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.

尿微量蛋白肌酐比、尿α1微球蛋白、尿β2微球蛋白对早期糖尿病肾病的诊断效果评价

目的分析尿微量蛋白肌酐比(microalbuminuria/creatatine,mALB/Cr)、尿α1微球蛋白(α1-Microglobu⁃lin,α1-MG)、尿β2微球蛋白(β2-Microglobulin,β2-MG)在早期2型糖尿病中的诊断效果。方法回顾性选取泉州市第一医院于2021年1月—2022年12月收治的55例早期糖尿病肾病患者(早期糖尿病肾病组)、47例2型糖尿病患者(正常蛋白尿组)的临床资料。对所有患者的mALB/Cr、α1-MG、β2-MG检验结果展开分析,对比单一检验和联合检验在诊断早期糖尿病肾病中的诊断价值。结果早期糖尿病肾病组的mALB/Cr、α1-MG、β2-MG均明显高于正常蛋白尿组,差异有统计学意义(P均<0.05)。受试者操作特征(receiver operating characteristic,ROC)曲线结果显示联合检验的灵敏度、特异度均高于mALB/Cr、α1-MG、β2-MG单一检验。结论在2型糖尿病患者中检验mALB/Cr、α1-MG、β2-MG,能尽早明确早期糖尿病肾病,而且联合检验与单一检验相比,诊断效能更高,能及时预防并发症的发生,为下一步治疗提供可靠依据。

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。

达格列净治疗糖尿病伴微量白蛋白尿的效果观察

目的:分析达格列净治疗糖尿病伴微量白蛋白尿的效果。方法:选取2021年1—12月北京市海淀区北太平庄社区卫生服务中心收治的糖尿病伴微量白蛋白尿患者60例作为研究对象,随机分为两组,各30例。对照组在常规治疗基础上加用磷酸西格列汀,试验组在常规治疗基础上加用达格列净治疗。比较两组血糖水平、肾小球滤过率(e GFR)和尿白蛋白与肌酐比值(UACR)、血压水平、体质量指数(BMI)、不良反应发生情况。结果:治疗前后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(Hb A_(1c))水平比较,差异无统计学意义(P>0.05);治疗后,两组FBG、2 h PBG、Hb A_(1c)水平低于治疗前,差异有统计学意义(P<0.05)。治疗前后,两组e GFR水平比较,差异无统计学意义(P>0.05)。治疗前,两组UACR水平比较,差异无统计学意义(P>0.05);治疗后,试验组UACR水平低于治疗前及同期对照组,差异有统计学意义(P<0.05)。治疗前后,两组舒张压、BMI比较,差异无统计学意义(P>0.05)。治疗前,两组收缩压(SBP)水平比较,差异无统计学意义(P>0.05);治疗后,试验组SBP水平低于治疗前与同期对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:达格列净治疗糖尿病伴微量白蛋白尿的效果显著,可降低患者血糖、尿白蛋白、SBP水平,且安全性较高。

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。

高血压合并肥胖患者左心室肥厚与RDW、微量白蛋白尿的关系

目的 探究高血压合并肥胖患者左心室肥厚与红细胞分布宽度(red blood cell distribution width, RDW)、微量白蛋白尿(micro albuminuria, MAU)的关系。方法 将138例高血压合并肥胖患者按照左心室质量指数(LVMI)分为80例左心室肥厚组与58例无左心室肥厚组,另选择同时期80例健康体检者作为对照组。对各组RDW、MAU进行检测,并分析其与患者左心室肥厚的关系。结果 左心室肥厚组RDW、MAU较无左心室肥厚组及对照组高,差异有统计学意义(P<0.05)。RDW、MAU与高血压合并肥胖患者左心室肥厚呈正相关(P<0.05)。左心室肥厚组体质量指数、高血压病程、收缩压较无左心室肥厚组高,HDL-C较无左心室肥厚组低,差异有统计学意义(P<0.05)。RDW、MAU、体质量指数、高血压病程均为患者左心室肥厚的高危因素(P<0.05)。结论 高血压合并肥胖患者左心室肥厚与RDW、MAU密切相关,检测RDW、MAU可为患者左心室肥厚防治提供一定参考依据。

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.

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.

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 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.

老年2型糖尿病患者发生低血糖事件的相关因素分析

目的 探讨老年2型糖尿病患者发生低血糖事件的相关危险因素。方法 选择2019年7月至2021年6月在清华大学附属垂杨柳医院内分泌科就诊的94例老年(年龄≥65岁)2型糖尿病患者,根据动态血糖监测结果进行分组:血糖<3.9mmol/L且持续时间在15min以上的34例患者为低血糖组,余60例患者为无低血糖组。比较两组患者的临床资料,采用多因素logistic回归分析老年2型糖尿病患者发生低血糖事件的危险因素。结果 低血糖组的34例患者中,发生夜间低血糖者占61.8%。低血糖组患者的体重指数、血糖平均值均低于无低血糖组,高密度脂蛋白胆固醇、尿微量白蛋白、尿微量白蛋白/尿肌酐比值、血糖变异系数和平均血糖波动幅度均高于无低血糖组,差异有显著性(P<0.05)。多因素logistic回归分析显示,尿微量白蛋白/尿肌酐比值、血糖变异系数与低血糖事件的发生呈正相关(OR=1.043、1.305);体重指数和血糖平均值与低血糖事件的发生呈负相关(OR=0.815、0.704)。结论 血糖变异系数、尿微量白蛋白/尿肌酐比值、体重指数及血糖平均值是老年2型糖尿病患者发生低血糖事件的独立危险因素。

益肾化浊汤治疗糖尿病肾病肾阴阳两虚证32例临床观察

目的观察益肾化浊汤治疗糖尿病肾病(diabetic nephropathy,DN)肾阴阳两虚证的临床疗效及其对微量白蛋白尿的影响。方法将64例DNⅢ期伴微量白蛋白尿患者随机分为对照组和观察组,每组32例。对照组给予糖尿病降糖药物基础治疗,观察组在对照组治疗基础上加用益肾化浊汤治疗,10 d为1个疗程,共治疗4个疗程。观察和比较两组患者治疗前后肾功能指标[血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,SCr)、尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)、肾小球滤过率估算值(estimated glomerular filtration,eGFR)]、临床疗效、中医证候积分以及不良反应。结果观察组临床疗效优于对照组(P<0.05)。两组患者治疗后各项中医证候积分均较治疗前显著减少(P<0.05),且观察组减少程度大于对照组(P<0.05)。与治疗前比较,治疗后两组患者BUN、SCr、UACR水平均显著下降(P<0.05),eGFR水平显著升高(P<0.05);观察组BUN、SCr、UACR、eGFR改善程度均优于对照组(P<0.05)。两组治疗过程中未见不良反应。结论益肾化浊汤治疗DN患者疗效显著,可明显改善患者微量白蛋白尿,且安全性高。

糖尿病肾脏病进展风险因素和预测模型构建

目的 探究2型糖尿病患者合并糖尿病肾脏病微量白蛋白尿期进展至大量白蛋白尿期的危险因素,开发和验证辅助临床预测糖尿病肾脏病进展的预测模型。方法 依据纳入标准和排除标准选取2018年12月1日—2021年12月1日于辽宁中医药大学附属医院内分泌科、肾内科、内分泌康复科住院并诊断为糖尿病肾脏病微量白蛋白尿期的患者病历资料834例,按7∶3的比例随机分为训练集584例、验证集250例,收集患者基本资料、人体测量指标、2型糖尿病病程、合并病、中医标证、实验室指标、复查指标,并参照复诊结果依据分期标准将训练集分为微量白蛋白尿组442例和大量白蛋白尿142例组。应用SPSS 26.0进行统计分析,通过多因素Logistic回归分析建立预测方程,绘制ROC曲线,外部诊断性验证,评价糖尿病肾脏病预测方程的临床有效性。结果 糖尿病肾脏病微量白蛋白尿期进展至大量白蛋白尿期的独立危险因素为性别(男)、高血压病病史、糖尿病视网膜病变病史、湿证、湿热证、糖化血红蛋白(HbA1c)(≥7%)、低密度脂蛋白胆固醇(LDL-C)[≥2.6 mmol·L^(-1)(无冠心病)/1.8 mmol·L^(-1)(合并冠心病)]、血清白蛋白(ALB)(<35 g·L^(-1))、钙离子(Ca2+)、游离三碘甲状腺原氨酸(FT3)、胱抑素C(CysC)。预测方程ROC曲线下面积为0.920(95%CI:0.895~0.946),外部验证提示预测方程一致性良好。结论 11个独立危险因素构成的预测方程可用于预测2型糖尿病合并糖尿病肾脏病微量白蛋白尿期进展至大量白蛋白尿期的风险。

消渴肾方对早中期糖尿病肾脏病db/db小鼠蛋白尿及纤维化相关因子的影响

目的 探讨消渴肾方对早中期糖尿病肾脏病db/db小鼠蛋白尿及纤维化相关因子的影响。方法 选用SPF级C57BL/KSJ系db/db小鼠50只,同遗传背景db/m小鼠10只。适应性饲养后将db/db小鼠随机分为模型组、西药组、消渴肾方低剂量组、消渴肾方中剂量组、消渴肾方高剂量组,db/m小鼠为正常组。连续给药12周,观察一般情况,检测随机血糖、给药前后24小时尿微量白蛋白,分别在光镜、透射电镜下观察肾脏病理形态学改变,蛋白免疫印迹法检测纤维化相关因子的表达。结果 (1)与模型组比,消渴肾方低、中剂量组随机血糖明显降低(P<0.01),较西药组更明显(P<0.01)。与模型组比,给药后西药组、消渴肾方低、中剂量组24小时尿微量白蛋白显著下降(P<0.01),且消渴肾方低、中剂量组较西药组更明显(P<0.05,P<0.01);(2)各组血清肌酐、尿素氮差异无统计学意义(P>0.05)。与模型组比,各用药组谷丙转氨酶差异无统计学意义(P>0.05),消渴肾方中剂量组的谷草转氨酶明显降低(P<0.01)。与模型组和西药组比,消渴肾方低、中剂量组血清白蛋白显著升高(P<0.01);(3)光镜下较模型组的肾小球结构紊乱、毛细血管袢肥大、基底膜增厚迂曲、系膜基质增生、肾小囊窄缩、肾小管上皮细胞空泡样变性、糖原沉积及胶原纤维增生等病理变化,西药组、消渴肾方低、中剂量组有不同程度改善。电镜下较模型组的基底膜呈弥漫性均质性增厚、三层结构模糊、足突广泛融合、足细胞下间隙、窗孔结构消失、系膜细胞增生、系膜基质增多呈团块状等超微结构改变,西药组、消渴肾方低、中剂量组均有不同程度改善;(4)纤维化相关因子检测发现,与模型组比,不同剂量消渴肾方组治疗后的转化生长因子-β1、磷酸化Smad2和Smad3表达有不同程度降低,其中消渴肾方中、高剂量组磷酸化Smad2的表达明显降低(P<0.05),Smad7表达无统计学差异(P>0.05);不同剂量消渴肾方不同程度上调E-钙黏蛋白表达、下调α-平滑肌肌动蛋白表达,其中高剂量组作用显著(P<0.01)。结论 低、中剂量的消渴肾方颗粒能有效降低早中期糖尿病肾脏病db/db小鼠的随机血糖和24小时尿微量白蛋白,改善肾脏病理损伤并修复肾脏超微结构。其肾脏保护作用可能与早期抑制转化生长因子-β1/Smad通路介导的肾脏纤维化相关。