青少年的成年起病型糖尿病(maturity-onset diabetes of the young, MODY)是一种异质性的单基因糖尿病,其中MODY1、MODY2和MODY3是常见的MODY亚型。近年来胰升糖素样肽1受体激动剂(GLP-1RA)、二肽基肽酶4抑制剂(DPP-4i)、钠-葡萄糖共转...青少年的成年起病型糖尿病(maturity-onset diabetes of the young, MODY)是一种异质性的单基因糖尿病,其中MODY1、MODY2和MODY3是常见的MODY亚型。近年来胰升糖素样肽1受体激动剂(GLP-1RA)、二肽基肽酶4抑制剂(DPP-4i)、钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)与葡萄糖激酶激动剂(GKA)等新型降糖药物在治疗糖尿病方面取得了良好的进展,本文结合目前最新的基础及临床证据,对上述三种MODY的发病机制、临床特征、关于新型降糖药物的诊疗进展作一综述,旨在为MODY的诊疗开拓更为安全有效的新方法。展开更多
Objective To analyze the association of variants of hepatocyte nuclear factor-1α （HNF-1α） gene with type 2 diabetes in Chinese population. Methods In 152 unrelated type 2 diabetes patients and 93 unrelated control...Objective To analyze the association of variants of hepatocyte nuclear factor-1α （HNF-1α） gene with type 2 diabetes in Chinese population. Methods In 152 unrelated type 2 diabetes patients and 93 unrelated controls, eleven single nucleotide polymorphisms （SNPs） were identified and genotyped. Statistical analyses were performed to investigate whether these SNPs were associated with diabetes status in our samples. Results In the individual SNP study, no SNP differed significantly in frequency between type 2 diabetes patients and controls. In the haplotype analysis, two haplotype blocks were identified. In haplotype block 1, no evidence was found between common HNF-1α haplotypes and type 2 diabetes. However, in haplotype block 2, a common haplotype GCGC formed by four tagging SNPs （tSNPs） was found to be associated with decreased risk of type 2 diabetes （odds ratio [OR] 0.6011, 95% confidence interval [CI] 0.4138-0.8732, P=0.0073, empirical P=0.0511, permutation test）. A similar trend was also observed in the diplotype analysis, indicating that the increasing copy number of the haplotype GCGC was associated with the decreased frequency of diabetes （P=0.0193）. Conclusion The results of this study provide evidence that the haplotype of HNF-1α decreases the risk of type 2 diabetes in Chinese individuals.展开更多
Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisatio...Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisation of increased uptake. It is hence widely used to differentiate malignant from benign lesions. "False positive" findings of hepatic lesions have been described in certain instances such as hepatic abscesses, but are rare in cases involving hepatocellular adenomas. To our knowledge, there have been only 7 reports in the English literature documenting PET-avid hepatocellular adenomas; 6 of the 7 reports were published in the last 3 years with the first report by Patel et al. We report the case of a 44-year-old Chinese female patient with a history of cervical adenocarcinoma, referred for a hepatic lesion noted on a surveillance computed tomography (CT) scan. A subsequent CT-PET performed showed a hypermetabolic lesion (standardized uptake value 7.9) in segment Ⅳb of the liver. After discussion at a multidisciplinary hepato-pancreato-biliary conference, the consensus was that of a metastatic lesion from her previous cervical adenocarcinoma, and a resection of the hepatic lesion was performed. Histology revealed features consistent with a hepatocyte nuclear factor-1 α inactivated steatotic hepatocellular adenoma.展开更多
肝细胞核因子1α(HNF1α)不仅是调节葡萄糖代谢的重要转录因子,还参与肝、胰等多个器官中蛋白质合成、物质代谢、增殖分化相关基因的表达调控。HNF1α突变或表达异常引发包括青少年糖尿病3型(maturity onset diabetes of young 3,MODY3...肝细胞核因子1α(HNF1α)不仅是调节葡萄糖代谢的重要转录因子,还参与肝、胰等多个器官中蛋白质合成、物质代谢、增殖分化相关基因的表达调控。HNF1α突变或表达异常引发包括青少年糖尿病3型(maturity onset diabetes of young 3,MODY3)在内的多种代谢疾病。Ser249是HNF1α重要的功能位点,该位点受ATM蛋白激酶直接磷酸化修饰,并可能是ATM蛋白激酶影响葡萄糖代谢的效应靶点,也可能是共济失调毛细血管扩张症(ataxia telangiectasia,AT)患者糖代谢异常的致病靶点。为进一步研究Ser249磷酸化在体内的功能,本文构建人源野生型HNF1α转基因小鼠(WT小鼠)和HNF1αS249A转基因小鼠(S249A小鼠),对其基础代谢水平和葡萄糖代谢能力进行检测。相较于对照小鼠,S249A小鼠的多项基础代谢指标异常,WT小鼠未显示差异;但当小鼠接受刺激后,无论是注射葡萄糖,还是丙酮酸或胰岛素,相较于各自的对照小鼠,WT小鼠都表现出更强的反应性,而S249A小鼠的糖异生反应和胰岛素敏感性均未显示出差异。实时定量PCR结果表明,WT小鼠肝的多个糖代谢基因表达上调,但S249A小鼠肝中糖代谢基因上调幅度明显小于WT小鼠。本研究提示,HNF1αSer249突变导致小鼠糖代谢异常,可能与磷酸化修饰失调进而影响其转录活性有关。展开更多
文摘青少年的成年起病型糖尿病(maturity-onset diabetes of the young, MODY)是一种异质性的单基因糖尿病,其中MODY1、MODY2和MODY3是常见的MODY亚型。近年来胰升糖素样肽1受体激动剂(GLP-1RA)、二肽基肽酶4抑制剂(DPP-4i)、钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)与葡萄糖激酶激动剂(GKA)等新型降糖药物在治疗糖尿病方面取得了良好的进展,本文结合目前最新的基础及临床证据,对上述三种MODY的发病机制、临床特征、关于新型降糖药物的诊疗进展作一综述,旨在为MODY的诊疗开拓更为安全有效的新方法。
基金This research was supported by the National 973 Program (2006 CB503901) the Major Project of Shanghai Science and Technology Development Foundation (02DJ14052-I)+1 种基金the Science and Technology Development Foundation of Shanghai Municipal Health Bureau (034043) the Young Doctor Training Project of Shanghai Municipal Health Bureau
文摘Objective To analyze the association of variants of hepatocyte nuclear factor-1α （HNF-1α） gene with type 2 diabetes in Chinese population. Methods In 152 unrelated type 2 diabetes patients and 93 unrelated controls, eleven single nucleotide polymorphisms （SNPs） were identified and genotyped. Statistical analyses were performed to investigate whether these SNPs were associated with diabetes status in our samples. Results In the individual SNP study, no SNP differed significantly in frequency between type 2 diabetes patients and controls. In the haplotype analysis, two haplotype blocks were identified. In haplotype block 1, no evidence was found between common HNF-1α haplotypes and type 2 diabetes. However, in haplotype block 2, a common haplotype GCGC formed by four tagging SNPs （tSNPs） was found to be associated with decreased risk of type 2 diabetes （odds ratio [OR] 0.6011, 95% confidence interval [CI] 0.4138-0.8732, P=0.0073, empirical P=0.0511, permutation test）. A similar trend was also observed in the diplotype analysis, indicating that the increasing copy number of the haplotype GCGC was associated with the decreased frequency of diabetes （P=0.0193）. Conclusion The results of this study provide evidence that the haplotype of HNF-1α decreases the risk of type 2 diabetes in Chinese individuals.
文摘Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisation of increased uptake. It is hence widely used to differentiate malignant from benign lesions. "False positive" findings of hepatic lesions have been described in certain instances such as hepatic abscesses, but are rare in cases involving hepatocellular adenomas. To our knowledge, there have been only 7 reports in the English literature documenting PET-avid hepatocellular adenomas; 6 of the 7 reports were published in the last 3 years with the first report by Patel et al. We report the case of a 44-year-old Chinese female patient with a history of cervical adenocarcinoma, referred for a hepatic lesion noted on a surveillance computed tomography (CT) scan. A subsequent CT-PET performed showed a hypermetabolic lesion (standardized uptake value 7.9) in segment Ⅳb of the liver. After discussion at a multidisciplinary hepato-pancreato-biliary conference, the consensus was that of a metastatic lesion from her previous cervical adenocarcinoma, and a resection of the hepatic lesion was performed. Histology revealed features consistent with a hepatocyte nuclear factor-1 α inactivated steatotic hepatocellular adenoma.
文摘肝细胞核因子1α(HNF1α)不仅是调节葡萄糖代谢的重要转录因子,还参与肝、胰等多个器官中蛋白质合成、物质代谢、增殖分化相关基因的表达调控。HNF1α突变或表达异常引发包括青少年糖尿病3型(maturity onset diabetes of young 3,MODY3)在内的多种代谢疾病。Ser249是HNF1α重要的功能位点,该位点受ATM蛋白激酶直接磷酸化修饰,并可能是ATM蛋白激酶影响葡萄糖代谢的效应靶点,也可能是共济失调毛细血管扩张症(ataxia telangiectasia,AT)患者糖代谢异常的致病靶点。为进一步研究Ser249磷酸化在体内的功能,本文构建人源野生型HNF1α转基因小鼠(WT小鼠)和HNF1αS249A转基因小鼠(S249A小鼠),对其基础代谢水平和葡萄糖代谢能力进行检测。相较于对照小鼠,S249A小鼠的多项基础代谢指标异常,WT小鼠未显示差异;但当小鼠接受刺激后,无论是注射葡萄糖,还是丙酮酸或胰岛素,相较于各自的对照小鼠,WT小鼠都表现出更强的反应性,而S249A小鼠的糖异生反应和胰岛素敏感性均未显示出差异。实时定量PCR结果表明,WT小鼠肝的多个糖代谢基因表达上调,但S249A小鼠肝中糖代谢基因上调幅度明显小于WT小鼠。本研究提示,HNF1αSer249突变导致小鼠糖代谢异常,可能与磷酸化修饰失调进而影响其转录活性有关。
