Determination of upper reference value of urinary calcium-creatinine ratio for the paediatric population in Burdwan district

To estimate the rate of excretion of urinary calcium, a 24-hour sample of urine is required and this is not always easy to collect accurately in infant and children. So, random urine calcium to creatinine ratio (Ca/Cr ratio) has been developed. But as the ratio varies worldwide, reference values of the parameter in paediatric population are not developed. To determine reference value, the present study was conducted in healthy paediatric population in Burdwan district, West Bengal. This study was performed on 693 healthy paediatric subjects, aged between 3 months to 18 years and divided into five groups. Early morning non-fasting urine samples from all study groups were analyzed for Ca/Cr ratio. A negative correlation was observed between age and urinary Ca/Cr ratio, but there was no significant difference of urinary Ca/Cr ratio between two sexes. Considering 97.5th percentile of the underlying distribution of values as the upper limit of reference range, upper reference values of urinary Ca/Cr ratio for age groups

Comparison between different methods of urine collection for estimation of albumin-creatinine ratio in patients with type-2 diabetes mellitus

In patients with diabetes mellitus, urinary albumin-creatinine-ratio (ACR) predicts progressive kidney disease. In order to determine the better urine sample for detecting ACR, we estimated ACR in three modes of urine sample. Two hundred patients of uncontrolled diabetes mellitus with proteinuria irrespective of age and sex were studied for urinary ACR in all the three types of samples over a period of 2 years. The statistical analysis showed that first morning ACR (r = 0.999, p > 0.001) of the subjects was more significantly correlated with their 24 hour urine sample ACR than spot urine (r = 0.995,

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus:A real-world experience

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.

Role of angiotensin converting enzyme and angiotensinogen gene polymorphisms in angiotensin converting enzyme inhibitor-mediated antiproteinuric action in type 2 diabetic nephropathy patients

AIM To investigate the role of genetic variants of angiotensin converting enzyme(ACE) and angiotensinogen(AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy(DN) patients.METHODS In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor(ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio(ACR) in urine. Genotyping of ACE I/D and AGT M235 T polymorphisms were performed by using primer specific polymerase chain reaction(PCR) and PCR-RFLP techniques, respectively. RESULTS Forty-eight percent of DN patients(responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric(≥ 30 and < 300 mg/g creatinine) or macro-albuminuric(≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients(55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235 T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response(72%). CONCLUSION ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235 T polymorphisms.

CHANGES OF URINARY HYDROXYPROLINE IN FRACTURE PATIENTS

Fifteen cases of fresh fractures have been studied, including 14 cases of tubu-lar bone fractures with age from 28 to 60 years and one case of vertebral fracture ofdorsolumbar region, 16 years of age. There were 13 male and 2 female patients. Theyhad no endocrine disturbances or other bone diseases. The ratio ofhydroxyproline/creatinine (HP/Cr) in these cases increased gradually within 20-30 daysafter fracture and then reached the peak value which was about 3-4 times of normal, thepeak value maintained for a long time. If the trauma was mild or the patient was young,the peak began to decline on the 60th day after fracture. While in those severe cases withprolonged confinement to bed, the peak only began to come down about 110th dayafter fracture. The ratio of HP/Cr decreased rapidly from the peak at first, then pursueda slow course. Generally, the ratio of HP/Cr returned to normal on the 240th to 310thday. Bone union began at a time when peak value started to decline, and with completionof the remodelling process, the HP/Cr value returned to normal.

Urine albumin excretion: Characterization of normal variability in healthy children

Objective: Elevated urine albumin to creatinine ratio (ACR) of >30 mg/gm is a widely agreed upon indicator of pathologic albuminuria in children. However, the most reliable specimen to measure ACR in children remains undefined. We assess the range and limits of upright and supine total albumin and ACR in healthy children. Methods: Healthy children age 6 - 18 years completed 24-hour and split upright and supine urine collections. Upright, supine and 24-hour protein, albumin and creatinine were measured. Primary outcomes are range and variation in urine albumin by diurnal status, age, gender, BMI percentile and Tanner stage. Results: In healthy children, with mean age 12.9 year (sd 3.2), upright ACR was 2-fold greater than supine (13.9 vs 6.8 mg/gm, p = 0.02). The range of ACR was much greater in the upright (2 - 323 mg/gm) compared to the supine (1.7 - 76 mg/gm) samples. The average total 24-hour urine albumin was 8.4 mg (sd 9.8) and the mean ACR was 8.9 mg/gm (sd 11.7). The 24-hour albumin increased with age and Tanner stage, but this relationship was not significant after adjusting for BSA or urine creatinine. A supine or upright ACR of >30 mg/gm was found in 5.4% of each group. However, in all subjects with an elevated ACR on an individual upright or supine sample, a second 1st am ACR sample was normal. Conclusions: In healthy children there is a marked diurnal variability in ACR with a higher value from a daytime sample compared to 1st morning specimen. Screening for pathologic albuminuria should always use a first morning urine specimen.

Kidney Volume in Kidney Function Assessment: Determinants and Clinical Correlates in Systemic Hypertension and Chronic Kidney Disease in Southwestern, Nigeria

Background: The kidney volume is a very reliable ultrasound measure, reflecting contributions from all kidney parts. It could be affected by gender, body size and disease conditions. Its use in renal function assessment is based on its correlation with the glomerular filtration rate (GFR). Objectives: To assess the determinants and clinical correlates of kidney volume in hypertension and in chronic kidney disease (CKD). Materials and Methods: The two-center study was carried out at the Federal Medical Centre, Abeokuta (June-December 2017) and Babcock University Teaching Hospital, Ilishan-Remo (August 2019-January 2020). The kidneys of sixty participants who had hypertension without kidney disease (HWKD) and 58 with CKD were scanned from the front and back and their blood samples were taken for electrolytes and hemoglobin concentration. Result: The participants with CKD were significantly older than those with hypertension, P < 0.001. The mean kidney volume of hypertensives, 132.4 ± 18.3, was significantly higher than those with CKD, 63.7 ± 5.9, P < 0.001. The glomerular filtration rate (GFR) and hemoglobin concentration were significantly higher in hypertensives than in CKD, P < 0.001, P < 0.001 respectively. The systolic blood pressure (SBP), creatinine and the albumin creatinine ratio (ACR) were significantly higher in CKD than in hypertension, P < 0.001, P < 0.001 and P < 0.001 respectively. Conclusion: The mean kidney volume was higher in hypertension and in males. The GFR and hemoglobin levels were significantly higher in hypertension than in CKD while blood pressure and ACR were significantly higher in CKD than in hypertension. Kidney volume was positively and negatively correlated with GFR and ACR respectively.

Association of NFkB1 Gene Polymorphism with Inflammatory Markers in Patients of Type 2 Diabetes Mellitus with or without Renal Involvement in Eastern India

Aims: To evaluate the association of Nuclear factor kappa B1(NFkB1) gene polymorphism with inflammatory markers Urinary Monocyte Chemoattractant Protein 1 (UMCP1) and Tumor Necrosis Factor alfa (TNF alfa) in Patients of diabetes mellitus with or without renal involvement in Eastern India. Material and Methods: Consecutive Patients of Type 2 Diabetes Mellitus (DM) with or without microalbuminuria attending SCB MEDICAL COLLEGE and HOSPITAL Medical OPDs in between September 2018 to September 2019 were recruited in this study. Patients were subjected to blood and urine investigations. DNA extraction and Restriction fragment Length Polymorphism (RFLP) was done in Department of Biochemistry. Controls were unrelated healthy attendants with no history of Diabetes Mellitus, HTN, Chronic Kidney Disease (CKD). Results: Mean Systolic BP, Fasting Blood Glucose, Post Prandial Blood Glucose, HBA1c, Total Cholesterol were significantly higher in diabetes mellitus and diabetic nephropathy groups than control group. Estimated Glomerular Filtration Rate was significantly lower in diabetic nephropathy (p value < 0.001). UMCP1, Urinary Albumin Creatinine Ratio, TNF alfa were higher in diabetes mellitus and nephropathy with p value (<0.001, 0.006 < 0.001) respectively. In between DM and Diabetic Nephropathy groups nfkb1 gene expression, umcp1 and tnf alfa levels were significantly increased in Diabetic nephropathy with p value 0.019, <0.01, 0.001 respectively. Insertion/insertion NFkB1 gene polymorphisms were more in diabetic nephropathy group and were positively correlated with inflammatory markers UMCP1 (r = 0.517, p < 0.01) and TNF alfa (r = 0.172, p = 0.19). Conclusion: insertion/insertion NFkB1 gene polymorphism increases the risk of nephropathy by 2.52 times (OR = 2.52, 95% CI: 0.04 - 0.63, p value = 0.019) in diabetes patients in eastern India.

Study on relationship between diabetic retinopathy and blood glucose, blood lipid

Objective: To provide scientific basis for the pathogenesis and prevention and control of diabetic retinopathy through studying on relationship between different stages of diabetic retinopathy and blood glucose, blood lipid andother related factors. Mehods: Collected 196 type 2 diabetes patients in a hospital branch ,it could be divided into NDR (n=180), NPDR (n=11) and PDR (n=5) and collected 40 control cases. Each object were surveyed fundus colorized photographyorfundus fluorescence angiography examination, physical and blood tests, and the results were statistically analyzed. Results: BMI, SBP, HbAlc, FPG, P2hPG, TG, HDL, DN and urinary albumin/creatinine ratio (UACR) between the four groups were statistically difference;SBP, HbAlc, P2hPG, TG and UACR were positively correlated relationship with different stage of DR;HDL was negatively related with different stage of DR. Conclusion: SBP, HbAlc, P2hPG, HDL and UACR were factors of different stages of DR, the SBP, HbAlc, P2hPG and TG were more higher and the HDL was more lower, the DR was more serious.

Diabetic Nephropathy and Management

Chronic kidney disease affects people worldwide. Approximately 1 out of 3 adults with diabetes have kidney disease. Among several etiological factors for CKD, diabetes mellitus (DM) and hypertension are the main factors. These factors not only cause CKD but are also responsible for several complications related to CKD. In this article, we have reviewed Diabetic Nephropathy (DN) in terms of etiology, pathophysiology, diagnosis, management, current guidelines for diabetic nephropathy management, and some of the research study findings. Diabetic nephropathy (DN) is the chief factor for end-stage renal disease (ESRD) development across the globe. The primary cause of DN is Diabetes Mellitus, which is an autoimmune lifestyle disorder having several etiological factors. Checking for urine albuminuria, estimated GFR (eGFR), and blood glucose are unswerving tests for DN diagnosis and subsequent monitoring. Controlling hyperglycemia, blood pressure, and proteinuria are critical in stopping the progression of DKD. Clinical practice and evidence-based medicine demonstrated that early diagnosis followed by treatment can prevent or halt DKD progression.

The relationship between association of microalbuminuria and retinal vessel diameter in population with essential hypertension

Objective To investigate the association of urinary albumin-to-creatinine ratio(UACR) and the diameter of retinal vessel in population with essential hypertension inFujian coastal area.Methods Central retinal artery

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。

蛋白尿与估算肾小球滤过率联合对糖尿病患者新发心血管疾病的影响

目的 观察估算肾小球滤过率(estimated glomerular filtration rate, eGFR)和尿微量白蛋白与肌酐比值(urine albumin-to-creatinine ratio, uACR)评估肾功能的一致性,探讨二者联合对糖尿病患者新发心脑血管疾病(cardia-cerebrovascular disease, CVD)(包括心力衰竭、心肌梗死、脑卒中)的影响。方法 选择参加开滦第5次或第6次健康体检且进行尿微量白蛋白及尿肌酐、血肌酐检测的8 791例2型糖尿病(type 2 diabetes mellitus, T2DM)患者为研究对象。依据基线uACR和eGFR水平分组:正常组(uACR<3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))、单纯eGFR下降组(uACR<3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))、单纯uACR升高组(uACR≥3 mg/mmol且eGFR≥90 mL·min^(-1)·1.73 m^(-2))和uACR升高合并eGFR下降组(uACR≥3 mg/mmol且eGFR<90 mL·min^(-1)·1.73 m^(-2))。观察eGFR和uACR评估的肾功能是否一致。采用多因素Cox回归模型分析uACR和eGFR联合分组对CVD发病风险的影响。结果 (1)研究对象基线年龄为(60.97±9.99)岁,男性占79.05%,中位uACR为1.68(0.81,4.60)mg/mmol,平均eGFR为(92.14±16.52) mL·min^(-1)·1.73 m^(-2),uACR升高与eGFR下降不一致者占43.59%。(2)中位随访时间为3.83年,共发生CVD事件694例(7.89%),4组总CVD事件的发病密度分别为12.96/1 000人年、19.04/1 000人年、25.65/1 000人年和46.87/1 000人年。(3)与正常组相比,单纯eGFR下降组、单纯uACR升高组和uACR升高合并eGFR下降组新发总CVD事件的风险分别升高1.06(95%CI 0.73~1.55)倍、1.99(95%CI 1.41~2.80)倍和3.00(95%CI 2.12~4.25)倍。结论 eGFR下降和uACR升高所评估的肾功能不一致现象较为常见,二者对CVD发病的影响存在联合作用。

尿微量白蛋白与尿肌酐比值、尿视黄醇结合蛋白及尿β2微球蛋白联合检测对糖尿病肾病的诊断价值

目的 探讨尿微量白蛋白与尿肌酐比值(ACR)、尿视黄醇结合蛋白(RBP)及尿β2微球蛋白(β2-MG)联合检测对糖尿病肾病的诊断价值。方法 对2022年1月—2023年6月本院收治的2型糖尿病(T2DM)患者200例临床资料进行回顾性分析,根据是否有糖尿病肾病分为肾病组(100例)、单纯糖尿病(DM)组(100例),均接受ACR、RBP及β2-MG联合检测,对检测结果进行分析。结果 肾病组ACR、RBP、β2-MG水平与单纯糖尿病组比较有明显差异(P<0.05);肾病组患者不同Mogensen分期患者的尿微量白蛋白/尿肌酐比值、尿视黄醇及尿β2微球蛋白水平比较有明显差异(P<0.05);单项检测的诊断特异度、灵敏度明显较联合检测低(P<0.05)。结论 ACR、RBP、β2-MG联合检测对糖尿病肾病具有较高的检测价值,在出现早期肾损伤时即可检出,也有助于评估肾病程度,为临床制定治疗方案提供参考依据。

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。

血清CAR和PCT及IL-10水平对上尿路结石患者术后泌尿系统感染的预测价值

目的:分析血清C反应蛋白(CRP)与清蛋白(ALB)的比值(CAR)、降钙素原(PCT)及白细胞介素-10(IL-10)水平对上尿路结石患者术后发生泌尿系统感染的预测价值。方法:回顾性分析石河子市人民医院2020年6月—2022年6月收治的100例上尿路结石患者的临床资料,根据术后是否发生泌尿系统感染将其分为感染组(n=26)与非感染组(n=74)。对上尿路结石患者术后发生泌尿系统感染的相关因素进行分析,采用Logistic回归分析其危险因素,采用受试者操作特征曲线(ROC)评估危险因素在术后发生泌尿系统感染中的预测价值。结果:单因素分析结果显示,合并其他慢性疾病,CAR、PCT、IL-10水平与上尿路结石患者术后发生泌尿系统感染相关(P<0.05);Logistic回归分析结果显示,CAR、PCT、IL-10水平上升是上尿路结石患者术后泌尿系统感染的危险因素(P<0.05);ROC曲线分析CAR、PCT、IL-10联合预测上尿路结石患者术后发生泌尿系统感染的ROC曲线下面积为0.995,灵敏度为95.90%,特异度为96.70%,均优于CAR、PCT、IL-10各指标单独预测(P<0.05)。结论:CAR、PCT、IL-10水平上升是上尿路结石患者术后泌尿系统感染的危险因素,对其具有较高的预测价值,且三者联合应用可有效提高应用效能。

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。

不同剂量非奈利酮治疗早期2型糖尿病肾病的疗效及对血清IGF-1、IL-6水平的影响

目的 探讨不同剂量非奈利酮治疗早期2型糖尿病肾病(DKD)患者的临床疗效及对血清胰岛素样生长因子-1(IGF-1)、白介素-6(IL-6)水平的影响。方法 选取2023年1月至2023年8月荆州市中心医院就诊的76例早期DKD患者为研究对象,随机分为小剂量组(10 mg/d,n=38)和大剂量组(20 mg/d,n=38),比较两组治疗前及治疗12周后肾功能指标[尿白蛋白/肌酐比值(UACR)、血清肌酐(Scr)、肾小球滤过率(eGFR)]、血钾、血压及血清IGF-1、IL-6水平的变化。结果 治疗后,两组UACR、Scr、IGF-1、IL-6均低于治疗前(P<0.05),eGFR、血钾均高于治疗前,且大剂量组上述指标改善效果优于小剂量组(P<0.05);两组治疗后SBP、DBP与治疗前比较,差异无统计学意义(P>0.05)。Pearson相关性分析显示,治疗前UACR与血清IGF-1、IL-6水平呈正相关;治疗后,大剂量组UACR与血清IGF-1、IL-6水平呈正相关,小剂量组UACR与血清IGF-1、IL-6水平无相关性。结论 与小剂量非奈利酮相比,大剂量非奈利酮能减少早期DKD患者的尿蛋白,降低血清IGF-1与IL-6水平,进一步改善肾功能,但可能有一定的血钾升高风险,临床应用时需关注。