Effect of sitagliptin combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in early diabetic nephropathy

BACKGROUND Early diabetic nephropathy(DN)is a complication of diabetes mellitus.It mainly affects kidney microvessels and glomerular function,and its timely and effective treatment is critical for early DN.However,the effects of treatments comprising simple Western medicine are not optimal.With the promotion and implementation of integrated Chinese and western medicine treatments,remarkable results have been achieved for many diseases.To this end,we explored the clinical efficacy of integrated traditional Chinese and western medicines for the treatment of early DN.AIM To investigate the effect of sitagliptin tablets combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in patients with early DN.METHODS Through a retrospective analysis,123 patients with early DN were admitted to the endocrinology clinic of the Changzhou NO.7 People’s Hospital from January 2021 to October 2022 and were selected as study subjects.After rigorous screening,100 patients with early DN were enrolled.The control group(CG,n=50)and the observation group(OG,n=50)were divided according to the treatment method.The CG were treated with sitagliptin,and the OG were treated with sitagliptin plus the Yiqi yangyin huoxue decoction.Both groups were treated for 3 mo.For both groups,the baseline data and clinical efficacy were compared,and changes in blood glucose levels,lipid levels,renal function,and hematological indicators before(T0)and after(T1)treatment were assessed.RESULTS The total effective rate for the OG was 94.00%and that of the CG was 80.00%(P<0.05).After treatment(T1),the levels of fasting blood glucose,2 h postprandial glucose,total cholesterol,triacylglycerol,and low-density lipoprotein cholesterol in OG patients were obviously lower than those in the CG(P<0.05),and cystatin C,homocysteine,urinary microalbumin,and blood creatinine values in OG patients were also obviously lower than those in the CG(P<0.05);erythrocyte deposition,plasma viscosity,whole blood high shear viscosity,and whole blood low shear viscosity were markedly lower in OG patients than in the CG(P<0.05).CONCLUSION Sitagliptin combined with Yiqi yangyin huoxue decoction has a remarkable effect when used to treat patients with early DN.Further,it is helpful in improving hemorheological indices and controlling disease progression.

Lipocalin-2 as a biomarker for diabetic nephropathy

Diabetes is a major global public health issue.The prevalence of type 1 diabetes is comparatively static,as hereditary and genetic causes are involved,while type 2 diabetes(T2D)prevalence is increasing day by day.T2D is associated with chronic complications,including diabetic neuropathy(DN),nephropathy,retinopathy,and other complications like diabetic foot.DN is the main complication of both types of diabetes.DN can be diagnosed by routine laboratory tests,microalbuminuria>300 mg/24 h,and a gradual decrease in glomerular filtration rate.As the appearance of microalbuminuria is a late manifestation,an early marker for renal damage is needed.Lipocalin-2,also known as neutrophil gelatinaseassociated lipocalin(NGAL),is a small protein purified from neutrophil granules and a good marker for kidney disease.NGAL is a transporter protein responsible for many physiological processes,such as inflammation,generation of the immune response,and metabolic homeostasis.NGAL has been reported to depict the early changes in renal damage when urine microalbumin is still undetecable.Therefore,elucidating the role of NGAL in detecting DN and understanding its mechanism can help establish it as a potential early marker for DN.

Knowledge Attitude and Practice of General Physicians for Early Detection of Diabetic Nephropathy in Cotonou

Introduction: General physicians can play an important role in the early detection of diabetic nephropathy (DN). Purpose: To assess the levels of general physicians’ knowledge, attitude and practice in terms of early detection of DN in Cotonou. Method: It was a cross-sectional, analytical and descriptive study which was conducted from 1st March 2015 to 30th September 2015. Every general physician working in a health structure in Cotonou who consented to participate in the study was included. We did not included medical specialists and general physicians working in nephrology department. Data were collected through a survey form designed with a score to assess the various items such as: knowledge, attitude and practice. The significance threshold is set to below 0.05. Results: In total, 202 general physicians were included. The average age was 30.9 ± 6.9 years ranging from 24 to 68 years. A male predominance was observed with 2.2 sex ratio. The majority of respondent medical physicians had poor knowledge in 76.2% cases, bad attitudes (61%) and bad practices (64.9%) in terms of early detection of diabetic nephropathy. There was positive impact of continuing medical training focused on diabetic nephropathy on attitudes (p = 0.016) and practices (p = 0.001) of these physicians. Conclusion: Diabetic nephropathy requires particular attention. General physicians’ continuous training is a principal solution.

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.

Protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms

Objective:To explore the protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms.Methods:A total of 50 patients with early diabetic nephropathy treated in our hospital between May 2012 and January 2016 were collected, and according to the random number table, the patients were divided into observation group (n=25) and control group (n=25). On the basis of conventional treatment, control group of patients received benazepril therapy, observation group of patients received calcium dobesilate combined with benazepril therapy, and the treatment lasted for 3 months. Before and after treatment, automatic biochemical analyzer was used to detect the levels of renal injury indexes in peripheral blood, RIA method was used to detect the levels of renal injury indexes in urine, ELISA method was used to detect the levels of renal fibrosis indexes and Western-blot method was used to detect the protein expression of TGF-β1/BMP-7 and Smad signaling pathway molecules in renal tissue. Results: Before treatment, differences in renal injury index levels, renal fibrosis index levels and signaling pathway molecule protein expression were not statistically significant between two groups of patients. After treatment, BUN, SCr andβ-TP levels in the peripheral blood as well as KIM-1 level in urine of observation group were lower than those of control group;renal fibrosis indexes TGF-β1, CTGF, TIMP-1, LN and HA levels in serum of observation group were lower than those of control group;TGF-β1 and Smad2/3 protein expression in renal tissue of observation group were lower than those of control group while Smad7 and BMP-7 protein expression were higher than those of control group.Conclusion: Calcium dobesilate combined with benazepril therapy can reduce the renal injury and inhibit the fibrosis process in patients with early diabetic nephropathy, and it achieves the above effect by regulating the TGF-β1/BMP-7 and Smad signaling pathway function.

Assessment of renal function and oxidative stress after alprostadil combined with valsartan treatment of early diabetic nephropathy

Objective:To analyze the renal function and oxidative stress after alprostadil combined with valsartan treatment of early diabetic nephropathy.Methods:A total of 230 patients with early diabetic nephropathy who were treated in our hospital between December 2011 and December 2015 were divided into control group (n=115) and observation group (n=115) according to random number table. Control group received valsartan treatment, observation group received alprostadil combined with valsartan treatment, and both lasted for one month. After treatment, renal blood flow parameters were evaluated by ultrasound contrast technique, renal function index levels in peripheral blood and urine were measured, and serum levels of oxidative stress indexes were detected.Results:After 1 month of treatment, area under curve (AUC) and time to peak (TTP) levels under ultrasound contrast of observation group were lower than those of control group while derived peak intensity (DPI) level was higher than that of control group;peripheral blood urea nitrogen (BUN) and serum creatinine (Scr) levels of observation group were lower than those of control group, albumin (Alb) level was higher than that of control group, and urine red blood cell (RBC) level was lower than that of control group;serum oxidative stress indexes malondialdehyde (MDA) and advanced oxidation protein products (AOPP) levels of observation group were lower than those of control group while superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) levels were higher than those of control group.Conclusion: Alprostadil combined with valsartan can optimize renal function and reduce systemic oxidative stress in patients with early diabetic nephropathy.

Evaluation of renal function and oxidative stress after adjuvant epalrestat treatment of early diabetic nephropathy

Objective:To explore the influence of adjuvant epalrestat treatment of early diabetic nephropathy on renal function and oxidative stress.Methods:A total of 80 patients with early diabetic nephropathy who were treated in our hospital between January 2013 and February 2016 were collected and divided into observation group and control group according to single-blind parallel control. Control group of patients received routine therapy, and observation group of patients received adjuvant epalrestat treatment on this basis. After 8 weeks of treatment, automatic biochemical analyzer was used to detect the renal function indexes of two groups of patients;RIA method was used to detect the serum renal fibrosis index levels;enzyme-linked immunosorbent assay (ELISA) was used to detect serum oxidative stress index levels.Results:Before treatment, differences in serum renal function, renal fibrosis and oxidative stress index levels were not statistically significant between two groups of patients;after 8 weeks of treatment, serum renal function indexes Scr, BUN, CysC andβ2-MG levels of observation group were lower than those of control group, renal fibrosis indexes CⅣ, CTGF and TGF-β1 levels were lower than those of control group, oxidation indexes ROS, LHP and AOPPs levels were lower than those of control group, anti-oxidation indexes SOD, VitE, VitC and T-AOC levels were significantly higher than those of control group, and the differences were statistically significant.Conclusion:Adjuvant epalrestat therapy can optimize the renal function and reduce the systemic oxidative stress response in patients with early diabetic nephropathy.

Assessment of the renal function, peroxidation damage and inflammatory injury after epalrestat combined with alprostadil treatment of early diabetic nephropathy

Objective:To study the renal function, peroxidation damage and inflammatory injury after epalrestat combined with alprostadil treatment of early diabetic nephropathy.Methods:90 patients with early diabetic nephropathy treated in our hospital between June 2011 and November 2015 were collected and divided into observation group and control group (n=45) according to the single-blind randomized control method. Observation group received epalrestat combined with alprostadil treatment, control group received alprostadil treatment alone, and the treatment of both groups lasted for 3 months. Before treatment and after 3 months of treatment, turbidimetric immunoassay was used to detect the renal function indexes in peripheral blood, rate method was used to detect the renal function indexes in urine, and ELISA method was used to detect the levels of peroxidation indexes and inflammation indexes.Results:Before treatment, differences in renal function, peroxidation damage and inflammatory damage indexes were not statistically significant between two groups of patients (P>0.05). After 3 months of treatment, creatinine (Scr), cystatin C (CysC),β2 microglobulin (β2-MG), N-acetyl-β-D-glucosaminidase (NAG), reactive oxygen species (ROS), advanced protein oxidation products (AOPPs), interleukin-8 (IL-8), interleukin-27 (IL-27) and procalcitonin (PCT) levels of observation group were lower than those of control group while catalase (CAT), total superoxide dismutase (TSOD), interleukin-4 (IL-4), interleukin-10 (IL-10) and interleukin-13 (IL-13) levels were higher than those of control group (P<0.05). Conclusions:Epalrestat combined with alprostadil can protect the renal function and inhibit the peroxidation damage and inflammatory injury in patients with early diabetic nephropathy.

Effects of Irbesartan combined Atorvastatin on serum levels of Cys C, Hcy, TNF-α, ET, TGF-b1 in patients with early diabetic nephropathyn

Objective: To observe the effects of Irbesartan combined with Atorvastatin on early diabetic nephropathy patients' serum Cys C, Hcy, TNF-α, ET and TGF-b1 levels. Methods: A total of 60 early diabetic nephropathy patients were randomly divided into observation group (30 cases) and control group (30 cases). Observation group: Irbesartan combined with Atorvastatin;control group: patients were treated only by Irbesartan. Recording and comparing the levels of Cys C, Hcy, TNF-α, ET and TGF-b1 before and after treatment. Results: (1) Before treatment, there was no statistically significant difference in the serum FBG, TG, Scr, BUN levels between the two groups. After treatment, compared with the same group before treatment, the serum TG, Scr, BUN levels of the two groups were significantly lower, and those levels of observation group were significantly better than the control group, the difference between two groups was statistically significant;(2) Before treatment, there was no statistically significant difference in the serum Cys C, Hcy, TNF-α, ET, TGF-b1 levels between the two groups. After treatment, compared with the same group before treatment, the serum Cys C, Hcy, TNF-α, ET, TGF-b1 levels of the two groups were significantly lower, and those levels of observation group were significantly better than the control group, the difference between two groups was statistically significant. Conclusion: Irbesartan combined with Atorvastatin for early diabetic nephropathy patients can reduce the levels of serum Cys C, Hcy, TNF-α, ET, TGF-b1 and be beneficial to protect their nephritic function.

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.

外周血单核细胞DNMT1及血清IL-6在糖尿病肾脏病中的表达及意义

目的 探讨外周血单核细胞DNA甲基化转移酶1(DNMT1)及血清白介素-6(IL-6)在糖尿病肾脏病(DKD)中的表达及临床意义。方法 选取150例DKD患者(DKD组)及50例同期健康体检者(对照组)。比较2组IL-6、DNMT1、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血肌酐、空腹血糖、肾小球滤过率估计值(e GFR)、24 h尿白蛋白排泄率(24 h UAER)的差异。Pearson相关分析IL-6、DNMT1与其他临床指标的相关性。多因素Logistic回归分析DKD发生的影响因素。受试者工作特征(ROC)曲线分析24 h UAER、IL-6、DNMT1及联合检测对DKD的诊断价值。结果 与对照组比较,DKD组的空腹血糖、IL-6、DNMT1、血肌酐、24 h UAER、LDL-C、糖化血红蛋白水平升高,而eGFR、HDL-C水平降低(均P<0.05)。DKD组的IL-6与DNMT1呈正相关(r=0.560,P<0.05);且IL-6、DNMT1与24 h UAER呈正相关(r分别为0.551和0.570,P<0.05)。24 h UAER、IL-6及DNMT1升高是影响DKD发生的独立危险因素(P<0.05)。24 h UAER、IL-6、DNMT1联合检测诊断DKD的曲线下面积优于单一指标检测。结论 DKD患者DNMT1、IL-6水平升高,24 h UAER、DNMT1、IL-6联合检测可作为临床诊断DKD的良好指标。

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.

糖尿病肾病(DN)诊断中早期生化检验的应用价值分析

目的探讨糖尿病肾病(diabetic nephropathy,DN)诊断中早期生化检验的应用价值。方法选取2021年6月—2022年6月在福建省龙岩市第一医院接受治疗的60例糖尿病肾病(DN)患者为观察组。再选取同期于本院接受体检的50例糖尿病患者为对照组。所有研究对象均接受生化检验,对比两组受检者的尿清蛋白/肌酐、糖化血红蛋白、血清胱抑素C、α1-微球蛋白、血清C-反应蛋白水平,对比两组受检者的上述指标的阳性率以及水平差异。结果观察组尿清蛋白/肌酐、糖化血红蛋白、血清胱抑素C、α1-微球蛋白、血清C-反应蛋白测定结果阳性率显著高于对照组,差异有统计学意义(P<0.05)。观察组尿清蛋白/肌酐、糖化血红蛋白、血清胱抑素C、α1-微球蛋白、血清中C-反应蛋白水平显著高于对照组,差异有统计学意义(P<0.05)。结论在DN诊断中早期生化检验具有较高的临床价值,能够为患者的临床治疗提供有价值的参考依据。

益气化瘀汤联合羟苯磺酸钙治疗糖尿病肾病气虚血瘀证的疗效及对VEGF,IGF-1表达水平的影响研究

【目的】观察益气化瘀汤(由黄芪、山药、茯苓、炒芡实、旱莲草、金樱子、焦山楂、女贞子、丹参、益母草等组成)联合羟苯磺酸钙治疗糖尿病肾病(DN)气虚血瘀证的临床疗效及对血管内皮生长因子(VEGF)、胰岛素样生长因子1(IGF-1)的影响。【方法】将90例DN气虚血瘀证患者随机分为观察组和对照组,每组各45例。所有患者均接受基础降糖治疗和控制血压、调节脂代谢紊乱等治疗。在此基础上,对照组患者给予羟苯磺酸钙治疗,观察组患者在对照组的基础上联合益气化瘀汤治疗,疗程为3个月。观察2组患者治疗前后中医证候积分、肾功能指标及血清VEGF、IGF-1水平的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面,治疗3个月后,观察组的总有效率为91.11%(41/45),对照组为75.56%(34/45),组间比较(χ2检验),观察组的疗效明显优于对照组(P<0.05)。(2)中医证候积分方面,治疗1个月和3个月后,2组患者的中医证候积分均较治疗前明显降低(P<0.05),且治疗3个月后又均较治疗1个月后明显降低(P<0.05);组间比较,观察组在治疗1个月和3个月后对中医证候积分的降低作用均明显优于对照组(P<0.01)。(3)肾功能指标方面,治疗后,2组患者的血肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(GFR)等肾功能指标均较治疗前明显改善(P<0.05),且观察组对各项肾功能指标的改善作用均明显优于对照组(P<0.01)。(4)血清VEGF、IGF-1水平方面,治疗后,2组患者的血清VEGF、IGF-1水平均较治疗前明显降低(P<0.05),且观察组对血清VEGF、IGF-1水平的降低作用均明显优于对照组(P<0.01)。(5)治疗过程中,2组患者均无明显不良反应发生,具有较高的安全性。【结论】益气化瘀汤联合羟苯磺酸钙治疗DN气虚血瘀证患者疗效确切,可有效下调血清VEGF、IGF-1水平,明显改善患者肾功能,显著减轻患者临床症状,且具有较高的安全性。

替米沙坦联合阿托伐他汀治疗老年早期DN患者的近远期疗效及对C反应蛋白、cysC的影响

目的:探讨替米沙坦联合阿托伐他汀治疗老年早期糖尿病肾病(Diabetic nephropathy, DN)患者的近远期疗效及对C反应蛋白(C-reactive protein, CRP)、胱抑素C(Cystatin C,Cysc)的影响。方法:2020年08月-2022年08月间在本院接受治疗的老年早期DN患者138例,参照随机数表法将其分为对照组(n=69)、观察组(n=69)。对照组予阿托伐他汀治疗,并予胰岛素控制血糖等常规治疗;观察组在对照组治疗基础上加用替米沙坦。持续治疗3月后评估近期疗效及血清CRP、cysC水平变化,治疗后随访半年并记录DN进展情况。结果:持续治疗3月后,对照组、观察组患者的疗效分级差异有统计学意义(P<0.05)。观察组患者的治疗总有效率较对照组患者高(P<0.05);观察组患者的血清CRP、cysC水平较对照组患者低(P<0.05)。治疗3月内,对照组、观察组患者的新发药物相关不良反应发生情况差异无统计学意义(P>0.05)。治疗后随访半年,观察组患者的DN进展率较对照组患者低(P<0.05)。结论:替米沙坦联合阿托伐他汀治疗老年早期DN患者近远期疗效均较为理想,可显著降低CRP、cysC水平,用药安全性可靠。

益肾别浊丸对糖尿病早期肾病患者血清Periostin水平及尿ACR的影响

目的:观察益肾别浊丸对糖尿病早期肾病患者血清Periostin水平及尿ACR的影响。方法:将180例患者随机分为A、B、C三组,在给予基础治疗的同时,A组加益肾别浊丸10 g,3次/d,B组加缬沙坦胶囊80 mg,1次/d,C组患者加中药益肾别浊丸联合缬沙坦胶囊。于治疗前、治疗1个月及治疗3个月时记录3组患者中医证候积分及临床生化指标。结果:各组患者治疗3个月后较治疗前,症状积分、血脂、尿ACR及血清Periostin水平均有较为明显改善(P<0.05),其中A、C组患者在治疗1个月时部分症状、尿ACR及血清Periostin水平改善较B组更为明显(P<0.05)。结论:益肾别浊丸可改善糖尿病早期肾病临床症状,明显降低患者尿ACR及血清Periostin水平。

脂肪酸结合蛋白4在2型糖尿病肾病中的诊断价值

目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清脂肪酸结合蛋白4(fatty acid-binding protein 4,FABP4)与糖尿病肾病(diabetic nephropathy,DN)的相关性及其作为DN早期诊断的应用价值。方法:纳入T2DM患者218例及健康体检者(对照组)20名,收集受试者的一般临床资料如身高、体质量、腰围、糖尿病病程等,计算BMI;收集血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、肝肾功能、血脂等指标,计算稳态模型胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR)。采用ELISA测定血清FABP4水平;采用联合血肌酐(serum creatinine,Scr)和胱抑素C(cystatin C,Cys C)的慢性肾脏病流行病学协作方程式计算肾小球滤过率;测定尿白蛋白和肌酐水平,计算尿微量蛋白与肌酐比值(urinary albumin to creatinine ratio,UACR)。根据估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)水平将T2DM患者分为肾功能正常组(eGFR≥90 mL/min/1.73 m^(2))、轻度肾功能不全组(eGFR 60~<90 mL/min/1.73 m^(2))和中度肾功能不全组(eGFR 30~<60 mL/min/1.73 m^(2));根据UACR水平分为正常蛋白尿组(UACR<30 mg/g)、微量蛋白尿组(UACR 30~<300 mg/g)和大量蛋白尿组(UACR≥300 mg/g)。采用回归分析评估FABP4与eGFR、UACR严重程度的相关性。结果:(1)与对照组相比,T2DM患者的血清FABP4显著升高。(2)在根据eGFR分层的3个亚组中,随着eGFR的下降,血清FABP4水平显著增加(P<0.001)。但在UACR亚组中差异无统计学意义(P=0.382)。(3)Spearman相关分析显示FABP4与eGFR呈负相关(r=-0.203,P=0.001),与UACR无相关性(r=0.130,P=0.055)。(4)多元线性回归表明,FABP4与eGFR呈独立负相关(r=-0.211,P<0.001),与UACR无相关性(r=-0.047,P=0.534)。(5)ROC曲线显示FABP4诊断DN的最佳截断值为103.9μg/L,AUC为0.745(灵敏度51.2%,特异度92.7%)。结论:T2DM患者血清FABP4水平升高与DN发生发展相关,有可能作为DN早期诊断的生物标志物。

依帕司他治疗早期2型糖尿病肾病临床观察

目的探讨依帕司他治疗早期2型糖尿病肾病的临床疗效。方法选取医院2021年5月至2023年5月收治的糖尿病肾病患者64例,随机分为对照组和观察组,各32例。两组患者均予常规综合治疗,观察组患者加服依帕司他片,两组均持续治疗12周。结果与对照组比较,观察组患者治疗后的糖化血红蛋白、空腹血糖、餐后2小时血糖水平均显著降低(P<0.05),尿量显著增加,尿蛋白和尿素氮水平均显著降低(P<0.05)。两组不良反应发生率无显著差异(P>0.05)。结论依帕司他治疗早期2型糖尿病肾病,能提高血糖控制效果,促进患者的肾功能恢复。

达格列净联合利格列汀治疗2型糖尿病合并早期糖尿病肾病的临床疗效研究

目的探讨达格列净联用利格列汀在2型糖尿病合并早期糖尿病肾病中的临床治疗效果。方法选取2021年4月—2023年4月新会区人民医院收治的76例2型糖尿病合并早期糖尿病肾病患者为研究对象,根据治疗方法的不同分为两组,观察组(39例)应用达格列净联合利格列汀治疗,对照组(37例)应用格列齐特缓释片+盐酸二甲双胍缓释片治疗,治疗3个月后比较两组患者的空腹血糖、糖化血红蛋白、血肌酐、24 h尿微量白蛋白、肾小球滤过率及不良反应发生情况。结果治疗后,两组空腹血糖及糖化血红蛋白水平均低于治疗前,差异有统计学意义(P均<0.05)。治疗后,对照组空腹血糖水平低于观察组,差异有统计学意义(P<0.05)。对照组治疗后24 h尿微量白蛋白、血肌酐及肾小球滤过率与治疗前比较,差异无统计学意义(P均>0.05);而观察组治疗后24 h尿微量白蛋白较治疗前减少,血肌酐较治疗前下降,肾小球滤过率较治疗前升高,差异有统计学意义(P均<0.05)。两组患者均未发生严重不良反应。结论达格列净联用利格列汀2型糖尿病合并早期糖尿病肾病的治疗中既能良好控制血糖,也能使尿蛋白减少、改善肾功能。

尿ACR、CN1在早期糖尿病肾病诊断中的价值

目的探讨尿ACR、CN1诊断早期糖尿病肾病(DN)的价值。方法选取90例DN患者为观察组,90例健康人为对照组,比较两组的尿ACR、CN1以及肾功能指标,分析尿ACR、CN1与DN患者肾功能指标的相关性以及对DN的诊断价值。结果观察组的尿ACR、CN1及血清Scr、BUN、AA、CysC水平高于对照组(P<0.05)。尿ACR、CN1与Scr、BUN、AA、Cys C均呈正相关(P<0.05)。尿ACR、CN1联合检测诊断DN的AUC高于ACR、CN1单独检测(P<0.05)。结论尿ACR、CN1在早期DN患者中表达升高并与患者肾功能指标存在相关性,联合检测二者可提高对早期DN的诊断价值。