The concentration of plasma fibronectin in burns patients treated with fresh frozen plasma or plasma protein fraction

A group of 10 patients with 30-70% burns were given intravenous infusions during the first 48 h following hospital admission either with fresh frozen plasma (FFP) or human plasma protein fraction ( HPPF ). FFP contained 300-400 mg/dl plasma fibronectin whereas none was detectable in HPPF . Circulating plasma fibronectin levels fell quickly in those patients receiving HPPF and levels remained low for 2-3 weeks. In those receiving FFP, plasma fibronectin remained normal during the 48-h transfusion period but fell subsequently. Fibronectin may be an important determinant in the resistance to shock and infections. Consideration should therefore be given to the use of blood products which contain fibronectin and to the monitoring of plasma levels both during the acute and recovery periods after burn injury.     

糖尿病肾病尿微量白蛋白的相关因素分析

糖尿病发病率增长之迅速，已使其成为一非传染性流行病。我国糖尿病的患病率已超过总人口的2．5％。30％～45％的1型糖尿病和5％～10％的2型糖尿病患将发展为终末期肾病，需透析或肾移植来维持生命。在临床常规方法诊断糖尿病肾病时几乎已无法防止患肾功能的衰退，如在早期诊断糖尿病肾病，即微量蛋白尿期或之前，予针对性治疗．有可能控制和延缓肾病的进一步发展。本研究旨在探讨与2型糖尿病尿微量白蛋白相关的各项危险因素，指导临床对糖尿病肾病的早期预防及诊疗。     

Increased plasma concentration of matrix metalloproteinase-7 in patients with coronary artery disease

BACKGROUND: Plaque rupture is often associated with breakdown of the extracellular matrix in the shoulder region of a plaque. We tested whether plasma concentrations of various matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase-1 (TIMP-1) could serve as markers for plaque instability as well as relationships between plasma MMPs and inflammatory markers. METHODS: The study group included 65 men with angiographically verified CAD (45 with stable and 20 with unstable CAD) and 28 healthy controls. Circulating MMP, TIMP-1, C-reactive protein, and cytokine concentrations were measured by ELISA. Leukocyte subtype counts in whole blood were determined, and T-cell subsets and natural killer cells were measured by flow cytometry. Differences in continuous variables between groups were tested by ANOVA with the Scheffé F-test used as a post hoc test, and correlations were analyzed by a linear regression method. RESULTS: The plasma concentration of MMP-7 was increased in patients with stable and unstable CAD, whereas MMP-2 and -3 concentrations were decreased. The plasma concentration of TIMP-1 was significantly increased in patients with unstable CAD. MMP-2, -3, and -7 showed no correlations with established markers of inflammation. However, MMP-2 correlated positively with the number of natural killer cells in patients with stable and unstable CAD. CONCLUSION: Plasma concentrations of MMPs and TIMPs may be markers of CAD but appear to be differentially regulated.     

Level of plasma fibronectin in patients with breast cancer

Plasma fibronectin was determined by laser nephelometric immunoassay in two populations: healthy individuals and patients with metastatic or non-metastatic breast cancer. The results showed that the fibronectin concentration was higher in the patient group than in the healthy controls of similar age, with a significant difference (p less than 0.05). The patients who had metastatic breast cancer tended to show higher levels than those with no detectable metastasis, but such a difference was not statistically significant. Since fibronectin is sensitive to clinical events unrelated to the malignancy status, it does not seem suitable as a tumor marker.     

早期糖尿病肾病患者血清同型半胱氨酸和尿微量白蛋白的相关性研究

[目的]测定2型糖尿病早期肾病患者血清同型半胱氨酸（Hcy）水平,探讨其与尿微量白蛋白的相关性。[方法]应用东芝120全自动生化分析仪用循环酶法检测62例糖尿病患者的血清Hcy浓度,其中早期糖尿病肾病组32例,单纯糖尿病组30例,并以30例健康体检者作为对照组。采用免疫比浊法测定尿微量白蛋白水平。[结果]早期糖尿病肾病组及单纯糖尿病组血清Hcy水平高于对照组（P〈0．05）,早期糖尿病肾病组血清Hcy水平与单纯糖尿病组比较有统计学差异（P〈0．05）,早期糖尿病肾病组血清Hcy与尿微量白蛋白呈正相关。[结论]血清Hcy对糖尿病早期肾损伤具有重要的诊断价值。     

护理干预对糖尿病尿微量蛋白异常患者的影响

目的:探讨护理干预对早期糖尿病肾病的影响.方法:将136例糖尿病尿微量蛋白异常患者分为实验组和对照组各68例,实验组采用系统的护理干预措施,对照组采用传统的护理方法.结果:实验组患者血糖、血压、血脂、体重指数、尿微量白蛋白数值明显低于对照组(P<0.05).结论:尿微量蛋白检查能尽早发现糖尿病肾病患者,系统的护理干预能显著阻断或延缓早期糖尿病肾病的发展.     

不同血糖浓度患者尿微量白蛋白指标分析

目的探讨不同糖尿病患者尿微量白蛋白(MA)指标检测的意义。方法随机选取100例门诊及住院患者病例样本分为健康对照组、糖尿病前期组和2型糖尿病组,检测空腹静脉血糖和尿MA,并对检测结果进行比较分析。结果健康对照组、糖尿病前期组和2型糖尿病组间的比较差异有统计学意义(P<0.05)。结论对糖尿病前期患者定期进行MA检测,来对比监测病程发展对于早期发现糖尿病肾病,早治疗早预防,改善预后具有非常重要的家庭和社会意义。     

Increased urinary transferrin excretion predicts microalbuminuria in patients with type 2 diabetes.

OBJECTIVE: We studied whether increased urinary transferrin excretion rates (TERs) (urinary transferrin-to-urinary creatinine ratio > or = 107 micrograms/mmol, which is the sum of an average and 2 SDs in 431 healthy nondiabetic individuals) would predict the development of microalbuminuria (urinary albumin-to-urinary creatinine ratio > or = 2.8 mg/mmol) in patients with type 2 diabetes and normal urinary albumin excretion rates (AERs) (albumin-to-creatinine ratio < 2.8 mg/mmol). We also studied the influence of blood pressure, glycemic control, and serum levels of lipids and apolipoproteins on the later development of microalbuminuria. RESEARCH DESIGN AND METHODS: In 77 diabetic patients with normal AER, AER and TER were measured at baseline and after 24 months of follow-up. Blood pressure, glycemic control, and serum levels of lipids and apolipoproteins were measured at 1- to 2-month intervals during the follow-up period. RESULTS: Of the 16 patients who initially had increased TER, 5 (31%) developed microalbuminuria. In contrast, of the 61 who initially had normal TER, 4 (7%) developed microalbuminuria (P = 0.016). At baseline, no difference was found in age, sex, diabetes duration, diabetic medications, prevalence of hypertension, blood pressure, HbA1c levels, or serum lipid and apolipoprotein concentrations between the two group of patients with normal and increased TER. There was also no difference in duration of hypertension and prevalence of users of ACE inhibitors between two subgroups of hypertensive patients with normal and increased TER. During the 24 month follow-up period, those whose condition progressed to microalbuminuria had increased serum levels of triglycerides (1.87 +/- 0.49 vs. 1.29 +/- 0.64 mmol/l, P = 0.003) and apolipoprotein B (114 +/- 20 vs. 102 +/- 24 mg/dl, P = 0.05) and tended to have increased HbA1c levels (7.7 +/- 1.0 vs. 7.1 +/- 1.1%, P = 0.10) compared with those in whom microalbuminuria did not develop. Blood pressure, however, did not differ. In multivariate stepwise logistic regression analysis, the association between increased TER at baseline and subsequent development of microalbuminuria was significant (odds ratio 7.04 [95% CI 1.02-48.5], P = 0.04). CONCLUSIONS: In patients with type 2 diabetes and normal AER, increased TER may predict the development of microalbuminuria and abnormalities in triglyceride-rich lipoprotein metabolism, and poor glycemic control may be associated with this progression.     

Intraperitoneal insulin reduces plasma leptin concentration in diabetic patients on CAPD.

OBJECTIVE: To determine the effects of subcutaneous (SC) and intraperitoneal (IP) insulin on serum leptin concentration in type I diabetic patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Prospective, open, before-after study. SETTING: Tertiary-care university hospital. PARTICIPANTS: Twelve type I diabetic patients with stabilized CAPD, age 43.9 +/- 2.8 years, and duration of diabetes 30.4 +/- 3.5 years. INTERVENTION: After stabilized CAPD therapy, all patients were treated first with SC insulin for a median of 3 months, and thereafter with IP insulin for another 3 months. MAIN OUTCOME MEASURES: Plasma leptin, insulin sensitivity with euglycemic clamp, and glycemic and uremic status after both treatment periods. RESULTS: During SC insulin therapy, plasma leptin concentration was significantly higher than during IP insulin (19.8 +/- 5.9 ng/mL and 12.8 +/- 6.2 ng/mL, respectively; p < 0.001). Leptin concentration was higher in CAPD patients and was related to body mass index in both genders. No correlation was detected between plasma leptin and fasting insulin, glycemic control, glucose disposal rate, or serum lipids. CONCLUSION: Plasma leptin concentration is lower during IP insulin therapy compared to SC insulin. Insulin has probably a direct effect on both peritoneal leptin clearance and adipose tissue leptin production. The significance of leptin in regulating appetite and anorexia in uremia remains unclear.     

Level of plasma fibronectin in patients with peripheral vascular disease

Plasma concentration of fibronectin, a recently characterized high molecular mass glycoprotein, was determined in patients with peripheral vascular disease. The plasma fibronectin concentration was lower in patients with peripheral obstructive arterial disease as well as in patients with venous disease, than in corresponding healthy controls. Patients with venous disease had significantly lower levels of plasma fibronectin than patients with peripheral obstructive arterial disease. The patients with peripheral arterial disease were divided into two groups, one having diabetes and another not having diabetes respectively. Between these two groups there was no significant difference in plasma fibronectin concentration.     

Plasma and urine fibronectin concentration in kidney-transplanted patients

Plasma and urine fibronectin concentration was determined by electroimmunoassay and ELISA-method in patients who received renal transplantation. The plasma fibronectin concentration decreased both after the transplantation, in relation to the acute rejection of the graft, and in the relation to immunosuppressive therapy. Urine fibronectin excretion increased in relation to the kidney transplantation and acute rejection of the graft. In association with improved kidney function, the urine fibronectin excretion decreased. It is suggested that it might be of clinical importance to determine the excretion of fibronectin into the urine in patients undergoing kidney transplantation.     

Increased thrombomodulin values in plasma of diabetic men with microangiopathy.

To study the significance of plasma thrombomodulin (TM) values in diabetes mellitus, we determined plasma TM in 34 patients with non-insulin-dependent diabetes mellitus (NIDDM) men, mean age 54 (SE 2) years. Plasma TM was determined by an enzyme immunoassay with anti-TM monoclonal antibodies. The plasma TM values were significantly greater in NIDDM patients with nephropathy than in patients without nephropathy (P less than 0.001). Also, a significant positive correlation was noted between the concentration of plasma TM and serum creatinine (r = 0.55, P less than 0.001). The plasma TM values of the patients with retinopathy were significantly greater than the values of those without it (P less than 0.002). Furthermore, we noted a significant positive correlation (r = 0.78, P less than 0.001) between plasma TM and the severity of diabetic retinopathy as graded by Scott's classification. These results suggest a close relationship between TM and diabetic microangiopathy.     

利拉鲁肽对微量白蛋白尿期糖尿病肾病患者肾功能的影响

目的 对利拉鲁肽治疗微量白蛋白尿期（Ⅲ期）糖尿病肾病（DN）疗效及安全性进行观察。方法 将86例微量蛋白尿期DN患者随机分为两组。对照组给予常规降糖治疗,观察组在对照组基础上给予利拉鲁肽治疗,治疗6个月后比较两组体重指数（BMI）、空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA IR)、尿微量白蛋白排泄率（UMAER）、血肌酐（SCr）、计算尿白蛋白肌酐比值(ACR)及肾小球滤过率(eGFR)。结果 治疗前,两组血糖及肾功能指标比较差异无统计学意义(P＞0.05)。治疗后,两组BMI、FBG、PBG、HbA1c、HOMA IR 、BUN、SCr、UMAER及ACR降低,而FINS及 eGFR水平升高(P＜0.05),但观察组改善更加明显（P＜0.01）。观察组低血糖的发生率低于对照组。结论 利拉鲁肽可在降血糖的基础上保护肾脏,改善肾功能且发生低血糖的概率低。     

Plasma and urine malondialdehyde levels in non-insulin-dependent diabetic patients with and without microalbuminuria

Summary Malondialdehyde, a marker of lipid peroxidation, was measured as thiobarbituric acid-reactive substance in 78 non-insulin-dependent diabetic patients and 28 healthy subjects. Patients were divided into groups and subgroups according to the presence of microalbuminuria and other complications. Plasma and urine malondialdehyde concentrations were significantly higher in patients with and without microalbuminuria than in controls. In contrast to urine malondialdehyde, plasma malondialdehyde levels were significantly higher in microalbuminuric diabetes than in the nomoalbuminuric diabetic group. There was no correlation between malondialdehyde concentration and glycemic control. This study confirmed the existence of lipid peroxidation disorders in diabetic patients.     

吡格列酮对2型糖尿病肾病患者骨桥蛋白和尿微量白蛋白的影响

目的:探讨吡格列酮对2型糖尿病(T2DM)早期肾病患者血清骨桥蛋白(OPN)及尿微量白蛋白/尿肌酐比值(UMA/Cr)的影响.方法:90例T2DM患者按照2009年ADA糖尿病指南以UMA/Cr分为单纯糖尿病组(DM,UMA/Cr＜ 30 μg/mg)30例、糖尿病肾病组(DN,UMA/Cr:30 ～ 299 μg/mg)60例,同时选择30名体检正常者为正常对照组.再将DN组随机分为吡格列酮组30例(吡格列酮30 mg/d+胰岛素,n=30)和安慰剂组30例(安慰剂+胰岛素,n=30),随访治疗3个月.所有对象均测定血糖、血脂、肾功能、C反应蛋白(CRP)、OPN和UMA/Cr等.结果:吡格列酮组治疗3个月后,UMA/Cr[(35.02±6.38) μg/mg vs(86.30±12.21) μg/mg、P＜0.01]、OPN[(394.24±19.43)ng/mL vs (457.00±15.21) ng/mL、P＜0.01]及HbA1c、TG、CRP与安慰剂组比较均显著降低,差异有统计学意义.相关性分析显示△UMA/Cr(△:治疗前-治疗后的差值)与血清△OPN(r=0.673,P=0.000)呈显著正相关.结论:T2DM肾病患者血清OPN水平升高.吡格列酮能减少UMA/Cr水平.其部分可能是通过降低血清OPN水平实现的.     

The effect of glycemic control on plasma soluble fibrin monomer complexes and fibronectin in diabetic patients

We have shown previously that increased concentrations of plasma soluble fibrin monomer complexes (SFMC) and elevated fibronectin (Fn) levels are closely related to the development of diabetic microangiopathy. The purpose of the present study was to explore whether or not changes in plasma glucose levels could have an effect on these protein constituents. Plasma glucose levels of 25 uncontrolled diabetic patients were brought under control with insulin and serial measurements of SFMC and Fn were made over a period of 4 weeks. Glucose values fell from an average of 312 mg/100 ml to 160 mg/100 ml. Ten patients with macroproteinuria (i.e. greater than or equal to 0.5 g/24 hr) showed initially elevated plasma SFMC and Fn concentrations. These levels fell significantly over the 4 week observation period: from 13.6 mg/100 ml to 9.4 mg/100 ml for SFMC and from 38.4 mg/100 ml to 34.5 mg/100 ml for Fn. The remaining 15 patients had nearly normal levels of both SFMC (7.9 mg/100 ml) and Fn (31.1 mg/100 ml) and glycemic control brought no further reduction. The data indicated that a) elevated SFMC and Fn levels are indeed associated with diabetic microangiopathy, especially in the presence of macroproteinuria; and b) adequate glycemic control is capable of normalizing the plasma concentration of these constituents.