2015年 · 第95卷第44期

Diabetes is a chronic disease that seriously endangers human health. Its rapidly rising prevalence and various serious complications bring a heavy burden to families and society. At the same time, diabetes also has accompanying phenomena with many diseases.

The process of modernization is accompanied by the increasing pressure of work and life, and the sleep pattern is changing. The number of sleep disorders is gradually increasing, which has become a common social problem. The association between sleep status and metabolic abnormalities is attracting academic attention. Sleep disorders are associated with diabetes and complications. Studies have found that 52.0% ~77.4% of patients with diabetes have poor sleep quality, far exceeding 34.1% of non-diabetic patients^[1]。 Sleep quality is closely related to the occurrence of diabetes, the control of metabolic abnormalities in diabetic patients, and the occurrence of diabetic complications. Prospective studies have found that sleep disorders are independent risk factors for the development of diabetes, and sleep disorders also affect blood sugar control in diabetics.

The prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) have both increased significantly in recent years. Epidemiological studies show that the prevalence of diabetes in China is 11.6%, and the prevalence of pre-diabetes is as high as 50.1%^[1]； The prevalence of NAFLD was 20.9% in mainland China^[2]And 42% in Hong Kong, China^[3]。 T2DM and NAFLD are closely related and influence each other. This article will sort out the relationship between epidemiology, pathogenesis and clinical management strategies, and provide ideas for formulating comprehensive intervention strategies in clinical practice.

Since 2009, public hospitals at all levels in China have carried out different forms of cooperative medical services, and it has continued to increase year by year. Public hospitals have gained many successful experiences in the process of cooperative medical construction and management, but also have many confusions and sharp problems. Where to go next in cooperative medical care and how to develop healthily are worth studying and thinking.

Essential thrombocythemia (ET) is a BCR-ABL1 gene-negative myeloproliferative neoplasm (MPN) that can transform into polycythemia vera (PV) and acute leukemia. The JAK2 gene mutation discovered in 2005 is the characteristic molecular marker of ET at present, and its incidence rate can reach 50% ~60%^[1,2]。 The thrombopoietin receptor gene MPL W515L/K, which was discovered since then, also has a 5% ~10% incidence rate in ET. Nevertheless, nearly 1/3 of ET patients do not have the above two gene mutations. At the end of 2013, Klampfl et al.^[3]Through whole exon sequencing, it was found that calreticulin (CALR) has a high incidence and certain clinical characteristics in MPN, especially in ET with negative mutation of JAK2 gene, which provides a new direction for us to understand and treat this class of subtypes^[3,4]。 This paper reviews the structure and function of CALR, its relationship with ET and possible pathogenic mechanisms.