目的 对比达格列净、维格列汀、阿卡波糖对新诊断2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨代谢影响.方法 选定医院2018年9月—2019年3月住院治疗的120例新诊断T2DM患者,根据"随机数字表法"分组,A组40例患者采纳达格列净+二甲双胍治疗,B组40例患者采纳维格列汀+二甲双胍治疗,C组40例患者采纳阿卡波糖+二甲双胍治疗,比较三组临床疗效、血糖指标、胰岛功能指标、血清Ⅰ型原胶原氨基端肽(N-terminal propeptide of typeⅠprecollagen,P1NP)、血清Ⅰ型胶原羧基末端肽(βcross-linked C-telopeptide of type I collagen,β-CTX)水平、不良反应发生率.结果 A组总有效率(95.00％)与B组(92.50％)、C组(87.50％)比较,P>0.05.A组治疗后空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h blood glucose after meal,2 hPG)、胰岛素抵抗指数(homeostasis model assessment,HOMA-IR)、胰岛β细胞功能指数(homeostasis model assessment-β,HOMA-β)与B组、C组比较,P>0.05.B组、C组治疗后血清P1NP、β-CTX均低于A组,P<0.05,B组血清P1NP、β-CTX水平与C组比较,P>0.05.A组不良反应发生率(5.00％)与B组(2.50％)、C组(7.50％)比较,P>0.05.结论 达格列净、维格列汀、阿卡波糖均可有效降低新诊断T2DM患者血糖,改善胰岛功能,但维格列汀、阿卡波糖可有效降低血清P1NP、β-CTX水平,预防骨质疏松.

Background: What and how the adipose-derived ApoE regulates biological features and lipid metabolism in the diabetic adipose tissue remain little known. Methods: ApoE-/- and wild type mice were randomly divided into 4 groups: ApoE-/- group (EKO); streptozotocin (STZ)-induced diabetic apoE-/- group (EKODM); wild type group(WT); and STZ-induced diabetic wild type group (WTDM). Epididymal white adipose tissue isolated from part EKODM mice were transplanted into backs of WT mice and WTDM mice respectively, all recipient mice were fed with standard chow for 8 weeks. Vital signs, fasting plasma glucose, serum triglycerides(TG) and total cholesterol(TC) were measured every 4 weeks. After sacrifice, epididymal and transplanted white adipose tissue were harvested from all recipient mice. Histomorphologic alterations of adipose tissue were observed. Lipid ingredients of adipose tissue were extracted and measured. Genes expression of ApoE,lipoprotein lipase (LPL),hormone sensitive lipase(HSL),fatty acid synthase(FAS) in adipose tissue were detected by the RT-PCR. Results: 1) After transplantation, the donor adipocytes size from EKODM→WT and EKODM→WTDM mice were both larger than that of EKODM itself. 2) Adipose TG contents of EKO and WTDM group were both lower than that of WT group, while EKODM→WT transplantation increased TG content but kept TC content unchanged compared with the EKODM→WTDM. 3) Adipose tissues of EKODM→WT and EKODM→WTDM group both significantly expressed ApoE. 4) Gene expressions of HSL, LPL, and FAS in donor adipose tissues from either EKODM→WT and EKODM→WTDM group were all significantly increased if compared with the EKODM group. Conclusions: Adipose-derived ApoE may facilitate adipocyte differentiation in mice, even in a diabetic state. Disclosure J. Ran: None. X. Pan: None. R. Zhang: None. P. Zhu: None. R. Tan: None. Y. Liu: None.

目的:观察新诊断的原发性甲状腺功能减退症(甲减)患者血脂谱特点;采用单纯左甲状腺素替代及联合阿托伐他汀治疗并动态观察血脂改变.方法:58例新诊断的甲减患者给予左甲状腺素(L-T4)替代治疗3个月后随机分为单纯替代治疗组(L-T4组)及联合阿托伐他汀(10mg/d)治疗组(阿托伐他汀组),每3个月复查患者的甲状腺功能(包括游离甲状腺素、游离三碘腺原氨酸及促甲状腺素)、血脂指标(包括甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)及谷丙转氨酶、肌酸激酶的变化.结果:L-T4替代治疗3个月后两组血游离甲状腺素、游离三碘腺原氨酸水平明显上升至正常范围,而促甲状腺素显著下降(P＜0.05);患者存在明显的高总胆固醇、低密度脂蛋白胆固醇血症;L-T4组在第6个月总胆固醇及低密度脂蛋白胆固醇仍呈高水平;阿托伐他汀组在第6个月总胆固醇、低密度脂蛋白胆固醇明显降低(P＜0.05),并在观察期间维持稳定.观察期间两组谷丙转氨酶、肌酸激酶水平均正常且无显著差别(P＞0.05).结论:甲减患者存在显著的高胆固醇血症;单纯左甲状腺素替代治疗难以改善血脂异常,而联合阿托伐他汀治疗有助于长期维持血脂正常和稳定.

1 病例资料<br>　　患者1：女，56岁，因“精神异常2年，言语不清1周”入院。患者精神异常主要表现为认知功能、智力、记忆力明显减退，呈渐行性加重。1周前出现构音不清，伴有吞咽困难、饮水呛咳。30年前因“甲状腺功能亢进症”，行“甲状腺次全切除术”；有“2型糖尿病”史2年，服用二甲双胍治疗，血糖控制欠佳。查体：生命体征稳定；面容呆滞，构音不清，言语基本成句，伸舌左偏，咽反射明显减弱，四肢肌力 V －级，双侧Babinski’s 征阳性；心肺腹部无明显异常。入院查血清钙为2．40 mmol ／l，两次游离钙分别1．22 mmol ／l、1．10 mmol／l，血清磷1．26mmol ／l，两次甲状旁腺素分别为2．19 pmol／L 、1．94 pmol ／L，1，25－羟维生素 D 136．00 nmol／L，均在正常范围；甲状腺功能：游离三碘甲状腺原氨酸2．49 pmol／L ，游离甲状腺素9．40 pmol ／L ，超敏促甲状腺激素7．63 mIU／L，抗甲状腺过氧化物酶抗体54．81 kIU／L，提示原发性甲状腺功能减退。

睾丸血管变异的报道在国内外并不少见。其中，睾丸动脉存在着数目、起源和行程的变异[1～3]，而睾丸静脉也存在着数目和注入部位的变异[4,5]。作者在解剖1具中年男性尸体时，发现其左睾丸动、静脉同时存在变异，实属罕见。