Non-Diabetic Renal Disease in Patients with Type 2 Diabetes Mellitus with Proteinuria

Background: Diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD) worldwide. Although DM with proteinuria is the ultimate result of diabetic nephropathy (DN), a wide spectrum of non-diabetic renal diseases (NDRD) can occur in such patients. Objective: To observe the frequency and histological pattern of NDRD in diabetic patients with proteinuria and to explore their association with clinical and laboratory parameters. Methods: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2016 to September 2017. In this study a total of 38 cases of DM with proteinuria (>1 gm/24-hour) were selected purposively. Renal biopsy was done in all patients. Based on histological findings they were categorized into two groups;Group 1 with NDRD and Group II with DN. Their clinical and laboratory parameters were analyzed and compared. Results: Among the total study subjects, 21 (55.3%) were male and 17 (44.7%) were female, mean (±SD) age 43.45 ± 9.99 years in the NDRD group and 41.57 ± 9.50 years in the DN group. Thirty one cases (81.6%) out of thirty eight had NDRD and seven (18.4%) cases had isolated DN;therefore more than two third cases had NDRD. Duration of DM was found to be significantly shorter (p = 0.004) in the NDRD group. Diabetic retinopathy was present in 12.9% cases in NDRD group vs. 57.1% cases in DN group (p = 0.025). Frequency of microscopic hematuria was significantly higher (90.3%) in NDRD patients (p = 0.002). Conclusion: The frequency of NDRD in type 2 diabetic patients other than diabetic nephropathy is relatively high. Membrano proliferative glomeru-lonephritis and membranous nephropathy are more common in NDRD. Absence of diabetic retinopathy, presence of hematuria and shorter duration of DM are markers associated with NDRD in type 2 DM, which are important indicators for renal biopsy in diabetic patients with proteinuria.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Importance of serum phosphate in elderly patients with diabetes mellitus

BACKGROUND Metabolic disturbances including changes in serum calcium,magnesium or phosphate(P)influence the prevalence of type 2 diabetes mellitus(DM).We assessed the importance of serum P in elderly patients with type 2 DM vs nondiabetes mellitus(non-DM)in relation to renal function.AIM To determine the association between serum P and serum glucose or insulin resistance in diabetic and non-diabetic patients.METHODS One hundred-ten subjects with a mean age of 69.02±14.3 years were enrolled.Twenty-nine of the participants had type 2 DM(26.4%).The incidence of hypertension,smoking and receiving vitamin D(vitD)derivates were recorded.The participants were classified by both estimated glomerular filtration rate(eGFR)and albuminuria categories according to the Kidney Disease Improving Global Outcomes 2012 criteria.RESULTS We divided the patients in two groups according to the P cut-off point related to DM value.A comparison between high and low P showed that body mass index 30.2±6.3 vs 28.1±4.6(P=0.04),mean glucose 63.6 vs 50.2(P=0.03),uric acid 6.7±1.6 vs 6.09±1.7(P=0.05),mean intact-parathyroid hormone 68.06 vs 47.4(P=0.001),systolic blood pressure 147.4±16.7 vs 140.2±16.1(P=0.02),mean albuminuria 63.2 vs 50.6(P=0.04)and eGFR 45.6±22.1 vs 55.4±21.5(P=0.02)were significantly different.χ^2 tests showed a significant association between high P and DM,hypertension,receiving vitD,smoking and eGFR stage(χ^2=6.3,P=0.01,χ^2=3.9,P=0.03,χ^2=6.9,P=0.009,χ^2=7.04,P=0.01 andχ^2=7.36,P=0.04,respectively).The adjusted model showed that older age,female gender and increased body mass index were significant predictors of type 2 DM when entering the covariates.CONCLUSION High serum P contributes to vascular and metabolic disturbances in elderly patients with type 2 DM and renal impairment.

Risk factors for mortality within 6 mo in patients with diabetes undergoing urgent-start peritoneal dialysis:A multicenter retrospective cohort study

BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。

The Spectrum of Kidney Disease in Type Two Diabetic Patients: A Single-Center Study

Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to assess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through medical record revision of 101 patients with type 2 diabetes undergoing percutaneous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized prospective investigations focused on identifying possible risk markers of NDRD are still in priority.

非奈利酮对2型糖尿病患者心肾保护作用的研究进展

盐皮质激素受体拮抗剂是心力衰竭患者的指南推荐治疗药物。然而,高钾血症和激素副作用的相关风险限制了其在2型糖尿病合并中晚期慢性肾脏病及心血管疾病高风险患者中的广泛使用。非奈利酮是一种新型非甾体类盐皮质激素受体拮抗剂,用于与2型糖尿病相关的心血管疾病和慢性肾脏病患者,达到心肾保护的作用。本文对非奈利酮在治疗2型糖尿病中心肾保护的作用机制、药理特性、安全性等进行综述,旨在为2型糖尿病合并心力衰竭及肾脏损伤患者的临床治疗提供帮助。

糖尿病终末期肾病血液透析患者相关生活质量影响因素分析

目的分析糖尿病终末期肾病血液透析患者相关生活质量影响因素。方法本研究回顾性分析2020年1月至2023年2月南京医科大学附属淮安第一医院血液净化中心收治的105例糖尿病终末期肾病行血液透析患者资料,采用肾脏病生存质量简表(KDQOL-SFTM1.3)统计糖尿病终末期肾病患者的生活质量实际得分情况,并通过多元线性回归分析其相关生活质量影响因素。结果本研究患者生活质量处于KDQOL-SFTM1.3量表的中低水平;不同年龄、费用支付方式、血清白蛋白、血磷、血钙、血清肌酐、估算肾小球滤过率、甲状旁腺激素、C反应蛋白、透析充分性、空腹血糖、餐后2 h血糖、糖化血红蛋白水平的糖尿病终末期肾病行血液透析患者KDQOL-SFTM1.3量表评分比较,差异有统计学意义(P<0.05)。多元线性回归结果显示,年龄(β=-0.176)、血清白蛋白(β=-0.247)、透析充分性(β=-0.160)、C反应蛋白(β=0.272)、糖化血红蛋白(β=0.516)为影响糖尿病终末期肾病血液透析患者相关生活质量影响因素(P<0.05)。结论糖尿病终末期肾病血液透析患者的生活质量主要受年龄、血清白蛋白、透析充分性、C反应蛋白、糖化血红蛋白因素影响。

Serum Levels of RBP4 Might Not Be Determined by Diabetes Mellitus but by Kidney Function and Renal Replacement Therapy

It has been reported that retinol-binding protein 4(RBP4) is associated to adiposity,insulin resistance,and type 2 diabetes.Meanwhile,circulating RBP4 levels are also affected by renal function.The aim of the present study is to investigate whether serum levels of RBP4 are primarily associated with different stages of chronic kidney disease(CKD) or type 2 diabetes,if there is more potential relevance between RBP4 and renal replacement therapy.The serum levels of RBP4 were assessed by commercial competitive enzyme-linked immunosorbent assay(ELISA)kit in 212 patients with the CKD stages 1—5 and in 24 healthy controls,while its correlation with clinical and metabolic parameters was analyzed.The serum level of RBP4 had a strong correlation with estimated glomerular filtration rate(e GFR)(P < 0.001).Stratified by e GFR and treatment,no more differences in RBP4 serum concentration were detected between type 2 diabetic and non-diabetic subjects [CKD stages 1—5,non-dialysis(ND),hemodialysis(HD) and peritoneal dialysis(PD);P > 0.05 for all].The elevation of RBP4 become higher in HD than in PD and ND in CKD5 patients(P = 0.008 and P = 0.04,respectively),while there was no significant difference between PD and ND groups.Multivariate linear regression analysis demonstrated three independent predictors of e GFR(β =-0.676,P < 0.001),C-reactive protein(CRP)(β =-0.573,P < 0.001) and creatine(β = 0.509,P = 0.024) in the study population.The study results demonstrated that the serum level of RBP4 was negatively related to the e GFR,whether diabetes mellitus(DM) affected the blood concentration of RBP4 or not.And the serum level of RBP4 exhibited significant difference in different renal replacement therapies.

影响糖尿病终末期肾病血液透析患者长期生存率的危险因素分析

目的探讨影响糖尿病终末期肾病(ESDN)血液透析患者长期生存率的危险因素,以提高ESDN血液透析患者的长期生存率。方法31例ESDN血液透析患者和同期透析的42例非糖尿病终末期肾病(non-ESDN)血液透析患者相比较,回顾性分析了死亡率、死亡原因、并发症、营养状态及血生化改变。结果ESDN组1、3年死亡率分别为19.3%和41.9%,3年死亡率明显高于non-ESDN组。主要死因为心血管病变(47.4%)和感染性疾病(26.3%)。主要并发症是心血管病变(94%)。两组营养状态评估(SGA)均差,但ESDN组的血浆清蛋白明显低于non-ESDN组。结论ESDN组并发症发生率及死亡率均比non-ESDN组高。积极治疗并发症,改善营养状态是提高生存率的关键。

2型糖尿病患者高尿酸血症与糖尿病肾病关系研究

目的探讨2型糖尿病（T2DM）患者中高尿酸血症与T2DM及2型糖尿病肾病（T2DKD）的关系。方法选取T2DM患者217例,根据男性和绝经后女性血尿酸≥420μmol/L、绝经前女性血尿酸≥360μmol/L,将其分成正常尿酸（NUA）组135例及高尿酸血症（HUA）组82例;根据尿白蛋白/肌酐比（ACR）及血肌酐（SCr）值分为ACR〈30μg/mg正常蛋白尿（DKD0）组82例,ACR≥30-300μg/mg微量白蛋白尿（DKD1）组56例,ACR≥300μg/mg大量蛋白尿（DKD2）组32例,ACR≥300μg/mg且SCr〉115μmol/L肾衰竭（DKD3）组45例。比较NUA组和HUA组临床资料及血尿酸、ALB、肌酐清除率（Ccr）、HUA患病率在DKD各组中的差异。结果 217例T2DM患者中HUA患病率为37.79%,133例T2DKD患者中HUA患病率为50.38%。HUA组患者年龄、体质量、空腹C肽、三酰甘油、ACR、血尿酸水平高于NUA组（P均〈0.05）,而DBP、空腹血糖、白蛋白、糖化血红蛋白、Ccr、HDL-C水平低于NUA组（P均〈0.05）。血尿酸及HUA患病率在DKD0组、DKD1组、DKD2组及DKD3组依次递增（P均〈0.05）;ALB、Ccr在DKD0组、DKD1组、DKD2组及DKD3组依次递减（P均〈0.05）。多因素线性回归分析结果显示T2DM患者Ccr与ACR、年龄、尿素氮、Cr、尿酸呈负相关,与体质量正相关（P〈0.01）。结论 T2DM及T2DKD患者中HUA患病率均较高。HUA可能参与和加速了T2DM患者肾功能的下降和DKD的发生、发展。

血脂康对2型糖尿病肾病血脂和微量蛋白尿的影响

目的观察血脂康对2型糖尿病肾病患者脂代谢紊乱和微量蛋白尿的治疗作用。方法将确诊为2型糖尿病肾病的128例患者随机分为2组,均予常规降糖治疗,治疗组同时加服血脂康胶囊,1.2 g/d,共8周。观察2组治疗前后的总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、血小板聚集率、纤维蛋白原及24 h尿微量蛋白指标的变化。结果治疗组治疗后上述各项指标均显著改善,与对照组比较有显著性差异。结论血脂康有较好的调节血脂、改善血黏度和降低尿蛋白排泄率的作用。

亚临床甲状腺功能减退症与糖尿病肾脏疾病的相关性

目的：探讨亚临床甲状腺功能减退症（SCH）与糖尿病肾脏疾病（DKD）的相关性。方法：入选我科住院合并DKD的2型糖尿病患者404例，根据FT3、FT4、TSH分组，甲功正常组331例。SCH组73例，比较两组临床指标及相关并发症的差异，分析SCH与DKD的相关性。结果：与甲功正常组相比，SCH组肌酐高（P〈0．001），尿素氮高（P〈0．001），肾小球滤过率（eGFR）低（P〈0．001），差异均有统计学意义；两组相比，SCH组肾功能不全[eGFR〈60mL／（min·1．73m2）]比例显著高于甲功正常组（47．95％ vs.22．96％，P〈0．001）。将eGFR作为因变量，进行多因素Logistic回归分析．SCH是DKD患者肾功能不全的独立危险因素（OR：2．015，95％CI：1．090～3．723。P=0．025）。结论：DKD合并SCH患者肾脏损害较甲功正常患者严重，发生肾功能不全风险高；SCH可能是DKD患者肾功能不全的独立危险因素。

肾脏病理对2型糖尿病患者合并原发性肾脏病的诊治意义

目的探讨肾脏病理对2型糖尿病患者合并原发性肾脏病诊治的指导意义。方法我科2004年1月至2007年8月收治的49例合并肾脏损害行肾活检的2型糖尿病患者,回顾性分析其肾脏病理类型、临床表现及治疗情况。入选标准:糖尿病病程小于5年;无明显糖尿病视网膜病变;肾功能快速恶化;短期内出现大量蛋白尿;明显血尿;排除其他可能导致肾损害的继发性疾病者。根据其不同的病理类型进行治疗、观察其治疗结果。结果①49例患者中43例(87.76%)伴发不同病理类型的原发性肾脏病;②2型糖尿病伴原发性肾脏病患者相同的临床表现可有不同的肾脏病理类型;③根据患者不同病理类型及临床表现,在严格控制血糖基础上,予不同的激素和/或特殊免疫抑制剂治疗方案,患者多可得到有效缓解。结论通过肾活检明确肾脏病理类型对2型糖尿病患者原发性肾脏病的早期诊断及治疗方案的选择具有指导意义。

2型糖尿病合并非糖尿病肾病的临床及病理分析

目的:回顾性分析2型糖尿病合并非糖尿病肾病的临床表现及病理特征。方法:回顾性分析2004年1月～2009年12月临床疑为合并非糖尿病肾病的110例2型糖尿病患者的肾活检资料。根据肾活检结果分为单纯糖尿病肾病(DN)组和糖尿病肾病合并非糖尿病肾病(NDRD)组,并对临床和病理资料进行分析。结果:110例2型糖尿病肾病患者中,50例(45.5%)合并非糖尿病肾病。糖尿病肾病合并非糖尿病肾病组蛋白尿、血尿发生率高于单纯糖尿病肾病组,但糖尿病视网膜病变发生率低于单纯糖尿病肾病组。两组年龄、糖尿病病程、高血压、血肌酐和肾小球滤过率差异无统计学意义。所有合并的非糖尿病肾病中,IgA肾病的比率最高为34%,其他依次为膜性肾病22.0%,系膜增殖性肾小球肾炎14%,HBV相关性肾小球肾炎8.0%,微小病变型肾小球肾炎10%,高血压肾小球硬化4.0%,FSGS4.0%,新月体肾小球肾炎2.0%,狼疮性肾炎2.0%。结论:2型糖尿病肾病合并非糖尿病肾病发生率45.5%,IgA肾病最常见。血尿、蛋白尿同时缺乏糖尿病视网膜病变强烈提示合并非糖尿病肾病。对于临床表现不典型的患者,肾活检是一项排除糖尿病肾脏病变的重要手段。

老年男性原发性高血压患者收缩压水平降低对心脑血管事件的影响

目的探讨老年男性原发性高血压患者降压治疗后,收缩压(SBP)水平与心脑血管事件发生的关系。方法采用回顾性研究方法 ,将836例老年男性原发性高血压患者,按降压治疗后SBP水平分为7组:1组29例,SBP<110 mm Hg(1 mm Hg=0.133 kPa);2组71例,SBP 110～11 9 mm Hg;3组224例,SBP 120～1 29 mm Hg,4组290例,SBP 1 30～1 39 mm Hg,5组150例,SBP 140～149 mm Hg,6组45例,SBP 150～1 59 mm Hg,7组27例,SBP≥1 60 mm Hg;应用COX比例风险模型分析不同SBP水平对心脑血管事件的影响。结果与4组比较,6组和7组心脑血管事件发生相对风险分别增加了123%和251%(P<0.01);在校正传统危险因素后,与4组比较,1组、6组和7组心脑血管终点事件发生相对风险分别增加了118%、75%和148%(P<0.05),心脑血管事件发生与SBP水平呈"J型曲线"现象。结论老年原发性高血压患者SBP水平过高或过低,均显著增加心脑血管事件,SBP在130～139 mm Hg是老年男性高血压患者合适的目标血压范围。

复方丹参滴丸对2型糖尿病肾病Ⅲ～Ⅴ期患者肾功能的影响

目的:探讨复方丹参滴丸对2型糖尿病肾病Ⅲ~Ⅴ期的患者肾功能的影响。方法:2型糖尿病肾病Ⅲ~Ⅴ期患者在强化降糖、降压、降脂的基础上,随机分为对照组和试验组,比较干预前后两组患者糖化血红蛋白、尿微量白蛋白排泄率、尿素氮、血肌酐的变化。结果:治疗后两组患者糖化血红蛋白、尿素氮、肌酐、尿白蛋白排泄率数值均明显下降(P<0.05);试验组中2型糖尿病肾病Ⅴ期较Ⅳ期患者、Ⅳ期较Ⅲ期患者血尿素氮、血肌酐及尿微量白蛋白排泄率下降更明显(P<0.05)。结论:复方丹参滴丸对于改善2型糖尿病肾病患者的肾功能有显著作用,且对于2型糖尿病肾病Ⅲ~Ⅴ期患者分期越高改善越明显。

2型糖尿病合并肾损害177例临床病理分析

目的分析2型糖尿病（T2DM）合并肾损害的临床病理特点,探讨肾穿刺活检在诊断T2DM合并肾损害时的重要性。方法回顾性分析177例T2DM合并肾损害患者的临床资料及肾穿刺活检的病理资料。结果 177例2型糖尿病合并肾损害患者占同期全部肾穿刺活检患者的6.7%（177/2653）,其中女性56例,男性121例。患者年龄24-76岁,平均年龄53.4岁。病理诊断糖尿病肾病（DN）62例,非糖尿病肾病（NDRD）106例,DN合并NDRD 9例。62例DN中,I型DN 2例,IIa型5例,IIb型8例,Ⅲ型41例,Ⅳ型6例。106例NDRD中,Ig A肾病27例,膜性肾病24例,系膜增生性肾小球肾炎21例,高血压肾损伤7例,肾小管间质性炎6例,局灶节段性肾小球硬化症（FSGS）和局灶增生硬化性肾小球肾炎各5例,ANCA相关性血管炎性肾损伤4例,增生硬化性肾小球肾炎3例,淀粉样变性肾病、膜增生性肾小球肾炎、过敏性紫癜性肾炎和新月体性肾小球肾炎各1例。9例DN合并NDRD中,Ⅲ型DN＋Ig A肾病、IIa型DN＋膜性肾病和Ⅲ型DN＋局灶增生性肾小球肾炎各2例,Ⅲ型DN＋系膜增生性肾小球肾炎、Ⅲ型DN＋ANCA相关性血管炎性肾损伤和IIb型DN＋Ⅳ型狼疮性肾炎各1例。结论 T2DM合并肾损害可以是DN也可以是NDRD,还可以是DN合并NDRD,不同的病理类型在临床治疗和预后上有很大的差异。肾穿刺活检可以从组织学上明确诊断,为治疗和判断预后提供依据。

糖尿病肾病治疗研究

糖尿病肾病的治疗是综合的治疗过程。曾有过针对糖尿病肾病发病机制各个主要环节干预实验,虽然大多在动物实验中取得理想的效果,但在人类糖尿病肾病的验证中,大多未能实际应用。目前,临床上糖尿病肾病治疗主要包括早期诊断、理想的降血糖、降血压、血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂的应用、脂代谢异常的调节和低蛋白饮食等,当糖尿病肾病发展至终末期时血液透析和肾移植是主要有效治疗手段。

阿托伐他汀对冠心病伴糖尿病患者的肾脏保护作用的临床观察

目的研究阿托伐他汀对冠心病伴有糖尿病患者进行冠状动脉造影及介入治疗后的肾脏保护作用。方法选取60例冠脉造影及70例冠脉介入治疗的冠心病伴糖尿病肾损伤的患者分为两组,再随机分为常规剂量阿托伐他汀组和较大剂量阿托伐他汀组,分别检测患者术前、术后1天、术后2天、术后5天患者血浆CRP;血浆胱抑素C(Cys C);测Scr;测尿α1-微球蛋白(α1-MG)、尿转铁蛋白(TRF)和尿微量白蛋白(mALB),肾小球滤过率(eGFR)。结果两组患者中常规剂量阿托伐他汀组较较大剂量阿托伐他汀组CRP及Cys C水平升高,差异有统计学意义(P<0.01);尿微量白蛋白水平也明显升高,差异有统计学意义(P<0.01);Scr及eGFR水平则差异无统计学意义(P>0.05)。而介入治疗组中常规剂量阿托伐他汀组较较大剂量阿托伐他汀组较造影组患者CRP及Cys C水平升高,差异有统计学意义(P<0.01);尿微量白蛋白水平也明显升高,差异有统计学意义(P<0.01);Scr及eGFR水平则差异无统计学意义(P>0.05)。结论造影剂能造成冠心病伴糖尿病患者出现肾损伤,而较大剂量阿托伐他汀可有效预防造影剂对肾脏的损伤作用。

老年人糖尿病终末期肾病血液透析患者危险因素分析

目的 探讨影响老年糖尿病终末期肾病 (ESDN)血液透析患者生活质量及长期存活的各种危险因素 ,以期提高老年ESDN血液透析患者整体治疗水平。方法 对 2 3例老年 (≥ 6 0岁 )ESDN血液透析患者和同期透析 5 8例同龄非糖尿病终末期肾病 (NOR -ESDN)患者为对照组 ,回顾性分析了死亡原因、存活率、并发症、营养状态及血生化改变。结果 老年ESDN存活组 1年、3年存活率分别为 84 .0 %和 36 .0 %。主要并发症是心血管病变为 92 .0 %。主要死因是心血管病变 ( 5 2 .1% )。与NOR -ESDN组比较有显著差异。两组营养状态评估 (SGA)均差 ,但ESDN的血浆白蛋白明显低于NOR -ESDN患者。结论 老年ESDN并发症发生率及病死率均比NOR -ESDN患者高 ,存活率低。提高营养 。