Maternal thyrotoxicosis in the first trimester: a clinical analysis of 150 cases / 中华全科医师杂志

Clinical data of 150 pregnant women,who were confirmed with maternal thyrotoxicosis during January 2010 to January 2014,including 104 cases of gestational transient thyrotoxicosis (GTT) and 46 cases of Graves disease (GD),were retrospectively analyzed;65 normal pregnant women served as controls.Patients with GD had lower body mass index (BMI) than those with GTF and normal controls [(18 ± 5),(20 ± 4) and (22 ± 4) kg/m2,respectively,P ＜ 0.05].The frequency of thyrotoxic history and hyperthyroidism symptoms in GD patients were significantly higher than that in GTT patients [33％ (15/46) vs.3％ (3/104) and 52％ (24/46) vs.15％ (16/104),respectively,both P ＜0.01].In the first trimester,patients with GD presented lower TSH levels than those with GTT and controls(M =0.021,0.045and 1.660 mU/L,respectively,P ＜ 0.05) and higher free T4 (FT4) (M =24.99 vs.19.99 pmol/L,P ＜0.05),free T3 (FT3) (7.10 vs.5.85 pmol/L,P ＜ 0.05),thyroid peroxidase antibody (TPOAb) (99.22vs.4.54 kU/L,P ＜ 0.05) and thyrotrophin receptor antibody (TRAb) (5.28 vs.0.11 U/L,P ＜ 0.05)levels than patients with GTT.In the second trimester,there were 67％ (70/104) GTT patientsand 4％ (2/46) GD patients had normal TSH;and FT4 returned to normal in 82％ (85/104) GTT patientsand 17％ (8/46) GD patients.In the third trimester,there were 100％ (104/104) GTT patients and 9％ (4/46)GD patients had normal TSH;and FT4 returned to normal in 100％ (104/104) GTT patients and 48％ (22/46)GD patients.

Clinical Observation of Calcitriol Soft Capsules Combined with Telmisartan Tablets in the Treatment of Early Diabetic Nephropathy / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of Calcitriol soft capsules combined with Telmisartan tab-lets in the treatment of early diabetic nephropathy(DN),and the effect on the levels of inflammatory factors. METHODS:Totally 110 patients with early DN were randomly divided into observation group and control group. The control group was orally given Telmisartan tablets with the initial dose of 40 mg,qd,and the maximum dose was 80 mg,qd;the observation group was orally giv-en Calcitriol soft capsules 0.25μg based on the treatment of control group,qd. The course was 1 month. The clinical data was com-pared,including the clinical efficacy and 24 h urinary protein,serum creatinine(Scr),urinary albumin excretion rate(UAER),se-rum C reactive protein (CRP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) before and after treatment. The adverse reactions were observed. RESULTS:After treatment,the total effective rate in observation group was significantly higher than con-trol group,with significant difference (P<0.05);the 24 h urinary protein,Scr,UAER,and levels of CRP,TNF-α and IL-6 in observation group were significantly lower than control group and before treatment,with significant differences(P<0.01 or P<0.05). There were no obvious adverse reactions in 2 groups. CONCLUSIONS:Calcitriol soft capsules combined with Telmisartan tablets has better efficacy than only Telmisartan tablets in the treatment of DN,and can more effectively improve the levels of CR, TNF-αand IL-6,which is helpful to delay progression of patients.

Rosuvastatin control CIAKI risk on diabetic patients with mild to moderate CKD and diuretics at high risk / 中国生化药物杂志

Objective To assess the application of rosuvastatin control contrast induced acute kidney injury (CIAKI) risk on diabetes mellitus (DM) patients with mild to moderate chronic kidney disease (CKD) and diuretics at high risk.Methods One hundred T2DM patients with mild to moderate CKD scheduled for coronary or peripheral vascular interventional diagnosis selected from May 2013 to June 2015 in endocrinology department of Zhejiang Huzhou Central Hospital and perioperative routine use of diuretics were randomly divided into observation group (51 cases) and control group (49 cases).The observation group received rosuvastatin at draught of night, 10mg per time and needed to take at least 2 times and then performed medical surgery, after surgery, continued to receive rosuvastatin for 3 d, and the total number of days taking rosuvastatin were not less than 5 d;control group not received any statins pre-and post-operation.Results The angiographic site, angiography showed lesions, the proportion of patients with coronary interventional therapy, iodixanol dosage during and preoperative and postoperative levels of SCr and eGFR and other project data between two groups were compared with no significant difference.The CIAKI incidence in observation group was 1.96% (1/51), which was significantly lower than that in control group of 16.33% (8/49) (P<0.05).The clinical follow-up after interventional treatment 30d results showed that secondary end points between two groups groups related to the project data surgery was not statistically significant.There were 2 cases with transaminases elevating, 1 case with rash and 1 case with gastrointestinal reactions, the adverse reactions rate was 7.84% (4/51) and 1 case with gastrointestinal reactions, 1 case with myalgia in control group, the adverse reactions rate was 4.08% (2/49), there was no significant difference between two groups.Conclusion This preliminary study demonstrates that rosuvastatin has the good efficacy on the DM patients with mild to moderate CKD received diuretics at high risk with security, which has the certain significance to control CIAKI.

Clinical treatment of 100 patients with subacute thyroiditis / 中华全科医师杂志

A total of 100 patients with subacute thyroiditis hospitalized from January 2011 to October 2012 were recruited.Each received glucocorticoid treatment for 8 weeks and there was a 2-month follow-up period after drug withdrawal.After treatment,the short-term recurrence rate was 34％ (34/100).If thyroid ultrasound was abnormal,the recurrence rate was 52％ (30/58).And it was significantly higher than 10％ recurrence rate for those with normal thyroid ultrasound (4/42,x2 =9.67,P ＜ 0.01).The recurrence rate of different erythrocyte sedimentation rate groups of 40-100 mm/1 h and ＞ 100 mm/1 h was 37％ (22/60) and 30％ (12/40) respectively (P ＞ 0.05).

Relationship between serum concentrations of retinol-binding protein 4 and high sensitive C reactive protein and macrovascular complications in type 2 diabetic mellitus patients / 中国医师进修杂志

Objective To investigate the levels of serum retinol-binding protein 4 (RBP4) and high sensitive C reactive protein (hs-CRP) in type 2 diabetic mellitus (T2DM) patients with macrovascular complications. Methods All of 115 subjects were divided into 3 groups: normal control group (35subjects), T2DM patients with macrovascular complications group (40 subjects) and simple T2DM patients group (40 subjects). Serum RBP4 and hs-CRP was detected and fasting blood glucose(FBG), glycosylated hemoglobin A1c (HbA1c), triacylglycerol (TG), total cholesterol (TC), high density lipopretein cholesferel (HDL-C), low density lipoprotein cholesferol(LDL-C) and fasting insulin(FINS) were measured. Body mass index (BMI) and HOMA-IR was calculated. The correlation of RBP4 and other factors were analyzed.Results The concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group and simple T2DM patients group compared with those in normal control group [hs-CRP:(9.12±4.21),(2.01±1.96), (0.98±0.36)mg/L; RBP4:(30.70 ± 5.45), (20.02±5.32),(12.02±3.45)mg/L] (P<0.01). Also,the concentrations of RBP4 and hs-CRP were significantly increased in T2DM patients with macrovascular complications group compared with those in simple T2DM patients group (P<0.01). Univariate analysis showed that serum RBP4 was positively associated with LDL-C,BMI,FBG,hs-CRP,FINS,HOMA-IR (r=0.325, 0.597, 0.323, 0.571, 0.275, 0.463,P<0.05 or <0.01).Conclusions The concentrations of RBP4 and hs-CRP are significantly higher in T2DM patients. The changes of RBP4 and hs-CRP are closely related to the occurrence and development of diabetic macrovascular complications.

Levels of serum retinol-binding protein 4 and related factors in type 2 diabetic patients / 中国医师进修杂志

Objective To investigate the levels of serum retinol-binding protein 4 (RBP4 )and related factors in type 2 diabetic patients. Methods Eighty type 2 diabetic and patients 30 non-diabetic subjects were recruited into obese-diabetic group [body mass index (BMI) 1525 kg/m~2],normal-weighted diabetic group(BMI < 25 kg/m~2)and control group(BMI < 25 kg/m~2). Serum adiponectin(APN), RBP4 and hemoglobin A_1c (HbA_1c)triacylglycerol (TG),total cholesterol (TC).high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C)and were measured on fasting samples. BMI, waist/hips girth ratio (WHR) and insulin resistance index (HOMA-IR) were calculated. The correlation between RBP4 and other factors was analyzed. Results The concentration of RBP4 was significantly increased in obese-diabetic group and normal-weighted diabetic group compared with that in control group [ (30.02 ± 5.32), (20.10 ± 5.45), (12.02 ± 3.45) mg/L] (P < 0.01). The concentration of RBP4 was higher in obese-diabetic group than that in normalweighted diabetic group (P < 0.01). Univariate analysis showed serum RBP4 was positively associated with TG,BMI,FBG, WHR,FINS,HOMA-IR and negatively associated with APN (r = 0.225, 0.697, 0.323,0.557, 0.272, 0.461, -0.398). Conclusions The concentration of RBP4 is significantly higher in type 2 diabetic patients compared with that in normal subjects. RBP4 possibly plays an important role in the insulin resistance and the occurrence and development of type 2 diabetes.