联羧基末端肽(β-CTX),同时记录身高、体重、体重指数(BMI)、生长速度、骨龄、身高标准差积分(HtSDS).结果 治疗前SGA组PINP水平低于健康对照组[(478.82±133.91)μg/L比(650.72±211.84)μg/L],β-CTX水平高于对照组[(0.82±0.31)比(0.54±0.17)μg/L],两者差异均有显著性(t=2.266、-2.711,P<0.05).SGA组rhGH治疗前后PINP及 β-CTX在性别间差异无显著性(P>0.05);SGA组应用rhGH治疗3个月后PINP水平[(735.51±155.95)μg/L]及β-CTX水平[(1.10±0.28)μg/L]均较治疗前升高(t=4.763、2.479,P<0.05),其中PINP升高更显著,HtSDS与治疗前比较[(-2.68±0.54)比(-2.96±0.47)],差异有显著性(t=2.716,P<0.05);治疗6个月与3个月比较,PINP水平[(860.95±255.19)μg/L]、β-CTX水平[(0.96±0.34)μg/L]及HtSDS[(-2.50±0.52)]无明显变化(t=1.363、-0.833、1.611,P>0.05).成骨指标PINP与IGF-1、IGFBP3呈正相关性(r=0.638、0.675,P<0.05),与破骨指标β-CTX无相关性(r=0.338,P>0.05),PINP、β-CTX与HtSDS呈正相关(r=0.656、0.783,P<0.05).结论 骨代谢指标PINP、β-CTX可作为rhGH治疗SGA早期疗效的指标之一.

目的 探讨亚临床甲减对血脂及动脉粥样硬化的影响.方法 纳入225例60岁及以上体检人群,按甲状腺功能状态分为亚临床甲减组65例,甲状腺功能正常组190例;测定两组促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3),游离甲状腺素(FT4)、总甲状腺激素(TT4)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、颈动脉内膜中层厚度(CIMT)平均厚度等.比较两组血脂水平及CIMT,并分析TSH与TC、LDL-C、CIMT的独立相关性.结果 亚临床甲减组与甲状腺功能正常组相比,年龄、性别比差异无统计学意义(P>0.05);亚临床甲减组TC、LDL-C、脂蛋白a[Lp(a)],高于甲状腺功能正常组(P<0.05);高密度脂蛋白脂蛋白(HDL-C)低于甲状腺功能正常组(P<0.05);亚临床甲减组内膜中层厚度(IMT)高于甲状腺功能正常组.两组体质指数(BMI)、Apo-A1、载脂蛋白B(Apo-B)、三酰甘油(TG)差异无统计学意义(P>0.05).Pearson相关分析显示TSH值与TC、LDL-C、CIMT成正相关(r=0.202、0.472、0.365,P均<0.05),与BMI、HDL-C、TG、Apo-A无明显相关.结论 老年亚临床甲减患者存在脂代谢异常并且是动脉粥样硬化高危人群,存在心血管疾病高风险.

目的 观察左甲状腺素片及生长激素在治疗甲状腺功能减退导致矮小症中的临床效果.方法 选择确诊为甲状腺功能减退症导致的矮小症患儿80例,将患儿随机分为对照组(左甲状腺素片治疗)和试验组(左甲状腺素片+生长激素治疗)各40例.比较2组治疗前和治疗后3个月、6个月生长速度(growth velocity,GV)、身高标准差积分(height standard deviation score,HtSDS)、预测成年身高(prediction of adultheight,PAH)、骨龄(bone age,BA)、血清骨钙素(osteocalcin,OC)水平.记录治疗前后血清甲状腺激素(thyroxine,T4)水平变化情况.结果 2组治疗后GV、HtSDS、PAH、OC水平均随时间逐渐升高,在治疗3个月时GV、HtSDS、PAH、OC水平无显著差异,治疗6个月时试验组GV、HtSDS、PAH、OC水平明显高于对照组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P＜0.05).2组BA组间、时点间、组间·时点间交互作用差异均无统计学意义(P＞0.05).2组治疗后3个月T4水平均明显升高,其时点间差异有统计学意义(P＜0.05),而其组间、组间·时点间交互作用差异均无统计学意义(P＞0.05).结论 左甲状腺素片联合重组人生长激素治疗甲状腺功能减退导致的矮小症患儿,可以促进其身高的增长,显著提高其甲状腺激素水平.

目的 探讨矮小症的病因,并观察重组人生长激素治疗生长激素缺乏症(growth hormone deficiency,GHD)及特发性矮小症(idiopathic short stature,ISS)的疗效.方法 将矮小症患儿485例依据病因进行分类.将青春期前的GHD及ISS患儿分别分为重组人生长激素治疗组及对照组,比较治疗前、治疗后3个月及治疗后6个月的身高、生长速度(growth rate,GV)及身高标准差积分(height standard deviation score,HtSDS),比较治疗前及治疗后6个月的骨龄.结果 矮小症患儿中ISS最多185例,其次GHD 140例,并发现了罕少疾病.GHD及ISS患儿治疗组身高呈逐渐增高趋势,GV呈先升高再降低趋势,HtDSD呈逐渐升高趋势,对照组身高、GV、HtDSD变化趋势不明显,治疗组身高、GV和HtDSD均明显高于对照组,其组间、时点间、组间时点间交互作用差异有统计学意义(P<0.05).2组GHD及ISS患儿治疗前和治疗6个月以及治疗前后骨龄差异均无统计学意义(P>0.05).结论 矮小症患儿病因多种,以ISS及GHD患儿多见;GHD及ISS患儿早期应用重组人生长激素治疗可实现追赶性生长.

目的 了解糖尿病视网膜病变(DR)患者泪液肿瘤坏死因子(TNF)-α水平及其与DR的关系,探讨以泪液TNF-α水平诊断DR的可行性.方法 分层随机抽样选择石家庄市9个社区,居住5年以上,年龄≥45岁的社区居民,进行横断面流行病学问卷调查,以口服糖耐量试验根据1999年WHO糖尿病(DM)诊断标准确立新诊断DM者.对新诊断及既往诊断DM者,检测泪液TNF-α水平,依据眼底检查确立DR.采用受试者工作特征曲线(ROC)进行判断,得到以泪液TNF-α水平诊断DR的最佳切点,计算阳性似然比(+LR),阴性似然比(-LR),阳性预测值(+PV),阴性预测值(-PV).结果 泪液TNF-α水平在正常糖耐量(NGT)组为(0.76±0.24)pg/ml,糖尿病无视网膜病变(NDR)组为(5.86±2.21)pg/ml,DR组为(10.69±3.67)pg/ml,组间差异有统计学意义(P<0.01).血液TNF-α在NGT组为(6.80±3.73)pg/ml,NDR组为(21.44±9.16)pg/ml,DR组为(31.16±10.43)pg/ml,组间差异有统计学意义(P<0.01).泪液TNF-α水平与血液TNF-α水平存在正相关(R=0.795,P<0.01).通过绘制ROC曲线,得到泪液TNF-α水平诊断DR相关的临界点为9.07 pg/ml,约登指数为0.600,敏感性和特异性分别为66.5%和6.5%,曲线下面积为0.867(95%CI为0.832~0.901).+LR 10.23,-LR 0.36,+PV为60.38%,-PV 54.53%.结论 石家庄市社区中老年DR患者泪液IL-6水平明显增高.泪液TNF-α水平作为DR诊断手段,有可行性.

Ojective To explore the effects of sitagliptin and irbesartan used alone or in combination on levels of serum cystatin C (CysC) and interleukin-18 (IL-18) and twenty-four hours urine albumin emission rate (UAER) in patients with early diabetic nephropathy.Methods Ninty patients with early diabetic nephropathy were randomly divided to three groups, with 30 patients in each group. Based on former treatment and life style, the patients in the sitagliptin group were treated with sitagliptin 100 mg, po, qd; the patients in the irbesartan group were treated with irbesartan 150 mg, po, qd; the patients in the combination therapy group were treated with sitagliptin (100 mg, po, qd) and irbesartan (150 mg, po, qd). All patients in each group received the correlative therapy for 12 weeks. Glycosylated hemoglobin (HbAlc), serum CysC, IL-18 and 24 h urine albumin emission rate (UAER) were measured before and after treatment.Results Compared with those before the treatment, levels of CysC, IL-18 and UAER were significant lower after treatment in three groups (P＜0.05), especially for the combination therapy group (P＜0.05). There was no significant difference between the sitagliptin group and irbesartan group (P＞0.05). The HbAlc level decreased in the sitagliptin group and combination therapy group (P＜0.05) after the treatments, no significant difference between two groups (P＞0.05).Conclusion Sitagliptin used alone or combined with irbesartan can ameliorate blood glucose level and improve renal function ameliorate in patients with early diabetic nephropathy, and the combination therapy is superior to monotherapy. Decline in serum CysC and IL-18 can effectively response the improvement of renal function, and sitagliptin may play a role of renal protection by resisting oxidative stress.

OBJECTIVE:To observe clinical efficacy and safety of sitagliptin combined with metformin in the treatment of type 2 diabetes complicating with metabolic syndrome. METHODS:Totally 80 patients with type 2 diabetes complicating with meta-bolic syndrome were divided into the observation group and control group with 40 cases in each group according to simple random sampling method. Both groups were given same diet and exercise plan;control group was additionally given metformin orally,0.5 g each time,tid;observation group was additionally given sitagliptin,100 mg each time,qd,on the basis of control group. Treat-ment course of 2 groups lasted for 12 weeks. The waist circumference(WC),body mass index(BMI),blood glucose,blood lip-id,fasting insulin (FINS) and serum adiponectin were detected in 2 groups,and steady-state model insulin resistance index (HOMA-IR)and whole body insulin sensitivity index(WBISI)were calculated. The occurrence of ADR was observed. RESULTS:Before treatment,there were no statistically significant differences between 2 groups in WC,BMI,systolic blood pressure,diastol-ic blood pressure,triglycerides,cholesterol,high-density lipoprotein cholester,low-density lipoprotein cholesterol,fasting plasma glucose,2 h postprandial blood glucose,FINS,HOMA-IR,WBISI and serum adiponectin(P>0.05). After treatment,the above indexes of 2 groups were obviously improved,and the improvement of observation group was significantly better than that of con-trol group,with statistical significance(P<0.05). 2 cases and 3 cases were withdraw from the study in control group and observa-tion group because of ADR,respectively.There was no statistically significant difference in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Sitagliptin combined with metformin shows significant clinical efficacy in the treatment of type 2 di-abetes complicating with metabolic syndrome. Its mechanism may be related to reducing insulin resistance,enhancing insulin sensi-tivity,decreasing patients’body weight and up-regulating serum adiponectin level.

目的 探讨西格列汀联合二甲双胍治疗血糖升高的代谢综合征的临床疗效,为血糖升高的代谢综合征患者的治疗提供临床依据.方法 选取2013年1月至2014年6月我院收治的血糖升高的代谢综合征患者75例,按照随机抽样方法分为观察组和对照组,对照组给予二甲双胍治疗,观察组给予西格列汀联合二甲双胍治疗,2组均给予同样的饮食和运动方案,疗程均为12周.检测2组患者的腰围(WC)、体质指数(BMI)、血糖、血脂、空腹胰岛素、血清脂联素等生化指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)和总体胰岛素敏感指数(WBISI)并进行对比.结果 治疗后,观察组和对照组患者的WC、BMI、收缩压(SBP)、舒张压(DBP)、甘油三脂(TG)、总胆固醇(rC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、HOMA-IR、WBISI和血清脂联素均较治疗前明显改善,观察组改善效果优于对照组(P＜0.05).结论 西格列汀联合二甲双胍治疗血糖升高的代谢综合征临床疗效更显著.

DiGeorge syndrome is caused by a microdeletion of chromosome 22q11.2 and leads to the abnormal development of the third and fourth pharyngeal pouches. This syndrome is characterized by hypoparathyroidism, cellular immunodeficiency secondary to thymic hypoplasia, congenital heart disease, and dysmorphic facial features. In this case report, we describe a 9-year-old male child who was admitted to our hospital because of hypocalcaemia-induced seizures. The patient presented with hypoparathyroidism, congenital heart defects, mild facial anomalies and short stature. A computed tomography (CT) scan of the brain showed extensive symmetric bilateral calcification within the basal ganglia. A chest CT scan showed that there was no thymus. The echocardiogram assessment revealed the presence of a ventricular septal defect. The electroencephalogram showed both a spike-slow wave and a sharp-slow wave. The multiplex ligation-dependent probe amplification (MLPA) revealed that the patient had a deletion of 22q11.2. The patient was treated with vitamin D and calcitriol and achieved an acceptable response. The patient did not experience additional seizures during the follow-up period and continued calcium treatment. The patient subsequently achieved compensatory growth.

Objective To investigate the effect of Sitagliptin on glucose and risk factors , relevant risk factors of car-diovascular complications in type 2 diabetes mellitus .Methods 60 patients selected in the study were first diagnosed with type 2 diabetes in the endocrinology department of the First Hospital of Shjiazhuang during January 2013 and June 2014 .They had poor glucose control after being treated with Metformin in the latest 3 months.The patients were randomly divided into Sitagliptin group (30 cases) and Acarbose group (30 cases).The two groups were respectively given a daily dose of 100 mil-ligram of Sitagliptin and a daily dose of 150 milligram of Acarbose in addition to routine treatment for 24 weeks.The body mass index (BMI), glucose level, blood pressure, carotid intimae media thickness (CIMT) and the markers of cardiovascular risk factor of the two groups pretherapy and 24 weeks after treatment were observed and compared .The adverse reaction of two groups during therapy was also observed .Results Compared with that of pretherapy , the levels of BMI , level of fasting plas-ma glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin were decreased after 24 weeks of treatment in both groups.After 24 weeks of treatment , the Sitagliptin group had a greater decrease in BMI , compared with the Acarbose group ( P<0.05 ) .Compared with that of pretherapy , the CIMT was decreased in Sitagliptin group after 24 weeks of treatment .Af-ter 24 weeks of treatment , compared with Acarbose group , the CIMT in Sitagliptin group was obviously reduced ( P<0.05 ) . Compared with that of pretherapy , the levels of homocysteine , C-reactive protein , mannose binding lectin , plasminogen activa-tor inhibitor-1, mat-rix metalloproteinase-9 declined significantly in the Sitagliptin group after 24 weeks of treatment .After 24 weeks of treatment , compared with those of Acarbose group , the markers of Sitagliplin group were lower ( P<0.05 ) .Conclu-sion Sitagliptin has similar effect in reducing blood glucose level as Acarbose , but Sitagliptin can reduce body weight effec-tively and has some protective effect on cardiovascular complications through inhibition of theses markers .

目的：研究西格列汀对2型糖尿病患者黎明现象的影响。方法：将住院行动态血糖监测且存在黎明现象的2型糖尿病患者65例，予以西格列汀口服2周后，比较治疗后血糖水平及黎明现象变化。治疗前后采用配对t检验。结果：口服西格列汀治疗2周后，患者24 h平均血糖、空腹血糖与夜间最低点血糖净增值（BG1）、早餐后2 h与早餐前血糖净增值（BG2）均显著低于治疗前（P ＜0．05）。治疗前后动态血糖监测低血糖的所占时间百分比差异无统计学意义（P ＞0．05）。结论：西格列汀通过改善胰岛功能而改善黎明现象，从而优化整体血糖水平。

目的 观察阿托伐他汀钙、普罗布考对非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)大鼠的影响,探讨其作用机制.方法 雄性成年SD大鼠32只随机分4组:正常对照组,普通饲料喂养,并予生理盐水灌胃;模型组,高脂饲料喂养,并予生理盐水灌胃;普罗布考干预组,高脂饲料喂养,并予普罗布考灌胃;普罗布考联合阿托伐他汀干预组(联合干预组),高脂饲料喂养,并予普罗布考灌胃和阿托伐他汀溶于生理盐水灌胃.饲养至18周末,处死大鼠,观察血脂、胰岛素、血糖等指标的变化,测定各组血清肿瘤坏死因子a(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)、白细胞介素8(interleukin-6,IL-8)的水平.结果 模型组、普罗布考干预组、联合干预组体质量和肝指数均高于正常对照组;普罗布考干预组、联合干预组体质量低于模型组(P＜0.05).模型组大鼠三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、丙氨酸转氨酶(alanine transaminase,ALT)明显高于正常对照组;普罗布考干预组TG、TC、LDL-C明显高于正常对照组,TG、TC、LDL-C、ALT低于模型组;联合干预组TG、TC、LDL-C、低于模型组和普罗布考干预组,ALT低于模型组;模型组、普罗布考干预组、联合干预组高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)低于正常对照组(P＜0.05).模型组、普罗布考干预组、联合干预组大鼠的血清胰岛素明显高于正常对照组(P＜0.05).模型组、普罗布考干预组、联合干预组大鼠内脏脂肪和内脏脂肪系数均高于正常对照组(P＜0.05),普罗布考干预组、联合干预组内脏脂肪高于模型组(P＜0.05).模型组、普罗布考干预组、联合干预组糖化血红蛋白高于正常对照组(P＜0.05).模型组、普罗布考干预组大鼠外周血清IL-8、IL-6、TNF-α水平高于正常对照组,普罗布考干预组、联合干预组血清IL-8、IL-6、TNF-α水平低于模型组,联合干预组血清IL-8、IL-6、TNF-α水平低于普罗布考干预组(P＜0.05).结论 普罗布考可能通过减轻肝细胞炎症反应来发挥保肝作用;普罗布考与阿托伐他汀在降脂方面可能存在协同作用.

Objective To observe the effects of probucol on the pathogenesis of nonalcoholic fatty liver ( NAFLD) in rats,and to explore its action mechanism.Methods Thirty SD rats were randomly divided into blank control group, high fat group and observation group, with 10 rats in each group.The rats were fed with high fat diet for 18 weeks to induce NAFLD models.Then all the rats were sacrificed,and the serum levels of blood lipid and liver function related indexes including TC, TG, AST, ALT,HDL and LDL were detected,at the same time, the expression levels of FXR and SHP and SREBP-1c mRNA were measured.Results Among the 3 groups, the degree of liver lesions in high fat group was the severest,which in blank control group was the slightest.The fatty pathological changes, severity of inflammation and fibrosis lesion scores in observation group were (297 ±0.18) points, (1.29 ±0.27) points and (0.05 ±0.02) points,respectively,which were located between the other two groups.The serum levels of TC,ALT, AST and LDL in high fat group were significantly increased,as compared with those in blank control group and observation group, moreover, the increase degree in high fat group was more obvious (P<0.05).The expression levels of FXR, SHP and SREBP-1c mRNA in blank control group were (0.92 ±0.42)β-actin, (1.01 ±0.60)β-actin,(0.68 ±0.27)β-actin,respectively,which were significantly higher than those in high fat group ( P <0.05).The expression levels of FXR, SHP mRNA in observation group were (0.28 ±0.13)β-actin and (0.42 ±0.23)β-actin,respectively,there were significant differences between observation group and the other two groups ( P <0.05 ) . However the expression levels of SREBP-1c mRNA in observation group were (0.68 ±0.22)β-actin, there were no significant differences between observation group and blank control group ( P >0.05 ) .Conclusion The probucol has certain preventive effects on NAFLD in rats induced by high fat diet,which can obviously relieve liver fatty degeneration of rats,and the action mechanism may be correlated to the enhancement of antioxidation ability of rats to reduce the incidence rate of tissue lesion caused by oxidative stress.

Objective To investigate the relationship between the severity of diabetic retinopathy( DR)in middle-aged and elderly diabetes patients and the levels of tear fluid TNF-α, serum TNF-α and serum HbA1c in Shijiazhuang. Methods From April to October in 2011,we selected 9 community residents(resident years≥5,age≥45)in Shijiazhuang using stratified random sampling. According to diagnostic criteria,the patients were definitely diagnosed and determined with different phrases. Venous blood was sampled,and FPG,2 hPG,blood lipid,TNF-α and HbA1c were determined. Capillary&nbsp;glass tube method was employed,and ELISA was employed to determine TNF-αlevel. Results A total of 1 447 patients were included,among which 467 had normal glucose tolerance ( NGT ) and 593 had DM;among subjects who received fundus examination and offered tear samples,105 subjects had NGT(210 eyes,NGT group),184 subjects had diabetes without retinopathy(368 eyes,NDR group),149 had non-proliferating diabetic retinopathy(298 eyes,NPDR group),and 63 had proliferative diabetic retinopathy(126 eyes,PDR group). The 4 groups were significantly different in BMI,WHR,SBP, DBP,FPG,TC,TG,HDL-C and LDL-C( P ﹤0. 01 for all). NGT group,NDR group,NPDR group and PDR group were significantly different in the levels of tear fluid TNF-α,serum TNF-α and serum HbA1c ( P ﹤0. 05 for all). NDR group,NPDR group and PDR group were higher than NGT group in the levels of tear fluid TNF-α,serum TNF-αand serum HbA1c ( P﹤0. 05 for all);NPDR group and PDR group were higher than NDR group in the levels of tear fluid TNF-α,serum TNF-α and serum HbA1c ( P﹤0. 05 for all);PDR group was higher than NPDR group in the levels of tear fluid TNF-α, serum TNF-α and serum HbA1c ( P﹤0. 05 for all). The level of tear fluid TNF-α was positively correlated with the level of serum TNF-α(b =0. 291,t =29. 28,P ﹤0. 01). Tear fluid TNF-α was positively correlated with serum HbA1c(b =1. 480,t=7. 58,P ﹤0. 01). Multivariate Logistic regression analysis showed that age,gender,history of diabetes,BMI, WHR,TG,FPG,2 hPG, tear fluid TNF-α, serum TNF-α and HbA1c were influencing factors for DR ( P ﹤0. 05 ). Conclusion Middle-aged and elderly residents with type 2 diabetes have higher tear fluid TNF-αlevel than healthy middle-aged and elderly residents. With the exacerbation of retinopathy,the tear fluid TNF-α level increases. The levels of tear fluid TNF-α,serum TNF-α and serum HbA1c may reflect the severity of DR to some extent.

Objective To investigate the relationship between HbA1c in blood and IL-6 in tear fluid of the elderly patients with diabetic retinopathy ( DR ) in Shijiazhuang urban communities , and the relationship between IL-6 in tear fluid and the severity of DR. Methods The elderly people who lived more than 5 years , older than ≥45 year old. in nine urban communities of Shijiazhuang were stratified randomly sampled and received cross-sectional epidemiology questionnaire survey and OGTT. A total of 1 447 subjects (509 males and 938 females) were included. Each participant underwent epidemiological surveys and oral glucose tolerance test (OGTT), according to the 1999 WHO diabetes mellitus (DM) diagnostic criteria established. For patients who were newly or previously diagnosed as DM. HbA1c level, tear fluid IL-6 and serum IL-6 tested.The severity of DR was evaluated by fundus examination, the people were divided into normal group(NGT), non-diabetic retinopathy ( NDR ) , non-proliferative diabetic retinopathy ( NPDR ) , and proliferative diabetic retinopathy ( PDR ) . The correlation of serum IL-6 and tear fluid IL-6,blood HbA1c and tear fluid IL-6 were assessed by SPSS 19.0 statistical software. Results Concentrations of tear fluid IL-6 were (3.10 ± 1.25)pg/mL in the NGT group, (10.25 ± 3.22)pg/mL in the NDR group,(16.80 ± 5.76)pg/mL in the NPDR group,(25.11 ± 5.20)pg/mL in the PDR group(P < 0.01). SNK-q test revealed significant differences between every two groups (P < 0.01,P <0.05,P < 0.05) Concentrations of serum IL-6 were (88.04 ± 17.06)pg/mL in the NGT group,(126.38 ± 20.73) pg/mL in the NDR group, (239.83 ± 40.33)pg/mL in the NPDR group, (268.36 ± 27.72)pg/mL in the PDR group(P < 0.01). SNK-q test revealed significant differences between every two groups (P < 0.01). Tear fluid IL-6 level was positively correlated with serum IL-6 level(R = 0.756,P < 0.01). Tear fluid IL-6 level was positively correlated with blood IL-6 level (R = 0.338, P < 0.01). Conclusion The tear fluid IL-6 levels of the elderly patients with DM in Shijiazhuang urban communities , increased; with the increased severity of DR , the levels of tear fluid IL-6 gradually increase. The level of tear fluid IL-6, serum IL-6, HbA1c closely correlates with the severity of DR.

There is currently no established treatment for non‑alcoholic fatty liver disease (NAFLD), including its most extreme form, non‑alcoholic steatohepatitis (NASH). Ezetimibe, an inhibitor of Niemann‑Pick C1 Like 1‑dependent cholesterol absorption, improves diet‑induced hyperlipidemia and attenuates liver steatosis and insulin resistance. The aim of the present study was to determine whether ezetimibe treatment is able to inhibit the development of NAFLD, and to elucidate the underlying mechanism, using C57BL/6J (B6) mice maintained on a high‑fat diet. Male B6 mice (20 weeks of age) were divided into the following two groups (n=7 in each group): Mice fed a high‑fat diet for four weeks and mice fed a high‑fat diet with 0.0064% (wt/wt) ezetimibe (5 mg/kg/day) for four weeks. Administration of ezetimibe significantly reduced liver steatosis and fibrosis. Ezetimibe reduced serum cholesterol, hepatic fat accumulation and insulin resistance in the liver of mice fed the high‑fat diet. Furthermore, ezetimibe significantly reduced hepatic mRNA expression of Acc1 and Scd1, which are involved in hepatic fatty acid synthesis. Ezetimibe significantly reduced hepatic Cd36 gene expression, upregulation of which is significantly associated with insulin resistance, hyperinsulinemia and increased steatosis. The protein expression of SKP2, a viable therapeutic target in human cancer, was also reduced by ezetimibe. These findings suggest that ezetimibe may be an effective therapy for high fat‑induced NAFLD, including NASH.

Objective To observe the curative effect of allogeneic induced pluripotent stem cells( IPSC)in treatment of diabetic foot ulcers in SD rats by local transplantation,and the effect on vascular endothelial growth factor( VEGF). Meth-ods A total of 40 male SD rats were randomly divided into IPSC treatment group(n=20)and control group(n=20). Rat&nbsp;models of diabetic foot ulcers were established in the two groups. In the IPSC treatment group,ulcer wounds were multipointly injected with IPSC suspensions into tunica dartos retia,while the control group was injected with the same volume of Knockout DMEM culture solution. The ulcer areas on the 1st d,5th d and 10th d of treatment and VEGF levels in peripheral blood of the two groups were observed and comparedResults The 40 SD rat models were successfully established. There was no significant difference in ulcer area on the 1st d of treatment in the two groups(P﹥0. 05);ulcer areas in IPSC treatment group on the 5th d and 10th d of treatment were significantly smaller compared with those in control group(P﹤0. 05). There was no significant difference in VEGF level of peripheral blood on the 1st d of treatment in the two groups(P﹥0. 05);levels of peripheral blood in IPSC treatment group on the 5th d and 10th d of treatment were significantly higher than those in control group(P﹤ 0. 05). Conclusion IPSC allotransplantation may promote the healing of diabetic foot ulcers and local neovascularization in SD rats.