目的研究尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值。方法选取邢台医学高等专科学校第二附属医院于2018年6月至2021年2月期间收治的168例肾结石患者,均接受经皮肾镜碎石取石术,患者检测血、尿生化指标以及尿...目的研究尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值。方法选取邢台医学高等专科学校第二附属医院于2018年6月至2021年2月期间收治的168例肾结石患者,均接受经皮肾镜碎石取石术,患者检测血、尿生化指标以及尿沉渣镜检。根据术后是否发生肾损伤分为损伤组、未损伤组。采用多因素Logistic回归分析术后肾损伤发生的危险因素,受试者工作特征曲线(receiver operating characteristic,ROC)分析各指标对术后肾损伤的诊断价值。结果损伤组患者术前血肌酐水平[(123.76±22.72)μmol/L比(92.62±17.53)μmol/L]、尿沉渣评分(0.67±0.17比0.54±0.13)及尿β2-微球蛋白(urinaryβ2-microglobulin,β2-MG)[(156.57±31.59)μg/L比(140.14±29.27)μg/L]、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinaseassoci⁃ated lipocalin,NGAL)[(62.57±10.59)μg/L比(50.14±9.43)μg/L]、乳酸脱氢酶(lactic dehydroge⁃nase,LDH)[(86.57±15.59)U/L比(76.14±11.27)U/L]水平均明显高于未损伤组(P<0.05)。两组患者治疗后尿沉渣评分(2.74±0.56比1.36±0.27)、β2-MG[(252.54±44.29)μg/L比(174.57±36.58)μg/L]、NGAL[(152.54±14.59)μg/L比(64.54±16.59)μg/L]、LDH[(142.48±21.29)U/L比(94.57±16.58)U/L]均呈增加趋势,其中损伤组的变化值均明显高于未损伤组(P<0.001)。Logistic回归分析显示,术前血肌酐、尿沉渣评分、β2-MG、NGAL、LDH(OR=2.540,2.307,1.964,1.702,2.164;95%CI:1.242~5.193,1.223~4.354,1.123~3.434,1.259~2.302,1.216~3.851)是患者术后肾损伤的危险因素(P<0.05)。尿沉渣评分、β2-MG、NGAL、LDH诊断术后肾损伤的曲线下的面积(area under the curve,AUC)分别为0.801,0.827,0.791,0.772(95%CI:0.729~0.873,0.751~0.904,0.705~0.878,0.698~0.846),明显低于联合诊断0.875(95%CI:0.819~0.931),差异有统计学意义(P<0.05)。结论术前尿沉渣评分、尿标志物(β2-MG、NGAL、LDH)与肾结石经皮肾镜碎石取石术后肾损伤存在相关性,联合检测可提高肾损伤的诊断效能。展开更多
Cholestasis is caused by the obstacle of bile formation or secretion and can develop into severe liver diseases. We previously reported the ethanol extract of Schisandra sphenanthera(Wuzhi tablet, WZ) can significantl...Cholestasis is caused by the obstacle of bile formation or secretion and can develop into severe liver diseases. We previously reported the ethanol extract of Schisandra sphenanthera(Wuzhi tablet, WZ) can significantly protect against lithocholic acid(LCA)-induced intrahepatic cholestasis in mice, partially due to the activation of PXR pathway and promotion of liver regeneration.However, the effect of WZ on the bile acids profile and gut microbiome in cholestastic mice remain unknown. In this study, the effect of WZ against LCA-induced liver injury was evaluated and its effect on the bile acids metabolome and gut microbiome profiles in cholestastic mice was further investigated. Targeted metabolomics analysis was performed to examine the change of bile acids in the serum, liver, intestine and feces. The change of intestinal flora were detected by the genomics method. Targeted metabolomics analysis revealed that WZ enhanced the excretion of bile acids from serum and liver to intestine and feces. Genomics analysis of gut microbiome showed that WZ can reverse LCA-induced gut microbiome disorder to the normal level. In conclusion, WZ protects against LCAinduced cholestastic liver injury by reversing abnormal bile acids profiles and alteration of gut microbiome.展开更多
文摘目的研究尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值。方法选取邢台医学高等专科学校第二附属医院于2018年6月至2021年2月期间收治的168例肾结石患者,均接受经皮肾镜碎石取石术,患者检测血、尿生化指标以及尿沉渣镜检。根据术后是否发生肾损伤分为损伤组、未损伤组。采用多因素Logistic回归分析术后肾损伤发生的危险因素,受试者工作特征曲线(receiver operating characteristic,ROC)分析各指标对术后肾损伤的诊断价值。结果损伤组患者术前血肌酐水平[(123.76±22.72)μmol/L比(92.62±17.53)μmol/L]、尿沉渣评分(0.67±0.17比0.54±0.13)及尿β2-微球蛋白(urinaryβ2-microglobulin,β2-MG)[(156.57±31.59)μg/L比(140.14±29.27)μg/L]、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinaseassoci⁃ated lipocalin,NGAL)[(62.57±10.59)μg/L比(50.14±9.43)μg/L]、乳酸脱氢酶(lactic dehydroge⁃nase,LDH)[(86.57±15.59)U/L比(76.14±11.27)U/L]水平均明显高于未损伤组(P<0.05)。两组患者治疗后尿沉渣评分(2.74±0.56比1.36±0.27)、β2-MG[(252.54±44.29)μg/L比(174.57±36.58)μg/L]、NGAL[(152.54±14.59)μg/L比(64.54±16.59)μg/L]、LDH[(142.48±21.29)U/L比(94.57±16.58)U/L]均呈增加趋势,其中损伤组的变化值均明显高于未损伤组(P<0.001)。Logistic回归分析显示,术前血肌酐、尿沉渣评分、β2-MG、NGAL、LDH(OR=2.540,2.307,1.964,1.702,2.164;95%CI:1.242~5.193,1.223~4.354,1.123~3.434,1.259~2.302,1.216~3.851)是患者术后肾损伤的危险因素(P<0.05)。尿沉渣评分、β2-MG、NGAL、LDH诊断术后肾损伤的曲线下的面积(area under the curve,AUC)分别为0.801,0.827,0.791,0.772(95%CI:0.729~0.873,0.751~0.904,0.705~0.878,0.698~0.846),明显低于联合诊断0.875(95%CI:0.819~0.931),差异有统计学意义(P<0.05)。结论术前尿沉渣评分、尿标志物(β2-MG、NGAL、LDH)与肾结石经皮肾镜碎石取石术后肾损伤存在相关性,联合检测可提高肾损伤的诊断效能。
基金supported by the Natural Science Foundation of China(Nos.81973392,81573489)the National Key Research and Development Program(No.2017YFE 0109900)+4 种基金the Natural Science Foundation of Guangdong(No.2017A030311018)the 111 project(No.B16047)the Key Laboratory Foundation of Guangdong Province(No.2017B030314030)the Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program(No.2017BT01Y093)the National Engineering and Technology Research Center for New drug Druggability Evaluation(Seed Program of Guangdong Province,No.2017B090903004)。
文摘Cholestasis is caused by the obstacle of bile formation or secretion and can develop into severe liver diseases. We previously reported the ethanol extract of Schisandra sphenanthera(Wuzhi tablet, WZ) can significantly protect against lithocholic acid(LCA)-induced intrahepatic cholestasis in mice, partially due to the activation of PXR pathway and promotion of liver regeneration.However, the effect of WZ on the bile acids profile and gut microbiome in cholestastic mice remain unknown. In this study, the effect of WZ against LCA-induced liver injury was evaluated and its effect on the bile acids metabolome and gut microbiome profiles in cholestastic mice was further investigated. Targeted metabolomics analysis was performed to examine the change of bile acids in the serum, liver, intestine and feces. The change of intestinal flora were detected by the genomics method. Targeted metabolomics analysis revealed that WZ enhanced the excretion of bile acids from serum and liver to intestine and feces. Genomics analysis of gut microbiome showed that WZ can reverse LCA-induced gut microbiome disorder to the normal level. In conclusion, WZ protects against LCAinduced cholestastic liver injury by reversing abnormal bile acids profiles and alteration of gut microbiome.
