目的 探讨红细胞分布宽度(RDW)与 2 型糖尿病患者(T2DM)心血管自主神经病变(CAN)的关系.方法 根据24h动态心电图检查结果将100 例T2DM疑似CAN患者分为CAN阳性组(66 例)与CAN阴性组(34 例).收集其一般资料(年龄、性别、吸烟史、腰围、臀围、BMI)、临床资料(收缩压、舒张压及T2DM病程)、实验室检查指标及心率变异性指标[全部正常窦性心搏间期(N-N)的标准差(SDNN)、连续5min正常R-R间期均值的标准差(SDANN)、相邻R-R间期差异≥50 ms的百分数(pNN50)、全程相邻N-N间期之差的均方根值(rMSSD)、低频功率(LF)、高频功率(HF)]并进行组间比较,相关性分析采用Spearman相关分析;采用多因素logistic回归分析评估T2DM患者CAN的影响因素;绘制受试者工作(ROC)曲线并计算曲线下面积(AUC),评估RDW对T2DM患者CAN的预测价值.结果 CAN阳性组患者年龄、T2DM病程、RDW均高于CAN阴性组患者,血红蛋白(Hb)、SDNN、SDANN、pNN50、rMSSD、LF、HF均低于CAN阴性组患者(P＜0.05).Spearman相关分析结果显示,T2DM患者RDW与心率变异性指标均呈负相关(r＜0,P＜0.05).多因素logistic回归分析结果显示,年龄、T2DM病程、RDW均为T2DM患者CAN的危险因素(OR＞1,P＜0.05).ROC曲线分析结果显示,RDW评估T2DM患者CAN的AUC为0.784,有一定的预测价值(P＜0.05).RDW评估低龄短病程、低龄长病程及高龄长病程T2DM患者CAN的AUC分别为0.834、0.813 和0.983,均有一定的预测价值(P＜0.05),RDW对高龄短病程T2DM患者CAN没有预测价值(P＞0.05).结论 T2DM患者CAN与RDW密切相关,RDW可能是T2DM患者发生CAN的独立危险因子;除高龄短病程的T2DM患者外,RDW对CAN有良好的评估效果.

目的 基于TGF-β1/FOXP3/RORγt信号通路观察芦荟多糖对小鼠自身免疫性甲状腺炎的保护作用.方法 选用2月龄雌性小鼠30只,随机分为正常组、模型组和芦荟多糖组,每组10只.通过皮下多点注射猪甲状腺球蛋白(PTg)+高碘水法建立小鼠自身免疫性甲状腺炎模型,其中芦荟多糖组灌胃给药300 mg/(kg·d),其余两组灌胃给予等量生理盐水.药物干预4周后分别HE染色观察各组小鼠甲状腺组织病理形态学变化;ELISA法检测各组小鼠血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离四碘甲状腺原氨酸(free thyroxine,FT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白介素1β(interleukin 1β,IL-1β)、白介素10(interleukin 10,IL-10)、白介素17(interleukin 17,IL-17)和甲状腺信号转导与转录激活因子3(signal transducer and activator of transcription 3,STAT3)、维甲酸相关核孤儿受体γt(retinoic acid-related orphan receptorγt,RORγt)、叉头状转录因子P3(forkhead box P3,FOXP3)、转化生长因子β(transforming growth factorβ,TGF-β)、IL-10和IL-17水平;免疫荧光法检测FOXP3和IL-17A水平;Western blot法检测TGF-β1/FOXP3/RORγt信号通路关键蛋白表达水平.结果 与模型组比较,芦荟多糖明显改善甲状腺组织病理学变化,降低血清TSH、TGAb、TPOAb、TNF-α、IL-1β和IL-17的水平(P<0.05),升高血清FT3、FT4和IL-10的水平(P<0.01),下调甲状腺组织STAT3、RORγt和IL-17水平(P<0.01),上调甲状腺FOXP3、TGF-β和IL-10水平(P<0.01).结论 芦荟多糖可能通过TGF-β1/FOXP3/RORγt信号通路对小鼠自身免疫性甲状腺炎具有较好的保护作用.

The prevalence of type 2 diabetes is associated with inflammatory bowels diseases, nonalcoholic steatohepatitis and even a spectrum of cancer such as colon cancer and liver cancer, resulting in a substantial healthcare burden on our society. Autophagy is a key regulator in metabolic homeostasis such as lipid metabolism, energy management and the balance of cellular mineral substances. Mitophagy is selective autophagy for clearing the damaged mitochondria and dysfunctional mitochondria. A myriad of evidence has demonstrated a major role of mitophagy in the regulation of type 2 diabetes and metabolic homeostasis. It is well established that defective mitophagy has been linked to the development of insulin resistance. Moreover, insulin resistance is further progressed to various diseases such as nephropathy, retinopathy and cardiovascular diseases. Concordantly, restoration of mitophagy will be a reliable and therapeutic target for type 2 diabetes. Recently, various phytochemicals have been proved to prevent dysfunctions of β-cells by mitophagy inductions during diabetes developments. In agreement with the above phenomenon, mitophagy inducers should be warranted as potential and novel therapeutic agents for treating diabetes. This review focuses on the role of mitophagy in type 2 diabetes relevant diseases and the pharmacological basis and therapeutic potential of autophagy regulators in type 2 diabetes.

目的 分析妊娠期肝内胆汁淤积症(ICP)产妇的临床资料,探讨不同程度ICP产妇的分娩方式.方法 选取住院并分娩的产妇20 388例进行回顾性分析,其中诊断为ICP 171例,占比为0.84％.分析ICP产妇的临床资料.结果171例ICP产妇中,轻度ICP142例,重度ICP29例.142例轻度ICP孕妇中阴道分娩115例,其中羊水胎粪污染20例(17.39％);剖宫产27例,其中羊水胎粪污染3例(11.11％);阴道分娩和剖宫产产妇羊水胎粪污染发生率比较,差异无统计学意义(P＞0.05).29例重度ICP孕妇中阴道分娩19例,其中羊水胎粪污染12例(63.16％);剖宫产10例,其中羊水胎粪污染1例(10.0％);阴道分娩与剖宫产产妇的羊水胎粪污染发生率比较,差异有统计学意义(x2=7.485,P=0.006).结论 ICP终止妊娠的时机及方式应遵循个体化综合评价原则,严密监测胎儿宫内情况,选择合适的孕周及方式终止妊娠,可明显改善母儿妊娠结局.轻度ICP产妇可在严密监测下阴道试产,但对于重度ICP产妇或已高度怀疑胎儿窘迫或存在其他阴道分娩禁忌证者,应行剖宫产终止妊娠,避免母儿不良结局.

Aberrant expression of miR-1256 has been reported to be closely associated with the development and progression of tumors, including colon cancer and lung cancer. However, study of its expression pattern and functional role in papillary thyroid cancer (PTC) is rare. Using quantitative real time PCR analysis, we found miR-1256 was significantly down-regulated in PTC tissues and cell lines. The correlation of miR-1256 expression with clinicopathological features was statistically analyzed. The results showed miR-1256 expression was significantly correlated with tumor size (p = 0.0124) and TNM stage (p = 0.0032). Restoring miR-1256 expression significantly inhibited proliferation and cell cycle progression of PTC cells demonstrated by CCK-8 and flow cytometry assays. Luciferase reporter assay and biotin-avidin pull-down assay showed miR-1256 can directly target 5-hydroxytryptamine receptor 3A (HTR3A) in PTC cells. The expression of miR-1256 was inversely correlated with HTR3A expression in PTC tissues. Knockdown of HTR3A imitated the suppressive effects of miR-1256 in PTC cells. Ectopic expression of HTR3A can antagonize the effects of miR-1256 on PTC cells. Furthermore, the suppressive effects of miR-1256 on the expression of PCNA, CDK4, Cyclin D1, and p21 were partially reversed by HTR3A overexpression in PTC cells. In summary, our data suggested that miR-1256 could suppress PTC cellular function by targeting HTR3A, which might be a potential therapeutic target for patients with PTC.

为探讨原钙粘蛋白8(PCDH8)基因甲基化与甲状腺乳头状癌(PTC)发病风险的关系,本文利用癌症基因组图谱(TCGA)数据库,筛选PTC中PCDH8基因差异甲基化位点,发现cg22763718、cg20366906、cg14950829、cg18002116的甲基化水平在甲状腺癌组织与癌旁组织之间存在显著差异,采用生存分析曲线分析发现PCDH8基因甲基化水平高的甲状腺癌患者生存时间短(P<0.05).另外,收集125例临床样本,经Sanger测序发现PTC组织PCDH8甲基化表达量为69.689％±20.992％,结节性甲状腺肿为69.004％±25.848％,甲状腺腺瘤为65.136％±33.248％,甲基化水平均高于癌旁正常组织(46.206％±31.105％)(P<0.05).结果表明,PCDH8基因甲基化可能与PTC发病风险有关.

目的 观察红曲醇提物对小鼠实验性自身免疫性甲状腺炎(EAT)的治疗作用.方法 SPF级雌性BALB/c小鼠60只,随机分为假手术组、模型组、雷公藤多苷片组、红曲低、中、高剂量组,每组10只.利用猪甲状腺球蛋白(PTg)免疫联合高碘水法制作小鼠EAT模型,其中雷公藤多苷片组灌胃给药6.25 mg/(kg5d),红曲醇提物低、中、高剂量组分别灌胃给药1 g/(kg5d)、2 g/(kg5d)、4 g/(kg5d),假手术组、模型组灌胃给予等量生理盐水.给药4周后检测各组小鼠血清甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)、肿瘤坏死因子α(TNF-α)、白介素6(interleukin 6,IL-6)、白介素10(IL-10)、白介素12(IL-12)的含量,观察甲状腺组织病理形态学.结果 与模型组比较,红曲醇提物低、中、高剂量组明显降低血清TGAb、TPOAb、TNF-α、IL-6、IL-12的含量(P<0.05或P<0.01),升高血清IL-10的含量(P<0.05或P<0.01),改善甲状腺组织病理学变化且呈剂量依赖性.雷公藤多苷片组也明显改善上述指标.结论 红曲醇提物对小鼠自身免疫性甲状腺炎具有较好的治疗作用且呈剂量依赖性.

目的:探讨通心络胶囊联合厄贝沙坦(Irb)治疗早期糖尿病肾病(DKD)的临床效果及对患者血清胱抑素C(CysC)、白细胞介素(IL)-18、内皮素(ET)-1、一氧化氮(NO)水平的影响.方法:选取我院2015年1月至2017年1月收治的138例早期DKD患者,采取随机数字表法均分为两组.对照组给予Irb治疗,观察组采取通心络胶囊联合Irb治疗.记录比较两组临床疗效,治疗前后血清CysC、IL-18、ET-1、NO水平的变化及不良反应的发生情况.结果:治疗12周后,观察组总有效率较对照组明显升高(P<0.05).与治疗前对比,两组治疗12周后血清CysC、IL-18、ET-1水平均显著下降(P<0.01),NO水平均显著升高(P<0.01),且观察组血清CysC、IL-18、ET-1水平显著低于对照组,NO水平明显高于对照组(P<0.01).两组不良反应发生率比较差异无统计学意义(P>0.05).结论:通心络胶囊联合厄贝沙坦治疗早期DKD能有效提高其临床疗效,改善肾功能,且安全性高,可能与其显著降低患者血清CysC、IL-18、ET-1水平,提高血清NO水平,进而改善机体微炎症状态及血管内皮功能有关.

目的:评估硫酸镁联合血压平颗粒在治疗妊娠高血压(pregnancy-induced hypertension,PIH)时的临床疗效,及其对血清白血病抑制因子(leukemia inhibitory Factor,LIF)、爱帕琳肽(Apelin)和β绒毛膜促性腺激素(β-Chorionic Gonadotropin,β-HCG)水平的影响.方法:本实验选取我院2015年12月至2016年12月收治的患者中符合标准的90例P IH病患为研究对象,随机分为对照组及实验组,每组45例.对照组45例予硫酸镁静脉滴注联合盐酸拉贝洛尔片口服治疗,实验组45例予硫酸镁静脉滴注联合血压平颗粒口服治疗.比较两组临床疗效,血清LIF、Apelin、β-HCG水平变化,观察两组患者治疗前后收缩压和舒张压变化情况,及不同治疗组的妊娠结局.结果:实验组总有效率(88.89％)高于对照组(64.44％),差异有统计学意义(P<0.05).两组血清指标比较,治疗前LIF、Apelin、β-HCG水平无明显差异(P>0.05);治疗后LIF水平均显著上升,且实验组上升水平高于对照组[(752.38±31.57)VS(703.01±32.02)],差异有统计学意义(P<0.05);Apelin、β-HCG水平均显著下降,且实验组下降水平高于对照组[(233.33±23.56)VS(271.69±24.83)、(15772.96±1705.93)VS(11473.19±1698.87)],差异有统计学意义(P<0.05).治疗前,收缩压、舒张压无明显差异(P>0.05);治疗后收缩压、舒张压均下降,且实验组下降程度高于正常组[(135.8±6.9)VS(153.1±8.7)、(88.0±5.8)VS(92.97±5.7)],差异有统计学意义(P<0.05).两组妊娠结局比较,自然分娩率实验组(77.78％)显著高于对照组(35.56％),差异有统计学意义(P<0.05).结论:血压平颗粒联合硫酸镁治疗对PIH患者的效果肯定,能够升高血清LIF水平,降低血清Apelin及β-HCG水平,降低血压水平及改善妊娠结局.

甲状腺癌是内分泌科中最常见的恶性肿瘤,而甲状腺乳头状癌( PTC)是甲状腺癌最常见的病理类型.目前PTC在临床上缺乏早期实验室检验指标,但伴随着实验室检测技术不断进步,PTC分子生物学标志物的研究在近年来取得了较大进展,其中包括微RNA、生化标志物以及基因标志物,这些标志物在PTC中均有异常表达,且与肿瘤的发生、发展密切相关,PTC分子生物学标志物有望成为诊断PTC的新标准.深入研究PTC分子生物学标志物可为临床医师提供肿瘤发病情况的实时信息,发现早期肿瘤提供有力的证据.

目的:分析瘢痕子宫与非瘢痕子宫剖宫产的临床结果.方法:选择2015年12月到2016年12月来我院实施剖宫产手术的瘢痕子宫产妇100例及同期时间来我院实施剖宫产手术的非瘢痕子宫产妇100例作为研究对象,将前者作为研究组,后者作为对照组.对比分析两组产妇手术时间、出血量、恶露时间,术后并发症发生率、新生儿窒息率.结果:研究组手术时间、出血量、恶露时间,术后并发症发生率、新生儿窒息率明显高于对照组,P<0.05.结论:瘢痕子宫产妇二次剖宫产存在较高的风险,因此,临床医生应给予产妇更合适的分娩建议,降低危险系数,保障产妇生命安全.

目的:探讨体质性青春发育延迟的临床特点和治疗方案.方法:对一例体质性青春发育延迟病例进行分析总结.结果:第二性征发育迟缓,体格发育无异常,疑似体质性青春期延迟病人,行随访观察半年,患者已获得较为正常的性成熟.结论:对体质性青春发育延迟的患者,需要根据每一个体的具体情况,决定是否需要进行药物治疗干预或仅仅只是随访观察.

Graves' ophthalmopathy (GO) is a common autoimmune disease that is difficult to deal with due to limited clinical evaluation methods. Recently miR-146a and Interleukin-17 (IL-17) have been found to be involved in autoimmune disorders and correlated with disease activity. However, it is unclear whether they are involved in Graves' ophthalmopathy (GO). The aim of this study is to investigate the correlation of circulating levels of miR-146a and IL-17 with clinical activity in GO patients. Fifty-seven study subjects were enrolled in four groups according to the corresponding criteria: active-GO, inactive-GO, Graves disease (GD) without ophthalmopathy, and healthy control group. The circulating levels of miR-146a and IL-17 were determined by qRT-PCR and ELISA, respectively. Serum IL-17 levels of GD, inactive-GO, and active-GO groups were all significantly higher than that of control (all P < 0.001). Active-GO group had significantly higher IL-17 level than inactive-GO and GD groups (P = 0.024 and P = 0.001, respectively). Active-GO and inactive-GO group had significantly lower miR-146a expressions than control (P < 0.05). Active-GO group had significantly lower miR-146a than inactive-GO group (P < 0.05). Serum levels of IL-17 and miR-146a were both significantly correlated with clinical activity score (CAS) in GO patients (P < 0.001, P < 0.001, respectively). There was a significant negative correlation of circulating miR-146a expression with serum IL-17 levels (P < 0.01). These findings indicated that circulating levels of miR-146a and IL-17 may be potential biomarkers of active GO, and may play a key role in the progression of GO.

Colorectal cancer is the one of the most common malignant tumor and surgical operation has been the most effective therapy for it. In the recent years, more and more data from literatures show that there are not significant difference between laparoscopic and open colorectal radical resection. This article is to explain the prophylaxis and treatment of complications inthe radical resction of colorectal cancer laparoscopy.

微小RNAs(miRNAs)的异常表达与肿瘤的发生、分化、转移及复发等密切相关。研究发现,在食管癌组织中,miR-NAs在表达水平上明显区别于癌旁正常组织;在外周血中,miRNAs也表达出显著的肿瘤相关性、组织特异性和表达稳定性。本文将对miRNA作为食管癌血清标志物的研究进展作一综述。