ABSTRACT
Objective@#To investigate the clinical characteristics and treatment strategies of diabetic hyperosmolar hyperglycemia (HHS) with rhabdomyolysis (RM).@*Methods@#The clinical data of 40 patients with HHS treated in the General Hospital of Shenyang Military Command from November 2013 to November 2017 were retrospectively analyzed.According to the serum levels of creatine phosphokinase and myoglobin, they were divided into RM group (12 cases) and non-RM group (28 cases). The clinical characteristics and treatment results of the two groups were compared.@*Results@#There were 12 cases in the RM group, 6 cases were diagnosed RM at the time of consultation, and 6 cases developed RM during the course of treatment.Compared with the non-RM group, RM group had lower systolic pressure[(98.3±17.8)mmHg vs.(128.0±18.1)mmHg, t=4.823, P=0.000], higher blood glucose level[(44.4±14.0)mmol/L vs.(32.6±8.1)mmol/L, t=2.717, P=0.016], and more acidosis, mainly manifested by lower pH[(7.16±0.15)vs.(7.32±0.13), t=3.355, P=0.002], lower bicarbonate[(12.92±5.23)mmol/L vs.(19.07±6.80)mmol/L, t=2.792, P=0.008], higher blood D-3 hydroxybutyric acid [(5.84±2.98)mmol/L vs.(2.55±2.13)mmol/L, t=4.012, P=0.000], and renal function was worse[creatinine (257.1±149.8)μmol/L vs.(148.1±85.3)μmol/L, t=2.925, P=0.006]. Individualized rehydration and low dose insulin were given to control blood sugar, and increasing blood pressure, kidney protection, correction of electrolyte disturbance, anti-infection and inhibition of gland secretion were given to the complications.Hydration and alkalization were given to 7 cases of RM, and continuous renal replacement therapy (CRRT) was given to 5 cases.In 10 cases of HHS with RM, creatine kinase decreased, renal function recovered, and 2 patients died.@*Conclusion@#It is very important to improve the understanding of RM in HHS patients, routinely monitor the dynamic changes of muscle enzymes, make a good early diagnosis and prevention of RM.Urine hydration and alkalization should be given in time after RM occurs, and CRRT treatment as early as possible can improve the survival rate of diabetic patients.
ABSTRACT
Objective To investigate the change of serum retinol binding protein 4(RBP4)levels in subjects with metabolic syndrome(MS),and their relationship with the components of MS.Methods Eighty subjects were enrolled and divided into different groups:MS,nonMS(NMS)and healthy controls(C).Subjects' anthropometric parameters,blood pressure,glucose and lipid metabolism parameters and insulin resistance index were measured.Serum RBP4 level,adiponectin(APN),high-sensitivity C-reactive protein(hsCRP)and fasting insulin(FINS)were measured.Homeostatic model assessment of insulin resistance(HOMA-IR)was calculated.A questionnaire was used to obtain participants' medical history and lifestyle information,such as smoking and alcohol ingestion habits.Results Serum RBP4 levels were significantly higher in the MS group compared with the NMS and C group.Males had significantly higher RBP4 levels than females.Serum RBP4 levels were positively correlated with BMI,WC,SBP,DBP,TC,LDL-C,lnhsCRP,lnUAE and smoking,and negatively correlated with ANP.Multiple stepwise regression anlysis showed that sex and BMI were independent related factors influencing serum RBP4 levels.Conclusion Serum RBP4 levels are significantly increased in subjects with MS.In all subjects,RBP4 is positively correlated with adiposity index(BMI,WC),blood pressure,lipid profile(TC,LDL-C),inflammatory indice(lnhsCRP),lnUAE and smoking,and negatively correlated with ANP,which is cardiovascular disease risk factor.RBP4 is independently associated with sex and BMI.