中华内科杂志最新文献

{"title":"[Clinical practice guidelines for adult patients with IgA nephropathy and IgA vasculitis-associated nephritis in China (2025)].","authors":"","doi":"10.3760/cma.j.cn112138-20250707-00396","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250707-00396","url":null,"abstract":"<p><p>IgA nephropathy (IgAN) is the most common primary glomerular disease in China and a leading cause of end-stage renal disease (uremia) in young adults. The diagnosis, prognostic assessment, and treatment strategies for IgAN and IgA vasculitis with nephritis (IgAVN) have been comprehensively evaluated by the Scientific Committee of the China IgA Nephropathy Network (IIgANN-China) and the Chinese Preventive Medicine Association's Committee for the Prevention and Control of Kidney Diseases based on recent literature and evidence-based medicine. As a result, clinical practice guidelines specifically tailored to Chinese patients have been developed. These guidelines introduce an integrated therapeutic framework that incorporates risk-stratified treatment, targeting both immune-mediated renal injury and chronic kidney disease progression, as well as stage-specific treatment, including both the induction and maintenance phases. The aim is to provide standardized guidance and practical recommendations for the clinical management of IgAN and IgAVN in China.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"918-944"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Attitudes and factors influencing insulin use among community-based patients with type 2 diabetes].","authors":"Y X Liu, J H Tian, C Cai, P P Bao, W P Jia","doi":"10.3760/cma.j.cn112138-20250603-00324","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250603-00324","url":null,"abstract":"<p><p><b>Objective:</b> To assess the attitudes toward and factors influencing starting insulin use among community-based patients with type 2 diabetes (T2D). <b>Methods:</b> A cross- sectional study. This secondary analysis used baseline data from patients with T2D recruited through convenience sampling from a community-based peer support intervention study implemented in nine community health service centers in Shanghai since 2017. Attitudes toward insulin use were assessed using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ); the higher the score, the more negative the attitude toward starting insulin use. Multiple linear regression was used to analyze the factors influencing attitudes toward starting insulin use. <b>Results:</b> A total of 336 patients with T2D were included in the survey. The patients had a mean age of (67.7±7.9) years, mean disease duration of (13.62±7.73) years, relatively low levels of depression [Patient Health Questionnaire 8 (PHQ-8): 2 (0, 5)] and diabetes distress [Diabetes Distress Scale 4 (DDS-4): 1.97±0.95], and suboptimal target achieving rates of risk factors including body mass index, blood pressure, blood glucose, and lipid levels. The total score on the Ch-ASIQ among all patients was 1.84±0.55. Multivariate analyses showed that refusing insulin use was positively significantly associated with higher scores on the Ch-ASIQ and the three sub-dimensions of \"Factors promoting self-efficacy,\" \"Fear of pain or needles,\" and \"Time and family support\" [<i>β</i> (95%<i>CI</i>): 0.515 (0.355-0.674), 0.728 (0.470-0.986), 0.273 (0.030-0.515), 0.909 (0.606-1.213), all <i>P</i><0.05]. In addition, disease duration [<i>β</i> (95%<i>CI</i>):-0.011 (-0.019 to -0.004)] was independently negatively associated with the Ch-ASIQ score. In comparison, age [<i>β</i> (95%<i>CI</i>): 0.011 (0.003-0.018)], DDS-4 [0.129 (0.069-0.190)], and PHQ-8 [0.015 (0.000-0.029)] were independently positively associated with the Ch-ASIQ score (all <i>P</i><0.05). There were slight differences in the factors influencing the four sub-dimensions of the Ch-ASIQ scale. <b>Conclusions:</b> Community-based patients with T2D had moderate negative attitudes toward starting insulin treatment. Refusing insulin use, shorter diabetes duration, older age, higher diabetes distress, and higher levels of depression were associated with higher negative attitudes towards starting insulin use.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"971-976"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The 512th case: fever, cough, acute kidney injury].","authors":"X C Yu, H X Li, M T Chen, N Ma, K He, J Sun, J N Niu, Q Wang, P Xia","doi":"10.3760/cma.j.cn112138-20250706-00391","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250706-00391","url":null,"abstract":"<p><p>A 70-year-old female patient presented with fatigue and edema for 3 months and was found to have elevated serum creatinine for 3 weeks. During the course of the disease, she had fever and cough. Examinations revealed multiple ground-glass opacities in both lungs and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibodies (ANCA), leading to a diagnosis of ANCA-associated vasculitis. The patient's condition initially improved after pulse glucocorticoid therapy combined with cyclophosphamide. During treatment, however, the patient developed hematochezia, and colonoscopy revealed multiple colonic ulcers. Immunohistochemistry of colonic mucosal biopsy confirmed cytomegalovirus (CMV) positivity, establishing a diagnosis of CMV colitis. The patient was found to have concurrent <i>Clostridioides</i> <i>difficile</i> and pulmonary infections. During the disease course, the patient also developed deep vein thrombosis and roxadustat-associated central hypothyroidism. Given the presence of multiple comorbidities, rituximab was subsequently used for vasculitis treatment, resulting in sustained remission. This case highlights the importance of highly individualized treatment strategies for older patients with vasculitis, requiring adjustment of immunosuppressive therapy intensity based on disease progression.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"1017-1022"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[An adult case of pseudotumor-like overlapping syndrome of MOG antibody-related disease and NMDAR encephalitis].","authors":"H L Jiang, Y Ding, H Wei, C J Li, Y N Gao, L J Guo, Y Guo","doi":"10.3760/cma.j.cn112138-20240930-00636","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240930-00636","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"992-996"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical analysis of a motor neuron disease-like phenotype associated with anti-IgLON5 disease].","authors":"Y Guo, C J Li, H Wei, Y Ding, L J Guo, Y N Gao","doi":"10.3760/cma.j.cn112138-20241018-00695","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241018-00695","url":null,"abstract":"<p><p>We report a case of anti-IgLON5 disease with a motor neuron disease-like presentation admitted to the Department of Neurology, Xuanwu Hospital, Capital Medical University in July 2021. The patient was a 71-year-old female who presented with the chief complaint of limb weakness persisting for 4 months. She showed progressive limb weakness accompanied by muscle atrophy. Electromyography (EMG) revealed extensive neurogenic damage. Initial serum evaluation for neural-specific autoantibodies was positive for IgLON5-Ab (1∶100). Repeat testing confirmed IgLON5-Ab positivity with a titer of 1∶1 000. The patient was diagnosed with anti-IgLON5 disease and treated with methylprednisolone and immunoglobulin, leading to clinical improvement. We found four relevant articles reporting a total of 11 similar cases. Thus, in this study, we analyzed a total of 12 cases, including our patient. Based on their clinical manifestations, these cases can be categorized into two types: amyotrophic lateral sclerosis(ALS)type and isolated bulbar type. Six cases-three males and three females-presented with the ALS type. Of these, three cases had diffuse limb weakness accompanied by muscle atrophy(two cases had diffuse hyperreflexia and one had a normal tendon reflex); one case presented with neck extensor weakness and bilateral asymmetric upper extremity weakness and was hyperreflexic at the bilateral patellar tendons; one case displayed asymmetric weakness in both lower limbs with normal deep reflexes, and one case exhibited neck weakness with hyperreflexia. EMG revealed diffuse lower motor neuron disease involving two or three regions. All patients tested positive for serum anti-IgLON5 antibodies. Four were also positive for anti-IgLON5 antibodies in cerebrospinal fluid, two were negative, and six were not tested. Among the 11 patients who received immunotherapy, 4 showed partial improvement in clinical symptoms, 2 exhibited transient improvement, 2 remained stable, and 3 showed no improvement. Testing for IgLON5-Ab should be considered among patients presenting with bulbar symptoms or ALS-like features, especially those with acute or subacute onset, rapid progression, autonomic dysfunction, vocal cord paralysis requiring tracheotomy, cognitive impairment, or involuntary movements. Early diagnosis and treatment may improve clinical symptoms and reduce adverse outcomes.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"977-983"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of osteopetrosis type Ⅱ presenting with anemia, splenomegaly, and thrombocytopenia].","authors":"M T Chen, X X Shi, L J Cui, M S Ma, W Zhang, X X Cao, D B Zhou, C Wei","doi":"10.3760/cma.j.cn112138-20250516-00287","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250516-00287","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"988-991"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of xanthogranulomatous pyelonephritis associated with immunological abnormality and severe pulmonary infection].","authors":"J Xing, D Chen, Y C Han, F M Wang, X L Zhang, B C Liu","doi":"10.3760/cma.j.cn112138-20250512-00271","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250512-00271","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"984-987"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Genetic and epigenetic mechanisms of insomnia].","authors":"T T Zhang, Y P Wang","doi":"10.3760/cma.j.cn112138-20250529-00314","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250529-00314","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"1003-1009"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interpretation of the clinical practice guidelines for adult patients with IgA nephropathy and IgA vasculitis-associated nephritis in China (2025)].","authors":"S F Shi, J C Lyu, H Zhang","doi":"10.3760/cma.j.cn112138-20250813-00481","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250813-00481","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"914-917"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of pre-dialysis blood pressure on all-cause and cardiovascular disease mortality in patients on maintenance hemodialysis].","authors":"C F Wang, B Pan, X S Xie, C P Xu, J H Chen, P Zhang","doi":"10.3760/cma.j.cn112138-20250307-00130","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250307-00130","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the effect of pre-dialysis blood pressure (Pre-BP) on all-cause and cardiovascular disease (CVD) mortality in patients on maintenance hemodialysis (MHD). <b>Methods:</b> This single-center, retrospective cohort study enrolled patients undergoing first-time hemodialysis between January 1, 2007, and June 30, 2021, from the dialysis registry of the First Affiliated Hospital, Zhejiang University School of Medicine. General information and laboratory parameters were collected. Pre-dialysis systolic blood pressure (Pre-SBP) and pre-dialysis diastolic blood pressure (Pre-DBP) were calculated and averaged at 4-6 months after dialysis. The mean Pre-SBP and Pre-DBP values were used as continuous variables, and restricted cubic spline (RCS) curves were used to assess the relationship between Pre-BP and mortality risk. Patients were subsequently divided into six groups for Pre-DBP and six groups for Pre-SBP combined with Pre-DBP. Survival analyses were performed using the Kaplan-Meier method. All-cause and CVD mortality were compared between groups using the log-rank test. Multivariate Cox regression models were used to analyze the associations between Pre-BP and all-cause and CVD mortality. <b>Results:</b> A total of 1 213 patients were enrolled. By the end of follow-up, 175 patients (14.4%) had died, of whom 62 (35.4%) died from CVD. Kaplan-Meier survival curves showed that the Pre-DBP<65 mmHg group (1 mmHg=0.133 kPa) had a significantly lower cumulative survival rate (<i>χ</i>²=90.52, <i>P</i><0.001) and a significantly higher CVD mortality rate (<i>χ</i>²=35.54, <i>P</i><0.001) than the other groups. The combined Pre-SBP and Pre-DBP analysis showed that the Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg groups had a significantly lower cumulative survival rate (<i>χ</i>²=45.58, <i>P</i><0.001) and a significantly higher CVD mortality rate (<i>χ</i>²=30.13, <i>P</i><0.001) than the other groups. Multivariate Cox regression model analysis showed that compared with other groups, the risk of MHD all-cause mortality was increased in the Pre-DBP<65 mmHg group and the Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg group [<i>HR</i> (95%<i>CI</i>)=1.927 (1.195-3.109), 3.298 (1.567-6.939), both <i>P</i><0.05]. <b>Conclusion:</b> In patients undergoing MHD, Pre-DBP<65 mmHg or Pre-SBP≥150 mmHg and Pre-DBP<80 mmHg were independent risk factors for all-cause mortality, with a low cumulative survival rate and a high risk of CVD mortality.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 10","pages":"945-953"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}