Helicobacter pylori seropositivity in diabetic patients is associated with microalbuminuria

AIM:To investigate the relationship between Helicobacter pylori(H.pylori) seropositivity and the presence of microalbuminuria.METHODS:Between December 2003 and February 2010,asymptomatic individuals who visited the Seoul National University Healthcare System Gangnam Center for a routine check-up and underwent tests for H.pylori immunoglobulin G antibodies and urinary albumin to creatinine ratio(UACR) were included.All study subjects completed a structured questionnaire,anthropometric measurements and laboratory tests.Anti-H.pylori immunoglobulin G was identified using an enzyme-linked immunosorbent assay kit.A random single-void urine sample,collected using a clean-catch technique,was obtained to determine the UACR.The presence of microalbuminuria was defined as a UACR from 30 to 300 μg/mg.The presence of diabetes mellitus(DM) was defined as either a fasting serum glucose level greater than or equal to 126 mg/dL or taking anti-diabetic medication.Multiple logistic regression analysis was performed to identify the risk factors.The dependent variable was microalbuminuria,and the independent variables were the other study variables.RESULTS:A total of 2716 subjects(male,71.8%;mean age,54.9 years) were included.Among them,224 subjects(8.2%) had microalbuminuria and 324 subjects(11.9%) had been diagnosed with DM.Subjects with microalbuminuria had a significantly higher H.pylori seropositivity rate than subjects without microalbuminuria(60.7% vs 52.8%,P = 0.024).Multivariate analysis after adjustment for age,body mass index(BMI),waist circumference,and glucose and triglyceride levels showed that H.pylori seropositivity was significantly associated with microalbuminuria [odds ratio(OR),1.40,95% CI,1.05-1.89,P = 0.024].After the data were stratified into cohorts by glucose levels(≤ 100 mg/dL,100 mg/dL < glucose < 126 mg/dL,and ≥ 126 mg/dL or history of DM),H.pylori seropositivity was found to be significantly associated with microalbuminuria in diabetic subjects after adjusting for age,BMI and serum creatinine level(OR,2.21,95% CI,1.20-4.08,P = 0.011).In addition,the subjects were divided into five groups.Those without microalbuminuria(an UACR of < 30 μg/mg) were divided into four groups in accordance with their UACR values,and subjects with microalbuminuria comprised their own group.Notably,H.pylori seropositivity gradually increased with an increase in UACR(P = 0.001) and was highest in subjects with microalbuminuria(OR,2.41,95% CI,1.14-5.11).This suggests that H.pylori seropositivity is positively associated with microalbuminuria in diabetic subjects.CONCLUSION:H.pylori seropositivity was independently associated with microalbuminuria,and the prevalence of H.pylori seropositivity was associated with the severity of UACR in diabetic subjects.

Effects of Chinese herbal medicine Yiqi Huaju Qingli Formula in metabolic syndrome patients with microalbuminuria:a randomized placebo-controlled trial

BACKGROUND： Microalbuminuria （MAU） is a key component of metabolic syndrome （MetS） and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients. OBJECTIVE： To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： Sixty patients with MetS were randomized into the Chinese herbal formula group （CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine） and control group （placebo in combination with Western medicine）. All treatments were administered for 12 weeks. MAIN OUTCOME MEASURES： Urinary microalbumin （MA）, urinary albumin-to-creatinine ratio （UACR）, 24-hour total urine protein （24-hTP）, body mass index （BMI）, waist circumference （WC）, waist-to-hip ratio （WHR）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2-hPPG）, glycosylated hemoglobin （HbAlc）, homeostasis model assessment for insulin resistance （HOMA-IR）, blood lipid profile and blood pressure were observed. RESULTS： Compared with the control group, CHF treatment significantly decreased BMI （P〈0.05）, WC （P〈0.01） and WHR （P〈0.01）. Both groups had significant decreases in FPG, 2-hPPG, HbAlc, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment （P〈0.05）. Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol （TAG）, and a greater reduction in TAG was observed with CHF treatment （P〈0.05）. The level of high-density lipoprotein cholesterol did not change in the control group after treatment （P〉0.05）, whereas it significantly increased with CHF treatment （P〈0.01）. Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups （P〈0.01）. However, there was no significant difference between the two groups （P〉0.05）. CONCLUSION： Combined treatment ofYiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER： This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.

Tangled relationship between insulin resistance and microalbuminuria in children with obesity

Childhood obesity represents a complex disease with a well-known cardiometabolic burden including fatty liver,type 2 diabetes,metabolic syndrome,and cardiovascular disease.From a pathogenic point of view,insulin resistance(IR)represents the key factor underlying the spectrum of these obesity consequences.As observed in adults,recent data supported the occurrence of microalbuminuria(MA)as marker of early kidney dysfunction and its potential link with cardiometabolic factors also in children with obesity.In fact,a well-documented pathophysiological hypothesis both in adults and children supported an intimate correlation with the major feature of obesity such as IR through the influence of insulin on renal hemodynamics.Based on the clinical and prognostic relevance of this relationship in daily practice(including an increased risk of chronic kidney disease development overtime),more scientific attention needs to be paid to the evaluation of early kidney damage in children with obesity.In this paper,we attempt to address three debated questions regarding the intriguing liaison between IR and MA in children with obesity:(1)What is the prevalence of pediatric MA?(2)What is the state of art of MA in children with obesity?and(3)Is there a link between IR and MA in children with obesity?

Significance of intensive glycemic control on early diabetic nephropathy patients with microalbuminuria

Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05),and this decrease was significantly greater than that in Group B. However,Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h,P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol),and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks,either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.

RENAL ENDOGENOUS ET-1 AND URINARY SODIUM EXCRETION AND MICROALBUMINURIA IN HUMAN SALT-SENSITIVE HYPERTENSION

Objective To investigate the urinary endothelin-1 (ET-l ) excretion and urinary sodium excretion, microalbuminuria and ambulatory blood pressure(ABP) in salt-sensitive(SS) hypertension patients. Methods Twen- ty-one cases of normotensive subjects and 32 cases of uncomplicated hypertensive patients were recruited in this study. Salt sensitivity was determined by acute venous saline loading test. Before saline loading, 24-hour ABP mea- surements were performed. Urine samples were collected to assay ET-1,urinary sodium excretion and urinary albumin excretion(UAF). Results Compared to slat-resistant(SR) subgroup, SS showed low urinary ET-1 excretion in nor- motensive group (P<0.05) or hypertensive group (P<0.01),regardless or saline loading or not. The nighttime MAP of SS was higher than SR subgroup in normotensive or hypertensive group. Urinary sodium excretion during 4h of saline loading was significantly lower in SS than that in SR hypertensive patients (P<0.05). Twenty-four-hour UAE of SS patients was higher than SR group (P<0.01). Results of further correlation analysis indicated that the urinary ET-1 excretion was positively related to urinary sodium content and negatively to ABP and UAE. Conclusion Uri- nary ET-1 is low in SS normotensives or hypertension patients,which may play a role in renal sodium retention and renal impairment or SS hypertension patients.

The development and validation of a risk score for predicting microalbuminuria in type 2 diabetic patients

Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set). The model evaluated at a tertiary hospital (validation set). A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ≤ 2) was 0.28, with moderate risk (scores 2.5 to 5.5) was 0.86, and high risk (scores ≥ 6) was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81) and 0.758 (95% CI 0.70 - 0.80), respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.

Microalbuminuria and Kidney Disease Risk in HIV Patients Taking Combined Antiretroviral Therapy

Objectives: This study proposes to evaluate risk factors for kidney disease in HIV patients treated chronically and correlate with microalbuminuria measurements. Methods: Review charts and analyses of microalbuminuria in subgroup of HIV patients treated at Ceara/Brazil. Results: 149 patients, 69.1% male, mean 38.5 years old, infection mean 86.8 months. Mean Creatinine Clearance 110.2%, Creatinine 0.97, Urea 27.76 mg/dl, CD4+ 600.37 cels/mm3 and detectable viral load 530.59 copies with 61.7% undetectable. Mean Dosages of microalbuminuria/24h 147, 46 ± 820, 45 (N = 48) and microalbuminuria (mg/dl) 32.05 ± 85.25 (N = 43). Kidney Diseases Classification analyses evidenced 6.4% patients in stages ≥3 and 6.2% presented altered Microalbuminuria/24h. Patients using Tenofovir (TDF) 27.27% had Stage 2 and protease inhibitors (PI) had 4.1% in Stage 3. Proteinuria was observed in 5% stage ≥3. Association PI/TDF had 4.1% in Stage 3. No statistical difference between CD4 > or 3 and microalbuminuria/24h > 300 mg (p = 0.69);detectable/undetectable viral load and microalbuminuria/24h (p = 0.63) or stage ≥3 (p = 0.17);relation to Diabetes or arterial hypertension and microalbuminuria 24 h (p = 0.5 and p = 0.21);relation stage ≥3 and microalbuminuria/24h (p = 0.33);relation HIV diagnoses >/< 60 months and stage ≥3 (p = 0.51);or microalbuminuria/24h and TDF (p = 0.4), PI (p = 1), TDF/PI (p = 0.69), Atazanavir (p = 0.4) or Lopinavir/r (p = 1) regimens. There was statistical significance comparing age > or or < 50 years and microalbuminuria/24h (p = 0.55) or microalbuminuria mg/d (p = 0.32). Relating comorbidities risk (Diabetes Mellitus plus Systemic Arterial Hypertension) to Kidney Diseases, it was found that 55.5% patients in Stage 3 or above with comorbidities compared with 15% with comorbidities in lower stages (P = 0.005). Nevertheless, comorbidities presence was not associated with microalbuminuria (p = 0.08). Conclusion: Kidney disease is a real risk for HIV patients and stages ≥3 have to be early detected. Microalbuminuria dosage did not demonstrate more sensibility than proteinuria to early diagnoses, even related to antiretroviral drugs. Major risk factor for kidney damage evidenced to be older than 50 years and there was no protective effect from CD4 or undetectable viral load.

Prevalence of microalbuminuria in type 2 diabetes patients in Tirana, a preliminary multicenter study

Background: Microalbuminuria is often the first sign of renal involvement predicting overt nephropathy. For this reason, monitoring microalbuminuria and other risk factors associated with this condition is important to take measures to prevent or postpone overt nephropathy. This study aimed to investigate the prevalence of microalbuminuria in type 2 diabetes patients attending three diabetes centers in Tirana city. Patients and Methods: Two hundred and twenty patients with type 2 diabetes attending diabetes centers in Tirana were recruited in this crosssectional study. Medical records were used to collect data on duration of diabetes, waist circumference, history of hypertension, smoking. Blood samples were drawn after 12 h overnight fasting to measure glycosylated hemoglobin (HbA1c), serum cholesterol, triglyceride and creatinine. Microalbuminuria was assessed using dipstick kits in early morning urine samples. Results: The prevalence of normoalbuminuria was 58.3%, microalbuminuria 38.6% and macroalbuminuria 3.1%. Systolic and diastolic blood pressure (p p < 0.01) and fasting plasma glucose (p moalbuminuric subjects. Multiple logistic regression analysis using microalbuminuria as the dependent variable in males shows that independent risk factors for diabetes patients with microalbuminuria were duration of diabetes, systolic blood pressure and waist circumference. We found that the OR for microalbuminuria became statistically significantly increased only at 16 years after the diagnosis of type 2 diabetes. At this time, 43.7% of patients had microalbuminuria. Conclusions: We found a high proportion of type 2 diabetes patients with microalbuminuria which raises implications for health policy inAlbania. This calls for early detection and good control of diabetes to reduce the burden of diabetic kidney disease in the future. Screening programs and optimized control of modifiable risk factors are needed to reduce the risk of diabetic nephropathy.

Microalbuminuria and Associated Factors in Diabetics at the CNHU-HKM of Cotonou

Diabetes mellitus is a disease of great frequency and is a major public health problem. Several complications can occur during the course of diabetes such as diabetic nephropathy, which starts with microalbuminuria in diabetic patients. This was a cross-sectional and analytical study which took place from 23 September to 23 December 2021 in the Endocrinology-Metabolism-Nutrition Department of the CNHU-HKM of Cotonou, Benin. We carried out an exhaustive census of the patients. Type 2 diabetic patients were included in the study, and 24-hour microalbumunuria, fundus examination and assessment of complications were performed. We identified 145 type 2 diabetic patients of whom 44 had positive microalbuminuria, i.e. a prevalence of 30.3%. There were 61 men and 84 women with a sex ratio of 0.72. The mean age was 59 years with extremes of 26 and 85 years. The complications identified in diabetics with positive microalbuminuria were Neuropathy (43.2%), Nephropathy (22.7%) and Retinopathy (20.5%). Factors associated with microalbuminuria in diabetics were: age, occupation, hypertension, diabetes imbalance, erectile dysfunction. Conclusion: Microalbuminuria is common in type 2 diabetes. It should be managed early to slow the progression of kidney disease to the end stage.

Microalbuminuria in pediatric patients with hypertension

Microalbuminuria in adults has been found to be an early indicator of both renal and systemic vascular disease, as well as significant cardiovascular risk predictor and therapeutic marker. Its role in essential hypertension in adults has also been well established. As diseases like hypertension and obesity have their roots in childhood and are already present in children, influencing the morbidity in adulthood, the role of microalbuminuria has been extensively investigated in children as well. Most investigations have been performed in diabetic children, confirming its clinical significance. There is also enough evidence to suggest that microalbuminuria in obese children should be taken as seriously as in children with diabetes. In children with hypertension rare studies also indicate that its presence identifies hypertensive children with higher risk, although the exact role has to be confirmed in prospective and larger studies. The mechanisms of microalbuminuria onset could be the result of renal damage secondary to hypertension or underlying renal and systemic endothelial dysfunction. Evidence from small intervention studies in children with microalbuminuria also suggests that early intervention with antihypertensive drugs is likely to be beneficial, pointing out the role of microalbuminuria as a therapeutic marker in children too. In addition, we have to stress the importance of follow-up of children with microalbuminuria, confirmation of its persistence and identification of progression. However, longitudinal prospective studies in children, investigating its future cardiovascular risk, are still lacking.

Microalbuminuria in White and Black Hypertensive Nondiabetic Brazilian Patients

Microalbuminuria (MAU) is a predictor of cardiovascular mortality in patients with diabetes mellitus (DM) and hypertension (HTN) and also in an unselected population. The American Diabetes Association (ADA) and the National Kidney Foundation (NKF) define MAU as an albumin/creatinine ratio (ACR) between 30 and 300 μg/mg in both men and women. Aim: To evaluate the possible relationship among MAU, HTN and gender and ethnicity in Brazilian nondiabetic primary hypertensive patients. Design: Population-based study. Participants: Ninety-eight men and women, seventy-two black and twenty-six white nondiabetic primary hypertensive patients aged 20 years or older were selected. Forty healthy individuals, paired according to age, gender, and ethnics were used as controls. Methods: Early-morning midstream urine was used. Urinary albumin was spectrophotometrically measured with Coomassie Brillant Blue G-250. Creatinine was determined by a method based on Jaffe’s reaction. ACR (μg albumin/mg creatinine) was calculated. Data are expressed as medians. Results: ACR level was significantly higher in 98 hypertensive patients (38.00) than in 40 control individuals (23.00) (P < 0.001). ACR level was significantly higher in 48 hypertensive male (46.00) than in 50 hypertensive female (34.00) (P = 0.008). No significant effect of ethnicity on ACR levels between 26 hypertensive Whites (35.50) and 72 hypertensive Blacks (38.00) was observed (P = 0.978). Conclusions: The ACR level, significantly higher in hypertensive patients than in control individuals, supports data from the literature. To our knowledge, this is the first study demonstrating that the ACR level is significantly higher in men than in women. The lack of an ethnicity effect supports what was already asserted, namely, that in Brazil, at an individual level, color, as determined by physical evaluation, is a poor predictor of genomic African ancestry, as estimated by molecular markers.

In vivo evaluation of renal function using diffusion weighted imaging and diffusion tensor imaging in type 2 diabetics with normoalbuminuria versus microalbuminuria

This work aims to estimate the value of diffusion weighted imaging （DWI） and diffusion tensor imaging （DTI） in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria （NAU） versus microalbuminuria （MAU） prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group （n = 14） or MAU group （n = 16） according to 8 h overnight urinary albuminuria excretion rate （AER） results. A contemporary cohort of health check-up recipients were included as controls （n = 12）. DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient （ADC） and fractional anisotropy （FA） of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm^2, the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls （P 〈 0.01）. The mean ADC in the MAU group [（2.22± 0.07） × 10^-3 mm^2/s] was slightly lower than that of the NAU group [（2.31 ± 0.22） × 10^- 3 mm^2/s], but this difference was not statistically significant （P 〉 0.05）. The FAvalue in the MAU group was higher than that in the control group （0.45 ± 0.07 vs. 0.3±0.03, P = 0.004） but did not differ from that in the NAU group （0.42 ± 0.03） （P 〉 0.05）. ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.

Microalbuminuria associated with systolic blood pressure and arterial compliance in Chinese metabolic syndrome patients

Background There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome （MS） patients remains unknown. Methods According to the definition of MS proposed by ATPⅢ in 2001, USA, subjects （n=362） were divided into three groups according to the number of risk factors： group 1 （control）, group 2 （medium, 〈 3 risk factors） and group 3 （MS, ≥ 3 risk factors）. Both large artery compliance （C1） and small artery compliance （C2） were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine. Results （1） As C1 and C2 levels elasticity decreased, albumin creatinine ratio （ACR） and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors （all P〈0.05）. （2） Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. （3） Multivariate regression analysis showed that increased systolic blood pressure （SBP） and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group. Conclusions The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities. Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.

Association of microalbuminuria with ambulatory arterial stiffness index in patients with type 2 diabets mellitus

Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.

原发性高血压患者血清Hcy、尿ACR、动态脉压指数水平与早期肾损害关系的分析

目的:探讨原发性高血压患者血清同型半胱氨酸(Hcy)、尿微量白蛋白/尿肌酐(ACR)、动态脉压指数(PPI)水平与早期肾损害的关系。方法:选取2021年1月至2024年1月在郑州市第二人民医院治疗的105例原发性高血压早期肾损害患者设为观察组,另选取同期在同一家医院治疗的98例原发性高血压未发生肾损害患者设为对照组。比较两组Hcy、ACR、PPI等实验室指标及一般临床资料,利用试者工作特征(ROC)曲线分析原发性高血压出现早期肾损害的危险因素及Hcy、ACR、PPI对原发性高血压早期肾损害的诊断价值。将观察组患者依据肾小球滤过率不同分成轻度组、中度组及重度组,比较3组间Hcy、ACR、PPI水平,分析上述指标与疾病严重程度的关系。结果:观察组与对照组一般临床资料及血脂、血糖比较无明显差异(P>0.05),但两组Hcy、ACR及PPI比较差异有统计学意义(P<0.001);行Logistic回归分析发现,Hcy、ACR及PPI均是原发性高血压发生早期肾损害的危险因素(P<0.05)。绘制Hcy、ACR及PPI诊断早期肾损害的ROC曲线,结果显示其曲线下面积分别为0.713、0.723及0.611(P<0.05)。轻度、中度及重度组间Hcy、ACR及PPI水平比较差异有统计学意义(P<0.05);经Spearman相关性分析,Hcy、ACR及PPI水平与肾损害程度呈正相关(P<0.05)。结论:Hcy、ACR及PPI水平升高是原发性高血压患者发生早期肾损害的危险因素,与损害程度密切相关,且可辅助诊断早期肾损害。

尿微量白蛋白、N-乙酰-β-D-葡萄糖苷酶及血清胱抑素C联合检测在糖尿病早期肾损伤诊断中的价值分析

目的分析尿微量白蛋白(microalbuminuria,m-ALB)、N-乙酰-β-D-葡萄糖苷酶(N-acetyl-β-D-glucosidase,NAG)及血清胱抑素C(cystatin C,CysC)联合检测在糖尿病早期肾损伤(early kidney damage in dia⁃betes,EKDID)诊断中的价值。方法回顾性选取2021年6月—2022年12月日照市人民医院收治的60例EKDID患者(A组)、60例单纯糖尿病患者(B组)和30名健康体检人群(C组)的临床资料,均进行尿m-ALB、NAG及血清CysC检查,比较3组尿m-ALB、NAG及血清CysC水平,并分析各项指标单独及联合检测的灵敏度、特异度、准确度、阳性预测值、阴性预测值。结果A组尿m-ALB、NAG及血清CysC水平均高于B组、C组,差异有统计学意义(P均<0.05);B组、C组间各指标水平比较,差异无统计学意义(P均>0.05)。三项指标联合检测EKDID的灵敏度、阴性预测值均高于各单项及两两组合检测,差异有统计学意义(P均<0.05)。结论尿m-ALB、NAG及血清Cys三项指标联合检测可明显提高诊断EKDID的价值。

中老年体检人群系统免疫炎症指数和系统炎症反应指数与微量白蛋白尿的相关性研究

背景微量白蛋白尿是反应肾脏早期微血管损害的敏感指标,也是心血管疾病的独立危险因素,既往研究表明长期慢性炎症在微量白蛋白尿的发生、发展中起着重要作用,但血液炎症标志物与微量白蛋白尿相关性的报道较少。目的探讨中老年体检人群中系统免疫炎症指数(SII)和系统炎症反应指数(SIRI)与微量白蛋白尿的相关性。方法本研究为横断面研究,选取2023年4—7月于东部战区总医院健康医学科进行健康体检的2105例40岁以上体检者为研究对象。根据尿微量白蛋白/尿肌酐比值(UACR)将研究对象分为两组:非微量白蛋白尿组(1857例,UACR<30 mg/g)和微量白蛋白尿组(248例,UACR=30~300 mg/g)。根据三分位数将SII分为T1(0.09~0.27)、T2(0.28~0.40)和T3(0.41~1.38),将SIRI分为t1(0.11~0.41)、t2(0.42~0.66)和t3(0.67~3.52)。收集两组研究对象的一般资料及实验室检查结果并进行比较,采用线性回归分析探讨SII、SIRI水平与UACR对数转化值(log UACR)的相关性,采用二元Logistic回归分析探讨SII、SIRI与微量白蛋白尿发生风险的相关性。结果两组性别、腰臀比、总胆固醇、低密度脂蛋白胆固醇、尿酸水平比较,差异无统计学意义(P>0.05);微量白蛋白尿组年龄、BMI、收缩压、舒张压、空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、同型半胱氨酸、肾小球滤过率、红细胞沉降率、SII、SIRI水平高于非微量白蛋白尿组,高密度脂蛋白胆固醇水平低于非微量白蛋白尿组(P<0.05)。线性回归分析结果显示,SII、SIRI水平与log UACR均呈正相关(P<0.05)。二元Logistic回归分析结果显示,校正各控制变量后,SII水平升高是微量白蛋白尿发生风险的危险因素(OR=1.17,95%CI=1.01~1.35,P=0.031);与T1水平患者相比,T3水平患者微量白蛋白尿发生风险升高(OR=1.43,95%CI=1.01~2.03,P=0.046),且微量白蛋白尿发生风险随着SII增加呈升高趋势(P趋势=0.038)。校正各控制变量后,SIRI水平升高是微量白蛋白尿发生风险的危险因素(OR=1.18,95%CI=1.03~1.35,P=0.019);与t1水平患者相比,t3水平患者微量白蛋白尿发生风险升高(OR=1.45,95%CI=1.01~2.09,P=0.046),且微量白蛋白尿发生风险随着SIRI增加呈升高趋势(P趋势=0.032)。结论中老年体检人群SII、SIRI水平与log UACR及微量白蛋白尿发生风险均呈正相关。

基于数据挖掘技术的糖尿病肾病微量蛋白尿期与临床蛋白尿期证候比较研究

[目的]分析糖尿病肾病(DKD)相关文献,运用数据挖掘技术,比较微量蛋白尿期与临床蛋白尿期中医证候特点,以期为临床规范分期治疗DKD提供新思路。[方法]检索中国知网(CNKI)、万方数据知识服务平台和维普中文科技期刊数据库自2014年1月1日—2023年12月31日收录的相关文献,筛选符合纳入标准的文献,进行证候和症状的提取、名称规范及拆分。建立数据库,采用统计学软件对DKD的微量蛋白尿期与临床蛋白尿期相关证候进行频数统计和聚类分析。[结果]共检索文献3506篇,最终纳入文献79篇。证候方面微量蛋白尿期以气阴两虚、血瘀证、湿热证、阴阳两虚和阴虚燥热最为常见;临床蛋白尿期以气阴两虚、血瘀证、阴阳两虚、湿热证和痰湿证最为常见。症状方面,微量蛋白尿期常见症状为倦怠乏力、口渴多饮、口干咽燥、肢体麻木、视物模糊、夜尿频多、腰膝酸软、头晕目眩、失眠多梦、肢体疼痛;临床蛋白尿期常见症状为倦怠乏力、肢体麻木、水肿、视物模糊、腰膝酸软、口干咽燥、口渴多饮、头晕目眩、少气懒言、尿浊。[结论]随着病情进展,DKD的临床蛋白尿期相比于微量蛋白尿期,证候种类更加复杂多样,阳虚相关证候比例显著上升。

尿糖与尿微量白蛋白联合检测在糖尿病早期肾损伤诊断中的应用价值及意义探讨

目的探讨尿糖与尿微量白蛋白(microalbuminuria,mAlb)联合检测在糖尿病早期肾损伤诊断中的应用价值及意义。方法回顾性选取2021年6月—2024年6月惠安县疗养院收治的76例糖尿病早期肾损伤患者和同期76例单纯糖尿病患者的临床资料,分别为研究组和对照组。两组均进行尿糖与mAlb检测,对比两组上述指标水平以及单独与联合检测的诊断效能。结果研究组mAlb水平为(36.57±5.46)mg/L,尿糖水平为(2.97±0.10)mmol/L,均高于对照组的(17.41±2.33)mg/L和(1.23±0.13)mmol/L,差异有统计学意义(t=28.137、92.487,P均<0.05)。联合检测的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于单一尿糖与mAlb检测,差异有统计学意义(P均<0.05)。结论尿糖与尿mAlb联合检测在糖尿病早期肾损伤诊断中具有较高的应用价值,能够显著提高诊断的灵敏度、特异度和准确度,有助于早期发现糖尿病患者的肾损伤,为临床及时干预和治疗提供重要依据。

糖尿病患者采用胱抑素C、β2-微球蛋白及尿微量白蛋白检测早期肾损伤的评估分析

目的分析胱抑素C(cystatin C,CysC)、β2-微球蛋白(β2-microglobulin,β2-MG)、尿微量白蛋白(microalbuminuria,mAlb)联合检测用于糖尿病患者早期肾损伤评估的效果。方法选取2022年1月—2023年12月阜宁县人民医院收治的70例糖尿病疑似早期肾损伤患者为研究对象,全部患者均测定CysC、β2-MG、mAlb水平,以综合诊断结果为金标准,分析CysC、β2-MG、mAlb指标单一检测及联合检测的诊断效能。结果综合诊断结果显示,在70例糖尿病患者中确诊早期肾损伤阳性38例,阴性32例;β2-MG检测阳性35例、阴性35例;mAlb检测阳性36例、阴性34例;CysC检测阳性36例、阴性34例;联合诊断阳性42例、阴性28例。联合检测的灵敏度高于β2-MG、CysC、mAlb指标单一检测,差异有统计学意义(P<0.05)。不同检测方法的特异度、准确度比较,差异均无统计学意义(P均>0.05)。结论CysC、β2-MG、mAlb联合检测诊断糖尿病早期肾损伤患者的灵敏度较高,测定其水平有助于医师准确评估患者肾损伤情况,对患者疾病的治疗方案拟定、预后改善有重要意义。