IgA肾病的近况

IgA 肾病在亚太地区是肾小球肾炎的最常见类型,易误诊为外科性血尿而进行不必要的检查。为此,本文重点对 IgA 肾病的流行病学、临床表现、经过、预后及治疗作一综合性介绍。     

IgA肾病中医诊治研究进展分析

IgA肾病（IgA nephropathy,IgAN）是特殊类型的原发性肾小球肾炎,发病以青壮年男性为主,是亚太地区最为常见的原发性肾小球疾病。目前,对于IgAN现代医学尚无理想的治疗方法,疗效欠理想,不良反应也多。近年来,中医学者采用恰当的中医药进行治疗,取得了一定的效果,但也存,     

IgA肾病补体靶向治疗研究进展

<正>IgA肾病(IgA nephropathy, IgAN)是最常见的原发性肾小球疾病。其特征为肾小球系膜区存在IgA沉积,肾脏中沉积的主要是IgA1亚群。在亚洲,IgAN约占原发性肾小球疾病的31%～50%,是终末期肾病(end stage kidney disease,ESKD)的重要原因^[1-2]。研究表明IgAN患者10、20和30年的肾脏生存率分别为80%、53%和25%^[3],造成严重的个人和社会经济损失。目前IgAN的发病机制尚不完全清楚,但越来越多的证据表明,补体的异常激活在IgAN中具有致病性,与疾病的严重程度及预后关系密切^[4]。近年来,IgAN的补体靶向治疗逐渐成为人们关注的焦点。在未来,补体靶向治疗可能会成为治疗IgAN重要的新领域。     

IgA肾病

ＩｇＡ肾病曾彩虹陈惠萍关键词ＩｇＡ肾病临床病理治疗预后１９６８年Ｂｅｒｇｅｒ和Ｈｉｎｇｌａｉｓ首次提出一种在全球范围内最常见的原发性肾小球疾病，即ＩｇＡ肾病（ＩｇＡＮｅｐｈｒｏｐａｔｈｙ，ＩｇＡＮ）。初期，人们认为ＩｇＡＮ预后良好，近来研究发现ＩｇＡ...     

IgA肾病与Th细胞关系的研究进展

IgA肾病是一种免疫复合物病,免疫调节系统失衡,淋巴细胞功能紊乱参与其发病机理.不同病理类型的IgA肾病的临床表现不尽相同,治疗上也有所差异,其发生可能与辅助性T细胞1(Th1)和辅助性T细胞2(Th2)免疫应答有关.现就IgA肾病临床病理与Th细胞关系的研究作一综述.     

IgA肾病的进展状况

IgA肾病是一个免疫病理学的诊断概念,主要是指在肾小球系膜区有广泛、显著的IgA沉着的肾小球疾病。现将本病的进展状况作一概述。一、病因及发病机理多数学者认为本病属于免疫性疾病。有人发现病人分泌IgA的B细胞株增加而抑制IgA分泌的T细胞减少,辅助/抑制T细胞比例增加表示免疫系统紊乱。皮肤、肝脏中有IgA及补体C_3沉着表示为系统性疾病。肾小球沉积物中的IgA多为多聚体,     

糖尿病肾病合并IgA肾病

病史摘要 病史患者男性,40岁,因“口干、多饮、多尿半年,尿检异常2月余”入院。患者入院前半年自觉口干、多饮、多尿,夜尿2～3次／夜,无视物模糊、手足麻木等不适,未治。     

IgA肾病靶向新药的研究进展

IgA肾病是引起我国青年人肾衰竭最常见的病因,在过去五十多年的时间内缺乏特异性治疗措施,临床主要以支持治疗及糖皮质激素治疗为主,然而患者整体预后改善非常有限。在过去的数年,临床基于IgA肾病发病机制研发的特异性靶向新药有了突飞猛进的进展,该病也正在经历从传统的免疫抑制治疗时代进入基于发病机制的靶向治疗新时代转变,这些新药的研发有望大幅度减少IgA肾病未来发生肾衰竭的风险。本文将逐一综述这些新药的研究进展。     

异常糖基化IgA1分子与IgA肾病

上世纪60年代,应用免疫组化技术,Berger与Hinglais[1]首次描述了IgA、IgG在肾小球系膜区共同沉积的肾小球疾病,并将其命名为"IgA肾病(IgAN)"(又名Berger病).     

IgA肾病的治疗近况

IgA肾病是我国最常见的原发性肾小球疾病,发病率占原发性肾小球疾病的26%~34%,常见于青壮年,临床表现轻重不一,预后也各不相同。IgA肾病患者在20年后有20%~30%的病人将进展到肾功能衰竭,所以在认识到这种疾病存在后的近40年里,各国学者从来没有停止过对该病的研究。目前IgA肾病     

Visfatin, low-grade inflammation and body mass index (BMI)

Objective Visfatin is an adipokine with revealing roles in inflammatory mechanisms but its implication in inflammation related to excessive adiposity/obesity is not studied yet. Our aim was to investigate the relations of visfatin with inflammation markers and body mass index (BMI) in the peripheral blood mononuclear cells (PBMCs), a type of cells closely related to inflammatory mechanisms. Design Cross‐sectional study, quantification of visfatin, TNF‐α, IL‐6 mRNA in PBMCs. Patients Eighty‐three supposed healthy individuals from the STANISLAS cohort, belonging in three BMI categories: BMI < 25 kg/m² (lean), 25 kg/m² ≤ BMI < 30 kg/m² (overweight) or BMI ≥ 30 kg/m² (obese). Measurements We measured visfatin gene expression (by real‐time quantitative PCR), in relation to gene expression of the pro‐inflammatory cytokines TNF‐α, IL‐6 in PBMCs and to anthropometric parameters (weight, BMI, waist : hip ratio), blood pressure, lipid profile, glucose and inflammatory markers (C‐reactive protein, lymphocyte count). Results Visfatin expression in PBMCs was significantly associated with BMI in a negative way (r = –0·21, P = 0·05). Global anova analysis test for lean and over‐weight/obese individuals showed a negative significant association between visfatin expression in PBMCs and BMI both for men and women (P = 0·05 and P = 0·01, respectively) and these associations remained significant after separating subjects in three groups (lean, overweight, obese) for men and women (P = 0·02 and P = 0·05, respectively). Correlation analysis between levels of expression of visfatin and TNF‐α showed a significant positive linear association (r² = 0·27, P < 0·0001). Conclusion These findings reveal a probable new role of visfatin in inflammation reflected in PBMCs, in the context of obesity.     

Flavor identification inversely correlates with body mass index (BMI)

Background and aimsDietary choices are influenced by several factors including physiological, social, or genetic factors. Among these, flavor is the most important determinant modulating food preferences. The aim of the present study was to assess flavor identification abilities in patients with obesity (Ob) in comparison with matched normal weight (NW) and over-weight (OW) subjects using a specific and validated chemosensory test.Methods and resultsThe flavor test was administered to 140 Ob patients recruited in the obesity outpatient Unit at the Federico II University hospital and to the same number of NW and OW subjects matched by sex, age, and smoking habit. Flavor score (FS) inversely correlated with BMI. Median [Q1; Q3] FS was significantly higher in NW (14.5 [12; 16]) than in Ob (13 [10; 15] p < 0.001) and not significantly different from OW (14 [12; 16]) individuals. FS was also higher in OW than in Ob subjects (p < 0.005). When separated according to age quartiles, the BMI-related differences in FS were still significant in younger quartiles, while they were abolished in the older.ConclusionsBMI is a critical factor modulating flavor identification, particularly in young subjects. Further investigations are needed to explore the precise mechanism and the causal relationship between body weight and olfactory dysfunctions.Clinicaltrial idNCT03506074.     

正常体重指数中老年人群三酰甘油葡萄糖指数与冠心病的关系

目的 分析正常体重指数(body mass index,BMI)中老年人群的三酰甘油葡萄糖(triglyceride-glucose,TyG)指数与冠心病的相关性,探讨TyG指数成为预测冠心病的生物学指标的可能性.方法 回顾性研究696例因疑有冠心病而行冠脉造影的患者,根据TyG指数的四分位数由低到高分为Q1、Q2、Q3、Q4组.分析各组的基线资料特点,以及TyG指数与冠心病的相关性.结果 与Q1组相比,Q4组2型糖尿病患者占比更大,舒张压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白等生物学参数均显著增高.冠心病的发生率在各组中呈线性趋势(χ2趋势=5.735,P=0.017).在调整性别和年龄等协变量后,进行多因素非条件Logistic回归分析,结果显示以Q1组为参照,Q2、Q4组TyG指数的调整OR(95％CI)值分别为1.833(1.012～3.317)和2.752(1.469～5.157),且差异有统计学意义(P<0.05);进一步调整吸烟状态、高血压病、2型糖尿病、BMI等协变量后,仍以Q1组为参照,Q2、Q4组TyG指数的调整OR(95％CI)值分别为2.062(1.123～3.784)和2.007(1.031～3.905),且差异有统计学意义(P<0.05).结论 在BMI正常的中老年人群中,TyG指数可作为预测冠心病的有效指标.随着TyG指数的增大,冠心病的风险成倍增加.合并冠心病危险因素的患者应密切关注TyG指数变化.     

Determinants of geographical variations in body mass index (BMI) and obesity in Spain.

OBJECTIVE: To identify the factors associated with geographic variations in Body Mass Index (BMI) and obesity in Spain. DESIGN: Cross-sectional, ecological analysis using data on illiteracy rate (per 1000 population), energy intake (kcal/person/d), sedentary population (%), smoking population (%), alcohol consumption (g/person/d), and percentage of population aged 65 y or over, for Spain's 50 provinces. SUBJECTS: Non-institutionalized population aged 16y or over. MEASUREMENTS: Median BMI and percentage of population with obesity, defined as BMI > 30 kg/m2. RESULTS: There was a clear geographical pattern, with some areas in the south and north-west of the country registering the highest BMI and prevalence of obesity and a north-south pattern on illiteracy per 1000 population. Multivariate regression analysis showed that illiteracy, sedentary lifestyle and energy intake explain 35% and 14% of the variation in BMI and obesity, respectively. Illiteracy proved to be the variable most associated with both BMI (regression coefficient (beta = 0.01; P = 0.005) and obesity (beta = 0.05; P = 0.013). Sedentary lifestyle showed a statistically significant relationship with BMI (beta = 0.01; P = 0.03), but not with obesity (beta = 0.03; P = 0.581). Energy intake exhibited a relationship with BMI (beta < 0.01 P = 0.03) that lost statistical significance when adjusted for age. CONCLUSION: Geographical variations in BMI in Spain are partly explained by illiteracy, sedentary lifestyle and, to a lesser extent, energy intake, whereas regional variations in obesity are related only to the educational level of the population.     

Correlation between fasting plasma ghrelin levels and age, body mass index (BMI), BMI percentiles, and 24-hour plasma ghrelin profiles in Prader-Willi syndrome

Ghrelin is a GH-releasing acylated peptide found in the stomach and a centrally acting food intake stimulator. Prader-Willi syndrome (PWS) is a genetic disorder characterized by a voracious appetite and increased fasting ghrelin levels. In this report we describe 24-h ghrelin profiles in PWS children (n = 5) and compare these with age, sex, and body mass index (BMI)-matched controls (n = 5). A 3- to 4-fold increase in ghrelin levels was found in PWS over a 24-h period, compared with controls (P < 0.001). Interestingly, there was a greater tendency for the up-regulation of ghrelin level in lean PWS than in obese PWS. To confirm this finding, we measured fasting ghrelin levels in 39 patients with PWS. Inverse correlations were found between plasma ghrelin levels and the following: age (r = -0.408, P = 0.005), BMI (r = -0.341, P = 0.017), percentage of the ideal weight for age (r = -0.382, P = 0.008), and BMI percentile (r = -0.311, P = 0.027). Our data show that there may be a suppressive (or up-regulating) controlling mechanism of ghrelin secretion in obese (or lean) PWS children. We hope that our data may further explain the mechanisms underlying the insatiable appetite and obesity characteristic of PWS.     

The relationship between the body mass index (BMI) and foot posture in elderly people

We wanted to evaluate the postural characteristics of the feet of older people and their relationship with the BMI. We evaluated 227 older women and 172 older men with respect to the BMI, the arch index (AI) and the foot posture index (FPI). The obese women presented mean values for the AI significantly greater than those of the normal and overweight women. The means for some of the criteria of the FPI were significantly higher in the obese men. There was a positive correlation between the BMI and the AI and some of the FPI criteria. The conclusion was that obese women presented flatter feet while obese men presented more pronated feet, indicating a relationship between high BMI values and postural characteristics of the feet of subjects studied.     

Body mass index (BMI), body composition and mortality of nursing home elderly residents

The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index = value/height²), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI = 0.73-2.89; OR = 1.73) and 0.63 (95% CI = 0.33-1.60; OR = 0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR = 2.42, 95% CI = 0.36-16.18; OR = 2.55 and RR = 3.22, 95% CI = 0.78-13.32; OR = 3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.     

Body mass index (BMI) at an early age and the risk of dementia

BMI change and BMI at an early age have not been investigated as risks for dementia. This case-control study included 286 dementia patients and 268 controls from two medical centers between 2007 and 2009. BMI information was collected from medical records and questionnaires. Men and women with low BMIs at the time of the study, in their 20s, and in their 40s had significantly increased risks of Alzheimer's disease (AD) (odds ratio = OR = 2.62–3.97) and increased vascular dementia (VaD) risk (20s and 40s: OR = 6.23–11.11) compared with those with normal BMIs. High BMI in the 20s and 40s was associated with increased VaD risk (OR = 15.29 and 10.32) among women. For BMI changes from the 20s or 40s, the second and third tertiles were significantly associated with decreased AD risk among women (OR = 0.15–0.35) compared to the first tertile. The third tertile of BMI change from the 20s or 40s was associated with decreased VaD risk among women (OR = 0.06 and 0.14). Low BMIs in the 20s and 40s were stronger predictors of AD and VaD. There was a U-shaped association between BMI at different ages and dementia among participants with VaD.     

中重度单纯性肥胖儿童体质量指数、血流变、血脂变化及其相关性分析

目的探讨预测肥胖儿童动脉粥样硬化危险性的方法。方法筛选60例中重度单纯性肥胖儿童（肥胖组）进行血糖、血脂及血流变等指标检测,选择年龄、性别等匹配的60例儿童作为对照组。结果与对照组比较,肥胖组TC、TG、LDL、apoB、OX—LDL、动脉粥样硬化指数（AI）及血黏度显著升高,HDL、apoA1显著下降,红细胞聚集能力增加。纤维蛋白原增多;体质量指数（BMI）与TC、TG、LDL、全血黏度（高切、中切）和红细胞电泳时间呈显著正相关,与HDL呈负相关。结论中重度单纯性肥胖儿童存在明显的脂质代谢紊乱,其发生动脉粥样硬化的危险性增加,可通过测定BMI对肥胖儿童的动脉粥样硬化危险性进行预测。