Volume 86  ·   Issue 30  ·  2006

metabolic syndrome (MS) is a hot topic of medical attention in recent years. Its main characteristics are the clustering of multiple metabolic risk factors, the main pathophysiological mechanisms involve abdominal obesity and insulin resistance (IR), and the main clinical consequences are atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes. However, the definition, diagnostic criteria, pathogenesis and prevention measures of MS have been unconsensus issues in academic circles.

metabolic syndrome (MS) was officially named by the World Health Organization in 1998 [1, 2]. It is now known that it is mainly composed of visceral obesity, insulin resistance, disorder of glucose metabolism, abnormal lipid metabolism and hypertension, and may appear vascular endothelial function damage, microinflammation, hypercoagulation state and hyperuricemia, etc. It is generally believed that MS is initiated by visceral obesity and centered on insulin resistance, that is, visceral obesity leads to insulin resistance, and insulin resistance leads to abnormalities of various components of MS [1-4].

Angiotensin converting enzyme inhibitor (ACEI) was recommended as the only antihypertensive drug with all six mandatory indications by the 7th report of the National Joint Committee on Hypertension (JNC7) for its definite antihypertensive effect and comprehensive cardiovascular protection. Renin-angiotensin system (RAS) plays an important role in the pathogenesis of metabolic syndrome (MS). Therefore, the relationship between ACEI and MS has aroused academic discussion.

Objective to investigate the feasibility and efficacy of suture combined with radiofrequency ablation (RFA) in the treatment of giant hepatic cavernous hemangioma (HCH). Methods From June 2004 to June 2005, 15 cases of 18 HCH lesions were treated with RFA after tumor suture under general anesthesia (suture group), and 15 cases of 17 lesions without suture were treated with RFA (no suture group). All patients showed upper abdominal discomfort, pain or abdominal distension. The lesions were all located on the surface of the liver, caudate lobe or adjacent to the gallbladder and other hollow organs. 7 cases were complicated with chronic atrophic cholecystitis, 6 cases were common bile duct stones, 5 cases were thrombocytopenia, 1 case was posthepatitic cirrhosis, and 13 cases had a history of middle and upper abdominal surgery. Results All 30 cases were successfully treated with open RFA under the guidance of ultrasound. At the same time, 7 cases underwent cholecystectomy due to chronic atrophic cholecystitis, 2 cases underwent cholecystectomy due to tumor involvement of the gallbladder bed and affecting the RFA operation, and 6 cases underwent T-tube drainage of common bile duct exploration. The average intraoperative bleeding volume in the sutured and unsutured groups was 88.0ml±22.4ml and 255.0ml±71.7ml, respectively (P<0.001). The average RFA treatment time of single lesion was 23.0min±7.5min and 53.3min±16.0min, respectively (P<0.001). The maximum diameter of lesion decreased by 61.8% and 44.8%, respectively, six months after operation (P<0.001). There were no serious complications related to RFA treatment in both groups. The total necrosis rate of lesions in both groups was 100% after 6-17 months (median 12 months). Conclusion RFA is safe and feasible in the treatment of giant HCH after suture, which can reduce the amount of bleeding, shorten the treatment time of RFA and improve the efficacy of RFA. The application of intraoperative ultrasound has certain effects on improving the treatment effect and reducing complications.

Objective to investigate the characteristics and possible causes of blood gas in patients with chronic severe hepatitis.Methods The arterial blood gas parameters of 126 patients with chronic severe hepatitis were measured by micro blood gas analyzer.Blood potassium,sodium,chlorine,urea nitrogen,and creatinine were measured simultaneously by venous blood.First, Kassirer formula was used to preliminarily judge the simple or mixed acid-base imbalance (ABD), and then according to the predictive compensation formula of each type of acid-base imbalance, the anion gap (AG) value and potential bicarbonate (PB) were calculated at the same time.Results Among 126 blood gas analyses, acid-base imbalance occurred in 115 cases (91.3%), among which the incidence of respiratory alkalosis combined with metabolic alkalosis was the highest, accounting for 31.7%; The triple acid-base imbalance was mainly found in TABD with basic chronic severe liver in cirrhosis and basic chronic severe liver in chronic hepatitis, respectively. The simple acid-base imbalance was found in 31.4% and 22.5%, and the multiple acid-base imbalance was found in 65.1% and 57.5%, respectively. There was no significant difference between them. A total of 34 cases of hypoxemia occurred in this group, accounting for 27.0%. The patients with pH<7.35 all appeared in the death group. Conclusion Alkalemia is the main type of acid-base imbalance in patients with chronic severe hepatitis, and respiratory alkalosis is the basic type of acid-base imbalance.

Objective to study the activation patterns of various subregions of anterior cingulate gyrus (ACC) in healthy volunteers undergoing different intensities of electrical stimulation by functional magnetic resonance imaging (fMRI) technique, and to explore the role of this brain region in pain regulation network.Methods Ten right-handed healthy volunteers were given three different intensities of electrical stimulation tasks: 1-fold pain threshold (P1), 2-fold pain threshold (P2) and 3-fold pain threshold (P3). At the same time, the data of brain functional activity were collected by GE Signa 1.5T superconducting magnetic resonance imaging system, and the activation images of ACC were obtained by post-processing with functional neuroimaging analysis (AFNI) software package. According to the mean brain functional activation maps of 10 subjects, the unique stimulation response characteristics of each subregion of ACC were analyzed. Results Anterior cingulate gyrus (aACC) was moderately activated under different intensities of electrical stimulation, and the mean activation pixels of this subregion were 324, 429 and 562 at P1, P2 and P3, respectively. The mean activation pixels of dorsal posterior anterior cingulate gyrus (dpACC) at P1, P2 and P3 were 311, 964 and 1414, and the BOLD signal was positively correlated with stimulus intensity, showing a stimulus intensity-dependent response, suggesting that this region was related to stimulus intensity coding; The posterior ventral part of anterior cingulate gyrus (vpACC) had no obvious activation at P1 and P2 (mean activation pixels were 262 and 375), but when the stimulation intensity increased to P3, the BOLD signal in this region was significantly enhanced (mean activation pixels were 1781), suggesting that this region was involved in pain intensity encoding.Conclusion Each subregion of anterior cingulate gyrus plays an important role in pain regulation network.Under the action of different intensities of electrical stimulation, this region showed dissociative activation characteristics, and the activation curves of each subregion showed their own pain regulation characteristics.

Objective to investigate the apoptosis of hepatocytes induced by endotoxin (i.e. lipopolysaccharide) and the mechanism of liver injury in rats with acute liver failure induced by D-galactosamine. Methods 48 Wistar rats were divided into three groups (16 rats in each group) at 6 h, 24 h and 48 h. Each group was divided into a treatment group and a control group (8 rats in each group). The rats in the treatment group were dissolved with lipopolysaccharide (50 μ g/kg) + D-galactosamine (300mg/kg) in 1 ml sterile saline and then injected intraperitoneally, while the animals in the control group were injected with only 1ml normal saline intraperitoneally. Liver tissue sections were examined by transmission electron microscopy and deoxyribonucleotide terminal transferase-mediated nick end labeling analysis (TUNEL analysis), respectively; Results ALT levels in all treatment groups were significantly higher than those in control group (66 U/L ± 3 U/L), while ALT levels in 6 h group (399U/L ± 83 U/L) were significantly lower than those in 24 h group (3178 U/L ± 63 U/L) and 48 h group (1506 U/L ± 56 U/L). 48 h The TUNEL analysis showed that there were few apoptotic cells in the liver tissues of the normal control group, but the apoptotic cells in the lipopolysaccharide/D-galactosamine treatment group for 6 h were significantly more, and most of them showed the characteristics of early apoptosis. The apoptosis of hepatocytes in the 24h and 48h groups was significantly more than that in the 6h group, and most of them showed the characteristics of late apoptosis. The expression of p53 gene was low in the control group and 6 h group, but was significantly higher in the 24h and 48 h groups; p21waf1/cip1 gene was not expressed in the control group, but the mRNA expression level reached a peak at 24 hours, and decreased rapidly to 0 at 48 hours. Conclusion Low-dose lipopolysaccharide can induce acute liver failure in D-galactosamine-sensitized rats; Apoptosis is an important pathomorphological change; The occurrence of liver injury in liver failure is closely related to the early high level of iNOS gene expression.

Objective to establish a model of liver metastasis of gallbladder carcinoma and screen high metastatic subsets of cells through the model, so as to provide a good experimental tool for the study of liver metastasis of gallbladder carcinoma. Methods GBC-SD cells of gallbladder carcinoma were cultured in RPMI1645 containing 10% fetal bovine serum in vitro, isolated with trypsin, prepared with normal saline 1×107/ml cell suspension, and inoculated in the spleen of 4~6 weeks old nude mice to establish a model of gallbladder carcinoma metastasis. Tumor cells were isolated from liver metastases of experimental animals, and metastasis models were established by primary and subculture methods. The second and third rounds of high metastatic phenotype gallbladder cancer cell subsets were screened. The metastases were observed under light microscope and the morphological characteristics of screening cells were selected; Three pairs of human-specific microsatellite sequences were amplified by PCR. Results A liver metastasis model of gallbladder carcinoma in nude mice was established. The metastases were distributed in all parts of the liver parenchyma, but mainly at the margins. The left lobe was mostly invaded, and some of the whole liver metastases were observed by histology. The metastatic lesions were adenocarcinoma in the first, second and third rounds, and the metastatic rates were 60%, 70% and 90%. The high metastatic subsets of gallbladder carcinoma cells were screened from the third round and named GBC-SD/M3. Compared with the parent cell GBC-SD, the screened GBC-SD/M3 had similar morphological characteristics. The product fragments amplified by GBC-SD and GBC-SD/M3 were identical at microsatellite D14S68, D18S69 and D20S199 sites, but the corresponding product fragments were not amplified in the liver of tumor-bearing nude mice. Conclusion This experiment successfully established the liver metastasis model of gallbladder carcinoma; GBC-SD/M3, a subset of highly metastatic gallbladder cancer cells, was screened from the metastatic model. Compared with the parental GBC-SD, the morphology and genetic background remained consistent, but the metastatic ability was higher.

Objective to investigate the incidence of peripheral arterial disease (PAD) in patients with metabolic syndrome and the relationship between metabolic syndrome and risk factors associated with PAD.Methods 2115 patients with metabolic syndrome, aged 32~91 (67.6±5.1) years old, 1132 males and 983 females, were admitted and outpatient.The relevant clinical data were collected and the ankle-brachial index was measured. The ankle-brachial index was less than 0.9 and PAD was diagnosed, and the relevant clinical data of PAD were analyzed and statistically processed.Results 476 patients with metabolic syndrome combined with PAD, the total incidence rate was 22.5%, 246 males, accounting for 51.68% of patients with metabolic syndrome combined with PAD; 230 cases (48.32%) were female; The average age was 71.3±9.4 and 71.2±8.2 years, respectively. The risk of PAD increased with age, OR was 1.069, 95% confidence interval was 1.054-1.083, and it was correlated with gender, smoking, diabetes, coronary heart disease and ischemic stroke (all P<0.05). The levels of blood urea nitrogen, blood creatinine and blood uric acid were significantly higher in female patients with metabolic syndrome with PAD than those without PAD (P<0.05). Conclusion Patients with metabolic syndrome were more likely to have PAD, and with the increase of related risk factors, patients with metabolic syndrome were more likely to have PAD.

Objective to investigate the cutting point of intra-abdominal fat area (VA) in metabolic syndrome (MS) and the relationship between VA and the detection rate of metabolic syndrome (MS). Methods The intra-abdominal fat area of 564 patients with metabolic syndrome, diabetes mellitus and hypertension was detected by spiral CT. The VA critical points of metabolic syndrome and its components were estimated by ROC working curve and quartile method respectively, and the corresponding simple body fat parameters included body mass index (BMI), abdominal circumference (WC) and waist-hip ratio (WHR), and the detection rate of metabolic syndrome under different VA areas. Results (1) The VA concentrated between 70 and 72 cm2 in female patients with dyslipidemia, abdominal obesity and metabolic syndrome, while the VA mostly ranged between 91 and 107 cm2 in male patients with the above metabolic disorders, and no corresponding VA cutting points were found for hyperglycemia and hypertension. (2) In female patients with metabolic disorders, the abdominal circumference was between 82 and 84 cm, and the BMI was between 24 and 25 kg/m2; (3) The detection rate of metabolic syndrome was 16.9%, 49.4%, 72.7% and 87.5% when VA was 70 cm2, 71-101 cm2, 102-133 cm2 and ≥134 cm2, respectively. The detection rate of metabolic syndrome was significantly higher when VA was ≥70 cm2 (P<0.01); The detection rate of metabolic syndrome was 7.7%, 44.0%, 67.2% and 87.5% when VA was<55 cm2, 55~84cm2, 85~104 cm2 and ≥105 cm2, respectively. The detection rate of metabolic syndrome was significantly higher when VA was ≥55 cm2 (P<0.01). Conclusion There is sex difference in the accumulation of intraabdominal fat in patients with metabolic syndrome; In the critical overweight or overweight stage, that is, intraabdominal fat accumulation and accumulation of various metabolic disorders have occurred; With the increase of intraabdominal fat content, the clinical detection rate of metabolic syndrome increased significantly.

Objective to investigate the changes of C-reactive protein (CRP) level and the risk of metabolic syndrome (MS) and its related components. Methods Baseline epidemiological data of metabolic syndrome and its related diseases in Huayang and Caoyang communities of Shanghai were collected from 1998 to 2001. 5502 patients (2379 males and 3123 females) over 20 years old with complete body fat parameters, blood pressure, blood lipid, insulin and CRP were included in this analysis. The diagnostic criteria of metabolic syndrome and its related components were determined by WHO working definition of metabolic syndrome in 1999. Rate scattering nephelometry was used to determine high sensitivity C-reactive protein. Results (1) The prevalence of metabolic syndrome and its components in this community was 21.63% of hyperglycemia (9.21% of diabetes mellitus, 12.41% of abnormal glucose regulation), 32.95% of hypertension, 46.04% of hypertriglyceride (TG) /low high density lipoprotein cholesterol (HDL-C), 40.68% of central obesity and 13.98% of metabolic syndrome The CRP level in MS subgroup was significantly higher than that in 1-2 metabolic abnormalities subgroup (P<0.01). The occurrence of metabolic syndrome increased with the increase of CRP level (trend analysis P<0.001). (4) Logistic regression analysis was performed on CRP scores or quartiles in male and female populations, with MS components and MS as strain variables and CRP distribution loci as independent variables. Compared with those with CRP in the lower 1/4 loci, the increased risk of metabolic abnormalities in patients with CRP in the upper 1/4 loci was as follows: 3.8 times of hyperglycemia, 2.8 times of hypertension, 1.3 times of high TG, 1.5 times of low HDL-C, 5.5 times of central obesity and 10.0 times of MS in males, 7.7 times of hyperglycemia, 6.1 times of hypertension, 3.6 times of high TG, 1.1 times of low HDL-C, 2.2 times of central obesity and 8.6 times of MS in females. Conclusion (1) CRP level is related to aging, the older the age, the higher the CRP level; (2) The higher the number of metabolic abnormalities in the same individual, the higher the CRP level; (3) The frequency of metabolic syndrome increased with the increase of CRP level; The risk of hyperglycemia, dyslipidemia, hypertension, central obesity and metabolic syndrome was significantly increased in males with CRP levels greater than 2.11mg/L and females with CRP levels greater than 2.22mg/L.

Objective to analyze the relationship between physical activity intensity, activity time and metabolic syndrome.Methods The total target of the 2002 nutrition and health survey of Chinese residents was 31 provinces, autonomous regions and municipalities, and a multi-stage stratified cluster random sampling method was adopted. The survey was carried out in 2002, including inquiry survey, medical examination, laboratory examination and dietary survey. 50 494 people completed the physical activity survey and measured fast fasting blood glucose OR 2 hours postprandial blood glucose, body mass index, high density lipoprotein cholesterol and triglyceride. The physical activity was graded and the activity time was grouped according to Gang and CDC adult exercise recommendations. Results After adjusting the effects of gender, age, smoking and drinking, the incidence of metabolic syndrome was reduced by 60% (95% CI: 0.362~0.443) in those with high physical activity rating compared with those with low physical activity rating (95% CI: 0.362~0.443). The risk of metabolic syndrome was slightly reduced in those with moderate physical activity of 151~300 min/week compared with that of 90~150 min/week (OR =0.935, 95% CI: 0.685~1.277), but the risk of metabolic syndrome was increased when the activity exceeded 300 min/week (OR = The occurrence of metabolic syndrome was reduced by 35% (95% CI: 0.451-0.933) in patients with low intensity physical activity of 301-420 min/week compared with 90-150 min/week, and the risk of metabolic syndrome was reduced when it exceeded 420 min/week, but the difference was not statistically significant (OR =0.871, 95% CI: 0.643-1.181). The occurrence of metabolic syndrome was reduced by 25% in patients with high intensity physical activity of more than 150 min/week compared with 10-60 min/week (95% CI: 0.603-0.951). Conclusion The weekly exercise time of low intensity physical activity of 301-420 min, moderate intensity physical activity of 90-300 min and high intensity physical activity of more than 150 min/week is helpful to reduce the risk of metabolic syndrome.

Objective to investigate the prevalence of metabolic syndrome (MS) in patients with coronary heart disease in China. Methods Fifty-two tertiary hospitals in 7 cities including northern cities (Beijing, Tianjin), central cities (Shanghai, Nanjing, Hangzhou, Wuhan) and southern cities (Guangzhou) were selected as cooperative research centers. From June 1, 2005 to September 31, 2005, all inpatients who met the inclusion criteria for coronary heart disease diagnosis were selected as the research subjects. A total of 3513 valid cases were collected. The investigation contents included: anthropometric data, coronary heart disease diagnosis, risk factors, glucose metabolism and blood lipid metabolism. Results According to the diagnostic criteria of MS of Diabetes Branch of Chinese Medical Association, the number of MS patients with coronary heart disease was 1064 (30.4%), 638 (27.4%) and 426 (36.4%), respectively. There was no significant difference in the prevalence of MS between different admission methods and different types of coronary heart disease (P =0.139, 0.446). The prevalence of MS in patients with coronary heart disease was 576 (36.5%), 375 (25.5%) and 113 (5.1%). The trend test showed a decreasing trend from north to south (x2=50.252, P<0.001). The trend x2 test showed that the prevalence of MS in patients with coronary heart disease showed an obvious trend of age, and the prevalence of MS increased with the increase of age (x2=23.625, P<0.001). The prevalence of MS was higher in males than females before the age of 60, and higher in females than males after the age of 60, and increased rapidly.

A 42-year-old male was admitted to the hospital on November 5, 2004 due to episodic flushing, sweating with increased blood pressure for 3 months. Three months ago, he experienced excessive sweating, flushing with fatigue after breakfast many times, and improved after rest. The blood pressure measured was 150~160/95~100 mm Hg (1 mm Hg =0.133kPa), unconsciousness, convulsions, no episodic severe headache, palpitations, no fever, abdominal pain, abdominal distension, no loss of appetite or weight loss, and took traditional Chinese medicine to reduce blood pressure, but the blood pressure control was not satisfactory. CT examination in the local hospital suggested that pheochromocytoma was possible, so he was referred to our hospital with hypertension and pheochromocytoma to be admitted to the endocrinology department. Past history: 11 years ago, he underwent splenectomy due to spleen rupture in a car accident.

A 53-year-old male was admitted to hospital with complaints of intermittent cough and shortness of breath for more than 2 years. There was no enlargement of superficial lymph nodes throughout the body, no abnormality in cardiopulmonary examination, and no abnormality in abdominal examination. Serum angiotensin converting enzyme (SACE) was 63.1 kU/L, and the tuberculin test (pure protein derivative PPD) was negative. Chest high-resolution CT showed multiple miliary and patchy shadows in both lungs, nodular thickening of interlobular septum, especially in both upper lungs (Figure 1), and multiple lymph nodes in mediastinum (Figure 2). Pulmonary function showed normal ventilatory function and normal diffusion function. Bronchoscopy showed congestion and edema in the left bronchial mucosa, and several thalamic nodules in the bronchial mucosa of the upper tongue. Bronchoalveolar lavage cell classification showed macrophages 42%, lymphocytes 57%, neutrophils 1%. Bronchoscopic mucosal biopsy showed non-caseous granuloma, and acid-fast staining was negative. The diagnosis was sarcoidosis stage II.

Hyperglycemia is the basic characteristic of diabetes mellitus, and its damage to tissues and organs of the body is mainly manifested by chronic persistence and fluctuation of blood glucose level.Recent studies have shown that the occurrence and development of chronic complications of diabetes mellitus are closely related not only to the overall blood glucose level, but also to the glycemic stability.Therefore, the clinical evaluation of blood glucose stability and its relationship with complications have become one of the hotspots of diabetic research at present.

Reducing the risk of cardiovascular disease by advocating a healthy diet and lifestyle is an important initiative of the American Heart Association (AHA).

Stem cells have attracted much attention from medical practitioners because of their powerful differentiation ability. In REPAIR-AMI (reinfusion of enriched progenitor cells and infarct remodeling in acute myocardial infarction) In the experiment, transplantation of autologous progenitor cells in patients with acute myocardial infarction can significantly increase left ventricular ejection fraction.

With the prolongation of time, the metabolism of red blood cells is exhausted, and the isolated blood cannot be stored forever. The application of new storage agents in 1980s prolonged the blood storage period to 2 times the initial period, which is close to 42 d. However, during the storage process, red blood cells undergo countless changes. With the prolongation of time, red blood cells become rigid, and the time through the capillary network is prolonged, and they cannot effectively release the oxygen carried by them. The clinical relevance of this change or storage harm is still unclear. Elliott Bennett-Guerrero, who is in charge of perioperative clinical research at Duke University Medical Research Institute, North Carolina, USA, conducted this research and published in June 22, 2006<Their findings were published in the journal Anesthesia and Analgesia.

Jaundice in liver malignant tumors usually appears in late stage, mostly due to extensive tumor spread, hepatic hilar invasion, severe cirrhosis, and gradual failure of liver function. Such patients generally have poor prognosis, more than death in a short time. In recent years, the literature recognizes that some patients with obstructive jaundice caused by bile duct tumor thrombus of liver malignant tumors can benefit from surgical treatment, obtain symptom relief, long-term survival, and even occasionally get radical cure [1-3]. Therefore, it is of great significance to re-distinguish and recognize these patients. We retrospectively analyzed the surgical treatment methods of 13 patients with obstructive jaundice caused by bile duct tumor thrombus of liver malignant tumors from 1999 to 2004, and the impact of surgical treatment on prognosis.

Hepatitis E (Hepatitis E) is one of the common viral hepatitis in clinical practice, mainly prevalent in developing countries. Serological investigation of 2548 cases of acute sporadic viral hepatitis in 17 cities in China showed that Hepatitis E accounted for 3.4% ~26.3%, with an average of 9.7% [1]. It is reported at home and abroad that this disease is acute self-limiting infection with good prognosis.

Gastric cancer is the most common digestive tract tumor in China, accounting for the first mortality rate of malignant tumors.The occurrence and development of gastric cancer is a complex process of multi-factors,multi-genes.At present, many gastric cancer-related genes have been discovered,such as RAS gene,MYC gene,ERBB gene,p53 and RB gene,etc. [1,2]. Apoptosis is closely related to the occurrence and development of tumor,and is an important cause of tumor drug resistance and side effects of chemotherapy and radiotherapy [3]. It has been found that there are many abnormalities of apoptosis genes.Human Apaf-1 gene is located in chromosome 12q23,Apaf-l and Casp9 are downstream components of p53 in c-myc-induced apoptosis of tumor cells, and participate in mitochondria-mediated apoptosis pathway [4,5]. This experiment studied the expression of Apaf-1 gene in gastric cancer, and explored the relationship between this gene and the occurrence, development and prognosis of gastric cancer.

Chronic hepatitis and liver cirrhosis are serious diseases that affect human health. In the past, the imaging studies of chronic liver disease focused on gross morphology, but magnetic resonance functional imaging was not much done. The study of assessing portal vein flow by phase contrast (PC) and the controlled study of serum markers of liver fibrosis (considered by many experts in liver fibrosis as a good tool as the "gold standard" of liver biopsy [1]) are rarely reported.

A 72-year-old male was admitted to the hospital with "recurrent right upper abdominal pain for 9 years and aggravated for 1 month". Nine years ago, he had recurrent dull right upper abdominal pain, which was more frequent than after eating greasy food. At that time, B-ultrasound diagnosed "gallbladder stones", and the symptoms relapsed in the past one month, accompanied by nausea and vomiting. He was admitted to the hospital with Mirizzi syndrome, chronic calculous cholecystitis and common bile duct stones.

The patient was a male, 2 years old and 6 months old. He was in good health in the past. The difficulty in walking gradually worsened. He was hospitalized in the neurology department for 6 months. The lower limbs were obviously stiff, and he was easy to fall backward when walking, without abdominal pain, fever, nausea, vomiting or jaundice. Abnormal signals in the white matter were found by cranial magnetic resonance imaging (MRI), which was suspected of leukodystrophy. Therefore, a series of systemic examinations were performed.

A 16-year-old male was admitted to the hospital in July 2005 for "dry mouth, polydipsia and polyuria for 1 year". The patient was admitted to the hospital for the first time in September 2004 for polydipsia and polyuria with urine volume of 7000~10000 ml/d. He was diagnosed as "idiopathic central diabetes insipidus and subclinical hypothyroidism" by water-free pressurization test and related laboratory tests. He was given micing and levothyroxine, and his condition improved once. He stopped using micing on his own 4 months ago and only took levothyroxine 50 μ g/d since then. At the time of admission, he suffered from loss of appetite, constipation, morning nausea and no vomiting.