Objective:To explore the clinical value of adenosine stress myocardial contrast echocardiography in detecting myocardial blood perfusion abnormalities in patients with type 2 diabetes mellitus.Methods:Twenty-six patients with type 2 diabetes mellitus clinically diagnosed from May 2019 to January 2020 in the endocrinology department of Fuwai Central China Cardiovascular Hospital and 28 healthy examinees with gender and age matched during the same period were enrolled. Routine echocardiography, rest and adenosine stress myocardial contrast echocardiography were performed, the plateau signal intensity(A value), curve rising slope(K value) and A×K value of the myocardial perfusion time-intensity curve were obtained by offline analysis. And general data such as age, gender, disease course, body mass index and glycated hemoglobin were collected, and results of the two groups were compared statistically.Results:In the rest state, the A value of the myocardial perfusion parameter in the diabetic group was not significantly different from that of the control group, both in whole and in segments ( P>0.05), while the K value and A×K value of the myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group ( P<0.05). In the stress state, the A value, K value and A×K value of myocardial perfusion parameters in the diabetic group were significantly lower than those in the control group, both in whole and in segments ( P<0.05). The detection rate of myocardial perfusion abnormality in the stress state was significantly higher than that in the rest state, and the difference was statistically significant ( P<0.05). The myocardial blood flow reserve in the diabetic group was negatively correlated with the course of disease and the level of glycated hemoglobin ( r=-0.580, P=0.020; r=-0.481, P=0.013). Conclusions:Adenosine stress myocardial contrast echocardiography can be used for detection of left ventricular myocardial perfusion abnormalities in patients with type 2 diabetes mellitus, which has great clinical application value.

Objective To investigate the levels of fibrinogen in patients with type 2 diabetes mellitus (T2DM) with hypothyroidism , and analyze its correlation with clinical biochemical parameters . Methods One hundred and forty-eight patients with T2DM complicated with hypothyroidism and 77 patients with T2DM who were treated in the First Affiliated Hospital of Zhengzhou University from October 2017 to March 2018 were selected as research objects .According to their disease condition , they were divided into T2DM with subclinical hypothyroidism group (79 cases), T2DM with clinical hypothyroidism group ( 69 cases ) and simple T2DM group ( 77 cases ).The general biochemical indexes , thyroid function and fibrinogen level of the three groups were measured .The change of fibrinogen level in T2DM patients with hypothyroidism and its correlation with clinical biochemical indexes were observed and analyzed by case-control study.Results The blood glucose in T2DM with subclinical hypothyroidism group and T2DM with clinical hypothyroidism group were lower than that in simple T 2DM group (P＜0.05).Compared to the simple T2DM group, the level of total cholesterol ( TC) , triglycerides (TG) , low density lipoprotein ( LDL), thyroid stimulating hormone ( TSH ), fibrinogen ( FIB ) were increased in T2DM with subclinical hypothyroidism group and T 2DM with clinical hypothyroidism group , but the level of free thyroxine ( FT4) was decreased ( P＜0.05).Compared to T2DM with subclinical hypothyroidism group , the level of TC, TG, LDL, TSH, FIB were higher in T2DM with clinical hypothyroidism group , but the level of FT4 was lower ( P ＜0.05 ).The level of FIB was negatively correlated with high density lipoprotein ( HDL ), free triodothyronine ( FT3 ), FT4 in T2DM with subclinical hypothyroidism group and T 2DM with clinical hypothyroidism group , but it was positively correlated with LDL, and TSH ( P ＜0.05 ).Conclusions Patients with T2DM complicated with hypothyroidism have dyslipidemia and elevated fibrinogen level .

目的 为探讨胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)受体激动剂对骨保护作用的机制,应用GLP-1受体激动剂(艾塞那肽)干预高脂导致的小鼠成骨细胞凋亡实验,观察艾塞那肽在成骨细胞凋亡过程中的保护作用.方法 体外应用含500μmol/L棕榈酸(palmitic acid,PA)完全培养基处理小鼠成骨细胞MC3T3-E114模拟体内高脂环境,分组如下:正常对照组(0μmol/L PA)、 高脂组(500μmol/L PA)、 高脂+艾塞那肽(1、10、100、1000 nmol/L)浓度梯度组分别孵育成骨细胞24 h.根据实验结果选择艾塞那肽最佳浓度100 nmol/L进行后续实验,分正常对照组、 艾塞那肽组、 高脂+艾塞那肽组、 高脂组,观察艾塞那肽对成骨细胞增殖和凋亡的影响.Cell Counting Kit-8试剂盒检测细胞增殖活性;Annexin V-FITC/PI凋亡检测试剂盒检测细胞凋亡率;RT-qPCR技术检测各组细胞内质网应激相关基因GRP78、CHOP、Caspase-12 mRNA的表达.结果 与正常对照组相比,高脂组细胞活性明显下降(OD值:2.612±0.106 vs.2.394±0.088,P<0.01);与高脂组相比,高脂+艾塞那肽1000 nmol/L组、 高脂+艾塞那肽100 nmol/L组、 高脂+艾塞那肽10 nmol/L组细胞增殖活性明显升高(OD值:2.394±0.088、2.547±0.068、2.579±0.060、2.496±0.114,P<0.05),高脂+艾塞那肽1 nmol/L组对细胞的增殖活力无明显影响(P>0.05).选择艾塞那肽100 nmol/L为最佳浓度重复干预后发现,与高脂组相比,高脂+艾塞那肽100 nmol/L组的细胞增殖活力明显升高(OD值:2.161±0.203,2.399±0.193,P<0.01);细胞凋亡率明显下降(19.633％±3.169％,5.400％±2.304％,P<0.01);GRP78、CHOP mRNA的表达量明显下降(P<0.01),Caspase-12 mRNA的表达量回升(P<0.05).结论 GLP-1受体激动剂艾塞那肽可能通过内质网应激途径,改善PA造成的小鼠成骨细胞增殖活性减低以及凋亡的发生.

Objective: To analyze the clinical and genetic features of primary hypertrophic osteoarthropathy (PHO). Methods: The clinical data of one Chinese pedigree of PHO, namely pachydermoperiostosis (PDP) were collected.Blood samples were drawn from the propositus and other family members.DNA was extracted and genetic analysis was performed by Sanger method after PCR.The sequencing data of HPGD gene exons were analyzed by alignment with sequences from National Center for Biotechnology Information (NCBI). Results: (1)The propositus represented symptoms in childhood including clubbing fingers, sweating, seborrhea, joint swelling and so on.Periosteal thickening and bone hyperplasia were found by X-ray. (2)The homozygous mutation named c. 310_311delCT in propositus, which located in the third exon of HPGD, was identified.His parents carried the same heterozygous mutation, while his sister did not inherit any mutation of this gene. (3)The prediction of spatial structure of proteins revealed that the mutant proteins had about 60% discrepancy compared with wild-type protein, losing a lot of motifs responsible for combining with coenzyms and prostaglandin E(2), as well as active sites of enzymes. Conclusions: The clinical manifestations and imaging findings are helpful to diagnose PDP. Moreover gene mutation analysis ensures the diagnosis.The structure and function of HPGD gene mutation induce 15-hydroxy prostaglandin dehydrogenase mutation, contributing to the occurrence of PDP.

目的 探讨自身免疫性甲状腺疾病(AITD)不同甲状腺功能状态下,患者血脂水平和其与甲状腺相关激素及抗体的相关性,为揭示AITD与血脂水平的内在关系提供理论依据.方法 以2015年9~12月郑州大学第一附属医院初诊的甲状腺疾病患者为病例组,包括弥漫性甲状腺肿(graves disease,GD)和慢性淋巴性甲状腺炎(hashimoto's thyroidi-tis,HT),其中HT组根据患者甲状腺功能分为甲状腺功能正常组、亢进组、减退组;同期性别、年龄相匹配的健康体检者为对照组.所有研究对象均检测其甲状腺功能及抗体、肝酶及血脂等水平,并进行统计学分析.结果 ①Graves组105例,平均年龄38.3岁.HT甲状腺功能亢进25例,平均年龄44.4岁;HT甲状腺功能减退33例,平均年龄40.33岁;HT甲状腺功能正常30例,平均年龄38.6岁;健康对照组50例,平均年龄34.64岁.②GD组和HT亢进组TC水平较正常对照组和HT正常组、减退组降低(P<0.05);GD组和HT亢进组、正常组TG水平较HT减退组降低(P<0.05);各组HDL水平较正常组降低,但组间比较,差异无统计学意义(P>0.05);GD组和HT亢进组的LDL值较正常对照组和HT正常组、减退组降低(P<0.05),HT减退组TC、TG、LDL水平较正常对照组升高(P<0.05).③相关性分析:Graves组TC水平分别与FT3、FT4、TPOAb呈负相关(r=-0.326,P<0.01;r=-0.477,P<0.01;r=-0.233,P<0.05);TG水平与TPOAb呈负相关(r=-0.223,P<0.05);LDL水平分别与FT3、FT4呈负相关(r=-0.315,P<0.01;r=-0.455,P<0.01);HT正常组TC水平与TGAb呈正相关(r=0.384,P<0.05);LDL水平与TGAb呈正相关(r=0.465,P<0.01);HT减退组TC与TRAb呈正相关(r=0.461,P<0.01);LDL分别与TSH、TRAb呈正相关(r=0.355,P<0.05;r=0.558,P<0.01).结论 AITD普遍存在着血脂紊乱,且血脂水平与甲状腺相关激素及抗体间存在相关性.