Spot urine protein/creatinine ratio—A quick and accurate method for diagnosis of pre-eclampsia

Objective(s):To assess the diagnostic accuracy of spot urine protein-creatinine (P/C) ratio and its compareson with 24-hour urine proteinuria for predicting eclampsia. Method(s): Spot urine P/C ratio was determined in a mid-stream urine sample, and the 24-hour urine protein was measured. The correlation between the spot P/C ratio and 24-hour urine protein amount was done. Logistic regression analysis and ROC curve analysis have been used to analyse data. Result(s): There was a strong correlation between the spot P/C ratio and 24-hour urine protein excretion (pearson’s correlation coefficient r = 0.71;P < 0.0001). The optimal spot P/C ratio cutoff point was 0.25, for 300 mg/24 h of protein excretion, with sensitivity and specificity of 69% and 75% respectively. Conclusion(s): Spot urine P/C ratio is a quick and reliable tool which can be used as an alternative method for evaluation of proteinuria for diagnosis of pre-eclampsia.

Correlation between glycated hemoglobin A1c,urinary microalbumin,urinary creatinine,β2 microglobulin,retinol binding protein and diabetic retinopathy

BACKGROUND Retinopathy is the most common microvascular disease of type 2 diabetes,and seriously threatens the life,health and quality of life of patients.It is worth noting that the development of diabetic retinopathy(DR)can be hidden,with few symptoms.Therefore,the preliminary screening of diabetic patients should identify DR as soon as possible,delay disease progression,and play a vital role in its diagnosis and treatment.AIM To investigate the correlation between glycated hemoglobin A1c(HbA1c),urinary microalbumin(U-mALB),urinary creatinine(U-CR),mALB/U-CR ratio,β2 microglobulin(β2MG),retinol binding protein(RBP)and DR.METHODS A total of 180 patients with type 2 diabetes mellitus attending the Second People’s Hospital of Hefei from January 2022 to August 2022 were retrospectively enrolled by ophthalmologists.Based on whether they had combined retinopathy and its degree,68 patients with diabetes mellitus without retinopathy(NDR)were assigned to the NDR group,54 patients with non-proliferative DR(NPDR)to the NPDR group,and 58 patients with proliferative DR to the PDR group.General data,and HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR results were collected from the patients and compared among the groups.Pearson's correlation method was used to analyze the correlation between HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR indices,and multiple linear regression was applied to identify the risk factors for DR.Receiver operator characteristic(ROC)curves were also drawn.RESULTS The differences in age,gender,systolic and diastolic blood pressure between the groups were not statistically significantly(P>0.05),but the difference in disease duration was statistically significant(P<0.05).The differences in fasting blood glucose,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,total cholesterol,and triglyceride between the groups were not statistically significant(P>0.05).HbA1c in the PDR group was higher than that in the NPDR and NDR groups(P<0.05).The levels of mALB,β2MG,RBP,mALB/U-CR and UCR in the PDR group were higher than those in the NPDR and NDR groups(P<0.05).Multiple linear regression analysis showed that disease duration,HbA1c,mALB,β2MG,RBP,mALB/U-CR and U-CR were risk factors for the development of DR.The ROC curve showed that the area under the curve(AUC)for the combination of indices(HbA1c+mALB+mALB/U-CR+U-CR+β2MG+RBP)was 0.958,with a sensitivity of 94.83%and specificity of 96.72%,which was higher than the AUC for single index prediction(P<0.05).CONCLUSION HbA1c,mALB,mALB/U-CR,U-CR,β2MG and RBP can reflect the development of DR and are risk factors affecting PDR,and the combination of these six indices has predictive value for PDR.

Increased Spot Urinary Protein-to-Creatinine Ratio Can Be a Useful Predictor of Preeclampsia

Objectives: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early diagnosis of preeclampsia is important to help patients with preeclampsia. However, 24-hour urine collection is the gold standard diagnostic method at present. Recently, the spot urinary protein-to-creatinine ratio (P/C ratio) has been used to detect suspected preeclampsia, because it can be used to estimate the amount of 24-hour urinary protein. The aim of this study is to investigate whether an increase in P/C ratio precedes emergence of hypertension among inpatients with preeclampsia. Method: The P/C ratio in normotensive (systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) pregnant women was measured during regular prenatal checkups and in inpatients with preeclampsia between April 1, 2013 and March 31, 2014. Results: We included in this study 4074 normotensive pregnant women. The 95th percentile values for the trimester of pregnancy were 0.100, 0.157, and 0.195, respectively. The 95th percentile value for each trimester of pregnancy and gestational age were determined as criterion (Y) and predictive variables (X), respectively. In a simple regression analysis, the regression line was calculated as Y = 0.0035X + 0.0849 (R2 = 0.9913). Twenty-one women were diagnosed with preeclampsia. In 14 patients with preeclampsia, the timing of the increase in P/C ratio to higher than the regression line preceded the emergence of hypertension. Six patients had no data on P/C ratio, and 1 patient had hypertension before the increase in P/C ratio. Conclusions: An increase in P/C ratio to higher than the 95th percentile value can be a useful predictor of preeclampsia.

Potential effect of Silybum marianum L. and Cistus ladaniferus L.extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L.and Cistus ladaniferus L.in normal rats.Methods:Four groups of rats were used in each experiment.The first group received water,the second group received Cistus ladaniferus L.extract(100 mg/kg b.wt),the third group received Silybum marianum L.extract(100 mg/kg b.wt),and the fourth group received furosemide(10 mg/kg b.wt).Variables including urine volume,plasma and urine sodium,potassium and creatinine,and creatinine clearance were measured.Two experiments were conducted.A single dose of each intervention was used and the variables were measured during 24 h,and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium(P<0.05).On the day 8 after daily administration,the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes(P<0.05),while furosemide caused hypokalemia.Both plant extracts significantly increased creatinine clearance(P<0.05).Conclusions:Silybum marianum L.and Cistus ladaniferus L Increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes.Silybum marianum L.is more potent than furosemide or Cistus ladaniferus L.

Exploration of Urinary Creatinine to Determine the Carcass and Its Protein Weight in Beef Cattle

This study was aimed to explore the use of creatinine as indicator to predict carcass and its protein weight in beef cattle. Eight Ongole crossbred cattle with initial body weight ranged at 133.5-228 kg and age of 6-18 months were used in this study. The cattle were fed Napier grass ad libitum and concentrate feeding for three months prior to be slaughtered. Concentrate feeding was consisted of rice bran and soybean meal which was provided to fulfill dry matter requirement at 2.1% of body weight （BW）. The availability of creatinine for prediction indicator was done by evaluate the correlation between the amount of daily urinary creatinine and the carcass and its protein weight. Carcass and its protein weight were measured by slaughtering the cattle, and chemically analyzed for determining protein content of carcass. The results showed that creatinine excreted in urine have a strong correlation with the cattle body weight （r = 0.88）, carcass weight （r = 0.67）, body protein （r = 0.70） and carcass protein （r = 0.72）. The conclusion of this study is creatinine excreted in urine have a strong relationship with the carcass and its protein, and therefore could be used to predict the carcass and its protein weight of beef cattle.

Urinary Creatinine Concentrations and Its Explanatory Variables in General Chinese Population:Implications for Creatinine Limits and Creatinine Adjustment

Objective The study aimed to analyze the applicability of the World Health Organization’s exclusionary guidelines for Urinary creatinine(Ucr)in the general Chinese population,and to identify Ucr related factors.Methods We conduct a cross-sectional study using baseline data from 21,167 participants in the China National Human Biomonitoring Program.Mixed linear models and restricted cubic splines(RCS)were used to analyze the associations between explanatory variables and Ucr concentration.Results The geometric mean and median concentrations of Ucr in the general Chinese population were 0.90 g/L and 1.01 g/L,respectively.And 9.36%samples were outside 0.3-3.0 g/L,including 7.83%below the lower limit and 1.53%above the upper limit.Middle age,male,obesity,smoking,higher frequency of red meat consumption and chronic kidney disease were associated significantly with higher concentrations of Ucr.Results of the RCS showed Ucr was positively and linearly associated with body mass index,inversely and linearly associated with systolic blood pressure,diastolic blood pressure,triglycerides level,and glomerular filtration rate,and were non-linearly associated with triiodothyronine.Conclusion The age-and gender-specific cut-off values of Ucr that determine the validity of urine samples in the general Chinese population were recommended.To avoid introducing bias into epidemiologic associations,the potential predictors of Ucr observed in the current study should be considered when using Ucr to adjust for variations in urine dilution.

PERINATAL FETAL WELL-BEING MONITORING: A COMPARISON BETWEEN RANDOMIZED URINARY ESTRIOL/CREATININE AND SERUM FREE ESTRIOL DETERMINATION

Randomized urinary and blood samples were obtained from three hundred and ninety-two cases of late pregnancies simultaneously for comparison of the validity in perinatal fetal monitoring. The results of randomized urinary estriol/creatinine （RUE3/C） and serum free estriol （SFE3） tests revealed that Ⅰ. The coefficient of correlation between RUE3/C and SFE3 level were close in either normal or high-risk pregnancies （y=0.1477X+14.2368, r=0.4586, n=170; y=0.1724X+8.6698, r=0.5868, n=222, respectively, P【0.001）; 2.92%cases of the false positive rate of RUE3/C were corrected by SFE3 test. In cases of pregnancy-induced hypertension （PIH） the false positive rate of RUE3/C were highest in comparison with those in cuses of other high-risk pregnancies （53.6%）; 3. The correct rate of SFE3 test in prenatal predication of fetal well-being was significantly higher （95.6%） than that of RUE3/C （87.3%） （X2=17.77, P【0.001）. This paper suggests that RUE3/C can be used as a first line test for perinatal monitoring. When RUE3/C value is lower than normal, SFE3 test should be added to ensure the reliability of perinatal diagnosis, especially in PIH cases. Obviously, to use these two tests for perinatal fetal monitoring simultaneously is better than to use any one test alone.

THE VALUE OF URINE PROTEIN EXCRETION IN DIAGNOSING EARLY DIABETIC NEPHROPATHY

We tested urine albumin excretion rate (UAER), urine transrerrin (TRF ), retinolulnding protein (RBP), N --acetyl--aD-gi ucosamlnldase (N AG ), P, - mi c rogl obu I in (P, -- M G ) and lgGIn 45 cases of NIDDM. Thirty cases with UAER<300 mg/d were divided into two groups. Data wereshown with urine protein index (urine protein/urine creatlne). ResultS showed that urine transferrinwas more seusltlve than albumlu, and the combined test or urine Protein is nontraumatic, which hadsteatncance to diagnose early diabetic nepkropatby.

Effect of Xuesaitong Combined with Autologous Platelet-rich Gel on Blood Glucose,AT-III,TNF-αand 24-h Urinary Protein Level in Patients with Diabetic Foot

[Objectives]To investigate the clinical effect of different doses of Xuesaitong combined with autologous platelet-rich gel(APG)on patients with diabetic foot(DF).[Methods]90 patients with diabetic foot admitted to our hospital from February 2017 to February 2019 were enrolled in the study.According to the random number table method,the subjects were divided into study group A and B and control group C.Group A was given a low dose of Xuesaitong combined with APG,while group B was given high-dose Xuesaitong combined with APG and group C was treated only with APG.Patients in the three groups were observed and the changes of related indexes were detected.[Results]After treatment,with regard to the three groups,the fasting blood glucose,2-h postprandial blood glucose level,HbA1c,TNF-α,Hcy,blood urea nitrogen(BUN),creatinine(Cr)and 24-h urine protein levels were all decreased,yet AT-III level was increased,and granulation tissue coverage and thickness,wound clearance rate were increased,while the repair time of ulcer surface was significantly reduced.The above indexes were all significantly different(P<0.05).Compared with the control group C,the changes of the indexes in the study group A and B were the same as above,and the difference was significant(P<0.05).Compared with the study group A,the level of AT-III in group B was significantly increased(P<0.05),while TNF-α,Hcy,BUN,Cr and 24-h urine protein levels were significantly decreased(P<0.05).There was no significant difference in the other indexes between groups A and B(P>0.05).[Conclusions]Xuesaitong combined with APG could effectively reduce the blood sugar level of DF patients,improve the clinical indexes,promote wound healing,and the high-dose group had more significant advantages and was worthy of promotion.

Age-related changes in urinary protein excretion in relation to indices of renal function in Wistar rats

Background: The study determined the fractions of proteins in the urine and plasma of rats at different ages, measured the plasma and urine concentrations of markers of renal function, with a view to determining the influence of proteinuria on renal function.Methods: Eighty Wistar rats were used for this study. Groups 1 and 2 each consisted of eight 1-month-old male and female rats; 3 and 4 had eight 3-month-old male and female rats; 5 and 6 had eight 6-month-old male and female rats; 7 and 8 had eight 9-month old male and female rats; and 9 and 10 had eight 12-month-old male and female rats.Results: A fraction of the molecular weight of protein in the urine of rats aged 1, 9 and 12 months was higher than that of 3 and 6 months. The total protein concentration in the urine of male and female rats aged 9 and 12 months was significantly higher than that of rats aged 1 and 3 months. The urine creatinine concentrations of male and female rats aged 9 months were significantly higher when compared with that of 1, 3, 6 and 12 months.Conclusion: Our results suggest that the 3-month-old rats seem less affected by proteinuria, because they had the least urine protein, and consistent and reduced plasma and urine concentrations of markers of renal function. The results of this study may provide a foundation for future mechanistic inquiries as to why this age group was the least affected by proteinuria.

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。

妊娠早、中期妇女尿碘/尿肌酐比值与亚临床甲状腺功能减退症合并自身抗体阳性的相关性

目的:探讨妊娠早、中期妇女尿碘/尿肌酐比值(UIC/UCr)与亚临床甲状腺功能减退症(SCH)合并自身抗体阳性的相关性。方法:回顾性选取2018年1月—2021年6月贵阳市第一人民医院进行孕检的妊娠早、中期SCH孕妇作为研究对象,依据甲状腺自身抗体检测结果,将其分为:妊娠早、中期甲状腺抗体阳性组;妊娠早、中期甲状腺抗体阴性组;另选取同时期进行检查的妊娠早、中期健康孕妇作为对照组,每组各100例,共计300例,观察甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、UIC/UCr、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)等指标。结果:妊娠早期三组孕妇一般临床资料比较,差异无统计学意义(P>0.05),妊娠中期三组孕妇收缩压(SBP)、舒张压(DBP)比较,差异有统计学意义(F=7.024、11.357,P<0.05);UIC/UCr分析显示,与其他组别比较,妊娠早、中期阳性组孕妇均值和百分位分布数值最低;甲状腺激素及抗体水平比较,除FT3和FT4外,妊娠早、中期阳性组孕妇UIC/UCr、TPOAb、TgAb和TSH水平与健康组和阴性组比较,差异有统计学意义(F=71.710、279.102、130.017、275.949、22.991、220.702、288.882、184.459,P<0.001);相关性分析结果显示,UIC/UCr与TSH、TgAb、TPOAb水平呈负相关;多元线性回归分析结果发现,UIC/UCr、TSH是TPOAb、TgAb的主要影响因素。结论:妊娠早、中期SCH合并自身抗体阳性孕妇,UIC/UCr显著偏低且与TPOAb、TgAb关系密切,建议在临床中加强UIC/UCr指标观察。

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。

尿液错误折叠蛋白与子痫前期发病风险及不良妊娠结局的关系

目的探讨尿液错误折叠蛋白与子痫前期发病风险及不良妊娠结局的关系。方法将2022年3月至2023年6月于该院进行产检的300例孕妇作为研究对象,通过刚果红斑点扩散法检测其尿液错误折叠蛋白水平。分析尿液错误折叠蛋白诊断子痫前期的灵敏度、特异度、阳性预测值和阴性预测值。根据孕妇子痫前期检出情况将其分为子痫前期组和非子痫前期组,比较2组孕妇一般资料、不良妊娠结局发生情况,分析尿液错误折叠蛋白与孕妇不良妊娠结局的关系。结果300例孕妇中有50例子痫前期孕妇,纳入子痫前期组,剩余250例非子痫前期孕妇纳入非子痫前期组;子痫前期组>29~34孕周的孕妇占比较高,为44.00%(22/50)。与非子痫前期组相比,子痫前期组不良妊娠结局发生率更高(P<0.05)。尿液错误折叠蛋白诊断子痫前期的阳性预测值为62.50%(40/64),阴性预测值为95.76%(226/236),检测灵敏度为80.00%(40/50),特异度为90.4%(226/250)。尿液错误折叠蛋白阳性孕妇不良妊娠结局发生率(20.31%)明显高于尿液错误折叠蛋白阴性孕妇(9.75%),差异有统计学意义(P<0.05)。结论尿液错误折叠蛋白与子痫前期发病风险及不良妊娠结局有关。

五苓散与麻黄五苓散对阿霉素肾病大鼠肾功能保护效应的比较研究

目的观察并比较五苓散与麻黄五苓散对阿霉素肾病(adriamycin nephropathy,AN)模型大鼠的干预效应,并研究其作用机制。方法50只SD大鼠随机分成5组,即空白对照组、模型组、贝那普利组、五苓散组、麻黄五苓散组。除空白对照组外,所有大鼠采用尾静脉注射盐酸阿霉素方法复制大鼠肾病模型。各给药组分别灌胃相应药物,给药期间监测大鼠每周体质量;5周后检测24 h尿量和尿蛋白;检测血清中肌酐(serum creatinine,SCr)、血尿酸(serum uric acid,SUA)、尿素氮(blood urea nitrogen,BUN)含量;Western blot检测肾组织中肾病蛋白(nephrin)、足突蛋白(podocin)表达水平;HE染色观察大鼠肾组织病理变化。结果与空白对照组比较,模型组大鼠平均体质量显著下降(P<0.01),尿量减少(P<0.05),24 h尿蛋白显著增加(P<0.01),SCr、SUA及BUN水平均显著升高(P<0.01),HE染色显示肾组织细胞形态不规则,胞核变形,染色质边集,nephrin、podocin蛋白表达显著下降(P<0.01)。与模型组比较,麻黄五苓散组大鼠平均体质量增加(P<0.01),尿量增加(P<0.05),24 h尿蛋白含量明显降低(P<0.05),SUA和BUN水平显著下降(P<0.01),大鼠肾组织微观病理损伤明显减轻,nephrin、podocin蛋白表达显著升高(P<0.01)。与五苓散组比较,麻黄五苓散组大鼠尿量显著增加(P<0.01),24 h尿蛋白含量明显减少(P<0.05),nephrin蛋白表达显著升高(P<0.01)。结论麻黄五苓散可有效抑制阿霉素肾病大鼠肾组织损伤,降低尿蛋白,改善肾功能。与五苓散比较,麻黄五苓散具有更明显的利尿和抑制尿蛋白作用。

Cr和NGAL预测老年重度烧伤患者早期急性肾损伤的应用价值

目的 探讨肌酐(Cr)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)预测老年重度烧伤患者早期急性肾损伤的应用价值。方法 选取53例老年烧伤患者,烧伤面积均大于20%,根据是否发生急性肾损伤(AKI)将患者分为AKI组(28例)及非AKI组(25例),在入院后的48 h内,每6 h收集1次全血NGAL和Cr的测量值。应用氧化酶法测定血清Cr水平;应用酶联免疫吸附法测定NGAL水平;利用受试者工作曲线(ROC)计算曲线下面积(AUC),比较各指标的诊断能力。结果 AKI组患者烧伤面积明显高于非AKI组患者(P<0.01);年龄、平均动脉压、中心静脉压、尿量在两组患者间比较差异无统计学意义(P>0.05)。AKI组患者6 h血NGAL水平明显高于非AKI组患者(P<0.01);AKI组患者12、24 h血NGAL、Cr水平明显高于非AKI组患者(P<0.01、P<0.05)。构建ROC曲线结果显示,血清Cr、血NGAL截断值为86.08μmol/L、125.75 ng/mL时对烧伤患者AKI具有较高的预测价值,其中,血NGAL水平预测烧伤患者AKI的灵敏度、阳性预测值更高。结论 入院48 h内测量血NGAL水平可以预测老年重度烧伤患者是否发生AKI,相较于血清Cr水平,血NGAL水平表现出更高的预测价值。

填精健脾逐水法联合足量激素改善原发性肾病综合征肾功能早期损害临床研究

目的:观察填精健脾逐水法联合足量激素改善原发性肾病综合征(PNS)肾功能早期损害治疗效果。方法:按随机数字表法分为观察组和对照组,各60例,对照组采用醋酸泼尼松片治疗,观察组在对照组的基础上加用填精健脾逐水法,共观察90 d。比较两组患者治疗后临床疗效、半胱氨酸蛋白酶抑制剂C(CysC)、内生肌酐清除率(CCr)、尿N乙酰β氨基葡苷酶(NAG)和血β2微球蛋白(β2-M)的变化情况。结果:观察组总有效率89.2%,高于对照组的82.7%(P<0.05)。治疗后两组CysC、CCr、尿NAG和血β2-M水平均下降(P<0.05)。结论:填精健脾逐水法联合足量激素改善PNS患者肾功能早期损害疗效更佳,具有增强机体的免疫功能,抑制炎症细胞,并能抑制血小板凝集、抗凝,改善肾血流量,从而改善肾功能等作用。

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。

亚硝酸盐对焦酚红法检测24 h尿液总蛋白的干扰分析

目的探讨亚硝酸盐对于焦酚红法检测24 h尿液总蛋白的干扰效应,并评估维生素C纠正干扰的可行性。方法根据美国临床和实验室标准协会(CLSI)EP7-A3文件,选取24 h尿液总蛋白定量结果为150 mg/L、500 mg/L和1000 mg/L的新鲜尿液标本作为对照样本,并配制含不同浓度亚硝酸钠的干扰物样本。利用配对差异实验确认亚硝酸盐的干扰作用,并通过剂量效应实验明确亚硝酸盐浓度与干扰程度的关系。在终浓度为200μg/mL亚硝酸钠存在的情况下,评估不同浓度维生素C纠正干扰的效果。同时收集61例亚硝酸盐阳性和40例亚硝酸盐阴性的临床标本,比较两组标本维生素C纠正前后的相对差值,评估其临床应用价值。结果配对差异实验中200μg/mL亚硝酸钠对150 mg/L和500 mg/L两个浓度的尿总蛋白测定分别存在-157.8%和-36.2%的相对干扰,显著大于1/2TEa(22%),而对于高浓度1000 mg/L的尿总蛋白虽存在-20.5%的负干扰,但在可接受范围内。剂量效应实验结果显示随着尿液中亚硝酸盐浓度的增加,尿总蛋白检测所受负干扰作用亦逐渐增大。在终浓度为200μg/mL亚硝酸钠存在的情况下,添加0.2 mg/mL的维生素C可分别将150 mg/L和500 mg/L的尿总蛋白纠正至148 mg/L(-1.1%)和402 mg/L(-19.5%),均处于可接受范围内。临床标本中亚硝酸盐阳性组通过维生素C纠正产生的相对差值显著高于亚硝酸盐阴性组(P<0.01)。结论亚硝酸盐对于焦酚红法检测尿液总蛋白存在负干扰,尤其是在尿总蛋白150 mg/L情况下,需引起临床实验室的关注。添加0.2 mg/mL维生素C可有效纠正低浓度尿总蛋白标本中亚硝酸盐的干扰作用,具有一定的临床应用价值。

维生素D及二甲双胍用于妊娠期糖尿病患者的疗效及对妊娠结局和视黄醇结合蛋白4的影响

目的分析维生素D与二甲双胍对妊娠期糖尿病患者的治疗效果。方法筛选2023年3月至2024年3月收治的200例妊娠期糖尿病患者,按照随机数字表法分为对照组和观察组,每组100例。对照组接受二甲双胍治疗,观察组在对照组基础上配合维生素D治疗。比较2组糖代谢指标、肾功能、血清因子[肿瘤坏死因子-α(TNF-α)、视黄醇结合蛋白4(RBP4)、内脂素(visfatin)]及血脂指标[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)],观察2组妊娠结局及不良反应。结果观察组治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白、稳态模型胰岛素抵抗指数、TNF-α、RBP4、visfatin、TC、TG、LDL-C低于对照组,空腹胰岛素高于对照组(P<0.05)。治疗后,2组血肌酐、24 h尿蛋白总量及血尿素低于治疗前,且观察组低于对照组(P<0.05)。观察组巨大儿、产后出血、新生儿窒息发生率以及不良反应总发生率均低于对照组(P<0.05)。结论妊娠期糖尿病应用维生素D与二甲双胍共同治疗的效果更好,可维持糖代谢和血脂水平,调节肾功能,稳定RBP4水平,从而改善妊娠结局,并控制不良反应。