目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health an...目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库,纳入8176名参与者。双能X射线吸收测定法(DXA)测量腰椎骨密度,并计算T值以判定腰椎骨量减少状态。NHHR由总胆固醇减去高密度脂蛋白胆固醇(HDL-C)后再除以HDL-C计算得出。参与者按NHHR分为四分位组,并收集其人口学特征、生活方式(如饮酒、吸烟、体力活动)和临床变量[如体质量指数(body mass index,BMI)、高血压、糖尿病等]。通过多元线性回归分析评估NHHR与腰椎骨量减少的关系,并利用限制性三次样条探讨NHHR与腰椎骨量减少及腰椎骨密度(bone mineral density,BMD)之间的关系。结果腰椎骨量减少组的NHHR显著高于非腰椎骨量减少组(P<0.001)。未调整模型中,NHHR升高与腰椎骨量减少呈正相关(OR:1.11,95%CI:1.07~1.16,P<0.001);调整年龄、性别、BMI等混杂因素后,相关性减弱但仍显著(OR:1.08,95%CI:1.03~1.13,P=0.004)。全面调整腰椎BMD及血脂水平后,NHHR与腰椎骨量减少的关联性不再显著(OR:0.99,P=0.931)。此外,限制性三次样条显示NHHR与腰椎骨量减少间存在非线性关系,J型曲线表明NHHR升高显著增加腰椎骨量减少风险(P<0.05)。NHHR与腰椎BMD呈负相关,拟合模型显示NHHR每增加1单位,腰椎BMD降低0.01 g/cm^(2)。结论NHHR可能作为预测腰椎骨量减少的潜在风险指标,但其与腰椎骨量减少的关联在全面调整后减弱,提示需要进一步研究以明确其机制及临床应用价值。展开更多
患者,男,60岁,因“纳差5个月”于2023年5月5日收入我院。患者5个月前出现纳差,伴腹胀、便秘(2~3天1次),偶有心慌、胸闷,无腹痛、腹泻、便血、黑便、胸痛,未进行诊疗。既往有高血压病史15年,血压最高达190/120 mm Hg,院外规律口服替米沙...患者,男,60岁,因“纳差5个月”于2023年5月5日收入我院。患者5个月前出现纳差,伴腹胀、便秘(2~3天1次),偶有心慌、胸闷,无腹痛、腹泻、便血、黑便、胸痛,未进行诊疗。既往有高血压病史15年,血压最高达190/120 mm Hg,院外规律口服替米沙坦80 mg每日1次、硝苯地平控释片30 mg每日1次及美托洛尔缓释片47.5 mg每日1次对症治疗,血压控制情况不详;Ig A肾病病史12年;糖尿病病史7年,院外规律皮下注射精蛋白生物合成人胰岛素注射液(预混30R)早晚各18U、口服阿卡波糖(50 mg每日3次),血糖控制情况不详。展开更多
目的:探讨转甲状腺素蛋白淀粉样变性(ATTR)的临床诊断、治疗及预后。方法:回顾性分析安徽医科大学第一附属医院2022年收治的1例ATTR患者的临床资料,并进行相关文献复习。结果:患者,男性,43岁,初期表现为间断腹泻,随后因双下肢麻木乏力...目的:探讨转甲状腺素蛋白淀粉样变性(ATTR)的临床诊断、治疗及预后。方法:回顾性分析安徽医科大学第一附属医院2022年收治的1例ATTR患者的临床资料,并进行相关文献复习。结果:患者,男性,43岁,初期表现为间断腹泻,随后因双下肢麻木乏力行神经活检提示神经淀粉样变性,现因双下肢浮肿及尿失禁就诊,经综合检查考虑淀粉样变性多系统累及,完善心脏磁共振、99mTc-PYP核素显像及基因检测,确诊ATTR,现予以氯苯唑酸治疗,随访截至2024年12月,患者病情稳定。结论:ATTR为淀粉样变性中的罕见类型,病例少,病情进展快,临床表现缺乏特异性,虽有针对性的治疗药物,但需做到早期诊断及治疗,总体预后不佳。Abstract: To explore the clinical diagnosis, treatment, and prognosis of transthyretin amyloidosis (ATTR). Method: A retrospective analysis was conducted on the clinical data of a patient with ATTR admitted to the First Affiliated Hospital of Anhui Medical University in 2022, and relevant literature was reviewed. Result: The patient, a 43-year-old male, initially presented with intermittent diarrhea. Subsequently, nerve biopsy was performed due to numbness and weakness in both lower limbs, indicating neuroamyloidosis. The patient is now seeking medical attention due to edema and urinary incontinence in both lower limbs. After comprehensive examination, it was considered that amyloidosis involves multiple systems. After completing cardiac magnetic resonance imaging, 99mTc PYP nuclear imaging, and genetic testing, the patient was diagnosed with ATTR and is now receiving treatment with chlorpromazine. Follow-up until December 2024 shows that the patient’s condition is stable. Conclusion: ATTR is a rare type of amyloidosis with few cases, rapid disease progression, and lack of specificity in clinical manifestations. Although there are targeted therapeutic drugs, early diagnosis and treatment are necessary, and the overall prognosis is poor.展开更多
文摘目的探讨非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比率(the non-high-density to high-density lipoprotein cholesterol ratio,NHHR)与腰椎骨量减少风险之间的关系。方法基于2011年-2018年美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库,纳入8176名参与者。双能X射线吸收测定法(DXA)测量腰椎骨密度,并计算T值以判定腰椎骨量减少状态。NHHR由总胆固醇减去高密度脂蛋白胆固醇(HDL-C)后再除以HDL-C计算得出。参与者按NHHR分为四分位组,并收集其人口学特征、生活方式(如饮酒、吸烟、体力活动)和临床变量[如体质量指数(body mass index,BMI)、高血压、糖尿病等]。通过多元线性回归分析评估NHHR与腰椎骨量减少的关系,并利用限制性三次样条探讨NHHR与腰椎骨量减少及腰椎骨密度(bone mineral density,BMD)之间的关系。结果腰椎骨量减少组的NHHR显著高于非腰椎骨量减少组(P<0.001)。未调整模型中,NHHR升高与腰椎骨量减少呈正相关(OR:1.11,95%CI:1.07~1.16,P<0.001);调整年龄、性别、BMI等混杂因素后,相关性减弱但仍显著(OR:1.08,95%CI:1.03~1.13,P=0.004)。全面调整腰椎BMD及血脂水平后,NHHR与腰椎骨量减少的关联性不再显著(OR:0.99,P=0.931)。此外,限制性三次样条显示NHHR与腰椎骨量减少间存在非线性关系,J型曲线表明NHHR升高显著增加腰椎骨量减少风险(P<0.05)。NHHR与腰椎BMD呈负相关,拟合模型显示NHHR每增加1单位,腰椎BMD降低0.01 g/cm^(2)。结论NHHR可能作为预测腰椎骨量减少的潜在风险指标,但其与腰椎骨量减少的关联在全面调整后减弱,提示需要进一步研究以明确其机制及临床应用价值。
文摘目的:探讨转甲状腺素蛋白淀粉样变性(ATTR)的临床诊断、治疗及预后。方法:回顾性分析安徽医科大学第一附属医院2022年收治的1例ATTR患者的临床资料,并进行相关文献复习。结果:患者,男性,43岁,初期表现为间断腹泻,随后因双下肢麻木乏力行神经活检提示神经淀粉样变性,现因双下肢浮肿及尿失禁就诊,经综合检查考虑淀粉样变性多系统累及,完善心脏磁共振、99mTc-PYP核素显像及基因检测,确诊ATTR,现予以氯苯唑酸治疗,随访截至2024年12月,患者病情稳定。结论:ATTR为淀粉样变性中的罕见类型,病例少,病情进展快,临床表现缺乏特异性,虽有针对性的治疗药物,但需做到早期诊断及治疗,总体预后不佳。Abstract: To explore the clinical diagnosis, treatment, and prognosis of transthyretin amyloidosis (ATTR). Method: A retrospective analysis was conducted on the clinical data of a patient with ATTR admitted to the First Affiliated Hospital of Anhui Medical University in 2022, and relevant literature was reviewed. Result: The patient, a 43-year-old male, initially presented with intermittent diarrhea. Subsequently, nerve biopsy was performed due to numbness and weakness in both lower limbs, indicating neuroamyloidosis. The patient is now seeking medical attention due to edema and urinary incontinence in both lower limbs. After comprehensive examination, it was considered that amyloidosis involves multiple systems. After completing cardiac magnetic resonance imaging, 99mTc PYP nuclear imaging, and genetic testing, the patient was diagnosed with ATTR and is now receiving treatment with chlorpromazine. Follow-up until December 2024 shows that the patient’s condition is stable. Conclusion: ATTR is a rare type of amyloidosis with few cases, rapid disease progression, and lack of specificity in clinical manifestations. Although there are targeted therapeutic drugs, early diagnosis and treatment are necessary, and the overall prognosis is poor.
