2016年 · 第96卷第17期

Diabetic nephropathy (DKD) is a serious microvascular complication of diabetes, occurring in about 1/3 of diabetic patients. The continuous increase in the prevalence of diabetes, which directly leads to an increase in the incidence and mortality of diabetic nephropathy, brings great challenges to the healthcare system. Genetic susceptibility is an important factor in the occurrence and progression of diabetic nephropathy, and the research to determine its susceptibility genes is being carried out worldwide. The risk of diabetic nephropathy in diabetic patients can be increased several times under the combined action of risk alleles at different susceptibility sites [such as angiotensin converting enzyme (ACE) gene, apolipoprotein E (ApoE) gene, adiponectin gene (ADIPOQ), etc.]. Therefore, finding genetic variation as a biomarker to detect patients at high risk of diabetic nephropathy is helpful for their early diagnosis, treatment and prevention. Among individuals with diabetic nephropathy, the different combination of genetic variation constitutes the genetic heterogeneity of the disease, while the genetic heterogeneity between different races constitutes the ethnic heterogeneity. Recently, genome-wide association studies (GWAS) to explore disease susceptibility genes have identified several novel pathogenic gene loci in diabetic nephropathy, emphasizing that more in-depth genetic studies in different ethnic populations can reveal their genetic susceptibility. Epigenetics has the role and effect of regulating the genetic susceptibility of diabetic nephropathy.

Diabetes is one of the important diseases that threaten human health at present. It is estimated that by 2030, the number of diabetic patients in the world will reach 550 million. Diabetic nephropathy is the main cause of renal failure in diabetic patients. A retrospective analysis of hospitalized diabetic patients in China in 2001 showed that 33.6% of them were complicated by diabetic nephropathy; The epidemiological study of chronic kidney disease in China shows that the prevalence of chronic kidney disease in China is 10.8%, and 36.4% of this population have diabetes^[1]。 The main pathological features of diabetic nephropathy are glomerular hypertrophy, basement membrane thickening and extracellular matrix accumulation, which gradually progresses to glomerular sclerosis and tubulointerstitial fibrosis. The clinical manifestation is early microalbuminuria, and gradually progresses to massive albuminuria, which eventually leads to renal failure. At present, the known pathogenesis of diabetic nephropathy includes genetic susceptibility, epigenetic regulation, oxidative stress, inflammatory response, cytokine activation and renal hemodynamic changes, etc. However, its pathogenesis is extremely complex and has not been fully elucidated. Therefore, it is important to understand the mechanism of diabetic nephropathy in depth for the prevention and treatment of diabetic nephropathy.

Diabetic nephropathy (DKD) is the leading cause of chronic kidney disease (CKD) in developed countries and is also becoming the leading cause of CKD in developing countries. DKD is one of the chronic microvascular complications of diabetes and one of the leading causes of death in diabetic patients. Patients with type 2 diabetes may develop DKD after 10 to 20 years. However, the renal reserve function of the elderly is reduced, and the degree of renal failure is more serious than that of the younger people. Therefore, preventing and delaying the development of DKD can improve the survival rate of elderly diabetic patients.

Thrombotic thrombocytopenic purpura (TTP) with abrupt onset, critical condition, poor prognosis and 90% mortality^[1]。 TTP is relatively rare, and it is more common in women of childbearing age. Pregnancy complicated with TTP accounts for 10% to 36% of the total incidence of TTP^[2]We now report a case of pregnancy complicated with TTP that we treated in May 2015 as follows.

At present, the treatment of osteoarthritis (OA) is still lacking the exact and effective treatment that can control the progression of the disease, and most of them are symptomatic treatment. Total joint replacement is needed to replace the original joint function in the late stage of the disease^[1,2]。 Studies have shown that many factors are involved in the occurrence and development of OA. Among them, the role of long chain non-coding RNA (lncRNA) in the regulation of gene expression has been paid more and more attention. The expression process of many important protein molecules closely related to the disease in the pathogenesis of OA is regulated by lncRNA, such as metalloproteinase (MMP), proteoglycanase (ADAMTS), insulin-like growth factor (IGF) -2, vascular endothelial growth factor (VEGF), etc. The study of the transcriptional regulation of lncRNA provides a new way of thinking for the treatment of OA. Therefore, the six lncRNAs closely related to them in the pathogenesis of OA and their roles and mechanisms are reviewed as follows.

With the development of society and the change of people's lifestyle, the number of diabetic patients worldwide is increasing year by year. The latest statistics of the World Health Organization show that there are about 347 million diabetic patients worldwide^[1]。 The prevalence of diabetes in China is even more severe. According to a 2010 survey by the National Center for Disease Control and the Endocrinology Society of Chinese Medical Association, the overall incidence of diabetes in adults over 18 years old in China reached 11.6%, and more than 20.4% of the elderly suffered from diabetes, of which more than 90.0% were type 2 diabetes^[2,3,4]This article mainly reviews the related research progress of type 2 diabetes.