2型糖尿病患者微量白蛋白尿与脑梗塞相关性研究

目的:探讨2型糖尿病患者微量白蛋白尿与脑梗塞的相关性。方法:将330例2型糖尿病患者根据尿白蛋白排泄率(UAER)分为三组,即A组(UAER<20μg/min),B组(UAER20～200μg/min),C组(UAER>200μg/min),对各组的脑梗塞发生率等情况进行比较。结果:三组间脑梗塞发生率呈递增关系。UAER与收缩压、空腹血糖、糖化血红蛋白、血尿酸、脑梗塞呈现正相关。结论:微量白蛋白尿是2型糖尿病患者发生脑梗塞的独立危险因素。

高血压伴阻塞性睡眠呼吸暂停低通气综合征患者肾功能影响因素分析

目的：分析伴阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的高血压患者肾功能的影响因素。方法：选取2011年3月至2014年3月在新疆医科大学第一附属医院确诊的高血压患者，对诉有夜间打鼾的438例患者行多导睡眠呼吸监测，根据呼吸暂停低通气指数（AHI）分为单纯高血压组（AHI〈10；K／h，102例）、轻度OSAHS组（AHI 10-〈15次／h，97例）、中度OSAHS组（AHI 15～〈30；L／h，149例）、重度OSAHS组（AHI≥30；k／h，90例），检测四组血尿素、肌酐、估算肾小球滤过率、24h尿蛋白、24h尿微量白蛋白、血清胱抑素C水平，分析其相关因素。结果：单纯高血压组和高血压伴不同程度OSAHS组患者年龄、性别构成比、体质指数、24h平均收缩压、空腹血糖、高密度脂蛋白胆固醇（HDL-C）等基线资料差异有统计学意义（均P〈0．05）；重度OSAHS组24h尿蛋白和24h尿微量白蛋白高于其他各组；不同程度OSAHS组血清胱抑素C高于单纯高血压组（均P〈0．05）；多因素logistic回归分析结果显示：体质指数（OR=1．486，95％CI：1．022—2．160）、重度OSAHS（OR=7．138，95％CI：1．835—27．769）为24h尿蛋白的影响因素；血压控制情况（OR=2．368，95％CI：1．324—4．234）、体质指数（OR=1．678，95％CI：1．263～2．230）为24h尿微量白蛋白的影响因素；年龄（OR=1．998，95％CI：1．325—3．013）、血压控制情况（OR=3．202，95％CI：1．319—7．773）、重度OSAHS（OR=5．462，95％CI：1．103—27．041）为血清胱抑素C的影响因素。结论：年龄、体质指数、血压控制情况、体质指数、重度OSAHS为高血压伴OSAHS患者肾功能损害的影响因素。OSAHS是高血压患者肾脏早期损害的危险因素。

Meta-analysis of the Use of ACEI for Inhibiting Albuminuria in Diabetic Patients

Aim To examine whether AER(albumin excretion rate) in normotensive diabeticpatients can be effectively inhibited by ACEI. Methods Literature on randomized controlled trials ofACEI for inhibiting AER in normotensive diabetic patients was searched. The electronic databasesretrieved were Medline (1980 ― 2003), Embase database (1980 ― 2000), Cochrane Library, CL( 1980 ―2004), CBMdisc( 1980 ― 2002), and IPA( 1980 ― 2002). Seven studies were chosen. Data werecombined by Revman 4.2. Results: The pooled effect of change in AER is - 56.31 μg·min^(-1)) [ -81.96, -30.66] (P<0.0001). According to the analysis of subgroups, the pooled effects of 1 - 5 yearsare - 11.97 μg·min^(-1)[-22.04, -1.89] (P = 0.02), -28.01 μg·min^(-1)[-34.50, -21.52](P<0.00001), -43.24 μg·min^(-1) [ -57.15, -29.32] (P< 0.00001), -61.65 μg·min^(-1)[77.77,-45.54] (P< 0.00001), and -98.41 μg·min^(-1)[-162.02,-34.79] (P = 0.002). Regarding progression toclinincal proteinuria as end-point, the pooled Peto OR =0.27 [0.18,0.40] (95% CI), P < 0.00001.According to the analysis of subgroups, the pooled effects of 2 and 5 years are Peto OR = 0.30[0.18,0.51] (P<0.00001) and Peto OR=0.25 [0.13, 0.50](P<0.0001). Publication bias is small.Conclusion In normotensive diabetic patients, ACEI inhibits AER effectively and reduces theprobability of progression of microalbuminuria to clinical proteinuria.

The inhibitory effect of lotus leaf extract on hyperuricemia and its potential mechanism

Objective:Lotus leaf is a traditional Chinese herb that has been used successfully for centuries for relieving edema by inducing diuresis.Based on its good clinical evidence and anti-hypertensive effectiveness,this study aimed to investigate the potential mechanism of the hyperuricemic inhibitory effects of lotus leaf crude extract(LL)and lotus leaf total alkaloids fraction(LA).Methods:The xanthine oxidase(XOD)inhibitory effect of LL and LA was analyzed in vitro by determining mRNA expression and protein expression levels of hepatic XOD.The hyperuricemic inhibitory effect of the lotus leaf was analyzed in vivo in a potassium oxonate(PO)-induced rat model by determining mRNA expression for renal urate transporters.Results:At a concentration of 40mg/mL,LL and LA suppressed XOD enzymatic activity by 37.35%±9.50%and 47.73%±8.32%,respectively.Both LL and LA administration significantly reduced the concentration of uric acid in the serum and liver of PO-induced hyperuricemic rats.Both LL and LA administration could inhibit XOD mRNA and protein expression,activate renal organic anion transporter 1/3 mRNA expression,and inhibit renal urate reabsorption by decreasing renal GLUT9 and renal urate transporter 1.Conclusions:Insight was gained into the mechanism behind the hyperuricemic inhibitory effects of LL and LA.Our results suggest that they act on two targets:decreasing the production of uric acid by inhibiting mRNA and protein expression of XOD in the liver,and regulating the mRNA expression of renal urate transporters in the kidneys.

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.

Effect of short-term acumagnetotherapy on diabetic kidney disease in patients with type Ⅱ diabetes and study on the molecular mechanism

Objective To explore whether magnetotherapy is preventive in retarding diabetic kidney disease（DKD） progression and investigate underling molecular mechanisms related to its therapeutic efficacy. Methods Twenty-eight patients with type Ⅱ diabetes（T2D） were undergone pulsed electromagnetic fields（PEMF） stimulation at the acupoints of Píshū（脾俞 BL 20）, Zúsānl（足三里 ST 36）, Shènshū（肾俞 BL 23） and Yíshū（胰俞, EX-B3） for a period of 4 weeks. Urinary micro-albumin（U-m Alb） excretion, plasma methane dicarboxylic aldehyde（MDA and lipopolysaccharide（LPS） of the patients were used for evaluating therapeutic efficacies. Results After the acumagnetotherapy, U-m Alb excretion in the participated patients was markedly reduced（27.21±3.51 vs 8.51±0.95, P0.001） accompanied with decreased MDA（16.46±1.17 vs 12.40±1.86, P0.05） and LPS（37.41±3.84 vs 21.63±3.61, P0.05） levels in plasma while the metabolic control of these patients was not significantly altered. Acumagnetotherapy increased IκBα content（0.69±1.17 vs 1.30±0.29, P0.01）, an inhibitory protein of inflammatory response, and correspondingly reduced the protein levels of inflammatory activating proteins, NF-κB p65（0.98±0.42 vs 0.43±0.28, P0.05） and NF-κB p50（1.19±0.40 vs 0.76±0.30, P0.05）. The acumagnetotherapy also inhibited the oxidantproducing enzyme, Nox4 protein expression（1.32±0.40 vs 0.37±0.23, P0.05） in patient ＇s blood lymphocytes. Conclusion Short-term intervention of acumagnetotherapy in patients with T2 D mitigates DKD progress potentially by its anti-oxidative and anti-inflammatory effects.