尿微量白蛋白检测在Ⅰ型糖尿病及糖尿病肾病诊断中的意义

目的探讨尿微量白蛋白(malb)对Ⅰ型糖尿病及糖尿病肾病患者的诊断价值。方法采用美国BECKMANARRAY360全自动分析仪进行尿微量白蛋白测定,并对检测结果进行比较。结果Ⅰ型糖尿病患者和糖尿病肾病患者的尿微量白蛋白的排出量明显高于正常健康者,差异有显著性(P<0.01)。结论尿微量白蛋白测定对Ⅰ型糖尿病及糖尿病肾病的早期诊断,早期治疗及预后有重要意义。

RELATION OF HYPERTENSION TO DIABETIC NEPHROPATHY IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES MELLITUS—A PAIR-MATCHED CASE-CONTROL STUDY

To assess the role of hypertension and family history of hypertensio n in the development of nephropathy in patients with non insulin dependent dia betes mellitus (NIDDM).Methods. A retrospective analysis was done on 2 groups of NIDDM patients, one g roup without proteinuria (urine protein< 300mg/24h, n=106) and the other group w ith proteinuria (urine protein≥500mg/24h, n=106). The 2 groups were matched by age(≤±3yrs), sex, ethnic and resident place. Some information of these subject s including demographic; history of disease, family history of diseases, lifesty le and behavior style variables was obtained by questionnaire; some variables w ere measured, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), quantity of protein in 24h urine. Then condi tional logistic regression analysis was performed.Results. Some factors, including history of hypertension, longer duration of hy pertension, higher levels of the past highest SBP and DBP, were independently as sociated with the occurrence risk of diabetic nephropathy (DN). Their correspond ing odd ratios (OR) with 95% confidence intervals (CI) were 2.00(1.17～3.43), 1 .25(1.08～1.46), 1.38(1.15～1.66), and 1.33(1.09～1.62) respectively, but family history of hypertension was not significantly associated with the development o f DN. When the above mentioned relations were respectively adjusted by some pos sible confounding factors, they still existed.Conclusions. History of hypertension, longer duration of hypertension, higher l evels of the past highest SBP and DBP are independent risk factors for DN in Chi nese NIDDM patients.

LOW MOLECULAR WEIGHT HEPARIN DECREASES THE ALBUMINURIA AND RENAL PATHOLOGICAL CHANGES IN DIABETIC NEPHROPATHY RATS

Objective To investigate the renoprotection effect of low molecular weight heparin(LMWH)in diabetic rats.Methods Diabetic rats were induced by injection of steptozotocin(STZ).Rats were randomly divided into three groups:control group,diabetic model group,and LMWH treatment group.The levels of total cholesterol(TC),triglyceride(TG),prothrombin time(PT),kaolin partial thromboplastin time(KPTT),24-hour urinary albumin excretion rate(UAER),and serum soluble P-selectin were determined after 8 weeks.Glomerular morphology was observed by light microscopy.Results The levels of TG,UAER,and P-selectin in LWMH treatment group were lower than those in model group(all P<0.01).The levels of PT and KPTT in LWMH treatment group were shorter than those in model group.And LWMH improved the histological changes of diabetic rats.Conclusion LMWH has some renal protective effects in diabetic rats,partly through down-regulating the expression of P-selectin.

Diabetes onset before or after the age of 65 does it affect the progression of renal and cardiovascular diseases in the elderly patient？

Type 2 diabetes （T2D） is common in the elderly and more than half of the people with diabetes are over 65 years old. Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chronic kidney disease than non-diabetic elderly patients and the risk of these complications increases with patient age, duration of the dia- betes and glycated hemoglobin values. Besides the known classical factors of renal disease progression,

TGF-b and Diabetes Mellitus

Diabetes mellitus is categorized as a major metabolic disease. Hyperglycemia is the populest mediator. The oxygen radicals＇ production or the peroxide production in the mitochondria is preceded as a possible mechanism. TGF-beta is characterized as the main protagonist. TGF-b is a molecular mediator with adherent and hypertrophic properties in diabetic nephropathy. 20 Balb/c male and female mice were used. They were separated in two age groups, one of 4 weeks old （childhood, n= 10） and one of 6 weeks old （puberty, n=10）. An immunochemical study for TGF-beta was undertaken. The basal petal of the external membrane of Bowmen is thickened. In significant percentage the basal membrane was thickened and the peduncles merge together. Mature sperm cells were not normal. The two age groups did not present significant differences in morphology of the exocrine pancreatic cells. The augmented levels of TGF-beta expression promote the increased proliferation of the pancreatic glandular cells, the derangement of differentiation and the apoptosis rhythm. The renal function is diminished sooner than the clinical manifestations. The testicles are less influenced concerning principally the spermiogenesis.

An update: the role of Nephrin inside and outside the kidney

Nephrin is a key molecule in podocytes to maintain normal slit diaphragm structure. Nephin interacts with many other podo- cyte and slit diaphragm protein and also mediates important cell signaling pathways in podocytes. Loss of nephrin during the development leads to the congenital nephrotic syndrome in children. Reduction of nephrin expression is often observed in adult kidney diseases including diabetic nephropathy and HIV-associated nephropathy. The critical role of nephrin has been confirmed by different animal models with nepbrin knockout and knockdown. Recent studies demonstrate that knockdown of nephrin expression in adult mice aggravates the progression of＇ unilateral nephrectomy and Adriamycin-induced kidney disease In addition to its critical role in maintaining normal glomerular filtration unit in the kidney, nephrin is also expressed in other organs. However, the exact role of nephrin in kidney and extra-renal organs has not been well characterized. Future studies are required to determine whether nephrin could be developed as a drug target to treat patients with kidney disease.

Retrospective study on Professor Zhongying Zhou's experience in Traditional Chinese Medicine treatment on diabetic nephropathy

OBJECTIVE:To study and analyze the etiology and pathogenesis,diagnosis and prescription for cases of diabetic nephropathy(DN) treated by Professor Zhongying Zhou(Prof.Zhou) with the help of dada mining technique,so as to inherit his clinical experience and academic thoughts.METHODS:After pretreatment of the medical record information,statistical software SPSS 13.0 was used to analyze and process the standardized data using the descriptive analysis,cluster analysis and association rules.RESULTS:Ninety-four entries derived from Traditional Chinese Medicine(TCM) four-diagnostic information were selected.Through data mining,the highest frequency was yellow-thin-greasy tongue coating,followed by dark tongue,and then by thready-slippery pulse.The main self-conscious symptoms were limb numbness,dry mouth,frequent micturition,etc.With respect to pathogenesis,the etiology related to kidney reached 73.46%.The frequency of pathological factors for deficiency,blood stasis,heat,dampness,phlegm and dryness were 137.65%,80.25%,78.40%,48.77%,21.60%,and 14.20% respectively.A total of 236 kinds of herbs were used 2913 person times,averaging 17.98 herbs per prescription.CONCLUSION:The pathological location of DN is in the kidney.The pathogenesis of the disease is deficiency in origin and excess in superficiality,the former of which include deficiency of the liver and kidney,and deficiency of both Qi and Yin.The main pathological factors are blood stasis,heat,dampness,phlegm,and dryness;and they act upon each other to form the complex pathogenesis in terms of blood stasis-heat,dampness-heat,phlegm-heat,and dryness-heat.All the above factors are always crucial in the aggravation of DN throughout the whole course of its pathological evolution.