目的:报道高脂血症继发血色病1例,总结患者临床资料,探讨该类疾病临床特征及诊疗要点。方法:收集1例反复严重脂代谢紊乱导致肝脏铁沉积的继发性血色病患者临床资料,并对相关文献进行复习。结果:患者老年男性,以纳差、乏力、恶心为主要...目的:报道高脂血症继发血色病1例,总结患者临床资料,探讨该类疾病临床特征及诊疗要点。方法:收集1例反复严重脂代谢紊乱导致肝脏铁沉积的继发性血色病患者临床资料,并对相关文献进行复习。结果:患者老年男性,以纳差、乏力、恶心为主要临床表现。实验室检查示,血脂异常(以甘油三酯极重度升高及重度高胆固醇血症为主)、重度肝功能异常、铁蛋白升高、血糖升高,上腹部MR检查示肝脏铁沉积,给予调脂及护肝治疗后,患者血脂、铁蛋白水平改善不理想。8个月后患者再次出现重度血脂代谢紊乱、肝功能异常及铁蛋白升高,上腹部MRI检查仍显示肝脏铁沉积。基因全外显子测序发现PCSK9基因3号外显子存在c.503C > T (p.Ala168Val)错义变异,加用阿利西尤单抗调脂治疗。7月后复查肝功能、血脂、铁代谢指标恢复正常,铁沉积不显著。结论:严重高脂血症继发血色病,遗传学分析有助于指导临床精准治疗。展开更多
随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作...随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作时血糖最低3.0 mmol/L,进食或补充葡萄糖后症状好转,持续葡萄糖监测示有反复低血糖发生。实验室检查示血清胰岛素自身抗体(IAA)阳性,确诊为IAS。入院后停用甲巯咪唑,改为丙硫氧嘧啶,调整饮食结构,予泼泥松30 mg/d,低血糖发作逐渐缓解。随访2个月,未再发生低血糖症状,血清IAA水平明显降低。IAS是发生反复低血糖的病因之一,可由服用含羟基药物诱发,以甲巯咪唑最为常见。IAA检测为诊断该病的主要依据,经治疗预后良好。A patient with methimazole-induced insulin autoimmune syndrome (IAS) was followed up with the analysis of his clinical data, diagnosis and treatment process, and a literature review was performed. After taking methimazole for 4 months, the patient repeatedly had “palpitations, fatigue, sweating”, accompanied by irritability, irritability and other anxious emotions, and visited the emergency department of our hospital many times, and the blood glucose was as low as 3.0 mmol/L at the time of the attack, symptoms improve with food or glucose supplementation, and continuous glucose monitoring (CGM) showed repeated hypoglycemia. Laboratory tests show a positive serum insulin autoantibody (IAA) and confirm the diagnosis of IAS. After admission, methimazole was stopped, propylthiouracil was replaced, the dietary structure was adjusted, and pronisolone 30 mg/d was given, and the hypoglycemic attack was gradually relieved. After 2 months of follow-up, there were no more symptoms of hypoglycemia and serum IAA levels were significantly reduced. IAS is one of the causes of recurrent hypoglycemia and can be triggered by the use of hydroxyxyl-containing drugs, most commonly methimazole. IAA testing is the mainstay of diagnosis and has a good prognosis after treatment.展开更多
文摘目的:报道高脂血症继发血色病1例,总结患者临床资料,探讨该类疾病临床特征及诊疗要点。方法:收集1例反复严重脂代谢紊乱导致肝脏铁沉积的继发性血色病患者临床资料,并对相关文献进行复习。结果:患者老年男性,以纳差、乏力、恶心为主要临床表现。实验室检查示,血脂异常(以甘油三酯极重度升高及重度高胆固醇血症为主)、重度肝功能异常、铁蛋白升高、血糖升高,上腹部MR检查示肝脏铁沉积,给予调脂及护肝治疗后,患者血脂、铁蛋白水平改善不理想。8个月后患者再次出现重度血脂代谢紊乱、肝功能异常及铁蛋白升高,上腹部MRI检查仍显示肝脏铁沉积。基因全外显子测序发现PCSK9基因3号外显子存在c.503C > T (p.Ala168Val)错义变异,加用阿利西尤单抗调脂治疗。7月后复查肝功能、血脂、铁代谢指标恢复正常,铁沉积不显著。结论:严重高脂血症继发血色病,遗传学分析有助于指导临床精准治疗。
文摘随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作时血糖最低3.0 mmol/L,进食或补充葡萄糖后症状好转,持续葡萄糖监测示有反复低血糖发生。实验室检查示血清胰岛素自身抗体(IAA)阳性,确诊为IAS。入院后停用甲巯咪唑,改为丙硫氧嘧啶,调整饮食结构,予泼泥松30 mg/d,低血糖发作逐渐缓解。随访2个月,未再发生低血糖症状,血清IAA水平明显降低。IAS是发生反复低血糖的病因之一,可由服用含羟基药物诱发,以甲巯咪唑最为常见。IAA检测为诊断该病的主要依据,经治疗预后良好。A patient with methimazole-induced insulin autoimmune syndrome (IAS) was followed up with the analysis of his clinical data, diagnosis and treatment process, and a literature review was performed. After taking methimazole for 4 months, the patient repeatedly had “palpitations, fatigue, sweating”, accompanied by irritability, irritability and other anxious emotions, and visited the emergency department of our hospital many times, and the blood glucose was as low as 3.0 mmol/L at the time of the attack, symptoms improve with food or glucose supplementation, and continuous glucose monitoring (CGM) showed repeated hypoglycemia. Laboratory tests show a positive serum insulin autoantibody (IAA) and confirm the diagnosis of IAS. After admission, methimazole was stopped, propylthiouracil was replaced, the dietary structure was adjusted, and pronisolone 30 mg/d was given, and the hypoglycemic attack was gradually relieved. After 2 months of follow-up, there were no more symptoms of hypoglycemia and serum IAA levels were significantly reduced. IAS is one of the causes of recurrent hypoglycemia and can be triggered by the use of hydroxyxyl-containing drugs, most commonly methimazole. IAA testing is the mainstay of diagnosis and has a good prognosis after treatment.
文摘目的:探讨男性痛风(Gout)患者血清尿酸(SUA)水平与载脂蛋白B (ApoB)的关系。方法:回顾性选取2019年1月1日至2021年3月31日于青岛大学附属医院内分泌与代谢性疾病科就诊的住院患者以及门诊患者,纳入符合条件的男性痛风患者73例。根据《中国高尿酸血症与痛风诊疗指南(2019)》要求,将患者分为SUA达标组(19例)和SUA升高组(54例),比较组间差异。采用Pearson相关分析SUA和ApoB的相关性,利用logistic回归模型进行相关危险因素分析。结果:与SUA达标组相比,SUA升高组ApoB的平均水平升高,差异有统计学意义(P 【0.05)。Pearson相关性分析显示ApoB与SUA呈正相关。单因素logistic回归分析显示,男性痛风患者SUA水平升高是ApoB的危险因素(OR = 0.986, 95% CI 0.979~0.993, P 【0.001);当校正年龄、空腹血糖(FBG)、身体质量指数(BMI)等因素后,两者关系仍然成立。结论:男性痛风患者SUA与ApoB相关,当SUA水平升高时,可导致ApoB水平升高。
