尿微量白蛋白测定在预防早期糖尿病视网膜病变中的意义

目的 了解早期糖尿病肾病(DN)患者尿微量白蛋白排泄率(UAER)与视网膜病变(DR)的关系.方法 对120例2型糖尿病患者进行24 h UAER测定及眼底检查.结果微量白蛋白尿发生率为37.5%,DR发生率为25.8%,UAER升高组DR发生率较UAER正常组明显增高,分别为60%和5.3%.差异有统计学意义(P＜0.01).DR发生率随病程增加及血糖的增高而增多.结论 DN的严重程度与DR病变程度相符,两者均与病程、血糖控制及尿蛋白的水平有密切关系,耱尿病患者定期检查眼底及UAER,对糖尿病微血管病变的早期诊治有重要意义.     

尿视黄醇结合蛋白在糖尿病肾病早期的诊断意义

目的探讨尿视黄醇结合蛋白(RBP)在糖尿病肾病早期的诊断意义.方法采用酶联免疫法(BLISA)测定78例非胰岛素依赖型糖尿病(NIDDM)患者和30例健康人的尿RBP,同时测定尿微量白蛋白(Alb)和尿β2-微球蛋白(β2-MG).结果NIDDM患者RBP较正常对照组增高,尿RBP与尿A1b、尿β2-MG呈正相关.结论尿RBP可作为诊断早期糖尿病肾病的敏感指标.     

尿视黄醇结合蛋白在糖尿病肾病早期的诊断意义

目的 探讨尿视黄醇结合蛋白(RBP)在糖尿病肾病早期的诊断意义。方法 采用酶联免疫法(ELISA)测定78例非胰岛素依赖型糖尿病(NIDDM)患者和30例健康人的尿RBP,同时测定尿微量白蛋白(Alb)和尿β_2-微球蛋白(β_2-MG)。结果 NIDDM患者RBP较正常对照组增高,尿RBP与尿Alb、尿β_2-MG呈正相关。结论 尿RBP可作为诊断早期糖尿病肾病的敏感指标。     

DCA^＋2000免疫比浊法与放射免疫法测定尿微量白蛋白的比较

微量白蛋白尿是糖尿病肾病早期诊断的重要指标 ,与糖尿病的其他慢性并发症有一定的联系 ,如伴有微量白蛋白尿的 2型糖尿病患者的心血管发病率和病死率明显升高 ,视网膜病变的发生率也增高。在非糖尿病人群中 ,越来越多的证据表明尿白蛋白排泄率升高同心血管疾病导致的早期伤残和死亡有关[1] 。本文同时用常规放射免疫法和快速免疫比浊法 (ＤＣＡ 2 0 0 0测定仪 )测定尿白蛋白 ,其结果如下。1　对象本院于 1999年 2月～ 1999年 8月住院糖尿病患者 52例 ,其中男 2 7例 ,女 2 5例。糖尿病诊断依据1985年ＷＨＯ标准。2　方法尿微量白蛋白常规放…     

高血压病患者5种尿微蛋白和NAG酶排泄的临床意义

目的测定高血压病(EH)患者尿微蛋白和N-乙酰-β-D葡萄糖苷酶(NAG)的排泄,间接了解肾单位受损的概貌。方法用放射免疫法和酶联免疫法测定了82例EH患者和30例正常对照者尿微量白蛋白(Alb)、转铁蛋白(Tf)、α1-微球蛋白(α1M),β2微蛋白(β2M)、Tamm-Horsfall蛋白(THP)及NAG活性。结果EH患者尿Alb、Tf、α1M、β2M、NAG均显著高于正常对照(P<0.05),而THP稍增高;各期及病程组Alb、Tf、α1M、NAG显著高于对照组(P<0.05),但Tf于Ⅰ、Ⅱ期增高,无显著差别;EH患者中有高血压家族史者尿Alb、α1M、β2M有增高趋势。结论EH患者早期即有肾单位受损,以肾小球和近曲小管为主,尚未及远曲小管;测定尿Alb、Tf、α1M、NAG可早期发现肾脏受损状况,有高血压家族史者肾受损无明显加重改变。     

非胰岛素依赖型糖尿病患者尿α_1-微球蛋白与尿微量白蛋白排泄率的相关性分析

对51例非胰岛素依赖型糖尿病(NIDDM)患者尿α_1-微球蛋白(α_1-mG)及每分尿微量白蛋白排泄率(UAER)进行检测并比较。结果显示:(1)尿α_1-mG与每分尿微量白蛋白排泄率(UAER)呈显著性正相关(P<0.01)。(2)尿α_1-mG临床糖尿病肾病(DN)组、无DN组与早期DN组比较均有显著性差异(P<0.01)。提示:尿α_1-mG可作为早期糖尿病肾病诊断的敏感指标。     

2型糖尿病尿白蛋白变化与下肢血管病变关系研究

微量白蛋白尿是糖尿病肾病的早期表现,临床测定简便易行。研究提示,尿白蛋白变化与糖尿病心脑血管并发症关系密切,因此研究糖尿病尿白蛋白变化与其他慢性血管并发症的关系有助于提高对糖尿病慢性并发症的早期预防。本文对我院住院的550例2型糖尿病患者尿蛋白排泄率与慢性并发症情况进行回顾分析,探讨其与糖尿病下肢血管病变的关系。     

尿特种蛋白与糖尿病早期肾损害关系的相关性研究

目的探讨尿特种蛋白微量白蛋白(Malb)、α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)与糖尿病早期肾损害关系。方法随机选择126例作为正常对照组,我院糖尿病患者据尿微量白蛋白排泄率分为无肾病组、初期肾病组、临床肾病组三组各126例,进行尿特种蛋白及尿肌酐(Cr)测定。结果糖尿病三组均与正常对照组进行t检验有统计学意义(按α=0.05水准,P<0.05)。结论尿特种蛋白与早期肾损害呈正相关,尿特种蛋白可作为发现糖尿病早期肾损害的常规筛查项目。     

2型糖尿病肾病患者血小板α-颗粒膜蛋白和血浆内皮素的变化

2型糖尿病肾病(DN)是2型糖尿病微血管病变的并发症之一,临床常以尿微量白蛋白排泄(UAE)作为DN早期诊断的特异性指标。近年来许多研究表明,血小板功能异常及内皮细胞产生的内皮素(ET)增多在糖尿病微血管病变的发生、发展中起重要作用。我们通过测定α-颗粒膜蛋白(GMP-0140),血浆内皮素(ET)水平的变化观察α型糖尿病(NIDDM)患者内皮细胞,血小板功能变化,及它们与UAE之间的关系,探讨DN的发病机理。     

尿白蛋白排泄与2型糖尿病视网膜病变的关系

糖尿病肾病(DN)和糖尿病视网膜病变(DR)是糖尿病(DM)的常见慢性并发症,其病理基础均为微血管病变,二者有密切的关系.我们选择2型DM患者86例进行24h尿白蛋白测定、眼底荧光血管造影及检眼镜等检查,观察尿白蛋白排泄(UAE)与DR的关系,为早期诊断、治疗DM慢性并发症提供参考.     

Effects of ACE inhibition and angiotensin II receptor blockade on glomerular basement membrane protein excretion and charge selectivity in type 2 diabetic patients.

Angiotensin-converting enzyme (ACE) inhibitors may reduce urinary albumin excretion (UAE) by decreasing glomerular pressure and increasing glomerular charge selectivity through preservation of glycosaminoglycans. The effect of Angiotensin II antagonism on glomerular charge selectivity remains to be determined. The aim of this study was to compare the effects of an AT1 blocker losartan and an ACE inhibitor (ACE-I) enalapril on UAE, extracellular matrix proteins, glycosaminoglycan excretion (UGAG) and red blood cell anionic charge (RBCCh) which are the indirect markers of glomerular basement membrane anionic content in hypertensive Type 2 diabetic patients. Twenty-four patients were randomised into two groups and received either enalapril (520 mg/d) or losartan (50100 mg/d). All parameters were measured at baseline and after six months of treatment. At the end of six months, systolic and diastolic blood pressures (BP), UAE rates, UGAG excretion and RBCCh were significantly and equally reduced in both treatment groups compared with baseline. RBCCh was negatively correlated with UAE (r=-0.57, p<0.0001) and UGAG excretion (r=-0.57, p<0.0001); UAE was correlated with UGAG excretion (r=0.58, p<0.0001). In conclusion, enalapril and losartan treatment were equally effective in reducing BP, UAE as well as UGAG excretion and preserving RBCCh in hypertensive Type 2 diabetic patients. ACE inhibition and AT1-receptor blockade may have favourable effects on preserving glomerular anionic content in hypertensive diabetic patients.     

Microalbuminuria as a marker of cardiac damage in essential hypertension

A subclinical elevation in urinary albumin excretion (UAE) microalbuminuria is frequently seen in essential hypertension. The level of blood pressure appears to be an important factor in the development of microalbuminuria. Moreover there is some evidence to indicate that microalbuminuria may be an early marker of increased cardiovascular risk. Aim of this study was to evaluate the prevalence of UAE in hypertensives with normal left ventricular mass and to study any association with blood pressure level and with possible modification in left ventricular function. A group of 112 subjects diagnosed as having stage 1-2 essential hypertension were included in the study. Patients underwent urinary collection to evaluate UAE and to 24/hours arterial blood pressure monitoring. Moreover a complete echocardiography was performed. According with UAE levels patients were divided into three groups: A: UAE 0-15 mg/24 h, B: UAE 16-29 mg/24 h, C: UAE 30-300 mg/24 h. We found a significant correlation between 24/h SBP, 24/h DBP and UAE. We observed a significant correlation between impaired diastolic function and UAE. UAE is influenced by BP levels with better correlation with 24/h systolic values. UAE is associated with subclinical decrease of left ventricular function and may be an early marker of cardiac involvement.     

THE 5-HT2 RECEPTOR ANTAGONIST SARPOGRELATE REDUCES URINARY AND PLASMA LEVELS OF THROMBOXANE A2 AND URINARY ALBUMIN EXCRETION IN NON-INSULIN-DEPENDENT DIABETES MELLITUS PATIENTS†

1. Therapeutic effects of a 5-HT2 receptor antagonist sarpogrelate on microalbuminuria and thromboxane (TX)A2 biosynthesis were examined in non-insulin-dependent diabetes mellitus (NIDDM) patients. 2. In protocol I, the ankle-brachial pressure index (API; an indicator of peripheral blood flow) and urinary albumin excretion (UalbV; an indicator of renal function) were determined in 42 NIDDM patients who had been treated with 300 mg/day sarpogrelate for 8 weeks. In an analysis of the results, the NIDDM patients were divided into four groups based on the severity of either vasculopathy or nephropathy as follows: group A, API < 0.9, UalbV > or = 100 mg/day; group B, API < 0.9, UalbV < 100 mg/day; group CAPI > or = 0.9, UalbV > or = 100 mg/day; and group D, API > or = 0.9, UalbV < 100 mg/day. 3. In protocol II, 10 NIDDM patients with UalbV values > 100 mg/day were divided into two groups to further confirm the effect of sarpogrelate on albuminuria: group E, the sarpogrelate treatment group (n = 5); and group F, the no treatment group (n = 5). 4. In protocol I, the incidence of a cold sensation in the lower extremities was reduced from 45.2 to 21.4% following sarpogrelate treatment. In patients with UalbV > or = 100 mg/day (groups A and C), UalbV was significantly decreased independent of API, while it did not change in patients with UalbV < 100 mg/day (groups B and D). Plasma TXB2 levels were significantly decreased following sarpogrelate treatment, whereas plasma 6-keto-prostaglandin F1 alpha levels were not. 5. In protocol II, in the sarpogrelate treatment group (group E), albuminuria was significantly improved and both plasma levels TXB2 and urinary TXB2 excretion were significantly decreased. In contrast, in the untreated group (group F), neither plasma levels TXB2 nor urinary TXB2 excretion was changed. 6. In conclusion, microalbuminuria was improved by treatment with the 5-HT2 receptor antagonist sarpogrelate independent of latent vasculopathy. Blockade of 5-HT2 receptors is suggested to be beneficial for the treatment of nephropathy in NIDDM patients. It is possible that the inhibition of TXA2 biosynthesis is involved in the therapeutic effect of 5-HT2 receptor antagonists.     

Urinary albumin excretion and the renin–angiotensin system in cardiovascular risk management

Microalbuminuria has been shown to be a strong predictor of cardiovascular morbidity and mortality in diabetic and hypertensive patients, but also in the general population. Moreover, several reports suggest that reduction of urinary albumin excretion (UAE) is associated with improvement of cardiovascular prognosis. Reduction of UAE can be achieved by lowering arterial blood pressure, but blockers of the renin–angiotensin system (RAS) with their specific renal actions have demonstrated to be able to reduce UAE more than might be expected from reduction of blood pressure alone. Consequently, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may also provide superior cardiovascular protection, especially in subjects with higher levels of albuminuria, but evidence is still scarce. The ability of both angiotensin-converting enzyme inhibitors and angiotensin receptor blockers to reduce UAE and provide cardiovascular protection suggests that the RAS may play a central role. New developments in this area include the use of aldosterone antagonists in albuminuric/proteinuric subjects, and the development of oral renin inhibitors. Combinations of the aforementioned drugs may have the ability to fully block the RAS, potentially avoiding all detrimental effects of this hormonal cascade. However, combination therapy is expected to also increase the incidence of side effects, such as hyperkalaemia and acute renal insufficiency. The current knowledge of microalbuminuria represents the proverbial tip of the iceberg, and future studies should focus on the underlying pathophysiological mechanism of urinary albumin excretion in relation to cardiovascular protection. Only then can a better understanding of the problem be achieved and the optimal pharmacological approach be ascertained.     

The impact of hormonal contraceptives on blood pressure, urinary albumin excretion and glomerular filtration rate

AIM: In short-term studies, hormonal contraceptives (HC) have been suggested to induce a rise in blood pressure (BP) and urinary albumin excretion (UAE), while the effect of HC in renal function (GFR) is still under debate. Data on long-term and withdrawal effects of HC use on these outcomes are, however, not available. We therefore studied whether the start and cessation of HC induce changes in BP, UAE and GFR. METHODS: We used data from the PREVEND Study, a prospective cohort of subjects aged 28-75 years. Eligible were women aged < or = 45 years with complete clinical and pharmacy data on baseline and follow-up screening (4 years later). Multivariate regression analysis was used to estimate the effects of HC on BP, UAE and GFR in those who started (n = 73), stopped (n = 117) or continued (n = 183) with those who never used HC (n = 286) as the reference group. RESULTS: BP increased among starters and fell in stoppers. These changes compared with never-users were statistically significant, even after adjustment for relevant variables. UAE increased by 14.2% in starters (P = 0.074) and fell by 10.6% in stoppers (P = 0.021), while GFR fell by 6.3% in starters (P < 0.001) and did not change in stoppers. The effects of stopping HC on UAE and GFR were significantly different compared with changes among never-users, even after adjustment for other variables (P = 0.023 and 0.036, respectively). CONCLUSIONS: The start of HC was independently associated with worsening of BP, UAE and GFR, while stopping HC use resulted in an improvement. These data suggest that long-term HC use (aged 28-45 years) may be deleterious from the cardiovascular and renal point of view, but stopping may result in correction of these effects.     

Urinary albumin excretion and the renin-angiotensin system in cardiovascular risk management

Microalbuminuria has been shown to be a strong predictor of cardiovascular morbidity and mortality in diabetic and hypertensive patients, but also in the general population. Moreover, several reports suggest that reduction of urinary albumin excretion (UAE) is associated with improvement of cardiovascular prognosis. Reduction of UAE can be achieved by lowering arterial blood pressure, but blockers of the renin-angiotensin system (RAS) with their specific renal actions have demonstrated to be able to reduce UAE more than might be expected from reduction of blood pressure alone. Consequently, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may also provide superior cardiovascular protection, especially in subjects with higher levels of albuminuria, but evidence is still scarce. The ability of both angiotensin-converting enzyme inhibitors and angiotensin receptor blockers to reduce UAE and provide cardiovascular protection suggests that the RAS may play a central role. New developments in this area include the use of aldosterone antagonists in albuminuric/proteinuric subjects, and the development of oral renin inhibitors. Combinations of the aforementioned drugs may have the ability to fully block the RAS, potentially avoiding all detrimental effects of this hormonal cascade. However, combination therapy is expected to also increase the incidence of side effects, such as hyperkalaemia and acute renal insufficiency. The current knowledge of microalbuminuria represents the proverbial tip of the iceberg, and future studies should focus on the underlying pathophysiological mechanism of urinary albumin excretion in relation to cardiovascular protection. Only then can a better understanding of the problem be achieved and the optimal pharmacological approach be ascertained.     

血清胱蛋白C对早期糖尿病肾病的诊断价值

目的寻找一种更为简便的诊断早期糖尿病肾病的方法。方法采用颗粒增强透射免疫比浊法(PENIA)测定67例糖尿病(DM)病人的血清胱蛋白C(Cysc)浓度,同时测定白蛋白排泄率(UAE)作为对照,以判断血清胱蛋白C浓度在早期糖尿病肾病中的临床意义及应用价值。结果UAE升高组(早期糖尿病肾病组)的血清Cysc浓度均较UAE正常组明显升高(P<0.01),与尿β2微球蛋白(β2-MG)浓度呈正相关,与肌酐清除率(Ccr)呈负相关。结论血清Cysc浓度升高可作为诊断早期糖尿病肾病的一项指标,它和UAE有相同的临床意义,并且简便易行。     

非胰岛素依赖型糖尿病患者血清唾液酸的改变

测定20例NIDDM伴有心脑血管病变的患者、20例单纯NIDDM患者的血清唾液酸（SA）水平，并与20例正常人进行比较。结果发现所有NIDDM患者的血清SA水平均显著增高（P＜0．01），其中伴有心脑血管疾病患者的血清SA水平显著高于单纯NIDDM患者（P＜0．05），同时血清SA水平与血清胰岛素及C肽水平、收好压之间存在相关。提示血清SA水平与NIDDM患者的心脑血管疾病关系密切，可能是心脑血管并发症发生的一个危险因素。     

Treatment with acarbose,an α-glucosidase inhibitor,reduces increased albumin excretion in streptozotocin-diabetic rats

• 1.1. We examined the effect of the α-glucosidase inhibitor acarbose on urinary albumin excretion (UAE) in streptozotocin diabetic rats.
• 2.2. Treatment with acarbose for 8 weeks after induction of diabetes prevented the significant increase in UAE observed in untreated diabetic rats relative to nondiabetic controls.
• 3.3. Acarbose significantly reduced integrated glycemia, which correlated with albumin excretion rates, and exerts a salutary effect on diabetic renal dysfunction.

     

The renal handling of sodium and potassium in environmental cadmium-exposed subjects with renal dysfunction.

To clarify using clearance methods the renal handling of sodium and potassium in a population with environmental cadmium (Cd)-induced renal dysfunction, 76 Cd-exposed subjects (32 men and 44 women) and 36 non-exposed subjects (18 men and 18 women) were selected. Fractional excretions of potassium and beta 2-microglobulin were higher in the Cd-exposed subjects than in the non-exposed subjects, while the fractional excretion of sodium in the Cd-exposed subjects was equal to that of the non-exposed subjects. The urinary excretion rate of sodium was significantly lower in the Cd-exposed subjects than in the non-exposed subjects, while no significant difference was found in the urinary potassium excretion rate. Fractional excretion of sodium showed a significant correlation with age in all the subjects, while that of potassium significantly correlated with serum beta 2-microglobulin. These results indicate that increases in the fractional excretion of sodium or potassium do not directly signify increased urinary excretion of sodium or potassium in Cd-induced renal tubular dysfunction. The fractional excretion of potassium may be more affected by Cd-induced renal dysfunction, while that of sodium appears to be more related to age.