Association of urinary albumin excretion with central foveal thickness and intravitreal conbercept treatment frequency in patients with diabetic macular edema

AIM: To investigate the effect of albuminuria on diabetic macular edema(DME) and the possible association between baseline urinary albumin excretion(UAE) and intravitreal conbercept(IVC) treatment frequency in DME patients. METHODS: In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy(NPDR) combined with albuminuria were divided into the microalbuminuria(UAE 30-300 mg/24 h) and macroalbuminuria(UAE>300 mg/24 h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness(CFT) were evaluated using Spearman’s correlation and linear regression analyses. Of the 52 patients with centerinvolved DME, 43 received an initial combined injection of conbercept(0.5 mg/0.05 mL) and triamcinolone acetonide(1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVCinjections during the first year of treatment was analyzed using Spearman’s partial correlation.RESULTS: Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy(NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro-and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12 mo of follow-up. CONCLUSION: Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.

The correlation of urinary albumin excretion rate with renal function, inflammatory response and oxidative stress response in patients with diabetic nephropathy

Objective:To study the correlation of urinary albumin excretion rate with renal function, inflammatory response and oxidative stress response in patients with diabetic nephropathy (DN).Methods: A total of 78 patients with DN treated in our hospital December 2012 and March 2016 were collected and divided into early diabetic nephropathy group (n=51) and middle-advanced diabetic nephropathy group (n=27) according to the DN grading standard;60 subjects with normal renal function who receiving physical examination in our hospital during the same period were selected as normal control group. Immediately after admission, the urinary albumin excretion rate (UAER) of all groups were determined;automatic biochemical analyzer was used to determine renal function index levels, ELISA method was used to determine inflammatory factor levels, and RIA method was used to determine the oxidative stress index levels;Pearson test was used to analyze the correlation of UAER value with renal function, inflammatory response and oxidative stress response in patients with DN.Results:Differences in UAER value as well as renal function index, inflammatory response index and oxidative stress index levels were statistically significant among three groups of subjects. UAER value as well as BUN, Scr, CysC,β2-MG, IL-6, hs-CRP, TNF- , MDA and AOPP levels of early DN group and middle-advanced DN group were higher than those of normal control group while T-AOC and SOD levels were lower than those of normal control group;UAER value as well as BUN, Scr, CysC,β2-MG, IL-6, hs-CRP, TNF- , MDA and AOPP levels of middle-advanced DN group was higher than those of early DN group while T-AOC and SOD levels were lower than those of early DN group;UAER value in patients with DN was correlated with renal function, inflammatory response and oxidative stress.Conclusion:UAER value can directly reflect the renal injury, inflammation and oxidative stress in patients with DN, and be the reliable means for early disease diagnosis and treatment guidance.

Correlation between Mineral Intake and Urinary Excretion in Free-Living Japanese Young Women

To clarify whether the urinary excretion of calcium, magnesium, phosphorus, iron, zinc, copper, manganese, selenium and molybdenum can be used as an index of their intake, the association between urinary excretion and intake in free-living individuals was examined. A total of 102 healthy free-living female university dietetics students aged 18 - 33 years voluntarily participated in this study, of which 76 students were eligible for this assessment. All food consumed for four consecutive days was recorded accurately by a weighed food record method. A 24-h urine sample was collected on the fourth day, and the urinary levels of sodium, potassium, calcium, magnesium, phosphorus, iron, zinc, copper, manganese, selenium and molybdenum were measured. Significant correlation between urinary excretion and intake was observed in sodium (r = 0.596, p < 0.001), potassium (r = 0.583, p < 0.001), calcium (r = 0.402, p < 0.001), magnesium (r = 0.365, p < 0.01), phosphorus (r = 0.509, p < 0.001), selenium (r = 0.349, p < 0.01) and molybdenum (r = 0.265, p < 0.01). On the other hand, urinary excretion was very low and completely independent of the intake in iron, zinc, copper and manganese. These results indicate that urinary calcium, magnesium, phosphorus, selenium and mo-lybdenum can be used as an index of their intake, similarly to sodium and potassium.

Association of a Tobacco-specific Nitrosamine Carcinogen with Urinary Cotinine,Urinary Sodium Excretion,and Total Energy Intake in Adolescents and Children

This study investigated the association of a tobacco-specific nitrosamine carcinogen,4-(methylnitrosamino)-1-(3-pyridy1)-I-butanol(NNAL)with urinary cotinine(uCot),urinary sodium(uNa)excretion,systolic blood pressure(sBP),and total energy intake in adolescents and children in relation to the subjects'age.A total of 790 subjects aged 6-19 years were evaluated.NNAL,uCot,corrected NNAL(cNNAL),the NNAL/uCot ratio,uNa,sBP,and nutrient intake were measured.A strong association between uCot and cNNAL was observed in children who were 11 years of age(r=0.881,P<0.001);however,no significant association was noted in adolescents who were 19 years of age.The uNa level was significantly higher(133.9 mmol/L vs.107.8 mmol/L,P<0.001)and sBP was significantly lower(105.3 mmHg vs.110.6 mmHg,P=0.012)in adolescents with elevated NNAL than in those without elevated NNAL.NNAL was significantly higher in subjects with increased uNa excretion than in those without increased uNa excretion.NNAL was positively correlated with uNa(r=0.183,P<0.001)and negatively correlated with sBP(r=0.142,P<0.001).Non-smokers with elevated NNAL/uCot ratios had significantly lower total energy intake than those without elevated NNAL/uCot ratios(1729.0 kcal/day vs.1911.0 kcal/day,P=0.008).The relationship between NNAL and uCot varied according to the subjects'age.NNAL seems to play a role in decreasing sBP by enhancing uNa excretion.Insufficient nutrient intake may contribute to endogenous formation of NNAL in non-smoking adolescents and children.

24-Hour Urinary Sodium Excretion Association with Cardiovascular Events:A Systematic Review and Dose-Response Meta-Analysis

Objective The relationship between sodium intake and cardiovascular(CV)events remains unconfirmed.Therefore,we carried out a systematic review and dose-response meta-analysis for evaluating the potential impact of 24-hour sodium excretion on CV risk.Besides,24-hour sodium excretion was used to replace daily sodium diet intake.Methods We searched ISI Web of Science,Embase,Pub Med,and the Cochrane Library.Our study included cohort studies reporting hazard ratio(HR).The random-effects model was used for summarizing the total relative risks(RRs)between the included studies.In addition,the generalized least-squares regression was employed to fit the study model.Results A total of 9 studies involving 645,006 participants were included in this study.A significant non-linear relationship was observed between sodium excretion and CV events(P^(non-linearity)<0.001).In studies collecting 24-h urine samples,the sodium excretion and CV events risk were associated linearly(RR:1.04;95%CI:1.01,1.07).Conclusion In a linear dose-response manner,every 1 g increase in sodium intake was associated with an increased risk of CV events up to 4%.Further studies are required to validate our conclusions further.

The <i>in Vivo</i>Antioxidant Effects of (&minus;)-Epigallocatechin-3-Gallate Consumption in Healthy Postmenopausal Women Measured by Urinary Excretion of Secondary Lipid Peroxidation Products

The present study was carried out to determine whether the consumption of epigallocatechin (EGCG), the major bioactive green tea catechin, exerts a positive effect on lowering in vivo lipid peroxidation, a measure of oxidative stress, in healthy postmenopausal women. Urinary excretion of secondary lipid peroxidation products, a measure of in vivo lipid peroxidation, was determined in 40 participants randomly assigned to consume a green tea catechin extract (843.0 ± 44.0 mg EGCG/d) or placebo capsules for 12 months. Urine samples were analyzed for individual polar and nonpolar lipophilic aldehydes and related carbonyl compounds by high-performance liquid chromatography (HPLC) at the beginning and at the end of the 12-month intervention period. Results show that two nonpolar aldehydes, nonanal and decatrienal, were both 48% lower (p in vivo antioxidant activity exists with long-term EGCG consumption, which could slightly limit oxidative damage associated with lipid peroxidation and the onset and progression of chronic diseases.

2型糖尿病患者血清25-羟维生素D水平与代谢指标的相关性

目的分析2型糖尿病患者25-羟维生素D[25(OH)D]水平,初步了解血清25(OH)D水平与2型糖尿病患者糖化血红蛋白(HbA1c)、胰岛功能等代谢指标的相关性。方法选择新乡市第一人民医院内分泌科2020年1月至2020年12月收治的459例2型糖尿病患者为研究对象。收集患者的临床资料,包括性别、年龄、血清25(OH)D、空腹胰岛素、C肽、HbA1c、空腹血糖、餐后血糖、尿微量白蛋白、尿白蛋白肌酐比值、血钙、血尿酸(UA)、三酰甘油(TG)、总胆固醇(TCH)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)等。根据血清25(OH)D水平将患者分为充足组[n=20,25(OH)D≥30μg·L^(-1)]、不足组[n=95,20μg·L^(-1)≤25(OH)D<30μg·L^(-1)]、缺乏组[n=231,10μg·L^(-1)≤25(OH)D<20μg·L^(-1)]、严重缺乏组[n=113,25(OH)D<10μg·L^(-1)]。比较4组患者各代谢指标的差异,采用Pearson相关分析25(OH)D与各代谢指标的相关性。结果2型糖尿病患者血清25(OH)D水平为3.00~46.59(15.75±0.35)μg·L^(-1),男性患者的血清25(OH)D水平显著高于女性患者(P<0.05)。2型糖尿病患者25(OH)D缺乏的患病率为74.9%(344/459),25(OH)D缺乏主要发生在1、2、3、4、11、12月份。不足组、缺乏组和严重缺乏组患者HbA1c显著高于充足组(P<0.05),缺乏组和严重缺乏组患者HbA1c显著高于不足组(P<0.05);缺乏组和严重缺乏组患者HbA1c比较差异无统计学意义(P>0.05)。充足组与不足组、缺乏组与严重缺乏组患者空腹血糖比较差异无统计学意义(P>0.05);缺乏组和严重缺乏组患者空腹血糖显著高于充足组、不足组(P<0.05)。充足组、不足组、缺乏组患者空腹胰岛素、尿微量白蛋白、日尿白蛋白总量、尿白蛋白肌酐比值比较差异无统计学意义(P>0.05);严重缺乏组患者空腹胰岛素显著低于充足组、不足组和缺乏组,尿微量白蛋白、日尿白蛋白总量、尿白蛋白肌酐比值显著高于充足组、不足组和缺乏组(P<0.05)。4组患者的稳态模型评估的胰岛素抵抗指数(HOMA-IR)、血清白蛋白、血肌酐、餐后1 h血糖、餐后2 h血糖、餐后3 h血糖、空腹C肽、餐后1 h C肽、餐后2 h C肽、餐后3 h C肽、TG、TCH、LDL、HDL、血UA、血钙比较差异均无统计学意义(P>0.05)。Pearson相关性分析结果显示,2型糖尿病患者血清25(OH)D水平与HbA1c、尿微量白蛋白、尿白蛋白肌酐比值呈负相关(r=-0.093、-0.166、-0.157,P<0.05),与空腹胰岛素呈正相关(r=0.089,P<0.05)。2型糖尿病患者血清25(OH)D水平与空腹血糖、HOMA-IR、血清白蛋白、血肌酐、餐后1 h血糖、餐后2 h血糖、餐后3 h血糖、空腹C肽、餐后1 h C肽、餐后2 h C肽、餐后3 h C肽、TG、TCH、LDL、HDL、血UA、血钙等无相关性(P>0.05)。结论2型糖尿病患者25(OH)D缺乏与不足普遍存在,女性患者缺乏更明显。2型糖尿病患者25(OH)D水平与空腹胰岛素呈正相关,与HbA1c、尿微量白蛋白、尿白蛋白肌酐比值呈负相关,25(OH)D缺乏的2型糖尿病患者主要分布在1、2、3、4、11、12月份。

我国社区人群甘油三酯葡萄糖乘积指数与尿白蛋白/肌酐比值的相关性

目的探讨我国社区人群甘油三酯葡萄糖乘积(TyG)指数与尿白蛋白/肌酐比值(UACR)的相关性,并比较不同胰岛素抵抗指数和肥胖指数对异常白蛋白尿预测价值的差异。方法共纳入来自REACTION(中国糖尿病患者癌症风险评估)数据库的34655例受试者,根据UACR值将其分为正常白蛋白尿组和异常白蛋白尿组,再根据TyG指数将其再分为TyG-Q_(1)组~TyG-Q_(4)组。收集所有受试者一般临床资料、实验室检查指标及各项指数并分组进行比较。采用多因素logistic回归分析评估TyG指数与UACR异常的相关性。采用受试者工作特征(ROC)曲线评估TyG指数等新型指标对异常白蛋白尿的预测效能。结果Q_(2)、Q_(3)和Q_(4)组受试者异常白蛋白尿发生率、体重、WC、HC、TC、ALT、AST、GGT、SBP、DBP均显著高于Q_(1)组;Q_(3)组受试者LDL-C显著高于Q_(1)组;Q_(4)组受试者身高显著高于Q_(1)组(P<0.001)。多因素logistic回归分析结果显示,TyG指数作为连续变量时,TyG指数与UACR异常呈显著正相关;TyG指数为分类变量时,高TyG指数与UACR异常呈显著正相关(Q3组P=0.015,Q4组P<0.001)。ROC曲线分析结果显示,TyG指数、HOME-IR、METS-IR、CVAI、ABSI和BMI对异常白蛋白尿发生均具有预测价值(P<0.001),TyG指数和CVAI的预测价值显著高于其他指标(P<0.05),但两者的预测效能无明显差异(P>0.05)。结论TyG指数升高与中国社区人群UACR异常显著相关,TyG指数和CVAI对异常白蛋白尿的发生预测价值最高,提示其在临床预测中具有潜在应用价值。

膜性肾病患者抗磷脂酶A2受体抗体定量水平与肾损伤标志物的相关性

目的探讨膜性肾病(MN)患者抗磷脂酶A2受体(PLA2R)抗体定量水平与肾损伤标志物的相关性。方法回顾性选取2020年5月至2021年4月就诊于厦门大学附属第一医院的79例MN患者作为MN组。另选取同期45例临床诊断非MN患者作为对照组。比较两组抗PLA2R抗体定量水平的差异及不同截断值下的诊断性能。收集MN组血清和尿液标志物检测结果,包括尿液24 h尿蛋白(24 h-UTP)、尿微量清蛋白(ALB)与肌酐(Cr)比值(ACR)以及血清总蛋白(TP)、ALB、尿素氮(BUN)、Cr、半胱氨酸蛋白酶抑制剂胱抑素C(Cys C)水平。根据改善全球肾脏病预后组织(KDIGO2012)指南以抗PLA2R抗体定量150 RU/mL为截断值分成低浓度组(≤150 RU/mL)和高浓度组(>150 RU/mL),分析比较各肾损伤标志物差异。绘制受试者工作特征(ROC)曲线评价诊断效能。采用Spearman相关分析抗PLA2R抗体水平与24 h-UTP、ACR、ALB、BUN的相关性。结果MN组抗PLA2R抗体水平[79.80(21.70,206.70)RU/mL]高于对照组[1.54(1.36,1.74)RU/mL],差异有统计学意义(Z=-8.47,P<0.01)。<40岁、40~60岁、>60岁抗PLA2R抗体水平分别为40.9(21.4,84.9)RU/mL、73.2(5.1,202.5)RU/mL、171.6(40.9,460.2)RU/mL,抗PLA2R抗体水平随年龄升高而升高,差异有统计学意义(H=10.44,P<0.05)。截断值≥20 RU/mL时,抗PLA2R抗体诊断MN的特异度为100.0%,但灵敏度仅78.5%。ROC曲线分析结果显示,最佳截断值为2.16 RU/mL时,灵敏度为92.4%,特异度为95.6%,约登指数为0.880。高浓度组纳入27例患者,低浓度组纳入52例患者。高浓度组24 h-UTP、ACR、BUN水平明显高于低浓度组,ALB水平明显低于低浓度组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,抗PLA2R抗体与24 h-UTP、ACR、BUN呈正相关(r=0.635、0.628、0.240,P<0.05),与ALB呈负相关(r=-0.344,P<0.05)。结论抗PLA2R抗体定量水平对于MN患者具有较好诊断价值,抗PLA2R抗体定量水平与肾损伤标志物存在一定相关性,研究结果为本地区MN的临床诊断治疗提供参考。

同型半胱氨酸及尿蛋白肌酐比与糖尿病肾病的关系

目的:本研究拟观察糖尿病肾病患者合并不同程度肾脏损害时,机体血清同型半胱氨酸(Hcy)与尿白蛋白/肌酐比值(UACR)的水平,并分析其与糖尿病肾病中肾脏损害的关系。方法:选取400例糖尿病肾病患者为研究对象(糖尿病肾病组);200例单纯2型糖尿病患者为对照组(2型糖尿病组)。对比两组患者血清Hcy与UACR的水平。参照肾小球滤过率(GFR)相关标准分组(将G1、G2期纳入早期糖尿病肾病组,G3-G5期纳入晚期糖尿病肾病组),对比两组患者年龄、性别等一般资料及血清Hcy与UACR水平。经二元回归分析后,将P值放宽至<0.1,将符合条件的因素同时纳入作为自变量,经Logistic回归分析上述指标与GFR水平的相关性。结果:与单纯2型糖尿病组患者相比,糖尿病肾病组患者血清Hcy与UACR水平较高(P<0.05);两组其他一般资料无统计学差异(P>0.05);经Logistic回归分析显示,2型糖尿病患者血清Hcy及UACR水平与肾损伤有关(OR=1.577,95%CI:1.320~1.738,P<0.05;OR=1.031,95%CI:1.024~1.038,P<0.05);晚期糖尿病肾病组患者血清Hcy及UACR水平高于早期糖尿病肾病组患者,GFR水平低于早期糖尿病肾病组患者(P<0.05);经双变量Spearman直线相关性检验显示,血清Hcy及UACR水平与糖尿病肾病患者肾损伤程度(GFR水平)均呈负相关(r=-0.468、-0.719,P<0.05)。结论:糖尿病肾病患者血清Hcy及UACR水平与肾脏损害(GFR水平)密切相关。

miR-150-5p、miR-135b在糖尿病肾病患者中的表达及意义

目的探讨外周血miR-150-5p、miR-135b水平与糖尿病肾病(DN)患者尿白蛋白排泄率(UAER)、预后的关系。方法采用前瞻性研究方法,选取2019年1月至2021年10月延安大学附属医院收治的85例DN患者作为DN组[男46例,女39例,年龄(46.28±4.41)岁,2型糖尿病(T2DM)病程(7.24±2.31)年],另纳入76例单纯T2DM患者作为T2DM组[男40例,女36例,年龄(44.95±6.13)岁,T2DM病程(6.98±3.28)年],80例健康体检者作为对照组[男43例,女37例,年龄(45.74±5.68)岁]。收集3组患者临床资料及外周血miR-150-5p、miR-135b水平,Spearman分析各指标与UAER相关性,绘制受试者操作特征曲线(ROC)及曲线下面积(AUC),分析各指标预后的预测效能,采用相对危险度(RR)及95%置信区间(CI)分析各指标对预后的影响。结果DN组外周血miR-150-5p、miR-135b水平>T2DM组>对照组[(3.36±0.68)比(1.03±0.62)比(0.78±0.21)、(3.96±0.51)比(1.24±0.48)比(0.66±0.12)],差异均有统计学意义(F=560.11、1519.26,均P<0.05);DN组UAER>300 mg/24 h患者外周血miR-150-5p、miR-135b水平>UAER 30~300 mg/24 h患者>UAER<30 mg/24 h患者[(4.10±0.92)比(3.42±0.64)比(2.73±0.51)、(5.40±0.87)比(3.87±0.61)比(3.02±0.49)],差异均有统计学意义(F=23.53、78.25,均P<0.05);DN患者外周血miR-150-5p、miR-135b水平与UREA呈正相关(r=0.783、0.835,均P<0.05);随访12个月,15例发生终末期肾病(ESRD),发生ESRD患者外周血miR-150-5p、miR-135b水平均高于未发生ESRD患者[(4.41±0.55)比(3.14±0.38)、(4.67±0.61)比(3.81±0.42)],差异均有统计学意义(t=10.67、6.53,均P<0.05);外周血miR-150-5p、miR-135b、联合预测DN并发ESRD的AUC分别为0.733、0.829、0.944。外周血miR-150-5p、miR-135b高水平患者并发ESRD的RR分别为低水平的3.619倍、10.889倍,其95%CI分别为1.105~11.856、1.503~78.872。结论外周血miR-150-5p、miR-135b水平与DN患者UAER呈正相关,联合检测可作为预测DN并发ESRD的重要辅助手段,为临床诊治提供可靠数据支持。

尿微量白蛋白/尿肌酐、血清胱抑素C、血清β2-微球蛋白在高血压肾病早期诊断中的价值

目的研讨尿微量白蛋白/尿肌酐(UACR)、血清胱抑素C(Cys-C)、血清β2-微球蛋白(β2-MG)再诊断早期高血压肾病中的价值。方法选择新乡医学院第三附属医院2022年1月至2022年12月收入的82例高血压患者,依照有无合并肾病分为高血压无明确肾病组40例和高血压肾病组42例,再选择42例同期入院的健康体检者为对照组。检测所有研究对象UACR、Cys-C、β2-MG水平,对比三组检测结果。结果高血压肾病组UACR、Cys-C、β2-MG水平均高于高血压无明确肾病组和对照组,高血压无明确肾病组UACR、Cys-C、β2-MG水平较对照组高,差异具有统计学意义(P<0.05);不同肾脏受损分级高血压患者的UACR、Cys-C、β2-MG水平存在差异,差异具有统计学意义(P<0.05),随着肾脏受损分级的增高,UACR、Cys-C、β2-MG水平也在不断增高;UACR联合Cys-C联合β2-MG检测高血压肾病阳性率97.62%,高于UACR、Cys-C、β2-MG单一检测的85.71%、80.95%、76.19%,差异具有统计学意义(P<0.05);UACR、Cys-C、β2-MG值均与肾脏受损程度呈正相关性(P<0.05)。结论UACR、Cys-C、β2-MG联合检测可辅助诊断早期高血压肾病,在临床应将三项指标联合应用,但还需结合病史和临床表现综合诊断。

保肾灵丸联合西药治疗糖尿病肾病的临床疗效及对患者尿白蛋白指标的影响

目的:分析保肾灵丸联合西药对糖尿病肾病患者(DN)临床疗效及尿白蛋白指标的影响。方法:纳入2022年1月—2023年12月于安庆市石化医院就诊的DN患者80例,按照随机数字表法分为保肾灵丸组、对照组,每组40例,两组均进行西药治疗,保肾灵丸组则加用保肾灵丸。比较两组治疗前后患者血糖、血清炎性因子、抗氧化酶及尿白蛋白指标水平,统计服药期间胃肠道不适、低血糖等不良反应。结果:治疗后两组患者血糖、血清炎性因子、尿白蛋白指标水平均显著下降,抗氧化酶水平均显著上升(P<0.01);保肾灵丸组治疗后空腹血糖(FPG)、空腹2 h血糖(2 h PG)显著低于对照组(P<0.01);血清白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.01);超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平显著高于对照组(P<0.01);尿微量白蛋白(U-mAlb)、尿微量白蛋白/尿肌酐(ACR)显著低于对照组(P<0.01);低血糖、胃肠道不适等不良反应总发生率比较,保肾灵丸组与对照组无显著差异(P>0.05)。结论:保肾灵丸联合西药治疗DN可有效改善尿白蛋白指标,降低患者血糖,下调炎性因子水平,提高机体抗氧化能力,延缓肾功能损伤,且安全性高,有较好的临床疗效。

高血压早期肾损害诊断指标的筛选

目的:筛选高血压早期肾损害的诊断指标。方法:搜集2020年1月至2023年2月河南省人民医院内科病房收治的高血压患者,选取高血压早期肾损害[30 mg/24 h≤尿白蛋白排泄率(uAER)<300 mg/24 h]患者51例(肾损害组),以及单纯高血压患者51例(对照组)。比较两组患者血清尿素氮(BUN)、肌酐(SCr)、同型半胱氨酸(HCY)、视黄醇结合蛋白(RBP)、胱抑素C(CysC)、尿微量白蛋白(umALB)、微量白蛋白/肌酐比值(uACR)、α1微球蛋白(uα1MG)、β2微球蛋白(uβ2MG)、N-乙酰-β-D氨基葡萄糖苷酶(uNAG)及转铁蛋白(uTF)水平的差异。绘制ROC曲线,比较上述指标对高血压早期肾损害的诊断效能。结果:肾损害组患者血清BUN、SCr、HCY、RBP、CysC水平及umALB、uAER、uACR、uα1MG、uβ2MG、uNAG、uTF水平均高于对照组(P均<0.05)。ROC曲线AUC>0.9的指标从高到低分别为uACR>CysC>uα1MG>uβ2MG>umALB>RBP,其中CysC+uACR联合诊断的效能和敏感度最高[AUC(95%CI)为0.994(0.954~1.000),敏感度为1.000]。结论:CysC+uACR为高血压患者早期肾损害的高效诊断指标。

2型糖尿病患者24 h尿钠排泄及IL-18水平与尿白蛋白的相关性研究

目的以24 h尿钠排泄水平(24 h UNa)作为钠摄入量评估指标,评估不同钠盐的摄入水平与血清炎症因子对2型糖尿病(T2DM)患者尿白蛋白(UA)发生风险的影响。方法纳入T2DM患者130例,依据尿白蛋白/肌酐比值(UACR)水平分为UA阳性组60例和UA阴性组70例。收集患者的临床资料,检测炎性因子及24 h尿液相关指标。采用Spearman相关分析T2DM患者临床指标与UACR的相关性;二元Logistic回归分析T2DM患者临床指标对UA的影响;二分类回归法分析24 h UNa和IL-18关联对UA的影响。结果24 h UNa水平(OR=1.019,95%CI 1.003~1.035,P=0.017)与IL-18(OR=1.204,95%CI 1.060~1.368,P=0.004)是T2DM患者UA阳性的独立危险因素。联合分析提示,与低钠低IL-18组比较,高钠高IL-18组UA阳性风险显著增加(OR=10.774,95%CI 2.105~55.155,P=0.004)。结论24 h UNa、IL-18水平升高是T2DM患者UA发生的危险因素。

半胱氨酸蛋白酶抑制剂C与糖尿病肾病的相关性

目的探讨半胱氨酸蛋白酶抑制剂C(Cys C)与糖尿病肾病(DKD)的相关性。方法收集2019年1月至12月陕西省人民医院内分泌科住院的122例2型糖尿病(T2DM)患者的临床资料,按尿白蛋白与肌酐比值(UACR)分为单纯糖尿病(DM)组(UACR<30 mg/g,89例)、DKD组(UACR≥30 mg/g,33例)。比较两组临床资料,采用logistic回归分析T2DM患者发生DKD的危险因素,绘制受试者操作特征(ROC)曲线评价Cys C对DKD的预测价值。结果DKD组收缩压、碱性磷酸酶、总蛋白、球蛋白、血清肌酐、尿微量白蛋白、尿α_(1)微球蛋白、UACR、Cys C均高于单纯DM组,病程长于单纯DM组(P<0.05)。logistic回归分析显示,Cys C是DKD的危险因素(OR=28.369,95%CI:1.208~666.129,P=0.038)。ROC曲线分析显示,Cys C预测DKD的曲线下面积为0.757(P<0.05)。结论Cys C与T2DM合并DKD密切相关,检测Cys C可用于评估DKD病情进展。

昆明市2社区2型糖尿病慢病管理患者服药依从性对病情控制的影响

目的分析昆明市2社区2型糖尿病(type 2 diabetes,T2DM)慢病管理患者服药依从性对病情控制的影响。方法选取2021年12月至2022年7月昆明市官渡、小板桥2个社区纳入慢病管理的2型糖尿病患者138例,完善基本信息采集、糖化血红蛋白(HbAlc)等相关检查,进行Morisliy服药依从性量表(8-item Morisky medication adherence scale,MMAS-8)问卷调查,分析服药依从性高(A组)、中(B组)、低(C组)3组的HbAlc等指标水平,并进行统计学分析。结果A组病例数占22.5%,B组占44.9%,C组占32.6%。2组间的尿白蛋白肌酐比(UACR)、HbA1c、血肌酐差异有统计学意义(P<0.05)。A组患者UACR、HbAlc、血肌酐水平低于B组、C组患者,UACR、HbAlc、血肌酐与用药依从率存在相关性,呈负相关(P<0.05)。结论昆明市官渡社区、小板桥2社区2型糖尿病慢病管理患者服药依从性高的患者比例仅为22.5%。依从性越高,患者UACR、HbAlc、血肌酐水平越低,两者之间存在相关性,提示应将服药的依从性作为社区糖尿病慢病管理中重点之一,并应加强对患者服药依从性的干预。

水蛭和黄连随证施量策略在糖尿病肾病治疗中的运用

糖尿病肾病是主要的糖尿病微血管并发症之一,该疾病早中期,患者常没有明显的临床症状,但会有蛋白尿,ACR升高等异常指标,因此在准确辨证基础上,应用针对降蛋白尿和降糖的中药水蛭和黄连,往往能获得较好的疗效。对于此类药物的剂量,要结合随证施量策略,选定调整剂量的指征,找准变量的时机,控制好药物用量的范围,才能在确保用药安全的基础上取得最佳疗效。

血清C型凝集素结构域家族11成员A在糖尿病肾脏病进展中的变化及在骨代谢评估中的意义

目的分析血清C型凝集素结构域家族11成员A(Clec11a)在糖尿病肾脏病(DKD)进展中的变化,评估其在DKD患者骨代谢评价中的价值。方法收集184例2型糖尿病(T2DM)患者临床资料并检测外周血Clec11a水平,根据尿白蛋白肌酐比(UACR)将纳入的患者分为三组:无蛋白尿组(UACR<30 mg/g,76例)、微量蛋白尿组(UACR 30~300 mg/g,72例)和大量蛋白尿组(UACR>300 mg/g,36例)。另选取同期体检健康者50例为正常对照组。比较各组患者的一般资料、骨密度(BMD)、骨代谢指标,分析非糖尿病、不同分期DKD患者血清Clec11a水平及其他骨代谢指标,评估UACR与Clec11a及其他骨代谢指标之间的相关性。结果T2DM各亚组Clec11a水平及估测肾小球滤过率(eGFR)均低于正常对照组(P<0.05)。在T2DM各亚组间比较,随着UACR上升,Clec11a水平及eGFR逐渐降低,差异有统计学意义(P<0.05)。微量蛋白尿组股骨颈BMD、Clec11a水平低于无蛋白尿组(P<0.05);大量蛋白尿组腰椎BMD、Clec11a水平低于微量蛋白尿组(P<0.05)。而骨代谢指标如25羟维生素D[25(OH)D]、骨钙素N端中分子片段、Ⅰ型前胶原氨基端前肽、甲状旁腺素、β胶原降解产物,微量蛋白尿组与无蛋白尿组之间差异无统计学意义。T2DM患者BMD、25(OH)D、Clec11a水平与UACR水平呈负相关(P<0.05),其中Clec11a与UACR相关性最强。结论T2DM患者血清Clec11a水平显著降低,且随着UACR的上升逐渐降低;与其他骨代谢指标比较,Clec11a与UACR间呈较强的负相关性。定期检测DKD患者血清Clec11a含量有助于早期识别骨量丢失。

格列美脲联合达格列净治疗2型糖尿病肾病的疗效及对BUN、CREA、ACR水平的影响

目的 探究格列美脲联合达格列净治疗2型糖尿病肾病的疗效及对尿素氮(BUN)、肌酐(CREA)、尿白蛋白/肌酐比值(ACR)水平的影响。方法 选取2021年3月至2023年3月120例临泉县人民医院内分泌科收治的2型糖尿病肾病患者为研究对象,依据治疗方式的不同分为达格列净治疗组(对照组)64例(给予达格列净治疗)与格列美脲联合达格列净治疗组(研究组)56例(给予格列美脲联合达格列净治疗)。对比两组临床疗效、血糖达标时间及胰岛素日用量间的差异,比较达格列净治疗组与格列美脲联合达格列净治疗组治疗前后的血糖指标及BUN、CREA、ACR水平。结果 格列美脲联合达格列净治疗组临床治疗总有效率96.43%显著高于达格列净治疗组82.81%,差异具有统计学意义(χ^(2)=2.006,P<0.05)。治疗12周后,与达格列净治疗组比较,格列美脲联合达格列净治疗组血糖达标时间明显缩短,胰岛素日用量也显著减少,差异均有统计学意义(t=4.449、9.958,P<0.05)。两组FPG、HbA1 c、BUN、CREA、ACR水平均下降,且格列美脲联合达格列净治疗组FPG、HbA1 c、BUN、CREA、ACR水平低于达格列净治疗组,差异有统计学意义(t=4.382、4.028、20.741、2.930、2.360,P<0.05)。结论 与单用达格列净治疗相比,采用格列美脲联合达格列净治疗可有效改善2型糖尿病肾病患者血糖控制情况,调节胰岛素抵抗状态,降低BUN、CREA、ACR水平。