尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素18在糖尿病肾病中的临床价值

目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和白细胞介素18(IL-18)在糖尿病肾病(DN)中的临床价值.方法:98例2型糖尿病患者根据尿白蛋白/尿肌酐(ACR),分为正常白蛋白尿(NA)组(ACR<30 mg/g),微量白蛋白尿组(ACR 30~300 mg/g)和大量白蛋白尿组(ACR>300 mg/g),同时随机选取30名同期健康体检者作为对照组.分别检测尿NGAL和IL-18水平,分析两者与ACR及肾小球滤过率之间的相关性.结果:各组尿NGAL与IL-18均随ACR的水平增加而增加(P<0.01).NGAL和IL-18均与ACR呈正相关关系(P<0.01);NGAL和IL-18均与肾小球滤过率呈负相关关系(P<0.01).尿NGAL与尿IL-18呈正相关关系(P<0.01).结论:DN患者尿NGAL和IL-18水平明显升高,除肾小球损伤外,DN患者还存在肾小管的损害,肾小管损害与肾小球损害密切相关.     

血清Fractalkine和超敏C反应蛋白与早期2型糖尿病肾病的相关性研究

目的探讨血清Fractalkine(FKN)和超敏C反应蛋白(hs-CRP)在2型糖尿病正常清蛋白尿期及微量清蛋白尿期(即早期2型糖尿病肾病)的变化及二者与相关代谢指标的相关性。方法选择2009年3月—2010年2月在江苏省中医院内分泌科就诊的139例2型糖尿病患者,根据尿清蛋白/肌酐(UACR)水平,将患者分为正常蛋白尿组(UACR<30 mg/g)92例和微量清蛋白尿组(30 mg/g≤UACR<300 mg/g)47例。收集两组患者的一般资料(包括性别、年龄、病程等);测定相关生化指标水平,计算UACR;采用双抗体夹心酶联免疫(ELISA)法检测血清FKN水平,免疫比浊法测定hs-CRP水平。比较两组患者的各项生化指标及血清FKN、hs-CRP水平,并采用Pearson相关分析和多元逐步回归分析探讨相关指标与血清FKN、hs-CRP水平的关系。结果 (1)正常蛋白尿组和微量清蛋白尿组患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、hs-CRP水平比较,差异有统计学意义(P<0.01);而两组血脂、FKN水平及肾小球滤过率(eGFR)比较,差异均无统计学意义(P>0.05)。(2)Pearson相关分析显示,血清FKN水平与体质指数(BMI)、腰围、三酰甘油(TG)、hs-CRP均呈正相关(P<0.05)。血清hs-CRP水平与BMI、腰围、eGFR、TG、UACR均呈正相关(P<0.01),与HDL-C呈负相关(P<0.05)。(3)多元逐步回归分析显示,血清FKN与BMI独立相关(β=0.32,P<0.01,R2=0.40);血清hs-CRP与BMI(β=0.30,P<0.01,R2=0.37)、UACR(β=0.17,P<0.01,R2=0.27)独立相关。结论血清FKN水平与早期2型糖尿病患者代谢指标及UACR水平无相关性,而hs-CRP水平与早期2型糖尿病肾病关系密切。     

Glomerular filtration rate and proteinuria in obstructive sleep apnea syndrome patients

目的 了解阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对蛋白尿及肾小球滤过功能的影响.方法 采用回顾性研究方法收集222例OSAHS患者的人口学资料、实验室检测指标[血肌酐、尿素氮、尿白蛋白与肌酐比(ACR)、血脂、血尿酸、空腹血糖、糖化血红蛋白、血红蛋白]及睡眠呼吸监测参数.将其中的OSAHS患者依据呼吸暂停低通气指数(AHI)分为3组,进行上述资料的比较.对肾小球滤过率及蛋白尿进行多元线性回归筛选独立预测因子.结果 OSAHS轻、中、重组对比,尿ACR差异有统计学意义(P=0.041),重度组明显高于轻度组(P=0.018).多元线性回归分析提示eGFR的影响因素有糖尿病(P=0.026)、年龄(P=0.000)、肥胖(P=0.017)、血尿酸水平(P=0.044).尿ACR的独立影响因素仅有收缩压(P=0.033).结论 OSAHS严重程度不同,尿ACR有差异,重度组尿ACR明显高于轻度组.OSAHS不是肾小球滤过率及尿ACR的独立预测因子.     

阻塞性睡眠呼吸暂停低通气综合征对肾小球滤过率及尿白蛋白与肌酐比的影响

目的了解阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对蛋白尿及肾小球滤过功能的影响。方法采用回顾性研究方法收集222例OSAHS患者的人口学资料、实验室检测指标[血肌酐、尿素氮、尿白蛋白与肌酐比(ACR)、血脂、血尿酸、空腹血糖、糖化血红蛋白、血红蛋白]及睡眠呼吸监测参数。将其中的OSAHS患者依据呼吸暂停低通气指数(AHI)分为3组,进行上述资料的比较。对肾小球滤过率及蛋白尿进行多元线性回归筛选独立预测因子。结果 OSAHS轻、中、重组对比,尿ACR差异有统计学意义(P=0.041),重度组明显高于轻度组(P=0.018)。多元线性回归分析提示eGFR的影响因素有糖尿病(P=0.026)、年龄(P=0.000)、肥胖(P=0.017)、血尿酸水平(P=0.044)。尿ACR的独立影响因素仅有收缩压(P=0.033)。结论 OSAHS严重程度不同,尿ACR有差异,重度组尿ACR明显高于轻度组。OSAHS不是肾小球滤过率及尿ACR的独立预测因子。     

尿肝型脂肪酸结合蛋白与糖尿病肾病进展的关系研究

目的：探讨尿肝型脂肪酸结合蛋白（ L-FABP）与糖尿病肾病进展的关系。方法选择1型和2型糖尿病患者132例,依据尿蛋白/肌酐比（ACR）和血清肌酐水平分为正常蛋白尿组（45例）,微量蛋白尿组（36例）,临床白蛋白尿组（30例）,肾功能衰竭组（21例）,以65例健康体检者为对照组,酶联免疫吸附法（ ELISA ）测定尿L-FABP含量,同时检测血肌酐（Scr）、尿肌酐、肝功能、血红蛋白、糖化血红蛋白（HbA1c）、白蛋白（Alb）、24 h尿蛋白量、尿白蛋白等指标。结果随着糖尿病肾病的进展,尿L-FABP水平逐渐增高（各组间比较P ＜0.01）,亚组分析显示正常白蛋白组尿L-FABP水平高于健康组（ P＜0.05）,微量白蛋白组尿L-FABP水平高于正常白蛋白组（ P ＜0.01）,临床白蛋白组尿L-FABP水平高于微量白蛋白组（ P＜0.01）,肾功能衰竭组尿L-FABP水平高于临床白蛋白组（ P ＜0.01）;尿L-FABP水平与估计肾小球滤过率（ eGFR ）呈负相关（ r ＝-0.812, P ＜0.01）,尿L-FABP水平与Scr呈正相关（ r ＝0.901, P ＜0.01）,与HbA1c无关（ P ＞0.05）。结论尿L-FABP水平不但可以更早预测糖尿病肾病的发生,还可以监测糖尿病肾病的进展。     

高龄糖尿病患者肾功能及相关危险因素分析

目的:了解高龄糖尿病老年人肾功能的情况及相关危险因素。 方法: 选择本院≥80岁老年糖尿病住院患者270例,同时选择来我院健康体检的≥80岁的非糖尿病老人100例为对照组,通过测定血FBG、BUN、Scr、SUA、Hcy、HbA1c等,用CKD-EPI公式估算肾小球滤过率(eGFR)值。 结果: 270例糖尿病患者中,eGFR平均值为(53.83±24.86）ml?min-1?1.73 m-2,肾功能下降的发生率为55.9%。肾功能下降组与肾功能正常组比较,BUN、Scr、SUA、Hcy、ACR异常率均偏高,但HBA1c偏低(P<0.05)。Spearman相关分析结果显示,eGFR与SBP、BUN、Scr、SUA、TC、Hcy呈负相关,与FPG、HbA1c呈正相关(P＜0.05)。排除年龄、性别、BMI的影响,多因素Logistic回归分析显示,病程、收缩压、尿素氮、高尿酸血症、高胆固醇血症是肾功能下降的危险因素（OR=2.671、2.707、5.078、4.188、3.422,均P<0.05）,舒张压升高是保护因素（OR=0.033,P<0.01）。 结论:高龄糖尿病老年人肾功能异常率高,影响其风险因素较多。     

2型糖尿病患者踝肱指数和肾小球滤过率的关系

目的探讨2型糖尿病患者踝肱指数和肾小球滤过率的相关性。方法纳入160例2型糖尿病患者,测算踝肱指数及肾小球滤过率。依照踝肱指数分为两组:ABI≤0.9和0.9相似文献   

蛋白尿阴性成人1型糖尿病肾小球滤过率相关因素分析

目的 评估蛋白尿阴性的成人1型糖尿病(type 1 diabetes mellitus, T1DM)患者肾小球滤过率(estimated glomerular filtration rate, eGFR),并探究影响eGFR的相关因素。方法 纳入2018年6月~2019年6月在北京协和医院门诊就诊的T1DM患者,收集人体测量学指标,检测血糖、血脂、肌酐、C肽等指标,计算eGFR,通过Pearson相关性分析、多元线性回归方法,探讨蛋白尿阴性的成人T1DM患者eGFR的相关因素。结果 共纳入89例T1DM患者,10例蛋白尿阳性,79例蛋白尿阴性,蛋白尿阴性患者平均年龄为39.03±13.20岁,平均病程为9.89±9.21年,平均HbA1c为7.44%±1.32%,平均eGFR为111.61±13.43ml/(min·1.73m²),其中eGFR 60~90ml/(min·1.73m²)者5例(6.3%)。Pearson相关性分析显示,年龄、病程、SBP、TC、2hCP均与eGFR相关,而HbA1c与蛋白尿阴性患者eGFR水平无关。多元线性回归分析发现年龄、病程是eGFR的独立危险因素。结论蛋白尿阴性的中国成人T1DM中eGFR下降不罕见,对于年龄较大、病程较长者,即使尿蛋白阴性仍需密切监测肾功能。     

糖尿病肾病患者尿微量清蛋白相关因素研究

目的探讨糖尿病肾病(DN)患者尿微量清蛋白(MAU)的相关因素。方法选择2009年在新疆医科大学第一附属医院住院的377例DN患者为研究对象,回顾性分析患者的一般资料〔性别、年龄、民族、糖尿病病程、身高、体质量、体质指数(BMI)等〕及实验室检查结果〔包括尿酸(BUA)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、糖化血红蛋白(HbA1c)、脂蛋白〕。根据尿MAU将患者分为低值蛋白尿组、高值蛋白尿组和极高值蛋白尿组,比较3组患者上述指标间的差异,并分析各指标与尿MAU的相关性。结果 (1)与低值蛋白尿组比较,高值蛋白尿组、极高值蛋白尿组患者年龄大、病程长,BMI、FBG、BUA、TG、TC、LDL、脂蛋白水平更高,而GFR降低,差异均有统计学意义(P<0.05)。(2)多元相关分析显示,年龄、糖尿病病程、BMI、BUA、FBG、HbA1c、TG、TC、LDL、脂蛋白均与MAU呈正相关(P<0.05)。(3)Lo-gistic回归分析显示,糖尿病病程、HbA1c、TC、LDL、BUA、FBG是尿MAU的独立危险因素。结论糖尿病病程、HbA1c、TC、LDL、BUA、FBG与DN患者尿MAU排泄增加有关。     

血清尿酸与2型糖尿病肾病的相关性分析

目的:分析2型糖尿病肾病的危险因素,并探讨血清尿酸与糖尿病肾病的相关性。方法:选取2016年1月至2018年3月新疆医科大学第一附属医院收治的并明确诊断为糖尿病肾病患者463例,收集详细的人口学资料、BMI、血脂、血肌酐、糖化血红蛋白、肾小球滤过率,通过Pearson相关性分析、多元线性回归探讨糖尿病肾病的危险因素,并研究分析血清尿酸与肾小球滤过率的关系。结果:463例糖尿病肾病患者中,男性占71.92%,平均年龄55.70岁,平均糖化血红蛋白8.58%,男性和女性间年龄、BMI、总胆固醇及低密度脂蛋白差异无统计学意义;依据尿酸不同水平分组,发现三组人群甘油三酯、高密度脂蛋白、血肌酐、尿素、糖化血红蛋白、eGFR等指标差异有统计学意义。Pearson相关性分析发现血尿酸与估算的肾小球滤过率呈负相关(r=-0.475,P<0.01),在多元线性回归中通过逐步回归法构建回归方程发现,血尿酸每增加一个标准差,eGFR下降0.036ml/(min×1.73m^²;)(P=0.009)。结论:随着血尿酸水平的增高,eGFR值逐渐下降(r=-0.429,P<0.01),血尿酸是2型糖尿病肾病患者肾小球滤过率下降的独立危险因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.