Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in applica...Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.展开更多
Glomerular filtration rate （GFR） is considered as the best marker of kidney function. Evaluation of various prediction equations to estimate GFR is rare in our population. The aim of this study was to compare GFR es...Glomerular filtration rate （GFR） is considered as the best marker of kidney function. Evaluation of various prediction equations to estimate GFR is rare in our population. The aim of this study was to compare GFR estimated by various prediction equations with GFR by creatinine clearance （GFRer） in Bangladeshi population. Serum creatinine and 24 hours urinary creatinine concentrations were measured in 216 adult Bangladeshi subjects （100 males and 116 females）. Creatinine clearance rate was calculated and adjusted for body surface area to obtain GFRcr. GFR was also calculated by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations and compared with GFRcr. Results were expressed as mean ＋ SD and compared by two-tailed paired t-test, precision （r2） and receiver-operating characteristic curve. Mean ± SD of age of the total subjects was 57.15 ±10.96 years. The mean GFILzr was 42.41 ± 22.95 mL/min/1.73m2. Estimated GFR （eGFR） by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffc 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations were 8.19 ± 13.80, 5.30 ±13.61, 11.54 ± 16.86, 8.66± 18.64, 17.25 ± 19.98, 10.86 ± 22.48, 14.60 ± 17.92, 12.18 ± 16.42, 39.86 ± 21.96 and 20.47 ± 20.49 mL/min/1.73m2 higher than GFR, （P 〈 0.001）. The precision （r2） of eGFRs were 0.7114, 0.6924, 0.6431, 0.4802, 0.5048, 0.5921, 0.6286, 0.6158, 0.1635, and 0.5586 for CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations, respectively. The area under receiver-operating characteristic curve was the lowest for MDRD4 equation. This study revealed that GFR estimated by standardized MDRD4 variables equation is closer to creatinine clearance rate in the study population.展开更多
目的分析尿素氮与肌酐比值(UCR)与血乳酸清除率(LCR)预测老年重症肺炎患者死亡风险的价值。方法选择南京鼓楼医院来安分院2018年5月至2022年3月呼吸重症监护室(RICU)收治的老年重症肺炎患者83例,收集患者临床资料,根据患者入院28 d的预...目的分析尿素氮与肌酐比值(UCR)与血乳酸清除率(LCR)预测老年重症肺炎患者死亡风险的价值。方法选择南京鼓楼医院来安分院2018年5月至2022年3月呼吸重症监护室(RICU)收治的老年重症肺炎患者83例,收集患者临床资料,根据患者入院28 d的预后情况分为生存组(n=22)与死亡组(n=61)。分析老年重症肺炎患者死亡的危险因素,以及入院6 h UCR、LCR和二者联合对老年重症肺炎患者死亡风险的预测价值。结果死亡组入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、年龄、入院时肺炎严重指数(PSI)分级>3级病例数占比、入院6 h超敏C反应蛋白(hs-CRP)、中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)、白细胞(WBC)计数和UCR高于生存组(P<0.05),入院6 h LCR低于生存组(P<0.05)。入院时PSI分级>3级、入院6 h UCR升高、LCR降低为老年重症肺炎患者死亡的危险因素(P<0.05)。入院后6 h UCR与LCR及二者联合预测老年重症肺炎患者死亡风险的曲线下面积(AUC)分别为0.715、0.701和0.805(P<0.05)。结论入院时PSI分级>3级、入院6 h UCR升高、LCR降低是老年重症肺炎患者死亡的影响因素;入院6 h UCR与LCR可用于预测老年重症肺炎患者的死亡风险,二者联合对于老年重症肺炎患者的死亡风险预测价值更高。展开更多
The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity...The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.展开更多
AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatecto...AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were calculated.Abnormal values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 m2.The maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were compared.RESULTS:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal eGFR5.Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.展开更多
目的探讨益气养阴通络方联合羟苯磺酸钙对糖尿病肾病(气阴两虚血瘀证)疗效的影响。方法选取120例糖尿病肾病(气阴两虚血瘀证)患者为研究对象,随机分为对照组(60例)和观察组(60例),其中对照组给予羟苯磺酸钙治疗,观察组给予益气养阴通络...目的探讨益气养阴通络方联合羟苯磺酸钙对糖尿病肾病(气阴两虚血瘀证)疗效的影响。方法选取120例糖尿病肾病(气阴两虚血瘀证)患者为研究对象,随机分为对照组(60例)和观察组(60例),其中对照组给予羟苯磺酸钙治疗,观察组给予益气养阴通络方联合羟苯磺酸钙治疗。比较2组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 h PGB)水平;利用自动生化分析仪检测治疗前后总胆固醇(TC)、甘油三酯(TG)水平;采用免疫比浊法测定血尿素氮(BUN)和血清肌酐(Scr)水平;采集患者治疗前后24 h尿液,利用苦味酸法检测24 h尿蛋白定量(24 h Upro)水平;采用酶联免疫吸附试剂盒检测血清血管内皮生长因子(VEGF)、内皮素(ET-1)及一氧化氮(NO)水平。结果观察组治疗总有效率为91.67%,高于对照组的70.00%,差异有统计学意义(P<0.05)。2组治疗后FBG、2 h PGB、TC、TG水平较治疗前下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后BUN、Scr及24 h Upro水平较治疗前均下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05);2组治疗后肌酐清除率(Ccr)水平相较于治疗升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后血液流变学指标水平较治疗前均下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后ET-1水平较治疗前下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05);2组治疗后VEGF、NO水平较治疗前升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。结论益气养阴通络方联合羟苯磺酸钙治疗糖尿病肾病可有效调节糖脂代谢,改善肾功能、血液流变学指标水平及血管内皮功能。展开更多
文摘Objective:Chemotherapy drugs such as platinum may cause damage to the renal function,creatinine clearance(Ccr),as a "golden standard" indicator in clinical evaluation of renal function,was limited in application due to complicated detection steps.By detecting the expression of serum Cystatin C(Cys C),Ccr and urinary micro-albumin(UMA),this study was designed to analyze and discuss their roles and status in renal function evaluation for cancer patients before and after chemotherapy with platinum.Methods:We retrospectively reviewed 110 patients who receiving platinum-containing protocols or non-platinum-containing ones,and got the expression of Cys C,Ccr(was calculated by Cockcroft-Gault equation) and UMA,then analyzed whether there were differences for Cys C,Ccr and UMA in those patients;for patients with mildly impaired renal function(Ccr between 50-75 mL/min),whether there were differences for Cys C and UMA before and after chemotherapy with platinum.Results:There was statistical significance for Ccr,Cys C and UMA in patients who receiving platinum-containing protocols(85.01 ± 28.40) vs(76.79 ± 26.63) mL/min,(1.49 ± 0.50) vs(1.80 ± 0.84) mg/L and(14.30 ± 9.15) vs(16.90 ± 10.95) mg/L,P = 0.00,0.00 and 0.01),and no statistical significance for those receiving non-platinum-containing ones(89.45 ± 29.69) vs(86.78 ± 27.96) mL/min,(1.51 ± 0.78) vs(1.63 ± 0.73)mg/L and(17.31 ± 10.46) vs(16.59 ± 8.33) mg/L,P = 0.45,0.07 and 0.57);and there were also significant differences for Cys C for patients with mildly impaired renal function before and after chemotherapy(1.68 ± 0.55) vs(2.04 ± 0.68) mg/L,P = 0.03),while no statistical significance for UMA for the same ones(21.11 ± 10.06) vs(21.22 ± 8.81) mg/L,P = 0.93).There were statistical significance both for Cys C and UMA before and after chemotherapy in platinum-containing group,but the AUC for Ccr and Cys C is greater than that for UMA(P < 0.02).Conclusion:Cys C and UMA can both access renal dysfunction early after chemotherapy,but Cys C is more sensitive than UMA in reflecting early renal dysfunction,so Cys C can replace Ccr and become a reliable indicator in the assessment of renal function for cancer patients before and after chemotherapy especially with platinum.
文摘Glomerular filtration rate （GFR） is considered as the best marker of kidney function. Evaluation of various prediction equations to estimate GFR is rare in our population. The aim of this study was to compare GFR estimated by various prediction equations with GFR by creatinine clearance （GFRer） in Bangladeshi population. Serum creatinine and 24 hours urinary creatinine concentrations were measured in 216 adult Bangladeshi subjects （100 males and 116 females）. Creatinine clearance rate was calculated and adjusted for body surface area to obtain GFRcr. GFR was also calculated by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations and compared with GFRcr. Results were expressed as mean ＋ SD and compared by two-tailed paired t-test, precision （r2） and receiver-operating characteristic curve. Mean ± SD of age of the total subjects was 57.15 ±10.96 years. The mean GFILzr was 42.41 ± 22.95 mL/min/1.73m2. Estimated GFR （eGFR） by CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffc 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations were 8.19 ± 13.80, 5.30 ±13.61, 11.54 ± 16.86, 8.66± 18.64, 17.25 ± 19.98, 10.86 ± 22.48, 14.60 ± 17.92, 12.18 ± 16.42, 39.86 ± 21.96 and 20.47 ± 20.49 mL/min/1.73m2 higher than GFR, （P 〈 0.001）. The precision （r2） of eGFRs were 0.7114, 0.6924, 0.6431, 0.4802, 0.5048, 0.5921, 0.6286, 0.6158, 0.1635, and 0.5586 for CKD-EPI, MDRD4, Cockcroft-Gault, Jelliffe 1, Jelliffe 2, Mawer, Bjornsson, Gates, Apollo-Chennai and Mayo Clinic prediction equations, respectively. The area under receiver-operating characteristic curve was the lowest for MDRD4 equation. This study revealed that GFR estimated by standardized MDRD4 variables equation is closer to creatinine clearance rate in the study population.
文摘目的分析尿素氮与肌酐比值(UCR)与血乳酸清除率(LCR)预测老年重症肺炎患者死亡风险的价值。方法选择南京鼓楼医院来安分院2018年5月至2022年3月呼吸重症监护室(RICU)收治的老年重症肺炎患者83例,收集患者临床资料,根据患者入院28 d的预后情况分为生存组(n=22)与死亡组(n=61)。分析老年重症肺炎患者死亡的危险因素,以及入院6 h UCR、LCR和二者联合对老年重症肺炎患者死亡风险的预测价值。结果死亡组入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、年龄、入院时肺炎严重指数(PSI)分级>3级病例数占比、入院6 h超敏C反应蛋白(hs-CRP)、中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)、白细胞(WBC)计数和UCR高于生存组(P<0.05),入院6 h LCR低于生存组(P<0.05)。入院时PSI分级>3级、入院6 h UCR升高、LCR降低为老年重症肺炎患者死亡的危险因素(P<0.05)。入院后6 h UCR与LCR及二者联合预测老年重症肺炎患者死亡风险的曲线下面积(AUC)分别为0.715、0.701和0.805(P<0.05)。结论入院时PSI分级>3级、入院6 h UCR升高、LCR降低是老年重症肺炎患者死亡的影响因素;入院6 h UCR与LCR可用于预测老年重症肺炎患者的死亡风险,二者联合对于老年重症肺炎患者的死亡风险预测价值更高。
基金the Research Service of the Raymond G. Murphy VA Medical Center for its support of this work
文摘The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.
文摘AIM:To compare creatinine clearance(Ccr) with estimated glomerular filtration rate(eGFR) in preoperative renal function tests in patients undergoing hepatectomy.METHODS:The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied,and preoperative Ccr,a three-variable equation for eGFR(eGFR3) and a five-variable equation for eGFR(eGFR5) were calculated.Abnormal values were defined as Ccr < 50 mL/min,eGFR3 and eGFR5 < 60 mL/min per 1.73 m2.The maximum increases in the postoperative serum creatinine(post Cr) level and postoperative rate of increase in the serum Cr level(post Cr rate) were compared.RESULTS:There were 37 patients(18.8%) with abnormal Ccr,31(15.7%) with abnormal eGFR3,and 40(20.3%) with abnormal eGFR5.Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr,eGFR3 and eGFR5 values,the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients(P < 0.0001).Post Cr level tended to be higher in patients with Ccr abnormality(P = 0.0936 and P = 0.0875,respectively).CONCLUSION:eGFR5 and the simpler eGFR3,rather than Ccr,are recommended as a preoperative renal function test in patients undergoing hepatectomy.
文摘目的探讨益气养阴通络方联合羟苯磺酸钙对糖尿病肾病(气阴两虚血瘀证)疗效的影响。方法选取120例糖尿病肾病(气阴两虚血瘀证)患者为研究对象,随机分为对照组(60例)和观察组(60例),其中对照组给予羟苯磺酸钙治疗,观察组给予益气养阴通络方联合羟苯磺酸钙治疗。比较2组患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 h PGB)水平;利用自动生化分析仪检测治疗前后总胆固醇(TC)、甘油三酯(TG)水平;采用免疫比浊法测定血尿素氮(BUN)和血清肌酐(Scr)水平;采集患者治疗前后24 h尿液,利用苦味酸法检测24 h尿蛋白定量(24 h Upro)水平;采用酶联免疫吸附试剂盒检测血清血管内皮生长因子(VEGF)、内皮素(ET-1)及一氧化氮(NO)水平。结果观察组治疗总有效率为91.67%,高于对照组的70.00%,差异有统计学意义(P<0.05)。2组治疗后FBG、2 h PGB、TC、TG水平较治疗前下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后BUN、Scr及24 h Upro水平较治疗前均下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05);2组治疗后肌酐清除率(Ccr)水平相较于治疗升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后血液流变学指标水平较治疗前均下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05)。2组治疗后ET-1水平较治疗前下降,且观察组下降幅度大于对照组,差异有统计学意义(P<0.05);2组治疗后VEGF、NO水平较治疗前升高,且观察组升高幅度大于对照组,差异有统计学意义(P<0.05)。结论益气养阴通络方联合羟苯磺酸钙治疗糖尿病肾病可有效调节糖脂代谢,改善肾功能、血液流变学指标水平及血管内皮功能。
