肾小管损伤因子在糖尿病高滤过患者中的水平变化

目的探讨肾小管损伤因子与2型糖尿病（T2DM）肾小球高滤过（GHF）的关系。方法以基于光抑素C（CysC）的Macisaac方程式估算肾小球滤过率（eGFR）,筛选T2DM患者高滤过组30例及正常滤过组58例,并设健康对照组24例。常规方法测定肌酐、CysC、血糖、糖化血红蛋白等含量,EEISA及比浊法分别检测肾小管损伤因子NGAL、KIM-1、NAG等的水平。多因素分析各指标与高滤过组eGFR的相关性。结果高滤过组尿液NGAL、KIM-1水平均显著高于其他两组,而血浆NGAL含量却显著降低（均P〈0．05）,尿液NAG水平在三组中差异无统计学意义。相关分析显示高滤过组eGFR与空腹血糖（r=0．250）、糖化血红蛋白（r=0．237）、尿液NGAL（r=0．388）,KIM-1（r=-0．470）等成正相关,与血浆NGAL（r=-0．159）成负相关。结论尿液肾小管损伤因子在DM高滤过组的高水平表达,说明GHF可能直接导致肾小管早期损伤。     

尿微量白蛋白检测对糖尿病、高血压早期肾损伤的诊断意义

目的 测定糖尿病、高血压患者尿微量白蛋白，探讨其对早期肾损伤的诊断意义及临床疗效监控作用。方法 采用速率散射比浊法，测定糖尿病、高血压患者及健康对照组尿微量白蛋白(MA)，同时联合测定α1-微球蛋白(α1-M)、β2-微球蛋白(β2-M)和免疫球蛋白(IgG)。对检测结果进行统计，分析。结果糖尿病组尿MA、α1-M、β2-M、IgG及尿常规蛋白定性阳性检出率、测定值都明显高于对照组，差异非常显著(P＜0.01)，且随病程增加，尿MA测定值及阳性检出率不断增高。高血压组、尿MA、α1-M、β2-M、IgG及尿常规蛋白定性阳性率、测定值亦显著高于对照组(P＜0.01)，差异有统计学意义。结论 尿微量白蛋白联合其他几种微量蛋白检测，对早期发现糖尿病、高血压病肾损伤有诊断价值，尤其对尿蛋白定性阴性的早期肾损伤有重要的临床意义。     

联合检测D-二聚体、纤维蛋白原和C反应蛋白对糖尿病肾病的临床价值

目的联合检测D-二聚体、纤维蛋白原和C反应蛋白水平,探讨其对DN的早期临床应用价值。方法对经确诊的糖尿病患者137例,按u MA的排泄率和SCr水平分为糖尿病无肾病组(A组)、DN初期组(B组)、u MA临床DN组(C组)、氮质血症组(D组),分别检测DD、FIB、CRP、u MA水平并和对照组比较。结果 4组DD、FIB、CRP与对照组比较,P<0.01,u MA除糖尿病无肾病组(A组)P>0.05外,其他三组P<0.01;四组DD、FIB、CRP、u MA间两两比较,P<0.01;联合检测DD、FIB、CRP三项指标对DN的检出阳性率除D组外均显著高于各单项检测(P<0.05);各组DD、FIB、CRP指标与u MA均呈现正相关,其相关系数分别为0.807、0.641和0.864,P<0.01。结论 DD、FIB和CRP水平的检测特别是三者联合检测可明显提高DM早期肾损害的检出率,对DN的早期预防、诊断和治疗具有临床应用价值。     

血清脂联素水平与2型糖尿病患者胰岛β细胞功能的相关性

目的 探讨血清脂联素(APN)与2型糖尿病(T2DM)胰岛β细胞功能的相关性.方法 采用ELISA法检测T2DM(DM组,86例)及正常对照组(NC组,30例)血清APN水平.同时进行75 g口服葡萄糖耐量试验,运用HOMA模型评价稳态时胰岛素抵抗指数(HOMA-IR)、胰岛β细胞分泌功能指数(HOMA-β),采用糖负荷状态下30 min净增胰岛素与葡萄糖的比值反映早相胰岛素分泌指数(ΔI30/ΔG30)、180 min胰岛素曲线下面积反映第二时相胰岛素分泌指数(AUC-I).结果 DM组APN水平明显低于NC组(P<0.05);DM组HOMA-β、ΔI30/ΔG30与APN正相关(r=0.222、0.507,P<0.05),HOMA-IR、AUC-I与APN呈负相关(r=-0.366、-0.258,P<0.05).结论 DM患者血清APN与胰岛素抵抗、早相胰岛素分泌指数显著相关;提高APN可能是改善患者胰岛β细胞功能的靶点.     

血清胱抑素C、血清肌酐和尿β_2-微球蛋白检测对高尿酸血症肾损害早期诊断的临床观察

目的对血清胱抑素C、血清肌酐和尿β2-微球蛋白检测在高尿酸血症肾损害早期诊断中的应用价值进行分析。方法以我院2014年1月~2015年7月收治的63例高尿酸血症肾损害患者作为观察组,以同期在我院进行健康体检的50例志愿者作为对照组,对比两组研究对象的血清胱抑素C、血清肌酐和尿β2-微球蛋白的检测结果。结果观察组的血清胱抑素C、血清肌酐和尿β2-微球蛋白指标显著高于对照组,差异具有统计学意义(P<0.05)。两组研究对象的BMI不具有统计学差异(P>0.05)。观察组患者血清胱抑素C与尿β2-微球蛋白指标之间呈正相关关系(r=0.923,P<0.01);血清胱抑素C与血清肌酐指标之间呈显著正相关关系(r=0.691,P<0.05)。结论血清胱抑素C、血清肌酐和尿β2-微球蛋白检测为高尿酸血症肾损害的有效诊断指标,可为该病的早期诊断及治疗提供可靠参考依据。     

血清维生素A与儿童1型糖尿病的相关性探讨

目的 初步探讨血清维生素A水平与儿童1型糖尿病(T1DM)关系,了解糖化血红蛋白(HbAlc)、血清空腹C-肽与血清维生素A的相关性.方法 选取32例T1DM患儿为T1DM组,28例健康体检儿童为对照组,用微量荧光方法 检测两组血清维生素A水平,用化学发光法、激光散射比浊法分别测定32例T1DM患儿血清C-肽、HbAlc.结果 T1DM组血清维生素A水平明显低于对照组(P<0.01);T1DM组血清维生素A水平与空腹血清C-肽水平呈正相关(r:0.356,P<0.05),与HbAlc呈负相关(r=-0.394,P<0.05).结论 T1DM患儿体内存在维生素A缺乏,维生素A水平低下可能与T1DM的发生有关.     

肝素对过敏性紫癜早期肾损伤患儿EGF、MA、β2-MG的影响

目的 探讨肝素对过敏性紫癜(HSP)早期肾损伤患儿尿表皮生长因子(EGF)、尿微量白蛋白(MA)及β2-微球蛋白(β2-MG)的影响,探讨肝素对肾脏的保护作用.方法 用酶联免疫吸附双抗体夹心法(ABC-ELISA)检测EGF,用放射免疫法检测MA和β2-MG,比较110例肝素组HSP和105例时照组HSP治疗前后EGF、MA、β2-MG水平的变化;并临床追踪观察6个月.结果 ①肝素组与对照组水平在治疗前EGF、MA、β2-MG分别比较无差异(P>0.05);治疗后肝素组EGF、MA、β2-MG水平较对照组均明显降低,差异有显著性(P相似文献   

IL-12、IL-4、IL-8、转化生长因子-β1及1,25-二羟基维生素D3在婴幼儿喘息性支气管炎表达水平及其临床意义

目的 探讨IL-12、IL-4、IL-8、转化生长因子-β1及1,25-二羟基维生素D3在婴幼儿喘息性支气管炎表达水平及其临床意义.方法 选取2013年1月至2015年1月于我院接受治疗的40例喘息性支气管炎患儿为研究对象,设为喘息组;选取同一时期来我院健康中心接受体检的婴幼儿40名为研究对象,设为对照组.检测两组婴幼儿1,25-(OH)D3及TGF-β1、IL-4、IL-8、IL-12表达水平.比较两组婴幼儿的1,25-(OH)D3、TGF-β1、IL-4、IL-8、IL-12水平及其相互关系.结果 喘息组1,25-(OH)D3、TGF-β1明显低于对照组(P＜0.05);喘息组患儿IL-4、IL-8水平明显高于对照组(P＜0.05);喘息组IL 12水平明显低于对照组(P＜0.05);1,25-(OH)D3与TGF-β1呈正相关(r=0.749,P＜0.05);1,25-(OH)D3与IL-12呈正相关(r=0.802,P＜0.05);1,25-(()H)D3与II-4呈负相关(r=-0.895,P＜0.05);1,25-(OH)D3与IL-8呈负相关(r=-0.736,P＜0.05).结论 1,25 (OH)D3、TGF-β1、IL-12降低及IL-4、IL-8升高与婴幼儿喘息型支气管炎发病有关,检测1,25-(OH)D3、TGF-β1、IL-12、IL-4、IL-8表达水平可作为判断婴幼儿喘息型支气管炎的重要指标.     

不同糖代谢状态下血清TNFα和FFA的变化及其意义

目的观察不同糖代谢状态下血清肿瘤坏死因子(TNFα)和游离脂肪酸(FFA)的变化,以探讨其在糖尿病发生发展中的作用.方法测定27例正常糖耐量(NGT组)、28例糖耐量受损(IGT组)和21例初诊2型糖尿病(T2DM组)个体空腹血清TNFα和FFA水平,分析其对胰岛素抵抗(Homa-IR)和胰岛β细胞功能(HBCI)的影响.结果①IGT组和T2DM组空腹TNFα和FFA明显高于NGT组(P﹤0.05);②NGT、IGT、T2DM组TNFα和FFA之间差异有显著性(r=0.701,P<0.01);③空腹TNFα和FFA与Homa-IR显著正相关(r分别为0.646,0.601,P<0.01),与HBCI负相关性(分别为r=-0.245,-0.244,P<0.05).结论 IGT和T2DM患者存在血清TNFα和FFA明显增高,且均与Homa-IR正相关,与HBCI负相关,提示高水平血清TNFα和FFA可能参与构成T2DM的病理生理基础,包括IR和β细胞功能障碍.     

老年T2DM患者血清NSE水平、炎性因子及胰岛素抵抗与认知功能障碍的相关性研究

目的 探讨老年2型糖尿病(T2DM)患者血清NSE水平,炎性因子水平及胰岛素抵抗程度与认知功能障碍的相关性.方法 选取225例T2DM老年患者,依据MMSE分级标准将其分为认知功能正常组(A组)、轻度障碍组(B组)、中度障碍组(C组)及重度障碍组(D组)四组,从中各随机抽取40例为研究对象.对所有患者行血脂(TC、TG、HDL-C及LDL-C)、血糖(FPG、HbA1c),胰岛素(FINS)、血清NSE及炎性因子(CRP、IL-1β)水平检测,计算胰岛素抵抗指数(HOMA-IR).结果 T2DM患者TC、TG、HDL-C及LDL-C水平比较,TC、LDL-C水平,C组及D组>B组>A组,差异有统计学意义(P<0.05),而C组及D组两者水平比较,差异无统计学意义(P>0.05);TG水平,D组>C组>B组>A组,差异有统计学意义(P<0.05).HDL-C水平四组比较,差异无统计学意义(P>0.05).T2DM患者FPG、HbA1c、FINS及HOMA-IR水平比较,D组>C组>B组>A组,差异有统计学意义(P<0.05).T2DM患者炎性因子CRP、IL-1β及NSE水平比较,D组>C组>B组>A组,差异有统计学意义(P<0.05).MMSE评分与TC、TG、LDL-C、FPG、HbA1c、FINS、HOMA-IR、CRP、IL-1β及NSE水平均呈负相关性(r=-0.572、-0.461、-0.734、-0.627、-0.522、-0.487、-0.417、0.459,-0.622及-0.434,P均<0.05),与HDL-C水平无相关性(r=0.082,P>0.05).结论 血糖控制不佳、胰岛素抵抗、血脂紊乱以及血清NSE及炎性因子水平升高与老年2型糖尿病认知功能障碍密切相关.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。