The objective was to report a relatively rare case of fulminant type 1 diabetes(FT1 DM)complicated with acute pancreatitis(AP),to summarize the characteristics as well as experience of diag-nosis and treatment,and to explore its pathogenesis.Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively.A 66-year-old male presented with acute fever and abdominal pain,accompanying with the significantly elevated pancreatic enzymes,and his abdominal CT scan showed exudation around the pancreas.The clinical manifestations mentioned above were consistent with the diagnosis of AP.Five days after onset,the patient developed clinical symptoms,such as obvious thirst,polyuria,polyasthenia and fatigue.Meanwhile,his plasma glucose increased significantly and the diabetic ketoacidosis(DKA)occurred.The patient's fasting and postprandial 2 hours C peptide decreased significantly(all 0.02 μg/L),glycated hemoglobin level was not high(6％),and his islet-related autoantibodies were undetectable.Thus,the patient could be diag-nosed with FT1DM.After the treatment of fasting,fluid replacement,anti-infection,somatostatin,anti-coagulation and intravenous insulin sequential subcutaneous insulin pump,the patient gained the allevia-tion of pancreatitis,restoration of oral intake,and relatively stable blood glucose levels.Summarizing the characte-ristics of this case and reviewing the literature,FT1DM complicated with AP was relatively rare in FT1DM.Its common characteristics were described below:(1)Most cases started with AP and the blood glucose elevated within 1 week,or some cases had the simultaneously onset of AP and FT1DM.(2)The clinical course of AP was short and relieved no more than 1 week;Pancreatic imaging could completely return to normal within 1 to 4 weeks after onset.(3)The etiology of AP most was idiopathic;The elevation of pancreatic enzyme level was slight and the recovery was rapidly compared with AP of other etiologies.FT1DM could be complicated with AP,which was different from the physiological mani-festations of pancreatic disease in general FT1DM patients.Virus infection mignt be the common cause of AP and FT1DM,and AP might be the early clinical manifestation of some FT1DM.The FT1DM patients developed with abdominal pain was easy to be missed,misdiagnosed and delayed,which should receive more attention in clinic.

Objective:To study the clinicopathological characteristics, treatment and prognosis in lupus nephritis (LN) patients with renal thrombotic microangiopathy (TMA), so as to provide more theoretical basis for clinicians to recognize and treat this disease.Methods:The clinical data of LN patients who underwent renal biopsy in the First Affiliated Hospital of Zhengzhou University from January 1, 2012 to May 31, 2019 were retrospectively collected and analyzed. According to renal clinicopathological examination, the patients were divided into renal TMA group and non-renal TMA group. The clinical data, laboratory examination, renal pathological examination, therapeutic measures and prognostic between the two groups were compared. Follow-up end points were defined as composite ends, including all-cause death, entry into end-stage renal disease, and estimated glomerular filtration rate decrease>50% of baseline. Kaplan-Meier survival curve and log-rank test were used to compare the difference of survival rate between the two groups, and multivariate Cox regression equation was used to analyze the risk factors of endpoint events in LN patients.Results:A total of 1 133 patients with LN were enrolled in this study. Patients with renal TMA were more likely to have hypertension ( χ2=16.310, P<0.001), higher baseline serum creatinine ( Z=-6.918, P<0.001) and 24-hour urine protein ( Z=-2.232, P=0.026), and higher renal pathology activity index (AI) score ( Z=1.957, P=0.001)and chronic index (CI) score ( Z=1.836, P=0.002). The proportions of hormone shock ( P<0.001) and plasma exchange ( P<0.001) in the renal TMA group were higher than those in non-renal TMA group. After treatment of (12±2) months, patients in the renal TMA group had a lower complete response rate ( χ2=10.455, P=0.001) and a higher non-response rate ( χ2=6.047, P=0.014) than those in non-renal TMA group, and were associated with worse prognosis (Log-rank test χ2=26.490, P<0.001). Renal TMA was an independent risk factor for poor prognosis ( HR=2.347, 95% CI 1.210-4.553, P=0.012). Conclusions:Compared with LN patients without renal TMA, LN patients with renal TMA are more likely to have hypertension, with higher serum creatinine, 24-hour urinary protein, AI and CI, suggesting poorer treatment response and renal prognosis. Moreover, renal TMA is an independent risk factor for poor prognosis in patients with LN.