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Objective:To assess the correlation between circulating chemerin and two indicators of renal function, estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR), in individuals with type 2 diabetes and to determine whether chemerin is an independent marker of early renal insufficiency.Methods:A total of 742 patients with type 2 diabetes were recruited into the cross-sectional community study. Basic information, anthropometric parameters, and biochemical parameters of these individuals were determined and collected, and serum chemerin level was measured using enzyme-linked immunosorbent assay.Results:Chemerin levels were significantly higher in the eGFR-impaired group compared with eGFR-normal group, and macroalbuminuria group compared to the normal or microalbuminuria groups. Spearman′ rank correlation analysis showed serum chemerin level was correlated with eGFR ( r=-0.25, P<0.001), UACR ( r=0.23, P<0.001) and some other biochemical indicators such as triglyceride. And univariate and multivariate logistic regression analyses revealed circulating chemerin was an independent risk factor for eGFR impairment or proteinuria after adjusting corresponding covariates. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) of circulating chemerin for predicting early impaired eGFR in type 2 diabetes was 0.747, while the AUC of circulating chemerin for predicting macroalbuminuria in type 2 diabetes was 0.748. Conclusion:Circulating chemerin is associated with eGFR or UACR and may be a potential diagnostic marker for early renal insufficiency in type 2 diabetes.
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Objective:To investigate the relationship between serum lipocalin-2 level and the risk of cardiovascular disease(CVD) in patients with type 2 diabetes.Methods:A total of 279 type 2 diabetic patients were enrolled in this study. Basic information and clinical data were collected. These patients were divided into CVD group and non-CVD group according to their cardiovascular disease status. Serum lipocalin-2 level was assessed by enzyme linked immunosorbent assay.Results:Compared to non-CVD group, serum lipocalin-2 level was significantly higher in CVD group( P<0.01). The Spearman correlation analysis showed that serum lipocalin-2 level was positively correlated with waist circumstance, diastolic blood pressure, uric acid, triglyceride, and HbA 1C( P<0.05), while negatively correlated with high density lipoprotein-cholesterol level( P<0.01). In addition, the univariate and multivariate logistic regression analysis revealed that serum lipocalin-2 was an independent risk factor for CVD( P<0.01)after adjustment for potential confounders. Moreover, receiver operating characteristic curve analysis demonstrated that the area under curve value of lipocalin-2 was 0.74, with the optimal cutoff value of lipocalin-2 66.84 ng/mL. Conclusion:Serum lipocalin-2 is closely associated with CVD in patients with type 2 diabetes, which might be considered as one of the predictors for CVD in type 2 diabetes mellitus.
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Objective To investigate the impact of glucose metabolism-related protein 1 (GMRP1) on the regulation of c-Myc gene transcription, to establish GMRP1 gene knockout mouse model, and to study the influence of GMRP1 on glucose metabolism. Methods Chromatin immunoprecipitation-PCR (ChIP-PCR) was utilized to screen out the genes transcriptionally regulated by GMRP1. Luciferase reporter system was applied to assay the regulation of c-Myc promoter activity by GMRP1. GMRP1 knockout mice were constructed and validated by PCR and western blotting. Body weight and random blood glucose were measured in both knockout and wild type mice fed with either chow diet or high-fat diet. The levels of glucose metabolism in mice of 20 or 28 weeks old were evaluated by intraperitoneal glucose tolerance test. Results GMRP1 was capable of binding to the promoter of c-Myc gene and activating the expression of c-Myc gene. There were no significant differences in body weight, random blood glucose or glucose tolerance between GMRP1-deficient and wild type mice fed with either chow diet or high-fat diet (all P > 0.05). Conclusion GMRP1 may activate the transcription of c-Myc gene. GMRP1 deficiency exerted no significant effects on mouse glucose metabolism.
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Objective Metabolites produced by metabolic imbalance such as free fatty acids and lipopolysaccharides can result in a state of chronic low-grade inflammation, or metabolic inflammation, which plays an important role in the pathogenesis of atherosclerosis, type 2 diabetes, non-alcoholic fatty liver disease, and obesity. The above metabolic disorders are closely related with the metabolic inflammation, which always coexist. Therefore, we proposed the concept ofmetabolic inflammatory syndrome ( MIS). According to our study, patients with two or more metabolic disorders above could be diagnosed as MIS. The current research is aimed to investigate the prevalence of MIS and its components, and to compare the clinical values of MIS and metabolic syndrome ( MS) . Methods 2 001 in patients with type 2 diabetes from 6 hospitals in Shanghai were recruited in the current multi-center cross-sectional study. The diagnostic rates of MIS and MS and their components of both syndromes were compared. Results In the patients with type 2 diabetes, the detective rate of MIS was 96. 2%, which was higher than that of MS (71. 3%). Among 4 components of MIS, atherosclerosis showed the highest detective rate (75.6%). MIS[OR=2.252(95%CI1.026-4.942),P=0.043],atherosclerosis[OR=2.726(95% CI1.953-3. 804),P<0. 001], and MS[OR=1. 915 (95%CI 1. 444-2. 540),P<0. 01] were the risk factors of coronary heart disease. Conclusion With atherosclerosis, type 2 diabetes mellitus, non-alcoholic fatty liver disease, and obesity as its 4 components, MIS has a high detective rate in patients with metabolic disorders, and seems to be more sensitive than MS to distinguish inflammation-related metabolic diseases. The concept of MIS will promote the screening and prevention of atherosclerosis in its early stage.
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[Summary] Four patients with hyperthyroid-associated exophthalmos, myxedema, acropachy ( EMA ) syndrome, including three male patients and one female patient were diagnosed with Graves′diseases and treated by 131 I therapy. Complaints of thyrotoxicosis were presented at the onset. Tibia myxedema and acropathy appeared, and eye symptoms aggravated in two patients after anti-thyroid drug therapy and 131 I therapy. Four cases were all given clobetasol propionate, miconazole nitrate, neomycin sulfate and urea cream alone or in combination with compound betamethasone local injection treatment, and three cases were given low-dose oral prednisone treatment. Complaints of tibia myxedema and eye symptoms were significantly improved after the treatment. Therefore, we should be wary of the occurrence of hyperthyroid-associated EMA syndrome after 131 I therapy. Corticosteroid might be the effective therapy for myxedema and eye symptoms of EMA syndrome.
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Objective To investigate the outcome of postoperative hypopituitarism and hormone replacement in patients with pituitary adenoma,and to analyze the potential factors related to postoperative hypopituitarism.Methods A total of 215 postoperative patients with pituitary adenoma were analyzed.Pituitary functions( including gonadal,thyroid,and adrenal axes ) were asessed by strict criteria.Data of surgery history and hormone replacement situation were collected for statistical analysis.Results The prevalence of hypopituitarism was 54.0％,including 36.7％ hypogonadism,32.6％ hypothyroidism,and 28.4％ hypoadrenalism.Replacements of gonadal steroid,glucocorticoid,and thyroxine were carried out in 25.6％,84.3％,and 80.6％ of the cases,respectively.Univariate analysis showed that male sex and large tumor were related to hypopituitarism. Conclusion After pituitary adenomectomy,approximately half of the patients present anterior pituitary dysfunction,while quite a number of them have not been treated appropriately.
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Pathogenic diagnosis is very important for the management of sellar mass.Many reasons can cause sellar mass,which makes it easily to be misdiagnosed and subsequently lead to mismanagement.The aim of this article is aimed to catch physicians′ attention to the differential diagnosis of sellar mass,in order to raise the management level of sellar mass and to reduce its misdiagnosis and mismanagement.
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Objective To evaluate desmopressin stimulated inferior petrosal sinus sampling in diagnosing Cushing′s disease.Methods Sixteen ACTH-dependent Cushing′s disease patients underwent bilateral desmopressin stimulated inferior petrosal sinus ( IPS ) sampling because of negative or equivocal magnetic resonance imaging.Cortisol response to high-dose dexamethasone suppression test was also evaluated.ACTH sampling was taken from a peripheral vein and bilateral IPS before and both 5 and 10 min after injection of desmopressin.Diagnosis was based on the ratio of ACTH level in between IPS to peripheral vein by desmopressin test.Diagnosis was confirmed after surgery.Results High-dose dexamethasone suppression test showed suppressible in 9 of 16 patients with Cushing′s disease.An IPS gradient ＞2 was found in 14 of the 16 cases (87.5％ )with Cushing′s disease after desmopressin injection,while before injection the respective figure was 12 of 16 (75.0％).No severe adverse effects were observed during or after the procedure.Conclusion Desmopressin test during bilateral IPS sampling is a safe and effective diagnostic procedure in Cushing′s disease.
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It is well known that the macrophages play an important defensive role in the innate immune system. During recent years, with the introduction of the concept of chronic low-grade inflammatory diseases and their further intensive study, the activation and balance of macrophage, as well as its inflammatory effects in chronic lowgrade inflammatory diseases, such as obesity, type 2 diabetes, atherosclerosis, and non-alcoholic fatty liver, are gradually becoming a hot topic of current research. The present article mainly gives an overview of the important role played by macrophages in the inflammatory effects in these diseases.
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A retrospective analysis was made on clinical data of 230 cases of metabolic syndrome (MS) and 239 cases of non-MS admitted to department of cardiology and endocrinology of Huashan Hospital from July 2005 to August 2009.Multiple linear regression analysis was performed to assess the association between levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and potential influencing factors.Covariance analysis was used for group comparison.Multiple linear regression analysis demonstrated that age,body mass index,systolic blood pressure,diastolic blood pressure,insulin resistance index,triglyceride,low density lipoprotein-cholesterol,creatine,left atrial diameter,left ventricular posterior wall dimensions,left ventricular ejection fraction were independent predictors for plasma levels of NT-proBNP in those subjects(P ＜ 0.05).Covariance analysis showed that plasma levels of NT-proBNP in MS group were significantly lower than those in non-MS group ( P ＜ 0.05).Further analysis found that plasma levels of NT-proBNP in MS patients with high triglyceride and body mass index,but normal systolic and diastolic blood pressure,normal fasting plasma glucose were significantly lower than those in non-MS group ( P ＜ 0.05 ).The results indicate that decreased plasma levels of NT-proBNP might be related to lipids disorder and obesity of MS patients.
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Objective To assess the efficacy of Ezscan in evaluating the risk of cardiac autonomic neuropathy (CAN) in diabetes. Methods This study included 144 patients with diabetes. Their serum lipid profile and HbA1c were determined. The heart rate variability was assessed by Holter, and the cardiac autonomic neuropathy by classic experiments. Meanwhile, Ezscan was carried out. Results There was a positive correlation between low frequency (LF) measurements by Holter and Ezscan score( r=0. 39, P＜0. 01 ), so did LF/HF and Ezscan score( r=0. 28, P＜0. 01 ). Correlations between Ezscan score and other Holter parameters were weaker. There was no correlation between HbA1c and LF measurements. In patients with positive classic experiments, the sensitivity and specificity of Ezscan were 58. 3% and 57.8% respectively. Conclusions Ezscan test is a valuable screening procedure for detecting diabetic complications. It is more facilitative and takes shorter time than does the classical autonomic function assessment.
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Objective To investigate the correlation between vibration perception thresholds test (VPT) and simple screening tests for peripheral neuropathy in the diabetes clinic in type 2 diabetic patients. Methods VPT and three simple screening tests including 10 g Semmes-Weinstein monofilament examination (SWME), vibration test by 128 Hz tuning fork, and temperature sensation test by Tip-Therm were completed in 487 Chinese patients diagnosed with type 2 diabetes aged over 30. The relationships between these simple screening tests and VPT were evaluated by Spearman correlation and observed agreement rate. Results Abnormal VPT was significantly associated with aging and fasting plasma glucose by binary logistic regression analysis. VPT was significantly correlated with SWME, temperature sensation test, vibration test by 128 Hz tuning fork, and the correlation coefficient was 0.176, 0.152 and 0.240, respectively (P<0.01);Observed agreement between VPT and three simple screening tests including SWME, temperature sensation test, vibration test by 128 Hz tuning fork was 49.5%, 59.8% and 51.1%, respectively. The percentage of abnormal results by SWME or vibration test by 128 Hz tuning fork with normal result by VPT was very low, only 2.7% and 1.2% respectively. Conclusions VPT should also be considered as a first-choice screening test for diabetic peripheral neuropathy.
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Objective To improve the recognition of pituitary hyperplasia secondary to primary hypothyroidism by analyzing clinical and imaging data. Methods The clinical features, hormone data,imaging findings, and treatment were reviewed in 32 patients with pituitary hyperplasia secondary to primary hypothyroidism in Huashan Hospital from 1999 to 2008. Results Thirty-two patients, most juvenile,presented clinical and imaging features suggestive of functional primary pituitary adenoma. The dose of levothyroxine was increased to maintain the thyrotropin concentration at normal values. Following adequate thyroxine replacement, pituitary hyperplasia regressed on average within 6 months. Conclusions Pituitary hyperplasia secondary to primary hypothyroidism seems to be quite prevalent in children and adolescents.Complete regression will be achieved with thyroxine replacement therapy.
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Objective To observe the effect of acetylated low-density lipoprotein (AcLDL) on the expression of adipophilin and the effect of adipophilin on AcLDL uptake and lipid accumulation in human vascular smooth muscle cells (HVSMCs)in order to approach the role played by adipophilin in genesis of macroangiopathy. Methodse HVSMCs were treated with various amount of AcLDL. Adipophilin expression levels were detected by Northern blot and Western blot. The effects of adipophilin on AcLDL uptake and lipid accumulation in HVSMCs were observed by the methods of siRNA, flow cytometry, enzymatic method and oil red stain. Results AcLDL dose-dependently increased adipophilin expression in HVSMCs. Silence adipophilin by siRNA decreased AcLDL uptake (decreasing by 38.7%, P<0. 05) and lipids accumulation (tfiglyceride and total cholesterol decreasing by 30.6% and 29.8% respectively, both P<0. 01) in HVSMCs, Conclusion Adipophilin is able to increase AcLDL uptake and lipid accumulation in HVSMCs, suggesting that it might play a role in enhancing atherosclerosis.
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Objective To understand treatment outcomes of patients diagnosed with type 2 diabetes aged over 30 years in Jiangninglu Neighborhood of downtown Shanghai. Methods Total 642 patients diagnosed as type 2 diabetes aged over 30 were investigated by cluster sampling in Jiangninglu Neighborhood of downtown Shanghai. Status of optimal control of diabetes in them was analyzed based on the recommendations proposed by International Diabetes Federation (IDF) for Western Pacific Region. Results and serum level of glycosylated hemoglobin Alc (HbAlc) of less than 6.5% was achieved in 37.5% (241/were achieved in 23.8% (153/642) and 18.1% (116/642) of them, respectively, and beth systolic and mmol/L was achieved in 21.7% (139/642) of all the participants investigated, triglyceride of less than 1.5 mmol/L in 46.6% (299/642), low-deusity lipoprotein-cholesterol (LDL-C) of less than 2.5 mmol/L in 23.7% (152/642) and high-density lipoprotein-cholesterol of greater than 1.1 mmol/L in 62.1% (399/of their blood glucose, blood pressure and serum LDL-C (defined as HbAlc less than 6.5%, blood pressure less than 130/80 mm Hg and LDL-C less than 2.5 retool/L). Conclusions Only 2.6% of all the patients diagnosed with diabetes aged over 30 in downtown Shanghai get optimal control of their blood glucose, blood pressure and serum lipid, so comprehensive prevention and control for diabetes shall be strengthened for them at community-level of urban areas.
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Objective To raise the level of clinical diagnosis for the patients with pituitary stalk interruption syndrome (PSIS). Methods Five patients (4 males) with PSIS were retrospectively analyzed with respects to the clinical features, endocrine status and image characteristics. Magnetic resonance imaging (MRI) scan was performed at hypothalamic-pituitary region. Results The clinical manifestations of all patients consisted of growth retardation and delayed puberty without polyuria. Deficiency of multiple anterior pituitary hormones was revealed in all patients by the evaluation of endocrine status. The features of MRI included a lack of visible pituitary stalk, absence of posterior lobe hypersignal in the sella turcica and a hyperintense spot in the region of the thalamus opticus. Conclusion The clinical characteristics of patients with PSIS are growth retardation and delayed puberty. The evaluation of anterior pituitary function is necessary. The detection of an anatomical abnormality around hypothalamic-pituitary region by MRI is important diagnostic evidence.
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Objective To understand the pathogenesis of primary hypothyroidism associated with polymyositis-like syndrome.Method Four cases were presented and the clinical characteristics were analyzed.Results All of the four patients were male.Complaints of weakness primarily affecting proximal muscles and elevation of muscle enzymes were presented.Primary hypothyroidism was diagnosed after clinical examination.Complaints of weakness and the elevated muscle enzymes were all improved after the substitution of thyroxine.Conclusion Hypothyroidism could cause polymyositis-like syndrome,and thyroid function should be screened when elevation of muscle enzymes is presented.
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<p><b>OBJECTIVE</b>To report the clinical characteristics, biochemical profiles, diagnosis and treatment of one Chinese pedigree with glucocorticoid-remediable aldosteronism (GRA) and to study its molecular mechanism.</p><p><b>METHODS</b>Plasma and urinary aldosterone, cortisol and plasma renin activities were dynamically tested and diagnostic therapy with dexamethasone was undergone in 3 affected subjects. Long-distance PCR as well as DNA sequencing were applied to detect the fusion gene in this pedigree.</p><p><b>RESULTS</b>In this GRA pedigree, there were 4 affected subjects who had hypertension, hypokalemia and low basic and provoked renin activity. Three patients were given dexamethasone treatment, and had a significant decrease in plasma aldosterone concentrations (PACs) (from 192 +/- 9 ng/L to 87 +/- 7ng/L, P < 0.05) after 5 days. Among them, one patient (II -3) responded quite satisfactorily to the therapy, with serum K(+) rising from baseline value of 2.5 to 2.9, 3.8 and 4.15 mEq/L on the 10th, 28th and 35th days after treatment respectively. Three weeks later, his blood pressure decreased from its original level of 146.3 +/- 1 0.7/94.6 +/- 5.3 mm Hg to 138.3 +/- 3.1/87.3 +/- 6.1 mm Hg (P < 0.05). The other 2 members (III -2 and III -4) showed modest improvement although their PACs decreased significantly. Using long-distance PCR, we found a 3.9 kb band in all 4 affected individuals, which was absent in 5 unaffected members from this pedigree or 8 patients with aldosterone-producing adenoma (APA) or idiopathic hyperaldosteronism (IHA). By DNA sequence analysis, we found that the breakpoint of "unequal crossing-over" is both within intron 2 of the 11beta-hydroxylase gene (CYP11B1) and the aldosterone synthase gene (CYP11B2).</p><p><b>CONCLUSIONS</b>The excess of mineralocorticoid in patients with GRA can be inhibited by exogenous glucocorticoids. The fusion gene resulting from unequal crossing-over between the 11beta-hydroxylase gene and the aldosterone synthase gene is the pathogenesis of this Chinese GRA pedigree.</p>
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Adult , Female , Humans , Adrenocorticotropic Hormone , Physiology , Aldosterone , Blood , Glucocorticoids , Therapeutic Uses , Hyperaldosteronism , Blood , Drug Therapy , Genetics , Mutation , PedigreeABSTRACT
Objective To evaluate the sensitivity and specificity of various assays in diagnosing Cushing′s syndrome. Methods The plasma cortisol, urinary free cortisol (UFC), circadian rhythm in cortisol secretion and dexamethasone suppression test were assessed in 173 patients clinically diagnosed Cushing′s syndrome. The data were compared with the postoperative pathologic diagnosis. Results The normal diurnal rhythm of cortisol secretion was lost in 92.9% patients with Cushing′s syndrome. The loss of normal diurnal rhythm of cortisol secretion of 2 time points occurred in 85.1% (8:00, 16:00) and 91.8% (8:00, 24:00), and that of 3 time points (8:00, 16:00, 24:00) in 94.7% of the cases. The excretion of UFC was increased in 91.7% of patients with Cushing′s syndrome. Low-dosedexamethasonedidnotsuppressthe excessive secretion of glucocorticoid in 79.7% (1 mg) and 84.3% (2 mg) patients with Cushing′s syndrome. The basal level of plasma cortisol was raised in 75.6% patients. The sensitivity of 8 mg dexamethasone suppression test was 50%-70% as the standard was set at 50% suppression, and specificity was more than 95%. Conclusion The most sensitive tests for Cushing′s syndrome are the loss of normal circadian rhythm of cortisol secretion and increased UFC. The method of 3 time points is more sensitive than that of 2 time points in the assessment of circadian rhythm. The 8 mg dexamethasone suppression test is the most useful method in differentiating Cushing′s disease from adrenal adenoma.
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AIM:To study the effect of astragalus polysaccharides(Aps)on cholesterol efflux in THP-1 macrophage-derived foam cells.METHODS:After exposed to Aps at different doses,cholesterol efflux and ABCA1 protein levels in cultured THP-1 macrophage-derived foam cells were determined by a ? counter and flow cytometry,respectively.RESULTS:Aps increased cholesterol efflux in THP-1 macrophage-derived foam cells with dose dependent pattern and resulted in an increase in the expression of ABCA1 protein in THP-1 macrophage-derived foam cells.CONCLUSION:The increase in cholesterol efflux by Aps might be related to the up-regulation of ABCA1.