脑梗死患者血清同型半胱氨酸、叶酸及维生素B_(12)水平的分析

目的探讨血清同型半胱氨酸(Hcy)、叶酸(FA)及维生素B12(VitB12)水平与脑梗死的关系。方法采用循环酶法和化学发光免疫法分别检测60例脑梗死患者血清Hcy、FA及VitB12水平,并与同期40例健康体检者进行比较。结果脑梗死组血清Hcy水平(23.16±8.17μmol/L)明显高于对照组(8.09±2.45μmol/L,P0.01),血清FA水平(6.12±2.19ng/mL)和VitB12水平(323.92±133.79μmol/L)明显低于对照组(10.57±5.70ng/mL,530.85±168.56μmol/L,P0.01)。脑梗死组血清Hcy水平与FA及VitB12水平均呈负相关(r1=-0.444,r2=-0.535,P0.05)。结论高同型半胱氨酸血症为脑梗死的独立危险因素,与FA和VitB12水平下降有关。     

呼和浩特地区1094例急性脑梗死患者血清维生素B_12、叶酸及同型半胱氨酸的测定分析

目的探讨呼和浩特地区急性脑梗死（ACI）与血清维生素B12、叶酸及同型半胱氨酸（Hcy）的关系。方法将1 094例ACI患者作为ACI组,100例健康体检者作为对照组。采用化学发光法测定其血清维生素B12、叶酸及Hcy浓度。结果 ACI组患者血清叶酸、维生素B12浓度显著低于对照组（P〈0.05）。ACI组患者服用叶酸、维生素B12前、后的血清Hcy浓度均显著高于对照组（P〈0.05）。结论血清维生素B12、叶酸及Hcy检测对ACI的治疗、预后判断具有重要意义。     

血浆同型半胱氨酸、叶酸及维生素B12联合检测在治疗脑梗死患者中的临床应用

目的 探讨血浆同型半胱氨酸、叶酸及维生素B12与脑梗死的关系以及应用叶酸、维生素B12干预治疗对于高同型半胱氨酸血症脑梗死患者体内血清同型半胱氨酸水平的影响.方法 选择急性脑梗死患者135例作为病例组,70例健康体检者作为对照组.对病例组及对照组分别空腹抽血测定血浆叶酸、维生素B12及同型半胱氨酸,对于高同型半胱氨酸的脑梗死患者进行补充叶酸和维生素B12治疗,1个月后复查血清同型半胱氨酸水平.结果 在病例组中,高同型半胱氨酸患者占63%,明显高于对照组14%(P<0.01);病例组患者中同型半胱氨酸平均水平(20.42±6.39)μmol/L,显著高于对照组中同型半胱氨酸[(8.78±3.88)μmol/L]平均水平,血浆叶酸水平为(7.42±4.36)ng/mL,显著低于对照组[(13.45±3.25)ng/mL,P<0.01],维生素B12水平为(324.56±167.85)pg/mL,显著低于对照组[(488.44±255.75)pg/mL,P<0.01];高同型半胱氨酸血症脑梗死患者中高同型半胱氨酸水平与叶酸及维生素B12水平呈负相关(r=-0.345、r=-0.587);对病例组中高同型半胱氨酸水平患者补充叶酸及维生素B12治疗1个月后同型半胱氨酸水平较之前有显著降低.结论 脑梗死患者血清同型半胱氨酸水平高于对照组,叶酸和维生素B12水平低于对照组,补充叶酸和维生素B12可有效降低高同型半胱氨酸脑梗死患者体内血清同型半胱氨酸水平,对预防和治疗脑梗死具有重要意义.     

叶酸、VitB12及血浆同型半胱氨酸水平对Alzheimer病的影响

目的:探讨叶酸、VitB12及血浆同型半胱氨酸(Hcy)水平对Alzheimer病(AD)的影响。方法:运用多聚酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP)检测42例AD及40例正常老年人MTHFR基因多态性,用高效液相色谱仪和电化学检测法测定42例AD及40例正常老年人血浆总Hcy水平,同时测定血浆叶酸及VitB12水平。结果:MTHFR基因型有3种,即纯合子(T/T)型,杂合子(T/C)型,纯合子(C/C)型。患者组基因型和等位基因频率与正常对照组相比,差异均无显著性(P>0.05)。AD患者血浆总Hcy水平显著高于正常组(t=16.64,P<0.001)。AD组血浆叶酸及VitB12水平明显低于对照组(t=7.24,9.11,P<0.001)。结论:MTHFR基因突变与AD发生无关;高同型半胱氨酸血症是AD发病的一个新的危险因素。     

急性脑梗死患者血浆同型半胱氨酸、半胱氨酸、叶酸及维生素B_(12)水平的变化及其相关性

目的观察急性脑梗死(ACI)患者血浆同型半胱氨酸(Hcy)、半胱氨酸(Cys)、叶酸(FA)及维生素B12(Vit B12)水平的变化,并探讨其相关性。方法 80例ACI患者根据动脉狭窄情况分为观察组A(36例)和观察组B(44例),另选取同期健康体检者30例设为对照组,检测3组血浆Hcy、Cys、FA及Vit B12水平。结果血浆Hcy、Cys水平在观察组A、B及对照组中呈逐渐下降趋势,FA、Vit B12水平在3组中呈逐渐上升趋势,两两比较差异显著(P0.05或P0.01)。相关性分析表明,血浆Hcy水平与Cys显著正相关(r=0.7798,P0.01),与FA及Vit B12水平负相关(r=-0.623,0.593,P0.01)。结论 ACI患者血浆Hcy、Cys水平显著升高,FA、Vit B12水平显著降低,高Hcy血症可能参与了ACI的发病过程。     

血清同型半胱氨酸水平与脑梗塞关系的临床研究

目的探讨血清同型半胱氨酸(HCY)水平与脑梗死之间的关系。方法检测140例脑梗死患者血清HCY、叶酸(FA)、维生素B12(VitB12)及血脂等指标,并与80例健康对照者相比较。结果脑梗死组血清HCY及甘油三脂(TG)水平高于健康对照组[(16.67±9.06)μmol/L vs.(10.51±2.33)μmol/L,和(1.63±1.12)mmol/L vs.(1.34±0.43)mmol/L,P均<0.001],而FA及VitB12水平则低于健康对照组[(4.62±2.37)g/L vs.(8.47±1.56)g/L,和(255.32±83.43)ng/L vs.(334.6±53.88)ng/L,P值均<0.001],两对照组间总胆固醇(TCHO)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)比较差异没有统计学意义(P>0.05)。结论血清HCY升高可能是脑梗死的危险因素,导致HCY升高的原因可能与血清内叶酸和维生素B12的降低有关。     

老年脑梗死患者血清同型半胱氨酸水平及药物干预研究

目的 了解正常人颈动脉硬化患者及脑梗死患者血清同型半脱氨酸(serum total nomocysteine,tHcy)水平及给予叶酸和维生素B12治疗后血tHcy含量的变化。方法 脑梗死组80例，男71例，女9例，年龄63—80岁，平均74岁，符合脑梗死的诊断标淮，均在发病后2周内测定tHcy含量；颈动脉硬化组80例，男71例，女9例，年龄62—79岁，平均72岁。双例颈动脉B超检查均存在颈动脉硬化及(或)粥祥斑块。以上两组均除外甲状腺功能衰退及肾功能衰退。入选者在测定血清叶酸、维生素B12、肌酐、血糖、血脂水平及血压和体重指数后，各组均随机分为两组，即干预治疗组及非干预治疗组，每组40例。干预治疗组患者给予叶酸1．25mg,隔日1次，维生素B12 8μg，1次／d，口服10个月后复查上述各项指标。结果 治疗前3组血tHcy水平各不相同，脑梗死组为(16&;#177;5)μmol/L，颈动脉硬化组为(14&;#177;5)μmol/L，正常老年人组为(12&;#177;3)μmol/L，3组比较差异有显著意义。血tHcy含量增高，叶酸水平越低。相关分析发现，血tHcy水平与叶酸、维生素B12呈负相关。干预治疗后，治疗组患者的血tHcy含量均有所下降。结论 不同程度的脑缺血性疾病与血tHcy水平有一定的关系，补充营养元素有助于降低血tHcy水平，以减少高tHcy对血管的素性作用。     

血浆叶酸、维生素B12、同型半胱氨酸水平与脑梗死的关系探讨

叶酸（FA）和维生素B12（VitB12）作为同型半胱氨酸（Hcy）合成蛋氨酸的辅酶,在Hcy代谢过程中起着重要作用。FA和VitB12缺乏时阻碍蛋氨酸的再生成,从而造成Hcy在体内的蓄积。近年来人们逐渐发现FA、VitB12缺乏和Hcy在体内蓄积与脑血管性疾病的发生有关。为此,我们对脑梗死患者进行血浆FA、VitB12以及Hcy浓度检测,探讨其与脑梗死的关系。     

急性脑梗死患者血浆同型半胱氨酸与叶酸、维生素B12水平的关系

目的探讨急性脑梗死患者与健康体检者血浆同型半胱氨酸(Hcy)、叶酸及维生素B12水平的差别及关系。方法分析102例急性脑梗死患者和72例健康体检者血清中Hcy、叶酸及维生素B12水平。结果急性脑梗死与健康对照组Hcy〔(65.88±13.81)vs(24.40±1.53)μmol/L,P<0.01〕、维生素B12〔(162.06±10.99)vs(270.07±20.81)pg/ml,P<0.01〕水平比较,差异均有统计学意义。2组叶酸水平比较差异无统计学意义(P>0.05)。结论高Hcy是急性脑梗死的一个重要危险因素。叶酸水平与Hcy水平无明显相关性,维生素B12水平随着Hcy水平的升高而降低,补充维生素B12可能是降低Hcy的关键。     

不同方程估算的肾小球滤过率在人群肾功能评价中的差异比较

目的比较3种肾小球滤过率(GFR)估算方程估算的GFR(eGFR)对人群肾功能评估的结果差异。方法本研究回顾性分析了门诊和住院患者中同时进行血清肌酐和胱抑素C检测者,共65 856例,以3个估算方程分别计算eGFR,并比较整体及不同肾功能分组人群eGFR结果的差异。以3个方程得到的eGFR对个体肾功能重新分期,比较肾功能各分期例数分布的差异。结果与肌酐方程估算eGFR比较,另两个方程估算eGFR的相关系数分别为0.81、0.90(均P0.05)。一致性分析GFR均值差值分别为6.19、1.79mL/(min×1.73m2),差异有统计学意义(P0.01),应用肌酐方程估算eGFR时,明显高估了个体的肾功能分期。结论 3种方程估算GFR有相关性但存在明显差异,在评估不同人群肾功能时应选择合适的估算方程。     

Influence of Renal Function on the Urinary Excretion of Amylase

Urinary excretion of endogenous amylase was studied during osmotic diuresis in normal rats and in rats with different kinds of induced kidney damage. In normal rats the amylase excretion varied almost proportionally with respect to plasma concentration of amylase and to glomerular filtration rate (GFR), estimated as clearance for polyethylene glycol 1000 (PEG 1000). The ratio between amylase clearance and GFR varied only slightly with body weight and was independent of urine flow in normal rats. Both increased glomerular permeability to proteins in aminonucleoside-nephrosis and tubular dysfunction after sodium maleate treatment augmented the ratio of amylase clearance to GFR. A considerable tubular reabsorption of amylase in normal rats is concluded. In unilateral pyelonephritis or unilateral ischemic kidney damage this ratio remained constant, but when the functional kidney mass was reduced by removal of the intact kidney, it increased considerably, possibly owing to decreased fractional reabsorption of fluid in the proximal tubules and increased glomerular filtration of proteins per nephron.     

Relationship between thyroid status and renal function in a general population of unselected outpatients

ObjectiveTo investigate the relationship between thyroid and kidney function.Design and methods13,383 results of serum creatinine and thyroid stimulating hormone (TSH) were retrieved from the database of our Laboratory.ResultsWhen compared with euthyroid subjects, those with TSH < 0.2 mIU/L and > 2.5 mIU/L had increased and decreased estimated glomerular filtration rate (e-GFR), respectively. TSH levels were an independent predictor of e-GFR.ConclusionsA mutual relationship was observed between kidney and thyroid status.     

替比夫定治疗慢性乙型肝炎96周对肾脏功能的影响

目的：研究替比夫定治疗慢性乙型肝炎患者对肾脏功能的影响。方法回顾性分析替比夫定治疗42例慢性乙型肝炎患者,比较治疗96周前后血清肌酐( CR),估算肾小球滤过率( eGFR)较基线的变化情况及eGFR≥90ml/(min·1.73m2)患者的比例。结果96周各随访点,患者 CR、eGFR 差异无显著性(P>0.05)。96周时,患者CR、eGFR较基线变化平均值为-1.6μmol/L、4.4ml/(min·1.73m2)。基线肾功能轻度受损[eGFR60~90 ml/(min·1.73m2)]的患者中,38.1%(8/21)患者上升至>90ml/(min·1.73m2),治疗96周时eGFR较基线差异有显著性(P=0.04)。 eGFR≥90ml/(min·1.73m2)患者比例由基线的50%升至96周的59.5%(P=0.381)。结论对于基线肾功能受损的患者[eGFR 60~90 ml/(min·1.73m2)],使用替比夫定抗病毒治疗,其肾功能可得到一定程度的改善。     

Effect of low protein diet on the renal response to meat ingestion in diabetic nephropathy

We measured the renal haemodynamic and proteinuric response to a meat meal (MM) in ten persistently proteinuric insulin-dependent diabetic patients in a randomized cross-over study of 3 weeks on low protein diet (LPD) or normal protein intake (NPD). On LPD, protein intake (0.64 +/- 0.05 vs 1.15 +/- 0.09 g kg-1 body weight (BW) per day, P less than 0.001), plasma urea (6.6 +/- 1.3 vs 11.0 +/- 2.0 mmol l-1, P less than 0.01) and urea appearance (0.06 +/- 0.01 vs 0.16 +/- 0.03 gN kg-1 body weight per day, P less than 0.001) were lower. Baseline glomerular filtration rate (GFR), renal plasma flow (RPF) and renal vascular resistance (RVR) were similar on the two diets and there were no significant average changes in these variables after the meat meal on either diet (NPD, before vs after MM: GFR: 67 +/- 11 vs 71 +/- 13 ml min-1 1.73 m-2; RPF: 479 +/- 70 vs 512 +/- 81 ml min-1 1.73 m-2; RVR: 181 +/- 45 vs 179 +/- 52 mmHg min-1 l-1); (LPD, before vs after MM: GFR: 64 +/- 10 vs 67 +/- 11 ml min-1 1.73 m-2; RPF: 506 +/- 60 vs 533 + 52 ml min-1 1.73 m-2; RVR: 151 +/- 28 vs 146 +/- 32 mmHg min-1 l-1). However, all patients with baseline GFR above 60 ml min-1 1.73 m-2 showed a GFR rise in response to the meat meal on both diets, while patients with lower baseline values tended to reduce their GRF.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determinants of impaired renal and vascular function are associated with elevated levels of procoagulant factors in the general population

Essentials

• Why venous thrombosis is more prevalent in chronic kidney disease is unclear.
• We investigated whether renal and vascular function are associated with hypercoagulability.
• Coagulation factors showed a procoagulant shift with impaired renal and vascular function.
• This suggests that renal and vascular function play a role in the etiology of thrombosis.

Summary

Background

Impaired renal and vascular function have been associated with venous thrombosis, but the mechanism is unclear.

Objectives

We investigated whether estimated glomerular filtration rate (eGFR), urinary albumin‐creatinine ratio (UACR), and pulse wave velocity (PWV) are associated with a procoagulant state.

Methods

In this cross‐sectional analysis of the NEO Study, eGFR, UACR, fibrinogen, and coagulation factors (F)VIII, FIX and FXI were determined in all participants (n = 6536), and PWV was assessed in a random subset (n = 2433). eGFR, UACR and PWV were analyzed continuously and per percentile: per six categories for eGFR (> 50^th [reference] to < 1st) and UACR (< 50^th [reference] to > 99th), and per four categories (< 50^th [reference] to > 95th percentile) for PWV. Linear regression was used and adjusted for age, sex, total body fat, smoking, education, ethnicity, total cholesterol, C‐reactive protein (CRP) and vitamin K antagonists use (FIX).

Results

Mean age was 55.6 years, mean eGFR 86.0 (12SD) mL 1.73 m^?² and median UACR 0.4 mg mmol^?1 (25th, 75th percentile; 0.3, 0.7). All coagulation factors showed a procoagulant shift with lower renal function and albuminuria. For example, FVIII was 22 IU dL^?1 (95% CI, 13–32) higher in the eGFR < 1st percentile compared with the > 50th percentile, and FVIII was 12 IU dL^?1 (95% CI, 3–22) higher in the UACR > 99th percentile compared with the < 50th percentile. PWV was positively associated with coagulation factors FIX and FXI in continuous analysis; per m/s difference in PWV, FIX was 2.0 IU dL^?1 (95% CI, 0.70–3.2) higher.

Conclusions

Impaired renal and vascular function was associated with higher levels of coagulation factors, underlining the role of renal function and vascular function in the development of venous thrombosis.

     

SHROOM3多态性与我国西南汉族人肾小球滤过率及终末期肾病的相关性研究

目的既往研究表明SHROOM3基因rs17319721多态性与西文人群肾小球滤过率(glovne-lular filtration rate,eGFR)相关。本研究目的是分析该多态性与中国西南汉族人群eGFR及终末期肾脏病(ESRD)发生的关系。方法纳入731健康(无肾脏疾病,高血压,糖尿病,eGFR>60ml/min/1.73m2)成年人及403例终末期肾脏病患者作为研究对象。采用ABI公司Taqman探针,用定量PCR仪对rs17319721进行基因分型。分析该多态性与eGFR及ESRD的相关性。结果尽管3种不同基因型的正常个体(AA,AG和GG)之间eGFR无明显差异[(88.2±24.2)ml/min,(99.1±18.3)ml/min,(100.8±18.6)ml/min,P=0.136],但是AA基因型个体的eGFR要更低。该多态性不同等位基因及不同基因型频率在正常对照与ESRD患者之间也无明显差异。Logistic回归分析也显示该多态性位点与健康个体的肾功能,以及与ESRD发生之间无明显相关性。结论我们对中国西南汉族人群的研究发现,SHROOM3基因AA基因型个体eGFR稍低,但是没有显示其与肾功能或ESRD发生有明显的相关性。     

Analysis of proteinuria in health and disease using sodium dodecyl sulphate-acrylamide gel electrophoresis

Abstract. Sodium dodecyl sulphate—acrylamide gel electrophoresis (SDS-AGE) separates proteins according to their molecular weight (MW) without being influenced by their electrostatic charge. It was carried out on the urine of 17 healthy control subjects and 92 ambulatory patients with suspected or known renal impairment. The SDS-AGE patterns were classified as physiological, low MW predominance, middle MW predominance, high MW predominance, or mixed low and high MW. Patients were separately classified as having either normal kidneys or glomerular, tubular or mixed renal lesions according to the results of clinical investigation. Comparison of both classifications revealed that SDS-AGE allowed a correct diagnosis of the site of renal involvement in 83 per cent of cases. Predominantly low MW protein excretion correlated with tubular damage. Middle and high MW patterns correlated with glomerular disease, and a relationship between nephrotic syndrome with minimal glomerular changes and middle MW pattern was found in two cases, suggesting that SDS-AGE could be used to evaluate the selectivity of proteinuria. However, the estimation of selectivity by SDS-AGE should be studied in a sufficient number of cases and compared with measurements of selectivity by the protein clearance method.     

比较不同测量肾脏深度方法及其对肾动态显像评估肾小球滤过率的影响

目的 对比采用CT、SPECT/CT侧位相、Tonnesen公式及Taylor公式4种方法得出的肾脏深度的差异,观察其对肾动态显像评估分肾肾小球滤过率(GFR)的影响.方法 连续收集84例同时接受放射性核素肾动态显像及腹部CT检查患者,采用CT、SPECT/CT侧位像、Tonnesen公式及Taylor公式测量双侧肾脏...     

Renal functional reserve in pigs: renal haemodynamics,renal tubular function and salt and water homeostatic hormones during amino acid and dopamine stimulation

The purpose of the study was to evaluate renal functional reserve [RFR is the difference between glomerular filtration rate (GFR) at rest and maximal GFR after stimulation] in a controlled study in normal pigs. Our basic hypothesis was that a decreased RFR may be used as an early indicator of renal deterioration, i.e. a test to disclose significant obstruction as opposed to simple dilatation in hydronephrosis. During various forms of stimulation (amino acids, captopril and dopamine), we measured changes in GFR, renal plasma flow (RPF), tubular reabsorption of sodium and water, net uptake from plasma to the kidney of three salt and water homeostatic hormones (angiotensin II, aldosterone and atrial natriuretic peptide) and of glucagon, which is thought to play a key role as mediator of the GFR increase during amino acid infusion. We found the largest GFR increase during combined infusion of amino acids and dopamine (+13%), but compared with a non-stimulated control group, the GFR increase was statistically non-significant. RPF increased by 57% during stimulation with amino acids plus dopamine (P<0·001), while tubular reabsorption of sodium and water, and renal uptake of angiotensin II, aldosterone and atrial natriuretic peptide showed no significant differences between control and stimulation groups. The renal uptake of glucagon increased significantly during amino acid stimulation with no concomitant GFR increase. We conclude that in this experimental, non-obstructed model, RFR is a very insensitive measure, which cannot be used to discriminate between obstruction and simple dilatation in hydronephrosis. Further, our study does not support the hypothesis that glucagon is involved in GFR changes after amino acids.