患者，女，55岁。因行走不稳2个月于2021年8月20日入院。患者2个月前无明显诱因出现行走不稳，表现为行走时晃动，易跌倒，步幅增宽，自觉右手笨拙。2年前患者因腰腹部僵硬感，诊断为“焦虑抑郁状态”;高血压病史2年余，规律口服苯磺酸左旋氨氯地平，血压控制可；亚临床甲状腺功能减退1年余，未予治疗；视物重影、左侧动眼神经麻痹1年余，曾用“胞磷胆碱钠、盐酸乙哌立松、甲钴胺、维生素B6”治疗，效果不佳，随后出现右侧眼睑下垂。

患者，男，75岁。因“20年内反复晕厥5次”于2019年8月20日入院。患者20年前长时间站立后觉空气闷热，随即出现意识丧失，晕厥前无胸痛、心悸、头晕、黑矇等前驱症状，晕厥过程中无双眼上翻、四肢抽搐，醒后活动如常。之后患者分别于2009、2016、2017、2018年发作类似晕厥共5次，最后一次晕厥发作在饱食后。既往有高血压病史20余年，平时口服“培哚普利”治疗，血压控制在140/90 mmHg。

Objective To observe the effects of gut microbiota metabolite succinic acid on blood lipids, glucose tolerance and liver pathological morphology in nonalcoholic fatty liver disease(NAFLD) mice.Methods From September 2021 to March 2022, experiments were carried out in the Laboratory of Guizhou Medical University. 40 male C57 mice were randomly divided into normal diet group(ND group) and normal diet + succinic acid treatment group(ND+ Suc group), high-fat diet group(HFD group), high-fat diet group + succinic acid treatment group(HFD+Suc group), 10 animals in each group. The mice were fed with 2.5% succinic acid, the HFD group was fed with high-fat diet to establish the NAFLD model, and the HFD+Suc group was fed with 2.5% succinic acid. Glycerol(TG) and total cholesterol(TC) levels, hematoxylin-eosin(HE) staining and oil red O staining in liver tissue were used to observe liver lipid deposition and hepatocyte pathological changes.Results After 15 weeks of the experiment, compared with the ND group, the HFD group increased body weight, blood glucose, serum TG and TC levels at each time point(0, 15, 30, 60, 120 min) of the OGTT test(P<0.01). Compared with other groups, body weight, blood glucose, serum TG and TC levels at each time point(0, 15, 30, 60, 120 min) of OGTT test in HFD+Suc group were decreased(P<0.01); There was no statistical significance in the comparison of indicators(P>0.05). HE staining and Oil Red O staining showed that hepatocytes in the liver tissue of the mice in the ND group and ND+Suc group were neatly arranged, the nucleus was large and round, the lobular structure was clearly visible, and no obvious lipid deposition was observed; the mice in the HFD group had liver tissue. Fat deposition was diffusely distributed in the cells, mainly mixed with large and small vesicles, and some nuclei were squeezed and deformed or even disappeared, and the arrangement of liver cells was disordered; the hepatic steatosis and hepatic lipid deposition in the HFD+Suc group were significantly less than those in the HFD group. Conclusion The intestinal flora metabolite succinate can reduce the body weight, serum TG and TC levels of NAFLD mice, alleviate the impaired glucose regulation and liver lipid deposition, and has a potential therapeutic effect on NAFLD.

Objective To investigate the correlation and predictive value of glycated serum protein(GSP), blood glucose variability(GV) and type 2 diabetes mellitus(T2 DM) complicated with dry eye.Methods From February 2018 to February 2022, 117 T2 DM-related dry eye patients(dry eye syndrome group) and 52 T2 DM patients without dry eye syndrome(control group) who were diagnosed and treated by the Department of Ophthalmology, Qianjiang Hospital Affiliated to Chongqing University were selected as the research objects. The international standard ocular surface disease index(OSDI) dry eye self-examination questionnaire score, non-contact tear break-up time(NIBUT), tear secretion test without ocular surface anesthesia(Schiemer I test), GSP, GV and blood glucose, blood lipid levels. Pearson method was used to analyze the correlation between GSP, GV and OSDI score, NIBUT and Schiemer I test; multivariate Logistic regression analysis was used to analyze the risk factors of dry eye in T2 DM, and receiver operating characteristic curve(ROC) was used to analyze GSP and GV to identify T2 DM with dry eye. the value of the disease.Results The duration of T2 DM, OSDI score, GSP, GV, and HbA1 c in the dry eye group were higher than those in the control group(t/P=7.699/<0.001, 16.211/<0.001, 11.620/<0.001, 10.784/<0.001, 10.984/<0.001), However, the results of NIBUT and Schiemer I tests were lower than those of the control group(t/P=18.160/<0.001, 20.529/<0.001). Pearson analysis showed that GSP and GV levels were positively correlated with OSDI scores(r=0.502, 0.619,P<0.001), and negatively correlated with NIBUT and Schiemer I test results(r=-0.402,-0.506,P<0.001). Logistic regression analysis showed that long course of T2 DM, high GSP and high GV were risk factors for dry eye in T2 DM patients [OR(95%CI)=2.061(1.226-3.464), 1.394(1.139-1.706), 1.984(1.335-2.947)]; the areas under the curve of GSP, GV and their combination in the diagnosis of T2 DM-related dry eye were 0.713, 0.824, 0.948, and the combined predictive value of the two was greater than that of their separate detection(Z/P=5.709/<0.001, 3.612/0.005). Conclusion The levels of GSP and GV in T2 DM-related dry eye patients were increased, and high GSP and GV levels were associated with the occurrence and severity of diabetes-related dry eye.

Objective To investigate the correlation of serum galectin-3 and soluble endoglin(S-endoglin) levels with glucose metabolism disorders and microvascular complications in children with type 1 diabetes(T1 DM). Methods From February 2016 to February 2022, 105 children with T1 DM(T1 DM group) were selected from the Pediatric Endocrinology Department of Tangshan Maternal and Child Health Hospital, Hebei Province, and 52 healthy children were selected as the healthy control group. Children with T1 DM were divided into a complication subgroup of 28 cases and an uncomplicated subgroup of 77 cases according to whether they had microvascular complications. Serum levels of galectin-3, S-endoglin, fasting blood glucose(FPG), fasting insulin(FINS), insulin resistance index(HOMA-IR) and glycosylated hemoglobin(HbA1 c) were detected in the two groups. Pearson analyzed the correlation of serum galectin-3 and S-endoglin with FPG, FINS, HOMA-IR and HbA 1 c in children with T1 DM, and the receiver operating characteristic curve(ROC) analyzed the value of serum galectin-3 and S-endoglin in the diagnosis of microvascular complications in T1 DM children. Results The levels of serum galectin-3, S-endoglin, FPG, FINS, HOMA-IR and HbA1 c in the T1 DM group were significantly higher than those in the healthy control group(t/P=24.934/<0.001, 13.370/<0.001, 12.924/<0.001, 5.954/<0.001, 88.256/<0.001, 14.378/<0.001). The levels of serum galectin-3 and S-endoglin in the complication subgroup were higher than those in the uncomplicated subgroup(t/P=21.812/<0.001, 7.495/<0.001). HbA1 c were positively correlated(galectin-3:r/P=0.356/0.006, 0.402/0.002, 0.562/<0.001, 0.411/<0.001; S-endoglin: r/P=0.327/0.009, 0.417/<0.001, 0.593/<0.001, 0.428/<0.001). The areas under the curve of serum galectin-3, S-endoglin and their combination in the diagnosis of microvascular complications in children with T1 DM were 0.739, 0.718, and 0.914. Conclusion The high serum levels of galectin-3 and S-endoglin in children with T1 DM may be related to the disturbance of glucose metabolism and the occurrence of microvascular complications.