目的 探讨白细胞介素-4(IL-4)/信转导和转录激活因子6(STAT6)通路相关基因对Graves病患者外周血B淋巴细胞水平的影响.方法 选择2021年1-6月在上海市第五人民医院门诊及病房初发、未使用过抗甲状腺药物治疗的Graves病患者20例作为Graves病组,选择同期在上海市第五人民医院体检健康且性别、年龄匹配的20例健康者作为健康对照组.留取外周血并收集血清,检测甲状腺功能[游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)]、甲状腺抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺激素受体抗体(TRAb)]、IL-4等指标.磁珠分选外周血B淋巴细胞,RT-PCR检测IL-4R mRNA的表达水平,流式细胞术检测 外周血CD19+、CD19+IL-4R+、CD19+pSTAT6+B淋 巴细胞水平.结果 与健康对照组相比,Graves病组FT3、FT4、TPOAb、TGAb水平升高(P＜0.05),CD19+B淋巴细胞比例明显增加(P＜0.05).与健康者相比,RT-PCR检测显示Graves病患者B淋巴细胞IL-4R mRNA表达增加(P＜0.05).Graves病组血清1L-4水平及外周血CD19+IL-4R+、CD19+pSTAT6+B淋巴细胞水平与健康对照组比较,差异均无统计学意义(P＞0.05).IL-4、CD19+IL-4R+B淋巴细胞、CD19+pSTAT6+B淋巴细胞与FT3、FT4及TPOAb、TGAb、TRAb均无相关性(P＞0.05).结论 虽然Graves病患者外周血B淋巴细胞显著增加,但是IL-4/STAT6通路相关基因可能不影响Graves病患者外周血B淋巴细胞增生,与疾病状态也无明显相关性.

Objective:To investigate the effects of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy on complications and adverse outcomes of pregnancy.Methods:A retrospective analysis was conducted in 784 pregnant women including 111 cases of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy and 673 pregnant women with normal thyroid function as control group. All women were registered and delivered in the Department of Obstetrics of our hospital from April 2016 to April 2017. The complications and adverse outcomes of pregnancy in the two groups were analyzed.Results:Age, body weight before pregnancy, body mass index(BMI), 1 h plasma glucose and 2 h plasma glucose during oral glucose tolerance test in persistent isolated hypothyroxinemia group were higher than those in control group( P<0.05), with increased incidence of anemia during pregnancy( P<0.05). However, there were no significant differences in the incidences of gestational diabetes mellitus and gestational hypertension between the two groups( P>0.05). No significant statistical differences were found in macrosomia, stillbirth, neonatal malformation, postpartum hemorrhage, acute delivery, premature delivery, fetal intrauterine development delay, and small full-term infants between the two groups( P>0.05). Logistic regression analysis showed that age( OR=1.1, 95% CI 1.0-1.1, P=0.002) and pre-pregnancy body weight( OR=1.0, 95% CI 1.0-1.1, P=0.046) were risk factors for the occurrence of persistent isolated hypothyroxinemia in the first and second trimesters of pregnancy. Persistent isolated hypothyroxinemia in the first and second trimesters was associated with anemia during pregnancy( OR=1.9, 95% CI 1.1-3.2, P=0.024). Conclusions:Pregnant women who are older and heavier before pregnancy should pay more attention to their thyroid function. Pregnant women with persistent isolated hypothyroxinemia in the first and second trimesters should be concerned for anemia.

目的 分析孕中期孕妇血清铁蛋白(SF)水平与甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体(TG-Ab)的关系.方法 以2016年12月至2017年7月该院产科门诊入选的1592例孕中期孕妇为研究对象,以SF 12μg/L为截点将研究对象分为铁缺乏组和铁正常组,分析两组间甲状腺功能指标及甲状腺自身抗体的差异,探讨孕中期孕妇SF水平与甲状腺自身抗体的关系.结果 铁缺乏组游离甲状腺素水平明显低于铁正常组,差异有统计学意义(P<0.05),而两组间促甲状腺激素水平、检出TPO-Ab或TG-Ab阳性率及亚临床甲状腺功能减退症比例比较,差异均无统计学意义(P>0.05).Logistic回归分析证实铁缺乏症为孕妇单纯TG-Ab水平异常升高的危险因素[OR=2.840,95％CI(1.385～5.825),P<0.05],不是孕妇TPO-Ab水平异常升高的危险因素[OR=0.712,95％C I(0.296～1.711),P>0.05].结论 孕中期铁缺乏症是TG-Ab水平异常升高的危险因素.

Objective:To Investigate comprehensive predictive ability of first-trimester complete blood count combined with maternal characteristics for gestational diabetes mellitus (GDM).Methods:From May 2015 to July 2018, 1 412 pregnant women were retrospectively screened at the Fifth People′s Hospital of Shanghai, Fudan University. We recruited 258 women who developed GDM and 1 154 women who had normal glucose level during pregnancy. At the first visit, clinical data and complete blood count result were obtained. GDM prediction models were established through logistic regression analysis of GDM related risk factors and the prediction abilities of each model were compared.Results:Logistic regression analyses identified age, pre-pregnancy body mass index, previous GDM history, family history of diabetes mellitus, the neutrophil-to-lymphocyte ratio, leukocyte, neutrophil, and monocyte counts were significantly independent predictors of GDM. In the entire cohort, the predictive ability of neutrophil and monocyte counts together with maternal basal characteristics model for the development of GDM [areas under the receiver operating characteristic curve (AUC-ROC)=0.809, integrated discrimination improvement (IDI)=0.056, P=0.001] was the best among various models (basal characteristics model, AUC-ROC=0.753; Monocyte count+ basal characteristics model, AUC-ROC=0.764; neutrophil count + basal characteristics model, AUC-ROC=0.775). Similar results obtained by the same way in all pregnant women without previous GDM history. Conclusion:It could improve the prediction of GDM with model incorporated maternal characteristics and first-trimester neutrophil and monocyte counts.

Background: Intestinal flora is associated with Graves’ disease (GD). This study explored the association of serum 25(OH)D with the diversity of the intestinal flora and serum IL-17 in GD patients. Methods: Patients newly diagnosed with GD at 2 centers between 2018 and 2021 were consecutively included. According to their 25(OH)D levels, they were divided into the deficiency group, the insufficiency group, and the sufficiency group. Some patients with vitamin D deficiency or insufficiency were randomly selected and were matched with healthy volunteers (normal control [NC]) in terms of sex, age, and case number. The diversity and differential species of the intestinal flora and serum IL-17 levels were compared. Results: Serum 25(OH)D negatively correlated with serum IL-17, the platelet/lymphocyte ratio, and TSH receptor antibody. The diversity of the intestinal flora decreased in the GD group, with noticeable differences in the composition of the intestinal flora when compared with the NC group. At the phylum level, the GD group exhibited a significantly lower abundance of Firmicutes but a higher abundance of Actinobacteria. At the genus level, the GD group exhibited higher relative abundances of Bifidobacterium, Collinsella, and Pediococcus but lower abundances of Roseburia and Dialister. Conclusions: The changes in the vitamin D level and the composition of the intestinal flora may partially contribute to the development of GD.

This article reported a case of a male patient with primary hyperparathyroidism(PHPT) caused by an ectopic parathyroid adenoma in the anterior superior mediastinal. Hospital routine examinations indicated hyperlipidemia, hyperuricemia, type 2 diabetes with nephropathy, chronic kidney disease in stage Ⅳ, elevated PTH, hypercalcemia, hypophosphatemia, clinically highly suspected hyperparathyroidism. There was no obvious abnormality of parathyroid ultrasound, while 18F-FDG systemic metabolic imaging and 99mTc-MIBI dual-phase parathyroid imaging suggested that an ectopic parathyroid gland in the anterior superior mediastinal which was hyperactive. Evaluations of anterior pituitary function, pancreas, and endocrine-related hormones showed no obvious abnormalities, and thus we ruled out the possibility of multiple endocrine adenomas, combined with the patient′s symptoms and previous medical history, and ruled out the possibility of tertiary hyperparathyroidism, the patient was diagnosed as PHPT caused by the anterior superior mediastinal ectopic parathyroid adenoma. To restore the blood calcium to normal, the patient was treated with intravenous rehydration, diuresis, calcitonin to promote urinary calcium excretion, and zoledronic acid to inhibit bone resorption. Further thoracoscopic mediastinal tumor resection was performed, and the diagnosis of parathyroid adenoma was confirmed by pathology. All the indicators were normal and no recurrence of hyperparathyroidism was found during the follow-up. Integration of the patient′s clinical manifestations, biochemical indicators, and imaging examinations are necessary to diagnose PHPT qualitatively and location-specifically. In particular, it is necessary to pay attention to whether there is the possibilities of ectopic adenoma and multiple endocrine adenomas, to reduce the rates of missed diagnosis and recurrence.

目的 探讨活性维生素D(VitD)通过维生素D受体(VDR)调控细胞因子信号转导抑制分子(SOCS)、酪氨酸激酶/信号转导和转录激活因子(JAK/STAT)通路在DKD中的作用及可能机制.方法 构建DKD小鼠及沉默VDR基因的DKD小鼠模型,随机分为DKD组、低浓度VitD3干预组(L-VitD3)、高浓度VitD3干预组(H-VitD3)、慢病毒转染沉默VDR基因表达组(Lenti-shVDR)、低浓度VitD3+慢病毒转染组(Lenti-shVDR+L-VitD3)、高浓度VitD3+慢病毒转染组(Lenti-shVDR+H-VitD3).饲养期间每天观察小鼠一般行为学变化,每3～4 d监测BG及体重,第1、4、8周测24小时尿蛋白(24 hUP),HE染色观察肾脏病理改变,Western blot法检测肾脏组织中JAK2、磷酸化JAK2(p-JAK2)、STAT3、p-STAT3、SOCS1和SOCS3蛋白表达水平.结果 与DKD组比较,L-VitD3、H-VitD3组体重、BG和24 hUP降低(P<0.05),H-VitD3组BG和24 hUP低于L-VitD3组(P<0.05),Lenti-shVDR组24 hUP升高(P<0.05).DKD组肾小球增大伴系膜基质增生,L-VitD3、H-VitD3组病变减轻;与DKD组比较,Lenti-shVDR组肾小球病变加重,Lenti-shVDR+L-VitD3、Lenti-shVDR+H-VitD3组病变较Lenti-shVDR组稍减轻.与DKD组比较,L-VitD3、H-VitD3组p-STAT3、SOCS1和SOCS3蛋白表达均降低(P<0.05);JAK2蛋白表达在L-VitD3组降低(P<0.05).与DKD组比较,Lenti-shVDR组JAK2、p-STAT3、SOCS1和SOCS3蛋白表达均增加(均<0.01).与Lenti-shVDR组比较,Lenti-shVDR+H-VitD3组JAK2、p-STAT3、SOCS1和SOCS3蛋白表达降低(P<0.01).结论 VitD可降低DKD小鼠尿蛋白,改善肾脏病理损伤,延缓肾损害.JAK2/STAT3/SOCS途径可能参与DKD进展,沉默VDR基因后可减弱活性VD对JAK/STAT通路激活的影响,提示活性VitD调控SOCS和JAK/STAT通路可能通过特异性受体VDR介导.

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清25羟维生素D[25 hydroxyvitamin D,25(OH)D]与振动感觉阈值(vibrating perception threshold,VPT)的相关性.方法 入选T2DM患者766例,根据VPT进行分层:振动觉正常组(vibration sensation normal group,VSN)(n=394)、振动觉减退组(vibration sensation impaired group,VSI)(n=227)及振动觉缺失组(vibration sensation deficiency group,VSD)(n=145).比较各组血清25(OH)D水平差异,采用Spearman相关分析和Stepwise多元逐步回归分析评价血清25(OH)D与VPT相关性.结果 与VSN组相比,VSI组和VSD组的年龄、病程和血清肌酐(serum creatinine,Scr)显著增加(P<0.001),体重指数(body mass index,BMI)、舒张压(diastolic blood pressure,DBP)、血清谷丙转氨酶(alanine transaminase,ALT)和25(OH)D显著降低(P<0.01).与VSI组相比,VSD组的病程更长(P<0.01),糖化血红蛋白(hemoglobin A1c,HbA1c)显著升高(P<0.05).Spearman相关分析显示,年龄、病程和Scr与VPT呈显著正相关,BMI、DBP、ALT和25(OH)D与VPT呈显著负相关.多元逐步回归分析显示年龄、病程、DBP、HbA1c、Scr及25(OH)D是VPT的独立危险因素.结论 血清25(OH)D与VPT呈显著负相关,可能是VPT的独立危险因素.

目的 探讨妊娠中期孕妇血清铁蛋白(SF)水平与甲状腺功能的相关性.方法 纳入2016年12月～2017年7月在我院产科门诊常规产检的妊娠中期孕妇1484例,根据是否存在ID(SF<20μg/L)将其分为铁缺乏症(ID)组348例和正常组1136例.收集并比较两组的一般资料、常规实验室指标及甲状腺功能和甲状腺自身抗体,分析妊娠中期孕妇SF水平与甲状腺功能的相关性.结果 与正常组比较,ID组孕妇的促甲状腺激素(TSH)水平明显升高,游离甲状腺素(FT4)水平明显降低(P<0.05),而两组间甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)比较差异无统计学意义(P>0.05).相关性分析结果显示,妊娠中期孕妇SF与TSH水平呈负相关(r=-0.120,P<0.001),与FT4呈正相关(r=0.205,P<0.001).logistic回归分析结果显示,SF水平降低是TSH水平升高和FT4水平降低的危险因素(β=-0.002,P=0.022;β=0.005,P=0.003).结论 SF水平降低是妊娠中期孕妇出现甲状腺功能异常的危险因素.

目的:探讨原发性醛固酮增多症(primary aldosteronism,PA)患者胰岛素敏感性和胰岛 β细胞功能变化情况.方法:选取2014年1月至2015年12月复旦大学附属上海市第五人民医院收治的PA患者95例和原发性高血压(essential hypertension,EH)患者210例.根据有无糖尿病病史分层分析PA患者和EH患者中胰岛素抵抗和胰岛 β细胞功能的情况.根据醛固酮/肾素活性(aldosterone to active renin ratio,ARR)是否大于50,将PA患者分为PA高值组(45例)及PA低值组(50例).采用QUICK指数、HOMA指数评估胰岛素敏感性,HOMA-β、早时相胰岛功能(ΔI30/ΔG30)评估胰岛β细胞功能.结果:单因素分析中,无糖尿病病史人群,PA高值组HOMA-β低于EH组(P<0.05),PA高值组及低值组 ΔI30/ΔG30均低于EH组(P<0.05);而在有糖尿病病史患者中,仅PA高值组HOMA-β低于EH组(P<0.05).多元线性回归显示,无糖尿病病史人群中,立位醛固酮水平对LnΔI30/ΔG30有显著负性影响(β=-0.375,P<0.05);有糖尿病病史人群,立位醛固酮对LnHOMA-β有显著负性影响(β=-0.367,P<0.01).无论有无糖尿病病史,醛固酮水平对胰岛素抵抗指标无影响.结论:PA引起的糖代谢异常可能与醛固酮增高致胰岛功能分泌障碍有关.

Graves病是器官特异性自身免疫性疾病,为甲状腺功能亢进症(简称甲亢)的最常见病因,发病率约为1％ ～1. 6％[1],男女比例约为5～10 :1[2].其致病机制为Graves病患者体内甲状腺受体抗体(TRAb)刺激促甲状腺激素(TSH)受体,使甲状腺不断分泌甲状腺素,导致体内甲状腺素水平升高.部分Graves病患者在接受抗甲状腺药物(ATD )治疗之前和之后均会发生粒细胞减少,前者主要为 Graves病本身的自身免疫导致,后者的发生主要是由 ATD引起.我们对近年来国内外Graves病患者粒细胞减少症的临床特点、发病机制、诊断和治疗策略进展进行综述.

为了探讨妊娠糖尿病(gestational diabetes mellitus,GDM)患者各种糖代谢指标对妊娠结局的预测价值,入选1 092例妊娠正常糖耐量(normal glucose tolerance,NGT)者、68例GDM患者和21例孕前糖尿病(pregestational diabetes mellitus,PGDM)患者.测定血脂、空腹血糖(fasting blood glucose,FBG)、餐后血糖(1 HBG和2HBG)、糖化血红蛋白(hemoglobin Alc,HbA1c)、孕前体重指数(body mass index,BMI)和空腹胰岛素(fasting insulin,FINS)等指标.采用稳态模式(homeostasis model assessment,HOMA)评价胰岛素抵抗(HOMA insulin resistance,HOMA-IR)、胰岛p细胞功能(HOMA β cell function,HOMA-β)和处置指数(desposition index,DI).GDM及PGDM组孕前BMI、FBG、1HBG、2HBG、HbA1c和LnHOMAIR高于NGT组(P＜0.05),PDGM组1HBG和HbA1c高于GDM组(P＜0.05).NGT、GDM及PGDM组大于胎龄儿(largefor gestaional age,LGA)发生率分别为6.8％、13.8％和20.0％,差异有统计学意义(P＜0.05).Spearman相关分析显示,新生儿体重与孕前BMI(r=0.183,P＜0.001)、FBG(r=0.070,P=0.019)、1HBG(r=0.183,P＜0.001)、2HBG(r=0.125,P＜0.001)、三酰甘油(r=0.112,P=0.001)、LnHOMA-IR(r=0.102,P=0.033)呈正相关.多元逐步回归显示,新生儿体重与FBG和孕前BMI呈独立正相关(P＜0.05).随着糖代谢紊乱加重,LGA发生率逐渐增加,FBG及孕前BMI是影响LGA的独立危险因素.

目的 探讨T2DM患者正常范围内血清直接胆红素(DBIL)与尿微量白蛋白(UmAlb)的相关性.方法 选取2011年10月至2013年10月于上海市第五人民医院内分泌科住院的T2DM患者1122例.按照DBIL四分位数分为Q1组(<2.5μmol/L)、Q2组(2.5～3.4μmol/L)、Q3组(3.4～4.3μmol/L)、Q4组(≥4.3μmol/L),分析血清DBIL与UACR的相关性.结果 随着DBIL水平降低,UACR升高(P<0.05).Pearson相关分析显示,DBIL与病程、Scr、UACR呈负相关(P<0.01),与性别无相关性.多元逐步回归分析结果显示,DBIL是UACR的独立影响因素(β=-0.248,P<0.01).Logistic回归分析结果显示,校正性别、年龄、病程、BMI、SBP、HbAlc、TC、TG、LDL–C、Scr、丙氨酸转氨酶(ALT)、吸烟史和饮酒史因素后,Q1组发生UmAlb和显性白蛋白尿的风险是Q4组的1.543倍和3.534倍(95％CI 1.150～2.071,1.597～7.818,P<0.01),Q2组是Q4组的1.364倍和2.068倍(95％CI 1.018～1.926,1.029～4.601,P<0.05).以UACR 30 mg/g、300 mg/g为分界值,绘制受试者工作特征曲线(ROC),DBIL最佳切点值为3.45μmol/L和2.75μmol/L.结论 T2DM患者血清DBIL与UmAlb密切相关.

目的 探讨妊娠中期妇女血清尿酸水平与25羟维生素D3[25 (OH) VD3]的关系.方法 选取妊娠中期妇女221例,收集其年龄、妊娠周期等一般资料,检测其肝、肾功能、空腹血糖(FPG)、甲状腺功能及25 (OH) VD3水平,并根据25(OH) VD3水平将其分为维生素D缺乏组(25(OH)VD3 ＜50 nmo/L)和维生素D适宜组(25 (OH) VD3≥50 nmol/L),比较两组患者的临床资料,并对影响25 (OH) VD3水平的因素进行分析.结果 221例妊娠中期妇女中,147例(67％)存在维生素D缺乏,74例(33％)维生素D适宜.维生素D缺乏组妊娠周期、血清尿酸、促甲状腺激素(TSH)水平均低于维生素D适宜组,游离甲状腺素(FT4)、FPG和总胆红素(TBIL)水平均高于维生素D适宜组,差异有统计学意义(P＜0.05).相关性分析结果显示,妊娠中期妇女25(OH) VD3水平与妊娠周期、血清尿酸、TSH呈正相关,与FT4、TBIL呈负相关(P＜0.05).Logistic回归分析结果显示,妊娠中期妇女血清尿酸水平降低是25(OH) VD3缺乏的危险因素(OR=1.008,P=0.024).结论 维生素D缺乏在妊娠中期妇女中较为常见,妊娠周期、血清尿酸、FT4、TSH及TBIL与妊娠中期妇女的25 (OH) VD3相关,其中血清尿酸水平降低是25 (OH) VD3缺乏的主要危险因素.

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者中血清磷(serum phosphorus)与振动感觉阈值(vibrating perception threshold,VPT)之间的相关性.方法:入选T2DM患者1027例,根据VPT进行分层,振动觉正常组(n=535例)、振动觉减退组(n=294例)及振动觉缺失组(n=198例),比较各组血清磷及相关指标的差异,采用Spearman相关分析和Stepwise多元逐步回归分析评价血清磷与VPT相关性.结果:与振动觉正常组相比,振动觉减退组和振动觉缺失组患者年龄更大、病程更长(P<0.05).与振动觉减退组相比,振动觉缺失组患者病程更长(P<0.05).与振动觉正常组相比,振动觉减退组和振动觉缺失组患者eGFR和血清磷水平降低(P<0.05).与振动觉减退组相比,振动觉缺失组患者eGFR和血清磷水平降低(P<0.05).Spearman相关分析显示,年龄(r=0.454,P<0.001)和病程(r=0.289,P<0.001)与VPT显著正相关;eGFR(r=-0.251,P<0.001)和血清磷(r=-0.145,P<0.001)与VPT显著负相关.多元逐步回归分析显示年龄、病程、HbA1c、eGFR及血清磷是VPT的独立危险因素.结论:2型糖尿病患者血清磷与VPT显著负相关,是VPT的独立危险因素.

目的 探讨2型糖尿病(T2DM)患者中性粒细胞/淋巴细胞比值(NLR)与振动感觉阈值(VPT)之间的相关性.方法 纳入在我院住院的T2DM患者965例,根据VPT将其分为振动觉正常组(A组,525例)、振动觉减退组(B组,265例)及振动觉缺失组(C组,175例),收集3组患者的年龄、病程、BMI、收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、ALT、血肌酐(Scr)、WBC、中性粒细胞(NEU)、淋巴细胞(LYM)计数、NLR和VPT并进行比较比较,采用Spearman相关分析和Stepwise多元逐步回归分析评价NLR与VPT的相关性.结果 与A组比较,B组和C组患者的年龄、病程和Scr明显增加(P均＜0.01);C组患者的NEU计数和NLR明显升高,LYM计数明显降低(P均＜0.05).Spearman相关分析结果显示,年龄(r=0.425,P＜0.001)、病程(r=0.227,P＜0.001)、Scr(r =0.147,P＜0.001)、NLR(r =0.105,P＜0.001)与VPT呈明显正相关,DBP(r=-0.087,P =0.007)、ALT(r=-0.101,P=0.003)及LYM(r=-0.126,P＜0.001)与VPT呈明显负相关.Stepwise多元逐步回归分析结果显示,年龄、病程、HbA1c、Scr和NLR是VPT的独立危险因素(P＜0.05).结论 NLR与VPT呈明显正相关,是VPT的独立危险因素.NLR可能参与糖尿病周围神经病变(DPN)的发生发展.

目的 探讨Graves病患者血清磷水平与甲状腺功能的相关性.方法 纳入初次发病或复发但未使用药物治疗的Graves病患者348例,收集电解质、肝肾功能、甲状腺功能、促甲状腺素受体抗体(TRAb)、摄碘率等临床资料.以血清磷正常参考值范围上限1.45 mmol/L为切点数值将其分为高磷组和正常磷组,采用非参数检验比较两组间各参数的差异,logistic回归分析评估可能影响血清磷水平的相关因素.结果 348例患者中,144例(41.38％)出现高磷血症.高磷组患者年龄和BMI均明显低于正常磷组(P＜0.05),而三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、TRAb、3小时摄碘率(3h RAIU)、24小时摄碘率(24h RAIU)和血清钙(Ca)均明显高于正常磷组(P＜0.05).Graves病患者的年龄(r=-0.158)和BMI(r=-0.146)与血清磷水平呈负相关,T3(r =0.188)、FT3(r =0.134)、3h RAIU(r=0.159)、24h RAIU(r =0.186)与血清磷水平呈正相关(P＜0.05).Logistic回归分析结果示,年龄(OR=0.982,95％ CI 0.966～0.998,P=0.032)、性别(OR =0.555,95％ CI 0.346 ～0.891,P=0.015)、FT3(OR=1.030,95％ CI1.007～1.053,P=0.011)是Graves病患者血清磷水平的影响因素.结论 Graves病患者存在磷代谢异常,年龄偏低、女性、FT3水平升高患者更易出现高磷血症.

血钙正常的原发性甲状旁腺功能亢进（normocalcemic primary hyperparathyroidism,NPHPT）是原发性甲状旁腺功能亢进（PHPT）的一种特殊类型,是指血钙水平持续正常,而血甲状旁腺激素（parathyroid hormone,PTH）水平升高,同时需除外继发性甲状旁腺功能亢进的因素。NPHPT发病机制、临床表现、自然进程及转归尚不清楚,治疗存在争议,首选手术治疗,但对于不能或不愿手术治疗的患者尚无统一意见,本文报道1例2017年7月行微波消融术治疗NPHPT老年患者,术后患者临床症状及PTH水平基本缓解。微波消融对于不愿手术的老年PHPT患者有一定的应用前景。

Objective To investigate the threshold values of insulin resistance ( IR) assessed by homeostasis model and the prevalence of IR in elderly people over 60 years old in Minhang district of Shanghai, and to evaluate the relationship between IR and metabolic syndrome ( MS) . Methods A total of 3003 elderly people aged 60 and over in the Jiangchuan community of Minhang District, Shanghai, were recruited, including 1286 males and 1717 females. Blood pressure, waist circumference, BMI, blood routine, serum creatinine, blood lipids, glucose, and fasting insulin were measured in all populations studied. Homeostasis model assessment ( HOMA) was used to estimate IR, and MS, and defined according to three diagnostic criteria including NCEP-ATPIII, IDF, and CDS. Results 75th percentile, 80th percentile and 90th percentile of HOMA values in 268 subjects with normotensive and normal BMI, glucose tolerance were considered as the thresholds of IR. The cut-off values were 2. 78, 3. 01 and 3. 56, respectively. And the prevalence of IR were 50. 0％, 42. 1％, and 27. 2％, respectively. IR level was significantly higher in people with MS. Based on the receiver operating characteristic ( ROC ) curve analysis, HOMA-IR and QUICKI index predicted MS well, and the optimal thresholds for diagnosing MS of HOMA-IR were 3. 17 for NCEP-ATPⅢ, 3. 02 for IDF and 3. 03 for CDS. BMI was the best factor for diagnosing IR among different MS components. Logistic regression analysis showed that gender, WC, BMI, SBP, HDL-C, TG, FBG and WBC were independent risk factors for IR. FBG≥5.84 mmol/L was the most dangerous factor of IR (OR=3.603,P<0.01), followed by WC≥85.4 cm(OR=2.152, P<0.01) and BMI≥24.6 kg/m2(OR=2.150,P<0.01). Conclusion The cut-off values of IR estimated by HOMA and the prevalence of IR were higher in elder subjects than other populations. IR was significantly positively correlated with MS. Excluding the conditions that insulin measurement were affected by external factors, HOMA-IR may predict the risk of MS. The components of MS were relative specific measurements of IR, FBG, BMI and WC were important risk predictors of IR in the elderly.

Objective To explore the effect of " hospital informationized blood glucose management" on perioperative diabetic patients. Methods Three hundred patients with type 2 diabetes mellitus, who underwent selective operations from orthopedics, general surgery, urological surgery, and thoracic surgery were divided into two groups: 150 cases of blood glucose information management group and 150 cases of traditional blood glucose monitoring and management group. The blood glucose on target rate, percent of hypoglycemic events, percent of hyperglycemic events, the blood glucose level on the first postoperative day, the average hospitalization day, perioperative infection rate were evaluated for efficacy. Results The blood glucose on target rate in informationized blood glucose management group was significantly higher than that of the control group [(52.52 ± 18.31)%vs (14.88 ± 8.39)%, P＜0.01]. The frequency of hyperglycemia, the average daily blood glucose, the average blood glucose on fasting, after three meals and at night, the fasting and postprandial blood glucose level on the first postoperative day in informationized blood glucose management group were significantly lower than that of the control group [( 45. 31 ± 18.87)%vs (84.41±8.86)%, (8.59±1.34 vs 12.47±2.37) mmol/L, (7.33±1.41 vs 10.01±1.99)mmol/L, (8.89 ±2.34vs13.61±3.47)mmol/L,(9.47±1.94vs13.46±2.77)mmol/L,(9.40±2.72vs13.28±2.94)mmol/L, (8.28±2.11vs11.31±2.89)mmol/L,(8.29±2.51vs11.58±3.52)mmol/L,(8.25±3.67vs17.65±19.68) mmol/L, all P＜0.01]. In addition, the average hospitalization day of the informationized blood glucose management group was significantly shorter than that of the control group [(16±7 vs 21±15)d, P＜0.05]. The infection rate of the management group and the control group were 41. 2% and 58. 8% respectively. There was no significant difference between two groups (P＞0.05). Conclusion The " hospital informationized blood glucose management" is simple and practical, which may significantly improve the rate of blood glucose control in each period, reduce the average hospitalization day, and decrease perioperative infection tendency.