血清胱抑素C对糖尿病肾病临床分期的价值

目的 探讨胱抑素C(Cys-C)作为2型糖尿病(T2DM)肾病分期指标的应用价值.方法 测定137例T2DM患者血肌酐(SCr)、Cys-C和24-h尿微量白蛋白排泄率(UAER).运用MDRD公式计算肾小球滤过率(GFR).将患者分为三组:GFR>120 ml·min~(-1)·1.73 m~(-2)为A组,GFR 60～120 m1·min~(-1)·1.73 m~(-2)为B组,GFR<60 ml·min~(-1)·1.73m~(-2)为C组.绘制散点图,比较三组Cys-C和UAER的数值及与GFR的相关性.结果 C组SCr和24-hUAER高于A组[(102.41±10.72)μmol/L vs.(42.73±3.99)μmol/L和(303.90±173.66)mg vs.(164.10±114.25)mg];A组Cys-C值明显低于B、C组[(0.47±0.21)mg/L vs.(o.68±0.13)mg/L,(1.59±0.58)mg/L)].UAER和Cys-C与GFR的相关系数分别为-0.132和-0.552(P<0.01).ROC分析提示,Cys-C和UAER的曲线下面积(AUC)分别为0.885和0.605(P<0.05).结论 Cys-C能很好的反映T2DM肾病肾小球滤过功能异常,与临床分期的对应性、诊断特异性和灵敏性都优于UAER.     

血清胱抑素C在糖尿病肾功能检测中的意义

目的探讨血清胱抑素C(Cys-C)在糖尿病肾功能检测中的意义。方法 40例2型糖尿病肾病患者作为研究组,同期40例健康体检者作为对照组,所有受检者均接受Cys-C、尿素氮(BUN)、血肌酐(Scr)及β2-微球蛋白(β2-MG)检测,对比两组各项肾功能指标的检测结果,研究组患者各项肾功能指标的阳性检出率。结果研究组Cys-C、BUN、Scr及β2-MG水平分别为(2.04±0.77)mg/L、(6.33±2.47)mmol/L、(108.64±18.27)μmol/L、(5.36±1.83)mg/L,均高于对照组的(0.82±0.14)mg/L、(4.70±1.52)mmol/L、(72.36±12.52)μmol/L、(2.68±0.57)mg/L,差异具有统计学意义(P<0.05)。研究组患者Cys-C的阳性检出率为100.00%,高于BUN、Scr、β2-MG的62.50%、65.00%、70.00%。结论糖尿病肾病患者的血清Cys-C水平明显偏高,其不仅可作为糖尿病肾病的早期诊断指标,还可作为病情监测、预后判断的重要依据,推广与应用价值较高。     

血清胱抑素C对糖尿病肾病的诊断价值

目的 探讨血清胱抑素C对糖尿病肾病的诊断价值.方法 将2010年1月至2013年12月山东大学齐鲁医院住院的853例肾病患者分为糖尿病肾病组(753例)和非糖尿病肾病组(100例),回顾性分析2组患者血清胱抑素C、血肌酐、尿素氮水平的差异,比较糖尿病肾病组(753例)患者血清胱抑素C、肌酐、尿素氮阳性比例的差异.糖尿病肾病中有344例患者同时检测血清胱抑素C和尿微量白蛋白,分析血清胱抑素C与尿微量白蛋白相关性.应用受试者工作特征曲线(RDC)评价血清胱抑素C诊断糖尿病肾病的灵敏度和特异性.结果 糖尿病肾病组血清胱抑素、血肌酐、尿素氮分别为(1.76±0.45)mg/L、(162.9±6.4) μmol/L、(10.4 ±0.4)mmol/L,非糖尿病肾病组分别为(0.81±0.02) mg/L、(61.3±1.8) μmol/L、(5.2 ±0.2) mmol/L,2组比较差异均有统计学意义(均P＜0.05).糖尿病肾病组患者血清胱抑素C、肌酐、尿素氮阳性率分别为62.0％(467/753)、38.6％ (291/753)、44.6％(336/753),血清胱抑素C与血肌酐、尿素氮之间阳性率差异有统计学意义(P ＜0.05);344例糖尿病肾病患者中血清胱抑素C与尿微量白蛋白之间具有相关性(r=0.368,P ＜0.05)为应用ROC曲线分析时血清胱抑素C在糖尿病肾病患者诊断中,曲线下面积为0.869,95％置信区间为0.839 ～0.899(P＜0.01),当分界点为0.535 mg/L时,血清胱抑素C诊断糖尿病肾病的灵敏度和特异性分别为99.7％和99.0％.结论 血清胱抑素C对糖尿病肾病具有一定的诊断价值.     

糖尿病并发急性脑梗死患者血清超敏C反应蛋白水平与病情及预后的关系

目的 探讨糖尿病并发急性脑梗死患者血清超敏C反应蛋白(hs-CRP)水平与病情及预后的关系.方法 采用免疫比浊法检测34例糖尿病并发急性脑梗死患者(A组)、30例单纯糖尿病患者(B组)及20例健康体检者(C组)血清hs-CRP水平,分析其与糖尿病并发急性脑梗死患者病情及预后的关系.结果 A、B、C组血清hs-CRP水平分别为(15.76±5.32)mg/L、(10.99±2.13)mg/L、(3.44±1.31)mg/L,A组与B、C 组差异均有统计学意义(均P＜0.05).A组病情轻、中、重度患者hs-CRP水平分别为(12.84±4.28)mg/L、(16.16±3.79)mg/L、(19.55±5.34)mg/L,不同病情患者间差异均有统计学意义(均P＜0.05).血清hs-CRP水平与患者病情正相关(r=3.412,P＜0.05).A组患者中,hs-CRP高、低水平者各17例,高水平者中恢复较好者(5例)显著低于hs-CRP低水平者(10例)(均P＜0.05).结论 血清hs-CRP水平可以反映糖尿病并发急性脑梗死患者病情的严重程度,并可作为患者预后的判断血清学指标.     

Cys-C、RBP、β2-MG及Hcy联合检测对糖尿病早期肾病的诊断价值分析

目的分析血清胱抑素(Cys-C)、视黄醇结合蛋白(RBP)、β2微球蛋白(β2-MG)及同型半胱氨酸(Hcy)联合检测对糖尿病早期肾病(DN)的诊断价值。方法选取70例2型糖尿病(T2DM)患者,依据临床尿蛋白排泄率(UAER)分为正常组(正常尿,33例)和微量组(微量蛋白尿,37例);另选取30例体检健康者作为对照组。分别对三组研究对象Cys-C、RBP、β2-MG、Hcy水平进行测定并比较,并比较单项检测与联合检测阳性率。结果正常组Cys-C、RBP、β2-MG及Hcy水平分别为(0.98±0.27)mg/L、(38.96±7.62)μg/ml、(2.54±0.57)mg/L、(18.94±4.94)μmol/L,微量组Cys-C、RBP、β2-MG及Hcy水平分别为(1.99±0.45)mg/L、(67.34±13.66)μg/ml、(4.14±1.00)mg/L、(39.82±9.16)μmol/L,对照组Cys-C、RBP、β2-MG及Hcy水平分别为(0.40±0.23)mg/L、(25.35±6.31)μg/ml、(1.03±0.20)mg/L、(8.48±7.10)μmol/L;正常组和微量组Cys-C、RBP、β2-MG及Hcy水平均明显高于对照组,微量组Cys-C、RBP、β2-MG及Hcy水平明显高于正常组,差异均有统计学意义(P<0.05)。正常组和微量组Cys-C、RBP、β2-MG、Hcy联合检测阳性率均明显高于单一检测阳性率,差异均具有统计学意义(P<0.05)。结论相对单一检测,Cys-C、RBP、β2-MG及Hcy联合检测可较好的反映糖尿病早期肾病患者肾功能损伤程度,其对临床诊断、防治及病情监测均具有重要意义。     

Cystatin C在糖尿病肾病中的应用评价

目的 检测血清胱抑素C(Cys-C),并与血肌酐(SCr)、尿微量白蛋白(MALB)、β2微球蛋白(β2-MG)结果进行比较,从而评价其对糖尿病肾病患者的早期诊断价值.方法 应用颗粒增强免疫比浊法测定206例糖尿病患者的血清胱抑素C浓度,并同时测量血清肌酐、尿微量白蛋白(MALB)、β2微球蛋白(β2-MG)以及24小时尿量及尿微量白蛋白(MALB)、尿肌酐(UCr)并计算出内生肌酐清除值(Ccr).结果 早期糖尿病肾病组Cys-C(1.49±0.92)、β2-MG(2.58±1.16)、Ccr(85.1±34.3)、SCr(75.1±33.7),和临床糖尿病肾病组的Cys-C(2.15±1.12)、β2-MG(3.15±1.49)、Ccr(68.7±20.6)、SCr(139.1±91.3)均较单纯糖尿病组Cys-C(1.13±0.46)、β2-MG(2.05±1.03)、Ccr(95±31.5)、SCr(68.4±27.7)的检测结果明显增高,有显著差异(P＜0.01);在早期糖尿病.肾病组中,Cys C、β2-MG和肌酐清除值(Ccr)、SCr阳性率分别为49.8%(32/69)、71.0%(49/69)、36.3%(5/69)、4.3%(3/69),在临床糖尿病肾病组中,Cys C、β2-MG和肌酐清除值(Ccr)、SCr阳性率分别为84.9%(45/53)、92.4%(49/53)、69.8%(37/53)、39.%(21/53),Cys-C与β2-MG的相关系数r=0.8362,P＜0.01,差异有显著性.结论 胱抑素C用于评价糖尿病患者的肾功能状况,其特异性好于β2微球蛋白,灵敏度高于Ccr、SCr的肾小球滤过率标志物.     

血清Cys-C、hs-CRP和Hcy联合检测在2型糖尿病肾病诊断中的应用

目的：探讨血清胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)联合检测对糖尿病肾病的诊断价值。方法160例2型糖尿病患者按24 h尿蛋白排泄率分为正常蛋白尿组(47例)、微量蛋白尿组(62例)和临床蛋白尿组(51例),另选健康体检者50例为对照组,比较各组血清hs-CRP、Cys-C、Hcy水平。结果正常蛋白尿组、微量蛋白尿组和临床蛋白尿组血清hs-CRP、Hcy、Cys-C水平均显著高于对照组(P<0.05),血清hs-CRP、Hcy、Cys-C水平随糖尿病肾病的严重程度逐渐升高;Cys-C、hs-CRP和Hcy联合检测可提高糖尿病肾病的阳性检出率。结论血清Cys-C、hs-CRP和Hcy可作为2型糖尿病肾病早期敏感、可靠的诊断指标,联合检测可提高阳性检出率。     

冠状动脉造影单支病变患者血清NO及内皮素检测的临床意义

目的 探讨冠状动脉造影单支病变患者血清NO及内皮素浓度变化及其意义.方法 94例冠心病患者按造影结果分为单支病变狭窄程度＞50％但＜70％组(A组,62例)及单支病变狭窄程度≥70％组(B组,32例),选择30例造影结果阴性成年人作为对照组(C组),检测并比较3组血清NO及内皮素浓度.结果 A组及B组患者血清NO水平均低于C组[(43±12) μmol/L,(50±11) μmol/L比(58±12) μmol/L,均P＜0.01],且B组明显高于A组(P＜0.01);A组及B组患者血清内皮素水平均高于C组[(60±12) pg/L,(80±22) pg/L比(50±11 )pg/L,均P＜0.01],且B组明显高于A组(P＜0.01).结论 冠心病患者血清NO及内皮素水平与冠心病单支病变狭窄程度相关,检测冠心病患者血清NO及内皮素有助于评估患者病情及指导治疗.     

恶性肿瘤患者血清同型半胱氨酸及胱抑素C水平检测分析

目的 探讨不同类型恶性肿瘤患者血清水平变化同型半胱氨酸(Hcy)及胱抑素C(CysC)水平变化.方法 120例恶性肿瘤患者按照疾病类型分成A组(胃癌)、B组(食管癌)、C组(肝癌)和D组(鼻咽癌),以25例健康志愿者为对照组.采用酶联免疫(ELISA)法检测四组患者血清Hcy及CysC水平.结果 A组、B组、C组和D组恶性肿瘤患者血清Hcy浓度分别为(19.71±3.40) μmol/L、(23.27±9.57) μmol/L、(21.37±0.38) μmol/L和(16.27±1.24)μmol/L,均显著高于对照组(均P＜0.05);A组、B组、C组和D组恶性肿瘤患者血清中CysC浓度分别为(19.71±3.40) mg/L、(19.71±3.40) mg/L、(19.71±3.40) mg/L和(19.71±3.40) mg/L,均显著高于对照组(均P＜0.05).胃癌血清Hcy及CysC水平与癌胚抗原(CEA)水平具有正相关性(r =0.9643、0.9842),食管癌、肝癌和鼻咽癌患者血清Hcy及CysC水平与胃癌患者血清CEA水平无相关性.结论 血清Hcy及CysC检测在恶性肿瘤诊断上具有潜在的临床价值.     

肾小球滤过率联合尿微量白蛋白与肌酐比值诊断糖尿病肾病的临床意义

目的:探讨2型糖尿病病人采用改良的中国公式计算肾小球率过滤(c-aGFR)联合尿微量白蛋白与尿肌酐比值(ACR)在诊断糖尿病肾病不同阶段中的临床意义,并做c-aGFR和ACR的相关性分析.方法:根据ACR不同阶段分成4组,A组(正常对照组),B组(糖尿病正常白蛋白尿组ACR＜ 30mg/g),C组(糖尿病肾病微量白蛋白尿组ACR30～300mg/g),D组(糖尿病肾病大量蛋白尿组ACR＞ 300mg/g);应用改良中国MDRD公式c-aGFR(mL/min·1.73m2)=175×[Hit Pcr]-1.234×年龄-0.179×[女性×0.79]计算GFR,(即c-aGFR,mL/min·1.73m2).双变量相关性分析采用Pearson相关分析.结果:与正常对照组相比糖尿病正常白蛋白尿组c-aGFR无明显变化(P＞0.05),糖尿病肾病微量白蛋白尿组与正常对照组相比c-aGFR降低,有显著变化(P＜0.05),糖尿病肾病大量蛋白尿组与正常对照组相比c-aGFR降低,有显著变化(P＜0.05),糖尿病肾病大量白蛋白尿组与糖尿病肾病微量蛋白尿组相比c-aGFR降低,有显著变化(P＜0.05).与正常对照组相比糖尿病正常白蛋白尿组ACR无明显变化(P＞0.05),糖尿病肾病微量白蛋白尿组与正常对照组相比ACR增高,有显著变化(P＜0.05),糖尿病肾病大量蛋白尿组与正常对照组相比ACR增高,有显著变化(P＜0.05),糖尿病肾病大量白蛋白尿组与糖尿病肾病微量蛋白尿组相比ACR增高,有显著变化(P＜0.05).c-aGFR随着ACR的增加呈下降趋势,Pearson分析显示二者具有显著负相关性.结论:c-aGFR及ACR可以做为糖尿病肾病诊断的重要监测指标;二者联合检测可以更准确的评估糖尿病患者肾脏功能的情况,对调整糖尿病患者经肾脏代谢的药物剂量及药物的选择都有极为重要的临床指导价值.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.