Relationship between hemodynamic type and syncopal symptoms in pediatric vasovagal syncope.

Vasovagal syncope (VVS) is a clinically common neurally mediated syncope. The relationship between different hemodynamic types of VVS and clinical syncopal symptoms has not been reported. The purpose of this research is to explore relationship between hemodynamic types and syncopal symptoms in pediatric VVS. Two thousand five hundred thirteen patients diagnosed with VVS at the age of 3-18 years, average age was 11.76 ± 2.83 years, including 1124 males and 1389 females, due to unexplained syncope and pre-syncope from single-center of January 2001 to December 2021 were retrospectively analyzed. Subjects were divided into two groups according to the presence or absence of syncopal symptoms: syncope group (1262 cases) and pre-syncope group (1251 cases). (1) Baseline characteristics: age, height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) increased in the syncope group compared with the pre-syncope group; the composition ratio of females was more than that of males in the syncope group; and the composition ratio of VVS-cardioinhibited (VVS-CI) and VVS-mixed (VVS-M) was more in the syncope group than that of the pre-syncope group (all P < 0.05). (2) Univariate analysis: age, height, weight, SBP, DBP, female, VVS-CI, and VVS-M were potential risk factors for the presence of syncopal symptoms (all P < 0.05). (3) Multivariate analysis: VVS-CI and VVS-M were independent risk factors for the presence of syncopal symptoms, with an increased probability of 203% and 175%, respectively, compared to VVS-vasoinhibited (VVS-VI) (all P < 0.01). CONCLUSION: The hemodynamic type of pediatric VVS is closely related to the syncopal symptoms. WHAT IS KNOWN: • There are varying probabilities of syncopal episodes in different hemodynamic types of VVS, and there is a lack of research to assess the comparative risk of syncope in children with different hemodynamic types of VVS. WHAT IS NEW: • The probability in presence of syncopal symptoms varies greatly between different hemodynamic types of VVS. • VVS-CI and VVS-M had a 203% and 175% increased risk in presence of syncopal symptoms compared with VVS-VI, respectively.

The relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope.

This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope. A total of 2513 children, 1124 males and 1389 females, age range 3-18 years, who presented to Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University with unexplained syncope or pre-syncope and were diagnosed with vasovagal syncope were retrospectively collected and divided into syncope group (n = 1262) and pre-syncope group (n = 1251). (1) Females had a 36% increased risk of syncope compared to males, a 27% increased risk of syncope for every 1-year increase in age, and a 2% decreased risk of syncope for every 1 cm increase in height. (2) A non-linear relationship between age, height, weight and syncope was observed. When age > 10.67 years, the risk of syncope increases by 45% for each 1-year increase in age; when height < 146 cm, the risk of syncope decreases by 4% for each 1 cm increase in height; when weight < 28.5 kg, the risk of syncope decreases by 10% for each 1 kg increase in weight. Demographic factors are strongly associated with syncopal symptom in pediatric vasovagal syncope and can help to predict the risk.

The value of QT interval in differentiating vasovagal syncope from epilepsy in children.

BACKGROUND: Both vasovagal syncope (VVS) and epilepsy present with transient loss of consciousness and are often difficult to identify. Hence this study aimed to explore the value of QT interval in the differentiation of VVS and epilepsy in children. METHODS: One hundred thirteen children with unexplained transient loss of consciousness were selected. 56 children with VVS (VVS group), including 37 males and 19 females, the average age is 9.88 ± 2.55 years old. 57 children with epilepsy (epilepsy group), including 36 males and 21 females, the average age is 8.96 ± 2.67 years old. At the same time, the 60 healthy individuals (control group) were examined according to age and sex. The QT interval of 12-lead electrocardiogram in a basal state of three groups was measured and statistically analyzed by SPSS 24.0 software. RESULTS: Compared with the control group, (1) QTcmax, QTcmin and QTcd were significantly longer in VVS group (P < 0.05), QTmax and QTmin were significantly shorter in VVS group (P < 0.05), and there were no significant differences in QTd between the two groups (P > 0.05). (2) The QTmax and QTmin were significantly shorter in epilepsy group (P < 0.05), and there were no significant differences in QTd, QTcmax, QTcmin, QTcd between the two groups (P > 0.05). Compared with the epilepsy group, The QTcmax, QTcmin, QTcd were significantly longer in VVS group (P < 0.05), and there were no significant differences in QTd, QTmax, QTmin between the two groups (P > 0.05). When QTcmax > 479.84 ms, QTcmin > 398.90 ms and QTcd > 53.56 ms, the sensitivity and specificity of diagnosing VVS were 62.5% and 77.19%, 82.14% and 50.88%, 82.14% and 38.60% respectively. CONCLUSION: QTcmax, QTcmin and QTcd have certain value in differentiating VVS from epilepsy in children.

The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents.

BACKGROUND: Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency. AIMS OF THE STUDY: This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. PATIENTS AND METHODS: Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. RESULTS: The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively. CONCLUSION: There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.

Clinical characteristics and hemodynamic responses to head-up tilt test in children and adolescents with unexplained sighing.

OBJECTIVE: Sighing is a common symptom in children and adolescents. In this study, we explored the clinical characteristics and hemodynamic responses to head-up tilt test (HUTT) in children and adolescents with unexplained sighing. METHODS: One hundred ninety-two children and adolescents complaining of unexplained sighing were enrolled as study group after excluding chest wall, lung, heart diseases, and psychogenic disorders. Sixty-nine healthy individuals were enrolled as control group. All the subjects underwent HUTT. RESULTS: Nitroglycerin-stimulated HUTT positive rate was higher in the study group than the control group (24.0% vs 10.1%, P = 0.014). In total, 32.3% of patients with sighing had positive responses to HUTT, which was higher than that of healthy individuals (32.3% vs 15.9%, P = 0.009). Among 62 cases with positive responses to HUTT in the study group, 48 cases were vasoinhibitory type vasovagal syncope (VVS), 5 cases were mixed type VVS, 3 cases were cardioinhibitory type VVS, 5 cases were postural tachycardia syndrome, and one case was orthostatic hypertension. Sighing patients with positive responses to HUTT had female dominance (54.8% vs39.2%, P = 0.045), older mean age (9.6 ± 2.8 vs 8.1 ± 2.7 years old, P = 0.001), higher basic systolic blood pressure (104.8 ± 10.4 vs 101.1 ± 9.9 mmHg, P = 0.019), and higher diastolic blood pressure (66.0 ± 7.5 vs 62.9 ± 9.2 mmHg, P = 0.021) compared with those of negative responses. CONCLUSIONS : Nearly one-third of children and adolescents with unexplained sighing had positive responses to HUTT, demonstrating that sighing was related to dysfunction of the autonomic nervous system. Elder female patients with higher systolic and diastolic blood pressure were more likely to have positive responses to HUTT.

Duration of treatment with oral rehydration salts for vasovagal syncope in children and adolescents.

BACKGROUND: Oral rehydration salt (ORS) is a first-line medication for vasovagal syncope (VVS) in children and adolescents. We retrospectively investigated the treatment with ORS-I (Na 90 mmol/L) for VVS in children and adolescents to define appropriate duration of treatment. METHODS: All patients with a diagnosis of VVS, based on the first head-up tilt test (HUTT) response, and who accepted ORS-I treatment were enrolled. ORS was stopped when the HUTT response turned negative. Patients were followed for six months after cessation of ORS treatment. RESULTS: The study group included 129 patients (57 male, 72 female; mean age, 11.8 ± 2.0 years, age range, 7.0- 17.0 years). Median duration of VVS was 4 months (range, 1 week to > 10 years). The number of syncope ranged from 2 times to > 20 times. Mean follow-up time was 27.8 ± 6.9 weeks (range, 26-33 weeks). It took to 2~13 weeks for HUTT response to turn negative, with an average time of 8.4 weeks (95% confidence interval, 6.89~9.84 weeks). There was no statistical difference for the time to negative HUTT response according to age groups ( < 12-year-old vs. ≥12-year-old), syncope type (vasodepressor vs. mixed), and the syncope frequency. No patient experienced syncope after cessation of ORS treatment. CONCLUSIONS: Our findings suggest that ORS-I is an effective measure to treat children and adolescents with VVS. We recommend a treatment course of 2 months.

Clinical values of creatine kinase and its isoenzymes in children and adolescents with vasovagal syncope.

BACKGROUND AND AIM: Vasovagal syncope (VVS) in children and adolescents is a common disorder. There may be an internal relationship between creatine kinase (CK) and its isoenzymes (CKMB) and syncope. The aim of this study was to evaluate the changes of CK and CKMB in children and adolescents with VVS. METHODS AND RESULTS: The VVS group included 218 patients (93 male and 125 female). The control group included 129 healthy children (78 male and 51 female). Serum CK and CKMB levels were estimated. We founded ①Serum CK and CK-MB levels decreased in VVS group than that in control group (P < 0.05). ②The CK levels of female were significantly lower than those of male in VVS group (P < 0.05). ③Serum level of CK-MB were in negative correlation with age, height, weight, BMI whereas in positively correlation with HR. ④CK was effected by CK-MB (ß = 0.147, P = 0.037) while CK-MB was independently influenced by age (ß = -0.203, P = 0.002) and DBP (ß = 0.171, P = 0.011). ⑤Both CK and CK-MB significantly influenced on VVS occurrence after adjusting for the effects of gender, age, height, weight, BMI and HR. CONCLUSION: The serum CK and CKMB levels decrease in children and adolescents with VVS. CK and CK-MB are the independent protective factors with VVS.

Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents.

OBJECTIVE: To develop an orthostatic intolerance symptom scoring system to assess orthostatic intolerance and then to compare the symptom score among different head-up tilt test responses. METHODS: 272 subjects (5-18 years) presenting with orthostatic intolerance symptoms finished questionnaire and head-up tilt test. According to head-up tilt test hemodynamic responses, the subjects were divided into head-up tilt test negative, vasovagal syncope, and postural tachycardia syndrome groups. RESULTS: We built up a symptom score according to the frequency of dizziness, headache, blurred vision, palpitations, chest discomfort, gastrointestinal symptoms, profuse perspiration, and syncope. The median score in postural tachycardia syndrome subjects was highest. A score of 2.5 for predicting vasovagal syncope yielded a sensitivity of 75.0% and specificity of 50.3%, a score of 5.5 for predicting postural tachycardia syndrome yielded a sensitivity of 69.7% and specificity of 72.0%. Furthermore, the median score in postural tachycardia syndrome subjects was significantly higher than that in head-up tilt test negative subjects with heart rate increment of 30-39 beats/min (P < .01). CONCLUSIONS: This suggests that the symptom score has some predictive value in head-up tilt test results, which can be served as a preliminary assessment instrument.

[Comparison of curative effect and serum electrolytes between different oral rehydration salts in treatment of neurally mediated syncope children].

OBJECTIVE: To compare the curative effect and the changes of serum electrolytes between oral rehydration salts (ORS) I and ORS III treatment in neurally mediated syncope children.
 Methods: The children with the symptom of unexplained syncope and pre-syncope were collected in Second Xiangya Hospital from May 2014 to May 2017. After head-up tilt test (HUTT), their serum electrolytes levels were examined. Children who were positive in the HUTT received ORS (ORS I or ORS III) and health education. Subjects were randomly divided into an ORS I group (n=27) and an ORS III group (n=49).
 Results: There was no statistical significance in sex, age, height, body mass, initial diagnosis and re-diagnosis interval between the 2 groups (P>0.05); the total efficiency after ORS III and ORS I treatment were 79.59% and 62.96%, respectively, with no statistical significance (χ2=2.483, P>0.05); the HUTT negative conversion rate after ORS III and ORS I treatment were 51.02% and 48.16%, respectively, with no statistical significance (χ2=0.058, P>0.05); before treatment, the serum sodium [(140.20±2.26) mmol/L vs (138.39±2.72) mmol/L; t=2.856, P<0.05] in the ORS III group was higher than that in the ORS I group, the serum phosphorus [(1.46±0.19) mmol/L vs (1.65±0.29) mmol/L; t=3.146, P<0.05] in the ORS III group was lower than that in the ORS I group; after treatment, the serum sodium [(140.31±2.01) mmol/L vs (138.88±2.08) mmol/L; t=2.692, P<0.05] and serum calcium [(2.31±0.09) mmol/L vs (2.24±0.11) mmol/L; t=2.696, P<0.05] in the ORS III group were higher than those in the ORS I group, the serum phosphorus [(1.45±0.16) mmol/L vs (1.61±0.25) mmol/L; t=3.128, P<0.05] in the ORS III group was lower than that in the ORS I group; after ORS III treatment, there was no statistical significance in serum electrolytes between HUTT positive group and HUTT negative group (P>0.05); after ORS I treatment, the serum calcium [(2.29±0.10) mmol/L vs (2.19±0.10) mmol/L; t=2.501, P<0.05] and serum phosphorus [(1.71±0.24) mmol/L vs (1.50±0.21) mmol/L; t=2.392, P<0.05] in HUTT positive group were higher than those in HUTT negative group. There was no statistical significance in serum sodium, potassium, magnesium, and chloride (P>0.05); there was no statistical significance in serum electrolytes between pre-treatment and post-treatment in the ORS I group and the ORS III group (P>0.05); there was no statistical significance in serum electrolytes between vasovagal syncope and postural orthostatic tachycardia syndrome in the ORS I group and the ORS III group before ORS treatment (P>0.05). 
 Conclusion: The ORS III and ORS I have the similar efficacy in the treatment of children with neurally mediated syncope. ORS III is easier to be accepted by children than ORS I, with better compliance.

[Relationship between unexplained palpitation in children and head-up tilt test].

OBJECTIVE: To explore the relationship between unexplained palpitation in children and head-up tilt test (HUTT).
 Methods: A total of 142 children with the main symptom of unexplained palpitation were admitted to the Specialist Out-Patient Clinic of Children's Cardiovascular Disease from Sept. 2008 to Feb. 2017 in the Second Xiangya Hospital, Central South University. Among them, 63 cases were male, 79 cases were female, with the mean age of (10.12±2.88) years old. The detailed history, physical examinations, conventional 12 electrocardiogram, chest X-ray, echocardiography, myocardial enzymes and thyroid function were all examined. The disorders of heart disease, systemic disease and drug effect were ruled out. The HUTT inspection was then given to them.
 Results: Among the 142 palpitation cases, 79 cases were HUTT positive (55.6%) and 63 cases were HUTT negative (44.4%). The age in HUTT positive patients was older than that in HUTT negative patients (P<0.05), with no significant difference in gender (P>0.05). There were three types of hemodynamic changes in HUTT positive patients. Among them, 38 cases were postural orthostatic tachycardia syndrome (48.1%), 36 cases were the vasovagal syncope vasodepressive type (45.6%) and 5 cases were the vasovagal syncope mixed type (6.3%). There were no hemodynamic types for vasovagal syncope cardioinhibitory type, orthostatic hypotension and orthostatic hypertension.
 Conclusion: Among the clinically unexplained palpitations children, more than half are caused by unbalanced autonomic nervous function. HUTT can help clear the cause of unexplained palpitations.

Involvement of receptor-interacting protein 140 in palmitate-stimulated macrophage infiltration of pancreatic beta cells.

Receptor-interacting protein 140 (RIP140) in macrophages stimulates the nuclear factor-κB subunit RelA to activate tumor necrosis factor (TNF)-α and interleukin (IL)-6 transcription. However, under lipotoxic conditions, the involvement of RIP140 in the infiltration of beta cells by macrophages remains unknown. In the present study, murine RAW264.7 macrophages were transfected with a RIP140 overexpression plasmid or siRNA prior to macrophage activation with 500 µM palmitate. Palmitate-free conditioned media was then collected and added to murine insulinoma MIN6 cells. Significant decreases were observed in cell viability (P<0.01), glucose-stimulated insulin secretion (P<0.01) and levels of peroxisome proliferator-activated receptor-γ coactivator-1α (P<0.05), phosphoenolpyruvate carboxykinase and proliferating cell nuclear antigen mRNA (P<0.01) in MIN6 cells. In addition, conditioned media from palmitate-treated and RIP140-upregulated macrophages significantly increased the levels of uncoupling protein-2 (P<0.01), inducible nitric oxide synthase 1 (P<0.01) and pancreatic and duodenal homeobox 1 (P<0.05) mRNA and levels of activated Jun N-terminal kinase (JNK) (P<0.01) and extracellular signal-regulated kinase (ERK) 1/2 (P<0.01). In turn, the conditioned media was found to be significantly enriched in TNF-α and IL-6 (both P<0.05). These results were the opposite of those obtained from MIN6 cells treated with conditioned media from palmitate-treated and RIP140-knockdown macrophages. MIN6 cells were transfected with RIP140 overexpression plasmid or siRNA prior to treatment with 500 µM palmitate and supernatant was collected for use in macrophage chemotaxis assays. In the palmitate-activated and RIP140-overexpressing MIN6 cells, TNF-α and IL-6 secretion increased significantly (both P<0.05) and macrophage chemotaxis towards MIN6 cells was enhanced. By contrast, downregulating RIP140 in MIN6 cells had the opposite effect. These data suggest that RIP140 in macrophages mediates the transcription of inflammatory cytokines when concentration of palmitate is high. Macrophage RIP140 may also impair beta cell function by activating the JNK and ERK1/2 signaling pathways and promoting specific gene transcription. Furthermore, expression of RIP140 in pancreatic beta cells may stimulate macrophage chemotaxis, thus triggering local low-grade inflammation.

Head-up tilt test results in child twins with nervous mediated syncope.

OBJECTIVE: To investigate the familial genetic characteristics of syncope in children. METHODS: A detailed medical history was taken from four twin pairs of children complaining of dizziness, headache, chest tightness, chest pain, prodromal symptoms of syncope or syncope, meanwhile, these patients were given routine physical examination, 12-lead ECG, echocardiography, Holter ECG, EEG, MRI of the head and other tests to exclude cardio-cerebrovascular and pulmonary diseases, with those with unknown origin for syncope undergoing head-up tilt test (HUTT) and inquiry of detailed family history. RESULTS: The four pairs of twins with syncope beginning at 7-12years and induced mostly by standing position (4/5), and positive family history was noted in two pairs. Vasovagal syncope (VVS)-vasoinhibitory response pattern was predominant in HUTT (4/5). The results and the response pattern in HUTT might diversify between two members within same twin pair: one appeared as vasoinhibitory response pattern and one postural orthostatic tachycardia syndrome (POTS) pattern in the first pair, one vasoinhibitory response pattern and one negative response pattern in the second pair, vasoinhibitory response pattern in the third pair and negative response pattern in the fourth pair. CONCLUSIONS: The hereditary factors may play a more important role in younger children with syncope. Environment and psychological factors may induced syncope attack. The results and the response pattern in HUTT are diversified and which might different between two members within twin pair.

The ventricular late potentials in children with vasodepressor response of vasovagal syncope.

OBJECTIVES: To discuss ventricular late potentials (VLPs) in children with vasodepressor response of vasovagal syncope (VVS-V). METHODS: 184 children diagnosed as VVS-V by head-up tilt test (HUTT) were enrolled as VVS-V group, 105 age and gender matched healthy individuals without syncope were used as control group, then signal-averaged electrocardiogram was measured. RESULTS: HR was decreased [(83.98±12.27) vs (87.28±13.75)bpm, P<0.05] in VVS-V group compared with control group. The prevalence of positive VLPs was not significantly different between the two groups. However the absolute values of TQRS [(84.89±12.05) vs (81.21±8.23)ms, P<0.01], RMS40 [(28.73±7.23) vs (26.89±7.36)µV, P<0.05] and LAS40 [(62.43±19.17) vs (56.79±1.83)ms, P<0.05] were significantly prolonged in VVS-V group compared with control group, and more patients in VVS-V group had abnormal prolonged LAS40 (94.57% vs 83.80%, P<0.01). CONCLUSIONS: The prevalence of positive VLPs was not significantly different, TQRS, RMS40, LAS40 were longer in children with VVS-V in comparison with healthy individuals, and the abnormal LAS40 occurred in a higher proportion of VVS-V group.

Oral rehydration salts: an effective choice for the treatment of children with vasovagal syncope.

To explore whether oral rehydration salts (ORS) is effective in the treatment of children with vasovagal syncope (VVS). One hundred and sixty-six consecutive patients with recurrent syncope and positive head-up tilt testing (HUTT) were recruited, randomly divided to conventional therapy (health education and tilt training) plus ORS (with 500 ml of water) group (Group I, 87 patients) and conventional therapy group (Group II, 79 patients). Therapeutic effect was evaluated by changes of syncopal episode and reperformed HUTT response. At the end of 6-month follow-up, syncopal episode did not reoccur in 49 (56.3 %) patients, decreased in 34 (39.1 %) patients, and had no obvious change or increased in four (4.6 %) patients in Group I, and the results were 31 (39.2 %), 37 (46.8 %), and 11 (14 %) in Group II, respectively. The difference was significant (χ (2) = 7.074, P < 0.05). When HUTT was reperformed, 57 (65.5 %) and 28 (35.4 %) patients had negative response and 30 (34.5 %) and 51 (64.6 %) patients had positive response, respectively, in Group I and Group II. The difference was also significant (χ (2) = 13.808, P < 0.01). In Group I, the two aspects had no difference between vasodepressor type and mixed type; however, syncopal episode had a significant difference between children aged ≤12 and >12 years (χ (2) = 6.371, P < 0.05); there was no difference in reperformed HUTT response. ORS with 500 ml of water is an effective therapy for VVS. It can be recommended as one of non- pharmacological treatment measures in children with VVS.

NR4A1 is associated with chronic low-grade inflammation in patients with type 2 diabetes.

Type 2 diabetes (T2D) is a common disorder characterized by chronic low-grade inflammation. In the present study, the expression levels of nuclear receptor subfamily 4 group A member 1 (NR4A1) and the correlation with inflammatory cytokine production and free fatty acids (FFAs) in patients with T2D and healthy participants were investigated. NR4A1 expression levels in peripheral blood mononuclear cells (PBMCs) from patients with T2D (n=30) and healthy controls (n=34) were analyzed. In addition, the levels of fasting blood glucose (FBG), fasting plasma insulin (FIN), FFAs, total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were analyzed, and the homeostasis model assessment (HOMA) was used to estimate the insulin resistance (IR). Additionally, PBMCs from healthy subjects were cultured with or without 250 µM palmitic acid (PA). Levels of NR4A1, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the PBMCs were also analyzed. The basal expression levels of NR4A1, TNF-α and IL-6 were higher in the T2D patients when compared with the controls. In addition, the levels of FFAs, TG and LDL-C, as well as the HOMA-IR, were higher in T2D patients. Furthermore, NR4A1 expression was demonstrated to positively correlate with the HOMA-IR and the levels of FFAs, TNF-α, IL-6, FIN and FBG. Furthermore, 250 µM PA stimulation was shown to increase NR4A1 expression and the secretion of inflammatory cytokines in the cultured PBMCs. Therefore, increased NR4A1 expression levels are correlated with a chronic low-grade inflammatory state and the disorder of lipid metabolism in patients with T2D.