Ectopic adrenocorticotropic hormone （ACTH） secretion rfrom a non-pituitary tumor is a main cause of Cushing＇s syndrome, which is associated with significant morbidity and mortality. Although early studies showed that the predominant cause of ectopic Cushing＇s syndrome is small cell carcinomas of the lungs, the incidence of carcinoid, including thymic carcinoid, has increased substantially in recent surveys） This evidence suggested that the clinical syndrome of ectopic ACTH production only occurs in tumors with high proopiomelanocortin （POMC, the precursor to ACTH） transcripts generated from the start of the pituitary transcription initiation site.2
BI Yu-fang YE Lei CHEN Yu-hong NING Guang SUN Shou-yue JIANG Lei ZHU Na ZHOU Wei-wei WANG Wei-qing
Background Subcutaneous absorption is accelerated by the monomeric conformation of insulin Aspart, which provides good glycemic control with a lower risk of hypoglycemia and less body weight increase. In the present study we investigated the efficacy and safety of a rapid-acting human insulin analogue （insulin Aspart） delivered with continuous subcutaneous insulin infusion （CSII） into Chinese diabetic patients. Methods A total of 21 patients with type 1 or type 2 diabetes were recruited for the 2-way cross-over, open-labeled trial, and then randomized to Group A （n=-10, treated with insulin Aspart） or Group B （n=11, treated with Novolin R）. Insulin Aspart and Novolin R were administered by CSII. Capillary glucose concentrations were measured at 8 time points, pre-prandial and postprandial, bedtime （10 pm）, midnight （2 am） every day during the treatment. Results The average capillary glucose profiles for the day were much better controlled in Group A than in Group B （P〈0.01）. The blood glucose levels were particularly better controlled in Group A than in Group B at pre-breakfast （（6.72±1.24） mmol/L vs （7.84±1.58） mmol/L, P=0.014）, post-breakfast （（8.96±2.41） mmol/L vs （11.70±3.11） mmol/L, P=0.0028）, post-supper （（8.15±2.10） mmol/L vs （10.07±2.36） mmol/L, P=0.008）, bed time （（7.73±1.72） mmol/L vs （9.39±.2.05） mmol/L, P=0.007） and midnight （（6.32±1.16） mmol/L vs （7.48±1.36） mmol/L, P=0.0049）. There was no significant difference in the frequency of hypoglycemic episodes between the two groups. Conclusion Insulin Aspart results in better control of blood glucose levels than regular human insulin （Novolin R） in diabetic patients during delivery by CSII.
BI Yu-fang ZHAO Lie-bin LI Xiao-ying WANG Wei-qing SUN Shou-yue CHEN Yu-hong HONG Jie SU Ting-wei LIU Jian-min NING Guang
目的探索以酮症起病的糖尿病患者的分型方法和评估这类患者的预后。方法根据胰岛细胞自身抗体是否阳性(A+、A-)及β细胞功能是否保留(β+、β-)将以酮症起病的99例糖尿病患者分成4组:A+β-组(17例),A-β-组(26例),A+β+组(10例)以及A-β+组(46例)。比较各组发病时的临床特点、改良的稳态模型(HOMA2)指数以及出院6个月后的病情转归。结果4组患者在入院时及出院半年后的多项指标上均有显著差别。A+β-组患者平均发病年龄为19.1岁,酮症酸中毒复发率为29.4%,胰岛素停用率为0%;A-β-组患者临床特点类似于A+β-组,但一级亲属糖尿病的患病率相对较高(38.5% vs 17.5%);A-β+组平均发病年龄为44.5岁,伴有明显的代谢紊乱,随访时间内酮症复发率低(2.2%,与A+β-组相比P<0.01),胰岛素停用率高(50%,与A+β-、A-β-组相比P<0.01);A+β+组临床特点类似于A-β+组。结论就区分酮症起病的糖尿病患者而言,A+β-、A-β-、A+β+及A-β+4组患者可分别对应于自身免疫性1型糖尿病、特发性1型糖尿病,成人隐匿型自身免疫性糖尿病及2型糖尿病。
