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[Recommendations for the diagnosis and treatment of Sjögren's syndrome in China]. 【中国Sjögren综合征诊疗建议】。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20221027-00797
W Zhang, Z Chen, X M Li, J Gao, Y Zhao

Sjögren's syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage. In addition to the impairment of salivary and lacrimal gland function, SS can present with multi-system and multi-organ involvement, accompanied by autoantibodies in serum and hyperimmunoglobulinemia. SS can be divided into primary and secondary forms based on the absence or presence, respectively, of concurrent connective tissue diseases such as systemic lupus erythematosus and rheumatoid arthritis. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association drafted standardized criteria for the diagnosis and treatment of primary SS. The objectives were to standardize the detection and interpretation of key indicators for the diagnosis of SS, including serum anti-SSA antibody and labial gland pathology, suggest the use of the widely accepted European League Against Rheumatism (EULAR)-SS disease activity index for the evaluation of the disease, and standardize the rational management of SS patients with topical and systemic therapies.

Sjögren综合征(SS)是一种以淋巴细胞增生和进行性外分泌腺损伤为特征的慢性系统性自身免疫性疾病。除了涎腺和泪腺功能受损外,SS可累及多系统、多器官,并伴有血清自身抗体和高免疫球蛋白血症。根据有无并发结缔组织疾病,如系统性红斑狼疮和类风湿关节炎,SS可分为原发性和继发性两种。中国风湿病学会根据国内外的证据和指南,起草了原发性SS的标准化诊断和治疗标准,目的是规范SS诊断的关键指标的检测和解释,包括血清抗ssa抗体和唇腺病理,建议使用被广泛接受的欧洲抗风湿病联盟(EULAR)-SS疾病活动性指数来评估疾病。规范对SS患者进行局部和全身治疗的合理管理。
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引用次数: 0
[Pancreatic β cell regeneration: the opportunities and challenges in diabetes therapies]. 胰岛β细胞再生:糖尿病治疗的机遇与挑战。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230309-00144
J Li, R Wei, T P Hong
恢复功能性胰岛β细胞数量(β细胞再生)是治疗糖尿病的重要策略。诱导干细胞定向分化、促进体细胞重编程、修复原有β细胞表型和功能是促进β细胞再生的重要路径,有望改变糖尿病的自然病程。然而,目前大多数干预方案面临β细胞再生效率低、难以获得功能完全成熟的β细胞、安全性尚待检验等挑战,未来需要进一步优化干预方案,并积累高质量的临床研究证据。.
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引用次数: 0
[The effect of subclinical hypercortisolism on bone metabolism]. 亚临床高皮质醇血症对骨代谢的影响。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230207-00065
L P Ren, H Chen, T Zhang, Q Pan
近年,随着影像学检查的进展及普及,肾上腺意外瘤(AI)的诊断率逐渐增多,随之发现有功能的AI中最为常见的是亚临床皮质醇增多症(SH)。SH患者无典型的库欣综合征症状及体征,但长期轻微过量的皮质醇增多也可引起糖脂代谢紊乱、心血管事件发生率增高及骨代谢异常。本文主要就AI所致SH患者的骨密度变化、骨折发生及机制进行综述。.
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引用次数: 0
[Recommendations for the diagnosis and treatment of rheumatic fever in China]. 【中国风湿热诊疗建议】。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20221029-00802
J R Gu, Z M Lin, Y L Wang, L Li, P T Yang, Y Zhao

Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.

风湿热是一种自身免疫性疾病,其特征是由咽喉A组链球菌感染引起的反复出现的急性或慢性全身结缔组织炎症。虽然风湿热在中国很常见,但缺乏诊断和治疗这种疾病的标准化标准。根据来自中国和其他国家的证据和指南,中国风湿病学会制定了中国风湿病诊断和治疗的标准化标准。旨在规范风湿热的诊断方法、治疗机会以及短期和长期治疗策略,以减少不可逆损害,改善预后。
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引用次数: 0
[Application of the Chinese Expert Consensus on Diabetes Classification in clinical practice]. 【中国糖尿病分型专家共识在临床中的应用】。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230131-00043
S T Yang, C Deng, B B He, X Chen, X Li, Z G Zhou

Objective: To evaluate the diagnostic for classification of newly diagnosed diabetes patients and assess the application of the screening tests recommended by the 2022 Chinese Expert Consensus on Diabetes Classification. Methods: Retrospective case series study. The data from the electronic medical record system of patients with new-onset diabetes mellitus (within 1 year of disease onset) who attending the Diabetes Specialist Outpatient Clinic at the Second Xiangya Hospital of Central South University from January 1, 2018 to December 31, 2021 were collected for the analysis. Based on the consensus, patients were categorized according their age of onset, body mass index (BMI), and suspicion of type 1 diabetes mellitus (T1DM). The chi-square statistic was used to compare key classifier indicators, including C-peptide, islet autoantibodies, and genetic markers, in the subgroups. The diagnosis in suspected T1DM patients was also evaluated. The screening strategy recommended in the consensus was further assessed using a logistic regression model and the area under the receiver-operating curve (AUC). Results: A total of 3 384 patients with new-onset diabetes were included. The average age of disease onset was (46.3±13.9) years, and 61.0% (2 065/3 384) of the patients were male. The proportions of patients who completed C-peptide and glutamic acid decarboxylase antibody (GADA) tests were 36.6% (1 238/3 384) and 37.5% (1 269/3 384), respectively. There were no significant differences in C-peptide test results among the subgroups (all P>0.05). In contrast, the GADA detection rate was higher in patients with young age of onset (<30 years old), in those who were non-obese (BMI<24 kg/m2), and in those clinically suspected of T1DM (all P<0.05). According to the diagnostic pathway proposed by the consensus, only 57.4% (1 941/3 384) of patients could be subtyped. For a definitive diagnosis, the remaining patients needed completion of C-peptide, islet autoantibody, genetic testing, or follow-up. Furthermore, among patients with clinical features of suspected T1DM, the antibody positivity rate was higher than in non-suspected T1DM patients [24.5% (154/628) vs. 7.1% (46/646), P<0.001]. When the clinical features of suspected T1DM defined in the consensus were taken as independent variables and antibody positivity was considered the outcome variable in the logistic regression model, young onset, non-obese onset, and ketosis onset could enter the model. Based on AUC analysis, the accuracy of the diagnostic model was 0.77 (95%CI 0.73-0.81), suggesting that the clinical features of suspected T1DM in the consensus have good clinical diagnostic value for this patient subgroup. Conclusions: There was a significant discrepancy between the clinical practice of diabetes classification and the process recommended by the consensus, which was specifically reflected in the low proportions of both subtyping

目的:评价新诊断糖尿病患者的分型诊断,评价《2022年中国糖尿病分型专家共识》推荐的筛查试验的应用情况。方法:回顾性病例系列研究。收集2018年1月1日至2021年12月31日在中南大学湘雅第二医院糖尿病专科门诊就诊的新发糖尿病(发病1年内)患者电子病历系统数据进行分析。在此基础上,根据患者的发病年龄、体重指数(BMI)和是否患有1型糖尿病(T1DM)进行分类。卡方统计用于比较关键分类指标,包括c肽,胰岛自身抗体和遗传标记,在亚组中。对疑似T1DM患者的诊断也进行了评估。共识中推荐的筛查策略进一步使用逻辑回归模型和接受者工作曲线下面积(AUC)进行评估。结果:共纳入3 384例新发糖尿病患者。平均发病年龄为(46.3±13.9)岁,男性占61.0%(2 065/3 384)。完成c肽和谷氨酸脱羧酶抗体(GADA)检测的比例分别为36.6%(1 238/3 384)和37.5%(1 269/3 384)。各组间c肽检测结果差异无统计学意义(均P>0.05)。相比之下,起病年龄较小的患者(2)和临床怀疑为T1DM的患者(PPCI均为0.73-0.81)GADA检出率较高,提示共识中怀疑为T1DM的临床特征对该患者亚组具有较好的临床诊断价值。结论:糖尿病分型的临床实践与共识推荐的分型流程存在显著差异,具体表现为分型指标检测和明确分型的糖尿病患者比例均较低。应重视共识中提出的分型诊断流程,提高糖尿病分型中c肽、胰岛自身抗体等关键糖尿病分型指标的临床检出率。值得注意的是,该共识提出的T1DM筛查策略具有良好的临床应用价值。
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引用次数: 0
[Clinical characteristics of sudden sensorineural hearing loss with acute cerebral infarction]. 【突发性感音神经性听力损失合并急性脑梗死的临床特点】。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230405-00184
H Y Li, Y Wang, Y P Tong, M Y Zhang, Y Ju, Y Xia

Objective: To analyze the clinical and imaging features of patients with sudden sensorineural deafness and acute cerebral infarction in order to provide evidence for early recognition of such diseases. Methods: This was a case series reporting study. A retrospective analysis was performed on the clinical and imaging data of 29 patients with sudden hearing loss (SHL) who admitted to the Otolaryngology Head and Neck Surgery Department of Beijing Tiantan Hospital from January 2017 to December 2021 and diagnosed with acute cerebral infarction using MRI-DWI. Results: The patients were aged 31-71 years, with an average age of 56±12 years, and 82.8% (24/29) were men. In total, 82.8% (24/29) of the patients had three or more atherosclerotic risk factors, and 24.1% (7/29) had a history of SHL. The hearing types were flat and total deafness: 86.2% (25/29) of the patients had severe hearing loss, 27.6% (8/29) had bilateral SHL, 17.2% (5/29) had further hearing loss during hospitalization, and 82.8% (24/29) had dizziness or vertigo at the onset. The signs of central nervous system involvement mainly included speech impairment, diplopia, dysphagia, central facial paralysis, facial and limb hypoesthesia, ataxia, and decreased muscle strength. Imaging evaluation showed that 21 cases were located in the posterior circulation supply area and 8 cases in the anterior circulation supply area. Additionally, 82.8% (24/29) patients had vertebrobasilar artery stenosis, and 58.6% (17/29) patients had severe vertebrobasilar artery stenosis or occlusion. Conclusions: Patients with SHL who progress to cerebral infarction often have multiple atherosclerotic risk factors and SHL. Most of the patients are middle-aged and older men who often complain of dizziness or dizziness accompanied by severe flat and total deafness with unilateral or bilateral SHL. Imaging findings suggest that most patients have posterior circulation infarction, often accompanied by severe stenosis or occlusion of the vertebrobasilar artery.

目的:分析突发性感音神经性耳聋合并急性脑梗死患者的临床及影像学特征,为早期识别此类疾病提供依据。方法:采用病例系列报告研究。回顾性分析2017年1月至2021年12月在北京天坛医院耳鼻喉头颈外科就诊并经MRI-DWI诊断为急性脑梗死的29例突发性听力损失(SHL)患者的临床及影像学资料。结果:患者年龄31 ~ 71岁,平均年龄56±12岁,男性占82.8%(24/29)。82.8%(24/29)的患者有3种及以上的动脉粥样硬化危险因素,24.1%(7/29)的患者有SHL病史。听力类型为平坦型和全聋:86.2%(25/29)的患者有重度听力损失,27.6%(8/29)的患者有双侧SHL, 17.2%(5/29)的患者在住院期间有进一步的听力损失,82.8%(24/29)的患者在发病时有头晕或眩晕。中枢神经系统受累的症状主要包括语言障碍、复视、吞咽困难、中枢性面瘫、面肢感觉减退、共济失调和肌力下降。影像学评价显示21例位于后循环供应区,8例位于前循环供应区。82.8%(24/29)的患者存在椎基底动脉狭窄,58.6%(17/29)的患者存在严重的椎基底动脉狭窄或闭塞。结论:SHL进展为脑梗死的患者通常有多种动脉粥样硬化危险因素和SHL。患者多为中老年男性,常主诉头晕或头晕伴单侧或双侧SHL的严重扁平和全聋。影像学结果提示大多数患者有后循环梗塞,常伴有椎基底动脉严重狭窄或闭塞。
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引用次数: 0
[Advances in the diagnosis and treatment of invasive fungal disease in HIV-infected patients]. hiv感染者侵袭性真菌病的诊断与治疗进展
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20221008-00737
M L Zhou, L Zhang, T S Li, Z Y Liu
侵袭性真菌病是HIV/AIDS患者机会性感染和死亡的主要原因。近2年来国内外多部关于HIV/AIDS感染者侵袭性真菌病诊断与治疗的指南与共识相继发布,真菌病原学诊断、抗原抗体检测、分子生物学检测方法均取得了新的进展。治疗方面,国内外对于念珠菌病、隐球菌病、肺孢子菌肺炎等HIV/AIDS患者不同类型侵袭性真菌病的治疗方案求同存异,新型抗真菌药物的研发及抗逆转录病毒疗法的优化也进一步推动了侵袭性真菌病诊疗的进步。本研究针对HIV/AIDS患者侵袭性真菌病相关的诊断及治疗进展予以综述,以期为临床诊疗工作提供参考。.
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引用次数: 0
[Stem cell therapy in diabetes: a promising future]. [干细胞治疗糖尿病:一个充满希望的未来]。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230626-00332
Y P Wang, L Zang, Y M Mu
干细胞以其自我更新和多向分化的生物学优势,通过免疫调节功能、组织修复功能及分化功能,在糖尿病的治疗中展现出良好的应用前景。间充质干细胞移植对1型和2型糖尿病患者有一定疗效,但临床结果不能令人满意,需要提高间充质干细胞体内存活时间及疗效。干细胞诱导分化的胰岛素分泌细胞为胰岛衰竭型糖尿病的治疗提供了理想的胰岛细胞补充来源,但免疫排斥及安全性问题仍是干细胞诱导分化的胰岛素分泌细胞应用中面临的主要问题,尚需开展临床研究探索其有效性及安全性。.
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引用次数: 0
[A novel approach for the treatment of type 1 diabetes mellitus: transplantation of pancreatic islets derived from human chemically induced pluripotent stem cells]. [一种治疗1型糖尿病的新方法:人类化学诱导多能干细胞衍生的胰岛移植]。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20230713-00365
Y Y Du, H K Deng
基于人多能干细胞的再生医学为1型糖尿病的治疗带来了全新的可能。人多能干细胞具备无限的增殖潜能和向人体任何细胞分化的潜能,通过定向分化技术,可以利用人多能干细胞在体外大规模制备人胰岛细胞,用于糖尿病的细胞替代治疗。.
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引用次数: 0
[Recommendations for the diagnosis and treatment of gout in China]. 【中国痛风诊断与治疗建议】。
Pub Date : 2023-09-01 DOI: 10.3760/cma.j.cn112138-20221027-00796
D Xu, X X Zhu, H J Zou, H Lin, Y Zhao

Gout is a metabolic disease resulting from the accumulation of monosodium urate (MSU) in joints, leading to crystal-induced arthritis. In China, gout is common, but there is insufficient knowledge regarding standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of gout in China. The purpose was to standardize gout diagnosis methods as well as treatment opportunities and strategies in order to reduce misdiagnosis, missed diagnosis, and irreversible damage.

痛风是一种代谢性疾病,由尿酸钠(MSU)在关节中的积累引起,导致晶体性关节炎。在中国,痛风很常见,但对这种疾病的诊断和治疗的标准化标准了解不足。根据来自中国和其他国家的证据和指南,中国风湿病学会制定了中国痛风诊断和治疗的标准化标准。目的是规范痛风的诊断方法、治疗机会和治疗策略,以减少误诊、漏诊和不可逆损害。
{"title":"[Recommendations for the diagnosis and treatment of gout in China].","authors":"D Xu,&nbsp;X X Zhu,&nbsp;H J Zou,&nbsp;H Lin,&nbsp;Y Zhao","doi":"10.3760/cma.j.cn112138-20221027-00796","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221027-00796","url":null,"abstract":"<p><p>Gout is a metabolic disease resulting from the accumulation of monosodium urate (MSU) in joints, leading to crystal-induced arthritis. In China, gout is common, but there is insufficient knowledge regarding standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of gout in China. The purpose was to standardize gout diagnosis methods as well as treatment opportunities and strategies in order to reduce misdiagnosis, missed diagnosis, and irreversible damage.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 9","pages":"1068-1076"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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