Rationale: Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal-dominant genetic syndrome, frequently misdiagnosed or neglected clinically, resulting in delayed therapy to patients. Patient concerns: A 47-year-old Chinese male patient underwent laparoscopic right adrenal tumorectomy, and postoperative pathology confirmed the tumor as pheochromocytoma (PHEO). He was readmitted to the department of endocrinology and metabolism due to constant increase in carcinoembryonic antigen (CEA) at 5 months after the operation. Diagnosis: The patient was confirmed with medullary thyroid carcinoma (MTC), multiple neck lymph node metastasis, and pituitary microadenoma. The p.Cys611Tyr (c.1832G>A, C611Y) mutation was detected. Therefore, he was diagnosed with MEN2A. Interventions: He underwent total thyroidectomy. The gene-sequencing analysis of his family was conducted, and the C611Y mutation was detected in his daughter. Outcomes: The level of carcinoembryonic antigen decreased significantly after thyroidectomy in this patient. Long-term follow-up management was conducted. Elevated serum calcitonin and bilateral thyroid nodules were found in his 13-year-old daughter. Thus, MEN2A was highly suspected and she was suggested to undergo total thyroidectomy. Conclusion Patients with MEN2A should be screened regularly and managed by a multidisciplinary team.

目的:探讨维格列汀对非酒精性脂肪肝(NAFLD)大鼠肝组织炎性因子表达的影响及其可能机制.方法:取SD大鼠24只随机分成3组,每组8只.模型组采用皮下注射CCL4溶液的方法建立NAFLD大鼠模型,正常组皮下注射等量生理盐水,干预组在建立NAFLD大鼠模型同时给予维格列汀灌胃.第8周断头处死大鼠,检测血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)水平;HE染色观察肝组织病理改变,实时PCR和免疫组化法检测肝组织解偶联蛋白2(UCP2)mRNA和蛋白表达.结果:干预组大鼠血清IL-6、TNF-α、ALT、AST水平较模型组均显著下降(均P<0.05).病理检查显示,正常组肝小叶结构清晰完整,肝细胞未见明显脂肪变性;模型组肝细胞肿胀,胞质疏散,含脂肪粒,肝细胞核固缩;干预组肝细胞趋于正常,脂肪粒变小.模型组大鼠肝组织UCP2 mRNA和蛋白表达均明显高于正常组和干预组(均P<0.05).结论:维格列汀可抑制NAFLD大鼠肝组织UCP2表达,降低血清炎性因子水平,改善肝功能.

目的 探讨维格列汀联合二甲双胍治疗2型糖尿病的疗效及安全性.方法 随机单双号法将150例2型糖尿病患者分为观察组与对照组,每组75例,对照组给予二甲双胍片1 g/次口服,2次/d;观察组在对照组基础上联合维格列汀片治疗,50 mg/次口服,2次/d.比较两组治疗前后血糖、胰岛素抵抗指数(HOMA-IR)、胰岛素β细胞功能指数(HOMA-β)、体重指数(BMI)及炎症因子变化,并观察两组不良反应.结果 两组治疗后空腹血糖(FPG)、餐后2h血糖(2hPG)、HOMA-IR、白介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)水平比同组治疗前均显著下降,HOMA-β显著上升,差异有统计学意义(P<0.05);观察组治疗后FPG、2hPG、HbAlc、IL-6、IL-1β、TNF-α水平均显著低于对照组,HOMA-β显著高于对照组,差异有统计学意义(P<0.05);两组治疗前后BMI、不良反应发生率比较差异均无统计学意义(P>0.05).结论 维格列汀联合二甲双胍能有效控制2型糖尿病患者血糖,改善胰岛B细胞功能,抑制炎症反应,安全可行.

目的 观察二甲双胍对非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)小鼠的肝组织NF-κB活性、血清白介素6(IL-6)表达及转氨酶影响,并探讨二甲双胍防治NASH的可能机制.方法 24只昆明小鼠随机分为3组:对照组、模型组、治疗组.凝胶迁移率变动分析(EMSA)检测小鼠肝组织NF-κB活性;ELISA法检测小鼠血清IL-6表达;全自动生化仪检测小鼠转氨酶水平,了解各组小鼠肝脏损伤情况.结果 与模型组比较,治疗组小鼠肝组织NF-κB活性、血清IL-6和转氨酶水平降低,差异有统计学意义(P＜0.05);与对照组比较,治疗组小鼠肝组织NF-κB活性、血清IL-6和转氨酶水平升高,差异有统计学意义(P＜0.05).结论 二甲双胍能降低NASH小鼠肝组织NF-κB活性、血清IL-6和转氨酶水平.

目的 观察维格列汀联合二甲双胍对新诊断2型糖尿病患者的疗效.方法 59例新诊断2型糖尿病患者依据随机数字表随机分为维格列汀组(n=20)、二甲双胍组(n=20)、维格列汀和二甲双胍联合治疗组(n=19),比较治疗前后三组患者空腹及餐后2h血糖、胰岛素(FPG、2hPG、Fins、2bIns)水平,糖化血红蛋白(HbAlc)水平,计算胰岛β细胞功能指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR).结果 三组患者血糖水平及HbAlc较治疗前均降低(P＜0.05);HOMA-β较治疗前升高(P＜0.05);HOMA-IR较治疗前有降低,仅二甲双胍组及联合治疗组差异有统计学意义(P＜0.05).组间比较联合治疗组各监测指标改善最明显(P＜0.05).三组均未出现肝肾功能异常亦无低血糖事件报告.结论 维格列汀联用二甲双胍可以良好控制新诊断2型糖尿病患者血糖,改善胰岛β细胞功能.

目的：观察维格列汀对2型糖尿病（T2DM）患者血清丙二醛（MDA）、超氧化物歧化酶（SOD）和8-羟基脱氧尿苷（8-hydroxy-deoxyguanosine，8-OHdG）水平的影响，了解其抗氧化应激作用。方法：30例血糖控制欠佳的T2DM患者在常规治疗基础上加用维格列汀治疗，24周后观察治疗前后检测血清MDA、SOD和8-OhdG水平变化。结果：治疗24周后，治疗组MDA和8-OHdG水平较治疗前明显下降（P＜0.05），差异显著；SOD水平较治疗前上升（P＜0.05），差异显著。结论：维格列汀能降低T2DM患者MDA、8-O－HdG和升高SOD水平，减轻T2DM患者的体内氧化应激。

OBJECTIVE:To evaluate the effect of vildagliptin on 8-hydroxy-deoxyguanosine (8-OHdG) in urine of patients with type 2 diabetes mellitus ( type 2 diabetes melitus.T2DM) and investigate its antioxidative stress effect and efficacy in the prevention and treatment of diabetic complications.METHODS:82 T2DM patients with poor blood glucose control were randomized to either combined vildagliptin treatment group ( group A ) or sulfonylurea drug treatment group ( group B ) for treatment of 12 weeks.Fasting blood glucose ( FBG ) , glycosylated hemoglobin ( HbA1c) and urinary 8-OHdG levels in the 2 groups were recorded before and after treatment.RESUTLS: After completion of 12-week treatment, among a total of 75 cases including 37 cases in group A and 38 cases in group B, 2 in group A and 2 in group B were lost to follow-up, and 2 in group A and 1 in group B were excluded because of failure to meet the target of blood glucose control.After 12 weeks of treatment, compared with before treatment, FBG, HbA1c and urinary 8-OHdG levels decreased significantly in both groups (P<0.01);the differences between the two groups in FBG, HbA1c levels were of no statistical significance (P>0.05), but the differences in urinary 8-OHdG levels have significant difference ( P<0.05 ) .CONCLUSIONS: The action of vildagliptin to reduce urinary 8-OHdG level and attenuate oxidative stress in patients with T2DM may be one of the mechanisms underlying its efficacy in the prevention and treatment of diabetic nephropathy and other chronic complications.

目的 了解甲钴胺、叶酸对2型糖尿病(T2DM)肾病(DN)患者的干预效果.方法 将T2DM肾病患者随机分为三组,分别给予叶酸、甲钴胺和叶酸+甲钴胺治疗,对照组为健康人.对比观察各组的血Hcy、尿蛋白、叶酸和VitB12水平.结果 干预前血浆Hcy与VitB12、叶酸均呈负相关.叶酸组、甲钴胺组和叶酸+甲钴胺组的Hcy、尿蛋白水平干预后低于干预前及对照组(P＜0.05).结论 叶酸与甲钴胺治疗可降低DN患者血中Hcy水平及尿蛋白(UAER及24H U-Pro)水平.

Objective To investigate the clinical significance of homocysteine(HCY) ,lipid and blood rheology indicator in patients with diabetic retinopathy .Methods A total of 121 patients with diabetes were divided into dia-betic retinopathy group(52 cases) and non-diabetic retinopathy group (69 cases) ,and 50 cases of healthy subjects were enrolled as control group .HCY ,fasting blood glucose(FBG) ,glycosylated hemoglobin(HbA1c) ,total cholester-ol(TC) ,triacylglycerol(TG) ,low density lipoprotein cholesterol(LDL-C) ,high density lipoprotein cholesterol(HDL-C) and blood rheology indexes were detected in all groups .Results (1)Compared with control group ,levels of HCY , FBG ,HbA1c ,TC ,TG ,LDL-C and blood rheology indexes in diabetic retinopathy group and non-diabetic retinopathy group were obviously higher(P<0 .01) .(2)Compared with non-diabetic retinopathy group ,levels of HCY ,HbA1c , TC ,TG ,LDL-C and blood rheology indexes in diabetic retinopathy group were obviously higher (P<0 .01) .(3)The difference of HDL-C level between each group were not significant (P>0 .05) .Conclusion Patients with Diabetic retinopathy might be with hyperhomocystinemia ,metabolic disorder of lipid and abnormal blood rheology ,and detec-tion of HCY ,blood lipid and blood rheology indexes could contribute to early diagnosis of diabetic retinopathy .

目的 探讨维格列汀与二甲双胍联合治疗对2型糖尿病患者白细胞介素6(IL-6)、肿瘤坏死因子a(TNF-a)、C反应蛋白(CRP)的影响.方法 将104例2型糖尿病患者平均分为研究组与对照组.对照组给予盐酸二甲双胍治疗,研究组在对照组的基础上联合维格列汀治疗.结果 两组血糖指标(FPG、HbAlc、2hPG)明显降低(P＜0.05);且研究组FPG、HbAlc水平低于对照组(P＜0.05).研究组IL-6、TNF-a、CRP水平明显低于对照组及治疗前(P＜0.05).结论 针对2型糖尿病患者采取维格列汀与二甲双胍联合治疗,可以有效改善血糖水平,延缓糖尿病病情进展,降低合并症及并发症的发生率,安全可靠,适于推广.