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期刊信息/Journal information
中华糖尿病杂志
中华医学会杂志社
中华糖尿病杂志

中华医学会杂志社

杨文英

月刊

1674-5809

zhtnb@cma.org.cn

010-85158316

100710

北京市东城区东四西大街42号

中华糖尿病杂志/Journal Chinese Journal of Diabetes MellitusCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊以从事糖尿病预防、治疗、科研工作者为对象,报道糖尿病领域最新科研成果和先进诊疗经验,以及密切结合临床、具有指导作用的基础理论研究。本刊欢迎临床研究、基础研究、急重症诊治、流行病学与人群防治、医学新视野、争鸣与讨论、学术动态、病例报告、读者来信及医路心语等稿件。本刊实行同行评审制,贯彻理论与实践、普及与提高相结合的方针,反映我国糖尿病学临床、科研工作的重大进展。
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    糖尿病足多学科团队诊疗的机遇与挑战

    刘彦张真稳徐刚刘宏君...
    285-291页
    查看更多>>摘要:糖尿病足致残率、致死率、复发率均高,迫切需要多学科合作诊治。糖尿病足多学科(MDT)团队和中心不断出现,亟需认证、监管和评价。各种指南及概念的更新需要糖尿病足MDT团队共同学习和实践,而这种实践会触发更深入的临床研究。糖尿病相关足病的规范化处理是医防融合的重点。糖尿病足联盟和糖尿病足MDT规范化诊疗基地可为糖尿病足MDT团队及社区医护人员的认证、培训、交流提供平台。社区慢性病防治工作和糖尿病相关足病筛查预防工作相结合,有利于解决我国目前糖尿病足医数量严重不足的困境,有利于糖尿病相关足病的早期精准识别与双向转诊,有望降低糖尿病足发病率、截肢率和治疗费用。

    糖尿病足糖尿病相关足病糖尿病高危足糖尿病足联盟糖尿病足多学科诊疗团队机遇挑战

    鞋具对糖尿病足溃疡高危患者预防的有效性:国际糖尿病足工作组2023年糖尿病足诊疗指南足溃疡预防部分解读

    魏晓伟许樟荣王爱红张志巍...
    292-296页
    查看更多>>摘要:糖尿病足溃疡是糖尿病的严重并发症。足溃疡的预防一直以来都是国际糖尿病足工作组的首要事项。该文对国际糖尿病足工作组2023年糖尿病足诊疗指南足溃疡预防部分进行解读。预防溃疡的措施众多,该解读聚焦于足溃疡预防部分相关研究证据,按照研究的分组方法进行分类总结,重点关注研究中不同鞋具对溃疡发生率/复发率、足底压力的影响,同时关注死亡率、不良事件、依从性等,旨在为临床工作者的诊疗实践提供参考。

    糖尿病足溃疡预防高危足治疗性鞋具足底压力

    基于机器学习构建甘肃省不同地区糖尿病性视网膜病变的临床预测模型

    洪豆豆杨建宁乔文俊王云芳...
    297-306页
    查看更多>>摘要:目的 基于机器学习构建甘肃省平原风沙与黄土丘陵地区糖尿病性视网膜病变(DR)的临床预测模型并分析其影响因素。 方法 为横断面研究。基于中国糖尿病并发症(CNDCS)研究的甘肃省流行病学数据进行模型的建立与验证。采用多阶段分层随机抽样的方法纳入2型糖尿病(T2DM)患者并按照7∶3的比例生成训练集和测试集。收集平原风沙与黄土丘陵地区T2DM患者并发DR的情况。采用递归特征消除(RFE)的方法筛选出两地区的最优变量,选用逻辑回归(LR)、决策树(DT)、支持向量机(SVM)、随机森林(RF)和极端梯度提升树(XGBoost)5种机器算法进行模型的训练,采用曲线下面积(AUC)对5种机器算法进行比较,并筛选出最优模型,进一步采用沙普利可加性特征解释(SHAP)分析法直观地解释最优机器学习模型的结果。 结果 共纳入1 739例T2DM患者。其中有23.63%(411/1 739)的患者并发DR。RFE法结果显示,平原风沙与黄土丘陵地区最终分别筛选出8和14个最优变量。通过综合评价,平原风沙与黄土丘陵地区的最佳临床预测模型分别为RF(训练集AUC=0.874,测试集AUC=0.737)和XGBoost(训练集AUC=0.899,测试集AUC=0.783)。进一步进行的SHAP分析法结果显示,RF模型中排在前5位的重要区分特征为糖化血红蛋白(HbA1c)、糖尿病病程、心率、尿微量白蛋白、收缩压,XGBoost模型中排在前5位的重要区分特征为糖尿病病程、尿微量白蛋白、血清白蛋白、尿素氮、HbA1c。 结论 RF与XGBoost模型对DR风险指标的评估具有较高的可靠性。糖尿病病程、HbA1c、尿微量白蛋白是DR的影响因素。 Objective To construct a clinical prediction model for diabetic retinopathy (DR) based on machine learning and to analyze the factors influencing DR in the windy desert area and loess hilly area of Gansu province. Methods This study was a cross-sectional study. Modeling and validation based on epidemiologic data from Gansu province of the China national diabetic complications study (CNDCS). The included type 2 diabetes mellitus (T2DM) patients were cut into training and test sets at a ratio of 7∶3 using multistage stratified random sampling. Collection of concomitant DR in patients with T2DM in windy desert area and loess hilly area. The recursive feature elimination (RFE) method was used to screen the optimal variables for the two regions. Five machine algorithms, logistic regression (LR), decision tree (DT), support vector machines (SVM), random forest (RF) and eXtreme gradient boosting (XGBoost) were selected to train the model. Five machine algorithms were compared using the area under the curve (AUC) of the subjects and the optimal model was selected. And the Shapley additive explanation (SHAP) analysis was further used to visually interpret the results of the optimal machine learning model. Results A total of 1 739 patients with T2DM were enrolled. Of these, 23.63% (411/1 739) had concurrent DR. The results of the RFE method showed that 8 and 14 optimal variables were finally screened for the windy desert area and the loess hilly area, respectively. According to the comprehensive evaluations, the RF model was identified as the best prediction model (AUC of the train set=0.874, AUC of the validation set=0.737) in windy desert area. The XGBoost model was identified as the best prediction model (AUC of train set=0.899, AUC of validation set=0.783) in loess hilly area. The results of further SHAP analysis method showed that the top five important distinguishing features of RF model were glycated hemoglobin A1c (HbA1c), duration of diabetes, heart rate, urine microalbumin and systolic blood pressure. The top five important distinguishing features of XGBoost model were duration of diabetes, urine microalbumin, blood albumin, blood urea nitrogen and HbA1c. Conclusions RF and XGBoost model had high reliability in assessing risk indicators of DR. Duration of diabetes, HbA1c, and urine microalbumin are influential factors in DR.

    糖尿病视网膜病变机器学习危险因素

    血清Hsa_circ_0057362在糖尿病足溃疡中的表达及其预测病情严重程度及预后的价值

    欧阳茹黎宗保裴翔张丽...
    307-313页
    查看更多>>摘要:目的 探讨血清Hsa_circ_0057362在糖尿病足溃疡(DFU)患者中的表达及其预测病情严重程度及预后的价值。 方法 。 为病例对照研究回顾性选取2020年1月至2023年3月海南省第三人民医院收治的116例DFU患者作为DFU组,选择我院同期收治的90例单纯2型糖尿病(T2DM)患者作为T2DM组,另选择同期来我院体检的正常人群60名作为对照组。根据Wagner分级标准,116例DFU患者中1级25例、2~3级54例、4~5级37例。按DFU感染严重程分为1~2级55例(无或轻度感染),3~4级61例(中重度感染)。根据DFU患者6个月预后情况分为预后良好组(68例)和预后不良组(48例)。使用实时荧光聚合酶链反应技术检测Hsa_circ_0057362水平,化学发光免疫分析法检测降钙素原(PCT)水平,酶联免疫吸附法检测血清白细胞介素-6(IL-6)水平,采用方差分析、SNK-q检验和t检验比较血清各组IL-6、CRP及Hsa_circ_0057362水平的差异。应用二元logistic回归分析法分析DFU患者预后不良的影响因素。绘制受试者工作特征曲线(ROC)分析Hsa_circ_0057362、CRP及IL-6预测DFU患者预后不良的价值。采用Spearman相关分析法分析DFU患者血清Hsa_circ_0057362表达水平与感染分级和Wagner分级的相关性。 结果 DFU组和T2DM组血清PCT、IL-6及Hsa_circ_0057362水平均明显高于对照组,且DFU组高于T2DM组(P<0.05)。预后不良组DFU病程、Wagner分级、血肌酐、尿酸、PCT、IL-6及Hsa_circ_0057362水平均明显高于预后良好组(P<0.05)。3~4级感染DFU患者血清Hsa_circ_0057362表达水平明显高于1~2级(分别为4.36±2.08和3.25±1.57,P<0.001)。随着Wagner分级增加,DFU患者Hsa_circ_0057362表达水平逐渐升高(4~5级为4.95±2.37,2~3级为3.56±1.79,1级为2.70±0.95,P<0.001)。多因素logistic回归分析结果显示,PCT(OR=2.793,95%CI 1.966~7.104)、IL-6(OR=2.376,95%CI 1.584~5.710)及Hsa_circ_0057362(OR=3.106,95%CI 2.624~10.248)水平升高是DFU患者预后不良的影响因素(P<0.05)。ROC曲线显示,Hsa_circ_0057362≥3.80预测DFU患者预后不良的AUC最大(0.891,95%CI 0.828~0.953),灵敏度为88.4%,特异度为86.2%。Spearman相关分析结果显示,DFU患者血清Hsa_circ_0057362表达水平与Wagner分级呈正相关(r=0.782,P<0.001)。 结论 Hsa_circ_0057362在DFU患者中呈高表达,其水平升高与病情严重程度及预后不良有关,是预测DFU患者预后不良的有用指标。 Objective To investigate the expression of serum Hsa_circ_0057362 in patients with diabetic foot ulcer (DFU) and its value in predicting the severity and prognosis. Methods This study was a case-control study. A total of 116 patients with DFU admitted to the Third People′s Hospital of Hainan Province from January 2020 to March 2023 were retrospectively selected as the DFU group, 90 patients with simple type 2 diabetes mellitus (T2DM) admitted to our hospital during the same period were selected as the T2DM group, and 60 normal people who came to our hospital for physical examination during the same period were selected as the control group. According to Wagner′s grading standard, 116 patients with DFU were divided into 25 cases of grade 1, 54 cases of grade 2-3, and 37 cases of grade 4-5. According to the severity of DFU infection, 55 cases were classified as 1-2 levels (no or mild infection), and 61 cases as 3-4 levels (moderate to severe infection). According to the prognosis of DFU patients, they were divided into a good prognosis group (68 cases) and a poor prognosis group (48 cases). Real-time fluorescent polymerase chain reaction was used to detect Hsa_circ_0057362 levels, chemiluminescence immunoassay was used to detect procalcitonin (PCT) levels, and enzyme-linked immunosorbent assay was used to detect serum interleukin-6 (IL-6) levels. The levels of serum IL-6, CRP and Hsa_circ_0057362 in each group were compared by ANOVA, SNK-q test and t test. Binary logistic regression was used to analyze the risk factors for poor prognosis in patients with DFU. Receiver operating characteristic (ROC) curve was drawn to analyze the value of Hsa_circ_0057362, CRP and IL-6 in predicting poor prognosis of DFU patients. Spearman correlation was used to analyze the correlation between serum Hsa_circ_0057362 expression level and infection grade and Wagner grade in DFU patients. Results The serum PCT, IL-6 and Hsa_circ_0057362 levels in DFU and T2DM groups were significantly higher than those in control group, and those in DFU group were higher than those in T2DM group (P<0.05). The DFU course, Wagner grade, serum creatinine, uric acid, PCT, IL-6 and Hsa_circ_0057362 levels in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05). The serum Hsa_circ_0057362 expression level in patients with DFU infection of grade 3-4 (4.36±2.08 vs. 3.25±1.57) was significantly higher than that of grade 1-2 (P<0.001). The expression level of Hsa_circ_0057362 in DFU patients increased with the increase of Wagner grade (grade 4-5 was 4.95±2.37, grade 2-3 was 3.56±1.79, grade 1 was 2.70±0.95,P<0.001). Multivariate Logistic regression analysis showed that the duration of PCT (OR=2.793, 95%CI 1.966-7.104), IL-6 (OR=2.376, 95%CI 1.584-5.710) and Hsa_circ_0057362 (OR=3.106, 95%CI 2.624-10.248) high level was a risk factor for poor prognosis in DFU patients (P<0.05). ROC curve showed that Hsa_circ_0057362≥3.80 had the highest AUC (0.891, 95%CI 0.828-0.953) in predicting poor prognosis in DFU patients, sensitivity was 88.4%, specificity was 86.2%. Spearman correlation analysis showed that serum Hsa_circ_0057362 expression level of DFU patients was positively correlated with Wagner grade (r=0.782, P<0.001). Conclusion Hsa_circ_0057362 is highly expressed in patients with DFU, and its elevated level is associated with disease severity and poor prognosis, making it a useful index for predicting poor prognosis in patients with DFU.

    糖尿病足足溃疡Hsa_circ_0057362预后疾病严重程度

    糖化血红蛋白变异指数和单核细胞/高密度脂蛋白胆固醇比值对2型糖尿病伴脑小血管病的预测价值

    薛慧邓旭李颖刘婷婷...
    314-320页
    查看更多>>摘要:目的 探讨糖化血红蛋白变异指数(HGI)和单核细胞/高密度脂蛋白胆固醇比值(MHR)对2型糖尿病(T2DM)伴脑小血管病(CSVD)的预测价值。 方法 为横断面研究。选取2020年1月至2022年12月在宿迁市第一人民医院内分泌科和神经内科住院的T2DM患者为研究对象。根据是否伴有CSVD将患者分为单纯T2DM和T2DM伴CSVD组。收集两组患者的单核细胞计数、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、空腹血糖(FPG),并计算MHR和HGI。两组间比较采用两独立样本t检验、Mann‐Whitney U检验或χ2检验,采用Spearman相关性分析法分析HGI和MHR与T2DM伴CSVD的相关性,采用多因素logistic回归分析法分析T2DM伴CSVD的影响因素,采用受试者工作特征(ROC)曲线评估HGI和MHR对T2DM伴CSVD的诊断价值。 结果 共纳入361例T2DM患者。其中,单纯T2DM组170例,T2DM伴CSVD组191例。与单纯T2DM组相比,T2DM伴CSVD组患者MHR和HGI均更高(P<0.001)。Spearman相关性分析结果显示,HGI(r=0.196,P<0.001)、MHR(r=0.349,P<0.001)与T2DM伴CSVD均呈正相关。多因素logistic回归分析结果显示,HGI(OR=1.314,95%CI 1.052~1.642,P=0.016)和MHR(OR=1.056,95%CI 1.039~1.073,P<0.001)均为T2DM伴CVSD的影响因素。ROC曲线分析结果显示,HGI、MHR预测T2DM伴CSVD的曲线下面积分别为0.613(95%CI 0.555~0.671,P<0.001)和0.702(95%CI 0.649~0.755,P<0.001),HGI和MHR联合预测T2DM伴CSVD的曲线下面积为0.729(95%CI 0.678~0.780,P<0.001)。 结论 HGI和MHR与T2DM患者的CSVD发病密切相关,对T2DM伴CSVD的预测均有一定的价值,两者联合预测价值更高。 Objective To explore the predictive value of hemoglobin glycation index (HGI) and monocyte to high-density lipoprotein-cholesterol ratio (MHR) in type 2 diabetes mellitus (T2DM) with cerebral small vessel disease (CSVD). Methods This was a cross-sectional study. Patients with T2DM who were hospitalized in the Department of Endocrinology and Department of Neurology of Suqian First Hospital from January 2020 to December 2022 were enrolled as the subjects. Patients were divided into T2DM alone group and T2DM with CSVD group according to whether they were combined with CSVD. Monocyte counts, high-density lipoprotein-cholesterol (HDL-C), glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) were collected, and MHR and HGI were calculated. Two independent sample t test, the Mann-Whitney U test, or the χ2 test were used for the comparisons between the two groups. Spearman correlation was used to analyze the correlation between HGI and MHR and T2DM with CSVD. Multivariate logistic regression analysis was used to determine the influencing factors of T2DM with CSVD. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of HGI and MHR for T2DM with CSVD. Results A total of 361 patients with T2DM were included. There were 170 patients in the T2DM alone group and 191 patients in the T2DM with CSVD group. Compared with T2DM alone, patients in T2DM with CSVD group had higher MHR and HGI (P<0.001). Spearman correlation analysis showed that both HGI (r=0.196, P<0.001) and MHR (r=0.349, P<0.001) were positively correlated with T2DM and CSVD. Multivariate logistic regression analysis showed that both HGI (OR=1.314, 95%CI 1.052-1.642,P=0.016) and MHR (OR=1.056, 95%CI 1.039-1.073, P<0.001) were the influencing factors of T2DM with CVSD. The results of ROC curve analysis showed that the areas under the HGI and MHR were 0.613 (95%CI 0.555-0.671,P<0.001) and 0.702 (95%CI 0.649-0.755,P<0.001), respectively. The area under the curve predicted by HGI and MHR was 0.729 (95%CI 0.678-0.780,P<0.001). Conclusion HGI and MHR are closely related to the onset of CSVD in T2DM patients, and have certain value in predicting T2DM with CSVD, their combined diagnostic value is higher.

    糖尿病,2型脑小血管病糖化血红蛋白变异指数单核细胞/高密度脂蛋白胆固醇比值

    单中心11例青春期及成人早老症临床与基因特征分析

    陈欣悦余洁崔云英阳洪波...
    321-327页
    查看更多>>摘要:目的 探讨早老症的临床表现及基因特征。 方法 收集北京协和医院2012年8月至2023年6月住院的11例早老症患者,提取相关临床资料,包括青春发育情况、糖代谢、脂代谢及既往心血管病变(动脉粥样硬化、心律失常、瓣膜病、心肌病)和治疗情况。分析早老症患者的早期临床表现及基因突变特征、实验室检查、青春发育状况,并对患者的糖脂代谢及心血管疾病进行评估。 结果 11例患者中,女性7例、男性4例,起病中位年龄3岁(1例为成人起病,其余为出生时或儿童青少年起病)。11例患者中半数以上有不同程度青春发育延迟,大部分患者有糖脂代谢异常,以胰岛素抵抗和低高密度脂蛋白胆固醇血症表现突出。心血管病变多见,3例患者为心肌广泛病变致心力衰竭,3例患者出现快速型或缓慢型心律失常,2例患者有动脉粥样硬化。5例患者完善基因检测,4例为核纤层蛋白A/C(LMNA)基因突变,均为非典型突变位点,分别为c.139G>T、c.1444C>A、c.398G>T、c.1045C>T,其中c.1444C>A尚未被报道;1例为RecQ3解旋酶(WRN)基因c.3913C>T突变。治疗上主要以针对糖脂代谢异常、心血管疾病等对症治疗为主。 结论 早老症患者临床表现多样,青春期及成人患者需进行青春发育、糖脂代谢及心血管病变评估,早期积极采取对症治疗。 Objective To explore the clinical manifestations, genetic characteristics, and treatment of progeria. Methods Clinical data of 11 progeria patients treated at Peking Union Medical College Hospital from August 2012 to June 2023 were collected, and clinical and genetic features were summarized, including pubertal development, glucose metabolism, lipid metabolism, previous cardiovascular lesions (atherosclerosis, cardiac arrhythmia, valvular disease, and cardiomyopathy) and treatment. Early clinical manifestations and gene mutation characteristics, laboratory tests, pubertal development, and assessment of glucose and lipid metabolism and cardiovascular disease in patients with progeria were analyzed. Results Of the 11 patients, 7 were female and 4 were male, with ages ranging from 9 to 37 years. One case had adult onset, while the rest had onset at birth or during childhood and adolescence. Majority of the patients had varying degrees of delayed puberty, and more than half had abnormalities in glucose and lipid metabolism, particularly insulin resistance, and markedly low high-density lipoprotein-cholesterol levels. Cardiovascular abnormalities were common, with 3 patients experiencing extensive myocardial damage leading to heart failure, 3 patients presenting with arrhythmia, and 2 patients showing atherosclerosis. Of the 5 patients who underwent comprehensive genetic testing, 4 had Lamin A/C (LMNA) gene mutations at non-typical mutation sites, namely c.139G>T, c.1444C>A, c.398G>T, and c.1045C>T. The c.1444C>A mutation has not been reported before, and 1 patient had a WRN gene c.3913C>T mutation. Treatment focused primarily on symptomatic interventions for abnormalities in glucose and lipid metabolism and cardiovascular diseases. Conclusions Progeria patients present with a variety of clinical manifestations. Adolescents and adults with progeria should pay attention to the assessment of puberty development, glucose and lipid metabolism, and cardiovascular abnormalities, and early intervention with targeted treatments is recommended.

    早衰青春发育胰岛素抵抗心血管病变

    1型糖尿病小鼠肠道菌群与免疫状态演变的实验研究

    黄宝江林小雅张军郭松...
    328-335页
    查看更多>>摘要:目的 探究链脲佐菌素(STZ)诱导的1型糖尿病(T1DM)小鼠在不同时期的肠道功能、血清相关抗体、脾脏细胞因子谱表达与肠道菌群的演变。 方法 取3~4周龄雄性C57BL/6小鼠28只,采用随机抽样法分为对照组(NC组,13只)和STZ组(15只)。STZ组连续5 d空腹腹腔注射STZ 50 mg·kg-1·d-1,NC组注射等体积溶剂。实验第3周测定随机血糖>16.7 mmol/L为建模成功,定义为基线水平,两组各取6只小鼠处死,剩余小鼠观察4周,即实验第7周(实验终点)处死剩余小鼠。每周测量体重、随机血糖和每日饮水量。采用酶联免疫吸附测定(ELISA)法检测脾脏细胞因子谱[肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素(IL)-6、IL-17、IL-4、IL-10、转化生长因子-β(TGF-β)]、血清相关抗体[胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)与谷氨酸脱羧酶抗体(GADA)]和结肠紧密连接蛋白1(ZO-1)的表达;采用流式细胞术检测脾脏CD4+FoxP3+调节性T细胞(Treg)水平;对粪便进行16SrRNA菌群测序分析。组间比较采用独立样本t检验。采用Spearman相关分析法分析CD4+FoxP3+Treg细胞、肠道菌群、各免疫生化指标之间的相关性。 结果 流式细胞术与ELISA结果显示,在基线水平,与NC组相比,STZ组小鼠脾脏CD4+FoxP3+Treg、TGF-β、TNF-α、IFN-γ、IL-6、IL-17与血清ICA、IAA表达水平增加,脾脏IL-4、IL-10表达水平下降(均P<0.05);在实验终点,与NC组相比,STZ组小鼠脾脏TNF-α、IFN-γ、IL-6,血清GADA、ICA与结肠ZO-1表达水平增加(均P<0.05)。16SrRNA测序结果显示,与NC组相比,STZ组乳杆菌属丰度明显下降(P<0.05),拟杆菌属、阿克曼菌属、普雷沃菌属和颤螺菌属丰度明显上升(均P<0.05)。Spearman相关性分析结果表明,乳杆菌属丰度与IL-10水平呈正相关(r=0.65,P<0.05),与TNF-α、IFN-γ、IL-6、IL-17和GADA水平呈负相关(r值-0.61~-0.58,均P<0.05);颤螺菌属丰度与TGF-β、TNF-α、IL-6和IAA水平呈正相关(r值0.55~0.72,均P<0.05),与IL-10水平呈负相关(r=-0.59,P<0.05)。 结论 多次低剂量STZ诱导的T1DM小鼠可能存在CD4+Foxp3+Treg及TGF-β介导的负性免疫调节和以增加结肠ZO-1表达的肠道调节,其中颤螺菌属与乳杆菌属丰度改变可能参与免疫调节。 Objective To explore the intestinal function, serum-related antibodies, expression of the spleen cytokine profile and intestinal flora evolution in streptozotocin (STZ)-induced type 1 diabetes mellitus (T1DM) mice at different stages. Methods Twenty-eight male C57BL/6 mice aged 3-4 weeks were randomly divided into control group (NC group, 13 mice) and streptozotocin group (STZ group, 15 mice). The STZ group was injected intraperitoneally with STZ 50 mg·kg-1·d-1 for 5 consecutive days on a fasting state, and the NC group was injected with an equal volume of solvent. In the third week of the experiment, the random blood glucose>16.7 mmol/L was determined as the successful modeling, which was defined as the baseline level. Six mice in each group were sacrificed, and the remaining mice were observed for 4 weeks,i.e. the remaining mice were sacrificed at the seventh week of the experiment (the end of the experiment). Body weight, random blood glucose and daily water intake were measured weekly. The expression of cytokines in spleen [tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), interleukin (IL)-6, IL-17, IL-4, IL-10, transforming growth factor-β (TGF-β)], serum-related antibodies [islet cell antibody (ICA), insulin autoantibody (IAA) and glutamic acid decarboxylase antibody (GADA)] and colonic tight junction protein 1 (ZO-1) were detected by enzyme-linked immunosorbent assay (ELISA). The level of CD4+FoxP3+Treg in spleen was determined by flow cytometry. Faeces were subjected to 16SrRNA flora sequencing analysis. Differences in expression between groups were compared using a two-sided unpaired t test. Spearman correlation analysis was used to compare the correlation between CD4+FoxP3+Treg cells and various immune biochemistry of intestinal flora. Results The results of flow cytometry and ELISA showed that at the baseline level, compared with the NC group, the expression of CD4+FoxP3+Treg, TGF-β, TNF-α, IFN-γ, IL-6, IL-17 in spleen and serum ICA and IAA increased (all P<0.05), and the expression of IL-4 and IL-10 in spleen decreased (allP<0.05). At the end of the experiment, the expression of TNF-α, IFN-γ, IL-6 in spleen, GADA, ICA in serum and ZO-1 in colon increased in STZ group (allP<0.05). The results of 16 SrRNA sequencing showed that compared with the NC group, the abundance ofLactobacillus in the STZ group was significantly decreased (P<0.05), and the abundance ofBacteroides, Akermansia, Prevotella and Oscillatoria was significantly increased (all P<0.05). Spearman correlation results showed that the abundance ofLactobacillus was positively correlated with IL-10 level (r=0.65, P<0.05), and negatively correlated with TNF-α, IFN-γ, IL-6, IL-17 and GADA levels (r=-0.61--0.58, all P<0.05). The abundance ofOscillatoria was positively correlated with the levels of TGF-β, TNF-α, IL-6 and IAA (r=0.55-0.72, all P<0.05), and negatively correlated with the level of IL-10 (r=-0.59, P<0.05). Conclusions Multiple low-dose STZ-induced T1DM mice may have negative immune regulation mediated by CD4+Foxp3+Treg and TGF-β and intestinal regulation to increase the expression of ZO-1 in the colon. Among these, the changes in the abundance of Oscillatoria and Lactobacillus may be involved in immune regulation.

    糖尿病,1型链脲佐菌素肠道菌群免疫反应自身免疫抗体

    肝细胞核因子1β突变所致的以肾囊肿为突出表现的早发糖尿病临床特征及基因突变分析

    徐新月杨亚玲瞿朵朵吴宸炜...
    336-340页
    查看更多>>摘要:目的 对1例因肝细胞核因子1β(HNF1β)突变所致的以肾囊肿为突出表现的新发青少年起病的成人型糖尿病(MODY)5型患者的临床资料进行回顾性分析,并对我国已发表MODY5患者的临床特征进行总结。 方法 选取1例于2021年7月就诊上海市公共卫生临床中心内分泌代谢科的MODY5型糖尿病患者作为研究对象,对患者的临床资料、就诊及随访经过和基因检测结果进行详细描述,并在美国国立医学图书馆数据库(PubMed)、中国期刊全文数据库(CNKI)和万方数据库自建库之日起至2022年8月15日检索所有关于中国MODY5患者的病例报告,综合分析检索所得患者的相关临床数据。以基因突变类型将患者分为杂合突变体和缺失突变2类,采用Mann‐Whitney U检验对2类患者间相关指标进行比较。 结果 上海市公共卫生临床中心内分泌代谢科MODY5患者19岁糖尿病起病,糖尿病自身免疫抗体均阴性,合并肾囊肿、高尿酸、肾脏发育不良、胰腺萎缩,携带HNF1β基因2号内含子c.544+3_544+6del缺失突变,该突变基因来自其母亲。文献检索共纳入32例MODY5患者,包括上海市公共卫生临床中心内分泌代谢科的此例MODY5患者,糖尿病起病多为青年[84.4%(27/32)],肾囊肿患病率高[84.4%(27/32)],常出现高尿酸血症[60.9%(14/23)]。32例患者共涉及27种基因突变类型,其中携带杂合突变体类型14种,缺失突变13种。携带杂合突变体的患者体重指数(BMI)及估算的肾小球滤过率(eGFR)均低于缺失突变患者[BMI分别为14.57(11.80,32.79)和16.97(13.85,22.30)kg/m2,eGFR分别为43.31(15.43,129.23)和73.29(53.76,146.27)ml·min-1·(1.73 m2)-1,均P<0.05]。 结论 对于糖尿病自身免疫抗体阴性、合并肾囊肿的早发糖尿病患者,需要考虑MODY5可能,HNF1β人群易合并较低的体重和eGFR。

    糖尿病青少年起病的成人型糖尿病肾囊肿高尿酸血症

    糖尿病纹状体病伴双侧舞蹈症1例

    王绮高冠起杜文华王宪丽...
    345-348页
    查看更多>>摘要:报道1例就诊于临沂市人民医院内分泌科的糖尿病纹状体病(DS)伴双侧舞蹈症患者的诊疗经过。DS是一种罕见的糖尿病并发症,多见于血糖控制不佳的老年女性糖尿病患者。该患者为81岁女性,因“四肢活动障碍1个月”入院,入院后病情加重出现双上肢快速、无规律、不自主抽动,检查结果提示非酮症性高血糖,颅脑磁共振见双侧纹状体T1WI高信号改变,符合DS诊断,予以胰岛素及氟哌啶醇联合治疗后好转。

    糖尿病纹状体病非酮症性高血糖偏身舞蹈症纹状体影像学

    1型糖尿病的非胰岛素治疗新技术与新策略

    陈榕刘连勇邹大进张晓冬...
    366-371页
    查看更多>>摘要:1型糖尿病(T1DM)是一种复杂的以自身免疫反应为主因的疾病,发病的核心机制在于机体产生自身免疫性抗体对胰岛β细胞的破坏。目前主要依靠胰岛素治疗,但胰岛素治疗不能从根本上治愈T1DM,多数患者仍面临血糖控制不佳、慢性并发症发生等问题。该文从免疫调节治疗、β细胞再生和替代等方面就目前T1DM治疗的研究进展和热点药物进行阐述和介绍。

    糖尿病,1型免疫调节治疗β细胞再生和替代