系统免疫炎症指数对社区老年2型糖尿病患者并发糖尿病肾病的临床诊断价值研究

背景 糖尿病肾病（DKD）是糖尿病常见并发症,以损伤肾脏微血管为主要特征,其早期诊断、积极防治是改善预后的关键。血液炎性指标可能与DKD存在相关性。 目的 探究系统免疫炎症指数（SII）对社区老年2型糖尿病（T2DM）患者并发DKD的诊断价值。 方法 回顾性分析2021年1—12月于首都医科大学附属北京朝阳医院西区社区医疗部常规体检的老年T2DM患者327例为研究对象。根据是否并发DKD将327例T2DM患者分为非DKD组（n=112）和DKD组（n=215）。收集两组患者的一般资料及实验室检查资料并进行比较。采用Pearson相关分析及Spearman秩相关分析探讨老年T2DM患者尿白蛋白/肌酐比值（UACR）与各指标的相关性;采用多因素Logistic回归分析探讨老年T2DM患者并发DKD的影响因素;采用受试者工作特征曲线（ROC曲线）评估中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、SII对社区老年T2DM患者并发DKD的诊断价值,并计算ROC曲线下面积（AUC）及其95%CI。 结果 DKD组患者的T2DM病程长于非DKD组,高血压病史比例、空腹葡萄糖（FPG）、低密度脂蛋白（LDL）、尿素氮（BUN）、血肌酐（Scr）、UACR、中性粒细胞计数、血小板计数、NLR、PLR、SII水平高于非DKD组（P<0.05）。相关性分析结果显示,老年T2DM患者UACR与T2DM病程、FPG、三酰甘油（TG）、LDL、中性粒细胞、血小板、NLR、PLR、SII呈正相关（r=0.716、0.114、0.113、0.144、0.533、0.226、0.538、0.430、0.494,P<0.05）。多因素Logistic回归分析结果显示,T2DM病程〔OR=1.300,95%CI（1.173,1.441）,P<0.001〕、LDL〔OR=2.565,95%CI（1.320,4.985）,P=0.005〕、Scr〔OR=1.093,95%CI（1.046,1.143）,P<0.001〕、NLR〔OR=2.565,95%CI（1.320,4.985）,P=0.005〕和SII〔OR=1.011,95%CI（1.007,1.015）,P<0.001〕均是老年T2DM患者并发DKD的影响因素。NLR诊断老年T2DM患者并发DKD的AUC为0.755〔95%CI（0.696,0.814）〕,最佳截断值为2.49,灵敏度和特异度分别为72.1%、70.5%;PLR诊断老年T2DM患者并发DKD的AUC为0.689〔95%CI（0.624,0.754）〕,最佳截断值为112.81,灵敏度和特异度分别为90.2%、43.8%;SII诊断老年T2DM患者并发DKD的AUC为0.836〔95%CI（0.791,0.881）〕,最佳截断值为492.08,灵敏度和特异度分别为80.5%、73.2%。 结论 T2DM病程、LDL、Scr、NLR、SII可能是老年T2DM患者并发DKD的影响因素;SII对社区老年T2DM患者并发DKD具有较高的临床诊断价值。     

C反应蛋白/高密度脂蛋白胆固醇在糖尿病肾病患者中的变化及诊断价值

目的 探讨C反应蛋白与高密度脂蛋白胆固醇比值(CHR)在2型糖尿病(T2DM)合并糖尿病肾病(DKD)患者中的变化及其诊断价值。方法 回顾性收集2019年10月至2022年6月就诊于郑州大学第一附属医院的321例T2DM患者，根据尿白蛋白与肌酐比值(UACR)分为单纯糖尿病(DM)组(正常蛋白尿)、早期DKD组(微量白蛋白尿)和临床DKD组(大量白蛋白尿)。收集并分析各组患者基本资料和实验室指标及CHR等指标在各组间的差异。采用Spearman秩相关分析CHR与炎症及肾功能指标的相关性。采用多因素logistic回归分析DKD蛋白尿的独立危险因素。绘制受试者工作特征(ROC)曲线评价CHR对早期DKD的预测价值。结果 CHR随蛋白尿增加而升高，早期DKD组和临床DKD组CHR均高于单纯DM组，且临床DKD组高于早期DKD组(P<0.05)。Spearman相关分析显示CHR与白细胞计数、中性粒细胞计数、UACR、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)呈正相关(P<0.05),与估算肾小球滤过率(eGFR)呈负相关(P<0.05)。多因素logistic回归分析显...     

白细胞介素-37与2型糖尿病肾脏病的相关性分析

【摘要】 目的 探讨白细胞介素-37（IL-37）在2型糖尿病（T2DM)及糖尿病肾脏病（DKD)患者中的表达及与DKD的相关性。方法纳入陕西省人民医院2018年12月~2019年12月住院的T2DM患者228例,根据尿白蛋白与肌酐比值（UACR)和估算肾小球滤过率（eGFR),分为正常蛋白尿（单纯DM)组80例、微量白蛋白尿（早期DKD)组76例、大量白蛋白尿（临床DKD)组72例,另选取60例门诊健康体检者作为对照组。收集各组基本资料、实验室指标,采用酶联免疫吸附（ELISA)法检测各组血清IL-37水平;分析IL-37浓度在各组间的差异及与实验室指标的相关性。结果单纯DM组、早期DKD组及临床DKD组患者血清IL-37浓度均显著高于对照组,差异有统计学意义（均P<0.05）;临床DKD组IL-37浓度较早期DKD组显著升高,差异有统计学意义(P=0.043),但早期DKD组IL-37浓度与单纯DM组相比差异无统计学意义（P>0.05）。Spearman相关分析血清IL-37浓度与尿蛋白定量、尿ALB、尿α1-MG、尿β2-MG及HbA1C呈显著正相关（r分别为0.302,0.286,0.222,0.216,0.265,P<0.05）,与eGFR呈显著负相关(r=-0.357,P=0.001）。Logistic回归分析提示IL-37可能是T2DM合并DKD的保护因素（OR=0.822,95%CI：0.702～0.962）。结论IL-37血清浓度与T2DM患者合并DKD的发展有关,IL-37可能成为治疗DKD的潜在新方法。     

2型糖尿病患者血清TNF-α水平与糖尿病肾脏疾病相关性研究

目的 探讨2型糖尿病患者外周血中TNF-α水平与糖尿病肾脏疾病的相关性以及外周血TNF-α水平用于糖尿病肾脏疾病患者早期诊断的临床价值。方法 选择2018年9月至2019年9月永康市第一人民医院就诊的DKD患者50例,设为糖尿病肾脏疾病组(DKD组),并根据患者尿白蛋白/尿肌酐将DKD患者分为微量蛋白尿组(n=32)、大量蛋白尿组(n=18),选同期T2DM不合并DKD患者200例,设为单纯糖尿病组(T2DM组)。检测并比较分析两组患者UACR、肾小球滤过率,检测并分析T2DM组患者和DKD组患者以及DKD患者两个亚组间TNF-α水平差异,采用Pearson或Spearman分析外周血TNF-α与eGFR或UACR的相关性,采用Logistic多元回归分析法分析TNF-α水平与DKD的关系,最后绘制ROC曲线分析TNF-α、eGFR或UACR用于DKD诊断的特异性和敏感性。结果 DKD组血清TNF-α水平高于T2DM组患者,且大量蛋白尿组血清TNF-α水平高于微量蛋白尿和单纯糖尿病组;TNF-α高水平是DKD的高危因素;血清TNF-α分别与UACR呈正相关(P0.05),与e GFR呈负相关。ROC曲线分析显示,外周血TNF-α水平检测DKD的曲线下面积为0.893,95%可信区间为0.675～1.000,敏感性和特异性分别为81.3%和89.3%,高于eGFR或UACR检测DKD的敏感性(73.4%,75.1%)和特异性(80.1%,83.5%)。结论 TNF-α可能参与DKD进程,在DKD病情变化中发挥重要作用,并在一定程度上反映肾小球滤过率,可作为DKD早期诊断的指标。     

NPDR伴糖尿病肾病患者黄斑区视网膜血管参数与尿白蛋白/尿肌酐比值的相关性分析

目的：探讨非增殖性糖尿病视网膜病变(NPDR)伴糖尿病肾病(DKD)患者的黄斑区视网膜血管参数与尿白蛋白/尿肌酐比值(UACR)的相关性。方法：纳入NPDR患者120例为研究对象,根据是否合并DKD分为NPDR组(60例)、NPDR+DKD组(60例),同时纳入无眼底病变的2型糖尿病(T2DM)患者16例为T2DM组。所有受检者均行空腹血糖(FBG)、糖化血红蛋白(HbAlc)、血清总胆固醇(TC)和UACR等检测,行眼科相关检查并使用光相干断层扫描血管成像(OCTA)测量整体及浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)血流密度以及黄斑中心凹无血管区(FAZ)面积、FAZ水平直径、SCP和DCP层微血管瘤数量;对黄斑区视网膜血管参数与UACR的相关性行Spearman分析。结果：NPDR组、NPDR+DKD组、T2DM组3组间FAZ面积、SCP和DCP微血管瘤数量比较,差异有统计学意义(P<0.05);与T2DM组、NPDR组相比,NPDR+DKD组的FAZ面积更大。Spearman相关性分析结果显示,UACR与黄斑中心凹区血流密度、FAZ水平直径呈负相关(r=-0.21...     

葡萄糖在目标范围内时间与糖尿病肾脏疾病的相关性研究

背景 葡萄糖在目标范围内时间（TIR）是近年兴起的糖尿病血糖管理的新指标。研究证实TIR与糖尿病慢性并发症存在密切联系。目前对TIR与糖尿病肾脏疾病（DKD）的研究主要集中在蛋白尿方面,常忽视了估算肾小球滤过率（eGFR）在其中的作用,且对TIR评价血糖控制的切点划分的研究较少。 目的 探讨TIR与2型糖尿病（T2DM）发生DKD的关系,为临床及时发现、诊治T2DM患者出现DKD提供理论依据。 方法 纳入2021年7—12月在上海交通大学医学院附属新华医院内分泌科住院的214例T2DM患者,收集患者一般资料、实验室检查指标及用药情况。根据尿白蛋白/肌酐比值（UACR）和eGFR结果,将患者分为DKD组〔UACR≥30 mg/g和/或eGFR<60 ml·min-1（1.73 m2）-1,n=58〕和单纯T2DM组〔UACR<30 mg/g和eGFR≥60 ml·min-1（1.73 m2）-1,n=156〕;采用TIR值40%、70%、85%作为切点将患者分为TIR1组（TIR>85%,n=90）、TIR2组（70%相似文献   

血清锌α2糖蛋白检测在早期预测糖尿病肾病发生中的价值

【摘要】 目的 探讨血清锌α2糖蛋白（ZAG）在早期预测糖尿病肾病（DKD）发生中的价值。 方法 选取2017年5月~2019年1月于保定市第一中心医院内分泌科就诊的2型糖尿病（T2DM）患者160例作为研究对象。依据尿白蛋白/尿肌酐比值（UACR）将患者随机分为正常蛋白尿组（NA组）56例、微量蛋白尿组（MA组）53例、大量蛋白尿组（LA组）51例,另外选取同期于本院体检科体检的性别、年龄相匹配的健康者50例作为正常对照组（NC组）。采用ELISA法测定各组ZAG水平;利用Spearman相关分析、多元逐步回归分析及ROC曲线分析等方法对其进行统计学分析,评估该指标在早期预测DKD发生中的价值。 结果 NA组ZAG水平明显高于NC组,MA组和LA组ZAG水平明显高于NA组,其中以LA组最高（P＜005）。Spearman相关分析显示血清ZAG水平与ALT、AST、eGFR呈负相关,与SBP、DBP、SCR、BUN、FBG、HbA1c、HOMA IR、UALB、UAER、UACR、24h尿蛋白呈正相关。多元线性回归分析显示UACR、eGFR为血清ZAG水平的独立影响因素。ROC曲线分析表明,ZAG可作为早期诊断糖尿病肾病的指标。 结论 随着DKD的不断进展,血清锌α2糖蛋白（ZAG）水平逐渐升高。ZAG水平变化为早期预测DKD的发生和发展提供了参考依据及应用价值。     

血清dp-ucMGP、BGP水平与2型糖尿病肾脏病变的相关性及预测价值

目的 探讨去磷酸-未羧化基质GLA蛋白(dp-ucMGP)、骨钙素(BGP)水平与2型糖尿病肾脏病变(DKD)的相关性及预测价值。方法 收集2020年9月～2021年11月在我院内分泌科住院的138例2型糖尿病(T2DM)患者,以尿微量白蛋白/肌酐(ACR)水平分组：ACR<3 mg/mmol为单纯糖尿病组(DM,n=56);ACR在3～30 mg/mmol为早期糖尿病肾脏病变组(eDKD,n=38);ACR>30 mg/mmol为临床糖尿病肾病组(cDKD,n=44);检测患者血中dp-ucMGP、BGP及临床生化指标。结果 与DM组相比,eDKD组和cDKD组患者的dp-ucMGP升高,BGP降低(均P<0.05)。Spearman相关性分析结果显示dp-ucMGP与CRE、UREA、ACR水平呈正相关,与eGFR呈负相关(均P<0.05);BGP与ACR呈负相关(P<0.05);Logistic回归提示dp-ucMGP是DKD的危险因素,BGP是DKD的保护性因素。通过ROC曲线分析确定两者联合诊断DKD的敏感性0.781,特异性0.750,AUC是...     

2型糖尿病患者血清miR-146a与糖尿病肾病相关性研究

目的 探讨2型糖尿病患者血清miR-146a及肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）与糖尿病肾病的关系。方法 收集2020年12月至2022年1月嘉兴市第一医院内分泌科收治的128例2型糖尿病患者，根据尿白蛋白与尿肌酐比值（urinary albumin-to-creatinine ratio，UACR）将患者分为3组：尿白蛋白正常组（UACR<30mg/g，58例）；微量尿白蛋白组（30mg/g≤UACR<300mg/g，44例）；大量尿白蛋白组（UACR≥300mg/g，26例）。收集患者的基线资料，采用实时荧光定量聚合酶链反应（real-time quantitative polymerase chain reaction，RT-qPCR）检测血清miR-146a的表达水平，酶联免疫吸附试验（enzyme linked immunosorbent assay，ELISA）检测血清TNF-α的表达水平。分析miR-146a及TNF-α与UACR的关系。结果 与尿白蛋白正常组相比，微量尿白蛋白组和大量尿白蛋白组患者的TNF-α水平均明显升高，且随尿蛋白升高递增，差异有统计学意义（P<0.05）。微量尿白蛋白组和大量尿白蛋白组患者的miR-146a水平均低于尿白蛋白正常组，差异有统计学意义（P<0.05）。Spearman相关分析显示，miR-146a与UACR呈负相关（r=–0.574，P<0.05），TNF-α与UACR呈正相关（r=0.824，P<0.05）。miR-146a预测糖尿病肾病的敏感度为77.1%，特异性为79.3%（95%CI：71.7%～87.4%，P<0.05）。结论 2型糖尿病患者血清miR-146a及TNF-α可作为预测糖尿病肾病的分子学标志物，有助于糖尿病肾病的早期诊断。     

尿胱抑素C作为糖尿病肾病早期诊断标准的评价

目的 评估尿胱抑素C （urinary cystatin C,UCysC）与尿白蛋白/肌酐（urine albumin-creatinine ratio,UACR）的相关性,进而探讨UCysC作为糖尿病肾病（diabetic nephropathy,DN）早期诊断标准的意义.方法 采取回顾性横断面研究方法,将100例糖尿病（diabetes mellitus,DM）患者依据UACR水平分为正常白蛋白尿组（n=19）、微量白蛋白尿组（n=59）和大量白蛋白尿组（n=22）.常规记录查体结果和相关生化指标,同时采用颗粒增强透射免疫比浊法（particle-enhanced turbimetric assay method）测定不同分组患者UCysC水平.结果 在正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组,UCysC随着UACR的增加而逐渐升高,差异具有统计学意义（P＜0.05）.UCysC与UACR之间呈正相关（r=0.766,P=0.000）,以UACR值30mg/g为切入点,作ROC曲线,得出曲线下面积为0.915,这说明UCysC对于早期DN来说,具有很好的敏感度和特异性.结论 UCysC与UACR之间具有独立相关性,UCysC可以作为DN早期诊断标准.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.