Xiao-hong Shi

Association of single-nucleotide polymorphisms in the STAT3 gene with autoimmune thyroid disease in Chinese individuals.

The aim of this study was to investigate the association between signal transducer and activator of transcription 3 (STAT3) polymorphisms and autoimmune thyroid diseases and clinical features. We genotyped six single-nucleotide polymorphisms (SNPs) rs1053005, rs2293152, rs744166, rs17593222, rs2291281, and rs2291282 of STAT3 gene in 667 patients with autoimmune thyroid disease (417 Graves’ disease (GD) and 250 Hashimoto’s thyroiditis (HT)) and 301 healthy controls. The allele A from rs1053005 was significantly less frequent in both GD and HT patients (P = 0.0024, OR = 0.6958, 95%CI = 0.5508–0.8788; P = 0.0091, OR = 0.7013, 95%CI = 0.5397–0.9112, respectively). The AA genotype of rs1053005 was less in GD and HT patients too (P = 0.0025,OR = 0.6278, 95%CI = 0.466–0.847) and (P = 0.0036,OR = 0.601, 95%CI = 0.428–0.843). The allele G from rs17593222 increased the susceptibility to the ophthalmopathy development both in autoimmune thyroid disease (AITD) and GD patients (P = 0.0007, OR = 3.980, 95%CI = 1.871–8.464; P = 0.0081, OR = 3.378, 95%CI = 1.441–7.919, respectively). The allele A and AA genotype of SNP rs1053005 may protect individuals from the susceptibility to AITD and their frequency decreased in AITD patients. In addition, the allele G of rs17593222 may increase the ophthalmopathy risk in AITD patients. Our findings suggest the existence of association between STAT3 gene and AITD, thus adding STAT3 gene to the list of the predisposing genes to AITD.

Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis.

BackgroundDiabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed.MethodsRandomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911.Results42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60–0.90, P = 0.003; absolute risk difference: −0.8 %, 95 %CI −1.4 to −0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46–0.96, P = 0.02; I2 = 0 %) and 0.64 (95 % CI 0.47– 0.88, P = 0.005; I2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44–0.82, P = 0.001; I2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer).ConclusionsThe available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.

Association between STAT4 Gene Polymorphisms and Autoimmune Thyroid Diseases in a Chinese Population

The STAT4 gene encodes a transcriptional factor that transmits signals induced by several key cytokines which play important roles in the development of autoimmune diseases. The aim of this study was to explore the association of STAT4 polymorphism with Graves’ disease (GD) and Hashimoto’s thyroiditis (HT). A total of 1048 autoimmune thyroid diseases (AITDs) patients (693 with GD and 355 with HT) and 909 age- and gender-matched controls were examined. STAT4 polymorphisms (rs7574865/rs10181656/rs7572482) were genotyped by multiplex polymerase chain reaction (PCR) and ligase detection reaction (LDR). The results indicated that the frequencies of rs7574865 genotypes in patients with GD differed significantly from the controls (p = 0.028), the T allele frequency of GD patients was also significantly higher than the controls (p = 0.020). The genotypes of rs10181656 differed significantly in GD patients from controls (p = 0.012); G allele frequencies were significantly higher in AITD patients than the controls (p = 0.014 and 0.031, respectively). The frequencies of haplotype GC with GD and HT patients were significantly lower than their controls (p = 0.015 and 0.030, respectively). In contrast, the frequencies of haplotype TG with GD and HT patients were significantly higher than their controls (p = 0.016 and 0.048, respectively). These findings strongly suggest that STAT4 rs7574865/rs10181656 polymorphisms increase the risk of AITD in a Chinese population.

Non-thyroidal illness syndrome in patients with cardiovascular diseases: A systematic review and meta-analysis

BACKGROUND Non-thyroidal illness syndrome (NTIS) is characterized by decreased serum triiodothyronine level without increased thyroid-stimulating hormone level during critical illness. The summary data on the prevalence of NTIS in cardiovascular patients are lacking, and its prognostic role in cardiovascular patients is also unclear. METHODS We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of NTIS in cardiovascular patients. The prevalence of NTIS was pooled using random-effect meta-analysis and the hazard ratios (HRs) for all-cause mortality, cardiac mortality and major adverse cardiovascular events (MACE) were also pooled. RESULTS Forty-one studies were finally included. The pooled prevalence of NTIS in cardiovascular patients was 21.7% (95% CI 18.4%-25.3%). Subgroup by the types of cardiovascular diseases showed the prevalence of NTIS was highest in patients with heart failure (24.5%), followed by acute myocardial infarction (18.9%) and acute coronary syndrome (17.1%). Meta-analysis of studies using strict diagnostic criteria of NITS showed that the pooled prevalence of NTIS in cardiovascular patients was 17.6% (95% CI 14.5%-21.2%). NTIS was independently associated with increased risks of all-cause mortality (HR=2.52, 95% CI 1.87-3.40, P<0.001) and cardiac mortality (HR=2.06, 95% CI 1.58-2.69, P<0.001) in cardiovascular patients. NTIS was also an independent predictor of MACE in cardiovascular patients (HR=1.73, 95% CI 1.32-2.26, P<0.001). CONCLUSION NTIS is very common in patients with cardiovascular diseases. NTIS is an independent prognostic factor in cardiovascular patients and is associated with increased risks of all-cause mortality, cardiac mortality and MACE.

Polymorphisms of CLEC16A Region and Autoimmune Thyroid Diseases

To investigate the association of CLEC16A gene polymorphisms and autoimmune thyroid diseases (AITDs). Six hundred sixty seven Han Chinese patients with AITDs were selected as study subjects, including 417 patients with Graves’ disease (GD), 250 patients with Hashimoto’s thyroiditis (HT) and 301 healthy control patients. Polymerase chain reaction-restriction fragment length polymorphism (RFLP) and the mass spectrometry technique were used to genotype five CLEC16A single-nucleotide polymorphisms (SNPs) (rs12708716, rs12917716, rs12931878, rs2903692, and rs6498169). Higher frequency of G allele of rs6498169 CLEC16A gene in AITDs patients [P = 0.029, odds ratio (OR) 1.29 and 95% confidence interval 1.022−1.505] was observed. In addition an association between rs6498169 and HT was observed with statistical significance (P = 0.018, OR 1.335, 95% confidence interval 1.051−1.696). Furthermore, the GG haplotype containing the major allele of (rs12708716 and rs6498169) was associated with an increased risk of HT (P = 0.0148, OR 1.344). When patients with HT and controls were compared, results from the dominant and recessive models showed that the genotype frequency of rs6498169 were at borderline levels (P = 0.054 and P = 0.05), and the other four SNPs of CLEC16A gene showed no significant association with AITDs. Our results suggest that polymorphisms rs6498169 of CLEC16A gene confers susceptibility to AITDs. We therefore disclose for the first time the association of rs6498169 SNP with AITDs.

Lack of association between polymorphisms in the UBASH3A gene and autoimmune thyroid disease: a case control study

OBJECTIVE The aim of this study was to investigate UBASH3A gene variation association with autoimmune thyroid disease and clinical features in a Chinese Han population. SUBJECTS AND METHODS A total of 667 AITD patients (417 GD and 250 HT) and 301 healthy controls were genotyped for two single nucleotide polymorphisms (SNPs) rs11203203, rs3788013 of UBASH3A gene, utilizing the Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometer (MALDI-TOF-MS) Platform. RESULTS Between the control group and AITD, GD and HT group, no statistically significant difference was observed in the genotypic and allelic frequencies of the two SNPs. There was no significant difference in allelic frequencies of the two SNPs between GD with and without ophthalmopathy. There was no significant difference in haplotype distributions between the control group and AITD, GD or HT group. CONCLUSION Rs11203203 and rs3788013 in UBASH3A gene may not be associated with AITD patients in Chinese Han population.

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

BACKGROUND Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. METHODS PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. RESULTS 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. CONCLUSION This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed.

Prevalence and independent risk factors of depression in Chinese patients with type 2 diabetes: a systematic review and meta-analysis

Abstract Background Studies of the prevalence of depression in patients with type 2 diabetes in China have reported inconsistent findings. The purpose of this study was to assess the prevalence and independent risk factors of depression in patients with type 2 diabetes in China. Methods We did a systematic review and meta-analysis of papers published in PubMed (1980–2016), Embase (1980–2016), China National Knowledge Infrastructure (1999–2016), and Wanfang Medical database (1998–2016). We selected population-based, cross-sectional studies investigating the prevalence of depression in patients with type 2 diabetes in China. We used a random-effects meta-analysis to pool the prevalence and relative risks (RR) with 95% CIs. This study was registered at PROSPERO, number CRD42016039795. Findings 26 studies published between May, 2003, and February, 2016, were included. The studies included 66 475 patients with type 2 diabetes in China. A meta-analysis of six studies comparing the depression prevalence in diabetes patients and healthy controls suggested that type 2 diabetes was associated with a doubled risk of depression in Chinese people (RR 2·06; 95% CI 1·46–2·92; p 1c (RR 1·44, 95% CI 1·11–1·88; p=0·0068), and use of insulin (RR 2·08, 95% CI 1·28–3·37; p=0·0030). Interpretation We found a high prevalence of depression in Chinese patients with type 2 diabetes. Patients with diabetes and depression should receive more attention than at present in the medical settings of China and effective interventions to decrease depression risk in patients with diabetes are needed. Funding National Natural Science Foundation of China (number 81471004).

Incidence and temporal trends of type 1 diabetes in China: a systematic review and meta-analysis

Abstract Background Studies of type 1 diabetes incidence in China have conflicting findings, and the epidemiology of type 1 diabetes in China is unclear. We aimed to assess the incidence and epidemiology of type 1 diabetes in relation to age, sex, and geographical area in mainland China. Methods In this systematic review and meta-analysis, we searched Pubmed (Jan 1, 1980, to May 18, 2016), Embase (Jan 1, 1980 to May 18, 2016), China National Knowledge Infrastructure (Jan 1, 1999, to May 20, 2016), and Wanfang Medical Database (Jan 1, 1998, to May 19, 2016) to identify population-based studies of type 1 diabetes incidence in mainland China. Only population-based studies with data on the incidence of type 1 diabetes in mainland China were included, and studies with overlapping data from included studies were excluded. We extracted data from the published reports and used random-effects meta-analysis to pool the incidence and incidence rate ratios (IRRs) with 95% CIs. We used the Q statistic and I 2 method to assess heterogeneity, and also did subgroup analyses by sex, age, and geographical area. Additionally, we used time trends to explore the difference in incidence over time. This study is registered with PROSPERO, number CRD42016039284. Findings We identified 816 reports from the search and included 19 reports of population-based studies published between 1994 and 2015 in the analysis. Overall incidence of type 1 diabetes in mainland China was 0·74 (95% CI 0·55–1·00) per 100 000 person-years between 1980 and 2013. Incidence (per 100 000 person-years) increased rapidly from 0·57 (0·43–0·75) in 1990 to 1·04 (0·64–1·68) in 2000 and 3·36 (1·66–6·82) in 2010 (p Interpretation To our knowledge, this is the first systematic review and meta-analysis to confirm the increasing incidence of type 1 diabetes over time in mainland China. Obvious disparities in incidence by sex, age, and geographical areas exist. Funding National Natural Science Foundation of China (81471004).

Prevalence of latent autoimmune diabetes in adults in China: a systematic review and meta-analysis

Abstract Background Studies of the prevalence of latent autoimmune diabetes in adults in China have reported inconsistent findings. We did a systematic review and meta-analysis to estimate the prevalence of latent autoimmune diabetes in adults in China. Methods For the systematic review, we searched PubMed, Embase, China Knowledge Resource Integrated Database, and Wanfang Medicine Database to identify studies investigating the prevalence of latent autoimmune diabetes in adults in China. In our meta-analysis we included hospital-based studies that recruited patients with newly diagnosed (less than 1 year from diagnosis) type 2 diabetes or population-based studies, which assessed the prevalence of latent autoimmune diabetes in adults in China and used a radioimmunoassay to test for glutamic acid decarboxylase autoantibodies. Subgroup analyses were done by study design, sex, and types of autoantibodies. Random-effects meta-analysis was used to pool the prevalence rate with 95% CIs. Ethical approval was granted by the ethical committee of our hospital This study was registered at PROSPERO, number CRD42016040163. Findings 12 studies with a total of 21 576 individuals were included. There were three population-based studies and nine hospital-based studies recruiting patients with newly diagnosed types 2 diabetes. The meta-analysis of 12 studies showed that the prevalence of latent autoimmune diabetes in adults in Chinese patients with type 2 diabetes was 7·4% (95% CI 6·5–8·5; 21 576 participants from 12 studies), which was similar to that in white populations (6·8%, 5·6–8·3; 28 415 participants from 15 studies). The prevalence of latent autoimmune diabetes in adults from the population-based studies was 6·7% (95% CI 5·4–8·3; 12 144 participants from three studies) and the prevalence of latent autoimmune diabetes in adults from hospital-based studies was 7·8% (6·9–8·8; 9432 participants from nine studies). The prevalence of latent autoimmune diabetes in adults in men was 7·9% (95% CI 6·2–10·0; 10 947 participants from ten studies) and in women was 7·0% (5·7–8·5; 9440 participants from ten studies). Subgroup analysis by types of autoantibodies suggested that glutamic acid decarboxylase autoantibodies was the highest prevalence (5·9%, 95% CI 5·2–6·8; 24 068 participants from 12 studies), followed by islet cell antibodies (2·4%, 1·5–3·8; 678 participants from two studies), insulin autoantibodies (2·1%, 1·4–3·2; 6559 participants from six studies), zinc transporter type 8 antibodies (1·7%, 1·5–2·1; 7059 participants from two studies), and protein tyrosine phosphatase-like IA-2 autoantibodies (1·7%, 1·2–2·4; 16 748 participants from 5 studies). The prevalence of latent autoimmune diabetes in adults diagnosed by non-glutamic acid decarboxylase autoantibodies in China was 1·7% (95% CI 1·0–2·8; 18 671 participants from eight studies). Interpretation Our finding provides evidence for a high prevalence of latent autoimmune diabetes in adults in China. Additionally, screening of latent autoimmune diabetes in adults with multiple diabetes-associated autoantibodies is necessary in China. Funding None.