2型糖尿病视网膜病变患者血浆N—乙酰—β—D氨基葡萄糖苷酶活性和肿瘤坏死因子的变化及意义

目的　探讨血浆N 乙酰 β D氨基葡萄糖甘酶 (NAG)及肿瘤坏死因子 (TNF α)活性变化与 2型糖尿病(DM)患者视网膜病变 (DR)之间的关系。方法　分别采用ELISA法和生物化学法检测 2 2例 2型DM患者 ,其中 12例伴DR ,10例不伴视网膜病变 (NDR)和 2 0例正常对照者 (NC)血浆TNF α、NAG变化。结果　糖尿病患者血浆NAG活性、TNF α水平明显高于对照组 (P <0 .0 1) ,DR组与NDR组NAG活性差异无显著意义 ,而DR组TNF α水平明显高于NDR组 (P <0 .0 1)。血浆NAG活性变化与TNF α成正相关 (r =0 .66,P <0 .0 5 ) ,与糖化血红蛋白(HbA1c)成正相关 (r =0 .2 2 ,P <0 .0 5 )。TNF α水平与血浆空腹胰岛素 (FINS)成正相关 (r =0 .72 ,P <0 .0 5 ) ,与胰岛素敏感指数 (ISI)成负相关 (r =- 0 .5 4,P <0 .0 5 )。结论　TNF α和NAG共同参与糖尿病视网膜病变的发生发展。NAG活性变化与糖尿病血糖控制情况及TNF α水平密切相关 ,动态监测其活性变化对DR早期诊断和检测糖尿病微血管并发症有重要意义。TNF α则对监测DR的发生、发展及疗效判断具有一定的参考价值     

糖尿病患者血清同型半胱氨酸、尿素氮、肌酐、尿酸检测的临床意义

目的 探讨糖尿病(DM)及其并发症患者血清同型半胱氨酸(Hcy)、尿素氮(Urea)、肌酐(Cr)、尿酸(UA)水平的变化及其临床意义.方法 选取健康者(对照组)及单纯DM、糖尿病早期肾损伤(DEKI)、糖尿病肾功能不全(DKF)、糖尿病伴视网膜病变(DRD)、非糖尿病肾功能不全(NDKF)、单纯视网膜病变(RD)患者各30例,进行血清Hcy、Urea、Cr、UA、空腹血糖(Glu)和糖化血红蛋白A1 (HbA1e)检测.结果 单纯DM及其并发症患者组血清Hey水平高于对照组(P＜0.05),并随着肾损伤的加重而增加;单纯DM组Urea、Crea和UA水平与对照组无统计学差异(P＜0.05),但患者出现肾损伤后,其血清水平显著增加;DRD组血清Hcy、Urea、Crea水平高于对照组(P＜0.05),但单纯RD组血清Hcy、Urea、Crea、UA水平与对照组无统计学差异(P＞0.05);DKF组血清Hey、Urea、Crea、UA水平高于NDKF组(P＜0.05);在糖尿病患者中,高Hey组血清Urea、Crea和UA水平均高于正常Hey组(P＜0.05).结论 Hey、Urea、Cr、UA联合检测对于DM并发肾病的预测和诊断可能具有重要作用.     

2型糖尿病患者血小板CD41、CD61、CD62p的表达及意义

目的研究2型糖尿病患者血小板膜糖蛋白变化与血管病变的关系及其影响因素.方法用流式细胞术测定35例2型糖尿病有血管病变患者、32例2型糖尿病无血管病变患者及31例健康者血小板膜糖蛋白CD41、CD61、CD62p的表达.结果2型糖尿病伴血管病变组CD62p显著高于无血管病变组及健康对照组(P＜0.001),无血管病变组与正常对照组无明显差异(P＞0.05);CD41、CD61在三组间无显著性差异(P＞0.05).结论血小板CD62p对判断糖尿病病人的血小板活化及血管病变的早期诊断有重要价值.     

2型糖尿病视网膜病变患者血浆N-乙酰-β-D氨基葡萄糖甘酶活性和肿瘤坏死因子的变化及意义

目的探讨血浆N-乙酰-β-D氨基葡萄糖甘酶(NAG)及肿瘤坏死因子(TNF-α)活性变化与2型糖尿病(DM)患者视网膜病变(DR)之间的关系.方法分别采用ELISA法和生物化学法检测22例2型DM患者,其中12例伴DR,10例不伴视网膜病变(NDR)和20例正常对照者(NC)血浆TNF-α、NAG变化.结果糖尿病患者血浆NAG活性、TNF-α水平明显高于对照组(P<0.01),DR组与NDR组NAG活性差异无显著意义,而DR组TNF-α水平明显高于NDR组(P<0.01).血浆NAG活性变化与TNF-α成正相关(r=0.66,P<0.05),与糖化血红蛋白(HbA1c)成正相关(r=0.22,P<0.05).TNF-α水平与血浆空腹胰岛素(FINS)成正相关(r=0.72,P<0.05),与胰岛素敏感指数(ISI)成负相关(r=-0.54,P<0.05).结论 TNF-α和NAG共同参与糖尿病视网膜病变的发生发展.NAG活性变化与糖尿病血糖控制情况及TNF-α水平密切相关,动态监测其活性变化对DR早期诊断和检测糖尿病微血管并发症有重要意义.TNF-α则对监测DR的发生、发展及疗效判断具有一定的参考价值.     

尿液中mALB、α1-M和NAG联合检测在诊断糖尿病和高血压患者肾脏早期损伤中的应用

目的 探讨尿微量清蛋白(mALB)、α1-微球蛋白(α1-M)和N-乙酰-β-D-氨基葡萄糖苷酶(NAG)检测在诊断肾脏早期损伤中的意义。方法 以63例糖尿病患者(糖尿病组),58例高血压患者(高血压组)和64例健康体检者(对照组)为研究对象,采用免疫散射比浊法检测尿液中mALB、α1-M水平,采用终点比色法测尿液中NAG活性。结果 糖尿病组和高血压组尿液中mALB、α1-M水平和NAG活性均高于对照组,差异有统计学意义(P<0.05)。糖尿病组和高血压组尿液中mALB、α1-M水平和NAG活性的单项检测阳性率均低于50.0%,任意2项指标联合检测的阳性率均高于50.0%,3项指标联合检测的阳性率则高于70.0%。结论 尿液中mALB、α1-M及NAG联合检测是诊断肾脏早期损伤的敏感指标。     

ADAMTS13和TSP-1在糖尿病视网膜病变的意义

目的研究血管性血友病因子裂解蛋白酶(ADAMTS13)及凝血酶敏感蛋白-1(TSP-1)与糖尿病眼底视网膜病变(DR)的关系。方法选取114例糖尿病患者分为单纯糖尿病(DM)组38例和糖尿病视网膜病变(DR)组76例,同时选取30例健康体检者作为对照组。用残余胶原结合试验法检测ADAMTS13活性;同时用酶联免疫吸附试验法检测血浆中TSP-1及血管性血友病因子(vWF)抗原水平。结果 DM组患者血浆中ADAMTS13活性低于对照组,差异有统计学意义(P0.01),vWF抗原和TSP-1水平均高于对照组,差异有统计学意义(P0.01);DR组ADAMTS13活性明显低于DM组,差异有统计学意义(P0.05),vWF抗原和TSP-1水平均高于DM组,差异有统计学意义(P0.05)。结论 ADAMTS13活性降低及TSP-1水平升高可能导致糖尿病眼底视网膜病变的发生和发展。     

血脂代谢异常、C反应蛋白与2型糖尿病患者视网膜病变的关系临床研究

目的研究血脂代谢异常、C反应蛋白(CRP)与2型糖尿病患者视网膜病变的关系。方法 167例糖尿病患者分为糖尿病无视网膜病变组(NDR)48例,非增殖性糖尿病性视网膜病变组(NPDR)63例,增殖性糖尿病性视网膜病变组(PDR)56例,并以同期健康体检人群38例为对照组,比较4个组CRP、空腹血糖(FPG)、糖化血红蛋白(HbA1c),甘油三脂(TG),胆固醇(Tc)差异性,并研究糖尿病患者血清CRP与各指标的相关性。结果 4个组各检测指标比较,PDR组、NPDR组、NDR组血清FPG高于对照组(P0.05),PDR组、NPDR组、NDR组3个组间血清FPG无统计学差异(P0.05);4个组HbA1c、CRP比较,PDR组、NPDR组、NDR组、对照组依次降低,组间两两比较均有有统计学差异(P0.05);4个组TG、TC比较,PDR组、NPDR组、NDR组均高于对照组(P0.05),PDR组、NPDR组高于NDR组(P0.05),PDR组、NPDR组无统计学差异(P0.05);糖尿病患者血清CRP与HbA1c(r=0.626)、TG(r=0.412)、Tc(r=0.468)均成正相关,均有统计学意义(P0.05),CRP与FPG无相关性(P0.05)。结论 CRP、高TG、TC与糖尿病患者视网膜病变密切相关。     

糖尿病视网膜病变患者血清E-selectin和sICAM-1检测及意义探讨

目的：探讨糖尿病视网膜病变患者血清中E选择素（E-selectin）、可溶性细胞间黏附分子-1（sICAM-1）的水平及其临床意义。方法将70例2型糖尿病确诊患者分为糖尿病无视网膜病变组（NDR组）33例,糖尿病并发非增殖期视网膜病变组（NPDR组）20例,糖尿病并发增殖期视网膜病变组（PDR组）17例。同期选取32例健康体检者作为正常对照组（NC组）。采用酶联免疫吸附试验（ELISA）检测血清中 E-selectin、sICAM-1水平,并将各组的检测结果进行比较。结果 PDR组、NPDR组、NDR组血清中E-selectin和sICAM-1水平明显高于NC组,差异有统计学意义（P＜0．01）;PDR组血清中E-selectin、sICAM-1水平明显高于NPDR组和NDR组,差异有统计学意义（P＜0．01）;NPDR组血清中E-selectin、sICAM-1水平明显高于 NDR组,差异有统计学意义（P＜0．01）。E-selectin水平与 sICAM-1水平呈明显正相关（r＝0．756,P＜0．01）。结论 E-selectin、sICAM-1参与了糖尿病视网膜病的形成与发展。早期检测血清中E-selectin、sICAM-1水平有助于保护糖尿病患者的血管内皮细胞,减少和预防动脉硬化的发生。     

2型糖尿病视网膜病变患者滑车上动脉及其相关动脉的超声表现

目的分析2型糖尿病视网膜病变患者滑车上动脉(STCA)及其相关动脉的超声特征。方法对52例糖尿病无视网膜病变组(NDR组)和60例糖尿病视网膜病变组(DR组)患者行STCA、眼动脉、视网膜中央动脉(CRA)及颈动脉超声检测,结果进行对比分析。结果与NDR组比较,DR组STCA、眼动脉及CRA的收缩期峰值速度(PSV)和舒张末期速度(EDV)下降,阻力指数(RI)增高,差异均有统计学意义(均P﹤0.001);DR组颈总动脉的内膜-中膜厚度增高,差异有统计学意义(P﹤0.05),但内径、PSV、EDV、RI与NDR组比较,差异均无统计学意义。DR组颈部动脉斑块检出率高于NDR组,差异有统计学意义(P﹤0.001)。结论糖尿病视网膜病变患者的STCA、眼动脉及CRA均可出现血流动力学异常,且大血管粥样硬化的检出率也增高,超声检查可以较准确地反映眼部血流变化的信息,具有重要临床价值。     

临床护理干预对糖尿病合并视网膜病变疗效和生活质量的影响

目的 探讨临床护理干预对糖尿病合并视网膜病变患者视功能及生活质量的影响.方法 将2011年1 ～12月收治的糖尿病合并视网膜病变患者32例设为对照组,开展常规护理;将2012年1～12月收治的糖尿病合并视网膜病变患者30例设为研究组,在常规护理的基础上实施护理干预.比较两组患者干预前及干预后第4个月末CLVQOL（中文版低视力者生活质量量表）、DMQLS（2型糖尿病患者生活质量量表）评分改善情况.结果 两组患者干预前各项CLVQOL评分无统计学差异,干预后第4个月末研究组各项CLVQOL评分均高于对照组（P＜0.05）;两组患者干预前各项DMQLS评分无统计学差异,干预后第4个月末研究组各项CLVQOL评分均低于对照组（P＜0.05）.结论 对糖尿病合并视网膜病变患者开展临床护理干预能够提高患者的视力功能,并改善其生活质量,可取得较为满意的临床效果.     

The activity of N-acetyl-beta-D-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

OBJECTIVE: The assessment of the clinical significance of TNF-alpha, IL-10 and NAG with its A and B isoforms concentrations in children with DM type 1 for the detection of early stages of both diabetic retinopathy and nephropathy. PATIENTS AND METHODS: One hundred and two children with DM type 1 and 35 healthy controls were analyzed. Levels of TNF-alpha, IL10 and total NAG enzyme activity with its A and B isoforms were measured in serum and urine of all participants. RESULTS: Children with diabetic retinopathy had a significantly higher levels of TNFalpha in serum (P=0.01) in comparison to those without retinopathy. The activity of NAG (P=0.002) and its isoform A (P=0.006) and isoform B (P=0.001) were significantly higher in children with diabetic retinopathy in comparison to those without this complication. Conversely, within the group with retinopathy, more children had detectable concentrations of IL10 in serum as compared to those without retinopathy (P=0.01). CONCLUSIONS: These results suggest that NAG activity and TNF-alpha concentration in diabetic retinopathy patients might show a relationship with a degree of renal glomeruli epithelial cells and renal proximal tubules damage.     

THE SIGNIFICANCE OF URINARY N-ACETYL-ß-D-GLUCOSAMINIDASE FOR PREDICTING EARLY STAGE DIABETIC NEPHROPATHY

We studied urinary N-acetyl-ß-D-glucosaminidase (NAG) in the early stage of diabetic nephropathy in 27 non-insulin-dependent diabetes mellitus (NIDDM) patients with a microalbumin level below 20 mg on 24-hour urine sample. Microalbumin and NAG excretion were measured in 24-hour urine samples collected on three separate occasions within seven days of admission. Creatinine clearance was determined simultaneously. There was a significant negative correlation between the creatinine clearance and 24-hour urinary NAG (r=-0.38, p<0.05). Elevation of urinary NAG may indicate decreased renal function during early stage NIDDM nephropathy.     

2型糖尿病肾病患者血D-二聚体、纤维蛋白原、C反应蛋白水平的临床意义

目的探讨联合检测血D-二聚体（DD）、纤维蛋白原（FIB）、C反应蛋白（CRP）水平对2型糖尿病肾病并发症的临床应用价值。方法对已确诊的116例2型糖尿病患者同时检测其清晨空腹血DD、FIB、CRP水平,并同时收集24h尿液进行尿微量白蛋白（MA）测定,按尿白蛋白排泄率（UAER）将糖尿病组分3组：正常蛋白尿组（NA组,UAER〈20μg／min）;微量蛋白尿组（MA组,UAER20～200μg／min）;临床蛋白尿组（cP组,UAER〉200μg/min）。结果2型糖尿病组患者DD、FIB、CRP水平在正常蛋白尿组已升高,与对照组比较,差异有统计学意义（P〈0．05）,且随UAER增加而增高,3组之间各指标差异均有统计学意义（P〈0．05）,且3项联合检测的阳性率明显高于单项检测。结论联合检测血DD、FIB、CRP水平对糖尿病微血管病的发展及糖尿病。肾病有早期诊断意义。     

Ⅰ型糖尿病患儿循环内皮细胞计数检测与尿白蛋白相关性研究

目的探讨Ⅰ型糖尿病患儿血管内皮损害标志物循环内皮细胞计数的变化,以及与尿白蛋白的相关性。方法将62例Ⅰ型糖尿病患儿根据尿白蛋白排泄率分为正常白蛋白尿组（A组）35例和微量白蛋白尿组（B组）27例,抽取同期健康体检儿童60例作为对照组（C组）,分别检测其循环内皮细胞计数和尿微量蛋白、糖化血红蛋白的变化,并进行相关性分析。结果Ⅰ型糖尿病患儿循环内皮细胞计数及糖化血红蛋白均显著高于正常对照组（P〈0．01）;微量白蛋白尿组糖尿病患儿均显著高于正常白蛋白尿组患儿（P〈0．05）;Ⅰ型糖尿病患者循环内皮细胞计数与糖化血红蛋白呈显著正相关（R=0．310,P〈0．05）。结论Ⅰ型糖尿病患儿在出现微量白蛋白尿前已存在血管内皮功能异常,循环内皮细胞计数的检测可作为早期筛查糖尿病肾病的可靠指标。     

Determination of urinary enzymes as a marker of early renal damage in diabetic patients

Diagnosis of diabetic nephropathy in the early stages is very important since there are no clinical signs or symptoms. Urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion has been recommended as a tubular dysfunction marker that elevates before other markers, such as microalbuminuria and a decrease in creatinine clearance. In this study, we compared excretion of urinary enzymes with other markers that are used routinely in diabetic nephropathy assessment. Urinary NAG, lactate dehydrogenase (LDH), alkaline phosphatase (AP) activities, urea, creatinine, and albumin, with levels of serum glucose and creatinine and whole blood glycosylated hemoglobin (HbA1c) were measured in 32 diabetes mellitus patients and 25 healthy subjects (controls). Notably, urinary NAG, AP, LDH excretion, and microalbuminuria in the diabetic patients group were significantly increased compared to those in the control groups (P<0.001, P<0.05, P<0.01, and P<0.01, respectively). Meanwhile, our results showed that the urinary NAG excretion had the highest sensitivity and specificity (100% and 87.5%, respectively) compared to other markers. We showed that measuring urinary NAG excretion could be useful for the assessment of renal failure in diabetes mellitus patients and confirmed the use of NAG as a routine screening test.     

Serum N-acetyl-beta-D-glucosaminidase profiles in type 1 diabetes secondary complications: causes of changes and significance of determination

The connection between changes in the activity of serum N-acetyl-beta-D-glucosaminidase (NAG, E.C.3.2.1.30) and iso-enzymes and degree of secondary complications was analyzed in four groups of type 1 diabetic patients (n=69): without complications (n=22); with retinopathy (n=16); with retinopathy and polyneuropathy (n=13), and with retinopathy, neuropathy, and nephropathy (n=18). In all groups statistically significant higher (P<0.001) percent fraction of A form (83.84+/-6.09, 84.37+/-5.74, 81.76+/-6.02, 76.37+/-7.38%, resp.) and lower (P<0.001, P<0.01) fraction of B form (15.87+/-5.65, 15.66+/-5.74, 18.33+/-5.98, 23.63+/-7.38, resp.) in total NAG compared with the control (A=69.38+/-4.79%, B=30.61+/-4.78%) were found. The differences in A as well as B forms between diabetic groups were not statistically significant. Significant strong positive correlations between total NAG and glycemia (0.494-0.623), total NAG and A form (0.934-0.966), and A form and glycemia (0.512-0.638) were found in all groups. No correlation was found between the fractions of B and A forms, except in the fourth group. The A form of diabetic patients in the fourth group was more acidic compared with the control and other diabetic groups. It was concluded that the changes in serum NAG and iso-enzymic profiles in diabetes are the consequence of its increased exocytose, especially of the A form, in hyperglycemia and posttranslational modifications of iso-enzymes. The total activity of serum NAG and iso-enzymic profiles cannot be used for monitoring the development and distinction of type 1 diabetes secondary complications.     

尿微量蛋白与尿酶和Ⅳ型胶原对糖尿病肾病早期诊断的意义

目的探讨早期诊断糖尿病肾病的方法。方法用酶联免疫吸附试验法检测尿中视黄醇结合蛋白（RBP）和Ⅳ型胶原（Ⅳ—C）,免疫发光法检测尿微量清蛋白（mAlb）及转铁蛋白（TF）,终点法测N-乙酰-β—D氨基葡萄糖苷酸酶（NAG）,Jaffe法测定尿肌酐（Cr）。结果健康对照组中尿TF／Cr为（1．10±0．76）mg／mmol、mAlb／Cr为（1．50±0．81）mg／mmol、NAG／Cr为（5．65±2．40）U／g、RBP／Cr为（2．15±0．93）mg／mmol及Ⅳ—C的含量为（44．68±17．2）ng／mL。在糖尿病无肾病组中,其inAlb的含量与健康对照组相近,差异无统计学意义（P〉0．05）;而NAG、RBP、TF及Ⅳ－C的含量与健康对照组相比,差异有统计学意义（P〈0．05）。在糖尿病的初期肾病组和临床肾病组,mAlb／Cr、NAG／Cr、RBP／Cr、TF／Cr及Ⅳ－C的含量均明显高于健康对照组,差异有统计学意义（P〈0．01）。结论联合检测尿NAG、RBP、TF及Ⅳ－C是诊断糖尿病肾病早期损伤灵敏、可靠的实验室指标。     

N-Acetyl-beta-D-glucosaminidase levels and diabetic microangiopathy.

N-Acetyl-beta-D-glucosaminidase (NAG) activity has been measured in the serum and urine of primary and secondary diabetics and in primary diabetics with microangiopathy. NAG activity has also been measured in the tears of diabetics with ocular complications and diabetics with no ocular changes. Results have shown significantly higher levels of urinary NAG in diabetics with proteinuria (p less than 0.001) and proteinuria and retinopathy (p less than 0.001). There was no correlation between urinary NAG activity and serum creatinine (r = 0.28) or urinary NAG and the degree of proteinuria (r = 0.24). Increased urinary NAG levels were also observed in secondary diabetes associated with haemochromatosis and acromegaly. Significantly higher serum NAG levels were found in newly diagnosed diabetics (p less than 0.01) and significantly lower levels in chemical diabetics (p less than 0.01). Compared to non-diabetic controls tear NAG levels were significantly higher in the diabetic controls (p less than 0.01), in diabetics with retinopathy (p less than 0.01), and in diabetics with cataract formation (p less than 0.05). An assessment of this enzyme is made in relation to the development of diabetic microangiopathy.     

1—型糖尿病患者血清铁蛋白测定的临床意义

采用化学免疫发光法,检测５０例１－型糖尿病患者及５５例正常对照的血清铁蛋白。结果表明,１－型糖尿病患者血清铁蛋白水平显著高于正常对照组（Ｐ〈０．０１）;１－型糖尿病患者组中血糖控制良好的（ＨｂＡ１Ｃ〈７％）因糖控制不良的（ＨｂＡ１Ｃ〉７％）两者之间铁蛋白水平也有显著差别（Ｐ〈０．０１）。其铁蛋白水平与ＨＢＡ１Ｃ水平有一定相关（Ｐ〈０．０５）。铁蛋白水平随血糖的短期波动而波动。     

胱抑素C在2型糖尿病不同肾损害期的变化

目的探讨血清胱抑素C（Cysc）在2型糖尿病不同肾损害期的变化,评价Cys—C在2型糖尿病肾病早期的诊断价值。方法用颗粒增强免疫比浊法检测135例2型糖尿病患者（其中合并糖尿病肾病不同损害期77例）血清CysC,同时检测尿微量白蛋白排泄率（UAER）,血Alb、Cr、BUN,根据MDRD公式计算肾小球滤过率。结果2型糖尿病正常向蛋白尿组与2型糖尿病微量白蛋白尿组间Cys—C水平差异有统计学意义（P〈0．05,）;2型椿尿病微量白蛋白尿组与2型槠尿病人量白蛋白尿组间Cys—C水平差异有统计学意义（P〈0．01）。结论血清CysC可作为辅助2型糖尿病肾病早期诊断的指标。