罗格列酮对高糖刺激下肾小管上皮细胞凋亡及整合素β1表达的影响

目的 观察罗格列酮(ROS)对肾小管上皮细胞凋亡及整合素β1 (integrin β1)水平的影响.方法 将体外培养的大鼠近端肾小管上皮细胞分为空白对照组、正常血糖(5 mmol/L)组、高糖(30 mmol/L)组、ROS (10 μmol/L)组、高糖(30 mmol/L) ROS (5 μmol/L)组和高糖30 mmol/L ROS 10 μmol/L 6组, 采用流式细胞仪检测细胞培养后24、48、72 h的凋亡情况、Western blot及RT-PCR检测不同浓度的ROS对高糖刺激下integrin β1蛋白质和mRNA表达的影响.结果 integrin β1的蛋白质和mRNA的改变趋势相同,高糖组较对照组及正常血糖组增加(P＜0.05) ,经ROS处理后integrin β1的表达较高糖组降低,且与ROS浓度呈剂量相关.各实验组在48 h、72 h的细胞凋亡率与空白对照组相比均降低(P＜0.05);48、72 h的细胞凋亡率低于24 h(P＜0.05),但48 h与72 h间的比较差异无统计学意义.结论 ROS可明显抑制高糖刺激下肾小管上皮细胞integrin β1的表达,且有明显剂量依赖关系,而ROS对细胞凋亡的影响可能与 integrin β1的参与有关.     

体内转染核因子-κB诱捕物可减轻急性缺血性肾损伤

目的　探讨核因子 κB (NF κB)诱捕物寡聚核苷酸 (ODN)对急性缺血性肾损伤的保护作用。方法　采用肾动脉夹闭法制备大鼠缺血性急性肾衰竭 (iARF)模型 ,应用鱼精蛋白 脂质体法经肾动脉转染NF κB诱捕物ODN进行治疗。 2 4只大鼠被分成 4组 :假手术组 ,急性肾衰竭组 (iARF组 ) ,NF κB诱捕物ODN治疗组 (NF κB组 )和错配物ODN处理组。应用生化和组织学指标检测肾脏损伤的程度 ;凝胶电泳迟滞分析检测肾组织NF κB/DNA结合活性 ;免疫组化和RT PCR技术分别检测单核 巨噬细胞浸润 (M/MΦ)和单核细胞趋化蛋白 1(MCP 1)的表达。结果　经鱼精蛋白 脂质体法转染NF κB诱捕物ODN 12h后 ,ODN主要分布在肾小管上皮。与假手术组比较 ,iARF组血清Cr、BUN水平分别增加 10倍和 5倍 ( 2 5 6 μmol/L± 84 μmol/Lvs 2 5 μmol/L± 5 μmol/L和 4 3 4 7μmol/L± 13 4 8μmol/Lvs8 4 5mmol/L± 1 0 7mmol/L ,Ps<0 0 1) ;肾小管损伤评分明显升高 ( 3 6 3± 0 15vs 0 0 0± 0 0 0 ,P <0 0 1) ;NF κB /DNA结合活性明显增加 [中位数 (M) :1 75vs0 15 ,P <0 0 5 ];M/MΦ以及MCP 1的表达水平明显上升。与iARF组比较 ,NF κB组经诱捕物ODN治疗后 ,血清Cr水平下降 70 % ( 79μmol/L± 2 1μmol/Lvs 2 5 6 μmol/L± 84 5     

Homocysteinemia in hypertensive patients with renal target organ damage (mild renal dysfunction)

The prevalence of high plasmatic levels of homocysteine in hypertensive patients with mild renal dysfunction (MRD) defined by 2003 European Hypertension Society Guidelines (men plasmatic creatinine between 1.3 and 1.5; women plasmatic creatinine between 1.2 and 1.4 mg/dl) has not been previously reported. To evaluate this item 18 MRD patients were recruited (54% males, mean age 59.2 +/- 17.3 years, mean plasmatic creatinine 1.30 +/- 0.12 mg/dl). They were compared with a control group of hypertensives with normal renal function (n = 87, 42,9% males, mean age 53.6 +/- 12.3 years, mean plasmatic creatinine 0.83 +/- 0.21 mg/dl) and a group of 29 chronic renal failure patients (51.7% males, mean age 56.9 +/- 15.0 years, mean plasmatic creatinine 2.39 +/- 0.95 mg/dl). Age and sex differences are not significant, plasmatic creatinine levels are different among three groups (p <0.001, t student test). Basal homocysteine levels of CRF (19.3 +/- 7.1 micromol/l) were higher than those of control group (11,0 +/- 4,3 micromol/l) and MRD patients (14.8 +/- 5.5 micromol/l; p = 0.027 vs. CRF and p = 0.007 vs. control, Mann-Whitney test). Mean creatinine clearance was 30.3 +/- 11.5 ml/min for CRF group, significantly lower than MRD patients creatinine clearance (54.5 +/- 9.4 ml/min, p <0.001, t student test) and control ones (88,9 +/- 18,9 ml/min, p <0.001, t student test). Hypertensive patients with mild renal dysfunction showed higher and pathological levels of homocysteinemia as compared with controls, this finding might be related to the higher cardiovascular risk described in this group of patients.     

体外鼠肝灌注时胆酸对胆汁、谷氨酸脱氢酶和线粒体膜稳定性的影响（英文）

目的：探讨熊脱氧胆酸（UDCA）和鹅脱胆酸（CDCA）对胆汁分泌，谷氨酸脱氢酶（GLDH）和线粒体膜结构的作用。以及UDCA的线粒体膜保护作用。方法：应用离体大鼠肝灌注技术，0．1－0．5mmol/L胆酸灌注鼠肝，测定胆汁分泌及GLDH释放，分离鼠肝线粒体，自旋标记物插入线粒体膜，研究膜结构变化。结果：CDCA（0.1,0.3,0.5mmol/L)可使胆汁分泌分别减少12％，77．25％，78．98％，明显增加GLDH释放达3，9和12倍，并增加线粒体膜的流动性，UDCA在0.3,0.5mmol/L时可增加胆汁分泌达1．8倍和1．9倍，不影响GLDH和线粒体膜结构，预灌注UDCA可部分缓解CDCA引起的GLDH释放和胆汁分泌减少，稳定线粒体膜结构，结论：CDCA破坏线粒体膜和引起肝功能减退，UDCA可改善胆汁分泌，部分阻止CDCA对线粒体的损害，低浓度CDCA不损害肝功能。     

高糖通过PI3K-Akt信号途径抑制内皮细胞迁移和增殖及血管发生改变

目的观察高糖对内皮细胞迁移、增殖和血管发生改变及PI3K-Akt信号途径的影响。方法不同浓度(5、15、30mmol/L)D-葡萄糖处理后,用体外“伤口愈合”实验、细胞增殖试剂盒和缺乏生长因子的Matrigel胶观察内皮细胞迁移、增殖和血管发生情况,并用免疫沉淀和Western印迹检测p85/PI3K、磷酸化PI3K、Akt、磷酸化Akt(苏氨酸308)和磷酸化GSK3β的表达变化。观察加入PI3K抑制剂——LY294002后,内皮细胞的迁移、增殖和血管发生的变化。结果与5mmol/LD-葡萄糖组(细胞迁移数为100个/μm2±23个/μm2,增殖细胞数为59128个/孔±7415个/孔)相比,15mmol/L和30mmol/LD-葡萄糖组内皮细胞迁移明显降低(77个/μm2±18个/μm2和46个/μm2±18个/μm2,均P<0·01)、细胞增殖(33144个/孔±9082个/孔和11625个/孔±4196个/孔,均P<0·01)和血管发生改变(包括血管床面积、平均血管长度、毛细血管数和血管分支点数)及磷酸化PI3K、磷酸化Akt(苏氨酸308)和磷酸化GSK3β的表达(均P<0·05或P<0·01),且随葡萄糖浓度增高抑制作用增强(均P<0·05或P<0·01)。0·1、1和10μmol/L的LY294002抑制内皮细胞迁移(细胞迁移率分别为68μm2±16μm2、36μm2±12μm2和13μm2±3μm2,均P<0·01)、增殖(增殖细胞数分别为42560个/孔±4213个/孔、17688个/孔±7198个/孔和5704个/孔±558个/孔,均P<0·01)和血管发生水平(均P<0·05或P<0·01),且随LY294002浓度增高抑制作用增强(均P<0·05)。结论高糖可能通过PI3K-Akt信号途径抑制内皮细胞的迁移、增殖和血管发生变化。     

Severe hypercalcaemia four months after acute oliguric renal failure—successful treatment with intravenous clodronate

A 33 year old man developed acute oliguric failure lasting 66 days, eight days after admission with multiple gun shot wounds. On day 99 after admission, serum calcium was elevated mildly at 2.54 mmol/ 1 (normal range 2.1-2.5 mmol/1). Serum parathormone was undetectable. He was discharged soon afterwards. He presented again on day 164 with nausea, vomiting and blurred vision. Fundoscopy revealed an ischaemic retinopathy and extensive keratopathy. Serum calcium was 3.48 mmol/1 and serum creatinine 262 umol/l (normal range 40-110 umol/l). Repeat parathormone was undetectable and there was no evidence of myeloma, sarcoidosis or malignancy. Following treatment with intravenous saline and frusemide, serum calcium fell to a nadir of 3.05 mmol/ I. On day 168 an infusion of sodium clodronate 300 mg was given. Twenty-four hours later serum calcium was 2.65 mmol/l and 48 hours later calcium was 2.26 mmol/1. Normocalcaemia was maintained for 17 days and severe hypercalcaemia never recurred.     

2型糖尿病大鼠心肌葡萄糖转运体4的变化及其对葡萄糖和脂肪酸代谢的影响

目的探讨2型糖尿病大鼠心肌葡萄糖转运体4(GLUT4)的表达与葡萄糖及其脂肪酸氧化代谢的关系,同时观察罗格列酮使用后上述指标的变化。方法24只SD雄性大鼠随机分为实验治疗组(6只)、实验对照组(6只)、正常治疗组(6只)和正常对照组(6只)。采用高脂喂养(40%脂肪、42%碳水化合物和18%蛋白质)4周及小剂量链脲佐菌素(35mg/kg)一次性腹腔注射建立2型糖尿病大鼠模型。实验治疗组和正常治疗组给予罗格列酮3mg·kg-1·d-1灌胃2周;各组大鼠进行30min等容离体心脏Langendorff灌注,灌注液含100μU胰岛素、5mmol/L葡萄糖、0.4mmol/L3H软脂酸,测定样本葡萄糖含量及3H2O计数,评估心肌葡萄糖和脂肪酸氧化率;Western印迹法检测心肌细胞膜GLUT4表达水平。结果与正常对照组比较,实验对照组大鼠心肌葡萄糖总氧化量明显较少[(55±6)μmol/g干重vs(69±6)μmol/g干重,P<0.01],葡萄糖氧化比例较少(18%vs25%),脂肪酸氧化率较高(82%vs75%);同时心肌细胞膜上GLUT4的表达量减少53%。与实验对照组比较,给予RSG的实验治疗组,心肌葡萄糖的氧化量较高为(64±6)μmol/g干重(P<0.05),葡萄糖和脂肪酸的氧化比例分别为24%和76%,GLUT4表达量也明显较大(92%vs47%,P<0.01)。结论心肌细胞膜上GLUT4表达减少可能是2型糖尿病心肌葡萄糖和脂肪酸氧化代谢改变的重要原因,罗格列酮通过增加GLUT4的表达,可以提高心肌葡萄糖氧化、降低脂肪酸氧化,这将有助于减轻糖尿病心肌细胞损伤,增强抗缺血的能力。     

Metformin treatment in NIDDM patients with mild renal impairment.

Metformin is contraindicated in patients with renal failure because of the risk of lactic acidosis. This study assessed the complications of metformin treatment in patients with non-insulin-dependent diabetes mellitis with normal and raised serum creatinine. Subjects using metformin with serum creatinine above the upper reference range (120 mu mol/l) were identified (n = 17) from a hospital diabetes register; those with abnormal liver function, cardiac failure, peripheral vascular disease or recent severe illness were excluded. Reference plasma lactate levels were established, mean 1.742 mu mol/l (SD 0.819) using age-matched non-diabetic subjects. Age-matched patients treated with metformin with normal serum creatinine levels formed the control group (n = 24). Details of gastrointestinal disturbance were recorded, and plasma lactic acid and vitamin B12 levels measured. The median total daily dose of metformin in both groups was 1700 mg. The mean plasma lactate in subjects with serum creatinine 80-120 mu mol/l (2.640 mmol/l (SD 1.434) p < 0.02) was higher than non-diabetic control levels while diabetic subjects with serum creatinine 120-160 mumol/l had a mean of 2.272 mmol/l (SD 0.763) p < 0.05. There was no significant difference between the two groups taking metformin, nor any significant difference in the reporting of gastrointestinal symptoms between the groups on metformin (11.76% vs 12.5%). Plasma lactic acid levels are higher in diabetic subjects taking metformin compared with healthy volunteers but, within the diabetic groups, the small elevation of serum creatinine was not associated with higher plasma lactate levels.     

阿司匹林诱导内皮细胞铁蛋白表达与抗氧化损伤作用的研究

目的探讨阿司匹林(aspirin,As)在抗H2O2损伤内皮细胞过程中对铁蛋白(ferritin,Fn)表达的作用.方法体外培养人血管内皮细胞,酶联免疫吸附法(ELISA)测定As在不同浓度(0.1～3mmol/L)、不同处理时间(4～24h)对细胞Fn表达的影响,以及消炎痛和水杨酸钠对Fn表达的作用;并观察经As预处理后的细胞加入H2O2(0.5mmol/L)后乳酸脱氢酶(lactatedehydrogenase,LDH)释放率、丙二醛(malondialdehyde,MDA)和细胞存活率的改变.用单因素方差分析对上述指标进行统计学处理.结果小剂量As(0.1mmol/L)即可明显诱导内皮细胞Fn表达(5.8ng/106细胞数±0.3ng/106细胞数),与正常对照组比较P<0.05;且As与Fn之间表现出剂量和时间依赖关系,0.5mmol/L、1mmol/L、2mmol/L、3mmol/L组Fn浓度分别为(6.4±0.4)ng/106细胞数、(7.0±0.7)ng/106细胞数、(7.4±0.4)ng/106细胞数和(7.7±0.5)ng/106细胞数;4h组Fn尚未明显增加(5.8ng/106细胞数±1.0ng/106细胞数,P>0.05),但8h组Fn浓度(6.5±1.0)ng/106细胞数与正常对照组比较P<0.05,24h组Fn浓度达最大值(7.8±0.8)ng/106细胞数.As诱导Fn表达后能明显增强细胞抗氧化的能力,0.1mmol/L的As可减少细胞50%的LDH释放率,保护74.4%的细胞避免H2O2的损伤,同时使氧自由基指标MDA明显下降.并随As剂量的增大保护作用逐渐增强,其结果与未饱和铁蛋白组相似.而水杨酸钠及消炎痛则无诱导Fn表达的作用.结论As在较小剂量(0.1mmol/L)时即可明显诱导内皮细胞Fn的表达,增强其抗氧化损伤的能力;但其他非甾体类抗炎药不具有这个作用.     

Troglitazone对人腹膜间皮细胞TGF-β1 和纤维连接蛋白表达的影响

目的:研究过氧化物增生体激活受体γ(PPAR-γ)激动剂troglitazone(曲格列酮,TGZ)对高浓度葡萄糖刺激下体外培养的人腹膜间皮细胞(HPMCs)中TGF-β1和细胞外基质纤维连接蛋白(Fn)表达的影响.方法:采用胰蛋白酶消化法从人大网膜组织中分离间皮细胞,建立稳定的体外培养模型.根据细胞增殖与毒性实验选择troglitazone的最佳浓度15 μmol/L,干预高浓度葡萄糖(30 mmol/L D-葡萄糖)刺激下的人腹膜间皮细胞.采用逆转录多聚酶链式反应(RT-PCR)半定量检测HPMCs中PPAR-γ,TGF-β1以及Fn的mRNA表达;采用双抗夹心法酶联免疫吸附实验检测HPMCs培养液中TGF-β1蛋白质水平;Western印迹检测Fn蛋白质水平.结果:高糖(30 mmol/L D-葡萄糖)刺激可在mRNA和蛋白质水平明显上调HPMCs表达TGF-β1和Fn(P＜0.01),troglitazone干预高糖孵育的HPMCs,可使TGF-β1和FnmRNA和蛋白质的表达明显下调(P＜0.05).结论:Troglitazone能够明显抑制在高糖刺激下的HPMCsTGF-β1和Fn的表达,这可能为临床防治长期腹膜透析患者的腹膜纤维化提供一种较为有效的方法.     

Protein creatinine index and Albustix in assessment of proteinuria

The protein creatinine index in early morning and random urine specimens was compared with the 24 hour urinary excretion of protein in normal subjects and outpatients with abnormal proteinuria. A protein creatinine index (defined as (mg protein/1 divided by creatinine mmol/1) times 10) below 125 in a random specimen excluded abnormal proteinuria, whereas an index of more than 136 indicated the presence of pathological proteinuria. The index for random specimens provided a useful semiquantitative assessment of the 24 hour excretion of protein (mg protein/24 hours), but the index for early morning specimens was less reliable. Errors with Albustix were partly due to intra and inter observer variations in the interpretation of the colour formed when compared with the chart provided. It is proposed that the protein creatinine index on random urine samples should be used to supplement dipsticks in screening for proteinuria in cases where misclassification would be serious.     

中国南方与北方地区糖尿病足病危险因素分析

目的调查并分析中国南方和北方部分医院糖尿病足病的危险因素。方法通过前瞻性地统一检查和调查方式,收集全国14家三甲医院的2004年全年门诊和住院糖尿病足病患者的社会人口学特征、代谢指标、住院天数和医疗费用等,分为南方地区和北方地区进行分析。结果634例患者中南方地区285例,北方地区349例,南北方患者在年龄（70岁vs66岁）、家庭人均月收入〉1000元者（57、7％vs45．6％）、冠心病合并率（42、6％vs61、0％）及视网膜病变合并率（35,7％vs49、5％）、糖化血红蛋白（7．90％vs8．80％）、低密度脂蛋白胆固醇（2、75mmol／Lvs2．98mmol／L）、白细胞（6．70×10^9／Lvs7．40×10^9／L）、红细胞压积（HCT：0．37vs0．38）、肌酐（87．000,mol／Lvs76.00μmol／L）、尿酸（332.54μmol／Lvs271.40μmol／L）、住院天数（19dvs22d）、足治愈率（19．1％VS10．3％）及截肢率（2．6％vs9.7％）差异均有统计学意义,而糖尿病病程、足病病程、教育水平、吸烟率、高血压、肾脏病变及周围神经病变合并率、空腹及餐后血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、血小板、尿素氮在南北方地区差异均无统计学意义。Logistic回归分析结果显示,南方地区影响糖尿病足严重程度的因素为踝肱指数（ABI）和白细胞,而北方地区的影响因素为ABI、血小板和HCT。结论北方地区的糖尿病足病患者年龄轻,糖尿病病程长,足病病程短。影响南北方糖尿病足严重程度的共同因素为ABI。     

阿托伐他汀对高血压肾病蛋白尿和炎症的治疗作用

目的评价阿托伐他汀对血压控制正常的高血压肾病患者蛋白尿和炎症的治疗作用.方法52例血压已控制正常的高血压肾病患者随机给与阿托伐他汀(10mg)或安慰剂治疗3个月,观察血压(SBP/DBP)、血浆C-反应蛋白(CRP)、白介素-1β(IL-1β)、血脂(TG、TC、HDL-C、LDL-C)、肌酐(Cr)、肌酐清除率(Ccr)、24 h尿蛋白(U-pro)和尿酸(UA)的变化.结果治疗3个月后,阿托伐他汀组的TC(3.93±0.58)vs(5.41±0 77)mmol/L、LDL-C(2.44±0.43)vs(3.49±0.66)mmol/L、CRP(2.59±1.02)vs(3.66±1.39)mg/L、IL-1β(98.79±24.06)vs(126.09±30.11)ng/L和U-pro(510 32±320.69)vs(748.34±411.60)ng/d较安慰剂组均显著降低(P＜0.05～0.01),而两组间的Cr、Ccr无明显改变(P＞0.05).多元线性回归分析显示,U-pro与Ccr(P=0.000)、Cr(P=0.000)、TC(P=0.000)和CRP(P=0.025)呈线性相关,阿托伐他汀组的尿蛋白减少量(△U-pro)与△CRP(P=0.000)、△Cr(P=0.013)呈线性相关.结论炎症参与了高血压肾病的肾脏损害,阿托伐他汀能通过抗炎作用减轻高血压肾病的蛋白尿.     

Significant positive correlation of plasma BPDE-albumin adducts to urinary 1-hydroxypyrene in coke oven workers

Objective To investigate the application of BPDE-albumin adducts as monitoring biomarkers for coke oven workers exposed to polycyclic aromatic hydrocarbons (PAHs) and to explore possible relationship between BPDE-albumin adducts and urinary 1-hydroxypyrene (1-OHP) levels in them. Methods Thirty-seven coke oven workers from a coke plant and 47 controls without the occupational exposure to PAHs were recruited in this study. The levels of plasma BPDE-albumin adducts and urinary 1-OHP were analyzed using high performance liquid chromatography. Results The median levels of BPDE-albumin adducts (42.10 fmol/mg albumin) and urinary 1-OHP (5.46 μmol/mol creatinine) were significantly higher in coke oven workers than in controls (14.16 fmol/mg albumin,2.96 μmol/mol creatinine,respectively; P<0.01). Multiple logistic regression analysis showed that coke oven workers were at higher risk of having BPDE-albumin adduct levels above 25.30 μmol/mg albumin (OR=1.79,P<0.01) and urinary 1-OHP levels above 4.13 μmol/mol creatinine (OR=2.45,P<0.05). There was a positive correlation between the levels of BPDE-albumin adducts and urinary 1-OHP in all subjects (rs=0.349,P<0.01). Conclusion BPDE-albumin adduct is a useful biomarker for monitoring long-term exposure to PAHs,and plasma BPDE-albumin adducts level is significantly correlated to urinary 1-OHP levels in coke oven workers.     

辛伐他汀对同型半胱氨酸诱导的人脐静脉内皮细胞的毒性和炎症反应的影响

目的探讨辛伐他汀对同型半胱氨酸(homocysteine,HCY)诱导的内皮细胞毒性和炎症的抑制作用。方法用不同浓度的HCY(0．1、0．25、0．5、1 mmol／L)处理人脐静脉内皮细胞24 h,采用四氮唑蓝检测细胞存活率;辛伐他汀(1、10、20μmol／L)预处理人脐静脉内皮细胞1 h,然后与HCY(0．25 mmol／L)共孵育,采用MTT检测细胞存活率,Western印迹和ELISA分析不同时间点相关炎性因子蛋白的表达。结果HCY处理后,人脐静脉内皮细胞存活率显著降低;而经过辛伐他汀(1、10、20μmol／L)预处理后,内皮细胞活性分别为47％±4％、68％±6％、89％±6％,明显高于单纯HCY(0．25 mmol／L)处理组(22％±3％,P均<0．01)。由HCY诱导的内皮细胞TNF-α、IL-6、MCP-1及ICAM-1的表达分别为0．23±0．05、0．14±0．03、0．13±0．04、0．21±0．07,与0 h时比较差异无统计学意义。结论辛伐他汀对同型半胱氨酸介导的内皮细胞损伤及炎症反应有明显的抑制作用。     

急性心肌梗死入院时血糖增高107例临床分析

目的:探讨总结急性心肌梗死(AMI)入院时血糖增高患者的临床特点。方法:将107例AMI患者按入院时的血糖高低分为两组:A组血糖≤8.2mmol/L共55例;B组血糖>8.2mmol/L共52例。分析两组在年龄、心功能、白细胞计数、血尿酸、肾功能、心肌酶谱及并发2型糖尿病、女性比例、心肌梗死部位与病死率的差别。结果:1两组在年龄,女性,前壁和多壁梗死所占比例上无显著性差异(P均>0.05)。2B组白细胞计数和乳酸脱氢酶高,住院期间病死率高,两组之间均有显著性差异(P均<0.05)。3B组入院时心功能差,血尿酸、尿素氮、肌酐和α-羟丁酸脱氢酶增高,并发2型糖尿病比例高,两组之间均有高度显著性差异(P均<0.01)。结论:伴有入院时血糖增高的AMI患者并发糖尿病多,入院多较晚,心肾功能差,白细胞计数高,住院期间病死率高。     

慢性肾脏病患者血清Cyfra21-1水平的变化及临床意义

目的 观察慢性肾脏病患者血清细胞角蛋白19片段抗原21-1(Cyfra21-1)水平的变化并探讨其临床意义.方法 将2016年1~8月到武汉大学人民医院就诊的尿微量白蛋白正常患者114例作为正常组,异常患者84例作为异常组,分别检测两组患者血清Cyfra21-1、肌酐、尿素的含量,采用非参数检验中的Mann-Whitney U检验比较三个指标在两组中的变化,通过ROC曲线比较三个指标对慢性肾脏病的诊断价值.结果 Cyfra21-1、肌酐、尿素三个指标在异常组的血清含量分别为3.6(2.8,4.8)ng/L、96.0(65.8,167.3)μmol/L、7.0(5.1,11.9)mmol/L,显著高于正常组的血清含量2.2(1.7,2.8)ng/L、68.5(59.3,78.0)μmol/L、5.5(4.9,6.5)mmol/L,两组血清含量比较差异均具有统计学意义(P<0.001);血清Cyfra21-1的ROC曲线下面积(AUC=0.838)大于肌酐(AUC=0.718)和尿素(AUC=0.675).结论 血清Cyfra21-1水平的升高可能提示尿微量白蛋白异常,对早期诊断慢性肾脏病有一定价值.     

2型糖尿病患者血尿酸与大血管病变的相关性

目的探讨2型糖尿病患者高尿酸血症与大血管病变及其影响因素的相关性。方法选择2型糖尿病患者472例,根据血尿酸水平分为高尿酸血症组(男性≥416.4μmol/L,女性≥356.9μmol/L)和正常血尿酸组。分析两组患者大血管病变及影响因素的关系。结果高尿酸血症组的AB I值、高密度脂蛋白胆固醇(HDL-C)低于尿酸正常组;而体质量指数(BM I)、三酰甘油(TG)、尿素氮(BUN)、肌酐(C r)、尿微量白蛋白(MAU)均高于尿酸正常组(P<0.05)。高尿酸血症组高血压病、冠心病的发病率高于尿酸正常组,差异有统计学意义(P<0.01)。多元线性回归分析显示,尿酸与病程(r=0.118)、BM I(r=0.204)、BUN(r=0.298)、C r(r=0.145)、糖化血红蛋白(r=0.107)、LDL-C(r=0.168)均呈正相关(P<0.05)。结论 2型糖尿病患者高尿酸血症与下肢动脉硬化密切相关,预防糖尿病的大血管并发症除控制血糖、血压、血脂、体质量等危险因素外,还应控制血尿酸水平。     

Comparison of microalbuminuria among treatment na?ve HIV sero-positive and negative adult clients in Faith Alive Foundation Hospital,Jos

Background:

This study is to determine microalbuminuria in human immunodeficiency virus (HIV) infected patients before commencement of highly active anti-retroviral treatment (HAART).

Patients and Methods:

Consecutive patients with the HIV infection seen in the HIV counselling and testing (HCT) unit of the Faith Alive Foundation Hospital, Jos, and a similar group of healthy uninfected patients were evaluated for renal disease: Urinary albumin and urinary creatinine were analysed.

Results:

Of the 200 patients with HIV infection and 100 uninfected controls studied, increased urinary albumin excretion (UAE) was present in 39 (19.5%) of the subjects and 5.0 (5.0%) of controls. The difference between the mean values for the UAE for both subjects and controls [182.3 ± 54.3 and 163.9 ± 39.3 mg/l, respectively (P = 0.006)] was statistically significant. On the other hand the urinary creatinine for both the subjects and controls [11.7 ± 5.2 and 12.0 ± 4.8 mmol/L, respectively (P = 0.6)] was not statistically significant. The difference between the mean urinary albumin/creatinine ratio (UACR) for both subjects and controls [1.8 ± 1.2 mg/mmol and 1.4 ± 0.4 mg/mmol respectively (P = 0.001)] was statistically significant.

Conclusion/Recommendation:

Increase UAE is a common complication of HIV infection due to a number of factors other than HAART. Early screening for renal disease using microalbuminuria is very useful since the use of medications such as angiotensin converting enzyme inhibitors, which could help reverse progression to end-stage renal disease.     

肥大心肌细胞能量代谢途径变化及药物干预效应研究

目的 探讨肥大心肌细胞能量代谢途径变化及药物干预的作用。方法 应用血管紧张素Ⅱ（angiotensin Ⅱ,Ang Ⅱ,0．1μmol／L）加去甲肾上腺素（norepinephrine,NE 1μmol／L）诱导培养大鼠心肌细胞肥大,以同位素液闪计数法测定丙酮酸脱氢酶（pyruvate dehydrogenase,PDH）、肉碱脂酰转移酶-1（carnitine palmitoyhransferase 1,CPT-1）活性,以及葡萄糖有氧氧化率、葡萄糖酵解率和脂肪酸有氧氧化率。结果 （1）与正常心肌细胞比较,肥大心肌细胞总的PDH活性没有明显改变,但活化型PDH活性和葡萄糖氧化代谢率（glucose oxidation rate,GOR）显著增强,CPT-1活性和脂肪酸有氧氧化代谢率（fatty acid oxidationrate,FOR）显著降低;（2）与对照肥大心肌细胞比较,二氯乙酸（dichloroacetate,DCA 1000～10000mmol／L）和曲美他嗪（Trimetazidine,TMZ 1～5mmol／L）呈剂量依赖性的升高PDH活性和GOR,抑制CPT-1活性、FOR和葡萄糖酵解率（glucolysis rate,GLR）;（3）与对照肥大心肌细胞比较,抗霉素A（antimycin A,0．1～10mmol／L）呈剂量依赖性的抑制PDH活性和GOR和GLR,增强CPT-1活性和FOR;（4）二氯乙酸（1000mmol／L）加曲美他嗪（1mmol／L）可更有效刺激PDH活性和GOR,抑制CPT-1活性、FOR和GLR。结论 肥大心肌细胞能量代谢向糖代谢转化,DCA和TMZ均可进一步增强糖有氧氧化代谢抑制脂肪酸代谢。