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中华内分泌代谢杂志
中华内分泌代谢杂志

宁光

月刊

1000-6699

cjem@vip.163.com

021-64315587

200025

上海市瑞金二路197号

中华内分泌代谢杂志/Journal Chinese Journal of Endocrinology and MetabolismCSCD北大核心CSTPCD
查看更多>>1985年创刊，中华医学会主办。本刊是反映我国当代及与国外合作的，在内分泌代谢病学领域内临床与科研最新成果的高级学术刊物。在强调刊文的先进性、科学性与新颖性的同时，也十分重视临床的实用性和论文的可读性。本刊设指南与共识、述评、专论、论坛、临床研究、基础研究、综述、讲座、临诊应对、当年学术进展与动态、临床经验交流、新药研究、学术争鸣及国外期刊论文评论等栏目。本刊的读者对象主要为各级从事临床和基础内分泌代谢病学工作的医、教、研人员及研究生，以及内、外、儿、妇科以及神经、泌尿、老年、营养等相关科室的人员。
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    建立餐后血脂标准化评估方案推进心血管疾病防治关口前移

    宁光朱梅华
    183-185页
    查看更多>>摘要：血脂紊乱与动脉粥样硬化的发生发展密切相关。临床实践多基于空腹血脂水平进行血脂紊乱评估，很少进行餐后肠源性脂蛋白水平的检测，进而忽视了餐后血脂异常所伴随的心血管代谢性疾病风险。作为血脂检测中不可或缺的一环，餐后血脂测定因缺乏试验餐和采血时间的统一规范而未能于临床常规开展。本期刊登的《口服脂肪耐量试验的优化研究》为解决餐后血脂测定提供了规范方法。相信未来会有更多采用此优化方法进行餐后血脂的相关研究，完善针对餐后血脂紊乱干预获益的循证医学证据，为尽早全面识别脂代谢紊乱人群以及实现心血管疾病的防治关口前移提供可靠科学依据。 Dyslipidemia is closely related to the development and progression of atherosclerosis. However, current clinical practice often relies on fasting lipid levels for the assessment of dyslipidemia, with little attention given to postprandial lipid levels, thereby overlooking the cardiometabolic disease risk associated with postprandial dyslipidemia. As an indispensable component of lipid management, postprandial lipids are not routinely measured in clinical practice due to the lack of standardized protocols about test meals and blood collection program. The paper titled " Optimization of oral fat tolerance test" published in this issue proposed a standardized protocol for postprandial lipid measurement. More studies are needed to accumulate evidence about the health benefits of possible interventions and to provide a reliable scientific basis for the early identification of dyslipidemic population as well as for the prevention and treatment of cardiovascular diseases.

    餐后血脂心血管疾病口服脂肪耐量试验

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    肥胖人群尿白蛋白/肌酐比值异常的危险因素分析

    曹哲杨童悦刘诗宇潘梦醒...
    186-191页
    查看更多>>摘要：目的 探究肥胖人群中尿白蛋白/肌酐比值(urinary albumin/creatinine ratio, UACR)异常的临床特征及危险因素。 方法 回顾性分析"中国2型糖尿病患者肿瘤发生风险流行病学研究(REACTION)"河南分中心2011年至2012年基线数据，筛选体重指数≥28 kg/m2的肥胖人群，根据是否存在UACR异常，以年龄、性别一致原则1∶1匹配分为UACR正常和UACR异常组(101对)。对肥胖人群基线资料进行多因素logistic回归、受试者工作特征(ROC)曲线及限制性立方样条(RCS)分析，探究UACR异常的危险因素。 结果 与UACR正常组相比，UACR异常组饮酒人数较多，高血压患病率更高，收缩压、三酰甘油等指标升高(均P<0.05)。多因素logistic回归分析结果显示，饮酒(P＝0.008)、收缩压(P<0.001)、三酰甘油(P＝0.049)、稳态模型评估的胰岛素抵抗指数(HOMA-IR, P＝0.033)为肥胖人群UACR异常的独立危险因素。ROC曲线分析结果显示，收缩压单因素诊断效能最强(ROC曲线下面积为0.801)，且与多因素联合诊断效能无显著差异。RCS分析结果显示，当收缩压处于130～158 mmHg(1 mmHg＝0.133 kPa)时，随着收缩压升高，UACR异常的概率呈单调递增趋势。当收缩压不在此区间内时，UACR异常的概率无明显变化趋势。三酰甘油亚组回归分析结果显示，当三酰甘油≥5.6 mmol/L时，UACR异常风险较前显著增高(P＝0.029)。 结论 收缩压、三酰甘油、HOMA-IR、饮酒史是肥胖人群UACR异常的独立危险因素；且当收缩压≥130 mmHg或三酰甘油≥5.6 mmol/L时，UACR异常的风险显著升高。 Objective To explore the clinical characteristics and risk factors of abnormal urinary albumin/creatinine ratio(UACR) in obese population. Methods Baseline data from 2011 to 2012 in Henan Sub-center of"Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) study"were utilized and those of body mass index≥28 kg/m2 were screened. The patients were divided into UACR normal group and UACR abnormal group(101 pairs) upon being matched on a 1∶1 basis by age and gender. Multivariate logistic regression analysis, receiver operating characteristic(ROC) curve, and restricted cubic spline(RCS)analysis were performed to explore the risk factors for abnormal UACR. Results Compared with the normal UACR group, the UACR abnormal group had a higher number of alcohol consumers, a higher prevalence of hypertension, elevated systolic blood pressure, and triglyceride(all P<0.05). Multivariate logistic regression analysis showed that alcohol consumption(P=0.008), systolic blood pressure(P<0.001), triglyceride(P=0.049), and homeostasis model assessment for insulin resistance(HOMA-IR, P=0.033) were independent risk factors for abnormal UACR in obese people. The ROC curve analysis indicated that systolic blood pressure had the strongest diagnostic performance as a single factor(ROC curve area=0.801), and there was no significant difference in diagnostic performance compared to multiple factors combination. RCS analysis results showed that the probability of abnormal UACR increased monotonically with the increase of systolic blood pressure when the systolic blood pressure was between 130 and 158 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure was not in the interval, the probability of abnormal UACR did not change significantly. The results of regression analysis of triglyceride subgroup showed that when triglyceride level was greater than or equal to 5.6 mmol/L, the risk of abnormal UACR level was significantly increased(P=0.029). Conclusion Systolic blood pressure, triglyceride, HOMA-IR, and alcohol drinking history are independent risk factors for abnormal UACR in obese people. When systolic blood pressure is≥130 mmHg or triglyceride is≥5.6 mmol/L, the risk of abnormal UACR is significantly increased.

    肥胖尿白蛋白/肌酐比值收缩压稳态模型评估的胰岛素抵抗指数

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    糖尿病患者肾上腺意外瘤患病率及其代谢特征

    刘婴宁邹显彤赵唯姚旬...
    192-197页
    查看更多>>摘要：目的 探究糖尿病患者中肾上腺意外瘤的患病率及其代谢特征。 方法 回顾性选取2020年3月至2021年5月于北京大学人民医院内分泌与代谢科住院的615例糖尿病患者。回顾入院胸部计算机断层扫描(CT)筛查肾上腺意外瘤并通过多平面重建的方法进行确诊。收集受试者相关身体指标、代谢指标及肾上腺功能指标。采用非配对t检验、Mann-Whitney U检验及卡方检验比较有或无肾上腺意外瘤组间代谢特征的差异。回归分析住院糖尿病患者肾上腺意外瘤与血糖、血脂、血压等代谢指标、肾上腺功能指标的相关性。 结果 615例糖尿病患者中共检出27例合并肾上腺意外瘤(4.4%)。合并肾上腺意外瘤患者的体重指数、腰围及臀围水平显著高于未合并肾上腺意外瘤患者[(29.4±5.1)kg/m2对(26.8±3.8)kg/m2, P＝0.018 (102.3±11.7)cm对(95.8±10.3)cm, P＝0.002 (107.3±10.1)cm对(101.4±7.6)cm, P＝0.008]。血尿酸、尿微量白蛋白/肌酐比值也在合并肾上腺意外瘤患者中显著升高[(409.6±118.1)μmol/L对(357.4±100.6)μmol/L, P＝0.009；21.25(7.49，180.24)mg/g对8.60(4.71，34.56)mg/g, P＝0.010]。另外，合并肾上腺意外瘤患者共患高血压病的风险显著增加(P＝0.045)。 结论 糖尿病患者中肾上腺意外瘤的患病率为4.4%。糖尿病患者合并肾上腺意外瘤者合并肥胖及高血压病的风险增加。 Objective To determine the incidence of adrenal incidentalomas(AIs) in patients with diabetes mellitus and the metabolism profiles. Methods A total of 615 hospitalized patients with diabetes mellitus in the Department of Endocrinology and Metabolism of Peking University People′s Hospital from March 2020 to May 2021 were retrospectively included in this study. AIs were screened by unenhanced chest computed tomography(CT) retrospectively and subsequently confirmed by multiplanar reconstruction. Participants′ physical indicators, metabolic profiles, and adrenal function parameters were collected. Unpaired t test, Mann-Whitney U test, and Chi-Square test were adopted to compare the metabolism profiles between diabetes mellitus patients with or without AIs. Regression models were used to estimate the correlations between AIs and the metabolism profiles such as blood glucose, blood lipids, blood pressure, and the adrenal function parameters. Results Twenty-seven out of 615 participants were detected with AIs(4.4%). Patients with AIs had higher body mass index, waist circumference, and hip circumference than patients without AIs [(29.4±5.1)kg/m2 vs(26.8±3.8)kg/m2, P=0.018 (102.3±11.7)cm vs(95.8±10.3)cm, P=0.002 (107.3±10.1)cm vs(101.4±7.6)cm, P=0.008]. The levels of serum uric acid and urinary albumin/creatinine ratio were also significantly increased in patients with AIs [(409.6±118.1)μmol/Lvs(357.4±100.6)μmol/L,P=0.009 21.25(7.49, 180.24)mg/g vs 8.60(4.71, 34.56)mg/g, P=0.010]. Besides, individuals with AIs were also associated with a higher risk of co-existing hypertension(P=0.045). Conclusion The incidence of AIs in patients with diabetes is 4.4%. The presence of AIs in patients with diabetes may associated with increased risk of obesity and hypertension.

    肾上腺意外瘤糖尿病计算机断层扫描高血压代谢异常

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    2型糖尿病患者血糖目标范围内时间与代谢相关脂肪性肝病及肝纤维化的相关性研究

    王丹钰刘凯坤邓欣如史晓阳...
    198-203页
    查看更多>>摘要：目的 探讨2型糖尿病患者血糖目标范围内时间(time in range, TIR)与代谢相关脂肪性肝病(metabolic associated fatty liver disease, MAFLD)及进展期肝纤维化的相关性。 方法 本研究为回顾性研究，选取2019年10月至2022年4月河南省人民医院内分泌科494例2型糖尿病患者作为研究对象，TIR来自持续血糖监测数据，腹部超声诊断脂肪肝，瞬时弹性成像技术的肝脏硬度值评估肝纤维化。采用Pearson相关性分析及多元线性回归分析评估TIR与肝脏硬度值的相关性，采用logistic回归分析评估TIR与MAFLD及进展期肝纤维化患病风险的相关性。 结果 Pearson相关性分析显示，TIR与肝脏硬度值呈负相关(r＝－0.86, P<0.001)，稳态模型评估的胰岛素抵抗指数(HOMA-IR)与肝脏硬度值呈正相关(r＝0.48, P<0.001)；调整混杂因素后，多元线性回归分析显示，TIR负向预测肝脏硬度值(β＝－0.75, P<0.001)，HOMA-IR正向预测肝脏硬度值(β＝0.21, P＝0.025)；调整混杂因素后，logistic回归分析显示，与TIR Q4患者相比，TIR Q1患者MAFLD(OR＝1.96, 95%CI 1.07～3.62, P＝0.027)及进展期肝纤维化(OR＝3.82, 95%CI 1.17～12.50, P＝0.027)患病风险增加，HOMA-IR是MAFLD(OR＝1.22, 95%CI 1.04～1.43, P＝0.005)及进展期肝纤维化(OR＝1.26, 95%CI 1.03～1.54, P＝0.025)的独立危险因素。 结论 2型糖尿病患者中，低水平TIR、胰岛素抵抗是MAFLD及进展期肝纤维化的独立危险因素，TIR对MAFLD及进展期肝纤维化发生有显著的预测价值。 Objective To investigate the association of time in range with metabolic associated fatty liver disease(MAFLD) and advanced liver fibrosis in patients with type 2 diabetes. Methods This study was a retrospective study. A total of 494 type 2 diabetic patients were recruited in the Department of Endocrinololgy of Henan Provincial People′s Hospital from November 2019 to April 2022. Time in range(TIR) was calculated with continuous glucose monitoring data. Abdominal ultrasound scan was used to diagnose fatty liver. Liver stiffness measurement(LSM) by transient elastography was used to evaluate liver fibrosis. Pearson and multivariate linear regression analysis was used to evaluate the association between TIR and LSM. Multivariate logistic regression analysis was used to analyze the association of TIR with risk of MAFLD and advanced liver fibrosis. Results Pearson correlation analysis showed that LSM was negatively correlated with TIR(r=-0.86, P<0.001) and was positively correlated with homeostasis model assessment for insulin resistance(HOMA-IR r=0.48, P<0.001). After adjusting for confounding factors, multivariate linear regression analysis showed that TIR significantly negatively predicted LSM(β=-0.75, P<0.001), and HOMA-IR significantly positively predicted LSM(β=0.21, P=0.025). After adjusting for confounding factors, logistic regression analysis showed that compared with TIR Q4 patients, TIR Q1 patients had an increased risk of MAFLD(OR=1.96, 95%CI 1.07-3.62, P=0.027), advanced liver fibrosis(OR=3.82, 95%CI 1.17-12.50, P=0.027), and HOMA-IR was an independent risk factor for MAFLD(OR=1.22, 95%CI 1.04-1.43, P=0.005) and advanced liver fibrosis(OR=1.26, 95%CI 1.03-1.54, P=0.025). Conclusions TIR and insulin resistance are independent risk factors for MAFLD and advanced liver fibrosis in patients with type 2 diabetes. TIR has a significant predictive value for MAFLD and advanced liver fibrosis.

    目标范围内时间代谢相关脂肪性肝病进展期肝纤维化

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    口服脂肪耐量试验的优化研究

    侯艺林马倩宋光耀侯晓宇...
    204-211页
    查看更多>>摘要：目的 本研究旨在对比不同试验餐对餐后三酰甘油的影响，优化口服脂肪耐量试验标准餐配方和采血方案。 方法 本研究为前瞻性、开放标签、随机、交叉试验。2023年3月在河北省人民医院招募志愿者36名，经过健康查体和口服葡萄糖耐量试验，26名健康志愿者符合入选标准(男性11名，女性15名)，平均年龄(39.08±4.56)岁。每位志愿者分别接受75 g蛋白餐、75 g脂肪餐、700 kcal固定热量高脂混合餐及根据10 kcal/kg体重调整热量的高脂混合餐试验，每次试验前普通饮食洗脱1周。在每次试验的空腹和餐后1、2、3、4、5、6 h采血，取血清检测三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血糖、胰岛素。分析不同试验餐餐后代谢指标随时间变化情况，比较两种混合餐的餐后代谢反应差异。 结果 蛋白餐、脂肪餐、固定热量高脂混合餐、调整热量高脂混合餐分别使餐后三酰甘油升高22.45%、115.40%、77.14%、63.63%，胰岛素升高560.43%、85.69%、554.18%、598.97%，总胆固醇、LDL-C、HDL-C降低5.64%～21.81%，血糖变化较小。代谢指标的主要变化发生在4 h以内。比较2种高脂混合餐后三酰甘油的特征，差异无统计学意义(P>0.05)。 结论 以700 kcal固定热量高脂混合餐为标准餐，在空腹和餐后1、2、3、4 h分别采血检测血脂水平，可作为口服脂肪耐量试验的优化方案。 Objective To compare the effects of different test meals on postprandial triglycerides and to optimize the standard meal composition and the blood sampling protocol for the oral fat tolerance test. Methods This study is a prospective, open-label, randomized, cross-over trial. In March 2023, 36 volunteers were recruited in Hebei General Hospital. They underwent a health examination and oral glucose tolerance test. Twenty-six healthy volunteers(11 males and 15 females) were included in this study, with an average age of(39.08±4.56) years. Each volunteer received 75 g protein meal, 75 g fat meal, 700 kcal fixed-calorie high-fat mixed meal, and a high-fat mixed meal with energy adjusted based on 10 kcal/kg body weight. A one-week washout period of regular diet was applied before each trial. Blood was collected at fasting status and 1, 2, 3, 4, 5, and 6 hours after a meal to detect serum triglycerides, total cholesterol, low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol(HDL-C), glucose, and insulin. The variations of postprandial metabolic indicators over time following the consumption of different test meals were analyzed. The disparities in postprandial metabolic responses between the two types of mixed meals were compared. Results The protein meal, fat meal, fixed-calorie high-fat mixed meal, and adjusted-calorie high-fat mixed meal resulted in postprandial triglyceride increases of 22.45%, 115.40%, 77.14%, and 63.63%, and insulin increase of 560.43%, 85.69%, 554.18%, and 598.97%, respectively, and with reductions in total cholesterol, LDL-C, and HDL-C ranging from 5.64%-21.81%, respectively. The blood glucose changed slightly. Changes in metabolic indicators mainly occured within 4 hours. The comparison of the characteristics of postprandial triglycerides between the two high-fat mixed meals showed no statistically significant differences(P>0.05). Conclusion A standardize protocol with a 700 kcal fixed-calorie high-fat mixed meal as test meal, and blood lipid levels measured at fasting and at 1, 2, 3, and 4 hours after consumption, can serve as an optimized approach for oral fat tolerance test.

    三酰甘油口服脂肪耐量试验餐后血脂健康人群心血管疾病

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    促甲状腺激素不适当分泌综合征的临床特点与鉴别诊断

    王莎莎李志臻赵艳艳张会娟...
    212-218页
    查看更多>>摘要：目的 通过全面的症状体征、生化、影像及动态试验分析，探讨垂体促甲状腺激素瘤(TSH瘤)和甲状腺激素抵抗综合征(RTH)的诊断和鉴别诊断。 方法 回顾性分析2016年7月至2022年9月于郑州大学第一附属医院就诊的14例血清学表现为游离三碘甲状腺原氨酸和(或)游离甲状腺素水平升高而促甲状腺激素浓度不低于正常值患者的临床资料。 结果 TSH瘤7例、RTH 7例，平均确诊年龄分别为40.0岁和26.6岁。13例患者因甲状腺毒症或偶发心慌症状就诊，部分伴垂体占位效应或生长发育异常；1例患者因颈部增粗就诊。3例TSH瘤患者的血清性激素结合球蛋白升高。垂体磁共振成像显示，7例TSH瘤患者均为大腺瘤、1例RTH患者存在微腺瘤。13例患者行奥曲肽抑制试验均被抑制，但TSH瘤和RTH 24 h/2 h TSH抑制率存在明显差异，分别为46.6%～83.9%和4.6%～28.8%。6例RTH患者存在甲状腺激素受体β亚基突变。 结论 促甲状腺激素不适当分泌综合征临床较为罕见，主要包括TSH瘤和RTH，两者诊断及鉴别需结合家族史、症状体征、检查检验、动态试验及基因检测等综合研判，其中奥曲肽抑制试验24 h/2 h TSH抑制率可有效鉴别TSH瘤与RTH。 Objective Through comprehensive analysis of symptoms and signs, biochemistry, imaging, and dynamic tests, to explore the diagnosis and differential diagnosis of thyrotropin-secreting pituitary adenoma(TSH adenoma) and syndrome of resistance to thyroid hormone(RTH). Methods A retrospective analysis was conducted on clinical data from 14 patients who visited the First Affiliated Hospital of Zhengzhou University from July 2016 to September 2022, exhibiting elevated levels of free thyroxine(FT4) and free triiodothyronine(FT3) in the presence of increased TSH. Results There were 7 cases of TSH adenoma and 7 cases of RTH, with the average age of diagnosis at 40.0 years and 26.6 years, respectively. Thirteen patients showed thyrotoxicosis or occasional palpitation, some with pituitary occupancy manifestations or abnormal growth and development One patient presented with neck thickening. Sex hormone binding globulin was elevated in 3 cases of TSH adenoma. Pituitary magnetic resonance imaging showed that all 7 cases of TSH adenoma were macroadenomas and 1 case of RTH was microadenoma. The octreotide suppression test in 13 patients was inhibited, but there was a significant difference in the inhibition rate of 24 h/2 h TSH inhibition rate of TSH adenoma and RTH, ranging from 46.6% to 83.9% and 4.6% to 28.8% respectively. Six cases of RTH had thyroid hormone receptor β mutation. Conclusion Syndrome of inappropriate secretion of thyrotropin is a rare condition, mainly including TSH adenoma and RTH. The diagnosis and differentiation of the two conditions require comprehensive assessment incorporating family history, symptoms and signs, laboratory tests, dynamic test, and genetic test. Among these, the 24 h/2 h TSH inhibition rate of octreotide suppression test can effectively distinguish TSH adenoma from RTH.

    促甲状腺激素不适当分泌综合征促甲状腺激素瘤甲状腺激素抵抗综合征奥曲肽抑制试验

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    甲巯咪唑所致粒细胞缺乏症及其他血液系统损害的骨髓特征及文献回顾

    罗媛琳马盼郑婕樊丽娅...
    219-227页
    查看更多>>摘要：目的 回顾性分析甲巯咪唑所致粒细胞缺乏症及其他血液系统损害的骨髓学特征，探索其与临床表现及预后之间的相关性。 方法 收集2000年1月至2022年12月在西安交通大学第一附属医院诊断为甲巯咪唑所致粒细胞缺乏症的20例Graves病患者骨髓学及临床参数，分析不同骨髓学特征患者外周血中性粒细胞恢复时间的组间差异；比较单纯粒细胞缺乏症与合并三系细胞减少患者外周血及骨髓学特征的差异；并回顾性分析甲巯咪唑所致血液系统疾病相关文献。 结果 相较于骨髓学特征为粒细胞及前体成熟障碍型(Ⅱ型)患者，再生障碍型(Ⅰ型)患者粒细胞系统各期细胞比例均显著下降(P<0.05)，淋巴细胞系统比例显著增加[51.00%(41.50%，75.50%)对22.00%(14.00%，35.00%),P＝0.002]，外周血中性粒细胞恢复时间更长[(6.58±1.68)d对(3.71±1.60)d, P＝0.003]；相关分析提示，骨髓粒红比值与外周血中性粒细胞恢复时间呈负相关(r＝－0.520, P＝0.023)，骨髓淋巴细胞比例与外周血中性粒细胞恢复时间呈正相关(r＝0.622, P＝0.004)。相对于单纯粒细胞缺乏症患者，合并外周血三系细胞减少者住院时间显著延长[(27.14±5.27)d对(14.15±7.36)d, P＝0.001]。文献回顾结果提示，甲巯咪唑可导致不同程度的血液系统损害和骨髓破坏。 结论 甲巯咪唑可导致多种血液系统疾病，分析骨髓特征有助于进一步判断其预后，临床医生在使用甲巯咪唑时应警惕可能发生的血液系统不良反应并及时诊治，避免严重后果的发生。 Objective To retrospectively analyze the bone marrow characteristics of methimazole-induced agranulocytosis and other hematologic damage, and to explore its correlation with clinical features and prognosis. Methods The bone marrow and clinical parameters of 20 patients of Graves′ disease diagnosed with methimazole-induced agranulocytosis at the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to December 2022 were collected. The intergroup differences in bone marrow characteristics and granulocyte recovery time were analyzed. Differences in peripheral blood and bone marrow characteristics between patients with single agranulocytosis and pancytopenia were compared. Besides, literature review of the bone marrow characteristics of methimazole-induced hematologic diseases was conducted. Results Compared to patients with bone marrow characteristics of granulocyte and precursor maturation disorders(Type Ⅱ), patients with aplastic marrow(Type Ⅰ) had significant decreases in the proportions of granulocytes in all phases(P<0.05). Patients with bone marrow characteristics of Type Ⅰ had a significant increase in the proportion of the lymphocyte system [51.00%(41.50%, 75.50%)vs 22.00%(14.00%, 35.00%), P=0.002], and got a longer to recovery time [(6.58±1.68)d vs(3.71±1.60)d, P=0.003] Correlation analysis suggested the granulocyte to erythrocyte ratio was negatively correlated with the granulocyte recovery time(r=-0.520, P=0.023), and the proportion of the bone marrow lymphocyte was positively correlated with granulocyte recovery time(r=0.622, P=0.004). Compared to patients with single agranulocytosis, patients with pancytopenia had a markedly longer hospital stay duration [(27.14±5.27)d vs(14.15±7.36)d, P=0.001]. Literature review suggestsed that methimazole may cause various degrees of damage to blood system and bone marrow. Conclusion Methimazole can induce a variety of hematologic damages. Analysis of bone marrow characteristics can aid in further prognosis assessment. Clinicians should be vigilant about potential hematologic adverse reactions when using methimazole and promptly diagnose and treat them to prevent serious consequences.

    甲巯咪唑粒细胞缺乏症三系细胞减少症骨髓造血功能损害

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    406例原发性醛固酮增多症患者手术预后及影响因素分析

    张益鑫宋颖胡金波杨淑敏...
    228-234页
    查看更多>>摘要：目的 评估单侧原发性醛固酮增多症(简称原醛症)术后生化和临床缓解率，分析相关影响因素。 方法 回顾性纳入2013年11月至2022年3月在重庆医科大学附属第一医院内分泌科明确分型并接受肾上腺切除术且完成随访的406例原醛症患者，记录基线和术后的临床资料及生化指标。根据原发性醛固酮增多症手术预后(Primary Aldosteronism Surgical Outcome, PASO)标准进行临床和生化疗效评估。采用多因素logistic回归分析评估影响原醛症术后临床缓解的主要因素。 结果 406例原醛症患者术后的生化完全缓解率为96.31%(391/406)，生化部分缓解率为0.99%(4/406)，生化未缓解率为2.71%(11/406)；临床完全缓解率为53.45%(217/406)，临床部分缓解率为46.55%(189/406)。相比于临床部分缓解组，临床完全缓解组年龄较小，女性占比更大，体重指数较低，高血压病程更短，降压药的限定日剂量更低，估算的肾小球滤过率(eGFR)更高，高血压家族史和糖尿病病史所占比例较低。多因素logistic回归分析进一步显示，性别(OR＝2.49，95%CI 1.42～4.35, P＝0.001)、体重指数(OR＝1.16，95%CI 1.05～1.28, P＝0.003)、降压药限定日剂量(OR＝1.83，95%CI 1.37～2.44, P<0.001)、高血压家族史(OR＝2.16，95%CI 1.22～3.83, P＝0.008)、糖尿病病史(OR＝2.47，95%CI 1.15～5.29, P＝0.021)和eGFR(OR＝0.98，95%CI 0.97～0.99, P＝0.001)是影响原醛症术后取得临床完全缓解的独立因素。 结论 单侧原醛症术后的生化完全缓解率较高，但仅有约一半患者实现临床完全缓解。 Objective To evaluate postoperative biochemical and clinical remission rates in patients with unilateral primary aldosteronism and analyze related influencing factors. Methods A total of 406 patients of primary aldosteronism with confirmed subtyping, who underwent adrenalectomy and completed follow-up in the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical University from November 2013 to March 2022 were retrospectively enrolled. Clinical and biochemical data were recorded. Postoperative clinical and biochemical outcomes were assessed according to Primary Aldosteronism Surgery Outcome(PASO) consensus. Results Complete biochemical success was achieved in 391(96.31%) of 406 primary aldosteronism patients, while partial and absent biochemical success in only 4(0.99%) and 11(2.71%) primary aldosteronism patients Complete clinical success was seen in 217(53.45%) patients, and partial clinical success in 189(46.55%) patients. Compared to the partial clinical success group, the complete clinical success group was younger, had a greater proportion of women, a smaller body mass index, a shorter duration of hypertension, a smaller daily defined dose value for antihypertensive medication, a higher estimated glomerular filtration rate(eGFR), and a lower proportion of family history of hypertension and diabetes mellitus. Multifactorial logistic regression analysis further showed that gender(OR=2.49, 95%CI 1.42-4.35, P=0.001), body mass index(OR=1.16, 95%CI 1.05-1.28, P=0.003), antihypertensive drug daily defined dose(OR=1.83, 95%CI 1.37-2.44, P<0.001), family history of hypertension(OR=2.16, 95%CI 1.22-3.83, P=0.008), history of diabetes(OR=2.47, 95%CI 1.15-5.29, P=0.021), and eGFR(OR=0.98, 95%CI 0.97-0.99, P=0.001) were independent factors influencing clinical prognosis of primary aldosteronism. Conclusion The postoperative complete biochemical success is higher in patients with unilateral primary aldosteronism, but only about half of all patients achieve complete clinical success.

    原发性醛固酮增多症单侧肾上腺切除术预后

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    辅酶Q10对高脂膳食小鼠的胆汁酸代谢和肥胖及相关脂质代谢紊乱的影响

    金梦程张佩雯朱璇李华文...
    235-241页
    查看更多>>摘要：目的 探索辅酶Q10(coenzyme Q10, CoQ10)对高脂膳食诱导的小鼠肥胖、脂质紊乱及胆汁酸代谢的影响。 方法 8周龄C57BL/6J小鼠根据体重按照随机区组法随机分为对照组(普通饲料)、高脂膳食组(45%高脂饲料)和CoQ10干预组(45%高脂饲料＋100 mg·kg－1·d－1 CoQ10)。收集各组小鼠体重、摄食量数据；试剂盒检测血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、丙氨酸转氨酶和天冬氨酸转氨酶水平；超高效液相色谱串联质谱(UPLC-MS/MS)检测小鼠血清、肝脏和结肠中17种胆汁酸的含量，Western印迹检测肝脏中胆固醇12α-羟化酶(cholesterol 12α-hydroxylase, CYP8B1)和氧固醇7α-羟化酶(oxysterol 7α-hydroxylase, CYP7B1)蛋白的表达。 结果 CoQ10显著降低了高脂膳食小鼠的体重并改善其脂质代谢紊乱。与对照组相比，高脂膳食组小鼠血清总胆汁酸水平降低(P<0.05)；与高脂膳食组相比，CoQ10干预升高了小鼠血清和结肠中的总胆汁酸水平(P＝0.021, P＝0.014)，并提高了小鼠肝脏、结肠和血清中脱氧胆酸和熊脱氧胆酸的水平(P<0.05)。CoQ10干预组小鼠结肠和血清脱氧胆酸水平均与小鼠体重呈负相关(P＝0.024, P＝0.019)，结肠脱氧胆酸和总胆固醇水平也呈负相关(P＝0.006)。CoQ10上调了高脂膳食小鼠肝脏中CYP8B1和CYP7B1蛋白的表达。 结论 CoQ10能够调节高脂膳食小鼠的胆汁酸代谢并减轻其肥胖及脂质代谢紊乱。 Objective To explore the effects of coenzyme Q10(CoQ10) on high-fat diet-induced obesity, lipid disorders, and bile acid metabolism in mice. Methods Eight-week-old C57BL/6J mice were randomly divided into control group(regular chow), high-fat diet group(45% high-fat chow), and CoQ10 intervention group(45% high-fat chow+ 100 mg·kg-1·d-1CoQ10) based on their body weights according to the randomized block design. The body weight and food intake of mice in each group were collected. The levels of serum total cholesterol, triglyceride, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, alanine aminotransferase, and aspartate aminotransferase were detected. The contents of 17 bile acids in serum, liver, and colon contents of mice were detected by ultra-performance liquid chromatography-tandem mass(UPLC-MS/MS). The protein expressions of cholesterol 12α-hydroxylase(CYP8B1) and oxysterol 7α-hydroxylase(CYP7B1) in liver were detected by Western blotting. Results CoQ10 significantly reduced body weight and ameliorated lipid metabolism disorders in mice fed a high-fat diet. Compared with the control group, serum total bile acid levels were reduced in the high-fat diet group(P<0.05) CoQ10 intervention elevated serum and colonic total bile acid levels(P=0.021, P=0.014) and increased liver, colon, and serum deoxycholic acid and ursodeoxycholic acid levels(P<0.05) in the mice compared with the high-fat diet group. Both colonic and serum deoxycholic acid levels in the CoQ10 intervention group were negatively correlated with body weights(P=0.024, P=0.019), and colonic deoxycholic acid and total cholesterol levels were also negatively correlated(P=0.006). CoQ10 increased the expression of CYP8B1 and CYP7B1 proteins in the liver of mice. Conclusion CoQ10 can modulate bile acid metabolism in high-fat diet-fed mice and alleviate their obesity and lipid metabolism disorders.

    辅酶Q10肥胖血脂紊乱胆汁酸

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    甲状腺眼病球后组织不同肌群受累差异的原因初探

    宋诗涵张曹旭李润钏张悦...
    242-247页
    查看更多>>摘要：目的 甲状腺眼病患者球后组织不同部位的眼外肌受累严重程度不同，但机制不明。本研究旨在探究不同部位眼外肌中促甲状腺激素受体(thyroid stimulating hormone receptor, TSHR)表达的差异与眼外肌受累程度不同之间的关系。 方法 分离大鼠的球后组织中的内直肌、外直肌、上直肌和下直肌，通过免疫荧光和荧光定量PCR检测TSHR在4条眼外肌的表达水平。收集斜视手术患者的眼外肌组织，通过荧光检测TSHR的表达及其表达的细胞类型。 结果 荧光定量PCR结果显示，TSHR在大鼠球后组织内直肌中的表达明显高于外直肌、上直肌和下直肌(内直肌对外直肌，P＝0.012；内直肌对上直肌，P＝0.015；内直肌对下直肌，P＝0.013)，但胰岛素样生长因子1受体(insulin-like growth factor 1, IGF-1R)无差异。双色免疫荧光结果显示，TSHR与肌卫星细胞的分子标志PAX7共表达，且大鼠和人的内直肌中的表达明显高于另外三条眼外肌。 结论 TSHR在内直肌肌卫星细胞中特异性高表达，可能是甲状腺眼病内直肌最容易受累的原因。 Objective The degree of involvement of extraocular muscles varies across different regions of retrobulbar tissue in patients with thyroid eye disease, but the mechanism is unclear. This study aims to explore the relationship between differential expression of thyroid-stimulating hormone receptor(TSHR) in different parts of the extraocular muscles and the varying degrees of muscle involvement. Methods The medial, lateral, superior, and inferior rectus muscle were separated from the retrobulbar tissue of rats, and the expression level of TSHR in four extraocular muscles was detected by immunofluorescence and qPCR. Extraocular muscle tissue of patients with strabismus was collected to detect the expression of TSHR and the cell types expressed by fluorescence. Results The results of qPCR showed that the expression of TSHR in the medial rectus muscle was significantly higher than that in the lateral, superior, and inferior rectus muscle(medial rectus vs lateral rectus, P=0.012 medial rectus vs superior rectus, P=0.015 medial rectus vs inferior rectus, P=0.013), but there was no difference in insulin-like growth factor 1(IGF-1R) expression. Immunofluorescence showed that TSHR was co-expressed with PAX7, a molecular marker of muscle satellite cells, and the expression level in the medial rectus muscle of rats and humans was significantly higher than those in the other three extraocular muscles. Conclusion The high specific expression of TSHR in the satellite cells of the medial rectus muscle may be the reason why the medial rectus muscle is most susceptible to involvement in thyroid eye disease.

    甲状腺眼病促甲状腺激素受体内直肌外直肌

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