Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test:A prospective study

AIM： To evaluate the use of the trypsinogen-2 dipstick （Actim Pancreatitis） test for early diagnosis and prediction of severity in acute pancreatitis （AP）. METHODS： Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test （UTDT） and conventional diagnostic tests were performed in all patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis. RESULTS： UTDT was positive in 87 （94.6%） of the AP patients and in two （8%） controls （P 〈 0.05）. Positive UTDT was found in 61 （92.4%） of 66 （71.7%） patients with mild pancreatitis and in all （100%） of the 26 （28.3%） with severe pancreatitis （P 〉 0.05）. UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis （6.2 ＋ 2.5 d vs 2.0 ＋ 1.43 d, P 〈 0.05）. The sensitivity, specificity, positive predictive value, negative predictive value （NPV）, positive likelihood ratio （PLR） and negative likelihood ratio （NLR） of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively. CONCLUSION： UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement.

Science Letters:Culture of Spirulina platensis in human urine for biomass production and O_2 evolution

Attempts were made to culture Spirulina platensis in human urine directly to achieve biomass production and O2 evolution, for potential application to nutrient regeneration and air revitalization in life support system. The culture results showed that Spirulinaplatensis grows successfully in diluted human urine, and yields maximal biomass at urine dilution ratios of 140-240. Accumulation of lipid and decreasing of protein occurred due to N deficiency. O2 release rate of Spirulina platensis in diluted human urine was higher than that in Zarrouk medium.

Study on the Hook Effect in the Detection of Beta2-Microglobulin with Different Reagents in Fully Automated Biochemical Analyzers

Objective:To investigate the hook effect in the detection of beta2-microglobulin(β2-MG)with different reagents as well as on two fully automated biochemical analyzers and their solutions.Methods:Using immunoturbidimetric assay forβ2-MG as the research object,β2-MG levels were detected by different concentration gradients ofβ2-microglobulin samples in Liedemann,Mack,and Myriad reagents of three manufacturers on two automatic biochemical analyzers,and the difference of the hook effect was comparatively analyzed.Results:Leadman reagent showed the hook effect on the Beckman AU5800 automated biochemistry analyzer,while both Maccura and Mindray reagents did not show the hook effect.After the experiments,we found the limit value of the pre-zone check of Leadman reagent,and changed the parameters of the instrument,when the limit value of the pre-zone check was reached,the instrument automatically diluted the specimen five times and then detected it again.After changing the parameters of the instrument,the correlation between the three methods of detecting samples of different concentrations was r>0.99.Conclusion:Before selecting the application of immunoturbidimetric reagents,we have to carry out the risk assessment of the hook effect and selectively set the parameters of the pre-zone check based on the highest concentration that may occur in the clinic;for the items that may have the hook effect,we have to selectively set the parameters of the pre-zone check when the ratio of average reaction rate and the immediate reaction rate is at the limit value,and the phenomenon of antigen excess may occur,the instrument will carry out automatic dilution before detection,so as to avoid the issuance of erroneous results of high-value samples due to the hook effect.

Urine Metabonomic Analysis of Interventions Effect of Soy Isoflavones on Rats Exposed to Di-(2-ethylhexyl) Phthalate

Objective Di-(2-ethylhexyl) phthalate(DEHP) is a ubiquitous environmental contaminant.As an endocrine disruptor,it seriously threatens human health and ecological environmental safety.This study examines the impact of intervention with soybean isoflavones(SIF) on DEHP-induced toxicity using a metabonomics approach.Methods Rats were randomly divided into control(H),SIF-treated(A,86 mg/kg body weight),DEHP-treated(B,68 mg/kg),and SIF plus DEHP-treated(D) groups.Rats were given SIF and DEHP daily through diet and gavage,respectively.After 30 d of treatment,rat urine was tested using UPLC/MS with multivariate analysis.Metabolic changes were also evaluated using biochemical assays.Results Metabolomics analyses revealed that p-cresol glucuronide,methyl hippuric acid,N1-methyl-2-pyridone-5-carboxamide,lysophosphatidycholine [18:2(9 Z,12 Z)] {lyso PC [18:2(9 Z,12 Z)]},lyso PC(16:0),xanthosine,undecanedioic acid,and N6-acetyl-l-lysine were present at significantly different levels in control and treatment groups.Conclusion SIF supplementation partially protects rats from DEHP-induced metabolic abnormalities by regulating fatty acid metabolism,antioxidant defense system,amino acid metabolism,and is also involved in the protection of mitochondria.

Improvement of resolution in 2-D gel analysis by simple pre-treatment of human urine with EDTA

Regardless of thermodynamic stability, less complex proteome than plasma, convenient and noninvasive sampling of urine, reproducibility and comparability of the data among laboratories are challenges for the urine proteome analysis. Pretreatment of urine with 10 mM EDTA in conjunction with desalting methods to remove interfering molecules significantly improved the presentation of urine proteome on 2-D gels. Statistical analysis of the average ratio of the spot numbers on 2-D gels between EDTA-treated and non-treated samples were 1.35 ± 0.167, 1.26 ± 0.091, and 1.24 ± 0.095 for dialysis, ultrafiltration, and desalting column, respectively, with the p-value of 5.85 × 10–6 for the overall comparison. This result came from the fact that EDTA-treated samples showed better resolutions with less streaks and clearer spots on 2-D gels than the control samples. The results suggest that a simple and non-fractionating EDTA-treatment can be employed to the procedures for the high resolution 2-D gel analysis and other urinary proteomic analysis.

The clinical significance evaluation of serum β_2-microglobulin for thyroid cancer patients

Objective： The aim of this study was to investigate the clinical value and relevance on the serum β2-microglobulin （β2-MG） of patients with thyroid cancer. Methods： One thousand and two normal cases, 95 thyroid cancer patients and 243 nodular goiter patients were selected to measure serum β2-MG levels using double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）. Results： The positive rate of 7.78% in normal population （78/1002） and 31.57% in thyroid cancer patients （30/95）. There were significant differences between the normal population and thyroid cancer patients （X2 = 55.352; P = 0.000）. The positive rate of 7.81% in nodular goiter patients （19/243） and there were no significant differences between the normal population and nodular goiter patients （X2 = 0.0004; P = 0.986）, but significant differences between nodular goiter patients and thyroid cancer patients （x2 = 31.106; P = 0.000）. Meanwhile, the significant difference of the positive rate existed in between the various pathological types of thyroid cancer （X2 = 10.015; P = 0.007）, anaplastic thyroid cancer patients with the highest positive rate and The significant difference was found between the positive lymph node metastasis groups and negative lymph node metastasis groups （x2 = 4.441; P = 0.035）, the presence of distant metastasis group and absence of distant metastasis group （X2 = 9.795; P = 0.002）. Conclusion： Serum β2-MG levels and prognosis of thyroid cancer patients was negatively correlated. It showed important clinical value to detect the level of β2-MG in the early diagnosis, prognosis and the clinical observation for thyroid cancer patients.

Changes of serum β2-MG, Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance

Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.

Twenty-Two-Year Observation on Urinary Cadmium and β_(2)-Microglobulin in Inhabitants after Cessation of Cadmium-Exposure in Japan

Objective: This is an epidemiological survey that was conducted for 22 years to investigate the physical effects on inhabitants who had been exposed to cadmium (Cd) from processing of remnants discharged at the time of copper refinement. It was possible to obtain findings on physical effects 27 years after Cd exposure. Materials and Methods: Of the inhabitants who were 50 years old or younger in 1981 and who were living in the most contaminated area in the Kakehashi River basin, 68 (32 males and 36 females) who underwent all of the 5 screenings during the 22-year period were extracted as subjects. Early morning urine was collected for urinalysis, and Cd and ?2-MG concentrations were determined. Results: 27 years after cessation of Cd exposure, it was shown that urinary Cd concentrations were significantly decreased and urinary ?2-MG concentrations were significantly increased. Conclusion: Once exposed to Cd, it takes about 30 years for the Cd that remains in the body to decrease by half. Once renal tubular dysfunction occurs after Cd exposure, irreversible aggravation is inevitable.

Determination of urinary 8-hydroxy-2′-deoxyguanosine by capillary electrophoresis with molecularly imprinted monolith in-tube solid phase microextraction

Urinary 8-hydroxy-2 -deoxyguanosine(8-OHdG) is an excellent marker of oxidative DNA damage.In this study,employing guanosine as dummy template a novel molecularly imprinted(MIP) monolithic capillary column had been synthesized,and that was used as medium of in-tube solid phase microextraction(SPME).Coupled with capillary electrophoresis-electrochemical detection(CE-ECD),the system of extraction and detection of 8-OHdG in urinary sample had been developed.Because of its greater phase ratio combined with conv...

Role of serum β2-microglobulin, glycosylated hemoglobin, and vascular endothelial growth factor levels in diabetic nephropathy

BACKGROUND Diabetic nephropathy(DN)is a common complication of type 1 and type 2 diabetes that can lead to kidney damage and high blood pressure.Increasing evidence support the important roles of microproteins and cytokines,such asβ2-microglobulin(β2-MG),glycosylated hemoglobin(HbA1c),and vascular endothelial growth factor(VEGF),in the pathogenesis of this disease.In this study,we identified novel therapeutic options for this disease.AIM To analyze the guiding significance ofβ2-MG,HbA1c,and VEGF levels in patients with DN.METHODS A total of 107 patients with type 2 diabetes mellitus complicated with nephropathy and treated in our hospital from May 2018 to February 2021 were included in the study.Additionally,107 healthy individuals and 107 patients with simple diabetes mellitus were selected as the control groups.Changes inβ2-MG,HbA1c,and VEGF levels in the three groups as well as the different proteinuria exhibited by the three groups were examined.RESULTS Changes inβ2-MG,HbA1c,and VEGF levels in the disease,healthy,and simple diabetes groups were significantly different(P<0.05).The expression of these factors from high to low were evaluated in different groups by pairwise comparison.In the disease group,high to low changes inβ2-MG,HbA1c,and VEGF levels were noted in the massive proteinuria,microproteinuria,and normal urinary protein groups,respectively.Changes in these factors were positively correlated with disease progression.CONCLUSION The expression of serumβ2-MG,HbA1c,and VEGF was closely correlated with DN progression,and disease progression could be evaluated by these factors.

Relationship between serum b2-microglobulin levels and virological breakthrough in HBeAg-negative chronic hepatitis B patients,under long-term treatment schedules including lamivudine

AIM: Predictive value of serum b2-microglobulin (b2m)levels for virological breakthrough (VB) in HBeAg-negative chronic hepatitis B (CHB) patients under long-term treatment schedules including lamivudine (LAM).METHODS: Serum b2m levels were calculated during treatment in 25 CHB patients under long-term LAM monotherapy (group A) and 12 patients under initial interferon plus LAM treatment followed by LAM monotherapy (group B), using the MEIA technology. We used Cox proportional hazard models in order to investigate the association between serum b2m levels and VB.RESULTS: Seven of 25 patients (28%), 9/25 (36%) and 14/25 (56%) from group A and 0/12, 2/12 (16.6%) and 3/12 (25%) from group B exhibited VB at months 12, 24 and 36 of treatment, respectively. All patients, from both groups, who did not show VB exhibited b2m elevation in mo 3. The duration of b2m elevation was significantly longer in the virological responder's subgroup from group A than the non-responder's one (7.3±2.6 vs 3.8±3.4 mo,P = 0.02). In comparison to group A patients whose b2m levels were increased at 3 mo, patients whose b2m levels were decreased had 4.6 times higher risk of experiencing VB (RR = 4.6, P = 0.024). When baseline variables were simultaneously included in the same Cox model, decreased b2m status was still associated with increased risk of VB (RR = 12.2, P = 0.03).CONCLUSION: In HBeAg-negative CHB patients under either long-term LAM monotherapy or initial combination treatment, serum b2m levels at 3 mo of treatment,compared to baseline ones, might be a predictor of risk for VB.

Role of β2-microglobulin in uremic patients may be greater than originally suspected

The role of beta2-microglobulin(β2M) in dialysisrelated amyloidosis as a specific amyloid precursor was defined in the 1980 s. Studies in those years were largely related to β2M amyloidosis. In 2005, for what was probably the first time in the available literature, we provided data about the association betweenβ2M and early-onset atherosclerosis in hemodialysis patients without co-morbidities. In recent years, the role of uremic toxins in uremic atherosclerosis and the interest in β2M as a marker of cardiovascular(CV) and/or mortality risk have grown. In the current literature,clinical studies suggest that β2M is an independent, significant predictor of mortality, not only in dialysis patients, but also in predialysis patients and in the highrisk portion of the general population, and it seems to be a factor strongly linked to the presence and severity of CV disease. It is still unknown whether β2M is only a uremic toxin marker or if it also has an active role in vascular damage, but data support that it may reflect an increased burden of systemic atherosclerosis in a setting of underlying chronic kidney disease. Thus, although there have been some inconsistencies among the various analyses relating to β2M, it promises to be a novel risk marker of kidney function in the awareness and detection of high-risk patients. However, more research is required to establish the pathophysiological relationships between retained uremic toxins and further biochemical modifications in the uremic milieu to get answers to the questions of why and how. In this review, the recent literature about the changing role of β2M in uremic patients will be examined.

Lrrk2 R1628P转基因小鼠尿液外泌体诱导帕金森病样病理变化

目的:探讨Lrrk2 R1628P转基因小鼠尿液外泌体能否诱导帕金森病(PD)样病理改变。方法:提取野生型(WT)和Lrrk2 R1628P转基因小鼠尿液外泌体,使用免疫印迹法检测尿液外泌体标记物TSG101和CD81,Y216位点磷酸化糖原合成酶激酶-3β(pGSK-3β-216)表达水平。在C57小鼠纹状体中分别注射WT小鼠(C57-WT组,n=8)和Lrrk2 R1628P小鼠尿液外泌体(C57-Lrrk2组,n=8)。注射前3天,注射后1、3、6个月,利用平衡木、挂线、转棒和旷场实验对小鼠进行行为学分析,免疫组化法分析脑组织中磷酸化α-突触核蛋白(pα-syn)的沉积情况,免疫印迹法检测脑组织中pα-syn的表达。结果:Lrrk2 R1628P小鼠尿液外泌体TSG101和CD81表达水平与WT小鼠比较,差异无统计学意义(P>0.05),pGSK-3β-216表达水平高于WT小鼠(P<0.001)。C57-Lrrk2组小鼠出现PD样行为学表型(P<0.001),皮层、纹状体和黑质中有pα-syn沉积,脑组织中pα-syn表达水平为(0.44±0.06),C57-WT组则无表达(P<0.001)。结论:小鼠纹状体中注射Lrrk2 R1628P转基因小鼠的尿液外泌体能够诱导PD样病理改变。

Effect of mechanical ventilation on urine volume and expression of aquaporins in rabbits

Objective:To explore biological mechanisms underlying the traditional Chinese medicine theory of 'lung governing the regulation of water passage' by observing effects of mechanical ventilation on urine volume and related bioactive substances.Methods:A total of 16 male rabbits were randomly divided into control and lung expansion model groups (n =8 per group),which were examined during the following four respiratory intervention stages (10 minutes each):(1) free breathing without any respiratory intervention;(2) lung expansion induced by mechanical ventilator;(3) free breathing without ventilator intervention;(4) cutting of bilateral sympathetic,vagus,and depressor nerves with mechanical ventilation.Data for breathing rate,blood pressure,and urine drops were recorded with a Medlab data acquisition system.Levels of nitric oxide (NO),antidiuretic hormone (ADH),endothelin 1 (ET-1),angiotensin Ⅱ (AngⅡ),prostaglandin E2 (PGE2),and atrial natriuretic peptide (ANP) were detected in lung tissue,kidney tissue,and serum by enzyme-linked immunosorbent assay.Protein expression of aquaporins 1 and 2 (AQP1 and AQP2) was detected in kidney tissue by immunohistochemistry,while Aqp1 mRNA and Aqp2 mRNA levels in kidney tissue were detected by real-time quantitative polymerase chain reaction.Histopathological changes in lung and kidney tissues were examined by hematoxylin and eosin staining.Results:Compared with the control group,number of urine drops during the second and fourth stages is significantly decreased in the model group (P <.05).In addition,NO and PGE2 content in lung and kidney tissues was significantly decreased in the model group (P <.05).ANP content in model group lung and kidney tissues was significantly increased (P <.05),while ET-1 content in these tissues was significantly decreased (P <.05).AngⅡ content in kidney tissue was significantly decreased in the model group (P <.05),while serum AngⅡ content of the animals was significantly increased (P <.05).Expression of AQP1 and AQP2 proteins in kidney tissue was significantly higher in the model group than in the control group (P <.05).No obvious histopathological changes were observed in lung or kidney tissues of animals in either group.Conclusions:Mechanical ventilation reduced urine volume,increased expression of AQP1 and AQP2 in kidney tissue,and altered levels of NO,ADH,ET-1,AngⅡ,PGE2,and ANP in lung tissue,kidney tissue,and serum.These results provide an experimental basis for preliminary studies of mechanisms under pinning the theory of 'lung governing the regulation of water passage'.

低T3综合征与2型糖尿病患者糖尿病肾病发生的关系

目的探讨低T3综合征(LT3S)的发生与糖尿病肾病(DKD)患者病情进展的关系。方法选取2020年1月至2022年2月在该院肾内科和内分泌科住院的202例T2DM患者为研究对象,并根据是否存在DKD,将患者分为NDKD组和DKD组。比较两组患者临床资料、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、清蛋白(ALB)、尿素氮(BUN)、糖化血红蛋白(HbA1c)、血清三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)和促甲状腺激素(TSH)等水平,根据慢性肾脏病流行病协作研究(CKD-EPI)公式由肌酐(Scr)计算肾小球滤过率(eGFR),结合反T3(rT3)数据明确LT3S的诊断,分析DKD发生的危险因素。结果NDKD组89例,DKD组113例。202例T2DM患者合并LT3S 14例,LT3S发病率为6.93%,LT3S在DKD组中的发生率为12.39%。DKD组年龄明显大于NDKD组,T2DM病程明显长于NDKD组,差异均有统计学意义(P<0.05)。与NDKD组比较,DKD组ACR、BUN水平明显升高,而ALB和eGFR水平明显降低,差异均有统计学意义(P<0.05)。与NDKD组比较,DKD组的T3和FT3水平明显降低,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BUN水平升高是DKD发生的危险因素(P<0.05),FT3水平升高是DKD发生的保护因素(P<0.05)。结论T2DM患者T3、FT3水平下降与DKD发生有关,即随着T2DM患者并发DKD,LT3S的发生率增加。早期检测甲状腺激素水平,有助于DKD患者的早期诊断和病情评估。

吉林省某医院成年人尿中邻苯二甲酸二(2-乙基己基)酯的暴露水平及其影响因素

目的评估成年人尿中邻苯二甲酸二(2-乙基己基)酯[di(2-ethylhexyl)phthalate,DEHP]代谢物水平及其影响因素。方法2022年3月本研究纳入吉林省某医院210名成年人,采集晨尿样并通过高效液相色谱串联质谱法测定尿液中5种DEHP代谢物(MEHP、MEOHP、MEHHP、MCMHP和MECPP)的水平。通过Spearman秩相关分析研究对象尿液中DEHP代谢产物浓度之间的关系,采用独立样本t检验比较每种变量不同项目间DEHP代谢产物水平的差异,使用多元线性回归模型分析所选因素与研究对象尿液中DEHP代谢产物水平之间的关系。结果MEHP和MEOHP检出率分别为98.6%和99.5%,MEHHP、MCMHP和MECPP的检出率均为100.0%。MCMHP的中位数浓度最高,为14.45μg/L(14.10μg/g肌酐)。在调整协变量后,主动吸烟与尿液MEOHP(β=-0.151,95%CI:-0.299~-0.004)显著相关;被动吸烟与MCMHP(β=-0.184,95%CI:-0.323~-0.045)、MECPP(β=-0.192,95%CI:-0.332~-0.051)和∑DEHP(β=-0.146,95%CI:-0.291~-0.001)显著相关;塑料水杯的使用与MEHHP(β=-0.147,95%CI:-0.284~-0.009)显著相关;护肤类化妆品的使用频率与MEOHP(β=-0.115,95%CI:-0.297~-0.012)和MEHHP(β=-0.194,95%CI:-0.337~-0.051)显著相关。结论本研究中成年人广泛暴露于DEHP,日常生活中不吸烟及远离二手烟、减少塑料水杯和护肤类化妆品的使用可降低DEHP的暴露水平。

胰岛β细胞功能及同型半胱氨酸、尿微量白蛋白/肌酐比值对2型糖尿病患者心率变异性的影响研究

目的探讨2型糖尿病(T2DM)患者心率变异性(HRV)与胰岛β细胞功能及同型半胱氨酸(Hcy)、尿微量白蛋白/肌酐比值(ACR)的相关性。方法选择上海市第六人民医院收治的300例T2DM患者作为研究对象,男性156例,女性144例;年龄(55.54±8.90)岁,年龄范围为32~78岁。根据24 h正常窦性心搏RR间期标准差(SDNN)将患者分为HRV正常组(100 ms≤SDNN≤180 ms,n=163)及HRV下降组(SDNN<100 ms,n=137)。收集HRV正常组和HRV下降组患者的一般资料、生化指标及HRV指标,分析胰岛β细胞功能及Hcy、ACR与T2DM患者HRV下降的相关性,采用Logistic回归模型评估T2DM患者HRV下降的危险因素,绘制受试者工作曲线分析预测指标对T2DM患者HRV下降的预测价值。结果与HRV正常组比较,HRV下降组年龄较大,病程较长,空腹血糖(FPG)、糖化血红蛋白(HbA1c)、Hcy、空腹C肽(C_(0))、ACR水平较高,餐后2 h C肽(C_(2))、C_(2)/C_(0)水平较低,SDNN、5 min正常RR间期均值的标准差(SDANN)、相邻正常RR间期相差超过50 ms的心搏数占总窦性心搏数的百分比(pNN50)、相邻RR间期之差的均方根(rMSSD)、低频功率(LF)、高频功率(HF)水平较低,差异均有统计学意义(P<0.05)。经Pearson相关系数分析显示,C_(2)、C_(2)/C_(0)与HRV指标之间均呈显著性正相关(P<0.05),C_(0)、Hcy、ACR与HRV指标之间均呈显著性负相关(P<0.05)。经Logistic回归模型分析显示,病程较长、FPG升高、Hcy升高、C_(0)升高、C_(2)降低、C_(2)/C_(0)降低及ACR升高是T2DM患者HRV下降的独立危险因素(P<0.05)。病程、FPG、Hcy、C_(0)、C_(2)、C_(2)/C_(0)、ACR及各指标联合对预测T2DM患者HRV下降均具备一定价值,且联合预测价值更高。结论病程、FPG、Hcy、C_(0)、C_(2)、C_(2)/C_(0)及ACR是T2DM患者HRV下降的独立危险因素,均具备一定预测价值,且联合预测价值更高。

β_(2)-MG、Hcy、尿Kim-1联合检测对高血压肾病的诊断价值

目的探究对高血压肾病患者采用β_(2)微球蛋白(β_(2)Microglobulin,β_(2)-MG)、同型半胱氨酸(Homocyste-ine,Hcy)、尿肾损伤分子-1(Kidney injury molecule 1,Kim-1)联合检测的诊断价值。方法非随机选取2020年1月—2022年12月睢宁县中医院收治的53例高血压肾病患者为A组,选取同期53例高血压无肾病患者为B组,选取同期52例健康体检者为C组。对上述3组患者均进行β_(2)-MG、Hcy、尿Kim-1检测,同时绘制受试者工作特征(Receiver Operating Characteristic,ROC)曲线,探究上述3个指标联合检测的诊断效能。结果A组β_(2)-MG(14.53±2.17)mg/L、Hcy(27.25±5.61)µmol/L、尿Kim-1(5.68±0.76)ng/mL高于B组(7.53±1.24)mg/L、(19.87±4.85)µmol/L、(2.65±0.50)ng/mL和C组(2.20±0.51)mg/L、(11.20±1.87)µmol/L、(0.48±0.09)ng/mL,差异有统计学意义(P均<0.05)。通过ROC曲线分析,β_(2)-MG、Hcy、尿Kim-1联合检测的曲线下面积(Area Under Curve,AUC)为0.873。结论在诊断高血压肾病患者时,采用β_(2)-MG、Hcy、尿Kim-1联合检测,有较高诊断价值。

尿微量白蛋白与尿肌酐比值、尿微量白蛋白及尿β2-微球蛋白检测诊断妊娠期糖尿病早期肾损害的价值

目的探讨尿微量白蛋白与尿肌酐比值(ACR)、尿微量白蛋白(mALB)、尿β2-微球蛋白(β2-MG)诊断妊娠期糖尿病早期肾损害的价值。方法选择正常孕中晚期孕妇100例为对照组,孕中晚期妊娠期糖尿病孕妇100例为观察组。采用免疫比浊法检测2组尿ACR,采用放射免疫法检测尿mALB、尿β2-MG水平,采用常规法测尿蛋白水平,采用脲酶法检测血清尿素氮(BUN)水平,采用苦味酸法检测血清肌酐(Cr)水平;以尿ACR≥3.0mg/mmol,尿mALB≥30mg/24h,尿β2-MG≥0.3mg/L,尿蛋白以干化学试纸条法显示变色为阳性,血BUN、Cr水平高于试剂说明中的参考值上线为阳性,计算2组上述各指标阳性率;应用受试者工作特征(ROC)曲线评价尿ACR、mALB、β2-MG预测妊娠期糖尿病孕妇早期肾损害的曲线下面积及敏感性。结果观察组尿ACR、尿mALB、尿β2-MG水平及阳性率均明显高于对照组(P均<0.05);2组血清BUN、Cr水平和阳性率比较差异均无统计学意义(P均>0.05)。尿ACR、尿mALB、尿β2-MG、尿ACR与mALB与β2-MG联合检测的曲线下面积分别为0.916,0.753,0.740,0.888,95%CI分别为[0.846,0.987],[0.632,0.875],[0.613,0.867],[0.802,0.973],差异均有统计学意义(P均<0.05)。结论联合检测尿ACR、尿mALB、尿β2-MG对诊断妊娠期糖尿病早期肾损害有重要价值。

高同型半胱氨酸血症是2型糖尿病微血管病变的危险因子

目的观察2型糖尿病血浆同型半胱氨酸(t-Hcy)水平与微血管病变的关系。方法比较高、正常尿微量白蛋白排泌率(UAER)组及糖尿病视网膜病变阳性、阴性组间血浆t-Hcy水平,并采用多元相关分析和多元线性回归分析UAER与血浆同型t-Hcy、年龄、病程、血肌酐、收缩压、舒张压间的相关性。结果2型糖尿病高UAER组和糖尿病视网膜病变阳性组血浆t-Hcy水平明显高于正常UAER组和糖尿病视网膜病变阴性组,且血浆t-Hcy水平、UAER和血肌酐间成正相关。结论高血浆同型半胱氨酸血症是2型糖尿病微血管病变加剧的危险因子,如何降低其水平也许可作为预防2型糖尿病微血管病变的新途径。