慢性肾病患者中低T3综合征的发生率及临床意义

目的:探讨低T3综合征在各期慢性肾病(CKD)非透析患者中的发生率,及低T3水平与肾脏病进展及贫血、营养不良、微炎症等疾病状态的相关性。方法:回顾性分析了176例CKD非透析患者的甲状腺功能指标,包括血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH),以及反应肾功能、营养状况及微炎症状况的相关生化指标,包括血清肌酐(Scr)、白蛋白(Alb)、胆固醇(TC)、三酰甘油(TG)、高敏C反应蛋白(CRP)及贫血指标血红蛋白(Hb)。根据CKD分期将所有患者分为4组,分析低T3综合征的各组中的发生率,及TT3、FT3与肾功能、贫血、营养状况、微炎症状况相关指标的线性关系。结果:CKD1～2期患者中低T3综合征的发生率为7.14%,3～5期中分别为33.33%、81.25%、92.5%。TT3与eGFR(r=0.498,P=0.001)和Hb(r=0.48,P=0.001)呈显著正相关,与Alb、TG、TC、CRP无相关性。FT3与eGFR(r=0.783,P<0.0001)和Hb(r=0.706,P<0.0001)呈显著正相关,与CRP(r=-0.38,P=0.011)呈显著负相关,与Alb、TG、TC无相关性。结论:低T3综合征在CKD患者中普遍存在,并且低T3水平与肾脏损害程度、贫血、微炎症状态等疾病状态密切相关,因此监测血清甲状腺激素水平对于判断CKD患者病情严重程度和预后具有一定意义。     

腹膜透析患者残余肾功能下降速率的相关影响因素分析

目的 探讨腹膜透析患者残余肾功能(RRF)下降速率的相关影响因素,以期为临床早期干预提供依据.方法 将纳入的95例患者按估算的肾小球滤过率(eGFR)水平分为A组[eGFR＜ 6mL·(min·1.73m2)-1]、B组[eGFR(6 ～10)mL·(min·1.73m2)-1]及C组[eGFR＞ 10mL·(min·1.73m2)-1],随访患者18个月或至终点事件发生,计算eGFR平均下降速率,并建立回归模型,分析各项指标与eGFR下降速率的关系.结果 95例患者eGFR下降速率平均为-0.156mL·(min·1.73m2)-1,其中A组为-0.091mL·(min·1.73m2)-1,B组为-0.153mL·(min·1.73m2)-1,C组为-0.251mL· (min·1.73m2)-1;共有37例(38.95％)eGFR丧失,其中A组18例(60.00％)、B组13例(40.63％),C组6例(18.18％);3组eGFR下降速率及eGFR丧失率组间比较均有显著差异(P ＜0.001).至终点时,3组死亡率、转HD治疗及行肾移植组间比较均无显著差异(P＞0.05).多因素回归分析显示,基线时eGFR、Hb、血清白蛋白、总胆固醇、NT-pro-BNP为为eGFR下降速率的独立影响因素.结论 腹膜透析患者eGFR下降速率与基线时eGFR、Hb、血浆白蛋白、总胆固醇及NT-pro-BNP水平等密切相关,临床上应识别并重视.     

慢性肾脏病患者脂质代谢紊乱危险因素分析

目的探讨慢性肾脏病(chronic kidney disease,CKD)3~5期患者血清甲状腺素(thyroid hormone,TH)水平的变化与血脂代谢的关系及其临床意义。方法选择在我院住院治疗的CKD 3~5期患者120例,根据CKD不同分期将其分为CKD 3期组(76例)、CKD 4期组(28例)、CKD 5期组(16例)。另选择我院50名同期健康体检者为对照组,采用放射免疫法分别检测CKD患者与健康体检者血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、超敏促甲状腺素(sensitive thyroid stimulating hormones,sTSH)的含量,同时采用全自动生化分析仪测定其血总胆固醇(serum total cholesterol,TC)、三酰甘油(triglycerides,TG)、高密度脂蛋白胆固醇(high density lipoprotein,HDL-C)、低密度脂蛋白胆固醇(10w density lipoprotein,LDLC)、血肌酐(SCr)、尿素氮(BUN)、尿酸(uric acid,UA)、血红蛋白(hemoglobin,Hb)、血白蛋白(alburnin,Alb)等,运用美国慢性肾脏病流行病合作工作组新开发的公式方程估算肾小球滤过率(estimated glomerular filtration rate,eGFR)。结果 CKD 3~5期患者血清FT3、FT4、eGFR低于正常对照组(P0,05),TSH与对照组比较,无统计学差异(P0.05);血清TG、TC、LDL-C高于正常对照组(P0.05),HDL-C低于对照组,但差异无统计学意义(P0.05)。Pearson相关性分析显示,CKD患者血清FT3分别与TG、TC呈负相关(r=-0.288,P0.05;r=-0.312,P0.05),与eGFR、HDL-C、Alb、Hb呈正相关(r=0.356,P0.01;r=0.199,P0.05;r=0.266,P0.01;r=0.276,P0.01);FT4分别与TC、LDL-C呈负相关(r=-0.199,P0.01;r=-0.297,P0.05),与eGFR、Alb、Hb呈正相关(r=0.405,P0.01;r=0.237,P0.01;r=0.24,P0.01);与TG、HDL-C均无明显相关性(P0.05);sTSH与Alb呈负相关(r=-0.195,P0.05),与eGFR、TG、TC、HDL-C、LDL-C均无明显相关性(P0.05)。回归分析发现TG的独立相关因素是eGFR和FT3。结论中晚期CKD患者常伴有TH水平异常,主要表现为低T3综合征,且与肾功能损害程度密切相关;中晚期CKD患者多合并有高脂血症,影响其血脂的因素较为复杂,其中eGFR、FT3是CKD患者脂质代谢紊乱的独立危险因素。     

2型糖尿病肾病患者血清Cys-C、尿视黄醇结合蛋白、尿β2微球蛋白指标检测及其与eGFR相关性的研究

目的:探究2型糖尿病肾病患者血清胱抑素C(CysC)、尿视黄醇结合蛋白(RBP)、尿β₂微球蛋白(β₂-MG)指标检测及其与肾小球滤过率(eGFR)相关性。方法:回顾性分析本院在2020年07月—2022年12月间收治的96例肾病患者的临床资料,作为观察组。根据观察组患者eGFR情况可将其分为三组,eGFR<60 ml·min^-1·1.73 m^-2(n=18),90 ml·min^-1·1.73 m^-2>eGFR≥60 ml·min^-1·1.73 m^-2(n=32),eGFR≥90 ml·min^-1·1.73 m^-2(n=46),分别为A、B、C组,另外,以本院同期体检健康者38例为对照组。比较各组CysC、尿RBP、尿β₂-MG水平情况,受试者工作特征曲线(ROC)分析各指标诊断价值;Pearson相关性及多元线性回归分析eGFR与各指...     

透析开始残余肾功能与维持性透析患者预后的关系

目的 评估终末期肾病患者透析开始残余肾功能与维持性透析预后的关系.方法 收集2005年1月1日至2009年9年30日新进入血透或腹透治疗的终末期肾病成年患者资料,随访至2010年3月31日.根据透析开始时估算肾小球滤过率(eGFR)分为≥10.5、8～＜10.5、6～＜8、＜6 ml· min-1·(1.73 m2)-1 4组.eGFR评估采用MDRD简化公式.终点事件为全因死亡和心脑血管死亡.结果 (1)共562例患者入选,透析开始中位eGFR为5.60(2.26～12.62) ml· min-1·(1.73 m2)-1;中位随访时间为17(0～58)个月 ;死亡141例,中位生存期为45.48(43.05 ～47.90)个月.随着透析开始eGFR下降,4组患者Scr、BUN、血尿酸(SUA)、血前白蛋白、血磷、血钙磷乘积、整段甲状旁腺激素(iPTH)、平均动脉压(MAP)逐渐升高 ;血红蛋白(Hb)、男性患者比例、并发糖尿病比例、Charison并发症指数≥5比例逐渐下降,差异均有统计学意义(均P＜ 0.05).随着透析开始eGFR下降,并发左室肥大比例有逐渐升高趋势,但差异无统计学意义.(2)Kaplan-Meier生存曲线显示4组患者总体生存率差异无统计学意义.Cox回归分析显示透析开始eGFR与透析预后无显著关系.对透析非早期(＞3个月)死亡患者进行Kaplan-Meier生存曲线分析,4组患者1年生存率差异无统计学意义.多因素Cox回归分析显示透析开始eGFR是透析1年生存预后的保护因素(HR =0.791,95％CI 0.669～0.935,P＜0.01).(3)以心脑血管死亡为终点事件,多因素Cox回归分析显示,透析开始eGFR是心脑血管生存预后(HR =0.868,95％CI 0.777～0.971,P＜0.05)和1年心脑血管生存预后(HR=0.937,95％CI 0.851～0.992,P＜0.05)的保护因素.(4)多因素Cox回归分析显示,透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,腹膜透析患者死亡风险下降10％(HR=0.90,95％CI 0.81～0.99,P＜ 0.05).血液透析方式4组患者Kaplan-Meier生存率分析显示,差异有统计学意义(Log-rank检验,P=0.047),8～＜10.5组生存率最低,与6～＜8组、＜6组差异有统计学意义(Log-rank检验,P=0.033,P=0.005).多因素Cox回归分析并未显示透析开始eGFR与预后相关.多因素Cox回归分析提示透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,慢性肾小球肾炎患者和慢性肾小球肾炎腹膜透析患者死亡风险分别降低16.6％(HR=0.834,95％CI 0.736～0.946,P＜0.01)和32.1％(HR=0.679,95％CI 0.535～0.862,P＜0.01).以心脑血管死亡为终点,多因素Cox回归分析显示透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,慢性肾小球肾炎患者心脑血管死亡风险下降18.2％(HR=0.818,95％CI 0.669～0.999,P＜0.05).结论 本组患者透析时机明显晚于国际透析指南的标准.随着透析开始eGFR降低,并发症增多及程度加重.早期透析可能无法提高透析患者的总体生存率,但可能有助于改善患者心脑血管及1年总体生存预后和腹膜透析、慢性肾小球肾炎患者的预后.     

甲状腺功能异常与血脂水平的相关性研究

目的:探讨甲状腺功能异常与血脂水平的关系。方法:选择2013年4月—2015年3月收治的甲状腺功能异常患者200例为研究对象,其中甲状腺功能亢进症与甲状腺功能减退症患者各100例,以同期健康体检者80例为对照,检测受试者甲状腺激素与血脂水平,并分析两者相关性。结果:单因素分析显示,3组间各甲状腺激素与血脂指标差异均有统计学意义(均P0.05);相关系分析显示,甲状腺功能异常患者促甲状腺激素(TSH)与总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B100(Apo B100)呈正相关(r=0.695、0.714、0.632);游离三碘甲状腺原氨酸(FT3)与TC、LDL-C、Apo B100呈负相关(r=-0.769、-0.705、-0.689);游离甲状腺素(FT4)与TC、LDL-C、Apo B100呈负相关(r=-0.728、-0.676、-0.625)(均P0.05)。结论:甲状腺功能异可导致血脂代谢的紊乱,临床上应予注意。     

慢性肾脏病3～4期患者左心室肥厚对肾脏预后的影响

目的了解慢性肾脏病(chronic kidney disease,CKD)3~4期患者左心室肥厚(left ventricular hypertrophy,LVH)的发生情况,并探讨其对肾脏预后的影响。方法选择2012年2月至2016年2月在湖北省中医院肾病内科门诊随访的CKD3~4期患者61例进行基线访视记录,了解LVH的发生情况并进行规律随访,记录终点事件包括血肌酐(SCr)水平翻倍、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)15 ml·min~(-1)·(1.73 m~2)~(-1)或下降大于50%、行肾脏替代治疗及死亡。将进入终点事件定义为肾功能进展组,截尾事件定义为肾功能平稳组,将2组各项指标进行比较,并运用COX风险回归模型对影响肾脏预后的相关因素进行分析。结果 61例CKD3~4期患者平均随访时间为(34.70±9.54)个月,其中1例脱落,22例患者进入终点,包括12例SCr水平翻倍/eGFR下降大于50%或15 ml·min~(-1)·(1.73 m~2)~(-1),8例进入维持性血液透析治疗,2例死亡。CKD3~4期患者左心室扩大、LVH、左心室舒张功能减退的比例分别为22.95%、37.70%、60.66%。肾功能进展组与肾功能平稳组比较,在收缩压、SCr、eGFR、室间隔厚度、左室舒张末期内径、左心室质量(left ventricular mass,LVM)、左心室质量指数(left ventricular mass index,LVMI)、左心室扩大比例及LVH比例方面,差异有统计学意义(P0.05)。COX回归分析单因素分析:收缩压(P=0.013)、LVM(P=0.003)、LVMI(P=0.001)、LVH(P0.001)、左心室扩大(P=0.009)是影响CKD3~4期患者肾脏进展的危险因素;多因素分析:收缩压(偏回归系数b=1.075,HR=2.931,P=0.025)、LVH(偏回归系数b=1.319,HR=3.740,P=0.048)进入回归方程。结论 LVH在CKD3~4期患者中已普遍存在,尽早对CKD3~4期患者血压、左心室结构异常进行干预和控制,对延缓病程进展,改善肾脏预后有重要意义。     

小儿心脏手术前补充甲状腺激素的作用

目的 观察小儿心脏手术前补充小剂量甲状腺激素对围术期甲状腺激素水平的影响及其对心肌的保护作用.方法 40例3～12岁先心病患儿随机均分为研究组(A组)和空白对照组(B组).A组于术前4 d至术前1 d每天按0.4 mg/kg口服甲状腺素片;B组不进行任何处理.分别于入院后、CPB前、CPB体温最低点、术后第1天、第2天、第4天取血测定三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)和促甲状腺激素(TSH)浓度.在手术结束前每组随机选6例患儿留取心房标本测定心肌球蛋白重链(MHC)亚型α、β mRNA的表达情况,在术后24 h取血测定血清肌酸激酶同工酶(CK-MB)及心肌肌钙蛋白(cTnI)阳性率.结果 A组患儿的T4浓度CPB体温最低点时降低(P＜0.05),而B组患儿的T4浓度CPB体温最低点、术后第1天和第2天时均有下降(P＜0.01).A组患儿T3和T4浓度在术后第1天、第2天高于B组(P＜0.05);FT3在CPB体温最低点、术后第1天和第2天时高于B组(P＜0.05);FT4在CPB前、术后第1天、第4天高于B组(P＜0.05).A组患儿正性肌力药的使用率低于B组(P＜0.05),CK-MB含量及cTnI阳性率也低于B组(P＜0.05).A组MHCα mRNA的表达量增强而MHCβmRNA的表达量减弱(P＜0.05).结论 心脏手术前补充小剂量甲状腺激素可明显纠正术后正常甲状腺病态综合征,减少正性肌力药物的使用并提供良好的心肌保护作用.     

肾功能不全患者行冠状动脉旁路移植术的长期随访结果

目的 分析估测肾小球滤过率(eGFR)<60 ml/(min·1.73 m~2)的患者冠状动脉旁路移植术后的长期随访结果.方法 回顾性分析1999年1月至2003年9月3371例冠状动脉旁路移植术患者的临床资料,用 Cockcroft-Gault公式计算eGFR,根据eGFR将患者分为肾功能不全组[eGFR<60 ml/(min·1.73 m~2),n=649]肾功能正常组[eGFR>=60 ml/(min·1.73 m~2),n=2722],比较两组患者的近远期随访结果.结果 肾功能不全组的住院病死率和随访4年病死率分别为2.77%和6.81%,明显高于肾功能正常组.肾功能不全组的其他围手术期并发症及远期不良事件发生率也明 显高于肾功能正常组.多因素 COX 回归分析结果显示,eGFR<60 ml/(rain·1.73 m~2)是冠状动脉旁 路移植术后远期死亡的独立危险因素(HR=1.948,95% CI:1.357-2.797,P<0.01).结论 eGFR <60 ml/(min·1.73 m~2)是冠状动脉旁路移植术的独立危险因素.     

尿富含半胱氨酸蛋白61在对比剂肾病中的早期诊断价值

目的探讨尿富含半胱氨酸蛋白61(cysteine-rich protein 61,CYR61)在对比剂肾病(contrast-induced nephropathy,CIN)早期诊断中的价值。方法于2017年1月至2018年8月在徐州医科大学附属淮安医院招募择期拟行经皮冠状动脉介入术的患者。采集患者一般临床资料、血生化、血常规、血凝常规。留取患者术前及术后2 h、4 h、8 h尿标本,采用ELISA法检测尿CYR61水平。统计分析时根据术前估算肾小球滤过率(eGFR)将患者分为eGFR≥60 mL·min~(-1)·(1.73 m~2)~(-1)(n=197)和eGFR60 mL·min~(-1)·(1.73 m~2)~(-1)(n=50)两组,两组中再按患者是否发生CIN分为CIN组与非CIN组,分别进行亚组分析,并绘制受试者工作曲线(ROC)评价尿CYR61在CIN早期诊断中的价值。结果在eGFR≥60 mL·min~(-1)·(1.73 m~2)~(-1)组与eGFR60 mL·min~(-1)·(1.73 m~2)~(-1)组中,发生CIN的患者的尿CYR61水平均在术后4 h达到高峰,此后尿CYR61水平出现下降。将术后4 h尿CYR61用于诊断CIN的发生,分别绘制ROC曲线,结果表明,eGFR≥60 mL·min~(-1)·(1.73 m~2)~(-1)患者采用术后4 h尿CYR61诊断CIN的最佳临界值为293.67 ng/L,灵敏度与特异度分别为90.91%、83.33%,AUC为0.88(95%CI 0.82～0.92);eGFR60 mL·min~(-1)·(1.73 m~2)~(-1)患者采用术后4 h尿CYR61诊断CIN的最佳临界值为266.23 ng/L,灵敏度与特异度分别为100.00%、78.79%,AUC为0.89(95%CI 0.77～0.96)。结论在eGFR≥60 mL·min~(-1)·(1.73 m~2)~(-1)患者和eGFR60 mL·min~(-1)·(1.73 m~2)~(-1)患者中,术后4 h尿CYR61水平可作为CIN的早期诊断指标。     

Correlation between serum asymmetric dimethylarginine and blood pressure variability in chronic kidney disease patients

Objective To determine the correlation between serum asymmetric dimethylarginine (ADMA) and non-spoon-shaped blood pressure of non-dialysis chronic kidney disease (CKD) patients, also to observe the impact of the serum ADMA level on the structure and function of left ventricle. Methods One hundred and twenty cases of non-dialysis CKD patients underwent 24-hour ambulatory blood pressure monitoring were divided into three groups: CKD1-2, CKD3, CKD 4-5. Serum ADMA concentration was measured using liquid chromatograph and other clnical data such as uric acid (UA), left ventricular mass index (LVMI), 24 h urine protein, and high-sensitivity C-reactive protein (hs-CRP) were collected for further statistical analysis. Results (1) With the decline of renal function, ADMA concentration was increased, from CKD 1-2 (1.70±0.48) μmol/L rose to CKD 4-5 (4.46±1.56) μmol/L (P＜0.05). (2)There were 42 cases of CKD patients with hypertension and 78 cases of CKD patients with normal blood pressure. The serum ADMA levels in hypertension group was significantly higher than those in non-hypertensive group [(3.53±1.70) μmol/L vs (2.01±0.65) μmol/L, P＜0.05]. (3)There were 50 cases of non-spoon-shaped normotensive CKD patients and 28 cases of spoon-shaped normotensive CKD patients. Serum ADMA level and LVMI in non-spoon-shaped group were significantly higher than that in spoon-shaped group when kidney functions appeared to be equal (P＜0.05). (4)Serum ADMA level was positively correlated with UA(r=0.352, P＜0.01), LVMI (r=0.345, P＜0.05), 24 h urine protein(r=0.200, P＜0.05), and high-sensitivity C-reactive protein (r=0.309, P＜0.01), but negatively correlated with the left ventricular ejection fraction (LVEF)(r=-0.329, P＜0.01) and estimated glomerular filtration rate (eGFR)(r=-0.011, P＜0.01). Multiple regression results showed that eGFR, UA, LVMI, hs-CRP, 24 h urine protein were associated with ADMA level. The regression equation was Y=1.991-0.011×[eGFR]+0.002×[UA]+0.008×[LVMI]+0.036× [hs-CRP]-0.084×[24 h urinary protein]. Conclusions Serum ADMA level begins to increase in early stage CKD and it progressively increases with the decline of renal function, also the non-spoon-shaped blood pressure ratio and the left ventricular damage increase. Kidney function, urine protein and microinflammatory state may impact on the serum ADMA level.     

慢性肾脏病患者血浆同型半胱氨酸水平与左心室肥大的关系

目的探讨早期慢性肾脏病（CKD）血浆同型半胱氨酸（Hcy）水平及其与左心室肥大（LVH）的关系。方法64例早期CKD患者分为3组,即A组[eGFR≥90ml·min^-1·（1．73m^2）^-1]31例;B组[eGFR60～89ml·min^-1·（1．73m^2）^-1]22例;C组[eGFR30～60ml·min^-1（1．73m^2）^-1]11例。另设同期健康体检者25例为对照组（N组）。采用荧光偏振免疫分析法测定血浆Hcy浓度,心脏超声检测左室舒张末期内径（LVDd）、室间隔厚度（IVST）和左室后壁厚度（LVPWT）、左心室心肌质量指数（LVMI）。结果①A组血浆Hcy与N组比较无统计学差异（P〉0．05）;B组和C组血浆Hcy显著高于A组和N组（P〈0．01）;C组血浆Hcy显著高于B组（P〈0．01）。CKD组高Hcy（〉12μmol／L）比例为39．06％,是N组的3．26倍。②A组、B组和C组各期左室质量指数（LV—MI）、左室舒张末期内径（LVDd）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）均较N组显著增加。③血浆Hcy与LVPWT显著正相关（r=0．400,P=0．000）,与LVMI、LVDd、IVST无相关性。结论早期CKD即出现高Hcy血症,随肾功能进展而加重;血浆Hcy与早期CKD的左心室肥厚有关。     

慢性肾脏病患者血清胎球蛋白A水平的测定和意义

目的：测定慢性肾脏病（CKD）患者血清中胎球蛋白A（FA）的水平,探讨FA在CKD患者中的表达,为CKD患者早期血管钙化的临床干预提供思路.方法：实验组：选择2013年1月～2013年12月在定西市人民医院肾内科治疗的CKD未透析患者90例,肾小球滤过率（glomeruarfiltrationrate,GFR）计算参照MDRD公式并依据CKD分期,将90例患者分为3个组,A组：eGFR≥60ml·min-1· 1.73 m-2（CKD1、2期）、B组：eGFR 30～59 ml·min-1· 1.73 m-2（CKD3期）、C组：eGFR≤29 ml·min-1·1.73 m-2（CKD4、5期）.对照组：同期在定西市人民医院体检中心选取30例年龄、性别相匹配的健康体检者.两组均抽取空腹静脉血,用ELISA法测定血清FA水平;同时测定血清白蛋白（Alb）,血清钙（Ca）,血清磷（P）,血iPTH等.采用SPSS 17.0统计软件对得出的数据进行处理.结果：（1）实验组与对照组比较：B组与对照组比较,FA水平低于对照组（P＜0.05）;C组与对照组比较,FA水平低于对照组（P＜0.05）,血磷水平高于对照组（P＜0.05）;（2）实验组组间进行比较：A组与B组：B组FA水平低于A组（P＜0.05）;C组与B组：C组FA水平低于B组（P＜0.05）.C组血磷水平高于B组（P＜0.05）;实验A组与实验C组：实验C组FA水平低于实验A组（P＜0.05）.实验C组血磷水平高于实验A组（P＜0.05）;（3）相关性分析结果显示,血清胎球蛋白A与血磷、钙磷乘积负相关（P＜0.05）.与白蛋白水平正相关（P＜0.05）.结论：（1）随着肾功能的下降,FA水平也下降,eGFR 30～59 ml/min（CKD3期）时,FA水平下降明显.（2）在CKD患者中,FA水平与血白蛋白成正相关,与血磷、钙磷乘积成负相关.     

Analysis of impact factors of serum N-terminal pro-brain natriuretic peptide in patients with renal failure in non-dialysis phase

Objective To analyze the impac factors of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with renal failure in non-dialysis phase, and to determine the cut-off point of as a diagnostic values in these patients with heart failure (HF). Methods Cross-sectional study was applied. Clinical data of 145 patients (37 cases of CKD4, 89 cases of CKD5, and 19 cases of acute renal injury (AKI) with renal failure in non-dialysis phase were collected. Comparison between groups and lineal regression analysis were utilized to investigate the impact factors of NT-proBNP, and the receiver operating characteristic curve (ROC curve) to select a better cut-off point of diagnosis in these patients with HF. Results (1) Compared with patients without HF, patients with HF had significantly higher edema, cardiac troponin I, serum phosphorus concentration, and left atrial diameter (LA), while ALB and left ventricular ejection fraction (LVEF) were decreased (P＜0.05). (2) The NT-proBNP was divided into 4 groups with four points: First groups of 36 cases, NT-proBNP 1 -862 ng/L, second groups 37 cases, 866-2670 ng/L, third groups 37 cases, 2790-20 000 ng/L, fourth groups 35 cases, 20 900-35 000 ng/L. With the increase of NT-proBNP levels, the occurrence of AKI and CKD4 decreased gradually while the occurrence of CKD and edema were significantly increased (P＜0.01). Systolic blood pressure, troponin I, uric acid, serum phosphorus, parathyroid hormone, 24 hours urine protein, LA, interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) level gradually increased. Hb, ALB, calcium, CO2, eGFR, LVEF significantly decreased (P＜0.01). The serum NT-proBNP of patients with HF was significantly higher than that of patients without HF (19 150 ng/L vs 1530 ng/L, P＜0.01). The serum NT-proBNP of patients with edema was significantly higher than that in patients without edema (5460 ng/L vs 1630 ng/L, P＜0.01). (3) Single factor linear regression analysis indicated that higher NT-proBNP was positive correlated with HF, edema, cardiac troponin I, uric acid, serum phosphorus, LA, IVS and LVPW (P＜0.05), while negative correlated with Hb, eGFR, ALB, serum calcium, CO2, LVEF (P＜0.05), and not correlated with eGFR, uric acid, serum calcium (P＞0.05). (4) The best cut-off point of NT-proBNP predicting HF in patients with renal failure in non-dialysis phase was 3805 ng/L, AUC=0.848, 95%CI 0.786-0.910. Sensitivity was 82.4%, specificity 74.5%, positive predictive value 62.1%, negative predictive value 87.3%, positive likelihood ratio 3.2, negative likelihood ratio 0.24. Conclusions The level of NT-proBNP＞20 000 ng/L is mainly found in end-stage renal disease patients with HF. HF is a main factor for the increase of NT-proBNP in patients with renal failure in non-dialysis phase. High phosphorus viremia, anemia, and hypoalbuminemia are closely related to NT-proBNP. Therefore NT-proBNP predicting HF should take into account the effects of these confounding factors in these patients.     

Relationship between interventricular septum thickness and renal function in patients with type 2 diabetes mellitus

Objective To investigate the relationship between interventricular septum thickness(IVS) and renal function in patients with diabetes mellitus. Methods Two hundred and sixty-five patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their IVS, the patients were divided into normal group (IVS≤11 mm) and higher IVS group (IVS＞11 mm). All patients according to evaluated glomerular filtration rate (eGFR) level were divided into eGFR≥60 ml?min-1?(1.73 m2)-1 group and eGFR＜60 ml?min-1?(1.73 m2)-1 group. The demographic characteristic, biochemical examination, eGFR, and proteinuria of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IVS and other parameters. eGFR＜60 ml?min-1?(1.73 m2)-1 and IVS thickening were analyzed by binary logistic regression. Risk factors affect the prognosis of renal function in patients with diabetes mellitus were analyzed by Cox regression analysis. Results Compared with normal group, patients in the higher IVS group had higher systolic pressure (P=0.002), their level of Scr, BUN, 24 h urinary protein were increased (all P＜0.05), while the level of eGFR, albumin (ALB), hemoglobin (Hb) and fasting blood glucose were decreased (all P＜0.05). The prevalence of hypertension was increased (81.16% vs 58.67%, χ2=11.273, P=0.001), and there was also a difference in the proportion of patients in each stage of CKD (χ2=34.593, P＜0.001). Correlation analysis showed that IVS was positively correlated with BMI, systolic BP, Scr, BUN, 24 h urinary albumin, 24 h urinary protein (all P＜0.05), while negative correlation was observed between the thickened degree of IVS and Hb, albumin, eGFR and total calcium (all P＜0.05). It's worth noting that IVS also correlated with history of hypertension and degree of renal injury (all P＜0.01). Logistic regression analysis showed that longer duration of diabetes, higher systolic pressure and BUN were independent risk factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05), while higher Hb and Alb were independent protective factors for eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Logistic regression analysis also showed that the baseline increased Scr was independent risk factor for interventricular thickening (P＜0.05), while the increase of fasting blood-glucose was independent protective factor for interventricular thickening (P＜0.05). Cox regression analysis showed that interventricular thickening was an independent risk factor in predicting the progression of type 2 diabetes (HR=1.396, 95%CI=1.098-1.774, P=0.006). Conclusion Interventricular septum thickness is closely related to the state of renal function, as well as is an independent risk factor to predict kidney function decline in patients with type 2 diabetes.     

Value of carnitine palmitoyltransferase 1α expression for the assessment of the degree of renal fibrosis and the progression of chronic kidney disease

Objective To study the relationship between the expression of carnitine palmitoyltransferase 1α (CPT1α) and progression of renal interstitial fibrosis and chronic kidney disease (CKD), and to evaluate the value of CPT1α as a biomarker in pathological diagnosis of renal interstitial fibrosis and CKD. Methods As a retrospective cohort study, information of CKD patients dignosed with tubulointerstitial fibrosis by renal biopsy and receiving follow-up from March 1, 2010 to July 30, 2017 in the Second Affiliated Hospital of Nanjing Medical University were collected. Renal tissues were stained by immunohistochemistry to detect the expression of CPT1α protein and then divided into three groups according to the quartile of proportion of CPT1α positive staining cells, including group Q1(＞67.89%), group Q2(49.84%-67.89%) and group Q3(＜49.84%). The degree of renal interstitial fibrosis was measured by Masson staining and lipid deposition was represented by Bodipy staining. Messenger RNA of CPT1α and collagen as well as other extracellular matrix genes were detected by real time-PCR. Relationships between proportion of CPT1α positive staining cells and renal interstitial fibrosis and renal function were analyzed by linear regression analysis. The relationship between CPT1α positive cell number ratio and renal function progression was measured by Pearson correlation analysis and generalized linear model. The effect of lipid-lowering medicine on renal function of CKD patients was analyzed by paired comparative analysis. Results Ninety patients with CKD were included in this study. Renal interstitial fibrosis and lipid droplets deposition area increased in Q2/Q3 group compared with Q1 group by Masson and Bodipy staining (all P＜0.05). Messenger RNA level of extracellular matrix-related proteins increased in Q2/Q3 group by real time-PCR than those of Q1 group (all P＜0.05). Linear regression analysis showed that fibrosis area was negatively correlated with the proportion of CPT1α positive staining cells (r=-0.309, P＜0.01). The baseline expression of CPT1α in renal issues was negatively related with serum creatinine (Scr) (r=-2.801, P＜0.001), positively related with estimated glomerular filtration rate (eGFR) (r=1.240, P＜0.001). After a medium follow-up of 3.47 years, CPT1α positive cell number ratio was positively correlated with eGFR change rate by Pearson analysis (r=0.220, P=0.038). Paired stratified analysis showed that taking lipid-lowering medicines attenuated the decrease of eGFR in Q2 group and Q3 group but not in Q1 group (both P＜0.05). Conclusions The decline of CPT1α in renal tissues of CKD patients is associated with the increase of Scr, the decrease of eGFR and renal interstitial fibrosis. CPT1α is a promising molecular marker to evaluate the degree of renal fibrosis and the progression of CKD.     

Assessment and risk factors analysis for quality of life in elderly patients with chronic kidney disease

Objective To understand the comprehensive geriatric assessment (CGA) scores in chronic kidney disease (CKD) patients aged 65 years and older, and analyze the related influencing factors of quality of life. Methods A total of 189 patients who were over 65 years old and diagnosed with CKD in the Department of Nephrology of Shanxi Provincial People's Hospital from October 2016 to October 2019 were included retrospectively. The patients were divided into dialysis group (n=90 cases) and non-dialysis group (n=99 cases) according to whether dialysis or not. The concise CGA scores included age, basic activities of daily living (BADL), instrumental activities of daily living (IADL), and modified cumulative illness rating score for geriatrics (MCIRS-G). Pearson correlation analysis was used to analyze the relationship between different scale scores and clinical indexes. Multiple linear regression analysis was used to further analyze independent related factors of the quality of life in elderly CKD patients. Results Compared with the non-dialysis group, the BADL score and IADL score in the dialysis group were significantly reduced [(70.00±33.28) vs (93.38±14.32), t=6.166, P＜0.001;(9.78±7.12) vs (15.95±5.74), t=6.520, P＜0.001], while the MCIRS-G score was significantly increased [(31.13±4.00) vs (27.29±5.17), t=-5.741, P＜0.001]. Linear regression analysis performed on the data of non-dialysis group patients showed that estimated glomerular filtration rate (eGFR), serum uric acid (SUA), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), blood potassium and chlorine were positively correlated with BADL and IADL scores (all P＜0.05). B-type natriuretic peptide (BNP) was negatively correlated with BADL score (P＜0.01). BNP and age were negatively correlated with IADL score (both P＜0.05). Fasting blood glucose (FBG) was positively correlated with MCIRS-G or MCIRS-G other than kidney (both P＜0.05), and eGFR, SUA, total cholesterol, and HDL-C were negatively correlated with MCIRS-G or MCIRS-G other than kidney (all P＜0.05). Multiple linear regression analysis showed that eGFR was an independent influencing factor for BADL (P＜0.01). Age and eGFR were independent influencing factors for IADL (both P＜0.05). Conclusions The decline of quality of life in elderly CKD patients is related with eGFR, SUA, age, BNP and HDL-C levels, and eGFR and age are independent influencing factors.     

Relationship between insulin resistance and increased carotid artery intima-media thickness in non-diabetic kidney disease patients

Objective To evaluate the relationship of insulin resistance (IR) and carotid artery intima-media thickness (CA-IMT), plaque status in non-diabetic non-dialysis chronic kidney disease (CKD) patients with different stages. Methods One hundred and seventeen non-diabetes non-dialysis CKD patients were enrolled into this cross-sectional observational study. Insulin resistance index (HOME-IR) was assessed by the homeostasis model assessment. Patients with HOME-IR≥1.73 were defined as insulin resistance. And patients with CA-IMT≥0.9 mm were defined as thickening. The blood pressure measurement, heart Doppler ultrasound, bilateral carotid artery ultrasound examination, blood biochemistry and urine protein test were performed, eGFR was calculated by EPI formula. Results The prevalence of IR was 47.01% in 117 non-diabetic non-dialysis CKD patients, and it was 35.71%, 50.00% and 54.55% in eGFR≥60ml•min-1•(1.73 m2)-1 group, 30≤eGFR＜60ml•min-1•(1.73 m2)-1 group, and eGFR＜30ml•min-1•(1.73 m2)-1 group separately. In eGFR＜30ml•min-1•(1.73 m2)-1 group, cystain C, homocysteine, parathyroid hormone, Scr, BUN, uric acid, interventricular septal thickness, left ventricular dimension, left ventricular posterior wall thickness were significantly higher than that in the other two groups (P＜0.01), while the level of hemoglobin was significantly lower (P＜0.01); then the levels of serum albumin and systolic pressure were higher than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group, however, the levels of total cholesterol and low-density lipoprotein-cholesterol were lower than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group. Correlation analysis showed that insulin resistance index was significantly correlated with CA-IMT (r=0.444, P=0.006）in the eGFR＜30ml•min-1•(1.73 m2)-1 group, however, there wasn’t correlation in other two groups. And although insulin resistance wasn’t correlated with soft plaque, it was significantly correlated with hard plaque (χ2=6.476, P=0.011) in the eGFR＜30ml•min-1•(1.73 m2)-1 group. The Logistic regression analysis results displayed aging increase was the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients but not insulin resistance. Conclusions HOMA-IR is correlated with CA-IMT and hard plaque when eGFR＜30ml•min-1•(1.73 m2)-1 in non-diabetes non-dialysis CKD patients. However, the insulin resistance isn’t the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients.     

Relationship between serum adiopocyte fatty acid binding protein and atherosclerosis in chronic kidney disease

Objective To investigate the expression of serum adiopocyte fatty acid binding protein(A-FABP) in chronic kidney disease (CKD) and the role that A-FABP plays in CKD with atherosclerosis. Methods A total of 138 patients with CKD and 20 health control volunteers (HC) were involved in this study. The levels of serum A-FABP, free fatty acid (FFA), interleukin- 6 (IL-6), monocyte chemotactic protein 1(MCP-1) were measured by enzyme-linked immunosorbent assay(ELISA). Inteima-media thickness of common carotid artery was measured by color doppler ultrasound.Results According to the progression of glomerular filtration rate(GFR), the patients with CKD were divided into three groups: group CKD1-2[eGFR≥ 60 ml·min-1·(1.73 m2)-1], group CKD 3-4[60 ml·min-1·(1.73 m2)-1 > eGFR ≥ 15 ml·min-1·(1.73 m2)-1], group CKD5[eGFR ＜ 15 ml·min-1·(1.73 m2)-1].The levels of serum A-FABP were relatively higher in CKD than that in HC group(P＜0.05), and that in the group CKD5 were the most highest (P＜0.01). The level of serum FFA in group CKD 1-2 was relatively higher than that in group HC (P＜0.05), and FFA had a rising trend with decreased eGFR. The level of serum A-FABP was positively correlated with the levels of serum FFA (r＝0.825, P＜0.01), and also positively correlated with IL-6 (r＝0.569, P＜0.01), MCP-1(r＝0.657, P＜0.01) in CKD by Pearson correlation analysis. The levels of A-FABP in 56 patients of CKD with vascular atherosclerosis were significantly higher than that in 82 patients without vascular atherosclerosis (P＜0.01). Conclusion Serum A-FABP maybe play an important role in the progression of vascular atherosclerosis in CKD.