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 探讨血清维生素D3水平与2型糖尿病老年患者颈内动脉内膜-中膜厚度及斑块的相关性.方法 选取阜阳市人民医院内分泌科就诊的147例老年2型糖尿病患者为研究对象,收集患者的临床和实验室检查资料.检测25(OH)D3水平,并使用超声检测颈动脉有无斑块及测量内膜-中膜厚度.使用多因素二元Logistic回归及多重线性回归明确影响患者颈动脉斑块和内膜-中膜厚度的因素.结果 根据血清25(OH)D3水平的三分位数(10.32 ng/ml和18.34 ng/ml)将患者分为3组.3组年龄、总胆固醇、低密度脂蛋白(LDL)、血总钙、颈动脉斑块和内膜-中膜厚度差异存在显著性差异(均P<0.05).同无斑块组患者相比,斑块组患者年龄更大、LDL和糖化血红蛋白(HbA1c)水平更高、内膜-中膜厚度更高且25(OH)D3水平显著下降(均P<0.05).多重线性回归结果显示,25(OH)D3、HbA1c、年龄和血总钙与颈动脉内膜-中膜厚度显著相关.患者年龄(OR=1.40)、HbA1c(OR=1.97)、LDL(OR=1.38)和25(OH)D3(OR=0.88)水平是斑块存在的独立危险因素.结论 维生素D水平过低可能与2型糖尿病老年患者颈动脉斑块形成及内膜-中膜厚度增加有关.

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 探讨甲状腺乳头状癌(PTC)患者的甲状腺功能、甲状腺结节超声特点及其诊断价值.方法 收集我院收治的PTC患者(PTC组,147例)和良性甲状腺结节患者(良性结节组,328例)共475例的一般资料、甲状腺功能及甲状腺结节超声检查结果等,并进行比较分析.结果 PTC组的男性患者比例、年龄、促甲状腺激素(TSH)水平及甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)阳性患者比例均明显高于良性结节组(P<0.05).PTC组患者结节质地实性、低回声、边缘不规则、微钙化、纵横比>1、单发灶、TI-RADS分类≥4类比例及结节最大径均明显高于良性结节组(P<0.05).Logistic回归分析结果示,年龄、TSH水平、结节低回声、边缘不规则、微钙化、最大径、单发灶、TI-RADS分类为PTC的临床预测因素(P<0.05).结论 年龄、TSH水平及甲状腺结节超声特点可能是PTC的临床预测风险因素.

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:观察甲亢患者骨代谢变化及其与甲状腺激素、甲亢性骨质疏松症关系.方法:选取2017年9月至2020年9月收治176例甲亢患者设为甲亢组,另选择同期100例健康体检者为对照组,比较两组入组时甲状腺激素[总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、总甲状腺素(TT4)、游离甲状腺素(FT4)、促甲状腺素(TSH)]及骨代谢指标[25-羟基维生素D[25-(OH)-D]、总I型胶原氨基端延长肽(TPINP)、β胶原特殊序列(β-CTX)、N端骨钙素(N-MID)]水平,采用Pearson相关分析法分析骨代谢指标与甲状腺激素相关性.通过骨密度检测评价甲亢患者是否合并骨质疏松症,以此为依据将患者分为骨质疏松组与非骨质疏松组,比较两组上述骨代谢指标差异,并绘制受试者工作特征(ROC)曲线分析骨代谢指标对甲亢性骨质疏松症预测价值.结果:甲亢组患者血清TT3、FT3、TT4及FT4水平均明显高于对照组(P<0.05),TSH水平明显低于对照组(P<0.05);25-(OH)-D水平明显低于对照组(P<0.05),TPINP、β-CTX、N-MID水平明显高于对照组(P<0.05).甲亢患者血清25-(OH)-D与TT3、FT3、TT4、FT4均呈负相关(P<0.05);TPINP与FT3、FT4均呈正相关(P<0.05);β-CTX与TT3、FT3、TT4、FT4均呈正相关(P<0.05),与TSH呈负相关(P<0.05);N-MID与TT3、FT3、TT4、FT4均呈正相关(P<0.05),与TSH呈负相关(P<0.05).176例甲亢患者骨质疏松症检出率23.30％(41例).骨质疏松组25-(OH)-D水平明显低于非骨质疏松组(P<0.05),TPINP、β-CTX、N-MID水平均明显高于非骨质疏松组(P<0.05).25-(OH)-D、TPINP、β-CTX、N-MID单项指标预测甲亢性骨质疏松症的ROC曲线下面积(AUC)分别为0.660、0.721、0.641、0.639(P<0.05),四者联合的AUC为0.786(P<0.05).结论:甲亢患者血清25-(OH)-D异常降低,TPINP、β-CTX、N-MID异常升高,且与甲状腺激素水平密切相关,联合检测25-(OH)-D、TPINP、β-CTX、N-MID水平对甲亢性骨质疏松症有一定预测价值.

目的:探讨中性粒细胞与淋巴细胞比值(NLR)与2型糖尿病(T2DM)病人不同程度白蛋白尿的相关性.方法:收集T2DM病人299例,按照白蛋白尿程度分为白蛋白尿正常组(NAU组)97例,微量白蛋白尿组(MAU组)91例及临床蛋白尿组(CAU组)111例.分析各组临床资料、NLR及实验室指标特征.结果:MAU组病人年龄、病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、超酶C-反应蛋白(hs-CRP)、胱抑素C(Cys-C)及NLR均高于NAU组(P<0.05～P<0.01),高密度脂蛋白胆固醇(HDL-C)低于NAU组(P<0.05);CAU组病人年龄、病程、收缩压、FBG、HbA1c、TC、TG、LDL-C、血肌酐(Cr)、尿酸(UA)、hs-CRP、Cys-C及NLR均高于NAU组(P<0.05～P<0.01),病程、FBG、HbA1c、Cr、UA、hs-CRP及NLR也均高于MAU组(P<0.01),HDL-C低于NAU组(P<0.01).多元logisitic回归分析显示,病程、收缩压、舒张压、FBG、TG、LDL-C、Cr、hs-CRP、Cys-C及NLR是影响T2DM白蛋白尿的相关因素(P<0.05～P<0.01).NLR与年龄、病程、FBG、HbA1C、TC、HDL-C、Cr、hs-CRP因素有统计学关联(P<0.05～P<0.01).结论:NLR与2型糖尿病白蛋白尿的发生相关.

目的 探讨甲状腺乳头状癌中央区淋巴结转移(CLNM)的临床特点及影响因素.方法 收集2017年2月至2018年6月在阜阳市人民医院首次细胞学诊断的甲状腺乳头状癌患者147例,术后病理均为甲状腺乳头状癌,按是否伴有CLNM,分为淋巴结转移组(CLNM组,45例)与淋巴结未转移组(nCLNM组,102例).收集两组患者的一般资料、甲状腺功能实验室结果 及甲状腺结节超声结果 等,并进行比较分析.结果 两组患者性别、年龄、促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb),甲状腺结节的边缘、微钙化、纵横比、最大径进行比较,差异均有统计学意义(P<0.05);血清游离三碘甲状腺原氨酸(FT3)、血清游离四碘甲状腺原氨酸(FT4),甲状腺结节的质地、回声、孤立灶及TIRADS分类差异无统计学意义(P>0.05).logistic回归分析显示,年龄(OR=1.054,95％CI:1.006～1.103)、性别(OR=6.499,95％CI:1.902～22.200)、TSH(OR=1.904,95％CI:1.395～2.598)、TGAb(OR=3.022,95％CI:1.005～9.084)、边缘(OR=11.483,95％CI:3.196～41.255)、纵横径比(OR=4.409,95％CI:1.508～12.890)及最大径(OR=1.894,95％CI:1.250～2.869)是甲状腺乳头状癌CLNM的影响因素(P<0.05).结论 年龄、性别、TSH、TGAb、甲状腺结节边缘、纵横比及最大径可能是甲状腺乳头状癌CLNM的影响因素.

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。

随着对人体肠道菌群的认识和探索,肠道菌群对人类健康发挥的重要作用亦逐渐被发现,包括其在2型糖尿病( diabe-tes mellitus,type 2, T2DM)病理生理过程中发挥的作用. 肠道菌群与T2DM发生发展的关系非常密切,本文就肠道菌群与T2DM关系的研究进展进行综述.

目的 评估妊娠期糖尿病(GDM)患者血清Kisspeptin表达水平及其影响因素.方法 选取2016年4—7月在安徽医科大学第一附属医院内分泌实验室行75 g葡萄糖耐量试验(OGTT)的孕妇120例,根据75 g OGTT结果将其分为GDM组(61例)和正常糖耐量(NGT)组(59例);根据体质指数(BMI)将GDM组和NGT组进行分组,BMI≤24 kg/m2作为GDM-A亚组(31例)和NGT-A亚组(30例),BMI>24 kg/m2作为GDM-B亚组(30例)和NGT-B亚组(29例).收集受试者年龄、妊娠期体质量、体质量差等资料,测定空腹血糖(FBG)、1 h血糖(PG)、2 hPG、空腹胰岛素(FINS)、1 h胰岛素(INS)、2 hINS、空腹C肽、1 h C肽、2 h C肽及血清Kisspeptin水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β).结果GDM组FBG、1 hPG、2 hPG、FINS、2 hINS、空腹C肽、2 h C肽、HOMA-IR均高于NGT组,HOMA-β低于NGT组(P<0.05).NGT-A亚组FINS、1 hINS、2 hINS、空腹C肽、HOMA-IR、HOMA-β均低于NGT-B亚组(P<0.05).GDM-A亚组的HOMA-IR低于GDM-B亚组(P<0.05).GDM组血清Kisspeptin水平高于NGT组(P<0.01).GDM-A亚组血清Kisspeptin水平高于NGT-A亚组(P<0.05).GDM-B亚组血清Kisspeptin水平高于NGT-B亚组(P<0.05).所有受试者血清Kisspeptin水平与FBG、1 hPG、2 hPG、2 hINS、空腹C肽、2 h C肽、HOMA-IR呈正相关,与HOMA-β呈负相关(P<0.05).NGT组血清Kisspeptin水平与FBG、2 hPG呈正相关(P<0.05).结论GDM组血清Kisspeptin水平较NGT组明显升高;Kisspeptin水平与FBG、1 hPG、2 hPG、2 hINS、空腹C肽、2 h C肽、HOMA-IR呈正相关,与HOMA-β呈负相关.