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Objective:To analyze the clinical features of type 2 diabetic patients with insulin autoimmune syndrome after treatment with exogenous insulin.Methods:A total of 106 patients with type 2 diabetes diagnosed with exogenous insulin-related insulin autoimmune syndrome (EIAS) were included from September 2017 to March 2019 in the Department of Endocrinology, Zhongshan Hospital, Fudan University. The clinical data, physical examination, and laboratory examination results of patients were collected.Results:Of the 106 patients, 84 (79.24%) used premixed human insulin or premixed insulin analogs, and 18 patients (16.98%) presented recurrent hypoglycemia. The arginine stimulation test showed that the median value of the baseline insulin was 73.40 (23.07-146.75) μU/ml, and the median ratio of 4 minute insulin to 0 minute insulin was 1.27 (1.03-1.85), with the mean of the ratio 1.72±1.47. The ratio of baseline insulin (μU/ml) to C-peptide (ng/ml) was 44.60 (14.92-87.93), with an average of 81.92±130.93. Taking the two-fold upper limit of fasting insulin reference value (49.8 μU/ml) as the cut-off point, the subjects were divided into insulin accumulation group (baseline insulin≥49.8 μU/ml) and insulin non-accumulation group (baseline insulin <49.8 μU/ml). Among the 66 patients in the insulin accumulation group, 14 patients had hypoglycemia (21.21%) and 4 patients in the insulin non-accumulation group presented hypoglycemia (10%). The ratio of 4 minute insulin to baseline insulin, ratio of baseline insulin to C-peptide, blood glucose level standard deviation (SDBG) and maximum blood glucose fluctuation amplitude (LAGE) in the insulin accumulation group were significantly higher than those in the insulin non-accumulation group (all P<0.05). Among 66 patients in the insulin accumulation group, 36 patients changed the type of insulin preparafion (insulin treatment group), 30 patients were changed from insulin to oral hypoglycemic agents (oral medication group). After treatment, both SDBG and LAGE in the two groups were significantly lower than before treatment ( P<0.05). Conclusions:With the aggravation of exogenous insulin accumulation, the fluctuation of blood glucose and the proportion of hypoglycemia were significantly increased. There was a characteristic change in islet function in patients with insulin autoimmune syndrome. After arginine stimulation, there was no significant peak of insulin secretion, showing a " high-level" curve. The baseline insulin/C-peptide ratio was significantly increased. The prognosis of EIAS patients is good after timely diagnosis and adjustment of treatment.
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Objective To analyze the association of fat content,enzymes,and fibrosis in liver with iron overload in patients with type 2 diabetes,and to explore the relationship between iron overload and severity of nonalcoholic fatty liver disease (NAFLD) in these patients.Methods Five hundred and thirty hospitalized patients with type 2 diabetes and 18 patients with abnormal glucose metabolism undergoing liver biopsy were recruited.History data,results of laboratory tests,liver ultrasound,hepatic 1 H-MRS were collected and serum ferritin level was determined.Results The serum ferritin level was significantly higher in patients with NAFLD than that without NAFLD [(328.7±252.2 vs 239.9 ± 171.8) μg/L,P＜0.01].Serum ferritin was an independent risk factor for NAFLD (P＜0.05).Multiple linear regression analysis showed that serum ferritin was positively correlated with liver fat content after adjustment for sex,age,and duration of diabetes.The serum ferritin level in NAFLD with elevated liver enzymes was significantly higher than that in simple steatosis [(429.9 ± 287.4 vs 293.4 ± 233.3) μg/L,P＜0.01].Serum ferritin was an independent risk factor for elevated liver enzymes in patients with NAFLD (P ＜0.05).Serum ferritin level in patients with advanced fibrosis was significantly lower than that in patients without advanced fibrosis [(246.8 ± 191.2 vs 382.5 ± 253.7) μg/L,P＜0.01].In 18 patients with NAFLD proven by biopsy,serum ferritin level was slightly higher in NASH group than that in simple steatosis group,but there was no statistically significant difference.Serum ferritin levels were comparable between patients with and without advanced fibrosis.Conclusion The iron overload in type 2 diabetic patients seems to be an independent risk factor for the development of NAFLD and elevated liver enzymes.Iron load in patients with advanced fibrosis is significantly decreased.
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Objective To investigate the effects of diabetic duration on liver fat content (LFC) in patients with type 2 diabetes,and to explore its relationship with the outcome of liver disease.Methods A total of 435hospitalized patients with type 2 diabetes were recruited.The history data,results of laboratory tests,and hepatic 1 H-MRS were collected,and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) was calculated.Results The prevalence of NAFLD in newly-diagnosed type 2 diabetes mellitus (NT2DM) group was higher than that in predousb-diagnosed type 2 diabetes mellitus (PT2DM) group (92.7％ vs 82.2％,P＜0.05),with higher LFC [(27.97 ± 16.88 vs 19.44± 15.54) ％,P＜0.01].The LFC was reduced with prolonged duration of diabetes.Partial correlation analysis showed that LFC was negatively correlated with duration of diabetes (rs =-0.233,P＜0.01) after adjustment for gender,age,body mass index (BMI),oral anti-diabetic drugs,lipid-lowering drugs,and insulin treatment.Multiple linear regression analysis showed that LFC was positively correlated with BMI,albumin,and alanine aminotransferase while negatively correlated with duration of diabetes.The proportion of patients without advanced fibrosis (NFS＜-1.455) was significantly higher in NT2DM group than that in PT2DM group (26.3％ vs 15.5％,P＜0.05),and the proportion of PT2DM in patients with advanced fibrosis (NFS＞0.676) was significantly higher than that of NT2DM (79.2％ vs 20.8％,P＜0.05).NFS was positively correlated with the duration of diabetes (rs =0.236,P＜0.01).The liver fat content in patients with advanced liver fibrosis decreased significantly,and the LFC was negatively correlated with NFS (rs =-0.164,P＜0.01).Conclusions The duration of diabetes is an independent influencing factor of LFC.With the extension of the duration of diabetes,the decreased LFC in type 2diabetic patients with NAFLD is related to the development of advanced fibrosis.The decrease in LFC in type 2diabetic patient is associated with poor outcome of NAFLD.
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Microsomal triglyceride transfer protein (MTP) is a key transfer protein in lipid metabolism and is mainly expressed in the hepatocytes and enterocytes.It plays an important role in transferring triglyceride as well as in assembly and secretion of very low density lipoprotein.Recent studies have shown that MTP is closely related to the onset and development of non-alcoholic fatty liver disease.
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This study was aimed to investigate the effect of visceral pain and water metabolism on irritable bowel syndrome with diarrhea (IBS-D) model rats by moxibustion and its products. A total of 40 SD rats were randomly di-vided into the normal group, model group, moxibustion group, non-smoke moxibustion group, and moxa smoke group. IBS-D model was induced by colorectal distension with an inflatable balloon. The general condition of rats was ob-served. Visceral pain was assessed by abdominal withdrawal reflex (AWR) scores. The immunohistochemical method was used in the detection of claudin-1, AQP3, AQP8 and Na+/K+-ATPase protein expression. The results showed that compared with the normal group, the AWR scores, claudin-1, AQP3, AQP8 and Na+/K+-ATPase protein expres-sion in the colon were decreased in the model group (P < 0.01). The stool was loose, which was on hair around the anus. After moxibustion, non-smoke moxibustion and moxa smoke stimulation, the stool conditions of IBS-D model rats were improved. The AWR scores were decreased in different degrees (P < 0.05 or P < 0.01). Except Na+/K+-ATPase, expressions of claudin-1, AQP3 and AQP8 in colon were increased in different degrees (P < 0.05 or P <0.01). The comprehensive therapeutic effect showed that moxibustion was better than non-smoke moxibustion; and non-smoke moxibustion was better than moxa smoke stimulation. It was concluded that the combination of warm stimulation, optical radiation and moxa smoke induced best effect in improving visceral pain and water metabolism on IBS-D model rats. Among them, warm stimulation and optical radiation may play the main role.
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Objective To evaluate the severity of non-alcoholic fatty liver disease(NAFLD) and progressive liver fibrosis(stage＞2)in hospitalized patients with type 2 diabetes mellitus(T2DM) by using NAFLD fibrosis score (NFS).The risk factors associated with progressive fibrosis were also analyzed.Methods A total of 721 hospitalized patients with T2DM and uhrasound verified NAFLD were involved.The history information and laboratory examinations were collected,NFS was calculated.The low cutoff score (-1.455) of NFS was used to exclude,and high cutoff score (0.676) to further accurately diagnose progressive fibrosis.Results (1) A total of 721 subjects (male/female 371/350) were diagnosed as NAFLD by ultrasound.In those subjects,173 patients were with progressive fibrosis (24.0％),111 patients without progressive fibrosis (15.4％),and 437 patients (60.6％) with NFS ranged from-1.455 to 0.676.(2) Aging,raised body mass index,aspartate amino transferase/alanine aminotransferase (AST/ALT) ratio,lowered albumin,and platelet were risk factors for progressive fibrosis of NAFLD.In addition,NFS was positively correlated with duration of diabetes,waist circumference,SBP,glycated albumin (GA),and GA/HbA1c(all P＜0.01),and negatively with red blood cell count,hemoglobin,white blood cell count (WBC),total cholesterol (TC),triglyceride,apolipoprotein-B,ALT,γ-glutamyltranspeptidase (all P＜0.01),AST,low-density lipoprotein cholesterol (all P＜0.05).(3) Logistic stepwise regression analysis showed diabetes duration,waist circunference,and GA were positively correlated with progressive liver fibrosis(OR =1.182,1.076,1.074,all P＜0.01),and negatively with WBC and TC (OR =0.613,0.703,all P＜0.01).Conclusions The detection rate of progressive fibrosis in patients with NAFLD and T2DM was approximately 24.0％ by applying NFS.Only 15.4％ of those subjects could be excluded from progressive fibrosis.It suggests that we should be alert to the risk of liver fibrosis in patients with type 2 diabetes.
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Objective:To observe the impacts of herb-partitioned moxibustion,warm moxibustion and electroacupuncture on the basic fibroblast growth factor(bFGF)and collagen type Ⅰ(Col Ⅰ)in colons of rats with Crohn' disease(CD),and discuss the mechanism of acupuncture therapy on the intestinal fibrosis in CD.Methods:The model rats were developed by TNBS as multiple proinflammatory method.The rats were randomly divided into 5 groups:a normal group,a model group,a warm moxibustion group,an electroacupuncture group and a herb-partitioned moxibustion group.The treatments were carried out at Tianshu(ST 25)(bilateral)and Qihai(CV 6)in different treatments.The immunohistochemistry was used to detect the expression position of Col Ⅰ and bFGF.Results:The expressions of Col Ⅰ and bFGF in colons of rots in the model group significantly increased(compared with the normal group,P<0.01).After the herb-partitioned moxibustion,warm moxibustion and electroacupuncture,the expressions of Col Ⅰ and bFGF reduced markedly in the rats with CD(P<0.01).The expression of bFGF and Col Ⅰ in the colons had an obvious correlation in the Spearman rank correlation analysis.Conclusion:Acupuncture treatment reduced the abnormally high levels of expressions for Col Ⅰ and bFGF in colons.Col Ⅰ and bFGF participated in the fibrosis.Acupuncture treatment may reduce the bFGF expression in colons to regulate the excessive deposition,treating the intestinal fibrosis in CD.
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Combining the personal clinical practice, the authors of this article illustrated the basic principle of treating obesity with acupuncture, studied its therapeutic effect evaluation,and demonstrated the idea and approaches in clinical application. In addition, the authors concluded that syndrome differentiation was the treatment principle and correct approach was crucial to the final result.