多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)是一种病因未明的异质性疾病,其与代谢综合征密切相关,被认为是一种天然的代谢综合征疾病。PCOS患者除存在胰岛素抵抗外,β细胞功能亦有损伤。约50%的PCOS患者超重或肥胖,大多为中心性肥胖,其原因与高胰岛素血症相关。由于胰岛素抵抗和肥胖的影响,PCOS患者常合并血脂异常,患心血管疾病的危险性增高。PCOS的治疗以提高胰岛素敏感性为主,包括减重及应用二甲双胍、噻唑烷二酮类、右手性肌醇等药物治疗。     

多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)是一种病因未明的异质性疾病，其与代谢综合征密切相关，被认为是一种天然的代谢综合征疾病。PCOS患者除存在胰岛素抵抗外，β细胞功能亦有损伤。约50％的PCOS患者超重或肥胖，大多为中心性肥胖，其原因与高胰岛素血症相关。由于胰岛素抵抗和肥胖的影响，PCOS患者常合并血脂异常，患心血管疾病的危险性增高。PCOS的治疗以提高胰岛素敏感性为主，包括减重及应用二甲双胍、噻唑烷二酮类、右手性肌醇等药物治疗。     

减重手术对肥胖相关代谢异常的作用

减重代谢手术减轻体重、改善代谢的长期效果已得到全球专家的广泛认可.临床已观察到减重代谢手术对肥胖相关2型糖尿病、高血压病、多囊卵巢综合征、代谢相关脂肪性肝病、远期心脑血管病等代谢紊乱的显著疗效.但现行指南推荐手术治疗2型糖尿病的BMI切点相对保守;且新的代谢手术方式如单吻合口十二指肠回肠吻合术,也展现出现极佳的减重降糖...     

多囊卵巢综合征合并代谢综合征患者血清AMH水平、窦卵泡计数变化及其意义

目的 探讨多囊卵巢综合征（PCOS）合并代谢综合征患者血清抗米勒管激素（AMH）水平及窦卵泡计数（AFC）变化及其临床意义。方法 选择PCOS合并代谢综合征患者130例（观察组）、单纯多囊卵巢综合征患者65例（对照组），采集所有研究对象外周静脉血，离心留取血清，检测血清AMH、空腹血糖（FPG）、空腹胰岛素（FINS）、TG、HDL并计算胰岛素抵抗指数（HOMA-IR），于月经第1～5天通过彩色超声诊断仪检测AFC。分析PCOS合并代谢综合征患者血清AMH水平及AFC与糖脂代谢指标的关系以及二者之间的关系。采用受试者工作特征（ROC）曲线分析血清AMH水平及AFC对PCOS合并代谢综合征的预测效能。结果 观察组与对照组血清AMH水平分别为（15.3±3.1）、（5.8±1.6）ng/mL,AFC分别为24(15,32)、8(4,15)个，观察组血清AMH水平及AFC均显著高于对照组（t/Z分别为16.021、12.041,P均<0.01）。观察组FPG、TG、FINS、HOMA-IR均高于对照组，HDL低于对照组（P均<0.05）。PCOS合并代谢综合征患者血清AMH水平及...     

内科主导的代谢手术治疗糖尿病的初步实践

肥胖症和2型糖尿病的流行已成为全球性公共卫生面临的重大挑战,2型糖尿病合并肥胖使其治疗更具挑战.近三十年来,临床实践显示肥胖合并糖尿病患者在接受减重手术后除体重下降外,糖尿病病情亦得到显著改善,大多无需用药即能有效地控制血糖在正常范围,疗效明显优于常规内科治疗[1-3],且伴随的代谢综合征和高血压等相关合并症也得到明显缓解[4],甚至有报道这类患者的肿瘤发生率也显著降低[5].糖尿病减重手术治疗的有效性已得到临床的充分认可,近年来多个专业学会先后发表声明、专家共识或指南将减重手术列为合并病态性肥胖的糖尿病患者的治疗方式[6-8].     

多囊卵巢综合征与代谢综合征

多囊卵巢综合征(PCOS)临床定义为月经过少伴随男性化现象,表现为痤疮、多毛等雄激素增高,常合并胰岛素抵抗(IR)、高胰岛素血症、黄体激素促卵泡成熟激素比值增高、腹型肥胖、不育。B超示多囊卵巢有重要诊断意义。PCOS常为糖尿病的前躯表现,应受到重视。一、PCOS和代谢综合征(MS)的相互重叠性。PCOS患者中有 30%伴有糖耐量受损( IGT), 7 5%合并糖尿病。PCOS患者与体重相当的女性对照组比较,高胰岛素血症和IR的发生率更高,程度更严重。超过 40%的 PCOS患者伴有肥胖。伴有的肥胖的患者与体重相当的对照组及低体重的PCOS患…     

多囊卵巢综合征不孕患者的治疗研究进展

多囊卵巢综合征(PCOS)是一种生殖功能障碍与代谢异常并存的内分泌紊乱综合征。改善卵巢功能及解决不孕,首先应针对PCOS的内分泌代谢进行综合治疗以纠正全身状况;对仍不能妊娠的患者可以借助各种助孕方式,包括促排卵治疗、手术治疗及辅助生殖技术等。该文对PCOS不孕患者的临床治疗研究进展情况进行综述。     

年龄联合腰臀比在肥胖PCOS患者合并SCH筛查的价值分析

目的研究肥胖伴多囊卵巢综合征（PCOS）患者合并亚临床甲状腺功能减退（SCH）的危险因素,并评估其筛查价值。 方法回顾性分析2021年1月1日至2021年7月1日在安徽医科大学第二附属医院减重代谢外科就诊的肥胖患者的临床资料,根据PCOS患病情况分为PCOS组和对照组,比较两组SCH患病率差异。进一步将PCOS组患者分为合并SCH组和不合并SCH组,分析患者的一般测量资料、性激素、甲状腺功能、生化等指标。 结果共纳入患者172例,其中单纯肥胖患者104例,PCOS患者68例,PCOS组中SCH的发生率显著高于对照组（36.76% vs. 17.31%;P=0.004,χ²=8.302）。多因素分析结果显示两个亚组间的年龄、腰臀比（P=0.016,OR=1.144;P=0.044,OR=10.387）具有统计学意义。受试者工作特征曲线（ROC）分析显示联合使用年龄、腰臀比可提高曲线下面积（AUC）,诊断SCH的灵敏度和特异度分别为55.8%、88.0%。 结论肥胖伴PCOS患者并发SCH的风险较高,且年龄、腰臀比是独立危险因素。对于此类患者,年龄联合腰臀比监测具有较好的灵敏度与特异度,可用于肥胖合并PCOS患者并发SCH的筛查。     

肥胖型阻塞性睡眠呼吸暂停低通气综合征减重干预研究进展

肥胖型阻塞性睡眠呼吸暂停低通气综合征是一种潜在的致死性疾病，由于肥胖是其最重要的可逆性危险因素，减重干预是其最基础且最重要的治疗手段。本文通过回顾相关文献，总结了目前关于肥胖型阻塞性睡眠呼吸暂停低通气综合征的减重干预手段[包括非手术干预（饮食干预、运动干预、知信行干预、持续气道正压通气治疗、减重药物治疗、中医疗法）、手术干预（减重代谢手术）]及其实际应用效果，并指出目前缺少明确的操作流程，相关研究样本量较少，且研究结论存在争议，急需搭建一个关于肥胖型阻塞性睡眠呼吸暂停低通气综合征患者减重干预的多学科团队协作平台。     

铁代谢异常及铁死亡与多囊卵巢综合征关系的研究进展

铁代谢参与机体许多重要生理活动, 铁死亡是一种新型程序性细胞死亡方式, 人们对铁代谢、铁死亡在多囊卵巢综合征(PCOS)中的作用了解局限。在患有PCOS的患者中发现铁超载现象, 且铁代谢也对PCOS患者的激素、代谢、生殖产生直接或间接影响。铁死亡亦可造成PCOS患者代谢紊乱。目前, PCOS的发病机制不明, 通过对铁代谢、铁死亡的了解阐明其与PCOS之间的关系, 以期探索出对PCOS的治疗新靶点。     

Syndromic Disorders with Short Stature

Short stature is one of the major components of many dysmorphic syndromes. Growth failure may be due to a wide variety of mechanisms, either related to the growth hormone (GH)/insulin-like growth factor axis or to underlying unknown pathologies. In this review, the relatively more frequently seen syndromes with short stature (Noonan syndrome, Prader-Willi syndrome, Silver-Russell syndrome and Aarskog-Scott syndrome) were discussed. These disorders are associated with a number of endocrinopathies, as well as with developmental, systemic and behavioral issues. At present, GH therapy is used in most syndromic disorders, although long-term studies evaluating this treatment are insufficient and some controversies exist with regard to GH dose, optimal age to begin therapy and adverse effects. Before starting GH treatment, patients with syndromic disorders should be evaluated extensively.     

Patients’ experiences of a diagnosis of Hughes’ syndrome

The objectives of the study were to describe the experience of patients immediately prior to a diagnosis of Hughes syndrome (HS) or antiphospholipid syndrome and post-diagnosis. A questionnaire survey was carried out set in the Hughes Syndrome Foundation, St. Thomas’ Hospital, London, 2006. Participants were all patients who are members of the Hughes Syndrome Foundation. The main outcome measures were responses to a questionnaire relating to the experiences of people with a diagnosis of HS, such as number of hospitalisations, number of consultants seen, number of miscarriages, etc. A total of 157 patients completed the questionnaire, giving a response rate of 60.4%. Most (85%) were women and mean age was 46 years (SD 12). The median time to diagnosis was 3 years. The median number of consultants seen was 2 (max 19) with a median time in hospital pre-diagnosis of 10 days. The most common initial diagnoses were migraines, multiple sclerosis and systemic lupus erythematosus. Among women, 46% had had a miscarriage. Two thirds of respondents thought a blood test would have led to an earlier diagnosis. Comments from patients indicated a lack of awareness among specialists and general practitioners. The survey demonstrated a long time lag for diagnosis of Hughes syndrome, with increased costs to the NHS and emotional and financial cost to the patient. Greater awareness of this condition would benefit patients and the NHS.     

从痰湿瘀热论治2型糖尿病代谢综合征52例

目的观察从痰、湿、瘀、热立论应用清热祛浊胶囊治疗2型糖尿病代谢综合征的疗效。方法 52例2型糖尿病代谢综合征患者,在原基础治疗基础上,加服清热祛浊胶囊5粒,每日3次。3个月后观察指标变化。结果治疗后患者的空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、收缩压、舒张压、体重指数明显下降(P<0.05或P<0.01);高密度脂蛋白胆固醇有所升高,但无统计学意义。治疗总有效率82.7%。结论从痰、湿、瘀、热立论组方的清热祛浊胶囊可以改善2型糖尿病代谢综合征患者的高血糖、高血压、高血脂、肥胖等多种心血管危险因子。     

The postcardiac injury syndromes.

Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.     

遗传性低钾失盐性肾小管病临床分析

目的：分析遗传性低钾失盐性肾小管病的临床特点。方法：回顾性分析上海瑞金医院肾内科住院治疗Bartter综合征和Gitelman综合征共23例，其中经典型Bartter综合征4例，Gitelman综合征19例。结果：4例Bartter综合征发病年龄4月-33岁，临床上以多饮、多尿、乏力主要表现，2例患儿表现为脱水、呕吐、生长发育障碍；19例Gitelman综合征患者发病年龄10—52岁，临床上以双下肢无力、多饮、多尿、夜尿增加为主要表现，部分Gitelman综合征患者伴手足抽搐；实验室检查均表现为低血钾代谢性碱中毒，尿钾排出增加，血肾素活性、血管紧张素Ⅱ及醛固酮明显升高。而血压正常；经典型Bartter综合征尿钙肌酐比〉0．2，Gitelman综合征表现为低血镁、低尿钙、低尿钙肌酐比〈0．2；补钾或联合消炎痛、安体舒通和门冬氨酸钾镁等药物治疗后症状缓解。结论：低钾失盐性肾小管病主要特点包括低血钾代谢性碱中毒、高尿钾、血肾素、血管紧张素Ⅱ、醛固酮水平增高而血压正常，Bartter综合征和Gitelman综合征鉴别主要在发病年龄、血镁和尿钙水平，本病治疗应补钾、补镁、前列腺素合成酶抑制剂、醛固酮拮抗剂等多种药物联合应用。     

预激综合征合并快慢综合征的临床分析

目的通过对12例预激综合征合并室上性心动过速患者临床及电生理资料的分析,提出室上性心动过速发作结束时伴发的晕厥可能是窦房结功能一过性受抑的结果,探讨和证实这一发生机制设想的合理性.方法12例预激综合征合并室上性心动过速患者,男8例,女4例,平均年龄32.5岁(19～49岁).均因室上性心动过速伴晕厥住院.经各种电生理检查评价窦房结功能,冠脉造影排除冠脉的异常,并进行射频消融术和(或)抗心动过速起搏器治疗.随访2～5年.结果12例患者均符合下列条件预激综合征伴发室上性心动过速结束时有晕厥发生,年龄多属青年、中年,经各种电生理检查提示窦房结功能正常.冠脉造影证实冠状动脉正常,室上性心动过速终止时心电图均证实为较长时间的窦性停搏.4例经植入抗心动过速起搏治疗,3例经射频消融术及抗心动过速起搏器治疗,5例经射频消融术治疗,经2～5年的随访,全组12例患者无一例再发生室上性心动过速及晕厥.结论预激综合征合并室上性心动过速伴发的晕厥均由功能性病态窦房结功能障碍机制引起,尽管因果关系明确,但与多数预激综合征患者的临床经过不一致的原因尚不清楚,有待进一步探讨.此外,这些符合快慢综合征患者晕厥治疗和预防的关键是根治室上性心动过速,植入人工心脏起搏器预防晕厥似乎必要性不大.     

Somatotype and idiopathic mitral valve prolapse

Records from 18 subjects with angiographic idiopathic mitral valve prolapse, 28 subjects with merely exaggerated posterior mitral leaflet systolic bulging, and 100 subjects with normal hemodynamic and angiographic findings were compared with regard to age, sex, height, weight, ponderal index (height/³ weight), auscultatory and echocardiographic abnormalities. Chest x-ray films available for subjects with mitral valve prolapse were reviewed. The ponderal index of subjects with mitral valve prolapse (13.1 ± 0.8) differed from that of subjects with merely exaggerated posterior mitral leaflet systolic bulging (12.6 ± 0.7) (P < 0.02) and from that of subjects without angiographic abnormality (12.3 ± 0.8) (P < 0.001). The three groups differed in ponderal index when equated statistically for age, height, weight, and sex (P < 0.001). Among mitral valve prolapse patients, an asthenic habitus occurred independent of the presence of thoracic skeletal abnormalities.     

Relapsing catastrophic antiphospholipid syndrome: report of three cases

BACKGROUND: The catastrophic variant of the antiphospholipid syndrome (CAPS), also now known as Asherson's syndrome, is defined as a potential life-threatening variant of the antiphospholipid syndrome, which is characterized by multiple small-vessel thrombosis that can lead to multiorgan failure. Relapses in patients with the CAPS are very uncommon. OBJECTIVE: To describe the clinical and laboratory features of patients with relapsing episodes of CAPS. METHODS: Three patients with relapsing CAPS are presented with their clinical and laboratory features. RESULTS: Seven episodes of CAPS that occurred in the 3 patients reported were analyzed. The median time between the episodes of CAPS was 12.5 months (range, 2.5-48). Precipitating factors were identified in 2 episodes only (Legionella respiratory tract infection and periodontal infection). The most significant manifestations of the episodes were renal involvement (5 episodes), central nervous system and cardiac involvement (4 episodes), and pulmonary and hepatic involvement (3 episodes each). Interestingly, laboratory features of definite microangiopathic hemolytic anemia (MHA) were present in 5 of 7 episodes of relapsing CAPS. The remaining episodes presented with thrombocytopenia, schistocytes, and anemia but data concerning hemolysis and Coombs tests were not reported. Rituximab was used in 2 episodes. CONCLUSIONS: Relapses occur very infrequently in patients with the CAPS. The presence of MHA is common in these patients, suggesting that an association between MHA and relapses of CAPS could be present and that a "continuum" between various MHAs might exist, as recently suggested.