冠心病患者肾动脉介入治疗后尿微球蛋白的变化

目的　评价冠心病合并肾动脉狭窄患者肾动脉支架术后的尿微球蛋白 (MG )变化。方法　根据肾动脉造影结果将 69例入选病人分为严重狭窄组 44例 ;轻度狭窄组 2 5例。记录两组肾动脉及冠状动脉 (冠脉 )介入的手术成功率和并发症 ,同时分别测定术前及术后 3个月尿α1和 β2 MG ,并比较随访情况。结果　两组冠脉介入治疗手术成功率和并发症发生率差异无显著性。严重肾动脉狭窄组病人术前尿α1 MG[(5 2± 2 5) μg/L比 (3 0± 2 7) μg/L ,P <0 0 0 1]和 β2 MG [(3 77± 173 )μg/L比 (2 0 2± 184) μg/L ,P <0 0 0 1]较轻度狭窄组显著升高。但两组尿α1 MG均未高于正常上限(<6μg/L)。肾动脉支架术后 3个月严重狭窄组尿 β2 MG较术前明显下降 [(2 3 7± 187) μg/L比(3 77± 173 ) μg/L ,P <0 0 1] ,而尿α1 MG较术前无明显变化。轻度狭窄组术后 3个月尿MG水平与术前无变化。在随访期内严重狭窄组血压改善较轻度狭窄组明显 (62 5%比 9 1% ,P <0 0 1)。而再住院率 (2 2 5%比 9 1% )、死亡 (5%比 0 )及肾功能衰竭 (5%比 0 )发生率较轻度狭窄组增高 ,但无统计学意义。多因素分析显示 ,持续性术后尿 β2 MG升高 (OR =3 0 1,95%CI 1 0 1～ 8 95,P =0 0 3 6)是肾动脉支架术后发生严重不良事件的独     

中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值与2型糖尿病患者肾小管损伤的相关性研究

目的探讨中性粒细胞/淋巴细胞(NLR)和血小板/淋巴细胞(PLR)与2型糖尿病(T2DM)患者肾小管损伤的相关性。方法收集2018年9月至2019年9月于中南大学湘雅三医院住院治疗的268例T2DM患者,根据尿白蛋白/肌酐比值(UACR),将其分为正常白蛋白尿组(UACR<30 mg/g)、微量白蛋白尿组(30 mg/g≤UACR<300 mg/g)和大量白蛋白尿组(UACR≥300 mg/g)。收集纳入患者的一般临床资料。空腹抽取肘静脉血检测血常规以及糖化血红蛋白、超敏C反应蛋白(hs-CRP)等生化指标,计算NLR、PLR和预估肾小球滤过率(eGFR),并检测尿α1微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)、视黄醇结合蛋白(RBP)、尿肌酐(Ucr),以α1-MG/Ucr、β2-MG/Ucr和RBP/Ucr作为反映肾小管损伤的指标。采用χ2检验、方差分析及非参数检验对各组指标的差异进行比较,采用Spearman相关分析法分析各炎性指标与肾损伤标志物的相关性,采用受试者工作特征(ROC)曲线分析模型预测价值。结果大量白蛋白尿组(94例)的NLR和PLR明显高于正常白蛋白尿组(94例)和微量白蛋白尿组(80例),微量白蛋白尿组NLR高于正常白蛋白尿组,差异有统计学意义(均P<0.05)。随着NLR、PLR四分位数的递增,患者UACR及RBP/Ucr、α1-MG/Ucr、β2-MG/Ucr逐渐升高,差异具有统计学意义(均P<0.05)。Spearman相关分析显示,NLR、PLR与UACR、RBP/Ucr、α1-MG/Ucr、β2-MG/Ucr均呈正相关(r=0.254~0.385,均P<0.01),与eGFR呈负相关(r=-0.328、-0.151,均P<0.01)。ROC曲线显示,NLR判定UACR>30 mg/g、eGFR<60 ml·min^-1·(1.73 m²)^-1及肾小管损伤的曲线下面积(AUC)分别为0.700、0.679、0.717、0.702、0.737,灵敏度分别为75.29%、85.87%、80.88%、83.74%、85.59%,均优于PLR(AUC分别为0.639、0.639、0.659、0.644、0.676,灵敏度分别为58.05%、75.00%、63.24%、65.04%、58.56%)和hs-CRP(AUC分别为0.597、0.559、0.618、0.644、0.653,灵敏度分别为62.50%、30.12%、63.93%、68.42%、70.87%)。结论NLR和PLR与T2DM患者肾小管损伤密切相关,NLR在综合反映肾小球及肾小管损伤方面优于PLR和hs-CRP。     

尿白蛋白排泄率异常的2型糖尿病患者尿N-乙酰-β-葡萄糖苷酶、α1-微球蛋白及视黄醇结合蛋白检测的改变

目的检测不同尿白蛋白排泄率（UAER）的2型糖尿病（T2DM）患者尿N-乙酰-β葡萄糖苷酶（NAG）、α1-微球蛋白（α1-MG）、视黄醇结合蛋白（RBP）水平,探讨其对2型糖尿病早期肾损害诊断的应用价值。方法选择我院就诊的T2DM患者196例,健康体检者57名,检测12小时UAER水平。根据UAER水平将T2DM患者分为UAER正常组和异常组。分别检测尿NAG、α1-MG、RBP,肌酐（Cr）水平,并分析各组间差异。结果196例T2DM患者NAG／Cr、α1-MG／Cr及RBP／Cr水平较健康对照组明显升高（P〈0．05）;与对照组比较,T2DM患者中UAER正常组及异常组NAG／Cr、α1-MG／Cr及RBP／D水平具有显著性差异（P〈0．05或P〈0．01）。在T2DM患者中,UAER与NAG／Cr、α1-MG／Cr及RBP／Cr之间没有相关性,而NAG／Cr与α1-MG／Cr及RBP／Cr之间存在相关性（P〈0．01）。T2DM患者中UAER、NAG、劬MG、RBP联合检测阳性率高于各单-指标的检测阳性率（P〈70．05）。结论T2DM患者联合检测尿NAG、α1-MG、RBP可以提高糖尿病早期肾损害的诊断的敏感性,利于糖尿病肾病的早期预防。     

非胰岛素依赖型糖尿病患者高血压的多因素分析

应用多因素逐步回归的分析方法对54例非胰岛素依赖型糖尿病(NIDDM)患者有关高血压的危险因素(年龄、病程、体重指数、血糖、血清放免胰岛素(IRI)、C肽、血脂及脂蛋日、载脂蛋白及尿系列蛋白)作了探讨.观察到:(1)NIDDM患者有较高的高血压发生率;(2)在21个因素中,年龄、总胆固醇、餐后血糖、空腹IRI、24小时尿Alb/Cr及TRF/Cr对血压影响较大,其中餐后血糖对血压影响最大,其次为 24小时尿Alb/Cr和总胆固醇.提示:糖尿病患者高血压的发生与皿糖控制不佳、血脂异常及糖尿病肾病相关.     

Increased excretion of N-acetyl-beta-D-glucosaminidase and beta2-microglobulin in gestational week 30

BACKGROUND: Little is known about when the urinary excretion of a combination of N-acetyl-beta-D-glucosaminidase (NAG) and beta2-microglobulin (beta2MG) concentration [relative to creatinine (Cr)] reaches maximal values during uncomplicated normotensive pregnancy. This study was thus designed to analyze when urinary excretion of biochemical parameters was increased during normotensive pregnancy. METHODS: NAG, beta2MG, total protein, albumin, and Cr were simultaneously measured in random (untimed) midstream urine samples from 22 healthy nonpregnant women and from 82 normotensive pregnant women (22 in gestational week 20, 25 in week 30, and 35 in week 37). RESULTS: NAG/Cr and beta2MG/Cr ratios were significantly higher (P < 0.01-0.05) in the normotensive pregnant women in gestational week 30 than in the nonpregnant control subjects and normotensive pregnant women in gestational week 20. The NAG/Cr and beta2MG/Cr ratios showed maximal values in gestational week 30. The total protein/Cr ratio was significantly higher in gestational weeks 20, 30, and 37 than in the control subjects. The albumin/Cr ratio was significantly higher in women in gestational week 30 and 37 than in women in gestational week 20 and in the control subjects. CONCLUSIONS: The excretion of both NAG and beta2MG relative to Cr was increased and showed the maximal values in gestational week 30 during normotensive pregnancy. The increase in a tubular enzyme (NAG) might be caused by renal tubular damage, and that in a low molecular weight protein (beta2MG) might result from decreased renal tubular reabsorption. These findings suggest that renal tubular damage and reabsorption dysfunction were increased in gestational week 30.     

正常血压高值与肾功能的相关性研究

目的:观察正常血压高值患者肾功能的变化,以探讨正常血压高值患者是否存在与血压升高相关的靶器官损害,以指导其治疗和预防.方法:根据JNC-7诊断标准筛选病例并分为3组:正常血压组(NT组)56例;正常血压高值组(PH组)51例;高血压组(EH组)54例.留取晨尿,抽取静脉血,离心后采用放免法和酶法测定尿β2-微球蛋白(β2-MG)、尿微量白蛋白(mAIb)及血尿素氮(BUN)、血肌酐(Cr).结果:与NT组相比,PH组和EH组尿β2-MG、mAIb水平明显升高(P＜0.05;P＜0.01);BUN、Cr在EH组明显升高,与NT组比较P＜0.01;在PH组BUN轻度升高,与NT组比较无显著性差异;血Cr明显升高, 与NT组比较P＜0.01.直线相关分析显示:血压水平与尿β2-MG、mAIb及BUN、Cr的水平均呈显著正相关.多因素回归分析显示:校正年龄、体质指数、血糖、胆固醇、TG,血压水平仍与尿β2-MG、mAIb有显著的相关性.结论:PH组患者尿β2- MG 、 mAIb 、 Cr 出现了异常变化.且血压水平与尿β2-MG、mAIb及BUN、Cr的水平均呈显著正相关.提示正常血压高值患者可能存在与血压升高相关的肾损害.血压水平是导致尿β2-MG、尿mAIb增加的独立危险因素.     

Elevated glycine betaine excretion in diabetes mellitus patients is associated with proximal tubular dysfunction and hyperglycemia

In an ambulatory population of diabetic subjects (Type 1 and Type 2), the urine excretion of the renal osmolyte, glycine betaine, was compared to known markers of glycemic control, renal dysfunction and to the excretion of related betaines, including trigonelline, proline betaine, carnitine and acetyl-carnitine. Of the 85 subjects, 20 patients had urine glycine betaine concentrations above the reference range for normal subjects. Plasma glycine betaine concentrations were within reference ranges for normal subjects. Patients with elevated glycine betaine excretion tended to have lower plasma glycine betaine concentrations, but this did not reach statistical significance. One way analysis of variance found excretion is independent of treatment, duration of diagnosed diabetes, blood pressure and body mass index (BMI). An association between glycine betaine excretion and glycemic control was observed with statistically significant correlations occurring with both plasma glucose (r = 0.43, P < 0.001) and glycated haemoglobin (HbA1c) (r = 0.35, P < 0.005). The excretion of carnitine, acetyl-carnitine and proline betaine were related to glycine betaine excretion (r = 0.49, P < 0.001; r = 0.40, P < 0.001; r = 0.27, P < 0.05, respectively). Urine carnitine and acetyl-carnitine concentrations were also related to plasma glucose concentrations (r = 0.30, P < 0.01). Increased urine retinol binding protein concentrations (RBP), a marker of proximal tubular dysfunction, correlated with elevated urine glycine betaine excretion and plasma HbA1c (r = 0.28, P < 0.01). These results suggest poor glycemic control is associated with the increase in urine glycine betaine, carnitine, acetyl-carnitine and RBP excretion in diabetic patients. However, < 50% of the observed increase in glycine betaine excretion has been accounted for by the variables measured, suggesting other unidentified processes may also be involved.     

老年高血压患者肾动脉阻力指数与血压水平及肾功能指标的相关性分析

目的了解老年高血压患者肾动脉阻力指数(RI)与血压水平的关系,分析肾动脉RI与肾功能指标的相关性。方法选择老年原发性高血压患者134例,其中Ⅲ级67例,Ⅱ级35例,Ⅰ级32例,对照组29例,用彩色多普勒超声分别测量双侧主肾动脉的RI,同时检测血尿素氮(BUN)、肌酐(Cr)、肌酐清除率(CCr)、尿β2微球蛋白(β2-MG)、血同型半胱氨酸(Hcy)水平,比较各组之间RI及肾功能指标的差异;分析RI与肾功能指标的相关性。结果Ⅱ、Ⅲ级高血压患者肾动脉RI明显高于对照组(P<0.01)。Ⅲ级高血压患者血BUN、Cr、CCr、尿β2-MG、血Hcy显著高于对照组(P<0.05),Ⅱ级高血压患者尿β2-MG、血Hcy高于对照组(P<0.05)。相关分析显示肾动脉RI与BUN、Cr、Hcy、尿β2-MG呈正相关,与CCr呈负相关。结论老年高血压患者的RI与血压水平相关,联合尿β2-MG、血Hcy水平等肾功能指标的检测可反映早期肾功能受损情况。     

老年高血压患者尿α_1-微球蛋白/肌酐相关因素的研究

目的通过分析老年高血压患者α1-微球蛋白/肌酐(alphal-microglobulin to creatinine ratio,α1-MG/Cr)的独立相关因素,来寻找减少老年高血压患者α1-MG排泄的方法。方法对1054例老年高血压患者进行动态血压检测、实验室检查、α1-MG和Cr检测,运用Logistic回归分析筛选老年高血压患者α1-MG/Cr的独立相关因素。结果老年高血压患者α1-MG/Cr的独立相关因素有24h脉压(β=0.07,P<0.01)、同型半胱氨酸(β=0.04,P<0.01),载脂蛋白AI(β=-1.10,P<0.01)和年龄(β=0.10,P<0.05)。结论降低24h脉压和同型半胱氨酸水平,提高载脂蛋白AI的水平,可能是减少老年高血压患者α1-MG排泄的重要方法。     

尿视黄醇结合蛋白、N-乙酰-β-D-氨基葡萄糖苷酶及尿蛋白检测在IgA肾病患者肾小管间质损害中的临床意义

目的 探讨尿视黄醇结合蛋白（RBP）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）及24小时尿蛋白定量（UPE）等指标判断IgA肾病（IgAN）患者肾小管间质损害程度的临床意义.方法 收集我院2010年5月～2013年2月114例住院IgAN患者的临床及病理资料,依据Lee氏病理分级系统将患者分为Lee I～Ⅱ级27例（A组）、LeeⅢ级46例（B组）和LeeⅣ～V级41例（C组）,分析不同分级IgAN肾小管间质病变情况与尿RBP、NAG、UPE等指标之间的相关性.结果 各组间血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（pre-ALB）、血肌酐（SCr）、尿素氮（BUN）、总胆固醇（TC）、UPE、尿RBP及NAG等指标比较差异有统计学意义（P＜0.01）,镜下血尿及高血压的发生率随病理程度加重而上升（P＜0.01）,肾小管萎缩、肾间质炎细胞浸润、肾间质纤维化及动脉硬化在各组间比较差异均有统计学意义（P＜0.01）,相关性分析显示尿RBP、NAG与肾小管萎缩、肾间质炎症细胞浸润、肾间质纤维化及动脉硬化程度呈正相关;UPE与肾小管萎缩程度呈负相关（r=-0.213,P＜0.05）,尿RBP、NAG水平与eGFR呈负相关.结论 IgAN患者高血压及血尿发生率、Hb、ALB、TC、肾功能、RBP、NAG、UPE等指标与肾脏病理损伤程度有关,尿RBP、NAG及UPE联合检测对判断肾小管病理损伤程度及肾功能有临床意义.     

Decline of renal function is associated with proteinuria and systolic blood pressure in the morning in diabetic nephropathy

The aim of this study was to investigate a significance of increased proteinuria in the morning and the effects of antihypertensive treatment on proteinuria and arterial blood pressure in the progression of chronic renal insufficiency in type 2 diabetic patients with hypertension and nephropathy. In three 24-hr urine samples and blood pressure monitoring, separated into a night-and daytime and spot urine in the morning, variation in protein-creatinine ratio (g/g) and blood pressure were assessed in 24 (58 +/- 3 years old; M/F: 17/7) diabetic patients with hypertension and nephropathy. Furthermore, the effects of antihypertensive therapy of combinations of angiotensin converting enzyme (ACE) inhibitor, calcium antagonists, diuretics, and alpha1 blocker were evaluated in 3 years. Home blood pressure measurement was carried out every month and 24-hr urine was collected every 2 months. The baseline urine excretion of protein-creatinine ratio and blood pressure were (1.22 +/- 0.13 g/g creatinine: 154/96 +/- 6/5 mmHg) in daytime and (1.39 +/- 0.13: 168/88 +/- 15/7) in the morning. At the end of the study, significant associations among a decline of 24-hr creatinine clearance and both of the urine excretion of protein-creatinine ratio (r = 0.47, p < .01) and the levels of systolic blood pressure (r = 0.46, p < .01) and between the levels of systolic blood pressure and the urine excretion of protein-creatinine ratio in the morning (r = 0.57, p < .001) were demonstrated. However, there were no significant associations among other variables. Analysis of patients who had systolic blood pressure in the morning less than 140 mmHg revealed that 65% of these patients received doxazosin-averaged doses of 4.8 +/- 1.5 mg daily. The levels of both blood pressure and proteinuria-creatinine ratio in the morning mainly associate with progression of renal function in diabetic patients with hypertension and nephropathy.     

Urine concentrations of apolipoprotein AI in renal tubular proteinuria

To test the hypothesis that a significant proportion of apolipoprotein AI (apoAI) metabolism occurs through glomerular filtration of free apoAI in serum and subsequent renal tubular metabolism, we have examined the urine concentration of apoAI in three situations in which proximal tubular reabsorption of another protein metabolized in this manner and retinol-binding protein (RBP) was impaired. Following infusion of a cross-linked gelatin polymer (Haemaccel) in four normal subjects, urine RBP excretion (normally about 100 micrograms/L), was between 14 and 46 mg/L, while urine apoAI excretion was less than 0.5 mg/L. On the third day following cardiac surgery involving Haemaccel infusion, urine RBP was between 27 and 159 mg/L while urine apoAI excretion was again less than 0.5 mg/L. In 16 samples from eight patients recently transplanted with allograft kidneys, urine RBP was between 9 and 70 mg/L, whereas in only two samples was apoAI detected in the urine at 0.5 mg/L. These results have been taken to indicate that significant metabolism of apoAI through glomerular filtration and tubular absorption is unlikely to occur in humans.     

动态脉压对高龄高血压病患者早期肾功能损害的影响

目的探讨高龄高血压病患者动态脉压（APP）对早期肾功能损害的影响。方法应用24h动态血压监测仪监测68例年龄≥80岁、常规尿蛋白（UP）、血清肌酐（SCr）、尿素氮（BUN）水平在正常范围的高血压病患者的APP水平，根据APP将患者分为两组，〈60mmHg为A组，≥60mmHg为B组。测定两组患者UP、血清／尿肌酐（S／UCr）、BUN、尿微量白蛋白（UMA）、尿β2-微球蛋白（Uβ2-MG）水平。结果两组UP、SCr、BUN、Uβ2-MG差异均无显著性意义；B组UMA比A组明显增加[（9．15±12．54）mg／mmol UCr vs （2．87±2．35）mg／mmol UCr]，差异有显著性意义（P〈0．01）；UMA与APP呈显著性正相关（r=0．39，P〈0．01）。结论APP高的高龄高血压病患者较APP低者的早期肾小球滤过功能损害更明显；APP越高，肾小球滤过功能损害越明显。     

Decline of Renal Function Is Associated with Proteinuria and Systolic Blood Pressure in the Morning in Diabetic Nephropathy

The aim of this study was to investigate a significance of increased proteinuria in the morning and the effects of antihypertensive treatment on proteinuria and arterial blood pressure in the progression of chronic renal insufficiency in type 2 diabetic patients with hypertension and nephropathy. In three 24-hr urine samples and blood pressure monitoring, separated into a night-and daytime and spot urine in the morning, variation in protein-creatinine ratio (g/g) and blood pressure were assessed in 24 (58 ± 3 years old; M/F: 17/7) diabetic patients with hypertension and nephropathy. Furthermore, the effects of antihypertensive therapy of combinations of angiotensin converting enzyme (ACE) inhibitor, calcium antagonists, diuretics, and α1 blocker were evaluated in 3 years. Home blood pressure measurement was carried out every month and 24-hr urine was collected every 2 months. The baseline urine excretion of protein-creatinine ratio and blood pressure were (1.22 ± 0.13 g/g creatinine: 154/96 ± 6/5 mmHg) in daytime and (1.39 ± 0.13: 168/88 ± 15/7) in the morning. At the end of the study, significant associations among a decline of 24-hr creatinine clearance and both of the urine excretion of protein-creatinine ratio (r = 0.47, p < .01) and the levels of systolic blood pressure (r = 0.46, p < .01) and between the levels of systolic blood pressure and the urine excretion of protein-creatinine ratio in the morning (r = 0.57, p < .001) were demonstrated. However, there were no significant associations among other variables. Analysis of patients who had systolic blood pressure in the morning less than 140 mmHg revealed that 65% of these patients received doxazosin-averaged doses of 4.8 ± 1.5 mg daily. The levels of both blood pressure and proteinuria-creatinine ratio in the morning mainly associate with progression of renal function in diabetic patients with hypertension and nephropathy.     

老年2型糖尿病肾功能异常的相关影响因素分析

目的探讨老年2型糖尿病（T2DM）肾功能异常的相关影响因素及临床意义。方法回顾性分析1997-2006年在解放军总医院住院治疗的老年T2DM患者临床资料,根据其肾小球滤过率（GFR）水平分为：GFR≥90（A组）、60～90（B组）、〈60（C组,肾功能异常组）ml/（min.1.73m^2）。对各组临床及实验室指标进行比较。结果共收集老年T2DM病例525例,A组159例（30.3%）,B组239例（45.5%）,C组127例（24.2%）。临床诊断糖尿病肾病（DN）者占13.7%,合并高血压者占71.05%;肾功能异常组中,DN仅占29.9%。在老年T2DM中,高血压病程、收缩压（SBP）、舒张压（DBP）、餐后2h血糖（2hPBG）、血清总胆固醇（TC）、血尿酸（BUa）为肾功能异常的独立相关影响因素,且高血压对其肾功能的影响更为显著。随血压水平增高、DM病程延长、尿白蛋白/肌酐比值（Alb/Cr）增加,GFR下降,肾功能异常发生率增加。血压〈130/80mmHg、≥130/80mmHg者,肾功能异常发生率分别为4.09%、41.72%;DM病程〈5年、5～10年、〉10年者,肾功能异常发生率依次为18.64%、26.09%和28.90%;尿Alb/Cr〈30、30～299、≥300mg/g者,肾功能异常发生率分别为10.53%、40.38%和75%。结论老年T2DM肾功能异常的影响因素较多,高血压病程、SBP、DBP、2hPBG、TC、BUa与之独立相关,高血压对其影响更为显著。血压、血糖控制良好为保护因素,针对上述影响因素的综合治疗对预防及延缓肾功能异常的发生、发展有重要的临床意义。     

氯沙坦对伴有微量蛋白尿的老年高血压患者的影响

目的　观察氯沙坦对伴有微量蛋白尿（ ＭＣＡ） 的老年高血压患者改善肾损害的作用。　方法　采用连续样本,自身前后及分组对照方法,对３２ 例高血压伴ＭＣＡ 者（ＥＨ 组） ,男２４ 例,女８ 例,平均年龄（７１－６ ±６－８）岁,观察在治疗前和每天服用氯沙坦５０ ｍ ｇ １２ 周后的血压、血尿素氮（ＢＵＮ） 、血肌酐（Ｃｒ） 、２４ｈ 内生肌酐清除率（Ｃｃｒ） 、尿白蛋白／ 肌酐（Ａｌｂ／Ｃｒ） 的变化,ＥＨ 组治疗前在ＢＵＮ、Ｃｒ 、Ｃｃｒ 方面与１２ 例非高血压老人作对照（ 对照组） 。　结果　治疗前ＥＨ 组的Ｃｃｒ 水平较对照组明显降低（ Ｐ＜ ０－０５） ,用氯沙坦治疗后,除血压有明显下降外,尿Ａｌｂ／Ｃｒ 亦显著性降低（ Ｐ＜ ０－０１） ,Ｃｃｒ 明显升高（ Ｐ＜ ０－０５） 。　结论　氯沙坦对老年高血压患者不仅有良好的降压效果,同时可降低尿白蛋白的排泄,改善肾功能     

运动对2型糖尿病患者尿微量白蛋白等指标的影响

目的 研究运动对2型糖尿病患者尿微量白蛋白（M-Alb)、转铁蛋白（TRF）、视黄醇组合蛋白（RBP）、铜蓝蛋白（Cp)的影响。方法 作次极量运动试验。设运动组和非运动组作交叉自身对照，分别测定及计算运动前、后各1h和非运动前、后各1h尿白蛋白/肌酐（Alb/Cr),TRF/Cr,RBP/Cr,CP/Cr的变化。结果 运动前、后尿Alb/Cr比较差异有显著性（运动后较运动前排量增加），尿RBP/Cr,TRF/Cr比较差异有显著性。非运动前后上述四项指标比较差异均无显著性。结论 尿Alb/Cr受运动影响显著，而CP/Cr,TRF/Cr,RBP/Cr受运动影响不明显。     

血管紧张素转化酶抑制剂对糖尿病肾病早期肾小管功能的保护作用研究

目的探讨血管紧张素转化酶抑制剂（ACEI）对肾小管功能的保护作用。方法选择142例2型糖尿病合并高血压的患者，按治疗方法不同分A组（降糖的同时口服ACEI类降压药）和B组（降糖的同时口服非ACEI类降压药），检测各组尿N-乙酰-β-葡萄糖苷酶（NAG）、视黄醇结合蛋白（RBP）、α1微球蛋白（α1-MG）、IV胶原（CIV）水平，并进行统计学分析。结果组尿微量白蛋白排泄明显低于B组（P〈0．05）；肾小管功能指标中尿RBP明显低于B组（P〈0．05），而NAG、α1—MG、CIV差异无显著性意义（P〉0．05）。结论ACEI能明显减少糖尿病肾病患者尿白蛋白的排泄，而且对糖尿病肾病患者的肾小管功能有保护作用，糖尿病患者应提前使用ACEI类降压药。     

Prophylactic effect of ulinastatin on cisplatin-induced renal disorders in lung cancer patients]

In order to determine whether ulinastatin (US) can prevent renal dysfunction due to cisplatin (CDDP) or not, we comparatively studied serum BUN, serum creatinine (Cr), creatinine clearance (Ccr), urine gamma-glutamyl transpeptidase (gamma-GTP) excretion, urine N-acetyl-beta-D-glucosaminidase (NAG) excretion, fractional excretion of Na (FENa) and urine beta 2-microglobulin excretion between one group of 10 patients receiving single treatment with CDDP and another group of 10 patients receiving combination treatment with CDDP+US, in 20 subjects with primary lung cancer. In the US combination treatment group, urine gamma-GTP excretion, urine NAG excretion, and FENa elevation were significantly inhibited. Urine beta 2-microglobulin excretion was inhibited. In summary, US was considered to have a preventive effect against renal toxicity due to CDDP.     

原发性高血压患者血压水平与早期肾损害的相关性研究

目的探讨原发性高血压患者脉压(PP)、SBP、DBP及平均动脉压(MAP)与早期肾损害的关系。方法选择180例初诊或停药2周以上的原发性高血压患者进行PP、SBP、DBP和MAP检查,以血β2微球蛋白(β2-MG)水平>2.6mg/L作为肾损害的标准,分为肾损害组和非肾损害组,其中肾损害组84例,非肾损害组96例。将两组血压参数进行比较,并与血β2-MG水平进行相关性分析。结果(1)肾损害组PP[(59±10)mmHg]及SBP[(168±28)mmHg]较非肾损害组[(41±8)mmHg,(151±10)mmHg]明显增高。(2)相关分析显示血β2-MG与PP、SBP呈正相关,尿β2-MG与PP、SBP、DBP、MAP呈正相关。其中与PP、SBP相关性较好。结论PP与SBP、DBP、MAP增高均可导致高血压患者早期肾损害,而PP、SBP增大是导致高血压患者早期肾损害的主要因素。