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The values of the new American Diabetes Association Diagnostic Criteria for screening of pre-diabetes and diabetes in patients undergoing elective coronary angiography

Xiliang ZHAO ; Yicong YE ; Shuyang ZHANG

Chinese Journal of Internal Medicine.2015;54(4):302-306. doi:10.3760/cma.j.issn.0578-1426.2015.04.006

Objective Glycosylated hemoglobin A1c (HbA1c) has become one of key components in new American Diabetes Association (ADA) diagnostic criteria for pre-diabetes and diabetes,which is not included in the World Health Organization (WHO) 1999 criteria.Thus,we aimed to compare the two criteria in diagnosis of pre-diabetes and diabetes in patients with non-acute coronary syndrome (non-ACS) in Chinese.Methods Non-ACS patients who had undergone elective coronary angiography (CAG) in Peking Union Medical College Hospital without previously known diabetes were enrolled consecutively from October 2013 to April 2014.Fasting plasma glucose (FPG),2-hour plasma glucose after a 75 g oral glucose load (2hPG) and HbA1c levels before CAG were measured.Both WHO and new ADA criteria were applied for pre-diabetes and diabetes screening.Results One hundred and thirty-nine patients were included,aged (61.9 ± 10.1) years and 88(63.3％) were men among them.According to WHO 1999 criteria,34 patients (24.4％) were normal glucose regulation,57 (41.0％) pre-diabetes (including one impaired fasting glucose and 56 impaired glucose tolerance),and 48 (34.5％) newly diagnosed diabetes mellitus.ADA criteria identified 12 more patients with pre-diabetes and eight more with diabetes than WHO criteria.Compared with those diagnosed by both criteria,the proportion of women was higher in diabetic patients diagnosed with HbA1c alone.They also had lower hemoglobin [(124.88 ± 17.74) g/L vs (140.15 ± 15.17) g/L,P =0.013] and higher fibrinogen levels [(3.47 ± 0.41) g/L vs (3.02 ± 0.68) g/L,P =0.024] than those diagnosed by both criteria.Conclusion Compared with WHO 1999,new ADA criteria with HbA1c assessment are able to identify more previously unknown pre-diabetes and diabetes patients.Measurement of HbA1c might be needed to carry out routinely for screening patients with glucose metabolism abnormalities before elective CAG.

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The efficacy and safety of human glucagon-like peptide-1 analogue liraglutide in newly diagnosed type 2 diabetes with glycosylated hemoglobin A1c ＞ 9％

Pin CHEN ; Chen CHEN ; Zhulin SHAO ; Xiangjin XU ; Qin HUANG

Chinese Journal of Internal Medicine.2015;54(4):307-312. doi:10.3760/cma.j.issn.0578-1426.2015.04.007

Objective To evaluate the efficacy and safety of human glucagon-like peptide-1 analogue liraglutide in newly diagnosed type 2 diabetes mellitus (T2DM) with glycosylated hemoglobin A1c (HbA1c) ＞ 9％.Methods This was an open-labelled,randomized,parallel-group,treat-to-target trial.Newly diagnosed T2DM patients with HbA1c ＞ 9％ were enrolled.These patients were treated with metformin with repaglinide and randomized to receive once-daily liraglutide (LIRA,n =25) or the insulin glargine (IGla,n =24) at bedtime.Efficacy and safety were assessed and compared after 18-month treatment.Results (1) Compared with the baseline,patients with LIRA had significantly reduced mean body weight,BMI and waist circumference (P ＜ 0.01),whereas,the above indexes were increased (P ＜ 0.01) in patients treated with IGla.(2) After 18 months of treatment,fasting plasma glucose (FPG),2-hour plasma glucose after a 75g oral glucose load(2hPG) and HbA1c were significantly improved in all patients (P ＜ 0.01),with 2hPG,mean blood glucose (MBG),the largest amplitude of glycemic excursions (LAGE),mean amplitude of glycemic excursions (MAGE) were significantly lower in LIRA group than in IGla group (all P ＜ 0.05).(3) HOMA-IR decreased in both groups (P ＜ 0.05).However,△I30/△G30,AUCCP180 and Matsuda index were only significantly increased in patients treated with LIRA (respectively,4.88 ± 1.55 vs 7.60 ± 1.91,9.23 ± 2.66 vs 13.18 ± 2.72,39.28 ± 20.35 vs 54.64 ± 23.34,all P ＜ 0.01),while HOMA-IR reduced(4.41 ± 1.58 vs 3.52 ± 1.44,P ＜0.05).But in IGla group only HOMAIR was reduced (4.92 ± 1.84 vs 4.57 ± 1.80,P ＜0.05).The index of △I30/△G30,AUCCP180 and Matsuda index in LIRA group are higher than those of indexes in IGla group(respectively,7.60 ± 1.91 vs 4.18 ± 1.00,13.18 ± 2.72 vs 10.53 ± 2.68,54.64 ± 23.34 vs 41.65 ± 17.84,all P ＜ 0.05),while HOMA-IR is lower (3.52 ± 1.44 vs 4.57 ± 1.80,P ＜ 0.05).(4) The rate of HbA1 c ≤ 6.5 ％ and the dosages of oral anti-diabetic drugs in LIRA group were significantly better than that in IGla group.(5) No significant differences were observed in hypoglycemic episodes and adverse events between two groups.Conclusion It seems that liraglutide is superior to insulin glargine in newly diagnosed T2DM patients with HbA1c ＞ 9％ in improving beta-cell function,insulin sensitivity and glucose homeostasis.

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Investigation of the risk of hepatitis B virus reactivation in arthritis patients undergoing anti-tumour necrosis factor alpha therapy

Dier JIN ; Ning TIE ; Jing LIU ; Lei ZHAO ; Donglin HAO ; Yan ZHAO

Chinese Journal of Internal Medicine.2015;54(4):313-316. doi:10.3760/cma.j.issn.0578-1426.2015.04.008

Objective To investigate the prevalence of HBV infection and the risk of hepatitis B virus (HBV) reactivation in patients with inflammatory arthritis receiving tumour hecrosis factor alpha (TNFα) inhibitors.Methods The liver function,serology of HBV and viral loads (HBV DNA) were tested before using TNFα inhibitors,at 3 months and 6 months.Patients with chronic hepatitis B (CHB) infection (HBV DNA ＞ 1 × 103copies/ml) were eliminated.Results A total of 162 patients were investigated including 156 patients who finished the study.Eleven (7.05％) patients were HBsAg-positive.Two patients with HBV DNA ＞ 1 × 103copies/ml were eliminated before starting anti-TNFα therapy.Among HBsAgpositive patients,HBV reactivation was documented in only one of the 11 patients.This patient with rheumatoid arthritis developed elevation of glutamic-pyruvic transaminase (ALT) and HBV DNA copies three months after infliximab therapy.Therefore lamivudine was given for three months,which translated into the fall of ALT and HBV DNA copies back to normal level.After follow-up for six months,the virology and serology remained stable.In contrast,none of the other 155 patients had demonstrated evidence of HBV infection or HBV reactivation.Conclusion The kinetics of HBV viral loads should be carefully monitored in patients with inflammatory arthritis and HBsAg-positive during anti-TNFα therapy.HBV reactivation should be treated with antiviral medicine through out the period of anti-TNFα therapy.

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An analysis for the clinical difference between post infectious irritable bowel syndrome and non post infectious irritable bowel syndrome

Hui SHI ; Jun WAN ; Wenhui LIU ; Binbin SU

Chinese Journal of Internal Medicine.2015;54(4):326-329. doi:10.3760/cma.j.issn.0578-1426.2015.04.011

Objective To study the clinical discrepancy between patients with post infectious irritable bowel syndrome(PI-IBS) and non post infectious irritable bowel syndrome(NPI-IBS),and assess the value of serum intestinal fatty acid binding protein (I-FABP) for differential diagnosis.Methods A total of 117 patients with PI-IBS,201 patients with NPI-IBS and 31 healthy controls were prospectively recruited in General Liberation Army Hospital from 2010 to 2013.Plasma samples and clinical data were collected.Serum I-FABP level was measured by an enzyme-linked immunosorbent assay.Results The median age of patients with PI-IBS was 36 years.The median time to diagnosis in PI-IBS group was significantly longer than that in NPI-IBS group [(19.7 ± 10.3) months vs (11.4 ± 5.3) months,P ＜ 0.05].Similarly,the proportion of anxiety [58.1％ (68/117) vs 28.9％ (58/201),P ＜ 0.05] and the value of I-FABP[(42.6 ± 14.8) μg/L vs (17.3 ± 11.5) μg/L,P ＜ 0.05] in PI-IBS group were significant higher than NPI-IBS patients.The level of I-FABP of healthy controls [(10.6 ± 8.2) μg/L] was also significantly lower than that of PI-IBS patients (P ＜ 0.05),yet no difference from that of NPI-IBS group.The I-FABP value of subgroup PI-IBS patients with diarrhoea (IBS-D) was significant higher than that of NPI-IBS group [(54.8 ± 9.3) μg/L vs (12.3 ± 6.2) μg/L,P ＜ 0.05].However,other parameters including gender,age,GSRS score,and I-FABP value of subgroup constipation (IBS-C) and mix (IBS-M),were not different between PI-IBS group and NPI-IBS group (all P ＞ 0.05).Conclusion PI-IBS is an occult intestinal inflammation disease with mucosa injury.I-FABP might be a potential testing marker for the diagnosis of PI-IBS.

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Effects of active and passive smoking on chronic kidney disease in patients with type 2 diabetes mellitus

Fei JIANG ; Miao CHEN ; Cheng HU ; Yuqian BAO ; Weiping JIA

Chinese Journal of Internal Medicine.2014;53(11):858-864. doi:10.3760/cma.j.issn.0578-1426.2014.11.005

Objective This study aimed to assess the effects of active and passive smoking on chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).Methods Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers,passive smokers and non-smokers.Twenty-four hour urinary albumin excretion (24hUAE) was measured,and estimate glomerular filtration rate (eGFR) was calculated with age and blood creatinine levels.Results (1) The proportion of CKD in T2DM in the present study was 31.63％ (223/705) with 28.6％ (22/77),30.0％ (15/50) and 29.6％ (73/247) for non-smokers,passive smokers and active smokers in men,and 29.9％ (40/134),35.9％ (66/184) and 7/13 for non-smokers,passive smokers and active smokers in women,respectively.In comparison with non-smokers,a higher risk of CKD was found in both passive and active smokers (OR =1.07 and OR =1.05 in men ; OR =1.31 and OR =2.74 in women,respectively).(2) Compared with non-smokers,passive smokers had a significant higher risk for albuminuria in women (OR =2.02,P =0.016).(3) After adjusting for gender,age,duration of T2DM,BMI,systolic blood pressure,glycosylated hemoglobin A1C and lipids,there was a significant decrease in eGFR between active and never smokers (P =0.018)or passive smokers (P =0.000) in women.No differences could be found in eGFR between each smoking statues in men.Conclusions Smoking exposure alone confers a high risk for CKD in patients with T2DM.Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.

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A report of seven cases of pulmonary sequestration complicated by aspergillosis and literature review

Xuefeng SUN ; Yi XIAO

Chinese Journal of Internal Medicine.2014;53(11):873-875. doi:10.3760/cma.j.issn.0578-1426.2014.11.007

Objective Pulmonary sequestration (PS) is a rare disease,and its clinical symptoms are usually related to subsequent pulmonary infections.We analyzed the clinical characteristics of PS complicated by aspergillosis,and reviewed related literature,so as to disclose the association between these two diseases.Methods Sixty-nine patients with surgery-confirmed PS in Peking Union Medical College Hospital between January 1990 and December 2013 were retrospectively analyzed,including seven cases complicated by aspergillosis.Clinical manifestation,imaging and surgery of these patients were analyzed.Literature focusing on PS complicated by aspergillosis in pubmed data base was reviewed.Results In these seven patients,four cases were male,and three cases were female.Age at diagnosis ranged from 29 to 58 years old.The interval from onset to definite diagnosis ranged from two weeks to 20 years.Clinical symptoms included productive cough in seven cases,hemoptysis in three cases,chest pain in two cases,and fever in one case.All cases were intralobar PS with four in the left lower lobe and three in the right lower lobe.Consolidation in chest CT was noted in six cases.Cavitation was positive in three cases.Surgery of lung lobe resection was performed in all patients.Aberrant arteries were found during operation with the origin from aortic artery in four cases,phrenic artery in two cases,and intercostal artery in one case.Aspergillosis was diagnosed by pathology in six cases and by lung tissue culture in one case.Conclusions PS complicated by aspergillosis is extremely rare,but the trend of an increase in recent years has been noted.Strict and cautious examinations for microorganisms and pathology will help find relatively insidious aspergillosis.

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The value of autofluorescence bronchoscopy in assessment of tumor extent and guide of therapeutic strategy in central lung cancer

Aimei PENG ; Ming LI ; Guoliang ZHANG ; Changhui WANG

Chinese Journal of Internal Medicine.2015;54(1):40-43. doi:10.3760/cma.j.issn.0578-1426.2015.01.011

Objective To determine the sensitivity of autofluorescence bronchoscopy (AFB) in the assessment of tumor size and therapeutic strategy.Methods Patients with imaging suspected of malignancy were examined with both white light bronchoscopy (WLB) and AFB.The area of tumor infiltration,imaging information and pathological results were analyzed.Results A total of 212 patients were enrolled,including 180 male and 32 female.In 24 patients (13.2％),greater tumor volume was revealed by AFB than by WLB alone.In these patients,the median diameter of tumor was ＞ 1 cm wider on AFB examination than on WLB.Therapeutic strategy was changed in 18 patients (9.9％) after receiving AFB,including 15 patients with expanded scope of removal and 3 patients with avoidance of surgery.In the univariate analysis,the pathological type of squamous cell carcinoma and tumor invasion in two or more segments of bronchus were independent predictive factors.Diagnostic sensitivity of AFB group was 85.7％,specificity 73.3％,positive predictive value 95.1％,false predictive value 45.8％.Diagnostic sensitivity of WLB group was 72.5％,specificity 60.0％,positive predictive value 91.7％,false predictive value 26.5％.Conclusion Our study suggests that compared with WLB alone,autofluorescence bronchoscopy plus WLB significantly improves the diagnostic value and treatment outcome of central lung cancer.

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The clinical significance of serum neopterin and adenosine deaminase in patients with secondary hemophagocytic lymphohistiocytosis

Weifeng CHEN ; Hongxia QIU ; Xiangchou YANG ; Wei ZHANG ; Sujiang ZHANG ; Xiaoyan ZHANG ; Jianyong LI

Chinese Journal of Internal Medicine.2015;54(1):44-47. doi:10.3760/cma.j.issn.0578-1426.2015.01.012

Objective To investigate the significance of plasma neopterin (Npt) and adenosine deaminase (ADA) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH).Methods Serum specimens from 39 patients with newly diagnosed sHLH,10 sHLH patients who had achieved clinical remission after treatment,and 15 healthy controls were collected.Serum Npt level was detected by enzyme linked immunosorbent assay (ELISA) and ADA activity was tested by kinetic method.Results Npt and ADA values in sHLH group were significantly higher than those in control group [Npt:(164.6 ± 90.0) nmol/L vs (7.9 ± 3.6) nmol/L; ADA:(117.2 ± 70.2) U/L vs (11.6 ± 4.0) U/L; all P ＜ 0.001].Among the 10 sHLH patients who obtained effective clinical treatment,posttreatment levels of Npt and ADA were significantly lower than pretreatment data [Npt:(17.5 ± 10.9) nmol/L vs (170.6 ± 117.9) nmol/L ; ADA:(22.5 ± 15.5) U/L vs (98.8 ± 52.6) U/L; all P ＜ 0.05].The Npt level in sHLH patients was positively correlated with the levels of serum soluble interleukin-2 receptor (sCD25) and serum ferritin (r =0.526 and r =0.507) ; while ADA activity had linear relationship with the level of lactate dehydrogenase (r =0.646).Receiver operating characteristic (ROC) curve analysis showed that 148.1 nmol/L was the critical value of serum Npt for the diagnosis of lymphoma associated hemophagocytic syndrome (LAHS) and the sensitivity and specificity were 70.0％ and 78.9％,respectively.As to ADA,103.1 U/L was the critical value for the diagnosis of LAHS and the sensitivity and specificity were 75.0％ and 84.2％,respectively.The sensitivity and specificity of combined parameters of Npt and ADA were 90.0％ and 94.7％,respectively.Conclusions It is concluded that Npt and ADA have great importance in the diagnosis and evaluation of therapeutic effect in patients with sHLH.Npt and ADA provide potential evidence to diagnose patients who are suspected with LAHS.

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A multicenter study of correlation between peripheral lymphocyte counts and CD4+ T cell counts in HIV/AIDS patients

Jing XIE ; Zhifeng QIU ; Yang HAN ; Yanling LI ; Xiaojing SONG ; Taisheng LI

Chinese Journal of Internal Medicine.2015;54(2):118-121. doi:10.3760/cma.j.issn.0578-1426.2015.02.007

Objective To evaluate the accuracy of lymphocyte count as a surrogate for CD4+T cell count in treatment-na(i)ve HIV-infected adults.Methods A total of 2 013 HIV-infected patients were screened at 23 sites in China.CD4+ T cell counts were measured by flow cytometry.Correlation between CD4+ T cell count and peripheral lymphocyte count were analyzed by spearman coefficient.AUCRoc were used to evaluate the performance of lymphocyte count as a surrogate for CD4+ T cell count.Results The lymphocyte count and CD4+T cell count of these 2 013 patients were (1 600±670) × 106/L and (244 ± 148) × 106/L respectively.CDa+ T cell count were positively correlated with lymphocyte count(r =0.482,P ＜0.000 1).AUCROC of lymphocyte count as a surrogate for CD4+ T cell counts of ＜ 100 × 106/L,＜200 × 106/L and ＜ 350 × 106/L were 0.790 (95％ CI 0.761-0.818,P ＜ 0.000 1),0.733 (95％ CI 0.710-0.755,P ＜ 0.000 1) and 0.732 (95％ CI 0.706-0.758,P ＜ 0.000 1) respectively.Conclusion Lymphocyte count could be considerad as a potential surrogate marker for CD4+ T cell count in HIV/AIDS patients not having access to T cell subset test by flowcytometry.

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The association between angiogenin gene variations and familial amyotrophic lateral sclerosis in Chinese Han patients

Huagang ZHANG ; Yingshuang ZHANG ; Lu TANG ; Nan ZHANG ; Dongsheng FAN

Chinese Journal of Internal Medicine.2015;54(2):122-124. doi:10.3760/cma.j.issn.0578-1426.2015.02.008

Objective To investigate effect of genetic variants in angiogenin (ANG) on the susceptibility of familial amyotrophic lateral sclerosis (FALS) in Han Chinese.Methods Thirty-one FALS families from 2009 to 2012 were collected and ANG gene was screened in the probands using PCR and direct sequencing.Results All 31 ALS families were autosomal dominant inheritance.No mutations and single nucleotide polymorphism were detectable in ANG gene in the 31 probands.Conclusion Our study suggests that ANG gene variations may be rare in Chinese Han FALS.

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