益肾化湿颗粒治疗大鼠糖尿病肾病中ERK表达及意义

目的探讨益肾化湿颗粒在治疗大鼠糖尿病肾病中的ERK表达及其意义。方法将40只SD(Sprague-Dawley)大鼠随机分为正常对照组(N组)、糖尿病肾病组(DN组)、益肾化湿颗粒治疗组(DN+Y组)、贝那普利治疗组(DN+B组)。对照组用等量柠檬酸缓冲液腹腔注射,糖尿病肾病组和各治疗组制备糖尿病模型,取血检测血糖(GLU)、血清肌酐(SCr)、血清尿素氮(BUN)、24 h尿蛋白定量,以免疫组化方法检测各组肾组织p-ERK1/2表达及其意义。结果治疗后8周,DN组大鼠血糖明显升高,血清肌酐(SCr)、血清尿素氮(BUN)、24h尿蛋白定量等指标与N组相比明显升高,二者差异有统计学意义(P0.05);DN组肾组织内p-ERK1/2的表达与N组相比明显增高,二者差异有统计学意义(P0.05);其他治疗组的血糖、SCr、BUN、24 h尿蛋白定量、p-ERK1/2表达等指标与DN组相比,差异无统计学意义(P0.05)。结论在糖尿病肾病的产生、发展过程中,ERK参与其中,其表达增加可能对DN的进一步发展造成影响;益肾化湿颗粒能够对DN大鼠肾皮质中ERK的活性予以有效限制,从而对DN肾脏起到一定的保护作用,这说明益肾化湿颗粒在糖尿病肾病的治疗中表达明显,具有较高的临床应用价值。     

sRAGE胞外段—IgG Fc融合蛋白对大鼠糖尿病肾病的作用

目的探讨可溶性人晚期糖基化终末产物受体胞外段—IgG Fc（sRAGE-IgG Fc）融合蛋白对糖尿病（DM）大鼠的肾脏保护作用。方法将60只大鼠随机分为正常对照组、糖尿病肾病（DN）组、洛汀新组、sRAGE-IgGFc 4 mg/kg组、sRAGE-IgG Fc 6 mg/kg组、sRAGE-IgG Fc 9 mg/kg组各10只。以左肾切除、高糖、高脂饲养及注射链脲佐菌素方法 ,建立DN模型。检测各组非空腹血糖（FPG）、胰岛素（INS）、血脂、血肌酐（Scr）、尿素氮（BUN）、肌酐清除率（Ccr）、尿白蛋白排泄率（UAER）等,观察其肾组织变化。结果与DN组比较,sRAGE-IgG Fc用药组、洛汀新组的Scr、BUN、Ccr、UAER等指标均明显降低,肾脏病变不同程度地减轻（P均〈0.01）;除正常对照组外,其他组间FPG、INS、血脂改变无统计学意义（P均〉0.05）。说明sRAGE-IgG Fc融合蛋白对DN大鼠的肾脏保护作用具有剂量依赖性。结论 sRAGE-IgG Fc融合蛋白对DN大鼠的肾脏有明显保护作用,其功能与洛丁新相当。     

缺氧诱导因子-1在糖尿病肾病大鼠肾脏的表达水平

目的 探讨吡格列酮干预对糖尿病肾病(DN)大鼠肾脏缺氧诱导因子-1( HIF-1)表达水平的影响及对过氧化物酶增殖体激活受体γ(PPARγ)表达的影响.方法 单次腹腔注射链脲佐菌素(STZ)诱导糖尿病大鼠模型,将糖尿病大鼠随机分为DN组(20只)和吡格列酮组(P组,20只),以正常大鼠(C组,20只)作对照.干预8w后,观察各组大鼠尿蛋白、血糖、血脂、血尿素氮(BUN)、血肌酐(SCr)变化;用实时荧光定量PCR分析肾脏HIF-1、PPARγ mRNA的表达.结果 (1)DN组大鼠尿蛋白、肾脏HIF-1蛋白及mRNA水平均较正常大鼠明显升高,PPARγ表达下调;而P组大鼠上述指标呈现相反的改变,24h尿蛋白定量分别与HIF-1蛋白、mRNA水平呈显著正相关.(2)DN组大鼠血糖、血脂均显著高于正常大鼠,吡格列酮治疗后上述指标无明显变化.结论 吡格列酮可能通过PPAR途径下调DN大鼠肾脏HIF-1表达,从而发挥其肾保护作用.     

前列地尔联合尿毒清辅助治疗Ⅳ期糖尿病肾病30例效果观察

目的探讨前列地尔联合尿毒清颗粒辅助治疗Ⅳ期糖尿病肾病（DN）的疗效和安全性。方法将60例Ⅳ期DN患者随机分为治疗组和对照组各30例,两组均予优质低蛋白饮食、控制血糖等常规治疗及尿毒清颗粒口服,在此基础上治疗组联合应用前列地尔,疗程均为14 d。观察两组治疗前后肾功能指标血肌酐（SCr）、尿素氮（BUN）、24 h尿蛋白定量（UPro）、胱抑素C（CysC）、尿β2微球蛋白（β2-MG）变化。结果两组治疗后SCr和BUN均明显下降,尤以治疗组为著（P〈0.05）;治疗组24hUPro、尿β2-MG及CysC均比治疗前明显下降（P〈0.05）,对照组无明显改变;两组均无严重不良反应发生。结论前列地尔联合尿毒清颗粒辅助治疗Ⅳ期DN可保护肾功能、延缓肾功能损害,且安全性高。     

消渴泄浊汤对糖尿病肾病大鼠内质网应激调控及肾功能改善的作用

目的 探讨消渴泄浊汤对糖尿病肾病(DN)大鼠的内质网应激调控及肾功能改善的作用。方法 将24只雄性SD大鼠随机分为正常组、DN组和治疗组各8只。构建DN大鼠模型后，治疗组以2 g/(kg·d)消渴泄浊汤灌胃，治疗8 w,正常组给予等量生理盐水灌胃。建模和治疗后每周检测大鼠体质量和空腹血糖水平(FBG)、24 h尿蛋白定量(UTP)、尿素氮(BUN)、血肌酐(SCr)及血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]指标；Western印迹检测肾脏组织中内质网应激相关蛋白[葡萄糖调节蛋白(GRP)78、人转录激活因子(ATF)4、C/EBP同源蛋白(CHOP)]的表达。结果 与正常组相比，DN组2～8 w体质量明显降低，FBG、24 h UTP、SCr、BUN、TC、TG、LDL-C水平明显升高(P<0.05);与DN组相比，治疗组可显著降低FBG、24 h UTP、血脂水平和肾脏损害(P<0.05)。与正常组相比，DN组中内质网应激蛋白表达显著上调(P<0.05);与DN组相比，治疗组可降低这些内质网应激相...     

阿魏酸钠对大鼠肾脏缺血再灌注损伤的作用

目的建立大鼠肾脏缺血再灌注损伤（IRI）模型，观察阿魏酸钠（SF）对大鼠肾脏是否具有保护作用，并初步探讨其机制。方法32只雄性Wistar大鼠，随机分为4组：①正常组，②假手术组，③模型组，④治疗组，测定各组血清肌酐（SCr）、尿素氮（BUN）及肾脏组织中丙二醛（MDA）和超氧化物歧化酶（SOD）水平，观察肾功能变化、组织过氧化情况及机体抗氧化能力；光镜下观察肾脏组织形态学变化。结果模型组各项指标与假手术组相比有显著差异，说明模型制作成功。同时治疗组可明显降低SCr、BUN及MDA含量，并升高SOD水平，与模型组相比有显著性差异，而且肾脏组织的病理改变减轻。结论SF对大鼠肾脏IRI有保护作用，其机制可能与对抗自由基、抗脂质过氧化等作用有关。     

胡芦巴多糖A2对糖尿病大鼠肾脏ECM的影响

目的探讨胡芦巴多糖A2对糖尿病（DM）大鼠肾脏结构和功能改变的影响,以阐述结缔组织生长因子（CTGF）在DM肾病（DN）发生发展中的可能机制。方法链脲佐菌素诱发大鼠DM后给予胡芦巴多糖A2治疗,观察其对血糖、血脂、肾功能和肾脏病理改变的影响。结果与模型组比较,多糖A2组大鼠血糖明显降低（Ρ〈0.01）;TG、TC、LDL-C水平均明显降低（P〈0.01）,而HDL-C水平则明显升高（P〈0.01）;尿蛋白排泄率（UAlb）、血肌酐（Scr）和尿素氮（BUN）均显著降低（P〈0.01）;光电镜结果表明多糖A2组大鼠肾小球病变明显减轻,免疫组化结果发现多糖A2组大鼠肾脏CTGF蛋白表达明显减少（P〈0.01）。结论DM大鼠给予多糖A2治疗后,可通过降低血糖,调节脂代谢紊乱、改善DM大鼠肾脏功能和结构损伤,多糖A2可能通过下调CTGF蛋白表达抑制ECM增多,从而减轻DN病变。     

外源性硫化氢对早期糖尿病肾脏疾病大鼠丝裂原活化细胞外信号调节蛋白激酶/细胞外信号调节激酶信号通路的影响

目的 研究外源性硫化氢(H₂S)通过丝裂原活化细胞外信号调节蛋白激酶(MEK)/细胞外信号调节激酶(ERK)信号通路对早期糖尿病肾脏疾病(DN)大鼠的保护作用。方法 随机选取SPF级健康雄性SD大鼠24只腹腔一次性注射1%链尿佐菌素(STZ)60 mg/kg制作DN模型，余下10只(正常对照组)腹腔一次性注射等量的柠檬酸缓冲液。3周后DN造模成功，再将24只DN大鼠随机分为DN组和DN+硫氢化钠(NaHS)组，每组各12只。DN+NaHS组予腹腔注射NaHS溶液56μmol·kg^-1·d^-1,正常对照组和DN组予等量生理盐水腹腔注射，3组大鼠均连续注射12周。检测各组血清肌酐(SCr)、尿素氮(BUN)及24小时尿蛋白(24h Upro)水平，观察其肾脏组织病理变化。采用Katafuchi评分评估大鼠肾脏病变(包括肾小球、肾小管及肾血管)。采用免疫组化法检测ERK1/2、MEK1和MEK2蛋白阳性区域面积百分比。结果 DN组大鼠SCr、BUN及24h Upro水平、肾脏组织Katafuchi评分、MEK1、MEK2及ER...     

糖尿病大鼠肾小球IL-18、ICAM-1和TNF-α表达的实验研究

目的探讨炎症细胞因子与糖尿病肾病（DN）发生、发展的关系。方法雄性SD大鼠32只分为糖尿病（DM）组20只和正常对照（NC）组12只。4、8周末检测血糖（BG）、尿素氮（BUN）、肌酐（SCr）及24小时尿蛋白（UPro/24h）。处死动物后计算肾重指数（KI）；镜下观察肾脏病理改变；检测肾小球白细胞介素18（IL-18）、细胞间黏附分子1（ICAM-1）、肿瘤坏死因子α（TNF-α）的表达。结果4、8周DM组分别与同期NC组相比：BG、KI、UPro/24h、SCr显著增高；肾小球体积增大、系膜细胞增生、毛细血管基底膜增厚、足突融合；IL-18、ICAM-1、TNF-α表达显著增高。8周DM组与4周DM组相比：KI、BUN、SCr、UPro/24h增高，肾脏病理改变加重，IL-18、ICAM-1、TNF-α在肾小球的表达增高。IL-18、ICAM-1、TNF-α三者表达之间呈正相关，与BUN、SCr、UPro/24h亦呈正相关（P均〈0.05）。结论糖尿病大鼠肾小球IL-18、ICAM-1、TNF-α的表达与DN的发生、发展密切相关。     

肾小球滤过率和肾有效血浆流量"分离现象"对诊断早期糖尿病肾病的意义

目的探讨肾小球滤过率(GFR)和肾有效血浆流量(ERPF)的变化对诊断早期糖尿病肾病(DN)的意义。方法根据尿白蛋白排泄率(UAER)将105例2型糖尿病(T2DM)患者分为3组:无DN(NDN)组,早期DN(EDN)组,临床DN(CDN)组。用SPECT测定GFR、ERPF值,并测定尿白蛋白(UAlb)、尿免疫球蛋白G(UIgG)、α1微球蛋白(Uα1-MG)、β2微球蛋白(Uβ2-MG)、血清肌酐(SCr)和尿素氮(BUN)。结果NDN组GFR和ERPF值增高,与UAlb负相关;EDN组GFR增高与UAlb正相关,ERPF低于正常对照组,与UAlb负相关,出现GFR和ERPF"分离现象";CDN组GFR和ERPF明显降低,与UAlb负相关。UAlb、UIgG、Uα1-MG、Uβ2-MG与SCr、BUN正相关。结论核素显像测定GFR、ERPF"分离现象"能够及时反映糖尿病的早期肾脏损害,与UAlb联合检测有助于了解DN的病变程度。     

Contrasting effects of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy

Microalbuminuria is a reliable predictor of the eventual development of overt diabetic nephropathy and blood pressure is known to accelerate the course of this nephropathy. In the present studies, the effect of a 6-week treatment by placebo (n = 7), nifedipine (n = 7) and captopril (n = 8) on renal function and urinary excretion of albumin (UAE) was investigated in normotensive, insulin-dependent, diabetic patients with incipient nephropathy (UAE greater than 15 micrograms/min). No change in arterial pressure, renal function or UAE was observed in the placebo group. In response to captopril and nifedipine, mean arterial pressure decreased slightly and similarly in both groups. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) increased to a similar extent in the nifedipine group, thus resulting in no change in filtration fraction (FF). In response to captopril, GFR was unchanged whilst ERPF increased; as a consequence FF decreased. Opposite changes in UAE were observed in response to the two treatments; UAE decreased by 40% in the captopril group and by 40% in nifedipine-treated patients. These results indicate that intrarenal changes may be crucial with respect to the effect of therapy on UAE. It is suggested that only agents which reduce FF and probably intraglomerular capillary pressure, such as converting enzyme inhibitors, alter UAE and may possibly interfere with the course of incipient diabetic nephropathy in normotensive patients.     

Beta2-microglobulin and cystatin C in type 2 diabetes: assessment of diabetic nephropathy.

BACKGROUND: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy (DN). This study was designed to demonstrate the clinical values of serum cystatin C (Cys C) and beta2-microglobulin in the assessment of renal function in type 2 diabetics by comparing them with the GFR, estimated from the uptake phase of 99 m technetium dimetiltriamino pentaacetic acid renogram (GFR-DTPA) and creatinine clearances. MATERIALS AND METHODS: 68 type 2 diabetic patients with (urinary albumin excretions (UAE) 30 - 300 mg/24 h) (n = 39) and without (UAE < 30 mg/24 h) (n = 29) microalbuminuria and 32 controls were enrolled in the study. Serum Cys C, beta2-microglobulin, creatinine, urinary microalbumin levels, creatinine clearances and GFR-DTPA values were determined in all groups. Non-parametric ROC curves, using a cut-off GFR-DTPA of 60 mL/min/1.73 m (2), were obtained for these markers. RESULTS: Serum Cys C, beta2-microglobulin, glucose and HbA1c concentrations were significantly higher in the group with diabetes compared to controls. In the patients with microalbuminuria, serum Cys C and glucose concentrations increased significantly in comparison to patients with normoalbuminuria, while no differences were observed for beta2-microglobulin levels. Serum creatinine concentrations, GFR-DTPA values and creatinine clearances were not different between both diabetic groups and controls. Cys C was positively correlated with beta2-microglobulin and creatinine and negatively with GFR values; beta2-microglobulin was also positively correlated with serum creatinine in microalbuminurics. A significant inverse correlation was found between beta2-microglobulin and GFR values in both microalbuminurics and normoalbuminurics. CONCLUSIONS: Increased Cys C and beta2-microglobulin in diabetics may be early indicators of incipient DN. The diagnostic accuracies of Cys C and beta2-microglobulin are superior to that of serum creatinine in distinguishing between mild and moderately reduced GFR.     

Effects of aminoguanidine and vitamin C on collagen type IV in diabetic nephropathy rats

The aim of this article is to investigate the effects of Aminoguanidine and vitamin C (VitC) on type IV collagen in diabetic nephropathy rats. Diabetic nephropathy rats were induced by intraperitoneal injection of STZ. Rats were randomly divided into five groups: normal control group (n = 10), diabetes group (n = 10), aminoguanidine group (n = 10), VitC group (n = 10), aminoguanidine and VitC group (n = 10). After 16 weeks, the general conditions, blood gloucose, glycosylated hemoglobin, blood urea nitrogen, serum creatinine, serum type IV collagen, urinary albumin excretion rate, and creatinine clearance rate were detected, type IV collagen protein was determined by immunohistochemical analysis as well as the expression of collagen type IVα1 mRNA were determined by in situ hybridization analysis in the kidneys of each group. The results were (1) diabetes mellitus and renal lesions occurred in the diabetes group, aminoguanidine group, VitC group, VitC and aminoguanidine group; (2) aminoguanidine and VitC improved the general conditions of diabetic nephropathy rats, decreased blood urea nitrogen, serum creatinine, and urinary albumin excretion rate as well as increased creatinine clearance rate. The expressions of collagen type IV were significantly down-regulated in treatment groups in contrast to the diabetes group. Aminoguanidine and VitC protect renal lesions in diabetic nephropathy, respectively, by inhibiting expression of type IV collagen, while aminoguanidine and VitC have a synergistic effect on them.     

瑞舒伐他汀对老年冠心病患者造影剂肾病的预防作用和对血脂的影响

目的 观察瑞舒伐他汀对老年冠心病患者造影剂肾病（CIN）的预防作用和对血脂的影响。方法 2014年1月~2014年12月确诊的老年冠心病患者114(男67,女47)例,年龄61~83岁,随机分为常规治疗组（n=57）和瑞舒伐他汀组（n=57）。瑞舒伐他汀组在常规治疗的基础上加服瑞舒伐他汀,每晚20 mg,连续8周。两组分别于造影前、造影后24 h、72 h和7 d测定尿素氮（BUN）及血肌酐（SCr）水平并计算内生肌酐清除率（CCr）,同时测定血脂水平。结果 造影前常规治疗组与瑞舒伐他汀组肾功能无显著差异,但瑞舒伐他汀组血脂明显低于常规治疗组（P<0.05,P<0.01）。常规治疗组造影后24 h、72 h BUN和SCr明显高于造影前（P<0.05,P<0.01）,而CCr则明显降低（P<0.01）,血脂无明显变化,这些变化均于7 d后恢复正常。瑞舒伐他汀组造影后仅SCr在24 h、72 h较造影前升高（P<0.05）,BUN和CCr无明显变化。常规治疗组发生CIN 6例（11%）于7 d后恢复,瑞舒伐他汀组无发生CIN病例,与常规治疗组CIN发生率比较有显著差异（P<0.05)。两组造影前后血脂均无显著变化。两组不良反应发生率无统计学差异。结论 瑞舒伐他汀对老年冠心病患者具有降血脂作用和对CIN有显著预防作用。     

胱抑素C在评估慢性心力衰竭患者肾功能不全中的价值

目的观察慢性心力衰竭（CHF）患者的血清胱抑素C（Cys-C）、血清肌酐（Scr）、肾小球率过滤（eGFR）水平,评估Cys-C在CHF患者肾功能不全中的诊断价值。方法选取我院住院88例CHF的患者测定Cys-C、Scr,计算eGRF（简化MDRD公式）,根据eGFR水平将患者分成4组：GRF正常组、GRF轻度下降组、GRF中度下降组、GRF重度下降及肾衰竭组,比较4组间Cys-C、Scr的差异并进行Cys-C、Scr与GRF的相关性分析。结果 4组患者的血清Cys-C水平分别为（0.93±0.18）,（1.08±0.22）,（1.58±0.59）,（2.7±0.86）mg/L,差异有显著统计学意义（P〈0.01）,血清Cys-C与GRF显著相关,相关系数为0.62（P〈0.01）。结论 Cys-C可以作为肾小球滤过率的判断指标,有助于慢性心力衰竭患者肾功能不全的早期诊断。     

丹参酮治疗高血压肾病的临床研究

目的:探讨丹参酮对高血压肾病的治疗作用。方法:选择符合高血压肾病入选标准的慢性肾病(CKD)Ⅰ~Ⅲ期患者60例,基础治疗全部用氯沙坦,随机分为丹参酮组、基础治疗对照组,治疗用药2周,检测并比较各组血压、肾功能、24 h尿蛋白定量、尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)等的变化。结果:2组治疗前、后血压变化无明显差异;丹参酮组治疗2周时血肌酐(SCr)水平较基线下降[(162.2±10.1)μmol/L比(134.0±7.1)μmol/L],与对照组治疗2周时[(151.8±8.3)μmol/L]比较差异有统计学意义(P<0.05),但治疗后组间比较无明显差异。与基线相比,丹参酮组尿NAG下降有明显差异,氯沙坦组无明显下降趋势。结论:在氯沙坦降低蛋白尿的基础上,丹参酮还具有保护肾小管功能及延缓肾功能进展的作用,且安全性好,是高血压肾病治疗的可选药物之一。     

Transforming growth factor beta1 and additional renoprotective effect of combination ACE inhibitor and angiotensin II receptor blocker in hypertensive subjects with minor renal abnormalities: a 24-week randomized controlled trial

OBJECTIVE: To verify the benefit of renin-angiotensin system blockade in hypertension, the effects of 24 weeks' losartan and ramipril treatment, both alone and in combination, on urinary albumin excretion (UAE) and circulating transforming growth factor beta1 (TGF beta1) have been evaluated in hypertensive subjects with minor renal abnormalities. DESIGN AND METHODS: Fifty-one patients with stage 1 and 2 essential hypertension and with UAE > or = 20 mg/24 h but with maintained renal function have been included. After a 4-week run-in with placebo administration, a randomized double-blind, three-arm double-dummy trial was used. All the hypertensives (HT) were allocated randomly to three treatment arms (17 patients for each group) and they were single-matched for age, gender, body mass index (BMI), systolic and diastolic blood pressure. Active treatment consisted of losartan (50 mg/day), ramipril (5 mg/day) and combined (losartan 50 mg/day plus ramipril 5 mg/day) for 24 weeks. Hydrochlorothiazide 12.5 mg/day was added in HT patients with uncontrolled blood pressure (> or = 140/90 mmHg) during the active treatment period. In all patients UAE, by immunonephelometric assay; circulating TGF beta1 by a solid-phase specific sandwich enzyme-linked immunosorbent assay (ELISA); and blood urea nitrogen (BUN), creatinine and creatinine clearance and potassium, by routine laboratory methods, were determined after placebo treatment and 24 weeks follow-up. RESULTS: The three treatment groups were comparable for gender, age, BMI, blood pressure, UAE and renal function measurements. During the active treatment period it was necessary to add hydrochlorothiazide in five patients--two each of the losartan and ramipril groups and one of the combined group. At the end of treatment, significant (P < 0.05) reductions in systolic, diastolic and mean blood pressure, UAE and TGF beta1 levels were observed in all the groups. No change in renal function measurements were observed. The absolute and percentage reduction in UAE and TGF beta1 were significantly higher in the combined group than in the losartan or ramipril groups. No significant changes in absolute and percentage reduction of systolic, diastolic and mean blood pressure were found. All treatment regimens were well tolerated with few and transient side-effects. CONCLUSION: These data indicate an additional renoprotective effect of dual blockade of the renin-angiotensin system (RAS) in hypertensive patients with minor renal abnormalities. In addition, the contemporaneus and marked decrease in TGF beta1 and UAE levels in hypertensives treated with combined therapy might indicate the presence of a subset of subjects who may benefit from complete RAS blockade.     

同型半胱氨酸、血清胱抑素C与高血压早期肾损害的相关性

目的探讨同型半胱氨酸（Hcy）、血清胱抑素C（Cys-c）与高血压早期肾损害的相关性。方法：收集我院2011年6月～2013年7月符合入选标准的153例高血压病患者,用同位素肾图检查作为金标准测定肾小球滤过率（GFR）,按照GFR数值分成两组：肾功能正常组和肾功能受损组。同时测定每组血清Hcy、Cys-C和24 h尿微量白蛋白（24h MAU）、血肌酐及尿素氮,比较两组之间是否有差异,最后对GFR与Cys-C及Hcy进行相关性分析。结果：肾功能无损害组与肾功能损害组Hcy、Cys-C比较差异有统计学意义（P〈0．05,P〈0．01）。Pearson相关分析显示,GFR与Hcy、Cys-C和尿素氮及肌酐呈负相关（均P〈0．01）。多元线性回归分析显示：Hcy、Cys-C是影响GFR的独立危险因素,其标准偏回归系数13值分别为-2．015（P〈0．05）、-5．448（P〈0．01）。结论：Hcy、Cys-C与原发性高血压早期肾损害有相关性。     

Changes of serum and urine neutrophil gelatinase-associated lipocalin in type-2 diabetic patients with nephropathy: one year observational follow-up study

We initiated the present work to explore whether neutrophil gelatinase-associated lipocalin (NGAL) could be used to predict the progression of diabetic nephropathy in type-2 diabetic patients. Seventy-four type-2 diabetic patients were divided into normo-, micro- and macro-albuminuria groups according to their 24 h-urinary albumin excreting rate. Serum and urine NGAL, and other clinical parameters were detected. Patients were followed and measurements were repeated 1 year later. An increased tendency of urine NGAL and a decreased tendency of serum NGAL were detected, from normo-albuminuria group to macro-albuminuria group. Serum NGAL was found to rise after follow-up. Moreover, urine NGAL was found to be correlated positively with cystatin C, urea nitrogen, and serum creatinine (SCr), and inversely with glomerular filtration rate (GFR), while serum NGAL correlated negatively with cystatin C and urea nitrogen, at both baseline and follow-up levels. The results indicate that NGAL correlates closely with renal function. Both serum and urine NGAL are sensitive for predicting the progression of type-2 diabetic nephropathy but they may change differently. Serum NGAL may be more useful in early detection and urine NGAL may be more meaningful in renal function assessment. Yi-Hua Yang and Xiao-Jie He contributed equally to the work. Shen-Ren Chen, En-Min Li and Li-Yan Xu are co-corresponding authors.     

Estimation of glomerular filtration rate from skeletal muscle mass. A new equation independent from age,weight, gender,and ethnicity

Background and aimsThe most used indicator for the renal function is the glomerular filtration rate (GFR). Current used predictive GFR equations were calibrated on patients with chronic kidney disease. Thus, they are not very precise in healthy individuals. The estimation of skeletal muscle mass (SMM) allows the prediction of the daily urinary creatinine excretion (24hUCrE). This study proposes an equation for the estimation of GFR based on SMM (eGFRMuscle) and serum creatinine (SCr).Methods and resultsFour hundred sixty-six free-living men underwent a bioelectrical impedance analysis for the evaluation of SMM (kg), a blood withdrawal for the measurement of SCr (mg/dL), and a 24-h urinary collection for the assessment of 24hUCrE (g/24 h). The linear regression analysis between SMM and 24hUCrE and the measurement of SCr allowed developing a predictive equation of eGFRMuscle. The equation predicting eGFRMuscle (ml/min/1.73 m²) was SMM (kg) × 3.06/SCr (mg/dL). eGFRMuscle was statistically different from eGFR predicted by Cockroft–Gault, MDRD Study, and CKD-EPI equations (p = 0.017, p < 0.001, and p < 0.001, respectively). Pairwise comparison of standard error of the area under the ROC curve (AUC) of eGFRMuscle with all the other AUCs of ROC curves highlighted significant differences.ConclusionsThe equation presented in this study results in age, weight, gender, and ethnicity independent because it arises directly from SMM estimation. Therefore, the proposed equation could allow evaluating the GFR also in healthy people with low, average, or high weight, and in older people, regardless of GFR and SCr levels.