中华内科杂志最新文献

Objective: To investigate the multidimensional glycemic profiles and their associations with chronic complications in patients with type 1 diabetes (T1D) of over 10 years' duration. Methods: This cross-sectional study used data from the prospective Peer Support for Long-standing T1D (PS-LT1D) cohort. T1D patients with a disease duration of 10-30 years were enrolled from the Chinese Type 1 Diabetes Consortium between 2022 and 2024. In addition to hemoglobin A_1c (HbA_1c) and continuous glucose monitoring metrics, advanced glycation end products (AGEs) were non-invasively measured as a surrogate marker for cumulative metabolic memory. Logistic regression analysis was employed to identify potential correlations between multidimensional glycemic indicators and diabetic microvascular/macrovascular complications. K-Means clustering was then applied to explore characteristic differences in complication prevalence across distinct glycemic patterns. Results: A total of 128 patients (median age 31.5 years; 41 men, 87 women) with a median disease duration of 14.3 years were included. Despite a median time-in-range (TIR) of 70.9%, the prevalence of microvascular complications remained high (42.2%, 54/128). Logistic regression analysis revealed that an elevated metabolic memory burden, represented by skin AGEs, was a significant risk factor for both microvascular and macrovascular complications (OR=1.04, 95%CI 1.01-1.07, P=0.009; OR=1.06, 95%CI 1.03-1.10, P=0.001, respectively), whereas TIR or HbA_1c were not. Based on the clustering of multidimensional glycemic indicators, patients were categorized into three glycemic control phenotypes. The subgroup characterized by a high metabolic memory burden demonstrated the highest risks of retinopathy and macrovascular complications. Conclusions: A significant "metabolic memory" effect persists in patients with T1D even during the mid-to-long term course of the disease. AGEs are strongly associated with the risk of chronic complications. Complication risks vary markedly across glycemic control patterns. In assessing complication risk among patients with long-duration T1D, AGE accumulation, serving as a cumulative metabolic memory indicator, holds greater predictive value than short-to-medium term glycemic markers such as HbA_1c.

Objective: To investigate the intra-individual variability of the plasma aldosterone concentration (PAC) and the plasma renin concentration (PRC) and explore its impact on screening for primary aldosteronism (PA). Methods: This cross-sectional study enrolled patients with PA and patients with essential hypertension (EH) who were admitted to the First Affiliated Hospital of Chongqing Medical University from July 2018 to December 2024. Clinical and biochemical data, including PAC and PRC, were collected. The intra-individual coefficient of variation (CV) and percentage difference (PD) were calculated. The rates of PA diagnosis missed were further analyzed. Results: In total, 431 patients with PA [mean age 48.2 years; 192 males (44.5%)] and 495 patients with EH [mean age 49.6 years; 198 males (40.0%)] were included. In the PA group, the intra-individual CVs for PAC, PRC, and the aldosterone-to-renin ratio (ARR) were 21.3%, 36.9%, and 39.5%, respectively, and the corresponding mean PDs were 23.1%, 38.5%, and 43.5%. In the EH group, the intra-individual CVs for PAC, PRC, and ARR were 23.5%, 33.5%, and 32.5%, respectively, and the mean PDs were 25.7%, 36.1%, and 36.3%, respectively. Due to intra-individual variability, 10.2% (44/431) of PA patients may be missed during screening, 70.5% (31/44) of whom exhibit a history of hypokalemia and/or adrenal nodules. Conclusions: Plasma aldosterone and renin levels display considerable intra-individual variability, which may compromise the accuracy of PA screening. Repeat testing is recommended for patients with an initial negative screening result who have a history of hypokalemia and/or adrenal nodules.

Objective: To assess the emotional characteristics, specifically anxiety and depression, in children with vertigo and their association with the subtypes of vertigo. Methods: This retrospective analysis was conducted on 189 children (103 male and 86 female children; age, 7-14 years; median, 10 years) who visited the Department of Otorhinolaryngology-Head and Neck Surgery at the Capital Institute of Pediatrics, Capital Medical University, between February 2021 and February 2024, with complaints of dizziness or vertigo. The participants comprised 44 children with recurrent vertigo, 127 with vestibular migraine, and 18 with possible vestibular migraine (PVMC). The participants' demographic and clinical data were collected, and emotional assessments, including anxiety and depression, were performed. Anxiety was assessed using the Children's Self-Rating Anxiety Scale, while depression was assessed using the Children's Self-Rating Depression Scale. Statistical analysis was performed using SPSS version 29.0 software to compare the clinical characteristics and correlations of anxiety and depression in children with vertigo. Results: Overall, 48.7% (92/189) of children with vertigo had anxiety, and 34.9% (66/189) had depression, indicating that anxiety was more prevalent than depression. Additionally, children in all groups had varying degrees of emotional problems. In the vestibular migraine group, 52.0% (66/127) had anxiety, while 36.2% (46/127) had depression. In the recurrent vertigo group, 38.6% (17/44) had anxiety and 31.8% (14/44) had depression. In the PVMC group comprising 18 children, 9 had anxiety while 6 had depression. Overall, the proportion of children with anxiety was higher than that of those with depression in all the groups; however, there was no statistically significant difference between the groups (anxiety score, U=0.877, P=0.645; depression score, U=0.524, P=0.770). Furthermore, there was a positive correlation between anxiety scores and depression scores in the recurrent vertigo group, vestibular migraine group, and PVMC group (r=0.71, P=0.012; r=0.59, P<0.001; r=0.70, P=0.001, respectively). Conclusion: Children with common vertigo have emotional problems, including anxiety and depression, which should be considered during diagnosis and treatment.

In China, the prevalence of diabetes has increased significantly, and rigorous challenges exist in diabetes prevention and glycemic control, especially in primary medical care. Under the guidance of the National Health Commission of the People's Republic of China and the Chinese Medical Association, the Office for Primary Diabetes Care of the National Basic Public Health Service Program issued the "National guidelines for the prevention and control of diabetes in primary care (2018)" in 2018. The present guideline, which incorporates the latest advances in diabetes research and practice from the 2018 and 2022 editions, aims to improve primary health facilities and provide standardized basic public health and medical services throughout China. It applies to healthcare providers who provide primary care to patients with type 2 diabetes aged 18 or older. It primarily includes basic management requirements; workflow of health management; diagnosis; classification; monitoring, screening, and assessment; treatment; identification and management of diabetic acute and chronic complications; traditional Chinese medicine; referral; health management; and health education.

A 72-year-old male patient presented with dry mouth and dry eyes, accompanied by decreased vision for more than 3 months, and the symptoms worsened over 5 weeks with parotid gland enlargement. PET/CT revealed increased metabolic activity in multiple nodules involving the lymph nodes, lacrimal glands, parotid glands, lungs, spleen, and muscles. Serum angiotensin-converting enzyme was significantly elevated. Biopsies of the parotid gland and lymph nodes revealed a large number of granulomatous lesions. The patient was given prednisone tablets combined with mycophenolate mofetil immunotherapy. Subsequently, the bilateral parotid gland swelling subsided, and the pulmonary patchy shadows, splenic nodules, and muscular nodules all either regressed or disappeared. A diagnosis of sarcoidosis involving multiple organs was established. However, during treatment, the pulmonary patchy shadows reappeared. After increasing the hormone dose, the pulmonary imaging manifestations again diminished or vanished, indicative of recurrent sarcoidosis. Therefore, atypical pulmonary manifestations of sarcoidosis may easily result in missed or incorrect diagnoses, emphasizing the importance of multisite histopathological biopsy. Besides, a favorable treatment response serves as additional supportive evidence for the diagnosis. Maintaining vigilance for disease recurrence is essential during hormone and immunosuppressive therapy.

A 44-year-old male presented with a 19-year history of urinary calculi and a 1-year history of polydipsia and weight loss. Laboratory tests revealed hyperparathyroidism and evidence of glucagonoma-associated diabetes. Imaging studies identified masses in the pancreatic head and body/tail, suggestive of glucagonoma and a parathyroid adenoma. Furthermore, the patient exhibited hypercalcitoninemia and elevated cortisol and adrenocorticotropic hormone levels. Genetic testing revealed a heterozygous MEN1 mutation [c.65T>G (p.Leu22Arg)], confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN-1). The patient subsequently underwent near-total parathyroidectomy and total pancreatectomy. Postoperative immunohistochemical staining of the pancreatic tail tumor was positive for glucagon and calcitonin. The patient's postoperative hormone levels (calcitonin, glucagon, adrenocorticotropic hormone, cortisol) normalized, suggesting a rare pancreatic neuroendocrine tumor (pNET) that was co-secreting multiple hormones. Postoperative management included pancreatic enzyme supplementation, calcium supplementation, vitamin D supplementation, and insulin for glycemic control. Follow-up evaluations at 10 months demonstrated a stable clinical condition, well-controlled blood glucose and biochemical parameters, and an acceptable quality of life. This case study highlights that the presence of pNETs should be considered in patients with MEN-1 and multiple abnormal hormone levels. Timely surgical management of the involved glands and postoperative complications can effectively improve prognosis.

Objective: To evaluate the efficacy and safety of the Chi-BEAM regimen (chidamide combined with carmustine, etoposide, cytarabine, and melphalan) followed by autologous hematopoietic stem cell transplantation (ASCT) in patients with high-risk or relapsed/refractory lymphoma. Methods: This retrospective case series included 78 patients with newly treated high-risk or relapsed/refractory lymphoma who underwent ASCT with the Chi-BEAM conditioning regimen in the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), from June 2021 to May 2024. Descriptive statistics were employed to evaluate clinical characteristics, efficacy, and adverse events. The Kaplan-Meier method was applied to calculate cumulative progression-free survival (PFS) and overall survival (OS) rates. Results: The median age of the 78 evaluable patients was 47 years (range 16-68), with 8 patients (10.3%) aged ≥60 years. At the first post-transplant assessment (3 months), the objective response rate was 94.9% (74/78). The median follow-up was 20.1 months (range 2.9-44.9). The median PFS time was 20.1 months (range 1.6-45.1), with a 2-year cumulative PFS rate of 81.8%. The median OS time was 20.6 months (range 3.1-45.1), with a cumulative 2-year OS rate of 93.2%. The regimen was well-tolerated; mild-to-moderate hypocalcemia within 1 week post-infusion and transient mild erythrocyturia on the infusion day were the primary adverse reactions. Conclusion: The Chi-BEAM regimen combined with ASCT demonstrates both safety and clinical benefit in patients with high-risk or relapsed/refractory lymphoma.