2015年 · 第95卷第29期

POEMS syndrome, also known as Takatsuki syndrome, Crow-Fukase syndrome and osteosclerosing myeloma, is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes^[1,2,3]。 Although POEMS syndrome is rare, it has a high rate of misdiagnosis and poor prognosis^[1]。 We retrospectively collected the clinical data of 3 cases of POEMS syndrome in the Department of Neurology of China-Japan Friendship Hospital, and analyzed their clinical characteristics, especially neuroelectrophysiological, bone marrow and neuropathological manifestations, so as to strengthen the understanding of the disease and reduce the misdiagnosis rate.

A 27-year-old female was admitted to the hospital on 14 June 2014 due to "sudden disadvantageous speech 2 d". After waking up in the morning 2 days before admission, he found unfavorable speech and difficulty in finding words, but understood others' speech, was unresponsive, and accompanied by abdominal distension. B-ultrasound in a maternity hospital showed peritoneal effusion. After symptomatic treatment, the above symptoms did not improve significantly. He went to the emergency department of Beijing Chaoyang Hospital 1 day before admission. CT and MRI of the head showed low-density foci in the left frontal and temporal lobes, and he was admitted to the neurology department for acute cerebral infarction. Embryo transfer was performed 10 days before admission. Married, menarche at the age of 14, irregular, about once every 40 days, lasting for 3 to 4 days. Pregnancy 0 delivery 0. Had a history of uterine fibroids 4 years ago. Physical examination: Body temperature 37.8 ℃, blood pressure 123/76 mmHg (1 mmHg =0.133 kPa), clarity, incomplete mixed aphasia, and other nervous system physical examination was roughly normal. In medical examination, the heart auscultation was roughly normal, and the breathing sound of lung auscultation was coarse. Abdominal distension, no abdominal wall varicose veins, no liver palm, spider nevus, no tenderness, rebound pain and muscle tension in the whole abdomen. Positive fluid wave tremor, positive mobile voicing, and mild edema of both lower limbs.

The pathological mechanism of sepsis caused by bacterial infection is mainly the generation of "inflammatory storm", including a series of immune cell activation and inflammatory factor release. natural killer T cells (NKT cells) are a subpopulation of T cells, and their role in inflammatory response caused by different causes has been widely paid attention to. At present, it is believed that they also play an important role in sepsis.

irisin is a new muscle factor reported by the Spiegelman lab in Nature in early 2012^[1]。 The discoverer named it after Iris, the rainbow goddess in Greek mythology, metaphorically, it acts as a messenger of skeletal muscle, transmitting signals from skeletal muscle and communicating the relationship between skeletal muscle and peripheral tissues. Since it was reported, journals such as Science, Nature and Cell have published review articles, believing that irisin may become a new target for the treatment of metabolic diseases^[2,3,4,5]。

miRNA is a class of single-stranded non-coding RNA that is highly conserved by endogenous evolution and has a wide range of biological functions. In the past decade or so, rapid progress has been made in the field of biology around miRNA biosynthesis, transcription regulation and function. The emergence of this new type of small molecule miRNA expands the complexity of gene regulatory network and deepens our understanding of the pathogenesis and pathological mechanisms of human disease. Ventricular remodeling is the pathological basis of heart failure. It is a pathological change of the heart under long-term stress and/or neuroendocrine factors stimulation, including morphological and structural changes of cardiomyocytes and non-cardiomyocardial components (fibroblasts and endothelial cells, interstitial). At present, miRNA has been widely studied in the cardiovascular field, involving heart development, atherosclerosis, ischemic heart disease (myocardial infarction), heart failure and arrhythmia, etc. This article focuses on its regulatory role in the pathological process of heart failure-ventricular remodeling.